1
|
Zhang H, Chai Y, Li Q, Han Q, Lv Z. Effects of fast-track anesthesia on miR-1 and neuropeptides in serum of patients undergoing cardiac surgery. Exp Ther Med 2020; 20:1480-1486. [PMID: 32742381 PMCID: PMC7388412 DOI: 10.3892/etm.2020.8823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 11/11/2019] [Indexed: 11/10/2022] Open
Abstract
Effects of fast-track anesthesia (FTA) on miR-1 and neuropeptides in serum of patients undergoing cardiac surgery were investigated. A total of 147 patients who underwent cardiac surgery at Jining No. 1 people's Hospital from August 2015 to July 2018 were selected. There were 72 patients who received the FTA technology during cardiac surgery in the intervention group, and 75 patients who received routine anesthesia during cardiac surgery in the control group. Venous blood was, respectively, collected before anesthesia (T0), 30 min after artery opening (T1), 60 min after artery opening (T2), and 180 min after artery opening (T3). Expression of serum miR-1 in patients at T0 to T3 were detected by real-time fluorescence quantitative PCR. Expression of neuropeptide indexes such as neuron-specific enolase (NSE), S100β protein (S100β), and amyloid β-protein (Aβ) in serum of patients in the two groups at T0 to T3 were detected by ELISA, and the correlation of expression of serum miR-1, serum NSE, S100β and Aβ was analyzed. There was no significant difference in the expression of serum miR-1 between the two groups at T0 (P>0.05). There was no significant difference in the expression of NSE, S100β and Aβ between the two groups at T0 (P>0.05). Expression of serum NSE, S100β and Aβ in both groups increased gradually, and expression of serum NSE, S100β and Aβ in the intervention group were significantly lower than those in the control group at T1-T3 (P<0.05). There was a positive correlation between expression of serum miR-1, serum NSE, S100β and Aβ (r=0.773, P<0.05; r=0.683, P<0.05; r=0.769, P<0.05). Application of the FTA technology in cardiac surgery can effectively reduce the level of serum miR-1 in patients undergoing surgical treatment and improve their neurological function.
Collapse
Affiliation(s)
- Hongxia Zhang
- Department of Anesthesiology, Jining No. 1 People's Hospital, Jining, Shandong 272011, P.R. China
| | - Yongjian Chai
- Department of Anesthesiology, First People's Hospital of Jinan, Jinan, Shandong 250000, P.R. China
| | - Qinggang Li
- Medical Department, The People's Hospital of Zhangqiu Area, Jinan, Shandong 250200, P.R. China
| | - Qingtao Han
- Interventional Vascular Diseases, The People's Hospital of Zhangqiu Area, Jinan, Shandong 250200, P.R. China
| | - Zhenqian Lv
- Cardiac Surgery, Qingdao Fuwai Cardiovascular Disease Hospital, Qingdao, Shandong 266034, P.R. China
| |
Collapse
|
2
|
Maruf FA, Salako BL, Akinpelu AO. Can aerobic exercise complement antihypertensive drugs to achieve blood pressure control in individuals with essential hypertension? J Cardiovasc Med (Hagerstown) 2014; 15:456-62. [DOI: 10.2459/jcm.0b013e32836263b2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
3
|
Abstract
AIM To test a priori hypotheses concerning client-treatment matching in the treatment of alcohol problems and to evaluate the more general hypothesis that client-treatment matching adds to the overall effectiveness of treatment. DESIGN Pragmatic, multi-centre, randomized controlled trial (the UK Alcohol Treatment Trial: UKATT) with open follow-up at 3 months after entry and blind follow-up at 12 months. SETTING Five treatment centres, comprising seven treatment sites, including National Health Service (NHS), social services and joint NHS/non-statutory facilities. TREATMENTS Motivational enhancement therapy and social behaviour and network therapy. MEASUREMENTS Matching hypotheses were tested by examining interactions between client attributes and treatment types at both 3 and 12 months follow-up using the outcome variables of percentage days abstinent, drinks per drinking day and scores on the Alcohol Problems Questionnaire and Leeds Dependence Questionnaire. FINDINGS None of five matching hypotheses was confirmed at either follow-up point on any outcome variable. CONCLUSION The findings strongly support the conclusion reached in Project MATCH in the United States that client-treatment matching, at least of the kind examined, is unlikely to result in substantial improvements to the effectiveness of treatment for alcohol problems. Possible reasons for this failure to support the general matching hypothesis are discussed, as are the implications of UKATT findings for the provision of treatment for alcohol problems in the United Kingdom.
