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Biomedical subjects

F Fedele

Publications and source records attributed to F Fedele.

At least 19 recordsLinked to original sources
PubMed2006

Long term effects of bosentan treatment in adult patients with pulmonary arterial hypertension related to congenital heart disease (Eisenmenger physiology): safety, tolerability, clinical, and haemodynamic effect.

BACKGROUND: Oral bosentan is an established treatment for pulmonary arterial hypertension (PAH). OBJECTIVE: To evaluate safety, tolerability, and clinical and haemodynamic effects of bosentan in patients with PAH related to congenital heart disease (CHD). PATIENTS: 22 patients with CHD related PAH (8 men, 14 women, mean (SD) age 38 (10) years) were treated with oral bosentan (62.5 mg x 2/day for the first 4 weeks and then 125 mg x 2/day). MAIN OUTCOME MEASURES: Clinical status, liver enzymes, World Health Organisation (WHO) functional class, resting oxygen saturations and 6-min walk test (6MWT) were assessed at baseline and at 1, 3, 6, and 12 months. Haemodynamic evaluation with cardiac catheterisation was performed at baseline and at 12 month follow-up. RESULTS: 12 patients had ventricular septal defect, 5 atrioventricular canal, 4 single ventricle, and 1 atrial septal defect. All patients tolerated bosentan well. No major side effects were seen. After a year of treatment, an improvement was seen in WHO functional class (2.5 (0.7) v 3.1 (0.7); p<0.05), oxygen saturation at rest (87 (6%) v 81 (9); p<0.001), heart rate at rest (81 (10) v 87 (14) bpm; p<0.05), distance travelled in the 6MWT (394 (73) v 320 (108) m; p<0.001), oxygen saturation at the end of the 6MWT (71 (14) v 63 (17%); p<0.05), Borg index (5.3 (1.8) v 6.5 (1.3); p<0.001), pulmonary vascular resistances index (14 (9) v 22 (12) WU m(2); p<0.001), systemic vascular resistances index (23 (11) v 27 (10) WU.m(2); p<0.01), pulmonary vascular resistances index/systemic vascular resistances index (0.6 (0.5) v 0.9 (0.6); p<0.05); pulmonary (4.0 (1.3) v 2.8 (0.9) l/min/m2; p<0.001) and systemic cardiac output (4.2 (1.4) v 3.4 (1.1) l/min/m2; p<0.05). CONCLUSIONS: Bosentan was safe and well tolerated in adults with CHD related PAH during 12 months of treatment. Clinical status, exercise tolerance, and pulmonary haemodynamics improved considerably.

Administration, Oral↗
PubMed2006

An algorithm for the recovery of fetal heart rate series from CTG data.

Cardiotocography (simultaneous recording of fetal heart rate (FHR) and uterine contractions) is one of the most used diagnostic techniques to evaluate fetal well-being and to investigate the functional state of the fetal autonomic nervous system. Recently, great interest has been paid to the variability of the FHR, and its frequency analysis, as a base for a more objective analysis of the cardiotocographic (CTG) tracings. FHR signals are unevenly sampled series. To obtain evenly sampled series, cardiotocographs often use zero-order interpolation. Such process is simple and fast but results unsuitable for frequency analyses because it introduces alterations in the FHR power spectrum. An algorithm for the recovery of the true FHR series out of the zero-order interpolated CTG data was developed and evaluated.

Algorithms↗
PubMed2006

Noninvasive testing for coronary artery disease in women.

Coronary artery disease is a major cause of morbidity and mortality for women in North America and Europe. Given the significance of coronary disease as a public health problem among women, accurate diagnosis of this condition is of great importance. Several noninvasive testing modalities are available for the diagnosis of coronary heart disease. An understanding of gender-based differences related to noninvasive cardiac testing is useful in order to optimally utilize these tests and improve detection and clinical outcomes in women.

Carotid Arteries↗
PubMed2005

Impact of intracoronary aspiration thrombectomy during primary angioplasty on left ventricular remodelling in patients with anterior ST elevation myocardial infarction.

