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P Lancellotti

Publications and source records attributed to P Lancellotti.

35 records · Page 2Linked to original sources
PubMed2001

Identification of viable myocardium early after acute myocardial infarction using closed-loop arbutamine echocardiography: comparison with positron emission tomography.

OBJECTIVE: This study sought to evaluate the safety and efficacy of arbutamine echocardiography in identifying contractile reserve and predicting functional improvement early after acute myocardial infarction (AMI). METHODS AND RESULTS: Seventeen patients with first AMI underwent arbutamine echocardiography 48 to 96 hours after AMI. Arbutamine was infused by a closed-loop delivery device. The heart rate slope was 4 beats/min and the heart rate target was 20 beats/min above baseline heart rate. A follow-up echocardiogram was obtained one month later. N-13 ammonia and F-18 FDG positron emission tomographic (PET) imaging were performed 6 +/- 2 days after AMI, before coronary angiography. Mean duration of arbutamine infusion was 6 +/- 2 min. There was no complication and there were no major side effects. Myocardial viability was identified with PET in 15 of the 17 patients. Contractile reserve was observed in 10 patients during arbutamine infusion. Functional recovery was identified in 12 patients. Sensitivity, specificity and accuracy of PET and arbutamine echocardiography for predicting functional recovery were 100%, 40%, 76% and 67%, 80%, 84%, respectively. CONCLUSIONS: Low-dose arbutamine stress testing is safe early after AMI. Contractile reserve can be rapidly identified by echocardiography and is specific, but moderately sensitive for predicting reversible dysfunction.

Adrenergic beta-Agonists↗
PubMed2001

[Shoshin beriberi: myth or reality?].

Shoshin is a fulminating form of cardiac beriberi developing in a few hours in a young alcoholic. Without specific treatment it evulers, toward death by cardiogenic shock and metabolic acidosis. Treatment by thiamine and alkalinisation permits a spectacular and fast recovery.

Acidosis↗
PubMed2001

[Ventricular septal defect and recent myocardial infarction].

Rupture of the interventricular septum is a classical complication of acute myocardial infarction. The diagnosis should be evoked when the patient's hemodynamic condition deteriorates in the presence of a new systolic murmur. A transthoracic or, preferably, transesophageal echocardiography confirms the diagnosis. Early surgical correction constitutes the best treatment. Despite recent progresses, mortality remains high but long term results are encouraging. The risk factors conditioning prognosis, the surgical options and the question of simultaneous coronary bypass will be discussed after a thorough review of the literature.

Coronary Artery Bypass↗
PubMed2000

[Acute myocardial infarction: management, prognosis and survival].

Acute myocardial infarction (AMI) is a serious condition which requires rapid hospital management. In this article, we review the current recommendations concerning AMI treatment, as well as our therapeutic approach, which is based on the evidence provided by several large well controlled clinical trials. Mid and long term prognosis are mainly related to the development of left ventricular dysfunction which determines heart failure, the occurrence of severe ventricular arrhythmias and the persistence of residual myocardial ischemia. Several treatments (aspirin, beta-blockade, ACE inhibitors, statins) have shown their benefit in terms of secondary prevention.

Adrenergic beta-Antagonists↗
PubMed1999

ST-segment elevation during dobutamine stress testing predicts functional recovery after acute myocardial infarction.

OBJECTIVES: The aims of this study were (1) to assess the relation between ST-segment elevation and wall motion response occurring during dobutamine testing and (2) to evaluate the usefulness of stress-induced ST-segment elevation for predicting functional recovery after acute myocardial infarction. BACKGROUND: Clinical significance of stress-induced ST-segment elevation after acute myocardial infarction remains controversial. According to previous studies, it may reflect a larger infarcted area, depressed left ventricular function, left ventricular aneurysm, stress-induced dyskinesia, residual myocardial ischemia, or viability in the affected region. Whether transient ST-segment elevation occurring during dobutamine testing may predict functional recovery is unknown. METHODS AND RESULTS: We studied 38 patients who underwent dobutamine stress testing early (5 +/- 2 days) after a first acute myocardial infarction. Dobutamine was infused at increasing doses from 5 to a maximum of 40 microg/kg per minute, with the addition of up to 1 mg of atropine if the target rate could not be reached by dobutamine alone. Twelve-lead electrocardiography and cross-sectional echocardiography were continuously monitored throughout the test. Dobutamine-induced ST-segment elevation was defined as a new or worsening >/=1 mm elevation, 80 ms after J point, in >/=2 infarct-related leads. Quantitative angiography was available in all patients before hospital discharge. Follow-up resting echocardiography was recorded in all patients 12 to 18 months after the acute event. ST-segment elevation was observed in 20 of the 38 patients. There were no significant differences between patients with and those without dobutamine-induced ST-segment elevation in age, site of infarction, peak level of total creatine kinase enzyme, and use of thrombolytic therapy, angioplasty, or both. Persistent akinesis without change during dobutamine stress testing was more frequently observed in patients without ST elevation (P <. 05). A biphasic response during dobutamine testing was more frequently observed in patients with ST-segment elevation (P =.01). Multivariate analysis selected 2 independent variables associated with ST-segment elevation: a biphasic response during dobutamine stress (chi-square = 7.3; P =.007) and the minimal lumen diameter of the infarct-related vessel at quantitative angiography (chi-square = 5.5; P <.02). Functional recovery was demonstrated in 26 patients. Sensitivity of ST-segment elevation for the prediction of functional recovery was 69%, specificity 83%, positive predictive value 90%, and accuracy 74%. Two independent variables predicting functional recovery were selected: dobutamine-induced ST-segment elevation (chi-square = 9.1; P =.003) and a biphasic response during stress (chi-square = 6.15; P =.013). CONCLUSIONS: Dobutamine-induced ST-segment elevation in the infarct-related leads is an ancillary sign of viable myocardium in jeopardy. It has a high specificity and an acceptable sensitivity for the prediction of functional recovery after acute myocardial infarction.

