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PubMed1990

Left ventricular systolic and diastolic function in the hypertrophied ventricle.

To investigate left ventricular (LV) systolic and diastolic function in cardiac hypertrophy, we analysed LV pressure (catheter tip-manometer) and simultaneously performed cineangiography in 24 patients with systemic hypertension (HT), 25 patients with hypertrophic cardiomyopathy (HCM) and 25 normal subjects. We digitized LV cineangiograms frame by frame and computed volume and its derivatives, wall thickness and circumferential wall stress. LV systolic pump function was normal or supernormal in HT and HCM. However, myocardial contractility assessed by end-systolic wall stress-volume relation was depressed in HCM whereas it is normally maintained in HT. LV diastolic function was also impaired in HCM and even in HT despite normal systolic function. The LV hypertrophy group showed significantly prolonged time constant of isovolumic relaxation, increased time from end-systole to the peak filling rate, and upward shift of the diastolic pressure-volume relationship. The characteristic findings of LV diastolic function in LV hypertrophy, therefore, can be summarized as impaired isovolumic relaxation, delayed early diastolic filling and decreased diastolic distensibility. The mechanisms of abnormal systolic and diastolic function may include myocardial ischemia and/or calcium overload in hypertrophied myocardium, but further study will be needed to clarify these problems.

Adult↗
PubMed1991

Clinical assessment of left ventricular systolic function by force-length and stress-shortening relationships.

Left ventricular (LV) systolic function was assessed in patients with hypertensive heart disease (HHD, n = 30), hypertrophic cardiomyopathy (HCM, n = 27), dilated cardiomyopathy (DCM, n = 25), volume overload heart (VOH, n = 31) and normal subjects (NS, n = 32) in the two-dimensional framework of force-length (end-systolic stress-end-systolic volume index) and stress-shortening (mid-systolic stress-ejection fraction). Quadratic discriminant analysis revealed that the ellipses of confidence of HHD and normal subjects were in the same place with regard to both force-length and stress-shortening, while all other groups were well-discriminated. Three subgroups of patients, those with DCM with mild heart failure and those with VOH (with and without heart failure), were easily distinguishable on the basis of stress-shortening, but not on the basis of force-length measurements. It is concluded that LV systolic function and afterload are maintained within the normal range under pressure and volume overload until symptoms of heart failure appear via the mechanism of compensatory hypertrophy. Stress-shortening appears to be a more useful parameter than force-length for the analysis of LV systolic function in clinical practice.

Adult↗
PubMed1995

Left ventricular systolic performance during acute hypoxemia.

STUDY OBJECTIVE: Although some of the cardiovascular responses to hypoxemia are well described, effects on myocardial contractility have not been defined. Such effects are readily assessed by noninvasive techniques and we have therefore evaluated Doppler-phonocardiographic parameters of systolic left ventricular contractility in normal humans rendered hypoxemic. DESIGN: Eight healthy male volunteers were studied. Parameters were measured after resting to achieve baseline haemodynamics, after 20 min moderate hypoxemia (SaO2 85 to 90%), and after a further 20 min of severe hypoxemia (SaO2 75 to 80%). Hypoxemia was induced by breathing a variable N2/O2 mixture. MEASUREMENTS: Pulsed-wave Doppler analysis of ascending aortic blood flow was combined with phonocardiography to measure indices of systolic left ventricular function at baseline and at the end of each period of hypoxemia. RESULTS: There was a significant, dose-related increase in cardiac output in response to hypoxemia, from 5.5 +/- 0.26 L/min at baseline to 6.1 +/- 0.08 L/min during moderate hypoxemia and to 7.0 +/- 0.23 L/min during severe hypoxemia. Likewise, heart rate increased significantly in dose-related fashion although stroke volume was not affected by either level of hypoxemia. Hypoxemia had no significant effects on systolic or diastolic blood pressures, but caused a significant reduction in systemic vascular resistance. Aortic peak and mean acceleration and acceleration time were not affected by moderate or severe hypoxemia. Although the systolic time intervals measured shortened significantly during severe hypoxemia, these were no longer significant when appropriate corrections were made for heart rate. CONCLUSIONS: Although cardiac output increases during hypoxemia, this is due to increases in heart rate but not to any effect on stroke volume. Parameters of left ventricular systolic function and myocardial inotropic state were also not affected by severe hypoxemia. Systolic left ventricular function and myocardial contractility are thus well preserved in normal humans during hypoxemia.

