Biomedical subjects

G Mattioli

Publications and source records attributed to G Mattioli.

At least 19 recordsLinked to original sources

PubMed2001

Frequency of atrial septal aneurysm in patients with recent stroke: preliminary results from a multicenter study.

BACKGROUND: The role of atrial septal aneurysm (ASA) as a risk factor for cerebral ischemia of unknown etiology is controversial. Recent studies have found an association between ASA and focal ischemic events, while results from other studies suggest a low incidence of embolism in patients with ASA. HYPOTHESIS: The present study was designed to evaluate the frequency of ASA, a minor cardioembolic source, in patients with a recent stroke presenting with normal carotid arteries. METHODS: In all, 394 patients with cerebral ischemic stroke were referred to our institutions. Patients underwent transthracic and transesophageal echocardiography and carotid artery ultrasound examination. The study population included 215 patients without significant arterial disease. Frequency and morphologic characteristics of ASA were evaluated. RESULTS: Transthoracic examination showed ASA in 39 patients (18%), while transesophageal echocardiography showed ASA in 61 patients (28%). A patent foramen ovale was found in 47 patients (21.8%) and was associated with ASA in 40 patients (65.5%). We observed an increased thickness of the aneurysmatic wall (3.80 +/- 1.7 mm) in all patients with ASA. CONCLUSIONS: The present study confirms the relationship between ASA and stroke in patients with normal carotid arteries. The most common abnormality associated with ASA was patent foramen ovale. We suggest that patients who have a stroke in the absence of significant carotid disease undergo transesophageal echocardiography to identify possible underlying septal abnormalities.

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PubMed2001

Atrial septal aneurysm as a cardioembolic source in adult patients with stroke and normal carotid arteries. A multicentre study.

BACKGROUND: Atrial septal aneurysm has been considered a potential source of cardiogenic embolism for many years. The present study evaluated the prevalence and characteristics of atrial septal aneurysm in a patient population with stroke and normal carotid arteries compared to a control population without stroke. METHODS: A total of 606 patients were enrolled between November 1990 and December 1996. The study group included 245 patients who had experienced cerebral ischaemic attack but had normal carotid arteries. The control group included 316 age- and sex-matched patients undergoing transoesophageal echocardiography for indications other than a search for a cardiac source of embolism. The prevalence and morphological characteristics of atrial septal aneurysm were evaluated and compared. Results We reported a higher prevalence of atrial septal aneurysm in the group with cerebral ischaemia; 68 patients (27.7%) vs 36 patients (9.9%) from the control group; P<0.001. A patent foramen ovale was detected with contrast injection in 69.2% of the patients with atrial septal aneurysm. Atrial septal aneurysm predicted the presence of a patent foramen ovale (odds ratio of patent foramen ovale 4.2; 95% CI 1.03-9.8). Multivariate analysis showed that atrial septal aneurysm was an independent predictor of an embolic event. In the 95% of patients with atrial septal aneurysm and cerebral ischaemia aged less than 45 years, transoesophageal echocardiography did not detect a source of embolism other than an associated patent foramen ovale. CONCLUSIONS: The prevalence of atrial septal aneurysm in patients with cerebral ischaemia and normal carotid arteries was 27.7%, higher than the control group. Atrial septal aneurysm was frequently associated with patent foramen ovale. In patients less than 45 years old, atrial septal aneurysm was the only potential cardiac source of embolism detected with transoesophageal echocardiography.

Adult↗

PubMed2000

Clinical, echocardiographic, and hormonal factors influencing spontaneous conversion of recent-onset atrial fibrillation to sinus rhythm.

The present study was designed to determine clinical, hormonal, and echocardiographic factors influencing spontaneous conversion to sinus rhythm of recent-onset atrial fibrillation (symptoms <6 hours). The most important predictor of spontaneous conversion was the time of onset of atrial fibrillation; patients who developed the arrhythmia during sleep had the highest probability of spontaneous conversion during the first 24 hours. A second predictor was the plasma concentration of atrial natriuretic peptide during the arrhythmia.

