Juxtaductal aortic coarctation was surgically created in beagle puppies at the age of 2 months an... more Juxtaductal aortic coarctation was surgically created in beagle puppies at the age of 2 months and resected at the age of 10 months, after the development of good collateral circulation. Control dogs undergoing sham operations on each occasion were studied in the same environment. Cardiac catheterization was performed 1 year after the coarctectomy to evaluate the recovery of the heart. Cardiac output, heart rate, end-diastolic pressure, and Vmax were similar in both groups of seven dogs, but the systolic pressure gradient (SPG) over the operated area during isoproterenol infusion was significantly higher in the coarctectomized group, with a mean of 8.9 + 6.3
KIVINIEMI, M.S., ET AL.: Complications Related to Permanent Pacemaker Therapy JThis study evaluat... more KIVINIEMI, M.S., ET AL.: Complications Related to Permanent Pacemaker Therapy JThis study evaluates complications related to permanent endocardial pacing in the era of modern pacemaker therapy. There is only limited information available about the complications related to modern cardiac pacing. Most of the existing data are based on the 1970s and are no longer valid for current practice. The recent reports on pacemaker complications are focused on some specific complication or are restricted to early complications. Thus, there are no reports available providing a comprehensive view of complications related to modern cardiac pacing. Four hundred forty-six patients, who received permanent endocardial pacemakers between January 1990 and December 1995 at Kuopio University Hospital, were reviewed retrospectively using patient records. Attention was paid to the occurrence of any complication during the implantation or follow-up. An early complication was detected in 6.7%, and 4.9% of patients were treated invasively due to the early complication. Late complication developed in 7.2% and reoperation was required in 6.3% of the patients. Complications related to the implantation procedure occurred in 3.1%. Inadequate capture or sensing was observed in 7.4% of the patients. Pacemaker infection was detected in 1.8% and erosion in 0.9% of the patients. An AV block developed in 3.6% (1.6%/year) patients who received an AAI(R)-pacemaker due to sick sinus syndrome. There was no mortality attributable to pacemaker therapy. A great majority (68%) of the complications occurred within the first 3 months after the implantation. Complications associated to modern permanent endocardial pacemaker therapy are not infrequent.Elevan percent of patients needed an invasive procedure due to an early or late complication. J (PACE 1999; 22:711-720} cardiac pacing, pacemaker complications, early complications, late complications Address for reprints: fiiha Hartikainen.
Secondary prevention, i.e. nonsmoking, exercise, weight control, correct nutrition and drugs affe... more Secondary prevention, i.e. nonsmoking, exercise, weight control, correct nutrition and drugs affecting the prognosis, constitute the basis for the treatment of stable coronary artery disease. The most important drug affecting the prognosis is acetylsalicylic acid. Statin medication can be reduced on the basis of adverse effects only. Angiotensin convertase inhibitor medication is often forgotten in coronary artery disease patients who have undergone cardiac infarction or a temporary stage of cardiac insufficiency. Long-acting nitrate is not the first-line antianginal treatment, beta-blockers and calcium channel blockers being recommended instead.
HRV and HRT are independent predictors of cardiovascular mortality. Aging reduces HRV, but result... more HRV and HRT are independent predictors of cardiovascular mortality. Aging reduces HRV, but results from the physical exercise trials are controversial. The primary aim was to study changes in heart rate variability (HRV) and heart rate turbulence (HRT) in a six-year controlled randomized trial at regular low to moderate intensity physical exercise. One hundred forty men aged 53--63 years were randomized in to an exercise or a control groups. The participants underwent a maximal bicycle ergometer exercise test with respiratory gas analyses annually for six years. At baseline and after intervention, 24-h ambulatory ECG registrations were performed to assess HRV (n=100). HRT was determined among subjects with single ventricular premature complexes (VPC) (n=73). In the exercise group, ventilatory aerobic threshold (VAT) increased by 16% indicating enhanced submaximal cardiorespiratory fitness. No significant differences were found in any of the HRV or HRT parameters between the groups. ...
It is widely accepted that myocardial infarction results in adrenergic denervation of the infarct... more It is widely accepted that myocardial infarction results in adrenergic denervation of the infarcted and peri-infarcted myocardium. On the contrary, the concept of re-innervation of adrenergic nerve fibres is less well established. Although there is evidence of partial re-innervation occuring several months after myocardial infarction, the extent and time scale of re-innervation are only poorly known. In this study we investigated changes in cardiac adrenergic innervation and myocardial perfusion during the early convalescence period (the first 3 months) after an acute myocardial infarction. Single-photon emission computed tomographic imaging was conducted in 15 men 1 week and 3 months after an acute myocardial infarction with I123-metaiodobentzylguanidine (MIBG) and Tc99m-sestamibi (MIBI) to determine the extent of adrenergic denervation and impaired perfusion, respectively. A MIBG and MIBI defect was determined as regional uptake </=30% of maximal myocardial activity. The size o...
