SummaryHypothesis: This study was undertaken to determine whether echo-derived left atrial dimension and other echocardiographic, clinical, and hemodynamic parmeters detected at the time of entry into the study may influence prognosis in patients with dilated cardiomyopathy during a long-term follow-up.M(>thod.s: This was a prospective cohort analysis of 123 patients with dilated cardiomyopathy. Clinical evaluation, chest x-ray, M-mode and two-dimensional echocardiogram, exercise test, 72-h ambulatory electrocardiogram monitoring, and cardiac catheterization study were performed in all patients. The study was divided into two phases: in the first phase, patients were divided into two groups according to the left atrial size (24.5 mm; <45 mm), with cardiac death as the end point. In the second phase, all patients were further divided into two groups according to their clinical course. A multivariate analysis was performed to determine independent correlated parameters of cardiac mortality and overall clinical outcome.Results: Cardiac mortality rate was 47.9%: 29% in the group without left atrial dilation and 54.3% in the group with dilated left atrium. Multivariate analysis revealed that left atrium 245 mm, New York Heart Association functional classes IIIAV, and the presence of one or more episodes of ventricular tachycardia at Holter monitoring were independent predicton of cardiac mortality, while left atrium 245 mm, left ventricular end-diastolic pressure >17 mmHg, and exercise tolerance I IS min were independent predictors of poor clinical outcome.Conclusions: Our results revealed that left atrial size is the principal independent predictor of prognosis in patients with dilated cardiomyopathy in that patients with left atrial dilation had an increase in mortality and a worse clinical outcome compared with those without left atrial dilation.

Abstract-To reduce cardiovascular complications, antihypertensive therapy should not only normalize blood pressure but also induce a regression of structural abnormalities, which are the expression of end-organ damage. We investigated the effects of transdermal 17␤-estradiol, combined with standard antihypertensive therapy, on the modification of left ventricular anatomy and systolic performance in hypertensive postmenopausal women. In a randomized, double-blind, placebo-controlled study, we enrolled 169 postmenopausal women with mild or moderate hypertension. Eighty-six patients (group 1) received transdermal 17␤-estradiol (50 g/d) and norethisterone acetate (2.5 mg/d, orally), and 83 patients (group 2) received placebo. At baseline, all women underwent M-mode and 2-D echocardiogram, which was repeated after 6, 12, and 18 months of follow-up. After 18 months of treatment, we observed a significant decrease in left ventricular diastolic septal and posterior wall thickness and mass in both groups. Furthermore, after 18 months, left ventricular mass was significantly less than in the estrogen-treated group. No significant modifications were observed in left ventricular systolic and diastolic dimensions or in systolic performance, as expressed by left ventricular fractional shortening. In conclusion, transdermal 17␤-estradiol, which is associated with antihypertensive therapy, may contribute in the reduction of left ventricular mass in hypertensive postmenopausal women. (Hypertension. 1999;34:1041-1046.)Key Words: hypertension, mild Ⅲ hypertrophy Ⅲ trials Ⅲ drugs Ⅲ estrogen Ⅲ menopause Ⅲ echocardiography T he increase in left ventricular mass (LVM) represents the general structural mechanism of adaptation of the heart in response to a chronic pressure overload of the left ventricle. 1 Epidemiological data indicates that left ventricular hypertrophy (LVH) is the most important independent risk factor for coronary heart disease in women. 2 No critical value has been detected to distinguish between compensatory and pathological hypertrophy; the risk of cardiovascular sequelae increases progressively with the increase in LVM. 3 Serum levels of 17␤-estradiol, which decrease at menopause, can be replaced by therapeutic intervention. The oral administration of estrogen improves the cardiovascular risk profile in postmenopausal women; 4 observational studies have shown its protective effect on the cardiovascular system, 5-7 and the Heart and Estrogen/progestin Replacement Study (HERS), 8 which is the only published trial on the secondary prevention of cardiovascular events in postmenopausal high-risk women, did not demonstrate beneficial effects of hormone replacement therapy (HRT). Transdermal application has been proposed as an alternative and effective route of administration, 9 -11 with the advantage that natural estrogen is used.There have been animal studies 12 that demonstrated some estrogen effect on cardiac anatomy, but there are none, to the best of our knowledge, that investigated the effects of estrogen on left...

Patients with AVRT have a lower mean age at arrhythmia symptom onset compared with those with AVNRT and have fewer associated cardiac abnormalities. Clinical presentation is quite similar as well as their outcome after ablation. A correct diagnosis by standard ECG is more frequent in AVNRT.

We investigated the effects of transdermal 17beta-estradiol, combined with standard antihypertensive therapy, on the modification of the cardiovascular risk profile in hypertensive postmenopausal women. In a randomized, double-blind, placebo-controlled study, we enrolled 200 postmenopausal women with mild to moderate hypertension. Patients received 17beta-estradiol (50 microg/day, transdermal) and norethisterone acetate (2.5 mg/ day, orally) or placebo. At baseline serum total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, glucose, and fibrinogen plasma levels were measured and all subjects underwent complete M-mode and 2-D echocardiograms, which were repeated after 6, 12, and 18 months of hormonal replacement therapy. Compared with placebo, all values decreased significantly except for HDL cholesterol. In both groups, no modifications were observed in echocardiographic parameters, except for left ventricular mean diastolic and systolic wall thickness and left ventricular mass index, which showed a significant decrease in both groups. The reduction was greater in the treated group; the percentage of patients with left ventricular hypertrophy was 46% before randomization and 17.2% after 18 months of treatment (P < .0001), whereas in group II the percentage was 48% at baseline and 31.5% after 18 months (P < .05). In conclusion, transdermal 17beta-estradiol, associated with antihypertensive therapy, may contribute to the reduction of cardiovascular risk profile in hypertensive postmenopausal women.

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