Comparative accuracy of cross-sectional echocardiography and cineventriculography for left ventricular evaluation after myocardial infarction

223 patients with a previous myocardial infarction (MI) 29-68 years old, have been studied in a double-blind manner both by 2D-Echocardiography and cineventriculography. 5 cross-sectional views and 2 angiographic projections have been employed in order to assess the presence of aneurysm and the motion of the left ventricle. The left ventricle has been divided into 5 anatomic regions: interventricular septum, anterolateral, posterolateral, apical and inferior walls. By cineangiography an aneurysm was diagnosed in 89 patients (one pseudoaneurysm); by 2D-Echo in 83 patients an aneurysm was diagnosed, whereas in the 6 remaining patients the Echocardiogram was nondiagnostic (specificity 100%, sensitivity 93%). Concerning regional motion characteristics, 997 (89%) of 1115 regions were visualized and 905 (91%) correctly identified according to the angiographic findings. Of 92 discrepancies (9%): 64 were attributed to 2D-Echo (69%) and 28 (31%) were attributed to cineangiography; most of the discrepancies attributed to echo resulted from minor grades of asynergy which caused unresolved disagreements between the Echo and angiography findings. It is concluded that Cross-sectional echocardiography is a valuable tool for the diagnosis of aneurysm of the left ventricle (specificity 100% and sensitivity 93%) and for the study of wall motion characteristics. In cases with generalized abnormality of left ventricle motion, resulting in a picture of congestive cardiomyopathy, 2D-Echo can be a substitute for cineangiography. In all other instances both techniques can provide more complete information on ventricular wall abnormalities.     

Annular subvalvular left ventricular aneurysm in Bahia, Brazil

Two cases of left ventricular aneurysm, a 16-year-old black boy and a 23-year-old white girl, from Bahia, Brazil, are presented. In both patients there was enlargement of the cardiac silhouette and a prominent bulge of the left inferior border. On the right oblique view a ring of calcium at the ventricular opening of the aneurysms was visualized. A left ventriculogram showed a huge aneurysm in the first case and a bulge on the lateral wall of the left ventricle in the other. Cardiac catheterization showed a rise in left and right ventricular end-diastolic pressures and in the mean pulmonary artery pressure. In the first case the contour of the right ventricular pressure curve showed a restrictive pattern. The similarities of these aneurysms with the annular submitral type described in young black Africans are stressed.     

Doppler stress echocardiography of the left and right ventricle: a new echo device to quantify left ventricular backward failure

OBJECTIVES: A novel non-invasive procedure which evaluates left-right ventricular interaction is introduced. This procedure is suitable for the classification of congestive heart failure. METHODS: In 48 patients showing mild, moderate or advanced stage congestive heart failure (NYHA I-III) Doppler echocardiography was performed at rest, during and after submaximal bicycle exercise. Mitral (m) and tricuspid (t) filling parameters were determined: early diastolic (VEm, VEt) and atrial maximal velocities (VAm, VAt), the velocity integrals (Em, Et, Am, At) and the corresponding ratios (VE/VAm, VE/VAt, E/Am, E/At). Group 1 (n = 29) was composed of those patients presenting with a VE/VAm < 1 at rest. Four individuals (group 2) were found to have a VE/VAm ratio < 1 during exercise only. Six other patients showing a dilated left ventricle or an ejection fraction of less than 40% produced false negative results in left ventricular Doppler examination (VE/VAm > 1) at rest and during exercise (group 3). In 9 cases (group 4) systolic function, size and Doppler echocardiographic parameters of the left ventricle were proven to be normal. RESULTS: The VE/VAt-ratio decreased notably during exercise (p < 0.05) but increased again after exercise in group 3. In the groups 1 and 2 similar changes occurred as well, however not to a significant degree. In group 4, exercise VE/VAt ratio did not differ from values seen at rest or during recovery (variability 4%). CONCLUSION: The results of this study indicate, that high sensitivity towards left ventricular backward failure can be achieved for Doppler stress echocardiography by extending the examination to right-sided diastolic parameters.     

