Biomedical subjects

Cesare Russo

Publications and source records attributed to Cesare Russo.

5 recordsLinked to original sources

PubMed2006

Isolated left ventricular diastolic dysfunction: implications for exercise left ventricular performance in patients without congestive heart failure.

OBJECTIVE: Clinical relevance of left ventricular (LV) diastolic dysfunction in the absence of congestive heart failure (CHF) and LV systolic dysfunction is not fully established. METHODS: Asymptomatic outpatients, sedentary, with cardiovascular risk factors but no history of cardiovascular events, underwent echocardiographic evaluation of LV structure and function by standard Doppler, color M-mode, and Doppler tissue methods, and exercise testing with simultaneous noninvasive assessment of LV stroke index and cardiac index. LV ejection fraction less than 50% and significant valvular disease or stress test suggestive of coronary disease were additional exclusion criteria. RESULTS: In 70 patients selected (40 +/- 10 years old, 63% men, 34% hypertensive, 34% diabetic, 4% diabetic and hypertensive, 11% with LV hypertrophy), LV diastolic dysfunction was detected in 26%, which was associated with hypertension, higher LV mass index, lower systolic function, lower peak exercise heart rate, and chronotropic reserve (all P < .05), and with lower peak exercise stroke index and cardiac index (both covariates adjusted P < .05), but not with lower peak exercise metabolic equivalents (P > .5). Abnormal LV relaxation was independently correlated with lower peak exercise cardiac index and stroke index (both P < .05). Peak exercise systolic and cardiac indices were comparable between patients with CHF risk factors (74%) versus those without. CONCLUSIONS: Isolated LV diastolic dysfunction was independently associated with lower peak exercise LV systolic performance in patients without CHF. Its diagnosis may provide a target for aggressive CHF risk management.

Adult↗

PubMed2006

Left ventricular chamber and myocardial systolic function reserve in patients with type 1 diabetes mellitus: insight from traditional and Doppler tissue imaging echocardiography.

OBJECTIVE: We sought to evaluate in patients with type 1 diabetes mellitus (DM1): (1) whether myocardial afterload correlates with left ventricular (LV) circumferential and longitudinal systolic function at rest and during low-dose dobutamine (LDD) infusion, and whether longitudinal and circumferential LV systolic function reserves are correlated; and (2) to explore relations between LV systolic mechanics and LV chamber output reserves. METHODS: A total of 20 patients with DM1 underwent echocardiography to assess LV systolic function at rest and at peak LDD (7.5 microg/kg/min). At rest, echocardiographic data of patients with DM1 were compared with those from 24 healthy control subjects. LV afterload was estimated by computing circumferential end-systolic stress (ESS). LV chamber systolic function was assessed by computing ejection fraction and ESS/end-systolic volume index; LV circumferential myocardial contractility was explored by computing midwall fractional shortening (MWS) and ESS-corrected MWS. Longitudinal LV systolic function was assessed using color Doppler tissue (DTI) to assess peak systolic velocities and maximal displacement of the lateral and medial mitral annulus in apical 4-chamber view; regional deformation analyses were computed at the midportion of the posterior interventricular septum (peak strain and peak strain rate); strain/ESS was assessed as an alternative indicator of longitudinal myocardial contractility. LV chamber output was assessed by computing stroke index. RESULTS: DM1 and control groups did not differ in terms of sex distribution, mean age, blood pressure, LV mass index and geometry, and at-rest parameters of LV systolic function (all P > .1), whereas body mass index was higher and systolic lateral mitral annulus velocity was lower in the DM1 than control group (both P < .01). At rest, in both groups, higher ESS correlated with lower ejection fraction and lower MWS; ESS did not show significant correlation with longitudinal systolic function parameters. At peak LDD in DM1, heart rate changed minimally; ESS decreased significantly (P < .01); circumferential and longitudinal LV systolic functions increased significantly but did not show intercorrelation; higher ESS correlated with lower ejection fraction; longitudinal LV systolic function parameters did not show correlation with ESS. In a multivariate analysis, percent increase in stroke index correlated with percent change of MWS (beta = 0.74, P < .01), and to a lesser extent with the percent increase of systolic lateral mitral annulus velocity (beta = 0.47, P = .04), independent to age, sex, percent change of ESS, and heart rate. CONCLUSIONS: LV longitudinal systolic function (DTI) parameters did not fall into the paradigm of the stress-shortening relationship used to describe LV contractility. However, both LV circumferential contractility and longitudinal systolic function reserves correlated with stroke index reserve during LDD.

Adult↗

PubMed2005

Relations of longitudinal left ventricular systolic function to left ventricular mass, load, and Doppler stroke volume.

AIMS: To evaluate whether the peak systolic velocities of the displacement of the lateral mitral anulus (Sa) and of the mid-portion of the interventricular septal wall (Sm) correlate with measures of left ventricular load, left ventricular mass, and Doppler stroke volume in normotensive and hypertensive subjects without clinically overt cardiovascular disease. METHODS AND RESULTS: Tissue Doppler imaging was used to evaluate Sa and Sm in apical 4-chamber view; standard echocardiographic procedures were used to assess left ventricular structure and traditional parameters of systolic function (ejection fraction, stress-corrected midwall shortening, meridional and circumferential end-systolic stress); pulsed Doppler was employed to evaluate stroke volume. In 87 subjects meeting inclusion criteria, Sa and Sm were not significantly correlated either with left ventricular end-diastolic volume and end-systolic stress, or with stroke volume; in contrast, endocardial and midwall fractional shortening were lower with higher afterload, as expected. Fractional shortening at endocardium and midwall, and Sm were lower with higher left ventricular mass. Mean Sa and Sm values were lower in subjects with low vs. those with normal stress-corrected midwall shortening, but low Sa was not associated with lower stress-corrected midwall shortening in our study sample. CONCLUSIONS: While Sa and Sm might be indices of longitudinal left ventricular systolic mechanics, they should not be considered as measures of left ventricular contractility alternative to well-established parameters of systolic function, such as stress-corrected midwall shortening, in subjects at rest without overt heart disease.

