Objective To investigate a population of elderly people for atrial fibrillation and to determine how many of the cases identified might benefit from treatment with anticoagulants. Methods From a practice of four primary care physicians, 1422 patients aged 65 years and over were identified, of whom 1207 (85% of the total population) underwent electrocardiographic screening to detect the presence of atrial fibrillation. Patients with the arrhythmia were further evaluated by echocardiography and interview, to stratify their risk of stroke based on echocardiographic and clinical risk factors, their perceived risk from anticoagulation, and their attitude towards this treatment. Their primary care physician was also interviewed to determine the factors influencing the prescription of anticoagulants. Results The arrhythmia occurred in 65 patients (5.4% overall), its prevalence increasing markedly with age (2.3% in 65 to 69 years age group; 8.1% in those over 85). Warfarin was being prescribed to 21.4% of these patients, although the findings of the study indicate that a further 20% were eligible for this treatment. Symptoms suggestive of cardiac failure were common (32.1%) and coexisting pathology was often identified by cardiac ultrasound in these patients (left ventricular hypertrophy, 32.1%; impaired left ventricular contractility, 21.4%; left atrial dilatation, 80.4%; mitral annular calcification, 42.9%; mitral stenosis, 7.1%; mitral regurgitation, 48.2%; aortic stenosis, 8.9%). In all but one case, the decision to anticoagulate was based on the clinical rather than the echocardiographic findings. Conclusions Individual risk–benefit assessment in elderly patients with atrial fibrillation suggests that almost half (41.4%) are eligible for full anticoagulation with warfarin, whereas presently only one fifth are receiving this treatment. The decision to anticoagulate can be made on clinical grounds in most cases. If these results are confirmed, a doubling of the current number of patients taking anticoagulants can be anticipated.

Objectives: Angiotensin II (ANG II) is known to be a potent vasoconstrictor agent in the pulmonary circulation Furthermore, type I ANG II receptor blockade with losartan attenuates acute hypoxic pulmonary vasoconstriction in normal subjects. The aim of this study was therefore to evaluate the haemodynamic and endocrine sequelae of type I ANG II receptor blockade in patients with hypoxaemic cor pulmonale. Methods: Nine patients with chronic obstructive pulmonary disease (COPD) age 67 +/- 3 years with pulmonary hypertension and normal left ventricular systolic function were studied on two separate occasions in a double-blind, placebo-controlled, crossover study. They were randomised to receive either 50 mg of oral losartan or matched placebo. Pulsed wave Doppler echocardiography was used to measure cardiac output (GO), mean pulmonary artery pressure (MPAP) and hence systemic vascular resistance (SVR) and total pulmonary vascular resistance (TPR). Haemodynamic measurements and venous blood samples were taken at baseline and after 2 and 4 h. Results: Maximal effects were observed at 4 h where losartan compared to placebo resulted in a significant reduction in both MPAP (28.6 +/- 2.0 vs 32.4 +/- 1.5 mmHg) and TPR (428 +/- 40 vs 510 +/- 40 dyn . s . cm(-5)), respectively. Similarly losartan compared to placebo resulted in a significant reduction in MAP (87 +/- 4.5 vs 93 +/- 3.2 mmHg) and SVR (1293 +/- 94 vs 1462 +/- 112 dyn . s . cm(-5)), and significantly increased CO (5.58 +/- 0.43 vs 5.31 +/- 0.42 l/min). In addition, plasma aldosterone was significantly lower after treatment with losartan compared to placebo: 76 +/- 23 vs 164 +/- 43 pg/ml respectively. Conclusions: Thus, selective type 1 ANG II receptor blockade appears to have beneficial pulmonary and endocrine effects, suggesting a possible therapeutic role in the management of hypoxaemic cor pulmonale.

