Reiki Yoshida

Exercise P-vector magnitude changes in angina pectoris: frank-vectorcardiographic and hemodynamic correlations

Multistage bicycle ergometer exercise testings with Frank vectorcardiogram and M-mode echocardiogram were performed on 12 patients with effort angina pectoris. The left atrial and left ventricular end-diastolic volume (LAV and LVEDV) were calculated as a cube of the left atrial and left ventricular end-diastolic dimension. The mean pulmonary artery wedge pressure (mPAWP) was measured with a Swan-Ganz catheter during the testing. At peak exercise a statistically significant increase was observed in mPAWP (p less than 0.001), LAV (p less than 0.005), the maximal horizontal P-vector magnitude (Hmax) (p less than 0.05) and the percent change in Hmax (%Hmax). %Hmax showed a significant correlation with the increment of mPAWP (delta mPAWP) (r = 0.66, p less than 0.05), the increment of LVEDV (delta LVEDV) (r = 0.83, p less than 0.01) and the increment of LAV (delta LAV) (r = 0.81, p less than 0.001). Multiple regression analysis was performed on %Hmax as a dependent variable with delta LAV, delta mPAWP, and the increment of heart rate (delta HR) as independent variables (r = 0.84, p less than 0.05), but the partial correlation coefficients of delta mPAWP and delta HR were not significant. The present study demonstrated that the increase in Hmax had a close relationship with the increase in mPAWP and LVEDV and that the preload of the left ventricle during exercise-induced anginal attack could be predicted noninvasively by %Hmax. The increase in Hmax was thought to be due to the increase in LAV during anginal attack.

Analysis of Diastolic Behavior of the Left Ventricle on Dynamic Exercise by Pulse Doppler Combined with 2-D Echocardiograph

Estimation of diastolic behavior of the left ventricle (LV) in hypertrophic cardiomyopathy (HCM) has been commonly carried out using invasive methods1) which have some limitations to be applied on dynamic exercise. However, using Doppler methods of investigation brings a number of practical advantages. In the absence of intracardiac shunt or valvular regurgitation, 2)–4) transmitral flow velocity represents the rate of LV volume change (dV/dt) in diastole, and is independent either of abnormal LV shape or regional movement of the LV wall. To assess LV diastolic behavior in HCM, the transmitral flow velocity was evaluated before and after dynamic leg exercise using a pulse Doppler flowmeter combined with two-dimensional (2-D) echo-cardiograph.