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Biomedical subjects

A F Parisi

Publications and source records attributed to A F Parisi.

At least 91 records · Page 5Linked to original sources
PubMed1983

Prognosis for aorta-coronary graft patency. A comparison of preoperative and intraoperative assessments.

For prognostication of aorta-coronary bypass graft patency, preoperative angiographic assessment of the recipient vessel and the regional left ventricle was compared with the intraoperative measurement of the internal diameter of the vessel and graft flow in 98 patients, in whom graft patency was evaluated at 1 year. Preoperative assessment of the recipient vessel did not correlate with the intraoperative measurement of the internal diameter or with the graft patency. Preoperative assessment of the regional left ventricular wall motion, on the other hand, was more valuable for prognosticating graft patency. Regions assessed as normal or hypokinetic had equally good graft patency, whereas akinetic or dyskinetic areas had only a 54% patency rate. Intraoperative measurement of the internal diameter of the vessel and graft flow were reliable predictors of graft patency: The larger the internal diameter and the greater the graft flow, the better the graft patency. Best surgical results can therefore be predicted when the internal diameter of the recipient vessel is 2.5 mm or more, graft flow is 100 ml/min or more, and the regional left ventricle moves well.

Coronary Angiography↗
PubMed1982

Thrombolytic therapy.

Explore the source record for details and available documents.

Arterial Occlusive Diseases↗
PubMed1982

Safety and efficacy of diltiazem hydrochloride for the treatment of stable angina pectoris: report of a cooperative clinical trial.

Sixty-three patients completed a multicenter 10 week, double-blind, parallel group protocol evaluating the efficacy of diltiazem versus placebo with respect to rate of attacks of angina, nitroglycerin consumption and duration of treadmill exercise. An additional 36 patients were evaluated for drug safety. A 4 week placebo lead-in phase was followed by a 2 week dose titration period and two treatment evaluation periods of 2 weeks each. Both diltiazem and placebo were associated with a significant reduction in weekly frequency of angina from the baseline rate. Intergroup comparison disclosed a significantly greater reduction for the patients receiving diltiazem than for those receiving placebo. A similar reduction was noted for nitroglycerin consumption. Total exercise duration at week 10 was statistically greater in patients treated with diltiazem. Diltiazem was well tolerated. No abnormalities in hematologic profiles or in routine serum chemistry values were observed; electrocardiographic P-R and QRS intervals were unaffected. Adverse effects that could have been related to drug administration were reported in 11 patients who received diltiazem and in 12 patients who received placebo. Of the 17 episodes in the diltiazem group only 3 were considered significant and drug-related, and only one of these resulted in discontinuation of the drug.

Aged↗
PubMed1982

The interval ejection fraction: a cineangiographic and radionuclide study.

To evaluate the clinical usefulness of the first-third ejection fraction (1/3 EF) for detecting patients with coronary artery disease (CAD), resting contrast ventriculography and first-pass radionuclide angiography with a high-count-rate, multicrystal camera system were performed in 47 subjects: 22 normal controls (group 1) and 25 patients with clinically stable angina pectoris and severe CAD (mean 2.3 vessels) without (group 2, n = 12) and with (group 3, n = 13) resting wall motion abnormalities. By contrast angiography, only group 3 had depressed global EF or 1/3 EF compared with control (global EF: group 1,0.71 +/- 0.09; group 2, 0.67 +/- 0.09 [NS]; group 3,049 +/- 0.05 [p less than 0.01 vs groups 1 and 2]; 1/3 EF: group 1,0.29% +/- 0.06;' group 2, 0.28 +/- 0.05 [NS]; group 3,0.22 +/- 0.05 [p less than 0.02 vs groups 1 and 2]). Whereas 11 of 25 CAD patients had global EF outside the normal range, only two of 25 had depressed 1/3 EF. Both had left ventricular asynergy and a depressed global EF. Studies performed using first-pass radionuclide angiography revealed similar results i.e., only four of 25 CAD patients, all with left ventricular asynergy and depressed global EF, had depressed 1/3 EF values. A wide range of 1/3 EF values was found in normal subjects by both techniques. Thus, the ejection fraction during the first third of systole at rest is of limited value for detecting patients with CAD.