Adult↗

PubMed2000

Serial evaluation of left atrial dimension after cardioversion for atrial fibrillation and relation to atrial function.

The size of the left atrium is usually increased during atrial fibrillation (AF). The aim of the present study was to evaluate changes in left atrial (LA) dimension after cardioversion for AF, and the relation between LA dimension and atrial function. The initial study population included 171 consecutive patients. Patients who had spontaneous cardioversion to sinus rhythm (56 patients) were compared with patients who had random cardio-version with drugs (50 patients) or direct-current (DC) shock (50 patients). Echocardiographic evaluations included LA size and volume. LA passive and active emptying volumes were calculated, and LA function was assessed. Atrial stunning was observed in 18 patients reverted with DC shock and in 7 patients reverted with drugs. The left atrium was dilated in all patients during AF (48 +/- 5 mm). The size of the left atrium decreased after restoration of sinus rhythm in all patients with spontaneous reversion to sinus rhythm, in 73% of patients reverted with drugs, and in 50% of patients reverted with DC shock. The comparison between patients with a normal mechanical atrial function and patients with reduced atrial function showed that a higher atrial ejection force was associated with a more marked reduction in LA size after restoration of sinus rhythm. A relation between LA volumes and atrial ejection force was observed in the group of patients with depressed atrial mechanical function (r = -0.78; p <0.001). The active emptying fraction was lower, although not significantly, in this group, whereas the conduit volume was increased. Thus, a depressed atrial mechanical function after cardioversion for AF was associated with a persistence of LA dilation.

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PubMed2000

Clastogenic effect of copper deficiency in cattle.

Copper plays an essential role as a micronutrient. Deficiency of this element (hypocuprosis) in experimental and domestic animals has a severe impact on growth as well as on reproduction. The occurrence of lesions during hypocuprosis is correlated with the depletion of an enzymatic group in which copper takes part. The aim of this work was to analyse chromosomal aberrations in Aberdeen Angus cows of the province of Buenos Aires in relation with the Cu plasma levels. Short term lymphocyte cultures were made from samples obtained from four groups of animals: two groups with normal levels of copper in plasma and two groups with severe hypocupremia. This analysis showed a significant increase of the frequency of chromosomal aberrations (p<0.001) in the hypocupremic groups in relation with control groups. Finally, the Spearman correlation analysis showed a significant negative association (p<0.05) between copper levels and the yield of chromosomal aberrations. The increase of the frequencies of chromosomal aberrations found in the hypocupremic groups could be explained by the higher oxidative stress suffered by these animals. A lower catalytic activity of enzymes such as Cu/Zn superoxide dismutase (Cu/Zn-SOD) and cytochrome-c oxidase could increase the intracellular production of active oxygen species (O(2)(-), H(2)O(2) and OH(o)) with the consequent clastogenic effects.

Animals↗

PubMed2000

Bronchoalveolar lavage and esophageal pH monitoring data in children with "difficult to treat" respiratory symptoms.

Gastroesophageal reflux (GER) may be associated with chronic or recurrent asthma-like symptoms secondary to bronchoconstrictor reflexes and/or inhalation of gastric content. The presence of lipid-laden alveolar macrophages has been proposed as an index to establish the degree of gastric aspiration. We evaluated 20 children with "difficult to treat" respiratory symptoms and a clinical history suggestive of GER. All children underwent 24-hr esophageal pH monitoring (pHm) and fiberoptic bronchoscopy with bronchoalveolar lavage (BAL). The amount of lipid per single macrophage was determined by a semiquantitative method, using fluorescence microscopy to detect Nile-Red-stained BAL cells and calculating a lipid-laden macrophage index (LLMI). Eleven children had positive pHm recordings, suggesting the presence of GER (pH-positive patients), and 9 had negative pHm records (pH-negative patients). The pH-positive patients had higher percentages of neutrophils and higher LLMI than the pH-negative children (P < 0.05). There were no correlations between the pHm records and either % BAL neutrophils or LLMI in pH-positive or pH-negative patients (P > 0.05; each correlation). In contrast, a single correlation was found between % BAL neuytrophils and LLMI, both in the pH-positive and in the pH-negative patients (r = 0.72, P = 0.02 and r = 0.71, P = 0.04, respectively). These data demonstrate that a significant proportion of pH-positive patients with respiratory symptoms have BAL abnormalities that suggest airway inflammation and gastric content aspiration. However, the intensity of GER as indicated by pH monitoring does not correspond with BAL data in all patients.

