European Heart Journal

Sechtem,, U.;Höpp, H., W.;Jungehülsing,, M.;, De Vivie, R.;Mennicken,, U.

doi: 10.1093/eurheartj/12.9.1040pmid: N/A

Abstract The diagnosis of left hemitruncus and large patent ductus arteriosus was made by magnetic resonance imaging in an adult patient with recurrent haemoptysis and dyspnoea on exertion. Previous cardiac catheterization and echocardiography failed to establish the complete diagnosis. Magnetic resonance imaging using spin-echo and gradient-echo pulse sequences is a useful imaging modality to evaluate anatomical and functional abnormalities in patients with complex congenital heart disease. Magnetic resonance imaging, hemitruncus, congenital heart disease This content is only available as a PDF. © 1991 The European Society of Cardiology

Johansson, S., R.;Wiklund,, O.;Karlsson,, T.;Hjalmarson,, Å.;Emanuelsson,, H.

doi: 10.1093/eurheartj/12.9.1020pmid: 1936002

Abstract Restenosis after coronary angioplasty (PTCA) is a major problem, limiting the long-term efficacy of the procedure. Lipoprotein levels are associated with the development of atherosclerosis and may also be associated with restenosis. In this study the serum levels of cholesterol (CH), triglycerides (TG), high density lipoprotein (HDL) and low density lipoprotein (LDL) were analysed in 157 patients undergoing 161 PTCA procedures. Follow-up coronary angiograms were performed after 6·0±4·3 months. The restenosis rate was 33%. Treatment with aspirin and a residual stenosis of 25–49% immediately after successful PTCA were the only variables associated with restenosis (P < 0·05), otherwise the clinical and angiographic characteristics were similar with and without restenosis. There was no relationship between restenosis and the levels of CH, TG, HDL or LDL (P > 0·05). In univariate and multivariate analysis of males (n = 121) and females (n = 40) separately, restenosis was associated with low HDL in men and high HDL in women (P < 0·05), but not with CH, TG or LDL (P > 0·05). We conclude that the serum levels of CH, TG and LDL do not seem to be related to restenosis after PTCA. It is suggested that low HDL in males and high HDL in females is related to restenosis. Lipoproteins, HDL, LDL, aspirin, restenosis, coronary angioplasty (PTCA) This content is only available as a PDF. © 1991 The European Society of Cardiology

doi: 10.1093/eurheartj/12.9.xxxiiipmid: N/A

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Cittadini,, A.;Fazio,, S.;D&apos;Ascia,, C.;Picardi,, G.;Saccà,, L.;Basso,, A.;Bazzicalupo,, L.

doi: 10.1093/eurheartj/12.9.1000pmid: N/A

Abstract In order to detect subclinical levels of Doxorubicin (D) cardiotoxicity, 21 patients aged 42 ±8 years with malignancies and treated with D as a part of a multiple regimen, were evaluated. The mean cumulative dose of D was 242 ±112 mg.m−2 (150 to 520 mg.m−2). Patients with systemic hypertension, valvular diseases, suspected coronary artery disease, ejection fraction <55% as assessed by radionuclide angiography, and aged more than 50 years were excluded from the study. A Doppler echocardiographic examination was performed before and after the course of D therapy with a mean interval of 142 days. The following variables were assessed: fractional shortening (FS), ejection fraction (EF), stroke volume (SV), isovolumic relaxation time (IVRT), maximal early diastolic flow velocity (Emax), maximal late diastolic flow velocity (Amax), and mitral deceleration time (Mdt). Indices derived from 19 aged-matched normal subjects were compared to those of the patients before the course of therapy. Doppler echocardiographic measurements did not differ significantly between the control group and patients before the course of therapy. While there were no significant changes in FS, EF, and SV in the study group before and after therapy, indices of diastolic filling showed striking differences: IVRT changed from 72±11 to 87±19 ms (P < 0·001), Emax from 81±12 to 65±17 cm.s−1 (P < 0·001), Mdt from 174±25 to 183±34 ms (P < 0·05), Amax from 44±17 to 52±16 cm.s−1 (P < 0·01). These data demonstrate impaired diastolic filling after doxorubicin therapy at conventional dosages. Doxorubicin cardiotoxicity, diastolic filling, pulsed Doppler echocardiography Presented in part at the 2nd International Conference on Cardiac Doppler-Echo and Colour Flow Imaging, Dubrovnik, May 1990. This content is only available as a PDF. © 1991 The European Society of Cardiology

