Biomedical subjects
Publications and source records attributed to R Canziani.
Cardiac hemangiomas are rare, primary benign cardiac tumors. The authors report their experience of diagnosis and treatment of an hemangioma localized into the left ventricle. The tumor could be successfully resected and there is no recurrence at 1 year follow-up.
We have studied with the echocardiography M-Mode, 2-D, Doppler three groups of 15 subjects for testing the presence of cardiac abnormalities probably related to primary collagen defect in patients with autosomal dominant polycystic kidney disease (ADPKD) The first group was made up of patients with ADPKD and normal renal function, the second of patients with ADPKD in hemodialysis (HD), the last one of patients in HD for other renal disease. In the first group we found no cardiovascular abnormalities while we found an increased incidence of valvular disease (p = 0.016) in patients with ADPKD in HD and an increased incidence in valvular disease (p = 0.016) and left atrial dilatation (p = 0.006) in patients in HD for different renal disease. When we estimated the cases on the ground of dialytic age uncorrelated with the initial renal disease, only the incidence of valvular calcifications was increased in patients on HD more than 3 years (p = 0.034). In our group of patients the echocardiographic abnormalities seem to be related more to uremic cardiomyopathy even if we cannot deny the existence of primary cardiac disease in patients with ADPKD.
High-resolution electrocardiography has been used as a non-invasive method for the study of delayed potentials in order to evaluate the risk of the onset of ventricular arrhythmia first in ischaemic cardiopathy and then in various cardiopathies, generally using XYZ orthogonal derivations. The aim of this study was to compare the results obtained with those using standard precordial leads, in particular V4 and V6 leads. A group of 28 patients, males and females, aged between 15 and 55 years of age, was examined. All patients were suffering from different cardiopathies. Subjects with delayed right and left ventricular activation on the surface ECG tracing were excluded from the study. A 60-200 Hertz bandpass filter and time averaging of 300 consecutive complexes were used to analyse tracings. Dual recordings were performed for each patient. The following parameters were examined: total duration of filtered QRS complex and root-mean-square voltage of potentials in the last 40 msec of filtered QRS (RMS). In particular, the comparison between RMS using Frank's method and those obtained using V4 and V6 precordial leads provided a coefficient of correlation of r = 0.91 with p < 0.001 and r = 0.92 with p < 0.001 respectively, and the comparison between QRS obtained using the same method and that obtained using V4-V6 precordial leads gave a coefficient of correlation of R = 0.80, p < 0.001 and r = 0.77 and p < 0.001 respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
Recently published reports have highlighted the presence of a high incidence of late potentials in patients with mitral valve prolapse. In order to verify this observation 29 patients suffering from this pathology were studied using high-resolution electrocardiography. Late potentials were present in 24% of patients with mitral valve prolapse in comparison to 5% of control subjects (p less than 0.05); no correlation was found however in patients with mitral valve prolapse between the presence of late potentials and Holter's ventricular hyperkinetic tachycardia. At a follow-up after 16 +/- 4 months no patient presented persistent ventricular tachycardia or sudden death. The presence of late potentials might be yet symptom of the mitral prolapse syndrome whose prognostic role, although not yet clear, does not appear to represent a negative factor in relation to major tachycardia attacks.
We mechanocardiographically evaluated 50 patients with acute myocardial infarction, invasively monitored by Swan-Ganz catheters, in order to assess if mechanocardiography could provide reliable hemodynamic informations. The last 25 subjects were also studied by pulsed Doppler echocardiography. Our results confirm the high precision of apexcardiography in assessing mean pulmonary capillary wedge pressure (r = 0.91) while Doppler echocardiography proved itself better than mechanocardiography in assessing cardiac output (r = 0.82 vs r = 0.78). Moreover, Doppler echocardiography allowed a good estimation of mean pulmonary artery pressure (r = 0.81) which cannot be assessed by other noninvasive methods. However, we could not find any clinically useful relationship between Doppler mitralic flow characteristics and mean pulmonary capillary wedge pressure. Therefore noninvasive methods could represent a valid alternative to right heart catheterization provided that an integrated Doppler echocardiographic and mechanocardiographic approach is used.
The paper reports a case of infective endocarditis of the valve, with an insidious and slow onset accompanied by low fever, debility, loss of weight, anemia, and the concomitant echocardiographic observation of pericardial effusion. Subsequent echocardiographic tests produced images which probably referred to valvular vegetation. As a matter of fact these findings proved to be result of the rupture of the latero-posterior tendinous cord of the mitral flap and other similar cords whose stumps, covered in fibrin, had adhered to the edge of the anterior cups. This finding was discovered during surgery, which was performed early and successfully, and was followed by excellent long-term results.
