[Efficacy and safety of ambulatory electric cardioversion of atrial fibrillation with monophasic and biphasic shock]. / Efficacia e sicurezza della cardioversione elettrica della fibrillazione atriale in regime di day-hospital con shock mono e bifasico.

BACKGROUND: The aim of this study was to evaluate the safety and efficacy of ambulatory external cardioversion (EC) by means of monophasic and biphasic shock in patients with persistent atrial fibrillation (AF). METHODS: One hundred and twenty-seven consecutive patients with AF were submitted to EC, preceded by short general anesthesia with propofol, after pretreatment with oral anticoagulants for at least 3 weeks and, if not contraindicated, with amiodarone. In 87 of these patients we used monophasic shock and in 40 patients we used biphasic shock. Our protocol provided for up to 3 shocks delivered at an energy level ranging between 200 and 360 J for monophasic and from 70 to 175 J for biphasic shock. The patients were discharged after 4 hours of ECG monitoring and following a determination of serum CK-MB at the fourth hour. RESULTS: The mean age of the patients submitted to EC with monophasic and biphasic shock (65 +/- 9 vs 67 +/- 7 years) and the duration of AF (34 +/- 22 vs 32 +/- 25 days) were similar. The efficacy of EC with monophasic shock was 85% and the mean energy delivered was 266 +/- 81.5 J. The efficacy of the EC with biphasic shock was 98% and the mean energy delivered was 127 +/- 40 J. The difference between the percentage of efficacy and the number of joules delivered was statistically significant (p < 0.05). The mean value of the CK-MB after 4 hours following delivery of the shock was not significantly different: 2.5 ng/ml for monophasic vs 1.7 ng/ml for biphasic shock (p = NS). CONCLUSIONS: In our patients, ambulatory EC of persistent AF is safe and feasible; biphasic shock is more efficacious and requires less energy with respect to monophasic shock.

[Cardiac metastasis of Grawitz tumor: transesophageal monitoring of the effectiveness of antineoplastic therapy]. / Metastasi cardiache di tumore di Grawitz: monitoraggio con ecocardiografia transesofagea dell'efficacia del trattamento antiblastico.

A patient with carcinoma of the kidney and right heart metastasis is reported. Transesophageal echocardiography allowed to detect the cardiac metastasis and to control the efficacy of antineoplastic therapy. The surgical resection of the primitive tumor was subsequently possible.

[Floating thromboembolism of the right atrium in pulmonary embolism. Effectiveness of treatment with rTPA]. / Tromboembolo fluttuante nelle cavità cardiache destre in corso di embolia polmonare. Efficacia del trattamento con rTPA.

We describe a case od echocardiographic visualisation of right atrial thrombus in a patient affected by pulmonary embolism. The thrombus had the characteristic aspect of embolus with venous origin. The litic treatment with rTPA, during echocardiographic monitoring, was effective with disappearance of the thrombus and quick improvement of symptoms.

[Dobutamine echocardiography and positron emission tomography in the assessment of viable myocardium after a thrombolized acute myocardial infarction. Comparison with spontaneous recovery]. / Test ecodobutamina e tomografia and emissione di positroni nella identificazione del miocardio vitale dopo un infarto miocardico acuto trombolisato. Confronto con la ripresa funzionale spontanea.

