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Sample records for ejection fraction obtained

  1. Ejection Fraction Heart Failure Measurement

    MedlinePlus

    ... 70. You can have a normal ejection fraction reading and still have heart failure (called HFpEF or ... to be made. Here we delve into the importance of shared decision making. HF Resources For Life ...

  2. Echocardiographic assessment of ejection fraction in left ventricular hypertrophy

    PubMed Central

    Wandt, B; Bojo, L; Tolagen, K; Wranne, B

    1999-01-01

    OBJECTIVE—To investigate the value of Simpson's rule, Teichholz's formula, and recording of mitral ring motion in assessing left ventricular ejection fraction (EF) in patients with left ventricular hypertrophy.
DESIGN—Left ventricular ejection fraction calculated by Simpson's rule and by Techholz's formula and estimated by mitral ring motion was compared with values obtained by radionuclide angiography.
SETTING—Secondary referral centre.
PATIENTS—16 patients with left ventricular hypertrophy and a clinical diagnosis of hypertrophic cardiomyopathy or hypertension.
RESULTS—Calculation by Teichholz's formula overestimated left ventricular ejection fraction by 10% (p = 0.002) and estimation based on mitral ring motion—that is, long axis measurements—underestimated ejection fraction by 19% (p = 0.002), without significant correlation between ring motion and ejection fraction. There was no significant difference between mean values of ejection fraction calculated by Simpson's rule and measured by the reference method, but a considerable scatter about the regression line with a standard error of the estimate of 9.3 EF%.
CONCLUSIONS—In patients with left ventricular hypertrophy the ejection fraction, calculated by Teichholz's formula or Simpson's rule, is a poor measure of left ventricular function. When mitral ring motion is used for the assessment in these patients the function should be expressed in ways other than by the ejection fraction.


Keywords: left ventricular hypertrophy; ejection fraction; mitral ring motion; atrioventricular plane displacement PMID:10409535

  3. Comparison of left ventricular ejection fraction values obtained using invasive contrast left ventriculography, two-dimensional echocardiography, and gated single-photon emission computed tomography

    PubMed Central

    Garg, Nadish; Dresser, Thomas; Aggarwal, Kul; Gupta, Vishal; Mittal, Mayank K; Alpert, Martin A

    2016-01-01

    Objectives: Left ventricular ejection fraction can be measured by a variety of invasive and non-invasive cardiac techniques. This study assesses the relation of three diagnostic modalities to each other in the measurement of left ventricular ejection fraction: invasive contrast left ventriculography, two-dimensional echocardiography, and quantitative gated single-photon emission computed tomography. Methods: Retrospective chart review was conducted on 58 patients hospitalized with chest pain, who underwent left ventricular ejection fraction evaluation using each of the aforementioned modalities within a 3-month period not interrupted by myocardial infarction or revascularization. Results: The mean left ventricular ejection fraction values were as follows: invasive contrast left ventriculography (0.44±0.15), two-dimensional echocardiography (0.46±0.13), and gated single-photon emission computed tomography (0.37±0.10). Correlations coefficients and associated p values were as follows: invasive contrast left ventriculography versus two-dimensional echocardiography (r=0.69, p<0.001), invasive contrast left ventriculography versus gated single-photon emission computed tomography (r=0.80, p<0.0001), and gated single-photon emission computed tomography versus two-dimensional echocardiography (r=0.69, p<0.001). Conclusion: Our results indicate that strong positive correlations exist among the three techniques studied.

  4. Heart failure with preserved ejection fraction

    PubMed Central

    Gladden, James D.; Linke, Wolfgang A.

    2014-01-01

    As part of this series devoted to heart failure (HF), we review the epidemiology, diagnosis, pathophysiology, and treatment of HF with preserved ejection fraction (HFpEF). Gaps in knowledge and needed future research are discussed. PMID:24663384

  5. Heart failure with preserved ejection fraction

    PubMed Central

    ElGuindy, Ahmed; Yacoub, Magdi H

    2012-01-01

    Abstract Heart failure with preserved ejection fraction (HFpEF) has recently emerged as a major cause of cardiovascular morbidity and mortality. Contrary to initial beliefs, HFpEF is now known to be as common as heart failure with reduced ejection fraction (HFrEF) and carries an unacceptably high mortality rate. With a prevalence that has been steadily rising over the past two decades, it is very likely that HFpEF will represent the dominant heart failure phenotype over the coming few years. The scarcity of trials in this semi-discrete form of heart failure and lack of unified enrolment criteria in the studies conducted to date might have contributed to the current absence of specific therapies. Understanding the epidemiological, pathophysiological and molecular differences (and similarities) between these two forms of heart failure is cornerstone to the development of targeted therapies. Carefully designed studies that adhere to unified diagnostic criteria with the recruitment of appropriate controls and adoption of practical end-points are urgently needed to help identify effective treatment strategies. PMID:25610841

  6. Air pollution and heart failure: Relationship with the ejection fraction

    PubMed Central

    Dominguez-Rodriguez, Alberto; Abreu-Afonso, Javier; Rodríguez, Sergio; Juarez-Prera, Ruben A; Arroyo-Ucar, Eduardo; Gonzalez, Yenny; Abreu-Gonzalez, Pedro; Avanzas, Pablo

    2013-01-01

    AIM: To study whether the concentrations of particulate matter in ambient air are associated with hospital admission due to heart failure in patients with heart failure with preserved ejection fraction and reduced ejection fraction. METHODS: We studied 353 consecutive patients admitted into a tertiary care hospital with a diagnosis of heart failure. Patients with ejection fraction of ≥ 45% were classified as having heart failure with preserved ejection fraction and those with an ejection fraction of < 45% were classified as having heart failure with reduced ejection fraction. We determined the average concentrations of different sizes of particulate matter (< 10, < 2.5, and < 1 μm) and the concentrations of gaseous pollutants (carbon monoxide, sulphur dioxide, nitrogen dioxide and ozone) from 1 d up to 7 d prior to admission. RESULTS: The heart failure with preserved ejection fraction population was exposed to higher nitrogen dioxide concentrations compared to the heart failure with reduced ejection fraction population (12.95 ± 8.22 μg/m3 vs 4.50 ± 2.34 μg/m3, P < 0.0001). Multivariate analysis showed that nitrogen dioxide was a significant predictor of heart failure with preserved ejection fraction (odds ratio ranging from (1.403, 95%CI: 1.003-2.007, P = 0.04) to (1.669, 95%CI: 1.043-2.671, P = 0.03). CONCLUSION: This study demonstrates that short-term nitrogen dioxide exposure is independently associated with admission in the heart failure with preserved ejection fraction population. PMID:23538391

  7. Videodensitometric ejection fraction from intravenous digital subtraction right ventriculograms: correlation with first pass radionuclide ejection fraction

    SciTech Connect

    Detrano, R.; MacIntyre, W.; Salcedo, E.E.; O'Donnell, J.; Underwood, D.A.; Simpfendorfer, C.; Go, R.T.; Butters, K.; Withrow, S.

    1985-06-01

    Thirty-one consecutive patients undergoing intravenous blurred mask digital subtraction right ventriculography were submitted to first pass radionuclide angiography. Second order mask resubtraction of end-diastolic and end-systolic right ventricular digital image frames was executed using preinjection end-diastolic and end-systolic frames to rid the digital subtraction images of mis-registration artifact. End-diastolic and end-systolic perimeters were drawn manually by two independent observers with a light pen. Ejection fractions calculated from the integrated videodensitometric counts within these perimeters correlated well with those derived from the first pass radionuclide right ventriculogram (r = 0.84) and the interobserver correlation was acceptable (r = 0.91). Interobserver differences occurred more frequently in patients with atrial fibrillation and in those whose tricuspid valve planes were difficult to discern on the digital subtraction right ventriculograms. These results suggest that videodensitometric analysis of digital subtraction right ventriculograms is an accurate method of determining right ventricular ejection fraction and may find wide clinical applicability.

  8. Classification of Contextual Use of Left Ventricular Ejection Fraction Assessments.

    PubMed

    Kim, Youngjun; Garvin, Jennifer; Goldstein, Mary K; Meystre, Stéphane M

    2015-01-01

    Knowledge of the left ventricular ejection fraction is critical for the optimal care of patients with heart failure. When a document contains multiple ejection fraction assessments, accurate classification of their contextual use is necessary to filter out historical findings or recommendations and prioritize the assessments for selection of document level ejection fraction information. We present a natural language processing system that classifies the contextual use of both quantitative and qualitative left ventricular ejection fraction assessments in clinical narrative documents. We created support vector machine classifiers with a variety of features extracted from the target assessment, associated concepts, and document section information. The experimental results showed that our classifiers achieved good performance, reaching 95.6% F1-measure for quantitative assessments and 94.2% F1-measure for qualitative assessments in a five-fold cross-validation evaluation. PMID:26262121

  9. Exercise Intolerance In Heart Failure With Preserved Ejection Fraction

    PubMed Central

    Gupte, Anisha A.; Hamilton, Dale J.

    2016-01-01

    More than 50% of Americans with heart failure have preserved ejection fraction (HFpEF). Exercise intolerance is a hallmark of HFpEF, but the pathophysiology is not well understood. Diverse etiologies and incomplete mechanistic understanding have resulted in ineffective management strategies to improve the outcomes of HFpEF. Traditional therapies that have been beneficial in the treatment of heart failure with reduced ejection fraction (HFrEF), neurohormonal blockade in particular, have not been effective in treating HFpEF. In this review, we address underlying mechanisms of HFpEF and present the rationale supporting exercise as a component of comprehensive management. PMID:27486493

  10. Exercise physiology in heart failure and preserved ejection fraction.

    PubMed

    Haykowsky, Mark J; Kitzman, Dalane W

    2014-07-01

    Recent advances in the pathophysiology of exercise intolerance in patients with heart failure with preserved ejection fraction (HFPEF) suggest that noncardiac peripheral factors contribute to the reduced peak V(o2) (peak exercise oxygen uptake) and to its improvement after endurance exercise training. A greater understanding of the peripheral skeletal muscle vascular adaptations that occur with physical conditioning may allow for tailored exercise rehabilitation programs. The identification of specific mechanisms that improve whole body and peripheral skeletal muscle oxygen uptake could establish potential therapeutic targets for medical therapies and a means to follow therapeutic response. PMID:24975908

  11. Heart failure with preserved ejection fraction - unwinding the diagnosis mystique

    PubMed Central

    Asrar ul Haq, Muhammad; Mutha, Vivek; Rudd, Nima; Hare, David L; Wong, Chiew

    2014-01-01

    A precise diagnosis of diastolic dysfunction is often difficult and requires invasive techniques to determine left ventricular volume, relaxation, and compliance properties. At this current point of time there is no single non-invasive index available to adequately reflect diastolic function, perhaps because of the numerous factors that can alter diastolic function. In most clinical settings, diastolic function is estimated using Doppler echocardiography. Cardiac magnetic resonance imaging (CMRI) is yet another emerging modality for diastolic function analysis. Here we present a comprehensive review of the various parameters used to assess diastolic function as part of diagnosis of clinical syndrome “Heart failure with preserved ejection fraction (HFPEF)”. PMID:25360388

  12. Right ventricular ejection fraction: an indicator of increased mortality in patients with congestive heart failure associated with coronary artery disease

    SciTech Connect

    Polak, J.F.; Holman, B.L.; Wynne, J.; Colucci, W.S.

    1983-08-01

    The predictive value of radionuclide ventriculography was studied in 34 patients with depressed left ventricular ejection fraction (less than 40%) and clinically evident congestive heart failure secondary to atherosclerotic coronary artery disease. In addition to left ventricular ejection fraction, right ventricular ejection fraction and extent of left ventricular paradox were obtained in an attempt to identify a subgroup at increased risk of mortality during the ensuing months. The 16 patients who were alive after a 2 year follow-up period had a higher right ventricular ejection fraction and less extensive left ventricular dyskinesia. When a right ventricular ejection fraction of less than 35% was used as a discriminant, mortality was significantly greater among the 21 patients with a depressed right ventricular ejection fraction (71 versus 23%), a finding confirmed by a life table analysis. It appears that the multiple factors contributing to the reduction in right ventricular ejection fraction make it a useful index not only for assessing biventricular function, but also for predicting patient outcome.

  13. Biomarkers in heart failure with preserved ejection fraction.

    PubMed

    Meijers, W C; van der Velde, A R; de Boer, R A

    2016-04-01

    Biomarkers are widely used and studied in heart failure. Most studies have described the utility and performance of biomarkers in sub-studies of randomised clinical trials, where the vast majority of the patients suffered from heart failure with reduced ejection fraction (HFrEF), and not with preserved ejection fraction (HFpEF). As a result, there is a scarcity of data describing the levels, dynamics, clinical and biochemical correlates, and biology of biomarkers in patients suffering from HFpEF, whereas HFpEF is in fact a very frequent clinical entity. This article discusses the value of different biomarkers in HFpEF. We describe various aspects of natriuretic peptide measurements in HFpEF patients, with a focus on diagnosis, prognosis and the risk prediction of developing heart failure. Further, we will discuss several emerging biomarkers such as galectin-3 and suppression of tumorigenicity 2, and recently discovered ones such as growth differentiation factor-15 and syndecan-1. PMID:26942916

  14. The interval ejection fraction: a cineangiographic and radionuclide study

    SciTech Connect

    Kemper, A.J.; Bianco, J.A.; Shulman, R.M.; Folland, E.D.; Parisi, A.F.; Tow, D.E.

    1982-06-01

    To evaluate the clinical usefulness of the first-third ejection fraction (1/3 EF) for detecting patients with coronary artery disease (CAD), resting contrast ventriculography and first-pass radionuclide angiography with a high-count-rate, multicrystal camera system were performed in 47 subjects: 22 normal controls and 25 patients with clinically stable angina pectoris and severe CAD without and with resting wall motion abnormalities. By contrast angiography, only group 3 had depressed global EF or 1/3 EF compared with control. Whereas 11 of 25 CAD patients had global EF outside the normal range, only two of 25 had depressed 1/3 EF. Both had left ventricular asynergy and a depressed global EF. Studies performed using first-pass radionuclide angiography revealed similar results. A wide range of 1/3 EF values was found in normal subjects by both techniques. Thus, the ejection fraction during the first third of systole at rest is of limited value for detecting patients with CAD.

  15. Update on heart failure with preserved ejection fraction

    PubMed Central

    Hummel, Scott L.; Kitzman, Dalane W.

    2013-01-01

    Heart failure with preserved ejection fraction (HFPEF) is the most common form of heart failure (HF) in older adults, and is increasing in prevalence as the population ages. Morbidity and long-term mortality in HFPEF are substantial and can be similar to HF with reduced ejection fraction (HFREF), yet HFPEF therapy remains empirical and treatment guidelines are based primarily on expert consensus. Neurohormonal blockade has revolutionized the management of HFREF, but trials in HFPEF based on this strategy have been disappointing to date. However, many recent studies have increased knowledge about HFPEF. The concept of HFPEF has evolved from a ‘cardio-centric’ model to a syndrome that may involve multiple cardiovascular and non-cardiovascular mechanisms. Emerging data highlight the importance of non-pharmacological management strategies and assessment of non-cardiovascular comorbidities. Animal models, epidemiological cohorts, and small human studies suggest that oxidative stress and inflammation contribute to HFPEF, potentially leading to development of new therapeutic targets. PMID:24860638

  16. Two-dimensional echocardiographic assessment of left ventricular volumes and ejection fraction in children

    SciTech Connect

    Mercier, J.C.; DiSessa, T.G.; Jarmakani, J.M.; Nakanishi, T.; Hiraishi, S.; Isabel-Jones, J.; Friedman, W.F.

    1982-05-01

    The ability of two-dimensional echocardiography to measure left ventricular volumes and ejection fraction was evaluated in 25 children with congenital heart disease. Dimensions and planimetered areas were obtained in the short-axis view at the mitral valve and high and low papillary muscle levels and in the apical two- and four-chamber views. Eight algorithms using five geometric models were assessed. Left ventricular end-diastolic volume, end-systolic volume and ejection fraction were compared with data from biplane cineangiocardiograms. The correlation varied with the algorithm used. Algorithms using short-axis views appeared superior to those using only apical long-axis views. Four algorithms estimated left ventricular volumes with equal accuracy (Simpson's rule, assuming the ventricle to be a truncated cone; Simpson's rule, algorithm that best estimated left ventricular ejection fraction was the ellipsoid biplane formula using the short-axis view at the papillary muscle level (r = 0.91, slope = 0.94, SEE = 6.7%). Thus, two-dimensional echocardiography can accurately assess left ventricular volumes and ejection fraction in children with congenital heart disease.

  17. Assessment of left ventricular ejection fraction by radionuclide angiography. Comparison to echocardiography and serial measurements in patients with myocardial infarction

    NASA Technical Reports Server (NTRS)

    Schelbert, H. R.; Henning, H.; Orourke, R. A.; Ashburn, W. L.

    1975-01-01

    Measurements of the left ventricular ejection fraction were compared in patients with previous myocardial infarctions. Left ventricular ejection fraction was measured by the radioisotopic method serially in patients early after an acute myocardial infarction and during the convalescence period. Ultrasound recordings were obtained utilizing a commercially available ultrasonoscope and a 1/9 cm transducer focused at 10 cm with a repetition rate of 1000 impulses per second. All recordings were made on a visicorder oscillography.

  18. The Association Between Alcohol Consumption and Left Ventricular Ejection Fraction

    PubMed Central

    Li, Zhao; Guo, Xiaofan; Bai, Yinglong; Sun, Guozhe; Guan, Yufan; Sun, Yingxian; Roselle, Abraham Maria

    2016-01-01

    Abstract The results of previous studies on the relation between alcohol consumption and heart failure (HF) have been inconsistent. This study aimed to evaluate the association between alcohol consumption and left ventricular ejection fraction (LVEF) in a general population. A total of 10,824 adults were examined using a multistage cluster sampling method to select a representative sample of individuals who were at least 35-years old. The participants were asked to provide information about their alcohol consumption. Echocardiograms were obtained, and LVEF was calculated using modified Simpson's rule. Of the 10,824 participants included in the present study, 46.1% were males, and the mean participant age was 54 years; age ranged from 35 to 93 years. The overall prevalence of LVEF< 0.50 and LVEF < 0.40 in the studied population was 11.6% and 2.9%, respectively. The prevalence of LVEF < 0.5 and LVEF < 0.04 was higher in both the moderate and heavy drinker groups than in the nondrinker group (P <0.05). Multivariate logistic regression analyses corrected according to the different levels of alcohol consumption showed that moderate and heavy drinkers had an –1.3-fold and 1.2-fold higher risk of LVEF <0.5, respectively, than nondrinkers (OR: 1.381, 95% CI: 1.115–1.711, P = 0.003 for moderate drinkers; OR: 1.246, 95% CI: 1.064–1.460, P = 0.006 for heavy drinkers). Heavy drinkers had an ∼1.5-fold higher risk of decreased LVEF < 0.4 than nondrinkers (OR: 1.482, 95% CI: 1.117–1.965, P = 0.006). Moderate drinkers did not show a risk of decreased LVEF < 0.4 that was significantly higher than that of nondrinkers (OR: 1.183, 95% CI: 0.774–1.808, P = 0.437). According to these results, we concluded that increased alcohol consumption was associated with decreased LVEF compared with no alcohol consumption in this general population. PMID:27227945

  19. Isosorbide Mononitrate in Heart Failure with Preserved Ejection Fraction

    PubMed Central

    Redfield, Margaret M.; Anstrom, Kevin J.; Levine, James A.; Koepp, Gabe A.; Borlaug, Barry A.; Chen, Horng H.; LeWinter, Martin M.; Joseph, Susan M.; Shah, Sanjiv J.; Semigran, Marc J.; Felker, G. Michael; Cole, Robert T.; Reeves, Gordon R.; Tedford, Ryan J.; Tang, W.H. Wilson; McNulty, Steven E.; Velazquez, Eric J.; Shah, Monica R.; Braunwald, Eugene

    2015-01-01

    BACKGROUND Nitrates are commonly prescribed to enhance activity tolerance in patients with heart failure and a preserved ejection fraction. We compared the effect of isosorbide mononitrate or placebo on daily activity in such patients. METHODS In this multicenter, double-blind, crossover study, 110 patients with heart failure and a preserved ejection fraction were randomly assigned to a 6-week dose-escalation regimen of isosorbide mononitrate (from 30 mg to 60 mg to 120 mg once daily) or placebo, with subsequent crossover to the other group for 6 weeks. The primary end point was the daily activity level, quantified as the average daily accelerometer units during the 120-mg phase, as assessed by patient-worn accelerometers. Secondary end points included hours of activity per day during the 120-mg phase, daily accelerometer units during all three dose regimens, quality-of-life scores, 6-minute walk distance, and levels of N-terminal pro–brain natriuretic peptide (NT-proBNP). RESULTS In the group receiving the 120-mg dose of isosorbide mononitrate, as compared with the placebo group, there was a nonsignificant trend toward lower daily activity (−381 accelerometer units; 95% confidence interval [CI], −780 to 17; P = 0.06) and a significant decrease in hours of activity per day (−0.30 hours; 95% CI, −0.55 to −0.05; P = 0.02). During all dose regimens, activity in the isosorbide mononitrate group was lower than that in the placebo group (−439 accelerometer units; 95% CI, −792 to −86; P = 0.02). Activity levels decreased progressively and significantly with increased doses of isosorbide mononitrate (but not placebo). There were no significant between-group differences in the 6-minute walk distance, quality-of-life scores, or NT-proBNP levels. CONCLUSIONS Patients with heart failure and a preserved ejection fraction who received isosorbide mononitrate were less active and did not have better quality of life or submaximal exercise capacity than did

  20. Systems Biology Applied to Heart Failure With Normal Ejection Fraction

    PubMed Central

    Mesquita, Evandro Tinoco; Jorge, Antonio Jose Lagoeiro; de Souza, Celso Vale; Cassino, João Paulo Pedroza

    2014-01-01

    Heart failure with normal ejection fraction (HFNEF) is currently the most prevalent clinical phenotype of heart failure. However, the treatments available have shown no reduction in mortality so far. Advances in the omics sciences and techniques of high data processing used in molecular biology have enabled the development of an integrating approach to HFNEF based on systems biology. This study aimed at presenting a systems-biology-based HFNEF model using the bottom-up and top-down approaches. A literature search was conducted for studies published between 1991 and 2013 regarding HFNEF pathophysiology, its biomarkers and systems biology. A conceptual model was developed using bottom-up and top-down approaches of systems biology. The use of systems-biology approaches for HFNEF, a complex clinical syndrome, can be useful to better understand its pathophysiology and to discover new therapeutic targets. PMID:24918915

  1. Ventricular Remodeling in Heart Failure with Preserved Ejection Fraction

    PubMed Central

    Shah, Amil M.

    2014-01-01

    Heart failure with preserved ejection fraction (HFpEF) is common, increasing in prevalence, and causes substantial morbidity and mortality. HFpEF has commonly been viewed as an expression of advanced hypertensive heart disease, with a cardiac phenotype characterized by an increase in wall thickness-to-chamber radius ratio (concentric hypertrophy). However, marked clinical heterogeneity within this syndrome is now well appreciated, and is mirrored in the variability in left ventricular structure. A review of larger imaging studies from epidemiology and clinical trial cohorts demonstrate that while concentric LV remodeling is common, it is by no means universal and many patients demonstrate normal LV geometry or even an eccentric pattern. More detailed assessment of cardiac structure and function in broader HFpEF populations will be necessary to better define the prevalence, determinants, and prognostic relevance of these measures, which may in turn serve as a foundation to identify pathophysiologically relevant sub-phenotypes within this diverse syndrome. PMID:24097113

  2. Metabolomic Fingerprint of Heart Failure with Preserved Ejection Fraction

    PubMed Central

    Zordoky, Beshay N.; Sung, Miranda M.; Ezekowitz, Justin; Mandal, Rupasri; Han, Beomsoo; Bjorndahl, Trent C.; Bouatra, Souhaila; Anderson, Todd; Oudit, Gavin Y.; Wishart, David S.; Dyck, Jason R. B.

    2015-01-01

    Background Heart failure (HF) with preserved ejection fraction (HFpEF) is increasingly recognized as an important clinical entity. Preclinical studies have shown differences in the pathophysiology between HFpEF and HF with reduced ejection fraction (HFrEF). Therefore, we hypothesized that a systematic metabolomic analysis would reveal a novel metabolomic fingerprint of HFpEF that will help understand its pathophysiology and assist in establishing new biomarkers for its diagnosis. Methods and Results Ambulatory patients with clinical diagnosis of HFpEF (n = 24), HFrEF (n = 20), and age-matched non-HF controls (n = 38) were selected for metabolomic analysis as part of the Alberta HEART (Heart Failure Etiology and Analysis Research Team) project. 181 serum metabolites were quantified by LC-MS/MS and 1H-NMR spectroscopy. Compared to non-HF control, HFpEF patients demonstrated higher serum concentrations of acylcarnitines, carnitine, creatinine, betaine, and amino acids; and lower levels of phosphatidylcholines, lysophosphatidylcholines, and sphingomyelins. Medium and long-chain acylcarnitines and ketone bodies were higher in HFpEF than HFrEF patients. Using logistic regression, two panels of metabolites were identified that can separate HFpEF patients from both non-HF controls and HFrEF patients with area under the receiver operating characteristic (ROC) curves of 0.942 and 0.981, respectively. Conclusions The metabolomics approach employed in this study identified a unique metabolomic fingerprint of HFpEF that is distinct from that of HFrEF. This metabolomic fingerprint has been utilized to identify two novel panels of metabolites that can separate HFpEF patients from both non-HF controls and HFrEF patients. Clinical Trial Registration ClinicalTrials.gov NCT02052804 PMID:26010610

  3. Interval ejection fraction: a cineangiographic and radionuclide study

    SciTech Connect

    Kemper, A.J.; Bianco, J.A.; Shulman, R.M.; Folland, E.D.; Paris, A.F.; Tow, D.E.

    1982-06-01

    To evaluate the clinical usefulness of the first-third ejection fraction (1/3 EF) for detecting patients with coronary artery disease (CAD), resting contrast ventriculography and first-pass radionuclide angiography with a high-count-rate, multicrystal camera system were performed in 47 subjects: 22 normal controls (group 1) and 25 patients with clinically stable angina pectoris and severe CAD (mean 2.3 vessels) without (group 2, n = 12) and with (group 3, n = 13) resting wall motion abnormalities. By contrast angiography, only group 3 had depressed global EF or 1/3 EF compared with control (global EF: group 1, 0.71 = 0.09; group 2, 0.67 = 0.09 (NS); group 3, 0.49 = 0.05 (p < 0.01 vs groups 1 and 2); 1/3 EF: group 1, 0.29 = 0.06; group 2, 0.28 = 0.05 (NS); group 3, 0.22 = 0.05 (p < 0.01 vs groups 1 and 2)). Whereas 11 of 25 CAD patients had global EF outside the normal range, only two of 25 had depressed 1/3 EF. Both had left ventricular asynergy and a depressed global EF. Studies performed using first-pass radionuclide angiography revealed similar results, i.e., only four of 25 CAD patients, all with left ventricular asynergy and depressed global EF, had depressed 1/3 EF values. A wide range of 1/3 EF values was found in normal subjects by both techniques. Thus, the ejection fraction during the first third of systole at rest is of limited value for detecting patients with CAD.

  4. Ejection fraction response to exercise in patients with chest pain and normal coronary arteriograms

    SciTech Connect

    Gibbons, R.L.; Lee, K.L.; Cobb, F.; Jones, R.H.

    1981-11-01

    In this study we describe the ejection fraction response to upright exercise using first-pass radionuclide angiocardiography in a group of 60 patients with chest pain, normal coronary ateriograms and normal resting ventricular function. A wide range of resting function (heart rate and ejection fraction) and exercise function (heart rate, ejection fraction, peak work load and estimated peak oxygen uptake) were measured. The ejection fraction response to exercise demonstrated wide variation, ranging from a decrease of 23% to an increase of 24%. Six of 22 clinical and radionuclide angiocardiographic variables (resting ejection fraction, peak work load, age, sex, body surface area and the change in end-diastolic volume index with exercise) were significant univariate predictors of the ejection fraction response to exercise. Multivariable analysis identified resting ejection fraction, the change in end-diastolic volume index with exercise and either sex or peak work load as variables that provided significant independent predictive information. These observations indicate that the ejection fraction response to exercise is a complex response that is influenced by multiple physiologic variables. The wide variation in this population suggests that the ejection fraction response to exercise is not a reliable test for the diagnosis of coronary artery disease because of its low specificity.

  5. [New therapy concepts for heart failure with preserved ejection fraction].

    PubMed

    Tschöpe, C; Pieske, B

    2015-04-01

    The management of patients with heart failure and preserved ejection fraction (HFpEF) remains challenging and requires an accurate diagnosis. Although currently no convincing therapy that can prolong survival in patients with HFpEF has been established, treatment of fluid retention, heart rate and control of comorbidities are important cornerstones to improve the quality of life and symptoms. In recent years many new therapy targets have been tested for development of successful interventional strategies for HFpEF. Insights into new mechanisms of HFpEF have shown that heart failure is associated with dysregulation of the nitric oxide-cyclic guanosine monophosphate-protein kinase (NO-cGMP-PK) pathway. Two new drugs are currently under investigation to test whether this pathway can be significantly improved by either the neprilysin inhibitor LCZ 696 due to an increase in natriuretic peptides or by the soluble guanylate cyclase stimulator vericiguat, which is also able to increase cGMP. In addition, several preclinical or early phase studies which are currently investigating new mechanisms for matrix, intracellular calcium and energy regulation including the role of microRNAs and new devices are presented and discussed. PMID:25737289

  6. The Emerging Epidemic of Heart Failure with Preserved Ejection Fraction

    PubMed Central

    Oktay, A. Afşin; Rich, Jonathan D.

    2013-01-01

    Heart failure with preserved ejection fraction (HFpEF), which currently represents approximately 50 % of heart failure (HF) cases, is common and associated with high morbidity and mortality. Understanding the epidemiology of HFpEF has been difficult due to the challenges in HFpEF diagnosis and the heterogeneous etiologies and pathophysiologies that underlie HFpEF. Nevertheless, several high-quality epidemiology and observational registry studies of HFpEF demonstrate that an increasing prevalence of HFpEF in both the outpatient and inpatient settings, coupled with a lack of evidence-based effective treatments for HFpEF, is resulting in an emerging epidemic of HFpEF. In this review, we discuss the emerging HFpEF epidemic, focusing on: (1) reasons for the rising prevalence of HFpEF; (2) the abnormalities in cardiac structure and function that dictate the transition from risk factors to HFpEF; (3) novel HFpEF mechanisms that may underlie the increase in HFpEF prevalence; (4) prognosis of HFpEF; and (5) risk prediction in HFpEF. We conclude with 10 unanswered questions on HFpEF epidemiology that will be important areas for future investigation. PMID:24078336

  7. Epidemiology of heart failure with preserved ejection fraction

    PubMed Central

    Andersson, Charlotte; Vasan, Ramachandran S

    2014-01-01

    Heart failure with preserved ejection fraction (HFPEF) is a common condition, especially among the elderly and in women, with the reported prevalence approaching 10% in women over the age of 80 years. With an increasing prevalence of hypertension, obesity, atrial fibrillation, and diabetes, and the growing elderly segment of the general population, the prevalence of HFPEF is projected to increase further. HFPEF presents a diagnostic challenge. As a consequence, studies differ widely in their reported incidence and mortality rates associated with this condition, although there is agreement that between a third and one half of heart failure patients in the community have HFPEF. Although several consensus statements and guidelines have been published during the last decade, some of the recent randomized clinical trials have reported low mortality rates, raising doubts whether all patients diagnosed with HFPEF do actually suffer from HFPEF (as opposed to misdiagnosis) or if the condition is heterogeneous by nature in terms of its etiology and prognosis. The overall reported prognosis of patients with HFPEF remains poor, with patients experiencing substantial comorbidity, high rates of repeated hospitalizations, and a high mortality. In both community-based and hospital-based cohorts, HFPEF was recently reported to be associated with approximately 159 (154–165) deaths per 1000 person-years. PMID:24975902

  8. Diastolic dysfunction and heart failure with a preserved ejection fraction: Relevance in critical illness and anaesthesia

    PubMed Central

    Maharaj, R.

    2012-01-01

    Epidemiological and clinical studies suggest that HF with a preserved ejection fraction will become the more common form of HF which clinicians will encounter. The spectrum of diastolic disease extends from the asymptomatic phase to fulminant cardiac failure. These patients are commonly encountered in operating rooms and critical care units. A clearer understanding of the underlying pathophysiology and clinical implications of HF with a preserved ejection fraction is fundamental to directing further research and to evaluate interventions. This review highlights the impact of diastolic dysfunction and HF with a preserved ejection fraction during the perioperative period and during critical illness. PMID:23960679

  9. Prevention by nifedipine of cold pressor-induced decrease in left ventricular ejection fraction

    SciTech Connect

    Goldhaber, S.Z.; White, H.D.; Holman, B.L.; Nesto, R.W.; Mudge, G.H. Jr.; Muller, J.E.; Kozlowski, J.; Wynne, J.

    1983-06-01

    To examine the effects of nifedipine on changes in ventricular function produced by cold, the cold pressor test was administered to eight patients with angiographically documented coronary artery disease. Radionuclide ventriculograms were obtained at baseline and during the cold pressor stimulus both before and after administration of nifedipine, 10 mg buccally; thus, four serial radionuclide ventriculograms were obtained per patient. The cold pressor stimulus did not produce any significant difference in the mean (+/- standard deviation) peak rate-pressure product during the control or nifedipine test (10,900 +/- 3,390 versus 10,600 +/- 3,700). However, the increase in systolic blood pressure (p . 0.05) and the peak systolic blood pressure achieved (p less than 0.001) were greater during the control (134 +/- 19 to 160 +/- 25 mm Hg) than during the nifedipine (125 +/- 18 to 145 +/- 21 mm Hg) cold pressor test. The mean global left ventricular ejection fraction decreased during the control cold pressor test from a baseline value of 0.60 +/- 0.08 to 0.52 +/- 0.08 (p . 0.004). After nifedipine, this variable did not change during the repeat cold pressor test (0.63 +/- 0.09) compared with the repeat baseline value (0.63 +/- 0.11). Therefore, the difference in left ventricular ejection fraction response during control versus nifedipine cold pressor testing was highly significant (p less than 0.0001). In patients with obstructive coronary artery disease, nifedipine abolished the decrease in left ventricular ejection fraction observed during the control cold pressor test and may be of value to protect patients from cold-induced left ventricular dysfunction. The mechanism may be a combination of coronary artery vasodilation and systolic unloading of the left ventricle.

  10. Fractionation of hydrogen and deuterium on Venus due to collisional ejection

    NASA Technical Reports Server (NTRS)

    Gurwell, Mark A.; Yung, Yuk L.

    1993-01-01

    The collisional ejection process for hydrogen on Venus is reanalyzed. Improved values for the efficiency of H and D escape as a function of the ionospheric temperature are reported. It is proposed that the reduction of the hydrogen flux for collisional ejection be reduced from 8 to 3.5 x 10 exp 6/sq cm/s, and a revised D/H fractional factor of 0.47 due to collisional ejection is suggested. The resulting deuterium flux is 3.1 x 10 exp 4/sq cm/s, roughly six times the flux due to charge exchange, making collisional ejection the dominant escape mechanism for deuterium on Venus.

  11. Fractionation of hydrogen and deuterium on Venus due to collisional ejection

    NASA Astrophysics Data System (ADS)

    Gurwell, M. A.; Yung, Y. L.

    1993-02-01

    The collisional ejection process for hydrogen on Venus is reanalyzed. Improved values for the efficiency of H and D escape as a function of the ionospheric temperature are reported. It is proposed that the reduction of the hydrogen flux for collisional ejection be reduced from 8 to 3.5 x 10 exp 6/sq cm/s, and a revised D/H fractional factor of 0.47 due to collisional ejection is suggested. The resulting deuterium flux is 3.1 x 10 exp 4/sq cm/s, roughly six times the flux due to charge exchange, making collisional ejection the dominant escape mechanism for deuterium on Venus.

  12. Carvedilol compared with metoprolol on left ventricular ejection fraction after coronary artery bypass graft.

    PubMed

    Shahzamani, Mehran; Ghanavati, Arash; Froutagheh, Azam Nouri; Foroughi, Mahnoosh; Rahimian, Hosein; Shahsanaei, Azadeh; Hasantash, Seyed Ahmad; Dabbagh, Ali

    2011-12-01

    A number of elective coronary artery bypass graft (CABG) surgery patients have impaired underlying left ventricular function (poor ejection fraction). This study was performed to compare the effect of postoperative oral carvedilol versus metoprolol on left ventricular ejection fraction (LVEF) after CABG compared with metoprolol. In a double-blind clinical trial, 60 patients with coronary artery disease, aged 35 to 65 years, who had an ejection fraction of 15% to 35% were included. Either carvedilol or metoprolol was administered the day after CABG. The patients were evaluated by the same cardiologist 14 days before and 2 and 6 months after elective CABG. The results demonstrated better improvements in LVEF in the carvedilol group. No difference regarding postoperative arrhythmias or mortality was detected. The results suggest that carvedilol may exert more of an improved myocardial effect than metoprolol for the low ejection fraction patients undergoing CABG in the early postoperative months. PMID:22099130

  13. Ejection fraction determination without planimetry by two-dimensional echocardiography: a new method

    SciTech Connect

    Baran, A.O.; Rogal, G.J.; Nanda, N.C.

    1983-06-01

    A new method for determining ejection fraction by two-dimensional echocardiography was assessed in 60 patients undergoing angiography. In method A, the left ventricular minor axis was measured at the midventricular cavity level in end-systole and end-diastole using the apical four chamber view in the 60 patients. The left ventricular major axis was also measured from the left ventricular apex to the base of the mitral valve at end-systole and end-diastole. The ejection fraction was determined using a modified cylinder-ellipse algorithm. In method B, measurements of the left ventricular minor axis were made in 40 consecutive patients, at the upper, middle and lower thirds of the left ventricular cavity at end-systole and end-diastole of the same cardiac cycle and left ventricular major axis was measured as in method A. With use of the same algorithm, three regional ejection fractions were determined and averaged to yield the total ejection fraction. The two echocardiographic methods were compared with single plane cineangiography in all patients and with gated nuclear scanning in 14 patients. Reproducibility was assessed by interobserver comparison. Correlation was determined in all patients and then separately for those with echocardiographic wall motion abnormalities. This method directly measures fractional shortening of left ventricular major axis and ejection fraction values are not arbitrarily modified by type of wall motion abnormality. With this method, accurate measurement of ejection fraction can be made by two-dimensional echocardiography without planimetry. In the absence of echocardiographic wall motion abnormalities, a very simple method A suffices. If wall motion abnormalities are present, the regional ejection fraction method B provides excellent results.

  14. Measurement of left ventricular ejection fraction in pediatric patients using the nuclear stethoscope

    SciTech Connect

    Spicer, R.L.; Rabinovitch, M.; Rosenthal, A.; Pitt, B.

    1984-01-01

    Left ventricular (LV) ejection fraction (EF) was measured in 25 patients, aged 2 weeks to 20 years (mean 8.6 years), using a portable nonimaging scintillation stethoscope. Technically satisfactory studies were obtained in 23 patients. LVEF was validated by cineangiography in 19 patients and by standard gated blood pool scintigraphy in 4. EF measured by the nuclear stethoscope correlated well with values obtained by cineangiography or scintigraphy over a wide range of EF values (18 to 79%). In children younger than 5 years (n . 11), the correlation was less satisfactory than in those older than 5 years. Although modifications in the instrument and further clinical trials with the stethoscope are needed before the device becomes clinically useful to pediatric cardiologists, our data indicate that the nuclear stethoscope can provide reliable assessment of LVEF in pediatric patients.

  15. Beyond ejection fraction: an integrative approach for assessment of cardiac structure and function in heart failure.

    PubMed

    Cikes, Maja; Solomon, Scott D

    2016-06-01

    Left ventricular ejection fraction (LVEF) has been the central parameter used for diagnosis and management in patients with heart failure. A good predictor of adverse outcomes in heart failure when below ∼45%, LVEF is less useful as a marker of risk as it approaches normal. As a measure of cardiac function, ejection fraction has several important limitations. Calculated as the stroke volume divided by end-diastolic volume, the estimation of ejection fraction is generally based on geometric assumptions that allow for assessment of volumes based on linear or two-dimensional measurements. Left ventricular ejection fraction is both preload- and afterload-dependent, can change substantially based on loading conditions, is only moderately reproducible, and represents only a single measure of risk in patients with heart failure. Moreover, the relationship between ejection fraction and risk in patients with heart failure is modified by factors such as hypertension, diabetes, and renal function. A more complete evaluation and understanding of left ventricular function in patients with heart failure requires a more comprehensive assessment: we conceptualize an integrative approach that incorporates measures of left and right ventricular function, left ventricular geometry, left atrial size, and valvular function, as well as non-imaging factors (such as clinical parameters and biomarkers), providing a comprehensive and accurate prediction of risk in heart failure. PMID:26417058

  16. Therapeutic interventions for heart failure with preserved ejection fraction: A summary of current evidence

    PubMed Central

    Asrar ul Haq, Muhammad; Wong, Chiew; Mutha, Vivek; Anavekar, Nagesh; Lim, Kwang; Barlis, Peter; Hare, David L

    2014-01-01

    Heart failure with preserved ejection fraction (HFPEF) is common and represents a major challenge in cardiovascular medicine. Most of the current treatment of HFPEF is based on morbidity benefits and symptom reduction. Various pharmacological interventions available for heart failure with reduced ejection fraction have not been supported by clinical studies for HFPEF. Addressing the specific aetiology and aggressive risk factor modification remain the mainstay in the treatment of HFPEF. We present a brief overview of the currently recommended therapeutic options with available evidence. PMID:24575173

  17. Abnormal gallbladder nuclear ejection fraction predicts success of cholecystectomy in patients with biliary dyskinesia.

    PubMed

    Sorenson, M K; Fancher, S; Lang, N P; Eidt, J F; Broadwater, J R

    1993-12-01

    The management of patients with symptoms consistent with biliary tract disease who do not have gallstones is difficult. We retrospectively reviewed the charts of 18 patients who underwent cholecystokinin cholescintigraphy at our institution to determine if this procedure was reliable in identifying patients who would benefit from cholecystectomy. All patients underwent biliary screening, and a gallbladder ejection fraction of less than or equal to 35% was considered abnormal. None of the patients had evidence of gallstones by ultrasound. There were 11 patients with abnormal ejection fractions. All 11 patients (100%) had "classic" biliary colic and underwent cholecystectomy. The pathologic diagnosis was chronic cholecystitis in every patient. All patients had complete relief of their symptoms postoperatively with a mean follow-up of 10 months. There were six patients with normal ejection fractions. Only one patient in this group had "classic" biliary colic. This patient had a gallbladder ejection fraction of 38% and endoscopic evidence of gastritis. This patient remains symptomatic despite H2 blockade. The remaining five patients had nonspecific right upper quadrant or epigastric pain. These patients had endoscopic evidence of gastritis, and symptoms were relieved with H2 blockade. The remaining patient had an indeterminate scan due to radioactivity in the duodenum overlying the gallbladder and was excluded from this analysis. Cholecystokinin cholescintigraphy is a useful test in identifying those patients with biliary dyskinesia or acalculous cholecystitis who will benefit from cholecystectomy. PMID:8273847

  18. [Revascularization versus transplantation in patients with limited ejection fraction].

    PubMed

    Muñoz Carvajal, I; Concha Ruiz, M

    1998-01-01

    Ventricular dysfunction caused by ischemia is frequently a consequence of episodes of myocardial infarction which occur in the context of coronary disease, as well as of the ischemic situation in patients with severe failure in the main coronary arteries. The physiopathological mechanisms, as well as the therapeutic possibilities, are different in the case of diagnosed necrosis of myocardium or in situations of its circulatory deficiency, and, in the latter case, they depend on the period of absence of blood flow to the ischemic area, and on the occurrence of reperfusion of the area at the end of the ischemic event, the existence of an adequate collateral flow, etc. Classically, moderate degrees of ischemic ventricular dysfunction were considered as a preferential indication for revascularization surgery, together with the existence of coronary disease anatomically suitable for bypass. However, severe degrees of ventricular dysfunction were regarded as a contraindication to surgery, as they were considered irreversible due to an ischemic myocardiopathy which could not be palliated by an ulterior revascularization. These patients were referred to heart transplantation or to medical treatment when they did not fulfill the criteria to be included in transplantation programmes. In a later stage, due to a scarcity of donors for transplantation and to the disappointing results of pharmacological treatment in these patients, revascularization operations begun to be performed on patients with severe heart failure. Although initial results were not comparable to the ones obtained nowadays, work continued on this track and rapid improvement was achieved when particular clinical and diagnostic patterns were followed. Thus the concept of myocardial viability was created, presently being a central criterion in deciding which patients should go through revascularization. There are different methods to assess viability, and new ones are added to the diagnostic arsenal every day

  19. RECURRENT STROKE IN THE WARFARIN VERSUS ASPIRIN IN REDUCED EJECTION FRACTION (WARCEF) TRIAL

    PubMed Central

    Pullicino, Patrick M.; Qian, Min; Sacco, Ralph L.; Freudenberger, Ron; Graham, Susan; Teerlink, John R.; Mann, Douglas; Di Tullio, Marco R.; Ponikowski, Piotr; Lok, Dirk J.; Anker, Stefan D.; Lip, Gregory Y.H.; Estol, Conrado J.; Levin, Bruce; Mohr, J.P.; Thompson, John L. P.; Homma, Shunichi

    2014-01-01

    Background and Purpose WARCEF randomized 2305 patients in sinus rhythm with ejection fraction (EF) ≤35% to warfarin (INR 2.0–3.5) or aspirin 325 mg. Warfarin reduced the incident ischemic stroke (IIS) hazard rate by 48% over aspirin in a secondary analysis. The IIS rate in heart failure (HF) is too low to warrant routine anticoagulation but epidemiologic studies show that prior stroke increases the stroke risk in HF. We here explore IIS rates in WARCEF patients with and without baseline stroke to look for risk factors for IIS and determine if a subgroup with an IIS rate high enough to give a clinically relevant stroke risk reduction can be identified. Methods We compared potential stroke risk factors between patients with baseline stroke and those without using the exact conditional score test for Poisson variables. We looked for risk factors for IIS, by comparing IIS rates between different risk factors. For EF we tried cutoff points of 10%, 15% and 20%. 15% was used as it was the highest EF that was associated with a significant increase in IIS rate. IIS and EF strata were balanced as to warfarin/aspirin assignment by the stratified randomized design. A multiple Poisson regression examined the simultaneous effects of all risk factors on IIS rate. IIS rates per hundred patient years (/100PY) were calculated in patient groups with significant risk factors. Missing values were assigned the modal value. Results Twenty of 248 (8.1%) patients with baseline stroke and 64 of 2048 (3.1%) without had IIS. IIS rate in patients with baseline stroke (2.37/100PY) was greater than patients without (0.89/100PY)(rate ratio 2.68, p<0.001). Fourteen of 219 (6.4%) patients with ejection fraction (EF)<15% and 70 of 2079 (3.4%) with EF ≥15% had IIS. In the multiple regression analysis stroke at baseline (p<0.001) and EF<15% vs. ≥15% (p=.005) remained significant predictors of IIS. IIS rate was 2.04/100PY in patients with EF<15% and 0.95/100PY in patients with EF ≥15% (p=0

  20. Foundations of Pharmacotherapy for Heart Failure With Reduced Ejection Fraction: Evidence Meets Practice, Part I.

    PubMed

    Paul, Sara; Page, Robert L

    2016-01-01

    Pharmacologic treatment for systolic heart failure, otherwise known as heart failure with reduced ejection fraction, has been established through clinical trials and is formulated into guidelines to standardize the diagnosis and treatment. The premise of pharmacologic therapy in heart failure with reduced ejection fraction is aimed primarily at interrupting the neurohormonal cascade that is responsible for altering left ventricular shape and function. This is the first in a series of articles to describe the pharmacologic agents in the guidelines that impact the morbidity and mortality associated with heart failure. Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and vasodilators will be presented in the context of the mechanism of action in heart failure, investigational trials that showed beneficial effects, and the practical application for clinical use. PMID:26296245

  1. Relation of Ankle Brachial Index to Left Ventricular Ejection Fraction in Non-Diabetic Individuals

    PubMed Central

    Abbasnezhad, Mohsen; Aliasgarzadeh, Akbar; Aslanabadi, Hasan; Habibzadeh, Afshin; Zamani, Bejan

    2011-01-01

    Introduction Peripheral arterial disease is associated with an excessive risk for cardi-ovascular events and mortality. Peripheral arterial disease is usually measured with ankle brachial index (ABI). It is previously shown that the ABI would reflect LV systolic func-tion, as well as atherosclerosis; however, these results are not shown in non-diabetic indi-viduals. In this study, we aim to evaluate this relation in non-diabetic individuals. Methods In a prospective study, 73 non-diabetic individuals (38.4% male with mean age of 59.20±14.42 years) referred for ABI determination who had had the left ventricular ejection fraction determined using trans-thoracic echocardiography were studied. Participants were compared in normal and low ABI groups. Results The mean left ventricular ejection fraction (LVEF) was 52.34±7.69, mean ankle brachial index for the right leg was 1.08±0.13, and the mean ankle brachial index for the left leg was 1.07±0.12. Low ABI incidence was 12.32%. Individuals with low ABI significantly were older (p<0.001) and had lower left ventricular ejection fraction (p<0.001). ABI had significantly inverse corre-lation with LVEF (r=-0.53, p<0.001) and positive correlation with age (r=0.43, p<0.001). The ABI correlated inversely with LVEF in the patients with (r =-0.52, p=0.008) and without (r=-0.55, p<0.001) IHD. Conclusion Results showed that ankle brachial index would be influenced by left ventricular ejection fraction in non-diabetics and to evaluate and monitor cardiovascular risk in patients these should be considered together. PMID:24250966

  2. Patterns of decrease in multidirectional myocardial deformations in patients with fluctuating left ventricular ejection fraction.

    PubMed

    Kim, Yong-Hyun; Choi, Jungsoon; Kim, Seong-Hwan; Kim, Dong-Hyeok; Ahn, Jeong-Cheon; Song, Woo-Hyuk

    2014-01-01

    Few studies have examined the variations in longitudinal/circumferential/radial strain (LS/CS/RS) and strain rate (LSr/CSr/RSr) in individual hearts when the left ventricular ejection fraction (LVEF) has changed. We hypothesized the relationships of strain/strain rate and LVEF are not linear, but vary with multiple inflection points (IPs) in individual hearts.Twenty-five patients with fluctuating LVEF (ΔLVEF > 10%) who had 2-D speckle tracking echocardiography available for analysis were enrolled. After models of best fit were obtained from the 'collective' plots to determine inflection points, the decrements of slopes above inflection points (IP) were compared with those below IPs in the 'individual hearts' plots.In the 'collective' plots, both LS and LSr linearly decreased in proportion to LVEF when LVEF ≥ 40% but remained constant regardless of LVEF when LVEF < 40% (IPs when LVEF = 40%, P < 0.0001). The RS-LVEF relationship was sigmoid with two IPs when LVEF = 30% and 50% (P < 0.0001). However, in the 'individual hearts' plots, the decrements of slopes above and below IPs were not different for LS-LVEF and LSr-LVEF, and marginally different for RS-LVEF (P = 0.049, across IP when LVEF = 50%).Collectively, the relationship of LS/LSr/RS and LVEF seemed to be not linear, but inflective, however, we could not prove the inflective relationship in individual hearts with fluctuating LVEF. Further study with more patients is needed to prove our hypothesis. PMID:24881586

  3. Nuclear cardiac ejection fraction and cardiac index in abdominal aortic surgery

    SciTech Connect

    Fiser, W.P.; Thompson, B.W.; Thompson, A.R.; Eason, C.; Read, R.C.

    1983-11-01

    Since atherosclerotic heart disease results in more than half of the perioperative deaths that follow abdominal aortic surgery, a prospective protocol was designed for preoperative evaluation and intraoperative hemodynamic monitoring. Twenty men who were prepared to undergo elective operation for aortoiliac occlusive disease (12 patients) and abdominal aortic aneurysm (eight patients) were evaluated with a cardiac scan and right heart catheterization. The night prior to operation, each patient received volume loading with crystalloid based upon ventricular performance curves. At the time of the operation, all patients were anesthetized with narcotics and nitrous oxide, and hemodynamic parameters were recorded throughout the operation. Aortic crossclamping resulted in a marked depression in CI in all patients. CI remained depressed after unclamping in the majority of patients. There were two perioperative deaths, both from myocardial infarction or failure. Both patients had ejection fractions less than 30% and initial CIs less than 2 L/M2, while the survivors' mean ejection fraction was 63% +/- 1 and their mean CI was 3.2 L/M2 +/- 0.6. The authors conclude that preoperative evaluation of ejection fraction can select those patients at a high risk of cardiac death from abdominal aortic operation. These patients should receive intensive preoperative monitoring with enhancement of ventricular performance.

  4. Assessment of left ventricular ejection fraction from technetium-99m-methoxy isobutyl isonitrile multiple-gated radionuclide angiocardiography

    SciTech Connect

    Davis, M.H.; Rezaie, B. . Dept. of Electrical Engineering); Weiland, F.L. . Dept. of Nuclear Medicine)

    1993-06-01

    Abnormal left ventricular function is a diagnostic indication of cardiac disease. Left ventricular function is commonly quantified by ejection fraction measurements. A novel approach for the determination of left ventricular ejection fraction from technetium-99m-methoxy isobutyl isonitrile multiple-gated radionuclide angiocardiography is presented. Data from 23 patients, symptomatic of cardiac disease, indicate that ejection fractions determined using the radionuclide technique correlate well with contrast X-ray single-plane cineangiography. Data from 14 of the patients indicate favorable correlation with technetium-99m-pertechnetate gated blood pool radionuclide angiocardiography.

  5. A geometric method of measuring the left ventricular ejection fraction on gated Tc-99m sestamibi myocardial imaging.

    PubMed

    Miron, S D; Finkelhor, R; Penuel, J H; Bahler, R; Bellon, E M

    1996-06-01

    Geometric measurements of the left ventricular diameters as used in biplane angiocardiography and echocardiography were applied to gated SPECT Tc-99m sestamibi myocardial scintigrams in order to calculate the left ventricular ejection fraction. These measurements take no longer than 5 minutes and require no additional computer software. In a review of 79 examinations, the left ventricular ejection fraction calculated using these measurements correlated well with the echocardiographically estimated ejection fraction (r = 0.78, P < 0.0001). The technique is highly reproducible with an intraobserver correlation of r = 0.94 and interobserver correlation of r = 0.93. PMID:8744176

  6. Heart Failure with Preserved Ejection Fraction – Concept, Pathophysiology, Diagnosis and Challenges for Treatment

    PubMed Central

    Miljkovik, Lidija Veterovska; Spiroska, Vera

    2015-01-01

    Heart failure (HF) with preserved left ventricular (LV) ejection fraction (HFpEF) occurs in 40 to 60% of the patients with HF, with a prognosis which is similar to HF with reduced ejection fraction (HFrEF). HFpEF pathophysiology is different from that of HFrEF, and has been characterized with diastolic dysfunction. Diastolic dysfunction has been defined with elevated left ventricular stiffness, prolonged iso-volumetric LV relaxation, slow LV filing and elevated LV end-diastolic pressure. Arterial hypertension occurs in majority cases with HFpEF worldwide. Patients are mostly older and obese. Diabetes mellitus and atrial fibrillation appear proportionally in a high frequency of patients with HFpEF. The HFpEF diagnosis is based on existence of symptoms and signs of heart failure, normal or approximately normal ejection and diagnosing of LV diastolic dysfunction by means of heart catheterization or Doppler echocardiography and/or elevated concentration of plasma natriuretic peptide. The present recommendations for HFpEF treatment include blood pressure control, heart chamber frequency control when atrial fibrillation exists, in some situations even coronary revascularization and an attempt for sinus rhythm reestablishment. Up to now, it is considered that no medication or a group of medications improve the survival of HFpEF patients. Due to these causes and the bad prognosis of the disorder, rigorous control is recommended of the previously mentioned precipitating factors for this disorder. This paper presents a universal review of the most important parameters which determine this disorder.

  7. Preoperative ejection fraction as a predictor of survival after coronary artery bypass grafting: comparison with a matched general population

    PubMed Central

    2010-01-01

    Background Preoperative left ventricular dysfunction is an established risk factor for early and late mortality after revascularization. This retrospective analysis demonstrates the effects of preoperative ejection fraction on the short-term and long-term survival of patients after coronary artery bypass grafting. Methods Early and late mortality were determined retrospectively in 10 626 consecutive patients who underwent isolated coronary bypass between January 1998 and December 2007. The subjects were divided into 3 groups according to their preoperative ejection fraction. Expected survival was estimated by comparison with a general Dutch population group described in the database of the Dutch Central Bureau for Statistics. For each of our groups with a known preoperative ejection fraction, a general Dutch population group was matched for age, sex, and year of operation. Results and Discussion One hundred twenty-two patients were lost to follow-up. In 219 patients, the preoperative ejection fraction could not be retrieved. In the remaining patients (n = 10 285), the results of multivariate logistic regression and Cox regression analysis identified the ejection fraction as a predictor of early and late mortality. When we compared long-term survival and expected survival, we found a relatively poorer outcome in all subjects with an ejection fraction of < 50%. In subjects with a preoperative ejection fraction of > 50%, long-term survival exceeded expected survival. Conclusions The severity of left ventricular dysfunction was associated with poor survival. Compared with the survival of the matched general population, our coronary bypass patients had a worse outcome only if their preoperative ejection fraction was < 50%. PMID:20416050

  8. Coronary Microvascular Rarefaction and Myocardial Fibrosis in Heart Failure with Preserved Ejection Fraction

    PubMed Central

    Mohammed, Selma F.; Hussain, Saad; Mirzoyev, Sultan A.; Edwards, William D.; Maleszewski, Joseph J.; Redfield, Margaret M.

    2014-01-01

    Background Characterization of myocardial structural changes in heart failure (HF) with preserved ejection fraction (HFpEF) has been hindered by limited availability of human cardiac tissue. Cardiac hypertrophy, coronary artery disease (CAD), coronary microvascular rarefaction and myocardial fibrosis may contribute to HFpEF pathophysiology. Methods and Results We identified HFpEF patients (n=124) and age-appropriate control patients (non-cardiac death, no HF diagnosis; n=104) who underwent autopsy. Heart weight and CAD severity were obtained from the autopsy reports. Using whole field digital microscopy and automated analysis algorithms in full thickness left ventricular (LV) sections, microvascular density (MVD), myocardial fibrosis and their relationship were quantified. Subjects with HFpEF had heavier hearts (median 538 g; 169% of age/sex/body size expected heart weight vs. 335 g; 112% in controls), more severe CAD (65% with ≥ one vessel with >50% diameter stenosis in HFpEF vs 13% in controls), more LV fibrosis (median % area fibrosis, 9.6 vs. 7.1) and lower MVD (median 961 vs. 1316 vessels per mm2) than control (p <0.0001 for all). Myocardial fibrosis increased with decreasing MVD in controls (r = − 0.28, p=0.004) and HFpEF (r = − 0.26, p=0.004). Adjusting for MVD attenuated the group differences in fibrosis. Heart weight, fibrosis and MVD were similar in HFpEF patients with vs without CAD. Conclusions In this study, patients with HFpEF had more cardiac hypertrophy, epicardial CAD, coronary microvascular rarefaction and myocardial fibrosis than controls. Each of these findings may contribute to the LV diastolic dysfunction and cardiac reserve function impairment characteristic of HFpEF. PMID:25552356

  9. Treatment of heart failure with normal ejection fraction: an inconvenient truth!

    PubMed

    Paulus, Walter J; van Ballegoij, Joris J M

    2010-02-01

    Despite use of similar drugs, outcomes of recent heart failure (HF) trials were frequently neutral in heart failure with normal left ventricular ejection fraction (HFNEF) and positive in heart failure with reduced left ventricular ejection fraction (HFREF). The neutral outcomes of HFNEF trials were often attributed to deficient HFNEF patient recruitment with inclusion of many HFREF or noncardiac patients. Patient recruitment criteria of 21 HFNEF trials were therefore reviewed in reference to diagnostic guidelines for HFNEF. In the 4 published sets of guidelines, a definite diagnosis of HFNEF required the simultaneous and obligatory presence of signs and/or symptoms of HF and evidence of normal systolic left ventricular (LV) function and of diastolic LV dysfunction. In 3 of 4 sets of guidelines, normal systolic LV function comprised both a left ventricular ejection fraction (LVEF) >50% and an absence of LV dilation. Among the 21 HFNEF trials, LVEF cutoff values ranged from 35% to 50%, with only 8 trials adhering to an LVEF >50%. Furthermore, only 1 trial specified a normal LV end-diastolic dimension as an enrollment criterion and only 7 trials required evidence of diastolic LV dysfunction. Nonadherence to diagnostic guidelines induced excessive enrollment into HFNEF trials of HF patients with eccentric LV remodeling and ischemic heart disease compared with HF patients with concentric LV remodeling and arterial hypertension. Nonadherence to guidelines also led to underpowered HFNEF trials with a low incidence of outcome events such as death or HF hospitalizations. Future HFNEF trials should therefore adhere to diagnostic guidelines for HFNEF. PMID:20152557

  10. Time-Dependent Regional Myocardial Strains in Patients with Heart Failure with a Preserved Ejection Fraction

    PubMed Central

    Smith, Shane P.; Secomb, Timothy W.; Hong, Brian D.; Moulton, Michael J.

    2016-01-01

    Objectives. To better understand the etiology of HFpEF in a controlled human population, regional time-varying strains were computed using echocardiography speckle tracking in patients with heart failure with a preserved ejection fraction and normal subjects. Methods. Eleven normal volunteers and ten patients with echo-graded diastolic dysfunction and symptoms of heart failure were imaged with echocardiography and longitudinal, circumferential, and rotational strains were determined using speckle-tracking. Diastolic strain rate was also determined. Patient demographics and echo-derived flows, volumes, and pressures were recorded. Results. Peak longitudinal and circumferential strain was globally reduced in patients (p < 0.001), when compared to controls. The patients attained peak longitudinal and circumferential strain at a consistently later point in systole than controls. Rotational strains were not different in most LV regions. Early diastolic strain rate was significantly reduced in the patients (p < 0.001). LV mass and wall thickness were significantly increased in the patients; however ejection fraction was preserved and stroke volume was diminished (p < 0.001). Conclusions. This study shows that patients with HFpEF have reduced early diastolic strain rate and reduced peak strain that is regionally homogeneous and that they also utilize a longer fraction of systole to achieve peak axial strains. PMID:27042673

  11. Neprilysin Inhibition in Heart Failure with Reduced Ejection Fraction: A Clinical Review.

    PubMed

    King, Jordan B; Bress, Adam P; Reese, Austin D; Munger, Mark A

    2015-09-01

    There has been a 10-year hiatus in the approval of a new pharmacotherapy for patients with chronic heart failure with a reduced ejection fraction (HFrEF). Combining an angiotensin receptor blocker, valsartan, with sacubitril, an inhibitor of neprilysin, results in increasing levels of natriuretic peptides that counterbalance high circulating levels of neurohormones in HFrEF. This has resulted in the development of a new agent, LCZ696. A comprehensive overview of LCZ696, its pharmacology, its role in the pathophysiology of HFrEF, completed and future clinical trial information, specific critical issues, and the place of LCZ696 in HFrEF therapy are presented. PMID:26406774

  12. Cholecystokinin enhanced hepatobiliary scanning with ejection fraction calculation as an indicator of disease of the gallbladder

    SciTech Connect

    Zech, E.R.; Simmons, L.B.; Kendrick, R.R.; Soballe, P.W.; Olcese, J.A.; Goff, W.B. II; Lawrence, D.P.; DeWeese, R.A. )

    1991-01-01

    Chronic acalculous cholecystitis represents 5 to 20 per cent of electively treated diseases of the gallbladder. A 70 per cent success rate in relieving these patients of chronic pain was reported when surgical treatment was recommended based on symptoms alone. The cholecystokinin ejection fraction, which is a quantitative measure of emptying of the gallbladder, was 95 per cent accurate in predicting which patients would be relieved of symptoms by surgical treatment. In this study, we report our consecutive experience during a 20 month period with 83 patients.

  13. Effect of sublingual nitroglycerin on ejection fraction and left ventricular asynergy in coronary disease.

    PubMed

    Khemka, M; Prakash, R; Aronow, W S; Kern, J C; Cassidy, J; Vangrow, J S; March, H

    1975-03-01

    After sublingual nitroglycerin, the ejection fraction increased at least 8 percent in 10 of 19 patients (53 percent), changed less than 8 percent in 5 of 19 patients (26 percent), and decreased at least 8 percent in 4 of 19 patients (21 percent). After sublingual nitroglycerin, 16 of 21 areas (76 percent) of hypokinesis improved, 2 (10 percent) did not change, and 3 (14 percent) became worse. After sublingual nitroglycerin, 6 of 6 akinetic areas did not change. After sublingual nitroglycerin, 2 of 3 dyskinetic areas did not change and one improved. Left ventriculography performed before and after sublingual nitroglycerin may be useful in predicting viable areas of ischemic myocardium. PMID:803800

  14. Targeting heart failure with preserved ejection fraction: current status and future prospects

    PubMed Central

    Kanwar, Manreet; Walter, Claire; Clarke, Megan; Patarroyo-Aponte, Maria

    2016-01-01

    Heart failure with preserved ejection fraction (HFpEF) portrays a significant burden in terms of prevalence, morbidity, mortality, and health care costs. There is a lack of consensus on the basic pathophysiology, definition, and therapeutic targets for therapy for this syndrome. To date, there are no approved therapies available for reducing mortality or hospitalization for these patients. Several clinical trials have recently started to try and bridge this major gap. There is an urgent need to focus on drug and device development for HFpEF as well as to understand HFpEF pathophysiology. PMID:27143907

  15. The sympathetic/parasympathetic imbalance in heart failure with reduced ejection fraction

    PubMed Central

    Floras, John S.; Ponikowski, Piotr

    2015-01-01

    Cardiovascular autonomic imbalance, a cardinal phenotype of human heart failure, has adverse implications for symptoms during wakefulness and sleep; for cardiac, renal, and immune function; for exercise capacity; and for lifespan and mode of death. The objectives of this Clinical Review are to summarize current knowledge concerning mechanisms for disturbed parasympathetic and sympathetic circulatory control in heart failure with reduced ejection fraction and its clinical and prognostic implications; to demonstrate the patient-specific nature of abnormalities underlying this common phenotype; and to illustrate how such variation provides opportunities to improve or restore normal sympathetic/parasympathetic balance through personalized drug or device therapy. PMID:25975657

  16. Treating Heart Failure with Preserved Ejection Fraction: A Challenge for Clinicians

    PubMed Central

    Howard, Patricia A.

    2015-01-01

    Despite a decline in many forms of cardiovascular disease, heart failure (HF) continues to increase. Heart failure with preserved ejection fraction (HFpEF) is common, especially among persons with multiple comorbidities. HFpEF presents many challenges for clinicians due to the incomplete understanding of the underlying mechanisms and lack of consensus on the most effective strategies for treatment. Angiotensin and beta receptor–blocking drugs, which form the cornerstone for the treatment of systolic HF, have failed to show similar benefits in patients with impaired diastolic function. This article provides an overview of drug therapy for HFpEF, including newer agents now under investigation. PMID:26405335

  17. The Volume Regulation Graph versus the Ejection Fraction as Metrics of Left Ventricular Performance in Heart Failure with and without a Preserved Ejection Fraction: A Mathematical Model Study

    PubMed Central

    Faes, Theo JC; Kerkhof, Peter LM

    2015-01-01

    In left ventricular heart failure, often a distinction is made between patients with a reduced and a preserved ejection fraction (EF). As EF is a composite metric of both the end-diastolic volume (EDV) and the end-systolic ventricular volume (ESV), the lucidity of the EF is sometimes questioned. As an alternative, the ESV–EDV graph is advocated. This study identifies the dependence of the EF and the EDV–ESV graph on the major determinants of ventricular performance. Numerical simulations were made using a model of the systemic circulation, consisting of an atrium–ventricle valves combination; a simple constant pressure as venous filling system; and a three-element Windkessel extended with a venous system. ESV–EDV graphs and EFs were calculated using this model while varying one by one the filling pressure, diastolic and systolic ventricular elastances, and diastolic pressure in the aorta. In conclusion, the ESV–EDV graph separates between diastolic and systolic dysfunction while the EF encompasses these two pathologies. Therefore, the ESV–EDV graph can provide an advantage over EF in heart failure studies. PMID:26052232

  18. Subclinical LV Dysfunction Detection Using Speckle Tracking Echocardiography in Hypertensive Patients with Preserved LV Ejection Fraction

    PubMed Central

    Ayoub, Amal Mohamed; Keddeas, Viola William; Ali, Yasmin Abdelrazek; El Okl, Reham Atef

    2016-01-01

    BACKGROUND Early detection of subclinical left ventricular (LV) systolic dysfunction in hypertensive patients is important for the prevention of progression of hypertensive heart disease. METHODS We studied 60 hypertensive patients (age ranged from 21 to 49 years, the duration of hypertension ranged from 1 to 18 years) and 30 healthy controls, all had preserved left ventricular ejection fraction (LVEF), detected by two-dimensional speckle tracking echocardiography (2D-STE). RESULTS There was no significant difference between the two groups regarding ejection fraction (EF) by Simpson’s method. Systolic velocity was significantly higher in the control group, and global longitudinal strain was significantly higher in the control group compared with the hypertensive group. In the hypertensive group, 23 of 60 patients had less negative global longitudinal strain than −19.1, defined as reduced systolic function, which is detected by 2D-STE (subclinical systolic dysfunction), when compared with 3 of 30 control subjects. CONCLUSION 2D-STE detected substantial impairment of LV systolic function in hypertensive patients with preserved LVEF, which identifies higher risk subgroups for earlier medical intervention. PMID:27385916

  19. Response of left ventricular ejection fraction to recovery from general anesthesia: measurement by gated radionuclide angiography

    SciTech Connect

    Coriat, P.; Mundler, O.; Bousseau, D.; Fauchet, M.; Rous, A.C.; Echter, E.; Viars, P.

    1986-06-01

    To test the hypothesis that, after anesthesia for noncardiac surgical procedures, the increased cardiac work during recovery induces wall motion and ejection fraction (EF) abnormalities in patients with mild angina pectoris, gated radionuclide angiography was performed in patients undergoing simple cholecystectomy under narcotic-relaxant general anesthesia. The ejection fraction was determined during anesthesia at the end of surgery, and then determined 3 min and 3 hr after extubation. A new angiography was performed 24 hr later, and a myocardial scintigraphy (Thallium 201) was performed during infusion of the coronary vasodilator, dipyridamole. In the first part of the investigation, eight patients without coronary artery disease (CAD) (group 1) and 20 patients with mild angina (group 2) were studied. In the second part of the study, seven patients (group 3) with mild angina pectoris received an intravenous infusion of 0.4 microgram X kg-1 X min-1 of nitroglycerin started before surgery and gradually decreased 4 hr after extubation. In group 1, EF remained unchanged at recovery. In contrast in group 2, EF responded abnormally to recovery: EF decreased from 55% during anesthesia to 45% 3 min after extubation (P less than 0.001). Patients in group 3, who received intravenous nitroglycerin, showed no change of EF at recovery. This study demonstrates that recovery from general anesthesia causes abnormalities in left ventricular function in patients suffering from CAD. These abnormalities are prevented by prophylactic intravenous nitroglycerin.

  20. Heart failure with preserved ejection fraction in the elderly: scope of the problem.

    PubMed

    Upadhya, Bharathi; Taffet, George E; Cheng, Che Ping; Kitzman, Dalane W

    2015-06-01

    Heart failure with preserved ejection fraction (HFpEF) is the most common form of heart failure (HF) in older adults, particularly women, and is increasing in prevalence as the population ages. With morbidity and mortality on par with HF with reduced ejection fraction, it remains a most challenging clinical syndrome for the practicing clinician and basic research scientist. Originally considered to be predominantly caused by diastolic dysfunction, more recent insights indicate that HFpEF in older persons is typified by a broad range of cardiac and non-cardiac abnormalities and reduced reserve capacity in multiple organ systems. The globally reduced reserve capacity is driven by: 1) inherent age-related changes; 2) multiple, concomitant co-morbidities; 3) HFpEF itself, which is likely a systemic disorder. These insights help explain why: 1) co-morbidities are among the strongest predictors of outcomes; 2) approximately 50% of clinical events in HFpEF patients are non-cardiovascular; 3) clinical drug trials in HFpEF have been negative on their primary outcomes. Embracing HFpEF as a true geriatric syndrome, with complex, multi-factorial pathophysiology and clinical heterogeneity could provide new mechanistic insights and opportunities for progress in management. This article is part of a Special Issue entitled CV Aging. PMID:25754674

  1. Patient Selection in Heart Failure With Preserved Ejection Fraction Clinical Trials

    PubMed Central

    Kelly, Jacob P.; Mentz, Robert J.; Mebazaa, Alexandre; Voors, Adriaan A.; Butler, Javed; Roessig, Lothar; Fiuzat, Mona; Zannad, Faiez; Pitt, Bertram; O’Connor, Christopher M.; Lam, Carolyn S.P.

    2015-01-01

    Recent clinical trials in patients with heart failure with preserved ejection fraction (HFpEF) have provided important insights into participant selection strategies. Historically, HFpEF trials have included patients with relatively preserved left ventricular ejection fraction ranging from 40% to 55% and a clinical history of heart failure. Contemporary HFpEF trials have also incorporated inclusion criteria such as hospitalization for HFpEF, altered functional capacity, cardiac structural and functional abnormalities, and abnormalities in neurohormonal status (e.g., elevated natriuretic peptide levels). Careful analyses of the impact of these patient selection criteria on outcomes in prior trials provide valuable lessons for future trial design. We review recent and ongoing HFpEF clinical trials from a patient selection perspective and appraise trial patient selection methodologies in relation to outcomes. This review reflects discussions between clinicians, scientists, trialists, regulators, and regulatory representatives at the 10th Global CardioVascular Clinical Trialists Forum in Paris, France on December 6, 2013. PMID:25908073

  2. Outcome of Heart Failure with Preserved Ejection Fraction: A Multicentre Spanish Registry

    PubMed Central

    Castillo, Juan C; Anguita1, Manuel P; Jiménez, Manuel

    2009-01-01

    Background: Studies on clinical features, treatment and prognosis of patients with congestive heart failure (CHF) and preserved left ventricular ejection fraction (LVEF) are few and their results frequently conflicting. Aims: To investigate the characteristics and long term prognosis of patients with CHF and preserved (≥ 45%) LVEF. Methods and Results: We conducted a prospective multicentre study with 4720 patients attended in 62 heart failure clinics from 1999 to 2003 in Spain (BADAPIC registry). LVEF was preserved in 30% patients. Age, female gender, prevalence of atrial fibrillation, hypertension and non-ischaemic cardiopathy were all significantly greater in patients with preserved LVEF. Mean follow-up was 40±12 months. Mortality and other cardiovascular complication rates during follow up were similar in both groups. On multivariate analysis ejection fraction was not an independent predictor for mortality. Survival at one and five years was similar in both groups (79% and 59% for patients with preserved LVEF and 78% and 57% for those with reduced LVEF, respectively). Conclusions: In the BADAPIC registry, a high percentage of heart failure patients had preserved LVEF. Although clinical differences were seen between groups, morbidity and mortality were similar in both groups. PMID:21037850

  3. Understanding heart failure with preserved ejection fraction: where are we today?

    PubMed

    van Heerebeek, L; Paulus, W J

    2016-04-01

    Heart failure with preserved ejection fraction (HFpEF) represents a complex and heterogeneous clinical syndrome, which is increasingly prevalent and associated with poor outcome. In contrast to heart failure with reduced ejection fraction (HFrEF), modern heart failure pharmacotherapy did not improve outcome in HFpEF, which was attributed to incomplete understanding of HFpEF pathophysiology, patient heterogeneity and lack of insight into primary pathophysiological processes. HFpEF patients are frequently elderly females and patients demonstrate a high prevalence of non-cardiac comorbidities, which independently adversely affect myocardial structural and functional remodelling. Furthermore, although diastolic left ventricular dysfunction represents the dominant abnormality in HFpEF, numerous ancillary mechanisms are frequently present, which also negatively impact on cardiovascular reserve. Over the past decade, clinical and translational research has improved insight into HFpEF pathophysiology and the importance of comorbidities and patient heterogeneity. Recently, a new paradigm for HFpEF was proposed, which states that comorbidities drive myocardial dysfunction and remodelling in HFpEF through coronary microvascular inflammation. Regarding the conceptual framework of HFpEF treatment, emphasis may need to shift from a 'one fits all' strategy to an individualised approach based on phenotypic patient characterisation and diagnostic and pathophysiological stratification of myocardial disease processes. This review will describe these novel insights from a pathophysiological standpoint. PMID:26909795

  4. Improving the appropriateness of sudden arrhythmic death primary prevention by implantable cardioverter-defibrillator therapy in patients with low left ventricular ejection fraction. Point of view

    PubMed Central

    Disertori, Marcello; Gulizia, Michele M.; Casolo, Giancarlo; Delise, Pietro; Di Lenarda, Andrea; Di Tano, Giuseppe; Lunati, Maurizio; Mestroni, Luisa; Salerno-Uriarte, Jorge; Tavazzi, Luigi

    2016-01-01

    It is generally accepted that the current guidelines for the primary prevention of sudden arrhythmic death, which are based on ejection fraction, do not allow the optimal selection of patients with low left ventricular ejection fraction of ischemic and nonischemic etiology for implantation of a cardioverter-defibrillator. Ejection fraction alone is limited in both sensitivity and specificity. An analysis of the risk of sudden arrhythmic death with a combination of multiple tests (ejection fraction associated with one or more arrhythmic risk markers) could partially compensate for these limitations. We propose a polyparametric approach for defining the risk of sudden arrhythmic death using ejection fraction in combination with other clinical and arrhythmic risk markers (i.e. late gadolinium enhancement cardiac magnetic resonance, T-wave alternans, programmed ventricular stimulation, autonomic tone, and genetic testing) that have been validated in nonrandomized trials. In this article, we examine these approaches to identify three subsets of patients who cannot be comprehensively assessed by the current guidelines: patients with ejection fraction of 35% or less and a relatively low risk of sudden arrhythmic death despite the ejection fraction value; patients with ejection fraction of 35% or less and high competitive risk of death due to evolution of heart failure or noncardiac causes; and patients with ejection fraction between 35 and 45% with relatively high risk of sudden arrhythmic death despite the ejection fraction value. PMID:26895401

  5. Baroreflex Activation Therapy in Heart Failure With Reduced Ejection Fraction: Available Data and Future Perspective.

    PubMed

    Halbach, Marcel; Fritz, Thorsten; Madershahian, Navid; Pfister, Roman; Reuter, Hannes

    2016-04-01

    Progression of heart failure with reduced ejection fraction (HFrEF) is promoted by sympathovagal imbalance. Baroreflex activation therapy, i.e., electrical stimulation of baroreceptors at the carotid sinus, can restore sympathovagal balance. Large animal studies of baroreflex activation therapy revealed improvements in cardiac function, susceptibility to ventricular arrhythmias, and a survival benefit as compared to untreated controls. Recently, the first randomized and controlled trial of optimal medical and device therapy alone or plus baroreflex activation therapy in patients suffering from HFrEF was published. It demonstrated a reasonable safety profile in this severely ill patient population. Moreover, the study found significant improvements in New York Heart Association class, quality of life, 6-min walk distance, and NT-proBNP levels. This review provides an overview on baroreflex activation therapy for the treatment of HFrEF-from the concept and preclinical findings to most recent clinical data and upcoming trials. PMID:26879389

  6. Pulmonary hypertension in patients with heart failure and preserved ejection fraction: differential diagnosis and management

    PubMed Central

    Charalampopoulos, Athanasios; Ramjug, Sheila; Condliffe, Robin; Elliot, Charlie A.; O’Toole, Laurence; Swift, Andrew; Kiely, David G

    2016-01-01

    Abstract The most common cause of pulmonary hypertension (PH) due to left heart disease (LHD) was previously rheumatic mitral valve disease. However, with the disappearance of rheumatic fever and an aging population, nonvalvular LHD is now the most common cause of group 2 PH in the developed world. In this review, we examine the challenge of investigating patients who have PH and heart failure with preserved ejection fraction (HF-pEF), where differentiating between pulmonary arterial hypertension (PAH) and PH-LHD can be difficult, and also discuss the entity of combined precapillary and postcapillary PH. Given the proven efficacy of targeted therapy for the treatment of PAH, there is increasing interest in whether these treatments may benefit selected patients with PH associated with HF-pEF, and we review current trial data. PMID:27162611

  7. Transthyretin cardiac amyloidosis: pathogenesis, treatments, and emerging role in heart failure with preserved ejection fraction.

    PubMed

    Ton, Van-Khue; Mukherjee, Monica; Judge, Daniel P

    2014-01-01

    Transthyretin (TTR) amyloidosis causes heart failure from cardiac deposition of TTR amyloid fibrils, the by-product of TTR homotetramer disassembly. Wild-type (WT) TTR deposition leads to senile amyloidosis, predominantly manifesting with cardiomyopathy. Missense mutations in the TTR gene result in familial TTR amyloidosis. Certain mutations are more likely to affect the heart, while others cause more neurologic involvement. Extracellular fibril deposition triggers intracellular stress response, upregulation of the inflammatory cascades, apoptosis, and organ dysfunction. Recent studies suggest that TTR cardiac amyloid may be a significant contributor to the pathogenesis of heart failure with preserved ejection fraction (HFpEF). Summarized in this review are the molecular pathways underlying the cellular toxicity of TTR amyloid fibrils and the emerging therapies aimed at TTR tetramer stabilization, abrogation of TTR synthesis in the liver, or inhibition of amyloidogenesis. PMID:25628512

  8. Breakthrough in heart failure with preserved ejection fraction: are we there yet?

    PubMed Central

    Lim, Shir Lynn; Lam, Carolyn Su Ping

    2016-01-01

    Heart failure with preserved ejection fraction (HFPEF) is a global health problem of considerable socioeconomic burden. It is projected to worsen with the aging population worldwide. The lack of effective therapies underscores our incomplete understanding of this complex heterogeneous syndrome. A novel paradigm has recently emerged, in which central roles are ascribed to systemic inflammation and generalized endothelial dysfunction in the pathophysiology of HFPEF. In this review, we discuss the role of the endothelium in cardiovascular homeostasis and how deranged endothelial-related signaling pathways contribute to the development of HFPEF. We also review the novel therapies in various stages of research and development that target different components of this signaling pathway. PMID:26767852

  9. Transthyretin Cardiac Amyloidosis: Pathogenesis, Treatments, and Emerging Role in Heart Failure with Preserved Ejection Fraction

    PubMed Central

    Ton, Van-Khue; Mukherjee, Monica; Judge, Daniel P

    2014-01-01

    Transthyretin (TTR) amyloidosis causes heart failure from cardiac deposition of TTR amyloid fibrils, the by-product of TTR homotetramer disassembly. Wild-type (WT) TTR deposition leads to senile amyloidosis, predominantly manifesting with cardiomyopathy. Missense mutations in the TTR gene result in familial TTR amyloidosis. Certain mutations are more likely to affect the heart, while others cause more neurologic involvement. Extracellular fibril deposition triggers intracellular stress response, upregulation of the inflammatory cascades, apoptosis, and organ dysfunction. Recent studies suggest that TTR cardiac amyloid may be a significant contributor to the pathogenesis of heart failure with preserved ejection fraction (HFpEF). Summarized in this review are the molecular pathways underlying the cellular toxicity of TTR amyloid fibrils and the emerging therapies aimed at TTR tetramer stabilization, abrogation of TTR synthesis in the liver, or inhibition of amyloidogenesis. PMID:25628512

  10. Determination of right ventricular ejection fraction in children with cystic fibrosis

    SciTech Connect

    Piepsz, A.; Ham, H.R.; Millet, E.; Dab, I.

