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PubMed2002

Finger systolic blood pressure indices for the diagnosis of vibration-induced white finger.

OBJECTIVES: To compare the accuracy of several finger systolic blood pressure indices (FSBPIs) for the diagnosis of cold-induced Raynaud's phenomenon in vibration-exposed worker groups with different prevalences of vibration-induced white finger (VWF). METHODS: The finger systolic blood pressure (FSBP) in a test finger at 10 degrees C as a percentage of the pressure at 30 degrees C, corrected for the change in systolic blood pressure in a reference finger [FSBPI(A)] or the arm [FSBPI(B)], was measured in 455 healthy controls and 874 workers exposed to hand-transmitted vibration (HTV). The following FSBPIs were also calculated: FSBPI(C), as the ratio between FSBP in the test finger at 10 degrees C and FSBP in the same finger at 30 degrees C; and FSBPI(D), as the ratio of FSBP to arm systolic blood pressure during finger cooling to 10 degrees C. The finding of zero systolic blood pressure, FSBP(0), in the cooled finger was taken as an objective sign of Raynaud's attack with complete closure of the digital arteries. RESULTS: On a group basis, all FSBPIs could discriminate between the controls and the HTV workers. In the vibration-exposed worker population, the FSBPIs were significantly lower in the subjects affected with VWF than in those without vasospastic symptoms. The lower normal limits of FSBPIs were derived from the results of the cold test in the controls and were found to vary from 50% to 60%. The FSBPI(A) showed the best sensitivity for the detection of cold-induced digital arterial hyper-responsiveness in both the total sample of HTV workers (sensitivity 87%) and most of the vibration-exposed groups with different prevalence of VWF (sensitivity from 79% to 100%). The results of the receiver operating characteristic analysis suggested a higher diagnostic accuracy of FSBPI(A) when compared with the global performance of the other FSBPIs. In the whole sample of HTV workers, the predictive value of a positive cold test varied from 73% [FSBPI(D)] to 89% [FSBP(0)] and that of a negative test ranged between 89% [FSBP(0)] and 97% [FSBPI(A)]. CONCLUSIONS: The findings of this investigation and clinical experience suggest that a discriminating threshold of FSBPI(A) <60% during finger cooling to 10 degrees C is an appropriate diagnostic criterion for the detection of abnormal cold response in the digital arteries of most vibration-exposed workers with a true history of symptoms of finger whiteness at the medical interview.

Adult↗
PubMed2003

Trials in isolated systolic hypertension: an update.

Isolated systolic hypertension (ISH) has proved to be a powerful predisposing factor for cardiovascular diseases in the elderly. Recent placebo-controlled interventional trials such as the Systolic Hypertension in the Elderly Program, the Systolic Hypertension in Europe, and the Systolic Hypertension in China showed that the lowering of systolic blood pressure using a diuretic- or a calcium antagonist-based treatment is associated with a decrease in cardiovascular events. Antihypertensive therapy was found especially effective in preventing stroke in the elderly with ISH. A slowing in the progression of dementia was observed in patients randomized to a calcium antagonist-based treatment. Patients at high cardiovascular risk such as those with diabetes benefited the most from treatment. In another trial performed in patients with left ventricular hypertrophy (Losartan Intervention For Endpoint Reduction), a subset of patients had ISH. In those patients, an angiotensin II antagonist-based treatment was superior to a b-blocker-based treatment in preventing cardiovascular complications. The experience accumulated in patients with ISH showed that combination therapy is often required to control blood pressure. Overall, the evidence available today indicates that pharmacologic treatment of ISH markedly improves the outcome of elderly patients.

Aged↗
PubMed2003

The Importance of Systolic Blood Pressure Control and Cardiovascular Disease Prevention.

Hypertension affects up to 75% of individuals 60 years of age and older. Cardiovascular risk is related to increases in systolic blood pressure and pulse pressure and to decreases in diastolic blood pressure, but systolic blood pressure reduction is the major target for improving outcomes in the elderly patient. Hypertension therapy in older individuals should include lifestyle modification, especially weight loss and sodium restriction, which may decrease the need for antihypertensive medication. The starting dose of medication should be one half that used in younger patients. If low initial doses are used, significant attention must be paid to adequate titration; combination therapy is usually required for optimal blood pressure control. The initial agent chosen is rarely the final agent used to achieve the recommended minimal systolic blood pressure goal of less than 140 mm Hg. If more than one agent is required, a diuretic should be included as one of the agents chosen. Although the reduction of blood pressure should occur more gradually in the older patient, the treatment goals should be similar and determined by the underlying concomitant disorder. The minimum goal should remain less than 140/90 mm Hg, with lower goals in diabetic patients and those with renal disease. Patients with isolated systolic hypertension should have a minimum systolic blood pressure goal of less than 140 mm Hg.

