Effects of digoxin, placebo and ibopamine on exercise tolerance and cardiac rhythm of patients with chronic post-infarct left ventricular failure.

This study compares the effects of digoxin, placebo and ibopamine (SB-7505), the orally active 3,4-diisobutyryl ester of N-methyl-dopamine, on exercise tolerance and cardiac rhythm of 14 patients whose left ventricular heart failure (end-diastolic pressure, 26.3 +/- 5.9 mmHg; ejection fraction, 0.42 +/- 0.10%) depended on a previous myocardial infarction. Patients were admitted to the study while on chronic oral digoxin treatment (serum levels between 1.1 and 1.9 ng/ml). Placebo instead of digoxin was given for the following month. Thereafter ibopamine 50 mg t.i.d. for one month was given. A sequence of one-month treatments with digoxin, placebo and ibopamine was repeated, then ibopamine was administered continuously for the next two months. The concurrent treatment (diuretics in all patients, nitroderivates in twelve, calcium antagonists in two) remained unchanged during the observation period. Symptoms-limited exercise tests and 24-h Holter recordings were obtained at admission, at the end of each one-month treatment and at the end of the observation period. Two patients developed unstable angina without increase of serum creatine phosphokinase while on ibopamine and were withdrawn. Out of the 12 patients that concluded the trial, one required supplementary doses of diuretic at the end of the second period on placebo. The results obtained during the trial suggest that: a) therapeutic plasma levels of digoxin have no deleterious effect on cardiac rhythm nor significantly increase exercise tolerance as compared with placebo; b) diuretics and nitrates appear to sustain the clinical stability of these patients as a group.(ABSTRACT TRUNCATED AT 250 WORDS)

[Echocardiographic and polygraphic study of acute/effects of Ibopamine on cardiac performance]. / Studio ecocardiografico e poligrafico degli effetti acuti della Ibopamina sulla performance cardiaca.

The effects of Ibopamine, a new orally active dopaminergic agent, on cardiac performance were studied both in a group of healthy volunteers and in a group of patients with congestive heart failure (CHF), using non-invasive methods, such as echocardiography and polygraphy. Randomly, and in double-blind fashion, the healthy volunteers received single doses of Ibopamine 50, 100 and 150 mg orally every 3 days. The CHF patients, also randomly and in double-blind fashion, were given single doses of either placebo or Ibopamine 100 or 150 mg every 2 days. Echocardiographic and polygraphic data were recorded in baseline conditions and 3, 6 and 8 hours after the drug administration. The heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured at the same time. The following parameters were considered: echocardiography: left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), interventricular septum excursion (IVSE), left ventricular posterior wall excursion (LVPWE), per cent fractional fiber shortening (%FS); polygraphy: electromechanical systole (Q-A2), total ejection time (ET), pre-ejection period (PEP), ET/PEP ratio. In CHF patients, body weight and 24-h diuresis were also measured daily. Neither of the two groups showed significant changes in HR, SBP and DBP with any drug dose. A shortening of ET (-2.2%, p less than 0.01) and Q-A2 (-2.8%, p less than 0.001) was found in the group of normal subjects with a dose of 50 mg.(ABSTRACT TRUNCATED AT 250 WORDS)

Antiarrhythmic effectiveness of creatinol O-phosphate in man.

Antiarrhythmic effectiveness of N-methyl-N-(beta-hydroxyethyl) guanidine O-phosphate (creatinol O-phosphate, COP) has been investigated in 10 patients with ischemic heart disease and frequent premature ventricular contractions (PVCs). Each patient received a random succession of treatment with the drug (1020 mg) and with a reference substance (solvent of COP) both administered i.m. twice a day over a 3-day period. In each patient a Holter ECG was recorded in the basal state and during the last 24 h of each treatment. Heart rate, PQ and QTc showed no changes. On the contrary, PVCs were significantly lower (P less than 0.01) with COP than with the reference substance. The drug showed a prevailing effect during daytime. Results are discussed in view of experimental observations suggesting that COP has a "membrane effect".

