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AimsThe clinical importance of cold-induced reversible myocardial ischaemia, known as cardiac Raynaud's phenomenon (C-Raynaud), has not been established in systemic sclerosis (SSc). This prospective study investigated the impact of C-Raynaud on long-term irreversible left ventricular (LV) functional and morphologic deterioration in SSc. Methods and resultsFifty-one SSc patients with no clinical evidence of cardiac involvement were prospectively followed up for 7.1 + 2.2 years. Systolic LV dysfunction was defined as a LV ejection fraction ,50%. Left ventricular remodelling was defined as an increase in LV volume during follow-up of more than 20% compared with baseline values. At the initial evaluation, C-Raynaud was found in 15 patients (29.4%). Of these, eight patients had severe C-Raynaud. None of the patients had systolic LV dysfunction. At the final evaluation, five patients had developed systolic LV dysfunction. In four of these five patients, the development of systolic LV dysfunction was associated with LV remodelling. At multivariate analysis, severe C-Raynaud was a strong independent determinant of the development of long-term systolic LV dysfunction. ConclusionThis study documents for the first time that severe C-Raynaud is a strong long-term predictor of systolic LV dysfunction in SSc patients. Detection of C-Raynaud is clinically important for identifying SSc patients at high risk of cardiac deterioration at latent stage.--

Wave intensity analysis is a method of studying intravascular flow wave propagation, calculated as the product of the rate of change in pressure (d P/ t) and the rate of change in velocity (d U/d t). The typical pattern of wave intensity seen during the cardiac cycle has two dominant peaks. The larger first peak (FP) occurs during early systole when a forward traveling compression wave is generated by the left ventricle. The second smaller peak (SP) follows a period of relatively little net wave production during mid-systole. Wave reflection is seen as a small backward-traveling compression wave occurring just after the first peak of wave intensity (NP). In this study, we investigated the usefulness of parameters from the wave intensity for estimating the efficacy of the Alpha-1 blocker, doxazosin, to reduce blood pressure, by the reduction of peripheral vascular resistance. We examined 20 patients with essential hypertension. Patients were included if their diastolic blood pressure was >95 mmHg on at least three separate visits to the clinic. The study consisted of a 2-week baseline phase followed by a 2-4-week dose-adjusted phase with doxazosin. Treatment began with 1 mg/day doxazosin, and the dose was doubled fortnightly until the diastolic blood pressure was <90 mmHg. Blood-pressure measurements and side effects were recorded at intervals of 2 weeks. Before and after 4 weeks of stable treatment with doxazosin, a comprehensive clinical evaluation was given. Doxazosin reduced systolic and diastolic blood pressure. Both FP and SP increased and NP decreased. DeltaMBP (change in mean blood pressure) correlated well with NP before and after the antihypertensive therapy. The efficacy of doxazosin was confirmed by the decreased reflection wave of aortic flow from wave intensity analysis. Thus, patients with a significant reflection wave may be good candidates for antihypertensive treatment by a vasodilator, such as doxazosin.

Background: Echocardiographic modalities have challenged the myocardial tissue characterization, but this reliability has not reached to the clinical use. This study investigated whether combined tissue harmonic imaging (THI) and integrated backscatter analysis (IB) provide the reliable and quantitative information about myocardial fibrosis in idiopathic dilated cardiomyopathy (DCM) in comparison with myocardial biopsy findings. Methods: We studied 56 patients with DCM. All patients underwent left ventricular endomyocardial biopsy and IB with fundamental imaging (FI) and THI. Results: In patients with good echocardiographic image quality, excellent correlations between the percentage of area occupied by myocardial fibrosis (% fibrosis) and the mean of integrated backscatter during a cardiac cycle (m-IB) measured with FI or THI were seen, and the correlation was closer with THI compared with FI. While in patients with poor image quality the correlation between m-IB and % fibrosis was only modest with FI, but the correlation was excellent with THI. Four cut-off values of m-IB with THI obtained from receiver operating characteristic curve discriminated between % fibrosis of more and less than 25, 30, 35, and 40% with high sensitivity and specificity. Multivariate analysis revealed that m-IB with THI was an independent predictor for discrimination of the severity of myocardial fibrosis. Conclusion: Combined IB and THI are a clinically applicable method and may be an alternative to myocardial biopsy in evaluating quantitatively myocardial fibrosis in DCM.

Intra-atrial electromechanical coupling intervals were delayed in patients with progressive systemic sclerosis. Thus, the mechanical late diastolic filling time due to atrial contraction in the total diastolic phase was severely limited, and this resulted in a restricted mitral A wave. We should therefore evaluate patients with progressive systemic sclerosis for significant atrial abnormalities.