Biomedical subjects
Publications and source records attributed to B Magnani.
We studied the pattern of inheritance of hypertrophic cardiomyopathy among 111 first-degree relatives of 30 patients with the disease. Results of segregation analysis suggest a genetic heterogeneity for hypertrophic cardiomyopathy in that both autosomal dominant and autosomal recessive mode of inheritance can occur.
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To assess the effects of left ventricular aneurysmectomy (l.v.a.) on left ventricular function (l.v.f.), a prospective clinical and hemodynamic study has been performed in nineteen patients (pts) operated on from 1979 to 1983. There where no operative deaths and only one late death during follow-up. A significant improvement in NYHA class was observed in 68% of the pts, 16% worsened, and the clinical status in the remaining 16% was unchanged. Hemodynamic data showed an increase in e.f. (33 +/- 12% to 43 +/- 10%; p less than 0.001), a reduction of the percentage of the abnormally contracting left ventricular segments (66 +/- 23% to 57 +/- 23%; p less than 0.05) and no significant changes of left ventricular end diastolic pressure. Revascularization index (nr. of bypassed vessels/nr. of stenotic vessels) and graft patency rate were low (0.57 and 0.72 respectively). No significant relation was noted between clinical and hemodynamic findings in the postoperative study. We conclude that l.v.a. is associated with an improvement of l.v.f. (mainly in e.f. and segmental wall contractility) and of clinical status of the pts but without a direct relation between these two parameters.
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The acute and chronic effects of Captopril were evaluated in 8 patients (5 males and 3 females, age 49 +/- 17 years) with chronic severe congestive heart failure. Acute hemodynamic effects were studied according to a randomized, double blind, placebo controlled protocol, by using two doses of Captopril (25 and 50 mg). The usual diuretic and digitalis treatment was kept unchanged throughout the trial. The acute administration of placebo associate with the usual doses of diuretic and digitalis was followed after 2 hours by a significant reduction of mean pulmonary wedge pressure (-23%, p less than 0.05). One hour following a single administration of Captopril, the following significant (p less than 0.05) changes were observed, respectively for the doses of 25 and 50 mg: heart rate -9% and -6%, cardiac index +13% and +10%, mean pulmonary wedge pressure -27% and -35%, mean pulmonary arterial pressure -29% and -26%, systemic vascular resistances -20% and -17%. A longer duration of effects on heart rate and cardiac index was noted after the 50 mg dose. All patients received long-term treatment with Captopril 75 or 150 mg daily. The NYHA functional class improved in all cases and there was a significant decrease of the cardio-thoracic ratio (from 0.61 +/- 0.05 to 0.55 +/- 0.09, p less than 0.01). A repeated hemodynamic study after a mean period of 6.5 months (range 2.5-22 months) revealed in 7 cases a sustained effect of the drug.(ABSTRACT TRUNCATED AT 250 WORDS)
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Lidocaine (L) in still considered the drug of choice in the treatment of life threatening ventricular arrhythmias in the setting of acute myocardial infarction (A.M.I.): this is mainly due to its proved efficacy and high therapeutic index. Since however L has well defined electrophysiologic properties (class 1 B) and does not seem to be effective in all of these patients we compared its antiarrhythmic efficacy with the one of amiodarone (A), an antiarrhythmic agent provided of electrophysiologic properties quite different from L (class 4) and usually well tolerated. Twenty-five consecutive patients with A.M.I. without haemodynamic consequences, were randomly assigned to L (bolus of 1 mg/kg followed by an infusion of 10 mg/min for 20 minutes and thereafter of 1,5 mg/min) or A (bolus of 5 mg/kg and an eventual repeat dose of 150 mg followed by an infusion of 1,8 g/24 h) The baseline arrhythmia was classified as Lown class 2 ore more in all the patients. The ventricular arrhythmias were completely relieved in 47% of the patients assigned to L and in 60% of those treated with A (p = N.S.); a minor efficacy was found in 40% of the patients of both groups; in two cases ventricular fibrillation occurred after the acute infusion of L. The antiarrhythmic effectiveness kept fit with both drugs over a 24 hours period. A prolongation of QTc interval was found to occur both after the bolus and 24 hours of treatment with A. In addition A provoked a slight decrease of systolic blood pressure. No important side effects were observed with both drugs regimens.(ABSTRACT TRUNCATED AT 250 WORDS)
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Vasodilator agents have been used to decrease pulmonary arterial pressure in patients with chronic thromboembolic pulmonary hypertension (CTPH). A case is reported of a patient who had a severe hemodynamic deterioration after 10 mg of sublingual nifedipine. A review of cases of CTPH treated with vasodilators is also discussed.
