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Biomedical subjects

S Iliceto

Publications and source records attributed to S Iliceto.

At least 55 records · Page 3Linked to original sources
PubMed1998

Interrupted inferior vena cava in asplenia syndrome and a review of the hereditary patterns of visceral situs abnormalities.

We present the clinical and postmortem findings of the first photographically documented case of asplenia and interrupted inferior vena cava and the anatomic findings of 5 previously reported cases. A brief review of the various hereditary patterns of visceral situs abnormalities suggests that, at least in some cases, the asplenia and polysplenia syndromes are etiologically and pathogenetically interrelated.

Abnormalities, Multiple↗
PubMed1998

Evaluation of dynamic changes in microvascular flow during ischemia-reperfusion by myocardial contrast echocardiography.

BACKGROUND: Dynamic changes of myocardial blood flow have been observed after reperfusion of an occluded coronary artery. MCE performed by intracoronary contrast injection can provide an estimate of microvascular flow. We hypothesized that MCE performed using intravenous infusion of a new generation contrast agent and electrocardiogram-gated harmonic imaging would be able to assess serial changes of microvascular perfusion. OBJECTIVE: To study the potential of myocardial contrast echocardiography (MCE) to assess serial changes of microvascular flow during ischemia-reperfusion. METHODS: Sixteen dogs underwent 90 or 180 min of left anterior descending coronary occlusion, followed by 180 min of reperfusion. Regional blood flow (RBF) was measured with fluorescent microspheres at baseline, during coronary occlusion, and at 5, 30, 90, and 180 min during reperfusion. At the same time points, MCE was performed with intravenous infusion of AF0150 (4 mg/min). Gated end-systolic images in short axis were acquired in harmonic mode and digitized on-line. Background-subtracted videointensity measured from MCE and RBF obtained from fluorescent microspheres were calculated for the risk area and for a control area, and were expressed as the ratio of the two areas. RESULTS: After initial hyperemia, a progressive reduction in flow was observed during reperfusion. MCE correctly detected the time course of changes in flow during occlusion-reperfusion. Videointensity ratio significantly correlated with RBF data (r=0.79; p < 0.0001). CONCLUSIONS: The progressive reduction in blood flow occurring within the postischemic microcirculation was accurately detected by MCE. This approach has potential application in the evaluation and management of postischemic reperfusion in humans.

Animals↗
PubMed1997

How European cardiologists perceive the role of calcium antagonists in the treatment of heart failure and left ventricular dysfunction.

In a poll of European cardiologists, one of the most popular of the given definitions of heart failure centres on the abnormality of ventricular function. However, opinion remains divided on the necessity of a distinction between diastolic and systolic heart failure, as it does on the value and procedures of stress testing. The 'no-reflow' phenomenon continues to pose a challenge in conditions requiring myocardial reperfusion, and precise identification of some heart disorders apparently remains difficult in many cases. Drug treatment of conditions like left ventricular dysfunction of arterial hypertension is open to continuing discussion, but calcium antagonists seem assured of an important role.

Calcium Channel Blockers↗
PubMed1997

Left ventricular dysfunction: which role for calcium antagonists?

Left ventricular dysfunction is the most common cause of congestive heart failure. Thus, treating or preventing left ventricular dysfunction represents an important therapeutic goal. The use of calcium antagonists in the treatment of left ventricular dysfunction or congestive heart failure has been proposed for many years now, mainly because of their potent vasodilatory effect. However, despite the theoretical basis, the results of studies exploring the possible use of calcium antagonists in this setting have not been at all encouraging. It has been suggested that this is because calcium antagonists have important additional effects: they depress cardiac contractility and activate the neurohormonal system. The various calcium antagonists have different characteristics and can be potentially useful in a variety of clinical conditions. Amlodipine (a calcium antagonist with a minimal cardiodepressant effect, long half-life and minimal activity on the neurohormonal system) has been shown to be clinically useful in congestive heart failure of nonischaemic origin. Calcium antagonists capable of limiting heart rate increment are useful in limiting ischaemia-induced left ventricular dysfunction. Verapamil exerts a potent protective effect on both microvascular damage and mechanical recovery during prolonged ischaemia followed by reperfusion. Lastly, nisoldipine is capable of ameliorating left ventricular function in patients with left ventricular diastolic dysfunction and has, therefore, potential in the treatment of congestive heart failure of left ventricular diastolic dysfunction origin. Thus, calcium antagonists may have a role in the treatment of left ventricular dysfunction provided that patient characteristics, the underlying mechanisms of the left ventricular dysfunction and the various calcium antagonist characteristics are well understood and carefully considered.

