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Is the regression of left ventricular hypertrophy accompanied by the decrease of ventricular arrhythmias?
AJH–April 2001–VOL. 14, NO. 4, PART 2
POSTERS: Heart Failure/Hypertrophy
211A
EH were also examined plasma (PNE) and urinary norepinephrine (UNE), plasma renin activity (PRA), plasma aldosterone concentration (PAC) after ingested a diet of 7g salt (NaCl) per day for a week. By multiple regression analysis, TEI index was significantly related to PAC as an independent variable (R2⫽0.40, p⬍0.005) but not to nighttime mean BP, PRA, PNE, and UNE. Since TEI index was significantly related to nighttime mean BP, it was suggested that TEI index would be useful for an index of the severity of hypertensive target organ damage. Moreover, since TEI index was strongly related to PAC rather than BP, PAC might be correlated with both left ventricular systolic and diastolic function.
is possible to achieve regression LVH, but it has not been proved what impact regression LVH has on arrhythmia markers. Methods: 75 patients with II-III stage hypertension (43 male) average age 55.9 ⫾ 8 and LVH determinated by echocardiography have been treated for a year. Arrhythmia parameters were the following: ventricular arrhythmias have been registered after 24 hour Holter monitoring and graded according to Lown; QT dispersion and heart rate variability (HRV) have been determined by time analysis from Holter monitoring. Results: After a year treatment a significant LV mass reduction (A) has been achieved in 37 patients (51%). Variable
Before Th
After Th
Key Words: total ejection isovolume index, left ventricular hypertrophy, aldosterone
LVMI (A) (g/m2) LVMI (B) (g/m2) VES (Lown) (A) VES (Lown) (B) VT and couplets (A) VT and couplets (B) QTc dispersion (A) QTc dispersion (B) SDNN (A) SDNN (B)
172 ⫾ 35.6 152.6 ⫾ 21.3 2.88 ⫾ 1.37 2.21 ⫾ 1.7 15 (20.5%) 9 (12.3%) 61.7 ⫾ 22.4 48.5 ⫾ 21.7 123.3 ⫾ 26 116.5 ⫾ 22.2⫾
142.1 ⫾ 25* 158.7 ⫾ 25.8 2 ⫾ 1.4* 2.1 ⫾ 1.48 6 (8.2%)* 7 (9,6%) 48.3 ⫾ 17.7* 50.8 ⫾ 21.2 129.3 ⫾ 29.1 118.4 ⫾ 23.4
P-538 ASSOCIATION BETWEEN CIRCULATING OXIDIZED LOW DENSITY LIPOPROTEIN LEVELS AND LEFT VENTRICULAR HYPERTROPHY IN PATIENTS WITH ESSENTIAL HYPERTENSION Minoru Takaoka, Shigeru Yamano, Yuta Yamamoto, Rie Sasaki, Kazuhiro Dohi. 1First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan [Purpose] Oxidative stress plays an important role in the pathogenesis of vascular injury and in the progression of atherosclerosis. Elevated levels of oxidized low density lipoprotein (OxLDL) have been reported to be a risk factor for coronary artery disease. We investigated the potential association between circulating OxLDL levels and left ventricular hypertrophy in patient with essential hypertension. [Methods] Thirty hypertensive patients ( 14 men and 16 women, mean age, 63years) were enrolled in this study. Left ventricular hypertrophy was evaluated with M-mode echocardiographic measurements of the left ventricle, as left ventricular mass index (LVMI). Common carotid artery vascular mass (VM) was also calculated as ( L { (CAD/2⫹IMT)2(CAD/2)2} ). CAD : vessel diameter of the common carotid artery, IMT : intima-media thickness ). Circulating OxLDL levels were measured by an enzyme immunoassay with use of specific antibodies against OxLDL ( FOH1a / DLH3 ) and apolipoprotein B. [Results] Circulating OxLDL levels were significantly higher in hypertensive patients with left ventricular hypertrophy than in those without left ventricular hypertrophy ( LVH 28.0⫾9.7 U/ml, non-LVH 21.5⫾9.0 ; p⫽0.03 ). Multiple regression analysis showed that the risk factors for LMVI in patients with essential hypertension were circulating OxLDL levels and VM. (p⫽0.01) [Conclusions] These results indicate that circulating OxLDL levels may be an independent risk factor for left ventricular hypertrophy in patients with essential hypertension. Key Words: oxidized low density protein, left ventricular hypertrophy, carotid artery vascular mass