Acute Disease↗
PubMed1982

Factors delaying end ejection from end systole of ventricle.

Although the end of ejection of the left ventricle has been generally accepted as almost synonymous with the end of mechanical systole of the ventricle, recent experimental studies showed the cases in which end ejection lagged markedly behind end systole as identified by the time at which the ventricular pressure-volume data point reached the peak isovolumic pressure-volume relation curve. To obtain a better insight into cardiovascular conditions of the delayed end ejection, a computer simulation study was carried out in which the performance of a time-varying elastance model of the ventricle connected with a modified Windkessel model of the arterial load was analyzed. Any change in the Windkessel parameters, ventricular contractility and heart rate sensitively shifted end ejection relative to end systole. Although end ejection coincided with end systole under limited circumstances, end ejection variably lagged behind end systole undermost circumstances. These results suggest that the interval between end systole and end ejection of the left ventricle in vivo is also variable depending on changes in the arterial loading conditions, ventricular contractility and heart rate.

Cardiac Output↗
PubMed2004

Prevalence, pathophysiology and treatment of isolated systolic hypertension in the elderly.

Isolated systolic hypertension is the predominant type of hypertension in the elderly and is associated with cardiovascular complications such as stroke, coronary heart disease and heart failure. In this review, the role of arterial stiffness, endothelial function, atherosclerosis and oxidative stress in the pathogenesis of isolated systolic hypertension is extensively discussed. Placebo-controlled intervention trials such as the Systolic Hypertension in Europe Trial and the Systolic Hypertension in the Elderly Program have clearly shown that pharmacological treatment of isolated systolic hypertension improves outcome in the elderly. Nevertheless, isolated systolic hypertension remains the major subtype of untreated and uncontrolled hypertension.

Aged↗
PubMed2007

Reduced systolic myocardial function in children with chronic renal insufficiency.

Increased left ventricular (LV) mass in children with chronic renal insufficiency (CRI) might be adaptive to sustain myocardial performance in the presence of increased loading conditions. It was hypothesized that in children with CRI, LV systolic function is impaired despite increased LV mass (LVM). Standard echocardiograms were obtained in 130 predialysis children who were aged 3 to 18 yr (59% boys) and had stages II through IV chronic kidney disease and in 130 healthy children of similar age, gender distribution, and body build. Systolic function was assessed by measurement of fractional shortening at the endocardial (eS) and midwall (mS) levels and computation of end-systolic stress (myocardial afterload). The patients with CRI exhibited a 6% lower eS (33.1 +/- 5.5 versus 35.3 +/- 6.1%; P < 0.05) and 10% lower mS (17.8 +/- 3.1 versus 19.7 +/- 2.7%; P < 0.001) than control subjects in the presence of significantly elevated BP, increased LVM, and more concentric LV geometry. Whereas the decreased eS was explained entirely by augmented end-systolic stress, mS remained reduced after correction for myocardial afterload. The prevalence of subclinical systolic dysfunction as defined by impaired mS was more than five-fold higher in patients with CRI compared with control subjects (24.6 versus 4.5%; P < 0.001). Systolic dysfunction was most common (48%) in patients with concentric hypertrophy and associated with lower hemoglobin levels. CRI in children is associated with impaired intrinsic LV contractility, which parallels increased LVM.

Adolescent↗
PubMedDate not supplied

Ultrasonographic assessment of regional radial and longitudinal systolic function in healthy awake dogs.

