Estudio sobre la miocardiopatía hipertrófica: aspectos clínicos, ecocardiográficos, hemodinámicos y angiocardiográficos en una serie de treinta pacientes / Hypertronic mycardiopathy study: clinical, ecocardiographic, ecographic, hemodynamic and angiographic aspects in series of thirty patients

Se hace la descripción clínica de la miocardiopatía hipertrófica en el medio venezolano. El estudio versó sobre los aspecto clínicos, ecocardiográficos, hemodinámicos y angiocardiográficos de esta entidad, el cual fue realizado en una serie de treinta pacientes, observados durante el lapso de 7 años (1978-1985) en nuestro país. El espectro clínico de la afección fue muy amplio, el cual abarcó desde formas asintomáticas hasta formas con sintomatología de severidad progresiva. El diagnóstico clínico se fundamentó en una historia clínica sugestiva, a veces de carácter familiar, con una signología en la que sobresalen las alteraciones del pulso, el hallazgo de un choque apexiano anormal (bífido o trífido), el latido presistólico y los soplos relacionados con la obstrucción del tracto de salida y la insufiencia valvular mitral. La enfermedad se caracterizó por un cuadro clínico de evolución progresiva. El diagnóstico clínico fue corroborado por la presencia de dos alteraciones ecocardiográficas significativas: 1) la hipertrofia septal asimétrica, 2) el movimiento sistólico anterior de la valva anterior de la válvula mitral o de ambos. En el estudio hemodinámico por la presencia de un gradiente de presión intraventricular en reposo o provocado y en la angiocardiografía por la constatación de la hipertrofia septal y de los músculos papilares. Se desconoce la prevalencia de la afección en escala mundial y nacional. Es necesario realizar estudios sobre el aspecto familiar y las alteraciones genéticas que presenta la afección en nuestro medio. Los estudios patológicos, realizados en el Instituto de Anatomía Patológica, UCV, han permitido corroborar las alteraciones estructurales características de la afección en el material patológico de nuestro medio

[Comparison of the sensitivity and specificity of the electrocardiography criteria for left ventricular hypertrophy according to the methods of Romhilt-Estes, Sokolow-Lyon, Cornell and Rodríguez Padial]. / Comparación de la sensibilidad y especificidad de los criterios electrocardiográficos para la hipertrofia ventricular izquierda según métodos de Romhilt-Estes, Sokolow-Lyon, Cornell y Rodríguez Padial.

INTRODUCTION AND OBJECTIVES: Because left ventricular mass is associated with an increase in the risk of morbidity and mortality of cardiovascular diseases in the general population having the electrocardiogram as an accessible and inexpensive method for the diagnosis of left ventricular hypertrophy, we decided to calculate the sensitivity and specificity of 5 electrocardiographic criteria for the diagnosis of left ventricular hypertrophy and to compare the results of the original authors to ours. PATIENTS AND METHODS: 135 patients were evaluated; 46 patients were excluded by the following criteria: chronic obstructive pulmonary disease, complete left or right bundle branch block, cardiovascular ischemic disease or Wolf-Parkinson-White Syndrome. 89 patients remained and had an electrocardiogram performed applying the following criteria: Romhilt-Estes Point-Score system. Sokolow-Lyon (SV1 + RV5 or V6 > 3.5 mV) and (RaVL > 1.1 mV), Cornell and Rodríguez Padial. Left ventricular hypertrophy was defined by the Penn Convention Criteria. RESULTS: In our study we obtained the following results: a) Romhilt-Estes had a sensitivity of 12% and a specificity of 87%; b) Sokolow-Lyon (SV1 + RV5 or V6) had a sensitivity of 22% and a specificity of 79%; c) Sokolow-Lyon (RaVL) has a sensitivity of 18% and a specificity of 92%; d) Cornel had a sensitivity of 31% and a specificity of 87%, and e) Rodríguez Padial had a sensitivity of 82% and a specificity of 8%. There are similarities between our results and the authors's original ones. However, there are significant statistical differences between them (p < or = 0.01). CONCLUSION: Our conclusion is that these criteria have a low diagnostic value in the isolated interpretation of patients with left ventricular hypertrophy, and we need to integrate them with the whole medical history and physical examination.

