Cardiology

Ilgenli, T. Fikret; Kilicaslan, Fethi; Kirilmaz, Ata; Uzun, Mehmet

doi: 10.1159/000092766pmid: 16636541

Left ventricular (LV) diastolic dysfunction (LVD) is a common complication secondary to hypertension. It has been reported that bisoprolol is effective in reducing blood pressure and has beneficial cardiac effects in patients with hypertension. However, its effect on LV diastolic function has not been studied in detail. In this study, we sought to determine bisoprolol’s effect on left ventricle diastolic function. Data from 25 patients were statistically analyzed. Peaks E and A wave, E/A ratio, isovolumetric relaxation time and E wave deceleration time were measured echocardiographically. Doppler echocardiography measurements after bisoprolol treatment revealed an improvement in LV diastolic function. In conclusion, our results show that treatment with bisoprolol, improves echocardiographic parameters of LV diastolic function after 3 months of treatment.

Chida, Koichi; Otani, Hiroki; Kohzuki, Masahiro; Saito, Haruo; Kagaya, Yutaka; Takai, Yoshihiro; Takahashi, Shoki; Yamada, Shogo; Zuguchi, Masayuki

doi: 10.1159/000092767pmid: 16636542

The purpose of this study was to evaluate the correlation between the plasma B-type natriuretic peptide (BNP) level and the myocardial phosphocreatine/adenosine triphosphate ratio determined using rapid phosphorus-31 magnetic resonance spectroscopy (³¹P-MRS) in patients with dilated cardiomyopathy (DCM). Thirteen DCM patients, who had slight or moderate heart failure, were examined. The plasma BNP was measured on a day close to the rapid ³¹P-MRS study. ³¹P-MRS measurements were conducted with a 1.5-T MR instrument. The plasma BNP levels tended to be correlated negatively with the myocardial phosphocreatine/adenosine triphosphate, although the correlation did not reach statistical significance (r = –0.54, p =0.06). By contrast, the log of the plasma BNP levels was correlated negatively with the myocardial phosphocreatine/adenosine triphosphate (r = –0.73, p < 0.01). Our results indicate that the myocardial energy metabolism evaluated using ³¹P-MRS tends to be correlated with the severity of heart failure and left ventricular dysfunction estimated using the plasma BNP levels in DCM patients. This paper provides additional information regarding the relationship between the BNP and myocardial energy metabolism in DCM patients.

Nieuwlaat, R.; Lenzen, M.; Crijns, H.J.G.M.; Prins, M.H.; Scholte op Reimer, W.J.; Battler, A.; Hasdai, D.; Danchin, N.; Gitt, A.K.; Simoons, M.L.; Boersma, E.

doi: 10.1159/000092768pmid: 16636543

Cocco, Giuseppe; Chu, David

doi: 10.1159/000092769pmid: 16636544

Several gender-specific differences in cardiovascular diseases are known and pharmacokinetics of β-blockers shows relevant sex-specific differences. The plasma levels of metoprolol, for example, are higher in women compared to men. However, randomized studies have shown that metoprolol has little or no greater reduction in the mortality of women following myocardial infarction. We tested the hypothesis that metoprolol might have significant gender-specific effects in patients with chronic angina pectoris. Body weight of women was slightly (–9%) less than that of men and the daily dose of metoprolol was similar in both groups. Thus, according to pharmacokinetics women should have obtained higher plasma levels of this drug and the ensuing pharmacologic effects of metoprolol should have been greater. Our results do not confirm this assumption. Metoprolol reduced the frequency of angina episodes and the consumption of nitroglycerin tablets to a similar extent in both sexes. However, the pretreatment hemodynamic profiles confirmed the existence of gender-specific differences: women had significantly higher heart rate and blood pressure both at rest and during exercise. Since both groups were comparable in age, comorbidities, and medications, the existing difference is likely to be due to gender-specificity. The hemodynamic differences persisted during therapy with metoprolol: resting heart rate, blood pressure and rate pressure product were reduced to a greater extent in men. During cycloergometry, there was a slight difference in the time of onset of ST depression and time of onset of angina, which were slightly higher in men, but probably because of the limited number of cases, the difference between men and women did not reach significance. On the other hand, with metoprolol the duration of exercise and, in parallel, the number of metabolic equivalents was significantly greater in males than in females. Thus in spite of a presumed greater plasma concentration of metoprolol in women, we found a significant difference in anti-ischemic effect in favor of men. We conclude that metoprolol might exert a significantly greater therapeutic effect on stress-induced angina pectoris in men than in women and this difference should be taken into account when prescribing this β-blocker.

