Showing papers in "Acta Cardiologica in 1996"

Determinants of right ventricular failure after heart transplantation

Abstract: Predictive factors of right ventricular failure after heart transplantation are not well identified. Clinical and hemodynamic data from 20 patients who developed right heart failure were compared to those of 20 matched patients who did not experience this complication after cardiac transplantation. Preoperative systemic and pulmonary hemodynamics were comparable in the two groups. Patients with posttransplant right ventricular failure had longer waiting time (27 +/- 6 vs 16 +/- 3 weeks, mean +/- SE, P < 0.05), no regression of pulmonary hypertension (0 +/- 0.1 vs 2.3 +/- 0.3 Wood units reduction in pulmonary vascular resistance after transplantation, P < 0.01), and had been ventilated with higher levels of positive end-expiratory pressure (5 +/- 1 vs 1.5 +/- 0.5 cm H2O, P < 0.05). One-month postoperative evolution (mortality, hospital stay, radionuclide ejection fractions) was similar in the two groups. These results suggest that a lesser reversibility of pulmonary hypertension (possibly due to a longer evolution of the cardiac disease, as indicated by the longer waiting time) is the main determinant of right ventricular failure after heart transplantation.

Infective endocarditis and occult splenic abscess caused by Brucella melitensis infection: a case report and review of the literature.

Abstract: This report describes a patient with prosthetic aortic valve endocarditis caused by Brucella melitensis infection with an initial relapse after apparent recovery due to associated occult splenic abscess. In spite of a prolonged period of recovery (6 months) achieved with splenectomy and antibrucella antimicrobial therapy, a second relapse occurred and cure was achieved after replacement of the infected prosthetic valve and prolonged courses of antibrucella antimicrobial therapy. There is controversy on the optimal therapy of such cases, but this report suggests that successful management requires a combination of medical and early surgical therapy.

Diagnosis, localization and evaluation of malignancy of heart and mediastinal tumors by conventional and transesophageal echocardiography.

Abstract: Transesophageal echocardiography is well established in detecting and diagnosing heart tumors. In contrast, its role in assessing presence, growth and evidence of malignancy of tumors originating from the mediastinal site remains widely uncertain. In a prospective and investigator-blind study, we evaluated 72 consecutive patients with cardiac and/or mediastinal tumor lesions to assess the diagnostic impact of transthoracic and transesophageal echocardiography in determining localization, growth and malignancy. All tumor lesions were diagnosed and carefully evaluated by computer tomography and/or magnetic resonance imaging prior to the study. Biopsy demonstrated a malignant tumor in 49 patients and a benign tumor in 23 patients. Transthoracic and transesophageal echocardiography were equally effective in visualizing tumors of the heart in 24 patients (92% vs 100%; N.S.). Tumors originating from the mediastinum were 2.9 times less likely to be detected by the transthoracic approach (p < 0.001). In these patients, transesophageal echocardiography was also superior in diagnosing myocardial infiltration (18 vs 4 patients, p < 0.001) and invasion or intracardiac growth of the tumor (13 vs 6 patients, p < 0.05). When compared to histological findings, transesophageal echocardiography predicted malignancy from the presence of tumor spread both in- and outside the heart, infiltration and invasion in 21/49 patients (43%), a false positive result was obtained in only 1/23 patients with a benign tumor. Conventional echocardiography predicted malignancy in only 4/49 patients (8%, p < 0.005). In conclusion, transesophageal echocardiography is increasingly used in patients with suspected mediastinal tumor lesions. Our study demonstrates, that transesophageal echocardiography is effective and superior to the conventional approach in predicting localization and growth of mediastinal tumors, as well as in accessing evidence of malignancy of the tumor.

Myocarditis--cardiomyopathy. Consensus Report of the German Association for Internal Medicine, presented at the 100th annual meeting, Wiesbaden, 13 April 1994.

