Jan J. Kellermann

Job stresses and risk factors in coronary heart disease among five occupational categories in kibbutzim

Abstract Relationships among job stresses and CHD risk factors in five occupational categories were studied in a sample of 762 adult male kibbutz members in Israel. Most CHD morbidity rates, the great majority of the average values of CHD risk factors, and most average scores on measures of job stresses and strains did not significantly differ among managerial and professional workers, clerical workers, craftsmen, factory workers, and agricultural workers. In order to investigate the patterns of associations of job stresses and strains with CHD risk factors, smallest space analysis was performed on the data matrix of each of the four major occupational categories separately. White-collar workers were most disposed to obesity as a possible risk factor, agricultural workers were most likely to experience job stresses and strains associated with increased CHD risk.

Menopause-Related Changes in Left Ventricular Function in Healthy Women

Using technetium scans, this study was aimed at examining possible changes in left ventricular function related to the natural process of cessation of ovarian estrogen production. Fourteen healthy postmenopausal women, divided into two groups according to the time-lapse from menopause (A > 3 years; B < 5 years), underwent a technetium heart scan. The two groups did not differ in heart rate, blood pressure, double product, systemic vascular resistance and cardiac index. The mean end-systolic volume in group A was 14.9 and 25.7 ml/m2 in group B (p = 0.003). The mean pressure/volume ratio was significantly higher in group A than in group B (8.6 vs. 4.7 mm Hg/ml/m2, p = 0.02). Peak ejection rate and peak filling rate were also significantly greater in group A compared to group B (3.3 vs. 2.8 end-diastolic volumes/s, p = 0.02; 2.8 vs. 2.1 end-diastolic volumes/s, p = 0.001, respectively). Our findings suggest that women at an early phase of menopause have a higher degree of myocardial contractility than women of a similar age whose menopause is of longer duration.

Altered left ventricular volume and ejection fraction responses to supine dynamic exercise in athletes

Two-dimensional echocardiography was used to determine the responses of left ventricular volumes, ejection fraction and segmental left ventricular motion to supine dynamic exercise in 22 professional athletes, comparing these responses with those in 22 age- and gender-matched healthy untrained individuals. End-systolic volume was significantly greater at rest and during exercise in the athletes (50 +/- 6 versus 29 +/- 4 ml and 40 +/- 5 versus 17 +/- 4 ml, respectively, p less than 0.001 for both). It decreased during exercise in all the untrained subjects, but did not change or increased in nine athletes (41%). End-diastolic volume was greater in the athletes at rest (143 +/- 12 versus 98 +/- 9 ml) and during exercise (157 +/- 14 versus 121 +/- 13 ml, p less than 0.01 for both). It increased in all the untrained subjects, but decreased or did not change in six athletes (27%). Ejection fraction was significantly lower in the athletes at rest and during exercise (65 +/- 4% versus 70 +/- 5% and 73 +/- 5% versus 86 +/- 5%, p less than 0.01 and 0.001, respectively); the values augmented normally in all the untrained subjects, but increased only by less than 5% units, did not change or decreased in nine athletes (41%). Eight athletes (36.5%) failed to demonstrate the expected symmetric hyperkinetic wall motion changes during exercise, which were seen in all the untrained subjects. No correlation was found between atypical responses to exercise and electrocardiographic patterns.(ABSTRACT TRUNCATED AT 250 WORDS)

Pressure/Volume Ratio and Pressure/Volume Ratio Exercise Quotient: An Echocardiographic Comparative Study of Left Ventricular Function Indicators

Noninvasive evaluation of left ventricular function (LVF) has been performed with two-dimensional echocardiography (TDE). Ejection fraction (EF), end systolic volume index (ESVI) and systolic blood pressure/end systolic volume index ratio (PVR)--an indicator which is independent of preload and afterload changes in a wide physiologic range--were assessed at rest and after exercise. Twenty-seven postmyocardial infarction (MI) patients were compared to 27 normal controls in an attempt to examine the above parameters of LVF in each group, measured by TDE. Correlation of TDE EF with radionuclide angiography EF proved the reliability of TDE. Rest and postexercise values of EF and PVR showed highly significant differences between the two groups. Using ESVI, a relatively lesser significant difference was found. PVR values at rest were 4.86 mm Hg/ml/m2 in the study group and 9.51 in the control group. These values increased to 5.34 and 15.15, respectively, after exercise. The ratio of PVR after exercise to PVR at rest, expressed as percentage change (PVREQ), seemed to be an additional tool in separating between both groups. This indicator merges pressure, volume, and the influence of exercise on both; a PVREQ of at least 145% correlated well with absence of MI in most of our patients.

Cardiocirculatory response to different types of training in patients with angina pectoris.

The effect of different training programs on various physiological parameters and the role of a possible placebo effect was investigated in 33 patients after myocardial infarction who suffered from an

Unusual Echocardiographic Pattern in Gaucher’s Disease

Described in this paper is a 73-year-old Ashkenazi Jew affected with adult type 1 (nonneuronopathic form) Gauchers disease. This was diagnosed at the age of 46 during an investigation of hepatosplenomegaly. No other members of his family were known to be affected with this disorder. The patient has been periodically examined at our Institute and has been free of all cardiopulmonary symptoms. This description emphasizes his echocardiographic pattern which revealed left ventricular hypertrophy, a septal muscular hump, and an extended area of apical akinesis. Myocardial involvement in Gauchers disease has seldom been reported in the past.

