Diminishment of respiratory sinus arrhythmia foreshadows doxorubicin-induced cardiomyopathy.
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BACKGROUND: The development of a microcomputer-based device permits quick, simple, and noninvasive quantification of the respiratory sinus arrhythmia (RSA) during quiet breathing. METHODS AND RESULTS: We prospectively and serially measured the radionuclide left ventricular ejection fraction and the RSA amplitude in 34 cancer patients receiving up to nine monthly bolus treatments with doxorubicin hydrochloride (60 mg/m2). Of the eight patients who ultimately developed symptomatic doxorubicin-induced congestive heart failure, seven (87.5%) demonstrated a significant decline in RSA amplitude; five of 26 subjects without clinical symptoms of cardiotoxicity (19.2%) showed a similar RSA amplitude decline. On average, significant RSA amplitude decline occurred 3 months before the last planned doxorubicin dose in patients destined to develop clinical congestive heart failure. CONCLUSION: Overall, RSA amplitude abnormality proved to be a more specific predictor of clinically significant congestive heart failure than did serial resting radionuclide ejection fractions.
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W. H. Gardner, Jr. Associate Professor
We study circuits for cognition. Using a combination of neurophysiology and biomedical engineering, we focus on the interaction between brain areas during visual perception, decision-making, and motor planning. Specific projects include the role of frontal cortex in metacognition, the role of cerebellar-frontal circuits in action timing, the neural basis of "good enough" decision-making (satisficing), and the neural mechanisms of transcranial magnetic stimulation (TMS).