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Biomedical subjects

E Astorri

Publications and source records attributed to E Astorri.

At least 19 recordsLinked to original sources
PubMed1994

[The effect of age on early and late mortality after an acute myocardial infarct].

The purpose of this study is to define the importance of age as predictor of early and late mortality following acute myocardial infarction (AMI). At the same time, effects coming from the use of various therapeutic approaches are considered. We have studied 341 patients, 188 aged < 70 years and 153 > or = 70 years, consecutively admitted to the coronary care unit with diagnosis of AMI. Our findings show that age > or = 70 years, female gender, cardiogenic shock, ventricular fibrillation and early post-infarction angina are significantly connected to higher intra-hospital mortality. As for predictors of 1-year mortality, they turned out to be the age > or = 70 years, indirect signs of more extensive infarction as previous necrosis, acute heart failure, cardiogenic shock, new bundle branch blocks and pre-discharging lower ventricular ejection fraction. In patients aged > or = 70 years, especially in ultra eighty-year old men, thrombolysis, heparin, beta-blockers and aspirin are significantly less employed. All drugs used in the early hours of AMI turned out to be bound to beneficial effects with reduced mortality, except diuretics and antiarrhythmics. The only drugs correlated with an improved 1 year survival are betablockers, aspirin and thrombolysis. On the contrary, the use of diuretics and digoxin is limited to patients with a greater clinical dysfunction. These drugs are associated to a higher late mortality. The present study confirms the finding that elderly patients with AMI who are submitted to less aggressive therapeutic approaches and are more frequently represented by women, have a higher mortality.

Age Factors↗
PubMed1994

[Female gender and acute myocardial infarction: what role does it play in the early and late prognosis].

The primary purpose of this study is to examine the influence of the female gender on the early and 1-year post-discharge prognosis after acute myocardial infarction (AMI). Moreover, the therapeutic approaches are compared between the two sexes during the early phase of AMI. We performed a retrospective cohort study of 341 patients, 219 men and 122 women, consecutively admitted to the coronary care unit with AMI. Among the baseline characteristics, the age greater than 70 years, the systemic hypertension and the diabetes mellitus are more represented in women; on the contrary cigarette smoking is prevalent in the male gender. The analysis of laboratory and clinical parameters does not show any statistic differences between the two sexes, except the ejection fraction and the coronary reperfusion. The first turns out to be lower in the females and the second one is more often observed in the males. As for the intra-hospital complications, the cardiogenic shock is prevalent in the female gender, the early mortality gets to 26% in women and 11% in men (p < 0.01). The late mortality during the follow-up does not present any difference between the two sexes. From our data, we conclude that transmural AMI, cardiogenic shock, ventricular fibrillation and 2-3 degree atrio-ventricular blocks are significantly bound to a higher early mortality in women. In them the atrial fibrillation is the only predictor of 1-year mortality. Finally, thrombolysis, beta-blockers and significantly aspirin and heparin (p < 0.05), are less used in the female patients, while diuretics and digoxin are more employed.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

[Radioisotope angiography in the differential diagnosis between aneurysm and pseudoaneurysm of left ventricle. Report of a case].

We describe the case of a patient with large posteroinferior left ventricular aneurysm following myocardial infarction. Contrast ventriculography, Doppler echocardiography, as well as radionuclide angiography indicated a small orifice that was in communication with the ventricular cavity. These data suggested the presence of left ventricular pseudoaneurysm. Thus a short-term surgical intervention was performed, but the diagnosis was not confirmed by surgical observation; indeed the presence of a true aneurysm was demonstrated. Our study confirms the diagnostic difficulties by invasive and non invasive techniques in the precise identification of postinfarct pseudoaneurysm. This observation suggests the remarkable interest of our radionuclide ventriculographic results, not usually observed. Thus, we point out the possibilities of several nuclear cardiology imaging in the study of diagnostic problems concerning the analysis of these conditions of myocardial pathology.

Aneurysm, False↗
PubMed1993

[Circadian variations in the incidence of transient ischemic myocardial episodes during hospitalization for acute myocardial infarct].

