1,720,970 research outputs found
PULMONARY TRUNK STENOSIS DUE TO CONSTRICTION BY A PERICARDIAL BAND
No full text[No abstract available
Dobutamine effects on spontaneuous variability of ventricular arrhythmias in patients with severe chronic heart failure: the Italian Multicenter Study.
No full textBackground. Dobutamina Studio Italiano Multicentrico (Do.S.I.M.) is a prospective, randomized,
multicenter interuniversity Italian study aimed at assessing the effects of dobutamine on spontaneous
variability of ventricular arrhythmias in sinus rhythm NYHA class III-IV patients with congestive
heart failure (CHF).
Methods. Out of 74 pre-hoc estimated CHF patients, 68 (92%) were randomized electively to either
being washed out of all active drugs except diuretics (group A) or to continue with the standard
regimen including digitalis, diuretics and ACE-inhibitors (group B, standard therapy). In 63 patients,
complete Holter data were obtained and are reported here. After 72 hours, in both groups, 48-hour
Holter monitoring (Holter 1) was performed. The spontaneous variability of ventricular arrhythmias
was assessed by calculating the natural logarithm of the sum of hourly incidences (during 48 consecutive
hours) of index events such as the mean heart rate or the various forms of total and either sustained
or non-sustained ventricular arrhythmias. The results were then grouped for the first and second
24-hour Holter periods. All patients were submitted to 10 μg/kg/min infusion of dobutamine for
72 hours and 48-hour Holter monitoring (Holter 2) was repeated 24 hours before the end of dobutamine
infusion. The incidence of arrhythmia and the distribution of laboratory and echocardiographic
variables was also studied in group A and B patients. The data of the two groups along with the intrapatient
± 95% confidence intervals were pooled, both on and off dobutamine.
Results. There was no significant difference between Holter 1 and Holter 2 in the rates of index
events in 63 patients with regard to pro-arrhythmic effects. Pro-arrhythmic effects were seen during
dobutamine infusion in 21% of cases, an effect which subsided (to 5%) when dobutamine was discontinued.
Interestingly, the positive inotropic effects of dobutamine (based on ejection fraction
changes) were parallel (22%) to the pro-arrhythmic changes, although they persisted long after dobutamine
discontinuation (18%). The pro-arrhythmic effects of dobutamine, both during (5%) as well
as after (1%) drug infusion, were unrelated to heart rate changes. The prevalence and incidence of
non-sustained ventricular tachycardia due to dobutamine were 47 and 29% respectively.
Conclusions. In sinus rhythm patients with severe CHF, dobutamine had chronotropic effects and
increased a depressed ejection fraction without significantly increasing arrhythmogenicity
Rottura biventricolare postinfartuale determinante shunt sinistro-destro extracardiaco attraverso pseudoaneurisma
No full textPostinflammatory scarring of cardiac valves of rheumatic and nonrheumatic etiology
No full textAbstract In rheumatic heart disease, cardiac valves often display only a nonspecific postinflammatory scarring, without specific features, such as the rheumatic granuloma. Fifty-five native valves excised from 47 patients, exhibiting postinflammatory scarring, were studied. Patients were subdivided into three groups according to their case histories: patients with both streptococcal infection and rheumatic fever (group I), with streptococdal infection without noncardiac major manifestations of rheumatic fever (group II), and without either of these features (group III). Pathological examination alone was unable to differentiate among the three groups, all the valves showing the same general pathological features. Differences in terms of sex, age, and valvular involvement were detected among group III and the others, whereas patients belonging to the first two groups did not differ significantly. These results suggest that diagnostic criteria for rheumatic fever are too restrictive and that a postinflammatory valvular scarring of nonrheumatic etiology does exist
[Univariate analysis of potential risk factors for early mortality (within 28 days) after aortocoronary bypass in Italy. OP-RISK Study Group].
