[Utility of verapamil in the treatment of diastolic dysfunction in patients with acromegaly]. / Utilidad del verapamil en el tratamiento de la disfunción diastólica de pacientes acromegálicos.

INTRODUCTION: Diastolic dysfunction is a common complication in patients with acromegaly. By using the metabolic treatment for acromegaly, an improvement in diastolic function is not always achieved and a group of these patients could obtain some benefit from a specific treatment for such a condition. The objective of the present study was to evaluate the utility of verapamil therapy in acromegalic patients with diastolic dysfunction. METHODS: Fourteen patients (7 males and 7 females) with the diagnosis of acromegaly and diastolic dysfunction confirmed by echocardiogram were studied. After six months of treatment with verapamil (240 mg/day) the echo-cardiographic parameters and the functional class (NYHA) of patients were reevaluated. RESULTS: All patients showed an increased basal measurement of the cardiac mass (mean [percentiles 25-75]: 149 g/m2 [128-264]) and no improvement was observed after treatment (182 g/m2 [123-328]). Also, no improvement was found regarding the studied diastolic function parameters: E/A relationship of left ventricle (0.70 [0.54-0.83] versus 0.61 [0.54-0.86]) and isovolumetric relaxation time (146 [119-193] versus 120 [97-169]). A trend towards improvement was indeed found in the functional class, although no statistical differences were observed. CONCLUSION: Our results did not demonstrate a benefit derived from the treatment with verapamil upon the diastolic function in patients with acromegaly.

[Thrombogenic and endothelial damage markers in patients with ischemic systolic impairment]. / Marcadores de hipercoagulabilidad y daño endotelial en pacientes con disfunción sistólica de origen isquémico.

INTRODUCTION: Anticoagulation is rarely indicated in patients with left ventricular dysfunction who show an increased risk for thromboembolism. In theory, the three arms of the Virchow' triad may be present: abnormal blood flow, endothelial damage and prothrombotic markers. The aim of this study was to identify the last two arms. PATIENTS AND METHOD: We studied 82 consecutive patients with demonstrated ischaemic heart disease and sinus rhythm, and compared them with a control group comprised of 32 healthy subjects matched for age and sex. None or the patients had had an acute coronary event or hemodynamic decompensation within the 3 months prior to inclusion in the study. The plasma concentration or von Willebrand factor and fibrin d-dimer and fibrinogen were determined as endothelial damage and prothrombotic markers, respectively. A fractional shortening less than 29% by echography was defined as ventricular systolic dysfunction. RESULTS: The patients showed significantly higher levels of von Willebrand factor with respect to the control group (109.2 31.9 vs 85.5 32.6%, p < 0.01), with no differences in fibrinogen and fibrin d-dimer values. Twenty-six patients fulfilled criteria of left ventricular systolic dysfunction. Patients with left ventricular dysfunction showed higher fibrinogen (386 118 vs 322 102 mg/dl, p = 0.03) and fibrin d-dimer (0.36 0.22 vs 0.26 0.10 g/ml; p = 0.04) levels, with no differences in von Willebrand factor levels. CONCLUSIONS: After acute coronary events, patients with ischaemic heart disease show markers of endothelial damage. However, patients with left ventricular dysfunction show a hypercoagulable state.