Collapse
Affiliation(s)
-
- School of Psychology and Sport Sciences, Northumbria University, Newcastle upon Tyne, UK.
| |
Collapse
|
4
|
Moran A, Simon JA, Pickering TG, Krauss RM. Response to "Is There Overlap in Blood-pressure Response to the Blockers of the Renin-Angiotensin System Between Lower and Higher Renin Subjects?". Am J Hypertens 2008. [DOI: 10.1038/ajh.2007.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
|
5
|
Drummond W, Munger MA, Rafique M, Maboudian M, Khan M, Keefe DL. Antihypertensive Efficacy of the Oral Direct Renin Inhibitor Aliskiren as Add-On Therapy in Patients Not Responding to Amlodipine Monotherapy. J Clin Hypertens (Greenwich) 2007; 9:742-50. [DOI: 10.1111/j.1524-6175.2007.06614.x] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
6
|
Narine L, Hague LK, Walker JH, Vicente C, Schilz R, Desjardins O, Einarson TR, Iskedjian M. Cost-minimization analysis of treprostinil vs. epoprostenol as an alternate to oral therapy non-responders for the treatment of pulmonary arterial hypertension. Curr Med Res Opin 2005; 21:2007-16. [PMID: 16368052 DOI: 10.1185/030079905x75104] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Idiopathic pulmonary arterial hypertension (IPAH) is associated with substantial morbidity and mortality. Treprostinil was compared to epoprostenol for the economic impact of treating IPAH patients who failed or were not candidates for bosentan. METHODS The model was a cost-minimization analysis, assuming clinical equivalence was achieved by proper dosing of both drugs, in terms of survival and surrogate measures. Two theoretical cohorts of 270 patients were treated with subcutaneous treprostinil and intravenous epoprostenol, and were evaluated over 3 years using a spreadsheet model. Annual survival rates were estimated for the cohorts so that at endpoint 114 (42%) patients survived in both groups. The model utilized resource valuation data for medication and supply costs from Medicare; hospital, consultation, surgical, and diagnostic procedural fees from North Carolina hospitals; and costs to treat adverse events from published sources. Costs were obtained from standard lists and were presented as 2003 US dollars, discounted at 3%. Sensitivity analyses were performed testing all model uncertainties. RESULTS In the base case analysis, treprostinil demonstrated savings of 22,701 US dollars and 37,433 US dollars per patient over 1- and 3-year time horizons, respectively. The greatest savings came from reduced or minimal hospitalizations attributed to the dose titration and treatment of adverse events, such as sepsis, associated with epoprostenol and its delivery system. Probabilistic sensitivity analyses resulted in average 3-year cost-savings of 41,051 US dollars (Standard Deviation = 13,902 US dollars) per patient. CONCLUSIONS By initiating and continuing treatment with treprostinil over a 3-year period, the economic burden associated with IPAH may be reduced compared to treatment with epoprostenol. The greatest saving with treprostinil was attributed to decreased sepsis.
Collapse
Affiliation(s)
- L Narine
- PharmIdeas USA Inc., Charlotte, NC, USA
| | | | | | | | | | | | | | | |
Collapse
|
7
|
Siest G, Marteau JB, Maumus S, Berrahmoune H, Jeannesson E, Samara A, Batt AM, Visvikis-Siest S. Pharmacogenomics and cardiovascular drugs: need for integrated biological system with phenotypes and proteomic markers. Eur J Pharmacol 2005; 527:1-22. [PMID: 16316654 DOI: 10.1016/j.ejphar.2005.10.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2005] [Revised: 09/23/2005] [Accepted: 10/05/2005] [Indexed: 01/22/2023]
Abstract
Personalized medicine is based on a better knowledge of biological variability, considering the important part due to genetics. When trying to identify involved genes and their products in differential cardiovascular drug responses, a five-step strategy is to be followed: 1) Pharmacokinetic-related genes and phenotypes (2) Pharmacodynamic targets, genes and products (3) Cardiovascular diseases and risks depending on specific or large metabolic cycles (4) Physiological variations of previously identified genes and proteins (5) Environment influences on them. After summarizing the most well-known genes involved in drug metabolism, we will take as example of drugs, the statins, considered as very important drugs from a Public-Health standpoint, but also for economical reasons. These drugs respond differently in human depending on multiple polymorphisms. We will give examples with common ApoE polymorphisms influencing the hypolipemic effects of statins. These drugs also have pleiotropic effects and decrease inflammatory markers. This illustrates the need to separate clinical diseases phenotypes in specific metabolic pathways, which could propose other classifications, of diseases and related genes. Hypertension is also a good example of clinical phenotype which should be followed after various therapeutic approaches by genes polymorphisms and proteins markers. Gene products are under clear environmental expression variations such as age, body mass index and obesity, alcohol, tobacco and dietary interventions which are the first therapeutical actions taken in cardiovascular diseases. But at each of the five steps, within a pharmacoproteomic strategy, we also need to use available information from peptides, proteins and metabolites, which usually are the gene products. A profiling approach, i.e., dealing with genomics, but now also with proteomics, is to be used. In conclusion, the profiling, as well as the large amount of data, will more than before render necessary an organized interpretation of DNA, RNA as well as proteins variations, both at individual and population level.
