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Biomedical subjects

F Miccoli

Publications and source records attributed to F Miccoli.

13 recordsLinked to original sources
PubMed2000

Italian BiodivYsio open registry (BiodivYsio PC-coated stent): study of clinical outcomes of the implant of a PC-coated coronary stent.

UNLABELLED: Rapid technological developments have made new materials available for percutaneous coronary intervention procedures. The coronary stent in particular has undergone progressive structural improvements leading to the recent availability of a third generation of stents, namely, coated stents. The rapid evolution of the stent has often made its evaluation problematical, since trials are frequently confined to small groups of patients in single centers. The purpose of this registry was to verify the safety and efficacy of the BiodivYsio stent (a stent coated with phosphorylcholine polymer) in a broad population of patients who reflect the daily reality of coronary intervention in a cardiac catheterization laboratory. METHODS AND RESULTS: The registry was designed to collect the principal angiographic and clinical data of a consecutive series of Oreal worldO patients. Patients were treated with a BiodivYsio stent (Biocompatibles, Galway, United Kingdom) in 12 centers (11 Italian and 1 Swiss) between January 1998 and January 1999. Procedural, in-hospital, 30-day and six-month follow-up data were collected. The monitoring, data entry and statistical analyses were carried out by an independent center. During the study, 218 patients were enrolled; 165 (76%) male and 53 (24%) female, with an average age of 61.6 +/- 9.4 years (range, 36Eth 84 years). A total of 258 stents were implanted in 233 lesions (1.1 stents per lesion), of which 233 (90%) were the BiodivYsio PC coated stent, the remaining 25 implants were of other stent types. The percutaneous transluminal coronary angioplasty and stenting procedure were carried out in 109 (50%) patients with unstable angina, 65 (30%) with stable angina, 29 (13%) with acute myocardial infarction, and 15 (7%) patients with silent ischemia. Procedural success was achieved in 217/218 (99.5%) patients. Optimal results were achieved in 212 (97.7%) patients. In 34 (15.6%) cases, patients were treated with periprocedural abciximab. During the hospitalization period, one (0.4%) death occurred on day 7 due to subacute occlusion of the stent, and 3 (1.4%) myocardial infarctions were reported. At 30-day follow-up, 211 (97.2%) patients were asymptomatic, as were 189 (87%) patients at clinical follow-up at 6 months. CONCLUSIONS: This study evaluated the safety and efficacy of a third-generation stent. The results demonstrate a high procedural success rate and a low incidence of major adverse cardiac events at short- and medium-term follow-up. It appears that the BiodivYsio stent should be considered safe in clinical and/or anatomical situations with a high risk of complications, confirming the hypothesis that PC may have non-thrombogenic properties. To corroborate these results, an appropriately designed study would be required to measure the stentOs efficacy in the most suitable clinical context, i.e., clinical situations that are at the highest risk of ischemic relapse.

Adult↗
PubMed1994

Relation between ECG strain pattern and left ventricular morphology, left ventricular function, and DPTI/SPTI ratio in patients with aortic regurgitation.

The relative contributions of left ventricular structural changes, dysfunction, and subendocardial ischemia in determining electrocardiographic repolarization abnormalities were assessed in 53 patients with chronic, pure aortic regurgitation and no evidence of coronary artery disease. Thirty-six patients with an abnormal electrocardiographic pattern of repolarization showed larger end-diastolic (154 +/- 46 vs 120 +/- 32 mL/m2; P < .001) and end-systolic (80 +/- 40 vs 52 +/- 30 mL/m2; P = .016) volumes, higher end-diastolic pressure (22 +/- 11 vs 15 +/- 10 mmHg; P = .021), lower ejection fraction (52 +/- 12 vs 59 +/- 13%; P < .05) and greater mass (168 +/- 48 vs 140 +/- 44 g/m2; P < .05) of the left ventricle compared to 17 patients with normal repolarization. Furthermore, patients with repolarization abnormalities also showed higher peak meridian (217 +/- 68 vs 153 +/- 92 Kdyne/cm2; P < .001) and circumferential (358 +/- 110 vs 259 +/- 153 Kdyne/cm2; P < .001) stress and a more spherical shape (end-diastolic shape: 1.4 +/- 0.1 vs 1.5 +/- 0.2, P = .046; end-systolic shape: 1.7 +/- 0.3 vs 1.9 +/- 0.3, P = .026) of the left ventricle. Patients with secondary repolarization abnormalities were also older than patients with normal repolarization (56 +/- 10 vs 40 +/- 11 years; P < .001). However, the diastolic pressure-time index/systolic pressure-time index, which is an estimate of the myocardial oxygen supply-to-demand ratio, was similar in both groups of patients (0.74 +/- 0.3 vs 0.8 +/- 0.2; P = NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Anatomo-functional correlations of changes in electrocardiographic repolarization in aortic and mitral valve insufficiency. Comparison of indices based on QRS voltages].

