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PubMed1979

[Microfocal myocardial infarct as a variant of exacerbation of ischemic heart disease].

The results of long-term (3- to 4-year) follow-up of 180 patients with microfocal myocardial infarction are analysed. The difference in the course and prognosis of primary and recurrent microfocal myocardial infarction is determined. It is shown that microfocal myocardial infarction as a form of exacerbation of ischemic heart disease is characterized by a complex of syndromes differing from the typical picture of marcrofocal myocardial infarction. As compared to macrofocal myocardial infarction, the course of the disease after microfocal myocardial infarction is characterized by more frequent exacerbations of coronary insufficiency and a greater tendency toward the development of recurrent myocardial infarction. In some cases, microfocal myocardial infarction heralds the development of macrofocal myocardial infarction with a severe course and high mortality rate, which provides the grounds for the conclusion that patients with microfocal myocardial infarction have a lower coronary reserve.

Aged↗

PubMed1979

Management of the patient with myocardial infarction.

Coronary atherosclerotic heart disease and myocardial infarction constitute an epidemic in this century, mandating that the primary care physician be familiar with their recognition and management. However, in recent decades, an improved understanding of pathophysiologic alterations, an enormous advance in technology and significant accomplishments in pharmacology and operative procedures have virtually revolutionized the management of patients with myocardial infarction. Although patterns of care described in this monograph may well be obsolete a few years hence, to be superseded by safer, more precise, more efficient and more cost-effective therapeutic modalities, nevertheless basic principles underlying the management of the patient with myocardial infarction remain as appropriate guidelines. In the hospital phase, efforts should be directed toward enhancing survival, saving myocardium and restoring function. The long-term ambulatory care should be designed to maintain functional capacities, to control symptoms, to retard or arrest the atherosclerotic process thus decreasing the likelihood of recurrent myocardial infarction and/or of sudden cardiac death and to restore the patient to a normal or near-normal life style.

Acute Disease↗

PubMed2006

["Smoker's paradox" in patients with acute myocardial infarction receiving primary coronary intervention].

OBJECTIVES: Smokers with acute myocardial infarction have lower mortality rates than non-smokers despite increased risk for coronary artery disease. This study assessed the effects of smoking on complications and outcomes after acute myocardial infarction, and investigated the relationship between the clinical factors and the paradoxical effects of smoking in patients receiving primary coronary intervention. METHODS: Subjects were 367 consecutive patients with acute myocardial infarction who were admitted within 24 hr of onset and underwent successful coronary intervention, 165 (45%) of whom were smokers. RESULTS: The smoking group contained significantly more male patients, and the smoking group was significantly younger than the non-smoking group (p < 0.0001). The value of acute phase brain natriuretic peptide (BNP) and atrial natriuretic peptide (ANP) were significantly lower (BNP: 250 +/- 366 vs 448 +/- 513pg/ml, p = 0.0002; ANP: 48 +/- 77 vs 74 +/- 82pg/ml, p = 0.005) in the smoking group. Peak creatine kinase time from onset was significantly earlier (12.9 +/- 9.3 vs 16.1 +/- 10.0 hr, p = 0.049) in the smoking group. Left ventricular ejection fraction in the chronic phase was significantly better in the smoking group (58 +/- 13% vs 52 +/- 14%, p = 0.03). The early ST-segment resolution rate was higher in the smoking group (81% vs 67%, p = 0.003), and there were significantly fewer patients with heart failure in the smoking group than in the non-smoking group (28% vs 41%, p = 0.01). The cardiac mortality rate during 6 months was significantly lower in the smoking group (3% vs 9%, p = 0.01). The beneficial effects of smoking on the prognosis were related with the differences in sex and age of the study group. CONCLUSIONS: The reason why smokers with acute myocardial infarction have lower mortality rates than non-smokers, the "smoker's paradox", may be related to less damage to the microvascular function after primary coronary intervention, with lower BNP and better left ventricular ejection fraction.

