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At least 883 records · Page 49Linked to original sources
PubMed2000

Changes in left ventricular function after cardiac arrest and reperfusion in hypertropheral hearts.

Hypertrophied hearts may be more susceptible to ischemia/reperfusion during cardiac surgery than normal hearts, so we designed to compare the alterations in left ventricular function after ischemia/reperfusion, in hypertrophied hearts (Group H) with those in normal hearts (Group C), using a rabbit heart model of hypertrophy induced by banding of the ascending thoracic aorta. The pre and postischemic left ventricular developed pressure (LVDP), left ventricular end-diastolic pressure (LVEDP), positive and negative dP/dt, and coronary flow were measured. The percent recovery of coronary flow and negative dP/dt were significantly lower in Group H than in Group C (p < 0.05). The LVEDP was significantly greater in Group H, and the LVEDP increased significantly from the base line value in Group H (p < 0.05). There was no significant difference in other value between two groups. These findings demonstrated that LV diastolic dysfunction rather than LV systolic dysfunction occurred in the early ischemic stage, especially to hypertrophied hearts, indicating that better protection is required for these hearts.

Animals↗
PubMed2001

[RyR-bound FKBP12.6 and the modulation].

In the pathogenesis of cardiac dysfunction in heart failure, a decrease in the activity of the sarcoplasmic reticulum (SR) Ca(2+) -ATPase is believed to be a major determinant. Recently, a novel mechanism of cardiac dysfunction in heart failure has been reported on the basis of the following findings:1) PKA hyperphosphorylation of RyR causes a dissociation of FKBP12.6 from RyR, resulting in the abnormal single-channel properties (increased Ca(2+) sensitivity for activation and elevated channel activity associated with destabilization of RyR (Marx et al, Cell 101:365, 2000), 2) a prominent abnormal Ca(2+) leak occurs through RyR, following a partial loss of RyR-bound FKBP12.6 and the resultant conformational change in RyR (Yano M et al, Circulation 102:2131, 2000). This abnormal Ca(2+) leak might possibly cause Ca(2+) overload and consequent diastolic dysfunction, as well as systolic dysfunction.

English Abstract↗
PubMed1995

[The assessment of left ventricular diastolic function in patients with systemic scleroderma by radionuclide ventriculography].

To assess left ventricular (LV) diastolic function in scleroderma systematica (SS) with regard to SS course and skin lesion degree, a total of 24 SS patients were examined versus control subjects. Though cardiac symptoms manifested clinically only in 8 patients, parameters of LV diastolic function underwent changes in the majority of the examinees: the time to attaining maximal filling velocity increased, contribution of the first diastolic third to LV filling diminished, hemodynamic significance of the left atrial systole grew. More pronounced dysfunction of the myocardium occurred in patients with diffuse skin lesions, acute and subacute disease who also appeared to have reduced LV ejection fraction. The conclusion is made on frequent subclinical pattern of myocardial involvement in SS patients which runs primarily as LV diastolic dysfunction. Systolic disturbance emerge later or in more active forms.

Acute Disease↗
PubMed1996

Therapy of angina pectoris with long-acting nitrates: which agent and when?

Nitroglycerin and the long-acting nitrates are effective antianginal agents that have been used in clinical medicine for over 100 years. These drugs are reliable, safe, familiar to clinicians, inexpensive, and easy to use. Side effects are limited to headache and postural hypotensive symptoms. Nitrate tolerance or attenuation, -ie, loss of, or decrease in, nitrate efficacy with repeated dosing-is common and represents the major drawback to chronic therapy. Carefully designed dosing regimens and/or appropriate use of nitrate formulations (to include a nitrate-free period each day) will decrease or eliminate the problem of nitrate tolerance. In head-on comparative studies, nitrates appear to be as effective as beta-blockers or calcium channel blockers in the monotherapy of chronic angina. Ideal patient characteristics for nitrate therapy include: predictably favourable response of chest pain to sublingual nitroglycerin; angina episodes suggestive of coronary vaso-constriction or spasm; left ventricular systolic dysfunction; symptoms of congestive heart failure (systolic or diastolic dysfunction).

Angina Pectoris↗
PubMed2006

Quantitative evaluation of left ventricle performance from two dimensional echo images.

