Assessment of left ventricular systolic and diastolic function with Doppler echocardiography in hypertensive patients receiving intravenous medroxalol.

Intravenous medroxalol, an alpha- and beta-adrenergic blocking agent, causes an immediate hypotensive effect. In 14 subjects with mild-to-moderate hypertension, cardiac output (CO) and cardiac index (CI) were significantly decreased without significant changes in stroke volume, reflecting the fact that a reduced CO and CI were related to decreases in heart rate. The vasodilator effect of intravenous medroxalol was not apparent with the dosages used in this study. Transient changes noted in two Doppler diastolic velocity indexes--mitral early diastolic peak flow velocity (PFVE) and the ratio of mitral late-to-early diastolic peak flow velocity (PFVA/E)--are suggestive of an improvement in left ventricular (LV) diastolic filling during medroxalol infusion, possibly related to changes in loading conditions. Systolic and diastolic blood pressure did not correlate with any of the Doppler diastolic and systolic indexes in our patient population. Reduced aortic peak flow velocity, rate of aortic flow acceleration, and the rate of mitral early diastolic deceleration were noted with increasing LV mass index, independent of age or blood pressure. Doppler echocardiography may be a useful tool in the assessment and follow-up of LV systolic and diastolic function in patients undergoing pharmacologic interventions.

Diastolic blood pressure as a determinant of Doppler left ventricular filling indexes in normotensive adolescents.

Alterations in left ventricular filling can occur with aging and in patients with hypertension, ischemic heart disease, congestive and hypertrophic cardiomyopathy and congenital heart disease. This study examines the effects of blood pressure on left ventricular diastolic filling indexes measured by Doppler ultrasound technique in 47 young normotensive adolescents (mean age 13 years). Left ventricular filling was assessed by Doppler peak early and late diastolic transmitral flow velocities, early and late diastolic flow velocity integrals and early diastolic deceleration. Systolic blood pressure did not correlate with any of the Doppler filling indexes, although it was related to echocardiographic left ventricular mass (r = 0.44, p less than 0.005). Diastolic blood pressure did not correlate with left ventricular mass; however, it was inversely related to peak early diastolic flow velocity (r = -0.44, p less than 0.005), early diastolic flow velocity integral (r = -0.40, p less than 0.01) and early diastolic deceleration (r = -0.32, p less than 0.05). The ratio of late to early peak filling (A/E) was directly related to diastolic blood pressure (r = 0.48, p less than 0.001). Examination of electrocardiograms showed that there was a stronger correlation between A/E ratio and diastolic blood pressure (r = 0.63) in 22 subjects with bimodal P waves in lead V1 than in subjects with unimodal P waves (r = 0.45).(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison of ethmozine to propranolol and the combination for ventricular arrhythmias.

A randomized, double-blind, crossover study was performed to evaluate the efficacy and tolerance of ethmozine, propranolol and a combination of ethmozine and propranolol for treatment of ventricular arrhythmias. Twenty-six patients received propranolol, 40 mg, or matching placebo 3 times daily, alone or in combination with ethmozine, 600 to 900 mg/day in 3 equally divided doses, for 1-week periods separated by matching placebo. As determined by 48-hour weekly Holter monitoring, the mean reduction in ventricular premature complex (VPC) frequency was significantly greater with ethmozine (86%) and with ethmozine plus propranolol (90%) than with propranolol (41%) (p less than 0.05). Seventy-five percent of patients had more than a 70% reduction in VPCs with ethmozine plus propranolol, although 70% of patients had an equal degree of suppression with ethmozine alone. Only 2 patients (10%) had the same degree of VPC suppression with propranolol. The results were similar for reductions in pairs of VPCs and VT runs. Two patients discontinued propranolol because of adverse effects, but no patient discontinued ethmozine or combination therapy. Adverse effects were not more frequent with combination therapy. Ventricular function as assessed by echocardiography during drug dosing showed no significant changes from placebo. Ethmozine alone or in combination with propranolol was effective in suppressing VPCs for as long as 1 year in patients who responded. It is concluded that ethmozine alone or in combination with propranolol is well tolerated. Propranolol does not appear to enhance the efficacy of ethmozine.