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Biomedical subjects

A Imparato

Publications and source records attributed to A Imparato.

34 records · Page 2Linked to original sources
PubMed1992

EAMI--exercise training in anterior myocardial infarction: an ongoing multicenter randomized study. Preliminary results on left ventricular function and remodeling. The EAMI Study Group.

To determine the effects of a 6-month exercise training program on left ventricular (LV) function and remodeling, 49 consecutive patients (pts) with first Q anterior myocardial infarction (51 +/- 8 years), in I-II NYHA class, were studied 4 to 8 weeks after the acute episode and 6 months later by 2D-ECHO and upright bicycle ergometric test. At entry, pts were randomly allocated to physical training (T = 25pts) or control (C = 24pts). Global endocardial surface area (ESA), LV volumes and EF, extent of abnormal wall motion (%WMA), of regional dilatation (%REG DIL), and the shape distortion (DIST) index were analyzed. After 6 months, a significant increase in work capacity (4,589 +/- 1,417 to 5,379 +/- 1,485 KPM/min, p less than 0.03) and in lactic anaerobic threshold (45 +/- 13 to 63 +/- 15 W, p less than 0.01) was observed only in T. Initial ESA, EDV, EF, %WMA, %REG DIL, and DIST index were similar and they did not change after 6 months in both groups. However, pts with less than 40%EF had greater (p less than 0.0001) EDV and %WMA with marked DIST index at entry and showed further (p less than 0.01) deterioration after 6 months both in C and in T (EDV, ml/m2: 68 +/- 12 to 77 +/- 18 in C, 71 +/- 12 to 74 +/- 18 in T; %REG DIL: 39 +/- 20 to 49 +/- 24 in C, 32 +/- 12 to 35 +/- 23 in T; DIST index: 0.16 +/- 0.07 to 0.21 +/- 0.09 in C, 0.2 +/- 0.07 to 0.22 +/- 0.1 in T). These variables did not change in pts with greater than 40%EF. Thus, from these preliminary data, pts with less than 40%EF at entry are prone to further global and regional LV deterioration. Physical training does not seem to increase this spontaneous deterioration.

Anaerobic Threshold↗
PubMed1991

Effects of mental exercise in patients with dilated cardiomyopathy and congestive heart failure. An echocardiographic Doppler study.

To assess the effects of mental stress on left ventricular diastolic function in patients with congestive heart failure, nine patients aged 57 +/- 12 years with dilated cardiomyopathy (end-diastolic volume, more than 110 ml/m2; ejection fraction, less than 40%; mean, 28 +/- 8%) and congestive heart failure in New York Heart Association functional class II or III and 14 normal volunteers (mean age, 49 +/- 8 years) were studied during mental arithmetic lasting 10 minutes with echocardiographic Doppler monitoring of transmitral flow velocity. During mental arithmetic, the ratio of peak flow velocity in early versus late diastole (E/A) and deceleration time of early diastole did not change in normal controls. However, E/A increased significantly (from 1.6 +/- 1.5 to 1.9 +/- 1.7; p less than 0.01) and deceleration time markedly decreased (from 156 +/- 49 to 108 +/- 31 msec; p less than 0.001) in patients with congestive heart failure. In 16 postinfarct patients with ejection fraction of less than 40% studied during mental arithmetic with simultaneous hemodynamics and Doppler recordings, good correlations were found between pulmonary wedge pressure and Doppler parameters (wedge pressure versus E/A, r = 0.89; wedge pressure versus deceleration time, r = -0.87). During mental arithmetic, the pulmonary wedge pressure-E/A correlation was weaker (r = 0.67), whereas the correlation between pulmonary wedge pressure and deceleration time was stronger (r = 0.91). The value of 153 msec in deceleration time was the best cutoff point in predicting 12 mm Hg pulmonary wedge pressure, both at rest and during mental arithmetic: the higher the deceleration time, the lower the pulmonary wedge pressure, and vice versa. Among patients with congestive heart failure, five showed normal baseline deceleration time (195 +/- 21 msec; pattern 1), and the remaining four showed a short (less than 153 msec) deceleration time (108 +/- 13 msec; pattern 2). During mental arithmetic, deceleration time markedly decreased to as short as 119 +/- 20 msec in all patients except one with baseline pattern 1. Deceleration time further decreased to 75 +/- 6 msec in all patients with baseline pattern 2. Mental arithmetic induces changes in left ventricular diastolic function in patients with congestive heart failure. Transmitral echocardiographic Doppler provides a simple noninvasive method of estimating and monitoring pulmonary wedge pressure in patients with severe left ventricular dysfunction.

