Perioperative Myocardial Infarction in Non-Cardiac Surgery Patients: A Prospective Observational Study.

BACKGROUND AND AIMS: Perioperative myocardial infarction is an underdiagnosed complication causing morbidity, mortality, and considerable costs. However, evidence of preventive and therapeutic options is scarce. We investigated the incidence and outcome of perioperative myocardial infarction in non-cardiac surgery patients in order to define a target population for future interventional trials. MATERIAL AND METHODS: We conducted a prospective single-center study on non-cardiac surgery patients aged 50 years or older. High-sensitivity troponin T and electrocardiograph were obtained five times perioperatively. Perioperative myocardial infarction diagnosis required a significant troponin T release and an ischemic sign or symptom. Perioperative risk calculator was used for risk assessment. RESULTS: Of 385 patients with systematic ischemia screening, 27 patients (7.0%) had perioperative myocardial infarction. The incidence was highest in vascular surgery-19 of 172 patients (11.0%). The 90-day mortality was 29.6% in patients with perioperative myocardial infarction and 5.6% in non-perioperative myocardial infarction patients ( p < 0.001). Perioperative risk calculator predicted perioperative myocardial infarction with an area under curve of 0.73 (95% confidence interval: 0.64-0.81). CONCLUSION: Perioperative myocardial infarction is a common complication associated with a 90-day mortality of 30%. The ability of the perioperative risk calculator to predict perioperative myocardial infarction was fair supporting its routine use.

Fertility of sows fed ad libitum with a high fibre diet during pregnancy.

The effect of ad libitum (ADLIB) feeding strategy on the fertility of the group housed sow was studied in a prospective field trial during 1.5 years. All study animals farrowed under standard farrowing circumstances in crates, and they were provided with an ad libitum feeding throughout the 30-day lactation. After weaning, animals were randomly allocated to one of the two dry sow feeding strategies (AD LIB or CONT). After oestrus detection in groups, they were artificially inseminated and moved into pregnancy pens with partially slatted floor, in groups of 40 sows each. The ADLIB sows (n = 447) were loose housed and provided with ad libitum access to 7.7 MJ/kg feed high in fibre from two feeders per group. The control sows (n = 479; CONT) were also loose housed and given a standard dry sow feed in feeding stalls once a day (2.5 kg/day. The energy content of the feed was 9.3 MJ/kg NE). The feeding strategy (ADLIB vs CONT) had no effect on pregnancy rate (85.8 vs 90.9, p > 0.05), weaning to oestrus interval (7.7 vs 7.3 days, p > 0.05), piglets born alive (11.5 ± 3.5 vs 11.6 ± 3.3, p > 0.05), stillborn piglets (1.2 ± 1.8 vs 0.9 ± 1.5, p > 0.05) nor on progesterone concentration (p > 0.05). CONT sows weaned more piglets (9.7 ± 2.2 vs 9.4 ± 2.0, p < 0.01), whereas the piglets of AD LIB sows were heavier at weaning (8.8 ± 0.9 vs 8.0 ± 1.3 kg, p < 0.05). In conclusion, ad libitum feeding with a high in fibre diet during pregnancy did not affect the reproductive performance.

Vulvar discharge syndrome in loosely housed Finnish pigs: prevalence and evaluation of vaginoscopy, bacteriology and cytology.

