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Biomedical subjects

N Marchionni

Publications and source records attributed to N Marchionni.

At least 19 recordsLinked to original sources
PubMed1998

Vascular entrapment of a ruptured intra-aortic balloon: a case report of successful removal without surgery.

Intra-aortic balloon pump entrapment is a rare complication that may necessitate major abdominal surgery that is potentially life threatening in the critically ill patients who require balloon counterpulsation. We report successful removal of a ruptured and entrapped intra-aortic balloon pump catheter after use of streptokinase solution to clear clots from the device. We suggest this procedure as a safer, nonsurgical method that may eliminate the need for abdominal surgery.

Aged↗
PubMed1998

Aims, design and enrollment rate of the Cardiac Rehabilitation in Advanced Age (CR-AGE) randomized, controlled trial.

Data regarding the efficacy of cardiac rehabilitation after acute myocardial infarction in advanced age are limited, and are derived from either controlled but non randomized trials, or observational studies. Several aspects of cardiac rehabilitation after myocardial infarction in advanced age, including its effectiveness on exercise tolerance and health-related quality of life, as well as the feasibility of rehabilitation programs, need clarification. The objectives of this randomized, controlled trial, Cardiac Rehabilitation in Advanced Age (CR-AGE), are to examine the effects of an 8-week comprehensive cardiac rehabilitation intervention, comparing 1) supervised outpatient, hospital-based cardiac rehabilitation, 2) home-based cardiac rehabilitation, and 3) usual care in each of three groups of post-myocardial infarction patients, 45-65, 66-75, and 76-85 years of age. The primary objective of the trial is to evaluate the change in physical fitness in each age group assessed by total work capacity at the end of the intervention, and during follow-up over both the medium- (6 months) and the long-term (1 and 2 years). Secondary objectives of the trial include an examination of the feasibility of cardiac rehabilitation in older patients, as well as the determination of the following: exercise complication rates; changes in peak oxygen consumption; changes in other outcome measures, such as health-related quality of life, prevalence of anxiety and depressive symptoms, fluid intelligence, body composition and mass index; incidence of new cardiac and non-cardiac events; and utilization rates of health care services. Enrollment in the CR-AGE trial is expected to be completed within the first half of 1998.

Aged↗
PubMed1998

Effective arterial elastance and the hemodynamic effects of intraaortic balloon counterpulsation in patients with coronary heart disease.

OBJECTIVES: The goal of the present study was to analyze the effects of different intraaortic balloon counterpulsation (IABC) inflation volumes on effective arterial elastance (Ea) in patients with complicated coronary heart disease and to determine whether Ea can predict the hemodynamic response to IABC. BACKGROUND: Ea (the central aortic end-systolic pressure to stroke volume ratio) incorporates the principal elements of input arterial impedance and has been proved useful to evaluate the effects of afterload reduction in patients with left ventricular (LV) failure. However, although the hemodynamic action of IABC can be considered as a typical example of "pure" afterload reduction, it has never been assessed in terms of changes in Ea. METHODS: After clinical stabilization, 18 patients treated with IABC for complicated acute myocardial infarction or unstable angina were enrolled in the study. Systemic hemodynamics were measured by use of right cardiac thermodilution catheters with IABC off (control) and IABC on at balloon inflation volumes of 20 and 40 ml, in randomized sequence. Aortic pressure was recorded through the central lumen of the IABC catheter to calculate Ea as the ratio of aortic dicrotic pressure to stroke volume. RESULTS: A higher control Ea was associated with a lower control LV stroke work and a larger IABC-related hemodynamic improvement (that was maximal with the 40 ml inflation volume). The increase in LV stroke work was closely related to the decrease in Ea. Accordingly, hemodynamic benefits from IABC were less evident in patients with lower control Ea. In conclusion, effects of IABC were related to both balloon inflation volume and control hemodynamics, reflecting the afterload dependence of a depressed LV function.

Aged↗
PubMed1998

Constant hierarchic patterns of physical functioning across seven populations in five countries.