The aim of this research was to evaluate the incidence and circadian variation of episodes of transient myocardial ischemia in the predischarge period after acute myocardial infarction (AMI). One hundred and ninety patients were selected in stable clinical condition, 83 with inferoposterior AMI, 61 with anterior AMI, 12 with lateral AMI (34 patients with non Q AMI). The patients with unstable clinical course during the first 48 hours after admission were excluded. All patients underwent dynamic electrocardiography (Pathfinder 3 Reynolds Medicals) between the tenth and the fifteenth day of the in-hospital phase. Sixteen/190 patients showed ECG changes due to transient myocardial ischemia, with a length higher than 60 sec and with an interval between episodes higher than 60 sec. Ten patients had ST depression, 6 patients had ST elevation. In total, the ischemic episodes were 25, silent 21 and symptomatic 4, with incidence from 1 to 4 during 24 hours, with a length from 1 to 17 min (mean 8 min); mean heart rate increased during ischemic episodes. Seventeen/25 ischemic episodes occurred between the twelfth and the twenty-fourth hours. A follow-up of 15 +/- 3 months was carried-out: 1 patient died after reinfarction, 1 patient died of non cardiac cause, 6 patients showed unstable angina (in 4 of them myocardial revascularization procedure was performed), 8 patients were asymptomatic; on the contrary, 32/174 patients without episodes of myocardial ischemia presented cardiac events, with lesser incidence than ischemic patients (p < 0.01). This retrospective analysis showed higher evidence of episodes due to transient myocardial ischemia during the afternoon and evening hours in the in-hospital phase after AMI.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Thallium-201 myocardial perfusion imaging after aortocoronary bypass in patients treated with sulodexide or ASA-dipyridamole].

The aim of this investigation was to compare the preventive effect of sulodexide, a glycosaminoglycan drug, tested versus ASA-dipyridamole association, on the occlusion of venous aortocoronary bypass. A group A of 23 patients, for a total of 22 anastomosis with internal mammary artery and 46 venous bypass, was treated with sulodexide 500 USL/day. A group B of 18 patients for a total of 19 anastomosis with internal mammary artery and 33 venous bypass, was treated with ASA-dipyridamole 300 mg + 400 mg/day. Three and 9 months after surgery, all patients underwent thallium-201 myocardial perfusion imaging, associated with ergometric test. At the first control after 3 months, reversible perfusion defect in one or more myocardial segments was observed in 8 patients of group A and 3 patients of group B (2 A patients and 1 B patient in non revascularized myocardial segments); after 9 months, reversible perfusion defects were observed in 4 A patients and in 4 B patients. After 3 months, non reversible perfusion defect imaging in non infarcted myocardial segments was observed in 2 A patients and in 1 B patient; after 9 months, in 1 patient of both groups. This research shows higher incidence, at first control after 3 months, of ischemic reversible perfusion defects in patients treated with sulodexide, with an evident improvement in some patients recontrolled after 9 months. At the last control after 9 months, the scintigraphic findings showed similar evidence of perfusion defects in both groups treated with sulodexide or ASA-dipyridamole, with concordant angiographic findings (78.6%). Our preliminary results are encouraging and suggest further widespread studies on sulodexide therapy.

Arterial Occlusive Diseases↗
PubMed1992

[Assessment of perioperative myocardial damage based on circulating heavy chain myosin fragments].

To evaluate myocardial damage induced by coronary bypass surgery, to construct a reference data set in postoperative patients and to ascertain the impact of perioperative myocardial infarction on myosin release from sarcolemmal membrane we serially measured levels of serum fragments of myosin heavy chains by means of monoclonal antibody immunoradiometric assay (MYOSIN IRMA ERIA Pasteur). After surgery serum levels of myosin increased from third postoperative day and peaked on seventh day. Peak myosin levels did correlate with enzymatic activities of CPK (r = 0.69; p < 0.001) and of CPK-MB (r = 0.75; p < 0.001). Six patients suffered postoperative myocardial infarction: in these patients myosin levels were significantly different from those without infarctions (3651 +/- 1569 versus 699 +/- 206 ng/ml; p < 0.01). No correlation could be demonstrated between cardiopulmonary bypass time or aortic cross clamp duration. The rise of myosin levels observed in nearly all patients suggests a minor intraoperative damage to the contractile apparatus that sometimes is diagnosed as myocardial infarction and often does not meet clinical diagnostic criteria.

