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The importance of left ventricular hypertrophy in cardiovascular
disease has gained wide recognition. Left ventricular hypertrophy
is a highly important risk factor associated with major
cardiovascular events, including symptomatic heart failure,
particularly in patients with systemic hypertension. Over the past
years much has been learned about the genetics, molecular
background, prevalence, incidence and prognosis of left ventricular
hypertrophy. A variety of noninvasive methods has emerged for
detecting left ventricular hypertrophy and the assessment of
reversal of hypertrophy. Yet, a lot of controversy remains about
the connotations and clinical implications of left ventricular
hypertrophy. For instance, in the athlete's heart left ventricular
hypertrophy may constitute a physiological adaptation to pressure
overload, which normalizes following discontinuation of strenuous
physical activity. On the other hand, in particular in patients
with hypertension, left ventricular hypertrophy denotes a serious
prognosis in the course of hypertension. In these patients left
ventricular hypertrophy should be regarded as a grave prognostic
sign rather than an innocent compensatory phenomenon. The
distinction between physiologic and pathophysiologic left
ventricular hypertrophy has been the basis for this book.
Few diagnostic methods in Cardiology have heralded such
revolutionary developments as the introduction of coronary
arteriography. When, in the early 1960's, Dr. F. Mason Sones
demonstrated that visualization of the coronary anatomy in living
humans was not only feasible but sufficiently safe and reliable to
be used as a clinical tool in the evaluation of patients with known
or suspected ischemic heart disease, the thus far somewhat
neglected area of coronary circulation became the focus of
interest. Naturally, for a considerable period of time a great deal
of emphasis was placed upon coronary anatomy. Simple relations
between narrowing lesions, impediment to flow, and prognosis were
assumed to exist. Spectacular results of surgical coronary
revascularization seemed to confirm this concept. Gradually it has
become evident that the pathophysiology of coronary artery disease
is considerably more complex. Diagnostic methods were introduced to
assess and quantify exercise-induced myocardial ischemia. At first,
these tests were used mainly to achieve a more discriminative
selection of candidates for coronary arteriography and the coronary
arteriogram remained the gold standard. Currently, these techniques
have evolved to the point where they provide valuable functional
and metabolic information. They have become powerful independent
tools in clinical investigations and evaluation of individual
patients.
A unique overview of all major angiographic lipid intervention
trials, presented by their principal investigators. Basic
mechanisms and methodological aspects, including biochemical as
well as angiographic aspects, are discussed by experts in these
fields. A careful comparison of all available data permits an
analysis to be made of what may currently be considered proved,
which aspects merit further investigation, and which hypotheses
should be rejected. Audience: Clinicians involved in the practice
of lipid lowering and investigators involved in lipid-lowering
clinical trials. Scientists involved in other areas of lipid
research and investigators conducting coronary angiographic trials
designed to study the influence of different interventions will
find a wealth of information and practical guidelines in this book.
The importance of left ventricular hypertrophy (LVH) in
cardiovascular disease has gained wide recognition. LVH is a highly
important risk factor associated with major cardiovascular events,
including symptomatic heart failure, particularly in patients with
systemic hypertension. In recent years much has been learned about
the genetics, molecular background, prevalence, incidence and
prognosis of LVH. A variety of noninvasive methods has emerged for
detecting LVH and the assessment of reversal of hypertrophy, yet a
lot of controversy remains about the connotations and clinical
implications of LVH. For instance, in the athlete's heart LVH may
constitute a physiological adaptation to pressure overload, which
normalizes following discontinuation of strenuous physical
activity. On the other hand, in particular in patients with
hypertension, LVH denotes a serious prognosis in the course of
hypertension. In these patients LVH should be regarded as a grave
prognostic sign rather than an innocent compensatory phenomenon.
The distinction between physiologic and pathophysiologic LVH is the
basis for this book. Left Ventricular Hypertrophy - Physiology
versus Pathology is a bibliographical reflection of a Boerhaave
Symposium held on April 9, 1999, in Leiden, The Netherlands. At
this symposium the major issues in dealing with LVH were discussed,
including etiology, genetics, detection, and therapy. In
particular, the book includes novel detection methods for LVH such
as magnetic resonance imaging and spectroscopy. Furthermore, much
attention was paid to the molecular and genetic approach of LVH.
This book will assist clinical cardiologists, fellows in
cardiology, general internists, radiologists, cardiothoracic
surgeons, biochemists, physiologists, pharmacologists, and basic
research fellows in understanding the most recent insights in the
background of physiologic versus pathologic LVH.
Few diagnostic methods in Cardiology have heralded such
revolutionary developments as the introduction of coronary
arteriography. When, in the early 1960's, Dr. F. Mason Sones
demonstrated that visualization of the coronary anatomy in living
humans was not only feasible but sufficiently safe and reliable to
be used as a clinical tool in the evaluation of patients with known
or suspected ischemic heart disease, the thus far somewhat
neglected area of coronary circulation became the focus of
interest. Naturally, for a considerable period of time a great deal
of emphasis was placed upon coronary anatomy. Simple relations
between narrowing lesions, impediment to flow, and prognosis were
assumed to exist. Spectacular results of surgical coronary
revascularization seemed to confirm this concept. Gradually it has
become evident that the pathophysiology of coronary artery disease
is considerably more complex. Diagnostic methods were introduced to
assess and quantify exercise-induced myocardial ischemia. At first,
these tests were used mainly to achieve a more discriminative
selection of candidates for coronary arteriography and the coronary
arteriogram remained the gold standard. Currently, these techniques
have evolved to the point where they provide valuable functional
and metabolic information. They have become powerful independent
tools in clinical investigations and evaluation of individual
patients.
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