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Biomedical subjects

B Magnani

Publications and source records attributed to B Magnani.

At least 91 records · Page 5Linked to original sources
PubMed1994

Neurocirculatory asthenia: a reassessment using modern psychosomatic criteria.

The purpose of this study was to assess the prevalence of mental illness and to evaluate the quality of life of patients with neurocirculatory asthenia. A consecutive series of 80 patients who satisfied the diagnostic criteria developed by Kannel et al. for neurocirculatory asthenia was included in this study. Patients underwent a psychiatric diagnostic research interview and extensive psychometric evaluation, with both observer and self-rated scales for depression, anxiety, phobic symptoms, quality of life and abnormal illness behavior. In 47 patients (59%), a psychiatric diagnosis (mainly an anxiety disorder) antedated the onset of neurocirculatory asthenia, which was thus defined as secondary, also because cardiorespiratory symptoms were part of the mental symptoms. In the remaining 33 patients (41%) neurocirculatory asthenia was the primary disorder. Patients with secondary neurocirculatory asthenia reported significantly higher levels of anxiety, depression, social phobia, abnormal illness behavior and an impaired quality of life compared with patients with primary neurocirculatory asthenia. This latter did not significantly differ in these variables (except for depression) from healthy control subjects matched for sociodemographic variables. At a 1-year follow-up, patients with primary neurocirculatory asthenia had a much better prognosis than those with secondary neurocirculatory asthenia. The results indicate the feasibility of the primary/secondary distinction based on the time of onset of mental and cardiorespiratory symptoms in neurocirculatory asthenia. Since only about one quarter of the patients were found to suffer from decreased energy and fatigue according to specified criteria, the terms neurocirculatory asthenia and effort syndrome should probably be discarded.

Adult↗
PubMed1994

[Low-dose aspirin in the long-term treatment of the patient with ischemic heart disease].

Coronary atherosclerosis is the process underlying virtually all the clinical manifestations of ischemic heart disease. When ulcer or fissure in the fibrous cap of the atheroma occur, platelet adhesion to subendothelium, aggregation and further platelet recruitment culminate in thrombus formation. These mechanisms are known to be responsible for most cases of acute events in patients with ischemic heart disease. Inside platelets, aspirin blocks the synthesis of thromboxane A2 by irreversibly inhibiting cyclooxygenase. Aspirin is recommended not only for treatment of patients with acute coronary syndromes (unstable angina, acute myocardial infarction), but also for secondary prevention of vascular events in chronic coronary syndromes. Aspirin prevents myocardial infarction in patients with chronic stable angina and reduces mortality, reinfarction and stroke in survivors of an acute myocardial infarction. Aspirin, alone or in combination with dipyridamole, prevents early and late occlusion of aortocoronary vein grafts. It is useful also in patients undergoing coronary angioplasty. Such benefits extend to all patients regardless of age, sex, history of hypertension or diabetes. Higher daily doses (900-1500 mg) are not more effective than lower doses (75-325 mg). Other antiplatelet drugs are not more effective than aspirin, which has the best risk-to-benefit and cost-to-benefit ratios. Ticlopidine is a reasonable alternative for use in preventing vascular events among patients intolerant to aspirin. Warfarin is an effective antithrombotic alternative to aspirin for secondary prevention after a myocardial infarction. However aspirin is easier to administer and follow-up when compared with warfarin. Warfarin should be preferred in high risk patients with left ventricular dysfunction with or without a mural thrombus, and those with associated atrial fibrillation.

Angina Pectoris↗
PubMed1994

[Non-hemodynamic vascular risk in the patient with arterial hypertension. The effects of medical therapy].

Systemic hypertension is associated with an increased risk of cerebrovascular and coronary events. The exact role of antihypertensive therapy in reversing or reducing the incremental risk is still a matter of debate. Stroke in hypertension can be large vessel disease (atherothrombotic ischemic stroke), or small vessel disease resulting in lacunar lesions or an intracerebral haemorrhage. In the major trials evaluating the benefits of antihypertensive therapy the entire excess risk of stroke (35 to 45%) can be reversed in 3-5 years. Data on coronary events are less clearcut but the most recent metanalyses including data from trials in elderly patients show that the reduction in coronary events is larger and more significant than in previous metanalyses (approximately 16%). ACE-inhibitors and calcium channel blockers have many potential advantages over diuretics and beta-blockers. Their role is under investigation in ongoing clinical trials.

