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Biomedical subjects

F Loperfido

Publications and source records attributed to F Loperfido.

At least 91 records · Page 5Linked to original sources
PubMed1982

Severe involvement of the conduction system in a patient with sclerodermal heart disease. An electrophysiological study.

A case of progressive systemic sclerosis with syncopal symptoms is reported. The presenting ECG pattern was that of an anterior myocardial infarction. The clinical history and the coronary angiography excluded significant coronary atherosclerotic heart disease. The ECG pattern evolved from the infarctual pattern associated with right bundle branch block to probably major degree of right bundle branch block associated with left posterior fascicular block. M-mode echocardiography, heart catheterization and angiographic studies did not reveal significant mechanical impairment of the left or right ventricle function. His bundle electrogram documented a markedly prolonged H-V interval, confirming an advanced impairment of distal conducting system. This case supports the suggestion that intraventricular conduction disorders in sclerodermal heart disease are not always related to diffuse myocardial involvement. The risk of sudden death justifies accurate electrophysiological evaluation in selected patients with sclerodermal cardiopathy.

Bundle-Branch Block↗
PubMed1981

An unusual ECG pattern: left posterior fascicular block obscuring a right ventricular conduction defect?

A 23-year-old man with a history of palpitations and a single syncopal attack is described. Results of the physical examination were negative. The ECG showed a marked right axis deviation, a QRS duration of 0.13 sec. and an rS pattern from V1 to V6. In the high right precordial leads an rsR' pattern was recorded. The VCG (Frank system) showed a rightward dislocation of QRS vectors, a clockwise inscription of the QRS loop in the frontal and transverse planes and a slowing of the rightward and posterior terminal vectors. The X-ray film and the echocardiogram were negative. Neither intra-cardiac shunts nor pressure abnormalities were detected at the heart catheterization. The basal His bundle electrogram showed an H-V prolongation. Atrial pacing caused a progressive increase of the QRS duration and the appearance of an R configuration in the V1 lead, without axis shifting. We propose that the electrocardiographic pattern was suggestive of a left posterior fascicular block masking in the standard right precordial leads an associated right ventricular conduction defect.

Adult↗
PubMed1981

Catheter induced distal intra-Hisian right bundle branch block in a patient with persistent proximal intra-Hisian complete A-V block.

We describe a patient with complete intra-Hisian A-V block and narrow QRS who developed catheter-induced right bundle branch block during an electrophysiological study. Selective His bundle pacing was performed during complete intra-Hisian A-V block and right bundle branch block pattern; the distal His bundle pacing normalized the QRS complex, while a more proximal His bundle stimulation showed a right bundle branch block configuration with the persistence of the proximal intra-Hisian lesion responsible for the complete A-V block. These electrophysiological findings suggest that the catheter-induced right bundle branch block in our patient was due to a focal lesion in the distal part of the main His bundle. To our knowledge, this is the first report of documented multilevel lesions within the His bundle in man.

Aged↗
PubMed1981

[Mexiletine in treatment of chronic ventricular refractary arrhythmias (author's transl)].

We studied the antiarrhythmic effect of oral Mexiletine in 20 patients with stable high-frequency ventricular arrhythmias refractory to therapeutic doses of conventional antiarrhythmic therapy. Arrhythmias were classified according to modified grading system of Lown and Wolf. The efficacy of Mexiletine was assessed with use of both the arrhythmic modified classification of Lown and Wolf and count of premature ventricular beats (PVB) from 24 hours ambulatory electrocardiographic recordings. The dose of Mexiletine was 300 mg every 8 hours; 24 hours ECG recordings were obtained in each patient on days 5,15 and 20 during Mexiletine therapy. The worst of tracings before and during Mexiletine therapy was compared. Mean decrease in PVB was 57% (P less than 0.001). The decrease in PVB was more than 80% in 11 patients. Comparison of the grade of arrhythmias disclosed a favorable effect of Mexiletine in 13 patients, a worsening in 1, and no effect in 6. Classification of the most severe arrhythmia revealed a significant decrease from an average grade of 3.05 to 1.75 (P less than 0.01). Before Mexiletine therapy, 40% of our patients were in Class 0 to II and 60% were in Class III or V, whereas during Mexiletine therapy the corresponding proportions were 75% and 25% respectively. Side effects (confusion, tremors, gastro-intestinal complaints) prompted reduction of the dose in 3 patients. Three additional patients had transient minor side effects (dizziness, nystagmus and gastrointestinal disorders) that did not necessitate a change in therapy and 14 patients reported no side effects. In conclusion our data suggest that Mexiletine is an effective agent in the long-term treatment of serious ventricular arrhythmias refractory to other agents. Since Mexiletine therapy is not associated with severe long-term side effects, it should now be possible to determine its role as a first-line drug for treating ventricular arrhythmias.

