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Biomedical subjects

B M Ianni

Publications and source records attributed to B M Ianni.

At least 19 recordsLinked to original sources
PubMed2000

Maximal functional capacity in patients with Chagas' cardiomyopathy without congestive heart failure.

BACKGROUND: Chagas' disease is a known dilated form of cardiomyopathy. However, a great number of patients, although showing electrocardiographic (ECG) well-recognized changes, maintain normal ventricular chamber dimensions and are asymptomatic. The aim of the present study was to objectively characterize functional capacity in asymptomatic patients with Chagas' disease and normal left ventricular function. METHODS AND RESULTS: Eighteen asymptomatic male patients with Chagas' disease, aged 33+/-6 years, were selected for the study. All showed ECG changes typical of the disease, as well as left ventricular fractional shortening (LVFS) greater than 0.30 on M-mode 2-dimensionally guided echocardiography. Twenty sedentary normal male patients, aged 29+/-6 years, served as controls. Both groups were submitted to ergoespirometry testing for assessment of exercise functional capacity. Patients with Chagas' disease, when compared with controls, showed lower (P < .001) maximal O2 consumption (VO2max, 24.3+/-4.2 v 37.0+/-5.4 mL x kg(-1) x min(-1) respectively); O2 pulse rate (PO2max, 10.5+/-1.4 v 15.1+/-2.5 mL/beat, respectively); maximal ventilation (VEmax, 50.1+/-13.5 v 113.0+/-17.6 L x min(-1), respectively); anaerobic threshold of maximal O2 consumption (VO2-AT, 15.8+/-3.6 v 24.6+/-4.7 mL x kg(-1) x min(-1), respectively); and maximal heart rate (HRmax, 154+/-21 v 186+/-7 beat x min(-1), respectively). CONCLUSIONS: Asymptomatic patients with Chagas' disease, although presenting normal left ventricular systolic function at rest, display a substantial impairment of exercise functional capacity.

Adult↗
PubMed1999

Neoplastic pericardial disease. Analysis of 26 patients.

PURPOSE: To characterize patients with neoplastic pericardial disease diagnosed by clinical presentation, complementary test findings, and the histological type of tumor. METHODS: Twenty-six patients with neoplastic pericardial disease were retrospectively analyzed. RESULTS: Clinical manifestations and abnormalities in chest roentgenograms and electrocardiograms were frequent, but were not specific. Most patients underwent surgery. There was a high positivity of the pericardial biopsy when associated with the cytological analysis of the pericardial liquid used to determine the histological type of the tumor, particularly when the procedure was performed with the aid of pericardioscopy. CONCLUSION: The correct diagnosis of neoplastic pericardial disease involves suspicious but nonspecific findings during clinical examination and in screen tests. The suspicious findings must be confirmed through more invasive diagnostic approaches, in particular pericardioscopy with biopsy and cytological study.

Adult↗
PubMed1998

Atrial fibrillation in endomyocardial fibrosis is a marker of worse prognosis.

We studied the incidence of AF in patients with endomyocardial fibrosis (EMF) and its influence on prognosis and associated clinical events. One hundred and sixty consecutive patients with EMF were followed for a mean period of 4 years. Their mean age was 39.7 years. There were 114 women. During follow-up there were 56 deaths. Eighty-eight patients (55%) were submitted to surgical intervention. AF was observed in 58 cases (36.2%). The presence of AF was associated with a greater prevalence of dyspnea, peripheral edema, hepatomegaly, lower left ventricular ejection fraction, lower right ventricular systolic pressure (37.8 vs 45.6 mmHg, P=0.0392), and greater incidence of tricuspid regurgitation (86.0 vs 63.2%, P=0.004). AF was more frequent among patients in whom the disease involved the right ventricle, particularly those with intense fibrosis. Overall, patients with AF had a higher mortality rate than those who did not have AF (43.1 vs 30.3%, P=0.0195), but among those submitted to surgery, AF did not have an impact on survival. In conclusion, AF is frequent among patients with EMF. It is more prevalent among patients with right ventricular involvement and its presence is associated with a greater incidence of heart failure. AF is associated with worse prognosis, but surgery potentially reverses this bad evolution.

Adult↗
PubMed1998

[Value of pericardial biopsy in the etiologic diagnosis of pericardial diseases].

