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Biomedical subjects

G Mattioli

Publications and source records attributed to G Mattioli.

At least 19 recordsLinked to original sources
PubMed1992

Effectiveness of the antihypertensive action of lisinopril on left ventricular mass and diastolic filling.

The effect of antihypertensive treatment with lisinopril (10 to 20 mg) on left ventricular mass and diastolic function was studied in 35 patients with mild to moderate hypertension. At baseline 6 and 12 months after treatment responders to lisinopril were examined by complete echo Doppler in order to measure left ventricular mass, diastolic and systolic function. Only 30 patients concluded the study follow-up. Lisinopril successfully reduced mean blood pressure (from 122 +/- 10 to 110 +/- 11 mmHg), without modification in heart rate, and left ventricular mass index (from 145 +/- 57 to 116 +/- 42 g.m-2) at month 6, with mild additional reduction at month 12. Isovolumic relaxation time was reduced but still abnormal at months 6 and 12, whereas deceleration time significantly changed only (from 230 +/- 40 to 195 +/- 35 msec) at month 12. Our results indicate that lisinopril is more successful in reducing left ventricular mass than in improving diastolic filling.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1992

Effect of antihypertensive treatment with nitrendipine on left ventricular mass and diastolic filling in patients with mild to moderate hypertension.

Nitrendipine is a dihydropyridine calcium antagonist that may be active when administered once daily. The aim of the study was to assess the effect of antihypertensive treatment with nitrendipine (20-40 mg) on left ventricular mass and diastolic function. Forty patients with mild to moderate hypertension (diastolic pressure greater than or equal to 90 and less than or equal to 114 mm Hg) were enrolled; a complete echo Doppler examination was performed at baseline, and 8 and 12 months after treatment in order to measure left ventricular mass and diastolic and systolic function. Only 28 patients completed the study follow-up. At month 8 nitrendipine had already successfully reduced blood pressure (mean 122 +/- 9 to 92 +/- 10 mm Hg) without modifying heart rate, and left ventricular mass index (150 +/- 48 to 123 +/- 34 g/m2), with a further reduction at month 12. Isovolumic relaxation time was reduced at month 8 from 138 +/- 28 to 111 +/- 17 ms, but the diastolic pattern was completely modified only after 1 year, with a normalization of deceleration time (from 220 +/- 35 to 188 +/- 12). Systolic function did not change. Our results indicate that nitrendipine is a powerful antihypertensive agent that reduces left ventricular mass, but requires a longer period of time to improve diastolic filling pattern.

Adult↗
PubMed1992

[Influence of the neurohumoral system on left ventricular performance in chronic congestive heart failure].

he influence of the neurohumoral system, as adrenergic system or renin-angiotensin system, on cardiac performance in heart failure is not yet know. In order to evaluate the influence of neurohumoral activation in chronic heart failure we followed 51 patients, 47 males and 4 females of mean age 58 +/- 10 years. They suffered from chronic heart failure of different origin and were classified according to NYHA classification: 42 patients were in class III and 9 were in class II. They were treated with digoxin and diuretics since long time. Ejection fraction (EF) was obtained by RVG at baseline and 8 months later. In order to test the influence of adrenergic system on EF we checked plasmatic norepinephrine levels and we divided the patients in two groups: Group A with high levels of plasmatic norepinephrine (1114 +/- 594 pg/ml) and Group B with normal level (426 +/- 139 pg/ml). Group A showed a reduction of EF (-3.73 +/- 1.27%) while, Group B showed a small increase of EF (+ 2.57 +/- 4.32%). To test the influence of renin-angiotensin system we also evaluated the patients according to the value of plasmatic renin activity: normal or high level. We did not observe a significant difference between the 2 groups. Patients with high plasmatic norepinephrine value presented a significant reduction of EF compared to those with low plasmatic norepinephrine. The adrenergic system seems to be more important than renin-angiotensin system or cardiac performance.

Aged↗
PubMed1991

[Caloric substrates in postoperative parenteral nutrition].

The paper describes the carbohydrate, lipidic and nitrogen metabolism of the postoperative period which is subdivided into an early and a late phase. Since the metabolism of caloric substrates in the early postoperative period is a stress metabolism with glucose intolerance and wide protein catabolism, the authors emphasise that an insufficient caloric intake is worse than the fasting state and suggest that alternative caloric sources, such as branched chain amino acids, fatty acids and, even, ketonic bodies, should be used.

Amino Acids, Branched-Chain↗
PubMed1991

[Computerized analysis of esophageal manometry].

