Biomedical subjects

Gennaro Cice

Publications and source records attributed to Gennaro Cice.

8 recordsLinked to original sources

PubMed2005

Prognostic value of intra-left ventricular electromechanical asynchrony in patients with hypertrophic cardiomyopathy.

AIMS: We sought to assess the indexes of myocardial activation delay, using Doppler myocardial imaging (DMI), as potential predictors of cardiac events in patients with hypertrophic cardiomyopathy (HCM). The distribution and magnitude of left ventricular (LV) hypertrophy are not uniform in patients with HCM, which results in heterogeneity of regional LV systolic function. METHODS AND RESULTS: The study population included 123 HCM patients (39.4+/-5.9 years) and 123 age- and sex-matched healthy subjects, followed up for 48.4+/-8.8 months. By use of pulsed DMI, the following regional parameters were evaluated in six different basal myocardial segments: myocardial peak velocities and systolic time-intervals; myocardial intraventricular (intra-V-Del) and interventricular (inter-V-Del) systolic delays. DMI analysis in HCM showed lower myocardial systolic and early-diastolic peak velocities of all the segments. As for time intervals, HCM showed significant inter- and intra-V delays (P<0.0001), whereas homogeneous systolic activation of the ventricular walls was assessed in controls. During the follow-up, 16 cardiac deaths (12 sudden deaths) were observed in HCM patients. InHCM, DMI intra-V-Del was the most powerful independent predictor of sudden cardiac death (P<0.0001). In particular, an intra-V-Del>45 ms is identified with high sensitivity and specificity in HCM patients at higher risk of ventricular tachycardia and sudden cardiac death (test accuracy: 88.8%). CONCLUSION: In HCM patients, DMI indexes of intra-V-Del may provide additional information for selecting subgroups of HCM patients at increased risk of ventricular arrhythmias and sudden cardiac death at follow-up. Accordingly, such patients may be more actively identified for early intensive treatment and survey.

Adult↗

PubMed2003

Carvedilol increases two-year survivalin dialysis patients with dilated cardiomyopathy: a prospective, placebo-controlled trial.

OBJECTIVES: We sought to evaluate the effects of carvedilol on mortality and morbidity in dialysis patients with dilated cardiomyopathy. BACKGROUND: Several lines of evidence support the concept that therapy with beta-blocking agents reduces morbidity and mortality in patients with congestive heart failure (HF), but the demonstration of such a survival benefit in dialysis patients with dilated cardiomyopathy is still lacking. METHODS: A total of 114 dialysis patients with dilated cardiomyopathy were randomized to receive either carvedilol or placebo in addition to standard therapy. A first analysis was performed at one year and was followed by an additional follow-up period of 12 months. RESULTS: Two-year echocardiographic data revealed a significant attenuation of pathologic remodeling, with smaller cavity diameters and higher ejection fractions in the active treatment group than in the placebo group. At two years, 51.7% of the patients died in the carvedilol group, compared with 73.2% in the placebo group (p < 0.01). Furthermore, there were significantly fewer cardiovascular deaths (29.3%) and hospital admissions (34.5%) among patients receiving carvedilol than among those receiving a placebo (67.9% and 58.9%, respectively; p < 0.00001). The exploratory analyses revealed that fatal myocardial infarctions, fatal strokes, and hospital admissions for worsening HF were lower in the carvedilol group than in the placebo group. A reduction in sudden deaths and pump-failure deaths was also observed, though it did not reach statistical significance. CONCLUSIONS: Carvedilol reduced morbidity and mortality in dialysis patients with dilated cardiomyopathy. These data suggest the use of carvedilol in all dialysis patients with chronic HF.

Adrenergic beta-Antagonists↗

PubMed2003

Right ventricular myocardial adaptation to different training protocols in top-level athletes.

OBJECTIVE: The aim of this study was to analyze right ventricular (RV) myocardial function in competitive athletes with left ventricular (LV) hypertrophy induced by either endurance or strength training. METHODS: Standard Doppler echo, maximal electrocardiogram (ECG) ergometric test, and pulsed tissue Doppler (TD) of LV mitral annulus and of RV tricuspid annulus were performed in 32 competitive endurance athletes (long-distance swimmers; ATE) and in 26 strength-trained athletes (short-distance swimmers; ATS), all males. By use of TD, the following parameters of myocardial function were assessed: systolic peak velocities (Sm), precontraction time, contraction time, early (Em) and late (Am) diastolic velocities, Em/Am ratio, and relaxation time. RESULTS: The two groups were comparable for age, but ATS at rest exhibited higher heart rate, systolic blood pressure, and body surface area. LV mass index did not significantly differ between the two groups. However, ATS characterized increased wall thickness and relative wall thickness, whereas LV stroke volume and both LV and RV end-diastolic diameters were greater in ATE. All transmitral and transtricuspid Doppler indexes were higher in ATE, with increased E/A ratios. TD analysis demonstrated in ATE higher Em and Em/Am ratio as well as longer relaxation time both at mitral and at tricuspid annulus level. In the overall population, distinct multiple linear regression models evidenced independent positive association between RV peak Em velocity and LV end-diastolic diameter (P < 0.001) as well as independent direct correlation of the same RV peak Em velocity with both LV stroke volume and maximal workload achieved by bicycle ergometer (both P < 0.001). CONCLUSIONS: Right ventricular early diastolic myocardial function is positively influenced by preload increase in athletes, and represents an independent determinant of cardiac performance during physical effort. Therefore, pulsed TD may be taken into account to distinguish different cardiac adaptation to either endurance or strength sport activities, and eventually to quantify RV adaptation degree to long-term training.

