Unresponsive Group Research Articles

One-year real-life efficacy of sitagliptin revealed importance of concomitant pioglitazone use in Japanese patients with type 2 diabetes mellitus

Dipeptidyl-peptidase 4 inhibitors have become one of the most popular antidiabetic drugs. However, what kind of combinations with other drugs were advantageous was not known. Here, we tried to elucidate it in a real-life clinical setting. We retrospectively studied efficacies of sitagliptin in 87 Japanese patients with type 2 diabetes mellitus for 52 weeks. We divided subjects into excellent, effective and unresponsive subgroups according to glycemic responses to sitagliptin. In the excellent and effective groups the minimum HbA1c values were attained at 16 weeks while HbA1c levels in the unresponsive group kept increasing during the study period. There was a significant difference in the baseline HbA1c values between the excellent and unresponsive groups (p=0.02). Interestingly, the mean doses of pioglitazone were highest in the excellent group and lowest in the unresponsive group (p=0.02). When we compared the effective and unresponsive groups, the mean doses of sulfonylureas were constantly higher in the effective group than in the unresponsive group (p=0.05). These data suggest that the baseline HbA1c value can be a factor that predicts the extent of HbA1c reduction and reveal a possibility that the concomitant use of pioglitazone augments glycemic responsiveness to sitagliptin.

Long-term Results of Stellate Ganglion Block in Patients with Olfactory Dysfunction

BackgroundOlfactory dysfunction, including anosmia and hyposmia is difficult to treat. Although the mechanism is not well known, stellate ganglion block (SGB) is used to treat olfactory dysfunction. There are no prior studies on the long-term effects of SGB on olfactory dysfunction. The purpose of this study was to evaluate the continuity of therapeutic effects and patient satisfaction with SGB treatment.MethodsThis was a follow-up study carried out via a telephonic survey. The olfactory function of the patient was evaluated using a visual analog scale (VAS). We checked VAS three times: VAS-I (pre-treatment VAS), VAS-A (post-treatment VAS), and VAS-C (VAS at follow up telephone survey). We divided the subjects into 2 groups according to their responsiveness to SGB: the responsive (R group) and the unresponsive groups (UR group). Patient satisfaction was evaluated using a Likert scale.ResultsOut of the 40 subjects, 37 responded to the telephone survey. In the UR group, there was difference in the olfactory function. However, in the R group, there were significant VAS differences; VAS-I was 9.6 ± 0.7, VAS-A was 5.1 ± 4.2, and VAS-C was 2.7 ± 2.7 (P < 0.05). On the Likert scale, patient satisfaction was as follows: grade 1, 17 patients (45.9%); grade 2, 6 patients (16.2%); grade 3, 6 patients (16.2%); and grade 4, 8 patients (21.6%).ConclusionsSGB is a safe, long-lasting, and effective therapeutic modality for olfactory dysfunction treatment.

Heroin Maintenance Treatment - Are the Further Investigation Needed?

The aim of this review is to give new emphasis to key aspects of the proposed treatment of drug addiction. Surveys for so called “second-line” treatment of drug addiction, with heroin (diacetylmorphine) as a pharmaceutical preparation, started since 1990, but this issue is becoming particularly popular in the last period. Drug addiction according to WHO and International Classification of Diseases (ICD10) is chronic, relapsing disease characterized by compulsive drug seeking and use despite harmful consequences as well as neurochemical and molecular changes in the brain. Drugs generate crime, violence and other social problems that are damaging society as a whole. Drug addiction is medical disorder to which contributes more factors and it is necessary to implement the treatment in multi disciplinary manner - from pharmacological, psychiatric, and social aspect. In recent periods studies are carrying out in several countries in the European region, to provide justification, with the scientific medical evidence, for use of heroin as a pharmaceutical dosage form, for treatment of drug addictions for previously unresponsive group. This review paper is focused on maintenance treatment with heroin, retention of the patients into treatment, whether the dose that is expected to be effective at the same time is safe, which organ (systems) are involved in eliminating the drug from the body, whether the injection is the best way for application of the drug. Purpose of this review paper is not to be supporter or opponent, but to inform, transparently to discuss all aspects and to set conclusions about this type of treatment, within national strategy context.

