High-dose therapy and autologous stem cell transplantation in patients with diffuse large B-cell lymphoma in first complete or partial remission.

Improved survival has been observed in poor-risk diffuse large B-cell lymphoma (DLBCL) patients treated with high-dose therapy (HDT) followed by autologous stem cell transplantation (ASCT) in first complete remission. Retrospective studies have suggested that HDT with ASCT can improve survival also in partial responders but some doubts about the advantage of intensive therapy in such patients still remain. We evaluated retrospectively the results of HDT and ASCT in 55 patients with confirmed DLBCL treated between May 1999 and July 2006. Thirty-six patients (65%) showed partial remission (PR) and 19 patients (35%) reached complete remission (CR) after induction treatment with (44%) or without (56%) concomitant rituximab (R) immunotherapy. After HDT and ASCT, 69% of patients fulfilled the criteria of CR, 22% had unconfirmed CR (CRu), 7% remained in PR and 1 patient (2%) relapsed. Twenty patients in PR after the induction treatment reached CR after ASCT, 12 other PR patients achieved CRu. The 5-year event-free survival (EFS) of the 55 transplanted patients was 76% (95% confidence interval /CI/, 63% to 89%) and the 5-year overall survival (OS) was 85% (95% CI, 73% to 97%). The EFS and OS rates differed significantly only between patients younger than 40 years and older groups (p=0.022 and p=0.046, respectively). On univariate analysis of prognostic factors, EFS and OS were not affected by any of the following: age, sex, stage, subtype of DLBCL, initial lactate dehydrogenase, beta-2-microglobulin and serum thymidine kinase levels, International Prognostic Index (IPI) and age-adjusted IPI scores, induction treatment with or without rituximab and type of primary therapeutic response (CR vs PR). These results show that first-line HDT and ASCT for adults up to the age of 65 years with poor-risk DLBCL is a feasible and effective treatment option even in the era of R-chemotherapy in CR as well as for patients in PR.

[Use of assessment of aggregation of thrombocytes induced by cationic propyl gallate to estimate recurrence of cardiovascular complications]. / Vyuzití stanovení agregability trombocytu po indukci kationickým propylgalátem v odhadu recidiv kardiovaskulárních komplikací.

INTRODUCTION: Recently resistance to an acetylsalicylic acid (ASA) administration has been a frequently mentioned problem. However, to identify ASA nonresponsive patients (ASA resistance) is difficult and common examination procedures can contain important preanalytic, analytic and postanalytic mistakes. Recently a possibility to use aggregometry after induction with cationic propyl gallate (CPG) has been discussed in this context; it's a robust, highly sensitive, and specific method for ASA resistance estimates. We asked ourselves following questions during our work: GOAL: a) Experience patients with acute coronary syndrome (ACS) ASA resistance more often than healthy volunteers?; b) Are aggregation values in both patients with different metabolic homeostasis disorders and patients with risk factors for atherosclerotic complications different?; c) Change results of measured aggregation induced by CPG in patients treated with identical ASA therapy during a several years long monitoring; respectively are patients assessed differently during the monitoring?; d) Is it possible to use one-shot aggregation assessment following CPG to estimate ASA resistance or is it necessary to repeat the examinations?; e) Is recurrence of ACS complications more frequent during two years of monitoring of patients with ACS history resistant to 100 mg doses of ASA per day? METHOD: 103 patients of an average age 69 were assessed. All of them suffered from ACS without ST segment elevations and were treated conservatively; in addition to it all of them were treated with 100 mg ASA/day. They were assessed at the onset of ACS and after 3, 12 and 24 months. The examination consisted of taking patient history, clinical examination, BMI determination, laboratory test for cholesterol, HDL, LDL, triacylglycerols, and glucose, and of an aggregation of thrombocytes assessment under standard conditions (spontaneous and after CPG induction). RESULTS AND CONCLUSION: a) ASA resistance is more frequent in patients with ACS compared to healthy volunteers (45% to 6%, p < 0.001). b) Patients with type II DM, smokers, patients with low HDL cholesterol levels or high triacylglycerols levels are ASA resistant more often (< 0.05). c) Results of measured aggregation of thrombocytes don't change during administration of the identical dose of 100 mg ASA/day during 2 years of monitoring. Respondents usually are assessed identically during monitoring (responsive/ASA nonresponsive). d) ASA resistance can be estimated from one-shot aggregation assessment following induction with CPG. e) Two years after diagnosing the ASA resistance a percentage of cardiovascular complications recurrence is higher in patients with history of ACS (p < 0.001). One-shot assessments of the CPG induced thrombocytes aggregation and the spontaneous aggregation are sensitive in 81% of patients with ACS history and specific in 100% of patients at risk of recurrence of cardiovascular complications. If these results are confirmed it could lead to a change in interventions in patients with ASA resistance proved by this method.

