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PubMed2006

Endothelin-1, vascular endothelial growth factor and systolic pulmonary artery pressure in patients with Chuvash polycythemia.

BACKGROUND AND OBJECTIVES: Endothelin-1 has been associated with development of hypoxia-related pulmonary hypertension and vascular endothelial growth factor (VEGF) with protection from this complication. In Chuvash polycythemia, homozygous germline von Hippel-Lindau (VHL) 598C->T leads to up-regulation during normoxia of hypoxia inducible factor-1a and several hypoxia-controlled genes including erythropoietin and VEGF. We postulated that endothelin-1 and pulmonary artery pressure may be elevated in Chuvash polycythemia. DESIGN AND METHODS: Systolic pulmonary artery blood pressure was estimated by Doppler echocardiography and plasma concentrations of endothelin-1, VEGF and erythropoietin were determined in 14 patients with Chuvash polycythemia and 14 controls. Results. Plasma endothelin-1 (p=0.010), VEGF (p=0.022) and erythropoietin (p<0.0005) concentrations and Doppler-estimated systolic pulmonary artery pressures (p<0.0005) were higher in the patients while systolic systemic blood pressures were lower (p=0.001). Five (36%) patients and no controls had mild pulmonary hypertension defined as systolic pulmonary artery pressure (c) 35 mmHg. Among the patients with Chuvash polycythemia, the trends of association of estimated pulmonary artery pressure with plasma concentrations of endothelin-1 (R = +0.236), VEGF (R = -0.389) and erythropoietin (R = +0.220) were not statistically significant. INTERPRETATIONS AND CONCLUSIONS: Estimated systolic pulmonary artery pressure and plasma concentrations of endothelin-1 and VEGF are increased in patients with Chuvash polycythemia patients. The lack of significant associations of estimated systolic pulmonary artery pressure with plasma endothelin-1 and VEGF levels could conceivably be due to the small sample size. Further studies are indicated, especially in view of the reported efficacy of endothelin-1 receptor blockers in treating hypoxia-associated pulmonary hypertension.

Altitude↗
PubMed2005

[Systolic and diastolic left ventricle function assessment by tissue Doppler echocardiography in patients with perfusion defects in SPECT study].

INTRODUCTION: Tissue Doppler imaging (TDI) facilitates the quantitative assessment of the regional systolic and diastolic left ventricle function. Heart scintigraphy (SPECT) facilitates the assessment of regional perfusion of the myocardium. The aim of the study was the evaluation of the correlation between the regional myocardial perfusion defects observed in the SPECT study and the regional systolic and diastolic left ventricle function observed in TDI examination in the ischaemic heart disease patients. MATERIAL AND METHODS: In 40 patients (33 men and 7 women) aged 43-74 years (mean age 56 years) diagnosed of ischaemic heart disease on the basis of coronary angiography, rest TDI examination was performed. Maximal systolic and maximal early-diastolic myocardial velocities were assessed in 13 myocardial segments of the left ventricle, supplied by respective coronary arteries (left anterior descending artery--LAD, circumflex artery--Cx, right coronary artery--RCA). During rest and exercise perfusion scintigraphy of the heart (Tc99 MIBI SPECT) myocardial perfusion was evaluated in the segments analysed previously during TDI study. On the basis of the SPECT examination results the patients were divided into three groups: group I) patients with fixed perfusion defects, group II) patients with exercise-induced perfusion defects and normal rest perfusion, group III) patients with normal perfusion during rest and exercise. RESULTS: Systolic and diastolic myocardial velocity in LAD and Cx supplied segments were significantly higher in group II and group III as compared with group I. Systolic and diastolic velocities of myocardium supplied by LAD were significantly lower in group II as compared with group III. In Cx supplied region the diastolic myocardial velocity was significantly lower in group II as compared with group Ill. CONCLUSIONS: In the left ventricle myocardial regions with fixed perfusion defects, statistically significant decrease of systolic and diastolic myocardial velocities was observed. Moreover, the decrease of diastolic myocardial velocity in the rest TDI examination was found in patients with normal rest perfusion and exercise-induced perfusion defects.

Adult↗
PubMed1991

[Early systolic and pansystolic murmurs--the main variants of the papillary muscle dysfunction in patients after myocardial infarction].

