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Biomedical subjects

E Picano

Publications and source records attributed to E Picano.

210 records · Page 12Linked to original sources
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↗
PubMedDate not supplied

The clinical value of blunting of cyclic gray level variation for the detection of acute cardiac rejection: a two-dimensional, Doppler, and videodensitometric ultrasound study.

Aims of this study were to assess (1) whether videodensitometric analysis of myocardial gray-level variation can distinguish normal from rejecting transplanted hearts in a clinical setting and (2) whether this sign, used in combination with the other conventional two-dimensional and Doppler echocardiographic findings, might improve the accuracy of ultrasound techniques. Thirty heart transplant recipients (23 men; mean age 40 years; range 20 to 54 years) were studied in 87 different situations by endomyocardial biopsy and echocardiographic evaluation. Of the 87 situations, 37 ("rejectors") showed histologic evidence of rejection of mild (n = 17) or moderate (n = 10) severity and 50 ("nonrejectors") did not show rejection processes. Cyclic variation was decreased significantly in rejectors compared with nonrejectors in both the septum (15% +/- 10% versus 25% +/- 11%; p < 0.0001) and the posterior wall (19% +/- 10% versus 25% +/- 12%; p < 0.01). When a cutoff of 20% or greater of cyclic variation in the septal wall was taken as a positivity criterion, it yielded a 70% sensitivity and 70% specificity for identifying rejection. Sensitivity of conventional two-dimensional and Doppler echocardiographic signs was 51% and increased to 89%, increased by the videodensitometric criteria (p < 0.001). Specificity was 92% and decreased to 62% with videodensitometric criteria (p < 0.001). Overall diagnostic accuracy was 75% for conventional two-dimensional echocardiographic Doppler criteria alone and remained unchanged by the addition of videodensitometric criteria. In conclusion, blunting of cyclic gray-level variation induced by rejection is detectable with videodensitometric analysis. The clinical impact of this sign appears to be limited, because the resulting increase in sensitivity is counter-balanced by a reduced specificity compared with the currently available conventional ultrasound techniques.

Acute Disease↗
PubMedDate not supplied

Regional concordance and discordance between rest thallium 201 and sestamibi imaging for assessing tissue viability: comparison with postrevascularization functional recovery.

BACKGROUND: Whether the combined analysis of rest 201Tl and sestamibi uptake provides additional information regarding myocardial viability in patients with coronary artery disease is still to be investigated. METHODS AND RESULTS: To this aim we studied 22 patients with previous myocardial infarction and regional ventricular dysfunction by quantitative rest sestamibi and 201Tl scintigraphy. All patients underwent revascularization, and echocardiography was repeated 11 +/- 2 weeks later. Concordant results were obtained in 80 of 105 dyssynergic segments. Fifty-one segments showed normal and 29 abnormal activity. Follow-up echocardiography showed increased wall motion contractility in 76% of segments with maintained 201Tl and sestamibi uptake and in only 17% of segments characterized by subthreshold activities. Twenty-five segments, or 24%, showed sestamibi/201Tl mismatch. Eleven of 12 segments with normal sestamibi/abnormal 201Tl activity did not improve after revascularization, whereas 11 of 13 segments with abnormal sestamibi but normal 201Tl showed postoperative improvement of regional wall motion. CONCLUSIONS: In patients with previous myocardial infarction, sestamibi and 201Tl showed concordant results in most segments. However, in segments with mismatch a maintained sestamibi uptake was a poor indicator of tissue viability, whereas significant 201Tl uptake reflected tissue viability in most segments.

Adult↗
PubMedDate not supplied

ECG in stress testing: child of a lesser diagnostic god?

When new technologies are added to the previously existing ones, the latter can be prematurely discarded and judged obsolete not only on the basis of rational scientific facts, but also on irrational trends. Old techniques, like electrocardiography, suffer from diagnostic ambiguities that can be solved by combination with a cardiac imaging technique, like stress echocardiography. ECG monitoring during all forms of stress testing can still offer surprising dividends for a better understanding of the complex physiology of coronary artery disease, a better clinical characterization of patients with microvascular angina, and may serve as an important adjunct marker to cardiac imaging techniques.

