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PubMedDate not supplied

Left ventricular relaxation time index and left atrial emptying index as early echocardiographic indicators in predicting hypertensive heart disease.

To study the earliest changes in left ventricular structure and function appearing in response to hypertensive heart disease the study was started with an initial group of subjects detected for the first time in their lives with elevated levels of systemic blood pressures. A careful follow up of these subjects during the next year allowed the division of these subjects into a group of healthy not hypertensive subjects and a group of subjects with mild essential systemic hypertension detected in an early phase. The next six years of repeated controls (arterial blood pressure measurement, clinical examination, routine chest X-ray pictures, standard 12 leads ECG and M-mode echocardiography) allowed a further division of the hypertensive subjects into two groups of patients: one correctly treated and the other treated incorrectly or not at all. It was found that left ventricular diastolic functions expressed by left ventricular relaxation time index (LVRTI) and left atrial emptying index (LAEI) are the earliest indicators of hypertensive heart disease due to mild essential systemic hypertension.

Adult↗
PubMed1987

Left ventricular hypertrophy in hypertension. Prevalence and relationship to pathophysiologic variables.

In less than a decade since development of echocardiographic measurement of left ventricular muscle mass, studies using this technique have provided considerable information about the prevalence and pathophysiology of left ventricular hypertrophy in human hypertension. Increased left ventricular mass has been found in a significant minority of patients with systemic hypertension, with the exact prevalence dependent both on how a population is selected and on the sex, race, and possibly age composition of its members. All published studies have reported that left ventricular hypertrophy is more closely related to blood pressure recorded in the patient's natural setting during normal activity or exercise-whether measured by portable recorder or home manometer-than to blood pressure measured by the physician. In addition, studies indicate that the classic hypertensive abnormalities of concentric left ventricular hypertrophy and increased peripheral resistance are interrelated, while left ventricular hypertrophy is absent in a subgroup of patients with mild essential hypertension who exhibit high cardiac output and evidence of supernormal myocardial contractility. Conversely, the left ventricular functional response to exercise is inversely related to the degree of hypertrophy. High levels of blood viscosity, which would tend to blunt the reduction in peripheral resistance expected during sleep or exercise, have also been associated with left ventricular hypertrophy in patients with essential hypertension. Echocardiographic studies have provided evidence both for and against the hypothesis that activity of the sympathetic or reninangiotensin systems plays a direct role in causing hypertensive cardiac hypertrophy. These findings demonstrate the useful role that echocardiographic assessment of left ventricular structure and function may play in hypertension research.

Age Factors↗
PubMed1991

Function and structure of the failing left ventricular myocardium in aortic valve disease before and after valve replacement.

Left ventricular (LV) cineangiography and endomyocardial biopsies were performed preoperatively in 49 patients (pts) with aortic stenosis (AS) and 35 pts with aortic insufficiency (AI). LV failure (group 1) was present in 15 pts with AS and 17 pts with AI. In these pts ejection fraction (EF) was less than 57% and either cardiac index was less than 2.5 L/min/m2 and/or LV end-diastolic pressure was greater than 20 mm Hg. Macroscopic LV hypertrophy was assessed by angiographic muscle mass (LMMI, g/m2). Morphometric evaluation of LV biopsies included the determination of muscle fiber diameter (MFD, mu), percent interstitial fibrosis (IF, %), volume fraction of myofibrils (VFM, %) and the calculation of LV fibrous content (FC, g/m2). Pts of group 1 and 2 were restudied 22.5 and 24.0 months, respectively, after successful aortic valve replacement. Preoperatively, group 1 pts had a significantly higher LMMI, MFD, and FC than did the patients in group 2 (non-failing group consisting of 34 pts with AS and 18 with AI). IF and VFM did not differ. After surgery EF increased significantly from 44% to 59% in group 1, whereas it remained unchanged in group 2 (66%). Although in both groups LMMI and MFD decreased significantly these quantities were increased after surgery in group 1 as compared to group 2. IF, VFM, and FC did not change significantly in group 1 after valve replacement. There was no difference in these latter three quantities between groups 1 and 2 after surgery. It is concluded that 1) macroscopic and microscopic hypertrophy is more marked in the failing than in the non-failing left ventricle, 2) left ventricular pump function is not related to percent interstitial fibrosis, and 3) at an intermediate time after aortic valve replacement pts with previously failing left ventricle show considerable improvement of ejection performance, but residual hypertrophy persists.

