The acute effects of cilazapril on pulmonary function tests and arterial blood gas changes in patients with pulmonary hypertension.

The aim of the present study was to evaluate pulmonary function tests and arterial oxygen transport in patients with pulmonary hypertension due to congestive heart failure before and after cilazapril treatment. Thirty patients (16 men and 14 women, mean age, 65 +/- 18 years) with congestive heart failure and 30 healthy volunteers (20 men and 10 women, mean age 59 +/- 12 years, p > 0.05) were included in the study. All patients underwent evaluation of pulmonary function by spirometry and arterial blood gas analysis. Arterial oxygen saturation and arterial oxygen transport changed significantly after treatment (81 +/- 7 to 87 +/- 8 and 317 +/- 74 to 392 +/- 8, respectively). Forced expiration volume in 1 second, vital capacity and total lung capacity were increased after cilazapril treatment (2.55 +/- 0.7 to 2.61 +/- 0.8, 3.2 +/- 0.9 to 3.3 +/- 1.0 and 3.6 +/- 0.9 to 4.1 +/- 1.1, respectively, p < 0.05). In conclusion, short-term cilazapril administration improved pulmonary function and arterial oxygen transport because it increased cardiac output, produced pulmonary vasodilatation, improved the pulmonary hemodynamics and removed interstitial fluid.

The acute effect of orlistat on endothelial function in young obese women.

Recent studies indicate that abdominal fat accumulation is related to impaired endothelial function in young healthy volunteers. The aim of this study was to determine the acute effect of gastrointestinal lipase inhibitor on brachial flow-mediated vasodilatation and hemodynamic parameters in young obese women. The study population was composed of 42 female obese patients (mean age 29 +/- 4 years, age range between 18 and 34 years). Flow-mediated endothelial-dependent vasodilatation was assessed in the brachial artery in response to reactive hyperemia using high-resolution ultrasound. Brachial artery diameter (3.46 +/- 0.72 mm to 3.82 +/- 0.84 mm) and flow-mediated vasodilation (7.6 +/- 0.8% to 9.8 +/- 1.6%) changed significantly after 12 weeks of therapy (p < 0.001). Brachial artery flow was not changed (124 +/- 92 ml/min to 148 +/- 14 ml/min, p > 0.05). The results of this study demonstrate that orlistat improved endothelial function, weight, body mass index and systolic and diastolic blood pressure in young women.

Non-invasive diagnosis and management of coronary arteriovenous fistula. A case report.

Coronary arteriovenous fistulas are rare anomalies resulting in abnormal communication between the coronary artery and any chamber of the heart. An asymptomatic patient was referred for evaluation of her murmur. Two-dimensional and color Doppler echocardiographic evaluation revealed an enlarged left main coronary artery. A retrograde, eccentric small jet was found within the right ventricular outflow tract at the pulmonary artery valvular level allowing us to detect the entrance site of the fistula. The diagnosis was confirmed by cardiac catheterization and angiocardiography. Although our case was asymptomatic, the decision to perform cardiac surgery was made because of the aneurysmatic appearance of the left coronary artery. In our opinion, visualization of coronary arteries by two-dimensional echocardiography, together with additional information obtained from the Doppler examination, provides an excellent technique for the noninvasive diagnosis of coronary artery fistula.

Diastolic spectrum of left-ventricular hypertrophy: the impact of etiology and coronary artery disease on Doppler transmitral velocity.

UNLABELLED: Diastolic filling of hypertrophied left ventricles has frequently been observed by Doppler methods. We hypothesized that filling characteristics in hypertrophy vary with etiology and concurrent ischemia. For patients with hypertrophy, the left-ventricular ejection fraction was > 0.47 +/- 0.16, end-diastolic pressure was > 15 +/- 2 mm Hg, end-diastolic volume index was < 96 +/- 12 ml/m2 and left-ventricular mass index was 127 +/- 7 g/m2. Peak E (early) and peak A (late) diastolic velocities and E-wave deceleration time, respectively, were as follows (significant unless otherwise indicated): normal subjects (NS), 79 +/- 9 and 82 +/- 19 cm/s, and 151 +/- 7 ms; cardiomyopathic hypertrophy, 63 +/- 16, 83 +/- 15 (NS) and 193 +/- 63, aortic stenosis without coronary disease, 110 +/- 10, 128 +/- 12 and 158 +/- 22 (NS); aortic stenosis with coronary disease, 57 +/- 12, 86 +/- 26 (NS) and 187 +/- 39; hypertension without coronary disease, 107 +/- 9, 128 +/- 9 and 143 +/- 22 (NS); hypertension with coronary disease, 58 +/- 12, 84 +/- 26 (NS) and 189 +/- 29. CONCLUSIONS: Hypertrophied left ventricles filled with two diastolic Doppler patterns: a relaxation abnormality with low peak E and delayed deceleration in hypertrophic cardiomyopathy, and a compliance abnormality with tall peak E and normal deceleration in pressure overload hypertrophy. When coronary artery disease occurred with pressure overload hypertrophy, impaired relaxation was the dominant pattern. Therefore, in addition to the known physiologic influences on diastolic filling, the etiology and presence of coronary artery disease modulate the configuration of transmitral velocities into hypertrophied ventricles.

