Search PubMed⌕ Search

Biomedical subjects

P Stritoni

Publications and source records attributed to P Stritoni.

At least 19 recordsLinked to original sources
PubMed1998

[Coronary angiography in two defined populations: Padua and Citadella].

BACKGROUND: Coronary angiography is an invasive procedure that is relatively expensive and that requires an appropriate indication. METHODS: Utilization rate and the appropriateness of the use of the coronary angiography have been compared in two defined populations, namely residents from the city of Padua (group A), and subjects from the local health unit of Cittadella (group B), who underwent coronary angiography between June 1, 1992 and May 31, 1993. Appropriateness was evaluated both by comparison with the AHA/ACC guidelines and by observation of the outcome following diagnosis one year after the coronary angiogram was performed. RESULTS: One hundred and seventy-one patients in group A and 100 patients in group B underwent coronary angiography: both groups had similar age and sex distribution. Utilization rate was 8 per 10,000 inhabitants in group A, and 10 per 10,000 inhabitants in group B. Appropriate coronary angiography, evaluated by comparison with the AHA/ACC guidelines, was 69.9% in group A and 68% in group B. Coronary angiogram showed at least one stenosis > or = 50% in 133 patients from group A and in 66 patients from group B. These patients were followed up for at least 12 months. Of 13 deaths, 12 occurred as fatal cardiac events, while of the 147 surviving patients who had complete follow-up data, 114 (77%) improved. The outcome was measured through symptoms and stress test. In addition, subjective improvement was measured in group A using the "Nottingham Health Profile". CONCLUSIONS: Criteria of appropriateness for an invasive diagnostic procedure such as coronary angiography, which is a determinant "entry point" for revascularization procedures, is based on common clinical knowledge that may be evolving with time. Based on these data, it seems that the current guidelines could be modified, especially for indications within the setting of myocardial infarction.

Adult↗
PubMed1997

Estimating mean pulmonary wedge pressure in patients with chronic atrial fibrillation from transthoracic Doppler indexes of mitral and pulmonary venous flow velocity.

OBJECTIVES: We sought to obtain a noninvasive estimation of mean pulmonary wedge pressure (MPWP) in patients with chronic atrial fibrillation (AF). BACKGROUND: It has previously been demonstrated that MPWP can be reliably estimated from Doppler indexes of mitral and pulmonary venous flow (PVF) in patients with sinus rhythm. Doppler estimation of MPWP has not been validated in patients with AF. METHODS: MPWP was correlated with variables of mitral and pulmonary venous flow velocity as assessed by Doppler transthoracic echocardiography in 35 consecutive patients. The derived algorithm was prospectively tested in 23 additional patients. RESULTS: In all patients the mitral flow pattern showed only a diastolic forward component. A significant but relatively weak correlation (r = -0.50) was observed between MPWP and mitral deceleration time. In 12 (34%) of 35 patients, the pulmonary vein flow tracing demonstrated only a diastolic forward component; a diastolic and late systolic forward flow was noted in the remaining 23 patients (66%). A strong negative correlation was observed between MPWP and the normalized duration of the diastolic flow (r = -0.80) and its initial deceleration slope time (r = -0.91). Deceleration time > 220 ms predicted MPWP < or = 12 mm Hg with 100% sensitivity and 100% specificity. When estimating MPWP by using the equation MPWP = -94.261 PVF deceleration time -9.831 Interval QRS to onset of diastolic PVF -16.337 Duration of PVF + 44.261, the measured and predicted MPWP closely agreed with a mean difference of -0.85 mm Hg. The 95% confidence limits were 4.8 and -6.1 mm Hg. CONCLUSIONS: In patients with chronic AF, MPWP can be estimated from transthoracic Doppler study of PVF velocity signals.

Age Factors↗
PubMed1996

Supernormal left ventricular performance in young subjects with mild hypertension: an alerting response to the echocardiographic procedure?