Aged↗
PubMed1992

[Observations on the natural history of heart failure. Changes due to the therapeutic use of captopril].

The purpose of this research was a retrospective evaluation of the mortality rate in 138 patients, considered after the first hospitalisation due to heart failure. After 5 years, the mortality rate was higher in the 54 patients with dilatative cardiomyopathy (74.3%), compared to the 44 patients with coronary heart disease (54.5%), while the 40 patients with valvular heart disease showed a lower mortality (37.5%). The mortality rate was higher in patients admitted in higher NYHA class. The primary aim of this research was to assess the effects of captopril on mortality in 101 treated patients, compared to 37 non treated patients, both receiving conventional treatment for heart failure. Between the 2 groups, the mortality rate showed lower percentage values for patients treated with captopril, with significant difference (p less than 0.01) at controls carried out every 12 months, until 5 years. Progressive heart failure was the greater cause of death in both groups, while the deaths classified as due to arrhythmia without pump failure were less frequent. Deaths due to reinfarction in patients with coronary heart disease showed lesser percentage values in patients treated with captopril. This research demonstrated the high mortality rate affecting a group of patients after the first hospitalisation due to heart failure. The addition of captopril to conventional treatment for heart failure significantly reduced mortality.

Age Factors↗
PubMed1991

[Notes on the use of equilibrium radionuclide angiography in the study of diastolic ventricular function].

Diastolic ventricular heart failure, as an isolated pathologic process, recently assumed a great speculative interest and become a fashionable concept, although not so readily defined and understood. Gated blood pool radionuclide ventriculography allows the measure of parametric data which investigate the dynamics of ventricular filling volumetric changes. Radionuclide ventriculography presents peculiar characteristics of non geometric analysis with practically tridimensional approach to the study of ventricular imaging. The parametric data obtained are indicated to verify diastolic functional condition in many types of cardiovascular pathology, but present same practical limitations, due in part to the impossibility of a precise identification of the four fundamental components of diastole on time-activity curve. Keeping these limitations in mind, and also the incomplete definition of pathophysiological mechanism of diastolic derangement, nuclear cardiology still offers way of serially investigate diastolic function in many clinical settings. From a review of our preceding researches, the radio between maximal rates of diastolic and systolic ventricular volumetric changes (PFR/PER) is here considered. Purpose of this review is a deeper knowledge of radionuclide parameters which investigate the function and dynamics of ventricular filling.

Diastole↗
PubMed1991

[Left ventricular function in arterial hypertension in relation to age. The short-term effects of nicardipine].

The purpose of this study was to assess the age related effects on left ventricular function after acute administration of the calcium-antagonist nicardipine. Gated radionuclide left ventriculography was performed before and 90 min after 40 mg of oral nicardipine in a group of 15 male patients with essential hypertension (H), 8 younger (HY) and 7 older (HO) than 60 years, and in a control group of 15 male subjects without cardiovascular disease (C), 7 younger (CY) and 8 older (CO) than 60 years. Baseline ejection fraction (EF) was similar in groups H and C, while peak ejection (PER) and peak filling (PFR) rates were lower in hypertensive patients as compared to controls. Baseline EF and PER were similar in subgroups HY and HO as well as in subgroups CY and CO, while PFR was particularly lower in the older hypertensive patients HO. After nicardipine, EF PER PFR significantly increased in groups H and C; EF and PER significantly increased in subgroups HY HO CY CO, while PFR had a significant increase in subgroups HY CY CO, but showed a not significant increase in subgroup HO. After nicardipine, the percentage changes of ventricular volume indexes were similar in the 4 subgroups; end diastolic volume was unchanged, end systolic volume had a clear decrease, stroke volume and cardiac output increased. The hypertensive patients had a damaged diastolic ventricular performance, as compared to the normal subjects, while EF was near to normal range in groups H and C.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[Right ventricular function before and 6 months after aortocoronary bypass. A radioisotope angiographic study].

