Shortening of Electromechanical Systole as a Manifestation of Excessive Adrenergic Stimulation in Acute Myocardial Infarction

Lewis, Richard P.; Boudoulas, Harisios; Forester, Wilbur F.; Weissler, Arnold M.

doi:10.1161/01.cir.46.5.856

Cited by 62 publications

(23 citation statements)

References 32 publications

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“…In the present study an excessive adrenergic tone was found the day before CBS as manifested by an increase in the urinary catecholamine excretion and a short QS2I (24,26). In the propranolol group the QSzI was within normal range indicating good beta blockade (5,6).…”

Section: Discussionsupporting

confidence: 54%

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Beneficial effect of continuation of propranolol through coronary bypass surgery

Boudoulas

Lewis

Snyder

et al. 1979

Clinical Cardiology

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Summary: The safety and beneficial effect of continuation of propranolol (Pr) through coronary bypass surgery (CBS) was studied in two groups of patients. In the control group (50 patients) Pr was discontinued 24 h before CBS without reinstitution afterwards. In the propranolol group the drug was maintained up to 4 to 10 h before surgery and was restarted within 24 h afterwards. The incidence of subendocardial myocardial infarction was significantly lower in the Pr group (lout of 30 vs 10 out of 50, p < 0.05) while the incidence of transmural infarction was the same in both groups (3 out of 30, 10 %, vs 5 out of 50, 10%). The incidence of supraventricular tachycardias during the first three postoperative days was significantly lower in the propranolol group compared to control (5% vs 30%, P < 0.01). The 24 h urinary epinephrine and norepinephri ne excretion was significantly greater than normal the day before surgery (136 ± 12 vs 39 ± 4,ug/24 h, P < 0.01), and was still high two weeks after surgery (115.1 ± 14 ,ug124 h). There were no complications related to propranolol. The left ventricular function as measured from the systolic time intervals was the same preSupported in part by the Central Ohio Heart Association, Chapter of the American Heart Association. and postoperatively in both groups. The results of this study show that administration of propranolol up to 4 h before coronary bypass and reinstitution immediately afterwards is safe and beneficial.

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Section: Discussionsupporting

confidence: 54%

“…The PEPIL VET was not different in both groups before and two weeks after surgery, and was mildly but significantly increased. Patients with peri operative infarction were exluded from this analysis, since it is known that peri-operative infarction produces a significant deterioration in left ventricular performance (4,8,10,20,24,25).…”

Section: Resultsmentioning

confidence: 99%

Beneficial effect of continuation of propranolol through coronary bypass surgery

Boudoulas

Lewis

Snyder

et al. 1979

Clinical Cardiology

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“…34 This is relevant to the previous demonstration that not only heart rate but also changes in myocardial inotropism 35 and increase of catecholamines release 33 can produce changes in diastolic time/left-ventricular ejection time ratio. All these factors tend to occur at high altitude; an activation of the sympathetic system leads to increased myocardial inotropism, and this is associated with prolongation of the left-ventricular systolic period and with the corresponding relative reduction in duration of diastole 9 associated with changes in central pulse waveform.…”

Section: Subendocardial Viability Ratiomentioning

confidence: 59%

Changes in Subendocardial Viability Ratio With Acute High-Altitude Exposure and Protective Role of Acetazolamide

et al. 2013

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Abstract-High-altitude tourism is increasingly frequent, involving also subjects with manifest or subclinical coronary artery disease. Little is known, however, on the effects of altitude exposure on factors affecting coronary perfusion. The aim of our study was to assess myocardial oxygen supply/demand ratio in healthy subjects during acute exposure at high altitude and to evaluate the effect of acetazolamide on this parameter. Forty-four subjects (21 men, age range: 24-59 years) were randomized to double-blind acetazolamide 250 mg bid or placebo. Subendocardial viability ratio and oxygen supply/demand ratio were estimated on carotid artery by means of a validated PulsePen tonometer, at sea level, before and after treatment, and after acute and more prolonged exposure to high altitude (4559 m). On arrival at high altitude, subendocardial viability ratio was reduced in both placebo (from 1.63±0.

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“…Conversely, a significant difference was found between the two examined groups in the effects of dynamic exercise upon HR, systolic arterial pressure, electromechanical systole and consequently, on diastolic time, suggesting a different cardiovascular re sponse to stress. In fact, CAD patients showed a greater exercise-induced increase in HR and SBP, probably related to a more adrenergic stimulation [13][14][15][16], and a smaller decrease in electromechanical sys tole, resulting in a more marked shortening of %D. In the two examined groups at rest, no difference was found in the slopes and intercepts of the obtained linear regressions between Q-inc and HR as well as between %D and RR, suggesting that in the resting condition in CAD patients, the physiological ratio between systole and diastole is well preserved.…”

Section: Discussionmentioning

confidence: 99%

Diastolic Time during Exercise in Normal Subjects and in Patients with Coronary Artery Disease

Ferrò¹,

Giunta²,

Maione³

et al. 1984

Cardiology

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Percent diastole (%D) was evaluated at rest and during effort (submaximal upright exercise) in 13 normal subjects and in 14 age-matched patients with coronary artery disease (CAD). Systolic time intervals were also simultaneously recorded by using the thermistor pulse transducer. At rest, in both groups, a positive linear regression was found between %D and cycle length (RR) (%D = 19.1 + 0.044RR, r = 0.83 in normals; %D = 21.2 + 0.044RR, r = 0.88 in CAD). During effort, while in normals no correlation was found between %D and RR values, in CAD patients %D and RR were linearly related (%D = -12.81 + 0.087RR, r = 0.67). These results prove that diastolic time is differently affected by the exercise in the two examined groups and that in CAD patients an abnormal reduction of %D occurs during stress test.

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Shortening of Electromechanical Systole as a Manifestation of Excessive Adrenergic Stimulation in Acute Myocardial Infarction

Abstract: SUMMARYThe relationship between shortened electromechanical systole (QS2I) and 24-hour urinary catecholamine excretion (E + NE) was

Cited by 62 publications

References 32 publications

Beneficial effect of continuation of propranolol through coronary bypass surgery

Beneficial effect of continuation of propranolol through coronary bypass surgery

Changes in Subendocardial Viability Ratio With Acute High-Altitude Exposure and Protective Role of Acetazolamide

Diastolic Time during Exercise in Normal Subjects and in Patients with Coronary Artery Disease

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