Biomedical subjects

O de Divitiis

Publications and source records attributed to O de Divitiis.

At least 37 records · Page 2Linked to original sources

PubMed1998

Use of pulsed Doppler tissue imaging to assess regional left ventricular diastolic dysfunction in hypertrophic cardiomyopathy.

In this study, regional diastolic patterns and their relations with transmitral Doppler inflow were investigated in hypertrophic cardiomyopathy (HC) by pulsed Doppler tissue imaging (DTI). Doppler echocardiography and DTI of basal septum and lateral wall (apical 4-chamber view) were performed in 20 patients (15 men and 5 women) with HC and in 10 healthy subjects (7 men and 3 women). Diabetes, hypertension, coronary artery and valvular disease, mitral regurgitation, New York Heart Association functional classes III to IV, sinus tachycardia, atrial fibrillation, and inadequate echocardiograms were exclusion criteria. Peak velocity and time-velocity integral of early and late waves and their ratios, and deceleration and isovolumic relaxation times were determined by standard Doppler and by DTI at the septal and lateral wall levels. The 2 groups were comparable for age, heart rate, blood pressure, and ejection fraction. Transmitral peak velocity and time-velocity integral E/A ratios were reduced (both p <0.05) and deceleration and isovolumic relaxation times prolonged (both p <0.00001) in HC. Septal DTI showed lower peak velocity and time-velocity integral e/a ratios (p <0.00001 and p <0.001, respectively) and lengthened regional deceleration (p <0.01) and isovolumic (p <0.001) relaxation times. DTI of the lateral wall showed a prolongation of deceleration and isovolumic relaxation times (both p <0.01). By dividing HC according to transmitral E/A, 8 patients with E/A <1 had lower DTI septal e/a ratio (p <0.01) and prolonged septal deceleration and isovolumic relaxation times (both p <0.01) but no changes in DTI pattern of lateral wall than 12 patients with E/A > 1. In conclusion, DTI is useful and complementary to standard Doppler imaging to characterize diastolic properties in HC, reflecting a typical pattern of intramyocardial impaired relaxation at the level of hypertrophied septum and also providing information about the degree of this regional impairment. The lateral wall presents minor changes in diastolic times, which indicate how diastolic asynchrony is not confined to the hypertrophied segment in HC.

Adult↗

PubMed1998

Impact of heart rate and atrioventricular delay on left ventricular diastolic filling in patients with dual-chamber pacing for sick sinus syndrome or atrioventricular block.

We examined the effect of left ventricular filling on different combinations of programmable heart rate and atrioventricular delay in patients with dual-chamber pacemakers. Pacing mode with heart rates of 60 beats/min and 156 ms of atrioventricular delay induced a diastolic pattern that resembles more than others the one observed in healthy subjects in sinus rhythm.

Aged↗

PubMed1998

Anomalous meningeal branches of the ophthalmic artery feeding meningiomas of the brain convexity.

Many anomalies may involve the ophthalmic and middle meningeal arteries, because of the close relationship of their development. The system of the ophthalmic artery may supply the dural convexity by the middle meningeal artery of ophthalmic origin, the anterior branch of the middle meningeal artery or an accessory meningeal artery. The development and the anatomic arrangement of these anomalous vessels are discussed. Three cases of meningiomas of the brain convexity supplied by anomalous meningeal arteries arising from the ophthalmic artery are described. In one case internal carotid angiography showed an anomalous anterior branch of the middle meningeal artery arising from the ophthalmic artery, whereas the maxillary artery provided only the posterior branch of the middle meningeal artery. In two cases the middle meningeal artery system was normal, but the ophthalmic artery provided an accessory meningeal artery supplying the meningioma. Whereas an ophthalmic origin of the middle meningeal artery is rather common, the angiographic finding of an accessory meningeal artery or an anterior branch of the middle meningeal artery arising from the ophthalmic arterial system is exceptional. The preoperative embolization of dural lesions supplied by anomalous meningeal vessels of ophthalmic origin is dangerous because of the risk of embolization into the ophthalmic circle.

Adult↗

PubMed1998

Territories of the perforating (lenticulostriate) branches of the middle cerebral artery.