doi: 10.1093/eurheartj/12.9.965pmid: N/A

Abstract Interest in early thrombolysis has prompted a study on the feasibility and time course of prehospital thrombolysis in patients with acute myocardial infarction (AMI) in six centres in Belgium. Patients with clinically suspected AMI and with typical ECG changes presenting within 4 h after onset of pain were treated with 30 units of Anisoylated Plasminogen Streptokinase Activator Complex (APSAC, eminase) intravenously by a mobile intensive care unit (MICU). Sixty-two patients were included in the study and an AMI was confirmed in 60. The mean time (± 1 SD) from onset of pain to injection of APSAC was 95 ± 47 min and the mean estimated time gain, calculated as the time difference between the arrival of the MICU at home and the arrival of the MICU at the emergency department, was 50 ± 17 min. In the prehospital period four patients developed ventricular fibrillation and one cardiogenic shock. During hospital stay severe complications were observed in four patients. Two events were fatal, one diffuse haemorrhage and one septal rupture; two events were non fatal, one ventricular fibrillation and one Dressler syndrome. This study confirms previous reports that prehospital thrombolysis is feasible and that an estimated time gain of 50 min can be obtained. Potential risks and benefits remain to be demonstrated in a large controlled clinical trial. Prehospital thrombolysis, acute myocardial infarction, APSAC This content is only available as a PDF. © 1991 The European Society of Cardiology

Wagner,, F.;Gohlke-Bärwolf,, C.;Trenk,, D.;Jähnchen,, E.;Roskamm,, H.

doi: 10.1093/eurheartj/12.9.994pmid: 1936012

Abstract The acute and short-term effects of treatment with 10 consecutive doses of isosorbide dinitrate 40 mg t.i.d. and molsidomine 8 mg t.i.d. in slow release formulations were investigated in 10 patients with angiographically documented coronary artery disease and stable angina pectoris according to a randomized, double-blind, double-dummy, cross-over study design using conventional symptom-limited exercise testing. Acute exercise testing 3 h following the first dose of ISDN and molsidomine showed a significant reduction of maximal ST segment depression and of the area above the ST segments. Time to occurrence of 0·1 mV ST segment depression, exercise duration, time to onset of angina and exercise tolerance increased significantly. On the fourth treatment day with ISDN and molsidomine an attenuation of these antiischaemic effects was seen. The mean effects on ST segment depression, area above ST segments, time to occurrence of 0·1 mV ST segment depression, exercise duration, time to onset of angina and exercise tolerance were reduced by 40%, 44%, 47%, 58%, 54% and 65%, respectively, in patients administered ISDN and by 33%, 48%, 58%, 59%, 45% and 60% in those given molsidomine. Thus, following sustained short-term therapy the antiischaemic effects of both drugs seem to be attenuated. In this respect no marked differences were found between ISDN and molsidomine. Molsidomine, isosorbide dinitrate, antiischaemic effects, angina pectoris, tolerance This content is only available as a PDF. © 1991 The European Society of Cardiology

Shahi,, M.;Thom,, S.;Poulter,, N.;Sever, P., S.;Foale, R., A.

doi: 10.1093/eurheartj/12.9.974pmid: 1834465

Abstract To investigate whether reduction in blood pressure has a beneficial effect on left ventricular diastolic function, we investigated 20 hypertensive patients with evidence of diastolic dysfunction at baseline and at 3 and 6 months after initiation of captopril therapy. Two-dimensional echocardiography was used to determine left ventricular mass index and Doppler ultrasound to assess diastolic function. Fifteen of the 20 patients had a significant reduction in blood pressure at 3 and 6 months and left ventricular mass index remained unchanged during the study period. Despite reduction in blood pressure, no difference in isovolumic relaxation time, early and atrial filling velocities or their ratio was observed. Our results suggest that a direct relationship between blood pressure and left ventricular diastolic function does not exist and that other factors such as alterations in muscle or collagen composition of the left ventricle may be more important in determining abnormal diastolic function in hypertension. Hypertension, diastolic function, blood pressure, echocardiography, Doppler ultrasound This content is only available as a PDF. © 1991 The European Society of Cardiology

, Di Mario, C.;Iavernaro,, A.;Cucchini,, F.

doi: 10.1093/eurheartj/12.9.1006pmid: 1936000

Abstract In 13 patients with chronic stable angina, left ventricular pressures were measured by catheter-tip micromanometer, and left cineventriculography was performed at matched atrial paced rates before and 20 min after administration of intravenous gallopamil (3 mg). Mean plasma concentration of gallopamil at the second haemodynamic and angiographic assessment was 18·6±5·7 ng . ml−1. Left ventricular peak systolic pressure decreased from 134±12 to 125 ±13 mmHg (P < 0·005) and mean aortic pressure from 94±11 to 91±9 mmHg (ns). Peak positive first derivative of left ventricular pressure (+dP/dt) and maximal velocity of the contractile element (Vcemax) significantly decreased (from 1828±334 to 1702 ±304 mmHg . s−1, P < 0·002, and from 51±11 to 43±5 s−1, P < 0·001, respectively). Left ventricular protodiastolic pressure decreased from −0·6±2·9 to −2·8±2·9 mmHg (P < 0·005) and left ventricular end-diastolic pressure from 9·5±3·4 to 8·9±4·6 mmHg (ns). No changes occurred in peak negative dP/dt, while a significant reduction was observed in the exponential time constant of the first 40 ms of isovolumetric relaxation (t-constant decreased from 38±8 to 34±7 ms, P < 0·01 ). No changes were observed in end-diastolic and end-systolic left ventricular volume indices and ejection fraction. Thus, intravenous gallopamil induced a moderate afterload reduction and a slight negative inotropic effect resulting in a net effect of unchanged left ventricular pump function. The observed improvement of early relaxation seems to be a potentially beneficial effect of gallopamil in patients with coronary artery disease. Gallopamil, coronary artery disease, left ventricular function This content is only available as a PDF. © 1991 The European Society of Cardiology

