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Webb CM, Underwood R, Anagnostopoulos C, Bennett JG, Pepper J, Lincoln C, Collins P. The effect of angiotensin converting enzyme inhibition on myocardial function and blood pressure after coronary artery bypass surgery--a randomised study. Eur J Cardiothorac Surg 1998; 13:42-8. [PMID: 9504729 DOI: 10.1016/s1010-7940(97)00284-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To investigate the effect of 6 weeks' pre-operative treatment with the angiotensin converting enzyme inhibitor, quinapril, on left ventricular function when measured 3 months after coronary artery bypass graft surgery and to examine the safety of such treatment. PATIENTS AND METHODS Patients (96) [86 males, 10 females; mean age 61 years] with chronic stable angina, on the waiting list for coronary artery bypass graft surgery, underwent measurement of left ventricular function by resting radionuclide ventriculography. Patients were then randomised to quinapril 20 mg once daily or placebo in a double-blind fashion, in addition to existing anti-anginal therapy and this regimen was continued for up to 6 weeks prior to operation. Measurement of left ventricular function was repeated 3 months following surgery, after recommencement of pre-surgery anti-anginal therapy for 1 week. Effects on systemic vascular resistance (SVR) during bypass were calculated from perfusion records and vasoconstrictor use during operation was documented. The safety of the addition of quinapril to the anti-anginal regimen was assessed by measurement of systemic blood pressure (BP) after the first dose of study medication, measurement of intra-operative BP, administration of inotropes and any intra-operative complications. RESULTS There was no difference between treatment groups in the pre-study left ventricular ejection fraction (mean (S.D.); 54.9 (13.8)% versus 55.6 (13.2)%, quinapril versus placebo, respectively), or 3 months after surgery (58.1 (13.6)%, versus 56.9 (12.6)%, quinapril versus placebo, respectively). Left ventricular ejection fraction 3 months after surgery did not change significantly from pre-treatment in either group (2.8 (10.7)% and 1.5 (10.1)%; quinapril and placebo, respectively). There was no first-dose hypotension (systolic BP < 100 mmHg). The intra-operative BP and the SVR during bypass in the two treatment groups were not significantly different. The ischaemic time (mean = 56 min) and the use of inotropes were the same in both groups and there was no mortality. CONCLUSIONS Angiotensin converting enzyme inhibitor treatment before coronary artery bypass graft surgery does not have a significant beneficial effect on left ventricular function following coronary artery bypass graft surgery. Angiotensin converting enzyme inhibition, administered in addition to anti-anginal therapy, does not cause first-dose hypotension or increase morbidity or mortality and can safely be used in patients with coronary heart disease prior to coronary artery bypass graft surgery.
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Abstract
Transfer of patients from palliative care services to nursing homes is necessary at present when a patient is relatively stable, but does not have adequate support systems at home. With the ageing of the population and the increasing incidence of cancer, the need for inpatient palliative care beds is growing with corresponding pressure for patients to be transferred to nursing homes. Transfer to a nursing home in the general population has been described extensively in the gerontology literature where a critical early phase of relocation has been identified by a high incidence of morbidity and mortality. The vulnerability of terminally ill patients means that they are at increased risk of suffering from stress associated with a transfer. The prognosis of a patient may be shorter than the time required for adjustment to the patient's new home. The issues surrounding transfer of palliative care patients to nursing homes and possible strategies designed to reduce distress associated with transfers are explored.
