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Biomedical subjects

S Scardi

Publications and source records attributed to S Scardi.

At least 37 records · Page 2Linked to original sources
PubMed1996

[Stratification of the thromboembolic risk in patients with non-rheumatic atrial fibrillation: assessment of left atrial dysfunction].

BACKGROUND: Patients with non rheumatic atrial fibrillation (NRAF) have an increased risk for thromboembolic complications. Recent evidence suggests that left atrial appendage function (contraction, filling dynamics) may provide clues to the thrombogenic potential of this structure. The aim of this study was to identify left atrial spontaneous echocontrast and thrombus between patients with NRAF and their relationship with left atrial appendage function. METHODS: Transthoracic (TTE) and biplane or multiplane transesophageal echocardiography (TEE) were performed in 143 patients with chronic NRAF enrolled in the Trieste Area Study on non rheumatic Atrial Fibrillation (TASAF), an ongoing prospective community study with a follow-up period of 2 years. The maximal and minimal areas of the left atrial appendage were measured during three cardiac cycles and the peak emptying and filling velocities profile were obtained by pulsed wave Doppler at the orifice of the left atrial appendage. The left atrium and appendage were inspected for thrombus and spontaneous echocontrast. RESULTS: Left atrial appendage thrombus was present in 37 patients (26%) and spontaneous echocontrast in 60 patients (42%), 45% of patients with spontaneous echocontrast had thrombus. Univariate analysis identified positive correlation of thrombus with duration of atrial fibrillation (p = 0.05), hypertension (p = 0.01), left atrial area (p = 0.005), mitral annular calcification (p = 0.01), left ventricular dysfunction (p = 0.03) and a non significant correlation with the mitral valve prolapse (p = 0.08) in the TTE. The presence of mitral regurgitation did not demonstrate a protective effect (p = 0.73) against thrombosis. The variables of left atrial appendage function identifying a subgroup of patients with increased risk of thrombus formation were: shortening fraction of the area in the horizontal and vertical sections (p = 0.0001 and p = 0.002 respectively), the peak filling and emptying velocity in horizontal (p = 0.0001 equal for both) and vertical sections (p = 0.0001 equal for both). In summary these patients have a larger left atrial maximal area (p = 0.004) and a lower flow velocity profile (p < 0.00001) and more intense spontaneous echocontrast (p < 0.00001) than the others. Spontaneous echocontrast was correlated with left ventricular dysfunction (p = 0.008), left atrial area (p = 0.02) and there was a non-significant correlation with mitral annular calcification (p = 0.09) and lower left ventricular shortening fraction (p = 0.06). Transesophageal echocardiography variables have identified the subgroup of patients with an increased risk of echocontrast formation. This was positively associated with a low flow velocity profile (p = 0.0001), a left atrial appendage low shortening fraction in horizontal section (p = 0.001) and in vertical section (p = 0.05) and a low peak filling velocity in horizontal section (p = 0.003) and in vertical section (p = 0.004) and a low peak emptying velocity in horizontal section (p = 0.003) and in vertical section (p = 0.001). Prophylactic therapy with anticoagulant or antiplatelet agents has little benefits in our experience. CONCLUSIONS: Spontaneous echocontrast and low flow profile velocity (low peak emptying and filling velocity) and increased area of left atrial appendage were strongly associated with left atrial and/or appendage thrombus in patients with NRAF. The assessment of left atrial appendage function by TEE is an important component of the comprehensive evaluation of potentially increased risk of thrombus formation.

Aged↗
PubMed1996

[Lipid factors and evolution of the atherosclerotic plaque: review of recent trials].

A beneficial impact of lipid-lowering therapy on the incidence of coronary artery disease has been demonstrated in several clinical trials. It has been suggested that lipid lowering therapy not only slows the progression of atherosclerotic lesions, but also promotes its regression. Furthermore, reduced levels of circulating cholesterol (total cholesterol as well as LDL fraction) might decrease plaque volume and growth, restore endothelial function and thus reduce vasomotor tone. The obtained increased plaque stability reduces the risk of disruption and subsequent cardiovascular events. Ongoing ultrasonographic and angioscopic studies will provided further insights into the disease itself and its management.

Controlled Clinical Trials as Topic↗
PubMed1995

[SFAAT: the study of nonrheumatic chronic atrial fibrillation in the Trieste area. Results of an enrollment study].