A total of 21 sow herds were randomly chosen to determine the prevalence of vulvar discharge syndrome (VDS) in loosely housed sows. The median VDS prevalence was low as expected, 0% (range 0-4.5%). Nine of the 655 animals examined (1.4%, 95% CI 0.5-2.3) displayed signs of VDS in 21 non-problem herds. In addition, five VDS problem farms were visited to gather more animals affected with the syndrome in order to estimate which methods of examination are useful. Altogether, 19 VDS animals and 19 healthy controls were found, inspected and sampled. Ten of the VDS animals (53%) and three of the controls (16%) were positive in bacterial culture (p = 0.04) taken with a guarded swab from the anterior vagina. In addition, 94% of VDS animals had a positive vaginoscopic examination result and the corresponding figure in the control sows was 28% (p < 0.0002). Cytological smears were classified as positive in 37% of the case sows and in 5% of the control sows (p = 0.04). Detection of vulvar discharge was associated with vaginoscopic examination findings (p = 0.0005) and with bacteriology (p = 0.04), but not with leucocyte counts (p = 0.07). Susceptibility testing was performed on pure bacterial cultures. Totally, 7 (44%) of 16 isolates were considered to be resistant or showed intermediate susceptibility to at least one of the antimicrobial agents tested (sulpha-trimethoprim and ampicillin). In conclusion, we found vaginoscopy and bacteriology as valid tools in diagnosis of VDS and susceptibility testing of antimicrobial treatments was found to be indicated.

Photoperiod and luteinizing hormone secretion in domestic and wild pigs.

During seasonal anoestrus (long-days), oestradiol can effectively inhibit the pulsatile secretion of luteinizing hormone (LH) in sheep. The aim of our trial was to determine whether the same regulatory mechanism exists in the pig. Altogether, 20 ovariectomized and oestradiol-implanted gilts (16 domestic pigs, 4 European wild boars) were randomly allocated to two treatment groups. The first group was kept under a short-day light-dark cycle of 8L:16D, and the second group under a long-day light regime of 16L:8D. After a 6-week treatment period, blood samples were taken at 20-min intervals for 12h. After sampling, the light regimens were switched. Sampling was then repeated following another 6 weeks of treatment. In both treatment groups, 2.3 LH pulses occurred every 12h. The basal LH level was 0.7+/-0.4 ng/ml for the short-day group and 1.0+/-0.5 ng/ml for the long-day group. The mean LH level was 0.9+/-0.4 and 1.3+/-0.6 ng/ml and the LH pulse amplitude 0.5+/-0.4 and 0.6+/-0.5 ng/ml, respectively. The basal and mean LH levels were therefore lower in short-day gilts (P<0.05), while LH pulse amplitude and frequency remained unaffected by treatment. In conclusion, the 6-week period under two different light regimes resulted in higher basal LH concentration in long-day gilts but was not able to produce changes in LH frequency in prepubertal gilts.

Lameness and fertility of sows and gilts in randomly selected loose-housed herds in Finland.

The prevalence of lameness among 646 sows and gilts in 21 selected herds was determined; 8.8 per cent of the animals were lame and the most common clinical diagnoses were osteochondrosis, infected skin lesions and claw lesions. The lame animals had higher serum concentrations of haptoglobin and C-reactive protein than the sound animals. Animals housed on slatted floors had twice the odds of being lame and 3.7 times the odds of being severely lame than animals housed on solid floors. Yorkshire pigs had 2.7 times the odds of being lame than Landrace or crossbred animals. Higher parity and the use of roughage decreased the odds of the sows not becoming pregnant; however, lameness was not a risk factor for non-pregnancy.

Seasonality of reproduction in gilts and sows.

In the wild, the pig adapts her reproductive functions according to the seasonal changes in the environment, such as the ambient temperature and availability of food. Like in other short day seasonal breeders, breeding season is favoured in the mid winter in order to provide the offspring with the best chances to survive four months later. Seasonal changes in environment are perceived mainly by the ability of the pig to recognise seasonal changes in photoperiod. This information is mediated through changes in the activity of the pineal gland to secret melatonin, essentially by the same mechanism as reported for other mammals. Stimulation of melatonin receptors located in the hypothalamus has a significant role for the release of GnRH and subsequent gonadotrophin release from the pituitary. Management and nutrition related factors determine the degree of seasonal effects on reproduction in the commercial piggery environment. Significant improvements in fertility in herds suffering from seasonal infertility are achievable by providing gilts and sows with abundant feed after mating. Attempts to alleviate the seasonal effects on fertility by applying light programs are underway and may lead to significant improvements in productivity of the domestic pig in the long run. Hormonal treatments may be somewhat effective, but not a sustainable solution to seasonal infertility. In conclusion, seasonal infertility is a photoperiod induced phenomenon that can be manipulated by changes in photoperiod and by accounting for season as a significant factor when feeding strategies are applied in commercial piggeries.

