Clara V. Massey

Influence of left ventricular mass on left ventricular diastolic filling in normotensive morbid obesity

To identify factors influencing left ventricular (LV) diastolic filling in patients with morbid obesity, we performed transthoracic and Doppler echocardiography on 50 subjects whose actual body weight was > or = twice their ideal body weight and on 50 normal lean control subjects. The transmitral Doppler E/A ratio and E wave deceleration half-time were used to assess LV diastolic filling. Significant negative correlations were seen between the E/A ratio and the LV internal dimension in diastole (r = 0.819, p = 0.0001), systolic blood pressure (r = 0.751, p = 0.0001), LV end-systolic wall stress (r = 0.782, p = 0.0001), and LV mass/height index (r = 0.901, p = 0.0001). Significant positive correlations were seen between the E wave deceleration half-time and the LV internal dimension in diastole (r = 0.743, p = 0.0001), systolic blood pressure (r = 0.789, p = 0.0001), LV end-systolic wall stress (r = 0.828, p = 0.0001), and LV mass/height index (r = 0.831, p = 0.0001). No correlation was seen between diastolic blood pressure and either index of LV diastolic filling. Thus increasing LV mass is associated with progressive impairment of LV diastolic filling in morbidly obese individuals. The aforementioned alterations in LV loading conditions may contribute to impairment of LV diastolic filling directly or by increasing LV mass.

The electrocardiogram in morbid obesity

Electrocardiographic variables that occurred with significantly higher frequency in morbidly obese patients than in lean controls were low QRS voltage, leftward shift of the P, QRS, and T axes and multiple electrocardiographic criteria for left ventricular hypertrophy and left atrial enlargement. P-terminal force, RaVL, SaVR, and R/S ratio in lead V1 values were significantly higher in morbidly obese than in lean subjects.

Prevalence of intraatrial thrombus in patients with atrial flutter.

In summary, left atrial thrombus occurs with disproportionately high frequency in patients hospitalized with atrial flutter. Male gender and a left ventricular ejection fraction < 40% are predictors of left atrial thrombus formation in such patients.

Myocardial Ischemia Secondary to a Large Coronary-Pulmonary Fistula A Case Report

Coronary-pulmonary fistulas are rare. The majority of these fistulas arise from the left anterior descending or the right coronary arteries; the circumflex coronary artery is rarely involved. The majority of patients are asymptomatic, but heart failure, angina, myocardial infarction, endo carditis, and dyspnea have rarely been reported. The management is controversial and recom mendations are based on anecdotal cases or very small retrospective series. A case of a 62- year-old female is reported who presented with chest pain and was found to have myocardial ischemia on SPECT sestamibi. Cardiac catheterization revealed no obstructive coronary artery disease and a large coronary pulmonary fistula communicating from the left circumflex coronary artery to the left pulmonary artery.

The normal and abnormal owl monkey (Aotus sp.) heart: Looking at cardiomyopathy changes with echocardiography and electrocardiography

Background  Cardiovascular disease, especially cardiomyopathy, was the major cause of death among owl monkeys (Aotus sp.) at a major colony and threatened colony sustainability. For this study, echocardiography (echo) and electrocardiography (ECG) normal values were established, and cardiomyopathy animals identified.

Is Primary Hyperaldosteronism a Risk Factor for Aortic Dissection

Primary hyperaldosteronism is a rare (<1%) and underdiagnosed cause of secondary hypertension. We present a case of aortic dissection in a patient with primary hyperaldosteronism. To our knowledge, there are six other reported cases of aortic dissection in patients with primary hyperaldosteronism. Our case strengthens the hypothesis that primary hyperaldosteronism is a potential independent risk factor for aortic dissection.

Left Ventricular Mass and Systolic Function in Human Immunodeficiency Virus-Infected Patients After Weight Loss

Transthoracic echocardiography was performed on 27 patients with human immunodificiency virus after weight loss and in 20 lean controls. Left ventricular mass index was significantly higher and left ventricular fractional shortening was significantly lower in patients with human immunodificiency virus after weight loss than in lean, normal controls.

Estrogen replacement therapy is underutilized among postmenopausal women at high risk for coronary heart disease.

Observational studies have found that estrogen replacement therapy (ERT) reduces the risk of coronary heart disease (CHD) in postmenopausal women. To determine the frequency of current use of ERT in an economically and racially diverse group of women at high risk for CHD, we examined the medical records of 393 women older than 40 who were admitted to the University of South Alabama Medical Center with symptoms suggestive of angina. Women in the study group were classified as African American or European American and data were examined for significant differences. Use of ERT was lower in African American women (11 of 111, 9.9%) than in European American women (26 of 152, 17.1%, odds ratio 1.9). Compared with the reported utilization of ERT in middle-class European American women, ERT is underutilized in this economically diverse group of women at high risk for coronary heart disease. In our population, European American women were twice as likely to be receiving ERT as African American women.

Incidence of Vitamin D Insufficiency in Coastal South-Eastern US Patient Population With Cardiovascular Disease.

Background Vitamin D insufficiency is increasingly gaining prominence as an associated cardiovascular disease (CVD) risk factor, often thought to be an issue in colder climates and higher altitudes. The intent of this study was to ascertain vitamin D levels in the southern Alabama gulf-coast region that has a high number of sunny days along with an annual average elevated UV ray index. Methods An observational retrospective study of 204 patients with established CVD treated at the University of South Alabama’s Heart Center from January 2007 through January 2013 was undertaken. One-way ANOVA analyses were performed to determine any significant difference in the mean 25-hydroxyvitamin D (25(OH)D) serum based on gender and also based on race/ethnicity. Further, odds ratio (OR) was computed to ascertain if there was a relationship between vitamin D insufficiency and elevated body mass index (BMI). Results Out of 204 patients, 53.4% (n = 109) were found to have vitamin D insufficiency (25(OH)D = 20.1 ng/mL), while 46.6% (n = 95) were within the normal range (25(OH)D = 37.8 ng/mL). The mean 25(OH)D of the entire group was 28.3, indicating a general trend of vitamin D insufficiency for patients treated at the cardiology clinics. Conclusion This study established the prevalence of vitamin D insufficiency in the hot and high UV ray index climate of the coastal south-eastern United States. Also, it revealed the relationship of increased BMI with low 25(OH)D serum level. More extensive studies should be conducted in similar climates to further assess vitamin D insufficiency.

982-117 Race Affects Time to Presentation, but not Diagnostic Evaluation of Women with Suspected Coronary Artery Disease

To determine whether racial differences exist in the time to presentation and diagnostic evaluation of women with suspected coronary artery disease. we studied 201 women older than 40 years who were admitted to the University of South Alabama Medical Center with chest pain suggestive of angina pectoris. The medical records of each subject were reviewed for clinical data, socioeconomic background and diagnostic cardiac procedures. Sixty percent of those studied were no pay or Medicaid patients. There was equal representation from urban and rural environments. The duration of symptoms prior to presentation was significantly longer in African American women (1169 hr) than in Euro-American women (759 hr, p l 0.01). Following admission, the percentage of women undergoing cardiac diagnostic evaluation of chest pain was not significantly different between the two groups: Ethnic Group N Echo- Stress Cardiac cardiogram Test Catheterization African American 135 98/135 (73%) 39/135 (29%) 76/135 (56%) Euro-American 66 50/66 (76%) 19/66 (29%) 38/ 66(58%) P N.S. N.S. N.S. The results suggest that African American women seek medical attention for chest pain significantly later than Euro-American women. Once hospitalized, diagnostic evaluation between the two groups is similar.