PURPOSE: To determine the value of pericardial biopsy as a complementary exam in the etiology of pericardial effusion. METHODS: We analyzed retrospectively (from 1990 to 1997) 38 patients with pericardial effusion. The age ranged between 3 months and 79 years (mean 41.15 +/- 21.78 years). Pericardial biopsy was performed in all cases through a subxiphoid incision. RESULTS: In 4 patients (10.5%) the biopsy was able to define etiology, 2 had tuberculosis and 2 neoplasias (1 undetermined adenocarcinoma, 1 mesotelioma). In 34 patients the biopsy showed non-specific chronic pericarditis. CONCLUSION: Pericardial biopsy was not an effective method to determine the etiological diagnosis in pericardial effusion patients. We believe that we have to individualize the indication of pericardial biopsy especially if tuberculosis or neoplasia are suspected.

Adolescent↗
PubMed1998

[Cardiovascular diseases observed during follow-up of a group of patients with undetermined form of Chagas' disease].

PURPOSE: The aim of this study was to evaluate the cardiovascular outcome in patients with the undetermined form of Chagas' disease and whether or not it is related to the infectious disease in the long-term. METHODS: One hundred and sixty patients were prospectively followed-up at three month intervals for up to 177 months. RESULTS: Twenty and three (14.4%) patients developed hypertension complicated by ischemic stroke in two (1.2%) and symptomatic heart failure in one (0.6%). Cardiac arrhythmias occurred in four (2.4%) patients corresponding to isolated ventricular ectopic beats in two (1.2%), isolated supraventricular ectopic beats in one (0.6%) and an isolated episode of acute atrial fibrillation in another (0.6%). Two (1.2%) patients developed symptoms of coronary artery disease, one of them had one episode of acute chest pain diagnosed as myocardial infarction and the other had chronic chest pain diagnosed as angina. CONCLUSION: Hypertension is the most common cardiovascular disease occurring in the long-term follow-up of patients with the undetermined form of Chagas' disease. Cardiac rhythm disturbances and coronary artery disease were not more frequent than those generally found in a healthy population. These data confirm a favorable long-term prognosis in patients with the undetermined form of Chagas' disease.

Adolescent↗
PubMed1998

[Idiopathic chylopericardium].

We describe a case of a patient with idiopathic pericardial effusion that during investigation proved to be a chylopericardium. Lymphangiography showed the chylopericardium to be due to partial aplasia of the thoracic duct. A brief review the etiology, clinical feature, diagnostic procedures and therapeutic possibilities of chylopericardium is presented.

Adult↗
PubMed1997

[Maximal functional capacity and diastolic function in patients with cardiomyopathy due to Chagas' disease without congestive heart failure].

PURPOSE: To identify early cardiac dysfunctions in asymptomatic patients with Chagas' cardiomyopathy. METHODS: We studied 38 male individuals: control group consisting of 20 sedentary normal individuals and Chagas' group, of 18 asymptomatic patients with Chagas' disease, with suggestive electrocardiographic alterations and normal fractional shortening (FS) on echocardiogram. Both groups were submitted to evaluation of the maximal functional capacity, with measurements of maximal O2 consumption (VO2max), O2-pulse rate (PO2max), maximal ventilation (VEmax), maximal heart rate (HRmax), and anaerobic threshold of the VO2max (VO2-AT). Left ventricular diastolic function was evaluated by conventional echocardiography (E wave, A wave and E/A ratio). RESULTS: No significant differences occurred between the two groups with regard to FS (p = 0.212) and age means (p = 0.060). The 2 groups were significantly different (p < 0.001) regarding the parameters VO2max, PO2max, VEmax, HRmax and VO2-AT, E wave and E/A ratio. There was no difference (p = 0.520) in A wave. CONCLUSION: Impaired ventricular function may account for the above mentioned differences, a consequence of both systolic and diastolic dysfunctions.

Adult↗
PubMed1997

[Radiological findings in endomyocardial fibrosis].

