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E Uslenghi

Publications and source records attributed to E Uslenghi.

At least 37 records · Page 2Linked to original sources
PubMed1996

Time domain signal-averaged electrocardiogram in predicting arrhythmic events after myocardial infarction: role of the duration of the filtered QRS complex.

Several studies showed that time domain analysis of the signal-averaged ECG may identify groups of patients with low and high risk for arrhythmic events after myocardial infarction (MI). However, the signal averaging methods were not uniform and the definition of abnormal signal-averaged ECG was empiric. To identify the best quantitative signal-averaged variable in predicting arrhythmic events (sustained ventricular tachycardia, ventricular fibrillation and witnessed, instantaneous death) 262 patients surviving acute MI were prospectively evaluated. Twelve clinical variables, left ventricular ejection fraction (LVEF), complex ventricular arrhythmias (CVA) on Holter monitoring and three conventional signal-averaged variables (either at 25-250 or 40-250 Hz) were entered in a Cox proportional hazards regression model. During a mean follow-up of 20.3 +/- 13.7 months 16 (6.1%) patients had arrhythmic events. All six signal-averaged variables were independent predictors of arrhythmic events and the filtered QRS duration (fQRSD) > or = 120 ms at 40 Hz high pass filtering resulted the most predictive. In a regression analysis, including the best signal-averaged variable, LVEF and CVA, only fQRSD > or = 120 ms at 40 Hz and LVEF independently predicted arrhythmic events. Sensitivity, specificity, positive predictive value and odds ratio for fQRSD > or = 120 ms at 40 Hz were 63, 90, 29 and 11%, respectively, and for the combination of fQRSD > or = 120 ms at 40 Hz and LVEF < 40%, were 73, 95, 47 and 39%, respectively. In conclusion, the fQRSD > or = 120 ms at 40 Hz best predicts arrhythmic events in the post-infarction period. The combination of signal-averaged ECG and LVEF is recommended to stratify patients at risk of arrhythmic events after MI.

Aged↗
PubMed1996

[The use of a check list for quality assurance of the treatment of acute myocardial infarction in the coronary care unit].

UNLABELLED: The implementation of Quality Assurance programs for the treatment of acute myocardial infarction in the Cardiac Intensive Care Unit may be specially important. In fact several therapeutic options are available in these patients, and delay in treatment must be as short as possible. A Quality Assurance program has been started in our center with a registry of all patients admitted within 24 hours of onset of acute myocardial infarction. PATIENTS AND METHODS: The following data were recorded: 1) indicators of Organization: pathway to admission, pre-hospital and in-hospital delay; 2) Process Indicators: duration of hospital stay, initial choice of therapy (conservative, intravenous lysis, primary angioplasty), and further diagnostic and interventional procedures; 3) Outcome Indicators: mortality and complications during admission, and 6-12 months follow-up. RESULTS: Since february 1994 to August 1995, 211 consecutive patients were included in the registry; 156 were male, mean age 66 years. Mean pre-hospital delay was 286 minutes. Admission was decided by a physician in 99 cases and by the patient him/herself in 112 cases; pre-hospital delay was 390 min. In the former group, and 194 min. In the latter (p < .001). Mean in-hospital delay was 61 minutes. Conservative treatment, intravenous lysis, and primary angioplasty were chosen by the attending cardiologist in 89 patients (group A), 69 patients (group B), and 53 patients (group C) respectively. The latter group included patients with highest risk on the basis of clinical and electrocardiographic characteristics. In-hospital mortality was 17, 7 and 9% In the 3 groups, respectively. An echocardiogram and coronary angiography were performed before discharge in 81% and 57% of patients, respectively. The mean duration of hospital stay was 11 days, irrespective of the initial therapeutic choice. CONCLUSIONS: A registry for patients with acute myocardial infarction provides information which is essential in the evaluation of therapeutic protocols; it may also help in improving the cooperation between the Emergency Department, the attending cardiologists, and the family physicians.

Aged↗
PubMed1995

Elective coronary angioplasty with and without surgical standby: clinical and angiographic criteria for the selection of patients.

