Assessment of left internal mammary artery grafts using dipyridamole Doppler echocardiography.

Color Doppler echocardiography of the left mammary artery was combined with dipyridamole testing in order to assess the presence of significant (>70%) graft stenosis in 87 patients with a mammary artery graft to the left anterior descending coronary artery presenting with chest pain. Occluded grafts are detected by absent diastolic flow velocities at baseline, whereas the response of the diastolic flow velocity to dipyridamole distinguishes patients with critical versus noncritical stenosis of a patent graft.

[Dilated cardiomyopathy: a new natural history? The experience of the Italian Multicenter Cardiomyopathy Study (SPIC)]. / Cardiomiopatia dilatativa: una nuova storia naturale? L'esperienza dello Studio Policentrico Italiano Cardiomiopatie (SPIC).

BACKGROUND: The natural history of idiopathic dilated cardiomyopathy (IDC), once a disease with a dire prognosis, is thought to be changing. Aim of this study was to describe the clinical characteristics, long term course and prognostic factors of IDC patients followed up prospectively since the late eighties. METHODS: Patients with a diagnosis of IDC confirmed by normal coronary angiography, non specific endomyocardial biopsy findings and a left ventricular ejection fraction below 50% were consecutively enrolled in a multicenter registry and followed up at 6-months intervals. RESULTS: From January 1986 till January 1994, 441 IDC patients with a mean age of 43 +/- 13 years (range 8-68) entered the registry. Thirty per cent of patients were women and 8% had familial dilated cardiomyopathy. NYHA class was I-II in 77% and 35% of patients were asymptomatic at the time of diagnosis. Treatment included digitalis in 235 patients (53%), diuretics in 239 (54%), angiotensin converting enzyme inhibitors in 269 (61%), betablockers in 108 (24%). Chronic atrial fibrillation was detected in 10% of patients and left bundle branch block in 24%. Mean cardiothoracic ratio was 0.54 +/- 0.06. Mean left ventricular end diastolic dimension was 38 +/- 6 mm/m2; 48% of patients had minimal or mild left ventricular dilatation. Mean left ventricular ejection fraction was 30 +/- 10%. At Holter monitoring 67% of cases had complex ventricular arrhythmias, 37% had ventricular tachycardia and 4% had advanced atrioventricular block. Mean exercise stress test duration was 9 +/- 4 minutes. After a mean follow up of 31 +/- 24 months, 337 patients were alive without transplantation and 5 were lost to follow up; 60 patients (14%) had died of cardiac causes, namely heart failure (6%), sudden death (7%) and pulmonary embolism (< 1%) and 30 had been transplanted (7%), while 4 had died of unclear causes. Survival and transplant-free survival were 94% and 90% at 2 years and 82 and 76% at 5 years, respectively. At multivariate analysis pulmonary capillary wedge pressure (p = 0.0001, odds ratio, for values > 15 mm Hg, 2.05) and betablocker treatment (p = 0.002, odds ratio 0.26) were independent predictors of survival. CONCLUSIONS: In this large, multicenter prospective study, prognosis of IDC in the eighties appears to be improved. Early diagnosis, together with improved medical treatment, probably bears a causal relation to these changes.

Comparison of clinical findings in idiopathic dilated cardiomyopathy in women versus men. The Italian Multicenter Cardiomyopathy Study Group (SPIC)

Clinical and laboratory findings were compared in 65 women and 238 men with invasively documented idiopathic dilated cardiomyopathy. Women had more severe symptoms (New York Heart Association class > or = III in 48 vs 39%; p < 0.05), presented more frequently with heart failure signs (63 vs 41%; p < 0.01), and had a higher cardiothoracic ratio (0.56 +/- 0.06 vs 0.53 +/- 0.06; p < 0.05) and higher frequency of left bundle branch block (41 vs 29%; p < 0.05). Echocardiographic measurements in women showed significantly greater left ventricular (LV) end-diastolic (42 +/- 7 vs 39 +/- 6 mm/m2; p < 0.0001) and end-systolic (36 +/- 7 vs 33 +/- 6 mm/m2; p < 0.001) diameters, and mean myocardial thickness (11 +/- 2 vs 10 +/- 2 mm; p < 0.05). Exercise duration was shorter in women than in men (7 +/- 3 vs 10 +/- 4 minutes; p < 0.001). After 18 +/- 16 months, 9 women and 27 men died, and 7 and 17, respectively, received transplants. Transplant-free survival was not significantly different according to gender. By Cox multivariate analysis, LV ejection fraction was a significant independent predictor of cardiac death or heart transplantation in both sexes (p < 0.05 in men, and p < 0.005 in women), together with left atrial diameter index (p < 0.01) in women, and mean pulmonary artery pressure (p < 0.001) in men. In conclusion, women with idiopathic dilated cardiomyopathy present a more advanced phase of the disease with greater LV dilation, but do not have a different prognosis.