Trojnarska, Olga; Szyszka, Andrzej; Gwizdala, Adrian; Oko-Sarnowska, Zofia; Katarzynski, Slawomir; Siniawski, Andrzej; Chmara, Ewa; Cieslinski, Andrzej

doi: 10.1159/000092770pmid: 16636545

Adults with patent atrial septal defect (ASD) usually find their exercise capacity satisfactory, and therefore hesitate to accept proposed surgical treatment of the heart disease. The aim of our study was to evaluate both the exercise capacity, using the cardio-pulmonary stress test, and brain natriuretic peptide (BNP) levels in asymptomatic adults with ASD. Thirty-six patients with patent secundum type ASD (aged mean 44.7 ± 8.2 years) were studied. The control group consisted of 25 healthy subjects at the mean age of 45.6 ± 6.1 years. Echocardiography and CPST were performed and BNP levels measured in all subjects. Oxygen uptake (VO_{2 max}) was lower in ASD patients than in controls (22.1 ± 5.6 vs. 30.0 ± 6.8 ml/kg/min, p = 0.00001); the VE/VO₂ slope was elevated in ASD patients compared with healthy subjects (31.3 ± 6.6 vs. 26.9 ± 3.3, p = 0.001), and exceeded 34 in 5 patients. VO_{2 max} showed a negative correlation with the pulmonary to systemic flow ratio Qp:Qs (r = –0.46, p = 0.004), and a positive correlation was found between the VE/VO₂ slope and Qp:Qs (r = 0.32, p = 0.05). BNP levels were higher in the ASD group than in the controls (60.6 ± 49.9 vs. 32.6 ± 24.5 pg/ml, p = 0.02). BNP correlated positively with RV diameter and Qp:Qs (r = 0.38 and 0.39 respectively, p = 0.03) and negatively with maximum VO₂ (r = –0.5, p = 0.004) and VO₂% (r = –0.32, p = 0.07). Conclusions: Although most adult patients with ASD perceive their exercise capacity as satisfactory, objective assessment reveals that in fact it is significantly decreased. BNP levels are increased comparing to healthy individuals. Decreased exercise capacity and increased BNP levels seem to result from right ventricular volume overload.

Ariyarajah, Vignendra; Spodick, David H.

doi: 10.1159/000092771pmid: 16636546

Interatrial block (IAB; P wave ≧110 ms), commonly associated with left atrial enlargement and its electromechanical dysfunction, is also a significant correlate of atrial tachyarrhythmias. While the arrhythmogenic mechanisms of atrial fibrillation and atrial flutter may indeed differ, there is actually considerably less literature showing evidence of prospective progression of IAB, be it partial or advanced, to atrial flutter. We present a unique case of atrial flutter occurring within months of diagnosis of advanced IAB in an otherwise healthy female to briefly generate our discussion on the possible reasons for this scenario.

