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Sample records for ejection fraction obtained

  1. Comparison of estimates of left ventricular ejection fraction obtained from gated blood pool imaging, different software packages and cameras

    PubMed Central

    Steyn, Rachelle; Boniaszczuk, John; Geldenhuys, Theodore

    2014-01-01

    Summary Objective To determine how two software packages, supplied by Siemens and Hermes, for processing gated blood pool (GBP) studies should be used in our department and whether the use of different cameras for the acquisition of raw data influences the results. Methods The study had two components. For the first component, 200 studies were acquired on a General Electric (GE) camera and processed three times by three operators using the Siemens and Hermes software packages. For the second part, 200 studies were acquired on two different cameras (GE and Siemens). The matched pairs of raw data were processed by one operator using the Siemens and Hermes software packages. Results The Siemens method consistently gave estimates that were 4.3% higher than the Hermes method (p < 0.001). The differences were not associated with any particular level of left ventricular ejection fraction (LVEF). There was no difference in the estimates of LVEF obtained by the three operators (p = 0.1794). The reproducibility of estimates was good. In 95% of patients, using the Siemens method, the SD of the three estimates of LVEF by operator 1 was ≤ 1.7, operator 2 was ≤ 2.1 and operator 3 was ≤ 1.3. The corresponding values for the Hermes method were ≤ 2.5, ≤ 2.0 and ≤ 2.1. There was no difference in the results of matched pairs of data acquired on different cameras (p = 0.4933) Conclusion Software packages for processing GBP studies are not interchangeable. The report should include the name and version of the software package used. Wherever possible, the same package should be used for serial studies. If this is not possible, the report should include the limits of agreement of the different packages. Data acquisition on different cameras did not influence the results. PMID:24844547

  2. 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 ...

  3. 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

  4. 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. PMID:27621804

  5. 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.

  6. 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

  7. 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

  8. 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

  9. Prognostic significance of left ventricular ejection fraction after acute myocardial infarction. A bedside radionuclide study.

    PubMed Central

    Kelly, M J; Thompson, P L; Quinlan, M F

    1985-01-01

    The prognostic significance of left ventricular ejection fraction measurements obtained at the bedside was assessed in 171 patients as soon as possible after acute myocardial infarction. Ejection fraction was measured with a radionuclide first pass portable probe method within a mean of 24 hours of the onset of major symptoms. The results were related prospectively to the subsequent incidence of ventricular fibrillation in hospital, and to hospital and postdischarge deaths in a mean follow up period of 15 (range 9-21) months. All eight episodes of primary ventricular fibrillation, all 12 deaths due to pump failure in hospital, and also 12 out of 13 postdischarge deaths occurred in that minority of 81 patients whose initial postinfarction left ventricular ejection fraction was less than 0.35. Multivariate correlation with clinical, enzymatic, and electrocardiographic indicators of myocardial infarction showed that the prognostic significance of these indicators could largely be explained by their association with low left ventricular ejection fractions. Left ventricular ejection fraction measured within the initial 24 hours after acute myocardial infarction predicts prognosis throughout the subsequent year. PMID:3966947

  10. Invasive hemodynamic characterization of heart failure with preserved ejection fraction.

    PubMed

    Andersen, Mads J; Borlaug, Barry A

    2014-07-01

    Recent hemodynamic studies have advanced our understanding of heart failure with preserved ejection fraction (HFpEF). Despite improved pathophysiologic insight, clinical trials have failed to identify an effective treatment for HFpEF. Invasive hemodynamic assessment can diagnose or exclude HFpEF, making it invaluable in understanding the basis of the disease. This article reviews the hemodynamic mechanisms underlying HFpEF and how they manifest clinically, discusses invasive hemodynamic assessment as a diagnostic tool, and explores how invasive hemodynamic profiling may allow understanding of pathophysiological differences and inform the design and entry criteria for future trials.

  11. 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.

  12. 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

  13. 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.

  14. 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.

  15. 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.

  16. 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

  17. 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

  18. Systems biology applied to heart failure with normal ejection fraction.

    PubMed

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

    2014-05-01

    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.

  19. 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

  20. 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

  1. 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.

  2. 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.

  3. Review: Heart failure with preserved ejection fraction in African Americans.

    PubMed

    Shah, Sachil

    2012-01-01

    Heart failure (HF) affects 5,700 000 people in the United States, with heart failure with preserved ejection fraction (HFPEF) being responsible for between 30%-50% of acute admissions. Epidemiological studies and HF registries have found HFPEF patients to be older, hypertensive and to have a history of atrial fibrillation. These findings, however, may not be fully applicable to African Americans, as they have been poorly studied making up only a minority of the test subjects. This review article is intended to discuss the pathophysiology and epidemiology of HFPEF within African Americans, highlight the differences compared to Caucasian populations and review current treatment guidelines. Studies looking at African Americans in particular have shown them to be younger, female and have worse diastolic dysfunction compared to Caucasian populations. African Americans also have been shown to have a worse mortality outcome especially in patients without coronary artery disease. The treatment of HFPEF is primarily symptomatic with no survival benefit seen in randomized controlled trials. Mechanisms postulated for the worse prognosis in African Americans with HFPEF include: greater incidence of hypertension and diastolic dysfunction, undefined race-driven genetic predispositions or relative resistance to medications that treat HF in general. The biological predispositions may also be compounded by inequality of healthcare access; something still felt to exist today. Prospective studies and randomized controlled trials need to be conducted with particular emphasis on African American populations to fully elucidate this disease and to formulate race specific treatment outcomes for the future.

  4. 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

  5. Measurement of left ventricular ejection fraction using gated 99mTc-sestamibi myocardial planar images: Comparison to contrast ventriculography

    SciTech Connect

    Parker, D.A.; Lloret, R.L.; Barilla, F.; Douthat, L.; Gheorghiade, M. )

    1991-01-01

    Using the new myocardial perfusion agent 99mTc-sestamibi and multigated acquisition on a nuclear medicine gamma camera, the left ventricular ejection fraction (LVEF) was derived in 13 patients with coronary artery disease (CAD). Cross-sectional activity profiles were used to measure the left ventricle from end-diastolic and end-systolic images. Several different geometric methods were then utilized to derive ejection fractions from the nuclear data. Comparison of the resultant ejection fractions to those obtained from contrast ventriculography showed significant correlation for all geometric methods (P less than 0.01, Sy X x = 6.2 to 9.6). The authors conclude that in patients with CAD one or more of these simple geometric methods can provide a useful estimate of the LVEF when performing 99mTc-sestamibi multigated myocardial perfusion imaging.

  6. 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

  7. Comparison of the reliability of E/E' to estimate pulmonary capillary wedge pressure in heart failure patients with preserved ejection fraction versus those with reduced ejection fraction.

    PubMed

    Matsushita, Kenichi; Minamishima, Toshinori; Goda, Ayumi; Ishiguro, Haruhisa; Kosho, Hideyasu; Sakata, Konomi; Satoh, Toru; Yoshino, Hideaki

    2015-12-01

    Accurate assessment of pulmonary capillary wedge pressure (PCWP) is essential for physicians to effectively manage patients with acute decompensated heart failure. The ratio of early transmittal velocity to tissue Doppler mitral annular early diastolic velocity (E/E') is used to estimate PCWP noninvasively in a wide range of cardiac patients. However, it remains contentious as to whether mitral E/E' is a reliable predictor of PCWP. In the present study, acute heart failure patients were divided into two groups on the basis of left ventricular (LV) systolic function: those with preserved ejection fraction (HFpEF) and those with reduced ejection fraction (HFrEF). The usefulness of mitral E/E' in estimating PCWP was compared between the two groups. Fifty consecutive patients who were admitted with acute decompensated heart failure and underwent both right-sided cardiac catheterization and transthoracic echocardiography during hospitalization were analyzed retrospectively. Pearson's correlation was used to evaluate associations between Doppler parameters and PCWP. E/E' was positively correlated with PCWP (r = 0.56, P = 0.01) in the heart failure with preserved ejection fraction group. However, no significant relationship was observed between PCWP and mitral E/E' (P = 0.85) in the heart failure with reduced ejection fraction group. There were no significant correlations between any of the conventional parameters considered (LVEF, left atrial dimension, E/A, IVRT, and DT) with PCWP in either group. In conclusion, mitral E/E' is useful for estimating PCWP in patients with acute heart failure with preserved ejection fraction but may not in those with reduced ejection fraction.

  8. 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.

  9. A model of the gastric gland ejection cycle: low ejection fractions require reduction of the glandular dead space.

    PubMed

    Kurbel, S; Kurbel, B; Dmitrović, B; Vcev, A

    2001-06-01

    This paper was inspired by the reported results of authors from Uppsala and Lund that gastric glands in rats rhythmically contract 3-7 cycles per minute and develop luminal pressures more than 10 mmHg. To ensure that pepsinogen is not retained in the acid-rich section of the gland, ejection fractions would need to be more than 50% of the gland volume. We have tried to calculate the ejection fraction of such contractions. Dimensions of human gastric glands were measured on the fresh frozen samples of macroscopically and histologically normal gastric mucosa. In total, 18 specimens (from nine persons) were measured under the microscope. The density of glands was 135 +/- 11 (mean +/- S.D.) glands per mm( 2) of gastric mucosa. A typical gastric gland is a tubular structure 1.2 +/- 0.22 mm long and 0.03-0.05 mm wide. We have used 1 mm for length and 0.03 mm for the gland diameter to calculate that each gland approximates a volume of 707 pl, suggesting that the total glandular volume for 15 million glands reaches 10.6 ml. Further calculations based on one to five contractions per minute on an average and on the total volume of gastric glands of 10 ml showed that only ejection fractions less than 10% deliver daily volumes less than 3 l. The presented model of the gastric gland activity is based on the idea that the low ejection fractions require a reduction of the glandular dead space. The reduced luminal pressure during the gland relaxation might cause backflux of hydrophobic viscoelastic mucus through the gland aperture. Repeated glandular contractions and relaxations would move the mucus all the way to the gland bottom, filling the gland cavity below the neck with an axial semisolid mucous cylinder. This filling would reduce the gland dead space. During contractions, the gland would eject mainly the peripheral, the more liquid part of its content. The decreasing luminal pressure in the relaxing gland would pull the outlet mucus inside, protecting gland apertures from

  10. Heart failure with a normal left ventricular ejection fraction: diastolic heart failure.

    PubMed

    Little, William C

    2008-01-01

    A reduced left ventricular ejection fraction measured by echocardiography in a patient with clinical features of heart failure demonstrates that the patient has a cardiac abnormality and that the clinical picture is, in fact, due to heart failure. As such, a reduced ejection fraction (< 0.30 or 0.35) has been used as entry criteria for almost all the large clinical trials that guide our therapy of patients with heart failure. However, it has been recently recognized that a substantial and increasing proportion of patients with heart failure have a normal ejection fraction (> 0.50). Such patients are typically elderly women with systolic hypertension. These patients are subject to the sudden development of pulmonary congestion (flash pulmonary edema). The finding of heart failure in patients with a normal ejection fraction has focused attention on the role of diastolic dysfunction in producing symptomatic heart failure. The optimal treatment of patients with heart failure and normal ejection fraction has not yet been defined, but the control of systolic hypertension and the avoidance of fluid overload are important.

  11. Murine models of diastolic dysfunction and heart failure with preserved ejection fraction.

    PubMed

    Horgan, S; Watson, C; Glezeva, N; Baugh, J

    2014-12-01

    Left ventricular diastolic dysfunction leads to heart failure with preserved ejection fraction, an increasingly prevalent condition largely driven by modern day lifestyle risk factors. As heart failure with preserved ejection fraction accounts for almost one-half of all patients with heart failure, appropriate nonhuman animal models are required to improve our understanding of the pathophysiology of this syndrome and to provide a platform for preclinical investigation of potential therapies. Hypertension, obesity, and diabetes are major risk factors for diastolic dysfunction and heart failure with preserved ejection fraction. This review focuses on murine models reflecting this disease continuum driven by the aforementioned common risk factors. We describe various models of diastolic dysfunction and highlight models of heart failure with preserved ejection fraction reported in the literature. Strengths and weaknesses of the different models are discussed to provide an aid to translational scientists when selecting an appropriate model. We also bring attention to the fact that heart failure with preserved ejection fraction is difficult to diagnose in animal models and that, therefore, there is a paucity of well described animal models of this increasingly important condition.

  12. Tolvaptan Improves the Long-Term Prognosis in Patients With Congestive Heart Failure With Preserved Ejection Fraction as Well as in Those With Reduced Ejection Fraction.

    PubMed

    Imamura, Teruhiko; Kinugawa, Koichiro

    2016-09-28

    Tolvaptan (TLV), an arginine vasopressin type 2 antagonist, has been shown to play a role in ameliorating symptomatic congestion and normalizing diluted hyponatremia in patients with congestive heart failure (HF). However, most evidence was derived from patients with HF with reduced ejection fraction (HFrEF), and the clinical efficacy of TLV in patients with HF with preserved ejection fraction (HFpEF) remains uncertain. In this study, we retrospectively enrolled 60 in-hospital patients with stage D HF, who had received TLV to treat symptomatic congestion at our institute between 2011 and 2013. As a control group, we also enrolled 60 background-matched HF patients who did not receive TLV therapy. Patients with HFpEF (n = 29), whose left ventricular ejection fraction was > 45%, had higher age and a lower urine aquaporin-2 level relative to the plasma arginine vasopressin concentration compared with those with HFrEF (n = 91). TLV therapy significantly reduced the 2-year readmission rates in both the HFrEF and HFpEF populations (P < 0.05 for both), indicating that TLV therapy may improve the long-term prognosis not only in patients with HFrEF but also in those with HFpEF. PMID:27581675

  13. Tolvaptan Improves the Long-Term Prognosis in Patients With Congestive Heart Failure With Preserved Ejection Fraction as Well as in Those With Reduced Ejection Fraction.

    PubMed

    Imamura, Teruhiko; Kinugawa, Koichiro

    2016-09-28

    Tolvaptan (TLV), an arginine vasopressin type 2 antagonist, has been shown to play a role in ameliorating symptomatic congestion and normalizing diluted hyponatremia in patients with congestive heart failure (HF). However, most evidence was derived from patients with HF with reduced ejection fraction (HFrEF), and the clinical efficacy of TLV in patients with HF with preserved ejection fraction (HFpEF) remains uncertain. In this study, we retrospectively enrolled 60 in-hospital patients with stage D HF, who had received TLV to treat symptomatic congestion at our institute between 2011 and 2013. As a control group, we also enrolled 60 background-matched HF patients who did not receive TLV therapy. Patients with HFpEF (n = 29), whose left ventricular ejection fraction was > 45%, had higher age and a lower urine aquaporin-2 level relative to the plasma arginine vasopressin concentration compared with those with HFrEF (n = 91). TLV therapy significantly reduced the 2-year readmission rates in both the HFrEF and HFpEF populations (P < 0.05 for both), indicating that TLV therapy may improve the long-term prognosis not only in patients with HFrEF but also in those with HFpEF.

  14. The relative impact of circumferential and longitudinal shortening on left ventricular ejection fraction and stroke volume

    PubMed Central

    MacIver, David H

    2012-01-01

    In vivo data have been unable to provide conclusive results with regard to the relative impact of circumferential and longitudinal shortening on stroke volume. The objective of the present study was to assess the relative contribution of circumferential and longitudinal myocardial shortening to left ventricular stroke volume and ejection fraction, and to evaluate the effect of left ventricular hypertrophy. A two-shell, three-dimensional mathematical model was used to assess the individual contributions of longitudinal and midwall circumferential shortening (or strain) to stroke volume and ejection fraction. Reducing either circumferential or longitudinal shortening resulted in a reduced ejection fraction and stroke volume. The stroke volume fell by 43% when circumferential strain was reduced from −20% to −5%, but only by 19% when longitudinal strain was similarly reduced. The sole contribution of circumferential and longitudinal shortening to stroke volume was 67% and 33%, respectively. These proportions were independent of wall thickness. The present study demonstrated that both longitudinal and midwall circumferential shortening contribute to different extents depending on the degree of abnormality of myocardial shortening. Contrary to most previous studies, the present study shows that circumferential shortening has a relatively greater contribution to stroke volume (ie, two-thirds) and ejection fraction than longitudinal shortening. These observations have important clinical and research implications in the assessment of left ventricular function. PMID:23204893

  15. Awake craniotomy in a patient with ejection fraction of 10%: considerations of cerebrovascular and cardiovascular physiology.

    PubMed

    Meng, Lingzhong; Weston, Stephen D; Chang, Edward F; Gelb, Adrian W

    2015-05-01

    A 37-year-old man with nonischemic 4-chamber dilated cardiomyopathy and low-output cardiac failure (estimated ejection fraction of 10%) underwent awake craniotomy for a low-grade oligodendroglioma resection under monitored anesthesia care. The cerebrovascular and cardiovascular physiologic challenges and our management of this patient are discussed.

  16. 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

  17. Determination of left ventricular ejection fraction in technetium-99m-methoxy isobutyl isonitrile radionuclide angiocardiography

    NASA Astrophysics Data System (ADS)

    Davis, Malcolm H.; Rezaie, Bahman; Weiland, Frederick L.

    1992-06-01

    Abnormal left ventricular function is a diagnostic indication of cardiac disease. Left ventricular function is most commonly quantified by ejection fraction measurements. This paper presents a novel approach for the measurement of left ventricular ejection fraction (L VEF) using the recently introduced myocardial imaging agent, technetium-99m methoxy isobutyl isonitrile (99mTc-sestamibi). The approach utilizes computer image processing techniques to determine L VEF in equilibrium 99mTc-sestamibi multiple gated radionuclide angiography (RNA). Equilibrium RNA is preferred to first-pass RNA techniques due to the higher signal-to-noise ratio of equilibrium RNA resulting from longer image acquisition times. Data from 23 patients, symptomatic of cardiac disease, indicate that L VEFs determined using this radionuclide technique correlate well with contrast x-ray single plane cineangiography (r equals 0.83, p < 0.0000003).

  18. 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.

  19. Simplified method of determining left ventricular ejection fraction from a radionuclide bolus.

    PubMed

    Hannan, W J; Hare, R J; Hughes, S H; Scorgie, R E; Muir, A L

    1977-06-30

    A method which does not require an online computer has been developed to measure left ventircular ejection fraction from a bolus of 99mTc-pertechnetate. The passage of the bolus through the cardiac chambers was imaged using a gamma camera and recorded on video tape. On replay a region of interest corresponding to the left ventricle was selected directly at the gamma camera console. Counts detected in this region were analysed in 30ms intervals. The data were corrected for the contribution from extra-cardiac activity and were then digitally filtered to remove statistical noise. Ejection fractions measured in 13 patients by this technique agreed well with those determined by contrast ventriculography (r=0.97, P less than 0.001).

  20. Genetic predisposition in patients with hypertension and normal ejection fraction to oxidative stress.

    PubMed

    Fazakas, Ádám; Szelényi, Zsuzsanna; Szénási, Gábor; Nyírő, Gábor; Szabó, Péter M; Patócs, Attila; Tegze, Narcis; Fekete, Bertalan C; Molvarec, Attila; Nagy, Bálint; Jakus, Judit; Örsi, Ferenc; Karádi, István; Vereckei, András

    2016-02-01

    The role of oxidative stress (OXS) due to myocardial nitric oxide synthase (NOS) uncoupling related to oxidative depletion of its cofactor tetrahydrobiopterin (BH4) emerged in the pathogenesis of heart failure with preserved ejection fraction. We determined the prevalence of six single nucleotide polymorphisms (SNPs) of genes encoding enzymes related to OXS, BH4 metabolism, and NOS function in ≥60-year-old 94 patients with hypertension and 18 age-matched controls with normal ejection fraction. Using echocardiography, 56/94 (60%) patients with hypertension had left ventricular (LV) diastolic dysfunction (HTDD+ group) and 38/94 (40%) patients had normal LV diastolic function (HTDD- group). Four SNPs (rs841, rs3783641, rs10483639, and rs807267) of guanosine triphosphate cyclohydrolase-1, the rate-limiting enzyme in BH4 synthesis, one (rs4880) of manganese superoxide dismutase, and one (rs1799983) of endothelial NOS genes were genotyped using real-time polymerase chain reaction method and Taqman probes. Protein carbonylation, BH4, and total biopterin levels were measured from plasma samples. No between-groups difference in minor allele frequency of SNPs was found. We calculated a genetic score indicating risk for OXS based on the minor allele frequencies of the SNPs. A high genetic risk for OXS was significantly associated with HTDD+ even after adjustment for confounding variables (odds ratio [95% confidence interval]:4.79 [1.12-20.54]; P = .035). In both patient groups protein carbonylation (P < .05 for both), plasma BH4 (P < .01 for both) and in the HTDD+ group total biopterin (P < .05) increased versus controls. In conclusion, in patients with hypertension and normal ejection fraction, a potential precursor of heart failure with preserved ejection fraction, a partly genetically determined increased OXS, seems to be associated with the presence of LV diastolic dysfunction. PMID:26778769

  1. 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.

  2. [Baroreflex activation therapy. A novel interventional approach to treat heart failure with reduced ejection fraction].

    PubMed

    Halbach, M; Fritz, T; Madershahian, N; Pfister, R; Reuter, H

    2015-11-01

    Sympathovagal imbalance plays an important role in the progression of heart failure with reduced ejection fraction. Baroreflex activation therapy (BAT), i. e. electrical stimulation of baroreceptors located at the carotid sinus, can reduce sympathetic and enhance parasympathetic tone. Large animal studies on BAT demonstrated improvements in cardiac function, arrhythmogenic risk and a survival benefit compared to untreated controls. The recently published Neo Randomized Heart Failure Study, the first multicenter, randomized and controlled trial of optimal medical and device therapy alone or plus BAT in patients with a left ventricular ejection fraction ≤ 35 %, demonstrated a reasonable safety profile of BAT in this severely ill patient population and no relevant interactions with other devices. The study found significant improvements in the New York Heart Association (NYHA) class of heart failure, quality of life as well as 6 min walking distance and data pointed to a reduction in hospitalization rates. Moreover, N-terminal pro-brain natriuretic peptide (NT-proBNP) levels were significantly reduced. This review gives an overview on BAT for the treatment of heart failure with reduced ejection fraction, from the rationale and animal experiments to the most recent clinical data and future perspectives.

  3. Comparison of characteristics and outcomes of patients with heart failure preserved ejection fraction versus reduced left ventricular ejection fraction in an urban cohort.

    PubMed

    Quiroz, Rene; Doros, Gheorghe; Shaw, Peter; Liang, Chang-Seng; Gauthier, Diane F; Sam, Flora

    2014-02-15

    Despite significant advances in therapies for patients with heart failure with reduced ejection fraction (HFrEF), there are no evidence-based therapies for heart failure with preserved ejection fraction (HFpEF), also known as diastolic heart failure (HF). Differences in pathophysiologic mechanisms are touted as to why patients with HFpEF purportedly do not derive similar therapeutic benefits compared with HFrEF. Similarly, the relative frequencies of HFpEF and HFrEF may differ between hospitalized and ambulatory settings. There are limited data on the prevalence, characteristics, treatment, and short-term outcomes of patients hospitalized with HFpEF. We sought to investigate these in patients hospitalized with HFpEF in an urban, hospitalized setting using the Get With The Guidelines registry. We retrospectively reviewed all consecutive discharges (n = 1,701) with a diagnosis of acute decompensated HF from December 1, 2006 to September 30, 2008. Patients with HFpEF (n = 499) were older, overweight, predominantly women, and had underlying hypertension and dyslipidemia. Presenting blood pressure and levels of creatinine were higher, with lower brain natriuretic peptide levels compared with patients with HFrEF (n = 598). Length of stay and 30-day mortality were comparable between patients with HFpEF and HFrEF. Thirty-day readmission was initially lower in patients with HFpEF. However 30-day mortality from any cause after the index HF hospitalization and survival curve at 1-year was no different between patients with HFpEF and HFrEF. In conclusion, lower 30-day readmissions do not translate into improved long-term outcome in patients with HFpEF.

  4. Estimation of left ventricular ejection fraction by computerized single cardiac probe system with echocardiogram

    SciTech Connect

    Suzuki, Y.; Ide, M.; Kenemoto, N.; Tomoda, H.; Nakamura, M.

    1984-01-01

    The authors developed a computerized single cardiac probe system combined with echocardiogram which permits the physician to position the detector more easily and properly. With this system left ventricular ejection fraction (LVEF) can be estimated by the three different modes: first pass (FP) mode, beat-by-beat (B-B) mode and ECG multigated (MG) mode. In FP mode complex demodulation technique is applied for estimation of the background counts. The purpose of this paper is to describe the accuracy and reproducibility of the LVEF estimated by this system. In 40 patients with various heart diseases, the LVEFs estimated by this system using above-mentioned 3 modes were compared with those of obtained by gamma camera. There were good correlations between the LVEFs estimated by each of the 3 modes of this system and obtained by gamma camera. The correlation coefficient (r) between the LVEFs estimated FP mode, B-B mode and MG mode, and those of by gamma camera was 0.938, 0.932, and 0.930, respectively. In 15 patients FP mode study was repeated continuously and LVEFs obtained in the initial and repeat studies were compared. There was good agreement between these results (r=0.953). In 12 patients positioning of the probe over the left ventricle and background area was repeated 5 times and LVEFs were estimated each time by B-B mode. There was no significant standard deviation compared to the mean LVEFs in each patient; the percent coefficient of variation was less than 8.0%. The authors conclude that their results suggest that LVEF can be estimated accurately be each of the 3 modes of this system and reproducibility seems to be sufficient for clinical studies.

  5. Heart Failure with Preserved Ejection Fraction - Concept, Pathophysiology, Diagnosis and Challenges for Treatment.

    PubMed

    Miljkovik, Lidija Veterovska; Spiroska, Vera

    2015-09-15

    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.

  6. Pulmonary Hypertension in Elderly Patients with Diastolic Dysfunction and Preserved Ejection Fraction

    PubMed Central

    Afshar, Majid; Collado, Fareed; Doukky, Rami

    2012-01-01

    Purpose: Patients with diastolic dysfunction may have a disproportionate degree of elevation in pulmonary pressure, particularly in the elderly. Higher pulmonary vascular resistance in the elderly patients with heart failure but preserved ejection fraction suggests that beyond the post-capillary contribution of pulmonary venous congestion, a pre-capillary component of pulmonary arterial hypertension occurs. We aim to identify if pulmonary vascular resistance in elderly patients with diastolic dysfunction is disproportionately higher than patients with systolic dysfunction independent of filling pressures. Methods: 389 patients identified retrospectively between 2003- 2010; elderly with preserved ejection fraction, elderly with depressed ejection fraction, and primary arterial hypertension who underwent right-heart catheterization at Rush University. Results: No significant difference in pulmonary vascular resistance between systolic and diastolic dysfunction. The mean difference in pulmonary vascular resistance was not statistically significant at 0.40 mmHg·min/l (95% CI -3.03 to 3.83) with similar left ventricular filling pressures with mean difference of 3.38 mmHg (95% CI, -1.27 to 8.02). When adjusted for filling pressures, there remained no difference in pulmonary vascular resistance for systolic and diastolic dysfunction. The mean pulmonary vascular resistance is more elevated in systolic heart failure compared to diastolic heart failure with means 3.13 mmHg·min/l and 3.52 mmHg·min/l, respectively. Conclusion: There was no other association identified for secondary pulmonary hypertension other than diastolic dysfunction and chronic venous pulmonary hypertension. Our results argue against any significant arterial remodeling that would lead to disproportionate pre-capillary hypertension, and implies that treatment should focus on lowering filling pressure rather than treating the pulmonary vascular tree. PMID:22282715

  7. 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

  8. 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

  9. 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.

  10. 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

  11. 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

  12. Heart failure with preserved ejection fraction: Defining the function of ROS and NO.

    PubMed

    Zuo, Li; Chuang, Chia-Chen; Hemmelgarn, Benjamin T; Best, Thomas M

    2015-10-15

    The understanding of complex molecular mechanisms underlying heart failure (HF) is constantly under revision. Recent research has paid much attention to understanding the growing number of patients that exhibit HF symptoms yet have an ejection fraction similar to a normal phenotype. Termed heart failure with preserved ejection fraction (HFpEF), this novel hypothesis traces its roots to a proinflammatory state initiated in part by the existence of comorbidities that create a favorable environment for the production of reactive oxygen species (ROS). Triggering a cascade that involves reduced nitric oxide (NO) availability, elevated ROS levels in the coronary endothelium eventually contribute to hypertrophy and increased resting tension in cardiomyocytes. Improved understanding of the molecular pathways associated with HFpEF has led to studies that concentrate on reducing ROS production in the heart, boosting NO availability, and increasing exercise capacity for HFpEF patients. This review will explore the latest research into the role of ROS and NO in the progression of HFpEF, as well as discuss the encouraging results of numerous therapeutic studies.

  13. 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

  14. Heart failure with preserved ejection fraction in women: the Dutch Queen of Hearts program.

    PubMed

    den Ruijter, H; Pasterkamp, G; Rutten, F H; Lam, C S P; Chi, C; Tan, K H; van Zonneveld, A J; Spaanderman, M; de Kleijn, D P V

    2015-02-01

    Heart failure (HF) poses a heavy burden on patients, their families and society. The syndrome of HF comes in two types: with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). The latter is on the increase and predominantly present in women, especially the older ones. There is an urgent need for mortality-reducing drugs in HFpEF, a disease affecting around 5 % of those aged 65 years and over. HFpEF develops in patients with risk factors and comorbidities such as obesity, hypertension, diabetes, COPD, but also preeclampsia. These conditions are likely to drive microvascular disease with involvement of the coronary microvasculature, which may eventually evolve into HFpEF. Currently, the diagnosis of HFPEF relies mainly on echocardiography. There are no biomarkers that can help diagnose female microvascular disease or facilitate the diagnosis of (early stages of) HFpEF. Recently a Dutch consortium was initiated, Queen of Hearts, with support from the Netherlands Heart Foundation, with the aim to discover and validate biomarkers for diastolic dysfunction and HFpEF in women. These biomarkers come from innovative blood-derived sources such as extracellular vesicles and circulating cells. Within the Queen of Hearts consortium, we will pursue female biomarkers that have the potential for further evolution in assays with point of care capabilities. As a spin-off, the consortium will gain knowledge on gender-specific pathology of HFpEF, possibly opening up novel treatment options. PMID:25614387

  15. 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.

  16. Facts and numbers on epidemiology and pharmacological treatment of heart failure with preserved ejection fraction

    PubMed Central

    2015-01-01

    Abstract Heart failure with preserved ejection fraction (HFpEF) is a major and growing public health problem. Epidemiologic studies demonstrated that heart failure (HF) can be clinically diagnosed in patients with normal or preserved left ventricular ejection fraction. These patients are therefore termed as having HFpEF. In the past, this was often called diastolic HF. Because of the permanent increase of the prevalence of HFpEF during the past decades, HFpEF now accounts for more than 50% of the total HF population. There are uncertainties and debates regarding the definition, diagnosis, and pathophysiology with the consequence that all outcome trials performed so far used criteria for inclusion and exclusion that were not consistent. These trials also failed to document improved prognosis. Recent smaller proof‐of‐concept or Phase II clinical trials investigating different pathophysiological approaches with substances such as the neprilysin inhibitor–angiotensin receptor blocker− combination (LCZ 696), ranolazine, or ivabradine were successful to improve biomarkers, haemodynamics, or functional capacity. Future trials will need to document whether also prognosis can be improved.

  17. 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

  18. Validation of reliable, noninvasive method for determining right ventricular ejection fraction

    SciTech Connect

    Preslar, J.S.; Rezai, K.; Kirchner, P.; Weiss, R.

    1988-12-01

    Paired scintigraphic and cine CT studies were performed on 29 patients to assess the accuracy of three scintigraphic method currently available for determination of right ventricular ejection fraction (RVEF). Following a bolus injection of 30 mCi (/sup 99m/Tc)pertechnetate, a serial mode acquisition of the first transit through the heart was recorded. Processing was performed in three ways: beat-by-beat (fixed ROI), equilibrium multigated acquisition (MUGA) (variable ROI), and first-pass MUGA (variable ROI). RVEF valued determined with the first pass MUGA technique showed the best correlation with cine CT values, while those determined with the beat-by-beat or the equilibrium MUGA techniques consistently underestimated the RVEF. Thus, the scintigraphic technique using a first-pass gated format with variable ROI appears to be reliable by correlation with cine CT as an inexpensive, noninvasive method for evaluation of RV function.

  19. 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

  20. 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.

  1. 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

  2. Low Fitness in Midlife: A Novel Therapeutic Target for Heart Failure with Preserved Ejection Fraction Prevention.

    PubMed

    Pandey, Ambarish; Darden, Douglas; Berry, Jarett D

    2015-01-01

    Heart failure (HF) with preserved ejection fraction (HFpEF) is common and recalcitrant to any medical therapy, highlighting the need for novel strategies focused on its prevention. Recent studies have shown that low cardiorespiratory fitness (CRF) in middle age identifies a subgroup of individuals at particularly high risk for HF, particularly HFpEF. These findings suggest that low CRF in middle age represents an upstream marker for late-life HFpEF. Furthermore, evidence from recent epidemiological studies suggests that low CRF associated risk for HFpEF appears to be modifiable with improvement in CRF. The primary objective of this review is to provide an overview of the potential mechanisms through which exercise training and improvement in CRF may protect against the transition from a low fit stage to clinical HFpEF among at-risk sedentary, middle-age adults.

  3. Pioglitazone-induced congestive heart failure and pulmonary edema in a patient with preserved ejection fraction.

    PubMed

    Jearath, Vaneet; Vashisht, Rajan; Rustagi, Vipul; Raina, Sujeet; Sharma, Rajesh

    2016-01-01

    Pioglitazone-induced heart failure is known in patients with underlying heart disease, but is not well documented in patients with normal left ventricular function. Pioglitazone has been very popular as it is an insulin sensitizer and insulin resistance is prevalent among Indians. Fluid retention exacerbates pre-existing heart failure or precipitates heart failure in a patient with underlying left ventricular dysfunction. However, pathogenesis of heart failure in a patient with normal left ventricular function is not known. Probably it is due to dose-related effect on pulmonary endothelial permeability, rather than alterations in left ventricular mass or ejection fraction. We report a patient who developed congestive heart failure and pulmonary edema with normal left ventricular function within 1 year of starting pioglitazone therapy. We have to be careful in monitoring all possible side effects during followup when patients are on pioglitazone therapy.