The physical state of ubiquinone-10, in pure form and incorporated into phospholipid bilayers. A Fourier-transform infrared spectroscopic study.

Long-chain quinones are essential components of both bacterial and eukaryotic respiratory chains, and some of the main unsolved questions on energy transduction in membranes are complicated by the lack of consistent information on the physical state of the quinones in membrane bilayers. We have recorded, at various temperatures and under different conditions, the infrared spectra of ubiquinone-10 (the main species in mitochondria) and several analogues. The C = O stretching vibration band located at 1663-1670 cm-1 has been identified as the most sensitive one to phase and environmental changes. Three distinct phases have been characterized in which pure ubiquinone-10 may exist: crystalline (LC1), isotropic liquid (IL) and liquid crystalline (Lc). The only allowed thermotropic transitions are LC1----IL, IL----Lc and Lc----LC1. Our investigations with pure quinones provide a simpler and more detailed description of their phase changes than any of the previous studies and shed light on their behaviour in membranes. When incorporated into phospholipid bilayers, ubiquinone-10 appears to be removed from the aqueous environment and is found to exist, in the 4-70 degrees C range, in an isotropic liquid phase, in the form of small aggregates.

Quantitative determination of hydrocarbon chain conformational order in bilayers of saturated phosphatidylcholines of various chain lengths by Fourier transform infrared spectroscopy.

The infrared spectra of aqueous dispersions of a homologous series of symmetric-chain, disaturated phosphatidylcholines, with fatty acyl chain lengths ranging from 12 to 19 carbons, have been measured at comparable reduced temperatures in their liquid-crystalline phases. The infrared spectra of these compounds contain bands that are dependent on the conformation of the fatty acyl chains. In particular, in the 1400-1300-cm-1 spectral region, there are bands due to CH2 wagging which are specific for the different types of gauche conformers. Thus, gauche-trans-gauché sequences (or kinks) give a band at 1367 cm-1, end-gauche conformers a band at 1341 cm-1, and double-gauche conformers a band at 1355 cm-1. The intensities of these bands were determined and normalized to the intensity of the conformation-insensitive band due to symmetric methyl bending at 1378 cm-1. The intensities of the different "gauche" bands yield a "per chain" intensity, which is directly related to the concentration of the different types of conformational defects. We find that, within experimental error, the concentration of end-gauche and double-gauche conformers is relatively low and practically invariant with chain length when a series of homologous phosphatidylcholines are compared at the same reduced temperature. In contrast, the concentration of gauche-trans-gauché sequences (kink defects) is much higher and increases as the chain length increases. For dipalmitoylphosphatidylcholine we find that there are about 1.2 kink, 0.5-0.6 end-gauche, and 0.4 double-gauche conformers per hydrocarbon chain.(ABSTRACT TRUNCATED AT 250 WORDS)

Spontaneous formation of small unilamellar vesicles by pH jump: a pH gradient across the bilayer membrane as the driving force.

31P NMR and infrared spectroscopic methods have been used to study the formation of small unilamellar vesicles by the pH-jump method. It is shown that increasing the pH of different lamellar phospholipid dispersions (phosphatidic acids and phosphatidylserines) induces a pH gradient. This pH gradient is estimated to be 4 +/- 1 pH units, and its direction is such that the inner monolayer of the vesicles is at lower pH. There is spectroscopic evidence for tighter packing of the lipid hydrocarbon chains in the inner monolayer, probably due to the constraints imposed by the high curvature of the small vesicles formed. These results are discussed in terms of the driving force of the spontaneous vesiculation.

Infrared and 31P-NMR studies of the interaction of Mg2+ with phosphatidylserines: effect of hydrocarbon chain unsaturation.