Collapse
Affiliation(s)
- Gérard Siest
- Inserm U525 Equipe 4, Université Henri Poincaré Nancy I, 30 rue Lionnois Faculté de Pharmacie, 54000 Nancy, France.
| | | | | | | | | | | | | | | |
Collapse
|
8
|
Rothwell PM. Treating individuals 2. Subgroup analysis in randomised controlled trials: importance, indications, and interpretation. Lancet 2005; 365:176-86. [PMID: 15639301 DOI: 10.1016/s0140-6736(05)17709-5] [Citation(s) in RCA: 611] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Large pragmatic trials provide the most reliable data about the effects of treatments, but should be designed, analysed, and reported to enable the most effective use of treatments in routine practice. Subgroup analyses are important if there are potentially large differences between groups in the risk of a poor outcome with or without treatment, if there is potential heterogeneity of treatment effect in relation to pathophysiology, if there are practical questions about when to treat, or if there are doubts about benefit in specific groups, such as elderly people, which are leading to potentially inappropriate undertreatment. Analyses must be predefined, carefully justified, and limited to a few clinically important questions, and post-hoc observations should be treated with scepticism irrespective of their statistical significance. If important subgroup effects are anticipated, trials should either be powered to detect them reliably or pooled analyses of several trials should be undertaken. Formal rules for the planning, analysis, and reporting of subgroup analyses are proposed.
Collapse
Affiliation(s)
- Peter M Rothwell
- Stroke Prevention Research Unit, University Department of Clinical Neurology, Radcliffe Infirmary, Oxford OX2 6HE, UK.
| |
Collapse
|
9
|
Abstract
Essential hypertension is a major cause of cardiovascular morbidity and mortality in the Western world, yet it remains poorly controlled. Single drug-antihypertensive therapy is unsuccessful in up to half of all patients with hypertension; although lack of adherence may account for a proportion of this, there is evidence of considerable variation in the response of different hypertensive patients to different drug classes. A number of algorithms have been proposed in the literature, with a view to predicting an individual's response to different antihypertensive agents. However, even using such algorithms, hypertension control remains problematic, and they are frequently difficult to apply in everyday clinical practice. Initiation of treatment with low-dose combination antihypertensive therapy, using a drug which reduces total body sodium and/or volume in combination with a drug which blocks the renin-angiotensin system, provides an effective and easily applicable means to improve hypertension control in the primary care setting.
Collapse
Affiliation(s)
- L Welsh
- Department of Clinical Pharmacology, GKT School of Medicine (Cardiovascular Division), King's College London, Guy's Hospital Campus, London, UK
| | | |
Collapse
|
10
|
Williams B, Poulter NR, Brown MJ, Davis M, McInnes GT, Potter JF, Sever PS, McG Thom S. Guidelines for management of hypertension: report of the fourth working party of the British Hypertension Society, 2004—BHS IV. J Hum Hypertens 2004; 18:139-85. [PMID: 14973512 DOI: 10.1038/sj.jhh.1001683] [Citation(s) in RCA: 685] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- B Williams
- Department of Cardiovascular Sciences, Clinical Sciences Building, Leicester Royal Infirmary, University of Leicester, UK.