Computerized analysis of esophageal manometry should consider the following objectives: a) objectivation of data acquisition; b) precision in calculating the various parameters; c) speed of analysis; d) an easy-to-read and promptly understandable graphic display of the manometric data; e) computation of new parameters capable of defining normal and pathologic function. It is with these objectives in mind that we launched our research project. Five normal subjects and 10 patients, of whom 5 presented esophageal achalasia and 5 gastroesophageal reflux disease, underwent computerized esophageal manometry and were evaluated on the basis of both traditional and innovative parameters, of our own inception. Among the various indexes tested, the "Esophageal transport" parameter, calculated as the ratio of momentum (dp*dT) over speed of propagation of the esophageal contractions, gave rise to particular interest. In our opinion, this parameter can be used as an index of the dynamic function of the organ.

Adult↗
PubMed1991

Right ventricular pacing and left ventricular filling pattern. An echo-Doppler study.

The influence of right ventricular pacing on left ventricular filling has not been completely clarified. The aim of the study was to analyze the possible alteration in and effects on left ventricular filling resulting from right ventricular pacing. The study population consisted of two groups; group A was comprised of 12 patients with a spontaneous left bundle branch block, and group B had 12 patients without left bundle branch block. All the patients underwent an interrogation of the mitral valve inflow by Doppler echocardiography, in order to measure isovolumic relaxation time, early and late peak velocity (E and A wave), E/A ratio and deceleration time. The study was performed at spontaneous rhythm and after, inhibition of the pacemaker. In group A, there were no changes in the Doppler parameters when passing from a spontaneous to an 80/min electrically induced rhythm. Analysis of group B revealed a statistically significant lengthening of IVR and Dec t with electrical stimulation. No statistically significant differences were found when we compared the Doppler parameters of the two populations at the same pacing frequency. Right ventricular pacing causes interventricular asynchrony and abnormalities in diastolic filling times, which resulted in a lengthening of either IVR and Dec t, simulating a pattern of abnormal relaxation.

Aged↗
PubMed1991

[Tolerance of beta blockader treatment in dilated cardiomyopathy].

We studied 78 consecutive patients with dilatative cardiomyopathy who were in our hospital because of heart failure. We wanted to evaluate which parameters could be useful in identifying patients who could be treated with betablockers. All patients were hemodynamically well balanced. They were treated with effective dosage of digoxin and diuretics. We evaluated the following hemodynamic parameters: heart rate, mean arterial pressure, mean pulmonary arterial pressure (MPAP), right atrial pressure, pulmonary wedge pressure, cardiac output, cardiac index, systemic vascular resistance, pulmonary vascular resistance, and also the neurohumoral parameters: VO2, max exercise duration, plasmatic norepinephrine levels (NE) and plasmatic renin activity (PRA). Then all patients were treated with atenolol 25 mg/die followed by 50 mg/die. In the overall population, 37 patients well tolerated the therapy with betablocker (Group A); 41 patients did not tolerate the therapy (Group B). Between the 2 groups we only found a significant difference in MPAP 31 +/- 20 vs 51 +/- 31 mmHg (p = 0.02), NE 781 +/- 467 vs 1551 +/- 1249 pg/ml (p = 0.01), PRA 1.8 +/- 2.9 vs 5.6 +/- 4.5 ng/ml/h (p = 0.02). On the basis of our results we hypothesize that patients with high neurohumoral activation do not tolerate betablocker treatment.

Adrenergic beta-Antagonists↗
PubMed1991

[Neurohumoral changes in patients with heart failure treated chronically with beta-blockers].

Long-term beta-blocker therapy may be useful in some patients affected by chronic heart failure. In a group of 15 patients with chronic heart failure of different origin we evaluated clinical, hemodynamic and neurohormonal features after 1 year of therapy. All patients were treated with atenolol at dosage of 50 mg/die. We observed a better ejection fraction by radionuclide angiography after 1 year of treatment. There was an increase of exercise time and VO2 max evaluated by cycloergometer test. There was a decrease of mean pulmonary artery pressure, of pulmonary vascular resistance and of right atrial pressure. Plasmatic norepinephrine decreased from 1294 +/- 568 to 574 +/- 33 pg/l. Our results suggest that patients who well tolerated chronic beta-blockade show an improvement of performance parameters.

Adrenergic beta-Antagonists↗
PubMed1990

Atenolol in dilated cardiomyopathy: a clinical instrumental study.