BACKGROUND Experimental models suggest that brain natriuretic peptide (BNP) can modify left ventricular diastolic performance. The aim of this study was to evaluate the effects of BNP on resting and exercise hemodynamics and neurohormones in patients with isolated diastolic heart failure. METHODS AND RESULTS Six patients with isolated diastolic heart failure were studied. After baseline hemodynamic measurements were obtained with use of thermistor-tipped pulmonary artery catheters, patients were randomized to receive infusion of BNP or placebo in a single-blind, crossover study. Hemodynamic and neurohormonal parameters were measured at rest after 30 minutes of infusion and during incremental supine bicycle exercise. BNP did not significantly affect resting hemodynamics but attenuated the rise in both pulmonary capillary wedge pressure (placebo, 23 +/- 2 mm Hg; BNP, 16 +/- 2 mm Hg; P < .01) and mean pulmonary artery pressure (placebo, 34 +/- 3 mm Hg; BNP, 29 +/- 3 mm Hg; P < .05) during exercise without affecting changes in heart rate, systemic blood pressure, or stroke volume. In response to BNP, there was significant suppression of plasma aldosterone concentration (placebo, 551 +/- 107 pmol/L; BNP, 381 +/- 56 pmol/L; P < .05). CONCLUSIONS BNP infusion causes beneficial hemodynamic and neurohormonal effects during exercise in patients with isolated diastolic heart failure.

Conference Abstract| February 01 1996 Effects of Brain Natriuretic Peptide Infusion on Exercise Haemodynamics in Isolated Diastolic Heart Failure PBM Clarkson; PBM Clarkson 1Department of Clinical Pharmacology, Ninewells Hospital & Medical School, University of Dundee, Dundee, UK Search for other works by this author on: This Site PubMed Google Scholar RJ McFadyen; RJ McFadyen 1Department of Clinical Pharmacology, Ninewells Hospital & Medical School, University of Dundee, Dundee, UK Search for other works by this author on: This Site PubMed Google Scholar NM Wheeldon; NM Wheeldon 1Department of Clinical Pharmacology, Ninewells Hospital & Medical School, University of Dundee, Dundee, UK Search for other works by this author on: This Site PubMed Google Scholar TM MacDonald TM MacDonald 1Department of Clinical Pharmacology, Ninewells Hospital & Medical School, University of Dundee, Dundee, UK Search for other works by this author on: This Site PubMed Google Scholar Clin Sci (Lond) (1996) 90 (s34): 11P. https://doi.org/10.1042/cs090011Pa Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Cite Icon Cite Get Permissions Citation PBM Clarkson, RJ McFadyen, NM Wheeldon, TM MacDonald; Effects of Brain Natriuretic Peptide Infusion on Exercise Haemodynamics in Isolated Diastolic Heart Failure. Clin Sci (Lond) 1 February 1996; 90 (s34): 11P. doi: https://doi.org/10.1042/cs090011Pa Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll JournalsClinical Science Search Advanced Search This content is only available as a PDF. © 1996 The Biochemical Society and the Medical Research Society1996 Article PDF first page preview Close Modal You do not currently have access to this content.

EDITOR,--Both the paper by C M Francis and colleagues1 and the accompanying editorial2 regarding open access echocardiography for heart failure might be interpreted as suggesting that a key role of such a service is the withdrawal of “inappropriate” drug treatment. It is suggested that this decision should be based on one echocardiographic examination per subject, with what might be regarded as a higher than average rate of non-quantitative study (42% quoted). If it is assumed, as is implied, that there was no corroborative history nor examination performed to assess patients further, …

OBJECTIVE:To evaluate the waveforms of left atrial area changes obtained by automated boundary detection with newly developed acoustic quantification technology.DESIGN:All subjects had measurements of left atrial areas taken in the apical four chamber, parasternal long axis, and parasternal short axis views using both conventional echocardiographic methods and automatic boundary detection on two occasions separated by at least a week. On the second visit measurements were also repeated in healthy volunteers after acute intravenous volume loading with 1 litre of saline over 2-5 minutes.SETTING:A university medical school echocardiographic laboratory.SUBJECTS:12 healthy male volunteers and 8 patients with cardiac disease (5 with congestive heart failure, 1 with mitral stenosis, and 2 with hypertensive left ventricular hypertrophy, and dilated left atria).RESULTS:There was close correlation between conventionally derived left atrial areas and those obtained by automatic boundary detection, particularly in the apical four chamber view (r = 0.98). Both inter and intra observer variabilities (coefficient of variation) for left atrial areas measured by automatic boundary detection were good (4.7-14.2% and 8.1-18.6% respectively). The reproducibility (coefficient of variation) for derived indices of left atrial function, however, was much poorer (10.4-104.8% and 12.5-88% respectively). After acute volume loading significant increases in left atrial area were observed at all stages in the cardiac cycle.CONCLUSIONS:These data demonstrate that although the reproducibility of left atrial functional indices is poor, instantaneous left atrial cavity measurements with automatic boundary detection are reproducible. This suggests that automatic boundary detection may assist in serial non-invasive measurement of left atrial size to assess disease states and treatments.