Aged↗

PubMed2003

Cohort study on effects of parathyroid surgery on multiple outcomes in primary hyperparathyroidism.

OBJECTIVES: To assess the effects of surgery compared with conservative treatment (no surgery) for primary hyperparathyroidism. DESIGN: Cohort study. SETTING: Nationwide Danish cohort. PARTICIPANTS: 3213 patients, mean age 61 (SD 16) years, with a diagnosis of primary hyperparathyroidism between 1980 and 1999. 1934 (60%) underwent surgery and 1279 (40%) were treated conservatively. MAIN OUTCOME MEASURES: Occurrence of fractures, osteoporosis, kidney or urinary tract stones, acute myocardial infarction, angina pectoris, cardiac arrhythmias, arterial hypertension, heart failure, stroke, acute pancreatitis, stomach or duodenal ulcers, muscle pain, malignant diseases, psychiatric disorders, and mortality. RESULTS: At diagnosis of primary hyperparathyroidism, patients who subsequently underwent surgery had a lower prevalence of previous fracture (odds ratio 0.64, 95% confidence interval 0.51 to 0.80), acute myocardial infarction (0.59, 0.42 to 0.83), stroke (0.57, 0.37 to 0.88), psychiatric disorders (0.54, 0.31 to 0.94), and painful muscle disorders (0.44, 0.26 to 0.76), whereas kidney stones (2.49, 1.93 to 3.23) and acute pancreatitis (2.77, 1.33 to 5.76) were more prevalent. After diagnosis, the risks of fractures (hazards ratio 0.69, 0.56 to 0.84) and gastric ulcers (0.59, 0.41 to 0.84) were lower in patients treated surgically than those treated conservatively. Events involving kidney or urinary tact stones were more prevalent in patients treated surgically than patients treated conservatively (1.87, 1.30 to 2.68). Mortality was lower in patients treated surgically (0.65, 0.57 to 0.73). CONCLUSIONS: Patients treated surgically for primary hyperparathyroidism have a lower prevalence of fractures and gastric ulcers than patients treated conservatively. The type of treatment had no effect on the occurrence of cardiovascular events.

Adult↗

PubMed1992

Myocardial infarction caused by cardiac microvasculopathy in a patient with the primary antiphospholipid syndrome.

Antiphospholipid antibodies occur in various clinical states, including the primary antiphospholipid syndrome. Clinical features in these conditions appear to be caused by vasculopathy associated with the presence of these antibodies. We report the case of a patient with primary antiphospholipid syndrome who experienced cardiac necrosis secondary to myocardial microvasculopathy in the absence of vasculitis. This case demonstrates unequivocally that noninflammatory myocardial microvasculopathy occurs in the primary antiphospholipid syndrome per se without any clinical or immunologic signs of systemic lupus erythematosus or other disease process. The histopathologic findings in the skin and myocardial biopsies showed a noninflammatory vasculopathy characterized by bland thrombi and lack of infiltration of the vessel wall by inflammatory cells. Ultrastructural examination of the myocardial biopsy confirmed the vascular thrombosis and endothelial activation and showed no deposits in basement membranes. The patient survived after appropriate treatment. Evidence presented here supports the concept that the vasculopathy in the antiphospholipid syndrome is distinct from other types of vascular occlusions seen in systemic lupus erythematosus. We suggest that myocardial biopsy can be crucial in showing an underlying myocardial ischemic process despite "normal" findings on coronary angiography. Results of the biopsy hastened the decision to use potentially lifesaving plasmapheresis and anticoagulation therapy in this patient.

Adult↗

PubMed1991

Risk factors, interventions and therapeutic agents in the prevention of atherosclerosis-related ischaemic diseases.

