The purpose of this study was the assessment of the left systolic atrial function (LSAF) in 45 hypertensive subjects (HS) with left ventricular hypertrophy (LVH). (LV mass index) (LVMI) (> 134 g/m2 for men, > 110 g/m2 for women) and in 32 normal subjects (NS). The both groups were matched for age, body surface, heart rate and LV fractional shortening. Left atrial volume (LAV) was calculated by the formula: LAV = 8 A1 x A2/3 pi l in which A1 is the area of the four-chamber view, A2 is the area of the two-chamber view and L is common length in the two views. The atrial function contractility was evaluated by the following parameters: 1. LA stroke volume (LASV) = LAV - LAMV where LAV is the volume before atrial systole and LAMV is the LA minimal volume. 2. LA ejection fraction (LAEF) = LASV/LAV. 3. Atrial ejection force (AEF) = peak A/MOA in which peak A wave is the maximal late diastolic velocity and MOA is the mitral orifice area. 4. Atrial transport (AT) = A/M in which M area is under the mitral velocity curve and A-area under the late diastolic velocity curved assessed by Doppler echo. [table: see text] Thus all above parameters are significantly increased in HS. In HS, LASV is correlated to LAV (r = 0.84; p < 0.001) and to LVMI (r = 0.32; p < 0.05). LAEF is correlated to peak A (r = 0.90; p < 0.001) and LVMI (r = 0.34; p < 0.05).In HS with LVH in comparison with N, the increase of the LA contractility is considered to be urged by the increase of LAV (Frank-Starling's law). These data could be explained by the less distensibility of LV chamber in relation to LVH.
In the last decades, there has been a growing demand for outpatient services; understanding the factors influencing patient satisfaction is critical for improving healthcare quality. This study evaluates patient satisfaction with nursing care and examines how satisfaction varies based on socio-demographic factors in ambulatory settings across five healthcare centers in the municipality of Vlora, Albania. In this cross-sectional study, a total of 246 patients were surveyed using the Patient Satisfaction with Nursing Care Quality Questionnaire (PSNCQQ), adapted for outpatient contexts, after assessing its validity and reliability. The mean age of the sample was 63.9 ± 13.1 years old with a range of 21 to 94 years, and 47.2% were aged between 50 and 69 years. The results indicate that the overall satisfaction level was fair, with a mean PSNCQQ score of 2.55 on a five-point scale. Socio-demographic factors, such as age, gender, education, and socio-economic status, significantly impacted patient satisfaction. Younger patients (aged 20-49), females, and those with a higher education and socio-economic status reported higher satisfaction. Medical history also played a role, with patients attending general check-ups showing greater satisfaction compared to those with chronic conditions. Older patients tend to report a lower level of satisfaction with the care provided compared to younger patients. Communication and nurse-patient interactions emerged as key areas for improvement, particularly in outpatient settings where care is episodic. These findings suggest that personalized care, improved communication, and greater attention to socio-demographic and medical factors can enhance patient satisfaction in ambulatory care settings.
Left ventricular (LV) transverse function is often used by the echocardiography to evaluate the systolic function in arterial hypertension (HTN). It would be interesting to know whether the LV long axis systolic dysfunction may precede the abnormalities of the transverse function in hypertension (HTN). For that purpose we evaluated by echo 36 patients (24 males, 12 females) with LV concentric hypertrophic (Lvmi > 134 g/m2 for men and > 110 g/m2 for women). All subjects were free of coronary heart disease and heart failure. According to the dimensions of the LV wall chickness (WTh) the HTN were subdivided in two groups: Group 1: Wth (12-14 mm) and Group 2: WTh (> 14 mm). The patients were compared to 30 healthy persons (control group) matched for age and LV systolic function (Fractional Shortening).LV long axis shortening was measured at the septal and lateral sides of the mitral annulus using M-mode from the apical four chamber view.Compared to control group, septal long axis shortening fell significantly (p < 0.05) in proportion to the degree of the wall thickness: control group: 21 +/- 2 mm. Group 1: 16 +/- 1 mm and Group 2: 14 +/- 1 mm. Lateral shortening was reduced only in the Group 2 (15 +/- 2 vs 20 +/- 2 mm) (p < 0.05). LV wall thickness correlated significantly (p < 0.05) to septal and lateral shortening respectively (r = -0.51) and (r = -0.48).1. Significant impairment of LV long axis function occurs in arterial hypertension with concentric hypertrophy even with normal transverse systolic function. 2. This alteration seems to be related to the dimensions of the LV wall thickness. 3. The prognostic implication of this disorder should be investigated further.
