Maximum Diastolic Pressure Research Articles

Lymphocytes and monocytes subpopulation composition in peripheral blood in patients with atrial fibrillation and futter

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): NSC "Institute of cardiology, clinical and regenerative medicine named by acad. Strazhesko" NAMS of Ukraine The purpose of the trial is to compare the state of intracardiac and systemic hemodynamics in patients with paroxysmal and persistent forms of atrial fibrillation and flutter that appeared on the base of arterial hypertension, depending on the lymphocytes and monocytes subpopulation composition in peripheral blood. Materials and methods The study involved 103 patients with atrial fibrillation and flutter and were divided into three main groups: I – with paroxysmal form of atrial fibrillation, II – with a persistent form of atrial fibrillation, III – with a persistent form of atrial flutter. The subpopulation composition of lymphocytes and monocytes in peripheral blood was assessed by the method of flow cytometry. Hemodynamic parameters were evaluated using echocardiography, office blood pressure measurement, daily blood pressure monitoring, and transesophageal echocardiography. For control, the data of patients with hypertension but without the above-mentioned arrhythmias were used, and practically healthy people who entered groups IV and V, respectively. Results and discussion The number of cells with cytotoxic activity (NK and T-NK) in both absolute and percentage values was significantly higher in groups with arrhythmia than in practically healthy individuals. A mathematically significant decrease of T-regulatory cells number (p ≤0.05) in the second and third groups compared to the control groups was detected, same as increased number of classical and intermediate monocytes fractions. Comparing echocardiogram results indicators between groups I, II, III and I V, a mathematical significant difference (p≤0.05) between the LVID was revealed: LVIDd, LVEDV, LVESV, IVS, PW thickness; LA AP, RVmid diameter at end-diastole, E/A and LVMI. Compared to V the group difference was significant only between LVIDd, LA AP size, IVS thickness, and PW thikness. Office systolic blood pressure was significantly higher in patients with arrhythmias. According to daily blood pressure monitoring, the difference between the indicators of average and maximum diastolic pressure was significant. Conclusions In patients with atrial fibrillation and flutter as a result of hypertension, compared to patients without arrhythmias or healthy people, there is an increased content of pro-inflammatory monocytes subpopulation, T-cytotoxic cells and a decreased amount of T-regulatory cells. According to EchoCG, these patients had more severe structural changes in the myocardium: an increased LA AP and LV hypertrophy, a thickening of IVS and PW, and diastolic dysfunction. The recorded measurement indicators of SBP and DBP differed mathematically significantly, which indicates hemodynamic disorders caused by both rhythm disturbances and manifestations of arterial hypertension.

S- and P-type cobra venom cardiotoxins differ in their action on isolated rat heart.

Background: The cardiovascular system is one of the first systems to be affected by snake toxins; but not many toxins exert a direct effect on the heart. Cobra venom cardiotoxins are among those few toxins that attack the heart. Although the two cardiotoxin types (S and P) differ in their central-loop structure, it is not known whether they differ in their effect on the mammalian heart. We compared the effects of S- and P-type cardiotoxins, CTХ-1 and CTХ-2, respectively, from the cobra Naja oxiana, on the isolated rat heart. Methods: An isolated rat heart perfused according to the Langendorff technique was used in this study to investigate the activity of cardiotoxins CTX-1 and CTX-2. The following parameters were registered: the left ventricular developed pressure, calculated as the difference between systolic and diastolic pressure in the left ventricle, the end-diastolic pressure, the heart rate, time to maximal end-diastolic pressure (heart contracture), and time to depression of the heart contraction.Results: Both cardiotoxins at the concentration of 5 μg/mL initially produce a slight increase in systolic intraventricular pressure, followed by its rapid decrease with a simultaneous increase in diastolic intraventricular pressure until reaching contracture. CTX-2 blocks cardiac contractions faster than CTX-1; in its presence the maximum diastolic pressure is reached faster and the magnitude of the developed contracture is higher.Conclusion: The P-type cardiotoxin CTX-2 more strongly impairs rat heart functional activity than the S-type cardiotoxin CTX-1, as expressed in its faster blockage of cardiac contractions as well as in more rapid development and greater magnitude of contracture in its presence.