Of the major risk factors for atherosclerosis, high factor VII and fibrinogen levels, genetic predisposition, gender and age cannot be influenced. Reduction of high blood pressure reduces the cerebral but not the coronary vascular risk and correction of dyslipidaemia correlates with cardiovascular risk. Other major risk factors (tobacco consumption, obesity, sedentary lifestyle and diabetes) can also be modified. Aspirin in doses of approximately 300 mg/day may be recommended for the primary prevention of myocardial infarction (MI), but only in those patients with a moderate to high risk of cardiovascular disease. Aspirin reduces the risk of fatal and nonfatal MI by about 50% and also decreases the overall mortality rate among patients with unstable angina. A lower dose of aspirin (150 mg/day) also reduces mortality by 23% in the acute phase of MI. In doses of 300 mg/day, aspirin is useful in the secondary prevention of MI and reduces the overall mortality rate by 15%. Various antiplatelet agents, including aspirin (alone or combined with dipyridamole) and ticlopidine, have proved useful in the prevention of thrombosis in aorto-coronary grafts, provided treatment begins at the latest 6 hours after surgery. The usefulness of antiplatelet drugs has been well established in the prevention of immediate reocclusion following coronary angioplasty, but not in the prevention of late reocclusion. Aspirin and ticlopidine are also beneficial in extracorporeal circulation techniques. In patients with a synthetic cardiac valve prosthesis, antivitamin K-anticoagulants are still indispensable lifelong, but their antithrombotic effect can be reinforced by dipyridamole or aspirin. Diuretics probably provide the best primary protection against cerebrovascular accidents, although medium doses of aspirin may be considered in elderly people at high risk of such accidents. Aspirin (alone or combined with dipyridamole) and ticlopidine may be recommended for the secondary prevention of cerebral ischaemic accidents. Aspirin (with or without dipyridamole) and ticlopidine reinforce the treatment of obliterative arterial disease in the lower limbs.

Aspirin↗

PubMed2005

Comparison of the prognostic effect of left versus right versus no bundle branch block on presenting electrocardiogram in acute myocardial infarction patients treated with primary angioplasty in the primary angioplasty in myocardial infarction trials.

The presence of bundle branch block (BBB) has been associated with poor outcomes in patients who have acute myocardial infarction. Whether this is true in the angioplasty era is not known. We sought to evaluate the outcome of patients with acute myocardial infarction and BBB who were treated with primary angioplasty. We evaluated 3,053 patients who underwent emergency catheterization in the PAMI trials. Patients who had left BBB (n = 48, 1.6%) on presenting electrocardiogram were compared with patients who had right BBB (n = 95, 3.1%) or no BBB (n = 2,910, 95.3%). Patients who had BBB were older and more frequently had diabetes mellitus, peripheral vascular disease, and previous coronary artery bypass grafting. They had lower ejection fraction and more multivessel disease. There were no significant differences in door-to-balloon time, final Thrombolysis In Myocardial Infarction flow grade or stent use. In-hospital major adverse cardiac events (death, ischemic target vessel revascularization, and reinfarction) were higher in patients who had BBB due primarily to increased in-hospital death (left BBB 14.6%, right BBB 7.4%, no BBB 2.8%, p < 0.0001). In multivariate logistic regression analysis, left BBB was an independent predictor of in-hospital death (odds ratio 5.53, 95% confidence interval 1.89 to 16.1, p = 0.002). In conclusion, patients who have acute myocardial infarction and BBB have increased co-morbidities and higher mortality rates despite treatment with primary angioplasty. Despite early identification of multivessel disease with triage to angioplasty or coronary artery bypass grafting, if necessary, similar treatment times, and final Thrombolysis In Myocardial Infarction grade 3 flow, the presence of left BBB on admission electrocardiogram in patients who have acute myocardial infarction is an independent predictor of in-hospital mortality. Because 85% of deaths in patients who have left BBB occur within the first week, these patients should be recognized early and receive prompt and aggressive treatment.

