PubMed Health⌕ Search

Biomedical subjects

G M Trovato

Publications and source records attributed to G M Trovato.

At least 19 recordsLinked to original sources
PubMed2004

[Quality of life in diabetes].

Different clinical features of diabetic patients and type of complications are certainly a critical components of the global individual perception of quality of life (qol); but also personal socio-cultural characteristics interfere concurrently. Qol in diabetes was assessed considering disease grade, complications and level of instruction in a population of 100 diabetic patients (30 m, 70 f), aged 66.99 +/- 13.68 years. Two questionnaires were administered to all patients; Sickness Impact Profile (SIP) and Functional Living Index (FLI). SIP is an index of psycho-social, physical and motor functionality; FLI derives from a scale devised for cancer patients and adapted to diabetic patients. Both were analysed by Spearman correlation test, and assayed vs. sociocultural profile and clinical symptoms. Neuro-muscular ailments were more prevalent in women; men experience severe limitations of working capacities an relational possibilities, with severe discomfort. In the whole, higher scores of SIP (greater disability p: ns) and lower score for FLI (scant well-being perception r = 0.29: p<0.01) are related with lower school instruction level. Global QOL score is related as well with degree of instruction (r = 0.22: p<0.03). So QOL is altered during chronic diseases: however, in diabetes, qol impairment does not seem related with severity, treatment features and complications of diabetes. Socio-cultural elements, and particularly instruction level quantified as school grades achieved, interfere with the manner of living diabetic disease.

Adolescent↗
PubMed2001

[Heart failure and nutritional status in hemodialysis].

Left ventricular function is impaired in long-term maintenance dialysis as a consequence of several inter-related conditions. Aim of the study was to assess if different degree of malnutrition can affect diastolic and systolic function of dialysis patients. Bio-electrical whole-body multifrequency impedance analysis (BIA) allows a dynamic assessment of body composition according to a multi-compartment model. This allows an assessment of lean (FFM) and fat mass (FAT), metabolically active cell mass (BCM) and a BIA Nutritional Index (NI). We studied 73 patients (53 M, 20 F), aged 54.41 +/- 3.1 yrs, on maintenance bicarbonate dialysis since 57.3 +/- 61.8 mths, by BIA, performed before and after a dialysis. I-PTH and serum albumin are correlated (r = -0.55, p < 0.001); the same trend is shown by I-PTH vs fat free mass (r = -0.47, p < 0.001) and vs NI (r = -0.51, p < 0.001). Ejection fraction (EF) is correlated with age (r = -0.50, p < 0.001) and with I-PTH (r = -0.59, p < 0.001). Moreover, albumin and EF are closely related (r = 0.36, p < 0.01), as well as EF vs FFM (r = 0.47, p < 0.001), and EF vs NI (r = 0.37, p < 0.01). A/E ratio, assumed as index of left ventricular diastolic function, shows a correlation vs albumin (r = -0.33, p < 0.01), BCM (r = -0.34, p < 0.01) and NI (r = -0.40, p < 0.01), but not with I-PTH. Malnutrition, defined both by BIA measurements and lower serum albumin, could exert unfavourable effects on left ventricular systolic and diastolic function of patients on long-term haemodialysis, even independently by hyperparathyroidism.

Female↗
PubMed2001

Relationship between cardiac function and insulin resistance in obese patients.

Both overweight and insulin resistance predispose to atherosclerosis and cardiovascular diseases, independently of other risk factors. We studied the relationship between insulin resistance and heart function and dimension in 39 patients with different degrees of obesity. Twenty-six women and 13 men with body mass index (BMI) ranging 26.1-41 kg/m2 (mean +/- SD = 33.9 +/- 3.8), without diabetes, hypertension and heart, liver or kidney diseases were studied. Patients were subdivided into 2 groups, 25 with overweight or grade I obesity (group A) and 14 with severe (grade II or III) obesity (group B). Insulin sensitivity was evaluated by the Insulin Tolerance Test (ITT), performed after an overnight fast and K(ITT) was calculated. Echocardiographic measurements were also assessed. Between the two groups no significant difference was observed for either K(ITT) (group A, K(ITT) = 5.47 +/- 1.30; group B, K(ITT) = 4.57 +/- 1.53) or the ejection fraction (EF%) (group A, 71.40 +/- 6.63; group B, 69.86 +/- 7.43). No correlation was observed between BMI and both the EF% and other echocardiographic measurements. In patients with mild obesity (group A) a significant negative correlation between EF% and KITT (r = -0.62,p < 0.001) was observed. In mild obesity, therefore, cardiac function changes occur in relation to the level of insulin resistance but these changes are not related to mass and/or volume changes. The cause(s) of this relationship is not clear, but most likely involves metabolic or endocrine factors. The increased EF% in moderately obese patients that are insulin-resistant may provide an initial compensatory mechanism but may also contribute to a late cardiac damage.

