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J Anconina

Publications and source records attributed to J Anconina.

At least 19 recordsLinked to original sources
PubMed1995

[Transluminal coronary angioplasty in patients with left ventricular dysfunction; immediate and long term results].

Transluminal coronary angioplasty is increasingly performed in patients with left ventricular dysfunction. However, there is little data available concerning the outcome of these patients. The aim of this retrospective study was to assess the immediate and long-term results in 90 patients (76 men and 14 women) with left ventricular ejection fractions < or = 35% (average 29 +/- 5%) undergoing angioplasty between 1980 and December 1992. Eighty-seven patients (96%) had a history of infarction, 27 (30%) had already at least one episode of left ventricular failure and 34 (38%) had unstable angina at the time of angioplasty. The coronary disease was usually multi-vessel. A total of 118 lesions were dilated with a primary success rate of 77% (91/118): 86% (82/95) in non-occlusive stenoses and 39% (9/23) in complete obstructions. The total success rate per procedure was 72% (65/90) with a hospital mortality rate of 5.5% (5 cases). The mean follow-up period was 53 +/- 47 months. Twelve patients died during this period and two were lost to follow-up. The total and cardiovascular mortality at the end of the study was 19% (17/88). Eight of the 71 survivors underwent another revascularisation procedure (4 bypasses and 4 angioplasties); 21 (29%) have stable angina, 50 (71%) have no anginal pain and 61 (86%) have antianginal treatment. The probability of survival at one and four years was 81 +/- 4% and 79 +/- 5%, respectively. A multivariate analysis using the Cox model showed three independent prognostic factors for long-term mortality: triple coronary vessel disease, the best predictive factor, left ventricular ejection fraction and female gender.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1995

Comparative effects of atenolol and clonidine on polygraphically recorded sleep in hypertensive men: a randomized, double-blind, crossover study.

The effects on sleep of atenolol and clonidine were compared in 8 hypertensive men (mean age 46.9 years, range 16-56 years) without prior history of sleep disturbances. Polygraphic sleep recordings were performed at baseline (NO) and after a single oral dose of atenolol (100 mg) or clonidine (0.15 mg) at 6:00 pm at a 48-hour interval in a double-blind randomized crossover protocol. Both medications lowered arterial pressure to a similar extent. The subjective quality of sleep was judged satisfactory after both medications, the number of patients reporting dreams decreased from 5 (NO) to 1 after each treatment night. Total sleep time decreased slightly but not significantly after atenolol (440 +/- 63 min vs 474 +/- 47 min at baseline). Sleep latency was not affected after atenolol but significantly decreased after clonidine (16.9 +/- 21.6 vs 28.6 +/- 16.6 at baseline, p < 0.02). Although rapid-eye movement (REM) sleep time decreased after atenolol (71 +/- 30 min vs 95 +/- 30 min at baseline, p < 0.05), the percentage of REM sleep was unchanged (22 +/- 7% vs 23 +/- 5%). In contrast, clonidine strikingly reduced both REM sleep time (54 +/- 28 min vs 95 +/- 30 min at baseline, p < 0.002) and percentage of REM sleep (14 +/- 6% vs 23 +/- 5%, p < 0.0005). Thus atenolol tends to decrease total sleep time but does not affect the normal architecture of sleep, clonidine has a marked hypnotic effect, similar to that of some sedative medications and significantly reduces REM sleep.

Adolescent↗
PubMed1995

[Is percutaneous transluminal coronary angioplasty in chronic total coronary occlusion justified? Long term results in a series of 201 patients].

Percutaneous transluminal coronary angioplasty of chronic total coronary occlusions has a low primary success rate and is associated with a high percentage of restenosis. The aim of this retrospective study was to assess the long-term benefits of these procedures. In a series of 201 patients with 203 chronic total occlusions, the technical success rate was 51%, the clinical success rate was 46% with 3% of major complications. The only factor associated with a favourable outcome was the presumed duration of the occlusion. The clinical follow-up period was established at 6 years. The result of the initial procedure was used to establish two groups of patients: group I, clinical success, and group II, clinical failure. Patients in group I had a probability of survival greater than that of those in group II (97 vs 92%; p < 0.05); survival without coronary bypass surgery was also significantly better (89 vs 74%; p < 0.003). On the other hand, the probability without angioplasty was less in group I (70 vs 77%; p < 0.01), the result of a high restenosis rate (48%). A Cox analysis identified clinical success of angioplasty as a good prognostic factor for survival. Moreover, the clinical status at long-term was significantly better in patients in group I. These results indicate that in patients with chronic total coronary occlusions, the success of angioplasty has a favourable effect on long-term outcome both in terms of survival and in quality of life. They must be interpreted in the light of the limitations inherent in a retrospective study and should be confirmed by prospective trials.