    1987-01-01

    The radionuclide right ventricular ejection fraction (RVEF) determined by means of Krypton-81m represents a simple, noninvasive, and accurate procedure to quantify the right ventricular contractility. This procedure was applied to 25 young patients with cystic fibrosis. The RVEF tended to decrease with the progression of the lung disease, as assessed by the clinical S-K score, the degree of the defects on lung scintigraphy, the PaO/sub 2/, and the lung function tests. However, the decrease of RVEF in patients with marked lung function tests. However, the decrease of RVEF in patients with marked lung involvement was moderate, and terminal lung disease was sometimes associated with normal right heart contractility.

  11. Treatment of Heart Failure With Reduced Ejection Fraction-Recent Developments.

    PubMed

    Travessa, André Miguel Ramos; Menezes Falcão, Luiz Filipe de

    2016-01-01

    Heart failure with reduced ejection fraction (HFrEF) represents at least half of the cases of heart failure, which is a syndrome defined as the inability of the heart to supply the body's tissues with an adequate amount of blood under conditions of normal cardiac filling pressure. HFrEF is responsible for high costs and rates of mortality, morbidity, and hospital admissions, mainly in developed countries. Thus, the need for better diagnostic methods and therapeutic approaches and consequently better outcomes is clear. In this article, we review the principal aspects of pathophysiology and diagnosis of HFrEF, with focus on emerging biomarkers and on recent echocardiographic methods for the assessment of left ventricular function. Furthermore, we discuss several major developments in pharmacological and nonpharmacological treatment of HFrEF in the last years, including cardiac resynchronization therapy, implantable cardioverter defibrillators, and the recent and promising drug LCZ696, focusing on current indications, unanswered questions, and other relevant aspects. PMID:26658805

  12. Developing Therapies for Heart Failure with Preserved Ejection Fraction: Current State and Future Directions

    PubMed Central

    Butler, Javed; Fonarow, Gregg C.; Zile, Michael R.; Lam, Carolyn S.; Roessig, Lothar; Schelbert, Erik B.; Shah, Sanjiv J.; Ahmed, Ali; Bonow, Robert O.; Cleland, John GF; Cody, Robert J.; Chioncel, Ovidiu; Collins, Sean P.; Dunnmon, Preston; Filippatos, Gerasimos; Lefkowitz, Martin P.; Marti, Catherine N.; McMurray, John J.; Misselwitz, Frank; Nodari, Savina; O’Connor, Christopher; Pfeffer, Marc A.; Pieske, Burkert; Pitt, Bertram; Rosano, Guiseppe; Sabbah, Hani N.; Senni, Michele; Solomon, Scott D.; Stockbridge, Norman; Teerlink, John R.; Georgiopoulou, Vasiliki V.; Gheorghiade, Mihai

    2014-01-01

    The burden of heart failure with preserved ejection fraction (HFpEF) is considerable and is projected to worsen. To date, there are no approved therapies available for reducing mortality or hospitalizations for these patients. The pathophysiology of HFpEF is complex and includes alterations in cardiac structure and function, systemic and pulmonary vascular abnormalities, end-organ involvement, and comorbidities. There remain major gaps in our understanding of HFpEF pathophysiology. To facilitate a discussion of how to proceed effectively in future with development of therapies for HFpEF, a meeting was facilitated by the FDA and included representatives from academia, industry and regulatory agencies. This document summarizes the proceedings from this meeting. PMID:24720916

  13. A Practical Guide for the Treatment of Symptomatic Heart Failure with Reduced Ejection Fraction (HFrEF)

    PubMed Central

    Reed, Brent N; Sueta, Carla A

    2015-01-01

    This review will outline the management of patients with symptomatic systolic heart failure or heart failure with reduced ejec-tion fraction (HFrEF), i.e., those with structural heart disease and previous or current symptoms. Determination of volume status and appropriate diuretic administration is important in heart failure management. Inhibition of the renin-angiotensin-aldosterone and sympathetic nervous systems improves survival and decreases hospitalizations in patients with systolic or reduced ejection fraction HF (HFrEF). Beta blockers and aldosterone antagonists improve ejection fraction. Indications for additional agents including nitrates plus hydralazine, digoxin, statins, omega 3 polyunsaturated fatty acids, anticoagulants, and antiarrhythmics will be discussed. Choice of agents, dose-related effects, strategies to minimize adverse effects, and medications to avoid will be presented. PMID:24251455

  14. Diagnosis and Management of Heart Failure with Preserved Ejection Frac-tion: 10 Key Lessons

    PubMed Central

    A, Afşin Oktay; Shah, Sanjiv J

    2015-01-01

    Heart failure with preserved ejection fraction (HFpEF) is a common clinical syndrome associated with high rates of morbidi-ty and mortality. Due to the lack of evidence-based therapies and increasing prevalence of HFpEF, clinicians are often con-fronted with these patients and yet have little guidance on how to effectively diagnose and manage them. Here we offer 10 key lessons to assist with the care of patients with HFpEF: (1) Know the difference between diastolic dysfunction, diastolic heart failure, and HFpEF; (2) diagnosing HFpEF is challenging, so be thorough and consider invasive hemodynamic testing to confirm the diagnosis; (3) a normal B-type natriuretic peptide does not exclude the diagnosis of HFpEF; (4) elevated pul-monary artery systolic pressure on echocardiography in the presence of a normal ejection fraction should prompt considera-tion of HFpEF; (5) use dynamic testing in evaluating the possibility of HFpEF in patients with unexplained dyspnea or exer-cise tolerance; (6) all patients with HFpEF should be systematically evaluated for the presence of coronary artery disease; (7) use targeted treatment for HFpEF patients based on their phenotypic classification; (8) treat HFpEF patients now by treating their comorbidities; (9) understand the importance of heart rate in HFpEF—lower is not always better; and (10) do not forget to consider rare diseases (“zebras”) as causes for HFpEF when evaluating and treating patients. Taken together, these 10 key lessons can help clinicians care for challenging patients with HFpEF while we eagerly await the results of ongoing HFpEF clinical trials and observational studies. PMID:24251461

  15. Follistatin like 1 Regulates Hypertrophy in Heart Failure with Preserved Ejection Fraction

    PubMed Central

    Wilson, Richard M.; Essick, Eric E.; Fowler, Conor T.; Nakamura, Kazuto; van den Hoff, Maurice; Ouchi, Noriyuki; Sam, Flora

    2016-01-01

    Objective We sought to determine whether Fstl1 plays a role in the regulation of cardiac hypertrophy in HFpEF. Background Heart failure (HF) with preserved ejection fraction (HFpEF), accounts for ~50% of all clinical presentations of HF and its prevalence is expected to increase. However, there are no evidence-based therapies for HFpEF; thus, HFpEF represents a major unmet need. Although hypertension is the single most important risk factor for HFpEF, with a prevalence of 60-89% from clinical trials and human HF registries, blood pressure therapy alone is insufficient to prevent and treat HFpEF. Follistatin like 1 (Fstl1), a divergent member of the follistatin family of extracellular glycoproteins, has previously been shown to be elevated in HF with reduced ejection fraction (HFrEF) and associated with increased left ventricular mass. Methods and Results In this study, blood levels of Fstl1 were increased in humans with HFpEF. This increase was also evident in mice with hypertension-induced HFpEF and adult rat ventricular myocytes stimulated with aldosterone. Treatment with recombinant Fstl1 abrogated aldosterone-induced cardiac myocyte hypertrophy, suggesting a role for Fstl1 in the regulation of hypertrophy in HFpEF. There was also a reduction in the E/A ratio, a measure of diastolic dysfunction. Furthermore, HFpEF induced in a mouse model that specifically ablates Fstl1 in cardiac myocytes (cFstl1-KO), showed exacerbation of HFpEF with worsened diastolic dysfunction. In addition, cFstl1-KO-HFpEF mice demonstrated more marked cardiac myocyte hypertrophy with increased molecular markers of anp and bnp expression. Conclusions These findings indicate that Fstl1exerts therapeutic effects by modulating cardiac hypertrophy in HFpEF. PMID:27430031

  16. Effects of Adiponectin on Calcium Handling Proteins in Heart Failure with Preserved Ejection Fraction

    PubMed Central

    Tanaka, Komei; Wilson, Richard M.; Essick, Eric E.; Duffen, Jennifer L.; Scherer, Philipp E.; Ouchi, Noriyuki; Sam, Flora

    2014-01-01

    Background Despite the increasing prevalence of heart failure (HF) with preserved ejection fraction (HFpEF) in humans, there remains no therapeutic options for HFpEF. Adiponectin (APN), an adipocyte-derived cytokine exerts cardioprotective actions and its deficiency is implicated in the development of hypertension and HF with reduced ejection fraction. Similarly APN deficiency in HFpEF exacerbates left ventricular hypertrophy (LVH), diastolic dysfunction and HF. However, the therapeutic effects of APN in HFpEF remain unknown. We sought to test the hypothesis that chronic APN overexpression protects against the progression of HF in a murine model of HFpEF. Methods and Results APN transgenic (APNTG) and wild-type (WT) mice underwent uninephrectomy, a continuous saline or d-aldosterone infusion and given 1.0% sodium chloride drinking water for 4-weeks. Aldosterone-infused WT mice developed HFpEF with hypertension, LVH and diastolic dysfunction. Aldosterone infusion increased myocardial oxidative stress and decreased sarcoplasmic reticulum Ca2+-ATPase (SERCA2a) protein expression in HFpEF. Although total phospholamban (PLN) protein expression was unchanged, there was decreased expression of PKA-dependent PLN phosphorylation at Ser16 and CaMKII-dependent PLN phosphorylation at Thr17. APN overexpression in aldosterone-infused mice ameliorated LVH, diastolic dysfunction, lung congestion and myocardial oxidative stress without affecting blood pressure (BP) and LVEF. This improvement in diastolic function parameters in aldosterone-infused APNTG mice was accompanied by preserved protein expression of PKA-dependent phosphorylation of PLN at Ser16. APN replacement prevented the progression of aldosterone-induced HFpEF, independent of BP, by improving diastolic dysfunction and modulating cardiac hypertrophy. Conclusions These findings suggest that APN may have therapeutic effects in patients with HFpEF. PMID:25149095

  17. Serum uric acid is associated with cardiac diastolic dysfunction among women with preserved ejection fraction.

    PubMed

    Nogi, Shinpei; Fujita, Shu-Ichi; Okamoto, Yusuke; Kizawa, Shun; Morita, Hideaki; Ito, Takahide; Sakane, Kazushi; Sohmiya, Koichi; Hoshiga, Masaaki; Ishizaka, Nobukazu

    2015-09-01

    Serum uric acid (SUA) is associated with the severity and prognosis of systolic heart failure. We investigated the potential association between SUA and cardiac diastolic dysfunction among total of 744 cardiac patients (202 women and 542 men) who had preserved left ventricular ejection fraction. Presence of diastolic dysfunction was assessed by echocardiographic data, plasma B-type natriuretic peptide concentration, and left ventricular hypertrophy. Univariate analysis showed that the prevalence of diastolic dysfunction increased with increasing SUA value in women, but not in men. When sex-nonspecific SUA quartiles were used, multivariate logistic regression analysis, among female patients who were not taking uric acid lowering medication, showed that the third (SUA, 5.7-6.4 mg) and the fourth (SUA, ≥6.5 mg/dl) SUA quartiles were associated with diastolic dysfunction with an odds ratio of 3.25 (P < 0.05) and 8.06 (P < 0.001), respectively, when compared with the first SUA quartile (≤4.7 mg/dl). When sex-specific SUA quartiles were used among these population, multivariate logistic regression analysis showed that the fourth SUA quartile (≥5.7 mg/dl) was associated with diastolic dysfunction with an odds ratio of 5.34 (P < 0.05) when compared with the first SUA quartile (≤4.1 mg/dl). By contrast, the relationship between SUA and diastolic dysfunction was not significant in men, irrespective of which of the sex-nonspecific or sex-specific SUA quartiles were used. These data indicated that among cardiac patients with preserved ejection fraction, SUA was significantly associated with diastolic dysfunction in women but not in men. PMID:26209055

  18. Computer-based assessment of left ventricular regional ejection fraction in patients after myocardial infarction

    NASA Astrophysics Data System (ADS)

    Teo, S.-K.; Su, Y.; Tan, R. S.; Zhong, L.

    2014-03-01

    After myocardial infarction (MI), the left ventricle (LV) undergoes progressive remodeling which adversely affects heart function and may lead to development of heart failure. There is an escalating need to accurately depict the LV remodeling process for disease surveillance and monitoring of therapeutic efficacy. Current practice of using ejection fraction to quantitate LV function is less than ideal as it obscures regional variation and anomaly. Therefore, we sought to (i) develop a quantitative method to assess LV regional ejection fraction (REF) using a 16-segment method, and (ii) evaluate the effectiveness of REF in discriminating 10 patients 1-3 months after MI and 9 normal control (sex- and agematched) based on cardiac magnetic resonance (CMR) imaging. Late gadolinium enhancement (LGE) CMR scans were also acquired for the MI patients to assess scar extent. We observed that the REF at the basal, mid-cavity and apical regions for the patient group is significantly lower as compared to the control group (P < 0.001 using a 2-tail student t-test). In addition, we correlated the patient REF over these regions with their corresponding LGE score in terms of 4 categories - High LGE, Low LGE, Border and Remote. We observed that the median REF decreases with increasing severity of infarction. The results suggest that REF could potentially be used as a discriminator for MI and employed to measure myocardium homogeneity with respect to degree of infarction. The computational performance per data sample took approximately 25 sec, which demonstrates its clinical potential as a real-time cardiac assessment tool.

  19. The spectrum of low-output low-gradient aortic stenosis with normal ejection fraction.

    PubMed

    Pislaru, Sorin V; Pellikka, Patricia A

    2016-05-01

    Low-flow, low-gradient (LF/LG) severe aortic stenosis (AS) with preserved ejection fraction refers to the condition of AS with aortic valve area ≤1 cm(2), stroke volume index <35 mL/m(2), mean aortic valve gradient <40 mm Hg and left ventricular ejection fraction ≥50%. This mismatch of aortic valve area suggesting severe stenosis and 'low' gradient in some patients has led to confusion as to the severity of stenosis. Conditions previously labelled as LF/LG severe AS include a spectrum, with measurement error probably being the most common cause of marked inconsistency between gradient, valve area and patient presentation. The presence of LG severe AS may be overestimated in petite patients, who may have aortic valve area slightly less than 1 cm(2)with only moderate AS. Concomitant cardiac conditions besides AS, including significant mitral and tricuspid regurgitation, intracardiac shunts and constrictive pericarditis, may contribute to reduced stroke volume, and evidence for these must be sought at the time of echocardiography. True LF/LG severe AS is associated with a unique and probably maladaptive remodelling pattern with smaller ventricles, increasing relative wall thickness, progressive worsening of diastolic function and higher afterload, as demonstrated by lower systemic arterial compliance, higher systemic vascular resistance and higher valvuloarterial impedance. Control of hypertension is essential to the appropriate management of patients with AS. Aortic valve replacement should be considered in patients with compelling evidence of severe AS who remain symptomatic despite optimal treatment of hypertension. PMID:26822426

  20. Outcomes and worsening renal function in patients hospitalized with heart failure with preserved ejection fraction.

    PubMed

    Sharma, Kavita; Hill, Terence; Grams, Morgan; Daya, Natalie R; Hays, Allison G; Fine, Derek; Thiemann, David R; Weiss, Robert G; Tedford, Ryan J; Kass, David A; Schulman, Steven P; Russell, Stuart D

    2015-11-15

    Heart failure with preserved ejection fraction (HFpEF) has been described as a disease of elderly subjects with female predominance and hypertension. Our clinical experience suggests patients with HFpEF from an urban population are far more heterogenous, with greater co-morbidities and significant inhospital morbidity. There are limited data on the hospitalization course and outcomes in acute decompensated HFpEF. Hospitalizations for acute heart failure at our institution from July 2011 to June 2012 were identified by International Classification of Diseases, Ninth Revision, codes and physician review for left ventricular ejection fraction ≥50% and were reviewed for patient characteristics and clinical outcomes. Worsening renal function (WRF) was defined as creatinine increase of ≥0.3 mg/dl by 72 hours after admission. Hospital readmission and mortality data were captured from electronic medical records and the Social Security Death Index. Of 434 heart failure admissions, 206 patients (47%) with HFpEF were identified. WRF developed in 40%, the highest reported in HFpEF to date, and was associated with higher blood pressure and lower volume of diuresis. Compared to previous reports, hospitalized patients with HFpEF were younger (mean age 63.2 ± 13.6 years), predominantly black (74%), and had more frequent and severe co-morbidities: hypertension (89%), diabetes (56%), and chronic kidney disease (55%). There were no significant differences in 1- and 12-month outcomes by gender, race, or WRF. In conclusion, we found hospitalized patients with HFpEF from an urban population develop a high rate of WRF are younger than previous cohorts, often black, and have greater co-morbidities than previously described. PMID:26410603

  1. Relationship of hyperuricemia with mortality in heart failure patients with preserved ejection fraction.

    PubMed

    Shimizu, Takeshi; Yoshihisa, Akiomi; Kanno, Yuki; Takiguchi, Mai; Sato, Akihiko; Miura, Shunsuke; Nakamura, Yuichi; Yamauchi, Hiroyuki; Owada, Takashi; Abe, Satoshi; Sato, Takamasa; Suzuki, Satoshi; Oikawa, Masayoshi; Yamaki, Takayoshi; Sugimoto, Koichi; Kunii, Hiroyuki; Nakazato, Kazuhiko; Suzuki, Hitoshi; Saitoh, Shu-ichi; Takeishi, Yasuchika

    2015-10-01

    Serum uric acid is a predictor of cardiovascular mortality in heart failure with reduced ejection fraction. However, the impact of uric acid on heart failure with preserved ejection fraction (HFpEF) remains unclear. Here, we investigated the association between hyperuricemia and mortality in HFpEF patients. Consecutive 424 patients, who were admitted to our hospital for decompensated heart failure and diagnosed as having HFpEF, were divided into two groups based on presence of hyperuricemia (serum uric acid ≥7 mg/dl or taking antihyperuricemic agents). We compared patient characteristics, echocardiographic data, cardio-ankle vascular index, and cardiopulmonary exercise test findings between the two groups and prospectively followed cardiac and all-cause mortality. Compared with the non-hyperuricemia group (n = 170), the hyperuricemia group (n = 254) had a higher prevalence of hypertension (P = 0.013), diabetes mellitus (P = 0.01), dyslipidemia (P = 0.038), atrial fibrillation (P = 0.001), and use of diuretics (P < 0.001). Cardio-ankle vascular index (8.7 vs. 7.5, P < 0.001) and V̇e/V̇co2 slope (34.9 vs. 31.9, P = 0.02) were also higher. In addition, peak V̇o2 (14.9 vs. 17.9 ml·kg(-1)·min(-1), P < 0.001) was lower. In the follow-up period (mean 897 days), cardiac and all-cause mortalities were significantly higher in those with hyperuricemia (P = 0.006 and P = 0.004, respectively). In the multivariable Cox proportional hazard analyses after adjustment for several confounding factors including chronic kidney disease and use of diuretics, hyperuricemia was an independent predictor of all-cause mortality (hazard ratio 1.98, 95% confidence interval 1.036-3.793, P = 0.039). Hyperuricemia is associated with arterial stiffness, impaired exercise capacity, and high mortality in HFpEF. PMID:26297226

  2. Characterization of Static and Dynamic Left Ventricular Diastolic Function in Patients With Heart Failure With a Preserved Ejection Fraction

    PubMed Central

    Prasad, Anand; Hastings, Jeffrey L.; Shibata, Shigeki; Popovic, Zoran B.; Arbab-Zadeh, Armin; Bhella, Paul S.; Okazaki, Kazunobu; Fu, Qi; Berk, Martin; Palmer, Dean; Greenberg, Neil L.; Garcia, Mario J.; Thomas, James D.; Levine, Benjamin D.

    2013-01-01

    Background Congestive heart failure in the setting of a preserved left ventricular (LV) ejection fraction is increasing in prevalence among the senior population. The underlying pathophysiologic abnormalities in ventricular function and structure remain unclear for this disorder. We hypothesized that patients with heart failure with preserved ejection fraction (HFPEF) would have marked abnormalities in LV diastolic function with increased static diastolic stiffness and slowed myocardial relaxation compared with age-matched healthy controls. Methods and Results Eleven highly screened patients (4 men, 7 women) aged 73±7 years with HFPEF were recruited to participate in this study. Thirteen sedentary healthy controls (7 men, 6 women) aged 70±4 years also were recruited. All subjects underwent pulmonary artery catheterization with measurement of cardiac output, end-diastolic volumes, and pulmonary capillary wedge pressures at baseline; cardiac unloading (lower-body negative pressure or upright tilt); and cardiac loading (rapid saline infusion). The data were used to define the Frank-Starling and LV end-diastolic pressure-volume relationships. Doppler echocardiographic data (tissue Doppler velocities, isovolumic relaxation time, propagation velocity of early mitral inflow , E/A-wave ratio) were obtained at each level of cardiac preload. Compared with healthy controls, patients with HFPEF had similar LV contractile function and static LV compliance but reduced LV chamber distensibility with elevated filling pressures and slower myocardial relaxation as assessed by tissue Doppler imaging. Conclusions In this small, highly screened patient population with hemodynamically confirmed HFPEF, increased end-diastolic static ventricular stiffness relative to age-matched controls was not a universal finding. Nevertheless, patients with HFPEF, even when well compensated, had elevated filling pressures, reduced distensibility, and increased diastolic wall stress compared with

  3. Effects of gender, ejection fraction and weight on cardiac force development in patients undergoing cardiac surgery – an experimental examination

    PubMed Central

    2013-01-01

    Background It has long been recognized that differences exist between men and women in the impact of risc factors, symptoms, development and outcome of special diseases like the cardiovascular disease. Gender determines the cardiac baseline parameters like the number of cardiac myocyte, size and demand and may suggest differences in myofilament function among genders, which might be pronounced under pathological conditions. Does gender impact and maybe impair the contractile apparatus? Are the differences more prominent when other factors like weight, age, ejection fraction are added? Therefore we performed a study on 36 patients (21 male, 15 female) undergoing aortic valve replacement (AVR) or aortocoronary bypass operation (CABG) to examine the influence of gender, ejection fraction, surgical procedure and body mass index (BMI) on cardiac force development. Methods Tissue was obtained from the right auricle and was stored in a special solution to prevent any stretching of the fibers. We used the skinned muscle fiber model and single muscle stripes, which were mounted on the “muscle machine” and exposed to a gradual increase of calcium concentration calculated by an attached computer program. Results 1.) In general female fibers show more force than male fibers: 3.9 mN vs. 2.0 mN (p = 0.03) 2.) Female fibers undergoing AVR achieved more force than those undergoing CABG operation: 5.7 mN vs. 2.8 mN (p = 0.02) as well as male fibers with AVR showed more force values compared to those undergoing CABG: 2.0 mN vs. 0.5 mN (p = 0.01). 3.) Male and female fibers of patients with EF > 55% developed significantly more force than from those with less ejection fraction than 30%: p = 0.002 for the male fibers (1.6 vs. 2.8 mN) and p = 0.04 for the female fibers (5.7 vs. 2.8 mN). 4.) Patients with a BMI between 18 till 25 develop significant more force than those with a BMI > 30: Females 5.1 vs. 2.6 mN; p 0.03, Males 3.8 vs. 0.8 mN; p 0

  4. Prognostic significance of hyponatremia among ambulatory patients with heart failure and preserved and reduced ejection fractions.

    PubMed

    Bavishi, Chirag; Ather, Sameer; Bambhroliya, Arvind; Jneid, Hani; Virani, Salim S; Bozkurt, Biykem; Deswal, Anita

    2014-06-01

    Hyponatremia in heart failure (HF) is an established predictor of adverse outcomes in hospitalized patients with reduced ejection fraction (EF). However, there is a paucity of data in ambulatory patients with HF with preserved ejection fraction (HFpEF). We examined the prevalence, risk factors, and long-term outcomes of hyponatremia (serum sodium ≤135 mEq/L) in ambulatory HFpEF and HF with reduced EF (HFrEF) in a national cohort of 8,862 veterans treated in Veterans Affairs clinics. Multivariable logistic regression models were used to identify factors associated with hyponatremia, and multivariable Cox proportional hazard models were used for analysis of outcomes. The cohort consisted of 6,185 patients with HFrEF and 2,704 patients with HFpEF with a 2-year follow-up. Hyponatremia was present in 13.8% and 12.9% patients in HFrEF and HFpEF, respectively. Hyponatremia was independently associated with younger age, diabetes, lower systolic blood pressure, anemia, body mass index <30 kg/m(2), and spironolactone use, whereas African-American race and statins were inversely associated. In multivariate analysis, hyponatremia remained a significant predictor of all-cause mortality in both HFrEF (hazards ratio [HR] 1.26, 95% confidence interval [CI] 1.11 to 1.44, p <0.001) and HFpEF (HR 1.40, 95% CI 1.12 to 1.75, p = 0.004) and a significant predictor of all-cause hospitalization in patients with HFrEF (HR 1.18, 95% CI 1.07 to 1.31, p = 0.001) but not in HFpEF (HR 1.08, 95% CI 0.92 to 1.27, p = 0.33). In conclusion, hyponatremia is prevalent at a similar frequency of over 10% in ambulatory patients with HFpEF and HFrEF. Hyponatremia is an independent prognostic marker of mortality across the spectrum of patients with HFpEF and HFrEF. In contrast, it is an independent predictor for hospitalization in patients with HFrEF but not in patients with HFpEF. PMID:24837261

  5. Predictors of Increased Left Ventricular Filling Pressure in Dialysis Patients with Preserved Left Ventricular Ejection Fraction

    PubMed Central

    Bajraktari, Gani; Berbatovci-Ukimeraj, Mimoza; Hajdari, Ali; Ibraimi, Lavdim; Daullxhiu, Irfan; Elezi, Ymer; Ndrepepa, Gjin

    2009-01-01

    Aim To study the left and right ventricular function and to assess the predictors of increased left ventricular (LV) filling pressure in dialysis patients with preserved LV ejection fraction. Methods This study included 63 consecutive patients (age 57 ± 14 years, 57% women) with end-stage renal failure. Echocardiography, including tissue Doppler measurements, was performed in all patients. Based on the median value of the ratio of transmitral early diastolic velocity to early myocardial velocity (E/E’ ratio), patients were divided into 2 groups: the group with high filling pressure (E/E’>10.16) and the group with low filling pressure (E/E’≤10.16). Results Compared with patients with low filling pressure, the group of patients with high filling pressure included a higher proportion of diabetic patients (41% vs 13%, P = 0.022) and had greater LV mass index (211 ± 77 vs 172 ± 71 g/m3, P = 0.04), lower LV lateral long axis amplitude (1.4 ± 0.3 vs 1.6 ± 0.3 cm, P = 0.01), higher E wave (84 ± 19 vs 64 ± 18cm/s, P < 0.001), lower systolic myocardial velocity (S’:8.6 ± 1.5 vs 7.0 ± 1.3 cm/s, P < 0.001), and lower diastolic myocardial velocities (E’: 6.3 ± 1.9 vs 9.5 ± 2.9 cm/s, P < 0.001; A’: 8.4 ± 1.9 vs 9.7 ± 2.5 cm/s, P = 0.018). Multivariate analysis identified LV systolic myocardial velocity – S’ wave (adjusted odds ratio, 1.909; 95% confidence interval, 1.060-3.439; P = 0.031) and age (1.053; 1.001-1.108; P = 0.048) as the only independent predictors of high LV filling pressure in dialysis patients. Conclusions In dialysis patients with preserved left ventricular ejection fraction, reduced systolic myocardial velocity and elderly age are independent predictors of increased left ventricular filling pressure. PMID:20017222

  6. Improvement of Ejection Fraction After Coronary Artery Bypass Grafting Surgery in Patients with Impaired Left Ventricular Function

    PubMed Central

    Haxhibeqiri-Karabdic, Ilirijana; Hasanovic, Aida; Kabil, Emir; Straus, Slavenka

    2014-01-01

    ABSTRACT Objectives: The present study evaluates our experience with aorto-coronary bypass grafting in patients with severe dysfunction of left ventricle (LV) and low ejection fraction-EF(<35%). Revascularization of myocardium in this settings remains contraversial because of concerns over morbidity, mortality and quality of life. Material and Methodes: Forty patients with severe coronary artery disease and dysfunction of LV (low ejection fraction <35%) underwent coronary artery bypass grafting in period of 3 years. Preoperative diagnostic of 40 patients was consisted of anamnesis, clinical exam, non-invasive methods EHO, MR and invasive diagnostic methods-cateterization. The major indication for surgery was severe anginal pain, heart failure symptoms and low ejection fraction. Internal mammary artery was used in all operated patients. Results: Average age of patients who have been operated was 59,8. In the present study, 81,3% were male and 18,8% female. We found one-vessel disease present in 2,5% (1/40) of patients, two -vessel disease in 40% (16/40), three-vessel disease in 42,5% (17/40) and four -vessel disease in 15% (6/40) of patients. One bypass grafting we implanted in 2,5% patients, two bypasses in 42,5%, three bypasses in 45 5%, and four bypasses in 10% of patients. Left ventricular ejection fraction assessed preoperativly was 18%-27% and postoperatively was improved to 31, 08% in period of 30 days. Conclusion: In patients with left ventricular dysfunction, coronary artery bypass grafting can be performed safely with improvement in quality of life and in left ventricular ejection fraction. PMID:25568566

  7. A Review of New Pharmacologic Treatments for Patients With Chronic Heart Failure With Reduced Ejection Fraction.

    PubMed

    Nguyen, Elaine; Weeda, Erin R; White, C Michael

    2016-08-01

    Heart failure (HF) impacts an estimated 5.7 million Americans, and its prevalence is projected to increase to more than 8 million Americans in the next 15 years. Key clinical trials have established an evidence-based foundation for treatment of heart failure with reduced ejection fraction (HFrEF). Ivabradine and sacubitril/valsartan, which inhibit the f-channel and the angiotensin receptor and neprilysin, respectively, were recently approved by the Food and Drug Administration for HFrEF. In systolic heart failure, treatment with the If inhibitor ivabradine significantly reduced the combined endpoint of cardiovascular mortality or heart failure hospital admission vs placebo (P < .05). In the Prospective Comparison of angiotensin receptor-neprilysin inhibitor (ARNI) with angiotensin-converting enzyme inhibitor (ACEI) to Determine Impact on Global Mortality and Morbidity in Heart Failure trial, sacubitril/valsartan significantly reduced the combined endpoint of cardiovascular death or heart failure hospitalization vs enalapril (P < .001). The place of therapy with ivabradine and sacubitril/valsartan is defined by these trials and their interplay with guideline-directed medical therapy. Ivabradine and sacubitril/valsartan increase pharmacotherapy options for the treatment of HFrEF but are not yet first-line agents. Clinical application will be better defined in the coming years as practitioners increase their familiarity with ivabradine and sacubitril/valsartan. PMID:26626162

  8. Electrophysiologic testing guided risk stratification approach for sudden cardiac death beyond the left ventricular ejection fraction.

    PubMed

    Gatzoulis, Konstantinos A; Tsiachris, Dimitris; Arsenos, Petros; Tousoulis, Dimitris

    2016-01-26

    Sudden cardiac death threats ischaemic and dilated cardiomyopathy patients. Anti- arrhythmic protection may be provided to these patients with implanted cardiac defibrillators (ICD), after an efficient risk stratification approach. The proposed risk stratifier of an impaired left ventricular ejection fraction has limited sensitivity meaning that a significant number of victims will remain undetectable by this risk stratification approach because they have a preserved left ventricular systolic function. Current risk stratification strategies focus on combinations of non invasive methods like T wave alternans, late potentials, heart rate turbulence, deceleration capacity and others, with invasive methods like the electrophysiologic study. In the presence of an electrically impaired substrate with formed post myocardial infarction fibrotic zones, programmed ventricular stimulation provides important prognostic information for the selection of the patients expected to benefit from an ICD implantation, while due to its high negative predictive value, patients at low risk level may also be detected. Clustering evidence from different research groups and electrophysiologic labs support an electrophysiologic testing guided risk stratification approach for sudden cardiac death. PMID:26839662

  9. Digoxin in Heart Failure with a Reduced Ejection Fraction: A Risk Factor or a Risk Marker.

    PubMed

    Konstantinou, Dimitrios M; Karvounis, Haralambos; Giannakoulas, George

    2016-01-01

    Digoxin is one of the oldest compounds used in cardiovascular medicine. Nevertheless, its mechanism of action and most importantly its clinical utility have been the subject of an endless dispute. Positive inotropic and neurohormonal modulation properties are attributed to digoxin, and it was the mainstay of heart failure therapeutics for decades. However, since the institution of β-blockers and aldosterone antagonists as part of modern heart failure medical therapy, digoxin prescription rates have been in free fall. The fact that digoxin is still listed as a valid therapeutic option in both American and European heart failure guidelines has not altered clinicians' attitude towards the drug. Since the publication of original Digitalis Investigation Group trial data, a series of reports based predominately on observational studies and post hoc analyses have raised concerns about the clinical efficacy and long-term safety of digoxin. In the present review, we will attempt a critical appraisal of the available clinical evidence regarding the efficacy and safety of digoxin in heart failure patients with a reduced ejection fraction. The methodological issues, strengths, and limitations of individual studies will be highlighted. PMID:26959501

  10. Sacubitril/Valsartan: A Review in Chronic Heart Failure with Reduced Ejection Fraction.

    PubMed

    McCormack, Paul L

    2016-03-01

    Sacubitril/valsartan (Entresto™; LCZ696) is an orally administered supramolecular sodium salt complex of the neprilysin inhibitor prodrug sacubitril and the angiotensin receptor blocker (ARB) valsartan, which was recently approved in the US and the EU for the treatment of chronic heart failure (NYHA class II-IV) with reduced ejection fraction (HFrEF). In the large, randomized, double-blind, PARADIGM-HF trial, sacubitril/valsartan reduced the incidence of death from cardiovascular causes or first hospitalization for worsening heart failure (composite primary endpoint) significantly more than the angiotensin converting enzyme (ACE) inhibitor enalapril. Sacubitril/valsartan was also superior to enalapril in reducing death from any cause and in limiting the progression of heart failure. Sacubitril/valsartan was generally well tolerated, with no increase in life-threatening adverse events. Symptomatic hypotension was significantly more common with sacubitril/valsartan than with enalapril; the incidence of angio-oedema was low. Therefore, sacubitril/valsartan is a more effective replacement for an ACE inhibitor or an ARB in the treatment of HFrEF, and is likely to influence the basic approach to treatment. PMID:26873495

  11. Echocardiographic assessment of left ventricular systolic function: from ejection fraction to torsion.

    PubMed

    Cameli, Matteo; Mondillo, Sergio; Solari, Marco; Righini, Francesca Maria; Andrei, Valentina; Contaldi, Carla; De Marco, Eugenia; Di Mauro, Michele; Esposito, Roberta; Gallina, Sabina; Montisci, Roberta; Rossi, Andrea; Galderisi, Maurizio; Nistri, Stefano; Agricola, Eustachio; Mele, Donato

    2016-01-01

    Assessment of left ventricular (LV) systolic function is the cornerstone of the echocardiographic examination. There are many echocardiographic parameters that can be used for clinical and research purposes, each one with its pros and cons. The LV ejection fraction is the most used one due to its feasibility and predictability, but it also has many limits, related to both the imaging technique used for calculation and to the definition itself. LV longitudinal function is expression of subendocardial fibers contraction. Because the subendocardium is often involved early in many pathological processes, its analysis has been a fertile field for the development of sensitive parameters. Longitudinal function can be evaluated in many ways, such as M-mode echocardiography, tissue Doppler imaging, and speckle tracking echocardiography. This latter is a relatively new tool to assess LV function through measurement of myocardial strain, with a high temporal and spatial resolution and a better inter- and intra-observer reproducibility compared to Doppler strain. It is angle independent, not affected by translation cardiac movements, and can assess simultaneously the entire myocardium along all the three-dimensional geometrical (longitudinal, circumferential, and radial) axes. Speckle tracking echocardiography also allows the analysis of LV torsion. The aim of this paper was to review the main echocardiographic parameters of LV systolic function and to describe its pros and cons. PMID:26712329

  12. Sarcopenic obesity and the pathogenesis of exercise intolerance in heart failure with preserved ejection fraction.

    PubMed

    Upadhya, Bharathi; Haykowsky, Mark J; Eggebeen, Joel; Kitzman, Dalane W

    2015-06-01

    Heart failure with preserved ejection fraction (HFpEF) is the most common form of heart failure (HF) in older adults. The primary chronic symptom in patients with HFpEF, even when well compensated, is severe exercise intolerance. Cardiac and peripheral functions contribute equally to exercise intolerance in HFpEF, though the latter has been the focus of fewer studies. Of note, multiple studies with exercise training have shown that exercise intolerance can improve significantly in the absence of improvements in exercise cardiac output, indicating a role of peripheral, noncardiac adaptations. In addition, clinical drug trials performed to date in HFpEF, all of which have focused on influencing cardiovascular function, have not been positive on primary clinical outcomes and most have not improved exercise capacity. Mounting evidence indicates that sarcopenic obesity, characterized by the coexistence of excess fat mass and decreased muscle mass, could contribute to the pathophysiology of exercise intolerance in older HFpEF patients and may provide avenues for novel treatments. PMID:25750186

  13. Role of preoperative radionuclide ejection fraction in direct abdominal aortic aneurysm repair

    SciTech Connect

    Kazmers, A.; Cerqueira, M.D.; Zierler, R.E.

    1988-08-01

    Preoperative radionuclide ventriculography was performed in 60 patients to assess whether such testing could define those at increased risk after direct abdominal aortic aneurysm (AAA) repair. None of the patients had prophylactic coronary artery reconstruction to reduce the risk of AAA repair despite angina in 27% and previous myocardial infarction (MI) in 42%. The mean ejection fraction (EF) was 52% +/- 15% (range 14% to 78%). Low EF (normal greater than 50%) was present in 40%, whereas ventricular wall motion abnormalities were present in 39% of patients. The overall perioperative (30-day) mortality rate was 5%. MI occurred in 7% within 30 postoperative days; none was fatal. Life-table analysis revealed that overall survival after AAA repair was significantly lower in patients with an EF of 50% or less (p less than 0.025, Mantel-Cox) during a follow-up of 20.1 +/- 11.9 months. Overall survival differences were even more striking for those with an EF of 35% or less (p = 0.003, Mantel-Cox). There was a marked difference in the cumulative mortality rate during follow-up, being 50% in those patients with an EF of 35% or less (n = 10) compared with 14% in those with an EF greater than 35% (n = 50, p = 0.036, Fisher exact test). There was no statistical difference in the incidence of perioperative MI or perioperative death for those with an EF of 35% or less vs EF greater than 35%. 50 references.

  14. Noncardiac Comorbidities in Heart Failure With Reduced Versus Preserved Ejection Fraction

    PubMed Central

    Mentz, Robert J.; Kelly, Jacob P.; von Lueder, Thomas G.; Voors, Adriaan A.; Lam, Carolyn S. P.; Cowie, Martin R.; Kjeldsen, Keld; Jankowska, Ewa A.; Atar, Dan; Butler, Javed; Fiuzat, Mona; Zannad, Faiez; Pitt, Bertram; O’Connor, Christopher M.

    2014-01-01

    Heart failure patients are classified by ejection fraction (EF) into distinct groups: heart failure with preserved EF (HFpEF) or heart failure with reduced EF (HFrEF). Although patients with heart failure commonly have multiple comorbidities that complicate management and may adversely affect outcomes, their role in the HFpEF and HFrEF groups is not well-characterized. This review summarizes the role of noncardiac comorbidities in patients with HFpEF versus HFrEF, emphasizing prevalence, underlying pathophysiologic mechanisms, and outcomes. Pulmonary disease, diabetes mellitus, anemia, and obesity tend to be more prevalent in HFpEF patients, but renal disease and sleep-disordered breathing burdens are similar. These comorbidities similarly increase morbidity and mortality risk in HFpEF and HFrEF patients. Common pathophysiologic mechanisms include systemic and endomyocardial inflammation with fibrosis. We also discuss implications for clinical care and future HF clinical trial design. The basis for this review was discussions between scientists, clinical trialists, and regulatory representatives at the 10th Global CardioVascular Clinical Trialists Forum. PMID:25456761

  15. Exercise Echocardiography in Asymptomatic Patients with Severe Aortic Stenosis and Preserved Left Ventricular Ejection Fraction

    PubMed Central

    Henri, Christine

    2014-01-01

    The management of asymptomatic patients with severe aortic stenosis (AS) remains controversial. Recent series reported that early aortic valve replacement might be associated with improved clinical outcomes. However, the risk-benefit ratio should be carefully evaluated and early surgery only be proposed to a subset of asymptomatic patients considered at higher risk. Exercise echocardiography can help unmask symptomatic patients combined with assessment of the hemodynamic consequences of AS. Recent studies have demonstrated that exercise echocardiography can provide incremental prognostic value to identify patients who may benefit most from early surgery. In "truly" asymptomatic patients, an increase in mean aortic gradient ≥ 18-20 mmHg, a limited left ventricular contractile reserve or a pulmonary hypertension during exercise are predictive parameters of adverse cardiac events. Exercise echocardiography is low-cost, safe and available in many referral centers, and does not expose patients to radiation. The purpose of this article is to describe the role of exercise testing and echocardiography in the management of asymptomatic patients with severe AS and preserved left ventricular ejection fraction. PMID:24753801

  16. Determination of right ventricular ejection fraction in children with cystic fibrosis, using krypton-81m

    SciTech Connect

    Piepsz, A.; Ham, H.R.; Millet, E.; Dab, I.

    1984-01-01

    The diagnosis of cor pulmonale and incipient heart failure remains difficult to assess in cystic fibrosis (CF) on the basis of the clinical as well as the biological parameters. The measurement of the right ventricular ejection fraction has been facilitated these last years by the introduction of the radionuclide methods. Methodological difficulties are however encountered when Tc-99m RBC are used, and are mainly related to heart chambers superposition (equilibrium method) or the low count density (first pass method). Few papers have been published on RVEF in cystic fibrosis and the results are somewhat contradictory. The authors have recently introduced a new method for the determination of RVEF, using equilibrium study during continuous injection of Kr-81m in glucose solution. This method offers several advantages related to an increased accuracy and a favorable dosimetry. In 25 patients aged 2 to 23 years with CF, one or more RVEF studies were performed. The severity of the disease was evaluated on the basis of the clinical Schwachman score, the lung function tests, the ventilation scan and the pa02. RVEF tended to decrease with the progression of the lung disease, although, owing to the spread of the results, no RVEF could be predicted on the basis of the other parameters. The decrease of RVEF in patients with advanced lung disease was moderate and terminal lung disease was sometimes associated with normal right heart contractility.

  17. Myocardial Hypertrophy and Its Role in Heart Failure with Preserved Ejection Fraction

    PubMed Central

    Heinzel, Frank R.; Hohendanner, Felix; Jin, Ge; Sedej, Simon; Edelmann, Frank

    2015-01-01

    Left ventricular hypertrophy (LVH) is the most common myocardial structural abnormality associated with heart failure with preserved ejection fraction (HFpEF). LVH is driven by neurohumoral activation, increased mechanical load and cytokines associated with arterial hypertension, chronic kidney disease, diabetes and other co-morbidities. Here we discuss the experimental and clinical evidence that links LVH to diastolic dysfunction and qualifies LVH as one diagnostic marker for HFpEF. Mechanisms leading to diastolic dysfunction in LVH are incompletely understood but may include extracellular matrix changes, vascular dysfunction as well as altered cardiomyocyte mechano-elastical properties. Beating cardiomyocytes from HFpEF patients have not yet been studied, but we and others have shown increased Ca2+ turnover and impaired relaxation in cardiomyocytes from hypertrophied hearts. Structural myocardial remodeling can lead to heterogeneity in regional myocardial contractile function, which contributes to diastolic dysfunction in HFpEF. In the clinical setting of patients with compound co-morbidities, diastolic dysfunction may occur independently of LVH. This may be one explanation why current approaches to reduce LVH have not been effective to improve symptoms and prognosis in HFpEF. Exercise training on the other hand, in clinical trials improved exercise tolerance and diastolic function but did not reduce LVH. Thus, current clinical evidence does not support regression of LVH as a surrogate marker for (short-term) improvement of HFpEF. PMID:26183480

  18. Exercise intolerance in heart failure with preserved ejection fraction: more than a heart problem

    PubMed Central

    Upadhya, Bharathi; Haykowsky, Mark J; Eggebeen, Joel; Kitzman, Dalane W

    2015-01-01

    Heart failure (HF) with preserved ejection fraction (HFpEF) is the most common form of HF in older adults, and is increasing in prevalence as the population ages. Furthermore, HFpEF is increasing out of proportion to HF with reduced EF (HFrEF), and its prognosis is worsening while that of HFrEF is improving. Despite the importance of HFpEF, our understanding of its pathophysiology is incomplete, and optimal treatment remains largely undefined. A cardinal feature of HFpEF is reduced exercise tolerance, which correlates with symptoms as well as reduced quality of life. The traditional concepts of exercise limitations have focused on central dysfunction related to poor cardiac pump function. However, the mechanisms are not exclusive to the heart and lungs, and the understanding of the pathophysiology of this disease has evolved. Substantial attention has focused on defining the central versus peripheral mechanisms underlying the reduced functional capacity and exercise tolerance among patients with HF. In fact, physical training can improve exercise tolerance via peripheral adaptive mechanisms even in the absence of favorable central hemodynamic function. In addition, the drug trials performed to date in HFpEF that have focused on influencing cardiovascular function have not improved exercise capacity. This suggests that peripheral limitations may play a significant role in HF limiting exercise tolerance, a hallmark feature of HFpEF. PMID:26089855

  19. Reduction of left ventricular ejection fraction after 12-month follow-up in hemodialysis patients

    PubMed Central

    Momeni, Ali; Khaledi, Arsalan; Hasanzadeh, Katayoun

    2016-01-01

    Introduction: Cardiovascular disease is the most common cause of morbidity and mortality in hemodialysis patients. Objectives: The aim of this study was to detect echocardiographic abnormality in the beginning and after 12-month follow-up in the hemodialysis patients. Patients and Methods: In a cross-sectional study, 60 hemodialysis patients older than 18 years and the dialysis duration longer than three months were enrolled. At the beginning of the study, echocardiography was done and after 12 months was repeated in all of the patients by the same cardiologist. At the end of the study, data were analyzed using SPSS software (version 19). Results: From the total of cases 37 were male and 23 female. At the beginning of the study, mitral regurgitation, tricuspid regurgitation and aortic insufficiency were found in 54, 47 and 11 patients respectively. After 12 months left ventricular ejection fraction (LVEF) decreased significantly, however there was no significant difference between other echocardiographic findings at the beginning and after 12 months. Conclusion: Decrease in LVEF over time in hemodialysis patients may be due to negative effect of uremia on cardiac function, so it seems that periodical cardiac evaluation of these patients is essential and beneficial. PMID:27069961

  20. Mineralocorticoid Accelerates Transition to Heart Failure with Preserved Ejection Fraction Via “Non-Genomic Effects”

    PubMed Central

    Mohammed, Selma F.; Ohtani, Tomohito; Korinek, Josef; Lam, Carolyn S.P.; Larsen, Katarina; Simari, Robert D.; Valencik, Maria L.; Burnett, John C.; Redfield, Margaret M.

    2010-01-01

    Background Mechanisms promoting the transition from hypertensive heart disease (HHD) to heart failure with preserved ejection fraction (HFpEF) are poorly understood. When inappropriate for salt status, mineralocorticoid (deoxycorticosterone acetate, DOCA) excess causes hypertrophy, fibrosis and diastolic dysfunction. As cardiac mineralocorticoid receptors (MR) are protected from mineralocorticoid binding by the absence of 11-ß hydroxysteroid dehydrogenase, salt-mineralocorticoid induced inflammation is postulated to cause oxidative stress and mediate cardiac effects. While previous studies have focused on salt/nephrectomy in accelerating mineralocorticoid induced cardiac effects, we hypothesized that HHD is associated with oxidative stress and sensitizes the heart to mineralocorticoid, accelerating hypertrophy, fibrosis and diastolic dysfunction. Methods and Results Cardiac structure and function, oxidative stress and MR-dependent gene transcription were measured in SHAM operated and transverse aortic constriction (TAC; studied two weeks later) mice without and with DOCA administration, all in the setting of normal salt diet. Compared to SHAM mice, SHAM+DOCA mice had mild hypertrophy without fibrosis or diastolic dysfunction. TAC mice displayed compensated HHD with hypertrophy, increased oxidative stress (osteopontin and NOX4 gene expression) and normal systolic function, filling pressures and diastolic stiffness. Compared to TAC mice, TAC+DOCA mice had similar LV systolic pressure and fractional shortening but more hypertrophy, fibrosis and diastolic dysfunction with increased lung weights consistent with HFpEF. There was progressive activation of markers of oxidative stress across the groups but no evidence of classic MR-dependent gene transcription. Conclusions Pressure overload hypertrophy sensitizes the heart to mineralocorticoid excess which promotes the transition to HFpEF independent of classic MR-dependent gene transcription. PMID:20625113

  1. Association between renal function and cardiovascular structure and function in heart failure with preserved ejection fraction

    PubMed Central

    Gori, Mauro; Senni, Michele; Gupta, Deepak K.; Charytan, David M.; Kraigher-Krainer, Elisabeth; Pieske, Burkert; Claggett, Brian; Shah, Amil M.; Santos, Angela B. S.; Zile, Michael R.; Voors, Adriaan A.; McMurray, John J. V.; Packer, Milton; Bransford, Toni; Lefkowitz, Martin; Solomon, Scott D.

    2014-01-01

    Aim Renal dysfunction is a common comorbidity in patients with heart failure and preserved ejection fraction (HFpEF). We sought to determine whether renal dysfunction was associated with measures of cardiovascular structure/function in patients with HFpEF. Methods We studied 217 participants from the PARAMOUNT study with HFpEF who had echocardiography and measures of kidney function. We evaluated the relationships between renal dysfunction [estimated glomerular filtration rate (eGFR) >30 and <60 mL/min/1.73 m2 and/or albuminuria] and cardiovascular structure/function. Results The mean age of the study population was 71 years, 55% were women, 94% hypertensive, and 40% diabetic. Impairment of at least one parameter of kidney function was present in 62% of patients (16% only albuminuria, 23% only low eGFR, 23% both). Renal dysfunction was associated with abnormal LV geometry (defined as concentric hypertrophy, or eccentric hypertrophy, or concentric remodelling) (adjusted P = 0.048), lower midwall fractional shortening (MWFS) (P = 0.009), and higher NT-proBNP (P = 0.006). Compared with patients without renal dysfunction, those with low eGFR and no albuminuria had a higher prevalence of abnormal LV geometry (P = 0.032) and lower MWFS (P < 0.01), as opposed to those with only albuminuria. Conversely, albuminuria alone was associated with greater LV dimensions (P < 0.05). Patients with combined renal impairment had mixed abnormalities (higher LV wall thicknesses, NT-proBNP; lower MWFS). Conclusion Renal dysfunction, as determined by both eGFR and albuminuria, is highly prevalent in HFpEF, and associated with cardiac remodelling and subtle systolic dysfunction. The observed differences in cardiac structure/function between each type of renal damage suggest that both parameters of kidney function might play a distinct role in HFpEF. PMID:24980489

  2. Antioxidative activities of fractions obtained from brewed coffee.

    PubMed

    Yanagimoto, Kenichi; Ochi, Hirotomo; Lee, Kwang-Geun; Shibamoto, Takayuki

    2004-02-11

    The antioxidative activity of column chromatographic fractions obtained from brewed coffee was investigated to find antioxidants and to assess the benefit of coffee drinking. The dichloromethane extract inhibited hexanal oxidation by 100 and 50% for 15 days and 30 days, respectively, at the level of 5 microg/mL. A GC/MS analysis of fractions, which exhibited oxidative activity, revealed the presence of antioxidative heterocyclic compounds including furans, pyrroles, and maltol. The residual aqueous solution exhibited slight antioxidative activity. The inhibitory activity (%) of the seven fractions from an aqueous solution toward malonaldehde formation from lipid oxidation ranged from 10 to 90 at a level of 300 microg/mL. The results indicate that brewed coffee contains many antioxidants and consumption of antioxidant-rich brewed coffee may inhibit diseases caused by oxidative damages. PMID:14759154

  3. Reporting trends of randomised controlled trials in heart failure with preserved ejection fraction: a systematic review

    PubMed Central

    Zheng, Sean L; Chan, Fiona T; Maclean, Edd; Jayakumar, Shruti; Nabeebaccus, Adam A

    2016-01-01

    Background Heart failure with preserved ejection fraction (HFpEF) causes significant cardiovascular morbidity and mortality. Current consensus guidelines reflect the neutral results from randomised controlled trials (RCTs). Adequate trial reporting is a fundamental requirement before concluding on RCT intervention efficacy and is necessary for accurate meta-analysis and to provide insight into future trial design. The Consolidated Standards of Reporting Trials (CONSORT) 2010 statement provides a framework for complete trial reporting. Reporting quality of HFpEF RCTs has not been previously assessed, and this represents an important validation of reporting qualities to date. Objectives The aim was to systematically identify RCTs investigating the efficacy of pharmacological therapies in HFpEF and to assess the quality of reporting using the CONSORT 2010 statement. Methods MEDLINE, EMBASE and CENTRAL databases were searched from January 1996 to November 2015, with RCTs assessing pharmacological therapies on clinical outcomes in HFpEF patients included. The quality of reporting was assessed against the CONSORT 2010 checklist. Results A total of 33 RCTs were included. The mean CONSORT score was 55.4% (SD 17.2%). The CONSORT score was strongly correlated with journal impact factor (r=0.53, p=0.003) and publication year (r=0.50, p=0.003). Articles published after the introduction of CONSORT 2010 statement had a significantly higher mean score compared with those published before (64% vs 50%, p=0.02). Conclusions Although the CONSORT score has increased with time, a significant proportion of HFpEF RCTs showed inadequate reporting standards. The level of adherence to CONSORT criteria could have an impact on the validity of trials and hence the interpretation of intervention efficacy. We recommend improving compliance with the CONSORT statement for future RCTs. PMID:27547434

  4. Calcium-Channel Blockers and Outcomes in Older Patients With Heart Failure and Preserved Ejection Fraction

    PubMed Central

    Patel, Kanan; Fonarow, Gregg C.; Ahmed, Momanna; Morgan, Charity; Kilgore, Meredith; Love, Thomas E.; Deedwania, Prakash; Aronow, Wilbert S.; Anker, Stefan D.; Ahmed, Ali

    2015-01-01

    Background Little is known about associations of calcium channel blockers (CCBs) with outcomes in patients with heart failure and preserved ejection fraction (HFpEF). Methods and Results Of the 10,570 hospitalized HFpEF patients, ≥65 years, EF ≥40%, in the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF; 2003–2004), linked to Medicare data (through December 31, 2008), 7514 had no prior history of CCB use. Of these, 815 (11%) patients received new discharge prescriptions for CCBs. Propensity scores for CCB initiation, calculated for each of the 7514 patients, were used to assemble a matched cohort of 1620 (810 pairs) patients (mean age, 80 years; mean EF, 56%; 65% women; 10% African American) receiving and not receiving CCBs, balanced on 114 baseline characteristics. The primary composite endpoint of all-cause mortality or HF hospitalization occurred in 82% and 81% of patients receiving and not receiving CCBs (hazard ratio {HR} for CCBs, 1.03; 95% confidence interval {CI}, 0.92–1.14). HRs (95% CIs) for all-cause mortality, HF hospitalization and all-cause hospitalization were 1.05 (0.94–1.18), 1.05 (0.91–1.21), and 1.03 (0.93–1.14), respectively. Similar associations were observed when we categorized patients into those receiving amlodipine and non-amlodipine CCBs. Among 7514 pre-match patients, multivariable-adjusted and propensity-adjusted HRs (95% CI) for primary composite endpoint were 1.03 (0.95–1.12) and 1.02 (0.94–1.11), respectively. Conclusions In hospitalized older HFpEF patients, new discharge prescriptions for CCBs had no associations with composite or individual endpoints of mortality or HF hospitalization, regardless of the class of CCBs. PMID:25296862

  5. Urinary Proteomics Pilot Study for Biomarker Discovery and Diagnosis in Heart Failure with Reduced Ejection Fraction

    PubMed Central

    Rossing, Kasper; Bosselmann, Helle Skovmand; Gustafsson, Finn; Zhang, Zhen-Yu; Gu, Yu-Mei; Kuznetsova, Tatiana; Nkuipou-Kenfack, Esther; Mischak, Harald; Staessen, Jan A.

    2016-01-01

    Background Biomarker discovery and new insights into the pathophysiology of heart failure with reduced ejection fraction (HFrEF) may emerge from recent advances in high-throughput urinary proteomics. This could lead to improved diagnosis, risk stratification and management of HFrEF. Methods and Results Urine samples were analyzed by on-line capillary electrophoresis coupled to electrospray ionization micro time-of-flight mass spectrometry (CE-MS) to generate individual urinary proteome profiles. In an initial biomarker discovery cohort, analysis of urinary proteome profiles from 33 HFrEF patients and 29 age- and sex-matched individuals without HFrEF resulted in identification of 103 peptides that were significantly differentially excreted in HFrEF. These 103 peptides were used to establish the support vector machine-based HFrEF classifier HFrEF103. In a subsequent validation cohort, HFrEF103 very accurately (area under the curve, AUC = 0.972) discriminated between HFrEF patients (N = 94, sensitivity = 93.6%) and control individuals with and without impaired renal function and hypertension (N = 552, specificity = 92.9%). Interestingly, HFrEF103 showed low sensitivity (12.6%) in individuals with diastolic left ventricular dysfunction (N = 176). The HFrEF-related peptide biomarkers mainly included fragments of fibrillar type I and III collagen but also, e.g., of fibrinogen beta and alpha-1-antitrypsin. Conclusion CE-MS based urine proteome analysis served as a sensitive tool to determine a vast array of HFrEF-related urinary peptide biomarkers which might help improving our understanding and diagnosis of heart failure. PMID:27308822

  6. Left ventricular volume regulation in heart failure with preserved ejection fraction

    PubMed Central

    Kerkhof, Peter L M; Yasha Kresh, J; Li, John K-J; Heyndrickx, Guy R

    2013-01-01

    Ejection Fraction (EF) has attained the recognition as indicator of global ventricular performance. Remarkably, precise historical origins promoting the apparent importance of EF are scant. During early utilization EF has been declared a gold standard for the evaluation of the heart as a pump. In contrast, during the last two decades, clinicians have developed a measure of doubt in the universal applicability of EF. This reluctance lead to the introduction of a new and prevalent syndrome in which heart failure (HF) is diagnosed as having a preserved EF (pEF). We examine the existing criticism regarding EF, and describe a novel avenue to characterize ventricular function within the unifying framework of cardiac input–output volume regulation. This approach relates end-systolic volume (ESV) to end-diastolic volume (EDV), and derives for a subgroup matching pEF criteria a distinct pattern in the ESV–EDV domain. In patients with pEF (n = 34), a clear difference (P < 0.0004) in the slope of the regression line for ESV versus EDV was demonstrated compared to control patients with EF < 50% (n = 29). These findings are confirmed by analysis of data presented in two independent publications. The volume regulation approach proposed employs primary end-point determinants (such as ESV and EDV) rather than derived quantities (e.g., the ratio EF or its differential parameter, that is, stroke volume) and confirms a distinct advantage over the classical Starling curve. Application of the ESV-EDV-construct provides the basis and clarifies why some patients present as HFpEF, while others have reduced EF. PMID:24303121

  7. Exercise Hemodynamics Enhance Diagnosis of Early Heart Failure with Preserved Ejection Fraction

    PubMed Central

    Borlaug, Barry A.; Nishimura, Rick A.; Sorajja, Paul; Lam, Carolyn S.P.; Redfield, Margaret M.

    2011-01-01

    Background When advanced, heart failure (HF) with preserved ejection fraction (HFpEF) is readily apparent. However, diagnosis of earlier disease may be challenging, as exertional dyspnea is not specific for HF, and biomarkers and hemodynamic indicators of volume overload may be absent at rest. Methods and Results Patients with exertional dyspnea and EF>50% were referred for hemodynamic catheterization. Those with no significant coronary disease, normal BNP, and normal resting hemodynamics (mean pulmonary artery (PA) pressure<25 mmHg & PA wedge (PCWP) pressure <15 mmHg; n=55) underwent exercise study. The exercise PCWP was used to classify patients as having HFpEF (PCWP≥25 mmHg; n=32) or non-cardiac dyspnea (NCD, PCWP<25 mmHg; n=23). At rest, HFpEF patients displayed higher resting PA pressures and PCWP, though all values fell within normal limits. Exercise-induced elevation in PCWP in HFpEF was confirmed by greater increases in left ventricular end-diastolic pressure, and was associated with blunted increases in heart rate, systemic vasodilation and cardiac output. Exercise-induced pulmonary hypertension was present in 88% of HFpEF patients and was related principally to elevated PCWP, as pulmonary vascular resistances dropped similarly in both groups. Exercise PCWP and PASP were highly correlated. An exercise PASP≥45mmHg identified HFpEF with 96% sensitivity and 95% specificity. Conclusions Euvolemic patients with exertional dyspnea, normal BNP and normal cardiac filling pressures at rest may have markedly abnormal hemodynamic responses during exercise, suggesting that chronic symptoms are related to heart failure. Earlier and more accurate diagnosis using exercise hemodynamics may allow better targeting of interventions to treat and prevent HFpEF progression. PMID:20543134

  8. Hemodynamic responses to small muscle mass exercise in heart failure patients with reduced ejection fraction.

    PubMed

    Barrett-O'Keefe, Zachary; Lee, Joshua F; Berbert, Amanda; Witman, Melissa A H; Nativi-Nicolau, Jose; Stehlik, Josef; Richardson, Russell S; Wray, D Walter

    2014-11-15

    To better understand the mechanisms responsible for exercise intolerance in heart failure with reduced ejection fraction (HFrEF), the present study sought to evaluate the hemodynamic responses to small muscle mass exercise in this cohort. In 25 HFrEF patients (64 ± 2 yr) and 17 healthy, age-matched control subjects (64 ± 2 yr), mean arterial pressure (MAP), cardiac output (CO), and limb blood flow were examined during graded static-intermittent handgrip (HG) and dynamic single-leg knee-extensor (KE) exercise. During HG exercise, MAP increased similarly between groups. CO increased significantly (+1.3 ± 0.3 l/min) in the control group, but it remained unchanged across workloads in HFrEF patients. At 15% maximum voluntary contraction (MVC), forearm blood flow was similar between groups, while HFrEF patients exhibited an attenuated increase at the two highest intensities compared with controls, with the greatest difference at the highest workload (352 ± 22 vs. 492 ± 48 ml/min, HFrEF vs. control, 45% MVC). During KE exercise, MAP and CO increased similarly across work rates between groups. However, HFrEF patients exhibited a diminished leg hyperemic response across all work rates, with the most substantial decrement at the highest intensity (1,842 ± 64 vs. 2,675 ± 81 ml/min; HFrEF vs. control, 15 W). Together, these findings indicate a marked attenuation in exercising limb perfusion attributable to impairments in peripheral vasodilatory capacity during both arm and leg exercise in patients with HFrEF, which likely plays a role in limiting exercise capacity in this patient population. PMID:25260608

  9. Mineralocorticoid receptor antagonists in heart failure with preserved ejection fraction (HFpEF).

    PubMed

    Capuano, Annalisa; Scavone, Cristina; Vitale, Cristiana; Sportiello, Liberata; Rossi, Francesco; Rosano, Giuseppe M C; Coats, Andrew J Stewart

    2015-12-01

    The role of spironolactone and eplerenone in patients with Heart Failure with preserved Ejection Fraction (HFpEF) is not well defined. Since a growing medical literature has suggested that mineralocorticoid receptor antagonists may be beneficial for patients with HFpEF, this review gives an in-depth update on the role of spironolactone and eplerenone and their implications for therapy in the setting of HFpEF. Eleven clinical studies, including seven randomized trials, were reviewed. Two randomized controlled trials evaluated the effect of eplerenone on different end-points, including 6 minute walk distance (6 MWD), cardiovascular mortality, non-fatal reinfarction, hospitalization for unstable angina and congestive heart failure. Eplerenone did not affect either 6 MWD or event-free survival rates in the overall study population in these two reports. The effects of spironolactone on similar composite endpoints were evaluated in 7 studies in patients with HFpEF. Compared to placebo, hospitalization for heart failure was significantly lower in the spironolactone group and spironolactone was also shown to improve diastolic function and induced beneficial remodeling through a reduction in myocardial fibrosis. The safety profile of spironolactone and eplerenone has been assessed in two recent studies. Data showed that eplerenone and spironolactone are both associated with the occurrence of gynecomastia, mastodynia, and abnormal vaginal bleeding and in addition, they can increase natriuresis and cause renal retention of potassium; furthermore, eplerenone may cause hyperkalemia and promote the onset of metabolic acidosis or hyponatremia. In conclusion although the mineralocorticoid receptor antagonists eplerenone and spironolactone improve clinical outcomes in patients with HFrEF, additional data will be necessary to better define their risk-benefit profile, especially for eplerenone, in the treatment of HFpEF. PMID:26404747

  10. Association of Chronic Kidney Disease With Chronotropic Incompetence in Heart Failure With Preserved Ejection Fraction.

    PubMed

    Klein, David A; Katz, Daniel H; Beussink-Nelson, Lauren; Sanchez, Cynthia L; Strzelczyk, Theresa A; Shah, Sanjiv J

    2015-10-01

    Chronotropic incompetence (CI) is common in heart failure with preserved ejection fraction (HFpEF) and may be a key reason underlying exercise intolerance in these patients. However, the determinants of CI in HFpEF are unknown. We prospectively studied 157 patients with consecutive HFpEF who underwent cardiopulmonary exercise testing and defined CI according to specific thresholds of the percent heart rate reserve (%HRR). CI was diagnosed as present if %HRR <80 if not taking a β blocker and <62 if taking β blockers. Participants who achieved inadequate exercise effort (respiratory exchange ratio ≤1.05) on cardiopulmonary exercise testing were excluded. Multivariable-adjusted logistic regression was used to determine the factors associated with CI. Of the 157 participants, 108 (69%) achieved a respiratory exchange ratio >1.05 and were included in the final analysis. Of these 108 participants, 70% were women, 62% were taking β blockers, and 38% had chronic kidney disease. Most patients with HFpEF met criteria for CI (81 of 108; 75%). Lower estimated glomerular filtration rate (GFR), higher B-type natriuretic peptide, and higher pulmonary artery systolic pressure were each associated with CI. A 1-SD decrease in GFR was independently associated with CI after multivariable adjustment (adjusted odds ratio 2.2, 95% confidence interval 1.1 to 4.4, p = 0.02). The association between reduced GFR and CI persisted when considering a variety of measures of chronotropic response. In conclusion, reduced GFR is the major clinical correlate of CI in patients with HFpEF, and further study of the relation between chronic kidney disease and CI may provide insight into the pathophysiology of CI in HFpEF. PMID:26260398

  11. Phenotype-Specific Treatment of Heart Failure With Preserved Ejection Fraction: A Multiorgan Roadmap.

    PubMed

    Shah, Sanjiv J; Kitzman, Dalane W; Borlaug, Barry A; van Heerebeek, Loek; Zile, Michael R; Kass, David A; Paulus, Walter J

    2016-07-01

    Heart failure (HF) with preserved ejection fraction (EF; HFpEF) accounts for 50% of HF cases, and its prevalence relative to HF with reduced EF continues to rise. In contrast to HF with reduced EF, large trials testing neurohumoral inhibition in HFpEF failed to reach a positive outcome. This failure was recently attributed to distinct systemic and myocardial signaling in HFpEF and to diversity of HFpEF phenotypes. In this review, an HFpEF treatment strategy is proposed that addresses HFpEF-specific signaling and phenotypic diversity. In HFpEF, extracardiac comorbidities such as metabolic risk, arterial hypertension, and renal insufficiency drive left ventricular remodeling and dysfunction through systemic inflammation and coronary microvascular endothelial dysfunction. The latter affects left ventricular diastolic dysfunction through macrophage infiltration, resulting in interstitial fibrosis, and through altered paracrine signaling to cardiomyocytes, which become hypertrophied and stiff because of low nitric oxide and cyclic guanosine monophosphate. Systemic inflammation also affects other organs such as lungs, skeletal muscle, and kidneys, leading, respectively, to pulmonary hypertension, muscle weakness, and sodium retention. Individual steps of these signaling cascades can be targeted by specific interventions: metabolic risk by caloric restriction, systemic inflammation by statins, pulmonary hypertension by phosphodiesterase 5 inhibitors, muscle weakness by exercise training, sodium retention by diuretics and monitoring devices, myocardial nitric oxide bioavailability by inorganic nitrate-nitrite, myocardial cyclic guanosine monophosphate content by neprilysin or phosphodiesterase 9 inhibition, and myocardial fibrosis by spironolactone. Because of phenotypic diversity in HFpEF, personalized therapeutic strategies are proposed, which are configured in a matrix with HFpEF presentations in the abscissa and HFpEF predispositions in the ordinate. PMID:27358439

  12. MicroRNA signatures differentiate preserved from reduced ejection fraction heart failure

    PubMed Central

    Watson, Chris J; Gupta, Shashi K; O'Connell, Eoin; Thum, Sabrina; Glezeva, Nadezhda; Fendrich, Jasmin; Gallagher, Joe; Ledwidge, Mark; Grote-Levi, Lea; McDonald, Kenneth; Thum, Thomas

    2015-01-01

    Aims Differentiation of heart failure with reduced (HFrEF) or preserved (HFpEF) ejection fraction independent of echocardiography is challenging in the community. Diagnostic strategies based on monitoring circulating microRNA (miRNA) levels may prove to be of clinical value in the near future. The aim of this study was to identify a novel miRNA signature that could be a useful HF diagnostic tool and provide valuable clinical information on whether a patient has HFrEF or HFpEF. Methods and results MiRNA biomarker discovery was carried out on three patient cohorts, no heart failure (no-HF), HFrEF, and HFpEF, using Taqman miRNA arrays. The top five miRNA candidates were selected based on differential expression in HFpEF and HFrEF (miR-30c, −146a, −221, −328, and −375), and their expression levels were also different between HF and no-HF. These selected miRNAs were further verified and validated in an independent cohort consisting of 225 patients. The discriminative value of BNP as a HF diagnostic could be improved by use in combination with any of the miRNA candidates alone or in a panel. Combinations of two or more miRNA candidates with BNP had the ability to improve significantly predictive models to distinguish HFpEF from HFrEF compared with using BNP alone (area under the receiver operating characteristic curve >0.82). Conclusion This study has shown for the first time that various miRNA combinations are useful biomarkers for HF, and also in the differentiation of HFpEF from HFrEF. The utility of these biomarker combinations can be altered by inclusion of natriuretic peptide. MiRNA biomarkers may support diagnostic strategies in subpopulations of patients with HF. PMID:25739750

  13. Phenomapping for Novel Classification of Heart Failure with Preserved Ejection Fraction

    PubMed Central

    Shah, Sanjiv J.; Katz, Daniel H.; Selvaraj, Senthil; Burke, Michael A.; Yancy, Clyde W.; Gheorghiade, Mihai; Bonow, Robert O.; Huang, Chiang-Ching; Deo, Rahul C.

    2014-01-01

    Introduction Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous clinical syndrome in need of improved phenotypic classification. We sought to evaluate whether unbiased clustering analysis using dense phenotypic data (“phenomapping”) could identify phenotypically distinct HFpEF categories. Methods and Results We prospectively studied 397 HFpEF patients and performed detailed clinical, laboratory, electrocardiographic, and echocardiographic phenotyping of the study participants. We used several statistical learning algorithms, including unbiased hierarchical cluster analysis of phenotypic data (67 continuous variables) and penalized model-based clustering to define and characterize mutually exclusive groups comprising a novel classification of HFpEF. All phenomapping analyses were performed blinded to clinical outcomes, and Cox regression was used to demonstrate the clinical validity of phenomapping. The mean age was 65±12 years, 62% were female, 39% were African-American, and comorbidities were common. Although all patients met published criteria for the diagnosis of HFpEF, phenomapping analysis classified study participants into 3 distinct groups that differed markedly in clinical characteristics, cardiac structure/function, invasive hemodynamics, and outcomes (e.g., pheno-group #3 had an increased risk of HF hospitalization [hazard ratio 4.2, 95% CI 2.0–9.1] even after adjustment for traditional risk factors [P<0.001]). The HFpEF pheno-group classification, including its ability to stratify risk, was successfully replicated in a prospective validation cohort (n=107). Conclusions Phenomapping results in novel classification of HFpEF. Statistical learning algorithms, applied to dense phenotypic data, may allow for improved classification of heterogeneous clinical syndromes, with the ultimate goal of defining therapeutically homogeneous patient subclasses. PMID:25398313

  14. Renin-Angiotensin Activation and Oxidative Stress in Early Heart Failure with Preserved Ejection Fraction

    PubMed Central

    Negi, Smita I.; Jeong, Euy-Myoung; Shukrullah, Irfan; Veleder, Emir; Jones, Dean P.; Fan, Tai-Hwang M.; Varadarajan, Sudhahar; Danilov, Sergei M.; Fukai, Tohru; Dudley, Samuel C.

    2015-01-01

    Animal models have suggested a role of renin-angiotensin system (RAS) activation and subsequent cardiac oxidation in heart failure with preserved ejection fraction (HFpEF). Nevertheless, RAS blockade has failed to show efficacy in treatment of HFpEF. We evaluated the role of RAS activation and subsequent systemic oxidation in HFpEF. Oxidative stress markers were compared in 50 subjects with and without early HFpEF. Derivatives of reactive oxidative metabolites (DROMs), F2-isoprostanes (IsoPs), and ratios of oxidized to reduced glutathione (Eh GSH) and cysteine (Eh CyS) were measured. Angiotensin converting enzyme (ACE) levels and activity were measured. On univariate analysis, HFpEF was associated with male sex (p = 0.04), higher body mass index (BMI) (p = 0.003), less oxidized Eh CyS (p = 0.001), lower DROMs (p = 0.02), and lower IsoP (p = 0.03). Higher BMI (OR: 1.3; 95% CI: 1.1–1.6) and less oxidized Eh CyS (OR: 1.2; 95% CI: 1.1–1.4) maintained associations with HFpEF on multivariate analysis. Though ACE levels were higher in early HFpEF (OR: 1.09; 95% CI: 1.01–1.05), ACE activity was similar to that in controls. HFpEF is not associated with significant systemic RAS activation or oxidative stress. This may explain the failure of RAS inhibitors to alter outcomes in HFpEF. PMID:26504834

  15. Effect of Selective Heart Rate Slowing in Heart Failure With Preserved Ejection Fraction

    PubMed Central

    Pal, Nikhil; Sivaswamy, Nadiya; Mahmod, Masliza; Yavari, Arash; Rudd, Amelia; Singh, Satnam; Dawson, Dana K.; Francis, Jane M.; Dwight, Jeremy S.; Watkins, Hugh; Neubauer, Stefan; Frenneaux, Michael

    2015-01-01

    Background— Heart failure with preserved ejection fraction (HFpEF) is associated with significant morbidity and mortality but is currently refractory to therapy. Despite limited evidence, heart rate reduction has been advocated, on the basis of physiological considerations, as a therapeutic strategy in HFpEF. We tested the hypothesis that heart rate reduction improves exercise capacity in HFpEF. Methods and Results— We conducted a randomized, crossover study comparing selective heart rate reduction with the If blocker ivabradine at 7.5 mg twice daily versus placebo for 2 weeks each in 22 symptomatic patients with HFpEF who had objective evidence of exercise limitation (peak oxygen consumption at maximal exercise [o2 peak] <80% predicted for age and sex). The result was compared with 22 similarly treated matched asymptomatic hypertensive volunteers. The primary end point was the change in o2 peak. Secondary outcomes included tissue Doppler–derived E/e′ at echocardiography, plasma brain natriuretic peptide, and quality-of-life scores. Ivabradine significantly reduced peak heart rate compared with placebo in the HFpEF (107 versus 129 bpm; P<0.0001) and hypertensive (127 versus 145 bpm; P=0.003) cohorts. Ivabradine compared with placebo significantly worsened the change in o2 peak in the HFpEF cohort (-2.1 versus 0.9 mL·kg−1·min−1; P=0.003) and significantly reduced submaximal exercise capacity, as determined by the oxygen uptake efficiency slope. No significant effects on the secondary end points were discernable. Conclusion— Our observations bring into question the value of heart rate reduction with ivabradine for improving symptoms in a HFpEF population characterized by exercise limitation. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT02354573. PMID:26338956

  16. Ethnic differences in the association of QRS duration with ejection fraction and outcome in heart failure

    PubMed Central

    Gijsberts, Crystel M; Benson, Lina; Dahlström, Ulf; Sim, David; Yeo, Daniel P S; Ong, Hean Yee; Jaufeerally, Fazlur; Leong, Gerard K T; Ling, Lieng H; Richards, A Mark; de Kleijn, Dominique P V; Lund, Lars H; Lam, Carolyn S P

    2016-01-01

    Background QRS duration (QRSd) criteria for device therapy in heart failure (HF) were derived from predominantly white populations and ethnic differences are poorly understood. Methods We compared the association of QRSd with ejection fraction (EF) and outcomes between 839 Singaporean Asian and 11 221 Swedish white patients with HF having preserved EF (HFPEF)and HF having reduced EF (HFREF) were followed in prospective population-based HF studies. Results Compared with whites, Asian patients with HF were younger (62 vs 74 years, p<0.001), had smaller body size (height 163 vs 171 cm, weight 70 vs 80 kg, both p<0.001) and had more severely impaired EF (EF was <30% in 47% of Asians vs 28% of whites). Overall, unadjusted QRSd was shorter in Asians than whites (101 vs 104 ms, p<0.001). Lower EF was associated with longer QRSd (p<0.001), with a steeper association among Asians than whites (pinteraction<0.001), independent of age, sex and clinical covariates (including body size). Excluding patients with left bundle branch block (LBBB) and adjusting for clinical covariates, QRSd was similar in Asians and whites with HFPEF, but longer in Asians compared with whites with HFREF (p=0.001). Longer QRSd was associated with increased risk of HF hospitalisation or death (absolute 2-year event rate for ≤120 ms was 40% and for >120 ms it was 52%; HR for 10 ms increase of QRSd was 1.04 (1.03 to 1.06), p<0.001), with no interaction by ethnicity. Conclusion We found ethnic differences in the association between EF and QRSd among patients with HF. QRS prolongation was similarly associated with increased risk, but the implications for ethnicity-specific QRSd cut-offs in clinical decision-making require further study. PMID:27402805

  17. Impact of body mass index on diastolic function in patients with normal left ventricular ejection fraction

    PubMed Central

    AlJaroudi, W; Halley, C; Houghtaling, P; Agarwal, S; Menon, V; Rodriguez, L; Grimm, R A; Thomas, J D; Jaber, W A

    2012-01-01

    Background: Obesity is a major public health epidemic and is associated with increased risk of heart failure and mortality. We evaluated the impact of body mass index (BMI) on the prevalence of diastolic dysfunction (DD). Methods: We reviewed clinical records and echocardiogram of patients with baseline echocardiogram between 1996 and 2005 that showed normal left ventricular ejection fraction (LVEF). Diastolic function was labeled as normal, stage 1, stage 2 or stage 3/4 dysfunction. Patients were categorized as normal weight (BMI <25 kg m−2), overweight (25–29.9 kg m−2), obese (30–39.9 kg m−2) and morbidly obese (⩾40 kg m−2). Multivariable ordinal and ordinary logistic regression were performed to identify factors associated with DD, and evaluate the independent relationship of BMI with DD. Results: The cohort included 21 666 patients (mean (s.d.) age, 57.1 (15.1); 55.5% female). There were 7352 (33.9%) overweight, 5995 (27.6%) obese and 1616 (7.4%) morbidly obese patients. Abnormal diastolic function was present in 13 414 (61.9%) patients, with stage 1 being the most common. As BMI increased, the prevalence of normal diastolic function decreased (P<0.0001). Furthermore, there were 1733 patients with age <35 years; 460 (26.5%) and 407 (23.5%) were overweight and obese, respectively, and had higher prevalence of DD (P<0.001). Using multivariable logistic regression, BMI remained significant in both ordinal (all stages of diastolic function) and binary (normal versus abnormal). Also, obesity was associated with increased odds of DD in all patients and those aged <35 years. Conclusions: In patients with normal LVEF, higher BMI was independently associated with worsening DD. PMID:23448803

  18. Prognostic value of right ventricular ejection fraction in pulmonary arterial hypertension.

    PubMed

    Courand, Pierre-Yves; Pina Jomir, Géraldine; Khouatra, Chahéra; Scheiber, Christian; Turquier, Ségolène; Glérant, Jean-Charles; Mastroianni, Bénédicte; Gentil, Béatrice; Blanchet-Legens, Anne-Sophie; Dib, Alfred; Derumeaux, Geneviève; Humbert, Marc; Mornex, Jean-François; Cordier, Jean-François; Cottin, Vincent

    2015-01-01

    Right ventricle ejection fraction (RVEF) evaluated with magnetic resonance imaging is a strong determinant of patient outcomes in pulmonary arterial hypertension. We evaluated the prognostic value of RVEF assessed with conventional planar equilibrium radionuclide angiography at baseline and change 3-6 months after initiating pulmonary arterial hypertension-specific therapy. In a prospective cohort of newly diagnosed patients with idiopathic, heritable or anorexigen-associated pulmonary arterial hypertension, RVEF was measured at baseline (n=100) and 3-6 months after initiation of therapy (n=78). After a median follow-up of 4.1 years, 41 deaths occurred, including 35 from cardiovascular causes. Patients with a (median) baseline RVEF >25% had better survival than those with a RVEF <25% using Kaplan-Meier analysis (p=0.010). RVEF at baseline was an independent predictor of all-cause and cardiovascular mortality in adjusted Cox regression model (p=0.002 and p=0.007, respectively; HR 0.93 for both). Patients with stable or increased RVEF at 3-6 months had a trend for improved all-cause survival (HR 2.43, p=0.086) and had less cardiovascular mortality (HR 3.25, p=0.034) than those in whom RVEF decreased despite therapy. RVEF assessed with conventional planar equilibrium radionuclide angiography at baseline and change in RVEF 3-6 months after therapy initiation independently predict outcomes in patients with pulmonary arterial hypertension. PMID:25537560

  19. Left ventricular ejection fraction response during exercise in asymptomatic systemic hypertension

    SciTech Connect

    Miller, D.D.; Ruddy, T.D.; Zusman, R.M.; Okada, R.D.; Strauss, H.W.; Kanarek, D.J.; Christensen, D.; Federman, E.B.; Boucher, C.A.

