Search PubMed⌕ Search

Biomedical subjects

D Rovai

Publications and source records attributed to D Rovai.

46 records · Page 3Linked to original sources
PubMed1985

Transient myocardial ischemia with minimal electrocardiographic changes: an echocardiographic study in patients with Prinzmetal's angina.

Kn patients with Prinzmetal's angina, episodes of transient T wave abnormalities (T abn) are often documented in addition to the typical episodes of ST segment elevation (ST). As the interpretation of these minor ECG changes is still uncertain, we investigated if transient T abn are associated with reversible ventricular asynergies, similar to episodes with ST. For this purpose an ECG lead and a two-dimensional echocardiographic projection, which showed clear-cut changes during previous episodes of ST, were simultaneously monitored in five patients with Prinzmetal's angina for a total of 13 hours and 20 minutes. In all patients, the 30 episodes of ST recorded were all accompanied by reversible ventricular asynergies. Furthermore, in four of these patients, 14 episodes of T abn (peaking, flattening, or the appearance of a diphasic T wave) were recorded. All T abn were associated with reversible asynergies, as detected by three independent observers. The mechanical impairment occurred in the same ventricular wall both during ST and during T abn. During T abn the degree of mechanical impairment appeared less severe (hypokinesia in 12 and akinesia in two episodes) than during ST (hypokinesia in one, akinesia in 25, and dyskinesia in four episodes) (p less than 0.001). The duration of asynergies was less during T abn (107 +/- 76 seconds) than during ST (169 +/- 83 seconds) (p less than 0.05). Chest pain was reported in 5 of 14 episodes of T abn (36%) and in 20 of 30 (66%) episodes of ST (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

Transient changes in left ventricular mechanics during attacks of Prinzmetal's angina: an M-mode echocardiographic study.

M-mode echocardiograms were recorded in 12 patients with Prinzmetal's angina during 29 episodes of transient myocardial ischemia at rest (18 spontaneous and 11 ergonovine-induced). At peak ST segment elevation a regional mechanical impairment was observed in the interventricular septum during 23 episodes of angina and in the posterior wall during six episodes. In the 18 spontaneous episodes the left ventricular ischemic wall, when compared to the basal state, was found to have a significant reduction in motion (-76.3 +/- 9.1%) (mean +/- SEM), in diastolic thickness (-11.7 +/- 2.5%), and in percent systolic thickening (-88.0 +/- 5.6%). Increase in left ventricular end-diastolic diameter (+13.1 +/- 2.1%) and decrease in percent fractional shortening (-38.1 +/- 3.7%) were also observed. When ST segment was back to the isoelectric line, a transient overshoot in regional left ventricular function was observed. In induced episodes statistically significant changes could be detected by M-mode echocardiography even before appearance of ST segment elevation and anginal pain. No significant difference was found in type or degree of mechanical impairment between induced and spontaneous episodes. Therefore, in patients with Prinzmetal's angina: (1) M-mode echocardiography allows detection of mechanical changes due to transient myocardial ischemia; and (2) mechanical impairment occurs earlier than clinical (pain) and electrocardiographic (ST segment elevation) signs of transmural ischemia.

Adult↗
PubMed1984

Transient changes in left ventricular mechanics during attacks of Prinzmetal angina: a two-dimensional echocardiographic study.

Fifty-five ischemic attacks at rest with ST segment elevation were recorded by two-dimensional echocardiography (2DE) in 20 patients with Prinzmetal angina. Eighteen ischemic attacks were recorded starting from intravenous injection of ergonovine maleate while 37 spontaneous ischemic attacks were recorded from onset of either anginal pain or ECG changes or from the basal state. In each ischemic attack at least one of the following transient alterations was observed by 2DE during ST elevation: (1) Regional hypokinesia, akinesia, or dyskinesia; (2) "step sign," that is, a sharp demarcation between an akinetic or dyskinetic area and an adjacent normal or hypercontracting region; and (3) geometric changes in left ventricular shape, that is, globular appearance in diastole and hourglass silhouette in systole. Regional myocardial asynergy was detected earlier than onset of pain (which was not present in 21 [38%] ischemic episodes) or ST segment elevation on ECG, as documented in 40 ischemic episodes (16 induced and 24 spontaneous) in which echocardiographic monitoring was performed from basal state and carried on up to the appearance of ischemia. All described mechanical changes were fully reversible after pain subsided and ST segment was back to isoelectric, either spontaneously or with nitrates; furthermore, a contractile "rebound phenomenon" of the previously ischemic wall was observed in some episodes. In conclusion, these results outline a role for 2DE in detecting cardiac mechanical impairment due to transient myocardial ischemia with ST segment elevation in humans.

