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Biomedical subjects

A F Parisi

Publications and source records attributed to A F Parisi.

At least 19 recordsLinked to original sources
PubMed1996

'Abnormal' diastolic Doppler patterns in patients over age 65 with severe left ventricular systolic dysfunction.

OBJECTIVE: The purpose of this study was to determine whether Doppler diastolic filling patterns of the left ventricle are altered in patients over age 65 with poor left ventricular function, compared to patients with normal left ventricular systolic function. BACKGROUND: In elderly, healthy subjects, the mitral valve Doppler inflow pattern exhibits an increase in atrial contribution to left ventricular filling. Myocardial disease, which results in stiffness, may also cause an increase in A wave velocity. METHODS: Twenty-seven patients over age 65, with left ventricular systolic dysfunction, were age and sex-matched with 19 patients with normal left ventricular systolic function. Patients with significant mitral or aortic valvular disease were excluded. Maximal early inflow velocity, maximal atrial inflow velocity, heart rate, acceleration time and deceleration time were calculated. RESULTS: Comparing the group with normal left ventricular systolic function, the group with decreased left ventricular systolic function had pseudonormalization of the maximal early flow/atrial flow velocity ratio (1.7 +/- 1.3 vs. 0.9 +/- 0.3; P = 0.003), E wave velocity was similar (82 +/- 28 vs. 70 +/- 24 cm/s; P = n.s.), and A wave velocity was diminished (66 +/- 30 vs. 84 +/- 20 cm/s; P = 0.02). The acceleration time was similar for the groups (53 +/- 17 vs. 46 +/- 21 ms), but the deceleration time was shorter in patients with left ventricular systolic dysfunction (122 +/- 33 vs. 192 +/- 80 ms; P < 0.001). CONCLUSION: Such differences may relate to increased left atrial pressure, increased left ventricular diastolic pressure and/or decreased atrial systolic function. These findings are important when interpreting left ventricular filling indices by Doppler echocardiography in elderly patients.

Aged↗
PubMed1996

Pathogenesis and prognostic significance of conduction abnormalities after coronary bypass surgery.

Of 200 men who underwent isolated coronary bypass graft surgery, 40 (20%) developed new postoperative, persistent conduction abnormalities. The pathogenesis of conduction abnormalities was examined by relating their presence to that of significant proximal left coronary disease before surgery, and to various intraoperative factors that included indices of myocardial preservation and revascularization. Proximal left coronary disease was observed in 92 (46%) of 200 patients, of whom 27 (29%) developed conduction abnormalities. In contrast, of the 108 patients without proximal left coronary disease, only 13 (12%) developed persistent conduction abnormalities (P < 0.01). Intraoperative factors appeared to have little or no role in the development of such abnormalities. It is concluded that the development of persistent postoperative conduction abnormalities is related more to proximal left coronary disease than to intraoperative factors and that such abnormalities do not progress during long-term follow-up (average 53 months).

Adult↗
PubMed1996

Long-term effects of multiple pregnancies on cardiac dimensions and systolic and diastolic function.

OBJECTIVE: This study evaluated whether the recurring volume loading and hormonal changes in multiple pregnancies might have some cumulative effect on heart size and function. STUDY DESIGN: Echocardiograms were performed on 20 healthy women with at least 4 (mean 5.2) term pregnancies; 20 healthy, age-matched, nulliparous women served as controls. RESULTS: There were no significant differences in chamber dimension, systolic or diastolic function, valvular incompetence, or heart rate between the groups. There was a small, but significant, prolongation in deceleration time of the E wave in the multiparous women. CONCLUSION: These findings show that the human heart is generally able to repeatedly adapt to multiple episodes of volume overload in pregnancy without lasting detrimental structural or functional changes.

Adult↗
PubMed1996

The role of noninvasive testing in evaluating patients for coronary artery disease.

Risk stratification of patients with coronary artery disease using noninvasive imaging techniques has become increasingly more important in the cost-conscious delivery of patient care. This is evidenced by significant developments involving both nuclear cardiology and echocardiography for the assessment of viability, silent myocardial ischemia and prognosis, as well as the emergence of new techniques, in particular the use of positron emission tomography isotopes with single photon emission computed tomography cameras and low-dose dobutamine echocardiography in the detection of viability. New developments regarding screening for and the clinical importance of silent myocardial ischemia as well as new developments regarding classification of radionuclide perfusion defects and stress echocardiograms that portend a poor prognosis are also reviewed. Finally, new techniques and stress agents have been development that add to the choices available to the clinician for the optimal assessment of the patient being considered for revascularization.

Coronary Disease↗
PubMed1995

A comparison of quality of life scores in patients with angina pectoris after angioplasty compared with after medical therapy. Outcomes of a randomized clinical trial. Veterans Affairs Study of Angioplasty Compared to Medical Therapy Investigators.

