Screening first-degree relatives of patients with idiopathic dilated cardiomyopathy.

BACKGROUND: This study evaluated whether subclinical myocardial dysfunction occurs in first-degree relatives of patients with idiopathic dilated cardiomyopathy (IDCM), using strain echocardiographic imaging, before apparent left ventricular (LV) failure is observed. PATIENTS AND METHODS: The study comprised 77 subjects aged 16-63 years who had first-degree relatives with a previous or new diagnosis of IDCM. LV myocardial deformation parameters of the first-degree relatives with normal LVEF (≥55%) values, as assessed using 2D echocardiography, were evaluated. The findings of the first-degree relatives were compared with an age- and sex-matched control group (n = 86). RESULTS: No difference in terms of age, gender, and body surface area was detected between first-degree relatives and controls. First-degree relatives of IDCM patients had significantly lower LVEF (62.04 ± 5.8% vs. 65.65 ± 6.3%, p < 0.001) and FS values (39.4 ± 6.6 vs. 41.45 ± 5.5, p = 0.03) compared with the controls. Assessment of LV deformation parameters revealed that LV global longitudinal strain (-17.34 ± 2.19% vs. -19.21 ± 2.16%, p < 0.001) and strain rate (0.94 ± 0.14 s-1 vs. 1.03 ± 0.14 s-1, p < 0.001), radial strain (34.47 ± 9.14% vs 42.79 ± 11.91%, p < 0.001) and strain rate (1.6 ± 0.38 s-1 vs. 1.75 ± 0.29 s-1, p = 0.006), circumferential strain (-6.07 ± 2.83% vs. -18.29 ± 3.39%, p < 0.001) and strain rate (1.09 ± 0.24 s-1 vs. 1.2 ± 0.25 s-1, p = 0.004), and torsion (10.07 ± 5.18o/cm vs. 12.42 ± 5.78o/cm, p = 0.009) were significantly reduced in first-degree relatives compared with controls. CONCLUSION: LV deformation parameters are impaired in first-degree relatives of patients with IDCM. Screening of this population using standard 2D echocardiography and strain imaging may provide early detection of those with subclinical myocardial dysfunction.

The efficacy of telmisartan compared with perindopril in patients with mild-to-moderate hypertension.

In this study, efficacy of the angiotensin II type 1 receptor blocker telmisartan given as monotherapy was compared with that of perindopril monotherapy in patients with mild-to-moderate hypertension. After a 2-week, single-blind, placebo run-in period, 60 patients were randomised to double-blind, once-daily treatment with telmisartan 80 mg or perindopril 4 mg for 6 weeks. Clinic and ambulatory blood pressure measurements and clinical laboratory evaluation were performed at the end of the placebo run-in and active treatment phases. Both telmisartan and perindopril significantly (p < 0.0001) reduced clinic systolic blood pressure (SBP) and diastolic blood pressure (DBP) compared with baseline values. Also, both drugs significantly (p < 0.0001) reduced 24-h mean ambulatory SBP and DBP compared with baseline. Comparison of the mean hourly antihypertensive activities showed that the reduction in mean ambulatory DBP for the last 8 h of the dosing interval was significantly greater (p < 0.05) in telmisartan-treated patients. A 24-h mean DBP of <85 mmHg was observed in 66.6% of the telmisartan-treated patients but in only 46.6% of the perindopril-treated patients (p < 0.05). It is concluded that telmisartan and perindopril both produce significant reductions in clinic SBP and DBP, but the mean reduction in ambulatory DBP during the last 8 h of the dosing interval is greater in patients treated with telmisartan.

Two cases of cardiac cyst hydatid with right and left ventricular involvement.

Cardiac cyst hydatic is a rare disease. Two cases with left and right ventricular involvement are presented that demonstrate the use of echocardiography in the diagnosis and during follow up of the disease.

Ruptured aneurysm of sinus of valsalva with ventricular septal defect: the role of transesophageal echocardiography in diagnosis.

We present a case of ruptured aneurysm of sinus of valsalva (ASV) along with subaortic ventricular septal defect (VSD). Transesophageal echocardiographic examination in addition to transthoracic echocardiography provides more powerful information about ASVs and coexistent cardiac malformations. This may be additional value for the cardiac surgeon planning resection of the lesion.

Right atrial and ventricular thrombi in Behçet's disease: a case report and review of literature.

Behçet's disease is a chronic multi-system disease presenting with recurrent oral and genital ulceration, and relapsing uveitis. Cardiac involvement is an extremely rare manifestation of this disorder. We report an unusual case of Behçet's disease characterized by a mural cardiac thrombi in the right atrium and right ventricle along with transient protein C and S deficiency.

Treatment of hypertension in dialysis patients by ultrafiltration: role of cardiac dilatation and time factor.

We retrospectively analyzed the blood pressure (BP) and cardiothoracic index (CTi) of 67 hemodialysis patients with hypertension who could be followed up for at least 8 months. A new treatment policy was adopted, aimed at strict volume control. Dietary salt restriction was strongly emphasized. Ultrafiltration (UF) was applied during regular dialysis sessions and sometimes in additional sessions, as long as BP and CTi remained at greater than normal values. All antihypertensive drugs were discontinued at the beginning of treatment. Average BP decreased from 173 +/- 17/102 +/- 9 to 139 +/- 18/86 +/- 11 mm Hg after 6 months and to 118 +/- 12/73 +/- 6 mm Hg after 36 months. Corresponding values for CTi were 52% +/- 4%, 47% +/- 3%, and 42% +/- 4%, respectively. Conventional relatively short dialysis (three times weekly for at least 4 hours) can achieve normal BPs with prolonged effort in most patients, whereas improvement in heart condition facilitates this.