Hercules Panayiotou

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.

Atrial wall tension changes and the release of atrial natriuretic factor on relief of cardiac tamponade

Cardiac tamponade causes elevation and equalization of cardiac filling pressures, sodium and water retention, and a paradoxically low plasma atrial natriuretic factor (ANF) concentration despite increased intraatrial pressures. Recent reports suggested that plasma ANF concentrations rise after relief of tamponade. The purposes of the present study were (1) to determine the time course and extent of ANF release on relief of cardiac tamponade; (2) to measure the atrial transmural wall pressures, atrial sizes, and atrial wall tension changes associated with relief of tamponade; and (3) to determine the biologic activity of elevated plasma ANF during and after relief of tamponade. We sampled blood for ANF and cyclic guanosine monophosphate (cGMP) immediately before and up to 24 hours after relief of cardiac tamponade in 10 patients. Atrial and pericardial pressures were measured immediately before and shortly after pericardiocentesis, and atrial dimensions were determined by two-dimensional echocardiography before and within 1 hour after the tap. Urine volumes were measured in 8-hour increments before and after the procedure. Relief of cardiac tamponade was associated with a prompt and massive increase in plasma ANF concentrations, reaching pharmacologically active levels. The rise in ANF was negatively correlated with atrial pressures but positively correlated with atrial transmural pressures, atrial size, and calculated wall tension. Plasma ANF levels peaked at 515 +/- 95 pg/ml 40 minutes after relief of tamponade and leveled off at 140% to 180% of the pretap concentrations. Plasma cGMP exhibited a slightly delayed but similar time course to the rise in ANF levels, and urine flow rate increased fourfold in the 8 hours after relief of tamponade.(ABSTRACT TRUNCATED AT 250 WORDS)

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.

Factors predicting coronary artery disease in patients with giant negative T waves.

Seventy-four patients with giant negative T waves were studied to determine which electrocardiographic variables predicted the presence of coronary artery disease. The absence of left ventricular hypertrophy and the presence of symmetric T-wave inversion predicted coronary artery disease.

Self-expanding intracoronary stent for symptomatic myocardial bridging

Myocardial bridging has been recognized as a potential cause of symptoms of angina, arrhythmias and even infarction. Various treatment strategies including beta‐blockers, surgery and more recently intra‐coronary stents have been used to manage bridging. We report a novel case of use of self‐expanding stent for myocardial bridging in a patient with symptoms of angina and ischemia on nuclear imaging. We further present the 18‐month follow up showing minima in‐stent stenosis. To our knowledge, this is the first report of using a self‐expanding stent in myocardial bridging. The use of self‐expanding stents could be a potential treatment for symptomatic myocardial bridging.