BACKGROUND: Evaluations of therapy for the treatment of angina have traditionally consisted of a combination of objective measures, such as exercise tolerance, and subjective markers, such as angina attack rate. Recently, the need to assess "how patients feel"--their quality of life (QOL)--has been regarded with increasing importance. Standard instruments are available to assess QOL and its change after therapeutic intervention. Although QOL instruments have been used to assess the efficacy of percutaneous transluminal coronary angioplasty (PTCA), they have not been used previously to compare the impact of PTCA with that of medical therapy in patients with angina pectoris. We report on the changes in self-assessed QOL among patients randomly assigned to treatment by PTCA or medical therapy and relate these measurements to changes in exercise performance and coronary angiograms. METHODS AND RESULTS: Patients with stable angina, a positive exercise tolerance test, and at least 70% stenosis (index lesion) in the proximal two thirds of one major coronary artery were randomly assigned to receive PTCA or medical therapy. Six months after randomization, each patient underwent repeat exercise testing and coronary angiography. Before randomization and at the 6-month visit, patients completed a self-administered QOL questionnaire that measured physical functioning and psychological well-being. We compared the changes in QOL with changes between the baseline and 6-month exercise tests, stratified by terciles (decrease in duration, 0- to 2-minute increase, and > 2-minute improvement). We also stratified patients by whether there was more or less than 2 SD change (18.8%) in diameter stenosis of the index lesion (initial minus follow-up angiogram), and we related these to changes in QOL measures. One hundred eighty-two patients with one-vessel disease completed baseline and 6-month questionnaires. At baseline, there were no differences in any QOL measurements between treatment groups. At the 6-month follow-up visit, there was greater improvement in both physical functioning and psychological well-being scores for patients receiving PTCA (+7.36 +/- 15.6, PTCA; +1.98 +/- 14.7, medical therapy; P < .02). Improvement in QOL variables was noted only in patients demonstrating an increase in exercise performance. Also, patients assigned to either treatment whose angiograms demonstrated more than 18.8% improvement in index lesion percent stenosis experienced a significant increase in their QOL scores. CONCLUSIONS: This was the first study of the relative changes in QOL measures assessed with the use of previously validated and standardized instruments in patients randomly assigned to treatment with PTCA or medical therapy. Patients assigned to PTCA demonstrated a significantly greater improvement in both physical and psychological measures. This improvement was noted in patients whose exercise performance improved and whose angiograms demonstrated an improvement in lesion severity.

Activities of Daily Living↗
PubMed1995

Pitfalls in the diagnosis and management of papillary muscle rupture: a study of four cases and review of the literature.

Four cases of papillary muscle rupture occurring in the setting of acute myocardial infarction are presented, which illustrate the following points: the diagnosis may not be apparent at presentation, a mitral regurgitant murmur may be absent, transesophageal echocardiography may establish the diagnosis when transthoracic echocardiography does not, and appropriate surgical correction can lead to excellent functional recovery.

Aged↗
PubMed1994

Echocardiographic assessment of the cardiac anatomy in patients with multifocal atrial tachycardia: a comparison with atrial fibrillation.

Although multifocal atrial tachycardia (MAT) has been recognized since 1968, few data exist on its associated anatomic correlates. Using echocardiography, the authors describe the cardiac anatomy observed in hospitalized patients with MAT. Because MAT closely resembles atrial fibrillation (AF), these echocardiographic data are compared with those from an age- and sex-matched population with AF. There were 25 patients in each of the MAT and AF groups. Biatrial enlargement was present in both groups. However, the atrial enlargement was mild and significantly less in the MAT group. The MAT group had normal ventricular and aortic dimensions. Right ventricular dysfunction was rare in both groups. Moderate to severe global left ventricular dysfunction was present in 7 of 25 in the MAT group and in 9 of 25 in the AF group. Systolic wall-motion abnormalities were significantly less in the MAT group. Severe Doppler and structural abnormalities were not common in the MAT group. Based on these parameters, physiologic and not anatomic factors are probably more important in the genesis of MAT as compared with AF.

Aged↗
PubMed1994

Relation between coronary artery stenosis assessed by visual, caliper, and computer methods and exercise capacity in patients with single-vessel coronary artery disease. The Veterans Affairs ACME Investigators.