Kato, Mahoto; Nakatani, Satoshi; Okazaki, Hidetoshi; Tagusari, Osamu; Kitakaze, Masafumi

doi: 10.1159/000092827pmid: 16636547

Although mitral annular calcification (MAC) is usually easy to diagnose by transthoracic echocardiography, we experienced a rare case with MAC which looked like an intracardiac tumor. The patient who had been on chronic hemodialysis for 20 years was admitted to our hospital because of dyspnea. Transthoracic echocardiography showed a mass with severe calcification on the anterior mitral annulus and mean mitral gradient of 20 mm Hg. Because of the suspicion of the intracardiac calcified tumor that restricted mitral valve motion causing mitral obstruction, she underwent resection of the mass and mitral valve replacement. Pathological findings showed that the mass had a calcified envelope containing liquefied necrotic eosinophilic material with lympocytic infiltrate inside consistent with MAC. We should consider a possibility of MAC when we see a severe calcified mass attached to the mitral annulus in a patient on long-term hemodialysis.

Trabi, Thomas; Dunitz-Scheer, Marguerite; Scheer, Peter J.

doi: 10.1159/000092844pmid: 16636548

Vizza, Carmine Dario; Badagliacca, Roberto; Sciomer, Susanna; Poscia, Roberto; Battagliese, Alessandro; Schina, Mauro; Agati, Luciano; Fedele, Francesco

doi: 10.1159/000092920pmid: 16645271

Background: Prostanoids are a well-established therapy for pulmonary arterial hypertension (PAH), and observational studies suggest their efficacy even in chronic thromboembolic pulmonary hypertension (CTEPH) patients. Objective: To compare the effects of 6 months of treatment with beraprost, an orally-active prostacyclin analog, in patients with distal CTEPH and PAH. Design: Case-control study. Population: Sixteen patients with severe pulmonary hypertension (NYHA II–IV), eight with distal CTEPH matched with eight patients with idiopathic PAH for similar effort tolerance. Methods: All patients were in stable clinical and hemodynamic condition for 3 months with maximal standard therapy. During the titration phase (4 weeks) beraprost was increased to maximal tolerated dose (mean daily dosage: CTEPH 275 ± 47 µg, PAH 277 ± 47 µg) in adjunction of standard therapy, patients were followed-up for 6 months. Main Outcome Measures: World Heart Organization (WHO) functional class, exercise capacity measured by distance walked in 6 min, and systolic pulmonary pressure (echocardiography), were evaluated at baseline, and at 1-, 3- and 6-month interval. Results: At 6 months WHO class decreased significantly in both groups (CTEPH from 2.7 ± 0.6 to 2.0 ± 0.24, p < 0.05; PAH from 3.0 ± 0.26 to 2.1 ± 0.25, p < 0.05), similarly the 6-min walk distance increased significantly from baseline (CTEPH from 312 ± 31 to 373 ± 29 m, p < 0.003; PAH from 303 ± 31 to 347 ± 29, p < 0.0003). Systolic pulmonary artery pressure showed a trend toward lower value (CTEPH from 85 ± 7 m to 81 ± 6 mm Hg, p = NS; PAH from 89 ± 7 to 82 ± 5, p = NS). During the observation period we did not have any death. The drug was well-tolerated with minor side-effects. Conclusion: In patients with CTEPH beraprost had similar mid-term clinical and hemodynamic improvements than in patients with PAH.

Meier, Bernhard

doi: 10.1159/000092957pmid: 16651851

After 75 years of invasive and over 50 years of interventional cardiology, cardiac catheter-based procedures have become the most frequently used interventions of modern medicine. Patients undergoing a percutaneous coronary intervention (PCI) outnumber those with coronary artery bypass surgery by a factor of 2 to 4. The default approach to PCI is the implantation of a (drug-eluting) stent, in spite of the fact that it improves the results of balloon angioplasty only in about 25% of cases. The dominance of stenting over conservative therapy or balloon angioplasty on one hand and bypass surgery on the other hand is a flagrant example of how medical research is digested an applied in real life. Apart from electrophysiological interventions, closure ot the patent foramen ovale and percutaneous replacement of the aortic valve in the elderly have the potential of becoming daily routine procedures in catheterization laboratories around the world. Stem cell regeneration of vessels or heart muscle, on the other hand, may remain a dream never to come true.