Identification of subclinical cardiac abnormality 5–15 Yrs. After therapeutic mediastinal irradiation

Identification of subclinical cardiac abnormality 5–15 Yrs. After therapeutic mediastinal irradiation

ABSTRACTS WEDNESDAY, MARCH 12, 1980 PM MYOPERICARDIAL DISEASE 2:00-3:30 IMPORTANCE OF LEFT VENTRICULAR FILLING IN DIFFERENTIATING CONSTRICTfVE PERICA...

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ABSTRACTS

WEDNESDAY, MARCH 12, 1980 PM MYOPERICARDIAL DISEASE 2:00-3:30 IMPORTANCE OF LEFT VENTRICULAR FILLING IN DIFFERENTIATING CONSTRICTfVE PERICARDITIS VS. RESTRICTIVE CARDIOMYOPATHY. Rene A. Langou, MD, FACC; Theodore I. Tyberg, MD; Yale University School of Allan-V.N.,Goodyer, MD, FACC. Medicine, New Haven, CT. Left ventricular filling (VF) "as evaluated by left ventriculograms (LVgram) in patients (pts) with 1) constrictive pericarditis (CP), 2) restrictive cardiomyopathy CRC), and 3) normals (NM). CP (7 pts) was established by characteristic right and left heart hemodynamFour pts had calcific CP its and surgical pathology. RC (4 pts) was estaband 3 had non-calcific pathology.

lished by right and left heart hemdynamics and postAll 4 pts had amyloid heart. NM mortem pathology. (7 ptg) had normal hemodynamics, LVgram, and coronary arteriography. LVgram silhouettes were digitized and left ventricular volumes (LVV) were calculated by computer at 16 msec. intervals. Curves of LW and VF rate were constructed Points along these for each pt and also for each group. curves were statistically analyzed using unpaired CP pts had a sudden and premature Stud&t "t" test. plateau of the diastolic LVV curve representing 8524% of VF. Furthermore, VF rate was faster than NM during RC pts had no plateau of the the first 50% of diastole. diastolic LW curves and their VF rate was slower than NM during the first 50% of diastole. Statistical analysis of VF rate in CP, RC and NM pts showed significant differences during the first half of diastole; CP had 85&4%, RC had 55?4% and NM had 66+5% of their VF completed at 50% of diastole (~~0.05). Thus, this study showed a significantly different profile of diastolic LVV and VF rate curves during the first half of diastole in CP and RC pts, suggesting their importance in differentiating CP and RC at cardiac catheterization.

AMYmID HU@ZI DISUSE: A SIMULATOROF CORONARY,(MYOCARDIAL Ii~ARCTION,SLJDDEN DEATH),PERICAPJlIAL,(CONSTRI~ION AND/ OR EFFUSION), VALVULAX (FLOPPYATRIOVFNIR1CUU.R VALVES) AND MYOCARDIAL(HYPERTROPHIC CARDIOMYOPATHY) HEART DISEASES- AN ANALYSISOF 42 NECROPSYPATIENK WITH GROSSLY-VISIBLE CARDIACAMYLQID Bruce F. Waller,MD, Renu Virmani,MD, WilliamC. Roberts, MD, FACC, NationalHeart, Lung, and Blood Institute, Bethesda,Maryland Cardiac involvement by amyloid (A) is well-bown but cardiac A simulating other heart diseases is not. We studied at necropsy 42 patients (pts) (aged21-89yrs [avg=60],29

men) with cardiacA which producedin each symptomsof cardiacdysfunction(CD):congestiveheart failurein 38 (90%),chest pain in 10 (24%)and suddendeath in 3 (7%). Some type of ECG abnormalitywas present in all 42 pts includinglow voltage,myocardialinfarcts(MI)patterns, conductionand rhythmdisturbances, and axis deviation. Althoughall had increasedheart weighs (370-780gm [avg= 5701,none by ECG had evidenceof ventricularhypertrophy. AlthoughCD was diagnosedclinicallyin all 42 pts, cardiac A was diagnosedin only 19 (45%). The cardiacconditions diagnosedin the other 23 pts (55%)were: coronary hear! disease,in 14 (33%),only 1 of whom had > 75% xsectlonalarea coronarynarrowing;pericardpl !P) heart disease in 5 (12%),3 of whom had large P e fusions;and hypertrophiccardiomyopathy (HC) (by echocardiogram) in 4 (lO%),all of whom had thickerventricularsepta from A than left ventricular(LV) free walls (ASH). Ten pts (24%)had LV transmuralmyocardialA depositswhich looked like transmuralhealedMI. Six (14%)pts had floppy atrio-ventricular valves,each of which had A depositsin the leaflets. Thus, pts with grossly-visible cardiacA had CD which simulatescoronary,pericardial, valvular, and/ormyocardialheart disease.