Bronchoalveolar Lavage↗

PubMed2000

Relationship between mean right atrial pressure and Doppler parameters in patients with right ventricular infarction.

BACKGROUND: The incidence of an inferior left ventricular infarction involving the right ventricle is very high, ranging from 14 to 84%. Isolated right ventricular infarction accounts for < 3% of all cases of infarction. HYPOTHESIS: The aim of the present study was to assess the relationship between Doppler parameters of hepatic vein and tricuspid inflow, as well as mean right atrial (RA) pressure in patients with right ventricular infarction. METHODS: In all, 59 consecutive patients with inferior left ventricular infarction involving the right ventricle were selected for the study. All patients underwent Doppler echocardiographic evaluation of tricuspid and hepatic vein parameters and catheterization of the right side of the heart. Patients were divided into two groups according to the presence or absence of severe tricuspid regurgitation. RESULTS: In patients with severe tricuspid regurgitation, a significant correlation (r = 0.64; p < 0.001) between RA maximal volume and mean right atrial pressure (RAP) was found, and the sensitivity of RA maximal volume in identifying mean RAP > 7 mmHg was 64% with a specificity of 78%. In patients without severe tricuspid regurgitation, the most significant relationship was observed between mean RAP and inferior vena cava collapse index. Significant correlations between maximal and minimal diameters of the inferior vena cava were also observed. CONCLUSIONS: Echocardiographic and Doppler parameters may be useful for evaluating mean RAP in patients with right ventricular infarction. In patients with severe tricuspid regurgitation, the more important parameters are maximal and minimal RA volumes. In patients without severe tricuspid regurgitation together with right atrial volume, the important parameters are acceleration and deceleration time of the tricuspid inflow peak E velocity and hepatic systolic and diastolic venous flow.

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PubMed2000

Right ventricular dysfunction after thrombolysis in patients with right ventricular infarction.

BACKGROUND: Right ventricular (RV) infarction is frequently associated with highest risk of death and major complications. Doppler echocardiography can be useful in the diagnosis of RV involvement. The goal of this study was to evaluate Doppler echocardiography features associated with RV involvement and a poor prognosis. METHODS: Two-dimensional Doppler echocardiography was performed before and after thrombolysis in 108 consecutive patients with an RV infarction. The bedside examination was performed before and 2 to 3 hours after thrombolytic therapy, and repeated after 1 and 7 days. All patients underwent coronary angiography after 20 days, and the perfusion of the coronary-related artery (> thrombolysis in myocardial infarction [TIMI] 3 grade) was evaluated. RESULTS: Patients were divided into 2 groups according to the recovery of global and regional RV function after thrombolytic therapy. In the group of patients who showed a normalization or improvement of RV wall motion (as assessed by RV wall motion score index), we found a TIMI grade III perfusion in 78% of patients. The analysis of interatrial septal motion and interventricular septal motion showed a normalization in all reperfused patients. Major complication and deaths were more frequent in patients with echocardiographic findings of RV dysfunction persisting after thrombolytic therapy. CONCLUSION: In patients with RV infarction treated with thrombolysis, persistent RV dysfunction is associated with a higher risk for the development of major cardiac complications and death.