Abstract: On the basis of several, partially divergent definitions, myocarditis-unlike the often aetiologically unexplained (idiopathic) cardiomyopathies (dilated, hypertrophic, restrictive)-can be classified as c specific disease of the myocardium. This disease often has a known cause and can be due to a large variety of aetiological agents (viral, autoreactive, toxic, infectious processes, etc.) (1). A question still to be answered is whether there is a connection between dilated cardiomyopathy and myocarditis, i.e. whether (virus-induced) myocarditis can progress via a subacute or chronic stage to dilated cardiomyopathy. This question is of considerable diagnostic and therapeutic relevance. The following consensus report thus deals with the clinically important problems related to the diagnosis of myocarditis and dilated cardiomyopathy, examines the aetiological role of immunological mechanisms and discusses the treatment of the two diseases and prognostic factors.

Cardiac involvement in connective tissue diseases and primary antiphospholipid syndrome : Echocardiographic assessment and correlation with antiphospholipid antibodies

Abstract: The aim of this study was to determine the incidence of cardiac involvement in systemic lupus erythematosus (SLE), progressive systemic sclerosis (PSS), rheumatoid arthritis (RA) and primary antiphospholipid syndrome (PAPS), and to evaluate the correlation between cardiac involvement and antiphospholipid autoimmunization. M-mode, two-dimensional and Doppler echocardiography was performed in 101 consecutive patients (46 with SLE, 23 with PSS, 12 with RA, 20 with PAPS) and in 20 healthy subjects. None of the patients and of the controls had clinical evidence of cardiac disease. IgG anticardiolipin antibodies (aCL) were measured by an enzyme-linked immunosorbent assay. Valvular lesions were found in 18 SLE patients (39.1%), in 4 PSS patients (17.4%) and in 3 RA patients (25%). In comparison with the control subjects abnormal indexes of left ventricular filling (characterized by a reduced E/A end E/A-VTI ratios, a lower deceleration rate of EF slope and a prolonged IVRT) was only found in patients with connective tissue disease (15.1% in SLE patients, 30% in PSS patients and 40% in RA patients). The presence of aCL was not related to a different prevalence of valve alterations or alterated left ventricular diastolic function. None of the patients with PAPS showed valvular involvement or altered left ventricular filling. It is concluded that cardiac involvement is frequent in patients with connective tissue diseases but is apparently unrelated to increased aCL levels.

Acute myocardial infarction and myocardial bridging: a case report.

Abstract: The present report describes a 55-year-old man who presented an anterior myocardial infarction in association with myocardial bridge of the left anterior descending artery (LAD). We discuss the pathophysiology of myocardial infarction occurring with myocardial bridge.

Hypertension and left ventricular hypertrophy

Abstract: In response to high blood pressure, left ventricular hypertrophy develops. But in hypertension, the myocardial hypertrophied structure is abnormal. The prevalence of this hypertrophy is influenced by age, gender, weight, race, genetics and the severity of high blood pressure. By echocardiography, it has been possible to detect non invasively and more precisely this hypertrophy and its anatomical pattern which is not uniform. This cardiac response is influenced by hemodynamic but also by non hemodynamic factors, but the exact mechanisms are not yet well understood. The humoral and tropic factors particularly affect the cardiac remodeling. Left ventricular hypertrophy has been noted by itself to be an independent risk factor for sudden death, ventricular arrhythmias, myocardial ischemia, and heart failure. Very early hypertension, diastolic dysfunction is noted. The progression to systolic failure in moderate hypertension usually occurs over several decades. According to the worse prognosis of left ventricular hypertrophy, it has been suggested that the reversibility of this anatomical modification by antihypertensive treatment is beneficial. Preliminary data support this idea.

Escherichia coli endocarditis of a native mitral valve with paravalvular pseudoaneurysm formation and fatal hemopericardium.

Abstract: Until recently only few cases have been described of acute infective endocarditis with E. Coli limited to a normal native mitral valve. Furthermore, mechanisms of so called abcess formation and rupture are still uncompletely understood. We report the case of an E. Coli endocarditis developing a rapidly progressive pseudoaneurysm of the mitral annulus. At necropsy diffuse infectious tissue weakening with pseudoaneurysm formation of the mitral ring and dissection into an hemorraghic pericard were seen. The authors further discuss the changing pattern of infectious agents causing acute infective endocarditis of the native mitral valve, transesophageal echocardiographic characteristics of paravalvular cavities and insights in mechanisms of pseudoaneurysm formation and dissection from clinicopathological findings.

