Effect of surgical reduction of left ventricular outflow obstruction on hemodynamics, coronary flow, and myocardial metabolism in hypertrophic cardiomyopathy.

Abstract:

:To assess the impact of operative reduction of left ventricular outflow obstruction in hypertrophic cardiomyopathy, measurements of great cardiac vein flow, oxygen and lactate content, left ventricular pressures, and cardiac index were measured at rest and during pacing stress in 20 consecutive patients (13, myotomy-myectomy; six, mitral valve replacement; one, both myotomy-myectomy and mitral valve replacement) who underwent both preoperative and postoperative studies. All had angiographically normal epicardial coronary arteries. Operation resulted in reduction in outflow gradient (64 +/- 38 to 4 +/- 7 mm Hg, p less than 0.001) and in left ventricular systolic pressure (186 +/- 32 to 128 +/- 22 mm Hg, p less than 0.001) and was associated with reduction in great cardiac vein flow (101 +/- 26 to 78 +/- 16 ml/min, p less than 0.001) and oxygen consumption in the anterior left ventricle and septum (11.9 +/- 4.1 to 8.4 +/- 1.9 ml O2/min, p less than 0.001) in the basal state. During rapid atrial pacing, 13 of 20 patients experienced chest pain postoperatively, whereas all 20 developed chest pain during preoperative pacing, with an improvement in pacing anginal threshold (or heart rate 150 if no chest pain was experienced) of 16 +/- 18 beats/min (p less than 0.001). The peak great cardiac vein flow (161 +/- 41 to 131 +/- 45 ml/min, p less than 0.025) and myocardial oxygen consumption (19.4 +/- 6.1 to 14.3 +/- 5.5 ml O2/min, p less than 0.005) during pacing, which correlated directly with the severity of the basal left ventricular gradient (p = 0.011 and p = 0.002, respectively), were also reduced by surgery. Lactate metabolism during pacing changed from net production before surgery to net consumption after operation (-17 +/- 47.6 to 4.4 +/- 29.8 mumol/min, p less than 0.01), with six of 20 patients producing lactate after surgery compared with 13 of 20 before surgery (p = 0.06). The six patients with the highest peak great cardiac vein flow (greater than 175 ml/min) during preoperative pacing had greater symptom and metabolic benefit during pacing after surgery compared with the 14 patients with lower peak coronary flow. Postpacing left ventricular end-diastolic pressure (30 +/- 7 to 23 +/- 7 mm Hg, p less than 0.001) and pulmonary artery wedge pressure (24 +/- 6 to 20 +/- 5, p less than 0.001) were reduced after surgery.(ABSTRACT TRUNCATED AT 400 WORDS)

journal_name

Circulation

journal_title

Circulation

authors

Cannon RO 3rd,McIntosh CL,Schenke WH,Maron BJ,Bonow RO,Epstein SE

doi

10.1161/01.cir.79.4.766

subject

Has Abstract

pub_date

1989-04-01 00:00:00

pages

766-75

issue

4

eissn

0009-7322

issn

1524-4539

journal_volume

79

pub_type

杂志文章
  • Regression of carotid atherosclerosis by control of postprandial hyperglycemia in type 2 diabetes mellitus.

    abstract:BACKGROUND:Postprandial hyperglycemia may be a risk factor for cardiovascular disease. We compared the effects of two insulin secretagogues, repaglinide and glyburide, known to have different efficacy on postprandial hyperglycemia, on carotid intima-media thickness (CIMT) and markers of systemic vascular inflammation i...

    journal_title:Circulation

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1161/01.CIR.0000134501.57864.66

    authors: Esposito K,Giugliano D,Nappo F,Marfella R,Campanian Postprandial Hyperglycemia Study Group.

    更新日期:2004-07-13 00:00:00

  • De subitaneis mortibus. XV. Hereditary stenosis of the His bundle in Pug dogs.

    abstract::Syncope and sudden death occurs in certain purebred Pug dogs which have been found to have intermittent sinus pauses and paroxysmal second degree heart block on electrocardiographic (ECG) study. We have established a colony of such dogs to study this problem and here report the results of histological examination of t...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.52.6.1152

    authors: James TN,Robertson BT,Waldo AL,Branch CE

    更新日期:1975-12-01 00:00:00

  • Pharmacoangiographic manipulation of renal collateral blood flow.

