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F Valagussa

Publications and source records attributed to F Valagussa.

At least 37 records · Page 2Linked to original sources
PubMed1997

[Appropriateness of indicating aortocoronary bypass and coronary angioplasty: results of an observational prospective study in the Lombardy region. Gruppo Interdisciplinare Valutazione Appropriatezza Rivascolarizzazione Coronarica].

OBJECTIVE: Most studies on the appropriateness of cardiac revascularization procedures have been aimed at detecting "overuse" (ie when patients get a procedure without a clear indication), while little attention has been paid yet to "underuse" (when patients who could benefit from a procedure do not get it). This study was planned to assess the extent of over- and underuse of revascularization procedures in northern Italy. METHODS: A multidisciplinary panel of experts convened by the Italian Association of Hospital Cardiologists (ANMCO) rated the appropriateness of 898 "theoretical indications" for coronary artery by-pass grafting (CABG) and percutaneous transluminal angioplasty (PTCA) using the RAND Corporation methodology. Standardized information has been collected on a consecutive sample of patients in the Lombardy region and identified during performance of a coronary angiogram at one of the services belonging to the GISE (Gruppo Italiano Studi Emodinamica) network. Out of the 2718 consecutive patients undergoing a coronary angiogram during the recruitment period (February-May 1995), a total of 1821 (70%) were eligible for the appropriateness study. RESULTS: Indication for CABG were appropriate in 565 (80%) patients, uncertain in 111 (16%) and inappropriate in 25 (4%). Corresponding values for PTCA were: 40% (n = 262), 46% (n = 300) and 14% (n = 90). Among the 394 to whom a medical therapy was recommended after angiography, the indication was considered appropriated in only 14% (n = 57) and uncertain for 30% (n = 117). For the remaining 220, the indication was considered inappropriate, suggesting that according to the panel criteria, 56% of the patients should have received a revascularization procedure (either a CABG or PTCA) instead. CONCLUSIONS: These results suggest that underuse of revascularization procedures represents a substantial health care problem in Lombardy region, at least with reference to the period covered by this study. The study in itself does not make it possible to understand whether these results reflect a structural shortage of services (limited accessibility and/or unprioritized waiting lists) or a more general quality-of-care problem. The study protocol now foresees a follow-up for 9 months after the index angiogram to assess the eventual utilization pattern of CABG/PTCA.

Angioplasty, Balloon, Coronary↗
PubMed1995

Ambulatory blood pressure normality: results from the PAMELA study.

OBJECTIVE: To determine ambulatory and home blood pressure means and distributions in relation to clinic blood pressure in a general population. METHODS: We obtained a random sample of 2400 subjects stratified by sex and 10 year age groups to be representative of residents aged 25-64 years of the city of Monza. Participation rate was 69% (1651 subjects). Blood pressure measurements consisted of clinic blood pressure (average of three measurements, sphygmomanometry), home blood pressure (average of morning and evening measurements, semiautomatic device) and ambulatory blood pressure (automatic readings at 20 min intervals, Spacelabs 90207). Clinic blood pressure was obtained both before and after home and ambulatory blood pressures. Data analysis did not include 213 subjects receiving antihypertensive drug treatment and was therefore limited to 1438 participants. RESULTS: In the 1438 subjects, clinic, home and ambulatory blood pressure showed a normal-like distribution, with a taller peak and a narrower base for ambulatory than for home and clinic values. Clinic, home and ambulatory blood pressures were significantly related to each other (P always < 0.001). The means of the two clinic blood pressures obtained on consecutive days were superimposable (127.4 +/- 17.0/82.3 +/- 9.8 and 128.2 +/- 16.5/81.9 +/- 9.9 mmHg) and both were markedly higher than home and 24 h average blood pressures (8.2 mmHg), which were similar to one another. The differences between clinic and home or 24 h average blood pressure were similar in both sexes but increased with increasing age and clinic blood pressure values. The influence of clinic blood pressure values on the clinic-ambulatory or clinic-home blood pressure differences was more important than age. Although higher than the 24 h average value, daytime average blood pressure was also lower than clinic blood pressure. Night-time blood pressure was markedly lower than the daytime value in both sexes and at all ages. CONCLUSION: Data from a large and unbiased sample of a general population show that home and 24 h or daytime average blood pressures are much lower than clinic blood pressure. The relatively close correlation between blood pressure values measured with the different methods used has allowed calculation of home and ambulatory blood pressure values corresponding to the accepted upper limit of normality of clinic blood pressure (140/90 mmHg). The upper limit of normality for the population was for both home and ambulatory blood pressures in the range 120-130 and 75-81 mmHg for systolic and diastolic values, respectively, with slight differences depending on sex and age. Taking 140/90 mmHg as the upper normal limit of the population is therefore an error that leads to individuals whose home or ambulatory blood pressures are high being considered as normotensive.

