Magnetic resonance imaging measurement of left ventricular blood flow and coronary flow reserve in patients with chronic heart failure due to coronary artery disease.

BACKGROUND: Coronary sinus flow reflects global cardiac perfusion and has been used for the assessment of myocardial flow reserve, which is reduced in chronic heart failure(CHF). Coronary flow reserve (CFR) can be measured by using phase-contrast (PC)velocity-encoded cine (VEC) magnetic resonance imaging (MRI). PURPOSE: To quantify and compare global left ventricular (LV) perfusion and CFR inpatients with CHF and in a healthy control group by measuring coronary sinus flow with PC VEC MRI, and to correlate this with global LV perfusion, segmental first-pass perfusion, and viability in the same patients. MATERIAL AND METHODS: Cardiac MRI was performed in 20 patients with CHF of ischemic origin and in a control group of healthy subjects (n=11) at rest and after pharmacological stress induced by i.v. dipyridamole. The MRI protocol included cine MRI, VEC MRI, first-pass perfusion, and delayed contrast-enhanced MRI for viability.Global LV perfusion was quantified by measuring coronary sinus flow on VEC MRI at rest in all subjects. CFR was determined as the ratio of global LV perfusion before and after pharmacologic stress. RESULTS: At rest, global LV perfusion was not significantly different in patients with CHF and the control group. After administration of dipyridamole, global LV perfusion and CFR were significantly lower in patients with CHF compared to the control group(P<0.001). An inverse correlation was observed between CFR and the number of infarcted and/or ischemic segments (P=0.083, P=0.037). CONCLUSION: A combined cardiac MRI protocol including function and perfusion techniques together with VEC MRI can be used to evaluate global LV perfusion and CFR in patients with CHF. Global LV perfusion and CFR measurements may have potential in the monitoring of CHF. Impaired CFR may contribute to progressive decline in LV function in patients with CHF.

Familial atrial myxomas.

This report describes atrial myxomas present in a mother and her daughter. The mother had biatrial tumors while that of the daughter was in the left atrium. We examined 48 relatives all of whom had normal hearts.

Significance of QT dispersion on ventricular arrhythmias in mitral valve prolapse.

The present study was designed to detect the arrhythmogenic effect of mitral valve prolapse, and the relationship between QT, QT dispersion and ventricular arrhythmias in subjects with mitral valve prolapse. Sixty-four mitral valve prolapse subjects (24 men and 40 women, mean age 27 +/- 6), and 80 healthy control subjects (32 men and 48 women, mean age 28 +/- 7) were studied. The frequency of ventricular arrhythmias by means of 24-h ambulatory electrocardiographic (ECG) monitoring was investigated. Grade > or = 3 ventricular arrhythmias according to modified Lown and Wolf classification were accepted as complex arrhythmias. The QT intervals were measured from the beginning of depolarization of the QRS complex to the end of the T wave. Using the Bazett formula, QT interval was corrected (QTc) for heart rate. QT dispersion was calculated as the difference between the maximum and minimum QT intervals on any of 12 leads. Premature ventricular complexes seemed to develop in 56 of 64 (87.5%) subjects with mitral valve prolapse. Thirty-eight of the mitral valve prolapse subjects had complex premature ventricular complexes during 24-h ECG and the prevalence of premature ventricular complexes was found to be higher than the control subjects (P < 0.001). We found QT and QTc intervals of 388 +/- 27 and 406 +/- 33 ms in mitral valve prolapse subjects, these values in control subjects were 382 +/- 18 and 402 +/- 11 ms respectively (P > 0.05). QT dispersion and QTc dispersion intervals were 71 +/- 17 and 78 +/- 19 ms in mitral valve prolapse subjects and these values were 43 +/- 16 and 52 +/- 22 ms in control subjects, respectively (P < 0.001). No correlation was found between complex premature ventricular complexes and QT, but there was a correlation between complex premature ventricular complexes and QT dispersion in the mitral valve prolapse subjects. It was concluded that QT dispersion might be a useful marker of cardiovascular morbidity and mortality due to complex ventricular arrhythmias.

The effect of chronic antihypertensive therapy on the index of left ventricular mass in patients with essential hypertension.

