Biomedical subjects
Publications and source records attributed to P Frídl.
We describe a new, catheter-based method for temporary management of hemodynamic instability after papillary muscle rupture in a patient with an acute myocardial infarction.
BACKGROUND: According to some work hypertension is in a pathogenetic relationship with hyperinsulinaemia or is considered to be the consequence of insulin resistance. It is, however, also known that there exists a familial predisposition for hypertension; according to genetic investigations half the family relatives can suffer from hypertension. In conjunction with these views on the pathogenesis of hypertension and its familial character the authors outlined the following objectives of their investigation: to test clinically and metabolically the condition of the offspring of probands with essential hypertension requiring systematic treatment. The authors investigated in particular indicators of body composition, insulin concentration and its relationship to serum levels and some indicators of lean body mass. METHODS AND RESULTS. There were 48 offspring (25 men and 23 women) from families of 30 probands suffering from hypertension. The mean age of the offspring was 38.4 +/- 7.8 years. They were compared with a group of 72 controls, mean age 35.8 +/- 8.2 years (36 men and 36 women) without a family history of hypertension and diabetes (t-test). The basal insulin concentration (IRI O' = 20.5 +/- 12.8 microU/ml, and 14.3 +/- 7.3 microU/ml resp., p < 0.01) and basal C peptide (O' = 0.59 +/- 0.31 pmol/ml and 0.50 +/- 0.20 pmol/ml resp., p < 0.05) were elevated. The offspring of probands with hypertension had a higher body weight (BMI = 25.3 +/- 3.5 kg/m2 and 23.3 +/- 2.5 kg/m2 resp., p < 0.001) a higher ratio of waist hip circumferences (0.94 +/- 0.1 and 0.87 +/- 0.1 resp., p < 0.001) similarly as blood pressure (131.5 mmHg +/- 11.8 mmHg and 116 mmHg +/- 13.3 mmHg resp., p < 0.001) and blood sugar level (5.29 +/- 0.61 mmol/l and 4.93 +/- 0.39 mmol/resp., p < 0.01). The authors also found differences in the serum cholesterol levels (5.9 +/- 1.3 mmol/l and 5.1 +/- 0.6 mmol/l resp., p < 0.01), HDL cholesterol (1.45 +/- 0.50 mmol/l and 1.65 +/- 0.60 mmol/l resp., p < 0.01) and triacylglycerol trends (1.66 +/- 1.54 mmol/l and 1.37 +/- 0.96 mmol/l resp., p < 0.1). On echocardiographic examination the cardiac dimensions were not enlarged, however, significant relations (linear regression) were proved in offspring in particular as regards the dimensions of the left ventricle and insulin (IRI O-left atrium p < 0.05, IRI 30-left atrium, p < 0.01. C peptide O-left atrium, p < 0.05). Between the body mass index, cholesterol, uric acid HDL-cholesterol the waist/hip ratio on the one side, the dimensions of the left atrium, thickness of septum and posterior wall (p < 0.01-0.001), between insulin and C peptide (p < 0.001) on the other side even closer relations were found. CONCLUSIONS: Elevated insulin concentrations may participate in the development of body composition, they influence the lipid transport and blood pressure in clinically healthy offspring of probands suffering from hypertension. The relationship between the insulin concentration and disposition towards enlargement of the left heart needs more detailed investigation.
The authors summarize their hitherto assembled experience with pericardiocentesis under echocardiographic control. From May 1986 to December 1991 they made these punctures 55 times in 49 patients. In the majority therapeutic puncture was involved, only seven times puncture was used for diagnostic purposes. Echocardiography can evaluate not only the presence of an exudate and assess its haemodynamic impact but it is the optimal method for finding an optimal site for puncture and it is very suitable for checking the course of the operation. In smaller operations and in biopsies of pathological pericardial tissue it is advisable to use special instruments which make the procedure safe. The authors recorded a total of three failures, in one instance the exudate was removed with the assistance of a surgeon, in one instance the situation was coped with by repeated puncture and in one instance by a conservative procedure. None of the patients developed complications. A list of the latter is discussed. The method is nowadays part of therapeutic procedures of the cardiologist.
