ISSN:0009-7322    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

ABSTRACTSystolic blood pressure (SBP) was determined annually for 12 to 15 years in 719 men, 18 to 30 years old at entry into the study. SBP values at entry were compared with those measured in the same individuals at the end of the follow‐up period. The cutoff point separating “normal” from “elevated” SBP was arbitrarily set at 140 mm Hg. The highest SBP recorded at entry was 170 mm Hg. Elevated SBP on follow‐up was 2.3 times more common among subjects with elevated SBP at entry. Yet, 89.2% of the subjects with elevated SBP at entry had a normal SBP on follow‐up. A normal SBP at entry did not reduce the risk of elevated SBP on follow‐up.Circulation 68, No. 3, 467‐469, 1983.

ISSN:0009-7322    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

ABSTRACTLeft ventricular hypertrophy (LVH), a target organ response in essential hypertension, is only weakly related to clinical measurements of blood pressure. To determine whether blood pressure measured under basal or stress conditions more closely determines LVH, we compared echocardiographic left ventricular mass index and relative wall thickness with clinical blood pressure and with 24 hr recordings (home, work, and sleep) in 19 normal subjects and 81 patients with mild hypertension. Only a weak correlation was observed in the entire group between left ventricular mass index and clinical measurements of systolic and diastolic blood pressure (r = .24, p < .02; r = .20, p < .05, respectively), which was only slightly improved by use of systolic and diastolic blood pressure readings taken in the home (r = .31, p < .005; r = .21, p < .05, respectively). Sleep and total 24 hr blood pressure also related poorly to left ventricular mass index. In contrast, substantially higher correlations existed between left ventricular mass index and systolic and diastolic blood pressure measured by portable recorder in 60 subjects at work (r = .50, p < .001; r = .39, p < .01, respectively). Similarly, work diastolic blood pressure bore the closest relationship to relative wall thickness (r = .59, p < .001). Home blood pressure readings taken on a work day also showed a moderate relationship with indices of LVH, whereas weaker correlations were found in employed subjects whose blood pressure was recorded on a non‐workday, and no relationship between blood pressure and LVH existed in subjects who were not employed. We conclude that hypertensive LVH is poorly related to clinical or home measurements of blood pressure but that a substantially closer relationship exists between LVH and blood pressure during recurring stress at work and between LVH and home blood pressure on a workday. Thus hypertensive cardiac hypertrophy appears to be more closely related to blood pressure during stressful situations than to basal blood pressure.Circulation 68, No. 3, 470‐476, 1983.

ISSN:0009-7322    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

ABSTRACTWe have monitored ambulant intra‐arterial blood pressure with the Oxford system in six subjects with autonomic failure who exhibited postural hypotension. Plotting pooled hourly mean values we have demonstrated a consistent circadian trend in blood pressure that was the inverse of the normal pattern, with the highest pressures at night and the lowest in the morning. In four subjects, confinement to bed did not substantially alter this pattern. Heart rate variability was much reduced in four of the subjects, but relatively normal in two in whom blood pressure variation was also less abnormal. There was a correlation of the nadir of the blood pressure measurements with the reported time of peak incidence of orthostatic symptoms. These findings are of importance in both the management and physiologic testing of patients with this condition.Circulation 68, No. 3, 477‐483, 1983.

ISSN:0009-7322    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

ABSTRACTReliability of angiographic assessment of the left main coronary artery segment was evaluated by review of 106 coronary cineangiograms from the Coronary Artery Surgery Study. The films were interpreted by three groups of angiographers: those at a clinical site, those at a quality control site, and those on a study census panel. Among the readings of these three groups, there was 41% to 59% agreement on the severity of the lesion, with 80% agreement on whether the lesion was greater or less than 50%. The severity of the lesion, its location, or presence of ectasia or calcium did not affect the discrepancy rate, whereas segments that were unusually short, diffusely diseased, or obscured by overlapping vessels were especially difficult to interpret.Circulation 68, No. 3, 484‐489, 1983.

