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PubMed1988

Isolated systolic hypertension in the elderly.

Results of prospective cohort epidemiological studies in different population groups indicate a constant positive and graded association between the level of systolic blood pressure and subsequent mortality from cardiovascular diseases and stroke, especially with advancing age, and irrespective of the level of diastolic blood pressure. Thus, isolated systolic hypertension in the elderly, defined as systolic blood pressure greater than or equal to 160 mmHg and diastolic blood pressure less than 90 mmHg, is a powerful risk factor for mortality and morbidity. In the Hypertension Detection and Follow-Up Program (HDFP), the multiple logistic analysis of the impact of isolated systolic hypertension on 8-year mortality showed that, in the age group 60-69 years, after adjustment for other factors, there was about a 1% increase in mortality each year for every 1-mmHg increase in systolic blood pressure (P less than 0.05). Similarly, among those screened during the Multiple Risk Factor Intervention Trial (MRFIT), aged 55 years and above, the relative risk of stroke mortality in those with isolated systolic hypertension was 3.0, with a 95% confidence interval of 1.3 to 6.8. The United States National Health Survey data estimate the prevalence of isolated systolic hypertension as 8.5% in the age group 65-74 years. The prevalence of isolated systolic hypertension rises significantly with age (6%, 11% and 18%, respectively in the age groups 60-69, 70-79 and above 80 years). Although treatment of diastolic hypertension in the elderly has been shown to be effective in reducing mortality, no adequate prospective evaluation has yet been completed to determine the efficacy of drug treatment of isolated systolic hypertension. Thus, the question of the efficacy of treatment remains unanswered.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

[Left ventricular function in dilated cardiomyopathy. Noninvasive determination of end-systolic stress-diameter and shortening fraction-stress relations].

The ejection fraction and fractional shortening are parameters of left ventricular function dependent on the conditions of load. They are not perfect indices of myocardial contractility. The study of the relationships between stress and diameter and fractional shortening and stress in end-systole provides a better means of assessing the contractile state of the myocardium. The relationships between end-systolic stress-diameter and end-systolic stress-fractional shortening were studied non-invasively in 10 normal subjects (Group I) and 7 patients with severe dilated cardiomyopathy (Group II). End-systolic longitudinal stress of the left ventricle was calculated from Grossman's formula by coupling automatic measurement of blood pressure (cuff method) with simultaneous M mode recordings guided by 2D echocardiography. The line of regression of end-systolic stress-end-systolic diameter was determined in all cases from a series of 14 points obtained after sublingual administration of 10 mg of isosorbide dinitrate. The line of regression of fractional shortening-end-systolic stress was established in both groups by using the values observed under basal conditions and at the peak of action of the isosorbide dinitrate. The following results obtained: Under basal conditions, patients in Group II had greater end-diastolic diameters (69 +/- 8 vs 49 +/- 4 cm, p less than 0.01), greater end-systolic diameters (61 +/- 8 vs 33 +/- 4 mm, p less than 0.001) and higher end-systolic stress (140 +/- 54 vs 67 +/- 13 10(3) dyn/cm2, p less than 0.001). Fractional shortening was lower in Group II than in Group I (12 +/- 5 vs 33 +/- 5%, p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Interrelationship of left ventricular mass, systolic function and diastolic filling in normotensive morbidly obese patients.

OBJECTIVE: To determine the interrelationship of left ventricular (LV) mass, systolic function and diastolic relaxation in morbidly obese subjects. METHOD: We obtained echocardiograms (M-mode, two dimension) and cardiac Doppler studies (pulse wave, continuous wave colour flow) on 50 subjects whose actual body weight was > or = twice ideal body weight. LV mass/height index was calculated from echocardiographic data (Penn Convention). LV systolic function was assessed by calculating LV fractional shortening. LV diastolic filling was assessed by measuring the transmitral Doppler E/A ratio and the transmitral E wave deceleration time. RESULTS: There were significant positive correlations between LV mass/height index and the LV internal dimensions in diastole, systolic blood pressure, LV end-systolic wall wall stress and the transmitral E wave deceleration time. There were significant negative correlations between LV mass/height index and both LV fractional shortening and the transmitral Doppler E/A ratio. There were significant negative correlations between LV fractional shortening and the LV internal dimension in diastole, systolic blood pressure LV end-systolic wall stress and the transmitral E wave deceleration time. There was a significant positive correlation between LV fractional shortening and the transmitral Doppler E/A ratio. There were significant positive correlations between the transmitral E wave deceleration time and LV internal dimension in diastole, systolic blood pressure and LV end-systolic wall stress. There were significant negative correlations between the transmitral Doppler E/A ratio and the aforementioned variables. CONCLUSIONS: Unfavourable alterations in LV loading conditions contribute to the development of LV hypertrophy and impairment systolic dysfunction in morbidly obese subjects. Increasing LV mass and altered loading conditions may synergistically contribute to impairment of LV diastolic filling in such individuals.