[Impact of acute fluid restriction on levels of natriuretic peptides in patients on a chronic dialysis program]. / Vliv akutni restrikce tekutin dialýzou na hladinu natriuretických peptidu u nemocných v chronickém dialyzacním programu.

In order to assess an impact of acute changes in blood volume on levels of B-type natriuretic peptides (BNP and NT-proBNP) 30 patients with a heart disease and chronic renal insufficiency on chronic dialysis program were assessed. An acute fluid restriction of 3750 ml on an average lead to decreased filling of the left heart ventricle (echocardiography revealed a reduced size of the left atrium, change in E/A parameters and deceleration time, and decreased end-diastolic volume of the left ventricle). Prior to dialysis normal levels of BNP (2.58 +/- 1.21 pg/ml) and elevated levels of NT-proBNP (193.2 +/- 117.7 pg/ml) had been indicated. Following dialysis a statistically significant decrease of BNP concentration in venous blood was proved, however it was "masked" by hemoconcentration. NT-proBNP level in venous blood remained unchanged. Correlation between BNP and NT-proBNP was not proved before dialysis nor after it. Correlation between BNP levels and echocardiographic parameters was not confirmed and a weak negative correlation with ejection fraction was proved in NT-proBNP. A BNP assessment could play an important role in the evaluation of acute changes in heart compensation. On the other way, NT-proBNP concentration is stable and is a long term marker of synchronisation of fluid circulation and function of the left ventricle. An importance of its assessment is probably rather prognostic.

[Personal experience with determination of NT-proBNP in clinical practice]. / Vlastní zkusenosti s vyuzitím stanovení NT-proBNP v klinické praxi.

INTRODUCTION AND OBJECTIVE: Recently in the literature information is found on estimation of natriuretic peptides in the differential diagnosis of dyspnoea. Because in the Czech Republic since the beginning of 2002 routine estimation of NT-proBNP is available (analyzer Elecsys 2010), the objective of our work was to find out whether it is possible to use in the everyday practice of a district hospital estimation of NT-proBNP to differentiate dyspnoea with affection of the heart muscle from other types of dyspnoea. METHOD: A group of 33 patients from the medical department of the Sternberk hospital was examined who attended on account of dyspnoea and lacked signs of acute coronary syndrome. All probands were diagnosed on the basis of defined criteria; according to the final diagnosis the patients were divided into three groups: group "LV" was formed by dyspnoic patients with organic affection of the left ventricle and signs of congestion in the lesser circulation, group "non-LV" was formed by patients where no organic affection of the left ventricle was found but other heart disease was present. Group "non-C" was formed by patients where a cardiac cause of dyspnoea was ruled out. In all patients on admission NT-proBNP was assessed. RESULTS: 33 probands were examined, 18 men and 15 women, mean age 74.5 years. 25 probands the dyspnoea was classified as dyspnoea with affection of one of the cardiac compartments [19 of them had signs of organic affection of the left ventricle (group "LV")]; in 6 probands no signs of organic left ventricular affection were found (group "Non-LV"). The remaining 8 patients had no signs of any disease of the heart muscle, valves, septa, endocardium and pericardium (group "Non-C). The baseline values of NTpro-BNP were closely associated with the NYHA classification (grade II--median 55.3 pmol/l (469 ng/l, grade III--median 399.3 pmol/l (3384 ng/l), grade IV--median 724.7 pmol/l (6294 ng/l), the differences were statistically significant, p < 0.05). The dyspnoic probands with concurrent affection of some cardiac compartment (groups "LV" and "Non-LV") had a NT-pro BNP concentration significantly higher than probands without affection of the heart (group "Non-C") (median 589.5 pmol (4996 ng/l as compared with 62.9 pmol/l (533 ng/l, p < 0.01). In the group of probands with heart disease probands with affections of the left ventricle (group "LV") had significantly higher NT-proBNP values than subjects without affection of the LV and without any heart disease (groups "Non-LV" and "Non-C") (median 670.6 pmol/l (5683 ng/l) as compared with 187.5 pmol/l (1589 ng/l), p < 0.01). In hospitalized probands after treatment along with improved cardiopulmonary compensation also a significant drop of NT pro-BNP occurred (median 303 pmol/l (3967.7 ng/l to 211 pmol/l (2561 ng/l), p < 0.05). When looking for associations between anamnestic, laboratory and clinical data we found that the value of NT-proBNP is associated with dyspnoea with cardiac affection (groups "LV" + "Non-LV", correlation coefficient 0.48), with the left ventricular ejection fraction (correlation coefficient 0.52) and the baseline NYHA classification (correlation coefficient 0.36). In the examined group we did not find an association between NT-proBNP and age, sex, diabetes mellitus, hypertension, the presence of atrial arrhythmias, aortal stenosis, or the width of the left atrium. When using as cut-off for NT-proBNP 59 pmol/l (500 ng/l), the sensitivity of NT-proBNP for dyspnoea with affection of the cardiac compartments was 92% and the specificity 67%. CONCLUSION: Assessment of NT-proBNP is an important diagnostic acid in the differential diagnosis of dyspnoea.