Electrocardiographic repolarization changes and voltage criteria for left ventricular hypertrophy were examined, in relation to hemodynamic, echocardiographic and angiographic data. This was done to evaluate their association with abnormalities in cardiac function and structure in 53 patients with chronic aortic regurgitation and 36 patients with chronic mitral regurgitation. No patient showed evidence of coronary artery disease. Of the patients with aortic regurgitation, the 27 patients with an abnormal repolarization pattern at ECG had worse NYHA functional class when compared to the 24 patients with normal repolarization (2.4 +/- 1 vs 1.6 +/- 0.9; p less than .01). They also had greater left ventricular dimensions (end-diastolic volume: 162 +/- 57 ml/m2 vs 109 +/- 15 ml/m2, p less than .01; end-systolic volume: 85 +/- 46 ml/m2 vs 44 +/- 31 ml/m2, p less than .01), lower left ventricular ejection fraction (.50 +/- .12 vs .63 +/- .14; p less than .01), greater left ventricular mass (170 +/- 56 gr/m2 vs 119 +/- 29 gr/m2; p less than .01) and higher end-diastolic left ventricular pressure (21 +/- 11 mmHg vs 11 +/- 8 mmHg; p less than .01). QRS voltage was less closely related to cardiac function and structure and thus, did not modify the conclusions based on repolarization findings alone. Furthermore, repolarization patterns identified patient subgroups with high or low prevalences of previously described predictors of poor surgical outcome. The presence or absence of the "strain" pattern was not related to differences in cardiac structure and function, in patients with mitral regurgitation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Surgical results in mitral insufficiency: prognostic value of the indices of left ventricular function].

Left ventricular function is a major prognostic factor in patients with mitral regurgitation, but the ability of echocardiographic and hemodynamic parameters to predict the surgical result is controversial. We investigated the prognostic role of various pre-operative indices of left ventricular function in 23 consecutive patients who underwent successful surgical correction of chronic mitral regurgitation. At a mean follow-up of 20 +/- 16 months, patients underwent echocardiography and radio-nuclide angiography and were grouped according to the post-operative left ventricular ejection fraction. Group A was made up of 16 patients with a left ventricular ejection fraction greater than or equal to .45: they showed post-operative reduction of the left ventricular end-diastolic diameter (from 36.3 +/- 3.2 to 30.5 +/- 4.5 mm/m2; p less than .001) and of the radius/thickness ratio (from 3.5 +/- 0.6 to 2.9 +/- 0.6; p less than .01). In 7 patients (group B), post-operative left ventricular ejection fraction was less than .45 and no significant changes in the left ventricular end-diastolic diameter (from 41.5 +/- 2.7 to 36.9 +/- 6.1 mm/m2; NS) or the radius/thickness ratio (from 3.9 +/- 0.9 to 3.4 +/- 1.0; NS) were observed. During the follow-up all group A patients remained asymptomatic or minimally symptomatic, whereas 2 group B patients died of refractory left ventricular failure. Pre-operative left ventricular volumes and diameters, both at end-diastole and end-systole, were significantly greater in group B patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

[Evaluation of left ventricular ejection fraction in coronary disease patients by the gated blood pool method and cineangiography. Critical analysis of divergences between the 2 methods].

In order to assess the reliability of left ventricular ejection fraction as estimated by gated blood pool method, radionuclide angiography (LAO) and single plane (RAO) contrast cineangiocardiography were performed within 14 days in 60 patients with coronary artery disease. The mean value of radionuclide ejection fraction was found to be 55 +/- 16%; contrast cineangiographic ejection fraction was 57 +/- 15%; r = 0.92. In 23 patients with previous anterior myocardial infarction gated blood pool method was found to underestimate left ventricular ejection fraction when compared with contrast cineangiography. The observed underestimation was wide significant in 11 patients with previous anterior infarction, low (less than 50%) radioisotopic ejection fraction and septal akinesia and/or apical dyskinesia; radionuclide ejection fraction = 33 +/- 8%; contrast cineangiographic ejection fraction = 42 +/- 9%; r = 0,76. This study confirms that the values of left ventricular ejection fraction as estimated by gated blood pool method in coronary patients are quite reliable; moreover, the intrinsic variability of the data is low. This may be not true in patients with previous anterior myocardial infarction. The Authors discuss the possible causes of disagreement between radioisotopic and contrastographic ejection fraction in patients with previous anterior infarction and poor left ventricular function: physical problems of measuring ejection fraction by gated blood pool in dilated ventricles; possible mistakes in evaluating blood pool due to the low mobility of the blood mass nearest to the scintillation camera; inhability of contrast cineangiography in RAO to recognize the interventricular septum and evaluate its kinetic abnormalities; unreliability of the geometrical model of revolution elypsoid in calculating end-systolic volumes in ventricles with abnormal wall-kinesis.(ABSTRACT TRUNCATED AT 250 WORDS)