| | | | | | | | | | | | | | | |
Collapse
|
11
|
Cherubini A, Fabris F, Ferrari E, Cucinotta D, Antonelli Incalzi R, Senin U. Comparative effects of lercanidipine, lacidipine, and nifedipine gastrointestinal therapeutic system on blood pressure and heart rate in elderly hypertensive patients: the ELderly and LErcanidipine (ELLE) study. Arch Gerontol Geriatr 2004; 37:203-12. [PMID: 14511846 DOI: 10.1016/s0167-4943(03)00047-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This study was conducted to compare the antihypertensive efficacy and safety of lercanidipine with those of lacidipine and nifedipine gastrointestinal therapeutic systems in patients aged 65 years or above with mild-to-moderate hypertension. Patients were randomized to receive lercanidipine 5 mg, lacidipine 2 mg, or nifedipine 30 mg for 24 weeks. After 2 weeks, the dose was doubled in non-responding patients. At 24 weeks, blood pressure was significantly reduced in the three treatment groups. The decrease in systolic blood pressure was similar in all three groups. The decrease in diastolic blood pressure in the lercanidipine group (-18.3 mmHg) was comparable to that in the nifedipine group (-17.7 mmHg), but exceeded that in the lacidipine group (-16.6 mmHg). The incidence of adverse drug reactions (ADRs) was lowest in the lercanidipine group (19.4%) compared with the nifedipine group (28.4%) and the lacidipine group (27.1%). In particular, edema was least frequent in the lercanidipine group (2.8%) compared with the lacidipine group (7.5%) and the nifedipine group (10.1%). These data demonstrate that lercanidipine is effective in lowering blood pressure in older adult hypertensive patients while maintaining a superior tolerability and safety profile.
Collapse
Affiliation(s)
- Antonio Cherubini
- Sezione di Gerontologia e Geriatria, Perugia University Medical School, Via Brunamonti, Policlino Monteluce, I-06122, Perugia, Italy.
| | | | | | | | | | | |
Collapse
|
12
|
Kostis JB. Treatment of hypertension in older patients: an updated look at the role of calcium antagonists. THE AMERICAN JOURNAL OF GERIATRIC CARDIOLOGY 2003; 12:319-27. [PMID: 12963858 DOI: 10.1111/j.1076-7460.2003.01722.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Hypertension is common in adults aged 60 years or older. Apart from age, hypertension is the most powerful predictor of cardiovascular end-organ damage and its associated morbidity and mortality. Although diastolic blood pressure is regarded as an important risk factor, it is now clear that systolic blood pressure, especially prevalent among older adults, is a better predictor of cardiovascular morbidity and mortality. Fewer than 30% of hypertensive patients have blood pressure levels controlled to <140/90 mm Hg as recommended by current guidelines. Controlled trials have demonstrated the benefits of lowering blood pressure for all hypertensive individuals, including those aged 65 years or older. Calcium antagonists of the dihydropyridine subclass, which include nifedipine, amlodipine, felodipine, and nitrendipine, as well as other drug classes, are potent antihypertensive agents that may be suitable for treatment of hypertension in older adults. However, as with all antihypertensive agents, adverse effects may limit their use; peripheral edema is particularly troublesome for dihydropyridines. Newer dihydropyridine calcium antagonists expected to be approved for use soon, including lercanidipine and lacidipine, have been associated with efficacy comparable to currently available calcium antagonists but with a lower incidence of adverse effects, especially ankle edema. Antihypertensive agents with improved tolerability profiles offer the potential for improved blood pressure control.
Collapse
Affiliation(s)
- John B Kostis
- Department of Medicine, Robert Wood Johnson Medical School, New Brunswick, NJ 08903, USA.
| |
Collapse
|
13
|
Affiliation(s)
- Morris J Brown
- Clinical Pharmacology Unit, Level 6, ACCI, Addenbrookes Hospital, Box 110, Cambridge CB2 2QQ, UK.
| |
Collapse
|
14
|
Montes Santiago J, Inaraja Bobo M, del Campo Fernández V. Nifedipino oral o sublingual: utilidad y efectividad a largo plazo de la educación médica para disminuir su uso en la hipertensión. Rev Clin Esp 2003. [DOI: 10.1016/s0014-2565(03)71185-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
15
|
Lim PO, Jung RT, MacDonald TM. Is aldosterone the missing link in refractory hypertension?: aldosterone-to-renin ratio as a marker of inappropriate aldosterone activity. J Hum Hypertens 2002; 16:153-8. [PMID: 11896503 DOI: 10.1038/sj.jhh.1001320] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2001] [Accepted: 10/11/2001] [Indexed: 11/08/2022]
Abstract
Use of the random aldosterone-to-renin ratio (ARR) as a reliable marker of inappropriate aldosterone activity has led to primary aldosteronism (PA) being increasingly diagnosed in hypertensive patients. At least 10% of hypertensives have been found to have PA, the majority of whom presumably have bilateral adrenal hyperplasia or idiopathic hyperaldosteronism as an aetiology for PA. Whilst these patients clearly have excess aldosterone activity, they have in common many features that are found in hypertensive patients in general, amongst which include heightened angiotensin II adrenal sensitivity. Whether these individuals belong within the spectrum of 'essential hypertension' is being debated, but is probably irrelevant clinically since they appear to respond favourably to spironolactone treatment. In addition, there is recent evidence suggesting that these patients overexpress a key enzyme involved in aldosterone production, the aldosterone synthase, the activity of which appears to relate to its genotypic variation.