Adult↗

PubMed2005

Individuals' cardiovascular risk profile projected by family doctors and individuals' knowledge of cardiovascular risk factors: a challenge for primary prevention. The cardiovascular risk prevention project "Help Your Heart Stay Young".

BACKGROUND: Whether the practice of family doctors of assessing individuals' cardiovascular risk profile improves individuals' knowledge of risk factors in primary prevention has not been established. Accordingly, we evaluated patients' knowledge of cardiovascular risk factors and lifestyle in healthy subjects whose family doctors provided individual cardiovascular risk score. METHODS: Subjects who visited their family doctor in a time frame of 3 months, who accepted to fill-in a simple questionnaire measuring their knowledge of cardiovascular risk factors and of non-pharmacological interventions able to reduce cardiovascular risk were evaluated. RESULTS: Fifty-one family doctors were involved. The study sample comprised 4239 subjects (mean age 56 +/- 9 years, 62% women) in primary prevention. They were classified by their family doctors, based on the Framingham algorithm, as being at low (< 10%; 45.7% of subjects), medium (10-20%; 38.7% of subjects) or moderate-to-high (> 20%; 15.6% of subjects) cardiovascular risk. The prevalence of obese subjects (40, 48, and 49%, respectively) and of heavy smokers (> or = 20 cigarettes/day; 26, 30, and 34%) increased from the low to the moderate-to-high risk group (both p < 0.05). The proportion of subjects unaware of personal history of arterial hypertension (5, 6, and 9%) and that of subjects who were unaware of history of elevated cholesterol levels (10, 11, and 12%, both p < 0.01) increased with higher cardiovascular risk score. The proportion of subjects self-reporting blood pressure > 135/85 mmHg, but self-reporting being normotensive (30, 50, and 52%), and the proportion of subjects who referred cholesterol levels > 200 mg/dl among those who self-referred not to have elevated cholesterol levels (13, 25, and 31%) increased both with cardiovascular risk category (p < 0.001). The proportion of subjects who were unaware of their personal history of diabetes was similar in the cardiovascular risk groups. The prevalence of low educational level was higher (56, 58, and 62%, p < 0.01) and the level of knowledge of non-pharmacological remedies to cardiovascular risk factors (63, 61, and 59%, p < 0.01) was lower in higher cardiovascular risk score group. Subjects aged < 55 years showed similar lack of knowledge about cardiovascular risk factors and the proportion of heavy smoking was as high as in the group of older participants. CONCLUSIONS: In cardiovascular primary prevention, the projection of higher individuals' risk profile by family doctors was not paralleled by an increase in individual's knowledge of major cardiovascular risk factors and of lifestyle interventions able to reduce the cardiovascular risk.

Cardiovascular Diseases↗

PubMed2004

Cardiovascular secondary prevention: patients' knowledge of cardiovascular risk factors and their attitude to reduce the risk burden, and the practice of family doctors. The "Help Your Heart Stay Young" study.

BACKGROUND: Whether the practice of family doctors of assessing the global cardiovascular risk profile improves the knowledge of cardiovascular risk factors and the attitude to lifestyle change in patients' secondary cardiovascular prevention is unknown. METHODS: We evaluated subjects who visited their family doctors and those with self-reported cardiovascular disease in the urban area of Naples, Italy. Patients self-administered a simple standard questionnaire to evaluate their knowledge of cardiovascular risk factors and of simple lifestyle modifications to reduce the cardiovascular risk burden. For each participant, family doctors, blinded to the information provided by patients, had to provide a global coronary risk based on the risk factors recorded in their electronic database, or report the missing information. RESULTS: The study sample comprised 560 subjects, 61% male, with mean age 60 +/- 9 years. Angina pectoris (49%) and myocardial infarction (40.9%) were the most frequently self-reported cardiovascular diseases in the study sample. The self-reported data revealed that 46% of the sample was overweight and an additional 20% overtly obese. Among those who self-reported arterial hypertension, approximately 11% admitted that they were unaware of their blood pressure, and 26% believed that they were normotensive but reported a recently detected blood pressure > 140/90 mmHg. Approximately 8% were not aware of whether they had high cholesterol levels, and among those who declared having normal cholesterol levels, 9% referred levels > 200 mg/dl. Of the sample, 22% self-reported diabetes, but 7% did not know whether they were diabetic or not. Thirty percent of the sample were smokers and among these, 40% smoked > 20 cigarettes/day. A low level of education was reported in 66% of the study sample. Women were more frequently obese, more often reported high cholesterol levels, had a low level of education and achieved a lower score from the questionnaire on knowledge of cardiovascular risk factors than men. Patients > 55 years more often reported an elevated blood pressure among those who defined themselves as normotensive, and achieved a lower score from the questionnaire on knowledge of cardiovascular risk factors than younger patients. CONCLUSIONS: With regard to secondary cardiovascular prevention, the study population was found to have insufficient knowledge of cardiovascular risk factors and of the correct approach to reduce their global risk despite the fact that the attitude of their family doctors in detecting and recording risk factors was above average.

Adult↗