Objective. To investigate the association between serum total cholesterol and all-cause mortality... more Objective. To investigate the association between serum total cholesterol and all-cause mortality in elderly individuals aged Ն 75 years. Design. A prospective cohort study with a six-year follow-up. Setting and subjects. A random sample (n ϭ 700) of all persons aged Ն 75 years living in Kuopio, Finland. After exclusion of participants living in institutional care and participants using lipid-modifying agents or missing data on blood pressure and cholesterol levels, the fi nal study population consisted of 490 home-dwelling elderly persons with clinical examination. We used the Cox proportional hazard model and the propensity score (PS) method. Main outcome measure. All-cause mortality. Results. In an age-and sex-adjusted analysis, participants with S-TC Ն 6mmol/l had the lowest risk of death (hazard ratio, HR ϭ 0.48, 95% CI 0.33 -0.70) compared with those with S-TC Ͻ 5 mmol/l. HR of death for a 1 mmol increase in S-TC was 0.78. In multivariate analyses, the HR of death for a 1 mmol increase in S-TC was 0.82 and using S-TC Ͻ 5 mmol/l as a reference, the HR of death for S-TC Ն 6 mmol/l was 0.59 (95% CI 0.39 -0.89) and for S-TC 5.0 -5.9 mmol/l, the HR was 0.62 (95% CI 0.42 -0.93). In a PS-adjusted model using S-TC Ͻ 5 mmol/l as a reference, the HR of death for S-TC Ն 6 mmol/l was 0.42 (95% CI 0.28 -0.62) and for S-TC 5.0 -5.9 mmol/l, the HR was 0.57 (95% CI 0.38 -0.84). Conclusions. Participants with low serum total cholesterol seem to have a lower survival rate than participants with an elevated cholesterol level, irrespective of concomitant diseases or health status.
Scandinavian Journal of Clinical & Laboratory Investigation, 1984
The conventional Stewart-Hamilton (SH) principle was compared to the gamma variate function fitti... more The conventional Stewart-Hamilton (SH) principle was compared to the gamma variate function fitting (G) method in on-line computer determination of cardiac output from dye dilution curves on anaesthetized animals (dogs, cats and reindeer), and on an artificial circulation model with known flows. In animal experiments, indicator was injected into the pulmonary artery (n = 674), the coefficient of linear correlation (Rlin) between G and SH was 0.982, and the regression line of G was 1.101 x SH-0.072 l/min. When the right atrium was the site of indicator injection (n = 88), Rlin was 0.982, and the regression line nearly agreed with the line of unity. In the artificial circulation model with the single circulation arrangement (n = 81), Rlin between SH and known flow (Q) was 0.959, and between G and Q it was 0.951; both methods over-estimated the flows, with the over-estimation being greater in the case of G. In the artificial model with recirculation effect (n = 31), Rlin between SH and Q was 0.953, and between G and Q 0.942, G again over-estimating the real flow essentially more than SH. Thus, in most cases the Stewart-Hamilton principle seems to be the more reliable way of analysis of dye dilution curves also in modern computer practice.
Scandinavian Journal of Clinical & Laboratory Investigation, 2009
Natriuretic peptides are well-known indicators of left ventricular dysfunction. The aim of this s... more Natriuretic peptides are well-known indicators of left ventricular dysfunction. The aim of this study was to examine whether the levels of B-type natriuretic peptide (BNP) and HDL are associated with systolic dysfunction in an elderly general population. The 355 study subjects aged 75 years or more were studied in the City of Kuopio, in East Finland. The association between clinical variables as well as echocardiographic left ventricular ejection fraction and BNP, total cholesterol and HDL were investigated using logistic and linear regression analysis. When tested as a dichotomous variable (EF &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;or= 45%), the only variables to show significant association with ejection fraction were age (odds ratio [OR] = 0.65 for a change of one standard deviation in age; p = 0.002), total cholesterol (OR = 1.43; p = 0.025), HDL (OR = 1.51; p = 0.013) and use of Angiotensin converting enzyme-inhibitor or Angiotensinogen receptor II-blocker (OR = 0.23; p = 0.046). Simultaneously tested only HDL (OR = 1.52; p = 0.013) and age (OR = 0.63; p = 0.002) had a significant association with ejection fraction. In the elderly general population aged 75 or older and in the subgroup of participants without previous heart failure HDL, but not BNP, shows significant correlation with left ventricular systolic dysfunction.
Photoinhibition of photosystem 11 (PSII) electron transport and subsequent degradation of the DI ... more Photoinhibition of photosystem 11 (PSII) electron transport and subsequent degradation of the DI protein were studied in pumpkin (Cucurbita pepo L.) leaves developed under high (1000 gmol mr2 s-') and low (80,umol mr2 s-') photon flux densities. The low-light leaves were more susceptible to high light. This difference was greatly diminished when illumination was performed in the presence of chloramphenicol, indicating that a poor capacity to repair photodamaged PSII centers is decisive in the susceptibility of lowlight leaves to photoinhibition. In fact, the first phases of the repair cycle, degradation and removal of photodamaged Dl protein from the reaction center complex, occurred slowly in low-light leaves, whereas in high-light leaves the degradation of the Dl protein more readily followed photoinhibition of PSII electron transport. A modified form of the Dl protein, with slightly slower electrophoretic mobility than the original Dl, accumulated in the appressed thylakoid membranes of low-light leaves during illumination and was subsequently degraded only slowly.
