Rationale for current drug treatment

In the initial phase of heart failure, cardiac output and pressure are maintained by increasing sympathetic drive and by cell hypertrophy. Elevated end-diastolic volume, a reduced ejection fraction and a higher filling pressure also occur. Only in more severe heart failure, when cardiac output cannot be maintained, do symptoms appear which may vary between congestion, exercise intolerance, left ventricular dysfunction, arrhythmias or a combination of each. Drug treatment has principally two aims: first, to improve symptoms, second, to influence prognosis, which is very poor in advanced heart failure. Symptom improvement will also depend on whether the condition is acute, subacute or chronic heart failure. In the acute situation diuretics are normally the first choice of treatment, whereas in chronic heart failure the ACE inhibitors have proved themselves to be the drugs which most improve prognosis. The role of digitalis, still frequently used, remains unclear, and its importance will be revealed when the results of ongoing studies are announce

Texas Forestry Paper No. 25

Tension wood in southern red oak quercus falcata michx.https://scholarworks.sfasu.edu/texas_forestry_papers/1013/thumbnail.jp

Chemical Comparison of Two Ecotypes of Loblolly Pine (Pinus Taeda L.)

Loblolly pine from the continuous range in east Texas was compared with an apparently drought-resistant ecotype, the so-called "Lost pines" or "Bastrop pines." The Bastrop pines are found in a small area of central Texas isolated from the rest of the loblolly range, and in a region receiving considerably less rainfall. Determinations made were: holocellulose, alpha cellulose, ash, specific gravity, and percentages of earlywood and latewood. Nutrient analyses for levels of sodium, potassium, calcium, magnesium, zinc, manganese, and copper were also performed. It was found that the earlywood of the east Texas population had significantly greater levels of holocellulose and alpha cellulose. Regression analyses were performed relating the nutrient values to the chemical components. The appearance of potassium and magnesium in these equations, for the Bastrop pines, may indicate physiological adaptation to the more xeric environment

Prolonged myocardial stunning after thrombolysis: can left ventricular function be assessed definitely at hospital discharge?

To assess whether myocardial dysfunction after acute reperfusion (‘stunning') may show delayed recovery, 33 patients of the European Cooperative Study (rtPA vs placebo) had radionuclide angiocardiography on day 9 and after 3-6 months. Sixteen patients (13 inferior, three anterior infarcts) had a normal left ventricular ejection fraction (LVEF) which remained unchanged (55.4 vs 53.9%). In contrast, LVEF of 17 patients (10 inferior, seven anterior infarcts) with depressed values on day 9 improved during follow-up from 38.8 to 45.2% (P<0.01). Improvement was only observed in patients with early reperfusion defined a priori as peak creatine kinase valuè ≤ 15 h of pain onset (from 40.9 to 49.3%; P<0.05) in contrast to patients without reperfusion (from 34.0 to 35.2%; ns). Accordingly, LVEF increased in patients with open infarct-related arteries at hospital discharge (n = 8; P = 0.053) but not with persistent occlusion (n = 7; P = 0.11). Thus, a depressed LVEF observed 9 days after reperfusion may show delayed recovery due to prolonged stunning. Therefore, after thrombolysis, left ventricular function may not be evaluated definitively at hospital discharge; results of such studies should be interpreted with cautio

Prognostic significance of right ventricular ejection fraction for persistent complex ventricular arrhythmias and/or sudden cardiac death after first myocardial infarction: Relation to infarct location, size and left ventricular function

To assess the prognostic significance of right ventricular dysfunction after a first myocardial infarction for complex ventricular arrhythmias and or sudden cardiac death in relation to infarct location, size and left ventricular function, a series of 127 consecutive patients was prospectively studied and followed up for one year. Prior to hospital discharge, a 24-hour electrocardiographic recording and radionuclide angiocardiography were performed. Right ventricular ejection fraction was related to inferior infarct location and size (r = 0.45, P 0.40 vs. ≤ 0.40 showed that presence of complex ventricular ectopic activity and/or sudden cardiac death after myocardial infarction was related not only to left, but also independently to right ventricular dysfunction. These results imply a significant prognostic contribution of right ventricular dysfunction to the occurrence of severe ventricular arrhythmias and/or sudden cardiac death after myocardial infarction independent of and additive to left ventricular dysfunctio

Anticardiolipin antibodies and coronary heart disease

Arterial or venous thrombotic events have been described as complications in patients with positive anticardiolipin antibodies (aCL), affecting various organs including the heart. In order to see whether aCL could be, among others, a predisposing factor for coronary artery occlusions and whether it could serve as a prognostic marker for coronary heart disease, 232patients enrolled in the European Concerted Action on Thrombosis Angina Pectoris Study were studied. aCL and various other haemostatic parameters were determined at time of admittance in order to see whether a relationship existed between haemostasis at baseline and extent or prognosis of the cardiovascular disease. A follow-up at 12 and 24 months after angiography included information about relapsing coronary or other thrombotic events, treatment and outcome of the disease. aCL were not found to be a marker of either progressive cardiovascular disease or recurrent thrombotic events. No correlation was found, either in aCL positive or in aCL negative patients, between high levels of haemostasis activation markers, such as fi-thromboglobulin, platelet factor 4 or fibrinopeptide A and recurrent cardiovascular diseas

Ambulatory scintigraphic assessment of transient changes in left ventricular function: a new method for detection of silent myocardial ischaemia

