Coronary artery disease in hypertensive patients with heart failure and left bundle branch block: diagnostic utility of adenosine TC99 tetrofosmin SPECT (original) (raw)
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Determinants of left ventricular hypertrophy and function in hypertension
The American Journal of Cardiology, 1982
Ventricular mass and 02 supply of the myocardium were evaluated in patients with left ventricular hypertrophy due to stenosis or insufficiency of the aortic valve and in control patients without cardiac disease. Calculation of left ventricular mass from the angiogram was verified by autopsy data in seven patients. Total mass, 03 consumption, and coronary blood flow, each was related quantitatively to left ventricular total load (force) in all patients. Left ventricular equatorial tension, however, was greater in proportion to HYPERTROPHY OF THE LEFT VENTRICLE, which involves both contractile and mitochondrial elements,' presumably is a result of the increase in ventricular wall force (total load) and metabolic rate. The degree of the hypertrophy as assessed by left ventricular wall thickness has been found to be related quantitatively to the increase in left ventricular systolic blood pressure.2 Left ventricular wall force per unit cross-sectional area (i.e., stress)3 and 02 consumption per gram4`6 have been reported to be nearly normal in chronically hypertrophied hearts. These observations suggest that the extent of hypertrophy may be regulated to keep wall force and 02 consumption per unit of myocardium within normal limits, a finding consistent with the theory that myocardial growth is regulated by the steady-state level of adenosine nucleotide phosphorylation.7 The objectives of the present investigation were to delineate more precisely the mechanical determinants of left ventricular hypertrophy and to evaluate the adequacy of the compensatory increase in coronary blood flow in meeting the augmented myocardial 02 requirements of the hypertrophied heart. We calculated equatorial tension and total force3 (load) of the left ventricular wall and determined the quantitative relationship between these mechanical expressions and left ventricular mass, 02 consumption, and coronary blood flow. The studies were performed in patients whose left ventricular hypertrophy was in response to one of two different types of chronic hemodynamic burden: isolated aortic stenosis or insufficiency. Methods Subjects We studied 24 patients with aortic valve disease: 15 had nearly pure aortic stenosis (AS) and nine nearly pure aortic
American Heart Journal, 1943
The question on whether the electrocardiographic criteria are reliable for detection of left ventricular hypertrophy (LVH) and play a role in predicting outcome is open. Answer can only proceed from population-based studies over unselected people followed up for years. In this study, 1,699 subjects from general population underwent echocardiogram and standard electrocardiogram (ECG) codified for LVH with Minnesota code and with other five methods. Other items were also recorded and used as covariables. Left ventricular mass index (LVMI) was 127.6 ± 44.9 g m -2 in men and 120.8 ± 41.2 g m -2 in women, and correlated directly with age in both genders. Prevalence of echocardiographic LVH was 36.6% in men and 53.4% in women. LVMI correlated directly with the Sokolow-Lyon score in both genders at any age, with the Romhilt-Estes, Cornell and R aVL scores in all subjects but elderly men, and with the Lewis score in men and women aged B69 years. Sensitivity and the predictive value of electrocardiographic tests, as well as the prevalence of LVH diagnosed with electrocardiographic criteria, were always low. Specificity was high for all the tests, and in particular for the Cornell index. Only when diagnosed with echocardiogram or with the Sokolow-Lyon criterion, LVH was an independent predictor of mortality. We conclude that electrocardiographic tests cannot be used as a surrogate of echocardiogram in detecting LVH in the general population because their positive predictive value (PPV) is unacceptably low. On the contrary, they could replace echocardiography in the follow up and for prediction of outcome, when LVH has previously been correctly diagnosed with other methods.
Echocardiographic criteria for left ventricular hypertrophy: The Framingham heart study
The American Journal of Cardiology, 1987
Cf 6,146 original cohort and offspring subjects of the Framingham Heart Study who underwent routine evaluation, a healthy group of 347 men (aged 42 f 12 years) and 517 women (aged 43 f 12 years) was identified to develop echocardiographic criteria for left ventricular (LV) hypertrophy. Healthy subjects were defined as normotensive, receiving no cardiac or antihypertensive mediiations, nonobese and free of cardtopulmonary disease. Echocardiographic criteria (in accordance with the American Society of Echocardiiraphy convention) for LV hypertrophy, based on mean plus 2 standard deviations for LV mass, LV mass corrected for body surface area and LV mass corrected for height in thii healthy sample are, respectively: 294 g, 150 g/m* and 163 g/m in men and 196 g, 120 g/m* and 121 g/m in women. Criteria based on LV mass/height result in higher prevalence rates of LV hypertrophy than LV mass/body surface arGa while still correcting for body size. The prevalence of LV hypertrophy in the entire study population (using LV mass/height criteria) is 16% in men and 19% in women. Until outcome guided criteria for LV hypertrophy are developed, application of sex-specific criteria based on a healthy population distribution of LV mass offer the best approach to echocardiographic diagnosis of LV hypertrophy. (Am J Cardiol 1967;59:956-960) From the Framingham Heart Study, Framingham Massachusetts; the National Heart, Lung, and Blood Institutes,
Medizinische Klinik (Munich, Germany : 1983), 2008
To investigate the correlation between the prevalence of ventricular arrhythmias (VA) and the type and degree of left ventricular hypertrophy (LVH) in hypertensive patients using exercise testing and Holter monitoring. A total of 192 patients (87 men and 105 women) without coronary disease were divided into three groups according to type of LVH (concentric, eccentric, and asymmetric) and three subgroups in relation to the degree of hypertrophy (mild, moderate, and severe). In all subjects blood pressure was measured, electrocardiographic and echocardiographic data obtained and the prevalence of VA determined by Holter monitoring and bicycle ergometry. The most frequent LVH type was the concentric (63%), followed by eccentric (28%) and asymmetric (9%). Severe LVH was found in 10% of patients. Complex VA during Holter monitoring were identified in > 40% of patients. During the stress test this percentage increased by additional 7.4%. There was no statistically significant differenc...
