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Biomedical subjects

F Arrigo

Publications and source records attributed to F Arrigo.

At least 19 recordsLinked to original sources
PubMed1996

[A comparison between propafenone and hydroquinidine perorally in the treatment of recent-onset atrial fibrillation].

The aim of this study was to assess the effectiveness of propafenone and quinidine to restore sinus rhythm in patients with paroxysmal atrial fibrillation. Eighty consecutive patients with recent onset atrial fibrillation were randomized to one of the following oral treatments: a) propafenone 450 mg as single dose followed by 300 mg t.i.d.; b) hydroquinidine 900 mg/24 hours + digoxin if necessary. Drugs were given for a maximum of three days and withdrawn at the restoration of sinus rhythm. If atrial fibrillation was persistent, the other drug was administered after two days wash out. The two groups did not differ from each other with respect to left atrial size, age and presence of organic heart disease, and kind of cardiopathies between the two groups. Sinus rhythm was restored in 39 patients of group 1 (93%) and 36 of group 2 (95%). In conclusion, oral propafenone is as effective as quinidine in the treatment of paroxysmal atrial fibrillation.

Administration, Oral↗
PubMed1994

[Non-invasive assessment of coronary reperfusion].

The patency of the infarct-related coronary artery seems to be an important prognostic factor after an acute myocardial infarction. Coronary angiography has been used until now to assess coronary patency. However, as it is an invasive procedure and its optimal timing after fibrinolytic treatment has not been established, a noninvasive marker is most desirable. There are a number of methods currently used to document coronary reperfusion non-invasively. This review discusses the advantages and disadvantages of the classic non-invasive methods, like resolution of chest pain, reperfusion arrhythmias, normalization of ST segment elevation, and enzymatic determinations. The imaging methods, especially echocardiography but also magnetic resonance imaging, offer interesting possibilities for the future.

Arrhythmias, Cardiac↗
PubMed1994

[Does aortic insufficiency influence Doppler-derived calculation of the valvular area in patients with mitral stenosis?].

BACKGROUND: The evaluation of mitral valve area (MVA) in patients with mitral stenosis represents the main purpose of any diagnostic method, provided that MVA is a key parameter to indicate the need for valve surgery. The aim of this study was to assess whether the presence of aortic regurgitation associated with mitral stenosis affects the MVA measurement by left atrial pressure half time (PHT). METHODS: Eighty-nine patients with mitral valve stenosis (68 females and 21 males, mean age 53.6 +/- 12.1 years), were studied. Fourty-eight patients (36 females and 12 males) had a concomitant aortic regurgitation (AR group), whereas 41 patients (32 females and 9 males) did not reflect any aortic valve involvement (no-AR group). Aortic regurgitation was graded on the basis of color flow analysis. The majority of patients had a slight to moderate regurgitation. MVA determination was carried out using both Hatle formula (220/PHT) and planimetric measurement in parasternal short axis view. RESULTS: Statistical analysis demonstrated a good correlation between the 2 MVA measurement in both groups (IA group: r = 0.9, p < 0.0001, SSE = 0.21 cm2, y = 0.91x + 0.05; no-IA group r = 0.92, p < 0.0001, SSE = 0.22 cm2, y = 0.92x + 0.04). The concomitant aortic valve disease did not affect in any way the MVA measurement by means of the PHT method. CONCLUSIONS: The Doppler derived method appears to be reliable for estimating the mitral valve area in patients with mitral stenosis even in the presence of aortic regurgitation.

Adult↗
PubMed1994

A multicenter trial on interobserver and intraobserver reproducibility of segmental scoring of thallium-201 planar myocardial imaging before and after reinjection. Italian Group of Nuclear Cardiology.