Infrared and 31P-NMR spectra of aqueous dispersions of 1,2-dimyristoyl-sn-glycero-3-phospho-L-serine (DMPS), 1-palmitoyl-2-oleoyl-sn-glycero-3-phospho-L-serine (POPS), 1,2-dioleoyl-sn-glycero-3-phospho-L-serine (DOPS) and ox brain phosphatidylserine in the presence of excess Mg2+ have been recorded. A consistent picture emerges from the application of infrared and 31P-NMR spectroscopy to Mg2+-PS interactions. Mg2+ forms crystalline complexes with saturated phosphatidylserines, such as DMPS, and probably with POPS. In these crystalline PS-Mg2+ complexes the phosphate group loses its water of hydration but the serine carboxylate remains hydrated. Furthermore, there is formation of an additional hydrogen bond to one of the ester carbonyl groups of DMPS, and interchain interactions appear to be enhanced as reflected by a tighter packing of the fatty acyl chains. One main conclusion of this work is that Mg2+ binding to PS bilayers shows a gradation, the binding is in the order DMPS greater than POPS greater than ox brain PS greater than DOPS. The molecular area increases in the order DMPS less than ox brain PS less than POPS less than DOPS and is apparently an important parameter determining the affinity of PS for Mg2+. The general trend is that with increasing molecular area, and hence spacing of the ligands, the binding of Mg2+ decreases. While PS with two saturated fatty acyl chains forms tightly packed, crystalline Mg2+ complexes with an immobilized headgroup, the unsaturated PS molecules such as ox brain PS and DOPS interact only weakly with Mg2+. Their interaction seems to be restricted to electrostatic shielding, since no major changes in molecular conformation, chain packing and headgroup hydration are found. The interaction of POPS with Mg2+ is intermediate between that of saturated PS and that of DOPS. POPS exhibits a higher affinity for Mg2+ than ox brain PS, although their molecular areas (and the surface charge density) are approximately the same. This apparent anomaly is proposed to be due to a discreteness of charge effect. It is proposed that a lipid surface with regularly spaced polar groups has a higher affinity for binding Mg2+.

Echophonocardiography in patients undergoing percutaneous mitral balloon valvotomy (PMV): the learning curve of PMV.

Percutaneous mitral balloon valvotomy (PMV) was performed in 10 female patients with mitral stenosis; their mean age was 31 +/- 1 years. All patients underwent echophonocardiography (Echophono) before and less than 24 hours after PMV1. Cardiac catheterization and Echophono were repeated 10 and 22 months after PMV1. Eight patients with suboptimal results (defined as a post-PMV mitral valve area [MVA]/less than 1.0 cm2 and mean gradient greater than/10 mm Hg) underwent repeat PMV (PMV2) 10 months after PMV1. The Echophono data are correlated with clinical and hemodynamic changes produced by PMV1 and PMV2. MVA increased from 0.6 +/- 0.1 to 1.1 +/- 0.01 cm2 (p = 0.0009) when PMV1 was performed with a mean effective balloon dilating area (EBDA) of 5 +/- 0.19 cm2. MVA increased from 1.0 +/- 0.1 to 1.7 +/- 0.2 cm2 (p = 0.0002) when PMV2 was performed with larger EBDA (6.4 +/- 0.34 cm2). Two factors related to the learning curve account for the superior result of PMV2: (1) use of larger EBDA and (2) optimal position of the balloons parallel to the long axis of the left ventricle. PMV1 resulted in Echophono changes consistent with decreased severity of mitral stenosis: shortening of Q-S1 from 93 +/- 4 to 82 +/- 4 msec (p less than 0.05) and (Q-S1)-(S2-OS) from 1.8 +/- 0.8 to -0.9 +/- 0.6 (p less than 0.01); prolongation of S2-OS from 75 +/- 5 to 91 +/- 5 msec (p less than 0.05) and increase of EF slope from 7 +/- 1 to 17 +/- 4 mm/sec (p less than 0.05). Compared with PMV1, post PMV2 Echophono showed a further decrease in the severity of mitral stenosis: Q-S1 decreased to 78 +/- 3 msec and (Q-S1)-(S2-OS) decreased to -0.5 +/- 0.3 msec. S2-OS increased to 86 +/- 5 msec and EF slope increased to 22 +/- 4 mm/sec. The hemodynamic and Echophono changes produced by PMV1 and PMV2 persisted at the corresponding follow-up studies. There was no evidence of restenosis. Thus Echophono is a simple, low cost method helpful in the evaluation and follow-up of patients undergoing PMV.

