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Biomedical subjects

A Maresta

Publications and source records attributed to A Maresta.

At least 19 recordsLinked to original sources
PubMed1992

Dose and test for dipyridamole infusion and cardiac imaging early after uncomplicated acute myocardial infarction.

To evaluate the relation of the dose of intravenous dipyridamole on results of thallium and echocardiographic testing, the results of standard- (0.56 mg/kg/4 minutes) versus high- (0.84 mg/kg/10 minutes) dose dipyridamole were obtained 9 +/- 3 days after uncomplicated acute myocardial infarction in 57 patients. New wall motion abnormalities were compared with redistribution of thallium imaging and results of discharge coronary angiography. The sensitivity of thallium in predicting the presence of multivessel coronary artery disease was significantly (p < 0.01) higher (85%) than echocardiography (53%) and was unaffected by the dose. However the sensitivity of echocardiography was better with the higher dose (53 vs 14%). Minor adverse effects occurred in 34 patients (59%) after receiving the high dose and only in 4 patients (7%) after the standard dose (p < 0.001). Thus, thallium-201 scintigraphy during standard-dose dipyridamole infusion is more effective than high-dose dipyridamole echocardiographic testing in safely identifying patients who could benefit from early invasive evaluation and therapy.

Angina Pectoris↗
PubMed1992

[Management and prognosis of acute myocardial infarct in advanced age: comparison of the cardiac intensive care unit and the cardiology ward].

The aim of this prospective study was to assess the prognostic and most suitable management of AMI in elderly patients (age > or = 75 years). From September 1988 to August 1991, 129 such patients (pts) were evaluated: 35 (27%) were admitted to CCU because of arrhythmias or severe hemodynamic complications; 94 (73%) were addressed, according to bed availability, to CCU (55 pts) or Cardiology Ward (39 pts), where all patients underwent continuous ECG monitoring for at least 72 hours. Age, gender, history of previous angina or myocardial infarction, presence of chest pain or ECG ischemia on admission, site and extent of AMI, delay on admission, CPK-MB peak, recurrent angina, arrhythmias, heart failure, emotional disorders, hospital mortality and length of hospital stay were compared. Our results show that elderly patients who suffered from complicated AMI were at high risk for death and severe in-hospital complications. No significant prognostic differences were observed between the two groups with uncomplicated AMI. Thus hospitalization in the Cardiology Ward seems to be valuable, safe and well tolerated in our population of elderly patients with AMI, and without initial complications.

Age Factors↗
PubMed1991

[Thallium and echo- dipyridamole in the early selection of patients at risk after acute myocardial infarction. Which test? What dose?].

UNLABELLED: The optimal iv dose of Dipyridamole (Dip) in echocardiography (echo) or Thallium scintigraphy (Tl) remains undetermined. To select the high-risk patients (pts) subset, we performed echo and Tl with standard dose (SD) and high dose (HD) Dip infusion (0.56 mg/Kg/4'-0.84 mg/Kg/10' respectively) in 40 pts 9 +/- 3 days after admission for acute myocardial infarction (AMI). Of these, 38 pts had coronary artery disease at angiography and 2 had no significant lesions. Worsening in regional wall motion on echo and reversible perfusion defects on Tl were considered abnormal patterns. SD had no side effects; only in one pt was ischemic ventricular dysfunction detected on echo, whereas Tl redistribution was found in 24 pts (12 had multivessel disease and 12 had one coronary stenosis greater than or equal to 70%). HD caused adverse reaction in 24 pts, did not enhance SD-Tl sensitivity, but induced abnormal echo in 18/24 pts with transient defects on SD-Tl. Eleven of the 16 Tl negative pts had occlusive disease, 3 had one vessel disease and 2 showed no evidence of coronary artery disease. IN CONCLUSION: SD is safe but often provokes a submaximal coronary vasodilation. Failure to detect ischemia on echo may be explained by this. SD-Tl is, however, able to identify high-risk pts who may benefit from early myocardial revascularization. HD does not enhance SD-Tl sensitivity, but it is necessary to induce echo abnormalities which are all too often undetectable at SD.

Adult↗
PubMed1989

Clinical evaluation of VDD pacing with a unipolar single-pass lead.