    1987-02-15

    To study the effect of mild-to-moderate elevations in diastolic blood pressure (BP) on systolic left ventricular (LV) function, 28 hypertensive patients and 20 normal subjects underwent upright exercise first-pass radionuclide angiography. All were asymptomatic, had normal rest and exercise electrocardiographic findings and no evidence of LV hypertrophy or coronary artery disease. LV function at rest was similar in the 2 groups, but with exercise hypertensive patients had a greater end-systolic volume (69 +/- 19 vs 51 +/- 19 ml, p less than 0.002) and lower ejection fraction (EF) (0.59 +/- 0.09 vs 0.72 +/- 0.07, p less than 0.0001), stroke volume (101 +/- 28 vs 130 +/- 36 ml, p less than 0.005) and peak oxygen uptake (23 +/- 7 vs 33 +/- 9 ml/kl/min, p less than 0.05). Hypertensive patients were separated into 3 groups: group 1-12 patients with an increase in EF with exercise greater than or equal to 0.05; group 2-7 patients with a change in EF with exercise less than 0.05; and group 3-9 patients with a decrease in EF with exercise greater than or equal to 0.05. Group 3 hypertensive patients were older, had a higher heart rate at rest and lower peak oxygen uptake. Rest LV function was similar in the 3 hypertensive subgroups, but exercise end-systolic volumes were higher in groups 2 and 3. Exercise thallium-201 images was normal in all but 1 of 14 hypertensive group 2 or 3 patients.

  20. Anaesthetic management of laparoscopic surgery for rectal cancer in patients of dilated cardiomyopathy with poor ejection fraction: a case report

    PubMed Central

    Wu, Yao-Hua; Hu, Liang; Xia, Jin; Hao, Quan-Shui; Feng, Li; Xiang, Hong-Bing

    2015-01-01

    A patient with dilated cardiomyopathy with poor ejection fraction posted for laparoscopic surgery for rectal cancer which was successfully performed under general anesthesia with endotracheal intubation and mechanical ventilation was reported. Our observations strongly indicate that detailed preoperative assessment, watchful intraoperative monitoring, and skillful optimization of fluid status and hemodynamic play important role in the high risk patient under general anesthesia with endotracheal intubation and mechanical ventilation. PMID:26309623

  1. Blood volume, heart rate, and left ventricular ejection fraction changes in dogs before and after exercise during endurance training

    SciTech Connect

    Mackintosh, I.C.; Dormehl, I.C.; van Gelder, A.L.; du Plessis, M.

    1983-10-01

    In Beagles after 7 weeks' endurance training, resting blood volume increased by an average of 13.1%. Resting heart rates were not significantly affected, but heart rates measured 2 minutes after exercise were significantly lower after the endurance training than before. Left ventricular ejection fractions determined by radionuclide angiography from 2 minutes after exercise showed no significant changes in response to a single exercise period or over the 50 days' training.

  2. Prevalence and Risk Factors of Heart Failure with Preserved Ejection Fraction: A Population-Based Study in Northeast China

    PubMed Central

    Guo, Liang; Guo, Xiaofan; Chang, Ye; Yang, Jun; Zhang, Limin; Li, Tan; Sun, Yingxian

    2016-01-01

    Background: Heart failure with preserved ejection fraction (HFpEF) has attracted increasing attention worldwide. We aimed to estimate the prevalence of HFpEF and analyze its correlates in a sample of residents of northeast China; Methods: A population-based study of 2230 participants ≥35 years old was conducted in rural areas of Liaoning Province from January 2012 through August 2013. Information about lifestyle and other potential risk factors was obtained. HFpEF was diagnosed according to the recommendations of European Society of Cardiology; Results: The overall prevalence of HFpEF was 3.5% (1.8% in men and 4.9% in women). The prevalence of HFpEF increased with age in both genders and was greater in women than in men for every age group. Multivariable logistic regression analysis found that female gender (OR, 3.575; 95% CI, 1.761–7.256), hypertension (OR, 3.711; 95% CI, 2.064–6.674), and history of heart disease (2.086; 95% CI, 1.243–3.498) were associated factors for prevalent HFpEF; Conclusions: In a general population from rural northeast China, we found that female gender, hypertension, and history of heart disease were risk factors for prevalent HFpEF. PMID:27483300

  3. ECG-gated blood pool tomography in the determination of left ventricular volume, ejection fraction, and wall motion

    SciTech Connect

    Underwood, S.R.; Ell, P.J.; Jarritt, P.H.; Emanuel, R.W.; Swanton, R.H.

    1984-01-01

    ECG-gated blood pool tomography promises to provide a ''gold standard'' for noninvasive measurement of left ventricular volume, ejection fraction, and wall motion. This study compares these measurements with those from planar radionuclide imaging and contrast ventriculography. End diastolic and end systolic blood pool images were acquired tomographically using an IGE400A rotating gamma camera and Star computer, and slices were reconstructed orthogonal to the long axis of the heart. Left ventricular volume was determined by summing the areas of the slices, and wall motion was determined by comparison of end diastolic and end systolic contours. In phantom experiments this provided an accurate measurement of volume (r=0.98). In 32 subjects who were either normal or who had coronary artery disease left ventricular volume (r=0.83) and ejection fraction (r=0.89) correlated well with those using a counts based planar technique. In 16 of 18 subjects who underwent right anterior oblique X-ray contrast ventriculography, tomographic wall motion agreed for anterior, apical, and inferior walls, but abnormal septal motion which was not apparent by contrast ventriculography, was seen in 12 subjects tomographically. All 12 had disease of the left anterior descending coronary artery and might have been expected to have abnormal septal motion. ECG-gated blood pool tomography can thus determine left ventricular volume and ejection fraction accurately, and provides a global description of wall motion in a way that is not possible from any single planar image.

  4. Submaximal oxygen uptake kinetics, functional mobility, and physical activity in older adults with heart failure and reduced ejection fraction

    PubMed Central

    Hummel, Scott L; Herald, John; Alpert, Craig; Gretebeck, Kimberlee A; Champoux, Wendy S; Dengel, Donald R; Vaitkevicius, Peter V; Alexander, Neil B

    2016-01-01

    Background Submaximal oxygen uptake measures are more feasible and may better predict clinical cardiac outcomes than maximal tests in older adults with heart failure (HF). We examined relationships between maximal oxygen uptake, submaximal oxygen kinetics, functional mobility, and physical activity in older adults with HF and reduced ejection fraction. Methods Older adults with HF and reduced ejection fraction (n = 25, age 75 ± 7 years) were compared to 25 healthy age- and gender-matched controls. Assessments included a maximal treadmill test for peak oxygen uptake (VO2peak), oxygen uptake kinetics at onset of and on recovery from a submaximal treadmill test, functional mobility testing [Get Up and Go (GUG), Comfortable Gait Speed (CGS), Unipedal Stance (US)], and self-reported physical activity (PA). Results Compared to controls, HF had worse performance on GUG, CGS, and US, greater delays in submaximal oxygen uptake kinetics, and lower PA. In controls, VO2peak was more strongly associated with functional mobility and PA than submaximal oxygen uptake kinetics. In HF patients, submaximal oxygen uptake kinetics were similarly associated with GUG and CGS as VO2peak, but weakly associated with PA. Conclusions Based on their mobility performance, older HF patients with reduced ejection fraction are at risk for adverse functional outcomes. In this population, submaximal oxygen uptake measures may be equivalent to VO2 peak in predicting functional mobility, and in addition to being more feasible, may provide better insight into how aerobic function relates to mobility in older adults with HF. PMID:27594875

  5. Ergospirometry and Echocardiography in Early Stage of Heart Failure with Preserved Ejection Fraction and in Healthy Individuals

    PubMed Central

    Garcia, Eduardo Lima; Menezes, Márcio Garcia; Stefani, Charles de Moraes; Danzmann, Luiz Cláudio; Torres, Marco Antonio Rodrigues

    2015-01-01

    Background Heart failure with preserved ejection fraction is a syndrome characterized by changes in diastolic function; it is more prevalent among the elderly, women, and individuals with systemic hypertension (SH) and diabetes mellitus. However, in its early stages, there are no signs of congestion and it is identified in tests by adverse remodeling, decreased exercise capacity and diastolic dysfunction. Objective To compare doppler, echocardiographic (Echo), and cardiopulmonary exercise test (CPET) variables - ergospirometry variables - between two population samples: one of individuals in the early stage of this syndrome, and the other of healthy individuals. Methods Twenty eight outpatients diagnosed with heart failure according to Framingham’s criteria, ejection fraction > 50% and diastolic dysfunction according to the european society of cardiology (ESC), and 24 healthy individuals underwent Echo and CPET. Results The group of patients showed indexed atrial volume and left ventricular mass as well as E/E’ and ILAV/A´ ratios significantly higher, in addition to a significant reduction in peak oxygen consumption and increased VE/VCO2 slope, even having similar left ventricular sizes in comparison to those of the sample of healthy individuals. Conclusion There are significant differences between the structural and functional variables analyzed by Echo and CPET when comparing two population samples: one of patients in the early stage of heart failure with ejection fraction greater than or equal to 50% and another of healthy individuals. PMID:26247247

  6. ANTIRADICAL AND ANTIMICROBIAL ACTIVITY OF PHENOLIC FRACTIONS OBTAINED FROM HONEYS.

    PubMed

    Mazol, Irena; Sroka, Zbigniew; Sowa, Alina; Ostrowska, Anna; Dryś, Andrzej; Gamian, Andrzej

    2016-01-01

    Honey is a natural product consisting of multiple components which determine its dietary and medicinal properties. In this work there were studied methanol fractions obtained from seven honeys from Lower Silesia (Poland) collected in different seasons of three successive years. Melissopalynologic studies revealed that two of them were polyfloral, and five were classified as monofloral (two buckwheat and three rapes). The amount of phenolic compounds in honeys varied from 0.09 to 0.38 mg per g of honey. Honeys harvested in 2010 were the richest in phenolic compounds and especially rich was buckwheat honey, comparing to 2011- 2012. Determination of antioxidant potential with the DPPH radical revealed that the strongest antiradical activity was exhibited by extracts obtained from polyfloral (1.22 TAU(515/mg)) and buckwheat (1.06 TAU(515lmg)) honeys, while the highest number of antiradical units was observed for rape honey (3.64 TAU(515/g)). Polyphenolic fractions exhibited various bactericidal activities against Klebsiella pneumoniae and Staphylococcus aureus and weak or no activity was observed against Pseudomonas aeruginosa. PMID:27180430

  7. Comparison and co-relation of invasive and noninvasive methods of ejection fraction measurement.

    PubMed Central

    Godkar, Darshan; Bachu, Kalyan; Dave, Bijal; Megna, Robert; Niranjan, Selva; Khanna, Ashok

    2007-01-01

    BACKGROUND: Accurate estimation of left ventricular ejection fraction (LVEF) has assumed great significance in the era of automatic implantable cardioverter defibrillators (AICDs), and a low EF may be one of the sole deciding factor in determining AICD implantation in certain patient populations. AIM: There are various methods, invasive and noninvasive, which can help calculate EF. We sought to conduct a retrospective study comparing EF estimation by invasive (angiography) and noninvasive methods [MUGA (multiple-gated acquisition), echocardiography (echo), single-photon emission computed tomography (SPECT)] in 5,558 patients in our hospital from 1995-2004. METHODS AND RESULTS: EF was estimated by > or = 1 method (angiography, MUGA, echo, SPECT) within a one-month period. Values for the four tests in 5,558 patients were as follows: angiography mean 46.2, range 20-75, standard deviation (SD) 13.1; MUGA mean 45.7, range 20-70, SD 11.6; echo mean 45.7, range 22-70, SD 11.2; and SPECT mean 54.4, range 30-75, SD 11.9. Excellent positive correlations were found among all four tests as follows: angiography and MUGA, correlation coefficient (r) = 0.97, angiography and echo r = 0.96, angiography and SPECT r = 0.94, MUGA and echo r = 0.97, MUGA and SPECT r = 0.94, and echo and SPECT r = 0.94. Values for SPECT were significantly higher than for angiography, echo and MUGA (p < 0.001). The arithmetic difference between angiography and MUGA (mean 0.50, range -5.0-5.0) and the arithmetic difference between angiography and echo (mean 0.52, range -5.0-15.0) were similar (p = 0.59). The arithmetic difference between SPECT and angiography (mean 8.2, range -15.0-20.0) was significantly larger than the arithmetic difference between angiography and echo (p < 0.001). CONCLUSIONS: All the four methods used to estimate EF corelate well with each other. However, values estimated during stress testing by SPECT overestimate EF and are significantly higher as compared to MUGA, echo and

  8. Congestive heart failure with preserved ejection fraction is associated with severely impaired dynamic Starling mechanism

    PubMed Central

    Shibata, Shigeki; Hastings, Jeff L.; Prasad, Anand; Fu, Qi; Bhella, Paul S.; Pacini, Eric; Krainski, Felix; Palmer, M. Dean; Zhang, Rong

    2011-01-01

    Sedentary aging leads to increased cardiovascular stiffening, which can be ameliorated by sufficient amounts of lifelong exercise training. An even more extreme form of cardiovascular stiffening can be seen in heart failure with preserved ejection fraction (HFpEF), which comprises ∼40∼50% of elderly patients diagnosed with congestive heart failure. There are two major interrelated hypotheses proposed to explain heart failure in these patients: 1) increased left ventricular (LV) diastolic stiffness and 2) increased arterial stiffening. The beat-to-beat dynamic Starling mechanism, which is impaired with healthy human aging, reflects the interaction between ventricular and arterial stiffness and thus may provide a link between these two mechanisms underlying HFpEF. Spectral transfer function analysis was applied between beat-to-beat changes in LV end-diastolic pressure (LVEDP; estimated from pulmonary artery diastolic pressure with a right heart catheter) and stroke volume (SV) index. The dynamic Starling mechanism (transfer function gain between LVEDP and the SV index) was impaired in HFpEF patients (n = 10) compared with healthy age-matched controls (n = 12) (HFpEF: 0.23 ± 0.10 ml·m−2·mmHg−1 and control: 0.37 ± 0.11 ml·m−2·mmHg−1, means ± SD, P = 0.008). There was also a markedly increased (3-fold) fluctuation of LV filling pressures (power spectral density of LVEDP) in HFpEF patients, which may predispose to pulmonary edema due to intermittent exposure to higher pulmonary capillary pressure (HFpEF: 12.2 ± 10.4 mmHg2 and control: 3.8 ± 2.9 mmHg2, P = 0.014). An impaired dynamic Starling mechanism, even more extreme than that observed with healthy aging, is associated with marked breath-by-breath LVEDP variability and may reflect advanced ventricular and arterial stiffness in HFpEF, possibly contributing to reduced forward output and pulmonary congestion. PMID:21310890

  9. Assessment of left ventricular ejection fraction using an ultrasonic stethoscope in critically ill patients

    PubMed Central

    2012-01-01

    Introduction Assessment of cardiac function is key in the management of intensive care unit (ICU) patients and frequently relies on the use of standard transthoracic echocardiography (TTE). A commercially available new generation ultrasound system with two-dimensional imaging capability, which has roughly the size of a mobile phone, is adequately suited to extend the physical examination. The primary endpoint of this study was to evaluate the additional value of this new miniaturized device used as an ultrasonic stethoscope (US) for the determination of left ventricular (LV) systolic function, when compared to conventional clinical assessment by experienced intensivists. The secondary endpoint was to validate the US against TTE for the semi-quantitative assessment of left ventricular ejection fraction (LVEF) in ICU patients. Methods In this single-center prospective descriptive study, LVEF was independently assessed clinically by the attending physician and echocardiographically by two experienced intensivists trained in critical care echocardiography who used the US (size: 135 × 73 × 28 mm; weight: 390 g) and TTE. LVEF was visually estimated semi-quantitatively and classified in one of the following categories: increased (LVEF > 75%), normal (LVEF: 50 to 75%), moderately reduced (LVEF: 30 to 49%), or severely reduced (LVEF < 30%). Biplane LVEF measured using the Simpson's rule on TTE loops by an independent investigator was used as reference. Results A total of 94 consecutive patients were studied (age: 60 ± 17 years; simplified acute physiologic score 2: 41 ± 15), 63 being mechanically ventilated and 36 receiving vasopressors and/or inotropes. Diagnostic concordance between the clinically estimated LVEF and biplane LVEF was poor (Kappa: 0.33; 95% CI: 0.16 to 0.49) and only slightly improved by the knowledge of a previously determined LVEF value (Kappa: 0.44; 95% CI: 0.22 to 0.66). In contrast, the diagnostic agreement was good between visually assessed LVEF

  10. Effect of Nebivolol on MIBG Parameters and Exercise in Heart Failure with Normal Ejection Fraction

    PubMed Central

    Messias, Leandro Rocha; Ferreira, Aryanne Guimarães; de Miranda, Sandra Marina Ribeiro; Teixeira, José Antônio Caldas; de Azevedo, Jader Cunha; Messias, Ana Carolina Nader Vasconcelos; Maróstica, Elisabeth; Mesquita, Claudio Tinoco

    2016-01-01

    Background More than 50% of the patients with heart failure have normal ejection fraction (HFNEF). Iodine-123 metaiodobenzylguanidine (123I-MIBG) scintigraphy and cardiopulmonary exercise test (CPET) are prognostic markers in HFNEF. Nebivolol is a beta-blocker with vasodilating properties. Objectives To evaluate the impact of nebivolol therapy on CPET and123I-MIBG scintigraphic parameters in patients with HFNEF. Methods Twenty-five patients underwent 123I-MIBG scintigraphy to determine the washout rate and early and late heart-to-mediastinum ratios. During the CPET, we analyzed the systolic blood pressure (SBP) response, heart rate (HR) during effort and recovery (HRR), and oxygen uptake (VO2). After the initial evaluation, we divided our cohort into control and intervention groups. We then started nebivolol and repeated the tests after 3 months. Results After treatment, the intervention group showed improvement in rest SBP (149 mmHg [143.5-171 mmHg] versus 135 mmHg [125-151 mmHg, p = 0.016]), rest HR (78 bpm [65.5-84 bpm] versus 64.5 bpm [57.5-75.5 bpm, p = 0.028]), peak SBP (235 mmHg [216.5-249 mmHg] versus 198 mmHg [191-220.5 mmHg], p = 0.001), peak HR (124.5 bpm [115-142 bpm] versus 115 bpm [103.7-124 bpm], p= 0.043), HRR on the 1st minute (6.5 bpm [4.75-12.75 bpm] versus 14.5 bpm [6.7-22 bpm], p = 0.025) and HRR on the 2nd minute (15.5 bpm [13-21.75 bpm] versus 23.5 bpm [16-31.7 bpm], p = 0.005), but no change in peak VO2 and 123I-MIBG scintigraphic parameters. Conclusion Despite a better control in SBP, HR during rest and exercise, and improvement in HRR, nebivolol failed to show a positive effect on peak VO2 and 123I-MIBG scintigraphic parameters. The lack of effect on adrenergic activity may be the cause of the lack of effect on functional capacity. PMID:27096522

  11. Assessing Strategies for Heart Failure with Preserved Ejection Fraction at the Outpatient Clinic

    PubMed Central

    Jorge, Antonio José Lagoeiro; Rosa, Maria Luiza Garcia; Ribeiro, Mario Luiz; Fernandes, Luiz Claudio Maluhy; Freire, Monica Di Calafiori; Correia, Dayse Silva; Teixeira, Patrick Duarte; Mesquita, Evandro Tinoco

    2014-01-01

    Background: Heart failure with preserved ejection fraction (HFPEF) is the most common form of heart failure (HF), its diagnosis being a challenge to the outpatient clinic practice. Objective: To describe and compare two strategies derived from algorithms of the European Society of Cardiology Diastology Guidelines for the diagnosis of HFPEF. Methods: Cross-sectional study with 166 consecutive ambulatory patients (67.9±11.7 years; 72% of women). The strategies to confirm HFPEF were established according to the European Society of Cardiology Diastology Guidelines criteria. In strategy 1 (S1), tissue Doppler echocardiography (TDE) and electrocardiography (ECG) were used; in strategy 2 (S2), B-type natriuretic peptide (BNP) measurement was included. Results: In S1, patients were divided into groups based on the E/E'ratio as follows: GI, E/E'> 15 (n = 16; 9%); GII, E/E'8 to 15 (n = 79; 48%); and GIII, E/E'< 8 (n = 71; 43%). HFPEF was confirmed in GI and excluded in GIII. In GII, TDE [left atrial volume index (LAVI) ≥ 40 mL/m2; left ventricular mass index LVMI) > 122 for women and > 149 g/m2 for men] and ECG (atrial fibrillation) parameters were assessed, confirming HFPEF in 33 more patients, adding up to 49 (29%). In S2, patients were divided into three groups based on BNP levels. GI (BNP > 200 pg/mL) consisted of 12 patients, HFPEF being confirmed in all of them. GII (BNP ranging from 100 to 200 pg/mL) consisted of 20 patients with LAVI > 29 mL/m2, or LVMI ≥ 96 g/m2 for women or ≥ 116 g/m2 for men, or E/E'≥ 8 or atrial fibrillation on ECG, and the diagnosis of HFPEF was confirmed in 15. GIII (BNP < 100 pg/mL) consisted of 134 patients, 26 of whom had the diagnosis of HFPEF confirmed when GII parameters were used. Measuring BNP levels in S2 identified 4 more patients (8%) with HFPEF as compared with those identified in S1. Conclusion: The association of BNP measurement and TDE data is better than the isolated use of those parameters. BNP can be useful in

  12. The Fraction of Interplanetary Coronal Mass Ejections That Are Magnetic Clouds: Evidence for a Solar Cycle Variation

    NASA Technical Reports Server (NTRS)

    Richardson, I. G.; Cane, H. V.

    2004-01-01

    "Magnetic clouds" (MCs) are a subset of interplanetary coronal mass ejections (ICMEs) characterized by enhanced magnetic fields with an organized rotation in direction, and low plasma beta. Though intensely studied, MCs only constitute a fraction of all the ICMEs that are detected in the solar wind. A comprehensive survey of ICMEs in the near- Earth solar wind during the ascending, maximum and early declining phases of solar cycle 23 in 1996 - 2003 shows that the MC fraction varies with the phase of the solar cycle, from approximately 100% (though with low statistics) at solar minimum to approximately 15% at solar maximum. A similar trend is evident in near-Earth observations during solar cycles 20 - 21, while Helios 1/2 spacecraft observations at 0.3 - 1.0 AU show a weaker trend and larger MC fraction.

  13. [Estimation of left ventricular volumes and ejection fraction with acoustic quantification in myocardial infarction. Comparison with echocardiographic, angiographic and scintigraphic data].

    PubMed

    Jennesseaux, C; Metz, D; Maillier, B; Nazeyrollas, P; Maes, D; Tassan, S; Chabert, J P; Elaerts, J

    1996-07-01

    The object of this study was to assess the reliability of measurements of left ventricular volumes and ejection fraction by acoustic quantification by the method of summation of discs in acute myocardial infarction. Thirty-two patients with an average age of 55.9 +/- 12 years were studied prospectively on average 6 +/- 2 days after the onset of myocardial infarction. Within 48 hours, the patients underwent TM echocardiography (Teichholz's method) two-dimensional echocardiography (Simpson's method on freeze frames and acoustic quantification) before left ventricular angiography and isotopic ventriculography, considered as the reference methods for comparing left ventricular volumes and ejection fractions. The data displayed in real time by acoustic quantification correlated well with the results of left ventricular angiography (r = 0.77; p = 0.0001) and moderately underestimated (+4.1 +/- 11.9%) the ejection fraction, but were relatively disappointing for estimating volumes. When compared with isotopic ejection fraction, the correlation coefficient was r = 0.71 (p = 0.0004) and the values were overestimated. In this study, acoustic quantification was the most reliable echocardiographic method of assessing the left ventricular ejection fraction with reference to contrast angiography (Teichholz: r = 0.56; p = 0.0014; Simpson: r = 0.76; p = 0.001). The authors conclude that assessing the left ventricular ejection fraction with acoustic quantification is reliable in acute myocardial infarction. However, the method is not very accurate in measuring end systolic and end diastolic volumes. PMID:8869245

  14. Current Treatment of Heart Failure with Preserved Ejection Fraction: Should We Add Life to the Remaining Years or Add Years to the Remaining Life?

    PubMed Central

    Li, Jia; Blankenberg, Stefan; Westermann, Dirk

    2013-01-01

    According to the ejection fraction, patients with heart failure may be divided into two different groups: heart failure with preserved or reduced ejection fraction. In recent years, accumulating studies showed that increased mortality and morbidity rates of these two groups are nearly equal. More importantly, despite decline in mortality after treatment in regard to current guideline in patients with heart failure with reduced ejection fraction, there are still no trials resulting in improved outcome in patients with heart failure with preserved ejection fraction so far. Thus, novel pathophysiological mechanisms are under development, and other new viewpoints, such as multiple comorbidities resulting in increased non-cardiac deaths in patients with heart failure and preserved ejection fraction, were presented recently. In this review, we will focus on the tested as well as the promising therapeutic options that are currently studied in patients with heart failure with preserved ejection fraction, along with a brief discussion of pathophysiological mechanisms and diagnostic options that are helpful to increase our understanding of novel therapeutic strategies. PMID:24251065

  15. Spectral transfer function analysis of respiratory hemodynamic fluctuations predicts end-diastolic stiffness in preserved ejection fraction heart failure.

    PubMed

    Abdellatif, Mahmoud; Leite, Sara; Alaa, Mohamed; Oliveira-Pinto, José; Tavares-Silva, Marta; Fontoura, Dulce; Falcão-Pires, Inês; Leite-Moreira, Adelino F; Lourenço, André P

    2016-01-01

    Preserved ejection fraction heart failure (HFpEF) diagnosis remains controversial, and invasive left ventricular (LV) hemodynamic evaluation and/or exercise testing is advocated by many. The stiffer HFpEF myocardium may show impaired stroke volume (SV) variation induced by fluctuating LV filling pressure during ventilation. Our aim was to investigate spectral transfer function (STF) gain from end-diastolic pressure (EDP) to indexed SV (SVi) in experimental HFpEF. Eighteen-week-old Wistar-Kyoto (WKY) and ZSF1 lean (ZSF1 Ln) and obese rats (ZSF1 Ob) randomly underwent LV open-chest (OC, n = 8 each group) or closed-chest hemodynamic evaluation (CC, n = 6 each group) under halogenate anesthesia and positive-pressure ventilation at constant inspiratory pressure. Beat-to-beat fluctuations in hemodynamic parameters during ventilation were assessed by STF. End-diastolic stiffness (βi) and end-systolic elastance (Eesi) for indexed volumes were obtained by inferior vena cava occlusion in OC (multibeat) or single-beat method estimates in CC. ZSF1 Ob showed higher EDP spectrum (P < 0.001), higher STF gain between end-diastolic volume and EDP, and impaired STF gain between EDP and SVi compared with both hypertensive ZSF1 Ln and normotensive WKY controls (P < 0.001). Likewise βi was only higher in ZSF1 Ob while Eesi was raised in both ZSF1 groups. On multivariate analysis βi and not Eesi correlated with impaired STF gain from EDP to SVi (P < 0.001), and receiver-operating characteristics analysis showed an area under curve of 0.89 for higher βi prediction (P < 0.001). Results support further clinical testing of STF analysis from right heart catheterization-derived EDP surrogates to noninvasively determined SV as screening/diagnostic tool to assess myocardial stiffness in HFpEF. PMID:26475584

  16. Relationship of number of phases per cardiac cycle and accuracy of measurement of left ventricular volumes, ejection fraction, and mass.

    PubMed

    Roussakis, Arkadios; Baras, Panagiotis; Seimenis, Ioannis; Andreou, John; Danias, Peter G

    2004-01-01

    In cine cardiac magnetic resonance imaging (MRI) studies, for any preset imaging parameters the number of phases per cardiac cycle for a single slice is proportional to breath-hold duration. We investigated the relationship between the accuracy of measurement of left ventricular (LV) end-diastolic and end-systolic volumes (EDV and ESV, respectively), mass and ejection fraction (EF), and the number of phases acquired per cardiac cycle. Twelve adult volunteers underwent cardiac MRI and five complete LV functional studies were obtained with 8, 11, 14, 17, and 20 phases per cardiac cycle. We calculated LV volumes, EF, and mass for each acquisition, and compared them using the 20-phase acquisition as the reference standard. The scan duration was proportional to the number of phases acquired. There was a systematic underestimation of LV, EDV, and EF, with decreasing number of phases. Differences from the reference standard became significant for the 8-phase acquisition (p<0.05). Subgroup analysis showed that only those with slower heart rates (<65/min) had significant differences in EDV, but not in EF, for the 8-phase acquisition. For those with faster heart rates, no differences were detected between the different acquisitions. There were no significant differences between all acquisitions for the LV ESV and mass. We conclude that at least 11 phases per cardiac cycle are needed to maintain accuracy for cine cardiac MRI studies. Decreasing the number of phases per cardiac cycle beyond this cutoff may introduce significant error of measurement, particularly for the left ventricular EDV and EF and especially for those with bradycardia, and should be avoided. PMID:15646887

  17. Coronary Artery Bypass Grafting in Patients with Advanced Left Ventricular Dysfunction: Excellent Early Outcome with Improved Ejection Fraction

    PubMed Central

    Salehi, Mehrdad; Bakhshandeh, Alireza; Rahmanian, Mehrzad; Saberi, Kianoosh; Kahrom, Mahdi; Sobhanian, Keivan

    2016-01-01

    Background: The prevalence of patients with severe left ventricular dysfunction (LVD) referred for coronary artery bypass grafting (CABG) is increasing. Preoperative LVD is an established risk factor for early and late mortality after revascularization. The aim of the present study was to assess the early outcome of patients with severe LVD undergoing CABG. Methods: Between December 2012 and November 2014, 145 consecutive patients with severely impaired LV function (ejection fraction ≤ 30%) undergoing either on-pump or off-pump CABG were enrolled. The primary end point was all-cause mortality. Different variables (preoperative, intraoperative, and postoperative) were evaluated and compared. Results: The mean age of the patients was 58.7 years (range, 34 to 87 years), and 82.8% of the patients were male. The mean preoperative LV ejection fraction was 25.33 ± 5.07% (10 to 30%), which improved to 26.67 ± 5.38% (10 to 40%) (p value < 0.001). An average of 3.85 coronary bypass grafts per patient was performed. Significant improvement in mitral regurgitation was also observed after CABG (p value < 0.001). Moreover, 120 patients underwent conventional CABG (82.8%) and 25 patients had off-pump CABG (17.2%). In-hospital mortality was 2.1% (3 patients). Patients who underwent off-pump CABG had higher operative mortality than did those undergoing conventional CABG despite a lower severity of coronary involvement and a significantly lower number of grafts (p value < 0.050). Conversely, morbidity was significantly higher in conventional CABG (p value < 0.050). Conclusion: CABG in patients with severe LVD can be performed with low mortality. CABG can be considered a safe and effective therapy for patients with a low ejection fraction who have ischemic heart disease and predominance of tissue viability.

  18. Benefits of β blockers in patients with heart failure and reduced ejection fraction: network meta-analysis

    PubMed Central

    Biondi-Zoccai, Giuseppe; Abbate, Antonio; D’Ascenzo, Fabrizio; Castagno, Davide; Van Tassell, Benjamin; Mukherjee, Debabrata; Lichstein, Edgar

    2013-01-01

    Objective To clarify whether any particular β blocker is superior in patients with heart failure and reduced ejection fraction or whether the benefits of these agents are mainly due to a class effect. Design Systematic review and network meta-analysis of efficacy of different β blockers in heart failure. Data sources CINAHL(1982-2011), Cochrane Collaboration Central Register of Controlled Trials (-2011), Embase (1980-2011), Medline/PubMed (1966-2011), and Web of Science (1965-2011). Study selection Randomized trials comparing β blockers with other β blockers or other treatments. Data extraction The primary endpoint was all cause death at the longest available follow-up, assessed with odds ratios and Bayesian random effect 95% credible intervals, with independent extraction by observers. Results 21 trials were included, focusing on atenolol, bisoprolol, bucindolol, carvedilol, metoprolol, and nebivolol. As expected, in the overall analysis, β blockers provided credible mortality benefits in comparison with placebo or standard treatment after a median of 12 months (odds ratio 0.69, 0.56 to 0.80). However, no obvious differences were found when comparing the different β blockers head to head for the risk of death, sudden cardiac death, death due to pump failure, or drug discontinuation. Accordingly, improvements in left ventricular ejection fraction were also similar irrespective of the individual study drug. Conclusion The benefits of β blockers in patients with heart failure with reduced ejection fraction seem to be mainly due to a class effect, as no statistical evidence from current trials supports the superiority of any single agent over the others. PMID:23325883

  19. End-systolic Pressure–Volume Relation, Ejection Fraction, and Heart Failure: Theoretical Aspect and Clinical Applications

    PubMed Central

    Shoucri, Rachad M

    2015-01-01

    A mathematical formalism describing the nonlinear end-systolic pressure–volume relation (ESPVR) is used to derive new indexes that can be used to assess the performance of the heart left ventricle by using the areas under the ESPVR (units of energy), the ordinates of the ESPVR (units of pressure), or from slopes of the curvilinear ESPVR. New relations between the ejection fraction (EF) and the parameters describing the ESPVR give some insight into the problem of heart failure (HF) with normal or preserved ejection fraction. Relations between percentage occurrence of HF and indexes derived from the ESPVR are also discussed. When ratios of pressures are used, calculation can be done in a noninvasive way with the possibility of interesting applications in routine clinical work. Applications to five groups of clinical data are given and discussed (normal group, aortic stenosis, aortic valvular regurgitation, mitral valvular regurgitation, miscellaneous cardiomyopathies). No one index allows a perfect segregation between all clinical groups, it is shown that appropriate use of two indexes (bivariate analysis) can lead to better separation of different clinical groups. PMID:26244035

  20. The clinical dilemma of heart failure with preserved ejection fraction: an update on pathophysiology and management for physicians.

    PubMed

    Irizarry Pagán, Emily E; Vargas, Pedro E; López-Candales, Angel

    2016-06-01

    The prevalence of heart failure with preserved ejection fraction (HFpEF) continues to grow at alarming rates and is predicted to become the most prevalent phenotype of heart failure over the next decade. Recent data show a higher non-cardiac comorbidity burden associated with HFpEF, and similar overall hospitalisation rates when compared with patients with heart failure with reduced ejection fraction (HFrEF). Unfortunately, clinicians mainly focus their efforts in diagnosis of HFrEF despite HFpEF accounting for 50% of the cases of heart failure. Therefore, this review is intended to create awareness on the pathophysiology, risk factors, diagnosis and management of patients with HFpEF and its core mechanical abnormality left ventricular diastolic dysfunction. Clinical distinction between HFpEF and HFrEF should be of particular interest to internal medicine physicians and general practitioners as this distinction is seldom made and early diagnosis can lag if appropriate risk factors are not promptly recognised. PMID:26964562

  1. Diagnostic and prognostic value of circulating microRNAs in heart failure with preserved and reduced ejection fraction

    PubMed Central

    Schulte, Christian; Westermann, Dirk; Blankenberg, Stefan; Zeller, Tanja

    2015-01-01

    microRNAs (miRNAs) are powerful regulators of posttranscriptional gene expression and play an important role in pathophysiological processes. Circulating miRNAs can be quantified in body liquids and are promising biomarkers in numerous diseases. In cardiovascular disease miRNAs have been proven to be reliable diagnostic biomarkers for different disease entities. In cardiac fibrosis (CF) and heart failure (HF) dysregulated circulating miRNAs have been identified, indicating their promising applicability as diagnostic biomarkers. Some miRNAs were successfully tested in risk stratification of HF implementing their potential use as prognostic biomarkers. In this respect miRNAs might soon be implemented in diagnostic clinical routine. In the young field of miRNA based research advances have been made in identifying miRNAs as potential targets for the treatment of experimental CF and HF. Promising study results suggest their potential future application as therapeutic agents in treatment of cardiovascular disease. This article summarizes the current state of the various aspects of miRNA research in the field of CF and HF with reduced ejection fraction as well as preserved ejection fraction. The review provides an overview of the application of circulating miRNAs as biomarkers in CF and HF and current approaches to therapeutically utilize miRNAs in this field of cardiovascular disease. PMID:26730290

  2. Uncovering heart failure with preserved ejection fraction in patients with type 2 diabetes in primary care: time for a change.

    PubMed

    Boonman-de Winter, L J M; Cramer, M J; Hoes, A W; Rutten, F H

    2016-04-01

    Undetected heart failure appears to be an important health problem in patients with type 2 diabetes and aged ≥ 60 years. The prevalence of previously unknown heart failure in these patients is high, steeply rises with age, and is overall higher in women than in men. The majority of the patients with newly detected heart failure have a preserved ejection fraction. A diagnostic algorithm to detect or exclude heart failure in these patients with variables from the medical files combined with items from history taking and physical examination provides a good to excellent accuracy. Annual screening appears to be cost-effective. Both unrecognised heart failure with reduced and with preserved ejection fraction were associated with a clinically relevant lower health status in patients with type 2 diabetes. Also the prognosis of these patients was worse than of those without heart failure. Existing disease-management programs for type 2 diabetes pay insufficient attention to early detection of cardiovascular diseases, including heart failure. We conclude that more attention is needed for detection of heart failure in older patients with type 2 diabetes. PMID:26905581

  3. The acute effects of low flow oxygen and isosorbide dinitrate on left and right ventricular ejection fractions in chronic obstructive pulmonary disease

    SciTech Connect

    Morrison, D.; Caldwell, J.; Lakshminaryan, S.; Ritchie, J.L.; Kennedy, J.W.

    1983-10-01

    The objectives of this study were to determine the effects of low flow oxygen and isosorbide dinitrate on rest and exercise biventricular ejection fractions in patients with chronic obstructive pulmonary disease and to relate these ejection fraction responses to changes in pressure and flow. Nine patients with stable, moderate to severe chronic obstructive pulmonary disease who had no prior history of heart failure performed supine exercise with simultaneous hemodynamic and radionuclide ventriculographic monitoring. Eight patients performed a second exercise during low flow oxygen breathing and five performed a third exercise after ingesting 10 mg oral isosorbide. Oxygen led to a decrease in exercise pulmonary artery pressure in all subjects and a decline in total pulmonary resistance in five of the seven in whom it was measured. Right ventricular ejection fraction increased 0.05 or more only in subjects who had a decrease in total pulmonary resistance. Isosorbide led to an increase in rest and exercise right and left ventricular ejection fractions with simultaneous decreases in pulmonary artery pressure, total pulmonary resistance, blood pressure and arterial oxygen tension. These results suggest that in patients with chronic obstructive pulmonary disease but without a history of right heart failure, the right ventricular systolic functional response to low flow oxygen and isosorbide at rest and exercise is, in part, determined by changes in total pulmonary resistance. The chronic relation between right ventricular ejection fraction and pulmonary hemodynamics in patients with chronic obstructive pulmonary disease remains to be evaluated.

  4. Risk Related to Pre–Diabetes Mellitus and Diabetes Mellitus in Heart Failure With Reduced Ejection Fraction

    PubMed Central

    Kristensen, Søren L.; Preiss, David; Jhund, Pardeep S.; Squire, Iain; Cardoso, José Silva; Merkely, Bela; Martinez, Felipe; Starling, Randall C.; Desai, Akshay S.; Lefkowitz, Martin P.; Rizkala, Adel R.; Rouleau, Jean L.; Shi, Victor C.; Solomon, Scott D.; Swedberg, Karl; Zile, Michael R.; Packer, Milton

    2016-01-01

    Background— The prevalence of pre–diabetes mellitus and its consequences in patients with heart failure and reduced ejection fraction are not known. We investigated these in the Prospective Comparison of ARNI With ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure (PARADIGM-HF) trial. Methods and Results— We examined clinical outcomes in 8399 patients with heart failure and reduced ejection fraction according to history of diabetes mellitus and glycemic status (baseline hemoglobin A1c [HbA1c]: <6.0% [<42 mmol/mol], 6.0%–6.4% [42–47 mmol/mol; pre–diabetes mellitus], and ≥6.5% [≥48 mmol/mol; diabetes mellitus]), in Cox regression models adjusted for known predictors of poor outcome. Patients with a history of diabetes mellitus (n=2907 [35%]) had a higher risk of the primary composite outcome of heart failure hospitalization or cardiovascular mortality compared with those without a history of diabetes mellitus: adjusted hazard ratio, 1.38; 95% confidence interval, 1.25 to 1.52; P<0.001. HbA1c measurement showed that an additional 1106 (13% of total) patients had undiagnosed diabetes mellitus and 2103 (25%) had pre–diabetes mellitus. The hazard ratio for patients with undiagnosed diabetes mellitus (HbA1c, >6.5%) and known diabetes mellitus compared with those with HbA1c<6.0% was 1.39 (1.17–1.64); P<0.001 and 1.64 (1.43–1.87); P<0.001, respectively. Patients with pre–diabetes mellitus were also at higher risk (hazard ratio, 1.27 [1.10–1.47]; P<0.001) compared with those with HbA1c<6.0%. The benefit of LCZ696 (sacubitril/valsartan) compared with enalapril was consistent across the range of HbA1c in the trial. Conclusions— In patients with heart failure and reduced ejection fraction, dysglycemia is common and pre–diabetes mellitus is associated with a higher risk of adverse cardiovascular outcomes (compared with patients with no diabetes mellitus and HbA1c <6.0%). LCZ696 was beneficial compared with enalapril

  5. Increased left ventricular ejection fraction after a meal: potential source of error in performance of radionuclide angiography

    SciTech Connect

    Brown, J.M.; White, C.J.; Sobol, S.M.; Lull, R.J.

    1983-06-01

    The effect of a standardized meal on left ventricular (LV) ejection fraction (EF) was determined by equilibrium radionuclide angiography in 16 patients with stable congestive heart failure but without pulmonary or valvular heart disease. LVEF was determined in the fasting state and 15, 30, and 45 minutes after a meal. Patients with moderately depressed fasting LVEF (30 to 50%), Group I, had a mean increase of 6.9 +/- 2.9% (p less than 0.005) in the LVEF at 45 minutes after the meal. Patients with severely depressed fasting LVEF (less than 30%), Group II, had no change after the meal. It is concluded that significant increases in LVEF may occur after meals in patients with moderate but not severe left ventricular dysfunction. Equilibrium radionuclide angiography studies that are not standardized for patients' mealtimes may introduce an important unmeasured variable that will affect the validity of data in serial studies of left ventricular function.

  6. Determination of left ventricular volume, ejection fraction, and myocardial mass by real-time three-dimensional echocardiography

    NASA Technical Reports Server (NTRS)

    Qin, J. X.; Shiota, T.; Thomas, J. D.

    2000-01-01

    Reconstructed three-dimensional (3-D) echocardiography is an accurate and reproducible method of assessing left ventricular (LV) functions. However, it has limitations for clinical study due to the requirement of complex computer and echocardiographic analysis systems, electrocardiographic/respiratory gating, and prolonged imaging times. Real-time 3-D echocardiography has a major advantage of conveniently visualizing the entire cardiac anatomy in three dimensions and of potentially accurately quantifying LV volumes, ejection fractions, and myocardial mass in patients even in the presence of an LV aneurysm. Although the image quality of the current real-time 3-D echocardiographic methods is not optimal, its widespread clinical application is possible because of the convenient and fast image acquisition. We review real-time 3-D echocardiographic image acquisition and quantitative analysis for the evaluation of LV function and LV mass.

  7. Heart failure with preserved ejection fraction: an insight into its prevalence, predictors, and implications of early detection.

    PubMed

    Ul Haq, Muhammad Asrar; Wong, Chiew; Hare, David L

    2015-01-01

    Heart failure with preserved ejection fraction (HFPEF) is common, and at least half of patients presenting with signs and symptoms of heart failure are found to have preserved left ventricular systolic function. They have high mortality and morbidity and exert a substantial impact on health care costs worldwide. A range of conditions has been shown to predispose individuals to development of diastolic dysfunction and HFPEF. Chronic hypertension is the most common cause; it has been suggested that up to 60% of patients with HFPEF are hypertensive. Coronary artery disease, obesity, and diabetes are some of the other common contributory factors. Early detection of asymptomatic patients identified as at risk of developing this syndrome has the potential to reduce the risk of subsequent heart failure; this may be of benefit to focus our attention on prevention and intervention strategies in this population. PMID:25813793

  8. Comparison of transesophageal echocardiographic and scintigraphic estimates of left ventricular end-diastolic volume index and ejection fraction in patients following coronary artery bypass grafting

    SciTech Connect

    Urbanowicz, J.H.; Shaaban, M.J.; Cohen, N.H.; Cahalan, M.K.; Botvinick, E.H.; Chatterjee, K.; Schiller, N.B.; Dae, M.W.; Matthay, M.A. )

    1990-04-01

    Transesophageal echocardiography (TEE) has become a commonly used monitor of left ventricular (LV) function and filling during cardiac surgery. Its use is based on the assumption that changes in LV short-axis ID reflect changes in LV volume. To study the ability of TEE to estimate LV volume and ejection immediately following CABG, 10 patients were studied using blood pool scintigraphy, TEE, and thermodilution cardiac output (CO). A single TEE short-axis cross-sectional image of the LV at the midpapillary muscle level was used for area analysis. Between 1 and 5 h postoperatively, simultaneous data sets (scintigraphy, TEE, and CO) were obtained three to five times in each patient. End-diastolic (EDa) and end-systolic (ESa) areas were measured by light pen. Ejection fraction area (EFa) was calculated (EFa = (EDa - ESa)/EDa). When EFa was compared with EF by scintigraphy, correlation was good (r = 0.82 SEE = 0.07). EDa was taken as an indicator of LV volume and compared with LVEDVI which was derived from EF by scintigraphy and CO. Correlation between EDa and LVEDVI was fair (r = 0.74 SEE = 3.75). The authors conclude that immediately following CABG, a single cross-sectional TEE image provides a reasonable estimate of EF but not LVEDVI.

  9. Mineralocorticoid Receptor Antagonist Use in Hospitalized Patients with Heart Failure, Reduced Ejection Fraction, and Diabetes Mellitus (from the EVEREST Trial)

    PubMed Central

    Vaduganathan, Muthiah; Cas, Alessandra Dei; Mentz, Robert J.; Greene, Stephen J.; Khan, Sadiya; Subacius, Haris P.; Chioncel, Ovidiu; Maggioni, Aldo P.; Konstam, Marvin A.; Senni, Michele; Fonarow, Gregg C.; Butler, Javed; Gheorghiade, Mihai

    2014-01-01

    Despite the well-established benefits of mineralocorticoid receptor agonists (MRAs) in heart failure with reduced ejection fraction, safety concerns remain in patients with concomitant diabetes mellitus (DM) because of common renal and electrolyte abnormalities in this population. We analyzed all-cause mortality and composite cardiovascular mortality and HF hospitalization over a median 9.9 months among 1,998 patients in the placebo arm of the Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study With Tolvaptan (EVEREST) trial by DM status and discharge MRA use. Of the 750 patients with DM, 59.2% were receiving MRAs compared with 62.5% in the non-DM patients. DM patients not receiving MRAs were older, more likely to be men, with an ischemic heart failure etiology and slightly worse renal function compared with those receiving MRAs. After adjustment for baseline risk factors, among DM patients, MRA use was not associated with either mortality (hazard ratio [HR] 0.93; 95% confidence interval [CI] 0.75 to 1.15) or the composite end point (HR 0.94; 95% CI 0.80 to 1.10). Similar findings were seen in non-DM patients (mortality [HR 1.01; 95% CI 0.84 to 1.22] or the composite end point [HR 0.98; 95% CI 0.85 to 1.13] [p >0.43 for DM interaction]). In conclusion, in-hospital initiation of MRA therapy was low (15% to 20%), and overall discharge MRA use was only 60% (with regional variation), regardless of DM status. There does not appear to be clear, clinically significant in-hospital hemodynamic or even renal differences between those on and off MRA. Discharge MRA use was not associated with postdischarge end points in patients hospitalized for worsening heart failure with reduced ejection fraction and co-morbid DM. DM does not appear to influence the effectiveness of MRA therapy. PMID:25060414

  10. New strategies for heart failure with preserved ejection fraction: the importance of targeted therapies for heart failure phenotypes.

    PubMed

    Senni, Michele; Paulus, Walter J; Gavazzi, Antonello; Fraser, Alan G; Díez, Javier; Solomon, Scott D; Smiseth, Otto A; Guazzi, Marco; Lam, Carolyn S P; Maggioni, Aldo P; Tschöpe, Carsten; Metra, Marco; Hummel, Scott L; Edelmann, Frank; Ambrosio, Giuseppe; Stewart Coats, Andrew J; Filippatos, Gerasimos S; Gheorghiade, Mihai; Anker, Stefan D; Levy, Daniel; Pfeffer, Marc A; Stough, Wendy Gattis; Pieske, Burkert M

    2014-10-21

    The management of heart failure with reduced ejection fraction (HF-REF) has improved significantly over the last two decades. In contrast, little or no progress has been made in identifying evidence-based, effective treatments for heart failure with preserved ejection fraction (HF-PEF). Despite the high prevalence, mortality, and cost of HF-PEF, large phase III international clinical trials investigating interventions to improve outcomes in HF-PEF have yielded disappointing results. Therefore, treatment of HF-PEF remains largely empiric, and almost no acknowledged standards exist. There is no single explanation for the negative results of past HF-PEF trials. Potential contributors include an incomplete understanding of HF-PEF pathophysiology, the heterogeneity of the patient population, inadequate diagnostic criteria, recruitment of patients without true heart failure or at early stages of the syndrome, poor matching of therapeutic mechanisms and primary pathophysiological processes, suboptimal study designs, or inadequate statistical power. Many novel agents are in various stages of research and development for potential use in patients with HF-PEF. To maximize the likelihood of identifying effective therapeutics for HF-PEF, lessons learned from the past decade of research should be applied to the design, conduct, and interpretation of future trials. This paper represents a synthesis of a workshop held in Bergamo, Italy, and it examines new and emerging therapies in the context of specific, targeted HF-PEF phenotypes where positive clinical benefit may be detected in clinical trials. Specific considerations related to patient and endpoint selection for future clinical trials design are also discussed. PMID:25104786

  11. Exercise Training in Older Patients with Heart Failure and Preserved Ejection Fraction: A Randomized, Controlled, Single-Blind Trial

    PubMed Central

    Kitzman, Dalane W.; Brubaker, Peter H.; Morgan, Timothy M.; Stewart, Kathryn P.; Little, William C.

    2011-01-01

    Background HF with preserved left ventricular ejection fraction (HFPEF) is the most common form of HF in the older population. Exercise intolerance is the primary chronic symptom in HFPEF patients and is a strong determinant of their reduced quality of life (QOL). Exercise training (ET) improves exercise intolerance and QOL in HF patients with reduced ejection fraction. However, the effect of ET in HFPEF has not been examined in a randomized, controlled trial. Methods and Results This was a randomized, attention-controlled, single blind study of 16 weeks of medically supervised ET (3 days per week) on exercise intolerance and QOL in 53 elderly (mean age 70±6 yrs; range 60–82; 46 women, 7 men) patients with isolated HFPEF (EF ≥ 50%, and no significant coronary, valvular, or pulmonary disease). Attention controls received biweekly follow-up telephone calls. Forty-six patients completed the study (24 ET, 22 controls). Attendance at exercise sessions in the ET group was excellent (88%; range 64–100%). There were no trial-related adverse events. Peak exercise oxygen uptake, the primary outcome, increased significantly in the ET group compared to the control group (13.8±2.5 to 16.1±2.6 ml/kg/min, change 2.3±2.2 ml/kg/min vs. 12.8±2.6 to 12.5±3.4, change −0.3±2.1 ml/kg/min) (p=0.0002). There were significant improvements in peak power output, exercise time, 6 minute walk distance, and ventilatory anaerobic threshold (all p<0.002). There was improvement in the physical QOL score (p=0.03) but not the total score (p=0.11). Conclusions ET improves peak and submaximal exercise capacity in older patients with HFPEF. PMID:20852060

  12. Pulmonary Arterial Capacitance Is an Important Predictor of Mortality in Heart Failure With a Preserved Ejection Fraction

    PubMed Central

    Al-Naamani, Nadine; Preston, Ioana R.; Paulus, Jessica K.; Hill, Nicholas S.; Roberts, Kari E.

    2015-01-01

    OBJECTIVES The purpose of this study was to determine the predictors of mortality in patients with pulmonary hypertension (PH) associated with heart failure with preserved ejection fraction (HFpEF). BACKGROUND PH is commonly associated with HFpEF. The predictors of mortality for patients with these conditions are not well characterized. METHODS In a prospective cohort of patients with right heart catheterization, we identified 73 adult patients who had pulmonary hypertension due to left heart disease (PH-LHD) associated with HFpEF (left ventricular ejection fraction ≥50% by echocardiography); hemodynamically defined as a mean pulmonary artery pressure ≥25 mm Hg and pulmonary artery wedge pressure >15 mm Hg. PH severity was classified according to the diastolic pressure gradient (DPG). Cox proportional hazards ratios were used to estimate the associations between clinical variables and mortality. Receiver-operating characteristic curves were used to evaluate the ability of hemodynamic measurements to predict mortality. RESULTS The mean age for study subjects was 69 ± 12 years and 74% were female. Patients classified as having combined post-capillary PH and pre-capillary PH (DPG ≥7) were not at increased risk of death as compared to patients with isolated post-capillary PH (DPG <7). A baseline pulmonary arterial capacitance (PAC) of <1.1 ml/mm Hg was 91% sensitive in predicting mortality, with better discriminatory ability than DPG, transpulmonary gradient, or pulmonary vascular resistance (area under the curve of 0.73, 0.50, 0.45, and 0.37, respectively). Fifty-seven subjects underwent acute vasoreactivity testing with inhaled nitric oxide. Acute vasodilator response by the Rich or Sitbon criteria was not associated with improved survival. CONCLUSIONS PAC is the best predictor of mortality in our cohort and may be useful in describing phenotypic subgroups among those with PH-LHD associated with HFpEF. Acute vasodilator testing did not predict outcome in our

  13. Diastolic function is associated with quality of life and exercise capacity in stable heart failure patients with reduced ejection fraction

    PubMed Central

    Bussoni, M.F.; Guirado, G.N.; Roscani, M.G.; Polegato, B.F.; Matsubara, L.S.; Bazan, S.G.Z.; Matsubara, B.B.

    2013-01-01

    Exercise capacity and quality of life (QOL) are important outcome predictors in patients with systolic heart failure (HF), independent of left ventricular (LV) ejection fraction (LVEF). LV diastolic function has been shown to be a better predictor of aerobic exercise capacity in patients with systolic dysfunction and a New York Heart Association (NYHA) classification ≥II. We hypothesized that the currently used index of diastolic function E/e' is associated with exercise capacity and QOL, even in optimally treated HF patients with reduced LVEF. This prospective study included 44 consecutive patients aged 55±11 years (27 men and 17 women), with LVEF<0.50 and NYHA functional class I-III, receiving optimal pharmacological treatment and in a stable clinical condition, as shown by the absence of dyspnea exacerbation for at least 3 months. All patients had conventional transthoracic echocardiography and answered the Minnesota Living with HF Questionnaire, followed by the 6-min walk test (6MWT). In a multivariable model with 6MWT as the dependent variable, age and E/e' explained 27% of the walked distance in 6MWT (P=0.002; multivariate regression analysis). No association was found between walk distance and LVEF or mitral annulus systolic velocity. Only normalized left atrium volume, a sensitive index of diastolic function, was associated with decreased QOL. Despite the small number of patients included, this study offers evidence that diastolic function is associated with physical capacity and QOL and should be considered along with ejection fraction in patients with compensated systolic HF. PMID:24036912

  14. New strategies for heart failure with preserved ejection fraction: the importance of targeted therapies for heart failure phenotypes

    PubMed Central

    Senni, Michele; Paulus, Walter J.; Gavazzi, Antonello; Fraser, Alan G.; Díez, Javier; Solomon, Scott D.; Smiseth, Otto A.; Guazzi, Marco; Lam, Carolyn S. P.; Maggioni, Aldo P.; Tschöpe, Carsten; Metra, Marco; Hummel, Scott L.; Edelmann, Frank; Ambrosio, Giuseppe; Stewart Coats, Andrew J.; Filippatos, Gerasimos S.; Gheorghiade, Mihai; Anker, Stefan D.; Levy, Daniel; Pfeffer, Marc A.; Stough, Wendy Gattis; Pieske, Burkert M.

    2014-01-01

    The management of heart failure with reduced ejection fraction (HF-REF) has improved significantly over the last two decades. In contrast, little or no progress has been made in identifying evidence-based, effective treatments for heart failure with preserved ejection fraction (HF-PEF). Despite the high prevalence, mortality, and cost of HF-PEF, large phase III international clinical trials investigating interventions to improve outcomes in HF-PEF have yielded disappointing results. Therefore, treatment of HF-PEF remains largely empiric, and almost no acknowledged standards exist. There is no single explanation for the negative results of past HF-PEF trials. Potential contributors include an incomplete understanding of HF-PEF pathophysiology, the heterogeneity of the patient population, inadequate diagnostic criteria, recruitment of patients without true heart failure or at early stages of the syndrome, poor matching of therapeutic mechanisms and primary pathophysiological processes, suboptimal study designs, or inadequate statistical power. Many novel agents are in various stages of research and development for potential use in patients with HF-PEF. To maximize the likelihood of identifying effective therapeutics for HF-PEF, lessons learned from the past decade of research should be applied to the design, conduct, and interpretation of future trials. This paper represents a synthesis of a workshop held in Bergamo, Italy, and it examines new and emerging therapies in the context of specific, targeted HF-PEF phenotypes where positive clinical benefit may be detected in clinical trials. Specific considerations related to patient and endpoint selection for future clinical trials design are also discussed. PMID:25104786

  15. Computer-based assessment of right ventricular regional ejection fraction in patients with repaired Tetralogy of Fallot

    NASA Astrophysics Data System (ADS)

    Teo, S.-K.; Wong, S. T.; Tan, M. L.; Su, Y.; Zhong, L.; Tan, Ru-San

    2015-03-01

    After surgical repair for Tetralogy of Fallot (TOF), most patients experience long-term complications as the right ventricle (RV) undergoes progressive remodeling that eventually affect heart functions. Thus, post-repair surgery is required to prevent further deterioration of RV functions that may result in malignant ventricular arrhythmias and mortality. The timing of such post-repair surgery therefore depends crucially on the quantitative assessment of the RV functions. Current clinical indices for such functional assessment measure global properties such as RV volumes and ejection fraction. However, these indices are less than ideal as regional variations and anomalies are obscured. Therefore, we sought to (i) develop a quantitative method to assess RV regional function using regional ejection fraction (REF) based on a 13-segment model, and (ii) evaluate the effectiveness of REF in discriminating 6 repaired TOF patients and 6 normal control based on cardiac magnetic resonance (CMR) imaging. We observed that the REF for the individual segments in the patient group is significantly lower compared to the control group (P < 0.05 using a 2-tail student t-test). In addition, we also observed that the aggregated REF at the basal, mid-cavity and apical regions for the patient group is significantly lower compared to the control group (P < 0.001 using a 2-tail student t-test). The results suggest that REF could potentially be used as a quantitative index for assessing RV regional functions. The computational time per data set is approximately 60 seconds, which demonstrates our method's clinical potential as a real-time cardiac assessment tool.

  16. Comparison of ejection fraction and Goldman risk factor analysis to dipyridamole-thallium 201 studies in the evaluation of cardiac morbidity after aortic aneurysm surgery

    SciTech Connect

    McEnroe, C.S.; O'Donnell, T.F. Jr.; Yeager, A.; Konstam, M.; Mackey, W.C. )

    1990-04-01

    Associated coronary artery disease is the critical factor that influences early and late mortality after abdominal aortic aneurysm surgery. Dipyridamole-thallium 201 scintigraphy, left ventricular ejection fraction, and Goldman risk factor analysis have been suggested as preoperative noninvasive screening methods to detect significant coronary artery disease. In this series of 95 elective abdominal aortic aneurysm repairs dipyridamole-thallium 201 scintigraphy was highly predictive of the absence of perioperative cardiac morbidity (96% specificity, 44/46 normal scans, no cardiac morbidity), whereas ejection fraction (73% specificity, 31/42 normal ejection fraction, no cardiac morbidity) and Goldman risk factor analysis (84% specificity, 44/51 class I, no cardiac morbidity) were less. Furthermore, thallium redistribution on dipyridamole-thallium 201 scintigraphy leading to coronary angiography identified a significant number of patients with occult coronary artery disease who required preoperative coronary revascularization (8%, 8/95) and might have remained undetected on the basis of left ventricular ejection fraction or Goldman risk factor analysis. Finally, fixed thallium deficit, which some investigators have interpreted as a low probability finding for cardiac morbidity, was associated with a higher than expected incidence of cardiac complications. Forty-six percent (7/15) of all postoperative cardiac complications (three myocardial infarctions, three ischemic events, one death) occurred in patients with abdominal aortic aneurysms with fixed deficits. This suggests that patients with fixed deficits on dipyridamole-thallium 201 scintigraphy should be considered for later delayed (4 hours) thallium images or coronary angiography or both.

  17. Challenging aspects of treatment strategies in heart failure with preserved ejection fraction: “Why did recent clinical trials fail?”

    PubMed Central

    Becher, Peter Moritz; Fluschnik, Nina; Blankenberg, Stefan; Westermann, Dirk

    2015-01-01

    Heart failure (HF) is the leading cause of hospitalization among older adults and the prevalence is growing with the aging populations in the Western countries. Epidemiologic reports suggest that approximately 50% of patients who have signs or symptoms of HF have preserved left ventricular ejection fraction. This HF type predominantly affects women and the elderly with other co-morbidities, such as diabetes, hypertension, and overt volume status. Most of the current treatment strategies are based on morbidity benefits such as quality of life and reduction of clinical HF symptoms. Treatment of patients with HF with preserved ejection fraction displayed disappointing results from several large randomized controlled trials. The heterogeneity of HF with preserved ejection fraction, understood as complex syndrome, seems to be one of the primary reasons. Here, we present an overview of the current management strategies with available evidence and new therapeutic approach from drugs currently in clinical trials, which target diastolic dysfunction, chronotropic incompetence, and risk factor management. We provide an outline and interpretation of recent clinical trials that failed to improve outcome and survival in patients with HF with preserved ejection fraction. PMID:26413231

  18. High-Speed Video for Investigating Splash Erosion Behaviour: Obtaining Initial Velocity and Angle of Ejections by Tracking Trajectories.

    NASA Astrophysics Data System (ADS)

    Ahn, S.; Doerr, S.; Douglas, P.; Bryant, R.; Hamlett, C.; McHale, G.; Newton, M.; Shirtcliffe, N.

    2012-04-01

    The use of high-speed videography has been shown to be very useful in some splash erosion studies. One methodological problem that arises in its application is the difficulty in tracking a large number of particles in slow motion, especially when the use of automatic tracking software is limited. With this problem, some studies simply assume a certain ejecting angle for all particles rather than actually tracking every particle. In this contribution, different combinations of variables (e.g. landing position, landing time or departing position, etc.) were compared in order to determine an efficient and sufficiently precise method for trajectory tracking when a large amount of particles are being ejected.

  19. Cardiac lipid content is unresponsive to a physical activity training intervention in type 2 diabetic patients, despite improved ejection fraction

    PubMed Central

    2011-01-01

    Background Increased cardiac lipid content has been associated with diabetic cardiomyopathy. We recently showed that cardiac lipid content is reduced after 12 weeks of physical activity training in healthy overweight subjects. The beneficial effect of exercise training on cardiovascular risk is well established and the decrease in cardiac lipid content with exercise training in healthy overweight subjects was accompanied by improved ejection fraction. It is yet unclear whether diabetic patients respond similarly to physical activity training and whether a lowered lipid content in the heart is necessary for improvements in cardiac function. Here, we investigated whether exercise training is able to lower cardiac lipid content and improve cardiac function in type 2 diabetic patients. Methods Eleven overweight-to-obese male patients with type 2 diabetes mellitus (age: 58.4 ± 0.9 years, BMI: 29.9 ± 0.01 kg/m2) followed a 12-week training program (combination endurance/strength training, three sessions/week). Before and after training, maximal whole body oxygen uptake (VO2max) and insulin sensitivity (by hyperinsulinemic, euglycemic clamp) was determined. Systolic function was determined under resting conditions by CINE-MRI and cardiac lipid content in the septum of the heart by Proton Magnetic Resonance Spectroscopy. Results VO2max increased (from 27.1 ± 1.5 to 30.1 ± 1.6 ml/min/kg, p = 0.001) and insulin sensitivity improved upon training (insulin stimulated glucose disposal (delta Rd of glucose) improved from 5.8 ± 1.9 to 10.3 ± 2.0 μmol/kg/min, p = 0.02. Left-ventricular ejection fraction improved after training (from 50.5 ± 2.0 to 55.6 ± 1.5%, p = 0.01) as well as cardiac index and cardiac output. Unexpectedly, cardiac lipid content in the septum remained unchanged (from 0.80 ± 0.22% to 0.95 ± 0.21%, p = 0.15). Conclusions Twelve weeks of progressive endurance/strength training was effective in improving VO2max, insulin sensitivity and cardiac function

  20. Copeptin in patients with heart failure and preserved ejection fraction: a report from the prospective KaRen-study

    PubMed Central

    Hage, Camilla; Lund, Lars H; Donal, Erwan; Daubert, Jean-Claude; Linde, Cecilia; Mellbin, Linda

    2015-01-01

    Introduction Underlying mechanisms of heart failure (HF) with preserved ejection fraction (HFPEF) remain unknown. We explored copeptin, a biomarker of the arginine vasopressin system, hypothesising that copeptin in HFPEF is elevated, associated with diastolic dysfunction and N-terminal pro-brain natriuretic peptide (NT-proBNP) and predictive of HF hospitalisation and mortality. Methods and analysis In a prospective observational substudy of the The Karolinska Rennes (KaRen) 86 patients with symptoms of acute HF and ejection fraction (EF) ≥45% were enrolled. After 4–8 weeks, blood sampling and echocardiography was performed. Plasma-copeptin was analysed in 86 patients and 62 healthy controls. Patients were followed in median 579 days (quartile 1; quartile 3 (Q1;Q3) 276;1178) regarding the composite end point all-cause mortality or HF hospitalisation. Ethics and dissemination The patients with HFPEF had higher copeptin levels, median 13.56 pmol/L (Q1;Q3 8.56;20.55) than controls 5.98 pmol/L (4.15;9.42; p<0.001). Diastolic dysfunction, assessable in 75/86 patients, was present in 45 and absent in 30 patients. Copeptin did not differ regarding diastolic dysfunction and did not correlate with cardiac function but with NT-proBNP (r=0.223; p value=0.040). In univariate Cox regression analysis log copeptin predicted the composite end point (HR 1.56 (95% CI 1.03 to 2.38; p value=0.037)) but not after adjusting for NT-proBNP (HR 1.39 (95% CI 0.91 to 2.12; p value=0.125)). Conclusions In the present patients with HFPEF, copeptin is elevated, correlates with NT-proBNP but not markers of diastolic dysfunction, and has prognostic implications, however blunted after adjustment for NT-proBNP. The HFPEF pathophysiology may be better reflected by markers of neurohormonal activation than by diastolic dysfunction. Trial registration number ClinicalTrials.gov NCT00774709. PMID:26568833

  1. Role of inflammation in the pathogenesis of heart failure with preserved ejection fraction and its potential as a therapeutic target.

    PubMed

    Glezeva, N; Baugh, J A

    2014-09-01

    Heart failure (HF) with preserved ejection fraction (HFPEF) is an increasingly prevalent clinical syndrome with many unresolved issues regarding diagnosis, pathophysiology, and treatment. The major pathophysiological mechanisms underlying HFPEF are known to be fibrosis and reduced ventricular compliance, and hypertension (HTN) is perhaps the most significant risk factor for the development of left ventricular diastolic dysfunction (LVDD). Inflammation is one of the earliest events in cardiac stress situations such as pressure and/or volume overload and involves elevated levels of endothelial adhesion molecules as well as increased production and release of inflammatory cytokines and chemokines in the tissue. The latter promotes the infiltration of activated inflammatory cells, particularly monocytes, into the cardiac tissue. Increased monocyte infiltration is seen in the early and late stages of HTN and HFPEF. Once inside the tissue, monocytes differentiate into macrophages and promote cardiac inflammation, tissue injury, and myocardial fibrosis. This review focuses on inflammation as the initial and primary trigger of ventricular remodelling in HTN and LVDD, affecting progression to HFPEF. The link between inflammation and b-type natriuretic peptide (BNP), a clinical marker of cardiac pressure overload which is positively associated with cardiac dysfunction and HF, is also described. Finally, current and prospective therapeutic approaches for HFPEF based on modification of the inflammatory response are reviewed. PMID:24005868

  2. Determination of left ventricular ejection fraction by visual estimation during real-time two-dimensional echocardiography

    SciTech Connect

    Rich, S.; Sheikh, A.; Gallastegui, J.; Kondos, G.T.; Mason, T.; Lam, W.

    1982-09-01

    It has been shown that the measured reduction in the cross-sectional area of the left ventricle (LV), as viewed in the short axis, closely approximates its ejection fraction (EF). We assessed the reliability of using two-dimensional echocardiography (2DE) to visually estimate the EF during real-time viewing, without the need of digitizers, planimetry, or calculations. Twenty-five adult hospitalized patients with either suspected or known cardiac disease were evaluated prospectively. Each patient also had gated nuclear angiography during the same admission, and 14 had cardiac catheterization with left ventriculography. The EF was determined by 2DE using a visual estimate of the percent area reduction of the LV cavity in the short-axis view at the level of the papillary muscles. All 2 DE studies were read by two or more blinded reviewers, with a value for the EF to the nearest 2.5% determined by consensus. These values correlated closely to the values determined in all 25 patients with gated nuclear angiography (r . 0.927) and the 14 patients who had left ventriculography (r . 0.935). We believe that this method of visually estimating the LVEF will enable echocardiographers to easily use 2 DE for a reliable and instantaneous assessment of ventricular function, without the need of sophisticated analytical equipment.

  3. The prognostic significance of left ventricular ejection fraction in patients with advanced cancer treated in phase I clinical trials

    PubMed Central

    Said, R.; Banchs, J.; Wheler, J.; Hess, K. R.; Falchook, G.; Fu, S.; Naing, A.; Hong, D.; Piha-Paul, S.; Ye, Y.; Yeh, E.; Wolff, R. A.; Tsimberidou, A. M.

    2014-01-01

    Background New targeted agents may cause acute cardiac events. The purpose of our study was to investigate the incidence and the prognostic significance of left ventricular ejection fraction (LVEF) in phase I trials. Patients and methods Between October 2008 and September 2011, the records of 1166 consecutive patients with advanced cancer treated in the Phase I Clinic who underwent echocardiography were retrospectively reviewed. Results Most of the patients were White (78%), and the most common tumor types were colorectal cancer and melanoma. Of 1166 patients, 177 (15.2%) patients had an LVEF of <50%. No difference in overall survival (OS) between patients with LVEF ≥ 50% and patients with LVEF < 50% was seen (median OS 7.4 versus 7.0 months, P = 0.84). Patients with LVEF ≤ 35% had shorter survival compared with those with LVEF between 35% and 50% (median 4.2 versus 8.0 months; P = 0.005). In multivariate analysis of patients with LVEF < 50%, independent factors predicting longer survival were LVEF > 35%, ≤2 prior systemic therapies, ≤2 metastatic sites, and normal lactate dehydrogenase and albumin levels. Conclusion Echocardiography would improve patient selection for enrollment in phase I clinical trials. These data suggest that it is safe to treat patients with LVEF between 35% and 50%. PMID:24356639

  4. Fuzzy Modeling to Predict Severely Depressed Left Ventricular Ejection Fraction following Admission to the Intensive Care Unit Using Clinical Physiology

    PubMed Central

    Pereira, Rúben Duarte M. A.; Salgado, Cátia M.; Dejam, Andre; Reti, Shane R.; Vieira, Susana M.; Sousa, João M. C.; Celi, Leo A.; Finkelstein, Stan N.

    2015-01-01

    Left ventricular ejection fraction (LVEF) constitutes an important physiological parameter for the assessment of cardiac function, particularly in the settings of coronary artery disease and heart failure. This study explores the use of routinely and easily acquired variables in the intensive care unit (ICU) to predict severely depressed LVEF following ICU admission. A retrospective study was conducted. We extracted clinical physiological variables derived from ICU monitoring and available within the MIMIC II database and developed a fuzzy model using sequential feature selection and compared it with the conventional logistic regression (LR) model. Maximum predictive performance was observed using easily acquired ICU variables within 6 hours after admission and satisfactory predictive performance was achieved using variables acquired as early as one hour after admission. The fuzzy model is able to predict LVEF ≤ 25% with an AUC of 0.71 ± 0.07, outperforming the LR model, with an AUC of 0.67 ± 0.07. To the best of the authors' knowledge, this is the first study predicting severely impaired LVEF using multivariate analysis of routinely collected data in the ICU. We recommend inclusion of these findings into triaged management plans that balance urgency with resources and clinical status, particularly for reducing the time of echocardiographic examination. PMID:26345130

  5. Challenges in the Management of Patients with Chronic Obstructive Pulmonary Disease and Heart Failure With Reduced Ejection Fraction.

    PubMed

    Jaiswal, Abhishek; Chichra, Astha; Nguyen, Vinh Q; Gadiraju, Taraka V; Le Jemtel, Thierry H

    2016-02-01

    Chronic obstructive pulmonary disease (COPD) and heart failure with reduced ejection fraction (HFrEF) commonly coexist in clinical practice. The prevalence of COPD among HFrEF patients ranges from 20 to 32 %. On the other hand; HFrEF is prevalent in more than 20 % of COPD patients. With an aging population, the number of patients with coexisting COPD and HFrEF is on rise. Coexisting COPD and HFrEF presents a unique diagnostic and therapeutic clinical conundrum. Common symptoms shared by both conditions mask the early referral and detection of the other. Beta blockers (BB), angiotensin-converting enzyme inhibitors, and aldosterone antagonists have been shown to reduce hospitalizations, morbidity, and mortality in HFrEF while long-acting inhaled bronchodilators (beta-2-agonists and anticholinergics) and corticosteroids have been endorsed for COPD treatment. The opposing pharmacotherapy of BBs and beta-2-agonists highlight the conflict in prescribing BBs in COPD and beta-2-agonists in HFrEF. This has resulted in underutilization of evidence-based therapy for HFrEF in COPD patients owing to fear of adverse effects. This review aims to provide an update and current perspective on diagnostic and therapeutic management of patients with coexisting COPD and HFrEF. PMID:26780914

  6. Age, Creatinine and Ejection Fraction Score in Brazil: Comparison with InsCor and the EuroSCORE

    PubMed Central

    Mejía, Omar Asdrúbal Vilca; Matrangolo, Bruna La Regina; Titinger, David Provenzale; de Faria, Leandro Batisti; Dallan, Luís Roberto Palma; Galas, Filomena Regina Barbosa; Lisboa, Luiz Augusto Ferreira; Dallan, Luís Alberto Oliveira; Jatene, Fabio Biscegli

    2015-01-01

    Background Risk scores for cardiac surgery cannot continue to be neglected. Objective To assess the performance of “Age, Creatinine and Ejection Fraction Score” (ACEF Score) to predict mortality in patients submitted to elective coronary artery bypass graft and/or heart valve surgery, and to compare it to other scores. Methods A prospective cohort study was carried out with the database of a Brazilian tertiary care center. A total of 2,565 patients submitted to elective surgeries between May 2007 and July 2009 were assessed. For a more detailed analysis, the ACEF Score performance was compared to the InsCor’s and EuroSCORE’s performance through correlation, calibration and discrimination tests. Results Patients were stratified into mild, moderate and severe for all models. Calibration was inadequate for ACEF Score (p = 0.046) and adequate for InsCor (p = 0.460) and EuroSCORE (p = 0.750). As for discrimination, the area under the ROC curve was questionable for the ACEF Score (0.625) and adequate for InsCor (0.744) and EuroSCORE (0.763). Conclusion Although simple to use and practical, the ACEF Score, unlike InsCor and EuroSCORE, was not accurate for predicting mortality in patients submitted to elective coronary artery bypass graft and/or heart valve surgery in a Brazilian tertiary care center. PMID:26312550

  7. A Systematic Review Concerning the Relation between the Sympathetic Nervous System and Heart Failure with Preserved Left Ventricular Ejection Fraction

    PubMed Central

    Verloop, Willemien L.; Beeftink, Martine M. A.; Santema, Bernadet T.; Bots, Michiel L.; Blankestijn, Peter J.; Cramer, Maarten J.; Doevendans, Pieter A.; Voskuil, Michiel

    2015-01-01

    Background Heart failure with preserved left ventricular ejection fraction (HFPEF) affects about half of all patients diagnosed with heart failure. The pathophysiological aspect of this complex disease state has been extensively explored, yet it is still not fully understood. Since the sympathetic nervous system is related to the development of systolic HF, we hypothesized that an increased sympathetic nerve activation (SNA) is also related to the development of HFPEF. This review summarizes the available literature regarding the relation between HFPEF and SNA. Methods and Results Electronic databases and reference lists through April 2014 were searched resulting in 7722 unique articles. Three authors independently evaluated citation titles and abstracts, resulting in 77 articles reporting about the role of the sympathetic nervous system and HFPEF. Of these 77 articles, 15 were included for critical appraisal: 6 animal and 9 human studies. Based on the critical appraisal, we selected 9 articles (3 animal, 6 human) for further analysis. In all the animal studies, isoproterenol was administered to mimic an increased sympathetic activity. In human studies, different modalities for assessment of sympathetic activity were used. The studies selected for further evaluation reported a clear relation between HFPEF and SNA. Conclusion Current literature confirms a relation between increased SNA and HFPEF. However, current literature is not able to distinguish whether enhanced SNA results in HFPEF, or HFPEF results in enhanced SNA. The most likely setting is a vicious circle in which HFPEF and SNA sustain each other. PMID:25658630

  8. Extracellular Volume Fraction Is More Closely Associated With Altered Regional Left Ventricular Velocities Than Left Ventricular Ejection Fraction in Non-Ischemic Cardiomyopathy

    PubMed Central

    Collins, Jeremy; Sommerville, Cort; Magrath, Patrick; Spottiswoode, Bruce; Freed, Benjamin H; Benzuly, Keith H; Gordon, Robert; Vidula, Himabindu; Lee, Dan C; Yancy, Clyde; Carr, James; Markl, Michael

    2014-01-01

    Background Non-ischemic cardiomyopathy (NICM) is a common cause of left ventricular (LV) dysfunction and myocardial fibrosis. The purpose of this study was to non-invasively evaluate changes in segmental LV extracellular volume fraction (ECV), LV velocities, myocardial scar, and wall motion in NICM patients. Methods and Results Cardiac MRI including pre- and post-contrast myocardial T1-mapping and velocity quantification (tissue phase mapping, TPM) of the LV (basal, mid-ventricular, apical short axis) was applied in 31 patients with NICM (50±18years). Analysis based on the 16-segment AHA model was employed to evaluate the segmental distribution of ECV, peak systolic and diastolic myocardial velocities, scar determined by late gadolinium enhancement (LGE), and wall motion abnormalities. LV segments with scar or impaired wall motion were significantly associated with elevated ECV (r=0.26, p<0.001) and reduced peak systolic radial velocities (r=−0.43, p<0.001). Regional myocardial velocities and ECV were similar for patients with reduced (n=12, ECV=0.28±0.06) and preserved LV ejection fraction (LVEF) (n=19, ECV=0.30±0.09). Patients with preserved LVEF showed significant relationships between increasing ECV and reduced systolic (r=−0.19, r=−0.30) and diastolic (r=0.34, r=0.26) radial and long-axis peak velocities (p<0.001). Even after excluding myocardial segments with LGE, significant relationships between ECV and segmental LV velocities were maintained indicating the potential of elevated ECV to identify regional diffuse fibrosis not visible by LGE which was associated with impaired regional LV function Conclusions Regionally elevated ECV negatively impacted myocardial velocities. The association of elevated regional ECV with reduced myocardial velocities independent of LVEF suggests a structure-function relationship between altered ECV and segmental myocardial function in NICM. PMID:25552491

  9. A prospective comparison of echocardiographic wall motion score index and radionuclide ejection fraction in predicting outcome following acute myocardial infarction

    PubMed Central

    Galasko, G; Basu, S; Lahiri, A; Senior, R

    2001-01-01

    OBJECTIVE—To characterise echocardiographic wall motion score index (WMSI) as a surrogate measure of left ventricular ejection fraction (EF) following acute myocardial infarction (AMI) and to compare its prognostic value with that of EF measured by radionuclide ventriculography (RNV).
DESIGN—A prospective study to compare baseline echocardiographic WMSI with RNV EF in consecutive patients thrombolysed for AMI, both performed on the same day before discharge, and their relative prognostic values in predicting cardiac events.
SETTING—District general hospital coronary care unit and cardiology department.
PATIENTS—120 consecutive patients free of exclusion criteria thrombolysed for AMI and followed up for a mean (SD) of 13 (10) months.
INTERVENTIONS—None.
MAIN OUTCOME MEASURES—Correlation coefficients and receiver operating characteristic curve analyses plus cardiac event rates at follow up between RNV EF and echocardiographic WMSI.
RESULTS—WMSI correlated well with RNV EF. The best corresponding WMSIs for EFs 45%, 40%, and 35% were 0.6, 0.8, and 1.1, respectively. There were 42 cardiac events during follow up. Although both RNV EF and WMSI were strong univariate predictors of cardiac events, only WMSI independently predicted outcome in a multivariate model. All three WMSI cut offs significantly predicted events, while an RNV EF cut off of ⩽ 45% v > 45% failed to reach significance.
CONCLUSIONS—Although both RNV and echocardiographic WMSI strongly predicted cardiac outcome, WMSI, a cheaper and more readily available technique, is more discriminatory, especially in cases of mild left ventricular dysfunction following AMI.