Cineangiography↗
PubMed1985

[Evaluation of the seriousness of aortic valve stenosis: calculation of the valvular area or peak? Reliability of Hakki's formula].

The severity of aortic valve stenosis should be assessed by means of the calculation of the valvular area; on the other hand, the routine use of the Gorlin's formula for the aortic area is laborious and time consuming. Recently Hakki proposed a simplified formula (area = cardiac output/square root gradient) for the calculation of valvular areas. This method does not require the assessment of the systolic ejection time or the transvalvular flow; furthermore, the peak systolic gradient instead of the mean gradient may be entered into the formula. We have evaluated the reliability of this formula on 83 patients with aortic valve stenosis either pure or with absent to mild aortic incompetence (angiographically first degree maximum). Twenty-eight patients had isolated aortic stenosis, 55 had associated mitral stenosis and/or mitral or tricuspid regurgitation. Our results show a good correlation between the values of valvular areas obtained by Hakki's formula and those obtained by Gorlin's formula (r = 0.90 in the first group and r = 0.91 in the second group of patients). On the contrary we observed a poor relationship between the peak systolic gradient and the valvular area, with a considerable scatter of the data, especially for low values of peak systolic gradient. We therefore conclude that the assessment of the aortic valve stenosis must be based on the estimation of the valvular area; in our hands the Hakki's formula has proven to be easy and sufficiently reliable for routine diagnostic studies.

Adolescent↗
PubMed1984

[Corrected transposition of the great vessels in the adult. Presentation of a case simulating ischemic cardiopathy].

We report the clinical and laboratory findings in a 58 years old woman with corrected transposition of the great arteries (CTGA), who that presented typical angina pectoris. The diagnosis of ischemic heart disease was supported by the history of a previous myocardial infarction. Other findings were a systolic murmur of mild mitral regurgitation, left bundle branch block and enlarged left ventricle on the chest X-ray. Cardiac catheterization showed a corrected transposition of the great arteries (L-malposition with situs solitus); left and right coronary arteries were free of luminal stenosis. We suggest therefore that anginal chest pain may be due to myocardial ischemia induced by discrepancy between myocardial oxygen consumption and coronary blood flow. This complication may occur in patients with corrected transposition of great arteries surviving in adulthood.

Angina Pectoris↗
PubMed1984

[Development of a method for the quantitative evaluation of the regional kinetics of the left ventricle].

Segmental wall motion abnormalities of the left ventricle frequently occur in ischemic heart disease. An objective, quantitative method is required to ensure the reproducibility of the assessment of left ventricular regional function, especially in evaluating the changes induced by diagnostic and therapeutic interventions. In 32 normal subjects we obtained 30 degrees right anterior oblique left ventriculograms and developed a method based on the following observations. The method should reflect the symmetric uniform motion of the left ventricular silhouette. Only actual contractile motion should be taken into account; therefore, rotatory and translational motion should be compensated for. Passive systolic movement of aortic and mitral valves accounts for the contraction of neighbouring myocardial segments. Left ventricular wall excursion is most often measured by a coordinate system: since the cavity of the left ventricle becomes relatively longer during systole, left ventricular walls contract neither toward a single central point nor toward the long axis; therefore the appropriate origin of the coordinate system will be a segment. Furthermore, as more elongated left ventricular end-diastolic silhouettes appear to show a greater extent of systolic lengthening (we show evidence of this), the length of the segment must be related to the end-diastolic shape. The basic steps of the method are: 1) identification of a symmetry line, from the aortic mid-point to the apex, by connecting the mid-point of 19 diameters perpendicular to the long axis; 2) roto-translation of the end-systolic silhouette so that the end-systolic apex and aortic mid-point lie on the symmetry line.(ABSTRACT TRUNCATED AT 250 WORDS)

Heart↗