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Biomedical subjects

B Zingone

Publications and source records attributed to B Zingone.

At least 19 recordsLinked to original sources
PubMed1995

[Results of coronary surgery in mildly symptomatic patients with left ventricular dysfunction, multivessel disease and stenotic single residual patent vessel].

BACKGROUND: While efficacy of coronary artery bypass surgery in patients with depressed left ventricular function and myocardial ischemia is widely recognized, its results in patients in the absence of clinical evidence of myocardial ischemia remain uncertain. The purpose of this study was to evaluate the effects of coronary revascularization in comparison with conventional medical therapy in subjects with ischemic cardiomyopathy and myocardial ischemia presumed on the basis of angiographic anatomy but not demonstrated by functional testings. METHODS: We selected retrospectively patients who underwent coronary angiography from 1986 trough 1993 and met the following criteria: presence of three-vessel coronary artery disease, occlusion of two and significant luminal narrowing (> or = 50%) of the third major epicardial artery, left ventricular dysfunction (ejection fraction < or = 40%), no angina or presence of mild angina, absence of inducible ischemia on exercise test and, when performed, of redistribution in the vascular territory of the patent vessel. RESULTS: Thirty-one consecutive patients underwent isolated surgical revascularization treatment, while thirty medically treated patients with matched clinical characteristics were selected. Age (61 +/- 10 vs 62 +/- 9), gender (M/F 27/3 vs 24/7), NYHA class I-II (53 vs 62%) or NYHA III-IV (47 vs 38%), incidence of previous infarction (87 vs 94%), number of reversible defects in the vascular territory of the patient vessel on stress scintigraphy (0.6 vs 0.5), patent vessel (right coronary artery 7 vs 10; left circumflex 14 vs 12; left anterior descending 9 vs 9) and left ventricular ejection fraction (28 +/- 8 vs 31 +/- 7), were similar in the two groups (medical vs surgical). Surgically treated patients exhibited a lower proportion of overall cardiac deaths (7/31, 23% vs 19/30, 63%; p < 0.001), and more prolonged survival (67 +/- 9.3 vs 34 +/- 2.5 months; p = 0.04, Mantel and Cox test) than medically treated patients, respectively. The incidence of perioperative myocardial infarction was 10% (3/31). Causes of cardiac death were myocardial ischemia (9/19; 47%), sudden death (5/19; 26%) and heart failure (5/19; 26%) in medical patients, while were surgery (3 cases) and surgery related infection (1 case) (total 4/7; 57%), myocardial ischemia (1/7; 14%), sudden death (1/7; 14%) and heart failure (1/7; 14%) in surgical patients. Cox proportional hazard regression analysis with survival as the dependent variable, identified treatment, surgical or medical, as the best predictor of cardiac events (chi square improvement 9.36, p = 0.002). The next most powerful predictors were NYHA class and ACE-inhibitors treatment (chi square improvement 4.47 and 2.79, respectively). CONCLUSIONS: In patients with left ventricular dysfunction, multivessel coronary artery disease and single patent but stenotic residual vessel, coronary artery bypass grafting appear to offer a better survival than medical therapy, even in the absence of clinically evident myocardial ischemia.

Aged↗
PubMed1991

Prognostic value of total ischemic burden in patients with stable ischemic heart disease.

Patients with stable coronary artery disease commonly have transient myocardial ischemia with or without experiencing angina, but the prognostic implications of this "total ischemic burden" is still a matter of debate. We studied 112 consecutive patients with coronary artery disease, normal left ventricular function at rest and exercise-induced myocardial ischemia, a 24-hour ambulatory EKG was performed after drug withdrawal. The mean exercise duration was 572 +/- 192 seconds, with an ischemic threshold (ST depression = 1 mm) of 390 +/- 190 seconds). By Holter monitoring 30 patients had no ischemia and 82 (73%) had a total of 332 episodes of ST segment changes, the majority of which were asymptomatic (242/332, 73%). Among 82 patients with transient myocardial ischemia, 44 (54%) had only asymptomatic episodes. Nine patients (11%) complained of angina coincident to ST changes. Twenty-nine patients (35%) had both painful and painless ST segment alterations. All patients were prospectively followed-up while on conventional medical therapy. During a mean follow up of 25 +/- 10 months cardiac events occurred in 31 patients; there were 5 cardiac deaths, 3 non-fatal myocardial infarctions, 2 hospitalization for unstable angina and 21 revascularization procedures (PTCA or CABG). By multivariate analysis the number of stenotic vessels on coronary angiography was predictive of the events during the follow-up (p = 0.03), while other demographic, clinical, ergometric and angiographic variables were not influential. Event-free survival was similar for all subsets of transient myocardial ischemia (silent, symptomatic, or none).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1990

Myocardial infarction following sublingual administration of isosorbide dinitrate.

