[Incidence of pericardial effusion and study of left ventricular function in patients with hepatic cirrhosis with ascites]. / Incidenza di versamento pericardico e studio della funzione ventricolare sinistra in pazienti con cirrosi epatica ascitogena.

Like hydrothorax, ascites and edema, pericardial effusion is present in decompensated hepatic cirrhosis. In order to evaluate the extent of effusion and to assess whether it is concomitant with left ventricular dysfunction, 21 patients who had been hospitalised for hepatic cirrhosis and ascites were studied following echocardiographic examinations and compared to 21 subjects without signs of cardiopathy. The following findings were statistically significant: the increased presence of pericardial effusion in patients with cirrhosis in comparison to controls, and likewise the higher ejection fraction in the former group. No differences were found between the two groups with regard to the size of the left ventricle. Within the group of patients affected by cirrhosis, the sole statistically significant difference between those patients with pericardial effusion and those without was observed with regard to the telediastolic diameter, which was greater in patients with pericardial effusion. In conclusion, pericardial effusion is common in patients with hepatic cirrhosis and ascites and is not accompanied by left ventricular dysfunction.

[A study of the distribution of some risk factors in patients with myocardial infarct. Different cardiovascular prevention methods in relation to age]. / Studio della distribuzione di alcuni fattori di rischio in pazienti con infarto del miocardio. Considerazioni per una differente prevenzione cardiovascolare in relazione all'età.

In order to evaluate whether a different method of preventive approach to ischemic cardiopathy is appropriate in relation to age, the distribution of some classic cardiovascular risk factors (cigarette smoke, cholesterol) and a stress-related risk factor (type of work) was studied in two groups of patients, aged respectively over and under 60, admitted to hospital for acute myocardial infarction. The most significant data were: blood cholesterol values less than 220 mg/ml, found mainly in older patients; a larger number of heavy smokers in the group of patients aged under 60; the majority of patients were employees. In the light of these results, the paper discussed the need for different forms of preventive intervention, both clinical and epidemiological, for Ischemic cardiopathy in relation to age.

Usefulness of stress testing for the evaluation of hypertensive heart disease in young hypertensive subjects.

To investigate the usefulness of stress testing for the evaluation of hypertensive heart disease, 40 subjects, 28 men and 12 women (mean age 30.8 +/- 6.2 years), with mild or moderate hypertension, without ST segment or T wave abnormalities in their resting ECG, were examined. 13 patients (32.5%) showed exercise-induced ST segment depression. The heart rate at rest was significantly higher in the patients with a positive response; 6 of the 7 subjects with electrocardiographic signs of left ventricular hypertrophy (summed SV1 + maximum R V5/V6 voltage of 45 mm or more) had a positive exercise electrocardiographic test. There were no significant differences between positive and negative cases in age, sex, systolic and diastolic blood pressure, or the double product (heart rate X systolic pressure) at rest or during exercise. After resting blood pressure values had been significantly decreased by giving methyldopa with or without diuretics for at least 6 months, there were a regression of left ventricular hypertrophy in the resting ECG and an impressive reduction in the prevalence of exercise-positive responses (to 17.5%). In the 7 patients with positive exercise electrocardiographic tests even after antihypertensive treatment, no significant reduction in blood pressure values during exercise was obtained.

Prognostic value of exercise EKG testing in asymptomatic normotensive subjects. A prospective matched study.

We prospectively studied 135 asymptomatic normotensive subjects with exercise-induced ST ischemic depression of 1 mm or more and compared them with 379 controls. At least two controls with negative responses on the exercise electrocardiographic (EKG) test were selected for each case and were matched for age, sex, work, community, and coronary-risk-factors index. The end points considered were the following coronary events: angina pectoris, myocardial infarction, and sudden death. After a median follow-up period of 6.0 years for the cases and 6.4 years for the controls, the relative risk was 5.55 (95 per cent confidence limits, 2.75 to 11.22). Coronary events occurred significantly earlier in the cases than in the controls. Our data also suggest that the exercise EKG response is a particularly good prognostic indicator for myocardial infarction. In addition, our analysis has confirmed the predictive roles of age, smoking, blood pressure, and the coronary-risk-factors index and suggests that the exercise EKG response is an additional independent risk indicator for coronary events.