Parvovirus antibodies in vaccinated gilts in field conditions--results with HI and ELISA tests.

This study was conducted to determine the antibody response for porcine parvovirus (PPV) of 39 gilts in field conditions after vaccination. Gilts from four herds endemically infected with PPV were injected twice with a commercial vaccine of inactivated PPV and Erysipelothrix rhusiopathiae. The PPV antibodies were analysed both with haemagglutination inhibition (HI) and enzyme-linked immunosorbent assay (ELISA) in order to study the agreement between these methods. The possible association between high-antibody titres and reproductive failure (repeat breeding, culling for infertility, < or = 6 piglets born alive) was also investigated. In these study herds, endemically infected by PPV, most gilts (84.6%) had not seroconverted by the age of 6 months. On-field vaccination resulted in a consistent increase of humoral immunity not exceeding the antibody level of 1 : 512 in the majority of gilts in all herds examined. The agreement between ELISA and HI tests was moderate (Spearman's rho = 0.87, kappa = 0.63). The seroconversion over the level >1:512 by mid-pregnancy was not associated with reproductive failure.

Effect of feeding level on progesterone concentration in early pregnant multiparous sows.

The effect of three feeding regimens on progesterone level was tested during early pregnancy in multiparous sows. A total of eighteen sows in their eighth parity (8.1 +/- 2.8, mean +/- S.D.) were used. During lactation the sows were fed to appetite and after weaning they received 4 kg (52 MJ) a commercial feed per day. Following ovulation, sows were allocated to one of three treatment groups and fed 2 kg/day (low feeding, LLL) or 4 kg/day (high feeding, HHH) throughout the trial or 2 kg/day for 11 days, 4 kg/day for 10 days, and 2 kg/day for the remaining days of the study (modified feeding, LHL). Blood for progesterone and cortisol analyses was collected daily throughout the study, and for luteinizing hormone (LH) assay for 12 h at 15 min intervals on days 14 and 21 of pregnancy. An adrenocorticotropic hormone (ACTH) challenge test was performed on all sows day 28 of pregnancy. Dietary treatment did not significantly affect hormonal parameters. However, progesterone concentration tended to be lower (P = 0.08) in the HHH group than in the LLL group. In the LHL group venous progesterone concentration seemed to fluctuate. No effects of feeding were observed on progesterone concentration in allantoic fluid on day 35 of pregnancy. Venous cortisol level was significantly higher (P < 0.05) during proestrus and oestrus in all groups and there was no significant difference between groups in response to ACTH challenge. The mean amplitude of LH pulses decreased significantly (P < 0.01) from days 14 to 21 of pregnancy in all groups. In addition, an interaction was found between feeding level and baseline LH concentration and also between feeding level and mean LH concentration. Embryonic recovery was highest in the LLL (69%), lowest in the HHH (45%) and moderate in the LHL (55%) group. Neither high feeding nor modified feeding provided any benefits for reproductive performance in multiparous sows. A low feeding regimen thus appears optimal for multiparous sows in early pregnancy at least with the management regime described.

Investigation of a simplified artificial lighting programme to improve the fertility of sows in commercial piggeries.