No full textThe multicenter OP-RISK study, developed during 1994-96, was aimed at: 1) investigating early (28 days) death rates following aortocoronary bypass surgery among patients recruited from four Centers representing geographical distribution in Italy; 2) defining possible risk factors for early mortality, also comparing these factors with those reported in previous studies. Average values are reported and compared of 65 variables (36 preoperative, 10 operative and 19 postoperative) out of 984 patients subdivided into alive (n = 940) or dead (n = 44, 4.47%) at 28 days (155 +/- 174 hours, interval between 12 and 576 hours) postoperatively. Causes of death were cardiac in 37 (77%), pulmonary in 3 (0.7%), vascular in 2 (0.5%) and infective in 2(0.5%) patients, respectively. During the study a total of 1126 patients were operated upon in the collaborative Centers with the diagnosis of coronary artery disease and 51 deaths were reported officially in-hospital (4.53%). Therefore, OP-RISK data represent 87% of overall patients and a superposable death rate. The potential role as risk factors of early mortality was assessed univariately for 17 preoperative, 5 operative (in 3 cases for the first time) and 5 postoperative factors. In general, it was confirmed that factors defining left ventricular function are sensitive predictors of mortality. In OP-RISK we were able to show, in addition, that tachycardia (> 130 b/min) at induction of anesthesia, and total time of anesthesia, cardiopulmonary bypass and aortic cross clamping may be significant factors among operative variables as might be among postoperative ones several arrhythmia types or a lower rate in antithrombotic therapy with aspirin at 6-12 hours postoperatively. The protective role of bypass surgery performed with at least 1 arterial segment was also ascertained. Most of these potential factors were significantly related to outcome (either directly or inversely) as were among them, as seen in a subsample (65%) of 639 patients in whom a correlation matrix was performed among 16 factors selected on the basis of the common denominator principle. Our results suggest that it is possible to collect in a multicenter experience univariate predictors of early mortality following aortocoronary bypass surgery in Italy, which are not different from those reported from previous studies performed abroad. Operative indicators may also have predictive capabilities. The effort may be worthwhile and demands further cooperative studies to be undertaken, aimed at obtaining nationwide coefficients of risk along with representative average values of factors that soon might emerge once multivariate statistics will be performed on this material
PREDICTION OF EARLY AND DELAYED POSTOPERATIVE DEATHS AFTER CORONARY ARTERY BYPASS SURGERY ALONE IN ITALY.
No full textExercise training counteracts the abnormal release of plasma endothelin-1 in normal subjects at risk of hypertension
No full textBACKGROUND: The hypothesis that in normotensive offspring of hypertensive parents exercise training could influence the systemic release of endothelin (ET)-1 during a provocative testing protocol was tested.
METHODS: The provocative handgrip test was performed in four groups of healthy young age-matched males: offspring of hypertensive parents following a regular swimming exercise regimen (group A, n = 14); offspring of hypertensive parents and leading a sedentary lifestyle (group B, n = 11); normal volunteers with no family history of hypertension: sedentary (group C, n = 10), and following a regular swimming regimen (group D, n = 10). The plasma ET-1 was measured at baseline, after 4 min of handgrip exercise at 50% maximal capacity and following 2 (R2) and 10 (R10) min of recovery from handgrip.
RESULTS: ET-1 plasma levels, within the normal range in all groups at baseline (group A 0.94 +/- 0.32 pg/ml, group B 0.84 +/- 0.26 pg/ml, group C 0.78 +/- 0.35 pg/ml, group D 0.85 +/- 0.26, p = NS) showed a progressive and significant increase in group B during and after handgrip exercise (peak handgrip 1.08 +/- 0.5 pg/ml, p = NS; R2 1.35 +/- 0.36 pg/ml, p < 0.05; R10 2.76 +/- 0.75 pg/ml, p < 0.01). Significant differences were found at R2 and R10 when the ET-1 levels measured in group B were compared to those observed in group A, group C and group D. Multivariate analysis demonstrated that the serum levels of ET-1 significantly contributed to predict handgrip-induced changes when the diastolic blood pressure was the dependent variable.
CONCLUSIONS: Routine aerobic exercise appeared to counteract the handgrip-induced abnormal release of plasma ET-1 and may favorably affect the preclinical endothelial alterations seen in healthy offspring of hypertensive parents
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