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Manna, Nayan Ranjan. "Development of an automated system for diagnoses of cardiae diseases." Thesis, University of North Bengal, 1993. http://hdl.handle.net/123456789/1037.
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Dumas, Florence. "Analyse de l’influence des interventions thérapeutiques précoces au sein d’une cohorte de patients survivants d’arrêt cardio-respiratoire." Thesis, Paris 5, 2012. http://www.theses.fr/2012PA05S006/document.
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Position du problème. L’arrêt cardiaque extra-hospitalier (ACEH), dont la forme clinique la plus caricaturale correspond à la « mort subite », représenterait la première cause de mortalité à travers le monde. Malgré les améliorations apportées à leur prise en charge, le pronostic de ces patients demeure très péjoratif, y compris chez ceux qui ont bénéficié d’une réanimation initiale avec succès. En effet, la longue période d’ischémie suivie du phénomène de reperfusion secondaire au retour d’une activité circulatoire (RACS) est à l’origine d’une cascade de phénomènes physiopathologiques qui caractérisent le syndrome post-arrêt cardiaque. Plusieurs éléments thérapeutiques, telles que la reperfusion coronaire précoce et l’hypothermie thérapeutique, se sont développés ces dernières années afin de diminuer la morbi-mortalité importante observée dans cette situation. L’intérêt de ces interventions précoces sur le pronostic ultérieur demeure cependant débattu, car il a souvent été établi sur des sous-groupes de patients très sélectionnés. Objectif. L’objectif de ce travail était d’évaluer l’influence de ces interventions thérapeutiques précoces sur le devenir des patients victimes d’ACEH et admis vivants en service de réanimation. Méthode. Depuis 2000, une cohorte de patients survivants d’ACR et admis vivants en réanimation a été constituée dans un centre spécialisé. L’ensemble des caractéristiques démographiques, pré-hospitalières et hospitalières ont été analysées. L’analyse multivariée des facteurs pronostiques dans cette cohorte a utilisé principalement les méthodes de régression logistique. Résultats principaux. Entre 2003 et 2008, 435 patients ont été admis, ne présentaient pas d’étiologie extra-cardiaque évidente et ont bénéficié d’une coronarographie immédiate et systématique. Une lésion coronaire récente a été observée chez près de la moitié d’entre eux. Les moyens de détection d’une étiologie cardiaque sont extrêmement limités que ce soit par des modèles prédictifs simples utilisant des paramètres démographiques ou circonstancielles ou par des paramètres para-cliniques tels que l’électrocardiogramme ou les enzymes cardiaques. En effet, ces derniers possèdent des valeurs prédictives médiocres et ne peuvent être considérés comme outil de triage de ces patients. En revanche, la coronarographie immédiate et systématique (suivie d’une reperfusion coronaire si nécessaire) était associée de manière significative et indépendante à la survie hospitalière (OR ajusté= 2.06 (1.16-3.66)) et ceci quelque soit l’aspect électrocardiographique. Entre 2000 et 2009, 1145 patients ont été admis et 2/3 d’entre eux ont été traités par hypothermie thérapeutique. Parmi eux, 708/1145 (62%) avait initialement un rythme cardiaque choquable et 437/1145 (38%) présentait un rythme non choquable. Après ajustement sur les autres facteurs pronostiques, l’hypothermie thérapeutique avait un rôle protecteur sur le pronostic neurologique des patients à la sortie de réanimation dans le groupe présentant initialement un rythme choquable (OR ajusté= 1.90 (1.18-3.06)). En revanche, l’association entre le pronostic et l’intervention dans le groupe « non-choquable » n’était pas significative (OR ajusté=0.71 (0.37-1.36)). Parmi les facteurs susceptibles d’altérer le bénéfice lié à ce traitement, les complications infectieuses chez les patients traités par hypothermie thérapeutique s’avèrent courantes La plus fréquente est la pneumopathie précoce, dont l’apparition est associée de manière significative au traitement par hypothermie (OR ajusté= 1.90 (1.28-2.80)), mais son rôle sur le pronostic n’est pas démontréBackground: Out-of-Hospital Cardiac Arrest (OHCA), usually clinically described as “sudden death”, is the leading worldwide cause of death. Despite recent improvements in management of OHCA, the prognosis of these patients remains very poor, even in those who benefitted from a successful initial resuscitation. During the period of ischemia following the Return of Spontaneous Circulation (ROSC), several pathophysiological phenomenons occur, characterizing the post cardiac arrest syndrome. Furthermore, different treatments, such as immediate coronary reperfusion or therapeutic hypothermia, are now implemented for the management of this syndrome in order to decrease the morbidities and the mortality involved during this period. However, the influence of these hospital interventions on prognosis is still debatable, since they have been assessed in very selected subgroups of patients.Objectives: The aim of our work was to assess the influence of these early interventions on the outcome of OHCA patients admitted alive in intensive care unit (ICU).Method: We set up an investigation cohort (starting in 2000) of OHCA patients, in whom a successful ROSC had been obtained and who were admitted alive in ICU. We gathered all demographic data, cardiac arrest circumstances, pre-hospital and hospital characteristics. We analyzed the different predictive factors of outcome using multivariate analysis, especially logistical regression.Results: Between 2003 and 2008, 435 patients without obvious extra-cardiac cause were included and benefited from an immediate and systematical coronary angiogram. We observed a recent lesion in nearly half of them. Detecting a cardiac etiology is very challenging even using simple predictive models including patient’s baseline characteristics and circumstances of the cardiac arrest. Moreover, other parameters, such as EKG patterns or cardiac biomarkers, did not seem helpful either. Indeed, these parameters had poor predictive values and consequently could not be considered as triage tools for these patients. Nevertheless, the immediate and systematical coronary angiogram, with percutaneous intervention if appropriate, was independently associated with an improvement of hospital survival (adjusted OR= 2.06 (1.16-3.66)), regardless of the EKG pattern.Between 2000 and 2009, 1145 patients were admitted and two third of them were treated with therapeutic hypothermia. Among them, 708/1145 (62%) had an initial shockable rhythm and 437/1145 (38%) presented a non shockable rhythm. On the one hand, after adjustment with other predictive factors, the therapeutic hypothermia significantly improved the good neurological outcome at ICU discharge (adjusted OR= 1.90 (1.18-3.06)). On the other hand, the influence of this intervention was not associated with prognosis on the “non-shockable” sub-group (adjusted OR=0.71 (0.37-1.36)). Among the undercurrent factors, which could minimize the benefit of this intervention, infectious complications in treated patients were common. The most frequent complication was early onset pneumonia, whose occurrence was significantly associated with hypothermia (adjusted OR= 1.90 (1.28-2.80)), even if its role on prognosis was not determined.Conclusions: Our findings support the international guidelines regarding the management of post-cardiac arrest, identifying the subgroups of patients who may benefit the most. These results encourage further prospective studies and randomized trials and bring helpful information in that way. Finally, ancillary analysis on an investigation cohort of hospital survivors suggests that protective
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Hadian, Mojtaba. "Study of collagen structure in canine myxomatous mitral valve disease." Thesis, University of Edinburgh, 2009. http://hdl.handle.net/1842/4383.