Demonstration of ischaemic left ventricular dysfunction in the absence of chest pain should provide important confirmation of silent myocardial ischaemia in patients with asymptomatic ST segment changes. For this purpose, a new portable scintillation probe (VEST) similar to a miniaturized nuclear stethoscope combined with a Hotter ECG was evaluated. After standard equilibrium radionuclide angiocardiography with technetium-99m labelled red blood cells, the VEST was positioned under gamma-camera control and data were recorded from 1-12 h in 61 unselected patients. Ejection fraction (LVEF), relative changes in volumes, heart rate and ST segment changes were determined. Reproducibility of LVEF at rest (r = 0.91; variability 3.8 ± 3%, N = 19) and during exercise (r = 0.98; variability 3.2 ± 2%, N = 19) was good. In 15 asymptomatic exercise tests four different patterns of LVEF and ST segment responses were identified: (1) decrease in LVEF followed by significant ST depression (five times); (2) ST depression followed by decrease in LVEF (three times); (3) decrease in LVEF without significant ST changes (three times); and (4) ST depression without significant LVEF change (four times). In this still small series, patterns (1) to (3) corresponded to patients with documented coronary artery disease, which was not the case for pattern (4). For detection of silent ischaemia at rest, a decrease in LVEF of >5% lasting for >1 min was defined as ischaemic LV dysfunction. Using this definition, four spontaneous episodes of silent LV dysfunction could be demonstrated in two of three CCU patients with unstable angina during 160-680 min of data recordings without simultaneous ST changes. Based on this initial experience, we conclude that VEST is a reproducible method to detect transient global LV dysfunction and will be useful to confirm silent ischaemia in otherwise uncertain ST segment change

Differences of disease progression in congestive heart failure due to alcoholic as compared to idiopathic dilated cardiomyopathy

In patients with alcoholic cardiomyopathy there is evidence that mild heart failure is reversible if patients abstain from alcohol, but there is no consensus whether the disease is progressive once structural myocardial dilatation has evolved. The aim of the present study was to compare the long-term course of congestive heart failure due to alcoholic and idiopathic dilated cardiomyopathy. Of 75 patients with overt congestive heart failure, 23 had alcoholic cardiomyopathy and were compared to 52 patients with idiopathic cardiomyopathy. The mean age was 48 ± 12 years. Despite medical therapy, heart failure class New York Heart Association III-IV was present in 52% of patients with alcoholic and 47% of patients with idiopathic cardiomyopathy (not significant). Their mean left ventricular ejection fraction was 30 ± l2% vs 28 ± 12% and left ventricular end-diastolic volumes were 264 ± 125 ml and 254 ± 100 ml respectively (not significant). Overall survival at 1, 5 and 10 years was l00%, 81% and 81% for the group with alcoholic dilated cardiomyopathy and 89%, 48% and 30% for the group with idiopathic cardiomyopathy, respectively (P=0·041 and the difference was even greater for transplant-free survival P=0·005 Clinical and invasive signs of left and right heart failure as well as left ventricular dimensions were predictive of a fatal outcome; however, symptom duration and left ventricular volumes were only predictive in patients with idiopathic cardiomyopathy, suggesting that in the two patient groups different mechanisms may lead to death. Mortality in patients with severe congestive heart failure and left ventricular dilatation due to alcoholic cardiomyopathy is significantly lower than that in patients with idiopathic cardiomyopathy and similar degrees of heart failure. Thus, despite structural changes mherent in marked left ventricular dilatation, disease progression in alcoholic dilated cardiomyopathy is different from that in idiopathic cardiomyopathy and thus may have implications for the choice of therap

Measurements of the effect of collisions on transverse beam halo diffusion in the Tevatron and in the LHC

Beam-beam forces and collision optics can strongly affect beam lifetime, dynamic aperture, and halo formation in particle colliders. Extensive analytical and numerical simulations are carried out in the design and operational stage of a machine to quantify these effects, but experimental data is scarce. The technique of small-step collimator scans was applied to the Fermilab Tevatron collider and to the CERN Large Hadron Collider to study the effect of collisions on transverse beam halo dynamics. We describe the technique and present a summary of the first results on the dependence of the halo diffusion coefficient on betatron amplitude in the Tevatron and in the LHC.Comment: 4 pages, 2 figures. Submitted to the Proceedings of the ICFA Mini-Workshop on Beam-beam Effects in Hadron Colliders (BB2013), Geneva, Switzerland, 18-22 March 201

Cardiac evaluation of candidates for kidney transplantation: value of exercise radionuclide angiocardiography

In view of the high incidence and mortality of coronary artery disease (CAD) in patients with kidney transplantation, a systematic cardiac evaluation was prospectively performed in 103 uraemic patients eligible for transplantation. After clinical examination, 28 patients with symptoms of CAD or diabetes mellitus were referred directly for coronary angiography, whereas the remaining 75 patients had rest and exercise radionuclide angiocardiography for evaluation of possible asymptomatic CAD. Among them, left ventricular ejection fraction was below 40% at rest or fell during exercise by at least 5 EF% in 12 patients; coronary angiography in nine showed CAD in four and hypertensive heart disease in five. In the remaining 63 (of 75) patients without severe resting left ventricular dysfunction or exercise ischaemia, the follow-up of 28 ±7 months revealed no clinical manifestation of CAD. Overall incidence of CAD in symptomatic and asymptomatic patients during a follow-up of 27 months after cardiac evaluation was 20 and 25% in non-diabetic and diabetic candidates for kidney transplantation, respectively (P = n.s.). Thus, clinical examination combined with exercise radionuclide angiocardiography in patients without signs or symptoms of heart disease had a high predictive accuracy for presence or absence of late manifestations of CAD. Exercise radionuclide angiocardiography is therefore a useful method for screening kidney transplantation candidates for asymptomatic CA