Introduction: Autonomic imbalance and hemodynamic disturbances has been described in pre-hyperten... more Introduction: Autonomic imbalance and hemodynamic disturbances has been described in pre-hypertensive patients (PHT-JNC-VII), with increments in sympathetic drive, cardiac index (CI) and vascular resistances1. However, these autonomic alterations aren't present in all of PHTs, and different status of autonomic balance (AB) could be coexisting with different hemodynamic patterns (HP), as distinct stages in the evolution to sustained HT. Objectives: a) To evaluate AB and HP in PHTs; and b) To asses different association patterns between them. Methods: Prospective study. We included 70 patients into three different groups; a) 40 PHTs (131.4 ± 5.9/84.2 ± 5.1 mm Hg), b) 10 normotensives (NT),(112.4 ± 5.3/73.4 ± 4.9 mm Hg), and c) 20 mild HTs (148.8 ± 13.5/93.6 ± 7.1 mm Hg), all of them without treatment. AB was determined by the expiration/inspiration index (E/I) in one second/ECG; and the different HP were evaluated by determination of CI, systemic vascular resistance index (SVRI) and cardiac work index (CWI) with impedance cardiography. A cut off point of 1.25 for E/I was applied Results: a) Abnormal AB (E/I<1.25) was detected in 56.6% of PHT, 20% of NT and 37.5% of HTs. b) In PHTs, abnormal AB was related with an HP characterized for increased SVR, while subjects with normal AB presented an hyper-dynamic HP, with low SVR. (table), c) HP of PHTs with altered AB was similar to HT patients Figure 1. No caption available. Conclusions: More than of 50% of PHTs presented altered AB. Subjects with normal AB showed a hyper-dynamic HP; abnormal AB was related with an HP characterized for SVR elevated, similar to the HT patients. Differences in α and β adrenoceptors sensitivity could be associated with these different HP. In some PHTs the HP typical of HT starts below of the BP threshold of HT (140/90 mm Hg). Therapeutical measures could be used to prevent the development of HT and related organ damage.
In order to determine the natural evolution of different clinical types of “unstable angina”, 167... more In order to determine the natural evolution of different clinical types of “unstable angina”, 167 patients were included in a prospective study. After angiography, 11 (6.5%) were excluded because they had no significant coronary lesions. The remaining 156 were sorted into different groups according to their clinical characteristics and were followed up for a period of 24 months at least. After that follow‐up period, mortality and incidence of acute myocardial infarction (AMI) were as follows: angina of recent onset (Class III‐IV NYHA): 8.5% (3/35) and 34.2% (12/35). Progressive angina: 7.4% (2/27) and 7.4% (2/27). Intermediate syndrome: 41.6% (10/24) and 37.5% (9/24).Prinzmetal's angina: 10% (1/10) and 10% (1/10). Post acute myocardial infarction angina: 35% (7/20) and 10% (2/20). Acute persistent ischemia: 2.5% (1/40) and 20% (8/40). Comparison of these figures pointed out significant differences (p < 0.001 for mortality and p < 0.03 for AMI incidence respectively).We con...
To study the efficacy of a treatment strategy for the management of hypertensive urgencies, the a... more To study the efficacy of a treatment strategy for the management of hypertensive urgencies, the authors evaluated 549 patients admitted to the emergency department. They were first assigned to a 30-minute rest period, then a follow-up blood pressure measurement was carried out. Patients who did not respond to rest were randomly assigned to receive an oral dose of an antihypertensive drug with different mechanisms of action and pharmacodynamic properties (perindopril, amlodipine, or labetalol), and blood pressure was reassessed at 60- and 120-minute intervals. A satisfactory blood pressure response to rest (defined as postintervention systolic blood pressure &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 180 mm Hg and diastolic blood pressure &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 110 mm Hg, with at least a 20 mm Hg reduction in basal systolic blood pressure and/or a 10-mm Hg reduction in basal diastolic blood pressure) was observed in 31.9% of population. Among nonresponders, 79.1% had a satisfactory blood pressure response to the antihypertensive drug treatment in a 2-hour average follow-up period. No major adverse events were observed. This treatment strategy, based on standardized rest as an initial step and different antihypertensive drugs, can be effective and safe for the management of patients with hypertensive urgencies.