UNLABELLED: Inter- and intraobserver reproducibility (R) of segmental 201Tl scores after stress (ST), redistribution (RD) and reinjection (RI) planar imaging were evaluated. METHODS: Images were examined from 396 patients with suspected coronary artery disease, demonstrated by means of post-ST imaging of at least one perfusion defect. To eliminate external sources of variability, the same gamma camera, acquisition protocol and computer software were used in this multicenter study. Thallium-201 images of the anterior, left anterior oblique and left lateral projections were obtained immediately, 4 hr after exercise and 30 min after the injection of additional 201Tl either on the same day or on a different day. The left ventricle was divided into 15 segments and evaluated by three independent observers, blinded to clinical data, according to a five-point scale. RESULTS: The R score for ST, RD and RI images, expressed as an intraclass correlation coefficient, was 0.76, 0.74 and 0.72, respectively. After averaging multiple observer scores, R increased to 0.91, 0.90 and 0.89, respectively. Individual observer measurement of the R score was 0.48, 0.51 and 0.32 for ST-RD, ST-RI and RD-RI image pairs, respectively, and multiple observer scores showed R increases to 0.74, 0.76 and 0.58. CONCLUSION: This qualitative scale reliably assesses the severity of 201Tl perfusion defects, particularly when multiple-observer scores are averaged. Individual observer change scores should be taken with great caution, especially in studies involving the visual evaluation of RD-RI image changes.

Coronary Disease↗
PubMed1993

[Role of transesophageal echography in the study of embolism of cardiac origin].

In the total population, cerebrovascular ischemic diseases account for 0.2-0.3% cases per year, and in the 20-40% of them it is possible to recognize a cardioembolic mechanism. The cardiological examination in patients with stroke is, therefore, aimed at detecting cardiac sources of emboli (left atrial, valvular, and ventricular thrombosis, atherosclerotic plaques of ascending aorta), and at identifying the cardiovascular disease directly or indirectly associated with ischemic stroke. Transesophageal echocardiography (TEE) is particularly suitable for this purpose, due to the proximity of the transducer to the posterior cardiac structures and to its better resolution. Many recent reports have demonstrated that TEE not only improves the recognition of known cardioembolic diseases (intracardiac thrombi, mitral stenosis, valvular prosthesis thrombosis, endocardial infectious diseases), but is also the most reliable non invasive technique suitable to detect atherosclerotic lesions of the ascending aorta. Furthermore, TEE allowed to recognize new anatomic and functional abnormalities, such as left atrial spontaneous echo contrast, atrial septal aneurysm, patent foramen ovale, frequently associated with stroke. Noteworthy, TEE is the only technique suitable for functional and anatomic evaluation of the left atrial appendage. The Authors studied by TEE the functional properties of left atrial appendage in patients with severe mitral stenosis with or without atrial fibrillation, as compared to patients with left atrial thrombosis. Results showed that fractional shortening of left appendage was greatly reduced, at the same extent in the 3 groups, demonstrating that abnormalities in left atrial appendage emptying could be a risk factor for atrial thrombosis. In order to compare TEE with the transthoracic 2D-echo for the detection of cardioembolic sources, the Authors studied 63 patients with ischemic stroke. TEE revealed a possible cardioembolic source in 70% of younger patients and in 50% of patients older than 45 years. These abnormalities were detected by TEE respectively in 10% and in 1.8% of cases. These data are in agreement with many other reports in literature, and suggest the usefulness of TEE in the evaluation of patients with ischemic stroke and no evidence of severe atherosclerotic cerebrovascular disease, in contrast to the poor role of TEE. Another important field is the prevention of stroke in patients at high risk of cardioembolic events. The role of TEE before and immediately after cardioversion in patients with atrial fibrillation has been recently studied by several papers. Cardioversion was proved at low risk of stroke when TEE did not show left atrial or left appendage thrombosis. Therefore, the transesophageal approach identifies patients needing prolonged anticoagulation (roughly 20%), avoiding an undue, potentially dangerous therapy.

Adult↗
PubMed1993

[Connections between ischemic heart disease and anti-cardiolipin antibody positivity].