P-539 IS THE REGRESSION OF LEFT VENTRICULAR HYPERTROPHY ACCOMPANIED BY THE DECREASE OF VENTRICULAR ARRHYTHMIAS? Ivan S. Tasic, Branko K. Lovic, Stevan B. Ilic, Dragan Lj Djordjevic, Natasa L. Miladinovic-Tasic. 1Cardiology, Institute “Niska Banja”, Niska Banja, Serbia, Yugoslavia, 2Cardiology, Institute “Niska Banja”, Niska Banja, Serbia, Yugoslavia, 3Cardiology, Institute “Niska Banja”, Niska Banja, Serbia, Yugoslavia, 4Cardiology, Institute “Niska Banja”, Niska Banja, Serbia, Yugoslavia, 5 Cardiology, Institute “Niska Banja”, Niska Banja, Serbia, Yugoslavia
*p⬍0.05; A: patients with significant LV mass reduction; B: patients with non significant LV mass reduction Conclusion: In patients with significant LV mass reduction significant decrease of ventricular arrhythmias frequency and QT dispersion have been achieved while heart rate variability has improved but not significantly. Key Words: hypertrophy, hypertension, arrhythmias
P-540 UTILITY OF PERINDOPRIL IN HEART FAILURE IN DAILY CLINICAL PRACTICE. THE METRICA STUDY Vivencio Barrios, Federico Lombera, Yolanda Peralta, Luis M. Ruilope. 1METRICA Investigators, Spain Despite the overwhelming evidence of ACE inhibitors (ACEi) in heart failure (HF), the usage of these drugs in clinical practice very often differs from scientific evidence. In fact, patients very rarely achieved the ACEi dosage recommended from randomized clinical trials. In this concern, the different ACEi exhibit significant differences in the feasibility to attain their maximal effective doses. With the aim to evaluate the rate of patients who achieve the effective dose of perindopril in HF and to assess the clinical and radiological efficacy of this ACEi in daily practice, a prospective, multicentre open study called METRICA was designed. This study included patients with HF class I-III, ACEi naive for at least 15 days, no contraindications for ACEi and with informed consent. Patients were initially treated with perindopril 2 mg and at 15 days whether the clinical and analytical tolerability was adequate, the ACEi was titrated to the effective dose (4 mg). Clinical, radiological and analytical follow up was performed at 1, 3 and 6 months. 175 patients (age: 65.8⫾9; 66% males) with HF (5% class I, 63% class II and 32% class III) were included. In 43% HF was due to IHD. 87.5% of patients achieved the effective dose (4 mg); 75% at the first month. 41 of 107 (38%) in class II and 49 of 55 (89%) in class III improved their clinical status. At final visit 33% of patients were in class I, 64% in II, and only 3% in III and the radiological cardio-thoracic index reduced from 0.57 to 0.54 (p⬍0.05). Side effects were observed in 22%, being cough the most frequent (11%). Only 3 patients (1.7%) withdrew. No serious adverse event was observed. In conclusion, in daily clinical practice the great majority of patients with HF (class I-III) achieve the effective dose of perindopril, what could be very useful. The clinical and radiological efficacy and the good tolerability of this drug have been confirmed in this study. Grant/Research Support - Servier
The increase of arrhythmia of hypertensive left ventricular hypertrophy is correlated with the risk of sudden death. In antihypertensive treatment it
Key Words: Heart Failure, Perindopril, ACE inhibitors dosage
POSTERS: Heart Failure/Hypertrophy
211A
EH were also examined plasma (PNE) and urinary norepinephrine (UNE), plasma renin activity (PRA), plasma aldosterone concentration (PAC) after ingested a diet of 7g salt (NaCl) per day for a week. By multiple regression analysis, TEI index was significantly related to PAC as an independent variable (R2⫽0.40, p⬍0.005) but not to nighttime mean BP, PRA, PNE, and UNE. Since TEI index was significantly related to nighttime mean BP, it was suggested that TEI index would be useful for an index of the severity of hypertensive target organ damage. Moreover, since TEI index was strongly related to PAC rather than BP, PAC might be correlated with both left ventricular systolic and diastolic function.