BACKGROUND: The cardiac catheterization laboratory (CCL) of our hospital is the only facility for invasive cardiology in a large district. No cardiac surgery is carried out in our hospital at present, the nearest facility being approximately 50 miles away. METHODS: Over a period of 2 years we recommended percutaneous transluminal coronary angioplasty (PTCA) with surgical standby for 164 cases, who were referred to CCLs with on-site surgical standby, and PTCA without surgical standby for 232 cases, 199 of whom underwent PTCA in our CCL. Criteria used in the selection of patients for PTCA without surgical standby were the following: (a) either limited extent or severely impaired function of the ventricular segment in jeopardy; (b) normal or near-normal function of the uninvolved myocardial segments; (c) absence of lesions of the left main or left anterior descending coronary arteries when the target stenosis was in the left coronary artery; (d) non-applicability and high risk-benefit ratio of emergency surgical revascularization in the individual patient. Clinical and angiographic characteristics of patients assigned to PTCA with and without surgical standby are compared. RESULTS: An initial success was achieved in 186 cases (93%) in our CCL. In 12 cases (6%), PTCA was not successful, and in two cases (1%) it was complicated by myocardial infarction. None of the patients died, or had to undergo further coronary interventions within 1 month. Coronary stents were implanted in 24 cases. CONCLUSION: For many PTCA candidates, emergency coronary surgery is not an option in case of occlusive complications. Our data suggest that PTCA can be performed with minor complications in these patients in the absence of surgical standby, provided strict criteria are used in the selection of cases.

Adult↗
PubMed1995

[The use of activated clotting time (ACT) to optimize heparinization during coronary angioplasty. The nursing personnel of the Hemodynamics Laboratory].

BACKGROUND: Suboptimal anticoagulation during coronary angioplasty is reported to be a major risk factor for occlusive complications. AIM: To define an appropriate timing for activated clotting time (ACT) tests in order to optimize anticoagulation with heparin during coronary angioplasty. METHODS: In 50 consecutive procedures of elective angioplasty ACT was measured at baseline, at 30, 60 and 120 min after heparin 10,000 U iv. In a subgroup of 25 patients (SG1) no additional heparin was given until the ACT test at 60 min. In a second subgroup of 25 patients (SG2) heparin 5,000 U was administered 30-45 min after the initial bolus if the ACT at 30 min was < 300 sec. ACT values were analyzed, and the correlation with the biological variables of patients was tested. RESULTS: In 20 patients out of 50 (40%) ACT values at 30 min were < 275 min. Heparin response was correlated with the body surface area but nor with age, neither with baseline ACT. Values at 60 min showed an adequate anticoagulation in only 6 patients (24%) in SG1 vs 21 (84%) in SG2. There were not complications. CONCLUSIONS: ACT testing 30 min after heparin 10,000 U during coronary angioplasty identifies most patients requiring early supplemental heparin. This yields an adequate anticoagulation at 60 min in most patients.

Adult↗
PubMed1994

On-line quantitative coronary analysis in clinical practice: one step closer to reality?

Quantitative coronary analysis is widely used in studies of progression/regression and restenosis of coronary lesions. On-line digital systems are used in diagnostic coronary angiography, and as a guide in coronary interventions. The aim of this investigation was to test the reliability of measures obtained with one commercially available on-line equipment. Well-visualized coronary lesions from patient studies were analyzed for variability in single-frame measurement. Procedural factors affecting the consistency of measurements were identified by repeated visualization of the same coronary lesion with hand- and power-injection of contrast in various positions in the field of the image intensifier, and by imaging of steel phantoms in the same positions. Steel phantoms closely resembling coronary lesions as encountered in practice were visualized in the most favourable radiologic setting compatible with clinical situations. Accuracy and precision of measurements were found to be worse than reported in validation studies. This may be due to a host of variables which may need to be tested in each laboratory performing on-line quantitative coronary angiography, when data so obtained are to be used in clinical decision making or in research studies.

Artifacts↗
PubMed1994

Reproducibility of the spectral turbulence analysis of the signal-averaged electrocardiogram.

Spectral turbulence analysis (STA) of the signal-averaged electrocardiogram (SAECG) is a recently proposed technique to identify patients with ventricular tachycardia as well as patients at risk for arrhythmic events after acute myocardial infarction (MI). The short-term reproducibility of this technique has been previously reported; our study evaluates the reproducibility of STA by shifting the reference points. Twenty patients with acute MI were recruited. SAECG was recorded 13 days after onset of the acute MI. Unfiltered data were transferred and analyzed by personal computer software for spectral turbulence analysis according to the standard condition; reference points of the segment of interest were shifted from QRS offset -10 ms and QRS onset -10 ms to QRS offset +10 ms and QRS onset +10 ms, step 2 ms. Thus, 10 analyses were computed. Reproducibility of the results was calculated using the coefficient of variation (CV) and the relative error (RE). The reproducibility of the classification (RC) was defined as the percentage of the identical classification compared with the standard segment. CV of the intersegment correlation standard deviation was statistically higher than the other parameters regardless of the lead considered. RE was not different in each parameter and in each lead. RC was > 90% in all parameters, except in spectral entropy which showed an RC > 80%. Reproducibility of the STA introducing a temporal shift in the analyzed segments was high in all considered parameters.