Journal Article↗
PubMed1978

The influence of atrial systole on ventricular capture by failing artificial pacemakers. II. Experimental observations.

The mechanism by which atrial systeole influences the efficacy of ventricular capture by a failing pacemaker was investigated in 12 dogs with atrioventricular heart block. Atrial systole caused facilitation of ventricular capture in eight dogs, and inhibition of capture in 10 dogs. Interpolating atrial extrasystoles caused an enhancement or depression of the hemodynamic performance of the atrial systole that affected the efficacy of the pacemaker stimulus. These interpolation experiments showed that atrial systole influenced the efficacy of capture by a mechanical mechanism and not by an electrotonic mechanism. Atrial systole probably caused motion of the endocardial pacing catheter and/or ventricular myocardium. This motion increased or decreased the contact between the pacing electrode and the endocardium with subsequent changes in the efficacy of capture. In three dogs with pacing through epicardial electrodes, atrial systole had no effect on the efficacy of capture.

Animals↗
PubMed1988

Aortic and right atrial systolic pressures during cardiopulmonary resuscitation: a potential indicator of the mechanism of blood flow.

The absolute difference between aortic and right atrial systolic pressure (systolic pressure gradient) and the difference between the aortic diastolic and right atrial diastolic pressure (coronary perfusion pressure) were evaluated in a series of 63 adult mongrel dogs undergoing five different methods of cardiopulmonary resuscitation (CPR). Fluid-filled pressure monitoring catheters were placed in the ascending aorta and right atrium in each of the animals after induction of anesthesia with morphine sulfate and 1% halothane and oxygen. The animals were then fibrillated with a transvenous electrode catheter that had been introduced into a ventricle. After a "down time" of 3 minutes during which no CPR was performed, the animals' lungs were ventilated, and one of five methods of CPR was initiated. The systolic pressure gradient and coronary perfusion pressure were measured in all animals 1 minute after CPR was begun, and in all but the group undergoing open-chest cardiac massage after 7 minutes and 17 minutes of CPR. The systolic pressure gradient and coronary perfusion pressure were greatest during open-chest cardiac massage (true cardiac compression), intermediate in external mechanical CPR (Thumper) and standard CPR (greater in small dogs than large dogs), and lowest in CPR performed with a combined thoracic and abdominal vest apparatus (predominantly thoracic pump). The observation that the systolic pressure gradient between intrathoracic chambers is largest in open-chest cardiac massage and smallest in vest CPR suggests that similar measurements recorded during the performance of human cardiac resuscitation may be useful in determining the mechanism of blood flow.

Animals↗
PubMed1991

Improvement of systolic and diastolic left ventricular wall motion by serial echocardiograms in selected patients treated for unstable angina.

The purpose of the study was to evaluate the effect of antiischemic treatment on left ventricular function in selected patients with unstable angina pectoris that was due to severe proximal left anterior descending coronary artery narrowing and to identify subgroups liable to an adverse outcome (mean term 2.7 years). Effect of antiischemic treatment on systolic and diastolic left ventricular wall motion was studied in 35 patients who had unstable angina pectoris and an electrocardiogram that indicated severe proximal left anterior descending coronary artery narrowing. Treatment consisted of either a revascularization procedure (17 patients) or antianginal drug therapy (18 patients). All patients underwent a two-dimensional echocardiographic study within 48 hours (mean 20 hours) of entry into the study. This study semiquantitatively analyzed systolic performance of the ischemia-related segments by calculation of a total wall motion score. In 16 patients this investigation was combined with a continuous detailed recording of only the apical interventricular septal wall motion. This detailed study included measurements for regional function by providing a typification of the pattern of systolic and early diastolic excursion of the endocardial border of the apical interventricular septum. A repeat ultrasonic study was performed at least 1 month (median 2 months, 7 days) after admission. Results of the systolic wall motion analyses of all 35 patients showed, in both treatment groups, a significant improvement in systolic wall motion of the anterior and apical segments (mean total wall motion score at early study vs late study: revascularization, 6.9 vs 2.2 and medical therapy, 4.6 vs 1.0).(ABSTRACT TRUNCATED AT 250 WORDS)

Angina, Unstable↗
PubMed1975

Systolic hypertension: nonhomogeneous diseases.