    abstract::Vasodilatory or vasoconstrictive renal pharmacoangiography was applied in investigating the significance of 50 renal artery stenoses. The technique involves comparison of selective magnification renal arteriograms before and after intra-arterial injection of epinephrine or acetylcholine, seeking changes in direction o...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.54.2.328

    authors: Bookstein JJ,Walter JF,Stanley JC,Fry WJ

    更新日期:1976-08-01 00:00:00

  • Mitral valve prolapse.

    abstract::For half a century the systolic click and late systolic murmur lay dormant as innocent auscultatory curiosities. The thirteen years since Barlow related these phenomena to mitral leaflet prolapse have witnessed an astonishing information explosion. We have sought to bring together the accumulated data in this review. ...

    journal_title:Circulation

    pub_type: 杂志文章,评审

    doi:10.1161/01.cir.54.1.3

    authors: Devereux RB,Perloff JK,Reichek N,Josephson ME

    更新日期:1976-07-01 00:00:00

  • Chronic kidney disease, cardiovascular risk, and response to angiotensin-converting enzyme inhibition after myocardial infarction: the Survival And Ventricular Enlargement (SAVE) study.

    abstract:BACKGROUND:Persons with end-stage renal disease and those with lesser degrees of chronic kidney disease (CKD) have an increased risk of death after myocardial infarction (MI) that is not fully explained by associated comorbidities. Future cardiovascular event rates and the relative response to therapy in persons with m...

    journal_title:Circulation

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1161/01.CIR.0000149806.01354.BF

    authors: Tokmakova MP,Skali H,Kenchaiah S,Braunwald E,Rouleau JL,Packer M,Chertow GM,Moyé LA,Pfeffer MA,Solomon SD

    更新日期:2004-12-14 00:00:00

  • Outcome in medically treated coronary artery disease. Ischemic events: nonfatal infarction and death.

    abstract::In this study we extended the characterization of outcome in 1214 medically treated patients with coronary disease by considering nonfatal infarction and death together as ischemic events. At 7 years, the cumulative event rate was 47% (18% for nonfatal infarction as the initial event and 29% for death as the initial e...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.62.4.718

    authors: Harris PJ,Lee KL,Harrell FE Jr,Behar VS,Rosati RA

    更新日期:1980-10-01 00:00:00

  • Pooling in chronic orthostatic intolerance: arterial vasoconstrictive but not venous compliance defects.

    abstract:BACKGROUND:Orthostatic intolerance is characterized by postural tachycardia syndrome (POTS) with exaggerated tachycardia, orthostatic symptoms, and "pooling" (which comprises acrocyanosis and dependent edema when upright). My colleagues and I tested the hypothesis that pooling results from increased venous compliance i...

    journal_title:Circulation

    pub_type: 临床试验,杂志文章

    doi:10.1161/01.cir.0000016348.55378.c4

    authors: Stewart JM

    更新日期:2002-05-14 00:00:00

  • Perspectives on systolic hypertension. The Framingham study.

    abstract::Diastolic hypertension has been widely and justifiably accepted as a cause of cardiovascular mortality. However, it has also been accepted that the cardiovascular sequelae of hypertension derive chiefly from the diastolic component. Because systolic and diastolic pressure are usually highly correlated it is not easy t...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.61.6.1179

    authors: Kannel WB,Dawber TR,McGee DL

    更新日期:1980-06-01 00:00:00

  • Peripartum cardiomyopathy as a part of familial dilated cardiomyopathy.

    abstract:BACKGROUND:Anecdotal cases of familial clustering of peripartum cardiomyopathy (PPCM) and familial occurrences of PPCM and idiopathic dilated cardiomyopathy (DCM) together have been observed, suggesting that genetic factors play a role in the pathogenesis of PPCM. We hypothesized that some cases of PPCM are part of the...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/CIRCULATIONAHA.109.929646

    authors: van Spaendonck-Zwarts KY,van Tintelen JP,van Veldhuisen DJ,van der Werf R,Jongbloed JD,Paulus WJ,Dooijes D,van den Berg MP

    更新日期:2010-05-25 00:00:00

  • Effects of L-arginine supplementation on endothelium-dependent coronary vasodilation in patients with angina pectoris and normal coronary arteriograms.

    abstract:BACKGROUND:The pathogenesis of impaired endothelium-dependent coronary vasodilation in angina pectoris and normal coronary arteriograms (microvascular angina pectoris) is not known. We examined whether supplementation with L-arginine, a precursor of endothelium-derived nitric oxide, improves endothelium-dependent coron...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.94.2.130

    authors: Egashira K,Hirooka Y,Kuga T,Mohri M,Takeshita A

    更新日期:1996-07-15 00:00:00

  • Platelet nitric oxide and superoxide release during the development of nitrate tolerance: effect of supplemental ascorbate.