Clinical risk factors associated with recurrence of ischemic stroke within two years: A cohort study.

To identify the clinical risk factors and investigate the efficacy of a classification model based on the identified factors for predicting 2-year recurrence after ischemic stroke.From June 2017 to January 2019, 358 patients with first-ever ischemic stroke were enrolled and followed up in Shenzhen Traditional Chinese Medicine Hospital. Demographic and clinical characteristics were recorded by trained medical staff. The outcome was defined as recurrence within 2 years. A multivariate logistic regression model with risk factors and their interaction effects was established and evaluated.The mean (standard deviation) age of the participants was 61.6 (12.1) years, and 101 (28.2%) of the 358 patients were female. The common comorbidities included hypertension (286 patients, 79.9%), diabetes (148 patients, 41.3%), and hyperlipidemia (149 patients, 41.6%). The 2-year recurrence rate was 30.7%. Of the 23 potential risk factors, 10 were significantly different between recurrent and non-recurrent subjects in the univariate analysis. A multivariate logistic regression model was developed based on 10 risk factors. The significant variables include diabetes mellitus, smoking status, peripheral artery disease, hypercoagulable state, depression, 24 h minimum systolic blood pressure, 24 h maximum diastolic blood pressure, age, family history of stroke, NIHSS score status. The area under the receiver operating characteristic curve (ROC) was 0.78 (95% confidence interval: 0.726–0.829) with a sensitivity of 0.61 and a specificity of 0.81, indicating a potential predictive ability.Ten risk factors were identified, and an effective classification model was built. This may aid clinicians in identifying high-risk patients who would benefit most from intensive follow-up and aggressive risk factor reduction.The clinical trial registration number: ChiCTR1800019647

Prognostic value of exercise tolerance test for predicting cardiovascular disease in asymptomatic individuals with heterozygous familiar hypercholesterolemia.

Heterozygous familiar hypercholesterolemia (hFH) is an autosomal dominant inherited dyslipidemia, associated with premature cardiovascular disease (CVD). Aim of the study was to define prognostic factors for cardiovascular events (CVE) in asymptomatic individuals with hFH. All participants with recent diagnosis of hFH were recruited from the outpatient lipid clinic from 1987 to 2016, without any previous clinical evidence of CVD. A detailed clinical evaluation and laboratory investigation was obtained. Exercise tolerance test (ETT) was performed until maximum exercise capacity was achieved, without evidence of ischemia. Primary endpoint of the study was the first CVE. Four hundred fifty one participants were followed up for 10 ± 8years, with 68 recorded cases of CVD (15%). Cumulative incidence of CVD was 15%, 24% and 32% for the 3 decades, respectively. In univariate analysis, male gender (p = 0.016), progression of age (p < 0.001), menopause (p = 0.030), waist-hip ratio (p = 0.043) and increased levels of Lp(α) (p = 0.014) were significantly associated with increased CVD incidence; whereas, exercise capacity (p = 0.025), low variation of heart rate (HR) during all stages of ETT compared to resting state (p = 0.020), maximum systolic (p = 0.014) and diastolic (p < 0.001) blood pressure were inversely associated with CVD. In multi-adjusted analysis, male gender (p < 0.001), duration of ETT (p = 0.023), estimated HR (p = 0.029), variation of HR during ETT compared to resting state (p < 0.05) and maximum diastolic pressure (p = 0.044) were significantly associated with CVD. Parameters of ETT in asymptomatic individuals with hFH, without any evidence of ischemia, may predict CVD in these high-risk patients after decades of observation.

