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Left ventricular (LV) filling patterns in 26 elderly (mean age 81 years) patients with severe aortic stenosis (AS) were evaluated using pulsed-wave Doppler echocardiography. Parameters of LV filling, including the ratio of the peak atrial velocity to the peak early diastolic velocity (A/E ratio) and the percent contribution of active atrial filling to total LV filling (%A), of these patients with AS (group I) were compared with 2 groups presumed to have abnormal LV filling: elderly patients (group II) and hypertensives with increased LV mass (group III), as well as with normal volunteers (group IV). The patients with AS had a broad range of LV inflow velocity patterns (A/E = 0.91 +/- 0.56, range 0.20 to 1.91; %A = 34.3 +/- 16.4, range 3.0 to 65), as compared with the consistently low A/E ratio (0.48 +/- 0.13) and %A (25 +/- 7) in the normal volunteers and the high A/E ratio and %A in the elderly (A/E = 1.48 +/- 0.28, %A = 49 +/- 11) and hypertensive (A/E = 1.41 +/- 0.32, %A = 49 +/- 8) groups. When comparing the data obtained by Doppler with hemodynamics at catheterization, the patients with AS and a high A/E ratio (A/E ratio greater than 1, n = 11) had lower LV mid-diastolic pressures (7 vs 18 mm Hg, p less than 0.001), lower pulmonary artery systolic pressures (33 vs 49 mm Hg, p less than 0.05) and less symptomatic heart failure than those patients with AS and a low A/E ratio (A/E less than 1). The aortic valve area was similar in these 2 subgroups (0.40 vs 0.37 cm2).(ABSTRACT TRUNCATED AT 250 WORDS)

This study assesses the effect of dietary supplements with high dose omega-3 fatty acid (N3FA) on the frequency of clinical restenosis during the 6 months after successful percutaneous transluminal coronary angioplasty (PTCA). One hundred ninety-four patients (214 significant coronary narrowings) were randomized after successful PTCA to receive conventional medical therapy or to an identical regimen supplemented by high dose N3FA (4.5 g/day). Enrollment required angina pectoris and successful dilatation of all significant coronary narrowings. The subjects were randomly assigned to either no N3FA (control, n = 99) or N3FA supplementation (n = 95). After a 1-week trial period, 11 (group 2) declined further treatment because of side effects. The remaining 84 subjects (group 1) continued N3FA throughout the 6-month period. Monthly clinical follow-up was obtained in all patients. Ninety-two percent of patients had cardiac testing for evaluation of recurrent ischemia. Except for a greater percentage of women in the group refusing N3FA supplementation (group 2), the 3 groups were similar in demographic data, medical history, dietary habits, history of previous PTCA and angiographic characteristics. Of the 194 subjects, 56 had clinical restenosis (45 by cardiac catheterization, 8 by exercise testing and 3 by symptoms alone [refused further clinical testing]). Reocclusion rates were: group 1 19%, group 2 46%, and control 35%. Analysis both in accordance with the principle of intention to treat and for subjects who actually received N3FA revealed a significant effect of N3FA on preventing clinical restenosis (p less than 0.04 and p = 0.008, respectively). These data suggest that high dose N3FA supplements reduce the clinical restenosis rate after successful PTCA.