Adrenomedullin: view on a novel vasodilatory peptide with natriuretic properties.

Abstract: Although initially described in human pheochromocytoma, adrenomedullin has been isolated in several animal and human peripheral organs, including cardiovascular tissues In experimental models, adrenomedullin exerts potent vasodilatory and natriuretic properties which could participate to maintain physiological cardiovascular and renal homeostasis Whether adrenomedullin is powerful in humans remains to be proven On the basis of increased plasma levels in hypertension and heart failure, adrenomedullin is suspected to contribute to the pathogenesis of these diseases A reduced clearance is another possibility but has not yet been investigated in these pathological states Finally, the ubiquitous distribution of adrenomedullin suggest various other biological activities that need to be established in future

Cardiorespiratory variables during a continuous ramp exercise protocol in normal young adults.

Abstract: The purpose of the present study was to determine whether the cardiorespiratory variables measured during an exercise test with a continuously increasing workload (ramp) protocol are reproducible and to compare them to the values obtained with a step-wise incremental (James) protocol. Twenty normal adolescents and young adults performed two exercise tests on a cycle-ergometer, one with each protocol, and twelve of these subjects additionally performed a second identical ramp test. The results show that the cardiorespiratory variables measured during exercise with ramp protocol are reproducible and that peak values are not different from those obtained with step-wise incremental exercise protocol, except for a higher peak power. At intermediate equivalent workloads, there were significant correlations between cardiorespiratory variables measured in steady-state conditions with the incremental protocol and those obtained in non-steady-state conditions with the ramp protocol.

Cardiovascular risk factors distribution in Hungarian adults.

Abstract: Between 1992-1994 nutrition and nutritional status of 2259 persons (1173 men, 1386 women) were examined in Hungary. The average of dietary fat intake was 38.0 (5.7) in %, the median of P/S ratio 0.26-0.27, showing the dominance of saturated fatty acids. According to TC, 34.4% of the examined persons could be ranked to moderate and 27.4% to high risk groups. Regarding LDL-C levels, 27.2-27.2% belonged to both groups. TG indicated risk in 19.5% and 2.4%, respectively and HDL-C values were under the lower limit of normal range in 7.6% Sodium intake is three- to fourfold of the desirable quantity, that of potassium just reaches or remains under the recommended level. As a result, the value of Na/K ratio (mmol/mmol) is over 4. Borderline and/or define hypertension was found according to systolic pressure in 27.4 and 7.9% of men and in 18.1 and 5.2% in women. Diastolic pressure was in this domain in the case of men in 16.9 and 21.9%, in women in 12.7 and 16.1%. Hypertension is frequent both in middle-aged and old men and women. The high CVD mortality in Hungary may be in considerable part explained by the outlined risk factors.

Inappropriate rate response in a VVI-R pacemaker

Abstract: The search for a pacemaker that accurately and easily mimics normal physiology is a continuing effort. Present pacing developments include AV synchrony and rate adaptiveness. The usefulness and clinical value of some of the new pacing systems remain unclear. Although the hemodynamic advantages of rate responsive pacing over classical ventricular pacing are well established (Kristensson et al., 1985), an ideal sensor for physiological demands has not been established. We report a case of apparently unequivocal increase in heart rate during upper limb movements in a patient with a VVI-R pacemaker using minute ventilation as a sensor. Inappropriate heart rate acceleration may result from changes in transthoracic impedance due to upper limb exercise and it does not necessarily represent sensor malfunction. Although this complication is well-known in VVI-R pacemakers using respiratory rate or minute ventilation as sensor (Santomauro et al., 1992), one must remain aware of this sensor-related problem. In this particular patient the problem could be solved by implanting the pacemaker can more medially.