Cardiac auscultation, phonocardiography, and two- dimensional echocardiography were performed in 32 patients who had sustained myocardial infarction in the presence of signs of mitral valve malfunction. Incomplete systolic closure of the mitral valve leaflets was detected in all the patients. The pattern of murmur appeared as its pansystolic and early systolic varieties. Apex rhomboid and late systolic murmurs were found in individual patients. The early systolic murmur was less loud and more frequently local than the pansystolic murmur. Twelve of 15 patients with the murmur proved to have an ++un-enlarged left ventricle. It is concluded that the occurrence of systolic murmur in the papillary muscle dysfunction syndrome is attributed to incomplete closure of the mitral++ valve. Left ventricular dilation results in transition of early systolic murmur to its pansystolic variant.

Adult↗
PubMed1990

[Effects of isosorbide dinitrate on left and right ventricular systolic time intervals in patients after myocardial infarction].

The purpose of the study was to assess effects various doses of isosorbide dinitrate (ISDN) on left and right ventricular systolic time intervals in patients after myocardial infarction. The study population consisted of 25 patients who were eight weeks after their first transmural myocardial infarction. Twelve patients were given 5 mg of ISDN by an intravenous infusion for 60 min, and remaining 13 patients were given 10 mg of ISDN in a similar manner. Subgroups did not differ with respect to their initial arterial blood pressure (mean = 133.3) 82.9 vs 134.3 (87.1 mm Hg) and systolic pulmonary arterial pressure (mean = 27.2 vs 28.8 mm Hg). The infarct localization was also similar. Left ventricular systolic time intervals were calculated noninvasively, whereas right ventricular systolic time intervals were measured from simultaneous electrocardiographic, phonocardiographic and pulmonary arterial pressure tracings. Both left and right ventricular systolic time intervals were determined before and at 15 and 60 min after the drug administration. Student's t-test for unpaired and paired variables was used to test for statistical significance. Changes in the parameters studied at 60 min of the ISDN infusion were greater than at 15 min, and therefore only they are taken into account in the presentation of the results. During a 5 mg infusion of ISDN arterial blood pressure showed a tendency to decrease. Left ventricular ejection time shortened (-3.9%) and the pre-ejection period lengthened (+ 21.9%). The pulmonary artery pressure showed minimal tendency to decrease. The right ventricular systolic time intervals showed a similar tendency but the changes were not significant.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Regression of hypertrophy following nitrendipine: effect on systolic and diastolic function].

The purpose of the present study was to determine whether an antihypertensive treatment with the dihydropyridine nitrendipine can induce regression of severe hypertensive hypertrophy and, whether alterations in systolic and diastolic ventricular function do occur. Eleven patients (age 49 +/- 11 years) with hypertensive hypertrophy were treated with nitrendipine (10-40 mg/day) for 12 months. Before and after therapy left ventricular hypertrophy, systolic, and diastolic function were measured by M-mode, two-dimensional- and digitized M-mode echocardiography. Systolic blood pressure dropped from 185.5 +/- 19.8 to 164.1 +/- 15.6 mm Hg (p less than 0.05). Left ventricular muscle mass was reduced from 234.5 +/- 51.2 to 201.5 +/- 37.9 g/m2 (p less than 0.05). Systolic wall stress (257.2 +/- 50.5 vs 245.2 +/- 44.4 x 10(3) dyn/cm2) and fractional shortening (34.9 +/- 6.1 vs 37.1 +/- 5.4%) remained nearly unchanged. The peak rate of left ventricular internal dimension change during diastole (MLVD), as an index of rapid early diastolic filling was increased (13.1 +/- 3.0 vs 16.5 +/- 3.7 cm/s; p less than 0.01), the relaxation time index, as an index of isovolumic relaxation, remained nearly unchanged (76 +/- 35 vs 64 +/- 24 ms; n.s.). A long-term treatment with nitrendipine regressed hypertensive left ventricular hypertrophy in proportion to blood pressure reduction. While systolic function remained unchanged as a consequence of an unaltered systolic wall stress, i.e. afterload, diastolic filling was markedly improved due to changes in left ventricular geometry through reduction in mass to volume ratio. Since relaxation time index remained nearly unchanged, factors contributing to the phase of isovolumic relaxation were not essentially affected by regression of left ventricular hypertrophy.

