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Biomedical subjects

R Scognamiglio

Publications and source records attributed to R Scognamiglio.

At least 73 records · Page 4Linked to original sources
PubMed1987

Effects of unloading and positive inotropic interventions on left ventricular function in asymptomatic patients with chronic severe aortic insufficiency.

The effect of an unloading (nifedipine, 20 mg sublingually) and of a combined unloading and positive inotropic intervention (nifedipine plus digoxin, 0.5 mg intravenously) on left ventricular performance was assessed in 48 patients with chronic severe aortic insufficiency. The left ventricular pump function-myocardial contractility relation (ejection fraction, EF vs. peak arterial pressure to end-systolic volume ratio, PAP/ESV), and the pump function-afterload relation (EF vs. mean systolic wall stress, MWS) were constructed by means of quantitative M-mode and two-dimensional echocardiography. In patients with normal control pump function (n = 14), nifedipine markedly decreased MWS, moving the patients to a new, more advantageous EF-MWS relation. In the 34 patients with abnormal pump function, the myocardial contractility level was the mean factor conditioning the response to pharmacological intervention. Patients with a value of PAP/ESV greater than 2.5 (n = 22) had normalization of EF after nifedipine and were upgraded to a more advantageous outlook for left ventricular mechanics EF-MWS and EF-PAP/ESV relations. Of the 12 patients without normalization of EF after nifedipine, only the 4 patients with PAP/ESV greater than 2 had normalization of pump function indices after combined administration of nifedipine and digoxin.

Adult↗
PubMed1987

[Ebstein disease and pregnancy].

Three patients with Ebstein's disease became pregnant 11 times, 6 of which ended as spontaneous abortion, 2 newborn deaths and 3 successful term pregnancies. Ventricular overloading, arterial hypoxemia and arrhythmias are the major physiopathologic determinants. The ventricular overloading is the most important risk factor for the mother, so as the hypoxemia and the arrhythmias for the fetus. Pregnancy in these patients must be considered at high risk, and a close cardiologic assess with continuous hormonal controls of fetus maturity during the last trimester should be done. A team including obstetricians, cardiologists and anesthesiologists is suggested for the care of these patients in the view of a successful outcome.

Abortion, Incomplete↗
PubMed1986

Progression of myocardial dysfunction in asymptomatic patients with severe aortic insufficiency.

By serial echocardiographic examinations, we investigated the parameters predictive of left ventricular (LV) deterioration in 38 asymptomatic patients with severe aortic insufficiency (AI). Based on their first echocardiograms, patients were divided into two groups: Group 1 (n = 30) had normal fractional shortening (FS); Group 2 (n = 8) had abnormal FS. Similar values of LV end-diastolic, end-systolic dimension (EDD, ESD), FS, radius/thickness ratio, and mean wall stress characterized stable and unstable patients of Group 1; unstable patients, who developed abnormal values of FS during the follow-up, showed significantly lower values of the contractility index (peak arterial pressure/end-systolic volume ratio, PAP/ESV). The unstable patients, moreover, were distributed near the onset of the downslope and moved along the descending limb of the curvilinear pump performance-myocardial contractility relation. No changes occurred in Group 2 patients during follow-up. Three unstable Group 1 patients and the 8 patients of Group 2 underwent aortic valve replacement (AVR): postoperative EDD was less than 65 mm and the changes from before to after AVR were greater than 11 mm in all cases. We conclude that the pump performance-myocardial contractility relation visualized the unstability of LV function in asymptomatic patients and that AVR can be delayed after the appearance of an abnormal FS for at least 36 months.

Age Factors↗
PubMed1986

Pulmonary atresia with intact ventricular septum: a quantitative cineventriculographic study of the right and left ventricular function.

Quantitative cineventriculographic measurements (ventricular volumes, ejection fraction, and myocardial mass) were obtained in 15 neonates with pulmonary atresia and intact ventricular septum. There was a wide dimensional range for the right ventricle, from a reduced through normal to enlarged. A restrictive tricuspid valve (less than 12 mm) was associated with a small or diminutive right ventricle. A normal function of the right ventricle was present only in those cases with normal-sized chambers. The left ventricular end-diastolic volume was always greater than normal. The ejection fraction was normal only if a normal myocardial mass was present. Additional abnormalities were frequent in the myocardium of both ventricles, such as extreme thinning of the wall of the right ventricle and hypoplasia or fibroelastosis of the left ventricle. All these factors can lead to a poor surgical prognosis despite good anatomical correction.

Cardiomegaly↗
PubMed1986

Variability of positive inotropic response to acute amrinone administration in chronic cardiac failure.

To determine the factors conditioning the variability of positive inotropic response after intravenous acute amrinone administration, 14 patients with chronic cardiac failure were studied by quantitative M-mode and cross-sectional echocardiography. Six patients had idiopathic dilated cardiomyopathy and 8 patients had severe chronic aortic insufficiency. Myocardial contractility (evaluated as peak arterial systolic pressure/end-systolic volume ratio: PAP/ESV) did not change in patients with idiopathic cardiomyopathy, a significant increase of myocardial contractility occurred in patients with aortic regurgitation only if the control value of PAP/ESV was greater than 1. Mean systolic wall stress decreased significantly in all patients, independent of aetiology of cardiac failure and was the factor determining the improvement of left ventricular performance (evaluated as fractional shortening) in patients without changes in myocardial contractility. Maximum improvement in left ventricular performance occurred 10 minutes after amrinone administration. It is concluded that the possibility of detecting the positive inotropic properties of amrinone in man depends on the aetiology of the cardiac failure and on the basal level of myocardial contractility.