Cardiomyopathy, Dilated↗
PubMed1989

Inaccuracy of various proposed electrocardiographic criteria in the diagnosis of apical myocardial infarction--a critical review.

The diagnostic accuracy of the standard electrocardiogram (ECG) in apical myocardial infarction (MI) was evaluated in 112 consecutive patients with recent MI and wall-motion abnormalities limited to the left ventricular (LV) apex on two-dimensional echocardiography, performed at rest 21 to 84 days after MI. The following patterns of abnormal (greater than or equal to 30 ms) Q waves were found: anteroseptal (Q V1-V4) in 44 patients (39.3%), anterolateral (Q V1-V6 and/or I, aVL) in 22 (19.6%), inferior (Q III, aVF or II, III, aVF) in five (4.5%), lateral (Q I, aVL and/or V5-V6) in five (4.5%), anteroinferior in six (5.3%); non-Q MI was present in 30 patients (26.8%). By applying various proposed ECG criteria, the presence of apical MI was correctly identified in very few (24, 21%) patients. LV apex was extensively asynergic in 85 patients (76%) and partially asynergic in 27 (24%). All the patients with Q waves in lateral leads and 47% of the patients with non-Q MI had partially asynergic LV apex, while in the other ECG patterns, extensively asynergic LV apex was predominant. The presence of both greater than or equal to 30 ms Q waves and loss of R in left precordial leads and I strongly suggests extensive apical asynergy; normal QRS in the same leads, however, does not exclude extensive apical involvement.(ABSTRACT TRUNCATED AT 250 WORDS)

Diagnostic Errors↗
PubMed1989

[Echocardiographic and electrocardiographic aspects indicative of necrosis caused by isolated disease of the right and circumflex coronary artery].

The value of 12-lead electrocardiogram (ECG) and two-dimensional echocardiography (2D-ECHO, wall motion abnormalities) in recognizing myocardial infarction due to left circumflex and right coronary artery disease was evaluated in 75 patients (aged 26-69 years, within 3 months of myocardial infarction) with single vessel disease (luminal stenosis greater than or equal to 70%). Twenty-five patients (pts) had left circumflex disease and 50 right coronary artery disease. In the group of pts with left circumflex disease, 13 (52%)--group I--showed asynergy limited to the postero-lateral wall and 12 pts (48%)--group II--had more extensive asynergy involving both the postero-lateral and the infero-posterior wall. No pts with left circumflex disease demonstrated asynergy of the interventricular septum. Good correlations were found between the site and extent of asynergy and the location of left circumflex narrowings: 9--group I pts--(69.2%) had obtuse marginal branch disease and 8--group II pts--(67%) had proximal left circumflex disease. Patients with right coronary artery disease were subdivided as follows: group I: 35 pts (70%) with asynergy of infero-posterior wall and posterior septum; group II: 11 pts (22%) with extensive asynergy of infero-posterior, postero-lateral walls and posterior septum; group III: 4 pts (8%) with asynergy limited to the infero-posterior wall. The location of right coronary artery narrowings had no relation to the site and extent of infarct asynergy in pts with single right coronary artery disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Reliability of standard electrocardiogram in detecting left ventricular asynergy in 315 patients with recent myocardial infarction.