Adult↗
PubMed1981

[Hypertrophic cardiomyopathy: ECG-VCG abnormalities in absence of the echocardiographic markers in a family (author's transl)].

We report a family, in which two members, the propositus and his father had an left ventriculography highly indicative of non-obstructive or labile mild obstructive hypertrophic cardiomyopathy. In these two members the M-mode and the two dimensional echocardiography did not reveal the features of the hypertrophic cardiomyopathy, i.e. the increased thickness of the interventricular septum and the asymmetric septal hypertrophy, whereas the electrocardiogram and the Frank vectorcardiogram showed an increase of the QRS anterior forces voltage in the transverse plane. In a third relative, the younger brother of the propositus, a similar discrepancy between the VCGraphic and the echocardiographic data was present. The presence of significant ECG-VCGraphic abnormalities in subjects with documented hypertrophic cardiomyopathy and slightly increased septalto-free wall ratio has been previously reported by other Authors. However, the interest of our observation is in the presence of this discrepancy in many members of the same family. Although the ventriculographic pattern was not consistent in our subjects with that found by Yagamuchi et al. in patients with apical non-obstructive hypertrophic cardiomyopathy, a prevailing obliteration of the apical portion of the left ventricular chamber at end-systole was evident in both our cases. This finding however was not revealed by two-dimensional echocardiogram. Although it was not possible exclude on firm grounds that cases described were a normal variant, our observation seems to confirm that the echocardiography does not offer the unique "gold standard" for the non-invasive identification of the hypertrophic cardiomyopathy.

Adolescent↗
PubMed1980

[Usefulness of multicenter evaluation of the reliability of a program for automatic analysis in clinical electrocardiography].

The HP-5 program for computer analysis of the ECG has been evaluated as far as sensibility and specificity in a multicenter study. A consistent number of tracings were sampled according to a statistical formula and all measurements and statements given by the computer were checked in a standardized manner. The collected data were classified and computerized. The HP-5 program has shown a very high specificity for tracings classified as normal (0.7% of false negatives) and for those classified abnormal (no false positive), while the level of agreement between manual and computer readings of the tracings classified atypical or borderline, was fair (75%). It is concluded that the new program represents a significant step forward in the practical use of computerized ECG.

Diagnosis, Computer-Assisted↗
PubMed1980

[Orthogonal ECG and a statistical system for computer diagnosis with ECG in chronic obstructive pneumopathy].

In 92 patients affected from chronic obstructive pulmonary disease (C.O.P.) undergoing spirometric evaluation, the ability of the Pipberger computer program for electrocardiographic interpretation to predict the presence of pulmonary disease with or without right ventricular hipertrophy was compared with that of the manually measured conventional and orthogonal (Frank system) electrocardiogram. The patients were classified as having mild, moderate and severe C.O.P. on the basis of spirometric data. Each system predicted the presence of C.O.P. with low sensitivity. P voltage in D2 greater than or equal to 2 mm (27,1%) and R/S voltage ratio in V5-V6 greater than or equal to 1 (22,8%) were the single conventional criteria more frequently satisfied. Results for 3 lead manual readings were only slightly lower: recognition rate of the R/S voltage ration in x lead less than or equal to 1,3 was 15,7%. The Pipberger program probabilistic answers were divided in "completely" and "partially" correct. Combined completely or partially correct diagnoses were made by the program 14,3% of patients with mild C.O.P., 17,2% of moderate and 48,8% of severe C.O.P. These results suggests that the Pipberger program has at least similar ability to predict C.O.P. compared with the 12 lead and orthogonal manually measured electrocardiogram.

Aged↗
PubMed1980

[Automatic analysis of systolic time intervals using polygraphic examinations].

For clinical purpose, poligraphyc signals are analyzed: systolic time intervals (STI) and all other significative magnitudes are measured. A system of modular programs (ATS), in Assembler and Fortran IV languages, digitalizes, filters and analyzes three simultaneous analogical signals: ECG, PCK and CP. ATS, adapted polynomial and gonyometrics leats-squares smoothings to the signals for leaving-out spikes and drifts, employs algorhythms that, by a statistic knowledge of the thresholds of the fist derivative of each signal and of the globality of smoothed signals, converge to the measures of the required significative magnitudes. A statistic investigation (on 100 samples) showed that ATS is better than every manual analysis in terms of efficiency, speed and amount of information. In conclusion ATS program is suitable for clinical purposes.

