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Biomedical subjects

S Betocchi

Publications and source records attributed to S Betocchi.

70 records · Page 4Linked to original sources
PubMed1981

His bundle electrogram recording using a multipolar electrode catheter via the arm veins.

In eighteen patients with atrioventricular conduction disturbance, His bundle electrograms were studied via the arm vein. A 6F Berkovits-Castellanos USCI hexapolar electrode catheter was introduced into the right atrium and looped across the tricuspid valve in a "golf club" shape. The main aim was to leave the two distal electrodes in contact with the atrial endocardium to perform atrial pacing, while displaying the other four electrodes along the superior angle of the tricuspid valve for proximal and distal His bundle recordings. His bundle electrograms were successfully obtained in all cases. The arm approach provides an alternate route whenever the femoral approach is not feasible. Moreover, the use of an hexapolar electrode catheter provides some practical advantages: 1) it enables atrial pacing to be performed, as well as proximal and distal His bundle recording to be obtained, by using the same multipolar electrode catheter; and 2) it allows long-term monitoring of His bundle potentials, in view of the stability of His bundle recordings. Finally, the arm approach could be the method of choice for the study of His bundle electrograms during leg supine exercise in selected patients.

Arm↗
PubMed1981

Clinical hemodynamic and angiographic findings in 94 patients with old myocardial infarction. Comparison with 79 patients with coronary artery disease and no myocardial infarction.

Clinical, hemodynamic, coronary arteriographic, and ventriculographic findings of 94 patients (pts) with coronary artery disease (CAD) and old myocardial infarction (MI) have been described and compared with those of 70 pts with CAD and no previous MI. Pts with old MI presented a more compromised functional and hemodynamic status, with a higher incidence of NYHA class III-IV pts (40%), symptoms of left ventricular (LV) failure (31%), cardiomegaly (70%), higher left ventricular end-diastolic pressure (LVEDP) (19.6 +/- 9.6 mmHg, p less than 0.05), compared with 32%, 22%, 54% and 16.0 +/- 6.8 mmHg respectively in CAD pts with no MI. MI pts presented more severe CAD, higher incidences of three vessel disease (56%, p less than .005) and of left anterior descending (LAD) (34%) and right coronary artery (RCA) (36%) occlusions, compared with 34%, 6%, and 9% respectively in pts with no MI. Furthermore, pts with old MI showed more diffused and severe LV segmental wall contraction abnormalities, with higher frequencies of LV aneurysm (31%) and of pts with asynergy of more than 2 LV segments (26%), compared with 1% and 3% respectively in pts with no MI. Within the group with old MI, LVEDP was higher in pts with anterior (A) (22.0 +/- 11 mmHg, p less than .02) and anterior ł diaphragmatic (AłD) (21.5+/- 7.9 mmHg, p less than .05) MI, compared with pts with diaphragmatic (D) MI (16.6 +/- 7.1 mmHg); furthermore, LVEDP increase was significantly correlated with the severity and the extent of LV asynergy. In A and D MI, LAD and RCA stenoses or occlusions were prevalent respectively; pts with AłD MI showed larger numbers of coronary stenosis (3.05) and occlusions (1.05) per patient. The coronary artery supplying the infarcted area showed stenosis (greater than 75%) in 95.6% and was normal in 2.2% of cases. Thus, pts with CAD and old MI, and particularly of AłD and A MI, show a more compromised hemodynamic status and more severe degrees of CAD and of LV segmental wall contraction abnormality, which are responsible for their poor prognosis, compared to pts with CAD but no old MI.

Adult↗
PubMed1979

Hemodynamic response to exercise after propranolol in patients with mitral stenosis.

Hemodynamic response to exercise before and 10 minutes after propranolol (5 mg intravenously) was studied in 10 young patients with pure mitral stenosis who had normal sinus rhythm and no cardiac failure. After propranolol the mean heart rate and cardiac index at rest were lower than during the control state (respectively, 95 +/- 4 versus 82 +/- 3 beats/min, P less than 0.005; 3.4 +/- 0.2 versus 2.8 +/- 0.1 liters/min per m2, P less than 0.025). As a result, the mean pulmonary wedge pressure and mean mitral valve gradient at rest were lower (respectively, 22 +/- 2 versus 18 +/- 2 mm Hg, P less than 0.005; 24 +/- 2 versus 17 +/- 2 mm Hg, P less than 0.001). During exercise after propranolol the values of pulmonary wedge pressure and mitral valve gradient were lower than control values during exercise (respectively, 39 +/- 3 versus 30 +/- 2 mm Hg, P less than 0.005; 44 +/- 3 versus 32 +/- 3 mm Hg, P less than 0.005), again because of the lower heart rate and cardiac index (130 +/- 6 versus 104 +/- 6 beats/min, P less than 0.001; 4.6 +/- 3 versus 3.7 +/- 2 liters/min per m2, P less than 0.01). Left ventricular end-diastolic pressure and stroke index showed no significant changes. Thus, propranolol may benefit patients with pure mitral stenosis with sinus rhythm and no cardiac failure whose symptoms occur during those reversible conditions characterized by an increase in heart rate or cardiac output, or both.