In Arterial hypertension abnormalities of left ventricular filling are constant and appear at an early stage, and in most cases signs of left ventricular failure (LVF) precede alterations in the left ventricular systolic function. The purpose of this study was to evaluate the frequency as well as the clinical and echocardiographic characteristics of LVF with normal systolic function in permanent arterial hypertension. 113 permanently hypertensive patients with normal left ventricular performance at echocardiography were studied clinically (functional class, congestive signs of LVF and/or presystolic gallop) and by means of echocardiographic recordings (dimensions of the left ventricle, mitral EF slope, left atrial diameter). The left ventricular wall thickness was normal (less than or equal to 11 mm) in 31 patients (group I), increased with asymmetrical septal hypertrophy in 36 patients (group II) and diffusely and symmetrically increased in 46 patients (group III). The EF slope was significantly smaller and left atrial dilatation was significantly more frequent in groups II and III than in group I. Clinical signs of LIF and presystolic gallop were observed in only groups II and III. Clinical LVF was found in 33/113 hypertensive patients (29%) and was always accompanied by symmetrical or asymmetrical left ventricular mural hypertrophy. Moreover, presystolic gallop (n = 8, i.e. 24%) and left atrial dilatation were significantly more frequent in patients with LVF than in those without LVF. Thus, LVF with normal systolic function is frequent in permanent hypertension. It results exclusively from abnormalities of left ventricular relaxation and/or compliance.
Results: In patients with inferior MI the delayed onset of the posterior long axis lengthening, with respect to end ejection, was not different from normal 69+28 vs 65+10 ms (NS), at admission. This delay correlated closely with ST segment (r=-0.8, p<0.001) and T wave (r=0.9, p<0.001) duration. In contrast, with anterior infarction the onset of anterior long axis lengthening was delayed by 20ms, 80+24 vs 60+9 ms, p<0.001 compared to normal. This delay became only related to ST duration 30 days after MI infarction (r=0.8, p<0.001) but not with the T wave. Conclusion: Patients with inferior MI recover their diastolic electromechanical re- lationship within days after thrombolysis, however with anterior infarction this rela- tionship becomes apparent 30 days after thrombolysis. These findings suggest a significant ventricular remodelling process after thrombolysis for anterior infarction. 2
Left (LV) and right ventricular (RV) filling was evaluated by pulsed doppler echocardiography in 56 hypertensive (HTN) untreated patients and in 30 normotensive (N) subjects, matched for age, body surface and heart rate. HTN were classified in two groups: HTN1: with normal LV mass index (LV mi) (< 135 g.m-2 for men, < or = 115 g.m.-2 for women); HTN2: with increased LV mi (> or = 135 g.m-2 for men, > or = 115 g.m-2 for women). All subjects had normal systolic function by echo. We derived: LV wall thickness (h), antero-posterior radius (r), h/r ratio, LV mi, ratio of early to late filling (E/A) in both ventricle. RESULTS. h and h/r were significantly in HTN1 (p < 0.01 vs N) and particularly in HTN2 (p < 0.001 vs N and HTA1). E/ALV and E/ARV were significantly decreased (p < 0.001) in both HTA compared to N. There was no significant difference between HTN1 and HTN2 concerning E/ALV and E/ARV. Relations of E/ALV and E/ARV with age, systolic blood pressure (SBP), LV mi, h, h/r: [table: see text] E/ALV is correlated to E/ARV (r = 0.37; p < 0.01) only in HTA. CONCLUSIONS. 1) In HTN in comparison with N: h, h/r are higher in the presence but also in the absence of increased LV mi. 2) In N and HTN: E/ALV and E/ARV are better correlated to h (and also to h/r in N) than to LV mi. Though the respective values of E/ALV and E/ARV are identical, they are correlated significantly only in HTN. 3) In the absence of the direct measures of the RV pressures and volumes, the interpretation of the results concerning the RV filling in uncertain. Only in HTN, they could be explained at least in part by the diastolic interplay between the two ventricles.
