Application of pulsed-Doppler tissue imaging in patients with dual chamber pacing: the importance of conduction time and AV delay on regional left ventricular wall dynamics.

UNLABELLED: Pulsed-Doppler tissue imaging (pDTI) is able to measure myocardial wall velocities (systolic: S; early diastolic: E; late diastolic: A) and their timings. Relationships have been demonstrated between the pre-ejection period and indexes of left ventricular systolic function. This study was designed to examine with pDTI the effects of variations in atrioventricular delay (AVD) (100 ms, 150 ms, 200 ms) on myocardial dynamics and on their timings at the basal interventricular septum (IVS) from an apical approach and at the posterior wall (PW) from the parasternal view. These data were compared with stroke volume measurements recorded from the left ventricular outflow tract. Seventeen patients with dual chamber pacemakers (7 because of complete heart block, 10 with sick sinus syndrome and first-degree AV block) were studied; full atrial and ventricular capture was present at any AVD. These data were also compared with those obtained in 10 age-matched healthy volunteers with comparable heart rates. RESULTS: Optimal atrial contribution to left ventricular filling and, consequently, best systolic performance were achieved when AVD was programmed such that a mean interval of 77 ms was allowed between the end of the A wave and the beginning of the S wave, similar to what was measured in the healthy control group by pDTI. CONCLUSION: The noninvasive measurement of timings of the cardiac cycle by pDTI is helpful to determine the optimal AVD in individual patients.

Prediction of survival after out-of-hospital cardiac arrest: results of a community-based study in Vienna.

The objective of this study was the assessment of out-of-hospital cardiac arrest and the definition of possible predictive factors for final hospital discharge. Out of a database of 89,557 consecutive missions of the Vienna emergency medical system (EMS) during 1990, there were 623 missions due to a collapse of non-traumatic origin: in 374 cases (60.0%) the patients were declared dead without further attempts at resuscitation. The remaining 249 patients were analysed for predictive factors at site. Survival to hospital admission: 109 patients survived to hospital admission (43.7%); bystander support had a small impact (P < 0.05) on survival to hospital arrival whereas age and gender had no predictive power. Most patients with ventricular tachycardia/fibrillation (VT/VF) survived primarily (69 of 117, i.e. 59.0%). Survival to hospital discharge: 27 patients were discharged from hospital care (10.8%). ECG findings on arrival of the EMS physician at the site proved to be the only powerful predictor for survival: 24 of 117 patients with VT/VF survived compared with only one of 81 with primary asystole, two of 39 with severe bradycardia, and no patient with electromechanical dissociation.

[Psychosomatic determinants of restenosis after percutaneous transluminal coronary angioplasty]. / Psychosomatische Einflussgrössen auf die Restenosierung nach Percutaner Transluminaler Koronarangioplastie (PTCA).

Coronary Angioplasty (PTCA) has become one of the standard procedures in the therapy of coronary heart disease. One of the main issues is the 20-40% incidence of restenosis of the dilated vessel. Up to now, the subject of predictors of restenosis has not yet been sufficiently clarified. Our study is concerned with two questions; first, is it possible to prove any connections between the amount of restenosis and psychosocial factors? Second, is it possible to distinguish groups of patients with and without subsequent restenosis on the basis of psychosocial variables, even before the diagnostic coronary angiography? 138 (91m, 47f) patients were assessed before the diagnostic coronarangiography, the 25 PTCA-patients (20m, 5f) were furthermore reassessed three months after the PTCA (the time of the angiographic control). Somatic and social data were collected and a semistandardised interview was conducted. In addition, coping, stress-coping control over disease and health and life-contentment were determined. Highly significant correlations was found between the amount of restenosis and resignative stress-coping, self-pity, depressive coping and flight-tendency. With the help of stress-coping-subtests (which were given at the first examination) it was possible to separate the group of patients with restenosis from the group without it.

Chronobiology of urinary acid glycosaminoglycan excretion.

Acid glycosaminoglycans (AGAG, mucopolysaccharides) are major constituents of the extracellular matrix. They play a role in filtration and permeability processes, isolation and scaffolding. In childhood no circadian rhythms have been reported up to now. We examined 11 children testing the parameters of: urine volume, creatinine concentration and -excretion, glycosaminoglycan concentration and -excretion, the glycosaminoglycan/creatinine ratio, chondroitin 4 sulfate (Ch4S) in % of total AGAG, Ch4S in mg/2 hrs, heparan sulfate (HS) in % of total AGAG and HS in mg/2 hrs. The biorhythmicity of these data were processed by the cosinor system. We found significant circadian rhythmus for urine volume (acrophase at 1704 hrs, p = 0.05), creatinine concentration (acrophase at 0512 hrs, p = 0.01) and glycosaminoglycan concentration (acrophase at 0358 hrs, p = 0.005). The data presented can form the physiological basis for studies of biorhythmicity in several pathological states as e.g. diabetes and mucopolysaccaridoses.

Periodicity of urinary beta-2-microglobulin excretion.

Using the cosinor system we examined the chronobiology of urinary beta-2-microglobulin excretion. The following dimensions were studied: urinary volume, creatinine concentration, creatinine excretion, beta-2-microglobulin concentration, beta-2-microglobulin excretion and the beta-2-microglobulin/creatinine ratio. Urinary volume showed an acrophase at 1704 hours (p = less than 0.01), creatinine concentration showed an acrophase at 0512 hrs (p = less than 0.006) and the beta-2-microglobulin/creatinine ratio presented an acrophase at 1736 hrs (p = less than 0.03). Data were related to a tau = 24 hrs. The data clearly reveal that the beta-2-microglobulin/creatinine ratio shows a circadian rhythm in urinary excretion.