Adult↗
PubMed1982

Serial evaluation of myocardial thickening and thinning in acute experimental infarction: identification and quantification using two-dimensional echocardiography.

Regional left ventricular function was studied serially by quantitative two-dimensional echocardiography (2-D echo) in 20 dogs after left anterior descending coronary artery ligation. Normal values for regional myocardial thickening were established in 20 healthy dogs and used as a standard to recognize abnormally contracting segments (ACS). In normal hearts, the mean percent thickening tended to increase from base (25.8%) to apex (34.0%), but showed considerable diversity from segment to segment (range 20.0-40.0%); nevertheless, at least some degree of thickening was seen in every segment. After coronary occlusion, myocardial segments either thinned or failed to thicken. At the papillary muscle level, there was an improvement in function between 2 and 48 hours, with thinning at 2 hours and thickening at 48 hours. Tissue infarct size (IS) determined at 48 hours was related to IS derived from a weighted summation of ACS at 2, 24 and 48 hours. At 2 hours, ACS considerably overpredicted and correlated poorly with tissue IS (25.3% vs 13.4%; r = 0.60); by 48 hours, IS predicted by ACS had decreased to 15.3% (p less than 0.05) and had an improved, but only fair correlation with tissue IS (r = 0.73, SEE = 4.9%). We conclude that there is considerable heterogeneity to myocardial thickening by 2-D-echo, but failure to thicken is not seen in the normal dog heart. In many dogs, the extent of myocardial dysfunction 2 hours after coronary ligation exceeds that seen later. Tissue IS is difficult to predict accurately from ACS. Since the amount of muscle dysfunction is not necessarily equivalent to the amount of tissue necrosis in acute myocardial infarction, ACS may be more appropriate used to tract the course of infarction rather than to predict IS.

Animals↗
PubMed1982

Enhanced detection of the evolution of tissue changes after acute myocardial infarction using color-encoded two-dimensional echocardiography.

Acute myocardial infarction was produced in 26 dogs by ligation of the left anterior descending coronary artery. Two-dimensional echocardiograms (2-D echoes) were performed through the chest wall before and serially after coronary ligation. The dogs were then killed in four groups at the following intervals: 24-48 hours, 1-2 weeks, 3 weeks and 6-8 weeks. Each 2-D echo was processed through a video quantizer, which encoded echo amplitudes progressively into eight regions of color. The myocardium was graded with respect to color composition in regions that showed any abnormally contracting segment (ACS). The ACS exhibited a progressive increase in echo intensity that became maximal 6-8 weeks after coronary ligation. Histopathologic and histochemical studies verified that these increases in echo amplitude correlated with the evolution of healing and myocardial scar formation. At 6-8 weeks, the mean collagen content of infarcted myocardium had increased by a factor of 4; concurrently, ACS echo amplitude had increased two- to threefold. These observations suggest that color-encoded 2-D echo promotes facile perception of serial changes in tissue characteristics that result from acute myocardial infarction.

Animals↗
PubMed1982

Resting early peak diastolic filling rate: a sensitive index of myocardial dysfunction in patients with coronary artery disease.