Morphometric features of ruptured congenital sinus of Valsalva aneurysm: implication for surgical treatment

Five hearts with ruptured congenital sinus of Valsalva aneurysm were studied. In 3 hearts of Caucasian patients, the sinus of Valsalva aneurysms were located in the immediate vicinity of the commissure between the noncoronary and right aortic cusps with rupture from the noncoronary sinus to the right atrium (n = 2) and from the right sinus to the right ventricle (n = 1). In 2 hearts of indigenous North Americans, the defects were sited in the immediate vicinity of the commissure between right and left aortic cusps with rupture into the right ventricle; both patients had an associated conal septal hypoplasia ventricular septal defect and aortic insufficiency. The diameters of the rupture holes at the base of the sinus of Valsalva aneurysms in the five hearts ranged from 0.4 to 1.1 cm (mean 0.7 cm). Histologic examination of longitudinal sections through the ruptured sinus of Valsalva showed 0.8 to 1.7 cm (mean 1.1 cm) wide areas in which there was lack of continuity between the aortic media and the aortic annulus. Conclusions. This study shows that the site of congenital weakness in sinus of Valsalva aneurysm in indigenous North American patients may be similar to that in Oriental patients, whereas the site tends to be different in Occidental patients. It also emphasizes the importance of patch closure rather than suture closure of ruptured sinus of Valsalva aneurysms.     

Longterm prognosis of 27 patients with left ventricular aneurysm and conservative treatment (author's transl)

The results of a follow-up study (mean 42 months after infarction) of 27 patients with conservatively treated left ventricular aneurysms showed: 1. 3/27 patients died of sudden death. Only one of these three could be predicted (ventricular fibrillation during exercise). 2. 3/24 remaining patients developed congestive heart failure. This could be predicted in one patient because of global hypocinesia of the left ventricle. 3. The exercise tolerance (Swan-Ganz) of the remaining 21 patients decreased from approximately 100 to 70 watts. Thus, all patients were able to lead an almost normal live. 4. Therefore conservative treatment of left ventricular aneurysms in most cases is the method of choice, since high surgical mortality, financial burdens of the society and man power has also to be considered. 5. The development of complications which would lead to aneurysmectomy (sudden death, life threatening arrhythmias, embolisation, congestive heart failure) cannot be foreseen from history, non-invasive and invasive data. 6. The close "patient to physician-contact" (risk-factors, medication) may have influenced the relatively good long-term prognosis of this group.     

Functional significance of coronary collateral vessels in patients with previous 'Q' wave infarction: relation to aneurysm, left ventricular end diastolic pressure and ejection fraction

The importance of coronary collateral circulation in relation to the left ventricular function, aneurysm formation and size was investigated in 100 patients with previous 'Q' wave myocardial infarction who underwent coronary angiography. Aneurysms were present in 20% of patients. The majority of these (80%) patients had severe or total occlusion of the left anterior descending artery. Thirty four percent of patients without aneurysm had significant collaterals whereas 25% of patients with aneurysms had collaterals (P > 0.05). However, the size of the aneurysm was smaller when adequate collateral circulation was present (Collateral Index 2 or above). The incidence of hypertension and diabetes was similar in both groups. Collateral circulation was more frequently seen in the anterior (60%) as compared to inferior myocardial infarction (40%), but Collateral Index was higher in right coronary artery disease. The number of patients with an elevated left ventricular end-diastolic pressure (> 12) or poor ejection fraction was similar in the two groups with and without collaterals. Thus, there was no beneficial effect of collateral circulation on left ventricular function. The incidence of aneurysm was not significantly lower, although the size of the aneurysm was significantly smaller in the presence of collateral circulation.     