ISSN:0009-7322    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

ABSTRACTLatent coronary heart disease was suspected in 115 of 2014 apparently healthy middleaged men after a baseline cardiovascular survey. One hundred five of these men underwent angiography and 36 were found to have normal coronary arteries (group 1). A 7 year follow‐up survey revealed that: (1) three had died of sudden cardiac death, (2) four had received a diagnosis of cardiomyopathy, (3) one had developed aortic dilatation/aortic regurgitation since the baseline survey, (4) they all had a significantly more rapid decline in their physical performance and maximal heart rate levels from the time of the baseline survey to follow‐up than did randomly selected normal controls (group 2), and (5) thallium study results were normal in both groups (27 and 26 patients), but technetium ventriculography revealed a subnormal increase in ejection fraction during exercise (< 5% units) in 14 of 27 group 1 subjects and in 4 of 26 group 2 subjects. Thus, incipient heart disease may be present in subjects in whom coronary angiographic examination has removed a previous suspicion of coronary heart disease.Circulation 68, No. 3, 490‐497, 1983.

ISSN:0009-7322    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

ABSTRACTWe sought to elucidate the mechanism of mitral regurgitation (MR) in dilated cardiomyopathy (DCM). Quantitative two‐dimensional echocardiographic examinations were performed in 27 patients, 18 with DCM (nine with MR on physical examination, nine without MR) and nine without underlying heart disease. The MR and “no MR” patients were clinically comparable. Spatial reconstructions from multiple apical cross sections were used to estimate the mitral leaflet area needed to occlude the orifice for a given midsystolic coaptation configuration (LEAF), as well as mitral annular area index, left ventricular volume, and left atrial volume. Similarly, reconstructions from parasternal short‐axis views were used to estimate central chordae tendinae length and angulation. From selective parasternal views papillary muscle (PM) length and contraction and the tethering length from the PM base to the annular plane were measured. The MR group was characterized by markedly enlarged occlusional leaflet area (LEAF 19.8 ± 3.1 in MR vs 13.8 ± 2.8 in no MR group vs 6.3 ± 0.9 cm2in normal group; p < .01), striking mitral annular dilatation (midsystolic annular area index 7.5 ± 0.8 in MR vs 4.6 ± 0.9 in no MR group vs 2.9 ± 0.4 cm2/m2in normal group; p < .01), and left atrial enlargement (end‐systolic left atrial volume 129 ± 39 in MR vs 73 ± 14 in no MR group vs 29 ± 5 ml in normal group; p < .01). Chordal length and angulation, PM length, contraction, and tethering length, and left ventricular volume were not significantly different in the MR vs the no MR group. Noncoaptation of the mitral leaflets at their free margins was not observed in any MR patient. With the use of stepwise linear regression LEAF was determined chiefly by annular size (R2.868), with left ventricular size having little additional influence (R2increment .071). Thus, DCM is associated with enlargement of the mitral anulus, which is more pronounced in those patients with MR. Based on the quantitative estimates of occlusional leaflet area, we postulate that mitral leaflet tissue can stretch somewhat to accommodate dilatation of the mitral complex, but as the requirement for occlusional leaflet area increases less tissue is available for coaptation. Thus, although coaptation continues to occur, the valvular seal becomes ineffective once a critical LEAF is reached. The chief determinant of LEAF is the mitral annular size, while left ventricular size is a less important factor.Circulation 68, No. 3, 498‐508, 1983.