Adult↗
PubMed1994

Ambulatory and home blood pressure normality: the Pamela Study.

Ambulatory blood pressure monitoring (ABPM) is increasingly used in the clinical evaluation of hypertension. However, a number of limitations restrict its routine use. One of the limitations is a lack of definite conclusions about ambulatory blood pressure normality, because of the shortcomings of previous studies on this issue. In the present study we describe a survey from a large sample of subjects within the age range of 25-64 years. It was found that 24-h average systolic and diastolic blood pressures are markedly lower than clinic blood pressure, and for daytime average and home blood pressure as well. In addition, it was found that the clinic ambulatory or home blood pressure disparity is related to the baseline clinic blood pressure (i.e., it increases with increasing clinic blood pressure values) and that the three pressures (ambulatory, home, clinic) are closely related to each other, thereby allowing the application of correction factors to obtain information on ambulatory or home blood pressure normality. This results in an upper normality limit for 24-h average blood pressure and home blood pressure of around 120 mm Hg systolic and 77 mm Hg diastolic pressure.

Adult↗
PubMed1994

Cardiac involvement by non-Hodgkin's lymphoma: an unusual presentation of heart conduction disturbances.

A 57-year-old man with non-Hodgkin's lymphoma presented with solitary sinus node dysfunction. Superior vena cava syndrome and progressive disturbance of the conduction system requiring dual chamber pacemaker implantation later appeared. Combination chemotherapy and radiation reversed abnormal sinus node function and the AV conduction disturbance, as demonstrated during electrophysiological evaluation.

Atrial Fibrillation↗
PubMed1992

Cardiopulmonary receptor and arterial baroreceptor reflexes after acute myocardial infarction.

The baroreceptor-heart rate reflex in human is impaired 2 days after a myocardial infarction but it improves 10 days after the acute coronary event. This study investigated whether (1) the baroreceptor-heart rate reflex improvement takes the reflex back to normal, and (2) the cardiopulmonary reflex is affected by myocardial infarction. In subjects studied 8 to 11 days after a transmural anterior or inferior myocardial infarction the baroreceptor-heart rate reflex sensitivity (slope of the linear regression between negative neck chamber pressures and lengthenings in RR interval) was similar to that seen in control subjects (-6.2 +/- 0.8 vs -6.0 +/- 0.6 ms/mm Hg, mean +/- SEM) and did not change when reassessed 10 days later. In contrast, the cardiopulmonary reflex sensitivity (changes in forearm vascular resistance induced by changing central venous pressure through nonhypotensive lower body suction and leg raising) was markedly less in subjects studied 8 to 11 days after myocardial infarction than in control subjects; the reduction amounted to 58.1 +/- 8% (p less than 0.01). The cardiopulmonary reflex sensitivity greatly improved when reassessed 28 to 45 days later. Thus, the baroreflex is normal about 10 days after myocardial infarction. This condition markedly impairs the cardiopulmonary reflex, but the impairment is also transient.

Blood Pressure↗
PubMed1992

[Drop in cardiovascular and coronary mortality in Lombardia, 1969-1987. Evaluation of reliability of the estimates and possible explaining hypothesis].