Adult↗
PubMed1995

The influence of preload on post-systolic shortening in ischaemic myocardium.

Post-systolic shortening is a wall motion abnormality defined as shortening of cardiac muscle after the end of ejection and usually regarded as a manifestation of ischaemia. This study was designed to determine whether changes in preload may alter the magnitude of ischaemia-induced post-systolic shortening. Eleven beagles were anaesthetized (halothane 0.8%) and instrumented for measurement of pressures, flows and dimensions in the apical subendocardium supplied by the left anterior descending coronary artery. Myocardial ischaemia was obtained by tightening a micrometer-controlled snare around the left anterior descending coronary artery. Post-systolic shortening, calculated as end-systolic length minus minimum length divided by end-systolic length, was measured at different levels of preload. Increasing the preload from 4 to 17 mmHg caused a significant reduction in post-systolic shortening (8.9% vs. 12.9%, P < 0.05, Student's paired t-test); post-systolic shortening was negatively correlated with coronary perfusion pressure (r = 0.35, P < 0.01) and positively correlated with systolic bulging. This study demonstrates that the amount of post-systolic shortening depends on the volume status, which therefore has to be taken into account in interpreting regional wall motion abnormalities, such as those detected by echocardiography.

Animals↗
PubMedDate not supplied

[Isolated systolic arterial hypertension in the elderly].

Isolated systolic hypertension is a common disorder in the elderly carrying a high risk of stroke and cardiovascular disease. Isolated systolic hypertension is usually defined as a systolic blood pressure greater than or equal to 160 mmHg and diastolic blood pressure less than 95 mmHg. The arterial stiffening is the principal cause of increasing systolic pressure in advanced age. It is due to degeneration of the arterial wall and is associated with progressive arterial dilatation. Hypertension in elderly patients is also characterized by increase of peripheral vascular resistance. Due to the wide variability of blood pressure usually seen in old persons, the isolated systolic hypertension is not easy to recognize and final diagnosis requires a long period of observation. The ambulatory blood pressure monitoring proved to be helpful in distinguishing patients with true isolated systolic hypertension from subjects with exaggerated alarm reaction to the pressure measurement. Although the increased risk of cardiovascular and cerebrovascular mortality is well established for isolated systolic hypertension, there has been much debate whether available antihypertensive treatment can prevent or delay cardiovascular and cerebrovascular complications in this condition. During the last year several large new trials have been published, the so-called STOP-Hypertension, SHEP and MRC trials. All studies have demonstrated that the treatment of isolated systolic hypertension with diuretics or/and beta blockers (frequently used in combination) resulted in a significant reduction in the incidence of stroke and major cardiovascular events. New antihypertensive agents such as calcium channel blockers and angiotensin-converting enzyme inhibitors have also been shown to effectively lower systolic blood pressure in the elderly but the effects on long-term morbidity and mortality are still unknown.

Aged↗
PubMed1975

Late systolic murmur of rheumatic mitral insufficiency.

Of 184 patients with acute rheumatic fever and associated mitral insufficiency encountered during a 15 year period, 34 manifested a mid-late systolic murmur or a nonejection click, or both, during the course of follow-up. The mid-late systolic murmur later disappeared in four patients whose condition is now considered normal. In one of the four, systolic prolapse of the mitral valve was demonstrated on an angiocardiogram obtained when the systolic murmur was present. Since disappearance of the murmur there has been no evidence of systolic prolapse on meticulous echocardiographic study of the mitral valve. In another child with angiographically demonstrated systolic prolapse of the mitral valve the systolic murmur has also disappeared, but systolic prolapse is still evident on echocardiographic study. None of the 34 patients with a mid-late systolic murmur manifested the T wave abnormalities commonly associated with the familial variety of mitral valve prolapse.

