Fixed combinations of delapril plus indapamide vs fosinopril plus hydrochlorothiazide in mild to moderate essential hypertension.

This 12-week randomized, parallel-group, multicenter study compared fixed combinations of delapril (D) 30 mg plus indapamide (I) 2.5 mg and fosinopril (F) 20 mg plus hydrochlorothiazide (H) 12.5 mg in 171 adult patients with mild to moderate essential hypertension. After a 2-week placebo run-in, sitting and standing systolic (SBP) and diastolic blood pressure (DBP) was measured by conventional sphygmomanometry. The primary efficacy endpoint was the percentage of normalized (sitting DBP < or =90 mm Hg) and responder (sitting DBP reduction of 10 mm Hg or DBP < or =90 mm Hg) patients. Treatment effects were analyzed in the intention-to-treat (ITT; n = 171) and the per-protocol (PP; n = 167) populations. The percentage of normalized and responder patients did not differ significantly between the D + I (87.4% and 92%) and the F + H (81% and 86.9%) ITT groups. Similar results were seen in the PP population. In ITT and PP patients, sitting and standing SBP and DBP values were comparable at baseline in the two groups and were significantly (P<.01) and similarly reduced at weeks 4, 8, and 12. Neither treatment induced reflex tachycardia, and both regimens were well tolerated. Four patients in the F + H group dropped out because of adverse events. In this study, the efficacy and safety of D + I were comparable to those of F + H in patients with mild to moderate essential hypertension.

[Doppler echocardiography in the evaluation of pulmonary hypertension in chronic obstructive pulmonary disease]. / Doplerska ehokardiografija u procjeni plucne hipertenzije kod kronicne opstrukcijske plucne bolesti.

Systolic pulmonary arterial pressure (PAPs) at rest and during submaximal exercise using bicycle ergometer was estimated in 80 patients with clinical stable obstructive pulmonary disease (COPD). Systolic pulmonary arterial pressure was estimated by using continuous Doppler from maximal velocity of the tricuspid regurgitant jet by applying the modified Bernoulli equation and regression: PAPs = 1.23 x 4 Vmax2-0.09 (mmHg). Pulmonary hypertension (PAPs (m) 30 mmHg at rest, or PAPs (o) 40 mmHg during the exercise) was registered in 56% of the patients with chronic obstructive pulmonary disease. Thirty percent of the patients (24/80) had mild degree latent pulmonary hypertension (PAPs (o) = 41-47 mmHg), and 26% (21/80) of the patients with COPD had mild to moderate manifest pulmonary hypertension (PAPs(m) = 33-47 mmHg). In 11 patients with manifest pulmonary hypertension (52%), a decrease of PAPs for 5 mmHg or more was registered after oxygen-test. These patients were grouped as responders. Systolic pulmonary arterial pressure at rest and during the exercise has best correlation with arterial PaO2 (r = -0.73 to -0.87), and out of parameters of pulmonary ventilation it has the best correlation with index FEF50/FVC (r = -0.49 to -0.68). By using continuous wave Doppler systolic pulmonary artery pressure was estimated in 84% of the patients with COPD (80/95). Fifteen patients were excluded from the study because of the bad echocardiographic window or inadequate Doppler tricuspid regurgitation signal.

Properties of ultrasonically marked leads.

We have developed an ultrasonic marking system for pacing leads and the electrophysiological study of catheters. The aim of this study was to evaluate the accuracy of our system, its usability in the measurement of performance of implanted leads, and to investigate the potential of electrical shock and ultrasonic hazard. The measurements have shown that different applications require specific electronic design, involving some compromise between accuracy and sensitivity. A higher sensitivity at the beginning of the ultrasonically guided cardiac lead implantation yields poorer accuracy. Quantitative measurements show that accuracy can be subsequently improved by reduction of sensitivity of the marking system. The transponder marking circuit is better suited for general use and the passive electronic circuit is better suited for multiple electrode electrophysiological studies. Experiments concerning electrical safety show that in the worst failure case, the energy of the marking system released within the heart is less than 10(-9) J per pulse within the pacing frequency spectrum and the current was below 50 microamperes. Ultrasound intensities were within the safety limits set by international and national organizations. The experiments using the marking system for detection of the pacing lead failure showed that the system can yield an early warning of the lead malfunction. The system can significantly reduce the exposure of the medical staff and the patients to x rays as well as improve patient follow-up accuracy.

Systolic direction of right ventricular contrast trajectories in the detection of ventricular septal defect with left-to-right shunt.

Abnormal systolic direction of contrast flow toward the transducer within the right ventricle was demonstrated on M-mode echocardiograms in patients with ventricular septal defect (VSD) and left-to-right shunt. The usefulness of this new technique was tested in 30 patients with VSD proved at catheterization and in 300 control subjects. In all subjects, 2-dimensional (2-D) visualization of the defect, 2-D negative contrast effect and M-mode demonstration of positive contrast within the left ventricular (LV) cavity were also performed. Sensitivity and specificity for each technique and each hemodynamic subgroup of patients were determined and compared. A sensitivity of 100% for the diagnosis of VSD by anterior right ventricular (RV) systolic direction of contrast trajectories was achieved in 20 patients with relatively small VSDs and mild to moderate elevation of RV pressure (RV-LV pressure ratio 60%) and mean pulmonary to systemic blood flow ratio of 1.7. Sensitivities of 2-D echocardiography, 2-D negative contrast technique and positive LV contrast appearance on M-mode echocardiography were 63%, 71% and 53%, respectively. Sensitivity of 100% for systolic anterior direction of contrast trajectories was also calculated in 6 patients with RV-LV pressure ratios from 61 to 80% and mean pulmonary to systemic blood flow ratio of 2.7. Sensitivities of 2-D echocardiography, 2-D negative contrast technique and positive contrast appearance in the LV cavity by M-mode echocardiography were 75%, 60% and 86%, respectively. In 4 patients with systemic or nearly systemic RV pressure, sensitivity of systolic anterior direction of RV contrast trajectories decreased drastically, to only 67%.(ABSTRACT TRUNCATED AT 250 WORDS)

Some new M-mode and two-dimensional echocardiographic findings in mitral valve prolapse.

Some new M-mode (contact lesion of the left side endocardium of the interventricular septum and its brisk early diastolic anterior motion) and two-dimensional (multiple mitral valve orifices and masses mimicking vegetations or tumour) echocardiographic findings are described.