[Clinical course, prognosis in patients treated for dilated cardiomyopathy]. / A dilatitiv cardiomyopathia kórlefolyása, prognózisa gondozott betegeken.

Studies on heart failure treatment established the rationale of polypharmacy: it means combined diuretics, digoxin and vasodilators first of all ACE inhibitor therapy. The aim of the study was to evaluate the effect of this therapy on the clinical course of 209 pts with dilatative cardiomyopathy and consecutive moderate--severe heart failure followed by and regularly controlled through 2.5-4 on the average 3 years at specialised out-patient clinic. Analysis of pts history showed the different frequency in occurrence of previous longlasting physical stress, alcohol consumption and viral infection respectively, which might have been the conditioning factors of heart failure. Cardiomegaly was evaluated on the basis of quantitative data of X-ray, and haemodynamic data from radionuclide measurements, that of the clinical course by a score system. The improvement of cardiomegaly and haemodynamic data, were observed in 6 months of treatment. The evaluation of clinical course showed improvement in 61%, and stable condition in 26% of pts in half a year. The rate of pts with improved and stable condition proved the beneficial effect of regular care and combined drug therapy. A similar longterm follow-up study on same large pts population with heart failure has not been published yet in Hungary.

[Evaluation of myocardial perfusion using intravenous contrast echocardiography]. / Myocardialis perfúzió értékelése intravénás kontraszt-echokardiográfia segítségével.

The aim of the study was to assess the accuracy of rest myocardial contrast echocardiography (MCE) in detecting perfusion abnormalities after intravenous contrast administration in chronic coronary artery disease. In 21 patients (mean age 49 years) contrast agent was injected intravenously. ATL HDI 5000 ultrasound machine was used. Triggering every fifth cardiac cycle in end-systole apical 2-chamber, 3-chamber and 4-chamber views were used. All patients underwent thallium scintigraphy on the same day and coronary angiography was performed within 24 hours. Second harmonic imaging and power Doppler were used in assessing presence or absence of perfusion, localization and extent of perfusion defects, and their relation with wall motion. In the first group all the 13 patients after myocardial infarction had akinetic segments on echocardiography in accordance with the coronary occlusion detected by coronary angiography. In the second group none of the 8 patients without previous myocardial infarction had wall motion abnormality. Group I: dividing the left ventricle into 16 segments out of 208 segments 44 were akinetic. Perfusion defect was detected by MCE in 29 segments. In 12 segments with wall motion abnormality the normal myocardial perfusion was consistent with viable myocardium, 2 inferior akinetic segments could not be evaluated due to contrast attenuation and in one inferior segment MCE in contrast to the thallium scintigraphy showed no perfusion defect. Group II: good contrast effect was detected in all 128 segments except one inferior segment in which there was a fixed perfusion defect also by thallium scintigraphy and coronary angiography revealed occluded right coronary artery. In conclusion MCE and second harmonic triggered imaging is comparable with thallium scintigraphy in detecting fixed perfusion abnormalities. MCE may contribute to the detection of viable myocardium.

Hyperthyroidism and the heart: study of left ventricular function in preclinical hyperthyroidism.

To study the response of the target organs to minor increments of thyroid hormone levels, left ventricular ejection fraction (LVEF) the primary indicator of left ventricular function, was measured in patients with preclinical hyperthyroidism and the results were compared with those obtained in euthyroid subjects and in patients with toxic adenoma. In euthyroid subjects and in patients with preclinical hyperthyroidism LVEF in response to exercise involving an isometric static work load revealed a minor increase, whereas in manifest hyperthyroidism (toxic adenoma) an opposite response with an impairment of left ventricular functional capacity was found. The results showed that the pituitary responds more sensitively to minor changes in the circulating thyroid hormone levels than does the heart and indicated that the typical hyperthyroid heart changes associated with the evolution of toxic adenoma develop gradually.

Hypothyroidism and the heart. Examination of left ventricular function in subclinical hypothyroidism.

For revealing whether cardiac performance is changed in subclinical hypothyroidism, the left ventricular ejection fraction (LVEF), a value characterizing left ventricular function, was studied in this clinical state. The results were compared to those obtained in euthyroid subjects and patients with overt hypothyroidism. In a part of subclinical cases, there is a subnormal resting LVEF, which on isometric exercise, increases, but to a lesser extent than in euthyroid controls. In overt hypothyroidism resting LVEF is considerably lower than in euthyroid and subclinically hypothyroid subjects and its value does not respond to exercise. There has been evidence that heterogeneous subclinical hypothyroidism is an intermediate state between euthyroidism and overt hypothyroidism; the majority of patients are euthyroid, a part of them, however, based on systolic time intervals and LVEF studies, are suspect of developing 'tissue' hypothyroidism, although their serum thyroid hormone level is still within normal limits.