Twenty patients with advanced AV block and normal sinus node function underwent pacemaker implantation, randomly receiving a CPI 910 ULTRA II model VDD pacemaker. The first 13 patients received the implantation of a single lead with a screw-in positive ventricular fixation tip and a unipolar ring floating atrial electrode spaced 13 cm from the tip. A subsequent group of seven patients received a conventional porous tinned-tip lead with a pair of unipolar ring floating electrodes. The second solution was adopted because the best atrial signal was not always in the high or mid-high atrium portion, but sometimes in the middle or mid-low position. With the modified double-electrode lead, the floating atrial electrode that detects the best signal can be selected, cutting out the pin of the one not used. The comparisons between minimal atrial slew rate and maximal ventricular slew rate, as well as those between minimal P wave amplitude and maximal R wave amplitude, show a highly significant range difference, as large as P less than 0.01. Surface electrocardiograms, stress tests, and 24-hour Holter monitoring showed the correct functioning of the system with an average sensing failure from 0.05 to 1%. In conclusion, VDD stimulation is feasible with a single unipolar lead and a floating atrial electrode in conjunction with a pacemaker generator (CPI 910 ULTRA II) originally designed for permanent twin-lead implantation.

Aged↗
PubMed1989

[Myocardial scintigraphy using 201-thallium and 2-dimensional echocardiogram after dipyridamole infusion in the early evaluation of post-infarct residual ischemia].

Dipyridamole thallium scintigraphy (TI-DP) and dipyridamole two-dimensional echocardiography (Echo-DP) were performed on 38 patients (pts), 11 +/- 4 days after acute myocardial infarction. Our study intends to assess whether or not imaging methods are useful both in identifying residual jeopardized myocardium and in selecting pts for coronary angiography. No serious side effects were induced during the DP test. In 11 pts angina was not induced, worsening of wall motion abnormalities was not detected on Echo-DP; no reversible defects were found on TI-DP. The remaining 27 pts who showed transient defects on TI-DP underwent coronary angiography. All pts had either multivessel coronary disease or severe single-vessel disease and myocardial revascularisation was performed in all of them. Of these 27 patients, only 5 suffered angina and showed ST-T depression; only in 15 dyskinetic wall motion development was detected on Echo-DP. Finally we can conclude: the DP-test can be safely performed in the early post-infarction period; both the reported imaging methods enable the identification of jeopardized myocardium even if with different ranges of sensitivity; pts negative to both TI-DP and Echo-DP can be safely followed without coronary angiography; pts with transient defects on TI-DP can be reasonably referred to coronary angiography.

Adult↗
PubMed1989

[Percutaneous pulmonary valvuloplasty. Immediate results and a follow-up: clinical, Doppler and hemodynamic evaluation].

The purpose of this investigation was to evaluate the efficacy and follow-up results of balloon dilation angioplasty for valvular pulmonary stenosis. Percutaneous dilation was performed on 25 patients with pulmonary stenosis (aged 1 month to 69 years, mean = 15 years). In all cases, a single balloon was used. The pressure gradients across the pulmonary valve were estimated by continuous wave Doppler (CWD) and catheterization before and after dilation. The peak systolic gradients obtained by both techniques both pre- and post-angioplasty were compared. There was good linear correlation between the catheter pressure gradient and the pressure gradient estimated by Doppler (r = 0.78). The mean pre-angioplasty gradient of 82 +/- 33 mmHg (range 40-180) was reduced to 29 +/- 12 mmHg (range 17-50). The mean right ventricular systolic pressure of 110 +/- 33 mmHg decreased to 52 +/- 13 mmHg post-angioplasty. An excellent linear correlation was found between the pre-dilation gradient and the right ventricular systolic pressure drop (r = 0.94). During the procedures no complications were noted, 30 hours after dilation a 6 months old child suffered of stroke with transient hemiparesis. Follow-up pressure gradient estimations by Doppler echocardiogram were obtained in all patients between 3 months and 42 months (mean = 12.4 months); in 4 cases the catheterization was performed. Mean follow-up gradient was 33 +/- 11 mmHg (range 15-55). In a 18 months old child was detected a severe pulmonary restenosis 12 months after dilation; a second successful dilation was performed.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

[Coronary angioplasty in the aged].