Meta-analysis of clinical and radiological efficacy of biologics in rheumatoid arthritis patients naive or inadequately responsive to methotrexate

Our aim was to compare all eight biologics available for rheumatoid arthritis in two patient populations, methotrexate-naive patients and inadequate responders to methotrexate, based on a comprehensive literature review. The five TNFα antagonists, rituximab, abatacept and tocilizumab used with methotrexate were compared to methotrexate monotherapy using the ACR50 response as the primary clinical endpoint and absence of radiographic progression after 1 year as the primary radiological endpoint. Odds ratios (ORs) were computed, as well as the number needed to treat (NNT) to obtain an ACR50 response for each biologic. We included 22 studies. Overall, combined biologic therapy was significantly more effective than methotrexate alone in both the naive group (OR: 2.11; 95% confidence interval [95%CI], 1.85–2.41) and the unresponsive group (OR: 4.82; 95%CI: 3.83, 6.08). Crude NNTs were as follows: etanercept, five in the naive group and three in the unresponsive group; adalimumab, seven and three; infliximab, seven and five; abatacept, seven and four; rituximab, five and five; and tocilizumab and certolizumab, four in the unresponsive group. None of the differences was statistically significant. In the naive group, combined biologic therapy was associated with a higher rate of absence of radiographic progression after 1 year compared to methotrexate alone (OR: 2.19; 95%CI: 1.55–3.08). All biologics had approximately the same efficacy. Methotrexate-naive patients treated with biologics had significantly less radiographic progression than those with cellular therapy.

Abstract 3004: Biomarker identification through integrative bioinformatics analysis of serous epithelial ovarian cancer tumor samples

Abstract Ovarian cancer is the leading cause of death from gynecological malignancies and the fifth major cancer in women in the world. Once diagnosed, ovarian cancer is usually treated by cytoreductive surgery followed by platinum and taxane-based chemotherapeutic drugs. However, resistance to chemotherapy is a major impediment in management of serous epithelial ovarian cancer (SEOC). We hypothesize that a multifaceted view of the alterations taking place at multiple cellular levels using molecular profiling technologies will offer insight into the mechanisms which play key roles in drug resistant ovarian carcinomas. Also, the application of appropriate bioinformatic and statistical data processing and analysis is of utmost importance in identification of key drug resistance pathways. Current study is performed on 25 high-grade serous epithelial ovarian tumor tissue samples from patients that demonstrated favorable, or unfavorable response to chemotherapy treatment. Four different microarray platforms were used for molecular profiling of the full sample cohort at different molecular levels, namely: Single Nucleotide Polymorphisms (SNP), mRNA expression, miRNA expression and promotor tiling arrays (methylation)., Integrative and systematic analyses using up-to-date statistical approaches, such as empirical Bayes, AUC, SAM, permuted t-test and lassoed PCA, among others, have been employed on these large datasets obtained through the various high-throughput platforms. Preliminary mRNA expression analysis identified an enrichment of upregulated genes involved in cellular growth and proliferation, cellular development as well as differential gene expression changes in the TGFB1, TNF, PI3K, IFNG networks, between the chemotherapy responsive and unresponsive groups. The major molecular and cellular functions associated were cell-to-cell signaling, molecular transport and cellular movement. Differences were also seen in the, CTNNB1, LH and FSH networks as analysed by Ingenuity Pathway Analysis. Additionally, genes involved in activation of NFκB pathway showed differential expression in the two groups. Furthermore, our ongoing development of a streamlined database in which the multiple data types obtained from our statistical analyses are stored, will allow for localized or genome wide querying across the multiple levels of biological data. These approaches and software will potentially elucidate the synergistic roles that the various biological levels play in the deregulation of pathways involved in primary chemoresistance. Our research findings will lead to the determination of putative candidates for diagnostic and prognostic biomarkers that can be targeted for development of treatment regimens for the treatment of SEOC. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 3004. doi:1538-7445.AM2012-3004

Genetic basis of apnoea of prematurity and caffeine treatment response: role of adenosine receptor polymorphisms