  4. Pioglitazone-induced congestive heart failure and pulmonary edema in a patient with preserved ejection fraction

    PubMed Central

    Jearath, Vaneet; Vashisht, Rajan; Rustagi, Vipul; Raina, Sujeet; Sharma, Rajesh

    2016-01-01

    Pioglitazone-induced heart failure is known in patients with underlying heart disease, but is not well documented in patients with normal left ventricular function. Pioglitazone has been very popular as it is an insulin sensitizer and insulin resistance is prevalent among Indians. Fluid retention exacerbates pre-existing heart failure or precipitates heart failure in a patient with underlying left ventricular dysfunction. However, pathogenesis of heart failure in a patient with normal left ventricular function is not known. Probably it is due to dose-related effect on pulmonary endothelial permeability, rather than alterations in left ventricular mass or ejection fraction. We report a patient who developed congestive heart failure and pulmonary edema with normal left ventricular function within 1 year of starting pioglitazone therapy. We have to be careful in monitoring all possible side effects during followup when patients are on pioglitazone therapy. PMID:27127397

  5. 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

  6. Radionuclide measurement of left ventricular ejection fraction in infants and children.

    PubMed Central

    Baker, E J; Ellam, S V; Maisey, M N; Tynan, M J

    1984-01-01

    The left ventricular ejection fraction was measured in 60 infants and children with congenital heart disease by both the equilibrium gated radionuclide technique and biplane left ventricular cineangiography. The median age of the patients studied was 2.25 years, and 17 were less than 1 year old. The correlation coefficient for the two sets of measurements was good and did not deteriorate in subgroups under 1 year old and with a large left to right shunt. In those infants with a right to left shunt the correlation was weak. Equilibrium gated radionuclide angiography is a valid and clinically valuable method of measuring left ventricular function in infants and children with congenital heart disease. PMID:6696805

  7. 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

  8. 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

  9. 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.

  10. 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

  11. 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.

  12. 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.

  13. Heterogeneous responses of systolic and diastolic left ventricular function to exercise in patients with heart failure and preserved ejection fraction

    PubMed Central

    Sinning, David; Lober, Jil; Post, Heiner; Fraser, Alan G.; Pieske, Burkert; Burkhoff, Daniel; Tschöpe, Carsten

    2015-01-01

    Abstract Aims This study aimed to evaluate ventricular diastolic properties using three‐dimensional echocardiography and tissue Doppler imaging at rest and during exercise in heart failure with preserved ejection fraction (HFpEF) patients with borderline evidence of diastolic dysfunction at rest. Methods and results Results obtained from 52 HFpEF patients (left ventricular ejection fraction ≥ 50%) identified on the basis of heart failure symptoms and E/E′ values between 8 and 15 were compared with those obtained in 26 control patients with no evidence of cardiovascular disease. Mitral flow patterns, tissue Doppler imaging, and volume analysis obtained by three‐dimensional echocardiography were performed at rest and during bicycle exercise. Diastolic compliance was indexed by the E/E′ ratio and left ventricular end‐diastolic volume [(E/E′)/EDV]. There were no significant differences in end‐diastolic volume (EDV), stroke volume (SV), or ejection fraction at rest between groups. In 27 of the 52 patients, E/E′ increased during exercise (11.2 ± 3.7 to 16.8 ± 10.5), driven by a failure to augment early diastole (E′). This correlated with a fall in SV and was associated with an increase in the diastolic index (E/E′)/EDV as a measure for LV stiffness (0.122 ± 0.038 to 0.217 ± 0.14/mL), indicating that impaired diastolic reserve (designated PEF‐IDR) contributed to exercise intolerance. Of the 52 patients, 25 showed no changes in E/E′ during exercise associated with a significant rise in SV and cardiac output, still inappropriate compared with controls. Despite disturbed early diastole (E′), a blunted increase in estimated systolic LV elastance indicated that impaired systolic reserve and chronotropic incompetence rather than primarily diastolic disturbances contributed to exercise intolerance in this group (designated PEF). Conclusion Three‐dimensional stress echocardiography may allow non‐invasive analysis of changes

  14. Heterogeneous responses of systolic and diastolic left ventricular function to exercise in patients with heart failure and preserved ejection fraction

    PubMed Central

    Sinning, David; Lober, Jil; Post, Heiner; Fraser, Alan G.; Pieske, Burkert; Burkhoff, Daniel; Tschöpe, Carsten

    2015-01-01

    Abstract Aims This study aimed to evaluate ventricular diastolic properties using three‐dimensional echocardiography and tissue Doppler imaging at rest and during exercise in heart failure with preserved ejection fraction (HFpEF) patients with borderline evidence of diastolic dysfunction at rest. Methods and results Results obtained from 52 HFpEF patients (left ventricular ejection fraction ≥ 50%) identified on the basis of heart failure symptoms and E/E′ values between 8 and 15 were compared with those obtained in 26 control patients with no evidence of cardiovascular disease. Mitral flow patterns, tissue Doppler imaging, and volume analysis obtained by three‐dimensional echocardiography were performed at rest and during bicycle exercise. Diastolic compliance was indexed by the E/E′ ratio and left ventricular end‐diastolic volume [(E/E′)/EDV]. There were no significant differences in end‐diastolic volume (EDV), stroke volume (SV), or ejection fraction at rest between groups. In 27 of the 52 patients, E/E′ increased during exercise (11.2 ± 3.7 to 16.8 ± 10.5), driven by a failure to augment early diastole (E′). This correlated with a fall in SV and was associated with an increase in the diastolic index (E/E′)/EDV as a measure for LV stiffness (0.122 ± 0.038 to 0.217 ± 0.14/mL), indicating that impaired diastolic reserve (designated PEF‐IDR) contributed to exercise intolerance. Of the 52 patients, 25 showed no changes in E/E′ during exercise associated with a significant rise in SV and cardiac output, still inappropriate compared with controls. Despite disturbed early diastole (E′), a blunted increase in estimated systolic LV elastance indicated that impaired systolic reserve and chronotropic incompetence rather than primarily diastolic disturbances contributed to exercise intolerance in this group (designated PEF). Conclusion Three‐dimensional stress echocardiography may allow non‐invasive analysis of changes

  15. Are angiotensin-converting enzyme inhibitors or angiotensin 2 receptor antagonists effective in heart failure with preserved ejection fraction?

    PubMed

    Rain, Carmen; Rada, Gabriel

    2015-03-19

    Angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) constitute first line treatment for patients with heart failure with reduced ejection fraction. However, their role in patients with preserved ejection fraction remains controversial. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified five systematic reviews including five randomized trials. We combined the evidence using meta-analysis and generated a summary of findings table following the GRADE approach. We concluded ACEI and ARB do not decrease mortality or hospitalization risk in this group of patients.

  16. Ischaemia change with revascularisation versus medical therapy in reduced ejection fraction

    PubMed Central

    Mentz, Robert J; Fiuzat, Mona; Shaw, Linda K; Farzaneh-Far, Afshin; M O'Connor, Christopher; Borges-Neto, Salvador

    2015-01-01

    Objective Nuclear imaging data demonstrate that revascularisation leads to favourable effects on ischaemia burden and improved outcomes compared with medical therapy (MT). In patients with heart failure (HF), the effects of MT versus revascularisation on ischaemia change and its independent prognostic significance requires investigation. Methods From the Duke Databank, we performed a retrospective analysis of 278 consecutive patients with coronary artery disease (CAD) and ejection fraction (EF) ≤40%, who underwent 2 serial myocardial perfusion scans between 1993 and 2009. Ischaemia change was calculated for patients undergoing MT alone, or revascularisation. Cox proportional hazards regression modelling was used to identify factors associated with death/myocardial infarction (MI). Results The magnitude of ischeamia reduction was greater with revascularisation than with MT alone (median change of −6% vs 0%, p<0.001). With revascularisation, more patients experienced ≥5% ischaemia reduction compared with MT (52% vs 25%, p<0.01) and a similar percentage experienced ≥5% ischaemia worsening (13% vs 18%, p=0.37). After risk adjustment, ≥5% ischaemia worsening was associated with decreased death/MI (HR=0.58; 95% CI 0.36 to 0.96). Conclusions In patients with HF with CAD, revascularisation improves long-term ischaemia burden compared with MT. Ischaemia worsening on nuclear imaging was associated with reduced risk of death/MI, potentially related to development of ischaemic viable myocardium as opposed to scar tissue. PMID:26339498

  17. 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.

  18. 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

  19. 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.

  20. 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

  1. Role of cardiac CTA in estimating left ventricular volumes and ejection fraction

    PubMed Central

    Singh, Robin Man; Singh, Balkrishna Man; Mehta, Jawahar Lal

    2014-01-01

    Left ventricular ejection fraction (LVEF) is an important predictor of cardiac outcome and helps in making important diagnostic and therapeutic decisions such as the treatment of different types of congestive heart failure or implantation of devices like cardiac resynchronization therapy-defibrillator. LVEF can be measured by various techniques such as transthoracic echocardiography, contrast ventriculography, radionuclide techniques, cardiac magnetic resonance imaging and cardiac computed tomographic angiography (CTA). The development of cardiac CTA using multi-detector row CT (MDCT) has seen a very rapid improvement in the technology for identifying coronary artery stenosis and coronary artery disease in the last decade. During the acquisition, processing and analysis of data to study coronary anatomy, MDCT provides a unique opportunity to measure left ventricular volumes and LVEF simultaneously with the same data set without the need for additional contrast or radiation exposure. The development of semi-automated and automated software to measure LVEF has now added uniformity, efficiency and reproducibility of practical value in clinical practice rather than just being a research tool. This article will address the feasibility, the accuracy and the limitations of MDCT in measuring LVEF. PMID:25276310

  2. 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.

  3. [Applicability to exercise test of thermodilution technique for right ventricular ejection fraction].

    PubMed

    Kakimoto, T; Yamabe, H; Itoh, K; Yasaka, Y; Namura, H; Hashimoto, Y; Fujita, H; Yokoyama, M

    1993-04-01

    To assess the reliability of right ventricular ejection fraction (RVEF) during exercise measured by thermodilution technique using a modified Swan-Gantz catheter with a fast-response thermister, we measured RVEF under several conditions in 19 patients with cardiac disease. Measurements were repeated 5 times in each condition, and average RVEF and coefficient of variation (CV) were evaluated. 1) Injectate volume did not affect RVEF and CV. 2) A reduction in RVEF occurred with the thermister moved from proximal portion to distal portion within the pulmonary artery. 3) There were no differences in measurements of RVEF and CV between those during spontaneous breathing and those during apnea. 4) Postural change from supine to sitting decreased RVEF (38 +/- 8 to 35 +/- 9%; p < 0.05) and increased CV (7 +/- 2 to 13 +/- 5%). 5) Exercise increased RVEF (35 +/- 9 to 37 +/- 10%; p < 0.05) but did not change CV (13 +/- 5 vs 13 +/- 5%) compared with rest in the sitting position. 6) Cardiac rhythm (sinus vs atrial fibrillation) did not affect CV. 7) Average value of RVEF and CV during exercise were not different among 3, 4, 5 times repeated measurements. We considered that thermodilution technique for RVEF was applicable to exercise test, and 3 measurements were enough to determine the average value of RVEF during exercise.

  4. The Nitrate-Nitrite-NO Pathway and Its Implications for Heart Failure and Preserved Ejection Fraction.

    PubMed

    Chirinos, Julio A; Zamani, Payman

    2016-02-01

    The pathogenesis of exercise intolerance in patients with heart failure and preserved ejection fraction (HFpEF) is likely multifactorial. In addition to cardiac abnormalities (diastolic dysfunction, abnormal contractile reserve, chronotropic incompetence), several peripheral abnormalities are likely to be involved. These include abnormal pulsatile hemodynamics, abnormal arterial vasodilatory responses to exercise, and abnormal peripheral O2 delivery, extraction, and utilization. The nitrate-nitrite-NO pathway is emerging as a potential target to modify key physiologic abnormalities, including late systolic left ventricular (LV) load from arterial wave reflections (which has deleterious short- and long-term consequences for the LV), arterial vasodilatory reserve, muscle O2 delivery, and skeletal muscle mitochondrial function. In a recently completed randomized trial, the administration of a single dose of exogenous inorganic nitrate has been shown to exert various salutary arterial hemodynamic effects, ultimately leading to enhanced aerobic capacity in patients with HFpEF. These effects have the potential for both immediate improvements in exercise tolerance and for long-term "disease-modifying" effects. In this review, we provide an overview of key mechanistic contributors to exercise intolerance in HFpEF, and of the potential therapeutic role of drugs that target the nitrate-nitrite-NO pathway.

  5. Spironolactone for Management of Heart Failure with Preserved Ejection Fraction: Whither to After TOPCAT?

    PubMed

    Mitter, Sumeet S; Shah, Sanjiv J

    2015-11-01

    Mineralocorticoid receptor antagonists (MRAs) represent an attractive class of drugs for the treatment of heart failure with preserved ejection fraction (HFpEF) because of the deleterious cardiovascular effects of aldosterone and because MRAs combat myocardial fibrosis and improve cardiac structure/function and vascular health. Recently, the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) study, a randomized, double-blind clinical trial of spironolactone versus placebo, was conducted in 3445 patients with symptomatic HFpEF. Although considered by some to be a negative trial, TOPCAT demonstrated that spironolactone decreases heart failure hospitalizations in patients with HFpEF. Furthermore, a pre-specified subgroup analysis of TOPCAT by geographic region uncovered concerning findings from Russia/Georgia, questioning (1) whether the correct patients were enrolled in this region and (2) whether enrolled patients actually received the study drug. In the Americas, spironolactone was clearly superior to placebo in reducing cardiovascular events. Given these data from TOPCAT, basic science evidence for the role of aldosterone in HFpEF, and results from other MRA clinical trials in HFpEF, we advocate using spironolactone in HFpEF with close monitoring of potassium and renal function. PMID:26408016

  6. 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

  7. 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

  8. 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.

  9. Heart failure preserved ejection fraction (HFpEF): an integrated and strategic review.

    PubMed

    Lekavich, Carolyn L; Barksdale, Debra J; Neelon, Virginia; Wu, Jia-Rong

    2015-11-01

    In the USA, 5.7 million Americans ≥20 years have heart failure (HF) and heart failure preserved ejection fraction (HFpEF) accounts for at least 50 % of all hospital admissions for HF. HFpEF has no single guideline for diagnosis or treatment, the patient population is heterogeneously and inconsistently described, and longitudinal studies are lacking. The primary aims of this manuscript were to present an integrated review of the current state of the science on HFpEF, demonstrate gaps in the literature and provide the rationale for the design and implementation of future research to yield insights into the syndrome of HFpEF. The scientific literature was comprehensively reviewed on HFpEF pathophysiology, patient characteristics, diagnostic criteria, echocardiography biomarkers, treatment approaches and outcomes. Discrepancies in patient characteristics, diagnostic criteria, study methods and echocardiographic biomarkers were identified. This review indicates that no single test or guideline exists for diagnosis or treatment for HFpEF; heterogeneity of the population is complicated by multiple comorbidities that factor into etiology, race and age are likely important factors that define the phenotype, and limited information is available that designates early markers of impending HFpEF. Studies designed and adequately powered to study the impact of race and age along with consistent use of HFpEF diagnostic criteria are critically needed to further incident HFpEF research.

  10. 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

  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.

  12. 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

  13. 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

  14. [Automatic calculation of left ventricular volume and ejection fraction from gated myocardial perfusion SPECT--basic evaluation using phantom].

    PubMed

    Kinoshita, Y; Nanbu, I; Tohyama, J; Ooba, S

    1998-02-01

    We evaluated accuracy of Quantitative Gated SPECT Program that enabled calculation of the left ventricular (LV) volume and ejection fraction by automatically tracing the contour of the cardiac surface. Cardiac phantoms filled with 99mTc-solution were used. Data acquisition was made by 180-degree projection in L type and 360-degree projection in opposed type. Automatic calculation could be done in all processes, which required 3-4 minutes. Reproducibility was sufficient. The adequate cut off value of a prefilter was 0.45. At this value LV volume was 93% of the actual volume in L type acquisition and 95.9% in opposed type acquisition. The LV volume obtained in L type was smaller than that obtained in opposed type (p < 0.05). The tracing of the defects was fair, on the cardiac phantoms with all of 90-degree defects and 180-degree defects of the septal and lateral wall. The LV volume was estimated to be larger on the phantom with 180-degree defect of the anterior wall, and to be smaller on the phantom of 180-degree defect of the inferoposterior wall. Because tracing was deviated anteriorly at the defects. In the patients with similar conditions to 180-degree defect of the anterior wall or inferoposterior wall, the LV volume should be carefully evaluated.

  15. Milk fat and primary fractions obtained by dry fractionation 1. Chemical composition and crystallisation properties.

    PubMed

    Lopez, Christelle; Bourgaux, Claudie; Lesieur, Pierre; Riaublanc, Alain; Ollivon, Michel

    2006-10-01

    The chemical composition and crystallisation properties of milk fat and its primary fractions, obtained by dry fractionation at 21 degrees C, were investigated. The solid fraction (stearin) and the liquid fraction (olein) displayed a different triacylglycerol (TG) composition. Stearin fraction was enriched in long-chain fatty acids, whereas olein fraction was enriched in short-chain and unsaturated fatty acids. Crystallisation properties of milk fat, and both the stearin and olein fractions were studied on cooling at |dT/dt|=1 degrees C min(-1) by differential scanning calorimetry and time-resolved synchrotron X-ray diffraction (XRD) at small and wide angles. Two main types of crystals corresponding to double chain length structures were characterised in the stearin fraction: alpha 2L(1) (47.5 Angstrom) and beta' 2L(2) (41.7 Angstrom). A triple chain length structure was formed in the olein fraction: alpha 3L (72.1 Angstrom). Crystallization of milk fat showed the formation of two 2L (47.3 and 41.6 Angstrom) and one 3L (72.1 Angstrom) lamellar structures with an hexagonal packing (alpha form). A schematic representation of the 3L packing of olein fraction was proposed to explain how a wide diversity of TG can accommodate to form a lamellar structure with a thickness of 72 Angstrom. Furthermore, the sharpness of the small-angle XRD lines associated to the alpha form was explained by the formation of liquid crystals of smectic type.

  16. Cardiac Mechanics in Isolated Bicuspid Aortic Valve Disease With Normal Ejection Fraction

    PubMed Central

    Zhang, Xijun; Zhu, Meihua; He, Tao; Yuan, Jianjun; Zhu, Haohui; Morrisroe, Dennis E.; Ashraf, Muhammad; Sahn, David J.

    2015-01-01

    Abstract Aortic stenosis (AS) and aortic regurgitation (AR) are associated with congenital isolated bicuspid aortic valve (BAV) disease. The chronic pressure overload of AS and the volume overload of AR are known to impair the left ventricular function. This study assessed whether two-dimensional speckle tracking echocardiography (2D-STE) is capable of detecting the myocardial dysfunction associated with BAV caused by various aortic valve lesions in patients retaining normal ejection fraction (EF). Thirty-two isolated BAV patients and 20 healthy tricuspid aortic valve (TAV) volunteers were recruited. BAV patients were divided into 4 subgroups based on aortic valvular lesion types: normal function (NF) group, isolated AS group, isolated AR group, and a group who had both AS&AR. Myocardial strain and degree of twist were analyzed and compared between the BAV and TAV groups, as well as between valvular lesion groups and the NF group. Compared with healthy TAV controls, global radial strain (GRS), global circumferential strain (GCS), global longitudinal strain (GLS), and twist angle absolute values were lower in the BAV group (P < 0.05). The AS, AR, and AS&AR groups all demonstrated a significant decrease in GRS and GCS when compared with the TAV group. The AS and AS&AR groups demonstrated lower GLS than the TAV group, and the smallest degree of twist was detected in the AR group. There were no significant differences between the NF and TAV groups. The AR and AS&AR groups demonstrated significant differences in multiple parameters of cardiac mechanics compared with the NF group. 2D-STE is able to detect altered cardiac mechanics associated with aortic lesion types in BAV patients with normal EF compared with normal TAV controls, and so can provide valuable information for clinical decision-making. PMID:26632719

  17. Relation of Pre-anthracycline Serum Bilirubin Levels to Left Ventricular Ejection Fraction After Chemotherapy

    PubMed Central

    Vera, Trinity; D’Agostino, Ralph B.; Jordan, Jennifer H.; Whitlock, Matthew C.; Meléndez, Giselle C.; Lamar, Zanetta S.; Porosnicu, Mercedes; Bonkovsky, Herbert L.; Poole, Leslie B.; Hundley, W. Gregory

    2015-01-01

    Myocardial injury because of oxidative stress manifesting through reductions in left ventricular ejection fraction (LVEF) may occur after the administration of anthracycline-based chemotherapy (A-bC). We hypothesized that bilirubin, an effective endogenous antioxidant, may attenuate the reduction in LVEF that sometimes occurs after receipt of A-bC. We identified 751 consecutively treated patients with cancer who underwent a pre-A-bC LVEF measurement, exhibited a serum total bilirubin level <2 mg/dl, and then received a post-A-bC LVEF assessment because of symptomatology associated with heart failure. Analysis of variance, Tukey’s Studentized range test, and chi-square tests were used to evaluate an association between bilirubin and LVEF changes. The LVEF decreased by 10.7 ± 13.7%, 8.9 ± 11.8%, and 7.7 ± 11.5% in group 1 (bilirubin at baseline ≤0.5 mg/dl), group 2 (bilirubin 0.6 to 0.8 mg/dl), and group 3 (bilirubin 0.9 to 1.9 mg/dl), respectively. More group 1 patients experienced >15% decrease in LVEF compared with those in group 3 (p = 0.039). After adjusting for age, coronary artery disease/myocardial infarction, diabetes mellitus, hematocrit, and the use of cardioactive medications, higher precancer treatment bilirubin levels and lesser total anthracycline doses were associated with LVEF preservation (p =0.047 and 0.011, respectively). In patients treated with anthracyclines who subsequently develop symptoms associated with heart failure, pre-anthracycline treatment serum bilirubin levels inversely correlate with subsequent deterioration in post-cancer treatment LVEF. In conclusion, these results suggest that increased levels of circulating serum total bilirubin, an intrinsic antioxidant, may facilitate preservation of LVEF in patients receiving A-bC for cancer. PMID:26433273

  18. 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

  19. 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

  20. 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.

  1. 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

  2. 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

  3. 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

  4. Ejection Fraction and Mortality Rate of Patients with Isolated Acute Inferior Myocardial Infarction Reperfused by Streptokinase

    PubMed Central

    Beiraghdar, Mozhdeh; Reza Torknezhad, Mohammad; Torkan, Ali

    2011-01-01

    BACKGROUND This study aimed to evaluate the effects of streptokinase on left ventricular ejection fraction and mortality rate of patients with inferior acute myocardial infarction (AMI) without right ventricular myocardial infarction (RVMI). METHODS Fifty five consecutive patients with the diagnosis of inferior AMI without RVMI in the coronary care unit (CCU) of Shariati Hospital in Isfahan were selected for this study. Patients who had a history and/or electrocardiogram (ECG) evidence of previous myocardial infarction, evidence of bundle branch block, historical or clinical findings of valvular or other non-coronary heart diseases or heart failure were excluded. Participants were divided into two groups. Group one (n=28) had no contraindication for taking thrombolytic therapy and group two (n=27) had at least one contraindication for this treatment. Patients in group one took 1,000,000 units streptokinase for one hour. Three days later, LVEF of all participants was measured by an experienced cardiologist using 2-dimentiona1 echocardiography. Patients were followed up until four weeks to assess the mortality rate. RESULTS One death in the first 24 hours was reported in group one. However, no death was reported in any group until four weeks after discharge. There was no significant difference in mortality rate during the first 24 hours and four weeks after discharge between the two groups. Mean LVEF in the two groups did not show any significant difference (P=0.21). CONCLUSION Probably streptokinase has no effects on one-month mortality rate and LVEF in patients with inferior AMI without RVMI. Therefore, streptokinase side effects must be taken into consideration when being administered for this group of patients. PMID:22577446

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

    PubMed Central

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

    2014-01-01

    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

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

    PubMed

    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 (E h GSH) and cysteine (E h 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 E h 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 E h 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

  7. 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.

  8. 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.

  9. [Asymptomatic severe aortic stenosis with preserved left ventricular ejection fraction. Evaluation by exercise test: which results and which decision?].

    PubMed

    Bensahi, I; Elfhal, A; Magne, J; Dulgheru, R; Lancellotti, P; Pierard, L

    2015-04-01

    Aortic stenosis is the most common valvular heart disease in Europe and North America and it is a real public health problem. Its prevalence increases with population aging. Symptomatic patients require surgery (class I, level of evidence B). In asymptomatic patients, a stress test with or without imaging is recommended to unmask the false asymptomatic patients and refine risk stratification of occurrence of major events. This support remains difficult and makes the optimal timing for surgery controversial in the absence of prospective data on the determinants of aortic stenosis progression, multicenter studies on risk stratification or randomized studies on patient management. The complexity of care arises from the balance between the spontaneous disease risk (risk of sudden death and irreversible left ventricular dysfunction) and the risk of surgery and prosthetic complications. It is therefore crucial to identify subgroups of patients at risk of pejorative progression in whom prophylactic surgery may be considered. This article focuses on evaluating during exercise asymptomatic patients with severe aortic stenosis and preserved left ventricular ejection fraction. We will explain how to perform the test, determine which echocardiographic measurements should be obtained, focusing on the diagnostic and prognostic value of these measurements and discuss indications for surgery according to new practice guidelines. PMID:25661422

  10. 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

  11. [Echocardiographic evaluation of systolic left ventricular function in heart failure: value of alternative parameters for determination of ejection fraction].

    PubMed

    Dornberger, V; Dittrich, H D; Busch, R

    2015-04-01

    Assessment of the left ventricular ejection fraction plays a key role in the echocardiographic diagnosis of heart failure. The parameter most commonly used is the ejection fraction computed with the biplane disc summation method of Simpson; however, there are numerous limitations to this method, such as the assumption of geometrical symmetry, a substantial intraobserver and interobserver variability, foreshortening of the left ventricle and insufficient image quality for endocardial tracking. Alternative parameters for the evaluation of left ventricular function should be taken into consideration. Speckle tracking echocardiography has proven to be a reliable prognostic factor and a good tool for differentiating cardiomyopathies. Simple measurements, which are also feasible with poor image quality, are mitral annular plane systolic excursion (MAPSE) and the velocity of mitral annular movement (Sm or S'). In mitral regurgitation, left ventricular dP/dt represents the time to build up a certain pressure gradient and is therefore a measure of the contractile force exerted. Three-dimensional echocardiography has proven to be an important tool not only for three-dimensional measurement of the left ventricular ejection fraction but also for multivectoral speckle tracking analysis.

  12. 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.

  13. Quantification of Left Ventricular Volumes, Mass and Ejection Fraction using Cine Displacement Encoding with Stimulated Echoes (DENSE) MRI

    PubMed Central

    Haggerty, Christopher M.; Kramer, Sage P.; Skrinjar, Oskar; Binkley, Cassi M.; Powell, David K.; Mattingly, Andrea C.; Epstein, Frederick H.; Fornwalt, Brandon K.

    2014-01-01

    Purpose To test the hypothesis that magnitude images from cine Displacement Encoding with Stimulated Echoes (DENSE) MRI can accurately quantify left ventricular (LV) volumes, mass, and ejection fraction. Materials and Methods Thirteen mice (C57BL/6J) were imaged using a 7T ClinScan MRI. A short-axis stack of cine T2-weighted black blood (BB) images was acquired for calculation of left ventricular volumes, mass, and ejection fraction (EF) using the gold standard sum-of-slices methodology. DENSE images were acquired during the same imaging session in three short-axis (basal, mid, apical) and two long-axis orientations. A custom surface fitting algorithm was applied to epicardial and endocardial borders from the DENSE magnitude images to calculate volumes, mass, and EF. Agreement between the DENSE-derived measures and BB-derived measures was assessed via coefficient of variation (CoV). Results 3D surface reconstruction was completed on the order of seconds from segmented images, and required fewer slices to be segmented. Volumes, mass, and EF from DENSE-derived surfaces matched well with BB data (CoVs ≤11%). Conclusion LV mass, volumes, and ejection fraction in mice can be quantified through sparse (5 slices) sampling with DENSE. This consolidation significantly reduces the time required to assess both mass/volume-based measures of cardiac function and advanced cardiac mechanics. PMID:24923710

  14. 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

  15. 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

  16. 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.

  17. 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

  18. 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

  19. 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

  20. 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

  1. 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

  2. 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.

  3. [Determination of the ejection fraction of the left ventricle by videodensitometric analysis of digital angiography. Preliminary results].

    PubMed

    Angel, C Y; Vuthien, H; Letienne, G; Pernes, J M; Brenot, P; Parola, J L; Raynaud, A; Gaux, J C

    1985-08-01

    Digitalisation enables angiocardiography to be performed by a peripheral intravenous injection. Computer-assisted analysis of the date widens the possibilities of quantification. The authors have developed a videodensitometric method of studying the left ventricular ejection fraction. The research was performed on an experimental model and the technique validated in a series of 10 patients. The experimental model consisted of a series of balloons which, when inflated with contrast medium assumed an allipsoid shape resembling a left ventricle. The balloons were blown up in two stages with an automatic injector to simulate systole and diastole. The images were recorded in the same way as during ventriculography. Videodensitometric measurements showed 3 to 5% variations from the true values. The method was then applied to the calculation of the left ventricular ejection fraction in 10 patients: left ventricular function was also quantified by geometrical methods (Dodge) from the same angiogrammes and the 2 sets of results were then compared. The correlation coefficient between the two methods was 0.97, so validating the new technique. Videodensitometry opens up new perspectives in the study of left ventricular function. On the other hand it can be used to monitor the ejection fraction in severely ill or recently operated patients, and, on the other hand the principle of videodensitometry eliminates the geometrical approximations inherent in the classical methods of angiographic analysis and would therefore seem to be more suitable for the study of pathological left ventricules (aneurysm...). Finally, the technique of videodensitometry represents a new step towards the measurement of true volumes and flow rates. PMID:3935074

  4. Dual antiplatelet compared to triple antithrombotic therapy in anterior wall acute myocardial infarction complicated by depressed left ventricular ejection fraction

    PubMed Central

    Oyetayo, Ola O.; Slicker, Kipp; De La Rosa, Lisa; Lane, Wesley; Langsjoen, Dane; Patel, Chhaya; Brough, Kevin; Chiles, Christopher

    2015-01-01

    Current guidelines recommend triple antithrombotic therapy (TT) consisting of warfarin, aspirin, and a P2Y12 inhibitor following an anterior ST elevation myocardial infarction (STEMI) complicated by extensive wall motion abnormalities. This recommendation, however, is based on data collected before percutaneous coronary intervention (PCI) became the standard of care for the treatment of STEMI. We designed a retrospective study of patients who received PCI for anterior STEMI over an 8-year period to compare rates of thromboembolic and bleeding events between patients receiving dual antiplatelet therapy (DAPT) and those receiving TT, including warfarin. Patients were included if the predischarge echocardiogram showed extensive wall motion abnormality and an ejection fraction ≤35%. Patients with known left ventricular thrombus were excluded. A total of 124 patients met the criteria, with 80 patients in the DAPT group and 44 in the TT group. The median age was 58 years in the TT group and 64 years in the DAPT group (P < 0.04), with an average ejection fraction of 31%. Thromboembolic events occurred in 4 patients (5%) in the DAPT group compared with 3 patients (6.8%) in the TT group (P = 0.70). Bleeding occurred in 2 patients in the DAPT group and 4 patients in the TT group (2.5% in DAPT vs. 9.1% in TT group, P = 0.18). No differences in rates of clinical embolism or left ventricular thrombus were found. Our data support recent findings that warfarin may not be indicated for patients following PCI for anterior STEMI, even when significant wall motion abnormalities and reduced ejection fraction ≤35% are present. PMID:26424937

  5. Regional ejection fraction and regional area strain for left ventricular function assessment in male patients after first-time myocardial infarction.

    PubMed

    Teo, Soo-Kng; Vos, F J A; Tan, Ru-San; Zhong, Liang; Su, Yi

    2015-04-01

    In this work, we present a method to assess left ventricle (LV) regional function from cardiac magnetic resonance (CMR) imaging based on the regional ejection fraction (REF) and regional area strain (RAS). CMR scans were performed for 30 patients after first-time myocardial infarction (MI) and nine age- and sex-matched healthy volunteers. The CMR images were processed to reconstruct three-dimensional LV geometry, and the REF and RAS in a 16-segment model were computed using our proposed methodology. The method of computing the REF was tested and shown to be robust against variation in user input. Furthermore, analysis of data was feasible in all patients and healthy volunteers without any exclusions. The REF correlated well with the RAS in a nonlinear manner (quadratic fit-R(2) = 0.88). In patients after first-time MI, the REF and RAS were significantly reduced across all 16 segments (REF: p < 0.05; RAS: p < 0.01). Moreover, the REF and RAS significantly decreased with the extent of transmural scar obtained from late gadolinium-enhanced CMR images. In addition, we show that the REF and RAS can be used to identify regions with compromised function in the patients with preserved global ejection fraction with reasonable accuracy (more than 78%). These preliminary results confirmed the validity of our approach for accurate analysis of LV regional function. Our approach potentially offers physicians new insights into the local characteristics of the myocardial mechanics after a MI.

  6. 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

  7. Computerized left ventricular regional ejection fraction analysis for detection of ischemic coronary artery disease with multidetector CT angiography.

    PubMed

    Zeb, Irfan; Li, Dong; Nasir, Khurram; Gupta, Mohit; Kadakia, Jigar; Gao, Yanlin; Ma, Eva; Mao, Song Shou; Budoff, Matthew

    2013-03-01

    Regional ejection fraction (REF) provides important functional information of the left ventricular regional myocardium. We aimed to test the diagnostic accuracy of computerized REF analysis for detecting the ischemia and significant stenosis with multidetector CT angiography (MDCT). This is a retrospective study including 155 patients who underwent MDCT scans for evaluation of coronary artery disease. Among them, 83 patients also underwent SPECT imaging and invasive coronary angiography (ICA). Two groups of patients were defined: Control group with 0 coronary artery calcium and normal global and regional ventricular function, and comparison group. REF measurement was performed on all patients using computerized software. Control group REF measurements will be used as reference standard (mean-2SD REF/mean global ejection fraction) to define abnormal REF. The sensitivity, specificity, positive and negative predictive value of REF in detecting perfusion defects (fixed and reversible) was 73, 80, 75 and 79 % respectively, in a patient based analysis of comparison group. The diagnostic accuracy of REF in predicting significant stenosis (>50 %) on ICA compared with SPECT was 72 versus 61 % and 85 versus 79 % in patient and vessel based analysis of comparison group, respectively. ROC curve analysis showed REF to be a better predictor of perfusion defects on SPECT compared with significant stenosis (>50 %) alone or stenosis combined with REF (P < 0.05). The computerized assessment of REF analysis is comparable to SPECT in predicting ischemia and a better predictor of significant stenosis than SPECT. This study also provides reference standard to define abnormal values.