Usefulness of Immediate Postexercise Two-Dimensional Echocardiography in Post-Myocardial Infarction Patients Without Ischemic ECG Changes in Stress Testing: Comparison with Radionuclide Angiography

Of 38 post-myocardial infarction (MI) applicants for a cardiac rehabilitation program, 17 (45%) did not have ischemic ECG changes in exercise testing. Ten (59%) of these 17 patients had echocardiographic wall motion abnormalities at rest. Immediate postexercise two-dimensional echocardiography demonstrated exercise-induced changes in 8 (47%) patients (2 with normal and 6 with abnor mal results from rest studies). The comparative radionuclide (RNA) examina tions showed that there were 6 patients with abnormal findings from rest RNA; exercise-induced changes were detected in 7 (44%) of 16 patients (3 with normal and 4 with abnormal results from rest RNA tests). Statistical analyses, using RNA as reference point, revealed that the total correctly diagnosed cases for the echocardiographic rest studies was 13/17 (77%) and for the exercise studies, 13/16 (81%). The negative predictive values were 7/7 (100%) and 7/8 (88%), respectively. The corresponding positive predictive values were 6/10 (60%) and 6/8 (75%). The same pattern was observed when each segment (septal, apical, and posterolateral) was evaluated separately. The authors conclude that in post- MI patients with a negative stress test, the efficacy of postexercise echocardiog raphy equals that of RNA in the identification of additional patients with ische mia.

Effects of population changes on psychological and physiological strain in kibbutz communities

The present study was directed toward determining the health implications of population policies followed by collective rural communities (kibbutzim) in Israel. It was hypothesized that, controlling for kibbutz longevity, higher rates of out-migration and/or lower rates of in-migration and population growth are associated with subsequent increases in psychological and physiological strain among kibbutz members. The hypothesis was tested by interrelating different sets of data on kibbutz communities, collected at two research centers. Data were subjected to both individual and ecological correlational analyses. At both levels, inconsistent patterns of relationships between demographic characteristics and strain were obtained. The consistent cross-level findings which were significant were contradictory to our hypothesis. Our results suggest that while demographic changes do appear to have some impact on subsequent affective strain among kibbutz members, their detrimental effect is rather weak and is probably mediated by small-group processes, such as peer social support, and by the adequacy of the individuals coping resources.

The Angina Pectoris Threshold Heart Rate as a Prognostic Sign

The aim of this study was to investigate the prognostic value of angina pectoris threshold heart rate (ATHR) in 300 patients aged 27-65 years, suffering from typical angina pectoris and being under follow-up at our institute for at least 5 years. A multistage symptom-limited ergometric test was performed in all examinees at least twice. The patients were divided into two groups. Group 1 consisted of all those whose ATHR was 120 beats and above; group 2 with ATHR below 120 beats/min. The mean age of group 1 was 47 +/- 5.8 years; the mean age of group 2 was 51 +/- 5.9 years. In group 1, in 47.3% the ATHR remained unchanged within the 5-year follow-up. Of the remaining 52.7% with changes (representing 100% with changes) 19.4% died from a cardiac cause within the period of follow-up. In group 2, 56.1% remained without ATHR changes within follow-up. In 43.9% with changes (representing 100% with changes), 48% died of a cardiac cause. Similar findings were obtained when the symptom-limited work load was taken into consideration. In group 1, which performed less than 50 W, 44.6% did not reveal any change during follow-up. In 55.4% (representing 100% with changes) 47.8% died of a cardiac cause. In group 2, patients who performed between 50 to 100 W, 52.5% were without changes. In 47.5% (representing 100% with changes) 21% died of a cardiac cause. In group 3, patients performed more than 100 W, 54.3% were without changes, while in 45.7% (representing 100% with changes) 19.2% died of a cardiac cause. Our findings clearly indicate the significance of the ATHR as a prognostic sign.

The Secondary Preventive Effect of Comprehensive Coronary Care (C.C.C.)

Till now there is a lack of scientific evidence on the secondary preventive effect of comprehensive intervention programs in patients with CHD. A cynical approach to this problem may always be suspicious of weakness and of scientific arrogancy. Nonetheless, I shall try to present the problem as objectively and unbiased as possible. In order to analyse the effectivity of programs implemented in the treatment of patients with CHD, it seems a necessity to discuss first of all the nature of prevention on coronary disease in general. It is common knowledge that atherosclerosis of the coronary vessels is considered to be the underlaying condition of coronary artery disease. Moreover, this disease has proved to be of multifactorial origin. While the notion that atherosclerosis is a reversible process was suggested already 60 years ago, a regression of these processes has been demonstrated only in animals. In humans such a reversibility could be shown only incompletely and it appeared that there exists many problems of interpretation. It has to be considered that the reversions of hyperlipidemic conditions may cause a regression of the atherosclerotic state. In humans such a regression may eventually be caused by a multiplicity of factors and not only by hypercholesterolemia, as in the experimental atherosclerosis induced in animals. These observations must be remembered before any conclusions can be drawn as to the effect of preventive measures in individuals without signs and symptoms of coronary atherosclerosis1.