Aged↗

PubMed2004

Primary care management of chronic stable angina and asymptomatic suspected or known coronary artery disease: a clinical practice guideline from the American College of Physicians.

In 1999, the American College of Physicians (ACP), then the American College of Physicians-American Society of Internal Medicine, and the American College of Cardiology/American Heart Association (ACC/AHA) developed joint guidelines on the management of patients with chronic stable angina. The ACC/AHA then published an updated guideline in 2002, which ACP recognized as a scientifically valid review of the evidence and background paper. This ACP guideline summarizes the recommendations of the 2002 ACC/AHA updated guideline and underscores the recommendations most likely to be important to physicians seeing patients in the primary care setting. This guideline is the second of 2 that provide guidance on the management of patients with chronic stable angina. This document covers treatment and follow-up of symptomatic patients who have not had an acute myocardial infarction or revascularization procedure in the previous 6 months. Sections addressing asymptomatic patients are also included. Asymptomatic refers to patients with known or suspected coronary disease based on a history or electrocardiographic evidence of previous myocardial infarction, coronary angiography, or abnormal results on noninvasive tests. A previous guideline covered diagnosis and risk stratification for symptomatic patients who have not had an acute myocardial infarction or revascularization procedure in the previous 6 months and asymptomatic patients with known or suspected coronary disease based on a history or electrocardiographic evidence of previous myocardial infarction, coronary angiography, or abnormal results on noninvasive tests.

Angina Pectoris↗

PubMed1985

Clinical trials on the efficacy of pharmacologic intervention reducing mortality from cardiovascular diseases.

Results of recent clinical trials on secondary prevention of ischemic heart disease indicate that judicious, long-term administration of adrenergic beta blockers and platelet-active drugs such as aspirin and Persantine (dipyridamole) would seem to yield protection against mortality associated with acute myocardial infarction, including sudden death. These drugs are beneficial also in prevention of recurrent myocardial infarction, especially among patients with unstable angina. These drugs should be considered as soon as the diagnosis of myocardial infarction or unstable angina is confirmed clinically. In terms of primary prevention of ischemic heart disease and cerebrovascular disease (stroke), the results of the Hypertension Detection and Follow-Up Program provide an excellent set of data on the efficacy of rigorous treatment of hypertension, especially those with mild hypertension. To be effective, treatment must start before there is evidence of target end organ damage, such as left ventricular hypertrophy. Recent data from the Australian Therapeutic Trial in Mild Hypertension also confirms these findings.

Adrenergic beta-Antagonists↗

PubMed1978

[Coronary heart disease in patients with primary type V hyperlipoproteinemia (author's transl)].

In two patients with primary Type V hyperlipoproteinemia with typical clinical features including recurrent bouts of abdominal pain a myocardial infarction was diagnosed. In both cases coronary angiography revealed a severe three vessel disease. The case reports demonstrate that the incidence of ischemic heart disease in patients with Type V hyperlipoproteinemia is higher than reported in the literature. In each case of severe abdominal pain, even in younger Type V patients, a myocardial infarction has to be excluded, In both patients a selective depression in the activity of lipoprotein lipase was found. The possible pathogenetic implication of this finding will be discussed.

Aged↗

PubMed2005

First myocardial infarction in a Dutch general practice population: trends in incidence from 1975-2003.

