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M Di Leo

Publications and source records attributed to M Di Leo.

At least 19 recordsLinked to original sources
PubMed2000

Acute myocardial infarction in young adults: prognostic role of angiotensin-converting enzyme, angiotensin II type I receptor, apolipoprotein E, endothelial constitutive nitric oxide synthase, and glycoprotein IIIa genetic polymorphisms at medium-term follow-up.

BACKGROUND: A number of reports have investigated the association between various gene polymorphisms and the phenotypic expression of myocardial infarction. No investigations have evaluated the prognostic role of genetic factors in young people with premature coronary disease. The aim of this study was to investigate the influence of genetic factors compared with that of conventional risk factors on follow-up events in a population of Italian young adults with myocardial infarction. METHODS AND RESULTS: The study population consisted of 106 young patients (mean age 40 +/- 4 years, range 23 to 45 years) with diagnosis of acute myocardial infarction. Clinical and genetic data from the group of patients with events during follow-up were compared with those from patients without events. The following genetic polymorphisms were tested: angiotensin I converting enzyme, angiotensin II type I receptor, apolipoprotein E (ApoE), endothelial constitutive nitric oxide synthase, and platelet glycoprotein IIIa. Coronary angiography was performed in 94 patients. Coronary angiography showed coronary artery disease in 93% of patients. During follow-up (46 +/- 12 months, range 25 to 72) the overall combined end points (cardiac death, myocardial infarction, and revascularization procedures) accounted for 21 events. Family history of coronary artery disease, smoking, stenosis of the left anterior descending artery at coronary angiography, and ApoE polymorphism (presence of epsilon4 allele) were significantly more prevalent (univariate analysis) in the group of patients with events. Logistic multivariate analysis showed that ApoE polymorphism (P =. 004, odds ratio [OR] 6.8, 95% confidence interval [CI] 2 to 22), family history (P =.005, OR 8.3, 95% CI 2 to 35), smoking after acute myocardial infarction (P =.008, OR 10.9, 95% CI 2 to 62), and left anterior descending coronary artery disease (P =.02. OR 6.6, 95% CI 1.3 to 33) were independent predictors of adverse events. CONCLUSIONS: Myocardial infarction at a young age is commonly characterized by evidence of multiple cardiovascular risk factors and by a favorable prognosis in short- and medium-term follow-up. Evidence of significant disease at coronary angiography suggests the presence of a premature atherosclerotic process. ApoE polymorphism (presence of epsilon4 allele) appears to be a strong independent predictor of adverse events, suggesting a remarkable influence in the accelerated coronary disease.

Adult↗
PubMed1999

Transesophageal echocardiographic evidence of more pronounced left atrial stunning after chemical (propafenone) rather than electrical attempts at cardioversion from atrial fibrillation.

We studied left atrial function in 55 patients undergoing electrical (n = 23) or chemical (intravenous administration of propafenone, n = 32) attempts at cardioversion from atrial fibrillation. Chemical attempts at cardioversion revealed a significant increase in spontaneous echo contrast and a significant decrease in left atrial appendage Doppler flow, even in patients who did not have successful conversion to sinus rhythm.

Adult↗
PubMed1999

Ictal bradycardia in a patient with a hypothalamic hamartoma: a stereo-EEG study.

Little is known about bradycardia and cardiac asystole which occur during partial epileptic seizures, especially whether they relate to ictal involvement of well-defined cortical areas. Several reports based on simultaneous electrocardiographic and intracranial depth electroencephalographic monitoring have shown that either the fronto-orbital cortex or the amygdalohippocampal complex could be responsible for such cardiac variations. We performed stereo-EEG recordings in a patient with refractory localization-related epilepsy associated with a hypothalamic hamartoma. We found that other cortical areas, such as the frontocentral region and the temporal neocortex, can contribute to the genesis of ictal bradyarrhythmia. Second, the lesion per se, although located within the hypothalamus, is not involved with this phenomenon.

Adult↗
PubMed1999

Serum and salivary antiendomysium antibodies in the screening of coeliac disease.