Knowledge of the contributions of transit time heterogeneity to the cardiopulmonary system is imp... more Knowledge of the contributions of transit time heterogeneity to the cardiopulmonary system is important for understanding cardiopulmonary function in patients with intracardiac shunt. We determined the heterogeneity of blood transit times occurring between the right atrium and the left ventricle. Eighty two patients with suspected left-to right shunt were investigated with first-pass 99mTc-labelled red blood cell radiocardiography at supine rest. Forty two of them had a pulmonary-to-systemic flow ratio (Qp:Qs) of less than 1.2 and they served as a control group. The remaining study subjects had a Qp:Qs ratio of 1.7 +/- 0.3 (mean +/- SD). The patients with shunt had significantly greater (p &lt; 0.001) heterogeneity of transit times (49 +/- 9%) than in the controls (39 +/- 7%). Overall heterogeneity of cardiopulmonary transit times in patients with shunt showed a curvature relationship; the highest values were centred in patients with moderate to severe shunt (1.5 &lt; Qp:Qs &lt; 2.5). The results suggest that the increased heterogeneity of transit times mainly occurs within the pulmonary capillary bed in patients with intracardiac shunt. This is probably due to the recruitment of the open capillaries without vessel distension.
Juxtaductal aortic coarctation was surgically created in beagle puppies at the age of 2 months an... more Juxtaductal aortic coarctation was surgically created in beagle puppies at the age of 2 months and resected at the age of 10 months, after the development of good collateral circulation. Control dogs undergoing sham operations on each occasion were studied in the same environment. Cardiac catheterization was performed 1 year after the coarctectomy to evaluate the recovery of the heart. Cardiac output, heart rate, end-diastolic pressure, and Vmax were similar in both groups of seven dogs, but the systolic pressure gradient (SPG) over the operated area during isoproterenol infusion was significantly higher in the coarctectomized group, with a mean of 8.9 + 6.3
This cross-sectional analysis of a population-based cohort investigates the postural changes in b... more This cross-sectional analysis of a population-based cohort investigates the postural changes in blood pressure (BP) and heart rate and assesses the prevalence of orthostatic hypotension (OH) and its associations with the medicines used by an elderly population. The study population (n=1000) was a random sample of persons aged 75 years or older in the City of Kuopio, Finland. In 2004, altogether, 781 persons participated in the study. After the exclusion of persons living in institutional care (n=82) and those without orthostatic test (n=46), the final study population comprised 653 home-dwelling elderly persons. OH was defined as a &gt; or =20 mm Hg drop of systolic BP or a &gt; or =10 mm Hg drop of diastolic BP or both 1 or 3 min after standing up from supine position. Systolic BP dropped for more than half of the home-dwelling elderly when they stood up from a supine to a standing position. The total prevalence of OH was 34% (n=220). No significant gender or age differences were seen. The prevalence of OH was related to the total number of medicines in regular use (P&lt;0.05). OH and postural changes in BP are more common among the home-dwelling elderly than reported in previous studies. The prevalence of OH is related to the number of medicines in regular use. There is an obvious need to measure orthostatic BP of elderly persons, as low BP and OH are important risk factors especially among the frail elderly persons.
Adenosine and Inappropriate Sinus Tachycardia. Introduction: Adenosine is an endogenous nucleosid... more Adenosine and Inappropriate Sinus Tachycardia. Introduction: Adenosine is an endogenous nucleoside that has an important role in the diagnosis and treatment of several cardiac arrhythmias. However, its effects on inappropriate sinus tachycardia (IST) are not well established.
A computer method was developed for the determination of electromechanical delay defined as the t... more A computer method was developed for the determination of electromechanical delay defined as the time between the onset of Q-wave and the onset of the left ventricular systolic pressure rise. It was validated for heart catheterization studies on 56 intact anaesthetized beagle dogs in 86 sessions. The mean basal value of the electromechanical delay was 22 +/- 4 msec. Heart rate, contractility, preload and afterload were changed by atrial pacing and by infusions of calcium chloride, isoproterenol, propranolol, dextran and phenylephrine. Increase of heart rate by pacing from the spontaneous rate of 90 per min to 240 per min prolonged the electromechanical delay from 21 +/- 5 to 33 +/- 14 msec (P less than 0.001). Otherwise the duration of electromechanical delay changed independently of the heart rate. If it changed, the direction of the change followed that of the pre-ejection period. Its proportion of the pre-ejection period varied from 26 to 52%. The electromechanical delay shortened when a positive inotropic effect was noticed or the presystolic fibre length increased.
Prevalence of dementing illnesses is expected to grow due to aging of the population throughout t... more Prevalence of dementing illnesses is expected to grow due to aging of the population throughout the world. Vascular dementia and Alzheimer&amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease share several risk factors and are nowadays considered two ends of a continuum rather than two distinct entities. Traditional cardiovascular risk markers such as diabetes, dyslipidemia, hypertension, metabolic syndrome and adiposity in mid-life are harbingers of cognitive decline, Alzheimer&amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease and vascular dementia later in life. In aged populations, only diabetes has been more constantly associated with the development of cognitive dysfunction, while other risk markers have shown more mixed results. Normal aging, co-morbidities and other changes connected to cognitive decline make the interpretation of the risk markers in the elderly challenging and probably explain these contradictory findings. Control of cardiovascular risk factors has been linked to beneficial effects in terms of cognition in cross-sectional and prospective follow up studies, but the results of interventional trials have been disappointing. More research in this area is needed, specifically, placebo-controlled randomized trials in both mid-life and late-life with cognitive dysfunction as a primary endpoint.
