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Biomedical subjects

A Ganau

Publications and source records attributed to A Ganau.

At least 37 records · Page 2Linked to original sources
PubMed1995

Ageing induces left ventricular concentric remodelling in normotensive subjects.

OBJECTIVE: To assess whether age affects left ventricular anatomy independently of age-related hypertension or concomitant heart diseases. DESIGN AND METHODS: In 430 consecutive normotensive and clinically healthy subjects aged 16-85 years we obtained echocardiographic measurements of left ventricular posterior wall thickness, internal diameter, relative wall thickness, Penn mass index and systemic haemodynamics. The pulse pressure : stroke volume ratio was calculated as an estimate of systemic arterial stiffness. The subjects were divided into three age groups: < or = 40 (group 1, n = 137), 41-64 (group 2, n = 261) and > or = 65 years (group 3, n = 32). RESULTS: Systolic blood pressure increased from group 1 to group 3, as did the pulse pressure : stroke volume ratio and posterior wall thickness, whereas the left ventricular internal diameter was less in group 3 than in groups 1 and 2. The relative wall thickness increased from group 1 to groups 2 and 3, whereas the left ventricular mass index did not differ among age groups. Age was related positively to the systolic blood pressure, pulse pressure : stroke volume ratio, posterior wall thickness index and relative wall thickness, and negatively to the left ventricular internal diameter but not to the left ventricular mass index. CONCLUSIONS: In healthy adults, relative wall thickness increases with age whereas left ventricular mass does not change. The concentric remodelling of left ventricular geometry parallels age-related stiffening of the arterial tree, elevation of systolic blood pressure and decrease in left ventricular volume. Thus partition values of relative wall thickness should be adjusted for age.

Adolescent↗
PubMed1994

Assessment of left ventricular function by the midwall fractional shortening/end-systolic stress relation in human hypertension.

OBJECTIVES: This study examined left ventricular performance in relatively unselected hypertensive patients by use of physiologically appropriate midwall shortening/end-systolic stress relations. BACKGROUND: Supranormal left ventricular function has been reported in hypertensive patients, possibly due to an artifact of mismatching endocardial rather than midwall fractional shortening to mean left ventricular end-systolic stress. METHODS: Samples of 474 hypertensive patients (150 women, 324 men) and 140 normal subjects (68 women, 72 men) were drawn from a large urban employed population. The inverse relations (p < 0.0001) of both echocardiographic endocardial and midwall fractional shortening to end-systolic stress in normal subjects were used to calculate the ratios of observed to predicted endocardial and midwall fractional shortening in hypertensive patients. Midwall shortening was calculated from an elliptic model, taking into account the epicardial migration of the midwall during systole. RESULTS: Use of midwall fractional shortening in hypertensive patients reduced the proportion of patients with function above the 95th percentile of normal from 22% to 4% (p < 0.0001) and fractional shortening as a percent of predicted from 107% (p < 0.001 vs. 100% in normotensive control subjects) to 95% (p < 0.0001; p < 0.001 vs. 101% in normotensive control subjects). Midwall shortening was below the 5th percentile of normal in 16% of hypertensive patients instead of 2% with endocardial shortening (p < 0.0001): They tended to be older than other hypertensive patients and had concentric left ventricular hypertrophy. Among hypertensive patients, those with concentric left ventricular hypertrophy or remodeling had reduced midwall shortening as a percent of predicted from end-systolic stress (p < 0.0001). CONCLUSIONS: Use of the physiologically more appropriate midwall shortening/end-systolic stress relation 1) markedly reduces the proportion of hypertensive subjects identified as having high endocardial left ventricular function; and 2) identifies a substantial subgroup of patients with reduced left ventricular function who have concentric geometry of the left ventricle, a pattern associated with high cardiovascular risk.

Adult↗
PubMed1994

Cardiac and arterial hypertrophy and atherosclerosis in hypertension.

Clinical evaluation of the hypertensive patient has traditionally relied on physician measurement of blood pressure and assessment of target-organ involvement by simple laboratory tests. However, this approach is limited in its ability to identify individual patients at high or low risk of complications. In recent years, noninvasive methods have been developed to identify pathological transformations of the heart and arteries that collectively comprise "preclinical hypertensive disease." Measurements by echocardiogram or other methods of left ventricular mass and relative wall thickness identify a spectrum of cardiac adaptations to hypertension, including concentric and eccentric hypertrophy, the recently described pattern of "concentric left ventricular remodeling" (normal mass but increased relative wall thickness), and normal ventricular geometry. In clinical studies, each anatomic pattern is associated with a distinct profile of resting hemodynamics, ambulatory blood pressure, myocardial contractility, and risk of adverse outcomes. Ultrasonic imaging of the carotid or other arteries makes it possible to detect increased arterial wall thickness and discrete atheromas noninvasively. Carotid wall thickness and lumen diameter parallel similar ventricular dimensions in normotensive and hypertensive humans, indicating the presence of integrated patterns of cardiac and vascular adaptation to hypertension. Furthermore, peripheral atherosclerosis is associated with higher ventricular mass and a more adverse 24-hour blood pressure profile. In summary, noninvasive visualization of the heart and blood vessels reveals a spectrum of patterns of anatomic and functional adaptations that are related to the pathophysiology and prognosis of hypertension.