Collapse
Affiliation(s)
- P O Lim
- Department of Cardiology, Wales Heart Research Institute, University of Wales College of Medicine, Heath Park, Cardiff CF14 4XN, Wales, UK.
| | | | | |
Collapse
|
16
|
Lim PO, Struthers AD, MacDonald TM. The neurohormonal natural history of essential hypertension: towards primary or tertiary aldosteronism? J Hypertens 2002; 20:11-5. [PMID: 11791020 DOI: 10.1097/00004872-200201000-00003] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Use of the aldosterone-to-renin ratio has controversially suggested that approximately 10% of hypertensives have primary aldosteronism, and most of these individuals are thought to have idiopathic hyperaldosteronism. The usual renin-angiotensin system control is intact in these individuals and is similar to that in low renin and essential hypertensives, differing only in the degree of sensitivity. There is recent evidence suggesting that hyperaldosteronism relates to aldosterone synthase genetic polymorphism, and also that increased angiotensin II stimulation of the adrenal glands appears to paradoxically upregulate the receptors increasing angiotensin II sensitivity. Taken together, the possibility arises that, in susceptible hypertensives, hyperaldosteronism could be acquired. Indeed, it is well known that renin-driven renovascular hypertension is associated with the development of hyperaldosteronism. Hypothetically, within the wider hypertensive population, these findings set the scene that angiotensin II adrenal sensitivity increases over time until the secretion of aldosterone becomes "autonomous" and hence "tertiary" aldosteronism in a significant proportion of hypertensives.
Collapse
Affiliation(s)
- Pitt O Lim
- Department of Cardiology, Wales Heart Research Institute, University of Wales College of Medicine, Heath Park, Cardiff CF14 4XN, Wales, UK.
| | | | | |
Collapse
|
17
|
Affiliation(s)
- M O'Sullivan
- Division of Cardiovascular Medicine, University of Cambridge Department of Medicine, Addenbrooke's Centre for Clinical Investigation, Addenbrooke's Hospital, Hills Road, Cambridge CB2 2QQ, UK.
| | | |
Collapse
|
18
|
Stengel SM, Allemann Y, Zimmerli M, Lipp E, Kucher N, Mohacsi P, Seiler C. Doppler tissue imaging for assessing left ventricular diastolic dysfunction in heart transplant rejection. Heart 2001; 86:432-7. [PMID: 11559685 PMCID: PMC1729918 DOI: 10.1136/heart.86.4.432] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To test the hypothesis that diastolic mitral annular motion velocity, as determined by Doppler tissue imaging and left ventricular diastolic flow propagation velocity, is related to the histological degree of heart transplant rejection according to the International Society of Heart and Lung Transplantation (ISHLT). METHODS In 41 heart transplant recipients undergoing 151 myocardial biopsies, the following Doppler echocardiographic measurements were performed within one hour of biopsy: transmitral and pulmonary vein flow indices; mitral annular motion velocity indices; left ventricular diastolic flow propagation velocity. RESULTS Late diastolic mitral annular motion velocity (A(DTI)) and mitral annular systolic contraction velocity (SC(DTI)) were higher in patients with ISHLT < IIIA than in those with ISHLT >/= IIIA (A(DTI), 8.8 cm/s v 7.7 cm/s (p = 0.03); SC(DTI), 19.3 cm/s v 9.3 cm/s (p < 0.05)). Sensitivity and specificity of A(DTI) < 8.7 cm/s (the best cut off value) in predicting significant heart transplant rejection were 82% and 53%, respectively. Early diastolic mitral annular motion velocity (E(DTI)) and flow propagation velocity were not related to the histological degree of heart transplant rejection. CONCLUSIONS Doppler tissue imaging of the mitral annulus is useful in diagnosing heart transplant rejection because a high late diastolic mitral annular motion velocity can reliably exclude severe rejection. However, a reduced late diastolic mitral annular motion velocity cannot predict severe rejection reliably because it is not specific enough.
Collapse
Affiliation(s)
- S M Stengel
- Cardiology, Swiss Cardiovascular Centre Bern, University Hospital, CH-3010 Bern, Switzerland
| | | | | | | | | | | | | |
Collapse
|