The relationship between asynergy of the left ventricular wall detected by two-dimensional echocardiography and ECG signs of necrosis (number of Q waves greater than or equal to 40 ms, Wagner's score) was evaluated in 315 patients (NYHA I-II) 23-90 days after a first Q-wave myocardial infarction (MI). Poor correlations were found between asynergy and ECG parameters. An ECG anterior MI is an apicoseptal MI by echo (independently of the ECG extent of Q waves) and the ECG is of little or no help in predicting the extent of asynergy to the inferior wall and proximal segments of the septum. An ECG inferior MI is inferoposterior by echo and the ECG has very limited value in predicting the extent of asynergy to the apex and septum. Patients with Q waves in leads II, III, and aVF had more extensive asynergy than those with either 2Q or greater than 3Q. R/S greater than or equal to 1 in V1 and/or V2 was present in 44% of patients with inferior MI while asynergy of at least one segment of the posterior wall was observed in 94%. In conclusion, standard ECG is sensitive in identifying anterior versus inferior infarct but it is unreliable in predicting the real extent of asynergy of the left ventricle, particularly in inferior infarcts.

Adult↗
PubMed1987

Influence of left ventricular cavity dimension on electrocardiographic estimation of the extent of wall motion abnormalities.

To estimate the influence of left ventricular cavity dimension on the electrocardiographic estimation of the extent of wall motion abnormalities, two-dimensional echocardiograms and standard 12-lead electrocardiograms (ECG) were carried out on 221 patients within 3 months after acute myocardial infarction (MI). Among the patients with anterior MI (96 patients; 43.4%) both the extent of asynergy (% of asynergic segments, an echo index taking into account the type of asynergy) and the electrocardiographic signs of necrosis (number of Q waves greater than or equal to 40 ms, Wagner's score) were significantly greater (p less than 0.001) in those with left ventricular dilatation (60 patients) than in those with normal ventricular size (36 patients); within the latter group, the ECG-asynergy correlations were good (r value 0.67-0.79). In patients with left ventricular dilatation no correlation was found. In inferior MI (108 patients, 48.9%), asynergy was more extensive in patients with left ventricular dilatation (p less than 0.001) than in those with normal left ventricle. However, the electrocardiographic extent of necrosis was similar in the two groups and no significant ECG-asynergy correlation was found. Likewise, in anteroinferior MI (17 patients; 7.7%), the ECG-asynergy correlations were statistically insignificant in both groups. In conclusion, the electrocardiographic patterns of necrosis are poorly related to the extent of asynergy and are greatly influenced by left ventricular dimensions.

Dilatation, Pathologic↗
PubMed1986

Is post-infarction angina related to poor residual left ventricular function?

To investigate the relationship between left ventricular function and presence and type of myocardial ischaemia in the post-acute phase of myocardial infarction (MI) 313 patients admitted consecutively to our Center of Rehabilitation were studied. In all subjects a good quality two-dimensional echocardiogram, 24-h ambulatory electrocardiogram and in 308 of them a symptom-limited exercise test were performed. Clinical observation was for 3 months since MI occurrence. Transient episodes of post-MI ischaemia were observed in 164 patients (52%). No differences in left ventricular asynergy or ejection fraction were noted among patients with and without post-MI ischaemia as a whole, nor in subsets identified on the basis of occurrence of pain or ischaemia characteristics (at rest or exercise-induced). Episodes of left ventricular failure occurred more frequently in patients with silent, myocardial ischaemia at rest. Sublingual isosorbide dinitrate (5 mg), administered to 20 patients, did not differently change asynergy and ejection fraction in patients with and without documented post-MI ischaemia. In conclusion, extent of asynergy and degree of left ventricular dysfunction at rest seem to be: unrelated to the risk of post-MI ischaemia occurrence; related to the infarct size and not to the presence of stunned myocardium.

Aged↗
PubMed1986

Can body surface mapping improve the diagnostic power of standard electrocardiography in effort myocardial ischemia?

