Predictive value of associations between carotid arterial sclerosis and left ventricular diastolic dysfunction in patients with cardiovascular risk factors.

It is well known that arterial stiffness affects the morbidity and mortality associated with cardiovascular disease. However, there are limited data addressing the relationship between arterial stiffness and left ventricular (LV) diastolic function in patients with cardiovascular risk factors. Subclinical atherosclerosis was determined by measuring the intima-media thickness and stiffness (beta) of the left and right common carotid arteries using B- and M-mode ultrasonography in 30 patients with one or more cardiovascular risk factors. LV systolic and diastolic function were also determined by measuring transmitral flow velocity, mitral annular motion velocity, and myocardial strain and strain rate profiles using pulsed Doppler, tissue velocity, and ultrasonic strain imaging. The carotid stiffness beta was greater and the peak early diastolic strain rates of the LV posterior and inferior walls were lower in these patients than in the age-matched control group. The carotid intima-media thickness correlated only with body mass index and LV wall thickness. The carotid stiffness beta correlated with age, peak early diastolic velocity and deceleration time of the transmitral flow, peak early diastolic mitral annular motion velocity, and peak early diastolic strain rates of the LV walls. Multiple linear regression analysis revealed that early diastolic strain rates of the LV walls are strongly related to carotid stiffness beta. In conclusion, LV relaxation is significantly associated with carotid arterial atherosclerosis, particularly sclerosis, in patients with cardiovascular risk factors. These results support the importance of screening using ultrasonic strain imaging and early intervention in this patient population.

Three-dimensional evaluation of dobutamine-induced changes in regional myocardial deformation in ischemic myocardium using ultrasonic strain measurements: the role of circumferential myocardial shortening.

Early identification of myocardial ischemia during high-dose dobutamine stress (DOB) has important clinical implications. Myocardial strain imaging can evaluate regional myocardial contractility in the radial, longitudinal, and circumferential directions. The aim of this study was to assess precisely the differences in deterioration of myocardial deformation among the 3 directions in patients with newly developed myocardial ischemia during high-dose (40 microg/kg/min) DOB infusion. Color Doppler tissue 2-dimensional images were recorded during DOB infusion in 20 patients without myocardial ischemia and 25 patients with scintigraphically diagnosed myocardial ischemia caused by left anterior descending coronary artery stenosis. In the offline analysis, systolic radial strain (Sr), longitudinal strain (Sl), and circumferential strain (Sc) were determined in the anteroseptal and anterolateral left ventricular walls. In 20 patients without myocardial ischemia, the peak systolic strains significantly increased in all 3 directions during DOB infusion at rates between 5 and 10 microg/kg/min (Sr 50%-69%, Sl 27%-36%, Sc 29%-38%, all P < .01) with a greater rate of change in the Sr (1.8 and 1.9 times, respectively, P < .001) than in the Sl and Sc. However, the peak systolic strains decreased significantly during DOB infusion at rates between 5 and 10 microg/kg/min in all 3 directions (Sr 56%-35%, Sl 27%-13%, both P < .01; Sc 29%-7%, P < .001) with the greatest rate of change in the Sc in 25 patients with newly developed myocardial ischemia. In conclusion, circumferential myocardial shortening deteriorated to a greater extent during DOB infusion in patients with coronary artery stenosis, and its measurement is a promising tool for detecting newly developed myocardial ischemia.

A patient responding to combined therapy with pirmenol and midodrine for refractory neurally mediated syncope complicated by prostatic hypertrophy.

A 67-year-old man with neurally mediated syncope (NMS) complicated by prostatic hypertrophy responded well to combined therapy with pirmenol and midodrine. In 2003, syncope occurred while the patient was driving a car. Results of head-up tilt-table testing (HUT) suggested a mixed type of NMS. Oral administration of disopyramide provided severe urinary obstruction. Pirmenol treatment was not associated with syncope during ordinary HUT, but nausea, sweating, and syncope occurred during HUT with provocative administration of isosorbide dinitrate. Combined therapy with pirmenol and midodrine avoided syncope during HUT, and has prevented attacks since discharge from the hospital.