The territories of the central branches of the middle cerebral artery (MCA) were examined in 21 injected human brains. It was noted that these central arteries supplied: the caudate nucleus (dorsolateral half of the rostral part of its head; the entire caudal part of the head; the body and rostral portion of the tail in some cases), the putamen (dorsolateral part of its rostral portion, the remainder of the putamen, except the most caudal part occasionally), the globus pallidus (the entire lateral segment, except the ventrorostral and, sometimes, the most caudal part), the basal forebrain (lateral parts of the basal nucleus of Meynert and the nucleus of the diagonal band, as well as fiber bundles in this region), the internal capsule (dorsal and ventrocaudal part of the anterior limb, dorsal part of the genu, dorsal and ventrorostral part of the posterior limb), the corona radiata (a narrow strip close to the internal capsule) and the cerebral cortex (the caudal orbitofrontal cortex occasionally). The presented data may have certain neuroradiologic, neurologic and neurosurgical significance.

Adult↗

PubMed1998

[The influence of left systolic ventricular function on right ventricular function after an acute myocardial infarct].

The aim of this study was to assess the interaction between left ventricular and right ventricular systolic function after acute myocardial infarction (AMI). The study population comprises 27 normal subjects and 71 patients assessed at predischarge (12 +/- 7 days) after AMI and divided into two subgroups, 24 with inferior AMI and 47 with non inferior AMI. The three groups were comparable for sex, age, heart rate and blood pressure. Right ventricular function was evaluated by two-dimensional assessment of tricuspid annular plane systolic excursion (TAPSE) and by Doppler analysis of right ventricular outflow tract. Left ventricular systolic function was evaluated by two-dimensional determination of ejection fraction and wall motion score index, and by Doppler analysis of left ventricular outflow tract. The overall AMI population showed reduced TAPSE, velocity-time integral (both p < 0.05) and peak velocity (p < 0.005) of right ventricular outflow tract, prolongation of Q-S2 interval and increase of pre-ejection period/acceleration time ratio (both p < 0.05) in comparison with normals. These alterations were accompanied by a decrease of left ventricular ejection fraction and increase of wall motion score index. (p < 0.0001) The changes of right ventricular indexes were confirmed in patients with inferior AMI who had also lower left ventricular ejection fraction (46 +/- 9%). Functional parameters of the right ventricle were not significantly modified in patients with non inferior AMI who had greater left ventricular ejection fraction (53 +/- 8.6%). In the overall AMI population, and in particular in inferior AMI, we found univariate relations between time-velocity integrals of left ventricular and right ventricular outflow tract and between left ventricular ejection fraction and TAPSE. Only in inferior AMI creatinkinase peak was related to time-velocity integral of right ventricular outflow tract (r = -0.59, p < 0.01). In conclusion, the magnitude of right ventricular systolic impairment developing after left ventricular AMI depends on the degree of left ventricular dysfunction, likewise by changes of hemodynamic load imposed to the right ventricle. AMI location and, only in inferior AMI, infarct extension participate in determining this dysfunction.

Analysis of Variance↗

PubMed1998

The oculomotor nuclear complex in humans. Microanatomy and clinical significance.

This study has been performed to define better the anatomical structure of the oculomotor nuclear complex and its neuronal components. The oculomotor nuclear complex was examined in fixed and serially sectioned midbrains from 12 adult subjects free from neurological diseases. The complex included the somatic portion, (formed by multipolar motor neurons), and the parasympathetic portion, (formed by oval or fusiform preganglionic cells), on each side of the median raphe. The somatic portion consisted of the lateral somatic cell column and the caudal central nucleus. The somatic column measured from 0.2 x 0.1 mm to 3.4 x 1.4 mm (X = 2.4 x 1.2 mm) in transverse section. It was divided into the principal, intrafascicular and extrafascicular parts. The principal part was subdivided into the dorsal, intermediate and ventral portions. Isolated multipolar neurons were also found in the periaqueductal gray matter, the interstitial nucleus of Cajal, the Edinger-Westphal nucleus and the fibre bundles of the oculomotor nerve. These cells most likely represent the displaced motor neurons of the oculomotor nerve. The caudal central nucleus was 0.8 x 0.6 mm in size. The Edinger-Westphal nucleus consisted of the rostral, ventral and dorsal parts; the longest rostrocaudal diameter of this nucleus measured 7.1 mm. The anatomical data of our study are relevant clinically and allow explanation of the neurologic signs following complete or partial lesions of the oculomotor nuclear complex.