Adult↗
PubMed1989

[Echocardiographic parameters and systolic times in arterial hypertension in the elderly].

In 40 subjects, 15 mean age 70.7 +/- 5.6 with systolic-diastolic hypertension, 15 mean age 75.5 +/- 6.8 years with systolic hypertension and 10 mean age 73.6 +/- 5.1 normotensive control group we have analyzed with M-mode 2D echocardiography and echophonocardiography the following parameters: diastolic--EDD--and systolic diameter--SD--of left ventricle, diastolic thickness of septum--SSD--and posterior wall--SPPD--of left ventricle, left ventricular ejection fraction--EF--(Theicholtr. formula), radius posterior wall thickness--R/SPPD--, left ventricular mass--LVM--(Devereux' formula), and systolic time intervals (Q-A2, LVET, PEP and PEP/LVET). The differences between groups are: systolic-diastolic hypertensive patients have increased EDD, SPPD and LVM, reduction of EF and increased PEP/LVET ratio in comparison with B and C groups; systolic hypertension doesn't increase EDD; SSD and PEP/LVET increase, while the EF remains within normal limits. In the healthy aged subjects SSD, SPPD and LVM are normal.

Aged↗
PubMed1988

Impact of systolic blood pressure on cardiovascular prognosis.

Traditionally, diastolic rather than systolic blood pressure has been regarded as the main risk factor for cardiovascular complications in hypertension. While this remains valid for clinical hypertensive emergencies (accelerated and malignant hypertension), it is becoming increasingly clear that the risk of incurring the more distant cardiovascular complications in chronic 'benign' hypertension is associated with the systolic rather than the diastolic component of arterial pressure. Assessment of increased systolic pressure as a risk factor in its own right has been based on three epidemiological approaches. First, the impact of systolic pressure per se was examined by statistical evaluation of prospectively studied populations with different blood pressures. Second, selected subgroups with 'isolated' systolic hypertension were followed up. A third assessment was based on the results of therapeutic trials. All three assessments confirm that systolic pressure is likely to become the main criterion in the evaluation of hypertension, particularly in the elderly.

Aged↗
PubMed1978

[The heart in hypertension. V. Systolic and diastolic wall stress and degree of hypertrophy as determinants of diagnostic and therapeutical consequences (author's transl)].

The appropriateness of hypertrophy was analyzed in 64 patients with essential hypertension during diagnostic cardiac catheterization and left ventriculography. The degree of hypertrophy may be described by the relationships between peak systolic pressure, mass to volume ratio and peak systolic wall stress. The peak systolic wall stress represents an important determinant of the appropriateness of hypertrophy and has great influence on left ventricular function and myocardial energy demand. The hypertrophy in essential hypertension may be subdivided into 3 different types of hypertrophy: (a) inappropriate hypertrophy associated with increased mass-to-volume ratio and decreased systolic wall stress, (b) appropriate hypertrophy with normal systolic wall stress and (c) inappropriate hypertrophy with normal or decreased mass-to-volume ratio, however with significantly increased systolic wall stress. On the basis of the appropriateness or degree of left ventricular hypertrophy in essential hypertension the therapeutical consequences are being discussed with special reference to beta receptor blockade and digitalis glycosides.

Adrenergic beta-Antagonists↗
PubMed1986

Systolic, diastolic, and combined hypertension. Differences between groups.

We used a classification system of systolic, diastolic, and combined (both systolic and diastolic) hypertension to ascertain whether there were significant differences between the groups. The study involved 182 consecutive outpatients for whom no secondary cause of hypertension could be found. There were 96 male and 86 female patients, with a mean age of 45.8 years. There were significant differences in age, with the systolic group being the oldest and the diastolic group the youngest. There were also differences in the prevalence of complications among the categories. Peripheral vascular disease, retinopathy, and coronary artery disease were more prevalent in the systolic and combined groups, while diabetes was more prevalent in the systolic group. We conclude that there appear to be clinical differences between systolic, diastolic, and combined hypertension with respect to presenting characteristics and complications.

Adolescent↗
PubMed1985

[Specificity and normality of peripheral systolic pressure measurement by the ultrasound Doppler technic in healthy angiography-imaged extremities].