BACKGROUND: Antiendomysium antibodies (EMA) detection in serum is the best screening test for coeliac disease (CD): in saliva it has not yet been assayed. Aims of this study are: to verify the presence of EMA in saliva collected with a not invasive technique; to evaluate the validity of serum and salivary EMA in CD screening. METHODS: We investigated 130 subjects divided into 3 groups: "A": 45 untreated CD patients (mean age 6.11); "B": 18 CD patients treated with a gluten free diet (mean age 13.2); "C": 67 controls (mean age 8.9). We performed the EMA test using the indirect immunofluorescence technique, in serum and in saliva concentrated samples. RESULTS: Our results show: sensitivity EMA serum 100%; specificity EMA serum 96.5%; sensitivity EMA saliva 46.5%; specificity EMA saliva 100%; pos. pred. value EMA serum 93.5%; neg. pred. value serum 100%; pos. pred. value EMA saliva 100%; neg. pred. value saliva 78.7%. CONCLUSIONS: Conclusion indicates a high specificity of salivary EMA and a high sensitivity of serum EMA, anyway biopsy is still recommended for diagnosis of CD.

Adolescent↗
PubMed1998

Lack of relationship between the P1A1/P1A2 polymorphism of platelet glycoprotein IIIa and premature myocardial infarction.

BACKGROUND: The P1A1/P1A2 polymorphism of the platelet glycoprotein IIIa has been variably associated with an increased risk of coronary thrombosis. MATERIALS: We investigated the linkage between the P1A1/P1A2 polymorphism and the risk of myocardial infarction in 98 patients who suffered their first myocardial infarction at the age of 45 years or less and 98 well-matched control subjects without coronary artery disease. Lipid parameters were measured using conventional methods of clinical chemistry; P1A genotypes were determined by polymerase chain reaction and restriction enzyme digestion. RESULTS: There was no significant difference in the prevalence of P1A2-positive genotypes (either P1A1/P1A2 or P1A2/P1A2) between patients and control subjects (chi 2 = 0.66, d.f. = 1, P = 0.41). CONCLUSIONS: These results suggest that the P1A2 polymorphism of the platelet glycoprotein IIIa does not contribute to the genetic susceptibility to premature myocardial infarction.

Adult↗
PubMed1997

[Pseudoaneurysm of the left ventricle after mitral valve replacement. Diagnosis 6 years after the intervention].

We present a case of left ventricular pseudoaneurysm diagnosed by chance 6 years after a second surgical intervention on the mitral valve (replacement with a St. Jude prosthesis). A combination of cross sectional and color-Doppler studies led to the correct diagnosis. A transesophageal echocardiographic investigation did not provide further information, while the diagnosis was confirmed by computed tomography with contrast agent. A retrospective analysis of previous examinations revealed that the pseudoaneurysm developed shortly after the mitral valve replacement, remaining stable over the years. The patient was clinically asymptomatic, the size of the pseudoaneurysm did not increase during a 2 years followup, and we decided to follow a conservative treatment.

Aged↗
PubMed1997

[Anticoagulation and electrical cardioversion of chronic atrial fibrillation: proposal for an abbreviated protocol].

BACKGROUND: Several weeks of prophylactic anticoagulation are routinely prescribed before and after electrical cardioversion of atrial fibrillation. Recent studies have supported the use of transesophageal echocardiography to guide early cardioversion: patients in whom no thrombus is observed are treated with heparin followed by one month of warfarin therapy after the procedure. This kind of treatment requires hospital admission during heparin infusion, because of the need for monitoring partial thromboplastin time. AIM OF THE STUDY: To evaluate if a short at-home treatment (three days) with warfarin is sufficient to reach a good level of anticoagulation, in order to permit safe electrical cardioversion in day-hospital for patients who show no thrombi on transesophageal echocardiography. METHODS: One hundred twenty-four patients with atrial fibrillation, who were candidates for cardioversion, were treated with warfarin: 10 mg the first and second day, 5 mg the third day in group A patients (n = 79); 15 mg the first day, 10 mg the second and third day in group B patients (n = 45). On the fourth day, INR value was measured and if it was < 2, warfarin therapy was prolonged until patients reached a good level of anticoagulation. Transesophageal echocardiography was performed when the INR was > or = 2, and patients were cardioverted with DC shock if there were no thrombi. The patients were discharged on the same day of the procedure, and warfarin therapy was continued for 4 weeks there-after. If a thrombus was detected, patients repeated transesophageal echocardiography after 6 weeks of warfarin therapy, and were cardioverted if the thrombus disappeared. Otherwise, cardioversion was deferred and they received prolonged warfarin treatment. If there was poor visualization of the left atrial appendage, patients received conventional warfarin therapy for 3 weeks before and 4 weeks after electrical cardioversion. RESULTS: Mean INR value after three days of warfarin treatment was 2.41 in group A patients and 3.02 in group B patients. Twenty-one patients from group A and 3 patients from group B required anticoagulant therapy for a mean of 3.3 and 5.1 days, respectively, before reaching a good level of anticoagulation (INR value > or = 2). Eight patients reverted spontaneously to sinus rhythm before transesophageal echocardiography. Eighteen thrombi (15.5%) were identified on the transesophageal echocardiography, all of which were in the left atrial appendage. In 11 cases, thrombus disappeared after 6 weeks of warfarin therapy. In 7 patients (6%), the atrial appendage was not sufficiently visualized. Electrical cardioversion was performed on 109 patients and was successful in 88 (80.7%). None of them experienced a clinical thromboembolic event. CONCLUSIONS: In the majority of patients in atrial fibrillation, a short at-home warfarin treatment is sufficient to reach a good level of anticoagulation in order to permit safe electrical cardioversion in a day-hospital situation. Larger initial doses can achieve even better results. This treatment algorithm minimizes the anticoagulation period, hospital stay, overall duration of atrial fibrillation and the time required for the mechanical function of the left atrium to return.