OBJECTIVE: To evaluate prospectively the impact on left ventricular (LV) remodelling of an intracoronary aspiration thrombectomy device as adjunctive therapy in primary percutaneous coronary intervention (PCI) in patients with anterior ST elevation myocardial infarction (STEMI). METHODS: 76 consecutive patients with anterior STEMI (65.3 (11.2) years, 48 men) were randomly assigned to intracoronary thrombectomy and stent placement (n = 38) or to conventional stenting (n = 38) of the infarct related artery. Each patient underwent transthoracic echocardiography immediately after PCI and at six months. At the time of echocardiographic control, major adverse cardiovascular events (MACE) in terms of death, new onset of myocardial infarction, and hospitalisation for heart failure were also evaluated. RESULTS: After a successful primary PCI, patients in the thrombectomy group achieved a higher rate of post-procedure myocardial blush grade 3 (36.8% v 13.1%, p = 0.03) and effective ST segment resolution at 90 minutes (81.6% v 55.3%, p = 0.02). Six months after the index intervention, 19 patients (26.8%) developed LV dilatation, defined as an increase in end diastolic volume (EDV) >or= 20%: 15 in the conventional group and four in the thrombectomy group (p = 0.006). Accordingly, at six months patients treated conventionally had significantly higher end systolic volumes (82 (7.7) ml v 75.3 (4.9) ml, p < 0.0001) and EDV (152.5 (18.1) ml v 138.1 (10.7) ml, p < 0.0001) than patients treated with thrombectomy. No differences in cumulative MACE were observed (10.5% in the conventional group v 8.6% in the thrombectomy group, not significant). CONCLUSION: Compared with conventional stenting, adjunctive aspiration thrombectomy in successful primary PCI seems to be associated with a significantly lower incidence of LV remodelling at six months in patients with anterior STEMI.

Adult↗
PubMed2005

Increased plasma levels of adrenomedullin, a vasoactive peptide, in patients with end-stage pulmonary disease.

AIM: To study adrenomedullin (AM) plasma levels in patients with severe lung disease and to analyze the relationship between AM and heart changes, hemodynamics and blood gases. METHODS: Case control study of 56 patients (36 men, 20 women) with severe lung disease and 9 control subjects (7 men, 2 women). Patients with end-stage pulmonary disease, including chronic obstructive pulmonary disease (COPD, n=11), cystic fibrosis (CF, 26), idiopatic pulmonary fibrosis (ILD, n=9), and idiopatic pulmonary arterial hypertension (PAH, n=10), who were evaluated for lung trasplantation between January 1997 and September 2000, and nine patients who underwent lung surgery for a solitary benign nodule. AM plasma levels in pulmonary artery (mixed venous blood, vein) and aorta or femoral artery (arterial, art), art and vein blood gases, pulmonary hemodynamics, systemic hemodynamics, two-dimensional transthoracic echocardiography and echo-Doppler study. RESULTS: Plasma AM (art and ven) levels were higher among patients' group compared to the controls (AMart p<0.02 and AMven p<0.04) for CF, ILD, PAH (AMart, pg ml(-1) Controls 13.7+/-3.6, COPD 22.8+/-6.2, CF 28.1+/-11.4, ILD 34.1+/-14.3, PAH 35.1+/-18.9; AMven, pg ml(-1) Controls 14.2+/-4.8, COPD 28.1+/-12.6, CF 31.7+/-14.1, ILD 38.7+/-16.5, PAH 40.1+/-4.4). We found with a trend towards higher concentration in ILD and PAH patients compared to COPD and CF but no statistical significant differences. Mixed-venous AM was higher than arterial AM in all groups resulting in AM uptake (AMPulmUp pg min(-1) Controls 4.8+/-22.6, COPD 21.1+/-44.9, CF 20.6+/-45.1, ILD 23.7+/-38.5, PAH 29.9+/-49.7). The univariate analysis showed a weak but significant correlation between AMart and mean systemic arterial pressure, heart rate, mean pulmonary arterial pressure and systemic vascular resistance. In the multivariate analysis, four variables emerged as independent factors of AMart including mean pulmonary arterial pressure, heart rate, mean systemic arterial pressure and left ventricular diastolic diameter (F=8.6, p<0.00001, r=0.60, r2=0.32). A similar weak correlation was apparent between AMven, systemic vascular resistance, and mean pulmonary arterial pressure. The results of multivariate analysis identify right atrial enlargement, mean right atrial pressure, heart rate and left ventricular dimensions as the only independent variables related to AMven (F=4.3, p<0.0004 r=0.56, r2=0.26). AM pulmonary uptake was significantly correlated with AMven (r=0.65), but not with hemodynamic, blood gas and echocardiographic variables. CONCLUSIONS: AM plasma levels are elevated in patients with severe lung disease in face of a preserved pulmonary uptake. These results suggest that the high AM plasma levels in patients with severe lung disease are not caused by a reduced pulmonary clearance, instead suggesting a systemic production.