Structural and conformational changes of beta-lactoglobulin B: an infrared spectroscopic study of the effect of pH and temperature.

Infrared spectra of 2.5 mM solutions of beta-lactoglobulin B were recorded as a function of pH (from pH 2 to pH 13) and as a function of temperature (from -100 degrees C to +90 degrees C). An analysis of the pH- and temperature-induced changes in the secondary structure was performed based on changes in the conformation-sensitive amide I bands of beta-lactoglobulin. Whereas the total amount of beta-structure remains constant (56-59%) between pH 2 and pH 10, the proportions of the various beta-components do change. In particular, the dimerization of the monomeric protein, induced by raising the pH from 2 to 3 , leads to an increase in the intensity of the 1636 cm-1 band (associated with antiparallel beta-sheet), at the expense of the 1626 cm-1 band (associated with exposed beta-strands). Both the thermal and alkaline denaturation of beta-lactoglobulin occur in two distinct stages. Although the spectra (i.e., the structures) after complete thermal or alkaline denaturation are clearly different, the spectrum of the protein after the first stage of thermal denaturation (at about 60 degrees C) is the same as that after the first stage of alkaline denaturation (at pH 11), suggesting a common denaturation intermediate, which probably represents a crossover point in a complex potential hypersurface.

Infrared studies of fully hydrated unsaturated phosphatidylserine bilayers. Effect of Li+ and Ca2+.

Infrared spectroscopy has been used to characterize the thermal-phase behavior of fully hydrated 1-palmitoyl-2-oleoyl-sn-glycero-3-phospho-L-serine (POPS) and 1,2-dioleoyl-sn-glycero-3-phospho-L-serine (DOPS) as well as their interaction with Li+ and Ca2+. The order-disorder transition of POPS-NH4+ is at 17 degrees C; in the presence of Li+ a POPS-Li+ complex is formed, and the transition temperature of this complex is 40 degrees C. DOPS-NH4+ has an order-disorder transition at -11 degrees C, and unlike POPS the addition of Li+ has no effect on the thermal behavior of DOPS-NH4+. This indicates that the binding of Li+ to DOPS is negligible or very weak. Li+ binds to the phosphate and carboxylate groups of POPS, and as a result these groups lose their water of hydration. Li+ binding induces a conformational change, probably in the glycerol backbone of POPS; however, the conformation of the two P-O ester bonds remains gauche-gauche as in POPS-NH4+. Both POPS and DOPS form crystalline complexes with Ca2+. As a result of Ca2+ binding to the phosphate, this group loses its water of hydration and there is a conformational change in the P-O ester bonds from gauche-gauche to antiplanar-antiplanar. In contrast to the POPS-Li+ complex, the carboxylate group remains hydrated in the Ca2+ complexes. Furthermore, in these PS-Ca2+ complexes a new hydrogen bond is formed between one of the ester C=O groups and probably water. Such a situation is not found in the NH4+ and Li+ salts of phosphatidylserine.

Conformational changes in proteins induced by low temperatures: an infrared study.

Infrared spectra of hemoglobin (met-hemoglobin) and myoglobin were recorded in the temperature range -110 degrees C to 30 degrees C. On cooling hydroalcoholic solutions of hemoglobin, the spectra indicate a conformational change (revealed by the appearance of a band at 1665 cm-1) compatible with the appearance of distortions in its alpha-helical structure. In the case of myoglobin smaller effects are observed. These conformational changes are entirely reversible and do not occur in frozen aqueous solutions.