Our investigations on 108 healthy extremities, whereby in all cases normality was angiographically proven, demonstrate that the ankle systolic pressure (156.9 +/- 23.8 mmHg) was significantly higher than the arm systolic pressure (140.6 +/- 21.7 mmHg). Blood pressure was not measured at the same time but consecutively. We used the CW-Doppler system. The specificity is 100% if the decided limit is placed at minus 5 mmHg, that is, the ankle systolic pressure lies 5 mmHg, below the arm systolic pressure. A sufficient discrimination is also-evident if the determined normality limit is defined as no difference in pressure or higher systolic pressure in the ankle than in the arm (specifity: 98.1%). With our method we have found differences in the left and right lower extremities in 43.2% of cases. The relation of peak systolic blood pressure of the arm to that of the ankle was not dependent on blood pressure nor age. Our investigation has shown that the diagnostic reliability of the Doppler ultrasonic technique is particularly high.

Adult↗
PubMed1984

[Beneficial effects of coronary transluminal angioplasty on resting left ventricular systolic function].

Resting left ventricular systolic function was studied by cardiac catheterisation before and 6 months after effective transluminal coronary angioplasty (TCA) to evaluate the myocardial effects of this procedure. The global left ventricular systolic function was assessed by measuring ventricular volumes, the ejection fraction, the mean velocity of circumferential fibre shortening (m VCF) and mean normalised systolic ejection rate (MNSER). The regional function was studied by dividing the left ventricle into 8 regions using the Stanford radial model and measuring the percentage shortening and velocity of circumferential fibre shortening (VCF). These parameters were obtained from selective left ventriculography filmed at 100 frames/second in the RAD plane. Left ventricular function was analysed from the whole of systolic ejection and then sequentially during each third of systole (early-mid-and end systole). The 10 patients studied had an average age of 45 years. Coronary angiography was performed for unstable angina (6 cases), stable angina (3 cases) and post-infarction angina (1 case). Except for 1 patient with associated LAD and right coronary disease they all had single vessel disease. TCA was performed on the LAD artery in 8 cases, on a dominant left circumflex artery in 1 case and on a right coronary artery in 1 case. The efficacy was demonstrated by angiographic reduction of the degree of stenosis (85 to 25 p. 100 immediately after TCA, and 30 p. 100 at control angiography at 6 months), and by a reduction of more than 40 p. 100 in the average transstenotic pressure gradient.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1981

[Serum levels of beta-methyldigoxin and contractile efficiency of the myocardium evaluated with systolic polygraphy and determination of cardiac output].

0.3 mg/day betamethyldigoxin was given per os in three daily administrations to 8 healthy subjects, and 8 compensated and 8 decompensated heart patients. Prior to the treatment, and 6 hr after the last administration, blood digoxin values were determined radio-immunologically, together with cardiac output, systolic stroke volume, cardiac index (dilution of indocyanine green), and systolic time intervals, by simultaneous recording of the ECG, carotid pulse, and the phonocardiogram. No significant change in output, stroke volume and cardiac index was noted in the healthy subjects, whereas these parameters were distinctly improved in the decompensated patients. Changes in the systolic intervals after treatment were significant in all cases though there was no significant correlation with the blood digoxin levels reached. In particular, the healthy and compensated subjects displayed a reduction in the corrected electromechanical systole (delta Q-S2), the corrected pre-ejection period (delta PEP), the corrected left ventricular ejection time (delta LVET), and their ratio (PEP/LVET), whereas in the decompensated patients the picture differed to the extent that the LVET increased owing to an augment-systolic stroke volume, the other parameters being reduced. In the healthy subjects, the polygraphic data were normal prior to the treatment, while in the compensated patients delta PEP and the PEP/LVET ratio were enhanced, and the delta LVET was less than in the normal subjects. It is felt that recording of the systolic intervals may be regarded as a sound method, owing to its simplicity and its ability to demonstrate latent cardiac failure before haemodynamic changes appear. Simultaneous determination of serum digoxin and the polygraphic data, therefore, opens the way to the commencement of appropriate, safe and timely management of as yet non-decompensated heart patients.

Adult↗
PubMedDate not supplied

[Chronodynocardiometry in healthy children. 1: Systolic times].

