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 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The presented analysis deals with the physiopathological mechanisms of the debelopment of postinfarction cardiac insufficiency and the clinical peculiarities of its manifestations. It is emphasized that the leading cause of cardiac insufficiency consists in a reduction of the contractile function of the left ventricular myocardium due to the development of asynergy in the cicatrical zone. The addition of several accompanying factors, such as heart mitralization, tachysystolic form of ventricular fibrillation, repeated infarction with a growing asynergic zone, aggravate the course of cardiac insufficiency providing for the development of hypertension in the general circulation system.
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PMID:[Cardiac insufficiency in ischemic heart disease]. 78 66

The paper presents the results of an examination of 62 patients with postinfarction cardiosclerosis by means of echocardiography and ultrasonic scanning. The impact of the asynergy zone on the development of cardiac insufficiency was studied with reference to the area of myocardial lesion. Myocardial hyperkinesia is characterized, its compensatory effect in postinfarction cardiosclerosis and arterial hypertension is discussed. The effect of Inderal and Ildomen on both the zones of hyperkinesia, and on the indices of cardiac haemodynamics as a whole is described.
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PMID:[Importance of myocardial asynergy zones in the development of cardiac insufficiency]. 101 9

Evaluation of the results of surgery for coronary artery disease requires a knowledge of the clinical course of patients not having this mode of treatment. To obtain such information we performed a retrospective analysis of the fate of 266 patients with arteriographically documented significant stenosis following from one to ten years. For the entire group the five year survival was 73%. Subdivided into single, double or triple vessel disease categories the percent five year survival rates were respectively 92, 65 and 55. A history of angina pectoris or myocardial infarction prior to angiography did not affect survival. However, hypertension, congestive heart failure, abnormal hemodynamics or left ventricular asynergy were all associated with a diminished five year survival, the values being respectively 61%, 38%, 62% and 58%. These results should be of VALUE IN ASSESSING THE PROGNOSIS OF NONSURGICALLY TREATED PATIENTS WITH CORONARY ARTERY DISEASE.
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PMID:Prognosis in coronary artery disease. Angiographic, hemodynamic, and clinical factors. 110 13

To evaluate the association between left ventricular false tendon (LVFT) and ventricular arrhythmias in acute myocardial infarction (MI) on the 1-st day of acute MI 71 patients were examined by 24-hour ECG-monitoring and M-mode, two-dimensional, Doppler echocardiography. LVFT was detected in 30 patients (42.3%). The frequency of left ventricular fibrillation, the number of patients with multiform ectopic ventricular beats (EVB), the number of single and pair EVB and runs of ventricular tachycardia were greater in group of patients with LVFT. 37 patients had Lown grades 1-2 (A) of arrhythmias, 34 patients had grades 3-5 (B). LVFT was revealed in four patients in group A (10.8%) and in 27 patients in group B (76.5%, p < 0.001). There were no significant differences between groups in left ventricular asynergy area and wall motion score, left and right ventricular, left atrium dimensions, left ventricular contractility indices, left ventricular walls thickness, frequency of mitral regurgitation. Multifactor analysis has shown significant relationship between Lown's class value and LVFT (p < 0.0001), Lown's class and arterial hypertension (p = 0.0376). Other 17 clinical factors were not connected with Lown's class value. Thus, LVFT was associated with severe ventricular arrhythmias in patients with AMI. This fact can be used as a predictor of these disturbances.
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PMID:Relationship between ventricular arrhythmias and left ventricular false tendons in acute myocardial infarction. 129 Jun 56