OBJECTIVES: We sought to quantify the left ventricle systolic dysfunction by a geometric index from two-dimensional (2D) echocardiography by implementing an automated fuzzy logic edge detection algorithm for the segmentation. BACKGROUND: The coronary injuries have repercussions on the left ventricle producing changes on wall contractility, the shape of the cavity, and as a whole changes on the ventricular function. METHODS: 2D echocardiogram and M-mode recordings were performed over the control group and those with the dysfunctions. From 2D recordings, individual frames were extracted for at least five cardiac cycles and then segmentation of left ventricle was done by automated fuzzy systems. In each frame, the volumes are measured and a geometric index, eccentricity ratio (ER), was derived. The endocardial fractional shortening (FS), midwall fractional shortening (mFS), and the relative wall thickness (RWT) were also measured in each case. RESULTS: Depressed value of endocardial FS (20.39 +/- 5.43 vs 34.28 +/- 9.36, P = 0.0046), mFS (33 +/- 8.3 vs 52.5 +/- 11.7, P = 0.0047), and the RWT (0.337 +/- 0.096 vs 0.525 +/- 0.119, P = 0.0002) was observed with dysfunction. ER measured at end-diastole (2.86 +/- 0.703 vs 4.14 +/- 0.38) and end-systole (3.14 +/- 0.79 vs 5.48 +/- 0.74) was found to be decreased in the dysfunction group and more significant at the end-systole (P = 0.00017 vs 6.6E-06). CONCLUSION: This work concludes that the regional and global left ventricle systolic dysfunction can be assessed by the ER measured at end-diastole and end-systole from 2D echocardiogram and may contribute to the high rate of cardiovascular disorders.

Adult↗
PubMed2001

Predictors of unfavourable prognosis in chronic Chagas' disease.

The aim of this study was to detect clinical predictors of left ventricular dysfunction, left ventricular dilatation and apical aneurysm on echocardiography, all known as independent predictors of lethal outcome for patients with chronic Chagas' disease. Seventy-four patients with a positive complement-fixation test for Chagas' disease participated; 44 (59%) had left ventricular dysfunction, 41 (55%) left ventricular dilatation and 15 (20%) apical aneurysm. A stepwise logistic regression analysis showed that systolic blood pressure (P < 0.001) and male sex (P < 0.001) were independent predictors of left ventricular dilatation on echocardiography. A receiver-operating characteristic curve provided a systolic blood pressure of 120 mmHg with a sensitivity of 70% and a specificity of 63% to predict left ventricular dilatation. The combination of male sex and systolic blood pressure of 120 mmHg had a sensitivity of 56% and a specificity of 91% to predict left ventricular dilatation. In a separate stepwise logistic regression analysis, left ventricular systolic dysfunction was independently predicted by systolic blood pressure (P = 0.006) and New York Heart Association functional class (P = 0.01). Receiver-operating curves provided a blood pressure of 120 mmHg with a sensitivity of 72% and a specificity of 59% to predict left ventricular dysfunction, whereas a New York Heart Association functional score of 2 predicted left ventricular systolic dysfunction with a sensitivity of 78% and a specificity of 50%. The combination of New York Heart Association functional class and a systolic blood pressure of 120 mmHg predicted left ventricular dysfunction with a sensitivity of 59% and a specificity of 77%. The apical aneurysm was independently predicted by myocardial necrosis on the resting ECG, but only with a sensitivity of 20%. Hence, echocardiographic markers of cardiac mortality and sudden cardiac death in Chagas' disease can be independently predicted by clinical examination. This may be useful for screening high-risk chagasic patients.

Cardiomyopathy, Dilated↗
PubMedDate not supplied

Evaluation of anthracycline-induced early left ventricular dysfunction in children with cancer: a comparative study with echocardiography and multigated radionuclide angiography.

The study aimed to compare diastolic and systolic dysfunctions detected by echocardiography (ECHO) and multigated radionuclide angiography (MUGA) in patients with cancer in the first 3 months after anthracycline-comprising chemotherapy. Children with leukemia and solid tumors who had anthracycline-comprising chemotherapy were enrolled in the study. ECHO and MUGA were performed in all patients before the first chemotherapy course and in the first 3 month of completing anthracycline-comprising chemotherapy. Cumulative anthracycline doses per body surface were calculated. Left ventricular systolic and diastolic functions were measured by both techniques. Twenty-one patients with a median age of 6.9 +/- 3.6 years were enrolled in the study. Mean cumulative anthracycline doses were equivalent to 276 +/- 83 mg/m2 doxorubicin. After anthracycline chemotherapy, cardiac dysfunction was detected in 14 and 48% of the patients by ECHO and MUGA, respectively. All dysfunctions detected by ECHO were systolic, whereas 29% of the patients had diastolic and 38% of the patients had systolic dysfunction in MUGA study. Although the study group is small, MUGA seems more sensitive in detecting anthracycline-induced systolic and diastolic cardiac dysfunctions compared to ECHO.