Keywords: echocardiographic wall motion score index; radionuclide ventriculography; prognosis; acute myocardial infarction PMID:11514477

  10. Cardiovascular Phenotype in Patients with Heart Failure and Preserved Ejection Fraction with or without Diabetes: A RELAX Trial Ancillary Study

    PubMed Central

    Lindman, Brian R.; Dávila-Román, Victor G.; Mann, Douglas L.; McNulty, Steven; Semigran, Marc J.; Lewis, Gregory D.; de las Fuentes, Lisa; Joseph, Susan M.; Vader, Justin; Hernandez, Adrian F.; Redfield, Margaret M.

    2014-01-01

    Background RELAX was a multicenter randomized trial of sildenafil versus placebo in heart failure and preserved ejection fraction (HFpEF) with rigorous entry criteria and extensive phenotypic characterization of participants. Objectives To characterize clinical features, exercise capacity, and outcomes in patients with HFpEF with or without diabetes and gain insight into contributing pathophysiologic mechanisms. Methods RELAX enrolled 216 stable outpatients with heart failure, EF ≥50%, elevated natriuretic peptide or intracardiac pressures, and reduced exercise capacity. Prospectively collected data included echocardiography, cardiac magnetic resonance imaging, a comprehensive biomarker panel, exercise testing, and clinical events over 6 months. Results Compared with non-diabetics (n=123), diabetic (n=93) HFpEF patients were younger, more obese, more often male, and had a higher prevalence of hypertension, renal dysfunction, pulmonary disease, and vascular disease (p<0.05 for all). Uric acid, C-reactive protein, galectin-3, carboxy-terminal telopeptide of collagen type I, and endothelin-1 levels were higher in diabetics (p<0.05 for all). Diabetic patients had more ventricular hypertrophy but systolic and diastolic ventricular function parameters were similar in diabetics and non-diabetics except for a trend toward higher filling pressures (E/e′) in diabetics. Diabetics had worse maximal (peak oxygen uptake) and submaximal (6-minute walk distance) exercise capacity (p<0.01 for both). Diabetic patients were more likely to have been hospitalized for HF in the year prior to study entry (47% vs 28%, p=0.004) and had a higher incidence of cardiac or renal hospitalization at 6 months after enrollment (23.7% vs 4.9%, p<0.001). Conclusions HFpEF patients with diabetes are at increased risk of hospitalization and have reduced exercise capacity. Multi-morbidity, impaired chronotropic reserve, left ventricular hypertrophy and activation of inflammatory, pro

  11. The Prognostic Importance of Impaired Systolic Function in Heart Failure with Preserved Ejection Fraction and the Impact of Spironolactone

    PubMed Central

    Shah, Amil M.; Claggett, Brian; Sweitzer, Nancy K.; Shah, Sanjiv J.; Anand, Inder S.; Liu, Li; Pitt, Bertram; Pfeffer, Marc A.; Solomon, Scott D.

    2015-01-01

    Background Impairment in left ventricular (LV) systolic function has been described in heart failure with preserved ejection fraction (HFpEF), but its prognostic relevance is not known. We determined whether LV longitudinal strain (LS) is predictive of cardiovascular (CV) outcomes in HFpEF beyond clinical and conventional echocardiographic measures. Methods and Results LS was assessed by 2D speckle-tracking echocardiography at baseline in 447 HFpEF patients enrolled in the Treatment Of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial. At a median follow-up of 2.6 (IQR 1.5–3.9) years, 115 patients experienced the primary composite outcome of CV death, HF hospitalization, or aborted cardiac arrest. Impaired LS, defined as an absolute LS<15.8%, was present in 52% of patients and was predictive of the composite outcome (adjusted HR 2.14, 95% CI 1.26–3.66; p=0.005), CV death alone (adjusted HR 3.20, 95% CI 1.44–7.12; p=0.004), and HF hospitalization alone (adjusted HR 2.23, 95% CI 1.16–4.28; p=0.016) after adjusting for clinical and conventional echocardiographic variables. LS was the strongest echocardiographic predictor of the composite outcome. Exploratory analysis in a subset of 131 patients with follow-up LS assessed after 12–18 months demonstrated a trend towards improvement in LS associated with spironolactone in patients enrolled in the Americas but not in Russia or Georgia. Conclusions Impaired LV systolic function is a powerful predictor of HF hospitalization, CV death, or aborted cardiac arrest in HFpEF, independent of clinical predictors. Impaired LS represents a novel imaging biomarker to identify HFpEF patients at particularly high risk for CV morbidity and mortality. Clinical Trial Registration Information Clinicaltrials.gov. Identifier NCT00094302. PMID:26130119

  12. Clinical Determinants of Left Ventricular Ejection Fraction Deterioration in Patients Suffered From Complete Left Bundle Branch Block

    PubMed Central

    Hashemi Jazi, Mohammad; Nilforoush, Peyman; Gharipour, Mojgan; Batvandi, Azadeh; Mohammadi, Robabeh; Najafi, Roya

    2015-01-01

    Background: Recently, the deleterious effects of left bundle branch block (LBBB) on left ventricular systolic function have been taken into consideration. Objectives: The present study aimed to identify underlying factors that predict left ventricular ejection fraction (LVEF) deterioration in patients suffered from complete LBBB. Patients and Methods: In a retrospective case-control study, the data of 220 consecutive patients diagnosed with LBBB on their electrocardiograms were assessed. They were referred to Isfahan Heart Center in Isfahan Province, Iran in 2013. LVEF deterioration was defined as a decrease in LVEF at least 10% between the baseline and follow-up echocardiography study. Thus, achieving the LVEF values ≤ 40% in patients with an initial EF of > 50% was considered LVEF deterioration. Results: Among 220 patients, 40% of LBBB patients suffered LVEF deterioration within 3 months of initial assessment. The group with LVEF deterioration had higher male to female ratio, had higher NYHA score, and suffered more from systolic hypertension than another group. Those with coronary artery disease (CAD) had also significantly lower LVEF than non-CAD ones. Adverse associations were revealed between systolic blood pressure and LVEF measurement (r = -0.193, P = 0.006) as well as between NYHA score and LVEF (r = -0.215, P = 0.002). A multivariable logistic regression model showed that among baseline variables, male gender (OR = 3.218, P < 0.001), history of systolic hypertension (OR = 2.012, P = 0.029), higher NYHA score (OR = 1.623, P = 0.005), and the presence of coronary artery disease (OR = 2.475, P = 0.028) could effectively predict LVEF deterioration in patients with LBBB. Conclusions: Male gender, history of hypertension, high NYHA score, and the presence of CAD predict LVEF deterioration in patients with LBBB. PMID:25838930

  13. Prevalence, Clinical Characteristics, and Outcomes Associated with Eccentric versus Concentric Left Ventricular Hypertrophy In Heart Failure with Preserved Ejection Fraction

    PubMed Central

    Katz, Daniel H.; Beussink, Lauren; Sauer, Andrew J.; Freed, Benjamin H.; Burke, Michael A.; Shah, Sanjiv J.

    2013-01-01

    While concentric remodeling (CR) and concentric hypertrophy (CH) are common forms of left ventricular (LV) remodeling in heart failure with preserved ejection fraction (HFpEF), eccentric hypertrophy (EH) can also occur in these patients. However, clinical characteristics and outcomes of EH have not been well described in HFpEF. We prospectively studied 402 patients with HFpEF, divided into 4 groups based on LV structure: normal geometry (no LV hypertrophy [LVH] and relative wall thickness [RWT] < 0.42); CR (no LVH and RWT > 0.42); CH (LVH and RWT > 0.42); and EH (LVH and RWT < 0.42). We compared clinical, laboratory, echocardiographic, invasive hemodynamic, and outcome data among groups. Of 402 patients, 48 (12%) had EH. Compared to CH, patients with EH had lower systolic blood pressure and less renal impairment despite similar rates of hypertension. After adjustment for covariates, EH was associated with reduced LV contractility compared to CH (lower LVEF [β-coefficient = −3.2; 95% confidence interval (CI) −5.4, −1.1%] and ratio of systolic blood pressure to end-systolic volume [β-coefficient = −1.0; 95% CI −1.5, −0.5 mmHg/ml]). EH was also associated with increased LV compliance compared to CH (LV end-diastolic volume at an idealized LV end-diastolic pressure of 20 mmHg [EDV20] β-coefficient = 14.2;95% CI 9.4, 19.1 ml). Despite these differences, EH and CH had similarly elevated cardiac filling pressures and equivalent adverse outcomes. In conclusion, the presence of EH denotes a distinct subset of HFpEF that is pathophysiologically similar to HF with reduced EF (HFrEF), and may benefit from HFrEF therapy. PMID:23810323

  14. Prognostic implications of heart failure with preserved ejection fraction in patients with an exacerbation of chronic obstructive pulmonary disease.

    PubMed

    Marcun, Robert; Stankovic, Ivan; Vidakovic, Radosav; Farkas, Jerneja; Kadivec, Sasa; Putnikovic, Biljana; Ilic, Ivan; Neskovic, Aleksandar N; Lainscak, Mitja

    2016-06-01

    Diagnosing heart failure with preserved ejection fraction (HFpEF) in patients with chronic obstructive pulmonary disease (COPD) is difficult due to overlapping pathophysiological pathways, risk factors and clinical presentations. We investigated the prevalence and prognostic implications of coexisting HFpEF in patients hospitalized for acute exacerbation of COPD. A total of 116 consecutive patients with an acute exacerbation of COPD were evaluated for HFpEF and followed for an average period of 22 ± 9 months for the occurrence of death from any cause. HFpEF was diagnosed in 22 (19 %) patients with COPD, who were older, and also had higher LV mass, left atrial size, and mitral E/Ea ratio than those without HFpEF (p < 0.05 for all comparisons). HFpEF was not independently associated with all-cause mortality [hazard ratio (HR) 1.07, 95 % confidence interval (CI) 0.44-2.62]. Global initiative for chronic Obstructive Lung Disease (GOLD) stage (IV vs. I-III, HR 2.37, CI 1.23-4.59) and N-terminal pro B-type natriuretic peptide (NT-proBNP) levels (HR 2.79, CI 1.12-6.98) were independent predictors of long-term survival. HFpEF is present in one-fifth of patients with exacerbated COPD. Non-invasively diagnosed HFpEF may not be an independent predictor of all-cause mortality. Elevated NT-proBNP levels and very severe COPD were independently associated with unfavorable overall survival. PMID:26423072

  15. Potential clinical impact of cardiovascular magnetic resonance assessment of ejection fraction on eligibility for cardioverter defibrillator implantation

    PubMed Central

    2012-01-01

    Background For the primary prevention of sudden cardiac death, guidelines provide left ventricular ejection fraction (EF) criteria for implantable cardioverter defibrillator (ICD) placement without specifying the technique by which it should be measured. We sought to investigate the potential impact of performing cardiovascular magnetic resonance (CMR) for EF on ICD eligibility. Methods The study population consisted of patients being considered for ICD implantation who were referred for EF assessment by CMR. Patients who underwent CMR within 30 days of echocardiography were included. Echocardiographic EF was determined by Simpson’s biplane method and CMR EF was measured by Simpson’s summation of discs method. Results Fifty-two patients (age 62±15 years, 81% male) had a mean EF of 38 ± 14% by echocardiography and 35 ± 14% by CMR. CMR had greater reproducibility than echocardiography for both intra-observer (ICC, 0.98 vs 0.94) and inter-observer comparisons (ICC 0.99 vs 0.93). The limits of agreement comparing CMR and echocardiographic EF were – 16 to +10 percentage points. CMR resulted in 11 of 52 (21%) and 5 of 52 (10%) of patients being reclassified regarding ICD eligibility at the EF thresholds of 35 and 30% respectively. Among patients with an echocardiographic EF of between 25 and 40%, 9 of 22 (41%) were reclassified by CMR at either the 35 or 30% threshold. Echocardiography identified only 1 of the 6 patients with left ventricular thrombus noted incidentally on CMR. Conclusions CMR resulted in 21% of patients being reclassified regarding ICD eligibility when strict EF criteria were used. In addition, CMR detected unexpected left ventricular thrombus in almost 10% of patients. Our findings suggest that the use of CMR for EF assessment may have a substantial impact on management in patients being considered for ICD implantation. PMID:23043729

  16. Myocardial Stiffness in Patients with Heart Failure and a Preserved Ejection Fraction: Contributions of Collagen and Titin

    PubMed Central

    Zile, Michael R.; Baicu, Catalin F.; Ikonomidis, John; Stroud, Robert E.; Nietert, Paul J.; Bradshaw, Amy D.; Slater, Rebecca; Palmer, Bradley M.; Van Buren, Peter; Meyer, Markus; Redfield, Margaret; Bull, David; Granzier, Henk; LeWinter, Martin M.

    2015-01-01

    Background The purpose of this study was to determine whether patients with heart failure and a preserved ejection fraction (HFpEF) have an increase in passive myocardial stiffness and the extent to which discovered changes are dependent on changes in extracellular matrix fibrillar collagen and/or cardiomyocyte titin. Methods and Results Seventy patients undergoing coronary artery bypass grafting underwent an echocardiogram, plasma biomarker determination, and intra-operative left ventricular (LV) epicardial anterior wall biopsy. Patients were divided into 3 groups: referent control (n=17, no hypertension or diabetes), hypertension (HTN) without(-) HFpEF (n=31), and HTN with(+) HFpEF (n=22). One or more of the following studies were performed on the biopsies: passive stiffness measurements to determine total, collagen-dependent and titin-dependent stiffness (differential extraction assay), collagen assays (biochemistry or histology), or titin isoform and phosphorylation assays. Compared with controls, patients with HTN(-)HFpEF had no change in LV end diastolic pressure (LVEDP), myocardial passive stiffness, collagen, or titin phosphorylation but had an increase in biomarkers of inflammation (CRP, sST2, TIMP-1). Compared with both control and HTN(-)HFpEF, patients with HTN(+)HFpEF had increased LVEDP, left atrial volume, NT-proBNP, total, collagen-dependent and titin-dependent stiffness, insoluble collagen, increased titin phosphorylation on PEVK S11878(S26), reduced phosphorylation on N2B S4185(S469), and increased biomarkers of inflammation. Conclusions Hypertension in the absence of HFpEF, did not alter passive myocardial stiffness. Patients with HTN(+)HFpEF had a significant increase in passive myocardial stiffness; collagen-dependent and titin-dependent stiffness were increased. These data suggest that the development of HFpEF is dependent on changes in both collagen and titin homeostasis. PMID:25637629

  17. Usefulness of the Hepatocyte Growth Factor as a Predictor of Mortality in Patients Hospitalized With Acute Heart Failure Regardless of Ejection Fraction.

    PubMed

    Pérez-Calvo, Juan-Ignacio; Morales-Rull, José-Luis; Gimeno-Orna, José-Antonio; Lasierra-Díaz, Pilar; Josa-Laorden, Claudia; Puente-Lanzarote, Juan-José; Bettencourt, Paulo; Pascual-Figal, Domingo A

    2016-08-15

    Hepatocyte growth factor (HGF) plays a role in the improvement of cardiac function and remodeling. Their serum levels are strongly related with mortality in chronic systolic heart failure (HF). The aim of this study was to study prognostic value of HGF in acute HF, interaction with ejection fraction, renal function, and natriuretic peptides. We included 373 patients (age 76 ± 10 years, left ventricular ejection fraction [LVEF] 46 ± 14%, 48% men) consecutively admitted for acute HF. Blood samples were obtained at admission. All patients were followed up until death or close of study (>1 year, median 371 days). HGF concentrations were determined using a commercial enzyme-linked immunosorbent assay (human HGF immunoassay). The predictive power of HGF was estimated by Cox regression with calculation of Harrell C-statistic. HGF had a median of 1,942 pg/ml (interquartile rank 1,354). According to HGF quartiles, mortality rates (per 1,000 patients/year) were 98, 183, 375, and 393, respectively (p <0.001). In Cox regression analysis, HGF (hazard ratio1SD = 1.5, 95% confidence interval 1.1 to 2.1, p = 0.002) and N-terminal pro b-type natriuretic peptide (NT-proBNP; hazard ratio1SD = 1.8, 95% confidence interval 1.2 to 2.6, p = 0.002) were independent predictors of mortality. Interaction between HGF and LVEF, origin, and renal function was nonsignificant. The addition of HGF improved the predictive ability of the models (C-statistic 0.768 vs 0.741, p = 0.016). HGF showed a complementary value over NT-proBNP (p = 0.001): mortality rate was 490 with both above the median versus 72 with both below. In conclusion, in patients with acute HF, serum HGF concentrations are elevated and identify patients at higher risk of mortality, regardless of LVEF, ischemic origin, or renal function. HGF had independent and additive information over NT-proBNP. PMID:27338207

  18. Assessment of vasodilator therapy in patients with severe congestive heart failure: limitations of measurements of left ventricular ejection fraction and volumes

    SciTech Connect

    Firth, B.G.; Dehmer, G.J.; Markham, R.V. Jr.; Willerson, J.T.; Hillis, L.D.

    1982-11-01

    Although noninvasive techniques are often used to assess the effect of vasodilator therapy in patients with congestive heart failure, it is unknown whether changes in noninvasively determined left ventricular ejection fraction, volume, or dimension reliably reflect alterations in intracardiac pressure and flow. Accordingly, we compared the acute effect of sodium nitroprusside on left ventricular volume and ejection fraction (determined scintigraphically) with its effect on intracardiac pressure and forward cardiac index (determined by thermodilution) in 12 patients with severe, chronic congestive heart failure and a markedly dilated left ventricle. Nitroprusside (infused at 1.3 +/- 1.1 (mean +/- standard deviation) microgram/kg/min) caused a decrease in mean systemic arterial, mean pulmonary arterial, and mean pulmonary capillary wedge pressure as well as a concomitant increase in forward cardiac index. Simultaneously, left ventricular end-diastolic and end-systolic volume indexes decreased, but the scintigraphically determined cardiac index did not change significantly. Left ventricular ejection fraction averaged 0.19 +/- 0.05 before nitroprusside administration and increased by less than 0.05 units in response to nitroprusside in 11 of 12 patients. The only significant correlation between scintigraphically and invasively determined variables was that between the percent change in end-diastolic volume index and the percent change in pulmonary capillary wedge pressure (r . 0.68, p . 0.01). Although nitroprusside produced changes in scintigraphically determined left ventricular ejection fraction, end-systolic volume index, and cardiac index, these alterations bore no predictable relation to changes in intracardiac pressure, forward cardiac index, or vascular resistance. Furthermore, nitroprusside produced a considerably greater percent change in the invasively measured variables than in the scintigraphically determined ones.

  19. Assessment of the Relationship between Galectin-3 and Ejection Fraction and Functional Capacity in the Patients with Compensated Systolic Heart Failure

    PubMed Central

    Atabakhshian, Roya; Kazerouni, Faranak; Raygan, Fariba; Amirrasouli, Hushang; Rahimipour, Ali; Shakeri, Nezhat

    2014-01-01

    Background: Galectin-3 is a soluble ß-galactoside–binding lectin released by activated cardiac macrophages. Galectin-3 has been proposed for diagnosis and prognosis of HF patients. Objectives: The present study aimed to investigate the relationship between galectin-3 as a biomarker and ejection fraction and functional capacity in the patients with compensated systolic heart failure. Patients and Methods: In this study, serum levels of Galectin-3 were measured in 76 patients with compensated heart failure with New York Heart Association class I–IV and left ventricular ejection fraction < 45%. Galectin-3 was measured by an ELISA kit. Besides, echocardiography was used to evaluate left ventricular ejection fraction. Additionally, functional capacity was determined based on the patients’ ability to perform a set of activities. After all, the data were analyzed used t-test, Kruskal-Wallis, one–way ANOVA, and chi-square test. P < 0.05 was considered as statistically significant. Results: The patients’ age ranged from 45 to 75 years, with the mean age of 63.85 ± 9 years. In addition 57.9% of the patients were male. The results revealed no significant correlation between Galectin-3 and age, body mass index, and estimated glomerular filtration rate. Also, no significant correlation was observed between Galectin-3 levels and left ventricular ejection fraction (P = 0.166) and functional capacity (P = 0.420). Yet, a significant difference was found between males and females regarding the mean of Galectin-3 (P = 0.039). Conclusions: The study results suggested that Galectin-3 could not be used as a marker of disease progression in the patients under treatment, which could probably be the result of medication use in these patients. PMID:25614856

  20. Patient barriers to implantable cardioverter defibrillator implantation for the primary prevention of sudden cardiac death in patients with heart failure and reduced ejection fraction

    PubMed Central

    Chan, Laura Lihua; Lim, Choon Pin; Aung, Soe Tin; Quetua, Paul; Ho, Kah Leng; Chong, Daniel; Teo, Wee Siong; Sim, David; Ching, Chi Keong

    2016-01-01

    INTRODUCTION Device therapy is efficacious in preventing sudden cardiac death (SCD) in patients with reduced ejection fraction. However, few who need the device eventually opt to undergo implantation and even fewer reconsider their decisions after deliberation. This is due to many factors, including unresolved patient barriers. This study identified the factors that influenced patients’ decision to decline implantable cardioverter defibrillator (ICD) implantation, and those that influenced patients who initially declined an implant to reconsider having one. METHODS A single-centre survey was conducted among 240 patients who had heart failure with reduced ejection fraction and met the ICD implantation criteria, but had declined ICD implantation. RESULTS Participants who refused ICD implantation were mostly male (84%), Chinese (71%), married (72%), currently employed (54%), and had up to primary or secondary education (78%) and monthly income of < SGD 3,000 (51%). Those who were more likely to reconsider their decision were aware that SCD was a consequence of heart failure with reduced ejection fraction, knowledgeable of the preventive role of ICDs, currently employed and aware that their doctor strongly recommended the implant. Based on multivariate analysis, knowledge of the role of ICDs for primary prophylaxis was the most important factor influencing patient decision. CONCLUSION This study identified the demographic and social factors of patients who refused ICD therapy. Knowledge of the role of ICDs in preventing SCD was found to be the strongest marker for reconsidering ICD implantation. Measures to address this information gap may lead to higher rates of ICD implantation. PMID:27075476

  1. Material ejection

    NASA Technical Reports Server (NTRS)

    Webb, David F.; Forbes, Terry G.; Aurass, Henry; Chen, James; Martens, Piet; Rompolt, Bogdan; Rusin, Vojtech; Martin, Sara F.

    1994-01-01

    This paper reviews the major discussions and conclusions of the Flares 22 Workshop concerning the physical processes involved in mass ejecta events, with an emphasis on large-scale phenomena, especially Coronal Mass Ejections (CMEs). New insights have been gained from recent data obtained from the Solar Maximum Mission (SMM) and Yohkoh spacecraft and from several new ground-based radio and optical instruments, as well as from theoretical advances concerning the origins, driving mechanisms and long-term evolution of CMEs.

  2. Clinical outcomes and cardiovascular responses to exercise training in heart failure patients with preserved ejection fraction: a systematic review and meta-analysis.

    PubMed

    Dieberg, Gudrun; Ismail, Hashbullah; Giallauria, Francesco; Smart, Neil A

    2015-09-15

    Exercise training induces physical adaptations for heart failure patients with systolic dysfunction, but less is known about those patients with preserved ejection fraction. To establish whether exercise training produces changes in peak V̇o2 and related measures, quality of life, general health, and diastolic function in heart failure patients with preserved ejection fraction. We conducted a MEDLINE search (1985 to October 10, 2014), for exercise-based rehabilitation trials in heart failure, using search terms "exercise training, heart failure with preserved ejection fraction, heart failure with normal ejection fraction, peak V̇o₂, and diastolic heart dysfunction". Seven intervention studies were included providing a total of 144 exercising subjects and 114 control subjects, a total of 258 participants. Peak V̇o₂ increased by a mean difference (MD) 2.13 ml·kg(-1)·min(-1) [95% confidence interval (CI) 1.54 to 2.71, P < 0.00001] in exercise training vs. sedentary control, equating to a 17% improvement from baseline. The corresponding data are provided for the following exercise test variables: V̇e/V̇co₂ slope, MD 0.85 ml·kg(-1)·min(-1) (95% CI 0.05 to 1.65, P = 0.04); maximum heart rate, MD 5.60 beats per minute (95% CI 3.95 to 7.25, P < 0.00001); Six-Minute Walk Test, MD 32.1 m (95% CI 17.2 to 47.1, P < 0.0001); and indices of diastolic function: E/A ratio, MD 0.07 (95% CI 0.02 to 0.12, P = 0.005); E/E' ratio MD -2.31 (95% CI -3.44 to -1.19, P < 0.0001); deceleration time (DT), MD -13.2 ms (95% CI -19.8 to -6.5, P = 0.0001); and quality of life: Minnesota Living with Heart Failure Questionnaire, MD -6.50 (95% CI -9.47 to -3.53, P < 0.0001); and short form-36 health survey (physical dimension), MD 15.6 (95% CI 7.4 to 23.8, P = 0.0002). In 3,744 h patient-hours of training, not one death was directly attributable to exercise. Exercise training appears to effect several health-related improvements in people with heart failure and preserved ejection

  3. Relation of Carotid Artery Diameter With Cardiac Geometry and Mechanics in Heart Failure With Preserved Ejection Fraction

    PubMed Central

    Liao, Zhen‐Yu; Peng, Ming‐Cheng; Yun, Chun‐Ho; Lai, Yau‐Huei; Po, Helen L.; Hou, Charles Jia‐Yin; Kuo, Jen‐Yuan; Hung, Chung‐Lieh; Wu, Yih‐Jer; Bulwer, Bernard E.; Yeh, Hung‐I; Tsai, Cheng‐Ho

    2012-01-01

    Background Central artery dilation and remodeling are associated with higher heart failure and cardiovascular risks. However, data regarding carotid artery diameter from hypertension to heart failure have remained elusive. We sought to investigate this issue by examining the association between carotid artery diameter and surrogates of ventricular dysfunction. Methods and Results Two hundred thirteen consecutive patients including 49 with heart failure and preserved ejection fraction (HFpEF), 116 with hypertension, and an additional 48 healthy participants underwent comprehensive echocardiography and tissue Doppler imaging. Ultrasonography of the common carotid arteries was performed for measurement of intima‐media thickness and diameter (CCAD). Cardiac mechanics, including LV twist, were assessed by novel speckle‐tracking software. A substantial graded enlargement of CCAD was observed across all 3 groups (6.8±0.6, 7.7±0.73, and 8.7±0.95 mm for normal, hypertension, and HFpEF groups, respectively; ANOVA P<0.001) and correlated with serum brain natriuretic peptide level (R2=0.31, P<0.001). Multivariable models showed that CCAD was associated with increased LV mass, LV mass‐to‐volume ratio (β‐coefficient=10.9 and 0.11, both P<0.001), reduced LV longitudinal and radial strain (β‐coeffficient=0.81 and −3.1, both P<0.05), and twist (β‐coefficient=−0.84, P<0.05). CCAD set at 8.07 mm as a cut‐off had a 77.6% sensitivity, 82.3% specificity, and area under the receiver operating characteristic curves (AUROC) of 0.86 (95% CI 0.80 to 0.92) in discriminating HFpEF. In addition, CCAD superimposed on myocardial deformation significantly expanded AUROC (for longitudinal strain, from 0.84 to 0.90, P of ΔAUROC=0.02) in heart failure discrimination models. Conclusions Increased carotid artery diameter is associated with worse LV geometry, higher brain natriuretic peptide level, and reduced contractile mechanics in individuals with HFpEF. PMID:23316319

  4. The Effect of Cardiac Rehabilitation Exercise Training on Cardiopulmonary Function in Ischemic Cardiomyopathy With Reduced Left Ventricular Ejection Fraction

    PubMed Central

    2016-01-01

    Objective To observe the effect and safety of cardiac rehabilitation (CR) exercise in ischemic cardiomyopathy and to compare the results between patients with preserved left ventricular ejection fraction (LVEF) and reduced LVEF. Methods Patients with ischemic cardiomyopathy with LVEF <50% were included as subjects. The patients were classified into the preserved LVEF (pLVEF; LVEF 41%–49%) group and the reduced LVEF (rLVEF; LVEF ≤40%) group. Patients underwent hourly aerobic exercise training sessions with an intensity of 60%–85% of heart rate reserve, three times a week for 6 weeks. Graded exercise test and transthoracic echocardiogram were performed in all study patients before and after completion of the CR exercise program. Results After completion of the CR exercise program, both groups (pLVEF, n=30; rLVEF, n=18) showed significant increases in LVEF and VO2max. In the pLVEF group, LVEF and VO2max increased from 45.1%±4.8% to 52.5%±9.6% (p<0.001) and from 24.1±6.3 to 28.1±8.8 mL/kg/min (p=0.002), respectively. In the rLVEF group, LVEF and VO2max increased from 29.7%±7.7% to 37.6%±10.3% (p<0.001) and from 17.6±4.7 to 21.2±5.1 mL/kg/min (p<0.001), respectively. Both groups completed their exercise program safely. Conclusion In both groups, patients with ischemic cardiomyopathy who completed a 6-week supervised CR exercise program demonstrated remarkable improvements in cardiopulmonary function. This result implies that neither of the two groups showed higher efficacy in comparison to each other, but we can conclude that CR exercise in the rLVEF group was as effective and safe as that in the pLVEF group. PMID:27606271

  5. Assessment of Left Ventricular Ejection Fraction Calculation on Long-axis Views From Cardiac Magnetic Resonance Imaging in Patients With Acute Myocardial Infarction

    PubMed Central

    Huttin, Olivier; Petit, Marie-Anaïs; Bozec, Erwan; Eschalier, Romain; Juillière, Yves; Moulin, Frédéric; Lemoine, Simon; Selton-Suty, Christine; Sadoul, Nicolas; Mandry, Damien; Beaumont, Marine; Felblinger, Jacques; Girerd, Nicolas; Marie, Pierre-Yves

    2015-01-01

    Abstract To assess left ventricular ejection fraction (LVEF) accurately, cardiac magnetic resonance (CMR) can be indicated and lays on the evaluation of multiple slices of the left ventricle in short axis (CMRSAX). The objective of this study was to assess another method consisting of the evaluation of 2 long-axis slices (CMRLAX) for LVEF determination in acute myocardial infarction. One hundred patients underwent CMR 2 to 4 days after acute myocardial infarction. LVEF was computed by the area-length method on horizontal and vertical CMRLAX images. Those results were compared to reference values obtained on contiguous CMRSAX images in one hand, and to values obtained from transthoracic echocardiography (TTE) in the other hand. For CMRSAX and TTE, LVEF was computed with Simpson method. Reproducibility of LVEF measurements was additionally determined. The accuracy of volume measurements was assessed against reference aortic stroke volumes obtained by phase-contrast MR imaging. LVEF from CMRLAX had a mean value of 47 ± 8% and were on average 5% higher than reference LVEF from CMRSAX (42 ± 8%), closer to routine values from TTELAX (49 ± 8%), much better correlated with the reference LVEF from CMRSAX (R = 0.88) than that from TTE (R = 0.58), obtained with a higher reproducibility than with the 2 other techniques (% of interobserver variability: CMRLAX 5%, CMRSAX 11%, and TTE 13%), and obtained with 4-fold lower recording and calculation times than for CMRSAX. Apart from this, CMRLAX stroke volume was well correlated with phase-contrast values (R = 0.81). In patients with predominantly regional contractility abnormalities, the determination of LVEF by CMRLAX is twice more reproducible than the reference CMRSAX method, even though the LVEF is consistently overestimated compared with CMRSAX. However, the CMRLAX LVEF determination provides values closer to TTE measurements, the most available and commonly used method in clinical practice, clinical

  6. Noninvasive prediction of the exercise-induced elevation in left ventricular filling pressure in post-heart transplant patients with normal left ventricular ejection fraction

    PubMed Central

    Meluzin, Jaroslav; Hude, Petr; Krejci, Jan; Spinarova, Lenka; Podrouzkova, Helena; Leinveber, Pavel; Dusek, Ladislav; Soska, Vladimir; Tomandl, Josef; Nemec, Petr

    2013-01-01

    OBJECTIVES: At present, there are conflicting data on the ability of echocardiographic parameters to predict the exercise-induced elevation of left ventricular (LV) filling pressure. The purpose of the present study was to validate the ratio of early diastolic transmitral (E) to mitral annular velocity (e′) obtained at peak exercise in its capacity to determine the exercise-induced elevation of pulmonary capillary wedge pressure (PCWP) and to reveal new noninvasive parameters with such capacity. METHODS: Sixty-one patients who had undergone heart transplantation with normal LV ejection fraction underwent simultaneous exercise echocardiography and right heart catheterization. RESULTS: In 50 patients with a normal PCWP at rest, exercise E/e′ ≥8.5 predicted exercise PCWP ≥25 mmHg with a sensitivity of 64.3% and a specificity of 84.2% (area under the curve [AUC]=0.74). A comparable or slightly better prediction was achieved by exercise E/peak systolic mitral annular velocity (s′) ≥11.0 (sensitivity 79.3%; specificity 57.9%; AUC=0.75) and exercise E/LV systolic longitudinal strain rate ≤−105 cm (sensitivity 78.9%; specificity 78.6%; AUC=0.87). Combined, exercise E/s′ and exercise E/e′ resulted in a trend toward a slightly more precise prediction (sensitivity 53.6%; specificity 89.5%; AUC=0.78) than did either variable alone. CONCLUSIONS: Exercise E/e′, used as a sole parameter, is not sufficiently precise to predict the exercise-induced elevation of PCWP. Exercise E/s′, E/LV systolic longitudinal strain rate or combinations of these parameters may represent further promising possibilities for predicting exercise PCWP elevation. PMID:23940422

  7. A mouse model of heart failure with preserved ejection fraction due to chronic infusion of a low subpressor dose of angiotensin II

    PubMed Central

    Regan, Jessica A.; Mauro, Adolfo Gabriele; Carbone, Salvatore; Marchetti, Carlo; Gill, Rabia; Mezzaroma, Eleonora; Valle Raleigh, Juan; Salloum, Fadi N.; Van Tassell, Benjamin W.; Abbate, Antonio

    2015-01-01

    Heart failure (HF) with preserved ejection fraction (HFpEF) is a clinical syndrome of HF symptoms associated with impaired diastolic function. Although it represents ∼50% of patients with HF, the mechanisms of disease are poorly understood, and therapies are generally ineffective in reducing HF progression. Animal models of HFpEF not due to pressure or volume overload are lacking, therefore limiting in-depth understanding of the pathophysiological mechanisms and the development of novel therapies. We hypothesize that a continuous infusion of low-dose angiotensin II (ATII) is sufficient to induce left ventricular (LV) diastolic dysfunction and HFpEF, without increasing blood pressure or inducing LV hypertrophy or dilatation. Osmotic pumps were implanted subcutaneously in 8-wk-old male mice assigned to the ATII (0.2 mg·kg−1·day−1) or volume-matched vehicle (N = 8/group) for 4 wk. We measured systolic and diastolic arterial blood pressures through a tail-cuff transducer, LV dimensions and ejection fraction through echocardiography, and LV relaxation through pulsed-wave Doppler and LV catheterization. Myocardial fibrosis and cardiomyocyte cross-sectional area were measured. ATII infusion had no effects on systemic arterial blood pressure. ATII induced significant impairment in LV diastolic function, as measured by an increase (worsening) in LV isovolumetric relaxation time, myocardial performance index, isovolumetric relaxation time constant, and LV end-diastolic pressure without altering LV dimensions, mass, or ejection fraction. Chronic infusion of low-dose ATII recapitulates the HFpEF phenotype in the mouse, without increasing systemic arterial blood pressure. This mouse model may provide insight into the mechanisms of HFpEF. PMID:26188021

  8. A mouse model of heart failure with preserved ejection fraction due to chronic infusion of a low subpressor dose of angiotensin II.

    PubMed

    Regan, Jessica A; Mauro, Adolfo Gabriele; Carbone, Salvatore; Marchetti, Carlo; Gill, Rabia; Mezzaroma, Eleonora; Valle Raleigh, Juan; Salloum, Fadi N; Van Tassell, Benjamin W; Abbate, Antonio; Toldo, Stefano

    2015-09-01

    Heart failure (HF) with preserved ejection fraction (HFpEF) is a clinical syndrome of HF symptoms associated with impaired diastolic function. Although it represents ∼50% of patients with HF, the mechanisms of disease are poorly understood, and therapies are generally ineffective in reducing HF progression. Animal models of HFpEF not due to pressure or volume overload are lacking, therefore limiting in-depth understanding of the pathophysiological mechanisms and the development of novel therapies. We hypothesize that a continuous infusion of low-dose angiotensin II (ATII) is sufficient to induce left ventricular (LV) diastolic dysfunction and HFpEF, without increasing blood pressure or inducing LV hypertrophy or dilatation. Osmotic pumps were implanted subcutaneously in 8-wk-old male mice assigned to the ATII (0.2 mg·kg(-1)·day(-1)) or volume-matched vehicle (N = 8/group) for 4 wk. We measured systolic and diastolic arterial blood pressures through a tail-cuff transducer, LV dimensions and ejection fraction through echocardiography, and LV relaxation through pulsed-wave Doppler and LV catheterization. Myocardial fibrosis and cardiomyocyte cross-sectional area were measured. ATII infusion had no effects on systemic arterial blood pressure. ATII induced significant impairment in LV diastolic function, as measured by an increase (worsening) in LV isovolumetric relaxation time, myocardial performance index, isovolumetric relaxation time constant, and LV end-diastolic pressure without altering LV dimensions, mass, or ejection fraction. Chronic infusion of low-dose ATII recapitulates the HFpEF phenotype in the mouse, without increasing systemic arterial blood pressure. This mouse model may provide insight into the mechanisms of HFpEF. PMID:26188021

  9. Time to retrieve the best benefits from renin angiotensin aldosterone system (RAAS) inhibition in heart failure patients with reduced ejection fraction: lessons from randomized controlled trials and registries.

    PubMed

    Rossignol, Patrick; Zannad, Faiez; Pitt, Bertram

    2014-12-20

    Numerous registries, including the most recent ESC Euro-observational registry, have reported a large and persistent gap between real-life practice in the use of life-saving evidence-based therapies (such as renin angiotensin antagonists, beta-blockers, mineralocorticoid receptor antagonists) and recommended practices in international guidelines. Although the use of multiple renin angiotensin aldosterone system-inhibitors is associated with the development of worsening renal function and hyperkalemia in patients with heart failure and reduced ejection fraction, increased efforts should be expended to initiate and maintain target doses of these agents so as to provide their benefits on mortality and hospitalizations for heart failure. PMID:25465821

  10. [First-tracer passage with a single-crystal gamma camera: completed assessment of left-ventricular function by determining enddiastolic volume, regional ejection fraction and %-akinetic segment (author's transl)].

    PubMed

    Bull, U; Knesewitsch, P; Kleinhans, E; Seiderer, M; Strauer, B E

    1981-06-01

    Determination of left ventricular (LV) enddiastolic volume (EDV) was achieved by calibration of the system (single-crystal gamma camera, equipped with a converging collimator) to a volume phantom (egg). A good correlation (r = 0.92) was found with EDV values, obtained from cineventriculography. Images, derived from enddiastole (ED) and endsystole (ES) were corrected for background by "parabolic background subtraction", which is a realistic form of background correction in view of the LV-shape. Regional ejection fraction (REF) was calculated by an electronical operation using the ejection fraction formula and these ED and ES images. REF values reflect regional or segmental LV pump function and are superior to one- or two-dimensional parameters (e.g. visual assessment of asynergy, hemiaxis shortening) since REF values include the third dimension by referring to regional volumes. In addition, per cent-akinetic segment may be replaced by REF. Results from the literature show that first-tracer passage with a single crystal gamma camera at rest (n = 534) yield equivalent results in comparison with cineventriculography. Therefore, this nuclear procedure may be routinely used. REF values complete the diagnostic parameter as yet available. PMID:6265871

  11. Left ventricular volumes, ejection fraction, and plasma proatrial natriuretic factor (1-98) after withdrawal of enalapril treatment initiated early after myocardial infarction. CONSENSUS II Multi-Echo Study Group.

    PubMed Central

    Bonarjee, V. V.; Omland, T.; Nilsen, D. W.; Carstensen, S.; Berning, J.; Edner, M.; Caidahl, K.

    1995-01-01

    OBJECTIVES--To assess whether the reduction in left ventricular dilatation after acute myocardial infarction obtained by early administration of angiotensin converting enzyme inhibitors depends on continuous treatment. DESIGN--Prospective observational and cross sectional study of withdrawal of randomised treatment with enalapril or placebo. PATIENTS--106 patients on 6 months trial treatment after an acute myocardial infarction. MAIN OUTCOME MEASURES--Left ventricular volumes and ejection fraction as assessed by echocardiography and circulating proatrial natriuretic factor (1-98) before and 4-6 weeks after withdrawal of treatment. RESULTS--There were no significant changes (mean (SD)) in left ventricular systolic (0.7 (4.7) ml/m2) and diastolic (0.4 (6.6) ml/m2) volume indices, ejection fraction (-0.9 (6)%), and proatrial natriuretic factor (172 (992) pmol/l) after withdrawal of enalapril. The significantly lower left ventricular volumes observed with 6 months of enalapril therapy after acute myocardial infarction, as compared with placebo, were maintained 6 weeks after drug withdrawal. CONCLUSION--The results show that the benefit of 6 months of enalapril treatment initiated early after myocardial infarction is maintained for at least 6 weeks after drug withdrawal, suggesting that the treatment effect on left ventricular structure is not reversed by changes in loading conditions caused by subsequent drug withdrawal. PMID:7626347

  12. Pharmacological Mechanisms Underlying Gastroprotective Activities of the Fractions Obtained from Polygonum minus in Sprague Dawley Rats

    PubMed Central

    Qader, Suhailah Wasman; Abdulla, Mahmood Ameen; Chua, Lee Suan; Sirat, Hasnah Mohd; Hamdan, Salehhuddin

    2012-01-01

    The leaves of Polygonum minus were fractionated using an eluting solvent to evaluate the pharmacological mechanisms underlying the anti-ulcerogenic activity of P. minus. Different P. minus fractions were obtained and evaluated for their ulcer preventing capabilities using the ethanol induction method. In this study, Sprague Dawley rats weighing 150–200 g were used. Different parameters were estimated to identify the active fraction underlying the mechanism of the gastroprotective action of P. minus: the gastric mucus barrier, as well as superoxide dismutase, total hexosamine, and prostaglandin synthesis. Amongst the five fractions from the ethanolic extract of P. minus, the ethyl acetate:methanol 1:1 v/v fraction (F2) significantly (p < 0.005) exhibited better inhibition of ulcer lesions in a dose-dependent manner. In addition, rats pre-treated with F2 showed a significant elevation in superoxide dismutase (SOD), hexosamine and PGE2 levels in the stomach wall mucosa in a dose-dependent matter. Based on these results, the ethyl acetate:methanol 1:1 v/v fraction was considered to be the best fraction for mucous protection in the ethanol induction model. The mechanisms underlying this protection were attributed to the synthesis of antioxidants and PGE2. PMID:22408403

  13. Pharmacological mechanisms underlying gastroprotective activities of the fractions obtained from Polygonum minus in Sprague Dawley rats.

    PubMed

    Qader, Suhailah Wasman; Abdulla, Mahmood Ameen; Chua, Lee Suan; Sirat, Hasnah Mohd; Hamdan, Salehhuddin

    2012-01-01

    The leaves of Polygonum minus were fractionated using an eluting solvent to evaluate the pharmacological mechanisms underlying the anti-ulcerogenic activity of P. minus. Different P. minus fractions were obtained and evaluated for their ulcer preventing capabilities using the ethanol induction method. In this study, Sprague Dawley rats weighing 150-200 g were used. Different parameters were estimated to identify the active fraction underlying the mechanism of the gastroprotective action of P. minus: the gastric mucus barrier, as well as superoxide dismutase, total hexosamine, and prostaglandin synthesis. Amongst the five fractions from the ethanolic extract of P. minus, the ethyl acetate:methanol 1:1 v/v fraction (F2) significantly (p < 0.005) exhibited better inhibition of ulcer lesions in a dose-dependent manner. In addition, rats pre-treated with F2 showed a significant elevation in superoxide dismutase (SOD), hexosamine and PGE2 levels in the stomach wall mucosa in a dose-dependent matter. Based on these results, the ethyl acetate:methanol 1:1 v/v fraction was considered to be the best fraction for mucous protection in the ethanol induction model. The mechanisms underlying this protection were attributed to the synthesis of antioxidants and PGE2. PMID:22408403

  14. Abnormal calcium homeostasis in heart failure with preserved ejection fraction is related to both reduced contractile function and incomplete relaxation: an electromechanically detailed biophysical modeling study

    PubMed Central

    Adeniran, Ismail; MacIver, David H.; Hancox, Jules C.; Zhang, Henggui

    2015-01-01

    Heart failure with preserved ejection fraction (HFpEF) accounts for about 50% of heart failure cases. It has features of incomplete relaxation and increased stiffness of the left ventricle. Studies from clinical electrophysiology and animal experiments have found that HFpEF is associated with impaired calcium homeostasis, ion channel remodeling and concentric left ventricle hypertrophy (LVH). However, it is still unclear how the abnormal calcium homeostasis, ion channel and structural remodeling affect the electro-mechanical dynamics of the ventricles. In this study we have developed multiscale models of the human left ventricle from single cells to the 3D organ, which take into consideration HFpEF-induced changes in calcium handling, ion channel remodeling and concentric LVH. Our simulation results suggest that at the cellular level, HFpEF reduces the systolic calcium level resulting in a reduced systolic contractile force, but elevates the diastolic calcium level resulting in an abnormal residual diastolic force. In our simulations, these abnormal electro-mechanical features of the ventricular cells became more pronounced with the increase of the heart rate. However, at the 3D organ level, the ejection fraction of the left ventricle was maintained due to the concentric LVH. The simulation results of this study mirror clinically observed features of HFpEF and provide new insights toward the understanding of the cellular bases of impaired cardiac electromechanical functions in heart failure. PMID:25852567

  15. Cognitive Function in Ambulatory Patients with Systolic Heart Failure: Insights from the Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction (WARCEF) Trial

    PubMed Central

    Graham, Susan; Ye, Siqin; Qian, Min; Sanford, Alexandra R.; Di Tullio, Marco R.; Sacco, Ralph L.; Mann, Douglas L.; Levin, Bruce; Pullicino, Patrick M.; Freudenberger, Ronald S.; Teerlink, John R.; Mohr, J. P.; Labovitz, Arthur J.; Lip, Gregory Y. H.; Estol, Conrado J.; Lok, Dirk J.; Ponikowski, Piotr; Anker, Stefan D.; Thompson, John L. P.; Homma, Shunichi

    2014-01-01

    We sought to determine whether cognitive function in stable outpatients with heart failure (HF) is affected by HF severity. A retrospective, cross-sectional analysis was performed using data from 2, 043 outpatients with systolic HF and without prior stroke enrolled in the Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction (WARCEF) Trial. Multivariable regression analysis was used to assess the relationship between cognitive function measured using the Mini-Mental Status Exam (MMSE) and markers of HF severity (left ventricular ejection fraction [LVEF], New York Heart Association [NYHA] functional class, and 6-minute walk distance). The mean (SD) for the MMSE was 28.6 (2.0), with 64 (3.1%) of the 2,043 patients meeting the cut-off of MMSE <24 that indicates need for further evaluation of cognitive impairment. After adjustment for demographic and clinical covariates, 6-minute walk distance (β-coefficient 0.002, p<0.0001), but not LVEF or NYHA functional class, was independently associated with the MMSE as a continuous measure. Age, education, smoking status, body mass index, and hemoglobin level were also independently associated with the MMSE. In conclusion, six-minute walk distance, but not LVEF or NYHA functional class, was an important predictor of cognitive function in ambulatory patients with systolic heart failure. PMID:25426862

  16. Cognitive function in ambulatory patients with systolic heart failure: insights from the warfarin versus aspirin in reduced cardiac ejection fraction (WARCEF) trial.

    PubMed

    Graham, Susan; Ye, Siqin; Qian, Min; Sanford, Alexandra R; Di Tullio, Marco R; Sacco, Ralph L; Mann, Douglas L; Levin, Bruce; Pullicino, Patrick M; Freudenberger, Ronald S; Teerlink, John R; Mohr, J P; Labovitz, Arthur J; Lip, Gregory Y H; Estol, Conrado J; Lok, Dirk J; Ponikowski, Piotr; Anker, Stefan D; Thompson, John L P; Homma, Shunichi

    2014-01-01

    We sought to determine whether cognitive function in stable outpatients with heart failure (HF) is affected by HF severity. A retrospective, cross-sectional analysis was performed using data from 2, 043 outpatients with systolic HF and without prior stroke enrolled in the Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction (WARCEF) Trial. Multivariable regression analysis was used to assess the relationship between cognitive function measured using the Mini-Mental Status Exam (MMSE) and markers of HF severity (left ventricular ejection fraction [LVEF], New York Heart Association [NYHA] functional class, and 6-minute walk distance). The mean (SD) for the MMSE was 28.6 (2.0), with 64 (3.1%) of the 2,043 patients meeting the cut-off of MMSE <24 that indicates need for further evaluation of cognitive impairment. After adjustment for demographic and clinical covariates, 6-minute walk distance (β-coefficient 0.002, p<0.0001), but not LVEF or NYHA functional class, was independently associated with the MMSE as a continuous measure. Age, education, smoking status, body mass index, and hemoglobin level were also independently associated with the MMSE. In conclusion, six-minute walk distance, but not LVEF or NYHA functional class, was an important predictor of cognitive function in ambulatory patients with systolic heart failure. PMID:25426862

  17. [Ejection fraction and sizes of the left ventricle of the heart after intracoronary administration of autologous mononuclear cells of the bone marrow in patients with coronary artery disease with low ejection fraction].

    PubMed

    Burnos, S N; Nemkov, A S; Belyĭ, S A; Lukashenko, V I

    2011-01-01

    Since 2003 intracoronary administration of autologous bone marrow mononuclear cells has been performed in 119 patients with inoperable coronary artery disease, 53 of which had reduced ejection function that was gradually increased after injection of mononuclear bone marrow cells. By the 6th year the difference between the median of systolic and diastolic sizes of the left ventricle decreased by 12 and 14 mm respectively. In the control group the dynamics of changes of these indices at the same period was of negative character. The introduction of intracoronary bone marrow mononuclear cells is a safe and effective method of invasive therapy in patients with coronary artery disease to whom surgery is contraindicated. PMID:22191250

  18. Cardiopulmonary Toxicity of Size-Fractionated Particulate Matter Obtained at Different Distances from a Highway

    EPA Science Inventory

    This study was initiated to determine the effect of size fractionated particulate matter (PM) obtained at different distances from a highway on acute cardiopulmonary toxicity in mice. PM was collected for 2 weeks using a three-stage (ultrafine: <0.1µm; fine: 0.1-2.5µm; and coarse...

  19. A novel convenient process to obtain a raw decaffeinated tea polyphenol fraction using a lignocellulose column.

    PubMed

    Sakanaka, Senji

    2003-05-01

    Lignocellulose prepared from sawdust was investigated for its potential application in obtaining a raw decaffeinated tea polyphenol fraction from tea extract. Tea polyphenols having gallate residues, namely, (-)epigallocatechin gallate (EGCg) and (-)epicatechin gallate (ECg), were adsorbed on the lignocellulose column, while caffeine was passed through it. Adsorbed polyphenols were eluted with 60% ethanol, and the elute was found to consist mainly of EGCg and ECg. The caffeine/EGCg ratio was 0.696 before lignocellulose column treatment, but it became 0.004 after the column treatment. These results suggest that the lignocellulose column provides a useful and convenient process of purification of tea polyphenol fraction accompanied by decaffeination. PMID:12720405

  20. Extraction by three processes of arabinoxylans from wheat bran and characterization of the fractions obtained.

    PubMed

    Aguedo, Mario; Fougnies, Christian; Dermience, Michaël; Richel, Aurore

    2014-05-25

    Arabinoxylans (AXs) were extracted from destarched wheat bran (DWB) according to different processes, with a view to their production at industrial scale. Two fractions (F3a and F3b, respectively, purified on 10kDa and 100kDa ultrafiltration membranes) were obtained with low yields by treating DWB with an endoxylanase and this process left a solid residue exhausted in enzyme-extractable AXs (EDWB). F1 and F2 AX fractions were obtained by treatment with sodium hydroxide of, respectively, DWB and EDWB. The fraction F4 resulted from a hydrothermal treatment of EDWB in a pressure reactor, followed by ethanol precipitation. The different AX fractions were characterized and compared for the composition in monosaccharides, for the contents in fats and in ferulic, phytic and uronic acids, for the molecular mass distribution and the degrees of methylation and acetylation. The alkaline extractions gave one deesterified AX population with molecular mass (MM) higher than 670kDa and arabinose/xylose ratios (Ara/Xyl) around 1. The enzyme and thermal treatments yielded AXs with two main populations in size-exclusion chromatography (the largest one at 5-12.5kDa and a second one at 140-160kDa), having overall Ara/Xyl of, respectively, 0.7 and 0.5 for both processes. These data bring information about the influence of the process on the characteristics of AX fractions obtained from pretreated wheat bran. Here are also reported processes that enabled to recover enzyme-unextractable AXs from DWB, including an original and up-scalable hydrothermal extraction. Phytate contents of isolated AXs are described for the first time. PMID:24708986

  1. Hydrolyzable Tannins from Sweet Chestnut Fractions Obtained by a Sustainable and Eco-friendly Industrial Process.

    PubMed

    Campo, Margherita; Pinelli, Patrizia; Romani, Annalisa

    2016-03-01

    Sweet Chestnut (Castanea sativa Mill.) wood extracts, rich in Hydrolyzable Tannins (HTs), are traditionally used in the tanning and textile industries, but recent studies suggest additional uses. The aim of this work is the HPLC-DAD-ESI-MS characterization of Sweet Chestnut aqueous extracts and fractions obtained through a membrane separation technology system without using other solvents, and the evaluation of their antioxidant and antiradical activities. Total tannins range between 2.7 and 138.4 mM; gallic acid ranges between 6% and 100%; castalagin and vescalagin range between 0% and 40%. Gallic Acid Equivalents, measured with the Folin-Ciocalteu test, range between 0.067 and 56.99 g/100 g extract weight; ORAC test results for the marketed fractions are 450.4 and 3050 µmol/g Trolox Equivalents/extract weight. EC₅₀ values, measured with the DPPH test, range between 0.444 and 2.399 µM. These results suggest a new ecofriendly and economically sustainable method for obtaining chestnut fractions with differentiated, stable and reproducible chemical compositions. Such fractions can be marketed for innovative uses in several sectors. PMID:27169194

  2. A Robust e-Epidemiology Tool in Phenotyping Heart Failure with Differentiation for Preserved and Reduced Ejection Fraction: the Electronic Medical Records and Genomics (eMERGE) Network.

    PubMed

    Bielinski, Suzette J; Pathak, Jyotishman; Carrell, David S; Takahashi, Paul Y; Olson, Janet E; Larson, Nicholas B; Liu, Hongfang; Sohn, Sunghwan; Wells, Quinn S; Denny, Joshua C; Rasmussen-Torvik, Laura J; Pacheco, Jennifer Allen; Jackson, Kathryn L; Lesnick, Timothy G; Gullerud, Rachel E; Decker, Paul A; Pereira, Naveen L; Ryu, Euijung; Dart, Richard A; Peissig, Peggy; Linneman, James G; Jarvik, Gail P; Larson, Eric B; Bock, Jonathan A; Tromp, Gerard C; de Andrade, Mariza; Roger, Véronique L

    2015-11-01

    Identifying populations of heart failure (HF) patients is paramount to research efforts aimed at developing strategies to effectively reduce the burden of this disease. The use of electronic medical record (EMR) data for this purpose is challenging given the syndromic nature of HF and the need to distinguish HF with preserved or reduced ejection fraction. Using a gold standard cohort of manually abstracted cases, an EMR-driven phenotype algorithm based on structured and unstructured data was developed to identify all the cases. The resulting algorithm was executed in two cohorts from the Electronic Medical Records and Genomics (eMERGE) Network with a positive predictive value of >95 %. The algorithm was expanded to include three hierarchical definitions of HF (i.e., definite, probable, possible) based on the degree of confidence of the classification to capture HF cases in a whole population whereby increasing the algorithm utility for use in e-Epidemiologic research. PMID:26195183

  3. Comparison of mortality and morbidity in patients with atrial fibrillation and heart failure with preserved versus decreased left ventricular ejection fraction.

    PubMed

    Badheka, Apurva O; Rathod, Ankit; Kizilbash, Mohammad A; Bhardwaj, Aditya; Ali, Omaima; Afonso, Luis; Jacob, Sony

    2011-11-01

    Almost 50% of patients with congestive heart failure (HF) have preserved ejection fraction (PEF). Data on the effect of HF-PEF on atrial fibrillation outcomes are lacking. We assessed the prognostic significance of HF-PEF in an atrial fibrillation population compared to a systolic heart failure (SHF) population. A post hoc analysis of the National Heart, Lung, and Blood Institute-limited access data set of the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) trial was carried out. The patients with a history of congestive HF and a preserved ejection fraction (EF >50%) were classified as having HF-PEF (n = 320). The patients with congestive HF and a qualitatively depressed EF (EF <50%) were classified as having SHF (n = 402). Cox proportional hazards analysis was performed. The mean follow-up duration was 1,181 ± 534 days/patient. The patients with HF-PEF had lower all-cause mortality (hazard ratio [HR] 0.62, 95% confidence interval [CI] 0.46 to 0.85, p = 0.003) and cardiovascular mortality (HR 0.56, 95% CI 0.38 to 0.84, p = 0.006), with a possible decreased arrhythmic end point (HR 0.39, 95% CI 0.16 to 1.006, p = 0.052) than did the patients with SHF. No differences were observed for ischemic stroke (HR 1.08, 95% CI 0.48 to 2.39, p = 0.86), rehospitalization (HR 0.89, 95% CI 0.75 to 1.07, p = 0.24), or progression to New York Heart Association class III-IV (odds ratio 0.80, 95% CI 0.42 to 1.54, p = 0.522). In conclusion, although patients with HF-PEF have better mortality outcomes than those with SHF, the morbidity appears to be similar. PMID:21855829

  4. Comparison of Estimations Versus Measured Oxygen Consumption at Rest in Patients With Heart Failure and Reduced Ejection Fraction Who Underwent Right-Sided Heart Catheterization.

    PubMed

    Chase, Paul J; Davis, Paul G; Wideman, Laurie; Starnes, Joseph W; Schulz, Mark R; Bensimhon, Daniel R

    2015-12-01

    Cardiac output during right-sided heart catheterization is an important variable for patient selection of advanced therapies (cardiac transplantation and left ventricular assist device implantation). The Fick method to determine cardiac output is commonly used and typically uses estimated oxygen consumption (VO2) from 1 of 3 published empirical formulas. However, these estimation equations have not been validated in patients with heart failure and reduced ejection fraction (HFrEF). The objectives of the present study were to determine the accuracy of 3 equations for estimating VO2 compared with direct measurement of VO2 and determine the extent clinically significant error occurred in calculating cardiac output of patients with HFrEF. Breath-by-breath measurements of VO2 from 44 patients who underwent cardiac catheterization (66% men; age, 65 ± 11 years, left ventricular ejection fraction, 22 ± 6%) were compared with the derived estimations of LaFarge and Miettinen, Dehmer et al, and Bergstra et al. Single-sample t tests found only the mean difference between the estimation of LaFarge and Miettinen and the measured VO2 to be nonsignificant (-10.3 ml/min ± 6.2 SE, p = 0.053). Bland-Altman plots demonstrated unacceptably large limits of agreement for all equations. The rate of ≥25% error in the equations by LaFarge and Miettinen, Dehmer et al, and Bergstra et al occurred in 11%, 23%, and 45% of patients, respectively. Misclassification of cardiac index derived from each equation for 2 clinically important classifications: cardiogenic shock-21%, 23%, and 32% and hypoperfusion-16%, 16%, and 25%; respectively. In conclusion, these findings do not support the use of these empiric formulas to estimate the VO2 at rest in patients with HFrEF who underwent right-sided heart catheterization. PMID:26443561

  5. Association of the Frontal QRS-T Angle with Adverse Cardiac Remodeling, Impaired Left and Right Ventricular Function, and Worse Outcomes in Heart Failure with Preserved Ejection Fraction

    PubMed Central

    Selvaraj, Senthil; Ilkhanoff, Leonard; Burke, Michael A.; Freed, Benjamin H.; Lang, Roberto M.; Martinez, Eva E.; Shah, Sanjiv J.

    2013-01-01

    Background No prior studies have investigated the association of QRS-T angle with cardiac structure/function and outcomes in heart failure with preserved ejection fraction (HFpEF). We hypothesized that increased frontal QRS-T angle is associated with worse cardiac function/remodeling and adverse outcomes in HFpEF. Methods We prospectively studied 376 patients with HFpEF (i.e. symptomatic HF with left ventricular [LV] ejection fraction >50%.) The frontal QRS-T angle was calculated from the 12-lead electrocardiogram. Patients were divided into tertiles by frontal QRS-T angle (0–26°, 27–75°, and 76–179°), and clinical, laboratory, and echocardiographic data were compared among groups. Cox proportional hazards analyses were performed to determine the association between QRS-T angle and outcomes. Results The mean age of the cohort was 64±13 years, 65% were women, and the mean QRS-T angle was 61±51°. Patients with increased QRS-T angle were older, had a lower body-mass index, more frequently had coronary artery disease, diabetes, chronic kidney disease, and atrial fibrillation, and had higher B-type natriuretic peptide (BNP) levels (P<0.05 for all comparisons). After multivariable adjustment, patients with increased QRS-T angle had higher BNP levels in addition to higher LV mass index, worse diastolic function parameters, more right ventricular (RV) remodeling, and worse RV systolic function (P<0.05 for all associations). QRS-T angle was independently associated with the composite outcome of cardiovascular hospitalization or death on multivariable analysis, even after adjusting for BNP (HR for the highest QRS-T tertile = 2.0, 95% CI 1.2–3.4; P=0.008). Conclusions In HFpEF, increased QRS-T angle is independently associated with worse left and right ventricular function/remodeling and adverse outcomes. PMID:24075945

  6. Association of Serum Triiodothyronine with B-type Natriuretic Peptide and Severe Left Ventricular Diastolic Dysfunction in Heart Failure with Preserved Ejection Fraction

    PubMed Central

    Selvaraj, Senthil; Klein, Irwin; Danzi, Sara; Akhter, Nausheen; Bonow, Robert O.; Shah, Sanjiv J.

    2012-01-01

    There are well-documented changes in thyroid hormone metabolism that accompany heart failure (HF). However, the frequency of thyroid hormone abnormalities in HF with preserved ejection fraction (HFpEF) is unknown, and no studies have investigated the association between triiodothyronine (T3) and markers of HF severity (B-type natriuretic peptide [BNP] and diastolic dysfunction [DD]) in HFpEF. We prospectively studied 89consecutive patients with HFpEF, defined as symptomatic HF with LV ejection fraction >50% and LV end-diastolic volume index < 97 ml/m2. Patients were dichotomized into two groups based upon median T3 levels, and clinical, laboratory, and echocardiographic data were compared between groups. Univariable and multivariable linear regression analyses were performed to determine whether BNP and DD were independently associated with T3 level. We found that 22% of HFpEF patients had reduced T3. Patients with lowerT3 levels were older, more symptomatic, more frequently had hyperlipidemia and diabetes, and had higher BNP levels. Severe (grade 3) DD, higher mitral E velocity, shorter deceleration time, and higher pulse pressure/stroke volume ratio were all associated with lower T3 levels. T3 was inversely associated with both log BNP (p=0.004) and severity of DD (p=0.039). On multivariable analysis, T3 was independently associated with both log BNP (β=−4.7 [95% CI −9.0, −0.41]ng/dl, p=0.032) and severe DD (β=−16.3 [95% CI −30.1, −2.5]ng/dl, p=0.022). In conclusion, T3 is inversely associated with markers of HFpEF severity (BNP and DD). Whether reduced T3 contributes to or is a consequence of increased severity of HFpEF remains to be determined. PMID:22502900

  7. Amyloid Light-Chain Amyloidosis Manifesting as Heart Failure with Preserved Ejection Fraction in a Patient with Hyper-Immunoglobulin E-emia

    PubMed Central

    Nojima, Yuhei; Ihara, Madoka; Kurimoto, Testuya; Nanto, Shinsuke

    2016-01-01

    Patient: Male, 53 Final Diagnosis: Acute heart failure • primary AL amyloidosis • hyper IgE-emia Symptoms: Progressive breathlessness Medication: Angiotensin-converting enzyme inhibitors and beta blockers Clinical Procedure: Skin and endomyocardial biopsy Specialty: Cardiology Objective: Rare co-existence of disease or pathology Background: Considering the increased prevalence of heart failure with preserved ejection fraction (HFpEF) as a result of the aging population, the pathophysiology of HFpEF needs to be examined. Furthermore, many comorbidity profiles in patients with HFpEF have been reported. Hypertrophic cardiomyopathy is a well-known specific etiology of HFpEF. Cardiac amyloidosis, which mimics infiltrative and hypertrophic cardiomyopathy, resulting from intensive amyloid deposition, is easily overlooked. Case Report: A 53-year-old man with a 2-week history of persistent breathlessness was referred to our hospital. Upon admission, transthoracic echocardiography showed concentric mild left ventricular (LV) hypertrophy without a characteristic granular sparkling appearance or pericardial effusion, preserved ejection fraction, and bi-atrial enlargement with normal ventricular chambers. Doppler-derived LV diastolic filling demonstrated a prominent restrictive pattern indicating LV stiffness and elevated LV filling pressure. Blood tests revealed severe elevation of B-type natriuretic peptide and marked elevation of immunoglobulin E without eosinophilia. He was diagnosed with primary amyloid light-chain (AL) amyloidosis via skin and endomyocardial biopsy. Conclusions: We encountered a rare case of hypertrophic cardiomyopathy with HFpEF and identified a Doppler-derived restrictive filling pattern suggestive of early-stage heart failure in infiltrative cardiomyopathies. We suggest that infiltrative cardiomyopathies, such as cardiac amyloidosis, should be considered if hypertrophic cardiomyopathy is observed in a patient with HFpEF. PMID:27064109

  8. The Prognostic Value of the Left Ventricular Ejection Fraction Is Dependent upon the Severity of Mitral Regurgitation in Patients with Acute Myocardial Infarction

    PubMed Central

    Cho, Jung Sun; Youn, Ho-Joong; Her, Sung-Ho; Park, Maen Won; Kim, Chan Joon; Park, Gyung-Min; Cho, Jae Yeong; Ahn, Youngkeun; Kim, Kye Hun; Park, Jong Chun; Seung, Ki Bae; Cho, Myeong Chan; Kim, Chong Jin; Kim, Young Jo; Han, Kyoo Rok; Kim, Hyo Soo

    2015-01-01

    The prognostic value of the left ventricle ejection fraction (LVEF) after acute myocardial infarction (AMI) has been questioned even though it is an accurate marker of left ventricle (LV) systolic dysfunction. This study aimed to examine the prognostic impact of LVEF in patients with AMI with or without high-grade mitral regurgitation (MR). A total of 15,097 patients with AMI who received echocardiography were registered in the Korean Acute Myocardial Infarction Registry (KAMIR) between January 2005 and July 2011. Patients with low-grade MR (grades 0-2) and high-grade MR (grades 3-4) were divided into the following two sub-groups according to LVEF: LVEF ≤ 40% (n = 2,422 and 197, respectively) and LVEF > 40% (n = 12,252 and 226, respectively). The primary endpoints were major adverse cardiac events (MACE), cardiac death, and all-cause death during the first year after registration. Independent predictors of mortality in the multivariate analysis in AMI patients with low-grade MR were age ≥ 75 yr, Killip class ≥ III, N-terminal pro-B-type natriuretic peptide > 4,000 pg/mL, high-sensitivity C-reactive protein ≥ 2.59 mg/L, LVEF ≤ 40%, estimated glomerular filtration rate (eGFR), and percutaneous coronary intervention (PCI). However, PCI was an independent predictor in AMI patients with high-grade MR. No differences in primary endpoints between AMI patients with high-grade MR (grades 3-4) and EF ≤ 40% or EF > 40% were noted. MR is a predictor of a poor outcome regardless of ejection fraction. LVEF is an inadequate method to evaluate contractile function of the ischemic heart in the face of significant MR. PMID:26130953

  9. A method to obtain a well-defined fraction of respirable para-aramid fibers.

    PubMed

    Schins, R P; Gaudichet, A; Jaurand, M C

    1993-10-01

    We developed a preparation method to obtain respirable-sized fractions of para-aramid fibers. The procedure, based on floatability, consists of stirring and subsequent settling of p-aramid pulp in distilled water. Two distinct phases are obtained, with small fibers in the upper part of the suspension, which represents about 33% of the total volume. Optimal results were obtained when 2.0 g pulp was stirred for 15 hr in 800 ml distilled water containing 0.125% ethanol and settled for 5 hr. The mass yield ranged between 0.4 and 0.6%, more than 90% of the particles had an aspect ratio > or = 3:1. The mean fiber length was about 6 microns, and the mean fiber diameter was about 0.4 microns as determined by transmission and scanning electron microscopy. The number of fibers obtained was 4 x 10(6) fibers/micrograms under our standard conditions. PMID:8119251

  10. Fractionation and Purification of Bioactive Compounds Obtained from a Brewery Waste Stream

    PubMed Central

    Barbosa-Pereira, Letricia; Pocheville, Ainara; Angulo, Inmaculada; Paseiro-Losada, Perfecto; Cruz, Jose M.

    2013-01-01

    The brewery industry generates waste that could be used to yield a natural extract containing bioactive phenolic compounds. We compared two methods of purifying the crude extract—solid-phase extraction (SPE) and supercritical fluid extraction (SFE)—with the aim of improving the quality of the final extract for potential use as safe food additive, functional food ingredient, or nutraceutical. The predominant fractions yielded by SPE were the most active, and the fraction eluted with 30% (v/v) of methanol displayed the highest antioxidant activity (0.20 g L−1), similar to that of BHA. The most active fraction yielded by SFE (EC50 of 0.23 g L−1) was obtained under the following conditions: temperature 40°C, pressure 140 bar, extraction time 30 minutes, ethanol (6%) as a modifier, and modifier flow 0.2 mL min−1. Finally, we found that SFE is the most suitable procedure for purifying the crude extracts and improves the organoleptic characteristics of the product: the final extract was odourless, did not contain solvent residues, and was not strongly coloured. Therefore, natural extracts obtained from the residual stream and purified by SFE can be used as natural antioxidants with potential applications in the food, cosmetic, and pharmaceutical industries. PMID:23762844

  11. ACE-I Inhibitory Activity from Phaseolus lunatus and Phaseolus vulgaris Peptide Fractions Obtained by Ultrafiltration.

    PubMed

    Betancur-Ancona, David; Dávila-Ortiz, Gloria; Chel-Guerrero, Luis Antonio; Torruco-Uco, Juan Gabriel

    2015-11-01

    The involvement of angiotensin-I-converting enzyme (ACE-I) as one of the mechanisms controlling blood pressure is being studied to find alternative means of control of hypertension on human beings. On the market there are synthetic drugs that can control it, but these can cause undesirable health side effects. In this work was assessed the fractionation by ultrafiltration of the Lima bean (Phaseolus lunatus) and Jamapa bean (Phaseolus vulgaris), protein hydrolysates obtained with Alcalase(®) and Flavourzyme(®) on ACE-I inhibitory activity. Four membranes of different molecular cutoffs (10, 5, 3, and 1 kDa) were used. Fractions that had a higher inhibitory activity in both legumes were denominated as E (<1 kDa) with IC50 of 30.3 and 51.8 μg/mL values for the P. lunatus with Alcalase and Flavourzyme, respectively, and for the Phaseolus vulgaris with Alcalase and Flavourzyme with about 63.8 and 65.8 μg/mL values, respectively. The amino acid composition of these fractions showed residues in essential amino acids, which make a good source of energy and amino acids. On the other hand, the presence of hydrophobic amino acids such as V and P is a determining factor in the ACE-I inhibitor effect. The results suggest the possibility of obtaining and utilizing these peptide fractions in the development and innovation of a functional product that helps with treatment and/or prevention of hypertension. PMID:26061663

  12. Fractionation of oil obtained by pyrolysis of lignocellulosic materials to recover a phenolic fraction for use in making phenol-formaldehyde resins

    SciTech Connect

    Gallivan, R.M.; Matschei, P.K.

    1980-06-24

    A method is provided for fractionation of oil obtained by pyrolysis of lignocellulosic materials to obtain useful chemical fractions, including a phenolic fraction which is suitable as a total or partial replacement for phenol in making phenolformaldehyde resins. The method comprises mixing the oil with a strong base such as sodium hydroxide to a ph level at which the neutral fraction of the oil is selectively soluble in a solvent such as methylene chloride or ether, and the mixture is extracted with the solvent to obtain a first extract containing the solvent and the neutral fraction, and a first raffinate containing the remaining fractions of the oil, I.E., the phenolic fraction, the organic acids fraction and an amorphous residue. The neutral fraction is recovered by distillation and the first raffinate is mixed with sulfuric acid to lower its ph to a level at which the phenolic fraction is selectively soluble in the solvent. This raffinate is extracted with the solvent to obtain a second extract containing the solvent and the phenolic fraction and a second raffinate containing the organic acids and the residues. The phenolic fraction is recovered by distillation and the second raffinate is mixed with sulfuric acid to lower its ph to a level at which the organic acids are selectively soluble in the solvent. After separation of the residues, the second raffinate is extracted with the solvent to obtain a third extract which is distilled to recover the organic acids fraction of the oil. The phenolic fraction may be used as partial or total replacement for pure phenol in making phenol-formaldehyde resins.

  13. Cardiac Structure and Function in Heart Failure with Preserved Ejection Fraction: Baseline Findings from the Echocardiographic Study of the Treatment Of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) Trial

    PubMed Central

    Shah, Amil M.; Shah, Sanjiv J.; Anand, Inder S.; Sweitzer, Nancy K.; O’Meara, Eileen; Heitner, John F.; Sopko, George; Li, Guichu; Assmann, Susan F.; McKinlay, Sonja M.; Pitt, Bertram; Pfeffer, Marc A.; Solomon, Scott D.

    2016-01-01

    Background Heart failure with preserved ejection fraction (HFpEF) is associated with substantial morbidity and mortality. Existing data on cardiac structure and function in HFpEF suggests significant heterogeneity in this population. Methods and Results Echocardiograms were obtained from 935 patients with HFpEF (left ventricular ejection fraction [LVEF] ≥45%) enrolled in the Treatment Of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial prior to initiation of randomized therapy. Average age was 70±10 years, 49% were female, 14% were of African descent, and co-morbidities were highly prevalent. Centralized quantitative analysis in a blinded core laboratory demonstrated a mean LVEF of 59.3±7.9%, with prevalent concentric LV remodeling (34%) and hypertrophy (43%), and left atrial (LA) enlargement (53%). Diastolic dysfunction was present in 66% of gradable participants, and was significantly associated with greater LV hypertrophy and a higher prevalence of LA enlargement. Doppler evidence of pulmonary hypertension was present in 36%. At least 1 measure of structural heart disease was present in 93% of patients. Conclusions Participants enrolled in TOPCAT demonstrated heterogeneous patterns of ventricular remodeling, with high prevalence of structural heart disease, including LV hypertrophy and LA enlargement, in addition to pulmonary hypertension, each of which has been associated with adverse outcomes in HFpEF. Diastolic function was normal in approximately one-third of gradable participants, highlighting the heterogeneity of the cardiac phenotype in this syndrome. These findings deepen our understanding of the TOPCAT trial population and expand our knowledge of the diversity of the cardiac phenotype in HFpEF. Clinical Trial Registration Clinicaltrials.gov Identifier NCT00094302 PMID:25122186

  14. Cardiac Structure and Function in Heart Failure with Preserved Ejection Fraction: Baseline Findings from the Echocardiographic Study of the Treatment Of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) Trial

    PubMed Central

    Shah, Amil M.; Shah, Sanjiv J.; Anand, Inder S.; Sweitzer, Nancy K.; O’Meara, Eileen; Heitner, John F.; Sopko, George; Li, Guichu; Assmann, Susan F.; McKinlay, Sonja M.; Pitt, Bertram; Pfeffer, Marc A.; Solomon, Scott D.

    2014-01-01

    Background Heart failure with preserved ejection fraction (HFpEF) is associated with substantial morbidity and mortality. Existing data on cardiac structure and function in HFpEF suggests significant heterogeneity in this population. Methods and Results Echocardiograms were obtained from 935 patients with HFpEF (left ventricular ejection fraction [LVEF] ≥45%) enrolled in the Treatment Of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial prior to initiation of randomized therapy. Average age was 70±10 years, 49% were female, 14% were of African descent, and co-morbidities were highly prevalent. Centralized quantitative analysis in a blinded core laboratory demonstrated a mean LVEF of 59.3±7.9%, with prevalent concentric LV remodeling (34%) and hypertrophy (43%), and left atrial (LA) enlargement (53%). Diastolic dysfunction was present in 66% of gradable participants, and was significantly associated with greater LV hypertrophy and a higher prevalence of LA enlargement. Doppler evidence of pulmonary hypertension was present in 36%. At least 1 measure of structural heart disease was present in 93% of patients. Conclusions Participants enrolled in TOPCAT demonstrated heterogeneous patterns of ventricular remodeling, with high prevalence of structural heart disease, including LV hypertrophy and LA enlargement, in addition to pulmonary hypertension, each of which has been associated with adverse outcomes in HFpEF. Diastolic function was normal in approximately one-third of gradable participants, highlighting the heterogeneity of the cardiac phenotype in this syndrome. These findings deepen our understanding of the TOPCAT trial population and expand our knowledge of the diversity of the cardiac phenotype in HFpEF. Clinical Trial Registration Clinicaltrials.gov Identifier NCT00094302 PMID:24249049

  15. Direct sequencing of human gut virome fractions obtained by flow cytometry.

    PubMed

    Džunková, Mária; D'Auria, Giuseppe; Moya, Andrés

    2015-01-01

    The sequence assembly of the human gut virome encounters several difficulties. A high proportion of human and bacterial matches is detected in purified viral samples. Viral DNA extraction results in a low DNA concentration, which does not reach the minimal limit required for sequencing library preparation. Therefore, the viromes are usually enriched by whole genome amplification (WGA), which is, however, prone to the development of chimeras and amplification bias. In addition, as there is a very wide diversity of gut viral species, very extensive sequencing efforts must be made for the assembling of whole viral genomes. We present an approach to improve human gut virome assembly by employing a more precise preparation of a viral sample before sequencing. Particles present in a virome previously filtered through 0.2 μm pores were further divided into groups in accordance with their size and DNA content by fluorescence activated cell sorting (FACS). One selected viral fraction was sequenced excluding the WGA step, so that unbiased sequences with high reliability were obtained. The DNA extracted from the 314 viral particles of the selected fraction was assembled into 34 contigs longer than 1,000 bp. This represents an increase to the number of assembled long contigs per sequenced Gb in comparison with other studies where non-fractioned viromes are sequenced. Seven of these contigs contained open reading frames (ORFs) with explicit matches to proteins related to bacteriophages. The remaining contigs also possessed uncharacterized ORFs with bacteriophage-related domains. When the particles that are present in the filtered viromes are sorted into smaller groups by FACS, large pieces of viral genomes can be recovered easily. This approach has several advantages over the conventional sequencing of non-fractioned viromes: non-viral contamination is reduced and the sequencing efforts required for viral assembly are minimized. PMID:26441889

  16. Direct sequencing of human gut virome fractions obtained by flow cytometry

    PubMed Central

    Džunková, Mária; D’Auria, Giuseppe; Moya, Andrés

    2015-01-01

    The sequence assembly of the human gut virome encounters several difficulties. A high proportion of human and bacterial matches is detected in purified viral samples. Viral DNA extraction results in a low DNA concentration, which does not reach the minimal limit required for sequencing library preparation. Therefore, the viromes are usually enriched by whole genome amplification (WGA), which is, however, prone to the development of chimeras and amplification bias. In addition, as there is a very wide diversity of gut viral species, very extensive sequencing efforts must be made for the assembling of whole viral genomes. We present an approach to improve human gut virome assembly by employing a more precise preparation of a viral sample before sequencing. Particles present in a virome previously filtered through 0.2 μm pores were further divided into groups in accordance with their size and DNA content by fluorescence activated cell sorting (FACS). One selected viral fraction was sequenced excluding the WGA step, so that unbiased sequences with high reliability were obtained. The DNA extracted from the 314 viral particles of the selected fraction was assembled into 34 contigs longer than 1,000 bp. This represents an increase to the number of assembled long contigs per sequenced Gb in comparison with other studies where non-fractioned viromes are sequenced. Seven of these contigs contained open reading frames (ORFs) with explicit matches to proteins related to bacteriophages. The remaining contigs also possessed uncharacterized ORFs with bacteriophage-related domains. When the particles that are present in the filtered viromes are sorted into smaller groups by FACS, large pieces of viral genomes can be recovered easily. This approach has several advantages over the conventional sequencing of non-fractioned viromes: non-viral contamination is reduced and the sequencing efforts required for viral assembly are minimized. PMID:26441889

  17. Left ventricular markers of global dyssynchrony predict limited exercise capacity in heart failure, but not in patients with preserved ejection fraction

    PubMed Central

    2012-01-01

    Background The aim of this study was to prospectively examine echocardiographic parameters that correlate and predict functional capacity assessed by 6 min walk test (6-MWT) in patients with heart failure (HF), irrespective of ejection fraction (EF). Methods In 147 HF patients (mean age 61 ± 11 years, 50.3% male), a 6-MWT and an echo-Doppler study were performed in the same day. Global LV dyssynchrony was indirectly assessed by total isovolumic time - t-IVT [in s/min; calculated as: 60 – (total ejection time + total filling time)], and Tei index (t-IVT/ejection time). Patients were divided into two groups based on the 6-MWT distance (Group I: ≤300 m and Group II: >300 m), and also in two groups according to EF (Group A: LVEF ≥ 45% and Group B: LVEF < 45%). Results In the cohort of patients as a whole, the 6-MWT correlated with t-IVT (r = −0.49, p < 0.001) and Tei index (r = −0.43, p < 0.001) but not with any of the other clinical or echocardiographic parameters. Group I had lower hemoglobin level (p = 0.02), lower EF (p = 0.003), larger left atrium (p = 0.02), thicker interventricular septum (p = 0.02), lower A wave (p = 0.01) and lateral wall late diastolic myocardial velocity a’ (p = 0.047), longer isovolumic relaxation time (r = 0.003) and longer t-IVT (p = 0.03), compared with Group II. In the patients cohort as a whole, only t-IVT ratio [1.257 (1.071-1.476), p = 0.005], LV EF [0.947 (0.903-0.993), p = 0.02], and E/A ratio [0.553 (0.315-0.972), p = 0.04] independently predicted poor 6-MWT performance (<300 m) in multivariate analysis. None of the echocardiographic measurements predicted exercise tolerance in HFpEF. Conclusion In patients with HF, the limited exercise capacity, assessed by 6-MWT, is related mostly to severity of global LV dyssynchrony, more than EF or raised filling pressures. The lack of exercise predictors in HFpEF reflects its multifactorial

  18. A method to obtain a well-defined fraction of respirable para-aramid fibers.

    PubMed Central

    Schins, R P; Gaudichet, A; Jaurand, M C

    1993-01-01

    We developed a preparation method to obtain respirable-sized fractions of para-aramid fibers. The procedure, based on floatability, consists of stirring and subsequent settling of p-aramid pulp in distilled water. Two distinct phases are obtained, with small fibers in the upper part of the suspension, which represents about 33% of the total volume. Optimal results were obtained when 2.0 g pulp was stirred for 15 hr in 800 ml distilled water containing 0.125% ethanol and settled for 5 hr. The mass yield ranged between 0.4 and 0.6%, more than 90% of the particles had an aspect ratio > or = 3:1. The mean fiber length was about 6 microns, and the mean fiber diameter was about 0.4 microns as determined by transmission and scanning electron microscopy. The number of fibers obtained was 4 x 10(6) fibers/micrograms under our standard conditions. Images p414-a Figure 1. Figure 2. Figure 3. PMID:8119251

  19. Effect of age and sex on efficacy and tolerability of β blockers in patients with heart failure with reduced ejection fraction: individual patient data meta-analysis

    PubMed Central

    Manzano, Luis; Krum, Henry; Rosano, Giuseppe; Holmes, Jane; Altman, Douglas G; Collins, Peter D; Packer, Milton; Wikstrand, John; Coats, Andrew J S; Cleland, John G F; Kirchhof, Paulus; von Lueder, Thomas G; Rigby, Alan S; Andersson, Bert; Lip, Gregory YH; van Veldhuisen, Dirk J; Shibata, Marcelo C; Wedel, Hans; Böhm, Michael; Flather, Marcus D

    2016-01-01

    Objectives To determine the efficacy and tolerability of β blockers in a broad age range of women and men with heart failure with reduced ejection fraction (HFrEF) by pooling individual patient data from placebo controlled randomised trials. Design Prospectively designed meta-analysis of individual patient data from patients aged 40-85 in sinus rhythm at baseline, with left ventricular ejection fraction <0.45. Participants 13 833 patients from 11 trials; median age 64; 24% women. Main outcome measures The primary outcome was all cause mortality; the major secondary outcome was admission to hospital for heart failure. Analysis was by intention to treat with an adjusted one stage Cox proportional hazards model. Results Compared with placebo, β blockers were effective in reducing mortality across all ages: hazard ratios were 0.66 (95% confidence interval 0.53 to 0.83) for the first quarter of age distribution (median age 50); 0.71 (0.58 to 0.87) for the second quarter (median age 60); 0.65 (0.53 to 0.78) for the third quarter (median age 68); and 0.77 (0.64 to 0.92) for the fourth quarter (median age 75). There was no significant interaction when age was modelled continuously (P=0.1), and the absolute reduction in mortality was 4.3% over a median follow-up of 1.3 years (number needed to treat 23). Admission to hospital for heart failure was significantly reduced by β blockers, although this effect was attenuated at older ages (interaction P=0.05). There was no evidence of an interaction between treatment effect and sex in any age group. Drug discontinuation was similar regardless of treatment allocation, age, or sex (14.4% in those give β blockers, 15.6% in those receiving placebo). Conclusion Irrespective of age or sex, patients with HFrEF in sinus rhythm should receive β blockers to reduce the risk of death and admission to hospital. Registration PROSPERO CRD42014010012; Clinicaltrials.gov NCT00832442. PMID:27098105

  20. Synergistic prognostic values of cardiac sympathetic innervation with left ventricular hypertrophy and left atrial size in heart failure patients without reduced left ventricular ejection fraction: a cohort study

    PubMed Central

    Doi, Takahiro; Nakata, Tomoaki; Hashimoto, Akiyoshi; Yuda, Satoshi; Wakabayashi, Takeru; Kouzu, Hidemichi; Kaneko, Naofumi; Hase, Mamoru; Tsuchihashi, Kazufumi; Miura, Tetsuji

    2012-01-01

    Objectives This study tested whether cardiac sympathetic innervation assessed by metaiodobenzylguanidine (MIBG) activity has long-term prognostic value in combination with left ventricular hypertrophy (LVH) and left atrial size in heart failure (HF) patients without reduced left ventricular ejection fraction (LVEF). Design A single-centre prospective cohort study. Setting/participants With primary endpoints of cardiac death and rehospitalisation due to HF progression, 178 consecutive symptomatic HF patients with 74% men, mean age of 56 years and mean LVEF of 64.5% were followed up for 80 months. The entry criteria consisted of LVEF more than 50%, completion of predischarge clinical evaluations including cardiac MIBG and echocardiographic studies and at least more than 1-year follow-up when survived. Results Thirty-four patients with cardiac evens had larger left atrial dimension (LAD), increased LV mass index, reduced MIBG activity quantified as heart-to-mediastinum ratio (HMR) than did the others. Multivariable Cox analysis showed that LAD and HMR were significant predictors (HR of 1.080 (95% CI 1.00 to 1.16, p=0.044) and 0.107 (95% CI 0.01 to 0.61, p=0.012, respectively). Thresholds of HMR (1.65) and LAD (37 mm) were closely related to identification of high-risk patients. In particular, HMR was a significant determinant of cardiac events in both patients with and without LV hypertrophy. Reduced HMR with enlarged LAD or LV hypertrophy identified patients at most increased risk; overall log-rank value, 11.5, p=0.0032 for LAD and 17.5, p=0.0002, respectively. Conclusions In HF patients without reduced LV ejection fraction, impairment of cardiac sympathetic innervation is related to cardiac outcomes independently and synergistically with LA size and LV hypertrophy. Cardiac sympathetic innervation assessment can contribute to better risk-stratification in combination with evaluation of LA size and LV mass but is needed to be evaluated for establishing aetiology

  1. Bleeding Risk and Antithrombotic Strategy in Patients With Sinus Rhythm and Heart Failure With Reduced Ejection Fraction Treated With Warfarin or Aspirin.