Aged↗
PubMed1994

Effect on early acute occlusion rate of adjunctive antithrombotic treatment with intravenously administered dipyridamole during percutaneous transluminal coronary angioplasty.

This study compared the acute occlusion and complication rates within 24 hours of coronary angioplasty in three groups of patients. In group 1, 178 procedures were performed by one operator who administered 30 mg of dipyridamole intravenously over 1 hour, starting immediately before the procedure; in group 2, 200 procedures were performed by the same operator before he administered dipyridamole; and in group 3, 599 procedures were performed during the same time period in the same catheterization laboratory by two other operators who did not administer dipyridamole. All patients received an intravenous bolus of heparin and aspirin. Baseline variables were similar in the three groups. The acute closure rate was 2.8% in group 1, 7.5% in group 2, and 5.2% in group 3 (p < 0.05 between groups 1 and 2); acute thrombosis was observed in 0.6%, 3.5%, and 3% of patients, respectively, in the three groups (p < 0.05 between group 1 and both groups 2 and 3), and acute dissection was noted in 2.2%, 4%, and 2% of patients, respectively (p = not significant). The cumulative rate of acute complications (death, acute myocardial infarction, or emergency coronary bypass surgery) was lower in group 1 (1.7%) than in group 2 (5.5%, p < 0.05) and group 3 (3.5%, p = not significant). Therefore in this retrospective study, adjunctive antithrombotic treatment with intravenously administered dipyridamole resulted in lower acute thrombosis and complication rates during the 24-hour period after the procedure than when heparin and aspirin therapy were used alone.

Acute Disease↗
PubMed1994

Long-term follow-up after coronary angioplasty in patients younger than 40 years of age.

Over an 11-year period, the initial and late outcomes of percutaneous transluminal coronary angioplasty (PTCA) were studied in 140 consecutive patients younger than 40 years of age (mean, 34 +/- 3 years; range, 23 to 39 years; 132 men). Before the procedure, 28% of the patients had unstable angina, and 44% had a history of prior myocardial infarction. Mean left ventricular ejection fraction was 64% +/- 10%, and 75% of the patients had one-vessel disease. Primary success was 86% (77% for the first 70 patients vs 93% for the last 70, p < 0.02). Complications were nine periprocedural myocardial infarctions, eight emergency coronary surgical procedures, and no deaths. During follow-up (mean, 6 +/- 3 years; range, 1 to 12 years), 39 (28%) of the 104 patients who had repeat coronary angiography had angiographic restenosis (all < 6 months after PTCA). Late events were 13 elective coronary surgical procedures (11 for restenosis, one for failed PTCA, and one for progression of coronary artery disease), 13 PTCAs on a new site, five deaths, and four nonfatal myocardial infarctions. Ten-year survival was 96% +/- 1%, and 10-year event-free survival (without myocardial infarction, elective coronary surgery, or repeat PTCA) was 58% +/- 6%. Among survivors, 88% were free of angina, and 93% had returned to work. In patients younger than 40 years of age, PTCA yields excellent long-term survival, provided that the eventuality of repeat procedures during the first months is accepted. In addition, PTCA for progression on a new site is not unusual after several years.

Adult↗
PubMed1994

[Influence of the severity of coronary stenosis on the course of left ventricular function in case of subsequent coronary occlusion. Longitudinal coronarographic study].

In order to evaluate the consequences concerning left ventricular function of the spontaneous occlusion of coronary stenoses, the authors studied the clinical and angiographic characteristics of 30 consecutive patients (25 men, 5 women, mean age: 54) undergoing successive coronary arteriograms showing progression to complete occlusion of the anterior interventricular or right coronary between the two investigations. Two groups of patients were identified: Group I (n = 19) with occlusion of a previously moderate (< or = 50%) stenosis; Group II (n = 11) with occlusion of an initially tight stenosis (> 50%). At the time of the first angiogram, left ventricular ejection fraction (LVEF) was 60 +/- 13% in Group I and 58 +/- 9% in Group II (NS). Times between the two investigations were similar in the two groups (58 +/- 43 months and 54 +/- 57 months, NS). Between the two coronary arteriograms, 7 patients of Group I sustained an infarction as against 3 in Group II (NS). Impairment of LVEF developed in 16 patients of Group I (84%) as against 5 of Group II (45%) (p < 0.005). Global LVEF varied on average by -10.4 +/- 13.3% (p < 0.005) in Group I and -0.1 +/- 9.5% (NS) in Group II. This difference in variation in LVEF between the two groups was significant (p < 0.04). Spontaneous occlusion of moderate coronary stenoses results in certain cases in greater impairment of left ventricular function than the occlusion of tight stenoses. The development of a collateral circulation probably plays a protective role in the second group.