Infrared studies of fully hydrated saturated phosphatidylserine bilayers. Effect of Li+ and Ca2+.

The thermotropic phase behavior of fully hydrated Na+ and/or NH4+ salts of 1,2-dimyristoyl-sn-glycero-3-phospho-L-serine (DMPS) was determined by temperature-dependent infrared spectra. The molecular level properties and thermal phase behavior of DMPS-Li+ complexes were also characterized by infrared spectroscopy. With increasing concentrations of Li+, the infrared spectra reveal the appearance of a second, more ordered, lipid phase which shows a gel to liquid-crystal transition at significantly higher temperatures (75-95 degrees C) than the Na+ or NH4+ salts of DMPS (39 degrees C). Li+ binds to the phosphate and carboxylate groups of DMPS, resulting in the following changes: (1) water of hydration is lost from both the carboxylate and phosphate groups; (2) there are changes in the conformation of the glycerol backbone but not in the P-O ester bonds of the phosphate group which remain in the gauche-gauche conformation; and (3) the packing of the fatty acyl chains becomes more ordered. In addition, the properties of the DMPS-Ca2+ complex were studied by infrared spectroscopy. While the DMPS-Ca2+ complex is also characterized by rigidly packed, well-ordered fatty acyl chains, the mode of Ca2+ binding to the DMPS head groups differs significantly from that of Li+ binding. By comparison, with dry DMPS-Ca2+ [Casal, H. L., Mantsch, H. H., Paltauf, F., & Hauser, H. (1987) Biochim. Biophys. Acta (in press)], the phosphate group undergoes a conformational change, probably to the antiplanar-antiplanar conformation, and loses its water of hydration.(ABSTRACT TRUNCATED AT 250 WORDS)

Infrared and 31P-NMR studies of the effect of Li+ and Ca2+ on phosphatidylserines.

Infrared and 31P-NMR spectra of solid samples of 1,2-dimyristoyl-sn-glycero-3-phospho-L-serine (DMPS), 1-palmitoyl-2-oleoyl-sn-glycero-3-phospho-L-serine (POPS) and 1,2-dioleoyl-sn-glycero-3-phospho-L-serine (DOPS) have been recorded. Comparison of the spectra of the Na+ salts of these phospholipids with those of complexes formed with Li+ and Ca2+ ions allows the characterization of conformational changes induced by complexation with Li+ and Ca2+. Ca2+ forms tight, crystalline complexes with these phosphatidylserines (PS), irrespective of the degree of unsaturation in the hydrocarbon chains. In these PS-Ca2+ complexes the torsion angles of the two P-O ester bonds exhibit the antiplanar-antiplanar conformation which is significantly different from the standard gauche-gauche conformation commonly found in phosphodiesters. In contrast, complexation with Li+ does not induce this conformational change in the phosphodiester group. It is shown that the degree of unsaturation in the hydrocarbon chains, and related to it, the cross-sectional area of the phospholipid or the surface charge density, determine the affinity of the phosphatidylserine for the metal ion. In general, the affinity of phosphatidylserines for both Li+ and Ca2+ decreases with increasing unsaturation in the hydrocarbon chains or decreasing surface charge density; it is in the order DMPS greater than POPS greater than DOPS.

Percutaneous balloon valvotomy for patients with severe mitral stenosis.