Adult↗

PubMed1997

Influence of nighttime blood pressure on left atrial size in uncomplicated arterial systemic hypertension.

The aim of the study was to determine the relations of 24-h blood pressure (BP) and its different phases with left atrial size. A total of 130 subjects (mean age 46 years) not taking cardiac drugs were studied by M-mode and Doppler echocardiography and ambulatory BP recording. Subjects (excluding those with coronary artery or valvular heart disease, heart failure, or diabetes) were classified into two groups: 25 normotensives and 105 hypertensives (history of antihypertensive treatment and office diastolic BP > 90 mm Hg). The two groups were comparable in terms of sex, age, and heart rate, whereas body mass index, (P < .01), office BP, average 24-h BP, and average daytime and nighttime BP (all P < .00001) were higher in hypertensives. Hypertensives also had increased left atrial dimension, left atrial dimension/aortic root ratio (both P < .001), and left ventricular mass (LV) indexed for height (P < .0001). Positive correlations of left atrial dimension were found with office BP, average 24-h, average daytime and nighttime systolic and diastolic BP, LV mass index, and Doppler-derived E/A ratio. In a multivariate model that included potentially confounding factors, only body mass index (standardized beta coefficient = 0.41, P < .00001), average nighttime diastolic BP (beta = 0.33, P < .00001), and male sex (beta = 0.18, P < .01) were independent predictors of left atrial size in the pooled population. In conclusion, left atrial size is more closely related to ambulatory, rather than office, BP measurements, and high average nighttime BP is a powerful marker of left atrial enlargement in arterial hypertension.

Adult↗

PubMed1997

The role of intraoperative sonography in reducing invasiveness during surgery for spinal tumors.

The authors describe the ultrasound-guided surgical approach to 20 spinal tumors (13 extramedullary and 7 intramedullary). Intraoperative sonography (IOS) is important to reduce the extent of the laminectomy and dural opening, thus avoiding useless removal of bone structures. In cases of intramedullary tumors, IOS defines the extent of the posterior myelotomy, the presence of syringomyelic cavities caudal and/or cranial to the tumor and the deep extension of the tumor to the anterior cord surface. For these reasons, the routine use of IOS during surgery for spinal tumors reduces the surgical invasivity of this approach. The advantages and limits of the ultrasound-guided spinal surgery and the operative ultrasonographic findings of different spinal neoplasms are discussed.

Adolescent↗

PubMed1997

Is insulin action a determinant of left ventricular relaxation in uncomplicated essential hypertension?

OBJECTIVE: To examine the relation of insulin action and left ventricular diastolic function in uncomplicated essential hypertension. METHODS: Doppler echocardiography and glucose clamping combined with indirect calorimetry were performed in 29, newly diagnosed, hypertensive men, free from cardiac and metabolic drugs. They were divided into two groups according to the clamp-derived whole-body glucose disposal level: 20 with insulin resistance (whole-body glucose disposal < 33 mumol/kg per min) and nine with normal insulin sensitivity. RESULTS: The two groups were comparable in age, body mass index, heart rate and blood pressure. No difference in diastolic function was found except for the isovolumic relaxation time, which was prolonged for patients with insulin resistance (P = 0.02). For the population as a whole, the relaxation time had univariate relations with the left ventricular mass index (r = 0.57, P < 0.001), whole-body glucose disposal (r = -0.56, P < 0.001) and non-oxidative glucose metabolism (r = -0.54, P = 0.002). In a multivariate model including age, body mass index, heart rate, diastolic blood pressure, left ventricular mass index and whole-body glucose disposal as potential determinants, only the left ventricular mass index (beta = 0.39, P = 0.02) and whole-body glucose disposal (beta = -0.38, P = 0.03) were independent predictors of the relaxation time (R2 = 0.43, P < 0.001). CONCLUSIONS: In uncomplicated essential hypertension the insulin resistance is a determinant of abnormalities in isovolumic relaxation, independently from the influence exerted by increased blood pressure levels, being overweight and left ventricular hypertrophy.

