Echocardiographic assessment of the different left ventricular geometric patterns in hypertensive patients.

OBJECTIVE: To identify left ventricular geometric patterns in hypertensive patients on echocardiography, and to correlate those patterns with casual blood pressure measurements and with the parameters obtained on a 24-hour ambulatory blood pressure monitoring. METHODS: We studied sixty hypertensive patients, grouped according to the Joint National Committee stages of hypertension. Using the single- and two-dimensional Doppler Echocardiography, we analyzed the left ventricular mass and the geometric patterns through the correlation of left ventricular mass index and relative wall thickness. On ambulatory blood pressure monitoring we assessed the means and pressure loads in the different geometric patterns detected on echocardiography RESULTS: We identified three left ventricular geometric patterns: 1) concentric hypertrophy, in 25% of the patients; 2) concentric remodeling, in 25%; and 3) normal geometry, in 50%. Casual systolic blood pressure was higher in the group with concentric hypertrophy than in the other groups (p=0.001). Mean systolic pressure in the 24h, daytime and nighttime periods was also higher in patients with concentric hypertrophy, as compared to the other groups (p=0.003, p=0.004 and p=0.007). Daytime systolic load and nighttime diastolic load were higher in patients with concentric hypertrophy ( p=0.004 and p=0.01, respectively). CONCLUSIONS: Left ventricular geometric patterns show significant correlation with casual systolic blood pressure, and with means and pressure loads on ambulatory blood pressure monitoring.

Effects of propranolol on the QT dispersion in congestive heart failure.

OBJECTIVE: Studies have shown that therapy with beta-blockers reduces mortality in patients with heart failure. However, there are no studies describing the effects of propranolol on the QT dispersion in this population. The objective of this study was to assess the electrophysiological profile, mainly QT dispersion, of patients with heart failure regularly using propranolol. METHODS: Fifteen patients with heart failure and using propranolol were assessed over a period of 12 months. Twelve-lead electrocardiograms (ECG) were recorded prior to the onset of beta-blocker therapy and after 3 months of drug use. RESULTS: A significant reduction in heart rate, in QT dispersion and in QTc dispersion was observed, as was also an increase in the PR interval and in the QT interval, after the use of propranolol in an average dosage of 100 mg/day. CONCLUSION: Reduction in QT dispersion in patients with heart failure using propranolol may explain the reduction in the risk of sudden cardiac death with beta-blocker therapy, in this specific group of patients.

Detection and quantification of small right-to-left shunts by the phase-plane method.

In six anesthetized dogs 70 indicator-dilution curves and phase-plane plots were recorded. Indocyanine green was injected into the superior vena cava and sampled through a dichromatic cuvette densitometer from the femoral artery. Dye-dilution curves were recorded from dogs with normal cardiovascular systems and repeated after right-to-left shunts of different magnitude were surgically produced. The percent of blood shunting was calculated according to standard indicator-dilution equations and also by means of oximetric determination of blood samples. They were compared with shunt estimates based on phase-plane loop measurements. Good correlation was found with standard indicator-dilution procedures (r = 0.890) but not with oximetry (r = 0.466). The phase plane shows its utility in the detection and evaluation of small right-to-left shunts. These shunts affect the initial portion of the phase plane and the alterations appear to be more evident than in the corresponding concentration-vs.-time curves.

Detection and quantification of small left-to-right shunts by the phase-plane method.

Sixty-five pairs of indicator-dilution curves were obtained in five anesthetized dogs. After the injection of indocyanine dye into the left atrium, blood was simultaneously sampled through dichromatic cuvette densitometers from the femoral artery and the distal pulmonary artery. Dye-dilution curves were recorded from dogs with normal cardiovascular systems and after the surgical production of left-to-right shunts of different magnitudes. The percent of blood shunting was calculated according to the double sampling method and compared with a new method based on the deviation observed in the terminal portion of the indicator-dilution phase-plane loop. A high level of correlation was observed between both methods (r = 0.961). The phase plane shows its utility in the quantification of small left-to-right shunts. The use of only one sampling site at a peripheral systemic artery is an important advantage because there is complete mixture between shunted and unshunted blood.