Apical muscular ventricular septal defects between the left ventricle and the right ventricular infundibulum. Diagnostic and interventional considerations

BACKGROUND: Effective transcatheter or surgical closure of apical muscular ventricular septal defects (VSDs) requires accurate delineation of variable and often complex anatomy. These defects have generally been considered as communications between the apexes of both left and right ventricles. METHODS AND RESULTS: Among 50 consecutive patients with multiple muscular VSDs referred for transcatheter device closure between October 1987 and April 1993, a subset of 10 patients (aged 7 days to 28 years) with apical muscular VSDs shared a unique set of anatomic characteristics: (1) large and often single opening in the left ventricle; (2) multiple right ventricular openings in the anterior aspect of the apical septum; and (3) separation of the right ventricular apical region into which the VSDs open from the rest of the right ventricular inflow and outflow by prominent muscle bundles. Additional analysis of the anatomy by use of echocardiography and cineangiography showed that these muscular defects were between the left ventricular apex and right ventricular infundibular apex. In 6 patients, the transcatheter devices used to create a septum in these hearts were placed in the right ventricle, straddling muscle bundles that separated the apical VSD from the rest of the right ventricular inflow and outflow, resulting in incorporation of a portion of the right ventricular infundibular apex into the physiological left ventricle. Three patients had devices placed between the apexes of the left ventricle and the infundibulum. The defect closed spontaneously within the right ventricle in 1 patient. One patient died after surgery for tetralogy of Fallot in situs inversus. The remaining 9 patients were all clinically well at the time of their most recent follow-up visit (follow-up duration, 32 +/- 11 months). This distinct type of apical VSD was identified by echocardiography in 20 of 274 patients who were followed up clinically for muscular VSDs. CONCLUSIONS: Left ventricular-infundibular apical VSDs constitute a distinct morphological type of muscular VSD that can be distinguished by echocardiography and cineangiography. In selected cases, the infundibular apex can be separated from the rest of the right ventricular inflow and outflow to eliminate flow across these defects.     

The effects of simulated akinetic and dyskinetic aneurysms on left ventricular systolic function: clinical implications

OBJECTIVE: Scant attention has been directed towards quantifying the degree of mechanical disadvantage produced by akinetic and dyskinetic aneurysms. The purpose of this study was to evaluate the mechanical disadvantages of simulated akinetic and dyskinetic aneurysms on left ventricular function. METHODS: An elaborate experimental apparatus consisting of a computer-controlled water pressure chamber in which is suspended a model rubber ventricle was developed. The system has been shown to reproduce accurately the ventricular and aortic pressures found in vivo. In this study, a procedure was designed to simulate akinetic and dyskinetic aneurysms of various sizes on ventricular function. RESULTS: The results indicated that an akinetic aneurysm produces little or no mechanical disadvantage with respect to ventricular pressure since systolic paradox is minimal. However, a dyskinetic aneurysm, irrespective of size, will usually compromise ventricular function due to paradoxical systolic expansion in the bulging aneurysmic sac. In vivo, other factors, such as blood coagulation and rhythm disturbances, may influence these results. CONCLUSIONS: An akinetic aneurysm causes little or no mechanical disadvantage while the dyskinetic aneurysm, irrespective of size. will restrict ventricular function. The experimental simulation system, notwithstanding its limitations, thus provides a unique procedure to quantify akinetic and dyskinetic aneurysms.     

Clinical observation on effect of xiaoyu zhixue tablet on 104 patients with idiopathic multifocal bleeding and platelet aggregation defect

In a group of 7,721 foetuses with a high or low risk of cardiovascular pathology of the foetus, examined by complete foetal echocardiography, the authors found hyperechogenic ventricular structures in 211 foetuses (2.73% of the group) with a dominating localization in the left ventricle (97%). These structures are in the great majority a benign development variant which involves no risk for the development of the foetus. Rare localization beyond the left ventricle were not risk for the development of the foetus. Rare localization beyond the left ventricle were not associated with cardiac or other foetal pathologies. Echogenic ventricular focuses were not visualized by transvaginal echocardiography in the 13th week of pregnancy, although they were revealed in the same patient during the 21st week. Their presence does not affect left ventricular function and the function of the mitral valve pre-or postnatally. In the differential diagnosis these structures must be always differentiated from thrombi or cardiac tumours.     

