Systolic Time Intervals: International Symposium, Graz, Austria September 1–2, 1978

318 Pages·1980·7.908 MB·English

by  A. M. Weissler, R. S. Stack, Y. H. Sohn (auth.), Professor Dr. Werner List, Professor Dr. Joachim S. Gravenstein, Professor David H. Spodick M. D., D. Sc. (eds.)

International Boehringer Mannheim Symposia
Systolic Time Intervals
Edited by
w. F. List, J. S. Gravenstein, and D. H. Spodick
J. Barden
Editorial Consultant
With 159 Figures and 46 Tables
Springer-Verlag Berlin Heidelberg New York 1980
International Symposium, Graz, Austria
September 1-2, 1978
Professor Dr. Werner List
Institut fUr Anasthesiologie der Universitat Graz
Landeskrankenhaus, Auenbruggerplatz, 8036 Graz (Austria)
Professor Dr. Joachim S. Gravenstein
Department of Anesthesiology, J. Hillis Miller Health Center
College of Medicine, University of Florida,
Gainesville, Florida 32610 (USA)
Professor David H. Spodick, M. D., D. Sc.
University of Massachusetts, Medical School and St. Vincent Hospital,
Worcester, Massachusetts 01604 (USA)
Editorial Consultant:
John Barden, M. D.
Department of Anesthesiology, University Hospitals,
2074 Abington Road, Cleveland, Ohio 44106 (USA)
ISBN-13: 978-3-540-09871-3 e-ISBN-13: 978-3-642-46418-8
DIO: 10.1007/978-3-642-46418-8
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Preface
Systolic time intervals (STI), known for a long time, were revived in the early
1960s by Arnold Weissler. The first important papers came from him; they eval
uated STI measurements in larger populations, established norms, and compared
STI measurements with other invasive methods. Since then, several hundred ex
cellent papers have appeared using and evaluating STI measurements for myo
cardial function studies. These have appeared in prominent cardiologic journals
throughout the world as well as in the anesthesiologic and pediatric medical
literature.
When consent of subjects to medical experimentation became a prominent and
necessary issue, the noninvasiveness of investigative methods in medicine, wher
ever possible, resolved the issue. Noninvasive measurements of STI proved to be
an excellent monitoring parameter of cardiac function during anesthesia, and
anesthesiologists wished to learn more from the long experience of cardiologists
with STI.
An organizing committee of List, Gravenstein, and Spodick was accordingly
formed. Invitations were issued for an international conference on STI. With
more than 40 clinical researchers using STI, it was, of course, difficult to hear
them all within two days.
A generous sponsor, the AVL Company, Graz-Schaffhausen, made possible the
International Conference at Graz. Publication of the proceedings of the Confer
ence became feasible with help from Boehringer-Mannheim.
Among the various noninvasive techniques available today for evaluation of myo
cardial function, echocardiography and STI measurements seem to be the most
important. It is fortunate, I think, that we have a number of papers comparing
the two noninvasive methods. There are also papers comparing noninvasive STI
measurements with invasive methods in animal and human experimentation.
There is no question that STI are of great help in studies of patients before and
after drug intervention or cardiac surgery. An other application might be a
screening test to assess the competency of the myocardium and the necessity of
digitalization. Here the easy and noninvasive applicability of STI measurements
seems to offer much. Yet persisting gray zones of doubt have first to be clari-
fied with further clinical investigations on a larger scale in the healthy and in
patients with cardiac disease of varying severity.
v
A number of the papers deal with the effect of work and preload changes on
STI. They could help clear up the STI gray zones and give dynamic quantitative
or semiquantitative measures of myocardial performance.
Clarification is possible only if studies are done on representative groups of the
population. An automated system for calculation of STI measurements in real
time is essential. With immediately available results, applicability of the meas
urements is increased, and therapeutic consequences can be monitored simulta
neously. Thus many investigators in the STI field have spent much time in re
search on computer applications. No less than seven groups presented such ap
proaches and results to this Conference.
It is certain that noninvasive methods, including STI measurements, will not
render invasive techniques unnecessary, especially when exact information on
pressure-volume relationships is needed. It seems possible, however, to preselect
the relatively few patients requiring invasive techniques and thus help reduce the
morbidity and mortality risks of those techniques.