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Myxomatous mitral valve disease (MMVD) is the single most common acquired cardiac disease of dogs, and is a disease of significant veterinary importance. It also bears close similarities to mitral valve prolapse in humans and therefore is a disease of emerging comparative interest. Realising the importance of collagen fibres in mitral heart valves and considering the paramount significance of myxomatous mitral valve disease, a better understanding of the pathogenesis of MMVD is essential. Thus, this study was designed to investigate the changes in collagen molecules, including fibril structure, fibril orientation, d-spacing, collagen density, collagen content, thermal stability, and the status of mature and immature crosslinks. A combination of biophysical and biochemical tools such as x-ray diffraction, neutron diffraction, HPLC were utilised in order to fulfil the objectives. Biochemical assay of hydroxyproline revealed a 10% depletion of collagen in mildly affacted (grade I and II) leaflets, while a 20% depletion of fibrillar collagen was revealed by mapping the collagen fibrils onto the anatomy of cardiac leaflets using x-ray data. Differential scanning calorimetry showed that there were no significant differences in the onset temperature of denaturation of collagen between the healthy and affected leaflets. However, in affected areas of leaflets, the enthalpy of denaturation significantly dropped by 20%. In the affected regions, neutron diffraction results showed an increase in the immature reducible cross-links though the low number of the samples can be considered a limiting factor in this regard. However, the HPLC results showed a 25% decrease in the number of mature cross-links. Additionally, the recently introduced imaging technologies to biology and medicine such as differential enhancing imaging (DEI) and coherent anti-Stokes Raman scattering spectroscopy (CARS) were, to the author’s best knowledge, applied for the first time to this disease. In doing so, this thesis furthers our understanding of the pathogenesis of MMVD, especially in relation to the collagen. The thesis provides new findings about MMVD and demonstrates the potential of biophysical tools for studying similar conditions.
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Padalino, Massimo. "Surgery for congenital heart disease in the adult age." Doctoral thesis, Università degli studi di Padova, 2008. http://hdl.handle.net/11577/3425554.
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Despite congenital heart malformations are currently treated in infancy and childhood, a great number of patients still need surgical treatment in adult age. For this reason, we have embarked on a multicentric study involving 7 major italian centers (Padova, Milano S.Donato, Milano Niguarda, Bergamo, Bologna, Massa, Napoli), so as to evaluate the impact of cardiac surgery in adults with congenital heart disease in our country and survival determinants. In addition, clinical late morbidity was analyzed in order to to evaluate correlated pre-operative and operative risk factors.
Methods
We collected data of 856 patients who underwent 1179 procedures from January,1st 2000 to December 31st 2004. Patients were divided into three groups: Group I- Palliation (3.1%): any operation performed to improve patientâ's clinical status without restoring normal anatomy or physiology. Bidirectional cavopulmonary anastomosis and pulmonary artery banding were the most frequent procedures.
Group II- Repair (69.7%): first operation performed in the patient, to achieve an anatomic or physiologic repair by separation of the pulmonary from systemic circulation (including also Fontan-types, and 1 and ’½ ventricle repairs). Most frequent procedures were: atrial septal defect closure (35.8%), partial anomalous pulmonary venous connection repair (7.2%), ventricular septal defect closure (5.3%).
Group III- Reoperation (27.4%): all procedures performed after repair either anatomic or physiologic. The most frequent procedures were conduit replacement (9.8%), aortic (8.6%) or pulmonary valve replacement (7.7%) .
Results
Preoperatively 34.6% of patients were in NYHA class I, 48.4% in class II, 14.2% in class III and 2.8% in class IV. Sinus rhythm was present in 83%.
There were 1179 procedure performed in 856 patients (1.37 procedure/patient), with a hospital mortality of 3.1%. Overall mean intensive care unit stay was 2.3 days (range:1-102 days). Major complications were reported in 247 pts (28.8%), with postoperative arrhythmias being the most frequent (26%).
At mean follow-up of 22 months (range 1 month- 5.5 years), 86% of data were available. Late death occurred in 5 patients (0.5%). Patients were in NYHA class I in 79.3 % , II in 17.6%, III in 2.9%, and only one patient in class IV (0.11%). Ability index was class I in 82%, class II in 13.7% and class III in 2.3%. Overall survival estimates is 82.6% , 99% and 91.8% at 5 years for groups I, II, III respectively. Freedom from adverse events at 5 years is 91% for acyanotic vs 63.9 % for preoperative cyanotic patients (p < 0.0001). Multivariate Cox analysis identifies among the most powerful incremental risk factors for survival preoperative NYHA class IV in cyanotic patients (Hazard Ratio-HR- 8.6, p value 0.001), preoperative NYHA class III (HR 2.7, p value 0.023), and reoperation (HR 2.3, p value 0.029). In addition, multivariate Cox analysis for postoperative morbidity expressed as NYHA class greater than 1, identifies among the most powerful incremental risk factors the length of ICU stay (HR 1.037, CI=1.002-1.072, p=0.036), number of operations (HR 1,445 CI=1,1213-1,721, p<0.001), cyanosis (HR 1,555, CI1,035-2,335, p=0,034), alteration of cardiac rhythm before surgery (HR 1,124, CI=1,040-1,215, p=0,03), pre-operative NYHA class>1 (Hazard Ratio 1,573, CI=0,954-2,593, p=0.076), age > 40y (HR 1,466, CI1,014-2,119, p=0.042).
Conclusions
Surgery for congenital heart disease in adult age is a safe and a low risk treatment. However patients with preoperative cyanosis show a higher incidence of late non-fatal complications. In addition, better preoperative clinical conditions are correlated with better late clinical outcomes, thus early repair (before cardiac and non cardiac organ deterioration occurs) is advocated.
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Bates, Matthew. "Cardiac manifestations of mitochondrial disease." Thesis, University of Newcastle upon Tyne, 2014. http://hdl.handle.net/10443/2525.
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Due to critical dependence of the heart on oxidative metabolism, cardiac involvement in mitochondrial disease is common and may occur as the principal clinical manifestation or part of multisystem disease. The basic features of cardiac mitochondrial disease expression remain uncertain and no effective treatment exists. Previous research has suggested that cardiac involvement in mitochondrial disease is an important cause of morbidity and early mortality in paediatric populations. In this thesis, a retrospective study confirms the frequent occurrence of cardiac involvement in adults, and demonstrates a significant impact on survival; the importance of specific mt-tRNA mutations and age of symptom onset as predictors of cardiac involvement is also highlighted. Conversely, in children with end-stage cardiomyopathy of unknown aetiology, a prospective study identifies respiratory chain disease as an important cause of disease, altering patient management in a high-risk population in whom mitochondrial disease was not suspected. Using histochemical and immunohistochemical analysis of cardiac tissue, profound complex I deficiency is demonstrated in all cardiomyocytes displaying any evidence of COX-deficiency but also in cells without COX deficiency, supporting the primacy of this factor in patients with well-characterised mt-tRNA mutations. Differences in cardiac complex I expression between patients harbouring m.3243A>G and m.8344A>G mutations may impact on cardiac phenotype; chamber-specific respiratory chain abnormalities are noted and, while tissue segregation may play a role in frequency and severity of cardiac involvement, skeletal muscle mitochondrial DNA mutation load is not a consistent marker of risk. Advanced imaging techniques are used to demonstrate early concentric hypertrophic remodelling, and specific changes in intramyocardial strains and torsion, in patients harbouring the m.3243A>G or m.8344A>G mutations without clinical evidence of cardiac involvement. However, an endurance exercise interventional study shows that patients experience comparable cardiac hypertrophic and haemodynamic adaptations to sedentary controls and confirms the safety and efficacy of 16 weeks’ training.
