David Harry Miller

Standardization of M-mode echocardiographic left ventricular anatomic measurements

To improve standardization of echocardiographic left ventricular anatomic measurements, echographic left ventricular dimensions and mass were related to body size indexes, sex, age and blood pressure. Independent normal populations comprised 92 hospital-based subjects (64 women, 28 men) and 133 subjects from a population sample (55 women, 78 men). All measurements of chamber size, wall thickness and mass differed between men and women in both series (p less than 0.01 to p less than 0.001). Left ventricular mass was related most closely to body surface area among measurements of body size (r = 0.37, p less than 0.01 to r = 0.57, p less than 0.001) in all four groups. Indexation by body surface area eliminated sex differences in wall thicknesses and internal dimension, but a significant sex difference in left ventricular mass index persisted (89 +/- 21 g/m2 in men versus 69 + 19 g/m2 in women in the entire series, p less than 0.0001). The 97th percentile of left ventricular mass index was identical in both groups of men (136 and 132 g/m2) and women (112 and 109 g/m2). A highly significant difference in lean body mass, estimated from 24 hour urine creatine excretion, was observed between men and women (58 +/- 15 versus 40 +/- 13 kg, p less than 0.001) and no sex difference existed in left ventricular mass indexed by lean body mass (3.4 +/- 1.3 versus 3.5 +/- 1.5 g/kg). Weak correlations were observed between left ventricular mass/lean body mass and systolic or diastolic blood pressure (r = 0.25, p less than 0.05 and r = 0.28, p less than 0.01, respectively) but not age (18 to 72 years).(ABSTRACT TRUNCATED AT 250 WORDS)

Performance of primary and derived M-mode echocardiographic measurements for detection of left ventricular hypertrophy in necropsied subjects and in patients with systemic hypertension, mitral regurgitation and dilated cardiomyopathy☆

To determine which M-mode echocardiographic (echo) measurement best detects left ventricular (LV) hypertrophy, the sensitivity and specificity of upper normal limits of echo LV anatomic measurements (previously shown to have 97% specificity in living normal subjects) were tested in 60 necropsied patients with anatomic hypertrophy and in 28 necropsied patients with normal left ventricles. The prevalence of hypertrophy by each echo criterion was determined in 165 living patients with systemic hypertension, mitral regurgitation or dilated cardiomyopathy. The best separation between patients with normal vs increased necropsy LV mass was obtained using sex-specific echo LV mass index criteria (overall accuracy = 73 of 88 patients, 83%). Lower overall accuracies for separation of patients with and without hypertrophy were observed for echo cross-sectional area (59 of 88 patients, 67%; p less than 0.05 vs LV mass index) and indexes of LV wall thickness (39 to 51%, p less than 0.001). Among 113 living patients with moderate or severe hypertension, mitral regurgitation or dilated cardiomyopathy, LV mass index was increased in 73%, cross-sectional area index in 58% (p less than 0.02 vs LV mass index), and posterior wall thickness, septal thickness and relative wall thickness in only 11 to 32% (all p less than 0.001 vs LV mass index). Thus, an M-mode echo LV mass index of more than 134 g/m2 in men and more than 110 g/m2 in women detects concentric and eccentric LV hypertrophy accurately by comparison with necropsy and clinical reference standards; cross-sectional area is slightly less useful; and other M-mode echo criteria of LV hypertrophy perform too poorly to be clinically applicable.

Electrocardiographic detection of left ventricular hypertrophy using echocardiographic determination of left ventricular mass as the reference standard: Comparison of standard criteria, computer diagnosis and physician interpretation

Electrocardiographic findings of left ventricular hypertrophy were compared with echocardiographic left ventricular mass in 148 patients to assess performance of standard electrocardiographic criteria, the IBM Bonner program and physician interpretation. On echocardiography, 43% of the patients had left ventricular hypertrophy (left ventricular mass greater than 215 g). Sokolow-Lyon voltage-(S in V1 + R in V5 or V6) and Romhilt-Estes point score correlated modestly with left ventricular mass (r = 0.40, p less than 0.001 and r = 0.55, p less than 0.001, respectively). Sensitivity of Sokolow-Lyon voltage greater than 3.5 mV for left ventricular hypertrophy was only 22%, but specificity was 93%. Point score for probable left ventricular hypertrophy (greater than or equal to 4 points) had 48% sensitivity and 85% specificity, whereas definite hypertrophy (greater than or equal to 5 points) had 34% sensitivity and 98% specificity. Computer analysis resulted in 45% sensitivity and 83% specificity. Overall diagnostic accuracy of the IBM Bonner program (67%) was better than that of Sokolow-Lyon voltage (62%), but worse than the Romhilt-Estes point score (69% for greater than or equal to 4 points or 70% for greater than or equal to 5 points). Three cardiologists interpreted electrocardiograms independently and in a blinded fashion. Physician sensitivity was 56%, specificity 92% and accuracy 76%. Correlation with left ventricular hypertrophy was good (r = 0.70, p less than 0.001). It is concluded that: 1) computer diagnosis of left ventricular hypertrophy by the IBM Bonner program is no more accurate than diagnosis by Sokolow-Lyon or Romhilt-Estes criteria, and 2) physician recognition of left ventricular hypertrophy is more accurate.(ABSTRACT TRUNCATED AT 250 WORDS)