Adult↗
PubMed2000

[Hyperthyroidism, therapy with erythropoietin, malnutrition and systolic function in hemodialysis: echocardiography study].

Secondary hyperparathyroidism is a frequent condition of dialysis patients. Endocrine derangements, with disturbance of calcium metabolism are complex, involving bone, heart (left ventricular hypertrophy-dilatation), bone marrow (anemia and erythropoietin resistance), muscle (increase of body fat mass) and insulin resistance. Aim of the study was to assess how these conditions are inter-correlated in the same patients. 45 patients (m 20, f 25; years 61.8 +/- 11.6) in maintenance bicarbonate three-weekly hemodialysis since > 3 years were studied. Cardiac function was assessed by echocardiography (EF%: left ventricular ejection fraction), which showed an inverse correlation both with parathormone (iPTH vs EF%: r = -0.64; p < 0.001) and with erythropoietin (rHu-EPO vs EF%: r = -0.62; p < 0.001). This suggests the possibility of a multi-endocrine resistance in dialysis patients with chronic renal failure, secondary to the degree of malnutrition. Lower lean mass is correlated with hyperparathyroidism (iPTH vs fat mass%: r = 0.37; p < 0.01), with lower left ventricular systolic function (EF% vs fat mass%: r = -0.41; p < 0.005) and with rHu-EPO resistance. Moreover, patients with higher iPTH show a hypercatabolic disposition, assessed as protein catabolic rate (PCR/kg vs iPTH r = 0.54; p < 0.001). This pattern can be a consequence of chronic renal failure, but bio-compatibility of materials can be involved as well.

Body Mass Index↗
PubMed1999

[Arterial hypertension in chronic kidney failure: a volume-dependent pathology or a disease due to malnutrition?].

BACKGROUND: Hemodialysis patients are a clinical circulatory model whose main feature is discontinuous fluid removal. Extracorporeal treatment in chronic renal failure exerts blood-volume and circulatory changes with effects on post-dialysis blood pressure (BP). We investigated if pre-dialysis body fluid disposition and body composition, assessed as lean and fat mass, have different relationship with blood pressure. METHODS: Bio-electrical whole-body multifrequency impedance analysis (BIA) enables dynamic assessment of body composition according to a multi-compartment model: extracellular (ECW) and total body water (TBW), lean (FFM) and fat (FAT) mass. We studied 73 patients (53 males, 20 females), mean age 54.4 +/- 13.1 years, on maintenance bicarbonate dialysis for 57.3 +/- 61.8 months. BIA was performed at the start and at the end of three consecutive dialysis sessions; blood pressure was monitored non-invasively throughout dialysis. Twenty-one patients (HP) were hypertensive (systolic BP 183.63 +/- 26.88 mmHg) and on pharmacological treatment, while 52 patients (NP) were normotensive (systolic BP 131.68 +/- 12.63 mmHg). RESULTS: Pre-dialysis assessment of blood pressure (BP) and body compartment in HP showed inverse relationships between systolic BP and percentage of total body water (r = -057, p < 0.001) and between BP vs lean mass/fat mass ratio (r = -0.68, p < 0.001). A high positive correlation was observed between systolic BP and percentage of fat mass (r = 0.73, p < 0.001). At the end of dialysis session, a strong relationship was observed between systolic BP and extracellular water (r = 0.77, p < 0.001). BP changes with dialysis do not show any special correlation with body compartment changes. No significant or overly weak correlations were observed in normotensive patients. CONCLUSIONS: Arterial hypertension of maintenance hemodialysis patients shows a strong relationship with the percentage of body fat and with FFM/FAT ratio, i.e. with the adiposity of diseased malnourished patients. Moreover, as suggested by the relationship between ECW and BP, present only at the end of dialysis, expansion of the extracellular water compartment or in other words, the degree of adequacy of water filtration during dialysis, seems to be an important condition in determining post-dialysis BP levels in hypertensive patients. The increase in BP during the interdialysis period is not closely interrelated with the degree of body hydration, but there is strong evidence that it is connected with the effects of malnutrition, including the increase in body lipids. This condition is multifactorial and can be a consequence of nutritional behavior, as well as of kidney disease and dialysis itself, with metabolic derangement also associated with protein and I-carnitine deficiency.

Adult↗
PubMed1998

Portal vein pulsatility ratio and heart failure.