[Initial experience with use of cationic propyl gallate as an inducer of thrombocyte aggregation in evaluation of anti-aggregation therapy]. / První zkusenosti s vyuzitím kationického propylgallátu jako induktoru agregace trombocytu v hodnocení úcinnosti antiagregacní terapie.

INTRODUCTION AND OBJECTIVE: Acetylsalicylic acid (ASA) is one of the basic preparations which are used in the treatment of cardiovascular diseases. ASA administration leads to irreversible restriction of platelet aggregation. The objective of our work was to test possibilities of monitoring the effectiveness of ASA therapy by measuring the platelet aggregability in vitro after induction with cationic propyl gallate (CPG) which is considered a very potent aggregation inductor. METHOD: We examined a group of 27 healthy volunteers divided into two sub-groups (n = 19, n = 8). In the first sub-group the platelet aggregation was examined before and after 24 hours following ingestion of 400 mg ASA after induction with ADP, collagen, adrenaline and CPG. In the second sub-group the platelet aggregation was examined before and after three-day administration of ASA--100 mg/day. RESULTS AND CONCLUSION: In a group of 27 volunteers we assessed normal values of aggregation after different inductors. A low stability of the methods used was proved (low stability or insignificant correlation of results of the same method before and after ASA ingestion. The most useful parameter by means of which it was possible to monitor the effectiveness of administration of 400 or 100 mg ASA was the C/G slope (paired t-test, p < 0.0000002, and p < 0.001 resp.). In parameter CPG slope we were able to assess in both groups the cut-off value (< 53%/min.) by means of which it is possible to discriminate probands according to ASA therapy (contrary to the other commonly used inductors). From the results ensues that when assessing the thrombocyte aggregation after CPG induction we find a significantly lower percentage of so-called ASA non-respondents than after other inductors. We consider the use of assessment of thrombocyte aggregation after CPG induction when monitoring antiaggregation therapy a very promising procedure.

Osteoprotegerin, RANK, RANKL.

Osteoprotegerin, RANK (Receptor Activator of Nuclear factor kappa B) and RANKL (Receptor Activator of Nuclear faktor kappa B ligand) became the aim of intensive research. RANK is considered as a hematopoietic surface receptor controlling osteoclastogenesis and calcium metabolism. RANKL may promote osteoresorption by induction of cathepsin K gene expression. The present paper summarizes the most significant data in osteoprotegerin, RANK and RANKL problems obtained.

Application of cationic propyl gallate as inducer of thrombocyte aggregation for evaluation of effectiveness of antiaggregation therapy.

