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Biomedical subjects

E A Bocchi

Publications and source records attributed to E A Bocchi.

At least 55 records · Page 3Linked to original sources
PubMed1996

[Acute effects of ibopamine on left ventricular mechanics and contractility in patients with idiopathic dilated cardiomyopathy].

PURPOSE: The effects of ibopamine (IBO) on left ventricular (LV) mechanics and contractility have not been described. The aim of this study was to test the hypothesis that IBO has a contractile effect at a dose of 200 mg. METHODS: Ten male patients (43 +/- 7 years) with refractory heart failure due to idiopathic dilated cardiomyopathy were studied. The patients were submitted to simultaneous echo-Doppler and hemodynamic (microtip catheter) studies, before (B) and after (20, 40 and 60 minutes) a dose of 200 mg of IBO. LV pressure/diameter and stress/strain relations were obtained. Subsequently, heart rate (HR-bpm), cardiac output (CO-L/m), end-diastolic pressure (EDP-mmHg); fractional shortening (FS-%); maximal elastance (Emax-mmHg/cm/s); end systolic (ESS-g/cm2) and end-diastolic (EDS-g/cm2) stress; chamber (Kp-mmHg/cm) and muscle (K(m)-g/cm2) stiffness, and the time of constant relaxation (Tau-ms) were analyzed. RESULTS: Results were presented as mean +/- standard deviation for conditions before and after IBO (20, 40 and 60 minutes) respectively. There was no change in HR (99 +/- 7; 100 +/- 7; 99 +/- 8; 99 +/- 10). Significant increases were observed in CO (4.13 +/- 1.28; 4.95 +/- 1.38; 5.13 +/- 1.86; 5.18 +/- 1.57), FS (13.7 +/- 2.4; 15.4 +/- 2.8; 15.9 +/- 1.8; 16.1 +/- 2.0), and Emax (14.8 +/- 3.2; 16 +/- 3.6; 17.7 +/- 4.2; 17.6 +/- 4.2). A transient (20 minutes) increase followed by a decrease (40 and 60 minutes) occurred in EDP (26.3 +/- 4.2; 30.6 +/- 6.4; 24.6 +/- 5.6; 22.3 +/- 4.6), EDS (79.7 +/- 22.8; 91.7 +/- 29.6; 79 +/- 31; 63 +/- 17.3), and Kp (27.2 +/- 12.6; 60 +/- 26.7; 27.9 +/- 11.7; 28.1 +/- 11). CONCLUSION: IBO has a beneficial effect on LV systolic and diastolic function as well as on contractility in patients with heart failure due to idiopathic dilated cardiomyopathy.

Adult↗
PubMed1995

Peak oxygen consumption and resting left ventricular ejection fraction changes after cardiomyoplasty at 6-month follow-up.

BACKGROUND: The effects of cardiomyoplasty on cardiopulmonary exercise test characteristics are not fully known. METHODS AND RESULTS: We determined in 19 patients who underwent cardiomyoplasty for treatment of refractory heart failure (New York Heart Association [NYHA] functional class III) before (pre) and at 6-month follow-up (post) maximum oxygen consumption (peak VO2), NYHA functional class, and resting left ventricular ejection fraction (LVEF) (MUGA). We analyzed the results according to pre peak VO2 < or > 14 mL/kg per minute and the correlation between the changes in absolute values of LVEF and peak VO2. Pre- and post-peak VO2 values were 15.9 +/- 4.4 and 18.6 +/- 6.4 mL/kg per minute, respectively (P = .059). In the subgroup with pre-peak VO2 < 14 mL/kg per minute, the peak VO2 increased from 11.1 +/- 1.9 to 16.4 +/- 6.2 mL/kg per minute (P = .02). The subgroup with peak VO2 > 14 mL/kg per minute showed pre- and post-peak VO2 of 19.2 +/- 2.6 and of 20.1 +/- 7 mL/kg per minute, respectively (P = .06). The pre-total exercise time of the entire group increased from 688.4 +/- 222.1 to 833.7 +/- 241.6 seconds (P < .04). For the subgroup with preoperative peak VO2 < 14 mL/kg per minute, exercise time improved from 585 +/- 76.9 to 825 +/- 186.3 seconds (P < .01). In the subgroup with preoperative VO2 > 14 mL/kg per minute, the preexercise and postexercise time was 763.6 +/- 264.4 and 840 +/- 282 seconds, respectively (P = .4). Pre-LVEF increased from 20.6 +/- 3.3% to 24.2 +/- 7.8% at 6 months of follow-up (P = .02). At 6 months of follow-up, 9 patients were in NYHA functional class I and 10 were in class II. There was no correlation between LVEF values and absolute values of peak VO2 before (r = .123, P = .6) and after (r = .27, P = .2) cardiomyoplasty. A weak correlation was observed between the changes in absolute values of peak VO2 and LVEF from the preoperative to the postoperative period (r = .48, P = .048). CONCLUSIONS: Cardiomyoplasty is a useful method for improving NYHA functional class and LVEF in patients with heart failure. Peak VO2 < 14 mL/kg per minute before cardiomyoplasty may be a selection criterion with which to determine improved exercise capacity after surgery. The effects of cardiomyoplasty on LVEF appear to be partially associated with maximum exercise capacity changes.