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Harcombe, Alun Andrew. "Immunological mechanisms in cardiac disease." Thesis, University of Edinburgh, 1995. http://hdl.handle.net/1842/20552.
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The aim of the work presented in this thesis was to examine cell and antibody-mediated immune mechanisms in heart muscle disease. The two conditions studied were acute rejection of cardiac allografts as an example of cell-mediated immune damage, and alcoholic heart muscle disease as a potential example of antibody-mediated disease. In the first study, experiments were performed on 94 endomyocardial biopsies (EMB) from 73 patients to determine the relationship between the ability to grow lymphocytes from EMB in culture and (i) grade of concurrent or future rejections, (ii) the presence of endocardial lymphocytic infiltrates (ELI), and (iii) donor/recipients HLA mismatches. These studies showed that outgrowth of lymphocytes was not closely related to the degree of rejection, not influenced by the use of polyclonal activators in the medium but it was affected by the presence to two HLA mismatches at the DR locus. The presence of ELI was related to rejection but not to outgrowth of the lymphocytes. It was concluded that, contrary to predictions in the literature, the ability to grow lymphocytes from EMB did not indicate presence of impending injection. In the second study, experiments were performed to test the hypothesis that alcoholic heart muscle disease may be caused by autoantibodies to acetaldehyde-modified myocardial proteins. Sera from 61 subjects were tested by Western analysis for antibodies against acetaldehyde-treated human myocardial proteins. No such antibodies were detected in 11 healthy controls subjects, or 28 patients with non-alcoholic heart diseases. In contrast, 4 out of 14 patients with alcoholic heart disease (28%) had detectable antibodies, suggesting a role for these antibodies in alcohol-induced heart muscle disease. To isolate potential antigenic myocardial proteins from small samples of myocardium a technique was developed for rapidly electroeluting proteins separated on a polyacrylamide gel. This system was validated by electroeluting endothelin receptors from human myocardium.
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Vitori, Tracey. "PSYCHOLOGICAL DISTRESS AND CARDIAC DISEASE." UKnowledge, 2016. https://uknowledge.uky.edu/nursing_etds/26.
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The purpose of this dissertation was to evaluate the association of psychological distress with cardiac disease, events, and mortality. Specific aims were to: 1) to evaluate the association between hostility level and recurrence of acute coronary syndrome (ACS) and all-cause mortality in patients with coronary heart disease (CHD); 2) to evaluate the psychometric properties of the Brief Symptom Inventory (BSI) hostility and anxiety subscales in a group of incarcerated participants at high risk of cardiovascular disease; and 3) to evaluate the association of patient and caregiver psychological state with quality of life in both patient and caregiver, and postoperative complications after cardiac surgery.
Specific aim one was addressed through a secondary analysis of data collected during the Patient Response to Myocardial Infarction following a Teaching Intervention Offered by Nurses trial to determine whether hostility was a predictor of ACS recurrence and mortality. Hostility was common after ACS and predicted all-cause mortality. Hostility did not predict recurrent ACS. Specific aim 2 was addressed in a secondary analysis of baseline data from a randomized controlled trial in male prisoners. Participants completed the BSI at baseline prior to the intervention. Internal consistency reliability was good for both subscales (Cronbach’s alpha - hostility 0.83, anxiety 0.81). Items from the two dimensions were analyzed together using exploratory factor analysis with varimax rotation. Two dimensions, anxiety and hostility, were identified. Construct validity was supported; those with high anxiety and hostility reported a greater number of days where their self-reported health was rated as fair or poor. Those prisoners with less perceived control had higher levels of anxiety and hostility. Specific aim 3 was addressed through a prospective, descriptive correlational study that measured patient and caregiver anxiety, hostility and depressive symptoms, at baseline to determine whether these predicted quality of life using a multilevel dyadic analysis; and to evaluate the association of baseline anxiety, hostility and depressive symptoms and quality of life with postoperative complications and mortality. Anxiety, hostility, and depressive symptoms were common in both cardiac patients and their caregiver. Psychological state influenced quality of life in both dyad members, but was not associated with complications.
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Luk, Ting-hin, and 陸庭軒. "Effect of cardiac rehabilitation on vascular function in patients withcoronary artery disease." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2010. http://hub.hku.hk/bib/B45153000.
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Williams, Lynn. "Predictors of outcome in cardiac disease : the role of personality and illness cognitions." Thesis, University of Stirling, 2007. http://hdl.handle.net/1893/359.
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Background: Coronary heart disease can have a long lasting impact on affected individuals in terms of both physical and psychological adjustment and quality of life. It is, therefore, important to investigate determinants of outcome in these patients. The thesis has four main aims; (i) to investigate predictors of outcome (adherence, quality of life, functional impairment, psychological distress and benefit finding) post-myocardial infarction (MI); (ii) to determine the prevalence and stability of Type D personality in the UK; (iii) to determine if personality predicts outcome after controlling for mood, demographic and clinical factors, and (iv) to investigate potential mechanisms which may explain the link between personality and poor prognosis in cardiac patients. Method: Five studies were conducted. In Studies 1-3, participants completed measures of Type D personality, health-related behaviour, social support and neuroticism. In Study 4, participants completed an experimental stressor with cardiovascular monitoring. Study 5 was a prospective study in which 131 MI patients completed measures of personality, illness cognitions and outcome at two time points, 3-5 days post-MI, then again 3 months later. Results: The prevalence of Type D personality in the UK is 39% in the healthy population, and 34% in the cardiac population. In addition, Type D is predictive of adherence, quality of life, and functional impairment in post-MI patients after controlling for mood, demographics, and clinical factors. Five possible mechanisms (health-related behaviour, adherence, social support, cardiovascular reactivity, and illness perceptions) by which Type D may lead to adverse outcome in cardiac patients were identified. Mood predicted quality of life and functional impairment post-MI, illness perceptions predicted quality of life post-MI, and future thinking predicted quality of life, functional impairment and depression post-MI. Discussion: These findings have important therapeutic and theoretical implications for understanding the role of personality and illness cognitions in the short-term recovery of post-MI patients.
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Pandey, Raghav. "MicroRNA Mediated Proliferation of Adult Cardiomyocytes to Regenerate Ischemic Myocardium." University of Cincinnati / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1505124343198575.
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Rigatto, Claudio. "Cardiac disease in renal transplant recipients /." St. John's, NF : [s.n.], 2001.
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McDonald, Cameron. "Investigations in Cardiac Development and Cardiac Regeneration." Thesis, Griffith University, 2009. http://hdl.handle.net/10072/366063.
