Intraventricular Septum Thickness Research Articles

Selenoproteins regulate contractility during hyperthyroidism‐induced cardiac hypertrophy

We assessed the hypothesis that selenoproteins are important for the heart during hyperthyroidism‐induced myocardial hypertrophy. Mice were injected with 1mg/kg triiodothyronine (T3) or vehicle control for 8 days. Expression levels of several selenoproteins were found to increase in heart tissue with T3‐treatment, with some of the most elevated mRNAs including selenoprotein R (Sel R), thioredoxin reductase−1, and both glutathione peroxidase (GPX)−1 and −3. T3‐treatment induced increases in thioredoxin reductase activity as well as GPX−4 and Sel R, but not GPX−1, proteins. We next utilized a mouse model (trspfl/fl X αMHC‐Cre), which involves reduced expression of Sec‐tRNA in the heart. The mice expressing reduced levels of Sec‐tRNA in the heart (Cre+ mice) developed similar levels of myocardial hypertrophy upon T3 injection compared to negative controls (Cre− mice) as determined by heart mass:body mass. As expected, T3‐treatment of Cre− mice resulted in altered cardiac parameters including increased fractional shortening, decreased systolic left ventricular inner diameter, and increased intraventricular septal thickness. In contrast, these cardiac parameters were not altered in Cre+ mice. These results suggest that restricting the elevation of selenoprotein synthesis by reducing Sec‐tRNA levels may lead to a loss of contractility needed for maintaining cardiac function during hypertrophy.

Respiratory muscle weakness and inefficient ventilation in heart failure due to light-chain amyloidosis

Background. Cardiac involvement in light-chain amyloidosis (AL) frequently results in heart failure with dyspnoea. In heart failure due to ischemic or idiopathic etiology, respiratory muscle dysfunction and ventilatory inefficiency contribute to symptoms and are independent prognostic predictors. However, in patients with AL, respiratory muscle function has not been elucidated.Methods. In 46 consecutive male patients with AL, lung function, maximal inspiratory (Pimax) and expiratory (Pemax) mouth occlusion pressures, cardiopulmonary exercise testing, echocardiography, and cardiac biomarkers were prospectively studied.Results. Pimax and Pemax were reduced, P0.1 did not differ between controls and AL. Pimax and Pemax were reduced in AL with congestive heart failure compared with asymptomatic patients (median (range) 5.4 (2.3–12.4) kPa vs 10.4 (6.5–14.0) kPa; p < 0.05). Respiratory muscle weakness occurred in systolic and diastolic LV dysfunction. Pimax was associated with peak exercise oxygen uptake, respiratory inefficiency, wall thickness, and N-terminal pro-brain natriuretic peptide.Conclusions. Respiratory muscle dysfunction and ventilatory inefficiency correlates well with intraventricular septum thickness and peak oxygen uptake and are present even in patients with diastolic dysfunction. Respiratory muscle dysfunction might contribute to dyspnea and exercise limitation and appears to represent a marker of cardiac impairment even in diastolic heart failure. Further studies of Pimax as a potential non-invasive prognostic marker are needed.

Relationship between Parathyroid Hormone and Cardiac Abnormalities in Chronic Dialysis Patients

It has been shown that parathyroid hormone (PTH) influences cardiac abnormalities in dialysis patients. The purpose of this study was to evaluate the relationship between the plasma PTH level and cardiac abnormalities in these patients without overt cardiac disease. A total of 81 of the 208 patients who received chronic dialysis treatment at our institution were included in this study. Plasma PTH level measurement, other blood examinations and echocardiography were performed in all patients. The subjects were divided into two groups based on plasma PTH level (<300 pg/ml: group A; > or =300 pg/ml: group B). There were no significant differences in echocardiographic parameters between group A and group B. The plasma PTH level was not significantly correlated with any echocardiographic parameter in any patient. In addition, we chose 10 patients with a plasma PTH level of more than 500 pg/ml from group B and 20 patients matched for various characteristics (excluding PTH level) from group A and compared the echocardiographic parameters between them. LVMI and intraventricular septum thickness (IVST) were significantly greater in patients with a plasma PTH level of greater than 500 pg/ml. PTH was not strongly associated with cardiac abnormalities such as LVH or decreased left ventricular function in the overall group of patients. PTH may not play a major role in the pathogenesis of cardiac abnormalities in these patients. However, PTH could influence LVH in patients with remarkably elevated plasma PTH levels.