BACKGROUND: Aim of the present study was to compare the ability of low-dose (5-10 gamma/Kg/min) dobutamine echocardiography (DE) and of positron emission tomography (PET), performed after a thrombolized acute myocardial infarction (AMI), to predict the spontaneous functional recovery (SFR) of viable but akinetic myocardial segments. PATIENTS AND METHODS: Twenty-one pts were studied by DE, 10 +/- 2 days (DE1) and 31 +/- 2 days (DE2), after a thrombolized AMI, and by PET (18F-FDS, glucose load) within 7 days after DE2; a basal echo was also performed 3 months after AMI. The left ventricle was divided in 16 segments, both in echo and PET examination. DE viability was defined as improvement in wall motion of akinetic seg; PET viability was defined as an FDG uptake > or = 40% of the maximum. RESULTS: In the 89 akinetic segments, DE1, DE2 and PET, respectively, identified, 16, 27 and 60 viable segments; the concordance with PET, in viable and not viable segments, resulted of 50% for DE1 and of 62% for DE2. After 3 months 29/89 segments had a SFR. In comparison with SFR the sensitivity of DE1 and DE2 was lower (51% and 68%) than PET (89%); the specificity was higher for DE1 and DE2 (98% and 96%) respect to PET (43%). CONCLUSIONS: In comparison with DE performed 10 days after a thrombolized AMI, DE performed 30 days after AMI revealed a greater extension of viable myocardium and a greater diagnostic accuracy in predicting SFR of akinetic segments. The concordance between DE and PET is high, if all myocardial segments are considered, and lower, if only akinetic segments are considered; in fact, PET identifies, as viable, a greater number of segments. In comparison with SRF, DE revealed the greatest specificity and PET the greatest sensitivity.

Erythrocyte Li+/Na+ and Na+/H+ exchange, cardiac anatomy and function in insulin-dependent diabetics.

It has been proposed that an increased activity of cell membrane Na+/H+ exchange, mirrored by increased erythrocyte Li+/Na+ exchange, may facilitate cell hypertrophy and hyperplasia. Patients with insulin-dependent diabetes mellitus may develop a specific cardiomyopathy with systolic and diastolic abnormalities and increased thickness of the left ventricle. Therefore, we have investigated the relationships between erythrocyte Li+/Na+ and Na+/H+ exchange and echocardiographic parameters in 31 male insulin-dependent diabetics (aged 17-68), in good metabolic control. Three had untreated mild hypertension. In all patients the urinary albumin excretion rate was less than 200 micrograms min-1. Ten patients had a Li+/Na+ countertransport higher than 0.37 mmol l-1 cell h-1, the upper normal limit for our laboratory (0.49 +/- 0.10, mean +/- SD). In comparison with the patients with normal countertransport, they had increased interventricular septum thickness and relative wall thickness (h/r). End diastolic volume and cardiac index were reduced while blood pressure and urinary albumin excretion rate were similar. In the whole study group, interventricular septum thickness was significantly correlated to Li+/Na+ exchange (r = 0.61, P less than 0.001) and Na+/H+ exchange (r = 0.35, P less than 0.05), independently of the effect of age and blood pressure. Posterior wall thickness was correlated to Li+/Na+ exchange (r = 0.38, P less than 0.05) and h/r to Li+/Na+ exchange (r = 0.41, P less than 0.05) and to Na+/H+ exchange (r = 0.44, P less than 0.05). Li+/Na+ exchange was negatively correlated to cardiac index (r = -0.37, P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Diabetes and coronary risk factors, relative risk for single factors and aggregation of more factors in a general population sample from northern Italy.

In the course of a general population survey in Mirano (Venice), Northern Italy, a random sample of 1,903 subjects (50.1% men) aged 20-59 was examined. Fifty-five were diabetic (fasting plasma glucose greater than or equal to 140 mg/dl or diagnosed by a physician) and 1,670 non-diabetic subjects (fasting plasma glucose below 110 mg/dl). In this paper an assessment was made on the more frequent occurrence of coronary risk factors (serum cholesterol and triglycerides, body mass index (BMI), systolic blood pressure, cigarette smoking) and, in particular, of their aggregation in diabetic patients as compared to non-diabetic controls. The occurrence of any one of the coronary risk factors studied was more frequent in diabetic subjects and significantly so for triglyceridemia in both sexes and for systolic blood pressure and BMI in men. The aggregation of two or more risk factors was also more frequent in diabetic subjects than controls. Finally, the combined score of coronary risk as calculated by multiple logistic function showed higher values for diabetic subjects. These results confirm the need for a systematic search for coronary risk factors in diabetic subjects in order to prevent cardiovascular complications.

