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Biomedical subjects

Fernando Boccalandro

Publications and source records attributed to Fernando Boccalandro.

27 records · Page 2Linked to original sources
PubMed2003

Combined intense lifestyle and pharmacologic lipid treatment further reduce coronary events and myocardial perfusion abnormalities compared with usual-care cholesterol-lowering drugs in coronary artery disease.

OBJECTIVES: The purpose of this study was to determine if combined intense lifestyle and pharmacologic lipid treatment reduce myocardial perfusion abnormalities and coronary events in comparison to usual-care cholesterol-lowering drugs and whether perfusion changes predict outcomes. BACKGROUND: Lifestyle and lipid drugs separately benefit patients with coronary artery disease (CAD). METHODS: A total of 409 patients with CAD, who underwent myocardial perfusion imaging by dipyridamole positron emission tomography at baseline and after 2.6 years, had quantitative size/severity of perfusion defects measured objectively by automated software with follow-up for five additional years for coronary artery bypass graft, percutaneous coronary intervention, myocardial infarction, or cardiac death. Patients were categorized blindly according to prospective, predefined criteria as "poor" treatment without diet or lipid drugs, or smoking; "moderate" treatment on American Heart Association diet and lipid-lowering drugs or on strict low-fat diet (<10% of calories) without lipid drugs; and "maximal" treatment with diet <10% of calories as fat, regular exercise, and lipid active drugs dosed to target goals of low-density lipoproteins <2.3 mmol/l (90 mg/dl), high-density lipoproteins >1.2 mmol/l (45 mg/dl), and triglycerides <1.1 mmol/l (100 mg/dl). RESULTS: Over five years, coronary events occurred in 6.6%, 20.3%, and 30.6% of patients on maximal, moderate, and poor treatment, respectively (p = 0.001). Size/severity of perfusion abnormalities significantly decreased for patients receiving maximal treatment and increased for patients undergoing moderate and poor treatment (p = 0.003 and 0.0001, respectively). Combined intense lifestyle change plus lipid active drugs and severity/change of perfusion abnormalities independently predicted cardiac events. CONCLUSIONS: Intense lifestyle and pharmacologic lipid treatment reduce size/severity of myocardial perfusion abnormalities and cardiac events compared with usual-care cholesterol-lowering drugs. Perfusion changes parallel treatment intensity and predict outcomes.

Aged↗
PubMed2003

Oral acetylcysteine does not protect renal function from moderate to high doses of intravenous radiographic contrast.

The use of radiographic contrast during cardiac catheterization can cause acute renal failure with an increase in morbidity and mortality. Prophylactic acetylcysteine plus intravenous hydration have been shown to prevent contrast-induced nephropathy (CIN) in patients with chronic renal failure undergoing computed tomography scan, who receive low doses of intravenous contrast. Whether the use of prophylactic acetylcysteine can decrease the incidence of CIN when larger doses of contrast are used remains to be determined. We sought to evaluate whether the prophylactic administration of acetylcysteine plus intravenous hydration is superior to intravenous hydration alone in prevention of CIN in patients with chronic renal failure undergoing cardiac catheterization and receiving moderate to high doses of intravenous contrast (> 1 cc/kg). Seventy-three consecutive patients with renal insufficiency who received intravenous hydration and 600 mg of acetylcysteine twice a day 24 hr before and the day of the cardiac catheterization were compared with 106 consecutive patients who received hydration alone. Baseline and 48-hr serum creatinine concentrations were compared between the two groups before and after cardiac catheterization. Multivariate and univariate analysis were performed to assess the effects of acetylcysteine and other clinical variables in the change of serum creatinine after the procedure. Both groups had comparable clinical characteristics and received similar volumes of intravenous hydration. The volume of contrast used was similar for the two groups (2.2 +/- 1.7 vs. 2.3 +/- 1.5 cc/kg; P = 0.67). A mean change in serum creatinine of 0.17 +/- 0.54 mg/dl for the acetylcysteine group vs. 0.19 +/- 0.40 mg/dl for the control group (P = 0.77) was observed at 48 hr. The incidence CIN was 13% in the acetylcysteine vs. 12% in the control group (P = 0.84). Acetylcysteine, whether analyzed with multivariate or univariate analysis, failed to demonstrate a significant effect in the change of serum creatinine after cardiac catheterization. In patients with chronic renal insufficiency, acetylcysteine in a dose of 600 mg twice a day before and after cardiac catheterization, along with intravenous fluids, is as effective as fluids alone in the prevention of CIN when moderate to high doses of contrast are used.

