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Biomedical subjects

F Chiarella

Publications and source records attributed to F Chiarella.

At least 37 records · Page 2Linked to original sources
PubMed1992

[Prognostic value of the dipyridamole-echocardiography test immediately after a non-complicated myocardial infarct: a large scale multicenter study. Echo Persantine Italian Cooperative Study].

BACKGROUND: Any new diagnostic test should follow a pathway similar to that of a new drug, from initial studies in highly selected populations under strictly controlled conditions, up to large scale multicenter trials more likely to represent the true performance of the test in the clinical arena. AIM OF THE STUDY: To evaluate the capability of prognostic stratification of high dose (up to 0.84 mg/kg over 10') dipyridamole-echocardiography test (DET) early after an acute myocardial infarction in a "phase IV" study, based upon 11 different echocardiographic laboratories, all with established experience in stress echo and fulfilling quality control requirements for stress echo readings. STUDY POPULATION: Nine-hundred twenty five patients were evaluated after a mean of 10 days from an acute myocardial infarction and followed up for a mean of 14 months. RESULTS: During DET, one major adverse reaction occurred, consisting of a prolonged ischemia resistant to aminophylline and nitrates, and progressing to small uncomplicated reinfarction. In 11 patients the lower dipyridamole dose (0.56 mg/kg over 4') gave limiting side effects. Patients were followed up for 14 +/- 9.9 months (range = 1.53). During the follow-up, there were 34 deaths and 37 non-fatal myocardial infarctions; 104 patients developed class III or IV angina, and 149 had coronary revascularization procedures (bypass or angioplasty). Considering all spontaneous events (angina, reinfarction and death), the most important univariate predictor was the result of DET (chi-square = 45.8). With a Cox analysis, echocardiographic positivity, age and sex were found to have an independent and additive value. Considering survival (and therefore death as the only event) age was the most meaningful parameter, followed by the Wall Motion Score Index during dipyridamole (chi-square = 12.1); among other parameters, the resting Wall Motion Score Index was a significant predictor of death. By Cox analysis, age (relative risk estimate = 1.02) and Wall Motion Score Index during dipyridamole (relative risk estimate = 14) showed an independent and additional prognostic value. In particular, considering death only, the event rate was of 2% in patients with negative DET, 4% in patients with high dose positive DET and 7% in patients with low dose positive DET. CONCLUSIONS: Dipyridamole echocardiography is feasible and safe early after uncomplicated myocardial infarction and allows an effective risk stratification on the basis of the presence, severity, extent and timing of the induced dyssynergy. In particular, the risk of death doubles in patients with high dose positivity and almost quadruples in patients with low dose positivity.

Adult↗
PubMed1991

Left ventricular thrombus in anterior acute myocardial infarction after thrombolysis. A GISSI-2 connected study.

BACKGROUND: Streptokinase reduces the incidence of left ventricular thrombosis after acute myocardial infarction. However, it is unknown whether a similar effect can be obtained with different thrombolytic agents and whether subcutaneous calcium heparin can have an additional efficacy. METHODS AND RESULTS: To compare the effects of two different thrombolytic agents combined or not with heparin on the incidence and features of left ventricular thrombi and their related embolic events, we performed a GISSI-2 ancillary echocardiographic study (the first echocardiogram obtained within 48 hours of symptoms onset and the second before hospital discharge) that enrolled 180 consecutive patients (mean age, 63 +/- 11 years, 142 men) with a first anterior acute myocardial infarction. Patients were randomized into four groups of treatment: recombinant tissue-type plasminogen activator (rt-PA) (n = 47), rt-PA plus heparin (n = 45), streptokinase (n = 39), and streptokinase plus heparin (n = 49). Left ventricular thrombosis was observed in 51 of 180 patients (28%). No significant differences were found concerning the incidence of thrombi in the four treatment groups. Mural shape of left ventricular thrombi was found more frequently than the protruding shape (71% versus 29% at the first examination, 64% versus 36% at the second), particularly in heparin-treated patients (93% versus 7% at first examination, 70% versus 30% at the second). Only one embolic event (0.5%) occurred during the hospitalization. CONCLUSIONS: We conclude that 1) the rate of left ventricular thrombi does not differ in patients with acute myocardial infarction treated either with streptokinase or rt-PA, 2) subcutaneous heparin, when begun 12 hours after intravenous thrombolysis, does not appear to further reduce the occurrence of thrombi but seems to influence the shape of left ventricular thrombi, and 3) during the predischarge period, embolic events are rare in patients treated by thrombolysis.