M-mode echocardiography was used in 80 patients with essential hypertension to study changes in the index of left ventricular mass during treatment over 3 years with reserpine, prazosin, indapamide and atenolol, separately or in combination. Forty patients completed a follow-up period of 36 months, while 5 patients died during this period. In all 5 groups, the index of left ventricular mass decreased significantly from the baseline after 1 and 3 years of treatment, except in those patients receiving prazosin in which there was no significant difference in the index of left ventricular mass between 1 and 3 years of treatment. Our results confirm that effective treatment of blood pressure results in a significant reduction in the index of left ventricular mass. Furthermore, this reduction was seen with all modes of treatment and suggests that it was reduction of blood pressure rather than any specific pharmacological property of the drugs that was of major importance.

Oral nifedipine in the treatment of hypertensive crises in patients with hypertensive encephalopathy.

Hypertensive emergencies, including hypertensive encephalopathy represents an acute threat to vital organ functions and call for urgent treatment. The intravenous medications currently available for the management of hypertensive emergencies, have significant potential for serious side effects and acute lowering of blood pressure has often been the cause of considerable morbidity and mortality. Nifedipine is known to be effective as an antihypertensive agent and it is widely used in hypertensive emergencies. We studied the efficacy and effective dose of nifedipine in 22 patients (9 females and 13 males; mean age 51) with hypertensive encephalopathy. Nifedipine (20 mg by oral drop) caused a significant fall in diastolic an systolic blood pressure in all patients from 236/121 to 172/96 mmHg after 30 minutes (P less than 0.005, P less than 0.001). Continuous therapy with nifedipine (2-5 mg every 2-3 hours, mean total dose 52 mg/24 h) gave successful control of blood pressure. These data prove that nifedipine can be used as the first-line drug for the treatment of hypertensive crises in patients with hypertensive encephalopathy.

Left ventricular mass index and prevalence of heart disease in the population aged 80 years and over.

Clinical, electrocardiographic and echocardiographic findings of 69 subjects aged 80 years or over were analyzed in order to assess the prevalence of left ventricular mass, hyperlipidemia, hypertension and cigarette smoking. Of the 69 subjects studied, 41 had no symptoms or sign of cardiovascular disease, 28 had one or more cardiac symptoms (NYHA stage 2-4). 25 had electrocardiographic evidence of left ventricular hypertrophy and there were no differences between the asymptomatic and symptomatic groups. Echocardiographically, the left ventricular mass index ranged between 103 to 247 g/m2 in men and 170 to 251 g/m2 in women. In 36 subjects with high left ventricular mass index, the ventricular septal thicknesses ranged from 12 mm to 15 mm in 19 subjects, and posterior wall thicknesses ranged from 12 mm to 16 mm in 17 subjects. Of the 58 patients with an adequate echocardiogram, 47 had clinically diagnosed hypertension (81%). In our study population, a prevalence of left ventricular hypertrophy (62%), isolated systolic hypertension (26%), definite hypertension (33.3%), high LDL-cholesterol (63%), low HDL-cholesterol (26%), abnormal Q wave (16%), cigarette smoking (47.8%) and diabetes mellitus (1.4%) were found.

Doppler evaluation of left ventricular diastolic filling in Behçet's disease.

Although cardiac involvement such as pericarditis, myocarditis, coronary arteritis and valvular disease in Behçet's disease occurs, few studies have assessed left ventricular diastolic function. This study assesses the prevalence of both systolic and diastolic left ventricular dysfunction in patients with Behçet's disease who have no clinical cardiac manifestations. Twenty-two patients (12 women and 10 men, mean age 34 +/- 2.4 years) underwent full clinical examination, electrocardiography, M-mode, two-dimensional, and Doppler echocardiography. The mean disease duration was 5 +/- 4.7 years (range, 1 month-16 years). As age and sex-matched control group of 20 healthy subjects was also studied. Prolonged isovolumic relaxation time, prolonged deceleration time, reversal of the early and late peak transmitral diastolic flow velocities, late peak transmitral diastolic flow velocities (E/A ratio) and increased atrial filling fraction were noted in five patients. It is concluded that left ventricular dysfunction occurs frequently in patients with Behçet's disease and Doppler echocardiography may be valuable in detecting diastolic filling abnormalities as an early sign of cardiac involvement.

The Jervell and Lange-Nielsen syndrome.