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Capes D, Martin K, Underwood R. Performance of a restrictive flow device and an electronic syringe driver for continuous subcutaneous infusion. J Pain Symptom Manage 1997; 14:210-7. [PMID: 9379068 DOI: 10.1016/s0885-3924(97)00181-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The aim of this study was to investigate the flow performance of the mechanical Springfusor 30 short model and the electronic Graseby MS16A. Flow rate was measured gravimetrically in a temperature-controlled cabinet. There was no statistically significant difference between the Graseby and Springfusor syringe drivers in the flow rate error at 25 degrees C. The percentage of flow rates within +/-20% accuracy during a 35-min periods at 25 degrees C was significantly less with the Graseby, being 91.9% compared with 100% for the Springfusor. Only 58.2% of flow rates with the Graseby were within the manufacturer claimed accuracy of +/-5%. The flow rate of the Springfusor was affected by temperature; at 30 degrees C the mean flow rate was 10.8% greater than at 25 degrees C. These results indicate that the Springfusor 30 had less flow rate variation than the Graseby MS16A. However, this would not be expected to cause noticeable clinical effects when used for opioid infusion in palliative care.
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Stacey B, Martin K, Underwood R. A continuum of palliative care services: reflections on an Australian model of care. J Palliat Care 1997; 13:45-9. [PMID: 9231588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Aoun S, Underwood R, Rouse I. Primary mental health care in a rural community: patient and illness profiles, treatment and referral. Aust J Rural Health 1997; 5:37-42. [PMID: 9437933 DOI: 10.1111/j.1440-1584.1997.tb00233.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The objective of this study was to determine the extent and nature of psychosocial morbidity and patterns of treatment and referral in rural general practice in a West Australian community. The research design was a survey based on structured questionnaires completed by the general practitioners about patients consulting with mental health problems in Bunbury in the rural south west region of Western Australia. Twenty-two general practitioners from five surgeries collected information on 428 patients, pertaining to socio-demographic characteristics, reasons for encounter, diagnoses, social problems, chronicity, counselling, medication and use of referral services. The positive stereotype of patients (i.e. most likely to be identified) consisted of a female preponderance in a ratio of 3:1, a high prevalence in the middle years (35-54), an overrepresentation of the divorced and separated, unemployed men and housewives. Neurosis was the most prevalent diagnosis at 68.5%, chronicity at 55%, and the most frequent social problems reported to the GPs related to relationship difficulties with partner, and being physically ill. Only a quarter of the patients were referred to other counselling services and social problems were an important reason for referral. Particular attention needs to be given to the negative stereotype in general practice of young people under the age of 25. With the bulk of psychosocial disorder concentrated in general practice, with the evident association of mental illness with physical illness and social problems, and with the lack of specialist resources in rural areas, innovative ways of support from other mental health professionals need to be addressed.
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Missouris CG, Forbat SM, Singer DR, Markandu ND, Underwood R, MacGregor GA. Echocardiography overestimates left ventricular mass: a comparative study with magnetic resonance imaging in patients with hypertension. J Hypertens 1996; 14:1005-10. [PMID: 8884556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare measurement of left ventricular mass (LVM) by M-mode echocardiography and magnetic resonance imaging (MRI) in hypertensive subjects. DESIGN A prospective study. SUBJECTS Twenty-four untreated hypertensive patients [19 men and five women, aged 51 +/- 2 (mean +/- SEM) years, supine blood pressure 159/101 +/- 3/1 mmHg]. SETTING The Blood Pressure Unit, St Georges Hospital Medical School and Magnetic Resonance Unit, Royal Brompton National Heart and Lung Hospital, London. MAIN OUTCOME MEASURES LVM estimated both by M-mode echocardiography and by MRI. RESULTS Using three standard M-mode formulae, widely different values of LVM were obtained with echocardiography [American Society of Echocardiography (ASE) 319 +/- 21 g, Penn 273 +/- 19 g. Teichholz 191 +/- 11 g]. By MRI, the LVM was 232 +/- 11 g. The differences between MRI and echocardiography could not be explained in terms of the timing of measurements in the cardiac cycle. When single-slice MRI measurements at the appropriate level were applied to the ASE and Penn formulae, the LVM was again overestimated. CONCLUSION Our study has shown major differences in LVM estimated using methods based on one-dimensional (echocardiography) compared with three-dimensional (MRI) data. These differences seem to be largely the result of the geometrical assumptions on which M-mode measurements are based. Our findings have important clinical implications for the assessment of the severity and response to treatment of left ventricular hypertrophy in hypertensive patients.
