European heart journal
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European heart journal · Dec 1991
Comparative StudyPredictability of aortic dissection as a function of aortic diameter.
The role of aortic diameter on the occurrence of type A dissection was investigated in 73 patients with dilated ascending aorta at the time of pre-operative evaluation. Using transthoracic echocardiography for diagnosis and measurements, 54 patients were identified with type A dissection (group 1) and 19 without dissection (group 2). The true mean aortic diameters were identical (6.0 +/- 1.3 cm in group 1 and 6.4 +/- 1.4 cm in group 2; mean +/- SD; ns) as were the indexed aortic diameters (ratio of diameter/body surface area; 3.2 +/- 0.8 cm.m-2 and 3.4 +/- 0.7 cm.m-2, respectively; ns). ⋯ It is concluded that patients with dilated ascending aorta have a substantial incidence of acute dissection. Their clinical course is unpredictable: acute dissection occurs in some, and in others the ascending aorta continues to enlarge without dissection. Because patients with dissection often arrive too late for elective repair and have to be operated on as emergencies with a higher operative risk, we recommend elective surgery before the diameter of the ascending aorta has reached 6 cm.
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European heart journal · Nov 1991
Relationship between signal-averaged electrocardiography and dangerous ventricular arrhythmias in patients with left ventricular aneurysm after myocardial infarction.
We performed signal-averaged electrocardiography (SAECG) and Holter monitoring, and subsequently followed-up 53 ambulatory patients with left ventricular aneurysm (LVA) after myocardial infarction (MI). A history of spontaneous episodes of sustained ventricular tachycardia (VT) was also analysed. Out of 53 patients, 25 (47%) had an abnormal SAECG. ⋯ Using multivariate analysis only a history of sustained VT was an independent factor in predicting the outcome of patients in this study. We conclude that an abnormal SAECG identifies those post infarction patients with LVA who are prone to complex ventricular arrhythmias. A normal SAECG and an absence of a history of sustained VT strongly indicate that the risk of developing arrhythmic events is very low.
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European heart journal · Sep 1991
Comparative StudyComparison between the positive inotropic effects of enoximone, a cardiac phosphodiesterase III inhibitor, and dobutamine in patients with moderate to severe congestive heart failure. A study using the end-systolic pressure-volume relationship method.
This study was designed to compare the positive inotropic properties of enoximone, a cardiac phosphodiesterase III inhibitor, with those of dobutamine in a population of moderate to severe congestive heart failure patients. The end-systolic pressure-volume relationship method was used. In addition, the haemodynamic effects of both drugs were compared. ⋯ At the therapeutic doses chosen, the difference between the inotropic effects of the two drugs was not significant (P = 0.07). Of the three patients available for comparison who did not manifest inotropic response with enoximone, two were also dobutamine 'non-responders': they differed from the 'responder' patients in two respects: they had undergone surgery for correction of valvular disease and had significantly higher pulmonary artery pressures. The haemodynamic measurements confirmed the vasodilatory properties of enoximone; in particular, the fall in ventricular filling pressures was much greater with enoximone than with dobutamine.(ABSTRACT TRUNCATED AT 250 WORDS)
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Cardiac output estimation is an important and much needed measurement for assessing patients in heart failure. In hypertension, it is vital for understanding the haemodynamic basis of the disease and the mode of action of drugs. Measurements of blood pressure and cardiac output provide the only means of estimating peripheral resistance. ⋯ Doppler velocimetry is the most promising technique, but it requires complex computer analysis and, as yet, can reliably be used only to measure changes in cardiac output in an individual. The technique has been assessed against the electromagnetic flowmeter in man and gives reasonable accuracy and repeatability. Echocardiography and impedance cardiography are not yet satisfactory for clinical use; neither are the radionuclide methods, apart from the 'first pass' method, but this also needs further verification.