Treated arterial hypertension--which echocardiographic parameters should we monitor?

AIMS: To identify discriminatory parameters of left ventricular systolic and diastolic function in a group of patients with treated arterial hypertension (HTN). METHODS AND RESULTS: 95 patients with treated essential HTN, recruited from a cardiology outpatient clinic, with a regular follow-up of at least one year, were evaluated with conventional echocardiography and pulsed tissue Doppler imaging (TDI). A) controlled HTN and B) uncontrolled HTN. Peak systolic (Sm) and early diastolic (Em) myocardial velocities and the ratio of mitral inflow E wave to Em (E/Em) were assessed. All patients had preserved ejection fraction. TDI study was consistent with impaired systolic and diastolic parameters in patients with uncontrolled HTN: septal Sm (cm/s) 7.8 +/- 1.8 vs. 6.8 +/- 2.2 (p = 0.004); lateral Sm (cm/s) 9.1+/- 2.8 vs. 7.7 +/- 1.7 (p = 0.001); septal Em (cm/s) 7.9 +/- 1.8 vs. 6.8 +/- 1.8 (p = 0.002); lateral Em (cm/s) 9.9 +/- 2.8 vs. 8.23 +/- 2.7 (p = 0.002); mean E/Em 8.7 +/- 2.2 vs. 10.8 +/- 3.9 (p = 0.002). CONCLUSION: In patients with uncontrolled HTN there are echocardiographic parameters that identify early changes in systolic function (reduction in septal and lateral Sm, with preserved ejection fraction) and diastolic function (with a reduction in septal and lateral Em). Regular monitoring of these parameters in hypertensive patients enables early identification of changes that may have repercussions on hypertension control.

Contrast-induced nephropathy following percutaneous coronary intervention: case report.

Angiography and percutaneous coronary and other vascular interventions are crucial for the diagnosis and treatment of vascular lesions, with a positive impact on patients' quality of life and prognosis. However, the use of intravascular contrast agents is the third leading cause of acute renal failure, accounting for considerable morbidity and mortality. The authors describe the case of a diabetic patient with no significant prior renal disease who developed severe oliguric acute renal failure requiring dialysis after the use of contrast for a percutaneous coronary intervention. The impact, risk factors and prophylaxis of contrast-induced nephropathy are reviewed.

Percutaneous aortic valvuloplasty in inoperable symptomatic severe aortic stenosis in the very elderly.

Aortic valve replacement is the first therapeutic option in patients with symptomatic severe aortic stenosis. Given the fact that percutaneous aortic valve implantation is a relatively new procedure and the need for palliative treatment in symptomatic patients with a high surgical risk, percutaneous balloon aortic valvuloplasty is still employed. The authors describe two cases of percutaneous balloon aortic valvuloplasty in very elderly patients with severe calcified aortic stenosis not suitable for cardiac surgery, exacerbated in one case by significant coronary artery disease and left ventricular systolic dysfunction. The authors also review the role of this procedure in current interventional cardiology.

Antiplatelet therapy and cardiovascular primary prevention: influence of gender, age and other risk factors.

Intervention for cardiovascular primary prevention has shown promising results in several trials. Studies performed up to 2002 showed a significant effect of aspirin in primary prevention of ischemic heart disease, with a significant reduction in non-fatal acute myocardial infarction, especially in men. Since then, new evidence has demonstrated the potential effect of antiplatelet therapy in cardiovascular primary prevention, particularly in less represented subgroups. In this article, we review the main studies on antiplatelet therapy and cardiovascular primary prevention, highlighting the results for these subgroups in terms of gender, age and presence of diabetes, chronic renal failure or atrial fibrillation, and then propose some clinical guidelines.