Left ventricular mass and function in young obese women.

OBJECTIVE: Obesity is associated with a high mortality rate due to cardiovascular disease. Left ventricular (LV) hypertrophy has been described in relation to obesity. The aim of this study was to evaluate echocardiographically the LV mass and function in young obese women as compared to lean women with similar characteristics. DESIGN: Prospective study. SUBJECTS: Eighty-two young women (< or =40 y), with obesity degree varying from I to III (BMI from 30 to 50 kg/m2) were compared to eighty young lean women. All of them were normotensive, none had cardiovascular complaints or any previous history of pulmonary disease, and none were taking any medication. The LV mass was calculated by the Devereux and Reichek formula. RESULTS: The LV mass was strongly increased in all obese groups (P<0.00003 to 0.000005) compared to lean subjects. LV mass adjusted indexes for height, BMI or volume were also increased compared to lean subjects and when adjusted for weight it was decreased. However when comparing LV mass/body surface area index this difference was not statistically significant. The linear regression analysis showed a strong association between the degree of obesity and LV mass, (r=0.52, P<0.001). Systolic and diastolic function in obese patients were similar to lean subjects, except for a lower E/A ratio in the obese group (P=0.005). CONCLUSION: In asymptomatic young obese women, there are some echocardiographic findings suggesting early cardiac involvement that seems to be related to the degree of obesity.

Difference in the in-hospital mortality of unstable angina pectoris between men and women.

PURPOSE: To assess differences in the in-hospital mortality (HM) rate between men and women with unstable angina pectoris (UA) according to age, depression of the ST segment, history of previous acute myocardial infarction (AMI), and risk factors for coronary heart disease. METHODS: From October 96 to March 98, 261 patients with UA were selected. Logistic regression models were developed to adjust the association between sex and HM for possible influence of covariables, such as hypertension, diabetes mellitus, dyslipidemia, sedentary lifestyle, smoking, and familial history of early coronary heart disease. RESULTS: HM due to UA was approximately three times higher in women (9.3%; 12/129) than in men (3.0%; 4/132) accounting for a relative risk of 3.07; 95% confidence interval (CI) = 1.02-9.27. In logistic regression models, the association between sex and death was not significantly altered when the following parameters were considered: age, depression of the ST segment, history of previous AMI and risk factors for coronary heart disease. The nonadjusted and adjusted odds ratio (OR) for the distinct covariables were 3.28 (CI 95% = 1.03-10.45) and 3.14 (CI = 95% = 0.88-11.20), respectively. CONCLUSION: Similarly to AMI, HM in UA is higher in women than in men. Age, risk factors for coronary heart disease, and depression of the ST segment in the electrocardiogram on patients' admission to the hospital did not significantly influence the association between sex and death.

Confirmation that heparin is an alternative means of promoting early reperfusion.

BACKGROUND: New strategies to increase coronary patency rate before primary angioplasty are under discussion. We tested the hypothesis that use of a high dose of a standard heparin bolus could achieve an acceptable rate of re-opening occluded infarct-related arteries thus providing an alternative to chemical thrombolysis before admission of the patient to hospital, and a pretreatment for primary angioplasty. METHODS: Forty-eight patients who presented within 12 h of acute myocardial infarction with ST segment elevation were assigned randomly to groups to receive aspirin (200 mg orally) and high-dose standard heparin 300 U/kg as an intravenous bolus (n = 25), or aspirin and placebo bolus (n = 23). Thereafter, all patients underwent coronary arteriography to assess their suitability for primary angioplasty. RESULTS: The high-dose heparin group had greater patency rate (Thrombolysis in Myocardial Infarction grade 2 or 3 flow in the infarct-related artery) than the placebo group (52% compared with 13%, P = 0.006). Hemorrhages related to the puncture site that required blood transfusion occurred in two of 25 and in one of 23 patients in the high-dose heparin and placebo groups, respectively. CONCLUSION: Our study suggests that high-dose standard heparin does have a thrombolytic action when administered as an intravenous bolus.

An expert system for diagnosis of acute myocardial infarction with ECG analysis.

Coronary heart disease is one of the most prevalent and costly health care problems in the world. The early and accurate diagnosis of coronary heart disease is a major problem in emergency settings. However, many primary and secondary hospitals and primary emergency units lack cardiologists on call which makes the diagnosis difficult. This paper describes an expert system for diagnosis of acute myocardial infarction developed to aid physicians without cardiology specialization. Our main goal was to develop an expert system that assists in the diagnosis and indicates the need of hospitalization in a coronary unit.