Validity of the ECG diagnosis of left ventricular hypertrophy in normotensive and moderately hypertensive men when using the echocardiographic assessment of left ventricular mass index as reference.

The diagnostic validity of ECG criteria for left ventricular hypertrophy (LVH) was assessed in 100 men aged 22-64 (mean 47) years with moderate hypertension (Group 1) and 95 age-matched normotensive men (Group 2) using echocardiographic recordings of LV mass index (MI) as reference. A diagnosis of LVH was made in subjects with LVMI greater than or equal to 125 g/m2. Mean LVMI was 126 +/- 34 g/m2 in Group 1 vs. 100 +/- g/m2 in Group 2 (P less than 0.001), and the prevalence of LVH was 48% and 11% respectively (P less than 0.001). The mean ECG voltage according to Sokolow-Lyon (S-L) was 28 +/- 8 mm in Group 1 and 27 +/- 7 mm in Group 2 (NS); with 19% having LVH in Group 1 and 14% in Group 2 (NS). Using the Cornell criterion Group 1 had on average 15 +/- 6 mm vs. 12 +/- 5 mm in Group 2 (P less than 0.001), but only two Group 1 patients had LVH. In Group 2 a significant negative correlation between age and S-L voltage was found (r = 0.33, P less than 0.001). LVMI was not correlated with any of the two voltage criteria using linear regression analysis whereas multiple regression analysis revealed a weak, but significant correlation between LVMI and S-L voltage in Group 1 (t = 2.06, P = 0.04). No subject had LV strain pattern or LVH according to the Romhilt Estes point score system. In the assessment of possible LVH in normal or moderately hypertensive men less than 65-70 years of age, ECG has limited value.

Correlations between left ventricular mass and systolic blood pressure at rest and during maximal exercise in moderately hypertensive men.

We examined 87 men with moderate hypertension (diastolic blood pressure, DPB, greater than or equal to 95 and less than 110 mmHg) (mean age 45, range 22-64, years) with echocardiography and maximal ergometer bicycle test. Left ventricular mass index (LVMI) was calculated according to the Penn convention. Mean LVMI was 126 (60-210) g/m2. The maximal systolic blood pressure (SBP) during exercise was on average 217 (155-260) mmHg. Linear regression analysis revealed a significant correlation between LVMI and SBP at rest (r = 0.48, P less than 0.001) and during exercise (r = 0.39, P less than 0.001). Multiple regression analysis correcting for differences in age, cumulative work and cholesterol level revealed a significant correlation between LVMI and SBP at rest (t = 4.07, P less than 0.0001) and during exercise (t = 3.25, P = 0.002). Thus in patients with established, moderate hypertension exercise SBP is not more predictable for LVMI than is SBP at rest.

Myocardial scintigraphy with 99mtechnetium stannous pyrophosphate in patients with possible acute myocardial infarction.

Fifty-six patients with a preliminary diagnosis of possible acute myocardial infarction (AMI) were studied on the second or third day after onset of symptoms by 99mtechnetium stannous pyrophosphate myocardial imaging. The scintigraphy was positive in 25 (44.6%). The final clinical diagnoses upon discharge were: definite AMI in 11 with positive scintigraphy in 9 (82%), intermediate coronary syndrome (ICS) in 37 with positive scintigraphy in 15 (40.5%), postinfarction failure in 4 with positive scintigraphy in 1, no diagnosis of coronary heart disease in 4 patients with negative scintigraphy in all. Of the 37 patients with a final diagnosis of ICS, 25 were admitted to the Coronary Care Unit with chest pain as the only symptom. In this group the mean percentage increase in ASAT was significantly higher in 9 patients with positive scintigrams than in 16 with negative. It is therefore assumed that among patients with ICS, a positive scintigraphy may reflect a more serious myocardial injury than a negative scintigram. Of six patients with an acute tachyarrhythmia and ICS, scintigraphy was positive in the three with the most long-lasting or severe arrhythmmias. False negative scintigrams may be seen in some patients with definite AMI.

M-mode echocardiographic findings in apparently healthy, non-athletic Norwegians aged 20-70 years. Influence of age, sex and body surface area.

