Evaluation of left ventricular mass and diastolic function in the treatment of hypertension with beta blockers [abstract]

Arterial hypertension is associated with left ventricular hypertrophy (LVH), and LVH increases the risk for cardiovascular morbidity and mortality. Selected antihypertensive agents have been shown to reverse LVH. In this study, the effects of celiprolol, a selective á1 blocker with partial agonist activity on á2 receptors and propranolol, a non-selective á-blocker, on blood pressure, left ventricular mass of diastolic function were compared. In a prospective study, twenty-nine patients with mild to moderate hypertension were randomly allocated to treatment with either celiprolol or propranolol for twelve weeks, after a three-week drug washout period. Cross-sectional doppler echocardiography was performed for the measurement of left ventricular mass and pulse doppler studies done for evaluation of left ventricular diastolic function. At the end of the study, both celiprolol and propranolol significantly reduced the diastolic blood pressure, while only celiprolol significantly reduced the systolic blood pressure. In the celiprolol group, there was a greater decrease in the left ventricular mass (7.9 percent) compared to the propranolol group (0.3 percent), but this was not significant. Doppler studies established that propranolol caused no significant change in the E/A ratio, while celiprolol caused a significant increase in the E/A ratio (p= 0.01). Propranolol increased the deceleration time (DT) (p= 0.001), while celiprolol decreased the isovolumetric relaxation time (IVRT) (p= 0.002) and increased the pulmonary venous A wave width (P= 0.02). In conclusion, short-term treatment with celiprolol demonstrated a trend towards decreasing the left ventricular mass, and caused significant improvement in left ventricular diastolic function, while propranolol did not. This may be due to the observation that celiprolol reduces total peripheral resistance by vasodilation. Treatment with celiprolol over a longer interval may result in significant reduction of left ventricular mass. (AU)

Echocardiographic findings in a Afro-Caribbean population reffered for evaluation of atrial fibrillation or flutter

Atrial fibrillation and/or flutter is the most common and the most significant cardiac arrhythmia in the Caribbean. This study is an attempt to determine the echocardiographic findings in a current, consecutive series of Afro-Caribbean patients referred for evaluation of atrial fibrillation and flutter. Between May 1998 and June 2000, 50 patients (mean age 67 years, 58 percent male) had echocardiograms done. Measurements include left atrial dimension (LA), left ventricular end-systolic dimension (LVESD), LV end-diastolic dimension (LVEDD), LV posterior wall thickness (LVPWT) and ventricular septal thickness (VST). Left ventricular ejection fraction (EF) was calculated. LA>4 cm, LVPWT or VST>13 mm, and LVEF<50 percent were considered abnormal. Atrial fibrillation was seen in 92 percent, atrial flutter in 8 percent; 60 percent were chronic, 40 percent paroxysmal; 56 percent had congestive heart failure. The most frequent echocardiographic finding was LV hypertrophy (19/50, 38 percent). Left ventricular systolic dysfonction was present in 12/50, 24 percent with LV hypertrophy also). Valvular disease (abnormal appearing valve, no Doppler study), was seen in 9/50, 18 percent. Normal findings ("lone atrial fibrillation") were seen in 10/50, 20 percent. Increased LA dimension was seen in 39/50, 78 percent. Patients with lone atrial fibrillation were younger (mean 56 years) than those with valvular disease (mean 64 years), LV systolic dysfunction (mean 69 years) and those with LV hypertrophy (mean 72 years). Thus, LV hypertrophy, probably secondary to hypertension, is the most frequent echocardiographic finding, with LV dysfunction (such as seen in coronary artery disease) seen less often. Valvular disease and lone atrial fibrillation rates are similar to rates in developed countries. (AU)