Adult↗
PubMed1990

Early appearance of left ventricular thrombi after anterior myocardial infarction: a marker of higher in-hospital mortality in patients not treated with antithrombotic drugs.

Left ventricular thrombus may develop both early and late after acute anterior myocardial infarction. To assess the possible prognostic implication of the time of thrombus appearance, 125 patients (87 males; age ranging from 35 to 92 years, mean: 65 +/- 10 years) consecutively admitted to our coronary care unit within 24 h of a first acute anterior myocardial infarction, untreated with antithrombotic drugs, underwent serial two-dimensional echocardiographic studies during hospitalization, then monthly for a follow-up of 1-48 (mean: 23 +/- 16) months among survivors. Left ventricular thrombi, detected in 71 patients (57%), appeared from 1 to 362 (mean: 13 +/- 44) days after acute infarction. In 40 patients (56%), early thrombus development, within 48 h of symptom onset, was noted. During the study period, 52 patients (42%) died. Global mortality rate was similar in patients with thrombi compared with those without thrombi (32/71: 45%, vs 20/54: 37%; P = ns). However, in-hospital mortality of patients who developed left ventricular thrombi within 48 h (17/40: 42.5%) was significantly higher compared with both patients with later thrombus appearance (4/31: 13%; P less than 0.008) and those without thrombi (10/54: 20%; P less than 0.01). Embolic events were more frequent in patients with thrombi (9/71, 13% vs 1/54, 2%; P less than 0.02), but there was no relationship with the time of thrombus appearance. The values of peak CPK levels and the degree of left ventricular wall motion abnormalities observed in patients with early left ventricular thrombus were significantly higher than the values detected in patients without thrombi, but similar to those obtained in patients with later thrombus occurrence.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Left ventricular thrombi: changes in size and in platelet deposition during treatment with indobufen and ticlopidine.

This study was designed to evaluate whether indobufen and ticlopidine can induce changes in the size of left ventricular thrombi and variations in the deposition of platelets on thrombus surface. Forty-seven patients with left ventricular thrombosis, who were not treated with antithrombotic drugs, were prospectively evaluated with 111In-oxine platelet imaging and two-dimensional echocardiography. The first scintigraphic examination was negative in 15 of the 47 patients with left ventricular thrombosis, thus they were excluded from further evaluation. The remaining 32 patients with evidence of labeled platelet deposition on the thrombus were divided into three groups. Group 1 comprises 11 patients treated with different doses of ticlopidine: 6 with 250 mg/day, and 5 with 500 mg/day. Group 2 comprises 12 patients who received 400 mg/day of indobufen. Group 3 comprises 9 patients who were not treated with antithrombotic drugs. All 32 patients underwent repeated 111In-oxine platelet imaging and echocardiography 40 +/- 11 days after the first examination. During treatment with ticlopidine, deposition of labeled platelets on the thrombus became absent in 2 patients (500 mg/day), and reduced in 5 (2 treated with 250 and 3 with 500 mg/day). A decrease of platelet deposition on the thrombus was also observed in 5 of the 12 patients receiving indobufen and in only 1 of 9 controls. With regard to thrombus dimensions, 1 patient treated with ticlopidine showed a decrease in thrombus size associated with a reduction of the scintigraphic activity. In conclusion, a decrease of the platelet uptake on the thrombus surface, without significant changes in the size, was detected in most patients during treatment with indobufen and ticlopidine.(ABSTRACT TRUNCATED AT 250 WORDS)

Echocardiography↗
PubMed1989

Influence of thrombolytic treatment followed by full dose anticoagulation on the frequency of left ventricular thrombi in acute myocardial infarction.