Adrenomedullin↗
PubMed2004

Respiratory and cardiovascular function at rest and during exercise testing in a healthy working population: effects of outdoor traffic air pollution.

BACKGROUND: There is controversy regarding long-term adverse effects of urban pollutants in urban workers. AIM: The aim of this study was to evaluate the effects of urban pollutants on respiratory and cardiovascular function in exposed traffic policemen compared to a control group. METHODS: Sixty-eight traffic policemen and 62 controls (all male) were investigated at rest and during symptom-limited incremental exercise test (performed with a cycle ergometer). The data were statistically evaluated. RESULTS: There were no significant differences in the mean values of resting ventilatory capacity, the forced spirometric test, or in blood gas parameters between the groups. The traffic exposed group demonstrated a number of significant changes in cardiorespiratory measures on exercise testing. Twenty-six traffic policemen and none of the controls experienced exercise-induced ECG abnormalities, hypertension or oxyhaemoglobin desaturation; 80% of the 26 had resting PaO(2) values <80 mmHg. CONCLUSION: The findings suggest that chronic occupational exposure to urban pollutants reduces resistance to physical effort and increases the risk of cardiovascular and respiratory changes including slight hypoxemia.

Adult↗
PubMed2004

Effects of rotational atherectomy with a reduced burr-to-artery ratio on coronary no-reflow.

AIM: The use of rotational atherectomy in addition to standard percutaneous coronary interventional procedures, although it improves coronary blood flow dynamics by improving vessel geometry, is often associated with distal embolization and the no-reflow phenomenon. We sought to evaluate the safety and effectiveness of a burr size/reference artery diameter (RAD) ratio <0.7 in rotational atherectomy in order to reduce the distal embolization and then to analyze the procedural and peri-procedural no-reflow phenomenon. METHODS: Between March 1999 and May 2003, 50 consecutive patients with a chronic stable angina lasting more than 3 months underwent rotablator atherectomy, adjunctive stent im-plantation (primary coronary stenting, PCS) or plain old balloon angioplasty (POBA) in case of de novo lesions or in stent restenosis, respectively. We analyzed the target vessel myocardial blush grade and the troponin I, creatine kinase and CK-MB values at 1.6 and every 8 h during the first day and then daily until discharge. RESULTS: Procedural success was achieved in all 50 patients (mean age 55+/-11 years; 45 males, 5 females). Quantitative angiography revealed, in the group treated with PCS, an increase in minimal lumen diameter (MLD) from 0.88+/-0.39 mm at baseline to 1.4+/-0.63 mm after rotablator (p<0.01) to 2.85+/-0.9 mm after stent implantation (p<0.01). On the other hand, for the group treated with POBA, the MLD changed from 1.8+/-0.32 mm at baseline to 2.2+/-0.54 mm after rotablator (p=0.6) to 3.28+/-0.91 mm after adjunctive balloon angioplasty (p<0.01). No statistically significant changes have been observed between myocardial blush grade and enzymes between baseline and after the procedure. CONCLUSION: Rotablator atherectomy with a reduced burr size/RAD ratio is a safe and effective interventional procedure without any peri-procedural no-reflow phenomenon.