The haemodynamic effects in the early phase of canine acute experimental pancreatitis (AP) were s... more The haemodynamic effects in the early phase of canine acute experimental pancreatitis (AP) were studied using a cardiac catheterization technique. AP was induced in anaesthetized dogs with an infusion of trypsin-sodium-taurocholate into the pancreatic duct. The initial haemodynamic measurements were performed after the preparation of the animal and 5 min after the induction of AP. Thereafter, pressure and volume parameters were measured at 10 min intervals. AP induced significant increases in heart rate, dP/dtma x and mean arterial pressure, but a decrease in Vm~x 5 min after the induction of AP. After the initial phase, the heart rate remained significantly increased, while constant and significant decreases of stroke volume, cardiac output, enddiastolic volume and end-diastolic pressure developed. The parameters of the contractility of the left ventricle were not affected to the same extent. It is suggested that the circulatory failure observed in AP, characterised by a prompt reduction of cardiac output, was primarily due to a heavy reduction in preload. This supports the theory that cardiac output is primarily affected by impaired venous return with consequently decreased preload rather than by a loss of ventricular contractility. Hence, the existence of a myocardial depressant factor in the early phase of experimental AP does not gain support from the present results.
European Journal of Nuclear Medicine and Molecular Imaging, 1999
To study its usefulness as a tracer for assessment of the perfusion and viability of myocardium, ... more To study its usefulness as a tracer for assessment of the perfusion and viability of myocardium, 15-(p-iodophenyl)pentadecanoic acid (IPPA) was compared with technetium-99m sestamibi (MIBI). Dual-tracer single-photon emission tomography rest imaging was performed no more than 2 months before and 3 months after coronary artery bypass grafting in 28 patients with previous anterior (n=13) or inferior (n=15) infarction. The size of MIBI and IPPA defects decreased from 14%+/-12% and 13%+/-9% to 10%+/-11% and 9%+/-7%, respectively (P&lt;0.001 for both). The MIBI uptake increased in the infarct zones from 35%+/-11% to 43%+/-8% (P&lt;0.001), and in the peri-infarct zones from 50%+/-11% to 55%+/-10% (P&lt;0.05). The IPPA uptake increased in the infarct zones from 37%+/-11% to 44%+/-13% (P&lt;0.001), and in the peri-infarct zones from 51%+/-11% to 57%+/-12% (P&lt;0.05). In nine patients with improved regional echocardiographic wall motion score after bypass surgery, the pre-operative uptake values of both MIBI and IPPA in the infarct and peri-infarct zones were on average slightly but not significantly higher than in 19 patients with no observed improvement in regional wall motion score. In patients with improved regional wall motion, the MIBI scans and the IPPA scans showed (non-significant) decreases in defect size and increases in infarct and peri-infarct zone uptake after bypass surgery. Similar (in some cases significant) changes were observed in the patients without improvement in wall motion. Thus IPPA and MIBI provided similar information about perfusion and viability in pre- and postoperative evaluation of patients with clinically evident myocardial infarction and with normal global ejection fraction. Regardless of the tracer used, the resolution capability of the dual-tracer method with a rest imaging protocol was not sufficient to differentiate viable from non-viable infarction defects in unselected individual patients with a normal ejection fraction.
Objective: We prospectively tested the hypothesis that atrial enlargement and increased level of ... more Objective: We prospectively tested the hypothesis that atrial enlargement and increased level of atrial natriuretic peptide, N-terminal atrial natriuretic peptide and brain natriuretic peptide would predict atrial fibrillation after coronary artery bypass grafting. Methods: Eighty-eight elective coronary artery bypass grafting patients had preoperative echocardiographic assessment. The level of atrial natriuretic peptide, Nterminal atrial natriuretic peptide and brain natriuretic peptide were measured preoperatively. Patients were ECG-monitored during the whole hospital stay. Results: Thirty one (35.2%) patients had postoperative atrial fibrillation. In univariate analysis increased age (P ¼ 0:003), enlargement of left and right atria (P ¼ 0:002 and P ¼ 0:004, respectively) and increased level of preoperative atrial natriuretic peptide and N-terminal atrial natriuretic peptide (P ¼ 0:016 and P ¼ 0:03, respectively) were associated with postoperative atrial fibrillation. There was correlation between the age and level of N-terminal atrial natriuretic peptide (r ¼ 0:45 and P , 0:001). In multivariate analysis only age and the left atrial enlargement were independent predictors of postoperative atrial fibrillation (P ¼ 0:02 and P ¼ 0:01). Conclusion: Left atrial enlargement was independent predictor for postoperative atrial fibrillation. However, atrial peptides were associated with age and did not independently predict postoperative atrial fibrillation. In addition, the wide variation of the peptide levels renders the implementation of this measure in clinical practice superfluous. q
Aims The purpose of this study was to calculate the prevalence of ectopic atrial tachycardia in a... more Aims The purpose of this study was to calculate the prevalence of ectopic atrial tachycardia in a population of young asymptomatic males and to assess its natural course both in asymptomatic subjects and in symptomatic hospital patients.
