[Non-invasive evaluation of coronary reperfusion. Analysis of the ST segment before and after thrombolysis in acute myocardial infarct]. / Valutazione non invasiva della riperfusione coronarica. Analisi del tratto ST prima e dopo trombolisi durante infarto miocardico acuto.

BACKGROUND: The aim of this study was to determine the role of the ST segment elevation resolution > 50% between the ECG before and 2 hours after thrombolytic therapy as a predictor of acute myocardial infarction (AMI)-related artery patency, assessed by a coronary angiography performed 1 month after AMI. MATERIALS AND METHODS: This study enrolled 95 patients, 75 men and 20 women, 58 years mean aged, admitted to the coronary care unit with diagnosis of AMI. Patients were treated with thrombolysis within 6 hours from the onset of chest pain, according to the GUSTO trial. RESULTS: The findings showed a significant prevalence of ST segment elevation resolution > 50% in inferior AMI (p < 0.01). It has been observed that the ST segment resolution is correlated with lower (p < 0.01) and earlier (p < 0.05) peak in serum creatinekinase (CK) and CK MB release and with less damage of left ventricular ejection fraction assessed by ventriculography (p < 0.01). All these findings indicated a lower extensive myocardial damage. Patients with ST segment resolution presented a prevalence of one or two-coronary vessel disease, with an infarct-related vessel narrowing like that observed in the other patients without ST resolution. Nevertheless a TIMI grade 2 or 3 flow was observed more frequently, but not significantly, in the subjects with ST resolution; a significant prevalence was limited to TIMI 3 grade flow (p < 0.05). In the present study ST segment elevation resolution > 50% represented a highly sensitive and a poor specific predictor of vessel patency in inferior AMI, but with a poor sensitivity and specificity in anterior AMI. CONCLUSIONS: Personal experience suggested that the thrombolytic therapy has a less favourable effect on the artery patency assessed 1 month after AMI, rather than in the acute phase as reported in previous studies. Dynamic changes of flow or a following worsening in atherosclerotic plaque could be probably responsible of reocclusion of an initially reperfused coronary artery.

[Diagnosis of pulmonary thromboembolism by transesophageal echocardiography. Report of a case]. / Diagnosi di tromboembolia polmonare mediante ecocardiografia transesofagea. Descrizione di un caso.

We describe the case of a 73-year-old man, admitted after several days of moderate dyspnea, followed by sincopal episode. Transesophageal echocardiography clearly demonstrated a high resolution image indicating thromboembolus of the proximal right main pulmonary artery. The patient's clinical conditions were moderately impaired; a treatment with heparin followed by warfarin was started. At 15 and 30 days interval, TEE controls were performed, showing an incomplete but evident resolution of pulmonary thromboembolism, associated to an improvement of clinical ECG and scintigraphic parameters. Our TEE observation, in accordance with the small number of similar observations reported in literature, showed a clear direct visualization with high resolutive diagnostic possibilities for pulmonary thromboembolism; successful resolution was confirmed by repeated TEE studies.

[Female gender and acute myocardial infarction: what role does it play in the early and late prognosis]. / Sesso femminile ed infarto miocardico acuto: quale ruolo nella prognosi a breve e medio termine?

The primary purpose of this study is to examine the influence of the female gender on the early and 1-year post-discharge prognosis after acute myocardial infarction (AMI). Moreover, the therapeutic approaches are compared between the two sexes during the early phase of AMI. We performed a retrospective cohort study of 341 patients, 219 men and 122 women, consecutively admitted to the coronary care unit with AMI. Among the baseline characteristics, the age greater than 70 years, the systemic hypertension and the diabetes mellitus are more represented in women; on the contrary cigarette smoking is prevalent in the male gender. The analysis of laboratory and clinical parameters does not show any statistic differences between the two sexes, except the ejection fraction and the coronary reperfusion. The first turns out to be lower in the females and the second one is more often observed in the males. As for the intra-hospital complications, the cardiogenic shock is prevalent in the female gender, the early mortality gets to 26% in women and 11% in men (p < 0.01). The late mortality during the follow-up does not present any difference between the two sexes. From our data, we conclude that transmural AMI, cardiogenic shock, ventricular fibrillation and 2-3 degree atrio-ventricular blocks are significantly bound to a higher early mortality in women. In them the atrial fibrillation is the only predictor of 1-year mortality. Finally, thrombolysis, beta-blockers and significantly aspirin and heparin (p < 0.05), are less used in the female patients, while diuretics and digoxin are more employed.(ABSTRACT TRUNCATED AT 250 WORDS)

[The effect of age on early and late mortality after an acute myocardial infarct]. / Influenza dell'età sulla mortalità precoce e tardiva dopo infarto miocardico acuto.

