Italian heart journal : official journal of the Italian Federation of Cardiology最新文献

{"title":"Prognostic role of non-sustained ventricular tachycardia in a large cohort of patients with idiopathic dilated cardiomyopathy.","authors":"Massimo Zecchin,&nbsp;Andrea Di Lenarda,&nbsp;Dario Gregori,&nbsp;Michele Moretti,&nbsp;Mauro Driussi,&nbsp;Aneta Aleksova,&nbsp;Dorita Chersevani,&nbsp;Gastone Sabbadini,&nbsp;Gianfranco Sinagra","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The identification of patients with idiopathic dilated cardiomyopathy (IDC) at higher risk of sudden death (SD) is still an unsolved issue, and the role of non-sustained ventricular tachycardia (NSVT) uncertain.</p><p><strong>Methods: </strong>The effect of NSVT on total mortality, SD and life-threatening arrhythmias was evaluated in 554 patients with IDC on optimal medical treatment and at long-term follow-up (81 +/- 58 months).</p><p><strong>Results: </strong>At diagnosis, 240 patients (43%) had NSVT at Holter monitoring and 314 (57%) did not. During follow-up, 189 patients (5/100 patients-year) died or underwent heart transplantation; SD occurred in 53 patients (1.4/100 patients-year); SD + non-fatal ventricular arrhythmias occurred in 75 patients (2/100 patients-year). Patients with and without NSVT at diagnosis had the same 5-year transplant-free survival rate (76 vs 76%, p = NS) and a similar incidence of SD (10 vs 7%, p = NS). The length and rate of NSVT did not show any significant relationship with the outcome. Only heart failure symptoms (NYHA class III-IV) (hazard ratio [HR] 1.9, p = 0.015) and severe left ventricular impairment (left ventricular ejection fraction < or = 0.30 and left ventricular end-diastolic diameter > or = 70 mm) (HR 2.7, p < 0.0001) were independently associated with higher SD risk. At multivariate analysis the presence of frequent NSVT episodes (> or = 3 runs/day) was associated with an increased risk of total mortality (HR 1.68, p = 0.041) and of major ventricular arrhythmias (HR 2.11, p = 0.037), but only in the subgroup of patients with severe left ventricular impairment.</p><p><strong>Conclusions: </strong>Patients with advanced heart failure symptoms, severe left ventricular dysfunction and dilation had a higher risk of SD independently of NSVT. The finding of more frequent NSVT was associated with an increased risk of all-cause mortality and of major ventricular arrhythmias in patients with severe left ventricular impairment.</p>","PeriodicalId":80289,"journal":{"name":"Italian heart journal : official journal of the Italian Federation of Cardiology","volume":"6 9","pages":"721-7"},"PeriodicalIF":0.0,"publicationDate":"2005-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25624612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Initial energy for biphasic external electrical cardioversion of atrial fibrillation.","authors":"Gennaro Miracapillo,&nbsp;Alessandro Costoli,&nbsp;Luigi Addonisio,&nbsp;Silva Severi","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>No international guidelines indicate the initial energy in biphasic external electrical cardioversion of atrial fibrillation (AF) actually. The aim of this study was to determine this value in order to find a reasonable compromise between the necessity of limiting tissue damage and of quickly restoring sinus rhythm as well.</p><p><strong>Methods: </strong>Fifty-six consecutive patients with AF candidate to external electrical cardioversion were treated using adhesive anterior-posterior paddles and biphasic wave defibrillator Lifepack 12, with steps of 50 J. After 6 hours troponin I levels were measured.</p><p><strong>Results: </strong>Thirty-four patients were cardioverted by 50 J (group A), 18 by 100 J (group B) and 3 by 150 J (group C). One patient was not cardioverted (success rate 98%). No significant differences were noted between groups A and B with regard to age, sex, weight, height, thoracic circumference, body mass index, body surface area, impedance, NYHA class, left ventricular ejection fraction, left atrial diameter, causes of heart disease, antiarrhythmic medications, and duration of current AF episode. No increase of troponin I levels occurred.</p><p><strong>Conclusions: </strong>An initial shock of 100 J in the biphasic external elective cardioversion of AF is a valid and highly effective option. An initial shock of 50 J was effective in 61% of our population, and it is probably appropriated in patients with a lower weight and body mass index.