ISSN:0009-7322    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Regression of left ventricular hypertrophy occurs with a number of antihypertensive drugs, but the time course of this regression has not been defined clearly. We obtained echocardiograms at baseline and serially (on seven occasions) during a 1 year treatment period with the l3- adrenergic receptor inhibitor atenolol in 12 patients with previously untreated essential hypertension. To ensure control of blood pressure in all patients throughout the study, it was necessary to add a thiazide diuretic to the therapy of five patients. Baseline blood pressure was 155/100 mm Hg and fell to 136/84 mm Hg; there was a 20% reduction in heart rate. Posterior and septal wall thicknesses were reduced from 1.16 ± 0.03 to 1.06 ± 0.02 cm (p < .05) and from 1.28 + 0.07 to 1.18 ± 0.06 cm (p < .05), respectively; this reduction became significant initially at 4 weeks. Left ventricular mass decreased from 144 ± 9 to 127 + 7 g/m2 (p < .05) and this fall first became statistically significant at 6 months. Significant reduction in electrocardiographic voltages was also seen at 6 months. Therefore, regression of left ventricular hypertrophy with atenolol-induced blood pressure control occurred as early as 4 weeks after starting therapy and was maintained thereafter without apparent compromise of left ventricular systolic function.

ISSN:0009-7322    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

To determine whether genetic factors could be involved in the pathogenesis of rheumatic heart disease, we performed HLA-A and HLA-B typing in 120 black patients with severe chronic rheumatic heart disease requiring cardiac surgery, and HLA-DR and HLA-DQ typing in 103 and 97 of these patients, respectively. The HLA typing was done by a standard microlymphocytotoxicity method. Patients were 12 to 60 years old (mean 27.6 ± 14.5). No differences in HLA-A, HLA-B, and HLA-DQ frequencies between patients and controls were noted. HLA-DR 1 antigen was present in 12.6% of patients compared with 2.7% of normal control subjects (corrected p < .045; relative risk = 5.2) and the HLA-DRw6 antigen was present in 31.1% of patients compared with 15% of control subjects (corrected p < .045; relative risk = 2.6). These findings suggest that genetically determined immune-response factors may play a role in the pathogenesis of severe chronic rheumatic heart disease.

ISSN:0009-7322    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

To assess the prevalence of valvular regurgitation in the aged, we studied 176 apparently healthy volunteers with no history or physical evidence of cardiac abnormality. Their ages ranged from 40 to 90 (66 ± 14, mean ± SD) years. We examined these subjects by pulsed Doppler echocardiography combined with two-dimensional echocardiography to determine the prevalence of valvular regurgitation. Regurgitation began to appear in subjects in their fifties, increasing in prevalence with advancing age (r = .81, p < .001), and was documented in all over age 80. Similarly, regurgitation involving more than one valve appeared in those 60 years and older, and was very common (89%) in subjects in their eighties. With each type of valvular regurgitation, the prevalence of each type of regurgitation increased with aging, but this tendency was most prominent for aortic regurgitation. We conclude that (1) single or multivalvular regurgitation as detected by pulsed Doppler echocardiography is very common in the aged and may be considered a normal finding in the absence of other evidence of heart disease, and (2) the high prevalence of regurgitation in the aged must be taken into account when Doppler examinations are being performed.

ISSN:0009-7322    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

The relations between parental history of early myocardial infarction and plasma lipids and apoproteins have been examined in a population of 4045 middle-aged (20 to 60 years old) working men at the initial examination of the Paris Prospective Study 2. Subjects with a history of myocardial infarction, angina pectoris, or penpheral arterial disease or those treated with hypolipidemic drugs were excluded from the analysis. The numbers of subjects with a paternal or maternal history of early myocardial infarction were 123 and 30, respectively. After adjustment for age, cigarette consumption, alcohol consumption, and body mass index, subjects with parental history of myocardial infarction had higher levels of total cholesterol (p < .01), low-density lipoprotein (LDL) cholesterol (p < .01), and apoprotein B (APOB) (p < .0001) and a lower level of high-density lipoprotein (HDL) cholesterol (p < .05) than subjects with no parental history of myocardial infarction. On the other hand, apoprotein Al (APOA1) and triglyceride levels were not different between the two groups. The ratios of HDL/total cholesterol and APOA1/APOB were also lower in presence of parental myocardial infarction (p < .001 and p < .01, respectively). When a discriminant analysis was performed, only APOB level was related to parental myocardial infarction. The results for paternal and maternal history were very similar and were grouped for the analysis. We conclude that part of the known relationship between parental history of myocardial infarction and coronary heart disease could be mediated by an increased APOB level.

ISSN:0009-7322    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Cholesterol levels of serum high-density lipoprotein (HDL) subclasses, HDL2 and HDL3, were examined in a random subsample (n = 561) of children (7 to 17 years of age) from a total biracial community. Overall, black children in younger (7 to 10 years) and older (11 to 17 years) age groups alike had significantly higher HDL2 cholesterol (HDL2-C) and HDL3-C than their white counterparts. In addition, black children had a relatively higher frequency ofjoint occurrence of high levels of both HDL2-C and HDL3-C. A significant sex-related difference, with girls showing higher values than boys, was noted among younger age groups for HDL2-C. A male-female crossover trend in HDL2-C levels was apparent only among white children, with girls showing higher values after age 11. Both age and sexual maturation were inversely associated with HDL3-C levels in white children, irrespective of sex (p < .001). Serum triglycerides were inversely related to both HDL2-C and HDL3-C only in white children (p < .001). A black-white difference in HDL2-C persisted only among boys and girls in the older age group after adjusting for the covariates (sexual maturation, age, adiposity, oral contraceptive use, cigarette smoking, alcohol use, and serum triglycerides). With respect to HDL3-C, the covariateadjusted difference remained significant only among boys in the older age group. Metabolic variations between the races in response to both physiologic and environmental factors likely account for the divergence in antiatherogenic HDL pattern.