Juxtaductal aortic coarctation was surgically created in beagle puppies at the age of 2 months an... more Juxtaductal aortic coarctation was surgically created in beagle puppies at the age of 2 months and resected at the age of 10 months, after the development of good collateral circulation. Control dogs undergoing sham operations on each occasion were studied in the same environment. Cardiac catheterization was performed 1 year after the coarctectomy to evaluate the recovery of the heart. Cardiac output, heart rate, end-diastolic pressure, and Vmax were similar in both groups of seven dogs, but the systolic pressure gradient (SPG) over the operated area during isoproterenol infusion was significantly higher in the coarctectomized group, with a mean of 8.9 + 6.3
KIVINIEMI, M.S., ET AL.: Complications Related to Permanent Pacemaker Therapy JThis study evaluat... more KIVINIEMI, M.S., ET AL.: Complications Related to Permanent Pacemaker Therapy JThis study evaluates complications related to permanent endocardial pacing in the era of modern pacemaker therapy. There is only limited information available about the complications related to modern cardiac pacing. Most of the existing data are based on the 1970s and are no longer valid for current practice. The recent reports on pacemaker complications are focused on some specific complication or are restricted to early complications. Thus, there are no reports available providing a comprehensive view of complications related to modern cardiac pacing. Four hundred forty-six patients, who received permanent endocardial pacemakers between January 1990 and December 1995 at Kuopio University Hospital, were reviewed retrospectively using patient records. Attention was paid to the occurrence of any complication during the implantation or follow-up. An early complication was detected in 6.7%, and 4.9% of patients were treated invasively due to the early complication. Late complication developed in 7.2% and reoperation was required in 6.3% of the patients. Complications related to the implantation procedure occurred in 3.1%. Inadequate capture or sensing was observed in 7.4% of the patients. Pacemaker infection was detected in 1.8% and erosion in 0.9% of the patients. An AV block developed in 3.6% (1.6%/year) patients who received an AAI(R)-pacemaker due to sick sinus syndrome. There was no mortality attributable to pacemaker therapy. A great majority (68%) of the complications occurred within the first 3 months after the implantation. Complications associated to modern permanent endocardial pacemaker therapy are not infrequent.Elevan percent of patients needed an invasive procedure due to an early or late complication. J (PACE 1999; 22:711-720} cardiac pacing, pacemaker complications, early complications, late complications Address for reprints: fiiha Hartikainen.
Secondary prevention, i.e. nonsmoking, exercise, weight control, correct nutrition and drugs affe... more Secondary prevention, i.e. nonsmoking, exercise, weight control, correct nutrition and drugs affecting the prognosis, constitute the basis for the treatment of stable coronary artery disease. The most important drug affecting the prognosis is acetylsalicylic acid. Statin medication can be reduced on the basis of adverse effects only. Angiotensin convertase inhibitor medication is often forgotten in coronary artery disease patients who have undergone cardiac infarction or a temporary stage of cardiac insufficiency. Long-acting nitrate is not the first-line antianginal treatment, beta-blockers and calcium channel blockers being recommended instead.
HRV and HRT are independent predictors of cardiovascular mortality. Aging reduces HRV, but result... more HRV and HRT are independent predictors of cardiovascular mortality. Aging reduces HRV, but results from the physical exercise trials are controversial. The primary aim was to study changes in heart rate variability (HRV) and heart rate turbulence (HRT) in a six-year controlled randomized trial at regular low to moderate intensity physical exercise. One hundred forty men aged 53--63 years were randomized in to an exercise or a control groups. The participants underwent a maximal bicycle ergometer exercise test with respiratory gas analyses annually for six years. At baseline and after intervention, 24-h ambulatory ECG registrations were performed to assess HRV (n=100). HRT was determined among subjects with single ventricular premature complexes (VPC) (n=73). In the exercise group, ventilatory aerobic threshold (VAT) increased by 16% indicating enhanced submaximal cardiorespiratory fitness. No significant differences were found in any of the HRV or HRT parameters between the groups. ...
It is widely accepted that myocardial infarction results in adrenergic denervation of the infarct... more It is widely accepted that myocardial infarction results in adrenergic denervation of the infarcted and peri-infarcted myocardium. On the contrary, the concept of re-innervation of adrenergic nerve fibres is less well established. Although there is evidence of partial re-innervation occuring several months after myocardial infarction, the extent and time scale of re-innervation are only poorly known. In this study we investigated changes in cardiac adrenergic innervation and myocardial perfusion during the early convalescence period (the first 3 months) after an acute myocardial infarction. Single-photon emission computed tomographic imaging was conducted in 15 men 1 week and 3 months after an acute myocardial infarction with I123-metaiodobentzylguanidine (MIBG) and Tc99m-sestamibi (MIBI) to determine the extent of adrenergic denervation and impaired perfusion, respectively. A MIBG and MIBI defect was determined as regional uptake </=30% of maximal myocardial activity. The size o...