Respiratory waveform variation can prevent pulsus paradoxus measurement by sphygmomanometry

Background: Pulsus paradoxus (PP) represents increased fluctuation of systolic pressure during the respiratory cycle. PP increases in pathologic conditions, including asthma and other obstructive airways diseases. Respiratory waveform variation (RWV) represents arterial-waveform baseline variability resulting from intra-pleural pressure changes during the respiratory cycle in the presence of airway obstruction. It is not known whether RWV influences manual PP measurement using a sphygmomanometer and stethoscope. Methods: We performed an observational study in six healthy adults. Participants performed tidal-breathing through a breathing apparatus with pre-determined inspiratory (0–45.6 cm H2O) and expiratory (0–24.4 cm H2O) resistance levels for a total of 23 data sets per participant. PP was measured from continuous radial artery pressure recordings as the absolute difference between maximum and minimum systolic pressure levels during a complete respiratory cycle. Results: In this study, PP values measured without applied airway resistance exceeded 10 mmHg, the traditional definition of PP, in five of the six participants. Manual measurement of PP would not be possible at greater RWV because the maximum diastolic pressure exceeded minimum systolic pressure during RWV. Conclusions: PP in normal adults may exceed 10 mmHg, and RWV may be of sufficient magnitude to preclude manual PP measurement.

134 Quantifying recurrence risk of preeclampsia in a population-based cohort: Effects of first pregnancy maximum diastolic pressure

Preeclampsia (PE) is a major source of maternal and fetal morbidity that affects 2.5% to 3.0% of all pregnancies. Recurrence estimates range from 0% to 67%. Such a wide range imposes a difficult challenge in counseling future pregnancies, and so a better assessment of pertinent risk factors for recurrence in the individual patient is required. We aim to estimate the recurrence risk of preeclampsia (PE) in the 2nd pregnancy and investigate the influence of first pregnancy maximum diastolic pressure and additional risk factors. We studied a linked cohort of 1st and 2nd pregnancies of 272.551 women from the Dutch Perinatal Registry collected between 2000 and 2007. We defined PE as hypertension (diastolic blood pressure >90 mmHg) plus proteinuria (>300 mg/24 h), included recorded PE cases and analysed the PE recurrence rate using logistic regression. To avoid potential listwise deletion bias, multiple imputation of missing maximum diastolic blood pressure data was used. Gestational and maternal ages, multiple pregnancy, chronic hypertension, diabetes, ethnicity and socioeconomic status were considered as covariates. The overall PE prevalences in the 1st and 2nd pregnancies were 2.4% and 0.9%, respectively. In the 2nd pregnancy the prevalence of PE was 10.4% for women with prior preeclampsia. Early onset PE in the 1st pregnancy with delivery before the 34th week was associated with increased recurrence risk proportional to the maximum diastolic blood pressure (DBP) in the 1st pregnancy: for DBP between 90 and 100 mmHg the recurrence risk was 15% (95% CI 11.1–20.6%) while for DBP above 110 mmHg the risk was 26.6% (95% CI 21.6–32.3%). For women with increased maximum DBP but no history of preeclampsia the corresponding rates were 2.2% (95% CI 2.0–2.4%) and 6.3% (95% CI 5.3–7.5%). The overall chance of recurrence of preeclampsia is 10.4%. Early onset preeclampsia complicated by severe hypertension increases this rate to about one in four. Severe hypertension in the 1st pregnancy in women that did not present preeclampsia is a major risk factor for preeclampsia in the following pregnancy. This knowledge can improve patient and physician awareness of the individual risks of occurrence and recurrence of preeclampsia which are fundamental for the proper management of subsequent pregnancies.