Adolescent↗
PubMed2004

Is B-type natriuretic peptide a useful screening test for systolic or diastolic dysfunction in patients with coronary disease? Data from the Heart and Soul Study.

BACKGROUND: Whether B-type natriuretic peptide (BNP) levels can be used to screen for ventricular dysfunction in patients at risk of heart failure but without overt symptoms is not known. We examined the characteristics of a BNP test for identifying systolic and diastolic dysfunction in outpatients with stable coronary disease. METHODS: In a cross-sectional study of 293 outpatients who had stable coronary disease and no history of heart failure, we compared elevations in plasma BNP levels with echocardiography for the diagnosis of systolic dysfunction (ejection fraction <55%) and diastolic dysfunction (diastolic dominant pulmonary vein flow with ejection fraction > or =55%). RESULTS: A total of 48 patients (16%) had systolic dysfunction, and among the remaining 245 with preserved systolic function, 31 (13%) had diastolic dysfunction. At the standard cutpoint of >100 pg/mL, an elevated BNP level was 38% sensitive (80% specific) for systolic dysfunction and 55% sensitive (85% specific) for diastolic dysfunction. Negative likelihood ratios were 0.8 (95% confidence interval [CI]: 0.6 to 1.0) for systolic dysfunction and 0.5 (95% CI: 0.4 to 0.8) for diastolic dysfunction. Positive likelihood ratios were 1.9 (95% CI: 1.2 to 2.9) for systolic dysfunction and 3.8 (95% CI: 2.4 to 5.9) for diastolic dysfunction. Areas under the receiver operating characteristic curves were 0.59 (95% CI: 0.49 to 0.69) for systolic dysfunction and 0.79 (95% CI: 0.71 to 0.87) for diastolic dysfunction. CONCLUSION: These data suggest that BNP is not a useful screening test for asymptomatic ventricular dysfunction in patients with stable coronary disease.

Aged↗
PubMed2005

Echocardiographic features and brain natriuretic peptides in patients presenting with heart failure and preserved systolic function.

OBJECTIVE: To characterise patients who appear to fulfil the diagnosis of heart failure with preserved systolic function clinically, echocardiographically, and by concentrations of brain-type natriuretic peptide (BNP). METHODS: 102 new cases of heart failure were identified over 24 months in 213 patients referred to a rapid access heart failure clinic. Patients with heart failure and preserved systolic function with contemporary markers of diastolic function were assessed to evaluate their cardiac status further. RESULTS: Forty patients (39%) had an ejection fraction (EF) < 45% and 62 (61%) had an EF > or = 45%. Of these 62 patients, 30 (48%) fulfilled the case definition of diastolic heart failure. The remaining 32 (52%) had neither an EF < 45% nor abnormalities of diastolic function. Dobutamine stress echocardiography was performed on 26 (42%) patients with EF > or = 45%, which provided an alternative explanation for symptoms in 15 (58%) patients. Concentrations of BNP were higher in patients with diastolic abnormalities (mean (SEM) 101.4 (32.5) pg/ml v 58.4 (6.78) pg/ml, p = 0.042) and with no diastolic abnormalities (199 (37.9) pg/ml v 58.4 (6.78) pg/ml, p < 0.0001) than in patients with no heart failure. CONCLUSION: Among ambulatory patients presenting with suspected heart failure in the community 19% have systolic dysfunction, 14% have diastolic dysfunction, and 15% seemingly have heart failure with neither systolic nor diastolic dysfunction. A new understanding, including alternative parameters of diastolic function, seems to be necessary to classify patients with heart failure and preserved systolic function.

Adult↗
PubMed2001

Utility of B-natriuretic peptide levels in identifying patients with left ventricular systolic or diastolic dysfunction.