At the National Institute of Pediatry (IMAN) were studied the phonomechanocardiographic recorders obtained of 125 children, all were eutrophic and healthy. The measure of the systolic time intervals were the purpose of the study. Children's age varied from 2 months old to 18 years old; 82 boys and 43 girls. The duration of the R-R space increased according to age (P less than 0.001), the electroacoustic systole and the ejection time showed more duration in older children (r = 0.61 and 0.77 respectively). In opposite, the pre-ejection time as well as its phases, had a similar duration in all ages. Tables of values and ranges of the systolic time intervals according to age are presented. The systolic time intervals were correlated to the R-R space duration, and showed a direct proportion with the electroacoustic systole (r = 0.76) and ejection time (r = 0.83), but the pre-ejection time had not significant changes. The electroacoustic diastole duration was proportional to the R-R space (r = 0.96). The regression equations were calculated to evaluate the normal range of the systolic time intervals in children, obviously in accordance to cardiac frequency.

Adolescent↗
PubMed1981

[Evaluation of systolic motion of the pulmonic valve with special reference to pulmonary arterial pressure and flow velocity (author's transl)].

To predict pulmonary arterial pressure non-invasively, systolic motion of the pulmonic valve was evaluated in relation to flow velocity at the pulmonic valve measured by the electromagnetic catheter-tip flow velocity probe or by linear contrast echo. Seventy-five cases including 45 cases with pulmonary hypertension (PH) of mean pulmonary arterial pressure (PAP) above 25 mmHg were studied. On the basis of the presence and velocity of mid-systolic semi-closure, the reopening and fluttering of the PV, the systolic motion of the pulmonic valve was classified into the following 5 types: 1) rapid semi-closure followed by reopening, 2) rapid semi-closure without reopening, 3) slow semi-closure followed by slow reopening, 4) rough fluttering during whole systole, and 5) rapid opening without semi-closure. Results were as follows: (1) In all cases in which mean PAP was normal, PV motion could be classified as type 5, (2) In 45 PH cases, mean PAP was 50.2 +/- 8.3 mmHg in type 1, 38.4 +/- 5.5 mmHg type 5, mean PAP was 16.3 +/- 11.7 mmHg when 30 normal cases were added. Flow velocity at the PV orifice was maximum in type I and decreased in type 2, 3 and 4 in this order. In type 4, cardiac indices were minimum in all groups of pulmonary hypertension. In conclusion, 1) systolic pulmonic valve motion is of value to predict PAP, and 2) it was suggested that mid-systolic semi-closure of the PV is related to increase in flow velocity at the PV orifice.

Blood Flow Velocity↗
PubMed1995

[4-year mortality of heart failure with intact systolic function: a retrospective studies].

Heart failure with normal systolic function has been recognised in 30-40% of patients investigated for congestive heart failure. The authors undertook a retrospective study of global and cardiovascular mortality at 4 years in two groups of patients with a history of congestive heart failure documented by equilibrium angioscintigraphy: group I (n = 109) with poor left ventricular systolic function (EF = 26 +/- 9%) and group II (n = 40) with normal systolic function (EF = 58 +/- 8%). The 4 year cardiovascular mortality was less in group II (21.6% vs 49%; p < 0.004) whereas the global mortality was comparable in the two groups. The only discriminating parameters for cardiovascular mortality between the two groups were age of more than 60 years and values of diastolic blood pressure exceeding 90 mmHg which were associated with a higher mortality in the group with normal systolic function. These results indicate a better prognosis in terms of cardiovascular mortality from congestive heart failure in patients with normal systolic function compared with those with poor systolic function.

Aged↗
PubMed1995

[Nisoldipine in the treatment of ischemic cardiopathy in the aged. Study of electric systole].