Acute Disease↗
PubMed1990

Radial arterial pressure measurements may be a poor guide to the beneficial effects of nitroprusside on left ventricular systolic pressure in congestive heart failure.

The effect of nitroprusside on pressure wave transmission from ascending aorta to radial artery was studied in 10 patients with severe congestive heart failure. Nitroprusside resulted in a beneficial increase in cardiac index, reduction of pulmonary wedge pressure and reductions of aortic and radial arterial mean pressures. In 6 patients with an identifiable late systolic peak of aortic pressure (group I), nitroprusside reduced aortic systolic pressure more than radial systolic pressure, resulting in an increase in the difference between aortic and radial systolic arterial pressure (group I control 13 +/- 4, nitroprusside 20 +/- 6 mm Hg; p less than 0.025). Yet in 4 patients in whom no aortic late systolic pressure wave was apparent (group II), nitroprusside did not alter the difference between aortic and radial systolic pressures. Radial arterial pressure is often used to estimate the effect of nitroprusside on the arterial pressure load on the left ventricle. These results indicate that a reduction of radial systolic pressure induced by nitroprusside may underestimate the true reduction of aortic systolic pressure and thus the effect of the vasodilator on the arterial load on the left ventricle. The enhanced difference between aortic and radial arterial systolic pressures appears to be the consequence of nitroprusside on arterial pressure reflections.

Adult↗
PubMed1991

Superior vena cava flow and tricuspid anular motion after cardioversion of atrial fibrillation, and role of right atrial relaxation on systolic venous return.

To determine whether atrial relaxation or systolic descent of the tricuspid anulus is the predominant factor determining systolic venous return, 22 patients with atrial fibrillation were studied. Venous return (i.e., superior vena cava (SVC) flow) was measured using pulsed Doppler echocardiography. Systolic descent of the tricuspid anulus (i.e., total excursion of tricuspid anulus during systole) was also measured using echocardiography. Serial examinations were performed before and after cardioversion of atrial fibrillation in 15 patients. In 11 patients, both the total excursion of the tricuspid anulus and SVC flow were examined in relation to the ratio of the preceding to the pre-preceding RR interval (R2/R1). Systolic forward flow of SVC increased as the ratio of late diastolic to total excursion of the tricuspid anulus (i.e., right atrial systolic function) increased. It correlated significantly with the ratio of late diastolic to total excursion of the tricuspid anulus but not with total excursion. Total excursion of the tricuspid anulus correlated significantly with R2/R1, but systolic forward flow of SVC did not. These results indicate that atrial relaxation rather than systolic descent of the tricuspid anulus was the predominant factor determining systolic forward flow in the SVC.

Atrial Fibrillation↗
PubMed2005

Determinants of functional capacity in patients with chronic heart failure: role of filling pressure and systolic and diastolic function.

BACKGROUND: Previous work suggesting a better correlation of diastolic than systolic function with exercise capacity in heart failure may reflect the relative insensitivity and load-dependence of ejection fraction (EF). We sought the correlation of new and more sensitive methods of quantifying systolic and diastolic function and filling pressure with functional capacity. METHODS: We studied 155 consecutive exercise tests on 95 patients with congestive heart failure (81 male, aged 62 +/- 10 years), who underwent resting 2-dimensional echocardiography and tissue Doppler imaging before and after measurement of maximum oxygen uptake (peak VO2). RESULTS: The resting EF was 31% +/- 10% and a peak VO2 was 13 +/- 5 mL/kg.min; the majority of these patients (80%) had an ischemic cardiomyopathy. Resting EF (r = 0.14, P = .09) correlated poorly with peak VO2 and mean systolic (r = 0.23, P = .004) and diastolic tissue velocities (r = 0.18, P = .02). Peak EF was weakly correlated with the mean systolic (r = 0.18, P = .02) and diastolic velocities (r = 0.16, P < .04). The mean sum of systolic and diastolic velocities in both annuli (r = 0.30, P < .001) and E/Ea ratio (r = -0.31, P < .001) were better correlated with peak VO2 . Prediction of peak VO2 was similar with models based on models of filling pressure (R = 0.61), systolic factors (R = 0.63), and diastolic factors (R = 0.59), although a composite model of filling pressure, systolic and diastolic function was a superior predictor of peak VO2 (R = 0.69; all P < .001). CONCLUSIONS: The reported association of diastolic rather than systolic function with functional capacity may have reflected the limitations of EF. Functional capacity appears related not only to diastolic function, but also to systolic function and filling pressure, and is most closely associated with a combination of these factors.

