[Electro-vectorcardiographic study of ventricular extrasystole in arrhythmogenic dysplasia of the right ventricle]. / Etude électro-vectocardiographique des extrasystoles ventriculaires dans la dysplasie arythmogène du ventricule droit.

The morphology of ventricular extrasystole (VES) in 46 cases of arrhythmogenic dysplasia of the right ventricle (ADRV) was correlated with the point of origin located by intracavitary mapping. The cases concerned 41 of left bundle-branch block (LBB) with various axes on the frontal plane (FP), 4 of right bundle-branch block (RBB), and 5 of atypical morphology (frontal plane shifted inferiorly and increased R from V1 to V6; on the horizontal plane, clockwise rotation of the loop oriented anteriorly and leftward). There is a good correlation with the site of origin: VESs which were LBB in appearance originated in the right ventricle (apex, septum, infundibulum); VESs which were RBB in appearance originated in the apex of the left ventricle, while the atypical VESs started in the upper posterior septum. A study of morphology may therefore also give an indication of the location of the disease.

[Contribution of electrovectorcardiography in the diagnosis of hypertrophic cardiomyopathy. Comparative study with an echocardiographic score]. / Apport de l'électro-vectocardiographie dans le diagnostic de la myocardiopathie hypertrophique. Etude comparative avec un "score" échocardiographique.

The object of the study was to define spreading and quantitative criteria of left ventricular hypertrophy in echocardiography by using a "score"--for this, the left ventricle has been divided into 11 regions and a "score" attributed to each one of them--and to find the correlation with the vectocardiogram (VCG) in 42 patients with hypertrophic myocardiopathy (HM). The results obtained show the following: 1) the left ventricular hypertrophy aspect on the ECG and the VCG is very sensitive for the identification of a diffuse HM; 2) the necrosis, hemiblock or septal hypertrophy indicate a hypertrophy located in the forepart septum or the whole of the septum; 3) the giant T waves indicate a hypertrophy of the apex; 4) a left ventricular hypertrophy associated with a necrosis or a hemiblock indicate a global myocardiopathy, with the basal region of the septum largely affected.

[Prognostic value of late exercise test after myocardial infarction]. / Valore prognostico della prova da sforzo tardiva dopo infarto miocardico acuto.

The parameters of a maximal exercise stress test, without therapy, 30 to 186 days after myocardial infarction were related to cardiac death, recurrent nonfatal infarction, coronary artery by-pass surgery, development of angina pectoris and ST segment depression during subsequent stress test in 209 patients. During a follow-up period of 9.5 to 119 months (medium 52) 12 patients died, 14 developed recurrent nonfatal myocardial infarction, 4 were submitted to coronary surgery, respectively 53 and 69 patients presented angina and ST segment depression at the first test, 23 and 33 developed them subsequently. Among the exercise parameters only the systolic blood pressure less than 140 mmHg was predictive of future mortality. Angina and ST segment depression when present at the first stress test were significantly related between them and with low heart rate, low maximal systolic blood pressure and low work load, but not with cardiac mortality, reinfarction and by-pass surgery. Our results show a low predictive value of the late maximal exercise test after a myocardial infarction. Probably that depends on evolution of coronary disease, which does not provide long-term prognostic informations.

Sensitivity, specificity and predictive accuracy of Q wave, QX/QT ratio, QTc interval and ST depression during exercise testing in men with coronary artery disease.

One hundred forty-three subjects (107 with coronary artery disease [CAD], 23 without CAD [evaluated by coronary angiography] and 13 athletes) were selected for this study. All subjects underwent exercise testing to evaluate sensitivity, specificity and predictive value of Q wave, QX/QT ratio, QTc interval and ST depression. The Q-wave analysis revealed less sensitivity (49%) and less specificity (83%) than ST depression (71% and 97%, respectively). The QTc criterion had greater sensitivity (80%) than ST depression but less specificity (11%). The QX/QT criterion was no different in sensitivity (74%) but had less specificity (69%). To establish the statistical evaluation of the positive predictive value in CAD, variations in the prevalence of the disease were considered. A 90% prevalence gives the best positive predictive value on all evaluated measurements, between 100% for ST depression and 89% for the QTc criterion. A 5% prevalence, however, gives an acceptable positive predictive value only on ST-segment depression (57%).

[Evaluation of clinical data and effort test in patients with angina pectoris: an approach to a multivariate analysis in different groups]. / Valutazione dei dati clinici e della prova da sforzo in pazienti con angina pectoris: un approccio mediante analisi multivariata a più gruppi.

One-hundred and eighty-nine patients who underwent cardiac catheterization for suspected ischemic heart disease were assigned to four different groups depending on the number of diseased vessels (0, 1, 2, 3), the dominant artery and the presence of left main coronary stenosis. Among the 45 parameters obtained from history, physical examination, E.C.G., and exercise test multivariate analysis identified (positive stress test, maximal systolic blood pressure, documented myocardial infarction, maximal heart rate, ipercholesterolemia, lateral myocardial infarction, angina during stress test) that were statistically significant. A score system was devised on the basis of the summed-up value of the seven parameters. When the patients were assigned, according to the score, to one of the previously mentioned 4 groups, the classification proved to be correct in 54% of the cases. When we divided the patients in two groups with or without coronary artery disease so that the attribution turned out to be correct in 92% of the cases (sensitivity 94%, specificity 77%), whereas when based on ST segment depression only, the classification was correct in 85% of the cases (sensitivity 84%, specificity 88%).

Decreased thrombotic mortality and morbidity after valvular cardiac surgery as a consequence of adequate coumarin anticoagulation. A retrospective study in 516 patients.

Two almost identical groups of 258 patients each who underwent surgery for the substitution of one or more than one cardiac valve were taken into consideration. After surgery all patients, with the exception of those who received a porcine allograph, were given coumarin drugs for 1 year for thrombosis prophylaxis. In the first group of patients operated in 1972 and 1973 the laboratory follow-up and the therapeutic range were neither constant nor uniform. In the case of the second group, which included patients operated in 1974 and 1975, adequate laboratory follow-up and constantly adequate therapeutic ranges were always kept. This retrospective study has shown a statistically significant decrease in mortality due to thromboembolism and to unknown causes in the second group of patients (x2 = 8,313, "p" less than 0,0025). A decrease of the non-lethal embolic complications was also noted in the second group of patients (x2 = 6,813, "p" less than 0,0025). On the other hand, bleeding complications were greater in the second group of patients (x2 = 3,485, "p" less than 0,05) and this was interpreted as secondary to the higher anticoagulation administered to the latter patients. The results indicate that an adequate coumarin anticoagulation seems able to decrease the incidence of lethal or non-lethal thromboembolic complications after cardiac valve replacement significantly.