In order to assess M-mode echocardiographic recordings in a normal Norwegian population, 190 apparently healthy subjects (95 women and 95 men) aged 21-69 years were examined with an Irex Meridian system. Measurements were performed according to criteria recommended by the American Society of Echocardiography. Absolute values for all parameters except for left ventricular (LV) shortening fraction (SF) were greater in men (P less than 0.001). When corrected for body surface area (BSA), the differences between the two genders were far less pronounced. Women had greater left atrium (LA) (P less than 0.01) and LV end-diastolic diameter (EDD) (P less than 0.001), whereas the interventricular septum in end-diastole (IVS-ED) (P less than 0.05) and LV posterior wall (PW) in ED (P less than 0.001) were thicker in men. Only weak correlations between age and the various echocardiographic parameters with r-values less than or equal to 0.30 were observed. It is recommended that BSA corrected values should be preferred since the differences between men and women are negligible. When absolute values are used, different normal ranges for both sexes should be applied.

Is left ventricular mass in apparently healthy, normotensive men correlated to maximal blood pressure during exercise?

In 95 apparently healthy normotensive men aged 21-69 (mean 44) years with supine blood pressure (BP) less than 150/90 mmHg when less than 50 years, and less than 160/95 when greater than or equal to 50 years of age, left ventricular mass (LVM) was measured by M-mode echocardiography and related to maximal BP during a symptom-limited ergometer bicycle test. Mean LVM was 195 (+/- 43) g and LVM index (I) 101 (+/- 20) g m-2 body surface area (BSA). The subjects were subdivided into two groups: Group 1 = 28 subjects (29%) with LVM greater than or equal to 220 g, and Group 2 = 67 subjects (71%) with LVM less than 220 g. Group 1 had a slightly larger BSA (P less than 0.05), weight (P less than 0.05) and resting systolic BP (P less than 0.05). A higher prevalence of smokers (P less than 0.01) and serum cholesterol levels (P less than 0.05) were also noted among Group 1 subjects, who had a higher maximal systolic BP during exercise (P less than 0.0001). Using linear regression analysis, significant positive correlations were observed between LVM and systolic BP at rest (r = 0.20, P less than 0.05), and maximal exercise systolic BP (r = 0.32, P less than 0.001). When correcting for differences in age, weight, body surface area, physical performance, smoking and hours of exercise per week, multiple regression analysis revealed a significant between LVM and maximal systolic BP (t = 2.38, P = 0.020, Partial F = 5.64).(ABSTRACT TRUNCATED AT 250 WORDS)

Changes in left ventricular dimensions and systolic function in 100 mildly hypertensive men during one year's treatment with atenolol vs. hydrochlorothiazide and amiloride (Moduretic): a double-blind, randomized study.

In a randomized double-blind study to compare the effect of atenolol vs. hydrochlorothiazide and amiloride (Moduretic) on left ventricular dimensions and systolic function, 100 hypertensive men were followed up during 1 year of treatment, 50 subjects being randomized to each drug. Echocardiography was performed at baseline, and after 3 and 12 months of treatment. A significant reduction in left ventricular mass with atenolol was paralleled by a decrease in left ventricular wall thickness and an increase in stroke volume. A similar reduction of left ventricular mass with Moduretic without a change in relative wall thickness and a decrease in stroke volume was observed. Cardiac output decreased in both groups.

Detection of mitral regurgitation by Doppler ultrasound. A comparison with left ventricular angiography.

Sixty-four patients with various heart diseases were evaluated for mitral regurgitation (MR) by left ventricular angiography and pulsed Doppler ultrasound within 2-3 days. Adequate Doppler recordings were obtained from 60 patients. The sensitivity of Doppler in detecting MR was 94%, specificity 90% and predictive value for a positive and a negative Doppler examination 90 and 93%, respectively. Two of the 3 false positive Doppler recordings were from patients with coronary heart disease, ischemic papillary muscle dysfunction may have caused MR inconsistently. Two false negative Doppler recordings may be related to problems in placing the ultrasonic sample volume at the systolic retrograde blood stream in the left atrial cavity. It is concluded that pulsed Doppler ultrasound, being a transcutaneous, non-invasive method, is a valuable tool in detecting MR. So far, we have not been able to quantitate the regurgitation.

