Clinical and morphologic features of hypertrophic cardiomyopathy in elderly patients 85 years or older.

We studied the distinctive morphology of the left ventricle (LV) and attempted to relate advanced age and hypertension to this characteristic feature in elderly patients with hypertrophic cardiomyopathy (HC). Fourteen elderly patients > or = 85 years old (mean age 90 +/- 5 years) with HC were compared with 45 young patients < or = 40 years (mean age 34 +/- 4 years) with this disease. More mild hypertension in the elderly (10/14, 71%) than in the young (0%), and more syncope in the young (10/45, 22%) than in the elderly (0%) were observed. Echocardiography showed that the elderly patients had relatively mild LV wall thickening, generally confined to the septum (elderly vs young: 18 +/- 4 vs 25 +/- 8 mm, p < 0.001), with more basal septal bulging (elderly vs young: 12/14, 86% vs 0%, p < 0.001) and anterior septal hypertrophy of LV (elderly vs young: 11/14, 79% vs 0%, p < 0.001). Elderly patients with mild hypertension showed a predominantly basal septal bulging (10/10, 100%) and anterior septal hypertrophy of LV (9/10, 90%). HC in elderly patients > or = 85 years old has a striking LV morphology. Mild hypertension and advanced age may contribute to the distinctive geometry.

Left ventricular filling profiles and angiotensin system activity in elite baseball players.

UNLABELLED: Left ventricular (LV) filling profiles in elite baseball players has not been reported in the literature. Also, angiotensin system activity in athletes has never been reported. We used echocardiography to compare 20 male elite baseball players (aged 21.9+/-1.0 years) with those of age- and sex-matched healthy sedentary subjects. Compared with the normal group, the athlete group showed a significant increase in LV mass, LV diastolic and systolic dimension, and left atrial dimension (P<0.05, <0.001, <0.001, and <0.001, respectively). No differences in relative wall thickness or fractional shortening were found between these two groups. Diastolic filling profiles, including peak early diastolic filling velocity (E), peak late diastolic filling velocity (A), E:A ratio, early time-velocity integral (Ei), atrial time-velocity integral (Ai), Ei:Ai ratio, early filling time, deceleration time of early filling, and isovolumic relaxation time, were similar in both groups. Angiotensin system activity, including plasma renin activity, plasma aldosterone, and 24-h urinary aldosterone excretion, showed no difference between these two groups. CONCLUSION: This study suggests that normal LV filling profile, which is mediated partly by normal angiotensin system activity, is not related to increase in LV dimension and mass in elite baseball players.

Left ventricular filling profiles in young white-coat hypertensive patients without hypertrophy.

This study was to assess left ventricular diastolic function in young white-coat hypertensive subjects < 50 years of age without hypertrophy. Hypertensive patients (systolic or diastolic blood pressure > or = 140 or > or = 90 mm Hg on all three visits) were defined as white coat if their average 24-hour blood pressure was < 127/81 mm Hg and at least 18/16 mm Hg lower than their average office values. We chose three groups balanced for sex, age, and body mass index: 50 sustained hypertensives, 25 white-coat hypertensives, and 25 normotensives. Office blood pressure was similar in white-coat and sustained hypertensives. Ambulatory blood pressure was comparable in white-coat hypertensives and normotensives. Compared with normotensives, white-coat hypertensives had more impaired diastolic function: increased ratio of late to early filling velocities, raised ratio of late to early time-velocity integral, prolonged deceleration time, and lengthened isovolumic relaxation time (P<.001, P<.001, P=.002, and P<.001, respectively). No difference was noticed between white-coat and sustained hypertensives. Compared with normotensives, white-coat hypertensives had higher values of plasma and urine norepinephrine (P<.001 and P<.001, respectively), plasma and urine aldosterone (P<.001 and P=.002, respectively), plasma renin activity (P=.04), total cholesterol (P=.001), and LDL cholesterol (P<.001). No difference was observed between white-coat and sustained hypertensives. Within white-coat hypertensives, 24-hour urinary aldosterone closely correlated with the ratio of late to early filling velocities (P=.008), and plasma and 24-hour urinary norepinephrine correlated well with total cholesterol (P=.037 and P=.006, respectively). No correlation was detected within the sustained hypertensives and normotensives. Heightened neurohumoral activity clearly supported the progression of diastolic dysfunction and metabolic abnormality in white-coat hypertensives.

Enalapril does not improve left ventricular diastolic dysfunction in young and mild hypertensives without concomitant hypertrophy.

The aim of the study was to determine whether enalapril monotherapy can improve left ventricular diastolic dysfunction (LVDD) in young and mild hypertensive patients without concomitant left ventricular hypertrophy (LVH). Fifty patients with hypertension < or = 160/100 mm Hg, aged < or = 50 years, normal two-dimensional echocardiographic (2-D echo) measurements, and LVDD were enrolled in this study. The LVDD was defined as a transmitral early (E) to atrial (A) peak velocity ratio of < or = 1. The mean documented hypertension was 6.3 years. The mean daily dose of enalapril was 13 mg. Baseline and 24-month follow-up echocardiograms were evaluated. Thirty-eight age- and sex-matched healthy subjects served to establish the normal reference values of 2-D echo measurements. After treatment, peak early diastolic velocity (E) (49 +/- 6 cm/sec v 48 +/- 10 cm/sec; P = not significant), peak atrial velocity (A) (62 +/- 9 cm/sec v 62 +/- 10 cm/sec; P = not significant), and E/A ratio (0.80 +/- 0.10 v 0.78 +/- 0.13; P = not significant) remained unchanged. Moreover, early to atrial velocity-time integral ratio (1.24 +/- 0.08 v 1.23 +/- 0.11; P = not significant) did not change. The left ventricular mass index, relative wall thickness, left ventricular end-systolic diameter, left atrial diameter, fractional shortening, heart rate, and body mass index did not show significant changes in all hypertensive patients. In conclusion, long-term antihypertensive therapy with enalapril did not lead to an improvement of LVDD in young and mild hypertension patients without concomitant LVH.

Brain SPECT imaging with 99Tcm-hexamethylpropyleneamine oxime in the early detection of cerebral infarction: comparison with transmission computed tomography.

A new cerebral blood flow agent, 99Tcm-hexamethylpropyleneamine oxime (HM-PAO), was evaluated for early detection of acute cerebral infarction in conjunction with the transmission computed tomographic (CT) studies. The data from 22 cases were analysed. Results reveal that 99Tcm-HM-PAO enables the early detection of acute cerebral infarction prior to CT with rather proper depiction of the extent of physiological abnormality in the majority of patients. This promising result together with the lack of logistical problems will make 99Tcm-HM-PAO a useful and practical agent worldwide for diagnosing and managing acute cerebral infarction.