PURPOSE: Although echocardiography is important for making the diagnosis of left ventricular dysfunction, its cost and lack of availability limit its use as a routine screening test. B-Natriuretic peptide levels accurately reflect ventricular pressure, and preliminary studies with a rapid assay have found that levels are sensitive and specific for diagnosing heart failure in patients with dyspnea. We hypothesized that B-natriuretic peptide levels obtained through the use of a rapid assay should correlate with echocardiographic abnormalities of ventricular function. SUBJECTS AND METHODS: We studied 400 patients who were referred for echocardiography at the San Diego Veteran's Healthcare System between June and August 2000 to evaluate ventricular function. B-natriuretic peptide levels were measured by a point-of-care immunoassay; cardiologists assessing left ventricular function were blinded to the assay results. Patients were grouped into those with normal ventricular function, systolic dysfunction only, diastolic dysfunction only, and both systolic and diastolic dysfunction. RESULTS: Mean (+/- SD) B-natriuretic peptide concentration was 416 +/- 413 pg/mL in the 253 patients diagnosed with abnormal left ventricular function, compared with 30 +/- 36 pg/mL in the 147 patients with normal left ventricular function. Patients with both systolic and diastolic dysfunction had the highest levels (675 +/- 423 pg/mL). The area under the receiver operating characteristic (ROC) curve for B-natriuretic peptide levels to detect any abnormal echocardiographic finding was 0.95 (91% confidence interval: 0.93 to 0.97). B-Natriuretic peptide levels were unable to differentiate systolic vs. diastolic dysfunction. In patients with symptoms of heart failure and normal systolic function, B-natriuretic peptide levels >57 pg/mL had a positive predictive value of 100% for diastolic abnormalities. CONCLUSIONS: A simple, rapid test for B-natriuretic peptide levels can reliably predict the presence or absence of left ventricular dysfunction on echocardiogram. For some patients, a normal level may preclude the need for echocardiography.

Aged↗
PubMed1995

Mechanism of mitral leaflet excursion.

The factors that influence the extent of mitral leaflet opening (MLO) and closure (MLC) have not been defined. We hypothesized that left ventricular (LV) systolic function determines the rate of increase of the early diastolic left atrial (LA)-LV pressure gradient, which is responsible for the extent of MLO, and also the rate of change of the early systolic LV-LA pressure gradient, which determines the degree of MLC. Accordingly, global LV function was changed by altering left main coronary artery flow with LA pressure held relatively constant. LV end-systolic dimension and peak positive LV rate of pressure development (dP/dt) correlated best with the degrees of MLO and MLC, with average correlation coefficients of 0.88 and 0.68, and 0.86 and 0.72, respectively. Although transsecting the submitral apparatus resulted in flailing of the mitral leaflets during normal LV systolic function, the extents of MLO and MLC during LV systolic dysfunction were still influenced by LV systolic function. It is concluded that LV systolic function determines the extent (both opening and closure) of mitral leaflet excursion.

Animals↗
PubMedDate not supplied

Comparative value of BNP and NT-proBNP in diagnosis of heart failure.

UNLABELLED: Heart failure (HF) remains a major diagnostic challenge. Brain natriuretic peptide (BNP) and the N-terminal portion of proBNP (NT-proBNP) have emerged as excellent diagnostic biohumoral indicators in cardiac disease. It is not clear which of the two is superior as a diagnostic marker in HF. OBJECTIVE: To compare the ability of BNP and NT-proBNP to distinguish subjects with HF from healthy volunteers, as well as to differentiate between HF with left ventricular (LV) systolic dysfunction (SD) and HF with preserved systolic function (PSF). METHODS: We measured plasma BNP (Shionogi, Osaka) and NT-proBNP (ELECSYS) in 21 healthy individuals (control group [CG]), 11 men, 10 women, mean age 54.4 +/- 11.6 years, with normal ECG and chest X-ray, and in 86 HF patients (HFG), 48 men, 38 women, mean age 71 +/- 11 years, in NYHA II-IV, fulfilling the European Society of Cardiology guidelines: 60 had HF with SD (SDG), ejection fraction (EF) < 40%, and 26 had HF and PSF (PFG), EF > 40%, increased LV mass index and/or dilated left atrium. BNP and NT-proBNP mean and median values were compared and the correlation between the 2 peptides was established. For each peptide sensitivity (sens), specificity (spec) 93.7%, positive predictive value (PPV) 75.5% and negative predictive value (NPV) were calculated. Areas under the ROC curve (AUC) were determined for each group vs. CG and for SDG vs. PFG. RESULTS: Levels of BNP and NT-proBNP were significantly higher in HF patients, particularly in the SDG, than in healthy subjects. There was reasonable agreement between BNP and NT-proBNP. For BNP, AUC were: HFG vs. CG: 97.7-98.0%; SDG vs. CG: 98.6-99.1%; PFG vs. CG: 95.1-95.9%; PFG vs. SDG: 69.7-70.9%; and for NT-proBNP: HFG vs. CG: 99.2-99.3%; SDG vs. CG: 99.6-99.7%; PFG vs. CG: 98.3-98.5%; PFG vs. SDG: 63.3-63.6%. For a cut-off of 32 pg/ml, BNP has 91.7% sens, 93.7% spec, 75.5% PPV and 98.3% NPV. A NT-proBNP cut-off of 126 pg/ml has 96.3% sens, 98.8% spec, 94.3% PPV and 99.3% NPV. CONCLUSIONS: Both peptides had an excellent ability to distinguish HF from non-HF subjects. NT-proBNP was more sensitive and specific. Nevertheless, neither peptide could differentiate between the SDG and the PFG by itself. NT-proBNP is a simple, highly effective diagnostic test for HF. A favorable impact on management and costs is expected from implementation of this diagnostic test in clinical practice.

