Left ventricular geometric patterns and QT dispersion in untreated essential hypertension.

The spectrum of left ventricular adaptation to hypertension, different types of hypertrophy patterns, and QT dispersion in different types of hypertrophy was investigated in 107 patients with untreated essential hypertension and 30 age- and gender-matched normal adults studied by 12-derivation electrocardiogram (ECG), two-dimensional, and M-mode echocardiography. Left ventricular mass (LVM), body mass index, total peripheral resistance (TPR), relative wall thickness (RWT), and QT dispersion were found to be statistically significantly higher in the hypertension group (P < .001 for all). Among hypertensive patients, 41.1% had both normal LVM and RWT, here called normal left ventricle in hypertension; 10.3% had concentric hypertrophy with increased LVM and RWT; 14.95% had eccentric hypertrophy with increased LVM and normal RWT; and 32.7% had concentric remodeling with normal LVM and increased RWT. Echocardiographically derived cardiac index was higher in the concentric hypertrophy and eccentric hypertrophy patterns (P = .002 and P < .0001, respectively), whereas TPR was higher in the concentric hypertrophy and concentric remodeling patterns (P = .017 and .02, respectively). QT dispersion values were found to be increased in the hypertensive group (P = .001), whereas similar values were calculated for different types of hypertrophy patterns. We conclude that the more common types of ventricular adaptation to essential hypertension are eccentric hypertrophy and concentric remodeling. Concentric hypertrophy is found to be associated with both volume and pressure overload, whereas eccentric hypertrophy is associated with volume overload only and concentric remodeling is associated with pressure overload. But different left ventricular geometric patterns seem to have similar effects on QT dispersion.

Acromegalic cardiomyopathy: evaluation of the left ventricular diastolic function in the subclinical stage.

It is recently shown that the majority of acromegalic patients without concomitant heart disease have diastolic dysfunction at rest. The aim of this study is to evaluate left ventricular diastolic function in normotensive acromegalic patients without any evidence of heart disease. Eleven acromegalic patients and 16 normal subjects of comparable age and sex distribution were studied by echocardiography. Left ventricular end-diastolic diameter, interventricular septal thickness, left ventricular posterior wall thickness, left ventricular end-diastolic volume and stroke volume were found to be significantly higher in acromegalic patients. Left ventricular mass and left ventricular mass index increased significantly in acromegalics in comparison with controls (229.16 +/- 46.11 g versus 167.17 +/- 24.57 g and 124.99 +/- 26.91 g/m2 versus 95.09 +/- 13.29 g/m2 respectively, p < 0.001). Mitral A wave desceleration rate and isovolumetric relaxation time (IVRT)-two of the studied parameters of left ventricular diastolic filling- were significantly prolonged in patients as compared with controls (p = 0.03 and p < 0.001 respectively). Four (36%) of the acromegalic patients had peak early/late diastolic mitral velocity ratio lower than 1, indicating diastolic dysfunction. All of the patients had IVRT longer than 90 ms (mean + 2 standart deviations of normals). It is concluded that in acromegalic patients without any other evidence of heart disease left ventricular diastolic function is impaired. This indicates a specific cardiomyopathy exists in the subclinical stage. IVRT is found to be more sensitive than other studied parameters for detecting diastolic dysfunction at this stage.

Importance of serum anticardiolipin antibody levels in coronary heart disease.

During the past 10 years it has been shown that some patients with antibodies to phospholipids develop recurrent venous and arterial thromboses, repeated fetal loss, and thrombocytopenia. The aim of this study is to determine the importance of levels of serum anticardiolipin antibodies (ACA) in patients with coronary heart disease (CHD). The study population consisted of 76 CHD patients (Group 1) and 22 healthy subjects (Group 2). Group 1 comprised three subgroups: (1a) 32 patients with acute myocardial infarction (MI), (1b) 22 patients with chronic CHD and a history of MI, and (1c) 22 patients with CHD but without previous MI. Immunoglobulin G anticardiolipin antibodies (IgG ACA) and immunoglobulin M anticardiolipin antibodies (IgM ACA) were detected by ELISA. High IgG ACA levels were found in 36 patients (47%) in Group 1, but no high levels were found in the control group. IgM ACA levels showed no significant difference between the two groups. The ACA (IgG and IgM) levels showed no correlation with age, gender, risk factor profiles, platelet counts, coronary artery lesions, left ventricular function, and morbidity and mortality rates during the follow-up period of 22 months. As a result, measurement of ACA in CHD patients is unlikely to yield information that is diagnostically or prognostically important. The importance of serum anticardiolipin antibody levels in the natural history and prognosis of CHD is still undetermined and remains to be clarified.

The short-term effects of cilazapril on left ventricular diastolic function.