Caffeine treatment reduces the frequency of apnoea of prematurity (AOP) and eliminates the need for mechanical ventilation by acting as a nonspecific inhibitor of adenosine A1 and adenosine 2A receptors. Patients with AOP have demonstrated variant responses to caffeine therapy. We proposed to investigate the role of A1 and 2A polymorphisms in the development of AOP and individual differences in caffeine response. Secondly, we aimed to determine whether these polymorphisms have any effect on bronchopulmonary dysplasia (BPD) development. Cord blood samples were collected from infants born with gestational ages between 24 and 34 weeks. Two groups were defined: patients without apnoea (n = 60) and patients with apnoea (n = 55). Patients with apnoea were divided into two subgroups: a caffeine-responsive group (n = 30) and an unresponsive group (n = 25). Six single-nucleotide polymorphisms were chosen for genotyping. Patients with apnoea over 28 weeks of gestational age who responded to the caffeine treatment were found to carry the rs16851030 C/C genotype rather than the C/T or T/T genotype. Logistic regression analysis showed a significant correlation between rs35320474-C/T and T/T genotypes and apnoea and BPD development. Our results indicate a role for adenosine receptor gene polymorphisms in susceptibility to AOP and BPD and in interindividual variability to caffeine response.

Understanding heterogeneity in price elasticities in the demand for alcohol for older individuals.

This paper estimates the price elasticity of demand for alcohol using Health and Retirement Study data. To account for unobserved heterogeneity in price responsiveness, we use finite mixture models. We recover two latent groups, one is significantly responsive to price, but the other is unresponsive. The group with greater responsiveness is disadvantaged in multiple domains, including health, financial resources, education and perhaps even planning abilities. These results have policy implications. The unresponsive group drinks more heavily, suggesting that a higher tax would fail to curb the negative alcohol-related externalities. In contrast, the more disadvantaged group is more responsive to price, thus suffering greater deadweight loss, yet this group consumes fewer drinks per day and might be less likely to impose negative externalities.

Determination of intracellular Th1/Th2 type cytokines in lymphocytes of chronic hepatitis B patients treated with interferon-alpha

Host-related immune factors in childhood chronic hepatitis B and change in the initial profile with interferon (IFN)-α treatment need to be clarified. Sixteen patients were included in the study, and 10 million units of IFN-α treatment 3 times per week for 6 months was initiated. Pre- and post-treatment percentages of interleukin (IL)-2 and IFN-γ in CD4+ T cells were assessed to determine intracellular T helper cell 1 (Th1) type cytokine expression. Similarly, percentages of intracellular IL-2 and IFN-γ were detected to verify cytotoxic T cell 1 (Tc1) type cytokine expression in CD8+ T cells. Percentages of Th2 and Tc2 type cytokine expression (IL-4 and IL-13) were determined in CD4+ and CD8+ T cells, respectively. Six (50%) of these were evaluated as having no response and the other half with partial/complete response. All patients had higher percentages of Th2 cells with respect to healthy controls pre-treatment. Tc percentages, both Tc1 and Tc2, were significantly different between these groups, being higher in the patient group. When values of the nonresponder group were compared with healthy controls, IL-4 expression was higher and the percentages of Th1 type cells were significantly low. IL13 expression in Th and Tc cells decreased after 6 months of treatment in the unresponsive group. The decrease we observed in Th1 percentages with treatment, in the responsive group, may be due to Th1 deposition shifting from the periphery to liver tissue, as reported before. Intracellular cytokine profiles of treatment responders and normal controls were not different. This is the first study in children comparing baseline and post-treatment intracellular cytokine profiles with values in healthy controls.

Predictive Factors for Recovery from Acute Urinary Retention after Non-Urogenital Surgery

Purpose: We performed this study to investigate the predictive factors that are related to recovery from acute urinary retention after non-urogenital surgery. Materials and Methods: We retrospectively analyzed the records of 160 patients who were referred to the department of urology because of lasting acute urinary retention after non-urogenital surgery at our institution between January 2004 and December 2006. Patients were divided into two groups: a transient retention group, which included patients who recovered voiding capability after urinary catheterization for 7 days, and the unresponsive retention group, which included patients who did not recover voiding capability. Surgical factors, patient factors, use of patientcontrolled analgesia (PCA), amount of residual urine, and medications during catheterization were analyzed. Results: In the chi-square analysis, gender (female, p=0.006), age (60 years old, p4,000 ml, p=0.002), and intraoperative indwelling of Foley catheter (p=0.026) were found to differ significantly between the two groups. In the multivariate logistic regression analysis, gender (female, p=0.002; OR=5.6), age (60 years old, p=0.001; OR=5.9), hypertension (p=0.049; OR=2.6), location of surgery (pelvic cavity, p4,000 ml, p=0.001; OR=8.5) were found to increase the risk of unresponsive urinary retention. The residual urine volume of the unresponsive urinary retention group was larger than that of the transient urinary retention group (741306 ml vs. 614222 ml, p=0.003). Conclusions: Use of a preoperative indwelling catheter and careful management of urination is necessary to prevent unresponsive urinary retention in patients with risk factors such as female gender, old age, hypertension, surgery in the pelvic cavity, and a large amount of intraoperative fluid injection.