Adult↗

PubMed1997

Regional diastolic function in normotensive versus hypertensive subjects: comparison using Doppler myocardial imaging.

BACKGROUND: Pulsed Doppler myocardial imaging (DMI) is a new technique that makes it possible to obtain an on-line quantitative assessment of wall motion in different myocardial segments through sample-volume placement. Therefore, this tool is suitable for identifying changes in regional diastolic function in uncomplicated arterial hypertension. In this study, we examined standard Doppler-derived indexes of global left ventricular diastolic function and regional diastolic parameters obtained by pulse-wave DMI in a population of hypertensive patients, comparing them with the indexes found in a control group of normotensive subjects. METHODS: Thirty-six patients with uncomplicated hypertension and 10 normotensive subjects (all males) underwent a complete Doppler echocardiographic examination and a pulsed DMI assessment of 4 different myocardial segments: basal and middle septum, basal and middle lateral wall. RESULTS: The 2 groups were comparable in age and heart rate, but body mass index, systolic and diastolic blood pressure and left ventricular mass index were higher in hypertensives. All of the transmitral diastolic measurements were impaired in hypertensives, without any difference in the Doppler indexes of global systolic function. While there were no changes in the regional systolic measurements, most of the DMI parameters for diastolic function changed significantly in all 4 of the segments examined, with a greater statistical difference at the basal and middle septum. We found a relationship between the number of segments involved in the diastolic dysfunction (ie with peak velocity E/A < 1) and the degree of impairment of the transmitral E/A ratio solely in the hypertensive population. CONCLUSIONS: DMI is a useful tool for distinguishing left ventricular diastolic function in hypertensive patients and it provides information about the extent and degree of diastolic impairment in different myocardial segments. The basal and middle septum present more evident diastolic alterations. Minor but significant changes can be identified at the basal and middle lateral walls. The higher the prevalence of the myocardial segments involved in diastolic dysfunction, the greater the impairment of the global diastolic function of the left ventricle will be.

Analysis of Variance↗

PubMed1996

Effects of short-term reduction in serum cholesterol with simvastatin in patients with stable angina pectoris and mild to moderate hypercholesterolemia.

To evaluate the effects of short-term cholesterol-lowering treatment on myocardial effort ischemia, 22 patients with stable effort ischemia and mild to moderate hypercholesterolemia (low density lipoprotein [LDL] cholesterol 160 to 220 mg/dl) were randomly allocated at baseline (TO) in 2 groups. Group A included 12 patients treated with simvastatin 10 mg bid; group B included 10 patients treated with placebo. All patients underwent a treadmill electrocardiography (ECG) test; total cholesterol, HDL and LDL cholesterol, triglycerides, plasma, and blood viscosity were measured. All tests were repeated after 4 and 12 weeks. For 18 of the same patients (11 taking simvastatin, 7 receiving placebo), forearm strain-gouge plethysmography was performed at baseline and after 4 weeks, both at rest and during reactive hyperemia. At 4 and 12 weeks, group A showed a significant reduction in total cholesterol (p <0.05) and LDL (p <0.05), with unchanged HDL, triglycerides, blood, and plasma viscosity. Effort was unmodified, ST-segment depression at peak effort and ischemic threshold were significantly improved after 4 and 12 weeks (all p <0.05) with unchanged heart rate x systolic blood pressure product. A significant increase in the excess flow response to reactive hyperemia was detected in group A (p <0.03); group B showed no changes in hematochemical and ergometric parameters. These data suggest that cholesterol-lowering treatment is associated with an improvement in myocardial effort ischemia; this might be explained by a more pronounced increase of coronary blood flow and capacity of vasodilation in response to effort.

Analysis of Variance↗

PubMed1996

Impact of ambulatory blood pressure on left ventricular diastolic dysfunction in uncomplicated arterial systemic hypertension.

