Toshiyuki Nakajima

Norepinephrine levels in the coronary sinus in patients with cardiovascular diseases at rest and during isometric handgrip exercise

In order to evaluate cardiac sympathetic nerve activity, plasma norepinephrine levels in the coronary sinus (NECS) and in the artery (NEA) were determined in 24 subjects with cardiovascular diseases and in six with functional murmur. The resting NECS was greater than NEA in 14 subjects with normal left ventricular end-diastolic pressure (LVEDP) (p < 0.001) and/or in 22 with normal cardiac index (p < 0.04), whereas NECS was not significantly different from NEA in the remaining patients with elevated LVEDP and/or with reduced cardiac index. Isometric handgrip exercise increased both NECS and NEA (p < 0.001). When subjects were divided into two groups according to the slope of the ventricular function curve (delta stroke work index/delta LVEDP), NECS during exercise was greater then NEA in the group having slopes of 1.0 or more (p < 0.01), but neither values significantly differed in the group with slopes of less than 1.0. In the latter group, cardiac NE overflow rat calculated from the difference between NECS and NEA multiplied by coronary sinus plasma flow, was significantly less than that of the former group before and during handgrip (p < 0.05 and p < 0.01, respectively). These results suggest that cardiac norepinephrine release into the coronary sinus is reduced in patients with impaired cardiac function.

The effect of pericardium on the end-systolic pressure-segment length relationship in canine left ventricle in acute volume overload.

The effect of the pericardium on the end-systolic pressure-segment length relationship in the left ventricle was examined with an ultrasonic miniature gauge in open-chest dogs. In 12 dogs, blood was infused until left ventricular (LV) end-diastolic pressure reached about 20 mm Hg, and then the pericardium was opened widely. In the other 12 dogs a pericardiectomy was performed without blood infusion. Stroke volume was measured in six dogs in the former group and in seven dogs in the latter group. After blood infusion, LV systolic, end-systolic, and end-diastolic pressures increased from 120 +/- 14 to 162 +/- 16 mm Hg (mean +/- SD), from 106 +/- 13 to 146 +/- 17 mm Hg, and from 8 +/- 2 to 19 +/- 2 mm Hg, respectively (all p less than .01). End-systolic and end-diastolic segment lengths increased from 8.9 +/- 2.1 to 10.6 +/- 2.2 mm and from 11.6 +/- 2.5 to 14.9 +/- 2.7 mm, respectively (both p less than .01). After pericardiectomy, the segments were further lengthened by 8.9 +/- 4.4% and by 10.0 +/- 6.2%, respectively (both p less than .01). Heart rate, LV systolic and end-systolic pressures, and peak positive dp/dt did not change, although end-diastolic pressure fell from 19 +/- 2 to 18 +/- 2 mm Hg (p less than .01). Stroke volume rose from 13.1 +/- 3.7 to 23.9 +/- 5.0 ml due to volume loading and further increased by 26.7 +/- 9.0% after pericardiectomy.(ABSTRACT TRUNCATED AT 250 WORDS)