Adult↗
PubMed1997

[Natriuretic peptides and the heart. Critical review and application].

This paper deals with a literature survey on natriuretic peptides (NP) and their clinical use in prognostic stratification and therapy of arterial hypertension and cardiac failure. After a brief historical introduction, the phylogenesis of NP is analyzed and the reasons of their preservation in the evolution are emphasized. The biochemistry of the NP is then treated, and the structure, synthesis, mechanism of cellular action and systems of regulation are analyzed. Subsequently, the authors have analyzed the physiology of the NP as well as their hemodynamic and biohumoral effects and actions on the central nervous system. A literature review on the significance of NP in arterial hypertension, on their usefulness as indicators of damage and on their therapeutic practice is then made. In particular, the possible future applications in the prevention of atherosclerotic damage are analyzed. The significance of NP and of their metabolites in heart failure and the prognostic implication of these peptides particularly in ischemic heart failure are then discussed. The most important papers on this topic are described. Finally the studies on the use of NP in the therapy of heart failure are analyzed and a guide on research of this topic is defined.

Atrial Natriuretic Factor↗
PubMed1996

[Clinical characteristics critical for patients "recovered" after surgical treatment for temporal lobe epilepsy].

We analyse subjective and objective clinical manifestations, in 33 patients, among the 63 with "pure" temporal lobe epilepsy, for which we obtained at least a video-EEG or video-stereo-EEG ictal recording. We compared video-EEG recordings (103 seizures, mean 3.9; min 1, max. 23) and video-stereo-EEG recordings (77 seizures, mean 3.2; min 1, max. 13) with anamnestical data, in order to define the degree of reliability of patient and relatives reports. Overall agreement between anamnestic and video-recorded informations is excellent for subjective symptoms, and fairly good for objective signs. Subjective manifestations (reported in 90.1% of this group) are described in detail as well as the objective ones, these latter split divided into early and late manifestations.

Electroencephalography↗
PubMed1995

[Transesophageal echocardiography in patients with atrial fibrillation, candidates for cardioversion: usefulness and limitations].

BACKGROUND: Thromboembolic complications after electrical cardioversion (CV) of atrial fibrillation (AF) have been attributed to the dislodgment of preexistent left atrial thrombus during the resumption of atrial contraction. Transesophageal echocardiography (TEE) has been used to identify patients without thrombus, who potentially could undergo CV without anticoagulation. However, embolic events after CV in patients without evidence of thrombus on TEE have recently been reported. AIM OF THE STUDY: To evaluate if absence of thrombi or prethrombotic conditions such as spontaneous echo contrast or left atrial appendage disfunction can justify electrical CV without anticoagulant therapy. METHODS: Seventy-four patients with AF and candidates for CV underwent monoplane TEE. Patients were cardioverted without anticoagulation in case of: 1) absence of thrombus and/or spontaneous echocardiographic contrast and 2) good visualization of left atrial appendage, with a well defined peak blood flow velocity greater than 20 cm/sec. In all other cases, patients underwent anticoagulant therapy which started 3 weeks before CV and continued for 4 weeks afterwards. RESULTS: Forty-six patients, without thrombus or "prethrombotic" conditions, did not receive anticoagulation, while 28 followed traditional therapy with warfarin. Four patients with a thrombus in the left atrial appendage were identified: 1 died of cerebral embolism 3 days after the beginning of anticoagulation, in another one CV was definitely deferred because of the persistence of thrombus after 1 month of warfarin therapy. One patient, with left atrial appendage disfunction, died suddenly after 5 days of anticoagulation. Two patients reverted spontaneously in sinus rhythm. Two patients refused electrical CV. The remaining 67 patients underwent electrical CV which was successful in 56 of them. Cerebral embolism occurred 24 hours after CV in one patient who did not receive anticoagulation. Repeat TEE soon after embolism showed absence of thrombus or spontaneous echo contrast, but the presence of low flow velocity in the left atrial appendage. CONCLUSIONS: In patients in AF candidates for CV, exclusion of thrombi or prethrombotic conditions by TEE does not exclude the risk of thromboembolic events and the need for anticoagulant therapy. Left atrial appendage function can be stunned or impaired immediately after CV, favouring a thrombogenic milieu and subsequent embolic events. Therapeutic anticoagulation at the time of as well as after cardioversion is actually recommended.

