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Biomedical subjects

D Cannata

Publications and source records attributed to D Cannata.

At least 37 records · Page 2Linked to original sources
PubMed1993

Left ventricular myocardial function in myotonic dystrophy.

Myotonic dystrophy is an autosomal dominant disease affecting many organ systems, including the heart. Abnormalities of the cardiac conduction system are a frequent and well-documented finding in this neuromuscular disease, whereas overt signs of heart failure are rarely reported. However, controversy exists about the prevalence of preclinical left ventricular (LV) dysfunction in patients with myotonic dystrophy who have no symptoms of heart failure. To address this issue, load-independent LV function indexes were compared in patients with myotonic dystrophy and in normal subjects. LV measurements were obtained with M-mode echocardiography in 43 consecutive patients with myotonic dystrophy (mean age 35 +/- 14 years) who had no clinical evidence of heart failure, and in 35 sex- and age-matched controls. A cuff sphygmomanometer was used to determine blood pressure. No difference was found between patients and control subjects in the percentage of LV ejection fraction predicted for end-systolic stress (103 +/- 7 vs 103 +/- 7%; p = 0.97) or in the end-systolic stress/volume index ratio (2.9 +/- 0.5 vs 2.7 +/- 0.4 dyne7/cm3; p = 0.09). Similarly, no significant difference in LV myocardial function was detected between the 19 patients with a mild degree of the neuromuscular disease and in the 24 with a moderate or severe degree of the disease. Finally, LV myocardial function was compared between patients with myotonic dystrophy and atrioventricular or intraventricular conduction disturbances (n = 8) and those without these disturbances (n = 35), but no significant difference in the percentage of LV ejection fraction predicted for end-systolic stress or in the end-systolic stress/volume index ratio could be detected.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Precursors of established hypertension in borderline hypertensives. A two-year follow-up.

We performed exercise testing, 24-h ambulatory blood pressure monitoring and echocardiography in 37 selected patients with borderline hypertension (24 men and 13 women, mean age 39.8 years, range 23-50) in an attempt to detect early cardiovascular changes that could predict future established hypertension. All subjects were clinically reinvestigated after a mean period of 28 +/- 4 months. At entry 24/37 (65%) showed an exaggerated blood pressure response to exercise (systolic pressure > or = 220 mmHg and/or diastolic pressure > or = 105 mmHg) while 13 (35%) had a normal pressure response. Patients with exaggerated pressure response showed significantly higher left ventricular mass index in comparison to those with normal pressure response (98.1 +/- 10.7 vs. 84 +/- 13, respectively; P < 0.05). They also had higher, although not significantly different, average 24-h systolic and diastolic blood pressure levels. At follow up seven subjects (16%) were diagnosed as having established hypertension, while 30 (84%) remained borderline hypertensives. No subject was judged normotensive. All of the seven hypertensive subjects were a proportion (7/24 = 29%) of the group with exaggerated blood pressure response to exercise. Also, they were the eldest of the total group of borderlines (mean age 44 years) and had the highest left ventricular mass index (100.6 +/- 13 g/m2). Borderline hypertensives show a spectrum of cardiovascular changes that could be considered as a part of the hypertensive risk profile. However, there are no specific characteristics that reliably distinguish subjects prone to develop hypertension. Repeated clinical observations and correct measurements of resting blood pressure may have greater relevance in the management of patients with borderline hypertension.

Adult↗
PubMed1993

Assessment of left ventricular hypertrophy in patients with essential hypertension. A rational basis for the electrocardiogram.

