Lemole, Gerald M.

McNicholas, Kathleen W.

Serra, A.Jorge

Shapira, Nadiv

Spagna, Paschal M.

Weiner, Henry

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270A ABSTRACTS JACC Vol. 17. No. Z February 19913273A 
DETERHINANTS OF ABNORMAL EFT VENTRGCULAR WALL 
THICKENING IN PATIENTS WITH ESSENTIiAL 
HYPERTENSION 
George A. Mensah, Xmes 
Blake, John H. $ragh, Richard B. De 3reux. 
Cornell Medical Center, New York, NY 
We have shown abnormal (abnl) LV relative wall 
thickness (RWT) is an independent predictor of 
complications in essential hypertensive (EH) 
pts. We studied 381 uncomplicated EM pts by 
echocardiography to determine the relationship 
between abnl RWT and age, systolic blood 
pressure (SBP), diastolic blood pr&sssure (DBP), 
cholesterol level (chol), height (ht), weight 
(wgt), sex and race. Relative wall thickness, 
defined as twice the LV free wall thickness 
divided by the LV internal dimension, 10.45 
was considered abnl. The study group consisted 
of 249 men and 132 women with a mean age=47113 
years, SBP=156&22 mm Hg, DBP=98+12 mm Hg, and 
cho1=239&54 mg/dl: 11% were black. Abnl RWT 
was found in 55 pts. In univariate analysis, 
age (p=O.OOOC), SBP (p<O.OOOl), DBP (p=O.O002), 
chol (p=O.OZ), ht (p=O.Ol) and race (p==O.O3), 
but not sex (p=O.55) or wgt (p=O.57), were 
associated with abnl RWT. In multivariate 
analysis, only chol (p=0.02), race (p=O:O4), 
DBP (pmO.05) and probably age (p=O.O6) were 
predictors of abnl RWT. Ht (p=O.51), wgt 
(p=O.26), and SBP (p=O.19) did not contribute 
significantly to multivariate equations. Thus, 
we conclude that abnl LV wall thickening 
reflects multiple factors including chol, race, 
DBP, and age, but not sex, ht and wgt. 
RELATIONSHIP BETWEEN PARATHYROID HORMONE AND IMPAIRED 
MICROCIRCULATION IN MODERATE SSENTIAL HYPERTENSION 
Deniel Duprea, Marc De Buyzere, Frank Bauwens, Jan Ver- 
cammen, Tine De Backer, Denis Clement, University 
Hospital, Gent, Belgium. 
The role oE non-hemodynamic factors on the microcircula- 
tion in patients with essential arterial hypertension has 
not yet been studied. In a series of 36 patients (age 
45.3~2.1 years) with newly diagnosed, Freviously un- 
treated moderate essential hypertension (mean SBP 1602 
3.4 mm Hg, mean DBP 102+-1.5 mm-Hg) parameters of the 
capillaroscopic examination of the Eingsr microcircula- 
tion (mean number (NRCAP) and length (LECAP, urn) of the 
capillaries, diameter (pm) of the efferent (EFDI) and 
afferent (AFDI) capillaries and mean red blood cell velo- 
city (RBCV, pmlsec) which was measured by the Elying 
spot technique were correlated with a number of hormones 
(Tartpled after an overnight East) including : insulin, 
cor:isol, aldosterone, renin and parathyroid hormone 
(PTH) . Significant correlation (p < 0.05) couldbe ob- 
tained between several parameters of the microcirculation 
and PTH : PTH (23.622.0 (SEM) pg/ml) -NRCA? (15.3+0.8) : 
~-0.535, p=O.O38 ; PTH-LECAP (219+24) : r=-0.429, ~30.107 
PTH-EFDI (183+0.38) : rm0.463, p=OrO28 ; PTH-AFDI (2.87+ 
0.35) : r - 0.631, p=O.Oll ; PTH-RBCV (780+76) : ra-0.6i5. 
p=o.o19. All patients had PTH levels (mea; 27, range 
lo-58 pgiml) within the reference limits. None of the 
other hormones 
niffcance with 
assayed could reveal any statistical-sig- 
the parameters of the microcirculation, 
Conclusion : In patients with moderate essential arterial 
hypertension, PTH is inversely correlated with the number 
of capillaries and the capillary red blood cell velocity, 
while it is positively correlated with the efferent and 
the afferent capillary diameter. 
EN HVPERTE 
Alvise Polese,Nicoletta DeCesare,Franco Fabbiocchi,ples- 
sandro Loaldi,Piero Montorsi,fktna ~postoIo,Setqio C0221p 