Cardiac function improvement 24 hours after Isradipine SRO in patients with chronic stable angina : A double-blind randomized study

Abstract: We recently showed that Isradipine, a calcium antagonist from the dihydropyridine group, reduces ischemia and improves ventricular function at rest and during exercise, 2 hours after a single oral dose, in patients with chronic stable angina. In the present study, we evaluated the effects of long acting slow release oral (SRO) Isradipine (5 mg) compared to a placebo in 30 coronary patients with stable chronic angina, randomized in a double blind-fashion. The following parameters were obtained at rest and during submaximal exercise: left and right ventricular (LV, RV) ejection fractions (EF; %) and peak filling rate (PFR; EDV/s), assessed by gated radionuclide angiography, clinical symptoms, electrocardiograms (ECG, ST segment depression; mm), systolic and diastolic blood pressure (SBP and DBP; mm Hg). Patients were then given two oral doses of either Isradipine or placebo (one a day). The same parameters were reassessed, at rest and during n equivalent exercise, 48 hours later (24 hours after the last administration of the drug). The results after Isradipine (n = 14) showed, at rest, a significant increase in LVEF and Pfr (51 +/- 9 to 54 +/- 8 and 1.97 +/- 0.44 to 2.36 +/- 0.71, respectively) and a decrease in DBP (93 +/- 11 to 87 +/- 13); and during exercise, a significant increase in LVEF (51 +/- 11 tot 55 +/- 13) and a decrease in ST segment depression (2.3 +/- 1.9 tot 1.9 +/- 1.6). No significant change was observed after placebo in the other 16 patients. We conclude that even 24 hours after an oral administration, Isradipine SRO maintains its beneficial effects both, at rest on LV systolic and diastolic function and pressure, and during exercise on ECG signs of ischemia with improvement in LV ejection fraction.

Mortality trends in Belgium and The Netherlands. Closing the gap.

Abstract: Mean life expectancy at birth (1967-1992) increased for both sexes combined with 5.6 years in Belgium and 3.6 years in The Netherlands. Age adjusted mortality from all causes and cardiovascular diseases has been followed up from 1968 onwards to 1989 in Belgium and The Netherlands and in Flanders and Wallonia from 1971 to 1989 for each sex and two age classes, 45-74 y and 75-85 + y. Flanders and Wallonia were selected because of differences in mortality and life-style. Total mortality decreased faster in Belgium, especially in the period 1980-89, for almost all comparisons in each sex and age class and for most cardiovascular diseases. A comparison of mortality trends in the period 1980-89 among 35 countries worldwide showed a better performance in Belgium than in The Netherlands for 10 different causes of death. The mortality gap between both countries is closing, especially between The Netherlands and Flanders. The decreasing slope in mortality from all causes is explained mostly by the change in cardiovascular mortality. Medical treatment and care, which are not better in Belgium, do not explain the differences in mortality trends Observed changes in life-style, including saturated and polyunsaturated fat intake, smoking habits and salt intake are consistent with the observed mortality changes.

Plasma endothelin-1 concentrations in patients with coronary artery disease during stress test before and after nisoldipine administration.

Abstract: The purpose of this study was to determine the response of plasma levels of endothelin-1 (ET-1) to dynamic exercise in patients with coronary artery disease and chronic stable angina pectoris and positive exercise tolerance test, before and after treatment with the calcium antagonist nisoldipine (20 mg/day buccally for 7 days). Plasma ET-1 levels and hemodynamic parameters (blood pressure and heart rate) were determined at rest, at peak exercise and recovery. All patients had a positive electrically and clinically stress test and all of the eight patients did not developed ECG signs of myocardial ischemia after nisoldipine administration. Before nisoldipine treatment the plasma ET-1 levels did not increase significantly during exercise. After nisoldipine treatment the plasma ET-1 levels were significantly lower at rest and during exercise compared with those revealed before calcium antagonist treatment. In conclusion our results suggest that in patients with chronic stable angina pectoris the treatment with calcium antagonist nisoldipine reduced ischemia and plasma ET-1 levels.

A 90-year old patient with atrial septal defect and sinus rhythm.