Congestive heart failure in patients with valvular aortic stenosis. A clinical and echocardiographic Doppler study

The aim of this study was to evaluate echographically anatomic and functional features of the left ventricle in adult patients with valvular aortic stenosis according to the presence or absence of congestive heart failure and the level of ventricular performance. Fifty-six adult patients with moderate-to-severe aortic stenosis underwent echocardiographic Doppler examination in order to evaluate left ventricular mass and dimensions, systolic function and filling dynamics. Twenty-seven patients had no heart failure and were symptomatic for angina (5), syncope (4) or were symptom-free (group I); the other 29 had heart failure (group II): 16 with normal left ventricular systolic performance (fractional shortening > 25%, group IIa) and 13 with systolic dysfunction (fractional shortening < or = 25%, group IIb). Despite a similar left ventricular mass, compared to group IIa, group IIb showed a significant left ventricular dilatation (end-diastolic diameter: 61 +/- 6.5 vs. 45.5 +/- 6.1 mm, p < 0.001) and mild or no increase in wall thickness (11.5 +/- 1.6 vs. 14.9 +/- 2 mm, p < 0.001). Indices of left ventricular filling on Doppler transmitral flow were also significantly different between the two groups, with a higher early-to-late filling ratio and a shorter deceleration time of early filling in group IIb (2.8 +/- 1.9 vs. 1.2 +/- 0.85, p < 0.01, and 122 +/- 66 vs. 190 +/- 87 ms, p < 0.05, respectively), both indirectly indicating higher left atrial pressure. Finally, heart failure was generally more severe in group IIb patients. In some patients with aortic stenosis, symptoms of heart failure may be present despite a normal left ventricular systolic function and seem to depend on abnormalities of diastolic function. The presence of systolic or isolated diastolic dysfunction appears to be related to a different geometric adaptation of the left ventricle to chronic pressure overload.     

Clinical significance of magnetic resonance and echocardiographic correlations in the evaluation of hypertrophic cardiomyopathy

Relatively few clinical studies have investigated the role of MRI in the patients with hypertrophic cardiomyopathy. To assess MR capabilities in defining the presence, distribution and severity of left ventricular hypertrophy, the prevalence and clinical correlations of right ventricular hypertrophy and the prevalence and clinical implications of structural myocardial abnormalities, MRI and echocardiography were performed on 37 unselected patients with hypertrophic cardiomyopathy. The two methods were in agreement in 100% of cases in diagnosing the disease and classifying left ventricular hypertrophy as asymmetric, concentric or apical, and in 92% of cases in assessing the topographic distribution of hypertrophy of ventricular segments. A statistically significant linear correlation was found between echocardiographic and MR measurements of interventricular septum (r = 0.69, p < 0.0001, SEE = 4) and left posterior wall of the left ventricle (r = 0.67, p < 0.0001, SEE = 2.4). Right ventricular hypertrophy (right anterior wall diastolic thickness > 5 mm) was demonstrated by MRI in 23 of 33 patients (70%). In this group, left posterior wall thickness and left atrial diameter were higher (15 +/- 4 vs 11 +/- 2, p < 0.01 and 45 +/- 9 vs 38 +/- 5 mm, p < 0.05, respectively). On T2-weighted sequences, areas of reduced signal intensity, probably due to myocardial fibrosis, were detected in 16 cases (43%). This group was characterized by higher max. septal thickness (25 +/- 7 vs 21 +/- 6 mm, p < 0.05) and max. left posterior wall thickness (15 +/- 9 vs 7 +/- 8 mm, p < 0.05). All the three cases with dilated and hypokinetic left ventricle showed this kind of tissue abnormality. In conclusion, MRI provided clear, accurate and exhaustive data on the presence and distribution of left ventricular hypertrophy in hypertrophic cardiomyopathy. Right ventricular hypertrophy and structural abnormalities of ventricular myocardium can also be detected and quantified. Right ventricular involvement is associated with more severe hypertrophy of left ventricular posterior wall. Structural myocardial abnormalities, probably due to fibrosis, are related to the extent of left ventricular hypertrophy.     

