In our study, 9I men, under 65 years of age, with clinically overt coronary heart disease were compared with 98 healthy men in respect of fasting plasma cholesterol, triglyceride and other lipid moieties, relevant past andfamily history, smoking habits, a ponderal index, blood pressure, and prevalence of corneal arcus, xanthomata, and baldness. Some dietary aspects were also taken into account.The analysis showed that the main discriminators were diastolic blood pressure, arcus, baldness, xanthelasma, a family history of hypertension, past smoking habits, and hyperlipidaemia. Of these factors, diastolic hypertension emerges as much the most important.

SUMMARY Two young women (aged 32 and 25 years) with systemic lupus erythematosus and heart valve lesions in association with antiphospholipid antibodies are presented. In addition to the presence of the 'lupus anticoagulant' and false positive Venereal Disease Research Laboratory (VDRL) tests, both patients had high levels of IgG anticardiolipin antibodies. The first patient additionally had contraceptive induced chorea, chorea gravidarum, seven miscarriages, livedo reticularis, pulmonary embolism, and thrombocytopenia and developed culture negative endocarditis as well as hypertension. The second patient, who had presented with hypertension, developed aortic and mitral regurgitation, suspected myocarditis, manifested transient ischaemic attacks, and responded well to anticoagulation and steroid treatment.

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Left ventricular 'relative wall thickness', determinedfrom the ratio between echocardiographic measurements of end-systolic wall thickness and cavity transverse dimension, was related to peak systolic intraventricular pressure in I5 normal subjects, in I5 patients with left ventricular volume or pressure overload without aortic stenosis, and in 23 patients with aortic stenosis. All these patients had a mean rate of circumferential fibre shortening greater than I.O circumference per second and were regarded as having good ventricular function. Relative wall thickness was found to be normal in cases of volume overload and to be increased in pressure overload, being proportional to the systolic intraventricular pressure. Values for the ratio of systolic intraventricular pressure to relative wall thickness in the normal subjects and patients without aortic stenosis were similar (mean 30+ 2.5). Based on this relation, estimates ofpeak systolic intraventricular pressure were made in the cases of aortic stenosis using theformula: systolic intraventricular pressure (kPa) = 30 x wall thickness . transverse dimension. Peak systolic aortic valve gradients derived by subtracting brachial artery systolic pressure, measured by sphygmomanometer, from the echocardiographic estimates of intraventricular pressure comparedfavourably with the gradients measured at left heart catheterization (r=o.87, P< o.OOi).Aortic valve orifice areas, derived from echocardiographic estimates of stroke volume, ejection time, and valve gradient, rangedfrom 0.21 to 3.16 cm2 and appeared to correlate with the severity of aortic stenosis. All patients with aortic stenosis, with or without coexistent mild aortic regurgitation, who were recommended for aortic valve surgery, had estimated valve orifice areas of less than o.8 cm2.A further io patients with pressure or volume overload had mean rates of circumferentialfibre shortening of less than I.o circumference per second and were regarded as having poor ventricular function. In these cases values for relative wall thickness were lower than in those with good ventricular function and were not proportional to systolic intraventricular pressure.In patients with good left ventricular function systolic intraventricular pressure is proportional to, and can be estimatedfrom, echocardiographic measurement of relative wall thickness.

Echocardiography detected asymmetric septal hypertrophy (ASH) in five of 200 adults being assessed for aortic valve surgery. Four of these were among 119 patients with dominant aortic stenosis, which was severe in three. ASH was confirmed at the time of aortic valve replacement in two of these patients; the third declined operation.The finding of ASH in only one of 81 patients with free aortic reflux is consistent with chance association. While the same explanation could apply to the higher prevalence in those with aortic stenosis, it may be that a long-standing pressure overload can trigger inappropriate septal hypertrophy in predisposed individuals.Brock (1957)