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Global and regional left ventricular response to bicycle exercise in coronary artery disease. Assessment by quantitative radionuclide angiocardiography
angiocardiography
Bicycle exercise Regional wall motion
Coronary artery disease
CREST syndrome
Progressive systemic sclerosis
Pulmonary artery hypertension
Scleroderma
-
Asymmetric hypertrophy
septal hypertrophy
profile
Essential hypertension Cardiovascular
profile
Debrisoquine Endocrine
Normal subjects and patients with mild or moderate hypertension received the adrenergic blocker, debrisoquine, for six weeks. Debrisoquine markedly reduced plasma and urinary norepinephrine in all groups. Blood pressure, pulse rate and plasma renin were decreased significantly in those with moderate hypertension, but a lesser reduction or no change occurred in normal or mildly hypertensive subjects. Differences between groups were not related to variations in drugdose, norepinephrine-inhibition, age, basal sodium balance or secondary blood volume expansion. Diuretic therapy in addition to sympathetic inhibition reversed the hypervolemia and further reduced the blood pressure in hypertensive patients. No severe or intolerable side effects occurred. Debrisoquine, combined with a diuretic, may provide a valuable mode of antihypertensive therapy. The hypotensive, cardiac-slowing and renin-inhibitory potential of adrenergic neuron blockade may be initiated by decreased norepinephrine outflow and modulated by variations in end organ responsiveness.
Flammer J, Weidmann P, Gliick 2, Ziegler WH, Reubi FC: Cardiovascular and endocrine profile of adrenergic neurone blockade in normal and hypertensive man. Am J Med 66: 34-42, 1979.
levels
neurone blockade
Norepinephrine
Adrenergic
Twenty-seven patients with acromegaly had echocardiograms performed. Six patients met the criteria for asymmetric septal hypertrophy and eight had concentric left ventricular hypertrophy. The remaining 13 patients were categorized as “normal,” although six had septal measurements >I 1 mm. The group with asymmetric septal hypertrophy had significantly greater systolic internal dimensional shortening of the left ventricle than did the normal group (p < 0.05) and the group with left ventricular hypertrophy (p < 0.01). Initial mean growth hormone levels were considerably higher in those with left ventricular hypertrophy than in the normal group (93 versus 34 ng/ml). Thus. echocardiographic abnormalities are common in acromegaly, and patients with asymmetric septal hypertrophy and acromegaly appear to have significantly increased ventricular ejection. Many of the patients with left ventricular hypertrophy have no evidence of clinical cardiovasculardisease, and their left ventricularhypertrophymay be related to higher initial growth hormone levels.
echocar-
Echocardiography
Smallridge RC, Rajfer S, Davia J, Schaaf M: Acromegaly and the heart-an diographic study. Am J Med 66: 22-27, 1979.
Left ventricular
Acromegaly
Continuedon page A45
Echocardiographic abnormalities were noted in 37 (69 per cent) of 54 patients with progressive systemic sclerosis (PSS). Thirty-one of the 54 patients also underwent right heart catheterization. Pericardial effusion was noted in 22 subjects (41 per cent), although it was suspected on clinical grounds in only seven. Although the presence of a small pericardial effusion did not adversely affect prognosis, the presence of a large effusion (>200 ml) was associated with a poor prognosis. Findings of right ventricular dilatation, asymmetrical left ventricular hypertrophy, left atrial dilatation, paradoxic motion of the interventricular septum or pulmonary hypertension on echocardiogram were seen predominantly or exclusively in patients who had pulmonary artery hyperlension at catheterization. This study confirms clinlcally the frequent involvement of myocardium and pericardium that has been reported in autopsy series and discusses the uses as well as the limitations of echocardiography in the assessment of patients with PSS.
Smith JW, Clements PJ, Levisman J, Furst D, Ross M: Echocardiographic features of progressive systemic sclerosis (PSS). Correlation with hemodynamic and Postmortem studies. Am J Med 66: 28-33, 1979.
Right heart catheterization
Echocardiography
The left ventricular response to bicycle exercise was evaluated in 60 patients with coronary artery disease (CAD) and in 13 normal control subjects. Left ventricular ejection fraction and ejection rate increased in all normal subjects. In contrast, global or regional evidence of compromised left ventricular reserve was found in 48 of 60 patlents with CAD. All 30 patients with electrocardiographic ischemia demonstrated a decrease or no change in ejection fraction with exercise, whereas the response in patients limited by fatigue was variable. These data indicate that exercise ventricular performance studies allow physiologic assessment of left ventricular functional reserve and noninvasive detection of CAD.
Berger HJ, Reduto LA, Johnstone DE, Borkowskl Ii, Sands JM. Cohen LS, Langou RA, Got&chalk A, Zaret EL, with the technical assistance of Pytlik L: Global and regional left ventricular response to bicycle exercise in coronary artery disease. Assessment by quantitative radionuclide angiocardiography. Am J Med 66: 13-2 1, 1979.