Doppler echocardiographic indices of diastolic function and systemic haemodynamics were studied in response to infusions of atrial natriuretic peptide (0.5, 1, 2, 5 pmol.kg-1.min-1) and placebo (0.9% (w/v) saline) in ten normal male subjects. Compared with placebo, atrial natriuretic peptide infusion produced a significant and dose-related reduction in the isovolumic relaxation time [(mean and 95% CI) -5.9 (-9.2 to -2.6) ms (P < 0.01) at 5 pg.kg-1 min-1] and a significant increase in the ratio between early and late transmitral peak velocities [0.46 (0.02 to 0.89) (P < 0.05) at 5 pg.kg-1 min-1]. No significant changes in heart rate, blood pressure or aortic stroke distance were observed with infusion of atrial natriuretic peptide compared with placebo. These data suggest that pathophysiological plasma concentrations of atrial natriuretic peptide improve diastolic function by increasing the rate of myocardial relaxation.

1. Elevated plasma concentrations of brain natriuretic peptide are found in conditions associated with impaired left ventricular diastolic function, The purpose of this study was to determine whether this peptide actually plays a physiological role in improving myocardial performance in diastole.2. Nine normal subjects received infusions of brain natriuretic peptide or placebo in a randomized, double-blind, crossover study, Brain natriuretic peptide infusion produced a significant reduction in isovolumic relaxation time (means and 95% confidence interval for difference -10.8 ms, -14.5 to -7.0 ms) (P<0.01) and significantly increased both the peak E/A velocity (0.54, 0.14-0.94) (P<0.05) and the E/A time velocity integral (1.09, 0.20-1.98) (P<0.05).3. These responses were evident at concentrations of brain natriuretic peptide that produced no associated effects on blood pressure, heart rate or stroke distance.4. Brain natriuretic peptide infusion in normal subjects significantly reduces isovolumic relaxation time and improves transmitral Doppler flow profiles, suggesting that this peptide may be important in the control of left ventricular diastolic relaxation in man.

Journal Article Acute effects of atrial natriuretic peptide on left ventricular diastolic function: A pulsed wave Doppler study in man Get access P. B. M. CLARKSON, P. B. M. CLARKSON University Department of Clinical Pharmacology, Ninewells Hospital and Medical SchoolDundee DD1 9SY, Scotland, U.K. Correspondence: Dr P. Clarkson, University Department of Clinical Pharmacology, Ninewells Hospital and Medical School, Dundee DD1 9SY, Scotland, U.K. Search for other works by this author on: Oxford Academic PubMed Google Scholar N. M. WHEELDON, N. M. WHEELDON University Department of Clinical Pharmacology, Ninewells Hospital and Medical SchoolDundee DD1 9SY, Scotland, U.K. Search for other works by this author on: Oxford Academic PubMed Google Scholar C. MACLEOD, C. MACLEOD University Department of Clinical Pharmacology, Ninewells Hospital and Medical SchoolDundee DD1 9SY, Scotland, U.K. Search for other works by this author on: Oxford Academic PubMed Google Scholar W. COUTIE, W. COUTIE University Department of Clinical Pharmacology, Ninewells Hospital and Medical SchoolDundee DD1 9SY, Scotland, U.K. Search for other works by this author on: Oxford Academic PubMed Google Scholar T. M. MACDONALD T. M. MACDONALD University Department of Clinical Pharmacology, Ninewells Hospital and Medical SchoolDundee DD1 9SY, Scotland, U.K. Search for other works by this author on: Oxford Academic PubMed Google Scholar European Heart Journal, Volume 16, Issue 11, November 1995, Pages 1710–1715, https://doi.org/10.1093/oxfordjournals.eurheartj.a060799 Published: 01 November 1995 Article history Accepted: 22 December 1994 Published: 01 November 1995