Arteries↗
PubMed1994

Left ventricular hypertrophy and geometric remodeling in hypertension: stimuli, functional consequences and prognostic implications.

OBJECTIVE: To provide a coherent overview of the stimuli to development of abnormal left ventricular geometric patterns, their impact on cardiac function and their relationship to the prognosis of hypertension, studies performed by the authors and other investigators are reviewed. RESULTS: Clinical and experimental studies have shown that an elevated left ventricular mass reflects the additive effects on the heart of higher arterial pressure over time, increased cardiac volume load related to obesity, sodium intake or other stimuli, reduced contractile efficiency of the myocardium and altered arterial hemodynamics related to vascular hypertrophy and atherosclerosis. The heart may adapt to hypertension by developing concentric or eccentric left ventricular hypertrophy, or the newly described pattern of concentric left ventricular remodeling, or by retaining normal left ventricular geometry. Each geometric pattern is associated with a distinct combination of pressure and volume stimuli, contractile efficiency (reduced in those with concentric left ventricular hypertrophy or remodeling) and prognosis (worst with concentric hypertrophy and best with normal left ventricular geometry). An appraisal of left ventricular mechanics by a physiologically appropriate midwall-shortening/end-systolic stress relationship can identify impaired contractility in an appreciable proportion of hypertensive patients. Numerous studies have shown that increased left ventricular mass and abnormal geometry have a strong predictive value for cardiovascular death, myocardial infarction and stroke. CONCLUSIONS: Increasing evidence has demonstrated the central importance of left ventricular mass and geometry in the pathophysiology and prognosis of hypertension. These measures of preclinical disease can aid clinical decision-making by separating patients into those with a high or a relatively low risk, and hence a need for pharmacological treatment or its intensification, as well as providing useful bioassays for a spectrum of clinical and experimental research.

Humans↗
PubMed1994

Evaluation of left ventricular hypertrophy by M-mode echocardiography in patients and experimental animals.

In validation studies, M-mode echocardiography has been shown to measure left ventricular (LV) mass with reasonable accuracy (r > or = .90 v necropsy measurements) in species ranging in body size from humans to rats. The sensitivity of antemortem echocardiography for the detection of necropsy LV hypertrophy as a qualitative abnormality has also been high (85% to 100%). Increased LV mass is strongly related to both increased blood pressure and to being overweight or to other causes of increased cardiac volume work. LV mass is also increased in the presence of exaggerated blood pressure responses to everyday activity, high sodium intake and blood viscosity, and genetic factors predisposing to hypertension. Indexation of LV mass by body surface area or height has advantages for the detection of hypertrophy related to hypertension or obesity. Indexation of LV mass for the power of its relation to height (2.7) revealed by analysis of growth (allometric) relations may accomplish both these goals. Recent research indicates that the level of LV mass measured by M-mode echocardiography is a stronger predictor of subsequent morbid events and death than blood pressure or other conventional risk factors except age. Preliminary findings of close relations between LV mass and arterial disease and between the change in LV mass during antihypertensive treatment and subsequent events contribute to explaining the strong predictive value of LV mass.

Adult↗
PubMed1993

Relation of arterial pressure waveform to left ventricular and carotid anatomy in normotensive subjects.

OBJECTIVES: The purpose of this study was to examine the relation of the central arterial pressure waveform to left ventricular and carotid structure. BACKGROUND: The pressure waveform in the central arteries is affected by reflection of the pressure wave from the periphery. When reflected waves merge with the incident wave during systole, a late systolic peak and increment in systolic blood pressure are observed. The consequent increase in hemodynamic load may stimulate left ventricular and vascular adaptive changes. METHODS: Sixty-seven normotensive adults were studied by noninvasive techniques. Anatomy and function of the left ventricle and carotid artery were investigated by ultrasonography. Pressure waveforms were recorded by an external tonometer applied to the carotid artery, and waveform shape was expressed by the augmentation index, calculated from the difference between the maximal systolic pressure and that at the inflection between early and late systolic pressure peaks divided by the pulse pressure. Subjects were assigned to groups with a dominant early (group 1, augmentation index < or = 0) or dominant late systolic peak (group 2, augmentation index > 0). RESULTS: Left ventricular mass index was significantly higher in group 2 than in group 1, a difference that persisted after controlling for the confounding effects of gender, age and blood pressure. Carotid wall thickness and regional arterial stiffness were significantly increased in group 2, but differences disappeared in the analysis of covariance for age. CONCLUSIONS: Left ventricular and carotid artery structure are related to the shape of the central pressure waveform. Although the increase in left ventricular mass seen in subjects with a dominant late systolic peak pressure appears to be directly related to the shape of the pressure waveform, changes in the structural and physical properties of the carotid artery appear to be more closely related to the aging process.

