Yasuhiko Oku

Impaired left ventricular filling in borderline hypertensive patients without cardiac structural changes

To determine the effect of borderline hypertension on left ventricular diastolic performance, 16 patients with borderline hypertension who did not have left ventricular hypertrophy and 16 age-sex-matched patients with normotension of similar age and body mass index were investigated. Pulsed Doppler echocardiography was used to record left ventricular filling signals at rest and immediately after supine ergometer exercise. All subjects had normal left ventricular structure and systolic function. At rest the borderline hypertension group in comparison with the normotension group had a depressed peak velocity of early filling (E) (44 +/- 7 vs 54 +/- 10 cm/sec; p < 0.01), no enhanced peak velocity of late filling (A) (52 +/- 8 vs 50 +/- 11 cm/sec; not significant), and a reduced E/A ratio (0.9 +/- 0.2 vs 1.1 +/- 0.3; p < 0.05). Atrial filling time and preejection period were similar in the two groups. The effect of exercise on left ventricular filling velocity in patients with borderline hypertensive resembled that in those with normotension. Percentage changes in E (+14% +/- 12% vs +14% +/- 13%) and A (+13% +/- 8% vs 11% +/- 12%) were equivalent, suggesting a preserved diastolic reserve for exercise in the borderline hypertension group. In conclusion, borderline hypertension appears to be predictive of early filling impairment, and a late filling compensative mechanism is not yet apparent. These findings in borderline hypertension without apparent cardiac damage call for clinical attention to prevent further deterioration in cardiac function.

Hypertrophic cardiomyopathy progressing to a dilated cardiomyopathy-like feature in Noonan's syndrome

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Coronary artery-cardiac chamber shunt: cineangiographic analysis

Coronary artery-cardiac chamber shunts (CA-CC shunts) were observed in 101 out of 2267 consecutive patients (4.5%) receiving selective coronary angiography. In these patients, contrast medium injected into the coronary artery escaped directly into the cardiac chamber. CA-CC shunts were angiographically classified into the following two types. Type I: The endocardial layer was diffusely opacified, and contrast medium escaped into the cardiac chamber on systole (n=83). Type II: Contrast medium escaped directly into the cardiac chamber via an undilated branch (n=11). Type I and type II shunts were observed simultaneously in 7 patients. It is speculated that type I is a shunt via a persistent arterio-sinusoidal vessel, while type II is a shunt via a persistent arterio-luminal vessel. Both types were observed frequently (24.9%) in hypertrophic cardiomyopathy. The degree of CA-CC shunts in hypertrophic cardiomyopathy was not influenced by the presence or absence of myocardial squeezing. CA-CC shunts are considered to be due to an abnormality in the coronary microcirculation of the myocardium. We describe the angiographic features of the two types of CA-CC shunt and discuss their pathophysiological significance.