The aim of the present paper is the study of the changes induced on right ventricular function after myocardial revascularization with aortocoronary bypass graft. Two-three days before and 6 months after operation gated radionuclide ventriculography has been performed in 25 patients with previous myocardial infarction (MI), anterior in 16 patients and inferior in 9. At postoperative examination, right ventricular ejection fraction (EF) was slightly but significantly reduced (p less than 0.01), while peak ejection and filling rates were unchanged. Symmetric parameters of left ventricular function did not show changes at post-operative control, except a clear-cut rise of left ventricular peak filling rate (p less than 0.05). Before operation, in patients with previous anterior MI, left ventricular EF was slightly less and right ventricular EF slightly more than in patients with previous inferior MI; after operation right ventricular EF significantly decreased (p less than 0.01) only in patients with previous anterior MI. No correlation has been demonstrated in pre- postoperative changes of the observed parameters, neither between the two groups of previous MI nor between right and left ventricular cavity. Six months after myocardial revascularization, left ventricular performance, as examined with radionuclide angiography, was practically unchanged except for improvement of diastolic function, while right ventricular performance was moderately impaired, more in patients with previous anterior MI than in those with previous inferior MI.

Adult↗
PubMed1989

[Analysis using scintigraphy with thallium-201 of the perfusion picture before and after myocardial revascularization].

The present study was undertaken to investigate the effects of coronary artery bypass surgery on myocardial perfusion analyzed by thallium-201 scintigraphy. In 34 patients early thallium-201 imaging, repeated 4 hours later at rest, was performed 2-3 days before and within 1 year following myocardial revascularization. Before surgery, exercise ECGs were positive in 22/34 patients, with scintigraphic perfusion defects in 33/34 patients; thallium-201 imaging showed reversible in 77 and irreversible perfusion defects in 51 myocardial segments. After surgery, exercise ECGs were positive in 3/34 patients, while thallium-201 perfusion data improved in 27, were unchanged in 4 and worsened in 3 patients. After surgery, thallium-201 imaging showed a remarkable improvement, with decreased number of reversible (8 segments) and irreversible (32 segments) perfusion defects. Ten of the 22 patients with previous myocardial infarction had improved irreversible perfusion defects in myocardial segments that were infarcted. Qualitative thallium-201 scintigraphy showed that myocardial revascularization exerted a clear favorable influence on reversible perfusion defects and in part on irreversible perfusion defects, suggesting that persistent defects are compatible not only with scar tissue, but also may represent hypoperfusion of viable myocardium.

Adult↗
PubMed1989

[Left ventricular function a short time after myocardial revascularization surgery: radioisotope angiographic study].

The short-term effects after coronary bypass surgery on left ventricular function were studied in 65 patients with coronary artery disease. Each patient underwent gated radionuclide left ventriculography on the second-third day before and 5-7 days after coronary bypass surgery. After surgery, global ventricular ejection fraction had a significant increase, anteroseptal wall motion was unchanged, while apical motion and mainly inferoposterior motion were significantly increased. The most important improvement of inferoposterior motion was observed in 18 patients who had complete revascularization of the previously infarcted inferior segments, while in the 11 patients with incomplete revascularization of the same area, inferoposterior motion had a slight increase. There was a slightly significant direct linear correlation between size and direction of the anteroseptal and inferoposterior motion changes. The patients were divided in subgroups related to the site and number of obstructed coronary vessels as well as of implanted grafts; the computed parameters showed similar changes in all subgroups. After surgery, peak ejection rate showed an evident increase, and time to peak reciprocally shortened. Peak filling rate, which had reduced preoperative values, was found clearly improved, with a corresponding shortening of the time to peak; these results confirmed that diastolic ventricular damage was a reversible disturbance related to myocardial ischemia. In 8 of the 65 patients, 24 hours urinary catecholamine levels showed similar values at both pre and postoperative radionuclide controls. In conclusion, the radionuclide angiography showed an evident improvement of left ventricular function during a short period following surgery, suggesting a better myocardial perfusion after revascularization.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Perfusion scintigraphy using thallium-201 in patients with previous transmural and non-transmural myocardial infarctions].