There is a large body of evidence that the electrocardiogram (ECG) is insensitive in the recognition of left ventricular hypertrophy (LVH), in comparison with the echocardiogram; however, its specificity is high. In this study we further analyzed the performance of the ECG in detecting LVH in 200 consecutive patients (124 men and 76 women, mean age 50.9 years) with mild to moderate essential hypertension, using echocardiographically determined left ventricular mass (LVM) as the standard for comparison. To test the hypothesis that, owing to the high number of true positive findings, the ECG may still be useful for clinical purposes by selecting subsets of hypertensives with higher degrees of LVH, we compared the mean values of LVM index corresponding to either positive (true positive) or negative (false negative) electrocardiographic signs of LVH. In this study 69 patients (34.5%) had echocardiographic LVH, as defined by a LVM index exceeding 125 g/m2 for men and 112 g/m2 for women. Almost all criteria demonstrated high levels of specificity (> or = 89%). In the whole group the Lewis index ((RI - RIII)+(SIII - SI) > or = 17 mm) showed a slight superiority in diagnosing LVH (sensitivity = 43%) in comparison to the remaining criteria; the confidence intervals estimate of sensitivities confirmed such diagnostic superiority only with respect to those criteria with a sensitivity < or = 17%. However, the use of McNemar's test to compare sensitivities of all electrocardiographic criteria at matched specificities (> or = 95%) did not show significant differences (P < .05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

The spectrum of echocardiographic and electrocardiographic abnormalities in nonaffected relatives of patients with hypertrophic cardiomyopathy: a transverse and longitudinal study.

We studied 122 relatives (18 parents, 33 siblings, 57 offspring, 10 nephews and 4 nieces; mean age 34 +/- 19 years) of 33 patients with hypertrophic cardiomyopathy (HC) to analyze the incidence and clinical significance of electrocardiographic and echocardiographic abnormalities. On the basis of conventional echocardiographic criteria 12 first-degree relatives were considered to be affected by HC. Thirteen first-degree relatives and 1 niece were judged as having probable but not definite HC, i.e. left ventricular (LV) wall thicknesses over the 95% upper limit of confidence interval for age and body surface area or borderline ventricular septal thickness but a septal-to-free wall thickness ratio > or = 1.3 in the absence of an identifiable origin. Ninety relatives had normal echocardiographic findings. The remaining 6 subjects were found to have essential hypertension and were therefore excluded from consideration. Electrocardiogram (ECG) showed major or minor abnormalities in all relatives with HC, in 7 of the 14 probably affected by HC and in 20 of the 90 with normal echocardiogram. Of the 122 relatives 44 (38 with normal echocardiogram and 6 probably affected by HC) were reexamined over a mean period of 4.3 years (range 2-7). In the course of the follow-up 3 subjects modified their cardiac status. Two offspring who had at entry LV hypertrophy at ECG as isolated cardiac abnormality developed HC over a period of 5 years. A sibling who had only minor electrocardiographic abnormalities in the first study became probably affected by HC 3 years later.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

[An algorithm for the analysis of the circadian profile of the arterial pressure in normotensive subjects].

In this paper we proposed the use of a spectral analysis technique, the fast Fourier transform (FFT), for the evaluation of the normal circadian blood pressure rhythm. By means of this algorithm it is possible to separate the slower and reproducible variations of the blood pressure profile (probably due to endogenous rhythm) from the faster and random ones (due to psychophysical status of the subject). The FFT technique is used for the analysis of ambulatory blood pressure monitorings obtained in 66 normotensive subjects (38 males and 28 females, mean age 35 +/- 10 years). Taking into account the mean duration of pressure variations related to major daily activities (e.g. sleeping, eating, etc) it is proposed to consider the first 10 harmonics as those having the main influence on the circadian blood pressure rhythm. The amplitude of the first 10 harmonics of the whole sample was evaluated by using the chi 2 and the Kolmogorov tests, and the results confirmed the assumption of a normal distribution of the amplitudes. The 95% confidence interval of these harmonics was chosen as the criteria for defining a normal range for the circadian blood pressure rhythm. This approach was tested in a group of 4 hypertensive patients showing that alteration of the circadian blood pressure rhythm can be easily diagnosed.