Adult↗
PubMed1979

[Echocardiographic size of the left atrium and pulmonary "capillary" pressure in different cardiopathies].

In order to investigate the relationship between left atrial pressure and volume, left atrial echograms and mean pulmonary wedge pressure were obtained on 64 patients with various cardiac diseases. A statistically significant relationship was found in the whole group (r = 0.67, p < 0.01), but there was a considerable degree of dispersion around the regression line. A good correlation was present in 6 patients with hypertrophic cardiomyopathy (r = 0.97, p < 0.01) and in 13 patients with long standing mitral valve disease (r = 0.85, p < 0.01). There was no correlation in coronary artery disease patients.

Adolescent↗
PubMed1979

[Iatrogenic ostial stenosis of the left coronary artery. Report of a case with Starr-Edwards aortic prosthesis (author's transl)].

A case of a 41 years-old-man, who had undergone surgical intervention ten years previously for aortic valve replacement in ECC with the coronary perfusion technique, is reported. This patient was studied because of the appearance of angina pectoris three months after the intervention and its progressive development. Selective left coronary angiography showed an ostial subocclusive stenosis; the run-off from the right coronary artery provided distal blood supply to the left coronary artery. A venous bypass was implanted between the aorta and the left anterior descending branch; the prosthesis was substituted because it was altered and caused hemolysis' problems. In accordance with most Authors late ostial coronary stenosis is a complication of the coronary perfusion technique, which is adopted for myocardial protection during surgical interventions for aortic valve replacement.

Adult↗
PubMed1976

[Importance of coronarographic evaluation in valvular diseases for correct surgical indication (author's transl)].

Among 100 patients who underwent cardiac catheterization for acquired valvular disease, selective coronaryangiography showed in 25 cases obstructive changes of coronary arteries, in many instances of such severity to modify the therapeutic program (myocardial revascularization associated with valvular repair, counter-indication to surgical therapy). Coronary artery alterations were discovered in patients without clinical and electrocardiographic signs of coronary insufficiency, and, on the contrary, normal coronary tree was found in patients with positive clinical and electrocardiographic findings. The importance of coronarography in the haemodynamic study of valvular patients is stressed, even in absence of evident clinical signs of coronary insufficiency. The preoperative evaluation of the coronary arteries is fundamental for a correct surgical indication and for the results of surgical therapy.

Coronary Angiography↗
PubMedDate not supplied

Anterior S-T changes during acute inferior myocardial infarction.

We investigated the clinical course of 57 patients with acute inferior myocardial infarction as regards anterior S-T segment depression. Thirty of them showed S-T segment depression greater than or equal to 0.15 mV in at least 2 precordial leads, and 27 did not exhibit such changes. Twenty-seven patients underwent post-infarction exercise stress test. Furthermore, coronary arteriographic findings and left ventricular performance were evaluated in 8 of these patients with and in 8 without anterior S-T segment depression. Patients with anterior S-T segment depression showed greater inferior S-T segment elevation on admission ECG and deeper Q wave in lead aVF in ECG tracings recorded 1 month later. Higher incidences of in-hospital angina (10/30 vs 2/27, P = 0.01) and of late development of cardiac failure (5/21 vs 0/19, P = 0.03) were found among patients with anterior S-T segment depression. They showed a higher overall coronary score (82.4 +/- 31.0 vs 32.5 +/- 28.9, P = 0.002) and left anterior descending artery score (44.1 +/- 20.7 vs 8.5 +/- 16.1, P = 0.0009) and a reduced ventricular performance, evaluated by ventriculography score (49.5 +/- 2.7 vs 51.8 +/- 2.4, P = 0.05). A higher incidence of mitral regurgitation, secondary to papillary muscle dysfunction, was also found among patients with anterior S-T segment depression (4/8 vs 0/8, P = 0.04). Furthermore, the degree of anterior S-T segment depression in each of these subjects was closely correlated with the corresponding difference from normal ventricular score (r = 0.86, P less than 0.01). Finally, no difference between the two groups of patients was found as to incidence of positive exercise stress tests.

Coronary Angiography↗
PubMedDate not supplied

Cardiac hypertrophy in the absence of pressure overload: an experimental and clinical report.