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Cardiovascular disease and congenital heart disease impose a massive burden on society around the world. From the cost in terms of lost human lives and diminished quality of life, to the financial expense of ongoing medical treatment, the heart’s inability to effectively repair and regenerate itself presents a major challenge for medical research. The research conducted within this thesis hoped to contribute to our knowledge of the molecular pathways of myocardial development, and to explore the potential of olfactory derived stem cells to repopulate insulted myocardium. A combination of molecular biology and classical embryology techniques were first used to characterise two novel cDNAs identified in an earlier study as being upregulated in the regions of cardiac development within the chick embryo. cDNA and genomic library screening along with RACE (rapid amplification of cDNA ends) produced products which were sequenced to identify both the transcript and genomic sequence for both of the genes. Protein expression constructs were then used to identify the localisation of the encoded proteins, and whole mount in situ hybridisation utilised to identify the temporal and spatial expression patterns of the genes. The first cDNA was identified as the vertebrate homologue of the Drosophila e(y)2 gene, and produces a transcript of approximately 600 bp in the chick with a genomic structure consisting of 5 exons covering approximately 6 Kb. The encoded protein localises to the nucleus. Its expression is ubiquitous both temporally and spatially, which is at odds with its initial method of identification. The second cDNA remains novel at the time of submission, and shows no homology to any characterised genes. This cDNA, named C1-3C, produces two alternative transcripts, one of approximately 700 bp, and a second of 9.9 Kb, with a genomic structure showing no introns within the 2 Kb of analysed sequence. The encoded protein again localises to the nucleus. Expression of the C1-3C gene demonstrated a discrete pattern, though this pattern is again contrary to an up-regulation within the cardiogenic regions. Whilst unfortunately neither of the investigated genes appear to play a direct role in cardiac development, the aim of characterisation of these novel cDNAs was achieved.Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Biomolecular and Physical Sciences
Science, Environment, Engineering and Technology
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Milstone, Zachary J. "Histone Deacetylase 1 and 2 are Essential for Early Cardiac Development." eScholarship@UMMS, 2019. https://escholarship.umassmed.edu/gsbs_diss/1014.
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Congenital heart disease is the most common congenital anomaly, affecting approximately 1% of all live births each year. Although clinical interventions are improving, many affected infants do not survive to adulthood. Congenital cardiac defects originate from disturbances during development, making the study of mammalian cardiogenesis critical to improving outcomes for infants with congenital heart disease. Development of the mammalian heart involves epigenetically-driven specification and commitment of a diverse landscape of cardiac progenitors. Recent studies determined that chromatin modifying enzymes play a previously underappreciated role in the pathogenesis of congenital heart defects. This thesis investigates the functions of Hdac1 and Hdac2, highly homologous Class I histone deacetylases, during early murine cardiac development. We establish that Hdac1 and Hdac2 cooperatively regulate cardiogenesis in distinct cardiac progenitor populations during development. Together, our findings demonstrate that Hdac1 and Hdac2 are critical mediators of the earliest stages of mammalian cardiogenesis through a variety of spatiotemporally specific, redundant, and dose-sensitive roles and indicate they may play important roles in the pathogenesis of human congenital cardiac defects.
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李詠鸞 and Wing-luen Lee. "Multidisciplinary cardiac program for patients with heart failure." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2009. http://hub.hku.hk/bib/B43251328.
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Berryman, Barbara Michelle Swindell. "Design of a cardiac fitness and lifestyle management tool for phase III cardiac rehabilitation patients." Thesis, Georgia Institute of Technology, 2002. http://hdl.handle.net/1853/23732.
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Mont, Girbau Lluís. "Contribución de los distintos métodos diagnósticos a la estratificación del riesgo post-infarto de miocardio." Doctoral thesis, Universitat de Barcelona, 1990. http://hdl.handle.net/10803/31919.
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La disfunción ventricular, las arritmias ventriculares o la isquemia residual son factores que condicionan la supervivencia y la aparición de nuevos accidentes coronarios tras el infarto de miocardio. Para conocer el riesgo de un determinado paciente y valorar la indicación de las técnicas de revascularización se han utilizado diferentes pruebas diagnósticas; sin embargo existe cierta controversia sobre si se deben practicar de forma sistemática. Los estudios realizados hasta el momento no son concluyentes y sugieren que las pruebas incruentas no aportan suficiente información pronóstica adicional a la obtenida de variables clínicas y electrocardiográficas y su realización no justifica el aumento de coste que producen. El presente estudio se planteó con los siguientes objetivos: (1) Identificar las variables clínicas que permiten conocer el pronóstico tras la fase aguda del infarto de miocardio. (2) Conocer los parámetros obtenidos mediante pruebas incruentas que aportan información pronóstica independiente, complementando la obtenida de las variables clínicas. (3) Determinar si la información obtenida del cateterismo mejora la predicción pronóstica realizada a partir de las variables clínicas y de las exploraciones incruentas. (4) Establecer la mejor pauta diagnóstica utilizando diversas pruebas.
MATERIAL Y METODOS: De 495 pacientes consecutivos ingresados en la Unidad Coronaria con el diagn6stico de infarto agudo de miocardio, 295 tenían menos de 65 años, sobrevivieron a la fase aguda del infarto y aceptaron ser incluidos en el estudio. De ellos 7 se perdieron en el seguimiento, por lo que la población estudiada se compone de 288 pacientes, de los cuales 16 fallecieron durante el seguimiento de un año. A su ingreso se recogieron datos sobre su historia previa y sobre la exploración física. Se practicó un electrocardiograma diariamente y se iniciaron las determinaciones de enzimas cardiacos. Entre el 4º y 5º día se practicó un ecocardiograma en modo M y bidimensional (231 pacientes), entre los días 8º y 10º se realizó un registro del electrocardiograma de 24 horas (204 pacientes), una ventriculografía isotópica con tecnecio para el cálculo de la fracción de eyección (120 pacientes) y un cateterismo cardiaco izquierdo que incluyó la medición de presiones endocavitarias, la práctica de angiografía en dos proyecciones y coronariografía selectiva. Al mes del alta se realizó una prueba de esfuerzo en bicicleta ergométrica limitada por síntomas y una gammagrafía con talio-201 (193 pacientes). Los objetivos del análisis estadístico fueron la identificación de las variables capaces de predecir la muerte por un lado y la isquemia grave por otro. Para cada uno de los objetivos se practicó un análisis univariado estudiando un total de 63 variables. A continuación se realizaron diversos análisis de regresión logística de tipo escalonado, incluyendo en el primero las variables clínicas y comparando en los siguientes las variables clínicas con las variables obtenidas de las diversas pruebas diagnósticas. Asimismo se trazaron curvas ROC de sensibilidad Y especificidad para cada una de las ecuaciones de regresión.
RESULTADOS. Predicción de muerte: Las variables clínicas que aportaron información pronóstica independiente fueron la existencia de diabetes, bloqueo bifascicular e infarto de miocardio previo al actual. Al añadir a estas variables la fracción de eyección isotópica, ésta tuvo valor pronóstico independiente así como también la presencia de más de 10 extrasístoles ventriculares por hora o taquicardia ventricular en el Holter, la presión arterial sistólica máxima alcanzada en la ergometría, la fracción de eyección angiográfica y el número de vasos coronarios afectados. Al realizar un análisis de regresión logística incluyendo las variables clínicas y las variables derivadas de las pruebas incruentas, tan sólo la diabetes y la fracción de eyección alcanzaron valor pronóstico independiente. Al comparar todas las pruebas simultáneamente, la diabetes, la fracción de eyección y el número de vasos fueron las variables con valor pronóstico independiente de muerte cardiaca.
Predicción de isquemia grave: Se consideró como segundo objetivo del análisis la predicción de eventos isquémicos graves no letales considerando como tales la necesidad de revascularización antes del alta, la angina inestable que requiriera reingreso, o el reinfarto no letal. Del presente análisis se excluyeron 7 pacientes sometidos a cirugía por presentar lesiones del tronco común y 15 pacientes que fallecieron sin eventos isquémicos previos. Ninguna de las variables derivadas de las exploraciones no invasivas aportó información pronóstica de eventos isquémicos graves. El análisis de regresión logística mostró que las dos variables clínicas con valor predictivo independiente eran la presencia de angina post-infarto precoz y la existencia de infarto previo. Al añadir la regresión la variable “número de vasos afectados” ésta aportó información independiente.