Adolescent↗
PubMed1992

Treatment of advanced pancreatic carcinoma with the somatostatin analogue BIM 23014. Preliminary results of a pilot study.

Treatment of advanced pancreatic cancer has not improved substantially in recent years. The search for new agents or new therapeutic modalities may be critical for further development in the therapy of this disease. Experimental and clinical findings suggest that it might be possible to develop a new hormonal therapy for exocrine cancer of the pancreas based on new somatostatin analogues. Preliminary results indicate clinical activity and increased survival in some patients. In this study, 19 patients with advanced exocrine pancreatic carcinoma were given the somatostatin analogue BIM 23014 using a range of doses from 250 micrograms/day to 1 mg/day. One patient had a partial response, 6 patients had stable disease, and 11 had progressive disease. Six patients showed a sharp improvement in pain and performance status. Side effects were mild. Plasma levels of growth hormone were evaluated in ten patients and remained unchanged. The clinical activity observed, even if limited, warrants further investigation using more appropriate schedules and administration techniques.

Antineoplastic Agents↗
PubMed1992

Limitations of the electrocardiographic diagnosis of left ventricular hypertrophy: the influence of left anterior hemiblock and right bundle branch block.

We analysed the performance of the electrocardiogram in diagnosing left ventricular hypertrophy in 70 patients with isolated left anterior hemiblock and in 75 patients with right bundle branch block, either isolated (44 cases) or associated (31 cases) with left anterior hemiblock. Left ventricular hypertrophy defined as an echocardiographically determined left ventricular mass greater than 261 g in men and 172 g in women or left ventricular mass index greater than 125 g/m2 in men and 112 g/m2 in women was present in 48 subjects (57%) with isolated left anterior hemiblock and 33 subjects (44%) with right bundle branch block. In patients with isolated left anterior hemiblock the best results were obtained using the SV1 or SV2 + (RV6 + SV6) greater than 25 mm with 74% in sensitivity and 67% in specificity; the criterion SIII + (R + S) maximal in a precordial lead greater than or equal to 30 mm showed a sensitivity of 74% but a specificity of 47%. In the whole group of patients with right bundle branch block none of the criteria nor combination of criteria achieved an acceptable performance (sensitivities ranged from 17% to 41% and specificities ranged from 54% to 85%). When these patients were divided according to the presence or absence of concomitant left anterior hemiblock the electrocardiographic indexes mostly showed, in comparison to whole group, higher values in sensitivity and lower values in specificity in right bundle branch block plus left anterior hemiblock and an opposite behaviour in isolated right bundle branch block.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

The natural course of cardiac conduction disturbances in myotonic dystrophy.

In this study we noninvasively followed for a mean period of 46 months 21 patients with different grades of myotonic dystrophy to evaluate the course of the involvement of the cardiac conducting system. Six patients (28.6%), 1 affected by a mild and 5 by a severe form of the neuromuscular disorder, showed appearance or deterioration of conduction disturbances suggesting a serious derangement of the specialized tissue; in 3 of them a permanent demand pacemaker was implanted. Conduction defects are the most frequent cardiac manifestations in myotonic dystrophy and become worse with time, mainly in patients with higher degrees of the disease. Furthermore, first-degree atrioventricular block may represent an early sign of developing of more advanced conduction defects.

Adolescent↗
PubMed1990

Electrocardiographic diagnosis of left ventricular hypertrophy in the presence of left bundle branch block: a wasted effort.