Aged↗
PubMedDate not supplied

[Doppler echocardiographic assessment of diastolic function of left ventricle].

Approximately half of the patients with overt congestive heart failure (CHF) have diastolic dysfunction without reduced ejection fraction (LVEF>50%). Diastolic dysfunction is an abnormality in left ventricular myocardial relaxation and/or compliance that alters the ease with which blood is accepted into the left ventricle during diastole. Elevated pressures in the left atrium are compensatory, ensuring adequate filling. All patients with systolic dysfunction have concomitant diastolic dysfunction. Indeed, in patients with CHF and reduced systolic function the level of diastolic dysfunction influences the severity of symptoms. It is now clear that hypertension, coronary artery disease and other diseases and conditions commonly produce diastolic dysfunction in the absence of significant systolic dysfunction. Accurate noninvasive Doppler-echocardiographic assessment of the presence and severity of diastolic impairment is crucial to the broad application and understanding of this common condition. This review discusses the clinical impact of classic and recent echocardiographic contributions to the field of diastology.

Diastole↗
PubMed2004

Use of NT-proBNP in routine testing and comparison to BNP.

OBJECTIVES: B-type natriuretic peptide (BNP) is a strong diagnostic predictor of left-ventricular (LV)-dysfunction. Recently, the aminoterminal portion of pro-BNP (NT-proBNP) has been introduced, which could be even more sensitive because of its longer half-life. The aim of this study was to evaluate the new marker NT-proBNP within a large, heterogeneous population of patients with suspected cardiovascular disease at risk of cardiovascular dysfunction and to compare it with the established diagnostic parameter BNP. SUBJECTS AND METHODS: NT-proBNP and BNP were measured in 339 hospitalised patients undergoing diagnostic angiography (median age 66 years, 244 male vs. 95 female). RESULTS: Median values of NT-proBNP increased with worsening LV-dysfunction and higher NYHA class. The area under the receiver operator characteristics curve (AUC) of NT-proBNP for detecting severe systolic dysfunction or for detecting any systolic LV-dysfunction was 0.83 and 0.77, respectively. The latter improved (AUC=0.81) when patients with clinically relevant heart disease like valvular dysfunction were included, independent of the haemodynamic values. Compared to BNP, NT-proBNP tended to be more accurate in identifying lesser degrees of LV-dysfunction. CONCLUSIONS: Even after optimisation of target criteria, there was still a substantial overlap of NT-proBNP values between patients with and without relevant heart disease. Therefore, NT-proBNP is not suitable as a screening test for LV-dysfunction in the community. Nevertheless, because of its good negative predictive value, NT-proBNP could be an easy and effective tool to rule out severe systolic LV-dysfunction in high risk patients. No clinically significant advantage of BNP testing could be found.

Aged↗
PubMed1984

Myocardial material mechanics: characteristic variation of the circumferential and longitudinal systolic moduli in left ventricular dysfunction.