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The detection of myocardial depression is an important goal in the management of patients with chronic severe aortic regurgitation but may be quite difficult at an early stage by the conventional basal measures of contractility. The response to afterload stress determined by angiotensin challenge and the end-systolic pressure-volume relationship was evaluated echocardiographically in 16 asymptomatic or mildly symptomatic patients with chronic severe aortic regurgitation, ages 15 to 56 years (mean 32 +/- 12). Nine normal subjects, ages 25 to 41 years (mean 31 +/- 5), served as a control group. In the group with aortic regurgitation, end-systolic dimensions were greater than 55 mm in five of 16 patients and fractional shortening was 25% or less in two of 16. In the control group angiotensin caused a decrease of stroke volume index in six out of nine patients (15% at the most) and a mild increase in three. In the group with aortic regurgitation stroke volume index decreased by 15% or more of the basal value in nine of 16 patients and increased or decreased by less than 15% in seven of 16. Ejection fraction decreased in both groups, from 61 +/- 6% to 52 +/- 7% in the control group and from 56 +/- 6% to 45 +/- 5% in the group with aortic regurgitation. Ventricular function curves were derived by relating end-diastolic volume index to stroke work index; seven of 16 patients had abnormal responses reflecting an afterload mismatch.(ABSTRACT TRUNCATED AT 250 WORDS)
Fifty-three patients with mild to moderate essential hypertension were treated with enalapril (10-40 mg q.d.) alone, in combination with a fixed dose of hydrochlorothiazide (50 mg/day), or in a randomized cross-over study with varying dosages of hydrochlorothiazide (50, 25, 12.5 mg/day). Normalization of blood pressure was obtained in 47% of the patients after enalapril. In the remaining patients, all except four were normalized by the combination with hydrochlorothiazide. The addition of hydrochlorothiazide was required in six patients who had optimally responded to enalapril during the first three months. In the cross-over study, diastolic blood pressure was maintained below 95 mmHg with all the doses of diuretic used in association with 40 mg enalapril. No adverse metabolic (blood glucose, cholesterol, triglycerides), renal (creatinine clearance, urinary lysozyme and gamma-GT) or haematological (total and differential counts) effects were observed after long-term treatment for one year with enalapril alone or in combination with hydrochlorothiazide. Blood uric acid decreased significantly after enalapril and tended to increase after the combination with hydrochlorothiazide. Enalapril increased Na/K ATPase activity on erythrocyte membranes thus reducing intracellular sodium and increasing potassium.
The sensitivity of the prenalterol test has been evaluated in 21 patients with pseudoischaemic T waves and no documented organic heart disease. The sensitivity of the test (40 micrograms/kg i.v. in 3 min) was 90.4%. In comparison, the isoproterenol test, performed in 10 of these patients, showed a similar sensitivity but prenalterol had a lower positive chronotropic effect than isoproterenol (p less than 0.0005). The possible advantages of the introduction of the prenalterol test in clinical practice are analysed.
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Digoxin plasma levels and digoxin erythrocytic membrane content have been evaluated in 39 patients treated with digoxin and amiodarone in a fixed dose for more than 3 months. The results were compared with those obtained in a group of patients treated with digoxin alone and matched for age, renal function and digoxin daily dose in micrograms/kg body weight. Digoxin plasma levels and digoxin erythrocytic content were significantly higher in patients treated with amiodarone than in controls, thus confirming the interaction between digoxin and amiodarone. The relation between digoxin plasma levels and digoxin bound to erythrocytic membranes--as a marker of the deep tissue accumulation--was not different in patients treated with digoxin or with digoxin + amiodarone, further indicating that amiodarone may not increase digoxin plasma levels by means of a displacement of the glycoside from tissues. The clinical significance of the interaction is still undefined.