Ability of Ambulatory Blood Pressure Monitoring and Myocardial/Carotid Ultrasound to Predict the Location and the Severity of Coronary Artery Lesions in Normotensive Patients: A Clinical Study

Pulse pressure has been recognized as a marker of cardiovascular disease in normotensives. Moreover, internal carotid artery intima-media thickness (IMT) has been proposed to reflect coronary artery lesions. The aim of the present study was to evaluate the predictive value of other parameters derived from ambulatory blood pressure monitoring (ABPM), myocardial ultrasound, and carotid ultrasound to predict the location and the severity of coronary artery disease in normotensives. One hundred and thirteen patients with suspected coronary artery disease underwent coronary angiography, 24-h ABPM and myocardial/carotid ultrasound. Multivariate analysis was applied and equations were extrapolated based on independent variables derived from ABPM and ultrasound. The Gensini score was independently correlated with male gender, pulse pressure, average heart rate for both 24-h (p=0.001) and night (p=0.006) values, as well as percentage of high systolic blood pressure (BP), average diastolic BP, average mean BP, and heart rate concerning daily mesurements (p=0.001). Moreover, the Gensini score was independently correlated with end-systolic volume, posterior wall thickness during systole and intraventricular septum thickness during diastole, along with male gender and age (p=0.001), as well as mean internal and right common carotid artery IMT (p=0.002). Similar mathematical formulas have been calculated separately for the coronary arteries and their main branches. In conclusion, the location and the severity of coronary disease can be effectively evaluated by ABPM and myocardial/carotid ultrasound in normotensives. This approach could be useful for determining atypical patients at risk and/or for treating patients with suspected coronary disease who refuse coronary angiography.

Adiposity and cardiac dimensions among 9- to 18-year-old youth: the Québec Family Study

The relationship between adiposity and cardiac dimensions were considered in healthy 9- to 18-year-old boys (n=198) and girls (n=154). Indicators of adiposity included the body mass index (BMI), sum of skinfolds (SSF) and trunk-to-extremity ratio (TER). The following left ventricular (LV) dimensions were measured by echocardiography: internal diameter (LVIDd); posterior wall thickness (PWT) and intraventricular septal wall thickness. LV mass (LVM) was estimated. In boys, 11 of 45 correlations were significant. The magnitude of the correlations increased across age groups and most of the correlations were significant in the oldest age group. In girls, 18 of 45 correlations were significant, but there were inconsistent patterns in the magnitude of the correlations across age groups. Correlations between BMI and LVIDd and LVM were highest in youth 13-15 years, whereas other correlations involving the BMI were rather constant across age groups. Correlations involving SSF were significant only in 9-12 and 13-15 year olds. There were no significant correlations involving TER in female subjects. In the total sample of boys, only correlations between the BMI and LV parameters were significant (r=0.14-0.38), except for the relationship between SSF and PWT (r=0.21). The TER was weakly associated with LV parameters. In the total sample of girls, correlations for LV parameters were significant for both the BMI (r=0.20-0.43) and SSF (r=0.18-0.28; except for LVIDd). TER was not significantly related to LV parameters except LVIDd (r=0.16). The findings indicate that the BMI is an important determinant of LV structure.

Oxidative Stress Causes Heart Failure with Impaired Mitochondrial Respiration

Elderly people insidiously manifest the symptoms of heart failure, such as dyspnea and/or physical disabilities in an age-dependent manner. Although previous studies suggested that oxidative stress plays a pathological role in the development of heart failure, no direct evidence has been documented so far. In order to investigate the pathological significance of oxidative stress in the heart, we generated heart/muscle-specific manganese superoxide dismutase-deficient mice. The mutant mice developed progressive congestive heart failure with specific molecular defects in mitochondrial respiration. In this paper, we showed for the first time that the oxidative stress caused specific morphological changes of mitochondria, excess formation of superoxide (O(2)(*)(-)), reduction of ATP, and transcriptional alterations of genes associated with heart failure in respect to cardiac contractility. Accordingly, administration of a superoxide dismutase mimetic significantly ameliorated the symptoms. These results implied that O(2)(*)(-) generated in mitochondria played a pivotal role in the development and progression of heart failure. We here present a bona fide model for human cardiac failure with oxidative stress valuable for therapeutic interventions.

