The use of single plane angiocardiograms for the calculation of left ventricular volume in man.
TL;DR: Volumes calculated from measurements made only on A-P films closely agreed with biplane calculations of volume and the use of single plane techniques did not result in significant errors for the calculation of absolute end-systolic volume or for calculation of stroke volume.
About: This article is published in American Heart Journal.The article was published on 1968-03-01. It has received 1081 citations till now. The article focuses on the topics: Biplane.
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TL;DR: The Program on the Surgical Control of the Hyperlipidemias (POSCH) randomized clinical trial was designed to test whether cholesterol lowering induced by the partial ileal bypass operation would favorably affect overall mortality or mortality due to coronary heart disease.
Abstract: Background and Methods The Program on the Surgical Control of the Hyperlipidemias (POSCH), a randomized clinical trial, was designed to test whether cholesterol lowering induced by the partial ileal bypass operation would favorably affect overall mortality or mortality due to coronary heart disease. The study population consisted of 838 patients (417 in the control group and 421 in the surgery group), both men (90.7 percent) and women, with an average age of 51 years, who had survived a first myocardial infarction. The mean follow-up period was 9.7 years. Results When compared with the control group at five years, the surgery group had a total plasma cholesterol level 23.3 percent lower (4.71±0.91 vs. 6.14±0.89 mmol per liter [mean ±SD]; P<0.0001), a low-density lipoprotein cholesterol level 37.7 percent lower (2.68±0.78 vs. 4.30±0.89 mmol per liter; P<0.0001), and a high-density lipoprotein cholesterol level 4.3 percent higher (1.08±0.26 vs. 1.04±0.25 mmol per liter; P = 0.02). Overall mortality...
988 citations
TL;DR: It is concluded that in patients with initially successful thrombolysis and suitable coronary-artery anatomy, immediate angioplasty offers no clear advantage over delayed elective angiopLasty.
Abstract: We compared the efficacy of immediate coronary angioplasty after acute myocardial infarction with that of elective angioplasty at 7 to 10 days in patients treated initially with intravenous tissue plasminogen activator. The plasminogen activator (150 mg) was administered 2.95 +/- 1.1 hours after the onset of symptoms, to 386 patients with acute myocardial infarction. Ninety minutes later, patency of the coronary artery serving the area of the infarct was demonstrated by coronary angiography in 288 patients (75 percent). Bleeding problems were frequently encountered, as evidenced by an average drop in hematocrit of 11.7 +/- 6.5 points from base line to nadir and by a need for transfusion not related to bypass surgery in 70 patients (18 percent). After successful thrombolysis, 197 patients with a patent but severely stenotic vessel suitable for angioplasty were randomly assigned to immediate angioplasty (n = 99) or, if indicated 7 to 10 days after infarction, to deferred (elective) angioplasty (n = 98). The incidence of reocclusion was similar in the two groups: 11 percent in the group assigned to immediate angioplasty and 13 percent in the group assigned to elective angioplasty. Neither group had a significant improvement in global left ventricular function, and regional wall motion in the infarct zone improved to a similar extent in the two groups. In the elective-angioplasty group, the rate of crossover to emergency angioplasty for recurrent ischemia was 16 percent (whereas 5 percent of the immediate-angioplasty group required emergency repeated angioplasty; P = 0.01). In 14 percent of the patients in the elective group, the stenosis was substantially reduced by the time of the seven-day follow-up angiography, obviating the need for angioplasty. We conclude that in patients with initially successful thrombolysis and suitable coronary-artery anatomy, immediate angioplasty offers no clear advantage over delayed elective angioplasty.
914 citations
TL;DR: It is suggested that aneurysmal coronary disease does not represent a distinct clinical entity but is, rather, a variant of coronary atherosclerosis.
Abstract: To examine the clinical and historical features and the natural history of aneurysmal coronary disease, we reviewed the registry data of the Coronary Artery Surgery Study (CASS). Nine hundred seventy-eight patients, representing 4.9% of the total registry population, were identified as having aneurysmal disease. No significant differences were noted between aneurysmal and nonaneurysmal coronary disease patients when features such as hypertension, diabetes, lipid abnormalities, family history, cigarette consumption, incidence of documented myocardial infarction, presence and severity of angina, and presence of peripheral vascular disease were examined. In addition, no difference in 5-year medical survival was noted between these two groups. These findings suggest that aneurysmal coronary disease does not represent a distinct clinical entity but is, rather, a variant of coronary atherosclerosis.
910 citations
TL;DR: It is concluded that large intrathoracic-pressure changes, such as those that occur in acute pulmonary disease, can influence cardiac performance and particularly left ventricular transmural pressures and thus afterload.