PURPOSE: Heart diseases can alter liver volume, morphology, and circulation. The Doppler pulsatility of the portal vein and its pulsatility ratio (PR) have been reported as being closely associated with the right atrial pressure and with the New York Heart Association (NYHA) class. We examined the relationships between measurements of liver and spleen dimensions and blood flow in portal and hepatic veins, assessed noninvasively by Doppler sonography, and compared them with echocardiographic data. METHODS: The study group comprised 87 inpatients with heart failure. The mean age was 64+/-12 years. Patients underwent duplex Doppler sonography of the heart and portal and hepatic veins. RESULTS: Patients with more severe left ventricular failure (NYHA class III-IV) showed more dilatation of the left ventricle and atrium, reduced systolic function, and reduced portal vein mean velocity compared with patients with milder heart failure (NYHA class I-II); in addition, the hepatic vein diameter was increased and portal vein PR was reduced. Considering all patients, significant positive correlations were found between portal vein PR and left ventricular shortening fraction (r= 0.34, p < 0.01) and ejection fraction (r= 0.38, p < 0.001). Significant negative correlations were found between PR and hepatic vein diameter (r= -0.44, p < 0.001), right ventricle diameter (r = -0.38, p < 0.001), left ventricular end-diastolic volume (r = -0.31, p < 0.01), and left atrium diameter (r = -0.33, p < 0.01). Patients with hepatic vein dilatation had increased left ventricular volumes, reduced systolic function indices, and portal vein alterations (increased diameter, reduced mean velocity, and reduced PR). In patients with an ejection fraction of no more than 50%, only PR was significantly reduced, while other sonographic liver measurements were not significantly different. CONCLUSIONS: The effects of cardiac failure on portal blood flow, which declines progressively with worsening cardiac function, is shown better by the pulsatility pattern of the portal vein than by morphologic caval and hepatic vein measurements. PR can be used as a reliable adjunctive sign of heart failure.

Echocardiography, Doppler↗
PubMed1998

Nifedipine and extracellular water in dialysis arterial hypertension.

Nifedipine is a Ca-antagonist drug that reduces contractility of vascular smooth muscle, and is used in the treatment of arterial hypertension and of stable and vasospastic angina. Aim of this study is to evaluate long-term effect of nifedipine on distribution of body fluid compartment, assessed by BIA (Bio-Impedance Analysis), and on cardiac function, in hypertensive patients on dialysis. Two groups of hypertensive patients were compared: a) a first group of nine patients (5 Male, 4 Female; age 62.67 +/- 10.39) treated with nifedipine (30 mg/day) for one year; b) a control group of sixteen dialysis patients (9 Male, 7 Female; age 56.31 +/- 14.44), previously hypertensive, with normal blood pressure without anti-hypertensive drugs for three months or more. By BIA, extracellular water percentage (ECW%) is higher in nifedipine-treated patients (p < 0.001) in comparison with the control group before dialysis; no other difference is present. The intradialytical variations (before dialysis vs. the end of dialysis) of body fluid compartments are a significant decrease of total body water % (52.33 +/- 2.89 vs. 48.72 +/- 3.35, p < 0.001), ECW% (40.97 +/- 2.2 vs. 37.56 +/- 3.47, p < 0.005), Left Ventricular End-Diastolic Volume (81.1 +/- 14.6 vs. 63.4 +/- 21.66 ml/m2, p < 0.003), Cardiac Output (3.35 +/- 0.71 vs. 2.51 +/- 0.76 l/min/m2, p < 0.04) and Stroke Volume (45.76 +/- 10.21 vs. 34.34 +/- 9.98 ml/m2, p < 0.02) in nifedipine-treated patients. Our findings suggest that nifedipine induces intermittent and prolonged expansion of extra-cellular volume. This condition, in patients otherwise without clinical and echocardiographic signs of heart failure, can be potentially detrimental for cardiac function on long-term nifedipine treatment.

Adult↗
PubMed1997

Systolic function impairment in higher erythropoietin requirement patients in hemodialysis.

Circulatory adaptation to hemodialysis (HD) depends on several inter-related factors, due to the particular patient and to technical procedures. The cardiac effects of nutritional status and the improvement that erythropoietin (r-HuEPO) treatment, through the reduction of anemia, can determine, were reported; r-HuEPO requirements are quite different, in different patients, while achieving similar haemoglobin end-point. Thirty-four patients on r-HuEPO and 11 patients not treated, all in hemodialysis, were studied by echocardiography at beginning and at the end of 3 consecutive dialysis sessions. Ejection fraction increased with hemodialysis in all patients of the control group. A slight and not significant decrease of ejection fraction was observed, as average, in the r-HuEPO treated patients. But, more in detail, 20 patients on r-HuEPO showed a worsening of systolic function with hemodialysis; in the other 14 patients on r-HuEPO, as in not treated control patients, systolic function improved. A significant difference between the two sub-groups on r-HuEPO was the higher drug dose requirement, associated with a slightly lower haemoglobin concentration, both observed in patients with decreased ejection fraction after hemodialysis. Moreover, a close relationship between higher r-HuEPO requirements and worsening of systolic function was observed. This trend is not associated with adequacy of dialysis and malnutrition. Patients with higher r-HuEPO requirement share a worse cardiac adaptation to hemodialysis and slightly lower haemoglobin levels.