Thirty-five patients with severe mitral stenosis underwent percutaneous mitral valvotomy (PMV). There were 29 female and six male patients (mean age 49 +/- 3 years, range 13 to 87). After transseptal left heart catheterization, PMV was performed with either a single- (20 patients) or double- (14 patients) balloon dilating catheter. Hemodynamic and left ventriculographic findings were evaluated before and after PMV. There was one death. Mitral regurgitation developed or increased in severity in 15 patients (43%). One patient developed complete heart block requiring a permanent pacemaker. PMV resulted in a significant decrease in mitral gradient from 18 +/- 1 to 7 +/- 1 mm Hg (p less than .0001) and a significant increase in both cardiac output from 3.9 +/- 0.2 to 4.6 +/- 0.2 liters/min (p less than .001) and in mitral valve area from 0.8 +/- 0.1 to 1.7 +/- 0.2 cm2 (p less than .0001) Effective balloon dilating diameter per square meter of body surface area correlated significantly with the decrease in mitral gradient but did not correlate with the degree of mitral regurgitation. There was no correlation of age, prior mitral commissurotomy or mitral calcification with hemodynamic results. PMV is an effective nonsurgical procedure for patients with mitral stenosis, including those with pliable valves, those with previous commissurotomy, and even those with mitral calcification.

Infrared spectroscopic characterization of the interaction of lipid bilayers with phenol, salicylic acid and o-acetylsalicylic acid.

The interaction of phenol (PHE), salicylic acid (SA) and o-acetylsalicylic acid (ASA) with bilayers of 1,2-dipalmitoyl-sn-glycero-3-phosphocholine (DPPC) was investigated by infrared spectrometry. The temperature of the main gel to liquid crystal phase transition of DPPC is markedly depressed in the presence of the three guest molecules. The temperature depression depends on the nature and concentration of the additives. The temperature of the pretransition is also affected by these guest molecules and the depression in temperature is even more pronounced than that of the main transition temperature. Possible modes of interaction of these guest molecules with the lipid bilayers are discussed.

Sustained ventricular tachycardia in chronic chagasic myocarditis: electrophysiologic and pharmacologic characteristics.

Sustained ventricular tachycardia (VT) develops in many patients with chronic Chagasic myocarditis. Programmed stimulation was used to study the electrophysiologic characteristics of VT in 15 patients with Chagas' cardiomyopathy. Nine patients were in New York Heart Association functional class I, 5 were in class II and 1 patient was in class III. The average ejection fraction was 56 +/- 7%, which is somewhat better than that reported in patients with VT owing to idiopathic cardiomyopathy. In 11 patients VT could be reproducibly initiated and terminated by programmed stimulation. Intravenous mexilitene prevented induction of VT in 7 of 8 patients; amiodarone did not prevent induction in 3 of 4 patients. Our data indicate that the mechanism of VT is likely to be reentrant in many patients, and therefore VT can be produced by extrastimuli. Electrophysiologic study is therefore useful for establishing the diagnosis of sustained VT and may be useful for guiding initial therapy in selected cases of Chagas' disease.

Radionuclide evaluation of left-ventricular function in chronic Chagas' cardiomyopathy.

Left-ventricular ejection fraction (LVEF) and abnormalities of regional wall motion (WMA) were studied by means of radionuclide ventriculography in 41 patients prospectively diagnosed as having chronic Chagas' disease. Thirteen patients were asymptomatic (ASY), 16 were arrhythmic (ARR), and 12 had congestive heart failure (CHF). Mean LVEF was normal in ASY (0.64 +/- 0.06) but markedly depressed in CHF (0.28 +/- 0.08). Regional WMAs were minimal in ASY and their severity increased in ARR. Most CHFs (75%) had diffuse hypokinesia of the left ventricle. The region most frequently affected was the infero-apical (63%). Seven patients had a distinct apical aneurysm. Correlation between radionuclide and contrast ventriculography data was good in 17 patients. For LVEF, r = 0.90. For WMA there was agreement between the two techniques in 77% of 65 segments compared. Best agreement occurred with infero-apical lesions (88%), and worst with septal (69%). Selective coronary arteriography showed normal arteries in all patients. Therefore, chronic Chagas' heart disease joins ischemic heart disease as a cause of regional WMA.

Interaction of dipalmitoylphosphatidylcholine and dimyristoylphosphatidylcholine-d54 mixtures with glycophorin. A fourier transform infrared investigation.