Abstract: Left ventricular dysfunction is common in respiratory-distress syndrome, asthma and obstructive lung disease. To understand the contribution of intrathoracic pressure to this problem, we studied the effects of Valsalva and Muller maneuvers on left ventricular function in eight patients. Implantation of intramyocardial markers permitted beat-by-beat measurement of the velocity of fiber shortening (VCF) and left ventricular volume. During the Muller maneuver, VCF and ejection fraction decreased despite an increase in left ventricular volume and a decline in arterial pressure. In addition, when arterial pressure was corrected for changes in intrapleural pressure during either maneuver it correlated better with left ventricular end-systolic volumes than did uncorrected arterial pressures. These findings suggest that negative intrathoracic pressure affects left ventricular function by increasing left ventricular transmural pressures and thus afterload. We conclude that large intrathoracic-pressure changes, such as those that occur in acute pulmonary disease, can influence cardiac performance.
751 citations
TL;DR: BRS was assessed by calculating the regression line relating phenylephrine-induced increases in systolic blood pressure to the attendant changes in the RR interval and found that a reduced BRS primarily reflects an impairment in the vagal efferent component of the baroreceptor reflexes.
Abstract: Experimental studies have shown that among dogs with a healed myocardial infarction, depressed baroreflex sensitivity (BRS) identifies a subgroup at higher risk for sudden death. We have examined the relation among BRS, several clinical cardiovascular variables, and subsequent mortality in 78 patients below the age of 65 years who have had a first myocardial infarction. BRS was assessed by calculating the regression line relating phenylephrine-induced increases in systolic blood pressure to the attendant changes in the RR interval. A reduced BRS primarily reflects an impairment in the vagal efferent component of the baroreceptor reflexes. The BRS of the entire population was 7.8 +/- 4.9 msec/mm Hg. BRS was lower among patients with an inferior myocardial infarction (6.1 +/- 3.3 vs. 8.9 +/- 5.8 msec/mm Hg, p = 0.03), with a three- versus a one-vessel disease (4.8 +/- 2.7 vs. 7.1 +/- 3.1 msec/mm Hg, p = 0.04), and with episodes of ventricular tachycardia (5.1 +/- 3.0 vs. 8.3 +/- 5.1, p = 0.03). There was no correlation between BRS and left ventricular ejection fraction or with mean pulmonary capillary wedge pressure at peak exercise, but a correlation (r = 0.35, p less than 0.001) was present with exercise tolerance. During the 24 months mean follow-up period, there were six cardiovascular deaths (7.6%), and four were sudden.(ABSTRACT TRUNCATED AT 250 WORDS)
662 citations
References
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TL;DR: Five methods for calculatingleft ventricular chamber volumes from biplane x-rays are described and evaluated by clay models and observations on 9 postmortem hearts in which the left ventricular chambers were distended with known volumes of contrast material to provide a basis for calculating the volume of the opacified left vent cardiac chamber as visualized by biplane angiocardiography.
1,172 citations
TL;DR: One-plane cineangiographic measurement of left ventricular volume uses angiocardiograms taken in the right anterior oblique view, which means that effects of drugs and other interventions can be studied by the informative techniques of semi-continuous volume measurement and pressure-volume analysis.
Abstract: One-plane cineangiographic measurement of left ventricular volume uses angiocardiograms taken in the right anterior oblique view. Its basic assumption is that the third (unvisualized) dimension, depth from septum to free wall, is of the same magnitude and behaves in the same way as the visualized short axis. Examination of this assumption with biplane x-ray equipment revealed that the unmeasured length averages 7% less and varies directly with the length of the measured short axis. Volumes measured correlate well with consecutive studies using serial biplane x-rays and are systematically somewhat larger than volumes obtained in autopsy specimens injected with barium sulfate paste. The method is tolerant of variations in positioning of the patient, is convenient, yields repeatable analyses from one experienced observer to another, allows 60 volume measurements per second so that rapid cardiac events can be studied, and the small doses of x-rays and contrast medium permit several observations at one cathete...
480 citations
TL;DR: Although rather complicated and time-consuming at present, the method permits construction of volume curves and estimation of stroke volume of the left ventricle for several successive contractions in the intact animal or man.
Abstract: A biplane cinefluorographic technic for measuring ventricular volume is described and its accuracy and limitations are assessed. Although rather complicated and time-consuming at present, the method permits construction of volume curves and estimation of stroke volume of the left ventricle for several successive contractions in the intact animal or man. This method may prove most useful for physiologic research and ultimately for diagnostic purposes.
324 citations
TL;DR: The Angiocardiographic Determination of Left Ventricular Volume 5, No. 5, pp. 321-339 as mentioned in this paper was the first publication of the left ventricular volume.
Abstract: (1961). Angiocardiographic Determination of Left Ventricular Volume. Acta Radiologica: Vol. 56, No. 5, pp. 321-339.
158 citations
TL;DR: Left ventricular stroke volume determined by this method has been compared with stroke volumes determined by the Fick and/or indicator-dilution methods in 14 subjects without arrhythmias or clinical evidence of valvular insufficiency.
Abstract: A method has been described for directly determining left ventricular stroke volume in man through the use of biplane angiocardiography. Left ventricular stroke volume determined by this method has been compared with stroke volumes determined by the Fick and/or indicator-dilution methods in 14 subjects without arrhythmias or clinical evidence of valvular insufficiency. Stroke volumes determined by these various methods showed close agreement.
154 citations