CONCLUSIONES: (1) Las variables clínicas con valor predictivo independiente de muerte cardiaca fueron la diabetes, el bloqueo bifascicular y el infarto previo. (2) De entre las pruebas incruentas analizadas el ecocardiograma y la gammagrafía cardiaca con talio no aportaron información pronóstica independiente de muerte. Asimismo, la información obtenida del Holter y la ergometría fue redundante con la aportada por la fracción de eyección. (3) La información obtenida del cateterismo cardiaco contribuyó de forma independiente a la predicción del riesgo, mejorando la información obtenida de las variables clínicas y de las pruebas no incruentas. (4) Las únicas variables que contribuyeron de forma independiente a la predicción de accidentes isquémicos no letales fueron la angina post-infarto precoz, el infarto previo y el número de vasos.The value of non-invasive methods in adding useful information to establish the prognosis in survivors of myocardial infarction is still under debate. Therefore we undertook the present investigation to analyze if non-invasive tests and cardiac catheterization added independent prognostic information to simple clinical variables. In 288 survivors of a myocardial infarction (MI) a cardiac catheterization was performed the 10th day after admission. An M-mode and bidimensional echocardiogram was obtained in 231 patients, left ventricular technetium ventriculography in 120 patients and Holter recording in 204 patients. One month after discharge, patients underwent a symptom limited exercise test with ergometric bicycle and an exercise and rest thallium gammagraphy. The first end-point was cardiac death. The variables that showed significant differences in the univariate analysis were entered in successive stepwise logistic regression analysis including the clinical variables and the results of one different test each time. Among the clinical variables, the presence of diabetes mellitus, the existence of bifascicular bundle branch block or previous myocardial infarction showed independent prognostic value for death. Isotopic ejection fraction, ventricular arrhythmias in the Holter, the systolic pressure during exercise test, the angiographic ejection fraction and the number of diseased vessels also showed independent prognostic value. When the clinical variables and all the non-invasive tests were analyzed together, the presence of diabetes mellitus and the ejection fraction were the only variables that showed independent prognostic value. When the variables "number of diseased vessels" was included in the analysis, it also showed independent value. The second end-point was the presence of severe non-fatal ischemia during the follow-up. Among the clinical variables, the early post-myocardial infarction angina and the existence of a previous myocardial infarction were the only ones that showed independent predictive value of severe ischemia. From the tests performed, on1y the number of diseased vessels added independent prognostic value to the equation obtained from the clinical variables. In conclusion the practice of a technetium ventriculography, exercise test or Holter can add some prognostic information for cardiac death to the one obtained from the clinical variables, although the practice of several tests did not improve the prediction. On the other hand non-invasive tests do not seem useful in predicting new several non-fatal ischemic events.
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Bradfield, Annette C. "Smokers with cardiac disease: A qualitative study." Thesis, University of Ottawa (Canada), 2004. http://hdl.handle.net/10393/26590.
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The purpose of this thesis is to describe the experiences of individuals who continue to smoke following a myocardial infarction. This manuscript-based thesis consists of three distinct papers to be submitted to nursing journals for publication. The first manuscript provides a critique of the research literature pertaining to predictors and perceptions of continued smoking for individuals with coronary artery disease. The second manuscript reports the findings of a qualitative study that was conducted to describe the meaning of smoking within the context of a myocardial infarction, and to determine factors that influence continued smoking. The third manuscript explores ethical implications that emerged from the first two manuscripts. This thesis illustrates how addictive behaviours often have underlying meanings, how continued smoking becomes more understandable when viewed in the context of people's lives, and how possibilities for change can be derived from the ways that clients view their heart disease and smoking.
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Dodd, Will. "Common Cardiac Disease in the Hospitalized Patient." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/8941.
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GREGORY, KIMBERLY NICOLE. "SARCOPLASMIC RETICULUM CALCIUM CYCLING AND CARDIAC DISEASE." University of Cincinnati / OhioLINK, 2005. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1116008332.
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Sheikh, Hajer Nisar. "Tropomyosin Phosphorylation in Cardiac Health and Disease." University of Cincinnati / OhioLINK, 2009. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1242913472.
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Baine, Stephen Hardy. "Regulation of Cardiac Calcium Signaling in Disease." The Ohio State University, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=osu1577952665232614.
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Cho, Jinsoo. "Velocity-based cardiac segmentation and motion-tracking." Diss., Available online, Georgia Institute of Technology, 2004:, 2003. http://etd.gatech.edu/theses/available/etd-04082004-180106/unrestricted/cho%5Fjinsoo%5F200312%5Fphd.pdf.
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Green, Kerrie L. "A descriptive analysis of cardiac rehabilitation education programs." Virtual Press, 2000. http://liblink.bsu.edu/uhtbin/catkey/1177976.
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The purpose of this research was to obtain information on the content of education within cardiac rehabilitation programs, methods of administering education, what the barriers are to providing education and which professionals administer education.To reach this goal, a questionnaire was modified from a previous study and a pilot study was undertaken to establish reliability of the questionnaire. The questionnaire was then sent to a sample of 100 directors of cardiac rehabilitation programs belonging to The American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR). The questionnaire focused on 13 established areas of education within cardiac rehabilitation programs.Once the questionnaires were completed, the information was transferred to a table format based upon the 13 content areas. The following conclusions were drawn from the research and the data gathered: 11 of the 13 content areas are offered at least 84% of the time, the major barriers for the 13 content areas were lack of time and lack of interest on the patient's behalf, the most frequent methods of education for all 13 content areas were individual education, print materials, and group education, and the primary educator overall for all 13 content areas was the nurse followed by the exercise physiologist and dietitian/nutritionist.Department of Physiology and Health Science
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Steele, Ian Conrad. "Pathophysiology of chronic cardiac failure." Thesis, Queen's University Belfast, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.337046.
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Mbangani, Roselyn. "Exploring the knowledge, attitudes, perceptions and practices of teachers around obesity and nutrition related non-communicable diseases." University of the Western Cape, 2018. http://hdl.handle.net/11394/6905.
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Magister Scientiae (Nutrition Management) - MSc(NM)Introduction: Non-communicable diseases (NCDs) are among the leading causes of premature death in South Africa. As is the case with many countries in transition, in South Africa the burden of pre-NCDs such as overweight and obesity is increasing. The aim of this mixed method study was to gain an understanding on the knowledge, attitudes, practices and perceptions and related factors of primary and secondary school teachers in Limpopo Province of South Africa regarding nutrition related non-communicable diseases (NR-NCDs). Methodology: A mixed method approach, parallel convergent study design was used to collect both qualitative and quantitative data from a group of randomly selected public school teachers in Rakwadu Circuit, Limpopo, with due consideration of the ethical issues involved. For the quantitative inquiry, a previously validated structured questionnaire was adapted to collect data from 114 teachers, while 2 Focus Group Discussions (FGDs) were conducted by the researcher to collect the qualitative data. Information collected included teachers‟ dietary practices, physical activity levels and their knowledge, attitudes and perceptions towards nutrition related non-communicable diseases. Each of these variables had a number of questions which were scored and a mean score for each participant was obtained. Anthropometric measurements collected included Body Mass Index (BMI) and waist circumference (WC).
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Wake, Emily. "The role of the intrinsic cardiac nervous system in cardiac physiology and disease." Thesis, University of Leicester, 2017. http://hdl.handle.net/2381/40499.