This study evaluated the influence of thrombolysis followed by full anticoagulation on the frequency of left ventricular (LV) thrombi after acute myocardial infarction (AMI). Nineteen consecutive patients with a first anterior wall AMI who received 1,500,000 IU of streptokinase within 3 hours of symptom onset, followed by full anticoagulation, underwent echocardiographic studies within 24 hours of symptoms, and then on days 2, 3, 5, 7, 12, 30 and 90. Forty-four patients, with comparable clinical features and echocardiographic protocol but without antithrombotic therapy, served as the control group. LV thrombi developed in 4 of 19 (21%) treated patients and in 23 of 44 (52%) control subjects (p = 0.02). LV aneurysm or major wall motion abnormalities were noted in 8 of 19 (42%) treated patients and in 30 of 44 (68%) control subjects (p less than 0.05). No significant difference was found between treated and untreated patients when comparing the incidence of thrombi in the subgroups of patients with aneurysm or major wall motion abnormalities (3 of 8 vs 21 of 30) and in the subgroups with less extensive LV dysfunction. Thrombi disappeared during hospitalization in 3 of 4 treated patients, but in none of the controls. Fewer patients treated with intravenous streptokinase followed by full anticoagulation developed LV thrombi compared to patients treated with conventional therapy. This difference may be related to a reduced occurrence of major LV wall motion abnormalities. Resolution of thrombi frequently occurs in the hospital phase of AMI; therefore, only frequent echocardiographic examinations can assess the true frequency of LV thrombi.

Echocardiography↗
PubMed1989

Clinical course and prognosis of hypertrophic cardiomyopathy in an outpatient population.

Hypertrophic cardiomyopathy has been investigated mainly at referral institutions. Thus, the clinical history of the disease that emerges from published studies could be influenced by a bias in patient selection. In the present study, we compared the clinical features of an outpatient population of 25 patients who had hypertrophic cardiomyopathy with those reported in 78 studies published during the past five years. In the 25 study patients, age, sex, and the extent of left ventricular hypertrophy, as well as the prevalence of diastolic filling abnormalities, subaortic obstruction, and ventricular arrhythmias, were similar to those in patients described in the literature. Cardiac symptoms, however, were much less severe in the study patients. Eighteen patients (72 percent) were asymptomatic, six (24 percent) had mild symptoms, and only one (4 percent) had moderate-to-severe symptoms. Of 24 patients followed for a mean period of 4.4 years (range, 2.9 to 5.7), none died or had clinical deterioration. Of 3404 patients described in the 78 studies we reviewed, 2483 (73 percent) came from only two referral institutions. Of the 1721 patients in whom severity of symptoms was reported, 757 (44 percent) had moderate-to-severe symptoms. However, 727 (96 percent) of these patients were studied at one of the same two referral institutions. We conclude that the natural history of hypertrophic cardiomyopathy may be more benign than can be inferred from published reports.

Adult↗
PubMed1989

Familial supravalvular aortic stenosis: a genetic study.

Supravalvular aortic stenosis (McKusick 18550) is a rare hereditary condition with autosomal dominant transmission. However, the available data have been limited to small family groups which do not allow the definition of the degree of penetrance of the disease. The present study describes a large family with a high frequency of supravalvular aortic stenosis including five generations and 80 subjects, the largest family group with this disease studied so far. The study was carried out prospectively in 66 subjects (clinical examination, ECG, M mode and two dimensional echocardiography). In 14 subjects available data were examined retrospectively. In 10 patients cardiac catheterisation was performed (prospective study in eight). The disease was present in 36 (45%) of the 80 subjects investigated, on the basis of clinical, echocardiographic, and haemodynamic (when available) criteria. The disease was found to be severe in eight cases (22%), moderate in six cases (17%), mild in 13 (36%), and undefined in eight (22%) patients. In one case (3%), multiple pulmonary stenoses were noted in the absence of supravalvular aortic stenosis. Genetic analysis of these data shows, for the first time, the degree of penetrance of the supravalvular aortic stenosis trait (K = 0.86) and confirms that it is transmitted with incomplete penetrance and variable expressivity.