Adult↗
PubMed2003

A comparison of exact and approximate adjoint sensitivities in fluorescence tomography.

Many approaches to fluorescence tomography utilize some form of regularized nonlinear least-squares algorithm for data inversion, thus requiring repeated computation of the Jacobian sensitivity matrix relating changes in observable quantities, such as emission fluence, to changes in underlying optical parameters, such as fluorescence absorption. An exact adjoint formulation of these sensitivities comprises three terms, reflecting the individual contributions of 1) sensitivities of diffusion and decay coefficients at the emission wavelength, 2) sensitivities of diffusion and decay coefficients at the excitation wavelength, and 3) sensitivity of the emission source term. Simplifying linearity assumptions are computationally attractive in that they cause the first and second terms to drop out of the formulation. The relative importance of the three terms is thus explored in order to determine the extent to which these approximations introduce error. Computational experiments show that, while the third term of the sensitivity matrix has the largest magnitude, the second term becomes increasingly significant as target fluorophore concentration or volume increases. Image reconstructions from experimental data confirm that neglecting the second term results in overestimation of sensitivities and consequently overestimation of the value and volume of the fluorescent target, whereas contributions of the first term are so low that they are probably not worth the additional computational costs.

Algorithms↗
PubMed2003

[Verapamil in the cardioversion of atrial fibrillation. Clinical study].

BACKGROUND: Prolonged periods of atrial fibrillation (AF) or high frequency atrial pacing lead to a significant shortening of atrial refractory periods. This time-dependent electric remodelling is reduced significantly by the administration of verapamil. METHODS: The present series consists of 24 patients all suffering from atrial fibrillation (33% acute AF and 66% chronic recurrent AF) admitted to our Cardiology Department (Rome University). Group G1 (13 patients) received i.v. verapamil (50 mg in 500 cc saline solution at 40 ml/hr). Group G2 (11 patients) received amiodarone i.v. (300 mg in bolus form followed by the infusion of 900 mg in 500 cc 5% glucosate solution, 33 ml/hr for 6 hours and subsequently 18 ml/hr). All patients received non-fractionated heparin i.v. at the same time. RESULTS: No statistically significant difference was observed in the percentage of pharmacological cardioversions in the two groups: G1=61% vs G2=54% p=0.94). The patients who were not cardioverted pharmacologically were done so electrically (external DC shock). CONCLUSIONS: Albeit in this small population of patients verapamil proved to possess anti-arrhythmic effects on a par with that of standard amiodarone antiarrhythmic treatment. This antiarrhythmic potential of verapamil should be demonstrated in a broader randomised study.

Aged↗
PubMed2002

Perforated aneurysms of left side valves during active infective endocarditis complicating hypertrophic obstructive cardiomyopathy.

The most frequent site of vegetative lesion in patients with hypertrophic cardiomyopathy is anterior mitral leaflet, due to chronic endocardial trauma arising from systolic anterior motion. We describe three cases of serious infective endocarditis complicated lesions (vegetation, aneurysm and perforation) on aortic and mitral valves, in patients with obstructive hypertrophic cardiomyopathy. In particular, we observed how severe valvular damage and dysfunction, combined with particular hemodynamic conditions, are followed by adverse clinical outcome. We performed transthoracic echocardiogram and transoesophageal echocardiography studies to define morphologic and hemodynamic features of infection, deciding the proper therapy and we planned the echocardiographic follow-up.

Adult↗
PubMed2002

[Primary non-Hodgkin's lymphoma of the colon: a rare but possible location. Therapeutic approach. Description of a clinical case and review of the literature].

