Recovery kinetics of oxygen uptake and heart rate in patients with coronary artery disease and heart failure.

BACKGROUND: Patients with congestive heart failure exhibit a prolonged period of recovery to baseline levels of oxygen consumption, but the decline of heart rate during recovery from exercise has been shown to be similar to that in healthy subjects, and the results of studies on the response of ventilation in recovery have been mixed. Patients with coronary artery disease have a reduced exercise capacity, but it is unknown whether the patterns of the decline in oxygen uptake (VO2), ventilation, or heart rate are similar to those in patients with heart failure. METHODS: We performed a cardiopulmonary exercise test with a ramping protocol in 18 healthy subjects, 18 patients with coronary artery disease, 19 patients with class A or B congestive heart failure, and 19 patients with class C congestive heart failure, according to the Weber classification. Peak oxygen uptake and the kinetics of oxygen uptake, ventilation, and heart rate were calculated and expressed as the slope of a single exponential relation between VO2 levels and time during the first 3 min of recovery as y(VO2) = y0Ae(-x/t). RESULTS: A difference in time of recovery of VO2 was found only between healthy subjects and patients with more severe heart failure (class C) (p < 0.05); no significant differences were observed among any of the groups in ventilation or heart rate recovery responses. CONCLUSION: VO2 recovery time is prolonged only in the presence of more severe heart failure. The presence and degree of heart disease has no effect on ventilation or heart rate recovery time.

Assessment of left ventricular filling in patients with systemic hypertension. A Doppler echocardiographic study.

To assess left ventricular (LV) diastolic function in patients with hypertension, a Doppler echocardiographic study of transmitral blood flow (TBF) was performed in 46 hypertensive patients (H), 18 without (H1) and 28 with (H2) left ventricular hypertrophy and in 25 age-matched normal subjects (N). All patients showed normal systolic function. The following indices of Doppler TBF were measured: peak flow velocity during early filling (Evel), atrial systole (Avel) and their ratio (E/Avel); area under early filling phase (Earea), area under atrial systole (Aarea), expressed as a percentage of total diastolic area and their ratio (E/Aarea); deceleration half-time (DHT) of early filling phase. When compared with N, H1 and H2 showed significant reductions in early filling indices and an increase in atrial contribution parameters. (Evel = 0.62 +/- 0.1(N), 0.52 +/- 0.1(H1) P less than 0.01, 0.44 +/- 0.1(H2) P less than 0.001; Earea = 56 +/- 5(N), 48 +/- 5(H1) P less than 0.001, 43 +/- 6(H2) P less than 0.001; Avel = 0.49 +/- 0.1(N), 0.59 +/- 0.1(H1) P less than 0.01, 0.69 +/- 0.14(H2) P less than 0.001; Aarea = 26 +/- 5(N), 41 +/- 4(H1) P less than 0.001, 47 +/- 7(H2) P less than 0.001). Also DHT was significantly prolonged, compared with N (80 +/- 12 msec), in H1 (90 +/- 12 msec, P less than 0.01) and H2 (105 +/- 20 msec, P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

The effect of beta-blockade therapy on the response to exercise training in postmyocardial infarction patients.

Cardiac rehabilitation after a myocardial infarction has been shown to improve exercise capacity. Beta blockade has been shown to be effective in treating angina and reducing mortality, but studies are controversial as to whether beta-blockade therapy attenuates the effects of training. We attempted to study the effects of beta blockade (metoprolol) on the response to training in patients enrolled in a cardiac rehabilitation program after an uncomplicated myocardial infarction. We studied 27 patients with a recent uncomplicated myocardial infarction who were subdivided in two groups: Group 1 (13 patients) not taking a beta blocker, and Group 2 (14 patients) taking metoprolol (mean 142 +/- 57 mg daily). All patients underwent a maximal cardiopulmonary exercise test before and after a 3-month training program. The training intensity was designed to approximate the ventilatory threshold. Results showed an increase in peak VO2 in both Group 1 (27%, p < 0.01) and Group 2 (33%, p < 0.001), and an increase in VO2 at the ventilatory threshold (39% in Group 1 and 28% in Group 2, p < 0.01). The mean changes in exercise capacity were not different between groups. It was concluded that metoprolol did not influence the beneficial effects of a cardiac rehabilitation program in postmyocardial infarction patients.

[Influence of various gastrointestinal disorders and dysproteinemia on the determination of blood digitalis by means of radioimmunoassay]. / Influenze di alcune turbe dell'apparato gastro - enterico e della disprotidemia sulla determinazione della digitalemia mediante dosaggio radio-immunologico.