Aged↗
PubMed2003

Congestive heart failure with preserved left ventricular systolic function after acute myocardial infarction: clinical and prognostic implications.

AIMS: To characterise the prevalence, in-hospital complications, management, and long-term outcome of patients with congestive heart failure but preserved left ventricular systolic function after acute myocardial infarction. METHODS: 3166 consecutive patients screened for entry in the Bucindolol Evaluation in Acute Myocardial Infarction Trial with definite acute myocardial infarction and echocardiographic assessment of left ventricular systolic function were included between 1998 and 1999 in this prospective observational study. Main outcome measures were occurrences of in-hospital complications and all cause mortality. RESULTS: Congestive heart failure was seen during hospitalisation in 1464 patients (46%), 717 patients had preserved left ventricular systolic function (wall motion index > or =1.3 corresponding to ejection fraction > or =0.40), and 732 patients had systolic dysfunction (wall motion index <1.3). One year mortality in patients with no heart failure, heart failure with preserved systolic function, and heart failure with systolic dysfunction were 6, 22 and 35%, P<0.0001. Unadjusted risk of death from all causes associated with heart failure and preserved systolic function was 3.3 (95% CI 2.8-4.0), and after adjustment for baseline characteristics and left ventricular systolic function in multivariate Cox proportional hazards analysis the risk was 2.1 (95% CI 1.7-2.6), P<0.0001. CONCLUSIONS: Congestive heart failure is frequently present in patients with preserved left ventricular systolic function, and is associated with increased risk of in-hospital complications and death following acute myocardial infarction.

Aged↗
PubMed2003

Myocardial ischemia assessed by Tc99m MIBI SPECT and left ventricle regional systolic and diastolic function evaluated by tissue Doppler echocardiography.

BACKGROUND: Tc99m MIBI single-photon emission computed tomography (SPECT) study facilitates the evaluation of the regional myocardial perfusion and tissue Doppler echocardiography imaging facilitates the quantitative assessment of the regional systolic and diastolic function of the myocardium. The aim of the study was an assessment of the correlation between regional rest myocardial perfusion defects and regional rest systolic and diastolic myocardial velocities in patients with ischemic heart disease (IHD). MATERIAL AND METHODS: In 40 IHD patients (33 men, 7 women) aged 43-74 years (mean 56 years) rest SPECT imaging with Tc99m MIBI and rest tissue Doppler examinations were performed. The control group consisted of 35 healthy sex and age matched pesons. The left ventricle was divided into 13 segments. The number of non-perfused segments in three myocardial perfusion regions (left anterior descending artery, circumflex artery, right coronary artery) was assessed in IHD patients. During tissue Doppler examination the maximal systolic and maximal early diastolic velocity of the myocardium in each segment were established in both examined groups. RESULTS: The systolic and diastolic myocardial velocities were significantly lower in IHD group as compared to control group. In the IHD group statistically significant decrease of systolic and diastolic velocities in relation to the number of non-perfused segments was found. In comparing the linear regression slopes for systolic and for diastolic myocardial velocities in terms of intensification of perfusion defects, a more pronounced decrease in diastolic velocity was encountered. CONCLUSIONS: Both systolic and diastolic myocardial velocities are decreased in the myocardial regions with perfusion defects, but the reduction of the diastolic velocity is higher than the reduction of the systolic velocities. Thus our results indicate a good correlation between the intensity of perfusion abnormalities and myocardial velocities. The levels of diastolic dysfunction is more pronounced than the level of systolic dysfunction in the ischemic myocardium.

Adult↗
PubMed2002

Pulmonary venous systolic flow: influence of gravity on pulmonary venous flow velocities assessed in patients with atrial fibrillation.