Angiography↗
PubMed1987

Arrhythmogenic right ventricular dysplasia presenting with ventricular tachycardia in a father and son.

A father and his son presented with ventricular tachycardia of left bundle-branch block configuration, two years apart. The patients had no clinical signs of right or left ventricular dysfunction. The diagnosis of arrhythmogenic right ventricular dysplasia was based on right ventricular angiographic and radionuclide findings. Microscopic sections obtained at surgery for the ventricular tachycardia in the father revealed abnormal infiltration of fat and focal fibrosis in the right ventricular myocardium, confirming the diagnosis. The importance of thorough evaluation of right and left ventricular function and structure in patients with ventricular tachycardia of right ventricular origin is emphasized. Currently available diagnostic techniques and management are presented.

Adolescent↗
PubMed1987

Age-dependent changes in myocardial ultrastructure during anoxia.

We have examined left ventricular function and structure of male C57BL/6J mice at 3 and 24 months of age prior to, during and 5 min following a 3-min exposure to anoxia. During anoxia young hearts were characterized structurally by the presence of clear, abnormal non-membrane bound lipid-like vacuoles closely associated to mitochondria. Myelin figures were also present, and mitochondrial ATPase was considerably reduced. By the end of the 3-min period of anoxia hearts in young mice had irreversibly failed, and upon reoxygenation mitochondria underwent further degradation, including loss of internal structure. While continuing to function throughout anoxia, hearts of old mice had normal appearing myofibrillar, mitochondrial and sarcoplasmic structures. During reoxygenation occasional myelin figures were seen in senescent myocardium, although mitochondrial ATPase was not affected. At all times of anoxia and recovery pathological changes were more extensive in young mice than in their aged counterparts.

Adenosine Triphosphatases↗
PubMed1987

Atrial natriuretic peptide in human hypertension.

Preliminary reports are that plasma levels of immunoreactive atrial natriuretic peptide (IR-ANP) are higher in essential hypertensive patients than in normotensive controls, and that the urinary response to injected alpha human atrial natriuretic peptide (alpha-hANP) is augmented in essential hypertension. Further, there are reports of positive relationships between IR-ANP levels and arterial pressure. Confirmation is needed, however, with larger numbers of patients and with careful matching of diet electrolytes, age and sex, body posture, time of day, and other factors which may alter release or plasma clearance of atrial peptides. If indeed IR-ANP levels are raised in essential hypertension, it is possible that increased demands on the atria as a consequence of altered left ventricular structure and function lead to augmented secretion of atrial peptides. Whether the observed minor increases in plasma IR-ANP could have biologic effects to oppose pressor systems, to sustain glomerular filtration rate, and to suppress vasoactive hormone secretion, is unclear since the threshold level of IR-ANP which has biologic actions in man, is unknown. Plasma IR-ANP levels are raised in primary aldosteronism, and fall with treatment. These early reports suggest that atrial peptides might play a role in the pathophysiology of primary aldosteronism and perhaps essential hypertension, but much more information is needed.

Atrial Natriuretic Factor↗
PubMedDate not supplied

[Evaluation of acute and chronic effects of ketanserin in the treatment of hypertension and hypothesis on a new mechanism of action].