The use of latissimus dorsi muscle flap in reconstructive heart surgery

Dynamic cardiomyoplasty is a technique for ventricular assistance indicated for the correction of left ventricle aneurysm and for cardiomyopathies in which heart transplantation is contraindicated. In this article, our first four patients to undergo cardiomyoplasty (from February 1991 until April 1992) with a left latissimus dorsi island flap, rotated into the thorax after a 3-week training period, are reviewed. Therapeutic indications were cardiomyopathy with contraindication for heart transplant in patients 1 and 4 and associated to surgery for left ventricle aneurysm for patients 2 and 3. Patient 1 died 4 months after surgery because of a cerebral embolism when he was at functional class II. The other three patients remain at functional class I, carrying out normal activities. All the data were evaluated with the paired t test. Ejection fraction values (obtained through echocardiography and scintigraphy studies) and maximum minute flow rate of blood (measured with an echo-Doppler) have increased significantly (p < 0.001, p < 0.05, and p < 0.01, respectively) after heart surgery. Clinical improvement has been found after cardiomyoplasty, which correlates with an increase in ejection fraction and maximum minute flow rate of blood.     

Right ventricular volume characteristics in ventricular septal defect

Right and left ventricular volume characteristics were determined from biplane cineangiocardiography in 37 patients with isolated ventricular septal defects. Patients were divided into three categories as determined by the degree of left-to-right shunt: small shunt-less than 35% of pulmonary blood flow (N=9); moderate shunt-35-49% (N=8), and large shunt-greater than 50% (N=20). Right ventricular (RV) end-diastolic volume was increased above normal in 15 of 20 studies performed in patients with large left-to-right shunts and averaged 159 +/- 10% of normal (P less than 0.001). In contrast, only one of the patients in the small shunt group and only half of the patients in the moderate shunt group showed increases in RV end-diastolic volume. The increase in RV volume was proportional to the corresponding increase in left ventricular end-diastolic volume, with the right ventricle ranging from 48 to 116% of LV end-diastolic volume (average 83%). Right ventricular ejection fraction was normal in all patient groups. Right ventricular outpur was increased commensurate with the increases in the RV end-diastolic volume. These data indicate that substantial augmentation in RV end-diastolic volume does occur in patients with isolated ventricular septal defects and large left-to-right shunts. These data can be explained by the significant diastolic and "isovolumic" shunting from left ventricle to right ventricle which occurs in these patients.     

Who cares for the mentally ill? Theory and practice hours with a ''mental illness'' focus in nursing curricula in Australian universities

A 72-year-old woman with inferior myocardial infarction presented with both a pseudoaneurysm and a ventricular septal rupture detected by two-dimensional and Doppler echocardiography. The pseudoaneurysm originated from the junctional area between the inferior portion of the ventricular septum and posterior left ventricular wall. The short-axis view of two-dimensional echocardiography revealed an abrupt discontinuity of the junctional area and an echo-free space behind the left ventricular cavity. The communication orifice was 5 mm wide. Color Doppler echocardiography showed a left-to-right shunt flow from the pseudoaneurysm to the right ventricle was visualized. Combined use of two-dimensional and color Doppler echocardiography was useful for detecting a pseudoaneurysm resulting in rupture of the ventricular septum.     

False aneurysm of the left ventricle and coronary aneurysms in Beh?et disease

A false left ventricular aneurysm and coronary artery aneurysm were discovered in a 29 year old patient with Beh?et's syndrome. The operation under cardiopulmonary bypass consisted of closing the neck of the false aneurysm by an endo-aneurysmal approach with a Gore-Tex patch. The coronary artery aneurysms were respected. There were no postoperative complications. Cardiac involvement is rare in Beh?et's syndrome (6%). The originality of this case is the association of two aneurysmal pathologies: the coronary and ventricular aneurysms due to the angiitis and the myocardial fragility induced by ischaemia.     