BACKGROUND: As morbidity registrations generally do not make distinct first and following myocardial infarctions, it is still unclear as to what extent the falling rates of myocardial infarctions are caused by lower incidences of first myocardial infarctions. AIM: To investigate the incidence of first myocardial infarctions in a general practice population. METHOD: Data were taken from the Continuous Morbidity Registration (CMR) Nijmegen, which has been collecting data from four general practices since 1971. For the 1975-2003 period, sex-specific and age-specific yearly incidence rates were obtained from the registration data of the CMR. Trends were studied with Poisson regression. RESULTS: During the study period, 827 patients with a first myocardial infarction were identified. The incidence of first myocardial infarctions has declined since 1986 to 2.1 per 1000 for men and to 1.5 per 1000 for women. The average age of getting a first myocardial infarction increased with 3 years for men and slightly decreased for women. Since 1986, the incidence of sudden cardiac death from a first myocardial infarction has considerably declined for men and women to 0.9 and 0.7 per 1000 respectively. CONCLUSION: A slight, significant, decline in incidence of first myocardial infarctions was found. From the mid eighties a mean annual decline of 3.5% in death from first myocardial infarction was observed. Though the variance in rates of coronary heart diseases is not unambiguous, this may indicate an effect of primary prevention. The decline was more pronounced in men, with an increasing age of getting a first myocardial infarction.

Age Distribution↗

PubMed1979

[Treatment of decompensated valvular disease with nitroglycerin (author's transl)].

The effects of parenteral nitroglycerin after acute and continuous infusion were investigated in 12 patients with mitral and (or) aortic valvular disease (stage IV of the New York Heart Association) and severe therapy-resistant pulmonary congestion. Intravenous injection of 1 mg led to immediate and marked decrease of right atrial mean pressure, and pulmonary artery and pulmonary capillary mean pressures, whereas mean arterial blood pressure, stroke volume index, cardiac frequency, and cardiac index remained unchanged. With a dosage of 3-10 mg/h the pressure lowering of the right circulation could be sustained. Pressure lowering of the right circulation abolished pulmonary congestion and led to marked reduction of shortness of breath. The principle of venous pooling can thus not only be used successfully in cases of increased pulmonary capillary pressure due to primary myocardial insufficiency, but also in cases with pulmonary congestion due to decompensated valvular disease.

Adult↗

PubMed1995

Time changes of creatine kinase and creatine kinase-MB isoenzyme versus discrimination values in the diagnosis of acute myocardial infarction: what is the optimal method for displaying the data?

We wanted to determine the optimal method for displaying data for the clinical evaluation of patients with possible acute myocardial infarction. Our primary question was, are the time changes (slopes) of the enzyme tests better predictors of disease than the discrimination values, i.e., the cut-off points? We studied 152 patients with and 114 without a diagnosis of acute myocardial infarction in their medical records. For patients with acute myocardial infarction, we found the most discriminating tests, in decreasing order of the area of the ROC curves, to be the creatine kinase-MB slope at 0 to 12 hours, the creatine kinase-MB slope at 12 to 24 hours, the creatine kinase-MB values between 12 and 24 hours, and the creatine kinase-MB values between 0 and 12 hours. Decreasing values of creatine kinase-MB in the first tests after admission were only slightly less discriminating than increasing ones. At 12 to 24 hours after admission, the total creatine kinase as a value or slope, or the "relative index" (a ratio of the creatine kinase-MB in microgram/l [times 100] to the total creatine kinase) as a value or slope were inferior to creatine kinase-MB presentations. From the data for 44 patients with acute myocardial infarction and a known time of onset of symptoms, we were able to estimate an approximate onset time in patients where this was not available.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical Enzyme Tests↗

PubMedDate not supplied

[Pulmonary diffusion capacity in patients with previous myocardial infarct (with respect to the influence of smoking and pulmonary congestion)].

Pulmonary diffusive capacity by the carbon monoxide method was evaluated in 43 patients two years after myocardial infarction, and without evidence of other types of heart disease. The patients did not have primary lung disease or clinic bronchitis. Special interest was given to the effects of cigarrette smoking and moderate pulmonary congestion. A significant decrease in diffusion capacity was observed in smokers and former smokers compared to none smokers. In moderate pulmonary congestive the oposite effects was registered. pO2 was decreased in half the patients with old myocardial infarction but there was no significant statistical correlations with D1co values. Mean values for pO2, pCO2, pH, EB did not show statistically valid differences among the subgroups under study. Different factors which may influence the evaluation of diffusion capacity are discussed.

