International journal of cardiology
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Comparative Study
The influence of age on gender-specific differences in the left ventricular cavity size and contractility in patients with hypertrophic cardiomyopathy.
The aim of the study was to assess gender-specific differences in left ventricular cavity size, contractility and left ventricular outflow tract obstruction in younger and older subgroups of patients with hypertrophic cardiomyopathy. ⋯ In patients with hypertrophic cardiomyopathy, the gender-based differences in the absolute value of left ventricular cavity size persisted with aging. In older females left ventricular contractility was higher and left ventricular outflow tract gradient occurred more frequently than in males. In younger patients with hypertophic cardiomyopathy these sex-based differences were absent. The gender-specific differences in the parameters of left ventricular systolic function became apparent with increasing age.
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Dobutamine-inducible left ventricular obstruction lacks a sound clinical meaning. This phenomenon may be related to an abnormal response of the heart to the sympathetic stimulation, and head-up tilt would elicit intraventricular obstruction in patients known to develop it during dobutamine administration, through the synergistic effects of reduced preload, hypercontractility, and reflex increase in the cardiac sympathetic tone. ⋯ Reflex cardiovascular adaptive responses as those elicited by passive tilt are not involved in dynamic intraventricular obstruction in dobutamine-inducible obstruction patients, data indicating that left ventricular geometry and hypercontractility are not sufficient pathophysiological determinants.
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Proinflammatory cytokines such as tumor necrosis factor alpha (TNF-alpha), interleukin (IL)-6, and IL-8 have been implicated in myocardial injury following cardiopulmonary bypass (CPB). However, little evidence is currently available to directly confirm such a relationship. We have previously documented that a newly discovered 'four and a half LIM-only protein 2' (FHL2) is exclusively expressed in myofibres. We hypothesized that the upregulation of FHL2 is proportional to the degree of myocardial injury and investigated the myocardial expression of FHL2 together with these cytokine messenger RNAs (mRNAs) during clinical CPB. ⋯ Our findings demonstrate for the first time that both IL-6 and IL-8 mRNAs are upregulated in human cardiac myocytes following CPB and these cytokines may be involved in myocardial ischemia-reperfusion injury, as reflected by their association with an increased expression of FHL2.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Safety and efficacy of valsartan versus enalapril in heart failure patients.
Although a cornerstone in the treatment of heart failure, angiotensin-converting enzyme inhibitors are under-used, partly due to side effects. If proven at least similarly efficacious to angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers may replace them due to their superior tolerability. We aimed to compare the efficacy and safety of valsartan and enalapril in heart failure patients stabilised on an angiotensin-converting enzyme inhibitor. ⋯ Left ventricular size (P<0.001) and function (P=0.048) improved significantly only in the valsartan group. Fewer patients experienced adverse events in the valsartan group (50%) than in the enalapril group (63%), although statistically non-significant. Valsartan is similarly efficacious and safe to enalapril in patients with stable, mild/moderate heart failure, previously stabilised on an angiotensin-converting enzyme inhibitor and directly switched to study medication.