International journal of cardiology
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To evaluate left atrial (LA) function in subjects with early stage primary hypertension (HT) and without enlargement of LA, we used transthoracic echocardiogram and measured LA volumetric emptying fraction and compared the results with those in healthy volunteers. ⋯ In subjects with early stage primary HT with normal sinus rhythm, in spite of a normal LAV, the LAEF may increase. This increase of LAEF may be regarded as one of the compensatory reactions against preload to the left side of the heart and precedes the occurrence of LA enlargement.
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Letter Case Reports
Autonomic nervous system instability, tetanic necrosis of the heart and myocardial TNFalpha expression in a tetanus fatal case.
The cardiovascular manifestations of tetanus consist of disturbances of heart rate and rhythm, blood pressure instability, arrhythmias, myocardial dysfunction and sympathetic overactivity. It was suggested that either a sudden loss of catecholamine stimulation or myocardial damage caused by the direct action of the tetanus toxin, could be involved in cardiac dysfunction described in tetanus. ⋯ We report a fatal case of tetanus in which we investigated the cardiac morphology and the expression of TNFalpha to elucidate the heart involvement in this case. Since it is well known that myocardial damage caused by catecholamines can induce synthesis of cytokines by myocytes, cytokines, specifically those with known cardiodepressant properties such as TNF-alpha, could be an alternative mechanism involved in cardiac dysfunction in the setting of tetanus.
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Randomized Controlled Trial
The use of B-type natriuretic peptide in the management of patients with atrial fibrillation and dyspnea.
The utility of B-type natriuretic peptide (BNP) testing in patients with atrial fibrillation (AF) is poorly defined. We analyzed patients (n=452) included in the BNP for Acute Shortness of Breath Evaluation (BASEL) study. Patients were randomly assigned to a diagnostic strategy with or without the use of BNP. ⋯ Initial total treatment costs (median) were $4239 [769-7422] in the BNP group and $5940 [4024-10848] in the control group (P=0.041). These benefits were maintained after 90 days: patients in the BNP group had spent fewer days in hospital (10 days [2-21] versus 15 days [IQR 9-27]; P=0.022) and induced lower total treatment costs ($4790 [1260-9387] versus $7179 [4311-13173]; P=0.016). In conclusion, the use of BNP seems to improve the management of patients with AF presenting with dyspnea.
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Early diastolic transmitral velocity (E)/early mitral annular diastolic velocity (Ea) ratio has been proposed as the best Doppler predictor for evaluating left ventricular (LV) filling pressure. ⋯ E/(EaxSa)(average) was the best predictor of LVEDP in sinus rhythm patients, regardless of LVEF, particularly in those with E/Ea(average) between 8 and 15 and in those with regional dysfunction.