, de Cock, C. C.;Visser, F., C.;Peels, K., H.;Kamp,, O.;, van Eenige, J.;Roos, J., P.

doi: 10.1093/eurheartj/12.9.1012pmid: 1936001

Abstract The long-term effects of oral nisoldipine or placebo on clinical variables, exercise test results and echo Doppler-determined systolic and diastolic functions were studied in 30 consecutive patients with reduced left ventricular function (predischarge echocardiographic wall motion score ⩾8) following myocardial infarction. Groups were comparable in clinical variables, exercise results, echo Doppler measurements and coronary anatomy. During 6 months follow-up, death, reinfarction and bypass surgery or balloon angioplasty were equally distributed. A significant increase in exercise duration and time to onset of ST-depression was found in the nisoldipine treatment group, compared to the placebo group after 3 and 6 months. Time to onset of angina was not significantly different. Echocardiographic indices of left ventricular systolic function (ejection fraction and wall motion score) were unaltered; however, the time-velocity integral of the early diastolic filling phase and the early vs late diastolic flow velocity ratio were significantly increased while the atrial time-velocity integral vs total time-velocity integral was significantly decreased in the nisoldipine treatment group after 3 and 6 months of follow-up. In conclusion, nisoldipine reduced exercise-induced ischaemia, improved exercise capacity and diastolic left ventricular function in postinfarction patients with reduced left ventricular function. nisoldipine, reduced left ventricular function, diastolic function, myocardial infarction This content is only available as a PDF. © 1991 The European Society of Cardiology

Installe,, E.;Gonzalez,, M.;Lessire,, H.;, De Coster, P.;Brichant,, Ch.;Cauwe,, F.

doi: 10.1093/eurheartj/12.9.985pmid: N/A

Abstract This study was designed to compare the positive inotropic properties of enoximone, a cardiac phosphodiesterase III inhibitor, with those of dobutamine in a population of moderate to severe congestive heart failure patients. The end-systolic pressure-volume relationship method was used. In addition, the haemodynamic effects of both drugs were compared. In seven of the 11 patients studied, enoximone induced a significant shift upwards and to the left of the end-ejection pressure/end-systolic volume (EEP/ESV) relation, giving evidence of a true positive inotropic effect. In the remaining patients, improvement in cardiac pump function was observed together with a shift of the EEP/ESV relation along the line of iso-inotropism and appeared to be the result of the vasodilatory effect of the drug alone. Data from nine patients were available for comparison with dobutamine which induced a shift upward and to the left of the EEP/ESV relation in seven patients. At the therapeutic doses chosen, the difference between the inotropic effects of the two drugs was not significant (P = 0·07). Of the three patients available for comparison who did not manifest inotropic response with enoximone, two were also dobutamine ‘non-responders’: they differed from the ‘responder’ patients in two respects: they had undergone surgery for correction of valvular disease and had significantly higher pulmonary artery pressures. The haemodynamic measurements confirmed the vasodilatory properties of enoximone; in particular, the fall in ventricular filling pressures was much greater with enoximone than with dobutamine. We conclude: (1) In moderate to severe congestive heart failure patients, enoximone shows positive inotropic properties in about 2/3 of patients. (2) No significant difference between the positive inotropic effects of the two drugs is observed. (3) Absence of a positive inotropic response to either drug in two of three patients suggests that failure of enoximone to induce a positive inotropic effect reflects myocardial refractoriness rather than drug ineffectiveness. However, the possible inadequacy of the EEP/ESV relationship method to detect changes in left ventricular inotropism in patients with pressure-overloaded right ventricles cannot be excluded. (4) Enoximone, like other phosphodiesterase inhibitors, is a potent vasodilator. Dobutamine, enoximone, left ventricular contractility, congestive heart failure, end-systolic pressure-volume relationship This work was presented in part at the 2nd Cardiovascular Pharmacotherapy International Symposium, October 18 to 22, 1987, San Francisco, California. This content is only available as a PDF. © 1991 The European Society of Cardiology