  8. 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

  9. Right ventricular ejection fraction is better reflected by transverse rather than longitudinal wall motion in pulmonary hypertension

    PubMed Central

    2010-01-01

    Background Longitudinal wall motion of the right ventricle (RV), generally quantified as tricuspid annular systolic excursion (TAPSE), has been well studied in pulmonary hypertension (PH). In contrast, transverse wall motion has been examined less. Therefore, the aim of this study was to evaluate regional RV transverse wall motion in PH, and its relation to global RV pump function, quantified as RV ejection fraction (RVEF). Methods In 101 PH patients and 29 control subjects cardiovascular magnetic resonance was performed. From four-chamber cine imaging, RV transverse motion was quantified as the change of the septum-free-wall (SF) distance between end-diastole and end-systole at seven levels along an apex-to-base axis. For each level, regional absolute and fractional transverse distance change (SFD and fractional-SFD) were computed and related to RVEF. Longitudinal measures, including TAPSE and fractional tricuspid-annulus-apex distance change (fractional-TAAD) were evaluated for comparison. Results Transverse wall motion was significantly reduced at all levels compared to control subjects (p < 0.001). For all levels, fractional-SFD and SFD were related to RVEF, with the strongest relation at mid RV (R2 = 0.70, p < 0.001 and R2 = 0.62, p < 0.001). For TAPSE and fractional-TAAD, weaker relations with RVEF were found (R2 = 0.21, p < 0.001 and R2 = 0.27, p < 0.001). Conclusions Regional transverse wall movements provide important information of RV function in PH. Compared to longitudinal motion, transverse motion at mid RV reveals a significantly stronger relationship with RVEF and thereby might be a better predictor for RV function. PMID:20525337

  10. 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.

  11. 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

  12. Anaesthetic Management of Renal Transplant Surgery in Patients of Dilated Cardiomyopathy with Ejection Fraction Less Than 40%

    PubMed Central

    Tiwari, Tanmay; Sahu, Sandeep; Chandra, Abhilash; Dhiraaj, Sanjay

    2014-01-01

    Cardiovascular disease (CVD) is an important comorbidity of chronic kidney disease, and reducing cardiovascular events in this population is an important goal for the clinicians who care for chronic kidney disease patients. The high risk for CVD in transplant recipients is in part explained by the high prevalence of conventional CVD risk factors (e.g., diabetes, hypertension, and dyslipidemia) in this patient population. Current transplant success allows recipients with previous contraindications to transplant to have access to this procedure with more frequency and safety. Herein we provide a series of eight patients with dilated cardiomyopathy with poor ejection fraction posted for live donor renal transplantation which was successfully performed under regional anesthesia with sedation. PMID:25210514

  13. 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.

  14. 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.

  15. Right ventricular ejection fraction measured by first-pass intravenous krypton-81m: reproducibility and comparison with technetium-99m.

    PubMed

    Wong, D F; Natarajan, T K; Summer, W; Tibbits, P A; Beck, T; Koller, D; Kasecamp, W; Lamb, J; Olynyk, J; Philp, M S

    1985-11-01

    Study of the effects of various diseases and therapeutic manipulation of pulmonary vascular resistance on the right ventricle has been restricted by methodologic limitations. The radioactive gas in solution, krypton-81m was used to study the right ventricle and the technique was compared with a technetium-99m method. In 22 subjects, first-pass krypton-81m right ventricular ejection fraction, acquired both in list mode and electrocardiogram-gated frame mode, correlated well (r = 0.81 and 0.86, respectively, p less than 0.01) with that determined by technetium-99m first-pass studies over a broad range of ventricular function. The reproducibility of the technique was excellent (r = 0.84 and 0.95 for each acquisition mode, respectively). Krypton-81m first-pass studies provide accurate and reproducible estimates of right ventricular function. Use of krypton allows multiple measurements, with or without perturbations, over a short period of time.

  16. 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

  17. 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.

  18. 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.

  19. 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

  20. Characterization of Subgroups of Heart Failure Patients with Preserved Ejection Fraction with Possible Implications for Prognosis and Treatment Response

    PubMed Central

    Kao, David P; Lewsey, James D; Anand, Inder S; Massie, Barry M; Zile, Michael; Carson, Peter E; McKelvie, Robert; Komajda, Michel; McMurray, John; Lindenfeld, JoAnn

    2015-01-01

    Background Patients with heart failure and preserved ejection fraction (HFpEF) have a poor prognosis, and no therapies have been proven to improve outcomes. It has been proposed that heart failure, including HFpEF, represents overlapping syndromes that may have different prognoses. We present an exploratory study of patients enrolled in the Irbesartan in Heart Failure with Preserved Ejection Fraction Study (I-PRESERVE) using latent class analysis (LCA) with validation using the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM)-Preserved study to identify HFpEF subgroups. Methods and results In total, 4113 HFpEF patients randomized to irbesartan or placebo were characterized according to 11 clinical features. HFpEF subgroups were identified using LCA. Event-free survival and effect of irbesartan on the composite of all-cause mortality and cardiovascular hospitalization were determined for each subgroup. Subgroup definitions were applied to 3203 patients enrolled in CHARM-Preserved to validate observations regarding prognosis and treatment response. Six subgroups were identified with significant differences in event-free survival (p<0.001). Clinical profiles and prognoses of the 6 subgroups were similar in CHARM-Preserved. The two subgroups with the worst event-free survival in both studies were characterized by a high prevalence of obesity, hyperlipidemia, diabetes mellitus, anemia, and renal insufficiency (Subgroup C) and by female predominance, advanced age, lower body mass index, and high rates of atrial fibrillation, valvular disease, renal insufficiency, and anemia (Subgroup F). Conclusion Using a data-driven approach, we identified HFpEF subgroups with significantly different prognoses. Further development of this approach for characterizing HFpEF subgroups is warranted. PMID:26250359

  1. Association of Modifiable Risk Factors and Left Ventricular Ejection Fraction among Hospitalized Native Hawaiians and Pacific Islanders with Heart Failure

    PubMed Central

    Seto, Todd B; Kaholokula, Joseph K; Howard, Barbara; Ratner, Robert E

    2014-01-01

    Background: Heart Failure (HF) disproportionately affects Native Hawaiians and Other Pacific Islanders (NHOPIs). This study examines risk factors associated with left ventricular ejection fraction (LVEF) among 151 hospitalized NHOPI HF patients enrolled at a single tertiary care hospital between June 2006 and April 2010. Methods: Enrollment criteria: (1) NHOPI by self-identification. (2) Age ≥ 21 yrs. (3) Diagnosis of HF defined: (a) left ventricular ejection fraction (LVEF) ≤ 40% or LVEF ≤ 60% with abnormal diastolic function and (b) classic HF signs/symptoms. LVEF was measured by echocardiography within 6 weeks of hospitalization. Clinical measures, medical history, and questionnaires were assessed using standardized protocols. Linear regression modeling was used to examine the association of significant correlates of LVEF, which were then included en bloc into the final model. A P-value < .05 was considered statistically significant. Results: Of 151 participants, 69% were men, mean age 54.3 ± 13.5 years, blood pressure 112 ± 20/69 ± 15 mmHg, and body mass index (BMI) 36.9 ± 9 kg/m2. Twenty-five percent of participants were smokers, 45% used alcohol and 23% reported a history of methamphetamine use. Clinically, 72% had hypertension, 49% were diabetic and 37% had a prior myocardial infarction. Nearly 60% had moderate to severe LVEF (< 35%). Higher LVEF was independently associated with female sex and greater BMI (P < .04) while pacemaker/defibrillator and methamphetamine use was independently associated with lower LVEF (P < .05). Conclusions: Methamphetamine use and BMI may be important modifiable risk factors associated with LVEF and may be important targets for improving HF morbidity and mortality. PMID:25535596

  2. 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

  3. 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.

  4. Scintigraphic prediction of pulmonary arterial systolic pressure by regional right ventricular ejection fraction during the second half of systole

    SciTech Connect

    Friedman, B.J.; Holman, B.L.

    1982-11-01

    In 49 patients in whom gated equilibrium ventriculography and cardiac catheterization were performed within a 6 day interval, total and fractional portions of global and regional right ventricular ejection fraction (RVEF) were correlated with pulmonary arterial systolic pressure. Pulmonary arterial systolic pressure was normal (30 mm Hg or less) in 27 patients (Group I) and elevated (31 mm Hg or greater) in 22 patients (Group II). The second-half regional RVEF was 38 +/- 8% (mean +/- standard deviation) with a range of 30 to 54% for Group I and 22 +/- 6% with a range of 13 to 32% for Group II. The difference between the means was statistically significant (p less than 0.001). Use of a second-half regional RVEF of 30% as the criterion of elevated pulmonary arterial systolic pressure resulted in a sensitivity of 0.86 and a specificity of 1.00. A power curve fit in which pulmonary arterial systolic pressure . 10.91 (second-half regional RVEF)-0.87 allowed accurate estimation (r . -0.85) of pulmonary arterial systolic pressure from the second-half regional RVEF. It is concluded that second-half regional RVEF may be used to accurately detect pulmonary arterial hypertension and to estimate its extent.

  5. 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

  6. Fractionation of elements by particle size of ashes ejected from Copahue Volcano, Argentina.

    PubMed

    Gómez, Dario; Smichowski, Patricia; Polla, Griselda; Ledesma, Ariel; Resnizky, Sara; Rosa, Susana

    2002-12-01

    The volcano Copahue, Neuquén province, Argentina has shown infrequent explosive eruptions since the 18th century. Recently, eruptive activity and seismicity were registered in the period July-October, 2000. As a consequence, ash clouds were dispersed by winds and affected Caviahue village located at about 9 km east of the volcano. Samples of deposited particles from this area were collected during this episode for their chemical analysis to determine elements of concern with respect to the health of the local population and its environment. Different techniques were used to evaluate the distribution of elements in four particle size ranges from 36 to 300 microm. X-ray powder diffraction (XRD) was selected to detect major components namely, minerals, silicate glass, fragments of rocks and sulfurs. Major and minor elements (Al, Ca, Cl, Fe, K, Mg, Mn, Na, S, Si and Ti), were detected by energy dispersive X ray analysis (EDAX). Trace element (As, Cd, Cr, Cu, Hg, Ni, Pb, Sb, U, V and Zn) content was quantified by inductively coupled plasma-mass spectrometry (ICP-MS). Nuclear activation analysis (NAA) was employed for the determination of Ce, Co, Cs, Eu, Hf, La, Lu, Rb, Sc, Sm, Ta and Yb. An enrichment was observed in the smallest size fraction of volcanic ashes for four elements (As, Cd, Cu and Sb) of particular interest from the environmental and human health point of view.

  7. Fractionation of elements by particle size of ashes ejected from Copahue Volcano, Argentina.

    PubMed

    Gómez, Dario; Smichowski, Patricia; Polla, Griselda; Ledesma, Ariel; Resnizky, Sara; Rosa, Susana

    2002-12-01

    The volcano Copahue, Neuquén province, Argentina has shown infrequent explosive eruptions since the 18th century. Recently, eruptive activity and seismicity were registered in the period July-October, 2000. As a consequence, ash clouds were dispersed by winds and affected Caviahue village located at about 9 km east of the volcano. Samples of deposited particles from this area were collected during this episode for their chemical analysis to determine elements of concern with respect to the health of the local population and its environment. Different techniques were used to evaluate the distribution of elements in four particle size ranges from 36 to 300 microm. X-ray powder diffraction (XRD) was selected to detect major components namely, minerals, silicate glass, fragments of rocks and sulfurs. Major and minor elements (Al, Ca, Cl, Fe, K, Mg, Mn, Na, S, Si and Ti), were detected by energy dispersive X ray analysis (EDAX). Trace element (As, Cd, Cr, Cu, Hg, Ni, Pb, Sb, U, V and Zn) content was quantified by inductively coupled plasma-mass spectrometry (ICP-MS). Nuclear activation analysis (NAA) was employed for the determination of Ce, Co, Cs, Eu, Hf, La, Lu, Rb, Sc, Sm, Ta and Yb. An enrichment was observed in the smallest size fraction of volcanic ashes for four elements (As, Cd, Cu and Sb) of particular interest from the environmental and human health point of view. PMID:12509053

  8. 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

  9. 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.

  10. 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

  11. 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.

  12. Development of Left Ventricular Diastolic Dysfunction with Preservation of Ejection Fraction during Progression of Infant Right Ventricular Hypertrophy

    PubMed Central

    Kitahori, Kazuo; He, Huamei; Kawata, Mitsuhiro; Cowan, Douglas B.; Friehs, Ingeborg; del Nido, Pedro J.; McGowan, Francis X.

    2011-01-01

    Background Progressive left ventricular (LV) dysfunction can be a major late complication in patients with chronic right ventricular (RV) pressure overload (e.g., tetralogy of Fallot). We therefore examined LV function (serial echocardiography and ex vivo Langendorff) and histology in a model of infant pressure-load RV hypertrophy (RVH). Methods and Results Ten-day-old rabbits (N=6 per time point, total = 48) that underwent pulmonary artery banding (PAB) were sacrificed at 2–8 weeks after PAB, and comparisons were made with age-matched sham controls. LV performance (myocardial performance index, MPI) decreased during the progression of RVH although the LV ejection fraction (EF) was maintained. In addition, RVH caused significant septal displacement, reduced septal contractility, and decreased LV end-systolic (LVDs) and diastolic (LVDd) dimensions, resulting in LV diastolic dysfunction with the appearance of preserved EF. Significant septal and LV free wall apoptosis (myocyte-specific TUNEL and activated caspase-3), fibrosis (Masson’s trichrome stain), and reduced capillary density (CD31 immunostaining) occurred in the PAB group after 6–8 wks (all p<0.05). Conclusion This is the first study showing that pressure overload of the RV resulting in RVH causes LV diastolic dysfunction while preserving EF through mechanical and molecular effects upon the septum and LV myocardium. In particular, the development of RVH is associated with septal and LV apoptosis and reduced LV capillary density. PMID:19919985

  13. 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

  14. Global and regional left ventricular strain indices in post-myocardial infarction patients with ventricular arrhythmias and moderately abnormal ejection fraction.

    PubMed

    Nguyen, Bich Lien; Capotosto, Lidia; Persi, Alessandro; Placanica, Attilio; Rafique, Asim; Piccirillo, Gianfranco; Gaudio, Carlo; Gang, Eli S; Siegel, Robert J; Vitarelli, Antonio

    2015-02-01

    The aim of the study described here was to compare myocardial strains in ischemic heart patients with and without sustained ventricular tachycardia (VT) and moderately abnormal left ventricular ejection fraction (LVEF) to investigate which index could better predict VT on the basis of the analysis of global and regional left ventricular (LV) dysfunction. We studied 467 patients with previous myocardial infarction and LVEF >35%. Fifty-one patients had documented VT, and 416 patients presented with no VT. LV volumes and score index were obtained by 2-D echocardiography. Longitudinal, radial and circumferential strains were determined. Strains of the infarct, border and remote zones were also obtained. There were no differences in standard LV 2-D parameters between patients with and those without VT. Receiver operating characteristic values were -12.7% for global longitudinal strain (area under the curve [AUC] = 0.72), -4.8% for posterior-inferior wall circumferential strain (AUC = 0.80), 61 ms for LV mechanical dispersion (AUC = 0.84), -10.1% for longitudinal strain of the border zone (AUC = 0.86) and -9.2% for circumferential strain of the border zone (AUC = 0.89). In patients with previous myocardial infarction and moderately abnormal LVEF, peri-infarct circumferential strain was the strongest predictor of documented ventricular arrhythmias among all strain quantitative indices. Additionally, strain values from posterior-inferior wall infarctions had a higher association with arrhythmic events compared with global strain.

  15. Systolic Longitudinal Function of the Left Ventricle Assessed by Speckle Tracking in Heart Failure Patients with Preserved Ejection Fraction

    PubMed Central

    Toufan, Mehrnoush; Mohammadzadeh Gharebaghi, Saeed; Pourafkari, Leili; Delir Abdolahinia, Elham

    2015-01-01

    Background: Echocardiographic evaluations of the longitudinal axis of the left ventricular (LV) function have been used in the diagnosis and assessment of heart failure with normal ejection fraction (HFNEF). The evaluation of the global and segmental peak systolic longitudinal strains (PSLSs) by two-dimensional speckle tracking echocardiography (STE) may correlate with conventional echocardiography findings. We aimed to use STE to evaluate the longitudinal function of the LV in patients with HFNEF. Methods: In this study, 126 patients with HFNEF and diastolic dysfunction and 60 normal subjects on conventional echocardiography underwent STE evaluations, including LV end-diastolic and end-systolic dimensions; interventricular septal thickness; posterior wall thickness; LV volume; LV ejection fraction; left atrial volume index; early diastolic peak flow velocity (𝐸); late diastolic peak flow velocity (𝐴); 𝐸/𝐴 ratio; deceleration time of 𝐸; early diastolic myocardial velocity (e′); late diastolic myocardial velocity (A′); systolic myocardial velocity (S); and global, basal, mid, and apical PSLSs. The correlations between these methods were assessed. Results: The mean age was 57.50 ± 10.07 years in the HFNEF patients and 54.90 ± 7.17 years in the control group. The HFNEF group comprised 69.8% males and 30.2% females, and the normal group consisted of 70% males and 30% females. The global, basal, mid, and apical PSLSs were significantly lower in the HFNEF group (p value < 0.001 for all). There was a significant positive correlation between the global PSLS and the septal e' (p value < 0.001). There was a negative correlation between the global PSLS and the E/e' ratio (p value = 0.001). There was a significant negative correlation between the E/e' ratio and the mid PSLS (p value = 0.002) and the basal PSLS (p value = 0.001). There was a weak positive correlation between the septal e' and the mid PSLS (p value = 0.001) and the

  16. 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

  17. Treating Heart Failure with Preserved Ejection Fraction Related to Arterial Stiffness. Can we Kill Two Birds With One Stone?

    PubMed

    Athyros, Vasilios G; Pagourelias, Efstathios D; Gossios, Thomas D; Vasilikos, Vasilios G

    2015-01-01

    Heart failure with preserved ejection fraction (HFpEF). Arterial hypertension (AH), arterial stiffness (AS), older age, and female gender are the main determinants of HFpEF, but several cardiac or extra-cardiac pathologies are also possible causes. The combined ventricular-vascular stiffening (abnormal left atrium-left ventricle coupling related to AS) is the main contributor of the increased prevalence of HFpEF in elderly persons, particularly elderly women, and in younger persons with AH. The hospitalization and mortality rates of HFpEF are similar to those of heart failure with reduced EF (HFrEF). However, although the prognosis of HFrEF has been substantially improved during the last 2 decades, the effective treatment of HFpEF remains an unmet need. Regimens effective in HFrEF have no substantial effect on HFpEF, because of different pathophysiologies of the 2 syndromes. Pipeline drugs seem promising, but it will take some years before they are commercially available. Aggressive treatment of noncardiac comorbidities seems to be the only option at hand. Treatment of anaemia, sleep disorders, chronic kidney disease (CKD), non-alcoholic fatty liver (NAFLD), atrial fibrillation, diabetes, and careful use of diuretics to reduce preload are effective to some degree. Statin treatment, despite the presence of dyslipidaemia, deserves special attention because it has been proven, mainly in small studies or post hoc analyses of trials, that it offers a substantial improvement in quality of life and a reduction in mortality rates. We need to urgently utilize these recourses to relieve a considerable part of the general population suffering from HFpEF, a deadly disease.

  18. 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

  19. 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

  20. Comparison of Causes of Death After Heart Transplantation in Patients With Left Ventricular Ejection Fractions ≤35% Versus >35.

    PubMed

    Birati, Edo Y; Mathelier, Hansie; Molina, Maria; Hanff, Thomas C; Mazurek, Jeremy A; Atluri, Pavan; Acker, Michael A; Rame, J Eduardo; Margulies, Kenneth B; Goldberg, Lee R; Jessup, Mariell

    2016-04-15

    Sudden cardiac death (SCD) is a common cause of death in the general population, occurring in 300,000 to 350,000 people in the United States alone. Currently, there are no data supporting implantable cardioverter-defibrillator therapy in patients who underwent orthotopic heart transplant (OHT) with low left ventricular ejection fraction (LVEF). In this retrospective study, we included all patients who underwent primary OHT at our institution from 2007 to 2013. We compared the cause of death in patients who underwent OHT and evaluated the correlation of the cause of death and the patients' LVEF. Our objectives were to determine whether patients who underwent OHT with LVEF <35% are at increased risk for SCD compared with those who underwent OHT with normal LVEF. To summarize our results, a total of 345 patients were included in our study (mean age 50 ± 14 years, 68% men). The mean follow-up was 1,260 ± 698 days. Forty patients (11.5%) died >6 months after OHT. Surviving patients had higher LVEF compared with deceased patients (64 ± 7% and 50 ± 24%, respectively, p ≤0.001). In all, 10 (25%) of the deceased patients died suddenly, 9 (23%) from sepsis, and 8 (20%) from malignancy. Of the 11 deceased patients with LVEF ≤35%, 2 patients (18%) died suddenly compared with 9 SCDs among the 29 deceased patients (31%) with LVEF >35% (p = 0.54). In conclusion, patients who underwent OHT who died were more likely to have LVEF <35%, and a quarter of the deceased patients who underwent OHT died suddenly. A reduced LVEF was not associated with an increased risk of SCD. PMID:26899490

  1. 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

  2. Comparison of Causes of Death After Heart Transplantation in Patients With Left Ventricular Ejection Fractions ≤35% Versus >35.

    PubMed

    Birati, Edo Y; Mathelier, Hansie; Molina, Maria; Hanff, Thomas C; Mazurek, Jeremy A; Atluri, Pavan; Acker, Michael A; Rame, J Eduardo; Margulies, Kenneth B; Goldberg, Lee R; Jessup, Mariell

    2016-04-15

    Sudden cardiac death (SCD) is a common cause of death in the general population, occurring in 300,000 to 350,000 people in the United States alone. Currently, there are no data supporting implantable cardioverter-defibrillator therapy in patients who underwent orthotopic heart transplant (OHT) with low left ventricular ejection fraction (LVEF). In this retrospective study, we included all patients who underwent primary OHT at our institution from 2007 to 2013. We compared the cause of death in patients who underwent OHT and evaluated the correlation of the cause of death and the patients' LVEF. Our objectives were to determine whether patients who underwent OHT with LVEF <35% are at increased risk for SCD compared with those who underwent OHT with normal LVEF. To summarize our results, a total of 345 patients were included in our study (mean age 50 ± 14 years, 68% men). The mean follow-up was 1,260 ± 698 days. Forty patients (11.5%) died >6 months after OHT. Surviving patients had higher LVEF compared with deceased patients (64 ± 7% and 50 ± 24%, respectively, p ≤0.001). In all, 10 (25%) of the deceased patients died suddenly, 9 (23%) from sepsis, and 8 (20%) from malignancy. Of the 11 deceased patients with LVEF ≤35%, 2 patients (18%) died suddenly compared with 9 SCDs among the 29 deceased patients (31%) with LVEF >35% (p = 0.54). In conclusion, patients who underwent OHT who died were more likely to have LVEF <35%, and a quarter of the deceased patients who underwent OHT died suddenly. A reduced LVEF was not associated with an increased risk of SCD.

  3. A pilot study of angiogenin in heart failure with preserved ejection fraction: a novel potential biomarker for diagnosis and prognosis?

    PubMed Central

    Jiang, Hong; Zhang, Lei; Yu, Ying; Liu, Ming; Jin, Xuejuan; Zhang, Peipei; Yu, Peng; Zhang, Shuning; Zhu, Hongmin; Chen, Ruizhen; Zou, Yunzeng; Ge, Junbo

    2014-01-01

    Characteristics of heart failure with preserved ejection fraction (HFPEF) have not yet been fully understood. The objectives of this pilot study are to detect protein expression profile in the sera of HFPEF patients, and to identify potential biomarkers for the disease. Five hundred and seven proteins were detected in the sera of healthy volunteers and patients with either HFPEF or hypertension using antibody microarrays (three in each group). The results showed that the serum concentrations of 17 proteins (e.g. angiogenin, activin A and artemin) differed considerably between HFPEF and non-HFPEF patients (hypertensive patients and healthy controls), while a protein expression pattern distinct from that in non-HFPEF patients was associated with HFPEF patients. The up-regulation of angiogenin in both HFPEF patients with LVEF ≥50% (P = 0.004) and a subset of HFPEF patients with LVEF = 41–49% (P < 0.001) was further validated in 16 HFPEF patients and 16 healthy controls. Meanwhile, angiogenin distinguished HFPEF patients from controls with a mean area under the receiver operating characteristic curve of 0.88 (P < 0.001) and a diagnostic cut-off point of 426 ng/ml. Moreover, the angiogenin levels in HFPEF patients were positively correlated with Lg(N-terminal pro-B-type natriuretic peptide, NT-proBNP) (P < 0.001). In addition, high angiogenin level (≥426 ng/ml) was a predictor of all-cause death within a short-term follow-up duration, but not in the longer term of 36 months. This pilot study indicates that the aforementioned 17 potential biomarkers, such as angiogenin, may hold great promise for both diagnosis and prognosis assessment of HFPEF. PMID:25124701

  4. Acute hemodynamic effects of inhaled sodium nitrite in pulmonary hypertension associated with heart failure with preserved ejection fraction

    PubMed Central

    Simon, Marc A.; Vanderpool, Rebecca R.; Nouraie, Mehdi; Bachman, Timothy N.; White, Pamela M.; Sugahara, Masataka; Gorcsan, John; Parsley, Ed L.; Gladwin, Mark T.

    2016-01-01

    BACKGROUND. Pulmonary hypertension (PH) is associated with poor outcomes, yet specific treatments only exist for a small subset of patients. The most common form of PH is that associated with left heart disease (Group 2), for which there is no approved therapy. Nitrite has shown efficacy in preclinical animal models of Group 1 and 2 PH, as well as in patients with left heart failure with preserved ejection fraction (HFpEF). We evaluated the safety and efficacy of a potentially novel inhaled formulation of nitrite in PH-HFpEF patients as compared with Group 1 and 3 PH. METHODS. Cardiopulmonary hemodynamics were recorded after acute administration of inhaled nitrite at 2 doses, 45 and 90 mg. Safety endpoints included change in systemic blood pressure and methemoglobin levels. Responses were also compared with those administered inhaled nitric oxide. RESULTS. Thirty-six patients were enrolled (10 PH-HFpEF, 20 Group 1 pulmonary arterial hypertension patients on background PH-specific therapy, and 6 Group 3 PH). Drug administration was well tolerated. Nitrite inhalation significantly lowered pulmonary, right atrial, and pulmonary capillary wedge pressures, most pronounced in patients with PH-HFpEF. There was a modest decrease in cardiac output and systemic blood pressure. Pulmonary vascular resistance decreased only in Group 3 PH patients. There was substantial increase in pulmonary artery compliance, most pronounced in patients with PH-HFpEF. CONCLUSIONS. Inhaled nitrite is safe in PH patients and may be efficacious in PH-HFpEF and Group 3 PH primarily via improvements in left and right ventricular filling pressures and pulmonary artery compliance. The lack of change in pulmonary vascular resistance likely may limit efficacy for Group 1 patients. TRIAL REGISTRATION. ClinicalTrials.gov NCT01431313 FUNDING. This work was supported in part by the NIH grants P01HL103455 (to MAS and MTG), R01HL098032 (to MTG), and R01HL096973 (to MTG), and Mast Therapeutics, Inc. PMID

  5. Early aneurysm formation following anterior mycardial infarction: A better predictor of mortality than left ventricular ejection fraction

    SciTech Connect

    Meizlish, J.L.; Plankey, M.; Berger, H.; Zaret, B.

    1984-01-01

    To compare the prognostic effect of aneurysmal infarct expansion (AN) to ejection fraction (EF), 52 consecutive high risk patients (pts) with initial anterior transmural myocardial infarction (MI) underwent 4-view bedside multigated cardiac blood pool imaging within 48 hours of chest pain and prehospital discharge. AN was strictly defined as an akinetic or diskinetic portion of the left ventricle which had diastolic deformity and was adjacent to areas with normal motion. EF < 35% was found to be the best EF cut-off for testing prediction of mortality. One year follow-up was performed by telephone interview (14 months, range 6-21). AN developed in 18/52 pts (35%), 9 developed by 48 hours and 9 further predischarge. 35/52 patients (69%) had EF < 35%. One year mortality was 27% (14/52). AN was highly predictive of death: 11/18 pts with AN died, while only 3/34 without AN died (chi/sup 2/ = 16.35, rho <.001). This was independent of EF: EF did not differ between pts with and without AN (27.5 +- 8.8 vs 31.5 +- 11.2, rho NS). In contrast EF < 35% was not as useful in predicting mortality; 12/35 pts with EF < 35% died while 2/17 with EF greater than or equal to 35% (chi/sup 2/ = 2.95, rho NS). The presence of AN was equally sensitive (79% vs. 86%) and far more specific (82% vs. 39%) than EF for the prediction of mortality. The authors conclude, AN occurs frequently early following anterior MI and is an important and specific marker for mortality. It is superior to EF as a prognostic indicator in this high risk subset of pts and therefore may be a useful parameter in stratification of pts in trials designed to reduce mortality.

  6. 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

  7. 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.

  8. 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.

  9. 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

  10. The reproducibility of measurement of right ventricular ejection fraction and cardiac output by the thermodilution technique in patients on mechanical ventilation.

    PubMed

    Jensen, P J; Andersen, P K; Thøgersen, C

    1994-07-01

    Thermodilution determined right ventricular ejection fraction (RVEF) and cardiac output (CO) were measured in 48 critically ill patients requiring mechanical ventilation and inotropic and/or vasoactive drugs. The coefficient of variation on CO and RVEF were calculated from triple determinations. The average coefficient of variation based on 551 triple determinations was 12.6% for RVEF (range 2-51%) and 4.9% for CO (range 0-24%). If a 10% coefficient of variation was chosen as acceptable, 95% of the CO measurements were acceptable. The coefficient of variation on RVEF only fulfilled the 10% criteria in 46% of the measurements, but if the accepted level was raised to a 20% coefficient of variation, 90% of the measurements were acceptable. The measurement of RVEF and CO are used for calculation of e.g. right ventricular end diastolic volume (RVEDV). By applying the average coefficient of variation of RVEF and CO, the accumulated error on calculation of RVEDV was found to be divided by 15%- +20% at worst. Before derived parameters such as RVEDV are interpreted or compared with previously obtained values, the accumulated error should be calculated. To ensure the quality of the measurements, our recommendation is always to calculate the coefficient of variation for each triple determination of RVEF and CO. PMID:7941945

  11. [Use of fourier row as a method for analyzing the course of circadian heart rate in patients with left ventricular ejection fraction impairment].

    PubMed

    Walichiewicz, P; Mrózek, A; Rozentryt, P; Wilczek, K; Jacheć, W; Wodniecki, J; Szyguła, E; Wantrych, M

    1998-06-01

    The circadian heart rate course was assessed in 3 groups of patients with left ventricular ejection fraction (LVEF) 10-15%, 20-25% and 30-35%. The study comprised 36 persons. In 9 patients heart failure was due to MI and in 17--to dilated cardiomyopathy. Those with atrial fibrillation, ventricular tachycardia, supraventricular tachycardia, diabetes, valvular heart diseases and with central system disorders were excluded from the study. Left ventricular ejection fraction was evaluated by echocardiography. Heart rate, calculated as a mean value every 5 minutes, was taken in patients during 24 hour recordings. For each patient separately, mean value of all measurement was calculated. Then a ratio of each actual value to the mean value was calculated. This ratio was defined as relative heart rate; [formula: see text] Circadian heart rate courses were approximated by Fourier row: [formula: see text]. The 24 harmonics were analyzed. Statistically significant differences in circadian courses were closed to amplitudes of 1st, 12th, 13th, 14th, 16th, 18th harmonics. Using test of variance homogeneity it has been demonstrated that variability of amplitudes of 12th and 17th harmonics as well as phase of 5th harmonic depend on left ventricular ejection fraction.

  12. 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.

  13. 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

  14. Carotid arterial stiffness and its relationship to exercise intolerance in older patients with heart failure and preserved ejection fraction.

    PubMed

    Kitzman, Dalane W; Herrington, David M; Brubaker, Peter H; Moore, J Brian; Eggebeen, Joel; Haykowsky, Mark J

    2013-01-01

    Heart failure with a preserved ejection fraction (HFpEF) is the dominant form of heart failure in the older population. The primary chronic symptom in HFpEF is severe exercise intolerance; however, its pathophysiology and therapy are not well understood. We tested the hypothesis that older patients with HFpEF have increased arterial stiffness beyond what occurs with normal aging and that this contributes to their severe exercise intolerance. Sixty-nine patients ≥60 years of age with HFpEF and 62 healthy volunteers (24 young healthy subjects ≤30 years and 38 older healthy subjects ≥60 years old) were examined. Carotid arterial stiffness was assessed using high-resolution ultrasound, and peak exercise oxygen consumption was measured using expired gas analysis. Peak exercise oxygen consumption was severely reduced in the HFpEF patients compared with older healthy subjects (14.1±2.9 versus 19.7±3.7 mL/kg per minute; P<0.001) and in both was reduced compared with young healthy subjects (32.0±7.2 mL/kg per minute; both P<0.001). In HFpEF compared with older healthy subjects, carotid arterial distensibility was reduced (0.97±0.45 versus 1.33±0.55×10(-3) mm Hg(-1); P=0.008) and Young's elastic modulus was increased (1320±884 versus 925±530 kPa; P<0.02). Carotid arterial distensibility was directly (0.28; P=0.02) and Young's elastic modulus was inversely (-0.32; P=0.01) related to peak exercise oxygen consumption. Carotid arterial distensibility is decreased in HFpEF beyond the changes attributed to normal aging and is related to peak exercise oxygen consumption. This supports the hypothesis that increased arterial stiffness contributes to exercise intolerance in HFpEF and is a potential therapeutic target.

  15. 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

  16. What is the Lowest Value of Left Ventricular Baseline Ejection Fraction that Predicts Response to Cardiac Resynchronization Therapy?

    PubMed Central

    Agir, Aysen Agacdiken; Celikyurt, Umut; Sahin, Tayfun; Yilmaz, Irem; Karauzum, Kurtulus; Bozyel, Serdar; Ural, Dilek; Vural, Ahmet

    2014-01-01

    Background Cardiac resynchronization therapy (CRT) is an effective treatment option for patients with refractory heart failure. However, many patients do not respond to therapy. Although it has been thought that there was no relation between response to CRT and baseline ejection fraction (EF), the response rate of patients with different baseline LVEF to CRT has not been evaluated in severe left ventricular systolic dysfunction. We aimed to investigate any difference in response to CRT between the severe heart failure patients with different baseline LVEF. Material/Methods In this study, 141 consecutive patients (mean age 59±13 years; 89 men) with severe heart failure and complete LBBB were included. Patients were divided into 3 groups according to their baseline LVEF: 5–15%, Group 1; 15–25%, Group 2, and 25–35%, Group 3. NYHA functional class, LVEF, LV volumes, and diameters were assessed at baseline and after 6 months of CRT. A response to CRT was defined as a decrease in LVSVi (left ventricular end-systolic volume index) ≥10% on echocardiography at 6 months. Results After 6 months, a significant increase of EF and a significant decrease of LVESVi and LVEDVi after 6 months of CRT were observed in all groups. Although the magnitude of improvement in EF was biggest in the first group, the percentage of decrease in LVESVi and LVEDVi was similar between the groups. The improvement in NYHA functional class was similar in all EF subgroups. At 6-month follow-up, 100 (71%) patients showed a reduction of >10% in LVESVi (mean reduction: −15.5±26.1 ml/m2) and were therefore classified as responders to CRT. Response rate to CRT was similar in all groups. It was 67%, 75%, and 70% in Group 1, 2, and 3, respectively, at 6-month follow-up (p>0.05). There was no statistically significant relation between the response rate to CRT and baseline LVEF, showing that the CRT has beneficial effects even in patients with very low LVEF. Conclusions It seems there is no lower

  17. 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.

