EFFECTIVE INVERSION OF LEFT HEART REMODELING BY PHENYLALANINE IN ESSENTIAL HYPERTENSION

Objective The aim is to ascertain whether phenylalanine (Phe) can inverse the left heart"remodeling" in patients with essential hypertension. Methods The changes of echocardiographic variables werecompared aler 3,6 and 9 months of observation between the Phe intervention group (Phe 1g/d+amiloride complex1 tablet/d, 20 cases) and control group (placebo 1g/d+amiloride complex 1 tablet/d, 20 cases) with eitherinterventricular septum and (or) post- wall thickness≥12mm, and were carried on further to compare incross- over trial. Results (1) Phe improved elfectively the left heart and systolic dyslunction; while theimprovement, also shown in control group due to the concurrent use of diuretic antihypertensive drug-amiloridecomplex, was much less evident than that in Phe group. (2) The disturbed left heart structure and systolic functionwere improved prominently while placebo was crossed over to Phe, and the improvement decreased afer Phe wascrrossed over to placebo. (3) The changes almost attained to its peak level after 6 months and not improved furtherat 9 months. (4) The differences seen between above 2 groops could not be eoplained by their diverse drops of bloodpressure. Conclusion Phe does exert an indopendent inverse effect on cardiac "remodeling", which mightimplicate an important clinical oplication upon the prevention and control of essential hypertension and itscomplications.

Animal models of pulmonary hypertension due to left heart disease

Pulmonary hypertension due to left heart disease(PH-LHD) is regarded as the most prevalent form of pulmonary hypertension(PH). Indeed, PH is an independent risk factor and predicts adverse prognosis for patients with left heart disease(LHD). Clinically, there are no drugs or treatments that directly address PH-LHD, and treatment of LHD alone will not also ameliorate PH. To target the underlying physiopathological alterations of PH-LHD and to develop novel therapeutic approaches for this population, animal models that simulate the pathophysiology of PH-LHD are required. There are several available models for PH-LHD that have been successfully employed in rodents or large animals by artificially provoking an elevated pressure load on the left heart, which by transduction elicits an escalated pressure in pulmonary artery. In addition, metabolic derangement combined with aortic banding or vascular endothelial growth factor receptor antagonist is also currently applied to reproduce the phenotype of PH-LHD. As of today, none of the animal models exactly recapitulates the condition of patients with PH-LHD. Nevertheless, the selection of an appropriate animal model is essential in basic and translational studies of PH-LHD. Therefore, this review will summarize the characteristics of each PH-LHD animal model and discuss the advantages and limitations of the different models.

Evaluation of the asynchronization and function of the left ventricle in patients with chronic pulmonary hypertension by velocity vector imaging

Background Pulmonary hypertension （PH） is a set of pathophysiological syndromes characterized by increased pulmonary artery pressure and pulmonary vascular resistance,resulting in increased right ventricular afterload.The left and right ventricles interact through hemodynamics.What impact will PH have on synchronization and function of the left ventricle （LV）？ The aim of this study was to evaluate the synchronization of the left ventricular wall motion and left ventricular function in patients with varying degrees of PH using velocity vector imaging （Wl） technology.Methods Sixty patients with chronic PH served as the experimental group,and 20 healthy volunteers served as the control group.According to the different degrees of pulmonary artery systolic pressure,the experimental group was divided into three groups：mild,moderate,and severe PH groups.The time to peak systolic longitudinal velocity （Tvl）,the peak systolic longitudinal velocity （Vsl）,the peak diastolic longitudinal velocity （Vel）,the peak systolic longitudinal strain （SI）,and strain rate （SRI） in 18 segments were measured in each group.Results TvI in the control group and each group with PH was reduced from basal to apical segment,and in control group Tvl in various segments of the same wall and in different walls showed no significant difference （P ＞0.05）.With increase in pulmonary artery pressure,Tvl values measured showed an increasing trend in groups with PH.In groups with PH,Vsl and Vel of each wall were reduced sequentially from basal to apical segments,showing gradient change; Vsl and Vel values measured showed a decreasing trend with increase in pulmonary artery pressure,in which the differences of Vel values measured in the control group and the mild PH group were statistically significant （P ＜0.01）,and the differences between other groups were statistically significant （P ＜0.01）.In groups with PH,SI and SRI in basal segment and the middle segment of each wall were decreased; the difference between groups was statistically significant （P ＜0.01）.Conclusions Asynchronization of the LV and decreased left ventricular function were present in patients with chronic PH;WI technology can accurately evaluate left ventricular function in patients with PH,and indicators such as Tvl,Vsl,and Vel are valuable.