A stimulated altitude of 7000 m was applied in rats chronically exposed to hypoxia in a hypobaric chamber. In these experimental conditions the contralateral ventricle not exposed to pressure overload (that is, the left) showed a significant degree of hypertrophy. The hypoxic stimulus did not affect systemic artery pressure or the heart rate. Chronic adrenergic stimulation performed in the rat treated with low doses of isoprenaline (a direct stimulating adrenergic drug) or with tyramine (primarily a releaser of endogenous catecholamines) induced hypertrophy of the right ventricle, left ventricle, and interventricular septum without modifying the haemodynamic parameters mentioned above. The development of ventricular hypertrophy in the absence of pressure overload is stressed. A role for neurohumoral factors (that is, adrenergic stimulation and catecholamines) in the development of ventricular hypertrophy is suggested.

Animals↗
PubMedDate not supplied

Left ventricular systolic and diastolic function in severe obesity: a radionuclide study.

To verify the impact of sever obesity (defined as body mass index > 31 kg/m2) on left ventricular (LV) function, 32 asymptomatic obese but otherwise healthy subjects (16 men; age 38 +/- 11 years) voluntarily underwent first-pass and equilibrium 99mTc radionuclide angiography at rest and, in 22 of them, during bicycle supine exercise. Data were compared to those obtained from 10 normal volunteers (age 48 +/- 13; p < 0.05, vs. obeses). End-diastolic and stroke volumes did not differ between the two groups, whereas end-systolic volume was significantly higher in obese subjects (67 +/- 20 vs. 49 +/- 20 ml; p < 0.05), and, as a consequence, LV ejection fraction at rest was decreased in obese subjects (59 +/- 7%) compared to normals (65 +/- 6%; p < 0.05). Due to the higher heart rate in obese subjects (81 +/- 13 vs. 69 +/- 10 pbm, respectively; p < 0.05) cardiac output was significantly greater compared to normals (7.1 +/- 0.8 vs. 6.2 +/- 0.2 liters/min, respectively; p < 0.01). During exercise, ejection fraction normally increased in normals (70 +/- 7%; p < 0.001, vs. baseline) but not in obese subjects (60 +/- 9%; p = nonsignificant vs. baseline). In addition, systolic blood pressure/end-systolic volume ratio was significantly decreased in obese subjects (23 +/- 1.3) compared to normals (2.8 +/- 1.6; p < 0.05). Peak filling rate, normalized to end-diastolic counts per second, was significantly lower in obese subjects (2.2 +/- 1.3) compared to normals (2.8 +/- 1.6; P < 0.05). This difference was also true when peak filling rate was computed in stroke counts per second (3.8 +/- 0.8 in obeses vs. 4.4 +/- 0.4 in normals; p < 0.05). Repeat analysis in a subgroup of 10 young obese subjects (age < or = 30 years) confirmed decreased ejection fraction at rest (60 +/- 4%; p < 0.05) and peak filling rate (2.4 +/- 0.4 end-diastolic counts/s; p < 0.05), as well as the lack of ejection fraction increase during exercise (59 +/- 9%). Thus, these data indicate a subclinical impairement of LV systolic and diastolic function at rest and during exercise in asymptomatic severely obese but otherwise healthy subjects.

Adult↗
PubMedDate not supplied

[Effects left ventricle asynchrony on systolic and diastolic function in patients with non-ischemic heart failure].

INTRODUCTION: The asynchrony of the left ventricle--i.e., its nonuniform contraction and relaxation--is an important factor for left ventricular function. Heart failure is often related to abnormal systolic function, sometimes associated with a diastolic dysfunction. We studied the relationship of left ventricular asynchrony to left ventricular function in patients with nonischemic heart failure. MATERIAL AND METHODS: Radionuclide angiography at rest was performed in 25 patients with nonischemic heart failure and in 26 age and sex matched normal subjects. In addition to ejection fraction and peak filling rate, two indices of left ventricular asynchrony were calculated: the coefficient of variation of regional time to end systole and the coefficient of variation of regional time to peak filling rate. These factors indicate how disperse are the regional values of time to end systole and of time to peak filling rate. In fact, the higher the value, the greater the asynchrony. RESULTS: A significant (r = .46, p < .05) inverse correlation was found between the ejection fraction and the coefficient of variation of regional time to end systole in both the normal subjects and the heart failure patients, while the ejection fraction correlated significantly (r = .46, p < .05) with the coefficient of variation of regional time to peak filling rate only in the patients. Moreover, the peak filling rate was inversely correlated (r = .57, p < .05) with the coefficient of variation of regional time to peak filling rate in the heart failure patients but not in the normal subjects. CONCLUSIONS: These results suggest that left ventricular systolic and diastolic asynchrony may contribute to impair left ventricular systolic and diastolic function in patients with nonischemic heart failure.

Adult↗