Animals↗
PubMed1997

Effects of atrial pacing stress test on ultrasonic integrated backscatter cyclic variations in normal subjects and in patients with coronary artery disease.

AIMS: To evaluate the effects of acute, atrial pacing-induced, reversible myocardial ischaemia on myocardial thickening and integrated backscatter cyclic variations in patients with or without coronary artery disease. METHODS AND RESULTS: Thirty-six patients with suspected coronary artery disease underwent transoesophageal echocardiography with simultaneous atrial pacing, and coronary angiography. In myocardial segments not related to a significantly narrowed coronary artery, both from patients with and without coronary artery disease, thickening and integrated backscatter cyclic variations were not reduced at peak pacing. In segments related to a significantly narrowed coronary artery, thickening decreased at peak pacing, was still reduced at pacing interruption and recovered at 2 min, while backscatter cyclic variations, blunted at peak pacing, immediately recovered after pacing interruption. CONCLUSION: During stress-induced myocardial ischaemia, backscatter cyclic variations are blunted and thickening reduced. Returning to baseline, pre-atrial pacing values occur more rapidly in backscatter cyclic variations than when thickening takes place. Evaluation of stress-induced alterations in backscatter cyclic variations may aid in the identification of ischaemia-induced regional left ventricular functional impairment and, hence, in coronary artery disease diagnosis.

Atrial Function↗
PubMed1997

Functional role of microvascular integrity in patients with infarct-related artery patency after acute myocardial infarction.

AIMS: The study was set up to evaluate the functional role of post-infarct preserved microvascular integrity. Low dose dobutamine echocardiography and myocardial contrast echocardiography were used to study patients before hospital discharge who had suffered a recent myocardial infarction and had a patent infarct-related artery (TIMI flow grade 3). METHOD: In the dysfunctioning infarct area, the wall motion score index was calculated at baseline, during the dobutamine infusion and at the 3 month follow-up echocardiogram; contrast echocardiography was performed at the time of coronary angiography, before hospital discharge. RESULTS: In patients with more than 50% of the dysfunctioning infarct area opacified at contrast echocardiography (group A), regional wall motion score index decreased, compared to baseline, during the dobutamine infusion (1.97 +/- 0.78 vs 2.5 +/- 0.35 at baseline; P < 0.001) and at follow-up echocardiography (1.83 +/- 0.63 vs 2.5 +/- 0.35 at baseline; P < 0.001). In patients with less extensive microvascular integrity as revealed by contrast echocardiography (group B), regional wall motion score index did not decrease from baseline during either the dobutamine infusion (2.73 +/- 0.21 vs 2.81 +/- 0.20 at baseline; P = ns), or at follow-up (2.81 +/- 0.20 vs 2.81 +/- 0.20 at baseline; P = ns). CONCLUSION: In patients with post-infarct dysfunctioning myocardium but a patent infarct-related artery, microvascular integrity, as assessed by myocardial contrast echocardiography, is an indicator of myocardial viability in terms of preserved contractile reserve, as demonstrated by dobutamine infusion and functional recovery at follow-up.

Cardiotonic Agents↗
PubMed1997

[Diagnosis of coronary disease using multiplane transesophageal echocardiography and atrial pacing].

The diagnostic value of echo-pacing has been previously report. Recently, monoplanar transesophageal echocardiography (TEE) has been used to improve the reliability of this stress procedure. Therefore, in 40 consecutive patients undergoing coronary angiography for suspected coronary artery disease (CAD) we tested the accuracy of atrial pacing (TAP) during multiplane TEE as a stress procedure. TAP was performed during TEE using a circular, adhesive electrode installed at the tip of the echoscope and connected to the pulse generator. In all patients TAP was firstly attempted by positioning the TEE probe in the esophagus and, if not successful, in the stomach. Left ventricular wall motion was monitored by means of 4, 2 chamber and long axis views from the esophagus and short axis scan from the stomach, in baseline conditions, at peak pacing and immediately after maximal heart rate. The test was considered positive if wall motion abnormalities developed during TAP. Stable capture of the atrium was obtained in 28 patients from the esophagus and in 6 patients from the stomach. Thus, TEE-TAP was performed in 34/40 patients (feasibility 85%). Wall motion abnormalities were detected during TAP in 20/24 with and in 2/10 patients without CAD. Thus, sensitivity and specificity of TEE-TAP were 83% and 80% respectively. The sensitivity of the test in single and multivessel disease resulted 72% and 92%. The 12 lead electrocardiogram during TAP showed a sensitivity of 66% and a specificity of 40% (p < 0.01 vs TEE-TAP). In conclusion, TEE-TAP is a new approach for CAD evaluation providing a complete and accurate imaging of left ventricular wall motion.