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PubMed2000

Doppler echocardiographic evaluation of right ventricular function in patients with right ventricular infarction.

The aim of the present study was to assess the utility of the myocardial performance index in patients with right ventricular infarction. During the study period, 120 patients were evaluated: 50 patients had a right ventricular infarction and 70 patients had an inferior left ventricular infarction without right ventricular involvement. On admission, an echocardiogram was obtained from all patients prior to the initiation of thrombolytic therapy. The right ventricular myocardial performance index was calculated, as were the Doppler-derived parameters of the right side of the heart. All patients with right ventricular infarction had undergone a right ventricular dilation, compared with 70 patients with left ventricular infarction (right ventricular end diastolic diameter 32 +/- 13 versus 26 +/- 24 mm; P < 0.01) and increased areas (diastolic area 24.8 +/- 9.9 versus 15.1 +/- 6.8 cm2; P < 0.01). Tricuspid regurgitation was detected in 26 patients. The mean peak velocity of tricuspid regurgitation was 3.8 +/- 0.8 m/s. The Doppler intervals, isovolumetric contraction times (136 +/- 30 versus 49 +/- 11 ms; P < 0.01), and relaxation times (71 +/- 28 versus 37 +/- 9 ms; P < 0.01) were prolonged in patients with right ventricular infarction, whereas the ejection time was significantly reduced (250 +/- 31 versus 330 +/- 26 ms; P < 0.001). The myocardial performance index was significantly increased in patients with right ventricular infarction (0.85 +/- 0.2 versus 0.26 +/- 0.1; P < 0.01). The inferior vena cava collapse was reduced in all patients with right ventricular infarction (35 +/- 20%). The right ventricular myocardial performance index was a useful indicator of right ventricular performance in patients with right ventricular infarction. The use of echocardiographic parameters of the right side of the heart and Doppler echocardiographic parameters of right ventricular function provides a reliable diagnosis of right ventricular infarction.

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PubMed2000

Heparin-induced thrombocytopenia in patients treated with unfractionated heparin: prevalence of thrombosis in a 1 year follow-up.

BACKGROUND: Patients with unstable angina are usually treated with unfractionated heparin and aspirin, but very little is known about the prevalence of heparin-induced antibodies and their relation to thrombotic complications some time after the acute phase of unstable angina. The aim of the present study was to establish the prevalence of heparin-induced thrombocytopenia and the prevalence of heparin-dependent platelet-reactive antibodies in patients treated with unfractionated heparin and the occurrence of thrombosis in a 1 year follow-up. METHODS: Patient population included 124 consecutive patients with unstable angina treated with unfractionated heparin for almost 5 days. The prevalence of heparin-dependent platelet-reactive antibodies using an ELISA assay was measured before the beginning of heparin therapy and after 7 and 40 days. The platelet count was measured at the same time and the presence of thrombotic occurrences was checked. Clinical follow-up lasted 1 year. RESULTS: At baseline no one patient was positive for heparin-induced antibodies. On day 6, 38 patients (30%) produced a positive heparin-induced antibody result and 30 patients (24%) had an intermediate result. The majority of patients (74%) who developed antibodies became positive after 6 days of heparin therapy. The combined incidence of death, myocardial infarction, recurrent angina, urgent revascularization and stroke was 66% in patients with antibodies and 44% in patients without antibodies during a 1 year follow-up. The incidence of combined primary end points was statistically higher in patients positive for antibodies. The log-rank test was statistically significant (chi2 = 4.39, p < 0.01). CONCLUSIONS: No one patient developed a clinical evidence of thrombocytopenia. Nevertheless thrombotic events during follow-up were more common in patients who developed heparin-induced antibodies. These patients need a more accurate evaluation and surveillance after hospital discharge.

Aged↗

PubMed1999

Efficacy and tolerability of a very low molecular weight heparin compared with standard heparin in patients with unstable angina: a pilot study.