Resting first-pass radionuclide angiocardiography (RNA) was used to derive left-ventricular (LV) peak diastolic filling rates (PFR) in normals (Group 1:N = 12) and in patients with coronary artery disease (CAD), both without (Group 2:N = 27) and with previous myocardial infarction (Group 3:N = 23). Resting peak filling rates were significantly depressed in both Group 2 (1.61 +/- 0.36; p less than 0.01) and Group 3 (1:35 +/- 0.26; p less than 0.001) patients when compared with Group 1, normals (2.14 +/- 0.63). Even though LV systolic function of Group 2 patients was normal and comparable to that in Group 1 (EF = 0.55 +/- 0.06 against EF 0.55 +/- 0.06 NS), diastolic dysfunction [PFR less than 1.61 end diastolic volume/sec (EDV/sec)] was present at rest in 14 of 27 (52%). Depressed PFR values was also seen in 20 of 23 Group 3 patients (87%). It appears that (a) resting PFR is a sensitive and easily obtainable parameter of the diastolic dysfunction associated with CAD; (b) abnormal PFR values are seen in almost all patients with previous myocardial damage, and (c) a significant proportion of CAD patients without any evidence of abnormal systolic function have depressed resting PFR of the LV.

Adult↗
PubMed1982

The noninvasive evaluation of the coronary artery disease patient: clinical, economic and social issues.

The patient with chest pain is a common but often challenging diagnostic problem to the physician. Evaluating such a patient for coronary artery disease requires a careful history, physical examination and judicious selection of laboratory procedures. Noninvasive stress tests for cardiac diagnosis need not be applied to every patient who presents with chest pain and, in general, are most likely to be helpful when they are used discriminately for patients who have an intermediate likelihood of coronary artery disease. A further elaboration of one systematic approach to this problem, based on Bayesian analysis of noninvasive testing procedures, is presented.

Aged↗
PubMed1982

Considerations in evaluating new antianginal drugs.

Diseases that cause symptoms incompletely relieved by available modes of treatment stimulate search for new therapies. Chronic disease processes, in which interventions are palliative rather than curative provide a particular challenge in determining the value of therapeutic intervention. Management of patients with angina pectoris is an example of this challenge.

Angina Pectoris↗
PubMed1982

Clinical use of thrombolytic agents in venous thromboembolism.

The use of thrombolytic agents in venous thromboembolism has been shown to be highly effective. Patients treated with lytic agents show more rapid clot resolution and lung reperfusion and more rapid and greater reversal of the abnormal hemodynamic responses to pulmonary embolism than patients receiving heparin. Moreover, lytic therapy removes thromboemboli more completely from the pulmonary microcirculation, whereas residual thromboemboli tend to accumulate with heparin therapy. In addition, lytic therapy tends to preserve the venous valves, whereas distortion and destruction occur with heparin therapy. Hence, lytic therapy confers a number of short- and long-term benefits not observed with heparin therapy.

Fibrinolytic Agents↗
PubMed1981

Non-invasive measurement of left ventricular function in coronary artery disease. Comparison of first pass radionuclide ventriculography, M-mode echocardiography, and systolic time intervals.

Fifty consecutive patients having had cardiac catheterisation for coronary artery disease also underwent testing by three non-invasive methods commonly employed for assessment of left ventricular function. These included the first pass radionuclide ejection fraction, fractional shortening of the M-mode echocardiographic left ventricular internal dimension, and pre-ejection period/left ventricular ejection time ratio derived from systolic time intervals (PEP/LVET). Linear correlations of these non-invasive measures with cineangiographic ejection fractions were calculated. The first pass radionuclide ejection fraction correlated best. Echocardiograms and systolic time intervals proved less versatile since 11 of 50 echocardiograms were technically not suitable for measurement and 11 of 50 systolic time intervals could not be used because of left ventricular conduction delays. Overall, radionuclide ventriculography proved to be the most accurate and practical of these non-invasive techniques in evaluating left ventricular function in this group of patients with coronary artery disease.

Adult↗
PubMed1981

Quantitative detection of regional left ventricular contraction abnormalities by two-dimensional echocardiography. I. Analysis of methods.