On the basis of a case of large cell, highly malignant, non-Hodgkin's lymphoma of the colon, the authors describe the special features of this rare location; the general aspects of this rare pathology of the colon are then considered. The clinical case relates to a large cell, highly malignant, non-Hodgkin's colic lymphoma located in the caecum at two thirds proximally of the ascending colon of which it occupies half the lumen. The patient had come to our observation for a quite aspecific symptomatology characterised by digestive disturbances and a tendency to stipsis. In disaccord with certain literature reports, surgical treatment was considered by the authors the key to the therapeutic approach. Surgical exeresis should be as radical as possible to permit complementary therapies (chemotherapy and radio-therapy) to act with most effectiveness and thus offer the patient a better life.

Humans↗
PubMed2001

Acute hemodynamic effects of inhaled nitric oxide, dobutamine and a combination of the two in patients with mild to moderate secondary pulmonary hypertension.

INTRODUCTION: The use of low-dose dobutamine to maintain hemodynamic stability in pulmonary hypertension may have a detrimental effect on gas exchange. The aim of this study was to investigate whether inhaled nitric oxide (INO), dobutamine and a combination of the two have beneficial effects in patients with end-stage airway lung disease and pulmonary hypertension. METHOD: Hemodynamic evaluation was assessed 10 min after the administration of each drug and of their combination, in 28 candidates for lung transplantation. RESULTS: Administration of INO caused a reduction in mean pulmonary arterial pressure (MPAP), an increase in PaO2 with a significant reduction in venous admixture effect (Qs/Qt).Dobutamine administration caused an increase in cardiac index and MPAP, with a decrease in PaO2 as a result of a higher Qs/Qt. Administration of a combination of the two drugs caused an increase in the cardiac index without MPAP modification and an increase in PaO2 and Qs/Qt. CONCLUSION: Dobutamine and INO have complementary effects on pulmonary circulation. Their association may be beneficial in the treatment of patients with mild to moderate pulmonary hypertension.

Administration, Inhalation↗
PubMed2001

Doppler myocardial imaging in patients with heart failure receiving biventricular pacing treatment.

BACKGROUND: In patients with heart failure, biventricular pacing (BIV) improves left ventricular (LV) performance by counteracting LV unsynchronized contraction caused by the presence of left bundle branch block (LBBB). However, no data are yet available on regional long-axis function in patients with LBBB or on BIV effectiveness in improving such a function in patients with heart failure and LBBB. METHODS AND RESULTS: We studied with standard 2D echocardiography and tissue Doppler imaging (TDI) 21 nonischemic patients in New York Heart Association (NYHA) class III-IV, with LBBB and QRS >/=120 ms, receiving BIV. To assess long-axis function, TDI qualitative analysis at the basal level of each LV wall was performed in M-mode color and pulsed wave Doppler modalities before and after BIV. By analysis of the interventricular septum, the inferior, posterior, lateral, and anterior walls, of 105 basal segments, the following electromechanical patterns were identified: normal (pattern I), mildly unsynchronized (pattern IIA), severely unsynchronized (pattern IIB), reversed early in systole (pattern IIIA), reversed late in systole (pattern IIIB), and reversed throughout all the systole (pattern IV). After BIV, (1) 49 (46.7%) of 105 segments showed unsynchronized contraction of the same degree as before; (2) 36 (34.3%) of 105 and 20 (19%) of 105 showed unsynchronized contraction of lesser and greater degree, respectively, than before; and (3) a preexcitation pattern was found in 11 (10.5%) of 105, but no segment with pattern IV was observed. According to TDI analysis, patients were divided into group 1 (10 of 21), with less severe LV asynchrony than before BIV, and group 2 (11 of 21), with no change or more severe LV asynchrony than before BIV. In group 1, (1) the LV ejection fraction increased significantly (P =.01); (2) the exercise tolerance, expressed as time and work capacity on the bicycle stress testing, increased significantly (P =.01, P =.003, respectively); (3) the 6-minute walked distance increased significantly (P =.01); and (4) the NYHA class decreased significantly (P =.003). In group 2, no significant differences were found either in LV ejection fraction, in NYHA class, or in exercise tolerance data (P = not significant for all). Conversely, the QRS narrowing was significant in both groups (P =.003 in group 1 and P =.01 in group 2). CONCLUSIONS: TDI is useful in assessing the severity of LV asynchrony in patients with LBBB with heart failure as well as in evaluating the pacing effects on long-axis function in these patients. BIV reduced unsynchronized and/or dyskinetic contraction in at least one third of the LV basal segments, whereas it induced preexcitation in approximately 10%. Such changes were responsible for better LV synchrony in approximately one half of patients. After BIV, LV performance improved significantly in patients with better LV synchrony evaluated by TDI, whereas the QRS narrowing was not predictive of this functional improvement.