BACKGROUND: Strain (St) and strain rate (SR) imaging are new ultrasound modalities based on tissue Doppler imaging (TDI) that allow quantitative assessment of segmental myocardial contraction or stretching and rate of deformation, respectively. HYPOTHESIS: Regional peak systolic St and SR could allow repeatable and reproducible assessment of systolic function of the right (RVW) and left (LVFW) myocardial walls in dogs. ANIMALS: Six healthy Beagle dogs were used to determine the repeatability and reproducibility of regional peak systolic St and SR in the RVW and LVFW (Study 1). These variables were also assessed in 30 healthy dogs of several breeds (Study 2). METHODS: Longitudinal peak systolic St and SR were recorded in 2 segments (basal and apical) of the RVW and LVFW. Radial peak systolic St and SR of the LVFW were also assessed. RESULTS: All within- and most (7/10) between-day coefficients of variation were <15%. Absolute values of the longitudinal deformation indices were significantly higher (P < .001) in the RVW (St = -39.5 +/- 5.5% and SR = -5.2 +/- 0.8 s(-1) at the base; St = -36.3 +/- 4.3% and SR = -4.7 +/- 1.1 s(-1) at the apex) than in the LVFW. Absolute values were also higher for the radial (St = 62.9 +/- 10.4% and SR = 5.8 +/- 1.1 s(-1), P < .001) than for the longitudinal LFVW motions. CONCLUSIONS AND CLINICAL IMPORTANCE: St and SR imaging is a repeatable and reproducible method for assessing systolic myocardial function. The combination of these indices with conventional echocardiographic variables may be useful for screening canine myocardial diseases.

Animals↗
PubMed2003

Prevalence and implications of uncontrolled systolic hypertension.

Risk of cardiovascular disease (CVD) increases incrementally with blood pressure, even within the high-normal range. In the general population, 27% of CVD in women and 37% in men is attributable to hypertension. A high percentage of these hypertension-related events occur in those with high-normal blood pressure and mild hypertension; about one-fourth of CVD events in elderly women and one-third in elderly men in the Framingham Study occurred in persons who had blood pressures of 140-159 mm Hg systolic and/or 90-95 mm Hg diastolic. The average systolic blood pressure (SBP) at which coronary heart disease occurs is rather modest (141 mm Hg), as is the pulse pressure (59-63 mm Hg). Of the CVD events in elderly participants in the Framingham Study, 24% in men and 36% in women occurred in persons receiving treatment for hypertension. There is a growing recognition of the importance of the systolic component of blood pressure. About 65% of hypertension in the elderly is isolated systolic hypertension (ISH), and CVD risk increases with pulse pressure. Pulse pressure is not simply a marker for stiff diseased arteries; treatment of ISH in trials promptly reduces the CVD risk, indicating that the pulse pressure generated by the stiff artery is the culprit. Analysis of data from clinical trials indicates that greater reliance should be placed on systolic pressure in evaluating the CVD potential of hypertension. Hypertension, including ISH, seldom occurs in isolation from other risk factors and overt CVD. Risk varies widely depending on the burden of accompanying risk factors. This makes global risk assessment mandatory for evaluating risk and the urgency and nature of treatment required. Evidence incriminating systolic pressure as the dominant blood pressure determinant of CVD has not been translated into clinical practice. Most of the uncontrolled hypertension observed in the Framingham Study is concentrated in those with ISH. This also extends to African-Americans, people with diabetes mellitus and the elderly. When should SBP be considered controlled? Substantial evidence supports the value of treating ISH with SBP exceeding 160 mm Hg. Trial data are not yet available to support recommendations to treat lesser elevations of ISH or pulse pressure per se, but since one-half of patients with mild ISH have two or more additional risk factors, most are candidates for treatment. In such patients, ISH should be considered controlled when their global CVD risk is reduced to below the average for their age.

Antihypertensive Agents↗
PubMed1996

Influence of dietary fats upon systolic blood pressure in the rat.