Different approaches to the quantification of regional left ventricular (LV) function from two-dimensional echocardiographic (2-D echo) images were assessed for their ability to optimize interobserver reproducibility in a heterogeneous patient population and to minimize the variability of regional function observed in a homogeneous normal population. Areas, hemiaxis and perimeter measurements were examined, as were the effect of the degree of image subdivision into halves, quadrants or octants. Each approach was also tested using both a fixed and a floating frame of reference for the definition of a regional-axis system. The area method was consistently superior to either linear method in optimizing both reproducibility and variability. Reproducibility decreased inversely with the degree of subdivision. The axis-system frame of reference had no effect on reproducibility. The floating-axis system yielded the same variability as the fixed system for short-axis sections at the mitral valve level, but slightly less variability for a papillary muscle level section. We conclude that area-based methods are superior for the evaluation of regional LV function with 2-D echo, but the degree of subdivision of the image and the frame of reference chosen do not greatly affect reproducibility or variability and should be chosen based on their performance in a well-defined clinical population.

Diastole↗
PubMed1981

Quantitative detection of regional left ventricular contraction abnormalities by two-dimensional echocardiography. II. Accuracy in coronary artery disease.

The quantitative approaches to the assessment of regional left ventricular (LV) function described in the preceding paper were applied in a well-defined population of patients with coronary artery disease. Two groups were chosen by electrocardiographic and angiographic criteria: group 1 had infarction and regional wall motion abnormalities and group 2 had no infarction and normal wall motion. Sensitivity to detect wall motion defects, specificity to correctly categorize normal segments, and overall predictive accuracy were evaluated for each two-dimensional echocardiographic approach. In addition, the ability of each method to localize regional contraction defects properly was evaluated. Area methods yielded better predictive accuracy than linear methods (87-95% vs 76-84%). No significant differences in accuracy were noted between quadrant and octant approaches. The fixed external-axis system was superior to a floating one for localizing contraction defects. We conclude that an area-based method, using a fixed-axis system and either octant or quadrant image subdivision, provides the best combination of predictive accuracy in categorizing LV segments as normal or abnormal and the greatest ability to localize LV regional abnormalities.

Adult↗
PubMed1981

Reproducibility of echocardiography. A study evaluating the variability of serial echocardiographic measurements.

In this study, serial reproducibility was determined on standard M-mode (M-mode) and two dimensional guided M-mode (2-D M-mode) records for ten normal volunteers and 20 patients. Overall intraobserver variability in the normal group was 518 +/- 1.8 percent (M-mode) and 3.1 +/- 0.8 percent (2-D M-mode), and in the patient group 3.1 +/- 0.6 percent (M-mode) and 4.7 +/- 0.7 percent (2-D M-mode) (P = NS). Variability on serial examination, however, was twofold to threefold greater. In the normal group, reproducibility varied by 10.8 +/- 1.6 percent (M-mode) and 9.4 +/- 1.2 percent (2-D M-mode), while in the patient group, it was 8.7 +/- 0.9 percent (M-mode) and 9.4 +/- 0.7 percent (2-D M-mode). The lowest serial variability achieved was for the diastolic LV dimension on serial M-mode examination (4 percent); the largest variability pertained to measurement of the interventricular septum (14 percent). Other structures had intermediate variation in reproducibility. This study emphasizes that establishing performance variability for an echocardiographic laboratory is an important part of the interpretation of serial records.

Echocardiography↗
PubMed1981

Platypnea syndrome after left pneumonectomy.

Contrast two-dimensional echocardiography (2DE) was used to demonstrate right-to-left shunting at the atrial level in a 49-year-old man with platypnea and orthostatic cyanosis which developed after a left pneumonectomy. This patient's systemic arterial saturation decreased with phlebotomy and increased with volume administration. This syndrome disappeared after repair of a previously unrecognized atrial septal defect. Right-to-left shunting in atrial septal defect is usually explained by a change in the relationship of right and left ventricular compliance with the right ventricle becoming less compliant (ie, stiffer) than the left. Pneumonectomy can affect atrial emptying either directly by mechanical means or indirectly by changing relationships in ventricular compliance. Contrast 2DE played key role in initially establishing the etiology of cyanosis in this complicated case.

Cyanosis↗