Plasma Brain-Derived Neurotrophic Factor as a Peripheral Marker for the Action Mechanism of Antidepressants

Numerous studies have demonstrated that depression is associated with a decreased expression of brain-derived neurotrophic factor (BDNF). BDNF shows antidepressant-like effects in animal models. Therefore, we tested the hypothesis that BDNF might be a peripheral marker for the mechanism of action of antidepressant agents in humans. Thirty-two patients meeting the DSM-IV criteria for major depressive disorder and 50 normal control subjects were recruited for this study. Plasma BDNF levels and Hamilton Depression Rating Scales were measured at baseline and 6 weeks after antidepressant administration. At baseline, the mean plasma BDNF level was lower in the depressive patients (698.1 ± 537.7 pg/ml) than in the control subjects (830.7 ± 624.8 pg/ml), although the difference was not statistically significant (p = 0.33). The plasma BDNF levels in depressive patients significantly increased from 698.1 ± 537.7 to 1,028.9 ± 744.5 after 6 weeks of antidepressant treatment (p = 0.01). Moreover, plasma BDNF levels were significantly increased after 6 weeks of treatment in the responder group, while there was no statistically significant change in the unresponsive group. These results suggest that the therapeutic response after antidepressant administration might be attributable to the increase in BDNF levels. BDNF may play a critical role in the action mechanism of antidepressant drugs. Further studies with a larger number of subjects are needed to verify these findings.

Abstract 1809: Survival And Neurologic Recovery In Patients With ST-Elevation Myocardial Infarction Resuscitated From Cardiac Arrest

Methods: We examined records of 2290 consecutive patients at our institution suspected of having ST-Elevation myocardial infarction (STEMI) from 1/1/02 to 12/31/06. Our study group comprised 99 STEMI patients resuscitated from cardiac arrest who were taken for emergent catheterization. Percutaneous coronary intervention was performed in 66, bypass surgery in 12, and 21 have neither. Endpoints were in-hospital death and neurologic recovery. Logistic regression was used for analysis. Results: Overall 64 (65%) survived and 35 (35%) died. Full neurologic recovery was seen in 59 (92%) of the survivors. On evaluation before catheterization: 25 were alert , 14 were minimally responsive to pain and stimuli, 60 were unresponsive . Patients in the latter two groups were intubated. In the unresponsive group (n=60), 27 survived (45%) and 33 died. Full neurologic recovery was seen in 23/27 survivors (85%). Predictors of death and neurologic recovery are shown in Table 1 and Table 2 . Table 1: Logistic Regression for Death For the Entire Group (c index = 0.894), N= 99 Table 2: Logistic Regression for Death for the Unresponsive Group (c index = 0.898), N=60

Effect of pinitol on glucose metabolism and adipocytokines in uncontrolled type 2 diabetes

Pinitol (3- O-methyl- d-chiro-inositol) was identified in putative insulin mediator fractions that have hypoglycemic activity, and appears to mimic the act effects of insulin by acting downstream in the insulin signaling pathway. We evaluated the effect of pinitol therapy in type 2 diabetic patients who were poorly controlled with hypoglycemic drugs, such as sulfonylurea, metformin and/or insulin. Twenty type 2 diabetic patients were enrolled in our study. Fasting glucose, fasting c-peptide, total cholesterol, triglyceride, and HDL- and LDL-cholesterol were checked before and after a 12-week pinitol treatment (20 mg kg −1 day −1). All subjects continued their current medications during the study. Adipocytokines, such as adiponectin, leptin, free fatty acids, and c-reactive protein (CRP) were checked before and after pinitol treatment. After pinitol treatment, fasting glucose, post-prandial glucose levels, and hemoglobin A1c were significantly decreased ( P < 0.05). Fasting serum adiponectin, leptin, free fatty acid, and CRP levels did not change after pinitol treatment. In the unresponsive group, serum c-peptide levels were higher than in the responsive group. Twelve weeks of pinitol treatment altered glucose metabolism, but not lipid profiles or adipocytokine levels, in type 2 diabetic patients. Additional research is needed to define the physiological and potential therapeutic effects of pinitol administration.