DIABETIC NEUROPATHY OF THE HEART AND ARTERIES John A. Mantle, MD, FACC; Eugene M. Strand, BA; Thomas N. James, KD, FACC; William J. Rogers, MD, FACC; Richard 0. Russell, Jr., MD, FACC; and Charles E. Rackley, MD, FACC; University of Alabama Medical Center, Birmingham, Alabama.

IDENTIFICATION OF SUBCLINICAL CARDIAC ABNORMALITY 5-15 YRS. AFTER THERAPEUTIC MEDIASTINAL IRRADIATION John S. Gottdiener, MD; Michael J. Katin, MD; Jeffrey S. Borer, MD, FACC; Stephen L. Bacharach, PhD; Michael V. Green, MS; Lewis C. Lipson, MD; NHLBI, Bethesda Md.

Autonomic neural regulation of the sinus node (SN) and systemic arteries was investigated in 16 diabetic (D) ischemic heart disease (IHD) patients (pts) and compared to 30 IHD pts without D and 5 normals. Neural regulation of the SN was examined by the beat by beat changes to respiration (sinus arrhythmia), valsalva (40 mmHg) and intravenous atropine (0.8-2 mg). Regulation of the arterial bed was studied by monitoring the abdominal aortic pressure during the valsalva. The duration of D ranged from 0 to 21 yrs. Nine D pts were insulin dependent, 2 were juvenile onset. Complications included retinopathy (5 pts), peripheral neuropathy (5 pts) and renal insufficiency (1 pt). Normal sinus arrhythmia was absent in 14 of 16 (88%) D pts. Twelve of the 16 (75%) D pts had an abnormally blunted reflex slowing with increase in arterial pressure. Fifteen of 16 D pts, however, had an increase in heart rate with atropine indicating some vagal influencq was still present. Six D pts had a normal arterial pressure response to the valsalva. Seven D pts had an abnormal progressive fall in diastolic pressure during strain and no overshoot after release. The arterial response could not be assessed in the other 3 D pts because of heart failure. There was a direct correlation between loss of cardiovascular neural regulation and the severity of the D. Summary: In adult diabetic pts with IHD: 1) cardiovascular neuropathy is prevalent, 2) both vagal and sympathetic defects occur as early complications, 3) important adaptive cardiovascular reflex control of heart rate and blood pressure may be absent.

Therapeutic irradiation of the mediastinum has been associated with pericardial, myocardial, and coronary arterial injury shortly after therapy. In order to assess the late effects of anterior irradiation, 28 pts. without prior cardiac disease or exposure to cardiotoxic chemotherapy, were prospectively recalled for evaluation 5-15 yrs. after radiation therapy for Hodgkins disease. Median age at evaluation was 34 yrs; range 25-29 yrs. ECG gated TcggM radionuclide left ventricular cineangiography (15 pts) at rest and with exercise, and M-mode echocardiography (28pts) were performed. Although radionuclide ejection fraction (EF) at rest was depressed in only 2/15 (13%) radiation pts, the average for this group (0.52+ 0.03 SEM) was below normal (0.57&0.01, ~~0.05). With exercise, EF was below normal in 5/15 (33%) pts. Average EF with exercise (0.58+0.04) was below normal (0.71+0.02, ~~0.05). Regional wall motion abnormality, at rest or with exercise, was present in only one pt, a 33 yr old woman with abnormal coronary arteriograms who did not have "risk factors" for atherosclerosis. Pericardial effusion on echocardiogram was present in 8/28 (29%) pts. Asymptomatic restrictive cardiomyopathy was documented at cardiac catheterization in 2 pts. Hence, asymptomatic pericardial effusion, restrictive cardiomyopathy, and systolic left ventricular dysfunction, are evident many years after therapeutic mediastinal irradiation. Left ventricular functional reserve may be decreased despite normal EF at rest. Life-long cardiologic follow-up is indicated for all pts following therapeutic mediastinal irradiation.

February

1980

The American

Journal

of CARDIOLOGY

Volume

45

475