ISSN:0009-7322    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

ABSTRACTIn asymptomatic patients with severe aortic regurgitation and normal left ventricular function, aortic valve replacement has been recommended to preserve left ventricular function. In such patients, however, the natural history without operation is unknown. We therefore performed serial studies in 77 asymptomatic patients with normal left ventricular ejection fraction at rest as determined by radionuclide angiography and normal left ventricular fractional shortening as determined by echocardiography; 63 patients had 3+to 4+aortic regurgitation visualized by aortic root cineangiography, and the other 14 patients had pulse pressures >70 mm Hg. During mean follow‐up of 49 months (range 6 to 114) no patient died and 12 patients underwent aortic valve replacement because of the onset of symptoms (11 patients) or the onset of left ventricular dysfunction without symptoms (one patient). By life table analysis, the percent of patients who did not require operation was 90 ± 3% (± SE) at 3 years, 81 ± 6% at 5 years, and 75 ± 7% at 7 years. In the 12 who did have surgery there were no operative or late deaths (postoperative follow‐up 8 to 75 months, mean 38), left ventricular ejection fraction increased (45 ± 5% [± SD] preoperatively, 58 ± 11 postoperatively; p < .001), and left ventricular diastolic dimension determined echocardiographically decreased (74 ± 4 mm preoperatively, 52 ± 5 mm postoperatively; p < .001). Thus, in asymptomatic patients with normal left ventricular function, death is rare, and less than 4% per year require aortic valve replacement because symptoms or left ventricular dysfunction develop. When aortic valve replacement is delayed until symptoms or left ventricular dysfunction develop, postoperative survival is excellent, and left ventricular size and function improve postoperatively. Hence, “prophylactic” aortic valve replacement to preserve left ventricular function should not be performed in asymptomatic patients with severe aortic regurgitation and normal left ventricular function.Circulation 68, No. 3, 509‐517, 1983.

ISSN:0009-7322    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

ABSTRACTSurgical resection of the endocardium and subendocardium often abolishes chronic recurrent sustained ventricular tachycardia in patients with healed myocardial infarcts or ventricular aneurysms, presumably by interrupting the reentrant pathway. To define the morphologic characteristics of cells in the reentrant pathway, we studied the histology and ultrastructure of the endocardial resections of 23 patients who underwent this procedure. Bundles of apparently viable myocardial fibers embedded in dense fibrous tissue were identified throughout the endocardial resections from all patients. These bundles of cells were separated from one another by fibrous tissue but extended uninterrupted to the margins of the surgical resection. In 14 patients Purkinje fibers were identified beneath the thickened endocardium whereas the remaining bundles were composed of ventricular muscle. The Purkinje fibers appeared to have normal ultrastructure and ventricular cells with both normal and abnormal ultrastructures were present. The abnormal muscle cells were characterized by loss of contractile elements, aggregates of dilated sarcoplasmic reticulum, and osmiophilic dense bodies. The sarcolemma was intact and the nuclear chromatin was evenly dispersed suggesting that these cells were still viable. The abnormal structure and arrangement of the surviving cardiac fibers in the endocardium may cause the abnormal electrophysiologic function that results in ventricular tachycardia.Circulation 68, No. 3, 518‐533, 1983.

ISSN:0009-7322    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

ABSTRACTTwo‐dimensional echocardiographic features were correlated with surgical findings in 25 patients with Ebstein's anomaly (age 7 days to 71 years). There was excellent agreement between echocardiographic and surgical findings. Echocardiographic observations of anterior leaflet tethering and restriction of motion, as well as small functional right ventricle, were the strongest noninvasively obtained indicators for valve replacement surgery. Plication/annuloplasty (plastic repair) was performed in 17 patients. This group differed from the group needing valve‐excision surgery in that the anterior leaflet was elongated, was not tethered, and showed large excursion. These observations support the use of two‐dimensional echocardiography as an excellent means for preoperative anatomic assessment of Ebstein's anomaly. This method allowed us to determine which patients were amenable to tricuspid valve excision or plastic repair. A noninvasively derived index of anatomic severity is proposed for easier recognition of patient subgroups.Circulation 68, No. 3, 534‐544, 1983.

ISSN:0009-7322    

出版商:OVID    

年代:1983

数据来源: OVID