201Tl for the differential diagnosis of cold thyroid nodules.

We used 201Tl-chloride for studying and differentiating thyroid areas shown to be 'cold' in previous 131I or 99mTc scanning. We investigated sixteen thyroid neoplasms that were removed surgically shortly afterwards. We found an intense intranodular accumulation of 301T1 in five scintigraphs shown to be of histologically malignant neoplasms, and an intense accumulation also in one of those shown to be histologically benign. We did not detect any 201Tl-chloride accumulation in two cases of thyroiditis; one of these had shown an intense accumulation in a previous 131Cs scintigram.

[Value of echocardiography in the diagnosis of dissecting aneurysm of the aorta]. / Validita' dell'ecocardiografia nella diagnosi di aneurisma dissecante dell'aorta.

A revision of 1300 echocardiograms of adults showed 14 patients whose echocardiographic diagnosis of aortic root dissecting aneurism (D.A.). Of these, 8 didn't have any anamnestic, clinical or instrumental evidence of D.A. In the other 6, admitted to our department with a suspected D.A., echocardiography proved to be useful in confirming such diagnosis in 4, in excluding it in 1, but gave a false positive diagnosis of D.A. in the sixth, affected by a diffuse carcinomatosis with pleuropericardial blood effusion. From the examination of the present experience, the Authors deem echocardiography is a useful diagnostic tool in the screening of D.A. when the following conditions are fulfilled: 1) presence of all the major criteria of Nanda and Gramiak, especially the aortic root anterior wall dilatation beyond 16 mm; 2) an almost suggestive story and clinical evidence of D.A. The usefulness of an echocardiographic pattern recently described as diagnostic of D.A. (loss of continuity between the borders of the anterior aortic wall with interventricular septum, and/or posterior aortic wall with mitral anulus) was confirmed: it was detected in 3 of the 4 D.A. patients but in none of the others. The presence of a false positive and the possibility of technical artifacts nevertheless induce caution in the interpretation of the echocardiographic pattern alone.

[Unstable angina: observtions on 187 patients of whom 84 were operated on for aorto-coronary bypass (author's transl)]. / Angina instabile Osservazioni su 187 pazienti di cui 84 operati di bypass aorto-coronarico

Clinical data, EKG and coronary angiography of 187 patients with unstable angina are given. The patients are divided into 4 groups: spontancous angina, spontaneous angina Prinzmetal's variant, "in crescendo" agina, intermediate syndrome. 103 patients were treated with pharmacological therapy only and 84 underwent aortocoronary bypass; 2 of them were operated on for acute myocardial infarction. The clinical and pathologic peculiarities of two groups are not similar and therefore the results are not comparable. There was a mortality rate of 10.3% of patients with pharmacological treatment and the incidence of non fatal myocardial infarction was 10.4%. The mortality during operation was 14.2% and the incidence of non fatal myocardial infarction was 13.1%. The spontaneous angina and Prinzmetal's variant often had normal rest EKG and a very similar coronary angiographic pattern, with obstructive lesions often localized in the proximal part of a single vessel. In 9% of cases coronary arteries were normal. The incidence of serious arrhythmias was higher in Prinzmetal's variant than in other types of unstable angina. The mortality in patients with Prinzmetal's angina was particularly high during the first period of experience (1970-1973) when the operation was performed after a few days of unsatisfactory results with pharmacological treatment; it decreased after patients underwent operation in an attenuate phase of the disease. The rest EKG of "in crescendo" angina was almost always pathologic; these cases presented obstructive lesions of 2 or 3 coronary arteries, functional impairment of left ventricle, collateral circulation. The mortality in patients treated with pharmacological therapy was higher than in other types of unstable angina. The mortality during operation, fairly high in the first period of experience, decreased in this group of patients as well, during the second period of experience.