American heart journal
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American heart journal · Dec 1996
Comparative StudyCorrespondence of aortic valve area determination from transesophageal echocardiography, transthoracic echocardiography, and cardiac catheterization.
The correspondence of aortic valve area measurements from transesophageal echocardiography, transthoracic echocardiography, and cardiac catheterization was determined in 100 patients with severe aortic stenosis (aortic valve area < or = 0.75 cm2), moderate aortic stenosis (aortic valve area > 0.75 to < or = 1.2 cm2), mild aortic stenosis (aortic valve area > 1.2 to < or = 2.0 cm2), and nonstenotic aortic valves (aortic valve area > 2.0 cm2). Because high correlation does not require high agreement, data were assessed by analysis of agreement. ⋯ Similar levels of agreement when comparing these independent methods for determining the aortic valve area indicate that direct planimetry by transesophageal echocardiography, the continuity equation with transthoracic echocardiography, and the Gorlin formula are equally accurate and may be used interchangeably. Clinically important discrepancies between methods are uncommon and are readily settled by adding a third method.
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American heart journal · Nov 1996
Randomized Controlled Trial Comparative Study Clinical TrialTreatment and post-treatment effects of alpha- versus beta-receptor blockers on left ventricular structure and function in essential hypertension.
This study was undertaken to compare the effects of alpha-receptor blockade and beta-receptor blockade on left ventricular structure and function in essential hypertension. The increase in left ventricular mass in patients with essential hypertension is at least partly induced by the sympathetic nervous system. We conducted a double-blind, randomized, controlled clinical trial to compare the effects of alpha-blockers and beta-blockers on left ventricular structure and function. ⋯ Furthermore, the increase in diastolic filling was lost shortly after withdrawal of metoprolol concomitant with the increase in heart rate. We conclude that alpha-blockers and beta-blockers are equally capable of reducing left ventricular mass in hypertensive patients. beta-Blockers lead to an increase in diastolic left ventricular filling. This effect may be of therapeutic value because diastolic dysfunction may precede systolic dysfunction in hypertensive heart disease.
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American heart journal · Oct 1996
Intermittent inotropic therapy in an outpatient setting: a cost-effective therapeutic modality in patients with refractory heart failure.
Patients with intractable heart failure (New York Heart Association [NYHA] class III and IV) who were receiving maximal conventional treatment were enrolled in an outpatient program that included inotropic infusions, intensive patient education, and close follow-up. The effects of this approach to therapy were evaluated on (1) the number of hospital admissions, (2) length of stay, and (3) number of emergency room visits during the ensuing year. These data were compared with similar data from the year before entry in the program for each patient. ⋯ After enrollment, patients had 10 emergency room visits, 34 admissions, and 150 days spent in the hospital. In conclusion, this therapeutic regimen reduced the number of hospital admissions, days spent in the hospital, and emergency room visits. Our study supports the concept that the use of intermittent inotropic therapy in the outpatient setting plays an important role in managing this severely ill group of patients.