</p>","PeriodicalId":80289,"journal":{"name":"Italian heart journal : official journal of the Italian Federation of Cardiology","volume":"6 9","pages":"757-60"},"PeriodicalIF":0.0,"publicationDate":"2005-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25626751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current perspective. Diabetic vascular disease: from endothelial dysfunction to atherosclerosis.","authors":"Riccardo Candido,&nbsp;Michela Zanetti","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Cardiovascular complications are the leading cause of death in diabetes. Over the past decade a number of studies have addressed the underlying mechanisms. Derangements of endothelial function, also referred to as endothelial dysfunction, have emerged to be the crucial early step in the development of atherosclerosis and are also involved in plaque progression and clinical emergence. Endothelial dysfunction is a condition of impaired endothelium-dependent vasodilation and most important of \"endothelial activation\", characterized by a proinflammatory, proliferative, and procoagulatory milieu that promotes initiation and complications of atherogenesis. A synergistic cross-talk among the conventional cardiovascular risk factors associated with diabetes contributes to disruption of endothelial integrity and accelerated atherosclerosis. This review will focus on the multifactorial nature of endothelial dysfunction in diabetes, the relationship between endothelial dysfunction, conventional cardiovascular risk factors and atherosclerosis, and the therapeutic options to improve endothelial function.</p>","PeriodicalId":80289,"journal":{"name":"Italian heart journal : official journal of the Italian Federation of Cardiology","volume":"6 9","pages":"703-20"},"PeriodicalIF":0.0,"publicationDate":"2005-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25624608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Two unusual cases of coincident atrioventricular nodal reentrant tachycardia and ventricular tachycardia.","authors":"Nicola Bottoni,&nbsp;Paolo Donateo,&nbsp;Fabio Quartieri,&nbsp;Michele Brignole,&nbsp;Carlo Menozzi","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The simultaneous occurrence of narrow and wide QRS complex tachycardias was observed in 2 patients evaluated at our electrophysiological centers. Electrophysiological testing revealed the coexistence of two types of arrhythmia (atrioventricular nodal reentrant tachycardia and verapamil-sensitive left ventricular tachycardia) in one patient and of three types of arrhythmia (atrioventricular nodal reentrant tachycardia, ventricular tachycardia originating from the right ventricular outflow tract, and left ventricular tachycardia) in the other. Both patients underwent successful radiofrequency ablation of all the types of tachycardia.</p>","PeriodicalId":80289,"journal":{"name":"Italian heart journal : official journal of the Italian Federation of Cardiology","volume":"6 9","pages":"765-70"},"PeriodicalIF":0.0,"publicationDate":"2005-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25626753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"DDD versus VVIR versus VVI mode in patients with indication to dual-chamber stimulation: a prospective, randomized, controlled, single-blind study.","authors":"Eugenio Moro,&nbsp;Francesco Caprioglio,&nbsp;Giuseppe Berton,&nbsp;Carlo Marcon,&nbsp;Umberto Riva,&nbsp;Giorgio Corbucci,&nbsp;Pietro Delise","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to compare VVI, VVIR and DDD modes in patients with indication to dual-chamber stimulation, depending on left ventricular function.</p><p><strong>Methods: </strong>Two groups of patients were implanted with a DDD pacemaker: Group I with ejection fraction > 40% and Group II with ejection fraction < 40%. Patients with a history of atrial arrhythmia or retrograde conduction were excluded. At follow-up (1 month each) quality of life (QoL), patient preference and echo parameters were collected. At hospital discharge all patients were programmed in DDD for 1 month and then randomized to VVI or VVIR mode. At the end of the period in VVI or VVIR mode each patient underwent a control period in DDD and then was programmed in VVIR or VVI mode.</p><p><strong>Results: </strong>Seventeen patients out of 23 preferred DDD mode and 6 did not perceive any subjective difference among DDD, VVI and VVIR modes (4/9 in Group I and 2/14 in Group II, p = 0.0017). QoL was significantly different between the two groups and at each follow-up showed the best values in DDD. The correlation between QoL and Tei index was 0.62 in Group I (p < 0.001) and 0.35 in Group II (p = 0.001). Neither ejection fraction nor fractional shortening showed any significant difference during the three phases of the study.