Maurizio D.Guarri. Institute of Cardiology,C.N.R.,UnIver- 
sity of Mllan,Italy. 
320 untreated primary hvpertensives (H) and 320 normoten- 
sifes (N) similar in aqe and qender distr lbutlon , under- 
went quantitative corondr~ anqioqraphy because of effort 
angina and oositive exercise test. In all pts at least one 
siqnrficant stenosis of a major coronary branch was docu- 
mented. Prevalence of single and double vessel disease 
CUD) in the 4th and 5th decades of life was similar in the 
two qroups and tended to decline with aging. Prevalence of 
triple VD was also similar In the two groups in the 4th 
and 5th deL SJ c .5,~,-ua~:.Ib-1) it rose with age and 
reached a pear at the 7th decade; the percentages of H in 
the 6th and 7th decades with triple VD were siqniflcantly 
(p< 0.01) greater (40 and SO%,respectively) thdn the 
corresponding values in N (25 and 3lX,respectivelyl. Left 
main was not more Involved in Ii. Pressure was moderately 
and similarly raised at any age in H; serum cholesterol 
and triglvcerides, blood qlucose and smoklnq hablt were 
comparable in the two qroups. Thus, coronary narrowings or 
multiple VD does not dppears to be accelerated by hvper- 
tension. Starting from the t,th decade the evolution of the 
coronary disease seems to be aggravated in Ii, ak reflected 
by an augmented number of diseased vessels: this process 
is probably related to hrqh blood pressure in 
itse!f:whether the severity of hypertension might also 
exert an influence is not inferable from this study, 
CIl though in high blood pressure coronary disorders other 
than atherosclerosis have d putative part in roronary 
events, the link between epicardial branth narrowlngs and 
classic effort angina seems to be a substantial one. 
PERICARDIAL ATTACHMENT OF TEMPORARY PACING LEADS: A SAFE 
ALTERNATIVE. 
Nadiv Shapira, A. Jorge Serra, Henry Weiner, Paschal M. 
Spagna, Kathleen w. McNicholas, Gerald M. Lemole, Med. Ctr. 
of DE, Wilmington, DE, and the Med. Coll. oE PA, Phila, PA 
Temporary pacing leads are routinely attached to the 
right ventricle and right atrium (RV,RA) during cardiac 
surgery. Attachment is accomplished by either passing the 
leads through the epicardium or by securing them to the 
epicardial surface by sutures. Both methods carry the 
potential risk of epicardial tear, hemorrhage and tempo- 
nade . Furthermore, atria1 pacing is frequently unsuccess- 
ful due to high threshold. 
A new method by which leads are attached to the cardiac 
aspect of the pericardium and only abut the RA or RV has 
been tested in 25 cardiac surgical pts. The pericardial 
RA (PRA! leads were compared to conventional epicardial or 
appendageal RA (ERA, ARA) 1eads;and the pericardial RV 
leads (PRV) to subepicardial RV (S.;RV) leads. 
None of the PRA leads have failed, while of the ERA and 
ARA leads, 4 and 5, consecutively, failed. The mean 
thresholds in the 1st post-op day cf the PRA leads was 
significantly (P < .05) lower than the ERA and ARA leadsa 
2.6el.I mA, 8.7 + 5.7 mA and 12.6 + 3.8 mA, consecutively. 
None of the RV leads has failed, anz the thresholds of the 
PRV and SERV leads were similar, 2.0 + 1.4 mA and 1.5 + 
0.5 mA, consecutively. The pericardizlly attached lea& 
were effective until removal on 5th post-op day, with only 
minimal increase in threshold. There were no &mplica- 
tions associated with removal of the leads. 
Thus, the method of pericardial attachment of pacing 
leads is effective, reliable and safe. 


Pericardial attachment of temporary pacing leads: A safe alternative 

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Pericardial attachment of temporary pacing leads: A safe alternative

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