    abstract:BACKGROUND:The therapeutic benefits that accompany the continuous administration of organic nitrates are attenuated by the development of tolerance to the compounds. Altered superoxide production and NO bioavailability have been implicated in contributing to the development of tolerance, an effect that may be ameliorat...

    journal_title:Circulation

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1161/01.cir.0000021600.84149.78

    authors: McVeigh GE,Hamilton P,Wilson M,Hanratty CG,Leahey WJ,Devine AB,Morgan DG,Dixon LJ,McGrath LT

    更新日期:2002-07-09 00:00:00

  • Reversal of global apoptosis and regional stress kinase activation by cardiac resynchronization.

    abstract:BACKGROUND:Cardiac dyssynchrony in the failing heart worsens global function and efficiency and generates regional loading disparities that may exacerbate stress-response molecular signaling and worsen cell survival. We hypothesized that cardiac resynchronization (CRT) from biventricular stimulation reverses such molec...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/CIRCULATIONAHA.107.706291

    authors: Chakir K,Daya SK,Tunin RS,Helm RH,Byrne MJ,Dimaano VL,Lardo AC,Abraham TP,Tomaselli GF,Kass DA

    更新日期:2008-03-18 00:00:00

  • Reduced ventricular volumes and improved systolic function with cardiac resynchronization therapy: a randomized trial comparing simultaneous biventricular pacing, sequential biventricular pacing, and left ventricular pacing.

    abstract:BACKGROUND:Cardiac resynchronization therapy has emerged as an important therapy for advanced systolic heart failure. Among available cardiac resynchronization therapy pacing modes that restore ventricular synchrony, it is uncertain whether simultaneous biventricular (BiV), sequential BiV, or left ventricular (LV) paci...

    journal_title:Circulation

    pub_type: 杂志文章,多中心研究,随机对照试验

    doi:10.1161/CIRCULATIONAHA.106.634444

    authors: Rao RK,Kumar UN,Schafer J,Viloria E,De Lurgio D,Foster E

    更新日期:2007-04-24 00:00:00

  • Endothelin 1 type a receptor antagonism prevents vascular dysfunction and hypertension induced by 11beta-hydroxysteroid dehydrogenase inhibition: role of nitric oxide.

    abstract:BACKGROUND:The enzyme 11beta-hydroxysteroid dehydrogenase (11beta-HSD) prevents inappropriate activation of the nonselective mineralocorticoid receptors by glucocorticoids. Renal activity of 11beta-HSD is decreased in patients with apparent mineralocorticoid excess (SAME), licorice-induced hypertension, and essential h...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.103.25.3129

    authors: Ruschitzka F,Quaschning T,Noll G,deGottardi A,Rossier MF,Enseleit F,Hürlimann D,Lüscher TF,Shaw SG

    更新日期:2001-06-26 00:00:00

  • Association between 2 angiographic subtypes of renal artery fibromuscular dysplasia and clinical characteristics.

    abstract:BACKGROUND:Initially based on histology, the diagnosis of renal artery fibromuscular dysplasia (FMD) is now based mostly on angiographic appearance because arterial tissue samples are rarely available. This retrospective cross-sectional study aimed to assess the clinical relevance of a binary angiographic classificatio...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/CIRCULATIONAHA.112.117499

    authors: Savard S,Steichen O,Azarine A,Azizi M,Jeunemaitre X,Plouin PF

    更新日期:2012-12-18 00:00:00

  • Ascorbic acid prevents contrast-mediated nephropathy in patients with renal dysfunction undergoing coronary angiography or intervention.

    abstract:BACKGROUND:Contrast agents can cause a reduction in renal function that may be due to the generation of reactive oxygen species. Conflicting evidence suggests that administration of the antioxidant acetylcysteine prevents this renal impairment. The action of other antioxidant agents has not been investigated. METHODS ...

    journal_title:Circulation

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1161/01.CIR.0000146396.19081.73

    authors: Spargias K,Alexopoulos E,Kyrzopoulos S,Iokovis P,Greenwood DC,Manginas A,Voudris V,Pavlides G,Buller CE,Kremastinos D,Cokkinos DV

    更新日期:2004-11-02 00:00:00

  • Flavone-8-acetic acid (Flavonoid) profoundly reduces platelet-dependent thrombosis and vasoconstriction after deep arterial injury In vivo.