Cardiac Pacing, Artificial↗
PubMed1996

Analysis of microvascular integrity, contractile reserve, and myocardial viability after acute myocardial infarction by dobutamine echocardiography and myocardial contrast echocardiography.

The purpose of this study was to evaluate, in postinfarction dysfunctioning myocardium, the relative potential of myocardial contrast and low-dose dobutamine echocardiography in detecting myocardial viability, and the relation between microvascular integrity, contractile reserve, and functional recovery at follow-up. Twenty-four patients with recent myocardial infarction were studied before hospital discharge with low-dose dobutamine and myocardial contrast echocardiography. In the dysfunctioning infarct area, wall motion score index was calculated at baseline, during low-dose dobutamine, and at 3-month follow-up. Revascularization of the infarct-related artery was performed if clinically indicated. Eighteen patients (group A) had myocardial enhancement of the dysfunctioning infarct area at myocardial contrast echocardiography of >50%, whereas the remaining patients (group B) had an increase of < or = 50%. Wall motion score index was similar at baseline in groups A and B (2.6 +/- 0.4 and 2.8 +/- 0.2; p = NS), but it improved during low-dose dobutamine and at follow-up only in group A (1.9 +/- 0.9 and 1.9 +/- 0.7, respectively; p <0.001 vs baseline). In group B, wall motion score index was 2.7 +/- 0.4 with low-dose dobutamine and 2.8 +/- 0.2 at follow-up (p = NS vs rest). In identifying viable myocardial segments, myocardial contrast echo had 100% sensitivity and 46% specificity, whereas low-dose dobutamine echo had 71% sensitivity and 88% specificity. Thus, microvascular integrity after acute myocardial infarction is a fundamental prerequisite for ensuring myocardial contractile reserve and regional functional recovery. Myocardial contrast and low-dose dobutamine echocardiography have different, but complementary, diagnostic characteristics in detecting myocardial viability.

Aged↗
PubMed1996

Improved Doppler detection of proximal left anterior descending coronary artery stenosis after intravenous injection of a lung-crossing contrast agent: a transesophageal Doppler echocardiographic study.

OBJECTIVE: This study was designed to verify the usefulness of transesophageal Doppler recording of blood flow velocity in the proximal left anterior descending coronary artery, after a peripheral injection of a lung-crossing contrast agent (SHU 508A), in detecting and locating a hemodynamically significant stenosis (vessel narrowing > or = 50%) affecting this portion of the vessel. BACKGROUND: Transesophageal Doppler echocardiography has a limited diagnostic impact on the evaluation of proximal left anterior descending coronary artery stenoses. Peripheral injection of SHU 508A, a lung-crossing contrast agent enhancing Doppler signal to noise ratio in coronary arteries, may allow recording of localized disturbed blood flow velocity at the stenosis site even in the absence of a clear B-mode visualization of the vessel. METHODS: Transesophageal Doppler echocardiography, before and after echo contrast injection, was performed in 31 patients who underwent coronary angiography. Using color Doppler as a guide, pulsed wave Doppler recording of blood flow velocity in the left anterior descending coronary artery was attempted to detect a localized increase in blood flow velocity. B-mode evaluation of the vessel was also performed. RESULTS: Angiography showed a significant proximal left anterior descending coronary artery stenosis in 16 patients (group 1) and no stenosis in 15 patients (group 2). In 15 of 16 group 1 patients, Doppler after contrast injection revealed a localized velocity increase of at least 50% of the reference value; mean (+/-SD) percent increase in velocity was 150 +/- 89% (range 367% to 0%). In group 2 Doppler after contrast injection revealed a mild localized increase in velocity in four patients and no increase in velocity in the remaining 11 patients; mean (+/-SD) percent increase in velocity was 5 +/- 7% (range 21% to 0%, p < 0.001 vs. percent increase in group 1). When a percent velocity increase > or = 50% of the reference value was considered a positive criterion for detecting significant stenosis, the sensitivity and specificity were 92% and 100% respectively. The sensitivity of the evaluation before contrast injection or considering B-mode imaging alone was much lower (25% and 19%, respectively, p < 0.001 vs. evaluation after contrast injection). In addition, color Doppler after contrast injection correctly located the stenosis along the vessel, as compared with angiography. CONCLUSIONS: Blood flow evaluation of the proximal left anterior descending coronary artery by transesophageal Doppler echocardiography after contrast injection is a feasible and reliable method for detecting and locating significant stenoses affecting this part of the vessel and is an improvement over the traditional ultrasound approach.