IgG and IgM anti-cardiolipin antibodies (aCL) were measured in 60 patients with ischaemic heart disease by an immunoenzymatic assay. aCL levels higher than normal were detected in 12 of 40 patients (30%) with acute myocardial infarction (AMI) and in 7 of 20 patients (35%) with angina pectoris (AP). These values were significantly higher (p < 0.05) than those detected in the control group (3/40; 7.5%). As regards the clinical picture, the complications and the outcome of the disease, no difference was observed between aCL-positive and negative patients with AMI. 9 of 12 aCL-positive patients with AMI showed increased levels of aCL in a blood sample obtained in day 1 after admission. Therefore, we must admit such positivity as preexistent to the myocardial infarction. These data together with the high prevalence of aCL in patients with AP suggest that an association should exist between raised levels of aCL and increased risk for AMI in patients with coronary artery disease.

Aged↗
PubMed1992

Arrhythmias during dipyridamole test. Report of 3 cases.

The authors report three cases in which the dipyridamole test provoked: (1) junctional rhythm with AV dissociation; (2) sinus arrest; (3) 2:1 AV block. The three cases described above draw attention to the possible effect of dipyridamole on the AV conduction, which is not yet completely known. This unwanted effect suggests that careful ECG monitoring should be performed during the dipyridamole test.

Arrhythmias, Cardiac↗
PubMed1992

Electrocardiographic changes associated with haematocrit variations.

The electrical resistivity of intracardiac blood is less than the resistivity of the surrounding tissues. This affects the transmission of cardiac forces to the body surface: the radial forces are enhanced, whereas the transmission of tangential forces is diminished (the Brody effect). Blood resistivity is directly related to haematocrit, hence, haematocrit changes are expected to affect the transmission of cardiac forces, resulting in changes in QRS complex voltage. To assess this hypothesis, a 12-lead electrocardiogram was recorded in 40 patients affected by thalassaemia before and after a transfusion of concentrated red cells. The voltage of each QRS component was carefully measured in every lead, and the sum of all R wave amplitudes (sigma R) was calculated. The post-transfusional electrocardiogram reflected a significant decrease in the R wave amplitude in every lead. sigma R also decreased, whereas S wave amplitude in lead V6 increased. A negative correlation between the ratio of haematocrit pre/post transfusion and that of the corresponding sigma R values was also observed (r = -0.434; P less than 0.01). An increase in haematocrit is therefore associated with a decrease in R wave amplitude. These findings explain why several patients with high haematocrit manifest relatively low voltage QRS complexes.

Adolescent↗
PubMed1992

[The frequency of early coronary reperfusion assessed by electrocardiographic criteria in relation to the timing of thrombolytic therapy in acute myocardial infarct].

This study was aimed at assessing coronary reperfusion in patients with acute myocardial infarction (AMI) undergoing systemic thrombolysis with SK and rtPA. The occurrence of reperfusion was related to the time of treatment. The evaluation of reperfusion was performed by monitoring ST segment changes. 56 patients with AMI were studied. 22 out of these (39.2%) showed a significant decrease (greater than 50%) in ST segment sum (sigma ST) at 100 minutes from the beginning of the treatment. Analysis of the relationship between reperfusion and elapsed time between the onset of symptoms and the treatment, reveals that the reperfusion is less frequent (p less than 0.05) in patients treated at 180 minutes or later. The standard electrocardiogram appears as the most useful method to evaluate indirectly coronary reperfusion in acute myocardial infarction. A further refinement of this method is desirable to recommend its widespread clinical use. The assessment of reperfusion by means of ECG in large series of patients will permit the evaluation of the benefits of reperfusion, in terms of survival, complications and incidence of ventricular dysfunction.

Adult↗
PubMed1991

[Pseudonecrosis waves: simulation of myocardial necrosis by retrograde P wave].