This research was aimed at identifying critical steps in the decline in physical function that often parallels aging. Six basic and nine instrumental activities of daily living (ADLs) were classified into four domains of disability characterized by specific underlying physical impairment. The hierarchical order of this classification was verified in two random samples representative of the older home-dwelling population. The concordance level of disability and results of performance-based measures of physical function were also tested. Finally, the cross-cultural reliability of the model was verified in seven population-based samples of older persons living in five European countries. In older persons the disabling process follows a general pattern of progression based on a typical sequence of impairments.

Activities of Daily Living↗
PubMed1997

Item re-scaling of an Italian version of the sickness impact profile: effect of age and profession of the observers.

An Italian version of the Sickness Impact Profile (SIP) obtained by professional and nonprofessional translators was checked for cross-cultural equivalence using a back-translation method followed by two scaling studies. The first scaling study involved 30 health professionals who ranked the items within each category for severity of dysfunction. By comparing Italian and US average ranks, 14 highly discordant items were identified. A revised translation was evaluated in a new study involving 120 observers stratified by age (< 65 versus > or = 65 years) and profession (health versus non health professionals) into 4 groups of the same size. The Italian and American item rank orders were almost equivalent, independently of the age and profession of the observers (93% of the ranks showing differences < 2), suggesting that this Italian version of SIP is cross-culturally unbiased. However, older age was associated with higher variability in the rank orders, and some caution is required for use in the geriatric population.

Adult↗
PubMed1995

Association of serum creatinine and age with headache caused by nitrates. Gruppo Italiano di Farmacovigilanza nell'Anziano.

To assess whether serum creatinine and age are associated with headache induced by nitrates, 2742 hospitalized patients taking nitrates were studied during their hospital stay. Those patients with admission serum creatinine levels from 97 to 133 mumol/L and > 133 mumol/L were compared with patients with creatinine levels < 97 mumol/L. Gender, body mass index, comorbidity, cognitive status, new intake of nitrates, number of daily administrations, and daily dosage, as well as intake of angiotensin converting enzyme inhibitors, calcium antagonists, diuretics and nonsteroidal anti-inflammatory drugs were examined as possible confounders. Fifty-six patients had headaches that had a causal link with intake of nitrates. Compared with the lowest creatinine group, after adjustment for potential confounding variables, the odds ratios and 95% confidence interval (95% CI) for headache caused by nitrates associated with increasing serum creatinine levels were 0.6 (95% CI, 0.3 to 1.1) and 0.2 (95% CI, 0.0 to 1.2), respectively (p for trend = 0.013). Increasing age was inversely associated with headache (odds ratio for 10-year increase, 0.6 [95% CI, 0.5 to 0.7]). Serum creatinine and age were independently and inversely associated with headache caused by nitrates.

Aged↗
PubMed1995

Immediate and long-term survival after intra-aortic balloon pumping: is advanced age an independent, unfavorable prognostic factor?

OBJECTIVE: To determine whether advanced age is an independent prognostic factor that may increase the risk of complications and reduce the immediate and long-term survival after treatment with intra-aortic balloon pumping (IABP) for acute ischemic heart disease. DESIGN: Retrospective analysis of a clinical series and long-term follow-up study. PATIENTS: A total of 142 patients (age range 23-86 years) in whom IABP was indicated following a standardized protocol. MEASUREMENTS: Univariate analysis of the association between age and anamnestic, clinical, and hemodynamic data significantly affecting prognosis; multivariate logistic regression analysis of variables showing significant associations. RESULTS: IABP-related complications were independent of age. At univariate analysis, pre-existing, noncardiac, associated conditions (chronic renal failure, stroke, bronchopulmonary disease) (P < .001), an indication to IABP for hemodynamic complications of acute myocardial infarction rather than for medically refractory myocardial ischemia (P < .001), a lack in hemodynamic response to IABP (P < .002), a prolonged delay to IABP initiation (P < .003), and advanced age (P < .025) were all predictors of in-hospital mortality. However, older patients were also more frequently affected by chronic comorbid conditions and by acute left ventricular failure as an indication to IABP. When these variables were entered into logistic regression models, the association between age and mortality was no longer statistically significant. Similarly, advancing age was associated (P < .012) with an increased mortality rate during an average follow-up of 94 +/- 9 months, but, again, such a significant association disappeared when simultaneously adjusting for New York Heart Association functional class, which was the single most important predictor of long-term mortality. CONCLUSIONS: Several anamnestic and clinical variables, rather than advanced age itself, are independent, prognostic factors negatively affecting the outcome of treatment with IABP. Technique-related complications are independent of age. Thus, old age should not be considered as a criterion to exclude any patient, a priori, from the potential benefits of this type of cardiocirculatory assistance.