We assessed the reliability of multiple electrocardiographic variables for detecting left ventricular hypertrophy in 100 patients (aged 23 to 92 years, mean age 39 +/- 14) with complete left bundle branch block and different underlying cardiac diseases. Left ventricular hypertrophy, defined as an echocardiographically evaluated left ventricular mass greater than 241 g, was present in 66 of the 100 patients. The electrocardiographic parameters with the highest sensitivity were both the Cornell voltage criteria (RaVL + SV3 greater than 28 mm in men and greater than 20 mm in women) and the combination of criteria proposed by Kafka (any of these four indexes: RaVL greater than or equal to 11 mm, QRS axis -40 degrees or less, SV1 + RV5 or RV6 greater than or equal to 40 mm, SV2 greater than or equal to 30 mm and SV3 greater than or equal to 25 mm), with a sensitivity of 77%. Both criteria had a very low specificity (32 and 35%, respectively). The high specificities (greater than or equal to 88%) of several electrocardiographic criteria were accompanied by ineffective low sensitivities (less than 35%). Moreover, the cumulative parameters of Kafka and Cornell voltage criteria achieved a sensitivity of 84 and 89%, respectively, in hypertensive patients and in those with valvar diseases. None of the electrocardiographic indexes tested showed a significant difference in sensitivity when applied in categories of patients with left ventricular hypertrophy and different left ventricular geometry (cavity dilation or concentric hypertrophy). These data indicate that both conventional and recently proposed electrocardiographic criteria for left ventricular hypertrophy in the presence of left bundle branch block poorly recognize an augmented left ventricular mass.

Adult↗
PubMed1989

Cardiovascular effects of lisuride continuous intravenous infusion in fluctuating Parkinson's disease.

The cardiovascular effects of a continuous intravenous infusion of lisuride plus oral domperidone were studied in 16 fluctuating parkinsonian patients as compared to their usual oral therapy with levodopa plus carbidopa. The study was performed using a 24-h ambulatory recording and an automatic noninvasive device for blood pressure monitoring. During lisuride infusion, a significant increase of systolic blood pressure was observed; however, in three patients, a decrease of systolic-diastolic blood pressure occurred; furthermore, a mild increase of atrial arrhythmias and, in two patients, a short run of atrial fibrillation were noted. Asymptomatic orthostatic hypotension, observed in seven patients during levodopa therapy, disappeared during lisuride infusion. Paradoxical hypertensive effects and disappearance of orthostatic hypotension observed in our patients seem related to the concurrent administration of domperidone.

Adult↗
PubMed1989

Autoantibodies in myotonic dystrophy.

We evaluated some immunological parameters in a group of 24 patients affected with myotonic dystrophy (MD). IgG, IgA, IgM immunoglobulin serum levels resulted decreased in most of the patients. Anti-smooth-muscle antibodies have been found in 10 out of 24 patients (45.5%). Moreover in some of them decreased C3 and C4 complement fraction serum levels have been found. Our data confirm the existence of some immunological abnormalities in a great number of subjects affected with the disease. Besides, these data evidence for most of the subjects the presence of autoantibodies non-organ-specific direct against myocellular antigens. These autoantibodies could be considered the expression of suffering of muscular fibres.

Adolescent↗
PubMed1988

Antimitochondrial autoantibodies in myocardial hypertrophy: comparison between hypertrophic cardiomyopathy, hypertensive heart disease, and athlete's heart.

Antimitochondrial autoantibodies (AMA) were tested by indirect immunofluorescence in three groups of subjects with different types of myocardial hypertrophy: 35 patients affected with hypertrophic cardiomyopathy (HC), 20 patients with cardiac hypertrophy secondary to essential hypertension, and 35 active endurance athletes with exercise-induced left ventricular hypertrophy. Forty-two healthy subjects served as a control group. Left ventricular hypertrophy was considered a left ventricular mass (LVM) echocardiographically calculated (Devereux formula), exceeding 244 gm or a LVM index exceeding 122 gm/m2 (greater than 2 SD from a previously studied normal population). AMA were found in 15 of 35 (43%) patients with HC and in 6 of 20 (30%) patients with hypertensive heart disease (p less than 0.01); in contrast, AMA were not present in the sera of athletes or in the sera of controls. Although the significance of AMA in subjects with pathologic myocardial hypertrophy has not yet been established, their absence in the sera of athletes strengthens the opinion that cellular changes, as a compensatory response of the myocardium to a work overload, have a physiologic fashion in these cases. Moreover, identification of AMA in the sera of athletes with disproportionate severe left ventricular hypertrophy of uncertain origin may be helpful to ensure a single diagnosis.