Prospective studies have shown that systolic hypertension is associated with increased cardiovascular risk, but few physiologic studies have characterized the problem. Therefore, two groups of men (older and younger than 35 years) with systolic hypertension (systolic pressure 150 mm Hg or greater and diastolic pressure 95 mm Hg or less) were studied hemodynamically. The 13 younger patients demonstrated a hyperkinetic circulation manifested by a significantly increased heart rate, elevated left ventricular ejection rate and cardiac indexes and normal vascular resistance. The 13 older patients had a normal heart rate, significantly reduced cardiac and left ventricular ejection rate indexes, and increased vascular resistance with respect to the younger men with systolic hypertension and normotensive control subjects. Plasma volume was reduced only in the older patients (P less than 0.05). These data demonstrate that systolic hypertension should not be considered a homogeneous disease entity clinically or physiologically. The physiologic differences between the younger and older patients suggest that different mechanisms may be operative.

Adult↗
PubMed1975

Dose-response relation between therapeutic levels of serum digoxin and systolic time intervals.

A dose-response relation between cardiac glycosides and systolic time intervals has previously been established in short-term studies in which the glycoside was administered intravenously in these studies there was uncertainty regarding the steady state kinetics, and maintenance of the early serum levels would have resulted in toxicity. Accordingly, we studied the effect on systolic time intervals of small increments of serum digoxin within the therapeutic range. Serum digoxin concentration and systolic time intervals were measured in 21 patients receiving 0.25 mg of the glycoside daily. The daily dose was increased to 0.5 mg and measurements were repeated 5 to 7 days later. Serum digoxin concentration with the smaller dose was 0.56 plus or minus (standard error) 0.06 ng/ml and increased to 1.18 plus or minus 0.11 ng/ml with the larger dose. Associated with the increased serum digoxin was a mean decrease in duration of total electromechanical events of 6.3 plus or minus 2.9 msec (P smaller than 0.025), which resulted from a mean shortening of left ventricular ejection time of 5.6 plus or minus 3.0 msec (P smaller than 0.05). The mean decrease in preejection phase of 1.1 plus or minus 2.1 msec was insignificant (P larger than 0.2). Repeated measurements in control patients showed no change in serum digoxin concentration or systolic time intervals. In nine patients the digoxin dose was randomly varied between 0 and 0.75 mg and measurements were made 4 to 5 days after drug administration at each dose level. The correlation coefficient between changes in serum digoxin and changes in left ventricular ejection time was minus 0.55 (P smaller than 0.01) the data indicated that increasing the maintenance dose of digoxin while keeping the serum level within therapeutic range will result in improved ventricular function as assessed by determination of systolic time intervals.

Adult↗
PubMed1982

Decrease in systolic blood pressure during exercise testing: reproducibility, response to coronary bypass surgery and prognostic significance.

To investigate the reproducibility and prognostic significance of an exercise-induced decrease in systolic blood pressure, 47 patients were identified who manifested such a reduction below the pre-exercise standing level in a consecutive series of 436 patients who underwent treadmill exercise testing and cardiac catheterization during a 3 year period. The prevalence of this abnormal finding was 11 percent in the total group but 21 percent in the 124 patients with three vessel or left main coronary artery disease. Patients with an exercise-induced reduction in systolic blood pressure were more likely to be male, have typical angina pectoris with class III or IV functional limitation and to have had a prior myocardial infarction than were patients without this finding (p less than 0.05). Although no complications occurred during the exercise test of these 47 patients, the majority had severe ischemic responses and 14 (30 percent) showed complex repetitive ventricular arrhythmias. Of the 47 patients, 24 (group 1a) received medical treatment and 23 (group 1b) underwent coronary bypass surgery. On repeat exercise testing in 42 patients, a decrease in systolic blood pressure during exercise was consistently present in group 1a (17 of 20) but entirely absent (0 of 22) in group 1b (p less than 0.001). The mean treadmill time, peak heart rate and systolic blood pressure were not significantly different in the initial and on repeat exercise tests in patients in group 1a; however, in patients in group 1b, all of these variables were significantly higher in the repeat test (p less than 0.001). At a mean follow-up time of 37 months, the total cardiac mortality rate was 8 percent (2 of 24) in group 1a and 4 percent (1 of 23) in group 1b. It is concluded that a decrease in systolic blood pressure during exercise testing is highly reproducible and appears to be reversed by coronary bypass surgery.