Studies were performed to determine whether feeding diets with differing fatty acid content and composition had an influence on systolic blood pressure in the rat. Weanling male rats were fed standard laboratory chow (2.9% fat in total), or synthetic diets (10% fat in total) containing fish oil, butter, coconut oil or corn oil, for 5 weeks. Coconut oil and butter diets were rich in saturated fatty acids, whilst fish oil and corn oil were rich in the n-3 and n-6 unsaturated fatty acids respectively. Systolic blood pressure was measured using an indirect tail-cuff method at the end of the feeding period, and compared to a group of weanling rats. Feeding the different diets did not alter the growth of the rats, so all animals were of similar weights at the time of blood pressure determination. Control (chow fed) animals, at nine weeks of age, had higher systolic blood pressures than the weanling, baseline control group. Fish oil fed rats had similar pressures to the chow fed rats. Corn oil fed rats had significantly lower systolic pressures than the controls. The rats led the diets rich in saturated fatty acids (butter and coconut oil) had significantly higher blood pressures than all other groups. Systolic blood pressure was found to be significantly related to the dietary intakes of saturated and unsaturated fatty acids. The dietary intake of linoleic acid was significantly higher in corn oil fed rats than in other groups. Systolic blood pressure was inversely related to linoleic acid intake. Feeding a diet rich in saturated fatty acids significantly increases blood pressure in the rat. A high intake of n-6 fatty acids, and in particular linoleic acid, appears to have a hypotensive effect. Prenatal exposure of the rats to a maternal low protein diet, abolished the hypertensive effects of the coconut oil diet and the hypotensive effect of the corn oil diet upon young adult females. The intrauterine environment may, therefore, be an important determinant of the effects of these fatty acids on blood pressure in later life.

Animals↗
PubMed1999

Elevated systolic blood pressure as a risk factor for cardiovascular and renal disease.

AIM: To review published literature on the relationship between systolic blood pressure and risk of cardiovascular and renal disease. DATA: identification Studies were retrieved using the MEDLINE database, bibliographies, and the authors' reference files. STUDY SELECTION: Prospective cohort studies and randomized controlled trials which were published in English-language journals. DATA EXTRACTION: All retrieved publications were reviewed by the two authors. Information on sample size, duration, study design, antihypertensive medication, participant characteristics and outcomes was abstracted for randomized controlled trials which reported reductions in systolic blood pressure during intervention. DATA SYNTHESIS: Results from several prospective cohort studies indicate that the association between systolic blood pressure and risk of coronary heart disease, stroke and end-stage renal disease is continuous, graded, and independent. Furthermore, they suggest that the association of systolic blood pressure with these outcomes is stronger than that of diastolic blood pressure. Pooling of the data available from randomized controlled trials indicates that an average reduction of 12-13 mmHg in systolic blood pressure over 4 years of follow-up is associated with a 21% reduction in coronary heart disease, a 37% reduction in stroke, a 25% reduction in total cardiovascular mortality, and a 13% reduction in all-cause mortality. CONCLUSION: Observational epidemiologic studies and randomized controlled trials have demonstrated that systolic blood pressure is an independent and strong predictor of risk of cardiovascular and renal disease.

Adult↗
PubMedDate not supplied

Effect of exercise training upon left ventricular systolic performance and effort capacity in patients with old myocardial infarction.

Recent studies suggested an improving of left ventricular (LV) systolic function during exercise training in patients with old myocardial infarction. Twenty patients with old myocardial infarction (3-6 weeks) were included in an exercise training programme (mainly cycloergometer) for 2 to 8 weeks. Before and after the exercise training programme, the effort capacity and LV systolic function were determined through exercise testing on cycloergometer and echocardiography. The peak effort raised from 4.39 to 5.27 METs (p < 0.05) and the difference DAF-DAM was reduced from 25% to 12% (p < 0.05). The double product (DP) at peak effort raised nonsignificantly (4.91%, p > > 0.05), but at submaximal effort levels DP decreased significantly on each effort step (12.16%, p < < 0.05). In turn, LV systolic function calculated parameters were practically the same before and after the exercise training programme. (EDD 54.3 vs 5.3 mm, ESD 39.3 vs 38 mm, EDV 160 vs 169 ml, ESV 60.6 vs 54.8 ml, EF 54.1% vs 57.8%, SF 27.6% vs 31.2%). It is concluded that exercise training raised the effort capacity in patients with old myocardial infarction, mainly through peripheral mechanisms, LV systolic function being unchanged. It is also important that exercise training have not any detrimental effect upon LV systolic function and consequently exercise training programmes can be applied and can be useful also in patients with old myocardial infarction and impaired LV systolic function.

