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Angelo Branzi

Publications and source records attributed to Angelo Branzi.

89 records · Page 5Linked to original sources
PubMed2002

Fluvastatin for prevention of cardiac events following successful first percutaneous coronary intervention: a randomized controlled trial.

CONTEXT: Percutaneous coronary intervention (PCI) is associated with excellent short-term improvements in ischemic symptoms, yet only three fifths of PCI patients at 5 years and one third of patients at 10 years remain free of major adverse cardiac events (MACE). OBJECTIVE: To determine whether treatment with fluvastatin reduces MACE in patients who have undergone PCI. DESIGN AND SETTING: Randomized, double-blind, placebo-controlled trial conducted at 77 referral centers in Europe, Canada, and Brazil. PATIENTS: A total of 1677 patients (aged 18-80 years) recruited between April 1996 and October 1998 with stable or unstable angina or silent ischemia following successful completion of their first PCI who had baseline total cholesterol levels between 135 and 270 mg/dL (3.5-7.0 mmol/L), with fasting triglyceride levels of less than 400 mg/dL (4.5 mmol/L). INTERVENTIONS: Patients were randomly assigned to receive treatment with fluvastatin, 80 mg/d (n = 844), or matching placebo (n = 833) at hospital discharge for 3 to 4 years. MAIN OUTCOME MEASURE: Survival time free of MACE, defined as cardiac death, nonfatal myocardial infarction, or reintervention procedure, compared between the treatment and placebo groups. RESULTS: Median time between PCI and first dose of study medication was 2.0 days, and median follow-up was 3.9 years. MACE-free survival time was significantly longer in the fluvastatin group (P =.01). One hundred eighty-one (21.4%) of 844 patients in the fluvastatin group and 222 (26.7%) of 833 patients in the placebo group had at least 1 MACE (relative risk [RR], 0.78; 95% confidence interval [CI], 0.64-0.95; P =.01). This result was independent of baseline total cholesterol levels (above [RR, 0.76; 95% CI, 0.56-1.04] vs below [RR, 0.77; 95% CI, 0.57-1.02] the median). In subgroup analysis, the risk of MACE was reduced in patients with diabetes (n = 202; RR, 0.53; 95% CI, 0.29-0.97; P =.04) and in those with multivessel disease (n = 614; RR, 0.66; 95% CI, 0.48-0.91; P =.01) who received fluvastatin compared with those who received placebo. There were no instances of creatine phosphokinase elevations 10 or more times the upper limit of normal or rhabdomyolysis in the fluvastatin group. CONCLUSION: Fluvastatin treatment in patients with average cholesterol levels undergoing their first successful PCI significantly reduces the risk of major adverse cardiac events.

Adult↗
PubMed2002

A randomised cross-over study on the haemodynamic effects of oral dofetilide compared with oral sotalol in patients with ischaemic heart disease and sustained ventricular tachycardia.

OBJECTIVE: To assess the haemodynamic effects of short-term treatment with dofetilide in comparison with sotalol in patients with ischaemic heart disease. METHODS: Twelve patients with ischaemic heart disease and sustained ventricular tachycardia were treated with dofetilide [500 microg twice daily (b.i.d.)] or sotalol (160 mg b.i.d., randomised sequence separated by wash-out period) for 3-5 days. Right-heart catheterisation was performed at baseline and at the end of each short-term treatment phase. RESULTS: The main findings were a significant reduction in heart rate, mean systemic pressure and cardiac index (-13%) during treatment with sotalol. Conversely, cardiac index increased significantly during dofetilide (mean percentage change 11%) with no effect on heart rate and systemic blood pressure. CONCLUSIONS: Oral dofetilide exerts favourable haemodynamic effects in comparison with D,L-sotalol following short-term oral treatment. In view of these observations, the use of dofetilide may be proposed also in patients with ventricular tachyarrhythmias associated with impaired left-ventricular function. Whether the haemodynamic differences between dofetilide and D,L-sotalol are the basis for differences in tolerability remains to be evaluated.

Administration, Oral↗
PubMed2002

Accelerated QRS widening as an independent predictor of cardiac death or of the need for heart transplantation in patients with congestive heart failure.

We analyzed QRS interval for 6 months or more in 82 patients with dilated cardiomyopathy. At 1 year, the incidence of cardiac death/need for heart transplantation was higher among patients with QRS-interval widening of 0.5 msec/month or greater (p = 0.002). At multivariate analysis, QRS widening independently and unfavorably predicted cardiac death/need for heart transplantation (p = 0.029). Randomized prospective studies are necessary to confirm the prognostic value of accelerated QRS widening in patients with dilated cardiomyopathy and to investigate its significance in selecting candidates for electrical resynchronization and heart transplantation.

