Bisoprolol reduces the perioperative incidence of death from cardiac causes and nonfatal myocardial infarction in high-risk patients who are undergoing major vascular surgery.

Background-The prevalence and clinical significance of isolated office (or white coat) hypertension is controversial, and population data are limited. We studied the prevalence of this condition and its association with echocardiographic left ventricular mass in the general population of the PAMELA (Pressione Arteriose Monitorate E Loro Associazioni) Study. Methods and Results-The study involved a large, randomized sample (nϭ3200) representative of the Monza (Milan) population, 25 to 74 years of age. Participants in the study (64% of the sample) underwent measurements of office, home, 24-hour ambulatory blood pressure, and echocardiography. Isolated office hypertension was defined as systolic or diastolic values Ն140 mm Hg or Ն90 mm Hg, respectively. Home and ambulatory normotension were defined according to criteria previously established from the PAMELA Study, for example, Ͻ132/83 mm Hg (systolic/diastolic) for home and 125/79 mm Hg for 24-hour average blood pressure. Treated hypertensive subjects were excluded from analysis that was made on a total of 1637 subjects. Depending on normotension being established on systolic or diastolic blood pressure measured at home or over 24 hours, the prevalence of isolated office hypertension ranged from 9% to 12%. In these subjects, left ventricular mass index was greater (PϽ0.01) than in subjects with normotension both in and outside the office. This was the case also for prevalence of left ventricular hypertrophy. Left ventricular mass index and hypertrophy were similarly greater in subjects found to have normal office but elevated home or ambulatory blood pressure (Ϸ10% of the population). Conclusions-Isolated office hypertension has a noticeable prevalence in the population and is accompanied by structural cardiac alterations, suggesting that it is not an entirely harmless phenomenon. This is the case also for the opposite condition, that is, normal office but elevated home or ambulatory blood pressure, which implies that limiting blood pressure measurements to office values may not suffice in identification of subjects at risk.

SonoVue-enhanced MCE demonstrated superior sensitivity but lower specificity for detection of CAD compared to SPECT in a population with a high incidence of CV risk factors and intermediate-high prevalence of CAD. (A phase III study to compare SonoVue® enhanced myocardial echocardiography [MCE] to single photon emission computerized tomography [ECG-GATED SPECT], at rest and at peak of low-dose Dipyridamole stress test, in the assessment of significant coronary artery disease [CAD] in patients with suspect or known CAD using Coronary Angiography as Gold Standard-SonoVue MCE vs SPECT; EUCTR2007-003492-39-GR).

Abstract-Evidence is available that in heart failure, cardiac resynchronization therapy by biventricular pacing improves myocardial function and exercise capacity. Whether this is accompanied by a sustained inhibition of heart failure-dependent sympathoexcitation is uncertain. In 11 heart failure patients (meanϮSEM age, 68.4Ϯ1.5 years) in New York Heart Association (NYHA) class III and IV under medical treatment with an intraventricular conduction delay (QRS duration Ն130 ms), with a markedly depressed left ventricular ejection fraction, and undergoing implantation of a biventricular pacemaker, we measured beat-to-beat blood pressure and muscle sympathetic nerve traffic. Measurements, which also included echocardiographic and clinical variables, were performed before and Ϸ10 weeks after successful resynchronization therapy. Ten age-and NYHA class-matched heart failure patients who were under medical treatment for the same time period served as controls. Long-term resynchronization therapy improved cardiac function and caused a significant increase in systolic blood pressure coupled with an improvement in maximal oxygen consumption and exercise capacity. These effects were coupled with a significant and marked reduction in sympathetic nerve traffic when expressed both as burst frequency over time (44.1Ϯ3.6 vs 30.7Ϯ3.0 bs/min, Ϫ30.5%, PϽ0.02) and as burst frequency corrected for heart rate (68.3Ϯ5.9 vs 47.3Ϯ4.3 bs/100 beats, Ϫ32.1%, PϽ0.02). No significant change in the aforementioned parameters was seen in the control group. These data provide the first direct evidence that in severe heart failure, resynchronization therapy exerts a marked and sustained sympathoinhibition. Because in heart failure sympathetic overactivity adversely affects prognosis, this may have important clinical implications. Key Words: electrical stimulation Ⅲ heart failure Ⅲ sympathetic nervous system Ⅲ autonomic nervous system C ardiac resynchronization therapy (CRT) by biventricular pacing exerts favorable effects in patients with congestive heart failure (CHF) and intraventricular conduction delay in whom it improves symptoms, functional class, and quality of life with an increase in exercise tolerance. [1][2][3] Whether the favorable effects include a reduction in the enhanced sympathetic cardiovascular drive characterizing CHF 4 -6 is uncertain, however, because the studies that have addressed this issue so far had either methodological or design limitations. That is, they assessed adrenergic function only indirectly by plasma norepinephrine assay 3,7 or used direct measurement of muscle sympathetic nerve activity (MSNA) that was confined, however, to the acute phase of biventricular pacing. 8,9 The present study was designed to determine the longterm sympathetic effects of CRT in CHF patients with an intraventricular conduction delay by using a design similar to the 1 used in the MIRACLE trial, which had shown CRT to be accompanied by a sustained improvement in patient clinical status. 3 Sympathetic activity was quantified both indire...

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TDI and speckle tracking are both feasible and reproducible. Myocardial velocity and deformation parameters obtained with them are significantly different. STE is the most reproducible technique, whereas TDI based measurements are lower reproducible. STE can easily be used during clinical follow up for its feasibility and high reproducibility.

Long-term beta-blocker use is associated with a reduction in the cardiac event rate, except for patients with 3 or more risk factors and positive findings on DSE.

Spontaneous improvement of contraction and perfusion occurs after acute myocardial infarction. The relative merit of low-dose dobutamine stress echocardiography (LDDE) and rest-redistribution thallium scintigraphy (RR TI) in this setting has not been evaluated. We studied 30 patients at 7 +/- 3 days after acute myocardial infarction with LDDE (5 to 10 micrograms/kg/min) and RR TI single photon emission computed tomography. Viability was defined as improvement of wall thickening at LDDE in the presence of redistribution or a defect with uptake > or = 50% of peak activity at RR TI. Baseline echocardiography and RR TI were repeated after 3 months. In 112 dyssynergic segments, viability was detected in 60 (54%) by RR TI and in 39 (35%) by LDDE (p < 0.005). Spontaneous improvement of function was detected in 35 (31 %) segments. In the same regions, thallium uptake increased significantly. The sensitivity, specificity, and accuracy of LDDE for predicting late improvement of wall motion were 77%, 84%, and 82%, respectively. Those of RR TI were 77%, 57%, and 63%, respectively. Specificity and accuracy of LDDE were higher than RR TI (p < 0.005). We conclude that a myocardial viability pattern after acute myocardial infarction is more frequently detected by RR TI than by LDDE. Both techniques are equally sensitive, but LDDE is a more specific predictor of spontaneous recovery of regional left ventricular function.