  18. 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

  19. 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

  20. Determination of antioxidant activity of bioactive peptide fractions obtained from yogurt.

    PubMed

    Aloğlu, H Sanlıdere; Oner, Z

    2011-11-01

    In this study, physicochemical and microbiological properties of traditional and commercial yogurt samples were determined during 4 wk of storage. Proteolytic activity, which occurs during the storage period of yogurt samples, was also determined. Peptide fractions obtained from yogurts were investigated and the effect of proteolysis on peptide release during storage was determined. The antioxidant activities of peptides released from yogurt water-soluble extracts (WSE) and from HPLC fractions were determined by 2,2'-azino-bis (3-ethylbenzothiazoline-6-sulfonic acid) (ABTS) and 2,2-diphenyl-1-picrylhydrazyl (DPPH) methods. The antioxidant activity of WSE from traditional yogurt was greater than that of WSE from commercial yogurts. In analysis by the ABTS method, mean values increased from 7.697 to 8.739 mM Trolox/g in commercial yogurts, and from 10.115 to 13.182 mM Trolox/g in traditional yogurts during storage. Antioxidant activities of peptides released from HPLC fractions of selected yogurt samples increased 10 to 200 times. In all yogurt samples, the greatest antioxidant activity was shown in the F2 fraction. After further fractionation of yogurt samples, the fractions coded as F2.2, F2.3, F4.3, and F4.4 had the highest antioxidant activity values. Total antioxidant activity of yogurts was low but after purification of peptides by fractionation in HPLC, peptide fractions with high antioxidant activity were obtained.

  1. Fibrosis assessment by integrated backscatter and its relationship with longitudinal deformation and diastolic function in heart failure with preserved ejection fraction.

    PubMed

    Carluccio, Erberto; Biagioli, Paolo; Zuchi, Cinzia; Bardelli, Giuliana; Murrone, Adriano; Lauciello, Rosanna; D'Addario, Sandra; Mengoni, Anna; Alunni, Gianfranco; Ambrosio, Giuseppe

    2016-07-01

    Myocardial reflectivity, as assessed by calibrated integrated backscatter (cIB) analysis, is a non-invasive surrogate for the amount of left ventricular (LV) fibrosis. The aim of this study was to assess the myocardial reflectivity pattern in patients with heart failure and preserved ejection fraction (HFpEF), and to evaluate its relationship with longitudinal systolic deformation of LV by 2D-speckle tracking echocardiography, and degree of diastolic dysfunction. Transthoracic echocardiography, myocardial Doppler-derived systolic (Sm) and early diastolic velocity (E'), global longitudinal strain (GLS), and tissue characterization by cIB, were obtained in 86 subjects, 46 with HFpEF, and 40 controls. GLS was significantly impaired in HFpEF patients (-15.4 ± 3.5 % vs -21.5 ± 2.9 % in controls; P < 0.0001). Increased myocardial reflectivity, as evidenced by less negative values of cIB, was also found in HFpEF compared to controls (-21.2 ± 4.4 dB vs -25.3 ± 3.9 dB, P < 0.0001). In HFpEF patients, myocardial reflectivity was positively related to GLS (r = 0.68, P < 0.0001), E/E' ratio (r = 0.38, P = 0.009), and Tau (r = 0.43, P = 0.002), and inversely related to E' velocity (r = -0.46, P = 0.0012). These associations remained significant after adjustment for age, preload and afterload indices. Patients with HFpEF show changes of LV structure consistent with enhanced fibrosis-as evidenced by increased myocardial reflectivity- which parallel the degree of diastolic dysfunction, and of longitudinal systolic dysfunction.

  2. 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

  3. 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

  4. 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

  5. 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

  6. 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

  7. A real-world perspective on the prevalence and treatment of heart failure with a reduced ejection fraction but no specific or only mild symptoms.

    PubMed

    Beygui, Farzin; Anguita, Manuel; Tebbe, Ulrich; Comin-Colet, Josep; Galinier, Michel; Bramlage, Peter; Turgonyi, Eva; Lins, Katharina; Imekraz, Lynda; de Frutos, Trinidad; Böhm, Michael

    2015-09-01

    Heart failure (HF) is commonly described according to the severity of symptoms, using the New York Heart Association (NYHA) classification, and the assessment of ventricular function, by measuring the left ventricular ejection fraction (LVEF). It is important to acknowledge, however, that the severity of symptoms does not systematically correlate with the level of ventricular systolic dysfunction. Patients with no or only mild symptoms are still at high risk of HF-related morbidity and mortality. The objective of this review was to summarize the prevalence, characteristics, and treatment of patients with chronic HF and mild or no symptoms and to review epidemiological data from three recent registries conducted in Europe. From a clinical practice perspective, patients with a reduced ejection fraction who have only mild symptoms appear to represent a group of patients for whom the provision of adequate medical care is yet to be optimized. While prescription of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and beta-blockers appears to be consistently high, the use of mineralocorticoid receptor antagonists is more variable and does not appear to be in accordance with the latest clinical guidelines. As approximately half of patients with HF and a reduced LVEF have NYHA class II symptoms, significant reductions in morbidity and mortality could be achieved by more comprehensive treatment of this population. PMID:26142166

  8. 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...

  9. 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.

  10. 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

  11. The effect of midazolam on left ventricular pump performance and contractility in anesthetized patients with coronary artery disease: effect of preoperative ejection fraction.

    PubMed

    Messina, A G; Paranicas, M; Yao, F S; Illner, P; Roman, M J; Saba, P S; Devereux, R B

    1995-10-01

    Forty patients undergoing coronary artery bypass grafting were studied, of whom 24 had depressed global left ventricular (LV) function at preoperative catheterization, to evaluate the effects of midazolam on LV pump performance and contractility. Transesophageal echocardiography and simultaneous hemodynamic measurements were used to assess LV preload, afterload, and systolic performance during inhalation of 100% O2 and after 0.1 mg/kg of midazolam. Systolic function indices were expressed as a percent of the predicted value for observed end-systolic stress to estimate LV contractility. In the entire study population, midazolam did not affect cardiac index. Heart rate and mean arterial pressure were reduced (63 +/- 13 to 59 +/- 12 bm; P < 0.0006 and 89 +/- 15 to 76 +/- 16 mm Hg; P < 0.0001) as were pulmonary capillary wedge pressure, central venous pressure, and systemic and pulmonary vascular resistance. Afterload, as measured by end-systolic stress, was reduced (55 +/- 33 to 48 +/- 26 kdyne/cm2; P = 0.007) with no change in fractional shortening or percent area change. As a result, systolic function decreased in relation to observed end-systolic stress, providing evidence of reduced LV contractility. Thus, midazolam administration (0.1 mg/kg) caused no change in cardiac pump performance but decreased LV contractility in the entire population. Myocardial contractility was lower at baseline and after the administration of midazolam in the depressed ejection fraction group, but the decrease in contractility was not exaggerated in the depressed ejection fraction group.(ABSTRACT TRUNCATED AT 250 WORDS)

  12. 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.

  13. 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.

  14. Circulating Fibroblast Growth Factor 21 is Associated with Diastolic Dysfunction in Heart Failure Patients with Preserved Ejection Fraction.

    PubMed

    Chou, Ruey-Hsing; Huang, Po-Hsun; Hsu, Chien-Yi; Chang, Chun-Chin; Leu, Hsin-Bang; Huang, Chin-Chou; Chen, Jaw-Wen; Lin, Shing-Jong

    2016-01-01

    Fibroblast growth factor 21 (FGF21), a polypeptide ligand promoted glucose homeostasis and lipids metabolism, was recently reported to attenuate cardiac hypertrophy. The aim of this study was to investigate the impact of FGF21 in diastolic heart failure. Subjects admitted for coronary angiogram were screened for heart failure, and those with left ventricular (LV) ejection fraction < 45% were excluded. Diastolic dysfunction was defined as functional abnormalities that exist during LV relaxation and filling by echocardiographic criteria. Plasma levels of FGF21 and N-terminal Pro-Brain Natriuretic Peptide (NT-pro-BNP) were determined. All patients were followed up for 1 year, or till the occurrence of heart failure readmission or death. Totally 95 patients with diastolic dysfunction and 143 controls were enrolled. Circulating FGF21 level was correlated with echocardiographic parameters of diastolic function and LV end-diastolic pressure (LVEDP). In multivariate logistic analysis, FGF21 was significantly associated with diastolic dysfunction, either identified by echocardiographic criteria (odds ratio: 2.97, p = 0.012) or confirmed with LVEDP level (odds ratio: 3.73, p = 0.030). Both plasma FGF21 (log rank p < 0.0001) and NT-pro-BNP levels (log rank p = 0.0057) showed good predictive power to the 1-year adverse cardiac events. This finding suggested FGF21 could be involved in the pathophysiology of diastolic heart failure. PMID:27650781

  15. Circulating Fibroblast Growth Factor 21 is Associated with Diastolic Dysfunction in Heart Failure Patients with Preserved Ejection Fraction

    PubMed Central

    Chou, Ruey-Hsing; Huang, Po-Hsun; Hsu, Chien-Yi; Chang, Chun-Chin; Leu, Hsin-Bang; Huang, Chin-Chou; Chen, Jaw-Wen; Lin, Shing-Jong

    2016-01-01

    Fibroblast growth factor 21 (FGF21), a polypeptide ligand promoted glucose homeostasis and lipids metabolism, was recently reported to attenuate cardiac hypertrophy. The aim of this study was to investigate the impact of FGF21 in diastolic heart failure. Subjects admitted for coronary angiogram were screened for heart failure, and those with left ventricular (LV) ejection fraction < 45% were excluded. Diastolic dysfunction was defined as functional abnormalities that exist during LV relaxation and filling by echocardiographic criteria. Plasma levels of FGF21 and N-terminal Pro-Brain Natriuretic Peptide (NT-pro-BNP) were determined. All patients were followed up for 1 year, or till the occurrence of heart failure readmission or death. Totally 95 patients with diastolic dysfunction and 143 controls were enrolled. Circulating FGF21 level was correlated with echocardiographic parameters of diastolic function and LV end-diastolic pressure (LVEDP). In multivariate logistic analysis, FGF21 was significantly associated with diastolic dysfunction, either identified by echocardiographic criteria (odds ratio: 2.97, p = 0.012) or confirmed with LVEDP level (odds ratio: 3.73, p = 0.030). Both plasma FGF21 (log rank p < 0.0001) and NT-pro-BNP levels (log rank p = 0.0057) showed good predictive power to the 1-year adverse cardiac events. This finding suggested FGF21 could be involved in the pathophysiology of diastolic heart failure. PMID:27650781

  16. Effect of Phosphodiesterase-5 Inhibition on Exercise Capacity and Clinical Status in Heart Failure with Preserved Ejection Fraction: A Randomized Clinical Trial

    PubMed Central

    Redfield, Margaret M; Chen, Horng H; Borlaug, Barry A; Semigran, Marc J.; Lee, Kerry L.; Lewis, Gregory; LeWinter, Martin M.; Rouleau, Jean L.; Bull, David A.; Mann, Douglas L.; Deswal, Anita; Stevenson, Lynne W.; Givertz, Michael M.; Ofili, Elizabeth O.; O’Connor, Christopher M.; Felker, G. Michael; Goldsmith, Steven R.; Bart, Bradley A.; McNulty, Steven E; Ibarra, Jenny C.; Lin, Grace; Oh, Jae K.; Patel, Manesh R.; Kim, Raymond J.; Tracy, Russell P.; Velazquez, Eric J.; Anstrom, Kevin J.; Hernandez, Adrian F.; Mascette, Alice M.; Braunwald, Eugene

    2013-01-01

    Importance Studies in experimental and human heart failure suggest that phosphodiesterase type-5 inhibitors may enhance cardiovascular function, and thus, exercise capacity in heart failure with preserved ejection fraction. Objective To determine the effect of the phosphodiesterase type-5 inhibitor, sildenafil, in comparison to placebo on exercise capacity and clinical status in heart failure with preserved ejection fraction. Design, setting, and patients Multicenter, double-blind, placebo-controlled, parallel design, randomized clinical trial of 216 stable outpatients with heart failure, ejection fraction ≥ 50%, elevated N-terminal pro-brain natriuretic peptide or elevated invasively-measured filling pressures, and reduced exercise capacity. Participants were randomized from October 2008 through February 2012 at 26 centers in the United States and Canada. Intervention Sildenafil (n=113) or placebo (n=103) administered orally at 20 mg three times daily for 12 weeks followed by 60 mg three times daily for 12 weeks. Main outcome measures Primary endpoint was change in peak oxygen consumption after 24 weeks of therapy. Secondary endpoints included change in six-minute walk distance and a three tier hierarchical composite clinical status score where patients were ranked (range 1-N) based on time to death, time to cardiovascular or cardiorenal hospitalization and change in quality of life for participants alive without cardiovascular or cardiorenal hospitalization at 24 weeks. Results Median age was 69 years and 48% of patients were female. At baseline, median peak oxygen consumption (11.7 ml/kg/min) and six-minute walk distance (308 meters) were reduced and median E/e′ (16), left atrial volume index (44 ml/m2) and pulmonary artery systolic pressure (41 mmHg) were consistent with chronically-elevated left ventricular filling pressures. At 24 weeks, median (interquartile range) changes in peak oxygen consumption (ml/kg/min) in patients who received placebo [−0

  17. Do X-ray determined cardiac volume and signs of congestive heart failure provide additional prognostic information after myocardial infarction if the left ventricular ejection fraction is known?

    PubMed

    Rollag, A; Mangschau, A; Jonsbu, J; Aase, O; Nerdrum, H J; Erikssen, J

    1989-04-01

    Cardiac volume (CV) was measured and indices of pulmonary congestion (PCG) were judged from routine chest films taken post myocardial infarction (AMI) in a consecutive series of 477 patients (340 first and 137 recurrent AMIs). Cardiac volume (CV) and signs of PCG were compared to left ventricular ejection fraction (LVEF), measured with isotope technique, and the prognostic value of all the parameters was assessed after 1 and 5 years. The accuracy of CV and PCG in predicting impaired LVEF was low (62% and 50% respectively). Although specificity is suboptimal, however, these parameters provided valuable prognostic information. For example, patients with signs of PCG had a very high 1 and 5 years' mortality, and two-thirds of those who died during the first year of observation had enlarged CV. The independent value of LVEF determination was mainly observed in re-AMI patients. A more restricted use of this expensive procedure may therefore be recommended. PMID:2498456

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

    PubMed Central

    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

    2015-01-01

    We sought to assess the performance of existing bleeding risk scores, such as HAS-BLED or 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 (WARCEF) trial. Proportional hazards models were used to test whether each score predicted major bleeding, and comparison of different risk scores was performed using Harell’s c-statistic and net-reclassification improvement (NRI) index. For the warfarin arm, both scores predicted bleeding risk, with OBRI having significantly higher c-statistic (0.72 vs 0.61; p=0.03) compared to HAS-BLED, though the NRI for comparing OBRI to HAS-BLED was not significant (0.32, 95% CI - 0.18-0.37). Performance of the OBRI and HAS-BLED risk scores were similar for the aspirin arm. For participants with OBRI score of 0 to 1, warfarin compared with aspirin reduced ischemic stroke (HR 0.51, 95% CI 0.26-0.98, p=0.042) without significantly increasing major bleeding (HR 1.24, 95% CI 0.66-2.30, 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 0.27-1.15, p=0.12), but major bleeding was increased (HR 4.04, 95% CI 1.99-8.22, p<0.001). In conclusion, existing bleeding risk scores can identify bleeding risk in HFrEF patients in SR, and could be tested for potentially identifying patients with a favorable risk / benefit profile for antithrombotic therapy with warfarin. PMID:26189039

  19. Sex differences in clinical characteristics and long-term outcome in acute decompensated heart failure patients with preserved and reduced ejection fraction.

    PubMed

    Nakada, Yasuki; Kawakami, Rika; Nakano, Tomoya; Takitsume, Akihiro; Nakagawa, Hitoshi; Ueda, Tomoya; Nishida, Taku; Onoue, Kenji; Soeda, Tsunenari; Okayama, Satoshi; Takeda, Yukiji; Watanabe, Makoto; Kawata, Hiroyuki; Okura, Hiroyuki; Saito, Yoshihiko

    2016-04-01

    In patients with acute decompensated heart failure (ADHF), sex differences considering clinical and pathophysiologic features are not fully understood. We investigated sex differences in left ventricular (LV) ejection fraction (LVEF), plasma B-type natriuretic peptide (BNP) levels, and prognostic factors in patients with ADHF in Japan. We studied 748 consecutive ADHF patients of 821 patients registered in the ADHF registry between January 2007 and December 2014. Patients were divided into four groups based on sex and LVEF [reduced (ejection fraction, or EF, <50%, heart failure with reduced EF, or HFrEF) or preserved (EF ≥50%, heart failure with preserved LVEF, or HFpEF)]. The primary endpoint was the combination of cardiovascular death and heart failure (HF) admission. The present study consisted of 311 female patients (50% HFrEF, 50% HFpEF) and 437 male patients (63% HFrEF, 37% HFpEF). There was significant difference between sexes in the LVEF distribution profile. The ratio of HFpEF patients was significantly higher in female patients than in male patients (P= 0.0004). Although there were no significant sex differences in median plasma BNP levels, the prognostic value of BNP levels was different between sexes. Kaplan-Meier analysis revealed that the high BNP group had worse prognosis than the low BNP group in male but not in female patients. In multivariate analysis, log transformed BNP at discharge predicted cardiovascular events in male but not in female HF patients (female, hazard ratio: 1.169; 95% confidence interval: 0.981-1.399;P= 0.0806; male, hazard ratio: 1.289; 95% confidence interval: 1.120-1.481;P= 0.0004). In patients with ADHF, the distribution of LV function and the prognostic significance of plasma BNP levels for long-term outcome were different between the sexes.

  20. 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.

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

    PubMed

    Cho, Jung Sun; Youn, Ho-Joong; Her, Sung-Ho; Park, Maen Won; Kim, Chan Joon; Park, Gyung-Min; Jeong, Myung Ho; 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

    2015-07-01

    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.

  2. Beta-Adrenergic Blockade Therapy for Autonomic Dysfunction is Less Effective for Elderly Patients with Heart Failure and Reduced Left Ventricular Ejection Fraction

    PubMed Central

    Shimamoto, Ken; Kawana, Masatoshi

    2015-01-01

    OBJECTIVE Heart rate variability (HRV) has been reported to be an independent predictor of all-cause and sudden cardiac death in patients with heart failure. In the aging heart, however, both autonomic and cardiac functions appear to be altered. We assessed the relationship between aging and responsiveness of HRV and ventricular remodeling to beta-adrenergic blockade therapy in patients with heart failure and reduced ejection fraction (HFREF). METHODS Twenty-eight clinically stable patients with chronic heart failure, sinus rhythm, and left ventricular ejection fraction <50% as confirmed by echocardiography were included. At baseline and after carvedilol treatment, 24-hour ambulatory Holter monitor recording was used to analyze HRV indices by the maximum entropy method. Changes in these parameters were compared among three age groups. RESULTS HR decreased in all groups after carvedilol treatment, but was still highest in the youngest group despite the same treatment doses. Time and frequency domain variables improved. The response of time domain variables (the standard deviation of all normal sinus to normal sinus [NN] intervals and the standard deviation of the averages of NN intervals in all 5-minute or 30-minute segments) to carvedilol therapy significantly decreased with increasing age. Ventricular reverse remodeling induced by carvedilol therapy significantly decreased with increasing age. Increases in time domain variables and a low-frequency domain moderately correlated with left ventricular reverse remodeling. CONCLUSION Beta-adrenergic blockade therapy improved HRV variables and ventricular remodeling in HFREF patients; however, the response tended to be milder in the elderly. HRV improvement was associated with ventricular reverse remodeling. PMID:26483614

  3. Convulsant activity and neurochemical alterations induced by a fraction obtained from fruit Averrhoa carambola (Oxalidaceae: Geraniales).

    PubMed

    Carolino, Ruither O G; Beleboni, Renê O; Pizzo, Andrea B; Vecchio, Flavio Del; Garcia-Cairasco, Norberto; Moyses-Neto, Miguel; Santos, Wagner F Dos; Coutinho-Netto, Joaquim

    2005-06-01

    We obtained a neurotoxic fraction (AcTx) from star fruit (Averrhoa carambola) and studied its effects on GABAergic and glutamatergic transmission systems. AcTx had no effect on GABA/glutamate uptake or release, or on glutamate binding. However, it specifically inhibited GABA binding in a concentration-dependent manner (IC(50)=0.89muM). Video-electroencephalogram recordings demonstrated that following cortical administration of AcTx, animals showed behavioral changes, including tonic-clonic seizures, evolving into status epilepticus, accompanied by cortical epileptiform activity. Chemical characterization of AcTx showed that this compound is a nonproteic molecule with a molecular weight less than 500, differing from oxalic acid. This neurotoxic fraction of star fruit may be considered a new tool for neurochemical and neuroethological research.

  4. 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

  5. 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

  6. 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

  7. 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

  8. Hormone therapy with tamoxifen reduces plasma levels of NT-B-type natriuretic peptide but does not change ventricular ejection fraction after chemotherapy in women with breast cancer.

    PubMed

    Silva, F B; Romero, W G; Carvalho, A L R; Borgo, M V; Amorim, M H C; Gouvea, S A; Abreu, G R

    2015-02-01

    The objective of this study was to evaluate the effect of tamoxifen on the plasma concentration of NT-pro-B-type natriuretic peptide (NT-proBNP) in women undergoing chemotherapy for breast cancer and to correlate changes in NT-proBNP with the left ventricular ejection fraction (LVEF). Over a period of 12 months, we followed 60 women with a diagnosis of breast cancer. The patients were separated into a group that received only chemotherapy (n=23), a group that received chemotherapy + tamoxifen (n=21), and a group that received only tamoxifen (n=16). Plasma levels of NT-proBNP were assessed at 0 (T0), 6 (T6), and 12 (T12) months of treatment, and echocardiography data were assessed at T0 and T12. Plasma NT-proBNP levels were increased in the chemotherapy-only group at T6 and T12, whereas elevated NT-proBNP levels were only found at T6 in the chemotherapy + tamoxifen group. At T12, the chemotherapy + tamoxifen group exhibited a significant reduction in the peptide to levels similar to the group that received tamoxifen alone. The chemotherapy-only group exhibited a significant decrease in LVEF at T12, whereas the chemotherapy + tamoxifen and tamoxifen-only groups maintained levels similar to those at the beginning of treatment. Treatment with tamoxifen for 6 months after chemotherapy significantly reduced the plasma levels of NT-proBNP and did not change LVEF in women with breast cancer.

  9. Changes in cardiopulmonary reserve and peripheral arterial function concomitantly with subclinical inflammation and oxidative stress in patients with heart failure with preserved ejection fraction.

    PubMed

    Vitiello, Damien; Harel, François; Touyz, Rhian M; Sirois, Martin G; Lavoie, Joel; Myers, Jonathan; Ducharme, Anique; Racine, Normand; O'Meara, Eileen; Gayda, Mathieu; Chabot-Blanchet, Malorie; Rouleau, Jean Lucien; de Denus, Simon; White, Michel

    2014-01-01

    Background. Changes in cardiopulmonary reserve and biomarkers related to wall stress, inflammation, and oxidative stress concomitantly with the evaluation of peripheral arterial blood flow have not been investigated in patients with heart failure with preserved ejection fraction (HFpEF) compared with healthy subjects (CTL). Methods and Results. Eighteen HFpEF patients and 14 CTL were recruited. Plasma levels of inflammatory and oxidative stress biomarkers were measured at rest. Brain natriuretic peptide (BNP) was measured at rest and peak exercise. Cardiopulmonary reserve was assessed using an exercise protocol with gas exchange analyses. Peripheral arterial blood flow was determined by strain gauge plethysmography. Peak VO2 (12.0 ± 0.4 versus 19.1 ± 1.1 mL/min/kg, P < 0.001) and oxygen uptake efficiency slope (1.55 ± 0.12 versus 2.06 ± 0.14, P < 0.05) were significantly decreased in HFpEF patients compared with CTL. BNP at rest and following stress, C-reactive-protein, interleukin-6, and TBARS were significantly elevated in HFpEF. Both basal and posthyperemic arterial blood flow were not significantly different between the HFpEF patients and CTL. Conclusions. HFpEF exhibits a severe reduction in cardiopulmonary reserve and oxygen uptake efficiency concomitantly with an elevation in a broad spectrum of biomarkers confirming an inflammatory and prooxidative status in patients with HFpEF. PMID:24719767

  10. Antithrombotic activity of fractions and components obtained from raspberry leaves (Rubus chingii).

    PubMed

    Han, Na; Gu, Yuhong; Ye, Chun; Cao, Yan; Liu, Zhihui; Yin, Jun

    2012-05-01

    The 70% ethanol fraction from an aqueous extract of raspberry leaves was shown to be the most antithrombotic fraction in in vitro and in vivo tests. The total flavonoids and phenolics in this fraction were 0.286g/g and 0.518g/g by colorimetry. Six compounds, including salicylic acid, kaempferol, quercetin, tiliroside, quercetin 3-O-β-d-glucopyranoside and kaempferol 3-O-β-d-glucopyranoside, were isolated from the active fraction. Among them, kaempferol, quercetin and tiliroside obviously delayed plasma recalcification time (PRT) in blood.

  11. 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

  12. Cardiosphere-derived cells reverse heart failure with preserved ejection fraction (HFpEF) in rats by decreasing fibrosis and inflammation

    PubMed Central

    Gallet, Romain; de Couto, Geoffrey; Simsolo, Eli; Valle, Jackelyn; Sun, Baiming; Liu, Weixin; Tseliou, Eleni; Zile, Michael R.; Marbán, Eduardo

    2016-01-01

    Background The pathogenesis of HFpEF is unclear, but fibrosis, inflammation and hypertrophy have been put forth as likely contributors. CDCs are heart-derived cell products with anti-fibrotic and anti-inflammatory properties. Objectives We questioned whether allogeneic rat CDCs might be able to decrease manifestations of HFpEF in hypertensive rats. Methods Starting at 7 weeks of age, Dahl salt-sensitive rats were fed a high-salt diet for 6–7 weeks and randomized to receive intracoronary CDCs or placebo. Dahl rats fed normal chow served as controls. Results High-salt rats developed hypertension, left ventricular (LV) hypertrophy and diastolic dysfunction, without impairment of ejection fraction. Four weeks after treatment, diastolic dysfunction resolved in CDC-treated rats but not in placebo. The improved LV relaxation was associated with lower LV end-diastolic pressure, decreased lung congestion and enhanced survival in CDC-treated rats. Histology and echocardiography revealed no decrease in cardiac hypertrophy after CDC treatment, consistent with the finding of sustained, equally-elevated blood pressure in CDC- and placebo-treated rats. Nevertheless, CDC treatment decreased LV fibrosis and inflammatory infiltrates. Serum inflammatory cytokines were likewise decreased after CDC treatment. Whole-transcriptome analysis revealed major HFpEF-related, CDC-reversed changes in numerous transcripts, including many involved in inflammation and/or fibrosis. Conclusion CDCs normalized LV relaxation and LV diastolic pressure while improving survival in a rat model of HFpEF. The benefits of CDCs occurred despite persistent hypertension and cardiac hypertrophy. By selectively reversing inflammation and fibrosis, CDCs may be beneficial in the treatment of HFpEF. PMID:27104217

  13. 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

  14. Speckle tracking determination of mitral tissue annular displacement: comparison with strain and ejection fraction, and association with outcomes in haemodialysis patients.

    PubMed

    Chiu, Diana Y Y; Abidin, Nik; Hughes, John; Sinha, Smeeta; Kalra, Philip A; Green, Darren

    2016-10-01

    Abnormal Global longitudinal strain (GLS) and reduced left ventricular ejection fraction (LVEF) are established poor prognostic risk factors in haemodialysis patients. Tissue motion annular displacement of mitral valve annulus (TMAD), determined by speckle tracking echocardiography (STE), can be performed rapidly and is an indicator of systolic dysfunction, but has been less well explored. This study aims to compare TMAD with GLS and LVEF and its association with outcomes in haemodialysis patients. 198 haemodialysis patients (median age 64.2 years, 69 % men) had 2D echocardiography, with STE determined GLS and TMAD. Bland-Altman analysis and linear regression assessed relationship between GLS, LVEF and TMAD. Cox regression analysis investigated association of TMAD with mortality and cardiac events. TMAD had low inter- and intra-observer variability with small biases and narrow limits of agreement (LOA) (bias of -0.01 ± 1.32 (95 % LOA was -2.60 to 2.58) and -0.07 ± 1.27 (95 % LOA -2.55 to 2.41) respectively). There was a moderate negative correlation between GLS and LVEF (r = -0.383, p < 0.001) and a weak positive correlation between TMAD and LVEF (r = 0.248, p < 0.001). There was strong negative correlation of TMAD with GLS (r = -0.614, p < 0.001). In a multivariable Cox regression analysis, TMAD was not associated with mortality (HR 1.04, 95 % CI 0.91-1.19), cardiac death (HR 1.03, 95 % CI 0.80-1.32) or cardiac events (HR 0.91, 95 % CI 0.80-1.02). TMAD is a quick and reproducible alternative to GLS which may be very useful in cardiovascular risk assessment, but does not have the same prognostic value in HD patients as GLS.

  15. Impact of Left Ventricular Ejection Fraction on Clinical Outcomes Over Five Years After Infarct-Related Coronary Artery Recanalization (from the Occluded Artery Trial [OAT])

    PubMed Central

    Kruk, Mariusz; Buller, Christopher E.; Tcheng, James Enlou; Dzavík, Vladimir; Menon, Venugopal; Mancini, G.B. John; Forman, Sandra A.; Kurray, Peter; Busz-Papiez, Benita; Lamas, Gervasio A.; Hochman, Judith S.

    2010-01-01

    In the Occluded Artery Trial (OAT), percutaneous coronary intervention (PCI) of an infarct-related artery on days 3 to 28 after acute myocardial infarction was of no benefit compared to medical therapy alone. The present analysis was conducted to determine whether PCI might provide benefit to the subgroup of higher risk patients with a depressed ejection fraction (EF). Of 2,185 analyzed patients (age 58.6 ± 11.0 years) with infarct-related artery occlusion on days 3 to 28 after acute myocardial infarction in the Occluded Artery Trial, 1,094 were assigned to PCI and 1,091 to medical therapy. The primary end point was a composite of death, reinfarction, and New York Heart Association class IV heart failure. The outcomes were analyzed by EF (first tertile, EF ≤44%, vs second and third tertiles combined, EF >44%). Interaction of the treatment effect with EF on the study outcomes were examined using the Cox survival model. The five-year rates of the primary end point (death, reinfarction, or New York Heart Association class IV heart failure) were not different in either subgroup (PCI vs medical therapy, hazard ratio 1.25, 99% confidence interval 0.83 to 1.88, for EF ≤44%; hazard ratio 0.98, 99% confidence interval 0.64 to 1.50, for EF >44%). However, in patients with an EF >44%, PCI reduced the rate of subsequent revascularization (p = 0.004, interaction p = 0.05). In conclusion, optimal medical therapy remains the overall treatment of choice for stable patients with a persistent total occlusion of the infarct-related artery after acute myocardial infarction, irrespective of the baseline EF. In patients with normal or moderately impaired left ventricular contractility, PCI reduced the need for subsequent revascularization but did not otherwise improve outcomes. PMID:20102883

  16. Comparison of ejection fraction and pulmonary blood volume ratio as markers of left ventricular dysfunction with single vessel coronary disease before and after PTCA

    SciTech Connect

    Liu, P.; Kiess, M.; Okada, R.D.; Boucher, C.A.; Strauss, H.W.

    1984-01-01

    Exercise induced increases in pulmonary blood volume (PBV) have been shown to correlate with transient exercised-induced increase in left ventricular (LV) filling pressure. To analyze the impact of single vessel disease on LV function, ejection fraction (EF) and PBV were measured by serial supine exercise gated scans (GBPS) on 53 patients with left anterior descending artery disease undergoing coronary angioplasty (PTCA). EF was defined by standard methods. The PBV ratio was taken as the exercise to rest counts from the lung regions of interest as previously reported. Regional wall motion (WM) was quantified by averaging the results of 5-point score system in each region from 3 observers. Normal was defined as: rest EF greater than or equal to .50 and increase in EF with exercise, PBV less than or equal to 1.06 and no deterioration in WM on exercise. Of the 53 patients, 54% were found to be abnormal by EF, but 83% by PBV (p<.01). Abnormal PBV ratio was also highly associated with exercise induced deterioration in WM on GBPS (p<.05). After PTCA, the proportion of patients with abnormal EF remained unchanged (50%), whereas those with abnormal PBV ratio decreased significantly (to 38%, p<0.01). The authors conclude: (1) PBV ratio (filling pressures) is more frequently abnormal than EF (systolic function) in single vessel disease; (2) There is a significant improvement of PBV ratio after PTGA; (3) This discordance of parameters of systolic and diastolic function suggests that PBV (and hence diastolic function) is a more sensitive indicator of changes in ventricular function following an intervention than EF.

  17. Diagnostic Accuracy of Cardiac Magnetic Resonance Imaging in the Evaluation of Newly Diagnosed Heart Failure With Reduced Left Ventricular Ejection Fraction.

    PubMed

    Won, Eugene; Donnino, Robert; Srichai, Monvadi B; Sedlis, Steven P; Feit, Frederick; Rolnitzky, Linda; Miller, Louis H; Iqbal, Sohah N; Axel, Leon; Nguyen, Brian; Slater, James; Shah, Binita

    2015-10-01

    The aim of this study was to determine the diagnostic value of cardiac magnetic resonance (CMR) imaging with late gadolinium enhancement (LGE), cine imaging, and resting first-pass perfusion (FPP) in the evaluation for ischemic (IC) versus nonischemic (NIC) cardiomyopathy in new-onset heart failure with reduced (≤40%) left ventricular ejection fraction (HFrEF). A retrospective chart review analysis identified 83 patients from January 2009 to June 2012 referred for CMR imaging evaluation for new-onset HFrEF with coronary angiography performed within 6 months of CMR. The diagnosis of IC was established using Felker criteria on coronary angiography. CMR sequences were evaluated for the presence of patterns suggestive of severe underlying coronary artery disease as the cause of HFrEF (subendocardial and/or transmural LGE, regional wall motion abnormality on cine, regional hypoperfusion defect on resting FPP). Discriminative power was assessed using receiver operator characteristics curve analysis. Coronary angiography identified 36 patients (43%) with IC. Presence of subendocardial and/or transmural LGE alone demonstrated good discriminative power (C-statistic 0.85, 95% confidence interval 0.76 to 0.94) for the diagnosis of IC. The presence of an ischemic pattern on both LGE and cine sequences resulted in a specificity of 87% for the diagnosis of IC, whereas the absence of an ischemic pattern on both LGE and cine sequences resulted in a specificity of 94% for the diagnosis of NIC. Addition of resting FPP on a subset of patients did not improve diagnostic values. In conclusion, CMR has potential value in the diagnostic evaluation of IC versus NIC.