Two artificial lighting regimens were studied in a commercial unit of 800 sows. The aim was to develop a simplified lighting regimen to overdrive the effects of season on reproduction. A long-day group had a constant 16 hours light and eight hours dark photoperiod in all units during a production cycle. A short-day group had eight hours of light and 16 hours darkness in a farrowing unit for four weeks and in a mating unit for four weeks. After one month of pregnancy the short-day group was transferred to 16 hours light and eight hours dark for the rest of the dry-sow period. Production data were collected for eight months, and the farrowing rate, weaning to oestrus interval, culling rate for fertility problems and the number of live-born piglets were analysed. Seasonal infertility, which had previously affected the herd, was not detected in either group during the follow-up period. The farrowing rate was 90 per cent for both groups. The median weaning to oestrus interval was five days in both lighting regimens with ranges from four to 74 days in the short-day group and three to 55 days in the long-day group. The long-day programme had a positive effect on the weaning to oestrus interval. When the sows were classified as either "normal", with a weaning to oestrus interval of up to 10 days, or "problem" animals, with a weaning to oestrus interval of over 10 days, the short-day programme also had a positive effect. The culling rate for fertility problems was 2.4 per cent for the short-day group and 3.2 per cent for the long-day group (P=0.027). The only significant predictor for the number of live-born piglets was parity (P=0.027).

Night-time melatonin secretion and seasonally delayed puberty in gilts.

This study was conducted to determine whether the seasonal delay in puberty in autumn is driven by individual differences in night-time melatonin secretion in domestic gilts at the attainment of puberty. A group of spring-born gilts (n = 30) were expected to reach puberty in autumn by the age of 7 months. Eighteen of these gilts were selected in pairs on the basis of matched days of birth. By the expected time, half of the animals showed oestrous symptoms (group CYCLING, n = 9) with the rest remaining silent (group SILENT, n = 9). Afterwards, all gilts were fitted with indwelling jugular catheters for frequent blood sampling. Blood samples were collected from all animals three times during the day followed by three times in the night at 2-h intervals for 48 h. The samples were analysed by a commercial radioimmunoassay (RIA). The results show a consistent 25-fold rise (on average) in night-time melatonin concentration in every animal sampled with group averages ranging from 0.28 +/- 0.04 to 0.37 +/- 0.06 pg/ml at day and from 10.20 +/- 2.16 to 10.67 +/- 0.05 pg/ml at night. Night-time group mean values between CYCLING and SILENT gilts did not differ significantly (10.26 +/- 0.67 and 10.38 +/- 0.94 for the CYCLING; 10.67 +/- 0.05 and 10.20 +/- 2.16 for the SILENT). When 10 pg/ml was used as a threshold value, six individuals did not reach it during the night (low responders). Two of these gilts were CYCLING and four were SILENT. In conclusion, the results presented imply no involvement of the level of night-time melatonin concentration in the seasonal delay of puberty in gilts.

Changes in feeding level during early pregnancy affect fertility in gilts.

Modified feeding combining the benefits of restricted feeding after ovulation and abundant feeding during implantation in autumn was tested. Three groups of eight gilts were housed with individual feeding stalls and fed 40 MJ per day of a commercial ration. Following insemination gilts were fed 27 MJ per day (LLL) or 54 MJ per day (HHH) for 34 days or 27 MJ per day for 10 days, 54 MJ per day for 7 days followed by 27 MJ per day until day 34 (LHL). Blood for progesterone analysis was collected daily during the week of ovulation and then twice a week until the end of the study. For LH assay, blood was collected from five gilts from each group at 15 min interval for 10 h on the day 15 of pregnancy. Gilts were weighed three times at intervals of 4 weeks. The effect of dietary treatment was significant (P<0.05) on body weight gain from days 0 to 30 of pregnancy, 1201, 287 and 438 g per day for groups HHH, LLL and LHL respectively. The pregnancy rate at day 34 was significantly higher (P<0.005) in HHH-group (100%) compared with LLL (25%) and LHL (38%) although HHH group had significantly lower (P<0.05) progesterone concentration on days 9 and 12. The basal LH level was significantly higher (P<0.01) in HHH group compared to LHL group (mean +/- S.D.) (0.98 +/- 0.22 and 0.60 +/- 0.08, respectively). Gilts in HHH group had a significantly higher mean LH concentration (1.18 +/- 0.24) than those in group LHL (0.7 +/- 0.07) (P<0.05), but not in group LLL (0.93 +/- 0.15) (P=0.09). There was a tendency (P=0.058) for amplitude to be higher for gilts in HHH group. The LHL feeding strategy did not provide the benefits anticipated. Instead, it was the HHH feeding strategy that provided a distinct advantage in pregnancy rate. The mechanism mediating supportive effect of high feeding level on the maintenance of early pregnancy is yet to be determined.

