Beta-blocker titration failure is independent of severity of heart failure.

In the present study, predictors of complicated initiation of beta blockade in patients with idiopathic dilated cardiomyopathy was studied. We found that generally accepted measures of severity of heart failure are not predictable, whereas low systolic blood pressure (< or =120 mm Hg) was the strongest predictor for problematic (up)titration.

Categorization of abnormal left ventricular function: comparison between radionuclide angiographic and echocardiographic technique in postinfarction patients.

In postinfarction patients, only biplane echocardiographic evaluation of left ventricular ejection fraction (EF) accurately predicts radionuclide EF > or <0.35, 0.40, and 0.45. A wall motion scoring system that does not account for hyperkinesia of healthy myocardium may be used to discriminate between radionuclide EF > or <0.40 or 0.45, but lacks accuracy for 0.35.

Biplane transesophageal color-flow Doppler imaging in assessing severity of mitral regurgitation: influence of hemodynamic circumstances and mechanism of regurgitation.

OBJECTIVE: To determine the value of biplane transesophageal echocardiography in the assessment of severity of mitral regurgitation compared with left ventricular angiography. DESIGN: Prospective study of consecutive patients. SETTING: Two university hospitals, one community hospital. PARTICIPANTS: Thirty-seven patients with angiographically proven mitral regurgitation. INTERVENTION: Transthoracic and biplane transesophageal echocardiography. In 19 patients, transesophageal echocardiography was performed during general anesthesia. MEASUREMENTS AND MAIN RESULTS: The largest mitral regurgitation jet area and longest jet as obtained with Doppler color-flow mapping from transthoracic and biplane transesophageal echocardiography and pulsed-Doppler pulmonary venous flow characteristics. Sensitivity and 100-minus-specificity were plotted to constitute receiver operating characteristics (ROC) curves. Areas under ROC curve for transverse, longitudinal, and biplane jet area were 0.77, 0.75, and 0.81, and for jet length, 0.82, 0.84, and 0.88, respectively; this was for biplane jet area in conscious patients; 0.99 compared with 0.72 in anesthetized patients (p < 0.05). CONCLUSIONS: Biplane measurements identified severe mitral regurgitation slightly more reliably than the transverse or longitudinal measurements alone. In conscious patients, jet area was an excellent test for estimating severity of mitral regurgitation. In anesthetized patients, a combination of biplane jet area and length and of systolic pulmonary venous flow reversal accurately predicted angiographic severity of mitral regurgitation. In anesthetized patients, the optimal cut-off value for jet area to distinguish between moderate and severe mitral regurgitation was lower than in conscious patients. In the total population, regardless of hemodynamic and technical variations, a combination of biplane jet area and length and of systolic pulmonary venous flow reversal accurately predicted the severity of mitral regurgitation.

Induction of dormancy during seed development by endogenous abscisic acid: studies on abscisic acid deficient genotypes of Arabidopsis thaliana (L.) Heynh.

Mutant lines of Arabidopsis thaliana (L.) Heynh., which are characterized by symptoms of withering and the absence of seed dormancy, showed much lower levels of endogenous abscisic acid (ABA) in developing seeds and fruits (siliquae) than the wild type. Reciprocal crosses of wild type and ABA-deficient mutants showed a dual origin of ABA in developing seeds. The genotype of the mother plant regulated a sharp rise in ABA content half-way seed development (maternal ABA). The genotype of the embryo and endosperm was responsible for a second ABA fraction (embryonic ABA), which reached much lower levels, but persisted for some time after the maximum in maternal ABA. The onset of dormancy correlated well with the presence of the embryonic ABA fraction and not with the maternal ABA. Dormancy developed in both the absence and presence of maternal ABA in the seeds. In this respect maternal ABA resembled exogenously applied ABA which did not induce dormancy in ABA-deficient seeds. However, both maternal and applied ABA stimulated the formation of a mucilage layer around the testa, which could be observed during imbibition of the mature seeds. In the mature state, ABA-deficient seeds germinated in the siliquae on the plant, but only when the atmosphere surrounding the plant was kept at high relative humidity. In younger stages germination in siliquae occurred after isolation from the plants and incubation on wet filter paper. Therefore, it seems that limited access to water is the primary trigger for the developmental arrest in these seeds.