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Biomedical subjects

L Campolo

Publications and source records attributed to L Campolo.

At least 37 records · Page 2Linked to original sources
PubMed1991

Exercise electrocardiography versus dipyridamole echocardiography testing in coronary angioplasty. Early functional evaluation and prediction of angina recurrence.

Recently, we have shown the usefulness of high-dose dipyridamole echocardiography testing (DET) as an exercise-independent method for the evaluation of patients having coronary angioplasty. The purpose of the present study was to determine the value of DET compared with exercise testing in the early functional evaluation after successful percutaneous transluminal coronary angioplasty (PTCA) and in the prediction of late recurrence of angina. We performed DET and exercise testing in 52 consecutive patients both before and after successful PTCA. Criteria of positivity for DET were transient dyssynergy absent or negligible in the baseline examination and exercise testing for an ST segment shift greater than 0.1 mV from baseline. All patients had an angiographically successful PTCA: the percent stenosis went from 78 +/- 7% before to 30 +/- 7% after PTCA. Exercise testing was positive in 49 and 29 patients, respectively, before and after PTCA (94% versus 44%, p less than 0.001). DET was positive in 47 patients before and in 10 after PTCA (90% versus 19%, p less than 0.001). Recurrence of angina was found in 18 patients: 14 of 23 with positive and four of 29 with negative exercise testing after PTCA. With DET, recurrence of angina was found in eight of 10 patients with positive and 10 of 42 with negative DET after PTCA.(ABSTRACT TRUNCATED AT 250 WORDS)

Angina Pectoris↗
PubMed1990

[Comparison of 6 and 8 French catheters for arterial catheterization and coronarography: prospects of the development of coronarography in ambulatory care].

The aim of this study was to evaluate day-hospital coronary angiography as a valid method to reduce hospital recovery costs and patient waiting lists. We evaluated its technical feasibility by randomizing sixty hospital patients. These were divided into two groups, and 6 or 8 French Judkins of Amplatz coronary angiography catheters were used for each group following the Judkins technique. Patients were invited to walk after four hours. Local complications, the number of catheters used, their stability and maneuverability, as well as the radiological resolution of the image were evaluated. No major cardiac complications occurred. One transient cerebral ischemic episode during 6F coronary angiography was quickly resolved by medical therapy. Two local haemorrhages and three cases of hypotension were observed in the 8 French group, while minor bleeding phenomena were similar in both groups (3 vs 5). Differences occurred in local haematoma incidence after 24 hours (13 in 8F vs 2 in 6F); there was no difference in the number of catheters used, the completion time of the examination, or the radiological resolution. Maneuverability and stability of the 6F group were reduced, but not so much as to compromise examination. The AA concluded that 6F catheters are useful in day-hospital coronary angiography, with a similar examination quality, and a reduction in local complication.

Aged↗
PubMed1990

[A prospective study of the evolution of coronary lesions: clinico-morphologic correlations].

In order to evaluate the evolution (progression and regression) of coronary atherosclerosis, 61 patients (8 with stable angina, 9 with unstable angina, 15 with a recent myocardial infarction, 29 with multivessel coronary artery disease and treated with successful one-vessel angioplasty) were enrolled in a prospective study. In the angioplasty group, only untreated vessels were considered for the analysis. All patients underwent coronary angiography before hospital discharge and after one year, in accordance with the study protocol. In 13 patients (21%) a repeat angiography was performed at 6.3 +/- 2.7 months for clinical reasons (myocardial infarction, changing pattern angina, angina recurrence). All patients were asymptomatic or mildly symptomatic on medical therapy between the angiographic studies. Progression (decrease in internal luminal diameter at the site of stenosis greater than or equal to 20%; new onset of lesions, new episodes of total occlusions) was found in 16 out of 216 stenoses (7%) and in 14 out of 61 patients (23%). Regression (increase greater than or equal to 20% in internal luminal diameter; reopening of a previously occluded vessel) was found in 11 out of 227 lesions (5%) and in 7 out 61 patients (11%). At repeat angiography, the increase in severity was found more frequently in stenoses greater than 5 mm in length and with a reduction of greater than or equal to 75% in luminal diameter. Regression was more frequent in the occluded vessel supplying a recently infarcted area. No significant relationship was observed between lesion morphology (concentric, eccentric, with plaque ulceration, thrombi, border irregularities) and progression or regression. Lesions with plaque ulceration (with or without superimposed thrombi) were found only in patients submitted to coronary angiography close to an acute ischemic attack. Morphologic regression (disappearance of ulceration, border irregularities, thrombi) was also observed, without any significant changes occurring in the severity of the underlying stenosis. Progression may occur independently of worsening in the clinical status; on the contrary, regression was only found in patients without new cardiac events. Nevertheless, clinical status does not seem to be closely correlated to progression, regression, or changes in plaque morphology.