Adolescent↗
PubMed1988

Equivocal and borderline myocardial hypertrophy in relatives of patients with hypertrophic cardiomyopathy: possible implications in genetics of the disease.

To determine the occurrence of familial and sporadic forms of hypertrophic cardiomyopathy (HC) 74 first-degree relatives of 21 patients with proven HC were studied by M-mode and two-dimensional echocardiography. A diagnosis of HC was made in 11 relatives (15%) while it was excluded in 61 of them (82%); 2 subjects (3%) were considered neither affected nor unaffected (borderline left ventricular hypertrophy suggestive of HC). Inspection of pedigrees revealed 38% of familial forms of HC with an autosomal dominant pattern of inheritance in 5/8 families (62%). Furthermore, among those relatives judged unaffected by means of full echocardiographic criteria for HC, an attempt was made to find out whether minor changes of left ventricular geometry were present for their possible implications in genetics of HC (latent or potential forms, low phenotypic expression of the disease). Eleven out of 61 unaffected relatives had a left ventricular wall thickness radius ratio greater than 0.50 (equivocal hypertrophy), a value that was higher than two standard deviations of the control group. Assessment of clinical significance of borderline and equivocal hypertrophy in relatives of patients with HC is required for a better understanding of genetic transmission of this disease. In this view the occurrence of sporadic and familial forms of HC might be revisited.

Adolescent↗
PubMed1988

Effects of left bundle branch block on left ventricular function in apparently normal subjects. Study by equilibrium radionuclide angiocardiography at rest.

To determine the independent effects of left bundle branch block (LBBB) on global and regional left ventricular (LV) function we performed equilibrium radionuclide angiocardiography at rest in 3 patients with chronic LBBB (group I, mean age 53.6 years and in 6 patients with intermittent LBBB (group II, mean age 41.5 years). All patients were judged to have an apparently normal heart. In 2 of 3 patients of group I a LV ejection fraction lower than 50% was observed, and in all 3 patients septal motion abnormalities were present. In all patients of group II the global LV ejection fraction was normal during normal conduction and decreased during LBBB; the inferoapical regional ejection fraction decreased in 5 of 6 cases and the posterolateral regional ejection fraction in 3 of 6 cases. Moreover, septal hypokinesis was observed both during normal and abnormal conduction in all group II patients. These findings seem to confirm that LBBB, chronic or intermittent, is able to deteriorate LV performance at rest, even in patients with an otherwise normal heart.

Adult↗
PubMed1988

Clinical relevance of the electrocardiogram in relatives of patients with hypertrophic cardiomyopathy.

Eighty-nine first-degree relatives of 22 patients with an established diagnosis of hypertrophic cardiomyopathy underwent electrocardiographic and echocardiographic screening. Scalar electrocardiogram was abnormal in 30/89 (33.7%) relatives. Of these thirty, eleven had definite evidence of hypertrophic cardiomyopathy at echo; one had borderline hypertrophy and was considered neither affected nor unaffected; four had questionable signs of hypertrophy. The remaining 14 relatives had normal echo-cardiograms. Fifty-nine relatives (66.3%) had normal electrocardiograms; at echo 3 were considered to have borderline hypertrophy, 16 had questionable signs of hypertrophy and 40 were normal. In relatives of patients with hypertrophic cardiomyopathy an abnormal electrocardiogram may reflect different morphologic conditions: a real hypertrophic cardiomyopathy or a myocardial hypertrophy of uncertain significance. Furthermore, in these categories of subjects, an abnormal electrocardiogram with normal echo must be considered with caution.

Adult↗