    abstract:BACKGROUND:Flavone-8-acetic acid (FAA; [Flavonoid]), an adjuvant antitumor drug, inhibits ristocetin-induced aggregation of human platelets. The effect of FAA on platelet-dependent thrombosis was studied in vivo in the porcine carotid artery after deep arterial injury by balloon angioplasty. METHODS AND RESULTS:(111)I...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.101.3.324

    authors: Mruk JS,Webster MW,Heras M,Reid JM,Grill DE,Chesebro JH

    更新日期:2000-01-25 00:00:00

  • Microbubble persistence in the microcirculation during ischemia/reperfusion and inflammation is caused by integrin- and complement-mediated adherence to activated leukocytes.

    abstract:BACKGROUND:Albumin microbubbles that are used for contrast echocardiography persist within the myocardial microcirculation after ischemia/reperfusion (I-R). The mechanism responsible for this phenomenon is unknown. METHODS AND RESULTS:Intravital microscopy of the microcirculation of exteriorized cremaster muscle was p...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.101.6.668

    authors: Lindner JR,Coggins MP,Kaul S,Klibanov AL,Brandenburger GH,Ley K

    更新日期:2000-02-15 00:00:00

  • Introduction to the Analysis of Survival Data in the Presence of Competing Risks.

    abstract::Competing risks occur frequently in the analysis of survival data. A competing risk is an event whose occurrence precludes the occurrence of the primary event of interest. In a study examining time to death attributable to cardiovascular causes, death attributable to noncardiovascular causes is a competing risk. When ...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/CIRCULATIONAHA.115.017719

    authors: Austin PC,Lee DS,Fine JP

    更新日期:2016-02-09 00:00:00

  • Thioredoxin-2 inhibits mitochondrial reactive oxygen species generation and apoptosis stress kinase-1 activity to maintain cardiac function.

    abstract:BACKGROUND:Thioredoxin 2 (Trx2) is a key mitochondrial protein that regulates cellular redox and survival by suppressing mitochondrial reactive oxygen species generation and by inhibiting apoptosis stress kinase-1 (ASK1)-dependent apoptotic signaling. To date, the role of the mitochondrial Trx2 system in heart failure ...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/CIRCULATIONAHA.114.012725

    authors: Huang Q,Zhou HJ,Zhang H,Huang Y,Hinojosa-Kirschenbaum F,Fan P,Yao L,Belardinelli L,Tellides G,Giordano FJ,Budas GR,Min W

    更新日期:2015-03-24 00:00:00

  • Impact of glucose intolerance and insulin resistance on cardiac structure and function: sex-related differences in the Framingham Heart Study.

    abstract:BACKGROUND:Although insulin resistance has been implicated in the pathogenesis of left ventricular (LV) hypertrophy, previous studies have yielded inconsistent results and are limited by referral bias. METHODS AND RESULTS:We examined the relations between echocardiographic LV measurements and glucose tolerance status ...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.0000045671.62860.98

    authors: Rutter MK,Parise H,Benjamin EJ,Levy D,Larson MG,Meigs JB,Nesto RW,Wilson PW,Vasan RS

    更新日期:2003-01-28 00:00:00

  • Critical role of endogenous thrombospondin-1 in preventing expansion of healing myocardial infarcts.

    abstract:BACKGROUND:Matricellular proteins are extracellular matrix proteins that do not contribute directly to tissue integrity but are capable of modulating cell function. We hypothesized that the matricellular protein thrombospondin (TSP)-1, a potent inhibitor of angiogenesis and activator of transforming growth factor (TGF-...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/CIRCULATIONAHA.104.510354

    authors: Frangogiannis NG,Ren G,Dewald O,Zymek P,Haudek S,Koerting A,Winkelmann K,Michael LH,Lawler J,Entman ML

    更新日期:2005-06-07 00:00:00

  • Central arterial compliance is associated with age- and habitual exercise-related differences in cardiovagal baroreflex sensitivity.

    abstract::Background- Cardiovagal baroreflex sensitivity (BRS) declines with age but is favorably modulated by habitual aerobic exercise. We tested the hypothesis that compliance (transducing capacity) of an elastic artery in which baroreceptors are located is associated with these age-exercise interactions. Methods and Results...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/hc3901.096670

    authors: Monahan KD,Tanaka H,Dinenno FA,Seals DR

    更新日期:2001-10-02 00:00:00

  • Distinct downregulation of C-type natriuretic peptide system in human aortic valve stenosis.