Angina Pectoris↗
PubMed1989

Exercise testing and dipyridamole echocardiography test before and 48 h after successful coronary angioplasty: prognostic implications.

The purpose of the present study was to determine the value of exercise testing (ET) and dipyridamole echocardiography test (DET) in the early functional evaluation after a successful coronary angioplasty (PTCA) and in the prediction of angina recurrence. 52 patients underwent ET and DET before and 48 h after a successful PTCA. During a 6-12 month follow-up period they all underwent clinical evaluation. Before PTCA, ET was positive in 49 of 52 patients (94%) and new asynergies were detected by DET in 47 of 52 patients (90%). 48 h after PTCA 23 patients (44%) had positive ET results and 10 had a positive DET response. During the follow-up, 17 patients experienced recurrence of angina. Positive predictive value (PPV) for angina recurrence of ET and DET performed early after the PTCA were, respectively, 57 and 80%. The PPV of ET increased to 88% when electrocardiographic (ECG) positivity was accompanied by angina. Negative predictive values of ET and DET were, respectively, 86% and 79%. Early after PTCA, exercise ECG positivity was not predictive of symptom recurrence while ECG positivity associated with angina revealed a high PPV, similar to that of DET.

Angioplasty, Balloon, Coronary↗
PubMed1989

Usefulness of high-dose dipyridamole echocardiography test in coronary angioplasty.

Seventy-four consecutive patients with angina undergoing single-lesion percutaneous transluminal coronary angioplasty were evaluated with high-dose (up to 0.84 mg/kg during 10 minutes) dipyridamole echocardiography test (DET) before angioplasty and when possible, afterward. Angioplasty was clinically or angiographically successful in 63 patients and unsuccessful in 11. Before the procedure, 69 patients had a positive DET. Of these 69 patients, six with clinicall unsuccessful angioplasty had a dipyridamole time (i.e., the time from the onset of dipyridamole infusion to development of asynergy) lower than the 63 patients with clinically successfully angioplasty (4.2 +/- 2.9 vs. 7.0 +/- 2.9 minutes, mean +/- SD, p less than 0.01). In the five patients with angiographically unsuccessful angioplasty (residual stenosis diameter, greater than 50%), coronary stenosis decreased from 89 +/- 10 to 69 +/- 22 (p = NS); DET was positive in all five before and in four of the five after the procedure (100% vs. 80%, p = NS). In the 63 patients with angiographically successful angioplasty, coronary stenosis diameter was reduced from 85 +/- 9% to 30 +/- 10% (p less than 0.01). DET was positive in 58 patients before and in only 16 after the procedure (92% vs. 25%, p less than 0.01). In the 16 patients with positive DET, before and after angioplasty, dipyridamole time increased from 5.6 +/- 2.2 before to 7.3 +/- 2.4 minutes immediately after the procedure (p less than 0.05). After an average follow-up time of 10.8 +/- 5.9 months, angina recurred in eight of 47 patients with negative DET after angioplasty and in 11 of 16 patients with positive DET (17% vs. 69%, p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon↗
PubMed1989

[Multiple coronary arteriovenous fistulas in a patient who had an orthotopic heart transplant].

We report the case of a young man who underwent orthotopic heart transplant at the De Gasperis Centre in May 1986. The patient, who was affected by Becker myopathy, was started on an immunosuppressive regimen consisting of cyclosporin and prednisone. The initial postoperative period was complicated by 2 moderate-severe rejection episodes which were treated successfully with i.v. steroids and rabbit anti-thymocyte globulin; after this period he was clinically well. On his first annual post-transplantation admission in February 1987 he was normotensive. Cardiac catheterization revealed normal hemodynamic status, completely normal coronary arteries and good left ventricular function. On re-admission in May 1989 the patient did well; he had a normal clinical status. No heart murmur was heard. Cardiac catheterization revealed abnormal right ventricular function (restrictive-constrictive physiology), normal cardiac index, apical hypokinesia of left ventricle with E.F. of 0.57. No QP/QS was detectable by oximetry. Coronary angiography showed the presence of a multiple coronary fistula. The latter arose from septal perforation of the left anterior descending artery and from the conus branch of the right coronary artery, respectively; both drained into the right ventricle. The development of these coronary fistulas was interpreted as a sequela to repeat endomyocardial biopsy. This hypothesis is supported by the fact that this kind of fistula drains uniformly into the right ventricle and generally does not arise directly from a major coronary artery.

Adult↗
PubMed1988

Dipyridamole-thallium 201 scintigraphy in the early post-infarction period. (Safety and accuracy in predicting the extent of coronary disease and future recurrence of angina in patients suffering from their first myocardial infarction).