BACKGROUND: Chronic atrial fibrillation unassociated with rheumatic valvular heart disease (NRAF) considerably increases the risk of thromboembolism. Recent studies have provided new evidence concerning the risk-benefit ratio of anticoagulant therapies in patients with AF. OBJECTIVE: To evaluate the incidence of primary end points (ischemic stroke, systemic embolism, bleeding complications to oral anticoagulant or antiplatelet therapy) and secondary end points (death, TIA) in patients with NRAF. METHODS AND RESULTS: Between November 1992 and June 1993, 694 patients with chronic NRAF were enrolled in the Trieste Area Study on Nonrheumatic Atrial Fibrillation (TASAF), an ongoing prospective community study with a follow-up period of 2 years. The preliminary results of the enrolled study population show: an elevated mean age (71 +/- 9 years), the prevalence of males (383/694), high prevalence of overt or previous heart failure (23%), of mitral regurgitation confirmed at echocardiography (30%) and of previous myocardial infarction (11%). Many of the enrolled patients had a history of hypertension (58%). With regard to the etiology of the underlying heart disease, the following should be emphasized: a high incidence of cardiac hypertrophy (with or without history of hypertension) (28%) and of degenerative cardiopathy (20%); unclassifiable cardiopathy (14%); and lone AF (13%). Echocardiographic findings: left ventricular dysfunction (17%); mitral annular calcification (27%); and good mean left ventricular function (EF 0.50 +/- 0.15). Retrospectively there were 96 clinically documented embolic events in 78 subjects while in 34 patients there were 38 episodes suspected for embolism or TIA. Nine patients suffered 1 recurrence of embolism; three patients suffered 2 recurrences; one patient had 3 recurrences; and 4 patients had one suspected recurrence of TIA. In 35 cases the embolic events clustered around the time of the onset of the arrhythmia. In the other 99 subjects the embolic complication appeared after the onset of AF: range 1-266 months. The group of patients with true embolic events in comparison with patients without embolism or with suspected embolism or TIA had same variables predictive of thromboembolic complications: arrhythmia duration (p = 0.09) and previous myocardial infarction (p = 0.03); in contrast mitral annular calcification (p = 0.06), history of hypertension (p = 0.09) and cardiac hypertrophy (with or without hypertension) (p = 0.07) demonstrated only a slight trend of statistical significance. Comparing the clinical characteristics and echocardiographic findings of patients without embolism with those of patients with tru embolism, or suspected embolism, or TIA the variables predictive of thromboembolic events were: arrhythmia duration (p = 0.007), history of hypertension (p = 0.01), cardiac hypertrophy (with or without hypertension (p = 0.02) and mitral annular calcification (p = 0.01), at the same time, age showed only a trend of statistical significance (p = 0.06). Among the 616 patients without a history of embolism only 3% were treated with oral anticoagulant agents and 28% with antiplatelet therapy, while among the 78 subjects with documented embolism only 28% were receiving anticoagulant therapy and 58% were receiving antiplatelet agents. CONCLUSIONS: NRAF is an important risk factor for thromboembolism. Some clinical characteristics and echocardiographic findings increase the risk. Physicians still hesitate to use oral anticoagulants and antiplatelet agents in their patients for the prevention of embolic complications.

Aged↗
PubMed1994

[Isolated double orifice mitral valve].

A 58-year old woman with paroxysmal atrial fibrillation and isolated double orifice mitral valve is presented. This congenital abnormality is usually discovered by autopsy or surgery. In this case it was diagnosed by echocardiography.

Atrial Fibrillation↗
PubMed1994

[Expired ethane as a non-invasive marker of the course of experimental multiple organ dysfunction syndrome (MODS)].

UNLABELLED: BACKGROUND AND WORK HYPOTHESIS: The mechanisms of organ damage in MODS are unclear. Given that lipid peroxidation induced by oxygen radicals may play a key role in organ damage, expired ethane, a marker of lipid peroxidation, could be correlated to the entity and evolution of experimental MODS. STUDY DESIGN AND METHODS: Forty wistar male rats (250 +/- 15 g body weight) were intraperitoneally injected with 10 ml of Zymosan mineral oil suspension (2.5%) to provoke MODS. Survival and symptoms were noted daily. On the 2nd, 7th and 14th day the animals underwent thorax CT scanning. CT images were processed to evaluate the relative density of lung parenchima. Expired ethane was measured using mass spectrometer and percentual changes were noted. Relative organ weight (liver and lung) were measured in 2nd, 7th and 14th day. STATISTICAL ANALYSIS: Pearson's linear correlation. RESULTS: The results show that maximal lung damage took place at the same moments as ethane concentrations peaked. A strict correlation (r = 0.93; p < 0.0001) was found between lung density and expired ethane. Strict correlation was found between organ weight, symptoms, survival and ethane production. CONCLUSIONS: Lipid peroxidation, as expressed by ethane production, might be an important cause of organ damage in MODS.

