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PubMed2004

The angiotensin receptor blocker eprosartan mesylate reduces pulse pressure in isolated systolic hypertension.

BACKGROUND: Isolated systolic hypertension (ISH) is a common and particularly poorly controlled form of hypertension. OBJECTIVE: To assess the effect of eprosartan 600 mg tablet once daily on blood pressure (BP), pulse pressure, BP response, compliance and safety in subjects with ISH compared with subjects with combined systolic-diastolic hypertension (non-ISH). PATIENTS AND METHODS: The present study is a post hoc evaluation of a prospective, randomized, open-label, multicentre study. Subjects 60 to 84 years old with ISH (systolic BP 140 mmHg or greater with diastolic BP less than 90 mmHg) (n=97) or non-ISH (systolic BP 140 mmHg or greater with diastolic BP 90 mmHg or greater) (n=98) received 10 weeks of treatment with either eprosartan alone or eprosartan plus home BP monitoring. RESULTS: Eprosartan significantly reduced systolic BP at the study end point from baseline in both the ISH group and the non-ISH group (-17.5+/-14.5 mmHg and -20.6+/-14.1 mmHg [mean +/- SD], respectively; P<0.0001). The reduction in diastolic BP was significantly greater in subjects with non-ISH than in those with ISH (-12.2+/-8.1 mmHg and -5.0+/-7.9 mmHg, respectively; P<0.0001). Mean pulse pressure was significantly reduced from baseline in both groups (P<0.0001), but was reduced to a significantly greater degree in the ISH group than in the non-ISH group (-12.5+/-12.3 mmHg and -8.4+/-11.1 mmHg, respectively; P<0.05). The most common adverse events were dizziness, headache and fatigue. CONCLUSIONS: Eprosartan effectively lowered BP and pulse pressure in all subjects. The magnitude of pulse pressure reduction was significantly greater in the ISH group, and the diastolic BP reduction was greater in the non-ISH group, suggesting that eprosartan may be especially suitable in the treatment of subjects with ISH.

Acrylates↗

PubMed1991

Prognosis in heart failure: is systolic or diastolic dysfunction more important?

The clinical syndrome of congestive heart failure can result from inadequate myocardial contraction (systolic myocardial failure), from pseudo-heart failure due to circulatory overload, or from failure of the ventricles to fill at low pressure (diastolic myocardial failure). The presence of systolic or diastolic heart failure is most precisely defined by an examination of left ventricular pressure-volume relations. Diastolic failure commonly coexists with systolic dysfunction. However, in many patients, diastolic dysfunction may exist alone or as the predominant physiologic disturbance. This is especially true in such common disease states as systemic hypertension and ischemic heart disease. Like systolic heart failure, diastolic failure results in significant morbidity and mortality. Diastolic heart failure may correlate better with prognosis for symptoms and survival than traditional indices of systolic function. The presence of predominantly diastolic dysfunction in large numbers of patients with the diagnosis of congestive heart failure has important therapeutic implications.

Diastole↗

PubMed1990

[Effects of anteroseptal myocardial infarction on systolic and diastolic filling function of the right ventricle].

To assess the effects of wall motion abnormalities of the anterior left ventricle and interventricular septum on right ventricular (RV) systolic and diastolic filling function, multiple-gated radionuclide angiography was performed at rest in 53 patients with previous anteroseptal myocardial infarction and 14 normal subjects. There were 26 patients with left ventricular ejection fraction (LVEF) greater than or equal to 45% (group 1) and 27 with LVEF less than 45% (group 2). Six measurements were obtained simultaneously in both ventricles: 1) EF, 2) peak ejection rate, 3) duration of systole, 4) peak filling rate, 5) time to the peak filling rate, and 6) ratio of the peak filling rate to the peak ejection rate. The mean RV ejection fraction and the peak ejection rate in groups 1 and 2 were similar to those in the normal subjects. The ratio of the peak RV filling rate to the peak RV ejection rate, a sensitive indicator of diastolic filling function, decreased significantly in group 1 (0.61 +/- 0.15, p less than 0.02) and group 2 (0.59 +/- 0.15, p less than 0.02) as compared with that in the normal subjects (0.74 +/- 0.14). This indicates an impairment of early diastolic RV filling compared with RV systolic function. Thus, RV systolic function appears to be normally maintained even when anteroseptal wall motion is severely impaired; however, even in the presence of mild anteroseptal wall motion abnormality, RV filling may be impaired without reduced RV systolic function.

