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Biomedical subjects

P Zardini

Publications and source records attributed to P Zardini.

At least 19 recordsLinked to original sources
PubMed1992

Long-acting angiotensin-converting enzyme inhibition: once-daily lisinopril versus twice-daily captopril in mild-to-moderate heart failure.

Once-daily lisinopril (5-20 mg) was compared with twice-daily captopril (12.5-50 mg) in a double-blind, randomized, parallel-group study of angiotensin-converting enzyme (ACE) inhibition conducted in 31 centers for 12 weeks in patients with heart failure (New York Heart Association class II-III) who were currently receiving digitalis and/or diuretics. The drugs were compared with regard to their effects on exercise duration, measured with bicycle ergometry, and on ectopic activity, measured using Holter monitoring. Both drugs significantly increased exercise duration after both 6 and 12 weeks of randomized treatment. Neither ACE inhibitor had any significant impact on the hourly rate of either ventricular ectopic counts or couplets, nor was there any difference between treatments with regard to the proportions of patients in whom ventricular ectopic counts were reduced. Both drugs were well tolerated, with no differences observed between treatments. Potassium, urea, and creatinine levels remained stable for both treatments throughout the study.

Adult↗
PubMed1992

Antihypertensive effect of lisinopril assessed by 24-hour ambulatory monitoring: a double-blind, placebo-controlled, cross-over study.

The antihypertensive effect of the angiotensin-converting enzyme (ACE) inhibitor lisinopril administered in a single dose of 20 mg was evaluated by ambulatory blood pressure monitoring (ABPM) in a double-blind, placebo-controlled, cross-over study. Twenty-four patients (21 men and 3 women, mean age 52 +/- 6 years) with mild to moderate hypertension were included in the study and randomly assigned to two consecutive treatments with lisinopril 20 mg and placebo, each administered for 4 weeks. On the last day of each treatment, BP was assessed by noninvasive 24-h ABPM. BP was significantly lower after lisinopril than after placebo in a 24-h period (mean 24-h systolic BP (SBP) with lisinopril 120 +/- 7 mm Hg and with placebo 135 +/- 9 mm Hg; mean day SBP with lisinopril 125 +/- 3 mm Hg and with placebo 142 +/- 5 mm Hg; mean night SBP with lisinopril 112 +/- 4 mm Hg and with placebo 124 +/- 6 mm Hg; mean 24-h diastolic BP (DBP) with lisinopril 76 +/- 6 mm Hg, and with placebo 87 +/- 8 mm Hg; mean day DBP with lisinopril 80 +/- 3 mm Hg and with placebo 93 +/- 4 mm Hg; mean night DBP with lisinopril 69 +/- 2 mm Hg and with placebo 79 +/- 5 mm Hg, p less than 0.001). Mean 24-h, mean day, and mean night heart rate (HR) did not differ significantly between placebo and lisinopril treatments. Repeated-measures analysis of variance (ANOVA) showed a significant influence on SBP (p less than 0.001) and DBP (p less than 0.001) throughout the treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Gallopamil in chronic stable angina: antianginal effect and mechanism of action. A randomized, placebo-controlled, double-blind, cross-over trial.

A double-blind, placebo-controlled, cross-over trial of oral gallopamil was performed in 10 patients with stable angina. Gallopamil significantly increased mean exercise time and 1-mm ST time. The rate-pressure product was increased at 1-mm ST time, but unmodified at the highest comparable work load and at peak exercise. The ST segment depression was significantly reduced both at the highest comparable work load and at peak exercise. Gallopamil proves safe and effective; the mechanism of its anti-ischemic effect seems to be due both to an increase in myocardial oxygen supply and to a reduction in myocardial oxygen demand.

Aged↗
PubMed1992

[The angiographic evaluation of elastic recoil after coronary angioplasty].