BACKGROUND: Unstable angina is an active thrombotic process that involves thrombus formation and platelets. It requires a rapid and intensive treatment with anticoagulants and antiplatelets. HYPOTHESIS: The aim of the present study was to compare the efficacy of a very low molecular weight heparin, OP 2000, with standard heparin in the treatment of unstable angina. Tolerance and safety were also assessed. METHODS: The study population included 120 consecutive hospitalized patients with unstable angina randomized for treatment with very low molecular weight heparin or with standard heparin. The dosage of the study drug was 200 mg intramuscular (i.m.) the first day followed by 150 mg IM/day. The control drug was standard heparin starting at a dosage of 5,000 UI/ml intravenously (i.v.) and followed by continuous infusion at an activated partial thromboplastin time-adjusted dosage. The primary end points were death, acute myocardial infarction, urgent revascularization, and recurrence of angina. Tolerability was assessed using bleeding parameters, thrombocytopenia, and allergic reactions. RESULTS: Fourteen clinical events were reported in the study group compared with 25 events in the control group (p < 0.05). No adverse events were reported in either group. CONCLUSION: During the acute phase of unstable angina, treatment with a very low molecular weight heparin plus aspirin was more effective than treatment with standard heparin plus aspirin.

Adult↗

PubMed1999

Pancreatitis caused by duodenal duplication.

The authors present the investigations and surgical treatment of two cases of duodenal cystic duplication. Abdominal pain and gastroesophageal reflux were the most important symptoms and signs associated with an history of recurrent acute pancreatitis. Computed tomography scan, ultrasound examination, and cholangiography confirmed preoperatively the diagnosis, and a transduodenal surgical approach was carried out in both children. A simple marsupialization of the cyst was performed in the former, and a sphincterotomy with papillosphincteroplasty was associated in the latter. The diagnosis was confirmed by microscopy, and both the children are asymptomatic after a 14 and 18 months of follow-up. This report focuses on the importance of the cholangiopancreatography for every child presenting with recurrent, unexplained bouts of acute pancreatitis, and underlines the technical surgical aspects on the basis of the anatomic identification of the malformation.

Acute Disease↗

PubMed1999

Treatment of vesico-ureteric reflux in children with neuropathic bladder: a comparison of surgical and endoscopic correction.

BACKGROUND/PURPOSE: Vesico-ureteric reflux (VUR) is a common problem in children with neuropathic bladder. Lesser-degree VUR may be manageable by intermittent catheterization or by anticholinergics, but higher grades usually require surgical treatment. If left untreated, two thirds of such patients may experience deterioration of the upper renal tracts. The aim of this study was to compare the results of the STING (Subureteric Teflon Injection) technique with surgical ureteric reimplantation as treatment for VUR in neuropathic bladder. METHODS: From January 1981 to December 1996, 58 children with NB (81 ureters) were treated for VUR. STING and Cohen ureteroneocystotomy were performed in 40 and 41 ureters, respectively. Mean age was 4.5 years (STING) and 5.1 years (Cohen). RESULTS: Twenty-nine of 40 refluxing ureters (72.5%) were cured by STING, whereas Cohen eradicated reflux in 39 of 41 ureters (95.5%). No complications were observed in either group. All the ureters in which STING failed were treated successfully by Cohen ureteroneocystostomy. The 2 ureters still refluxing after surgical reimplantation were cured successfully by a single STING. The mean follow-up was 6.8 years in the Cohen group and 4.8 years in the STING group. During follow-up, no recurrence was observed in patients cured by open reimplantation. In the STING group, 2 previously cured ureters showed recurrence of VUR: both were treated successfully by a further STING. CONCLUSIONS: Open ureteral reimplantation is more effective than STING in correcting VUR in children with neuropathic bladder dysfunction. Nevertheless, the good success rate, the relative technical simplicity, outpatient nature, and rapid recovery point to STING as a safe and effective procedure for the initial treatment of VUR. Failure of STING does not preclude a successful open operation.