Cerebrovascular Circulation↗
PubMed1994

[Angioplasty in patients already treated with aortocoronary bypass: immediate and short-term results].

Percutaneous transluminal coronary angioplasty (PTCA) is performed in patients with prior aortocoronary bypass grafting (CABG) with good results in native vessels and in the coronary graft anastomoses, but with high percentage of restenosis in the body and in the proximal portion of the grafts. The use of intracoronary stents is now spreading, their implantation can improve the immediate outcome and may decrease the incidence of restenosis, mostly in the body of the graft. In order to evaluate PTCA in CABG patients as to numbers and short-term results, the data regarding the year 1993 of 10 Italian Centers are presented. In these Centers 3,519 PTCA were performed, 233 (6.6%) of which on CABG patients. PTCA has been performed in native vessels in 136 patients and in CABG in 126 patients, with 29 patients treated in native vessels as well as in CABG. An angiographic and clinical success was obtained in 215 patients (92%). A major complication occurred in 11 (4.7%) patients with 8 (3.4%) myocardial infarctions, and 3 (1.3%) deaths. Forty-five (19.3%) stents were implanted with considerable differences among the Centers. One hundred seventy-three patients were followed up for 6 months: 110 (63.6%) were asymptomatic and 57 (32.9%) had complained angina; 27 (15.6%) had a second PTCA and 6 (3.5%) had CABG surgery; 1 patient (0.6%) suffered a myocardial infarction and 7 (4%) died (3 due to CABG reinterventions). To evaluate the long-term follow-up, data regarding 58 patients submitted to PTCA in the Institute of Cardiology of Bologna since 1985 to 1993 are showed, with a 3-year follow-up (36 +/- 26 months).(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon, Coronary↗
PubMed1993

Comparison of efficacy of low molecular weight heparin (parnaparin) with that of unfractionated heparin in the presence of activated platelets in healthy subjects.

Arterial thrombosis is typically platelet-rich. In this study, it is shown that heparin levels resulting in the usual activated partial thromboplastin time therapeutic range provide only a small anticoagulant effect in the presence of activated platelets. Thrombin inhibition is also negligible when heparin is added to platelet-rich plasma. Aspirin improves the anticoagulant effect of heparin in these circumstances, but the degree of anticoagulation is still considerably lower than that observed in platelet-poor plasma. A low molecular weight heparin (parnaparin) is more active in the presence of activated platelets (such as may occur in acute coronary syndromes) regardless of whether aspirin is used concomitantly.

Aspirin↗
PubMed1993

Evidence of a partial escape of renin-angiotensin-aldosterone blockade in patients with acute myocardial infarction treated with ACE inhibitors.

Angiotensin-converting enzyme (ACE) inhibitors have been designed to block the renin-angiotensin system and can represent an effective therapeutic approach in those settings where such a system is active, such as myocardial infarction. In a randomized placebo-controlled study, 10 patients with acute myocardial infarction allocated to treatment with increasing doses of zofenopril calcium and 10 patients allocated to placebo were studied in hospital, within 24 hours from symptoms, during 11 sampling periods to assess the time course of ACE inhibition and renin-angiotensin-aldosterone blockade. Zofenopril administration was followed by a dose-dependent inhibition of in vitro ACE activity (7.5 mg, 65%; 15 mg, 89%; 30 mg, 94.5%) and a progressive increase in plasma active renin. Conversely, plasma aldosterone decreased during the first 3 days of treatment and then returned toward baseline values, as did blood pressure, despite a persistent inhibition of ACE. The present data suggest the existence of an interesting dissociation between the time-course of ACE inhibition and that of blockade of the renin-angiotensin system in patients with acute myocardial infarction. This discrepancy could arise from the combination of an only partial in vivo ACE inhibition and the compensatory increase in plasma renin that occurs during treatment with ACE inhibitors. A better understanding of this relationship would seem to be useful in addressing the correct use of ACE inhibitors in patients with acute myocardial injury.

Aldosterone↗
PubMed1993

Effect of enoximone alone and in combination with metoprolol on myocardial function and energetics in severe congestive heart failure: improvement in hemodynamic and metabolic profile.