To evaluate the safety and usefulness of myocardial thallium-201 scintigraphy after intravenous dipyridamole during the early post-infarction period, 35 patients under 60 years of age and with recent first transmural uncomplicated myocardial infarction (27 inferior, 8 anterior) were examined between the 5th and 13th day of hospitalization. Although four patients experienced angina and transient ischemic ST depression during the test, there were no serious complications. Patients were followed for a mean period of 11.4 +/- 6.3 months after hospital discharge. None of the patients experienced recurrent infarction and there were no cardiac deaths. In 11 patients there were reversible perfusion defects in areas different from those of myocardial infarction. Of these patients, seven (one with infarct vessel stenosis only and six with multivessel coronary disease) developed angina during the follow-up: five underwent coronary surgery because of severe angina refractory to full medical therapy. Out of the 24 patients without reversible perfusion defects, only two (with multivessel coronary disease) showed typical angina symptoms. The presence of redistribution on thallium scans was significantly more frequent in patients who developed a recurrence of angina over a period of 11.4 +/- 6.3 months of follow-up (P less than 0.0005). Thus dipyridamole-thallium 201 scintigraphy is a safe, non-invasive stress test which may be used early following uncomplicated myocardial infarction in order to identify patients at risk for the recurrence of angina.

Adult↗
PubMed1987

[The Italian Group for the Study of Streptokinase in Myocardial Infarct: Coronarographic and ventriculographic study].

The effects of intravenous thrombolytic treatment on the reperfusion of infarct related coronary artery and left ventricular function were assessed in 251 pts. with first episode of myocardial infarction, enrolled in the G.I.S.S.I. trial, in which coronary angiography and left ventriculography have been performed within the second and third week from the onset of symptoms. A total of 251 pts. were randomized in two groups--133 treated with streptokinase (SK) and 118 controls. Among those treated with SK, in 71 (57.9%) the treatment was started within 3 hours and in 56 (42.1%) after 3 hours from the onset of symptoms. The infarct related vessel was occluded in 43 (32.3%) patients treated and in 60 (50.9%) controls (p less than 0.01). No significant difference was found in the left ventricular ejection fraction among the treated patients and controls while a significant difference resulted in the percentage of patients who had left ventricular ejection fraction greater than or equal to 50% in the group of patients with SK within 3 hours in comparison to controls. Left ventricular ejection fraction remained normal without any correlation with the type and time of the treatment, if the infarct related vessel resulted open at the coronary angiography. The study of the regional wall motion of left ventricle did not show any significant difference neither in the infarct size nor in the type and the time of treatment. In conclusion, the thrombolitic treatment with SK in acute myocardial infarction using the protocol adopted in the G.I.S.S.I. trial, obtains the reopening of infarct related vessel in an high percentage of patients; this event helps in great measure to conserve left ventricular function, especially in patients with anterior myocardial infarction if the treatment was started within the first 3 hours from the onset of symptoms.

Clinical Trials as Topic↗
PubMed1986

Indications for surgical treatment in post-infarction angina.

In order to evaluate whether or not criteria for surgical revascularization in patients with early post-infarction angina (EPIA) should be different from those commonly used for patients with angina, the incidence and prognostic implications of EPIA were analysed in 188 AMI patients in Killip's class I or II on admission. Sixty-two patients (33%) complained of EPIA (Group I) and 126 patients were symptom-free (Group II). There were no differences between the two groups in in-hospital and late mortality and reinfarction. On the contrary, severity of angina was significantly associated with the occurrence of in-hospital and late cardiac death, reinfarction and revascularization procedures. EPIA patients underwent revascularization procedures significantly more frequently than group II patients, both during hospitalization (29% versus 1%; P less than 0.001) and follow up (10% versus 1%; P less than 0.01). Coronary artery involvement was significantly more severe in group I than in group II and in the operated patients compared with the non-operated ones. Our data suggest that the severity of angina should be the leading criterion for surgery, as it is able to identify most of the patients with severe coronary artery disease and poor prognosis.

Aged↗
PubMed1985

[Myocardial revascularization in patients with severe ventricular impairment. Short-term follow-up].

To assess the influence of aorto-coronary bypass grafting on surgical risk and short-term survival of patients with marked impairment of left ventricular (LV) function, we evaluated--among 435 patients who underwent coronary bypass surgery between January 1981 and December 1982--22 cases with: LV ejection fraction (EF) less than or equal to 0.35 (mean 0.27 +/- 0.06), LV end-diastolic pressure greater than or equal to 15 mmHg (mean 19.9 +/- 6.9 mmHg.), presence of three or more dysfunctional (hypokinetic or akinetic) segments on biplane LV angiography, three vessels disease in 90.1%. All patients but two had angina refractory to medical therapy. Operative mortality rate was 4.5%. Perioperative non fatal infarction rate was 9.1%. There were three late deaths. Mean duration of follow-up was 10.5 +/- 8.3 months with a survival of 81.8%. In the survivors we observed: dramatic improvement in respect to angina (94.5% are asymptomatic) and quality of life; exercise performance improvement (75% of patients have a functional impairment less than or equal to 30% at treadmill test); significant improvement in global and segmental LV function (mean echocardiographic EF 0.37 +/- 0.10, p less than 0.001). Because of relative low surgical risk and encouraging short-term results, aortocoronary bypass grafting can be performed even in patients with important LV disfunction, when associated with severe angina.