Adolescent↗
PubMed1989

[Supravalvular aortic stenosis: clinical and genetic study of a family group].

We describe a family with a high frequency of supravalvular aortic stenosis. The family includes 5 generations and 80 subjects (prospective study in 66, on whom physical examination, ECG, M-mode and two-dimensional echocardiogram were performed, and retrospective analysis of available data in 14). This is the largest family group with this disease studied so far. Thirty-six subjects (45%) were found to be affected. On the basis of the echocardiographic image and of the haemodynamic gradient (when available), three different degrees of supravalvular aortic stenosis were identified. The disease was found to be severe in 8 subjects (22%), moderate in 6 (17%), mild in 13 (36%) and undefined in 8 (22%). In 4 cases multiple pulmonary stenoses were associated with supravalvular aortic stenosis, while in one subject multiple pulmonary stenoses were noted in the absence of aortic abnormalities. In the family we studied, the supravalvular aortic stenosis gene is transmitted with a pattern of inheritance consistent with an autosomal dominant trait with variable expressivity and penetrance (penetrance coefficient = 0.86). A high mortality rate in early childhood was observed, while symptoms and ECG abnormalities were not related to the degree of the stenosis. Furthermore, we found a high rate of mitral valve echocardiographic abnormalities, such as mitral prolapse and systolic anterior motion. The absence of Williams dysmorphic somatic features in the many generations as well as in the large number of patients we studied, appears to exclude the coexistence of Williams and Eisenberg's syndromes in the same family group.

Adolescent↗
PubMed1988

Two-dimensional and Doppler echocardiographic diagnosis of left ventricular pseudoaneurysm.

In an oligosymptomatic patient with recent acute anterior myocardial infarction, two-dimensional and Doppler echocardiography allowed us to detect, unmistakably, the presence of an apical pseudoaneurysm. Prompt and successful repair was made without performing left ventriculography. To our knowledge, this is the first case of pseudoaneurysm referred for surgery on the basis of echocardiographic findings.

Echocardiography↗
PubMed1987

Activity of left ventricular thrombi of different ages. Assessment with indium-oxine platelet imaging and cross-sectional echocardiography.

To evaluate the possible relation between the age of intracardiac thrombi and the presence and degree of their activity, 29 patients with left ventricular thrombi that developed after an anterior myocardial infarction were evaluated by means of 111In-oxine autologous platelet imaging. None of the patients was treated with anticoagulants or platelet inhibitors during either the acute phase of infarction or the follow-up. The time of appearance and the shape of left ventricular thrombi were assessed by serial cross-sectional echocardiograms, obtained within 24 hours of onset of the chest pain, every 24 hours until the fifth day, every 48 hours until the 15th day, and then every month for a follow-up of 1 to 17 months (mean: 8 months). At the time of the scintigraphic examination, left ventricular thrombi were aged 1 month in 9 patients, and 2 to 14 months in the remaining 20 patients. 111In-oxine imaging with autologous platelets was obtained in all patients at 4, 24, 48 and 72 hours, in the sagittal, 30 degrees and 45 degrees left anterior oblique projections. In 25 patients the degree of haematological activity of the thrombi was evaluated by dividing the values of thrombus activity/background activity, obtained at 4, 24, 48 and 72 hours, respectively, by the value observed at 4 hours (uptake index). Scintigraphic imaging showed the presence of an active thrombus in every patient. In the 9 patients with recent thrombi, the uptake index was significantly greater than in subjects with older ones (P less than 0.01). Hence, in patients with anterior myocardial infarction, untreated with anticoagulants or platelet inhibitors, haematologically active thrombi can be observed even more than one year after their appearance. The uptake of platelets on the surface of thrombi is greater in recent left ventricular thrombi than in older ones.

Adult↗
PubMed1987

Spontaneous morphologic changes in left ventricular thrombi: a prospective two-dimensional echocardiographic study.