is possible to achieve regression LVH, but it has not been proved what impact regression LVH has on arrhythmia markers. Methods: 75 patients with II-III stage hypertension (43 male) average age 55.9 ⫾ 8 and LVH determinated by echocardiography have been treated for a year. Arrhythmia parameters were the following: ventricular arrhythmias have been registered after 24 hour Holter monitoring and graded according to Lown; QT dispersion and heart rate variability (HRV) have been determined by time analysis from Holter monitoring. Results: After a year treatment a significant LV mass reduction (A) has been achieved in 37 patients (51%). Variable
Before Th
After Th
Key Words: total ejection isovolume index, left ventricular hypertrophy, aldosterone
LVMI (A) (g/m2) LVMI (B) (g/m2) VES (Lown) (A) VES (Lown) (B) VT and couplets (A) VT and couplets (B) QTc dispersion (A) QTc dispersion (B) SDNN (A) SDNN (B)
172 ⫾ 35.6 152.6 ⫾ 21.3 2.88 ⫾ 1.37 2.21 ⫾ 1.7 15 (20.5%) 9 (12.3%) 61.7 ⫾ 22.4 48.5 ⫾ 21.7 123.3 ⫾ 26 116.5 ⫾ 22.2⫾
142.1 ⫾ 25* 158.7 ⫾ 25.8 2 ⫾ 1.4* 2.1 ⫾ 1.48 6 (8.2%)* 7 (9,6%) 48.3 ⫾ 17.7* 50.8 ⫾ 21.2 129.3 ⫾ 29.1 118.4 ⫾ 23.4
P-538 ASSOCIATION BETWEEN CIRCULATING OXIDIZED LOW DENSITY LIPOPROTEIN LEVELS AND LEFT VENTRICULAR HYPERTROPHY IN PATIENTS WITH ESSENTIAL HYPERTENSION Minoru Takaoka, Shigeru Yamano, Yuta Yamamoto, Rie Sasaki, Kazuhiro Dohi. 1First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan [Purpose] Oxidative stress plays an important role in the pathogenesis of vascular injury and in the progression of atherosclerosis. Elevated levels of oxidized low density lipoprotein (OxLDL) have been reported to be a risk factor for coronary artery disease. We investigated the potential association between circulating OxLDL levels and left ventricular hypertrophy in patient with essential hypertension. [Methods] Thirty hypertensive patients ( 14 men and 16 women, mean age, 63years) were enrolled in this study. Left ventricular hypertrophy was evaluated with M-mode echocardiographic measurements of the left ventricle, as left ventricular mass index (LVMI). Common carotid artery vascular mass (VM) was also calculated as ( L { (CAD/2⫹IMT)2(CAD/2)2} ). CAD : vessel diameter of the common carotid artery, IMT : intima-media thickness ). Circulating OxLDL levels were measured by an enzyme immunoassay with use of specific antibodies against OxLDL ( FOH1a / DLH3 ) and apolipoprotein B. [Results] Circulating OxLDL levels were significantly higher in hypertensive patients with left ventricular hypertrophy than in those without left ventricular hypertrophy ( LVH 28.0⫾9.7 U/ml, non-LVH 21.5⫾9.0 ; p⫽0.03 ). Multiple regression analysis showed that the risk factors for LMVI in patients with essential hypertension were circulating OxLDL levels and VM. (p⫽0.01) [Conclusions] These results indicate that circulating OxLDL levels may be an independent risk factor for left ventricular hypertrophy in patients with essential hypertension. Key Words: oxidized low density protein, left ventricular hypertrophy, carotid artery vascular mass