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It is well recognised that the complex neuronal hierarchy of the autonomic nervous system is important in the pathology of heart disease. In addition to the peripheral autonomic nerves, there is a dense network of intrinsic cardiac ganglia located at the level of the heart and acting as the final stage in the autonomic regulation of cardiac function. Understanding the role of this network in cardiac function could prove vital in understanding heart disease. The aims of this study were to characterise the topography and neurochemical phenotype of the rabbit intrinsic cardiac nervous system (ICNS) as well as to investigate the functional effects of electrical stimulation of intrinsic cardiac ganglia on the sinus and AV nodes. A coronary artery ligation heart failure model was used to examine the effects of myocardial infarction (MI) and heart failure (HF) on both the topography of the ICNS and the functional role of the ICNS. Histochemical staining revealed an intricate network of nerves and ganglia located primarily on the heart hilum. Significant neuronal remodelling was evident following MI, with the enlargement of somata within ganglia that are known to preferentially innervate the ventricles. Heart rate changes occurred primarily as a result of stimulation of ganglia within the right atrial (RA) and right neuronal cluster (RNC) regions. MI resulted in exaggerated bradycardic responses during stimulation of the RA and RNC regions, accompanied by a significant increase in tachycardia responses during stimulation of ganglia within the RA and RNC. In conclusion, it is becoming increasingly evident that the ICNS is a key network in the cardiac neuronal hierarchy. The ability of the ICNS to function both in normal physiology and also to adapt following MI and HF suggests that the ICNS could be a significant potential therapeutic target for the prevention and treatment of cardiac disease.
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Dal-Santo, Mary Gail. "Evaluation of an early discharge service for cardiac rehabilitation at home." Thesis, University of British Columbia, 1987. http://hdl.handle.net/2429/26198.
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This study evaluates the outcomes of a hospital-based cardiac rehabilitation program designed to deliver the first phase of cardiac rehabilitation services at home. The program was established in a community hospital in 1985, operating under the administration of the hospital's Medical Day Centre. Patients suffering from acute myocardial infarction (MI) are referred to the program by their physician and receive services from a cardiac nurse specialist immediately upon discharge. The services continue for a period of 6 weeks. The outcomes of importance in the study are the effects of the program on hospital services in the initial 10 month period and on patient's health related behaviour 3 months post infarction. Results of the study indicate that program goals were achieved during the initial 10 months of the study. Physicians referred 92% of the eligible patients and the average length of stay (ALOS) in hospital was satisfactorily reduced. For patients with uncomplicated MI the ALOS was 8.6 days by the tenth month. At 3 month follow up, patients reported significant improvements over their pre infarction health related behaviour. There were significant increases in the frequency of light exercise (p<-0005), in the regular use of low fat dairy products (p=.0003) and in the practice of restricting calories (p=.003) while significant decreases were reported in the frequency of consuming fried foods (p<.0005), salted foods (p<.0005) and rich foods (p<.005) and in the regular use of table salt (p=.00003). Smoking cessation was reported by 50% of the smokers at follow up. Patients reported a high level of satisfaction with the program, describing the service as well timed, informative, practical and valuable in restoring their self confidence. While these results were satisfactory with regards to the program goals, the evaluation was based on a single group design and further investigation is desirable with comparisons between hospitals and between patients with and without exposure to the program.Medicine, Faculty of
Population and Public Health (SPPH), School of
Graduate
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DiMichele, Laura Antonietta Taylor Joan M. "Focal adhesion kinase in cardiac development and disease." Chapel Hill, N.C. : University of North Carolina at Chapel Hill, 2007. http://dc.lib.unc.edu/u?/etd,1356.
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Thesis (Ph. D.)--University of North Carolina at Chapel Hill, 2007.Title from electronic title page (viewed Apr. 25, 2008). "... in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Department of Pathology and Laboratory Medicine." Discipline: Pathology and Laboratory Medicine; Department/School: Medicine.
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Taylor, Ann Elizabeth. "Effects of rehabilitation in patients with cardiac disease." Thesis, University of Nottingham, 1996. http://eprints.nottingham.ac.uk/11953/.
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Prospective, randomised controlled trials were performed to investigate the benefits of cardiac rehabilitation in two selected patient groups. One group comprised patients in the early stage of recovery after an uncomplicated myocardial infarction. The other consisted of patients with stable chronic heart failure, who are usually excluded from exercise programmes. The reliability and validity of a new method of measuring ambulatory activity was determined. The rehabilitation programme for the post myocardial infarction patients lasted six weeks and contained education and exercise components. Three groups were recruited; a control group, a group who only undertook the education sessions and a group who also participated in a training programme. Comparison of changes in psycho-social parameters and physiological function were made between the groups after completing the programme and three months later. The education + exercise group showed significantly greater improvements (p<0.05) in anxiety, ambulatory activity and rehabilitation status compared to the other groups. Indications of predominantly peripheral adaptation to training were observed, but no significant differences in physiological function were found between the three groups. The education only group did not show any significant differences to the control group in any areas. A crossover-design was used in the chronic heart failure study. This comprised a control and exercise period, each lasting two months. Assessments of psycho-social parameters and physiological function were made at monthly intervals. Exercise training produced significant improvements in depression, quality of life and ambulatory activity. Both central and peripheral adaptations to training were observed, with significant benefits in peak cardiac index, oxygen uptake and resting heart rate. Improvements in ventilator efficiency were also noted.
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McDowell, Garry. "Natriuretic peptide studies in health and cardiac disease." Thesis, Queen's University Belfast, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.361232.
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Sensky, Penelope Ruth. "Cardiac magnetic resonance studies in coronary artery disease." Thesis, University of Leicester, 2002. http://hdl.handle.net/2381/29408.
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Varian, Kenneth Dean. "Cardiac Myofilament Calcium Sensitivity in Health and Disease." The Ohio State University, 2008. http://rave.ohiolink.edu/etdc/view?acc_num=osu1211898886.
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Langen, Irene Marijke van. "Clinical genetic care in diseases predisposing to sudden cardiac death." [S.l. : Amsterdam : s.n.] ; Universiteit van Amsterdam [Host], 2005. http://dare.uva.nl/document/88619.
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Ye, Yanping. "Designing New Drugs to Treat Cardiac Arrhythmia." PDXScholar, 2012. https://pdxscholar.library.pdx.edu/open_access_etds/638.
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Heart failure resulting from different forms of cardiomyopathy is defined as the inability of the heart to pump sufficient blood to meet the body's metabolic demands. It is a major disease burden worldwide and the statistics show that 50% of the people who have the heart failure will eventually die from sudden cardiac death (SCD) associated with an arrhythmia. The central cause of disability and SCD is because of ventricular arrhythmias. Genetic mutations and acquired modifications to RyR2, the calcium release channel from sarcoplasmic reticulum, can increase the pathologic SR Ca2+ leak during diastole, which leads to defects in SR calcium handling and causes ventricular arrhythmias. The mechanism of RyR2 dysfunction includes abnormal phosphorylation, disrupted interaction with regulatory proteins and ions, or altered RyR2 domain interactions. Many pharmacological strategies have shown promising prospects to modulate the RyR2 as a therapy for treating cardiac arrhythmias. Here, we are trying to establish a novel approach to designing new drugs to treat heart failure and cardiac arrhythmias. Previously, we demonstrated that all pharmacological inhibitors of RyR channels are electron donors while all activators of RyR channels are electron acceptors. This was the first demonstration that an exchange of electrons was a common molecular mechanism involved in modifying the function of the RyR. Moreover, we found that there is a strong correlation between the strength of the electron donor/acceptor, and its potency as a channel inhibitor/activator, which could serve as a basis and direction for developing new drugs targeting the RyR. In this study, two new potent RyR inhibitors, 4-methoxy-3-methyl phenol (4-MmC) and the 1,3 dioxole derivative of K201, were synthesized which are derivatives of the known RyR modulators, 4-chloro-3-methyl phenol (4-CmC) and K201. The ability of K201, 1,3 dioxole derivative of K201 and 4-MmC to inhibit the cardiac calcium channel is examined and compared at the single channel level. All of these compounds inhibited the channel activity at low micromolar concentrations or sub-micromolar concentrations.