Limitations of the standard 12-lead electrocardiogram in sensitivity, specificity and information content on the effort induced ischemic process might be partly due to an inadequate sampling of cardiac electrical events. An extensive array of electrodes is an effective way to verify this hypothesis. Actually body surface mapping provides: a 10-15% increase in diagnostic yield mainly in patients with mild coronary artery disease and elusive signs of ischemia in standard leads a very approximate indication of the extent of coronary artery disease a substantial contribution to the identification of the site of ischemia. Regarding the last point, preliminary results of an ongoing study are reported. One hundred and three patients with recent myocardial infarction have been studied by exercise test with simultaneous recording of surface map and Thallium 201 scan. So far in the subset with inferior myocardial infarction (76 patients) three different map patterns corresponding to different ischemic regions (anterior, inferior and posterior) have been identified. In anterior myocardial infarction (27 patients) a characteristic map pattern for exercise-induced myocardial ischemia has been observed, apparently able to discriminate between ischemia and the changes of early repolarization induced by the dyskinesia of the infarcted ventricular wall. In conclusion, electrocardiographic mapping makes a practical contribution to the understanding of ischemia-induced cardiac electrical events.

Action Potentials↗
PubMed1985

[Effect of beta-receptor block on QT/QS2 behavior during isometric and dynamic exercise].

Our study is aimed to evaluate the change of QT/QS2 ratio in normal subjects during both isometric and dynamic exercise before and after propranolol administration. We studied 10 young volunteers healthy subjects who performed an isometric exercise by squeezing a grip dynamometer at 70% of their maximal voluntary contraction as long as possible. They also performed a dynamic exercise undergoing a submaximal bicycle stress test. Both tests were performed before and after administration of propranolol (0.15 mg/Kg e.v.) QT and QS2 intervals were measured at rest, during exercise and in the recovery period. Heart rate and blood pressure were also determined. Isometric exercise induces a significant shortening of both intervals although minor for QT so that the ratio significantly increases in comparison to baseline (p less than .001). At rest propranolol induces a significant decrease of heart rate and only a slight lengthening of QT and QS2 so that the ratio is unchanged. During exercise propranolol does not influence the increase of heart rate and blood pressure and the shortening of QT interval but prevent exercise-induced QS2 shortening so that the ratio after beta-blockade is significantly reduced at the peak of exercise (p less than .005). During dynamic exercise QT and QS2 behaviour is similar to that of isometric exercise; in fact both intervals are shortened and QS2 decrease is major than QT so that the ratio increases (p less than .001). These results confirm that QT/QS2 ratio can monitor the effects of adrenergic stimulation on the heart during physiological manoeuvres enhancing sympathetic discharge like occurs during both isometric and dynamic exercise.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1979

Hand-held toy squeaker during carotid endarterectomy in the awake patient.

A toy squeaker held by the patient in the contralateral hand is used to monitor cerebral circulation during carotid endarterectomy. Regional anesthesia--cervical plexus block--allowed the patient to cooperate and give useful information, especially during the crucial period of test clamping. In a series of 300 cases, during a period of five years, it was instrumental in avoiding brain damage in 6% of the cases.

Anesthesia, Conduction↗
PubMed1979

Angiographically undetected ulceration of the carotid bifurcation as a cause of embolic stroke.

The accuracy of angiographic diagnosis of carotid artery ulceration was evaluated. Of those carotid bifurcations showing ulceration at surgery, 60% were diagnosed as having ulcers at angiography. Half of the remaining ulcers occurred in smooth, benign-appearing plaques and were too small to be seen at angiography. An incorrect angiographic diagnosis of ulceration was made in 17 of 50 carotid arteries; in most cases this was due to the presence of a subintimal hematoma in the wall of the artery.

Carotid Artery Diseases↗
PubMed1979

Atherosclerotic subintimal hematoma of the carotid artery.

A presumed new radiological-pathological entity of atherosclerotic subintimal of the carotid artery is described. Subintimal hematomas were found in 12 of 50 (24%) carotid bifurcations during surgery for repeated transient ischemic attacks in a single hemispheric distribution; only 33% were associated with ulcerations. The typical angiographic appearance was a sharply marginated, rounded, eccentric filling defect located near the extracranial carotid bifurcation, although occasionally it may simulate a typical smooth or even ulcerated atherosclerotic plaque. Pathological mechanisms responsible for the hemorrhage into the atherosclerotic plaque resulting in the hematoma are discussed.

Arteriosclerosis↗