Adult↗
PubMed2000

Noninvasive estimation of the end systolic pressure-volume relationship using impedance cardiography.

PURPOSE: Traditional measures of cardiac contractility such as dp/dt and ejection fraction has been noted to be sensitive to preload and afterload conditions. The end systolic pressure-volume relationship of the left ventricle (ESPVR, Suga Index or Emax) has been found to be the best load independent measure of the cardiac contractile state. However, determination of the ESPVR requires very highly invasive procedures. Impedance cardiography (IC) is a reliable noninvasive method for calculating stroke volume and may also be useful for estimating the end systolic volume. METHODS: An equation was derived using the systolic time intervals (PEP = pre-ejection period, LVET = left ventricular ejection time) and determined stroke volume (SV) as calculated from the impedance cardiograph to estimate the end systolic volume of the left ventricle. Likewise, and systolic pressure (ESP) was estimated from brachial cuff pressures using a previously published method. The resulting ESPVR was then calculated from tracings recorded in healthy normal subjects and compared to those obtained from patients in decompensated congestive heart failure (ejection fraction < 30% by echocardiogram) using the standard t test (p < 0.05). RESULTS: Using the derived equation (ESPVR = ESP/(SV/(1.125-1.25(PEP/LVET)) - SV), the ESPVR for the normal group of 6 averaged 2.72 +/- 0.71 and was significantly different from the 1.04 +/- 0.45 found in 6 patients with known systolic dysfunction. In a further test of the method, 15 patients who received concurrent echocardiographic and IC evaluations were found to have calculated ESPVR values that significantly correlated with determined ejection fractions (r = 0.83, p < 0.01). CONCLUSIONS: A noninvasive method for estimating the ESPVR that differentiates the myocardial contractile state in the clinically setting was derived using parameters obtained from IC. While further studies are needed to correlate this new equation with invasive measurements, this method has the potential for easily estimating load independent contractility in patients with cardiac dysfunction.

Adult↗
PubMed2001

[Incidence of systolic pulmonary venous flow reversal in patients with mitral valve prolapse: influence of the prolapse site].

OBJECTIVES: Systolic pulmonary venous flow reversal identified by pulsed Doppler echocardiography is useful for the diagnosis of severe mitral regurgitation. The direction of the mitral regurgitant jet in severe mitral regurgitation significantly influences the systolic pulmonary venous flow reversal in an experimental model. This study investigated the influence of the site of mitral valve prolapse on the incidence of systolic pulmonary venous flow reversal in patients with severe mitral regurgitation using transthoracic color Doppler echocardiography. METHODS: This study included 59 consecutive patients with severe mitral regurgitation (regurgitant fraction > 50%) due to mitral valve prolapse. Exclusion criteria were left ventricular ejection fraction < 45%, non sinus rhythms, associated aortic valve disease, bileaflet prolapse, and inadequate Doppler recordings. Right upper pulmonary venous flow was recorded and regurgitant fraction of mitral regurgitation measured by transthoracic color Doppler echocardiography. The sites of mitral valve prolapse were confirmed at operation in all patients. RESULTS: The incidence of systolic pulmonary venous flow reversal was 78% (14/18) in the patients with anterior leaflet prolapse, 82% (9/11) in the patients with medial commissure prolapse, 75% (12/16) in the patients with posterior middle scallop prolapse, 20% (2/10) in the patients with posterior medial scallop prolapse, and 25% (1/4) in the patients with posterior lateral scallop prolapse. There were no significant differences in regurgitant fraction between the five groups. The incidence of systolic pulmonary venous flow reversal was significantly lower in the patients with posterior medial scallop prolapse compared to the other sites of mitral valve prolapse (p < 0.01). CONCLUSIONS: Assessment of the severity of mitral regurgitation by systolic pulmonary venous flow reversal using transthoracic color Doppler echocardiography may be underestimated in patients with prolapse of the posterior medial scallop.