  18. Combination of hemoglobin and left ventricular ejection fraction as a new predictor of contrast induced nephropathy in patients with non-ST elevation myocardial infarction

    PubMed Central

    Ugur, Murat; Uluganyan, Mahmut; Ekmekci, Ahmet; Bozbay, Mehmet; Karaca, Gurkan; Cicek, Gokhan; Koroglu, Bayram; Tusun, Eyup; Murat, Ahmet; Turan, Burak; Uyarel, Huseyin; Orhan, Ahmet Lutfi; Eren, Mehmet

    2014-01-01

    Background Hemoglobin concentration (Hb) and left ventricular ejection fraction (EF) are known predictors of contrast induced nephropathy (CIN). We hypothesized that combination of Hb concentration and left ventricular EF is superior to either variable alone in predicting contrast induced nephropathy in patients with acute coronary syndrome (ACS). Material/Methods Consecutive patients with ACS were prospectively enrolled. Patients considered for invasive strategy were included. Baseline creatinine levels were detected on admission and 24, 48 and 72 hours after coronary intervention. 25% or 0,5 umol/L increase in creatinine level was considered as CIN. Results 268 patients with ACS (mean age 58±11 years, 77% male) were enrolled. Contrast induced nephropathy was observed in 26 (9.7%) of patients. Baseline creatinine concentration, left ventricular EF, and Hemoglobin was significantly different between two groups. Contrast volume to estimated glomerular filtration rate ratio (OR: 1.310, 95% CI: 1.077–1.593, p=0.007) and the combination of Hb and left ventricular EF (OR: 0.996, 95% CI: 0.994–0.998, p=0.001) were found to be independent predictors for CIN. Hb × LVEF £690 had 85% sensitivity and 57% specificity to predict CIN (area under curve: 0.724, 95% CI: 0.625–0.824, p<0.001). In addition, Hb × LVEF £690 had a negative predictive value of 97% in our analysis. Conclusions The combination of Hb and left ventricular EF is better than either variable alone at predicting CIN in patients with ACS that undergone percutaneous coronary intervention. The prediction was independent of baseline renal function and volume of contrast agent. PMID:24920294

  19. Progression from normal to reduced left ventricular ejection fraction in patients with concentric left ventricular hypertrophy after long-term follow-up.

    PubMed

    Krishnamoorthy, Arun; Brown, Timothy; Ayers, Colby R; Gupta, Sachin; Rame, J Eduardo; Patel, Parag C; Markham, David W; Drazner, Mark H

    2011-10-01

    Whether concentric left ventricular (LV) hypertrophy (LVH) is a common precursor to depressed LV ejection fraction (EF) in humans is uncertain. From 1992 through 1994, 555 patients at our institution underwent echocardiography and had LVH (posterior or septal wall thickness ≥1.3 cm or concentric LVH noted) and normal LVEF. Of these, 220 (40%) had a follow-up assessment of LVEF by December 2008. The duration of follow-up was classified as short (≤7.5 years) or long (>7.5 years) term. The primary outcome was the development of a qualitatively depressed LVEF (mildly, moderately, or severely depressed). After a median follow-up of 7.5 years, 20% of the patients with concentric LVH developed a low LVEF. A low LVEF developed in 13% of subjects without interval myocardial infarction (MI) and 50% of subjects with interval MI during short-term follow-up (p <0.005). A low LVEF developed in 20% of subjects without interval MI and 44% of subjects with interval MI during long-term follow-up (p = 0.01). Of the subjects who developed a reduced LVEF, the relative wall thickness (median 0.5, 25th to 75th percentile 0.4 to 0.6) at follow-up was consistent with a concentric, rather than eccentric, phenotype. In conclusion, in patients with concentric LVH, the transition from a normal LVEF to a low LVEF was relatively infrequent (20%) after long-term follow-up in the absence of interval MI and usually did not result in a change in the LV geometry from a concentric to an eccentric phenotype. PMID:21798496

  20. 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.

  1. Low IL-10/TNFα ratio in patients with coronary artery disease and reduced left ventricular ejection fraction with a poor prognosis after 10 years.

    PubMed

    Dopheide, Jörn F; Knopf, Pascal; Zeller, Geraldine C; Vosseler, Markus; Abegunewardene, Nico; Münzel, Thomas; Espinola-Klein, Christine

    2015-04-01

    Monocytes and dendritic cells (DC) produce tumour necrosis factor (TNF)α during inflammatory processes, but secrete interleukin (IL)-10 simultaneously in order to balance the pro-inflammation. In the present study, we investigated the expression of TNFα and IL-10 by monocytes and DC in patients with a poor cardiovascular prognosis after 10 years. Peripheral blood monocytes were isolated from 30 patients with coronary artery disease (CAD) with stable angina pectoris (SAP), or with an acute coronary syndrome (ACS). Monocytes were differentiated over 7 days to DC. Intracellular accumulation of TNFα and IL-10 in monocytes and DC was analysed by flow cytometry and correlated with the heart function, total and cardiovascular (CV) mortality, as well as with cardiovascular event rate over 10 years. We observed a decreased left ventricular function (LV-EF) for both SAP and ACS patients (p<0.01), as well as a reduced IL-10/TNFα ratio for monocytes (p=0.01) and DC (p<0.01) for both patient groups in comparison to age-matched control group. Only the IL-10/TNFα ratio for monocytes correlated with LV-EF (r=0.4302; p<0.01). Patients with a low LV-EF as well as patients with a low IL-10/TNFα ratio showed an increased cardiovascular mortality over 10 years (both p<0.05). The IL-10/TNFα ratio is decreased in patients with low ejection fraction and poor prognosis. The reduced heart function correlates with an increased proinflammatory state (low monocytic IL-10/TNFα ratio) in patients with CAD. This observed imbalance of IL-10 and TNFα in monocytes might explain pathophysiological processes in atherosclerosis and heart failure. PMID:25384561

  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.

  3. Low-sodium dietary approaches to stop hypertension diet reduces blood pressure, arterial stiffness, and oxidative stress in hypertensive heart failure with preserved ejection fraction.

    PubMed

    Hummel, Scott L; Seymour, E Mitchell; Brook, Robert D; Kolias, Theodore J; Sheth, Samar S; Rosenblum, Hannah R; Wells, Joanna M; Weder, Alan B

    2012-11-01

    Recent studies suggest that oxidative stress and vascular dysfunction contribute to heart failure with preserved ejection fraction (HFPEF). In salt-sensitive HFPEF animal models, diets low in sodium and high in potassium, calcium, magnesium, and antioxidants attenuate oxidative stress and cardiovascular damage. We hypothesized that the sodium-restricted Dietary Approaches to Stop Hypertension diet (DASH/SRD) would have similar effects in human hypertensive HFPEF. Thirteen patients with treated hypertension and compensated HFPEF consumed the DASH/SRD for 21 days (all food/most beverages provided). The DASH/SRD reduced clinic systolic (155-138 mm Hg; P=0.02) and diastolic blood pressure (79-72 mm Hg; P=0.04), 24-hour ambulatory systolic (130-123 mm Hg; P=0.02) and diastolic blood pressure (67-62 mm Hg; P=0.02), and carotid-femoral pulse wave velocity (12.4-11.0 m/s; P=0.03). Urinary F2-isoprostanes decreased by 31% (209-144 pmol/mmol Cr; P=0.02) despite increased urinary aldosterone excretion. The reduction in urinary F2-isoprostanes closely correlated with the reduction in urinary sodium excretion on the DASH/SRD. In this cohort of HFPEF patients with treated hypertension, the DASH/SRD reduced systemic blood pressure, arterial stiffness, and oxidative stress. These findings are characteristic of salt-sensitive hypertension, a phenotype present in many HFPEF animal models and suggest shared pathophysiological mechanisms linking these 2 conditions. Further dietary modification studies could provide insights into the development and progression of hypertensive HFPEF.

  4. 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

  5. Risk stratification of patients with chronic heart failure using cardiac iodine‐123 metaiodobenzylguanidine imaging: incremental prognostic value over right ventricular ejection fraction

    PubMed Central

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

    2015-01-01

    Abstract Aims Right ventricular (RV) systolic dysfunction has been shown to be an independent predictor of clinical outcome in patients with chronic heart failure (CHF), and cardiac metaiodobenzylguanidine (MIBG) imaging also provides prognostic information. We aimed to evaluate the long‐term predictive value of combining RV systolic dysfunction and abnormal findings of cardiac MIBG imaging on outcome in CHF patients. Methods and results We enrolled 63 CHF outpatients with left ventricular ejection fraction (EF) <40% in a prospective cohort study. At entry, RVEF was measured by radionuclide angiography. Furthermore, cardiac MIBG imaging was performed, and the cardiac MIBG washout rate (WR) was calculated. Reduced RVEF was defined as ≤37%, and abnormal WR was defined as >27%. The study endpoint was unplanned hospitalization for worsening heart failure (WHF) and cardiac death. During a follow‐up period of 8.9 ± 4.3 years, 19 of 63 patients had unplanned hospitalization for WHF, and 19 of 63 patients had cardiac death. In multivariate analysis, both WR and RVEF were independent predictors of unplanned WHF hospitalization, while WR was also an independent predictor of cardiac death. A risk‐stratification model based on independent predictors of unplanned WHF hospitalization separated the patients into those with low (absence of the predictors), intermediate (one of the predictors), and high (two or more of the predictors) risk of unplanned WHF hospitalization (P < 0.0001) or cardiac death (P = 0.0113). Conclusions Cardiac MIBG imaging provides incremental value when it is used along with RV systolic dysfunction to predict clinical outcome in patients with CHF.

  6. Gluten protein composition in several fractions obtained by shear induced separation of wheat flour.

    PubMed

    van der Zalm, Elizabeth E J; Grabowska, Katarzyna J; Strubel, Maurice; van der Goot, Atze J; Hamer, Rob J; Boom, Remko M

    2010-10-13

    Recently, it was found that applying curvilinear shear flow in a cone-cone shearing device to wheat flour dough induces separation, resulting in a gluten-enriched fraction in the apex of the cone and gluten-depleted fraction at the outer part. This article describes whether fractionation of the various proteineous components occurs during and after separation of Soissons wheat flour. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and size-exclusion high performance liquid chromatography (SE-HPLC) were found to be suitable techniques for this. It is concluded that all protein fractions migrate to the center of the cone as a result of which the composition of the gluten-enriched fraction remains rather similar to that in the original flour. However, the larger glutenin polymer fraction migrated faster, as a result of which the concentration of large polymers was increased with a factor 2.4 compared to that of Soissons flour. The concentration of monomers in the gluten-enriched fraction was decreased to 70% of the original concentration in the original wheat flour.

  7. [Fractional and amino acid composition of krill proteins and the potential for obtaining protein preparations].

    PubMed

    Orlova, T A; Churina, E E; Kuranova, L K

    1985-01-01

    Studies of the fractional composition of krill proteins demonstrated that the content of protein fractions changes depending on the time of krill catch. The highest amount of water-soluble proteins is contained by krill caught in December (64%), of salt-soluble by krill caught in June (12%), base-soluble by krill caught in May, September and February (34%). Krill protein contains from 50 to 60% of water- and salt-soluble fractions. Analysis of the amino acid composition of krill proteins showed that it does not differ essentially from that of adequate food proteins.

  8. 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.

  9. Opposite predictive value of pulse pressure and aortic pulse wave velocity on heart failure with reduced left ventricular ejection fraction: insights from an Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS) substudy.

    PubMed

    Regnault, Veronique; Lagrange, Jérémy; Pizard, Anne; Safar, Michel E; Fay, Renaud; Pitt, Bertram; Challande, Pascal; Rossignol, Patrick; Zannad, Faiez; Lacolley, Patrick

    2014-01-01

    Although hypertension contributes significantly to worsen cardiovascular risk, blood pressure increment in subjects with heart failure is paradoxically associated with lower risk. The objective was to determine whether pulse pressure and pulse wave velocity (PWV) remain prognostic markers, independent of treatment in heart failure with reduced left ventricular function. The investigation involved 6632 patients of the Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study. All subjects had acute myocardial infarction with left ventricular ejection fraction <40% and signs/symptoms of heart failure. Carotid-femoral PWV was measured in a subpopulation of 306 subjects. In the overall population, baseline mean arterial pressure <90 mm Hg was associated with higher all-cause death (hazard ratio, 1.14 [95% confidence interval, 1.00-1.30]; P<0.05), whereas higher left ventricular ejection fraction or pulse pressure was associated with lower rates of all-cause death, cardiovascular death/hospitalization, and cardiovascular death. In the subpopulation, increased baseline PWV was associated with worse outcomes (all-cause death: 1.16 [1.03-1.30]; P<0.05 and cardiovascular deaths: 1.16 [1.03-1.31]; P<0.05), independent of age and left ventricular ejection fraction. Using multiple regression analysis, systolic blood pressure and age were the main independent factors positively associated with pulse pressure or PWV, both in the entire population or in the PWV substudy. In heart failure and low ejection fraction, our results suggest that pulse pressure, being negatively associated with outcome, is more dependent on left ventricular function and thereby no longer a marker of aortic elasticity. In contrast, increased aortic stiffness, assessed by PWV, contributes significantly to cardiovascular death.

  10. 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.

  11. 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

  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. 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.

  14. Relationship of Multidirectional Myocardial Strain with Radial Thickening and Ejection Fraction and Impact of Left Ventricular Hypertrophy. A Study in a Community-Based Cohort

    PubMed Central

    Russo, Cesare; Jin, Zhezhen; Homma, Shunichi; Rundek, Tatjana; Elkind, Mitchell S.V.; Sacco, Ralph L.; Di Tullio, Marco R.

    2012-01-01

    Background Left ventricular (LV) systolic strain provides additional prognostic value to LV ejection fraction (LVEF) and wall motion analysis. However, the relationship between myocardial multidirectional strain and LVEF, and the effect of LV hypertrophy on this relationship, are not completely understood especially in unselected populations. Methods LV global longitudinal (εL) and circumferential (εC) systolic strain analysis was performed by two-dimensional speckle-tracking echocardiography in 215 participants from a community-based study. LV radial wall thickening was measured as global radial strain (εR), and LVEF was assessed by biplane Simpson’s method. Results εR was significantly associated with εC (β=−0.56, p<0.01) and with εL (β= −0.18, p<0.01). The contribution of εL to εR was especially evident in subjects with lower εC and in presence of LV hypertrophy (β= −0.30, p<0.01). εL and εC were significantly associated with LVEF (β= −0.36 and β=−0.49, both p<0.01) independent of LV mass and other confounders, and their interaction significantly improved the prediction of LVEF (R-square change=0.14) but not of εR (R-square change=0.002). Conclusions εR is mainly related to εC with a smaller contribution of εL, which becomes especially evident in subjects with lower εC and in presence of LV hypertrophy. Therefore, radial thickening may not detect subclinical LV longitudinal function reduction in normal ventricles and when εC is preserved. While a reduction in εL has a limited impact on εR, it exerts a greater effect on global LVEF, therefore for a more accurate LVEF prediction both εL and εC need to be considered. PMID:23360509

  15. 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

  16. 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

  17. Point defect survival and clustering fractions obtained from molecular dynamics simulations of high energy cascades

    SciTech Connect

    Stoller, R.E.

    1995-12-31

    Evolution of high-energy displacement cascades in iron has been investigated for times up to 200 ps using molecular dynamics simulation. The simulations were carried out using the MOLDY code and a modified version of the many-body interatomic potential developed by Finnis and Sinclair. Previously reported results have been supplemented by a series of 10 keV simulations at 900 K and 20 keV simulations at 100K. Results indicate that the fraction of the Frenkel pairs escaping in-cascade recombination is somewhat higher and the fraction of the surviving point defects that cluster is lower in iron than in materials such as copper. In particular, vacancy clustering appears to be inhibited in iron. Many of the larger interstitial clusters were observed to exhibit a complex, three-dimensional morphology. Apparent mobility of the <111> crowdion and clusters of <111> crowdions was very high.

  18. 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

  19. 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.

  20. 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.

  1. The impact of hypertension as a road to heart failure with preserved ejection fraction: diagnostic value of two-dimensional speckle tracking echocardiography for the early impairment of left atrial-left ventricular-arterial coupling.

    PubMed

    Oki, Takashi; Miyoshi, Hirokazu; Oishi, Yoshifumi; Mizuguchi, Yukio; Ara, Nusrat; Iuchi, Arata

    2014-01-01

    Heart failure with preserved ejection fraction (HFPEF) is a syndrome that frequently occurs in older people and patients with cardiovascular risk factors, particularly hypertension. This syndrome is not a specific disease process, whereas is associated with high morbidity and mortality in patients with heart failure with reduced ejection fraction (HFREF) as well. Therefore, a "one size fits all" diagnosis strategy is unlikely to operate for patients with HFPEF. Assessment of left atrial (LA)-left ventricular (LV)-arterial coupling seems to have a clinical impact on hypertensive patients, because HF signs and symptoms have been found to be significantly related to inappropriate LA-LV interaction during diastole and LV-arterial interaction during systole. Two-dimensional speckle tracking echocardiography (2DSTE) is a new tool that may have a role in earlier detecting the impaired LA, LV, and arterial function in asymptomatic patients. This review explored the impact of LA-LV-arterial coupling in understanding the pathophysiology of hypertension as a road to HFPEF, and the possibilities of clinical application by using 2DSTE.

  2. 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

  3. 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

  4. Leaf area index retrieval using gap fractions obtained from high resolution satellite data: Comparisons of approaches, scales and atmospheric effects

    NASA Astrophysics Data System (ADS)

    Gonsamo, Alemu

    2010-08-01

    This study is aimed at demonstrating the feasibility of the large scale LAI inversion algorithms using red and near infrared reflectance obtained from high resolution satellite imagery. Radiances in digital counts were obtained in 10 m resolution acquired on cloud free day of August 23, 2007, by the SPOT 5 high resolution geometric (HRG) instrument on mostly temperate hardwood forest located in the Great Lakes - St. Lawrence forest in Southern Quebec. Normalized difference vegetation index (NDVI), scaled difference vegetation index (SDVI) and modified soil-adjusted vegetation index (MSAVI) were applied to calculate gap fractions. LAI was inverted from the gap fraction using the common Beer-Lambert's law of light extinction under forest canopy. The robustness of the algorithm was evaluated using the ground-based LAI measurements and by applying the methods for the independently simulated reflectance data using PROSPECT + SAIL coupled radiative transfer models. Furthermore, the high resolution LAI was compared with MODIS LAI product. The effects of atmospheric corrections and scales were investigated for all of the LAI retrieval methods. NDVI was found to be not suitable index for large scale LAI inversion due to the sensitivity to scale and atmospheric effects. SDVI was virtually scale and atmospheric correction invariant. MSAVI was also scale invariant. Considering all sensitivity analysis, MSAVI performed best followed by SDVI for robust LAI inversion from high resolution imagery.

  5. The no-touch vein graft for coronary artery bypass surgery preserves the left ventricular ejection fraction at 16 years postoperatively: long-term data from a longitudinal randomised trial

    PubMed Central

    Johansson, Benny; Samano, Ninos; Souza, Domingos; Bodin, Lennart; Filbey, Derek; Mannion, John D; Bojö, Leif

    2015-01-01

    Objectives To assess the left ventricular heart function and the clinical outcome 16 years after coronary artery bypass surgery. Design In a randomised trial, the no-touch (NT) vein graft in coronary artery bypass surgery has shown a superior patency rate, a slower progression of atherosclerosis and better clinical outcome compared to the conventional (C) vein graft at 8.5 years. All patients at mean time 16 years were offered an echocardiographic and clinical examination. Results In the NT-group 34 patients and in the C-group 31 patients underwent an echocardiography examination. A significantly better left ventricle ejection fraction was seen in the NT-group compared to the C-group (57.9% vs 49.4%; p=0.011). The size of the left atrium in NT was 21.7 cm2 compared to 23.9 cm2 in C; p=0.034. No patient in NT had atrial fibrillation compared to five patients in C (p=0.021). Patients with a brain natriuretic peptide value (BNP) ≥150 was 30% in NT compared to 38% in C. Total mortality was 25% in NT vs 27% in C. Cardiac-related deaths were 8% and 12% in NT and C respectively. Conclusions The NT vein graft preserves the left ventricular ejection fraction after 16 years. A smaller left atrium, a lower BNP and no atrial fibrillation indicates an improved diastolic left ventricular function in the NT-group. Trial registration The study is registered with clinicaltrials.gov (NCT01686100) and The Research and Development registry in Sweden (no. 102841). PMID:25852948

  6. Comparison of Echocardiographic and Cardiac Magnetic Resonance Imaging Measurements of Functional Single Ventricular Volumes, Mass, and Ejection Fraction (From the Pediatric Heart Network Multicenter Fontan Cross-Sectional Study)

    PubMed Central

    Margossian, Renee; Schwartz, Marcy L.; Prakash, Ashwin; Wruck, Lisa; Colan, Steven D.; Atz, Andrew M.; Bradley, Timothy J.; Fogel, Mark A.; Hurwitz, Lynne M.; Marcus, Edward; Powell, Andrew J.; Printz, Beth F.; Puchalski, Michael D.; Rychik, Jack; Shirali, Girish; Williams, Richard; Yoo, Shi-Joon; Geva, Tal

    2009-01-01

    Assessment of the size and function of the functional single ventricle (FSV) is a key element in the management of patients following the Fontan procedure. Measurement variability of ventricular mass, volume and ejection fraction between observers by echocardiography and CMR and their reproducibility between readers in these patients has not been described. From the 546 patients enrolled in the Pediatric Heart Network Fontan Cross-Sectional Study (mean age 11.9±3.4 years), 100 echocardiograms and 50 CMR studies were assessed for measurement reproducibility; 124 subjects with paired studies were selected for comparison between modalities. Inter-observer agreement for qualitative grading of ventricular function by echocardiography was modest for left ventricular (LV) morphology (kappa= 0.42) and weak for right ventricular (RV) morphology (kappa= 0.12). For quantitative assessment, high intra-class correlation coefficients (ICC) were found for echocardiographic inter-observer (LV= 0.87–0.92; RV= 0.82–0.85) agreement of systolic and diastolic volumes, respectively. In contrast, ICCs for LV and RV mass were moderate (LV= 0.78; RV= 0.72). The corresponding ICCs by CMR were high (LV= 0.96; RV= 0.85). Volumes by echocardiography averaged 70% of CMR values. Interobserver reproducibility of EF was similar for both modalities. Although the absolute mean difference between modalities for ejection fraction was small (<2%), 95% limits of agreement were wide. In conclusion, agreement between observers of qualitative FSV function by echocardiography is modest. Measurements of FSV volume by 2D echocardiography underestimate CMR measurements but their reproducibility is high. Echocardiographic and CMR measurements of FSV EF demonstrate similar interobserver reproducibility whereas measurements of FSV mass and LV diastolic volume are more reproducible by CMR. PMID:19616678

  7. Stable Ejection Seat

    NASA Technical Reports Server (NTRS)

    Hirsch, R. S.

    1986-01-01

    Drogue chute for ejection seat slows down seat in more stable fashion than conventional parachutes and thus improves chances for survival. Square drogue linked to seat from its corners suppresses tendency of seat to rotate in pitch and yaw. New parachute expected to reduce dynamic forces on ejected person and extend maximum possible ejection altitude by 50 percent. Used at high or low speeds.

  8. [Retrieval of dust fraction of atmospheric aerosols based on spectra characteristics of refractive indices obtained from remote sensing measurements].

    PubMed

    Wang, Ling; Li, Zheng-Qiang; Li, Dong-Hui; Li, Kai-Tao; Tian, Qing-Jiu; Li, Li; Zhang, Ying; Lü, Yang; Gu, Xing-Fa

    2012-06-01

    Mineral dust is an important chemical component of aerosol, which has a significant impact on the climate and environmental changes. The spectral behavior of aerosol refractive indices at four wavelengths from 440 to 1 020 nm was analyzed based on one year observation obtained from Beijing AERONET site. The real parts of refractive index (n) in each band did not differ greatly, however the imaginary parts (k) showed a significant difference due to the absorption of mineral dust in aerosol. From 440 to 670 nm k decreased rapidly, while from 670 to 1 020 nm featured a lower, constant value. Accordingly, k(440 nm) could be considered separately with other three bands. Hence, we added mineral dust into the currently used three-component aerosol chemical model to form a new four-component model (i. e. BC, AS, dust and water) which is more suitable to represent the aerosol chemical composition. Then we presented a method to retrieve dust content in aerosols using this four-component model and refractive indices obtained from the sunphotometer measurements. Finally the dust content in aerosol was investigated under different weather conditions, i. e. clear, haze and dust in Beijing. The results showed that volume fractions of the dust component were 88%, 37% and 48% for clear, hazy and dusty day respectively, which was consistent with the coarse mode proportion in aerosols calculated from aerosol size distributions.

  9. The Solar Mass Ejection Imager

    NASA Technical Reports Server (NTRS)

    Jackson, B. V.; Buffington, A.; Hick, P. L.; Kahler, S. W.; Altrock, R. C.; Gold, R. E.; Webb, D. F.

    1995-01-01

    We are designing a Solar Mass Ejection Imager (SMEI) capable of observing the Thomson-scattered signal from transient density features in the heliosphere from a spacecraft situated near AU. The imager is designed to trace these features, which include coronal mass ejections. corotating structures and shock waves, to elongations greater than 90 deg from the Sun. The instrument may be regarded as a progeny of the heliospheric imaging capability shown possible by the zodiacal-light photometers of the HELIOS spacecraft. The instrument we are designing would make more effective use of in-situ solar wind data from spacecraft in the vicinity of the imager by extending these observations to the surrounding environment. The observations from the instrument should allow deconvolution of these structures from the perspective views obtained as they pass the spacecraft. An imager at Earth could allow up to three days warning of the arrival of a mass ejection from the Sun .

  10. 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

  11. 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

  12. Antioxidant activity measured in different solvent fractions obtained from Mentha spicata Linn.: an analysis by ABTS*+ decolorization assay.

    PubMed

    Arumugam, Ponnan; Ramamurthy, Perumal; Santhiya, Sathiyavedu Thyagarajan; Ramesh, Arabandi

    2006-01-01

    Antioxidant compounds are abundantly available in plants and play an important role in scavenging free radicals, thus providing protection to humans against oxidative DNA damage. Mentha spicata Linn., commonly called spearmint, belongs to the family lamiaceae. It was selected in the present study because Mentha extracts have antioxidant properties due to the presence of eugenol, caffeic acid, rosmarinic acid and alpha-tocopherol. Four solvent fractions (hexane, chloroform, ethyl acetate and water) of ethanolic extract of dried leaves powder of M. spicata were analyzed for total antioxidant activity (TAA) and relative antioxidant activity (RAA) and compared with standard antioxidants such as Quercetin, beta-carotene, L-ascorbic acid and glutathione using ABTS*+ decolorization assay (ABTS/Potassium persulphate). The antioxidant activity was assumed to be from the total phenolic content of the ethanolic extract. Total phenolics are found to be highest in ethyl acetate fraction (54 mg/g) and least in hexane fraction (13 mg/g) and more or less similar in water and chloroform fractions (30-32 mg/g). TAA is found to be less in hexane and chloroform fractions (<53% at 50 microg/ml) and highest in ethyl acetate (95% at 20 microg/ml) and water (84% at 30 microg/ml) fractions. The RAA of ethyl acetate fraction is 1.1 compared to quercetin (at 5 microM/ml), but greater when compared to beta-carotene (15 microM/ml), L-ascorbic acid (15 microM/ml) and glutathione (15 microM/ml). The RAAs with these antioxidants are in the range of 1.31 -1.6. The values of RAAs for water fraction also show similar trend and are in the range of 1.0-1.4. The antioxidant activities of the solvent factions are closely related to the content of total phenolics present in them.

  13. 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

  14. Potentiation of antifungal effect of a mixture of two antifungal fractions obtained from Baccharis glutinosa and Jacquinia macrocarpa plants.

    PubMed

    Medina-López, Carlos F; Plascencia-Jatomea, Maribel; Cinco-Moroyoqui, Francisco J; Yépiz-Gómez, María S; Cortez-Rocha, Mario O; Rosas-Burgos, Ema C

    2016-11-01

    The aim of the present work was to evaluate the effect of mixtures of antifungal fractions extracted from Baccharis glutinosa and Jacquinia macrocarpa plants on the development of the filamentous fungi Aspergillus flavus and Fusarium verticillioides. The minimal inhibitory concentration that inhibited 50% of growth (MIC50) of each plant antifungal fraction was determined from the percentage radial growth inhibition of both fungi. Binomial mixtures made with both plant fractions were used at their MIC50 to determine the Fractional Inhibitory Concentration index (FIC index) for each fungus in order to evaluate their synergistic effect. Each synergistic mixture was analyzed in their effect on spore germination, spore size, spore viability, mitotic divisions, hyphal diameter and length, and number of septa per hypha. Some antifungal mixtures, even at low concentrations, showed higher antifungal effect than those of the individual antifungal fraction. The FIC indices of mixtures that showed the highest antifungal activity against A. flavus and F. verticillioides were 0.5272 and 0.4577, respectively, indicating a synergistic effect against both fungi. Only 12% and 8% of the spores of A. flavus and F. verticillioides, respectively, treated with the synergistic mixtures, were able to germinate, although their viability was not affected. An increase in the number of septa per hypha of both fungi was observed. The results indicated that the synergistic mixtures strongly affected the fungal growth even at lower concentrations than those of the individual plant fractions. PMID:27382921

  15. 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.

  16. Longitudinal Assessment of Concurrent Changes in Left Ventricular Ejection Fraction and Left Ventricular Myocardial Tissue Characteristics After Administration of Cardiotoxic Chemotherapies Using T1-Weighted and T2-Weighted Cardiovascular Magnetic Resonance

    PubMed Central

    Jordan, Jennifer H.; D’Agostino, Ralph B.; Hamilton, Craig A.; Vasu, Sujethra; Hall, Michael E.; Kitzman, Dalane W.; Thohan, Vinay; Lawrence, Julia A.; Ellis, Leslie R.; Lash, Timothy L.; Hundley, W. Gregory

    2014-01-01

    Background In a murine anthracycline-related cardiotoxicity model, increases in cardiovascular magnetic resonance (CMR) myocardial contrast-enhanced T1-weighted signal intensity are associated with myocellular injury and decreases in left ventricular ejection fraction (LVEF). We sought to determine if T1- and T2-weighted measures of signal intensity associate with decreases in LVEF in human subjects receiving potentially cardiotoxic chemotherapy. Methods and Results In 65 individuals with breast cancer (n=51) or a hematologic malignancy (n=14), we measured left ventricular volumes, EF, and contrast-enhanced T1-weighted and T2-weighted signal intensity prior to and 3 months after initiating potentially cardiotoxic chemotherapy using blinded, unpaired analysis of CMR images. Participants were aged 51±12 years of whom 55% received an anthracycline, 38% received a monoclonal antibody, and 6% received an antimicrotubule agent. Overall, LVEF decreased from 57±6% to 54±7% (p<0.001) due to an increase in end-systolic volume (p<0.05). T1-weighted signal intensities also increased from 14.1±5.1 to 15.9±6.8 (p<0.05) with baseline values trending higher among individuals who received chemotherapy prior to study enrollment (p=0.06). Changes in T1-weighted signal intensity did not differ within the 17 LV myocardial segments (p=0.97). Myocardial edema quantified from T2-weighted images did not change significantly after 3 months (p=0.70). Conclusions Concordant with previous animal studies, CMR measures of contrast-enhanced T1-weighted signal intensity occur commensurate with small but significant LVEF declines 3 months after receipt of potentially cardiotoxic chemotherapy. These data indicate that changes in T1-weighted signal intensity may serve as an early marker of subclinical injury related to the administration of potentially cardiotoxic chemotherapy in human subjects. PMID:25273568

  17. 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).

  18. 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

  19. Impact of Preprocedural Left Ventricular Ejection Fraction on 1-Year Outcomes After MitraClip Implantation (from the ACCESS-EU Phase I, a Prospective, Multicenter, Nonrandomized Postapproval Study of the MitraClip Therapy in Europe).

    PubMed

    Schäfer, Ulrich; Maisano, Francesco; Butter, Christian; Franzen, Olaf; Baldus, Stephan; Hausleiter, Jörg; Ussia, Gian Paolo; Sievert, Horst; Geist, Volker; Widder, Julian Daniel; Moccetti, Tiziano; Schillinger, Wolfgang

    2016-09-15

    This report describes the 12-month outcomes of the a prospective, multicenter, nonrandomized post-approval study of the MitraClip therapy in Europe (ACCESS-EU postapproval study of MitraClip therapy) with respect to preprocedural left ventricular ejection fraction (LVEF). Transcatheter deployment of the MitraClip device may be considered for patients who are not suitable for conventional surgery. A total of 567 patients with significant mitral regurgitation (MR) underwent MitraClip therapy. Of those, 393 had functional MR (FMR) and were subdivided by preprocedural LVEF (A: 10% to 20%, B: >20% to 30%, C: >30% to 40%, D: >40%). Procedural safety and efficacy and treatment outcomes including MR grade, New York Heart Association (NYHA) functional class, 6-minute walk test, and the Minnesota Living with Heart Failure Questionnaire were analyzed at baseline, 30 days, and 12 months. Baseline mean logistic EuroSCORE was 25 ± 19; 87% of patients were in NYHA classes III or IV (A: 96%, B: 83%, C: 90%, D: 86%). There was no incidence of death or stroke intraprocedurally. Eleven patients died within 30 days with no differences among subgroups. Kaplan-Meier survival at 12 months was 81.8% (A: 71%, B: 79%, C: 87%, D: 86%). There was a significant improvement in MR severity at 30 days and 12 months (p <0.0001). At 12 months, all subgroups experienced similar improvements in NYHA class, 6-minute walk test, and Minnesota Living with Heart Failure Questionnaire. This real-world registry reports promising results of MitraClip therapy in patients with FMR. In conclusion, the low rates of hospital mortality and adverse events in patients with FMR-even in patients with severely reduced LVEF-provide additional evidence of substantial benefits after MitraClip implantation. PMID:27575279

  20. 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

  1. 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.

  2. 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.

  3. 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

  4. 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

  5. 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.