Ketanserin is a specific antagonist of the 5-HT2 serotoninergic receptors; it is located on the smooth muscle cells of the vessel wall, and its stimulation causes vasoconstriction. The aim of this study is to evaluate the antihypertensive effect of ketanserin in patients with essential and secondary hypertension. Both systolic and diastolic blood pressure significantly decreased, in 18 patients, after chronic treatment with oral therapy (40-80 mg/day), and in 37 patients, after acute administration of sublingual (20 mg) and intravenous (10 mg) ketanserin. Acute administration of ketanserin was less effective than nifedipine (10 mg) in severe hypertension. Ketanserin, compared to placebo, permitted the normalization of blood pressure in 6/10 patients. Cardiovascular effects of ketanserin were studied with the ECOCG method in 8 patients with hypertension: peripheral resistances decreased, but left ventricular function and structure did not change. The effect of ketanserin on Na transmembrane transport systems in erythrocytes was studied both in vivo and in vitro, in order to evaluate the ketanserin action mechanism. The Na/K pump decreased and Na/Li countertransport increased, while different concentrations of serotonin did not change the transmembrane transport systems. In conclusion, ketanserin has a direct effect on transmembrane transport systems, not mediated by the serotonin receptors. This effect, with an antagonist of 5-HT2 serotoninergic and alpha 1 adrenergic receptor action, can cause a hypotensive effect.

Adult↗
PubMed1989

[Echocardiographic assessment of left ventricular function in patients with early type I diabetes].

M-mode, resting echocardiographic examination has been performed under 2-D control in 19 patients (mean age-26 years) with controlled, type 1 diabetes lasting up to 2 years (D group). The control group (C) consisted of 20 healthy men (average age-25 yrs). Greater cardiac index has been stated in D group (p less than 0.05). Left ventricular systolic function parameters such as: ejection fraction, percentage of fractional shortening and a mean rate of circumferential shortening indicate greater contractility in D patients. Left ventricular mass also has been significantly greater (p less than 0.04) and the total peripheral resistance significantly lowered (p less than 0.05) in the D group. Stated alterations in left ventricular function and structure are probably due to adaptation for increased peripheral flow.

Adult↗
PubMed1988

Systolic and diastolic flow abnormalities in elderly patients with hypertensive hypertrophic cardiomyopathy.

Seventeen patients with clinical and echocardiographic features of hypertensive hypertrophic cardiomyopathy of the elderly were studied to more completely characterize left ventricular systolic and diastolic function in this group. Measurements of left ventricular structure and systolic and diastolic function were made in the study patients and compared with those of age-matched control subjects. The study group had significantly greater left ventricular mass, wall thickness, shortening fraction and relative wall thickness than did the control subjects. Left ventricular end-diastolic dimension was smaller and left atrial size was not different in study patients compared with control subjects. Left ventricular filling was characterized by an increased peak atrial velocity and reduced ratio of peak early to peak atrial velocity in the study group. Left ventricular outflow velocities were elevated in 14 of the 17 study patients with peak velocities ranging from 1.2 to 5.0 m/s corresponding to a peak intraventricular gradient of 16 to 100 mm Hg. The velocity waveforms in these patients were late-peaking, similar to those described in hypertrophic obstructive cardiomyopathy. The elevated velocities were localized to the left ventricular outflow tract. These findings imply a pathophysiologic state in these elderly patients with long-standing hypertension, very similar to that in hypertrophic obstructive cardiomyopathy, and provide further support for the use of pharmacologic agents with negative inotropic properties or positive lusitropic properties in this group.

Aged↗
PubMed1990

Cardiac structure and function in continuous ambulatory peritoneal dialysis: influence of blood purification and hypercirculation.