Aged↗
PubMed2001

Systolic and diastolic heart failure--diagnostic and therapeutic dilemmas.

Clinical suspicion of congestive heart failure (CHF) always requires a careful diagnostic workup. This comprises the verification of the presence of CHF (in contrast to other conditions that cause nonspecific phenomena such as shortness of breath and edema), evaluation of the underlying cause of heart failure, and assessment of left ventricular (LV) systolic function. In addition to clinical examination, echocardiography is warranted in most cases. On the basis of this information, patients can be selected for further studies, such as exercise testing, cardiac catheterization and coronary angiography. In view of the serious prognosis of heart failure, especially systolic CHF, the threshold for specialist consultation should be low. Although the classification of CHF into systolic and diastolic forms is complex, clinically meaningful data can be derived simply by determining whether LV systolic function is impaired (predominantly systolic CHF) or not (probable diastolic CHF). In the latter case, treatment is mainly symptomatic in addition to the management of the underlying condition (e.g. hypertension). In systolic CHF, considerable therapeutic advances have recently been made and it is important that patients receive appropriate care to improve their prognosis. These measures include angiotensin-converting enzyme inhibitors, beta-blockers and spironolactone.

Diastole↗
PubMed2003

[Myocardial systolic function of the left ventricle along the long axis in patients with essential hypertension: a study by pulsed tissue Doppler imaging].

OBJECTIVES: Myocardial contractility of the left ventricle along the long axis in hypertensives is not well characterized. The systolic velocities of the left ventricular myocardium along the long axis were measured by pulsed tissue Doppler imaging in patients with mild to moderate essential hypertension. The relationships between the systolic velocity of left ventricular myocardium along the long axis and the blood pressure, and the left ventricular geometry were investigated. METHODS: The study included 60 untreated hypertensive patients (hypertension group) and 59 age-matched healthy subjects (control group). M-mode echocardiograms were recorded, and the relative wall thickness, left ventricular mass index and left ventricular end-systolic stress were calculated. The peak systolic velocities of the left ventricular posterior wall motion (Sw) were measured by pulsed tissue Doppler imaging. RESULTS: The Sw was significantly lower in the hypertension group than in the control group (8.3 +/- 1.9 vs 9.2 +/- 2.0 cm/sec, p < 0.05). The Sw was correlated inversely with systolic blood pressure (r = -0.31, p < 0.005), diastolic blood pressure (r = -0.25, p < 0.0001), interventricular septal thickness (r = -0.41, p < 0.0001), left ventricular posterior wall thickness (r = -0.39, p < 0.0001), relative wall thickness (r = -0.33, p < 0.001), and left ventricular mass index (r = -0.37, p < 0.001) in all subjects. CONCLUSIONS: The systolic velocity of the left ventricular myocardium along the long axis is decreased in patients with mild to moderate essential hypertension, and is negatively correlated with blood pressure and the severity of left ventricular concentric hypertrophy.

Adult↗
PubMed2004

[Method for measuring different phases of left ventricular systole period with ultrasonic Doppler and synchronism electrocardiogram in normal persons].

This study of methodology was aimed to assess the feasibility of measuring different phase of left ventricular systole period with ultrasonic Doppler and synchronism electrocardiogram. We measured the phases of left ventricular systole period and left ventricular volumes in 13 normal persons, using spectrum of aortic valve orifice flow and synchronism electrocardiogram. The values measured by routine method and by Doppler method were compared. The correlation and agreement between the measures ascertained by the two ways were analyzed. The time parameters of end systole of left ventricule showed no significant difference between the two ways (P>0.05); there was high linear correlation between the two parameters (r=0.91, P<0.01); there were good agreements between the two parameters of the two ways by Bland-Altman analysis. The volume parameters of left ventricular systole end showed no significant difference between the two ways (P>0.05); there was high linear correlation between the two parameters (r=0.97, P<0.01); there were good agreements between the two volume parameters of the two ways. The volume in the left ventricular systole end determined by Doppler method and the volume in the left ventricular diastole end determined by the routine method showed no significant difference (P>0.05); there was high linear correlation between the two parameters (r=0.98, P<0.01); there was good agreement between the two volume parameters of the two ways. It is feasible to measure different phases of left ventricular systole period with the combined use of ultrasonic Doppler and synchronism electrocardiogram, and this combinaterial method and the routine method can be replaced with each other according to the clinical setting.