Adult↗
PubMed1984

Transient predominant right ventricular ischemia caused by coronary vasospasm.

This study describes the clinical experience with four patients with variant angina caused by spasm of the right coronary artery who were assessed for evidence of right ventricular involvement. The patients were suspected of having predominant right ventricular ischemia on the basis of normal thallium-201 scans, left ventricular ejection fraction, regional wall motion assessed by equilibrium radionuclide angiography (RNA), two-dimensional echocardiographic findings, and left ventricular hemodynamics; all procedures were performed during transient ST segment elevation in the inferior leads. Right ventricular ischemia was documented in four patients by first-pass radionuclide studies and phase analysis of RNA, and in three patients by simultaneous right and left hemodynamic monitoring. The clinical findings from these four patients are compared with those from four other patients with similar electrocardiographic changes, coronary anatomic distribution, and documented right coronary spasm but with evidence of left ventricular involvement as documented by abnormal thallium-201 scintigraphy, RNA, two-dimensional echocardiography, and left hemodynamics during ischemic episodes. Although preliminary, these data indicate the existence of prevalent right ventricular ischemia during variant angina caused by right coronary vasospasm. This condition should be suspected whenever typical anginal symptoms and/or ischemic electrocardiographic changes are accompanied by normal thallium-201 scintigraphic findings and/or normal left ventricular function as assessed by RNA, echocardiography, and left hemodynamic monitoring. Among noninvasive procedures, first-pass radionuclide study and phase analysis of RNA represent suitable techniques for detecting transient right ventricular dysfunction.

Angina Pectoris, Variant↗
PubMed1983

Intravenous dl-carnitine fails to increase the double-product during atrial pacing in patients with effort angina. A double-blind randomized study.

Infusions of DL-carnitine are reported to improve the tolerance to atrial pacing of patients with angina pectoris. In the present study, six patients with angina of effort and triple vessel disease received two placebo and two carnitine infusions administered in a double-blind randomized fashion. Carnitine did not affect either the double product (heart rate X systolic blood pressure) at maximal pacing (ST depression: 2.3 +/- 0.2 mm, +/- SEM) or the tolerated pacing time. Intravenous carnitine, in the dose given, is of no therapeutic benefit in myocardial ischemia precipitated by tachycardia. It could be effective when free fatty acids are elevated as during catecholamine stimulation.

Angina Pectoris↗
PubMed1981

[Diagnosis of transient acute myocardial ischemia in man by M-mode echocardiography (author's transl)].

Under basal conditions the echocardiographic findings in anginal patients (pts.) without previous myocardial infarction appears usually normal. Consequently, the usefulness of the ultrasounds evaluation in angina pectoris has been commonly considered poor and the utilization of this technique in coronary artery disease has been restricted to the detection of myocardial infarction in its acute phase or to its chronic mechanical alterations. The purpose of this study was to assess the possibility offered by M-mode echocardiography to detect changes caused by transient myocardial ischemia at rest in man, in view of the possible diagnostic application of this technique. The reported results were obtained from 25 ischemic attacks (13 spontaneous and 12 ergonovine induced) with ST segment elevation or pseudonormalization of a basally negative T wave at rest. The semiautomatic computerized analysis of echocardiograms continuously recorded during these attacks showed a reduction of motion and of systolic thickening, accompanied by a diastolic thinning of the wall involved by the ischemia. These changes occur very early: they appear few seconds before ECG changes and are accompanied by a reduction of contraction and relaxation dP/dt and precede the onset of chest pain; moreover, they are followed by an increase in left ventricular internal diameters. In conclusion M-mode echocardiography is a sensitive technique capable to detect transient myocardial ischemia in the course of spontaneous or induced angina with ST segment elevation or positivity of negative T wave. This approach could be helpful in the diagnostic evaluation of patients with atypical chest pain and/or aspecific ECG changes and it can be complementary to other non invasive techniques such dynamic ECG and nuclear cardiology techniques.