Continuous ambulatory peritoneal dialysis (CAPD) is associated with obvious hemodynamic and blood purification advantages over intermittent hemodialysis. To determine whether this is reflected in favorable left ventricular (LV) structure and function, a group of 55 normotensive patients (aged 58.4 +/- 11.0 years) undergoing CAPD was analyzed by means of echocardiography. Characteristic findings were LV hypertrophy (158 +/- 50 gm/m2), mainly the result of septal thickening (13.3 +/- 2.8 mm), and left atrial dilatation (40.9 +/- 7.4 mm). Mean LV diameter in end diastole and end systole and posterior wall thickness were normal. Parameters of LV systolic function (ejection fraction [EF]: 62.0 +/- 13.0%; velocity of circumferential fiber shortening [Vcf]: 1.58 +/- 0.46 circ/sec) were in the upper normal range at a hyperdynamic circulatory state (cardiac index [CI] 4.67 +/- 1.82 L/min/m2. The amount of LV hypertrophy was related to the amount of hypercirculation (CI: p less than 0.001; hemoglobin: p less than 0.025) and quality of blood purification (creatinine, urea: p less than 0.02) but not to blood pressure, age, or duration of dialysis. Left atrial dilatation was inversely related to LV systolic function (EF, Vcf: p less than 0.001) and directly related to LV muscle mass (p less than 0.02). A low prevalence (13%) of pericardial effusion was independent of blood purification. We conclude that in normotensive patients receiving CAPD, a high prevalence of left atrial dilatation and asymmetric septal hypertrophy is found, the latter being related both to the amount of hypercirculation and the quality of blood purification.

Adult↗
PubMed1990

Altered systolic and diastolic function in children after "successful" repair of coarctation of the aorta.

We investigated whether left ventricular (LV) structural or functional abnormalities persist in children on long-term follow-up after successful correction of coarctation of the aorta. Two-dimensional directed M-mode and Doppler echocardiographic examinations were performed in 11 such subjects and 22 age-matched control subjects. Digitized tracings were made from M-mode recordings of the LV and Doppler mitral valve inflow recordings to measure septal, posterior wall, and LV dimensions, LV mass, shortening fraction, peak shortening and lengthening velocities, diastolic filling time, peak E velocity, peak A velocity, and velocity time integrals. Despite group similarities in age, body size, and systolic blood pressure, greater fractional shortening (p = 0.0001), indexed peak shortening velocity (p less than 0.001), and greater LV mass index (p less than 0.05) were seen in the coarctation group in the face of lower LV wall stress (p = 0.0001). LV mass index correlated with the resting arm-leg gradient, which ranged from -4 to +10 mm Hg. The coarctation group had decreased early filling (p less than 0.006) with compensatory increased late diastolic filling (p less than 0.05). Diastolic filling abnormalities were prominent in the older coarctation subjects and were related to both systolic blood pressure (p less than 0.001) and LV mass index (p less than 0.01). Despite apparently successful repair of coarctation of the aorta, persistent alterations in both systolic and diastolic LV function and LV mass are present in children at long-term follow-up, which are related to the resting arm-leg gradient.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

Right ventricular wall thickness and function in hypertensive patients with and without left ventricular hypertrophy: echo-Doppler study.

The structure and function of the right ventricle in arterial hypertension have been the subject of only a few reports. The present study evaluated the functional and structural changes in both left and right ventricles. Doppler and standard echocardiography were performed in 58 hypertensive patients (33 without and 25 with left ventricular hypertrophy). We concluded that right ventricular wall thickness is significantly increased in hypertensive patients compared with normotensive subjects, and that there is a significant, direct correlation between right and left ventricular thickness. Abnormalities in right and left ventricular filling, characterized by a reduction in early and an increase in late diastolic flow velocity, occur in hypertensive patients, and there is a direct correlation between late mitral and tricuspidal flow velocities and left and right ventricular thickness.

Adult↗
PubMed1992

Left ventricular structure and determinants in normotensive offspring of essential hypertensive parents.