  6. A Platform for Screening Potential Anticholinesterase Fractions and Components Obtained from Anemarrhena asphodeloides Bge for Treating Alzheimer's Disease

    PubMed Central

    Sun, Yu; Peng, Ying; Li, Lin-Guang; Zheng, Li-Wei; Lin, Dong-Ju; Li, Ling-Zhi; Song, Shao-Jiang

    2014-01-01

    Alzheimer's disease (AD) is a neurodegenerative disease characterized by progressive memory loss and cognitive impairment. Cholinesterase inhibitors are widely used for the symptomatic treatment of Alzheimer's disease to enhance central cholinergic transmission. In this study, a bioactivity-oriented screening platform based on a modified Ellman's method and HPLC-QTOF MS technique was developed to rapidly screen active agents of Anemarrhena asphodeloides Bge. The 60% ethanol fraction from an ethyl acetate extract exhibited the most potential anticholinesterase activity. Fifteen steroid saponins were identified by the mass spectrum, standards and literature reports. Twenty-five compounds were isolated from the active fraction. The results showed that compounds with the C6–C3–C6 skeleton probably had both AChE and BuChE inhibitory activities. Xanthone and benzene derivatives exhibited no or little activity. Lignans showed weak BuChE inhibitory activity. The steroidal saponins demonstrated moderate or weak AChE inhibitory activity. PMID:24864153

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

    PubMed

    Resink, S G; Steenbergen, W

    2016-01-21

    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. PMID:26682957

  8. 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.

  9. Dynamics of polymer ejection from capsid

    NASA Astrophysics Data System (ADS)

    Linna, R. P.; Moisio, J. E.; Suhonen, P. M.; Kaski, K.

    2014-05-01

    Polymer ejection from a capsid through a nanoscale pore is an important biological process with relevance to modern biotechnology. Here, we study generic capsid ejection using Langevin dynamics. We show that even when the ejection takes place within the drift-dominated region there is a very high probability for the ejection process not to be completed. Introducing a small aligning force at the pore entrance enhances ejection dramatically. Such a pore asymmetry is a candidate for a mechanism by which viral ejection is completed. By detailed high-resolution simulations we show that such capsid ejection is an out-of-equilibrium process that shares many common features with the much studied driven polymer translocation through a pore in a wall or a membrane. We find that the ejection times scale with polymer length, τ ˜Nα. We show that for the pore without the asymmetry the previous predictions corroborated by Monte Carlo simulations do not hold. For the pore with the asymmetry the scaling exponent varies with the initial monomer density (monomers per capsid volume) ρ inside the capsid. For very low densities ρ ≤0.002 the polymer is only weakly confined by the capsid, and we measure α =1.33, which is close to α =1.4 obtained for polymer translocation. At intermediate densities the scaling exponents α =1.25 and 1.21 for ρ =0.01 and 0.02, respectively. These scalings are in accord with a crude derivation for the lower limit α =1.2. For the asymmetrical pore precise scaling breaks down, when the density exceeds the value for complete confinement by the capsid, ρ ⪆0.25. The high-resolution data show that the capsid ejection for both pores, analogously to polymer translocation, can be characterized as a multiplicative stochastic process that is dominated by small-scale transitions.

  10. Impact of Epoetin Alfa on LV Structure, Function, and Pressure-Volume Relations as Assessed by Cardiac Magnetic Resonance – The Heart Failure Preserved Ejection Fraction (HFPEF) Anemia Trial

    PubMed Central

    Green, Philip; Babu, Benson A.; Teruya, Sergio; Helmke, Stephen; Prince, Martin; Maurer, Mathew S.

    2013-01-01

    Background Anemia, a common co-morbidity in older adults with heart failure and a preserved ejection fraction (HFPEF), is associated with worse outcomes. We quantified the effect of anemia treatment on left ventricular (LV) structure and function as measured by cardiac magnetic resonance (CMR) imaging. Methods Prospective, randomized single blind clinical trial (NCT NCT00286182) comparing the safety and efficacy of epoetin alfa versus placebo for 24 weeks in which a sub-group (n=22) had cardiac MRI at baseline and after 3 and 6 months to evaluate changes in cardiac structure and function. Pressure volume (PV) indices were derived from MRI measures of ventricular volume coupled with sphygmomanometer-measured pressure and Doppler estimates of filling pressure. The end-systolic and end-diastolic PV relations and the area between them as a function of end-diastolic pressure, the isovolumic PV area (PVAiso), were calculated Results Subjects (75±10 years, 64% female) with HFPEF (EF=63±15%) with average hemoglobin of 10.3±1.1 gm/dl were treated with epoetin alfa using a dose adjusted algorithm that increased hemoglobin compared to placebo (p<0.0001). As compared to baseline, there were no significant changes in end diastolic (−7±8 vs. −3±8 ml, p=0.81) or end systolic (−0.4±2 vs. −0.7±5 ml, p= 0.96) volumes at 6 month follow-up between epoetin alfa compared with placebo. LV function as measured based on EF (−1.5±1.6% vs.−2.6±3.3%, p= 0.91) and pressure volume indices (PVa-iso-EDP at 30 mm Hg, −5071±4308 vs. −1662±4140 p=0.58) did not differ between epoetin alfa and placebo. Conclusion Administration of epoetin alfa to older adult patients with HFPEF resulted in a significant increase in hemoglobin, without evident change in LV structure, function, or pressure volume relationships as measured quantitatively using CMR. PMID:23517485

  11. Relation of serum uric acid levels and outcomes among patients hospitalized for worsening heart failure with reduced ejection fraction (from the efficacy of vasopressin antagonism in heart failure outcome study with tolvaptan trial).

    PubMed

    Vaduganathan, Muthiah; Greene, Stephen J; Ambrosy, Andrew P; Mentz, Robert J; Subacius, Haris P; Chioncel, Ovidiu; Maggioni, Aldo P; Swedberg, Karl; Zannad, Faiez; Konstam, Marvin A; Senni, Michele; Givertz, Michael M; Butler, Javed; Gheorghiade, Mihai

    2014-12-01

    We investigated the clinical profiles associated with serum uric acid (sUA) levels in a large cohort of patients hospitalized for worsening chronic heart failure with ejection fraction (EF) ≤40%, with specific focus on gender, race, and renal function based interactions. In 3,955 of 4,133 patients (96%) with baseline sUA data, clinical characteristics and outcomes were compared across sUA quartiles. The primary end points were all-cause mortality and a composite of cardiovascular mortality or heart failure hospitalization. Interaction analyses were performed for gender, race, and baseline renal function. Median follow-up was 9.9 months. Mean sUA was 9.1 ± 2.8 mg/dl and was higher in men than in women (9.3 ± 2.7 vs 8.7 ± 3.0 mg/dl, p <0.001) and in blacks than in whites (10.0 ± 2.7 vs 9.0 ± 2.8 mg/dl, p <0.001). Higher sUA was associated with lower systolic blood pressure and EF, higher natriuretic peptides, and more impaired renal function. After accounting for 24 baseline covariates, in patients with enrollment estimated glomerular filtration rate ≥30 ml/min/1.73 m(2), sUA was strongly associated with increased all-cause mortality (hazard ratio 1.44, 95% confidence interval 1.22 to 1.69, p <0.001) and the composite end point (hazard ratio 1.44, 95% confidence interval 1.26 to 1.64, p <0.001). However, in patients with estimated glomerular filtration rate <30 ml/min/1.73 m(2), sUA was not related with either end point (both p >0.4). Adjusted interaction analyses for gender, race, and admission allopurinol use were not significant. In conclusion, sUA is commonly elevated in patients hospitalized for worsening chronic heart failure and reduced EF, especially in men and blacks. The prognostic use of sUA differs by baseline renal function, suggesting different biologic and pathophysiologic significance of sUA among those with and without significant renal dysfunction. PMID:25312638

  12. Validation of the FEW16 questionnaire for the assessment of physical well‐being in patients with heart failure with reduced ejection fraction: results from the CIBIS‐ELD study

    PubMed Central

    Lashki, D. J.; Trippel, T. D.; Tscholl, V.; Fritschka, M.; Musial‐Bright, L.; Busjahn, A.; Kolip, P.; Störk, S.; Rauchfuß, M.; Inkrot, S.; Lainscak, M.; Apostolović, S.; Vesković, J.; Lončar, G.; Doehner, W.; Zelenak, C.; Düngen, H. D.

    2015-01-01

    Abstract Aims Patients with heart failure (HF) commonly suffer from severe impairment of quality of life (QoL). One main goal of HF treatment is improvement of QoL. Physical well‐being is an essential component of QoL. To enable assessment of physical well‐being in HF patients, we validated the FEW16 questionnaire in a prospective study with patients from the Cardiac Insufficiency Bisoprolol Study in ELDerly. Methods and results In 127 HF patients (age 73 ± 5.5 years, 72% male, 60% New York Heart Association class II, left ventricular ejection fraction 37 ± 8.5%), we measured physical well‐being (FEW16), QoL [36‐Item Short‐Form Health Survey (SF36)], and depressive symptoms [PRIME MD Patient Health Questionnaire German short version for depression (PHQ‐D)] at baseline and two follow‐up visits, and correlated FEW16 scores with QoL data and clinical parameters. FEW16 mean scores are 3.04 ± 1.04 at baseline, 3.19 ± 0.94 after 3 months, and 2.77 ± 0.94 after 2–4 years. We assessed data quality, scale assumptions, and construct validity and reliability. Cronbach's alpha for subscales resilience: 0.84; ability to enjoy: 0.80; vitality: 0.88; inner peace: 0.87; total score: 0.95. Intraclass correlation coefficient (ICC) is 0.87 (95% CI 0.84–0.89, ICC (1.4). Pearson's correlations of FEW16 with SF36 and PHQ‐D were significant. Six minutes walking distance and heart rate correlated significantly with the FEW16 total score. Conclusions The FEW16 showed good reliability, internal consistency, and intraclass correlation. FEW16 scores correlated well with psychological and physical well‐being (SF36) and clinical markers of exercise tolerance (6 min walk test and heart rate). Our results indicate a strong correlation of self‐reported physical well‐being with psychological factors. FEW16 values at baseline predicted the development of several aspects of QoL during beta‐blocker up‐titration.

  13. A Flying Ejection Seat

    NASA Technical Reports Server (NTRS)

    Hollrock, R. H.; Barzda, J. J.

    1972-01-01

    To increase aircrewmen's chances for safe rescue in combat zones, the armed forces are investigating advanced escape and rescue concepts that will provide independent flight after ejection and thus reduce the risk of capture. One of the candidate concepts is discussed; namely, a stowable autogyro that serves as the crewman's seat during normal operations and automatically converts to a flight vehicle after ejection. Discussed are (1) the mechanism subsystems that the concept embodies to meet the weight and cockpit-packaging constraints and (2) tests that demonstrated the technical feasibility of the stowage, deployment, and flight operation of the rotor lift system.

  14. Taenia saginata metacestode antigenic fractions obtained by ion-exchange chromatography: potential source of immunodominant markers applicable in the immunodiagnosis of human neurocysticercosis.

    PubMed

    Nunes, Daniela da Silva; Gonzaga, Henrique Tomaz; Ribeiro, Vanessa da Silva; da Cunha, Jair Pereira; Costa-Cruz, Julia Maria

    2013-05-01

    The aim of this study was to fractionate and partially characterize fractions obtained from the total saline extract (SE) of Taenia saginata metacestodes after ion-exchange procedure in carboxymethyl sepharose (CM) and diethylaminoethyl sepharose (DEAE) resins, as a source of antigenic markers applicable in the immunodiagnosis of neurocysticercosis (NCC). For IgG detection by enzyme-linked immunosorbent assay (ELISA) and immunoblotting, 140 serum samples were analyzed: 45 from patients with NCC (G1), 50 from patients with other parasitic infections (G2), and 45 from healthy individuals. Sensitivity (Se), specificity (Sp), area under curve (AUC), and likelihood ratios (LR) were calculated. CM S2 and DEAE S2 fractions provided high diagnostic values (Se 88.8% and 93.4%; Sp 93.7% and 92.6%; AUC 0.965 and 0.987; LR+ 14.07 and 12.67; LR- 0.11 and 0.07, respectively). In conclusion, CM S2 and DEAE S2 fractions are important sources of specific peptides, with high efficiency to diagnose NCC.

  15. A new Doppler method of assessing left ventricular ejection force in chronic congestive heart failure.

    PubMed

    Isaaz, K; Ethevenot, G; Admant, P; Brembilla, B; Pernot, C

    1989-07-01

    A noninvasive method using Doppler echocardiography was developed to determine the force exerted by the left ventricle in accelerating the blood into the aorta. The value of this new Doppler ejection index in the assessment of left ventricular (LV) performance was tested in 36 patients with chronic congestive heart disease undergoing cardiac catheterization and in 11 age-matched normal control subjects. The 36 patients were subgrouped into 3 groups based on angiographic ejection fraction (LV ejection fraction greater than 60, 41 to 60 and less than or equal to 40%). According to Newton's second law of motion (force = mass X acceleration), the LV ejection force was derived from the product of the mass of blood ejected during the acceleration time with the mean acceleration undergone during that time. In patients with LV ejection fraction less than or equal to 40%, LV ejection force, peak aortic velocity and mean acceleration were severely depressed when compared with the other groups (p less than 0.001). In patients with LV ejection fraction of 41 to 60%, LV ejection force was significantly reduced (22 +/- 3 kdynes) when compared with normal subjects (29 +/- 5 kdynes, p = 0.002) and with patients with LV ejection fraction greater than 60% (29 +/- 7 kdynes, p = 0.009); peak velocity and mean acceleration did not differ between these 3 groups. The LV ejection force showed a good linear correlation with LV ejection fraction (r = 0.86) and a better power fit (r = 0.91). Peak aortic blood velocity and mean acceleration showed less good linear correlations with LV ejection fraction (r = 0.73 and r = 0.66, respectively). The mass of blood ejected during the acceleration time also showed a weak linear correlation with LV ejection fraction (r = 0.64). An LV ejection force less than 20 kdynes was associated with a depressed LV performance (LV ejection fraction less than 50%) with 91% sensitivity and 90% specificity. Thus, these findings suggest that LV ejection force is a new

  16. 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.

  17. 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

  18. 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.

  19. Identification, virulence, and mass spectrometry of toxic ECP fractions of West Alabama isolates of Aeromonas hydrophila obtained from a 2010 disease outbreak.

    PubMed

    Pridgeon, Julia W; Klesius, Phillip H; Song, Lin; Zhang, Dunhua; Kojima, Kyoko; Mobley, James A

    2013-06-28

    In West Alabama, disease outbreaks in 2009 caused by Aeromonas hydrophila have led to an estimated loss of more than $3 million. In 2010, disease outbreak occurred again in West Alabama, causing losses of hundreds of thousands of pounds of market size channel catfish. During the 2010 disease outbreak in West Alabama, four isolates of A. hydrophila were cultured from the kidney tissues of diseased channel catfish. Both analytical profile index (API) 20 E biochemical tests and 16S-23S rRNA sequencing results confirmed the four isolates as A. hydrophila. Virulence studies revealed that the four isolates were highly virulent to channel catfish by intraperitoneal injection, with LD50 value of ≈ 1.3 × 10(5)CFU/fish. Extracellular proteins (ECPs) of A. hydrophila are well known to be toxic to fish. Therefore, ECPs of the four 2010 West Alabama isolates of A. hydrophila were characterized in this study. The ECPs of the four 2010 isolates were found to be toxic to channel catfish fingerlings, with LD50 value of 16 μg/fish. Thirty ECP fractions were obtained from the ECPs of the 2010 isolates of A. hydrophila by cation-exchange chromatography, of which nine fractions were found to be toxic to catfish gill cells and channel catfish fingerlings. Mass spectrometry identified 228 proteins from the nine toxic fractions, of which 23 were shared by toxic fractions, including well known virulence factors such as hemolysin, aerolysin, elastase (metalloprotease), nuclease, and 5'-nucleotidase. Hemolytic activity, protease activity, and nuclease activity of the four isolates were found to be significantly (P<0.05) higher than that of a reference A. hydrophila strain AL98-C1B. Our results might shed light on the possible virulence factors of the highly virulent West Alabama isolates of A. hydrophila.

  20. SEC-ICP-MS studies for elements binding to different molecular weight fractions of humic substances in compost extract obtained from urban solid waste.

    PubMed

    Sadi, Baki B M; Wrobel, Kazimierz; Wrobel, Katarzyna; Kannamkumarath, Sasi S; Castillo, J R; Caruso, J A

    2002-12-01

    In this work, the speciation of elements in compost was studied with emphasis on their binding to humic substances. In order to assess the distribution of As, Cd, Co, Cr, Cu, Mn, Mo, Ni, Pb, U, Th and Zn among molecular weight fractions of humic substances, the compost extract (extracted by 0.1 mol l(-1) sodium pyrophosphate) was analyzed by size exclusion chromatography coupled on-line with UV-Vis spectrophotometric and ICP-MS detection. Similar chromatograms were obtained for standard humic acid (Fluka) and for compost extract (254 nm, 400 nm) and three size fractions were operationally defined that corresponded to the apparent molecular weight ranges > 15 kDa, 1-15 kDa and < 1 kDa. The percentage of total element content in compost that was leached to the extract ranged from 30% up to 100% for different elements. The elution profiles of Co, Cr, Cu, Ni and Pb (ICP-MS) followed that of humic substances, while for other elements the bulk elution peak matched the retention time observed for the element in the absence of compost extract. Spiking experiments were carried out to confirm elements' binding and to estimate the affinity of individual elements for humic substances derived from compost. The results obtained indicated the following order of decreasing affinity: Cu > Ni > Co > Pb > Cd > (Cr, U, Th) > (As, Mn, Mo, Zn). After standard addition, further binding of Cu, Ni and Co with the two molecular weight fractions of humic substances was observed, indicating that humic substances derived from compost were not saturated with these elements.

  1. 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.

  2. 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

  3. 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

  4. Action as ejection.

    PubMed

    Franco, Daisy

    2006-01-01

    The systematic analysis of acting-out episodes can be used in assessing analytic progress. Variables to be considered are the nature of the wish, the type of defense, and the degree of concreteness (versus symbolization) of the mental processes used in attempting actualization (as distinct from the resort to action). Two acting-out episodes of a borderline patient who acted out as a character trait, both occurring outside the analytic setting, are presented as illustrations. In the first one, occurring relatively early in the analysis, when split-off negative and positive self-images had to be rigidly maintained, ejection of the negative self-image was actualized via the regressive use of a symbolic equation and the mechanism of displacement, obliterating the distinction between an internal feeling and an external thing that here was literally thrown out. The later episode, occurring after the split was healed and within the context of a frustrating heterosexual involvement, contained an acted-out allusion to identification and competition with the mother. As in a dream, via associations, an unconscious wish for oedipal victory was revealed. Whereas in the first episode the goal of ejection was central, with splitting and denial the underlying defenses, it was absent from the second, in which an attempt was made to actualize a repressed infantile wish and made greater use of symbolization. It is concluded that acting-out episodes at different periods of the analysis, when systematically analyzed, can serve in assessing a patient's progress.

  5. 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

  6. 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.

  7. Use of SP-Sephadexto fractionate and obtain semi-pure preparation from whole pituitaries of Indian water buffaloes (Bubalus bubalis).

    PubMed

    Chaudhary, Rajesh; Muralidhar, K

    2004-11-01

    Different charge isoforms of native Luteinizing hormone (LH) (dimeric form) Ve/Vo = 1.49 can be fractionated on SP-Sephadex into four different charge isoforms (LHUB, LH25, LH50, and LH100) by stepwise elution using different molarities of Na2HPO4. LHUB was found to be difficult to purify, whereas LH50 and LH100 were found to be pure and highly immunoreactive against anti-bLHbeta serum as indicated by the results obtained from direct binding ELISA and Western blot analysis. SDS-PAGE of LH50 and LH100 showed two bands corresponding to the two subunits of LH. LH25 can be purified to homogeneity by rechromatography on S-300. Purification of buLH as a highly immunoreactive preparation has also been described using SP-Sephadex. This LH preparation (SP25B), which was obtained after slight modification in the pre-existing protocol, has been found to be highly immunoreactive against anti-bLHbeta serum in direct binding ELISA. Being a very simple and reproducible method, it can be used to obtain pure LH preparation, as a reference material, in a short period of time for various immunoassays and bioassays.

  8. High pressure melt ejection

    SciTech Connect

    Tarbell, W.W.; Brockmann, J.E.; Pilch, M.

    1983-01-01

    Recent probabilistic risk assessments have identified the potential for reactor pressure vessel failure while the reactor coolant system is at elevated pressure. The analyses postulate that the blowdown of steam and hydrogen into the reactor cavity will cause the core material to be swept from the cavity region into the containment building. The High Pressure Melt Streaming (HIPS) program is an experimental study of the high pressure ejection of molten material and subsequent interactions within a concrete cavity. The program focuses on using prototypic system conditions and scaled models of reactor geometries to accurately simulate the ex-vessel processes during high-pressure accident sequences. Scaling analyses of the experiment show that the criteria established for core debris removal from the cavity are met or exceeded. Tests are performed at two scales, representing 1/10th and 1/20th linear reproductions of the Zion reactor plant. Results of the 1/20th scale tests are presented.

  9. 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

  10. 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

  11. Coronal ejectives in Ahtna Athabaskan

    NASA Astrophysics Data System (ADS)

    Tuttle, Siri

    2005-04-01

    Ahtna, a non-tonal Alaskan language, is one of few Athabaskan languages that has retained word-final ejectives. The loss of stem-final glottal stops and ejectives in the other languages is correlated with tonogenesis. Hargus (2004) finds voice quality distinctions (creakiness, variability, and increased energy in higher harmonics) preceding stem-final glottal consonants in Witsuwiten, another nontonal Northern language. The present study considers the acoustics of stem-initial and stem-final [t'] and [ts'] in Central and Lower Ahtna. Stem-initial ejectives are canonically shaped, with defined silent period following oral release. In stem-final position, as predicted by Kari (1990), variable non-ejective realizations are found in both word-final and intervocalic (suffixed) position. These realizations are accompanied by variable voice quality effects in preceding vowels, more frequent and pronounced than those found variably in vowels following stem-initial ejectives. Stem-final [t'] is frequently pronounced as glottal stop, and final [ts'] as ['s] where <,> stands for glottal stop. Strikingly, non-ejective realizations of stem-finals are found in suffixed and non-suffixed pairs with the same stem, suggesting that stem-final effects generalize to all tokens of stems. These findings support Leers (1979) picture of spirantization and suprasegmentalization in Athabaskan tonogenesis, as glottal effects gravitate to nucleus position.

  12. A multipurpose satellite ejection system

    NASA Technical Reports Server (NTRS)

    Moore, Michael B.

    1987-01-01

    A design is presented for a pneumatic ejection system capable of ejecting a spin stabilized satellite from the cargo bay of space vehicles. This system was orginally designed for use on the Spacelab 6 shuttle mission, but is now being considered for use with expendable rockets for launching satellites. The ejection system was designed to launch a 150 lb satellite at an initial ejection velocity of 32 ft/sec with a spin rate of 30 rev/min. The ejection system consists of a pneumatic cylinder, satellite retaining mechanism, and bearing assembly to allow the satellite to rotate during the spin up phase. As the cylinder is pressurized rapidly causing movement of the actuation piston, the mechanism automatically releases the spinning satellite by retracting a pneumatic locking pin and three spring loaded holddown pins. When the piston reaches the end of its stroke, it encounters a crushable aluminum honeycomb shock absorber which decelerates the piston and retaining mechanism. The assembly is designed for multiple uses except for the crushable shock absorber and pyrotechnic valves. The advantage of the design is discussed and patent no. and date given.

  13. 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.

  14. Restraint effectiveness, occupant ejection from cars, and fatality reductions.

    PubMed

    Evans, L

    1990-04-01

    The effectiveness of air cushion restraint systems, or airbags, in preventing fatalities is estimated by assuming that they do not affect ejection probability, and protect only in frontal, or near frontal, crashes with impact-reducing effectiveness equal to that of lap/shoulder belts. In order to compute airbag effectiveness, lap/shoulder belt effectiveness and the fraction of fatalities preventable by eliminating ejection are estimated using Fatal Accident Reporting System (FARS) data. Ejection prevention is found to account for almost half of the effectiveness of lap/shoulder belts (essentially all for lap belts only). Airbag effectiveness is estimated as (18 +/- 4)% in preventing fatalities to drivers and (13 +/- 4)% to right front passengers. Drivers switching from lap/shoulder belt to airbag-only protection increase their fatality risk by 41%. PMID:2331291

  15. 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.

  16. Photoprotecting action and phytochemical analysis of a multiple radical scavenger lipophilic fraction obtained from the leaf of the seagrass Thalassia testudinum.

    PubMed

    Regalado, Erik L; Rodríguez, María; Menéndez, Roberto; Fernandez, Xavier; Hernández, Ivones; Morales, Ruth A; Fernández, Miguel D; Thomas, Olivier P; Pino, Jorge A; Concepción, Angel R; Laguna, Abilio

    2011-01-01

    The apolar fraction F1 of Thalassia testudinum was chemically characterized by gas chromatography-mass spectrometry, which led to the identification of 43 metabolites, all of them reported for the first time in the genus Thalassia. More than 80% of the F1 composition was constituted by aromatic metabolites including the major components 1,1-bis(p-tolyl)ethane (6.0%), 4,4'-diisopropylbiphenyl (4.8%) and a 1,1-bis(p-tolyl)ethane isomer (4.7%). This lipophilic fraction was assayed for its antioxidant effects and skin protective action. In vitro assays showed that F1 strongly scavenged DPPH* (IC(50) 312.0 ± 8.0 μg mL(-1)), hydroxyl (IC(50) 23.8 ± 0.5 μg mL(-1)) and peroxyl radical (IC(50) 6.6 ± 0.3 μg mL(-1) ), as well as superoxide anion (IC(50) 50.0 ± 0.7 μg mL(-1)). Also, F1 markedly inhibited the spontaneous lipid peroxidation (LPO) in brain homogenates (IC(50) 93.0 ± 6.0 μg mL(-1)) and the LPS-stimulated nitrite generation on RAW624.7 macrophages (58.6 ± 3.2%, 400 μg mL(-1)). In agreement with these findings, its topical application at 250 and 500 μg cm(-2) strikingly reduced skin damage on mice exposed to acute UVB radiation by 45% and 70%, respectively and significantly attenuated the LPO developed following the first 48 h after acute exposure to UVB irradiation, as manifested by the decreased malondialdehide level and by the increased of reduced gluthatione content. Our results suggest that F1 may contribute to skin repair by attenuating oxidative stress due to its antioxidant activity.

  17. Dependency of Dynamical Ejections of O Stars on the Masses of Very Young Star Clusters

    NASA Astrophysics Data System (ADS)

    Oh, Seungkyung; Kroupa, Pavel; Pflamm-Altenburg, Jan

    2015-06-01

    Massive stars can be efficiently ejected from their birth star clusters through encounters with other massive stars. We study how the dynamical ejection fraction of O star systems varies with the masses of very young star clusters, {{M}ecl}, by means of direct N-body calculations. We include diverse initial conditions by varying the half-mass radius, initial mass segregation, initial binary fraction, and orbital parameters of the massive binaries. The results show robustly that the ejection fraction of O star systems exhibits a maximum at a cluster mass of {{10}3.5} {{M}⊙ } for all models, even though the number of ejected systems increases with cluster mass. We show that lower mass clusters ({{M}ecl}≈ 400 {{M}⊙ }) are the dominant sources for populating the Galactic field with O stars by dynamical ejections, considering the mass function of embedded clusters. About 15% (up to ≈38%, depending on the cluster models) of O stars of which a significant fraction are binaries, and which would have formed in a ≈10 Myr epoch of star formation in a distribution of embedded clusters, will be dynamically ejected to the field. Individual clusters may eject 100% of their original O star content. A large fraction of such O stars have velocities up to only 10 km s-1. Synthesising a young star cluster mass function, it follows, given the stellar-dynamical results presented here, that the observed fractions of field and runaway O stars, and the binary fractions among them, can be well understood theoretically if all O stars form in embedded clusters.

  18. 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.

  19. 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

  20. Ejecting phage DNA against cellular turgor pressure.

    PubMed

    Marion, Sanjin; Siber, Antonio

    2014-10-21

    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.

  1. Effect of energy window on cardiac ejection fraction

    SciTech Connect

    Bacharach, S.L.; Green, M.V.; Bonow, R.O.; Findley, S.L.; Daube-Witherspoon, M.E.; Larson, S.M.

    1988-03-01

    ECG gated gamma-ray energy spectra from the left ventricle were created each 50 msec during the cardiac cycle. Nine of ten subjects were studied with a nonimaging Nal probe, and the tenth with a high-resolution Germanium detector. Placing multiple energy windows over the energy spectra, EF was found to vary with the energy window selected. Moving a 20% window across the photopeak produced a roughly linear increase in EF with energy (2.3 EF units per 10 keV increase in energy) in eight of the ten subjects. Dividing the photopeak into a low (126-140 keV) and high-energy (140-154 keV) portion gave significantly different EFs (high energy exceeding low energy by 17%). Increasing the width of a narrow window centered about the photopeak produced negligible change in EF. Examining the energy spectra showed that the small-angle scattered radiation (126-139 keV) was proportionately greater at end systole than at end diastole, after normalizing the spectra to the same photopeak area.

  2. 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.

  3. Chemical Treatment of US Department of Energy High Level and Low Level Waste to Obtain a Pure Radiochemical Fraction for Determination of Californium Alpha-Decay Content

    SciTech Connect

    Dewberry, R.

    2002-12-02

    We have developed a chemical separation technique that allows the radiochemical determination of the californium a-decay content in Department of Energy (DOE) high level wastes from the Hanford and Savannah River sites. The chemical separation technique uses a series of column extraction chromatography steps that use Eichrom Industries' lanthanide and actinide plus 3 oxidation state selective Ln-resin(R) and the transuranic selective plus 4 oxidation state TRU-resin(R) to obtain intermediate product phases in dilute nitric acid. The technique has been demonstrated on three types of authentic DOE high and low level waste samples. We obtain discrimination from Pu a-activity by a factor of over 200 and from Cm-244 a-activity by a factor approaching 1700. Californium recoveries are measured by addition of a Cf-249 spike and are in the range of 50 percent to 90 percent in the synthetic samples and are in the range of 1.4 percent to 48 percent for the authentic DOE waste samples.

  4. 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.

  5. Generalization and Optimization of Biological and Biomimetic Ejection Mechanisms

    NASA Astrophysics Data System (ADS)

    Dabiri, John O.; Milano, Michele; Gharib, Morteza

    2003-11-01

    Unsteady mechanisms for fluid ejection are found in biological systems from jellyfish to the human heart. An understanding of these mechanisms is needed to correct pathologies in natural systems and to design biomimetic systems. In particular, the formation process of the recurring vortex ring motif must be studied. It has been previously shown that ring formation is limited by the energy available from the vortex generator, and that ejection efficiency is maximized as the limit is reached. To assess the ability of biological systems to extend this limit, we derive a set of nondimensional criteria that facilitate comparison of ejection mechanisms with dissimilar kinematics. We optimize the derived criteria by means of an evolutionary algorithm, to design optimal ejection mechanisms. The results obtained are compared with some natural systems to derive general principles for the design of better unsteady ejection mechanisms. Additionally, the generalized criteria clarify the effect of previous suggestions for extending the vortex ring formation limit. This work is supported by a grant from the National Science Foundation.

  6. Experimental investigation on ejecting low-temperature cooling superconducting magnets

    NASA Astrophysics Data System (ADS)

    Liu, Bin; Zhang, Qiang; Tong, Ming-wei; Hu, Peng; Wu, Shuang-ying; Cai, Qin; Qin, Zeng-hu

    2013-10-01

    With the development of the high-temperature superconducting (HTS) materials and refrigeration technologies, using ejecting refrigeration to cool the superconducting materials becomes the direction of HTS applications. In this paper, an experimental study has been carried out on the basis of the theory of analyzing the ejecting low-temperature cooling superconducting magnet. The relationship between area ratios and refrigeration performance at different system pressures was derived. In addition, the working fluid flow and suction chamber pressure of the ejector with different area ratios at various inlet pressures have been examined to obtain the performance of ejectors under different working conditions. The result shows that the temperature of liquid nitrogen can be reduced to 70 K by controlling the inlet water pressure when the pressurized water at 20 °C is used to eject the saturated liquid nitrogen, which can provide the stable operational conditions for the HTS magnets cooling.

  7. 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.

  8. Quantitative fraction evaluation of dermal collagen and elastic fibres in the skin samples obtained in two orientations from the trunk region.

    PubMed

    Kumar, Naveen; Kumar, Pramod; Nayak Badagabettu, Satheesha; Prasad, Keerthana; Kudva, Ranjini; Raghuveer, Coimbatore Vasudevarao

    2014-01-01

    Background. Histomorphic evaluation of dermal collagen and elastic fibres was analysed by image analysis technique. The quantification of dermal elements was performed in skin tissues, collected in horizontal and vertical directions from trunk region and discussed under the perspective of consequences of scar related complications. Materials and Method. Total number of 200 skin samples collected from 5 areas of trunk region were processed histologically and subjected to tissue-quant image analysis. Statistical analysis involving mean with SEM and paired t test by SPSS were employed to the percentage values obtained from image analysis. Result. Among the chosen 5 areas of trunk region, abdomen showed the statistically significant difference for both collagen and elastic content between horizontal and vertical orientations (P< 0.05), whereas upper back, presternal, and lateral chest areas showed significant difference (P< 0.05) only for collagen and groin only for elastic content. Conclusion. The differences in the distribution of dermal collagen and elastic fibres in 2 directions of the samples from the same areas might be attributed to final outcome of wound healing process by influencing the appearance and behaviour of scar related complications in the region of trunk. PMID:25328512

  9. 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.

  10. 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

  11. Merging galaxies and black hole ejections

    NASA Technical Reports Server (NTRS)

    Valtonen, M. J.

    1990-01-01

    In mergers of galaxies their central black holes are accumulated together. Researchers show that few black hole systems arise which decay through black hole collisions and black hole ejections. The ejection statistics are calculated and compared with two observed systems where ejections have been previously suggested: double radio sources and high redshift quasars near low redshift galaxies. In both cases certain aspects of the associations are explained by the merger hypothesis.

  12. Mass ejections. [during solar flares

    NASA Technical Reports Server (NTRS)

    Rust, D. M.; Hildner, E.; Hansen, R. T.; Dryer, M.; Mcclymont, A. N.; Mckenna-Lawlor, S. M. P.; Mclean, D. J.; Schmahl, E. J.; Steinolfson, R. S.; Tandberg-Hanssen, E.

    1980-01-01

    Observations and model simulations of solar mass ejection phenomena are examined in an investigation of flare processes. Consideration is given to Skylab and other observations of flare-associated sprays, eruptive prominences, surges and coronal transients, and to MHD, gas dynamic and magnetic loop models developed to account for them. Magnetic forces are found to confine spray material, which originates in preexisting active-region filaments, within steadily expanding loops, while surges follow unmoving, preexisting magnetic field lines. Simulations of effects of a sudden pressure pulse at the bottom of the corona are found to exhibit many characteristics of coronal transients associated with flares, and impulsive heating low in the chromosphere is found to be able to account for surges. The importance of the magnetic field as the ultimate source of energy which drives eruptive phenomena as well as flares is pointed out.