Angina Pectoris↗
PubMed1990

Systolic blood pressure and cardiovascular mortality among 13,740 Dutch women.

Prospective data of cardiovascular mortality in relation to the systolic blood pressure of women are scarce, especially when combined with other risk factors. The association between systolic blood pressure and cardiovascular mortality was therefore studied in a 10-year follow-up of a population of 13,740 Dutch women, born between 1911 and 1925 who participated in a population-based breast cancer screening project (the DOM Project). Age-adjusted mortality rates over the 10-year follow-up period suggest a J-shaped pattern of cardiovascular mortality according to level of systolic blood pressure. Age-adjusted total cardiovascular, coronary, and cerebrovascular mortality rate ratios were significantly greater than 1.0 among women with elevated systolic blood pressure. Within categories of other risk factors (obesity index, diabetes mellitus, current smoking, and use of antihypertensive medicines) the age-adjusted cardiovascular rate ratios did not show confounding by any of these variables. A very high increase in cardiovascular mortality was observed among hypertensive diabetic women. This study shows that elevated systolic blood pressure is associated with increased rates of cardiovascular mortality for women in this age group.

Body Mass Index↗
PubMed1987

Overview on atherosclerotic systolic hypertension.

Hypertension in older atherosclerotic patients is characterised by a disproportionate elevation of systolic and pulse pressure contrasting with a subnormal diastolic level. Increased systolic pressure is strongly related to the excess of cerebrovascular complications and congestive heart failure observed in these patients. The physiopathological pattern is marked by a strong reduction in compliance of large arteries directly responsible for the predominant high systolic pressure because of the impairment of the buffering function of the arteries on the cardiac pulse wave. Clinical management is directed to the elevation of athero-arteriosclerotic changes of large arteries by means of appropriate non-invasive ultrasonic techniques and specific lowering in systolic pressure. Antihypertensive treatment must specifically decrease systolic pressure without superimposing adverse effects on the generalized and focalized atherosclerotic process. In this respect, new pharmacological agents capable of direct actions on large arteries might be suitable.

Aged↗
PubMed1989

Isolated chronic mitral regurgitation with preserved systolic left ventricular function and severe pulmonary hypertension.

Pulmonary hypertension in chronic mitral valve disease has been related most commonly to left ventricular dysfunction or mitral stenosis; its association with chronic, isolated mitral regurgitation and preserved left ventricular systolic function is unclear. In 41 catheterized patients with chronic mitral regurgitation (known history of mitral regurgitation for greater than 18 months) and preserved left ventricular systolic function (ejection fraction greater than 0.55), historic, electrocardiographic, echocardiographic and hemodynamic variables were analyzed. Ten patients (Group I) had normal pulmonary artery systolic pressure (less than 30 mm Hg), whereas 31 patients had pulmonary hypertension. Pulmonary artery systolic pressure was mildly increased (30 to 49 mm Hg) in 13 patients (Group II) and was greater than or equal to 50 mm Hg in 18 patients (Group III). Univariate analysis showed the more frequent occurrence of male gender and ruptured chordae tendineae in the groups with pulmonary hypertension. Mean pulmonary capillary wedge pressure, size of the V wave in pulmonary capillary wedge pressure and pulmonary arteriole resistance were higher, whereas cardiac index was lower in the hypertension groups. Multivariate stepwise analysis revealed higher mean pulmonary capillary wedge pressure and pulmonary arteriole resistance as the only variables independently differing among groups. In conclusion, pulmonary hypertension occurs frequently (76% of cases) in patients with chronic, isolated mitral regurgitation with preserved left ventricular systolic function. In these patients, a severe increase in pulmonary capillary wedge pressure is associated with elevation in pulmonary artery resistance, a finding similar to that in mitral stenosis.

Echocardiography↗
PubMed1990

Size dependence of the end-systolic stress/volume ratio in humans: implications for the evaluation of myocardial contractile performance in pressure and volume overload.