OBJECTIVE: To assess whether currently normotensive offspring of essential hypertensive parents may have alterations in left ventricular mass (LVM) and function, and how these relate to some potential determinants. DESIGN AND METHODS: Echocardiographical indices of LVM (assessed by two-dimensional guided M-mode echocardiogram), 'clinic' blood pressure and daytime ambulatory blood pressure profiles, blood pressure responses to dynamic and isometric exercise testing, haematocrit, plasma and 24-h urinary electrolytes and catecholamines, and plasma angiotensin II were assessed on a defined Na+ intake in 31 normotensive lean sons of essential hypertensive parents (OHYP group) and 30 body mass index- and age-matched sons of normotensive parents (ONORM group). RESULTS: Clinic supine systolic blood pressure was higher in the OHYP than the ONORM group, but clinic diastolic and daytime ambulatory mean blood pressures, blood pressure loads and blood pressure during dynamic or isometric exercise did not differ significantly. LVM index (LVMI), interventricular septum thickness (IVST), posterior wall thickness (PWT), the IVST:PWT ratio, ejection fraction, fractional shortening, cardiac index and measured biochemical variables also did not differ significantly between groups. In the whole study population the LVMI correlated positively with the body mass index and negatively with plasma noradrenaline. CONCLUSIONS: In young lean men with one essential hypertensive parent and blood pressure still in the normal range, left ventricular structure and systolic function, as assessed by echocardiography, seem to be often unaltered and appropriate relative to the existing body habitus and blood pressure. Moreover, an early tendency for increasing resting blood pressure in genetically hypertension-prone humans may be more apparent under clinic than usual ambulatory conditions, whereas the blood pressure reactivity to physical stress seems to be largely normal at this stage.

Adult↗
PubMed1992

Effects of the angiotensin converting enzyme inhibitor enalapril on the long-term progression of left ventricular dysfunction in patients with heart failure. SOLVD Investigators.

BACKGROUND: In patients with heart failure, activation of the renin-angiotensin system is common and has been postulated to provide a stimulus for further left ventricular (LV) structural and functional derangement. We tested the hypothesis that chronic administration of the angiotensin converting enzyme (ACE) inhibitor enalapril prevents or reverses LV dilatation and systolic dysfunction among patients with depressed ejection fraction (EF) and symptomatic heart failure. METHODS AND RESULTS: We examined subsets of patients enrolled in the Treatment Trial of Studies of Left Ventricular Dysfunction (SOLVD). Fifty-six patients with mild to moderate heart failure underwent serial radionuclide ventriculograms, and 16 underwent serial left heart catheterizations, before and after randomization to enalapril (2.5-20 mg/day) or placebo. At 1 year, there were significant treatment differences in LV end-diastolic volume (EDV; p less than 0.01), end-systolic volume (ESV; p less than 0.005), and EF (p less than 0.05). These effects resulted from increases in EDV (mean +/- SD, 136 +/- 27 to 151 +/- 38 ml/m2) and ESV (103 +/- 24 to 116 +/- 24 ml/m2) in the placebo group and decreases in EDV (140 +/- 44 to 127 +/- 37 ml/m2) and ESV (106 +/- 42 to 93 +/- 37 ml/m2) in the enalapril group. Mean LVEF increased in enalapril patients from 0.25 +/- 0.07 to 0.29 +/- 0.08 (p less than 0.01). There was a significant treatment difference in LV end-diastolic pressure at 1 year (p less than 0.05), with changes paralleling those of EDV. The time constant of LV relaxation changed only in the placebo group (p less than 0.01 versus enalapril), increasing from 59.2 +/- 8.0 to 67.8 +/- 7.2 msec. Serial radionuclide studies over a period of 33 months showed increases in LV volumes only in the placebo group. Two weeks after withdrawal of enalapril, EDV and ESV increased to baseline levels but not to the higher levels observed with placebo. CONCLUSIONS: In patients with heart failure and reduced LVEF, chronic ACE inhibition with enalapril prevents progressive LV dilatation and systolic dysfunction (increased ESV). These effects probably result from a combination of altered remodeling and sustained reduction in preload and afterload.

Angiotensin-Converting Enzyme Inhibitors↗
PubMedDate not supplied

Echocardiographic design of a multicenter investigation of free-living elderly subjects: the Cardiovascular Health Study.