Roles of large and small arteries in vascular disease

Roles of large and small arteries in vascular disease

Noninvasive diagnosis of biopsy-proven cardiac amyloidosis

ObjectivesThis study analyzed the utility of electrocardiographic (ECG) and echocardiographic findings in the diagnosis of amyloidosis proven by endomyocardial biopsy. BackgroundCardiac amyloidosis is associated with characteristic ECG and echocardiographic changes, yet each finding alone is relatively nonspecific. A combination of noninvasive prognostic parameters would be desirable for this tissue-based diagnosis. MethodsWe performed an analysis of 196 consecutive patients referred for endomyocardial biopsy because of clinical suspicion of cardiac amyloidosis. The diagnosis was confirmed in 58 patients (29%). The ECGs, echocardiograms, and right heart hemodynamic data were reviewed to determine which findings strongly correlate with the diagnosis. These findings were then used to build multivariate logistic regression models that predict the log-odds of having cardiac amyloidosis. ResultsThe univariate analysis showed that low-voltage and pseudo-infarction patterns on the ECG and increased myocardial thickness and speckled-appearing myocardium on the echocardiogram were associated with biopsy-proven cardiac amyloidosis (each p < 0.01). In multivariate logistic regression models, a combination of a low voltage and measures of myocardial thickness produced the most statistically useful models. For instance, one model showed that if a low voltage was present and interventricular septal thickness is >1.98 cm, the diagnosis of cardiac amyloidosis could be made with a sensitivity of 72% and a specificity of 91%. In this model, the positive predictive and negative predictive values were 79% and 88%, respectively. ConclusionsIn patients with suspected cardiac amyloidosis, a combination of noninvasive parameters—namely, a low voltage and increased intraventricular septal thickness—is a useful diagnostic tool.

Hereditary systemic amyloidosis associated with a new apolipoprotein AII stop codon mutation Stop78Arg

Hereditary systemic amyloidosis associated with a new apolipoprotein AII stop codon mutation Stop78Arg. Mutations in the gene for apolipoprotein AII (apoAII) have recently been found to cause hereditary renal amyloidosis. In each case amyloid deposition has been associated with a peptide extension at the carboxyl-terminus of apoAII, the result of mutations in the normal stop codon. A Caucasian man who has had progressive renal dysfunction since age of 34 was found to have amyloidosis on renal biopsy at age 56. Echocardiogram showed mild intraventricular septal thickness and technetium-99m (99mTc)-pyrophosphate scintigraphy demonstrated uptake by cardiac muscle consistent with amyloid deposition in the myocardium. His father died of renal failure and his paternal half brother has renal dysfunction. DNA sequencing of the apoAII gene in the proband showed a T to C transition at the first position of the stop codon indicating replacement of the stop codon by l-arginine (Arg) at residue 78. Western analysis of the proband's plasma under reducing conditions using anti-apoAII revealed an extra band at approximately 10 kD in addition to the normal apoAII band at 8 kD. Western analysis of solubilized amyloid fibrils isolated from rectal biopsy tissue contained only the variant apoAII. These results indicate that the proband's amyloid fibrils are derived from apoAII and the amyloidogenesis is linked to the peptide extension at the carboxyl-terminus of variant apoAII. Of particular interest is that this novel apoAII variant may cause amyloid cardiomyopathy in addition to renal amyloid.

Autologous Peripheral Blood Stem Cell Transplantation Following Heart Transplantation for Primary Systemic Amyloidosis

A 47 years old woman was admitted with severe congestive heart failure. Cardiac echography showed increased intra-ventricular septum thickness, and there was a serum Ig G LD monoclonal component. Cardiac biopsies confirmed diffuse amyloidosis of Al type. To avoid cardiac toxicity of chemotherapy, the patient received first a heart transplantation (HT), followed six months later by melphaian 200 mg/m2 and autologous peripheral blood stem cell support (PBSCT). This case suggests that such strategy is feasible with a favorable outcome, and HT may be an appropriate procedure for some patients with Al amyloidosis who meet the criteria for PBSCT.

