The utility of cardiac CT beyond the assessment of suspected coronary artery disease.

Extensive work has been done over recent years to improve the spatial and temporal resolution of electrocardiogram (ECG)-gated cardiac computed tomography (CT). Advances in both hardware and software analysis have enabled the development of non-invasive coronary angiography. However, these high-quality examinations lend themselves to multiple additional applications beyond coronary angiography. In this review, we illustrate and discuss some established and some emerging applications of ECG-gated cardiac CT beyond the assessment of suspected coronary disease, particularly in light of recent recommendations on the appropriate use of this technology.

An unusual cause of stroke in an older patient.

The case of an older patient admitted with an acute stroke in the presence of atrial fibrillation is presented. Subsequent transthoracic echocardiography and advanced imaging suggested the diagnosis of a large papillary fibroelastoma on the anterior mitral valve leaflet (AML). The patient underwent surgical resection and made an excellent clinical recovery.

Proficiency test for gamma spectroscopic analysis with a simulated fission product reference spectrum.

Within the proficiency test programme for the radionuclide laboratories supporting the verification of the Comprehensive Nuclear-Test-Ban Treaty, a simulated gamma spectrum with the characteristics of an atmospheric nuclear test was used as reference material. The spectrum was produced by the MCNP-based Virtual Gamma Spectroscopy Laboratory (VGSL), using analysis results of a historical measurement of nuclear weapons debris as input. The method was found suitable for a proficiency test assessing laboratories' gamma spectroscopic analysis.

Beat-to-beat variability of left ventricular indexes measured by acoustic quantification: influence of heart rate and respiration--correlation with M-mode echocardiography.

Influence of heart rate and respiration on beat-to-beat variability of left ventricular indexes measured by acoustic quantification was examined. These indexes were correlated with their counterparts measured by M-mode echocardiography. Parameters of left ventricular performance were recorded for 1 full minute in 43 children with a mean age of 5.9 +/- 3.9 years. Beat-to-beat variability was documented. The effect of respiration on such variability was examined in another 10 subjects. A wide range of heart rates and respiration did not show significant influence on the degree of variance among these parameters. The indexes measured correlated well with their counterparts measured by M-mode echocardiography. Acoustic quantification separated those with normal from those with abnormal left ventricular function with the same statistical significance as did M-mode echocardiography. A moderate degree of beat-to-beat variability occurs in acoustic quantification-derived left ventricular indexes. Heart rate variability and respiration do not influence the beat-to-beat variance of parameters of left ventricular performance measured with the acoustic quantification. Excellent correlation was documented between this technique and M-mode echocardiography.

Phenobarbital minimally alters plasma concentrations of losartan and its active metabolite E-3174.

Losartan, a selective angiotensin II (AT1) receptor antagonist for hypertension, is metabolized to an active carboxylic acid metabolite, E-3174, which has a longer half-life. To investigate the effects of induction of cytochrome P450 on the metabolism of losartan, we evaluated the effects of phenobarbital on the plasma profiles of losartan and E-3174 in 15 healthy male subjects. Ten subjects received a single 100 mg oral dose of losartan before and during phenobarbital administration (100 mg/day for 16 days), and five subjects received losartan before and during placebo. Urinary excretion of 6-beta-hydroxycortisol (relative to 17-hydroxycorticosteroids) was measured as an endogenous marker of cytochrome P450 induction. The geometric mean area under the plasma concentration-time curve ratios (with/without phenobarbital and 90% confidence intervals) for losartan and its metabolite (E-3174) were 0.795 (0.723, 0.875) and 0.799 (0.778, 0.820), respectively, indicating that phenobarbital treatment significantly but to a clinically minor extent reduced plasma concentrations of losartan and E-3174 (p<0.01). Half-life values of losartan and E-3174 were unchanged. The ratio of 6-beta-hydroxycortisol to 17-hydroxycorticosteroids doubled in the phenobarbital group (p < 0.001) and did not change appreciably in the placebo group.

Biochemical effects of losartan, a nonpeptide angiotensin II receptor antagonist, on the renin-angiotensin-aldosterone system in hypertensive patients.

We investigated the effects of angiotensin II (Ang II) type 1 receptor blockade with losartan on the renin-angiotensin-aldosterone system in hypertensive patients (supine diastolic blood pressure, 95 to 110 mm Hg). Qualifying patients (n = 51) were allocated to placebo, 25 or 100 mg losartan, or 20 mg enalapril. Blood pressure, plasma drug concentrations, and renin-angiotensin-aldosterone system mediators were measured on 4 inpatient days: end of placebo run-in, after first dose, and 2 and 6 weeks of treatment. Plasma drug concentrations were similar after the first and last doses of losartan. At 6 weeks, 100 mg losartan and 20 mg enalapril showed comparable antihypertensive activity. Four hours after dosing, compared with the run-in day, 100 mg losartan increased plasma renin activity 1.7-fold and Ang II 2.5-fold, whereas enalapril increased plasma renin activity 2.8-fold and decreased Ang II 77%. Both drugs decreased plasma aldosterone concentration. For losartan, plasma renin activity and Ang II increases were greater at 2 than at 6 weeks. Effects of losartan were dose related. After the last dose of losartan, plasma renin activity and Ang II changes were similar to placebo changes by 36 hours. These results indicate that long-term blockade of the feedback Ang II receptor in hypertensive patients produces modest increases of plasma renin activity and Ang II that do not appear to affect the antihypertensive response to the antagonist.