    abstract:BACKGROUND:Aortic valve calcification is an actively regulated process that displays hallmarks of atherosclerosis. Natriuretic peptides (A-, B-, and C-type natriuretic peptides [ANP, BNP, and CNP]) have been reported to have a role in the pathogenesis of vascular atherosclerosis, but their expression in aortic valves i...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/CIRCULATIONAHA.106.685743

    authors: Peltonen TO,Taskinen P,Soini Y,Rysä J,Ronkainen J,Ohtonen P,Satta J,Juvonen T,Ruskoaho H,Leskinen H

    更新日期:2007-09-11 00:00:00

  • Arrhythmia burden in adults with surgically repaired tetralogy of Fallot: a multi-institutional study.

    abstract:BACKGROUND:The arrhythmia burden in tetralogy of Fallot, types of arrhythmias encountered, and risk profile may change as the population ages. METHODS AND RESULTS:The Alliance for Adult Research in Congenital Cardiology (AARCC) conducted a multicenter cross-sectional study to quantify the arrhythmia burden in tetralog...

    journal_title:Circulation

    pub_type: 杂志文章,多中心研究

    doi:10.1161/CIRCULATIONAHA.109.928481

    authors: Khairy P,Aboulhosn J,Gurvitz MZ,Opotowsky AR,Mongeon FP,Kay J,Valente AM,Earing MG,Lui G,Gersony DR,Cook S,Ting JG,Nickolaus MJ,Webb G,Landzberg MJ,Broberg CS,Alliance for Adult Research in Congenital Cardiology (AARCC).

    更新日期:2010-08-31 00:00:00

  • Apoptosis induced by inhibition of cyclic AMP response element-binding protein in vascular smooth muscle cells.

    abstract:BACKGROUND:The balance between apoptosis and proliferation of vascular smooth muscle cells (VSMCs) is believed to contribute to the vascular remodeling process. Cyclic AMP response element-binding protein (CREB) is a critical transcription factor for the survival of neuronal cells and T lymphocytes. However, the role o...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.CIR.0000085164.13439.89

    authors: Tokunou T,Shibata R,Kai H,Ichiki T,Morisaki T,Fukuyama K,Ono H,Iino N,Masuda S,Shimokawa H,Egashira K,Imaizumi T,Takeshita A

    更新日期:2003-09-09 00:00:00

  • Intensive blood pressure control reduces the risk of cardiovascular events in patients with peripheral arterial disease and type 2 diabetes.

    abstract:BACKGROUND:Peripheral arterial disease (PAD) and diabetes are both associated with a high risk of ischemic events, but the role of intensive blood pressure control in PAD has not been established. METHODS AND RESULTS:The Appropriate Blood Pressure Control in Diabetes study followed 950 subjects with type 2 diabetes fo...

    journal_title:Circulation

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1161/01.cir.0000049640.46039.52

    authors: Mehler PS,Coll JR,Estacio R,Esler A,Schrier RW,Hiatt WR

    更新日期:2003-02-11 00:00:00

  • Ticlopidine and clopidogrel.

    abstract::The thienopyridines ticlopidine and clopidogrel are inhibitors of platelet function in vivo. Their mode of action has not been defined, but it appears that they require conversion to as yet unidentified metabolites that are noncompetitive antagonists of the platelet ADP receptor. Inhibition of platelet aggregation wit...

    journal_title:Circulation

    pub_type: 杂志文章,评审

    doi:10.1161/01.cir.100.15.1667

    authors: Quinn MJ,Fitzgerald DJ

    更新日期:1999-10-12 00:00:00

  • Direct evidence for a crucial role of the arterial wall in control of atherosclerosis susceptibility.

    abstract:BACKGROUND:Inbred mouse strains C57BL/6J (B6) and C3H/HeJ (C3H) exhibit marked differences in atherosclerosis susceptibility. We sought to determine whether the difference in atherosclerosis susceptibility resides at the level of arterial walls. METHODS AND RESULTS:Thoracic aortic segments from 8-week-old female B6 an...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/CIRCULATIONAHA.106.640185

    authors: Pei H,Wang Y,Miyoshi T,Zhang Z,Matsumoto AH,Helm GA,Tellides G,Shi W

    更新日期:2006-11-28 00:00:00

  • A new noninvasive method for the estimation of peak dP/dt.

    abstract:BACKGROUND:Peak dP/dt is a good index of ventricular performance that is not influenced by afterload, wall motion abnormalities, or the variations in ventricular anatomy and morphology commonly encountered among patients with congenital heart disease. Unfortunately, the clinical utility of peak dP/dt has been limited b...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.88.6.2693

    authors: Rhodes J,Udelson JE,Marx GR,Schmid CH,Konstam MA,Hijazi ZM,Bova SA,Fulton DR

    更新日期:1993-12-01 00:00:00