Rapidity Dependence of the Charged Particle Multiplicity Distributions in e+ e- Annihilation at 29-GeV

Abstract The charged particle multiplicity distribution for e+e− annihilations at s = 29 GeV has been measured using the High Resolution Spectrometer at PEP. The multiplicity distribution, expressed as a function of the mean, shows KNO scaling when compared to e+e− data at other energies. Multiplicity distributions for particles selected in different central rapidity spans are presented. All of these are well presented by the Negative binomial distribution. As the rapidity span is narrowed, the distributions become broader and approach a constant value of the parameter k.

Improved measurements of D meson semileptonic decays to π and K mesons

Using the entire CLEO-c {psi}(3770){yields}DD event sample, corresponding to an integrated luminosity of 818 pb{sup -1} and approximately 5.4x10{sup 6} DD events, we present a study of the decays D{sup 0}{yields}{pi}{sup -}e{sup +}{nu}{sub e}, D{sup 0}{yields}K{sup -}e{sup +}{nu}{sub e}, D{sup +}{yields}{pi}{sup 0}e{sup +}{nu}{sub e}, and D{sup +}{yields}K{sup 0}e{sup +}{nu}{sub e}. Via a tagged analysis technique, in which one D is fully reconstructed in a hadronic mode, partial rates for semileptonic decays by the other D are measured in several q{sup 2} bins. We fit these rates using several form factor parametrizations and report the results, including form factor shape parameters and the branching fractions B(D{sup 0}{yields}{pi}{sup -}e{sup +}{nu}{sub e})=(0.288{+-}0.008{+-}0.003)%, B(D{sup 0}{yields}K{sup -}e{sup +}{nu}{sub e})=(3.50{+-}0.03{+-}0.04)%, B(D{sup +}{yields}{pi}{sup 0}e{sup +}{nu}{sub e})=(0.405{+-}0.016{+-}0.009)%, and B(D{sup +}{yields}K{sup 0}e{sup +}{nu}{sub e})=(8.83{+-}0.10{+-}0.20)%, where the first uncertainties are statistical and the second are systematic. Taking input from lattice quantum chromodynamics, we also find |V{sub cd}|=0.234{+-}0.007{+-}0.002{+-}0.025 and |V{sub cs}|=0.985{+-}0.009{+-}0.006{+-}0.103, where the third uncertainties are from lattice quantum chromodynamics.

Influence of thrombolytic therapy, with or without intra-aortic balloon counterpulsation, on 12-month survival in the SHOCK trial

BACKGROUND The enhancement of diastolic coronary blood flow by the combination of thrombolytic therapy (TT) and intra-aortic balloon counterpulsation (IABP) in experimental studies provides a rationale for their combined use in acute myocardial infarction (MI) complicated by cardiogenic shock. We examined the relation between TT (with and without IABP) and 12-month survival in the SHould We Emergently Revascularize Occluded Coronaries for Cardiogenic ShocK (SHOCK) Trial. METHODS AND RESULTS Among 302 patients with myocardial infarction and cardiogenic shock who were randomized in the SHOCK Trial, 16 had absolute contraindications to TT. Among 150 patients randomly assigned to initial medical stabilization (IMS), 63% received TT, as recommended per protocol, compared with 49% of 152 patients randomly assigned to emergency revascularization, in whom TT was not recommended if immediate angiography was available. IABP deployment, which was protocol-recommended, was used in 86% of patients. The rate of severe bleeding was similar in patients receiving TT and in those not receiving TT (31% vs 26%, P =.37). Among patients randomly assigned to IMS, TT was associated with improved 12-month survival (unadjusted mortality hazard ratio, 0.59; P =.01; mortality hazard ratio adjusted for age and prior MI, 0.62; P =.02). TT was not associated with improved 12-month survival among patients randomly assigned to emergency revascularization (unadjusted mortality hazard ratio, 0.93; P =.76; mortality hazard ratio adjusted for age and prior MI, 1.06, P =.81). The test for interaction of TT and randomization group P value was.16, and there was insufficient statistical power to demonstrate a differential effect of TT on 12-month survival by treatment group assignment. CONCLUSIONS Among patients randomly assigned to IMS in the SHOCK Trial, TT was associated with improved 12-month survival and did not significantly increase the risk of severe bleeding.