Aged↗

PubMed1990

Treatment of isolated systolic hypertension with labetalol in the elderly.

Antihypertensive therapy with labetalol was evaluated in a prospective, randomized, multicenter, double-blind study of 133 elderly patients with isolated systolic hypertension (standing systolic blood pressure [BP] greater than or equal to 160 mm Hg; diastolic BP less than 95 mm Hg). Following a placebo-washout period, patients received either labetalol (n = 70) or placebo (n = 63), which was titrated as necessary from 100 to 400 mg twice a day over a 6-week period. Once the BP was controlled (standing systolic BP less than 160 mm Hg, and greater than or equal to 10-mm Hg decrease from baseline) or the maximum dosage had been given, patients continued receiving the same regimen until the end of the titration period and throughout a 4-week maintenance period. Blood pressure was controlled in 57 (81%) of 70 of the labetalol-treated patients (86% receiving less than or equal to 200 mg twice a day) compared with 34 (54%) of 63 of the placebo-treated patients. Throughout the active treatment periods, BP was significantly lower in patients treated with labetalol compared with those taking placebo; mean standing systolic BP decreased 26 mm Hg in the labetalol group vs 9 mm Hg in the placebo group. Side effects were generally mild, and the dropout rates due to adverse experiences were similar between treatment groups (14% in the labetalol group vs 10% in the placebo group). In summary, labetalol can effectively lower systolic BP in the elderly without causing adverse orthostatic changes.

Age Factors↗

PubMed1985

[Mechanism of systolic anterior motion of the mitral valve in dogs].

The mechanism of systolic anterior motion (SAM) of the mitral valve remains somewhat controversial. We previously reported that SAM can be produced in dogs using dobutamine infusion. In the present study, dobutamine infusion, dextran infusion and venesection were performed in 13 anesthetized closed-chest dogs to study the mechanism of SAM. The degree of SAM was determined by M-mode echocardiography. End-systolic and end-diastolic short-axis areas of the left ventricle at the level of the chordae tendineae and the fractional area changes were measured by two-dimensional echocardiography. SAM was produced in six of the 13 dogs during dobutamine infusions (Group 1), but not in the other seven dogs (Group 2). During dobutamine infusions, % fractional area changes were greater in Group 1 (85 +/- 5; mean +/- standard deviation) than in Group 2 (65 +/- 15) (p less than 0.01), and the end-systolic short-axis area of the left ventricle was smaller in Group 1 (0.7 +/- 0.4 cm2) than in Group 2 (1.9 +/- 0.3 cm2) (p less than 0.01), although no significant change was observed between Groups 1 and 2 in the end-diastolic short-axis area of the left ventricle. Subsequent injections of dextran (mean 340 ml) in Group 1, decreased the degree of SAM and increased the end-diastolic and end-systolic short-axis areas of the left ventricle. Subsequently, venesections (mean 400 ml) in Group 1 resulted in increases in the degrees of SAM and decreases in the end-diastolic and end-systolic short-axis areas of the left ventricle.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMedDate not supplied

[Systolic dynamics in chronic anemias].

The study of the systolic time intervals in 168 cases with chronic anemia revealed three categories of anemic persons with the following systolic dynamics: cardiac hyperkinesia, cardiac insufficiency and normal systolic dynamics. The dynamic systolic type is especially determined by the degree and age of anemia. In case anemia was severe (Hb less than 4 g per cent) but of less than 2 years, a cardiac hyperkinesia was present. If anemia was severe and older than 2.6 years, then a prolonged cardiac hyperkinesia lead to clinically manifest or latent cardiac insufficiency. In anemias with Hb over 3 g per cent, under 1.6 years, 80 per cent of cases had a normal systolic dynamics, a state never encountered in the severe cases.

Adolescent↗

PubMed1988

Isolated systolic hypertension: data from the European Working Party on High Blood Pressure in the Elderly.