Adaptation, Physiological↗

PubMed2003

Different involvement of right ventricular myocardial function in either physiologic or pathologic left ventricular hypertrophy: a Doppler tissue study.

The aim of the study was to analyze right ventricular (RV) myocardial function in patients with left ventricular (LV) hypertrophy secondary to either hypertrophic cardiomyopathy (HC) or athletic endurance training. Doppler echocardiography and pulsed Doppler tissue imaging of the posterior septal wall, and mitral and tricuspid annulus were performed in 32 top-level endurance athletes (AT) and in 27 patients with HC, all men. LV mass index was comparable between the 2 groups. All transmitral Doppler indexes were higher in AT, whereas only tricuspid inflow peak E and E/A ratio were slightly decreased in the HC group. In the HC group, Doppler tissue analysis showed lower myocardial systolic and early-diastolic (Em) peak velocities, and longer time intervals at the level of all the analyzed segments, even after correction for age, heart rate, and LV mass index. Distinct multiple linear regression models revealed an independent positive association between RV peak Em velocity and LV end-diastolic diameter (beta coefficient = 0.72, P <.0001) in AT, and an independent inverse correlation of the same peak Em velocity of tricuspid annulus with septal thickness (beta = - 0.65, P <.001) in the HC group. Of interest, a RV Em peak velocity < 0.16 m/s differentiated AT and HC groups better than tricuspid Doppler (89% sensitivity and 93% specificity). In conclusion, Em RV myocardial function is positively influenced by preload increase in AT and negatively associated to increased septal thickness in patients with HC. Therefore, Doppler tissue imaging may represent a useful tool in the differential diagnosis between athlete's heart and HC, underlining the different involvement of RV myocardial function in either physiologic or pathologic LV hypertrophy.

Adult↗

PubMed2003

Sustained-release diltiazem reduces myocardial ischemic episodes in end-stage renal disease: a double-blind, randomized, crossover, placebo-controlled trial.

End-stage renal disease (ESRD) patients receiving maintenance hemodialysis and suffering from coronary artery disease (CAD) often receive doses of calcium channel antagonists that are too low. This may be the result of physician's desire to avoid adverse side effects during hemodialysis. The aim of this study was the assessment of the safety and efficacy of incremental doses of diltiazem for the treatment of myocardial ischemia in ERSD patients with CAD to identify the optimal dose of the drug. A total of 196 chronic hemodialysis patients were enrolled with CAD showing more than 5 min of transient myocardial ischemia during a 48-h Holter ECG monitoring. A double-blind, randomized, crossover, placebo-controlled trial design was used. Incremental doses of diltiazem (120 to 240 mg/d) were administered in 4 mo. With a dose of 120 and 180 mg/d, a significant reduction in the number and duration of total and symptomatic ischemic episodes was observed (P < 0.001), but the number and the duration of silent ischemic episodes were not reduced. Conversely, the efficacy on silent myocardial ischemia was obtained with a dosage of diltiazem of 240 mg/d (P < 0.001). In addition, with a sustained-release formulation (120 mg twice daily), the efficacy was similar to that obtained with four 60-mg tablets, but the safety was improved, especially during hemodialytic session. The circadian variations analysis of transient ischemic episodes showed a significant reduction in both ischemic peaks observed at baseline only with 240 mg/d of diltiazem. The findings emphasize that sustained-release diltiazem (120 mg twice daily) can be largely useful in uremic patients with CAD on maintenance dialysis. Diltiazem reduces the number and the duration of silent ischemic episodes, has a good tolerability, and positively modifies the circadian pattern of ischemic episodes.

Aged↗

PubMed2002

Association between left ventricular structure and cardiac performance during effort in two morphological forms of athlete's heart.

