[Diabetic cardiomyopathy: preclinical pathology disclosed by the increase in ventricular afterload]. / Cardiomiopatia diabetica: patologia preclinica evidenziabile con l'incremento dell'afterload ventricolare.

In order to test the importance of the association of diabetes mellitus and arterial hypertension in generating morphological and functional changes of the left ventricle (LV) consistent with a cardiomyopathy, 37 patients, aged 27 +/- 6.7 years, were studied by standard and digitized M-Mode echo: eighteen of them were affected by diabetes mellitus, 11 by arterial hypertension, 8 by diabetes and hypertension. Each group was compared to the others and with a group of 14 normal subjects. In order to verify the importance of increased ventricular after-load in modifying ventricular performance of diabetic patients, changes of the peak rate of systolic and diastolic variation of LV diameter and changes of the peak rate of interventricular septum and posterior wall excursion (IVSE, PWE) were evaluated after methoxamine hydrochloride infusion in 8 diabetic and 6 normal subjects. In diabetics the ratio between ventricular thickness and diameter (h/r) was greater than normal subjects (p less than 0.02); this ratio resulted higher in patients with diabetic rhinopathy who also exhibited an isovolumic diastolic period longer than normal (p less than 0.02). Both h/r ratio and isovolumic diastolic period (IDP) were higher in diabetic-hypertensive group as compared to normals (p less than 0.001), strictly diabetic (p less than 0.01 and p less than 0.001) or hypertensive subjects (p less than 0.01). Diabetic-hypertensive group, exhibited a lowering of the systolic and diastolic peak rate of IVSE (p less than 0.01) as well as of systolic peak rate of PWE as compared to the other three groups (p less than 0.05).

[Hypertrophic cardiomyopathy. Correlation between the morphologic-quantitative data of the 2-dimensional echocardiogram and electro-vectorcardiographic aspects]. / Cardiomiopatia ipertrofica. Correlazione tra i dati morfologico-quantitativi dell'ecocardiogramma bidimensionale e gli aspetti elettro-vettorcardiografici.

39 patients affected with hypertrophic cardiomyopathy (ICM) have been studied by M-mode and two-dimensional echocardiography (1 and 2D Echo), standard electrocardiogram (ECG) and vectorcardiogram (VCG). For each patient we have outlined the anatomical shape of the left ventricle and we have tried to measure the myocardial hypertrophy by a score system that determines its size and extent. For this reason we have followed the echocardiographic segmental analysis procedure suggested by Edward (1981) but we have modified it dividing the left ventricle into 11 segments and measuring the value of the apex three times. We have given each patient a hypertrophy score by assigning a value 0 to any segment with a thickness less than or equal to 12 mm, a value 1 if the thickness was greater than 12 less than or equal to 17 mm, a value 2 if it was greater than 17 less than or equal to 22 mm, a value 3 if greater than 22 mm. We have also calculated the distribution index of the hypertrophy dividing the number of the hypertrophied segments by the number of the ventricular segments. We have identified five patterns of hypertrophic cardiomyopathy: 7 cases with a partial involvement of the interventricular septum (IVS) (pattern 1), 7 cases with a full involvement of the IVS (pattern 2), 22 cases with involvement of the free wall of the left ventricle (pattern 3), 2 cases with involvement of the distal IVS and the apex (pattern 4), 1 case with involvement of the inferior and lateral wall (pattern 5). The highest hypertrophy score and distribution index was noticed in the third anatomical pattern (p less than 0.001). Comparing the three more frequent anatomical patterns with their Ecg-Vcg aspects, we have found a higher prevalence of the left anterior hemiblock in pattern 1, of the pathological Q waves in pattern 2, of the left ventricular hypertrophy in pattern 3. However this correlation was not significant while the correlation between the Ecg-Vcg aspects and the myocardial hypertrophy score and distribution index was extremely significant (p less than 0.001). Consequently the size and distribution of the myocardial hypertrophy could differentiate the Ecg-Vcg aspects better than the anatomical shape of the left ventricle; when hypertrophy was moderate the left anterior hemiblock and the pathological Q waves were more frequent. On the contrary when hypertrophy was high and widespread the prevailing Ecg-Vcg aspect was the left ventricle hypertrophy.

[Post-ischemic inversion of the T wave]. / L'inversione post-ischemica dell'onda T.

The significance of new T wave inversion (so called post-ischemic T wave inversion) in the basal electrocardiogram of patients suffering from unstable angina is still controversial. Some AA suggest that the patients who develop this ecg pattern represent a subgroup with poor prognosis, particularly when to deep negative T waves (greater than 3 mm) a long QT interval is associated (giant negative T waves). On the contrary other AA suggest that there is not a different prognosis between patients which develop and which do not develop post-ischemic T waves (post-I T waves). We studied 113 patients with unstable angina: 95 patients were reviewed retrospectively (group I), 18 patients were studied perspectively (group II). In group I 63/95 developed post-I T waves (49 in anterior, 9 in inferior and 5 in both anterior and inferior leads) while 32/95 did not develop post-ischemic T waves. In group II all 18 patients developed post-ischemic T waves according to the characteristics of giant negative T waves. Follow up periods were 62 +/- 36 months in group I and 11 +/- 7 months in group II. In 61 cases (45 of group I and 16 of group II) the electrocardiogram was registered during anginal pain. ST increase and/or pseudonormalization of T wave from negative to positive, indicating transmural ischemia, was observed in 59% of patients with post-ischemic T waves vs 30% of pts without post-ischemic T waves (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)