Total and coronary heart disease mortality in relation to major risk factors--Quebec cardiovascular study.

The relationships of blood pressure, smoking, serum cholesterol and education levels on total and coronary artery disease (CAD) mortality were evaluated in 4576 Quebec men aged 35 to 64 years, free from overt CAD at entry and followed for 12 years. From January 1974 to January 1986, there were 417 deaths, 131 due to CAD. A progressive increase in total and CAD mortality was observed from quintile 3 to 5 for both systolic and diastolic blood pressure.

Prognosis in patients with a strongly positive exercise electrocardiogram.

In patients with a strongly positive exercise electro-cardiogram, the workload achieved during the test allows the identification of subsets with good or poor survival rates. To determine whether the same criteria also predict acute ischemic heart events such as unstable angina and myocardial infarction, fatal and nonfatal acute manifestations were documented in 241 patients medically treated during an 8-year follow-up. All patients had a Bruce protocol treadmill exercise test with ST-segment depression greater than or equal to 2 mm and coronary angiographic studies.

Some applications of the P-V relation to the study of left ventricular performance.

There is still controversy as to which characteristics of the pressure-volume relation should be used to define myocardial contractility. In the present study a mathematical model for the left ventricle as a two-dimensional cylinder contracting radially and symmetrically was used to establish a relation between a calculated intramyocardial pressure (Dh) and the P-V relation (PVR) at end-systole. Four new indices are introduced that allow a better assessment of change in inotropic state of the myocardium, namely the calculated intramyocardial pressure (Dh), the calculated resultant pressure across the inner surface of the myocardium (Dh-P) (P = cavity pressure), the work Wt related to the pressure (Dh) and the work Wd related to the pressure (Dh-P).

Survival with painless strongly positive exercise electrocardiogram.

To determine the prognosis of patients with painless strongly positive exercise electrocardiogram, the 6-year cumulative survival rate was computed for 298 medically treated patients who terminated their exercise test with or without angina. All had horizontal or downsloping ST depression greater than or equal to 2 mm during a treadmill exercise test according to the standardized multistage Bruce protocol. Of the 298 patients, 119 terminated the exercise test because of dyspnea or fatigue and 179 stopped because of angina.

Blood pressure profile in two adult male populations.

Causal blood pressure measurements were recorded in two groups of men aged 40 to 64 years; of the 7024 men in metropolitan Saint John, NB, and the 4044 men in seven suburbs of Quebec who were asked, 5840 (83.1%) and 3097 (76.6%) respectively agreed to participate.

Effects of perfluorochemical hemodilution on coronary blood flow distribution in dogs.

To determine the effect of perfluorocarbon (PFC) hemodilution on myocardial vessel capacity to autoregulate, circumflex coronary artery pressure-flow relations were studied in anesthetized dogs under three conditions: maximal vasodilatation before and after PFC; autoregulation before and after PFC with 100% oxygen supplemented with room air ventilation, and autoregulation with PFC hemodilution during either room air or 100% oxygen supplemented with room air ventilation. During coronary vasodilatation, PFC did not modify coronary conductance or zero-flow pressure. During autoregulation after PFC, the lower pressure limit of the autoregulatory pressure-flow relation was shifted leftward.

Smoking, alcohol consumption, lipid and lipoprotein levels.

The lipid profiles of 1165 French Canadian men (aged 42 to 59 years) were studied and related to drinking and smoking habits. Alcohol consumption and smoking were closely related, smokers consuming twice as much alcohol as non-smokers. When relative body weight, total cholesterol, triglyceride and alcohol consumption were controlled in a covariate analysis, plasma levels of high density lipoprotein (HDL) cholesterol, HDL2 and HDL3 differed significantly between smokers, ex-smokers and nonsmokers.

[Physical fitness improves after mitral valve replacement].

To determine whether women with mitral valve prostheses can improve their physical fitness without suffering cardiac dysfunction or hemolysis, 10 women (mean age 47 years) who had undergone mitral valve replacement (an average of 3.7 years earlier) were enrolled in an 8-week program of exercise on a bicycle ergometer. They exercised three times a week, starting at 60% and increasing to 80% of their maximal heart rate achieved during stress testing.

Lipid profile of a French-Canadian population: 1. Association of plasma lipid and lipoprotein levels with age, relative body weight and education.

Plasma lipid and lipoprotein levels were determined in a randomly selected population of 1169 French-Canadian men in the Quebec City area. The mean levels of total plasma cholesterol and triglycerides were 224.0 and 166.