Effect of a gonadotrophin-releasing hormone antagonist on luteinising hormone secretion and early pregnancy in gilts.

The aims of the present study were: (1) to determine the duration of suppression of luteinising hormone (LH) following a single treatment with a gonadotrophin-releasing hormone (GnRH) antagonist (BIM-21009; Biomeasure) at a dose of 100 microg kg(-1); (2) to block LH pulses only for certain days of pregnancy; and (3) to determine the period of early pregnancy most susceptible to suppression of LH. Three groups of gilts were injected with 100 microg kg(-1) on Day 16 (n = 5), 14 (n = 6) or 19 (n = 4) of pregnancy. Blood for LH analysis was collected at 20-min intervals for 12 h on the day before treatment and during varying stages of early pregnancy. Blood for progesterone analysis was collected daily and development of pregnancy was followed using real-time ultrasound. Prior to treatment, gilts had 2.6 +/- 0.7 LH pulses per 12 h. The GnRH antagonist abolished LH pulses for a period of 2.7 +/- 1.8 days and, thereafter, suppressed the resumed LH pulses (P < 0.05). Pregnancy was disrupted in three pigs (20%) with a mean treatment-to-abortion period of 4.7 days concurrent with a mean treatment-to-progesterone decline interval of 4.3 days. In a proportion of pigs, short-term LH suppression may cause early disruption of pregnancy.

Early disruption of pregnancy as a manifestation of seasonal infertility in pigs.

All gilts and sows in production from which the detailed production information was available in a 160-sow unit were included to the study. In winter-spring, there were complete data available from 47 animals and in summer-autumn from 64 animals. The farm had a consistent history of the seasonally reduced farrowing rate in summer-autumn. Success of inseminations was monitored during a 4-month breeding period in winter-spring and in summer-autumn. Each animal was bled twice a week for 6 weeks starting a day before insemination and the blood samples were assayed to determine serum progesterone concentration. The blood samples were also assayed for cortisol to detect any acute infectious response. Starting on day 18, animals were pregnancy tested by transcutaneous real time ultrasound twice a week. In winter-spring, the farrowing rate was 72% (58 inseminations, 1.2 inseminations/sow) and in summer-autumn 63% (81 inseminations, 1.3 inseminations/sow). In winter-spring, there was only one detected case of early disruption of pregnancy (EDP), whereas nine such cases were recognised in summer-autumn. Five out of those nine animals returned to oestrus with a mean insemination to oestrus interval of 25.8+/-1.6 days. One sow returned to oestrus 35 days after insemination and three sows did not return to oestrus within 45 days. However, two of these sows had progesterone profiles that indicated an undetected oestrus around day 25. In those nine animals, no acute phase infectious response as indicated by a rise in serum cortisol was evident. Serum progesterone concentrations in the animals eventually loosing the pregnancy tended to be lower on day 13 (no significant difference) and were significantly lower on day 20 when compared with animals remaining pregnant. There was no difference in serum progesterone levels of pregnant animals between winter-spring and summer-autumn. Litter size was not affected by the season. The weaning to oestrus interval tended to be longer in summer-autumn. This study showed that the seasonally decreased farrowing rate is partly caused by EDP. The lowered progesterone concentrations in summer-autumn were demonstrable only in "problem animals".

Regional eradication of Mycoplasma hyopneumoniae from pig herds and documentation of freedom of the disease.