Hypertrophic Cardiomyopathy in Greece: Clinical Course and Outcome

Evaluation of clinical course and outcome of hypertrophic cardiomyopathy in a representative Greek population. Hypertrophic cardiomyopathy is characterized by unexplained left ventricular hypertrophy and varied clinical expression. Recent studies suggest ethnic differences. One hundred seventy-four consecutive Greek patients (117 male, 57 female, age 47+/-16 years) from 143 different families were assessed at the Department of Cardiology of the University of Athens, Greece, and the State Cardiac Department, Hippokration Hospital, both located in Athens, Greece. To reduce selection bias, referral was based on disease diagnosis irrespective of clinical status or treatment needs. All patients were examined clinically, echocardiographically, and by ECG ambulatory monitoring at 6-month intervals for a period of 74+/-22 months (range, 8 to 108 months). Most patients (n = 156, 89.7%) were in New York Heart Association (NYHA) functional class I or II. The disease was familial (at least one affected first-degree relative) in 81 of the 143 families (56.6%), and in 19 of these (13.3%) there was familial history of sudden cardiac death. At initial examination, intraventricular septal thickness was 17.3+/-4.1 mm and posterior wall thickness was 13.7+/-3.8 mm and a left ventricular outflow gradient >30 mm Hg was present in 58 patients (33.3%). Similar were the findings during the last examination (17.5+/-4.3 mm, 13.5+/-4.4 mm, and 56 (32.2%, respectively, p = not significant). Episodes of nonsustained ventricular tachycardia were noted in 15 patients (8.6%). There were eight deaths during follow-up: four sudden deaths and four from intractable heart failure. Syncope was reported by all patients who died. The annual mortality in this study was 1%. Syncope and NYHA class were the only predictors of outcome. In this representative Greek patient cohort with hypertrophic cardiomyopathy, the arrhythmogenic substrate was modest and the clinical course benign. Sudden cardiac death was infrequent and syncope, functional class, and ventricular arrhythmias were the only predictors of a poor outcome.

Fetal cardiac function and septal thickness in diabetic pregnancy: a controlled observational and reproducibility study.

To determine the reproducibility of duplex Doppler waveform analysis and fetal cardiac interventricular septal thickness measurement and to compare these parameters in matched pregnancies with and without well-controlled maternal Type 1 diabetes at 18-20 weeks of gestation. A prospective blind twin cohort study and a blinded inter-observer and intra-observer agreement study. A tertiary referral prenatal diagnostic unit within a university hospital. Good inter- and intra-observer agreement was found for the measurement of transvalvular peak flow velocities and the duration of ventricular ejection in the fetal heart. Inter-observer agreement for aortic flow acceleration rate was poor. M-mode measurement of interventricular septal thickness showed moderate reproducibility. The mean (SD) width of the interventricular septum in the fetuses of well controlled diabetic women was 2 1 mm (0.2 mm), and was significantly greater (P=0.01) when compared with the corresponding value in matched controls [1.9 mm (0.2 mm)]. No cardiac functional differences were evident. On-screen video analysis of Doppler cardiac flow waveforms and M-mode measurement of intraventricular septal thickness demonstrated good reproducibility. The fetuses of well controlled diabetic pregnancies demonstrated signs of altered cardiac morphology early in pregnancy, before any evident alterations in cardiac function.

Results of Daily Hemodialysis in Catanzaro: 12‐Year Experience With 22 Patients Treated For More Than One Year

Since 1985, we have been treating patients with daily hemodialysis (D-HD). We report our results with 22 patients treated on D-HD and daily home hemodialysis (DHHD) for a long-term period. Patients had very good survival of native forearm arteriovenous fistula access, and upper arm access with superficialized basilic vein. One access survived 18 years: 8 years on standard hemodialysis (STND-HD) and 10 years on D-HD. Only two fistulas failed. Blood pressure control in 12 hypertensive patients was obtained without antihypertensive drugs in 8 and with fewer medications in 4. Hematocrit and hemoglobin improved in all patients. Cardiothoratic index decreased in all patients, and we noticed a reduction in the most important echocardiographic indices in 12 patients with cardiac hypertrophy: intraventricular septum thickness, left ventricle posterior wall thickness, left ventricle internal diastolic diameter, and left atrium diameter. Data also showed improvement in nutritional status. For the most part, the levels of hormones normalized, with regular menstrual cycles in women and good sexual function in men. In our experience both elderly and young patients with severe cardiovascular diseases, severe hypertension or hypotension, anemia, and nutritional problems can, with D-HD, achieve good quality of life and start work again. D-HD, in our opinion, is the treatment of choice for patients without comorbid conditions, because good metabolic control, good nutrition, and a more normal hormonal status allow them to feel well and to have an almost normal lifestyle.