</p><p><strong>Conclusions: </strong>Most patients preferred the DDD mode. The Tei index showed a good correlation with QoL and both QoL and Tei index significantly improved with DDD mode as compared to VVI and VVIR.</p>","PeriodicalId":80289,"journal":{"name":"Italian heart journal : official journal of the Italian Federation of Cardiology","volume":"6 9","pages":"728-33"},"PeriodicalIF":0.0,"publicationDate":"2005-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25624614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Percutaneous treatment of the left main coronary artery ostial obstruction following aortic valve replacement.","authors":"Angelo Placci,&nbsp;Marco Balducelli,&nbsp;Roberto Casanova,&nbsp;Aleardo Maresta","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Iatrogenic left main coronary artery ostial stenosis is a rare and late life-threatening complication of aortic valve replacement. The exact causes of this critical condition, despite being still nowadays elusive, are possibly related to the insertion of perfusion catheters into the left coronary system for cardioplegia delivery. We describe the case of a 69-year-old man, with normal coronary arteries documented by preoperative coronary angiography before surgery, who developed 1 year after aortic valve replacement worsening effort angina. A second coronary angiography revealed a severe left main ostial stem stenosis, which was successfully treated by sirolimus-eluting stent deployment. This case demonstrates a new percutaneous approach of this poorly understood, yet potentially fatal complication following aortic valve replacement.</p>","PeriodicalId":80289,"journal":{"name":"Italian heart journal : official journal of the Italian Federation of Cardiology","volume":"6 9","pages":"775-7"},"PeriodicalIF":0.0,"publicationDate":"2005-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25626755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Congestive heart failure secondary to right ventricular metastasis of colon cancer. A case report and review of the literature.","authors":"Carlo Oneglia,&nbsp;Alberto Negri,&nbsp;Daniele Bonora-Ottoni,&nbsp;Marco Gambarotti,&nbsp;Gianluigi Bisleri,&nbsp;Cesare Rusconi,&nbsp;Claudio Muneretto","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Although metastatic tumors of the heart occur more frequently than primary ones, infiltration of the right heart by a metastatic colon cancer has rarely been reported. We report the case of a woman previously operated on for colon cancer, presenting with symptoms of congestive heart failure due to metastatic invasion of the right ventricular cavity. Both transthoracic and transesophageal echocardiography were useful in detecting the mass, but not in defining its nature. The patient underwent a palliative surgical resection of the neoplastic mass but died soon after the intervention.</p>","PeriodicalId":80289,"journal":{"name":"Italian heart journal : official journal of the Italian Federation of Cardiology","volume":"6 9","pages":"778-81"},"PeriodicalIF":0.0,"publicationDate":"2005-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25626756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age-related variations of left ventricular endocardial and midwall function in healthy infants, children, and adolescents.","authors":"Roberto Crepaz,&nbsp;Roberto Cemin,&nbsp;Cristina Pedron,&nbsp;Lino Gentili,&nbsp;Diego Trevisan,&nbsp;Walter Pitscheider","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>In pediatric age echocardiographic evaluation of left ventricular systolic function is usually based on indexes obtained by measurements at the endocardial level. In the presence of ventricular hypertrophy this may lead to an overestimation of systolic function. The aim of this study was to assess the developmental changes of left ventricular systolic mechanics measured at the endocardial and midwall levels.</p><p><strong>Methods: </strong>In 239 normal subjects divided into six age groups we measured left ventricular end-diastolic volume, mass and mass/volume ratio, fractional shortening, and rate-corrected mean velocity of circumferential shortening at the endocardial and midwall levels. Endocardial meridional end-systolic stress and midwall circumferential end-systolic stress were considered as indexes of afterload. Relations of extent and velocity of fiber shortening to afterload at the endocardial and midwall levels were used to assess left ventricular contractility.