    PubMed

    Ye, Siqin; Cheng, Bin; Lip, Gregory Y H; Buchsbaum, Richard; Sacco, Ralph L; Levin, Bruce; Di Tullio, Marco R; Qian, Min; Mann, Douglas L; Pullicino, Patrick M; Freudenberger, Ronald S; Teerlink, John R; Mohr, J P; Graham, Susan; Labovitz, Arthur J; Estol, Conrado J; Lok, Dirk J; Ponikowski, Piotr; Anker, Stefan D; Thompson, John L P; Homma, Shunichi

    2015-09-15

    We sought to assess the performance of existing bleeding risk scores, such as the Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, Elderly, Drugs/Alcohol Concomitantly (HAS-BLED) score or the Outpatient Bleeding Risk Index (OBRI), in patients with heart failure with reduced ejection fraction (HFrEF) in sinus rhythm (SR) treated with warfarin or aspirin. We calculated HAS-BLED and OBRI risk scores for 2,305 patients with HFrEF in SR enrolled in the Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction trial. Proportional hazards models were used to test whether each score predicted major bleeding, and comparison of different risk scores was performed using Harell C-statistic and net reclassification improvement index. For the warfarin arm, both scores predicted bleeding risk, with OBRI having significantly greater C-statistic (0.72 vs 0.61; p = 0.03) compared to HAS-BLED, although the net reclassification improvement for comparing OBRI to HAS-BLED was not significant (0.32, 95% confidence interval [CI] -0.18 to 0.37). Performance of the OBRI and HAS-BLED risk scores was similar for the aspirin arm. For participants with OBRI scores of 0 to 1, warfarin compared with aspirin reduced ischemic stroke (hazard ratio [HR] 0.51, 95% CI 0.26 to 0.98, p = 0.042) without significantly increasing major bleeding (HR 1.24, 95% CI 0.66 to 2.30, p = 0.51). For those with OBRI score of ≥2, there was a trend for reduced ischemic stroke with warfarin compared to aspirin (HR 0.56, 95% CI 0.27 to 1.15, p = 0.12), but major bleeding was increased (HR 4.04, 95% CI 1.99 to 8.22, p <0.001). In conclusion, existing bleeding risk scores can identify bleeding risk in patients with HFrEF in SR and could be tested for potentially identifying patients with a favorable risk/benefit profile for antithrombotic therapy with warfarin. PMID:26189039

  2. Heart failure with preserved ejection fraction: chronic low-intensity interval exercise training preserves myocardial O2 balance and diastolic function

    PubMed Central

    Marshall, Kurt D.; Muller, Brittany N.; Krenz, Maike; Hanft, Laurin M.; McDonald, Kerry S.; Dellsperger, Kevin C.

    2013-01-01

    We have previously reported chronic low-intensity interval exercise training attenuates fibrosis, impaired cardiac mitochondrial function, and coronary vascular dysfunction in miniature swine with left ventricular (LV) hypertrophy (Emter CA, Baines CP. Am J Physiol Heart Circ Physiol 299: H1348–H1356, 2010; Emter CA, et al. Am J Physiol Heart Circ Physiol 301: H1687–H1694, 2011). The purpose of this study was to test two hypotheses: 1) chronic low-intensity interval training preserves normal myocardial oxygen supply/demand balance; and 2) training-dependent attenuation of LV fibrotic remodeling improves diastolic function in aortic-banded sedentary, exercise-trained (HF-TR), and control sedentary male Yucatan miniature swine displaying symptoms of heart failure with preserved ejection fraction. Pressure-volume loops, coronary blood flow, and two-dimensional speckle tracking ultrasound were utilized in vivo under conditions of increasing peripheral mean arterial pressure and β-adrenergic stimulation 6 mo postsurgery to evaluate cardiac function. Normal diastolic function in HF-TR animals was characterized by prevention of increased time constant of isovolumic relaxation, normal LV untwisting rate, and enhanced apical circumferential and radial strain rate. Reduced fibrosis, normal matrix metalloproteinase-2 and tissue inhibitors of metalloproteinase-4 mRNA expression, and increased collagen III isoform mRNA levels (P < 0.05) accompanied improved diastolic function following chronic training. Exercise-dependent improvements in coronary blood flow for a given myocardial oxygen consumption (P < 0.05) and cardiac efficiency (stroke work to myocardial oxygen consumption, P < 0.05) were associated with preserved contractile reserve. LV hypertrophy in HF-TR animals was associated with increased activation of Akt and preservation of activated JNK/SAPK. In conclusion, chronic low-intensity interval exercise training attenuates diastolic impairment by promoting compliant

  3. Comparison of left ventricular ejection fraction and inducible ventricular tachycardia in ST-elevation myocardial infarction treated by primary angioplasty versus thrombolysis.

    PubMed

    Chong, James J H; Ganesan, Anand N; Eipper, Vicki; Kovoor, Pramesh

    2008-01-15

    Electrophysiologic studies predict the risk for sudden death after myocardial infarction (MI). Although primary angioplasty has become the preferred method of treatment for ST-elevation MI, intravenous thrombolysis remains the first-line treatment in 30% to 70% of cases worldwide. Rates of ventricular tachyarrhythmias may vary according to type of reperfusion treatment. This study was undertaken to examine the hypothesis that the left ventricular ejection fraction (LVEF) and rates of inducible ventricular tachycardia may be more favorable in treatment with primary angioplasty rather than thrombolysis. Consecutive patients receiving primary angioplasty (n = 225) or thrombolysis (n = 195) for ST-elevation MI were included. The mean LVEF was 48 +/- 12% for the primary angioplasty group and 46 +/- 13% for the thrombolysis group (p = 0.30). The proportion of patients with LVEFs <40% was 30% in the primary angioplasty group and 30% in the thrombolysis group (p = 0.98). Patients with LVEFs <40% underwent electrophysiologic studies. Ventricular tachycardia was inducible in 23 of 66 primary angioplasty patients (34.8%) compared with 21 of 55 (38.1%) thrombolysis patients (p = 0.69). Implantable cardiac defibrillators were inserted in 30 patients, of whom 8 (27%) had appropriate device activations. The mean time from MI to first spontaneous activation was 387 +/- 458 days. In conclusion, patients treated with thrombolysis or primary angioplasty for ST-elevation MIs had similar resultant LVEFs and rates of inducible ventricular tachycardia. There was a surprisingly high rate of spontaneous defibrillator activations, often occurring late after MI. PMID:18178398

  4. Comparison of Ventricular Structure and Function in Chinese Patients With Heart Failure and Ejection Fractions >55% Versus 40% to 55% Versus <40%

    PubMed Central

    He, Kun-Lun; Burkhoff, Daniel; Leng, Wen-Xiu; Liang, Zhi-Ru; Fan, Li; Wang, Jie; Maurer, Mathew S.

    2016-01-01

    Subjects with heart failure (HF) and a preserved ejection fraction (EF) are heterogenous and the EF used to define this syndrome varies considerably among studies. We sought to determine if physiologic differences exist between subjects with a normal EF (>55%) or mildly decreased EF (40% to 55%). 357 consecutive Chinese patients who were healthy (n = 93) or had HF (n = 264) underwent comprehensive echocardiography, Doppler analysis, and measurement of neurohormones. Subjects with HF were stratified by EF into those with normal EF (>55%, n = 128), mildly decreased EF (40% to 55%, n = 38), or moderate to severely decreased EF (<40%, n = 100). Employing noninvasive pressure–volume analysis, estimated end-systolic and end-diastolic pressure–volume relations were calculated. Subjects with HF and an EF 40% to 55% more often had a previous myocardial infarction and diabetes than those with HF and an EF >55%. Physiologically, the cohort with a mildly decreased EF had eccentrically enlarged ventricles with evidence of remodeling (rightward shifted end-diastolic pressure–volume relation) and decreased chamber contractility (downward shifted end-systolic pressure–volume relation) most comparable to subjects with overt systolic HF. In conclusion, in subjects with HF and a preserved EF, there are distinct physiologic differences between those with a normal (>55%) and a mildly decreased (40% to 55%) EF. PMID:19268743

  5. The impact of glucose-insulin-potassium infusion in acute myocardial infarction on infarct size and left ventricular ejection fraction [ISRCTN56720616

    PubMed Central

    van der Horst, Iwan CC; Ottervanger, Jan Paul; van 't Hof, Arnoud WJ; Reiffers, Stoffer; Miedema, Kor; Hoorntje, Jan CA; Dambrink, Jan-Henk E; Gosselink, AT Marcel; Nijsten, Maarten WN; Suryapranata, Harry; de Boer, Menko-Jan; Zijlstra, Felix

    2005-01-01

    Background Favorable clinical outcomes have been observed with glucose-insulin-potassium infusion (GIK) in acute myocardial infarction (MI). The mechanisms of this beneficial effect have not been delineated clearly. GIK has metabolic, anti-inflammatory and profibrinolytic effects and it may preserve the ischemic myocardium. We sought to assess the effect of GIK infusion on infarct size and left ventricular function, as part of a randomized controlled trial. Methods Patients (n = 940) treated for acute MI by primary percutaneous coronary intervention (PCI) were randomized to GIK infusion or no infusion. Endpoints were the creatinine kinase MB-fraction (CK-MB) and left ventricular ejection fraction (LVEF). CK-MB levels were determined 0, 2, 4, 6, 24, 48, 72 and 96 hours after admission and the LVEF was measured before discharge. Results There were no differences between the two groups in the time course or magnitude of CK-MB release: the peak CK-MB level was 249 ± 228 U/L in the GIK group and 240 ± 200 U/L in the control group (NS). The mean LVEF was 43.7 ± 11.0 % in the GIK group and 42.4 ± 11.7% in the control group (P = 0.12). A LVEF ≤ 30% was observed in 18% in the controls and in 12% of the GIK group (P = 0.01). Conclusion Treatment with GIK has no effect on myocardial function as determined by LVEF and by the pattern or magnitude of enzyme release. However, left ventricular function was preserved in GIK treated patients. PMID:15932638

  6. Albuminuria is Independently Associated with Cardiac Remodeling, Abnormal Right and Left Ventricular Function, and Worse Outcomes in Heart Failure with Preserved Ejection Fraction

    PubMed Central

    Katz, Daniel H.; Burns, Jacob A.; Aguilar, Frank G.; Beussink, Lauren; Shah, Sanjiv J.

    2014-01-01

    Objectives To determine the relationship between albuminuria and cardiac structure/function in heart failure with preserved ejection fraction (HFpEF). Background Albuminuria, a marker of endothelial dysfunction, has been associated with adverse cardiovascular outcomes in HFpEF. However, the relationship between albuminuria and cardiac structure/function in HFpEF has not been well studied. Methods We measured urinary albumin-to-creatinine ratio (UACR) and performed comprehensive echocardiography, including tissue Doppler imaging and right ventricular (RV) evaluation, in a prospective study of 144 patients with HFpEF. Multivariable-adjusted linear regression was used to determine the association between UACR and echocardiographic parameters. Cox proportional hazards analyses were used to determine the association between UACR and outcomes. Results The mean age was 66±11 years, 62% were female, and 42% were African-American. Higher UACR was associated with greater left ventricular (LV) mass, lower preload-recruitable stroke work, and lower global longitudinal strain. Higher UACR was also significantly associated with RV remodeling (for each doubling of UACR, RV wall thickness was 0.9 mm higher [95% confidence interval (CI) 0.05–0.14 mm; P=0.001, adjusted P=0.01]) and worse RV systolic function (for each doubling of UACR, RV fractional area change was 0.56% lower [95% CI 0.14–0.98%; P=0.01, adjusted P=0.03]. The association between UACR and RV parameters persisted after excluding patients with macroalbuminuria (UACR > 300 mg/g). Increased UACR was also independently associated with worse outcomes. Conclusions In HFpEF, increased UACR is a prognostic marker and is associated with increased RV and LV remodeling, and longitudinal systolic dysfunction. PMID:25282032

  7. Development of functional spaghetti enriched in bioactive compounds using barley coarse fraction obtained by air classification.

    PubMed

    Verardo, Vito; Gómez-Caravaca, Ana Maria; Messia, Maria Cristina; Marconi, Emanuele; Caboni, Maria Fiorenza

    2011-09-14

    Barley byproducts obtained by air classification have been used to produce a different barley functional spaghetti, which were compared to different commercial whole semolina samples. Total, insoluble, and soluble fiber and β-glucan contents of the barley spaghetti were found to be greater than those of commercial samples. Furthermore, it was proved that barley spaghetti reached the FDA requirements, which could allow these pastas to deserve the health claims "good source of dietary fiber" and "may reduce the risk of heart disease". When the barley coarse fraction was used, a flavan-3-ols enrichment and an increase of antioxidant activity were reported, while commercial samples showed the absence of flavan-3-ols and a higher presence of phenolic acids and tannins. Whole semolina commercial spaghetti had a significantly higher content of phenolic acids than semolina spaghetti samples. Besides, it was observed that when vital gluten was added to the spaghetti formulation, phenolic compounds were blocked in the gluten network and were partially released during the cooking process. PMID:21806068

  8. Cytotoxic activity of a dichloromethane extract and fractions obtained from Eudistoma vannamei (Tunicata: Ascidiacea).

    PubMed

    Jimenez, Paula C; Wilke, Diego V; Takeara, Renata; Lotufo, Tito M C; Pessoa, Cláudia; de Moraes, Manoel Odorico; Lopes, Norberto P; Costa-Lotufo, Letícia V

    2008-11-01

    This study consists of the bioassay-guided fractionation of the dichloromethane extract from Eudistoma vannamei and the pharmacological characterization of the active fractions. The dried hydromethanolic extract dissolved in aqueous methanol was partitioned with dichloromethane and chromatographed on a silica gel flash column. The anti-proliferative effect was monitored by the MTT assay. Four of the latest fractions, numbered 14 to 17, which held many chemical similarities amongst each other, were found to be the most active. The selected fractions were tested for viability, proliferation and death induction on cultures of HL-60 promyeloblastic leukemia cells. The results suggested that the observed cytotoxicity is related to apoptosis induction. PMID:17400012

  9. Pattern of endothelial progenitor cells and apoptotic endothelial cell-derived microparticles in chronic heart failure patients with preserved and reduced left ventricular ejection fraction

    PubMed Central

    Berezin, Alexander E.; Kremzer, Alexander A.; Martovitskaya, Yulia V.; Berezina, Tatyana A.; Gromenko, Elena A.

    2016-01-01

    Background Chronic heart failure (HF) remains a leading cause of cardiovascular (CV) mortality and morbidity worldwide. The aim of the study was to investigate whether the pattern of angiogenic endothelial progenitor cells (EPCs) and apoptotic endothelial cell-derived microparticles (EMPs) would be able to differentiate HF with reduced (HFrEF) and preserved (HFpEF) ejection fraction. Methods One hundred sixty four chronic HF subjects met inclusion criteria. Patients with global left ventricular ejection fraction ≥ 50% were categorized as the HFpEF group (n = 79) and those with ≤ 45% as the HFrEF group (n = 85). Therefore, to compare the circulating levels of biological markers 35 control subjects without HF were included in the study. All control individuals were age- and sex-matched chronic HF patients. The serum level of biomarkers was measured at baseline. The flow cytometric technique was used for predictably distinguishing circulating cell subsets depending on expression of CD45, CD34, CD14, Tie-2, and CD309 antigens and determining endothelial cell-derived microparticles. CD31+/annexin V+ was defined as apoptotic endothelial cell-derived MPs, MPs labeled for CD105+ or CD62E+ were determined as MPs produced due to activation of endothelial cells. Results In multivariate logistic regression model T2DM (R2 = 0.26; P = 0.001), obesity (R2 = 0.22; P = 0.001), previous MI (R2 = 0.17; P = 0.012), galectin-3 (R2 = 0.67; P = 0.012), CD31+/annexin V+ EMPs (R2 = 0.11; P = 0.001), NT-proBNP (R2 = 0.11; P = 0.046), CD14+ CD309+ cells (R2 = 0.058; P = 0.001), and CD14+ СD309+ Tie-2+ cells (R2 = 0.044; P = 0.028) were found as independent predictors of HFpEF. Using multivariate Cox-regression analysis adjusted etiology (previous myocardial infarction), cardiovascular risk factors (obesity, type 2 diabetes mellitus) we found that NT-proBNP (OR 1.08; 95% CI = 1.03–1.12; P = 0.001) and CD31+/annexin V+ EMPs to CD14+ CD309

  10. ST-elevation myocardial infarction with reduced left ventricular ejection fraction: Insights into persisting left ventricular dysfunction. A pPCI-registry analysis.

    PubMed

    Stolfo, Davide; Cinquetti, Martino; Merlo, Marco; Santangelo, Sara; Barbati, Giulia; Alonge, Marco; Vitrella, Giancarlo; Rakar, Serena; Salvi, Alessandro; Perkan, Andrea; Sinagra, Gianfranco

    2016-07-15

    Primary percutaneous coronary intervention (pPCI) largely reduced the rate of left ventricular (LV) dysfunction after ST-segment elevation acute myocardial infarction (STEMI). Though LV recovery begins early following revascularization, the optimal timing for re-assessment of LV function is still unclear. We sought to assess the proportion and timing of LV recovery in STEMI patients presenting with LV dysfunction treated by pPCI and to identify possible early predictors of adverse LV remodeling. STEMI patients with LV ejection fraction (LVEF ≤40%) at presentation treated by pPCI from 2007 to 2013 were included whether they had an available 3-step LVEF assessment (<24h post-pPCI, discharge and follow-up). Primary endpoint was LVEF ≤35% at follow-up. At a median time of 3months, 43 out of 154 patients (28%) had LVEF ≤35%. In patients with persistent LV dysfunction, LVEF was lower at admission and increased less during hospitalization (from 31±6 to 35±4% Vs 35±5 to 43±8% for patients with 3-months LVEF >35%, p<0.001). Independent predictors of 3-months LVEF ≤35% were creatinine at admission, peak troponin I and LVEF. Of note, LVEF re-assessment at discharge (median time 6days, IQR 4-9) showed an increased accuracy to predict 3-months LV dysfunction compared to LVEF at admission (AUC 0.80, 95% CI 0.72-0.88 vs AUC 0.69, 95% CI 0.58-0.79 respectively, p=0.03). In most of patients presenting with STEMI and LV dysfunction, a significant LV recovery can be observed early following pPCI. LVEF measurement at discharge indeed emerged as the best indicator of late persistence of severe LV dysfunction. PMID:27128558

  11. Haemoconcentration, renal function, and post-discharge outcomes among patients hospitalized for heart failure with reduced ejection fraction: insights from the EVEREST trial

    PubMed Central

    Greene, Stephen J.; Gheorghiade, Mihai; Vaduganathan, Muthiah; Ambrosy, Andrew P.; Mentz, Robert J.; Subacius, Haris; Maggioni, Aldo P.; Nodari, Savina; Konstam, Marvin A.; Butler, Javed; Filippatos, Gerasimos

    2013-01-01

    Aims Haemoconcentration has been studied as a marker of decongestion in patients with hospitalization for heart failure (HHF). We describe the relationship between haemoconcentration, worsening renal function, post-discharge outcomes, and clinical and laboratory markers of congestion in a large multinational cohort of patients with HHF. Methods and results In 1684 patients with HHF with ejection fraction (EF) ≤40% assigned to the placebo arm of the Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with Tolvaptan (EVEREST) trial, absolute in-hospital haematocrit change was calculated as the change between baseline and discharge or day 7 (whichever occurred first). Patient characteristics, changes in renal function, and outcomes over a median follow-up of 9.9 months were compared by in-hospital haematocrit change. Overall, 26% of patients had evidence of haemoconcentration (i.e. ≥3% absolute increase in haematocrit). Patients with greater increases in haematocrit tended to have better baseline renal function. Haemoconcentration correlated with greater risk of in-hospital worsening renal function, but renal parameters generally returned to baseline within 4 weeks post-discharge. Patients with haemoconcentration were less likely to have clinical congestion at discharge, and experienced greater in-hospital decreases in body weight and natriuretic peptide levels. After adjustment for baseline clinical risk factors, every 5% increase of in-hospital haematocrit change was associated with a decreased risk of all-cause death [hazard ratio (HR) 0.81, 95% confidence interval (CI) 0.70–0.95]. Haematocrit change was also associated with decreased cardiovascular mortality or heart failure (HF) hospitalization at ≤100 days post-randomization (HR 0.73, 95% CI 0.71–0.76). Conclusion In this large cohort of patients with HHF with reduced EF, haemoconcentration was associated with greater improvements in congestion and decreased mortality and HF re

  12. Quality of Anticoagulation Control in Preventing Adverse Events in Heart Failure Patients in Sinus Rhythm: A Warfarin Aspirin Reduced Cardiac Ejection Fraction Trial (WARCEF) Substudy

    PubMed Central

    Homma, Shunichi; Thompson, John L.P.; Qian, Min; Ye, Siqin; Di Tullio, Marco R.; Lip, Gregory Y.H.; Mann, Douglas L.; Sacco, Ralph L.; Levin, Bruce; Pullicino, Patrick M.; Freudenberger, Ronald S.; Teerlink, John R.; Graham, Susan; Mohr, J.P.; Labovitz, Arthur J.; Buchsbaum, Richard; Estol, Conrado J.; Lok, Dirk J.; Ponikowski, Piotr; Anker, Stefan D.

    2015-01-01

    Background The aim of this study is to examine the relationship between time in therapeutic range (TTR) and clinical outcomes in heart failure (HF) patients in sinus rhythm (SR) treated with warfarin. Methods and Results We used data from the Warfarin vs. Aspirin in Reduced Cardiac Ejection Fraction Trial (WARCEF) to assess the relationship of TTR with the WARCEF primary outcome (ischemic stroke, intracerebral hemorrhage, or death); with death alone; ischemic stroke alone; major hemorrhage alone; and net clinical benefit (primary outcome and major hemorrhage combined). Multivariable Cox models were used to examine how the event risk changed with TTR and to compare the high TTR, low TTR, and aspirin patients, with TTR being treated as a time-dependent covariate. 2,217 patients were included in the analyses, among whom 1,067 were randomized to warfarin and 1,150 were randomized to aspirin. The median (IQR) follow-up duration was 3.6 (2.0–5.0) years. Mean (±SD) age was 61±11.3 years, with 80% being men. The mean (±SD) TTR was 57% (±28.5%). Increasing TTR was significantly associated with reduction in primary outcome (adjusted p<0.001), death alone (adjusted p=0.001), and improved net clinical benefit (adjusted p<0.001). A similar trend was observed for the other two outcomes but significance was not reached (adjusted p=0.082 for ischemic stroke, adjusted p=0.109 for major hemorrhage). Conclusions In HF patients in SR, increasing TTR is associated with better outcome and improved net clinical benefit. Patients in whom good quality anticoagulation can be achieved may benefit from the use of anticoagulants. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00041938. PMID:25850425

  13. Changes in serum potassium levels during hospitalization in patients with worsening heart failure and reduced ejection fraction (from the EVEREST trial).

    PubMed

    Khan, Sadiya S; Campia, Umberto; Chioncel, Ovidiu; Zannad, Faiez; Rossignol, Patrick; Maggioni, Aldo P; Swedberg, Karl; Konstam, Marvin A; Senni, Michele; Nodari, Savina; Vaduganathan, Muthiah; Subacius, Haris; Butler, Javed; Gheorghiade, Mihai

    2015-03-15

    Both hyperkalemia and hypokalemia may be related to heart failure (HF) therapy and are associated with adverse outcomes. Abnormalities in serum potassium levels in hospitalized patients with HF and reduced ejection fraction (EF) have not been previously investigated. A post hoc analysis was performed in 1,907 hospitalized patients with worsening HF and reduced EF in the placebo arm of the Efficacy of Vasopressin Antagonism in HF Outcome Study with Tolvaptan (EVEREST) trial. Serum potassium was measured at randomization and at discharge or day 7. The co-primary end points were all-cause mortality (ACM) and cardiovascular mortality or the first HF hospitalization (CVM + HFH). The association between inhospital change in potassium levels and time to outcomes was evaluated using multivariate Cox regression models. Study participants had a mean age of 65.6 ± 12.0 years and were on optimal guideline-directed medical therapies, including β blockers (77%), angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (85%), and aldosterone antagonists (55%). Baseline potassium concentration was 4.3 ± 0.6 mEq/l, and hyperkalemia or hypokalemia was seen in 6.5% of the participants. On average, serum potassium level increased by 0.21 ± 0.66 mEq/l, p <0.0001, during hospitalization. Inhospital potassium change was not associated with either the primary or the secondary end point over a median follow-up of 9.9 months. In conclusion, in patients with reduced EF hospitalized for worsening HF, serum potassium abnormalities are common at baseline (within 48 hours of admission) and potassium levels increase during hospitalization, despite aggressive diuretic therapy. However, they are not associated with all-cause or CVM or HFH. Inhospital changes in potassium may limit the implementation of evidence-based therapies such as mineralocorticoid receptor antagonists. PMID:25728846

  14. Usefulness of cardiac meta-iodobenzylguanidine imaging to identify patients with chronic heart failure and left ventricular ejection fraction <35% at low risk for sudden cardiac death.

    PubMed

    Kawai, Tsutomu; Yamada, Takahisa; Tamaki, Shunsuke; Morita, Takashi; Furukawa, Yoshio; Iwasaki, Yusuke; Kawasaki, Masato; Kikuchi, Atsushi; Kondo, Takumi; Takahashi, Satoshi; Ishimi, Masashi; Hakui, Hideyuki; Ozaki, Tatsuhisa; Sato, Yoshihiro; Seo, Masahiro; Sakata, Yasushi; Fukunami, Masatake

    2015-06-01

    Patients with chronic heart failure (CHF) at risk of sudden cardiac death (SCD) are often treated with implantable cardiac defibrillators (ICDs). However, current criteria for device use that is based largely on left ventricular ejection fraction (LVEF) lead to many patients receiving ICDs that never deliver therapy. It is of clinical significance to identify patients who do not require ICDs. Although cardiac I-123 meta-iodobenzylguanidine (MIBG) imaging provides prognostic information about CHF, whether it can identify patients with CHF who do not require an ICD remains unclear. We studied 81 patients with CHF and LVEF <35%, assessed by cardiac MIBG imaging at enrollment. The heart-to-mediastinal ratio (H/M) in delayed images and washout rates were divided into 6 grades from 0 to 5, according to the degree of deviation from control values. The study patients were classified into 3 groups: low (1 to 4), intermediate (5 to 7), and high (8 to 10), according to the MIBG scores defined as the sum of the H/M and washout rate scores. Sixteen patients died of SCD during a follow-up period. Patients with low MIBG score had a significantly lower risk of SCD than those with intermediate and high scores (low [n = 19], 0%; intermediate [n = 37], 19%; high [n = 25], 36%; p = 0.001). The positive predictive value of low MIBG score for identifying patients without SCD was 100%. In conclusion, the MIBG score can identify patients with CHF and LVEF <35% who have low risk of developing SCD. PMID:25851796

  15. Dual A1/A2B Receptor Blockade Improves Cardiac and Renal Outcomes in a Rat Model of Heart Failure with Preserved Ejection Fraction.

    PubMed

    Tofovic, Stevan P; Salah, Eman M; Smits, Glenn J; Whalley, Eric T; Ticho, Barry; Deykin, Aaron; Jackson, Edwin K

    2016-02-01

    Heart failure with preserved ejection fraction (HFpEF) is prevalent and often accompanied by metabolic syndrome. Current treatment options are limited. Here, we test the hypothesis that combined A1/A2B adenosine receptor blockade is beneficial in obese ZSF1 rats, an animal model of HFpEF with metabolic syndrome. The combined A1/A2B receptor antagonist 3-[4-(2,6-dioxo-1,3-dipropyl-7H-purin-8-yl)-1-bicyclo[2.2.2]octanyl]propanoic acid (BG9928) was administered orally (10 mg/kg/day) to obese ZSF1 rats (n = 10) for 24 weeks (from 20 to 44 weeks of age). Untreated ZSF1 rats (n = 9) served as controls. After 24 weeks of administration, BG9928 significantly lowered plasma triglycerides (in mg/dl: control group, 4351 ± 550; BG9928 group, 2900 ± 551) without adversely affecting plasma cholesterol or activating renin release. BG9928 significantly decreased 24-hour urinary glucose excretion (in mg/kg/day: control group, 823 ± 179; BG9928 group, 196 ± 80) and improved oral glucose tolerance, polydipsia, and polyuria. BG9928 significantly augmented left ventricular diastolic function in association with a reduction in cardiac vasculitis and cardiac necrosis. BG9928 significantly reduced 24-hour urinary protein excretion (in mg/kg/day: control group, 1702 ± 263; BG9928 group, 1076 ± 238), and this was associated with a reduction in focal segmental glomerulosclerosis, tubular atrophy, tubular dilation, and deposition of proteinaceous material in the tubules. These findings show that, in a model of HFpEF with metabolic syndrome, A1/A2B receptor inhibition improves hyperlipidemia, exerts antidiabetic actions, reduces HFpEF, improves cardiac histopathology, and affords renal protection. We conclude that chronic administration of combined A1/A2B receptor antagonists could be beneficial in patients with HFpEF, in particular those with comorbidities such as obesity, diabetes, and dyslipidemias. PMID:26585572

  16. Right ventricular ejection fraction during exercise in normal subjects and in coronary artery disease patients: assessment by multiple-gated equilibrium scintigraphy

    SciTech Connect

    Maddahi, J.; Berman, D.S.; Matsuoka, D.T.; Waxman, A.D.; Forrester, J.S.; Swan, H.J.C.

    1980-07-01

    The response of right ventricular ejection fraction (RVEF) during exercise and its relationship to the location and extent of coronary artery disease are not fully understood. We have recently developed and validated a new method for scintigraphic evaluation of RVEF using rapid multiple-gated equilibrium scintigraphy and multiple right ventricular regions of interest. The technique has been applied during upright bicycle exercise in 10 normal subjects and 20 patients with coronary artery disease. Resting RVEF was not significantly different between the groups (0.49 +- 0.04 vs 0.47 +- 0.09, respectively, mean +- SD). In all 10 normal subjects RVEF rose (0.49 +- 0.04 to 0.66 +- 0.08, p < 0.01) at peak exercise. At peak exercise in coronary artery disease patients, the group RVEF remained unchanged (0.47 +- 0.09 to 0.50 +- 0.11, p = NS), but the individual responses varied. In the coronary artery disease patients, the relationship between RVEF response to exercise and exercise left ventricular function, septal motion and right coronary artery stenosis were studied. Significant statistical association was found only between exercise RVEF and right coronary artery stenosis. RVEF rose during exercise in seven of seven patients without right coronary artery stenosis (0.42 +- 0.06 to 0.58 +- 0.08, p = 0.001) and was unchanged or fell in 12 of 13 patients with right coronary artery stenosis (0.50 +- 0.09 to 0.45 +- 0.10, p = NS). We conclude that (1) in normal subjects RVEF increases during upright exercise and (2) although RVEF at rest is not necessarily affected by coronary artery disease, failure of RVEF to increase during exercise, in the absence of chronic obstructive pulmonary disease or valvular heart disease, may be related to the presence of significant right coronary artery stenosis.

  17. Prevalence, Clinical Phenotype, and Outcomes Associated with Normal B-Type Natriuretic Peptide Levels in Heart Failure with Preserved Ejection Fraction

    PubMed Central

    Anjan, Venkatesh Y.; Loftus, Timothy M.; Burke, Michael A.; Akhter, Nausheen; Fonarow, Gregg C.; Gheorghiade, Mihai; Shah, Sanjiv J.

    2012-01-01

    B-type natriuretic peptide (BNP) is used widely to exclude heart failure (HF) in patients with dyspnea. However, most studies of BNP have focused on diagnosing HF with reduced ejection fraction (EF). We hypothesized that a normal BNP (≤ 100 pg/ml) is relatively common in HF with preserved EF (HFpEF), a heterogeneous disorder commonly associated with obesity. We prospectively studied 159 consecutive patients enrolled in the Northwestern University HFpEF Program. All subjects had symptomatic HF with EF>50% and elevated pulmonary capillary wedge pressure (PCWP). BNP was tested at baseline in all subjects. We compared clinical characteristics, echocardiographic parameters, invasive hemodynamics, and outcomes among HFpEF patients with normal (≤ 100 pg/ml) vs. elevated (>100 pg/ml) BNP. Of the 159 HFpEF patients, 46 (29%) had BNP ≤ 100 pg/ml. Subjects with normal BNP were younger, more often female, had higher rates of obesity and higher body-mass index, and less commonly had chronic kidney disease and atrial fibrillation. Both EF and PCWP were similar in normal vs. elevated BNP groups (62±7 vs. 61±7% [P=0.67] and 25±8 vs. 27±9 mmHg [P=0.42], respectively). Elevated BNP was associated with enlarged left atrial volume, worse diastolic function, abnormal right ventricular structure/function, and worse outcomes (e.g., adjusted hazard ratio for HF hospitalization = 4.0, 95% confidence interval 1.6-9.7, P=0.003). In conclusion, a normal BNP is present in 29% of symptomatic outpatients with HFpEF who have elevated PCWP, obesity is likely the primary driver of this finding, and although BNP is useful as a prognostic marker in HFpEF, a normal BNP does not exclude the outpatient diagnosis of HFpEF. PMID:22681864

  18. Relation of Elevated Heart Rate in Patients With Heart Failure With Reduced Ejection Fraction to One-Year Outcomes and Costs.

    PubMed

    DeVore, Adam D; Schulte, Phillip J; Mentz, Robert J; Hardy, N Chantelle; Kelly, Jacob P; Velazquez, Eric J; Maya, Juan F; Kielhorn, Adrian; Patel, Harshali K; Reed, Shelby D; Hernandez, Adrian F

    2016-03-15

    There are limited data describing outcomes associated with an elevated heart rate in patients with heart failure with reduced ejection fraction (HFrEF) in routine clinical practice. We identified patients with HFrEF at Duke University Hospital undergoing echocardiograms and heart rate assessments without paced rhythms or atrial fibrillation. Outcomes (all-cause mortality or hospitalization and medical costs per day alive) were assessed using electronic medical records, hospital cost accounting data, and national death records. Patients were stratified by heart rate (<70 and ≥70 beats/min) and compared using generalized linear models specified with gamma error distributions and log links for costs and proportional hazard models for mortality/hospitalization. Of 722 eligible patients, 582 patients (81%) were treated with β blockers. The median heart rate was 81 beats/min (25th and 75th percentiles 69 to 96) and 527 patients (73%) had a heart rate ≥70 beats/min. After multivariate adjustment, a heart rate ≥70 beats/min was associated with increased 1-year all-cause mortality or hospitalization, hazard ratio 1.37 (95% CI 1.07 to 1.75) and increased medical costs per day alive, cost ratio 2.03 (95% CI 1.53 to 2.69). In conclusion, at a large tertiary care center, despite broad use of β blockers, a heart rate ≥70 beats/min was observed in 73% of patients with HFrEF and associated with worse 1-year outcomes and increased direct medical costs per day alive. PMID:26805662

  19. Variability in cardiac MR measurement of left ventricular ejection fraction, volumes and mass in healthy adults: defining a significant change at 1 year

    PubMed Central

    Edwards, N C; Chue, C D; Taylor, R J; Ferro, C J; Townend, J N; Steeds, R P

    2015-01-01

    Objective: Variability in the measurement of left ventricular (LV) parameters in cardiovascular imaging has typically been assessed over a short time interval, but clinicians most commonly compare results from studies performed a year apart. To account for variation in technical, procedural and biological factors over this time frame, we quantified the within-subject changes in LV volumes, LV mass (LVM) and LV ejection fraction (EF) in a well-defined cohort of healthy adults at 12 months. Methods: Cardiac MR (CMR) was performed in 42 healthy control subjects at baseline and at 1 year (1.5 T Magnetom® Avanto; Siemens Healthcare, Erlangen, Germany). Analysis of steady-state free precession images was performed manually offline (Argus software; Siemens Healthcare) for assessment of LV volumes, LVM and EF by a single blinded observer. A random subset of 10 participants also underwent repeat imaging within 7 days to determine short-term interstudy reproducibility. Results: There were no significant changes in any LV parameter on repeat CMR at 12 months. The short-term interstudy biases were not significantly different from the long-term changes observed at 1 year. The smallest detectable change (SDC) for LVEF, end-diastolic volume, end-systolic volume and LVM that could be recognized with 95% confidence were 6%, 13 ml, 7 ml and 6 g, respectively. Conclusion: The variability in CMR-derived LV measures arising from technical, procedural and biological factors remains minimal at 12 months. Thus, for patients undergoing repeat annual assessment by CMR, even small differences in LV function, size and LVM (which are greater than the SDC) may be attributed to disease-related factors. Advances in knowledge: The reproducibility and reliability of CMR data at 12 months is excellent allowing clinicians to be confident that even small changes in LV structure and function over this time frame are real. PMID:25710361

  20. Effect of bucindolol on heart failure outcomes and heart rate response in patients with reduced ejection fraction heart failure and atrial fibrillation

    PubMed Central

    Kao, David P.; Davis, Gordon; Aleong, Ryan; O'Connor, Christopher M.; Fiuzat, Mona; Carson, Peter E.; Anand, Inder S.; Plehn, Jonathan F.; Gottlieb, Stephen S.; Silver, Marc A.; Lindenfeld, JoAnn; Miller, Alan B.; White, Michel; Murphy, Guinevere A.; Sauer, Will; Bristow, Michael R.

    2013-01-01

    Aims There is little evidence of beta-blocker treatment benefit in patients with heart failure and reduced left ventricular ejection fraction (HFREF) and atrial fibrillation (AF). We investigated the effects of bucindolol in HFREF patients with AF enrolled in the Beta-blocker Evaluation of Survival Trial (BEST). Methods and results A post-hoc analysis of patients in BEST with and without AF was performed to estimate the effect of bucindolol on mortality and hospitalization. Patients were also evaluated for treatment effects on heart rate and the influence of beta1-adrenergic receptor position 389 (β1389) arginine (Arg) vs. glycine (Gly) genotypes. In the 303/2708 patients in AF, patients receiving bucindolol were more likely to achieve a resting heart rate ≤80 b.p.m. at 3 months (P < 0.005) in the absence of treatment-limiting bradycardia. In AF patients and sinus rhythm (SR) patients who achieved a resting heart rate ≤80 b.p.m., there were beneficial treatment effects on cardiovascular mortality/cardiovascular hospitalization [hazard ratio (HR) 0.61, P = 0.025, and 0.79, P = 0.002]. Without achieving a resting heart rate ≤80 b.p.m., there were no treatment effects on events in either group. β1389-Arg/Arg AF patients had nominally significant reductions in all-cause mortality/HF hospitalization and cardiovascular mortality/hospitalization with bucindolol (HR 0.23, P = 0.037 and 0.28, P = 0.039), whereas Gly carriers did not. There was no evidence of diminished heart rate response in β1389-Arg homozygotes. Conclusion In HFREF patients with AF, bucindolol was associated with reductions in composite HF endpoints in those who achieved a resting heart rate ≤80 b.p.m. and nominally in those with the β1389-Arg homozygous genotype. PMID:23223178

  1. Temporal Trends in Treatment and Outcomes for Advanced Heart Failure with Reduced Ejection Fraction from 1993-2010: Findings from a University Referral Center

    PubMed Central

    Loh, John C.; Creaser, Julie; Rourke, Darlene A.; Livingston, Nancy; Harrison, Tamara K.; Vandenbogart, Elizabeth; Moriguchi, Jaime; Hamilton, Michele A.; Tseng, Chi-Hong; Fonarow, Gregg C.; Horwich, Tamara B.

    2013-01-01

    Background Randomized trials have demonstrated the efficacy of several new therapies for heart failure (HF) with reduced ejection fraction over the preceding two decades. This study investigates whether these therapeutic advances have translated into improvement in outcomes for patients with advanced HF referred to a heart transplant center. Methods and Results Patients with HF (n=2507) referred to a single university center were analyzed in three 6-year eras during which medical and device therapies were evolving: 1993-1998 (era 1), 1999-2004 (era 2), and 2005-2010 (era 3). Impaired hemodynamics and comorbidities were more frequent at time of referral in later eras, whereas other HF severity parameters where similar or improved. Successive eras had greater utilization of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, beta-blockers, aldosterone antagonists, implantable cardioverter defibrillators, and cardiac resynchronization therapy, consistent with evolving evidence and guideline-recommendations over the study period. All-cause mortality and sudden death were significantly lower in era 2 and 3 compared to era 1. After multivariable risk adjustment, era 3 had significantly decreased 2- and 3-year all-cause mortality risk and significantly decreased 1- and 3-year sudden death risk compared to era 1. However, progressive HF death and the combined outcome of mortality / urgent transplant / ventricular assist device were modestly increased in the latter eras. Conclusions Over the past two decades, patients with advanced HF referred to and managed at a tertiary university referral center have benefited from advances in HF medications and devices, as evidenced by improvements in overall survival and sudden death risk. PMID:23479563

  2. Guideline-Directed Medication Use in Patients With Heart Failure With Reduced Ejection Fraction in India: American College of Cardiology's PINNACLE India Quality Improvement Program.

    PubMed

    Pokharel, Yashashwi; Wei, Jessica; Hira, Ravi S; Kalra, Ankur; Shore, Supriya; Kerkar, Prafulla G; Kumar, Ganesh; Risch, Samantha; Vicera, Veronique; Oetgen, William J; Deswal, Anita; Turakhia, Mintu P; Glusenkamp, Nathan; Virani, Salim S

    2016-03-01

    Little is known about the use of guideline-directed medical therapy (GDMT) in outpatients with heart failure with reduced left ventricular ejection fraction (HFrEF; ≤40%) in India. Our objective was to understand the use of GDMT in outpatients with HFrEF in India. The Practice Innovation And Clinical Excellence (PINNACLE) India Quality Improvement Program (PIQIP) is a registry for cardiovascular quality improvement in India supported by the American College of Cardiology Foundation. Between January 2008 and September 2014, we evaluated documentation of use of angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs) and β-blockers, or both, among outpatients with HFrEF seeking care in 10 centers enrolled in the PIQIP registry. Among 75 639 patients in the PIQIP registry, 34 995 had EF reported, and 15 870 had an EF ≤40%. The mean age was 56 years; 23% were female. Hypertension, diabetes, coronary artery disease, and myocardial infarction were present in 37%, 23%, 27%, and 17%, respectively. Use of ACEIs/ARBs, β-blockers, and both were documented in 33.5%, 34.9%, and 29.6% of patients, respectively. The documentation of GDMT was higher in men, in patients age ≥65 years, and in those with presence of hypertension, diabetes, or coronary artery disease. Documentation of GDMT gradually increased over the study period. Among patients enrolled in the PIQIP registry, about two-thirds of patients with EF ≤40% did not have documented receipt of GDMT. This study is an initial step toward improving adherence to GDMT in India and highlights the feasibility of examining quality of care in HFrEF in a resource-limited setting. PMID:26880649

  3. High-intensity interval training attenuates endothelial dysfunction in a Dahl salt-sensitive rat model of heart failure with preserved ejection fraction.

    PubMed

    Adams, Volker; Alves, Marcia; Fischer, Tina; Rolim, Natale; Werner, Sarah; Schütt, Nicole; Bowen, T Scott; Linke, Axel; Schuler, Gerhard; Wisloff, Ulrik

    2015-09-15

    Heart failure patients with preserved left ventricular ejection fraction (HFpEF) have endothelial dysfunction, but the underlying molecular mechanisms remain unknown. In addition, whether exercise training improves endothelial function in HFpEF is still controversial. The present study therefore aimed to determine the functional and molecular alterations in the endothelium associated with HFpEF, while further assessing the effects of high-intensity interval training (HIT). Female Dahl salt-sensitive rats were randomized for 28 wk into the following groups: 1) control: fed 0.3% NaCl; 2) HFpEF: fed 8% NaCl; and 3) HFpEF + HIT: animals fed 8% NaCl and HIT treadmill exercise. Echocardiography and invasive hemodynamic measurements were used to assess diastolic dysfunction. Endothelial function of the aorta was measured in vitro. Expression of endothelial nitric oxide synthase (eNOS), nicotinamide adenine dinucleotide phosphate-oxidase [NAD(P)H oxidase], and advanced glycation end product (AGE)-modified proteins were quantified by Western blot, and zymography quantified matrix metalloproteinase (MMP) activity. In this model of HFpEF, endothelium-dependent and -independent vasodilation was impaired. However, this was prevented by HIT. In HFpEF protein expression of eNOS was reduced by 47%, but MMP-2 and MMP-9 activity was elevated by 186 and 68%. The expression of AGE-modified proteins was increased by 106%. All of these changes were prevented by HIT. Endothelial function was impaired in this model of HFpEF, which was associated with reduced expression of eNOS, increased MMP activity, and increased AGE-modified proteins. HIT was able to attenuate both these functional and molecular alterations. These findings therefore suggest HFpEF induces endothelial dysfunction, but this is reversible by HIT. PMID:26229002

  4. COMPARATIVE TOXICITY OF SIZE FRACTIONATED AIRBORNE PARTICULATE MATTER OBTAINED FROM DIFFERENT CITIES IN THE USA

    EPA Science Inventory

    This paper is the result of a collaboration to assess effects of size fractionated PM from different locations on murine pulmonary inflammatory responses. In the course of this, they also determined the chemical makeup of each of the samples.

  5. Antioxidant activity of fractions from oregano essential oils obtained by molecular distillation.

    PubMed

    Olmedo, Ruben; Nepote, Valeria; Grosso, Nelson Ruben

    2014-08-01

    The objective of this study was to determine the antioxidant activity of fractions separated from oregano essential oil by short-path molecular distillation. Two residue (R1 and R2) and two distillate (D1 and D2) fractions were prepared by molecular distillation. The major components were: carvacrol, terpinen-4-ol and γ-terpinene in R1 and R2; and γ-terpinene, α-terpineol and sabinene in D1 and D2. Free-radical scavenging activity was observed in all fractions and was highest in R2 (77.2%). D1 and D2 showed a smaller amount of volatile oxidation compounds produced from sunflower oil stored at 60°C for 14days. The greatest antioxidant activity was observed in D1 and D2. The thermal stability of oregano essential oil and its fractions was also analysed. R1 and R2 presented an increased carvacrol concentration and thermal stability. The short-path molecular distillation fractions can be used to prepare fractions from oregano essential oil with a higher antioxidant activity. PMID:24629960

  6. Comparison of Gated SPECT Myocardial Perfusion Imaging with Echocardiography for the Measurement of Left Ventricular Volumes and Ejection Fraction in Patients With Severe Heart Failure

    PubMed Central

    Shojaeifard, Maryam; Ghaedian, Tahereh; Yaghoobi, Nahid; Malek, Hadi; Firoozabadi, Hasan; Bitarafan-Rajabi, Ahmad; Haghjoo, Majid; Amin, Ahmad; Azizian, Nasrin; Rastgou, Feridoon

    2015-01-01

    Background: Gated single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) is known as a feasible tool for the measurement of left ventricular ejection fraction (EF) and volumes, which are of great importance in the management and follow-up of patients with coronary artery diseases. However, considering the technical shortcomings of SPECT in the presence of perfusion defect, the accuracy of this method in heart failure patients is still controversial. Objectives: The aim of the present study was to compare the results from gated SPECT MPI with those from echocardiography in heart failure patients to compare echocardiographically-derived left ventricular dimension and function data to those from gated SPECT MPI in heart failure patients. Patients and Methods: Forty-one patients with severely reduced left ventricular systolic function (EF ≤ 35%) who were referred for gated SPECT MPI were prospectively enrolled. Quantification of EF, end-diastolic volume (EDV), and end-systolic volume (ESV) was performed by using quantitative gated spect (QGS) (QGS, version 0.4, May 2009) and emory cardiac toolbox (ECTb) (ECTb, revision 1.0, copyright 2007) software packages. EF, EDV, and ESV were also measured with two-dimensional echocardiography within 3 days after MPI. Results: A good correlation was found between echocardiographically-derived EF, EDV, and ESV and the values derived using QGS (r = 0.67, r = 0.78, and r = 0.80 for EF, EDV, and ESV, respectively; P < 0.001) and ECTb (r = 0.68, 0.79, and r = 0.80 for EF, EDV, and ESV, respectively; P < 0.001). However, Bland-Altman plots indicated significantly different mean values for EF, 11.4 and 20.9 using QGS and ECTb, respectively, as compared with echocardiography. ECTb-derived EDV was also significantly higher than the EDV measured with echocardiography and QGS. The highest correlation between echocardiography and gated SPECT MPI was found for mean values of ESV different. Conclusions: Gated

  7. Effect of Varying Definitions of Contrast-Induced Acute Kidney Injury and Left Ventricular Ejection Fraction on One-Year Mortality in Patients Having Transcatheter Aortic Valve Implantation.

    PubMed

    Pyxaras, Stylianos A; Zhang, Yuan; Wolf, Alexander; Schmitz, Thomas; Naber, Christoph K

    2015-08-01

    The prognostic relevance of direct contrast toxicity in patients treated with transcatheter aortic valve implantation (TAVI) remains unclear because of the confounding hemodynamic effect of acute left ventricular ejection fraction (LVEF) impairment on kidney function estimation. In addition, different definitions of contrast-induced acute kidney injury (CI-AKI) may have different prognostic stratification potential. In the present study, 240 consecutive patients who underwent TAVI were prospectively enrolled. CI-AKI was defined (1) according to the postprocedural creatinine increase of ≥0.3 mg/dl or (2) according to the postprocedural decrease of the creatinine clearance of at least 25%. Primary end point of the study was 1-year all-cause mortality. At a mean follow-up of 1.7 ± 1.4 years, all-cause mortality was significantly higher in the CI-AKI patient group, using both CI-AKI definitions (for (1) and (2) p = 0.025 and p <0.001, respectively). In the Cox regression multivariate analysis, CI-AKI was an independent predictor of mortality (hazard ratio 2.244, 95% CI 1.064 to 4.732, p = 0.034), along with LVEF (hazard ratio 0.974, 95% CI 0.946 to 0.993, p = 0.012). Although LVEF and creatinine values at admission were not significantly associated with CI-AKI, their interaction term significantly defined CI-AKI (p = 0.033). The prognostic accuracy of definition (2) was higher (area under the curve 0.704; p <0.001) as with respect to definition (1) (area under the curve 0.602; p = 0.037) for the primary end point of 1-year mortality. In conclusion, in a nonselected patient population who underwent TAVI, CI-AKI was confirmed as an independent predictor of clinical outcome. Only the interaction between LVEF and baseline creatinine values was found to determine CI-AKI. Definition of CI-AKI based to creatinine clearance values had higher prognostic accuracy in comparison with the CI-AKI definition based on creatinine absolute value changes. PMID:26026866

  8. Incremental Prognostic Significance of the Elevated Levels of Pentraxin 3 in Patients With Heart Failure With Normal Left Ventricular Ejection Fraction

    PubMed Central

    Matsubara, Junichi; Sugiyama, Seigo; Nozaki, Toshimitsu; Akiyama, Eiichi; Matsuzawa, Yasushi; Kurokawa, Hirofumi; Maeda, Hirofumi; Fujisue, Koichiro; Sugamura, Koichi; Yamamoto, Eiichiro; Matsui, Kunihiko; Jinnouchi, Hideaki; Ogawa, Hisao

    2014-01-01

    Background Pentraxin 3 (PTX3) is a novel inflammatory marker produced by various cell types including those of the vasculature and the heart. The relationship between inflammatory markers and prognosis of patients with heart failure with normal ejection fraction (HFNEF) remains unknown. We investigated whether plasma PTX3 levels can predict future cardiovascular events in patients with HFNEF. Methods and Results Plasma PTX3, high‐sensitivity C‐reactive protein, and B‐type natriuretic peptide levels were measured prospectively in 360 stable patients with HFNEF. The subsequent incidence of cardiovascular events, including cardiovascular death, nonfatal myocardial infarction (MI), unstable angina pectoris, nonfatal ischemic stroke, hospitalization for heart failure decompensation, and coronary revascularization, was determined. During a mean 30‐month follow‐up, 106 patients experienced cardiovascular events. These events were more frequent in patients with high plasma PTX3 levels (>3.0 ng/mL) than low levels (≤3.0 ng/mL). Multivariable Cox hazard analysis showed that PTX3 (hazard ratio: 1.16; 95% CI: 1.05 to 1.27; P<0.01) and B‐type natriuretic peptide (hazard ratio: 1.08; 95% CI: 1.03 to 1.14; P<0.001), but not high‐sensitivity C‐reactive protein levels, were significant predictors of future cardiovascular events. Multivariable Cox analysis with the forced inclusion model, including 5 previously identified prognostic factors, found that PTX3 was a significant predictor of cardiovascular events (hazard ratio: 1.16; 95% CI: 1.06 to 1.27; P<0.01). The C‐statistics for cardiovascular events substantially increased from 0.617 to 0.683 when PTX3 was added to the 5 previously identified prognostic factors. Conclusions High plasma PTX3 levels, but not other inflammatory markers, are correlated with future cardiovascular events in patients with HFNEF. PTX3 may be a useful biomarker for assessment of risk stratification in HFNEF. Clinical Trial Registration

  9. Do Optimal Prognostic Thresholds in Continuous Physiological Variables Really Exist? Analysis of Origin of Apparent Thresholds, with Systematic Review for Peak Oxygen Consumption, Ejection Fraction and BNP

    PubMed Central

    Leong, Tora; Rehman, Michaela B.; Pastormerlo, Luigi Emilio; Harrell, Frank E.; Coats, Andrew J. S.; Francis, Darrel P.

    2014-01-01

    Background Clinicians are sometimes advised to make decisions using thresholds in measured variables, derived from prognostic studies. Objectives We studied why there are conflicting apparently-optimal prognostic thresholds, for example in exercise peak oxygen uptake (pVO2), ejection fraction (EF), and Brain Natriuretic Peptide (BNP) in heart failure (HF). Data Sources and Eligibility Criteria Studies testing pVO2, EF or BNP prognostic thresholds in heart failure, published between 1990 and 2010, listed on Pubmed. Methods First, we examined studies testing pVO2, EF or BNP prognostic thresholds. Second, we created repeated simulations of 1500 patients to identify whether an apparently-optimal prognostic threshold indicates step change in risk. Results 33 studies (8946 patients) tested a pVO2 threshold. 18 found it prognostically significant: the actual reported threshold ranged widely (10–18 ml/kg/min) but was overwhelmingly controlled by the individual study population's mean pVO2 (r = 0.86, p<0.00001). In contrast, the 15 negative publications were testing thresholds 199% further from their means (p = 0.0001). Likewise, of 35 EF studies (10220 patients), the thresholds in the 22 positive reports were strongly determined by study means (r = 0.90, p<0.0001). Similarly, in the 19 positives of 20 BNP studies (9725 patients): r = 0.86 (p<0.0001). Second, survival simulations always discovered a “most significant” threshold, even when there was definitely no step change in mortality. With linear increase in risk, the apparently-optimal threshold was always near the sample mean (r = 0.99, p<0.001). Limitations This study cannot report the best threshold for any of these variables; instead it explains how common clinical research procedures routinely produce false thresholds. Key Findings First, shifting (and/or disappearance) of an apparently-optimal prognostic threshold is strongly determined by studies' average pVO2, EF or BNP. Second

  10. Low-Sodium DASH Diet Improves Diastolic Function and Ventricular-Arterial Coupling in Hypertensive Heart Failure with Preserved Ejection Fraction

    PubMed Central

    Hummel, Scott L.; Seymour, E. Mitchell; Brook, Robert D.; Sheth, Samar S.; Ghosh, Erina; Zhu, Simeng; Weder, Alan B.; Kovács, Sándor J.; Kolias, Theodore J.

    2014-01-01

    Background Heart failure with preserved ejection fraction (HFPEF) involves failure of cardiovascular reserve in multiple domains. In HFPEF animal models, dietary sodium restriction improves ventricular and vascular stiffness and function. We hypothesized that the sodium-restricted Dietary Approaches to Stop Hypertension diet (DASH/SRD) would improve left ventricular diastolic function, arterial elastance, and ventricular-arterial (V-A) coupling in hypertensive HFPEF. Methods and Results Thirteen patients with treated hypertension and compensated HFPEF consumed the DASH/SRD (target sodium 50 mmol/2100 kcal) for 21 days. We measured baseline and post-DASH/SRD brachial and central BP (via radial arterial tonometry), and cardiovascular function with echocardiographic measures (all previously invasively validated). Diastolic function was quantified via the Parametrized Diastolic Filling formalism, which yields relaxation/viscoelastic (c) and passive/stiffness (k) constants through analysis of Doppler mitral inflow velocity (E-wave) contours. Effective arterial elastance (Ea) end-systolic elastance (Ees), and V-A coupling (defined as the ratio Ees:Ea) were determined using previously published techniques. Wilcoxon matched-pairs tests were used for pre-post comparisons. The DASH/SRD reduced clinic and 24-hour brachial systolic pressure (155±35 to 138±30 and 130±16 to 123±18 mmHg, both p=.02) and central end-systolic pressure trended lower (116±18 to 111±16 mmHg, p=.12). In conjunction, diastolic function improved (c, 24.3±5.3 to 22.7±8.1 s−1;p=.03; k, 252±115 to 170±37 s−1;p=.03), Ea decreased (2.0±0.4 to 1.7±0.4 mmHg/ml;p=.007), and V-A coupling improved (Ees:Ea, 1.5±0.3 to 1.7±0.4;p=.04). Conclusions In hypertensive HFPEF patients, the sodium-restricted DASH diet was associated with favorable changes in ventricular diastolic function, arterial elastance, and V-A coupling. PMID:23985432

  11. High-intensity interval training vs. moderate-intensity continuous exercise training in heart failure with preserved ejection fraction: a pilot study.

    PubMed

    Angadi, Siddhartha S; Mookadam, Farouk; Lee, Chong D; Tucker, Wesley J; Haykowsky, Mark J; Gaesser, Glenn A

    2015-09-15

    Heart failure with preserved ejection fraction (HFpEF) is a major cause of morbidity and mortality. Exercise training is an established adjuvant therapy in heart failure; however, the effects of high-intensity interval training (HIIT) in HFpEF are unknown. We compared the effects of HIIT vs. moderate-intensity aerobic continuous training (MI-ACT) on peak oxygen uptake (V̇o₂peak), left ventricular diastolic dysfunction, and endothelial function in patients with HFpEF. Nineteen patients with HFpEF (age 70 ± 8.3 yr) were randomized to either HIIT (4 × 4 min at 85-90% peak heart rate, with 3 min active recovery) or MI-ACT (30 min at 70% peak heart rate). Fifteen patients completed exercise training (HIIT: n = 9; MI-ACT: n = 6). Patients trained 3 days/wk for 4 wk. Before and after training patients underwent a treadmill test for V̇o₂peak determination, 2D-echocardiography for assessment of left ventricular diastolic dysfunction, and brachial artery flow-mediated dilation (FMD) for assessment of endothelial function. HIIT improved V̇o₂peak (pre = 19.2 ± 5.2 ml·kg(-1)·min(-1); post = 21.0 ± 5.2 ml·kg(-1)·min(-1); P = 0.04) and left ventricular diastolic dysfunction grade (pre = 2.1 ± 0.3; post = 1.3 ± 0.7; P = 0.02), but FMD was unchanged (pre = 6.9 ± 3.7%; post = 7.0 ± 4.2%). No changes were observed following MI-ACT. A trend for reduced left atrial volume index was observed following HIIT compared with MI-ACT (-3.3 ± 6.6 vs. +5.8 ± 10.7 ml/m(2); P = 0.06). In HFpEF patients 4 wk of HIIT significantly improved V̇o₂peak and left ventricular diastolic dysfunction. HIIT may provide a more robust stimulus than MI-ACT for early exercise training adaptations in HFpEF. PMID:25190739

  12. On Obtaining Estimates of the Fraction of Missing Information from Full Information Maximum Likelihood

    ERIC Educational Resources Information Center

    Savalei, Victoria; Rhemtulla, Mijke

    2012-01-01

    Fraction of missing information [lambda][subscript j] is a useful measure of the impact of missing data on the quality of estimation of a particular parameter. This measure can be computed for all parameters in the model, and it communicates the relative loss of efficiency in the estimation of a particular parameter due to missing data. It has…

  13. OBTAINING IMPROVED PRODUCTS FROM THE ORGANIC FRACTION OF MUNICIPAL SOLID WASTE

    EPA Science Inventory

    This project has investigated several processes for the conversion of the organic fraction of municipal solid waste (MSW) to a powder. The study concentrated on two types of processes: (1) conversion of MSW to a powdered carbon char by low-temperature pyrolysis, and (2) embrittle...

  14. Comparative Composition and Antioxidant Activity of Peptide Fractions Obtained by Ultrafiltration of Egg Yolk Protein Enzymatic Hydrolysates

    PubMed Central

    Chay Pak Ting, Bertrand P.; Mine, Yoshinori; Juneja, Lekh R.; Okubo, Tsutomu; Gauthier, Sylvie F.; Pouliot, Yves

    2011-01-01

    The objective of the study was to compare the antioxidant activity of two distinct hydrolysates and their peptide fractions prepared by ultrafiltration (UF) using membranes with molecular weight cut-off of 5 and 1 kDa. The hydrolysates were a delipidated egg yolk protein concentrate (EYP) intensively hydrolyzed with a combination of two bacterial proteases, and a phosphoproteins (PPP) extract partially hydrolyzed with trypsin. Antioxidant activity, as determined by the oxygen radical absorbance capacity (ORAC) assay, was low for EYP and PPP hydrolysates with values of 613.1 and 489.2 μM TE·g−1 protein, respectively. UF-fractionation of EYP hydrolysate increased slightly the antioxidant activity in permeate fractions (720.5–867.8 μM TE·g−1 protein). However, ORAC values were increased by more than 3-fold in UF-fractions prepared from PPP hydrolysate, which were enriched in peptides with molecular weight lower than 5 kDa. These UF-fractions were characterized by their lower N/P atomic ratio and higher phosphorus content compared to the same UF-fractions obtained from EYP-TH. They also contained high amounts of His, Met, Leu, and Phe, which are recognized as antioxidant amino acids, but also high content in Lys and Arg which both represent target amino acids of trypsin used for the hydrolysis of PPP. PMID:24957729

  15. Causes and predictors of hospital readmissions in patients older than 65 years hospitalized for heart failure with preserved left ventricular ejection fraction in western Romania

    PubMed Central

    Mavrea, Adelina Marioara; Dragomir, Tiberiu; Bordejevic, Diana Aurora; Tomescu, Mirela Cleopatra; Ancusa, Oana; Marincu, Iosif

    2015-01-01

    Background Heart failure with preserved ejection fraction (HFpEF) is more frequent in the elderly and is associated with important economic implications because of repetitive and prolonged hospitalizations, due to both cardiovascular and noncardiovascular causes. Purpose To identify the causes, as well as the clinical and biological markers, that could be used as predictors of hospital readmissions in HFpEF patients aged ≥65 years. Patients and methods Consecutive eligible patients hospitalized for a first heart failure (HF) episode were prospectively included and divided into one of two age groups (elderly: ≥65 years; and nonelderly: <65 years). The clinical features, therapeutic approaches, and clinical outcomes during the 1-year follow-up period were analyzed. Results A total of 178 patients were included, with a mean age of 64.6±8.6 years; 80 (45%) were women. A total of 98 patients (55%) were aged ≥65 years, and 80 (45%) were aged <65 years. In the group aged ≥65 years, 58 patients (59%) were women, while in the group aged <65 years, 22 patients (28%) were women (P=0.0001). During the 1-year follow-up, no patients died or were lost to follow-up. Moreover, 116 (65%) of the HFpEF patients experienced hospital readmissions. The elderly patients had a significantly higher readmission rate (73% vs 55%, respectively; P<0.02); readmissions due to aggravated HF were significantly more frequent in this age group (41% vs 18%, respectively; P<0.002). Multivariate logistic regression analysis indicated that the independent predictors of readmission due to HF aggravation included plasma levels of brain natriuretic peptide >450 pg/mL (P<0.01) and N-terminal-pro-brain natriuretic peptide >477 pg/mL (P<0.02) in the elderly group, while in the nonelderly group, the independent predictors of this outcome were a New York Heart Association functional class of IV at initial hospitalization (P<0.04), as well as plasma levels of brain natriuretic peptide >390 pg/mL (P=0

  16. Blending of mango kernel fat and palm oil mid-fraction to obtain cocoa butter equivalent.

    PubMed

    Sonwai, Sopark; Kaphueakngam, Phimnipha; Flood, Adrian

    2014-10-01

    Cocoa butter equivalent (CBE) was produced from a blend of mango kernel fat (MKF) and palm oil mid-fraction (PMF). Five fat blends with different ratios of MKF/PMF (90/10, 80/20, 70/30, 60/40 and 50/50 (%wt)) and pure MKF, PMF and cocoa butter (CB) were characterized. Similar to CB, all fat blends contained palmitic (P), stearic (S) and oleic (O) acids as the main fatty acid components. The triglyceride compositions of all blends were significantly different from CB. However, blend 80/20, which contained higher content of SOS, similar content of POP and lower content of POS compared to CB, exhibited a slip melting point, crystallization and melting behavior most similar to CB and hence it was recommended as CBE. The chosen CBE was then mixed with CB in a ratio of 1:5.64 (wt), mimicking that of typical dark chocolate where 5 % of CBE is added to the finished product. The crystallization behavior, the crystal morphology and bloom behavior of the mixture was investigated and was found to be not significantly different from CB. PMID:25328175

  17. Comparative study of emulsifying properties in acidic condition of soluble polysaccharides fractions obtained from soy hull and defatted soy flour.

    PubMed

    Porfiri, María Cecilia; Cabezas, Darío Marcelino; Wagner, Jorge Ricardo

    2016-02-01

    The present study compares the emulsifying properties in acidic conditions of hull soluble polysaccharides (HSPS), soybean soluble polysaccharides (SSPS) and its mixtures. These fractions were obtained from byproducts of soybean processing industry (soy hull and residual fiber after isolation of soy cotyledon protein, respectively). Although SSPS is already characterized, HSPS is a novel fraction which has not been studied in deep and it is still unexplored as emulsifier. Dispersions of both fraction and a mixture 50:50 of them at pH 3.0 were used as aqueous phase (1.0-3.0 % w/w) in coarse and fine oil-in-water emulsions (oil mass fraction = 0.3). Its stability was evaluated through the evolution of backscattering profiles (%BS), particle size distribution and mean particle diameters. The rheology of the emulsions was also analyzed. Both fractions provided stability to creaming when increasing the polysaccharide concentration and energy of homogenization. While coarse emulsions were unstable systems, fine emulsions were stable enough and allowed a deeper analysis of the destabilizing processes. A bridging flocculation phenomenon in the presence of HSPS and HSPS/SSPS mixtures is suggested, which influences the creaming and rheological behavior. Also, coalescence index increases according HSPS and HSPS/SSPS concentrations, but particle sizes reached were smaller than in SSPS emulsions. Fine emulsions with 3 % of HSPS/SSPS mixtures yielded the best results on the overall stability at 28 days. So, functional properties of the fractions may improve by the formulation of emulsions consisting in mixtures of them. These results are of interest to the manufacturing of acidic foods, taking advantage of obtaining byproducts from residual materials. PMID:27162375

  18. Comparison of rain fractions over tropical and sub-tropical ocean obtained from precipitation retrieval algorithms for microwave sounders

    NASA Astrophysics Data System (ADS)

    Kida, Satoshi; Shige, Shoichi; Manabe, Takeshi

    2010-12-01

    We compare the fractional occurrence of precipitation (rain fraction) over ocean derived using the Global Satellite Mapping of Precipitation algorithm for the Advanced Microwave Sounding Unit (GSMaP_AMSU) and the Microwave Surface and Precipitation Products System Day 2 rainfall algorithm (NOAA_AMSU) for the Kwajalein radar site and over tropical and subtropical ocean. The rain fractions of GSMaP_AMSU and NOAA_AMSU are lower than that of Kwajalein radar estimates because of failure to detect areas of light rain. Over tropical and subtropical ocean, the rain fraction of GSMaP_AMSU is closer to that obtained using a microwave imager (MWI) and little different from that of Tropical Rainfall Measuring Mission Precipitation Radar (PR) data, whilethe rain fraction of NOAA_AMSU is much smaller than that obtained using MWI or PR data. In the case of the edge of the South Pacific Convergence Zone where the PR observes scattered shallow rain, while NOAA_AMSU fails to detect the scattered rain, GSMaP_AMSU detects the scattered rain through consideration of the scattering index, which is the difference in brightness temperature (Tb) between 89 and 150 GHz. Although the scattering index is designed on the basis that Tb decreases in response to scattering by precipitation at these frequencies and increases rapidly with frequency, there are emission and scattering regimes. Furthermore, the scattering index also responds to emission in light rain with a low concentration of cloud liquid water. As a result, the light rain pixel can be detected using the scattering index to take advantage of the emission signature from raindrops.

  19. Comparison of Frequency of Frailty and Severely Impaired Physical Function in Patients ≥60 Years Hospitalized With Acute Decompensated Heart Failure Versus Chronic Stable Heart Failure With Reduced and Preserved Left Ventricular Ejection Fraction.

    PubMed

    Reeves, Gordon R; Whellan, David J; Patel, Mahesh J; O'Connor, Christopher M; Duncan, Pamela; Eggebeen, Joel D; Morgan, Timothy M; Hewston, Leigh A; Pastva, Amy M; Kitzman, Dalane W

    2016-06-15

    Older patients with acute decompensated heart failure (ADHF) have persistently poor outcomes including frequent rehospitalization despite guidelines-based therapy. We hypothesized that such patients have multiple, severe impairments in physical function, cognition, and mood that are not addressed by current care pathways. We prospectively examined frailty, physical function, cognition, mood, and quality of life in 27 consecutive older patients with ADHF at 3 medical centers and compared these with 197 participants in 3 age-matched cohorts: stable heart failure (HF) with preserved ejection fraction (n = 80), stable HF with reduced ejection fraction (n = 56), and healthy older adults (n = 61). Based on Fried criteria, frailty was present in 56% of patients with ADHF versus 0 for the age-matched chronic HF and health cohorts. Patients with ADHF had markedly reduced Short Physical Performance Battery score (5.3 ± 2.8) and 6-minute walk distance (178 ± 102 m) (p <0.001 vs other cohorts), with severe deficits in all domains of physical function: balance, mobility, strength, and endurance. In the patients with ADHF, cognitive impairment (78%) and depression (30%) were common, and quality of life was poor. In conclusion, older patients with ADHF are frequently frail with severe and widespread impairments in physical function, cognition, mood, and quality of life that may contribute to their persistently poor outcomes, are frequently unrecognized, are not addressed in current ADHF care paradigms, and are potentially modifiable with targeted interventions. PMID:27156830

  20. Structural determination by atmospheric pressure photoionization tandem mass spectrometry of some compounds isolated from the SARA fractions obtained from bitumen.

    PubMed

    Tachon, Nadine; Jahouh, Farid; Delmas, Michel; Banoub, Joseph H

    2011-09-30

    We have identified compounds obtained from the SARA fractions of bitumen by using atmospheric pressure photoionization mass spectrometry and low-energy collision tandem mass spectrometric analyses with a QqToF-MS/MS hybrid instrument. The identified compounds were isolated from the maltene saturated oil and the aromatic fractions of the SARA components of a bitumen. The QqToF instrument had sufficient mass resolution to provide accurate molecular weight information and to enhance the tandem mass spectrometry results. The APPI-QqToF-MS analysis of the separated compounds showed a series of protonated molecules [M + H](+) and molecular ions [M](+▪) of the same mass but having different chemical structures, in the maltene saturated oil and the aromatic SARA fractions. These isobaric ions were a molecular ion [M2 ](+▪) at m/z 418.2787 and a protonated molecule [M5 + H](+) at m/z 287.1625 in the saturated oil fraction, and molecular ions [M6 ](+▪) at m/z 418.1584 and [M7 ](+▪) at m/z 287.1285 in the aromatic fraction. The identification of this series of chemical compounds was achieved by performing CID-MS/MS analyses of the molecular ions [M](+▪) ([M1 ](+▪) at m/z 446. 2980, [M2 ](+▪) at m/z 418.2787, [M3 ](+▪) at m/z 360.3350 and [M4 ](+▪) at m/z 346.2095) in the saturated oil fraction and of the [M5 + H](+) ion at m/z 287.1625 also in the saturated oil fraction. The observed CID-MS/MS fragmentation differences were explained by proposed different breakdown processes of the precursor ions. The presented tandem mass spectrometric study shows the capability of MS/MS experiments to differentiate between different classes of chemical compounds of the SARA components of bitumen and to explain the reasons for the observed mass spectrometric differences. However, greater mass resolution than that provided by the QqToF-MS/MS instrument would be required for the analysis of the asphaltene fraction of bitumen. PMID:23657961

  1. Pressurized water extraction of β-glucan enriched fractions with bile acids-binding capacities obtained from edible mushrooms.

    PubMed

    Palanisamy, Marimuthu; Aldars-García, Laila; Gil-Ramírez, Alicia; Ruiz-Rodríguez, Alejandro; Marín, Francisco R; Reglero, Guillermo; Soler-Rivas, Cristina

    2014-01-01

    A pressurized water extraction (PWE) method was developed in order to extract β-glucans with bile acids-binding capacities from cultivated mushrooms (Agaricus bisporus, Lentinula edodes, and Pleurotus ostreatus) to be used as supplements to design novel foods with hypocholesterolemic properties. Extraction yields were higher in individual than sequential extractions being the optimal extraction parameters: 200°C, 5 cycles of 5 min each at 10.3 MPa. The crude polysaccharide (PSC) fractions, isolated from the PWE extracts contained mainly β-glucans (including chitooligosaccharides deriving from chitin hydrolysis), α-glucans, and other PSCs (hetero-/proteo-glucans) depending on the extraction temperature and mushroom strain considered. The observed bile acids-binding capacities of some extracts were similar to a β-glucan enriched fraction obtained from cereals. PMID:24399760

  2. Amino acid composition, antinutrients and allergens in the peanut protein fraction obtained by an aqueous enzymatic process.

    PubMed

    Latif, S; Pfannstiel, J; Makkar, H P S; Becker, K

    2013-01-01

    Enzyme-assisted aqueous extraction (EAE) of peanut kernel was used to extract oil and protein. The aqueous fraction (AF) obtained by EAE had a better essential amino acid profile than the residues obtained by solvent extraction (Rs) and cold pressing (Rc). No major difference in the trypsin inhibitor activity among AF, Rs and Rc was observed; however, the trypsin inhibitor activity was drastically reduced in the residue obtained after EAE. AF was subjected to MALDI-TOF/MS, revealing it to be rich in peptides (107) with molecular masses from m/z 700 to 2369Da. AF had an extremely low phytate content and was rich in peptides, which could be used as a food supplement. ESI-MS/MS data were used for the identification of major peanut allergens, viz., Ara h1, h3, h6-8. Their allergenic potential needs to be established. PMID:23017415

  3. The cloud cover fraction obtained from a ground CCD camera and its effect on a radiative transfer model

    NASA Astrophysics Data System (ADS)

    Souza, M. P.; Pereira, E. B.; Martins, F. R.; Chagas, R. C.; Freitas, W. S., Jr.

    2003-04-01

    Clouds are the major factor that rules the solar irradiance over Earth's surface. They interact with solar radiation in the shortwave spectra and with terrestrial radiation emitted by Earth's surface in the longwave range. Information about cloud cover is a very important input data for radiative transfer models and great effort is being made to improve methods to get this information. This paper reports the effects on a radiative transfer model by using the simple cloud fraction obtained by a ground set CCD camera instead of the satellite derived cloud index. The BRASIL-SR model is a radiative transfer model that calculates surface solar irradiance, using a normalized cloud index determined by statistical analyses of satellites images and from climatological values of temperature and albedo. Cloud fraction was obtained from digital images collected by a ground set CCD (Charge Coupled Device) camera, in the visible range (0.4mm - 0.7mm) as RGB (Red - Green - Blue) compositions. The method initially transforms the image attributes from the RGB space to the IHS (Intensity - Hue - Saturation) space. The algorithm defines threshold values for the saturation component of the IHS system to classify a pixel as cloudy or clear sky. Clear skies are identified by high values of saturation in the visible range while cloudy condition presents a mixture of several wavelengths and consequently lower saturation values. Results from the CCD camera and from the satellite were compared with the Kt and Kd from pyranometer data obtained from a local BSRN radiation station at Florianópolis (27º 28'S, 48º 29'W) and show that cloud fraction is only a poor information about the cloud sky status since it does not bear any information on the cloud optical depth which is needed in most radiative transfer models such as the one used in this paper (the BRASIL-SR).

  4. Diagnosis, Clinical Course, and 1-Year Outcome in Patients Hospitalized for Heart Failure With Preserved Ejection Fraction (from the Polish Cohort of the European Society of Cardiology Heart Failure Long-Term Registry).