We compared the beta 1-selective adrenoceptor antagonists bisoprolol and atenolol in a double-blind, randomized crossover study. After 4 weeks placebo phase, 59 patients with essential hypertension received either 10 mg bisoprolol or 50 mg atenolol once daily for 8 weeks, increased if necessary (target BP < or = 150/90 mmHg) to 20 and 100 mg, respectively, after 4 weeks. After a second placebo phase, crossover occurred to the alternative drug. We measured resting systolic and diastolic blood pressures and heart rate at 24 h post-dose baseline and after 4 and 8 weeks treatment. Both drugs significantly lowered systolic and diastolic blood pressures and heart rate at 8 weeks compared to baseline (all p < 0.05). Bisoprolol reduced heart rate significantly more than atenolol (p < 0.01), but systolic and diastolic blood pressure changes were not different between the two drugs. There was no difference in patient acceptability of the drugs as assessed by visual analogue scale. Despite theoretical and circumstantial evidence to suggest superiority of bisoprolol over atenolol, no significant difference between the two was found except for greater heart rate reduction with bisoprolol.

Conference Abstract| February 01 1995 Systolic and Diastolic Effects of β-Adrenergic Stimulation in Normal Man PBM Clarkson; PBM Clarkson 1Department of Clinical Pharmacology, Ninewells Hospital & Medical School, Dundee DD1 9SY, Scotland, UK Search for other works by this author on: This Site PubMed Google Scholar TM MacDonald; TM MacDonald 1Department of Clinical Pharmacology, Ninewells Hospital & Medical School, Dundee DD1 9SY, Scotland, UK Search for other works by this author on: This Site PubMed Google Scholar C MacLeod; C MacLeod 1Department of Clinical Pharmacology, Ninewells Hospital & Medical School, Dundee DD1 9SY, Scotland, UK Search for other works by this author on: This Site PubMed Google Scholar NM Wheeldon NM Wheeldon 1Department of Clinical Pharmacology, Ninewells Hospital & Medical School, Dundee DD1 9SY, Scotland, UK Search for other works by this author on: This Site PubMed Google Scholar Clin Sci (Lond) (1995) 88 (s32): 9P–10P. https://doi.org/10.1042/cs088009Pb Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Cite Icon Cite Get Permissions Citation PBM Clarkson, TM MacDonald, C MacLeod, NM Wheeldon; Systolic and Diastolic Effects of β-Adrenergic Stimulation in Normal Man. Clin Sci (Lond) 1 February 1995; 88 (s32): 9P–10P. doi: https://doi.org/10.1042/cs088009Pb Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search nav search search input Search input auto suggest search filter All ContentAll JournalsClinical Science Search Advanced Search This content is only available as a PDF. © 1995 The Biochemical Society and the Medical Research Society1995 Article PDF first page preview Close Modal You do not currently have access to this content.

The aim of the present study was to evaluate the central effects of single doses of the β-adrenoceptor antagonist atenolol and the calcium antagonist nifedipine retard, alone and in combination, in normal subjects. Twelve normal males received single oral doses of atenolol 100 mg, nifedipine retard 20 mg, atenolol 100 mg and nifedipine retard 20 mg in combination, diazepam 5 mg (active control), and each of two matching placebos in a double-blind, randomised fashion. Psychomotor performance was assessed using digit symbol substitution, letter cancellation (LCT), continuous attention, choice reaction time, finger tapping, immediate recall and short-term memory. Two flash fusion and critical flicker fusion thresholds were measured and subjective assessments made using visual analogue scales (VAS). Diazepam 5 mg significantly worsened LCT scores at 4h, significantly impaired alertness at 2 h and 4 h, and tended to increase reaction time and impair continuous attention and physiological measurements. Atenolol 100 mg alone significantly reduced alertness at 2 h and 4 h, and also tended to impair physiological measurements. Nifedipine retard 20 mg produced no significant psychomotor effects. Combined atenolol and nifedipine retard administration produced a small but significant improvement in continuous attention and a reduction in body sway, with no adverse effects being evident on performance or subjective awareness. The results suggest that no significant adverse effects on psychomotor performance are produced by single doses of atenolol 100 mg and nifedipine retard 20 mg when given together in normal subjects. The combination may therefore be useful in the treatment of hypertensive patients requiring dual therapy, and in whom adverse central effects are of particular importance.

We conclude that stimulation of β-adrenergic receptors with low-dose isoprenaline exerts greater effects on myocardial relaxation than contraction. This suggests that diastolic function is exquisitely sensitive to acute changes in sympathetic tone, a finding that may have relevance in the pathogenesis and treatment of disease states associated with impaired ventricular filling.