The association of prolongation of the QT interval with recurrent attacks of syncope, sudden death, and malignant ventricular arrhythmias is known as the long QT syndrome. The syndrome may be familial with or without congenital deafness, or idiopatic. The syndrome with deafness (Jervell and Lange-Nielsen syndrome) is inherited through an autosomal recessive mechanism. In this study, we attempted to identify patients with the Jervell Lange-Nielsen syndrome amongst 154 deaf mute school children. Two patients had a corrected QT interval of 0.52 and congenital sensorineural hearing loss with the other electrocardiographic changes characteristic of the syndrome, such as inverted or bifid T wave. There was no evidence of electrocardiographic (ECG) abnormality in family members, except only one case of parental deafness. This is the first and preliminary report that analyzed the incidence of the Jervell and Lange-Nielsen syndrome amongst 154 deaf mute school children in Turkey. Our study was conducted to identify patients with this syndrome amongst children of another deaf mute school in Turkey.

Abnormal QT dispersion in Behçet's disease.

Behçet's disease, which was originally described by Hulusi Behçet in 1937, is a generalized chronic inflammatory disease characterized by recurrent oral and genital ulcerations, ocular and dermal manifestations. Cardiac manifestations include pericarditis, myocarditis, conduction system disturbances, coronary arteritis, mitral valve insufficiency, dilated cardiomyopathy, ventricular arrhythmias and sudden cardiac death. There is little knowledge about the mechanism of ventricular arrhythmias in Behçet's disease. In this study, we examined the value of dispersion of ventricular repolarization as a diagnostic tool to assess the risk for ventricular arrhythmias and sudden cardiac death in Behçet's disease. We examined 38 patients (age: 34 +/- 4.6 years, 20F, 18M) with Behçet's disease and 30 age-matched healthy subjects were selected to serve as the control group. Repolarization dispersion parameters were calculated as the difference between maximal and minimal values of QT, QTc, JT and JTC from 12-lead ECG recordings at 25 or 50 mm/s. We found QTd, QTc-d, JTd and JTc-d intervals of 60.65 +/- 16.1, 78.45 +/- 11.4, 71.51 +/- 18.3 and 92.33 +/- 15.4 ms in Behçet's disease patients, these values in control subjects were 40.1 +/- 9.7, 56.36 +/- 7.5, 41.66 +/- 4.3 and 53.92 +/- 9.2 ms respectively (p < 0.001). Striking increases in QT and JT dispersion indicating regional inhomogeneity of ventricular repolarization were noted in patients with Behçet's disease. This new finding suggests a possible explanation for the presence of ventricular arrhythmias in patients with Behçet's disease.

Significance of QTc prolongation on ventricular arrhythmias in patients with left ventricular hypertrophy secondary to essential hypertension.

The present study was designed to detect the arrhythmogenic effect of left ventricular hypertrophy, QTc prolongation and the relationship between the QTc duration and ventricular arrhythmias in patients with left ventricular hypertrophy secondary to essential hypertension. Sixty-eight hypertensive patients (51 male and 17 female, mean age 52+/-6 years) and 30 healthy normotensive subjects (22 male and eight female, mean age 49+/-6 years) were enrolled in the study. The frequency of ventricular arrhythmias was investigated with 24-h ambulatory electrocardiographic monitoring and grade 3 and 4 ventricular arrhythmias according to a modified Lown and Wolf classification were accepted as complex arrhythmias. The echocardiographic features of the patients were divided into five groups as follows: (1) normal left ventricular diameter and wall thickness, (2) concentric left ventricular hypertrophy, (3) asymmetric septal hypertrophy, (4) dilated left ventricle, (5) dilated and hypertrophic left ventricle. The frequency of complex ventricular ectopia and the QTc duration were estimated for each group and compared with Student's t-test. Left ventricular hypertrophy was detected in 38 of 68 patients (56%) with essential hypertension. In patients with left ventricular hypertrophy, the incidence of complex ventricular arrhythmias was two- and fivefold higher compared with patients without left ventricular hypertrophy and with controls, respectively. All of the patients with echocardiographic left ventricular dilatation had experienced complex ventricular arrhythmias. QTc duration correlated positively with left ventricular mass index and left ventricular internal diastolic dimension. The highest QTc intervals were detected in patients with left ventricular hypertrophy and complex arrhythmias. In patients with left ventricular hypertrophy, a QTc duration longer than 380 ms had a sensitivity of 74% and a specificity of 89% for detecting complex ventricular arrhythmias. It is concluded that patients with left ventricular hypertrophy have a higher incidence of complex ventricular arrhythmias and QTc prolongation in those patients can be a good marker for the increased risk of arrhythmias.

Echocardiographic features and QT dispersion in borderline isolated systolic hypertension in the elderly.