Adult↗
PubMed1994

[Systemic embolism and aortic atheroma. Contribution of transesophageal echography. Apropos of a case of systemic embolism caused by cholesterol crystals].

Systemic embolisms involving cholesterol crystals sometimes occur following vascular catheterization and may be responsible for a variety of clinical signs. The authors report a case in which the etiological diagnosis included a transesophageal echography (TEE) which revealed atheromatous plaques on the thoracic aorta which were probably responsible for the projections. It is possible that episodes of embolism, either fibrinocruoric or due to the release of cholesterol crystals, arising from the thoracic aorta, have hitherto been underestimated by imaging methods such as scans and angiographs. Further studies with TEE may make it possible to estimate the extent of this disorder.

Aged↗
PubMed1993

Results of percutaneous transluminal coronary angioplasty of either the left anterior descending or left circumflex coronary artery in patients with chronic total occlusion of the right coronary artery.

The acute and long-term results of percutaneous transluminal coronary angioplasty (PTCA) of the left coronary artery in 106 patients (group 1) with chronic occlusion of the right coronary artery were compared with those of 106 patients matched for sex (92 male) and age (56 +/- 10 years) undergoing left PTCA with a normal right coronary artery (group 2). Before the procedure, group 1 had more unstable angina (42 vs 29%; p < 0.05), more frequent prior myocardial infarction (80 vs 25%; p < 0.001), and a lower left ventricular ejection fraction (56 +/- 10% vs 65 +/- 11%; p < 0.005). Acute results were not different in the 2 groups with respect to primary success (group 1: 93%; and group 2: 89%) and complications (group 1: 2 with emergency coronary surgery, and 4 with periprocedural myocardial infarction and no death; and group 2: 1 with emergency coronary surgery, 1 death, and 3 with periprocedural myocardial infarction). At 6 months, 79 patients in group 1 and 71 patients in group 2 had reangiography; the rate of restenosis was 35% in group 1 and 42% in group 2. In both groups, left ventricular ejection fraction increased significantly in patients without restenosis (58 +/- 12% vs 63 +/- 10%, p < 0.001 [n = 44] in group 1; and 66 +/- 9% vs 70 +/- 10%, p < 0.001 [n = 29] in group 2). In group 1, improvement was significant only for patients without collaterals to the occluded right coronary artery (59 +/- 10% vs 66 +/- 7%; p < 0.003 [n = 24]).(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon, Coronary↗
PubMed1993

Usefulness of exercise SPECT-thallium to detect asymptomatic restenosis in patients who had angina before coronary angioplasty.

The usefulness of exercise single photon emission computed tomography (SPECT)-thallium for detecting asymptomatic restenosis was assessed prospectively in 62 patients with angina before angioplasty, who underwent < or = 6-month re-angiography and exercise SPECT-thallium imaging. Among patients with restenosis, nine had recurrence of angina but eight did not. These two subgroups had equivalent percentages of restenosis (71 +/- 16% vs 64 +/- 16%, NS) and extent of reversible thallium defects (2.8 +/- 1.7 vs 4.1 +/- 2.6, NS), and both subgroups had poorer hemodynamic responses to exercise compared with patients without restenosis (maximal) rate-pressure product [X 100], 258 +/- 54 and 239 +/- 33 vs 302 +/- 61; p < 0.05 and p < 0.01, respectively). Exercise testing detected fewer patients with restenosis compared to exercise SPECT-thallium imaging, especially among asymptomatic patients (25% vs 100%, p < 0.005). Asymptomatic restenosis occurs frequently, induces an amount of stress ischemia equivalent to that of symptomatic restenosis, and is efficiently detected by exercise SPECT-thallium with rest-reinjection but not by exercise testing.

Aged↗
PubMed1993

[Outcome of Doppler parameters of left ventricular systolic function during atrial stimulation as a function of coronary disease].