The origin of the pulmonary venous (PV) systolic flow wave is still unclear and could be the atrial relaxation and systolic descent of the atrioventricular plane, which decrease atrial pressure (suction) or raised PV pressure. In atrial fibrillation (AF), loss of atrial contraction and relaxation significantly modifies the systolic PV flow wave. The effect of recumbent positional changes on PV, however, has not yet been characterized in AF. The purpose of this study was to evaluate the effect of positional changes on systolic PV flow in patients with AF studied by transesophageal echocardiography. The study group consisted of 45 patients with AF (34 patients with AF, alone, and 11 patients with mitral stenosis [MS]). To assess the influence of left atrial pressure, we included patients with MS and AF. Pulsed wave Doppler transesophageal echocardiography of the left and right upper PV were performed in the left lateral recumbent position in all patients and repeated records were obtained with the subject in the supine position in 25 (AF alone: n = 20, MS: n = 5) of 45 patients. In the left lateral recumbent position, the systolic PV flow velocity and systolic fraction of the left PV, which were recorded on the recumbent subject's lower side, were significantly increased compared with those of the right PV in both AF alone and MS with AF (33.9 +/- 10.8 vs 13.8 +/- 6.4 cm/s, 0.45 +/- 0.09 vs 0.20 +/- 0.10 in AF alone; 30.2 +/- 11.7 vs 14.6 +/- 6.0 cm/s, 0.43 +/- 0.12 vs 0.20 +/- 0.07 in MS, respectively, P < .01). By changing the position from the left lateral to the supine position, systolic PV flow velocity and systolic fraction of the left and right PV became the same (29.3 +/- 8.4 vs 27.9 +/- 8.4 cm/s, 0.39 +/- 0.09 vs 0.36 +/- 0.06 in AF alone, 23.5 +/- 8.8 vs 27.5 +/- 5.0 cm/s, 0.35 +/- 0.08 vs 0.35 +/- 0.09 in MS, respectively). These findings show that the PV volume (hydrostatic pressure) significantly modifies systolic PV flow wave in patients without atrial contraction and relaxation. We should take into consideration the body position on which PV flow is studied.

Aged↗
PubMed2004

Left ventricular systolic dysfunction and atrial fibrillation in older people in the community--a need for screening?

BACKGROUND: Heart failure and stroke are major causes of morbidity and mortality in older people. Angiotensin converting enzyme inhibitors improve symptoms and survival in left ventricular systolic dysfunction. Anticoagulants are effective in stroke prevention in atrial fibrillation with aspirin being a less effective alternative. OBJECTIVES: To determine the prevalence of left ventricular systolic dysfunction, health services utilisation and prescribing of diuretics and angiotensin converting enzyme inhibitors in left ventricular systolic dysfunction, and the prevalence of atrial fibrillation and anti-platelet/thrombotic therapy in atrial fibrillation in older people in the community. METHODS: 500 subjects were drawn by two-stage random sampling from 5,002 subjects aged 70 years and over living at home. Subjects were screened for atrial fibrillation and left ventricular systolic dysfunction using electrocardiography and echocardiography. RESULTS: The population prevalence amongst older people of left ventricular systolic dysfunction was 9.8% and of atrial fibrillation 7.8%. More than two-thirds of those with left ventricular systolic dysfunction were not on angiotensin converting enzyme inhibitors. Of those in atrial fibrillation, 35% were taking aspirin, 24% were taking warfarin and 41% were on neither aspirin nor warfarin. Nearly 90% of older people in the community have had contact with their general practitioner over the past year, and over half of those with left ventricular systolic dysfunction have had contact with hospital-based services over the past 2 years. CONCLUSIONS: Left ventricular systolic dysfunction is under-treated in older people in the community. Despite the high level of contact with hospital and community-based services, the majority of those with systolic left ventricular dysfunction are not on angiotensin converting enzyme inhibitors and a significant proportion of those in atrial fibrillation are not on any treatment for stroke prevention.

Adrenergic beta-Antagonists↗
PubMed2004

Effect of obesity and being overweight on long-term mortality in congestive heart failure: influence of left ventricular systolic function.