ISSN:0009-7322    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Mortality rates in the United States from coronary artery disease are higher among blacks than whites at younger ages, with a crossover to lower rates above the age of 70. The factors that determine this crossover of age-specific death rates have not been elucidated. Selection from the black population of younger individuals who are sicker by virtue of being more coronary prone might leave a relatively healthier group of older persons. Support for this hypothesis would consist in part of evidence that coronary artery disease has an earlier onset in the black population. We examined data from the National Hospital Discharge Survey for the years 1973–1984 to determine if age-related differences in case-fatality rates existed between whites and nonwhites. In-hospital case fatality rates were 10% to 70% higher for each of the 10 year age groups for nonwhites up to age 70, at which time a crossover occurred. The median age at death from myocardial infarction was approximately 5 years younger in nonwhites compared with whites. National estimates of hospitalization rates for myocardial infarction from these data likewise suggest that nonwhites receive less health care for coronary artery disease than whites relative to recorded fatal events. The age-specific trends in case-fatality support the hypothesis that a cohort selection effect in part determines the black/white differentials in coronary artery disease. Relative susceptibility of the black and white population is thus not appropriately estimated by ageadjusted rates, but should be examined on an age-specific basis within the framework of selection effects on a cohort.

ISSN:0009-7322    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

We investigated the mechanism and significance of ST segment changes in inferior infarction by studying 100 patients with acute inferior infarction in whom body surface maps were recorded on admission. The magnitude of the maximum ST segment elevation (denoted Vmax) and magnitude of the maximum ST segment depression (denoted Vmin), as well as the ST depression on the standard 12-lead electrocardiogram were analyzed against morbidity and mortality (at a median followup time of 14 months). A value obtained by subtracting Vmax from Vmin correlated (p < .0002) with outcome. Correlations were also found between Vmin and complications, Vmin and mortality, and between increasing levels of ST depression on the 12-lead electrocardiogram and mortality. The maps were also studied by grouping the 100 ST segment map patterns into five groups by cluster analysis techniques. One group showed marked anterior negativity and had 37% mortality compared with an overall 5% mortality for the remaining groups. The limited arteriographic and autopsy data available indicated that the findings of a diseased artery or arteries corresponded with the results of mapping. The mean map patterns of the five groups showed that, in most patients with inferior infarction, the standard chest leads V, to V6 are over a region of steep voltage gradient. Small changes in the position of the standard chest lead can cause large changes in the displayed potentials. This study indicates that patients at high risk after acute inferior infarction can be identified by surface mapping on admission to the coronary care unit.

ISSN:0009-7322    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

The role of combined two-dimensional and pulsed Doppler echocardiography in the postoperative assessment of patients with total anomalous pulmonary venous connection was evaluated. Twenty-two cases with a median age of 9.5 weeks at the initial examination were evaluated. Serial ultrasound examinations were performed throughout the study period. The ultrasound results were compared with chest radiographs obtained during the same period. Of the 22 patients, 16 had normal pulmonary venous flow profiles characterized by low-velocity laminar flow. Of this group 12 had persistent radiographic postoperative pulmonary edema that cleared in all by 4 months. Six patients with pulmonary venous obstruction were identified, the diagnosis being confirmed at catheterization or autopsy. The venous flow pattern in this group was uniformly high velocity and turbulent. It was possible to localize the site of obstruction in each case. Although pulmonary edema was present in each patient, the chest radiograph did not provide reliable information as to the exact site of obstruction. Combined two-dimensional and Doppler echocardiography is a useful adjunct in the postoperative evaluation of patients with total anomalous pulmonary venous connection.

ISSN:0009-7322    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

A definitive diagnosis of myocarditis requires right ventricular biopsy. Despite its specificity, however, right ventricular biopsy may lack sensitivity due to the focal nature of the disease. Because indium 11 -monoclonal antimyosin antibody imaging can be used to detect myocardial necrosis, this procedure was performed on 28 patients clinically suspected of having myocarditis, 25 of whom had left ventricular ejection fractions of less than 45%, and the results were compared with those of right ventricular biopsy performed within 48 hr of the scan. Antimyosin scans were positive in nine patients who had evidence of myocarditis on right ventricular biopsy, and negative in 11 who had no evidence of myocarditis-by biopsy. The remaining eight had positive antimyosin scans but showed no evidence of myocarditis on right ventricular biopsy. On the basis of a right ventricular biopsy standard, the sensitivity of this method was 100%, the specificity 58%. We conclude that antimyosin antibody imaging is a reliable screening method for the evaluation of patients suspected of having myocarditis, and that a positive antimyosin scan indicates the need for right ventricular biopsy to establish the histologic diagnosis.

ISSN:0009-7322    

出版商:OVID    

年代:1987

数据来源: OVID