The Authors describe a case of a patient showing, during an episode of chest pain, an ecg-pattern of wide and tall "Q" wave simulating inferior myocardial infarction. In fact, a further ecg recorded during sinus rhythm denotes that the "Q" wave was a retrograde P wave generated by a nodal rhythm. The other known causes of "pseudonecrosis" are discussed.

Aged↗
PubMed1991

[Evaluation of the kinetics of MB creatine kinase in patients undergoing systemic thrombolytic therapy].

This study was aimed to evaluate if the time-course of creatinkinase MB in acute myocardial infarction (AMI) is influenced by therapy and which index, derived from the enzymatic curve, is the most reliable marker of successful coronary artery recanalization. We studied the enzymatic curves in 38 patients with transmural myocardial infarction, 19 treated with streptokinase (SK) and 19 with tissue plasminogen activator (rtPA). Blood samples were obtained every 2 hours for the first 12 hours and every 6 hours until the level of serum CK returned to baseline. Three indexes were calculated: peak serum enzyme level, time to peak enzyme level and maximal enzyme rise velocity. Time to peak did not differ significantly between SK and rtPA groups. Peak levels were significantly higher (414 +/- 40 vs 249 +/- 33; p = 0.004) in rtPA groups, as well as maximal enzyme rise velocity (1.7 +/- 0.4 vs 0.8 +/- 0.1; p = 0.02). However, infarct size evaluated by the total release of CK-MB in 28 patients was greater in rtPA group (10949 +/- 1097 vs 6346 +/- 869; p = 0.002). These findings suggest that differences in peak level and in maximal velocity of rise observed between SK and rtPA are due to differences in infarct size and not to a different recanalization rate. Thus, enzymatic estimate of infarct size significantly correlates to peak enzyme (r = 0.894, p less than 0.001), and to maximal rise velocity (r = 0.518, p = 0.007) but not to time to peak (r = 0.208, NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Creatine Kinase↗
PubMed1990

Long-term therapy with slow-release nifedipine in essential hypertension.

The purpose of this study, designed as an open multicenter trial, was to test the antihypertensive efficacy, patient acceptability, and side effects of long-term treatment with slow-release nifedipine in a large population. The drug was studied in 330 outpatients with essential hypertension, WHO stage 1-2, recruited in 20 hospital centers. After washout period was completed, nifedipine (20 mg bid) was given for 1 month (phase 1). Then, the treatment was extended for 4 months (phase 2) with variable doses (range 20-80 mg daily). No other antihypertensive drugs were administered during phase 1. However diuretics, beta blockers, or captopril were added to nifedipine during phase 2 in 11 patients. Seventy patients did not meet criteria for inclusion at washout. During phase 1 and 2, 66 additional patients were excluded due to side effects, the need of other antihypertensive drugs, or non-compliance. Systolic blood pressure significantly lowered (10% or more) in 84% patients in phase 1 and in 76% in phase 2. No responders were 6.1% and 3.6%, respectively. Diastolic blood pressure was normalized in 60% of patients after 5 months of therapy. Effects on blood pressure were equal in young patients and in the elderly, but a minimal rise in heart rate was recorded in younger patients. At least one side effect occurred in 46.6% patients, mainly headache (15.4%), hot flashes (13.3%), ankle edema (12.8%), or palpitation (6.6%). Sixteen patients (8.2%) were obliged to stop nifedipine treatment due to the severity of the side effects. This trial confirms the efficacy of nifedipine in hypertension, both in young and in aged patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[An analysis of the circadian frequency in the onset of acute myocardial infarct].