Adult↗
PubMedDate not supplied

Assessment of left ventricular systolic and diastolic function in juvenile rheumatoid arthritis.

BACKGROUND AND AIMS: Recognizing the paucity of data regarding echocardiographic studies of Left ventricular (LV) systolic and diastolic function in patients with juvenile rheumatoid arthritis (JRA), a study was carried out to study these parameters in these subjects. SETTINGS, DESIGN AND METHODS: Thirty-five patients with JRA and an equal number of age- and sex-matched controls were studied by two-dimensional and Doppler echocardiography. RESULTS: Patients with JRA had higher systolic and diastolic blood pressures, resting heart rates, LV systolic (26.9+/-4.3 vs. 22.4 +/- 4.1 mm, p=0.001) and diastolic size (42.3+/-4.6 vs. 35.4+/-3.8 mm, p< 0.001) and volumes. Though ejection fraction (EF) and fractional shortening (FS) were normal, they were lower in those with JRA as compared to controls (EF: 62.9+/-4.47 vs. 67.5+/-3.63 %, p< 0.001; FS: 36.4+/-4.5 vs. 38.5 +/- 6.87, p=0.2). On Doppler analysis the JRA group had lower peak E velocity, higher peak A velocity, higher A VTI and more prolonged IVRT. Male patients had higher A VTI and IVRT as compared to females. Those with longer duration of disease had larger LV systolic (r=0.517, p=0.01) and diastolic dimension (r=0.40, p=0.05) and lower FS (r=-0.506, p=0.01). Patients with polyarticular JRA had higher E and A VTI as compared to those with systemic or oligoarticular types. CONCLUSION: Despite an asymptomatic cardiac status, significant systolic and diastolic functional abnormalities exist in patients with JRA. The duration of the disease, mode of presentation, patient's age and gender have a significant impact on the left ventricular systolic and diastolic functions in patients with JRA.

Adolescent↗
PubMed2005

[Long term prognosis in relation to the presence of systolic heart murmurs in healthy middle-aged men].

BACKGROUND: The long-term prognostic value of systolic murmurs revealed by heart auscultation has previously not been published. In this survey the prognostic value of systolic murmurs has been studied in relation to coronary heart disease and aortic valve operations. MATERIAL AND METHODS: During 1972-75, a cohort of 2014 apparently healthy men (40-59 years) from five companies in Oslo, Norway underwent heart auscultation under standardized conditions. Systolic murmurs were graded from I to VI. The men were prospectively followed up for 21.5 years in order to study the frequency of aortic valve operations, myocardial infarctions and coronary bypass operations. RESULTS: Modest systolic murmurs (grade I-II, n = 441) were associated with an unadjusted relative risk of 5.4 (95% CI 2.1-14.0), and moderate to strong murmurs (grade III-IV: n = 32) with a relative risk of 114.6 (95% CI 44.9-292.1) for aortic valve operation over the course of 21.5 years. The incidence of myocardial infarctions did not show any significant relationship to murmurs. Among those who underwent aortic valve surgery and who had a baseline murmur > or = III, a fourfold increase in bypass operations was observed. INTERPRETATION: Apparently healthy middle-aged men with systolic murmurs grade III or IV revealed by heart auscultation should be followed up carefully with regard to future need for aortic valve surgery. The increased frequency of coronary bypass operations among those with systolic murmur grade III or IV is possibly a result of aortic valve and bypass surgery being performed simultaneously.

Adult↗