Adaptation, Physiological↗
PubMed1994

[Effects of atrial fibrillation on the increase of atrial natriuretic peptide in congestive heart failure].

Aim of the study was to assess possible differences in ANP levels between patients with congestive heart failure (CHF) with and without chronic atrial fibrillation (AF). We studied 12 patients with chronic AF and 17 patients with sinus rhythm (SR), (m 16, f 13, years 67.7 +/- 8.6), with CHF, not hypertensive, without valvular or congenital heart disease, NYHA class II-III, by ANP RIA and echocardiography. Left atrial (LA/m2) dimensions were significantly higher in patients with AF, and ANP was also more increased in AF. Significant linear correlations between heart rate and ANP, ANP and LV shortening fraction and ANP and A/E ratio, assessed by Doppler trans-mitral flow, were observed in SR but not in AF patients. A significant correlation between ANP and left ventricular mass g/m2 was observed only in AF. Higher ANP levels seem associated with left ventricular enlargement, assessed as left ventricular mass, in AF patients; in SR patients, higher ANP levels are associated with depressed systolic function and with decreased left ventricular compliance. Rate dependent ANP incretion seems blunted in chronic AF; neurogenic heart rate control and/or coordinated atrial systoles may be ANP modulators in sinus rhythm CHF.

Aged↗
PubMed1992

[Functional evaluation of the left ventricle in chronic pulmonary heart disease].

20 patients (18 m., 2 f., age 64.8 +/- 6.3 years), with chronic pulmonary heart disease (CPHD) secondary to chronic obstructive pulmonary disease and/or arterial hypertension were studied in comparison with a control group of subjects, age and sex matched, with normal respiratory function tests and without heart disease. CPHD patients did not show any difference of left ventricle (LV) systolic function, assessed by echocardiography, in comparison with the control group. However, among CPHD patients, significant correlations were found between lower arterial pH and cardiac output/m2 and between spirometric tests of bronchial obstruction and echocardiographic parameters of LV function. These results confirm that LV function in CPHD is maintained if other pathologic conditions are absent. On the other hand, correlations between echocardiography and spirometry and blood gas analysis strengthen the functional interdependence concept between left and right heart chambers.

Aged↗
PubMed1989

Isolated congenital left ventricular diverticulum.

We describe a patient with congenital left ventricular diverticulum as an isolated lesion. The patient was asymptomatic until adult life and the diagnosis was apparent on cross-sectional echocardiography. The finding was confirmed by cardiac catheterisation.

Adolescent↗
PubMed1989

[Correlative evaluation of electrocardiographic changes and spirometric parameters in pulmonary cardiopathy secondary to chronic obstructive bronchopneumopathy].

EKG is not considered a sensitive procedure for diagnosis of chronic pulmonary heart disease (CPHD). We performed a correlative study between EKG signs and spirometry in chronic obstructive pulmonary disease (COPD). Fifty-six consecutive in-patients (M 52, F 4, age 59.1 +/- 13.1 yrs) with COPD and echocardiographic/roentgenologic signs of right ventricular enlargement were studied. An EKG score system (0-6) was developed considering: 1) AQRS greater than or equal to 90 degrees; 2) P waves greater than or equal to 2.5 mm; 3) R wave V1 greater than or equal to 7 mm or R/S V1 greater than or equal to 1; 4) R/S V5 less than or equal to 1; 5) RV strain pattern; 6) RBBB. Significant (p less than 0.01) linear correlations were observed between: a) AQRS vs FEV1 (r = -0.59); b) AQRS vs FEV1/FVC% (r = -0.61); c) R/S V5 vs FEV1, (r = +0.38); d) EKG score vs FEV1 (r = -0.42); e) EKG score vs FEV1/FVC% (r = -0.40). Significant relationship between EKG score and spirometry suggests that this criterium can be useful for a more reliable ecg diagnosis of CPHD.

Aged↗
PubMed1989

[Antiphospholipid antibody syndrome: description of a case].

A case of anti-phospholipids auto-antibodies syndrome is reported; it was an unusual expression of Systemic Lupus Erythematosus (SLE). The patient is a 38 years old woman, with a history of recurrent peripheral thrombosis, pulmonary and cerebral embolism, thrombocytopenia, abortions; moreover she suffered from arterial hypertension, and headache. Features of onset, with several episodes of relevant clinical severity and the long period without clinical and laboratory hallmarks of SLE suggest a serious caution in the diagnosis of "pure" anti-phospholipids auto-antibodies syndrome.

Adult↗