Influence of infarct-zone viability on left ventricular remodeling after acute myocardial infarction

BACKGROUND: The relation between residual myocardial viability after acute myocardial infarction (AMI) and ventricular remodeling has yet to be fully elucidated. We hypothesized that the presence of residual viability would favorably influence left ventricular remodeling after AMI and that serial changes in left ventricular dimensions might be related to the extent of myocardial viability in the infarct zone. METHODS AND RESULTS: Ninety-three patients with a first AMI successfully treated with primary coronary angioplasty underwent two-dimensional echocardiography within 24 hours of admission and low-dose dobutamine echocardiography at a mean of 3 days after AMI. Two-dimensional echocardiography and coronary angiography were obtained in all patients 1 and 6 months after coronary angioplasty. On the basis of dobutamine echocardiography responses, patients were divided in two subsets: those with (n=48; group I) and those without (n=45; group II) infarct-zone viability. There was no difference in minimal lesion diameter and infarct-related artery patency at 1 and 6 months between the two groups. Group II patients had significantly greater end-diastolic (76+/-18 versus 53+/-14 mL/m2; P<.0003) and end-systolic (42+/-17 versus 22+/-11 mL/m2; P<.0003) volumes at 6 months than did patients in group 1. The extent of infarct-zone viability was significantly inversely correlated with percent changes in end-diastolic volumes at 6 months (r=-.66; P<.000001) and was the most powerful independent predictor of late left ventricular dilation. CONCLUSIONS: After reperfused AMI, the degree of left ventricular dilation, when it occurs, is inversely related to the extent of residual myocardial viability in the infarct zone. Thus, the absence of residual infarct-zone viability discriminates patients who develop progressive left ventricular dilation after reperfused AMI from those who maintain normal left ventricular geometry.     

Preclinical cardiac dysfunction in transfusion-dependent children and young adults detected with low-dose dobutamine stress echocardiography

Transfusion-dependent (TD) patients develop cardiac iron overload that will eventually lead to cardiac pump failure. Low-dose dobutamine stress echocardiography may complement resting echocardiography and identify preclinical myocardial dysfunction caused by early cardiac hemosiderosis. Twenty-six iron-overloaded TD patients had stress echocardiography with 5 microg/kg per minute of dobutamine. Indexed left ventricular (LV) mass, LV dimensions, meridional wall stress, and cardiac index were significantly increased. TD patients had similar LV shortening fraction by M-mode (40.5% +/- 5.6% vs 39.4% +/- 4.5%) but had a lower mean LV ejection fraction (53.3% +/- 3.9% vs 46.8% +/- 6.9%, P < .002) and a subnormal increase in cardiac index during dobutamine stress (35% +/- 20% vs 11% +/- 16%, P < .0001). Impairment in LV relaxation was demonstrated by a prolonged isovolumetric relaxation time (0.060 +/- 0.005 vs 0.088 +/- 0.019 seconds, P < .0001), increased peak mitral E wave, and abnormal E/A ratio. Asymptomatic TD patients demonstrate decreased systolic functional reserve and abnormal left ventricular relaxation that may be caused by cardiac hemosiderosis. Low-dose dobutamine stress echocardiography may be useful for detecting and following cardiac dysfunction in patients at risk for cardiac hemosiderosis.     