Coronary angioplasty is an effective recanalization technique, but is plagued by a high restenosis rate. One of the major effects of balloon dilatation is the stretching of the vessel wall and the subsequent elastic recoil. Although a well known phenomenon, few data have been published on the evaluation of elastic recoil after coronary angioplasty. The purpose of this study was to quantify the acute and short-term elastic recoil after coronary dilatation. Thirty-six patients underwent coronary angioplasty. A digital end-diastolic acquisition of the coronary artery was performed before, immediately after, at 15 min and at 20 hours after dilatation. Elastic recoil was defined as the difference between the diameter of the inflated balloon and the diameter of the vessel after dilatation. It was quantified by a semi-automatic computer-assisted program. Our data show a high elastic recoil immediately after dilatation, equal to 27.9% (p < 0.0001), which continues for the next 20 hours to a final value of 34.1%. No difference was found in the amount of elastic recoil depending on the coronary artery involved, length, severity and eccentricity of the stenosis, time and pressure used during balloon inflation. Elastic recoil was more pronounced (p = 0.002) using balloons with a balloon diameter/vessel diameter ratio > 1.

Angioplasty, Balloon, Coronary↗
PubMed1991

Early left ventricular filling: an approach to its multifactorial nature using a combined hemodynamic-Doppler technique.

It has recently been shown that early left ventricular filling is a multifactorially determined phenomenon, the characteristics of which are highly dependent on relative changes in any of its determinants (left ventricular end-systolic volume, the constant of isovolumic left ventricular pressure decay, left atrial pressure at the onset of mitral valve flow, and left ventricular and left atrial compliance). Thus changes in the pattern of filling do not necessarily reflect changes in diastolic properties; they might instead simply reflect changes in loading conditions. To define a clinically implemented approach where the contribution of each of the covariates of early filling to the filling process and their modification by load manipulation could be assessed, nine patients with ischemic heart disease underwent simultaneous assessment of micromanometer left ventricular pressure and two-dimensional echo-guided Doppler mitral flow velocity before and after administration of nitroglycerin (0.2 mg intravenously). Nitroglycerin induced a significant reduction in the early-filling E wave (from 41 +/- 5 cm/sec to 32 +/- 7 cm/sec; p less than 0.002), whereas the late-filling A wave did not change (from 51 +/- 12 cm/sec to 55 +/- 9 cm/sec; p = 0.15), so that the E/A ratio decreased 27 +/- 16% (p = 0.016). End-systolic volume, the constant of isovolumic left ventricular pressure decay, and left atrioventricular pressure crossover at the onset of mitral flow decreased (from 49 +/- 37 to 43 +/- 38 ml [p = 0.016], from 52 +/- 14 to 47 +/- 13 msec [p = 0.016], and from 19 +/- 10 to 12 +/- 7 mm Hg [p = 0.08], respectively), whereas left atrial compliance (defined as stroke volume/atrioventricular pressure crossover) and left ventricular compliance (computed as change in volume/change in pressure at early and late diastole) did not change (p = 0.15 and p = 0.38, respectively); the diastolic pressure-volume relationship, however, was displaced slightly leftward and markedly downward, suggesting relief of pericardial constraint. A multilinear regression analysis, performed with pooled data at baseline and during infusion of nitroglycerin in each patient, identified left atrioventricular pressure crossover at the onset of mitral flow as the only significant predictor (p less than 0.02) of peak E wave velocity in the circumstances considered. Thus the interaction among covariates of early left ventricular filling and the relationship between filling and diastolic left ventricular and left atrial properties can be addressed with relative ease by means of this clinically implemented approach, in an effort to sort out the contribution of each cofactor to such a complex event.

Echocardiography, Doppler↗
PubMed1991

[Electrocardiographic monitoring of myocardial ischemia during coronary angioplasty correlated with results of the procedure].