Abstract: A 90-year old patient with an atrial septal defect (ASD) and sinus rhythm, but no history of atrial fibrillation of heart failure is presented. Literature searches revealed no similar report of such a case. In addition, this patient represents the oldest documented patients with ASD associated and sinus rhythm.

Staging of cardiac rejection by simultaneous administration of 123I-antimyosin and 111In-anti MHC class II antibodies.

Abstract: Noninvasive diagnosis of cardiac rejection before the advent of myocyte necrosis is important in clinical management of cardiac transplantation. Mice with abdominal heart transplants were studied to determine whether a dual scintigraphy using antimyosin and anti-major histocompatibility complex (MHC) class II antigen monoclonal antibody (mAb) labeled with different isotopes allows to detect early rejection just before myocyte necrosis. Allografts from BALB/c donors were transplanted into C3H/He recipients. Mice were intravenously injected with 100 microCi each of 123I labeled antimyosin and 111In labeled anti-MHC class II mAbs and were sacrificed for gamma counting from 2 to 9 days after transplantation. Localization of two different isotopes was compared with histological degree of acute rejection. Uptake of 111In labeled anti-MHC class II mAb increased from the fourth day after transplantation, however, that of 123I labeled antimyosin mAb was shown only 9 days after transplantation. Induction of MHC class II antigen develops preceding the development of myocyte necrosis, and this difference in time course can be identified by the dual scintigraphy. Thus, dual scintigraphy using anti-myosin and anti-MHC class II mAbs is potentially useful in staging of cardiac rejection.

Treatment of hypertensive patients according to the conventional or ambulatory pressure: a progress report on the APTH trial. APTH Investigators. Ambulatory Blood Pressure and Treatment of Hypertension.

Abstract: The main objective of the Ambulatory Blood Pressure and Treatment of Hypertension (APTH) trial is to test the hypothesis that antihypertensive treatment based on ambulatory monitoring may be more beneficial than treatment guided by conventional sphygmomanometry. After a 2-month run-in period on single-blind placebo, hypertensive patients were randomized to two groups, one in which the target pressure was a sitting diastolic pressure from 80 through 89 mm Hg on conventional sphygmomanometry (conventional blood pressure [CBP] group), and one in which a daytime (from 10 to 20 h) diastolic pressure from 80 through 89 mm Hg had to be achieved (ambulatory blood pressure [ABP] group). After randomization all patients were started on lisinopril 10 mg/day. One month later lisinopril could be continued at 10 or 20 mg/day or discontinued depending on the attained blood pressure level. This article is an interim report on 207 patients followed for two months into the trial. At one month lisinopril was discontinued more frequently in the ABP than the CBP group (24 vs 9 patients, p = 0.004). Nevertheless at two months, blood pressure control was not significantly different in the two treatment groups. The baseline-adjusted differences in systolic pressure between the two treatment arms of the trial (ABP-CBP group) were +2.7 mm Hg (95% confidence interval [CI]): -2.9, +8.3) for the conventional pressure, +0.4 mm Hg (CI: -4.3, +5.1) for the 24 h pressure, -0.1 mm Hg (CI: -5.1, +4.8) for the daytime pressure and -0.7 mm Hg (CI: -6.7, +5.4) for the night-time pressure. The corresponding differences in diastolic pressure were -1.3 mm Hg (CI: -4, +1.4), +0.1 mm Hg (CI: -3, +3.1), -1.1 mmgH (CI: -4.4, +2.1) and +0.3 mm Hg (CI: -3.7, +4.3), respectively. Thus, the present findings do not refute the APTH research hypothesis. In terms of blood pressure control and the number of patients remaining on antihypertensive drugs, treatment based on ambulatory recordings may be preferable to treatment guided by conventional sphygmomanometry.

Unusual atrial pro-arrhythmic effect of flecainide: a contemporary review.

Abstract: The authors report the case of a patient with drug-resistant atrial fibrillation, who developed, for more than 2 hours, a well-tolerated attack of palpitations, after taking 500 mg of flecainide acetate. The Holter monitoring demonstrated atrial flutter with 1:1 AV conduction and a ventricular rate at 220 bpm. This atrial pro-arrhythmic effect is rare and the mechanism is discussed.