Adolescent↗

PubMed1999

Atrial ejection force in patients with atrial fibrillation: comparison between DC shock and pharmacological cardioversion.

It is well known that the restoration of sinus rhythm is not always associated with the return of effective atrial contraction. Atrial ejection force (AEF) is a noninvasive Doppler derived parameter that measures the strength of the atrial contraction. The aim of the present study was to use pulsed-Doppler echocardiography to determine if different modalities of cardioversion influence the delay in the return of effective atrial contraction after cardioversion. DC shock and pharmacological therapy were compared. Sixty-eight patients were randomly cardioverted, either using DC shock or i.v. procainamide. The patients who were restored to a sinus rhythm had a complete Doppler echocardiographic examination within 1 hour after the restoration, after 24 hours, after 1 month, and after 3 months. AEF was measured and compared in the two groups of patients and within the same group. AEF was greater immediately and at 24 hours after cardioversion in patients who underwent pharmacological therapy compared to patients treated with DC shock (peak A wave, 60 +/- 9 vs 31 +/- 8 msec, P < 0.001; AEF 11.3 +/- 3 vs 5 +/- 2.9 dynes, P < 0.001). In both groups, AEF increases over time. In conclusion, AEF is a noninvasive parameter that can be easily measured after cardioversion and can give accurate information about the recovery of left atrial mechanical function. This finding may have important implications for guiding the anticoagulant therapy after cardioversion.

Anti-Arrhythmia Agents↗

PubMed1999

Stroke in paced patients with sick sinus syndrome: influence of left atrial function and size.

Patients with sick sinus syndrome have a high prevalence of cerebral ischemia. The present study was designed to establish the prevalence of stroke in patients with sick sinus syndrome and the role of atrial size and function. This prospective study analyzed 100 consecutive patients with sick sinus syndrome without atrial fibrillation who received either dual chamber or ventricular pacemakers. Patients underwent a cranial CT scan at the time of enrollment and again at the end of the study 24 months later. Endpoint of the study was cerebral ischemia. Clinical and echocardiographic features were assessed at the beginning of the study. A multivariate regression analysis was applied to all variables that had at least a marginal univariate predictive value. Cerebral ischemia occurred in 18 patients. Univariate predictors for embolism were age >65 years (p < 0.001), low atrial ejection force (p < 0.01) and a dilated left atrium with spontaneous echo contrast (p < 0.05). These findings identified patients at high risk for the development of peripheral embolism among the group of patients paced for sick sinus syndrome.

Aged↗

PubMed1999

Doppler sonographic evaluation of left atrial function after cardioversion of atrial fibrillation.

Restoration of sinus rhythm is not always followed by immediate return of effective atrial contraction. Left atrial mechanical function can be assessed by Doppler echocardiography; in the present study we measured the atrial ejection force, which is a noninvasive Doppler-derived parameter that measures the strength of atrial contraction. The aim of the present study was to evaluate the influence of clinical and echocardiographic parameters: duration and cause of atrial fibrillation, different modality of cardioversion, and left atrial size with respect to the delay in the return of effective atrial contraction after cardioversion. Seventy patients were randomly chosen to undergo cardioversion by either direct current shock or intravenously administered procainamide hydrochloride. The 52 patients who had sinus rhythm restored underwent a complete Doppler echocardiographic examination 1 h after the restoration of sinus rhythm and after 1 day, 7 days, and 1 month. The relation between clinical variables and atrial ejection force was tested. Atrial ejection force was greater immediately and 24 h after cardioversion in patients who underwent pharmacologic therapy compared to patients treated with direct current shock (11.3+/-3 versus 5+/-2.9 dynes; P<0.001). In both groups atrial ejection force increased over time. The mode of cardioversion was significantly associated with recovery of left atrial mechanical function by day 1 in univariate and multivariate analysis (odds ratio, 0.14; 95% confidence interval, 0.02-1.2). The other variable associated with the delay in the recovery of atrial function was a dilated left atrium (odds ratio, 0.16; 95% confidence interval, 0.12-1.6). Atrial ejection force is a noninvasive parameter that can be easily measured after cardioversion and gives accurate information about the recovery of left atrial mechanical function. The recovery of left atrial function was influenced by the mode of cardioversion and left atrial size.