A 78-year-old with healed septal necrosis suffered a recurrent myocardial infarction of the anterior wall following the administration of isosorbide dinitrate 5 mg sublingually. After detailing the course of events, we discuss the role of paradoxical coronary spasm and hypotension-mediated myocardial ischemia occurring downstream to significant coronary arterial stenosis in the pathophysiology of acute coronary insufficiency.

Administration, Sublingual↗
PubMed1990

Transient myocardial ischaemia: a multivariate analysis on clinical, angiographic and ergometric variables.

The availability of ambulatory ECG monitoring allows identification of transient myocardial ischaemia, the clinical relevance of which is currently being investigated. Ninety-four consecutive patients with ischaemic heart disease and a positive exercise test (greater than or equal to 1 mm ST-segment depression) were studied to evaluate the prevalence of transient myocardial ischaemia (either painless or painful) during 24-h dynamic electrocardiogram (ECG) and the clinical, angiographic and ergometric variables predicting its appearance. Two-hundred-and-eighty-one episodes of transient electocardiographic myocardial ischaemia were recorded in 69 patients (73.4% of all patients). Transient myocardial ischaemia was more frequent, although not significantly so, in patients with diabetes, with previous myocardial infarction, or with multivessel disease. When tested by multivariate analysis, neither the clinical variables nor the severity of coronary artery disease allowed prediction of the occurrence of transient myocardial ischaemia during dynamic ECG. The duration of exercise testing up to the ischaemic threshold (ST-segment depression = 1 mm) and the peak heart rate during exercise were more accurate predictors of transient myocardial ischaemia (P = 0.019 and 0.012 respectively). Patients with transient myocardial ischaemia had a lower ischaemic threshold (355 +/- 175 vs 498 +/- 150 s, mean +/- SD, P = 0.001) despite a lower peak heart rate (129 +/- 18 vs 137 +/- 12 beats min-1, P = 0.047) than patients without transient myocardial ischaemia. In conclusion, exercise testing may help select patients for examination by dynamic ECG.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary Angiography↗
PubMed1988

Sequential rupture of the left ventricular free wall and of the interventricular septum after myocardial infarction. Surgical implications.

Two patients are reported in whom ventricular septal rupture complicated the recovery from surgery for left ventricular free wall rupture. One patient was successfully reoperated upon, but the second died before the diagnosis was obtained. The importance of being aware of the association and of excluding a left ventricular to right ventricular shunt at the time of surgery, or subsequently during clinical deterioration, is discussed.

Aged↗
PubMed1988

[Evaluation of flow reserve in internal mammary artery in situ bypass].

The internal mammary artery, when used as a conduit for coronary artery bypass, offers a better long-term patency and survival rate than the saphenous vein. However, concern exists that the flow through the internal mammary artery may be inadequate during periods of peak myocardial demand. This flow was investigated in 18 consecutive patients who were selected for coronary bypass of the left anterior descending artery using the internal mammary artery. All patients were evaluated post-operatively within 12 months by means of graded maximal stress test, cardiac catheterization and exercise thallium-201 scintigraphy. Significant improvement in work capacity, maximal rate-pressure product, effort angina and ECG abnormalities during exercise stress testing were observed following internal mammary artery myocardial revascularization. The patency rate for internal mammary artery grafts was 100% (vs 85% for vein grafts); during the followup period, occlusion of a saphenous vein bypass or development of a new stenosis in a native coronary artery was noted in five patients, and two patients were classified as having partial revascularization. Ischemia, demonstrated by perfusion deficits at peak stress which disappeared in the 3-hour delayed film, was documented in 7.4% (4/54) of the areas supplied by internal mammary artery grafts, compared to 31% (13/42) of the regions revascularized using saphenous vein conduits. Although this result was not statistically significant, a definite trend is suggested. We conclude that ischemia demonstrated by stress thallium scintigraphy in the post-operative period is uncommon when an internal mammary artery graft has been used. This suggests that adequate coronary flow exists at peak myocardial demand during exercise.

Aged↗
PubMed1988

[Reoperation in patients with heart valve prostheses. Analysis of risk factors affecting perioperative mortality].