To determine the relations of 24-hour blood pressure (BP) and its different phases with left ventricular (LV) diastolic filling, 125 subjects (mean age 46 years) not taking cardiac drugs were studied by Doppler echocardiography and ambulatory BP recording. Subjects (excluding those with coronary artery or valvular heart disease, heart failure, or diabetes) were classified into 2 groups according to the level of Doppler-derived ratio of peak early to atrial velocity (E/A ratio): 59 had E/A >1 (normal diastole), 62 had E/A <1 (impaired diastole), and 4 had E/A = 1. Patients with E/A <1 were older and had higher LV mass indexed for height, average 24-hour BP, average nighttime BP, and lower day-night BP decrease, whereas average daytime BP did not differ significantly between the 2 groups. Negative correlations of E/A were found with age, heart rate, office, average 24-hour and average nighttime systolic and diastolic BP, and LV mass index. In a multivariate model that included potentially confounding factors, only age (standardized beta coefficient = -0.52, p<0.00001), nighttime BP (beta = -0.28, p<0.0001), and heart rate (beta = -0.22, p<0.001) were independent predictors of E/A in the pooled population. In conclusion, LV diastolic function is more closely related to ambulatory, rather than to clinic, BP measurements, and high average nocturnal diastolic BP is a powerful marker of LV filling impairment.

Adult↗

PubMed1996

Treatment of hypertension associated with stable angina pectoris: favourable interaction between new metoprolol formulation (OROS) and nifedipine.

This was a double-blind, within-patient, crossover study to evaluate the effects of a new formulation of metoprolol on blood pressure (BP) and myocardial ischemia. Twenty outpatients with mild to moderate essential arterial hypertension, chronic stable angina pectoris and positive exercise test, after a 2-week baseline placebo period, were randomized to receive long-acting metoprolol (OROS) 14/190 mg o.d., nifedipine SR 20 mg b.i.d. or their combination in a sequence of a 3 x 3 Latin square design. Two patients withdrew from the study (1 for adverse event during metoprolol and 1 for rise of BP during nifedipine). Nifedipine, metoprolol and their combination significantly reduced the weekly number of angina attacks and nitroglycerin consumption with respect to baseline. The total number of ischemic events (at 24-hour ECG monitoring) significantly decreased after each treatment with respect to baseline. Twenty-four hours mean systolic and diastolic BP were reduced by both nifedipine alone and metoprolol alone; the combination of the two drugs led to a further decrease in both systolic and diastolic BP. The duration of silent ischemic episodes was significantly reduced by nifedipine and combination but not by metoprolol. On the other hand 24 hours symptomatic attacks/patient were significantly reduced by beta-blocker and combination, but not by nifedipine. Metoprolol alone and administered with nifedipine caused a decrease, with respect to placebo baseline, in 24-hour mean heart rate (HR) and reduced the increase of HR and systolic BP at the onset of ST depression during symptomatic ischemic episodes. The effort time and time to ST = -1 mm at treadmill were significantly increased by treatment with nifedipine alone, with metoprolol alone and with their combination, but the combination was more effective than the individual therapies. ST depression at peak exercise was significantly reduced by each treatment. The slopes of correlations between the ST-segment variation and systolic BP, HR and rate-pressure product during exercise, significantly decreased after all treatments with respect to placebo baseline, more with the combination therapy than with nifedipine alone and metoprolol alone. In conclusion, based on our results the favourable interaction of metoprolol OROS and nifedipine given concomitantly, is likely to be due to a better control, respect to each individual therapy, of the pathogenetic mechanism of myocardia ischemia: BP and HR increases during exercise and during symptomatic ischemic episodes are controlled by the beta-blocker and coronary vasoconstriction during silent ischemia is prevented by the calcium-antagonist.

Angina Pectoris↗

PubMed1996

[Absence of an association of the D allele of the ACE gene with arterial pressure in mild-moderate essential arterial hypertension].