AIM: The aim of the study was to evaluate in 263 competitive athletes possible correlations between changes induced by different sport activities in left ventricular (LV) structure and cardiac response during maximal physical effort. METHODS: A total of 160 top-level endurance athletes (ATE; swimmers, runners; 28+/-4 years; 98 male) and 103 strength-trained athletes (ATS; weight-lifters, body-builders; 27+/-5 years; male), selected on the basis of training protocol (dynamic vs. static exercise), underwent standard Doppler echocardiography, heart rate variability analysis and maximal exercise stress test by bicycle ergometry. M- and B-mode echocardiographic LV measurements were determined at rest, while the following functional indexes were assessed during effort: maximal heart rate (HR), maximal systolic blood pressure (SBP) and maximal workload (Watts reached by bicycle test). RESULTS: The two groups were comparable for age and sex, but ATS at rest showed higher HR, SBP, and body surface area (BSA). By echo analysis, LV mass index and ejection fraction did not significantly differ between the two groups. However, ATS showed increased sum of wall thickness (septum+posterior wall), relative wall thickness and LV end-systolic stress, while LV stroke volume and LV end-diastolic diameter (P<0.01) were greater in ATE. HR variability analysis underlined in ATE increased indexes of vagal tone (P<0.01). During maximal physical effort, ATE showed a better functional capacity, with greater maximal workload (P<0.001) reached with lower maximal HR and SBP. After adjusting for HR, age, sex, BSA and SBP, distinct multiple linear regression models evidenced in ATE independent associations of maximal effort workload with LV end-diastolic diameter (P<0.001), HR (P<0.001) at rest and LV end-systolic stress (P<0.01) were found in ATE. On the other hand, independent direct correlation of SBP max during effort with sum of wall thickness (P<0.001), BSA (P<0.05) and LV end-systolic stress (P<0.001) was evidenced in ATS. CONCLUSIONS: LV structural changes in competitive athletes represent adaptation to hemodynamic overload induced by training and are consistent with different kinds of sport activity. Work capacity during exercise is positively influenced by preload increase in ATE, while increased afterload due to isometric training in ATS determines higher systemic resistance during physical effort.

Adult↗

PubMed2002

Effects of different training protocols on left ventricular myocardial function in competitive athletes: a Doppler tissue imaging study.

BACKGROUND: The aim of the study was to analyze the differences in myocardial function in case of left ventricular (LV) hypertrophy induced by either endurance or strength training in top-level athletes. METHODS: Standard Doppler echo and pulsed Doppler tissue imaging (DTI) of the interventricular septum and of the LV inferior wall were performed in 26 competitive endurance athletes (long-distance swimmers) (group A) and in 20 strength-trained athletes (short-distance swimmers) (group B). By means of DTI, the following parameters of myocardial function were assessed: the systolic peak velocities (Sm), the pre-contraction time, the contraction time, the early (Em) and late (Am) diastolic velocities, the Em/Am ratio and the relaxation time. RESULTS: The two groups were comparable for age and sex, but at rest group B showed a higher heart rate, systolic blood pressure and body surface area. The LV mass index and fractional shortening did not significantly differ between the two groups. However, group B showed an increased sum of the wall thicknesses (septum + posterior wall) (p < 0.001) and of the relative wall thickness, while the LV stroke volume and LV end-diastolic diameter (p < 0.001) were greater in group A. All transmitral Doppler indexes were higher in group A, with an increased E/A ratio. DTI analysis showed, in group A, a higher Em and Em/Am ratio as well as a longer relaxation time both at the septal and at the inferior wall levels, with comparable Sm, pre-contraction and contraction times. Distinct multiple linear regression models revealed an independent positive association between the inferior peak Em velocity and the LV end-diastolic diameter (p < 0.001) in group A, and an independent direct correlation of the inferior peak Sm velocity with the sum of the wall thicknesses (p < 0.001) and with the end-systolic stress in group B. CONCLUSIONS: The early diastolic myocardial function is positively influenced by the preload increase in group A, while an increased afterload and LV wall thickness in group B mainly seem to induce an enhancement of the regional myocardial systolic function.

Adaptation, Physiological↗

PubMedDate not supplied

Risk factors and underlying cardiovascular diseases in incident ESRD patients.

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of mortality and morbidity in dialysis patients. The aim of this study was to evaluate the prevalence of cardiovascular risk factors and of CVD on admission to hemodialysis. METHODS: Data were collected in 31 Italian clinics belonging to a clinic network using a prospective database (EuCliD), the main purpose of which is the support of quality assurance. Six hundred and thirty-six patients, mean age 63.9+/-15.4 years, admitted between January 1, 2000 and September 30, 2003, were separated into two groups on the basis of presence of CVD and observed for a median follow-up period of 16 months. RESULTS: In the CVD group, patients were significantly older and the percentage of diabetics and smokers was significantly greater than in the CVD-free group. There were no significant differences between the groups in term of uremia-related risk factors. According to logistic regression analysis evaluating the impact of traditional and nontraditional cardiovascular risk factors, only smoking habit (OR 1.87, 95% CI 1.25-2.79) and diabetes (OR 1.87, 95% CI 1.19-2.95) were associated with a higher relative risk for the presence of CVD at baseline. At the time of admission, CVD was present in 27% of patients. The following de novo development of CVD was observed: hypertensive disease (0.28 new cases/100 pt-years), ischemic heart disease (0.71 new cases/100 pt-years), other forms of heart disease (1.57 new cases/100 pt-years), disease of arteries, arterioles, etc. (1.85 new cases/100 pt-years) and cerebrovascular disease (0.71 new cases/100 pt-years). The rate of developing de novo CVD events was 3.70 per 100 patient-years. CONCLUSIONS: The prevalence of cardiovascular risk factors is already high at admission to dialysis. Despite the care provided to dialysis patients, a significant proportion of patients develop de novo CVD.

Aged↗