Adult↗

PubMed2006

Continuation of hormone replacement therapy during acute myocardial infarction after the women's health initiative study. Is it the time for change?

Hormone replacement therapy (HRT) was given for many years in order to relieve menopausal symptoms and was used for as long as symptom control was necessary. The Heart and Estrogen/Progestin Replacement Study (HERS) and Women's Health Initiative (WHI) studies showed that HRT should not be given for primary or secondary prevention of coronary heart disease (CHD). However, what about those patients during acute myocardial infarction who are already taking HRT? Is the 'don't stop don't start' rule still true? A 58-year-old white female, on HRT was admitted with acute myocardial infarction (MI). We tried to answer the above questions in light of the new information:Based on current evidence available from HERS and WHI trials, it is not advisable to initiate HRT in women with established CHD for the sole purpose of preventing first or recurring coronary events. A statement by the American Heart Association recommends that the decision to continue or stop HRT in women with CV disease should be based on established benefits and risks, taking patients preference into account. The WHI study did not change this policy in the acute phase. In most cases, we believe HRT should be continued for some period (our decision for 3 months long was arbitrary), and discontinued gradually. We believe that this should be the policy until we have a double-blind placebo-control data to revise.

Decision Making↗

PubMed2006

Association of haematological indices with the degree of microvascular injury in patients with acute anterior wall myocardial infarction treated with primary percutaneous coronary intervention.

BACKGROUND: In acute myocardial infarction (AMI), increased neutrophil count has been associated with more severe coronary artery disease and larger infarct size. Increased mean platelet volume (MPV) is also associated with poor clinical outcome and impaired angiographic reperfusion in patients with AMI. However, the associations of neutrophil count and MPV with the indices of tissue level reperfusion were not fully elucidated. AIM: To elucidate the relationship between baseline neutrophil count and MPV on presentation and microvascular injury in patients with anterior AMI treated with primary percutaneous coronary intervention (pPCI). METHODS: 41 patients with anterior wall AMI treated successfully with pPCI were included. The leucocyte count, neutrophil count and MPV were obtained on admission, and the percentage of neutrophils was calculated. After PCI thrombolysis in myocardial infarction, grade 3 flow was established in all patients. The coronary flow velocity pattern (diastolic deceleration time (DDT)) was examined with transthoracic echocardiography and measured intracoronary pressures with fibreoptic pressure-temperature sensor-tipped guidewire in the left anterior descending artery within 48 h after pPCI. Thermodilution-derived coronary flow reserve (CFR) was calculated. Index of microvascular resistance (IMR) was defined as simultaneously measured distal coronary pressure divided by the inverse of the thermodilution-derived hyperaemic mean transit time. Subsequently, a short compliant balloon was placed in the stented segment and inflated to measure coronary wedge pressure (CWP). RESULTS: Higher neutrophil counts were strongly associated with higher IMR (r = 0.86, p<0.001), lower CFR (r = -0.60, p<0.001), shorter DDT (r = -0.73, p<0.001) and higher CWP (r = 0.73, p<0.001). Likewise, there were significant correlations among the percentage of neutrophils and CFR (r = -0.34, p = 0.02), IMR (r = 0.46, p = 0.002), DDT (r = -0.36, p = 0.01) and CWP (r = 0.49, p = 0.001). Relationships among leucocyte count and IMR (r = 0.38, p = 0.01), CFR (r = -0.33, p = 0.03), DDT (r = -0.36, p = 0.01) and CWP (r = 0.32, p = 0.026) were slightly significant. Higher neutrophil count remained independently associated with indices of microvascular perfusion in multivariable models controlling for age, smoking habits and time to treatment. Also, higher MPV on admission was strongly associated with higher IMR (r = 0.89, p<0.001), steeper DDT (r = -0.64, p<0.001), lower CFR (r = -0.43, p = 0.004) and higher CWP (r = 0.77, p<0.001). CONCLUSION: Absolute and relative neutrophilia and higher MPV on admission were independently associated with impaired microvascular perfusion in patients with anterior AMI treated with pPCI. It is possible that neutrophilia and high MPV are simple surrogate markers of worse microvascular injury in patients with AMI.