Adult↗
PubMed1986

[Tachycardia and ventricular fibrillation in the arrhythmogenic right ventricle (arrhythmogenic dysplasia of the right ventricle). Clinical and electrocardiographic spectrum].

In this paper we report the arrhythmias recorded on basal ECG, on Holter monitoring or on exercise test, in 32 pts affected by arrhythmogenic right ventricle (ARV). A sustained ventricular tachycardia (VT) was present in 11 pts a non sustained VT in 15 pts, a slow VT in 2 pts, a ventricular fibrillation (VF) in 3 pts and both sustained VT and VF in 1 pt. All but 1 case of sustained VT showed a LBBB like pattern. The heart rate during VT ranged between 170 and 280 beats/min. The frontal axis of the VT showed a wide range of deviation. Among non sustained VT, 9 cases had LBBB like pattern and 6 cases had polymorphic configuration. The 2 cases of slow VT showed LBBB like pattern with right axis deviation. A comparison between ventricular arrhythmias and RV impairment was made. The data obtained suggest that the effort plays an important role in the induction of VT in pts with localized RV impairment. In conclusion a wide spectrum of ventricular tachyarrhythmias is present in the ARV. Probably the RV "arrhythmogenic" zones and the electrophysiological mechanism causing the arrhythmias are various.

Adolescent↗
PubMed1985

Uncommon pattern of tricuspid stenosis in Ebstein's anomaly.

The echocardiographic and cineangiographic features of an unusual type of tricuspid stenosis in Ebstein's anomaly are described. The displaced septal and mural leaflets of the tricuspid valve are inserted to an anomalous apical muscle shelf and cause a restrictive communication between the atrialized portion and the trabecular zone of the right ventricle. The antero-superior leaflet is not involved.

Adult↗
PubMed1985

Effect of muzolimine in aortic insufficiency with different levels of left ventricular function.

The effect of muzolimine (initial dose 60 mg followed by 30 mg/day for 14 days) on 15 patients with aortic and mitral incompetence and chronic cardiac failure, functional class 3, was analyzed on the basis of repeated clinical observations, metabolic studies as well as mono and bidimensional echo changes 2, 24 hours and 15 days after the initial dose. An important variation was a reduction in body weight by 3-4% after the first day and by a further 1-2% after 2 weeks. No significant variations were observed regarding heart rate and blood pressure at rest. Plasma level of electrolytes as well as other important biochemical parameters in the serum (BUN, glucose and creatinine) were uninfluenced. A small increase was observed in both the plasma level of chloride and in the red cell count. Urine volume increased by two to threefold after the first day; this increase was still present after 2 weeks. Changes in the left ventricular end-diastolic and end-systolic volumes were not significant after the first day; however a slight but significant reduction was observed after 2 weeks and was in parallel with the improvement of the functional class of the patients. Data, in particular the possible mode of action of muzolimine after acute administration and after short-term therapy, are discussed.

Adult↗
PubMed1984

Relation between myocardial contractility, hypertrophy and pump performance in patients with chronic aortic regurgitation: an echocardiographic study.

The aim of this study was to establish prognostic indices and to detect irreversible left ventricular dysfunction before aortic valve replacement in patients with chronic aortic regurgitation. Therefore, we determined the left ventricular pump/contractility relation (expressed as a ration between ejection fraction and peak systolic pressure/end-systolic volume), afterload mismatch (the relation between the ejection fraction and mean systolic wall stress) and the left ventricular end-diastolic radius/posterior wall thickness ratio in 52 patients with chronic aortic regurgitation by means of M-mode echocardiography. These indices were also calculated in 14 patients with idiopathic dilated cardiomyopathy and in 20 normal controls. The indices allowed separation of normals and patients with mild to moderate aortic insufficiency from patients with idiopathic dilated cardiomyopathy indicating that these indices could distinguish between patients with a reversible afterload mismatch and those with irreversible impaired muscle function. The 38 patients with severe aortic insufficiency showed a large overlap between normal and abnormal indices. Twelve of these patients had a pump/contractility index and a ratio between ejection fraction and wall stress similar to that found in patients with idiopathic dilated cardiomyopathy. All these patients, however, had a left ventricular end-diastolic radius/thickness ratio greater than 4 indicating "inadequate hypertrophy". Of these, 3 patients died perioperatively and 4 developed congestive heart failure within 12 months postoperatively. We conclude that an end-diastolic radius/thickness ratio greater than 4 is a sensitive but not a specific preoperative indicator of irreversible left ventricular damage in patients with chronic aortic regurgitation. This index is readily obtained preoperatively by M-mode echocardiography.

Adolescent↗