Acute Disease↗
PubMed1994

Improved exercise tolerance by cardiac rehabilitation after myocardial infarction in the elderly: results of a preliminary, controlled study.

Elderly patients are commonly excluded from cardiac rehabilitation after myocardial infarction (MI). The present controlled, non-randomized trial was undertaken as a preliminary study to compare some effects of cardiac rehabilitation between patients younger and older than 65 years without contraindications to physical exercise. Baseline total work capacity (TWC) was assessed by a maximal ergometric stress testing 4 weeks after MI. Patients were then prospectively enrolled into an 8-week ambulatory rehabilitation program (R-group: age < or = 65 N = 16; age > 65 N = 16). Those who refused or who could not participate in the program because of logistic difficulties served as controls (NR-group: age < or = 65 N = 16; age > 65 N = 14). In spite of non-randomized allocation, clinical characteristics did not differ between either treatment groups or age groups. TWC was re-assessed at 8 weeks from baseline evaluation in all patients. The number of completed training sessions in the R-group, and the proportion of sessions which were suspended for physiological or pathological (adverse events during exercise) causes were similar under and over 65 years. TWC increased (p < 0.001) in the R-group, the improvement being similar in the two age cohorts (< or = 65: +55% vs > 65: +65%, NS). A spontaneous enhancement of TWC (+37%, p < 0.001) occurred among younger controls as well. Only older controls did not improve their TWC; moreover, their +16% change was significantly (p < 0.05) less than the +65% increase obtained by the R-group of the same age.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1993

Relationship between health status, fluid intelligence and disability in a non demented elderly population.

This study examines the impact of overall health status and common chronic medical conditions on cognitive performance in an older population and the effect of poor cognitive performance on functional disability. The study population consisted of 485 subjects who were 77 and 78 years old, and residing in district No. 6 of the city of Florence; all participants underwent a structured interview to collect information on demographics, education, physical health, disability, and cognitive status. Data from 94 subjects, who were previously diagnosed as affected by dementia or other conditions known to be direct causes of cognitive impairment, and from 6 subjects, who scored less than 20 in the Mini-Mental State Examination, were excluded from the analysis. The number of chronic conditions, drugs used, contacts with the physician, days in bed, and days of hospitalization in the last 6 months were considered as indicators of physical health. Functional disability was assessed evaluating both ADLs and IADLs. The Mini-Mental State and the "Blocks" test, a component of the Wechsler Adult Intelligence Scale Revised, were used for the assessment of cognitive status. After adjusting for the level of formal education, physical health status and several specific chronic conditions were predictors of cognitive performance. A significant association was found between a low "Blocks" test score and a decreased level of functional status. In a multivariate model, better performance on the "Blocks" test was associated with a higher score in the disability scale. This association was independent of the effect of education. The results suggest that in the elderly, poor health status is associated with a cognitive impairment that can be measured by the "Blocks" test. However, the role of this association in the pathway from disease to disability remains unclear.

Activities of Daily Living↗
PubMed1993

Acute and long-term effects of flosequinan in patients with chronic cardiac failure.

The acute and long-term effects of the orally active vasodilator flosequinan were assessed in 10 patients with New York Heart Association class II to IV cardiac failure. Baseline hemodynamics, exercise capacity, left and right ventricular ejection fraction, and pulmonary transit time were measured by right cardiac catheterization, bicycle ergometer stress testing, and nuclear angiocardiography during a run-in period on placebo. Acute hemodynamic effects of flosequinan were monitored for 48 hours; the drug was then given as a single 100 mg daily dose for 6 weeks. Exercise capacity was reevaluated every 2 weeks, and right cardiac catheterization and nuclear angiocardiography were repeated at the end of the 6-week period. Placebo did not exert any effect. Flosequinan reduced right atrial, pulmonary artery, and pulmonary artery wedge pressures from 60 minutes to 48 hours after dosing. Heart rate was minimally increased. Cardiac index, mean systemic arterial pressure, and systemic and pulmonary vascular resistance were substantially unaffected. These effects were maintained after 6 weeks. Exercise capacity was enhanced after 2, 4, and 6 weeks. Left ventricular ejection fraction was unchanged, whereas right ventricular ejection fraction and pulmonary transit time were improved. In conclusion, flosequinan exerted a potent, long-lasting, venodilating effect that was maintained long-term, without evidence of tolerance.