AIMS: Previous studies have suggested that a high body mass index (BMI) is associated with an improved outcome in congestive heart failure (CHF). However, the studies addressing this problem have not included enough patients with non-systolic heart failure to evaluate how left ventricular systolic function interacts with obesity on prognosis in CHF. The aim of this study was to evaluate how BMI influences mortality in patients hospitalized with CHF, and to address in particular whether the effect of BMI is influenced by left ventricular (LV) systolic function. METHODS AND RESULTS: Retrospective analysis of baseline and survival data for 4700 hospitalized CHF patients for whom BMI was available. LV systolic function, as assessed by wall motion index was available for 95% of the patients. Follow-up time ranged from 5 to 8 years. In the total population, the risk of death decreased steadily with increasing BMI from the underweight to the obese. Compared with normal weight, and adjusted for sex and age, risk ratios (RR) and 95% confidence limits were: underweight 1.56 (1.33-1.84), overweight 0.90 (0.83-0.97), obese 0.77 (0.70-0.86). Being underweight conferred a greater risk in CHF patients with normal systolic function [RR 1.66 (1.29-2.14), compared with normal weight] than in patients with reduced systolic function [RR 1.11 (0.87-1.42), P for interaction 0.03]. In patients with systolic dysfunction, obesity was associated with increased risk compared with normal weight [RR 1.21 (1.01-1.45)]. CONCLUSION: Increasing BMI in CHF is associated with a lower mortality, but the influence is complex and depends on left ventricular systolic function. Hence, in patients with systolic dysfunction obesity may indicate an increased risk.

Aged↗
PubMed1985

Isolated systolic hypertension in 14 communities.

In the Hypertension Detection and Follow-up Program, 158,906 individuals from 14 communities around the United States had their blood pressure measured in their homes in 1972-1973. Of the total population screened, 2.4% had isolated systolic hypertension (systolic blood pressure greater than or equal to 160 mmHg and diastolic blood pressure less than 90 mmHg). Isolated systolic hypertension was present for 0.5% of those aged 30-39 years and 6.8% among those aged 60-69 years. The prevalence in blacks and women was greater than the prevalences in both whites and men. The prevalence among those taking antihypertensive medications at the time of screening was 6.1%, and 1.9% among those not on antihypertensive medications. From the individuals with "normal" diastolic blood pressure on the single home measurement (less than 90 mmHg), a random sample of 5,032 individuals were followed for mortality for eight years. Prevalence of isolated systolic hypertension was similar in this sample to that in the total. Among those not on antihypertensive medications, 8-year life table all-cause mortality rates adjusted for age, race, and sex were 17.6% for those with systolic blood pressure greater than or equal to 160 mmHg and 7.7% for those with systolic blood pressure greater than 160 mmHg. Among this population, all of whom had a diastolic blood pressure less than 90 mmHg, a multiple logistic analysis adjusting for baseline treatment status, age, race, sex, education, smoking, weight, pulse, physical activity, and systolic blood pressure revealed that each millimeter increase in systolic blood pressure was associated with approximately a 1% increase in mortality over the eight years of follow-up (p less than 0.05). Isolated systolic hypertension is both relatively common and a significant risk factor for subsequent mortality.

Actuarial Analysis↗
PubMed1993

Relationship between blood pressure measured in the clinic and by ambulatory monitoring and left ventricular size as measured by electrocardiogram in elderly patients with isolated systolic hypertension.

OBJECTIVE: To assess the additional diagnostic precision conferred by ambulatory blood pressure monitoring on clinic blood pressure measurement in evaluating the severity of isolated systolic hypertension. METHODS: The association between left ventricular size as determined by ECG voltages [R-wave voltages in lead V5 (RV5) and S-wave voltages in lead V1 (SV1)] and blood pressure as assessed by clinic measurements and ambulatory blood pressure monitoring was studied in 97 elderly patients included in the placebo run-in phase of the Syst-Eur trial. The additional diagnostic precision conferred by ambulatory monitoring on clinic blood pressure measurements was assessed by relating the residual ambulatory blood pressure level to the ECG-left ventricular size. The residual ambulatory blood pressure level was calculated by subtracting the predicted ambulatory blood pressure level for each patient (using the linear regression equation relating both techniques for the group) from the observed ambulatory blood pressure. RESULTS: Clinic systolic blood pressure was on average 20 mmHg higher (P < 0.001) than daytime ambulatory blood pressure while diastolic blood pressure was similar with both techniques. The sum of SV1 + RV5 was significantly related to clinic systolic pressure (r = 0.25), and 24-h (systolic, r = 0.37; diastolic, r = 0.29), daytime (systolic, r = 0.30; diastolic, r = 0.19) and night-time (systolic, r = 0.33; diastolic, r = 0.28) ambulatory blood pressure levels. These findings were not affected by adjustment for gender, age and the body mass index. The sum of SV1 + RV5 was significantly related to the residual 24-h (systolic, r = 0.30; diastolic, r = 0.31), daytime systolic (r = 0.20) and night-time (systolic, r = 0.31; diastolic, r = 0.29) ambulatory blood pressure monitoring levels. CONCLUSION: Ambulatory blood pressure monitoring adds to the diagnostic precision of clinic blood pressure measurement in assessing the severity of hypertension in this population. The ongoing side project on ambulatory blood pressure monitoring in the Syst-Eur study should establish whether these findings hold true for morbidity and mortality.