The hemodynamic and myocardial metabolic effects of enoximone (phosphodiesterase III inhibitor), alone or in combination with metoprolol (beta-adrenergic blocker), were studied in patients with congestive heart failure. Ten patients (New York Heart Association Class III-IV) underwent right heart and coronary sinus catheterization, and parameters were assessed at basal condition, at peak enoximone response (mean intravenous loading dose = 2.2 mg/kg), and after the combination with metoprolol (mean intravenous dose = 8.5 mg). Heart rate tended to increase during enoximone administration (from 102 +/- 16 to 107 +/- 16 min-1, ns) and was reduced during enoximone plus metoprolol (to 88 +/- 15 min-1, p < 0.05 vs. basal). Cardiac index was increased during enoximone (from 2.2 +/- 0.2 to 3.8 +/- 0.5 1/min/m2, p < 0.05) and decreased during enoximone plus metoprolol (to 2.8 +/- 0.5 1/min/m2, p < 0.05 vs. enoximone). Mean pulmonary wedge pressure fell during enoximone and remained reduced during enoximone plus metoprolol (from 27 +/- 9 to 9 +/- 3 and to 13 +/- 4 mmHg, respectively, both p < 0.05). Myocardial oxygen consumption did not change during enoximone (from 27 +/- 8 to 25 +/- 13 ml/min, ns) and was reduced during enoximone plus metoprolol (to 19 +/- 8 ml/min, p < 0.05 vs. basal). Myocardial lactate extraction tended to be lower during enoximone and during enoximone plus metoprolol conditions (from 38 +/- 17% to 26 +/- 20% and to 29 +/- 24%, respectively), but no statistical significance was found. Myocardial efficiency was increased during enoximone and during enoximone plus metoprolol (from 9 +/- 3% to 15 +/- 6% and to 14 +/- 6%, respectively, both p < 0.05). Thus in patients with congestive heart failure enoximone improves hemodynamics and, in most cases, it does not influence energetics. The addition of metoprolol to enoximone reduces heart rate, cardiac index, and myocardial oxygen consumption without any other major changes, producing a more physiologic hemodynamic and metabolic profile.

Adult↗
PubMed1993

Benefit of adding low molecular weight heparin to the conventional treatment of stable angina pectoris. A double-blind, randomized, placebo-controlled trial.

BACKGROUND: Patients with chronic coronary artery disease exhibit a dysfunctioning endothelium, which may be responsible for exercise-induced platelet activation and expression of a procoagulant moiety. In this study, we evaluated the therapeutic efficacy of a low molecular weight heparin (Parnaparin) in patients with stable angina pectoris. METHODS AND RESULTS: According to a double-blind, randomized, placebo-controlled trial, 29 patients with stable exercise-induced angina pectoris and angiographically proven coronary artery disease received a single daily subcutaneous injection of Parnaparin or placebo on top of aspirin and conventional antianginal medication over 3 months. Patients randomized to Parnaparin showed a significant decrease in the fibrinogen level (P = .035) and an improvement in both the time to 1-mm ST segment depression (P = .008) and the peak ST segment depression (P = .015). The Canadian Cardiovascular Society class for angina pectoris was also improved by Parnaparin (P = .016). Parnaparin did not affect ADP and collagen-induced platelet aggregation, whereas thrombin-induced aggregation was reduced (P = .0001). The bleeding time was slightly prolonged, but this was not associated with any significant bleeding. CONCLUSIONS: Patients with stable angina pectoris may be treated with Parnaparin in addition to aspirin and conventional antianginal medication. Side effects are negligible, and compliance is excellent.

Adult↗
PubMed1993

[Vasodilator agents: the lesson from large clinical trials].

The results of trials of vasodilators in patients with chronic heart failure showed improved survival by adding ACE-inhibitors or a combination of isosorbide dinitrate and hydralazine to the usual therapy with digoxin and diuretics. However, the mean prolongation of life is unsatisfactory (10-17 months) and very small effects are observed on the various measures of quality of life. In patients with asymptomatic left ventricular dysfunction, the treatment with ACE-inhibitors reduces the progression to the clinical phase of heart failure but not in all patients. Therefore is attractive to evaluate new agents to improve the results of the present therapeutic strategies. The attempts to combine new vasodilators to regimens including ACE-inhibitors have been inconclusive or even deleterious. The identification of subgroups of patients with different clinical, hemodynamic and neurohormonal characteristics may allow a more appropriate use of the new therapeutic resources.

Clinical Trials as Topic↗
PubMed1993

[Restrictive cardiomyopathies].

