The differential effects of positive inotropic and vasodilator therapy on diastolic properties in patients with congestive cardiomyopathy.

Symptoms of congestive heart failure frequently reflect abnormalities in both systolic and diastolic performance. While much work has been reported regarding the mechanisms by which positive inotropic and vasodilator therapy affect systolic performance, little is known about their effect on diastolic function. In 12 patients with diffuse congestive cardiomyopathy micromanometer left ventricular and aortic pressure measurements were recorded simultaneously with two-dimensionally targeted M mode echocardiograms and thermodilution-determined cardiac output. Each patient received dopamine (2, 4, and 6 micrograms/kg/min), and dobutamine (2, 6, and 10 micrograms/kg/min), and 10 received nitroprusside (0.125 to 2.0 micrograms/kg/min). Baseline hemodynamics were characterized by low cardiac index (2.1 +/- 0.7 liter/min/m2, mean +/- SD), high left ventricular end-diastolic pressure (24 +/- 10 mm Hg), and increased end-diastolic (6.8 +/- 1.0 cm) and end-systolic dimensions (6.0 +/- 1.0 cm). All patients had abnormal left ventricular pressure decay with a prolonged time constant (67 +/- 20 msec) and reduced peak diastolic lengthening rates. Dopamine and dobutamine decreased the time constant of relaxation and increased the peak lengthening rate. Dobutamine also reduced the minimum diastolic pressure from 14 +/- 7 to 10 +/- 9 mm Hg (p less than .01); neither drug reduced end-diastolic pressure. In fact, dopamine elevated end-diastolic pressures in seven patients, despite more rapid pressure decay. Diastolic pressure-dimension relations after dopamine and dobutamine showed a leftward shift with a reduced end-systolic chamber size, but no significant changes in passive chamber stiffness. Nitroprusside decreased left ventricular minimum diastolic pressure by 4 +/- 2 mm Hg and end-diastolic pressure by 7 +/- 4 mm Hg (p less than .01). It did not consistently accelerate left ventricular pressure decay at the doses tested. The decreased end-diastolic pressure with nitroprusside was due to a reduced end-diastolic dimension in five patients. In the other patients, all of whom had elevated right atrial pressures, diastolic pressure-dimension relations showed a parallel downward shift after nitroprusside. Thus, positive inotropic therapy with beta 1-adrenoceptor agonists enhances early diastolic distensibility by accelerating relaxation, augmenting filling, and reducing end-systolic chamber size. Vasodilator therapy is much more effective in lowering diastolic pressures.(ABSTRACT TRUNCATED AT 400 WORDS)

Scintigraphic diagnosis of tricuspid regurgitation.

The authors describe a simple technique for diagnosis of tricuspid regurgitation. Red blood cells were labeled in vivo with 99mTc and 22 patients were studied with ECG-gated blood-pool imaging of the liver. A single region of interest was manually drawn around the liver and a time-activity curve obtained. The per cent change in liver counts during the cardiac cycle was found to be significantly higher in the 12 patients with tricuspid regurgitation (Group I) (mean, 4.04 +/- 1.6%; range, 1.3-21.4%) compared with the 10 controls (Group II) (mean, 0.35 +/- 0.16%; range, 0.013-1.3%) (p less than 0.05). Using a 1% change in liver counts as the criterion of a positive study, all 12 cases in Group I were diagnosed correctly, but there was one false positive in Group II; thus the sensitivity was 100% and the specificity 90%.

Effects of creep feeding and monensin on reproductive performance and lactation of beef heifers.

A 23 factorial arrangement of treatments was utilized to determine the effect of breed, creep feeding and monensin on subsequent reproductive performance and lactation of 32 primiparous heifers. One-half of each breed (Angus and Hereford) group had access to creep feed (2.67 Mcal metabolizable energy/kg) while nursing their dams. Approximately 40 d before breeding through 120 d of lactation, all heifers were fed a suboptimal energy diet and 50% of each breed and creep group received 200 mg monensin/head daily. Estrus was synchronized with a progestogen. Volatile fatty acids (VFA) were determined periodically throughout the monensin-feeding portion of the experiment. Twenty-four hour milk production, percentage butterfat and percentage solids-not-fat were determined at 60 and 120 d postpartum. Weaning weights (adjusted to 205 d and for age of dam) of the original heifers were heavier (P less than .05) for those that were creep fed compared with those not creep fed (219 vs 202 kg). Monensin-supplemented females gained significantly more weight from the initiation of treatment to immediately postcalving and gave birth to heavier calves (P less than .05) even though they received comparable amounts of dietary energy as those that did not receive monensin. The energy stressed, monensin-supplemented first-calf heifers exhibited a shorter postpartum interval (P less than .05) to first estrus than did those that did not receive monensin (55.7 vs 69.1 d, respectively). First-calf heifers that had been creep fed while nursing their dams had a lower (P less than .05) daily milk yield at 120 d post-partum than those that did not have access to creep feed. No detrimental effects were observed due to long-term monensin supplementation.

Effects of energy level and monensin on reproductive performance and lactation of beef cows.

This experiment consisted of a 2 year drylot study involving 80 multiparous, suckled beef cows (40 Angus and 40 Herefords). Experimental treatments (breed, monensin and year) were arranged in 2(3) factorial to evaluate the effect of breed and monensin on reproductive performance and lactation. Cows received 85% of the NRC total digestible nutrient (TDN) requirement for the first 56 days of the 140 day trial. Cows were synchronized with Synchro-Mate B and artificially inseminated 30 days into each trial with blood samples collected for luteinizing hormone (LH) analysis from one-half of each treatment group from 24 to 36 hours after implant removal. Progesterone determinations were made on plasma samples collected at day 9 and 16 after implant removal. On day 56, milk yield estimates were obtained by the weigh-suckle-weight technique. Following these collections, energy levels were increased by allowing ad lib consumption of forage. Calves, which were removed from the cows during feeding, were given access to a 75% TDN creep ration after day 56. Milk estimates were again evaluated at 140 days. Monensin supplementation did not result in a difference in cow weight change through the restricted energy period (first 56 days) or throughout the entire 140 day period. Milk yield estimates at 56 and 140 days and calf gains throught the trial, were unaffected by monensin supplementation. Monensin resulted in no effect on conception rate or services per conception. The time of the LH peak was shifted slightly forward by monensin although not significantly. Progesterone levels were not consistently affected by monensin supplementation.