INTRODUCTION AND AIM OF THE STUDY: Acetylsalicylic acid (ASA) is one of basic preparations used in the therapy of cardiovascular diseases. Application of ASA leads to irreversible reduction of platelet aggregation. The aim of the present study was to verify monitoring of effectiveness of ASA therapy using the measurement of platelet aggregability in vitro after induction by cationic propyl gallate (CPG), which is considered to be a highly potent inducer of aggregation. METHODS: We examined a group of 27 healthy volunteers, divided into two subgroups (n = 19, n = 8). The first subgroup was examined for thrombocyte aggregation before and 24 hours after administration of 400 mg of ASA after induction by ADP, collagen, adrenalin and CPG. The second subgroup was examined for thrombocyte aggregation before and after a three-day administration of ASA in a dose of 100 mg/day. RESULTS AND CONCLUSION: In the group of 27 healthy volunteers we determined normal values of aggregability for individual inducers. Low stability of the used methods was proved (weak or insignificant correlation of results of the same method before and after administration of ASA). The most advantageous parameter for monitoring of effectiveness of 400 and 100 mg of ASA was CPG slope (paired t test, p < 0.00000002, resp. p < 0.001). The parameter of CPG slope we determined in both subgroups the cut-off value (< 53s), by means of which it is possible to discriminate probands according to ASA therapy (in contrast to other routinely used inducers). The obtained results indicate that measurement of thrombocyte aggregation after CPG induction reveals a significantly lower percentage of ASA non-responders ASA than after other inducers. Measurement of thrombocyte aggregation after CPG induction is predicted to be highly promising for monitoring the effectiveness of anti-aggregation therapy.

Determination of leptin receptor in the serum and relations to laboratory and anthropological parameters in patients with atherosclerotic complications.

Leptin receptors are supposed to have signal effects and are located in most tissues in the organism but we failed to find literary data on concentration (measurement) of leptin receptors in the system circulation. We examined by the method of randomized selection the group of 20 patients with manifested atherosclerosis in whom BMI was calculated. Then we analyzed concentration of leptin receptor (double sandwich ELISA, standard recombinant human leptin), leptin, glucose, insulin, proinsulin, CRP and uric acid in the serum. The control group consisted of 103 probands without signs of atherosclerosis or other manifested diseases. The control group was subjected to determination of BMI, leptin and leptin receptor in the serum. Concentration of leptin receptor does not differ significantly between the patients with atherosclerosis and normal population. Probands with atherosclerosis showed a very close negative correlation between concentration of leptin receptor and leptinemia which is absent in normal population.

[Assessment of risk for the development of manifest atherosclerosis and indications for hypolipidemic therapy (global risk assessment)]. / Odhad rizika vzniku manifestní aterosklerózy pri indikaci hypolipidemické lécby (Global Risk Assessment).

The estimated risk of development of complications of atherosclerosis (coronary or cerebral ischaemia) is one of the activities every physician should include in the diagnostic and therapeutic algorithm. Treatment with hypolipidaemic agents is indicated according to the European consensus if the danger of a coronary or cerebral event is 20%/10 years. The objective of preventive provisions should be reduction of this risk to < 5%/10 years in younger subjects (< 45 years in men and < 50 years in women) and < 10%/10 years in elderly subjects. These recommendations obviously do not apply to secondary prevention (in case of complications of atherosclerosis) where treatment with hypolipidaemic agents is indicated already when the LDL-cholesterol level is 2.3 mmol/l or when triacylglycerols are 2.3 mmol/l, combined with a drop of HDL-cholesterol to < 0.9 mmol/l.

[Leptinemia in individuals with hypertension (pilot study)]. / Leptinémie u osob s hypertenzí (pilotní studie).

UNLABELLED: During the last decade several papers were published where obesity in included among the building stones of the so-called metabolic cardiovascular syndrome (along with hypertension, dyslipidaemia, impaired glucose tolerance and hyperinsulinaemia). Several months ago it was also revealed that some patients with the metabolic syndrome suffer from hyperleptinaemia. Leptinaemia is considered by some authors as independent indicator of the risk of accelerated atherosclerosis. The cause of these hypothesis were (in addition to the known conclusions on the occurrence frequent incidence of leptin resistance and insulin resistance) in particular the results of experimental studies where evidence was provided that infusion induced hyperleptinaemia leads in animals to hypertension due to its direct effect on sympathicotonia and peripheral vascular resistance. The authors of these hypothesis assume that hyperleptinaemia (in particular in subjects with metabolic syndrome) in one of the basic causes of hypertension which is frequently encountered in these patients. OBJECTIVE: To assess the relations between leptinaemia and the blood pressure reading (actual and mean values) and leptinaemia and the classification of hypertension according to WHO. METHOD: The authors examined 35 hypertensive subject and 10 subject with tetanies (without hypertension). The blood pressure was assessed under standard conditions (rest, semi-recumbent position, three readings). The mean blood pressure readings during the last three months were obtained from case records. Leptin was assessed by the ELISA method of Bio Vendor Co. RESULTS: The group of hypertonic can be classified as subjects with mild obesity (BMI 30.1). The values of leptin were elevated but did not differ significantly from those of the normal population. No correlations were found between leptinaemia (incl. values calculated for BMI) and the actual and mean blood pressure readings. No correlations were found between leptinaemia (incl. BP calculated with regard to BMI) and the stage of hypertension according to WHO. CONCLUSION: Hypertonic subject do not differ significantly as to the serum leptin concentration from the general population. Leptinaemia does not correlate with the actual or mean blood pressure reading nor with stage of hypertension according to the WHO classification. Thus the authors did not confirm the hypothesis on the fundamental effect of leptinaemia on the genesis and development of hypertension. It is probable that leptin is only one of the many factors which have an impact on blood pressure.