Sixty-two patients with at least one prosthetic heart valve each underwent a total of 70 reoperations. Their cases were analysed with special regard to the risk of perioperative mortality and to the factors affecting that risk. The age of the patients studied was 47 +/- 14.6 years (mean +/- 1 SD), and 4.75 +/- 4 years had elapsed since their previous operation. A total of 85 prostheses were implanted at the time of initial surgery. Forty-nine of those were mitral, 28 were aortic, and 8 were tricuspid prostheses. There were 48 mechanical valves, 24 bioprostheses and 13 Carpentier rings (9 of the latter being mitral and 4 tricuspid). At reoperation (n = 70) 95 valves required treatment. Eighteen patients died following their first reoperation (18/62, 29%), and two more died after a second reoperation (2/8, 25%). Actuarial probability of hospital survivors being alive 8-9 years following reoperation was 47 +/- 15%. It was found by multiple regression analysis that the duration of cardiopulmonary bypass (p less than 0.01), surgical priority (p less than 0.05) and the patient's age (p less than 0.05) were the only independent predictors of hospital death. A review of the literature and our own results suggest that surgical problems encountered with reoperation have unfavourably affected surgical results in the past. Objective risk factors are currently more related to the operative outcome. For these to be neutralised, patients with dysfunctioning prosthetic heart valves should be operated at an early stage before they reach a critical one. Only patients with stable, mild dysfunction unlikely to worsen acutely may probably be followed-up safely.

Actuarial Analysis↗
PubMed1985

A reappraisal of the factors affecting early patency of aortocoronary saphenous vein bypass grafts. Current experience with extensive revascularization employing sequential grafting techniques.

A number of factors potentially influencing the patency rates of aortocoronary bypass grafts were investigated in a consecutive series of 50 patients by control angiography at 28 +/- 26 days and by univariate and multivariate analysis of a selected set of clinical, surgical and angiographic predictors. There were 234 anastomoses in this series, a mean of 4.7 per patient (range 1 to 9), 215 of which were connected to sequential vein grafts. After surgery, 40 patients were treated with anticoagulants and/or platelet inhibitors. Of the 234 coronary anastomoses studied, 219 were patent (93.6%). Coronary artery diameter, patient's age and previous myocardial infarction were shown to be independent predictors of increased risk of anastomotic occlusion. Arteries less than 1.5 mm in diameter had a patency rate of 84.9%, versus 96.1% for vessels 1.5 mm or larger (p = 0.009). The use of side-to-side anastomoses with sequential grafts seemed to counterbalance the unfavourable effect of small arterial size. Patients aged 65 or older had a lower probability of having all their grafts patent than younger patients did (50 vs 89%, p = 0.01). Patients with previous myocardial infarction similarly had a lower probability of having all their grafts patent compared to patients without previous infarction (68 vs 95%, p less than 0.05); this correlation was explained by a more frequent occlusion rate of grafts directed to fibrotic left ventricular areas. The effect of anticoagulants and of platelet-inhibitors was favourable, but did not reach statistical significance.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1984

[Coronary spasm as a mechanism of ischemia or myocardial necrosis immediately after coronary surgery. Considerations on 5 cases and review of the literature].

Several recent reports suggest that coronary artery spasm may represent a major complication of coronary artery bypass surgery, and that it may have gone unrecognized in the past. During a three-year interval ending July 1983 we have encountered 5 cases in whom reversible S-T changes, angina, arterial hypotension, major arrythmias and/or angiography prompted the diagnosis of coronary arterial spasm early after aorto-coronary bypass surgery. Our experience and the review of 15 previously reported cases reveals that in most cases the clinical presentation was that of an acute, severe, ischemic cardiac event that occurred few hours after termination of cardiopulmonary bypass. A more benign course took place in a minority of cases, although some of them showed evidence of myocardial necrosis on ECG and/or left ventriculography. The mortality rate in the collective series was 20%, and the rate of perioperative non fatal myocardial infarction was 25%. Glyceryl trinitrate administration into the ascending aorta or into the spastic coronary artery appeared to be the most effective way of treating this condition, while the same drug was seemingly uneffective when administered intravenously. The use of calcium antagonists was associated with a favourable outcome in some patients, but on the whole the results were unpredictable. Prompt consideration of the possibility of coronary artery spasm and aggressive treatment are required in order to minimize its impact on perioperative mortality and morbidity rates.

Adult↗