Analysis of Variance↗
PubMed1994

[Elective coronary angioplasty in total absence of heart surgery].

BACKGROUND: One-hundred consecutive procedures of elective coronary angioplasty were attempted in 95 patients, in the absence of any surgical stand-by. All patients had angina and/or signs of inducible ischemia. METHODS: All patients and attending physicians were informed that no surgical coverage was available, and gave their consent. The choice was made on the basis of the estimate, on clinical and angiographic grounds, of the consequences of vessel occlusion, of the possible help offered by percutaneous bail-out techniques, and of the applicability of surgical stand-by. RESULTS: A primary success was achieved in 92 cases: in 5 cases a Palmaz-Schatz stent was implanted. In 6 cases the procedure was unsuccessful, with no complications. Two patients sustained a myocardial infarction without new Q-waves. No patient died, nor underwent cardiac surgery within 1 month of discharge. CONCLUSIONS: Our initial experience suggests that, in the absence of surgical stand-by, elective coronary angioplasty can be performed in selected patients at an acceptable risk.

Adult↗
PubMed1994

[Invasive cardiological diagnosis in an ambulatory regimen of transported inpatients].

We report our initial experience with 302 consecutive cases of percutaneous cardiac catheterization in in-patients from other hospitals. The patients reached our laboratory immediately before the procedure in an ambulance with an attending physician and were transported back to their hospital soon after completion of the procedure. This accounts for 35% of 864 diagnostic cardiac catheterization procedures in our laboratory in the first 12 months of activity. There were no complications related to this regimen, and a substantial reduction in unnecessary overnight admission to the cardiology ward was achieved. This report confirms the safety and the advantages of this practice. Implications for the organization of the catheterization laboratory are discussed.

Adult↗
PubMed1993

[Diagnostic hemodynamics in day-hospital care].

Our initial experience with 180 consecutive cases of transfemoral cardiac catheterization in ambulatory patients is presented. It accounts for 21% of 864 diagnostic cardiac catheterization procedures in our laboratory in the first 12 months of activity. There were no complications. Patient satisfaction was high, and a substantial reduction of unnecessary overnight admissions in the cardiology ward could be achieved. This confirms the safety and the advantages of this practice. Implications for the organization of the Catheterization Laboratory are also discussed, as well as possible causes for the sofar limited use of ambulatory cardiac catheterization in our country.

Adolescent↗
PubMed1989

[Effects of simvastatin on plasma levels of lipids, lipoproteins and apolipoproteins in primary hypercholesterolemia].

To evaluate the effectiveness, tolerance and safety of simvastatin (MK 733), a new HMG-CoA reductase inhibitor, a 28-week, single blind study with placebo was carried out on 10 patients suffering from primary hypercholesterolaemia. All patients followed the AHA Phase 1 or Phase 2 diet and underwent active treatment for 24 weeks with increasing doses of simvastatin from 10 to 40 mg in a single evening administration. A reduction in plasma levels of total cholesterol (-29%, p less than 0.001 and -41%, p less than 0.001), LDL cholesterol (-35%, p less than 0.001 and -49%, p less than 0.001), VLDL cholesterol (-9%, ns and -38%, ns), Apo-B (-27%, p less than 0.005 and -37%, p less than 0.001), Apo-A2 (-3%, ns and -3%, ns), and triglycerides (+2%, ns and -10%, ns), was obtained in the VIth and XXIVth week. There was also an increase in HDL cholesterol (+4%, ns and +17%, p less than 0.05), HDL2 subfractions (+9%, p less than 0.05 and +36%, p less than 0.05), HDL3 (+3%, ns and +11%, ns) and Apo-A1 (+7%, ns and +4%, ns). In all patients, simvastatin was generally tolerated and there were no clinical, laboratory or ophthalmological side-effects related to the drug. If long-term studies confirm its safety, simvastatin will offer excellent prospects for the prevention of ischaemic cardiopathy.

Anticholesteremic Agents↗
PubMed1989

[Torsade de pointes following intravenous infusion of amiodarone].

A case of intravenous amiodarone induced QT-interval prolongation and ventricular arrhythmia of the torsade de pointes type is described: the arrhythmia developed in the presence of hypokalemia. The efficacy of lidocaine in suppressing this type of arrhythmia is reported. The electrophysiologic effects of intravenous and oral amiodarone administration are compared.

Aged↗
PubMed1988

Long-term treatment of essential arterial hypertension with nitrendipine.