    PubMed

    Kapłon-Cieślicka, Agnieszka; Tymińska, Agata; Peller, Michał; Balsam, Paweł; Ozierański, Krzysztof; Galas, Michalina; Marchel, Michał; Crespo-Leiro, Maria G; Maggioni, Aldo Pietro; Drożdż, Jarosław; Filipiak, Krzysztof J; Opolski, Grzegorz

    2016-08-15

    Compared with heart failure (HF) with reduced ejection fraction (HF-REF), the diagnosis of HF with preserved EF (HF-PEF) is more challenging. The aim of the study was to assess the prevalence of HF-PEF among patients hospitalized for HF, to evaluate the pertinence of HF-PEF diagnosis and to compare HF-PEF and HF-REF patients with respect to outcomes. The analysis included 661 Polish patients hospitalized for HF, selected from the European Society of Cardiology (ESC)-HF Long-Term Registry. Patients with an EF of ≥50% were included in the HF-PEF group and patients with an EF of <50% - in the HF-REF group. The primary end point was all-cause death at 1 year. The secondary end point was a composite of all-cause death and rehospitalization for HF at 1 year. HF-PEF was present in 187 patients (28%). Of those 187 patients, mitral inflow pattern was echocardiographically assessed in 116 patients (62%) and classified as restrictive/pseudonormal in 37 patients (20%). Compared with HF-REF subjects, patients with HF-PEF were older, more often female, and had a higher prevalence of hypertension, atrial fibrillation and sleep apnea. Despite lower B-type natriuretic peptide concentrations and lower prevalence of moderate-to-severe mitral regurgitation in patients with HF-PEF, congestive symptoms at admission were as severe as in patients with HF-REF. There were no significant differences in in-hospital mortality between the HF groups. One-year mortality was high in both groups (17% in HF-PEF vs 21% in HF-REF, p = 0.22). There was a trend toward a lower frequency of the secondary end point in the HF-PEF group (32% vs 40%, p = 0.07). In conclusion, in clinical practice, even easily obtainable echocardiographic indexes of diastolic dysfunction are relatively rarely acquired. One-year survival rate of patients with HF-PEF is not significantly better than that of patients with HF-REF. PMID:27374606

  5. Capillary SFC-APCI-MS characterization of PACs obtained by the fractionation of a contaminated pond sediment

    SciTech Connect

    Thomas, D.; Sim, P.G.; Crain, S.M.; Benoit, F.M.

    1994-12-31

    Capillary supercritical fluid chromotography can be directly coupled to a mass spectrometer by utilizing interfaces based on the direct fluid interface. In these, the capillary restrictor passes through a probe, at the end of which is positioned a heating element used to directly heat the end of the capillary restrictor to prevent solute precipitation and freezing of the mobile phase in the restrictor during decompression. Such SFC interfaces, which pass directly into the source of the MS, suffer from sensitivity problems, especially in the electron impact mode. Many of the problem associated with SFC-MS could effectively be removed if the ionization of the compounds were to occur at atmospheric pressure. Capillary SFC was combined with APCI-MS via heated pneumatic nebulizer interfaces modified for use with SFC, and applied to analyze a complex mixture of polycyclic aromatic compounds obtained by the fractionation of a contaminated pond sediment.

  6. Emulsifying and Foaming Properties of Different Protein Fractions Obtained from a Novel Lupin Variety AluProt-CGNA(®) (Lupinus luteus).

    PubMed

    Burgos-Díaz, César; Piornos, José A; Wandersleben, Traudy; Ogura, Takahiro; Hernández, Xaviera; Rubilar, Mónica

    2016-07-01

    The use of vegetable proteins as food ingredient is becoming increasingly important due to their high versatility and environmental acceptability. This work describes a chemical characterization and techno-functional properties (emulsifying and foaming properties) of 3 protein fractions obtained from a protein-rich novel lupin variety, AluProt-CGNA(®) . This nongenetically modified variety have a great protein content in dehulled seeds (60.6 g protein/100 g, dry matter), which is higher than soybean and other lupin varieties. A simple procedure was utilized to obtain 3 different fractions by using alkali solubilization and isoelectric precipitation. Fractions 1 and 3 were mainly composed of protein and polysaccharides (NNE), whereas fraction 2 was mainly composed by protein (97%, w/w). Fraction 3 presented interesting and potential foaming properties in comparison to the other fractions evaluated in the study. Besides, its solubility, foaming and emulsifying capacity were practically not affected by pH variations. The 3 fractions also presented good emulsion stability, reaching values above a 95%. SDS-PAGE showed that fractions 1 and 2 contained mainly conglutin α, β, and δ, but in different ratios, whereas fraction 3 contained mainly conglutin γ and albumins. The results of this work will provide better understanding for the utilization of each protein fractions as potential ingredients in food industry. PMID:27232549

  7. Impact of Race, Ethnicity, and Multimodality Biomarkers on the Incidence of New-Onset Heart Failure With Preserved Ejection Fraction (from the Multi-Ethnic Study of Atherosclerosis).

    PubMed

    Silverman, Michael G; Patel, Birju; Blankstein, Ron; Lima, Joao A C; Blumenthal, Roger S; Nasir, Khurram; Blaha, Michael J

    2016-05-01

    Heart failure with preserved ejection fraction (HFpEF) is a prevalent condition with no established prevention or treatment strategies. Furthermore, the pathophysiology and predisposing risk factors for HFpEF are incompletely understood. Therefore, we sought to characterize the incidence and determinants of HFpEF in the Multi-Ethnic Study of Atherosclerosis (MESA). Our study included 6,781 MESA participants (White, Black, Chinese, and Hispanic men and women age 45 to 84 years, free of baseline cardiovascular disease). The primary end point was time to diagnosis of HFpEF (left ventricular ejection fraction ≥45%). Multivariable adjusted hazard ratios (HRs) with 95% confidence intervals were calculated to identify predictors of HFpEF. Over median follow-up of 11.2 years (10.6 to 11.7), 111 subjects developed HFpEF (cumulative incidence 1.7%). Incidence rates were similar across all races/ethnicities. Age (HR 2.3 [1.7 to 3.0]), hypertension (HR 1.8 [1.1 to 2.9]), diabetes (HR 2.3 [1.5 to 3.7]), body mass index (HR 1.4 [1.1 to 1.7]), left ventricular hypertrophy by electrocardiography (HR 4.3 [1.7 to 11.0]), interim myocardial infarction (HR 4.8 [2.7 to 8.6]), elevated N-terminal of the prohormone brain natriuretic peptide (HR 2.4 [1.5 to 4.0]), detectable troponin T (HR 4.5 [1.9 to 10.9]), and left ventricular mass index by magnetic resonance imaging (MRI; 1.3 [1.0 to 1.6]) were significant predictors of incident HFpEF. Worsening renal function, inflammatory markers, and coronary artery calcium were significant univariate but not multivariate predictors of HFpEF. Gender was neither a univariate nor multivariate predictor of HFpEF. In conclusion, we demonstrate several risk factors and biomarkers associated with incident HFpEF that were consistent across different racial/ethnic groups and may represent potential therapeutic targets for the prevention and treatment of HFpEF. PMID:27001449

  8. Factors Affecting Ejection Risk in Rollover Crashes

    PubMed Central

    Funk, James R.; Cormier, Joseph M.; Bain, Charles E.; Wirth, Jeffrey L.; Bonugli, Enrique B.; Watson, Richard A.

    2012-01-01

    Ejection greatly increases the risk of injury and fatality in a rollover crash. The purpose of this study was to determine the crash, vehicle, and occupant characteristics that affect the risk of ejection in rollovers. Information from real world rollover crashes occurring from 2000 – 2010 was obtained from the National Automotive Sampling System (NASS) in order to analyze the effect of the following parameters on ejection risk: seatbelt use, rollover severity, vehicle type, seating position, roof crush, side curtain airbag deployment, glazing type, and occupant age, gender, and size. Seatbelt use was found to reduce the risk of partial ejection and virtually eliminate the risk of complete ejection. For belted occupants, the risk of partial ejection risk was significantly increased in rollover crashes involving more roof inversions, light trucks and vans (LTVs), and larger occupants. For unbelted occupants, the risk of complete ejection was significantly increased in rollover crashes involving more roof inversions, LTVs, far side occupants, and higher levels of roof crush. Roof crush was not a significant predictor of ejection after normalizing for rollover severity. Curtain airbag deployment was associated with reduced rates of partial and complete ejection, but the effect was not statistically significant, perhaps due to the small sample size (n = 89 raw cases with curtain deployments). A much greater proportion of occupants who were ejected in spite of curtain airbag deployment passed through the sunroof and other portals as opposed to the adjacent side window compared to occupants who were ejected in rollovers without a curtain airbag deployment. The primary factors that reduce ejection risk in rollover crashes are, in generally decreasing order of importance: seatbelt use, fewer roof inversions, passenger car body type, curtain airbag deployment, near side seating position, and small occupant size. PMID:23169130

  9. Factors affecting ejection risk in rollover crashes.

    PubMed

    Funk, James R; Cormier, Joseph M; Bain, Charles E; Wirth, Jeffrey L; Bonugli, Enrique B; Watson, Richard A

    2012-01-01

    Ejection greatly increases the risk of injury and fatality in a rollover crash. The purpose of this study was to determine the crash, vehicle, and occupant characteristics that affect the risk of ejection in rollovers. Information from real world rollover crashes occurring from 2000 - 2010 was obtained from the National Automotive Sampling System (NASS) in order to analyze the effect of the following parameters on ejection risk: seatbelt use, rollover severity, vehicle type, seating position, roof crush, side curtain airbag deployment, glazing type, and occupant age, gender, and size. Seatbelt use was found to reduce the risk of partial ejection and virtually eliminate the risk of complete ejection. For belted occupants, the risk of partial ejection risk was significantly increased in rollover crashes involving more roof inversions, light trucks and vans (LTVs), and larger occupants. For unbelted occupants, the risk of complete ejection was significantly increased in rollover crashes involving more roof inversions, LTVs, far side occupants, and higher levels of roof crush. Roof crush was not a significant predictor of ejection after normalizing for rollover severity. Curtain airbag deployment was associated with reduced rates of partial and complete ejection, but the effect was not statistically significant, perhaps due to the small sample size (n = 89 raw cases with curtain deployments). A much greater proportion of occupants who were ejected in spite of curtain airbag deployment passed through the sunroof and other portals as opposed to the adjacent side window compared to occupants who were ejected in rollovers without a curtain airbag deployment. The primary factors that reduce ejection risk in rollover crashes are, in generally decreasing order of importance: seatbelt use, fewer roof inversions, passenger car body type, curtain airbag deployment, near side seating position, and small occupant size. PMID:23169130

  10. Hemodynamic Responses to Etomidate Versus Ketamine-Thiopental Sodium Combination for Anesthetic Induction in Coronary Artery Bypass Graft Surgery Patients with Low Ejection Fraction: A Double-Blind, Randomized, Clinical Trial

    PubMed Central

    Habibi, Mohammad Reza; Soleimani, Aria; Zeydi, Amir Emami; Nia, Hamid Sharif; Habibi, Ali; Onagh, Naser

    2014-01-01

    Background: During induction of anesthesia and intubation, hemodynamic changes are very important; especially in patients with coronary artery disease (CAD) and left ventricular dysfunction. A little information is available on the hemodynamic effects of a combination of ketamine-thiopental for induction of anesthesia in patients undergoing coronary artery bypass graft (CABG) surgery, with impaired ventricular function. Aim: The aim of this study was to compare the hemodynamic responses to etomidate versus ketamine-thiopental sodium combination for anesthetic induction in CABG surgery patients with low ejection fraction (EF<45%). Materials and Methods: In a double blind randomized clinical trial, a total of 100 patients, scheduled for elective CABG surgery were randomly assigned into two groups. These patients received either etomidate or ketamine-thiopental sodium combination at induction of anesthesia. Hemodynamics variable were measured and recorded at baseline, immediately before and after laryngoscopy and intubation, one, two and three minutes after intubation. Also, muscle twitching incidence among patients in two groups was evaluated. Results: No significant differences between the two groups regarding the changes of hemodynamic variables including systolic and diastolic arterial blood pressure, mean arterial pressure and heart rate, were notice (p>0.05). Muscle twitching was not observed in the two groups. Conclusion: Hemodynamic stability after administration of ketamine-thiopental sodium combination for induction of anesthesia in patients undergoing CABG surgery, with impaired ventricular function, supports the clinical impression that this combination is safe in CABG surgery patients with low EF. PMID:25478364

  11. Effect of exercise training program in post-CRET post-CABG patients with normal and subnormal ejection fraction (EF > 50% or < 50%) after coronary artery bypass grafting surgery.

    PubMed

    Ansari, Basit; Qureshi, Masood A; Zohra, Raheela Rahmat

    2014-11-01

    The aim of the present study is to compare the effect of exercise training program in post-Cardiac Rehabilitation Exercise Training (CRET), post-CABG patients with normal & subnormal ejection fraction (EF >50% or <50%) who have undergoing coronary artery bypass grafting (CABG) surgery. The study was conducted on 100 cardiac patients of both sexes (age: 57-65 years) who after CABG surgery, were referred to the department of Physiotherapy and Rehabilitation between 2008 and 2010 at Liaquat National Hospital & Medical College, Karachi. The patients undertook exercise training program (using treadmill, Recumbent Bike), keeping in view the Borg's scale of perceived exertion, for 6 weeks. Heart Rate (HR) and Blood Pressure (BP) were measured & compared in post CABG Patients with EF (>50% or <50%) at the start and end of the exercise training program. Statistical formulae were applied to analyze the improvement in cardiac functional indicators. Exercise significantly restores the values of HR and BP (systolic) in post CABGT Patients with EF (>50% or <50%) from the baseline to the last session of the training program. There appeared significant improvement in cardiac function four to six weeks of treadmill exercise training program. After CABG all patients showed similar improvement in cardiac function with exercise training program. The exercise training program is beneficial for improving exercise capacity linked with recovery cardiac function in Pakistani CABG patients. PMID:26045379

  12. Composition of Coronal Mass Ejections

    NASA Astrophysics Data System (ADS)

    Zurbuchen, T. H.; Weberg, M.; von Steiger, R.; Mewaldt, R. A.; Lepri, S. T.; Antiochos, S. K.

    2016-07-01

    We analyze the physical origin of plasmas that are ejected from the solar corona. To address this issue, we perform a comprehensive analysis of the elemental composition of interplanetary coronal mass ejections (ICMEs) using recently released elemental composition data for Fe, Mg, Si, S, C, N, Ne, and He as compared to O and H. We find that ICMEs exhibit a systematic abundance increase of elements with first ionization potential (FIP) < 10 eV, as well as a significant increase of Ne as compared to quasi-stationary solar wind. ICME plasmas have a stronger FIP effect than slow wind, which indicates either that an FIP process is active during the ICME ejection or that a different type of solar plasma is injected into ICMEs. The observed FIP fractionation is largest during times when the Fe ionic charge states are elevated above Q Fe > 12.0. For ICMEs with elevated charge states, the FIP effect is enhanced by 70% over that of the slow wind. We argue that the compositionally hot parts of ICMEs are active region loops that do not normally have access to the heliosphere through the processes that give rise to solar wind. We also discuss the implications of this result for solar energetic particles accelerated during solar eruptions and for the origin of the slow wind itself.

  13. Chronic vagal stimulation for the treatment of low ejection fraction heart failure: results of the NEural Cardiac TherApy foR Heart Failure (NECTAR-HF) randomized controlled trial

    PubMed Central

    Zannad, Faiez; De Ferrari, Gaetano M.; Tuinenburg, Anton E.; Wright, David; Brugada, Josep; Butter, Christian; Klein, Helmut; Stolen, Craig; Meyer, Scott; Stein, Kenneth M.; Ramuzat, Agnes; Schubert, Bernd; Daum, Doug; Neuzil, Petr; Botman, Cornelis; Castel, Maria Angeles; D'Onofrio, Antonio; Solomon, Scott D.; Wold, Nicholas; Ruble, Stephen B.

    2015-01-01

    Aim The neural cardiac therapy for heart failure (NECTAR-HF) was a randomized sham-controlled trial designed to evaluate whether a single dose of vagal nerve stimulation (VNS) would attenuate cardiac remodelling, improve cardiac function and increase exercise capacity in symptomatic heart failure patients with severe left ventricular (LV) systolic dysfunction despite guideline recommended medical therapy. Methods Patients were randomized in a 2 : 1 ratio to receive therapy (VNS ON) or control (VNS OFF) for a 6-month period. The primary endpoint was the change in LV end systolic diameter (LVESD) at 6 months for control vs. therapy, with secondary endpoints of other echocardiography measurements, exercise capacity, quality-of-life assessments, 24-h Holter, and circulating biomarkers. Results Of the 96 implanted patients, 87 had paired datasets for the primary endpoint. Change in LVESD from baseline to 6 months was −0.04 ± 0.25 cm in the therapy group compared with −0.08 ± 0.32 cm in the control group (P = 0.60). Additional echocardiographic parameters of LV end diastolic dimension, LV end systolic volume, left ventricular end diastolic volume, LV ejection fraction, peak V02, and N-terminal pro-hormone brain natriuretic peptide failed to show superiority compared to the control group. However, there were statistically significant improvements in quality of life for the Minnesota Living with Heart Failure Questionnaire (P = 0.049), New York Heart Association class (P = 0.032), and the SF-36 Physical Component (P = 0.016) in the therapy group. Conclusion Vagal nerve stimulation as delivered in the NECTAR-HF trial failed to demonstrate a significant effect on primary and secondary endpoint measures of cardiac remodelling and functional capacity in symptomatic heart failure patients, but quality-of-life measures showed significant improvement. PMID:25176942

  14. Comparison of Baseline versus Posttreatment Left Ventricular Ejection Fraction in Patients with Acute Decompensated Heart Failure for Predicting Cardiovascular Outcome: Implications from Single-Center Systolic Heart Failure Cohort

    PubMed Central

    Wang, Chao-Hung; Wen, Ming-Shien; Kuo, Chi-Tai; Tsai, Feng-Chun; Wu, Victor Chien-Chia; Chen, Tien-Hsing

    2016-01-01

    Aims The prognostic values of left ventricular ejection fraction (LVEF) during heart failure (HF) with acute decompensation or after optimal treatment have not been extensively studied. We hypothesized that posttreatment LVEF has superior predictive value for long-term prognosis than LVEF at admission does. Methods and Results In Protocol 1, 428 acute decompensated HF (ADHF) patients with LVEF ≤35% in a tertiary medical center were enrolled and followed for a mean period of 34.7 ± 10.8 months. The primary and secondary end points were all-cause mortality and HF readmission, respectively. In total, 86 deaths and 240 HF readmissions were recorded. The predictive values of baseline LVEF at admission and LVEF 6 months posttreatment were analyzed and compared. The posttreatment LVEFs were predictive for future events (P = 0.01 for all-cause mortality, P < 0.001 for HF readmission), but the baseline LVEFs were not. In Protocol 2, the outcomes of patients with improved LVEF (change of LVEF: ≥+10%), unchanged LVEF (change of LVEF: –10% to +10%), and reduced LVEF (change of LVEF: ≤–10%) were analyzed and compared. Improved LVEF occurred in 171 patients and was associated with a superior long-term prognosis among all groups (P = 0.02 for all-cause mortality, P < 0.001 for HF readmission). In Protocol 3, independent predictors of improved LVEF were analyzed, and baseline LV end-diastolic dimension (LVEDD) was identified as a powerful predictor in ADHF patients (P < 0.001). Conclusions In patients with ADHF, posttreatment LVEF but not baseline LVEF had prognostic power. Improved LVEF was associated with superior long-term prognosis, and baseline LVEDD identified patients who were more likely to have improved LVEF. Therefore, baseline LVEF should not be considered a relevant prognosis factor in clinical practice for patients with ADHF. PMID:26752417

  15. Serum levels of NT- pro ANP, BNP, NT-pro BNP and function of the left atrium in patients with heart failure and preserved ejection fraction after myocardial infarction

    NASA Astrophysics Data System (ADS)

    Shurupov, V.; Suslova, T.; Ryabov, V.

    2015-11-01

    The objective of our study was to evaluate the levels of natriuretic peptides in patients (pts) with heart failure with preserved ejection fraction (HFpEF) in 12 month after ST elevation myocardial infarction (STEMI) with a focus on the function of left atrium (LA) and left ventricular (LV) filling pressure. 55 pts were included in the study. 6-minute walk test was performed. Echo exam was performed by the diagnostic system VIVID 7. BNP in whole blood was determined using the Triage ® Meter BNP test. The serum levels of NT-pro BNP, NT-pro ANP («Biomedica», Austria) were determined in blood samples by enzyme-linked immune-sorbent assay (ELISA). LA volume index were differences (16.03±3.39 ml/m2; 25.36±8.26 ml/m2; 29.41±9.46 ml/m2 accordingly I, II, III class) depending on severity of HF. Well as E/E' ratio were differences (7.5±1.4; 9.8±5.1; 13.5±7.6 accordingly I, II, III class) depending on severity of HF. The LA volume index correlated with levels of NT-pro ANP (R=0.29; p=0.04), levels of NT-pro BNP (R=0.37; p=0.01), levels of BNP (R=0.51; p=0.0001). The LV filling pressure correlated with levels of NT-pro ANP (R=0.45; p=0.002), levels of NT-pro BNP (R=0.49; p=0.001), levels of BNP (R=0.37; p=0.01).

  16. A study of the effect of dietary fiber fractions obtained from artichoke (Cynara cardunculus L. var. scolymus) on the growth of intestinal bacteria associated with health.

    PubMed

    Fissore, Eliana N; Santo Domingo, Cinthia; Gerschenson, Lía N; Giannuzzi, Leda

    2015-05-01

    The effect of different fractions enriched in soluble fiber obtained from artichoke using citric acid or citric acid/hemicellulase on the selective growth of Lactobacillus plantarum 8114 and Bifidobacterium bifidum ATCC 11863 was evaluated. Gompertz modeling of Lactobacillus plantarum 8114 growth showed a higher specific growth rate (μ: 0.16 h(-1)) in the presence of fractions isolated from stems using hemicellulase (fraction A) than in the presence of glucose (μ: 0.09 h(-1)). In the case of Bifidobacterium bifidum 11863, the highest μ was obtained for the microorganism grown in the presence of fraction A and for the fraction isolated from stems without hemicellulase, their rate being twice that observed for glucose (0.04 h(-1)). The positive prebiotic activity scores observed with respect to Escherichia coli 25922 indicated that fibers assayed are metabolized as well as glucose by Lactobacillus plantarum 8114 and Bifidobacterium bifidum ATCC 11863 and that they are selectively metabolized by these microorganisms. The potential capacity to selectively stimulate the growth of intestinal bacteria associated with health shown by fraction A can be ascribed to its high inulin and low methylation degree pectin contents. PMID:25904284

  17. The E-Wave Deceleration Rate E/DT Outperforms the Tissue Doppler-Derived Index E/e' in Characterizing Lung Remodeling in Heart Failure with Preserved Ejection Fraction

    PubMed Central

    Nguyen, T. Dung; Shingu, Yasushige; Schwarzer, Michael; Schrepper, Andrea; Doenst, Torsten

    2013-01-01

    Background Diastolic dysfunction in heart failure with preserved ejection fraction (HFpEF) may result in pulmonary congestion and lung remodeling. We evaluated the usefulness of major diastolic echocardiographic parameters and of the deceleration rate of early transmitral diastolic velocity (E/DT) in predicting lung remodeling in a rat model of HFpEF. Methods and Results Rats underwent aortic banding (AoB) to induce pressure overload (PO). Left ventricular hypertrophy fully developed 2 weeks after AoB. At 4 and 6 weeks, the lung weight-to-body weight ratio (LW/BW), a sensitive marker for pulmonary congestion and remodeling, dramatically increased despite preserved fractional shortening, indicating the presence of HFpEF. The time course of LW/BW was well reflected by E/DT, by the ratio of early to late transmitral diastolic velocity (E/A) and the deceleration time of E (DT), but not by the ratio of transmitral to mitral annular early diastolic velocity (E/e'). In agreement, the best correlation with LW/BW was found for E/DT (r = 0.76; p<0.0001), followed by E/A (r = 0.69; p<0.0001), DT (r = −0.62; p<0.0001) and finally E/e' (r = 0.51; p<0.001). Furthermore, analysis of receiver-operating characteristic curves for the prediction of increased LW/BW revealed excellent area under the curve values for E/DT (AUC = 0.98) and DT (AUC = 0.95), which are significantly higher than that of E/e' (AUC = 0.82). In a second approach, we also found that the new parameter E/DT correlated well with right ventricular weight index and echocardiographic measures of right ventricular systolic function. Conclusions The novel parameter E/DT outperforms the tissue Doppler index E/e' in detecting and monitoring lung remodeling induced by pressure overload. The results may provide a handy tool to point towards secondary lung disease in HFpEF and warrant further clinical investigations. PMID:24312628

  18. Comparative toxicity of size-fractionated airborne particulate matter obtained from different cities in the United States

    SciTech Connect

    Gilmour, M.I.; McGee, J.; Duvall, R.M.; Dailey, L.; Daniels, M.; Boykin, E.; Cho, S.H.; Doerfler, D.; Gordon, T.; Devlin, R.B.

    2007-07-01

    Hundreds of epidemiological studies have shown that exposure to ambient particulate matter (PM) is associated with dose-dependent increases in morbidity and mortality. While early reports focused on PM less than 10 {mu}m (PM10), numerous studies have since shown that the effects can occur with PM stratified into ultrafine (UF), fine (FI), and coarse (CO) size modes despite the fact that these materials differ significantly in both evolution and chemistry. Furthermore the chemical makeup of these different size fractions can vary tremendously depending on location, meteorology, and source profile. For this reason, high-volume three-stage particle impactors with the capacity to collect UF, FI, and CO particles were deployed to four different locations in the United States (Seattle, WA; Salt Lake City, UT; Sterling Forest and South Bronx, NY), and weekly samples were collected for 1 mo in each place. The particles were extracted, assayed for a standardized battery of chemical components, and instilled into mouse lungs (female BALB/c) at doses of 25 and 100 {mu}g. Eighteen hours later animals were euthanized and parameters of injury and inflammation were monitored in the bronchoalveolar lavage fluid and plasma. Of the four locations, the South Bronx coarse fraction was the most potent sample in both pulmonary and systemic biomarkers. Receptor source modeling on the PM2.5 samples showed that the South Bronx sample was heavily influenced by emissions from coal fired power plants (31%) and mobile sources (22%). Further studies will assess how source profiles correlate with the observed effects for all locations and size fractions.

  19. Phytotoxic Effects and Phytochemical Fingerprinting of Hydrodistilled Oil, Enriched Fractions, and Isolated Compounds Obtained from Cryptocarya massoy (Oken) Kosterm. Bark.

    PubMed

    Rolli, Enrico; Marieschi, Matteo; Maietti, Silvia; Guerrini, Alessandra; Grandini, Alessandro; Sacchetti, Gianni; Bruni, Renato

    2016-01-01

    The hydrodistilled oil of Cryptocarya massoy bark was characterized by GC-FID and GC/MS analyses, allowing the identification of unusual C10 massoia lactone (3, 56.2%), C12 massoia lactone (4, 16.5%), benzyl benzoate (1, 12.7%), C8 massoia lactone (3.4%), δ-decalactone (5, 1.5%), and benzyl salicylate (2, 1.8%) as main constituents. The phytotoxic activities of the oil, three enriched fractions (lactone-rich, ester-rich, and sesquiterpene-rich), and four constituents (compounds 1, 2, 5, and δ-dodecalactone (6)) against Lycopersicon esculentum and Cucumis sativus seeds and seedlings were screened. At a concentration of 1000 μl/l, the essential oil and the massoia lactone-rich fraction caused a complete inhibition of the germination of both seeds, and, when applied on tomato plantlets, they induced an 85 and 100% dieback, respectively. These performances exceeded those of the well-known phytotoxic essential oils of Syzygium aromaticum and Cymbopogon citratus, already used in commercial products for the weed and pest management. The same substances were also evaluated against four phytopathogenic bacteria and ten phytopathogenic fungi, providing EC50 values against the most susceptible strains in the 100-500 μl/l range for the essential oil and in the 10-50 μl/l range for compound 6 and the lactone-rich fraction. The phytotoxic behavior was related mainly to massoia lactones and benzyl esters, while a greater amount of 6 may infer a good activity against some phytopathogenic fungi. Further investigations of these secondary metabolites are warranted, to evaluate their use as natural herbicides. PMID:26765353

  20. Comparative toxicity of size-fractionated airborne particulate matter obtained from different cities in the United States.

    PubMed

    Gilmour, M Ian; McGee, John; Duvall, Rachelle M; Dailey, Lisa; Daniels, Mary; Boykin, Elizabeth; Cho, Seung-Hyun; Doerfler, Donald; Gordon, Terry; Devlin, Robert B

    2007-01-01

    Hundreds of epidemiological studies have shown that exposure to ambient particulate matter (PM) is associated with dose-dependent increases in morbidity and mortality. While early reports focused on PM less than 10 microm (PM10), numerous studies have since shown that the effects can occur with PM stratified into ultrafine (UF), fine (FI), and coarse (CO) size modes despite the fact that these materials differ significantly in both evolution and chemistry. Furthermore the chemical makeup of these different size fractions can vary tremendously depending on location, meteorology, and source profile. For this reason, high-volume three-stage particle impactors with the capacity to collect UF, FI, and CO particles were deployed to four different locations in the United States (Seattle, WA; Salt Lake City, UT; Sterling Forest and South Bronx, NY), and weekly samples were collected for 1 mo in each place. The particles were extracted, assayed for a standardized battery of chemical components, and instilled into mouse lungs (female BALB/c) at doses of 25 and 100 microg. Eighteen hours later animals were euthanized and parameters of injury and inflammation were monitored in the bronchoalveolar lavage fluid and plasma. Of the four locations, the South Bronx coarse fraction was the most potent sample in both pulmonary and systemic biomarkers, with a strong increase in lung inflammatory cells as well as elevated levels of creatine kinase in the plasma. These effects did not correlate with lipopolysaccharide (LPS) or total zinc or sulfate content, but were associated with total iron. Receptor source modeling on the PM2.5 samples showed that the South Bronx sample was heavily influenced by emissions from coal fired power plants (31%) and mobile sources (22%). Further studies will assess how source profiles correlate with the observed effects for all locations and size fractions. PMID:17886044

  1. CFD Simulations of Vibration Induced Droplet Ejection.

    NASA Astrophysics Data System (ADS)

    James, Ashley; Smith, Marc K.; Glezer, Ari

    1998-11-01

    Vibration-induced droplet ejection is a process that occurs when a liquid droplet is placed on a vibrating membrane. Above a critical value of the excitation amplitude, Faraday waves form on the surface of the drop. As the amplitude is increased secondary drops are ejected from the wave crests. A Navier-Stokes solver designed to simulate the transient fluid mechanics of the process is presented. The solver is based on a MAC method on a staggered grid. A volume of fluid method is implemented to track the free surface. The volume fraction is advected via a second-order, unsplit method that minimizes numerical diffusion of the interface. Surface tension is incorporated as a continuum surface force. This work is intended to provide a comprehensive description of the fluid dynamics involved in vibration-induced droplet ejection, with the aim of understanding the mechanism behind the ejection process. The evolution of the interface through droplet ejection will be simulated. The dependence of the ejection process on the driving parameters will be evaluated and the resonance characteristics of the drop will be determined. The results of the computations will be compared with experimental results.

  2. Liquid metal drop ejection

    NASA Technical Reports Server (NTRS)

    Khuri-Yakub, B. T.

    1993-01-01

    The aim of this project was to demonstrate the possibility of ejecting liquid metals using drop on demand printing technology. The plan was to make transducers for operation in the 100 MHz frequency range and to use these transducers to demonstrate the ability to eject drops of liquid metals such as gallium. Two transducers were made by indium bonding piezoelectric lithium niobate to quartz buffer rods. The lithium niobate plates were thinned by mechanical polishing to a thickness of 37 microns for operation at 100 MHz. Hemispherical lenses were polished in the opposite ends of the buffer rods. The lenses, which focus the sound waves in the liquid metal, had an F-number equals 1. A mechanical housing was made to hold the transducers and to allow precise control over the liquid level above the lens. We started by demonstrating the ability to eject drops of water on demand. The drops of water had a diameter of 15 microns which corresponds to the wavelength of the sound wave in the water. A videotape of this ejection was made. We then used a mixture of Gallium and Indium (used to lower the melting temperature of the Gallium) to demonstrate the ejection of liquid metal drops. This proved to be difficult because of the oxide skin which forms on the surface of the liquid. In some instances, we were able to eject metal drops, however, this was not consistent and reproducible. An experiment was set up at NASA-Lewis to stabilize the process of drop on demand liquid metal ejection. The object was to place the transducer and liquid metal in a vacuum station so that no oxide would form on the surface. We were successful in demonstrating that liquid metals could be ejected on demand and that this technology could be used for making sheet metal in space.

  3. Tandem pulsed acousto-optics: obtaining the tagged light fraction from modulated non-ideal speckle patterns

    NASA Astrophysics Data System (ADS)

    Resink, S. G.; Steenbergen, W.

    2016-01-01

    Recently we presented novel methods for acousto-optic (AO) imaging of biological tissues, taking (1) the mean square difference of speckle patterns (subtraction method) or (2) the contrast of the summation of speckle patterns (summation method) acquired from nanosecond pulses of coherent light, fired at different ultrasound phases. In this study we relate the two methods both analytically and experimentally. We experimentally show that these two methods are nearly identical provided that the maximum achievable speckle contrast is determined correctly. We show with simulations that after correction the outcome is independent of experimental detection parameters. This makes the AO methods in this study reliable, allowing quantifying speckle observations in terms of the ultrasonically tagged fractions of light. The use of tandem nanosecond pulses in one burst of ultrasound overcomes the challenge of tissue dynamics.

  4. Biochemical assessment of growth factors and circulation of blood components contained in the different fractions obtained by centrifugation of venous blood.

    PubMed

    Corigiano, M; Ciobanu, G; Baldoni, E; Pompa, G

    2014-01-01

    The aim of this study was to evaluate a biochemical marker with different elements of a normal blood serum and centrifuged blood serum after a different rotation system. For this technique, we used five fractions of a blood Concentrated Growth Factors system (bCGF) and a particular device for the different rotation program. Blood samples were collected from 10 volunteers aged between 35 and 55 in the Operative Unit of the “Sapienza” University of Rome with only a fraction of different biochemical elements. Through an individual blood phase separator tube of venous blood, active factions of serum and 4 fractions of red buffy coat were taken. The biochemical markers with 14 elements were examined at times: P1-11 minutes, P2-12minutes, P3-15 minutes. Exclusively biological materials which are normally applied in the regeneration techniques for different defects and lesions were used with this technique. After specific rotation programs, a different result was obtained for each cycle: P1, P2, P3. In test tubes obtained by separated blood, we observed a higher concentration of proteins, ions, and other antigens compared to normal blood plasma. Examining the biochemical results of different elements, we observed an increase (P≤0,01). Since each person’s DNA is different, we could not have the same results in 5 fractions of blood concentration, we did, however, find a good increase in only a fraction of proteins, immunoglobulin and different ions. We obtained five fractions after centrifugation, and we had an increase in different biochemical elements compared to normal blood (P≤0,01) which is significant at different times. These biochemical elements were stimulated by different growth factors, which are used by the immune system, and they induced the formation of hard and soft tissues and good regeneration. PMID:25001662

  5. Spironolactone use and higher hospital readmission for Medicare beneficiaries with heart failure, left ventricular ejection fraction <45%, and estimated glomerular filtration rate <45 ml/min/1.73 m(2.).

    PubMed

    Inampudi, Chakradhari; Parvataneni, Sridivya; Morgan, Charity J; Deedwania, Prakash; Fonarow, Gregg C; Sanders, Paul W; Prabhu, Sumanth D; Butler, Javed; Forman, Daniel E; Aronow, Wilbert S; Allman, Richard M; Ahmed, Ali

    2014-07-01

    Although randomized controlled trials have demonstrated benefits of aldosterone antagonists for patients with heart failure and reduced ejection fraction (HFrEF), they excluded patients with serum creatinine >2.5 mg/dl, and their use is contraindicated in those with advanced chronic kidney disease (CKD). In the present analysis, we examined the association of spironolactone use with readmission in hospitalized Medicare beneficiaries with HFrEF and advanced CKD. Of the 1,140 patients with HFrEF (EF <45%) and advanced CKD (estimated glomerular filtration rate [eGFR] <45 ml/min/1.73 m(2)), 207 received discharge prescriptions for spironolactone. Using propensity scores (PSs) for the receipt of discharge prescriptions for spironolactone, we estimated PS-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for spironolactone-associated outcomes. Patients (mean age 76 years, 49% women, 25% African-American) had mean EF 28%, mean eGFR 31 ml/min/1.73 m(2), and mean potassium 4.5 mEq/L. Spironolactone use had significant PS-adjusted association with higher risk of 30-day (HR 1.41, 95% CI 1.04 to 1.90) and 1-year (HR 1.36, 95% CI 1.13 to 1.63) all-cause readmissions. The risk of 1-year all-cause readmission was higher among 106 patients with eGFR <15 ml/min/1.73 m(2) (HR 4.75, 95% CI 1.84 to 12.28) than among those with eGFR 15 to 45 ml/min/1.73 m(2) (HR 1.34, 95% CI 1.11 to 1.61, p for interaction 0.003). Spironolactone use had no association with HF readmission and all-cause mortality. In conclusion, among hospitalized patients with HFrEF and advanced CKD, spironolactone use was associated with higher all-cause readmission but had no association with all-cause mortality or HF readmission. PMID:24846806

  6. Randomised comparison of zofenopril and ramipril plus acetylsalicylic acid in postmyocardial infarction patients with left ventricular systolic dysfunction: a post hoc analysis of the SMILE-4 Study in patients according to levels of left ventricular ejection fraction at entry

    PubMed Central

    Borghi, Claudio; Omboni, Stefano; Cicero, Arrigo FG; Bacchelli, Stefano; Degli Esposti, Daniela; Novo, Salvatore; Vinereanu, Dragos; Ambrosio, Giuseppe; Ambrosioni, Ettore

    2015-01-01

    Objective Conflicting evidence exists on the benefits of treating patients with coronary artery disease and preserved left ventricular ejection fraction (LVEF) with an ACE inhibitor. This retrospective analysis of the SMILE-4 Study sought to compare the efficacy of zofenopril 60 mg plus acetylsalicylic acid (ASA) versus ramipril 10 mg plus ASA 100 mg in patients with acute myocardial infarction (AMI) and heart failure, according to an impaired or preserved LVEF. Methods The primary study end point was 1-year combined occurrence of death or hospitalisation for cardiovascular causes. A preserved LVEF was defined by a baseline LVEF >40% and an impaired one by an LVEF ≤40%. Results 448 patients (63%) had preserved and 262 (37%) had impaired LVEF. The primary end point occurred in 125 patients with preserved (28%) and 106 patients with impaired LVEF (41%, p=0.001). In the first group, the rate of major cardiovascular events was significantly lower under zofenopril than under ramipril (23% vs 33%; OR and 95% CI 0.60, 0.39 to 0.91; p=0.016). This was also the case for patients with impaired LVEF, though between-group difference was not statistically significant (38% zofenopril vs 44% ramipril; OR 0.77, 0.47 to 1.26; p=0.297). LVEF values significantly (p<0.0001) increased during the follow-up in both subsets with no between-treatment differences. However, improvement rates in LVEF (increase ≥5%) were higher in patients with impaired LVEF (72% vs 61%, p=0.006). Conclusions In the SMILE-4 Study, the cardiovascular outcome of patients with post-AMI with preserved LVEF was more favourable in the zofenopril than in the ramipril treatment group. Trial registration number EudraCT Number: 2004-001150-88 (http://www.clinicaltrialsregister.eu); Italian Ministry of Health Code: GUIDOTT_III_2004_001 (https://oss-sper-clin.agenziafarmaco.it). PMID:26288740

  7. Coronal mass ejections

    SciTech Connect

    Steinolfson, R.S.

    1990-01-01

    Coronal mass ejections (CMEs) are now recognized as an important component of the large-scale evolution of the solar corona. Some representative observations of CMEs are reviewed with emphasis on more recent results. Recent observations and theory are examined as they relate to the following aspects of CMEs: (1) the role of waves in determining the white-light signature; and (2) the mechanism by which the CME is driven (or launched) into the corona.

  8. Fast Centrifugal Partition Chromatography Fractionation of Concentrated Agave (Agave salmiana) Sap to Obtain Saponins with Apoptotic Effect on Colon Cancer Cells.

    PubMed

    Santos-Zea, Liliana; Fajardo-Ramírez, Oscar R; Romo-López, Irasema; Gutiérrez-Uribe, Janet A

    2016-03-01

    Separation of potentially bioactive components from foods and plant extracts is one of the main challenges for their study. Centrifugal partition chromatography has been a successful technique for the screening and identification of molecules with bioactive potential, such as steroidal saponins. Agave is a source of steroidal saponins with anticancer potential, though the activity of these compounds in concentrated agave sap has not been yet explored. In this study, fast centrifugal partition chromatography (FCPC) was used coupled with in vitro tests on HT-29 cells as a screening procedure to identify apoptotic saponins from an acetonic extract of concentrated agave sap. The three most bioactive fractions obtained by FCPC at partition coefficients between 0.23 and 0.4 contained steroidal saponins, predominantly magueyoside b. Flow cytometry analysis determined that the fraction rich in kammogenin and manogenin glycosides induced apoptosis, but when gentrogenin and hecogenin glycosides were also found in the fraction, a necrotic effect was observed. In conclusion, this study provides the evidence that steroidal saponins in concentrated agave sap were potential inductors of apoptosis and that it was possible to separate them using fast centrifugal partition chromatography. PMID:26701355

  9. Application of the cruciform specimen geometry to obtain transverse interface-property data in a high-fiber-volume-fraction SiC/Titanium alloy composite

    NASA Astrophysics Data System (ADS)

    Boehlert, C. J.; Majumdar, B. S.; Miracle, D. B.

    2001-12-01

    A combined experimental and computational methodology was used to determine the relevant strength and residual-stress parameters in a manufactured, high-fiber-volume-fraction multiply metal matrix composite (MMC). The method was similar to that previously demonstrated on single-fiber composites, which had an extremely low fiber volume fraction. Variabilities in residual stresses and debond strengths in high-fiber-volume-fraction multiply composites, as well as current demands on the micromechanics-based computational prediction and validation of complex composite systems, necessitated the establishment of the test methodology described here. The model material chosen for this investigation was a plasma-processed six-ply, unidirectional Sigma-1240/Ti-6Al-2Sn-4Zr-2Mo (wt pct) MMC containing 32 vol pct continuous fibers. Room-temperature transverse tensile experiments were conducted on cruciform specimens. In addition, rectangular specimens were also evaluated in order to verify their applicability in obtaining valid interfacial property data. Debonding events, evaluated at different positions within a given specimen geometry, were captured by stress-strain curves and metallographic examination. Analytical and finite-element stress analyses were conducted to estimate the geometrical stress-concentration factors associated with the cruciform geometry. Residual stresses were estimated using etching and computational procedures. For the cruciform specimens, the experimental fiber-matrix debond strength was determined to be 22 MPa. Separation occurred within the carbon-rich interfacial layer, consistent with some previous observations on similar systems. Thus, the cruciform test methodology described here can be successfully used for transverse interfacial-property evaluation of high-fiber-volume-fraction composites. For the rectangular specimens, the strain gages at different positions along the specimen width confirmed that the interface crack had initiated from the

  10. Polymer ejection from strong spherical confinement

    NASA Astrophysics Data System (ADS)

    Piili, J.; Linna, R. P.

    2015-12-01

    We examine the ejection of an initially strongly confined flexible polymer from a spherical capsid through a nanoscale pore. We use molecular dynamics for unprecedentedly high initial monomer densities. We show that the time for an individual monomer to eject grows exponentially with the number of ejected monomers. By measurements of the force at the pore we show this dependence to be a consequence of the excess free energy of the polymer due to confinement growing exponentially with the number of monomers initially inside the capsid. This growth relates closely to the divergence of mixing energy in the Flory-Huggins theory at large concentration. We show that the pressure inside the capsid driving the ejection dominates the process that is characterized by the ejection time growing linearly with the lengths of different polymers. Waiting time profiles would indicate that the superlinear dependence obtained for polymers amenable to computer simulations results from a finite-size effect due to the final retraction of polymers' tails from capsids.

  11. How much dust does Enceladus eject?

    NASA Astrophysics Data System (ADS)

    Kempf, Sascha; Southworth, Benjamin; Schmidt, Juergen; Srama, Ralf; Postberg, Frank

    2016-04-01

    There is an ongoing argument how much dust per second the ice volcanoes on Saturn's ice moon eject. By adjusting their plume model to the dust flux measured by the Cassini dust detector during the close Enceladus flyby in 2005, Schmidt et al. (2008) obtained a total dust production rate in the plumes of about

  12. How much dust does Enceladus eject?

    NASA Astrophysics Data System (ADS)

    Kempf, Sascha; Srama, Ralf; Postberg, Frank; Schmidt, Juergen

    2016-07-01

    There is an ongoing argument how much dust per second the ice volcanoes on Saturn's ice moon eject. By adjusting their plume model to the dust flux measured by the Cassini dust detector during the close Enceladus flyby in 2005, Schmidt et al. (2008) obtained a total dust production rate in the plumes of about

  13. In vitro and in vivo antileishmania activity of sesquiterpene lactone-rich dichloromethane fraction obtained from Tanacetum parthenium (L.) Schultz-Bip.

    PubMed

    Rabito, Mirela Fulgencio; Britta, Elizandra Aparecida; Pelegrini, Bruna Luiza; Scariot, Débora Botura; Almeida, Mariana Bortholazzi; Nixdorf, Suzana Lucy; Nakamura, Celso Vataru; Ferreira, Izabel Cristina Piloto

    2014-08-01

    The discovery of new treatments for neglected diseases, including leishmaniasis, is a substantial challenge for scientific research. Plant extracts have shown potential in the selective treatment of tropical diseases. The present study evaluated the in vitro and in vivo antileishmania effects of a sesquiterpene lactone-rich dichloromethane fraction (DF) obtained from the aerial parts of Tanacetum parthenium (L.) Schultz-Bip. In vitro studies of the DF indicated an IC50 of 2.40±0.76 μg mL(-1) against the promastigote form and 1.76±0.25 μg mL(-1) against the axenic amastigote form of Leishmania amazonensis. In vivo intramuscular treatment with DF decreased the growth and size of footpad lesions in mice. The DF also significantly decreased the parasite population compared with animals that were treated with the reference drug. Plasma malondialdehyde levels were increased slightly by the DF, attributable to its parthenolide-rich composition that causes cellular apoptosis, compared with the control group, demonstrating treatment efficacy without toxicity or genotoxicity. Because the isolation and purification of plant compounds are costly and time-consuming and generate low yields, extract fractions, such as the DF studied herein, represent a promising alternative for the treatment of leishmaniasis. PMID:24810433

  14. Evolution of process control parameters during extended co-composting of green waste and solid fraction of cattle slurry to obtain growing media.

    PubMed

    Cáceres, Rafaela; Coromina, Narcís; Malińska, Krystyna; Marfà, Oriol

    2015-03-01

    This study aimed to monitor process parameters when two by-products (green waste - GW, and the solid fraction of cattle slurry - SFCS) were composted to obtain growing media. Using compost in growing medium mixtures involves prolonged composting processes that can last at least half a year. It is therefore crucial to study the parameters that affect compost stability as measured in the field in order to shorten the composting process at composting facilities. Two mixtures were prepared: GW25 (25% GW and 75% SFCS, v/v) and GW75 (75% GW and 25% SFCS, v/v). The different raw mixtures resulted in the production of two different growing media, and the evolution of process management parameters was different. A new parameter has been proposed to deal with attaining the thermophilic temperature range and maintaining it during composting, not only it would be useful to optimize composting processes, but also to assess the hygienization degree. PMID:25553571

  15. The tripole linear ion trap with highly efficient orthogonal ion ejection designed by computer simulations.

    PubMed

    Salazar, Gary A; Masujima, Tsutomu

    2008-05-01

    An ion guide, consisting of three rods carrying three alternating current (AC) voltages symmetrically delayed, called a tripole, was used as a linear ion trap (LIT) and studied by computer simulations. Radial containment of ions was also demonstrated with the pseudopotential which was calculated by approximating the tripole electric potential to the multipoles expansion. This work found a new analyte concentrator, which performs effective ion ejection, and is suitable for use with time-of-flight mass spectrometry. The efficiency of the overall process from the trapping until the ejection was higher than 90%, although some degree of ion spatial and kinetic energy spread which can be corrected with a reflectron was obtained. The reason for the ejection of this tripole linear ion trap (tLIT) lies in the high space available between the rods. The ejection is optimized with the application of focusing voltages, especially suitable for a tripole symmetry (one electrode has a pulse offset voltage and the other two have a fraction of that pulse). The beam is finally well parallelized with a rectangular Einzel lens. PMID:18384193

  16. Interplanetary Coronal Mass Ejections During 1996 - 2007

    NASA Technical Reports Server (NTRS)

    Richardson, I. G.; Cane, H. V.

    2007-01-01

    Interplanetary coronal mass ejections, the interplanetary counterparts of coronal mass ejections at the Sun, are the major drivers of interplanetary shocks in the heliosphere, and are associated with modulations of the galactic cosmic ray intensity, both short term (Forbush decreases caused by the passage of the shock, post-shock sheath, and ICME), and possibly with longer term modulation. Using several in-situ signatures of ICMEs, including plasma temperature, and composition, magnetic fields, and cosmic ray modulations, made by near-Earth spacecraft, we have compiled a "comprehensive" list of ICMEs passing the Earth since 1996, encompassing solar cycle 23. We summarize the properties of these ICMEs, such as their occurrence rate, speeds and other parameters, the fraction of ICMEs that are classic magnetic clouds, and their association with solar energetic particle events, halo CMEs, interplanetary shocks, geomagnetic storms, shocks and cosmic ray decreases.

  17. Induction of milk ejection and milk removal in different production systems.

    PubMed

    Bruckmaier, R M; Wellnitz, O

    2008-03-01

    Milk ejection is important during milking or suckling to obtain the alveolar milk fraction, which can represent more than 80% of the milk stored in the udder of dairy cows. In response to tactile teat stimulation, either manually or by the milking machine, milk ejection is induced by the release of oxytocin and resultant myoepithelial contraction. The time from the start of tactile stimulation until the occurrence of milk ejection spans 40 s to > 2 min and increases with a decreasing degree of udder filling. Therefore, cows need a longer prestimulation in the late stages of lactation or if the milking is performed shortly after the previous milking, whereas in full udders prestimulation is less important. Milk ejection is disturbed under several conditions, such as during milking in unfamiliar surroundings (i.e., a novel milking environment) or for several weeks immediately after parturition in primiparous cows. Disturbed milk ejection is due to a reduction of or absence of oxytocin release from the pituitary. The severity of disturbed milk ejection and the coping capacity toward a novel milking environment is related to cortisol release in response to ACTH (i.e., adrenal cortex activity). Therefore, susceptibility of individual cows to the inhibition of oxytocin release and milk ejection can be predicted by an ACTH challenge test. Comfortable surroundings, such as feeding in and lighting of the milking parlor, can increase the secretion of oxytocin. Overcoming the lack of oxytocin release by injection of exogenous oxytocin for an extended time results in a reduction of the mammary response to endogenous oxytocin. In different production systems, it has to be verified that udder stimulation is sufficient to prevent disturbed milk ejection. Different brands of automatic milking systems induce a sufficient prestimulation of the udder, even if a few minutes are needed for a successful onset of the teat clusters. Specific breeds used for less intense milk production

  18. Forces during Bacteriophage DNA Packaging and Ejection

    PubMed Central

    Purohit, Prashant K.; Inamdar, Mandar M.; Grayson, Paul D.; Squires, Todd M.; Kondev, Jané; Phillips, Rob

    2005-01-01

    The conjunction of insights from structural biology, solution biochemistry, genetics, and single-molecule biophysics has provided a renewed impetus for the construction of quantitative models of biological processes. One area that has been a beneficiary of these experimental techniques is the study of viruses. In this article we describe how the insights obtained from such experiments can be utilized to construct physical models of processes in the viral life cycle. We focus on dsDNA bacteriophages and show that the bending elasticity of DNA and its electrostatics in solution can be combined to determine the forces experienced during packaging and ejection of the viral genome. Furthermore, we quantitatively analyze the effect of fluid viscosity and capsid expansion on the forces experienced during packaging. Finally, we present a model for DNA ejection from bacteriophages based on the hypothesis that the energy stored in the tightly packed genome within the capsid leads to its forceful ejection. The predictions of our model can be tested through experiments in vitro where DNA ejection is inhibited by the application of external osmotic pressure. PMID:15556983

  19. Antioxidant properties of chemical extracts and bioaccessible fractions obtained from six Spanish monovarietal extra virgin olive oils: assays in Caco-2 cells.

    PubMed

    Borges, Thays H; Cabrera-Vique, Carmen; Seiquer, Isabel

    2015-07-01

    The antioxidant activity and the total phenolic content (TPC) of six Spanish commercial monovarietal extra virgin olive oils (Arbequina, Cornicabra, Hojiblanca, Manzanilla, Picual and Picudo) were evaluated in chemical extracts and in bioaccessible fractions (BF) obtained after in vitro digestion. Moreover, the effects of the BF on cell viability and the generation of reactive oxygen species (ROS) were investigated in Caco-2 cell cultures. The in vitro digestion process increased the TPC and antioxidant activity evaluated by different methods (ABTS, DPPH and FRAP) compared with chemical extracts. After digestion, the Picual variety showed better beneficial effects in preserving cell integrity than the other varieties studied. Significant reductions of ROS production were observed after incubation of Caco-2 cells with the BF of all the varieties and, moreover, a protective effect against the oxidative stress induced by t-BOOH was shown for Arbequina, Cornicabra, Hojiblanca, Manzanilla and Picual. These findings seem to be an additional reason supporting the health benefits of Spanish extra virgin olive oil varieties. Multivariate factor analysis and principal component analysis were applied to assess the contribution of antioxidant activity and TPC, before and after digestion, to the characterization of the different varieties. PMID:26087367

  20. Long-term validation of tropospheric column-averaged CH4 mole fractions obtained by mid-infrared ground-based FTIR spectrometry

    NASA Astrophysics Data System (ADS)

    Sepúlveda, E.; Schneider, M.; Hase, F.; García, O. E.; Gomez-Pelaez, A.; Dohe, S.; Blumenstock, T.; Guerra, J. C.

    2012-06-01

    At the Izaña Atmospheric Research Center, high-resolution mid-infrared solar absorption spectra have been recorded for more than 12 yr using Fourier Transform InfraRed (FTIR) spectrometers. We use the spectral fitting algorithm PROFFIT to retrieve long-term time series of methane (CH4) from the measured spectra. We investigate the total column-averaged dry air mole fractions of methane (totXCH4) obtained from a profile scaling and a profile retrieval, and apply two approaches for deriving the tropospheric column-averaged dry air mole fractions: firstly, we use the FTIR hydrogen fluoride (HF) total column amounts as an estimator for the stratospheric CH4 contribution and a posteriori correct the totXCH4 data of a profile scaling retrieval accordingly (troXCH4post); secondly, we directly determine the tropospheric column-averaged dry air mole fractions of methane (troXCH4retr) from retrieved CH4 profiles. Our theoretical estimation indicates that the scaling retrieval leads to totXCH4 amounts that are subject to a large smoothing error, which can be widely avoided by applying a profile retrieval (for the latter we estimate an overall precision of 0.41%). We compare the different FTIR CH4 data to Izaña's Global Atmospheric Watch (GAW) surface in-situ CH4 data (CH4GAW), which in the case of the Izaña Atmospheric Research Center high mountain observatory are very representative for the free tropospheric CH4 amounts. Concerning totXCH4, the agreement between the FTIR data product and the in-situ measurement is rather poor documenting that totXCH4 is not a valid free tropospheric CH4 proxy, as it is significantly affected by the varying stratospheric CH4 contribution and it rather follows the variation in the tropopause altitude. The a posteriori correction method as applied here only removes a part of this stratospheric CH4 contribution. In contrast the profile retrieval allows for a direct estimation of the tropospheric column-averaged CH4 amounts. Results of the

  1. In vitro antioxidant activities of the methanol extract and its different solvent fractions obtained from the fruit pericarp of Terminalia bellerica.

    PubMed

    Nampoothiri, Suresh V; Binil Raj, S S; Prathapan, A; Abhilash, P A; Arumughan, C; Sundaresan, A

    2011-02-01

    Terminalia bellerica has been used as a traditional medicine in a variety of ailments including anaemia, asthma, cancer, inflammation, rheumatism and hypertension. In this study, the free radical scavenging and antioxidant activities of methanol extract (ME) and its different solvent fractions (namely hexane (HE), ethyl acetate (EA), butanol (BL) and water (WA)) of the T. bellerica fruit pericarp were evaluated and compared with standard antioxidant compounds like gallic acid (GA), catechin and ascorbic acid. Among the different fractions tested, the EA fraction exhibited higher antioxidant and radical scavenging activity against 1,1-diphenyl-2-picrylhydrazyl (DPPH), superoxide and hydroxyl radicals than the other fractions, which may be attributed to its higher phenolic and flavonoid content, since a linear relation was observed between the phenolic content and the antioxidant parameters. The HPTLC analysis of the EA fraction revealed that it mainly contains GA and ferulic acid (FA) as major phenolics, and the higher antioxidant activities of EA fraction may be due to the presence of these compounds. PMID:21294040

  2. A polyphenol-rich fraction obtained from table grapes decreases adiposity, insulin resistance and markers of inflammation and impacts gut microbiota in high-fat-fed mice.

    PubMed

    Collins, Brian; Hoffman, Jessie; Martinez, Kristina; Grace, Mary; Lila, Mary Ann; Cockrell, Chase; Nadimpalli, Anuradha; Chang, Eugene; Chuang, Chia-Chi; Zhong, Wei; Mackert, Jessica; Shen, Wan; Cooney, Paula; Hopkins, Robin; McIntosh, Michael

    2016-05-01

    The objective of this study was to determine if consuming an extractable or nonextractable fraction of table grapes reduced the metabolic consequences of consuming a high-fat, American-type diet. Male C57BL/6J mice were fed a low fat (LF) diet, a high fat (HF) diet, or an HF diet containing whole table grape powder (5% w/w), an extractable, polyphenol-rich (HF-EP) fraction, a nonextractable, polyphenol-poor (HF-NEP) fraction or equal combinations of both fractions (HF-EP+NEP) from grape powder for 16weeks. Mice fed the HF-EP and HF-EP+NEP diets had lower percentages of body fat and amounts of white adipose tissue (WAT) and improved glucose tolerance compared to the HF-fed controls. Mice fed the HF-EP+NEP diet had lower liver weights and triglyceride (TG) levels compared to the HF-fed controls. Mice fed the HF-EP+NEP diets had higher hepatic mRNA levels of hormone sensitive lipase and adipose TG lipase, and decreased expression of c-reactive protein compared to the HF-fed controls. In epididymal (visceral) WAT, the expression levels of several inflammatory genes were lower in mice fed the HF-EP and HF-EP+NEP diets compared to the HF-fed controls. Mice fed the HF diets had increased myeloperoxidase activity and impaired localization of the tight junction protein zonula occludens-1 in ileal mucosa compared to the HF-EP and HF-NEP diets. Several of these treatment effects were associated with alterations in gut bacterial community structure. Collectively, these data demonstrate that the polyphenol-rich, EP fraction from table grapes attenuated many of the adverse health consequences associated with consuming an HF diet. PMID:27133434

  3. Multivalent counterions inhibit DNA ejection from viral capsid

    NASA Astrophysics Data System (ADS)

    Nguyen, Toan

    2008-03-01

    Viral DNA packaged inside a bacteriophage is tighly bent. This stored bending energy of DNA is believed to be the main driving force to eject viral DNA into host cell upon capsid binding. One can control the amount of ejected DNA by subjecting the virus to a solution of PEG8000 molecules. The molecules cannot penetrate the viral capsid, therefore, they exert an osmotic pressure on the virus preventing DNA ejection. Experiments showed that for a given osmotic pressure, the degree of ejection also depends on the concentration of small ions in solution. Interestingly, for multivalent ions (such as Mg2+, Spd3+ or HexCo3+), this dependence is non-monotonic. We propose a simple electrostatic theory to explain this non-monotonic behavior. This is based on the fact that DNA molecules can invert its net charge at high enough multivalent counterion concentration. In other words, as multivalent counterion concentration is increased from zero, charge of DNA molecules change from negative to positive. At the concentration where DNA net charge is zero, the DNA molecules experience an attraction between different segments and DNA ejected amount is reduced. At low or high counterion concentration, DNA segments are charged (negatively or positively), repel each other and DNA ejected amount is increased. Fitting the result of the theory to experimental data, we obtain a numerical value for Mg2+ mediated DNA - DNA attraction energy to be -0.008kT per base.

  4. Effects of residual lignin and heteropolysaccharides on the bioconversion of softwood lignocellulose nanofibrils obtained by SO2-ethanol-water fractionation.

    PubMed

    Morales, Luis O; Iakovlev, Mikhail; Martin-Sampedro, Raquel; Rahikainen, Jenni L; Laine, Janne; van Heiningen, Adriaan; Rojas, Orlando J

    2014-06-01

    The amount of residual lignin and hemicelluloses in softwood fibers was systematically varied by SO2-ethanol-water fractionation for integrated biorefinery with nanomaterial and biofuel production. On the basis of their low energy demand in mechanical processing, the fibers were deconstructed to lignocellulose nanofibrils (LCNF) and used as substrate for bioconversion. The effect of LCNF composition on saccharification via multicomponent enzymes was investigated at different loadings. LCNF digestibility was compared with the enzyme activity measured with a quartz crystal microbalance. LCNF hydrolysis rate gradually decreased with lignin and hemicellulose concentration, both of which limited enzyme accessibility. Enzyme inhibition resulted from non-productive binding of proteins onto lignin. Near complete LCNF hydrolysis was achieved, even at high lignin and hemicellulose content. Sugar yields for LCNF were higher than those for precursor SEW fibers, highlighting the benefits of high surface area in LCNF. PMID:24686371

  5. F-16 pilot experience with combat ejections during the Persian Gulf War.

    PubMed

    Williams, C S

    1993-09-01

    Most experience with ejections from modern fighter aircraft has occurred outside of true combat operations. During Operation Desert Storm, the 401st Fighter Wing, Torrejon Air Base, Spain, lost four F-16C aircraft while on combat missions, with all four pilots ejecting safely. Since the circumstances of a combat vs. peacetime ejection are likely different and many combat mishaps and ejections cannot be extensively investigated (three out of these four), a questionnaire was developed to recall and review pilot ejection experiences. Questions ranged from recalling the parameters of egress to conscious recollections of the event and assessment of how well the system worked. Each of the four ejections occurred under different parameters, and no one suffered significant injury. Two of the ejections occurred at high altitude, previously rare in the F-16. This was one of the first times that experience was obtained with the F-16's ACES-II egress system under combat operations and, in the experience of these four pilots, the system was life-saving in combat. Finally, the overall ejection survival rate for U.S. Air Force fighter/attack combat ejections during Operation Desert Storm was similar to the peacetime rate. It is the author's hypothesis that the reason for this may correlate with a quicker, more predetermined decision to eject from an aircraft disabled by combat fire. PMID:8216147

  6. Angular Momentum Ejection and Recoil*

    NASA Astrophysics Data System (ADS)

    Ohia, O.; Coppi, B.

    2009-11-01

    The spontaneous rotation phenomenon observed in axisymmetric magnetically confined plasmas has been explained by the ``accretion theory'' [1] that considers the plasma angular momentum as gained from its interaction with the magnetic field and the surrounding material wall. The ejection of angular momentum to the wall, and the consequent recoil are attributed to modes excited at the edge while the transport of the (recoil) angular momentum from the edge toward the center is attributed to a different kind of mode. The toroidal phase velocity of the edge mode, to which the sign of the ejected angular momentum is related, is considered to change its direction in the transition from the H-regime to the L-regime. For the latter case, edge modes with phase velocity in the direction of vdi are driven by the temperature gradient of a cold ion population at the edge and damped on the ``hot'' ion population. The ``balanced'' double interaction [2] of the mode with the two populations, corresponding to a condition of marginal stability, leads to ejection of hot ions and loss of angular momentum in the direction of vdi while the cold population acquires angular momentum in the opposite direction. In the H-regime resistive ballooning modes with phase velocities in the direction of vde are viewed as the best candidates for the excited edge modes. *Sponsored in part by the U.S. DOE. [1] B. Coppi, Nucl. Fusion 42, 1 (2002) [2] B. Coppi and F. Pegoraro, Nucl. Fusion 17, 969 (1977)

  7. Characterizing the original ejection velocity field of the Koronis family

    NASA Astrophysics Data System (ADS)

    Carruba, V.; Nesvorný, D.; Aljbaae, S.

    2016-06-01

    An asteroid family forms as a result of a collision between an impactor and a parent body. The fragments with ejection speeds higher than the escape velocity from the parent body can escape its gravitational pull. The cloud of escaping debris can be identified by the proximity of orbits in proper element, or frequency, domains. Obtaining estimates of the original ejection speed can provide valuable constraints on the physical processes occurring during collision, and used to calibrate impact simulations. Unfortunately, proper elements of asteroids families are modified by gravitational and non-gravitational effects, such as resonant dynamics, encounters with massive bodies, and the Yarkovsky effect, such that information on the original ejection speeds is often lost, especially for older, more evolved families. It has been recently suggested that the distribution in proper inclination of the Koronis family may have not been significantly perturbed by local dynamics, and that information on the component of the ejection velocity that is perpendicular to the orbital plane (vW), may still be available, at least in part. In this work we estimate the magnitude of the original ejection velocity speeds of Koronis members using the observed distribution in proper eccentricity and inclination, and accounting for the spread caused by dynamical effects. Our results show that (i) the spread in the original ejection speeds is, to within a 15% error, inversely proportional to the fragment size, and (ii) the minimum ejection velocity is of the order of 50 m/s, with larger values possible depending on the orbital configuration at the break-up.

  8. Ejecting Phage DNA against Cellular Turgor Pressure

    PubMed Central

    Marion, Sanjin; Šiber, Antonio

    2014-01-01

    We examine in vivo ejection of noncondensed DNA from tailed bacteriophages into bacteria. The ejection is dominantly governed by the physical conditions in the bacteria. The confinement of the DNA in the virus capsid only slightly helps the ejection, becoming completely irrelevant during its last stages. A simple calculation based on the premise of condensed DNA in the cell enables us to estimate the maximal bacterial turgor pressure against which the ejection can still be fully realized. The calculated pressure (∼5 atm) shows that the ejection of DNA into Gram-negative bacteria could proceed spontaneously, i.e., without the need to invoke active mechanisms. PMID:25418173

  9. Evaluation of the gastroprotective activity of the extracts, fractions, and pure compounds obtained from aerial parts of Rubus imperialis in different experimental models.

    PubMed

    Berté, Priscila Elisabeth; da Silva Lopes, Jhonny; Comandulli, Nicole Garbin; Rangel, Daniele Wolff; Monache, Franco Delle; Filho, Valdir Cechinel; Niero, Rivaldo; de Andrade, Sergio Faloni

    2014-04-01

    Previous phytochemical studies carried out with Rubus imperialis Chum. Schl. (Rosaceae) have demonstrated the presence of triterpenes (niga-ichigoside F1 and 2β,3β,19α-trihydroxyursolic acid) in this species. The literature indicates that triterpenes are closely related to some pharmacological activities, including antiulcer activity. Therefore, in view of the previous promising results with this species, this work extends the phytochemical studies, as well as investigates its gastroprotective action in different models using rodents. The hydroalcoholic extract was tested using the following protocols in mice: ethanol/HCl and nonsteroidal anti-inflammatory drug (NSAID)-induced ulcer, acetic acid-induced chronic ulcer, ligature pylorus model, and free mucus quantification in mucosa. Isolated triterpenes were investigated in the ethanol/HCl-induced ulcer model. The results of this study show that R. imperialis extract (100, 250, or 500 mg) displays gastroprotective activity in the ethanol-induced ulcer model with a percentage of inhibition of gastric lesions of 70, 71, and 86 %, respectively. The extract also significantly reduced the ulcerative lesions in the indomethacin-induced ulcer. In this model, the percentage of inhibition of ulcer was 41, 44, and 70 %, respectively. Regarding the model of gastric secretion, a reduction of gastric juice volume and total acidity was observed, as well as an increase in gastric pH; however, gastric mucus production was not altered by treatment with the extract. It was also observed that the ethyl acetate fraction presented higher activity, leading to the isolation of niga-ichigoside F1 and 2β,3β-19-α-trihydroxyursolic acid, which presented antiulcer activity comparable to that of omeprazole, with an inhibition percentage of 98 and 99 %, respectively. These results demonstrate that R. imperialis extract and isolated compounds (niga-ichigoside F1 and 2β,3β-19-α-trihydroxyursolic acid) produce gastroprotective effects

  10. Interplanetary Propagation of Coronal Mass Ejections

    NASA Technical Reports Server (NTRS)

    Gopalswamy, Nat

    2011-01-01

    Although more than ten thousand coronal mass ejections (CMEs) are produced during each solar cycle at the Sun, only a small fraction hits the Earth. Only a small fraction of the Earth-directed CMEs ultimately arrive at Earth depending on their interaction with the solar wind and other large-scale structures such as coronal holes and CMEs. The interplanetary propagation is essentially controlled by the drag force because the propelling force and the solar gravity are significant only near the Sun. Combined remote-sensing and in situ observations have helped us estimate the influence of the solar wind on the propagation of CMEs. However, these measurements have severe limitations because the remote-sensed and in-situ observations correspond to different portions of the CME. Attempts to overcome this problem are made in two ways: the first is to model the CME and get the space speed of the CME, which can be compared with the in situ speed. The second method is to use stereoscopic observation so that the remote-sensed and in-situ observations make measurements on the Earth-arriving part of CMEs. The Solar Terrestrial Relations Observatory (STEREO) mission observed several such CMEs, which helped understand the interplanetary evolution of these CMEs and to test earlier model results. This paper discusses some of these issues and updates the CME/shock travel time estimates for a number of CMEs.

  11. Radionuclide analysis of ejection time, peak ejection rate, and time to peak ejection rate: response to supine bicycle exercise in normal subjects and in patients with coronary heart disease

    SciTech Connect

    Slutsky, R.A.; Mancini, G.B.; Gerber, K.H.; Carey, P.H.; Ashburn, W.L.; Higgins, C.B.

    1983-05-01

    Using equilibrium radionuclide angiography, we evaluated the ejection time (ET), peak ejection rate (PER), and time to peak ejection rate (TTp) at test and during supine bicycle exercise in 39 subjects, divided into three groups: group 1 . 13 normal subjects; group 2 . 10 patients with a previous infarction (MI); and group 3 . 16 patients with coronary disease without a previous MI. Normal subjects had greater ejection fractions and PERs than the other two groups at rest or peak exercise (p less than 0.05). PER was no more useful than ejection fraction in identifying cardiac dysfunction at either rest or exercise. The time of its occurrence varied with the group studied, and was slightly but significantly later in systole in groups 2 and 3 when compared to normals (p less than 0.05), though substantial overlap between groups occurred. During exercise, absolute ET shortened in all groups, but actually increased as a function of the R-R interval. The time to peak ejection rate (normalized for the R-R interval) was greater in the noninfarct group (group 3) patients (p less than 0.05) when compared to the group 1 or group 2 individuals at peak exercise. In conclusion, equilibrium radionuclide angiography is a useful technique for the quantification and characterization of events during systole, and is capable of providing information on the timing of events during ejection. Tardokinesis, or the delay of ventricular ejection, is not seen in the response of global indices of left ventricular function to exercise stress. While global early systolic indexes may not detect regional dyssynchrony, their timing during stress may occasionally aid in discerning the presence of cardiac dysfunction.

  12. MEMEX: Mechanisms of Energetic Mass Ejection Explorer

    NASA Astrophysics Data System (ADS)

    Moore, T. E.; Chappell, C. R.; Clemmons, J. H.; Cully, C. M.; Donovan, E.; Earle, G. D.; Heelis, R. A.; Kistler, L. M.; Kepko, L.; Khazanov, G. V.; Knudsen, D. J.; Lessard, M.; McFadden, J. P.; Nicolls, M. J.; Pollock, C. J.; Pfaff, R. F.; Rankin, R.; Rowland, D. E.; Semeter, J. L.; Thayer, J. P.; Winglee, R.

    2013-12-01

    MEMEX is designed to find out how gravitationally-trapped volatile matter is being lost from atmospheres by energetic processes, depleting them of key constituents, as has occurred most dramatically at Mars. This process is exemplified in geospace by the dissipation of solar energy to produce ionospheric outflows that feed back on dynamics of the solar wind interaction with Earth's magnetosphere. Kinetic and electromagnetic energy flow from the Sun into the coupled (auroral) ionosphere, where resultant electron, ion, and gas heating give rise to upwelling, ionization, and mass ejection. Proposed mechanisms involve wave-particle heating interactions, upward ambipolar electric fields, or ponderomotive forces. A large number of free energy sources have been identified, but empirical guidance remains weak concerning their relative importance. Moreover, it is unclear if the waves interact with particles primarily in a cyclotron resonant mode, or in a lower hybrid exchange of electron (parallel) and ion (perpendicular) energy, or in a bulk ponderomotive mode. MEMEX will answer the questions raised by these issues: Where do the waves that produce mass ejection grow? How do they propagate and transport energy? How can wave amplitudes, heating, and escape rates be derived from solar wind conditions? Is the heating a cyclotron resonant process or a bulk ponderomotive forcing process? To obtain answers, MEMEX will for the first time simultaneously observe the magnetospheric and atmospheric boundary conditions applied to the topside or exobase layer, and the response of ions and electrons to the ensuing battle between electrodynamic forcing and collisional damping.

  13. Three-dimensional reconstruction of coronal mass ejections

    NASA Technical Reports Server (NTRS)

    Jackson, Bernard V.; Hick, Paul

    1994-01-01

    Computer assisted tomography (CAT) techniques are used to reconstruct the three dimensional shape of coronal mass ejections in the interplanetary medium. Both the Helios 2 spacecraft zodiacal-light photometers and the Solwind coronograph measure changes in Thomson scattering of sunlight from electrons. The technique from near-perpendicular Solwind and Helios views are applied to determine the density of a mass ejection which left the solar surface on 24 May 1979. The coronograph and the Helios perspective views are not simultaneous; the Solwind observations extend outward to sky plane distances of only 10 of the solar radius, whereas the Helios 16 photometer observes to as close as 17 of the solar radius from the sun. The solution is obtained by assuming outward radial expansion and that the coronal mass ejections (CME's) have the same speed everywhere at the same height. The analyses show that CME's are extensive three dimensional structures (the CME of 24 May appears approximately shell) like in three dimensions.

  14. Prognostic implications of cardiac scintigraphic parameters obtained in the early phase of acute myocardial infarction

    SciTech Connect

    Suzuki, A.; Matsushima, H.; Satoh, A.; Hayashi, H.; Sotobata, I.

    1988-06-01

    A cohort of 76 patients with acute myocardial infarction was studied with infarct-avid scan, radionuclide ventriculography, and thallium-201 myocardial perfusion scintigraphy. Infarct area, left ventricular ejection fraction, and defect score were calculated as radionuclide indices of the extent of myocardial infarction. The correlation was studied between these indices and cardiac events (death, congestive heart failure, postinfarction angina, and recurrence of myocardial infarction) in the first postinfarction year. High-risk patients (nonsurvivors and patients who developed heart failure) had a larger infarct area, a lower left ventricular ejection fraction, and a larger defect score than the others. Univariate linear discriminant analysis was done to determine the optimal threshold of these parameters for distinguishing high-risk patients from others. Radionuclide parameters obtained in the early phase of acute myocardial infarction were useful for detecting both patients with grave complications and those with poor late prognosis during a mean follow-up period of 2.6 years.

  15. Geometrical Properties of Coronal Mass Ejections

    NASA Astrophysics Data System (ADS)

    Cremades, Hebe; Bothmer, Volker

    Based on the SOHO/LASCO dataset, a collection of "structured" coronal mass ejections (CMEs) has been compiled within the period 1996-2002, in order to analyze their three-dimensional configuration. These CME events exhibit white-light fine structures, likely indicative of their possible 3D topology. From a detailed investigation of the associated low coronal and photospheric source regions, a generic scheme has been deduced, which considers the white-light topology of a CME projected in the plane of the sky as being primarily dependent on the orientation and position of the source region's neutral line on the solar disk. The obtained results imply that structured CMEs are essentially organized along a symmetry axis, in a cylindrical manner. The measured dimensions of the cylinder's base and length yield a ratio of 1.6. These CMEs seem to be better approximated by elliptic cones, rather than by the classical ice cream cone, characterized by a circular cross section.

  16. Dynamical ejections of massive stars from young star clusters under diverse initial conditions

    NASA Astrophysics Data System (ADS)

    Oh, Seungkyung; Kroupa, Pavel

    2016-05-01

    We study the effects that initial conditions of star clusters and their massive star population have on dynamical ejections of massive stars from star clusters up to an age of 3 Myr. We use a large set of direct N-body calculations for moderately massive star clusters (Mecl ≈ 103.5 M⊙). We vary the initial conditions of the calculations, such as the initial half-mass radius of the clusters, initial binary populations for massive stars and initial mass segregation. We find that the initial density is the most influential parameter for the ejection fraction of the massive systems. The clusters with an initial half-mass radius rh(0) of 0.1 (0.3) pc can eject up to 50% (30)% of their O-star systems on average, while initially larger (rh(0) = 0.8 pc) clusters, that is, lower density clusters, eject hardly any OB stars (at most ≈ 4.5%). When the binaries are composed of two stars of similar mass, the ejections are most effective. Most of the models show that the average ejection fraction decreases with decreasing stellar mass. For clusters that are efficient at ejecting O stars, the mass function of the ejected stars is top-heavy compared to the given initial mass function (IMF), while the mass function of stars that remain in the cluster becomes slightly steeper (top-light) than the IMF. The top-light mass functions of stars in 3 Myr old clusters in our N-body models agree well with the mean mass function of young intermediate-mass clusters in M 31, as reported previously. This implies that the IMF of the observed young clusters is the canonical IMF. We show that the multiplicity fraction of the ejected massive stars can be as high as ≈ 60%, that massive high-order multiple systems can be dynamically ejected, and that high-order multiples become common especially in the cluster. We also discuss binary populations of the ejected massive systems. Clusters that are initially not mass-segregated begin ejecting massive stars after a time delay that is caused by mass

  17. Ejection time by ear densitogram and its derivative - Clinical and physiologic applications.

    NASA Technical Reports Server (NTRS)

    Quarry-Pigott, V.; Chirife, R.; Spodick, D. H.

    1973-01-01

    Ear densitographic ejection times (EDET) and first derivative ear densitogram ejection times (dEDET) were studied to determine whether their reliability and validity justify their substitution for ejection times derived from the far less stable carotid pulse tracing. Inter- and intra-subject comparisons were made on thirty individuals under a wide variety of disease and challenge states. Statistical analysis of the data - which had been obtained through a blinded procedure - showed an overall correlation (r) of .98 for carotid vs EDET and .99 for carotid vs dEDET. The t-test demonstrated no significant differences among ejection times derived from the three methods. Moreover, the close tracking at rest and during challenges of ejection times derived from these curves with those from the carotid indicate that either method may be substituted for standard carotid curves without sacrificing reliability or validity of the measure.

  18. Constraints on the original ejection velocity fields of asteroid families

    NASA Astrophysics Data System (ADS)

    Carruba, V.; Nesvorný, D.

    2016-04-01

    Asteroid families form as a result of large-scale collisions among main belt asteroids. The orbital distribution of fragments after a family-forming impact could inform us about their ejection velocities. Unfortunately, however, orbits dynamically evolve by a number of effects, including the Yarkovsky drift, chaotic diffusion, and gravitational encounters with massive asteroids, such that it is difficult to infer the ejection velocities eons after each family's formation. Here, we analyse the inclination distribution of asteroid families, because proper inclination can remain constant over long time intervals, and could help us to understand the distribution of the component of the ejection velocity that is perpendicular to the orbital plane (vW). From modelling the initial break up, we find that the distribution of vW of the fragments, which manage to escape the parent body's gravity, should be more peaked than a Gaussian distribution (i.e. be leptokurtic) even if the initial distribution was Gaussian. We surveyed known asteroid families for signs of a peaked distribution of vW using a statistical measure of the distribution peakedness or flatness known as kurtosis. We identified eight families whose vW distribution is significantly leptokurtic. These cases (e.g. the Koronis family) are located in dynamically quiet regions of the main belt, where, presumably, the initial distribution of vW was not modified by subsequent orbital evolution. We suggest that, in these cases, the inclination distribution can be used to obtain interesting information about the original ejection velocity field.

  19. THE PROPERTIES OF DYNAMICALLY EJECTED RUNAWAY AND HYPER-RUNAWAY STARS

    SciTech Connect

    Perets, Hagai B.; Subr, Ladislav

    2012-06-01

    Runaway stars are stars observed to have large peculiar velocities. Two mechanisms are thought to contribute to the ejection of runaway stars, both of which involve binarity (or higher multiplicity). In the binary supernova scenario, a runaway star receives its velocity when its binary massive companion explodes as a supernova (SN). In the alternative dynamical ejection scenario, runaway stars are formed through gravitational interactions between stars and binaries in dense, compact clusters or cluster cores. Here we study the ejection scenario. We make use of extensive N-body simulations of massive clusters, as well as analytic arguments, in order to characterize the expected ejection velocity distribution of runaway stars. We find that the ejection velocity distribution of the fastest runaways (v {approx}> 80 km s{sup -1}) depends on the binary distribution in the cluster, consistent with our analytic toy model, whereas the distribution of lower velocity runaways appears independent of the binaries' properties. For a realistic log constant distribution of binary separations, we find the velocity distribution to follow a simple power law: {Gamma}(v){proportional_to}v{sup -8/3} for the high-velocity runaways and v{sup -3/2} for the low-velocity ones. We calculate the total expected ejection rates of runaway stars from our simulated massive clusters and explore their mass function and their binarity. The mass function of runaway stars is biased toward high masses and strongly depends on their velocity. The binarity of runaways is a decreasing function of their ejection velocity, with no binaries expected to be ejected with v > 150 km s{sup -1}. We also find that hyper-runaways with velocities of hundreds of km s{sup -1} can be dynamically ejected from stellar clusters, but only at very low rates, which cannot account for a significant fraction of the observed population of hyper-velocity stars in the Galactic halo.

  20. Initiation of Coronal Mass Ejections

    NASA Technical Reports Server (NTRS)

    Moore, Ronald L.; Sterling, Alphonse C.

    2005-01-01

    This paper is a synopsis of the initiation of the strong-field magnetic explosions that produce large, fast coronal mass ejections. Cartoons based on observations are used to describe the inferred basic physical processes and sequences that trigger and drive the explosion. The magnetic field that explodes is a sheared-core bipole that may or may not be embedded in surrounding strong magnetic field, and may or may not contain a flux rope before it starts to explode. We describe three different mechanisms that singly or in combination trigger the explosion: (1) runaway internal tether-cutting reconnection, (2) runaway external tether-cutting reconnection, and (3) ideal MHD instability or loss or equilibrium. For most eruptions, high-resolution, high-cadence magnetograms and chromospheric and coronal movies (such as from TRACE and/or Solar-B) of the pre-eruption region and of the onset of the eruption and flare are needed to tell which one or which combination of these mechanisms is the trigger. Whatever the trigger, it leads to the production of an erupting flux rope. Using a simple model flux rope, we demonstrate that the explosion can be driven by the magnetic pressure of the expanding flux rope, provided the shape of the expansion is "fat" enough.