The end-systolic stress/volume ratio is currently recognized as a relatively load-independent index of myocardial contractile performance, but its dependence on ventricular size may limit its value for interpatient comparisons. In this study, the relation between the end-systolic stress/volume ratio and left ventricular end-diastolic volume was angiographically analyzed in 104 patients with normal coronary angiograms. Eighteen patients had a normal ventricle, 24 had aortic stenosis, 18 had aortic regurgitation, 9 had mitral regurgitation and 35 had cardiomyopathy. An inverse relation between the end-systolic stress/volume ratio and left ventricular end-diastolic volume was demonstrated in the normal group (r = 0.72, p less than 0.001); subjects with a larger left ventricle had a reduced index but, presumably, the same degree of contractility as that of subjects with a smaller ventricle. Attempts to normalize values by using end-diastolic volume or body surface area were unsuccessful. A similar inverse relation was demonstrated in the aortic stenosis group (r = 0.48, p less than 0.05), probably because hypertrophy helps to keep wall stress normal or low despite progressive ventricular enlargement in these patients. The end-systolic stress/volume ratio was also inversely related to left ventricular chamber size in patients with volume overload due to aortic regurgitation (r = 0.80, p less than 0.001) and in those with cardiomyopathy (r = 0.84, p less than 0.001). However, at a given left ventricular end-diastolic volume, the end-systolic stress/volume ratio was higher in patients with aortic regurgitation than in those with cardiomyopathy, suggesting better contractile performance for a comparable degree of ventricular dilation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Nonlinearity of the left ventricular end-systolic wall stress-velocity of fiber shortening relation in young pigs: a potential pitfall in its use as a single-beat index of contractility.

OBJECTIVES: We sought to evaluate in the young heart the primary assumptions on which the current use of the mean "velocity of fiber shortening corrected for heart rate" as a noninvasive index of contractility are based. BACKGROUND: End-systolic wall stress-velocity of fiber shortening relation has been applied as a single-beat, load-independent index of contractility in children. This use is based on poorly validated assumptions of linearity, parallel shifts with changing contractile state and inotropic sensitivity of the end-systolic wall stress-velocity of fiber shortening relation. METHODS: In eight anesthetized young piglets, 5F mciromanometric catheters were placed in the ascending aorta and balloon occlusion catheters in the descending aorta. End-systolic wall stress and velocity of fiber shortening were calculated from aortic pressure and M-mode echocardiography under six conditions: in three contractile states 1) baseline, 2) increased contractility during dobutamine infusion (10 micrograms/kg per min), and 3) decreased contractility after propranolol injection (1 mg/kg), each at two afterload states (normal and increased load by partial aortic occlusion). RESULTS: Dobutamine increased and propranolol decreased afterload-matched velocity of fiber shortening corrected for heart rate significantly to 140% and 77% of baseline, respectively. However, the slope of end-systolic wall stress-velocity of fiber shortening relation was much greater (251% of baseline) during dobutamine infusion, which also significantly decreased wall stress, and was much less (27% of baseline) after propranolol injection, which increased wall stress. CONCLUSIONS: The velocity of fiber shortening corrected for heart rate did change predictably with changes in contractility and as such can be used noninvasively in the temporal evaluation of individual patients undergoing therapeutic interventions or to define the natural history of a disease process. However, the relation on which it is based is not defined by parallel straight lines across contractile states, so that abnormal single point measurements may reflect only the nonlinearity of the relation rather than abnormalities in contractility. Thus, we recommend that the end-systolic wall stress-velocity of fiber shortening relation should not be used as a single-beat index of contractility.

Aging↗
PubMed1996

Effect of dual-chamber pacing on systolic and diastolic function in patients with hypertrophic cardiomyopathy. Acute Doppler echocardiographic and catheterization hemodynamic study.

