Publisher's Synopsis
Excerpt from Annual Report of National Heart, Lung, and Blood Institute: October 1, 1992 September 30, 1993
The Cardiology Branch continues its research in hypertrophic cardiomyopathy (hcm). They showed in more than iso patients that dual chamber pacing is effective in relieving drug-refractory symptoms and in reducing LV outflow obstruction. This has rendered traditional therapy with either a LV myectomy or mitral valve replacement unnecessary. They found that chronic pacing alters electrical and hemodynamic cardiac properties that persist even after the pacing is discontinued. Further studies are underway to determine the molecular basis of this observation. In studies of endothelial dysfunction, they showed that patients with hypertension or hypercholesterolemia have impaired endothelium-dependent vascular responses to acetylcholine, and that this abnormality is' related to a defect in the nitric oxide system. Now they have found that this impaired endothelial function is not related to decreased availability of the precursor, L-arginine.
They showed that reinjection of thallium, after a 3-4 hour period of redistribution identifies patients with viable but dysfunctional myocardium. The results of the thallium reinjection study are essentially the same as those from positron emission tomography, as far as predicting the recovery of function after revascularization procedures. This is important information since pet is very expensive and requires a cyclotron, while thallium imaging is readily available at most hospitals equipped for routine nuclear medicine procedures. In their study of molecular-based therapeutic strategies, they demonstrated that an adenovirus-delivered gene is capable of inhibiting smooth muscle cell proliferation in vitro. Further work is underway to see if such gene therapy might prevent restenosis after percutaneous coronary angioplasty.
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