Adult↗
PubMed1995

Clinical and left ventricular function outcomes up to five years after dynamic cardiomyoplasty.

Improvement in congestive heart failure and left ventricular function after dynamic cardiomyoplasty has been reported in patients with severe cardiomyopathies, but the long-term effects of this procedure remain unclear. In this investigation 31 patients undergoing cardiomyoplasty for treatment of idiopathic dilated cardiomyopathy were annually investigated with radionuclide scintigraphy, Doppler echocardiography, and right-sided heart catheterization. They were in New York Heart Association functional class III or IV before the operation. No hospital deaths occurred, but one patient with progressive heart failure required urgent heart transplantation 42 days after cardiomyoplasty. The other patients were followed up from 6 to 70 months (mean 25.6 months) and 12 patients died at late follow-up. Actuarial survivals were 86% at 1 year, 61.4% at 2 years, and 42.5% at 3 to 5 years of follow-up. Multivariate analysis of factors influencing outcome showed that long-term survival was significantly affected by preoperative functional class and pulmonary vascular resistance. Functional class improved from 3.2 +/- 0.4 to 1.7 +/- 0.7 in the surviving patients (p < 0.01). Furthermore, left ventricular ejection fraction improved from 19.8% +/- 3% to 23.9% +/- 7.2% (p < 0.01), and significant changes in stroke index, arterial pressure, pulmonary wedge pressure, and left ventricular stroke work index were also found at 6 months of follow-up. In the late postoperative period, the left ventricular ejection fraction tended to decrease and returned to preoperative levels at 5 years, whereas hemodynamic variables did not change significantly. Thus, despite the tendency of the left ventricular ejection fraction to decrease at late follow-up, the long-term course of these patients seems to be characterized by the maintenance of hemodynamic improvement. However, long-term survival after cardiomyoplasty is limited by the severity of the patient's condition before the operation.

Actuarial Analysis↗
PubMed1995

Present trends in clinical experience with dynamic cardiomyoplasty.

Dynamic cardiomyoplasty has been performed to reinforce the myocardium in the treatment of patients with severe cardiomyopathies. At the Heart Institute of São Paulo University Medical School, 36 patients were submitted to cardiomyoplasty between May 1988 and December 1993. The indications were idiopathic dilated cardiomyopathy in 31, ischemic cardiomyopathy in 3, and Chagas' disease cardiomyopathy in 2 patients. Twenty-eight patients were categorized in New York Heart Association (NYHA) Class III and 8 in Class IV despite the use of maximal medical therapy. There were no hospital deaths, and patients were followed up from 2 to 70 months (mean, 24 months). Besides the improvement of NYHA functional class from 3.2 +/- 0.6 to 1.6 +/- 0.9 at 6 months of follow-up, patients also presented significant changes in the left ventricular systolic and diastolic functions. Nevertheless, 16 patients died, and 2 patients were submitted to heart transplantation during late follow-up. Actuarial survival rates were 82.3% at 1 year, 61.5% at 2 years, and 38.8% at 5 years of follow-up. Otherwise, the analysis of factors influencing the outcome showed that long-term survival was significantly affected by preoperative functional class and by pulmonary vascular resistance. The 26 patients operated in NYHA functional Class III and with pulmonary vascular resistance below 4 Wood units presented survival rates of 72.7% at 2 years and of 63% at 5 years of follow-up. In conclusion dynamic cardiomyoplasty improves functional class and left ventricular function in patients with severe cardiomyopathies. However, the long-term survival after this surgical procedure may be limited by the patients' condition before the operation.