The objectives of this study were to 1) screen all sow herds in a region for M. hyopneumoniae, 2) to effectuate an eradication programme in all those herds which were shown to be infected with M. hyopneumoniae, and 3) to follow the success of the screening and the eradication programmes. The ultimate goal was to eradicate M. hyopneumoniae from all member herds of a cooperative slaughterhouse (153 farrowing herds + 85 farrowing-to-finishing herds + 150 specialised finishing herds) before year 2000. During 1998 and 1999, a total of 5067 colostral whey and 755 serum samples (mean, 25 samples/herd) were collected from sow herds and analysed for antibodies to M. hyopneumoniae by ELISA. Antibodies were detected in 208 (3.6%) samples. Two farrowing herds (1.3%) and 20 farrowing-to-finishing herds (23.5%) were shown to be infected with M. hyopneumoniae. A programme to eradicate the infection from these herds was undertaken. During March 2000, a survey was made to prove the success of the screening and the eradication programmes. In total, 509 serum samples were collected randomly from slaughtered finishing pigs. Antibodies to M. hyopneumoniae were not detected in 506 of the samples, whereas 3 samples were considered suspicious or positive. Accordingly, 3 herds were shown to be infected. One of the herds was previously falsely classified as non-infected. Two of the herds were finishing herds practising continuous flow system (CF). Unlike finishing herds which practice all-in/all-out management routines on herd level, CF herds do not get rid of transmissible diseases spontaneously between batches, for which reason a screening was made in the rest of the CF herds (total n = 7). Consequently, 2 more infected herds were detected. In addition to the results of the survey, a decreasing prevalence of lung lesions at slaughter (from 5.2% to 0.1%) and lack of clinical breakdowns indicated that all member herds were finally free from M. hyopneumoniae in the end of year 2000.

Baroreflex sensitivity and variants of the renin angiotensin system genes.

OBJECTIVES: Because the renin-angiotensin-aldosterone system (RAS) modifies cardiovascular autonomic regulation, we studied the possible associations between baroreflex sensitivity (BRS) and polymorphism in the RAS genes. BACKGROUND: Wide intersubject variability in BRS is not well explained by cardiovascular risk factors or life style, suggesting a genetic component responsible for the variation of BRS. METHODS: Baroreflex sensitivity as measured from the overshoot phase of the Valsalva maneuver and genetic polymorphisms were examined in a random sample of 161 women and 154 men aged 41 to 61 years and then in an independent random cohort of 29 men and 37 women aged 36 to 37 years. An insertion/deletion (I/D) polymorphism of angiotensin-converting enzyme (ACE), M235T variants of angiotensinogen (AGT) and two diallelic polymorphisms in the gene encoding aldosterone synthase (CYP11B2), one in the promoter (-344C/T) and the other in the second intron, were identified by polymerase chain reaction. RESULTS: In the older population, BRS differed significantly across CYP11B2 genotype groups in women (10.1 +/- 4.5, 8.7 +/- 3.8 and 7.1 +/- 3.2 ms x mm Hg(-1) in genotypes -344TT, CT and CC, respectively, p = 0.003 and 11.1 +/- 4.4, 8.9 +/- 4.1 and 7.5 +/- 3.4 ms x mm Hg(-1) in intron 2 genotypes 1/1, 1/2 and 2/2, respectively, p = 0.002), but not in men. No comparable associations were found for BRS with the I/D polymorphism of ACE or the M235T variant of AGT. In the younger population, BRS was even more strongly related to the CYP11B2 promoter genotype (p = 0.0003). The association was statistically significant both in men (p = 0.015) and in women (p = 0.03). CONCLUSIONS: Common genetic polymorphisms in the aldosterone synthase (CYP11B2) gene is associated with interindividual variation in BRS.

Associations between human aldosterone synthase (CYP11B2) gene polymorphisms and left ventricular size, mass, and function.

