Examination of left ventricular contractile reserve by Doppler myocardial imaging in patients with dilated cardiomyopathy.

Detection of left ventricular contractile reserve by means of dobutamine stress echocardiography is a well known technique. The aim of the present study was to detect velocity changes during the administration of dobutamine, to establish if Doppler myocardial imaging is a suitable method for determining left ventricular contractile reserve, and to determine if the technique provides more information than traditional stress echocardiography. Twenty-five patients (all males; mean age, 53.4 years) were examined for a clinical diagnosis of idiopathic dilated cardiomyopathy with a poor left ventricular systolic function (ejection fraction less than 30%). Doses of 5-10 and 20 mg/kg/min dobutamine were administered and elevated at 4-minute intervals. Ejection fraction was calculated using the Simpson rule. The peak systolic and the early and late diastolic velocities were measured in the basal segment of the septum and the inferior wall at baseline and at full dose of dobutamine. Results indicated that peak systolic velocity increased significantly, both in the septum (0.11±0.03 vs. 0.20±0.05 m/sec; p=0.001) and in the inferior wall (0.10±0.05 vs. 0.17±0.06 m/sec; p=0.03). Late diastolic velocities also increased significantly, both in the septum (0.17±0.05 vs. 0.22±0.07 m/sec; p=0.01) and in the inferior wall (0.18±0.08 vs.0.21±0.02 m/sec; p=0.01). There was a significant linear correlation between the relative increases in basal ejection fraction value and in peak systolic velocity upon dobutamine stimulation. Patients were divided into responders and nonresponders based on responses in either ejection fraction (25% relative increase) or peak systolic velocity (5 cm/s increase). This study concludes that 1) Doppler myocardial imaging is an adequate and simple technique to examine left ventricular contractile reserve; and 2) measurement of peak systolic velocity during dobutamine stimulation seems to be a simple and good indicator of left ventricular contractile reserve. (c)2001 CHF, Inc.

[Side effects during dobutamine stress echocardiography in patients with aortic stenosis]. / Bezpieczenstwo echokardiograficznego testu obciazeniowego z dobutamina zastosowanego u chorych ze zwezeniem zastawki aortalnej.

The purpose of the study was to assess the safety of the dobutamine stress echocardiography (DASE) in patients with aortic stenosis (AS). 161 patients (mean age 59 +/- 13 years) with AS were prospectively studied with DASE. There were 58 female and 103 male. Dobutamine was given in stepwise increasing doses from 5 to 40 ug/kg/min. Mean maximal dose achieved was 31.4 ug/kg/min. The test was positive in 40 (24.8%) patients. Significant coronary artery disease was present in 60 (37.3%) patients. DASE resulted in significant increase in transvalvular mean gradient from 29.3 +/- 12.5 mmHg at rest to 46.3 +/- 19.3 mmHg at peak dose. There was no significant increase in valve area. There were no death, myocardial infarction or episodes of sustained ventricular tachycardia as a result of DASE. The test was terminated when following conditions were revealed: target heart rate (39.1%), left ventricular asynergy (25.5%), maximal established dose achieved (8.1%), side effects (27.3%). The most common side effects with the need of test cessation were arrhythmias (9.9%) and hypotension (9.9%). The most side effects were usually well tolerated without need of medical treatment. We conclude that DASE may be safely performed in patients with AS. Side effects are more common than in patients with coronary disease, but are usually well tolerated without need of medical treatment.

[Prediction of the result of high-risk coronary bypass surgery by positron emission tomography]. / Nagy kockázatú koszorúér bypass mütét eredményességének elörejelzése pozitron emissziós tomográfiával.

