Clinical determinants of increased QT dispersion in patients with diabetes mellitus.

AIMS: To compare QT dispersion measurements in diabetic patients to control subjects and assess any associations between QT dispersion and diabetic clinical characteristics. METHODS: A total of 512 diabetics and 50 age and gender matched controls were studied. QT interval was measured manually in 12-lead conventional electrocardiograms, and QT dispersion (QTd), heart rate-corrected QT dispersion (QTcd), number of leads-adjusted QT dispersion (adjuQTd) and adjacent QT dispersion (adjaQTd) were calculated. Demographic, clinical, laboratory and electrocardiographic data were recorded. RESULTS: Diabetics showed increased QT dispersion compared to controls (QTd: P<0.001, QTcd: P<0.001, adjuQTd: P<0.001), even those with recent diagnosis (less than 2 years) and without arterial hypertension, ECG abnormalities or chronic degenerative complications (QTd: P=0.01, QTcd: P<0.001, adjuQTd: P=0.04). Left ventricular hypertrophy (QTd: P<0.001, QTcd: P<0.001, adjuQTd: P<0.001, adjaQTd: P<0.001) and conduction disturbances (QTd: P=0.002, QTcd: P=0.003, adjuQTd: P=0.003) were the electrocardiographic findings associated with increased QT dispersion in bivariate analysis. Clinical variables were the presence of arterial hypertension (QTd: P=0.004, QTcd: P=0.01, adjuQTd: P<0.001), even without left ventricular hypertrophy (QTd: P=0.01, QTcd: P=0.03, adjuQTd: P=0.003), and the presence of diabetic cardiovascular complications (QTd: P=0.02, QTcd: P=0.01, adjuQTd: P=0.008, adjaQTd: P=0.03). No association between QT dispersion and the presence of diabetic microvascular complications, glycaemic control, age and gender, or cardiovascular drugs was observed. Multivariate regressive statistical analysis confirmed the associations noted in bivariate analysis. CONCLUSIONS: Diabetic patients have increased QT dispersion compared to non-diabetics even those without arterial hypertension and cardiovascular complications and with recent diagnosis. The presence of arterial hypertension, diabetic cardiovascular complications and electrocardiographic abnormalities of left ventricular hypertrophy and conduction disturbances were associated to increased QT dispersion in diabetes mellitus.

Congestive heart failure. Correlation between functional class and systolic and diastolic functions assessed by Doppler echocardiography.

OBJECTIVE: To evaluate the influence of systolic or diastolic dysfunction, or both on congestive heart failure functional class. METHODS: Thirty-six consecutive patients with a clinical diagnosis of congestive heart failure with sinus rhythm, who were seen between September and November of 1998 answered an adapted questionnaire about tolerance to physical activity for the determination of NYHA functional class. The patients were studied with transthoracic Doppler echocardiography. Two groups were compared: group 1 (19 patients in functional classes I and II) and group 2 (17 patients in functional classes III and IV). RESULTS: The average ejection fraction was significantly higher in group 1 (44.84 % +/- 8.04 % vs. 32.59 % +/- 11.48 % with p = 0.0007). The mean ratio of the initial/final maximum diastolic filling velocity (E/A) of the left ventricle was significantly smaller in group 1 (1.07 +/- 0.72 vs. 1.98 +/- 1.49 with p = 0.03). The average maximum systolic pulmonary venous velocity (S) was significantly higher in group 1 (53.53 cm/s +/- 12.02 cm/s vs. 43.41 cm/s +/- 13.55 cm/s with p = 0.02). The mean ratio of maximum systolic/diastolic pulmonary venous velocity was significantly higher in group 1 (1.52 +/- 0.48 vs. 1.08 +/- 0.48 with p = 0.01). A predominance of pseudo-normal and restrictive diastolic patterns existed in group 2 (58.83 % in group 2 vs. 21.06 % in group 1 with p = 0.03). CONCLUSION: Both the systolic dysfunction index and the patterns of diastolic dysfunction evaluated by Doppler echocardiography worsened with the evolution of congestive heart failure.