It may be that the time will come when noninvasive myocardial function tests
are as important and widely used as the ECG in cardiology, internal medicine,
and anesthesiology.
Graz, 1980 W.F. List
VI
Table of Contents
1 The Accuracy of the Systolic Time Intervals as a Measure of Left
Ventricular Function
(A. M. Weissler, R. S. Stack, and Y. H. Sohn) . . .. 1
2 The Systolic Time Intervals: A New Method of Study
(A. A. Luisada, P. K. Bhat, and V. Knighten) . . . . .. 14
3 Limitations of Systolic Time Intervals for Evaluation of Cardiac
Function
(H. Kesteloot). . . . . . . . . . . . . . . . . . . . . . 30
4 Assessment of Myocardial Contractility by Using the Systolic
Time Intervals
(G. E. Levinson) . . . . . . . . . . . . . . . . . . . . . 36
5 Noninvasive Score for Evaluation of Left Ventricular Function
(U. Gleichmann, 1. Bistreanu, J. Mannebach, H.M. Mertens,
U. Sigwart, and G. Trieb) . . . . . . . . . . . . . . . . . 40
6 Physiologic Responses During Uninterrupted Exercise and Recovery:
Methodology for Systolic Time Intervals and Results with Bicycle
and Treadmill
(D. H. Spodick) ...... 46
7 Use of Systolic Time Intervals in the Operating Room
(P. J. Dauchot, M.D., and J. S. Gravenstein) ... 49
8 Hemodynamic Response to Bicycle Exercise Correlated to Pre
ejection Index
(K. GUnther, J. Schauer, and D. Schneider). . . . . . . . . . . 57
VII
9 Systolic Time Intervals for the Diagnosis and Management of
Coronary Artery Disease
(R.P. Lewis, H. Boudoulas, P. Ruff, and R.E. Kates) . . . . 62
10 Computer Evaluation of Human Circulation Based on Noninvasive
Methods
(J. Simonyi, J. Lehoczky, Z. Herpai, A. Godry, and 1. Szauder) 72
11 Correlation of Invasive Measures of Cardiac Function with
Expressions Derived from Systolic Time Intervals in the
Anesthetized Dog
(J. Zanella, Jr., R. Steinberg, P. Katona, P. J. Dauchot, and
J.S. Gravenstein) ............... . 82
12 A Computer Program for Evaluating Systolic Time Intervals at
Rest and During Intervention Tests
(H. Mannebach, L. Bechtloff, H.H. Mertens, L. Przybilla, and
U. Gleichmann) . . . . . . . . . . . . . . . . . . 88
13 Automatic Versus Visual Evaluation of Systolic Time Intervals
(H.V. Schalk, W.F. List, and H.J. Marsoner) 95
14 Computer Algorithms for Automatic Determination of Systolic
Time Intervals
(J.J.H. Donders) . . . . . . . . . . . . . . . . . . . . 100
15 An Instrument for the On-line Determination of Systolic Time
Intervals
(H.J. Marsoner, C. Savora, W. Moser, and W.F. List) 110
16 Systolic Time Intervals Measured by a Thermistor Pulse Transducer:
A New Means for the Evaluation of Cardiac Performance During
Exercise
(G. Ferro, M. Chiarello, V. Santinelli, M.G. Tari, and
M. Condorelli) ............. . ... 117
17 Measurement and Interpretation of Pulse Pressure and Flow
During Systole
(K.P. Pfeiffer and T. Kenner) . . . . . . . . . . . . . . . 124
VIII
18 Technical Aspects for Acquisition of Systolic Time Intervals
Especially for Determination of the Pre-ejection Index
(W. Rentsch) . . . . . . . . . . . . . . . . .. 133
19 Can Inappropriate Correction Methods Distort the Results of
Evaluative Studies?