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Lo, Ling-fun, and 盧玲芬. "Cardiac risk factors in Hong Kong adults." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2002. http://hub.hku.hk/bib/B25797463.
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(Uncorrected OCR)
Abstract
Many studies have been conducted in Caucasian populations on the optimal body mass index cut-off for obesity, as well as the relationship between body mass index and percentage body fat and their associations with cardiovascular risk factors. However, few studies of this kind have been conducted in the Hong Kong Chinese population, This research is deemed to be important due to ethnic differences between Asians and Caucasians, Therefore, this dissertation aims to determine any ethnic differences from a sample of the local Hong Kong Chinese population, in order to advance health care policies controlling known cardiovascular risk factors.
A total of 800 subjects were randomly selected from a pool of subjects participated in a Hong Kong Cardiovascular Risk Factor Prevalence study conducted in 1994-1996. These subjects were contacted and 453 disease-free subjects (210 males and 243 females) consented to participate in the current study, Data collected included serum and blood pressure measurements, body mass index, percentage body fat measured by bioelectrical impedance analysis, and a self-completed cardiovascular risk factor questionnaire,
The mean age of the 453 subjects was 51.64 years (SD=12.3). When obesity was defined as percentage body fat ~ 25 and 2: 30 in males and females respectively, 23 kg/m2 was found to be the optimum cut-off value, with 78% correct classification (95% CI = 69%-87%). The corresponding sensitivity and specificity were 88% (95% CI = 81 %-95%) and 67% (95% CI = 57%-77%) respectively. On the other hand, if obesity was defined as percentage body fat ~ 25 and 2: 35 in males and females respectively, then 25 kg/m2 was found to be the best cut-off value with 82% correct classification
(95% CI = 74%-90%). The corresponding sensitivity and specificity were 78% (95% CI = 69%-87%) and 85% (95% Cl = 78%-92%) respectively.
Moreover, body mass index was found to be quadratically body fat. The quadratic relationship did not appear two genders, except that the percentage body fat of of females by 9.97 (SE=0.33).
Finally, except for total cholesterol, high density lipoprotein cholesterol, and fasting glucose, body mass index did not provide any substantial information additional to percentage body fat on serum and blood pressure measurements. was the only measure on which percentage body fat did additional to body mass index. When waist-hip body mass index and percentage body fat,. except for
body mass index did not have additional information on measurements when percentage body fat or/and
[n conclusion, the optimal body mass index cut-off for obesity in Hong Kong Chinese was lower than the 30kg/m2 recommended by the World Health Organization, a clear reflection of ethnic difference between Asians and Caucasians. The quadratic relationship between percentage body fat and body mass index was similar in Hong Kong Chinese as in Caucasians and Blacks. Moreover, percentage body fat together with waist-hip-ratio were found to be better indicators of cardiovascular risk factors in Hong Kong. This was the first time such findings were found in the Hong Kong Chinese population.
IIabstract
toc
Medical Sciences
Master
Master of Medical Sciences
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Roberts, Timothy Lloyd. "Linoleic acid and sudden cardiac death." Thesis, University College London (University of London), 1994. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.281772.
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Tee, Michael Weiseng. "Image analysis of cardiac computed tomography towards regional functional analysis." Thesis, University of Oxford, 2015. https://ora.ox.ac.uk/objects/uuid:14f50b88-1af6-40b6-91b3-9e39d77fe83a.
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Global assessment of myocardial function is widely performed by estimating ejection fraction (EF), but many common cardiac diseases initially affect the myocardium on a regional, rather than global, basis. Computed tomography (CT), most commonly applied to assess the coronary arteries, is a prime candidate for such regional analysis. This doctoral thesis makes steps towards regional CT functional analysis with two clinical and two technical contributions. The first clinical contribution focuses on evaluating the feasibility and utility of functional analysis with currently available CT technology. Our study found that CT strain analysis could identify regional wall motion abnormalities in cardiomyopathy that are not otherwise detected using conventional metrics of myocardial function such as EF. In order for cine CT of the heart to become routine clinical practice, improvements need to be made to the image acquisition protocol. The second clinical contribution focus on making these improvements with results pointing to the possibility of one millisievert range cine CT images with high (>50 milliseconds) temporal resolutions. Moving to technical considerations, a key concern has been how to better characterise the myocardium in CT. To address this, the first technical contribution examines the use of feature-based attribute vectors, which were found to improve image registration towards deriving more reliable motion estimations. The second technical contribution focus on developing a pipeline tailored towards CT strain analysis. Noting that CT naturally provides information in 3D, a 3D hyperelastic biomechanical model fitting method was evaluated. Analysis of an infarction model demonstrated that regional myocardial strain can be estimated in the 3D space and areas of infarction can be detected. By considering both technical and clinical perspectives, these advances will contribute to the the field of regional cardiac functional analysis towards improving patient care.
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莊婉瑜 and Yuen-yu Chong. "Psychosocial smoking cessation interventions for hospitalized patientswith cardiac disease." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2009. http://hub.hku.hk/bib/B43251146.
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Quigley, Gillian Margaret. "Inflammation of the heart in heart disease." Thesis, University of Manchester, 2013. https://www.research.manchester.ac.uk/portal/en/theses/inflammation-of-the-heart-in-heart-disease(eae19e58-aeb4-4673-924e-1dbd1c831fec).html.
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Heart failure patients have dysfunction of the cardiac conduction system that contributes to a high burden of arrhythmias including atrial fibrillation and sudden cardiac death. Heart failure has been associated with the inflammatory response, but it is unknown if inflammation is playing a role in the remodelling of the cardiac conduction system in heart failure. Inflammation has been shown to be present in the myocardium from failing hearts and it is known to have detrimental effects on cardiac function, inducing fibrosis, remodelling of ion channels and even arrhythmias. However, the effect of inflammation on the cardiac conduction system has not been investigated. The aims of this study were to determine if there is an increase of pro-inflammatory cytokines and inflammatory cells in the cardiac conduction system in heart failure. In addition, to identify if there is possible inflammation-associated fibrosis and apoptosis in the cardiac conduction system in heart failure. To test these aims, three models of heart failure were used: a rat model of pulmonary arterial hypertension, a rabbit model of congestive heart failure and a rat model of myocardial infarction. In the rat model of pulmonary arterial hypertension there was a bradycardia, a prolongation of the QT interval, and an increase in the atrioventricular and ventricular refractory periods, suggesting electrical remodelling in these animals. The rats with pulmonary arterial hypertension displayed an increase in pro-inflammatory cytokines such as interleukins 1β and TGFβ in the right side of the heart, including the sinoatrial node and right Purkinje fibres of the cardiac conduction system. In addition, in these areas, there was an increase in components of the extracellular matrix, including fibronectin, collagen I and vimentin. Histology revealed regions of non-myocyte nuclei, only in the right ventricle of the rats with pulmonary arterial hypertension. Immunohistochemistry demonstrated patches of CD68 and vimentin expression (markers for macrophages and fibroblasts, respectively) in the right side of the heart in these animals. TUNEL staining also revealed an increase in apoptosis in the right side of the heart. In the rabbit model of congestive heart failure, the region most affected by inflammation was the right atrium, while few changes were measured in the ventricles or cardiac conduction system. Although these results are surprising, it is suggested that the atria could be more sensitive to the physical stretch produced in this model. In the rat model of myocardial infarction, there were regions of non-myocyte nuclei in the border zone. This region also had increases in pro-inflammatory and fibrosis markers. In conclusion, this work has presented the novel finding that there can be inflammation in the cardiac conduction system in heart failure. This could be contributing to the arrhythmias seen in heart failure patients. This could possibly lead the way to anti-inflammatories as a possible novel therapeutic for heart failure patients.