Adults with childhood-onset growth hormone deficiency: effects of growth hormone treatment on cardiac structure.

To evaluate the effects of growth hormone deficiency (GHD) and of growth hormone (GH) therapy on cardiac structure in adults with childhood-onset GHD. Out-patient clinic in the Italian Institute for Auxology, Milan. Eight adults with childhood-onset GHD and eight healthy controls, matched for sex, age, exercise and body mass index. Recombinant GH (Saizen Serono, Italy), administered in a conventional dose of 0.5 IU kg-1 week-1 for 6 months. Cardiac structure parameters, evaluated by two-dimensional, M-mode and Doppler echocardiograms, and stress test, by means of a modified Bruce protocol with a bicycle ergometer, were determined before and after 6 months GH therapy. Before treatment, mean (+/- SE) intraventricular septal thickness (IVST: 7.1 +/- 0.2 mm), LV posterior wall thickness (LVPT: 5.2 +/- 0.1 mm), LV mass (LVM: 94.6 +/- 5.0 g), LV mass index (LVM/body surface area, LVMI: 65.1 +/- 3.0 g m-2) and left ventricular end-diastolic diameter (LVED: 41.4 +/- 0.6 mm) of patients were significantly lower (P < 0.01) than in controls, whilst LV end-systolic diameter (LVES) of patients (25.5 +/- 0.7 mm) was similar to controls (27.5 +/- 0.7). GH treatment significantly (P < 0.01) increased LVPT (6.8 +/- 0.2 mm), LVM (111.6 +/- 4.6 g) and LVMI (80.5 +/- 3.5 g m-2); no significant changes were observed in LVED, LVES and IVST values. The stress test showed a significant improvement of cardiac performance, as demonstrated by the reduction of blood pressure x heart rate product at the same workload (basal: 32,722.5 +/- 897.4 vs. after: 25,574.6 +/- 439.7). GH plays a role in the maintenance of a normal cardiac structure in adulthood. The present study suggests that GH treatment might be able to improve the cardiac structure of patients with childhood-onset GHD.

The Influence of the Angiotensin I Converting Enzyme Genotype in Familial Hypertrophic Cardiomyopathy Varies with the Disease Gene Mutation

Familial hypertrophic cardiomyopathy is an autosomal dominant genetically heterogeneous disease characterized by a partial penetrance and variable expressivity. Previous studies showed that the extent of hypertrophy is influenced by the angiotensin I converting enzyme insertion/deletion (I/D) polymorphism. Recently, molecular genetic analysis revealed the existence of healthy carriers and that as many as a quarter of genetically affected individuals do not express the disease. This data prompted us to re-investigate the role of the angiotensin I converting enzyme polymorphism on hypertrophy by assessing both clinically affected individuals and healthy carriers. For this, several families with mutations in the cardiac myosin binding protein C or theβ-myosin heavy chain genes were analysed. The mean maximal intraventricular septum thickness was compared as a function of angiotensin I converting enzyme genotypes in all genetically affected individuals (n=114), and in subsets of subjects carrying either a splice acceptor site mutation in the cardiac myosin binding protein C gene (n=33), or various missense mutations in the cardiacβ-myosin heavy chain gene (n=81) or finally, mutations in the Arg403 codon of theβ-myosin heavy chain gene (n=54). Significant association between the D allele and hypertrophy was observed only in the case of Arg403 codon mutations (mean septum thickness for subjects with the DD genotype: 19.3±2.7 mm; with the ID genotype: 13.4±1.3 mm and with the II genotype: 11.0±0.9 mm;P<0.02). These results were confirmed by theχ2test showing an over-representation of DD genotype in patients carrying an Arg403 codon mutation associated with septal hypertrophy (P<0.05). Our data confirms that the angiotensin I converting enzyme genotypes can influence the phenotypic expression of hypertrophy and shows that this influence depends on the mutation, raising the concept of multiple genetic modifiers in familial hypertrophic cardiomyopathy.

Clinical, electrocardiographic, and echocardiographic features in patients with asymptomatic aortic abdominal aneurysm.

