[Clinical and echocardiographic evaluation of thalassemic cardiomyopathy]. / Valutazione clinica ed ecocardiografica della cardiomiopatia talassemica.

To evaluate the reliability of the echocardiographic examination in assessment of adult patient with thalassemia major, in comparison with clinical, electrocardiographic and/or chest x ray exams, 103 patients with thalassemia major, mean age 20 years (range 14 to 30 years), were studied and compared with 30 age matched normal subjects. All patients were receiving transfusions regularly to maintain hemoglobin levels above 11 g/dl and subcutaneous infusions of desferrioxamine (about 40 mg/kg/day) to reduce hemosiderosis. The patients were divided into three groups according to their cardiac impairment, deduced by clinical history, electrocardiography (ECG) and/or chest x ray. Group I (36 patients) showed no signs or symptoms of cardiac impairment. Group II (38 patients) had only signs of cardiac impairment by ECG and/or chest x ray. Group III (29 patients) had both symptoms and signs of cardiac failure. In comparison to normal controls, Group I showed an increase in left ventricular (LV) dimension (EDD) and mass (p < 0.001), Group II and III showed a decrease in LV fractional shortening (FS; p < 0.001) too. In comparison to Group I, Group II showed a decrease in LV FS (p < 0.05), Group III showed an increase in LV EDD and mass (p < 0.001) too. In comparison to Group II, Group III showed an increase in LV EDD and mass (p < 0.001), and a decrease in LV FS (p < 0.001). In conclusion, echocardiographic examination appears a tool more reliable than clinical, electrocardiographic and/or chest x ray examination in assessment of adult patient with thalassemia major.(ABSTRACT TRUNCATED AT 250 WORDS)

[Chronology of regression of hypertensive ventricular hypertrophy during antihypertensive therapy with beta blockers]. / Cronologia della regressione dell'ipertrofia ventricolare ipertensiva durante terapia antipertensiva con betabloccanti.

To define the time course of regression of left ventricular hypertrophy (LVH) during antihypertensive therapy with beta-blocking agents, 73 hypertensive patients were serially studied by echocardiography during 12-months therapy with beta-blockers. Blood pressure decreased significantly after 1 month and further on after 12 months (from 164 +/- 18/110 +/- 9 to 139 +/- 14/94 +/- 7 mmHg, p < 0.001). Left ventricular (LV) end-diastolic dimension increased significantly after 1 month (from 51.2 +/- 3.9 to 52.2 +/- 4.7 mm, p < 0.01) and decreased after 12 months (50.4 +/- 4.0 mm, p < 0.05). Septal and posterior wall thickness decreased progressively after 1 month and 3 months, respectively. LV mass index decreased significantly after 3 months, and further on after 12 months (from 164 +/- 42 to 145 +/- 33 g/m2, p < 0.001). LV fractional shortening did not significantly change throughout the study. Thus, a reduction of hypertensive LVH occurred after 3 months of therapy with beta-blocking agents and went on during the subsequent months without impairment of LV systolic function.

[Effects of verapamil on left ventricular mass and diastolic function in hypertensive patients]. / Effetti del verapamil sulla massa e sulla funzione diastolica del ventricolo sinistro in pazienti ipertesi.

To evaluate the effects of antihypertensive therapy with verapamil on left ventricular (LV) mass, systolic and diastolic function, 12 hypertensive patients, mean age 44 years, were studied during 12 months of treatment with verapamil, in a gradual release from (240-480 mg/day), by serial recordings of ECG, blood pressure (BP) and echocardiogram. In pretreatment conditions, 8 patients showed LV hypertrophy and 2 patients impaired LV diastolic function. Blood pressure decreased significantly after 1 month of therapy, septal and LV posterior wall thickness after 3 months and LV mass after 6 months. No significant changes were observed in LV fractional shortening and diastolic transmitral flow. At the end of the study BP normalized in 8 patients and LV mass in 1 patient. Left ventricular diastolic function was normalized in 1 patient but became worse in another, in spite of the reduction in BP and LV mass. Thus, verapamil was an effective antihypertensive drug and was able to revert hypertensive LV hypertrophy. However, the behaviour of LV diastolic function seems to be independent of the effects of the drug on BP and LV mass. Further studies are necessary to clarify this problem.