[Clinical and prognostic significance of echocardiographic parameters in dilated cardiomyopathy: a prospective study on 225 patients. The Italian Multicenter Study of Cardiomyopathies Group]. / Significato clinico e prognostico dei parametri ecocardiografici nella cardiomiopatia dilatativa: studio prospettico su 225 pazienti. Gruppo SPIC.

To assess the prognostic role of echocardiographic indexes and their relation to clinical conditions, 225 patients with dilated cardiomyopathy were studied prospectively. All cases had a normal coronary angiogram and non specific endomyocardial biopsy findings. 163 men (72.4%) and 62 women (27.6%), mean age 41.5 +/- 12.3 (range 8-61), were studied. Clinical, electrocardiographic and echocardiographic parameters, normalized for body surface area, were tested according to NYHA class and presence of segmental or diffuse wall motion abnormalities. One hundred-four patients were in NYHA class I-IIa, 94 were in class IIb-III and 27 were in class IV. Left ventricular end systolic diameter index, right ventricular end diastolic diameter index, left atrial diameter index, left ventricular fractional shortening and ejection fraction, and radius to wall thickness ratio were significantly more impaired in patients with more severe symptoms. Twenty-eight patients (13%) showed segmental wall motion abnormalities and had smaller left ventricular end systolic and left atrial diameter index and higher left ventricular fractional shortening and ejection fraction. During a mean follow up of 23 +/- 15 months (range 1-67 months), 25 patients (11.1%) died from cardiac causes and 16 (7.1%) underwent heart transplant because of refractory heart failure. Prognostic evaluation was performed separately for cardiovascular mortality alone and for cardiac events (cardiovascular mortality and heart transplantation). At Cox multivariate analysis only right ventricular end diastolic diameter index (p < 0.005) predicted cardiovascular mortality, while left atrial diameter index (p < 0.001), right ventricular end diastolic diameter index (p < 0.01) and left ventricular ejection fraction (p < 0.05) were significant independent predictors of cardiac events.

Early predictors of smoking cessation after myocardial infarction.

The determinants of long-term smoking cessation were evaluated in 80 patients who smoked cigarettes and survived a myocardial infarction. All patients underwent a program of rehabilitation and secondary prevention including in-hospital counseling and physician-guided reinforcing sessions at 1, 3, and 6 months after discharge. At 18 months of follow-up, 53 patients (66.3%) had quit smoking. Variables associated with smoking cessation were duration of hospital stay greater than or equal to 19 days (79 vs. 48%; p less than 0.005) and peak creatine phosphokinase (CPK) elevation greater than or equal to 500 U/l (76 vs. 54%; p less than 0.05). Males tended to quit in higher proportion than females (68 vs. 44%). Age, prior myocardial infarction, other cardiovascular risk factors, infarction location, Killip class at entry, and duration of stay in coronary care unit did not significantly affect the quitting rates. Logistic regression analysis singled out the duration of hospital stay as a significant predictor of smoking cessation (p less than 0.005). Early and intensive secondary prevention during the hospital stay is crucial in promoting sustained smoking cessation after myocardial infarction.

[Effects of acute intravenous administration of propafenone on left ventricular function in patients with acute myocardial infarction]. / Effetti della somministrazione acuta endovena di propafenone sulla funzione ventricolare sinistra in pazienti con infarto miocardico acuto.

UNLABELLED: In order to evaluate the effects of propafenone (an antiarrhythmic class 1 c agent) acutely administered intravenously on left ventricular function, 10 patients with acute myocardial infarction (AMI), affected by arrhythmias (greater than or equal to Lown class III), belonging to Killip class I and II, and with normal serum electrolyte levels, were studied 2-4 days after an acute episode. No patients had previously been treated with antiarrhythmic drugs, or, if treated, the agent was withdrawn since at least 4 half-lives. In no case were inotropic substances or other pharmacological treatments, capable affecting L.V. function administered. Intravenous nitroderivative (Venitrin) infusion was continued when indicated. Each patient was administered a propafenone bolus (1 mg pro Kg in 4 minutes). Two dimensional and Doppler echocardiography were performed under basal conditions i.e. before propafenone infusion, during the infusion and after 1, 2, 3 and 4 hours, deriving following parameters: L.V. end diastolic and end systolic dimensions and volumes, ejection fraction (area-length method), II motion abnormalities, and transmitral flow velocity profile (E/A ratio). Statistical data were obtained using two way analysis of variance. RESULTS: In no case was the treatment interrupted, on the basis of our protocol criteria (reactions of hypersensitivity, proarrhythmic effects, acute hemodynamic deterioration that requires immediate positive inotropic and chronotropic agents administration, worsening of previous arrhythmic class). Heart rate and systemic arterial blood pressure did not change significatively during or after infusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Interstitial myocardial lipomatosis: a morphological study on endomyocardial biopsies and diseased hearts surgically removed for heart transplantation.