Doppler ultrasound in mitral stenosis. Assessment of pressure gradient and atrioventricular pressure half-time.

In 16 patients with mitral stenosis (MS), alone or in combination with either mitral insufficiency (2 pats.) or aortic valve disease (3 pats.), the mean diastolic pressure gradients across the mitral valve calculated by Doppler ultrasound were significantly correlated to the catheterization data. The average mean pressure drop by Doppler was 11.8 mmHg and by catheterization at rest 16.7 mmHg. A significant correlation between gradients was also found in 5 patients who exercised supine on a bicycle. Atrioventricular pressure half-time (T1/2), i.e. the time during which the pressure drops from the peak value to half of its initial value by the Doppler technique, was significantly correlated to mitral valve area (MVA) determined from catheterization data. Increasing T1/2 reflected decreasing MVA. It is concluded that Doppler ultrasound is a useful method in the evaluation of patients with MS.

Clinical course in acute self-poisonings: a prospective study of 1125 consecutively hospitalised adults.

The clinical course in an unselected group of 1125 consecutively hospitalised self-poisonings was studied during 1 year in Oslo. Mortality was 0.5%, but only 0.3% in those admitted without cardiac and respiratory arrest. Mortality among those in grade IV coma was 4.2%. The deepest comas (grade III or IV) occurred in 25.1% of the admissions with a mean duration of the coma of 5.8 h (range 1-80). Complications occurred in 21.7% of the admissions and 6.9% suffered more than one complication of which the most frequent were respiratory depression (13.5%), hypotension (5.3%), pneumonia (4.4%), and hypothermia (1.6%). The complication rate was highest in poisonings with opiates (60.7%), meprobamate (37.5%) and antihistamines (30.0%). Arrhythmias and respiratory depression were closely associated with poisonings with antidepressants and opiates, respectively. Owing to frequent polydrug overdoses it was difficult to associate other complications with other main toxic agents. Administration of antidotes (20.6%), cuffed intubation (4.4%) and forced alkaline diuresis (3.4%) were the most frequent special therapeutic measures taken. The change in pattern of self-poisonings in Oslo focuses on antidote therapy and intensive care, especially outside hospital, but limits the need for haemodialysis and haemoperfusion which were performed in only 1.0% of the admissions.

A prospective study of 1212 cases of acute poisoning: general epidemiology.

A prospective multicentre study of all acute poisonings among adults admitted to hospital (n = 1145) or dying outside hospital (n = 67) in Oslo was performed during 1980. Of the 1212 episodes, 98.3% were self-poisonings, giving an annual incidence of 2.8 per 1000 inhabitants (0/00), 3.1 0/00 in males and 2.6 0/00 in females. The main toxic agents among the self-poisoned patients were ethanol (19.7%), benzodiazepines (17.8%), opiates (14.9%), neuroleptics (10.4%) and antidepressants (9.3%). In 58.9% of the episodes more than one toxic agent was taken. Abuse among the self-poisoned patients was significantly (p less than 0.005) more common among males than females (64.2 v. 34.5%). The rate of suicide attempts was significantly (p less than 0.005) higher among females than males (20.2 v. 12.9%), females showing increasing rate with age. However, when excluding abusers the rate of suicide attempts was similar in both sexes (27.6 v. 25.0%). Compared to a reference population self-poisonings were most common in the lower middle and the lowest social classes. Patients in these social classes, however, showed a lower rate of suicide attempts than those in the two highest social classes. Overall mortality was 6.0% (n = 73), but 91.8% of all deaths occurred outside hospital indicating the importance of including these figures when self-poisonings are studied.

Self-poisoning and moon phases in Oslo.

During 1980 the relation between the moon phases and 1187 cases of self-poisonings in Oslo was studied. In contrast to a previous report from India no significant correlation was found between the full moon and self-poisoning. The aetiology of self-poisonings in western countries is rather more complex than to be explained by speculative 'human tidal waves'.