The authors studied the effects of transoesophageal atrial pacing on Doppler parameters derived from flow in the left ventricular out flow tract (maximal velocity (V max), velocity-time integral (VTI), mean acceleration of aortic flow (Acc), acceleration force (AF) of the left ventricle). These parameters were recorded in patients with normal left ventricular wall motion at rest, with and without coronary disease. Eight patients had angiographically normal coronary arteries (Group 1) and 21 had coronary disease (Group 2) including 10 with an isolated stenosis of the left anterior descending artery (Group 2a) and 11 with multivessel disease (Group 2b). The heart rate was increased by increments of 20 beats per minute from 90 to 130 each minute. In coronary patients, atrial pacing resulted in a fall in V max from 0.99 +/- 0.15 to 0.90 +/- 0.12 m/s, p < 0.0005 and in AF from 23.1 +/- 6.3 to 19.6 +/- 4.8 Kdynes, p < 0.0005, whereas the Acc remained stable (13.51 +/- 3.27 and 13.53 +/- 2.47 m/s/s, NS). Conversely, V max (1.04 +/- 0.11 and 1.04 +/- 0.11, NS) and AF (25.2 +/- 5.7 and 26.3 +/- 6.7, NS) were unchanged in normal controls and the Acc improved from 13.87 +/- 3.61 to 17.04 +/- 3.49, (p < 0.05). The VTI fell significantly in both groups. The percentage variations of V max, Acc and AF were significantly different in coronary patients compared with normal controls. There were no differences between the two coronary subgroups.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1993

[Immediate and long-term results of coronary transluminal angioplasty in patients under 35 years of age].

Over an eleven year period, 57 patients under 35 years of age underwent percutaneous transluminal coronary angioplasty (PTCA). The features of the study population were: 55 men and 2 women, average age 32 +/- 3 years; unstable angina in 30%, previous myocardial infarction in 53%, average left ventricular ejection fraction 59 +/- 12%, single vessel disease in 84%. A total of 63 vessels were dilated. The primary success rate was 81% (72% in the first 29 patients compared with 89% in the latter 28 patients, p = 0.1). The following complications were observed: peri-procedural infarction (4 cases), emergency coronary bypass surgery (4 cases), no fatalities. During follow-up (average 6 +/- 3 years), of the 43 patients who underwent control coronary angiography in the last 6 months, 14 (33%) had angiographic restenosis. The long-term outcome was marked by 5 coronary bypass operations (3 for restenosis, 1 after failure of PTCA and 1 for progression of the coronary disease), 8 PTCAs for a new lesion due to progression of the coronary disease, 2 deaths and 2 non-lethal infarctions. The 10 year survival was 96 +/- 3% and the survival rate without cardiac events (infarction, surgical revascularisation or repeat PTCA) was 62 +/- 10% at 10 years. Of the 54 survivors, 50 (92%) have no angina, and 44 (81%) continue to take antiischaemic drug therapy. Of the 50 patients who were in full employment, 37 (74%) have gone back to full-time working and 8 (16%) have taken part-time jobs. (ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Irreversible auriculo-ventricular block of viral origin].

Transitory disturbances of atrioventricular conduction are an usual feature of the acute phase of viral myocarditis. In contrast, the onset of complete heart block is rarer. The authors report a case of permanent heart block of progressive onset in a context of infectious mononucleosis in a 29-year-old male, requiring fitting with a permanent pacemaker. A long term follow-up visit confirmed the irreversible nature of the conduction disturbance.

Adult↗
PubMed1992

[Vasomotor disorders in the atherosclerotic coronary artery. Are there practical repercussions today?].

The 1980s have brought increasing evidence that coronary vasomotricity has a major role in the pathophysiology of stable angina pectoris. Specifically, it has been shown that mediators such as serotonin have opposite effects on normal and atherosclerotic coronary arteries, resulting in vasodilation and increased coronary blood flow in the former and vasoconstriction with decreased flow in the latter. Other studies have shown that, even in patients with stable angina, coronary vaso-constriction is likely to trigger clinical episodes of angina. In this regard, the adjunction of coronary vasodilator medications to medications reducing myocardial demand might prove useful in patients with stable angina.

Acetylcholine↗
PubMed1992

[Transluminal coronary angioplasty in patients over 75 years of age. Immediate and long-term results].