Doppler echocardiography has become a very useful and widely employed imaging technique for evaluating valvular regurgitation, and has thus lead to the discovery of regurgitation in unexpected subjects. In this study, we examined left-sided valvular regurgitation in 31 healthy subjects, 35 patients with hypertension and 43 patients with old myocardial infarction by Doppler echocardiography. Aortic regurgitation was found in 3% of healthy subjects, 8% of hypertensive patients and 5% of patients with myocardial infarction. Mitral regurgitation was found in 35% of healthy subjects, 69% of hypertensive patients and 84% of patients with myocardial infarction. The pathogenesis of mitral regurgitation in hypertension is considered to be the impairment of the mitral leaflets, since neither anatomical nor functional abnormalities were found in the subvalvular mitral apparatus. Left ventricular dilatation and asynergy near the papillary muscles were related to the pathogenesis of mitral regurgitation in myocardial infarction. Mitral regurgitation in healthy subjects and hypertensive patients was mild and resistant to afterload stress, suggesting that it was less pathological. On the other hand, mitral regurgitation in myocardial infarction was easily worsened by afterload stress. Doppler echocardiography has thus provided us with new insights into valvular regurgitation in healthy subjects and patients without rheumatic valvular disease.
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PMID:Evaluation of left-sided valvular regurgitation in healthy, hypertensive and myocardial infarction subjects by Doppler echocardiography. 236 14

We investigated the relationship between parameters of left ventricular diastolic filling using pulsed Doppler echocardiography and the A wave ratio of apexcardiography (ACG), and then evaluate the characteristic features of diastolic behavior in hypertrophic hearts and in various cardiac diseases. The study population consisted of 68 patients and 25 normal subjects, and included 19 cases of chronic renal failure (CRF), 17 cases of ischemic heart disease (IHD), 16 cases of hypertension (HT), six cases of hypertrophic cardiomyopathy, two cases of aortic stenosis, two cases of arrhythmias, and six of other cardiac diseases. The A wave ratio of ACG was calculated as the ratio of A wave amplitude and total excursion [(A/E-O) x 100]. At the same time, the peak early filling velocity (R), the peak late filling velocity (A), the ratio of R to A (A/R), acceleration time (AT), and deceleration time (DT) were measured from the left ventricular inflow velocity pattern using pulsed Doppler echocardiography. The results were as follows: 1. There was a close positive correlation between the A wave ratio of ACG and the A/R of pulsed Doppler echocardiography. 2. In patients with left ventricular hypertrophy (LVH), both the A wave ratio and the A/R were significantly higher than those in normal subjects. And in LVH with asynergy, both the A wave ratio and the A/R were significantly higher than those in LVH without asynergy. 3. In CRF, IHD, and HT, both the A wave ration and the A/R were significantly higher than those in normal subjects, but there were no significant differences among these three disease entities.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Relationship between left ventricular diastolic behavior and the A wave ratio by the apexcardiogram: a study with echocardiography and pulsed Doppler echocardiography]. 296 12

To assess the prevalence and significance of left ventricular dilatation in patients with severe left ventricular dysfunction secondary to coronary artery disease (or coronary artery cardiomyopathy), we studied 70 patients with an ejection fraction of 35 percent or less and one-vessel coronary artery disease (n = 14) or with multivessel coronary artery disease (n = 56). None had had a recent myocardial infarction or valvular heart disease. Patients who underwent myocardial revascularization during follow-up were excluded. The left ventricular end-diastolic volume (measured by contrast ventriculography) was less than 110 ml/sq m in 14 patients (20 percent) (group 1), and was 110 ml/sq m or more in 56 patients (80 percent) (group 2). There were no differences between the two groups in age, sex, diabetes mellitus, hypertension, extent of coronary artery disease, or left ventricular asynergy. Patients in group 1 had lower pulmonary arterial wedge pressure (13 +/- 6 vs 22 +/- 10 mm Hg; p = 0.0008), lower left ventricular end-diastolic pressure (21 +/- 6 vs 27 +/- 9 mm Hg; p = 0.007), and higher left ventricular ejection fraction (31 +/- 2 vs 25 +/- 7 percent; p = 0.001) than patients in group 2. At a mean follow-up of 27 months, 24 patients had died of cardiac causes, all of whom were in group 2. Survival was significantly better in group 1 than in group 2 (Mantel-Cox, p = 0.009). Survival analysis (Cox models) of 20 clinical, hemodynamic, and angiographic variables showed that ejection fraction (chi2 = 13.6; p less than 0.001) and end-diastolic volume chi2 = 4.7; p = 0.03) were the most significant predictors of death. Thus, minimally dilated coronary artery cardiomyopathy is a distinct entity with favorable hemodynamics. Prognostically, the end-diastolic volume adds significant predictive information to the ejection fraction among conservatively treated patients.
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PMID:Coronary artery cardiomyopathy. Hemodynamic and prognostic implications. 394 48