A morphological study was designed to assess on histological grounds the frequency and degree of interstitial adipose tissue in the myocardium of diseased and transplanted hearts. A review was conducted on 144 right ventricular histological sections (RVs) from hearts surgically resected for heart transplantation, 115 endomyocardial biopsies (EMB) from 100 patients investigated for dilated cardiomyopathy (DCM), and 309 biopsies from 26 heart-transplant patients. Interstitial lipomatosis (IL) was the preferred term to describe the mere presence of adipose tissue in the myocardium, and the arbitrary classification of grade 0, 1, and 2 IL was devised to collect data. Only grade 2 IL was considered as potentially pathological. Morphometric analysis was adopted on the 144 RVs from surgical hearts; only a morphological approach was preferred for the EMB. Grade 2 IL was observed in 58/144 RVs (40.27%), in 5/365 (1.3%) myocardial samples from 115 EMB in patients with DCM, and in 5/1296 (0.38%) myocardial samples from 309 biopsies of 26 transplants. Morphometric analysis of the surgical hearts revealed a case in which a significant grade 2 IL of the RV was associated with life-threatening ventricular arrhythmias.

Semen evaluation in heroin and methadone addicts.

We studied 32 heroin and methadone addicts, divided into 4 groups according to the type of drugs used: 5 heroin-dependent, 10 taking methadone plus heroin more or less constantly, 10 taking methadone plus heroin occasionally, and 7 taking methadone only. 93% of the heroin addicts and 65% of those taking methadone had abnormal semen. The most frequent abnormality was in motility (78%). Teratozoospermia was the second most frequent (28%) and oligozoospermia the third (16%). The 7 patients taking methadone only had neither teratozoospermia nor oligozoospermia. This semen pathology is probably secondary to decreased testosterone production, with relative hypofunction of the seminal tracts and the accessory glands.

[Uni- and cross-sectional bidimensional echocardiography in coronary care unit. Study on 117 patients (author's transl)]. / Impiego dell'ecocardiografia uni e bidimensionale in unita' coronarica. Studio di 117 casi.

The Authors present the results of an unidimensional and cross-sectional bidimensional echocardiographic study carried out on 117 patients taken into the Coronary Care Unit of the Divisione Rizzi in the Milano-Niguarda Hospital. The purpose of this work was to reconsider the usefulness of this diagnostic methodology in situations of cardiologic emergency, with particular reference to acute coronaropaties. The echocardiographic examination was recorded within 24-48 hours since the admission in CCU of patients taken in for acute myocardial infarction, cardiogenic shock, serious dysrhythmias and unstable angina. In particular, 17 cases of acute myocardial infarction have been followed with cross-sectional bidimensional echocardiography, holding the exams at the time of admission and in II, III, V and XV day of illness. Moreover, such examinations were held in emergency situations as occurred in CCU. All the patients were also investigated from the clinical, electrocardiograhic, radiological and laboratorial point of view. The obtained results were the following: 1) In contrast with unidimensional echocardiography, cross-sectional bidimensional echocardiography has turned out to be technically feasible in all cases; moreover, it has permitted a view of the zones of the left ventricul that couldn't be explored by unidimensional technique. 2) A good correlation has been demonstrated between electrocardiographical location of acute myocardial infarction and dyskinetic zones as seen on the echocadiogram; indeed, in some cases, echocardiography has been able to point out an impairment of wall motion greater than expected only on the basis of electrocardiographic evaluation. 3) Systematic use of the echocardiography in CCU has often been able to point out pathological findings whose diagnosis was not feasible only on the basis of the usual clinical or instrumental data. In conclusion, the Authors confirm the diagnostic and prognostic usefulness of unidimensional echocardiographic study in CCU and underline that the event of cross-sectional bidimensional echocadiography opens new opportunities for the employment of the ultrasonographic methodology, although it is not yet in the position to completely substitute unidimensional echocardiography.