Animals↗
PubMed1994

[Multicenter study on exercise-induced silent myocardial ischemia: clinical, anamnestic and ergometric parameters in 4389 patients with proven ischemic cardiopathy].

AIM OF THE STUDY: In order to evaluate the incidence and clinical significance of myocardial ischemia during exercise testing (ExT) in patients (pts) with proven ischemic heart disease (Stable Effort Angina = SEA, Myocardial Infarction = MI, PTCA or CABG) 73 ergometric laboratories participated in a multicenter prospective study (SMISS) coordinated by the Italian Working Group on Cardiac Rehabilitation. Here we report the clinical and ergometric parameters. METHODS: Over a period of six months 4,389 consecutive pts were enrolled in the study after performing a maximal limited ExT (25 watts x 3') after drug withdrawal. All pts are followed at 6 and 12 months, at which time electrocardiogram, physical examination and clinical history were reassessed. A preliminary quality control of ECGraphic signal of ischemia was performed. Between the core center and the ergometric laboratories there was an 88% agreement (positive/negative ECG). 617 (14%) pts with angina (Group A), 2621 (59.7%) MI pts (Group B), 313 (7.2%) PTCA pts (Group C1), 838 (19.1%) patients with previous coronary bypass (Group C2) were studied. RESULTS: Interruption criteria were: maximal heart rate (11.7%), fatigue (66.6%), angina (10.9%), dispnea (2.3%), ST depression (13.9%), complex VPBs (2.2%), abnormal blood pressure (3.3%). In all pts the maximal work load was 100.3 +/- 31 W (lower in SEA pts). HR was 141 +/- 20/min at maximal work load (lower in SEA pts). The incidence of complex VPBs was 7.9% (higher in Mi and CABG pts). The results of ExT were: normal in 62% of all pts (21% in SEA pts), angina alone in 3.3% (7.6% in SEA pts and 1.8% in MI pts), symptomatic ischemia in 12.7% (40% in SEA pts, 9.3% in MI pts and 5.7% in CABG pts), silent ischemia in 22% (31.8% in SEA pts, 21.6 in MI pts and 16.6% in CABG pts). All differences were significant (p < 0.01). CONCLUSIONS: In a low risk group of coronary patients the incidence of myocardial ischemia during ExT was 38%. Ischemia was silent in 58% of the patients.

Aged↗
PubMed1994

[Evaluation of an experimental model of multiple organ dysfunction].

OBJECTIVE: To perform an experimental model of Multiple Organ Dysfunction Syndrome (MODS) without employing bacteria or endotoxin stimulus and to follow its evolution in vivo by a Computerized Tomography analysis of the lungs. DESIGN: Rats were submitted to intraperitoneal injection of a 2.5% zymosan suspension in mineral oil (1 g/kg weight) or mineral oil alone; control rats received no treatment. METHODS: The observation period was 15 days. During this period symptoms and survival were noticed daily. CT scans of lungs were made at the 7th and 14th days; data were post-processed to obtain information on lung density. The rats were sacrificed at the 15th day by heart puncture; blood was utilized for determination of hemochrome, differential leukocyte count, thrombocytes, glycemia, uremia, bilirubin. Lungs, liver, spleen and kidney were dissected and weighted for determination of relative organ weight. DATA ANALYSIS: Data were compared by "t" Student's test for impaired data and Fisher Exact test. RESULTS: Symptoms, survival, blood analysis and relative organ weight agreed with a progressive, ingravescent, triphasic illness caused by a systemic inflammatory response involving remote organ too. The CT study proved able to monitoring and analyzing organ damage: a temporal sequence of evolution of damage exists; organ damage is localized in microcirculatory system (density augment) and in parenchyma (morphologic alterations and fibrosis). DISCUSSION: The described experimental model reproduces a MODS-like illness in zymosan receiving rats; the CT scan is effective to evaluate the evolution of organ damage.

Animals↗
PubMed1993

[Severe pulmonary arterial hypertension and primary antiphospholipid antibodies syndrome].

A young patient with severe pulmonary hypertension of thromboembolic origin due to recurrent deep vein thrombosis is described. Although he presented no signs of systemic lupus erythematous, a high quantity of cardiolipin antibodies was found in his serum. Therefore, we discuss a possible association between the primary antiphospholipid antibodies syndrome and pulmonary embolic events.

Adolescent↗
PubMed1992

[Lack of tolerance after administration of delayed-action isosorbide-5-mononitrate for 3 days in patients with exercise-induced silent ischemia: control with placebo].

