Bengt R. Widgren

Enhanced left ventricular endocardial border delineation with an intravenous injection of SonoVue, a new echocardiographic contrast agent : A European multicenter study.

The safety and efficacy of SonoVue (also referred to as BR1), a new contrast agent for delineating endocardial border of the left ventricle after intravenous administration, was assessed. Two hundred and eighteen patients with suspected coronary artery disease undergoing fundamental echocardiography for the assessment of left ventricle were enrolled in a prospective multicenter, single blind, cross‐over study with random sequence allocation of four different doses of SonoVue. Endocardial border definition in the apical and parasternal views was scored as O = not visible, 1 = barely visible, and 2 = well visualized before and after contrast enhancement. Analysis was performed by two pairs of off‐site observers. Safety of SonoVue was also assessed. Results of our study indicated that the mean improvements in the endocardial border visualization score were as follows: 3.1 ± 7.8 (95% CI, 2.5 and 3.7) for 0.5 ml, 3.4 ± 8.0 (95% CI, 2.8 and 4.0) for 1 ml, 3.4 ± 7.9 (95% CI, 2.8 and 4.0) for 2 ml, and 3.7 ± 8.0 (95% CI, 3.1 and 4.3) for 4 ml (P < 0.05 for all doses from baseline). Changes from baseline in endocardial visualization scores were also seen in the apical views (P < 0.05) and they were dose‐dependent (P < 0.001). Similar enhancements of endocardial visualization scores were observed in the apical views in patients with suboptimal baseline echocardiographic images. Diagnostic confidence for assigning a score and image quality also were significantly better following contrast enhancement. No significant changes in the laboratory parameters and vital signs were noted following contrast enhancement, and the side effects were minimal. It was concluded that SonoVue is safe and effective in delineating endocardial border, including in patients with suboptimal baseline images.

Reduced venous compliance in normotensive men with positive family histories of hypertension

OBJECTIVE To test the hypothesis of reduced venous compliance and increased cardiovascular responses to volume expansion and alpha-agonist stimulation. METHOD Non-hypertensive healthy young men with positive (PFH) and negative family histories of hypertension were investigated regarding peripheral haemodynamics and changes in central venous pressure (CVP) and arterial blood pressure in response to graded doses of phenylephrine and acute i.v. fluid volume loading (1000 saline solution in 10 min). The control group was divided into one group matched for body mass index to PFH subjects (NFHO) and one lean control group (NFHN). RESULTS Supine blood pressure was higher in PFH and NFHO subjects compared with NFHN subjects, whilst CVP was similar in the three groups at baseline. No significant differences in calf or forearm haemodynamics or blood volume were observed between the three groups. Cardiovascular responses to bolus doses of phenylephrine did not differ between the three groups. Saline infusion significantly increased CVP and systolic blood pressure, and effective vascular compliance (change in blood volume: CVP ratio) was reduced in PFH subjects. CONCLUSION PFH subjects have decreased effective vascular compliance and altered arterial blood pressure responses to acute increases in vascular fluid volume. This may result from multiple factors such as increased venous vascular tone, structural reduction of venous distensibility and/or an altered neurohormonal response to increased CVP.

Resting and volume-stimulated circulating atrial natriuretic peptide in young normotensive men with positive family histories of hypertension

Normotensive young men (36 +/- 5 years old) with positive family histories of hypertension (n = 11) and age-matched controls (n = 21) with negative family histories of hypertension were examined. The control group was divided into one group matched for body mass index with those subjects with positive family histories (n = 10) and one group with normal body mass index (n = 11). Blood pressure, central venous pressure (CVP), plasma atrial natriuretic peptide (ANP) and serum aldosterone were examined at a baseline and during an acute volume load with 1000 ml saline solution. Subjects with positive family histories and controls matched for body mass index had a higher blood pressure at baseline than controls with normal body mass index. CVP and serum aldosterone did not differ between the three groups, while sodium intake and plasma concentrations of ANP were significantly higher in subjects with positive family histories. During volume loading, CVP increased significantly more in subjects with positive family histories as compared with the two control groups. A blunted response to ANP was observed during volume loading in subjects with positive family histories, while subjects in the two control groups demonstrated comparable and significant increases in circulating ANP. Serum aldosterone, however, decreased during volume loading in all three groups, with no difference between the groups. We conclude that normotensive subjects with positive family histories are characterized by increased basal concentrations of ANP and exhibit a blunted response to an acute volume load.(ABSTRACT TRUNCATED AT 250 WORDS)