To investigate the short-term effects of cilazapril on left ventricular diastolic functions in patients with essential hypertension, 20 patients with mild-to-moderate essential hypertension were evaluated. Following 2 weeks of placebo washout, all patients underwent blood pressure determination and echo-Doppler ultrasonography recordings. Cilazapril, 2.5 mg, was given to all patients, and blood pressure was determined. Echo Doppler ultrasonography recordings were repeated 3 h after drug therapy. The investigated diastolic function parameters were peak and mean velocities of mitral E and A waves, ratio of peak E to peak A, and acceleration and deceleration rates of E and A waves. Both systolic and diastolic blood pressure changes were insignificant. The E wave peak and mean velocities were significantly increased (p = 0.006 and 0.02, respectively), and the A wave peak and mean velocities were significantly reduced (p = 0.006 and 0.02, respectively) after cilazapril therapy. The ratio of peak E to peak A velocity was also found to be increased following cilazapril therapy (p = 0.006). It is to be concluded that the immediate improvement of left ventricular diastolic functions after cilazapril therapy despite the lack of blood pressure decrease is probably a result of the inhibition of tissue angiotensin-converting enzyme and/or other local humoral factors, but this needs to be further investigated.

The effects of slow-release verapamil on blood pressure and cardiovascular system in essential hypertension.

The study consisted of 26 patients (15 female, 11 male; mean age 43 +/- 10 years) with mild to moderate essential hypertension (EH). They were followed for a 2-week washout period and then for another 2-week single-blind placebo phase. Four patients receiving placebo dropped out of the study. Patients qualified for active medication if their sitting diastolic blood pressures (BPs), the median of three readings, were between 95 and 115 mm Hg at the end of the placebo period. Slow-release verapamil 240 mg was given once or twice daily as the sole antihypertensive agent and was continued for 6 weeks. Two patients (9%) were excluded from the trial due to early side effects. A target diastolic BP of less than 90 mm Hg was obtained in the remaining 20 patients. At the end of the study, the mean value of sitting BP was reduced from an initial 170/103 (125) mm Hg to 130/81 (98) mm Hg (p less than 0.001) and the mean standing BP was decreased from 167/103 (125) mm Hg to 130/81 (98) mm Hg (p less than 0.001). The drug had no significant effects on the laboratory data, left ventricular performance as assessed by echocardiography and systolic time intervals, and the electrocardiogram parameters with the exception of PR prolongation (p less than 0.05). Adverse effects were noted in only three patients (14%). We conclude that slow-release verapamil is an effective, safe, and well-tolerated drug in treating EH.

Acute systolic hypertension after acute myocardial infarction: prognostic and therapeutic significance.

In this study, the incidence of acute systolic hypertension (ASH) after acute myocardial infarction and the effects of this complication on the clinical course and prognosis of the disease were studied retrospectively in 950 cases. ASH was characterized as an elevation of systolic blood pressure over 170 mmHg for at least 30 minutes in a previously normotensive subject. There were 50 cases with ASH (5.3%) and 370 (38.9%) with normal blood pressures among the studied 950. The incidences of acute left ventricular failure and of arrhythmias such as sinus tachycardia, atrial and ventricular premature beats and ventricular tachycardia were significantly higher in the group with ASH in comparison with those with normal blood pressures. The group with ASH had also a greater average number of recurrent ventricular fibrillation attacks. The peak SGOT levels were found to be significantly increased in cases in whom the ASH sustained for more than 12 hours. The results suggested that the ASH which occurred predominantly in the early period of acute myocardial infarction was associated with more extensive myocardial damage resulting in a poor clinical course complicated by frequent ventricular arrhythmias and left ventricular failure. It is our conclusion that ASH after myocardial infraction is associated with relatively poor prognosis.

Prognostic significance of isolated left anterior hemiblock and left axis deviation in the course of acute myocardial infarction.

In 700 patients with acute myocardial infarction admitted to the intensive coronary care unit of our hospital, the incidence and significance of left anterior hemiblock and left axis deviation has been studied in the acute phase of disease. In 102 (14.6%) of the 700 patients, isolated left axis deviation (mean QRS axis-45 degrees) was found and 69 of them (9.9%) met the criteria of left anterior hemiblock. Of the 69 patients with left anterior hemiblock, 61 had acute anterior myocardial infarction, 5 had inferior infarction, and 3 had subendocardial infarction. The anterior hemiblock was transient in 5 patients, but persisted in 64. All patients with and without isolated left anterior hemiblock and left axis deviation were compared statistically with reference to mortality rate and the incidence of arrythmias; no significant difference was noted. However, in patients over the age of 65 and also in those with hypertension, the incidence of left axis deviation was significantly higher (P less than 0.05 and P less than 0.001, respectively). It was concluded that isolated left anterior hemiblock and left axis deviation occurring in the course of acute myocardial infarction no influence on the prognosis of acute myocardial infarction.

Electrocardiographic findings in 24 patients with myasthenia gravis.

Twenty four myasthenia gravis patients, 14 females and 10 males, aged between 5 and 65 years (average 29) were studied electrocardiographically. The abnormalities found in the ECG were: prolonged "Q-T" intervals (10 cases, 44.1%), sinus tachycardias (5 cases, 20.8%), sinus arrhythmias (5 cases, 20.8%), right bundle branch block (4 cases, 16.6%), and non-specific "T" wave changes (2 cases, 8.3%). Among our 24 patients with myasthenia gravis, in contrast to previous reports, only two had non-specific "T" wave abnormalities. But prolonged "Q-T" intervals, right bundle branch block, sinus tachycardias and sinus arrhythmias, when compared to normal population incidence, were found to be quite significant. In pathogenesis, primary myocardial histo-pathological abnormalities, and the role of extracardiac factors in producing the changes were discussed.