In order to assess the development of tolerance we analyzed in a placebo-controlled study the effect of monotherapy with isosorbide-5-mononitrate (IS-5-MN) 60 mg in a controlled release formulation (Durules) once-a-day. The IS-5-MN was evaluated after the first dose and after once-a-day therapy for three days in 11 ambulatory patients (10 males, 1 female, aged 54 +/- 9 years) with stable exercise-induced silent myocardial ischaemia and significant coronary stenoses. The drug was given at 8 o'clock in the morning, and a bicycle ergometer exercise test was performed after 4 hours. The ST segment depression was evaluated by a computer-assisted system. Standing blood pressure decreased during all three periods of active treatment with IS-5-MN, (in comparison with placebo p < 0.001 and p < 0.01, p < 0.01 respectively). Heart rate did not change significantly. Compared with placebo baseline values, ischaemic threshold increased during the first day of treatment (188 sec, p < 0.0001 at 4 hours), and to a lesser extent both in second (103 sec, p < 0.003) and third day (116 sec, p < 0.003). The total exercise time increased during all three days of active therapy but significantly so only during the first day. The exercise stress test performed in the 5th day during placebo demonstrated a high reproducibility of ischaemic-threshold (235 vs 241 sec, p: ns), implying that the improvement during the active treatment with IS-5-MN was not due to a "training effect". Headache in 2 patients was the only significant side-effect.(ABSTRACT TRUNCATED AT 250 WORDS)

Delayed-Action Preparations↗
PubMed1992

[Perception threshold of angina and transient myocardial ischemia in ambulatory electrocardiography].

AIM OF THE STUDY: We studied the predictive value of prolonged angina perception threshold in identifying patients with stable coronary artery disease at risk of silent myocardial ischemia during daily life. METHODS AND RESULTS: 71 patients with documented coronary artery disease (previous myocardial infarction or stenotic lesion > 60% at angiography) underwent a symptom-limited exercise test and out-of-hospital Holter monitoring after drug withdrawal. A second exercise test was performed before disconnecting the dynamic EKG in order to validate the ST-depression recorded during ambulatory monitoring. 23 patients (32.4%) (Group A) had angina perception threshold > 60 sec after onset of ischemia (ST > 1 mm), while in 48 (67.7%) the delay in the perception of angina was shorter than 60 sec (Group B). The demographic, clinical and angiographic variables did not influence the angina perception threshold; however, this parameter was the most powerful predictor of ambulatory ischemia among the two groups (4.8 vs 2.8 p < 0.02), and in particular of the painless episodes (3.8 vs 1.8 p < 0.002). Moreover, the silent ischemic time was longer in patients of group A (4362 vs 1774 sec p < 0.017). Finally, the event-free survival was similar in the two groups of patients during the 2 years of follow-up (cardiac death 1 vs 3, nonfatal myocardial infarction 1 vs 1, aorto-coronary bypass 2 vs 7, PTCA 2 vs 2, unstable angina 0 vs 2), total events 6 vs 15 p = ns. CONCLUSIONS: These results demonstrate that the patients at risk for silent ischemia during ambulatory monitoring may be identified simply by evaluating their angina perception threshold during exercise test; however, silent ischemia does not have an adverse prognostic value.

Aged↗
PubMed1991

Efficacy of continuous and intermittent transdermal treatment with nitroglycerin in effort angina pectoris: a multicentric study. The Collaborative Nitro Group.

Eighty-eight patients (84 men and 4 women; mean age 59.3 years) with stable exercise-induced angina pectoris were enrolled in this within-patient, placebo-controlled study aimed at comparing the efficacy of the continuous and intermittent (12 hour on, 12 hour off) application of transdermal nitroglycerin. Eighty-one patients completed the study. After a 1-week placebo run-in period, during which the stability of angina was assessed on a bicycle ergometer, the patients received continuous treatment (two 10 mg/24 hour patches twice daily, at 8 a.m. and 8 p.m.), intermittent treatment (two 10 mg/24 hour patches at 8 a.m. and two placebo patches at 8 p.m.) and placebo (two placebo patches twice daily, at 8 a.m. and 8 p.m.), each given for one week in a double-blind randomised sequence, according to a 3 x 3 latin-square design. A cycloergometric exercise test was performed at the end of each period of treatment, 4 and 10 hours after the application of the morning patch. In comparison with placebo, both schedules of the active treatment induced a significant increase in both the ischemic (duration of exercise to 1 mm ST segment depression) and the angina threshold (duration of exercise to mild angina) at the 4th and at the 10th hours after-dosing. A significant difference was also found between continuous and intermittent treatment at the same times of observation, in favour of the intermittent schedule. The limited number of anginal attacks recorded during placebo prevented any clinical evaluation of the treatments. This study shows that the efficacy of transdermal nitroglycerin is more pronounced when it is given following an intermittent schedule.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