In 24 patients 2 leads Holter monitoring was performed during percutaneous transluminal coronary angioplasty (PTCA) of left anterior descending (17 patients), right coronary artery (6 patients), left circumflex (1 patient). In 20 patients (83%) significant ST segment deviations were recorded in the lead CM2 or RV. The following characteristics of ST segment deviation were analyzed during 7 +/- 3 successive occlusions: time to onset, maximal ST shift, slope to development, time to onset and slope of ST segment normalization. In 17 patients with successful PTCA the slope of ST segment normalization increased progressively from the first to the third-fifth inflation and then was constant. The improvement in ST segment normalization velocity was correlated (p less than 0.01) with the reduction of the diameter and with improvement of sectional area of the dilated vessel. The maximal ST segment normalization slope was correlated (p less than 0.01) with the diameter and the area of the residual stenosis. Continuous electrocardiographic recording, during PTCA, for evaluation of ST segment normalization velocity is a promising approach for monitoring the immediate result of coronary angioplasty.

Adult↗
PubMed1991

[Modifications in left atrial function in response to changes in left ventricular filling].

In order to investigate the effects of increasing degrees of left ventricular filling impairment on left atrial function, in 9 A-fillers (E/A ratio less than 1, E wave deceleration time greater than 170 ms) and 9 E-fillers (E/A ratio greater than 1, E wave deceleration time less than 150 ms) we constructed the left ventricular and the left atrial volume curves according to a previously validated Doppler 2-dimensional echo method which combines mitral and pulmonary venous flow. Eight normals served as control. The left atrial reservoir (defined as maximum-minimum atrial volume), pump (defined by the volume of blood that enters the left ventricle with the atrial contraction) and conduit functions (defined as left ventricular filling volume--the reservoir and the pump volume) expressed as % of the left ventricular filling volumes, varied significantly between normals (37 +/- 9%, 25 +/- 3%, 37 +/- 11%), A-fillers (48 +/- 9% p less than 0.05, 39 +/- 5% p less than 0.05, 14 +/- 10% p less than 0.001) and E-fillers (27 +/- 6% p less than 0.05, 19 +/- 7% p less than 0.05, 54 +/- 10% p less than 0.01). Also maximum left ventricular and left atrial volumes differed significantly (normals 165 +/- 31 ml, 76 +/- 20 ml; A-fillers 174 +/- 33 ml, 100 +/- 20 ml p less than 0.05; E-fillers 322 +/- 34 ml p less than 0.001, 136 +/- 41 ml p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Angina Pectoris↗
PubMed1991

[Intraluminal ultrasound echotomography: a new method in the study of arterial angioplasty. Evaluation of a case].

Intravascular ultrasound angioscopy allows to better define the structure of arterial wall and the effect of angioplasty. We report the case of a patient previously treated by coronary angioplasty, who underwent peripheral angioplasty for a stenosis of the left iliac artery. Intravascular ultrasound imaging performed before and after balloon dilatation clearly identified the plain of dissection and the partial resolution of the stenosis in a better way compared to digital angiography.

Angiography↗
PubMed1991

[Value of serial exercise tests after coronary angioplasty in relation to extension of heart disease and the degree of revascularization].

With the aim of investigating the functional result of the coronary angioplasty (PTCA) and verifying the predictive value of the exercise test for detecting restenosis, 165 patients who underwent successful PTCA were evaluated through exercise stress tests performed 10, 75 and 165 days after PTCA and through coronary angiography performed 5 to 6 months after PTCA. The percentage of negative tests and the rate-pressure product (RPP) increased significantly with respect to the tests performed before PTCA, both in patients with single-vessel and those with multivessel disease. Maximal ST segment depression and ST/HR were significantly reduced only in patients with complete revascularization. The percentage of positive tests 10 days after PTCA was lower in patients with single-vessel than in those with multivessel disease (2.5% versus 10.8%) and, of the latter, in patients with complete rather than incomplete revascularization (0% versus 13.5%). In patients with complete revascularization, the mean exercise time rose significantly (703 s versus 538 s). The percentage of positive tests increased progressively with time, in accordance with probable increasing restenosis. In comparison with the results of angiography, sensitivity of the exercise stress test proved to be poor (59%), especially in patients with single-vessel disease (45%), while the specificity was very high (98%). The predictive value of a negative test was 77% in patients with multi-vessel and 87% in patients with single-vessel disease. The predictive value of a positive test was over 90% in both groups of patients.