The potential of echocardiography in evaluating myocardial rejection was determined in 56 patients (8 females) following orthotopic heart transplantation. The patients' average age was 42.3 (range 18-67) years. Endomyocardial biopsy was used as the reference method. The study included a total of 254 results of biopsy: 137 specimens were free of any signs of rejection while 51 showed incipient rejection and mild rejection was found in 54 specimens. Moderate rejection was detected in 12 specimens; severe rejection was not present in any case. Echocardiography was used to determine ventricular size, wall thickness, left ventricular function, pericardial effusion, mitral and tricuspid flow and isovolumic relaxation time. Rejection has been found to be associated with ventricular wall thickening; the appearance of or an increase in pericardial effusion seems to be a relatively specific feature (a very low-sensitivity marker though); change in isovolumic relaxation time is believed to be the most sensitive marker. No relation between rejection and mitral and tricuspid flow was demonstrated. Echocardiography may alert the cardiologist to a rejection episode; isovolumic relaxation time and its alterations are the most informative features in this respect. The method may help postpone the intervals of biopsy which, however, must be performed on the slightest suspicion of rejection. Still, it cannot be regarded as a replacement for endomyocardial biopsy at the moment.
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Hypoxaemic precordial ST mapping was compared with precordial exercise mapping in a group of 64 patients. During hypoxaemia, IHD patients show ischaemic changes in ST maps similar to those found in exercise maps, and a significant increase in the sums of ST depressions. The test can be recommended to detect coronary insufficiency in cases where the exercise ECG test is not feasible or available, and to expand the arsenal of non-invasive diagnostic procedures. The physical exercise test, however, remains the strongest test for ECG detection of myocardial ischaemia.
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Between 1 January, 1989, and 28 April, 1990, a total of 888 selective coronary arteriographies were performed at the Institute for Clinical and Experimental Medicine in Prague. Of that number, 58 findings were assessed as at least 50% stenosis of the left main coronary artery (LCA). Having applied exclusion criteria, 50 patients (i.e., 5.63% of all those examined) were entered into a retrospective study. They were 45 men (90.0%) and 5 women (10.0%) with significant cumulation of risk factors for IHD; more than half on them had a history of coronary event. The patients had marked symptomatology--NYHA Class III and higher angina pectoris was present in 96%, a low tolerance of exercise was found in 26 patients undergoing ergometry (average workload of 13 kJ and heart rate of 111/min); exercise testing was invariably evaluated as positive. Coronary angiography regularly revealed multiple coronary artery lesions; the right coronary artery was also involved in 90%; a collateral circulation was present in as little as 34%. The localization of coronary stenoses and the mostly preserved left ventricular mechanical function allowed operative management of IHD in 84% of cases. In the group of patients undergoing surgery, hospital mortality was 4.8%. On long-term follow-up (mean 6.2 months) of the group of patients operated on, 59.9% were free of problem, 31% had NYHA Class II angina pectoris, and there was no improvement at all in one patient only (2.4%). In the group provided conservative therapy (not operated on primarily for severe left ventricular dysfunction), one patient died of recurrent myocardial infarction and cardiogenic shock, 2 have NYHA Class IV angina pectoris, and the remaining subjects continue experiencing NYHA Class III problems.
The long-term results on 36 patients undergoing tricuspid annuloplasty according to DeVega over the years 1981-1990 were analyzed. All had mitral valve replacement or repair in addition to the above procedure. Moreover, three patients had aortic valve replacement while aortocoronary bypass and interatrial septal defect closure was performed in two cases each. Duration of follow-up ranged between 6 to 72 months (mean 36 months). All patients were examined by echocardiography. Significant tricuspid regurgitation was found in three of the patients operated on, manifest clinical signs of the condition were present in one female patient only. Functional evaluation reassigned 72% of the operated patients from Class III and IV to Class I and II, and apparent subjective improvement was reported by 81% of patients. The analysis showed that indication of patients for simultaneous management of tricuspid regurgitation associated with mitral valve disease is justified, and that the surgical technique employed is appropriate.