Introducción La hipertrofia del ventrículo izquierdo (HVI) incluye diferentes etiologías, estados... more Introducción La hipertrofia del ventrículo izquierdo (HVI) incluye diferentes etiologías, estados evolutivos y pronóstico. El strain rate sistólico (SRS) o estudio de la deformación miocárdica permite analizar la función sistólica regional al evaluar la velocidad de acortamiento ...
PABLO RODRÍGUEZ, 1, MARTÍN O'FLAHERTY2, PEDRO FORCADA2, DANIEL GRASSI2, MÓNICA DÍAZ1, DANIE... more PABLO RODRÍGUEZ, 1, MARTÍN O'FLAHERTY2, PEDRO FORCADA2, DANIEL GRASSI2, MÓNICA DÍAZ1, DANIEL FERRANTE3, MARCELO PELLIZZARI2, MARIO BENDERSKY1, DOMINGO TURRIMTSAC, 2, CAROL KOTLIAR2, en representación del Grupo de Investigadores del ...
ABSTRACT Precedents: In pathological left ventricular (LV) hypertrophy (H) of hypertensive patien... more ABSTRACT Precedents: In pathological left ventricular (LV) hypertrophy (H) of hypertensive patients (P) there is a deposition of collagen. Myocardial fibrosis is one of the factors responsible for systolic and diastolic dysfunction. Athletes increase their ventricular mass as physiological ventricular H. Integrated backscatter (IB) demonstrates changes in myocardial acoustic properties, depending upon their composition and function.Objectives: (1).Assess the capability of IB to differentiate physiological from pathological H. (2).Correlate IB with overall and regional systolic and diastolic functions.Methods: Group I(GI):13 hypertensive P with an LV mass index (LVMI)&gt;124 gr/m2, Group II(G2):11 athletes, Group III(G3): 8 volunteers. We determined overall systolic and diastolic functions and regional function of the basal septum, IB and cyclic variation of the IB (CVIB) of the posterior wall.Results: Age (years): G1:52 ± 15, G2:28 ± 8 G3:35 ± 8 p = 0.000; Sex: G1:m/f 12/1, G2: m/f 9/2, G3: m/f 4/4, LVMI: G1: 180.1 ± 58 gr/m2, G2:130.2 ± 20 gr/m2 G3: 90.2 ± 16 gr/m2 p = 0.000. Left atrial area (LAA): G1: 22 ± 4 cm2, G2: 18.8 ± 1.8 cm2, G3: 15.8 cm2 p = 0.001, mid-wall shortening fraction (MWSF): G1:26.9 ± 3.5, G2:27.5 ± 4 G3:25 ± 3 p = NS; CVIB: G1:5,3 ± 2,5 G2:7.6 ± 2,1 G3:6.4 ± 1.1 P = 0.048.Correlation of IB and MWSF, p = NS; IB and MWSF p = NS, IB and CVIB:-0.56 p = 0.005.Table TABLE. Group 1 Goup 2 Group 3 PCorrelation IB PRegional S4.83 ± 0.95.68 ± 0.85.65 ± 1.30.03regional−0.49 (p = cm/seg S 0.015)Regional e/a 0.8 ± 0.3 2.1 ± 0.6 1.9 ± 1.30.002e/a−0.43 (p = 0.038)Transmitral 1.2 ± 0.3 2 ± 0.75 1.9 ± 0.90.008E/ANS E/A BI (dB)41 ± 629 ± 635 ± 80.001LAA0.43 (p = 0.037)Conclusion: (1). An increase in IB was seen in hypertensive patients, which may be the echocardiographic manifestation of myocardial fibrosis and/or depressed ventricular function. (2). IB differentiates physiological from pathological H. (3). Regional systolic and diastolic functions correlate inversely with IB in hypertensive patients, whereas LAA correlates with IB.
Hypertensive Urgencies in the Emergency Department: Evaluating Blood Pressure Response to Rest and to Antihypertensive Drugs With Different Profiles, 2008
To study the efficacy of a treatment strategy for
the management of hypertensive urgencies, the
a... more To study the efficacy of a treatment strategy for the management of hypertensive urgencies, the authors evaluated 549 patients admitted to the emergency department. They were first assigned to a 30-minute rest period, then a follow-up blood pressure measurement was carried out. Patients who did not respond to rest were randomly assigned to receive an oral dose of an antihypertensive drug with different mechanisms of action and pharmacodynamic properties (perindopril, amlodipine, or labetalol), and blood pressure was reassessed at 60- and 120-minute intervals. A satisfactory blood pressure response to rest (defined as postintervention systolic blood pressure <180 mm Hg and diastolic blood pressure <110 mm Hg, with at least a 20 mm Hg reduction in basal systolic blood pressure and ⁄ or a 10-mm Hg reduction in basal diastolic blood pressure) was observed in 31.9% of population. Among nonresponders, 79.1% had a satisfactory blood pressure response to the antihypertensive drug treatment in a 2-hour average follow-up period. No major adverse events were observed. This treatment strategy, based on standardized rest as an initial step and different antihypertensive drugs, can be effective and safe for the management of patients with hypertensive urgencies.
