Alpha-myosin heavy chain isoform and atrial size in patients with various types of mitral valve dysfunction: a quantitative study.

The cardiac myosin phenotype, an important determinant of myocardial contractility, is modified by chronic increases in hemodynamic load. To quantify the proportion of atrial alpha-myosin heavy chain in various types of left atrial overload and to assess the possible relation between this proportion and atrial size, 34 patients were studied, 4 with Wolff-Parkinson-White syndrome, 29 with various types of mitral valve dysfunction and 1 with an atrial septal defect. Four normal autopsy hearts were also studied. The proportion of alpha-myosin heavy chain among total (alpha plus beta) myosin heavy chains was determined in each atrial sample, using an enzyme-linked immunosorbent assay. The size of the left atrium was assessed by one- and two-dimensional echocardiography. Alpha-myosin heavy chain was the main isoform present in the normal atria (85.5 +/- 9% of total myosin heavy chains). Patients with pure tight mitral stenosis (n = 9), mitral stenosis plus mild regurgitation (n = 8) and severe mitral regurgitation (n = 8), who had a higher indexed left atrial transverse diameter than those with Wolff-Parkinson-White syndrome (33 +/- 6, 39 +/- 10 and 46 +/- 5 versus 19.5 +/- 2 mm/m2, p less than 0.01, p less than 0.001 and p less than 0.001, respectively), also demonstrated a much smaller percent of alpha-myosin heavy chain content (28 +/- 20, 23.5 +/- 13 and 12 +/- 10 versus 58 +/- 18%, p less than 0.01, p less than 0.01 and p less than 0.001, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Noninvasive study of cardiac structure and function after rilmenidine for essential hypertension.

The hemodynamic effects of rilmenidine (S 3341) were evaluated noninvasively by aortic Doppler velocimetry, M-mode echocardiography and phonocardiography in hypertensive patients treated for 28 days. After a 2-week placebo run-in period, patients with mild hypertension (group I, n = 8, mean diastolic blood pressure [BP] = 97.18 +/- 0.65 mm Hg) received 1 mg of rilmenidine each morning and patients with moderate hypertension (group II, n = 6, mean diastolic BP = 107.62 +/- 1.18 mm Hg) received 1 mg twice daily. The hemodynamic variations in both groups after the first administration (day 1) showed that during the first 3 hours, mean arterial pressure and cardiac index (CI) were significantly reduced, whereas total peripheral resistance (TPR) was increased. From the third to the fifth hour, the decrease in mean arterial pressure was maintained, CI was higher than initial values and TPR decreased, indicating a persistent vasodilator effect. On day 28, hemodynamic variations were similar but of a lower amplitude. Before administration on day 28, a significant decrease in systolic and diastolic BP was observed, demonstrating that the antihypertensive activity of 1 mg was maintained for 24 hours, with a significant reduction in TPR and no modification of CI or stroke index. The M-mode and phonocardiographic left ventricular function indexes remained unchanged. Rilmenidine has a prolonged antihypertensive activity with a chronic vasodilator effect and no negative inotropic effect.

[Comparative assessment of cardiac and psychologic results of aortocoronary bypass]. / Evaluation comparative des résultats cardiaques et psychiques du pontage aorto-coronaire.

Two categories of criteria are used to evaluate the cardiological and psychological results of aortocoronary bypass (ACB): objective criteria, which support the clinician's judgement, and subjective criteria, which contribute to the patient's comfort. Numerous studies have revealed major discrepancies between these two modes of evaluation. A prospective study was undertaken to compare the cardiological and psychological results of ACB at 1 year. The study was based on 24 parameters collected in an ordinary cardiology consultation and from an open discussion between the patient and his (or her) partner and a psychiatrist. In the first phase of the study the results observed in 51 patients were classified as "good" in 40 and "poor" in 11 by the cardiologist, as against "good" in 32 and "poor" in 19 by the psychiatrist. The psychiatrist's assessment differed from that of the cardiologist on 22 patients, being better in 7 and not as good in 15. The second phase of the study has been devised to validate the results obtained in the first phase and to evaluate the contribution of ergonometric test to the cardiological classification of 37 new patients. This study makes it possible to analyze the reasons for the difference in assessment of the cardiological and psychological benefits of ACB, and to develop a method for measuring the impact on these results of new therapeutic measures, such as rehabilitation.