The usefulness of beta blockers in the treatment of congestive heart failure has been questioned. We selected 11 patients, mean age 47.1 +/- 13.8, affected by dilated cardiomyopathy in NYHA class III, who had been taking digoxin and diuretics for a long time. Atenolol 50 mg was added to conventional therapy. Both before and 3 months after treatment a clinical evaluation, chest x-ray, an exercise test, and an echocardiogram were performed. We observed an improvement of NYHA class in five patients. However, the exercise test showed no improvement: 2310 +/- 1299 vs. 2902 +/- 983 total kgm (ns). The echocardiogram showed improvements of the end-systolic diameter (from 6.3 +/- 1 cm to 5.9 +/- 0.8 cm; p less than 0.02), the fractional shortening (from 13.6 +/- 6.3% to 15.2 +/- 5.6%; p less than 0.05) the radius/thickness ratio (from 4.14 +/- 0.5 to 3.5 +/- 0.5; p less than 0.05), and the wall stress (from 208.4 +/- 49 g/cm2 to 163.5 +/- 41 g/cm2; p less than 0.02). The inotropic state index did not show any changes. We conclude that in some patients with dilated cardiomyopathy beta blockers may improve the clinical status and left ventricular performance.

Atenolol↗
PubMed1990

[Hemodynamic effects of the nitroprusside test in chronic congestive heart failure treated with long-term beta blocking therapy].

In patients with congestive heart failure (CHF) sympathetic reflexes are attenuated because of down regulation of beta receptors. Many Authors suggest that betablockers therapy can be useful in selected patients. We wanted to test if betablockers therapy could modify sympathetic reflex during nitroprusside test. We studied 20 patients: 10 were healthy volunteers and 10 were affected by CHF of different origin. They were divided in 4 groups in relation to therapy. During nitroprusside infusion we evaluated the following parameters: heart rate (HR), mean arterial pressure (MAP), mean pulmonary arterial pressure (MPAP), pulmonary capillary wedge pressure (PCWP), right atrial pressure (RAP), cardiac index (CI), systemic vascular resistance (SVR), pulmonary vascular resistance (PVR). In normal subjects we observed that the heart rate increased and the PAM and SVR decreased significantly. Betablockers therapy did not modify hemodynamic response of PAM and SVR, while we did not find any modification of the heart rate. In patients with CHF we observed a decrease of PAM, MPAP, SVR and PVR. Betablockers therapy in CHF did not modify the hemodynamic response to nitroprusside test. This effect is probably due to beta adrenergic receptor down regulation that decrease the responsiveness to sympathetic stimulation evoked by vasodilatation.

Adrenergic beta-Antagonists↗
PubMed1990

[Hemodynamic effects of the cold pressor test in patients with heart failure treated with beta blockers for a long time].

In congestive heart failure (CHF) the beta-adrenoceptor density and functional responsiveness is markedly reduced presumably due to endogenous down-regulation. In the last few years evidence has accumulated that betablockers therapy can improve clinical condition in selected patients with CHF. To evaluate sympathetic response in CHF we measured hemodynamic effects of cold pressor test. This study was composed by 20 patients, 10 with CHF of different origin and 10 healthy volunteers. They were divided into 4 groups in relation to therapy. We evaluated the modification of the following hemodynamic parameters during cold pressor test: heart rate, mean arterial pressure, mean pulmonary arterial pressure, pulmonary capillary wedge pressure, right atrial pressure, cardiac index, systemic vascular resistance, pulmonary vascular resistance. In normal subjects we observed hemodynamic modification of heart rate, mean arterial pressure and systemic vascular resistance according to many other Authors. In atenolol-treated subjects the sympathetic response is strongly attenuated. Patients with CHF not treated with betablockers showed an increase in heart rate and in systemic vascular resistance and a reduction of cardiac index. Chronic treatment with atenolol did not modify heart rate response to cold pressor test. The mean arterial pressure increased while the systemic vascular resistance did not show any significant modification. We observed a trend to increase of the cardiac index; this could explain the beneficial effect of betablockers therapy in selected patients.

Adrenergic beta-Antagonists↗
PubMed1990

[Magnetic resonance imaging in non-Q wave infarction].

The aim of this study is to evaluate magnetic resonance (MR) as a clinical tool to identify the site of non-Q myocardial infarction, when other techniques are inadequate. Ten patients underwent MR examination 3 - 15 days after the onset of symptoms. The examinations were performed with a General Electric 1.5 Tesla II unit, by means of ECG-gated MR imaging. The 10 patients were 35 to 56 years of age, 9 were men. In 5 patients it was the first myocardial infarction, in 5 patients the second. MR allowed us to identify the site of myocardial infarction: 5 inferior, 1 posterior, 2 postero-inferior, 1 apical, 2 subendocardial. Thus the MR examination is suggested in non-Q myocardial infarction to detect the site and the extent of the infarct. The MR is useful when echocardiography is technically non adequate or when it is not possible to identify regional wall motion abnormalities. We suggest to use this technique in patients with coronary artery bypass and in patients with multiple infarctions.

