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Angelo Bartoletti

Publications and source records attributed to Angelo Bartoletti.

5 recordsLinked to original sources
PubMed2004

Efficacy of tilt training in the treatment of neurally mediated syncope. A randomized study.

Recurrent neurally mediated syncope represents a common clinical event and a therapeutic challenge. Recently tilt training has been proposed for the treatment of recurrent neurally mediated syncope. To evaluate the efficacy of tilt training in preventing tilt-induced syncope and its feasibility, this controlled, randomized study was undertaken. Sixty-eight consenting patients (25 males and 43 females, mean age 40 +/- 19) with recurrent neurally mediated syncope and 2 consecutive positive nitroglycerin-potentiated head-up tilt tests were randomized to tilt training (35 patients) or no treatment (controls, 33 patients). The tilt training programme consisted of daily 30-min sessions of upright standing against a vertical wall 6 days a week for at least 3 weeks, until a reevaluation tilt test (3 patients of both groups dropped out). On this third head-up tilt test, 19 (59%) of 32 tilt trained patients and 18 (60%) of 30 controls still had a positive test. Treated patients performed a mean number of 15 +/- 7 sessions (median 16) and only 11 patients (34%) did all the programmed sessions. Only 1 patient (3%) discontinued treatment because of intolerance, while all other patients did not perform tilt training adequately, because of poor compliance. Thus, in our study tilt training was not effective in reducing tilt testing positivity rate in patients with neurally mediated syncope. Because of poor compliance, tilt training appears to be a feasible treatment only for highly motivated patients, but not for the majority of patients with recurrent neurally mediated syncope.

Adult↗
PubMed2004

[How is syncope studied in the Italian hospitals?].

BACKGROUND: The aim of this study was to evaluate how the main tests for the diagnostic assessment of syncope are currently performed in the Italian hospitals. METHODS: During the early 2003 dedicated questionnaires were administered to about 400 Italian hospitals. About each test information was requested relative to: test protocol, laboratory equipment, patients evaluated during 2002. RESULTS: Eighty-four hospitals answered the questionnaire. A syncope-dedicated ambulatory (at least once a week) was available during 2002 in 59/84 hospitals, and 56 were dependent on the Cardiology Division. Carotid sinus massage was performed either in clinostatic and in orthostatic position in 60 Centers and was repeated after atropine in 15. To define the test positivity, 35 Centers followed the "symptom method". Only 15 Centers performed > 100 procedures during 2002 (range 3-500). Tilt testing was performed in 72 hospitals. A dedicated tilting bed was available in 65 Centers, continuous beat-to-beat pressure measurement in 22. Out of the 72 Centers, 55 followed the so-called "Italian protocol" as the main methodology of the test. Only 17 Centers performed > 100 procedures during 2002 (range 3-500). Adenosine test was performed in 26 hospitals, the median dose of drug was 18 mg (range 6-20 mg); 25 out 26 Centers considered the test as positive when an asystolic pause > or = 6 s was observed. Only 6 Centers performed > 15 procedures during 2002 (range 1-204). An implantable loop recorder was available in 48 Centers. The number of implant procedures during 2002 varied among the Centers from 1 to 22. CONCLUSIONS: A great variability was observed concerning the methodology of each test and the number of procedures performed. Thus, a standardization effort about the methodology of syncope study is still needed by the medical associations.

Adenosine↗
PubMed2002

[Heart rupture during myocardial infarction: the long-lasting challenge for the hospital cardiologist is close to the last battle].

Cardiac rupture is a catastrophic and generally unexpected (although not always unpredictable) complication of acute myocardial infarction, and still represents a challenge for the hospital cardiologist. In fact, diagnostic criteria are not available which allow us to detect in the individual patients an impending rupture. On the other hand the early diagnosis of the rupture, although possible if based on clinical and echocardiographic criteria, allows only a small number of the patients to survive, and cannot be considered as a satisfying solution for this clinical problem. Starting from these discouraging considerations, the finding is underscored that heart rupture only rarely occurs among patients treated with primary coronary angioplasty. Thus primary angioplasty (unlike systemic thrombolysis) seems to be able to prevent the postinfarction cardiac rupture. As a consequence, primary angioplasty should be considered instead systemic thrombolysis for the reperfusion treatment of patients with acute myocardial infarction and clinically at risk for cardiac rupture (i.e., those aged > 60 years and with ST-segment elevation at hospital admission).

Cardiology↗