Vigorous physical training after aortic valve replacement: analysis of 10 patients.

Improved prosthetic aortic valves have reduced the incidence of complications to a point where it can be hypothesized that functional class I subjects after aortic valve replacement (AVR) should adapt to a vigorous training program without a significant increase of hemolytic activity or clinical signs of prosthesis malfunction. To test this hypothesis, 10 men (mean age 52 years) who had undergone AVR (7 Björk-Shiley and 3 Lillehei-Kaster) were submitted to an 8-week training program on ergometer, 3 times/week, from 60 to 80% of individual maximal heart rate. Ten other men who had undergone AVR but did not participate in the training program were control subjects.

Coronary vasodilator reserve impairment distal to systolic coronary artery compression in dogs.

To investigate the mechanism by which muscular coronary overbridging can cause myocardial ischaemia, we studied the effect of systolic compression (SC) of the proximal left circumflex coronary artery in ten anaesthetised dogs, with both intact autoregulation and maximally dilated coronary arteries. Systolic compression was produced by a mechanical device adjusted to interrupt circumflex coronary flow only during the aortic ejection period and we measured left ventricular, aortic and distal circumflex coronary pressures, phasic coronary blood flow, regional myocardial blood flow (RMBF), myocardial oxygen consumption (MVO2), and myocardial lactate extraction (MLE). During both autoregulation and maximal coronary vasodilatation, there was a diastolic time lag after SC to restart phasic circumflex coronary blood flow (34 +/- 3 vs 31 +/- 3 ms) and to increase distal circumflex coronary pressure (69 +/- 4 vs 79 +/- 6 ms).

[Incidence of arterial hypertension in the Quebec region].

The objectives of this study were to determine the incidence of high blood pressure (HBP) in Quebec suburbs and evaluate age, baseline blood pressure level and overweight as determinants of future hypertension. From a cohort of 4828 men, aged 35-64, screened in 1974, 1090 normotensives (blood pressure less than 160/95 mmHg without medication) free of cardiovascular disease were re-evaluated in 1979-1980. Among these 1090 men, 183 have developed a blood pressure greater than or equal to 160/95 mmHg or less than 160/95 mmHg associated with antihypertensive medication.

Predictive value of atrial pacing test for survival of patients with coronary artery disease.

There is evidence that patients with signs of poor left ventricular function or marked ischemia at low work load during an exercise test have a poor prognosis for survival. To determine whether a pacing test can provide similar information, the 6-yr survival rate was computed in 118 medically-treated patients who had undergone a standardized atrial pacing test. Among the 118 patients, 80 had significant coronary artery disease (CAD).

Survival of patients with a strongly positive exercise electrocardiogram.

To assess the prognosis of patients with a strongly positive exercise ECG, the 5-year cumulative survival rate was computed for 220 medically treated patients. Of these patients, 107 had coronary angiograms (group A) and 113 did not (group B). All had horizontal or downsloping ST depression greater than or equal to 2 mm during a multistage Bruce protocol treadmill exercise test.

Long term treatment of two familial hypercholesterolemic heterozygote patients with batch affinity chromatography (BAC).

Two familial hypercholesterolemic heterozygote patients were treated for a period of 2 years using an extracorporeal technique involving batch affinity chromatography. In both cases LDL-cholesterol levels were drastically lowered and HDL-cholesterol levels were normalized. No untoward side effects were noted during the 2 year experimental period.

Effects of metoprolol on effort angina during the postprandial state.

To determine whether beta blockers prevent the more rapid onset of effort angina during the postprandial state, metoprolol 100 mg was given before and after an 800-calorie meal in 12 male patients with stable angina and coronary artery disease. Three graded treadmill exercise tests were done daily on 2 days. After an overnight fast the first test on each day was done after a placebo to detect day-to-day variations.

Computer assisted instruction for retraining family doctors in hypertension and hyperlipoproteinemia.

In an attempt to retrain family doctors in hypertension and hyperlipoproteinemia, computer assisted instruction (CAI) was assessed in fourteen doctors (Group 1) and its efficiency was compared to that of traditional lectures given to twenty-one doctors (Group 2). The same objectives, contents and illustrations were used in both teaching approaches. There was no significant difference for age, year of graduation and type of practice in the two groups.

Anaesthesia for facial rhytidectomy.

Observations on anaesthesia for facial rhytidectomy in 200 patients, without tracheal intubation or artificial ventilation, are reported in this survey.