Cardiac involvement in peripheral vascular diseases can present interesting patho-physiological aspects and can influence the prognosis. The authors evaluated the cardiac condition of patients with asymptomatic aortic abdominal aneurysm (AAAA) by using clinical, electrocardiographic, and echocardiographic techniques. Seventy-eight patients were studied, 74 men and 4 women, with ages ranging from fifty-five to eighty-one years (mean 69.5 +/- 6.4). All patients were submitted to a complete clinical examination, usual blood tests, a 12-lead resting electrocardiogram, and an echo-Doppler evaluation. Forty-eight subjects (61.5%) were affected by hypertension, 53 (67.9%) were smokers, 25 (32.1%) were alcohol abusers, 39 (50%) had a history of angina pectoris, 20 (25.6%) had had previous myocardial infarction, and 30 (38.5%) were receiving active cardiovascular treatment. All patients except 2, who had chronic atrial fibrillation, manifested sinus rhythm. Electrocardiographic signs of left ventricular (LV) hypertrophy were present in 20 cases (25.6%), intraventricular conduction disturbances in 19 (24.4%), pathological Q waves in 20 (25.6%), and primary repolarization abnormalities in 25 (32.1%). Echocardiography showed a slight increase in left atrial diameter and intraventricular septum thickness (41.5 +/- 4.3 and 12.3 +/- 2 mm respectively). A clearer increase was found in LV mass index (159 +/- 44 g/m2). In 31 patients one or more LV asynergic segments were found. In our patients with AAAA the prevalence of major risk factors for atherosclerosis and ischemic heart disease including previous myocardial infarction was high. Echo-derived LV myocardial mass index was higher than normal even though electrocardiographic criteria for LV hypertrophy did not match echocardiographic data in all subjects. Finally a moderate prevalence of intraventricular conduction disturbances was recorded.

Vascular wall thickness in hypertension: the perindopril regression of vascular thickening European community trial: Protect

A high prevalence of increased intima/media thickness of the arterial wall has been documented in hypertension. These alterations in vascular wall structure may be potent determinants for the promotion of the development of atherosclerosis. Direct histologic data from animal models of hypertension, and indirect data from hypertensive patients, have demonstrated a marked regression of increased intima/media thickness by angiotensinconverting enzyme (ACE) inhibition. Long-term effects of ACE inhibition on structural wall changes in humans have not been examined. Therefore, a multicenter, randomized, double-blind European trial was designed to compare the effects of the ACE inhibitor perindopril and the diuretic hydrochlorothiazide in slowing or reversing progression of increased intima/media thickness of carotid and femoral arteries in hypertensive patients. A total of 800 patients at 17 clinical centers in 7 European countries, aged 35–65 years, with hypertension and ultrasonographically proven intima/media thickness ≥0.8 mm of the common carotid artery will be randomly assigned to receive in a doubleblind fashion either perindopril or hydrochlorothiazide and will be followed for 24 months. High resolution duplex sonography will be used to quantify intima/media thickness at baseline and twice a year during follow-up. A change of 0.1 mm of intima/media thickness from baseline is considered to be detectable, and the standard deviations of the changes from baseline are expected not to be higher than 0.2 mm. The primary endpoint of the study is the comparison of changes in intima/media thickness of the common carotid artery. Secondary endpoints include comparison of the effectiveness of the two treatments on left ventricular mass, posterior wall thickness, intraventricular septal thickness, left ventricular end-diastolic diameter, and comparison of the 2 treatments on ultrasonographically determined thickness of the intima/media complex of the common femoral artery. Further analyses will assess the relation between intima/ media thickness changes and the changes of blood pressure, heart rate, low and high density lipoprotein cholesterol, triglycerides, and glucose. The study is designed to assess the impact of antihypertensive therapy on early pathological vascular wall changes and to clarify whether this is due to a drug-specific action or only dependent on the blood pressure lowering effect.