Adult↗
PubMed1990

Acute anterior myocardial infarction: streptokinase prevents ventricular thrombosis independently of its effect on infarct size.

Left ventricular thrombosis (LVT) is a frequent complication after acute anterior myocardial infarction (AMI). The purpose of this study is to evaluate whether streptokinase (SK) therapy prevents LVT, and whether this effect is due to the preservation of left ventricular function or to the fibrinolytic action of the drug. Sixty-five patients who underwent a left ventricular angiography within 2 months after a first AMI were studied. Twenty-eight patients (SK group) received SK 1,500,000 U i.v. administered over 60 min within 6 h from the onset of symptoms. A lower incidence of LVT was found in the SK group (p = 0.0003). We divided patients into two classes according to the value of akinetic-dyskinetic area (AD): the first group with a lower value of AD, the second group with a higher value of AD. In both groups, a reduced incidence of LVT was associated with SK therapy (p = 0.014, p = 0.015, respectively). Early infusion of SK during AMI seems to prevent the development of LVT, with an effect partly independent from its action on infarct size for small to large myocardial infarction.

Female↗
PubMed1990

Increase in plasma digitalis-like activity during percutaneous transluminal coronary angioplasty in patients with coronary stenosis.

Despite the fact that numerous studies have been published regarding the possible presence in plasma of an endogenous Na-K pump inhibitor with a digitalis-like structure in essential hypertension, very little is known about this factor in heart disease in general, and in situations characterized by low cardiac output. We measured the ability of plasma obtained from the femoral vein to inhibit a human renal Na(+)-K+ ATPase before and immediately after percutaneous transluminal coronary angioplasty (PTCA) in 6 patients suffering from angina pectoris and severe coronary stenosis. Intraerythrocyte sodium and potassium concentrations were also measured simultaneously. Na(+)-K+ ATPase inhibition proved significantly greater after angioplasty as compared to basal activity (percentage inhibition: 31.5 +/- 7.8 vs 16.1 +/- 12.2). No significant changes in intraerythrocyte sodium and potassium were detected. Though we are not in a position to define the mechanism underlying the increase in the digitalis-like factor, a plausible hypothesis may be that the reduction in cardiac output during PTCA by raising cardiac pressures may stimulate the production of a factor of compensatory inotropic significance.

Angioplasty, Balloon, Coronary↗
PubMed1990

[Intra- and perioperative arrhythmia and ischemic signals in myocardial revascularization patients].

In order to evaluate perioperative electrical cardiac disturbances and ST segment changes, 42 patients (38 M, 4 F, aged 57 +/- 6 ys) were studied using 24-hour Holter monitoring before, during and after coronary bypass surgery. In the 4-6 hours before cardioplegic arrest, 38% of patients had ST segment changes. No patient and malignant arrhythmias. The injection of cold cardioplegic solution was followed by bradycardia, ventricular tachycardia, ventricular fibrillation and isoelectric line within 2-4 minutes. After aortic declamping, 30 patients were defibrillated. Impulse formation and conduction disturbances, found in 55% of patients, solved themselves in 1 to 60 minutes. Bundle branch block continued in just 4 cases. A total of 59% of patients had ST segment elevation for 14 +/- 14 minutes and 19% had ST segment depression for 19 +/- 20 minutes. Successive transient ST segment changes were detected in 38% of patients. Sustained ventricular tachycardia occurred during 2 ischemic episodes. Impulse formation and conduction disturbances were not related to the duration of cardiac arrest or ventricular fibrillation, but were more frequent and lasted longer in patients with incomplete revascularization. Transient ST segment depression far from aortic declamping correlated with preclamping ischemia. Transient ST segment elevation correlated with incomplete revascularization. We concluded that ECG signs of intraoperative damage were reversible. Moreover, perioperative transitory ischemia was frequent but could be prevented by coronary active drug administration. On the other hand incomplete revascularization was associated with electrical disturbances and ischemia.