Radioimmunologically determined digoxin and beta methyl digoxin values were the same in cardiopaths with and without clinical and instrumental changes referable to chronic cirrhosis or hepatitis. Lower values, however, were noted when gastroenteric disturbances were present. This was especially true of beta methyl digoxin in subjects with hyperkinetic-hyperchlorhydric syndromes due to depressed gastric pH, with a consequent inhibition of beta methyl digoxin absorption, presumably caused by lability of the molecule as a result of methylation of the terminal digitoxose group.

Achieving business growth through minority equity partnerships.

Healthcare organizations can become more accessible to patients and managed care organizations and can expand their patient base by forming minority equity partnerships with physician practices. By investing in practices, healthcare organizations provide capital and guidance to help the practices grow. Such an arrangement fosters goodwill as the physicians retain ownership interests, which preserves their entrepreneurial spirit.

Medical group practices today and tomorrow. Key challenges and opportunities. Roundtable discussion.

McManis Associates, a nationally known health care consulting firm, and MGMA sponsored a round table for executives from leading medical groups across the country in May 1997. The purpose of the session was to share thoughts and insights related to creating successful medical groups, with a special focus on how medical groups approach partnerships and what makes those partnerships successes or failures. This article briefly profiles the round table participants and their organizations, summarizes the highlights of the discussion that took place and synthesizes the information into lessons learned that may be applicable to others.

Group practices say growth good but tough.

McManis Associates, a health care consulting firm, in conjunction with MGMA, sponsored the fourth annual roundtable for executives from leading medical groups across the country. This event is structured to capture key insights related to the success of medical group, with a special focus on medical group growth strategies. This article briefly profiles the roundtable participants and their organizations, summarizes the highlights of the discussion that took place and synthesizes the information into lessons learned that are applicable to other medical groups.

Integration: opportunities and issues for medical group practices.

McManis Associates, a health care management consulting firm, recently gathered several medical group practice leaders for an informal discussion of integration and other key trends affecting medical groups. The goal of this "Forum for Medical Group Practice Leaders" was to elicit candid discussion among a small group of executives (who are in key positions in medical group practices), identify some of the key strategic issues they are facing and encourage them to share their opinions and experiences. The forum participants come from diverse backgrounds, a wide range of geographic locations and many different types of professional settings, including a single specialty medical group; independent, physician-owned multispecialty groups; an integrated medical center with its own hospital; the physician component of a large, integrated, multi-hospital system; and the leadership of the Medical Group Management Association (MGMA). The discussion was facilitated by Gerald L. McManis, president of McManis Associates, Inc., Louis Pavia Jr., senior vice president, and F. Kenneth Ackerman Jr., FACMPE, principal associate with the management consulting firm. This article provides a summary of the forum's proceedings, and the executive views and opinions of some of the key issues and challenges facing medical group practices today, including integration initiatives, governance, access to capital, critical success factors for group practices, as well as trends and projections for the future.

Opportunities and issues for medical group practices.

For the second consecutive year, McManis Associates, a health care management consulting firm and subsidiary of MMI Companies Inc., held, in conjunction with the 1996 MGMA/AMA joint legislation conference, an executive forum for leaders of medical group practices for a discussion of some of the key trends and issues they are facing today. The forum included five group practice executives from a variety of organization types and situations, and was structured to encourage them to engage in a candid exchange about their own opinions and experiences. Discussion was facilitated by Gerald L. McManis, president of McManis Associates, Louis Pavia Jr., executive vice president, and F. Kenneth Ackerman Jr., FACMPE, principal associate. This article provides a summary of the forum proceedings, as well as some commentary by the authors, based on their experience in working with medical group practices around the country.

[Efficacy of long-term treatment with enalapril in patients with congestive heart failure]. / Efficacia del trattamento a lungo termine con enalapril in pazienti con scompenso cardiaco congestizio.

Effects of enalapril on congestive heart failure and survival until 12 months have been evaluated in 60 patients with congestive heart failure (II, III, IV NYHA class) versus 60 control patients. Enalapril has been administered with digitalis and diuretic for 12 months 5 mg twice a day; in 60 control patients only digitalis and diuretic have been administered. Patients have been controlled every month during 12 months evaluating: NYHA class, time of exercise at treadmill, ejection time of left ventricle, speed index of ejection, cardiac output, systolic output, ECG, blood pressure, creatinine, BUN and electrolytes. After 12 months a significant increase (p less than 0.001) of systolic and cardiac output in patients with enalapril has been recorded. Also the increase of exercise time was more evident in patients with enalapril (p less than 0.01). The results show that long term treatment with enalapril in patients with congestive heart failure, improving cardiac performance, gives an hemodynamic and symptomatic benefit.