Download Men with Poor Left Ventricular Function Have Lower Levels of

8P
Medical Research Society
that this shortening of ED was due to shortening of mid systole (controls =
109 ms versus CHF = 67 ms;Pd.001)and explicable by early wave
reflection. Vitamin C increased ED from 284 f 5 ms to 298 f 6 ms
(P<O.001) but there was no change following normal saline (from 274 f 8
ms to 275 f 8 ms; P=NS). Time sequence analysis revealed that this
prolongation was almost exclusively due to a prolongation of mid systole
(increase from 66ms to 76 ms;P=O.OI) and entirely explicable by a delay in
wave reflection.
Conclusions - Early wave reflection contributes to shortened ED in CHF.
Vitamin C increases ED, which appears, at least in part a consequenceof
delayed wave reflection.
25
MEN WITH LOW LEVELS OF ANDROGENS HAVE
WORSE LEFT VENTRICULAR FUNCTION FOLLOWING
ACUTE MYOCARDIAL INFARCTION
PJ PUGH, KM ENGLISH, TH JONES and KS CHANNER
Department of Cardiology, Royal Hallamshire Hospital, Sheffield,
Department of Human Metabolism and Clinical Biochemistry,
University of Sheffield
Background: Low androgen levels in men are associated with risk
factors for acute myocardial infarction (AMI). The fall in
testosterone following AMI may themfore be associated with
poorer outcome. We examined the relation of androgens with
infarct size and cardiac function in men with AMI.
Methods: 22 male patients with AMI were recruited. Blood was
taken at presentation (day 1) and on days 2, 3 and 6 following
admission. Levels of total (TT), free (FT) and bio-available (BT)
testosterone and DHEAS were measured. Peak creatine kinase
(CK) was determined. The development of left ventricular failure
(LVF) during admission and the subsequent finding of left
ventricular dysfunction (LVD) at echo or cardiac catheter were
recorded.
Results: Baseline androgens did not predict the peak CK. TT on
day 3 correlated inversely with peak CK (I=-0.43, e.047).
Baseline DHEAS correlated with admission diastolic blood
pressure. (14.53, p==O.Oll).Subjects who developed LVF had
lower baseline levels of FT (35.9pM v 49.8pM, @.025). Those
who developed LVD had higher peak CK (1979UL v 766UL,
~ 4 . 0 3 7 )and lower baseline TT (10.4nM v 14.6nM, e . 0 3 9 ) ;
they also had a greater fall in DHEAS level during their hospital
stay (-0.95pM v +0.53pM, p=O.043). The development of Q waves
was associated with a higher peak CK (2389UL v 836UL.
p4.001) and greater fall in BT (-l.OnM v -O.lnM, ~ 4 . 0 1 6 ) .
Conclusion: Bigger infarct size and poorer cardiac function are
associated with lower androgen levels in men with AMI. These
findings may suggest a possible protective role of androgens in
limiting myocardial damage.
function (n=8) and Group C had normal LV function with normal
valves and coronary arteries (n=8). Blood was taken between 0800
and 0900hours. Levels of total (TT) and bio-available (BT)
testosterone were measured.
Results: Age and body mass index did not differ significantly
between groups. TT and BT levels in Group C were 19.6nMf3.0 and
5 . 7 m 1 . 3 respectively. Subjects in Group A had significantly lower
levels of both TT (14.3nMf2.9, p4.003) and BT (4.lnMf1.0,
fl.017). Subjects in Group B also had lower levels but not
significantly (TT=l8.7*6.9,
~ 4 . 7 4 0 BT=S.OnMkl
;
.O, ~ 4 . 2 4 2 ) .
The difference in hormone levels between Groups A and B was not
significant for TT (p4.121) or BT @=O.llI).
Conclusion: Men with heart failure due to LVD have lower
testosterone levels than men with normal left ventricular function.
However, in men with heart failure from VHD who have preserved
ventricular function, testosterone levels are not significantly altered,
suggesting that the reduced androgen level is associated with
myocardial disease rather than systemic abnormalities. Low
androgen levels could contribute to altered vascular tone and the
muscle wasting and fatigue seen in patients with heart failure.
27
NON-ACE
MEDIATED
pRoDucIlON
ANGXOTENSIN
II
26 MEN WITH POOR LEFT VENTRICULAR FUNCTION
HAVE LOWER LEVELS OF TESTOSTERONE THAN MEN
WITH NORMAL LEFT VENTRICULAR FUNCTION
PJ PUGH, KM ENGLISH, TH JONES and KS CHANNER
Department of Cardiology, Royal Hallamshire Hospital, Shefield,
Department of Human Metabolism and Clinical Biochemisw,
University of Sheffield
Background Testosterone is an anabolic hormone which has been
shown to act as a vasodilator in men.Patients with heart failure have
abnormal vascular tone and excess catabolism. We examined
testosterone levels in men with heart failure due to either left
ventricular dysfunction (LVD) or valvular heart disease (VHD).
Methods: Male patients undergoing elective cardiac catheterisation
were recruited. Group A consisted of men with LVD due to coronary
disease (n=8), Group B had significant VHD but normal LV systolic
28 CAROTID DISEASE IN A LOCAL POPULATION: THE
EFFICACY OF AN OPEN ACCESS CAROTID DUPLEX
SERVICE
CWh4 CHAN, AR BRADWELL*, AD WRIGHT* and CHE
IMRAY
Vascular Investigation Unit, Walsgrave Hospital, Coventry CV2
2DX
Duplex scanning is well established in identifying high grade carotid
stenosis suitable for surgery. Whilst differing carotid surgery rates
within the United Kingdom may, in part, be due to population
differences, local practice and referral patterns may play a more
insidious role in the identification of the population at risk.