The purpose of this research was to analyze myocardial perfusion in patients with previous myocardial infarction (MI). The study was carried-out in 46 patients with symptomatic myocardial ischemia. Nineteen patients had a previous anteroseptal MI - 12 transmural and 7 non transmural; 5 lateral MI - 2 transmural and 3 non transmural; 22 inferior MI - 11 transmural and 11 non transmural. Six patients had critical stenosis of 1, 19 of 2, 21 of 3 coronary vessels; the patients with non transmural MI had a higher patency rate of infarcted-related vessels, as compared to the patients with transmural MI. In each patient, 2 mCi of thallium-201 were injected 60 s before the end of a symptom-limited bicycle exercise; images were taken 5 min after the exercise and 4 hours later, at rest. An irreversible perfusion defect was observed in 24/25 patients with transmural MI and in a smaller number (8/21) of patients with non transmural MI (p less than 0.001). A complete or partially reversible perfusion defect in the peri-infarction areas was observed in 9/25 patients with transmural MI and in 16/21 patients with non transmural MI (p less than 0.01). Reversible (12 patients) and irreversible (5 patients) perfusion defects were observed in myocardial segments different from those of MI. The planar qualitative thallium-201 scintigraphy presented a high sensitivity concerning the individuation of irreversible myocardial perfusion defects, localized in areas of a previous transmural MI. Thallium-201 scintigraphy was not a good predictor of the site of a previous non transmural MI.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Myocardial perfusion in coronary disease: thallium-201 planar scintigraphy].

This research evaluated the diagnostic and analytic effectiveness of 201-thallium imaging in a group of patients with coronary artery disease, each one of them with different localization, extent and number of coronary vessel obstructions. The thallium-201 imaging was performed immediately after ergometric test and repeated 4 hours later. In a large percentage of patients thallium-201 imaging of reversible and irreversible perfusion defects have been found; thallium-201 scintigraphy showed a greater sensitivity than exercise ECG. With particular evidence 201-Tl imaging showed perfusion defects in a high percentage of patients with obstruction of one and two coronary vessels; in these patients, in the former especially, the results of exercise ECGs showed a lower sensitivity. Both thallium-201 and exercise ECG had a similar sensitivity in patients with obstruction of three coronary vessels. In patients with obstruction of one or two vessels, thallium-201 imaging clearly showed a regional hypoperfusion corresponding to the specific perfusion coronary vessels, while exercise ECG gave aspecific topographic results. Irreversible perfusion defects resulted corresponding to the myocardial segments that were infarcted, but were also observed in patients without previous myocardial infarction.

Adult↗
PubMed1989

[Radioisotopic angiographic study of left ventricular function in hypertensive disease].

The aim of this study was to evaluate left ventricular function in 26 patients with essential arterial hypertension, compared with 33 normal subjects, using gated radionuclide ventriculography. The hypertensive patients had reduced values of ventricular ejection fraction (EF), peak ejection and peak filling (PRF) rates. A group of 10 hypertensive patients with normal EF, showed significantly reduced values of PFR, as compared to normal subjects. The older hypertensive patients had significantly reduced PRF values, compared to younger patients. PFR is a more sensitive index in evaluating the impairment of ventricular function in patients with hypertension, though it lacks real discriminating diagnostic value. In hypertrophic heart disease the association between arterial hypertension and old age contributed to accentuate the abnormality in ventricular diastolic filling.

Adult↗
PubMed1986

Left ventricular diastolic filling rate assessed by gated radionuclide angiography in patients with coronary artery disease.

This study was undertaken to determine the significance of diastolic left ventricular function in 26 normal subjects and in 74 patients with coronary artery disease (CAD). Gated radionuclide left ventriculography in supine position and left anterior oblique projection was performed at rest in both groups considered and during exercise in 11 normal subjects and in 35 patients with CAD. Compared with the normal subjects, the group of patients with CAD showed lower values of global and regional ejection fraction as well as of peak ejection and filling rates. 33 patients with CAD, presenting an ejection fraction greater than 54%, showed similar values of global and regional ejection fraction, compared with the group of normal subjects, while peak filling rate was significantly lower. During exercise peak filling rate significantly increased in normal subjects and in patients with CAD; this increase was constant and similar in the various subgroups considered among patients with CAD. We conclude that peak filling rate represents a more sensitive index than ejection fraction in evaluating left ventricular function in patients with CAD, as shown by the comparison between normal subjects and patients with CAD, who had an ejection fraction greater than 54%.

Adult↗