Aged↗
PubMed1992

Synergistic action of postextrasystolic potentiation and diperdipine on left ventricular wall motion abnormalities in coronary heart disease.

The effects on left ventricular function of postextrasystolic potentiation and the dihydropyridinic calcium antagonist diperdipine, alone or in combination, were studied in 14 patients with coronary heart disease by means of two consecutive left ventricular angiographies. To ensure the reproducibility of coupling intervals of the extrasystolic and postextrasystolic beats, the heart was paced during both angiographies. Results showed that postextrasystolic potentiation and diperdipine improved left ventricular ejection fraction to the same degree, but the mechanisms of such an improvement were different and consisted, respectively, of a positive inotropic effect associated with an increase in preload and a slight increase in preload coupled with a marked decrease in afterload. Diperdipine did not abolish the inotropic component of postextrasystolic potentiation, and a combination of the two interventions had additive effects on the improvements in left ventricular ejection fraction and regional wall motion analyzed by the centerline method. Ventricular segments that were normokinetic or hypokinetic during the control basal cycle responded equally to postextrasystolic potentiation and to diperdipine, whereas the former intervention alone had no significant effect on akinetic segments. Diperdipine restored the responsiveness of akinetic segments to postextrasystolic potentiation, a finding that, although it remains to be confirmed by independent techniques, may be interpreted as a possible consequence of improved calcium metabolism or coronary flow in ischemic but still viable myocardium. However, it is concluded that the calcium antagonist revealed a contractile reserve in most of the severely asynergic areas, which would have otherwise been judged to be irreversibly damaged on the basis of the unresponsiveness to postextrasystolic potentiation alone.

Calcium Channel Blockers↗
PubMed1991

Acute hemodynamic effects of intravenous diperdipine, a new dihydropyridine derivative, in coronary heart disease.

The acute hemodynamic effects of a new dihydropyridine calcium channel blocker, diperdipine, which is suitable for intravenous administration, were studied by right and left cardiac catheterization in 16 patients with coronary heart disease. Diperdipine markedly reduced systemic vascular resistance and improved stroke index and left ventricular ejection fraction. Mean pulmonary artery and wedge pressures were slightly increased as a possible consequence of enhanced venous return, whereas right atrial and left ventricular end-diastolic pressures were not significantly changed. Nevertheless, an increase in preload was clearly indicated by an augmented left ventricular end-diastolic volume index after administration of diperdipine. Left ventricular contractility, which was estimated by the end-systolic pressure-volume ratio and by dP/dt max was not significantly changed, though analysis of individual data suggests a minimally negative inotropic effect. However, such a minor effect on left ventricular contractility was largely counterbalanced by the marked reduction of afterload, which produced a sharp improvement of stroke index. Enhancement of left ventricular ejection fraction and reduction in systemic vascular resistance were inversely and directly correlated to control values. Overall, diperdipine was well tolerated, but one patient had a major untoward reaction that consisted of an ischemic episode that was possibly related to drug administration. In conclusion, intravenous diperdipine appears to be a potent arteriolar dilating agent that does not affect left ventricular contractility.

Calcium Channel Blockers↗
PubMed1991

Value of combined assessment of physical health and functional status in community-dwelling aged: a prospective study in Florence, Italy.

A survey of the health and social conditions of a representative sample of 967 persons aged 60 years and older from the city of Florence, Italy, was undertaken in 1980. In 1987, a follow-up survey of this cohort was performed. There were 391 documented deaths, 408 survivors, and 168 individuals who could not be located. Functional ability at baseline was assessed using a World Health Organization 14-item scale. Indicators of physical health status included chronic disease status, number of drugs, physician visits, and days of hospitalization. After adjustment for age and sex, both functional ability and indicators of physical health status were found to be independent, statistically significant predictors of mortality. The results of this study further support the view that biomedical and functional assessment are both necessary for a comprehensive evaluation of the older population.

