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Group Interview

Pentti Rautaharju

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Farida Rautaharju

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Year: February 19th, 2001
Location: Anna Maria, Florida
Interviewed by: Blackburn, Henry

Abstract

Three old friends talk sense and nonsense about the early days of CVD epidemiology, working on the Minnesota Code, the stresses of recording ECGs and pulse waves in survey settings from Serbia to Kyushu, early researches and the people, chance encounters, and events that created their careers. There is much folderol about crises in the field and in the MRFIT ECG processing due to technical failures.

They deal generally kindly with mentors Keys, Paul White, Otto Schmitt, Ernst Simonson, and Martti Karvonen. The whole is conversational and probably of interest only to cognoscenti, not to the real historian or the general reader. (Henry Blackburn)

Quotes

Frank leads are the only one that really survived and they are now transformed from components of a 12-lead ECG! Our old friend Fred Dower who developed the method to calculate 12 leads from Frank leads that never worked. It works much better the other way around. That is the only surviving part of a huge investment in the computer ECG. Of preexisters. Everybody wanted to become immortal with his own lead system. Burch’s Tetrahedron, the Schmitt-Simonson III.

I became so convinced that three leads would replace the 12 I lost interest in 12 leads for a long period of time. Especially because those days computers could handle only 3 leads at a time. That was a limitation. It took me 3 years of effort before I realized it was a losing battle. Back to 12 leads! (3)

A Disaster

From all those [lab and field recording events[ I learned enough medical biophysics concepts to be able to handle that kind of problem, such as fetal electrocardiography, signal enhancement, by applying the same technical tools. I remember after 5 years of experimental work we published that paper. “Experience with small computers.” Technically it was extremely demanding.

I remember Makarska I had in those days everything possible… small digital computers and other computers for ECG processing. I brought there some gear we were asked by Ancel to demonstrate for the Makarska team and visitors [ISC Research Committee], some of our [so-called, advanced techniques]…

HB: I remember. We went together through the Austrian Alps in the [loaded] VW van.

PR: I had all those things ready for the demonstration and one fuse blew and it was impossible to get a replacement. I went back with this to the Italian border and they let me through. I had to ship all those instruments by railroad back to Frankfurt and driving our empty Volkswagen bus following the train. (5)

Encore a disaster

Then there was the Dalhousie ECG problem for MRFIT. Remember that was when we had over hundreds of ECGs for people during stress testing. That was a technical disaster marking the model 3500 recorder units in 32 clinics. And they started sending cassettes to Halifax to process for MRFIT. And it turned out that when at Easter time we were ready to run the study we couldn’t play a single one from any of those clinics. They started coming in at a very fast rate and nothing worked. We could not believe it. And Easter Sunday, Mike Cudahy… the President of Marquette, called me that they know what the problem is but they can do nothing about it. And as it was, you wouldn’t able to produce hard copies for visual coding. It was horrible. From an ECG point of view, completely… We worked 5 days and 5 nights. I had a very good medical attendant, to blind all those stress testing ECGs on those and clean and insert by hand and even count the signals.

HB: All onsets and offsets.

PR: All the leads were still in 3 at the time and the one started in another area starting the next… We were able to rescue the whole… But I remember always that Easter; it never leaves my mind.

HB: Yes, you were really under stress.

PR: It was a tremendous responsibility for a young group, such a massive project. (pg. 6)

Improved ECG Prediction

We have been able to accept even Frank leads for analysis. For instance I have found out in the CHS, Cardiovascular Health Study, that by far the most important single risk factor, at least in men, is T wave axis that we have never looked at. It came after the Rotterdam Study. Not the angle between QRST, I looked at it. But at the… T-axis from the normal high positive T wave in V1 as a criterion. Nobody ever paid any attention to the T wave in V1. We can extract it now from those… from Frank leads from MRFIT. We have the database now for 30-year risk analysis on that item alone. In addition to all those hundreds of measurements from [other risk factors].