The aim of our study was to examine the structure of left ventricle, diastolic filling indexes and QT dispersion in elderly patients (aged 60 years and over) with borderline isolated systolic hypertension in a population screening program and to compare them with age matched controls. One hundred and four subjects (66 female, 38 male, mean age 66+/-5) and 110 normotensive age and sex matched controls (64 female, 46 male, mean age 66+/-5) were included in the study. Echocardiographic features of left ventricle, left atrium and cardiac valves, diastolic filling indexes and QT dispersion in 12 lead electrocardiographic examination were studied. In borderline hypertensive elderly, left ventricular hypertrophy was a more frequent finding compared with the controls (33% versus 15% respectively). Diastolic filling indexes were impaired, presence of left atrial enlargement and cardiac valve calcification were also more frequent in the patients group. In the electrocardiographic examination, the duration of QT and corrected QT interval and dispersion of QT and QTc were significantly prolonged compared with the controls. It is concluded that patients with borderline isolated systolic hypertension have more unfavourable echocardiographic and electrocardiographic findings compared with the normotensive elderly and especially those with end organ damage should be treated as defined for isolated systolic hypertension.

Echocardiography and magnetic resonance imaging of sinus of Valsalva aneurysm with rupture into the ventricle.

A 53 year-old man with rupture of sinus of Valsalva aneurysm into the right ventricle diagnosed by two dimensional echocardiography (2DE), magnetic resonance imaging (MRI), and catheterisation study is reported in this paper. Despite the fact that its incidence is low, early diagnosis is very important in this illness because of the possibility of complete cure with surgery. In this study it was shown that MRI as well as 2DE is an excellent diagnostic method for this illness. The diagnosis was also confirmed with surgery in this patient.

Treatment of hypertensive urgencies with oral nifedipine, nicardipine, and captopril.

Sixty-five patients with uncomplicated hypertensive urgencies were treated in the emergency and cardiology departments with 20 mg nifedipine, 20 mg nicardipine, or 25 mg captopril in a randomized study. The study population consisted of 65 patients ranging in age from forty-one to seventy-one. Blood pressure and heart rate were assessed for six hours after intake of the antihypertensive agents. Within sixty minutes nifedipine reduced blood pressure by an average of 74.7 mmHg for the systolic and 35.4 mmHg for the diastolic. Average heart rate increased significantly by 11.6 beats/min at within thirty minutes. Nicardipine and captopril produced equivalent falls in systolic (-81.6 and -79.4 mmHg) and diastolic (-37.3 and -33 mmHg) blood pressure respectively, but did not increase heart rate significantly. The antihypertensive effect of each drug was maintained until six hours after medication. In conclusion, nifedipine, nicardipine, and captopril show similar efficacy in the treatment of hypertensive urgencies. The authors believe that these drugs can be used as first-line therapy in the treatment of hypertensive urgencies safely and effectively.

Cerebral dural sinus thrombosis. A case report.

Cerebral dural sinus thrombosis is an uncommon syndrome that a patient presents with severe headache, which may be associated with complex physical and neurologic findings. The authors present a thirty-two-year-old woman with severe headache, focal motor seizures, and subsequent hemiparesis when she was ten weeks pregnant, diagnosed as having a dural sinus thrombosis by magnetic resonance imaging and magnetic resonance angiography. In this report, the application of magnetic resonance techniques, including angiography to diagnose and monitor therapy for dural sinus thrombosis, is presented.

Prevalence of ventricular premature complexes in healthy and untreated hypertensive elderly people.

Twenty-four-hour ambulatory electrocardiographic examination was performed in 130 elderly patients (49 healthy, active subjects; 40 hypertensive without left ventricular hypertrophy; and 41 hypertensive with left ventricular hypertrophy). In the study group, mean age was 72.4 +/- 7.1 (sixty-five to eighty-eight) years. A significantly high prevalence of ventricular ectopic complexes was found both in hypertensive and in normotensive groups. According to the Lown grades, in grade 1, VPCs had very high prevalence in healthy subjects, in grade 2, VPCs had a high prevalence in hypertensives with left ventricular hypertrophy (73.5% and 48.8%, respectively). The results of this study demonstrate that ventricular premature complexes were common in hypertensive patients and healthy elderly but did not cause high complexity in either group. Ventricular premature complexes detected by ambulatory ECG monitoring in healthy, active subjects and in untreated hypertensive patients are not an independent risk factor in elderly patients.

Tuberculous pericarditis in north-east Turkey. An echocardiographic study.