Glycophorin from the human erythrocyte membrane has been isolated in pure form and reconstituted into large unilamellar vesicles comprised of binary mixtures of 1,2-dipalmitoyl-3-sn-phosphatidylcholine (DPPC) and chain perdeuterated 1,2-dimyristoyl-3-sn-phosphatidylcholine (DMPC-d54). The effect of temperature and protein on lipid structure and mixing was monitored by using Fourier transform infrared spectroscopy; deuteration of one of the components of the mixture permits observation of the protein interaction with each lipid species. The melting curves were analyzed by assuming that each lipid chain can exist in one of two physical states (i.e., gel or liquid crystalline), characterized by a temperature-dependent Lorentzian distribution for the line shape of the C-H or C-D stretching vibrations. The fraction of each lipid component melted at temperatures within the two-phase region of the phase diagram was calculated and approximate phase diagrams were constructed. Addition of protein lowers the liquidus line of the phase diagram while leaving the solidus line essentially unchanged. No lipid phase separation is observed. The effect of protein is more pronounced on the DPPC component than on the DMPC-d54. The former is significantly more disordered and/or fluidized at all lipid mole fractions in the ternary system than in the binary phospholipid mixture.

Endomyocardial disease in South America--report on 23 cases in Venezuela.

Twenty-three cases of endomyocardial disease (ED) are presented, studied in Venezuela, a tropical country in northern South America. The diagnosis was confirmed in 18 cases by means of pathological studies, and in 5 cases by angiocardiography which showed the characteristic obliterative ventricular lesions. Eosinophilia was present in 35% of the patients. The most frequent clinical feature was heart failure associated with mitral regurgitation. Systemic embolism was the first clinical feature in 5 cases. In 2 cases, ED was associated with autoimmune haemolytic anaemia or vasculitis. Necropsy revealed a predominance of the left-sided (9/16 cases) and biventricular (6/16 cases) types. The pathological lesions were characterised by fibrous thickening of the endocardium at the apex and the ventricular inflow tracts extending to the myocardium and involving the atrioventricular valves. ED is frequently misdiagnosed as rheumatic valvular cardiopathy. The two-dimensional echocardiogram is a very useful procedure for determining the spatial anatomy of ED. The echo findings were closely correlated with ventriculographic and necropsy findings. Even though ED is widely spread around the world, it is most frequently found in tropical and subtropical countries in Africa, Asia and America, such as Venezuela and Brazil. This suggests that there are aetiological factors in these latitudes, about which little is known.

[Electrophysiological evaluation of the treatment of patients with recurrent ventricular tachycardia]. / Evaluación electrofisiológica del tratamiento de pacientes con taquicardia ventricular recurrente.

In order to asses the predictive value of serial electrophysiologic studies in the selection of an effective long-term effective antiarrhythmic regimen, we studied 16 patients with recurrent sustained ventricular tachycardia (VT), resistant to conventional medical treatment. (group 1) Eleven patients in this group had chronic chagas myocarditis, and several hospitalizations and cardioversions had been required for therapy of VT. In addition, 35 patients (group 2: control) underwent electrophysiological studies to evaluate rhythm disturbances differences to TV. Ventricular Tachycardia was successfully initiated and terminate with programmed electrical stimulation of the right ventricle only in the group 1. After control studies, the effects of several drugs (ajmalin, amiodarone, carbamazepine, disopyramide, diphenilhydantoin, mexiletine, procainamide, propranolol, quinidine and verapamil on the ability to initiate VT were assessed. A drug was considered effective only if it prevented the initiation of VT and allowed long-term suppression o clinical VT. All the patients of group 1 were placed on chronic oral therapy with the effective agent and were followed for an average period of 16 months (range 5 to 47 months). In all 16 patients we could document complete long-term prophylaxis against VT. This method offers advantage in terms of morbidity, mortality, duration of therapy, and promptness of choosing an effective drug add expense to the patient over traditional empirical methods of drug selection.