The restrictive cardiomyopathies are the least common of the 3 major categories of cardiomyopathic disorders seen in Western countries. According to the report of the WHO/ISFC Task Force the term restrictive cardiomyopathy applies to only 2 conditions: endomyocardial fibrosis and Loeffler endocarditis while many specific myocardial diseases can develop a restrictive pathophysiologic profile along their natural history. During the last decade this topic has received 2 main contributions: the identification of a common pathophysiologic ground linking Loeffler endocarditis and endomyocardial fibrosis and the identification of the so-called idiopathic restrictive cardiomyopathy. This condition, defined as a myocardial disease with restrictive physiology, unknown etiology and without histological evidence of infiltrative or storage diseases, appears to be the single most frequent type of restrictive cardiomyopathy in Western countries. A revision of the current classification of cardiomyopathies and particularly of restrictive myocardial disease is necessary.

Cardiomyopathy, Restrictive↗
PubMed1993

Flecainide acetate: concentration-response relationships for antiarrhythmic and electrocardiographic effects.

In order to evaluate the concentration-response relationship for either antiarrhythmic or electrocardiographic effects, 13 patients with symptomatic, stable, premature ventricular contractions (> 100/hour) were selected, and flecainide was administered as a single oral dose (200 mg) and as chronic treatment (150 mg b.i.d. for 21 days). In both settings a Holter monitoring, serial electrocardiogram (ECG) tracings and serum samples for flecainide concentrations were obtained; the relationships between drug levels, antiarrhythmic efficacy, and ECG modifications were analysed. The results obtained indicated that QRS and PR intervals lengthened significantly either after acute oral administration or after chronic treatment by 21-36% (mean values), and that the QRS interval changes were significantly correlated to serum flecainide concentrations (r = 0.68, p < 0.001 after acute and r = 0.79, p < 0.001 after chronic administration). However, for any given plasma concentration of flecainide, the percentage widening of QRS intervals was smaller after chronic treatment, as shown by the different slopes of the correlation lines (7.7 +/- 4.0% ml.micrograms -1 after acute dosing versus 3.8 +/- 1.1% ml.micrograms -1 after chronic treatment, p < 0.001). This finding suggests a relative reduction of flecainide's effects on ECG intervals during chronic treatment, while the antiarrhythmic efficacy was maintained (flecainide effective in 8/13 patients in acute and in 11/13 patients in chronic) without significant differences between flecainide's minimal effective concentrations (262 +/- 119 ng/ml and 319 +/- 276 ng/ml for acute vs chronic respectively). We conclude that during chronic treatment a dissociation seems to occur between the electrocardiographic and the antiarrhythmic effects and this could limit the clinical usefulness of monitoring QRS intervals.

Administration, Oral↗
PubMed1993

[The immediate and long-term efficacy of electrical cardioversion in atrial fibrillation].

With the aim to identify short- and long-term features predictive of successful electric cardioversion in stable atrial fibrillation, 186 consecutive patients submitted to electric cardioversion were reviewed. The following parameters were considered: age, atrial fibrillation duration, previous atrial fibrillation episodes, echocardiographic left atrial diameter, pre-treatment and prophylaxis with amiodarone. The patients were divided in 3 groups: Group I included 97 patients with mitral valve disease or mitral prosthesis, Group II included 27 patients with lone atrial fibrillation and Group III included 62 patients with different heart and extracardiac diseases. The electric cardioversion restored sinus rhythm in 155 patients (83%). The failure of the electric cardioversion was related only to a longer atrial fibrillation duration and to pre-treatment with amiodarone. Moreover, the failure of the electric cardioversion was more frequent in Group II patients (with lone atrial fibrillation) than in Group I patients (mitral disease or prosthesis; p < 0.005). Only for Group I patients failure of the cardioversion was related to a larger left atrium diameter (p < 0.05). Eighty-nine (57%) of the 155 patients converted to sinus rhythm were followed for at least 1 year. At 1 year sinus rhythm persisted in 57 patients (64%), and prophylaxis with amiodarone was the only predictor of sinus rhythm persistence (p < 0.05). Out of 68 patients with a 3 year follow-up, 29% still showed sinus rhythm after a single cardioversion and 37% after 2 or more cardioversions; after 5 years, out of 58 patients, those showing sinus rhythm were 6 (10.3%) and 9 (16%) respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[The 24-hour hemodynamic changes after percutaneous mitral valvuloplasty].