The purpose of this study is to define the importance of age as predictor of early and late mortality following acute myocardial infarction (AMI). At the same time, effects coming from the use of various therapeutic approaches are considered. We have studied 341 patients, 188 aged < 70 years and 153 > or = 70 years, consecutively admitted to the coronary care unit with diagnosis of AMI. Our findings show that age > or = 70 years, female gender, cardiogenic shock, ventricular fibrillation and early post-infarction angina are significantly connected to higher intra-hospital mortality. As for predictors of 1-year mortality, they turned out to be the age > or = 70 years, indirect signs of more extensive infarction as previous necrosis, acute heart failure, cardiogenic shock, new bundle branch blocks and pre-discharging lower ventricular ejection fraction. In patients aged > or = 70 years, especially in ultra eighty-year old men, thrombolysis, heparin, beta-blockers and aspirin are significantly less employed. All drugs used in the early hours of AMI turned out to be bound to beneficial effects with reduced mortality, except diuretics and antiarrhythmics. The only drugs correlated with an improved 1 year survival are betablockers, aspirin and thrombolysis. On the contrary, the use of diuretics and digoxin is limited to patients with a greater clinical dysfunction. These drugs are associated to a higher late mortality. The present study confirms the finding that elderly patients with AMI who are submitted to less aggressive therapeutic approaches and are more frequently represented by women, have a higher mortality.

[Observations on the natural history of heart failure. Changes due to the therapeutic use of captopril]. / Osservazioni sulla storia naturale dell'insufficienza cardiaca. Modificazioni indotte dall'impiego terapeutico di captopril.

The purpose of this research was a retrospective evaluation of the mortality rate in 138 patients, considered after the first hospitalisation due to heart failure. After 5 years, the mortality rate was higher in the 54 patients with dilatative cardiomyopathy (74.3%), compared to the 44 patients with coronary heart disease (54.5%), while the 40 patients with valvular heart disease showed a lower mortality (37.5%). The mortality rate was higher in patients admitted in higher NYHA class. The primary aim of this research was to assess the effects of captopril on mortality in 101 treated patients, compared to 37 non treated patients, both receiving conventional treatment for heart failure. Between the 2 groups, the mortality rate showed lower percentage values for patients treated with captopril, with significant difference (p less than 0.01) at controls carried out every 12 months, until 5 years. Progressive heart failure was the greater cause of death in both groups, while the deaths classified as due to arrhythmia without pump failure were less frequent. Deaths due to reinfarction in patients with coronary heart disease showed lesser percentage values in patients treated with captopril. This research demonstrated the high mortality rate affecting a group of patients after the first hospitalisation due to heart failure. The addition of captopril to conventional treatment for heart failure significantly reduced mortality.

[Verapamil in effort angina: a multi-centre study]. / Il verapamil nell'angina da sforzo: valutazione policentrica.

We have performed a multi-centre study with 47 outpatients in order to evaluate the efficacy of Verapamil (V) in the treatment of stable effort angina, and to compare the effect of two different doses of the drug (240 and 360 mg/die). The protocol consisted of a first period of Placebo, followed by the double-blind randomized cross-over administration of Placebo (P) and Verapamil (V) in doses of 240 and 360 mg/die. The symptomatology, the consumption of TNG, the ECG pattern at rest and during exercise, the maximum exercise tolerance during exercise and the rate of recovery were evaluated at the end of each 1 month period. V. provided a significant reduction of the number of angina attacks and of the consumption of TNG pills with improvement of symptomatology. The maximum exercise performance improved without changes in maximum rate pressure double product. A decrease of double product was observed at rest and during the recovery period. The higher dose of V. (360 mg/die) provides a better improvement in the number of angina attacks, in the symptomatology, in the double product at rest, and in the rate of recovery than the lower dose (240 mg/die). Thus these data indicate that V. provides anti-anginal efficacy by reducing myocardial oxygen demand, and increases exercise tolerance in effort angina patients.