Coronary angiography revealed three-vessel disease in a 56-year-old male with two previous myocardial infarctions. Coronary bypass surgery was initially ruled out by cardiac surgeon because of the poor left ventricular function (EF: 23%), despite moderate viability signs during conventional isotope techniques. Positron emission tomography with 18FDG indicated a large periinfarction area of hibernating myocardium. Accordingly, coronary bypass grafting was performed. Postoperatively, the symptoms disappeared, the left ventricular wall motion abnormalities (with the exception of the scarred region demonstrated by PET) improved, and the global left ventricular function increased significantly. This case and the role of cardiac PET study for prediction of the result of revascularization are discussed.

[Coumarin combined with low-dose acetylsalicylic acid in the prevention of thromboembolic complications in patients with mitral and aortic valve prostheses]. / Kumarin és kis adagú acetilszalicilsav együttes adása mitralis és aorta mechanikus mübillentyüs betegek thromboemboliás szövödményeinek megelözésében.

Authors studied the effect of coumarin, and its combination with low-dose (125 mg/day) acetylsalicylic acid in the prevention of thromboembolic complication during a 10-year period (average 4.7 years) in a randomized trial of 296 patients aged 18-60 year with tilting disc type prosthetic heart valve (159 mitral and 137 aortic) in sinus rhythm. In the group treated with coumarin (152 patients, 743.4 patient-years) 4 cases (2 of them fatal) of valve thrombosis, 12 cases of peripheral embolism and 9 cases (3 intracranial, 3 among them fatal) of major bleeding were observed; in the group treated with coumarin plus acetylsalicylic acid (144 patients, 638.7 patient-years) 2 cases (1 of them fatal) of valve thrombosis, 4 cases of peripheral embolism and 14 cases (3 of them fatal) of major bleeding were observed. In the case of valve thromboses the difference between the two groups was non-significant but still clinically remarkable; peripheral embolism occurred in significantly higher number (p < 0.05). There was no statistically significant difference of bleeding complications between the two groups. The results suggest that the combination of coumarin plus low-dose acetylsalicylic acid is more effective in the prevention of thromboembolic complications in patients with mitral and aortic prosthetic heart valve than coumarin alone; the danger of bleeding complications seems to be acceptable with adequate control.

Myocardial gallium-67 citrate scintigraphy in patients with systemic sclerosis.

OBJECTIVE: To detect myocardial involvement in 16 patients with systemic sclerosis using radiogallium scintigraphy METHODS: Sixteen patients with systemic sclerosis were investigated by myocardial gallium-67 citrate scintigraphy. Echocardiographic studies and (in the positive cases) magnetic resonance imaging were also performed. RESULTS: Increased myocardial gallium uptake was found in five of the 16 patients. None of these positive cases exhibited any 'classical' clinical, electrocardiographic or laboratory signs characteristic of myocarditis. The mean age of the positive cases was 60.8 (SD 5.0) years compared with 44.6 (10.7) years for the negative cases; no difference was detected in the mean disease duration between these two groups. Two of the affected cases belonged to the limited scleroderma subgroup. CONCLUSIONS: In spite of the low number of patients investigated, it is tempting to speculate that elderly patients with a disease onset around 60 years tend to be the candidates in whom a positive gallium-67 scintigraphy test may best indicate a silent myocardial interstitial inflammation.

Left ventricular wall motion abnormalities in 80 patients with systemic sclerosis.

Segmental analysis of left ventricular wall motion was performed in 80 patients with systemic sclerosis by echocardiography. Half of the cases showed normal wall motion. Eighteen of the 57 patients with limited cutaneous systemic sclerosis (31.6%) exhibited hypokinetic wall motion abnormalities, while five of the 23 cases with diffuse cutaneous systemic sclerosis (21.7%) had similar findings. The three cases showing akinesis also belonged to the limited scleroderma subgroup. Our findings show that hypokinetic wall motion abnormalities can be detected in a remarkably high proportion of cases with limited cutaneous systemic sclerosis.

[Ischemic cerebrovascular lesion caused by left atrial myxoma]. / Bal pitvari myxoma átal okozott ischaemiás cerebrovascularis laesio.