1. To assess the clinical significance of supernormal left ventricular systolic function in the initial phase of hypertension, 635 never-treated 18-45-year-old borderline to mild hypertensive subjects (477 males, 158 females) were studied. All subjects underwent echocardiography, 24 h ambulatory blood pressure monitoring and 24 h urine collection for catecholamine dosage. 2. Subjects whose left ventricular shortening-stress relationship was above the 95% confidence intervals of 50 normotensive subjects of similar age and sex distribution were defined as having supernormal function. 3. Age, duration of hypertension and left ventricular mass were similar in the hypertensive subjects with normal (85%) and supernormal (15%) ejective performance. Subjects with supernormal function showed higher office systolic blood pressure (P < 0001), office heart rate (P = 0.03) and cardiac index (P < 0001). Conversely, 24 h systolic blood pressure, 24 h heart rate and 24 h catecholamine output did not differ according to left ventricular function. 4. In conclusion, the greater white-coat effect and the normal baseline sympathetic tone exhibited by the patients with increased performance suggest that supernormal left ventricular pump function is only a marker of the alerting reaction elicited by the echocardiographic examination.

Adult↗
PubMed1996

Usefulness of transthoracic and transoesophageal echocardiography in recognition and management of cardiovascular injuries after blunt chest trauma.

OBJECTIVE: To assess the diagnostic potential of transthoracic and transoesophageal echocardiography for the detection of traumatic cardiovascular injuries in patients suffering from severe blunt chest trauma. DESIGN: Prospective study over a three year period. SETTING: A regional cardiothoracic centre. PATIENTS: 134 consecutive patients (94 M/40 F; mean age 38 (SD 14) years) suffering from severe blunt chest trauma (injury severity score 33.5 (18.2)). Most patients (89%) were victims of motor vehicle accidents. EVALUATION: All patients underwent transthoracic and transoesophageal echocardiography within 8 h of admission. Aortography was performed in the first 20 patients and in a further five equivocal cases. RESULTS: Transthoracic echocardiography provided suboptimal images in 83 patients, detecting three aortic ruptures, 28 pericardial effusions (one cardiac tamponade), 35 left pleural effusions, and 15 myocardial contusions. Transoesophageal echocardiography was feasible in 131 patients and detected 14 aortic ruptures (13 at the isthmus), 40 pericardial effusions, 51 left pleural effusions, 34 periaortic haematomas, 45 myocardial contusions, right atrial laceration in one patient with cardiac tamponade, one tricuspid valve rupture, and one severe mitral regurgitation caused by annular disruption. For the detection of aortic rupture transoesophageal echocardiography showed 93% sensitivity, 98% specificity, and 98% accuracy. Time to surgery was significantly shorter (30 (12) v 71 (21) min; P < 0.05) for patients operated on only on the basis of transoesophageal echocardiographic findings. CONCLUSIONS: Transthoracic echocardiography has low diagnostic yield in severe blunt chest trauma, while transoesophageal echocardiography provides accurate diagnosis in a short time at the bedside, is inexpensive, minimally invasive, and does not interfere with other diagnostic or therapeutic procedures.

Accidents, Traffic↗
PubMed1996

Atypical electromechanical dissociation in a patient with recurrent pulmonary embolism.

A 47-year-old man experienced recurrent pulmonary embolism resistant to aggressive medical and surgical prophylaxis. Although paraneoplastic hypercoagulability was suspected, no endoscopic or radiologic signs of malignancy were detected. Death was the result of electromechanical dissociation, which was attributed to right ventricular outflow obstruction. At autopsy, anaplastic lung carcinoma was found in the left basal segment with superimposed pulmonary infarction. A huge pedunculated thrombus was attached to the left ventricular apex and extended into the ascending aorta, obstructing the left ventricular outflow. To our knowledge, this is the first case of electromechanical dissociation due to left ventricular thrombus in a patient with pulmonary embolism. Radiologic and echocardiographic evaluation of such patients should take into account possible masking of the underlying neoplasm by embolic or hemorrhagic phenomena, or both, and the presence of left-sided cardiac thombi, which may cause catastrophic events.

Arrhythmias, Cardiac↗
PubMed1996

[Coronary angioplasty in unstable angina at rest. Influence of the degree of clinical instability on the immediate and long-term results].

