ABSTRACT
PURPOSE: To evaluate the arrhythmogenic profile of patients with dilated cardiomyopathy of low ejection fraction and its prognostic significance. METHODS: Data from 40 patients (30 males; mean age: 52 +/- 13 years) were analysed including ventricular arrhythmias (24h - Holter monitoring), autonomic balance from heart rate variability in time domain (rMSSD and pNN50 indexes), ventricular late potentials (signal averaged electrocardiogram (ECG) and dispersion of ventricular repolarization measured from 12-lead ECG. RESULTS: There was a high prevalence of ventricular arrhythmias with at least one episode of nonsustained ventricular tachycardia (VT) in 60% of the patients. Depressed vagal activity was observed in more than half of the patients. In only 30% of the patients the signal-averaged ECG was positive. The dispersion of ventricular repolarization ranged from 20 to 100 ms. The presence of > 30 ventricular premature beats or nonsustained VT on Holter monitoring was the most significant predictor of cardiac death and sudden cardiac death with a relative risk of 1.9 and 3.2, respectively (p = 0.01 and 0.000). CONCLUSION: In this study population it was noted that patients with dilated cardiomyopathy and low ejection fraction had an abnormal electrical and autonomic cardiac behaviour. These findings could represent risk factors for the occurrence of life-threatening arrhythmias or fatal events.
Subject(s)
Arrhythmias, Cardiac/physiopathology , Cardiomyopathy, Dilated/physiopathology , Stroke Volume , Female , Heart Ventricles/physiopathology , Humans , Male , Middle Aged , Prospective Studies , Risk FactorsABSTRACT
OBJETIVO - Avaliar o perfil arritmogênico ventricular de pacientes com miocardiopatia dilatada e fraçäo de ejeçäo diminuída. MÉTODOS - Estudo prospectivo em 40 pacientes com fraçäo de ejeçäo média ao ecocardiograma de 32,5ñ2,1 'por cento', obtida pela análise do Holter de 24h, do balanço autonômico cardíaco, determinado por índices de variabilidade da freqüência cardíaca (rMSSD e pNN50), do eletrocardiograma (ECG) de alta resoluçäo (ECGAR) e do grau de dispersäo da repolarizaçäo ventricular determinado no ECG de superfície. Por regressäo logística determinaram-se, a partir dos resultados, os preditores de risco para morte cardíaca e morte súbita. RESULTADOS - Observou-se na populaçäo envolvida uma elevada incidência de ectopias ventriculares isoladas, pareadas e de surtos näo sustentados de taquicardia ventricular. Pela análise do balanço autonômico notou-se depressäo da atividade vagal cardíaca em mais da metade dos pacientes, sendo que apenas 30 'por cento' apresentaram ECGAR positivo. O grau de dispersäo temporal da repolarizaçäo ventricular variou de 20 a 100ms. A presença de > 30 extra-sístoles isoladas por hora e de taquicardia ventricular näo sustentada ao Holter foram os preditores de risco com valores mais elevados para a morte cardíaca e morte súbita, com uma razäo de risco respectiva de 1,9 e 3,2 (p=0,01 e 0,000). CONCLUSÄO - Foram observadas importantes alteraçöes no comportamento elétrico e autonômico cardíaco, constituindo-se fatores de risco para a ocorrência de eventos arrítmicos graves ou fatais.
Subject(s)
Humans , Male , Female , Middle Aged , Arrhythmias, Cardiac/physiopathology , Cardiomyopathy, Dilated/physiopathology , Stroke Volume , Prospective Studies , Risk FactorsABSTRACT
PURPOSE: To evaluate the efficacy and tolerability of isradipine, a new dihydropyridine calcium antagonist, in the treatment of mild-to-moderate hypertension. PATIENTS AND METHODS: One hundred and eighty outpatients with different races, who had supine and orthostatic diastolic blood pressure (DBP) > or = 95 mmHg and < or = 115 mmHg, with a mean age of 52.03 +/- 11.47 years, 70 men, 110 women; underwent the study. After a two-week wash-out period patients received isradipine 2.5 mg b.i.d. for 90 days. Follow-up visits were performed at the 30th, 60th and 90th days of treatment. RESULTS: At the end of treatment (90 days), a statistically significant decrease (p < 0.05) in SBP and DBP in supine position was observed. A mean SBP was reduced from 159.28 +/- 16.99 to 142.51 +/- 15.12, and mean DBP declined from 101.49 +/- 6.82 to 86.63 +/- 7.40. Heart rate, weight, electrocardiograms and laboratory tests did not shows significant changes during treatment when compared to baseline evaluation. The most frequent related side effects (headache and dizziness with nausea) were transient, and at the end of the study 96.7% of the patients did not have any complaint. However, two patients were withdrawn from the trial because of important headache. CONCLUSION: Isradipine 2.5 mg by oral route, b.i.d. has shown to be effective and well tolerated in the treatment of mild-to-moderate hypertension in patients of both sexes and several ages and races.