</p><p><strong>Results: </strong>Blood pressure, left ventricular afterload, volume and mass increased, whereas the mass/volume ratio remained stable during growth. Fractional shortening and mean velocity of circumferential shortening at the endocardial level decreased and showed an inverse relation to afterload. Midwall fractional shortening and rate-corrected mean velocity of circumferential shortening were lower during the first months and did not change during the first year of life.</p><p><strong>Conclusions: </strong>Left ventricular volume and mass increase with age, mass/volume ratio remains almost constant while afterload increases. Endocardial systolic function indexes are higher in the first period of life, due to low afterload and increased mass/volume ratio. In the first months of life the left ventricular myocardium shows a greater sensitivity to changes in afterload and a reduced contractility measured at the midwall level.</p>","PeriodicalId":80289,"journal":{"name":"Italian heart journal : official journal of the Italian Federation of Cardiology","volume":"6 8","pages":"634-9"},"PeriodicalIF":0.0,"publicationDate":"2005-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25299837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rupture of an aortic dissection into the right atrium in a patient with a previous aortic valve replacement: a case report.","authors":"Gaetano Panzarella,&nbsp;Gabriella Carlino,&nbsp;Kahlil Fattouch,&nbsp;Giovanni Ruvolo,&nbsp;Luigi Messina,&nbsp;Enrico Hoffmann,&nbsp;Egle Incalcaterra,&nbsp;Salvatore Novo","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>We report the case of a 73-year-old man with a history of previous aortic valve replacement in 1990 and rupture of an aortic dissection into the right atrium. The patient was admitted to the emergency room because of chest pain, stopped not long after. The electrocardiogram did not show any signs of ischemia and myocardial enzymes were not increased. Transthoracic echocardiography revealed aortic root dilation (maximum diameter 60 mm) extended to the aortic arch, and the presence of a flow from the ascending aorta to the right atrium (evocative of a fistula between the two chambers). The aortic valvular prosthesis function was good. Transesophageal echocardiography confirmed an aorta-right atrium fistula. Cardiac catheterization did not show any luminal obstructions in the coronary arteries; there was a small shunt from the aorta to the right atrium. The ascending aorta and the aortic root were replaced with a Dacron graft. Right and left sinuses were reimplanted to the graft. The fistula was repaired with 4-0 pledgeted Prolene sutures. The surgeon's diagnosis was \"type A aortic dissection in a patient with an ascending aorta aneurysm and an old ascending aorta-right atrium fistula\".</p>","PeriodicalId":80289,"journal":{"name":"Italian heart journal : official journal of the Italian Federation of Cardiology","volume":"6 8","pages":"658-60"},"PeriodicalIF":0.0,"publicationDate":"2005-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25299841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delayed profound thrombocytopenia after abciximab administration for coronary stenting in acute coronary syndrome. Case reports and review of the literature.","authors":"Gaia Trapolin,&nbsp;Stefano Savonitto,&nbsp;Piera Angelica Merlini,&nbsp;Maria Teresa Caimi,&nbsp;Silvio Klugmann","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Profound thrombocytopenia occurring 1 week after drug administration is a seldom described, self-limiting and mostly uneventful immune reaction to abciximab. Quick differential diagnosis is essential, since other forms of thrombocytopenia associated with concomitant antithrombotic therapies may be much more severe and require prompt treatment. Awareness of this reaction may avoid unnecessary and risky discontinuation of other antiplatelet therapies in the critical phase after coronary stenting.</p>","PeriodicalId":80289,"journal":{"name":"Italian heart journal : official journal of the Italian Federation of Cardiology","volume":"6 8","pages":"647-51"},"PeriodicalIF":0.0,"publicationDate":"2005-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25299839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}