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Thompson GR, Forbat S, Underwood R. Electron-beam CT scanning for detection of coronary calcification and prediction of coronary heart disease. QJM 1996; 89:565-70. [PMID: 8935477 DOI: 10.1093/qjmed/89.8.565] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Electron-beam or ultrafast computerized tomographic (CT) scanning provides a convenient and sensitive means of detecting coronary calcification, which is an early index of atherosclerosis. The procedure has strong negative predictive power for the presence of coronary artery disease, but a limited ability to predict disease severity. However, preliminary indications are that it is as good or better than conventional risk factors in this respect. Although further validation is needed before electron-beam CT can be regarded as an established method of detecting presymptomatic coronary atherosclerosis, the procedure has potential in this context.
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Schmitz T, Underwood R, Khiroya R, Bachovchin WW, Huber BT. Potentiation of the immune response in HIV-1+ individuals. J Clin Invest 1996; 97:1545-9. [PMID: 8617888 PMCID: PMC507215 DOI: 10.1172/jci118577] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
T cells from HIV-1+ individuals have a defect in mounting an antigen specific response. HIV-1 Tat has been implicated as the causative agent of this immunosuppression. We have previously shown that HIV-1 Tat inhibits antigen specific proliferation of normal T cells in vitro by binding to the accessory molecule CD26, a dipeptidase expressed on the surface of activated T cells. We now demonstrate that the defective in vitro recall antigen response in HIV-1 infected individuals can be restored by the addition of soluble CD26, probably by serving as a decoy receptor for HIV-1 Tat. The restored response is comparable to that of an HIV-1- individual, suggesting that early in HIV infection there is a block in the memory cell response, rather than deletion of these cells.
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Beale CM, Underwood R, Graeme Bennett J, Pepper J, Lincoln C, Collins P. Blood pressure response during bypass surgery in patients taking ACE inhibitors. J Am Coll Cardiol 1996. [DOI: 10.1016/s0735-1097(96)80574-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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85
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Houlihan WJ, Prasad K, Underwood R, Repic O, Munder PG. Antitumor activity of the R- and S-enantiomers of RS-2-[[hydroxy[[2-[ (octadecyloxy)methyl]tetrahydrofuran-2-yl]methoxy]-phosphinyl]oxy]-N, N,N,-trimethylethylaminium hydroxide inner salt. J Med Chem 1996; 39:605-8. [PMID: 8558533 DOI: 10.1021/jm950072e] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The R- and S-enantiomers of 2-[[hydroxyl[[2-[(octadecyloxy) methyl]tetrahydrofuran-2-yl]methoxy]-phosphinyl]oxy]-N,N,N,- trimethylethylaminium hydroxide salt (SRI 62-834) have been evaluated in several assays to determine potential antitumor activity. The S-enantiomer showed slightly greater cytotoxic activity than the R- or RS-forms against several murine tumor cell lines. In the mouse Meth A fibrosarcoma model, the S-enantiomer was ca. 4 times more effective than the R-isomer in controlling size of tumor growth and increasing the number of survivors.