The European Working Party on High Blood Pressure in the Elderly study (EWPHE) was a placebo-controlled, double-blind, inter-patient assessment of diuretic treatment in hypertensive patients aged 60 years or more. Of the 840 patients included in the study 247 had isolated systolic hypertension (systolic blood pressure greater than or equal to 160 and diastolic blood pressure less than or equal to 95 mmHg). In those (n = 120) randomized to active treatment (diazide-hydrochlorothiazide with triamterene +/- methyldopa) blood pressure after 3 years was, on average, 19/8 mmHg lower than in the placebo group (n = 119) and after 5 years the difference was 9/7 mmHg. Data on mortality and morbidity were insufficient for firm conclusions to be drawn. The data are presented here only to communicate the trends observed and to provide information that may be useful in the design of future trials. The trends observed for cardiac mortality, terminating non-fatal events (including severe heart failure) and combined fatal and non-fatal cardiovascular events follow a similar pattern to that observed in the trial overall, in that active treatment appeared to confer benefit. However, in the case of isolated systolic hypertension none of these differences between active and placebo treatment achieved statistical significance. We conclude that, given the epidemiological data incriminating systolic hypertension as a risk factor and the data presented here, a rigorous assessment of the value of treating isolated systolic hypertension is justified.

Aged↗

PubMed1987

[Relation between systolic and diastolic elastic muscle properties and the morphology of the hypertrophic pressure-loaded left ventricle].

According to Maxwell's model, left ventricular (LV) systolic elastic properties are characterized by a series-elastic element and LV diastolic properties by a parallel-elastic element. It is not known whether this functional concept is reflected by some morphological counterparts. In 12 patients with aortic stenosis (AS) before and 19 months after aortic valve replacement, and in ten controls, LV biplane volume and simultaneous high-fidelity pressure measurements were performed during diagnostic catheterization. The constant (k) of systolic myocardial stiffness was determined from LV peak wall stress, the maximum rate of systolic stress rise and instantaneous LV midwall circumferential fiber shortening rate at peak stress. The constant (k*; circ-1) of diastolic stiffness was assessed from the diastolic stress-stiffness relationship, using a viscoelastic model. In AS patients pre- and postoperative endomyocardial biopsies were taken to assess muscle fiber diameter, interstitial fibrosis and LV fibrous content. Systolic myocardial stiffness constant was 15 circ-1 in controls, 14 circ-1 in preoperative and 12 circ-1 in postoperative AS patients (P less than 0.01 vs. controls). Diastolic myocardial stiffness constant was 19 circ-1 in controls, 23 circ-1 in preoperative AS patients and increased slightly but not significantly to 33 circ-1 after valve replacement. Parallel to the postoperative decrease in systolic stiffness, muscle fiber diameter decreased significantly from 33 to 27 mu (P less than 0.05). The slight increase in diastolic stiffness was accompanied by a significant increase in interstitial fibrosis from 15% to 26% (P less than 0.05); LV fibrous content remained essentially unchanged after operation.(ABSTRACT TRUNCATED AT 250 WORDS)

Aortic Valve Stenosis↗

PubMed1987

[Correlation of the indices of phase structure of left ventricular systole in patients with isolated left ventricular and combined biventricular myocardial infarction].

The correlation of indices of the phase structure of the left ventricular systole in patients with isolated left ventricular (140 patients) and combined biventricular (60 patients) myocardial infarction showed prolonged tension time resulting from isometric contraction, and a great difference between the actual and proper systolic values in the affection of both ventricles irrespective of the outcome of disease. In low sensitivity of indices of the phase analysis of the left ventricular systole the following indices proved to be specific and informative for recognition of the right ventricle involvement: a period of isometric contraction, duration of the common systole, difference between the actual and proper systolic values, and tension time.

Electrocardiography↗

PubMed1987

[Right ventricular systolic and diastolic functions assessed by 81mKr scintigraphy and relation to ventricular septal ischemia].