PURPOSE: To determine through conventional radiology the type of ventricular involvement in endomyocardial fibrosis (EMF). METHODS: We analyzed 56 cases with EMF confirmed by angiocardiography and 9 by postmortem study, aged between 16 and 56 years (mean 32); there were 42 females. Only one radiologist analyzed X-rays without any knowledge of the cineangiography findings. RESULTS: The right side of the heart was primarily involved in 9 patients and the cardiac silhouette was characteristically globular and had oligemic pulmonary fields (66.66%). The cardiothoracic ratio was 0.62 +/- 0.11. Out of 9 patients, 8 were female. The left side of the heart was established as being primarily involved in 11 cases and simulated rheumatic mitral disease. The cardiothoracic ratio was 0.51 +/- 0.09 and there were increased pulmonary fields in 63.6%. The biventricular disease occurred in 36 cases. There were radiologic findings of right and left side. The cardiothoracic ratio was 0.63 +/- 0.06 and there was oligemic pulmonary fields in 38.8%, increased pulmonary fields in 33.3% and was normal in 27.7%. There were 4:1 females. CONCLUSION: The radiological study is fundamental in the initial diagnosis of EMF. The type of involvement could be done in 66.07% of all cases by chest X-ray.

Adolescent↗
PubMed1996

[Normal maximal functional capacity in patients with congestive heart failure due to Chagas' cardiomyopathy].

PURPOSE: To compare patients with heart failure due to Chagas' cardiomyopathy and maximal oxygen consumption greater than 20mL/kg-1/min-1 to normal individuals. METHODS: We studied 104 male patients with heart failure due to Chagas' cardiomyopathy, functional classe II-IV, age 18 to 65 years (40.3 +/- 9.0), and 23 normal sedentary male individuals (GI) age 17 to 51 years (35 +/- 8.7). Maximal oxygen consumption (VO2max) was obtained using a Beckman metabolic measurement cart, and left ventricular ejection fraction (EF) by conventional transthoracic echocardiography. Comparisons between means were made with t-test. RESULTS: Thirty seven patients (35.6%) presented VO2max above 20mL/kg-1/min-1 (G2), with values ranging from 20.5 to 30 (24.5 +/- 2.9) and EF between 19 and 63% (42 +/- 11.7). GI had VO2max between 21 and 42mL/kg-1/min-1 (33.3 +/- 5.6) and EF between 70 and 82% (75.1 +/- 3.2). Ages were not significantly different for the two groups (p = 0.1136). VO2max and EF were lower in G2, and this was statistically significant (p < 0.0001). CONCLUSION: These results indicate that patients with congestive heart failure due to Chagas disease may show values of VO2max, greater than 20mL/kg-1/min-1 which does not mean that they have normal maximal functional capacity.

Adolescent↗
PubMed1995

[Relationship between ventricular arrhythmia and cardiac function in Chagas disease].

PURPOSE: It is well established the association between heart failure and arrhythmias in different cardiopathies. There are no studies in Chagas' myocardiopathy that analyze the relation between arrhythmias and left ventricular function. METHODS: We studied 629 patients with Chagas' disease, divided in 3 groups, according to ejection fraction obtained through echocardiographic study (normal, between 0.64 and 0.45, and below 0.44). RESULTS: At conventional ECG, the presence of ventricular arrhythmias was respectively in the 3 groups: 15%, 36% and 64%, showing higher incidence when left ventricular function was getting worse. CONCLUSION: Ventricular arrhythmias in Chagas' disease are frequent in patients with normal ejection fraction, and become more intense as ventricular dysfunction progresses.

Adolescent↗
PubMed1993

[Male sex. Prognostic factor in Chagas' disease].

PURPOSE: To verify if the ventricular function and the incidence of arrhythmias in patients of both sexes could be predominant in male patients with Chagas' disease. METHODS: Six hundred and thirty one patients were studied, 329 female and 302 male, with age of 10 to 64 years old (mean 40). All patients were submitted to M mode echocardiographic study to analyse the ejection fraction (EF). To verify the importance of the ventricular dysfunction in male and female patients, they were divided according to the EF in three groups: A) normal EF, B) EF between 0.64 and 0.45 and C) EF less than 0.44. The incidence of ventricular tachycardia was analyzed at the stress test or 24h Holter studies. RESULTS: The number of patients with depressed EF was more frequent on male patients (p < 0.0001). The incidence of ventricular tachycardia was similar in both sexes, however it was more frequent in patients with ventricular dysfunction. CONCLUSION: Our results show that there are greater myocardial dysfunction on male patients, what could explain the worse prognosis observed on patients of this sex.