Angioplasty, Balloon, Coronary↗

PubMed2006

Early intervention and prevention of myocardial infarction.

Although there has been a decline in the incidence of ischaemic heart disease in Western Europe, North America and Australia/New Zealand, it remains a major cause of morbidity and mortality worldwide due to rapidly increasing incidences in developing countries. Prevention is key to reducing the burden of this disease. The INTERHEART study performed in 52 countries around the world has shown that the major risk factors are tobacco smoking, elevated apolipoprotein A, hypertension, diabetes mellitus, abdominal obesity, psychosocial factors, low fruit and vegetable intake, physical inactivity and alcohol consumption. Strategies for prevention by reducing risk factors are applicable universally. Individual healthcare providers can implement primary and secondary preventive measures to individual patients. Primary prevention involves the avoidance of disease in high-risk subjects free of disease, whereas the purpose of secondary prevention is to avoid recurrence of myocardial infarction. The general principle is to encourage improved and proven lifestyle measures and to prescribe evidence-based effective medications. Primary prevention requires greater investment and planning to identify people at high risk, plus the implementation of life-style intervention and pharmacological prevention. In both situations, strategies will have to be tailored to suit individual countries and economies. Life-style measures (i.e. sensible diet, physical exercise and smoking cessation) are effective and need to be promoted. Compliance with preventive measures is achievable. Primordial prevention, which involves reducing the prevalence of risk factors, rests mainly on public education, media, legislation and government policy, and is very dependent on individual governments' commitment and determination. It requires promoting a healthier life-style in the population as a whole by encouraging people to seek alternatives and making them available.

Clinical Trials as Topic↗

PubMed1995

M mode and Doppler echocardiographic assessment of left ventricular diastolic function in primary antiphospholipid syndrome.

BACKGROUND: High titres of serum antiphospholipid antibodies are a possible pathogenic factor for cardiac lesions in patients with systemic lupus erythematosus. OBJECTIVE: To test the hypothesis of a causal link between high titres of antiphospholipid antibodies in the serum and myocardial involvement in patients without systemic lupus erythematosus. PATIENTS AND DESIGN: 18 patients with primary antiphospholipid syndrome (recurrent fetal loss, arterial and/or venous thrombosis, high titres of antiphospholipid antibodies, and no criteria for systemic lupus erythematosus) were prospectively studied by cross sectional, M mode, and pulsed Doppler echocardiography, and compared with 18 healthy controls. The pulsed Doppler indices of left ventricular diastolic function included isovolumic relaxation time and four mitral outflow indices: peak velocity of early flow, peak velocity of late flow, early to late peak flow velocity ratio, and rate of deceleration of early flow. Four computerised M mode indices were also measured: peak rate of left ventricular enlargement in diastole, peak rate of posterior wall thinning, peak velocity of lengthening of the posterior wall, and velocity of circumferential chamber lengthening. RESULTS: Compared with controls, patients with primary antiphospholipid syndrome had higher values for isovolumic relaxation time and peak velocity of late mitral outflow and lower values for early to late mitral peak outflow velocity ratio, rate of deceleration of early mitral outflow, peak rate of left ventricular enlargement in diastole, peak rate of posterior wall thinning, peak velocity of lengthening of the posterior wall and velocity of circumferential chamber lengthening. CONCLUSION: This abnormal pattern reflects an impairment of myocardial relaxation and filling dynamics of the left ventricle in patients with primary antiphospholipid syndrome who were free of any clinically detectable heart disease. These data suggest that high serum titres of antiphospholipid antibodies may be associated with subclinical myocardial damage.

Adult↗