Previous retrospective echocardiographic studies have reported a higher embolic potential of left ventricular thrombi with protruding configuration and patterns of mobility. The present study was performed to prospectively assess the shape and mobility patterns of left ventricular thrombi and their spontaneous changes with time. Two-dimensional echocardiograms were obtained in 109 consecutive patients with acute anterior myocardial infarction within 24 hr of the onset of symptoms, every 24 hr until day 5, every 48 hr until day 15, and then every month for a follow-up of 1 to 29 (mean 14 +/- 8) months in the survivors. None of the patients were treated with anticoagulants or platelet inhibitors during the study period. Left ventricular thrombi, detected in 59 patients (54%), appeared from 1 to 362 (mean 12 +/- 47) days after myocardial infarction. At first detection, the shape was mural in 21 patients and protruding in 38; patterns of mobility were present in eight patients. During follow-up, changes in the shape of the thrombi were noted in 24 patients (41%; from mural to protruding in nine, from protruding to mural in 15). These variations were encountered between 2 and 490 (mean 64 +/- 117) days after the first observation of the thrombus. Patterns of mobility, previously detected in eight patients, disappeared in five of eight within 2 to 28 (mean 14 +/- 11) days.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

[Echocardiographic and anatomic evaluation of left ventricular thrombosis].

The aim of this study was to assess the correspondence between two-dimensional echocardiographic (2D-Echo) and anatomic features of left ventricular thrombi (LVT), with particular reference to LVT shape and dimensions. The study population was composed of 23 patients who were admitted to our intensive cardiac care unit with an anterior acute myocardial infarction and who died during the hospitalization. Every patient underwent serial echocardiographic examinations, the last one performed within the 24 hours preceding death. The diagnosis of LVT required the agreement of three independent observers. Doubtful cases were considered as negative. With regard to shape, the LVT were defined as mural or protruding. Two measures of the LVT were obtained in each case: the longest dimension and the greatest one perpendicular to the initial dimension. At post-mortem examination we obtained sections of the heart comparable with an echocardiographic four chamber view. LVT were detected by 2D-Echo in 12/23 cases. Post-mortem examination confirmed the presence of LVT in these 12 patients. A thin apical thrombotic layer, whose presence had been defined previously as doubtful, was observed in another patient. The sensitivity of 2D-Echo was 92% and the specificity 100%. At 2D-Echo, shape was mural in 2 patients and protruding in 10. Complete agreement was found between 2D-Echo and anatomic findings as far as the morphology of LVT is concerned. The 2D-Echo measurements of LVT showed a high correlation with autopsy (r = 0.95; r = 0.86); we conclude that 2D-Echo provides accurate evaluations of the shape and the dimensions of LVT.

Aged↗
PubMed1986

Noninvasive assessment of left ventricular diastolic function: comparative analysis of pulsed Doppler ultrasound and digitized M-mode echocardiography.

The relation between Doppler and digitized M-mode echocardiographic indexes of left ventricular (LV) diastolic function was analyzed. Diastolic variables obtained with these 2 techniques were compared in 19 normal volunteers and in 25 patients with a variety of cardiac diseases. The 2 techniques were in agreement in distinguishing normal from abnormal diastolic function in 20 of the 25 patients (80%) with cardiac disease. Furthermore, a close linear relation with a high correlation coefficient and a small standard error of the estimate was identified between measurements of isovolumic relaxation determined by Doppler and by M-mode echocardiography (r = 0.82, standard error of the estimate = 18 ms). Doppler indexes of diastolic filling such as the slope (descent) and the duration of the early diastolic flow-velocity peak did not show a close correlation with the peak rate and the time to peak rate of increase in LV internal dimension determined by digitized echocardiography. Thus, Doppler and digitized echocardiography were consistent in distinguishing normal from abnormal diastolic function in most of the study patients, although specific variables of LV ventricular filling determined by the 2 techniques were not closely related. In addition, Doppler and M-mode echocardiographic measurements of isovolumic relaxation showed an excellent correlation.

Adolescent↗
PubMed1986

Early echocardiographic detection of right-sided intracardiac thrombus.

A right atrioventricular thrombus occurring as a consequence of a central venous catheter was echocardiographically detected in an asymptomatic 62-year-old man after an acute myocardial infarction. Prompt surgical removal of the thrombus removed the potential for pulmonary embolism.

