Ivan Řiháček

Variability of changes in Doppler transmitral filling pattern during stress echocardiography in patients with stable angina pectoris

Stress electrocardiography and echocardiography using atrial pacing together with the right-sided heart catheterization were performed in 21 patients with stable angina pectoris. Peak velocity of transmitral flow in early diastole (E) and in atrial contraction (A), deceleration time of early filling, and pulmonary artery wedge pressure were measured simultaneously at rest and immediately after each pacing frequency. Patients were divided according to their stress pulmonary artery wedge pressure changes into Group A (14 patients with an increase in pulmonary artery wedge pressure > or = 3 mmHg during stress) and into Group B (6 patients with a change in pulmonary artery wedge pressure < or = 2 mmHg during stress). One patient, T.L., with an increase in pulmonary artery wedge pressure > or = 5 mmHg after each pacing frequency was evaluated separately. In Group A patients, the non-linear course of the E/A ratio changes (from 0.78 +/- 0.06 to 0.66 +/- 0.05, P < 0.01; to 0.72 +/- 0.05, P = NS; and to 0.93 +/- 0.06, P < 0.01) and deceleration time changes (from 188.9 +/- 7.2 ms to 195.3 +/- 8.9 ms, P = NS; to 188.8 +/- 9.9 ms, P = NS; and to 154.2 +/- 6.7 ms, P < 0.01) was seen.(ABSTRACT TRUNCATED AT 250 WORDS)

A multicentre study on unattended automated office blood pressure measurement in treated hypertensive patients

Abstract Aims: Unattended automated office blood pressure (uAutoOBP) may eliminate white-coat effect. In the present study, we studied its relationships to attended office blood pressure (BP) and ambulatory BP monitoring (ABPM). Material and methods: Stable treated hypertensive subjects were examined in four Czech academic hypertension centres. uAutoOBP was measured with the BP Tru device; attended BP was measured six times: three times with auscultatory method (AuscOBP) by the physician followed optionally by three oscillometric measurements (OscOBP). ABPM was performed within one week from the clinical visit. Results: Data on 172 subjects aged 63.7 ± 12.4 years with AuscOBP 127.6 ± 12.1/77.6 ± 10.0 mm Hg are reported. uAutoOBP was by 8.5 ± 9.0/3.0 ± 6.1 mm Hg lower than AuscOBP. The AuscOBP-uAutoOBP difference increased with the AuscOBP level and it did not depend on any other factor. OscOBP differed by 8.6 ± 8.6/1.9 ± 5.7 mm Hg from uAutoOBP. 24-hour mean BP was by 4.2 ± 12.1/3.5 ± 7.8 mm Hg lower than AuscOBP and by 4.3 ± 11.0/0.5 ± 6.9 mm Hg higher than uAutoOBP; the correlation coefficients of 24-hour mean BP with AuscOBP and with uAutoOBP did not differ (p for difference ≥.13). In the lowest BP group (systolic AuscOBP <120 mm Hg or diastolic AuscOBP <70 mm Hg), both AuscOBP and uAutoOBP were lower than 24-hour mean BP, while in the highest BP group (systolic AuscOBP ≥140 mm Hg or diastolic AuscOBP ≥90 mm Hg), they were higher. Conclusions: Compared to uAutoOBP, attended BP measurement gives higher values, both when measured with auscultatory or oscillometric method. Inter-individual variability of AutoOBP – uAuscOBP difference, as well of uAutoOBP – ABPM difference, is large. We did not prove that uAutoOBP would be associated to 24-hour ambulatory BP more closely than attended BP.

Evaluation of autonomic nervous system dysfunction by phase shift and XYt graph methods

BACKGROUND: We postulated that the phase shift between blood pressure and heart rate fluctuation near the frequency of 0.10 Hz might be useful in assessing autonomic circulatory control. CONCLUSIONS: The frequency of 0.10 Hz represents a useful and potentially important one for controlled breathing, at which differences in blood pressure-RR interactions become evident. These interactions, whether computed as a variability of phase to define stability of the blood pressure-heart rate interaction or defined as the baroreflex sensitivity to define the gain in heart rate response to blood pressure changes, are significantly different in patients at risk for sudden arrhythmic death.

THE NORMALIZED SMOOTHNESS INDEX AND POPULATION RDH INDEX OFLOSARTANE AND TELMISARTANE IN PATIENTS WITH NEWLY DIAGNOSEDHYPERTENSION AND METABOLIC SYNDROME.

Objective: To determine the normalized smoothness index and the population RDH index of two once daily dosed sartans (losartane, telmisartane) in patients with newly diagnosed hypertension and metabolic syndrome. Design and Methods: BP measurement using mercury sphygmomanometer and 24-hour ambulatory blood pressure monitoring (SpaceLabs 90207) according to the ESH criteria. Metabolic syndrome and hypertension was defined by ATP III criteria. We evaluated 57 patients in two groups before and after 1 year of treatment with losartane or telmisartane once daily. The programmer Excel for Windows was used for the statistic evaluation. Results: Systolic blood pressure (SBP) normalized smoothness index (nSI) of losartane ± standard error of mean (SEM) was 1.10 ± 0.13, diastolic blood pressure (DBP) nSI of losartane ± SEM was 0.81 ± 0.11. SBP nSI of telmisartane ± SEM was 0.96 ± 0.12, DBP nSI of telmisartane ± SEM was 0.80 ± 0.12. SBP population RDH (RDHp) index of losartane was (24.24.0) and DBP RDHp index of losartane was (24.24.0). SBP RDHp index of telmisartane was (22.17.2) and DBP RDHp index of telmisartane was (21.15.2). Conclusions: In our groups of patients once daily administration of losartane have reasonably better homogenous effect on blood pressure throughout 24-hour than telmisartane in patients with metabolic syndrome and newly diagnosed hypertension.

Depth of Breathing and Baroreflex Sensitivity

The aim of the study: Comparison between breathing on the 0.1 Hz and 0.33 Hz. At a breathing frequency of 0.10 Hz, differences in baroreflex sensitivity (P<0.01) became evident, even though these differences were not apparent at the 0.33-Hz breathing frequency. CONCLUSIONS: The frequency of 0.10 Hz represents a useful and potentially important one for controlled breathing, at which differences in blood pressure-RR interactions become evident. These measurements of short-term circulatory control might help in risk stratification for sudden cardiac death.