Captopril test for primary aldosteronism

Volume Number

Table

112 6

Letters

I. Echocardiographic results

&iitor

1357

~_- .._. --..

_-.-_~--_~ Group I (Iv) (n = 9)

LA/A0 RV/m’ LVEDV/m* LVESV/m’ Cardiac index (L/min/m? Systolic index (ml/m’) LVEF Systemic resistance (relative units) Q; shortening VCF ESSN index LV mass (pm/m’)

to th,r

(:roup

Group II (Anemia without (n = 7)

Ii1

( !+‘A)

X.4)

/ n = 1:!.I --.-

II___

1.01 * 0.03 0.76 + 0.9 64.8 + 6.9

1.17 +_ 0.13 0.83 t 0.9 82.4 + 10

I .9:1 t 0.09 :. ’ k 0.8 x3 f 7.6

23.2 -i- 3.3 3.05 + 0.2 41.6 k 4.3 0.64 34.4 a 3.8 0.34 + 0.02

26.6 i- 3.9 4.3 I 0.7 55.4 t_ 8.9 0.64 20 r 4.1 0.35 t 0.02

:Q, I r :i. ; ‘. ,Fl” f. ‘,.6fi I-: i ! ;.- .t

1.1 +- 0.06 2.15 f 0.22

100 t- 9

ml f 0.97), seven had anemia without SCA (hemoglobin = 5.2 gm/lOO ml _+ 1.2), and nine were normals (hemoglobin = 13 gm/lOO ml c 0.27). All subjects had a hemodynamic angiocardiographic and echocardiographic study. The results of the echocardiographic examination are given in Table I. Although there were fewer cases in our study, we showed significant differences. Like Balfour et al., we observed a more significant increase of myocardial mass among SCA patients. On the other hand, the increase of left ventricular diastolic volume was equal among subjects with SCA and those having anemia without SCA. We evaluated myocardial performance by a test not modified by preload and afterload (which modifies systolic times)-i.e., the end-systolicstress/volume index. A decrease of this ratio was observed among the two groups of patients. With this test, Denenberg et al.’ observed a decrease of myocardial function among SCA patients, but they did not compare SCA patients with an anemic control group without SCA. Finally, we think that there is no difference between the decrease of left ventricular function in anemic patients and SCA patients. Only the left ventricular mass is more important in SCA. This increase of myocardial mass could be due to the long duration of the anemia in SCA. T. Murdelle A. Ekra Ed. Bertrand

1.2 f 0.17

I :i .t (I.15 .:’ i t O.“K

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LVESV = left ventricular end-systolic : olume; i,VEF = left index = end-systolic-stress/volume I~U!PT. I,V mass = leli

determined by programmed electrical stimulation” 1986;111:661. On page 662, the Methods section presents the dosage in a manner that may be misleading. We gave 15 mg’ per kilogram per day in three divided dosages every 8 hours, The 15 mg per kilogram every 8 hours would be three times that. amount and would be an excessive dose. John

!:

Somherg,

M.D.

Wiv~~src~rz of Cardiology

Albert

Einstein 1.300

Collrgu

oj Medicine Avenur frmnx, NY tmi1

Mwrrs

Park

CAPTOPRIL TEST FOR PRIMARY ALDOSTERONISM To the Editor.

Please be advised that in Table III of our article “Is single oral administration of captopril beneficial in screening for primary aldosteronism?” (AM HEART J 1986;112:361.) in the JOLIHNAL, the specificity after captopril should be “67/72 = 93%” instead of “65/72” in the final column of the table for plasma aldosterone concentration (PAC) 28.9 ng/dl and PACIPRA ratio 2 12.6.

Institute of Abidjan BP V 206 Abidjan Ivory Coast, West Africa

Heart

Hiroml

Muratani,

2nd Ilrpt. oj Internal

M.1).

Medicine

F~lc~~lty of Medicine K.vushu University I,:;kuoka 812. *Japan

REFERENCES

1. Balfour IC, Covitz W, Davis H, Rao PS, Strong WB, Alpert BS: Cardiac size and function in children with sickle cell anemia. AM HEART J 1984;108:345. 2. Denenberg BS, Criner G, Jones R, Spann JF: Cardiac function in sickle cell anemia. Am J Cardiol 1983;51:1674.

2 0.03

1.4 i 0.14

109 _t 20

Abbreviations: LA = left atrium; A0 = aorta; LVEDV = left ventricular end-diastolic volume; ESWV ventricular ejection fraction: VCF = velocity of circumferential fiber shortening; ventricular mass; SCA = sicke ceil anemia; RV = right ventricle; N = normal controls.

3.6 (I.6 ,l.r;

TREATMENT OF VENTRICULAR FIBRILLATION To the Editor:

CORRECTED ETHMOZINE DOSAGE To the Editor:

Recently the JOURNAL published our article “Antiarrhythmic efficacy of ethmozine in patients with ventricular tachycardia as

I read with interest the article by Somberg et al. entitled “The treatment of ventricular rhythm disturbances.“’ I wish to query their statement that administration of isoproterenol combined with defibrillation may be the next step after bretylium in patients who are unresponsive to electroshock therapy. The authors base this statement on our observation, in animals, of a decrease in defibrillation threshold by isoproterenol.2 We wish to