P-539 IS THE REGRESSION OF LEFT VENTRICULAR HYPERTROPHY ACCOMPANIED BY THE DECREASE OF VENTRICULAR ARRHYTHMIAS? Ivan S. Tasic, Branko K. Lovic, Stevan B. Ilic, Dragan Lj Djordjevic, Natasa L. Miladinovic-Tasic. 1Cardiology, Institute “Niska Banja”, Niska Banja, Serbia, Yugoslavia, 2Cardiology, Institute “Niska Banja”, Niska Banja, Serbia, Yugoslavia, 3Cardiology, Institute “Niska Banja”, Niska Banja, Serbia, Yugoslavia, 4Cardiology, Institute “Niska Banja”, Niska Banja, Serbia, Yugoslavia, 5 Cardiology, Institute “Niska Banja”, Niska Banja, Serbia, Yugoslavia
*p⬍0.05; A: patients with significant LV mass reduction; B: patients with non significant LV mass reduction Conclusion: In patients with significant LV mass reduction significant decrease of ventricular arrhythmias frequency and QT dispersion have been achieved while heart rate variability has improved but not significantly. Key Words: hypertrophy, hypertension, arrhythmias
P-540 UTILITY OF PERINDOPRIL IN HEART FAILURE IN DAILY CLINICAL PRACTICE. THE METRICA STUDY Vivencio Barrios, Federico Lombera, Yolanda Peralta, Luis M. Ruilope. 1METRICA Investigators, Spain Despite the overwhelming evidence of ACE inhibitors (ACEi) in heart failure (HF), the usage of these drugs in clinical practice very often differs from scientific evidence. In fact, patients very rarely achieved the ACEi dosage recommended from randomized clinical trials. In this concern, the different ACEi exhibit significant differences in the feasibility to attain their maximal effective doses. With the aim to evaluate the rate of patients who achieve the effective dose of perindopril in HF and to assess the clinical and radiological efficacy of this ACEi in daily practice, a prospective, multicentre open study called METRICA was designed. This study included patients with HF class I-III, ACEi naive for at least 15 days, no contraindications for ACEi and with informed consent. Patients were initially treated with perindopril 2 mg and at 15 days whether the clinical and analytical tolerability was adequate, the ACEi was titrated to the effective dose (4 mg). Clinical, radiological and analytical follow up was performed at 1, 3 and 6 months. 175 patients (age: 65.8⫾9; 66% males) with HF (5% class I, 63% class II and 32% class III) were included. In 43% HF was due to IHD. 87.5% of patients achieved the effective dose (4 mg); 75% at the first month. 41 of 107 (38%) in class II and 49 of 55 (89%) in class III improved their clinical status. At final visit 33% of patients were in class I, 64% in II, and only 3% in III and the radiological cardio-thoracic index reduced from 0.57 to 0.54 (p⬍0.05). Side effects were observed in 22%, being cough the most frequent (11%). Only 3 patients (1.7%) withdrew. No serious adverse event was observed. In conclusion, in daily clinical practice the great majority of patients with HF (class I-III) achieve the effective dose of perindopril, what could be very useful. The clinical and radiological efficacy and the good tolerability of this drug have been confirmed in this study. Grant/Research Support - Servier
The increase of arrhythmia of hypertensive left ventricular hypertrophy is correlated with the risk of sudden death. In antihypertensive treatment it
Key Words: Heart Failure, Perindopril, ACE inhibitors dosage