The results of the present analysis indicate, from 1969 to 1987, a sharp and stable decline in cardiovascular (CVD) mortality in Italians aged 35-74 years (37.6% in males 53.6% in females). These trends were responsible for consistent reductions of total mortality (27.5% and 38% in the two gender groups, respectively), and for the increase of life expectancy. The decrease involved the two major components of CVD mortality, i.e. coronary heart disease (CHD) (23% in males and 44% in females) and cerebrovascular diseases (Stroke) (42.6% in the former and 51% in latter gender group). All these mortality decrements have been higher in the Lombardia Region. Comparing age-adjusted mortality rates in 1968 and 1987, it was possible to estimate that 23,040 deaths were saved in one year among the residents of this northern part of Italy, and the decrease of CHD mortality was responsible for about 30% of the total national decrement of CHD deaths, within comparable age strata. This is attributable both to the higher rates registered at the beginning of the studied period, and to the sharper decline observed. The social impact, in terms of reduction of deaths, was prominent for males. Among the northern male population, the amount of prevented deaths due to CHD and Stroke was equivalent (2072 vs 2172). Data from a MONICA Collaborating Center, located in the region--Area Brianza--, allow us to estimate, for coronary diagnoses reported on death certificates in the 1980s, acceptable levels of accuracy (Cohen's Kappa of .35, with 99% CI .27-.43) and sensitivity (87%). In comparison with earlier estimates carried out in the late 1970s, it is possible to hypothesize an increase of sensitivity over time for certified myocardial infarction diagnoses, which could have contributed to the underestimation of the observed decrements. In dealing with estimates of the reasons for these declines, only suggestions could be addressed because results of specific and comprehensive studies are not presently available. By comparing MONICA data with the results obtained in earlier surveys, it is possible to estimate that about 20 to 30% of the CHD decline, which occurred in the Region, might be attributed to the decrease of in-hospital coronary case-fatality. Moreover, major coronary risk factors (total cholesterol, blood pressure and cigarette smoking) show parallel positive changes, but their contribution in predicting the CHD downfall is difficult to evaluate on the basis of existing data.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1991

Ambulatory blood pressure normalcy: the PAMELA Study.

Although ambulatory blood pressure monitoring is gaining in popularity, it still has important limitations in clinical use, particularly for the definition and diagnosis of hypertension. Various attempts have been made to calculate 'normal' or 'reference' values for ambulatory blood pressure, mostly by 24-h non-invasive monitoring in groups of 'normal' subjects. The most appropriate approach, however, is to compare 24-h ambulatory blood pressure values and casual or clinic blood pressure values in a random sample of a suitably large population. The PAMELA Study has been planned to obtain an epidemiological evaluation of 24-h ambulatory blood pressure values, and its design is described here. In the city of Monza, 2400 subjects aged between 25 and 64 years have been randomly selected according to World Health Organization Monitoring Cardiovascular Diseases (WHO-MONICA) project criteria within sex and age strata. In these subjects, clinic blood pressure, random-zero blood pressure, ambulatory blood pressure (24-h monitoring with SpaceLabs 90207; Redmond, Washington, USA), home blood pressure, electrocardiographic and echocardiographic indices, cardiovascular risk factors and psychological variables are being measured.

Adult↗
PubMed1991

[Cardioangioimmunology: the immune implications in the principle cardiovascular pathologies].

At present, it is known that the immune system acts through the release of protein factors, so-called cytokines. In addition to their immunomodulating and endocrinometabolic effects, cytokines have appeared to be able to have an influence on the cardiovascular system by inducing important haemodynamic changes. Cytokines cause hypotension, particularly IL-2 and TNF, due at least in part to a production of nitric oxide by endothelial cells. Cytokines, such as IL-1, IL-6 and TNF, stimulate myocardial infiltration by activating leukocytes and inducing the release of cytotoxic factors during myocardial infarction; that would extend the area of necrosis. Finally, cytokines would be involved in the pathogenesis of the atherosclerosis, and cholesterol metabolism itself would be under a cytokine control. On these bases, it is possible to suggest in the near future the elaboration of new therapeutic strategies and prognostic indications, according to the bioimmunological response of patients with cardiovascular diseases.

Arteriosclerosis↗
PubMed1990

Early alterations of the baroreceptor control of heart rate in patients with acute myocardial infarction.