Hemodynamic studies were performed immediately before, within 1/2 hour and 24 hours after percutaneous mitral valvuloplasty in 31 patients with severe mitral stenosis and pulmonary hypertension. Single rubber-nylon balloon (Inoue balloon) technique was used in all the procedures. Mean transmitral gradient fell from 12.7 +/- 5.4 mmHg to 6.1 +/- 3.1 mmHg (p < 0.001). Mitral valve area increased from 0.9 +/- 0.2 cm2 to 1.8 +/- 0.3 cm2 (p < 0.001). Mean pressure in the left atrium decreased from 21.8 +/- 7.1 mmHg to 16.9 +/- 5.1 mmHg (p < 0.001). After 24 hours there was a significant further drop in left atrial pressure (or pulmonary capillary wedge pressure), that decreased to 11.5 +/- 5 mmHg (p < 0.001). Mean cardiac output increased from 4.1 +/- 0.8 l/min to 4.5 +/- 0.9 l/min immediately after successful valvuloplasty and after 24 hours was significantly higher (5.4 +/- 1.2 l/min; p < 0.001). Mean pulmonary pressure immediately decreased from 29.2 +/- 9.7 mmHg to 26.5 +/- 6 mmHg (p < 0.05) and after 24 hours was 19.4 +/- 6 mmHg (p < 0.001). Left ventricular end-diastolic pressure increased from 9.9 +/- 3.8 mmHg to 13.8 +/- 5 mmHg (p < 0.001). In conclusion, pulmonary hemodynamic and cardiac output improve immediately after percutaneous mitral valvuloplasty and get progressively better up to 24 hours from the procedure.

Adult↗
PubMed1993

[Identification of viable myocardium by 201Tl scintigraphy: a comparison of methods].

The present study was undertaken to compare four different imaging approaches to evaluate uptake defect reversibility. 24 infarcted patients underwent standard stress/redistribution 201Tl imaging (R1). Then, after reinjection of 37 MBq of 201Tl, patients were re-imaged either after 15 min (R2) 24 h later (R3). A separate rest study (R4) following a new tracer injection was done within 2-3 days. Planar images were obtained in the standard three views and subdivided into 216 segments for qualitative analysis based on a visual score. A semiquantitative analysis based upon circumferential profiles was also applied. A stress defect was found in 127 segments (58.7%). By visual inspection reperfusion was considered to occur in 32.3%, 41.7%, 33.0% and 49.6% of the cases with R1, R2, R3, and R4, respectively. The semiquantitative method showed a high reperfusion only with R1 (62%), while the other procedures proved less effective. No improvement was found with R4. Six patients (25%) showed myocardial viability that was not detected with the early reinjection technique.

Female↗
PubMed1993

[Aortic dissection without intimal laceration: a case report and review of the problem].

A 43-year-old hypertensive woman with symptoms of aortic dissection was referred to our hospital 3 days after the initial episode. Transesophageal echocardiography and magnetic resonance showed a large intramural hematoma of the ascending and descending aorta without intimal flap and tears. Aortography confirmed the absence of intimal disruption. Medical therapy with beta and alpha blocking agents was established. After 5 months the patient was asymptomatic. On transesophageal echocardiogram and magnetic resonance, complete reabsorption of the hematoma of descending aorta was evident while a clearly identifiable false lumen and intimal flap (without tear) were present at the aortic arch level. The diagnostic criteria and therapeutic options are discussed and the literature on this topic is reviewed.

Adult↗
PubMed1993

[Paroxysmal atrial fibrillation: the significance of the dynamic behavior of the atrial cycle].

The aim of this study was to evaluate the dynamic atrial endocardial activation pattern during atrial fibrillation and to investigate the electrophysiologic changes related to the self-termination of the arrhythmia. Twenty patients with daily recurrences of lone paroxysmal atrial fibrillation episodes underwent electrophysiological study with contemporary recording of the atrial signal in high right atrium, low right atrium and coronary sinus. Sixty episodes lasting longer than 1 min were recorded, 22 spontaneous and 38 induced with a single extrastimulus. A significant correlation has been demonstrated for the mean of 100 consecutive intervals evaluated at the arrhythmia onset and the atrial functional refractory period (R = 0.73, p < 0.001). Mean FF length increased significantly in the minute preceding self-termination of atrial fibrillation in all the 3 recording sites. On the contrary, a significant decrease of mean FF length was documented in long lasting episodes. Self-termination of atrial fibrillation episodes implies a peculiar pattern of intra-atrial interval. Therefore the analysis of FF intervals seems to have pathophysiological implication and may be applied also to evaluate pharmacological interventions.

Adolescent↗