Objective. To investigate the association between serum total cholesterol and all-cause mortality... more Objective. To investigate the association between serum total cholesterol and all-cause mortality in elderly individuals aged Ն 75 years. Design. A prospective cohort study with a six-year follow-up. Setting and subjects. A random sample (n ϭ 700) of all persons aged Ն 75 years living in Kuopio, Finland. After exclusion of participants living in institutional care and participants using lipid-modifying agents or missing data on blood pressure and cholesterol levels, the fi nal study population consisted of 490 home-dwelling elderly persons with clinical examination. We used the Cox proportional hazard model and the propensity score (PS) method. Main outcome measure. All-cause mortality. Results. In an age-and sex-adjusted analysis, participants with S-TC Ն 6mmol/l had the lowest risk of death (hazard ratio, HR ϭ 0.48, 95% CI 0.33 -0.70) compared with those with S-TC Ͻ 5 mmol/l. HR of death for a 1 mmol increase in S-TC was 0.78. In multivariate analyses, the HR of death for a 1 mmol increase in S-TC was 0.82 and using S-TC Ͻ 5 mmol/l as a reference, the HR of death for S-TC Ն 6 mmol/l was 0.59 (95% CI 0.39 -0.89) and for S-TC 5.0 -5.9 mmol/l, the HR was 0.62 (95% CI 0.42 -0.93). In a PS-adjusted model using S-TC Ͻ 5 mmol/l as a reference, the HR of death for S-TC Ն 6 mmol/l was 0.42 (95% CI 0.28 -0.62) and for S-TC 5.0 -5.9 mmol/l, the HR was 0.57 (95% CI 0.38 -0.84). Conclusions. Participants with low serum total cholesterol seem to have a lower survival rate than participants with an elevated cholesterol level, irrespective of concomitant diseases or health status.
Scandinavian Journal of Clinical & Laboratory Investigation, 1984
The conventional Stewart-Hamilton (SH) principle was compared to the gamma variate function fitti... more The conventional Stewart-Hamilton (SH) principle was compared to the gamma variate function fitting (G) method in on-line computer determination of cardiac output from dye dilution curves on anaesthetized animals (dogs, cats and reindeer), and on an artificial circulation model with known flows. In animal experiments, indicator was injected into the pulmonary artery (n = 674), the coefficient of linear correlation (Rlin) between G and SH was 0.982, and the regression line of G was 1.101 x SH-0.072 l/min. When the right atrium was the site of indicator injection (n = 88), Rlin was 0.982, and the regression line nearly agreed with the line of unity. In the artificial circulation model with the single circulation arrangement (n = 81), Rlin between SH and known flow (Q) was 0.959, and between G and Q it was 0.951; both methods over-estimated the flows, with the over-estimation being greater in the case of G. In the artificial model with recirculation effect (n = 31), Rlin between SH and Q was 0.953, and between G and Q 0.942, G again over-estimating the real flow essentially more than SH. Thus, in most cases the Stewart-Hamilton principle seems to be the more reliable way of analysis of dye dilution curves also in modern computer practice.
Scandinavian Journal of Clinical & Laboratory Investigation, 2009
Natriuretic peptides are well-known indicators of left ventricular dysfunction. The aim of this s... more Natriuretic peptides are well-known indicators of left ventricular dysfunction. The aim of this study was to examine whether the levels of B-type natriuretic peptide (BNP) and HDL are associated with systolic dysfunction in an elderly general population. The 355 study subjects aged 75 years or more were studied in the City of Kuopio, in East Finland. The association between clinical variables as well as echocardiographic left ventricular ejection fraction and BNP, total cholesterol and HDL were investigated using logistic and linear regression analysis. When tested as a dichotomous variable (EF &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;or= 45%), the only variables to show significant association with ejection fraction were age (odds ratio [OR] = 0.65 for a change of one standard deviation in age; p = 0.002), total cholesterol (OR = 1.43; p = 0.025), HDL (OR = 1.51; p = 0.013) and use of Angiotensin converting enzyme-inhibitor or Angiotensinogen receptor II-blocker (OR = 0.23; p = 0.046). Simultaneously tested only HDL (OR = 1.52; p = 0.013) and age (OR = 0.63; p = 0.002) had a significant association with ejection fraction. In the elderly general population aged 75 or older and in the subgroup of participants without previous heart failure HDL, but not BNP, shows significant correlation with left ventricular systolic dysfunction.
Photoinhibition of photosystem 11 (PSII) electron transport and subsequent degradation of the DI ... more Photoinhibition of photosystem 11 (PSII) electron transport and subsequent degradation of the DI protein were studied in pumpkin (Cucurbita pepo L.) leaves developed under high (1000 gmol mr2 s-') and low (80,umol mr2 s-') photon flux densities. The low-light leaves were more susceptible to high light. This difference was greatly diminished when illumination was performed in the presence of chloramphenicol, indicating that a poor capacity to repair photodamaged PSII centers is decisive in the susceptibility of lowlight leaves to photoinhibition. In fact, the first phases of the repair cycle, degradation and removal of photodamaged Dl protein from the reaction center complex, occurred slowly in low-light leaves, whereas in high-light leaves the degradation of the Dl protein more readily followed photoinhibition of PSII electron transport. A modified form of the Dl protein, with slightly slower electrophoretic mobility than the original Dl, accumulated in the appressed thylakoid membranes of low-light leaves during illumination and was subsequently degraded only slowly.