Difference between hypoglossal and phrenic activities during lung inflation and swallowing in the rat

We aimed in this study to elucidate the discharge properties and neuronal mechanisms of the dissociation between hypoglossal and phrenic inspiratory activities in decerebrate rats, which had been subjected to neuromuscular blockade and artificially ventilated. The discharge of the hypoglossal nerve and the intracellular activity of hypoglossal motoneurones were monitored during respiration and fictive-swallowing evoked by electrical stimulation of the superior laryngeal nerve, and were compared with the activity of the phrenic nerve. The hypoglossal nerve activity was characterized by its onset preceding the phrenic nerve activity ('pre-I' activity). By manipulating artificial respiration, we could augment the 'pre-I' activity, and could elicit another type of hypoglossal activity decoupled from the phrenic-associated inspiratory bursts ('decoupled' activity). We further scrutinized the correlatives of 'pre-I' and 'decoupled' activities in individual hypoglossal motoneurones. Hypoglossal motoneurones consisted of inspiratory (n = 42), expiratory (n = 18) and non-respiratory (n = 1) neurones and were classified by their swallowing activity into depolarized, hyperpolarized, hyperpolarized-depolarized and unresponsive groups. All of the inspiratory neurones were depolarized in accordance with the 'pre-I' and 'decoupled' activities, and all of the expiratory neurones were hyperpolarized during these activities. Fictive swallowing, which was characterized by its frequent emergence just after the phrenic inspiratory activity, was also evoked just after the 'decoupled' hypoglossal activity, suggesting that this activity may have similar effects on swallowing as the 'overt' inspiratory activity. Such a coupling between 'decoupled' and swallowing activities was also revealed in each motoneurone. These findings suggest that the 'pre-I' and 'decoupled' activities may reflect some internal inspiratory activity of the respiratory centre and that hypoglossal motoneurones may be driven by a distinct group of premotor neurones that possibly play a role in the coordination of respiration and swallowing.

Endometrial unresponsiveness: a novel approach to assessment and prognosis in in vitro fertilization cycles

To categorize endometrial responsiveness to orally administered estriol in natural cycles of patients with thin endometrium. The value of endometrial responsiveness in predicting the outcome of subsequent IVF-ET cycles was evaluated. Prospective clinical study. Miami IVF-ICSI Center, Alexandria, Egypt, a private center. Forty-two patients undergoing IVF-ET. All had endometrial thickness < or = 7 mm at the time of maximal follicular diameter in natural cycle. Estriol was orally administered in subsequent unstimulated cycle. Patients were categorized into responsive and unresponsive groups (those with improved and unimproved endometrial thickness, respectively). Lastly, controlled ovarian hyperstimulation (COH) with or without estriol was started in the IVF-ET cycles. The endometrial thickness during COH with or without estriol, fertilization, pregnancy, and abortion rates. The responsive group compared with the unresponsive group had a significantly higher rate of improved endometrial thickness, a similar number of oocytes retrieved, a similar fertilization rate, and a significantly higher pregnancy rate. Patients with endometrial unresponsiveness to estriol in their natural cycles rarely improve by COH and have a poor pregnancy rate in IVF cycles.

Predicting nursing-home resident responsiveness to a urinary incontinence treatment protocol

Urinary incontinence in nursing homes is a health problem that costs close to $2 billion annually. Prompted voiding is a validated procedure to treat urinary incontinence in this setting. Past research has found this technique to be effective in approximately one-third of incontinent nursing home residents. Nursing staff can only maintain the prompted voiding procedure with these responsive residents; it is therefore necessary to separate those who will be responsive from those who will not. The purpose of this paper is to identify resident variables that discriminate between these two groups. The identification of such variables may suggest supplementary treatment for nursing home residents who do not respond to prompted voiding alone. Data from 155 residents from seven separate nursing homes were analyzed. Prompted voiding was implemented by the research team, and the residents were separated into responsive and unresponsive groups based on the level of continence attained during a 6-day treatment period. A stepwise multiple regression analysis was performed, and the following variables were found to be most predictive of responsiveness: the resident's maximum voided urine volume, length of residency in the nursing home, baseline frequency of voiding, age and mental status score. Less responsive residents had smaller maximum voided urine volumes, a longer length of residency, and a larger postvoid residual. These variables may be useful in assisting NH staff in designing an effective and efficient strategy to manage urinary incontinence.