Adolescent↗
PubMed1990

[Indeterminate form of Chagas' disease. A polymorphic disease].

PURPOSE: To evaluate the association between the indeterminate form of Chagas' disease and abnormalities in non-invasive cardiovascular propedeutics. PATIENTS AND METHODS: Twenty-two patients in the indeterminate form of Chagas' disease, 17 female, with ages between 25 and 50 years were submitted to studies of: vectorcardiography, echocardiography, stress test, dynamic electrocardiography and scintigraphic studies (scintigraphic ventriculography and cardiac mapping with pyrophosphate of technetium), in a period of two months after first consultation. RESULTS: The analysis shows the percentual of altered exams: vectorcardiogram--68.2% (conduction disturbance--22.7%); echocardiogram--15.8% (apical hypokinesia); cardiac mapping 61.8%; scintigraphic ventriculography--68.2%; stress test--72.2% (reduced delta PS--50%, ventricular arrhythmia--50%); and dynamic electrocardiographic--50% (ventricular arrhythmias). We could observe also that the great majority of the patients has more than three exams altered (63.6%). The study of relation between methods, shows only association between reduced delta PS and ventricular arrhythmia, with concordant results in 72.7%. CONCLUSION: Indeterminate form of Chagas' disease appears to be a really chronic form, may be of attenuate aggressive potential, with indeterminate evolution and with polymorphic clinical exteriorization seeing only through invasive and non invasive propedeutic techniques.

Adult↗
PubMed1989

[The value of the electrocardiogram in evaluating myocardial function in patients with Chagas' disease].

The authors studied the electrocardiogram of 1004 patients with Chagas' disease. The fit of this observation was the correlation between the electrocardiographic alterations with the cardiac compromise, which was analysed clinically, by thorax X-ray, echocardiogram and stress test. The results show that increased cardiothoracic index, and decreased ejection fraction, decreased difference between systolic blood pressure before the exercise and at the final of the stress test at maximal weight were associated with greater incidence of ventricular premature beat, intraventricular heart block, inactive area, ST-T alteration. chi 2 test shows that these association was significative. The presence of premature ventricular beats and inactive area on the electrocardiographic study seems to determine worse prognosis to the patients since these alterations were more frequent on the patients that died due to Chagas' disease.

Adolescent↗
PubMed1989

[Cardiac thrombosis and embolism in patients having died of chronic Chagas cardiopathy].

The authors studied the files of 111 patients (mean age 47.5 years) with chronic Chagas' disease and severe heart failure who had died between 1978 and 1984; they were 72 men and 39 women. Eighty-one patients (73%) had cardiac thrombosis, 65 times (53%) in right chambers and 56 times (46%) in left ones. Sixty-seven patients (60%) had thromboembolic episodes, 41 (65%) to the lungs, 23 (38%) to other organs (target organs: the kidneys in 21 cases, spleen in four, brain in two, abdominal aorta in one, mesenteric artery in one and iliac artery in one). Right chamber thrombosis occurred 65 times, 35 (53%) with pulmonary thromboembolism. Left chamber thrombosis occurred 56 times, 24 (42%) with systemic thromboembolism. A total of 41 patients had pulmonary thromboembolism, only six (14%) without right chamber thrombosis; of 26 patients with systemic thromboembolism, only two (7%) did not have left chamber thrombosis. The authors concluded that the incidence of thrombosis and thromboembolism was high in the group studied, and that there was a relationship between chamber thrombosis and systemic or pulmonary thromboembolism.

Adolescent↗
PubMed1989

[The biopsy in the diagnosis of pericardial involvement by malignant tumor].

We performed pericardial biopsy by subxiphoid approach in twelve patients (eight men, four women) with cardiac tamponade or pericardial effusion without low cardiac output, in order to search for the underlying disease. Five patients (41%) had pericardial biopsy with malignant neoplastic invasion. In seven patients (59%) the biopsy was nonspecific; in these patients, the diagnosis was made by another methods. We concluded that the pericardial biopsy is a safe method, with high especificity but low sensibility in the diagnosis of malignant pericardial invasion.

Biopsy↗