Echocardiogram in common (single) ventricle: angiographic-anatomic correlation

Common ventricle is a rare congenital anomaly in which the ventricular chamber receives blood from two separate atrioventricular (A-V) valves or a common A-V valve. Diagnosis of common ventricle was established in 55 patients aged 3 months to 33 years (mean 10 years) at cardiac catheterization in all 55 and at operation or autopsy in 24. In common ventricle with two angiographically demonstrable A-V valves (47 patients), the echocardiographic features included: (1) simultaneous recording (in the same sonic beam with the transducer held stationary) of the echoes of an anterior and a posterior A-V valve without an intervening septal echo (45 of 47 patients); (2) absence, on a base to apex scan, of the ventricular septal echo in the usual position separating the A-V valves (47 of 47 patients); (3) recording, in patients with common ventricle and outflow chamber, of this small outflow chamber anterior to the A-V valves (20 of 23 patients); and (4) recording of echographic continuity of the posterior A-V valve and great artery (27 of 31 patients). In common ventricle with a common A-V valve (8 patients), the echocardiographic features included: (1) a single demonstrable A-V valve, located posteriorly in the ventricle, which showed a large amplitude of excursion during diastole; and (2) absence of a second A-V valve echo or ventricular septal echo. Eight patients were studied postoperatively after surgical correction by ventricular septation. Echographic features included visualization of a prosthetic septum that produced a dense echo and divided the common ventricle into "right" and "left" ventricular chambers. This septum had a large excursion anteriorly during systole. Because common ventricle is now amenable to surgical correction, echocardiography should play an important role in assessment of ventricular anatomy in this complex congenital cardiac defect.     

The apical ventricular lesion in Chagas' heart disease

Apical lesions of the left ventricle, ranging from endocardial thickening to aneurysms, are commonly found in Chagas' heart disease. These abnormalities can be identified by ventriculography, two-dimensional echocardiography and radioisotopic studies. Generally, clinical manifestations are limited to arrhythmias and thromboembolic. The lesions are usually small and apparently do not play a role in ventricular dysfunction.     

Managing complex orthodontic problems: the use of implants for anchorage

In congestive heart failure captopril modifies the left ventricular filling pattern mainly by unloading the heart. We investigated whether the structural characteristics of the left ventricle may influence the acute effects of captopril on this pattern in patients with untreated hypertensive (H group, 6 patients) or idiopathic (I group, 14 patients) cardiomyopathy. We evaluated changes of pulsed Doppler mitral flow, of systemic arterial and wedge pulmonary pressures 40 min after 25 mg captopril administered sublingually, and correlated these changes with the M-mode echocardiographic relative wall thickness index (h/r). Baseline mean arterial pressure (H = 137 +/- 20 mm Hg, mean +/- SD, I = 95 +/- 19 mm Hg; p < 0.001), and h/r (H = 0.38 +/- 0.03, I = 0.28 +/- 0.09; p < 0.05) were greater in the high blood pressure group; wedge pressure, echocardiographic biplane ejection fraction, and Doppler indexes of the left ventricular filling were similar in the two populations. After captopril, ejection fraction did not change significantly, mean arterial pressure decreased significantly in hypertensive patients (H group, baseline = 137 +/- 20, captopril = 119 +/- 10, p = 0.02; I group, baseline = 95 +/- 19, captopril = 90 +/- 24, p = nonsignificant), and the wedge pressure was reduced by the same extent in both groups (H group, baseline = 27.7 +/- 3, captopril = 21 +/- 7, p < 0.05; I group, baseline = 20 +/- 12, captopril = 15 +/- 8, p < 0.05). In the H group early mitral flow increased [(E wave integral) x (mitral annulus area)] by 38 +/- 15%, and was almost steady in the I group (-1.3 +/- 30%; group H vs. I = p < 0.01); late mitral flow [(A wave integral) x (mitral annulus area)] showed a pattern exactly opposite to this (H = +0.4 +/- 40%, I = +38 +/- 19; p < 0.01). In the whole population there was a significant correlation between the early/late flow ratio variations and baseline h/r (r = 0.6, p < 0.05). In chronic congestive heart failure, changes in left ventricular filling with captopril are related to h/r: a higher index, as recorded in the H group, is associated with "true normalization' of the filling pattern after captopril; a lower index, as recorded in the I group, is associated with "pseudonormalization' despite a similar decrease of left ventricular filling pressure.