47 Quantifying recurrence risk of preeclampsia in a population-based cohort: Effects of first pregnancy maximum diastolic pressure

Introduction Preeclampsia (PE) is a major source of maternal and fetal morbidity that affects 2.5–3.0% of all pregnancies. Recurrence estimates range from 0% to 67%. Such a wide range imposes a difficult challenge in counseling future pregnancies, and so a better assessment of pertinent risk factors for recurrence in the individual patient is required. Objective We aim to estimate the recurrence risk of preeclampsia (PE) in the 2nd pregnancy and investigate the influence of first pregnancy maximum diastolic pressure and additional risk factors. Methods We studied a linked cohort of 1st and 2nd pregnancies of 272.551 women from the Dutch Perinatal Registry collected between 2000 and 2007. We defined PE as hypertension (diastolic blood pressure >90 mmHg) plus proteinuria (>300 mg/24 h), included recorded PE cases and analysed the PE recurrence rate using logistic regression. To avoid potential listwise deletion bias, multiple imputation of missing maximum diastolic blood pressure data was used. Gestational and maternal ages, multiple pregnancy, chronic hypertension, diabetes, ethnicity and socioeconomic status were considered as covariates. Results The overall PE prevalences in the 1st and 2nd pregnancies were 2.4% and 0.9%, respectively. In the 2nd pregnancy the prevalence of PE was 10.4% for women with prior preeclampsia. Early onset PE in the 1st pregnancy with delivery before the 34th week was associated with increased recurrence risk proportional to the maximum diastolic blood pressure (DBP) in the 1st pregnancy: for DBP between 90 and 100 mmHg the recurrence risk was 15% (95% CI 11.1–20.6%) while for DBP above 110 mmHg the risk was 26.6% (95% CI 21.6–32.3%). For women with increased maximum DBP but no history of preeclampsia the corresponding rates were 2.2% (95% CI 2.0–2.4%) and 6.3% (95% CI 5.3–7.5%). Conclusion The overall chance of recurrence of preeclampsia is 10.4%. Early onset preeclampsia complicated by severe hypertension increases this rate to about one in four. Severe hypertension in the 1st pregnancy in women that did not present preeclampsia is a major risk factor for preeclampsia in the following pregnancy. This knowledge can improve patient and physician awareness of the individual risks of occurrence and recurrence of preeclampsia which are fundamental for the proper management of subsequent pregnancies.

Fatores preditivos de hipertensão gestacional em adolescentes primíparas: análise do pré-natal, da MAPA e da microalbuminúria

To quantify PH prevalence in primiparous adolescents; define predictive factors for the occurrence of PH and its impact on newborns. We followed 29 primiparous adolescents from the prenatal period through the 12th week of the puerperium, with a mean of sixteen years of age, served at the Outpatient Facility for Adolescents of Maternidade Escola Assis Chateaubriand (MEAC) of Universidade Federal do Ceará (Fortaleza, Brazil). The pregnant adolescents were divided into two groups, that is, those who remained normotensive (Group I) and those who developed PH (Group II). The variables investigated in the assessment of the value of predictability for the development of PH were anthropometric measures, socioeconomic aspects, smoking habit, inheritance for SAH (father/mother), prenatal tests requested in the first prenatal care visit in addition to microalbuminuria and ambulatory blood pressure monitoring (ABPM) in the 28th week of gestation. The pregnant adolescents were followed up at delivery and late puerperium (12th week after the puerperium). The newborns to the mothers included in our study were assessed at birth according to the Apgar score and the Capurro method, for weight, height and perinatal hypoxia. The prevalence of PH was 51.7%. Inheritance for SAH presented the highest predictive value for PH with an odds ratio of 10.99. Diastolic arterial pressure equal to or above 70 mmHg at the gestational age of 35 weeks was statistically significant as a predictive value for PH. At ABPM we found a predictive value for PH: diastolic pressure load during alertness, diastolic and systolic pressure load during night sleep, pressure variability and maximum diastolic pressure during sleep. Specifically a maximum diastolic arterial pressure (DAP) at ABPM during the period of night sleep (3)64 mmHg presented an odds ratio of 6 for PH with a sensitivity of 80% and a specificity of 60% for the development of PH. The research for PH predictive factors in primiparous adolescents showed to be easy to apply and useful to stratify high-risk pregnant women as regards the development of PH.