Adolescent↗
PubMed1995

[Infections in 100 heart transplantation patients].

PURPOSE: A prospective study of infective agents in diagnosed infections and deaths by specific agents in cardiac transplant patients. METHODS: Infections occurring in a series of 100 consecutive cardiac transplant patients after transplantation with definite infectious diagnosis were studied; follow-up after transplantation was 3 to 90 (medium 25.38 +/- 25.97) months. Diagnostic criteria for defining infections were those used in the Epidemiology and Quality Control Division of the INCOR, that are the same published by the Centers for Disease Control. The following parameters were analysed: infections/patient/time, causes of infection and organs infected, clinical presentation and clinical aspects of infections, methods used for the infective diagnosis and relationship between rejection episodes and infection. Death caused by infections and survival rates per infection were also studied. RESULTS: Bacterial infections were more frequent (56.3% of all infections), followed by viral infections (19.6%), fungal infections (18%) and protozoal infections (6.1%). Of all deaths after transplantation, 25% were caused by infections. CONCLUSION: Infections are an important cause of mortality and morbidity in this patient population; our data are in accordance to the other reported series.

Actuarial Analysis↗
PubMed1995

[Magnetic resonance imaging in chronic Chagas cardiopathy. Correlation with endomyocardial biopsy findings].

PURPOSE: To study the correlation between magnetic resonance imaging of the heart and right ventricle endomyocardial biopsy results in chronic Chagas' heart disease. METHODS: Ten patients with Chagas' disease, mean age 47 +/- 7 years, all males, in congestive heart failure with New York Heart Association class II (2 patients), III (6) and IV (2) were studied. Mean left ventricular ejection fraction was at echocardiogram 36 +/- 6%. The patients were submitted to right ventricular endomyocardial biopsy and magnetic resonance imaging of the heart. The results of this group were compared with a control group of patients with idiopathic dilated cardiomyopathy, with mean age of 46 +/- 10 years and left ventricular ejection fraction of 30 +/- 4%, in heart failure with functional class II (1 patient), III (5) and IV (1). RESULTS: All patients with Chagas' heart disease presented an increase in magnetic ressonance imaging signal of the heart after gadolinium use. The septal signal intensity changed from 0.87 +/- 0.06 to 1.54 +/- 0.16 (p < 0.001). In the control group the mean septal signal intensity was 0.93 +/- 0.07 before and 0.89 +/- 0.06 after the gadolinium (p = ns). Eight patients of the Chagas' disease group had biopsy proven myocarditis and two had borderline myocarditis. However, only one patient of the control group had diagnosis of borderline myocarditis. CONCLUSION: Myocarditis is frequently found in Chagas' heart disease patients and who unlike controls present a significant increase in myocardial signal intensity after gadolinium infusion. The magnetic resonance imaging of the heart seems a promising alternative method for the diagnosis of an inflammatory process in Chagas' heart disease.

Adult↗
PubMed1994

Unsuspected rheumatic fever carditis ending in heart transplantation.

A 25-year-old female patient with presumed peripartum cardiomyopathy was submitted after two years to orthotopic heart transplantation. Pathological examination of the excised heart revealed acute rheumatic fever. Five days after the transplantation persistent fever developed. The patient's condition deteriorated until death after six weeks, which was attributed to cytomegalovirus disease.

Adult↗
PubMed1994

Arrhythmias and sudden death after dynamic cardiomyoplasty.