  13. 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.

  14. 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.

  15. Magnetized Accretion-Ejection Structures

    NASA Astrophysics Data System (ADS)

    Ferreira, Jonathan

    1994-09-01

    For both active galactic nuclei (AGN) and young stellar objects (YSO), the common belief is growing that there is an interdependency between accretion of mass onto a central object and the highly collimated jets. This thesis deals with the investigation of the physical mechanism that leads to the formation of jets from a magnetized accretion disk. This has been done by solving the set of magnetohydrodynamical (MHD) equations in the case of an isothermal disk, using a self-similar approach. All the dynamical terms are included, so that the main results are independant of the modelling and thus, completely general. Indeed, a different temperature vertical profile only slightly modifies the parameters required for stationarity. A resistive thin accretion disk is thread by open magnetic field lines, sheared by its differential rotation. The field lines brake the disk and extract both angular momentum and mechanical energy from it. Because of the large magnetic "lever arm" acting on the disk, the magnetic braking is always dominant and the viscous torque is negligible. An equipartition magnetic field is enough, without significantly perturbing the Keplerian rotation. Thus, jets carry away all the angular momentum of the underlying accretion disk. Steady state accretion is achieved in the disk due to an anomalous magnetic diffusivity that allows the matter to slip across the field lines. This anomalous transport coefficient should arise from the saturation of a strong magnetic instability triggered in the disk. Ambipolar diffusion, which could have been used without losing the generality of the present results, remains however smaller than this anomalous diffusivity in the inner parts of a circumstellar disk. It has been found that steady state ejection can be achieved only if the magnetic torque changes its sign at the disk surface. From this point on, the field lines accelerate azimuthaly the matter transfering it both angular momentum and energy. This requires a

  16. Models for coronal mass ejections

    NASA Astrophysics Data System (ADS)

    Jacobs, Carla; Poedts, Stefaan

    2011-06-01

    Coronal mass ejections (CMEs) play a key role in space weather. The mathematical modelling of these violent solar phenomena can contribute to a better understanding of their origin and evolution and as such improve space weather predictions. We review the state-of-the-art in CME simulations, including a brief overview of current models for the background solar wind as it has been shown that the background solar wind affects the onset and initial evolution of CMEs quite substantially. We mainly focus on the attempt to retrieve the initiation and propagation of CMEs in the framework of computational magnetofluid dynamics (CMFD). Advanced numerical techniques and large computer resources are indispensable when attempting to reconstruct an event from Sun to Earth. Especially the simulations developed in dedicated event studies yield very realistic results, comparable with the observations. However, there are still a lot of free parameters in these models and ad hoc source terms are often added to the equations, mimicking the physics that is not really understood yet in detail.

  17. 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.

  18. 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.

  19. 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...

  20. 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...

  1. 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.

  2. 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

  3. 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

  4. 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.

  5. 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

  6. Bipolar Ejection of Matter from Hot Stars

    NASA Technical Reports Server (NTRS)

    Pismis, P.

    1985-01-01

    A general program on the internal velocities in H II regions was carried out within the past decade by the use of photographic Fabry-Perot interferometry, in the H (alpha) line and lately also in the N IIlambda 6584 line. Among the score of objects studied three H II regions and one planetary nebula possess pronounced symmetry around their ionizing stars. Velocity data combined with morphological properties suggest strongly that the nebulae were formed essentially by matter ejected from the central star and that ejection occurred preferentially from diametrially opposite regions on the star, that is, in a bi-polar fashion. The nebulae are discussed individually and a model for the ejection mechanism is presented.

  7. 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.

  8. 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.

  9. 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.

  10. 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.

  11. Uncertainties in polarimetric 3D reconstructions of coronal mass ejections

    NASA Astrophysics Data System (ADS)

    Bemporad, A.; Pagano, P.

    2015-04-01

    Aims: The aim of this work is to quantify the uncertainties in the three-dimensional (3D) reconstruction of the location of coronal mass ejections (CMEs) obtained with the so-called polarization ratio technique. The method takes advantage of the different distributions along the line of sight of total (tB) and polarized (pB) brightnesses emitted by Thomson scattering to estimate the average location of the emitting plasma. This is particularly important to correctly identify of CME propagation angles and unprojected velocities, thus allowing better capabilities for space weather forecastings. Methods: To this end, we assumed two simple electron density distributions along the line of sight (a constant density and Gaussian density profiles) for a plasma blob and synthesized the expected tB and pB for different distances z of the blob from the plane of the sky and different projected altitudes ρ. Reconstructed locations of the blob along the line of sight were thus compared with the real ones, allowing a precise determination of uncertainties in the method. Results: Results show that, independently of the analytical density profile, when the blob is centered at a small distance from the plane of the sky (i.e. for limb CMEs) the distance from the plane of the sky starts to be significantly overestimated. Polarization ratio technique provides the line-of-sight position of the center of mass of what we call folded density distribution, given by reflecting and summing in front of the plane of the sky the fraction of density profile located behind that plane. On the other hand, when the blob is far from the plane of the sky, but with very small projected altitudes (i.e. for halo CMEs, ρ< 1.4R⊙), the inferred distance from that plane is significantly underestimated. Better determination of the real blob position along the line of sight is given for intermediate locations, and in particular when the blob is centered at an angle of 20° from the plane of the sky

  12. 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

  13. 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.

  14. 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

  15. 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.

  16. 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.

  17. 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.

  18. 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

  19. 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.

  20. 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).

  1. 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.

  2. 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

  3. Ejection safety for advanced fighter helmets

    NASA Astrophysics Data System (ADS)

    Wiley, Larry L.; Brown, Randall W.; MacMillan, Robert T.

    1995-05-01

    The old saying, `Safety is paramount.' was never more true than it is in the area of ejection safety for high-speed fighter aircraft. The fighter aircraft of today has been designed to endure tremendous structural loading during dogfight or evasive maneuvers. It can fly faster, turn quicker, stay in the air longer (with in-flight refuel) and carry more bombs than its predecessor. Because of human physiological limits, the human has become the weak link in today's fighter aircraft. The fighter pilot must endure and function with peak performance in conditions that are much worse than anything the majority of us will ever encounter. When these conditions reach a point that human endurance is exceeded, devices such as anti-g suits and positive pressure breathing apparatus help the fighter pilot squeeze out that extra percentage of strength necessary to outperform the opponent. As fighter aircraft become more sophisticated, helmet trackers, helmet displays and noise cancellation devices are being added to the helmet. Yet the fighter pilot's helmet must remain lightweight and be aesthetically appealing, while still offering ballistic protection. It must function with existing life support equipment such as the Combined Advanced Technology Enhanced Design g-Ensemble (COMBAT-EDGE). It must not impede the pilot's ability to perform any action necessary to accomplish the planned mission. The helmet must protect the pilot during the harsh environment of ejection. When the pilot's only resort is to pull the handle and initiate the ejection sequence, the helmet becomes his salvation or instant death. This paper discusses the safety concerns relative to the catapult phase of ejecting from a high-speed fighter while wearing an advanced fighter helmet.

  4. 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.

  5. 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.

  6. 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.

  7. Gas Ejection from Spiral Galaxy Disks

    NASA Astrophysics Data System (ADS)

    Durelle, Jeremy

    We present the results of three proposed mechanisms for ejection of gas from a spiral arm into the halo. The mechanisms were modelled using magnetohydrodynamics (MHD) as a theoretical template. Each mechanism was run through simulations using a Fortran code: ZEUS-3D, an MHD equation solver. The first mechanism modelled the gas dynamics with a modified Hartmann flow which describes the fluid flow between two parallel plates. We initialized the problem based on observation of lagging halos; that is, that the rotational velocity falls to a zero at some height above the plane of the disk. When adopting a density profile which takes into account the various warm and cold H I and HII molecular clouds, the system evolves very strangely and does not reproduce the steady velocity gradient observed in edge-on galaxies. This density profile, adopted from Martos and Cox (1998), was used in the remaining models. However, when treating a system with a uniform density profile, a stable simulation can result. Next we considered supernova (SN) blasts as a possible mechanism for gas ejection. While a single SN was shown to be insufficient to promote vertical gas structures from the disk, multiple SN explosions proved to be enough to promote gas ejection from the disk. In these simulations, gas ejected to a height of 0.5 kpc at a velocity of 130 km s--1 from 500 supernovae, extending to an approximate maximum height of 1 kpc at a velocity of 6.7 x 103 km s--1 from 1500 supernovae after 0.15 Myr, the approximate time of propagation of a supernova shock wave. Finally, we simulated gas flowing into the spiral arm at such a speed to promote a jump in the disk gas, termed a hydraulic jump. The height of the jump was found to be slightly less than a kiloparsec with a flow velocity of 41 km s--1 into the halo after 167 Myr. The latter models proved to be effective mechanisms through which gas is ejected from the disk whereas the Hartmann flow (or toy model) mechanism remains unclear as the

  8. Aircrew ejections in the Republic of Bulgaria, 1953-93.

    PubMed

    Milanov, L

    1996-04-01

    We reviewed the ejections of 60 pilots who ejected from 54 aircraft of Soviet production in the Republic of Bulgaria from 1953-93. The following factors were correlated with the degree of injury during ejection: the fliers' height, weight, and age; type of aircraft and ejection seat; altitude and speed of the aircraft at ejection; and the reason for ejection. The act of ejection can be a life-saving procedure when the aircraft gets into a non-recoverable situation, especially when carried out at an altitude above of 300 m, or at ground level. Survival rate of pilots in those cases is 95-100% respectively, compared to the general survival rate, which is 83%. Of the 60 ejectees, 10 (16.7%) were killed, 14 (23.3%) suffered major injuries, 17 (28.3%) suffered minor injuries, and 19 (31.7%) were uninjured. PMID:8900991

  9. 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.

  10. 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.

  11. 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.

  12. Fractional randomness

    NASA Astrophysics Data System (ADS)

    Tapiero, Charles S.; Vallois, Pierre

    2016-11-01

    The premise of this paper is that a fractional probability distribution is based on fractional operators and the fractional (Hurst) index used that alters the classical setting of random variables. For example, a random variable defined by its density function might not have a fractional density function defined in its conventional sense. Practically, it implies that a distribution's granularity defined by a fractional kernel may have properties that differ due to the fractional index used and the fractional calculus applied to define it. The purpose of this paper is to consider an application of fractional calculus to define the fractional density function of a random variable. In addition, we provide and prove a number of results, defining the functional forms of these distributions as well as their existence. In particular, we define fractional probability distributions for increasing and decreasing functions that are right continuous. Examples are used to motivate the usefulness of a statistical approach to fractional calculus and its application to economic and financial problems. In conclusion, this paper is a preliminary attempt to construct statistical fractional models. Due to the breadth and the extent of such problems, this paper may be considered as an initial attempt to do so.

  13. 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.

  14. 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.

  15. 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).

  16. 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.

  17. 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

  18. 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.

  19. Dysphoric milk ejection reflex: A case report

    PubMed Central

    2011-01-01

    Dysphoric Milk Ejection Reflex (D-MER) is an abrupt emotional "drop" that occurs in some women just before milk release and continues for not more than a few minutes. The brief negative feelings range in severity from wistfulness to self-loathing, and appear to have a physiological cause. The authors suggest that an abrupt drop in dopamine may occur when milk release is triggered, resulting in a real or relative brief dopamine deficit for affected women. Clinicians can support women with D-MER in several ways; often, simply knowing that it is a recognized phenomenon makes the condition tolerable. Further study is needed. PMID:21645333

  20. Safety belt use, ejection and entrapment.

    PubMed

    O'Day, J; Scott, R E

    1984-01-01

    One in every five occupants thrown from a car receives fatal injuries. A motorist who uses a safety belt, in all probability, will not be thrown from the car during a crash. The rate of fatal injury for ejected occupants was found to be 40 times the rate for occupants not thrown from their cars, as determined from national accident sampling data. These data refute the popular notion that "being thrown clear" has survival benefit. In addition, there was no evidence that wearing a safety belt increased fatality risk from vehicle fire or submersion. PMID:6519997

  1. Swapping Rocks: Ejection and Exchange of Surface Material Among the Terrestrial Planets

    NASA Astrophysics Data System (ADS)

    Melosh, H. J.; Tonks, W. B.

    1993-07-01

    The discovery of meteorites originating from both the Moon and Mars has led to the realization that major impacts can eject material from planetary-sized objects. Although there is not yet any direct proof, there appears to be no reason why such impacts cannot eject material from the surfaces of Earth and Venus as well. Because of this possibility, and in view of the implications of such exchange for biological evolution, we examined the orbital evolution and ultimate fate of ejecta from each of the terrestrial planets. This work employed an Opik-type orbital evolution model in which both planets and ejected particles follow elliptical orbits about the Sun, with uniformly precessing arguments of perihelion and ascending nodes. An encounter takes place when the particle passes within the sphere of influence of the planet. When this occurs, the encounter is treated as a two-body scattering event, with a randomly chosen impact parameter within the sphere of influence. If the impact parameter is less than the planet's radius, an impact is scored. Otherwise, the scattered particle either takes up a new Keplerian orbit or is ejected from the solar system. We incorporated several different space erosion models and examined the full matrix of possible outcomes of ejection from each planet in random directions with velocities at great distance from the planet of 0.5, 2.5, and 5.0 km/s. Each run analyzed the evolution of 5000 particles to achieve sufficient statistical resolution. Both the ultimate fate and median transit times of particles was recorded. The results show very little dependence on velocity of ejection. Mercury ejecta is nearly all reaccreted by Mercury or eroded in space--very little ever evolves to cross the orbits of the other planets (a few percent impact Venus). The median time between ejection and reimpact is about 30 m.y. for all erosion models. Venus ejecta is mostly reaccreted by Venus, but a significant fraction (about 30%) falls on the Earth with a

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. 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.

  8. 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.

  9. 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.

  10. 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.

  11. Kinematics of Earth Impacting Coronal Mass Ejections

    NASA Astrophysics Data System (ADS)

    Colaninno, R. C.; Vourlidas, A.

    2012-12-01

    With the data from the STEREO mission, we are able to continuously monitor Coronal Mass Ejections (CMEs) as they progress from the Sun to Earth. However, even with continuous monitoring with remote sensing observations, we are still unable to accurately predict the arrival or terrestrial impact of a CME. In this study, we analyze nine CMEs from the Sun to Earth as observed in both the remote sensing and in situ data sets. In this study, we track nine CMEs from the Sun to 70% - 98% of the distance to Earth with the remote sensing data. We use the Graduate Cyclical Shell (GCS) model to estimate the position of each CME as it is observed in the inner heliosphere. From the derived kinematics, we compare the predicted arrival times and impact velocities with the in situ data. We consider different method for fitting the kinematics and the modeled geometry of the CME to improve the predicted arrival time.

  12. 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.

  13. 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

  14. 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.

  15. 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.

  16. 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.

  17. Ejection of Supernova-Enriched Gas From Dwarf Disk Galaxies

    SciTech Connect

    Fragile, P C; Murray, S D; Lin, D C

    2004-06-15

    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 10{sup 8} and 10{sup 9} M{sub {circle_dot}} with supernova rates of 30, 300, and 3000 Myr{sup -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, we find the loss of enriched material to be much less efficient (as low as 21%) 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 predications indicates that, when undergoing self-regulated star formation, galaxies in the mass range considered shall efficiently retain the products of Type II supernovae.

  18. Hot plasma associated with a coronal mass ejection

    SciTech Connect

    Landi, E.; Miralles, M. P.; Raymond, J. C.; Hara, H.

    2013-11-20

    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.

  19. 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.

  20. 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.

  1. 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…

  2. 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

  3. Spinal injuries caused by the acceleration of ejection.

    PubMed

    Lewis, M E

    2002-03-01

    The speed and altitude at which modern military aircraft operate are such that escape can only be achieved by some means of forcibly propelling the aircrew clear of the aircraft. The most common method of doing this is by use of an ejection seat. The use of such seats, whilst generally life saving, exposes aircrew to forces that may be at the limits of human tolerance. Each phase of the ejection sequence is associated with characteristic injury patterns and of particular concern is the occurrence of spinal compression fractures, which are caused by the upward acceleration of the ejection seat. Thorough investigation of aircrew who eject is necessary and magnetic resonance imaging of the spines of these aircrew is now becoming mandatory. Aircrew who sustain stable anterior wedge compression fractures usually require no invasive treatment, but are prevented from flying aircraft fitted with ejection seats for 3-4 months. PMID:12024887

  4. 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

  5. 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.

  6. Detection of coronal mass ejections using AdaBoost on grayscale statistic features

    NASA Astrophysics Data System (ADS)

    Zhang, Ling; Yin, Jian-qin; Lin, Jia-ben; Wang, Xiao-fan; Guo, Juan

    2016-10-01

    We present an automatic algorithm to detect coronal mass ejections (CMEs) in Large Angle Spectrometric Coronagraph (LASCO) C2 running difference images. The algorithm includes 3 steps: (1) split the running difference images into blocks according to slice size and analyze the grayscale statistics of the blocks from a set of images with and without CMEs; (2) select the optimal parameters for slice size, gray threshold and fraction of the bright points and (3) use AdaBoost to combine the weak classifiers designed according to the optimal parameters. Experimental results show that our method is effective and has a high accuracy rate.

  7. Radio-quiet Fast Coronal Mass Ejections

    NASA Astrophysics Data System (ADS)

    Gopalswamy, N.; Aguilar-Rodriguez, E.; Kaiser, M. L.; Howard, R. A.

    2004-12-01

    Coronal mass ejections (CMEs) drive shocks in the interplanetary medium that produce type II radio emission. These CMEs are faster and wider on the average, than the general population of CMEs. However, when we start from fast (speed > 900 km/s) and wide (angular width > 60 degrees), more than half of them are not associated with radio bursts. In order to understand why these CMEs are radio quiet, we collected all the fast and wide (FW) CMEs detected by the Solar and Heliospheric Observatory (SOHO) mission's Large Angle and Spectrometric Coronagraph (LASCO) and isolated those without associated type II radio bursts. The radio bursts were identified in the dynamic spectra of the Radio and Plasma Wave (WAVES) Experiment on board the Wind spacecraft. We also checked the list against metric type II radio bursts reported in Solar Geophysical Data and isolated those without any radio emission. This exercise resulted in about 140 radio-quiet FW CMEs. We identified the source regions of these CMEs using the Solar Geophysical Data listings, cross-checked against the eruption regions in the SOHO/EIT movies. We explored a number of possibilities for the radio-quietness: (i) Source region being too far behind the limb, (ii) flare size, (iii) brightness of the CME, and (iv) the density of the ambient medium. We suggest that a combination of CME energy and the Alfven speed profile of the ambient medium is primarily responsible for the radio-quietness of these FW CMEs.

  8. 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.

  9. 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.

  10. Why are halo coronal mass ejections faster?

    NASA Astrophysics Data System (ADS)

    Zhang, Qing-Min; Guo, Yang; Chen, Peng-Fei; Ding, Ming-De; Fang, Cheng

    2010-05-01

    Halo coronal mass ejections (CMEs) have been to be significantly faster than normal CMEs, which is a long-standing puzzle. In order to solve the puzzle, we first investigate the observed properties of 31 limb CMEs that clearly display loop-shaped frontal loops. The observational results show a strong tendency that slower CMEs are weaker in white-light intensity. Then, we perform a Monte Carlo simulation of 20000 artificial limb CMEs that have an average velocity of ~523 km s-1. The Thomson scattering of these events is calculated when they are assumed to be observed as limb and halo events, respectively. It is found that the white-light intensity of many slow CMEs becomes remarkably reduced when they turn from being viewed as a limb event to being viewed as a halo event. When the intensity is below the background solar wind fluctuation, it is assumed that they would be missed by coronagraphs. The average velocity of “detectable" halo CMEs is ~922 km s-1 very close to the observed value. This also indicates that wider events are more likely to be recorded. The results soundly suggest that the higher average velocity of halo CMEs is due to that a majority of slow events and some of narrow fast events carrying less material are so faint that they are blended with the solar wind fluctuations, and therefore are not observed.

  11. 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.

  12. 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.

  13. 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.

  14. 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.

  15. 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.

  16. Effect of solar Coronal Mass Ejections on the ionosphere

    NASA Astrophysics Data System (ADS)

    Sheiner, Olga; Fridman, Vladimir; Rakhlin, Alexander; Pershin, Alexsander; Vybornov, Feodor

    The influence of solar processes on the state of near-earth space is constantly the object of serious study. First of all the solar radiation affects the parameters of the ionosphere and ionizing processes in it. The basic level indicator of the ionized particles is the critical frequency f0F2 of the reflection of radio signal during sounding of ionosphere. Understanding of the role of Coronal Mass Ejections (CME) in global solar-terrestrial processes allow us to put up the problem about their possible influence on near Earth’ processes and ionosphere behavior. Earlier the authors proposed the procedure of the detection the influence of CMEs on the differential parameters of the upper ionosphere Deltaf0F2 as more sensitive in comparison with the traditional methods. First results were based on the data of regular observations of critical frequency f0F2 during the cycle of solar activity (1975-1986). To verify the relationship discovered we used in the proposed study the data of critical frequency f0F2, determined from uniform ionograms obtained with the modern digital Ionosonde CADI. This ionosonde is installed at the landfill NIRFI "Vasilsursk" (near Nizhny Novgorod), and working program of regular observations allowed to obtain ionograms at least once in 1 minutes. The accuracy of determining the critical frequency was less than ± 50 kHz. There are many examples of time coincidence between the periods of CMEs existence and negative deflection in Deltaf0F2 behaviour.

  17. 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.

  18. 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.

  19. 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.

  20. Magnetohydrodynamic simulations of the ejection of a magnetic flux rope

    NASA Astrophysics Data System (ADS)

    Pagano, P.; Mackay, D. H.; Poedts, S.

    2013-06-01

    Context. Coronal mass ejections (CME's) are one of the most violent phenomena found on the Sun. One model to explain their occurrence is the flux rope ejection model. In this model, magnetic flux ropes form slowly over time periods of days to weeks. They then lose equilibrium and are ejected from the solar corona over a few hours. The contrasting time scales of formation and ejection pose a serious problem for numerical simulations. Aims: We simulate the whole life span of a flux rope from slow formation to rapid ejection and investigate whether magnetic flux ropes formed from a continuous magnetic field distribution, during a quasi-static evolution, can erupt to produce a CME. Methods: To model the full life span of magnetic flux ropes we couple two models. The global non-linear force-free field (GNLFFF) evolution model is used to follow the quasi-static formation of a flux rope. The MHD code ARMVAC is used to simulate the production of a CME through the loss of equilibrium and ejection of this flux rope. Results: We show that the two distinct models may be successfully coupled and that the flux rope is ejected out of our simulation box, where the outer boundary is placed at 2.5 R⊙. The plasma expelled during the flux rope ejection travels outward at a speed of 100 km s-1, which is consistent with the observed speed of CMEs in the low corona. Conclusions: Our work shows that flux ropes formed in the GNLFFF can lead to the ejection of a mass loaded magnetic flux rope in full MHD simulations. Coupling the two distinct models opens up a new avenue of research to investigate phenomena where different phases of their evolution occur on drastically different time scales. Movies are available in electronic form at http://www.aanda.org

  1. The effect of an exteroceptive stimulus on milk ejection in lactating rats

    PubMed Central

    Deis, R. P.

    1968-01-01

    1. The exteroceptive stimulus emanating from a lactating rat and the litter while suckling was used to induce milk ejection in another lactating mother 15 min before the replacement of her own litter. The effect of the external stimulus on milk ejection during one 30 min period and four 15 min periods of nursing was studied. 2. After being isolated for 9 hr the litter from the mother subjected to the exteroceptive nursing stimulus (induced rat) obtained a significantly greater amount of milk during 30 min of nursing than that obtained by the litter from the control mother. 3. When deaf mother rats were used the gain of milk by the litter showed no difference between the control and the induced mother. This result indicated that the effective external stimulus is an auditory one and is probably produced by the mother rat and the young while suckling. 4. The administration of oxytocin (Syntocinon, Sandoz) 20 m-u./100 g body wt., 15 min before the replacement of the litter produced a milk ejection similar to that obtained under the influence of the auditory stimulus. This would indicate that the exteroceptive stimulus probably evokes the release of oxytocin from the neurohypophysis. 5. When nursing was performed in four periods of 15 min each the litter of the control mother obtained milk only in the second period of nursing while the litter of the induced mother obtained milk in all four periods of nursing and the amount of milk obtained in the whole hour was greater than that from the control rat. 6. The administration of oxytocin just before the replacement of the litter every 15 min produced milk ejection only in the first two periods of suckling in the control rats but the induced rats were capable of ejecting milk during all four periods. 7. The most satisfactory conclusion for the results obtained is that the C.N.S. regulates both the release of oxytocin in response to suckling and the response of the mammary gland to oxytocin, in the lactating rat. PMID

  2. 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.

  3. 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.

  4. 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.

  5. Stealth Coronal Mass Ejections: A Perspective

    NASA Astrophysics Data System (ADS)

    Howard, Timothy A.; Harrison, Richard A.

    2013-07-01

    "Stealth CME" has become a commonly used term in recent studies of solar activity. It refers to a coronal mass ejection (CME) with no apparent solar surface association, and therefore has no easily identifiable signature to locate the region on the Sun from which the CME erupted. We review the literature and express caution in categorising CMEs in this way. CMEs were discovered some 40 years ago and there have been numerous statistical studies of associations with phenomena in the solar atmosphere which clearly identify a range of associations, from bright flares and large prominence eruptions to small flares, and even a lack of flares or any identifiable surface activity at all. In this sense the stealth CME concept is not new. One major question relates to whether the range of associations reveal different CME classes, i.e. different CME launch processes, or are indicative of a spectrum of coronal responses to one common process. We favour the latter and stress that this spectrum must be considered in the description of the CME launch, meaning that the physics of a so-called stealth CME must not be fundamentally different from a CME associated with major surface events. On the other hand we also stress that the use of a stealth CME category implies that all surface activity could indeed be detected using modern instrumentation. We argue that this may not be the case, and that even in the SDO era of full-Sun, high resolution imaging, we are restricted by instrument sensitivity and bandwidth issues. Thus, having reviewed the case for stealth CMEs as a distinct category, we stress the need to keep the concept in perspective.

  6. Projection effects in coronal mass ejections

    NASA Astrophysics Data System (ADS)

    Vršnak, B.; Sudar, D.; Ruždjak, D.; Žic, T.

    2007-07-01

    Context: Basic observational parameters of a coronal mass ejection (CME) are its speed and angular width. Measurements of the CME speed and angular width are severely influenced by projection effects. Aims: The goal of this paper is to investigate a statistical relationship between the plane-of-sky speeds of CMEs and the direction of their propagation, hopefully providing an estimate of the true speeds of CMEs. Methods: We analyze the correlation between the plane-of-sky velocity and the position of the CME source region, employing several non-halo CME samples. The samples are formed applying various restrictions to avoid crosstalk of relevant parameters. For example, we select only CMEs observed to radial distances larger than 10 solar radii; we omit CMEs showing a considerable acceleration in the considered distance range and treat CMEs of different angular widths separately. Finally, we combine these restriction criteria, up to the limits beyond which the statistical significance of the results becomes ambiguous. Results: A distinct anti-correlation is found between the angular width of CMEs and their source-region position, clearly showing an increasing trend towards the disc center. Similarly, all of the considered subsamples show a correlation between the CME projected speed and the distance of the source region from the disc center. On average, velocities of non-halo limb-CMEs are 1.5-2 times higher than in the case of non-halo CMEs launched from regions located close to the disc center. Conclusions: Unfortunately, the established empirical relationships provide only a rough estimate of the velocity correction as a function of the source-region location. To a certain degree, the results can be explained in terms of CME cone models, but only after taking crosstalk of various parameters and observational artifacts into account.

  7. Comet ejection and dynamics of nonspherical dust particles and meteoroids

    SciTech Connect

    Gustafson, B.A.S.

    1989-02-01

    This paper generalizes the formalism for calculating the ejection velocity of meteoroids and dust from comets and the forces to which such objects are subject in interplanetary space, including the dust tail of comets. It is found that spheres have the smallest cross section of any geometrical figures of the same valume averaged over random orientations, so for a fixed volume and mass, both the ejection velocity and beta reaches a minimum for bodies of spherical shapes. Flakes in random orientation are ejected near 70 percent of the highest ejection velocity for any orientation. Needles in random orientation escape a comet at nearly 90 percent of their maximum velocities. Randomly oriented cylinders of finite thickness escape at lower velocities that are slightly closer to their maximum velocities. The average beta acting on spin-aligned, perfectly absorbing needles is more than half that acting on a sphere of the same material and radius. 16 references.

  8. 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.

  9. 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.

  10. 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.

  11. 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.

  12. "Paradoxical" reduction in postexercise ejection time and increased transthoracic impedance.

    PubMed

    Nakamura, Y; Kotilainen, P; Haffty, B; Jolda, R; Bishop, R; Spodick, D

    1978-12-01

    Despite decreasing heart rate, left ventricular ejection time (LVET) transiently falls immediately following bicycle exercise. In seven normal, untrained subjects LVET decreases at 15 s postexercise corresponded (r = 0.78) with an increase in transthoracic electrical impedance (Z) consistent with decreased venous return to the thorax. Because the determinants of LVET are stroke volume (SV) and ejection rate, the deltaZ implies that decreased SV contributed to the "paradoxical" fall in LVET.

  13. 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.

  14. RADIAL FLOW PATTERN OF A SLOW CORONAL MASS EJECTION

    SciTech Connect

    Feng, Li; Gan, Weiqun; Inhester, Bernd

    2015-06-01

    Height–time plots of the leading edge of coronal mass ejections (CMEs) have often been used to study CME kinematics. We propose a new method to analyze the CME kinematics in more detail by determining the radial mass transport process throughout the entire CME. Thus, our method is able to estimate not only the speed of the CME front but also the radial flow speed inside the CME. We have applied this method to a slow CME with an average leading edge speed of about 480 km s{sup −1}. In the Lagrangian frame, the speeds of the individual CME mass elements stay almost constant within 2 and 15 R{sub S}, the range over which we analyzed the CME. Hence, we have no evidence of net radial forces acting on parts of the CME in this range or of a pile up of mass ahead of the CME. We find evidence that the leading edge trajectory obtained by tie-pointing may gradually lag behind the Lagrangian front-side trajectories derived from our analysis. Our results also allow a much more precise estimate of the CME energy. Compared with conventional estimates using the CME total mass and leading edge motion, we find that the latter may overestimate the kinetic energy and the gravitational potential energy.

  15. FG Sge at the stage of dust shell ejection

    NASA Astrophysics Data System (ADS)

    Arkhipova, V. P.; Esipov, V. F.; Ikonnikova, N. P.; Komissarova, G. V.; Shugarov, S. Yu.

    2009-08-01

    New photometric observations of the variable star FG Sge, a rapidly evolving planetary nebula nucleus, were performed in 2003-2008. On 230 nights, we obtained 86 UBV and 155 BV RI (or R c , I c ) magnitude estimates. The maximum amplitude of the V-band light variations was >8 m . Six deep minima and four high maxima were observed. Analysis of the light curve has shown that the pulsation period of the star remained constant since 1991 and was P = 115 days. We have studied the wavelength dependence of the extinction at various phases of the light curve. The blueing of the B- V color at deep minima is interpreted as the result of light scattering in the circumstellar dust shell of the star formed by preceding dust ejections since 1992. Our spectroscopic observations performed on nine nights in 2003-2007 with the 125-cm telescope at the Crimean Station of the Sternberg Institute have confirmed the previously detected intensity variations of the Swan bands and the sodium doublet with brightness. It is noted that the Swan bands originate in the upper atmosphere, the star’s extended envelope, while the sodium doublet originates mainly in the circumstellar shell of FG Sge. We suggest that the star is currently located in the temperature-luminosity diagram at the turning point of the horizontal track of cooling in the direction of hot stars—evolution caused by the last helium shell flash at the planetary nebula stage.

  16. 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

  17. A spectacular coronal mass ejection event and associated phenomena

    NASA Astrophysics Data System (ADS)

    Ma, Yuan; Li, Chun-Sheng; Song, Qian

    Based on the data taken from S. G. D. and relevant simultaneous observations of solar radio bursts, gamma-ray emission and geophysical effects on June 15, 1991 the relationships among these phenomena are discussed in this paper. Through the analyses it is considered that proton events and GLE events occurred on June 15 in 1991, which were the geophysic responses caused by CME (V>=750 km/s). Simultaneous observation of the bursts at the centimetric and decimetric wavelengths can obtain the U-shape spectrum of speak fluxes, which is still one of the effective tools for predicting proton events and its production mechanism can be explained by using the acceleration of the direct current field parallel to the magnetic field in the electric current sheet formed in the process of the production of spray prominences. However, the process in which electrons are accelerated up to the high energy state remains to be explained. The whole event of June 15 1991, from the coronal matter ejection (or the spray prominences in active regions) to the production of various geophysic effects, has explained and verified.

  18. 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.

  19. Vertebral fracture after aircraft ejection during Operation Desert Storm.

    PubMed

    Osborne, R G; Cook, A A

    1997-04-01

    During Operation Desert Storm, 21 United States and 2 Italian military personnel were held in Iraq as prisoners of war. Of these, 18 had ejected from fixed-wing, ejection seat-equipped, combat aircraft prior to their capture. Of the 18, 6 (33%) had sustained vertebral fractures; 4 of these were compression fractures. This fracture rate is comparable to that of previously studied groups. Fractures were noted to be at several different vertebral sites and after ejecting from a variety of aircraft. Apart from contusions and abrasions, vertebral fractures were the most common injuries discovered in this repatriated population. None of the vertebral fractures produced recognizable neurological disability. The development of vertebral fractures was neither associated with the use of any particular ejection system or aircraft nor did the development of vertebral fractures appear dependent on the age, height or length of service of the affected personnel. Ejected aircrew with low altitude mission profiles seemed more predisposed to vertebral fracture than those at high altitudes, but with a small sample population, this relationship was not statistically significant (p > 0.25). Reliable data were unavailable on aircrew positioning and preparation time for ejection. PMID:9096832

  20. DNA heats up: energetics of genome ejection from phage revealed by isothermal titration calorimetry.

    PubMed

    Jeembaeva, Meerim; Jönsson, Bengt; Castelnovo, Martin; Evilevitch, Alex

    2010-02-01

    Most bacteriophages are known to inject their double-stranded DNA into bacteria upon receptor binding in an essentially spontaneous way. This downhill thermodynamic process from the intact virion to the empty viral capsid plus released DNA is made possible by the energy stored during active packaging of the genome into the capsid. Only indirect measurements of this energy have been available until now, using either single-molecule or osmotic suppression techniques. In this work, we describe for the first time the use of isothermal titration calorimetry to directly measure the heat released (or, equivalently, the enthalpy) during DNA ejection from phage lambda, triggered in solution by a solubilized receptor. Quantitative analyses of the results lead to the identification of thermodynamic determinants associated with DNA ejection. The values obtained were found to be consistent with those previously predicted by analytical models and numerical simulations. Moreover, the results confirm the role of DNA hydration in the energetics of genome confinement in viral capsids.