Activation of alpha 1-adrenoceptors is not essential for the mediation of ischaemic preconditioning in rat heart.

1. The aim of the present study was to clarify the role of alpha1-adrenoceptors in the mechanism of ischaemic preconditioning (IP). 2. Rat isolated perfused hearts were either non- preconditioned, preconditioned with 5 min ischaemia or treated for 5 min with alpha1-adrenoceptor agonists (50 micromol/L phenylephrine; 0.1, 0.5 and 1 micromol/L methoxamine) before being subjected to 45 min of sustained ischaemia followed by 60 min reperfusion. 3. Within each of the above protocols, hearts were divided into groups to which alpha1-adrenoceptor antagonists (prazosin, 5'-methyl urapidil and chloroethylclonidine (CEC)) were administered. Functional recovery and infarct size were used as indices of the effects of ischaemia. Ischaemic contracture characteristics and maximal diastolic pressure during reflow were also assessed. 4. Blockade of alpha(1)-adrenoceptors with prazosin or the subtype-selective antagonists 5'-methyl urapidil and CEC did not abolish the protective effect of IP with respect to both functional recovery and infarct size reduction. 5. Protection afforded by phenylephrine was attenuated in hearts treated with prazosin or the alpha(1B)-adrenoceptor- selective antagonist CEC, but not in those treated with the alpha(1A)-adrenoceptor-selective antagonist 5'-methyl urapidil. 6. Treatment with low concentrations of methoxamine, considered to be alpha(1A)-adrenoceptor selective, did not confer any protection to the ischaemic myocardium. 7. A close relationship between accelerated ischaemic contracture and enhanced cardioprotection was observed. 8. The results suggest that alpha1-adrenoceptor stimulation mimics IP, but it is not an essential component in the mechanism behind the protective effect of IP in rat heart. In addition, the present study demonstrates that stimulation of the alpha(1B)- but not the alpha(1A)-adrenoceptor subtype is responsible for the catecholamine-induced protection of ischaemic myocardium in rat.

Effect of nifedipine on cystometry-induced elevation of blood pressure in patients with a reflex urinary bladder after a high level spinal cord injury

In 10 patients with a reflex urinary bladder after a cervical or high thoracic spinal cord injury, the effect of nifedipine on the cystometry-induced elevation of blood pressure was studied. The blood pressure was measured every 30 s in four consecutive cystometries before and after administration of 10 mg nifedipine sublingually. In each patient there was a decrease in the maximum systolic and diastolic blood pressure after the administration of nifedipine. In the whole group the mean maximum systolic pressure decreased significantly from 147 mmHg (range 119-165, SD 14) to 118 mmHg (range 99-145, SD 14). The mean maximum diastolic pressure decreased from 110 mmHg (range 96-124, SD 10) to 83 mmHg (range 71-99, SD 10). The effect of nifedipine was significant in each of the four cystometries that were performed. The decrease in blood pressure was due to both a significant decrease of the baseline pressure and a significant decrease of the blood pressure reaction during cystometry. Nifedipine may be useful in order to prevent dangerous blood pressure reactions, e.g. during cystoscopy and other diagnostic or therapeutic procedures in spinal cord injured patients with autonomic dysreflexia.