The purpose of this study was to evaluate if the occurrence of acute myocardial infarction (AMI) follows a regular pattern during the day and, if so, to assess any difference according to sex and patients' age. To determine 24-hour trend of AMI onset, clinical recordings of patients admitted to the CCU for AMI over a period of 8 years were reviewed: 427 patients (310 men and 117 women, aged 24-95 years), with a first AMI and in whom the time of onset of cardiac pain due to MI could be accurately established by history, were selected. Analysis of hourly distribution of the event was performed using a mathematical model based on Whittaker's method for periodic phenomena. It showed the occurrence is cyclic with 2 waves with periods of 6 and 12 hours in all age groups in men an women. No statistical differences were found between observed figures of periods and values calculated by Fourier analysis. The overall occurrence of MI showed a regular pattern with 4 peaks at 4.00 am, 10.00 am, 4.00 am and 10.00 pm. This periodic behaviour is nearly the same both in men and in women. The occurrence of MI is maximal in the morning (34.2% in men, and 35.9% in women); the minimum was recorded during the evening in male patients over 70 years and during the night in the other age groups; it was recorded during the afternoon and the night in women.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1989

Trifascicular block with asynchronous intraventricular recovery and "supernormal" AV conduction.

The authors present a case of trifascicular block: complete right bundle branch block, tachycardia-dependent left anterior hemiblock, and bradycardia-dependent left posterior hemiblock. There is, in addition, a complicating independent AV junctional rhythm that is in most instances not affected by the conducted sinus impulses. Occasionally, however, this focus is discharged by very early sinus impulses that are unexpectedly conducted to the ventricles (a manifestation of "supernormal" conduction). A complex electrocardiographic pattern results from the interplay of the aforementioned mechanisms.

Atrioventricular Node↗
PubMed1989

[Correlation between the sites of mitral annular calcification and conduction disturbances: echocardiographic evaluation].

A clinical, electrocardiographic and echocardiographic (M-Mode, 2D) study was performed to explain the causal relationship between mitral annular calcification and cardiac conduction disturbances. Forty-seven patients, 28 women and 19 men (mean age 69) with mitral annular calcification were studied. In 18 patients A-V and/or intraventricular conduction disturbances were present. In this study we have found: a greater incidence of posterior than anterior mitral annular calcification; the anterior mitral annular calcification is often associated with aortic valve calcification and ultimately the common association between anterior mitral annular calcification and conduction disturbances.

Aged↗
PubMed1989

[Treatment of recent atrial fibrillation with intravenous propafenone].

Intravenous propafenone (1 mg/Kg in 3 min) has been administered to 14 patients with recent atrial fibrillation. The sinus rhythm was restored in 7 patients within 30 min after the injection. The left atrial size, evaluated by M-mode echocardiography, was no different in the group of responders, with respect to the non-responders. No adverse effect has been observed. One single patient manifested a long asystolic pause (3860 ms), at the restoration of sinus rhythm. Propafenone appears to be useful in the treatment of recent atrial fibrillation.

Atrial Fibrillation↗
PubMed1988

"Irregular" ventricular parasystole: the influence of sinus rhythm on a parasystolic focus.

Fifteen cases of ventricular parasystole were analyzed to determine whether the interectopic intervals were regular, as expressed by long intervals being exact multiples of the short ones, or not. The regularity of the interectopic intervals was assessed by means of the variation index: the ratio of the maximal difference between various measurements of the parasystolic cycle length and the mean parasystolic cycle length. Three out of 15 cases had a variation index less than 5, and were classified as "regular parasystole." Twelve cases were associated with a variation index greater than 7.5, and were classified as "irregular parasystole." The cases of irregular parasystole were then analyzed to determine whether the variability of the interectopic intervals was casual or dependent on action of the sinus beats. A parasystolic resetting by critically timed sinus impulses (a form of intermittent parasystole) was evident in three cases. The irregularity in the remaining nine cases was due to modulation (viz., due to electrotonic influence exerted by the sinus beats on the parasystolic focus). In every case of modulated parasystole a phase-response curve was constructed, which enabled an analysis of all the interectopic intervals on the basis of a time-dependent effect exerted by the sinus impulses on an otherwise rhythmic parasystolic focus.

Adolescent↗