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Underwood R. Nuclear cardiology studies--principles for stress modality selection. BRITISH JOURNAL OF CLINICAL PRACTICE. SUPPLEMENT 1995; 82:10-12. [PMID: 8729581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Severi S, Underwood R, Mohiaddin RH, Boyd H, Paterni M, Camici PG. Dobutamine stress: effects on regional myocardial blood flow and wall motion. J Am Coll Cardiol 1995; 26:1187-95. [PMID: 7594031 DOI: 10.1016/0735-1097(95)00319-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES This investigation studied the relation between regional myocardial blood flow and left ventricular function during dobutamine stress in patients with coronary artery disease. BACKGROUND Dobutamine stress is becoming more frequently used as an alternative to dynamic exercise in patients with ischemic heart disease. METHODS We studied 12 patients with coronary artery disease. Dobutamine was infused from 5 micrograms/kg body weight per min up to 40 micrograms/kg per min or until chest pain or other intolerable side effects. Regional myocardial blood flow was measured with positron emission tomography and oxygen-15-labeled water. Regional wall motion was assessed in three short-axis slices by magnetic resonance imaging. Each slice was subdivided into four regions: septal, anterior, lateral and inferior. A total of 140 regions were suitable for comparison. RESULTS During stress, new wall motion abnormalities developed in 27 regions. Myocardial blood flow (mean +/- SD) increased in 113 regions that did not develop wall motion abnormalities (0.98 +/- 0.26 [baseline] vs. 1.98 +/- 0.87 [dobutamine] ml/min per g, p < 0.001), whereas it did not change significantly in regions with stress-induced wall motion abnormalities (1.00 +/- 0.28 [baseline] vs. 1.30 +/- 0.62 [dobutamine] ml/min per g, p = NS). An absolute decrease in myocardial blood flow below the value at rest was observed in seven segments that developed wall motion abnormalities during stress. CONCLUSIONS The normal functional response to dobutamine stress is paralleled by an increase in coronary flow, whereas mechanical dysfunction is accompanied by a blunted increase, or even a paradoxic decrease, in regional coronary flow.
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Anagnostopoulos C, Laney R, Pennell D, Proukakis H, Underwood R. A comparison of resting images from two myocardial perfusion tracers. EUROPEAN JOURNAL OF NUCLEAR MEDICINE 1995; 22:1029-34. [PMID: 7588940 DOI: 10.1007/bf00808415] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We have compared stress-redistribution and delayed rest thallium-201 with rest technetium-99m methoxyisobutylisonitrile (MIBI) tomograms in order to compare the tracers for the assessment of myocardial viability and to validate a rapid protocol combining the two tracers. We studied 30 consecutive patients with known or suspected coronary artery disease [group 1: 16 with normal left ventricular function, mean left ventricular ejection fraction (LVEF) 55%, SD 6%; group 2: 14 with abnormal function, mean LVEF 28%, SD 8%]. 201Tl was injected during infusion of adenosine followed by acquisition of conventional stress and redistribution tomograms. On a separate day, 201Tl was injected at rest with imaging 4 h later. 99mTc-MIBI was then given at rest and imaging was performed. Three images were compared: redistribution 201Tl, rest 201Tl, and rest 99mTc-MIBI. Tracer activity was classified visually and quantitatively in nine segments and segments with > 50% activity were defined as containing clinically significant viable myocardium. Mean (+/- SD) global tracer uptake as a percentage of maximum was similar in group 1 (rest 201Tl 69% +/- 12%, redistribution 201Tl 69% +/- 15%, rest 99mTc-MIBI 70% +/- 13%, ANOVA P > 0.05), but in group 2 mean tracer uptake was significantly greater in the rest 201Tl images (59% +/- 16%) than in redistribution 201Tl images (53% +/- 17%) or rest 99mTc-MIBI images (53% +/- 19%) (ANOVA P = 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)
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Mohiaddin RH, Underwood R, Romeira L, Anagnostopoulos C, Karwatowski SP, Laney R, Somerville J. Comparison between cine magnetic resonance velocity mapping and first-pass radionuclide angiocardiography for quantitating intracardiac shunts. Am J Cardiol 1995; 75:529-32. [PMID: 7864007 DOI: 10.1016/s0002-9149(99)80600-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Mohiaddin RH, Roberts RH, Underwood R, Rothman M. Localization of a misplaced coronary artery stent by magnetic resonance imaging. Clin Cardiol 1995; 18:175-7. [PMID: 7743690 DOI: 10.1002/clc.4960180313] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Coronary artery stents have been developed to overcome arterial abrupt closure and restenosis following balloon angioplasty. Complications of stent insertion include loss of the device from its delivery system into the peripheral circulation. Certain types of stents are almost radiolucent, making localization of the lost devices difficult. Nonferromagnetic metallic biomedical implants induce alteration of the local magnetic field and this leads to loss of signal from the surrounding tissues. We have used this property to localize a misplaced coronary artery stent in a 53-year-old man who underwent unsuccessful stent insertion. A 0.5 Tesla magnetic resonance scanner was used to acquire gradient-echo and spin-echo images. An in vitro experiment was first carried out on a stent similar to that used in our patient to establish that it was nonferromagnetic and to determine the optimum imaging technique. Gradient-echo images with a relatively long echo time (22 ms) gave the largest area of signal loss around the stent, and this sequence was used for localization of the stent found in the patient's left profunda femoris artery. This was subsequently confirmed by digital radiography. We have demonstrated the convenience and practicality of using magnetic resonance imaging for the localization of a misplaced coronary artery stent in a patient. The technique is safe, noninvasive, and uses no ionizing radiation.