Aging↗
PubMed1993

Left ventricular hypertrophy associated with hypertension and its relevance as a risk factor for complications.

Recent research indicates that the level of left ventricular (LV) mass, commonly measured by echocardiography, reflects the combined effects of a variety of factors involved in the pathophysiology of hypertension, including obesity, blood pressure responses to everyday activity, high sodium intake and blood viscosity, the volume work load of the heart, and genetic factors predisposing to hypertension. Prospective studies indicate that LV mass is a stronger predictor of subsequent morbid events and death than blood pressure or other conventional risk factors except age. Preliminary findings of close relations between LV mass and arterial disease and between the change in LV mass during antihypertensive treatment and subsequent events contribute to explaining the strong predictive value of LV mass. Further research is needed to clarify the biologic basis of these observations and to determine whether stratification of hypertensive patients based on their level of LV mass can improve the treatment of hypertension.

Cardiovascular Diseases↗
PubMed1993

Left ventricular hypertrophy and hypertension.

The level of left ventricular (LV) mass as measured by echocardiography or other techniques in hypertensive patients reflects the integrated effects of the level of arterial pressure, the concomitant volume load imposed on the heart, and of alterations in arterial waveform morphology as well as of body size and non-hemodynamic variables. The LV may respond to these stimuli by concentric or eccentric hypertrophy or by the recently-described pattern of concentric remodeling, in which LV mass is normal but relative wall thickness is increased. The are strong parallelisms between increases in cardiac and systemic arterial wall thicknesses, and patients with discrete atheromas detectable by carotid ultrasound have elevated LV masses. Patients with eccentric and concentric LV hypertrophy have two to four-fold increases in the incidence of cardiovascular morbid events compared to hypertensive patients with normal LV geometry, and the change in LV mass during treatment has been associated with the risk of subsequent morbidity in initial studies. In contrast to the strong predictive power of LV geometric assessment, use of indirect measures of target organ status in the WHO system for classification of the severity of hypertension does not improve on the prediction of prognosis that can be obtained by consideration of the level of arterial pressure. Current evidence suggests that evaluation of LV geometry may contribute to improved clinical decision-making in situations where more precise stratification of risk would clarify whether or not to institute treatment, or whether it should be with drugs or non-pharmacologic measures.

Adaptation, Physiological↗
PubMed1993

[Echo-flowmetric control 6 years after percutaneous treatment of varicocele].

Several Authors have discussed the long term efficacy of sclerotherapy; somebody supposes that percutaneous angiographic treatment of spermatic vein is not sure at all because the occlusion due to the sclerosing agents is not retained as long lasting. Studies have been done by other Authors about comparison of recurrent varicocele anatomy following surgery and percutaneous balloon occlusion: it is concluded that venous collaterals are identified easily by renal venography, and knowledge of these collaterals is helpful in planning further radiological treatment. Since 1980 we have always treated left varicocele by means of percutaneous sclerotherapy of the spermatic veins following renal phlebography: the treatment is done on an outpatient basis, in local anaesthesia. Sclerosing agents we usually adopt are: sodium-tetradecyl sulphate and alcohol. At our knowledge long-term results of this treatment have never been published; this is the reason for which long-term follow-up of 27 patients that 6 years ago underwent percutaneous sclerotherapy was done. Only 16 of them have accepted to repeat: a) physical examination; b) Doppler flowmetry; c) scrotal ultrasound. The presence of a varicocele was demonstrated in 2 out of 16 patients (12.5% of the case). These data confirms that percutaneous treatment performed following the procedures we adopted in 1986 has a long term efficacy in 87.5% of the cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

Familial insulinoma: description of two cases.

We describe cases of isolated functioning insulinoma occurring in two members of the same family (father and daughter). The father had a first encapsulated insulinoma diagnosed at 14 years of age and at the age of 33 years he was operated on for a second insulinoma infiltrating the exocrine pancreas with lymph node metastases. The daughter was operated on for an encapsulated insulinoma in the tail of the pancreas when she was 6 years old. No clinical and laboratory signs of other endocrine disturbances have so far been detected in either care or in any other members of the family. Our report suggests the possibility of multiple familial insulinoma, although this is an extremely rare condition. Our data also indicate that insulinomas, even if well controlled by medical treatment, should always be removed by surgery because malignancy cannot be excluded with certainty. Moreover, patients should be closely followed up, as recurrence may develop up to 15 years after surgery.

