Biomedical subjects

Giuseppe Tarantini

Publications and source records attributed to Giuseppe Tarantini.

24 records · Page 2Linked to original sources

PubMed2003

Aortic valve replacement in severe aortic stenosis with left ventricular dysfunction: determinants of cardiac mortality and ventricular function recovery.

OBJECTIVE: The influence of left ventricular (LV) dysfunction on survival of patients with severe aortic stenosis is poorly characterized. Few data are available about preoperative predictors of cardiac mortality and LV function recovery after aortic valve replacement of such patients. The aim of our study was to examine the outcome and the preoperative predictors of postoperative cardiac death and of LV function recovery in these patients. METHODS: We evaluated 85 consecutive patients with severe aortic stenosis (aortic valve area <1 cm(2)) and severe depression of LV ejection fraction (EF) <35% at cardiac catheterization. Among them, 52 underwent aortic valve replacement and they were compared to patients who were not operated on. All patients had a mean clinical follow-up of 53 months and 94% of them had a mean echocardiographic follow-up of 14 months after aortic valve replacement. RESULTS: The mean baseline characteristics included: LVEF 28+/-6%, peak-to-peak transvalvular gradient 51+/-29 mmHg, aortic valve area 0.63+/-0.25 cm(2). Thirty-three patients did not undergo aortic valve replacement: 32 of them died within 3 years. Fifty-two patients underwent aortic valve replacement and 16 had a concomitant coronary bypass surgery. In-hospital mortality was 8%. Postoperative NYHA functional class changed from 2.84+/-0.67 to 1.43+/-0.44 (P<0.001) and LVEF from 29+/-6% to 43+/-10% (P<0.001). At follow-up 10 patients died of heart disease. By multivariate analysis, preoperative LV end-systolic volume index (ESVI) was the only covariate of cardiac death (LVESVI/10 ml/m(2), OR 1.3, CI 1.1-1.8, P<0.028). By using a receiver operating characteristic curve, LVESVI< or =90 ml/m(2) was the best cut-off value (sensitivity and specificity 78%) to fit with a better survival (93% vs. 63%, P<0.01) and with LVEF recovery after aortic valve replacement (EF improved by 15+/-10% vs. 8+/-5%, P<0.001). CONCLUSIONS: Despite LV dysfunction, aortic valve replacement appears to change drastically the natural history of severe aortic stenosis. Preoperative LV levels predict different postoperative survival rate and LVEF recovery.

Adult↗

PubMed2003

Gender differences in left ventricular function in patients with isolated aortic stenosis.

BACKGROUND AND AIM OF THE STUDY: Hypertrophic response of the left ventricle to systolic overload in aortic stenosis appears to be gender-dependent. METHODS: To examine gender-related differences in left ventricular (LV) function in patients with isolated severe aortic stenosis, 145 patients (65 women, 80 men; mean age 66 +/- 8 years; range: 50 to 89 years) with aortic valve area <0.8 cm2 who underwent cardiac catheterization were studied. No patient had associated myocardial, coronary or other valve disease; patients with diabetes mellitus and systemic hypertension were excluded. RESULTS: No significant differences were seen in aortic valve area between men and women. Neither were there any significant gender-related differences in LV end-systolic and end-diastolic volumes, LV end-diastolic pressure, LV mass indexed by body surface area, LV mass:volume ratio, LV mass:height ratio, elastic stiffness constant, ejection fraction, pulmonary wedge pressure, pulmonary arteriolar resistance and preload. Women showed significantly higher mean transaortic gradient, LV peak systolic pressure and peak systolic stress, end-systolic stress:end-systolic volume ratio, heart rate and cardiac index. In the subgroup of patients with LV pressure >199 mmHg, the mass:volume ratio was increased in men compared with women; of note, the mass:volume ratio in women was not increased in this subgroup compared with the general population. LV pump function in this subgroup was normal and did not differ between men and women. CONCLUSION: Although no clear-cut difference in hemodynamic parameters was seen, there was a trend towards a less compensatory increase in LV mass in females.