Urokinase plus heparin versus aspirin in unstable angina and non-Q-wave myocardial infarction

The pivotal role of thrombosis in unstable angina and non-Q-wave myocardial infarction has been established recently. To assess the value and safety of thrombolytic therapy compared to conventional antithrombotic therapy (aspirin) in arresting progression in this setting to recurrent ischemic end-points, 25 patients presenting with unstable angina and an electrocardiogram showing subendocardial ischemia were randomized to receive either aspirin 325 mg daily, or urokinase 3 x 10(6) U intravenously, over 30 minutes followed by heparin. Incidence of endpoints (intractable ischemia requiring mechanical intervention, new myocardial infarction or death) was determined over 7 days. Coronary arteriography was performed at 24 to 72 hours to determine extent of coronary artery disease and morphologic severity of the culprit lesion, graded by a semiquantitative scoring system ranging from 4+ (definite thrombosis) to 0 (chronic lesion). In the first 24 hours, 7 of 13 aspirin versus 1 of 12 urokinase patients exhibited ischemia progression (p less than 0.05). By 7 days, progression to a primary ischemic endpoint occurred in 8 of 13 aspirin patients (3 myocardial infarctions and 5 intractable ischemias) versus 3 of 12 urokinase patients (2 intractable ischemias and 1 death) (p = 0.18). The apparent benefit of urokinase followed by heparin compared to conventional aspirin therapy in arresting early progression of unstable angina or non-Q-wave myocardial infarction was not associated with enhanced culprit lesion morphology (mean lesion severity score 2.7 +/- 1.5 vs 2.8 +/- 1.6 in aspirin-treated patients). Large scale, randomized trials to assess the clinical utility of urokinase for unstable angina are warranted.

Measurements of D meson decays to two pseudoscalar mesons

Using data collected on the {psi}(3770) resonance and near the D{sub s}*{sup {+-}D}{sub s}{sup {+-}}peak production energy by the CLEO-c detector, we study the decays of the possible D{yields}PP modes and report measurements of or upper limits on all branching fractions for Cabibbo-favored, singly Cabibbo-suppressed, and doubly Cabibbo-suppressed D{yields}PP decays except modes involving K{sub L}{sup 0} (and except D{sup 0{yields}}K{sup +{pi}-}). We normalize with respect to the Cabibbo-favored D modes, D{sup 0{yields}}K{sup -{pi}+}, D{sup +{yields}}K{sup -{pi}+{pi}+}, and D{sub s}{sup +{yields}}K{sup +}K{sub S}{sup 0}.

Measurement of the ηb(1S) mass and the branching fraction for Υ(3S)→γηb(1S)

We report evidence for the ground state of bottomonium, eta_b(1S), in the radiative decay Upsilon(3S) --> gamma eta_b in e^+e^- annihilation data taken with the CLEO III detector. Using 6 million Upsilon(3S) decays, and assuming Gamma(eta_b) = 10 MeV/c^2, we obtain B(Upsilon(3S) --> gamma eta_b) = (7.1 +- 1.8 +- 1.1) X 10^{-4}, where the first error is statistical and the second is systematic. The statistical significance is about 4 sigma. The mass is determined to be M(eta_b) = 9391.8 +- 6.6 +- 2.0 MeV/c^2, which corresponds to the hyperfine splitting Delta M_{hf}(1S)_b = 68.5 +- 6.6 +- 2.0 MeV/c^2. Using 9 million Upsilon(2S) decays, we place an upper limit on the corresponding Y(2S) decay, B(Y(2S) --> gamma eta_b) < 8.4 X 10^{-4} at 90 % confidence level.

Comparison of charged particle multiplicities in quark and gluon jets produced in e+e- annihilation at 29 GeV

The charged particle multiplicities of the quark and gluon jets in the three-fold symmetric e+e− → qqg events at √s = 29 GeV have been studied using the high resolution spectrometer at PEP. A value of 〈n〉g = 6.7−2.1+1.1±1.0 for gluon jet s with an energy of 9.7−2.0+1.5 GeV is measured. The ratio, 〈n〉g/〈n〉q, is 1.29−0.41+0.21±0.20, which i s significantly lower than the value of 94 naively expected from the ration of the gluon-to-quark color charges.