Adult↗
PubMed1980

[Systolic time intervals at rest in subjects under prolonged stress: a computerized analysis].

Systolic time intervals were measured in 21 endurance-athletes (middle and lung distance runners) with a computerized method. Data from athletes were compared with that obtained in 27 age-matched normal untrained subjects. Endurance athletes showed significantly inferior values than normal untrained subjects of heart rate, total ejection time (TET), rapid ejection time (TER), electromechanical systole duration (QS2). Authors suggest that these results, particularly the reduction of TER at rest, could be due to a more rapid ejection rate primary or secondary to a left ventricular after-load reduction, following the cardiovascular adaptations induced by training in these athletes.

Adolescent↗
PubMed1980

Transient right bundle branch block unmasking anteroseptal infarction concealed by left posterior fascicular block.

A case of acute anteroseptal myocardial infarction (MI) associated with transient right bundle branch block (RBBB) and a probably persistent left posterior fascicular block is reported. When the RBBB disappeared, small initial r waves were present in the right precordial leads concealing the evidence of MI. Finally, the electrocardiographic pattern evolved to an atypical form of incomplete left bundle branch block. An hypothetic role of the middle septal fascicle in this electrocardiographic evolution is discussed.

Bundle-Branch Block↗
PubMed1980

A computerized system for the analysis of the carotid pulse and apexcardiogram.

A computer program for the on-line analysis of the carotid pulse (CP) and of the apexcardiogram (ACG) is described. The program measures the absolute and the heart rate-corrected time intervals, the time intervals ratios, the amplitude absolute values, the quantitative ACG (DA/Dt), the ejection fraction and the circumferential fiber shortening velocity, according to Antani. Normalized amplitude and angular ACG items are also calculated. 80 normal subjects were examined to evaluate the reliability of the computer measurements in comparison with the manual measurements and to establish normal computerized values. No significant differences resulted in the comparison of the manual and computerized measurements. The normal computerized values are quite similar to those reported in the literature. The systolic time intervals (STI) were derived from the CP/phonocardiogram recording and directly from the ACG, utilizing the second peak of the first ACG derivative as marker of the onset of the ejection period. The left ventricular ejection time was 286.36 +/- 14 and 282.35 +/- 21.80 (no significant difference) and the pre-ejection period 87 +/- 14 and 93.16 +/- 23.16 (no significant) utilizing the CP/phonocardiogram and the ACG respectively. The results demonstrate a good reliability of the computer system and the usefulness of the system in the direct estimate of the STI from the ACG.

Adult↗
PubMed1980

[Multicenter study and clinical use of HP-5 program (author's transl)].

The HP-5 program for computer analysis of the ECG has been evaluated as far as sensibility and specificity in a multicenter study. A consistent number of tracings (850) were sampled according to a statistical formula and all measurements and statements given by the computer were checked in a standardized manner. The collected data were classified and computerized. The HP-5 program has shown a very high specificity for tracings classified as normal (0.7% of false negatives) and for those classified abnormal (no false positive), while the level of agreement between manual and computer readings of the tracings classified atypical or borderline, was practical of computerized ECG.

Computers↗
PubMed1980

[The sclerodermic cardiopathy. Infarction-like electrocardiographic picture and clinico-echocardiographic correlation in three observed cases (author's transl)].

We present three cases of primary sclerodermic cardiopathy with an electrocardiographic picture of anterior myocardial infarction not preceded by chest pain. On one of the cases a coronary angiography was performed with negative results. The echocardiogram of case no 1 showed a pattern of congestive cardiomyopathy, while case no 2 showed a picture of an infiltrative cardiomyopathy. In case no 2 the electrocardiographic picture changed to that of a right bundle branch block with left posterior fascicular block and with the disappearance of the anterior infarction. The His bundle electrogram showed a prolongation of the HV interval, while hemodynamically no signs were shown of impaired mechanical heart function. The clinical and echocardiographic aspects of the sclerodermic cardiopathy are here discussed with particular reference to the possibility of the prevalent compromise of the conduction system that could explain the not uncommon incidence of sudden death.

Adult↗