Hypertension during reduction of long-term steroid therapy in young subjects with asthma

Corticosteroids can induce hypertension, which reportedly remits as the drug is withdrawn. We studied nine patients with steroid-requiring asthma, aged 9 to 16 years, who had elevated blood pressures during corticosteroid treatment. Unlike in previous studies, all nine patients developed hypertension during corticosteroid reduction. Diastolic blood pressures were 50 to 84 mm Hg during maximum corticosteroid therapy (1 to 4 mg/kg/day); these values were in the normal range for seven of the nine patients and in the high normal range for the other two patients. Maximum diastolic pressures were 100 to 120 mm Hg, 1 to 8 weeks after corticosteroid reduction was started. Hypertension occurred at 0% to 70% of their maximum corticosteroid dose. Corticosteroid reduction was the only medication change. Renal causes of hypertension were excluded. Six patients had levels of renin and aldosterone measured before onset of treatment. All six patients had elevated levels of renin, and five patients had elevated levels of aldosterone. Blood pressure elevations were resistant to diuretic therapy but responded rapidly to angiotensin-converting enzyme inhibitors. Caretakers of subjects with asthma need to be aware that hypertension may occur both during maximum corticosteroid use and during corticosteroid reduction.

Pulmonary artery pressure and activities in chronic heart failure

Long-term continuous pulmonary artery pressure monitoring was used to investigate pressure changes during different types of exercise and normal daily activities in patients with chronic heart failure. Nine men (mean age 55 years) with treated chronic heart failure underwent continuous pulmonary artery pressure measurement with use of a micromanometer-tipped catheter with in vivo calibration and frequency-modulated recording.The mean (± SD) maximal systolic pulmonary artery pressure (in mm Hg) was 59.4 ± 26.1 on treadmill exercise, 54.9 ± 30.6 on bicycle exercise, 52.5 ± 26.1 walking up and down state and 43.5 ± 23.9 walking on a flat surface. The mean maximal diastolic pressure (in mm Hg) was 27.8 ± 14.6 on treadmill exercise, 25.5 ± 14.9 on bicycle exercise, 24.9 ± 14.8 walking up and down stairs and 20.4 ± 12.5 walking on a flat surface. The increase in pulmonary artery pressure did not correlate with the severity of the limiting symptoms except during walking on a flat surface.All patients had marked postural changes in pressure, with the systolic pressure difference from lying to standing ranging from 8 to 25 mm Hg and the diastolic pressure difference ranging from 3 to 13 mm Hg. Eating meals caused an increase in pressure in three patients, but less than that when lying flat. There was an increase in pressure during urination in four patients equal to that when walking on a flat surface. None of these activities was associated with symptoms.Neither symptoms nor pulmonary artery pressure during maximal exercise is the same as during daily activities. This may restrict the value of maximal exercise tests in assessing patients with chronic heart failure.

REVISED DEFINITION OF PRE-ECLAMPSIA

Different measures of raised blood pressure were analysed in 16 211 singleton pregnancies to determine the most effective way of identifying pre-eclampsia. Increments from baseline in the first half of pregnancy were considered as well as absolute levels. A combination of a high maximum diastolic pressure with a large increase from baseline was better for identifying a group with pre-eclamptic features than either measurement on its own. A first diastolic pressure below 90 mm Hg, a subsequent increase of at least 25 mm Hg, and a maximum reading of at least 90 mm Hg gave appropriate criteria. These were applied to a second set of 15 624 singleton pregnancies and successfully identified a group with pre-eclamptic features. Fewer women were identified as pre-eclamptic than with criteria modified from an existing definition widely used in Britain. The women excluded by the new criteria had the features of mild chronic hypertension rather than pre-eclampsia. The new definition is simple to use but like all other definitions of pre-eclampsia cannot be precise.

Blood pressure in the midtrimester and future eclampsia

The purpose of this report was to investigate the potential usefulness of average mean arterial pressure, maximal mean arterial pressure, and maximal diastolic pressure during the second trimester in predicting the development of eclampsia in 207 nulliparas and 20 multiparas with eclampsia. In the nulliparas, both the mean arterial pressure and the maximal mean arterial pressure during the second trimester were greater than or equal to 90 mm Hg in 22% and 34% of the patients, respectively. For the multiparas, the percentages with greater than or equal to 90 mm Hg were 30% and 35%, respectively. Only 8.7% of nulliparas with eclampsia had a maximal diastolic pressure during the second trimester greater than or equal to 80 mm Hg and no patient had a diastolic pressure of greater than or equal to 90 mm Hg. A review of the literature suggests that the mean arterial pressure observed during the second trimester has poor predictive value for future development of preeclampsia-eclampsia. We conclude that there is no correlation between second-trimester blood pressure recordings and subsequent eclampsia.

