Burch, Michael

Davies, Michael J.

Mann, Jessica M.

McKenna, William J.

Elsevier - Publisher Connector 

328A ABSTRACTS JACC Vol. 17, No. 2 February 1991:3?8A 
ATRIAL NATRIURETIC PEPTIDE RELEASE IN 
; IYPERTROPHIC CARDIOMYOPATHY (HCM): ASSOCIATION 
WITH ABNORMAL PERIPHERAL VASCULAR RESPONSES 
DISTINCTION BETWEEN ATHLETE HEART AND 
HYPERTROPHIC CARDIOMYOPATHY 
QUANTITATIVE ASSESSMENT OF REGION:: 
, Vitantonio Di Bello, Eugenio Picano, Paolo Spirito, 
Maria Teresa Caputo, Luigi Talarico, Alessandro Maxzarisi, Luigi 
Landini, Carmine Di Muro, Gino Santoro, Costantino Giusti, Carlo 
Vccchio. Istitute of Clinical Physiology C.N.R., 2nd Medical Clinic, 
University of Pisa and Cardiology Division, Galliera Hospital, 
Genova, Italy. 
We have previously shown that integrated backscatter (IB) index is 
higher in 
control su Ii 
ts with hypertrophic cardiomyopathy (HCM) than in 
jects. To ascertain whether IB value is useful in the 
distinction between HCM and athletes with myocatdiat hypertrophy, 
we evaluated with conventional echo-Doppler technique 10 HCM 
asymptomatic pts and 10 elite athletes (weight lifters). An on-line 
radio frequency analysis (by means of a prototype implemented in our 
Institute) was also performed to obtain quantitative operator 
independent measurements of the IB signal of the ventricular septum 
and the posterior wall. The integrated values of the radio frequency 
agnal were nonnaked for the pericardial interface and expressed in 
percent (IBQ). HCM pts and athletes showed comparable values LV 
end-dtastolic diameter (46 f 7, mean f SD, vs 53 f 4 mm), septal(17 
f I vs 15 f 1 mm) and posterior wall (IO f I vs 12 f 1 mm) 
end-diastolic thickness, On the contrary, IB% values were 
significantly higher in HCM vs athlethes for both the septum (55 f 14 
vs 23 f 8%. pc.01) and the posterior wall (40 f I2 vs 12 f 3, 
tX.01). 
We conclude that quartitative assessment of ultrasonic reflectivity may 
be of.value in distinguishing physiologic LV hypertrophy due to 
athlehc training from pathologic LV hypertrophy due to HCM. 
. 
ASSESSHENT OF 
NOONAN’S SYNDR 
, Michael Burch, Michael J. Davies. 
Wil l iam J. NcKenna, St George’s Hospital, London. 
Patients with Noonan’s syndrome ,NS) have been reported 
to have echocardiographic features of hypertrophic 
cardiomyopathy (HCM). The presence of characteristic 
histological features of HCH in NS has not been 
assessed. We studied the hearts of 7 necropsy patients 
with NS and echocardiographic LVH vho died suddenly or 
in heart failure (age 2 weeks to 10 years; 6 were male). 
These were compared to age-matched control children 
dying of non-cardiac causes. In all cases, a transverse 
cut of both ventricles was fixed and stained with H&E, 
and the presence or absence of disarray evaluated with 
an image analyser at a constant magnification of x 16. 
The ventricular septum was evaluated counting 200 fields 
for each of the Noonan patients and 100 for the 
controls . The presence of disarray was significantly 
higher in the septum of NS (26.14 vs 3.832, p<O.OOl). 
The same procedure was carried out for the left 
ventricular free wall, screening 100 fields for each of 
the Noonan patients and controls. The frequency of 
disarray in the LV free wall was also significanely 
higher in NS (22.33 vs 3.33%. p~O.001). Thus, NS with 
LVH shows a significantly higher incidence of q yocardial 
disarray than age-matched controls. Similar post-mortem 
evaluation of children with HCN has not been reported, 
however, the extent of disarray seen in NS is similar to 
that reported in adults with HCM. Whether the presence 
of echocardiographic and histological features of HCW in 
patients with NS represents autosomal dominant familial 
HCM remains to be determined by pedigree analysis and 
ultimately by identification of the molecular defect. 
8:30 
MULTIVESSEL CORONARY ANGIOPLASTY IN THE 
ELDERLY : 10 YEAR EXPERIENCE. 
Barry D. Rutherford, David R. 
McConahay, Lee b. Giorgi, Warren L. Johnson, 
James H. O'Keefe, Thomas M. Shimshak, Geoffrey 
0. Hartzler, Mid America Heart Institute, 
Kansas City, MO. 
Bypass surgery 
increased morbidity (='!nd 
is associated 
elderly. 
mortality 
Accordingly, we examined the outcome 
of 1373 Pts, 
underwent 1640 
65 (7125) years and older, who 
multivessel coronary 
plasty (Mv PTCA) procedures over 10 ig!:z. 
224 (14%) Pts had an ejection fraction ~40% 
and 412 (25%) had prior CABS. A mean of 3.5 
lesions were dilaErfe pe;f R96\ith an angro- 
graphic success Complete 
reFsc;;ari..z3a\y)n was achieved in 857 (5?%) 
comilication: 
Fts experienced a 
There were 27 (1.6%) death?:: 
(1.4%) myocardial infarctions, and 14 (018%) 
emergent CABS procedures. Independent pre- 
dictors of mortality were ejection fraction 
(40% (PSO. 001) , 3 vessel disease (psO.Ol), 
female gender (psO.O2), and procedure date 
before 1985 (~~0.05). 1023 Pts have been 
followed 21 year (33+21 months). 
Pts underwent CABS, 
162 (16%) 
81 (8%) had a myocardial 
infarction and 156 (15%) died during follow- 
Zuarial survival was 92% 86% iEE% BpfS* 
371 (36%) Pts required 
3 and 5 ears. 
in Pts w th 2 vessel disease (psO.008) and in 1 
Improved s&viva1 was observe; 
those completely revascularized 
Conclusion 1) WV PTCA in 
(p10.001). 
high prima success rate 
e elderly has a 
complete revascularization 
IOU risk. 2) 
survival. 
improves long-term 
WV PTCA is a safe and effective 
alternative to CABS in the elderly. 


Assessment of myocardial disarray in patients with Noonan's syndrome and left ventricular hypertrophy 

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Assessment of myocardial disarray in patients with Noonan's syndrome and left ventricular hypertrophy

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