Adrenergic beta-Agonists↗
PubMed1998

Relative value of clinical and transesophageal echocardiographic variables for risk stratification in patients with infective endocarditis.

BACKGROUND: Infective endocarditis remains a life-threatening disease, and its optimal management is of paramount importance. Transesophageal echocardiography (TEE) is useful for the diagnosis of endocarditis-induced lesions, but the prognostic significance of the method remains controversial. HYPOTHESIS: The purpose of this study was to relate clinical and TEE characteristics to the occurrence of mortality and/or systemic embolization in a consecutive series of 45 patients with a diagnosis of infective endocarditis. METHODS: All patients underwent at least one monoplane TEE. Clinical data, episodes of embolization, and echocardiographic characteristics were prospectively recorded. Stepwise logistic discriminant analysis was performed to identify the independent variables that best predicted three binary outcomes: systemic embolization, death, and systemic embolization and/or death. RESULTS: Twelve of the 45 patients (27%) died from the endocarditis. Significant univariate predictors of death were the presence of paravalvular abscess (p = 0.025), number of vegetations (p = 0.021), Staphylococcus aureus isolated in blood cultures (p = 0.002), medical treatment alone (p < 0.002), and systemic embolism (p < 0.001). In multivariate analysis, systemic embolism (chi 2 = 29.3; p < 0.01), echocardiographic evidence of paravalvular abscess (chi 2 = 5.6; p = 0.018), Staphylococcus aureus endocarditis (chi 2 = 5.5; p = 0.016), and medical treatment alone (chi 2 = 5.11; p = 0.024) emerged as optimal predictors of death. Systemic embolization occurred in 12 patients. Independent variables predicting systemic embolization were a total length of vegetations > 14 mm (p = 0.01), greater age (p = 0.02), and medical treatment alone (p = 0.03). When two or more vegetations were observed, the total length is the sum of the individual sizes. Independent risk factors for the development of systemic emboli and/or death as a combined end point were total length of vegetations on TEE (chi 2 = 6.4; p = 0.003) and medical treatment alone (chi 2 = 4.1; p = 0.047). CONCLUSIONS: High-risk patients may be identified by the combination of clinical variables and TEE characteristics.

Discriminant Analysis↗
PubMed1998

The role of early measurement of nitrogen-13 ammonia uptake for predicting contractile recovery after acute myocardial infarction.

Previous studies have shown that the maintenance of cell membrane integrity and metabolism requires the persistence of residual myocardial blood flow. The purpose of this study was to assess the role of N-13 ammonia positron emission tomographic (PET) imaging performed early after an acute myocardial infarction for predicting functional recovery. Seventeen patients with an acute myocardial infarction were included in the study. Thirteen received thrombolytic therapy, 2 underwent immediate angioplasty of the infarct-related artery and 2 were treated with heparin. N-13 ammonia imaging was performed 6 +/- 2 days after the acute event and was followed by elective angioplasty in 13 patients. Using a 16-segment polar map display, regional N-13 ammonia uptake was expressed as a percentage of maximal segmental uptake and classified as normal (> 63%), moderately reduced (63-50%) and severely reduced (< 50%) based on values of tracer uptake obtained from healthy subjects. By echocardiographic assessment of regional wall thickening within 96 hours and at 1 month after the infarct, we examined the relationship between blood flow and functional outcome of myocardial segments in the infarct-related area. Regional wall thickening was graded on a 4-point scale: normal (1), hypokinesia (2), akinesia (3) and dyskinesia (4). Of 77 dyssynergic segments at baseline echocardiographic study, 43 had normal flow, 15 moderately reduced flow and 19 severely reduced flow. Segments with N-13 ammonia uptake > or = 50% demonstrated a significant improvement in wall thickening score at follow-up (p < 0.001), whereas segments with N-13 ammonia uptake < 50% showed no improvement in wall thickening scores (p < 0.001). The proportion of segments improving contractility by at least 1 score was significantly higher in the group of segments with N-13 ammonia uptake > 63%. The predictive value for defining functional recovery with segmental N-13 ammonia uptake > 63% was 86%. The predictive value for absence of recovery (uptake < 50%) was 54%. In conclusion, our data showed that early after an acute myocardial infarction N-13 ammonia imaging provides information regarding functional outcome.