Aged↗
PubMed1996

Effects of preload on regional nonischemic end-systolic performance.

BACKGROUND: Nonischemic segmental performance, assessed by end-systolic measures of shortening and thickening, decreases during ischemia. These changes in performance are likely to be dependent on the size, and, possibly, the site of the ischemic zone. This study was designed to examine the effect of preload, independently from ischemic zone size, on nonischemic end-systolic performance. METHODS: Twelve beagles were instrumented with sonomicrometers and micromanometer pressure gauges. End-systolic pressure length and thickness relationship data were obtained during vena caval balloon inflation. Control data were obtained both in left anterior descending and in left circumflex regions at left ventricular end-diastolic pressures of 5, 10 and 15 mmHg. The left circumflex artery was occluded for 90 s and nonischemic end-systolic pressure length and thickness data were obtained at each diastolic pressure. A 20 min recovery period was allowed between coronary occlusions. RESULTS: The isovolumic bulge in the ischemic area was more pronounced at an end-diastolic pressure of 5 mmHg than it was at an end-diastolic pressure of 15 mmHg. The slope of the nonischemic end-systolic pressure length and thickness relationships decreased at an end-diastolic pressure of 5 mmHg, whereas at 10 and 15 mmHg the slope of these relationships did not change significantly. The shift in the nonischemic end-systolic pressure-length relationship to the right was more pronounced at a low end-diastolic pressure (5 mmHg) than it was at a high end-diastolic pressure (15 mmHg). Similarly, the extent of the shift in the end-systolic pressure-thickness relationship to the left was more marked at a low end-diastolic pressure than it was at the higher end-diastolic pressure. CONCLUSION: Regional ischemia decreases the end-systolic performance of the nonischemic region. The extent of the shift and the degree to which the slopes of the nonischemic end-systolic relations decrease are influenced by loading conditions.

Animals↗
PubMed1998

Left Ventricular Systolic Function in a Population Sample of Elderly Men.

BACKGROUND: The present study was designed to evaluate the usefulness and discriminatory power of different echocardiographic indices of left ventricular (LV) systolic function in a healthy screening sample of 584 men who were 70 years old. METHODS: Ejection fraction (EF), fractional shortening (FS), stroke index (SI), left ventricular diameter in systole (LVESD), and cardiac index (CI) were evaluated, in addition to LV wall motion score and atrioventricular plane displacement (AVPD). RESULTS: Subjects with hypertension or coronary heart disease (CHD), but not those with diabetes mellitus, showed impairments in EF, FS, LVESD, AVPD, and LV wall motion scores compared with the healthy subjects in the sample (P < 0.01-0.001). SI and CI findings in those with hypertension or CHD were, however, no different from those in the healthy group. The index of LV systolic function that discriminated best between diseased and healthy subjects was LV wall motion score, being correlated with EF, LVESD, and AVPD but only poorly with SI and CI. SI evaluated with use of the Teichholz formula was correlated to LV end-diastolic diameter (r = 0.72, P < 0.0001), whereas the corresponding correlation between SI measured with Doppler (aortic flow) and LVEDD was weak. The difference between the Teichholz and Doppler evaluations of SI was dependent on LV end-diastolic diameter (r = 0.51, P < 0.001) but not on LV systolic function. An index, the systolic two-dimensional index, which takes into account both the longitudinal motion (AVPD) and movement along the short axis (LVESD) during systole, was suggested by the formula AVPD + 5/LVESD. CONCLUSIONS: Impaired LV systolic function was found in both elderly men with hypertension and those with CHD. SI was normal in these groups, however, although overestimated when measured with the Teichholz formula in this population with a large proportion of subjects with LV dilatation. AVPD appears to be applicable in the present population, and a new systolic index consisting of LVESD and AVPD is suggested for the evaluation of LV systolic function in two dimensions.

Journal Article↗