BACKGROUND: The main causes of death in patients with severe cardiomyopathy are progressive heart failure and sudden death. The influence of cardiomyoplasty on the incidence of sudden death and arrhythmias in patients with cardiomyopathy remains unclear. The aim of this study was to investigate the occurrence of arrhythmias and sudden death after cardiomyoplasty. METHODS AND RESULTS: We studied 32 patients (26 male, 6 female; mean age, 48 +/- 12 years) who submitted to cardiomyoplasty for treatment of heart failure in New York Heart Association (NYHA) class III (n = 24) or class IV (n = 8). The etiology was idiopathic dilated cardiomyopathy in 27 patients, ischemic heart disease in 3 patients, and Chagas' heart disease in 2 patients. Patients were routinely studied before and every 6 months after cardiomyoplasty by means of radioisotopic angiography and 24-hour Holter monitor recordings. There were no operative or immediate postoperative deaths. During the postoperative period, 5 patients presented with acute atrial fibrillation and 1 had an episode of sustained ventricular tachycardia. All episodes were successfully treated with intravenous antiarrhythmic drugs or cardioversion. During follow-up (from 2 to 66 months), 15 patients died from sudden death (n = 5) or progressive heart failure (n = 10). Survival rates at 1, 2, and 4 years were 79.9 +/- 7%, 62.5 +/- 9.7% and 35 +/- 12.1%, respectively. At 6-month follow-up, NYHA functional class improved from 3.2 +/- 0.4 to 1.7 +/- 0.6 (P = .001) and left ventricular ejection fraction increased from 19.8 +/- 3.3% to 24 +/- 8.2% (P = .004). The mean values per day of premature ventricular complexes (PVCs) and episodes of nonsustained ventricular tachycardia (NSVT) did not change statistically. The mean number of PVCs per 24 hours before and at 6, 12, 24, 36, and 48 months after surgery were 126 +/- 44, 96 +/- 33, 90 +/- 29, 81 +/- 35, 71 +/- 35, and 59 +/- 48. The mean number of episodes of NSVT per 24 hours before and at 6, 12, 24, 36, and 48 months after surgery were 3.3 +/- 1.3, 1.9 +/- 0.5, 1.3 +/- 0.5, 1 +/- 0.5, 1.5 +/- 1.1, and 0.6 +/- 0.5, respectively. With respect to analysis of the idiopathic dilated cardiomyopathy subgroup, there also were no significant differences in the incidences of pre- and postoperative arrhythmias. CONCLUSIONS: Despite NYHA functional class and left ventricular function improvements observed after cardiomyoplasty, the incidence of arrhythmias did not change, and sudden death was an important finding mainly in late follow-up. The problem of sudden death after cardiomyoplasty, the mechanism that produces it, and the means to prevent it remain critical areas for future research.

Arrhythmias, Cardiac↗
PubMed1994

[Percutaneous transluminal coronary angioplasty after orthotopic heart transplantation].

We report the case of 22 year-old male who developed coronary artery disease two years after orthotopic cardiac transplantation, manifested as congestive heart failure NYHA functional class III. The left ventricular radioisotopic evaluation at rest revealed worsening of left ventricular ejection fraction from 50% to 39% (normal value > or = 55%) and septal hypokinesia. The hemodynamic and coronariographic study showed two subocclusive lesions at the mid portion and distal portion of the left descending coronary artery and the patient underwent PTCA of both lesions, successfully reducing them to 30%. A new radionuclide and echocardiographic evaluation of left ventricular function at rest, showed marked improvement of global function no regional abnormalities, increasing the ejection fraction from 39% to 45%. The patient showed improvement of NYHA functional class, passing to functional class II and was discharged home. We conclude that PTCA could be performed in a successful manner in this patient.

Adult↗
PubMed1994

[Dynamics of patient selection for heart transplantation or cardiomyoplasty].

PURPOSE: To evaluate patient selection for heart transplantation or dynamic cardiomyoplasty. METHODS: We evaluated 380 patients from April 1991 to July 1993. The ages ranged between 16 and 68 (mean 43.5 +/- 11.46) years, 303 (79.7%) were male. The diagnoses were dilated cardiomyopathy in 163 (42.9%), Chagas' cardiomyopathy in 70 (18.4%), ischemic heart disease in 61 (16.1%), hypertensive heart disease in 40 (10.5%), valvular heart disease in 23 (6.1%), alcoholic cardiomyopathy in 12(3.2%), peripartum cardiomyopathy in 5 (1.3%) and myocarditis of unknown etiology in 5 (1.3%). RESULTS: The indication of heart transplantation was eventually done in 55 (14.4%), and 19 (5%) were submitted to transplantation. Dynamic cardiomyoplasty was indicated in 9 (2.3%) patients and was performed in 8 (2.1%). In 30 (7.8%) patients there were clinical contraindications for transplantation. Conventional surgical treatment was indicated for 12 (3.1%) patients: myocardial revascularization and/or ventricular aneurismectomy in 5, surgical treatment of valvular heart disease in 6 and of atrial fibrillation in 1. Socioeconomic limitations precluded transplantation in 43 (11.3%) and psychic limitations hindered transplantation in 23 (6.0%) patients. Refusal of procedure by the patient occurred in 10 (2.6%) cases. Improvement of the symptoms occurred in 69 (18.1%) patients. CONCLUSION: A small percentage of patients are eligible and are eventually submitted to heart transplantation or dynamic cardiomyoplasty. New strategies may be delineated during follow up, as deferring transplantation or conventional surgical treatment of ischemic or valvular heart disease. Sociopsychic evaluation is an important step in the care of the patients.