BACKGROUND: Coronary angioplasty in patients with unstable angina is associated with higher rate of complications and less favourable long term results in contrast to those patients with stable angina. OBJECTIVES: To establish whether temporary clinical stabilization of at least 48 hours prior to PTCA in patients with angina at rest carries an improvement in immediate and long term results. METHODS: A survey was carried out on 188 consecutive patients with recent onset angina at rest. Analysis included immediate results, complication rate, and 1 year follow up status. Patients were divided in 2 groups in accordance with Braunwald classification: i.e. on the basis of absence (Group II B, 90 patients) or presence (Group III B, 98 patients) of spontaneous angina at rest in the 48 hours prior of PTCA. Patients excluded were those with early postinfarction angina (15 days) and those with unstable angina following coronary restenoses after PTCA. RESULTS: The 2 groups were similar with regard to the main baseline clinical and angiographic characteristics, with the exception of intravenous administration of heparin and nitrates at the time of PTCA (47% in Group II B vs 85% in Group III B, p < 0.01) and the rate of intracoronary thrombus in the angiograms before dilatation (3% vs 15% respectively, p < 0.05). Complication rate was 2% in Group II B (2 acute myocardial infarction--AMI) and 4% in Group III B (1 death and 3 emergency By-pass operation) (p = n.s.). Clinical success was achieved in 93% of II B patients and 92% in Group III B (p = n.s.). During 12 months follow-up no significant difference in adverse events was found in either groups. There were no late deaths. Two patients in both groups experienced AMI. Thirtyone per cent of patients in Group II B and 34% in Group III B complained of recurrence of angina. The 12-months event free survival (the absence of AMI, repeat PTCA, by-pass operation and recurrence of angina) was 62% in both groups. CONCLUSIONS: In patients with unstable angina who underwent intensive pharmacological treatment including intravenous heparin and nitrates, the results of PTCA showed no negative influence of spontaneous angina which occurred in the 48 hours prior the procedure. To obtain complete clinical stabilization over a 48 hour waiting period would therefore appear to be no longer warranted.

Angina, Unstable↗
PubMed1996

Endocardial versus midwall measurement of left ventricular function in mild hypertension: an insight from the Harvest Study.

OBJECTIVE: To compare endocardial and midwall measurement of left ventricular fractional shortening in assessing cardiac systolic function in hypertension. SETTING: Seventeen hypertension clinics in northeast Italy. MAIN OUTCOME MEASURES: Left ventricular endocardial fractional shorteningcircumferential stress relationship versus midwall shortening-stress relationship in the subjects divided according to relative wall thickness (RWT) and left ventricular mass indexed by body surface area. PATIENTS: Borderline-to-mild hypertensives [n = 635, aged 33 +/- 0.3 years (mean +/- SEM), office blood pressure 146 +/- 0.4/94 +/- 0.2 mmHg (means +/- SEM)] in the Harvest Study and 50 normotensive controls with similar age and sex distributions. METHODS: Blood pressure was measured by 24 h ambulatory monitoring. Left ventricular dimensional and functional indices were assessed by M-mode echocardiography. RESULTS: In the subjects divided into quintiles of RWT, the left ventricular shortening-stress relationship was increased in a parallel fashion when calculated by endocardial and by midwall measurements for RWT < or = 0.35. Instead, for greater RWT values (> or = 0.37) endocardial measurement constantly gave large values than did midwall measurement. Both the endocardial and the midwall shortening-stress relationships progressively decreased with increasing RWT. However, the endocardial shortening-stress relationship remained greater than normal at any RWT, whereas the midwall shortening-stress relationship was decreased for RWT > or = 0.37. In a multiple-regression analysis RWT was the most potent predictor of the endocardialmidwall shortening difference, left ventricular mass and 24 h systolic blood pressure being the second and third most potent predictors. CONCLUSIONS: We found a parallel increase in indices of cavity emptying and of myocardial contractility in mild hypertensive subjects with normal left ventricular geometry. When the RWT is increased, ejection phase indices may be normal in the presence of decreased myocardial contractility.

Adolescent↗
PubMed1996

[Secondary prevention of myocardial ischemia. From theory to clinical reality: preliminary results of the EUROASPIRE study in Italy. European Action on Secondary Prevention through Intervention to Reduce Events].

EUROASPIRE study has been carried out in 9 European countries with the aim of assessing coronary risk factors in high-risk patients admitted to hospital to undergo coronary revascularization procedures (coronary angioplasty or coronary artery bypass grafting) or because of angina or myocardial infarction. The results of the initial stage of the study in Italy, investigating the data from 691 hospital medical records, showed that management of risk factors in these patients was inferior than expected. In particular, the prevalence of hyperlipidaemia (63%), hypertension (40%) and diabetes (27%) was remarkably high. These results suggest that there is still a need for secondary prevention of coronary heart disease.

Aged↗
PubMed1995

Echocardiography in infective endocarditis: reassessment of the diagnostic criteria of vegetation as evaluated from the precordial and transesophageal approach.