[The effect of a single dose of Bisoprolol on changes in blood pressure and hemodynamic indicators in patients with mild hypertension]. / Vliv jednorázového podání Bisoprololu na zmenu krevního tlaku a hemodynamických ukazatelu u nemocných s mírnou hypertenzi.

The authors administered to 10 patients with mild hypertension a single dose of 10 mg bisoprolol (Concor-Merck) during bioimpedance control of changes of the cardiac index and peripheral vascular resistance after an interval of 3 and 24 hours following administration of the drug. In all patients administration of the drug led to a statistically significant drop of the blood pressure. In patients with a high cardiac output (group A, n = 6) the decline of blood pressure was due to a blocked increment of the cardiac output and a slight block of the peripheral vascular resistance. In the group with a low cardiac output and high peripheral vascular resistance (group B, n = 3) the drop of the blood pressure was caused by peripheral vascular dilatation, the cardiac output was influenced minimally. Bisoprolol did not affect the left ventricular systolic function.

[The effect of a single dose of Bisoprolol on changes in blood pressure and hemodymic indicators in patients with mild hypertension during loading]. / Vliv jednorázového podání Bisoprololu na zmenu krevního tlaku a hemodynamických ukazatelu u nemocných s mírnou hypertenzí pri zátezi.

The authors administered to 10 patients with mild hypertension a single dose of 10 mg bisoprolol (CONCOR-Merck) during bioimpedance control of changes of the cardiac index and peripheral vascular resistance during an isometric load after an interval of 3 and 24 hours following administration of the drug. In all patients administration of the drug led during the third hour to a statistically significant drop of the blood pressure after a load. Twenty-four hours after administration the drop was no longer statistically significant. In patients with a high cardiac index (group A, n = 6) the decline of blood pressure was due to a blocked increment of the cardiac output and a slight block of the peripheral vascular resistance. In the group with a low cardiac index and high peripheral vascular resistance (group B, n = 3) the drop of the blood pressure was less marked than in group A and it was due only to the blocked increment of the cardiac output. The increment of the peripheral vascular resistance was not influenced by the preparation. Bisoprolol did not affect the left ventricular systolic function.

Effect of physical load on the platelet function and ultrastructure in patients with ischemic heart disease.

The aggregability of the blood platelets and their ultrastructure were examined during the bicycle exercise test in 20 patients with ischemic heart disease and stable angina pectoris. In 8 patients with unequivocally positive exercise test a significant increment of stimulated aggregation from 58.2 (CV7%) to 71.2 (13.6%) resulted in comparison with a group of patients who did not fulfilled criteria of exercise testing. In this group the aggregability dropped from 56.0 (5%) to 38.7 (8.4%) eventually. No changes in a diameter and shape were observed during the exercise test was positive the amount of granules decreased. It is considered to be an indirect proof of the functional changes in thrombocytes during a certain rise in aggregability.

[Echocardiographic determination of morphologic and functional indicators in competitive runners with mild hypertension]. / Echokardiografické stanovení nekterých morfologických a funkcních ukazatelu závodních bezcu s mírnou hypertenzí.