Acute Disease↗
PubMed1981

[Comparison between M-mode echocardiography and 201thallium myocardial scintigraphy for diagnosis of transient myocardial ischemia (author's transl)].

Purpose of this study was to evaluate the capability of M-mode echocardiography (M-mode) and of 201Thallium myocardial scintigraphy (201T1) to detect transient myocardial ischemia at rest in man. Fourteen male patients (pts) were studied by the two techniques under basal conditions and during episodes of angina at rest. Data were obtained in 2 pts in rapid succession during the same episode, in the remaining 12 pts in different episodes with electrocardiographic changes similar in site, type, entity and duration. Echocardiographic criteria of transient ischemia (reversible asynergies and transient reduction of systolic thickening) were present in 9/11 pts during episodes of ST segment elevation; the scintigraphic ones (reversible perfusion defects) in 10/11 pts. In 3 pts during episodes of ST segment depression M-mode was positive in 2, 201T1 in all three. The poor acoustic window in 2 pts and the involvement in one of left ventricular lateral wall not seen by M-mode on parasternal approach, may account for the 3 false negatives of M-mode. The single false negative of 201T1 can be related to the short duration (1') of the episode. A complete correspondence of site of ischemia, detected by ECG, M-mode and T1, was observed. In conclusion, M-mode appears a reliable technique for detecting transient ischemic episodes, being the main limits the acoustic window and the incapacity in exploring all ventricular walls and the main advantage the high temporal resolution, which permits to study continuously the full sequence of the ischemic event. On the other hand 201T1 does not allow detection of episodes of short duration. This two techniques, when combined in anginal patients, provide complementary information on perfusion and contraction respectively. The reliability of these techniques in the assessment of transient myocardial ischemia is the basis for their possible diagnostic use in pts with transient specific ECG changes or with typical anginal pain without ECG evidence of ischemia.

Adult↗
PubMedDate not supplied

Echocardiographic contrast imaging of the human right heart: a multicenter study of the efficacy, safety, and reproducibility of intravenous SHU-454.

The contrast agent SHU-454 was intravenously injected in 103 patients during echocardiography: 37 mL/patient +/- 7 ml/patient. The quality of the contrast effect was optimal in 13, good in 51, sufficient in 30, and poor in 9 patients; reproducibility was optimal in 38, good in 46, sufficient in 17, and poor in 2 patients. Taste sensation, arm discomfort, or atypical chest pain occurred in 5 patients, premature ventricular contractions in 3. An isolated anginal attack occurred in 1 patient with frequent episodes at rest. A slight reduction in hematologic indices was attributed to hemodilution. Thus, SHU-454 produces a good and reproducible contrast effect with tolerable side effects.

Contrast Media↗
PubMedDate not supplied

Cardiac cycle-dependent gray-level variation is not distorted by abnormal septal motion after cardiac surgery: a transesophageal videodensitometric study in humans.

Variation in cyclic (systolic-to-diastolic) echodensity has been demonstrated to be a reliable index of preserved myocardial function. Paradoxic septal motion can be observed frequently after cardiac surgery in the absence of any functional impairment. The aim of the study was to evaluate whether regional cycle-dependent gray-level variation in the septum is affected by abnormal septal motion after cardiac surgery. Ten patients undergoing cardiac surgery for coronary artery bypass grafting were evaluated by continuous transesophageal echocardiographic monitoring from the transgastric approach, both before and after surgery. In each patient septal motion was assessed qualitatively as normal or paradoxic. Images were digitized off-line and cyclic gray-level variation was measured in each patient by means of dedicated software. By selection, all patients exhibited normal septal motion and thickening at baseline. After surgery, five patients showed a paradoxic septal motion (group I), whereas in the remaining five patients (group II) septal motion remained normal. Percent area change, measured with the floating center-of-mass reference system, was similar in the two groups both before (I = 42% +/- 7% versus II = 44% +/- 13%; difference not significant) and after surgery (I = 39% +/- 8% versus II = 40% +/- 1%; difference not significant). Cyclic gray-level variation was also similar in the two groups, both at baseline (group I = 61% +/- 16% versus group II = 68% +/- 18%; difference not significant) and after surgery (50% +/- 13% versus 57% +/- 16%; difference not significant).(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac Surgical Procedures↗