The authors examine the behaviour of electric systole during nisoldipine treatment using doses of at least 10 mg/die in association with modifications of ischemic signs recorded using surface ECG in a series of 70 elderly patients. Patients were subdivided into three groups according to the results obtained from a comparison of real electric systole (QT) with that corrected for ventricular frequency (Qtc), as well as the difference expressed in mean values (VM). 1) Patients with elongated QT. Following nisoldipine treatment this group showed a mean elongation of electric systole of 0.393" +/- 0.025 with a R correlation index between electric systoles before and after treatment of 0.633" which expresses the amplitude of the elongation for each starting QT unit (p < 0.001). The mean value in the two conditions increased from -1.381 +/- 2.111 contraction units to 3.568 +/- 2.697 elongation units and mean deviation was 4.886 +/- 2.170 units with an absolute value of 211.0 units which expresses the elongation of the electric systole in the overall sample compared to calcium antagonists as an iatrogenic phenomenon. Ischemic signs improved or disappeared in 40 out of 44 cases (90.91%) for the T wave and in 36 out of 41 cases (87.80%) for the ST tract. 2) Patients with normalised QT. In 6 cases which showed elongated pretreatment electric systole, it was observed that values became normal passing from a mean of 0.390" +/- 0.40 to 0.377" +/- 0.053. Mean deviation diminished from 3.833 +/- 0.983 units to 1.333 +/- 1.211 units with statistical significance only for paired data in 2 groups (p < 0.001), without correlation.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

[The heart in systolic hypertension].

Among the various forms of systolic hypertension, the primary hyperkinetic heart syndrome (overactivity of the cardiac beta-receptors) and the systolic hypertension in the elderly are the more interesting ones. The former, although involving subjects in the second or third decade of life, is a separate entity from the hyperdynamic phase of primary hypertension. Beta-adrenergic blockade, even at very long-term, is able to normalize all the major features of the syndrome (systolic hypertension, high cardiac output and systolic ejection rate, and variability of the repolarization phase of the electrocardiogram related to changes in the cardiac adrenergic tone). Beta-blockade is not curative and the syndrome reappears as soon as treatment is interrupted. It is a sort of clinical experimental model allowing the following deductions: high cardiac output is able to cause systolic hypertension; its persistence does not promote the development of an elevated systemic vascular resistance; although exposed to some of the stimuli that promote cardiac hypertrophy, such as increased stress of the ventricular wall, very prolonged adrenergic stimulation, activation of the renin system, the syndrome does not evolve towards ventricular hypertrophy. Regarding isolated systolic hypertension in the elderly, the so called de novo and "burned out" hypertension, are currently indicated as the two forms that characterize patients in the seventh and eighth decades of life. Both are interpreted as due to a loss of capacitance of the arterial system. It follows that the great vessels do not propel blood during diastole, thus increasing the hemodynamic burden on the left ventricle, prolonging diastole and delaying relaxation.(ABSTRACT TRUNCATED AT 250 WORDS)

Heart↗
PubMed1995

Prediction of right ventricular ejection fraction by Doppler determination of right systolic time intervals.

OBJECTIVES: This study was designed to evaluate the right ventricular function by means of the determination of right ventricular systolic time intervals measured in pulmonary artery flow detected by Doppler. BACKGROUND: Left ventricular systolic time intervals have been used to evaluate left ventricular performance. There is, however, no information as to whether right ventricular systolic time intervals may be useful in the evaluation of right ventricular function. METHODS: Simultaneous measurements of right ventricular ejection fraction and Doppler determination of right systolic time intervals were made in four pigs in 47 different hemodynamic conditions that permit the modification of the right ventricular ejection fraction from 15% to 68%. The preejection time, the ratio of right preejection time to right ventricular ejection time, with and without correction by the heart rate, were correlated simultaneously to invasively determined right ventricular ejection fraction and other hemodynamic parameters, measured with a modified pulmonary artery catheter with a rapidly responding thermistor. RESULTS: There was a significant linear correlation between Doppler determination of right systolic time intervals and right ventricular ejection fraction. A similar correlation was found for preejection time (r = .80, p < .0001) and the ratio of right preejection time to right ventricular ejection time with correction by the heart rate (r = .83, p < .0001). When we used a preejection time > 70 msec as a criterion to detect a ejection fraction < 40% we found a sensitivity of 89% and specificity of 88%. A preejection time > 80 msec, as criterion of more severe ventricular disfunction (ejection fraction < 30%), displayed a sensitivity of 76% and specificity of 100%. CONCLUSION: These results show that right ventricular systolic time intervals determined by Doppler study correlate significantly with the right ventricular ejection fraction. In view of its simplicity and its accuracy in the prediction of right ventricular ejection fraction, this method may provide useful non-invasive alternative in the prediction of right ventricular ejection fraction.

Animals↗