A case presentation is given of a 40 years old woman with acute ischemic cerebrovascular lesion in the territory of the left middle cerebral artery caused by embolization from a myxoma in the left atrium. The tumor was diagnosed by transthoracic echocardiography. Histological examination after cardiac surgery revealed a benignant myxoma. In the six-month-long postoperative follow up gradual improvement of the neurological signs was observed. The most important morphological and clinical characteristics of myxomas are summarized. The necessity of detailed cardiological examination of each young patient with stroke is emphasized.

Left ventricular wall thickness and disease duration in systemic sclerosis.

Myocardial thickness, left ventricular functions, and right heart overloading were investigated in 80 patients with systemic sclerosis by echocardiography. Based on the left ventricular wall thickness, three groups were formed. Fifteen patients with asymmetrical left ventricular wall hypertrophy (Group 1) showed shorter mean disease duration with marked diastolic and mild systolic left ventricular functional impairment. The 25 patients with wall thinning (Group 3) had a slight increase in left ventricular diameters, impaired systolic functions and longer disease duration. Group 2 with wall thickness exhibited mixed changes. Patients with increased wall thickness tended to have a shorter disease duration than patients with wall thinning. Patients with systemic sclerosis showed systolic and diastolic function impairment as compared to the 18 control healthy individuals. Pericardial disease was found in 23 cases (28.7%).

[Late post-infarction angina]. / A késöi postinfarctusos angina.

The authors survey the clinical features and therapeutic results of 88 patients suffering from late postinfarctional angina. The results of the bicycle ergometer ECG tests were negative only in the case of 8 patients. Exercise-induced silent myocardial ischaemia was registered in 45.4%. Coronary angiography revealed that 54 (61%) of the patients suffered from multivessel disease. Coronary bypass surgery was carried out in 56.8% and the rate of peripheral anastomoses was 3.1/patient. The authors consider it to be essential to detect the ischaemia in the infarct survivors with chest pain. Taking into consideration the clinical feature and the results of exercise tests, the authors propose cardiac catheterization. Myocardial revascularization is recommended if the medical therapy is not successful or the patients suffered from left main, triple-vessels disease and the myocardium is jeopardized to a large extend.

Echocardiographic tests in chronically haemodialysed patients.

Fifty-two patients kept alive by chronic dialysis have been subjected to echocardiography carried out by means of a Picker Echoview equipment with M-mode 2D technique. The revealed alterations were suggestive of hypertropic, dilatative uraemic cardiomyopathy, associated with impaired diastolic compliance. Left auricular dilatation as a source of inference for the degree of compliance diminution was found in a high percentage of patients.

Primary aortitis in childhood.

The case of a 5-year-old boy affected by autoimmune aortitis is reported. The onset was acute, the progression rapid. Hypertension, absence of right radial pulse, elevated ESRand immune globulin levels, cellular and humoral immunity against blood vessel wall were observed. The tests suggested an autoimmune origin of the aortitis. On immunosuppressive treatment the signs of activity disappeared and the condition improved and after captopril treatment the blood pressure decreased.

Metabolism and pharmacokinetics of dibromodulcitol (DBD, NSC-104800) in man--II. pharmacokinetics of DBD.

Dibromodulcitol (DBD), labelled with [3H] at position C-1, was administered orally to 6 patients in a single dose of 15 mg/kg. Kinetic parameters were calculated for the effective drug (DBD + BrEpG + DAG), protein-bound hexitol moieties and free metabolites. Approximate values were estimated for the oral bioavailability of DBD. Disposal of the drug by metabolism and excretion was described by a simplified catenary model. The results indicated that 8-20% of the drug became firmly bound to macromolecules, probably by alkylation. The slow rate of alkylation in vivo (half-life 14 hr) may imply conversion of DBD into epoxides and their alkylating interaction with the target nucleophiles. The long retention of the firmly bound hexitol moieties in the body may be an indicator of the cumulative potency of DBD and must be taken into consideration by developing dosage schedules.