Adult↗
PubMed1985

[Assessment of coronary stenosis by myocardial scintigraphy with thallium-201 after dipyridamol infusion].

After a 4 minute i.v. dipyridamole infusion (0.14 mg/Kg/min) serial Thallium-201 scans were obtained in 45 patients, without myocardial necrosis, undergoing coronarography. Twelve patients had effort angina, 6 rest angina, 14 effort associated with rest angina, 13 had atypical chest pain. Thirty-two patients had a 50% or greater stenosis of 1 or more coronary artery (8 had three vessels disease, 7 two vessels, 17 one vessel); 13 patients had no significant coronary stenosis ("control group"). The test induced electrocardiographic signs of ischemia in 18 patients, all with significant coronary stenosis, 15 of them experienced angina too. Sensitivity of Thallium-201 for detecting coronary artery stenosis was 94% (30 of 32) and specificity was 85% (11 of 13). In the group of the 17 patients with one vessel disease we obtained a sensitivity and specificity of 100% (17 of 17). We conclude that Thallium-201 myocardial imaging after pharmacologic vasodilatation with dipyridamole is a highly sensitive and specific test for detecting coronary artery stenoses without necessary overt ischemia. In fact dipyridamole, as consequence of its important coronary vasodilatation, produces differences in myocardial perfusion with relative perfusion defects detectable with Thallium-201 imaging.

Adult↗
PubMed1984

Percutaneous transluminal coronary angioplasty. Critical assessment of preliminary results.

Since June 1981 until July 1983, 40 percutaneous transluminal coronary angioplasty procedures in 38 patients have been performed. Results in the whole series are as follows: stenosis crossed in 33 patients (83%); balloon inflation done in 31 (78%), not done in 2 due to clinical instability induced by crossing of the stenosis; successful dilatation obtained in 25 patients (63%); emergency bypass surgery in 6 patients (15%) with 2 perioperative myocardial infarctions; no deaths. The whole series can be subdivided in two groups by the following parameters: premedication by nitrates (A) or by verapamil (B); temporal concentration of the procedures: 1/month up to February 83 (A), 3.7/month thereafter (B). Results are different in the two groups: 21 attempts in 21 patients: stenosis crossed in 14 cases (67%), balloon inflated in 12 (57%), successful dilatation obtained in 8 patients (38%), emergency bypass in 5 patients (24%). 19 attempts in 17 patients (2 vessel angioplasty in 2 patients): stenosis crossed and balloon inflated in 19 (100%), successful dilatation in 17 cases (89%), uncomplicated emergency bypass in 1 patient (5%). On the basis of personal more recent results an optimistic attitude towards the percutaneous transluminal coronary angioplasty is justified.

Angioplasty, Balloon↗
PubMed1984

[Long-term clinical results after intervention using aorto-coronary bypass].

The survival and symptoms of 294 consecutive patients discharged from the hospital after isolated coronary artery bypass grafting from 1970 to 1975 were evaluated 6 to 10 years after surgery. The actuarial 10 years expectancy of cardiac death as 10.0 +/- 2.4% the non fatal myocardial infarction one was 11.2 +/- 2.8; the yearly probability of severe ischemic event therefore was 2.1%. One year after surgery, 56% patients were free from angina, 31% improved and only 7% symptomatically unchanged. These percentages became 45%, 26% and 13% respectively at the end of the follow-up, thus showing a definite though slight deterioration. Clinical status one year after operation was predictive of further evolution: only 6.2% of the symptom-free patients developed severe ischemic events, as opposed to 20% of the highly symptomatic ones. The actuarially determined curve of recurrence of angina in the patients asymptomatic at the first control shows, after 2 years of steady state, a progressive upslope which reaches 40% by the 7th year and 90% at the 10th year of follow-up. Subgroup analysis indicated that long term prognosis is influenced by the presence of left main stenosis and by perioperative myocardial damage. Clinical results at one year are influenced by completeness of revascularization, graft patency and perioperative myocardial infarction. The tendency of symptoms to recur in patients who are free from angina one year after intervention, is similar in the various subgroups and is adversely influenced only by perioperative myocardial damage. These results show that coronary artery bypass grafting has a true clinical impact, although symptomatic improvement is somewhat temporary.

Actuarial Analysis↗