The safety and clinical efficacy of percutaneous transluminal coronary angioplasty (PTCA) in elderly patients has not been established. PTCA was attempted in 34 patients aged 65 or more (mean age 67.4). Patients were referred for angioplasty because of significant symptomatic ischemic heart disease with either stable, unstable angina or chest pain after myocardial infarction. Primary success was achieved in 29 patients (85.3%). Significant complications were encountered in three patients (8.8%): two emergency surgical procedures (5.8%), one transmural infarction (3%). In two patients (5.8%) the PTCA failed because the balloon dilating catheter didn't cross the tight stenosis. Follow-up data (mean 13.8 +/- 10.3 months) are available: 22 (73.4%) are asymptomatic. A clinically apparent recurrence occurred in 8 patients (26.6%). Coronary angiography was performed in 19 patients (63.3%) 6.3 +/- 2.4 months after PTCA. Angiographic restenosis occurred in 10 patients (52.6%). All patients with restenosis were ridilated with completely success. In conclusion, PTCA can be performed in elderly patients with a good success rate, an acceptable complication rate, a relatively low clinically apparent recurrence rate, and should be considered as a therapeutic modality for selected geriatric patients.

Age Factors↗
PubMed1987

Effects of coronary artery revascularization and perioperative myocardial infarction on left ventricular wall motion.

The effects of coronary artery revascularization and perioperative myocardial infarction on left ventricular wall motion are still controversial. In this study perioperative myocardial infarction was quantitatively estimated with the cumulative activity of the CK-MB isoenzyme in the perioperative period in a group of 77 consecutive patients undergoing coronary artery bypass surgery. After the operation (on average 9 +/- 1.8 months) all the patients were submitted to left ventricular and coronary angiography. Overall the global left ventricular ejection fraction was unchanged after the operation. The subgroup of patients with all patent grafts showed an improvement of both regional wall motion (P less than 0.05) and ejection fraction (from 58 +/- 13 to 64 +/- 13%, P less than 0.005); the number of angiographically abnormal left ventricular segments decreased from 28.5 to 16.6% (P less than 0.001). The cumulative activity of CK-MB enzyme was significantly correlated with the pre- and postoperative changes of ejection fraction (r = -0.51, P less than 0.01). Thus coronary artery bypass surgery can improve regional wall motion, but the likely benefit is observed in the absence of a perioperative myocardial ischemic damage.

Adult↗
PubMed1986

[Risk of obstruction of secondary vessels in coronary angioplasty].

To define the risk of side branch occlusion during percutaneous transluminal coronary angioplasty (PTCA), 99 consecutive procedures, performed on 92 patients, were examined. In 77 of them side branches existed, originating from the stenosed segment; analysis was performed on 65 successful procedures (success rate = 84.4%). The 121 side branches were divided as follows: 53 (43.8%) originating from the stenosis itself (group A), of which 32 small in size (less than 1 mm) and 21 "moderate" (greater than or equal to 1 mm); 68 (56.2%) originating in the immediate vicinity of the stenosis (group B) of which 23 small and 45 moderate. After PTCA 3 side branches were occluded (2.5%): a small 1 of group A and 2 (1 small and 1 moderate) of group B. Three side branches (2.5%) all of group B, 1 small and 2 moderate, became stenotic in their take-off. In one only patient who had a side branch occlusion a slight CK-MB elevation (25 mU/ml) occurred together with a Q wave appearance in the aVL lead. In conclusion, side branches at risk are frequently present (in our population they account for 83.7% of the patients) but the real incidence of damage of these branches after PTCA is quite low, without any considerable difference between groups A and B, and significant clinical consequences are usually rare.

Angioplasty, Balloon↗
PubMed1986

Nifedipine compared with verapamil in unstable angina pectoris.

A randomized trial was performed in 22 patients with unstable angina to compare the efficacy of oral verapamil with nifedipine in reducing symptomatic ischaemic episodes. The trial consisted of a 48 h control period, a 96 h treatment period with nifedipine (20 mg every 6 h) or verapamil (120 mg every 6 h), and a follow-up period. Patients who had a minimum of four symptomatic ischaemic episodes during the control period were entered into the trial. Asymptomatic ischaemic episodes were evaluated by Holter monitoring. Coronary angiography was performed at the end of the treatment period. Both nifedipine and verapamil significantly reduced the mean number of daily symptomatic ischaemic episodes (p less than 0.01) and the total number of ischaemic episodes (p less than 0.03). This study confirmed the high degree of efficacy of both nifedipine and verapamil in reducing the number of ischaemic episodes during short-term treatment of unstable angina. Nevertheless, a significant number of myocardial infarctions occurred in these patients, and some required subsequent coronary bypass graft operations.

Adult↗