Effects of losartan on blood pressure, plasma renin activity, and angiotensin II in volunteers.

Losartan is an orally active, nonpeptide angiotensin II (Ang II) (site-1) receptor antagonist. We conducted a multiple-dose study in healthy male volunteers to investigate the tolerability, blood pressure effects, and changes in plasma renin activity (PRA) and plasma Ang II concentration associated with once-daily administration of 100 mg losartan for a week. Subjects were studied on a standardized sodium diet (24-hour urinary sodium excretion, 98 +/- 37 [SD] mEq per 24 hours on the placebo run-in day). Measurements of blood pressure, heart rate, PRA, Ang II, and aldosterone were taken during a placebo run-in day and after single and multiple (7 days) daily doses of losartan (100 mg, n = 10) or placebo (n = 4). Ang II was measured specifically by high performance liquid chromatography coupled with radioimmunoassay. In subjects given losartan, respective decreases (systolic/diastolic) from run-in in supine blood pressure 6 hours after dosing were (mean +/- SD), compared with the placebo run-in day, first dose: -8.8 +/- 9.6/-6.8 +/- 5.0, last dose: -11.6 +/- 8.9/-7.0 +/- 4.8 mm Hg (p < 0.05 for all changes). At this 6-hour time point, corresponding increases from run-in in PRA were from 1.2 +/- 0.6 to 12.0 +/- 6.3 (first dose) and 9.6 +/- 4.9 (last dose) ng angiotensin I per milliliter per hour and in Ang II were from 4.3 +/- 1.7 to 72.4 +/- 33.3 and 45.7 +/- 14.1 pg/mL. All changes in PRA and Ang II were statistically significant within the losartan-treated group, and the biochemical changes were significantly greater than those in the placebo-treated group. The increment in Ang II was less after the last dose than after the first (p < 0.05). The drug was well tolerated by all subjects. These data indicate that, under the conditions of this study, losartan administration (100 mg/day for eight doses over 9 days) results in treatment-related decreases in blood pressure and increases in PRA and Ang II octapeptide.

Acute and long-term hemodynamic response to low-dose enoximone in refractory heart failure.

Enoximone possesses both positive inotropic and vasodilatory properties. In heart failure, doses varying between 3 mg/kg and 6 mg/kg produce a beneficial acute hemodynamic response but have been associated with significant side effects. Little is known about the long-term hemodynamic efficacy of this agent. To assess whether a lower dose of enoximone could produce both acute and long-term hemodynamic benefits and be better tolerated, 15 patients with refractory heart failure were given enoximone 100 mg every 8 hours (mean dose, 1.7 mg/kg). The cardiac index, pulmonary capillary wedge pressure, pulmonary artery pressure, right atrial pressure, systemic vascular resistance, pulmonary vascular resistance, and stroke volume index all improved significantly during the first 24 hours. The systemic blood pressure and heart rate did not alter appreciably during this period. Five of six patients remaining on therapy at 6 months had a follow-up hemodynamic study. Sustained improvement was seen in the cardiac index, pulmonary capillary wedge pressure, and pulmonary artery pressure when compared to baseline (all p less than 0.05). A satisfactory trend, which did not reach statistical significance, was noted in the right atrial pressure (p = 0.09) and stroke volume index (p = 0.06). Diarrhea occurred in one patient. These findings indicate that enoximone has a beneficial acute and long-term hemodynamic effect at a low dose that is clinically well tolerated.

Functional assessment of patients treated with permanent dual chamber pacing as a primary treatment for hypertrophic cardiomyopathy.

Patients with severe hypertrophic cardiomyopathy pose a difficult management problem. Between 1984 and 1986, 11 such patients have been treated by dual chamber pacing. (DDD). Subjectively all patients improved and objectively there was an increase in exercise tolerance during paced rhythm.

Immunoperoxidase staining of Legionella pneumophila.

Immunoperoxidase staining has been applied to sections of pneumonic lung from a previously published case of Legionnaires' disease. Specific staining of Legionella pneumophila was accomplished with sub-group I antiserum, which also revealed staining of phagosomes, and in some areas diffuse background staining of 'soluble' antigen. Some organisms remained unstained with the specific antiserum, and these were revealed by progressive haemalum staining. In other sections, some organisms stained specifically with anti-mu chain serum but not with anti-gamma chain serum, this result suggesting that the organisms were coated with patient's IgM specific antibody.