Adult↗
PubMed2002

Hospitalization for congestive heart failure: is it still a cardiology business?

BACKGROUND: Hospital management of CHF and predictors of hospital mortality remain unclear. METHODS: To address these issues, we analyzed the hospital admissions for CHF during 1996 in a large university hospital. Patients discharged with the principal diagnosis of CHF were considered eligible for the study. RESULTS: Among the 1511 patients (3% of all discharges) who satisfied the inclusion criteria, 75% were treated in general medicine departments (GMD) and 22% in cardiology units (CU). Patients admitted to GMD were older than those treated in CU (79+/-10 vs. 68+/-15 years, P<0.001), included a higher proportion of females (56% vs. 37%, P<0.001), and presented a higher rate of hospital mortality (13% vs. 4%, P<0.001). The overall mean length of stay was 11+/-9 days. At multivariate analysis, length of stay was not associated with the department (i.e. GMD/CU) (P=0.273). CONCLUSIONS: CHF is a common lethal condition often requiring treatment in GMD. Length of stay appears to depend more on patients' characteristics than on differences in practice between GMD and CU. Patients admitted to GMD present higher rates of comorbidity and hospital mortality. Strategies are urgently needed to improve hospital management of CHF.

Age Distribution↗
PubMed2002

Combined use of morphology discrimination, sudden onset, and stability as discriminating algorithms in single chamber cardioverter defibrillators.

Morphology Discrimination (MD) is a rhythm discriminator based on QRS morphology analysis that can be combined with other discriminators like Stability, with or without Sinus Interval History (SIH) and Sudden Onset. Thirty-five patients implanted with a St. Jude Medical single chamber ICD were evaluated during exercise testing, during induced AF, and during follow-up for 14 +/- 5 months. At exercise testing (60 episodes detected) MD had a specificity (SP) of 96.7% and Sudden Onset a SP of 91.7%; during induced AF (25 episodes) both MD and Stability had a SP of 96.0%. The diagnostic performance on spontaneous arrhythmias was as follows: for ventricular tachycardia (126 episodes) a sensitivity (SE) of 94.4% for MD, 92.1% for Sudden Onset, 89.7% for Stability without SIH and 79.4% for Stability + SIH; for sinus tachycardia (44 episodes) a SP of 86.4% for MD, 97.7% for Sudden Onset, 2.3% for Stability and of 95.5% for Stability + SIH. For AF (165 cases) a SP of 67.9% for MD, 69.1% for Stability and 90.3% for Stability + SIH, 44.8% for Sudden Onset. Use of MD alone provided a SE of 94.4% and a SP of 71.4% for spontaneous arrhythmias and combined use of the discriminators in a "2 of 3" diagnostic logic implied a SP of 90.9% with maintenance of 96.0% of SE. In single chamber ICDs a wide range of SE/SP ratios may be obtained by use of multiple discriminators, but use of the algorithm in a 2 of 3 diagnostic logic may achieve a SP of 90.9% and a SE of 96.0%.

Algorithms↗
PubMed2002

Atrial signal analysis and defibrillation threshold assessment in chronic persistent and reinduced atrial fibrillation.

INTRODUCTION: Induced versus spontaneous atrial fibrillation (AF) is of interest for assessing atrial defibrillation threshold reproducibility. METHODS AND RESULTS: Twenty-one patients with chronic AF underwent internal cardioversion with assessment of atrial defibrillation threshold at baseline and at reinduced AF. High right atrial (HRA) and coronary sinus (CS) bipolar recordings were analyzed to measure the mean local atrial period, its coefficient of variation, the 5th (P5) and 95th (P95) percentiles of atrial intervals, and the percentage of points lying at the baseline (number of occurrences), and to quantify AF organization. Atrial defibrillation threshold was comparable in baseline and reinduced AF in terms of leading-edge voltage and delivered energy. Baseline and reinduced AF were comparable with regard to overall signal parameters (both in HRA and CS) and the presence of an organized arrhythmia pattern. As for individual variables, P5 increased while P95 and coefficient of variation decreased in reinduced AF compared with spontaneous AF (statistical significance was achieved for all these parameters in HRA, but only for coefficient of variation and P95 in CS). CONCLUSION: Sustained AF reinduced after cardioversion of chronic AF is comparable with baseline AF in terms of atrial defibrillation threshold, atrial cycle length, and pattern of organization. Therefore, a clinical model based on reinduction of sustained AF after cardioversion is suitable for studying the effects of a series of interventions on atrial defibrillation threshold. However, because this model does not yield a form of AF with comparable indices of local refractoriness (e.g., P5), it is not recommended when analyzing local electrophysiologic properties.