The authors examined four groups of 30-60-year-old men who different by the blood pressure at rest and the amount of physical activity: a control group of healthy inactive subjects (n = 10), healthy contesting endurance runners (n = 10), inactive men with mild essential hypertension (n = 10) and contesting endurance runners with mild essential hypertension who had been active for at least 8 years and had dispensary care (n = 10). Indicators of left ventricular hypertrophy were evaluated by one-dimensional echocardiography and also some functional indicators (pulse volume, systemic vascular resistance and fractionated reduction), using the method of pulsed Doppler echocardiography. The hypertonic runners had in all investigated indicators of left ventricular hypertrophy the highest values but differed significantly only from the control group (p less than 0.01). Individual prevalence of values which are beyond the accepted physiological range are however surprisingly low (10-20%). From the functional aspect they are characterized by a significantly higher pulse volume as compared with controls, in the remaining indicators they do not differ significantly. Echocardiographic examination of runners with mild hypertension can help to detect subjects with left ventricular hypertrophy which may already be a complication of the basic disease. Contest activities should not be permitted, unless it is possible to test left ventricular function by a haemodynamic loading test.

[Echocardiographic monitoring of treatment of mild hypertension using nifedipine]. / Echokardiografická kontrola lécby mírné hypertenze nifedipinem.

Forty men with hypertension and a BPd lower than 14.66 kPa (110 mmHg) were treated for six months with nifedipine, 30 x 10 mg, with echocardiographically controlled changes of the minute output of the heart and the peripheral vascular resistance at rest and during an isometric load. In the group a wide range of values of cardiac output and peripheral vascular resistance was recorded. In patients with a high peripheral vascular resistance (group B, n = 11) a substantially better therapeutic effect was proved than in patients with a low initial vascular resistance (group A, n = 20). Nifedipine is indicated in patient with a slow heart rate at rest which does not markedly change after an isometric load. In patients with a more rapid heart rate preparations from the group of beta-blockers are more suitable.

Carotid and lower extremity arterial disease in hypertensions.

Atherosclerotic changes of carotid and lower extremity arteries were studied in the selected industrial population represented by 58 men with arterial hypertension. Affection of peripheral arterial system was detected by means of non-invasive ultrasound methods. Stenoses of carotid arteries were recorded in 19% of cases (11 of 58), stenoses of lower extremity arteries in 7% (4 of 58). Hypertonic individuals did not show neurological symptomatology, including one patients with total occlusion of the arteria carotis interna. One man underwent the attack of cerebrovascular ischemia. Stenoses of lower extremity arteries were also in the subclinical stage and without intermittent claudications. A high number of risk factors of atherosclerosis was found in the series: obesity in 90%, smoking 57%, hypercholesterolemia in 47%. Peripheral arterial changes were associated with combined risk factors (two and more). This indicates their involvement in the origin and development of atherosclerotic lesions.

[Echocardiographic control of treatment of mild hypertension with trimepranol]. / Echokardiografická kontrola lécby mírné hypertenze trimepranolem.

Forty men with hypertension, diastolic BP lower than 14.66 kPa, were treated for six months with Trimepranol, 10 mg three times per day, with echocardiographic checking of changes of the cardiac minute output and the peripheral vascular resistance at rest and during an isometric load. In patients with a low baseline vascular resistance (group A, n = 20) a substantially better therapeutic effect was recorded than in patients with a markedly elevated peripheral resistance (group B, n = 11). Trimepranol is indicated in patients with a higher heart rate at rest and with a significant increase of the latter during isometric loading tests.

[Left ventricular systolic function during exertion in persons with mild and medium levels of hypertension]. / Systolická funkce levé komory pri zátezi u osob s mírnou a strední hypertenzí.

In a group of 34 men aged 30-59 years with essential hypertension of a mild or moderate degree the authors evaluated the behavior of the left ventricular ejection fraction and the rate of shortening of the circumferential fibre, using radionuclide ventriculography during exercise. The results were compared with a control group of 19 subjects lacking signs of cardiovascular disease. Asymptomatic hypertonic patients without signs complicating IHD have on average a small statistically insignificant reduction of values of the ejection fraction at rest and of the shortening of the circumferential fibre. However, they respond to a load by a significantly lower rise of the resting values than the control group. In 12% of the patients the authors found an abnormal reaction of the ejection fraction, i.e. a decline as compared with original values. The above differences can be ascribed to a reduction of left ventricular systolic function during chronic overload as a result of arterial hypertension. This functional reduction is not related to the values of the systolic or diastolic pressure at rest nor to the duration of hypertension.