Prevention of thromboembolic events in valvular heart disease.

Abstract: Thromboembolic events are major causes of morbidity and mortality in patients with native heart valve disease and artificial heart valves. Oral anticoagulation can reduce these complications. The indication for and intensity of oral anticoagulation depends on both, the risk for thromboembolic events and the risk of hemorrhage. The indications for oral anticoagulation in the various pathological conditions are defined. Risk factor adjusted intensity of oral anticoagulation and risk factor modification are new and very important aspects in the management of these patients which may lead to a reduction in anticoagulation associated complications and an improvement in antithrombotic effectivity. Further studies to identify the optimal therapeutic ranges of anticoagulation for the individual patient are needed. Multi-centre prospective randomized studies in this field should help us to answer the still open questions including new hemostatic molecular markers to further identify patients with different risk profiles.

Holt-Oram syndrome with malformations of renal and cerebral arteries.

Abstract: The case of a 40-year-old woman with Holt-Oram syndrome is presented. Besides the absence of thumbs and an atrial septal defect, she presented multiple strokes and end-stage renal failure. The latter might be attributed to malformations of the arteries of the brain and kidneys within the expression of the syndrome, despite the small possibility of coincidence.

Effect of sublingual nifedipine on left ventricular diastolic dysfunction in hypertensives: Echo-Doppler study at rest and during handgrip

Abstract: Using digitized M-mode echocardiography, we evaluated the acute effect of nifedipine on left ventricular (LV) diastolic dysfunction in 30 untreated hypertensives, evaluated at rest and during handgrip, both before and 30' after nifedipine (20 mg sublingually). At rest, after nifedipine blood pressure and end-systolic wall stress significantly decreased and peak lengthening rate of LV diameter, peak thinning rate of LV posterior wall and Doppler E/A ratio increased. Before and after nifedipine handgrip induced significant increases of blood pressure, heart rate and end-systolic wall stress; diastolic parameters significantly decreased during basal handgrip and did not change during handgrip after nifedipine. Nifedipine induced an acute improvement of LV diastolic dysfunction, that persisted when afterload increased during handgrip. Therefore nifedipine seems to improve LV diastolic function not only by reducing afterload, but also through a direct action on the myocardium. Besides, these results demonstrate that LV diastolic abnormalities in hypertension are partly dynamic and reversible.

beta-Endorphin and propiomelanocortin-correlates peptides response in suspected and confirmed ischemic heart disease during exercise.

Abstract: UNLABELLED In this study, we investigated circulating beta-endorphin, ACTH and cortisol in subjects with suspected coronary artery disease (CAD) and in patients with CAD during stress testing. Group I: 18 subjects, all male (average age 48 +/- 9 yrs) with suspected (CAD) were enrolled. Group II: 35 patients, 30 males and 5 females (average age 54.3 +/- 7 yrs) with CAD, were enrolled. Ten patients had previous myocardial infarction. In all patients that underwent coronarography a stenosis > 75% was found in at least one coronary artery. The stress test was performed with a cycloergometer, increasing work loads 25 watt every 2 min. All subjects and patients were in the recumbent position for at least 30 minutes prior to testing. During this period a 3-way catheter was placed in the antecubital vein and blood was drawn for Beta-endorphin, ACTH and cortisol; additional blood samples were drawn using a pre-chilled syringe at maximum effort and during the recovery period. RESULTS group I: 9 of the subjects with suspected CAD had either ECG or clinical signs of ischemic during the stress test. In subjects with a negative test, the test was carried out for a longer period of time and at a higher work load. There was an increase in Beta-endorphin and ACTH at peak exercise and during recovery. Plasma cortisol increase during the period of recovery. Group II: 16 of the 35 patients with CAD exhibited ECG signs of induced myocardial ischemia; there was no difference in work loads in patients with positive or negative stress test. Exercise time was reduced in all patients and plasma Beta-endorphin increased at peak exercise and recovery in patients with a negative stress test. In conclusion our study revealed a different response of Beta-endorphin, ACTH and cortisol plasma levels in subjects with suspected CAD and in patients with CAD during exercise testing.