  1. Numerical investigation on the mixing and combustion in supersonic ejecting flow of RBCC

    NASA Astrophysics Data System (ADS)

    Huang, S. H.; He, G. Q.; He, H. Q.; Xu, S. L.

    3D mixing and reacting flows of five RBCC configurations in ejecting mode were investigated with numerical techniques and newly established mixing degree model. The effects of secondary combustion and geometry configuration on ejecting and mixing were analyzed in detail. It was concluded that: 1) The geometry configuration of RBCC affects the mixing process of rocket ejector mode greatly, in which the geometry structure of primary nozzle mainly determines the upstream mixing, while the geometry of flow path determines the downstream. 2) The secondary combustion can promote the thrust, but for different configuration, the promotion magnitude is different. 3) The key elements of thrust augmentation obtained by the improved configuration are higher mixing degree, positive pressure state and higher combustion efficiency.

  2. 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.

  3. Are halo coronal mass ejections special events?

    NASA Astrophysics Data System (ADS)

    Lara, Alejandro; Gopalswamy, Nat; Xie, Hong; Mendoza-Torres, Eduardo; PéRez-EríQuez, RomáN.; Michalek, Gregory

    2006-06-01

    We revisited the properties of wide coronal mass ejections (CMEs) called halo CMEs. Using the large LASCO/SOHO CMEs data set, from 1996 to 2004, we examined the statistical properties of (partial and full) halo CMEs and compare with the same properties of "normal" width (lower than 120°) CMEs. We found that halo CMEs have different properties than "normal" CMEs, which cannot be explained merely by the current geometric interpretation that they are seen as halos because they are traveling in the Sun Earth direction. We found that the CME width distribution is formed by, at least, three different populations: Two gaussians: a narrow and a medium distribution centered at ˜17° and ˜38°, respectively; the narrow population most likely corresponds to the "true" observed widths, whereas the medium width population is the product of projection effects. The third distribution corresponds to wider CMEs (80° < W < 210°) which behaves as a power law. Partial and full halo CMEs wider than these do not follow any particular distribution. This lack of regularity may be due to the small number of such events. In particular, we found (and test by a statistical approach) that the number of observed full halo CMEs is lower than expected. The CME speed follows a log-normal distribution, except for the very low speed CME population, which follows a gaussian distribution centered at ˜100 km/s and is probably due to projection effects. When the CMEs are divided by width into nonhalo, partial halo, and full halo, we found that the peaks of the distributions are shifted toward higher speeds, ˜300, ˜400 and ˜600 km/s for nonhalo, partial halo, and full halo CMEs, respectively. This confirms that halo CMEs tend to be high speed CMEs. The acceleration of full halo CMEs tends to be more negative compared with nonhalo and partial halo CMEs. We introduce a new observational CME parameter: The final observed distance (FOD), i.e., the highest point within the coronograph field of view

  4. 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

  5. Characterisation of heart failure with normal ejection fraction in a tertiary hospital in Nigeria

    PubMed Central

    2009-01-01

    Background The study aimed to determine the frequency and characteristics of heart failure with normal EF in a native African population with heart failure. Methods It was a hospital cohort study. Subjects were 177 consecutive individuals with heart failure and ninety apparently normal control subjects. All the subjects underwent transthoracic echocardiography. The group with heart failure was further subdivided into heart failure with normal EF (EF ≥ 50) (HFNEF) and heart failure with low EF(EF <50)(HFLEF). Results The subjects with heart failure have a mean age of 52.3 ± 16.64 years vs 52.1 ± 11.84 years in the control subjects; p = 0.914. Other baseline characteristics except blood pressure parameters and height were comparable between the group with heart failure and the control subjects. The frequency of HFNEF was 39.5%. Compared with the HFLEF group, the HFNEF group have a smaller left ventricular diameter (in diastole and systole): (5.2 ± 1.22 cm vs 6.2 ± 1.39 cm; p < 0.0001 and 3.6 ± 1.24 cm vs 5.4 ± 1.35 cm;p < 0.0001) respectively, a higher relative wall thickness and deceleration time of the early mitral inflow velocity: (0.4 ± 0.12 vs 0.3 ± 0.14 p < 0.0001 and 149.6 ± 72.35 vs 110.9 ± 63.40 p = 0.001) respectively. The two groups with heart failure differed significantly from the control subjects in virtually all echocardiographic measurements except aortic root diameter, LV posterior wall thickness(HFLEF), and late mitral inflow velocity(HFNEF). HFNEF accounted for 70(39.5%) of cases of heart failure in this study. Hypertension is the underlying cardiovascular disease in 134(75.7%) of the combined heart failure population, 58 (82.9%) of the subjects with HFNEF group and 76(71%) of the HFLEF group. Females accounted for 44 (62.9%) of the subjects with HFNEF against 42(39.3%) in the HFLEF group (p = 0.002). Conclusion The frequency of heart failure with normal EF in this native African cohort with heart failure is comparable with the frequency in other populations. These groups of patients are more likely female, hypertensive with concentric pattern of left ventricular hypertrophy. PMID:19922629

  6. Forward ejection fraction: a new index of left ventricular function in mitral regurgitation.

    PubMed

    Clancy, K F; Hakki, A H; Iskandrian, A S; Hadjimiltiades, S; Mundth, E D; Hakki, A H; Bemis, C E; Nestico, P F; DePace, N L; Segal, B L

    1985-09-01

    Previous studies have shown that a normal LVEF is not a reliable index of LV function in MR. We hypothesized that the forward EF, which is the forward stroke volume (measured by Fick or thermodilution) divided by end-diastolic volume (measured by contrast ventriculography) may be a useful index of LV function, since it represents LV emptying into the aorta. This index was examined in 54 patients with chronic MR who had normal EF (greater than or equal to 50%). There were significant correlations between the forward EF and the end-diastolic volume index (r = -0.69, p less than 0.001), end-systolic volume index (r = -0.64, p less than 0.001), cardiac index (r = 0.43, p less than 0.01), and the ratio of systolic pressure-to-end-systolic volume (r = 0.65, p less than 0.001). Patients were divided into two groups according to the forward EF: group I (n = 34) had forward EF less than or equal to 35%; and group II (n = 20) had forward EF greater than 35%. Of the 32 patients who subsequently underwent mitral valve replacement, 24 patients were in group I and eight patients were in group II. At a mean follow-up of 35 months, four patients died; all of them were in group I. Improvement in functional class occurred in 75% of surgical survivors (80% in group I and 63% in group II, p = NS). These preliminary data suggest that forward EF may be a useful index of LV performance in patients with MR who have normal EF.

  7. 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.

  8. STOCHASTIC INTEGRATION FOR TEMPERED FRACTIONAL BROWNIAN MOTION.

    PubMed

    Meerschaert, Mark M; Sabzikar, Farzad

    2014-07-01

    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.

  9. STOCHASTIC INTEGRATION FOR TEMPERED FRACTIONAL BROWNIAN MOTION.

    PubMed

    Meerschaert, Mark M; Sabzikar, Farzad

    2014-07-01

    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

  10. Magnetic ejection of submilimeter-sized diamagnetic grains observed in a chamber-type drop shaft

    NASA Astrophysics Data System (ADS)

    Hisayoshi, K.; Uyeda, C.; Kuwada, K.; Mamiya, M.; H; Nagai

    2011-12-01

    Mass dependence of magnetically induced translation is examined for submilimeter-sized diamagnetic grain, which is floated in a diffused gas medium of 70 Pa by the use of microgravity μG condition. Here the grains are ejected from field-center of a pole-piece magnetic circuit by field-gradient force in a direction of decreasing field; maximum field-intensity at initial point is about 0.6T. It was deduced from an energy conservation rule that magnetic potential of the grain at initial position was partially converted to kinetic energy during translation. Therefore, observed velocity was expected to be independent to mass of particle; this is because magnetic potential is proportional to mass of particle. In a given field distribution, the velocity was uniquely determined by intrinsic magnetic susceptibility χ DIA of material. We report here that the magnetic ejection in μ G condition is realized for sub-mm sized crystals of bismuth, graphite and magnesia. The χ DIA values obtained from the ejection agreed fairly well with the published values for the three materials. The mass-independent property of translation was examined by observing the translation of two bismuth grains with different sizes. A chamber-type drop shaft having a height of 1.5 m was introduced to produce the μ G condition. By the use of this drop shaft, study of field-induced motion of a single diamagnetic particle becomes possible in an ordinary laboratory.

  11. 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.

  12. Inhibition of DNA ejection from bacteriophage by Mg^+2 counterions

    NASA Astrophysics Data System (ADS)

    Lee, Seil; Tran, Cathy V.; Nguyen, Toan T.

    2009-03-01

    The problem of inhibiting viral DNA ejection from bacteriophages by multivalent counterions, especially Mg^+2 counterions, is studied. Experimentally, it is known that MgSO4 salt has a strong and non-monotonic effect on the amount of DNA ejected. There exists an optimal concentration at which the least 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, DNA net charge 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. Our theory fits experimental data well. The strength of DNA-DNA short range attraction, mediated by Mg^+2, is found to be -0.003 kBT per nucleotide base.

  13. 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.

  14. 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).

  15. 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).

  16. Multiple fractional Fourier transform holography

    NASA Astrophysics Data System (ADS)

    Zeng, Yangsu; Zhang, Yixiao; Gao, Feng; Gao, Fuhua; Huang, Xiaoyang; Guo, Yongkang

    2002-04-01

    In this paper, we introduce the recording and reconstruction theories of the multiple fractional Fourier transform hologram (M-FRTH). We fabricated a multiple fractional Fourier transform hologram, and obtained satisfying reconstruction results. The experimental result shows that the M-FRTH has a high anti-counterfeiting capacity and can be used in the fabrication of the trademark, ID, and the notes.

  17. 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.

  18. 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

  19. 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

  20. 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

  1. 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

  2. Ejection of a rear facing, golf cart passenger.

    PubMed

    Schau, Kyle; Masory, Oren

    2013-10-01

    The following report details the findings of a series of experiments and simulations performed on a commercially available, shuttle style golf cart during several maneuvers involving rapid accelerations of the vehicle. It is determined that the current set of passive restraints on these types of golf carts are not adequate in preventing ejection of a rear facing passenger during rapid accelerations in the forward and lateral directions. Experimental data and simulations show that a hip restraint must be a minimum of 13 in. above the seat in order to secure a rear facing passenger during sharp turns, compared to the current restraint height of 5 in. Furthermore, it is determined that a restraint directly in front of the rear facing passenger is necessary to prevent ejection. In addressing these issues, golf cart manufacturers could greatly reduce the likelihood of injury due to ejection of a rear facing, golf cart passenger. PMID:23958856

  3. The Numerical Simulation of Flow around Ejection System

    NASA Astrophysics Data System (ADS)

    Zhang, Dalin; Wei, Tao

    Aerodynamic characteristics of an Ejection Seat System at different angles of attack are studied by the numerical method and the flow mechanisms for such flows are carefully analyzed. The governing equations are Reynolds-averaged Navier-Stokes equations which are solved by the unstructured finite volume method. Upwind Osher scheme is used for spatial discretization and five-stage Runge-Kutta scheme is applied for temporal discretization. The DES model based on S-A one equation turbulence model is adopted. Parallel computation is based on the domain decomposition method and multi-block is achieved by using METIS system. The experimental data is used to validate this method. This research is helpful to understand the aerodynamic characteristics and flow mechanisms of Ejection Seat System at different angles of attack and Mach numbers, and can provide reasonable reference for Ejection Seat System design.

  4. Lil HAL: digital kneeboard for ejection seat aircraft

    NASA Astrophysics Data System (ADS)

    Parisi, Vince

    2004-09-01

    In the last few years, airlines, commercial air carriers and the military have begun to introduce electronic tools into the cockpit to replace paper versions of flight publications, flight plans, departure and approach plates, maps, etc. These devices have varied from the common laptop to the smaller pen-tablet type computers. In some instances these devices have been connected to aircraft data buses to collect maintenance data, fault codes and other useful information. None of these devices, however, have been found satisfactory in ejection seat aircraft due to their size, weight, and dynamic characteristics when subjected to the inertial and aerodynamic forces that occur during an ejection. This paper describes an electronic digital kneeboard suitable for use in an ejection seat aircraft. The kneeboard consists of a look at helmet-mounted display, a small streamlined kneeboard input device, a carry-on/carry-off computer and its associated support interfaces.

  5. Ejection of a rear facing, golf cart passenger.

    PubMed

    Schau, Kyle; Masory, Oren

    2013-10-01

    The following report details the findings of a series of experiments and simulations performed on a commercially available, shuttle style golf cart during several maneuvers involving rapid accelerations of the vehicle. It is determined that the current set of passive restraints on these types of golf carts are not adequate in preventing ejection of a rear facing passenger during rapid accelerations in the forward and lateral directions. Experimental data and simulations show that a hip restraint must be a minimum of 13 in. above the seat in order to secure a rear facing passenger during sharp turns, compared to the current restraint height of 5 in. Furthermore, it is determined that a restraint directly in front of the rear facing passenger is necessary to prevent ejection. In addressing these issues, golf cart manufacturers could greatly reduce the likelihood of injury due to ejection of a rear facing, golf cart passenger.

  6. 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.

  7. Numerical simulation of fluid ejection from a spinning cylinder

    NASA Astrophysics Data System (ADS)

    Fedele, P. D.

    1985-02-01

    A computer code, based on a convective flux approximation on a finite difference Eulerian grid, was to model the rate of fluid ejection from the opened end of an azimuthally rotating cylinder. The computer code, SOLA-VOF/CSL is described in a previous support. A constantly rotating cylinder, with an 80% fluid fill, is set in equilibrium solid body rotation and one end is instantaneously removed, allowing the centrifugal force to drive the fluid from the opened end. Fluid parameters have been chosen to model the behavior of water and glycerin at 25 C. The ratio of the volume ejection rate to the volume rotation shows similarity when expressed as a function of the cylinder rotation time. The fluid viscosity is observed to have negligible effect on the ejection rate for the spin rates of interest. This behavior is shown to be consistent with a dimensional analysis of the flows considered.

  8. A SOLAR CORONAL JET EVENT TRIGGERS A CORONAL MASS EJECTION

    SciTech Connect

    Liu, Jiajia; Wang, Yuming; Shen, Chenglong; Liu, Kai; Pan, Zonghao; Wang, S.

    2015-11-10

    In this paper, we present multi-point, multi-wavelength observations and analysis of a solar coronal jet and coronal mass ejection (CME) event. Employing the GCS model, we obtained the real (three-dimensional) heliocentric distance and direction of the CME and found it to propagate at a high speed of over 1000 km s{sup −1}. The jet erupted before the CME and shared the same source region. The temporal and spacial relationship between these two events lead us to the possibility that the jet triggered the CME and became its core. This scenario hold the promise of enriching our understanding of the triggering mechanism of CMEs and their relations to coronal large-scale jets. On the other hand, the magnetic field configuration of the source region observed by the Solar Dynamics Observatory (SDO)/HMI instrument along with the off-limb inverse Y-shaped configuration observed by SDO/AIA in the 171 Å passband provide the first detailed observation of the three-dimensional reconnection process of a large-scale jet as simulated in Pariat et al. The eruption process of the jet highlights the importance of filament-like material during the eruption of not only small-scale X-ray jets, but likely also of large-scale EUV jets. Based on our observations and analysis, we propose the most probable mechanism for the whole event, with a blob structure overlaying the three-dimensional structure of the jet, to describe the interaction between the jet and the CME.

  9. 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.

  10. 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.

  11. Ventricular ejection force in growth-retarded fetuses.

    PubMed

    Rizzo, G; Capponi, A; Rinaldo, D; Arduini, D; Romanini, C

    1995-04-01

    The objective of this study was to determine whether in growth-retarded fetuses secondary to uteroplacental insufficiency the cardiac ventricles exert a force different from that of appropriately grown fetuses. Doppler echocardiographic studies were performed in 156 appropriately grown fetuses (gestational age 18-38 weeks) and in 72 growth-retarded fetuses (gestational age 24-36 weeks) free from structural and chromosomal abnormalities and characterized by Doppler changes in the umbilical artery and middle cerebral artery suggesting uteroplacental insufficiency as the most likely etiology of the growth defect. Right and left ventricular ejection force values were calculated from velocity waveforms recorded at the level of aortic and pulmonary valves, according to Newton's second law of motion. In appropriately grown fetuses, left and right ventricular ejection force values significantly increased with advancing gestation and the two ventricles exerted similar force. In growth-retarded fetuses, the ventricular ejection force was significantly and symmetrically decreased in both ventricles. Among growth-retarded fetuses, a poorer perinatal outcome was observed in those fetuses in which the ejection force of both ventricles was below the 5th centile of the normal limits for gestation. In 12 growth-retarded fetuses followed longitudinally during the last week preceding intrauterine death or Cesarean section due to antepartum heart-rate late decelerations, a significant decrease of ejection force was found in both ventricles. Finally, a significant relationship was found between the severity of acidosis and right and left ventricular ejection force values in 22 fetuses in which Doppler recordings were performed immediately before cordocentesis.(ABSTRACT TRUNCATED AT 250 WORDS)

  12. Forces in magnetospheric launching of micro-ejections

    NASA Astrophysics Data System (ADS)

    Cemeljic, Miljenko

    2013-07-01

    In 2D-axisymmetric simulations with our resistive MHD code Zeus-347 we show that micro-ejections, a quasi-stationary fast ejecta of matter of small mass and angular momentum fluxes, can be launched from a purely resistive magnetosphere above the disk gap. They are produced by a combination of pressure gradient and magnetic forces, in presence of ongoing magnetic reconnection along the boundary layer between the star and the disk, where a current sheet is formed. Mass flux of micro-ejections increases with increasing magnetic field strength and stellar rotation rate.

  13. Coronal mass ejections and magnetic flux ropes in interplanetary space

    NASA Technical Reports Server (NTRS)

    Gosling, J. T.

    1990-01-01

    Coronal mass ejections (CMEs) are formed in the solar corona by the ejection of material from closed field regions that were not previously participating in the solar wind expansion. CMEs commonly exhibit a signature consisting of a counterstreaming flux of suprathermal electrons with energies above about 80 eV, indicating closed field structures that are either rooted at both ends in the sun or entirely disconnected from it. About 30 percent of all CME events at 1 AU exhibit large, coherent internal field rotations typical of magnetic flux ropes. It is suggested that interplanetary magnetic flux ropes form as a result of reconnection within rising, previously sheared coronal magnetic loops.

  14. 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.

  15. 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.

  16. 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).

  17. 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.

  18. 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...

  19. 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...

  20. 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.

  1. Dynamo-driven plasmoid ejections above a spherical surface

    NASA Astrophysics Data System (ADS)

    Warnecke, J.; Brandenburg, A.; Mitra, D.

    2011-10-01

    Aims: We extend earlier models of turbulent dynamos with an upper, nearly force-free exterior to spherical geometry, and study how flux emerges from lower layers to the upper ones without being driven by magnetic buoyancy. We also study how this affects the possibility of plasmoid ejection. Methods: A spherical wedge is used that includes northern and southern hemispheres up to mid-latitudes and a certain range in longitude of the Sun. In radius, we cover both the region that corresponds to the convection zone in the Sun and the immediate exterior up to twice the radius of the Sun. Turbulence is driven with a helical forcing function in the interior, where the sign changes at the equator between the two hemispheres. Results: An oscillatory large-scale dynamo with equatorward migration is found to operate in the turbulence zone. Plasmoid ejections occur in regular intervals, similar to what is seen in earlier Cartesian models. These plasmoid ejections are tentatively associated with coronal mass ejections (CMEs). The magnetic helicity is found to change sign outside the turbulence zone, which is in agreement with recent findings for the solar wind. Movie is available in electronic form at http://www.aanda.org

  2. Certain optimal parameters of high-velocity Venturi ejection tubes

    NASA Astrophysics Data System (ADS)

    Stark, S. B.; Reznichenko, I. G.; Pavlenko, Y. P.

    1984-11-01

    The influence of the geometrical characteristics of centrifugal nozzles in high velocity Venturi ejection tubes for atomizing liquid in gas cleaning plant is analyzed. An optimal value of the nozzle geometrical characteristic, which is a function of the degree of filling of the nozzle outlet opening by the liquid, is given, at which the throat length is independent of water pressure before the nozzle.

  3. 49 CFR 571.226 - Standard No. 226; Ejection Mitigation.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... (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...

  4. 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.

  5. 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

  6. 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.

  7. Effect of coolant flow ejection on aerodynamic performance of low-aspect-ratio vanes. 2: Performance with coolant flow ejection at temperature ratios up to 2

    NASA Technical Reports Server (NTRS)

    Hass, J. E.; Kofskey, M. G.

    1977-01-01

    The aerodynamic performance of a 0.5 aspect ratio turbine vane configuration with coolant flow ejection was experimentally determined in a full annular cascade. The vanes were tested at a nominal mean section ideal critical velocity ratio of 0.890 over a range of primary to coolant total temperature ratio from 1.0 to 2.08 and a range of coolant to primary total pressure ratio from 1.0 to 1.4 which corresponded to coolant flows from 3.0 to 10.7 percent of the primary flow. The variations in primary and thermodynamic efficiency and exit flow conditions with circumferential and radial position were obtained.

  8. The Accretion Flow–Discrete Ejection Connection in GRS 1915+105

    NASA Astrophysics Data System (ADS)

    Punsly, Brian; Rodriguez, Jérôme; Trushkin, Sergei A.

    2016-07-01

    The microquasar GRS 1915+105 is known for its spectacular discrete ejections. They occur unexpectedly, thus their inception has escaped direct observation. It has been shown that the X-ray flux increases in the hours leading up to a major ejection. In this article, we consider the serendipitous interferometric monitoring of a modest version of a discrete ejection described in Reid et al. that would have otherwise escaped detection in daily radio light curves. The observation begins ˜1 hr after the onset of the ejection, providing unprecedented accuracy on the estimate of the ejection time. The astrometric measurements allow us to determine the time of ejection as {{MJD}} {56436.274}-0.013+0.016, i.e., within a precision of 41 minutes (95% confidence). Just like larger flares, we find that the X-ray luminosity increases in last 2–4 hr preceding ejection. Our finite temporal resolution indicates that this elevated X-ray flux persists within {21.8}-19.1+22.6 minutes of the ejection with 95% confidence, the highest temporal precision of the X-ray–superluminal ejection connection to date. This observation provides direct evidence that the physics that launches major flares occurs on smaller scales as well (lower radio flux and shorter ejection episodes). The observation of a X-ray spike prior to a discrete ejection, although of very modest amplitude, suggests that the process linking accretion behavior to ejection is general from the smallest scales to high luminosity major superluminal flares.

  9. Coronal Mass Ejections and Non-recurrent Forbush Decreases

    NASA Astrophysics Data System (ADS)

    Belov, A.; Abunin, A.; Abunina, M.; Eroshenko, E.; Oleneva, V.; Yanke, V.; Papaioannou, A.; Mavromichalaki, H.; Gopalswamy, N.; Yashiro, S.

    2014-10-01

    Coronal mass ejections (CMEs) and their interplanetary counterparts (interplanetary coronal mass ejections, ICMEs) are responsible for large solar energetic particle events and severe geomagnetic storms. They can modulate the intensity of Galactic cosmic rays, resulting in non-recurrent Forbush decreases (FDs). We investigate the connection between CME manifestations and FDs. We used specially processed data from the worldwide neutron monitor network to pinpoint the characteristics of the recorded FDs together with CME-related data from the detailed online catalog based upon the Solar and Heliospheric Observatory (SOHO)/ Large Angle and Spectrometric Coronagraph (LASCO) data. We report on the correlations of the FD magnitude to the CME initial speed, the ICME transit speed, and the maximum solar wind speed. Comparisons between the features of CMEs (mass, width, velocity) and the characteristics of FDs are also discussed. FD features for halo, partial halo, and non-halo CMEs are presented and discussed.

  10. Radiation dose distributions due to sudden ejection of cobalt device.

    PubMed

    Abdelhady, Amr

    2016-09-01

    The evaluation of the radiation dose during accident in a nuclear reactor is of great concern from the viewpoint of safety. One of important accident must be analyzed and may be occurred in open pool type reactor is the rejection of cobalt device. The study is evaluating the dose rate levels resulting from upset withdrawal of co device especially the radiation dose received by the operator in the control room. Study of indirect radiation exposure to the environment due to skyshine effect is also taken into consideration in order to evaluate the radiation dose levels around the reactor during the ejection trip. Microshield, SHLDUTIL, and MCSky codes were used in this study to calculate the radiation dose profiles during cobalt device ejection trip inside and outside the reactor building.

  11. Radiation dose distributions due to sudden ejection of cobalt device.

    PubMed

    Abdelhady, Amr

    2016-09-01

    The evaluation of the radiation dose during accident in a nuclear reactor is of great concern from the viewpoint of safety. One of important accident must be analyzed and may be occurred in open pool type reactor is the rejection of cobalt device. The study is evaluating the dose rate levels resulting from upset withdrawal of co device especially the radiation dose received by the operator in the control room. Study of indirect radiation exposure to the environment due to skyshine effect is also taken into consideration in order to evaluate the radiation dose levels around the reactor during the ejection trip. Microshield, SHLDUTIL, and MCSky codes were used in this study to calculate the radiation dose profiles during cobalt device ejection trip inside and outside the reactor building. PMID:27423021

  12. Light-induced ejection of calcium atoms from polymer surfaces

    NASA Astrophysics Data System (ADS)

    Mango, F.; Maccioni, E.

    2008-12-01

    Laser-induced fluorescence (LIF) of calcium atoms at room temperature has been observed in a polydimethylsiloxane (PDMS) coated cell when the walls are illuminated with non resonant visible light. Ca atomic density in the gas phase, monitored by the LIF, is much higher than normal room-temperature vapour pressure of calcium. In past years photon-stimulated desorption (PSD) was observed for several alkali metals that adsorbed to solid films of PDMS polymers. High yields of photo-desorbed atoms (and molecules in the case of sodium) can be induced, at room temperature and below, by weak intensity radiation. The desorption is characterised by a frequency threshold, whereas any power threshold is undetectable. The calcium photo-ejection is characterised both by a frequency threshold (about 18 500 cm-1) and by an observable power threshold (whose value becomes lower when the photo-ejecting light wavelength decreases).

  13. Stoichiometric relationship between energy-dependent proton ejection and electron transport in mitochondria.

    PubMed

    Brand, M D; Reynafarje, B; Lehninger, A L

    1976-02-01

    The number of protons ejected during electron transport per pair of electrons per energy-conserving site (the H+/site ratio) was measured in rat liver mitochondria by three different methods under conditions in which transmembrane movements of endogenous phosphate were minized or eliminated. (1) In the Ca2+ pulse method, between 3.5 and 4.0 molecules of 3-hydroxybutyrate and 1.75 to 2.0 Ca2+ ions were accumulated per 2 e- per site during Ca2+ induced electron transport in the presence of rotenone, when measured under conditions in which movements of endogenous phosphate were negligible. Since entry of 3-hydroxybutyrate requires its protonation to the free acid these data correspond to an H+/site ratio of 3.5-4.0 (2) In the oxygen pulse method addition of known amounts of oxygen to anaerobic mitochondria in the presence of substrate yielded H+/site ratios of 3.0 when phosphate transport was eliminated by addition of N-ethylmaleimide or by anaerobic washing to remove endogenous phosphate. In the absence of such measures the observed H+/site ratio was 2.0. (3) In the reductant pulse method measurement of the initial steady rates of H+ ejection and oxygen consumption by mitochondria in an aerobic medium after addition of substrate gave H+/site near 4.0 in the presence of N-ethylmaleimide; in the absence of the inhibitor the observed ratio was only 2.0. These and other experiments reported indicate that the values of 2.0 earlier obtained for the H+/site ratio by Mitchell and Moyle [Biochem J. (1967) 105, 1147-1162] and others were underestimates due to the unrecognized masking of H+ ejection by movements of endogenous phosphate. The results presented here show that the H+/site ratio of mitochondrial electron transport is at least 3.0 and may be as high as 4.0.

  14. The impact ejection of living organisms into space

    NASA Technical Reports Server (NTRS)

    Melosh, H. J.

    1985-01-01

    The possibility of natural processes to blast living organisms into space was examined. It is suggested that rocks ejected from the Earth by a giant meteorite or comet impact can carry microorganisms into space. Such microscopic Earth life would have an opportunity to colonize the other planets if it can survive the rigors of space until it falls into the atmosphere of a hospitable planet.

  15. Determining the full halo coronal mass ejection characteristics

    NASA Astrophysics Data System (ADS)

    Fainshtein, V. G.

    2009-03-01

    In this paper we determined the parameters of 45 full halo coronal mass ejections (HCMEs) for various modifications of their cone forms (“ice cream cone models”). We show that the CME determined characteristics depend significantly on the CME chosen form. We show that, regardless of the CME chosen form, the trajectory of practically all the considered HCMEs deviate from the radial direction to the Sun-to-Earth axis at the initial stage of their movement.

  16. Evolving Magnetic Structures and Their Relation to Coronal Mass Ejections

    NASA Technical Reports Server (NTRS)

    Feynman, J.

    1996-01-01

    Solar activity regions are frequently concentrated into cluster which persist for many solar rotations. These activity complexes are associated with weak dispersed magnetic fields which are most apparent after the activity itself has ceased. We call this combination of persistent activity and dispersed Evolving Magnetic Structures (EMS). Here we show examples of EMSs and describe the evolution of an EMS associated with major Coronal Mass Ejections (CME) and other solar and magnetic disturbances.

  17. Associations between coronal mass ejections and interplanetary shocks

    NASA Technical Reports Server (NTRS)

    Sheeley, N. R., Jr.; Howard, R. A.; Koomen, M. J.; Michels, D. J.; Schwenn, R.; Muhlhauser, K. H.; Rosenbauer, H.

    1983-01-01

    Nearly continuous complementary coronal observations and interplanetary plasma measurements for the years 1979-1982 are compared. It is shown that almost all low latitude high speed coronal mass ejections (CME's) were associated with shocks at HELIOS 1. Some suitably directed low speed CME's were clearly associated with shocks while others may have been associated with disturbed plasma (such as NCDE's) without shocks. A few opposite hemisphere CME's associated with great flares seem to be associated with shocks at HELIOS.

  18. Dynamics of bacteriophage genome ejection in vitro and in vivo

    NASA Astrophysics Data System (ADS)

    Panja, Debabrata; Molineux, Ian J.

    2010-12-01

    Bacteriophages, phages for short, are viruses of bacteria. The majority of phages contain a double-stranded DNA genome packaged in a capsid at a density of ~500 mg ml-1. This high density requires substantial compression of the normal B-form helix, leading to the conjecture that DNA in mature phage virions is under significant pressure, and that pressure is used to eject the DNA during infection. A large number of theoretical, computer simulation and in vitro experimental studies surrounding this conjecture have revealed many—though often isolated and/or contradictory—aspects of packaged DNA. This prompts us to present a unified view of the statistical physics and thermodynamics of DNA packaged in phage capsids. We argue that the DNA in a mature phage is in a (meta)stable state, wherein electrostatic self-repulsion is balanced by curvature stress due to confinement in the capsid. We show that in addition to the osmotic pressure associated with the packaged DNA and its counterions, there are four different pressures within the capsid: pressure on the DNA, hydrostatic pressure, the pressure experienced by the capsid and the pressure associated with the chemical potential of DNA ejection. Significantly, we analyze the mechanism of force transmission in the packaged DNA and demonstrate that the pressure on DNA is not important for ejection. We derive equations showing a strong hydrostatic pressure difference across the capsid shell. We propose that when a phage is triggered to eject by interaction with its receptor in vitro, the (thermodynamic) incentive of water molecules to enter the phage capsid flushes the DNA out of the capsid. In vivo, the difference between the osmotic pressures in the bacterial cell cytoplasm and the culture medium similarly results in a water flow that drags the DNA out of the capsid and into the bacterial cell.

  19. Ejection behavior characteristics in experimental cratering in sandstone targets

    NASA Astrophysics Data System (ADS)

    Sommer, Frank; Reiser, Fiona; Dufresne, Anja; Poelchau, Michael H.; Hoerth, Tobias; Deutsch, Alex; Kenkmann, Thomas; Thoma, Klaus

    2013-01-01

    Within the frame of the MEMIN research unit (Multidisciplinary Experimental and Numerical Impact Research Network), impact experiments on sandstone targets were carried out to systematically study the influence of projectile mass, velocity, and target water saturation on the cratering and ejection processes. The projectiles were accelerated with two-stage light-gas guns (Ernst-Mach-Institute) onto fine-grained targets (Seeberger sandstone) with about 23% porosity. Collection of the ejecta on custom-designed catchers allowed determination of particle shape, size distribution, ejection angle, and microstructures. Mapping of the ejecta imprints on the catcher surface enabled linking of the different patterns to ejection stages observed on high-speed videos. The increase in projectile mass from 0.067 to 7.1 g correlates with an increase in the total ejected mass; ejecta angles, however, are similar in range for all experiments. The increase in projectile velocity from 2.5 to 5.1 km s-1 correlates with a total ejecta mass increase as well as in an increase in comminution efficiency, and a widening of the ejecta cone. A higher degree of water saturation of the target yields an increase in total ejecta mass up to 400% with respect to dry targets, higher ejecta velocity, and a steeper cone. These data, in turn, suggest that the reduced impedance contrast between the quartz grains of the target and the pores plays a primary role in the ejecta mass increase, while vaporization of water determines the ejecta behavior concerning ejecta velocity and particle distribution.

  20. Multinucleon Ejection Model for Two Body Current Neutrino Interactions

    SciTech Connect

    Sobczyk, Jan T.; /Fermilab

    2012-06-01

    A model is proposed to describe nucleons ejected from a nucleus as a result of two-body-current neutrino interactions. The model can be easily implemented in Monte Carlo neutrino event generators. Various possibilities to measure the two-body-current contribution are discussed. The model can help identify genuine charge current quasielastic events and allow for a better determination of the systematic error on neutrino energy reconstruction in neutrino oscillation experiments.

  1. Conformable Fractional Nikiforov—Uvarov Method

    NASA Astrophysics Data System (ADS)

    Karayer, H.; Demirhan, D.; Büyükkılıç, F.

    2016-07-01

    We introduce conformable fractional Nikiforov—Uvarov (NU) method by means of conformable fractional derivative which is the most natural definition in non-integer calculus. Since, NU method gives exact eigenstate solutions of Schrödinger equation (SE) for certain potentials in quantum mechanics, this method is carried into the domain of fractional calculus to obtain the solutions of fractional SE. In order to demonstrate the applicability of the conformable fractional NU method, we solve fractional SE for harmonic oscillator potential, Woods—Saxon potential, and Hulthen potential.

  2. Velocity-dependent isotope