To assess the relationship between the angiotensin converting enzyme (ACE) gene I/D polymorphism, blood pressure (BP) and family history of hypertension, 133 hypertensive subjects (mean age 50 +/- 9 years, 78 males, 55 females) were selected according to both casual supine BP > 140/90 mmHg and ambulatory BP > 134/88 mmHg. Drug treatment was discontinued 2 weeks before entering the study. Subjects with myocardial ischemia, as well as those with "white coat" hypertension, were excluded. The study population was subclassified according to age < or = 50 years. Polymerase chain reaction was used to detect the I/D polymorphism of the ACE gene, and the DD genotype was analysed twice. The frequencies of the I and D allele were 42 and 58%, and the distribution of the ID+ II and DD genotypes were 69 and 31% respectively. No significant relation was found among ACE genotypes (DD vs ID+ II) and casual systolic or diastolic BP as well as ambulatory BP, both in the whole study population and in the subpopulation < 50 years old. No difference was found also in the distribution of dippers and no dippers, as well as in the distribution of subjects with a positive family history in the whole sample and hypertensives < 50 years old.

Adult↗

PubMed1995

Favourable interaction of calcium antagonist plus ACE inhibitor on cardiac haemodynamics in treating hypertension: rest and effort evaluation.

The aim of the study was to evaluate the effects of verapamil sustained release (SR) 240 mg, enalapril and their combination on blood pressure (BP) and cardiac haemodynamics at rest and during exercise in 20 patients with moderate essential hypertension (seven men and 13 women, mean age +/- s.d. 53.7 +/- 15.8 years). After a 4 week placebo run-in period, patients were randomly allocated to received verapamil SR 240 mg once daily or enalapril 20 mg once daily for 4 weeks in a double-blind fashion. Patients whose diastolic blood pressure (DBP) was still > or = 95 mm Hg at the end of this period received verapamil SR plus enalapril for an additional 4 weeks. At the end of the placebo, single and combined treatment periods, resting and exercise (bicycle ergometry) haemodynamics were evaluated by radionuclide ventricular angiography (technetium-99m) and the following parameters were assessed: BP, heart rate, double product, systemic vascular resistances (SVR), cardiac output (CO), stroke volume (SV), ejection fraction (EF) mean ejection rate (mER) and peak filling rate (PFR). Both verapamil SR and enalapril monotherapies significantly reduced resting and exercise BP (P < 0.01), with a BP normalisation (DBP < or = 95 mm Hg) of five of 10 and 4 of 10 patients respectively. A greater BP fall and a normalisation of 11 of 11 patients was obtained in non-responders to monotherapy, when treated with verapamil SR and enalapril (P < 0.01). Verapamil SR also reduced heart rate at rest and during exercise (-11.8% and -18.4%, respectively, P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1995

[The SINTESI Project: software in cardiovascular prevention].

Coronary heart disease is the most important cause of mortality in adults. New approaches may reduce the cardiovascular risk in population. "SINTESI" is an original data base designed in collaboration with the Italian Group for the Study of Metabolism Disease and Atherosclerosis to improve the evaluation of the major risk factors in the population and to create a data bank for medical research. It runs in Windows. The software includes the following electronics archives: Demographics; History; Follow-up; ECG; Laboratory; Doppler-echocardiography; Stress test-ECT; Ambulatory blood pressure monitoring; Holter-ECG; Nuclear imaging; Vascular echo-Doppler; Hemodynamics; Radiology. We named the most important file "Main Working Area" (MWA). This displays all the most important information on the clinical status of the patients and represents the "console" for using the software. In fact, in MWA "buttons" are displayed to enter all the electronic archives. The software displays graphics and the flow-chart of clinical history. We implemented "routines" for automatic evaluation of several variables. We also simplify the statistical use of the data implementing functions for "query" that permit the management of data bank. The use of this software may facilitate the correct evaluation and stratification of the cardiovascular risk. In conclusion, "Progetto SINTESI" is an easy, synthetic organization of patient's clinical data and a complete data bank. It is our opinion that the use of this software may promote a standard way of collecting a large number of data to improve the stratification of cardiovascular risk.

Adult↗

PubMed1995

[Atrial filling fraction predicts left ventricular systolic function after myocardial infarction: pre-discharge echocardiographic evaluation].