The effects of nisoldipine on carotid artery stiffness and left ventricular functions.

Doppler echocardiographic determination, left ventricular (LV) fractional shortening (FS), cardiac output (CO), diastolic function parameter (E/A ratio) and carotid artery pulse wave velocity and stiffness were evaluated in 36 patients with essential hypertension before and after nisoldipine treatment. Blood pressure decreased significantly, and carotid artery width and fractional shortening increased significantly following nisoldipine administration (p < 0.0001). Carotid artery pulse wave peak velocity did not change following the treatment period (p > 0.05). In conclusion, short term nisoldipine administration improved blood pressure and LV systolic function, whereas LV diastolic function and carotid artery stiffness did not change. Nisoldipine did not alter serum biochemical parameters, including cholesterol, triglyceride, HDL-cholesterol, and LDL-cholesterol (p > 0.05). Only one patient manifested symptoms of hypotension as an adverse effect of the drug.

The use of the handgrip maneuver to identify left ventricular diastolic function abnormalities by Doppler echocardiography in patients with coronary artery disease.

Doppler echocardiography accurately identifies diastolic dysfunction through the assessment of transmitral flow patterns during the application of the handgrip (HG) maneuver. In this study, 45 normal control patients (mean age 46 +/- 9, group A) and 13 patients with coronary artery disease (CAD) (mean age 51 +/- 6, group B) were involved. The effects of handgrip maneuver on transmitral flow patterns were studied by Doppler echocardiography. Group B patients had higher peak late diastolic filling velocities (A), lower peak early (E) to late diastolic filling velocity ratios (E/A) and longer isovolumic relaxation times (IVRT) compared to group A. On the other hand, systolic blood pressure (SBP), heart rate (HR) and peak E velocity (E) did not change significantly (p > 0.05) in either group, at rest. During the supine handgrip maneuver, NR (mean +/- standard error of mean, +21 +/- 13%, p < 0.05) and SBP (+21 +/- 9%, p < 0.05) increased significantly in both group A and group B (+21 +/- 13%, p < 0.05, +22 +/- 15%, p < 0.05, respectively). In group B, E/A ratio (-28 +/- 7%) decreased significantly (p < 0.05) compared to group A (-20 +/- 6%), as a consequence of significantly increased peak A velocity in group B (+7 +/- 5%) compared to group A (+6 +/- 3%, p < 0.05). Deceleration time decreased significantly in both groups (-10 +/- 6% vs -9 +/- 6%, p < 0.05). Isovolumic relaxation time (IVRT) significantly increased in both groups (+18 +/- 7% vs +16 +/- 6%, p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

A comparison of left ventricular volumes and regurgitant fraction by Doppler echocardiography and angiography in children.

Regurgitant fraction calculations by echocardiography were compared to angiocardiography in 11 patients with mitral regurgitation. Although there was a very good correlation when compared with angiocardiography (r = 0.99, SEE: 6.26, P < 0.001), two-dimensional echocardiography underestimated left ventricular end-diastolic volumes (P < 0.05). The mean regurgitant fraction was 36.2 +/- 13.5% by echocardiography and 43.6 +/- 15.7% (P < 0.05) by angiography. Most of the variability in measuring the regurgitant fraction is attributed to the left ventricular volume measurements. In conclusion, regurgitant fraction calculations of mitral regurgitation by echocardiography compares favorably to angiography. Since the severity of mitral regurgitation is an important determinant of prognosis, quantification of the regurgitant fraction may be useful in the long term follow-up of those patients.

Doppler-derived aortic valve gradients: imaging versus non-imaging techniques.

BACKGROUND: Quantitative Doppler echocardiography has become an established method for estimating aortic valve area in aortic stenosis, replacing cardiac catheterization as the confirmatory study. The technique is time consuming, especially when measuring the transaortic velocity, which is performed by convention. This is accomplished by interrogating multiple windows with a non-imaging probe to record the maximal velocity. To determine how the examination could be expedited, we prospectively compared aortic valve gradients measured by Pedof and duplex transducers. METHODS: One hundred eighty-two consecutive patients with native aortic valve disease, mechanical or bioprosthetic aortic valves were studied. Two technicians measured maximal transaortic valve velocities from apical, subcostal, right parasternal and suprasternal notch windows with a 2 MHz Pedof probe and from the apical window with a 3-3.5 MHz duplex probe using color flow to orient the continuous wave beam. Angle-corrected and non-angle-corrected signals were recorded. There were 109 comparisons read by two observers; intra- and inter-reader variations were 0.4% and 2.0%, respectively. RESULTS: Duplex imaging velocity gradients were consistently smaller than Pedof non-imaging measurements with a mean +/- 1 standard deviation difference between peak velocities of 0.40 +/- 0.71 meters per second (m/s) for angle-corrected, and 0.76 +/- 0.68 for non-angle-corrected signals (both p < 0.001). Technician variability accounted for some of the difference (p < 0.02). CONCLUSION: Although non-imaging and imaging methods share the apical window, the Pedof probe scans unlimited planes to locate the maximal aortic valve gradient, whereas the duplex probe is confined to the plane providing the optimal two-dimensional image. Therefore, Doppler echocardiographic estimations of aortic valve areas still require careful, time-intensive non-imaging recordings of transaortic velocities.