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Stables RH, Denne L, Anagnostopoulos C, Underwood R, Buller NP, Denison DM. 1028-120 Physician Prejudice Influences Treatment Allocation in Single Vessel Coronary Artery Disease. J Am Coll Cardiol 1995. [DOI: 10.1016/0735-1097(95)93168-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Underwood R, Wood D. Dipyridamole and dobutamine for myocardial perfusion imaging. Heart 1994; 72:594. [PMID: 7726936 PMCID: PMC1025655 DOI: 10.1136/hrt.72.6.594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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93
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Shephard JN, Underwood R, Evans TW. The application of a non-imaging nuclear probe system to the critically ill: laboratory validation and a clinical trial. Nucl Med Commun 1994; 15:653-8. [PMID: 7970447 DOI: 10.1097/00006231-199408000-00010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Non-imaging nuclear probe systems have been available for bedside monitoring of left ventricular function since the early 1970s. The purpose of this study was to evaluate a recently developed system, the Cardioscint (Oakfield Instruments, Oxford, UK), both in the laboratory and clinically prior to its application in the critically ill on the intensive care unit. The probe system was stable at body temperature for prolonged periods and its count rate capability was adequate for those encountered clinically. An adequate period of data acquisition was shown to be important because random isotope decay produces a significant noise at these count rates. Left ventricular ejection fraction in patients with symmetrical ventricular contraction agree closely with the results obtained with radionuclide ventriculography (mean difference = 0.98%, S.D. = 2.8%, n = 30). However, in patients with asymmetrical ventricular contraction the agreement is poor (mean difference = -3.0%, S.D. = 6.2%, n = 10).
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Henein MY, Rosano GM, Underwood R, Poole-Wilson PA, Gibson DG. Relations between resting ventricular long axis function, the electrocardiogram, and myocardial perfusion imaging in syndrome X. BRITISH HEART JOURNAL 1994; 71:541-7. [PMID: 8043335 PMCID: PMC1025450 DOI: 10.1136/hrt.71.6.541] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To investigate interrelations between ventricular long axis function, resting electrocardiogram, and myocardial perfusion imaging in a group of patients with syndrome X in order to define possible underlying mechanisms. DESIGN Prospective echocardiographic, electrocardiographic, and myocardial perfusion imaging. SETTING A tertiary referral centre for cardiac diseases with invasive and non-invasive facilities. PATIENTS 50 consecutive patients with syndrome X selected on the basis of a history of angina, ST segment depression on exercise, and normal coronary arteriograms and 21 controls of similar age. RESULTS Long axis motion of one or both ventricles assessed by echocardiography was abnormal in 37 patients. The onset of systolic shortening was delayed by > 130 ms (upper limit of normal 95% confidence interval) in eight patients, and was associated with prolonged shortening during the isovolumic relaxation period in seven (p < 0.01) (systolic abnormalities). The onset of diastolic lengthening was delayed by > 80 ms in 20. Early diastolic peak lengthening rate was < 4.5 cm.s-1 in 13 patients, and the relative amplitude of lengthening during atrial systole was > 45% in 18. On the resting electrocardiogram septal q waves were absent in 12 patients. This was associated with long axis systolic disturbances in seven patients (p < 0.05). T waves were abnormal in 10 and associated with delayed onset of early diastolic lengthening in all (p < 0.001). Late