Adolescent↗
PubMed1994

[Hemodynamic and neurohormonal profile during assisted circulation with heterotopic artificial ventricle followed by heart transplantation].

We describe the hemodynamic and neurohormonal data during ventricular assistance device system support as a bridge to heart transplantation of one patient, 30 years old, with heart failure due to Chagas' heart disease in functional class IV. We determined the pressures in mmHg of right atrium (RA), pulmonary artery pressure (PAP), pulmonary wedge pressure (WEDGE), arterial blood pressure (AP), and the cardiac output (CO) in l/min. In addition, the blood levels of norepinephrine (Ne), renin (Re), epinephrine (Ep), lactate and the mixed venous oxygen pressure (pVO2) were determined. The CO increased from 2.14 to 3.9-4.2 l/min, the AD decreased from 26mmHg to 8mmHg, the MPAP reduced from 38mmHg to 14-24mmHg, the WEDGE reduced from 25 to 4mmHg and the AP become normal. The Ne reduced from 1927pg/ml to 983pg/ml, the lactate reduced from 99mg/dl to 22mg/dl and the pVO2 increased from 28mmHg to 43mmHg. The EP remained between 81pg/ml and 129pg/ml, the renin activity remained between 113ng/ml/hr and 136ng/ml/hr. Thus, during the ventricular assistance device system support there was a improvement in hemodynamic and neurohormonal conditions. The patient underwent successful heart transplantation.

Adult↗
PubMed1993

Current expectations in dynamic cardiomyoplasty.

Dynamic cardiomyoplasty has been evaluated in the treatment of severe cardiomyopathies. This report outlines the results of this procedure in 21 patients with dilated or ischemic cardiomyopathy who were in New York Heart Association class III or IV before operation. There were no operative deaths. Patients were followed up for a mean of 17.6 months. Eight patients died during late follow-up, and actuarial survival rates were 73.2% at 1 year and 65.9% at 2 years of follow-up. Functional class improvement was documented in the surviving patients. Furthermore, significant improvement in left ventricular function was demonstrated by radioisotopic angiography and by heart catheterization for more than 2 years after the operation. These studies documented that left ventricular ejection fraction increased as a result of global improvement in regional wall motion. Absence of clinical and hemodynamic improvement after cardiomyoplasty seems to be related to muscle flap ischemic compromise, whereas the patient's condition before operation seems to influence the long-term outcome of cardiomyoplasty.

Adolescent↗
PubMed1992

Effects of dynamic cardiomyoplasty on regional wall motion, ejection fraction, and geometry of left ventricle.

BACKGROUND: Dynamic cardiomyoplasty may provide functional and hemodynamic improvement in patients with heart failure. The purpose of this study was to investigate the effects of cardiomyoplasty on global ejection fraction, regional wall motion, and geometry of the left ventricle. METHODS AND RESULTS: These parameters were determined in 10 patients submitted to cardiomyoplasty for treatment of refractory heart failure by left ventricular (LV) angiography. The studies were performed before and 16.5 +/- 4.8 months after cardiomyoplasty with the myostimulator turned on. They were repeated 24 +/- 1 hours with the myostimulator turned off in eight patients. LV ejection fractions were determined by the area-length method, and the centerline method was used for assessment of regional wall motion. LV geometry was studied by LV major-to-minor axis ratio and sphericity index. A LV ejection fraction improvement from 15 +/- 8% to 30.9 +/- 8.3% (p < 0.01) was demonstrated with the myostimulator turned on after cardiomyoplasty. The values with the myostimulator turned off were 23 +/- 13%, remaining higher than the values observed before surgery (p < 0.05). Regional wall motion analysis showed an improvement in all studied regions. Regarding the LV shape, the left ventricle became markedly more spheric in the diastole. CONCLUSIONS: Dynamic cardiomyoplasty may improve LV function in selected patients. The analysis of LV wall motion corroborated these results, and these changes were associated with modifications in the LV geometry.

Assisted Circulation↗