Vascular wall thickness in hypertension

A high prevalence of increased intima/media thickness of the arterial wall has been documented in hypertension. These alterations in vascular wall structure may be potent determinants for the promotion of the development of atherosclerosis. Direct histologic data from animal models of hypertension, and indirect data from hypertensive patients, have demonstrated a marked regression of increased intima/media thickness by angiotensinconverting enzyme (ACE) inhibition. long-term effects of ACE inhibition on structural wall changes in humans have not been examined. Therefore, a multicenter, randomized, double-blind European trial was designed to compare the effects of the ACE inhibitor perindopril and the diuretic hydrochlorothiazide in slowing or reversing progression of increased intima/media thickness of carotid and femoral arteries in hypertensive patients. A total of 800 patients at 17 clinical centers in 7 European countries, aged 35-65 years, with hypertension and ultrasonographically proven intima/media thickness ~0.8 mm of the common carotid artery will be randomly assigned to receive in a doubleblind fashion either perindopril or hydrochlorothiazide and will be followed for 24 months. High resolution duplex sonography will be used to quantify intima/media thickness at baseline and twice a year during follow-up. A change of 0.1 mm of intima/media thickness from baseline is considered to be detectable, and the standard deviations of the changes from baseline are expected not to be higher than 0.2 mm. The primary endpoint of the study is the comparison of changes in intima/media thickness of the common carotid artery. Secondary endpoints include comparison of the effectiveness of the two treatments on left ventricular mass, posteriorwall thickness, intraventricular septal thickness, left ventricular end-diastolic diameter, and comparisonof the 2 treatments on ultrasonographitally determined thickness of the intima/media complex of the common femoral artery. Further analyses will assess the relation between intima/ media thickness changes and the changes of blood pressure, heart rate, low and high density lipoprotein cholesterol, triglycerides, and glucose. The study is designed to assess the impact of antihypertensive therapy on early pathological vascular wall changes and to clarify whether this is due to a drug-specific action or only dependent on the blood pressure lowering effect. (Am J Cardioll995; 7650E64E)

Echocardiographic parameters and indices in the normal beagle dog.

M-mode and two-dimensional echocardiographic measurements were made from the right sternal border of 50 healthy Beagles (25 males and 25 females) approximately 7 months old. The dogs were conscious and standing during the investigation. The following parameters, in systole and diastole, were measured on the echocardiographic images: left ventricular posterior wall thickness (LVWT); intraventricular septum thickness (IST); left ventricular internal dimension (LVID); and circumference (LVC). Fractional shortening (FS) and ejection fraction (EF) were also calculated. Mean, standard deviation, range and coefficient of variation are reported for each echocardiographic parameter and for body weight. Males and females were considered separately and together. Each parameter was analysed statistically to check for differences between the sexes and for correlations with body weight. A statistically significant difference between the sexes was only observed for LVWT in systole and diastole. A linear regression with body weight was obtained only for LVID in systole and in diastole. The results show that morphofunctional cardiac homogeneity is independent of size in dogs of this breed and age.

Sodium-lithium countertransport and cardiorenal abnormalities in essential hypertension.

The rate of red blood cell sodium-lithium countertransport is elevated only in a subgroup of patients with essential hypertension. We have therefore compared renal and cardiac function and morphology in two groups of hypertensive patients with high (n = 23) or normal (n = 22) sodium-lithium countertransport (mean +/- SEM: 0.61 +/- 0.10 versus 0.29 +/- 0.07 mmol/l red blood cells.hr). The two groups were similar in age, sex distribution, body mass index, smoking habit, duration of hypertension, and actual levels of untreated blood pressure. Hypertensive patients with elevated sodium-lithium countertransport activity showed elevated glomerular filtration rate (118 +/- 2 versus 109 +/- 2 ml/min.1.73 m2; p less than 0.001), albumin excretion rate (23 +/- 3 versus 14 +/- 2 micrograms/min; p less than 0.001), larger kidney volume (250 +/- 15 versus 203 +/- 13 ml.1.73 m2; p less than 0.01), lower lithium clearance rate (26.7 +/- 0.3 versus 28.9 +/- 0.3 ml/min.1.73 m2; p less than 0.01), and higher total body exchangeable sodium (2,716 +/- 33 versus 2,485 +/- 41 mmol.1.73 m2; p less than 0.01). Left ventricular mass index (139 +/- 6 versus 119 +/- 6 g/m2; p less than 0.05), relative wall thickness (0.39 +/- 0.05 versus 0.29 +/- 0.04 cm; p less than 0.001), and left posterior wall plus intraventricular septum thickness (2.02 +/- 0.04 versus 1.76 +/- 0.03 cm; p less than 0.05) were also higher in patients with high sodium-lithium countertransport. Hypertensive patients with normal sodium-lithium countertransport had renal and cardiac parameters similar to those of a normotensive control group (n = 21) except for a higher glomerular filtration rate and left ventricular mass index.(ABSTRACT TRUNCATED AT 250 WORDS)