Active systolic moduli for the circumferential (E theta) and longitudinal (E phi) axes of the left ventricle were determined along with circumferential and longitudinal contractile filament stress (sigma theta and sigma phi) and circumferential and longitudinal fiber strain (epsilon theta and epsilon phi). These material property parameters were determined at four points during cardiac systole. Thirty-nine patients comprising five clinical groups were evaluated using pressure and volume data acquired from single-plane cineangiography. The results indicate that the active moduli exponentially decrease during cardiac systole. Characteristic variations from normal differentiated the various pathological groups. With compensated volume overload, E theta was significantly reduced during the latter half of systole (p less than 0.25). With decompensated volume overload, both E theta and E phi were not significantly different from the normal group throughout cardiac systole. With compensated pressure overload, both E theta and E phi were significantly lower than the normal group at end-systole (p less than 0.005; p less than 0.005). With congestive cardiomyopathy, both E theta and E phi were significantly greater during the latter half of systole compared to the normal group (p less than 0.05 and p less than or equal to 0.025).

Adult↗
PubMed2005

[Dobutamine hemodynamics for aortic stenosis with left ventricular dysfunction].

Patients with aortic stenosis (AS) and left ventricular (LV) systolic dysfunction have a poor short-term prognosis. In this setting, the decrease in transaortic gradients has an independent prognostic value for operative risk and long-term outcome. The 2 main issues for these patients are: (1) The real severity of AS; (2) How to stratify operative risk and evaluate long-term prognosis. Dobutamine Hemodynamics has the potential to address these issues. In case of relative AS, valve area is increased by dobutamine (final valve area > 1.2 cm2 with a mean pressure gradient <30 mmHg); on the basis of published data, medical treatment is justified in this case. Left ventricular contractile reserve is defined an increase in stroke volume, by 20% or more, under dobutamine. Operative risk is between 5 and 11% in case of LV contractile reserve and long-term outcome is improved by surgery in this case. In contrast, operative risk varies from 30 to 60% in case of exhausted reserve; this risk is also determined by other factors such as the presence of coronary artery disease and associated comorbidities. All these parameters are factored into risk-benefit analysis in order to determine the best therapeutic approach for each patient.

Aortic Valve Stenosis↗
PubMed2005

Recurrent infarction causes the most deaths following myocardial infarction with left ventricular dysfunction.

PURPOSE: The development of left ventricular systolic dysfunction or heart failure following an acute myocardial infarction (MI) is a powerful marker of an adverse prognosis. Recurrent MI could be an important cause of death, either directly or by provoking arrhythmias. METHODS: The OPTIMAAL trial randomized 5477 patients with heart failure or evidence of left ventricular dysfunction following acute MI to losartan or captopril. Over a follow-up of 2.7 years, there were 946 deaths. Of the 180 (19%) of these deaths for which autopsy reports were available, acute MI was found in 57% (102 of 180) of the autopsies. By comparison, an endpoints adjudication committee using clinical data attributed death to acute MI in only 29 cases. An acute MI was found at autopsy in 55% (37 of 67) of the deaths that had been classified as due to an arrhythmia and in 81% (21 of 26) of the deaths classified as due to progressive heart failure. Including autopsy diagnoses, the rate of acute MI in patients who died suddenly was independent of the time elapsed since the index MI, but in patients not classified as dying suddenly, there was a time-related decrease in recurrent MI from 78% in the first 30 days to 30% by the end of follow-up. However, only 19% of patients who died underwent autopsy, so recurrent MI may have been substantially more common and perhaps had a different relation to time since the index MI if more patients had undergone autopsy. CONCLUSIONS: In patients with evidence of major cardiac dysfunction after MI, recurrent MI found at autopsy is common and has often not been clinically detected.

Aged↗
PubMed1975

Pulmonary stenosis and impaired myocardial function.

Two young Black female patients with pulmonary valve stenosis and intact ventricular septa are presented in protracted congestive cardiac failure with severe tricuspid insufficiency and, in one, atrial fibrillation. Right ventricular systolic dysfunction was manifested by peak systolic pressures below systemic level, raised end-diastolic pressures and low cardiac output, but without right-to-left shunt. These findings are in strong contrast to those found in most patients with pulmonary stenosis of long standing, where persistent impairment of right ventricular function is diastolic with a high end-diastolic pressure and reversal of an interatrial shunt which result from poor right ventricular compliance. Evidence of left ventricular dysfunction was also present in both cases. Protracted heart failure in these patients is believed to have been the result of coincidental cardiomyopathy in a racial group highly predisposed to this disorder. A diagnostic appreciation of this phenomenon is important in the evaluation of heart disease in the Black, since cardiomyopathy may modify or even mask the features of the underlying disorder.

Adolescent↗