Basement membrane thickening in small intramyocardial vessels in eosinophilic myocarditis.

Abstract: The case reported in this paper, besides illustrating several aspects of the eosinophilic myocarditis, documents a yet undescribed feature of the cardiac involvement in idiopathic hypereosinophilic syndrome characterized by marked basement membrane thickening of small intramyocardial vessels. We are unaware of previous reports showing the presence of an extensive thickening of the basement membrane of arteriolar and capillary intramyocardial vessels in eosinophilic myocarditis. Considering the findings in the present case, i.e., the focal nature of the lesions, the type of necrosis, and the diffuse microangiopathy, it can be hypothesized that the microvascular disease could play a role in the development of the myocardial changes.

Clinical nuclear cardiology: flow tracers and free fatty acid analogs to detect viable myocardium after infarction.

Abstract: Among the available invasive and noninvasive modalities, nuclear cardiology techniques utilizing single photon emission computerized tomography (SPECT) have achieved a preeminent position for the assessment of myocardial viability. This arises from the rather unique potential of scintigraphic methods to assess myocardial perfusion, cell membrane integrity, and metabolic activity. The purpose of this article is to review the relative merits and limitations of myocardial flow tracers (thallium and sestamibi) and metabolic tracers (fatty acid analogs) to identify residual myocardial viability in patients with coronary artery disease and left ventricular dysfunction.

Atrial natriuretic peptide in normotensive and hypertensive heart transplanted patients.

Abstract: AIM OF THE STUDY The present study is aimed to investigate the 24-hour pattern of Atrial Natriuretic Peptide (ANP) plasma concentration in normotensive (N) and hypertensive (H) heart transplanted patients (HTP) in order to detect the pathophysiological role of blood pressure regimen for ANP increase in HTP. METHODS Eight NHTP and five HHTP have been investigated, all being hemodynamically compensated, without histological evidence of rejection and treated by Cyclosporine, Azathioprine and Prednisone. The control group was constituted by 10 clinically healthy subjects (CHS). ANP was assayed six times over the 24 h span. The contrasts between groups were statistically analyzed by means of Student's t-test for the 24 h mean values. RESULTS The t-test found a statistically significant difference between the ANP 24 h mean levels either of CHS and HTP or NHTP and HHTP. The ANP 24 h mean plasma levels are increased of 190.4% in HHTP and of 44.3% in NHTP in comparison with CHS. DISCUSSION The findings suggest that the further elevation of ANP in HHTP is a compensatory mechanism to antagonize high blood pressure. Moreover, being the ANP percent increase in HHTP three times more.

Exercise myocardial perfusion and wall motion imaging to predict recurrence of angina pectoris after successful angioplasty.

Abstract: OBJECTIVES This study investigates the predictive value of concurrent exercise radionuclide ventriculography and myocardial perfusion scintigraphy obtained six weeks after successful percutaneous transluminal coronary angioplasty for the recurrence of angina. METHODS Both studies were obtained simultaneously with a single injection of technetium-99m sestamibi using the first-pass technique and the computerized tomographic technique, respectively. Ninety-five patients were investigated at rest and at maximal exercise 6 weeks after technically successful coronary angioplasty. RESULTS Exercise-induced left ventricular dysfunction was present in 44 patients (46%). Exercise-induced myocardial perfusion defects were noted in 29 patients (30%). All patients underwent a six months follow-up. Seventeen patients (18%) had recurrent angina pectoris. Exercise-induced left ventricular dysfunction at six weeks after angioplasty was significantly associated with the recurrence of angina (p = 0.002), but exercise-induced perfusion defects were not. An abnormal left ventricular response to exercise was more sensitive than exercise-induced perfusion defects (82% versus 47%) to identify those patients with recurrent angina. The combination of both tests allows to select patients at a very high (40%) and very low (7%) risk of recurrent angina. CONCLUSION Exercise-induced left ventricular dysfunction is more strongly associated with the recurrence of angina pectoris during a 6 month follow-up than are exercise-induced myocardial perfusion defects.