Adult↗
PubMed2002

Transvenous internal cardioversion for atrial fibrillation: a randomized comparison between catheters with different coil length.

OBJECTIVES: The aim of this study was to evaluate the effects of 2 different right atrial electrode coil lengths on energy and voltage requirements for transvenous atrial cardioversion. METHODS: Twenty-six patients (mean age 61 +/- 11 years) with chronic persistent atrial fibrillation (AF) (mean duration 11 +/- 10 months) underwent transvenous cardioversion. A 6F catheter with a 5.5-cm coil was positioned in the coronary sinus. Another catheter with either a 5.5-cm or an 8-cm coil was positioned along the lateral wall of the right atrium, according to a randomized allocation. R wave-synchronized biphasic shocks were delivered according to a step-up protocol. After cardioversion of baseline AF, AF was reinduced, the right atrial catheter was substituted, and cardioversion was repeated with the alternative right atrial coil. RESULTS: Successful cardioversion was obtained in all of the patients. Leading edge voltage of effective shocks was significantly lower when catheters with an 8-cm coil in right atrium were used compared with the alternative 5-cm coil catheters (301 +/- 80 volts vs 340 +/- 78 volts, P <.001), and delivered energy (6.75 +/- 4.25 joules vs 7.86 +/- 4.29 joules, P =.043) and shock impedance (60 +/- 9 ohm vs 66 +/- 10 ohm, P <.001) were lower. Moreover, shock-induced discomfort, evaluated by assessment of pain score, was reduced (3.69 +/- 1.09 vs 4.12 +/- 0.99, P =.035). CONCLUSIONS: The use of a longer right atrial coil results in lower shock impedance, lower energy and voltage requirements, and lower discomfort during transvenous atrial cardioversion. The results of the current study are of value either for transvenous internal cardioversion of chronic persistent AF or for implantable atrial defibrillators.

Adult↗
PubMed2002

Current clinical perspectives on implantable devices for atrial defibrillation.

The role of devices that deliver shock therapy for atrial fibrillation is still debated. Following technical improvements in catheter-based atrial defibrillation, implantable devices have become available either in the form of stand-alone atrial defibrillators or in the form of dual defibrillators. Although preliminary results do not support their use as a single, unique treatment for atrial fibrillation patients, in combination with drugs, pacing or other treatments such as ablation, atrial defibrillators should help appropriately selected groups of patients.

Atrial Fibrillation↗
PubMed2002

Oral loading with propafenone for conversion of recent-onset atrial fibrillation: a review on in-hospital treatment.

Atrial fibrillation (AF) is a very common arrhythmia. In order to treat acute AF rapidly, effective drug regimens are required. Propafenone is a class IC antiarrhythmic agent that is suitable for oral loading as it reaches peak plasma concentrations within 2 to 4 hours of administration. The use of propafenone loading in patients with AF must be based on appropriate patient selection in view of the negative inotropic effect and the potential proarrhythmic effects of the drug. A series of controlled trials in patients with recent-onset AF without heart failure who were hospitalised with enforced bed rest has shown that orally loaded propafenone (450 to 600 mg as single dose) exerts a relatively quick effect (within 3 to 4 hours) and a high rate of efficacy (72 to 78% within 8 hours). A potentially harmful effect of class IC agents is the risk of transforming AF into atrial flutter (3.5 to 5% of patients). However, atrial flutter with 1 : 1 atrioventricular response was observed in only two of 709 patients receiving propafenone (0.3% incidence). Nevertheless, the potential negative inotropic effect of propafenone demands careful patient selection, with systematic exclusion of patients with left ventricular dysfunction or congestive heart failure. Oral loading with propafenone can be considered as an episodic treatment in patients with AF recurrences, as has been proposed for other drugs in the past. However, the safety of oral loading with propafenone as an outpatient treatment in appropriately selected patients has to be assessed by appropriately designed prospective studies.

Administration, Oral↗
PubMedDate not supplied

Predictors of 32P beta brachytherapy failure in patients with high-risk in-stent restenosis.