Evaluation of a psychological treatment programme for climacteric women

A psychological assessment and treatment programme designed for a group of climacteric women with severe and varied psychological complaints and symptoms is described and evaluated. All the women were currently experiencing stressful psychosocial difficulties within their life situation. The treatment programme comprised an educational, a counselling and a behavioural component. By the end of the sixth session of therapy, most women showed a significant improvement in their main complaint, accompanied by improvements in general symptoms and personal adjustment. Two-thirds considered that they had benefited substantially from treatment. The outcome of the treatment was considered to be encouraging in what might otherwise be considered a potentially unresponsive group of women.

Heart-rate and the behaviour of sheep in yards

Heart-rate (HR) of 30 Merino wethers was measured by radiotelemetry in two environments: standing alone in a handling race, but in sight of other sheep; and while moving within a group around yards. Subjects were selected three months previously on the basis of each animal's reaction to short-term social isolation. Ten responded physically by trying to escape from the yards or to rejoin the group in an adjacent wool-shed, 10 responded by vocalising, and 10 were unresponsive. No animals in the first group vocalised. Reliable individual differences in HR were observed in the two tests, and measures for both ranked agitated > vocal > unresponsive. However, HR for the two responsive groups was only significantly higher than the unresponsive group in the race, and there was no significant difference in HR between responsive sheep in either setting. The use of HR as an index of social stress and likely position preferences in forced movement orders in yards is discussed.

Suppressor T Cells: Presence in Mice Rendered Tolerant by Neonatal Treatment with Anti-Receptor Antibody or Antigen

Specific tolerance to phosphorylcholine (PC) was induced in BALB/c mice by two methods. Neonatal mice received a single injection of either: 1)PnC, the C-polysaccharide from S. pneumoniae, R36a vaccine which has PC as a major antigenic determinant or 2) ARA, an homologous antibody directed against the receptor for PC. Spleen cells from animals treated as neonates with either PnC or ARA were specifically suppressed for the response to PC antigens in vitro. In addition, cells from either group of unresponsive animals co-cultured with spleen cells of normal BALB/c mice markedly suppressed the response of the normal cells to PC. Greater than 90% inhibition of the plaque-forming cell response was obtained when unresponsive cells were mixed with normal cells in ratios of 1:1 or greater. Equal numbers of cells from animals made unresponsive by PnC or ARA produced an equivalent degree of suppression. Neither supernatants of cultures nor sera of animals of either unresponsive group suppressed the response of normal spleen cells to PC. Suppression by cells from both groups of tolerant mice was eliminated by treatment with anti-Thy 1.2 serum and C. Presumably, a common cell is responsible for suppression caused by cells from mice made unresponsive by either procedure.

Ultrastructural changes of pituitary gonadotropic cells in estrogen-treated pregnant rats.

An ultrastructural study of gonadotropic pituitary cells was performed in estrogen-treated pregnant rats. Estradiol-treatment on Day 10 of pregnancy led to signs of ovulation or luteinization on Day 12 in 50% of the animals. Degranulation was observed in the FSH and LH cells of estrogen-responsive rats, whereas in the unresponsive group, the same cells were intensely granulated. The FSH cells of the control group showed signs of degranulation which could be correlated with follicular development. LH cells were sometimes degranulated. The role played by FSH and LH cells in the triggering of ovulation and luteinization by estrogen in the pregnant rat is discussed in the light of the ultrastructural observations.

Nitroglycerin and Ventricular Performance: Differential Effect in the Presence of Reversible and Irreversible Asynergy

The effect of nitroglycerin administration on left venticular performance relative to its ability to improve contraction of asynergic zones was examined in 66 patients with coronary artery disease, divided into those whose asynergic zones responded following nitroglycerin administration and those in whom no response was observed. In the responsive group with asynergy of more than one segment, the ejection fraction improved (P less than 0.001), while in the unresponsive group, it decreased (P less than 0.05). Similarly, in patients with one-segment asynergy, the responsive group exhibited a significant increase in ejection fraction P less than 0.001), while the unresponsive group showed no change. The stroke volume index remained unchanged in the responsive group with asynergy of more than one segment, while it decreased significantly (P less than 0.05) in the unresponsive patients. Left ventricular pressures and volumes changed to a similar degree after nitroglycerin administration in all of the patients, regardless of the responsiveness of asynergic zones. It is concluded that nitroglycerin administration results in a differential effect on total left ventricular performance depending on the responsiveness of asynergic zones.