Subject(s)
Dihydropyridines/administration & dosage , Hypertension/drug therapy , Administration, Oral , Adult , Aged , Brazil , Female , Humans , Male , Middle AgedABSTRACT
The authors studied cardiac performance of 36 patients with dilated cardiomiopathy through cardiac catheterization and left ventriculography in comparison with a control group. It has been verified that the end systolic volume (ESV) is more sensitive than ejection fraction (EF) as an indicator of the presence and degree of systolic dysfunction. Isoproterenol (IP) (18 patients) and D-isosorbitol (IS) (18 patients) have been used in the evaluation of hemodynamic response of DM. It has been verified equivalent responses such as: 1--decrease of ESV and end diastolic pressure (EDP); 2--increase of stroke volume and EF. The contractility indexes of left ventricle, however, showed different responses to the 2 substances: 1--with IP there was an increase of peak dp/dt and common peak isovolumetric pressure (CPIP 45 mmHg); 2--with IS there was no variation. The authors conclude that: 1--IP or similar drugs may be used during cardiac catheterization to evaluate the contractile reserve of the myocardium; 2--IS may be used in ambulatorial treatment of DM to improve ventricular function through a tendency to normalize intracardiac pressure-volume relation.
Subject(s)
Cardiomyopathy, Dilated/physiopathology , Hemodynamics/drug effects , Isoproterenol/pharmacology , Isosorbide/pharmacology , Sorbitol/analogs & derivatives , Adolescent , Adult , Blood Pressure/drug effects , Female , Heart Ventricles/physiopathology , Humans , Male , Middle Aged , Stroke Volume/drug effectsABSTRACT
The authors reviewed 1474 consecutive selective coronary arteriograms performed on patients with suspected coronary insufficiency for the diagnosis of obstructive coronary disease and found 281 (19.1%) cases of apparently normal coronary arteries. These patients presented mean age of 47 +/- 10 years; they were 135 (48%) males and 146 (52%) females. The objective of this study was to obtain the hemodynamic profile of these patients for the following parameters: a) aortic and left ventricular pressures; b) volumes, ejection fraction, segmentary contraction, wall thickness and mass of left ventricle; c) morphology, mobility and competence of the mitral valve. Eight groups of patients were selected: 1) without hemodynamic alterations - 18.9%; 2) with systemic arterial hypertension - 48.7%; 3) with abnormal myocardial contraction - 16.7%; 4) with idiopathic left ventricular hypertrophy - 6.4%; 5) with mitral valve prolapse - 2.5%; 7) with myocardial bridge of the left anterior descending coronary artery - 1.8%; 8) with coronary arterial microfistula of the left ventricle - 0.4%. It is desirable to determine before situations of cardiac emergencies, whether provoked ischemia, as detected by noninvasive stress testing, is present before the performing coronary arteriography in patients, specially females, with systemic arterial hypertension, left ventricular hypertrophy, disorders of ventricular contraction or mitral valve prolapse.
Subject(s)
Cineangiography , Coronary Angiography , Coronary Disease/physiopathology , Hemodynamics , Adult , Blood Pressure , Female , Humans , Male , Middle Aged , Mitral Valve/physiopathology , Myocardial Contraction , Stroke VolumeABSTRACT
Foi feito estudo eletrofisiologico do nodulo atrioventricular (AV) em 40 portadores de cardiopatia chagasica cronica com conducao AV 1:1 e varias formas de bloqueios de ramo. Utilizam como criterios de avaliacao da funcao nodal a medida do intervalo A-H, o ciclo artificial de desenvolvimento do fenomeno de Wenckebach, a presenca do fenomeno de acomodacao nodal, a determinacao por tecnica de extra-estimulos do periodo refratario relativo efetivo e funcional e as relacoes entre A1A2/ H1H2 com a finalidade de detectar curvas anormais de resposta nodal. Com os resultados demonstram alteracoes expressivas da funcao nodal, independentes da condutividade basal e manifestadas principalmente pela existencia da chamada "juncao AV preguicosa", que se podera apresentar com carater reativo ou nao, pelo prolongamento do periodo refratario efetivo e funcional, observando-se uma dissociacao nas relacoes entre esses periodos e a condutividade nodal basal e pela presenca de curvas nodais anormais sugestivas de dissociacao longitudinal funcional
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Heart Block , Chagas Cardiomyopathy , Sinoatrial Node , ElectrocardiographyABSTRACT
Os autores analisam a eletrofisiologia do nodulo sinusal de 31 portadores de cardiopatia chagasica cronica, com conducao AV 1:1 e varias formas de bloqueio de ramo ao ECG. Utilizam, como metodologia, a medida do tempo de recuperacao do nodulo simusal corrigido, determinado por estimulacao atrial continua e parada brusca da unidade geradora; a medida do tempo de conducao sino-atrial obtido por extra-estimulos pelas relacoes A1A2/A2A3 em seus percentuais sobre A1A1. Os resultados demonstram uma alta incidencia de transtornos do tecido perissinusal, sugerindo a existencia, nos casos de disfuncao sinusal em chagasicos, de um mecanismo misto de producao, envolvendo o automatismo celular e a condutividade tecidual. Sugerem que as lesoes do tecido perissinusal favorecem o aparecimento de mecanismos de reentrada, bem como representam fator de limitacao para a medida do tempo de recuperacao do nodulo sinusal. Descrevem, com os extra-extimulos um possivel novo tipo de fenomeno de "gap" ocorrendo entre o tecido atrial e a juncao sino-atrial