Coronary Disease↗
PubMedDate not supplied

Imaging-documented cardiovascular signal database for assessing methods for ischaemia analysis.

A new database of cardiovascular signals has recently been developed at the CNR Institute of Clinical Physiology in a study based on patients admitted to the Coronary Care Unit for suspected ischaemic heart disease (IHD), who underwent both ECG effort stress test and echo or radionuclide diagnostic imaging procedures associated with pharmacological test of myocardial ischaemia. During stress testing, in addition to 12-lead ECG, arterial blood pressure and respiration signals are measured non-invasively and recorded. Signals and representative image frames at baseline and during ischaemia are stored in the database, which is planned to include 50 cases, annotated beat by beat and archived on CD-ROM. Each case also contains resting ECG and a comprehensive patient clinical record; if possible Holter ECG and coronary arteriography frames.

Blood Pressure Monitors↗
PubMedDate not supplied

[The dipyridamole-echo-ECG test in hypertensives with microvascular angina].

Microvascular angina - chest pain syndrome in the presence of angiographically normal epicardial coronary arteries and reduced flow reserve - has been also described in patients with essential hypertension and it has been linked to the development of left ventricular hypertrophy. Dipyridamole-Echocardiography Test (DET: 2D-echo and 12 lead ECG monitoring with dipyridamole infusion, up to 0.84 mg/kg over 10') was performed in 28 essential hypertensives meeting the following inclusion criteria; 1) history of chest pain; 2) angiographically normal coronary arteries; 3) normal resting regional and global left ventricular function. A group of 12 (age and sex matched) normotensives with the same inclusion criteria, as well as with negative exercise stress test, was also evaluated. During DET, none, either in essential hypertensives or in control group, developed a regional dyssynergy of contraction; 15 in essential hypertensives, and 2 in control group had a diagnostic (greater than 0.1 mVolt from baseline) ST segment depression on ECG tracing (54 vs 17% p less than 0.01); 16 in essential hypertensives and 2 in control group had chest pain (57 vs 17%, p less than 0.01). None of the control group and 9 of the essential hypertensives had echocardiographically assessed left ventricular hypertrophy. In the essential hypertensives group, ventricular hypertrophy was present in 7/20 patients with and in 2/8 patients without dipyridamole induced chest pain and/or ST segment depression (35 vs 25%, p = ns). In conclusion, essential hypertensives patients with chest pain and angiographically normal coronary arteries frequently show "echocardiographically silent" angina and/or ST segment depression during DET. The presence of ventricular hypertrophy does not appear to be a prerequisite for the induction of angina in these patients.

Angina Pectoris↗
PubMedDate not supplied

[Increase in tolerance to physical effort in patients with X syndrome after acute administration of aminophylline].

Myocardial flow maldistribution and transmural steal phenomena, due to excessive arteriolar dilation elicited by elevated adenosine release during exercise, might be the mechanism of myocardial ischemia in patients with syndrome X. The effect of the adenosine receptor blocker aminophylline (AM) on effort ischemia in patients with syndrome X was tested: following double blind, randomized intravenous infusion of aminophylline (6 mg/kg over 15 minutes) or placebo, 8 patients with syndrome X underwent exercise stress test. After AM administration there was an increase in work tolerance (AM = 7.7 +/- 1.2 minutes of exercise vs placebo = 5.6 +/- 0.9, p less than 0.01) paralleled by an increase of the ischemic threshold, evaluated through the rate pressure product (mmHg x beats/min x 1/100) at 0.1 mV of ST-segment depression or at peak exercise (AM = 278 +/- 55 vs placebo = 230 +/- 24, p less than 0.05). AM prevented the occurrence of ischemic ECG signs in all 8 patients. Thus, at a dosage which effectively inhibits adenosine receptors, aminophylline infusion exerts beneficial effect on exercise induced ischemia in syndrome X, possibly through the prevention of transmural steal phenomena, elicited by inappropriate adenosine release during effort.

Adult↗