The efficacy and safety of long-term treatment with oral nitrendipine were evaluated in 34 patients with essential arterial hypertension. Nitrendipine alone significantly lowered systolic and diastolic blood pressure levels in 28 patients who completed the preliminary four-week dose-setting phase. Twenty-one patients completed the one-year treatment. Blood pressure control was maintained by nitrendipine alone in 11 patients. Ten patients not adequately controlled at the end of the dose-setting phase were successfully treated with nitrendipine combined with acebutolol or muzolimine. It is concluded that nitrendipine is a promising calcium antagonist for the treatment of arterial hypertension.

Acebutolol↗
PubMed1985

[Control of the efficacy of anti-arrhythmia drug therapy with the ambulatory electrocardiogram. Proposal for a new analytical statistical model].

Ambulatory electrocardiography is used for evaluating antiarrhythmic drug effectiveness. Statistical methods based on the analysis of the number of ventricular ectopic beats are currently employed. These techniques are not useful to compare groups of patients with different therapies, due to the wide spontaneous variability of the ectopic beats. We propose a new statistical method, based on the likelihood function. The new method has been tested both retrospectively on 102 patients treated with different antiarrhythmic drugs and prospectively on 12 patients subjected to three consecutive control ambulatory electrocardiograms and to a fourth one after treatment with propafenone. This new statistical method was found to be useful for comparing therapeutic effectiveness between groups of patients, whereas the traditional quantitative methods are to be preferred when drug effectiveness is evaluated in the single patient.

Adrenergic beta-Antagonists↗
PubMed1984

[Which general practitioner requests cardiologic consultation?].

Since health care costs continue to rise, the Regions and the Local Health Boards needs to draw up their plans, and permanent training initiatives must be undertaken for physicians, it was decided to see if and which personal and professional characteristics influence primary physicians in their requests for cardiological consultation. It is, in fact, well known that the attitudes of doctors not only affect the health of the population, but also the cost of such health to the community. Assessment of calls for heart examinations on the part of general practitioners attached to a local health board showed that neither age nor sex, nor the fact of working solely for the health service, nor the number of patients on a doctor's panel made any appreciable difference with respect to cardiological consultations. It was noted, however, that doctors whose only activity consisted of general practice under the health service called for fewer consultations than their colleagues with other activities, and that older physicians measured blood pressure less frequently and tended to give shorter descriptions of their findings to the cardiologist. The survey tended to show that the decision to send a patient to a cardiologist was probably more influenced by the characteristics of his complaint and his condition, and the medical attendant's clinical and psychological convictions than on such factors as age, sex, number of persons looked after, and working solely for the general health service.

Age Factors↗
PubMed1982

[Verapamil in effort angina: a multi-centre study].

We have performed a multi-centre study with 47 outpatients in order to evaluate the efficacy of Verapamil (V) in the treatment of stable effort angina, and to compare the effect of two different doses of the drug (240 and 360 mg/die). The protocol consisted of a first period of Placebo, followed by the double-blind randomized cross-over administration of Placebo (P) and Verapamil (V) in doses of 240 and 360 mg/die. The symptomatology, the consumption of TNG, the ECG pattern at rest and during exercise, the maximum exercise tolerance during exercise and the rate of recovery were evaluated at the end of each 1 month period. V. provided a significant reduction of the number of angina attacks and of the consumption of TNG pills with improvement of symptomatology. The maximum exercise performance improved without changes in maximum rate pressure double product. A decrease of double product was observed at rest and during the recovery period. The higher dose of V. (360 mg/die) provides a better improvement in the number of angina attacks, in the symptomatology, in the double product at rest, and in the rate of recovery than the lower dose (240 mg/die). Thus these data indicate that V. provides anti-anginal efficacy by reducing myocardial oxygen demand, and increases exercise tolerance in effort angina patients.

Adult↗
PubMed1981

[Effects of the administration of acebutolol in patients with chronic angina of effort].

12 patients suffering from chronic coronary insufficiency with signs of ischemia in the ECG, were treated orally with 200 mg of acebutolol t.i.d. for a period of 3 weeks. The following parameters were examined at the beginning of the therapy as well as at the end of every week: number of stenocardiac attacks, characteristics of pain, nitroglycerin consumption, B.P., H.R., respiratory rate, ECG, maximal exercise test, PEP, LVET, PEP/LVET at rest and immediately after effort. The treatment with acebutolol was effective inducing an improvement of subjective symptoms (reduction of stenocardiac crises, intensity and duration of angor, trinitrin pearls consumption) and an increase of effort tolerance. The utility of the therapy was also proved by the reduction of the systolic pressure and by the following decrease of hemodynamic overload and, therefore, of the heart muscle's work. This positive effect is due to the reduction of the myocardial oxygen consumption, modulated among others by the bradycardiac action of the drug. The cardioselectivity of acebutolol avoided to cause peripherical disorders usually observed with other non selective beta blocking drugs.

Acebutolol↗