Aged↗
PubMed1990

[Effects of magnesium pidolate on cardiovascular hemodynamics].

Aim of this study is to define the hemodynamic effects of magnesium (Mg) in patients with ischemic heart disease. Thus, the effects of 1 g of Mg pidolate injected over 3 min iv were evaluated in 10 patients by analysis of pressure data from a micromanometer catheter in the left ventricle and of volume data derived from Doppler and 2-dimensional echocardiography. Recordings were made before and immediately after the injection, at 3, 5, and 8 min. At 5 min, Mg induced a significant reduction in left ventricular peak systolic pressure (from 132.4 +/- 19.4 to 122.7 +/- 17.5 mmHg, p = 0.015, with early filling notably augmented (E wave of Doppler curve; from 39.4 +/- 8.5 to 43.9 +/- 9.7 cm/s, p = 0.013) and a slight increase in cardiac output (from 6.23 +/- 1.4 to 6.9 +/- 1.7 l/min, p = 0.092). Heart rate increased (from 75.9 +/- 9.6 to 78.13 +/- 8.4 b/min, p = 0.062) and the constant of isovolumetric pressure decay decreased (from 48.9 +/- 13.2 to 45.7 +/- 14.9 ms, p = 0.065), probably as a final effect of aortic pressure reduction. The diastolic pressure-volume relationship was insignificantly displaced downward (p = 0.11) and to the right (p = 0.62). In conclusion, Mg unloads the ischemic left ventricle through a reduction of systemic aortic pressure, with a secondary increase in early filling; this increase may derive from a rise in the atrioventricular diastolic gradient, subsequent to an improvement in ventricular emptying. Active relaxation is improved, and passive diastolic properties are not affected, in spite of the reported calcium-antagonist action of the drug.

Adult↗
PubMed1989

Effect of streptokinase on left ventricular modeling and function after myocardial infarction: the GISSI (Gruppo Italiano per lo Studio della Streptochinasi nell'Infarto Miocardico) Trial.

It has been shown that streptokinase administration at the time of acute myocardial infarction reduces mortality significantly, and that this reduction in mortality should be related to salvage of jeopardized myocardium and preservation of left ventricular function. To better define the relation between thrombolytic therapy and left ventricular modeling and function after acute myocardial infarction, 331 consecutive patients enrolled in the Gruppo Italiano per lo Studio della Streptochinasi nell'Infarto Miocardico trial were studied by two-dimensional echocardiography just before discharge from the hospital. A 6 month follow-up examination was also available in 232 of these patients. Ventricular volumes were computed from an apical four chamber view, according to a previously published algorithm. An infarct size index was also semiquantitatively assessed, according to the number of akinetic and dyskinetic segments in an 11 segment left ventricular model. At predischarge examination, the 161 patients assigned to streptokinase treatment showed smaller ventricular volumes (end-diastolic volume 119.3 +/- 49.7 versus 134.5 +/- 57.8 ml [p = 0.011]; end-systolic volume 65.4 +/- 36.4 versus 74.9 +/- 45.7 ml [p = 0.036]) and smaller regional wall motion index (2.2 +/- 1.9 versus 2.7 +/- 1.9 segments; p = 0.019) compared with values in the 170 patients assigned to standard care; there was no difference in ejection fraction (46.6 +/- 14.1 versus 45.9 +/- 14.9%; p = 0.64). For both groups of patients, there was a significant relation between end-systolic volume and regional wall motion index (p less than 0.001); for large and similar extents of infarct size, ventricular volume was smaller in patients assigned to thrombolytic treatment than in patients assigned to standard care. At 6 months' follow-up, the differences in volume and regional dysfunction detected at the early examination persisted: 110.8 +/- 47.6 versus 127.9 +/- 53.8 ml for end-diastolic volume (p = 0.001), 56.3 +/- 33.6 versus 69.4 +/- 42.1 ml for end-systolic volume (p = 0.001) and 1.8 +/- 1.8 versus 2.3 +/- 1.8 segments for regional wall motion index (p = 0.001). Again, for comparable extents of infarct size, end-systolic volume was smaller in patients who received streptokinase (n = 110) than in those assigned to conventional treatment (n = 122). It is concluded that streptokinase improves left ventricular modeling and function in patients with myocardial infarction, reducing the extent of regional wall motion abnormalities and lessening postinfarction ventricular dilation. The beneficial effects persist up to 6 months.