Nutcracker syndrome

The nutcracker phenomenon [left renal vein(LRV) entrapment syndrome] refers to compression of the LRV most commonly between abdominal aorta and superior mesenteric artery.Term of nutcracker syndrome(NCS) is used for patients with clinical symptoms associated with nutcracker anatomy.LRV entrapment divided into 2 types:anterior and posterior.Posterior and right-sided NCSs are rare conditions.The symptoms vary from asymptomatic hematuria to severe pelvic congestion.Symptoms include hematuria,orthostatic proteinuria,flank pain,abdominal pain,varicocele,dyspareunia,dysmenorrhea,fatigue and orthostatic intolerance.Existence of the clinical features constitutes a basis for the diagnosis.Several imaging methods such as Doppler ultrasonography,computed tomography angiography,magnetic resonance angiography and retrograde venography are used to diagnose NCS.The management of NCS depends upon the clinical presentation and the severity of the LRV hypertension.The treatment options are ranged from surveillance to nephrectomy.Treatment decision should be based on the severity of symptoms and their expected reversibility with regard to patient's age and the stage of the syndrome.

Multi-Institutional US Experience of the Occlutech AFR Device in Congenital and Acquired Heart Disease

Objectives:To detail the US multi-institutional experience with the Occlutech©(Occlutech International AB,Helsingborg,Sweden)atrial flow regulator(AFR)in children and adults with acquired or congenital heart disease.Background:The creation of a long-term atrial communication is desirable in several cardiovascular disease phenotypes,most notably pulmonary arterial hypertension,disorders of increased left ventricular filling and increased cavopulmonary pressures in patients with a Fontan type circulation.Methods:Patients were identified for inclusion from the AFR device manufacturer database.Data was collected using a RedCap database following IRB approval.8 weeks of follow up data was sought for each patient based on available data.Data was analyzed and summarized using SPSS.Results:We report the experience of 6 US centers in the implantation of AFR devices in 15 patients,across a wide age range,with different disease phenotypes and a variety of indications.Implantation was technically successful in all patients and improvement was noted in both clinical and hemodynamic parameters.There were no immediate or intermediate term complications reported.3 patients died remote from implantation.Their deaths were not felt to be related to the AFR device or related procedural complications.Conclusion:Compassionate use of the AFR device in children and adults with congenital&acquired heart disease is technically feasible and produces beneficial short term hemodynamic and symptomatic improvement.Widespread uptake of this technique and treatment at specialist centers has the potential to provide significant benefits to a variety of complex patients with currently limited treatment options and indeterminate prognosis.

EFFECT OF PERINDOPRIL AND METOPROLOL ON LEFT VENTRICULAR HYPERTROPHY AND PERFORMANCE IN ESSENTIAL HYPERTENSION

The effects of perindopril and metoprolol on left ventricular hypertrophy (LVH) and function were studied in 47 essential hypertensive patients with LVH. Previous antihypertensive drugs were discontinued for at least 2 weeks, after which patients were randomly divided into 2 groups. 25 subjects were treated with perindopril 4 to 8 mg once daily in the morning (Group A) and 22 subjects with metoprolol 25 to 62.5 mg twice daily (Group B). The subjects were evaluated before and after 4 and 8 weeks of treatment by use of echocardiography. Before treatment LV mass indexes (LVMI) of two groups were respectively 143.2 ± 21.3 g / m2 and 140.6 ± 23.7 g / m2 (P>0.05). In Group A, reduction of LVMI occurred after 4 weeks of treatment, and more pronounced after 8 weeks (from 143.2 ± 21.3 g / m2 to 126.6 ± 15.3 g / m2, P< 0.001), whereas reduction of LVMI occurred only after 8 weeks in Group B (from 140.6 ± 23.7 g / m2 to 133.4 ± 13.2 g / m2, P< 0.001). In addition, there was a significant (P<0.05) difference in LVMI between the two groups after 8 weeks. LV systolic function remained unchanged, whereas E / A increased significantly (P< 0.001) in two groups after 8 weeks. In conclusion, antihypertensive treatment with perindopril and metoprolol induced a significant regression of LVH associated with improvement in LV diastolic performance. Perindopril, compared with metoprolol, was more effective in reversing LVH.

Characteristics of biochemical markers in patients with pulmonary hypertension related to left heart disease

Objective To investigate the differences of biochemical markers between the patients with pulmonary hypertension related to left heart disease(PH-LHD)and LHD;to explore the sensitive biomarkers which may predict PH in LHD patients.Methods A total of 355 LHD patients admitted to our hospital from 2014-01 to

THE EFFECT OF ISOPTIN SR ON BLOOD PRESSURE,HEART FUNCTION AND HYPERTROPHY OF LEFT VENTRICLEOF HYPERTENSIVE PATIENTS

Isoptin SR was used in 65 essential hypertensive patients.240mg Isoptin SR(German Knoll Pharmaceutical company) Per day was used in group A(35 cases)for 6 weeks,and in guoup B(30 cases)for 24 weeks,BP in group a and B decreased obviously in the first and second week after treament.