Right ventricular (RV) systolic and diastolic functions were assessed in patients with previous anteroseptal myocardial infarction to ascertain the influence of interventricular septal ischemia on RV function. Gated right ventriculography with continuous infusion of krypton-81 m was performed in 12 normal subjects and 28 patients with infarction but without significant stenosis of the right coronary artery. Furthermore, RV contractile reserve by postextrasystolic potentiation was evaluated by gated radionuclide ventriculography with 99mTc-HSA. The patients with anteroseptal infarction were divided into two groups by the presence or absence of three hours' redistribution in the septal region on exercise thallium-201 myocardial scintigraphy. Two indices of systolic function (ejection fraction and the peak ejection rate) and three indices of diastolic function (1/3 diastolic filling rate, the peak filling rate and time to the peak filling rate) were derived from the right ventricular time-activity curve and its derivative curve. There was no difference in systolic function among normal subjects and patients with or without redistribution. However, diastolic function was impaired only in the patients without redistribution. The RV contractile reserve in the patients without redistribution was less than in those with it. Thus, RV systolic function was maintained in the patients with anteroseptal infarction, but contractile reserve deteriorated only in severe septal ischemia. Similarly, diastolic function was maintained in mild septal ischemia, but impaired in severe septal ischemia. We concluded that RV systolic and diastolic functions are closely related to interventricular septal ischemia.

Diastole↗

PubMed1987

[Noninvasive estimation of left ventricular end-systolic pressure].

A method for noninvasively determining left ventricular (LV) end-systolic pressure (ESP) using carotid pulse tracings and cuff-measured blood pressure was re-evaluated. It was validated during diagnostic cardiac catheterization in 60 patients with cardiovascular diseases. LVESP calculated by this method and systolic blood pressure measured by the cuff were compared with aortic dicrotic notch pressures obtained by a catheter-tip manometer system as true LVESP. The calculated ESP was measured by the following formula; [the ratio of the excursion of dicrotic notch (b) to the peak (a) in carotid pulse tracings: (b/a) x pulse pressure] + diastolic blood pressure. This calculated ESP had a high correlation coefficient with true ESP invasively measured (r = 0.96), but was estimated to be 5.3 +/- 5.0 mmHg less than true ESP. Systolic blood pressure, used as a noninvasive index of ESP, accurately estimated ESP, but it was higher by 14.8 +/- 11.2 mmHg (r = 0.84). Calculated ESP measured by the present method was not affected by age or systemic vascular resistance. This is a reliable noninvasive means of estimating LV end-systolic pressure. Compared with the peak arterial pressure, this is a better parameter for the analysis of LV contractility, such as stress-shortening, and end-systolic pressure-volume relations.

Adolescent↗

PubMed1987

[Ratio of electrical and electromechanical ventricular systoles in the acute period of myocardial infarct and its significance for the late prognosis of sudden death].

The lengthening of the electric ventricular systole in relation to electromechanical systole in acute myocardial infarction is shown to be significant for long-term postinfarction prognosis of sudden death. The use of electromechanical systole as a reference for electrical systole appears to be a more sensitive predictive index, as compared to the electrical systole duration with a correction for heart rate.

Death, Sudden↗

PubMed1987

[Acute and chronic effects of verapamil on indices of systolic and diastolic function of the left ventricle in patients with hypertrophic cardiomyopathy].