The left atrial appendage (LAA) is a small muscular extension that grows from the anterolateral w... more The left atrial appendage (LAA) is a small muscular extension that grows from the anterolateral wall of the left atrium, in the proximity of the left pulmonary veins. The presence of a membrane in the LAA is a rare clinical entity whose origin is not known. Its clinical implication in the genesis of atrial arrhythmias and thromboembolic risk remains unknown. We report a case of an obstructive membrane located at the base of the LAA, found incidentally in a young patient who was initially undergoing a transesophageal echocardiogram prior to an invasive treatment for atrial fibrillation.
Introduction: Autonomic imbalance and hemodynamic disturbances has been described in pre-hyperten... more Introduction: Autonomic imbalance and hemodynamic disturbances has been described in pre-hypertensive patients (PHT-JNC-VII), with increments in sympathetic drive, cardiac index (CI) and vascular resistances1. However, these autonomic alterations aren't present in all of PHTs, and different status of autonomic balance (AB) could be coexisting with different hemodynamic patterns (HP), as distinct stages in the evolution to sustained HT. Objectives: a) To evaluate AB and HP in PHTs; and b) To asses different association patterns between them. Methods: Prospective study. We included 70 patients into three different groups; a) 40 PHTs (131.4 ± 5.9/84.2 ± 5.1 mm Hg), b) 10 normotensives (NT),(112.4 ± 5.3/73.4 ± 4.9 mm Hg), and c) 20 mild HTs (148.8 ± 13.5/93.6 ± 7.1 mm Hg), all of them without treatment. AB was determined by the expiration/inspiration index (E/I) in one second/ECG; and the different HP were evaluated by determination of CI, systemic vascular resistance index (SVRI) and cardiac work index (CWI) with impedance cardiography. A cut off point of 1.25 for E/I was applied Results: a) Abnormal AB (E/I<1.25) was detected in 56.6% of PHT, 20% of NT and 37.5% of HTs. b) In PHTs, abnormal AB was related with an HP characterized for increased SVR, while subjects with normal AB presented an hyper-dynamic HP, with low SVR. (table), c) HP of PHTs with altered AB was similar to HT patients Figure 1. No caption available. Conclusions: More than of 50% of PHTs presented altered AB. Subjects with normal AB showed a hyper-dynamic HP; abnormal AB was related with an HP characterized for SVR elevated, similar to the HT patients. Differences in α and β adrenoceptors sensitivity could be associated with these different HP. In some PHTs the HP typical of HT starts below of the BP threshold of HT (140/90 mm Hg). Therapeutical measures could be used to prevent the development of HT and related organ damage.
In order to determine the natural evolution of different clinical types of “unstable angina”, 167... more In order to determine the natural evolution of different clinical types of “unstable angina”, 167 patients were included in a prospective study. After angiography, 11 (6.5%) were excluded because they had no significant coronary lesions. The remaining 156 were sorted into different groups according to their clinical characteristics and were followed up for a period of 24 months at least. After that follow‐up period, mortality and incidence of acute myocardial infarction (AMI) were as follows: angina of recent onset (Class III‐IV NYHA): 8.5% (3/35) and 34.2% (12/35). Progressive angina: 7.4% (2/27) and 7.4% (2/27). Intermediate syndrome: 41.6% (10/24) and 37.5% (9/24).Prinzmetal's angina: 10% (1/10) and 10% (1/10). Post acute myocardial infarction angina: 35% (7/20) and 10% (2/20). Acute persistent ischemia: 2.5% (1/40) and 20% (8/40). Comparison of these figures pointed out significant differences (p < 0.001 for mortality and p < 0.03 for AMI incidence respectively).We con...