BACKGROUND: Aldosterone has direct and indirect effects on the heart, and genetic variations in aldosterone synthesis could therefore influence cardiac structure and function. Such variations might be associated with polymorphisms in the gene encoding aldosterone synthase (CYP11B2), the enzyme catalyzing the last steps of aldosterone biosynthesis. METHODS AND RESULTS: A Finnish population sample of 84 persons (44 women) aged 36 to 37 years was studied by M-mode and Doppler echocardiography to assess left ventricular size, mass, and function. Subjects were genotyped through the use of the polymerase chain reaction for two diallelic polymorphisms in CYP11B2: one in the transcriptional regulatory region (promoter) and the other in the second intron. In multiple regression analyses, the CYP11B2 promoter genotype predicted statistically significant variations in left ventricular end-diastolic diameter (beta=.40, P<.0001), end-systolic diameter (beta=.33, P=.0009), and mass (beta=.17, P=.023). These effects were independent of potentially confounding factors, including sex, body size, blood pressure, physical activity, smoking, and ethanol consumption. Genotype groups also differed in a measure of left ventricular diastolic function, the heart rate-adjusted atrial filling fraction (P=.018). Increased dietary salt, which is known to predict increased left ventricular mass, had this effect only in association with certain CYP11B2 genotypes (P<.001). CONCLUSIONS: Genetic variations in or near the aldosterone synthase (CYP11B2) gene strongly affect left ventricular size and mass in young adults free of clinical heart disease. These polymorphisms may also influence the response of the left ventricle to increases in dietary salt.

Evolution of heart rate variability in cardiac transplant recipients: a clinical study.

OBJECTIVES: To investigate in cardiac transplant patients whether post-transplantation time, graft arteriosclerosis, allograft rejection, or earlier cytomegalovirus infection affect the neural regulatory mechanisms of the donor heart. DESIGN: A consecutive series of heart transplant patients during a 12-month period. SETTING: A university hospital in Finland. SUBJECTS: Consecutive cardiac transplant recipients (n = 38) attending the hospital for their annual clinical examination were studied. Their mean (SD) age was 45.4 (11.5) years, 37 were male, and the median (range) time since transplantation was 36 (12-72) months. INTERVENTIONS: Power spectral analysis of R-R intervals (during 5 min of controlled breathing, the Valsalva manoeuvre, and deep breathing), routine coronary arteriography, cytomegalovirus serology. RESULTS: R-R interval (r = 0.67; P < 0.001), the root mean square difference of successive R-R intervals (r = 0.38; P < 0.05), the total R-R interval power (r = 0.45; P < 0.01), the power of the very low frequency (0.0-0.07 Hz) component (r = 0.53; P < 0.01), and the power of the nonrespiratory (0.0-0.15 Hz) component (r = 0.49; P < 0.01) were related to the length of time since the operation. Patients having had a transplantation 3 years ago or more had significantly greater median (range) total R-R interval power than those having had the operation less than 3 years ago (59 [10-265] vs. 20 [3-113] ms2; P = 0.02). There was also a difference between the two groups in the very low frequency component (18 [1-226] vs. 5 [0-45] ms2; P = 0.01), in the nonrespiratory component (30[1-227] vs. 9 [0-53]ms2; P = 0.02), and in the Valsalva ratio (0.995 [0.955-1.065] vs. 1.020 [0.975-1.155]; P = 0.03). Patients with and without graft arteriosclerosis, episodes of rejection, or earlier cytomegalovirus infection showed no difference in the power spectral measures. CONCLUSIONS: The donor heart rate variability increases with post-transplantation time. Heart rate variability in transplant recipients is not related to the extent of graft arteriosclerosis, episodes of allograft rejection, or earlier cytomegalovirus infection.

Influence of negative intrathoracic pressure on right atrial and systemic venous dynamics.