The aim of this study has been the analysis of acute and chronic effects of Verapamil on resting left ventricular (LV) systolic and diastolic function indices derived from ECG gated radionuclide Angiocardiography (GRA) in patients (pts) affected by Hypertrophic Cardiomyopathy (HCM). 18 pts with HCM were imaged in basal conditions (twice in two different days) and after i.v. infusion of Verapamil 0.1 mg/kg (1st acute test); than chronic oral treatment of Verapamil (240 mg/die) was started. Three months later 14 pts were studied again, during oral chronic therapy and after a second administration of Verapamil i.v. 0.1 mg/kg (2nd acute test). After acute infusion we observed a significant increase of the peak filling rate (PFR) (from 3.3 +/- 0.9 to 3.51 +/- 0.71 EDV/sec, P less than 0.01) and a shortening of the time to PFR (from 188.1 +/- 24.9 to 165 +/- 30 msec, P less than 0.005). No significant variations of the contribution of atrial systole to the ventricular filling (AS) (from 17.03 +/- 5.96 to 18.15 +/- 6.91%), of the heart rate (from 70 +/- 12 to 69 +/- 12 bat/min), and of systolic function indices, ejection fraction (EF) (from 74.4 +/- 9.7 to 74.30 +/- 10.02), peak ejection rate (ER) (from 4.17 +/- 0.92 to 4.10 +/- 0.9), ejection time (ET) (from 307.4 +/- 46.4 to 322.22 +/- 48.6) were noticed. After chronic oral therapy we observed a significant shortening of the time to PFR (from 197.5 +/- 16.7 to 182.8 +/- 13.7 msec, P 0.01), while the remaining indices of diastolic function we analyzed (PFR from 3.2 +/- 0.6 to 3.3 +/- 0.8 EDV/sec; AS from 17.1 +/- 4.9 to 17.1 +/- 6.6%), the systolic function indices (EF from 74.4 +/- 10.5 to 75.4 +/- 9.4%; ER from 4.2 +/- 0.8 to 4.2 +/- 0.6 EDV/sec; ET from 309.6 +/- 48.5 to 308.9 +/- 40.5 msec) and the heart rate (from 67.7 +/- 8 to 66 +/- 8) were not modified. If a 30 msec time to PFR variation was considered significative (confidence limit of 95% between absolute changes measured on two basal studies) the 1st acute test was predictive of chronic efficacy in 10/14 (71%) pts. Four of five pts in which a shortening of TTPFR was observed during the 2nd acute test, showed the same effect with a higher chronic dose of Verapamil (360 mg/die). Our results suggest that Verapamil after acute or chronic treatment improves diastolic filling of LV, without worsening systolic indices.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗

PubMed1985

Rapid changes in rate-corrected and uncorrected systolic time intervals during cold pressor test.

The changes in heart rate and systolic time intervals were studied in a group of 10 young healthy male volunteers during immersion of their hand in ice water for 1 min. The heart rate and systolic time intervals were measured from electro-, phono-, and impedance cardiograms in the standard way. When the cold immersion was done in the supine position the left ventricular ejection time (LVET) and the electromechanic systole (Q-S2Tc) shortened, and when corrected for the heart rate the Q-S2Tc lengthened in the beginning of the immersion. In the head-up position the Q-S2T shortened in the beginning of the immersion while the rate-corrected systolic time intervals remained unchanged. Most of the changes in the systolic time intervals disappeared before the last quarter of the cold immersion. It was observed that during the cold immersion the linear regression coefficients between the heart rate and the Q-S2T in the supine position as well as between the heart rate and the LVET, Q-S2T and the PEP in the head-up position were greater than the regression coefficients used in the rate correction.

Adult↗

PubMed1983

[Action of digoxin on systolic and diastolic time intervals. An echocardiographic study in infants].

The effects of digoxin on systolic and diastolic time intervals were studied in 25 children and infants the majority of whom had congenital heart disease by M mode echocardiography. The recordings were performed before and after the administration of digoxin. Serum digoxin levels were measured to confirm therapeutic dosage. After digoxin, the right and left ventricular pre-ejection periods, the duration of the corrected electromechanical systole and the Weissler indices decreased, and the isovolumic relaxation periods increased. The ventricular ejection times were unchanged except for the corrected right ventricular ejection time which was only slightly decreased. Our results concerning left ventricular systolic time intervals are in agreement with other studies in children. As no other studies of the effects of digoxin on the right ventricular systolic time intervals, or of the right and left isovolumic relaxation time are available, confirmatory studies are required. The decrease in the right and left pre-ejection periods, electromechanical systole and the Weissler indices, is interpreted as being related to the positive inotropic effect of digoxin whilst the increase in isovolumic relaxation reflects only a decrease in preload. This study allows a better understanding of the effects of digoxin on the different phases of the cardiac cycle and a better appreciation of its action potential.

Diastole↗

PubMed1983

[Diastolic and systolic functions of the left ventricle determined by M-echocardiography in idiopathic hypertrophic cardiomyopathy].