BACKGROUND: The effectiveness of coronary radiation therapy for the treatment of in-stent restenosis (ISR) has been established in several randomized clinical trials. The efficacy of this treatment in the general population is less well established. METHODS AND MATERIALS: We report our experience in 118 consecutive patients with nonselected high-risk ISR who had undergone successful percutaneous coronary intervention and brachytherapy with (32)P beta-irradiation and who were prospectively enrolled in a quantitative angiographic and clinical follow-up protocol at 7 months after the index procedure. The aim of this study was to investigate the independent predictor of angiographic restenosis after (32)P brachytherapy treatment. RESULTS: Of the patients, 28.8% were diabetics. The mean lesion and mean radiated lengths were, respectively, 30.1 +/- 17.2 and 43.8 +/- 16.9 mm. The ISR pattern was diffuse in 96% of the treated lesions; in particular, 22.1% presented an occlusive pattern and 37.1% a proliferative pattern. At follow-up angiographic, restenosis and major adverse cardiac events (MACE) rates were, respectively, 20.8% and 29.6%. The univariate predictors of angiographic restenosis were procedural geographic miss, pattern IV ISR, manual pullback maneuver of the radiation source, preprocedural lesion percentage stenosis and preprocedural lesion MLD. At logistic regression analysis, only geographic miss and pattern IV ISR were independent predictors of post intracoronary radiation therapy (IRT) angiographic restenosis. CONCLUSION: These data indicate that 7-month angiographic restenosis after (32)P IRT in complex patients with ISR is not a frequent event and is predicted mainly by an occlusive lesion at baseline and by procedural geographical miss.

Aged↗
PubMedDate not supplied

Association between HFE mutations and acute myocardial infarction: a study in patients from Northern and Southern Italy.

There is interest in the role of iron in age-related diseases such as atherosclerosis. Tissue iron deposition could be harmful, because Fe(2+) can react with H(2)O(2) to form OH(-) radicals and Fe(2+) can react with O(2) to form reactive oxygen species. Free radicals react with cell membranes and cell organelles and could lead to the development of atherosclerosis by initiating lipid peroxidation. Hereditary hemochromatosis provides an opportunity for studying the effects of iron on cardiovascular disease. Some studies have shown that individuals who carried HFE mutations may be at greater risk of developing coronary heart disease than those without the mutations. In contrast, a large number of studies have reported no association between HFE mutations and coronary heart disease. These studies have possible confounding factors, such as the homogeneity of the population in term of geographical origin among others. We studied the relation between HFE mutations and acute myocardial infarction in two case-control studies involving two sets of subjects representing different age groups from different geographic regions in Italy. The first one was composed of 172 older patients (139 males and 33 females; mean age 67) and 207 healthy controls (91 males and 116 females; mean age 46) from Emilia-Romagna. The second one was composed of younger 77 patients (75 males and 2 females; mean age 41) and 172 healthy controls (75 males and 97 females, mean age: 38) from Sicily. All patients were genotyped for ApoE alleles, since the ApoE- epsilon 4 allele is considered a risk factor for cardiovascular diseases and can interfere with other genetic and environmental factors by modifying susceptibility to this disease. DNA typing for C282Y and H63D HFE alleles was performed also. There were no significant differences in frequencies of the different HFE alleles between acute myocardial infarction patients and controls in cohorts of both old and young patients. Also taking into account the presence or absence of the ApoE- epsilon 4 allele, no significant differences in H63D allele frequencies were observed. Thus, our study, performed in two samples of genetically homogeneous patients and controls, does not support the suggestion that HFE mutations may be associated with acute myocardial infarction in susceptible individuals.

Adult↗
PubMedDate not supplied

Emerging medical therapies for pulmonary arterial hypertension.

Until a few years ago, "conventional" treatment for pulmonary arterial hypertension (PAH) included oral anticoagulants, calcium channel blockers, diuretics, digoxin, and oxygen. In the 1990s, 3 randomized studies demonstrated that the continuous intravenous infusion of epoprostenol improved functional capacity, cardiopulmonary hemodynamics, and survival in patients with severe PAH. Recently, the thromboxane inhibitor terbogrel, the prostacyclin analogues treprostinil, beraprost, and iloprost, and the endothelin receptor antagonist bosentan have been tested in clinical trials in more than 1,100 patients. Except for terbogrel, all compounds have improved by different degrees the mean exercise capacity as assessed by 6 minutes walking distance. Conversely, these trials differ for the severity and etiology of included PAH patients as well as for the effects on combined clinical events, on quality of life, and on hemodynamics. No trials have shown effects on mortality, and each new compound presents different side effects that seem unpredictable in the individual patient. At present, additional new compounds such as sitaxentan, ambisentan, L-arginine, and sildenafil are studied in clinical trials. The new therapeutic options are currently in different phases of approval by regulatory agencies, and when they will become available we will have the opportunity to select the most appropriate treatment for the single patient, according to an individualized benefit-to-risk ratio.