BACKGROUND: Practitioners often assume a close relation between angiographic coronary artery stenosis and patient functional capacity. To test this unproven hypothesis, we analyzed the relation between coronary artery stenosis measured by different methods and maximal treadmill exercise tolerance in patients with single-vessel disease before and after intervention by percutaneous transluminal coronary angioplasty (PTCA). METHODS AND RESULTS: Coronary angiography and maximal exercise testing off anti-ischemic medication were performed before random assignment of 227 patients with single-vessel coronary artery disease to PTCA or drug therapy. Six months later, angiography and exercise testing were repeated with patients assigned to PTCA off anti-ischemic therapy so that the altered coronary stenosis was the only consistent variable. Patients assigned to drug therapy were exercised on drug therapy. Coronary stenosis was assessed visually by the local investigator and quantitatively by blinded caliper and computer methods in central laboratories. Variabilities of caliper and computer measurements were established in a subset read twice. Visually estimated stenosis > or = 90% at baseline was associated with shorter exercise duration (7.9 versus 9.2 minutes, P < .04). Similar segregation at baseline was not observed with caliper or computer methods. Regardless of the method of measurement used, correlation between changes of lesion severity and exercise duration from baseline to follow-up was poor. Patients were angiographically classified as "better," "unchanged," or "worse" if follow-up stenosis was below, within, or above 2 SD of mean technical variability from baseline (+/- 18.8%, caliper, +/- 14.6%, computer). Exercise duration for PTCA patients improved among those with better lesions (+2.4 minutes, n = 50, P = .001) but also among those with unchanged lesions (+1.9 minutes, n = 41, P < or = .001). Unchanged medically treated patients improved less (+0.5 minutes, n = 86, P = .04). Results were similar when patients were angiographically classified by minimum lumen diameter. CONCLUSIONS: Handheld calipers and quantitative coronary angiography are equivalent techniques for making anatomic measurements. Neither method identified patients having reduced exercise capacity at baseline as well as visual estimation. The relation between changes of coronary stenosis and exercise duration is highly variable, at least in part because of the insensitivity of angiographic methods for detecting small but potentially important changes. Minimal anatomic improvement 6 months after PTCA does not preclude a good functional outcome. Contrary to common belief, angiographic stenosis does not correlate well with functional capacity, even in patients with single-vessel disease.

Angioplasty, Balloon, Coronary↗
PubMed1992

A comparison of angioplasty with medical therapy in the treatment of single-vessel coronary artery disease. Veterans Affairs ACME Investigators.

BACKGROUND: Despite the widespread use of percutaneous transluminal coronary angioplasty (PTCA), only a few prospective trials have assessed its efficacy. We compared the effects of PTCA with those of medical therapy on angina and exercise tolerance in patients with stable single-vessel coronary artery disease. METHODS: Patients with 70 to 99 percent stenosis of one epicardial coronary artery and with exercise-induced myocardial ischemia were randomly assigned either to undergo PTCA or to receive medical therapy and were evaluated monthly. The patients assigned to PTCA were urged to have repeat angioplasty if their symptoms suggested restenosis. After six months, all the patients had repeat exercise testing and coronary angiography. RESULTS: A total of 107 patients were randomly assigned to medical therapy and 105 to PTCA. PTCA was clinically successful in 80 of the 100 patients who actually had the procedure, with an initial reduction in mean percent stenosis from 76 to 36 percent. Two patients in the PTCA group required emergency coronary-artery bypass surgery. By six months after the procedure, 16 patients had had repeat PTCA. Myocardial infarction occurred in five patients assigned to PTCA and in three patients assigned to medical therapy. At six months 64 percent of the patients in the PTCA group (61 of 96) were free of angina, as compared with 46 percent of the medically treated patients (47 of 102; P less than 0.01). The patients in the PTCA group were able to increase their total duration of exercise more than the medical patients (2.1 vs. 0.5 minutes, P less than 0.0001) and were able to exercise longer without angina on treadmill testing (P less than 0.01). CONCLUSIONS: For patients with single-vessel coronary artery disease, PTCA offers earlier and more complete relief of angina than medical therapy and is associated with better performance on the exercise test. However, PTCA initially costs more than medical treatment and is associated with a higher frequency of complications.

Adrenergic beta-Antagonists↗
PubMed1992

The value and promise of echocardiography in acute myocardial infarction and coronary artery disease.

Two-dimensional and Doppler echocardiography have become extremely useful in the management of patients with acute myocardial infarction (AMI). Echocardiography is noninvasive, relatively inexpensive, and has no known biohazards. It offers unequaled information about cardiac anatomy and function. In the acute setting it is useful in the diagnosis of AMI and its complications. It is an excellent tool for monitoring therapy. Echocardiography has been shown to be useful in risk stratification upon presentation to the emergency ward and prior to hospital discharge. Stress echocardiography has broadened and sharpened the diagnostic and prognostic information. Contrast echocardiography has promise for demonstrating coronary artery flow. Research in ultrasonic myocardial tissue characterization shows potential for differentiating ischemic myocardium from infarcted myocardium. Thus, echocardiography is likely to become increasingly important in the future management of patients with AMI.

Coronary Circulation↗