Aged↗
PubMed1993

Streptokinase induces intravascular release of platelet-activating factor in patients with acute myocardial infarction and stimulates its synthesis by cultured human endothelial cells.

BACKGROUND: Reocclusion of a successfully recanalized infarct-related artery may account for failure of thrombolytic therapy. Evidence suggests that the intravascular activation of platelets may limit the response to this treatment. The aim of the present study was to investigate whether platelet-activating factor (PAF), an ether lipid mediator with multiple potent biological activities, is synthesized during therapy with thrombolytic agents. Two sets of experiments were performed: (1) we extracted and quantified PAF in blood of patients with acute myocardial infarction treated or untreated with streptokinase (SK), and (2) since the endothelium/platelet interaction is thought to be at the basis of vascular reocclusion, we studied whether cultured human endothelial cells synthesize PAF after stimulation with SK or plasmin. METHODS AND RESULTS: PAF was extracted from blood samples immediately after acidification to destroy the acid-labile PAF-acetylhydrolase in 25 patients with acute myocardial infarction treated (group A, n = 14) and untreated (group B, n = 11) with intravenous infusion of SK. PAF was detected in 10 of 14 patients of group A and none of group B. PAF began to be detectable 60 to 90 minutes after SK infusion and disappeared from the circulation within 120 to 180 minutes. Percent variation of platelet count over basal values correlated negatively with the amount of PAF present in the circulation at 90 minutes (r = -.719; P < .001) and at 120 minutes (r = -.652; P < .001). Cultured human umbilical cord vein-derived endothelial cells (ECs) synthesized PAF in a dose-dependent manner in response to SK and plasmin, with a synthesis that peaked at 15 minutes and persisted up to 30 minutes for SK and 2 hours for plasmin. PAF extracted from blood samples or from ECs was quantified by bioassay performed after purification by thin-layer chromatography and high-performance liquid chromatography (HPLC). PAF-bioactive material was characterized as PAF with physicochemical and enzymatic treatments, HPLC-tandem mass spectrometry, and specific PAF-receptor antagonists. CONCLUSIONS: The observation that PAF was detectable in the blood of patients of group A only after treatment with SK and was not detectable in patients with a comparable infarct not treated with SK (group B) suggested that SK stimulates the synthesis of this mediator either directly or via plasmin generation. Indeed, cultured human ECs synthesize PAF after stimulation with both SK and plasmin. PAF production by ECs may promote platelet activation and interaction of these cells as well as of circulating leukocytes with endothelium. These events may limit the beneficial effects of thrombolytic therapy.

Cells, Cultured↗
PubMed1993

[Cor triatriatum associated with inter-atrial defect: diagnosis by transesophageal echocardiography].

Cor triatriatum (CT) is a rare malformation consisting of a fibromuscolar membrane that subdivides the left atrium in a postero-superior (or accessory) chamber and an antero-inferior chamber (true left atrium, containing the left atrial appendage). In its classic form, the accessory chamber receives the pulmonary veins and communication with the left atrium is accomplished by way of one or more fenestrations in the membrane. The malformation is usually isolated, but in about one in four patients is associated with other congenital defects of a complex nature. We describe a case of CT associated with atrial septal defect, in which transthoracic echocardiography failed to document the existence of CT membrane, while this abnormality was clearly seen and defined by use of transesophageal echocardiography. The patient was a 26 year-old girl, presented at our outpatient clinic after an episode of palpitations and dyspnea, which lasted for two hours. She suffered of mild dyspnea on exertion during the last three months. Physical examination revealed the typical findings of an atrial septal defect (ASD), and the electrocardiogram revealed right bundle branch block. The two-dimensional echocardiography disclosed an ostium secundum ASD with left to right shunt; dilatation of the right cavities; paradoxical movement of the interventricular septum. A small linear echo originating from the lateral wall of the left atrium, with no evidence of turbulent flow on pulsed wave Doppler and color flow examination, was interpreted as an artifact. Transesophageal echocardiography clearly visualized a tense, bulging membrane separating left atrium into two chambers.(ABSTRACT TRUNCATED AT 250 WORDS)

Abnormalities, Multiple↗
PubMed1992

Value of exercise stress test, radionuclide angiography and coronary angiography in predicting new coronary events in asymptomatic patients after a first episode of myocardial infarction.