Bundle-Branch Block↗
PubMed2001

New insights into regional systolic and diastolic left ventricular function with tissue Doppler echocardiography: from qualitative analysis to a quantitative approach.

Tissue Doppler echocardiography is a variation of conventional Doppler flow imaging. This modality allows quantification of the Doppler shift within the range of myocardial tissue motion. The velocity at a variety of myocardial sites can be determined and distinguished very rapidly by using Doppler techniques. The velocity of moving tissue can be studied with pulsed wave tissue Doppler sampling, which displays the velocity of a selected myocardial region against time, with high temporal resolution. In addition, the velocities can be calculated with time-velocity maps and displayed as color-encoded velocity maps in either an M-mode or 2-dimensional format. This review will focus on the technical aspects and the different methods of tissue Doppler echocardiography for the analysis of regional systolic and diastolic left ventricular function. Whereas pulsed wave tissue Doppler echocardiography allows measurements of velocities of a selected myocardial region, color tissue Doppler gives the best overview of cardiac dynamics because the entire scanned color data are displayed simultaneously. However, there is an increasing need for objective evaluation of tissue Doppler information. Digital images and postprocessing of the data allow for quantitative off-line analysis, and the different approaches and parameters proposed from different centers are discussed.

Diastole↗
PubMed2001

Long term treatment of pulmonary arterial hypertension with beraprost, an oral prostacyclin analogue.

OBJECTIVE: To evaluate the effects of one year's treatment with beraprost, an orally active prostacyclin analogue, in patients with severe pulmonary hypertension. PATIENTS: 13 patients with severe pulmonary hypertension. This was primary in nine, thromboembolic in three, and caused by Eisenmenger syndrome in one. METHODS: All patients underwent right heart catheterisation. Mean (SD) right atrial pressure was 5 (3) mm Hg, mean pulmonary artery pressure was 48 (12) mm Hg, cardiac index was 2.6 (0.8) l/min/m(2), and mixed venous oxygen saturation was 68 (7)%. Beraprost was started at the dose of 20 microgram three to four times a day (1 microgram/kg/day), increasing after one month to 40 microgram three to four times a day (2 microgram/kg/day), with further increases of 20 microgram three to four times a day in case of clinical deterioration. MAIN OUTCOME MEASURES: New York Heart Association (NYHA) functional class, exercise capacity measured by distance walked in six minutes, and systolic pulmonary pressure (by echocardiography) were evaluated at baseline, after one month's treatment, and then every three months for a year. RESULTS: After the first month of treatment, NYHA class decreased from 3.4 (0.7) to 2.9 (0.7) (p < 0.05), the six minute walking distance increased from 213 (64) to 276 (101) m (p < 0.05), and systolic pulmonary artery pressure decreased from 93 (15) to 85 (18) mm Hg (NS). One patient died after 40 days from refractory right heart failure, and another was lost for follow up at six months. The 11 remaining patients had persistent improvements in functional class and exercise capacity and a significant decrease in systolic pulmonary artery pressure in the period from 1-12 months. Side effects were minor. CONCLUSIONS: Oral administration of beraprost may result in long lasting clinical and haemodynamic improvements in patients with severe pulmonary hypertension.

Administration, Oral↗