But I prefer always using variables that are model-based participants, from a biological reason for the risk. Otherwise it is more applied studies. If you don’t have a model you can find an association that is significant but it has to have some pathophysiological base; then it becomes interesting. (8)

Other predictors

…what turned out to be a very important predictor from those body measurements that we always used [in MRFIT], and that was very exciting, also… was chest size… And that was very exciting and now we have finally something that has physiological meaning. It makes sense because chest size… lung size, larger lungs if you are… getting enough oxygen for a big heart to transport more blood. (9)

Karvonen Again

He had visited the Stadium [lab. in Minnesota] and he came back full of ideas… I worked with him at that time. That was ‘53-‘54. And he came back determined to start investigating those diet-heart cholesterol samples even around various communities east and west in Finland. You would not believe how difficult it was. The mornings we did all the examinations, in the afternoon Martti and I would travel around from house to house asking men to come for the examination in the middle of their field work. But they came.

I was missing the first 2 months in medical school. My friends saw my name in the news.. The first Finnish Public Radio picked up this survey going on and mentioned that this important international work was going on and at the end of the story they mentioned the scientists, these two people, Martti Karvonen and me, a med student!

He [Karvonen] was an optimist. He never gave up. It’s a long story. (pg. 16)

Paul Dudley White: Epidemiological Credit Card

Martti had his distress during those early days when the medical profession more or less ridiculed him. I asked him once how can he take this and he said when things get really bad he goes to his office, lies down on the floor on his back, and crosses his fingers and laughs. That relieves all the stress that he has.

For a physiologist to start it was quite something. It was only after Paul White came for a visit, medical people started paying some attention. Ancel went through the same kind of castrations.

HB: Maurice Visscher was vicious in his dislike of Ancel. Of course, Ancel was not that much fun to get along with then, I’m sure. He didn’t like teaching and he didn’t like teaching physiology students and he didn’t think he was a good lecturer and he was right. He had other things on his mind and he had these grand visions of sizeable experiments and sizeable observations so he broke away from Visscher and developed the Stadium Lab. But it was interesting how he [too] sold himself to the medical profession through Paul White. (18)

Minnesota Code Precursor

I remember during that 1956 visit Ancel saw me analyzing the ECGs. I made a list of what I thought for criteria and I used that system to give them numbers. He said, I have Henry Blackburn who is working with that kind of thing, a formulary for epidemiology, and that’s when Ancel started thinking of us together.

Things happened very fast. I always remember and it was almost the first time. Was it in the Big 10 or some other bar across the street, we went to write the final draft of Minnesota Code.

HB: We were probably reviewing it together because Ernst and Ancel were taking it to a methods meeting at Princeton to present it. They took it away from us! I was furious when Ancel relabeled it, “normal and abnormal, and infarct and possible infarct”, all the things I had gotten away from by having a purely objective, descriptive program. He put those diagnostic labels back in and Ernst presented them at the Princeton conference because I was too “young” to take along.

PR: They realized the importance of it.

HB: And we got it back and you and I and Gunnar did most of the testing on it.

PR: It was not easy because, as you remember, there was no validated data, just clinical impressions.

HB: Clinical impressions and we had a little bit of Ernst Simonson’s normal/abnormal group comparisons to start with, Q3 or something like that. I got some Mayo autopsy validated material I think. But after that it was just a matter of what seems clinically reasonable, let’s try it out [for distributions], and is it repeatable?

PR: In those days we didn’t have any formal training or experience with logisticx… this has become a science in itself. How do you decide mutually exclusive categories. Next time basis. Those days in Minneapolis were wonderful. (20)

Hazards in the Field

Esko was leading the field survey. Martti was there, right at the Russian border. Huge, what they call smoke sauna and we went there and… the river, there was a fresh aroma from the smoke sauna. You felt so refreshed. Later in the fall it was the first cold day and the landlady, Martta, we lived in an old inn, she had heated the stones in an old ceramic stove and we entered the room, I opened the door and that stink that was there! There evidently was a dead rat under… and somewhere it was. It was heated, the aroma was really a stink when you came into the room. I’m oversensitive, maybe that was the first time I was smelling it. I opened the window and started vomiting into the street.

Martti was laughing so loudly, lying on his back on the floor just laughing and the phone rang. It was the wife of one of the cardiologists, a professor… nowadays retired. She asked, “What on earth is that noise back there?” “Oh, nothing special, Pentti is vomiting into the street, Martti is lying on the floor laughing. Nothing special.” That was the start of his divorce. I don’t know if that was the cause, but it was a contributing factor. There couldn’t have been anything innocent coming from the sauna. But that stink, exactly like a… That is why ever since I have been oversensitive to sulphur, and H2S. (23)

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