Electrocardiographic findings in hypertensive patients of a population sample. Role of sex, age, and antihypertensive treatment.

During the initial phase of the World Health Organization (WHO) "Community Control Program of Hypertension" in Italy, 1190 subjects with high blood pressure derived from a general population random sample (5856 people of both sexes, aged 20 to 64 years) were enrolled in a hypertension register. At the registration visit (RV), each of them gave case history details and underwent a complete clinical examination, blood and urine tests, and a standard 12-lead electrocardiogram (ECG). All the ECGs were read by a single coder, using the second version of the Minnesota Code (MC). We calculated the prevalence of electrocardiographic codes according to sex, age, and the state of antihypertensive treatment. The overall prevalence of electrocardiographic abnormalities (i.e., all codes except 1:0 and isolated 9:4) was 40.8% with a slightly higher prevalence in males than in females: 42.4% versus 39.4%. Codes related to left ventricular hypertrophy (LVH) (3:1 or 3:3) were also more frequent in males (21.2%) than in females (14.5%) but not those related to ischemia (4:1-4:3 or 5:1-5:3). In fact, group 4 codes were present in 4.0% of males and 16.1% of females; group 5 codes, in 5.7% of males and 18.1% of females. Abnormal codes generally increased with increasing age, but those related to LVH did not follow this general rule in males. In fact, in the age class 20-29 years, codes 3:1 were found in 11.1% and codes 3:3 in 17.5% of the subjects, whereas the corresponding frequencies in the oldest age group (60-64 years) were 15.2% and 12.4%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

[Electrocardiographic changes in a cohort of hypertensive patients in a community intervention program]. / Modificazioni elettrocardiografiche in una coorte di ipertesi durante un programma di intervento su base comunitaria.

A pilot project for the control of hypertension in the Community was carried out in Italy as a part of the WHO Programme "Community Control of Hypertension". 1190 subjects identified as hypertensive (BP greater than or equal to 160 and/or 95 mmHg at two subsequent measurements, or under treatment) during the screening of a random sample of the population between 20 and 64 years in the District of Camposampiero (Padova) were enrolled in a Hypertension Register during a subsequent visit (Registration Visit: VR) carried out two months after the screening. In the following 5 years they were recalled about once a year at a Hypertension Clinic for a complete visit (VA). On both the VR and the VAs a resting electrocardiogram (ECG) was recorded and subsequently assessed according to the Minnesota Code (MC). Out of the 1190 registered hypertensive subjects, 872 (400 males and 472 females) participated in the last VA visit after 5 years, which corresponds to an overall participation rate of 69.4% in males (M) and 76.9% in females (F). Among subjects with normal and abnormal ECG at the VR, the participation rates at the last VA were, respectively, 67.9 and 71.5% in M (not significant difference); 80.0% and 70.8% in F (significant difference: P less than 0.001). Between the VR and the last VA the mean BP values of the 872 subjects investigated decreased from 162. 9/102.2 mmHg to 148. 6/90.4 mmHg in M and from 168. 7/102.2 mmHg to 155. 3/91.7 mmHg in F. The rate of abnormal ECGs increased from 44.0% to 50.3% in M and from 36.4% to 47.9% in F, involving most single items and all the classes of the MC with the exception of classes 8 and 9. The items which diminished generally had a rather low prevalence or were those indicating minor abnormalities. The apparent regression of some pathological patterns could actually be accounted for by a shift towards more severe abnormalities. The most remarkable changes occurred in codes indicating respectively left ventricular hypertrophy (3: 1 or 3: 3) and myocardial ischaemia (4: 1-3 or 5: 1-3 or 7: 1).(ABSTRACT TRUNCATED AT 400 WORDS)