Acetylcysteine↗
PubMed2003

Cavernous hemangioma of the foot and antecubital fossa: an alternative therapeutic option.

We present two cases of recurrent cavernous hemangiomas of the extremities. These conditions were initially treated unsuccessfully with surgical resection. After recurrence, the hemangiomas were treated by percutaneous transcatheter embolization. To the best of our knowledge, this is the first case report of treatment of cavernous hemangioma involving the extremities using an angiographically directed vascular embolization technique.

Adult↗
PubMed2002

New method for calculating right ventricular ejection fraction using gated myocardial perfusion studies.

BACKGROUND: Quantification of right ventricular ejection fraction (RVEF) is important in patients who have right heart failure or cor pulmonale. When Tl-201 was the primary radiotracer used to evaluate myocardial perfusion, the outline of the right ventricle could vary and was not visualized in most patients. However, visualization of the right ventricle has become easier with the use of Tc-99m-labeled myocardial perfusion agents. PURPOSE: This study describes a new method for quantifying RVEF using gated stress myocardial perfusion (GMP) slices. The results are compared with those of first-pass radionuclide ventriculography (FPRNA) in the same patients. METHODS: Fifty-two consecutive patients referred for routine GMP imaging were included. After administration of Tc-99m tetrofosmin, all patients underwent FPRNA using a single crystal gamma camera and a GMP study. Regions of interest (ROI) were drawn to outline the right ventricular cavity at end diastole and end systole from three pairs of GMP slices. The RVEF was calculated from the number of pixels within the ROIs. The mean RVEF obtained using FPRNA and GMP imaging was 51.8 +/- 10.8% and 51.9 +/- 12.3%, respectively. The two methods showed good correlation with r = 0.81. In addition, there was no significant difference in the RVEFs calculated using these methods (P = 0.85). Bland-Altman analysis also showed good agreement between the two methods (limits of agreement +14.4% to -14.0%, slope = 0.19). Intraobserver and interobserver correlation were evaluated by reanalyzing 12 patients using the new RVEF quantification method and were good at r = 0.87 and 0.82, respectively. Therefore, this is a new convenient method for evaluating RVEF as part of a routine tomographic gated myocardial perfusion study.

Adult↗
PubMed2002

Restrictive left ventricular filling pattern with preserved systolic function assessed by Doppler echocardiography: clinical, echocardiographic and prognostic implications.

From an echocardiographic laboratory database, echocardiographic characteristics of clinical and cardiovascular mortality were compared in patients with restrictive pattern of left ventricular filling (RPLVF) and left ventricular ejection fraction (LVEF) >50% (n = 36), with patients with RPLVF and LVEF <50% (n = 120) and echocardiographic controls (n = 160). Preserved LVEF was found in 21% of the patients with RPLVF. Mortality in patients with RPLVF was worst compared with echocardiographic controls regardless of their underlying LVEF after 2.7 +/- 1 years of follow-up. Patients with RPLVF had distinctive predictors of cardiovascular death, with clinical and echocardiographic characteristics according to their LVEF.

Adult↗
PubMedDate not supplied

Severe reversible dilated cardiomyopathy and hyperthyroidism: case report and review of the literature.

OBJECTIVE: To describe a case of a 46-year-old woman with Graves' disease and reversible low-output congestive heart failure and present a comparative analysis of 23 similar cases reported in the literature. METHODS: A detailed case report is presented. In addition, a review of the pertinent literature published between 1960 and 2002 was performed to identify similar cases of dilated cardiomyopathy and thyrotoxicosis and to assess the findings in these patients. RESULTS: A 46-year-old woman without primary heart disease was admitted to the hospital with Graves' thyrotoxicosis and severe low-output congestive heart failure. Her left ventricular ejection fraction (LVEF) at the time of initial assessment was less than 20%, and her condition was categorized as New York Heart Association (NYHA) functional class III. Nineteen months after she was treated for hyperthyroidism, her LVEF was 49% and her status was NYHA class I. A severe hypotensive episode occurred when b-adrenergic blockade therapy was initiated. The group of 23 similar cases from the literature plus our currently described patient had a mean age of 45 years, a male-to-female ratio of 1:1.2, Graves' disease as the principal cause, and LVEF improvement from 29% to 58%. CONCLUSION: Dilated cardiomyopathy is an unusual manifestation of hyperthyroidism with unclear cause. Clinicians should be aware of this entity because it is treatable and hypotension can occur if b-adrenergic blockade treatment is initiated.

Adrenergic beta-Antagonists↗