Ammonia↗
PubMed1998

[How I study the assessment of the risk of sudden death in Wolff-Parkinson-White syndrome].

The identification of a WPW impose to evaluate the potential risk of sudden cardiac death. The risk depends on the duration of the refractory period of the accessory pathway. If the preexcitation disappears when the patient is stressed on a treadmill, there is no risk of sudden death. If it does not, an electrophysiological study will have to be performed to measure the refractory period of the accessory pathway. If a risk of sudden death is present (refractory period < 220 ms), the accessory pathway has to be ablated using radiofrequency.

Catheter Ablation↗
PubMed1998

[Follow-up of patients treated by amiodarone].

Amiodarone is a highly effective antiarrhythmic agent. Its iodine content and tissue accumulation are however responsible for various side effects. In this article, we review the various amiodarone related side effects and propose a monitoring chart for patients treated by this specific agent.

Amiodarone↗
PubMed1997

Myocardial viability. Stress echocardiography vs nuclear medicine.

Myocardial dyssynergy does not necessarily indicate myocardial necrosis in patients with coronary artery disease. The differentiation between viable and non-viable tissue is of great clinical importance in order to make the most appropriate clinical decision in the individual patient. Several techniques are used to assess myocardial viability. Nuclear medicine gives reliable information on regional perfusion, metabolism and cell membrane integrity, while echocardiography provides real time visualization of myocardial thickening in basal conditions and continuously during pharmacological interventions. The presence or absence of contractile reserve in akinetic regions can be evaluated by pharmacological stress echocardiography. This article presents the semiology of myocardial viability as characterized by these different methods and reviews their relative value in different clinical settings.

Animals↗
PubMed1994

Infective endocarditis: prevention, diagnosis and management.

Infective endocarditis remains an important problem and the means of prevention are still insufficient. The causal bacteria have changed very little, but the incidence of nosocomial infections and endocarditis complicating intravenous drug abuse are increasing. The distinction between subacute and acute clinical presentations remains appropriate. Cardiac and neurological complications are frequent and carry a high risk of mortality. The diagnosis is obtained by the integration of clinical data and the results of blood cultures. Echocardiography is extremely useful for detecting vegetations, and for assessing the haemodynamic consequences and specific cardiac complications. Risk stratification can be obtained by correct integration of multiple parameters. The causal agent should be identified before the initiation of antimicrobial therapy. Surgery is frequently required, and should be performed rapidly when indicated.

Adult↗
PubMedDate not supplied

The usual causes of left ventricular outflow tract obstruction below the aortic valve in normal ventriculoarterial connection: review of the physiopathology and surgical implications.

Subaortic narrowing leading to left ventricular outflow tract obstruction (LVOTO) is a significant pathology that may be encountered pre- or postoperatively in both acquired or congenital cardiac disease. Through a review of the morphological features and mechanisms in the different clinical situations, the anatomic, dynamic and mixed forms of subaortic obstruction are emphasized. Knowledge of the substrate of LVOTO, its physiopathology and natural history allows to plan accordingly the surgical repair and the postoperative management.

Aortic Stenosis, Subvalvular↗
PubMedDate not supplied

Primary amyloidosis (AL) as a cause of nephrotic syndrome.

AL amyloidosis is a rare systemic disease resulting from tissue accumulation of amyloid fibrils derived from monoclonal immunoglobulin light chains. It can disrupt the tissue architecture and consequently cause organ dysfunction. The prognosis is poor with a median survival of 13 months in untreated patients. By illustrating the case of a patient whose AL amyloidosis was detected after presenting a nephrotic syndrome, the characteristics of the disease are reviewed as well as diagnostic criteria and current available therapeutics.

Amyloidosis↗
PubMedDate not supplied

[Congestive heart failure and diabetes mellitus].

Diabetic patients frequently develop heart failure and have a guarded prognosis because of the combination of diabetic cardiomyopathy, hypertension and ischaemic heart disease. The lack of patient awareness of the association between diabetes and cardiovascular disease contributes to the risk of heart failure in the diabetic population. Therefore, physicians should consider the risk of comorbidities and use appropriate screening tests to achieve early identification and initiate preventive strategies. There is evidence suggesting that adequate glycaemic control may improve cardiac metabolism and myocardial function in diabetics with heart failure. Improvement in cardiac function engendered by neurohumoral inhibition is associated with a decrease in mortality that is at least as great in the diabetic patients with heart failure as it is in the non diabetic patients. However, several therapeutic interventions have not yet been specifically validated in diabetic subjects. Thus, physicians should be encouraged to use therapies tested in the diabetic population, such as B-blockers and ACE inhibitors. Diabetic patients would benefit from more aggressive preventive programs aimed at reducing the incidence of cardiovascular morbidity and mortality.

Adrenergic beta-Antagonists↗