Propranolol
Radionuclide
Left ventricular function
Bicycle exercise Regional wall motion
Coronary artery disease
CREST syndrome
Progressive systemic sclerosis
Pulmonary artery hypertension
Scleroderma
-
Asymmetric hypertrophy
septal hypertrophy
profile
Essential hypertension Cardiovascular
profile
Debrisoquine Endocrine
Normal subjects and patients with mild or moderate hypertension received the adrenergic blocker, debrisoquine, for six weeks. Debrisoquine markedly reduced plasma and urinary norepinephrine in all groups. Blood pressure, pulse rate and plasma renin were decreased significantly in those with moderate hypertension, but a lesser reduction or no change occurred in normal or mildly hypertensive subjects. Differences between groups were not related to variations in drugdose, norepinephrine-inhibition, age, basal sodium balance or secondary blood volume expansion. Diuretic therapy in addition to sympathetic inhibition reversed the hypervolemia and further reduced the blood pressure in hypertensive patients. No severe or intolerable side effects occurred. Debrisoquine, combined with a diuretic, may provide a valuable mode of antihypertensive therapy. The hypotensive, cardiac-slowing and renin-inhibitory potential of adrenergic neuron blockade may be initiated by decreased norepinephrine outflow and modulated by variations in end organ responsiveness.
Flammer J, Weidmann P, Gliick 2, Ziegler WH, Reubi FC: Cardiovascular and endocrine profile of adrenergic neurone blockade in normal and hypertensive man. Am J Med 66: 34-42, 1979.
levels
neurone blockade
Norepinephrine
Adrenergic
Twenty-seven patients with acromegaly had echocardiograms performed. Six patients met the criteria for asymmetric septal hypertrophy and eight had concentric left ventricular hypertrophy. The remaining 13 patients were categorized as “normal,” although six had septal measurements >I 1 mm. The group with asymmetric septal hypertrophy had significantly greater systolic internal dimensional shortening of the left ventricle than did the normal group (p < 0.05) and the group with left ventricular hypertrophy (p < 0.01). Initial mean growth hormone levels were considerably higher in those with left ventricular hypertrophy than in the normal group (93 versus 34 ng/ml). Thus. echocardiographic abnormalities are common in acromegaly, and patients with asymmetric septal hypertrophy and acromegaly appear to have significantly increased ventricular ejection. Many of the patients with left ventricular hypertrophy have no evidence of clinical cardiovasculardisease, and their left ventricularhypertrophymay be related to higher initial growth hormone levels.
echocar-
Echocardiography
Smallridge RC, Rajfer S, Davia J, Schaaf M: Acromegaly and the heart-an diographic study. Am J Med 66: 22-27, 1979.
Left ventricular
Acromegaly
Continuedon page A45
Echocardiographic abnormalities were noted in 37 (69 per cent) of 54 patients with progressive systemic sclerosis (PSS). Thirty-one of the 54 patients also underwent right heart catheterization. Pericardial effusion was noted in 22 subjects (41 per cent), although it was suspected on clinical grounds in only seven. Although the presence of a small pericardial effusion did not adversely affect prognosis, the presence of a large effusion (>200 ml) was associated with a poor prognosis. Findings of right ventricular dilatation, asymmetrical left ventricular hypertrophy, left atrial dilatation, paradoxic motion of the interventricular septum or pulmonary hypertension on echocardiogram were seen predominantly or exclusively in patients who had pulmonary artery hyperlension at catheterization. This study confirms clinlcally the frequent involvement of myocardium and pericardium that has been reported in autopsy series and discusses the uses as well as the limitations of echocardiography in the assessment of patients with PSS.
Smith JW, Clements PJ, Levisman J, Furst D, Ross M: Echocardiographic features of progressive systemic sclerosis (PSS). Correlation with hemodynamic and Postmortem studies. Am J Med 66: 28-33, 1979.
Right heart catheterization
Echocardiography
The left ventricular response to bicycle exercise was evaluated in 60 patients with coronary artery disease (CAD) and in 13 normal control subjects. Left ventricular ejection fraction and ejection rate increased in all normal subjects. In contrast, global or regional evidence of compromised left ventricular reserve was found in 48 of 60 patlents with CAD. All 30 patients with electrocardiographic ischemia demonstrated a decrease or no change in ejection fraction with exercise, whereas the response in patients limited by fatigue was variable. These data indicate that exercise ventricular performance studies allow physiologic assessment of left ventricular functional reserve and noninvasive detection of CAD.
Berger HJ, Reduto LA, Johnstone DE, Borkowskl Ii, Sands JM. Cohen LS, Langou RA, Got&chalk A, Zaret EL, with the technical assistance of Pytlik L: Global and regional left ventricular response to bicycle exercise in coronary artery disease. Assessment by quantitative radionuclide angiocardiography. Am J Med 66: 13-2 1, 1979.
Propranolol
Radionuclide
Left ventricular function