To study the efficacy of a treatment strategy for the management of hypertensive urgencies, the a... more To study the efficacy of a treatment strategy for the management of hypertensive urgencies, the authors evaluated 549 patients admitted to the emergency department. They were first assigned to a 30-minute rest period, then a follow-up blood pressure measurement was carried out. Patients who did not respond to rest were randomly assigned to receive an oral dose of an antihypertensive drug with different mechanisms of action and pharmacodynamic properties (perindopril, amlodipine, or labetalol), and blood pressure was reassessed at 60- and 120-minute intervals. A satisfactory blood pressure response to rest (defined as postintervention systolic blood pressure &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 180 mm Hg and diastolic blood pressure &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 110 mm Hg, with at least a 20 mm Hg reduction in basal systolic blood pressure and/or a 10-mm Hg reduction in basal diastolic blood pressure) was observed in 31.9% of population. Among nonresponders, 79.1% had a satisfactory blood pressure response to the antihypertensive drug treatment in a 2-hour average follow-up period. No major adverse events were observed. This treatment strategy, based on standardized rest as an initial step and different antihypertensive drugs, can be effective and safe for the management of patients with hypertensive urgencies.
Introducción La hipertrofia del ventrículo izquierdo (HVI) incluye diferentes etiologías, estados... more Introducción La hipertrofia del ventrículo izquierdo (HVI) incluye diferentes etiologías, estados evolutivos y pronóstico. El strain rate sistólico (SRS) o estudio de la deformación miocárdica permite analizar la función sistólica regional al evaluar la velocidad de acortamiento ...
PABLO RODRÍGUEZ, 1, MARTÍN O'FLAHERTY2, PEDRO FORCADA2, DANIEL GRASSI2, MÓNICA DÍAZ1, DANIE... more PABLO RODRÍGUEZ, 1, MARTÍN O'FLAHERTY2, PEDRO FORCADA2, DANIEL GRASSI2, MÓNICA DÍAZ1, DANIEL FERRANTE3, MARCELO PELLIZZARI2, MARIO BENDERSKY1, DOMINGO TURRIMTSAC, 2, CAROL KOTLIAR2, en representación del Grupo de Investigadores del ...
ABSTRACT Precedents: In pathological left ventricular (LV) hypertrophy (H) of hypertensive patien... more ABSTRACT Precedents: In pathological left ventricular (LV) hypertrophy (H) of hypertensive patients (P) there is a deposition of collagen. Myocardial fibrosis is one of the factors responsible for systolic and diastolic dysfunction. Athletes increase their ventricular mass as physiological ventricular H. Integrated backscatter (IB) demonstrates changes in myocardial acoustic properties, depending upon their composition and function.Objectives: (1).Assess the capability of IB to differentiate physiological from pathological H. (2).Correlate IB with overall and regional systolic and diastolic functions.Methods: Group I(GI):13 hypertensive P with an LV mass index (LVMI)&gt;124 gr/m2, Group II(G2):11 athletes, Group III(G3): 8 volunteers. We determined overall systolic and diastolic functions and regional function of the basal septum, IB and cyclic variation of the IB (CVIB) of the posterior wall.Results: Age (years): G1:52 ± 15, G2:28 ± 8 G3:35 ± 8 p = 0.000; Sex: G1:m/f 12/1, G2: m/f 9/2, G3: m/f 4/4, LVMI: G1: 180.1 ± 58 gr/m2, G2:130.2 ± 20 gr/m2 G3: 90.2 ± 16 gr/m2 p = 0.000. Left atrial area (LAA): G1: 22 ± 4 cm2, G2: 18.8 ± 1.8 cm2, G3: 15.8 cm2 p = 0.001, mid-wall shortening fraction (MWSF): G1:26.9 ± 3.5, G2:27.5 ± 4 G3:25 ± 3 p = NS; CVIB: G1:5,3 ± 2,5 G2:7.6 ± 2,1 G3:6.4 ± 1.1 P = 0.048.Correlation of IB and MWSF, p = NS; IB and MWSF p = NS, IB and CVIB:-0.56 p = 0.005.Table TABLE. Group 1 Goup 2 Group 3 PCorrelation IB PRegional S4.83 ± 0.95.68 ± 0.85.65 ± 1.30.03regional−0.49 (p = cm/seg S 0.015)Regional e/a 0.8 ± 0.3 2.1 ± 0.6 1.9 ± 1.30.002e/a−0.43 (p = 0.038)Transmitral 1.2 ± 0.3 2 ± 0.75 1.9 ± 0.90.008E/ANS E/A BI (dB)41 ± 629 ± 635 ± 80.001LAA0.43 (p = 0.037)Conclusion: (1). An increase in IB was seen in hypertensive patients, which may be the echocardiographic manifestation of myocardial fibrosis and/or depressed ventricular function. (2). IB differentiates physiological from pathological H. (3). Regional systolic and diastolic functions correlate inversely with IB in hypertensive patients, whereas LAA correlates with IB.