To investigate the effect of a sustained fall in intrathoracic pressure (Mueller manoeuvre) on blood flow through the right heart and on systemic venous dynamics, 16 patients were studied using thermodilution, cinevenograms and simultaneous pressure recordings with two micromanometric transducers. The reductions in airway pressure (median [range]) during two graded Mueller manoeuvres were 25 (20-30) and 42 (22-52) mmHg. Right atrial mean pressure decreased by 17 (2-25) mmHg during the former and 38 (0-49) mmHg during the latter, and simultaneously, pressure gradients of 23 (1-32) and 45 (1-82) mmHg developed between the inferior vena cava and right atrium (P < 0.003 for all). Internal jugular venous pressure decreased by 16 (4-25) and 24 (4-43) mmHg (P < 0.03 for both), respectively, and no pressure gradient developed between internal jugular and superior caval veins. The minimum diameter of the proximal inferior vena cava decreased by 69 (-49-84)% (P = 0.002) during the greater manoeuvre. Cardiac index tended to increase by 26 (-17-40)% (P < 0.066) during the lesser manoeuvre but did not change statistically significantly during the greater. In conclusion, during negative intrathoracic pressure caused acutely by the Mueller manoeuvre, right atrial pressure decreases and the inferior vena cava collapses partially at or below the diaphragm. Despite a significant venous obstruction between the lower body and right atrium, blood flow through the right heart increases or remains constant.

Heart rate and blood pressure variability and baroreflex sensitivity in hypercholesterolaemia.

To evaluate cardiovascular autonomic function in hypercholesterolaemia, we studied 16 age-matched pairs of healthy males with elevated serum cholesterol and normocholesterolaemic control subjects (altogether 37 men, aged 27-56 years). We used power spectral analysis to measure short-term heart rate and blood pressure variability, and the phenylephrine method to determine baroreceptor reflex sensitivity. The mean (SD) serum cholesterol concentration was 6.43 (1.22) among the hypercholesterolaemic subjects and 4.30 (0.44) mmol/l among the control men (P < 0.001). The respective low density lipoprotein (LDL) cholesterol concentrations were 4.44 (1.22) and 2.46 (0.38) mmol/l (P < 0.001). The total power (0.0-0.5 Hz) of heart rate and blood pressure variability did not differ between the groups, and neither did the high-frequency (0.15-0.5 Hz) and medium-frequency components (0.07-0.15 Hz). Mean (SD) baroreceptor reflex sensitivity was 18.1 (7.9) in hypercholesterolaemic and 19.4 (6.3) ms mmHg-1 in normocholesterolaemic subjects (P = 0.352). when all the subjects were analysed together, we observed a slight inverse trend between serum LDL cholesterol and baroreceptor reflex sensitivity (r = -0.235, P = 0.161). In conclusion, hypercholesterolaemia does not alter autonomic neural regulation of the cardiovascular system as assessed heart rate and blood pressure variability and baroreflex sensitivity.

Effect of negative intrathoracic pressure on left ventricular pressure dynamics and relaxation.

To investigate the effect of a fall of intrathoracic pressure on left ventricular (LV) hemodynamics and relaxation, simultaneous micromanometric recordings of LV and aortic pressures were performed at rest and during two graded Mueller maneuvers in 16 patients undergoing cardiac catheterization for aortic valve stenosis (n = 8) or chest pain (n = 8). The reductions (means +/- SE) of airway pressure during the lesser and greater maneuvers were 26 +/- 1 and 42 +/- 1 mmHg, respectively. Simultaneously, LV isovolumic-developed pressure increased by 9 +/- 3 and 21 +/- 4 mmHg, respectively (P < 0.03 for both). During the greater maneuver, the individual changes of the time constant of LV isovolumic relaxation (tau) correlated with the changes of LV isovolumic-developed pressure (r = 0.73; P = 0.002). In patients with a > 20-mmHg rise in isovolumic-developed pressure, tau increased by 10.3 +/- 4.6 ms. By multiple-regression analysis, the change of tau was related directly to the change of isovolumic-developed pressure (standardized coefficient beta = 0.80; P = 0.001) and inversely related to the resting systolic LV-aortic pressure gradient (beta = -0.37; P = 0.050). The other hemodynamic changes were independent of aortic valve stenosis. In conclusion, during the Mueller maneuver, the LV isovolumic contraction load increases and tau lengthens, particularly with higher elevations of LV systolic load.