(G. K. Wolf). . . . . . . . . . . . . . . . . . . . . . 142
20 Systolic Time Intervals Obtained During Various Interventions
(G.M.A. Van der Hoeven, P.J.A. Clerens, and C. de Monchy) . . . 144
21 The Systolic Time Intervals. Note II. A Comparative Study of
Various Age Groups
(A. A. Luisada, P.K. Chat, and V. Knighten) .. . . . . . . . . 152
22 Increasing Sensitivity of Systolic Time Intervals of Left
Ventricular Function Using Intervention Tests - Comparison
Between Exercise and Changing Preload
(H.M. Mertens, T. Bistreanu, H. Mannebach, U. Sigwart, and
U. Gleichmann) . . . . . . . . . . . . . . . . . . 160
23 Noninvasive Evaluation of the Cardiovascular Function by Means
of the Pre-ejection Index
(W. Urbaszek) . . . . . . . . . . . . . . . . . . . . . 169
24 Influence of Upright Posture on the Systolic Time Intervals in
Children with Congenital Heart Defects and Innocent Precordial
Vibrator Murmurs
(C. de Monchy and G.M.A. Van der Hoeven) . . . . . . . . . 175
25 Systolic Time Intervals in Right Ventricular Volume Overload:
An Echocardiographic Study
(J. Yoshikawa, K. Yanagihara, T. Owaki, H. Kato, Y. Takagi,
E. Okumachi, Y. Tomita, T. Fukaya, and K. Baba) . . 182
26 Systolic Time Intervals: Comparison of Echocardiographic and
Conventional Methods
(A.H. Khan). . . . . . . . . . . . . . . . . . .. 192
27 Echocardiographic Evaluation of Systolic Time Intervals: The Time
Discrepancy Between Valve Closure and the Second Heart Sound
(T. Sakamoto, M. Matsuhisa, H. Kawaratani, H. Ichiyasu, and
T. Hayashi) . . . . . . . . . . . . . . . . . . . .. 202
IX
28 Comparative Assessment of Left Ventricular Function by Echo
cardiography and Thermistor Plethysmography
(G. Stefan) . . . . . . . . . . . . . . . . . . . .. 210
29 Correlation of Systolic Time Intervals with Stroke Volume in Man
(D.F. Grum and P.J. Dauchot). . . . . . . . . . . .. 218
30 Evaluation of Left Ventricular Function by Systolic Time In
tervals in Patients with Calcified Mitral Annulus
(S. Zoneraich, O. Zoneraich, M. Patel, and S. Thaniks) . 223
31 Systolic Time Intervals After Single and Repetitive Oral Digitalis
Doses in Man
(G.G. Belz, R. Erbel, E. Czermak, and G. Belz) . . . . . . . . 231
32 The Clinical Relevancy of the Pre-ejection Index for Evaluation
of Digitalis Therapy in Patients with Chronic Coronary Artery
Disease
(J. Schauer, K. GUnther, and D. Schneider). . . . . . . . . . 236
33 Usefulness of the Systolic Time Intervals in the Study of Beta
Blocking Agents
(H. Boudoulas, R.P. Lewis, R.E. Kates, G. Dalamangas, and
B.M. Beaver) . . . . . . . . . . . . . . . . . . .. 243
34 Evaluation of Long-Term Therapy with Propranolol in Mitral
Valve Prolapse Syndrome
(R. Erbel, P. Schweizer, G. Wagner, W. Merx, and S. Effert) .. . 256
35 Changes in Systolic Time Intervals During Halothane, Enflurane
or Isoflurane Anesthesia in Healthy Man
(N.T. Smith, R.K. Calverley, E.!. Eger, M. Quinn, and
G. Prys-Roberts) . . . . . . . . . . . . . . . . .. 265
36 A Comparison of the PEP and QF Interval as a Monitoring
Variable
(J.A. Reitan and N.A. Levine). . . . . . . . . . . . .. 273
37 Systolic Time Interval Measurements for the Assessment of the
Effect of Cardiovascular Drugs
(L. Matos) . . . . . . . . . . . . . . . . . . . . . . 281
x
Epilogue: Summary of the International Conference on Systolic
Time Intervals
(A.M. Weissler) 290
Remarks After Final Session
(N.T. Smith) 293
Are Systolic Time Intervals Cost-Effective?
(J .S. Gravenstein) 295
Subject Index . . 297
XI