diastolic long axis disturbances were not associated with any consistent electrocardiographic abnormality. Myocardial perfusion imaging was abnormal in six of 33 patients, four of whom had systolic abnormalities (p < 0.03). Imaging was normal in the rest, but in 13 of them long axis function was abnormal in the left side and in four it was abnormal on the right ventricle. Both electrocardiography and imaging were normal in 10 patients. No patient with an abnormal electrocardiogram or myocardial perfusion had normal long axis motion on echocardiography. CONCLUSION The function of the left and right ventricular long axes was abnormal in about 70% of a sample of patients with syndrome X. Systolic disturbances were consistently associated with absent septal q wave and abnormal myocardial perfusion imaging, while early diastolic disturbances correlated with T wave abnormalities. These associations suggest that the three different investigations detect related objective abnormalities in one or more subgroups of patients with syndrome X.
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Underwood R. Magnetic resonance imaging compared with thallium myocardial perfusion tomography after acute myocardial infarction. Magn Reson Imaging 1994; 12:827. [PMID: 7934670 DOI: 10.1016/0730-725x(94)92208-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Underwood R, Pennell D. Management of acute myocardial infarction. JOURNAL OF THE ROYAL COLLEGE OF PHYSICIANS OF LONDON 1994; 28:485. [PMID: 7865020 PMCID: PMC5401022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Underwood R. Detection of viable myocardium in segments with fixed defects on thaillium-201 scintigraphy: usefulness of magnetic resonance imaging early after acute myocardial infarction. Magn Reson Imaging 1994; 12:1277. [PMID: 7854034 DOI: 10.1016/0730-725x(94)90095-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Brogi E, Winkles JA, Underwood R, Clinton SK, Alberts GF, Libby P. Distinct patterns of expression of fibroblast growth factors and their receptors in human atheroma and nonatherosclerotic arteries. Association of acidic FGF with plaque microvessels and macrophages. J Clin Invest 1993; 92:2408-18. [PMID: 7693761 PMCID: PMC288424 DOI: 10.1172/jci116847] [Citation(s) in RCA: 163] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Because fibroblast growth factors (FGFs) modulate important functions of endothelial cells (EC) and smooth muscle cells (SMC), we studied FGF expression in human vascular cells and control or atherosclerotic arteries. All cells and arteries contained acidic (a) FGF and basic (b) FGF mRNA. Northern analysis detected aFGF mRNA only in one of five control arteries but in all five atheroma tested, while levels of bFGF mRNA did not differ among control (n = 3) vs. plaque specimens (n = 6). Immunolocalization revealed abundant bFGF protein in control vessels (n = 10), but little in plaques (n = 14). In contrast, atheroma (n = 14), but not control arteries (n = 10), consistently exhibited immunoreactive aFGF, notably in neovascularized and macrophage-rich regions of plaque. Because macrophages colocalized with aFGF, we tested human monocytoid THP-1 cells and demonstrated accumulation of aFGF mRNA during PMA-induced differentiation. We also examined the expression of mRNA encoding FGF receptors (FGFRs). All cells and arteries contained FGFR-1 mRNA. Only SMC and control vessels had FGFR-2 mRNA, while EC and some arteries contained FGFR-4 mRNA. The relative lack of bFGF in plaques vs. normal arteries suggests that this growth factor may not contribute to cell proliferation in advanced atherosclerosis. However, aFGF produced by plaque macrophages may stimulate the growth of microvessels during human atherogenesis.
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