Survival in medically treated coronary artery disease.
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Biomedical subjects
Publications and source records attributed to A M Perosio.
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Among one hundred and five consecutive patients with pre-excitation (PE) syndrome studied during a 10-year period, eight had an associated hypertrophic cardiomyopathy (HC) (7.62 per cent), eight had a coronary heart disease (7.62 per cent) and nine had a hypertensive heart disease (8.57 per cent). Of the eight patients with HC, four had an asymmetrical form (three of them with an obstructive component), and four a symmetrical form. Seven of these patients had a Wolff-Parkinson-White (WPW) type of PE and the remainder a Lown-Ganong-Levine type of PE. The incidence of paroxysmal tachycardias in the total group was 56.2% (61/105) and in the patients with associated HC was 62.5% (5/8). One of these latter patients had a concomitant brady-tachy syndrome and a severe obstructive form of HC. He was surgically treated (septal myomectomy and section of accessory atrioventricular pathway). The ECGs and VCGs of the seven patients with the HC-WPW type of PE association showed the coexistence of incomplete left bundle branch block of left ventricular hypertrophy patterns. The eight patients with associated HC were closely followed up from two to seven years (total follow-up period 435 patient/months). One of them died suddenly during the 40th month of follow-up. This study suggests that: 1) HC-PE association is not infrequent; 2) the incidence of paroxysmal tachycardias in the subgroup is quite similar to that presented in isolated PE; and 3) the electrocardiographic and vectorcardiographic changes in the HC-WPW type of PE association are highly specific.
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Echocardiographic left atrial size was correlated with 27 electrovectorcardiographic parameters in 93 subjects. In 20 of them hemodynamic studies, including calculation of the left atrial volume, were performed. Subjects were divided into four groups as follows: Group I, 21 healthy subjects; group II, 45 patients with heart disease but no left atrial enlargement; group III, 15 patients with heart disease and left atrial size from 4.1 to 5 cm; and group IV, 12 patients with heart disease and a left atrial size exceeding 5 cm. A good correlation was found between left atrial size and the following parameters: Duration of P wave in standard lead II, voltage of both terminal forces of P wave in lead V1 and its maximal vector in the frontal and sagittal planes. A new index (duration/voltage of P wave in lead II) was postulated, which showed an excellent correlation with left atrial size (p less than 0.001). In all cases the superposition between groups was excessive. These findings indicate the limitations of the classical patterns and raise interest in new parameters concerning the electrocardiographic diagnosis of left atrial enlargement.
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Two patients with severe primary pulmonary hypertension, who are alive 38 and 27 years after the onset of the disease, were closely followed by the authors for 24 years. No previous report of such a long course has been found. Despite pulmonary artery pressures at systemic level, effort syncope disappeared and there were long intervals without symptoms during which the 2 patients were able to take part in physical activity with minimal discomfort. Severe primary pulmonary hypertension should not always be considered a malignant disease.
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