Catheterization↗
PubMed1986

[Clinical applicability of myocardial scintigraphy with gallium-67 in the study of dilated cardiomyopathy].

Gallium-67-citrate imaging has been recently proposed, in addition to endocardial biopsy, to detect myocardial inflammation in idiopathic dilated cardiomyopathy (IDCM). In order to evaluate the clinical usefulness of this method, 33 patients (pts) suffering from IDCM, 24 pts with various other cardiac diseases (inflammatory etiology in 7), and 11 controls underwent Gallium-67 scintigraphy (anterior and 30 degrees left anterior oblique projections; acquisition at 48 and 72 hrs). In 31 pts repeated scintigraphic examinations (at least two) were obtained. Scans were interpreted by two independent observers. Positivity of scintigrams was based on three different criteria: 1) myocardial activity greater than that of the sternum; 2) presence of focal myocardial activity; 3) semiquantitative index (index = activity of sternum/myocardial activity). Significant differences, either in the percentage of positive scans or in the values of the semiquantitative index, were found between controls and all pts with cardiac diseases. However, no difference was observed when comparing pts with IDCM to pts with other cardiac diseases. Finally, among the pts with cardiac disorders other than IDCM, the qualitative and semiquantitative results of the 7 pts with inflammatory etiology of the disease were similar to those obtained in the remaining 17. Of those pts who underwent longitudinal study, about a third showed modified scintigraphic results later on. No significant difference in behaviour was observed between IDCM and other cardiac disorders. Therefore, we conclude that Gallium 67-citrate imaging does not appear to be a suitable method for the identification of pts. with IDCM. The usefulness of this technique should be tested in samples of pts should previously selected with other more specific methods.

Adolescent↗
PubMed1986

[Left ventricular diastolic function in type I diabetes. A longitudinal echocardiographic study].

The present study was performed to assess the extent of left ventricular diastolic abnormalities and their possible progression with time in patients with type I (insulin dependent) diabetes. Two echocardiographic examinations were performed at an interval of 5 years in 18 study patients. Left ventricular diastolic function was assessed by computer digitized analysis of the M-mode echocardiographic tracings. During the study period all patients remained in satisfactory metabolic control and without retinopathy. Twelve normal subjects, matched for age and sex, were used as control group. Peak rate of left ventricular posterior wall excursion and the peak rate of increase in left ventricular internal dimensions were significantly reduced in patients with diabetes (14.12 +/- 2.5; 16.48 +/- 3.9 cm/sec) compared with controls (17.25 +/- 2.8; 20.41 +/- 3.6 cm/sec) (p less than .005; p less than .01). In addition time to peak rate of increase in left ventricular internal dimensions, isovolumic relaxation index and isovolumic relaxation time were significantly prolonged in patients with diabetes (63.66 +/- 16.5; 23.9 +/- 9; 72.7 +/- 14 msec) compared to controls (46.83 +/- 9.8; 13.4 +/- 4; 61.1 +/- 12 msec) (p less than .005; p less than .001; p less than .05). In the study patients, no relation was found between the extent of diastolic abnormalities and age, duration of the disease and insulin dosage. The extent of left ventricular diastolic dysfunction did not show significant changes during follow-up. Our results indicate that diastolic abnormalities are common in patients with type I diabetes and are not related to the duration of the disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Diabetes Mellitus, Type 1↗
PubMed1985

Unusual distribution of left ventricular hypertrophy in obstructive hypertrophic cardiomyopathy: localized posterobasal free wall thickening in two patients.

Two patients with hypertrophic cardiomyopathy and a previously unreported distribution of left ventricular hypertrophy are described. Each patient showed substantial wall thickening that was confined to the posterobasal segment of the left ventricular free wall, as well as evidence of dynamic subaortic obstruction. This observation emphasizes the fact that hypertrophic cardiomyopathy is characterized by a broad morphologic spectrum. Furthermore, it demonstrates a unique circumstance in which left ventricular outflow tract obstruction may occur in the absence of anterior and basal septal hypertrophy.

Adult↗