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ABSTRACT: Changes in myocardial lactate metabolism during ramp exercise were investigated through great cardiac vein catheterization in 15 patients with effort angina (EA) and 7 patients with microvascular angina (MVA). The exercise test was performed using a supine bicycle ergometer. Blood samples were obtained from the great cardiac vein (GCV) and the radial artery each minute during exercise. Patients in the EA group showed a point at which the lactate extraction ratio (LER) and the ST level decreased rapidly during exercise. This point was clearly recognized in 12 of 13 patients, and may represent the ischemic threshold. Both the LER and ST level showed similar changes during exercise, and these values were significantly different between the ischemic threshold and peak exercise (p < 0.01). Both the LER and ST level were strongly correlated with the duration of exercise until the threshold (r = 0.703). In the MVA group, both the LER and ST level during exercise continuously decreased throughout exercise without an ischemic threshold in all of the subjects. Endomyocardial biopsy revealed sclerosis of small arteries in the myocardium in all of the patients. In both effort angina and microvascular angina, a close correlation was noted between the change in ST and that in the myocardial lactate extraction ratio.
Japanese Circulation Journal 11/1996; 60(11):876-88.
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ABSTRACT: We studied the influence of bathing on cardiac function and hemodynamics in patients with myocardial infarction (MI) using Swan-Ganz catheter, and using Doppler echocardiography noninvasive indices to assess the increase in pulmonary arterial pressure or pulmonary capillary wedge pressure during bathing were also studied. Fifty-four patients with MI (mean age 56.0 years) were examined (19 with extensive anterior MI, 13 with anterior, 17 with inferior and 5 with anterior and inferior MI). Bathing was conducted with patient in the supine position using tap water at 42 degrees C for 5 min in the Hubbard tank. The patients were classified into 2 groups; one with an increase in the pulmonary capillary wedge pressure (delta PCWP) above 10 mmHg (Group A), and the other with pressure below 10 mmHg (Group B). The hemodynamic data and echocardiographic indices such as peak velocities of blood flow (PV) at the right and left ventricular outflow tracts (RVOT and LVOT) and blood flow pattern at the left ventricular inflow tract (LVIT) were compared between these 2 groups using Doppler echocardiography. In Group A, extensive anterior MI was more frequent (p < 0.05). The exercise duration time was significantly short (6.3 +/- 1.6 min vs 10.2 +/- 2.8 min, p < 0.001) in the exercise tolerance test by bicycle ergometer. The left ventricular end-diastolic pressure was significantly high (17.8 +/- 8.2 mmHg vs 14.8 +/- 4.4 mmHg, p < 0.05) and the left ventricular ejection fraction was lower (39.8 +/- 19.6% vs 56.2 +/- 16.8%, p < 0.01) in cardiac catheterization. This indicated that they had cardiac dysfunction. In Group A, there were marked increases in pulmonary arterial pressure and right atrial pressure during bathing. PV at the RVOT was significantly increased in both Groups A and B (110.3 +/- 5.8%, 112.7 +/- 11.8%, both, p < 0.001). The ratio between 2 peak velocities (A and R) (A/R) at the LVIT in Group A was significantly increased compared with Group B (110.0 +/- 24.5% vs 98.1 +/- 14.5%, p < 0.01), while PV at the LVOT decreased significantly in Group A (92.0 +/- 14.6%, p < 0.01) and increased in Group B (115.0 +/- 17.7%, p < 0.001).(ABSTRACT TRUNCATED AT 400 WORDS)
Journal of Cardiology 01/1991; 21(3):527-37. · 1.28 Impact Factor
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ABSTRACT: Hemodynamic changes during bathing in patients with myocardial infarction were studied using a Swan-Ganz catheter and Doppler echocardiography. The subjects consisted of 14 patients with myocardial infarction (mean age 55.6 years), including the six extensive ones of the anterior wall, five of the anteroseptal wall, two of the inferior wall, and one of the inferoposterior wall. Bathing was by means of 42 degrees C tap water for five min in the supine position in a Hubbard tank. Pulsed wave Doppler was used to analyze left and right ventricular inflow velocity patterns, and continuous wave Doppler was employed to measure right ventricular outflow velocity. Blood pressure, pulmonary arterial pressure, pulmonary arterial wedge pressure and right atrial pressure increased significantly during bathing. After bathing, these parameters decreased and remained lower than the baseline levels before bathing. Heart rate and the cardiac index increased significantly during bathing, but decreased after bathing. The systemic vascular resistance index and pulmonary vascular resistance index decreased significantly during bathing, but increased after bathing. The A/R ratio at the left and right ventricular inflow tracts increased during bathing, and right ventricular outflow velocity increased significantly. However, when the subjects were categorized into two groups, i.e., those whose pulmonary arterial pressure consistently increased to the higher level than the average during bathing and those who did not show any increase, the A/R ratio at the inflow tract of the left ventricle increased significantly during bathing in the former group, but there was no significant change in the latter group.(ABSTRACT TRUNCATED AT 250 WORDS)
Journal of Cardiology 01/1989; 18(4):979-87. · 1.28 Impact Factor