Knowledge of the contributions of transit time heterogeneity to the cardiopulmonary system is imp... more Knowledge of the contributions of transit time heterogeneity to the cardiopulmonary system is important for understanding cardiopulmonary function in patients with intracardiac shunt. We determined the heterogeneity of blood transit times occurring between the right atrium and the left ventricle. Eighty two patients with suspected left-to right shunt were investigated with first-pass 99mTc-labelled red blood cell radiocardiography at supine rest. Forty two of them had a pulmonary-to-systemic flow ratio (Qp:Qs) of less than 1.2 and they served as a control group. The remaining study subjects had a Qp:Qs ratio of 1.7 +/- 0.3 (mean +/- SD). The patients with shunt had significantly greater (p &lt; 0.001) heterogeneity of transit times (49 +/- 9%) than in the controls (39 +/- 7%). Overall heterogeneity of cardiopulmonary transit times in patients with shunt showed a curvature relationship; the highest values were centred in patients with moderate to severe shunt (1.5 &lt; Qp:Qs &lt; 2.5). The results suggest that the increased heterogeneity of transit times mainly occurs within the pulmonary capillary bed in patients with intracardiac shunt. This is probably due to the recruitment of the open capillaries without vessel distension.
Juxtaductal aortic coarctation was surgically created in beagle puppies at the age of 2 months an... more Juxtaductal aortic coarctation was surgically created in beagle puppies at the age of 2 months and resected at the age of 10 months, after the development of good collateral circulation. Control dogs undergoing sham operations on each occasion were studied in the same environment. Cardiac catheterization was performed 1 year after the coarctectomy to evaluate the recovery of the heart. Cardiac output, heart rate, end-diastolic pressure, and Vmax were similar in both groups of seven dogs, but the systolic pressure gradient (SPG) over the operated area during isoproterenol infusion was significantly higher in the coarctectomized group, with a mean of 8.9 + 6.3
This cross-sectional analysis of a population-based cohort investigates the postural changes in b... more This cross-sectional analysis of a population-based cohort investigates the postural changes in blood pressure (BP) and heart rate and assesses the prevalence of orthostatic hypotension (OH) and its associations with the medicines used by an elderly population. The study population (n=1000) was a random sample of persons aged 75 years or older in the City of Kuopio, Finland. In 2004, altogether, 781 persons participated in the study. After the exclusion of persons living in institutional care (n=82) and those without orthostatic test (n=46), the final study population comprised 653 home-dwelling elderly persons. OH was defined as a &gt; or =20 mm Hg drop of systolic BP or a &gt; or =10 mm Hg drop of diastolic BP or both 1 or 3 min after standing up from supine position. Systolic BP dropped for more than half of the home-dwelling elderly when they stood up from a supine to a standing position. The total prevalence of OH was 34% (n=220). No significant gender or age differences were seen. The prevalence of OH was related to the total number of medicines in regular use (P&lt;0.05). OH and postural changes in BP are more common among the home-dwelling elderly than reported in previous studies. The prevalence of OH is related to the number of medicines in regular use. There is an obvious need to measure orthostatic BP of elderly persons, as low BP and OH are important risk factors especially among the frail elderly persons.
Adenosine and Inappropriate Sinus Tachycardia. Introduction: Adenosine is an endogenous nucleosid... more Adenosine and Inappropriate Sinus Tachycardia. Introduction: Adenosine is an endogenous nucleoside that has an important role in the diagnosis and treatment of several cardiac arrhythmias. However, its effects on inappropriate sinus tachycardia (IST) are not well established.
A computer method was developed for the determination of electromechanical delay defined as the t... more A computer method was developed for the determination of electromechanical delay defined as the time between the onset of Q-wave and the onset of the left ventricular systolic pressure rise. It was validated for heart catheterization studies on 56 intact anaesthetized beagle dogs in 86 sessions. The mean basal value of the electromechanical delay was 22 +/- 4 msec. Heart rate, contractility, preload and afterload were changed by atrial pacing and by infusions of calcium chloride, isoproterenol, propranolol, dextran and phenylephrine. Increase of heart rate by pacing from the spontaneous rate of 90 per min to 240 per min prolonged the electromechanical delay from 21 +/- 5 to 33 +/- 14 msec (P less than 0.001). Otherwise the duration of electromechanical delay changed independently of the heart rate. If it changed, the direction of the change followed that of the pre-ejection period. Its proportion of the pre-ejection period varied from 26 to 52%. The electromechanical delay shortened when a positive inotropic effect was noticed or the presystolic fibre length increased.
Prevalence of dementing illnesses is expected to grow due to aging of the population throughout t... more Prevalence of dementing illnesses is expected to grow due to aging of the population throughout the world. Vascular dementia and Alzheimer&amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease share several risk factors and are nowadays considered two ends of a continuum rather than two distinct entities. Traditional cardiovascular risk markers such as diabetes, dyslipidemia, hypertension, metabolic syndrome and adiposity in mid-life are harbingers of cognitive decline, Alzheimer&amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease and vascular dementia later in life. In aged populations, only diabetes has been more constantly associated with the development of cognitive dysfunction, while other risk markers have shown more mixed results. Normal aging, co-morbidities and other changes connected to cognitive decline make the interpretation of the risk markers in the elderly challenging and probably explain these contradictory findings. Control of cardiovascular risk factors has been linked to beneficial effects in terms of cognition in cross-sectional and prospective follow up studies, but the results of interventional trials have been disappointing. More research in this area is needed, specifically, placebo-controlled randomized trials in both mid-life and late-life with cognitive dysfunction as a primary endpoint.