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The frequency and characteristics of cardiac involvement have been evaluated in 22 patients with Friedreich's ataxia and in 10 patients with non Friedreich's ataxia (Strumpell-Lorraine 5 cases; Pierre Marie 5 cases), classified according to the severity and the lasting of neurological disease. In a high percentage (45%) of patients with Friedreich's ataxia, the results show left ventricular hypertrophy as proved echocardiographically by an increase of the interventricular septum thickness and of the posterior wall thickness. On the contrary, no patient with non Friedreich's ataxia had left ventricular hypertrophy. In the patients with Friedreich's ataxia, left ventricular hypertrophy was of concentric type in 27% of the cases and of asymmetric type in 18% of the cases; left ventricular systolic indexes were not reduced. The left ventricular end-diastolic diameter was normal in all the patients. Furthermore, in 4 patients with Friedreich's ataxia (18% of the cases) without left ventricular hypertrophy, mitral valve prolapse has been found. No correlation exists between the severity and the lasting of neurologic disease and the presence of cardiac hypertrophy. This supports the hypothesis that the cardiac abnormality is a primary expression of a genetic defect and not a secondary manifestation of spinocerebellar degeneration. It is therefore necessary to always consider a patient with Friedreich's ataxia as affected with a cardiac disease even if it is not clinically evident.
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Using digitized M-mode ecocardiography, 26 young subjects with type I diabetes mellitus of at least three years duration, without any clinical evidence of heart disease have been studied, searching for subclinical impairment of left ventricular function. Patients have been divided in two groups according to the presence (Group I, N degrees 7 patients) or absence (Group II, N degrees 19 patients) of retinopathy. The time interval from the shortest left ventricular diameter to the onset of mitral valve opening was significantly increased as compared with the control Group (10.20 +/- 8.88 control Group; 29.21 +/- 12.99 Group II, p less than 0.001; 41.00 +/- 12.29 Group I, p less than 0.001). Furthermore, a close correlation between the above named time interval and the duration of diabetes was found (r = 0.496, p less than 0.01). Finally, the change of left ventricular dimension during the time interval from the shortest left ventricular diameter to the onset of mitral valve opening, expressed as a percentage of left ventricular end-diastolic diameter, was increased (3.20 +/- 3.43 control Group; 8.21 +/- 5.51 Group II, p less than 0.02; 12.43 +/- 5.56 Group I, p less than 0.001). Our results suggest an impairment of ventricular relaxation due to increased wall stiffness. We conclude that there are often subclinical cardiac abnormalities in young diabetics resulting in impairment of diastolic function that is correlate with the duration of diabetes and with the presence of clinical complications such as retinopathy.
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Thirty eight acromegalic patients (A) and a control group (C) of subjects without heart disease, were studied with echocardiography. Acromegalies were divided in two groups, A1 and A2, who had increase or normal serum growth hormone (GH) levels respectively after treatment (pituitary adenectomy and/or bromocriptine), at the time of the study. In acromegalic patients (A) mean left ventricular (LV) dimensions were normal while LV wall and septal thickness, LV mass and left atrial (LA) dimension were increased compared to control subjects. LVH was present in 79% of acromegalic patients. Asymmetric septal hypertrophy (ASH) was found in 10,5% of our patients. In group A1, IVS, LVPW, LVMM/m2 were significantly increased as compared to group A2. Fractional shortening (FS), ejection fraction (EF), mean velocity of circumferential fibre shortening (Vcf), frequency-normalized Vcf (Vcfn), posterior left ventricular wall velocity (PWV), and normalized PWV (PWVn) were normal in both groups. In patients with active acromegaly (Al) IVS and LVMM/m2 correlated well with the total duration of the disease (r=0.550 p less than 0.01 for IVS; r=0.624 p less than 0.01 for LVMM/m2) and with the duration of acromegaly before treatment (r=0.568, p less than 0.01 for IVS; r=0.500 p less than 0.01 for LVMM/m2). Furthermore a positive correlation was found between IVS and GH levels (r=0,550 p less than 0.01). Concomitant coronary artery disease and or hypertension did not seem to play any role in causing the above mentioned echocardiographic changes. Echocardiography is useful in assessing the cardiac involvement in patients with acromegaly.
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