The diastolic function and the correlation between pump and diastolic function of left ventricle were studied in 35 patients with idiopathic hypertrophic cardiomyopathy with subaortic stenosis via a M-echocardiographic investigation by Echoview 80 C in the routine method. The following indices were used: A. For the diastolic function: 1. Telediastolic dimension (TDD) and volume (TDV) of left ventricular cavity. 2. Dimension (DPhFF) and volume (VPhFF) of the left ventricular cavity at the end of the phase of fast filling; 3. Velocity of fast filling of the left ventricle (ml/sec) - (formula; see text) 4. Fraction of fast filling of left ventricle (%) - (formula; see text) 5. Velocity of backward motion of the anterior mitral cusp at the beginning of diastole (E - F segment); 6. Velocity of early diastolic motion of the posterior wall of left ventricle (PWLV); 7. Ratio between early diastolic (D) and systolic (S) interval of PWLV: D/S; 8. Telediastolic interval (A - C) of mitral valve; 9. Index of fast emptying of left ventricle; 10. Amplitude E - E' of mitral echogram; II. Area (cm2) between two mitral cusps in diastole. B. For the systolic (pump) function: 1. Stroke and minute volume (SV, MV) of left ventricle according to the cubic formula and Teicholz formula; 2. Telesystolic dimension (TSD) and volume (TSV) of left ventricular cavity; 3. Fraction of shortening (FS) of left ventricle (%); 4. Mean velocity of shortening of the circumferential fibres (mVcf) of left ventricle (circumf./S); 5. Ejection fraction (EF) of left ventricle (%). 6. Distance between left ventricular endocardium of interventricular septum and point E of mitral valve; 7. Fraction of systolic thickening of IVS and PWLV; 8. Velocity of systolic thickening of IVS and PWLV; 9. Amplitude of systolic motion of IVS and PWLV.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1980

Mechanical properties of the ventricle during systole.

The systolic mechanical properties of the ventricular chamber, such as its volume elasticity and apparent viscosity or resistance, provide a useful framework for studying ventricular contraction. During systole, elasticity describes the dependence of pressure generated by the ventricle on chamber volume, while resistance describes changes in pressure related to the rate of ejection. Elastic stiffness increases throughout contraction and is sensitive to changes in inotropic state. Resistance also increases during contraction in parallel with ventricular pressure, but changes in inotropic state do not alter the relation between resistance and pressure. These two mechanical properties offer an insight into the performance of the ventricle as a pump; hence, they may be useful in assessing changes in pump function. This review examines several different approaches to the measurement of elasticity and resistance during systole: one approach lumped all the mechanical properties into a mean value expressed as an average impedance; another focused on elasticity, particularly the maximum elasticity achieved at end-systole; a third approach examined elasticity and resistance at high frequencies of volume oscillation; and the final method utilized a flow-pulse technique to study the variations in both elasticity and resistance throughout systole.

Animals↗

PubMed1995

Systolic anterior motion of the mitral valve in hypertrophic cardiomyopathy: an in vitro pulsatile flow study.

Hypertrophic cardiomyopathy, or HCM, is a relatively common disease which results in the hospitalization of more than 13,000 patients every year. It is characterized by a thickening of the interventricular septum and by systolic anterior motion, or SAM, of the mitral valve, which occurs when the distal tip of the mitral leaflets contacts the hypertrophied septum during systole and obstructs the left ventricular outflow tract. Using an in vitro pulsatile flow model of the left ventricle, the objective of the study was to investigate the relationship between the ventricular flow field and the mechanism of SAM and to specifically address the hypothesis that papillary muscle displacement can alter left ventricular flow patterns and create drag forces that can initiate SAM. Flow visualization revealed the presence in the ventricle of a large organized recirculation region throughout diastole. Besides maintaining the mitral leaflets close to the posterior wall, normally positioned papillary muscles also caused the diastolic vortex to help the mitral valve close near the posterior wall while simultaneously prepositioning the upcoming systolic outflow stream close to the septum, thereby minimizing the flow forces acting on the mitral valve. In contrast, the anterior displacement of the papillary muscles moves the entire mitral apparatus into the outflow tract. It also reverses the direction of the recirculating diastolic flows: The diastolic vortex now promotes the initiation of SAM by displacing the closing mitral leaflets anteriorly and by positioning the systolic outflow stream close to the posterior wall. These events lead to the creation of form drag forces as the systolic flow impacts the posterior side of the mitral leaflets, initiating SAM.

Cardiac Output↗