The haemodynamic effects in the early phase of canine acute experimental pancreatitis (AP) were s... more The haemodynamic effects in the early phase of canine acute experimental pancreatitis (AP) were studied using a cardiac catheterization technique. AP was induced in anaesthetized dogs with an infusion of trypsin-sodium-taurocholate into the pancreatic duct. The initial haemodynamic measurements were performed after the preparation of the animal and 5 min after the induction of AP. Thereafter, pressure and volume parameters were measured at 10 min intervals. AP induced significant increases in heart rate, dP/dtma x and mean arterial pressure, but a decrease in Vm~x 5 min after the induction of AP. After the initial phase, the heart rate remained significantly increased, while constant and significant decreases of stroke volume, cardiac output, enddiastolic volume and end-diastolic pressure developed. The parameters of the contractility of the left ventricle were not affected to the same extent. It is suggested that the circulatory failure observed in AP, characterised by a prompt reduction of cardiac output, was primarily due to a heavy reduction in preload. This supports the theory that cardiac output is primarily affected by impaired venous return with consequently decreased preload rather than by a loss of ventricular contractility. Hence, the existence of a myocardial depressant factor in the early phase of experimental AP does not gain support from the present results.
European Journal of Nuclear Medicine and Molecular Imaging, 1999
To study its usefulness as a tracer for assessment of the perfusion and viability of myocardium, ... more To study its usefulness as a tracer for assessment of the perfusion and viability of myocardium, 15-(p-iodophenyl)pentadecanoic acid (IPPA) was compared with technetium-99m sestamibi (MIBI). Dual-tracer single-photon emission tomography rest imaging was performed no more than 2 months before and 3 months after coronary artery bypass grafting in 28 patients with previous anterior (n=13) or inferior (n=15) infarction. The size of MIBI and IPPA defects decreased from 14%+/-12% and 13%+/-9% to 10%+/-11% and 9%+/-7%, respectively (P&lt;0.001 for both). The MIBI uptake increased in the infarct zones from 35%+/-11% to 43%+/-8% (P&lt;0.001), and in the peri-infarct zones from 50%+/-11% to 55%+/-10% (P&lt;0.05). The IPPA uptake increased in the infarct zones from 37%+/-11% to 44%+/-13% (P&lt;0.001), and in the peri-infarct zones from 51%+/-11% to 57%+/-12% (P&lt;0.05). In nine patients with improved regional echocardiographic wall motion score after bypass surgery, the pre-operative uptake values of both MIBI and IPPA in the infarct and peri-infarct zones were on average slightly but not significantly higher than in 19 patients with no observed improvement in regional wall motion score. In patients with improved regional wall motion, the MIBI scans and the IPPA scans showed (non-significant) decreases in defect size and increases in infarct and peri-infarct zone uptake after bypass surgery. Similar (in some cases significant) changes were observed in the patients without improvement in wall motion. Thus IPPA and MIBI provided similar information about perfusion and viability in pre- and postoperative evaluation of patients with clinically evident myocardial infarction and with normal global ejection fraction. Regardless of the tracer used, the resolution capability of the dual-tracer method with a rest imaging protocol was not sufficient to differentiate viable from non-viable infarction defects in unselected individual patients with a normal ejection fraction.
Objective: We prospectively tested the hypothesis that atrial enlargement and increased level of ... more Objective: We prospectively tested the hypothesis that atrial enlargement and increased level of atrial natriuretic peptide, N-terminal atrial natriuretic peptide and brain natriuretic peptide would predict atrial fibrillation after coronary artery bypass grafting. Methods: Eighty-eight elective coronary artery bypass grafting patients had preoperative echocardiographic assessment. The level of atrial natriuretic peptide, Nterminal atrial natriuretic peptide and brain natriuretic peptide were measured preoperatively. Patients were ECG-monitored during the whole hospital stay. Results: Thirty one (35.2%) patients had postoperative atrial fibrillation. In univariate analysis increased age (P ¼ 0:003), enlargement of left and right atria (P ¼ 0:002 and P ¼ 0:004, respectively) and increased level of preoperative atrial natriuretic peptide and N-terminal atrial natriuretic peptide (P ¼ 0:016 and P ¼ 0:03, respectively) were associated with postoperative atrial fibrillation. There was correlation between the age and level of N-terminal atrial natriuretic peptide (r ¼ 0:45 and P , 0:001). In multivariate analysis only age and the left atrial enlargement were independent predictors of postoperative atrial fibrillation (P ¼ 0:02 and P ¼ 0:01). Conclusion: Left atrial enlargement was independent predictor for postoperative atrial fibrillation. However, atrial peptides were associated with age and did not independently predict postoperative atrial fibrillation. In addition, the wide variation of the peptide levels renders the implementation of this measure in clinical practice superfluous. q
Aims The purpose of this study was to calculate the prevalence of ectopic atrial tachycardia in a... more Aims The purpose of this study was to calculate the prevalence of ectopic atrial tachycardia in a population of young asymptomatic males and to assess its natural course both in asymptomatic subjects and in symptomatic hospital patients.
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Papers by Raimo Kettunen