Insulin sensitivity is more related to fat distribution than to heredity for hypertension in normotensive men

The insulin-mediated glucose disposal rate was assessed during a euglycemic hyperinsulinemic clamp in 16 normotensive men (mean age, 41 +/- 5 years) with positive family histories of hypertension and mild overweight (PFHO) and in 25 men with negative family histories of hypertension (NFH). The control group was divided into one group with normal body weight ([NFHN] n = 11) and a second group with a similar degree of overweight ([NFHO] n = 14) as in the group with PFHO. Systolic and diastolic blood pressures were significantly greater in subjects with PFHO as compared with the NFHN group. Blood glucose and plasma insulin at baseline and during the insulin clamp did not differ between the three groups. Insulin sensitivity, expressed as the glucose disposal rate per total body weight, was significantly (P < .01) decreased in PFHO subjects (7.7 +/- 3.0 mg/kg/min) and in NFHO subjects (7.1 +/- 3.5 mg/kg/min) as compared with NFHN subjects (11.1 +/- 4.0 mg/kg/min). In multivariate analysis using body mass index, waist to hip ratio, and blood pressure as predictor variables, the waist to hip ratio was significantly related to both baseline plasma insulin (r = .70, P < .0001) and insulin sensitivity (r = -.71, P < .0001). In the present study, insulin sensitivity was related to body weight and fat distribution, whereas no difference was found regarding insulin sensitivity in subjects with or without positive family histories of hypertension.

Ambulatory blood pressure: a predictor of left ventricular mass and future blood pressure in subjects predisposed for hypertension.

Twenty-four-hour ambulatory blood pressure (SpaceLab 5200) and a single laboratory blood pressure were measured in a population-derived sample of normotensive men (mean age 36 years) with (n = 13) or without (n = 16) a positive family history of hypertension. The aim was to determine whether ambulatory monitoring was a better predictor than clinical measurements for echocardiographic derived indices of left ventricular mass and for future blood pressure. At the initial examination ambulatory blood pressure could discriminate between the groups, showing significant differences that were not evident from the clinical blood pressure measurement. After 5 years the blood pressure had increased in the group with a family predisposition for hypertension but only one subject had overt hypertension. The correlation between the average day-time blood pressure and the clinical blood pressure at follow-up was only marginally better than the correlation for the initial clinical blood pressure. In contrast to the clinical blood pressure, both day-time and night-time blood pressure averages were significantly correlated to left ventricular mass at the initial examination. It is concluded that in still normotensive subjects, ambulatory monitoring is a better predictor than clinical measurements for left ventricular mass but not for future blood pressure.

Central hemodynamics and brachial artery compliance during therapy with isradipine, a new calcium antagonist

Seventeen middle-aged males with sustained essential hypertension (WHO stage II) and diastolic blood pressures (BP) exceeding 100 mm Hg during a placebo run-in period completed a trial to assess the hemodynamic effects of isradipine, a new dihydropyridine calcium antagonist. The study was double-blind and placebo-controlled with a crossover design. Brachial artery compliance was assessed as the ratio of stroke volumes and simultaneous pulse pressure. During therapy with isradipine (all patients received 7.5 mg b.i.d.), highly significant reductions in supine systolic BP [from 184 ± 16 to 162 ± 20 mm Hg (mean ± S.D.)] and diastolic BP (from 96 ± 8 to 83 ± 8 mm Hg) were observed. Heart rate was unchanged (69 ± 3 vs. 73 ± 2 beats/min) during chronic therapy. Total peripheral resistance was significantly reduced (from 24.8 ± 9 to 17.4 ± 5 units) while cardiac output was unchanged (6.0 ± 1.9 vs. 7.2 ± 1.8 L/min). Stroke volume was unchanged (92 ± 25 vs. 100 ± 25 ml/beat), and a significant (p < 0.05) increase in brachial artery compliance (from 1.05 ± 0.25 to 1.26 ± 0.35 ml/mm Hg) was observed.