OBJECTIVES: This study sought to evaluate prospectively the acute hemodynamic effect of dual-chamber pacing by using a combined hemodynamic approach of high fidelity pressure and Doppler velocity measurements. BACKGROUND: Dual-chamber pacing has been proposed recently as an alternative in the symptomatic treatment of patients with hypertrophic obstructive cardiomyopathy. Although early reports documented a decrease in left ventricular outflow tract gradient and symptomatic improvement, questions remain about the hemodynamic effects of dual-chamber pacing on systolic and diastolic function. METHODS: Twenty-nine patients with hypertrophic cardiomyopathy underwent a combined cardiac catheterization and Doppler echocardiographic study during normal sinus rhythm and P-synchronous pacing at various atrioventricular (AV) intervals. High fidelity pressure measurements of left ventricular inflow and left atrial pressures, ascending aortic pressure, thermodilution cardiac output and Doppler mitral flow velocity curves were obtained to evaluate both systolic and diastolic left ventricular function. RESULTS: During AV pacing at the shortest delay of 60 ms, there was a significant decrease in cardiac output (p < 0.05) and peak positive dP/dt (p < 0.05), an increase in mean left atrial pressure (p < 0.05) and a prolongation of tau, the time constant of relaxation (p < 0.05), compared with that during normal sinus rhythm. During pacing at the optimal AV delay (longest AV interval with pre-excitation), there was a similar trend, with deterioration in both systolic and diastolic function variables but of lesser magnitude than that during pacing at the shortest AV intervals. The deterioration in both systolic and diastolic function was present in 21 patients with and 8 without left ventricular outflow obstruction. There was a modest decrease in left ventricular outflow tract gradient from 73.3 +/- 45.0 (mean +/- SD) to 61.3 +/- 40.5 mm Hg (p = 0.03) during dual-chamber pacing at the optimal AV delay compared with that during normal sinus rhythm. CONCLUSIONS: The acute effect of pacing the right atrium and ventricle may be detrimental to both systolic and diastolic function of the left ventricle, particularly at the short AV intervals. Further studies of the long-term effects of dual-chamber pacing in carefully performed randomized studies are needed.

Blood Flow Velocity↗
PubMed1991

Left ventricular end-systolic pressure estimated from measurements in a peripheral artery.

Aortic and radial arterial pressure measurements were compared after cannulation and before cardiopulmonary bypass in 26 patients scheduled for coronary artery bypass grafting. The radial artery blood pressure range was 89 to 147 mm Hg systolic and 44 to 75 mm Hg diastolic. A difference was found between the central and peripheral dicrotic notch pressures, the former being 7.9 +/- 2.7 (SD) mm Hg higher than the latter. When 8 mm Hg was added to the notch pressure measured in the radial artery to construct a calculated end-systolic pressure, there was good agreement with the centrally measured notch pressure. The mean difference was -0.15 mm Hg with a 95% confidence interval of -1.2 to 0.9 mm Hg. It was not possible to calculate peak systolic aortic pressure with the same accuracy from the systolic and diastolic pressure measurements in the radial artery. It is concluded that left ventricular end-systolic pressure measured as the aortic dicrotic notch pressure can be calculated from the dicrotic notch pressure in the radial artery with reasonable accuracy.

Aorta↗
PubMed2006

The impact of hypertension on systolic and diastolic left ventricular function. A tissue Doppler echocardiographic study.

BACKGROUND: The purpose of this study is to assess the impact of hypertension on systolic function and diastolic function using 2-dimensional echocardiography, conventional Doppler imaging of the transmitral inflow, and tissue Doppler imaging (TDI) of the mitral annulus. METHODS: From an outpatient clinic population, 414 consecutive patients underwent 2-dimensional echocardiography, conventional Doppler imaging of the transmitral inflow, and TDI of the septal, lateral, inferior, and posterior walls near the mitral annulus. Parameters of systolic left ventricular (LV) function and diastolic LV function were assessed. Patients were divided according to the presence or absence of systemic hypertension (blood pressure > or = 140/90 mm Hg on > or = 3 measurements or treatment with antihypertensive medication). RESULTS: A complete echocardiographic evaluation was obtained in 397 patients. Among these, 269 (68%) had hypertension. There was no difference with respect to age between patients with and without hypertension. Patients with hypertension had higher LV mass index and relative wall thickness and lower TDI peak systolic velocity (V(S)) when compared with patients without hypertension. In addition, indices of diastolic LV function were significantly impaired in hypertensive patients. CONCLUSIONS: Quantitative echocardiography using TDI reveals that hypertensive patients with preserved global LV systolic function often have combined impairment of systolic function and diastolic function.

Coronary Circulation↗
PubMed2005

Effectiveness of echocardiographic imaging by nurses to identify left ventricular systolic dysfunction in high-risk patients.

Recognizing left ventricular (LV) systolic dysfunction is critical. The investigators sought to evaluate whether nurses could be trained to use a hand-carried ultrasound (HCU) device to screen for LV systolic dysfunction in high-risk patients. Sixty-three patients from an outpatient diabetes clinic underwent brief echocardiographic examinations by nurses using HCU devices. Of the 63 patients enrolled in the study, 3 (4.7%) had LV systolic dysfunction. The nurses correctly identified these 3 patients as having LV systolic dysfunction (sensitivity 100%, negative predictive value 100%). The identification of occult LV systolic dysfunction in diabetic patients may allow the initiation of therapies known to improve prognosis.

Ambulatory Care↗