Adaptation, Physiological↗

PubMed2003

Insulin-treated diabetes mellitus and predictors of mid-term clinical outcome after percutaneous coronary interventions with stent implantation.

BACKGROUND: Patients with type II, insulin-dependent diabetes mellitus have a high risk of death and repeat revascularization following successful percutaneous coronary interventions. The predictors of outcome in such patients after coronary stenting have not been clarified. METHODS: We studied 133 consecutive patients with type II, insulin-dependent diabetes mellitus who underwent coronary stenting from November 1992 to May 2001. The clinical outcome and predictors of major adverse cardiac events (MACE; that is death, myocardial infarction, target vessel revascularization) at follow-up were assessed. RESULTS: Out of 133 patients, 102 (76%) had multivessel (> or = 2 vessels) disease. Eight patients (6.0%) had in-hospital MACE. Clinical follow-up data at 19.5 months (range 6.1-100 months) were available for 121 (91%) patients. The MACE rate was 40.5%; 22 patients (18%) died, 17 (14%) of a cardiac death; 7 (5.8%) patients had a myocardial infarction, and target vessel revascularization was performed in 35 (28.9%) patients. At univariate analysis, hypertension (odds ratio-OR 5.5; confidence interval-CI 2.5-12.3; p < 0.001), hypercholesterolemia (OR 3.7; CI 1.7-8.2; p = 0.001), a prior percutaneous coronary intervention (OR 6.6; CI 2.9-15.4; p < 0.001), a prior myocardial infarction (OR 3.1; CI 1.5-6.7; p = 0.003) and the stent length (> or = 15 mm) (OR 2.7; CI 1.5-4.3; p = 0.008) were related to MACE. At multivariate analysis, hypertension (OR 4.1; CI 1.7-9.9; p = 0.002), a prior percutaneous coronary intervention (OR 4.8; CI 1.9-12; p = 0.001) and the stent length (OR 3.0; CI 1.3-7.4; p = 0.01) remained as independent predictors of MACE. CONCLUSIONS: Patients with insulin-dependent diabetes mellitus continue to face a high mortality and incidence of adverse events after stenting. The occurrence of events was related to a history including hypertension, percutaneous coronary interventions and to the stent length.

Aged↗

PubMed2002

[When is valve stenosis considered to be critical?].

The aim of the present paper was to determine why mitral stenosis is considered critical when the valve area is < or = 1 cm2, and an aortic stenosis when the valve area is < or = 0.8 cm2. An area-resistance curve was drawn for 490 patients with mitral stenosis, and for 525 with aortic stenosis. All points lie on the same curve, but mitral stenosis fell in the low resistance, while aortic stenosis fell in the high resistance section. Critical stenosis respectively begins and ends at the point of curve inflection, i.e. where the valve resistance increases or decreases sharply.

Aortic Valve Stenosis↗

PubMed2002

Refractory angina with severe left ventricular dysfunction: a case for percutaneous transseptal ventricular assistance supported revascularization.

A 73-year-old female patient with medical refractory angina, severe multivessel disease and a critically depressed left ventricular function (ejection fraction 30%) was admitted to our hospital. Considered a poor candidate for surgical revascularization, she underwent urgent high-risk revascularization supported by use of a novel percutaneous left ventricular assist system.

Aged↗

PubMed2002

Effect of renal artery stenting on the progression of renovascular renal failure: a case of intravascular ultrasound-confirmed renovascular disease.

We report the case of a 71-year-old male, submitted to percutaneous transluminal renal angioplasty (PTA) plus stent implantation following the confirmation, at intravascular ultrasound, of severe unilateral renal artery stenosis in the setting of a single functional kidney and of evidence of renal insufficiency (serum creatinine value 300 mumol/l). At 6 months of follow-up the serum creatinine levels had returned to normal (98 mumol/l). This case shows the role of direct PTA on the overall renal function in a case of global renal ischemia.

Aged↗