  1. Characteristics of Coronal Mass Ejections

    NASA Astrophysics Data System (ADS)

    Talukder, F.; Marchese, A. K.; Tulsee, T.

    2014-12-01

    A coronal mass ejection (CME) is a release of charged particles resulting from solar activity. These charged particles can affect electronics on spacecraft, airplanes, global positioning systems, and communication satellites. The purpose of this research was to study CME data from satellites and correlate these to other properties. Solar wind data collected by STEREO A/B and ACE satellites were analyzed. The data consisted of solar wind flux for various elements (helium through iron), as well as the components of the interplanetary magnetic field. CME events are known to cause a surge in the helium flux, as well as other particles. It is hypothesized that a CME event will cause an increase in the number of lighter elements relative to heavier particles. This is because for a given input of energy, lighter elements are expected to be accelerated to a greater extent than heavier elements. A significant increase was observed in the ratio between helium to oxygen (He/O) prior to intense CMEs. A CME event on November 4, 2003 caused an eleven-fold increase in the He/O ratio, while for another event on April 2, 2001 the He/O ratio increased from 80 to 700. A significant increase in He/O ratio is not observed during weaker CMEs. Furthermore, it was also observed that not all increases in the ratio were accompanied by CMEs. The increase in He/O ratio prior to the CME arrival might be used as a way to predict future events.

  2. An idealized transient model for melt dispersal from reactor cavities during pressurized melt ejection accident scenarios

    SciTech Connect

    Tutu, N.K.

    1991-06-01

    The direct Containment Heating (DCH) calculations require that the transient rate at which the melt is ejected from the reactor cavity during hypothetical pressurized melt ejection accident scenarios be calculated. However, at present no models, that are able to predict the available melt dispersal data from small scale reactor cavity models, are available. In this report, a simple idealized model of the melt dispersal process within a reactor cavity during a pressurized melt ejection accident scenario is presented. The predictions from the model agree reasonably well with the integral data obtained from the melt dispersal experiments using a small scale model of the Surry reactor cavity. 17 refs., 15 figs.

  3. Sept. 28, 2012 Coronal Mass Ejection

    NASA Video Gallery

    This Sept. 28 coronal mass ejection (CME) from the sun, captured by NASA’s Solar Dynamics Observatory (SDO), is the event which caused the near total annihilation of the new radiation belt and sl...

  4. Aug. 31, 2012 Coronal Mass Ejection

    NASA Video Gallery

    This two part movie shows an Aug. 31 coronal mass ejection (CME) from the sun , the same event that caused depletion and refilling of the radiation belts just after the Relativistic Electron-Proton...

  5. Coronal Mass Ejections and Their Heliospheric Consequences

    NASA Technical Reports Server (NTRS)

    Gopalswamy, Nat

    2011-01-01

    Coronal mass ejections (CMEs) have been recognized as the most energetic phenomenon in the heliosphere, deriving their energy from the stressed magnetic fields on the Sun. The Solar and Heliospheric Observatory (SOHO) mission has accumulated a wealth of information on CMEs with unprecedented extent, clarity, and uniformity. The CME data base has been useful in confirming results from past missions and obtaining a number of new results on the initiation, propagation, and heliospheric consequences of CMEs. This paper highlights some of the recent results on the morphological, physical, and kinematic properties of CMEs observed during solar cycle 23. White-light signatures of CMEs and their utility in inferring coronal magnetic fields near the Sun will be discussed. Presence of coronal holes near eruption regions have been shown to significantly modify the trajectories of CMEs. New results on the interaction of CMEs with large-scale structures such as coronal holes and other CMEs will be presented. Finally, the CME consequences in the heliosphere such as interplanetary shocks, type II radio bursts, energetic particles, geomagnetic storms, and cosmic ray modulation will be discussed

  6. Spontaneous Aerosol Ejection: Origin of Inorganic Particles in Biomass Pyrolysis.

    PubMed

    Teixeira, Andrew R; Gantt, Rachel; Joseph, Kristeen E; Maduskar, Saurabh; Paulsen, Alex D; Krumm, Christoph; Zhu, Cheng; Dauenhauer, Paul J

    2016-06-01

    At high thermal flux and temperatures of approximately 500 °C, lignocellulosic biomass transforms to a reactive liquid intermediate before evaporating to condensable bio-oil for downstream upgrading to renewable fuels and chemicals. However, the existence of a fraction of nonvolatile compounds in condensed bio-oil diminishes the product quality and, in the case of inorganic materials, catalyzes undesirable aging reactions within bio-oil. In this study, ablative pyrolysis of crystalline cellulose was evaluated, with and without doped calcium, for the generation of inorganic-transporting aerosols by reactive boiling ejection from liquid intermediate cellulose. Aerosols were characterized by laser diffraction light scattering, inductively coupled plasma spectroscopy, and high-speed photography. Pyrolysis product fractionation revealed that approximately 3 % of the initial feed (both organic and inorganic) was transported to the gas phase as aerosols. Large bubble-to-aerosol size ratios and visualization of significant late-time ejections in the pyrolyzing cellulose suggest the formation of film bubbles in addition to the previously discovered jet formation mechanism. PMID:27125341

  7. Low speed vehicle passenger ejection restraint effectiveness.

    PubMed

    Seluga, Kristopher J; Ojalvo, Irving U; Obert, Richard M

    2005-07-01

    Current golf carts and LSV's (Low Speed Vehicles) produce a significant number of passenger ejections during sharp turns. These LSV's do not typically possess seatbelts, but do provide outboard bench seat hip restraints that also serve as handholds. However, many current restraint designs appear incapable of preventing passenger ejections due to their low height and inefficient handhold position. Alternative handhold and hip restraint designs may improve passenger safety. Accordingly, this paper examines minimum size requirements for hip restraints to prevent passenger ejection during sharp turns and evaluates the effectiveness of a handhold mounted at the center of the bench seat. In this study, a simulation of a turning cart supplies the dynamic input to a biomechanical model of an adult male seated in a golf cart. Various restraint combinations are considered, both with and without the central handhold, to determine the likelihood of passenger ejection. It is shown that only the largest restraint geometries prevent passenger ejection. Adequate hip restraints should be much larger than current designs and a central handhold should be provided. In this way, golf cart and LSV manufacturers could reduce passenger ejections and improve fleet safety by incorporating recommendations provided herein. PMID:15893288

  8. What triggers coronal mass ejections ?

    NASA Astrophysics Data System (ADS)

    Aulanier, Guillaume

    Coronal mass ejections (CMEs) are large clouds of highly magnetized plasma. They are ac-celerated from the solar atmosphere into interplanetary space by the Lorentz force, which is associated to their strong current-carrying magnetic fields. Both theory and observations lead to the inevitable conclusion that the launch of a CME must result from the sudden release of free magnetic energy, which has slowly been accumulated in the corona for a long time before the eruption. Since the incomplete, but seminal, loss-of-equilibrium model was proposed by van Tend and Kuperus (1978), a large variety of analytical and numerical storage-and-release MHD models has been put forward in the past 20 years or so. All these models rely on the slow increase of currents and/or the slow decrease of the restraining magnetic tension preceding the eruption. But they all put the emphazis on different physical mechanisms to achieve this preeruptive evolution, and to suddenly trigger and later drive a CME. Nevertheless, all these models actually share many common features, which all describe many individual observed aspects of solar eruptions. It is therefore not always clear which of all the suggested mecha-nisms do really account for the triggering of observed CMEs in general. Also, these mechanisms should arguably not be as numerous as the models themselves, owing to the common occurence of CMEs. In order to shed some light on this challenging, but unripe, topic, I will attempt to rediscuss the applicability of the models to the Sun, and to rethink the most sensitive ones in a common frame, so as to find their common denominator. I will elaborate on the idea that many of the proposed triggering mechanisms may actually only be considered as different ways to apply a "last push", which puts the system beyond its eruptive threshold. I will argue that, in most cases, the eruptive threshold is determined by the vertical gradient of the magnetic field in the low-β corona, just like the usual

  9. Numerical Simulations of a Flux Rope Ejection

    NASA Astrophysics Data System (ADS)

    Pagano, P.; Mackay, D. H.; Poedts, S.

    2015-03-01

    Coronal mass ejections (CMEs) are the most violent phenomena observed on the Sun. One of the most successful models to explain CMEs is the flux rope ejection model, where a magnetic flux rope is expelled from the solar corona after a long phase along which the flux rope stays in equilibrium while magnetic energy is being accumulated. However, still many questions are outstanding on the detailed mechanism of the ejection and observations continuously provide new data to interpret and put in the context. Currently, extreme ultraviolet (EUV) images from the Atmospheric Imaging Assembly (AIA) on board the Solar Dynamic Observatory (SDO) are providing new insights into the early phase of CME evolution. In particular, observations show the ejection of magnetic flux ropes from the solar corona and how they evolve into CMEs. However, these observations are difficult to interpret in terms of basic physical mechanisms and quantities, thus, we need to compare equivalent quantities to test and improve our models. In our work, we intend to bridge the gap between models and observations with our model of flux rope ejection where we consistently describe the full life span of a flux rope from its formation to ejection. This is done by coupling the global non-linear force-free model (GNLFFF) built to describe the slow low- β formation phase, with a full MHD simulation run with the software MPI-AMRVAC, suitable to describe the fast MHD evolution of the flux rope ejection that happens in a heterogeneous β regime. We also explore the parameter space to identify the conditions upon which the ejection is favoured (gravity stratification and magnetic field intensity) and we produce synthesised AIA observations (171 Å and 211 Å). To carry this out, we run 3D MHD simulation in spherical coordinates where we include the role of thermal conduction and radiative losses, both of which are important for determining the temperature distribution of the solar corona during a CME. Our model of

  10. Computational fluid dynamics of left ventricular ejection.

    PubMed

    Georgiadis, J G; Wang, M; Pasipoularides, A

    1992-01-01

    The present investigation addresses the effects of simple geometric variations on intraventricular ejection dynamics, by methods from computational fluid dynamics. It is an early step in incorporating more and more relevant characteristics of the ejection process, such as a continuously changing irregular geometry, in numerical simulations. We consider the effects of varying chamber eccentricities and outflow valve orifice-to-inner surface area ratios on instantaneous ejection gradients along the axis of symmetry of the left ventricle. The equation of motion for the streamfunction was discretized and solved iteratively with specified boundary conditions on a boundary-fitted adaptive grid, using an alternating-direction-implicit (ADI) algorithm. The unsteady aspects of the ejection process were subsequently introduced into the numerical simulation. It was shown that for given chamber volume and outflow orifice area, higher chamber eccentricities require higher ejection pressure gradients for the same velocity and local acceleration values at the aortic anulus than more spherical shapes. This finding is referable to the rise in local acceleration effects across the outflow axis. This is to be contrasted with the case of outflow orifice stenosis, in which it was shown that it is the convective acceleration effects that are intensified strongly. PMID:1562106

  11. A transcriptome resource for pharaoh cuttlefish (Sepia pharaonis) after ink ejection by brief pressing.

    PubMed

    Wen, Jing; Zhong, Huan; Xiao, Jun; Zhou, Yi; Chen, Ziming; Zeng, Ling; Chen, Daohai; Sun, Yulin; Zhao, Juan; Wang, Fenghua

    2016-08-01

    Ink ejection is one of the most important defense mechanisms against external stimuli for pharaoh cuttlefish (Sepia pharaonis). The molecular changes during this process remain unknown. To understand the transcriptome changes after ink ejection by brief pressing, two cDNA libraries of pharaoh cuttlefish, from the inkjet group and control group were sequenced using Illumina HiSeq™ 2000. A total of 9,255,502,440nt bases were obtained and by de novo assembly, 73,298 unigenes were generated, which first provided numerous expressed sequence tags from pharaoh cuttlefish. By comparing the expression levels between the two groups, we identified 7064 up-regulated and 2024 down-regulated genes after ink ejection. These differentially-expressed genes included genes related to immunity, cancer, and blood coagulation, which indicated the various effects after ink ejection by brief pressing. These results provide new valuable resources for functional genomic and genetic studies on pharaoh cuttlefish. PMID:27270126

  12. EPISODIC EJECTION FROM ACTIVE ASTEROID 311P/PANSTARRS

    SciTech Connect

    Jewitt, David; Agarwal, Jessica; Weaver, Harold; Mutchler, Max; Larson, Stephen

    2015-01-10

    We examine the development of the active asteroid 311P/PANSTARRS (formerly, 2013 P5) in the period from 2013 September to 2014 February using high resolution images from the Hubble Space Telescope. This multi-tailed object is characterized by a single, reddish nucleus of absolute magnitude H ≥ 18.98 ± 0.10, corresponding to an equal-area sphere of radius ≤200 ± 20 m (for assumed geometric albedo 0.29 ± 0.09). We set an upper limit to the radii of possible companion nuclei at ∼10 m. The nucleus ejected debris in nine discrete episodes, spread irregularly over a nine month interval, each time forming a distinct tail. Particles in the tails range from about 10 μm to at least 80 mm in radius, and were ejected at speeds <1 m s{sup –1}. The ratio of the total ejected dust mass to the nucleus mass is ∼3×10{sup –5}, corresponding to a global surface layer ∼2 mm thick, or to a deeper layer covering a smaller fraction of the surface. The observations are incompatible with an origin of the activity by impact or by the sublimation of entrapped ice. This object appears to be shedding its regolith by rotational (presumably YORP-driven) instability. Long-term fading of the photometry (months) is attributed to gradual dissipation of near-nucleus dust. Photometric variations on short timescales (<0.7 hr) are probably caused by fast rotation of the nucleus. However, because of limited time coverage and dilution of the nucleus signal by near-nucleus dust, we have not been able to determine the rotation period.

  13. Driving mechanisms for coronal mass ejections.

    NASA Astrophysics Data System (ADS)

    Steinolfson, R. S.

    Mass ejections are new bright features observed in white-light that give the appearance of outward moving material. An acknowledged key ingredient in both the ejection and its progenitor is the magnetic field, although the precise nature of its role, particularily in the driving mechanism, remains unclear. The author begins by reviewing analyses of coordinated data sets that establish the relative time sequence and spatial location of individually identified phenomena (such as the flare impulsive phase, eruptive prominence, CME trajectory, etc.) that better define potential drivers. Some of the models and numerical simulations that have been developed with the intent of determining the physical interactions in the driving mechanism and coronal mass ejection are then considered.

  14. Whipple's ejection model and the Geminid stream

    NASA Astrophysics Data System (ADS)

    Jones, J.; Poole, L. M. G.; Webster, A. R.

    2016-02-01

    Many attempts to model the Geminid meteor stream have been based on Whipple's model for the ejection of meteoroids from comets. Using the most accurate data available from the IAU photographic meteor data base and by considering the scatter of the secularly near-invariant quantities of the simulated ejected test particles predicted by applying Whipple's model to the asteroid Phaethon - the prime candidate for the progenitor of the Geminid stream - we show that the model predicts ejection speeds that are about a factor of at least 3 too low. We have considered the other candidate progenitors: the asteroids 2005 UD and 1999 YC, and find neither of these to be credible candidates although we find that 2005 is the likely parent of the day-time Sextantid stream.

  15. Coronal mass ejections and coronal structures

    NASA Technical Reports Server (NTRS)

    Hildner, E.; Bassi, J.; Bougeret, J. L.; Duncan, R. A.; Gary, D. E.; Gergely, T. E.; Harrison, R. A.; Howard, R. A.; Illing, R. M. E.; Jackson, B. V.

    1986-01-01

    Research on coronal mass ejections (CMF) took a variety of forms, both observational and theoretical. On the observational side there were: case studies of individual events, in which it was attempted to provide the most complete descriptions possible, using correlative observations in diverse wavelengths; statistical studies of the properties CMEs and their associated activity; observations which may tell us about the initiation of mass ejections; interplanetary observations of associated shocks and energetic particles even observations of CMEs traversing interplanetary space; and the beautiful synoptic charts which show to what degree mass ejections affect the background corona and how rapidly (if at all) the corona recovers its pre-disturbance form. These efforts are described in capsule form with an emphasis on presenting pictures, graphs, and tables so that the reader can form a personal appreciation of the work and its results.

  16. ROTATION OF CORONAL MASS EJECTIONS DURING ERUPTION

    SciTech Connect

    Lynch, B. J.; Li, Y.; Luhmann, J. G.; Antiochos, S. K.; DeVore, C. R. E-mail: yanli@ssl.berkeley.edu E-mail: spiro.k.antiochos@nasa.gov

    2009-06-01

    Understanding the connection between coronal mass ejections (CMEs) and their interplanetary counterparts (ICMEs) is one of the most important problems in solar-terrestrial physics. We calculate the rotation of erupting field structures predicted by numerical simulations of CME initiation via the magnetic breakout model. In this model, the initial potential magnetic field has a multipolar topology and the system is driven by imposing a shear flow at the photospheric boundary. Our results yield insight on how to connect solar observations of the orientation of the filament or polarity inversion line (PIL) in the CME source region, the orientation of the CME axis as inferred from coronagraph images, and the ICME flux rope orientation obtained from in situ measurements. We present the results of two numerical simulations that differ only in the direction of the applied shearing motions (i.e., the handedness of the sheared-arcade systems and their resulting CME fields). In both simulations, eruptive flare reconnection occurs underneath the rapidly expanding sheared fields transforming the ejecta fields into three-dimensional flux rope structures. As the erupting flux ropes propagate through the low corona (from 2 to 4 R{sub sun}) the right-handed breakout flux rope rotates clockwise and the left-handed breakout flux rope rotates counterclockwise, in agreement with recent observations of the rotation of erupting filaments. We find that by 3.5 R {sub sun} the average rotation angle between the flux rope axes and the active region PIL is approximately 50 deg. We discuss the implications of these results for predicting, from the observed chirality of the pre-eruption filament and/or other properties of the CME source region, the direction and amount of rotation that magnetic flux rope structures will experience during eruption. We also discuss the implications of our results for CME initiation models.

  17. How much dust does Enceladus eject?

    NASA Astrophysics Data System (ADS)

    Kempf, Sascha; Horanyi, Mihaly; Schmidt, Jürgen; Southworth, Ben

    2015-04-01

    There is an ongoing argument how much dust per second the ice volcanoes on Saturn's ice moon Enceladus eject. By adjusting their plume model to the dust flux measured by the Cassini dust detector during the close Enceladus flyby in 2005, as well as to the plume brightness in Cassini imaging, Schmidt et al. (2008) obtained a total dust production rate in the plumes of about 5 kg/s. On the other hand, Ingersoll and Ewald (2011) derived a dust production rate of 51 kg/s from photometry of very high phase-angle images of the plume, a method that is sensitive also to particles in the size range of microns and larger. Knowledge of the production rate is essential for estimating the dust to gas mass ratio, which in turn is an important constraint for finding the plume source mechanism. Here we report on numerical simulations of the Enceladus dust plume. We run a large number of dynamical simulations including gravity and Lorentz force to investigate the earliest phase of the ring particle life span. The magnetic field in the vicinity of Enceladus is based on the model by Simon et al. (2012). The evolution of the electrostatic charge carried by the initially uncharged grains is treated self-consistently. Our numerical simulations reproduce dust measurements by the Cassini Cosmic Dust Analyzer (CDA) during Cassini plume traversals as well as the snowfall pattern derived from ISS observations of the Enceladus surface (Schenk et al, 2011, EPSC abstract). Based on our simulation results we are able to draw conclusions about the dust production rate as well as wether the Enceladus dust plume constitutes a dusty plasma.

  18. Falls and ejections from pickup trucks.

    PubMed

    Bucklew, P A; Osler, T M; Eidson, J J; Clevenger, F W; Olson, S E; Demarest, G B

    1992-04-01

    The medical records of 50 patients who sustained injuries during falls or ejections from pickup truck beds and were admitted to the University of New Mexico Level I Trauma Center between January 1985 and December 1989 were retrospectively examined. Falls and ejections commonly involve young adults, and usually occur in the summer months during the afternoon or evening. Twenty-three individuals were thrown from the pickup truck bed during a motor vehicle collision and 27 simply fell out, and this distinction was not related to age or ethanol use. Although those thrown from the pickup truck bed during a crash were less severely injured (average ISS 15.4) than those who simply fell from the bed (average ISS 17.4), this difference was not statistically significant. Mortality was equal in these two groups, with three deaths occurring in each group. Overall, injuries incurred during falls and ejections were more serious than those incurred in MVCs (average ISS 16.5 vs. 14.5, p = 0.06). The head was the most frequently injured body region following falls or ejections (68%), followed by the extremities (46%), the face (28%), the thorax (22%), and the abdomen (10%). Every death in this series was attributed to a head injury. The overall mortality for the series was 12%. Sixteen additional fatalities from falls and ejections during the study period were discovered in a review of the records of the State Medical Examiner. The average age of this cohort was 24 years. Fifteen of these deaths were the result of falls rather than ejections (94%), and 13 were attributed to head injuries (81%).(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1569621

  19. Halo Coronal Mass Ejections and Geomagnetic Storms

    NASA Technical Reports Server (NTRS)

    Gopalswamy, Nat

    2009-01-01

    In this letter, I show that the discrepancies in the geoeffectiveness of halo coronal mass ejections (CMEs) reported in the literature arise due to the varied definitions of halo CMEs used by different authors. In particular, I show that the low geoeffectiveness rate is a direct consequence of including partial halo CMEs. The geoeffectiveness of partial halo CMEs is lower because they are of low speed and likely to make a glancing impact on Earth. Key words: Coronal mass ejections, geomagnetic storms, geoeffectiveness, halo CMEs.

  20. Bacteriophage P22 ejects all of its internal proteins before its genome.

    PubMed

    Jin, Yan; Sdao, Sophia M; Dover, John A; Porcek, Natalia B; Knobler, Charles M; Gelbart, William M; Parent, Kristin N

    2015-11-01

    Double-stranded DNA bacteriophages are highly pressurized, providing a force driving ejection of a significant fraction of the genome from its capsid. In P22-like Podoviridae, internal proteins ("E proteins") are packaged into the capsid along with the genome, and without them the virus is not infectious. However, little is known about how and when these proteins come out of the virus. We employed an in vitro osmotic suppression system with high-molecular-weight polyethylene glycol to study P22 E protein release. While slow ejection of the DNA can be triggered by lipopolysaccharide (LPS), the rate is significantly enhanced by the membrane protein OmpA from Salmonella. In contrast, E proteins are not ejected unless both OmpA and LPS are present and their ejection when OmpA is present is largely complete before any genome is ejected, suggesting that E proteins play a key role in the early stage of transferring P22 DNA into the host. PMID:26245366

  1. The DNA ejection process in bacteriophage lambda

    NASA Astrophysics Data System (ADS)

    Grayson, Paul

    Bacteriophages have long served as model systems through which the nature of life may be explored. From a physical or mechanical point of view, phages are excellent examples of natural nanotechnology: they are nanometer-scale systems which depend critically on forces, pressures, velocities, and other fundamentally physical quantities for their biological functions. The study of the physical properties of phages has therefore provided an arena for application of physics to biology. In particular, recent studies of the motor responsible for packaging a phage gnome into a capsid showed a buildup of pressure within the capsid of tens of atmospheres. This thesis reports a combined theoretical and experimental study on various aspects of the genome ejection process, so that a comparison may be drawn with the packaging experiments. In particular, we examine various theoretical models of the forces within a phage capsid, deriving formulas both for the force driving genome ejection and for the velocity at which the genome is translocated into a host cell. We describe an experiment in which the force was measured as a function of the amount of genome within the phage capsid, and another where the genome ejection velocity was measured for single phages under the microscope. We make direct quantitative comparisons between the theory and experiments, stringently testing the extent to which we are able to model the genome ejection process.

  2. Do centrioles generate a polar ejection force?

    PubMed

    Wells, Jonathan

    2005-01-01

    A microtubule-dependent polar ejection force that pushes chromosomes away from spindle poles during prometaphase is observed in animal cells but not in the cells of higher plants. Elongating microtubules and kinesin-like motor molecules have been proposed as possible causes, but neither accounts for all the data. In the hypothesis proposed here a polar ejection force is generated by centrioles, which are found in animals but not in higher plants. Centrioles consist of nine microtubule triplets arranged like the blades of a tiny turbine. Instead of viewing centrioles through the spectacles of molecular reductionism and neo-Darwinism, this hypothesis assumes that they are holistically designed to be turbines. Orthogonally oriented centriolar turbines could generate oscillations in spindle microtubules that resemble the motion produced by a laboratory vortexer. The result would be a microtubule-mediated ejection force tending to move chromosomes away from the spindle axis and the poles. A rise in intracellular calcium at the onset of anaphase could regulate the polar ejection force by shutting down the centriolar turbines, but defective regulation could result in an excessive force that contributes to the chromosomal instability characteristic of most cancer cells. PMID:15889341

  3. LOW IONIZATION STATE PLASMA IN CORONAL MASS EJECTIONS

    SciTech Connect

    Lee, Jin-Yi; Raymond, John C.

    2012-10-20

    The Ultraviolet Coronagraph Spectrometer (UVCS) on board the Solar and Heliospheric Observatory often observes low ionization state coronal mass ejection (CME) plasma at ultraviolet wavelengths. The CME plasmas are often detected in O VI (3 Multiplication-Sign 10{sup 5} K), C III (8 Multiplication-Sign 10{sup 4} K), Ly{alpha}, and Ly{beta}, with the low ionization plasma confined to bright filaments or blobs that appear in small segments of the UVCS slit. On the other hand, in situ observations by the Solar Wind Ion Composition Spectrometer on board Advanced Composition Explorer (ACE) have shown mostly high ionization state plasmas in the magnetic clouds in interplanetary coronal mass ejection (ICME) events, while low ionization states are rarely seen. In this analysis, we investigate whether the low ionization state CME plasmas observed by UVCS occupy small enough fractions of the CME to be consistent with the small fraction of ACE ICMEs that show low ionization plasma, or whether the CME plasma must be further ionized after passing the UVCS slit. To do this, we determine the covering factors of low ionization state plasma for 10 CME events. We find that the low ionization state plasmas in CMEs observed by UVCS show average covering factors below 10%. This indicates that the lack of low ionization state ICME plasmas observed by the ACE results from a small probability that the spacecraft passes through a region of low ionization plasma. We also find that the low ionization state plasma covering factors in faster CMEs are smaller than in slower CMEs.

  4. Application of the Accurate Mass and Time Tag Approach to the Proteome Analysis of Sub-cellular Fractions Obtained from Rhodobacter sphaeroides 2.4.1 Aerobic and Photosynthetic Cell Cultures

    SciTech Connect

    Callister, Stephen J.; Dominguez, Migual; Nicora, Carrie D.; Zeng, Xiaohua; Tavano, Christine; Kaplan, Samuel; Donohue, Timothy; Smith, Richard D.; Lipton, Mary S.

    2006-08-04

    Abstract The high-throughput accurate mass and time tag (AMT) proteomic approach was utilized to characterize the proteomes for cytoplasm, cytoplasmic membrane, periplasm, and outer membrane fractions from aerobic and photosynthetic cultures of the gram-nagtive bacterium Rhodobacter sphaeroides 2.4.1. In addition, we analyzed the proteins within purified chromatophore fractions that house the photosynthetic apparatus from photosynthetically grown cells. In total, 8300 peptides were identified with high confidence from at least one sub-cellular fraction from either cell culture. These peptides were derived from 1514 genes or 35% percent of proteins predicted to be encoded by the genome. A significant number of these proteins were detected within a single sub-cellular fraction and their localization was compared to in-silico predictions. However, the majority of proteins were observed in multiple sub-cellular fractions, and the most likely sub-cellular localization for these proteins was investigated using a Z-score analysis of peptide abundance along with clustering techniques. Good (81%) agreement was observed between the experimental results and in-silico predictions. The AMT tag approach provides localization evidence for those proteins that have no predicted localization information, those annotated as putative proteins, and/or for those proteins annotated as hypothetical and conserved hypothetical.

  5. Electrostatic Droplet Ejection Using Planar Needle Inkjet Head

    NASA Astrophysics Data System (ADS)

    Hakiai, Kazunori; Ishida, Yuji; Baba, Akiyoshi; Asano, Tanemasa

    2005-07-01

    For the purpose of investigating the electrostatic droplet ejection event, a planar needle inkjet head with a projected cone-shaped needle (3-D head) was prepared to observe the phenomenon of droplet ejection. As the initial approach to developing a liquid ejection monitoring method, electric current was also measured. The ejection was found to take place as a series of single events that are composed of fine droplet ejections forming the Taylor cone and the subsequent swing back of the liquid front owing to the relationship between surface tension and electrostatic force. The critical factors for ejecting fine droplets in the case of using the inkjet head having a protruding needle were back pressure from the reservoir and the wetting control of the structures. The fast Fourier transform of electric current revealed the appearance of periodic signals during ejection, which may be used in developing a technique of sensing droplet ejection.

  6. Nonlinear dispersion of a pollutant ejected into a channel flow

    NASA Astrophysics Data System (ADS)

    Van Gorder, Robert A.; Vajravelu, Kuppalapalle

    2011-10-01

    In this paper, we study the nonlinear coupled boundary value problem arising from the nonlinear dispersion of a pollutant ejected by an external source into a channel flow. We obtain exact solutions for the steady flow for some special cases and an implicit exact solution for the unsteady flow. Additionally, we obtain analytical solutions for the transient flow. From the obtained solutions, we are able to deduce the qualitative influence of the model parameters on the solutions. Furthermore, we are able to give both exact and analytical expressions for the skin friction and wall mass transfer rate as functions of the model parameters. The model considered can be useful for understanding the polluting situations of an improper discharge incident and evaluating the effects of decontaminating measures for the water bodies.

  7. Light vehicle occupant ejections--a comprehensive investigation.

    PubMed

    Malliaris, A C; DeBlois, J H; Digges, K H

    1996-01-01

    Occupant ejections, about 1.5% of all crash-involved occupant events, are relatively infrequent but very harmful events in highway crashes of light vehicles, including cars, pickup trucks, vans, and multipurpose vehicles (utility vehicles, jeeps, etc.). The disparity between frequency of harm to ejectees and ejection frequency is at least one order of magnitude. Partial ejections, although less frequent, have an incidence that is comparable to that of complete ejections, except for restrained occupants, where complete ejections are very infrequent. Notwithstanding the high effectiveness of safety belts in preventing ejections, and the multifold growth of safety belt use in the last 10 years, there is no detectable reduction in the ejection rate in the same period. Ejections per se and not other pre-ejection occupant impacts are responsible for the bulk of the harm to ejectees. Furthermore, ejected occupants sustain harm much larger than that which would have occurred, had these occupants not been ejected. "Closed glazing" is the leading ejection path. "Doors" and "windshield" are distant seconds. All glazing except the windshield fail overwhelmingly by disintegration. Latch failure is the primary mode of failure in opening doors. Hinges and other modes of failure are relatively minor concerns. The sources of data in this investigation are: the National Accident Sampling System for the years 1988 to 1991, and the Fatal Accident Reporting System for 1982 to 1992. PMID:8924175

  8. Real barchan dune collisions and ejections

    NASA Astrophysics Data System (ADS)

    Hugenholtz, Chris H.; Barchyn, Thomas E.

    2012-01-01

    From high-resolution satellite imagery of barchan sand dunes, we provide geomorphological evidence of collisions that result in the ejection of a barchan from the wake of another barchan dune. Previous interpretations suggest this outcome is evidence of soliton or solitary wave behaviour; however, the physical mechanisms for mass exchange are not fully understood, resulting in debate. Our evidence and interpretation indicates that mass is transferred to the upwind barchan by shadowing a portion of downwind barchan's stoss slope. Turbulent, unsaturated airflow erodes the surface between the dunes, creating a smaller dune that ejects from the wake region. Previous observations lacked the spatial resolution required to document this process; therefore, our observations clarify the collision dynamics of barchans. A broader implication of our observations is the role of collisions in maintaining an “equilibrium” size distribution in barchan swarms.

  9. MHD shocks in coronal mass ejections

    NASA Technical Reports Server (NTRS)

    Steinolfson, R. S.

    1991-01-01

    The primary objective of this research program is the study of the magnetohydrodynamic (MHD) shocks and nonlinear simple waves produced as a result of the interaction of ejected lower coronal plasma with the ambient corona. The types of shocks and nonlinear simple waves produced for representative coronal conditions and disturbance velocities were determined. The wave system and the interactions between the ejecta and ambient corona were studied using both analytic theory and numerical solutions of the time-dependent, nonlinear MHD equations. Observations from the SMM coronagraph/polarimeter provided both guidance and motivation and are used extensively in evaluating the results. As a natural consequence of the comparisons with the data, the simulations assisted in better understanding the physical interactions in coronal mass ejections (CME's).

  10. Interplanetary Coronal Mass Ejections detected by HAWC

    NASA Astrophysics Data System (ADS)

    Lara, Alejandro

    The High Altitude Water Cherenkov (HAWC) observatory is being constructed at the volcano Sierra Negra (4100 m a.s.l.) in Mexico. HAWC’s primary purpose is the study of both: galactic and extra-galactic sources of high energy gamma rays. HAWC will consist of 300 large water Cherenkov detectors (WCD), instrumented with 1200 photo-multipliers. The Data taking has already started while construction continues, with the completion projected for late 2014. The HAWC counting rate will be sensitive to cosmic rays with energies above the geomagnetic cutoff of the site (˜ 8 GV). In particular, HAWC will detect solar energetic particles known as Ground Level Enhancements (GLEs), and the effects of Coronal Mass Ejections on the galactic cosmic ray flux, known as Forbush Decreases. In this paper, we present a description of the instrument and its response to interplanetary coronal mass ejections, and other solar wind large scale structures, observed during the August-December 2013 period.

  11. Pilot ejection, parachute, and helicopter crash injuries.

    PubMed

    McBratney, Colleen M; Rush, Stephen; Kharod, Chetan U

    2014-01-01

    USAF Pararescuemen (PJs) respond to downed aircrew as a fundamental mission for personnel recovery (PR), one of the Air Force's core functions. In addition to responding to these in Military settings, the PJs from the 212 Rescue Squadron routinely respond to small plane crashes in remote regions of Alaska. While there is a paucity of information on the latter, there have been articles detailing injuries sustained from helicopter crashes and while ejecting or parachuting from fixed wing aircraft. The following represents a new chapter added to the Pararescue Medical Operations Handbook, Sixth Edition (2014, editors Matt Wolf, MD, and Stephen Rush, MD, in press). It was designed to be a quick reference for PJs and their Special Operations flight surgeons to help with understanding of mechanism of injury with regard to pilot ejection, parachute, and helicopter accident injuries. It outlines the nature of the injuries sustained in such mishaps and provides an epidemiologic framework from which to approach the problem. PMID:25399374

  12. Ejectable underwater sound source recovery assembly

    NASA Technical Reports Server (NTRS)

    Irick, S. C. (Inventor)

    1974-01-01

    An underwater sound source is described that may be ejectably mounted on any mobile device that travels over water, to facilitate in the location and recovery of the device when submerged. A length of flexible line maintains a connection between the mobile device and the sound source. During recovery, the sound source is located be particularly useful in the recovery of spent rocket motors that bury in the ocean floor upon impact.

  13. Sputter ejection of matter from Io

    NASA Technical Reports Server (NTRS)

    Haff, P. K.; Watson, C. C.; Yung, Y. L.

    1981-01-01

    Direct collisional interaction of magnetospheric particles, particularly 520-eV S ions, with Io, cause sputter removal of matter. It is estimated that direct sputtering of a full-disk S-containing atmosphere with an exobase at a few hundred km, can provide up to 5 x 10 to the tenth S atoms per sq cm-s. Supplies of S and O required to stabilize the torus are estimated to be from 10 to the 10th to 10 to the 12th per sq cm-s. Sputtering rates are calculated for an atmosphere containing a one percent concentration of Na and K, and are found to be large enough to supply the fluxes required to maintain the Na and K clouds. Sputtering is found to remove heavy molecules from the atmosphere, and the rate of direct sputtering of unprotected surfaces is calculated for ejections of S and Na. Atomic species on the surface are ejected at a rate proportional to the surface abundance; and plume sputtering, avalanche cascading, and ionic saltation which lead to spatial and temporal variations in the number of ejected particles are observed.

  14. Potential Method of Predicting Coronal Mass Ejection

    NASA Astrophysics Data System (ADS)

    Imholt, Timothy

    2001-10-01

    Coronal Mass Ejections (CME) may be described as a blast of gas and highly charged solar mass fragments ejected into space. These ejections, when directed toward Earth, have many different effects on terrestrial systems ranging from the Aurora Borealis to changes in wireless communication. The early prediction of these solar events cannot be overlooked. There are several models currently accepted and utilized to predict these events, however, with earlier prediction of both the event and the location on the sun where the event occurs allows us to have earlier warnings as to when they will affect man-made systems. A better prediction could perhaps be achieved by utilizing low angular resolution radio telescope arrays to catalog data from the sun at different radio frequencies on a regular basis. Once this data is cataloged a better predictor for these CME’s could be found. We propose a model that allows a prediction to be made that appears to be longer than 24 hours.

  15. Potential Method of Predicting Coronal Mass Ejection

    NASA Astrophysics Data System (ADS)

    Imholt, Timothy; Roberts, J. A.; Scott, J. B.; University Of North Texas Team

    2000-10-01

    Coronal Mass Ejections (CME) may be described as a blast of gas and highly charged solar mass fragments ejected into space. These ejections, when directed toward Earth, have many different effects on terrestrial systems ranging from the Aurora Borealis to changes in wireless communications. The importance of an early prediction of these solar events cannot be overlooked. There are several models currently accepted and utilized to predict these events, however, with earlier prediction of both the event and the location on the sun where the event occur allows us to have earlier warnings as to when they will effect man-made systems. A better prediction could perhaps be achieved by utilizing low angular resolution radio telescope arrays to catalog data from the sun at different radio frequencies on a regular basis. Once this data is cataloged a better predictor for these CME's could be found. We propose a model that allows a prediction to be made that appears to be longer than 24 hours.

  16. Transient ion ejection during nanocomposite thermite reactions

    NASA Astrophysics Data System (ADS)

    Zhou, Lei; Piekiel, Nicholas; Chowdhury, Snehaunshu; Lee, Donggeun; Zachariah, Michael R.

    2009-10-01

    We observe an intense ion pulse from nanocomposite thermite reactions, which we temporally probe using a recently developed temperature jump/time of flight mass spectrometer. These ion pulses are observed to be much shorter in duration than the overall thermite reaction time. Ion ejection appears in stages as positive ions are ejected prior to nanocomposite thermite ignition, and ignition of the thermite mixtures leads to a second ionization step which is primarily dominated by negative species. The positive species are identified from mass spectrometric measurements and the results show that the positive ion species are comprised of Na ions with minor species of Al and K ions. This observation can be explained by a diffusion based ion-current mechanism, in which strong Al ion diffusion flux formed through the oxide shell, and the surface Na and K ions from salt contaminations are ejected by the strong electrostatic repulsion. The fact that the negative ionization step occurs during the ignition event suggests a strong relation between the nanocomposite thermite reaction and the negative ionization process.

  17. The distribution of ejected brown dwarfs in clusters

    NASA Astrophysics Data System (ADS)

    Goodwin, S. P.; Hubber, D. A.; Moraux, E.; Whitworth, A. P.

    2005-12-01

    We examine the spatial distribution of brown dwarfs produced by the decay of small-N stellar systems as expected from the embryo ejection scenario. We model a cluster of several hundred stars grouped into 'cores' of a few stars/brown dwarfs. These cores decay, preferentially ejecting their lowest-mass members. Brown dwarfs are found to have a wider spatial distribution than stars, however once the effects of limited survey areas and unresolved binaries are taken into account it can be difficult to distinguish between clusters with many or no ejections. A large difference between the distributions probably indicates that ejections have occurred, however similar distributions sometimes arise even with ejections. Thus the spatial distribution of brown dwarfs is not necessarily a good discriminator between ejection and non-ejection scenarios.

  18. Role of osmotic and hydrostatic pressures in bacteriophage genome ejection

    NASA Astrophysics Data System (ADS)

    Lemay, Serge G.; Panja, Debabrata; Molineux, Ian J.

    2013-02-01

    A critical step in the bacteriophage life cycle is genome ejection into host bacteria. The ejection process for double-stranded DNA phages has been studied thoroughly in vitro, where after triggering with the cellular receptor the genome ejects into a buffer. The experimental data have been interpreted in terms of the decrease in free energy of the densely packed DNA associated with genome ejection. Here we detail a simple model of genome ejection in terms of the hydrostatic and osmotic pressures inside the phage, a bacterium, and a buffer solution or culture medium. We argue that the hydrodynamic flow associated with the water movement from the buffer solution into the phage capsid and further drainage into the bacterial cytoplasm, driven by the osmotic gradient between the bacterial cytoplasm and culture medium, provides an alternative mechanism for phage genome ejection in vivo; the mechanism is perfectly consistent with phage genome ejection in vitro.

  19. Effects of flavonoid glycosides obtained from a Ginkgo biloba extract fraction on the physical and oxidative stabilities of oil-in-water emulsions prepared from a stripped structured lipid with a low omega-6 to omega-3 ratio.

    PubMed

    Yang, Dan; Wang, Xiang-Yu; Gan, Lu-Jing; Zhang, Hua; Shin, Jung-Ah; Lee, Ki-Teak; Hong, Soon-Taek

    2015-05-01

    In this study, we have produced a structured lipid with a low ω6/ω3 ratio by lipase-catalysed interesterification with perilla and grape seed oils (1:3, wt/wt). A Ginkgo biloba leaf extract was fractionated in a column packed with HP-20 resin, producing a flavonoid glycoside fraction (FA) and a biflavone fraction (FB). FA exhibited higher antioxidant capacity than FB, showing 58.4 mmol gallic acid equivalent (GAE)/g-of-total-phenol-content, 58.8 mg quercetin equivalent (QUE)/g-of-total-flavonoid-content, 4.5 mmol trolox/g-of-trolox-equivalent antioxidant capacity, 0.14 mg extract/mL-of-free-radical-scavenging-activity (DPPH assay, IC50), and 2.3 mmol Fe2SO4 · 7H2O/g-of-ferric-reducing-antioxidant-power. The oil-in-water emulsion containing the stripped structured lipid as an oil phase with FA exhibited the highest stability and the lowest oil globule diameters (d43 and d32), where the aggregation was unnoticeable by Turbiscan and particle size analyses during 30 days of storage. Furthermore, FA was effective in retarding the oxidation of the emulsions. PMID:25529661

  20. Interactive visualization of solar mass ejection imager (SMEI) volumetric data

    NASA Astrophysics Data System (ADS)

    Yu, Yang; Hick, P. P.; Jackson, Bernard V.

    2005-08-01

    We present a volume rendering system developed for the real time visualization and manipulation of 3D heliospheric volumetric solar wind density and velocity data obtained from the Solar Mass Ejection Imager (SMEI) and interplanetary scintillation (IPS) velocities over the same time period. Our system exploits the capabilities of the VolumePro 1000 board from TeraRecon, Inc., a low-cost 64-bit PCI board capable of rendering up to a 512-cubed array of volume data in real time at up to 30 frames per second on a standard PC. Many volume-rendering operations have been implemented with this system such as stereo/perspective views, animations of time-sequences, and determination of coronal mass ejection (CME) volumes and masses. In these visualizations we highlight one time period where a halo CMEs was observed by SMEI to engulf Earth on October 29, 2003. We demonstrate how this system is used to measure the distribution of structure and provide 3D mass for individual CME features, including the ejecta associated with the large prominence viewed moving to the south of Earth following the late October CME. Comparisons with the IPS velocity volumetric data give pixel by pixel and total kinetic energies for these events.

  1. Full-halo coronal mass ejections: Arrival at the Earth

    NASA Astrophysics Data System (ADS)

    Shen, Chenglong; Wang, Yuming; Pan, Zonghao; Miao, Bin; Ye, Pinzhong; Wang, S.

    2014-07-01

    A geomagnetic storm is mainly caused by a frontside coronal mass ejection (CME) hitting the Earth and then interacting with the magnetosphere. However, not all frontside CMEs can hit the Earth. Thus, which CMEs hit the Earth and when they do so are important issues in the study and forecasting of space weather. In our previous work, the deprojected parameters of the full-halo coronal mass ejections (FHCMEs) that occurred from 1 March 2007 to 31 May 2012 were estimated, and there are 39 frontside events that could be fitted by the Graduated Cylindrical Shell model. In this work, we continue to study whether and when these frontside FHCMEs (FFHCMEs) hit the Earth. It is found that 59% of these FFHCMEs hit the Earth, and for central events, whose deviation angles ɛ, which are the angles between the propagation direction and the Sun-Earth line, are smaller than 45°, the fraction increases to 75%. After checking the deprojected angular widths of the CMEs, we found that all of the Earth-encountered CMEs satisfy a simple criterion that the angular width (ω) is larger than twice the deviation angle (ɛ). This result suggests that some simple criteria can be used to forecast whether a CME could hit the Earth. Furthermore, for Earth-encountered CMEs, the transit time is found to be roughly anticorrelated with the deprojected velocity, but some events significantly deviate from the linearity. For CMEs with similar velocities, the differences of their transit times can be up to several days. Such deviation is further demonstrated to be mainly caused by the CME geometry and propagation direction, which are essential in the forecasting of CME arrival.

  2. High-resolution imaging of ejection dynamics in laser-induced forward transfer

    NASA Astrophysics Data System (ADS)

    Pohl, R.; Visser, C. W.; Römer, G. R. B. E.; Sun, C.; Huis in't Veld, A. J.; Lohse, D.

    2014-03-01

    Laser-induced Forward Transfer (LIFT) is a 3D direct-write method suitable for precision printing of various materials. As the ejection mechanism of picosecond LIFT has not been visualized in detail, the governing physics are not fully understood yet. Therefore, this article presents an experimental imaging study on the ejection process of gold-based LIFT. The LIFT experiments were performed using a 6.7 picosecond Yb:YAG laser source equipped with a SHG. The beam was focused onto a 200 nm thick gold donor layer. The high magnification images were obtained using bright field illumination by a 6 ns pulsed Nd:YAG laser source and a 50× long-distance microscope objective that was combined with a 200 mm tube lens. For laser fluence levels up to two times the donor-transfer-threshold, the ejection of a single droplet was observed. The typical droplet radius was estimated to be less than 3 μm. A transition of ejection features towards higher fluence, indicates a second fluence-regime in the ejection process. For higher laser fluence, the formation of an elongated gold jet was observed. This jet fragments into multiple relatively small droplets, resulting in a spray of particles on the receiving substrate.

  3. THE NATURE OF HYPERVELOCITY STARS AND THE TIME BETWEEN THEIR FORMATION AND EJECTION

    SciTech Connect

    Brown, Warren R.; Geller, Margaret J.; Kenyon, Scott J.; Cohen, Judith G. E-mail: mgeller@cfa.harvard.edu E-mail: jlc@astro.caltech.edu

    2012-07-20

    We obtain Keck HIRES spectroscopy of HVS5, one of the fastest unbound stars in the Milky Way halo. We show that HVS5 is a 3.62 {+-} 0.11 M{sub Sun} main-sequence B star at a distance of 50 {+-} 5 kpc. The difference between its age and its flight time from the Galactic center is 105 {+-} 18 (stat) {+-}30 (sys) Myr; flight times from locations elsewhere in the Galactic disk are similar. This 10{sup 8} yr 'arrival time' between formation and ejection is difficult to reconcile with any ejection scenario involving massive stars that live for only 10{sup 7} yr. For comparison, we derive arrival times of 10{sup 7} yr for two unbound runaway B stars, consistent with their disk origin where ejection results from a supernova in a binary system or dynamical interactions between massive stars in a dense star cluster. For HVS5, ejection during the first 10{sup 7} yr of its lifetime is ruled out at the 3{sigma} level. Together with the 10{sup 8} yr arrival times inferred for three other well-studied hypervelocity stars (HVSs), these results are consistent with a Galactic center origin for the HVSs. If the HVSs were indeed ejected by the central black hole, then the Galactic center was forming stars {approx_equal}200 Myr ago, and the progenitors of the HVSs took {approx_equal}100 Myr to enter the black hole's loss cone.

  4. Energetics of genome ejection from phage revealed by isothermal titration calorimetry

    NASA Astrophysics Data System (ADS)

    Jeembaeva, Meerim; Jonsson, Bengt; Castelnovo, Martin; Evilevitch, Alex

    2009-03-01

    It has been experimentally shown that ejection of double-stranded DNA from phage is driven by internal pressure reaching tens of atmospheres. This internal pressure is partially responsible for delivery of DNA into the host cell. While several theoretical models and simulations nicely describe the experimental data of internal forces either resisting active packaging or equivalently favoring spontaneous ejection, there are no direct energy measurements available that would help to verify how quantitative these theories are. We performed direct measurements of the enthalpy responsible for DNA ejection from phage λ, using Isothermal Titration Calorimetry. The phage capsids were ``opened'' in vitro by titrating λ into a solution with LamB receptor and the enthalpy of DNA ejection process was measured. In his way, enthalpy stored in λ was determined as a function of packaged DNA length comparing wild-type phage λ (48.5 kb) with a shorter λ-DNA length mutant (37.7 kb). The temperature dependence of the ejection enthalpy was also investigated. The values obtained were in good agreement with existing models and provide a better understanding of ds- DNA packaging and release mechanisms in motor-packaged viruses (e.g., tailed bacteriophages, Herpes Simplex, and adenoviruses).

  5. Cartridge firing device designed for attachment, release and ejection of a satellite

    NASA Technical Reports Server (NTRS)

    Pierron, L.

    1977-01-01

    The device functions were performed by a one-piece unit with resulting performances which were of interest regarding the satellite attachment and the accuracies of the path and velocity during separation and ejection. A gain in weight may be obtained relative to the conventional device used, i.e. maintenance belt, belt unlocking device, pusher spring, and cartridge fired pusher.

  6. Mass ejection by pulsational pair instability in very massive stars and implications for luminous supernovae

    NASA Astrophysics Data System (ADS)

    Yoshida, Takashi; Umeda, Hideyuki; Maeda, Keiichi; Ishii, Tatsuo

    2016-03-01

    Massive stars having a CO core of ˜40-60 M⊙ experience pulsational pair-instability (PPI) after carbon-burning. This instability induces strong pulsations of the whole star and a part of outer envelope is ejected. We investigate the evolution and mass ejection of metal-poor very massive stars which experience PPI. We use stellar models with initial masses of 140, 200, and 250 M⊙ and the metallicity Z = 0.004. Their masses decrease to 54.09, 58.65, and 61.03 M⊙ before the neon-burning owing to mass-loss and He mass fraction at the surface becomes about 20 per cent. During the PPI period of ˜1-2000 yr, they experience six, four, and three pulsations, respectively. The larger CO-core model has the longer PPI period and ejects the larger amount of mass. Since almost all surface He has been lost by the pulsations, these stars become Type Ic supernovae if they explode. Light curves during the PPI stage and supernovae are investigated and are implicated in luminous supernovae. The luminosity created by the interaction of different PPI ejecta becomes Mbol ˜ -16 to -20. The interaction between the circumstellar shell ejected by PPI and the supernova ejecta can be more luminous. These luminous transients could be an origin of Type I superluminous supernovae and supernovae with precursor.

  7. Dipole Field Effects on Ion Ejections from a Paul Ion Trap

    NASA Technical Reports Server (NTRS)

    MacAskill, J. A.; Chutjian, A.

    2011-01-01

    Attempts at improving the quality of mass spectra obtained from a Paul trap mass spectrometer prompted an investigation of the effects of additional fields to supplement the primary rf quadrupole trapping field. Reported here are the results of the first in a series of tests that focuses on the application of a single dipole field to augment the trapping and subsequent ejections of ions stored within a Paul trap. Measurements are presented for a fixed quadrupole frequency with varying dipole frequencies. The presence of the dipole field during the quadrupole trapping phase causes ion ejections of single m/z species at discrete dipole frequencies. During the mass analysis phase, the varying dipole frequency produces a complex set of resonant structures that impact ejection time (mass range), as well as mass spectral peak intensity and width

  8. Ultraviolet Spectroscopy of Narrow Coronal Mass Ejections

    NASA Astrophysics Data System (ADS)

    Dobrzycka, D.; Raymond, J. C.; Biesecker, D. A.; Li, J.; Ciaravella, A.

    2003-05-01

    We present Ultraviolet Coronagraph Spectrometer (UVCS) observations of five narrow coronal mass ejections (CMEs) that were among 15 narrow CMEs originally selected by Gilbert and coworkers. Two events (1999 March 27, April 15) were ``structured,'' i.e., in white-light data they exhibited well-defined interior features, and three (1999 May 9, May 21, June 3) were ``unstructured,'' i.e., appeared featureless. In UVCS data the events were seen as 4°-13° wide enhancements of the strongest coronal lines H I Lyα and O VI λλ1032, 1037. We derived electron densities for several of the events from the Large Angle and Spectrometric Coronagraph Experiment (LASCO) C2 white-light observations. They are comparable to or smaller than densities inferred for other CMEs. We modeled the observable properties of examples of the structured (1999 April 15) and unstructured (1999 May 9) narrow CMEs at different heights in the corona between 1.5 and 2 Rsolar. The derived electron temperatures, densities, and outflow speeds are similar for those two types of ejections. They were compared with properties of polar coronal jets and other CMEs. We discuss different scenarios of narrow CME formation as either a jet formed by reconnection onto open field lines or a CME ejected by expansion of closed field structures. Overall, we conclude that the existing observations do not definitively place the narrow CMEs into the jet or the CME picture, but the acceleration of the 1999 April 15 event resembles acceleration seen in many CMEs, rather than constant speeds or deceleration observed in jets.

  9. Particle Ejection and Levitation Technology (PELT)

    NASA Technical Reports Server (NTRS)

    2008-01-01

    Each of the six Apollo landers touched down at unique sites on the lunar surface. Aside from the Apollo 12 landing site located 180 meters from the Surveyor III lander, plume impingement effects on ground hardware during the landings were not a problem. The planned return to the Moon requires numerous landings at the same site. Since the top few centimeters of lunar soil are loosely packed regolith, plume impingement from the lander will eject the granular material at high velocities. A picture shows what the astronauts viewed from the window of the Apollo 14 lander. There was tremendous dust excavation beneath the vehicle. With high-vacuum conditions on the Moon (10 (exp -14) to 10 (exp -12) torr), motion of all particles is completely ballistic. Estimates derived from damage to Surveyor III caused by the Apollo 12 lander show that the speed of the ejected regolith particles varies from 100 m/s to 2,000 m/s. It is imperative to understand the physics of plume impingement to safely design landing sites for future Moon missions. Aerospace scientists and engineers have examined and analyzed images from Apollo video extensively in an effort to determine the theoretical effects of rocket exhaust impingement. KSC has joined the University of Central Florida (UCF) to develop an instrument that will measure the 3-D vector of dust flow caused by plume impingement during descent of landers. The data collected from the instrument will augment the theoretical studies and analysis of the Apollo videos.

  10. Drop Ejection From an Oscillating Rod

    NASA Technical Reports Server (NTRS)

    Wilkes, E. D.; Basaran, O. A.

    1999-01-01

    The dynamics of a drop of a Newtonian liquid that is pendant from or sessile on a solid rod that is forced to undergo time-periodic oscillations along its axis is studied theoretically. The free boundary problem governing the time evolution of the shape of the drop and the flow field inside it is solved by a method of lines using a finite element algorithm incorporating an adaptive mesh. When the forcing amplitude is small, the drop approaches a limit cycle at large times and undergoes steady oscillations thereafter. However, drop breakup is the consequence if the forcing amplitude exceeds a critical value. Over a wide range of amplitudes above this critical value, drop ejection from the rod occurs during the second oscillation period from the commencement of rod motion. Remarkably, the shape of the interface at breakup and the volume of the primary drop formed are insensitive to changes in forcing amplitude. The interface shape at times close to and at breakup is a multi-valued function of distance measured along the rod axis and hence cannot be described by recently popularized one-dimensional approximations. The computations show that drop ejection occurs without the formation of a long neck. Therefore, this method of drop formation holds promise of preventing formation of undesirable satellite droplets.

  11. Solar Mass Ejection Imager (SMEI) space experiment

    NASA Astrophysics Data System (ADS)

    Radick, Richard R.

    2001-12-01

    The Solar Mass Ejection Imager (SMEI) is a proof-of-concept space experiment designed to observe solar coronal mass ejections (CMEs) and forecast their arrival at Earth. SMEI will image CMEs by sensing sunlight scattered from the free electrons in these ejecta (i.e., Thomson scattering). SMEI will be launched by a Titan II rocket into a circular, 830-km, sun-synchronous orbit in mid-2002 as part of the Space Test Program's CORIOLIS mission. SMEI will image nearly the entire sky once per spacecraft orbit over a mission lifetime of three years. Successful operation of SMEI will represent a major step in improving space weather forecasts by providing one- to three-day predictions of geomagnetic storms at the Earth. The SMEI experiment is being designed and constructed by a team of scientists and engineers from the Air Force Research Laboratory, the University of Birmingham (UB) in the United Kingdom, the University of California at San Diego (UCSD), and Boston University. The Air Force, NASA, and UB are providing financial support.

  12. Electrically induced drop detachment and ejection

    NASA Astrophysics Data System (ADS)

    Cavalli, Andrea; Preston, Daniel J.; Tio, Evelyn; Martin, David W.; Miljkovic, Nenad; Wang, Evelyn N.; Blanchette, Francois; Bush, John W. M.

    2016-02-01

    A deformed droplet may leap from a solid substrate, impelled to detach through the conversion of surface energy into kinetic energy that arises as it relaxes to a sphere. Electrowetting provides a means of preparing a droplet on a substrate for lift-off. When a voltage is applied between a water droplet and a dielectric-coated electrode, the wettability of the substrate increases in a controlled way, leading to the spreading of the droplet. Once the voltage is released, the droplet recoils, due to a sudden excess in surface energy, and droplet detachment may follow. The process of drop detachment and lift-off, prevalent in both biology and micro-engineering, has to date been considered primarily in terms of qualitative scaling arguments for idealized superhydrophobic substrates. We here consider the eletrically-induced ejection of droplets from substrates of finite wettability and analyze the process quantitatively. We compare experiments to numerical simulations and analyze how the energy conversion efficiency is affected by the applied voltage and the intrinsic contact angle of the droplet on the substrate. Our results indicate that the finite wettability of the substrate significantly affects the detachment dynamics, and so provide new rationale for the previously reported large critical radius for drop ejection from micro-textured substrates.

  13. Global Response to Local Ionospheric Mass Ejection

    NASA Technical Reports Server (NTRS)

    Moore, T. E.; Fok, M.-C.; Delcourt, D. C.; Slinker, S. P.; Fedder, J. A.

    2010-01-01

    We revisit a reported "Ionospheric Mass Ejection" using prior event observations to guide a global simulation of local ionospheric outflows, global magnetospheric circulation, and plasma sheet pressurization, and comparing our results with the observed global response. Our simulation framework is based on test particle motions in the Lyon-Fedder-Mobarry (LFM) global circulation model electromagnetic fields. The inner magnetosphere is simulated with the Comprehensive Ring Current Model (CRCM) of Fok and Wolf, driven by the transpolar potential developed by the LFM magnetosphere, and includes an embedded plasmaspheric simulation. Global circulation is stimulated using the observed solar wind conditions for the period 24-25 Sept 1998. This period begins with the arrival of a Coronal Mass Ejection, initially with northward, but later with southward interplanetary magnetic field. Test particles are launched from the ionosphere with fluxes specified by local empirical relationships of outflow to electrodynamic and particle precipitation imposed by the MIlD simulation. Particles are tracked until they are lost from the system downstream or into the atmosphere, using the full equations of motion. Results are compared with the observed ring current and a simulation of polar and auroral wind outflows driven globally by solar wind dynamic pressure. We find good quantitative agreement with the observed ring current, and reasonable qualitative agreement with earlier simulation results, suggesting that the solar wind driven global simulation generates realistic energy dissipation in the ionosphere and that the Strangeway relations provide a realistic local outflow description.

  14. Coronal Mass Ejections from a Young K0 Dwarf Star

    NASA Astrophysics Data System (ADS)

    Soderblom, David R.

    We propose to carry out a joint ESA NASA IUE and ground-based spectroscopic study of the rapid ly rotating (P = 0.514 day), bright (V =6.9). young K0 dwarf HD 36705 (= AB Doradus). Cameron and Robinson have recently discovered prominence-like clouds of neutral material in the outer corona of this star. We intend to determine the column densities and temperatures of the clouds from the widths of the Mg II h and k absorption features produced as those clouds transit the stellar disk. We can thus determine the masses of these clouds, which are ejected from the star about twice per day, and hence their effectiveness as a magnetic braking mechanism in very young, low-mass, main sequence stars. Between Mg II observations. we will obtain short-wavelength spectra to monitor the variability in other chromospheric and transition region line emissions over six consecutive stellar rotations.

  15. Development of coronal mass ejections and association with interplanetary events

    NASA Technical Reports Server (NTRS)

    Pick, M.; Maia, D.; Howard, R.; Thompson, B.; Lanzerotti, L. J. L.; Bothmer, V.; Lamy, P.

    1997-01-01

    Results are presented on the development of two coronal mass ejections (CMEs) obtained by comparing the observations of the large angle spectroscopic coronagraph (LASCO) and the extreme ultraviolet imaging telescope (EIT) instrument onboard the SOHO with those of the Nancay radioheliograph. The radioheliograph provides images at five levels in the corona. An excellent spatial association is found between the position and extent of the type 4 radio sources and the CMEs seen by LASCO. One result is the existence for these two events of discrete successive phases in their development. For these events, Ulysses and SOHO missions measured interplanetary particles of coronal origin. The coronal acceleration site was attempted to be identified, as well as the path of these particles from the corona to the interplanetary medium.

  16. An ice-cream cone model for coronal mass ejections

    NASA Astrophysics Data System (ADS)

    Xue, X. H.; Wang, C. B.; Dou, X. K.

    2005-08-01

    In this study, we use an ice-cream cone model to analyze the geometrical and kinematical properties of the coronal mass ejections (CMEs). Assuming that in the early phase CMEs propagate with near-constant speed and angular width, some useful properties of CMEs, namely the radial speed (v), the angular width (α), and the location at the heliosphere, can be obtained considering the geometrical shapes of a CME as an ice-cream cone. This model is improved by (1) using an ice-cream cone to show the near real configuration of a CME, (2) determining the radial speed via fitting the projected speeds calculated from the height-time relation in different azimuthal angles, (3) not only applying to halo CMEs but also applying to nonhalo CMEs.

  17. Impact ejection, spallation, and the origin of meteorites

    NASA Technical Reports Server (NTRS)

    Melosh, H. J.

    1984-01-01

    A model for the ejection of material from an impact crater which links ejection velocity, fragment size, and shock pressure through a simplified stress-wave propagation and reflection scheme is presented. It is shown that a small amount of material (0.01 to 0.05 projectile mass) may be ejected at high velocity without suffering petrologically detectable shock pressures. The largest fragments ejected at any velocity are spalls that originate from the target planet's surface. The spall size is proportional to the radius of the primary impactor and the target tensile strength and inversely proportional to ejection velocity. The shock level in the spalls is low, typically half of the dynamic crushing strength of the rock. The model also predicts the aspect ratio of the spalled fragments, the angle of ejection, and the sizes and shock level of other fragments originating deeper in the target. Comparison with observational and experimental data shows generally good agreement.

  18. Three-Dimensional Structure and Energy Balance of a Coronal Mass Ejection

    NASA Technical Reports Server (NTRS)

    Lee, J.-Y.; Raymond, J. C.; Ko, Y.-K.; Kim, K.-S.

    2009-01-01

    UVCS observed Doppler-shifted material of a partial halo coronal mass ejection (CME) on 2001 December 13. The observed ratio of [O VJ/O V] is a reliable density diagnostic important for assessing the state of the plasma. Earlier UVCS observations of CMEs found evidence that the ejected plasma is heated long after the eruption. This paper investigated the heating rates, which represent a significant fraction of the CME energy budget. The parameterized heating and radiative and adiabatic cooling have been used to evaluate the temperature evolution of the CME material with a time-dependent ionization state model. Continuous heating is required to match the UVCS observations. To match the O VI bright knots, a higher heating rate is required such that the heating energy is greater than the kinetic energy.

  19. Space probe/satellite ejection apparatus for spacecraft

    NASA Technical Reports Server (NTRS)

    Smyly, H. M.; Miller, C. D.; Cloyd, R. A.; Heller, C. (Inventor)

    1985-01-01

    An ejection apparatus for spinning and propelling objects for ejection from a spacecraft at a desired velocity and rotational speed is discussed. The apparatus includes a launch cradle on which the space object to be ejected rests. The cradle is rotatably supported by a central hub secured to the upper end of the pneumatic cylinder piston shaft. Release mechanisms consisting of a retractable pin and locking lug is utilized to hold the cradle and object to be ejected. The release mechanism has a fixed barrier member which holds the retractable pin in engagement with the locking lug until release by upward movement of the launch cradle beyond the barrier height.

  20. Space probe/satellite ejection apparatus for spacecraft

    NASA Technical Reports Server (NTRS)

    Smyly, H. M.; Miller, C. D.; Cloyd, R. A.; Heller, C. (Inventor)

    1984-01-01

    An ejection apparatus for spinning and propelling objects for ejection from a spacecraft at a desired velocity and rotational speed is discussed. The apparatus includes a launch cradle on which the space object to be ejected rests. The cradle is rotatably supported by a central hub secured to the upper end of the pneumatic cylinder piston shaft. Release mechanisms consisting of a retractable pin and locking lug is utilized to hold the cradle and object to be ejected. The release mechanism has a fixed barrier member which holds the retractable pin in engagement with the locking lug until release by upward movement of the launch cradle beyond the barrier height.

  1. MAGNETOHYDRODYNAMIC SIMULATIONS OF INTERPLANETARY CORONAL MASS EJECTIONS

    SciTech Connect

    Lionello, Roberto; Downs, Cooper; Linker, Jon A.; Török, Tibor; Riley, Pete; Mikić, Zoran E-mail: cdowns@predsci.com E-mail: tibor@predsci.com E-mail: mikic@predsci.com

    2013-11-01

    We describe a new MHD model for the propagation of interplanetary coronal mass ejections (ICMEs) in the solar wind. Accurately following the propagation of ICMEs is important for determining space weather conditions. Our model solves the MHD equations in spherical coordinates from a lower boundary above the critical point to Earth and beyond. On this spherical surface, we prescribe the magnetic field, velocity, density, and temperature calculated typically directly from a coronal MHD model as time-dependent boundary conditions. However, any model that can provide such quantities either in the inertial or rotating frame of the Sun is suitable. We present two validations of the technique employed in our new model and a more realistic simulation of the propagation of an ICME from the Sun to Earth.

  2. Global Acceleration of Coronal Mass Ejections

    NASA Technical Reports Server (NTRS)

    Gopalswamy, Nat; Lara, Alejandro; Lepping, Ronald; Kaiser, Michael; Berdichevsky, Daniel; St. Cyr, O. Chris; Lazarus, Al

    1999-01-01

    Using the observed relation between speeds of coronal mass ejections (CMEs) near the Sun and in the solar wind, we estimate a global acceleration acting on the CMEs. Our study quantifies the qualitative results of Gosling [1997] and numerical simulations that CMEs at 1 AU with speeds closer to the solar wind. We found a linear relation between the global acceleration and the initial speed of the CMEs and the absolute value of the acceleration is similar to the slow solar wind acceleration. Our study naturally divides CMEs into fast and slow ones, the dividing line being the solar wind speed. Our results have important implications to space weather prediction models which need to incorporate this effect in estimating the CME arrival time at 1 AU. We show that the arrival times of CMEs at 1 AU are drastically different from the zero acceleration case.

  3. Solar Eruptions: Coronal Mass Ejections and Flares

    NASA Technical Reports Server (NTRS)

    Gopalswamy, Nat

    2012-01-01

    This lecture introduces the topic of Coronal mass ejections (CMEs) and solar flares, collectively known as solar eruptions. During solar eruptions, the released energy flows out from the Sun in the form of magnetized plasma and electromagnetic radiation. The electromagnetic radiation suddenly increases the ionization content of the ionosphere, thus impacting communication and navigation systems. Flares can be eruptive or confined. Eruptive flares accompany CMEs, while confined flares hav only electromagnetic signature. CMEs can drive MHD shocks that accelerate charged particles to very high energies in the interplanetary space, which pose radiation hazard to astronauts and space systems. CMEs heading in the direction of Earth arrive in about two days and impact Earth's magnetosphere, producing geomagnetic storms. The magnetic storms result in a number of effects including induced currnts that can disrupt power grids, railroads, and underground pipelines

  4. Coronal Mass Ejections: From Sun to Earth

    NASA Astrophysics Data System (ADS)

    Patsourakos, S.

    2016-06-01

    Coronal Mass Ejections (CMEs) are gigantic expulsions of magnetized plasmas from the solar corona into the interplanetary (IP) space. CMEs spawn ~ 1015 gr of mass and reach speeds ranging between several hundred to a few thousand km/s (e.g., Gopalswamy et al. 2009; Vourlidas et al. 2010). It takes 1-5 days for a CME to reach Earth. CMEs are one of the most energetic eruptive manifestations in the solar system and are major drivers of space weather via their magnetic fields and energetic particles, which are accelerated by CME-driven shocks. In this review we give a short account of recent, mainly observational, results on CMEs from the STEREO and SDO missions which include the nature of their pre-eruptive and eruptive configurations and the CME propagation from Sun to Earth. We conclude with a discussion of the exciting capabilities in CME studies that will soon become available from new solar and heliospheric instrumentation.

  5. A catastrophe mechanism for coronal mass ejections

    NASA Technical Reports Server (NTRS)

    Forbes, T. G.; Isenberg, P. A.

    1991-01-01

    The ideal-MHD equations are used to show that a coronal current filament can suddenly lose equilibrium if its magnetic energy exceeds a critical value. The loss of equilibrium in the configuration results from an imbalance between magnetic tension and compression, and this imbalance ejects the filament upwards. Near the critical value, the equilibrium configuration develops a vertical current sheet attached to the photosphere at the point directly below the filament. When equilibrium is lost, field lines anchored to the photosphere are stretched upwards, and the current sheet rapidly grows longer. Without reconnection in the current sheet, the filament travels only a short distance before reaching a new equilibrium, and the net magnetic energy released is less than 1 percent of the stored magnetic energy. However, with reconnection, the filament travels upwards indefinitely, and all of the stored energy is released.

  6. Fractional oscillator.

    PubMed

    Stanislavsky, A A

    2004-11-01

    We consider a fractional oscillator which is a generalization of the conventional linear oscillator in the framework of fractional calculus. It is interpreted as an ensemble average of ordinary harmonic oscillators governed by a stochastic time arrow. The intrinsic absorption of the fractional oscillator results from the full contribution of the harmonic oscillator ensemble: these oscillators differ a little from each other in frequency so that each response is compensated by an antiphase response of another harmonic oscillator. This allows one to draw a parallel in the dispersion analysis for media described by a fractional oscillator and an ensemble of ordinary harmonic oscillators with damping. The features of this analysis are discussed. PMID:15600586

  7. Probing Coronal Mass Ejections with Faraday Rotation

    NASA Astrophysics Data System (ADS)

    Spangler, Steven R.; Fischer, P. D.; Kooi, J. E.; Buffo, J. J.

    2013-07-01

    Coronal Mass Ejections (CMEs) are one of the most important solar phenomena in affecting conditions on Earth. There is not a consensus as to the physical mechanisms responsible for ejecting CME material from the solar atmosphere. Measurements that specify basic physical properties close to the Sun, when the CME is still evolving, should be useful in determining the correct theoretical model. One of the best observational techniques is that of Faraday rotation, a rotation in the plane of polarization of radio waves when propagating through a magnetized medium like the corona. The importance of Faraday rotation in determining the structure and evolutionary history of CMEs was discussed in Liu et al (ApJ 665, 1439, 2007). In this paper, we report Faraday rotation observations of ``constellations'' of background extragalactic radio sources near the Sun on three days in August, 2012, with the intention of observing a source occulted by a CME. Observations were made with the Jansky Very Large Array (VLA) of the National Radio Astronomy Observatory. We made polarization measurements at 6 frequencies between 1.31 and 1.94 GHz. On August 2, 2012, a CME clearly visible on the LASCO C3 coronagraph occulted a radio source from our sample, 0843+1547. Preliminary data analysis shows a Faraday rotation transient for 0843+1547 which appears to be associated with the CME. The Faraday rotation measure changes from nearly 0 before CME passage, to a value of about -12 radians/square-meter before declining after CME passage. We will discuss the interpretation of these data in terms of models for CME structure, as well as the status of our observations of other sources on August 2, and on other days. This work was supported at the University of Iowa by grant ATM09-56901.

  8. Magnetic Reconnection in Interplanetary Coronal Mass Ejections

    NASA Astrophysics Data System (ADS)

    Fermo, R. L.; Opher, M.; Drake, J. F.

    2014-12-01

    Magnetic reconnection is a ubiquitous phenomenon in many varied space and astrophysical plasmas, and as such plays an important role in the dynamics of interplanetary coronal mass ejections (ICMEs). It is widely regarded that reconnection is instrumental in the formation and ejection of the initial CME flux rope, but reconnection also continues to affect the dynamics as it propagates through the interplanetary medium. For example, reconnection on the leading edge of the ICME, by which it interacts with the interplanetary medium, leads to flux erosion. However, recent in situ observations by Gosling et al. found signatures of reconnection exhausts in the interior. In light of this data, we consider the stability properties of systems with this flux rope geometry with regard to their minimum energy Taylor state. Variations from this state will result in the magnetic field relaxing back towards the minimum energy state, subject to the constraints that the toroidal flux and magnetic helicity remain invariant. In reversed field pinches, this relaxation is mediated by reconnection in the interior of the system, as has been shown theoretically and experimentally. By treating the ICME flux rope in a similar fashion, we show analytically that the the elongation of the flux tube cross section in the latitudinal direction will result in a departure from the Taylor state. The resulting relaxation of the magnetic field causes reconnection to commence in the interior of the ICME, in agreement with the observations of Gosling et al. We present MHD simulations in which reconnection initiates at a number of rational surfaces, and ultimately produces a stochastic magnetic field. If the time scales for this process are shorter than the propagation time to 1 AU, this result explains why many ICME flux ropes no longer exhibit the smooth, helical flux structure characteristic of a magnetic cloud.

  9. Radio-Loud Coronal Mass Ejections without Shocks near Earth

    NASA Astrophysics Data System (ADS)

    Akiyama, S.; Gopalswamy, N.; Xie, H.; Yashiro, S.; Makela, P. A.; St Cyr, O. C.; MacDowall, R. J.; Kaiser, M. L.

    2010-12-01

    Type II radio bursts are produced by low energy electrons accelerated in shocks driven by coronal mass ejections (CMEs). One can infer shocks near the Sun, in the Interplanetary medium, and near Earth depending on the wavelength range in which the type II bursts are produced. In fact, type II bursts are good indicators of CMEs that produce solar energetic particles. If the type II burst occurs from a source on the Earth-facing side of the solar disk, it is highly likely that a shock arrives at Earth in 2-3 days and hence can be used to predict shock arrival at Earth. However, a significant fraction of CMEs producing type II bursts were not associated shocks at Earth, even though the CMEs originated close to the disk center. There are several reasons for the lack of shock at 1 AU. CMEs originating at large central meridian distances (CMDs) may be driving a shock, but the shock may not be extended sufficiently to reach to the Sun-Earth line. Another possibility is CME cannibalism because of which shocks merge and one observes a single shock at Earth. Finally, the CME-driven shock may become weak and dissipate before reaching 1 AU. We examined a set of 30 type II bursts observed by the Wind/WAVES experiment that had the solar sources very close to the disk center (within a CMD of 15 degrees), but did not have shock at Earth. We find that the near-Sun speeds of the associated CMEs average to ~600 km/s, only slightly higher than the average speed of CMEs associated with radio-quiet shocks. However, the fraction of halo CMEs is only ~28%, compared to 40% for radio-quiet shocks and 72% for all radio-loud shocks. We conclude that the disk-center radio loud CMEs with no shocks at 1 AU are generally of lower energy and they drive shocks only close to the Sun.

  10. Ejection of Supernova-enriched Gas from Dwarf Disk Galaxies

    NASA Astrophysics Data System (ADS)

    Fragile, P. Chris; Murray, Stephen D.; Lin, Douglas N. C.

    2004-12-01

    We examine the efficiency with which supernova-enriched gas may be ejected from dwarf disk galaxies, using a methodology previously employed to study the self-enrichment efficiency of dwarf spheroidal systems. Unlike previous studies that focused on highly concentrated starbursts, in the current work we consider discrete supernova events spread throughout various fractions of the disk. We model disk systems having gas masses of 108 and 109 Msolar with supernova rates of 30, 300, and 3000 Myr-1. The supernova events are confined to the midplane of the disk but distributed over radii of 0%, 30%, and 80% of the disk radius, consistent with expectations for Type II supernovae. In agreement with earlier studies, we find that the enriched material from supernovae is largely lost when the supernovae are concentrated near the nucleus, as expected for a starburst event. In contrast, however, we find the loss of enriched material to be much less efficient when the supernovae occur over even a relatively small fraction of the disk. The difference is due to the ability of the system to relax following supernova events that occur over more extended regions. Larger physical separations also reduce the likelihood of supernovae going off within low-density ``chimneys'' swept out by previous supernovae. We also find that for the most distributed systems, significant metal loss is more likely to be accompanied by significant mass loss. A comparison with theoretical predictions indicates that when undergoing self-regulated star formation, galaxies in the mass range considered will efficiently retain the products of Type II supernovae.

  11. Hot Plasma Associated with a Coronal Mass Ejection

    NASA Astrophysics Data System (ADS)

    Landi, E.; Miralles, M. P.; Raymond, J. C.; Hara, H.

    2013-11-01

    We analyze coordinated observations from the EUV Imaging Spectrometer (EIS) and X-Ray Telescope (XRT) on board Hinode of an X-ray Plasma Ejection (XPE) that occurred during the coronal mass ejection (CME) event of 2008 April 9. The XPE was trailing the CME core from behind, following the same trajectory, and could be identified both in EIS and XRT observations. Using the EIS spectrometer, we have determined the XPE plasma parameters, measuring the electron density, thermal distribution, and elemental composition. We have found that the XPE composition and electron density were very similar to those of the pre-event active region plasma. The XPE temperature was higher, and its thermal distribution peaked at around 3 MK also, typical flare lines were absent from EIS spectra, indicating that any XPE component with temperatures in excess of 5 MK was likely either faint or absent. We used XRT data to investigate the presence of hotter plasma components in the XPE that could have gone undetected by EIS and found that—if at all present—these components have small emission measure values and their temperature is in the 8-12.5 MK range. The very hot plasma found in earlier XPE observations obtained by Yohkoh seems to be largely absent in this CME, although plasma ionization timescales may lead to non-equilibrium ionization effects that could make bright lines from ions formed in a 10 MK plasma not detectable by EIS. Our results supersede the XPE findings of Landi et al., who studied the same event with older response functions for the XRT Al-poly filter; the differences in the results stress the importance of using accurate filter response functions.

  12. Fighter Pilot Ejection Study as an Educational Tool

    ERIC Educational Resources Information Center

    Robinson, Garry; Jovanoski, Zlatko

    2010-01-01

    In this article, we apply the well-known equations of projectile motion to the case of a fighter pilot ejecting from an aircraft, the aim being to establish under what conditions there is danger of impact with the rear vertical stabilizer. The drag force on the pilot after ejection is assumed to vary as the velocity squared and the aircraft motion…

  13. A simultaneous spin/eject mechanism for aerospace payloads

    NASA Technical Reports Server (NTRS)

    Palmer, G. D.; Banks, T. N.

    1976-01-01

    A simultaneous spin/eject mechanism was developed for aerospace applications requiring a compact, passive device which would accommodate payload support and controlled-release functions, and which would provide a highly accurate spin-ejection motion to the payload. The mechanism satisfied the requirements and is adaptable to other deployment applications.

  14. On Modeling of Ejection Process in a Training Combat Aircraft

    NASA Astrophysics Data System (ADS)

    Głowiński, Sebastian; Krzyżyński, Tomasz

    2011-09-01

    The paper deals with modeling and simulation of motion trajectory of an ejection seat in the training-combat aircraft TS-11 "Iskra". The ejection seat and its operation are characterized. Mathematical and computer models are elaborated with the help of MATLAB-Simulink applications. Additionally, simulations are conducted for various velocities of the aircraft.

  15. What is a fractional derivative?

    NASA Astrophysics Data System (ADS)

    Ortigueira, Manuel D.; Tenreiro Machado, J. A.

    2015-07-01

    This paper discusses the concepts underlying the formulation of operators capable of being interpreted as fractional derivatives or fractional integrals. Two criteria for required by a fractional operator are formulated. The Grünwald-Letnikov, Riemann-Liouville and Caputo fractional derivatives and the Riesz potential are accessed in the light of the proposed criteria. A Leibniz rule is also obtained for the Riesz potential.

  16. Young Star Probably Ejected From Triple System

    NASA Astrophysics Data System (ADS)

    2003-01-01

    Astronomers analyzing nearly 20 years of data from the National Science Foundation's Very Large Array radio telescope have discovered that a small star in a multiple-star system in the constellation Taurus probably has been ejected from the system after a close encounter with one of the system's more-massive components, presumed to be a compact double star. This is the first time any such event has been observed. Path of Small Star, 1983-2001 "Our analysis shows a drastic change in the orbit of this young star after it made a close approach to another object in the system," said Luis Rodriguez of the Institute of Astronomy of the National Autonomous University of Mexico (UNAM). "The young star was accelerated to a large velocity by the close approach, and certainly now is in a very different, more remote orbit, and may even completely escape its companions," said Laurent Loinard, leader of the research team that also included Monica Rodriguez in addition to Luis Rodriguez. The UNAM astronomers presented their findings at the American Astronomical Society's meeting in Seattle, WA. The discovery of this chaotic event will be important for advancing our understanding of classical dynamic astronomy and of how stars evolve, including possibly providing an explanation for the production of the mysterious "brown dwarfs," the astronomers said. The scientists analyzed VLA observations of T Tauri, a multiple system of young stars some 450 light-years from Earth. The observations were made from 1983 to 2001. The T Tauri system includes a "Northern" star, the famous star that gives its name to the class of young visible stars, and a "Southern" system of stars, all orbiting each other. The VLA data were used to track the orbit of the smaller Southern star around the larger Southern object, presumed to be a pair of stars orbiting each other closely. The astronomers' plot of the smaller star's orbit shows that it followed an apparently elliptical orbit around its twin companions

  17. The size distributions of fragments ejected at a given velocity from impact craters

    NASA Technical Reports Server (NTRS)

    Okeefe, J. D.; Ahrens, T. J.