Hypertensive Urgencies in the Emergency Department: Evaluating Blood Pressure Response to Rest and to Antihypertensive Drugs With Different Profiles, 2008
To study the efficacy of a treatment strategy for
the management of hypertensive urgencies, the
a... more To study the efficacy of a treatment strategy for the management of hypertensive urgencies, the authors evaluated 549 patients admitted to the emergency department. They were first assigned to a 30-minute rest period, then a follow-up blood pressure measurement was carried out. Patients who did not respond to rest were randomly assigned to receive an oral dose of an antihypertensive drug with different mechanisms of action and pharmacodynamic properties (perindopril, amlodipine, or labetalol), and blood pressure was reassessed at 60- and 120-minute intervals. A satisfactory blood pressure response to rest (defined as postintervention systolic blood pressure <180 mm Hg and diastolic blood pressure <110 mm Hg, with at least a 20 mm Hg reduction in basal systolic blood pressure and ⁄ or a 10-mm Hg reduction in basal diastolic blood pressure) was observed in 31.9% of population. Among nonresponders, 79.1% had a satisfactory blood pressure response to the antihypertensive drug treatment in a 2-hour average follow-up period. No major adverse events were observed. This treatment strategy, based on standardized rest as an initial step and different antihypertensive drugs, can be effective and safe for the management of patients with hypertensive urgencies.
The left atrial appendage (LAA) is a small muscular extension that grows from the anterolateral w... more The left atrial appendage (LAA) is a small muscular extension that grows from the anterolateral wall of the left atrium, in the proximity of the left pulmonary veins. The presence of a membrane in the LAA is a rare clinical entity whose origin is not known. Its clinical implication in the genesis of atrial arrhythmias and thromboembolic risk remains unknown. We report a case of an obstructive membrane located at the base of the LAA, found incidentally in a young patient who was initially undergoing a transesophageal echocardiogram prior to an invasive treatment for atrial fibrillation.
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Papers by Domingo Turri
the management of hypertensive urgencies, the
authors evaluated 549 patients admitted to the
emergency department. They were first assigned
to a 30-minute rest period, then a follow-up
blood pressure measurement was carried out.
Patients who did not respond to rest were randomly
assigned to receive an oral dose of an antihypertensive
drug with different mechanisms of
action and pharmacodynamic properties (perindopril,
amlodipine, or labetalol), and blood
pressure was reassessed at 60- and 120-minute
intervals. A satisfactory blood pressure response
to rest (defined as postintervention systolic blood
pressure <180 mm Hg and diastolic blood pressure
<110 mm Hg, with at least a 20 mm Hg
reduction in basal systolic blood pressure and ⁄ or
a 10-mm Hg reduction in basal diastolic blood
pressure) was observed in 31.9% of population.
Among nonresponders, 79.1% had a satisfactory
blood pressure response to the antihypertensive
drug treatment in a 2-hour average follow-up
period. No major adverse events were observed.
This treatment strategy, based on standardized
rest as an initial step and different antihypertensive
drugs, can be effective and safe for the
management of patients with hypertensive
urgencies.
the management of hypertensive urgencies, the
authors evaluated 549 patients admitted to the
emergency department. They were first assigned
to a 30-minute rest period, then a follow-up
blood pressure measurement was carried out.
Patients who did not respond to rest were randomly
assigned to receive an oral dose of an antihypertensive
drug with different mechanisms of
action and pharmacodynamic properties (perindopril,
amlodipine, or labetalol), and blood
pressure was reassessed at 60- and 120-minute
intervals. A satisfactory blood pressure response
to rest (defined as postintervention systolic blood
pressure <180 mm Hg and diastolic blood pressure
<110 mm Hg, with at least a 20 mm Hg
reduction in basal systolic blood pressure and ⁄ or
a 10-mm Hg reduction in basal diastolic blood
pressure) was observed in 31.9% of population.
Among nonresponders, 79.1% had a satisfactory
blood pressure response to the antihypertensive
drug treatment in a 2-hour average follow-up
period. No major adverse events were observed.
This treatment strategy, based on standardized
rest as an initial step and different antihypertensive
drugs, can be effective and safe for the
management of patients with hypertensive
urgencies.