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Hui, Ling, and 許凌. "Dobutamine stress echocardiography for children with acquired and congenital cardiac diseases." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2003. http://hub.hku.hk/bib/B29914954.
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Hwang, David Muren. "Analysis of gene expression in cardiac development and disease." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape10/PQDD_0012/NQ41443.pdf.
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Mahy, Ian Richard John. "Observations on human peripheral microvascular function in cardiac disease." Thesis, Imperial College London, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.308969.
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Green, Harry. "Mathematical modelling of cardiac rhythms in health and disease." Thesis, University of Exeter, 2017. http://hdl.handle.net/10871/31564.
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Cardiac disease is the most common cause of death among the adult population worldwide and atrial fibrillation (AF) is the most common cardiac arrhythmia. The state of the art in AF treatment involves creating lesions of heart tissue through radiofrequency ablation. In this thesis, mathematical modelling techniques are developed to design decision support tools that could help a cardiologist determine the best location to ablate in clinic. Firstly, parameter optimisation methods are explored to adapt a model designed for the ventricles to the atria, and a novel technique is introduced to characterise pathways through parameter space from a healthy state to a diseased state using a multi-objective genetic algorithm. Next, I reproduce clinical signals recorded during AF ablation through the use of a phenomenological model of the cardiac action potential on a cylinder and show how this model can enable us to recover information lost in clinic to improve clinical decision. This is followed by introducing a more simplistic approach to the same problem, by characterising the electrical activity on the recording by a sine wave. Finally, the effectiveness of these two approaches is compared in the clinical setting by testing both as decision support tools. The emphasis of the approaches throughout the thesis is on developing techniques with clinical applicability. We demonstrate that lost information in clinic can affect the decision made by an experienced clinician, and that the mathematical modelling approaches developed in the thesis can significantly reduce the impact that this information loss can have on clinical decision making.
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Koekemoer, Andrea Louise. "The role of ms1 in cardiac physiology and disease." Thesis, University of Leicester, 2008. http://hdl.handle.net/2381/29906.
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Previous work in the group identified a novel gene, designated myocyte stress 1 (ms1), which is up-regulated within 1 hour in the left ventricular following aortic banding in the rat, suggesting a possible role for ms1 in the initial signalling of the hypertrophic response. ms1 is also expressed during cardiac development and is transiently up-regulated during ischaemia-reperfusion in vitro. This suggests that ms1 may play a more widespread role in cardiac physiology.;The aim of the work in this thesis was to better understand the role of ms1 in cardiac physiology and disease through a combination of in vitro and in vivo approaches. It was demonstrated that transient over-expression of a c-Myc-ms1 fusion protein into a heart-derived rat cell line, H9c2, colocalised with actin and altered gene expression of known hypertrophic and cardioprotective markers that are target genes of the myocardin-related transcription factor (MRTF)/serum response factor (SRF) transcriptional pathway. The size of cells over-expressing ms1 significantly increased by 47% when compared to untransfected cells and over-expression of ms1 markedly inhibited staurosporine-induced apoptosis by 88%. A Cre/loxP system based construct was developed to assess the in vivo of increased ms1 expression and was confirmed to work in a cell-based system. However, two independent attempts to make a transgenic mouse over-expressing ms1 were unsuccessful despite successful integration of the transgene.;Overall the findings suggest that ms1 induces a hypertrophic response and provides cardioprotection via a MRTF-SRF signalling mechanism. The findings provide for the first time direct evidence of the involvement of ms1 in hypertrophy and cardioprotection.
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O'Leary, Caroline Ann. "Inherited renal and cardiac disease in the bull terrier /." [St. Lucia, Qld.], 2002. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe16727.pdf.
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Anderson, Brian R. "The Biophysics of Titin in Cardiac Health and Disease." Diss., The University of Arizona, 2014. http://hdl.handle.net/10150/319877.
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The giant protein titin is the third myofilament in the cardiac sarcomere. It is responsible for generating passive forces in stretched myocardium and maintaining sarcomere structure. The force generation properties of titin are determined by titin's elastic springlike elements, and this dissertation focuses on the determination of the physical properties of these springlike elements using atomic force microscopy. The primary project of this dissertation investigates the link between a single point mutation in one of titin's subdomains and arrhythmogenic cardiomyopathy.
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Fredericks, Salim. "Cardiac troponins and creative kinase isoenzymes in uraemia." Thesis, St George's, University of London, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.271541.
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Cotter, Paul Eoin. "Cardiac parameters in young patients with cryptogenic stroke." Thesis, University of Cambridge, 2014. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.648802.
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De’Ath, Henry D. I. "Trauma associated cardiac injury & dysfunction." Thesis, Queen Mary, University of London, 2013. http://qmro.qmul.ac.uk/xmlui/handle/123456789/8466.
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The existence of a trauma induced secondary cardiac injury (TISCI) remains in doubt. The risk factors and pathological processes that lead to its development are not known, whilst the effects of TISCI on injured patient outcome are uncertain. Concurrently, the incidence of coronary heart disease (CHD) in a trauma population and its influence on mortality are inconclusive. The aim of this research project was to address these specific areas of uncertainty. Critically injured patients (n=135) were retrospectively investigated for the incidence and nature of adverse cardiac events (ACEs), and levels of the cardiac specific biomarkers Troponin I, B-type Natriuretic Peptide and Heart-type Fatty Acid Binding Protein were measured. Biomarkers and cardiac events were evaluated against outcome. Thereafter, the relationship of pro-inflammatory cytokines with TISCI was explored. A prospective cohort study of 199 trauma patients followed, to confirm the existence of TISCI and describe its clinical features, risk factors and outcomes. Finally, coronary artery calcium, as a marker of CHD, was evaluated on 432 CT scans of the chest of trauma patients aged 45 years or over, and its association with survival after injury was established. ACEs and early biomarker rises occurred in trauma patients and both were unrelated to the severity of chest injury. Each was associated with higher mortality, and confirmed the existence of TISCI. Risk factors for the development of the condition included increasing age, worsening tissue injury and shock. A relationship with cytokines was demonstrated, and implicated acute inflammation in the pathogenesis of TISCI. Calcification on CT scans revealed the incidence of CHD in an injured cohort approached 70%, although its presence did not impact survival. There exists a trauma induced secondary cardiac injury which was related to poorer outcome. The condition was associated with inflammation. CHD was widespread in older trauma patients but was not associated with increased in-hospital mortality.
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Taylor, Kelly A. "Benefits of cardiac rehabilitation." Honors in the Major Thesis, University of Central Florida, 2001. http://digital.library.ucf.edu/cdm/ref/collection/ETH/id/251.
Full textAbstract:
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