The time course of regression of left ventricular hypertrophy and changes in left ventricular function were followed in 52 middle-aged hypertensive patients divided into two groups: 30 treated with betablockers and 22 with methyldopa. In case of inadequate blood pressure control, diuretics and/or vasodilators were added in both groups. Blood pressure decreased significantly over a three-year follow-up period. The decrease was most pronounced during the first three months. The biggest decrease in posterior wall and interventricular septum thickness was detected by echocardiography also within the first three months. While complete regression of posterior wall hypertrophy was noted within the next three months, interventricular septum thickness decreased steadily over a period of two years. No significant change was seen in the septum in the third year of follow-up. Complete regression of hypertrophy was found in 30 (57.7%) of probands, with no change altogether observed in as few as two patients. Regression was incomplete in 20 (38.4%) obese patients with manifest hypertrophy at the start of the study. Regression of hypertrophy was not associated with left ventricular function deterioration and was observed even after vasodilator administration. There were no differences between the two groups of patients.
Eighteen patients were examined by echocardiography one month before, and one month after orthotopic heart transplantation (OHT). The right-heart echocardiographic parameters were compared with pulmonary haemodynamics. All recipients showed increased mean pulmonary artery pressure (PAP) (42 +/- 8 mmHg) and pulmonary vascular resistance 3.0 +/- 1.3 u.) before OHT. The causes of the pulmonary hypertension, and indications for OHT, were the end stage of dilated cardiomyopathy (n = 8), ischaemic heart disease (n = 9) and aortic valve disease (n = 1). After transplantation, the donor's right ventricle dilates due to the recipient's elevated pulmonary vascular resistance. The right ventricular dimension after OHT was greater than 30 mm in 1/3 of patients. The right ventricular diastolic dimension correlates statistically significantly with mean PAP of the recipient before the procedure. Right ventricular dilatation is accompanied by a mild degree of tricuspid insufficiency (in 89% of cases), as documented by Doppler examination. Neither the degree of right ventricular dilatation, nor the degree of tricuspid insufficiency show a tendency to progression during follow-up.
The authors give an account of the evaluation of diastolic functions by means of pulsed Doppler echocardiography. It is a relatively new method which is still seeking its position in the pattern of examinations. However, some authors have already demonstrated that it is valuable and can contribute towards a more accurate description of the functional state of the myocardium and help to detect initial stages of disease. As it is non-invasive, it can be repeated, as required without damaging the patient and thus can be used to follow up the effect of therapy.
A cardiac pseudoaneurysm (PA) is a rare complication of myocardial infarction. It may occur isolated, after cardiosurgery or after an accident. Echocardiography is of fundamental importance in its diagnosis. Coronarography provides important data on the state of the coronary arteries which is essential for planning further, in particular surgical treatment of the condition. The authors describe from four patients with PA.
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Fifty-two middle-aged hypertensive males with left ventricular hypertrophy, diagnosed by echocardiography, were divided into two groups; 30 of them were treated with beta-blockers and 22 with methyldopa. Where blood pressure was insufficiently controlled, diuretics and, eventually vasodilating agents, were added to both treatment regimes. During 2 years of follow-up, blood pressure decreased significantly. The greatest decrease was observed during the first 3 months. Echocardiography revealed the greatest decrease in posterior wall and interventricular septal thickness also during the first 3 months. Posterior wall hypertrophy was reversed completely in the next 3 months, while further regression of interventricular septal hypertrophy was continuous during the remaining follow-up period. Left ventricular hypertrophy was reversed completely in 27 (51.9%) probands and remained unchanged in two patients. The regression was incomplete in 23 (44.2%) patients who were more obese and whose left ventricular hypertrophy was initially more pronounced. Regression of hypertrophy was not associated with a deterioration in left ventricular function and was achieved even after the addition of vasodilating drugs. No differences were observed between the treatment groups. The pathogenesis of left ventricular hypertrophy still remains unclear. After 2 years, no changes in peripheral vascular resistance in the forearm were observed at reactive hyperaemia. These results indicate that there might be a delay in the regression of vessel hypertrophy compared with that of the left ventricle.
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