Aim of the study was to examine the relation between Doppler-derived indices of left ventricular diastolic and systolic function early after myocardial infarction. Fifty-three patients (31 males, 22 females) recovering from acute myocardial infarction underwent predischarge Doppler echocardiographic examination. Patients with age > 70 years, previous myocardial infarction, more than mild mitral and aortic regurgitation, mitral and aortic stenosis were excluded. Twenty-two healthy subjects (13 males; 9 females) free of coronary risk factors were selected as the control group. Both end-diastolic and end-systolic volumes and ejection fraction were measured by two-dimensional echocardiography. Pulsed Doppler was used to evaluate mitral inflow and left ventricular outflow velocity patterns. The following indices were measured: peak velocity of early (E) and late (A) flows, ratio of E/A peak velocities, ratio of early to late time velocity integrals, atrial filling fraction (time velocity integral A / time velocity integral of flow during total diastole) and deceleration time of E wave for mitral inflow; peak and time-velocity integral for left ventricular outflow. Stroke volume and cardiac output were obtained by pulsed Doppler using the left ventricular outflow method. The two groups were comparable for age, with blood pressure (p < 0.05) and heart rate (p < 0.01) reduced in myocardial infarction patients. Both end-diastolic and end-systolic volumes were significantly higher (both p < 0.0001) and ejection fraction (p < 0.0001) lower after myocardial infarction. Also stroke volume and cardiac output (both p < 0.0001) were reduced in myocardial infarction patients. No significant difference in Doppler indices of diastolic function was observed between the two groups, except for shortened deceleration time (p < 0.0001) in myocardial infarction patients. Multilinear regression analyses were performed separately into the two groups to identify determinants of left ventricular systolic function. After adjusting for age, heart rate, systolic blood pressure and both end-diastolic and end-systolic volumes, atrial filling fraction was an independent predictor of stroke volume, with a direct relation (beta coefficient = 0.53, p < 0.001), in myocardial infarction patients but not in health subjects. In conclusion, our study confirms the pseudonormalization of diastolic pattern after myocardial infarction. The direct relation between atrial filling fraction and stroke volume indicates the importance of atrial contribution to maintain an adequate systolic performance in patients with myocardial infarction.

Atrial Function, Right↗

PubMed1994

Cardiac abnormalities in young women with anorexia nervosa.

OBJECTIVE: To identify the characteristics of cardiac involvement in the self-induced starvation phase of anorexia nervosa. METHODS: Doppler echocardiographic indices of left ventricular geometry, function, and filling were examined in 21 white women (mean (SD) 22 (5) years) with anorexia nervosa according to the DSMIII (Diagnostic and Statistical Manual of Mental Disorders) criteria, 19 women (23 (2) years) of normal weight, and 22 constitutionally thin women (21 (4) years) with body mass index < 20. RESULTS: 13 patients (62%) had abnormalities of mitral valve motion compared with one normal weight woman and two thin women (p < 0.001) v both control groups). Left ventricular chamber dimension and mass were significantly less in women with anorexia nervosa than in either the women of normal weight or the thin women, even after standardisation for body size or after controlling for blood pressure. There were no substantial changes in left ventricular shape. Midwall shortening as a percentage of the values predicted from end systolic stress was significantly lower in the starving patients than in women of normal weight: when endocardial shortening was used as the index this difference was overestimated. The cardiac index was also significantly reduced in anorexia nervosa because of a low stroke index and heart rate. The total peripheral resistance was significantly higher in starving patients than in both control groups. The left atrial dimension was significantly smaller in anorexia than in the women of normal weight and the thin women, independently of body size. The transmitral flow velocity E/A ratio was significantly higher in anorexia than in both the control groups because of the reduction of peak velocity A. When data from all three groups were pooled the flow velocity E/A ratio was inversely related to left atrial dimension (r = -0.43, p < 0.0001) and cardiac output (r = -0.64, p < 0.0001) independently of body size. CONCLUSIONS: Anorexia nervosa caused demonstrable abnormalities of mitral valve motion and reduced left ventricular mass and filling associated with systolic dysfunction.

Adult↗