    1986-01-01

    The mass distribution of fragments that are ejected at a given velocity for impact craters is modeled to allow extrapolation of laboratory, field, and numerical results to large scale planetary events. The model is semi-empirical in nature and is derived from: (1) numerical calculations of cratering and the resultant mass versus ejection velocity, (2) observed ejecta blanket particle size distributions, (3) an empirical relationship between maximum ejecta fragment size and crater diameter, (4) measurements and theory of maximum ejecta size versus ejecta velocity, and (5) an assumption on the functional form for the distribution of fragments ejected at a given velocity. This model implies that or planetary impacts into competent rock, the distribution of fragments ejected at a given velocity is broad, e.g., 68% of the mass of the ejecta at a given velocity contains fragments having a mass less than 0.1 times a mass of the largest fragment moving at that velocity. The broad distribution suggests that in impact processes, additional comminution of ejecta occurs after the upward initial shock has passed in the process of the ejecta velocity vector rotating from an initially downward orientation. This additional comminution produces the broader size distribution in impact ejecta as compared to that obtained in simple brittle failure experiments.

  18. Magnetic Reconfiguration in CMEs/Ejective Flares

    NASA Technical Reports Server (NTRS)

    Moore, Ronald L.; Sterling, A. C.; Suess, S. T.

    2008-01-01

    We present (1) the standard concept for the large transient change in field configuration in the solar magnetic explosions that produce an ejective flare and become a coronal mass ejection (CME) and (2) an observational test of this picture of CME production. In linear span, the largest change in field configuration in these events is wrought by the CME in the outer corona and solar wind. In the outer corona, the CME is essentially a magnetic bubble that transiently pushes aside the previously radial surrounding field. The source magnetic field that explodes to become the CME is initially a closed arcade enveloping sheared and twisted sigmoid field that snakes along the polarity dividing line and forms the core of the arcade. The sigmoid field has a large store of pent-up free magnetic energy. This eventually causes the sigmoid to become unstable and to begin to erupt as a flux rope. The erupting flux rope becomes the core of the CME plasmoid. The flux rope and enveloping CME plasmoid are created and built up (given more magnetic flux) and unleashed to escape by reconnection of the legs of the erupting sigmoid and arcade. Simultaneously, this tether-cutting reconnection produces beneath the escaping plasmoid a growing coronal X-ray flare arcade rooted in two separating ribbons of chromospheric flare emission. As the unleashed CME plasmoid propels itself into the outer corona, it takes with it the top of the arcade envelope field that arches over it. The continuing reconnection finally recloses the 'opened' stretched legs of the envelope, thus restoring the pre-eruption closed-arcade field configuration. This reconnection scenario for producing the CME plasmoid implies that the magnetic flux spanned by the full-grown flare arcade nearly equals the magnetic flux in the CME plasmoid in the outer corona. We have found that a wide range of exploding source regions produce CMEs that pass this test for production by tether-cutting reconnection (Moore, Sterling, &Suess

  19. Status of the Solar Mass Ejection Imager

    NASA Astrophysics Data System (ADS)

    Johnston, J. C.; Radick, R. R.; Webb, D. F.

    2001-05-01

    The Solar Mass Ejection Imager (SMEI) is a proof-of-concept experiment designed to detect and track coronal mass ejections (CMEs) as they propagate from the Sun through interplanetary space to the Earth and beyond. SMEI will Image CMEs by sensing sunlight scattered from the free electrons in these structures (Thomson scattering). SMEI will be launched by a Titan II rocket into a circular, sun-synchronous (830 km) orbit in 2002 as part of the Space Test Program's CORIOLIS mission. SMEI will image the entire sky once per spacecraft orbit over a mission lifetime of three years. The major subsystems of SMEI are three electronic camera assemblies and a data-handling unit. Each camera consists of a baffle, a radiator, a bright object sensor, an electronics box, and a strongbox containing a shutter, optics and a CCD. Each camera images a 3x60 degree field. Together, they view a 180-degree slice of sky, and sweep over the entire sky once per orbit. SMEI's basic data product will be a 100-minute cadence of all-sky maps of heliospheric brightness, with stars removed, having an angular resolution of about one degree and a photometric precision of about 0.1%. Successful operation of SMEI will represent a major step in improving space weather forecasts. When combined with in-situ solar wind measurements from upstream monitors such as WIND and ACE, SMEI will provide one- to three-day predictions of impending geomagnetic storms at the Earth. SMEI will complement missions such as SoHO, GOES SXI, Solar-B, and STEREO by providing data relating solar drivers to terrestrial effects. Other benefits of SMEI will include observations of variable stars, extra-Solar planetary transits, novae and supernovae, comets and asteroids. The SMEI experiment is being designed and constructed by a team of scientists and engineers from the Air Force Research Laboratory, the University of Birmingham (UB) in the United Kingdom, the University of California at San Diego (UCSD), and Boston University. The

  20. Pulse Ejection Presentation System Synchronized with Breathing

    NASA Astrophysics Data System (ADS)

    Kadowaki, Ami; Sato, Junta; Ohtsu, Kaori; Bannai, Yuichi; Okada, Kenichi

    Trials on transmission of olfactory information together with audio/visual information are currently being conducted in the field of multimedia. However, continuous emission of scents in high concentration creates problems of human adaptation and remnant odors in air. To overcome such problems we developed an olfactory display in conjunction with Canon Inc. This display has high emission control in the ink-jet so that it can provide stable pulse emission of scents. Humans catch a scent when they breathe in and inhale smell molecules in air. Therefore, it is important that the timing of scent presentation is synchronized with human breathing. We also developed a breath sensor which detects human inspiration. In this study, we combined the olfactory display with the breath sensor to make a pulse ejection presentation system synchronized the breath. The experimental evaluation showed that the system had more than 90 percent of detection rate. Another evaluation was held at KEIO TECHNO-MALL 2007. From questionnaire results of the participants, we found that the system made the user feel continuous sense of smell avoiding adaptation. It is expected that our system enables olfactory information to be synchronized with audio/visual information in arbitrary duration at any time.

  1. Streamer Waves Driven by Coronal Mass Ejections

    NASA Astrophysics Data System (ADS)

    Chen, Yao; Song, Hong-Qiang; Li, Bo; Xia, Li-Dong; Wu, Zhao; Fu, Hui

    Between July 5th and July 7th 2004, two intriguing fast coronal mass ejection(CME)-streamer interaction events were recorded by the Large Angle and Spectrometric Coronagraph (LASCO). At the beginning of the events, the streamer was pushed aside from their equilibrium position upon the impact of the rapidly outgoing and expanding ejecta; then, the streamer structure, mainly the bright streamer belt, exhibited elegant large scale sinusoidal wavelike motions. The motions were apparently driven by the restoring magnetic forces resulting from the CME impingement, suggestive of magnetohydrodynamic kink mode propagating outwards along the plasma sheet of the streamer. The mode is supported collectively by the streamer structure and is therefore named "streamer wave" in the present study. With the whitelight coronagraph data, we show that the streamer wave has a period of about 1 hour, a wavelength varying from 2 to 4 solar radii, an amplitude of about a few tens of solar radii, and a propagating phase speed in the range 300 to 500 km/s. We also find that there is a tendency for the phase speed to decline with increasing heliocentric distance. These observations provide good examples of large scale wave phenomena carried by corona structures, and have significance in developing seismological techniques for diagnosing plasma and magnetic parameters in the outer corona.

  2. Streamer Waves Driven by Coronal Mass Ejections

    NASA Astrophysics Data System (ADS)

    Chen, Y.; Song, H. Q.; Li, B.; Xia, L. D.; Wu, Z.; Fu, H.; Li, Xing

    2010-05-01

    Between 2004 July 5 and July 7, two intriguing fast coronal mass ejection (CME)-streamer interaction events were recorded by the Large Angle and Spectrometric Coronagraph. At the beginning of the events, the streamer was pushed aside from its equilibrium position upon the impact of the rapidly outgoing and expanding ejecta; then, the streamer structure, mainly the bright streamer belt, exhibited elegant large-scale sinusoidal wavelike motions. The motions were apparently driven by the restoring magnetic forces resulting from the CME impingement, suggestive of magnetohydrodynamic kink mode propagating outward along the plasma sheet of the streamer. The mode is supported collectively by the streamer-plasma sheet structure and is therefore named "streamer wave" in the present study. With the white light coronagraph data, we show that the streamer wave has a period of about 1 hr, a wavelength varying from 2 to 4 solar radii, an amplitude of about a few tens of solar radii, and a propagating phase speed in the range 300-500 km s-1. We also find that there is a tendency for the phase speed to decline with increasing heliocentric distance. These observations provide good examples of large-scale wave phenomena carried by coronal structures and have significance in developing seismological techniques for diagnosing plasma and magnetic parameters in the outer corona.

  3. Coronal Mass Ejections and Solar Radio Emissions

    NASA Technical Reports Server (NTRS)

    Gopalswamy, Nat

    2010-01-01

    Coronal mass ejections (CMEs) have important connections to various types of radio emissions from the Sun. The persistent noise storm radiation (type I storm at metric wavelengths, type III storms at longer wavelengths) can be clearly interrupted by the occurrence of a CME in the active region that produces the storm. Sometimes the noise storm completely disappears and other times, it reappears in the active region. Long-lasting type III bursts are associated with CME eruption, thought to be due to the reconnection process taking place beneath the erupting CME. Type II bursts are indicative of electron acceleration in the CME-driven shocks and hence considered to be the direct response of the CME propagation in the corona and interplanetary medium. Finally type IV bursts indicate large-scale post-eruption arcades containing trapped electrons that produce radio emission. This paper summarizes some key results that connect CMEs to various types of radio emission and what we can learn about particle acceleration in the corona) and interplanetary medium. Particular emphasis will be placed on type If bursts because of their connection to interplanetary shocks detected in situ.

  4. Planet Scattering Around Binaries: Ejections, Not Collisions

    NASA Astrophysics Data System (ADS)

    Smullen, Rachel A.; Kratter, Kaitlin M.; Shannon, Andrew

    2016-06-01

    Transiting circumbinary planets discovered by Kepler provide unique insight into binary star and planet formation. Several features of this new found population, for example the apparent pile-up of planets near the innermost stable orbit, may distinguish between formation theories. In this work, we determine how planet-planet scattering shapes planetary systems around binaries as compared to single stars. In particular, we look for signatures that arise due to differences in dynamical evolution in binary systems. We carry out a parameter study of N-body scattering simulations for four distinct planet populations around both binary and single stars. While binarity has little influence on the final system multiplicity or orbital distribution, the presence of a binary dramatically effects the means by which planets are lost from the system. Most circumbinary planets are lost due to ejections rather than planet-planet or planet-star collisions. The most massive planet in the system tends to control the evolution. Systems similar to the only observed multi-planet circumbinary system, Kepler-47, can arise from much more tightly packed, unstable systems. Only extreme initial conditions introduce differences in the final planet populations. Thus, we suggest that any intrinsic differences in the populations are imprinted by formation.

  5. Particle Heating Resulting from Coronal Mass Ejection

    NASA Astrophysics Data System (ADS)

    Paul, Suman; Sundar De, Syam; Guha, Gautam

    2016-07-01

    Coronal Mass Ejection (CME) is a continuous phenomena occurring from the entire solar coronal zone responsible for the outflow of solar masses, viz., protons, electrons, neutrons and solar wind in the form of plasma. These perturb the Earth's atmosphere via magnetopause. Very high temperature plasma generator in the solar atmosphere produces huge magnetic dipoles with intense magnetic field. It traps the energetic charged particles released from the solar corona. These particles gyrate along the magnetic field lines and are gradually elongated outwards from the Sun. Due to this, the field lines get detached at some critical limit thereby enhancing the magnetic reconnection with the interplanetary magnetic field releasing huge energy in the form of X-rays and γ-rays. This perturbs the Earth's atmosphere. In this work, the situation has been investigated by momentum balance equation, energy balance equation along with the equations of continuity and states. From the analyses, the dispersive nature of the thermospheric medium is studied. Variation of normalized electron temperature with dimensionless time has been critically contemplated. The altitude dependent electric field in the medium is also investigated.

  6. Dynamic simulation of coronal mass ejections

    NASA Technical Reports Server (NTRS)

    Steinolfson, R. S.; Wu, S. T.

    1980-01-01

    A model is developed for the formation and propagation through the lower corona of the loop-like coronal transients in which mass is ejected from near the solar surface to the outer corona. It is assumed that the initial state for the transient is a coronal streamer. The initial state for the streamer is a polytropic, hydrodynamic solution to the steady-state radial equation of motion coupled with a force-free dipole magnetic field. The numerical solution of the complete time-dependent equations then gradually approaches a stationary coronal streamer configuration. The streamer configuration becomes the initial state for the coronal transient. The streamer and transient simulations are performed completely independent of each other. The transient is created by a sudden increase in the pressure at the base of the closed-field region in the streamer configuration. Both coronal streamers and coronal transients are calculated for values of the plasma beta (the ratio of thermal to magnetic pressure) varying from 0.1 to 100.

  7. Solar Sources of Coronal Mass Ejections

    NASA Astrophysics Data System (ADS)

    Li, Y.

    2014-12-01

    Coronal mass ejections (CMEs) originate in the solar corona.Due to recent ample solar images from space missions, especially the STEREO mission, we know that CMEs initiate not only from flaring active regions of strong magnetic field, prominence (filaments) in decayed active regions, but also from coronal structures in higher coronaover regions no apparent strong magnetic fields on the solar disk. Regardless the differences of their appearances, these regionsmust all include non-potential magnetic field or free magnetic energy in order to produce CMEs. When an energized magnetic structure erupts, the free magnetic energy converts to kinetic energy and few other types ofenergy, and the magnetic structure leaves the corona and propagates into the interplanetary space. At the source regions, the initiations of CMEs often accompany with solar flares, filament eruptions, coronalEUV dimmings and waves, and post eruption loop brightennings. Studying the CME source regions and the processes is essential for the understanding of CME initiation and their interplanetary consequences.

  8. STREAMER WAVES DRIVEN BY CORONAL MASS EJECTIONS

    SciTech Connect

    Chen, Y.; Song, H. Q.; Li, B.; Xia, L. D.; Wu, Z.; Fu, H.; Li Xing

    2010-05-01

    Between 2004 July 5 and July 7, two intriguing fast coronal mass ejection (CME)-streamer interaction events were recorded by the Large Angle and Spectrometric Coronagraph. At the beginning of the events, the streamer was pushed aside from its equilibrium position upon the impact of the rapidly outgoing and expanding ejecta; then, the streamer structure, mainly the bright streamer belt, exhibited elegant large-scale sinusoidal wavelike motions. The motions were apparently driven by the restoring magnetic forces resulting from the CME impingement, suggestive of magnetohydrodynamic kink mode propagating outward along the plasma sheet of the streamer. The mode is supported collectively by the streamer-plasma sheet structure and is therefore named 'streamer wave' in the present study. With the white light coronagraph data, we show that the streamer wave has a period of about 1 hr, a wavelength varying from 2 to 4 solar radii, an amplitude of about a few tens of solar radii, and a propagating phase speed in the range 300-500 km s{sup -1}. We also find that there is a tendency for the phase speed to decline with increasing heliocentric distance. These observations provide good examples of large-scale wave phenomena carried by coronal structures and have significance in developing seismological techniques for diagnosing plasma and magnetic parameters in the outer corona.

  9. Solar origins of coronal mass ejections

    NASA Technical Reports Server (NTRS)

    Kahler, Stephen

    1987-01-01

    The large scale properties of coronal mass ejections (CMEs), such as morphology, leading edge speed, and angular width and position, have been cataloged for many events observed with coronagraphs on the Skylab, P-78, and SMM spacecraft. While considerable study has been devoted to the characteristics of the SMEs, their solar origins are still only poorly understood. Recent observational work has involved statistical associations of CMEs with flares and filament eruptions, and some evidence exists that the flare and eruptive-filament associated CMEs define two classes of events, with the former being generally more energetic. Nevertheless, it is found that eruptive-filament CMEs can at times be very energetic, giving rise to interplanetary shocks and energetic particle events. The size of the impulsive phase in a flare-associated CME seems to play no significant role in the size or speed of the CME, but the angular sizes of CMEs may correlate with the scale sizes of the 1-8 angstrom x-ray flares. At the present time, He 10830 angstrom observations should be useful in studying the late development of double-ribbon flares and transient coronal holes to yield insights into the CME aftermath. The recently available white-light synoptic maps may also prove fruitful in defining the coronal conditions giving rise to CMEs.

  10. EIT Observations of Coronal Mass Ejections

    NASA Technical Reports Server (NTRS)

    Gurman, J. B.; Fisher, Richard B. (Technical Monitor)

    2000-01-01

    Before the Solar and Heliospheric Observatory (SOHO), we had only the sketchiest of clues as to the nature and topology of coronal mass ejections (CMEs) below 1.1 - 1.2 solar radii. Occasionally, dimmings (or 'transient coronal holes') were observed in time series of soft X-ray images, but they were far less frequent than CME's. Simply by imaging the Sun frequently and continually at temperatures of 0.9 - 2.5 MK we have stumbled upon a zoo of CME phenomena in this previously obscured volume of the corona: (1) waves, (2) dimmings, and (3) a great variety of ejecta. In the three and a half years since our first observations of coronal waves associated with CME's, combined Large Angle Spectroscopic Coronagraph (LASCO) and extreme ultra-violet imaging telescope (EIT) synoptic observations have become a standard prediction tool for space weather forecasters, but our progress in actually understanding the CME phenomenon in the low corona has been somewhat slower. I will summarize the observations of waves, hot (> 0.9 MK) and cool ejecta, and some of the interpretations advanced to date. I will try to identify those phenomena, analysis of which could most benefit from the spectroscopic information available from ultraviolet coronograph spectrometer (UVCS) observations.

  11. Planet scattering around binaries: ejections, not collisions

    NASA Astrophysics Data System (ADS)

    Smullen, Rachel A.; Kratter, Kaitlin M.; Shannon, Andrew

    2016-09-01

    Transiting circumbinary planets discovered by Kepler provide unique insight into binary star and planet formation. Several features of this new found population, for example the apparent pile-up of planets near the innermost stable orbit, may distinguish between formation theories. In this work, we determine how planet-planet scattering shapes planetary systems around binaries as compared to single stars. In particular, we look for signatures that arise due to differences in dynamical evolution in binary systems. We carry out a parameter study of N-body scattering simulations for four distinct planet populations around both binary and single stars. While binarity has little influence on the final system multiplicity or orbital distribution, the presence of a binary dramatically affects the means by which planets are lost from the system. Most circumbinary planets are lost due to ejections rather than planet-planet or planet-star collisions. The most massive planet in the system tends to control the evolution. Systems similar to the only observed multiplanet circumbinary system, Kepler-47, can arise from much more tightly packed, unstable systems. Only extreme initial conditions introduce differences in the final planet populations. Thus, we suggest that any intrinsic differences in the populations are imprinted by formation.

  12. Investigating pyroclast ejection dynamics using shock-tube experiments: temperature, grain size and vent geometry effects.

    NASA Astrophysics Data System (ADS)

    Cigala, V.; Kueppers, U.; Dingwell, D. B.

    2015-12-01

    Explosive volcanic eruptions eject large quantities of gas and particles into the atmosphere. The portion directly above the vent commonly shows characteristics of underexpanded jets. Understanding the factors that influence the initial pyroclast ejection dynamics is necessary in order to better assess the resulting near- and far-field hazards. Field observations are often insufficient for the characterization of volcanic explosions due to lack of safe access to such environments. Fortunately, their dynamics can be simulated in the laboratory where experiments are performed under controlled conditions. We ejected loose natural particles from a shock-tube while controlling temperature (25˚ and 500˚C), overpressure (15MPa), starting grain size distribution (1-2 mm, 0.5-1 mm and 0.125-0.250 mm), sample-to-vent distance and vent geometry. For each explosion we quantified the velocity of individual particles, the jet spreading angle and the production of fines. Further, we varied the setup to allow for different sample-to-gas ratios and deployed four different vent geometries: 1) cylindrical, 2) funnel with a flaring of 30˚, 3) funnel with a flaring of 15˚ and 4) nozzle. The results showed maximum particle velocities up to 296 m/s, gas spreading angles varying from 21˚ to 37˚ and particle spreading angles from 3˚ to 40˚. Moreover we observed dynamically evolving ejection characteristics and variations in the production of fines during the course of individual experiments. Our experiments mechanistically mimic the process of pyroclast ejection. Thus the capability for constraining the effects of input parameters (fragmentation conditions) and conduit/vent geometry on ballistic pyroclastic plumes has been clearly established. These data obtained in the presence of well-documented conduit and vent conditions, should greatly enhance our ability to numerically model explosive ejecta in nature.

  13. Fast magnetic reconnection with plasmoid / current sheet ejection events in laboratory experiments

    NASA Astrophysics Data System (ADS)

    Inomoto, Michiaki; Ono, Yasushi; Hayashi, Yoshinori

    2012-07-01

    Non-steady and fast magnetic reconnections due to plasmoid or current sheet ejection events have been investigated in laboratory experiments using TS-3, TS-4 and UTST plasma merging devices in the University of Tokyo. In these devices, magnetic reconnection is induced by two different schemes, a) push reconnection driven by flux injection from the upstream region, b) pull reconnection driven by flux extraction to the downstream region. Current sheet or plasmoid ejection events are observed in these reconnection experiments particularly with strong guide magnetic field parallel to the reconnection electric field. In push reconnection experiments, anomalous resistivity is induced by the ion's kinetic effect (meandering motion) when the current sheet width is compressed shorter than the ion gyroradius by the strongly injected inflow flux. This fast reconnection regime does not involve plasmoid / current sheet ejection events. On the other hand, the guide field reduces the ion gyroradius and suppresses the onset of the anomalous resistivity, providing slow and steady magnetic reconnection. Impulsive fast reconnection with strong guide field develops, nevertheless, due to plasmoid / current sheet ejection events in pull and push reconnection experiments with extremely large external driving forces. In such a situation, the inflow flux is forcedly pushed into the reconnection region even faster than the maximal reconnection rate, resulting in flux pile up in front of the diffusion region. This piled flux induces large current density inside the current sheet in which plasmoid structure with closed flux surface is formed in pull reconnection case. The induced large current density or plasmoid is then ejected from the diffusion region with significant increase of reconnection electric field. As a result, magnetic reconnection condition with even larger reconnection rate than that obtained by anomalous resistivity was achieved under strong guide field and large external

  14. Evidence linking coronal mass ejections with interplanetary magnetic clouds

    NASA Technical Reports Server (NTRS)

    Wilson, R. M.; Hildner, E.

    1983-01-01

    Using proxy data for the occurrence of those mass ejections from the solar corona which are directed earthward, we investigate the association between the post-1970 interplanetary magnetic clouds of Klein and Burlaga and coronal mass ejections. The evidence linking magnetic clouds following shocks with coronal mass ejections is striking; six of nine clouds observed at Earth were preceded an appropriate time earlier by meter-wave type II radio bursts indicative of coronal shock waves and coronal mass ejections occurring near central meridian. During the selected periods when no clouds were detected near Earth, the only type II bursts reported were associated with solar activity near the limbs. Where the proxy solar data to be sought are not so clearly suggested, that is, for clouds preceding interaction regions and clouds within cold magnetic enhancements, the evidence linking the clouds and coronal mass ejections is not as clear; proxy data usually suggest many candidate mass-ejection events for each cloud. Overall, the data are consistent with and support the hypothesis suggested by Klein and Burlaga that magnetic clouds observed with spacecraft at 1 AU are manifestations of solar coronal mass ejection transients.

  15. Energy ejection in the collapse of a cold spherical self-gravitating cloud

    NASA Astrophysics Data System (ADS)

    Joyce, M.; Marcos, B.; Sylos Labini, F.

    2009-08-01

    When an open system of classical point particles interacting by Newtonian gravity collapses and relaxes violently, an arbitrary amount of energy may, in principle, be carried away by particles which escape to infinity. We investigate here, using numerical simulations, how this released energy and other related quantities (notably the binding energy and size of the virialized structure) depend on the initial conditions, for the one-parameter family of starting configurations given by randomly distributing N cold particles in a spherical volume. Previous studies have established that the minimal size reached by the system scales approximately as N1/3, a behaviour which follows trivially when the growth of perturbations (which regularize the singularity of the cold collapse in the N -> ∞ limit) is assumed to be unaffected by the boundaries. Our study shows that the energy ejected grows approximately in proportion to N1/3, while the fraction of the initial mass ejected grows only very slowly with N, approximately logarithmically, in the range of N simulated. We examine in detail the mechanism of this mass and energy ejection, showing explicitly that it arises from the interplay of the growth of perturbations with the finite size of the system. A net lag of particles compared to their uniform spherical collapse trajectories develops first at the boundaries and then propagates into the volume during the collapse. Particles in the outer shells are then ejected as they scatter through the time-dependent potential of an already re-expanding central core. Using modified initial configurations, we explore the importance of fluctuations at different scales and discreteness (i.e. non-Vlasov) effects in the dynamics.

  16. Portal Stability Controls Dynamics of DNA Ejection from Phage.

    PubMed

    Freeman, Krista G; Behrens, Manja A; Streletzky, Kiril A; Olsson, Ulf; Evilevitch, Alex

    2016-07-01

    Through a unique combination of time-resolved single-molecule (cryo-TEM) and bulk measurements (light scattering and small-angle X-ray scattering), we provide a detailed study of the dynamics of stochastic DNA ejection events from phage λ. We reveal that both binding with the specific phage receptor, LamB, and thermo-mechanical destabilization of the portal vertex on the capsid are required for initiation of ejection of the pressurized λ-DNA from the phage. Specifically, we found that a measurable activation energy barrier for initiation of DNA ejection with LamB present, Ea = (1.2 ± 0.1) × 10(-19) J/phage (corresponding to ∼28 kTbody/phage at Tbody = 37 °C), results in 15 times increased rate of ejection event dynamics when the temperature is raised from 15 to 45 °C (7.5 min versus 30 s average lag time for initiation of ejection). This suggests that phages have a double fail-safe mechanism for ejection-in addition to receptor binding, phage must also overcome (through thermal energy and internal DNA pressure) an energy barrier for DNA ejection. This energy barrier ensures that viral genome ejection into cells occurs with high efficiency only when the temperature conditions are favorable for genome replication. At lower suboptimal temperatures, the infectious phage titer is preserved over much longer times, since DNA ejection dynamics is strongly inhibited even in the presence of solubilized receptor or susceptible cells. This work also establishes a light scattering based approach to investigate the influence of external solution conditions, mimicking those of the bacterial cytoplasm, on the stability of the viral capsid portal, which is directly linked to dynamics of virion deactivation. PMID:27176921

  17. Improved Measurement of Ejection Velocities From Craters Formed in Sand

    NASA Technical Reports Server (NTRS)

    Cintala, Mark J.; Byers, Terry; Cardenas, Francisco; Montes, Roland; Potter, Elliot E.

    2014-01-01

    A typical impact crater is formed by two major processes: compression of the target (essentially equivalent to a footprint in soil) and ejection of material. The Ejection-Velocity Measurement System (EVMS) in the Experimental Impact Laboratory has been used to study ejection velocities from impact craters formed in sand since the late 1990s. The original system used an early-generation Charge-Coupled Device (CCD) camera; custom-written software; and a complex, multicomponent optical system to direct laser light for illumination. Unfortunately, the electronic equipment was overtaken by age, and the software became obsolete in light of improved computer hardware.

  18. Fraction Reduction through Continued Fractions

    ERIC Educational Resources Information Center

    Carley, Holly

    2011-01-01

    This article presents a method of reducing fractions without factoring. The ideas presented may be useful as a project for motivated students in an undergraduate number theory course. The discussion is related to the Euclidean Algorithm and its variations may lead to projects or early examples involving efficiency of an algorithm.

  19. Comparison of Cone Model Parameters for Halo Coronal Mass Ejections

    NASA Astrophysics Data System (ADS)

    Na, Hyeonock; Moon, Y.-J.; Jang, Soojeong; Lee, Kyoung-Sun; Kim, Hae-Yeon

    2013-11-01

    Halo coronal mass ejections (HCMEs) are a major cause of geomagnetic storms, hence their three-dimensional structures are important for space weather. We compare three cone models: an elliptical-cone model, an ice-cream-cone model, and an asymmetric-cone model. These models allow us to determine three-dimensional parameters of HCMEs such as radial speed, angular width, and the angle [ γ] between sky plane and cone axis. We compare these parameters obtained from three models using 62 HCMEs observed by SOHO/LASCO from 2001 to 2002. Then we obtain the root-mean-square (RMS) error between the highest measured projection speeds and their calculated projection speeds from the cone models. As a result, we find that the radial speeds obtained from the models are well correlated with one another ( R > 0.8). The correlation coefficients between angular widths range from 0.1 to 0.48 and those between γ-values range from -0.08 to 0.47, which is much smaller than expected. The reason may be the different assumptions and methods. The RMS errors between the highest measured projection speeds and the highest estimated projection speeds of the elliptical-cone model, the ice-cream-cone model, and the asymmetric-cone model are 376 km s-1, 169 km s-1, and 152 km s-1. We obtain the correlation coefficients between the location from the models and the flare location ( R > 0.45). Finally, we discuss strengths and weaknesses of these models in terms of space-weather application.

  20. A Model for Stealth Coronal Mass Ejections

    NASA Astrophysics Data System (ADS)

    Lynch, Benjamin J.; Masson, Sophie; Li, Yan; DeVore, C. Richard; Luhmann, Janet; Antiochos, Spiro K.; Fisher, George H.

    2016-05-01

    Stealth coronal mass ejections (CMEs) are events in which there are almost no observable signatures of the CME eruption in the low corona but often a well-resolved slow flux rope CME observed in the coronagraph data. We present results from a three-dimensional numerical magnetohydrodynamics (MHD) simulation of the 2008 June 1-2 slow streamer blowout CME that Robbrecht et al. [2009] called “the CME from nowhere.” We model the global coronal structure using a 1.4 MK isothermal solar wind and a low-order potential field source surface representation of the Carrington Rotation 2070 magnetogram synoptic map. The bipolar streamer belt arcade is energized by simple shearing flows applied in the vicinity of the helmet streamer’s polarity inversion line. The slow expansion of the energized helmet-streamer arcade results in the formation of a radial current sheet. The subsequent onset of expansion-driven flare reconnection initiates the stealth CME while gradually releasing ~1.5E+30 erg of stored magnetic energy over the 20+ hour eruption duration. We show the energy flux available for flare heating and flare emission during the eruption is approximately two orders of magnitude below the energy flux required to heat the ambient background corona, thus confirming the “stealth” character of the 2008 June 1-2 CME’s lack of observable on disk signatures. We also present favorable comparisons between our simulation results and the multi-viewpoint SOHO-LASCO and STEREO-SECCHI coronagraph observations of the pre-eruption streamer structure and the initiation and evolution of the stealth streamer blowout CME.

  1. System for measuring spatial distribution of ejected droplets, a concept

    NASA Technical Reports Server (NTRS)

    Ayvazian, R. A.

    1968-01-01

    System measures the spatial distribution of high-velocity droplets ejected from a nozzle or spray gun. The system employs an electrically resistive grid as the sensing screen, electrical leads, and a signal scanner such as a cathode ray tube.

  2. Particle ejection during mergers of dark matter halos

    SciTech Connect

    Carucci, Isabella P.; Sparre, Martin; Hansen, Steen H.; Joyce, Michael E-mail: sparre@dark-cosmology.dk E-mail: joyce@lpnhe.in2p3.fr

    2014-06-01

    Dark matter halos are built from accretion and merging. During merging some of the dark matter particles may be ejected with velocities higher than the escape velocity. We use both N-body simulations and single-particle smooth-field simulations to demonstrate that rapid changes to the mean field potential are responsible for such ejection, and in particular that dynamical friction plays no significant role in it. Studying a range of minor mergers, we find that typically between 5–15% of the particles from the smaller of the two merging structures are ejected. We also find that the ejected particles originate essentially from the small halo, and more specifically are particles in the small halo which pass later through the region in which the merging occurs.

  3. Mass ejected by impacts with materials of various strengths

    SciTech Connect

    Canavan, G.H.

    1997-02-01

    Similarity solutions are used to discuss impacts on asteroids of various strengths, concentrating on the voids produced, the mass ejected, and its thermodynamic and mechanical state. Numerical calculations have advantages and limitations for the next step in complexity.

  4. Radio-Loud Coronal Mass Ejections Without Shocks Near Earth

    NASA Technical Reports Server (NTRS)

    Gopalswamy, N.; SaintCyr, O. C.; MacDowall, R. J.; Kaiser, M. L.; Xie, H.; Makela, P.; Akiyama, S.

    2010-01-01

    Type II radio bursts are produced by low energy electrons accelerated in shocks driven by corona) mass ejections (CMEs). One can infer shocks near the Sun, in the Interplanetary medium, and near Earth depending on the wavelength range in which the type II bursts are produced. In fact, type II bursts are good indicators of CMEs that produce solar energetic particles. If the type 11 burst occurs from a source on the Earth-facing side of the solar disk, it is highly likely that a shock arrives at Earth in 2-3 days and hence can be used to predict shock arrival at Earth. However, a significant fraction of CMEs producing type II bursts were not associated shocks at Earth, even though the CMEs originated close to the disk center. There are several reasons for the lack of shock at 1 AU. CMEs originating at large central meridian distances (CMDs) may be driving a shock, but the shock may not be extended sufficiently to reach to the Sun-Earth line. Another possibility is CME cannibalism because of which shocks merge and one observes a single shock at Earth. Finally, the CME-driven shock may become weak and dissipate before reaching 1 AU. We examined a set of 30 type II bursts observed by the Wind/WAVES experiment that had the solar sources very close to the disk center (within a CMD of 15 degrees), but did not have shock at Earth. We find that the near-Sun speeds of the associated CMEs average to approx.600 km/s, only slightly higher than the average speed of CMEs associated with radio-quiet shocks. However, the fraction of halo CMEs is only approx.28%, compared to 40% for radio-quiet shocks and 72% for all radio-loud shocks. We conclude that the disk-center radio loud CMEs with no shocks at 1 AU are generally of lower energy and they drive shocks only close to the Sun.

  5. Ejection of gaseous clumps from gravitationally unstable protostellar disks

    NASA Astrophysics Data System (ADS)

    Vorobyov, E. I.

    2016-05-01

    Aims: We investigate the dynamics of gaseous clumps formed via gravitational fragmentation in young protostellar disks, focusing on the fragments that are ejected from the disk via many-body gravitational interaction. Methods: Numerical hydrodynamics simulations were employed to study the evolution of young protostellar disks that were formed from the collapse of rotating pre-stellar cores. Results: The protostellar disks that formed in our models undergo gravitational fragmentation driven by continuing mass-loading from parental collapsing cores. Several fragments can be ejected from the disk during the early evolution, but the low-mass fragments (<15 MJup) disperse, which creates spectacular bow-type structures while passing through the disk and collapsing core. The least massive fragment that survived the ejection (21 MJup) straddles the planetary-mass limit, while the most massive ejected fragments (145 MJup) can break up into several pieces, leading to the ejection of wide separation binary clumps in the brown-dwarf mass range. About half of the ejected fragments are gravitationally bound, the majority are supported by rotation against gravity, and all fragments have the specific angular momentum that is much higher than that expected for brown dwarfs. We found that the internal structure of the ejected fragments is distinct from what would be expected for gravitationally contracting clumps formed via molecular cloud fragmentation, which can help in differentiating their origin. Conclusions: The ejection of fragments is an important process, which is inherent to massive protostellar disks, and which produces freely floating pre-brown dwarf cores, regulates the disk and stellar masses and, potentially, enriches the intracluster medium with processed dust and complex organics.

  6. Mist Ejection of Silicon Microparticle Using a Silicon Nozzle

    NASA Astrophysics Data System (ADS)

    Yokoyama, Yoshinori; Murakami, Takaaki; Yoshida, Yukihisa; Itoh, Toshihiro

    The novel mist-jet technology using a silicon nozzle and a silicon reflector has been developed. Ejection of water mist containing the silicon microparticles is demonstrated. Impurities of the silicon microparticles ejected on the substrate are analyzed. It has been verified for the first time that the contamination is reduced by the silicon head. The silicon pattern drawn by the head is successfully formed.

  7. Automatic Determination of the Conic Coronal Mass Ejection Model Parameters

    NASA Technical Reports Server (NTRS)

    Pulkkinen, A.; Oates, T.; Taktakishvili, A.

    2009-01-01

    Characterization of the three-dimensional structure of solar transients using incomplete plane of sky data is a difficult problem whose solutions have potential for societal benefit in terms of space weather applications. In this paper transients are characterized in three dimensions by means of conic coronal mass ejection (CME) approximation. A novel method for the automatic determination of cone model parameters from observed halo CMEs is introduced. The method uses both standard image processing techniques to extract the CME mass from white-light coronagraph images and a novel inversion routine providing the final cone parameters. A bootstrap technique is used to provide model parameter distributions. When combined with heliospheric modeling, the cone model parameter distributions will provide direct means for ensemble predictions of transient propagation in the heliosphere. An initial validation of the automatic method is carried by comparison to manually determined cone model parameters. It is shown using 14 halo CME events that there is reasonable agreement, especially between the heliocentric locations of the cones derived with the two methods. It is argued that both the heliocentric locations and the opening half-angles of the automatically determined cones may be more realistic than those obtained from the manual analysis

  8. Interactive Visualization of Solar Mass Ejection Imager (SMEI) Volumetric Data

    NASA Astrophysics Data System (ADS)

    Wang, X.; Hick, P. P.; Jackson, B. V.

    2004-12-01

    We present a volume rendering system developed for the real time visualization and manipulation of 3D heliospheric volumetric solar wind density and velocity data obtained from the Solar Mass Ejection Imager (SMEI) and interplanetary scintillation (IPS) velocities over the same time period. Our system exploits the capabilities of the VolumePro 1000 board from TeraRecon, Inc., a low-cost 64-bit PCI board capable of rendering up to a 512-cubed array of volume data in real time at up to 30 frames per second on a standard PC. Many volume-rendering operations have been implemented with this system such as stereo/perspective views, animations of time-sequences, and determination of CME volumes and masses. In these visualizations we highlight two time periods where halo CMEs were observed by SMEI to engulf Earth, on May 30, 2003 and on October 29, 2003. We demonstrate how this system is used to measure the distribution of structure and provide 3D mass for individual CME features, including the ejecta associated with the large prominence viewed moving to the south of Earth following the late October CME.

  9. Survivability of bacteria ejected from icy surfaces after hypervelocity impact.

    PubMed

    Burchell, Mark J; Galloway, James A; Bunch, Alan W; Brandão, Pedro F B

    2003-02-01

    Both the Saturnian and Jovian systems contain satellites with icy surfaces. If life exists on any of these icy bodies (in putative subsurface oceans for example) then the possibility exists for transfer of life from icy body to icy body. This is an application of the idea of Panspermia, wherein life migrates naturally through space. A possible mechanism would be that life, here taken as bacteria, could become frozen in the icy surface of one body. If a high-speed impact occurred on that surface, ejecta containing the bacteria could be thrown into space. It could then migrate around the local region of space until it arrived at a second icy body in another high-speed impact. In this paper we consider some of the necessary steps for such a process to occur, concentrating on the ejection of ice bearing bacteria in the initial impact, and on what happens when bacteria laden projectiles hit an icy surface. Laboratory experiments using high-speed impacts with a light gas gun show that obtaining icy ejecta with viable bacterial loads is straightforward. In addition to demonstrating the viability of the bacteria carried on the ejecta, we have also measured the angular and size distribution of the ejecta produced in hypervelocity impacts on ice. We have however been unsuccessful at transferring viable bacteria to icy surfaces from bacteria laden projectiles impacting at hypervelocities. PMID:12967273

  10. Stereoscopic Observations of Low Coronal Ejections With and Without CMEs

    NASA Astrophysics Data System (ADS)

    Nitta, N. V.; Wülser, J.; Aschwanden, M. J.; Lemen, J. R.

    2007-12-01

    Yohkoh soft X-ray images of solar flares have frequently shown characteristic ejections during the impulsive phase. They are thought to be plasmoids that hold important information on magnetic reconnection. These ejections are intimately associated with coronal mass ejections (e.g., Nitta & Akiyama 1999; Kim et al. 2005). They probably represent internal structures of CMEs, i.e., high-temperature counterparts of filament eruptions. However, their relation with ejections seen at low temperatures has not been studied systematically, although TRACE has revealed many beautiful examples. In this work we study ejections observed by the SECCHI EUVI on STEREO. Some of them are associated with CMEs, and others are not. Using pairs of EUVI images from spacecraft A and B, the trajectories of ejecta in individual channels (with representative temperatures 0.1-2 MK) are reconstructed in 3D. We discuss these ejections at different temperatures in the context of CMEs. Specifically, we ask what kinetic properties are correlated with CMEs and how they are related with CME manifestations in the low corona such as dimming and waves.

  11. Focused transport of energetic particles along magnetic field lines draped around a coronal mass ejection

    NASA Technical Reports Server (NTRS)

    Tan, L. C.; Mason, G. M.; Lee, M. A.; Klecker, B.; Ipavich, F. M.

    1992-01-01

    Evidence is presented for focused transport of energetic particles along magnetic field lines draped around a coronal mass ejection. This evidence was obtained with the University of Maryland/Max-Planck-Institute experiment on the ISEE-3 spacecraft during the decay phase of the June 6, 1979, solar particle event. During the early portion of the decay phase of this event, interplanetary magnetic field lines were apparently draped around a coronal mass ejection, leading to a small focusing length on the western flank where ISEE 3 was located. A period of very slow decrease of particle intensity was observed, along with large sunward anisotropy in the solar wind frame, which is inconsistent with predictions of the standard Fokker-Planck equation models for diffusive transport. It was found possible to fit the observations, assuming that focused transport dominates and that the particle pitch angle scattering is isotropic.

  12. Knot structures in jets formed by a two-mode ejection velocity time-variability

    NASA Astrophysics Data System (ADS)

    Raga, A. C.; Rodríguez-Ramírez, J. C.; Cantó, J.; Velázquez, P. F.

    2015-11-01

    We present a 1D analytic model for the formation of working surfaces along a jet produced by an outflow source with a double-sinusoidal mode ejection velocity variability. We succeed in obtaining simple expressions for the distance of formation and for the initial velocity jump across the `fast-mode' working surfaces, which are modulated by the phase of the `slow mode'. These results can be straightforwardly applied to interpret observations of Herbig-Haro jets showing a chain of aligned knots close to the source, and large `heads' at greater distances, for which a two-mode ejection variability is likely to be applicable. We use our new analytic model to interpret observations of the externally photoionized HH 333 jet.

  13. Multipartite Fully Entangled Fraction

    NASA Astrophysics Data System (ADS)

    Xu, Jianwei

    2016-06-01

    Fully entangled fraction is a definition for bipartite states, which is tightly related to bipartite maximally entangled states, and has clear experimental and theoretical significance. In this work, we generalize it to multipartite case, we call the generalized version multipartite fully entangled fraction (MFEF). MFEF measures the closeness of a state to GHZ states. The analytical expressions of MFEF are very difficult to obtain except for very special states, however, we show that, the MFEF of any state is determined by a system of finite-order polynomial equations. Therefore, the MFEF can be efficiently numerically computed.

  14. OT1_tgull_3: The Homunculus: Clues to Massive Ejection from the Most Massive Stars

    NASA Astrophysics Data System (ADS)

    Gull, T.

    2010-07-01

    Eta Carinae is a lynchpin between mass ejection by highly evolved massive stars and the enriched ISM. The Homunculus, a very dusty, neutral bipolar shell ejected in the 1840s, is known to contain at least 12 solar masses, based upon gas/dust=100. But this ejecta is very N-rich with C and O being 0.02 that of solar abundance. What dust formed and how much total mass was ejected? Our ultimate goal is to obtain the total ejected mass. We propose to obtain full spectral scans of the Homunculus with PACS and SPIRES and selected scans with HIFI. We will use these spectra to identify molecules and atomic species associated with this C- and O-depleted gas. While most of this depletion is due to CNO processing and conduction in stars > 60 solar masses, additional depletion is likely due to the first molecules and dust formed at high temperatures during the 1840s eruption. In line of sight we see overabundances of metals not ordinarily seen in the ISM: Sr, Sc, V. These metals have been trapped in atomic state due to limited O and C being available to form molecules. Yet dust has still formed. But what kind of dust? Through existing HST/STIS and VLT/UVES spectra combined with the proposed Herschel spectra and detailed modeling, we will gain much better insight on how molecules and dust can formed in depleted C,O conditions, and in turn provide an improved estimate of the total mass loss. Implications from this study apply to the first massive stars and the earliest dust in the Universe.

  15. Advances in Echocardiographic Imaging in Heart Failure With Reduced and Preserved Ejection Fraction.

    PubMed

    Omar, Alaa Mabrouk Salem; Bansal, Manish; Sengupta, Partho P

    2016-07-01

    Echocardiography, given its safety, easy availability, and the ability to permit a comprehensive assessment of cardiac structure and function, is an indispensable tool in the evaluation and management of patients with heart failure (HF). From initial phenotyping and risk stratification to providing vital data for guiding therapeutic decision-making and monitoring, echocardiography plays a pivotal role in the care of HF patients. The recent advent of multiparametric approaches for myocardial deformation imaging has provided valuable insights in the pathogenesis of HF, elucidating distinct patterns of myocardial dysfunction and events that are associated with progression from subclinical stage to overt HF. At the same time, miniaturization of echocardiography has further expanded clinical application of echocardiography, with the use of pocket cardiac ultrasound as an adjunct to physical examination demonstrated to improve diagnostic accuracy and risk stratification. Furthermore, ongoing advances in the field of big data analytics promise to create an exciting opportunity to operationalize precision medicine as the new approach to healthcare delivery that aims to individualize patient care by integrating data extracted from clinical, laboratory, echocardiographic, and genetic assessments. The present review summarizes the recent advances in the field of echocardiography, with emphasis on their role in HF phenotyping, risk stratification, and optimizing clinical outcomes. PMID:27390337

  16. Heart Failure with Preserved Ejection Fraction: Molecular Pathways of the Aging Myocardium

    PubMed Central

    Loffredo, Francesco S.; Nikolova, Andriana P.; Pancoast, James R.; Lee, Richard T.

    2014-01-01

    Age-related diastolic dysfunction is a major factor in the epidemic of heart failure. In patients hospitalized with heart failure, diastolic heart failure is now as common as systolic heart failure. We now have many successful treatments for HFrEF, while specific treatment options for HFpEF patients remain elusive. The lack of treatments for HFpEF reflects our very incomplete understanding of this constellation of diseases. There are many pathophysiological factors in HFpEF, but aging appears to play an important role. Here we propose that aging of the myocardium is itself a specific pathophysiological process. New insights into the aging heart, including hormonal controls and specific molecular pathways such as microRNAs, are pointing to myocardial aging as a potentially reversible process. While the overall process of aging remains mysterious, understanding the molecular pathways of myocardial aging has never been more important. Unraveling these pathways could lead to new therapies for the enormous and growing problem of HFpEF. PMID:24951760

  17. Statins in heart failure--With preserved and reduced ejection fraction. An update.

    PubMed

    Tousoulis, Dimitris; Oikonomou, Evangelos; Siasos, Gerasimos; Stefanadis, Christodoulos

    2014-01-01

    HMG-CoA reductase inhibitors or statins beyond their lipid lowering properties and mevalonate inhibition exert also their actions through a multiplicity of mechanisms. In heart failure (HF) the inhibition of isoprenoid intermediates and small GTPases, which control cellular function such as cell shape, secretion and proliferation, is of clinical significance. Statins share also the peroxisome proliferator-activated receptor pathway and inactivate extracellular-signal-regulated kinase phosphorylation suppressing inflammatory cascade. By down-regulating Rho/Rho kinase signaling pathways, statins increase the stability of eNOS mRNA and induce activation of eNOS through phosphatidylinositol 3-kinase/Akt/eNOS pathway restoring endothelial function. Statins change also myocardial action potential plateau by modulation of Kv1.5 and Kv4.3 channel activity and inhibit sympathetic nerve activity suppressing arrhythmogenesis. Less documented evidence proposes also that statins have anti-hypertrophic effects - through p21ras/mitogen activated protein kinase pathway - which modulate synthesis of matrix metalloproteinases and procollagen 1 expression affecting interstitial fibrosis and diastolic dysfunction. Clinical studies have partly confirmed the experimental findings and despite current guidelines new evidence supports the notion that statins can be beneficial in some cases of HF. In subjects with diastolic HF, moderately impaired systolic function, low b-type natriuretic peptide levels, exacerbated inflammatory response and mild interstitial fibrosis evidence supports that statins can favorably affect the outcome. Under the lights of this evidence in this review article we discuss the current knowledge on the mechanisms of statins' actions and we link current experimental and clinical data to further understand the possible impact of statins' treatment on HF syndrome. PMID:24022031

  18. Atrial Fibrillation and Outcomes in Heart Failure With Preserved Versus Reduced Left Ventricular Ejection Fraction

    PubMed Central

    McManus, David D.; Hsu, Grace; Sung, Sue Hee; Saczynski, Jane S.; Smith, David H.; Magid, David J.; Gurwitz, Jerry H.; Goldberg, Robert J.; Go, Alan S.

    2013-01-01

    Background Atrial fibrillation (AF) and heart failure (HF) are 2 of the most common cardiovascular conditions nationally and AF frequently complicates HF. We examined how AF has impacts on adverse outcomes in HF‐PEF versus HF‐REF within a large, contemporary cohort. Methods and Results We identified all adults diagnosed with HF‐PEF or HF‐REF based on hospital discharge and ambulatory visit diagnoses and relevant imaging results for 2005–2008 from 4 health plans in the Cardiovascular Research Network. Data on demographic features, diagnoses, procedures, outpatient pharmacy use, and laboratory results were ascertained from health plan databases. Hospitalizations for HF, stroke, and any reason were identified from hospital discharge and billing claims databases. Deaths were ascertained from health plan and state death files. Among 23 644 patients with HF, 11 429 (48.3%) had documented AF (9081 preexisting, 2348 incident). Compared with patients who did not have AF, patients with AF had higher adjusted rates of ischemic stroke (hazard ratio [HR] 2.47 for incident AF; HR 1.57 for preexisting AF), hospitalization for HF (HR 2.00 for incident AF; HR 1.22 for preexisting AF), all‐cause hospitalization (HR 1.45 for incident AF; HR 1.15 for preexisting AF), and death (incident AF HR 1.67; preexisting AF HR 1.13). The associations of AF with these outcomes were similar for HF‐PEF and HF‐REF, with the exception of ischemic stroke. Conclusions AF is a potent risk factor for adverse outcomes in patients with HF‐PEF or HF‐REF. Effective interventions are needed to improve the prognosis of these high‐risk patients. PMID:23525446

  19. STOCHASTIC INTEGRATION FOR TEMPERED FRACTIONAL BROWNIAN MOTION

    PubMed Central

    MEERSCHAERT, MARK M.; SABZIKAR, FARZAD

    2014-01-01

    Tempered fractional Brownian motion is obtained when the power law kernel in the moving average representation of a fractional Brownian motion is multiplied by an exponential tempering factor. This paper develops the theory of stochastic integrals for tempered fractional Brownian motion. Along the way, we develop some basic results on tempered fractional calculus. PMID:24872598

  20. Fractional telegrapher's equation from fractional persistent random walks

    NASA Astrophysics Data System (ADS)

    Masoliver, Jaume

    2016-05-01

    We generalize the telegrapher's equation to allow for anomalous transport. We derive the space-time fractional telegrapher's equation using the formalism of the persistent random walk in continuous time. We also obtain the characteristic function of the space-time fractional process and study some particular cases and asymptotic approximations. Similarly to the ordinary telegrapher's equation, the time-fractional equation also presents distinct behaviors for different time scales. Specifically, transitions between different subdiffusive regimes or from superdiffusion to subdiffusion are shown by the fractional equation as time progresses.

  1. Fractional telegrapher's equation from fractional persistent random walks.

    PubMed

    Masoliver, Jaume

    2016-05-01

    We generalize the telegrapher's equation to allow for anomalous transport. We derive the space-time fractional telegrapher's equation using the formalism of the persistent random walk in continuous time. We also obtain the characteristic function of the space-time fractional process and study some particular cases and asymptotic approximations. Similarly to the ordinary telegrapher's equation, the time-fractional equation also presents distinct behaviors for different time scales. Specifically, transitions between different subdiffusive regimes or from superdiffusion to subdiffusion are shown by the fractional equation as time progresses. PMID:27300830

  2. Two Solar Flares that Became X-ray Plasma Ejections

    NASA Astrophysics Data System (ADS)

    Tomczak, M.

    Solar flares and X-ray plasma ejections (XPEs) occur simultaneously but usually are separated spatially. We present two exceptional events observed by Yohkoh in 2001 October 2 (event 1) and 2000 October 16 (event 2), in which features of flares and XPEs are mixed. Namely, the soft and hard X-ray images show intense sources of emission that move dynamically. Both events occurred inside broad active regions showing complicated multi-level structure reaching up to 200 Mm high. Both events show also similar four-stages evolution: (1) a fast rise of a system of loops, (2) sudden changes in their emission distribution, (3) a reconfiguration leading to liberation of large amounts of plasma, (4) a small, static loop as the final remnant. Nevertheless, the events are probably caused by different physical processes: emerging magnetic flux plus reconnection (event 1) and reconnection plus ballooning instability (event 2). Different is also the final destination of the ejected plasma: in the event 1 overlying magnetic fields stop the ejection, in the event 2 the ejection destabilizes the overall magnetic structure and forms a coronal mass ejection (CME).

  3. Could Jupiter or Saturn Have Ejected a Fifth Giant Planet?

    NASA Astrophysics Data System (ADS)

    Cloutier, Ryan; Tamayo, Daniel; Valencia, Diana

    2015-11-01

    Models of the dynamical evolution of the early solar system that follow the dispersal of the gaseous protoplanetary disk have been widely successful in reconstructing the current orbital configuration of the giant planets. Statistically, some of the most successful dynamical evolution simulations have initially included a hypothetical fifth giant planet, of ice giant (IG) mass, which gets ejected by a gas giant during the early solar system’s proposed instability phase. We investigate the likelihood of an IG ejection (IGE) event by either Jupiter or Saturn through constraints imposed by the current orbits of their wide-separation regular satellites Callisto and Iapetus, respectively. We show that planetary encounters that are sufficient to eject an IG often provide excessive perturbations to the orbits of Callisto and Iapetus, making it difficult to reconcile a planet ejection event with the current orbit of either satellite. Quantitatively, we compute the likelihood of reconciling a regular Jovian satellite orbit with the current orbit of Callisto following an IGE by Jupiter of ∼42%, and conclude that such a large likelihood supports the hypothesis of a fifth giant planet’s existence. A similar calculation for Iapetus reveals that it is much more difficult for Saturn to have ejected an IG and reconciled a Kronian satellite orbit with that of Iapetus (likelihood ∼1%), although uncertainties regarding the formation of Iapetus, with its unusual orbit, complicates the interpretation of this result.

  4. Inhibition of DNA ejection from bacteriophage by Mg+2 counterions

    NASA Astrophysics Data System (ADS)

    Lee, Sell; Tran, C. V.; Nguyen, T. T.

    2011-03-01

    The problem of inhibiting viral DNA ejection from bacteriophages by multivalent counterions, specifically Mg+2 counterions, is studied. Experimentally, it is known that MgSO4 salt has a strong and nonmonotonic effect on the amount of DNA ejected. There exists an optimal concentration at which the minimum amount of DNA is ejected from the virus. At lower or higher concentrations, more DNA is ejected from the capsid. We propose that this phenomenon is the result of DNA overcharging by Mg+2 multivalent counterions. As Mg+2 concentration increases from zero, the net charge of DNA changes from negative to positive. The optimal inhibition corresponds to the Mg+2 concentration where DNA is neutral. At lower/higher concentrations, DNA genome is charged. It prefers to be in solution to lower its electrostatic self-energy, which consequently leads to an increase in DNA ejection. By fitting our theory to available experimental data, the strength of DNA-DNA short range attraction energies, mediated by Mg+2, is found to be -0.004 kBT per nucleotide base. This and other fitted parameters agree well with known values from other experiments and computer simulations. The parameters are also in agreement qualitatively with values for tri- and tetravalent counterions.

  5. Analysis of melt ejection during long pulsed laser drilling

    NASA Astrophysics Data System (ADS)

    Ting-Zhong, Zhang; Zhi-Chao, Jia; Hai-Chao, Cui; De-Hua, Zhu; Xiao-Wu, Ni; Jian, Lu

    2016-05-01

    In pulsed laser drilling, melt ejection greatly influences the keyhole shape and its quality as well, but its mechanism has not been well understood. In this paper, numerical simulation and experimental investigations based on 304 stainless steel and aluminum targets are performed to study the effects of material parameters on melt ejection. The numerical method is employed to predict the temperatures, velocity fields in the solid, liquid, and vapour front, and melt pool dynamics of targets as well. The experimental methods include the shadow-graphic technique, weight method, and optical microscope imaging, which are applied to real-time observations of melt ejection phenomena, measurements of collected melt and changes of target mass, observations of surface morphology and the cross-section of the keyhole, respectively. Numerical and experimental results show that the metallic material with high thermal diffusivity like aluminum is prone to have a thick liquid zone and a large quantity of melt ejection. Additionally, to the best of our knowledge, the liquid zone is used to illustrate the relations between melt ejection and material thermal diffusivity for the first time. The research result in this paper is useful for manufacturing optimization and quality control in laser-material interaction. Project supported by the Natural Science Foundation of Jiangsu Province, China (Grant No. KYLX_0341) and the National Natural Science Foundation of China (Grant No. 61405147).

  6. Testing fractional action cosmology

    NASA Astrophysics Data System (ADS)

    Shchigolev, V. K.

    2016-08-01

    The present work deals with a combined test of the so-called Fractional Action Cosmology (FAC) on the example of a specific model obtained by the author earlier. In this model, the effective cosmological term is proportional to the Hubble parameter squared through the so-called kinematic induction. The reason of studying this cosmological model could be explained by its ability to describe two periods of accelerated expansion, that is in agreement with the recent observations and the cosmological inflation paradigm. First of all, we put our model through the theoretical tests, which gives a general conception of the influence of the model parameters on its behavior. Then, we obtain some restrictions on the principal parameters of the model, including the fractional index, by means of the observational data. Finally, the cosmography parameters and the observational data compared to the theoretical predictions are presented both analytically and graphically.

  7. Incorporating sweeps and ejections into Lagrangian stochastic models of spore trajectories within plant canopy turbulence: modeled contact distributions are heavy-tailed.

    PubMed

    Reynolds, A M

    2012-11-01

    ABSTRACT The turbulent dispersal of fungal spores within plant canopies is very different from that within atmospheric boundary-layers and closely analogous to dispersal within turbulent mixing-layers. The process is dominated by the presence of large coherent flow structures, high-velocity downdrafts (sweeps) and updrafts (ejections), that punctuate otherwise quiescent flow. Turbulent dispersion within plant canopies is best predicted by Lagrangian stochastic (particle-tracking) models because other approaches (e.g., diffusion models and similarity theory) are either inappropriate or invalid. Nonetheless, attempts to construct such models have not been wholly successful. Accounting for sweeps and ejections has substantially worsened rather than improved model agreement with experimental dispersion data. Here we show how this long-standing difficulty with the formulation of Lagrangian stochastic models can be overcome. The new model is shown to be in good agreement with data from a carefully controlled, well-documented wind-tunnel study of scalar dispersion within plant canopy turbulence. Equally good agreement with this data is obtained using Thomson's (1987) Gaussian model. This bolsters confidence in the application of this simple model to the prediction of spore dispersal within plant canopy turbulence. Contact distributions-the probability distribution function for the distance of viable fungal spore movement until deposition-are predicted to have "heavy" inverse power-law tails. It is known that heavy-tailed contact distributions also characterize the dispersal of spores which pass through the canopy turbulence and enter into the overlying atmospheric boundary-layer. Plant disease epidemics due to the airborne dispersal of fungal spores are therefore predicted to develop as accelerating waves over a vast range of scales-from the within field scale to intercontinental scales. This prediction is consistent with recent analyses of field and historical data for

  8. Fractional Galilean symmetries

    NASA Astrophysics Data System (ADS)

    Hosseiny, Ali; Rouhani, Shahin

    2016-09-01

    We generalize the differential representation of the operators of the Galilean algebras to include fractional derivatives. As a result a whole new class of scale invariant Galilean algebras are obtained. The first member of this class has dynamical index z = 2 similar to the Schrödinger algebra. The second member of the class has dynamical index z = 3 / 2, which happens to be the dynamical index Kardar-Parisi-Zhang equation.

  9. Polarization instability of Raman solitons ejected during supercontinuum generation.

    PubMed

    Chao, Qing; Wagner, Kelvin H

    2015-12-28

    We numerically investigate polarization instability of soliton fission and the polarization dynamics of Raman solitons ejected during supercontinuum generation in a photonics crystal fiber using the coupled vector generalized nonlinear Schrödinger equations for both linear and circular birefringent fibers. The evolution of the state of polarizations of the ejected Raman soliton as representated on the Poincaré sphere is affected by both nonlinear and linear polarization rotations on the Poincaré sphere. The polarization dynamics reveal the presence of a polarization separatrix and the emergence of stable slow and unstable fast eigen-polarizations for the Raman solitons ejected in the supercontinuum generation process. Circularly birefringent fiber is investigated and found to simplify the nonlinear polarization dynamics. PMID:26832032

  10. Fluctuation Pressure Assisted Ejection of DNA From Bacteriophage

    NASA Astrophysics Data System (ADS)

    Harrison, Michael J.

    2011-03-01

    The role of thermal pressure fluctuations excited within tightly packaged DNA while it is ejected from protein capsid shells is discussed in a model calculation. At equilibrium before ejection we assume the DNA is folded many times into a bundle of parallel segments that forms an equilibrium conformation at minimum free energy, which presses tightly against capsid walls. Using a canonical ensemble at temperature T we calculate internal pressure fluctuations against a slowly moving or static capsid mantle for an elastic continuum model of the folded DNA bundle. It is found that fluctuating pressures on the capsid from thermal excitation of longitudinal acoustic vibrations in the bundle whose wavelengths are exceeded by the bend persistence length may have root-mean-square values that are several tens of atmospheres for typically small phage dimensions. Comparisons are given with measured data on three mutants of lambda phage with different base pair lengths and total genome ejection pressures.

  11. Capstan Friction Model for DNA Ejection from Bacteriophages

    NASA Astrophysics Data System (ADS)

    Ghosal, Sandip

    2012-12-01

    Bacteriophages infect cells by attaching to the outer membrane and injecting their DNA into the cell. The phage DNA is then transcribed by the cell’s transcription machinery. A number of physical mechanisms by which DNA can be translocated from the phage capsid into the cell have been identified. A fast ejection driven by the elastic and electrostatic potential energy of the compacted DNA within the viral capsid appears to be used by most phages, at least to initiate infection. In recent in vitro experiments, the speed of DNA translocation from a λ phage capsid has been measured as a function of ejected length over the entire duration of the event. Here, a mechanical model is proposed that is able to explain the observed dependence of exit velocity on ejected length, and that is also consistent with the accepted picture of the geometric arrangement of DNA within the viral capsid.

  12. EUV Coronal Dimming and its Relationship to Coronal Mass Ejections

    NASA Astrophysics Data System (ADS)

    Mason, James

    2016-05-01

    As a coronal mass ejection (CME) departs from the inner solar atmosphere, it leaves behind a void. This region of depleted plasma results in a corresponding decrease in coronal emissions that can be observed by instruments tuned to measure the extreme ultraviolet (EUV) part of the electromagnetic spectrum. These coronal dimmings can be observed with EUV imagers and EUV spectral irradiance instruments. Onboard the Solar Dynamics Observatory (SDO), the EUV Variability Experiment (EVE) and Atmospheric Imaging Assembly (AIA) provide complementary observations; together they can be used to obtain high spatial and spectral resolution. AIA provides information about the location, extent, and spatial evolution of the dimming while EVE data are important to understand plasma temperature evolution. Concurrent processes with similar timescales to mass-loss dimming also impact the observations, which makes a deconvolution method necessary for the irradiance time series in order to have a “clean” mass-loss dimming light curve that can be parameterized and compared with CME kinematics. This presentation will first provide background on these various physical processes and the deconvolution method developed. Two case studies will then be presented, followed by a semi-statistical study (~30 events) to establish a correlation between dimming and CME parameters. In particular, the slope of the deconvolved irradiance dimming light curve is representative of the CME speed, and the irradiance dimming depth can serve as a proxy for CME mass. Finally, plans and early results from a more complete statistical study of all dimmings in the SDO era, based on an automated detection routine using EVE data, will be described and compared with independently derived dimmings automatically detected with AIA data.

  13. Recent STEREO Observations of Coronal Mass Ejections

    NASA Technical Reports Server (NTRS)

    SaintCyr, Chris Orville; Xie, Hong; Mays, Mona Leila; Davila, Joseph M.; Gilbert, Holly R.; Jones, Shaela I.; Pesnell, William Dean; Gopalswamy, Nat; Gurman, Joseph B.; Yashiro, Seiji; Wuelser, Jean-Pierre; Howard, Russell A.; Thompson, Barbara J.; Thompson, William T.

    2008-01-01

    Over 400 CMEs have been observed by STEREO SECCHI COR1 during the mission's three year duration (2006-2009). Many of the solar activity indicators have been at minimal values over this period, and the Carrington rotation-averaged CME rate has been comparable to that measured during the minima between Cycle 21-22 (SMM C/P) and Cycle 22-23 (SOHO LASCO). That rate is about 0.5 CMEs/day. During the current solar minimum (leading to Cycle 24), there have been entire Carrington rotations where no sunspots were detected and the daily values of the 2800 MHz solar flux remained below 70 sfu. CMEs continued to be detected during these exceptionally quiet periods, indicating that active regions are not necessary to the generation of at least a portion of the CME population. In the past, researchers were limited to a single view of the Sun and could conclude that activity on the unseen portion of the disk might be associated with CMEs. But as the STEREO mission has progressed we have been able to observe an increasing fraction of the Sun's corona with STEREO SECCHI EUVI and were able to eliminate this possibility. Here we report on the nature of CMEs detected during these exceptionally quiet periods, and we speculate on how the corona remains dynamic during such conditions.

  14. Nanoparticle plasma ejected directly from solid copper by localized microwaves

    SciTech Connect

    Jerby, E.; Golts, A.; Shamir, Y.; Wonde, S.; Ashkenazi, D.; Eliaz, N.; Mitchell, J. B. A.; LeGarrec, J. L.; Narayanan, T.; Sztucki, M.; Barkay, Z.

    2009-11-09

    A plasma column ejected directly from solid copper by localized microwaves is studied. The effect stems from an induced hotspot that melts and emits ionized copper vapors as a confined fire column. Nanoparticles of {approx}20-120 nm size were revealed in the ejected column by in situ small-angle x-ray scattering. Optical spectroscopy confirmed the dominance of copper particles in the plasma column originating directly from the copper substrate. Nano- and macroparticles of copper were verified also by ex situ scanning electron microscopy. The direct conversion of solid metals to nanoparticles is demonstrated and various applications are proposed.

  15. Nusat I - The first gas can ejected satellite

    NASA Astrophysics Data System (ADS)

    Twiggs, Robert J.

    Nusat I, an 18-inch diameter satellite, made history on April 29, 1985 by being the first satellite ejected from a newly designed Get-Away-Special canister on the Challenger orbiter. This ejection marked the beginning of a new era of satellite designs which can be inexpensively placed in orbit via the Space Shuttle. This paper describes the development of that project, including the project organization and funding, satellite design evolution, final design objectives, final satellite assembly and testing, integration before launch, and operational performance.

  16. Ejection of cool plasma into the hot corona

    NASA Astrophysics Data System (ADS)

    Zacharias, P.; Peter, H.; Bingert, S.

    2011-08-01

    Context. The corona is highly dynamic and shows transient events on various scales in space and time. Most of these features are related to changes in the magnetic field structure or impulsive heating caused by the conversion of magnetic to thermal energy. Aims: We investigate the processes that lead to the formation, ejection and fall of a confined plasma ejection that was observed in a numerical experiment of the solar corona. By quantifying physical parameters such as mass, velocity, and orientation of the plasma ejection relative to the magnetic field, we provide a description of the nature of this particular plasma ejection. Methods: The time-dependent three-dimensional magnetohydrodynamic (3D MHD) equations are solved in a box extending from the chromosphere, which serves as a reservoir for mass and energy, to the lower corona. The plasma is heated by currents that are induced through field line braiding as a consequence of photospheric motions included in the model. Spectra of optically thin emission lines in the extreme ultraviolet range are synthesized, and magnetic field lines are traced over time. We determine the trajectory of the plasma ejection and identify anomalies in the profiles of the plasma parameters. Results: Following strong heating just above the chromosphere, the pressure rapidly increases, leading to a hydrodynamic explosion above the upper chromosphere in the low transition region. The explosion drives the plasma, which needs to follow the magnetic field lines. The ejection is then moving more or less ballistically along the loop-like field lines and eventually drops down onto the surface of the Sun. The speed of the ejection is in the range of the sound speed, well below the Alfvén velocity. Conclusions: The plasma ejection observed in a numerical experiment of the solar corona is basically a hydrodynamic phenomenon, whereas the rise of the heating rate is of magnetic nature. The granular motions in the photosphere lead (by chance) to a

  17. Binaries discovered by the SPY survey. VI. Discovery of a low mass companion to the hot subluminous planetary nebula central star EGB 5 - a recently ejected common envelope?

    NASA Astrophysics Data System (ADS)

    Geier, S.; Napiwotzki, R.; Heber, U.; Nelemans, G.

    2011-04-01

    Hot subdwarf B stars (sdBs) in close binary systems are assumed to be formed via common envelope ejection. According to theoretical models, the amount of energy and angular momentum deposited in the common envelope scales with the mass of the companion. That low mass companions near or below the core hydrogen-burning limit are able to trigger the ejection of this envelope is well known. The currently known systems have very short periods ≃0.1-0.3 d. Here we report the discovery of a low mass companion (M2 > 0.14 M⊙) orbiting the sdB star and central star of a planetary nebula EGB 5 with an orbital period of 16.5 d at a minimum separation of 23 R⊙. Its long period is only just consistent with the energy balance prescription of the common envelope. The marked difference between the short and long period systems will provide strong constraints on the common envelope phase, in particular if the masses of the sdB stars can be measured accurately. Due to selection effects, the fraction of sdBs with low mass companions and similar or longer periods may be quite high. Low mass stellar and substellar companions may therefore play a significant role for the still unclear formation of hot subdwarf stars. Furthermore, the nebula around EGB 5 may be the remnant of the ejected common envelope making this binary a unique system to study this short und poorly understood phase of binary evolution. Based on observations at the Paranal Observatory of the European Southern Observatory for programmes No. 167.H-0407(A) and 71.D-0383(A). Based on observations collected at the Centro Astronómico Hispano Alemán (CAHA) at Calar Alto, operated jointly by the Max-Planck Institut für Astronomie and the Instituto de Astrofísica de Andalucía (CSIC). Some of the data used in this work were obtained at the William Herschel Telescope (WHT) operated by the Isaac Newton Group of Telescopes (ING).

  18. IMPULSIVE ACCELERATION OF CORONAL MASS EJECTIONS. I. STATISTICS AND CORONAL MASS EJECTION SOURCE REGION CHARACTERISTICS

    SciTech Connect

    Bein, B. M.; Berkebile-Stoiser, S.; Veronig, A. M.; Temmer, M.; Muhr, N.; Kienreich, I.; Utz, D.

    2011-09-10

    We use high time cadence images acquired by the STEREO EUVI and COR instruments to study the evolution of coronal mass ejections (CMEs) from their initiation through impulsive acceleration to the propagation phase. For a set of 95 CMEs we derived detailed height, velocity, and acceleration profiles and statistically analyzed characteristic CME parameters: peak acceleration, peak velocity, acceleration duration, initiation height, height at peak velocity, height at peak acceleration, and size of the CME source region. The CME peak accelerations we derived range from 20 to 6800 m s{sup -2} and are inversely correlated with the acceleration duration and the height at peak acceleration. Seventy-four percent of the events reach their peak acceleration at heights below 0.5 R{sub sun}. CMEs that originate from compact sources low in the corona are more impulsive and reach higher peak accelerations at smaller heights. These findings can be explained by the Lorentz force, which drives the CME accelerations and decreases with height and CME size.

  19. Ejected Sedimentary Rocks of Mud Volcanoes as Indicators of Depositional Environments and of Hydrocarbon Generation within the South Caspian Basin, Azerbaijan

    NASA Astrophysics Data System (ADS)

    Berner, U.; Scheeder, G.; Kus, J.; Köthe, A.; Movsumova, U.

    2009-04-01

    Mud volcanoes are prominent geological features of the South Caspian Basin of Azerbaijan, one of the oldest oil producing regions worldwide. The basin is characterized by extreme sedimentation rates, which lead to the accumulation of large volumes of Mesozoic and Cenozoic sediments. These mostly unconsolidated strata reach thicknesses of up to 20 km and overlay a continental basement in the onshore part. Tectonic forces control the occurrences of mud volcanoes in regions with over-pressured subsurface sediments as mud volcanoes are closely linked to fault systems. The mud volcanoes of Azerbaijan are a surface expression of vertical hydrocarbon migration and offer the chance to investigate the subsurface by means of ejected rocks transported to the surface. These rocks of Mesozoic and Cenozoic sedimentary sequences are potential indicators of the regional hydrocarbon generation. The mud of nineteen volcano cones contained numerous ejected rock fragments, which we use to identify environmental and depositional parameters of the sediments of the Caspian Basin. We also intended to estimate the depth range from which the mud was transported to the surface using organic geochemical parameters. Mircopalaeontological investigations (calcareous nannoplankton) have been performed on selected samples. These analyses suggest that the investigated sediments are of Late Cretaceous to Palaeogene ages and relate to the stratigraphic interval during which the main hydrocarbon source rocks of Azerbaijan have been deposited. Organic geochemical, organic petrographical and mircopalaeontological investigations have been performed on selected samples of nineteen mud volcanoes. Analyses total organic carbon and total sulphur were performed on an elemental analyzer. These analyses suggest that the sediments can be classified as anoxic marine deposits whereas only few are sediments of a lacustrine environment. Bulk source rock information were obtained from RockEval pyrolysis. Resulting

  20. Discovery of collimated ejection from the symbiotic binary BF Cygni

    NASA Astrophysics Data System (ADS)

    Skopal, A.; Tomov, N. A.; Tomova, M. T.

    2013-03-01

    Context. Detection of collimated ejection from white dwarfs (WD) in symbiotic binaries is very rare and has employed a variety of methods in X-ray, radio, optical imagery, and spectroscopy. To date, its signature in the optical spectra has only been recorded for four objects (MWC 560, Hen 3-1341, StHα 190, and Z And). Aims: We present the first observational evidence of highly-collimated bipolar ejection from the symbiotic binary BF Cyg, which developed during its current (2006-12) active phase, and determine their physical parameters. Methods: We monitored the outburst with the optical high-resolution spectroscopy and multicolour UBVRCIC photometry. Results: During 2009, three years after the 2006-eruption of BF Cyg, satellite components to Hα and Hβ lines emerged in the spectrum. During 2012, they became stable and were located symmetrically with respect to the main emission core of the line. Spectral properties of these components suggest bipolar ejection collimated within an opening angle of ≲15°, whose radiation is produced by an optically thin medium with the emission measure of 1-2 × 1059 (d/3.8 kpc)2 cm-3. Conclusions: Formation of the collimated ejection a few years after the eruption and its evolution on a time scale of years at a constant optical brightness can aid us in better understanding the accretion process during the active phases of symbiotic stars. Based on data collected with 2-m telescope at the Rozhen National Astronomical Observatory and the David Dunlap Observatory.

  1. 49 CFR 571.226 - Standard No. 226; Ejection Mitigation.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... (within the meaning of 49 CFR 567.7). S3. Definitions. Ejection impactor means a device specified in S7.1... three or fewer carlines, as that term is defined in 49 CFR 583.4, in the United States during a... of 49 CFR 567.7) before September 1, 2018, after having been previously certified in accordance...

  2. 49 CFR 571.226 - Standard No. 226; Ejection Mitigation.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... (within the meaning of 49 CFR 567.7). S3. Definitions. Ejection impactor means a device specified in S7.1... three or fewer carlines, as that term is defined in 49 CFR 583.4, in the United States during a... of 49 CFR 567.7) before September 1, 2018, after having been previously certified in accordance...

  3. 49 CFR 571.226 - Standard No. 226; Ejection Mitigation.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 6 2014-10-01 2014-10-01 false Standard No. 226; Ejection Mitigation. 571.226 Section 571.226 Transportation Other Regulations Relating to Transportation (Continued) NATIONAL HIGHWAY TRAFFIC SAFETY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION FEDERAL MOTOR VEHICLE SAFETY STANDARDS Federal Motor Vehicle Safety Standards §...

  4. An Investigation of ejected particulate from shocked Lead (Pb) surfaces

    NASA Astrophysics Data System (ADS)

    Routley, Nathan; Kendall, Paul; Edwards, Terry; Burns, Malcolm; Mears, Alan

    2011-06-01

    Abstract. An experimental series has been carried out to investigate the relationship between shock break out pressure, surface roughness and the quantity of ejected particulate emitted from Lead (Pb) samples. High Explosives (HE) mounted against the rear surface of the Pb samples generate an attenuating shock wave in the Pb. For each shot, the Pb sample thickness was chosen to provide a range of shock break out pressures, which spanned melt on release, ~27 GPa for Pb. For the majority of the experiments the free surface finish was manufactured to have a predefined groove depth and wavelength. The interaction of the shock wave with these surface features on the Pb / vacuum interface can lead to micro-jetting from the Pb with particulate being ejected. The ejected particulate was diagnosed using a mixture of piezoelectric probes and Asay barrier style probes. The free surface velocity history was measured with heterodyne velocimetry probes. The ejected particulate mass-velocity distributions have been correlated with the shock breakout pressure and surface roughness. The results show a transition in ejecta production at the Pb melt on release pressure.

  5. Electronic circuit detects left ventricular ejection events in cardiovascular system

    NASA Technical Reports Server (NTRS)

    Gebben, V. D.; Webb, J. A., Jr.

    1972-01-01

    Electronic circuit processes arterial blood pressure waveform to produce discrete signals that coincide with beginning and end of left ventricular ejection. Output signals provide timing signals for computers that monitor cardiovascular systems. Circuit operates reliably for heart rates between 50 and 200 beats per minute.

  6. Iron Charge Distribution as an Identifier of Interplanetary Coronal Mass Ejections

    NASA Technical Reports Server (NTRS)

    Lepri, S. T.; Zurbuchen, T. H.; Fisk, L. A.; Richardson, I. G.; Cane, H. V.; Gloeckler, G.

    2001-01-01

    We present solar wind Fe charge state data measured on the Advanced Composition Explorer (ACE) from early 1998 to the middle of 2000. Average Fe charge states in the solar wind are typically around 9 to 11. However, deviations from these average charge states occur, including intervals with a large fraction of Fe(sup greater or = 16+) which are consistently associated with interplanetary coronal mass ejections (ICMEs). By studying the Fe charge state distribution we are able to extract coronal electron temperatures often exceeding 2 x 10(exp 6) kelvins. We also discuss the temporal trends of these events, indicating the more frequent appearance of periods with high Fe charge states as solar activity increases.

  7. T-wave alternans negative coronary patients with low ejection and benefit from defibrillator implantation

    NASA Technical Reports Server (NTRS)

    Hohnloser, S. H.; Ikeda, T.; Bloomfield, D. M.; Dabbous, O. H.; Cohen, R. J.

    2003-01-01

    In a trial of prophylactic implantation of a defibrillator, a mortality benefit was seen among patients with previous myocardial infarction and a left-ventricular ejection fraction of 0.30 or less. We identified 129 similar patients from two previously published clinical trials in which microvolt T-wave alternans testing was prospectively assessed. At 24 months of follow-up, no sudden cardiac death or cardiac arrest was seen among patients who tested T-wave alternans negative, compared with an event rate of 15.6% among the remaining patients. Testing of T-wave alternans seems to identify patients who are at low risk of ventricular tachyarrhythmic event and who may not benefit from defibrillator therapy.

  8. Soot Volume Fraction Imaging

    NASA Technical Reports Server (NTRS)

    Greenberg, Paul S.; Ku, Jerry C.

    1994-01-01

    A new technique is described for the full-field determination of soot volume fractions via laser extinction measurements. This technique differs from previously reported point-wise methods in that a two-dimensional array (i.e., image) of data is acquired simultaneously. In this fashion, the net data rate is increased, allowing the study of time-dependent phenomena and the investigation of spatial and temporal correlations. A telecentric imaging configuration is employed to provide depth-invariant magnification and to permit the specification of the collection angle for scattered light. To improve the threshold measurement sensitivity, a method is employed to suppress undesirable coherent imaging effects. A discussion of the tomographic inversion process is provided, including the results obtained from numerical simulation. Results obtained with this method from an ethylene diffusion flame are shown to be in close agreement with those previously obtained by sequential point-wise interrogation.

  9. ON SUN-TO-EARTH PROPAGATION OF CORONAL MASS EJECTIONS

    SciTech Connect

    Liu, Ying D.; Luhmann, Janet G.; Moestl, Christian; Bale, Stuart D.; Lin, Robert P.; Lugaz, Noe; Davies, Jackie A.

    2013-05-20

    We investigate how coronal mass ejections (CMEs) propagate through, and interact with, the inner heliosphere between the Sun and Earth, a key question in CME research and space weather forecasting. CME Sun-to-Earth kinematics are constrained by combining wide-angle heliospheric imaging observations, interplanetary radio type II bursts, and in situ measurements from multiple vantage points. We select three events for this study, the 2012 January 19, 23, and March 7 CMEs. Different from previous event studies, this work attempts to create a general picture for CME Sun-to-Earth propagation and compare different techniques for determining CME interplanetary kinematics. Key results are obtained concerning CME Sun-to-Earth propagation: (1) the Sun-to-Earth propagation of fast CMEs can be approximately formulated into three phases: an impulsive acceleration, then a rapid deceleration, and finally a nearly constant speed propagation (or gradual deceleration); (2) the CMEs studied here are still accelerating even after the flare maximum, so energy must be continuously fed into the CME even after the time of the maximum heating and radiation has elapsed in the corona; (3) the rapid deceleration, presumably due to interactions with the ambient medium, mainly occurs over a relatively short timescale following the acceleration phase; and (4) CME-CME interactions seem a common phenomenon close to solar maximum. Our comparison between different techniques (and data sets) has important implications for CME observations and their interpretations: (1) for the current cases, triangulation assuming a compact CME geometry is more reliable than triangulation assuming a spherical front attached to the Sun for distances below 50-70 solar radii from the Sun, but beyond about 100 solar radii we would trust the latter more; (2) a proper treatment of CME geometry must be performed in determining CME Sun-to-Earth kinematics, especially when the CME propagation direction is far away from the

  10. Fractional channel multichannel analyzer

    DOEpatents

    Brackenbush, L.W.; Anderson, G.A.

    1994-08-23

    A multichannel analyzer incorporating the feature