One-hundred-and-fifty-five consecutive symptom-free patients underwent maximal treadmill exercise testing, rest and stress radionuclide angiography at least two months after an uncomplicated acute myocardial infarction; of these, 90 underwent coronary angiography. All patients were followed-up for a mean of 32 +/- 13 months regarding the prediction of hard (death and reinfarction) and soft (angina and coronary surgery) coronary events. The specificity, sensitivity, positive and negative predictive value of exercise stress test were 47%, 76% and 41% for any coronary events; none of the patients who incurred a hard coronary event showed ischemia during electrocardiographic exercise tests. Sensitivity, specificity and positive predictive value for failure to increase the ejection fraction of at least 5% were 60%, 45% and 30% for any coronary event and 25%, 49% and 2% for any hard coronary event. The presence of multivessel disease at coronary angiography showed a sensitivity of 62% for any coronary event and of 67% for hard coronary events; specificities were 66% and 57%, and predictive values were 52% and 10%, respectively. It is concluded that electrocardiographic exercise testing, radionuclide angiography and coronary angiography are not helpful two months after an episode of uncomplicated myocardial infarction in order to identify patients who will suffer a new coronary event.

Adult↗
PubMed1991

Intracoronary streptokinase in unstable angina: a prospective randomised study.

Results of our prospective, randomised pilot trial to evaluate the clinical effects and the angiographic correlates of early thrombolysis in patients with unstable angina are reported. Sixty-seven patients had coronary angiography 10 +/- 8 (median 7) hours after an episode of transient chest pain at rest with reversible ischaemic changes on the electrocardiogram. Patients with left main disease (4), or diffuse coronary disease and unidentified ischemia-producing lesions (13) were excluded, as were those without severe (greater than or equal to 70%) stenosis (10). Intracoronary thrombus was identified at angiography in 7 patients (17%) and complex coronary lesions in 5 (12%) of the remaining 40 patients who were randomised to either intracoronary streptokinase 250,000 IU followed by intravenous heparin along with conventional treatment (20 patients), or to conventional treatment alone (20 patients). All patients received Aspirin. No differences between the streptokinase and the conventional treatment groups were observed with respect to demographic and clinical characteristics at admission to the study. During observation in the intensive care unit for 3 +/- 1 days, 8 patients (40%) with streptokinase and 10 (50%) with conventional treatment were free from angina and infarction (p = 0.75; 95% confidence interval for the difference in response rates = -20 to 40%). There were no bleeding complications and no patient died. Patients enrolled in our study had fewer coronary thrombi at angiography than currently reported. Our data did not show that adjunct treatment with streptokinase and heparin is superior to conventional treatment alone in these patients.

Aged↗
PubMed1990

[The midterm clinical results of myocardial revascularization with the internal mammary artery].

After a 3-year (1985-1988) experience of myocardial revascularization using internal mammary artery (AMI) grafts and after having excluded (1986) an higher operative mortality and morbidity, clinical medium-term results have been analysed. The first 144 patients discharged alive after AMI bypass surgery in 1985 were clinically evaluated, with a mean interval of 21 months from surgery (range: 5-29 months). Exercise electrocardiographic test was performed by 100 patients, and angiography repeated in 15. Actuarial survival function was estimated by Cutler-Ederer method: 2-year actuarial survival was 99.3 +/- 0.7% (94 +/- 1.8%, when operative deaths were included). Non fatal myocardial infarction occurred in 3 patients and, at follow-up, 26 were symptomatic for angina: 2 patients underwent re-operation and 2 angioplasty. Two years after AMI bypass surgery, actuarial estimate of ischemic event-free patients was 70.9 +/- 4.5% (67.7 +/- 4.5%, when operative deaths were included): 73 out of 100 exercise tests were negative for both angina and ischemia, although only 43 patients, reached maximal work load; 9 were positive for both angina and ischemia and 18 for ischemia only. All patients who underwent angiographic evaluation (15 patients, 11 of whom because of angina relapse) had AMI grafts open, while in only 4 patients all the implanted grafts were open.

Aged↗