The Framingham study has shown by M-mode echocardiography that left ventricular hypertrophy is a powerful, independent predictor for the development of coronary heart disease and that increased left atrial dimension has been associated with an increased risk of stroke. No previous population-based study has evaluated the risk factor correlates and predictive value for coronary heart disease and stroke of two-dimensional and Doppler, as well as M-mode, echocardiography. The Cardiovascular Health Study is a multi-year prospective epidemiologic study of 5201 men and women older than 65 recruited from four geographic sites in the United States. The main objectives of incorporating echocardiography were to determine whether echocardiographic indices, or changes in these indices, are (1) correlated with traditional risk factors for coronary heart disease and stroke; and (2) independent predictors of morbidity and mortality for coronary heart disease and stroke. Echocardiographic measurements of interest include those related to global and segmental left ventricular systolic and diastolic structure and function and left atrial size. For each subject, a baseline echocardiogram was recorded in super-VHS tape using a standard protocol and equipment. All studies were sent to a reading center where images were digitized and measurements were made using customized computer algorithms. Calculated data and images were stored on optical disks to facilitate retrieval and future comparisons in longitudinal studies. A second echocardiogram is scheduled in year 7, with a goal of determining whether changes in cardiac anatomy or function over a 5-year period are important predictors of morbidity or mortality from coronary heart disease and stroke. Quality control measures included standardized training of echocardiography technicians and readers, technician observation by a trained echocardiographer, periodic blind duplicate readings with reader review sessions, phantom studies, and quality control adults.

Allied Health Personnel↗
PubMed1987

Noninvasive assessment of systolic and diastolic left ventricular function in female runners.

Nine female runners and 9 matched control subjects were investigated with echocardiography and Doppler velocimetry to assess cardiac structure and systolic and diastolic left ventricular (LV) function at rest. LV mass was considerably larger in the athletes (171 vs 123 g; P less than 0.01). Minute distance, the Doppler index of cardiac output, was similar in runners and controls; the lower heart rate (P less than 0.01) of the athletes was associated with a higher stroke distance (P less than 0.05). The latter could be attributed to a larger end-diastolic LV internal diameter (46 vs 43 mm; P less than 0.05); wall stress and the various indices of systolic LV function were not different between runners and controls. Early diastolic LV function, estimated from the velocity of LV relaxation and the LV inflow pattern, and late diastolic function, assessed by Doppler velocimetry, were similar in runners and controls. The unchanged ratio of the peak velocities of LV filling during atrial contraction and early filling (0.49 vs 0.44; NS) indicates that LV distensibility is unaltered in the athletes. In conclusion, the higher left ventricular mass of female runners is not associated with changes of systolic and diastolic LV function.

Cardiac Volume↗
PubMed1991

Effect of nifedipine GITS on left ventricular mass and diastolic function in severe hypertension.

Treatment of severe hypertension is beneficial, but reversibility of target-organ damage has not been characterized. Serial studies were performed in 15 patients with severe essential hypertension (age of 56 +/- 3 years, mean +/- SEM) treated for 1 year with 60 to 150 mg/day of continuous-release nifedipine; 3 patients required 50 mg of chlorthalidone/day to lower diastolic blood pressure (BP) to less than 95 mm Hg. Left ventricular (LV) structure and function was evaluated with two-dimensional-directed M-mode echocardiography, digitized from videotape and analyzed blindly. BP was markedly reduced from 194 +/- 8/115 +/- 4 to 146 +/- 4/88 +/- 14 mm Hg (p less than 0.0001) and maintained at this level for 1 year. Posterior wall and septal LV thickness, elevated at entry (12.9 +/- 0.1 and 13.4 +/- 0.1 mm), dropped steadily over 1 year into the normal range (10.0 +/- 0.03 and 11.2 +/- 0.1 mm, p less than 0.001). LV mass index, above 95% for normals at entry, decreased by 19% at 6 months (129 +/- 10 to 104 +/- 7 g/m2, p less than 0.01), and remained at this level at 1 year. LV fractional shortening rose steadily over 1 year from 34 to 42% (p less than 0.02). Atrial natriuretic peptide, which reflects LV filling pressures, was markedly elevated at entry, but was significantly reduced by 6 months (76 +/- 22 vs. 45 +/- 14 pg/ml, p less than 0.05). Sustained reduction of arterial BP with continuous-release nifedipine for 1 year normalizes LV mass, improves LV systolic function, and reduces circulating levels of atrial natriuretic peptide.

Blood Pressure↗