Conference Abstract| February 01 1995 Effects of Acute Volume Loading on Left Atrial Function - a Study Using Automatic Endocardial Border Detection PBM Clarkson; PBM Clarkson *Department of Clinical Pharmacology, Ninewells Hospital and Medical School, Dundee DD1 9SY, Scotland, UK Search for other works by this author on: This Site PubMed Google Scholar S Pringle; S Pringle +Cardiology, Ninewells Hospital and Medical School, Dundee DD1 9SY, Scotland, UK Search for other works by this author on: This Site PubMed Google Scholar NM Wheeldon; NM Wheeldon *Department of Clinical Pharmacology, Ninewells Hospital and Medical School, Dundee DD1 9SY, Scotland, UK Search for other works by this author on: This Site PubMed Google Scholar TM MacDonald TM MacDonald *Department of Clinical Pharmacology, Ninewells Hospital and Medical School, Dundee DD1 9SY, Scotland, UK Search for other works by this author on: This Site PubMed Google Scholar Clin Sci (Lond) (1995) 88 (s32): 10P. https://doi.org/10.1042/cs088010P Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Cite Icon Cite Get Permissions Citation PBM Clarkson, S Pringle, NM Wheeldon, TM MacDonald; Effects of Acute Volume Loading on Left Atrial Function - a Study Using Automatic Endocardial Border Detection. Clin Sci (Lond) 1 February 1995; 88 (s32): 10P. doi: https://doi.org/10.1042/cs088010P Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll JournalsClinical Science Search Advanced Search This content is only available as a PDF. © 1995 The Biochemical Society and the Medical Research Society1995 Article PDF first page preview Close Modal You do not currently have access to this content.

Journal Article Atrial fibrillation and anticoagulant therapy Get access N. M. WHEELDON N. M. WHEELDON Cardiothoracic Unit, Northern General HospitalSheffield S5 7AU, U.K. Correspondence: Dr Nigel Wheeldon, Cardiothoracic Unit, Northern General Hospital, Sheffield S5 7AU, U.K Search for other works by this author on: Oxford Academic PubMed Google Scholar European Heart Journal, Volume 16, Issue 3, March 1995, Pages 302–312, https://doi.org/10.1093/oxfordjournals.eurheartj.a060911 Published: 01 March 1995 Article history Received: 23 August 1994 Accepted: 26 August 1994 Published: 01 March 1995

Conference Abstract| December 01 1994 Left Ventricular Diastolic Filling is Improved by Atrial Natriuretic Peptide in Man Pbm Clarkson; Pbm Clarkson 1Department of Clinical Pharmacology, Ninewells Hospital and Medical School. Dundee DD1 9SY. Scotland, UK. Search for other works by this author on: This Site PubMed Google Scholar TM Macdonald; TM Macdonald 1Department of Clinical Pharmacology, Ninewells Hospital and Medical School. Dundee DD1 9SY. Scotland, UK. Search for other works by this author on: This Site PubMed Google Scholar C Macleod; C Macleod 1Department of Clinical Pharmacology, Ninewells Hospital and Medical School. Dundee DD1 9SY. Scotland, UK. Search for other works by this author on: This Site PubMed Google Scholar NM Wheeldon NM Wheeldon 1Department of Clinical Pharmacology, Ninewells Hospital and Medical School. Dundee DD1 9SY. Scotland, UK. Search for other works by this author on: This Site PubMed Google Scholar Author and article information Publisher: Portland Press Ltd Online ISSN: 1470-8736 Print ISSN: 0143-5221 © 1994 The Biochemical Society and the Medical Research Society1994 Clin Sci (Lond) (1994) 87 (s31): 5P. https://doi.org/10.1042/cs045005Pb_pt2 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn Email Cite Icon Cite Get Permissions Citation Pbm Clarkson, TM Macdonald, C Macleod, NM Wheeldon; Left Ventricular Diastolic Filling is Improved by Atrial Natriuretic Peptide in Man. Clin Sci (Lond) 1 December 1994; 87 (s31): 5P. doi: https://doi.org/10.1042/cs045005Pb_pt2 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll JournalsClinical Science Search Advanced Search This content is only available as a PDF. © 1994 The Biochemical Society and the Medical Research Society1994 Article PDF first page preview Close Modal You do not currently have access to this content.