Studying the natural history of coronary artery disease could provide a frame of reference for prognosis and appraisal of treatment for patients having this disease. We studied a total of 465 consecutive patients with angiographically significant coronary artery disease, defined as greater than 50% stenosis in at least one principal artery, who were followed with medical treatment only from 1 to 7 years. Excluding patients with left main coronary disease, there were 73 deaths, of whom 63 were cardiac. The 5-year cumulative survival rates were 72% for the entire group, 87% for single vessel disease, 73% for double vessel disease and 51% for triple vessel disease. In single vessel disease, patients with left anterior descending artery involvement tended to have higher mortality. In double vessel disease, survival was worse with the combination of left anterior descending and right coronary artery involvements than the other 2 combinations. A history of myocardial infarction was not significantly different from angina in 5-year survival rate. Nevertheless, an abnormal Q-wave in ECG was associated with lower survival. History of hypertension and electrocardiographic left ventricular hypertrophy did not affect survival. While congestive heart failure, abnormal resting LVEDP and left ventricular asynergy were all associated with reduced survival. The left ventricular ejection fraction had highly prognostic value, only 42% of patients survived with ejection fraction less than 0.3 at the end of 5 years after angiography.
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PMID:Natural history of coronary artery disease in relation to angiographic, hemodynamic and clinical factors. 407 May 5

Three patients with mitral regurgitation (MR) associated with aortitis syndrome are presented. All had multiple lesions of the large sized arteries, calcification of the aorta, mild inflammatory findings, a chronic course, and congestive heart failure. MR was observed by ventriculography in all 3 patients. Case 1 had mitral valve prolapse and secondary systemic hypertension. Case 2 showed mildly thickened mitral valve leaflets and had moderate aortic regurgitation (AR). Case 3 had massive AR. The grade of MR was moderate in Cases 1 and 2, and massive in Case 3. The left ventricle was moderately dilated in Cases 1 and 2 but contracted sufficiently and symmetrically in all 3 patients. Other than the prolapse, no significant mitral valve deformity or left ventricular asynergy was evident by ventriculography. The incidence of MR was 3.1% of 128 patients with aortitis syndrome observed in our clinic. MR may be found in the late stage of aortitis syndrome. It may be caused by a mild valvular lesion related to aortitis syndrome and be exacerbated by increased hemodynamic loads such as those which occur in secondary hypertension and AR.
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PMID:Mitral regurgitation associated with aortitis syndrome. 613 11

This study was undertaken to determine the prevalence and significance of diastolic left ventricular (LV) dysfunction in mild to moderate systemic hypertension. Rest and exercise equilibrium blood pool scintigraphy was performed in 39 hypertensive subjects (mean systolic blood pressure [BP] 156 +/- 14 mm Hg [+/- standard deviation]; mean diastolic BP 103 +/- 5 mm Hg) and 11 normal control subjects. These studies were analyzed for ejection fraction (EF), segmental wall motion, peak filling rate (PFR), time to PFR and filling fraction in the first third of diastole normalized for cycle length (first-third filling fraction). EF at rest was similar in the hypertensive patients and control subjects (0.63 +/- 0.09 versus 0.65 +/- 0.07); only 2 patients had a reduced EF. The EF response to exercise was normal in every hypertensive patient (increasing to a mean of 0.74 +/- 0.08); only 1 patient had asynergy. In contrast, even when the 2 patients with abnormal systolic function were excluded, each index of diastolic filling was significantly different from the control group. PFR was lower (2.29 +/- 0.49 vs 2.63 +/- 0.39 end-diastolic volumes per second [EDV/s], p less than 0.05), time to PFR was longer (199 +/- 47 versus 158 +/- 17 ms/s), p less than 0.01) and first-third filling fraction was smaller (0.38 +/- 0.11 vs 0.60 +/- 0.07, p less than 0.001). The latter index fell below the lowest normal value in 84% of the hypertensive patients. The degree of diastolic filling abnormality was not related to the patients' age, heart rate, BP, duration of systemic hypertension or systolic function.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Abnormal left ventricular filling: an early finding in mild to moderate systemic hypertension. 669 Dec 48


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