Electrocardiography and conventional radiology accuracy compared to echocardiography in evaluating left ventricular remodelling patterns in hypertensive patients.

AIM: The value of conventional radiology, electrocardiography and echocardiography in estimating the prevalence of left ventricular (LV) remodeling patterns in patients with newly discovered hypertension was less studied. The aim of the present study was to assess the accuracy of conventional radiology and electrocardiography compared to echocardiography in the diagnosis of left ventricular hypertrophy (LVH) and different remodeling types in male patients with recent primary arterial hypertension (PAH). METHODS: This cross-sectional study, enrolled 420 male patients with recent stage 2 PAH, diagnosed less than a year before, and 420 normotensive male subjects, using conventional radiological methods, ECG and also echocardiography. The ultrasound examination documented four types of LV remodeling, based on the measurement of LV parameters: concentric hypertrophy (CH), eccentric hypertrophy (EH), concentric remodeling (CR) and the normal variant (NV). RESULTS: In the recent PAH group, echocardiography diagnosed LV patterns in different proportions (34.285% CR; 24.285% NV; 21.43% EH; 20% CH), whereas the standard radiological examination and ECG documented LVH positive criteria in a much lower proportion of cases, for these patterns. CONCLUSION: The ECG and radiological examinations detected LVH in patients with EH, and CH, but both examinations were inconclusive in those with CR and NV. This study comparatively reflects the effectiveness of echocardiography, electrocardiography and conventional radiology, in the diagnosis of LV patterns in newly discovered hypertension and also illustrates the arguments for and against the usage of these three imagery techniques.

Abnormalities of left ventricular long-axis function predict the onset of hypertension independent of blood pressure: a 7-year prospective study.

Increased blood pressure and left ventricular (LV) mass predict the onset of the clinically manifest hypertension, but little is known regarding the possible predictive value of LV function. The present study was designed to evaluate the association between echocardiographic LV long-axis systolic, and diastolic function and hypertension onset. We prospectively followed 244 normotensive adults with a family history of hypertension (HTN), with echocardiography for 7 years. M-mode derived atrioventricular plane displacement of the mitral and tricuspid annuli (MAVPD and TAVPD respectively), and LV circumferential fractional shortening were calculated. Diastolic function of the left and right ventricle were assessed using Doppler indices of the mitral and tricuspid inflow. During follow-up, 79 subjects developed hypertension (H group) and 165 subjects remained normotensive (N group). H group subjects had diminished MAVPD (13.8+/-3.4 vs 15.0+/-3.1 mm; P=0.007), lower mitral E/A ratio, and longer mitral E-wave deceleration time as compared to N group. In multivariate Cox model MAVPD and mitral E/A ratio predicted the onset of hypertension independent of LV mass index, blood pressure, pre-hypertensive status at baseline, age, sex and body mass index. During follow-up, H subjects experienced a significant decline in MAVPD and mitral E/A ratio, whereas the indices of right ventricular function and LV circumferential shortening remained intact. In conclusion, alterations in LV long-axis systolic and diastolic function, as measured by MAVPD and E/A ratio predict the onset of hypertension. These parameters declined during the development of hypertension.

Myocardial function in patients with breast cancer after therapy with anthracyclines and chest irradiation.

PURPOSE: To evaluate and compare the left ventricular performance in female patients with breast cancer treated with chemotherapy (CT) and either left or right thoracic irradiation (RT), using Doppler echocardiography. PATIENTS AND METHODS: Thirty-four patients with cancer of the left breast treated with surgical resection, adjuvant EC CT (epirubicin and cyclophosphamide) and conventionally fractionated left thoracic RT (study group) and a gender-and age-matched group of 34 patients with cancer of the right breast also treated with surgical resection, adjuvant EC CT and right thoracic RT (control group), were studied by echocardiography. Assessed were the left ventricular systolic performance by measuring the global ejection fraction (EF) and the shortening fraction (SF). Left ventricular diastolic performance was assessed by measuring the Doppler transmitral flow: the maximal velocity of the E wave (rapid filling/ Emax) and A wave (atrial filling/Emax) were measured. The ratio of Emax/Amax, the pressure half-time (PHT) of the E wave and the isovolumic relaxation time (IVRT) were also calculated. RESULTS: The left ventricular diastolic performance was altered in the study group which showed a significant decrease (p <0.001) of Emax. A wave was significantly increased in the study group compared with the control group (p <0.001. The mitral E/A ratio was subunitary in both groups but more depressed in the study group. The E wave PHT was more prolonged in the study group compared to the control group (p <0.001). The IVRT was prolonged in the study group compared with the controls (p <0.05). The left ventricular systolic performance was within normal limits in both groups. CONCLUSION: Our Doppler echocardiography study documented an impaired left ventricular diastolic performance in patients with cancer of the left breast treated with fractionated thoracic RT and CT. This impairment is due to poor left ventricular compliance.

Does epirubicin affect left ventricular systolic performance in oncologic patients?

PURPOSE: In the present study the left ventricular diastolic and systolic functions were evaluated in patients treated with lower total doses of epirubicin using Doppler echocardiography. PATIENTS AND METHODS: Seventeen patients with different malignant tumors treated with epirubicin up to 450 mg/m(2) (study group), and a gender-and age-matched group of 29 patients diagnosed with tumors, who had not started treatment yet (control group), were assessed by echocardiography. Left ventricular diastolic function was assessed by measuring the Doppler transmitral flow. We measured the maximal velocity of the E wave (rapid filling) and A wave (atrial filling). The ratio of Emax/Amax, the pressure half time (PHT) of the E wave and the iso-volumic relaxation time (IVRT) were also calculated. The left ventricular systolic performance was assessed by measuring the global ejection fraction (EF). RESULTS: The left ventricular diastolic performance was altered in the study group. In this group we noticed a significant decrease ( p < 0.001) of Emax. A wave was significantly increased in the study group compared to the control group ( p < 0.001). The mitral E/A ratio was subunitary in the study group. The E wave PHT was prolonged in the epirubicin-treated group in comparison to the controls (p<0.001). The IVRT was prolonged in the study group in comparison to the controls (p<0.05). The left ventricular systolic performance was not significantly altered in the study group compared to the control group. Although the EF was lower in the study group the difference did not reach statistical significance. CONCLUSION: Our Doppler echocardiography study documented an impaired left ventricular diastolic performance in patients with various malignancies treated with lower total doses of epirubicin. This impairment is due to poor left ventricular compliance.

Guancydine, a new hypotensive agent with complex action.

Guancydine (1-cyano-3-tert-amylguanidine) lowered within normal limits the tensional values in an interval of four hours after its administration in eight out of nine hypertensive patients under experiment. The hypotensive effect of a single oral dose of 500-750 mg persists for about 6-7 hours after its administration. Guancydine does not impair the vasopressor response to angiotensin II but reduces the action of this peptide on the excretion of water, Na, K and Ca through urine. The hypotensive effect of Guancydine is associated with a decrease of platelet adhesiveness and an activation of fibrinolysis. In view of this fact, Guancydine might play a role in the prophylaxis of complications of arterial hypertension - atherosclerosis and trombosis. The increase of venous blood oxygenation after Guancydine could be attributed to the opening of arterio-venous shunts or to the reduction of tissular extraction of oxygen. Guancydine does not seem to be toxic. It produced, in some patients, slight headache and orthostatic hypotension, especially during the first hours after administration.