Arginine↗
PubMedDate not supplied

Relevance of cardioverter defibrillators for the prevention of sudden cardiac death on the timing of heart transplantation.

UNLABELLED: Information on the incidence of decompensation of chronic heart failure (CHF) in heart transplantation (HT) candidates eligible for prophylactic implantable cardioverter defibrillators (ICD) could provide insights into the influence of ICD on the timing for HT. METHODS: We investigated the prevalence of candidates satisfying SCD-HeFT and MADIT-II criteria for prophylactic ICD among patients (n = 317) with CHF referred to our tertiary center for HT. In addition to standard clinical and laboratory assessments, baseline evaluation included two-dimensional standard transthoracic echocardiogram and 12-lead electrocardiogram. RESULTS: At baseline, 19% of patients (n = 60) satisfied MADIT II criteria, and 58% (n = 185) fulfilled SCD-HeFT criteria. A total of 60% patients (n = 190) were eligible for prophylactic ICD implantation according to at least one set of criteria. Five-yr CHF decompensation-free survival was 68 +/- 4% in patients eligible for prophylactic ICD (p = 0.003), (RR 2.5, 95% CI 1.35-4.63). CONCLUSIONS: SCD-HeFT could imply a threefold rise in ICD eligibility in tertiary settings. As ICD-eligible patients would likely remain at high risk of progressive ventricular dysfunction, strict follow-up should be considered extremely important to allow a timely referral for HT.

Death, Sudden, Cardiac↗
PubMedDate not supplied

Distance between patients' subjective perceptions and objectively evaluated disease severity in chronic heart failure.

BACKGROUND: Chronic heart failure (CHF) is a socially relevant condition carrying an adverse prognosis. Systematic analysis is needed of the relationship between quality of life (QoL) - what patients are most interested in - and objective parameters of CHF severity - which largely determines physicians' care. METHODS: We prospectively investigated QoL, as ascertained by the Minnesota Living with Heart Failure Questionnaire, alongside all the currently used objective clinical/instrumental (electrocardiographic, echocardiographic, hemodynamic and functional capacity) indicators of disease severity in 106 consecutive CHF patients. RESULTS: Besides persistence of sinus rhythm (p = 0.007), the only objective parameters that correlated with QoL were NYHA class (p < 0.001) and distance covered during the six minutes walking test (p < 0.001) (two indications of patients' ability to attend to their daily needs). Presence of left bundle branch block was associated with a worse QoL only in patients with CHF due to ischemic heart disease (p = 0.032). All the other clinical/instrumental parameters showed no relation with QoL (p > 0.150 in all cases). CONCLUSIONS: Objective indicators of disease severity, which largely determine physicians' care, appear to have little bearing on QoL, suggesting that current treatment for CHF fails to satisfy patients' perceived needs. The possibility of cost-effective nonpharmaceutical therapeutic protocols (e.g. psychological interventions) specifically designed to improve patients' QoL deserves investigation as a much needed new approach to the management of CHF.

Activities of Daily Living↗
PubMedDate not supplied

Clinical use of novel antithrombotic agents in the management of acute coronary syndromes.

Among patients with ST elevation-acute coronary syndrome (ACS) novel thrombolytic agents can be given as a bolus (reteplase, tenecteplase) and their delivery is easier and may shorten the time to treatment, providing the ideal tool in the pre-hospital setting. Reinfarction after thrombolysis occurs in the 3-5% range in all major trials. Reinfarction after thrombolysis rate may be reduced by abciximab and enoxaparin. However major hemorrhage is doubled by abciximab (but not by enoxaparin). When primary angioplasty is preferred to thrombolysis, adjunctive abciximab decreases the need for urgent target vessel revascularization. A whole body of literature tells that aspirin is not enough in patients without ST elevation ACS. Most patients benefit from concomitant clopidogrel. High-risk patients are candidate to the use GP IIb-IIIA blockers, particularly if they need coronary angioplasty. All patients with glomerular filtration rate > or = 30 ml/min should receive low molecular weight heparin. Evidence for that is mainly driven by studies using enoxaparin.

Acute Disease↗