Adult↗
PubMed1989

Echocardiographic monitoring of mental stress test in ischemic heart disease.

Mental stress testing can induce ischemia in coronary patients, but often may not induce chest pain and/or electrocardiographic changes. Therefore, we tested the utility of echocardiography to increase the sensitivity of the method. For this purpose, 56 patients undertook arithmetic mental stress tests and then were subjected to coronary angiography. During the test we evaluated left ventricular function, electrocardiography results, and emotional involvement measured by STAI (State Trait Anxiety Inventory). Echocardiography was positive in 21 patients, and electrocardiogram only in 2 patients. No patient complained of chest pain. The remaining 35 patients were negative. Comparing echo data with coronary angiography, in all the cases, sensitivity was 73.5%, specificity 93.3%. Analysis of the STAI revealed that the negative test we observed could be due to a low stressor efficacy. In conclusion, echocardiography in mental stress testing permits improved sensitivity, with loss of specificity in comparison with conventional electrocardiographic monitoring.

Coronary Disease↗
PubMed1989

The long-term efficacy of ibopamine in treating patients with severe heart failure: a multicenter investigation.

This randomized, double-blind, placebo-controlled, multicenter trial compared the effects of treatment with ibopamine with those of placebo in patients with severe heart failure who still showed symptoms although they were receiving standard therapy with digitalis and diuretics. The results showed a significant and sustained improvement in exercise tolerance (+70% about in average), clinical condition, and NYHA functional class and a decrease in cardiothoracic ratio and left ventricular end-systolic wall stress in patients treated with ibopamine, digitalis, and diuretics (group 1) compared with patients treated with digitalis, diuretics, and placebo (group 2).

Adult↗
PubMed1989

[Effects of infusions of different doses of dopamine in dilated cardiomyopathy. Observations during and after treatment with beta-blockers].

It is well known that there are abnormalities of the sympathetic nervous system in chronic congestive heart failure. The aim of our study was to verify the effects on heart rate, blood pressure and some echocardiographic parameters of performance and inotropic state of iv infusion of dopamine at different dosages in 14 patients affected by dilated cardiomyopathy. The patients were divided into 3 groups: the first one of patients on standard treatment, the second of subjects on standard treatment and beta blockers, the third of patients who stopped beta blocker therapy and remained on standard therapy. In the first group dopamine at low dosage did not significantly modify heart rate, blood pressure, performance and contractile state, while it did decrease end systolic wall stress. In the second group the same dosage significantly decreased blood pressure and stress, maintaining unchanged the other indexes; the same behaviour was presented by the third group. At high dosage dopamine in the first group significantly increased blood pressure, ejection fraction, contractility and stress. No modifications were observed in the second group, probably because of a pharmacological inhibition of beta receptors. The third group showed a significant increase in blood pressure, stress and inotropic state. From our data it appears that dopamine treatment in chronic congestive heart failure may reveal the presence of the so-called "down regulation" phenomenon.

Adrenergic beta-Antagonists↗
PubMed1989

[Acute hemodynamic effects of nicardipine in patients with chronic congestive heart failure].

We evaluated haemodynamic parameters in 13 patients suffering from chronic heart failure (CHF) in III and IV NYHA class. They were 10 males and 3 females, average age 57 +/- 11 years. Haemodynamic monitoring was made at basal condition and for 40 min after the administration of nicardipine (10 mg iv). We observed that mean arterial pressure and systemic vascular resistances (SVR) showed an important decrease (respectively -10.8%, p less than 0.001 and -22%, p less than 0.001); total pulmonary resistances (TPR) also decreased (-16.6%, p less than 0.001), while mean pulmonary pressure did not show significant reduction. Cardiac index increased with the highest value at the fifteenth minute (-11.7%, p less than 0.01). Pulmonary wedge pressure (PWP) did not show statistic variations, and heart rate too. Cardiac index (CI) did not rise in 3 patients with clinical worsening during the monitoring (patients non responders) (CI increase was less than 15%); while in 10 patients CI increased more than 15% (patients responders). Patients non responders did not show any decrease of TPR and only a transitory reduction of SVR; patients responders showed an important decrease of TPR, SVR, PWP. We observed that at baseline, the difference between the 2 groups was based on the value of TPR and PWP. We conclude that nicardipine is an efficient drug in patients affected by CHF without severe hemodynamic failure.

Aged↗