Aged↗
PubMed1989

Single coronary artery from the left sinus of Valsalva.

A patient with chronic exertional angina and electrocardiographic signs of myocardial ischemia at exercise stress test had recent onset of rest chest pain and underwent coronary arteriography. Besides severe atherosclerotic coronary disease (which was probably responsible for clinical presentation), a single coronary artery arising from the left sinus of Valsalva was discovered. This is an exceptional finding, and its in-life diagnosis may be relevant for surgical treatment.

Angiography↗
PubMed1989

Open-ended guidewire: new technique for balloon angioplasty of chronically occluded coronary arteries.

Chronic total coronary occlusion is a growing indication to percutaneous transluminal coronary angioplasty. Since primary success of balloon angioplasty in this condition is usually limited by the difficulty of crossing the occlusion, different techniques have been described for this purpose, such as use of stiff guidewires, coronary infusion catheters, guidewires with an olive-shaped tip, or new developing methods (atherectomy, laser), in association with balloon dilatation. Here, we describe our initial experience with a thick (0.035 in) and relatively stiff open-ended guidewire, which has an inner (0.018 in diameter) lumen provided with a core wire. Several advantages are considered. The core wire yields a perfect means of steerability of the whole system, while pushability of a thicker guidewire is much greater. Moreover, the core wire can be removed, and contrast injections beyond the occlusion through the inner lumen can assure proper intraluminal location. Finally, position across the occlusion can be kept easily, since an exchange wire for conventional balloon catheters can be inserted in the inner lumen of the open-ended guidewire.

Angioplasty, Balloon↗
PubMed1989

Coronary arterial aneurysms after percutaneous transluminal coronary angioplasty--a not uncommon finding at elective follow-up angiography.

Five coronary arterial aneurysms were found in 4 of 80 (5%) patients who underwent elective coronary arteriography 6 months after successful percutaneous transluminal coronary angioplasty. None of them was present immediately after dilatation. All patients had been suffering from stable angina before angioplasty, while no case had recurrent angina or definite angiographic restenosis at the 6-month follow-up. Quantitative coronary angiography was performed in all angiograms. The coronary aneurysms only developed in the dilated portions (4 in left anterior descending and 1 in an intermediate branch of the left coronary artery): their diameter ranged from 3.1 to 4.4 mm, and their length from 2.2 to 4.9 mm. The ratio between the aneurysm diameter and the coronary arterial diameter (aneurysm: artery ratio) varied from 1.15 to 1.91 (mean 1.47). No significant clinical or technical differences were found between patients who developed aneurysm after angioplasty, and patients who did not. On the other hand, 4 of the 5 patients who developed aneurysm had angiographic evidence of "non-pathologic" dissection immediately after balloon dilatation. Moreover, the ratio between the measured angiographic diameters of the balloon (at maximal inflating pressure) and of the coronary artery selected for the procedure showed that the balloon was mildly oversized (balloon: artery ratio ranging from 1.10 to 1.37, mean 1.28) in all cases with aneurysm except the only 1 in whom dissection did not occur. In conclusion, aneurysm formation after coronary angioplasty is not infrequent in our experience: balloon size and wall dissection seem to be the major factors related to this event.

Angioplasty, Balloon↗