Over a 4-year period, 120 transluminal coronary angioplasties were performed in 102 patients older than 75 years. There were 56 men and 46 women aged from 75 to 89 years (mean: 78 +/- 3 years) presenting with the following characteristics: left ventricular ejection fraction 60 +/- 11 percent; severe angina (class III or IV) 86 percent; history of myocardial infarction 43 percent; one-vessel lesion 39 percent; 66 percent of the arteries dilated were calcified. Altogether, 158 vessels (1.3 per procedure) were dilated: 1 vessel in 74 percent of the patients, 2 in 20 percent and 3 in 6 percent. The primary success rate was 80 percent per lesion (126/158 lesions) and 77 percent per procedure (92/120 procedures). This primary success rate was significantly higher when the stenosis dilated was not calcified (88 versus 75 percent, P < 0.05) and in cases with stenosis rather than complete occlusion (83 versus 53 percent, P < 0.01). Three patients died (3 percent) and 9 (7.5 percent) developed infarction with Q wave, but no emergency bypass was needed. The first 79 patients could be followed up for a mean period of 23 +/- 13 months (range: 8-61 months), and no patient was lost sight of. During that period, 11 patients died (including 7 of cardiac cause), 2 had a non-lethal infarction, 7 underwent distant aortocoronary bypass and 18 had a second angioplasty for restenosis. The long-term survival rate (Kaplan-Meier) was 83 +/- 6 percent at 4 years (90 percent when the angioplasty was successful and 73 percent when it failed; P < 0.02). Among the 65 survivors, 73 percent no longer had angina, 96 percent are in the New York Heart Association class I or II, and 92 percent are still on oral anti-angina therapy. Thus, transluminal coronary angioplasty can be performed in very old patients with good efficacy and an acceptable complication rate. The improvement obtained persists for a long time when the angioplasty is successful.

Aged↗
PubMed1992

Percutaneous transluminal coronary angioplasty in patients more than 75 years old: early and long-term results.

Over 4 yr, 102 consecutive patients more than 75 yr old (56 men, 46 women; mean age 78 +/- 3 years, range: 76-89 years) underwent 120 percutaneous transluminal coronary angioplasty procedures. At baseline, 86% had severe anginal symptoms (Canadian class III or IV), 43% had a history of prior myocardial infarction; 61% had multivessel coronary artery disease, and mean left ventricular ejection fraction was 60 +/- 11%. Calcifications were observed on 66% of the dilated arteries. A total of 158 vessels (1.3 vessel per procedure) were attempted: 1 vessel in 89 procedures (74%), 2 vessels in 24 (20%) and 3 vessels in 7 (6%). The primary success rate was 80% per lesion (126/158) and 77% per procedure (92/120). Complications included 3 deaths (3%), 9 Q-wave infarctions (7.5%) and there was no emergency coronary bypass surgery. The primary success rate was significantly related to the absence of coronary calcifications on the dilated segment (88% versus 75%, p < 0.05) and to the initial patency of the dilated artery (subtotal stenosis: 83% versus total occlusion: 53%, p < 0.05). Follow-up data were obtained in the 79 consecutive patients with a duration of follow-up exceeding 8 months. The mean duration of follow-up was 23 +/- 13 months (range 8 to 61 months). No patient was lost to follow-up; 11 patients died (cardiac causes: 7), 2 had a non-fatal infarction, 7 had aortocoronary bypass surgery and 18 had repeat percutaneous transluminal coronary angioplasty.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

Impact of finite orifice size on proximal flow convergence. Implications for Doppler quantification of valvular regurgitation.

Analysis of velocity acceleration proximal to a regurgitant valve has been proposed as a method to quantify the regurgitant flow rate (Qo). Previous work has assumed inviscid flow through an infinitesimal orifice, predicting hemispheric isovelocity shells, with calculated flow rate given by Qc = 2 pi rN2vN, where vN is user-selected velocity of interest and rN is the distance from that velocity to the orifice. To validate this approach more rigorously and investigate the impact of finite orifice size on the assumption of hemispheric symmetry, numerical and in vitro modeling was used. Finite-difference modeling demonstrated hemispheric shape for contours more than two orifice diameters from the orifice. More proximal than this (where the measured velocity vN exceeded 3% of the orifice velocity vo), flow was progressively underestimated, with a proportional error delta Q/Qo nearly identical to the ratio of contour velocity to orifice velocity, vN/vo. For the in vitro investigations, flow rates from 4.3 to 150 cm3/sec through 0.3 and 1.0 cm2 circular orifices were imaged with color Doppler with aliasing velocities from 19 to 36 cm/sec. Overall, the calculated flow (assuming hemispheric symmetry) correlated well with the true flow, Qc = 0.88Qo-7.82 (r = 0.945, SD = 12.2 cm3/sec, p less than 0.0001, n = 48), but progressively underestimated flow when the vN approached the orifice velocity vo. Applying a correction factor predicted by the numerical modeling, delta Q was improved from -13.81 +/- 13.01 cm3/sec (mean +/- SD) to +1.54 +/- 5.67 cm3/sec.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Circulation↗