2023
Aim: Left ventricular (LV) hypertrophy (LVH) is a common and relevant complication of arterial hypertension (AH) and 12-lead electrocardiogram (ECG) is widely used for its preliminary assessment. The aim of the study was to compare the correlations of four ECG-derived criteria of LVH and left atrial (LA) anteroposterior diameter with LVH assessed by echocardiography and expressed as left ventricular mass (LVM) index (LVMI) in search of the most accurate preliminary indicator of LVH. Methods: The study included 61 subjects with AH [age (year) 69 ± 10, 17 females] and 27 without AH, (age 40 ± 9, 10 females) evaluated with 12-lead ECG and transthoracic echocardiography (TTE). As the ECG-based criteria of LVH Sokolow-Lyon index (SLI), Cornell voltage (CV), Cornell product (CP), and Romhilt-Estes point score (RES) system were evaluated. The ECG indices and LA diameter were correlated with LVMI and correlations coefficients were compared. Results: Among ECG-LVH indicators SLI showed the closest correlation with LVMI [rank correlation coefficients (rho) = 0.38, P < 0.0001], followed by CV and CP with rho = 0.33, P = 0.002 and rho = 0.32, P = 0.002, respectively, whereas RES did not correlate significantly with LVMI. The strongest correlation with LVMI was found for the LA diameter with rho = 0.73 and P < 0.0001, showing an even stronger correlation in women-rho = 0.8 (P < 0.0001) vs. rho = 0.65 (P < 0.0001) in men. In the multivariate analysis, the LA was the only independent predictor of the increased LVMI with R 2 = 0.52, P < 0.0001. Conclusions: LA diameter outperformed significantly the ECG indices as far as the correlation with LVMI was concerned and emerged as the only independent predictor of mild and moderate LVH in hypertensive patients. Among the ECG criteria, the strongest correlation was shown for SLI, followed by CV and CP indices.
Factors influencing cardiac hypertrophy in hypertensive patients
Clinical science (London, …, 1981
1. Seventeen male patients with essential hypertension were studied after 4 weeks of placebo and after 8 weeks of P-adrenoceptorblockade therapy with atenolol (100 mg/day). 2. The influence of the following factors on left ventricular wall thickness and left ventricular mass index as determined by echocardiography was examined: patient's age, duration of hypertension, arterial pressure, blood pressure variability, supine heart rate, maximal exercise heart rate, left ventricular wall stress and 24 h urinary catecholamines. 3. Left ventricular mass index was related to systolic blood pressure (r = 0-54, P < 0.05) and to extent of increase in heart rate with maximal exercise (r = 0-62, P < 0.05). No significant correlation was present between mass index and other variables. 4. After atenolol therapy, left ventricular mass index decreased by 14 g/mZ (12%). Changes in mass were related to its initial value (r = 0.69, P < 0.0 1) and to % change in wall stress (r = 0.64, P < 0.05). Patients who had a decrease in mass index of 10% or greater had an initially lower diastolic pressure (P < 0.001). Other factors did not appear to influence significantly the regression of hypertensive left ventricular hypertrophy.
Echocardiographic studies of regression of left ventricular hypertrophy in hypertension
Hypertension, 1987
The availability of echocardiography has allowed direct determinations of left ventricular wall thickness and calculation of left ventricular mass. As a result, the past decade has witnessed a remarkable evolution in our understanding of structural changes in the heart. Moreover, cardiac hypertrophy was found to be reversible by some forms of therapy. In general, reduction of left ventricular mass became evident after 8 to 12 weeks of antihypertensive therapy. Sympatholytics (including methyldopa and reserpine), converting enzyme inhibitors (captopril and enalapril), and calcium entry blockers led to significant regression of left ventricular hypertrophy. On the other hand, arteriolar vasodilators (hydralazine, trimazosin, and minoxidil) were not associated with regression of hypertrophy despite adequate blood pressure control. Finally, data regarding diuretics and beta-blockers are controversial. These differences in results among various antihypertensive drugs reflect the multipli...
International cardiovascular research journal, 2014
The present study aimed to investigate the relationship between Left Atrial Volume (LAV), a marker of diastolic dysfunction, and the frequency of malignant ventricular arrhythmia in the patients with left ventricular dysfunction and a previously implanted Implantable Cardioverter Defibrillator (ICD) device. This cross-sectional study was conducted on 32 patients with ischemic or idiopathic dilated cardiomyopathy, each having had an ICD device implanted at least 1 year beforehand. The ventricular arrhythmia episodes which were detected and stored by the device were retrieved and evaluated. In addition to routine echocardiographic measurements, all the patients had their LAV and LAV indexes calculated. After all, student's t-test, Mann-Whitney U test, and Pearson correlation were used to analyze the data. Besides, P value < 0.05 was considered as statistically significant. This study was conducted on 4 female and 28 male patients with the mean age of 58.41 ± 9.97 years. Among t...