Aged↗

PubMed1999

[Restoring the mechanical atrial function after cardioversion of atrial fibrillation: clinical and echocardiographic predictive factors].

BACKGROUND: A delay in the recovery of effective mechanical atrial function after cardioversion for atrial fibrillation can predispose to thromboembolism. The aim of the present study was to assess the influence of clinical and echocardiographic parameters on the recovery of left atrial contraction after cardioversion of atrial fibrillation. METHODS: One hundred and 36 consecutive patients were evaluated and 80 were randomly cardioverted using either DC shock or i.v. procainamide. Patients who recovered sinus rhythm (26 patients treated with procainamide and 39 patients cardioverted with DC shock) underwent a complete Doppler echocardiographic examination 1 hour after the restoration of sinus rhythm and after 1 and 7 days and 1, 3, and 6 months. The following parameters were evaluated: age, underlying cardiac disease, duration and etiology of atrial fibrillation, mode of cardioversion, left ventricular diameters and function, left atrial diameters and function, assessed as atrial ejection force. The relation between these variables and atrial ejection force was tested. RESULTS: Atrial ejection force was greater immediately and at 24 hours after cardioversion in patients who underwent pharmacological therapy compared to patients treated with DC shock. In all groups atrial ejection force increased over time. The mode of cardioversion was significantly associated with the recovery of left atrial mechanical function by day 1 in univariate and multivariate analyses (odds ratio 0.14, 95% confidence interval 0.03-1.6). The other variable associated with atrial ejection force was left atrial size (odds ratio 0.15, 95% confidence interval 0.17-1.9). CONCLUSIONS: Atrial ejection force can be easily measured after cardioversion to obtain accurate information about the recovery of left atrial mechanical function. In the present study the recovery of left atrial function was influenced by the mode of cardioversion and left atrial size.

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PubMed1998

Clinical and echocardiographic features influencing recovery of atrial function after cardioversion of atrial fibrillation.

Atrial mechanical dysfunction after cardioversion for atrial fibrillation has been widely evaluated in recent years. Nevertheless, the influence of many clinical and echocardiographic parameters is not yet understood. The aim of the present study was to evaluate the influence of clinical and echocardiographic parameters on the return of effective atrial contraction. A total of 109 patients were evaluated: 41 patients had spontaneous recovery of sinus rhythm and 68 patients were randomly treated using either direct-current (DC) shock or intravenous procainamide. Elective cardioversion was accomplished pharmacologically in 23 patients (67%) and with DC shock in 29 patients (85%). Patients underwent a complete echocardiographic examination 1 hour after the restoration of sinus rhythm and after 1 and 7 days and 1 month. The following parameters were evaluated: patient age, cardiac disease, duration and etiology of atrial fibrillation, mode of cardioversion, left ventricular diameters and function, and left atrial diameter and function assessed as atrial ejection force. The relation between these variables and atrial ejection force was tested. Atrial ejection force was greater immediately and 24 hours after cardioversion in patients who had spontaneous recovery of sinus rhythm and in patients treated with drugs than in patients treated with DC shock. The mode of cardioversion was significantly associated with the recovery of atrial mechanical function by day 1 in univariate and multivariate analyses (odds ratio 0.14; 95% confidence interval 0.02 to 1.2). The other variable associated with the recovery of function was normal left atrial size (odds ratio 0.16; 95% confidence interval 0.12 to 1.6). In conclusion, atrial ejection force is a noninvasive parameter that can be easily measured and can provide accurate information about the recovery of left atrial mechanical function. The recovery of atrial function was influenced by the mode of cardioversion and the size of the left atrium.

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