[Morpho-functional cardiac evaluation in young normotensive children of hypertensive patients. A prospective Doppler-echocardiographic study]. / Avaliação morfo-funcional cardíaca em jovens normotensos, filhos de hipertensos. Estudo Doppler-ecocardiográfico prospectivo.

PURPOSE: Evaluate functional and/or structural cardiac changes in young normotensive subjects with a family history of hypertension. METHODS: Prospective study was performed with 62 normotensive persons, ages 15 to 30 years, divided in 32 children of hypertensive patients (group 1) and 30 children of normotensive persons (group 2) comparable in blood pressure, body surface area, heart rate, age and sex. After clinical examination, all underwent Doppler-echocardiogram to evaluate cardiac structure and left ventricular (LV) systolic and diastolic function. RESULTS: Systolic LV fractional shortening was increased in group 1 when compared with group 2 (38.03 +/- 4.95% and 34.7 +/- 4.48%, respectively--p < 0.01). Mitral deceleration time (DT) ranged from 85 to 160 ms--mean values 116.47 +/- 16.99 ms--in group 1 and from 100 to 220 ms--mean values 126.73 +/- 26.66 ms--in group 2 (p < 0.05). A correlation between LV mass and left atrium (LA) diameter was noted in group 1 (r-0.514, p < 0.01). CONCLUSION: Children of hypertensive patients show increased LV function, similar to what occurs in early hypertension and in borderline hypertension, even when there is no evidence of LV hypertrophy or high blood pressure. Mitral DT (shorten in group 1) was the only diastolic parameter that differed in the groups. The correlation between LV mass and LA dimension suggests that LA size could be related to functional and hemodynamic LV changes.

M-mode and two-dimensional echocardiographic features in cardiac amyloidosis.

Twenty-eight patients with cardiac amyloidosis were studied by echocardiography -- 26 by M-mode and 13 by two-dimensional (2D) studies. All had heart failure and biopsy-proved amyloidosis, M-mode features included (1) normal left ventricular (LV) dimension in all; (2) thickened ventricular septum (88%), LV posterior wall (77%), and right ventricular (RV) anterior wall (79%); (3) decreased thickening of ventricular septum (96%) and of LV posterior wall (65%) and reduced LV global function (62%); (4) left atrial enlargement (50%); and (5) pericardial effusion (58%). Two-dimensional echocardiography provided additional features: (1) thickened papillary muscles (five of 13); (2) thickened valves (four of 13); (3) better appreciation of thickened RV wall; and (4) a characteristic "granular sparkling" appearance of thickened cardiac walls -- presumably secondary to the amyloid deposit -- which was noted in 12 of 13 patients. Thus, M-mode echocardiography is helpful in the recognition of cardiac amyloidosis. However, the better appreciation with 2D echocardiography of thickened cardiac walls with a "granular sparkling" appearance in patients with unexplained cardiac failure is virtually diagnostic of cardiac amyloidosis.

Primary inferior vena cava thrombosis: report of nine cases.

All cases of inferior vena cava obstruction diagnosed at the Mayo Clinic between 1950 and 1973 were reviewed. Diagnosis was confirmed by surgery, phlebography, or postmortem examinations in 64 cases; the cause in 55 cases is described. Carcinoma of the kidney was the most common cause (31% pf cases). In nine cases, extensive laboratory investigation failed to reveal the cause of the process. These cases were considered to be primary inferior vena cava thrombosis and are reviewed in detail.

Glucagon-blood catecholamine test: use in isolated and familial pheochromocytoma.

In 149 cases, blood pressure response to glucagon test did not exceed 20/10 mm Hg more than the response in the cold pressor test control and was considered negative. Plasma catecholamine level increases may be seen in 95% of patients without pheochromocytomas. Among six patients with pheochromocytomas, urinary metanephrine levels were of diagnostic importance in two with isolated pheochromocytoma and in one with the multiple endocrine neoplasia of type 2 (MEN-type 2). Urinary metanephrine determinations yielded false-negative results in three patients with MEN-type 2, while vanilmandelic acid level was normal in one and nephrotomograms were positive in two of these three. These results suggest that the early diagnosis of pheochromocytoma in patients with MEN-type 2 may be difficult and may require multiple biochemical and roentgenographic investigations.