Adolescent↗
PubMed1992

Patterns of left ventricular hypertrophy and geometric remodeling in essential hypertension.

The spectrum of left ventricular geometric adaptation to hypertension was investigated in 165 patients with untreated essential hypertension and 125 age- and gender-matched normal adults studied by two-dimensional and M-mode echocardiography. Among hypertensive patients, left ventricular mass index and relative wall thickness were normal in 52%, whereas 13% had increased relative wall thickness with normal ventricular mass ("concentric remodeling"), 27% had increased mass with normal relative wall thickness (eccentric hypertrophy) and only 8% had "typical" hypertensive concentric hypertrophy (increase in both variables). Systemic hemodynamics paralleled ventricular geometry, with the highest peripheral resistance in the groups with concentric remodeling and hypertrophy, whereas cardiac index was super-normal in those with eccentric hypertrophy and low normal in patients with concentric remodeling. The left ventricular short-axis/long-axis ratio was positively related to stroke volume (r = 0.45, p less than 0.001), with cavity shape most elliptic in patients with concentric remodeling and most spheric in those with eccentric hypertrophy. Normality of left ventricular mass in concentric remodeling appeared to reflect offsetting by volume "underload" of the effects of pressure overload, whereas eccentric hypertrophy was associated with concomitant pressure and volume overload. Thus, arterial hypertension is associated with a spectrum of cardiac geometric adaptation matched to systemic hemodynamics and ventricular load. Concentric left ventricular remodeling and eccentric hypertrophy are more common than the typical pattern of concentric hypertrophy in untreated hypertensive patients.

Adaptation, Physiological↗
PubMed1991

Gender differences in left ventricular anatomy, blood viscosity and volume regulatory hormones in normal adults.

Gender differences in left ventricular (LV) anatomy, whole blood and plasma viscosity, and blood volume regulatory hormones were studied in 110 normotensive employed adults (28 black and 34 white men [mean age 51 +/- 12 years], 20 black and 28 white women [mean age 53 +/- 12 years]). LV mass and wall thicknesses were positively related to whole blood viscosity, primarily because of higher values of both variables in men. LV chamber size was inversely related to hematocrit and to blood viscosity (p less than 0.002) in women but not in men. Whole blood viscosity increased with age in men (p less than 0.01), but tended to decrease in women; older women also had better LV function, larger LV chambers, and a trend toward increasing LV mass. Atrial natriuretic factor increased with age in women but not in men (r = 0.60, p less than 0.001), and plasma renin activity decreased (r = -0.35, p less than 0.02). Thus, in women, increase in LV chamber size with age and associated changes in LV systolic function, atrial natriuretic factor levels and plasma renin activity suggest plasma volume expansion related to the aging process. These findings also suggest that an increase in LV volume load with age may contribute to previously reported increases in LV mass in older women.

Adolescent↗
PubMed1991

A case of hyperglycemic hyperosmolar non-ketotic coma during anesthesia: a possible cause of failed re-awakening.

The case of a non diabetic 6-year-old boy affected by Down's syndrome, who developed hyperosmolar hyperglycemic non-ketotic coma following the infusion of hypertonic dextrose solution during general anesthesia for a surgical procedure for cryptorchidism is reported. Following surgery, the patient remained deeply comatose and generalized seizures occurred. Hyperosmolarity due to hyperglycemia and acidosis were reduced by administration of insulin at low rate, hypotonic saline and sodium-bicarbonate solutions. The patient's clinical conditions promptly improved following normalization of blood glucose levels. An oral glucose tolerance test performed three months later was normal. The authors emphasize the potential risk of hyperosmolar hyperglycemic non-ketotic coma also in non diabetic patients treated with hypertonic dextrose solutions, during surgery events.

Anesthesia, General↗
PubMed1990

The relationship between 'job strain,' workplace diastolic blood pressure, and left ventricular mass index. Results of a case-control study.

To determine whether "job strain" (defined as high psychological demands and low decision latitude on the job) is associated with increased workplace diastolic blood pressure and the left ventricular mass index, we conducted a case-control study at seven urban work sites of 215 employed men aged 30 to 60 years without evidence of coronary heart disease. After comprehensive blood pressure screening of male employees (N = 2556) at the work site, 87 cases of hypertension and a random sample of 128 controls were studied. In a multiple logistic regression model, job strain was significantly related to hypertension, with an estimated odds ratio of 3.1, after adjusting for age, race, body-mass index, type A behavior, alcohol intake, smoking, work site, 24-hour urine sodium excretion, education, and physical demand level of the job. Controlling for the above variables in subjects aged 30 to 40 years with job strain, we found that the echocardiographically determined left ventricular mass index was, on average, 10.8 g/m2 greater than in subjects without job strain. We conclude that job strain may be a risk factor for both hypertension and structural changes of the heart in working men.

Adult↗