Mechanocardiographic effects of an elevated central venous pressure.

Since 1985 we demonstrated that the increase of left ventricular mean diastolic pressure shortens the interval existing between the onset of the electrocardiographic P-wave and the onset of the left apexcardiographic "a"-wave (Aubert et al., 1981; Mortarino et al., 1985). In particular we showed that left P-"a" time interval shortens below 100 msec when left ventricular mean diastolic pressure rises above 12 mmHg. Our results thus substantiated the previous reports related to the P-4th heart sound shortening and 4th heart sound--1st heart sound increase occurring in patients with left ventricular failure (Shapira et al., 1982). In that same period, Kesteloot and collaborators showed a direct relationship between the velocity of appearance of the right internal jugular pulse (JVP) waves and the value of central venous pressure (CVP) (Minten et al., 1985). Moreover the range of variability of the right P-"a" interval (which is the time elapsing between the onset of the electrocardiographic P-wave and the onset of the "a"-wave on the JVP tracing) is, in adult subjects, of similar magnitude of the left P-"a" interval (respectively 60-140 msec (Fishleder, 1968) and 80-160 msec (Mortarino et al., 1985) suggesting a symmetric effect of an elevation of diastolic pressure on left and right P-"a" intervals. We therefore decided to test this hypothesis in a group of patients.

Mechanocardiographic effects of ACE-inhibitors.

Twenty-one subjects who suffered a recent medium sized anterior myocardial infarction conditioning a mild congestive heart failure were randomly allocated to treatment with captopril (25 mg b.i.d., 10 pts) or placebo (11 pts). After 2 months of therapy the group on the active treatment showed a significant increase of apexcardiographic protodiastolic filling period duration reflecting a clear cut decrease of mean pulmonary capillary wedge pressure (from 14 +/- 2 to 7 +/- 3 mm Hg) while patients on placebo did not show any difference in respect to baseline. Neither treatment significantly modified the PEP/LVET ratio despite a significant increase of left ventricular ejection fraction in patients receiving captopril (from 37 +/- 4% to 43 +/- 5%). Cardiac response to ACE-inhibitors can thus be noninvasively monitored by apexcardiography.

Mean levels and distribution of some risk factors for atherosclerosis in Sardinia: the ATS-Sardegna Survey.

Six population samples of randomly chosen men and women aged 20-59 years in the four provinces of the island of Sardinia, for a total of 5,697 individuals (overall participation 55%), were examined to determine the mean levels and distribution of some risk factors for atherosclerosis. A remarkable uniformity of such levels, with some minor exceptions, was found throughout the island. The overall, age-standardized mean levels for the factors considered are as follows (men and women, respectively): total cholesterol (TC) (mg/dl) 204 and 196; LDL-cholesterol (LDL-C) (mg/dl) 131 and 125; apolipoprotein B (ApoB) (mg/dl) (five out of six areas) 112 and 104; HDL-cholesterol (HDL-C) (mg/dl) 48 and 53; triglyceride (TG) (mg/dl) 117 and 89; systolic blood pressure (mmHg) 129 and 128; diastolic blood pressure (mmHg) 81 and 80; body mass index (BMI) [kg/(m)2] 26 and 25; prevalence of smokers (%) 48 and 15; cigarettes per day among smokers 19 and 11. A regular increase with increasing age exists for TC, LDL-C, ApoB, blood pressure (systolic and diastolic) and BMI. Compared to the results of a previous survey eight years earlier, an unfavorable trend is in progress, particularly for TC levels in both sexes and smoking among women.