Activities of Daily Living↗
PubMed1990

Age-related changes in the pharmacodynamics of intravenous glyceryl trinitrate.

Comparable hemodynamic effects were obtained administering a much lower intravenous dose of glyceryl trinitrate (GTN) in elderly than in younger patients. The pharmacodynamics and kinetics of GTN were thus assessed in 2 groups of patients with acute myocardial infarction (group A: less than or equal to 65 years, 6 patients; group B: greater than or equal to 75 years, 6 patients). The arterial and venous dose-concentration relationship and the associated hemodynamic changes at end-point (EP: 10% reduction in mean systemic arterial pressure) were similar in the 2 groups. However, in older subjects EP was reached at a lower GTN infusion rate (0.11 +/- 0.04 vs 0.33 +/- 0.11 micrograms.kg-1.min-1, mean +/- S.D.; p less than 0.001), and with lower arterial and venous drug concentrations (arterial [GTN]: 1.2 +/- 0.1 vs 4.6 +/- 1.2 ng.ml-1; p less than 0.01; venous [GTN]; 0.09 +/- 0.05 vs 0.35 +/- 0.15 ng.ml-1; p less than 0.05), whereas overall GTN kinetics appeared to be substantially independent of age. Thus, the enhanced efficacy of GTN in advanced age seems to stem mainly from pharmacodynamic changes, which may be the consequence of dampened baroreceptor reflexes, as suggested by a lower heart rate increase per unitary fall in systolic arterial pressure observed in group B (0.12 +/- 0.07 vs 0.41 +/- 0.29 b.min-1.mmHg-1; p less than 0.05).

Aged↗
PubMed1990

Effects of diltiazem on postextrasystolic potentiation in coronary heart disease patients.

The effects of the calcium antagonist, diltiazem (D), on left ventricular (LV) response to postextrasystolic potentiation (PESP) were investigated in 15 coronary artery disease patients. Several haemodynamic and LV function parameters, as well as regional wall kinetics, were analysed. During LV angiography, which was performed before and after D administration (0.25 mg kg-1 bolus and 1.4 microgram kg-1 min-1 infusion), programmed atrial stimulation was applied with the sequence: S1-S1 = 600 ms; S1-S2 = 400 ms; S2-S3 = 800 ms. The results indicate that D exerts a mild negative inotropic effect which is more evident in the postextrasystolic beat (postextrasystolic ESP/ESV and dP/dtmax were significantly lower after D) but the postextrasystolic increase of EF is maintained by the effects of the drug on loading conditions of the left ventricle. Our results indicate that both a reduction of afterload and an increase of preload take place after D. The greater preload reserve induced by the drug (EDVI was significantly higher in each patient after D) was associated with a slight increase in left ventricular filling rate, while end-diastolic compliance and pressure did not show significant variations. These results suggest that the increase in left ventricular preload is due to an increase in left atrial driving pressure, an improvement of left ventricular relaxation or both. D does not affect regional wall kinetics either in basal or in the postextrasystolic beat when overall areas are considered, however its effect seems to be related to the degree of basal regional contraction.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Prognostic significance of early clinical manifestations in postanoxic coma: a retrospective study of 58 patients resuscitated after prehospital cardiac arrest.

The neurologic progress for 58 patients resuscitated after prehospital cardiac arrest was analyzed in order to evaluate their prognostic significance. Twenty-four patients were conscious on admission; their inhospital mortality rate was 4%. Thirty-four patients showed alterations of their state of consciousness; their inhospital mortality rate was 53%. On admission, only the absence of spontaneous breathing was significantly predictive of an unfavorable outcome. The failure of response to painful stimulation and pupillary light reflex became significantly predictive of an unfavorable outcome only in the late inhospital course. The time delay before onset of CPR was significantly longer in unconscious patients, but in this group no difference was observed between survivors and nonsurvivors. At discharge, no patient was in a comatose or vegetative state; three patients showed severe neurologic impairment. These data indicate that, in patients with postanoxic coma, early clinical evidence of severe neurologic dysfunction is predictive of neither inhospital death nor neurologic sequelae.

Aged↗