The echocardiographic characteristics of vegetation used by precordial echocardiography (PE) have been transferred unchanged to transesophageal echocardiography (TEE), which has different image definition and structural resolution. Twelve diagnostic criteria of vegetation were tested for their accuracy in 52 patients evaluated by PE and TEE for suspected endocarditis (36 men, 16 women; mean age, 62 +/- 18 years; 42 with proven endocarditis). Results of PE and TEE were validated against gross anatomic and histologic findings. Significant differences (P < .05) included the fact that TEE disclosed more vegetations not prolapsing in the subvalvular region and in absence of valvular regurgitation. At TEE vegetations presented motion distinct from the endocardial surface, irregular conformation, and uneven margins. Only chaotic motion was significantly associated with vegetations at PE; size < 0.5 cm and increased echogenicity characterized pseudovegetations at PE. Other features such as shaggy echoes or location out of the annular zone (previously indicated as typical of vegetations) were not significantly associated with infective lesions. Discriminant analysis of TEE characteristics of vegetations disclosed that chaotic motion was the variable most significantly (P = .008) associated with vegetation. Coexistence of this sign with size < 0.5 cm and uneven margins was associated with 93.3% sensitivity and 83.7% specificity. In conclusion, the echocardiographic aspect of vegetations is rather different when examined from the precordial and the transesophageal approach. Learning about pitfalls and normal variants should improve TEE specificity in the assessment of infective lesions.

Aged↗
PubMed1994

Comparative diagnostic value of transesophageal echocardiography and retrograde aortography in the evaluation of thoracic aortic dissection.

The aim of this study was to assess the comparative diagnostic value of transesophageal echocardiography (TEE) and retrograde aortography for morphologic evaluation and anatomic mapping of aortic dissection. Seventy patients (aged 18 to 79 years) were prospectively evaluated with both techniques for suspected aortic dissection. In 64 patients, findings on aortography and TEE could be validated against intraoperative (n = 53) and postmortem (n = 11) findings. Examination time was significantly shorter for TEE (9 +/- 6 vs 48 +/- 25 minutes; p < 0.001). For the detection of aortic dissection, aortography showed lower sensitivity (87.5% vs 97.5%) and negative predictive value (85.3% vs 96.7%; both trends did not reach statistical significance) due mostly to the inability to identify noncommunicating dissection (dissection without intimal tears). For the epiphenomena of aortic dissection, aortography was significantly more accurate (97.2% vs 78%; p < 0.05) in assessing the site of entry, and TEE was more accurate in identifying thrombus formation (90% vs 65%; p < 0.05). There was no significant difference between aortography and TEE with regard to assessing secondary tears, aortic regurgitation, coronary dissection, and extension of the dissection. Thus, both TEE and aortography offer detailed anatomic mapping for guided surgical interventions. In elective patients, integration of both techniques seems the best approach; in unstable patients, TEE may be preferential because it is less invasive, requires no contrast injection, and provides accurate diagnosis in a short time at the bedside.

Adult↗
PubMed1994

Estimation of left ventricular diastolic pressures from precordial pulsed-Doppler analysis of pulmonary venous and mitral flow.

Because analysis of pulmonary venous flow (PVF) will be extensively used in comprehensive Doppler assessment of left ventricular diastolic function, this study was designed to (1) evaluate the feasibility of PVF measurement in 116 consecutive patients with various cardiac abnormalities by using precordial pulsed Doppler echocardiography; (2) Estimate mean pulmonary capillary pressure (MPCP) and left ventricular end-diastolic pressure (LVEDP) from Doppler variables of PVF and mitral inflow; and (3) evaluate the influence of clinical and hemodynamic variables on PVF Doppler patterns. We adequately recorded anterograde PVF in 96 (82.7%) patients and retrograde PVF in 45 (38.7%) patients. The strongest correlation between MPCP and Doppler variables of PVF was found with systolic fraction (the systolic velocity time integral expressed as a fraction of total anterograde PVF) (r = -0.88; p < 0.001). Age influenced this relation, with progressive increase of the systolic fraction in older patients. A good correlation (r = 0.72; p < 0.001) was found between LVEDP and the difference in duration of the reversal PVF and the mitral a wave. In conclusion, (1) PVF can be recorded adequately in most patients with precordial Doppler echocardiography; (2) left ventricular diastolic pressures can be estimated reliably by precordial Doppler echocardiography; and (3) the clinical meaning of Doppler-derived indexes of left ventricular diastolic performance is age-related.