Twenty patients with tuberculous pericarditis who were referred to the Blacksea Technical University Medical School Cardiology Department from January 1979 to January 1992 were followed for 12-18 months by repeated echocardiography, before and after antituberculous therapy. Initial echocardiograms revealed moderate pericardial effusion in 7 patients (35%), and large effusion in 13 (65%). Thickened pericardium was noted in 2. After medical treatment, at the follow-up period, echocardiography revealed small effusion in only 2, the remaining had no effusion. Despite adequate antituberculous therapy, 6 patients developed pericardial thickening, 3 required pericardiectomy for constriction.

Impact of hemodialysis on comprehensive ventricular repolarization.

Cardiac arrhythmia are one of the most important problems in haemodialysis patients. An important cause of the arrhythmias is inhomogenous myocardial repolarization. In this study, the ventricular repolarization parameters (QT, QTc, JT and JTc) and dispersions (d) of the parameters (QT-d, QTc-d, JT-d and JTc-d) were evaluated. Also were recorded the right-sided leads (RV3-6) and posterior leads (V7-9) in addition to the standard 12 lead ECG to assess comprehensive ventricular repolarization. The leads were divided in three groups: Group A (Standard ECG leads), Group B (Right-sided leads) and Group C (All of the leads). Among the above mentioned parameters, only JT and JTc intervals decreased significantly in all groups. There was no significant difference between the groups in evaluation of the parameters. It was concluded that in assessment of ventricular repolarization, the most important ECG intervals may be JT and JTc intervals, and the standard 12 lead ECG record is sufficient in evaluation of ventricular repolarization in hemodialysis patients.

Cardiac arrhythmias in patients on maintenance hemodialysis.

Cardiac arrhythmias were evaluated in 20 patients (14 males and 6 females; 38.2 +/- 17.6 years) undergoing regular maintenance hemodialysis (HD) for chronic and renal failure (CRF) by Holter ECG monitoring a 24-hour period. Ventricular arrhythmias (VAs) were observed in 18 of 20 patients (90%). Sporadic VAs were recorded in 75% and frequent VAs in 15% of 20 patients. It was found that VAs were correlated with an increase in duration of CRF, but there was no relation with age, duration of HD, frequency of HD, body surface area, the levels of serum sodium, chloride creatinine, phosphorous (P), magnesium, free calcium (Ca), and free fatty acids, Ca x P, cardiothoracic ratio, ejection fraction, fractional shortening, interventricular septum thickness, left ventricular wall thickness, left ventricular end-diastolic dimension and left ventricular end-diastolic index. VAs recorded frequently during HD and for 4 hours after HD. In addition, sporadic supraventricular arrhythmias (SVAs) were observed in 16 patients (80%) and frequent SVAs were recorded in 2 patients (10%). It was concluded that cardiac arrhythmias frequently developed in patients with CRF receiving HD, VAs significantly increase during HD and for 4 h after HD and frequency of VAs may be correlated with duration of CRF and the use of acetate as a buffer in the dialysate.

Hydatid cyst of the interventricular septum and contribution of magnetic resonance imaging.

Cardiac echinococcosis has not been reported frequently. Because of the risk of potentially lethal complications, early diagnosis and definitive treatment are very important. We report a case of a cardiac echinococcal cyst in the interventricular septum. The cyst that caused angina and showed ischemic changes in electrocardiogram was diagnosed by two-dimensional echocardiography and magnetic resonance imaging and was treated surgically.

Impact of hemodialysis on QT interval.

Holter electrocardiographic recordings were performed for 24 hours in 20 patients with chronic renal failure on chronic hemodialysis to evaluate the effects of changes in serum calcium and potassium during hemodialysis period on the QT interval. Hemodialysis caused an increase in serum calcium from a predialysis value of 9.1 +/- 1.3 mg/dl to 11.5 +/- 1.2 mg/dl and a decrease in serum potassium from 5.6 +/- 1.4 mEg/L to 4.9 +/- 1.2 mEg/L. The Q-oTC interval shortened from a predialysis value of 0.240 +/- 0.0023 sec to 0.216 +/- 0.024 sec during the 5th hour of hemodialysis. The Q-eTc interval increased from a predialyse value of 0.391 +/- 0.030 sec to 0.412 +/- 0.024 sec during the 5th hour of hemodialysis. This shortening of Q-oTc interval was correlated with an increase in serum calcium and Q-eTc interval prolongation was correlated with a decrease in serum potassium. It was concluded that hemodialysis caused a lengthening of the Q-eTc interval and a shortening of the Q-oTc interval.