Aged↗
PubMed1996

Myocardial contrast echocardiography in acute myocardial infarction. Pathophysiological background and clinical applications.

Myocardial contrast echocardiography is a technique used in experimental and clinical settings in order to visualize the pattern of intramyocardial perfusion. In the acute phase of myocardial infarction, regional absence of flow during myocardial contrast echocardiography delineates the area at risk of necrosis, while the definitive non-perfused area expresses infarct size. Reopening the infarct-related artery, which may be achieved spontaneously by thrombolysis or percutaneous transluminal coronary angioplasty, is not a reliable indicator of intramyocardial reperfusion. If myocardial ischaemia due to coronary occlusion has been sufficiently prolonged and severe, not only myocyte viability, but also microvascular integrity is lost. Myocardial contrast echocardiography, using intracoronary injection of sonicated contrast medium, gives information about microvascular integrity and the effective presence of intramyocardial reflow. Anatomical integrity of microvasculature does not necessarily imply preserved function, and thus the microvessel vasodilating reserve may also be impaired. Myocardial contrast echocardiography has the potential to assess alterations in microvascular function, showing, in the myocardial area with reduced coronary reserve, a relatively reduced increase in echocontrast signal intensity when an intravenous vasodilator agent is administered.

Animals↗
PubMed1995

Effects of L-carnitine administration on left ventricular remodeling after acute anterior myocardial infarction: the L-Carnitine Ecocardiografia Digitalizzata Infarto Miocardico (CEDIM) Trial.

OBJECTIVES: This study was performed to evaluate the effects of L-carnitine administration on long-term left ventricular dilation in patients with acute anterior myocardial infarction. BACKGROUND: Carnitine is a physiologic compound that performs an essential role in myocardial energy production at the mitochondrial level. Myocardial carnitine deprivation occurs during ischemia, acute myocardial infarction and cardiac failure. Experimental studies have suggested that exogenous carnitine administration during these events has a beneficial effect on function. METHODS: The L-Carnitine Ecocardiografia Digitalizzata Infarto Miocardico (CEDIM) trial was a randomized, double-blind, placebo-controlled, multicenter trial in which 472 patients with a first acute myocardial infarction and high quality two-dimensional echocardiograms received either placebo (239 patients) or L-carnitine (233 patients) within 24 h of onset of chest pain. Placebo or L-carnitine was given at a dose of 9 g/day intravenously for the first 5 days and then 6 g/day orally for the next 12 months. Left ventricular volumes and ejection fraction were evaluated on admission, at discharge from hospital and at 3, 6 and 12 months after acute myocardial infarction. RESULTS: A significant attenuation of left ventricular dilation in the first year after acute myocardial infarction was observed in patients treated with L-carnitine compared with those receiving placebo. The percent increase in both end-diastolic and end-systolic volumes from admission to 3-, 6- and 12-month evaluation was significantly reduced in the L-carnitine group. No significant differences were observed in left ventricular ejection fraction changes over time in the two groups. Although not designed to demonstrate differences in clinical end points, the combined incidence of death and congestive heart failure after discharge was 14 (6%) in the L-carnitine treatment group versus 23 (9.6%) in the placebo group (p = NS). Incidence of ischemic events during follow-up was similar in the two groups of patients. CONCLUSIONS: L-Carnitine treatment initiated early after acute myocardial infarction and continued for 12 months can attenuate left ventricular dilation during the first year after an acute myocardial infarction, resulting in smaller left ventricular volumes at 3, 6 and 12 months after the emergent event.

Adult↗
PubMed1995

Pharmacological agents for stress testing in the diagnosis of coronary artery disease.

Non-invasive diagnosis of coronary artery disease is based on the combined use of a technique capable of identifying accurately the presence of ischaemia and a stress capable of safely inducing myocardial ischaemia. In the last few years great progress has been made in this field thanks to the use (a) of cardiac imaging techniques that clearly depict the presence and extent of myocardial ischaemia and to (b) the introduction of stresses other than exercise. These stresses are mainly pharmacological and are particularly useful in patients unable to exercise or who cannot exercise to a level considered adequate for diagnostic purposes. These alternative stress procedures are particularly useful when dealing with echocardiography since exercise usually prevents the acquisition of images of sufficient quality to be considered diagnostic.

Coronary Disease↗