Experimental coronary occlusion is accompanied by an acute impairment of the baroreceptor-heart rate reflex. This study was planned to determine whether this impairment also occurs in humans. In 30 patients admitted to a coronary care unit for an anterior (n = 14) or inferior (n = 16) transmural myocardial infarction (MI), we measured 1) the increase in RR interval induced by stimulating carotid baroreceptors through progressive reductions in neck chamber pressure, 2) the increase in RR interval induced by stimulating arterial baroreceptors through intravenous boluses of phenylephrine, and 3) the reduction in RR interval induced by deactivating arterial baroreceptors through intravenous boluses of nitroglycerin. Measurements were performed 49.5 +/- 2.4 hours (mean +/- SEM) after the MI. The results were compared with those of five age-matched patients admitted to the coronary care unit for chest pain and found free from ischemic heart disease. The sensitivity of the carotid baroreceptor-heart rate reflex (slope of the linear regression of RR interval over neck pressure changes) was markedly less in MI than in control patients (3.8 +/- 0.5 vs. 5.9 +/- 0.6 msec/mm Hg, p less than 0.05), the reduction being similar in patients with anterior and inferior MI. This was the case also for the baroreflex sensitivity measured by the phenylephrine and the nitroglycerin methods (slope of the linear regression of RR interval over systolic blood pressure changes). However, 10.2 +/- 0.3 days later, the baroreflex sensitivity measured by all three methods increased significantly (p less than 0.05 or 0.01) and became similar to that of control subjects, which showed no significant change from the early to the late period after admission into the coronary care unit. Thus, MI is accompanied by an acute marked impairment of the baroreceptor control of the heart in humans, and this is the case both for an anterior and an inferior MI. The impairment is largely transient in nature, however, and a clear-cut recovery of the baroreflex can be seen a few days later.

Carotid Sinus↗
PubMed1986

Effects of digoxin, placebo and ibopamine on exercise tolerance and cardiac rhythm of patients with chronic post-infarct left ventricular failure.

This study compares the effects of digoxin, placebo and ibopamine (SB-7505), the orally active 3,4-diisobutyryl ester of N-methyl-dopamine, on exercise tolerance and cardiac rhythm of 14 patients whose left ventricular heart failure (end-diastolic pressure, 26.3 +/- 5.9 mmHg; ejection fraction, 0.42 +/- 0.10%) depended on a previous myocardial infarction. Patients were admitted to the study while on chronic oral digoxin treatment (serum levels between 1.1 and 1.9 ng/ml). Placebo instead of digoxin was given for the following month. Thereafter ibopamine 50 mg t.i.d. for one month was given. A sequence of one-month treatments with digoxin, placebo and ibopamine was repeated, then ibopamine was administered continuously for the next two months. The concurrent treatment (diuretics in all patients, nitroderivates in twelve, calcium antagonists in two) remained unchanged during the observation period. Symptoms-limited exercise tests and 24-h Holter recordings were obtained at admission, at the end of each one-month treatment and at the end of the observation period. Two patients developed unstable angina without increase of serum creatine phosphokinase while on ibopamine and were withdrawn. Out of the 12 patients that concluded the trial, one required supplementary doses of diuretic at the end of the second period on placebo. The results obtained during the trial suggest that: a) therapeutic plasma levels of digoxin have no deleterious effect on cardiac rhythm nor significantly increase exercise tolerance as compared with placebo; b) diuretics and nitrates appear to sustain the clinical stability of these patients as a group.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1982

[Analysis of the sinus node warming-up curve after atrial pacing].

Sinus node recovery to the pre-pacing heart rate after atrial pacing is generally gradual: this phase is called "warming-up" of the sinus node. We evaluated the sinus node warming-up curve in 47 patients who underwent electrophysiological endocavitary examination for diagnostic purposes: we evaluated this phenomenon after atrial pacing at a rate from 90 to 150 b.p.m., 1' lasting for each rate. Twenty-three patients, with impaired sinus node function (group 2), showed as an average a slower sinus node warming-up curve, compared to 24 patients with apparently normal sinus node function (group 1). In group 1, 20.83% of the patients showed abnormal sinus node warming-up curve compared to 60.86% of group 2 subjects. Irregular warming-up curves, i.e. with prolonged secondary pauses, are most frequently seen in group 2 patients with sinoatrial conduction disturbances.

Aged↗