Penbutolol and molsidomine synergism in angina pectoris. A double blind ergometric trial

In order to test the additional efficacy of the combination of a beta blocker (penbutolol 40 mg single dose) with molsidomine (2 mg single dose), a double blind cross-over trial was performed in 30 patients with stable angina pectoris. Stress tests were done before and 1 h after the beta blocker alone and the combination therapy. Some training effect could be detected on comparing results from the first and second days. Combined therapy showed a better response of resting systolic arterial pressure, resting and maximal diastolic pressure, heart rate gain (from rest to maximal effort) and particularly in the angina severity score. All of these variables changed significantly in comparison to the beta blocker alone, 46 out of 60 post-drug ergometric studies were negative; of the 14 positive tests, 11 followed the beta blocker and only 3 the combined therapy. The combination of a preload reducer molsidomine and a beta blocker may be adequate for patients only partially compensated or with cardiomegaly and/or a depressed ejection fraction.

Right ventricular pressure response to +GZ acceleration stress.

Measurements of right ventricular pressure in miniature swine were made at +Gz levels from +1 through +9 Gz. Polyethylene catheters were chronically placed in the cranial vena cava of five 2-yr-old female miniature swine (35-50 kg). The catheters were large enough to allow the introduction of a Millar pressure transducer into the venous system for placement in the right heart. The animals were fitted with an abdominal anti-G suit, restrained in a fiberglass couch, and exposed to the various +Gz levels on a centrifuge while fully conscious and unanesthetized. Right ventricular pressure and heart rate were measured during and for 2 min following 30-s exposures to each level of +Gz stress. The maximum right ventricular systolic pressure observed during +Gz was 200 Torr at +5 Gz with the maximum diastolic pressure being 88 Torr observed at +5 Gz. Mean heart rates were 200-210 beats/min at all levels of +Gz greater than or equal to +3 Gz when the animal remained stable. Mean maximum right ventricular pressures during +Gz stress were observed to increase through +5 Gz (85 Torr) and to decrease at higher levels of +Gz, indicating that through +5 Gz there is at least a partial compensation during acceleration stress. Decompensation in response to the stress began to occur during acceleration above +5 Gz with all animals decompensating during +9 Gz.

Relation between left ventricular filling pressure and angiographic findings in coronary heart disease. Ventriculography used as a stress test.

In 80 male patients with coronary heart disease maximum diastolic pressure in the left ventricle (LVMDP) (usually the top of the a wave), and 'post a' end-diastolic pressure (LVEDP) before and 2 and 3 minutes after ventriculography were correlated to angiographic estimates of left ventricular function (aneurysm, ejection fraction (EF), and to lesions shown by selective coronary arteriography using a score system (coronary artery lesions index, CALI). A significant correlation between CALI and LVEDP (or LVMDP) could not be shown either before or after ventriculography. Before ventriculography, however, LVEDP and LVMDP were good predictors of left ventricular dyskinesia (aneurysm and/or EF less than 50%). A positive and significant correlation between CALI and the LVEDP (and LVMDP) increments following ventriculography (delta LVEDP, delta LVMDP) was found in patients with LVEDP (or LVMDP) below 12 mmHg before ventriculography. Using delta LVEDP the correlation coefficient was 0-51 (n = 41, P less than 0-001, 95 per cent confidence interval 0-24 to 0-88). Using delta LVMDP r = 0-47 (n = 41, 0-001 less than P less than 0-01). Delta LVEDP greater than 12 mmHg was found only in patients with triple vessel disease.