Adult↗
PubMed1994

[The distribution and activities of hemodynamic laboratories in Italy: the implications for the quality of services].

BACKGROUND: The diffusion of cardiac catheterization laboratories in Italy has been increasing in the last decade, often without a rational planning process evaluating costs, safety, concentration and case loads. METHODS: Data have been provided by the 1990 annual report of the Italian Group of Hemodynamic Studies and Interventional Cardiology which includes, following the best estimates, about 90% of public and private labs. These data include all cardiac catheterization visits. In analysis, PTCA's have been separately considered. RESULTS: In 1990, 85 laboratories with 101 rooms were active. The distribution of the labs was 58% in the north, 14% in the middle and 28% in the south of the country. The number of labs per million inhabitants was 1.9, 1.1 and 1.2 respectively, with a national average of 1.5. The percentage of labs performing fewer than 300 visits per year was 33% in the country. Within the areas, such percentages were 33%, 17% and 42% respectively. A total of 48,518 exams were performed (61%, 18% and 21% in the three areas) with a rate per 100,000 of 115, 82 and 51 (national rate 86). 5,145 PTCA's were carried out in the same year, about 80% of which were in the north area. CONCLUSIONS: Even if data could be underestimated, a great difference in geographical distribution of labs was confirmed. This might be explained by morbidity, population age and mobility of patients across the country. The percentage of labs performing fewer than 300 studies is relevant, in particular in the south and in the Isles. Planning for future requirements should include the amelioration of utilization rates (in a perspective of cost containment and patient safety), a thorough evaluation of demographic and morbidity trends, and an estimate of the proportion of inappropriate procedures.

Angioplasty, Balloon, Coronary↗
PubMed1993

[Coding and identification of heart failure].

The prevalence of the diagnosis of heart failure (HF) presents large differences, comparing the data of hospital discharge obtained from USA and Italy through te code 428 of ninth revision of International Classification of Diseases (ICD-9). As possibly the difference is related to classification, we reviewed homogeneous diagnosis in Padua General Hospital as a whole and the diagnosis at discharge in the department of Cardiology of the same hospital. Hospital HF discharge rate is on average 0.43% (0.37-0.51); while from department of Cardiology is on average 0.7% (0.15-0.85). Medical records of a group of patients (the first hundred of 1992) are analysed and recorded using the Boston criteria for scoring the certainty of HF diagnosis. The group with unlikely HF (68%) does'nt codes 428; there is 2 code 428 in group with possible (16%) and 2 in group with definite (16%) diagnosis of HF. The physician probably prefers sometimes an anatomical rather than a functional classification and therefore he underscores the impairment of left ventricular systolic function. A better code-use is needed before comparing prevalence rate from different centres.

Aged↗
PubMed1993

[Morphofunctional correlations in dilated cardiomyopathies].

The aim of this study was to state whether in patients with dilated cardiomyopathy indices of left ventricular function (i.e. left ventricular end-diastolic and end-systolic volumes, ejection fraction, end-systolic pressure to end-systolic volume ratio, mass to volume ratio, elastic stiffness constant) are related to histologic findings, namely percentage of myocytes, of fibrosis and of interstitium. We have studied 26 patients (18 males and 8 females) aged 13-65 years, who underwent right and left heart catheterization, quantitative angiography, coronary angiogram, and in whom a diagnosis of dilated cardiomyopathy was established. All of them had a biopsy specimen taken from the right aspect of interventricular septum, following the technique of King's College. Histology was automatically evaluated with a computerized system for the percent content of myocytes, of fibrous tissue and interstitium. Correlation with hemodynamic parameters was calculated with the least square method. A significant correlation was found between percentage of fibrosis, left and right ventricular ejection fraction and preload index, and between percent myocytes and right ventricular ejection fraction and duration of disease. Thus, left ventricular function indices do not correlate with percent myocytes, as previously shown: this could be due to the fact that alterations in contractile machinery are due primarily to alterations in cell biochemistry. Moreover, the inverse relationship between myocyte content and duration of the disease may reflect those mechanisms, which tend to perpetuate failure in a dilated heart by increasing subendocardial fibrosis. However, the correlation found between myocyte content and right ventricular ejection fraction may be due to the fact that biopsy specimens were taken from the right ventricle.

Adolescent↗