PubMed Health⌕ Search

Biomedical subjects

M G Modena

Publications and source records attributed to M G Modena.

At least 37 records · Page 2Linked to original sources
PubMed1997

Left atrial size is the major predictor of cardiac death and overall clinical outcome in patients with dilated cardiomyopathy: a long-term follow-up study.

HYPOTHESIS: This study was undertaken to determine whether echo-derived left atrial dimension and other echocardiographic, clinical, and hemodynamic parameters detected at the time of entry into the study may influence prognosis in patients with dilated cardiomyopathy during a long-term follow-up. METHODS: This was a prospective cohort analysis of 123 patients with dilated cardiomyopathy. Clinical evaluation, chest x-ray, M-mode and two-dimensional echocardiogram, exercise test, 72-h ambulatory electrocardiogram monitoring, and cardiac catheterization study were performed in all patients. The study was divided into two phases: in the first phase, patients were divided into two groups according to the left atrial size (> or = 45 mm; < 45 mm), with cardiac death as the end point. In the second phase, all patients were further divided into two groups according to their clinical course. A multivariate analysis was performed to determine independent correlated parameters of cardiac mortality and overall clinical outcome. RESULTS: Cardiac mortality rate was 47.9%: 29% in the group without left atrial dilation and 54.3% in the group with dilated left atrium. Multivariate analysis revealed that left atrium > or = 45 mm, New York Heart Association functional classes III/IV, and the presence of one or more episodes of ventricular tachycardia at Holter monitoring were independent predictors of cardiac mortality, while left atrium > or = 45 mm, left ventricular end-diastolic pressure > 17 mmHg, and exercise tolerance < or = 15 min were independent predictors of poor clinical outcome. CONCLUSIONS: Our results revealed that left atrial size is the principal independent predictor of prognosis in patients with dilated cardiomyopathy in that patients with left atrial dilation had an increase in mortality and a worse clinical outcome compared with those without left atrial dilation.

Adult↗
PubMed1997

Relationship between atrial function, left ventricular isovolumic relation time, and early filling in dual chamber-paced patients.

This investigation was performed to study atrial systolic function is response to modification of atrioventricular delay in a sample of 36 patients with a DDD pacemaker implanted for complete atrioventricular block. The relation between atrial systolic performance and diastolic-related parameters was also evaluated. Isovolumic relaxation time, early diastolic peak velocity, late (atrial) diastolic peak velocity, atrial filing fraction, and atrial ejection force were recorded at a pacing rate of 70 impulses/min and at atrioventricular delay of 200, 150, and 100 msec. Our data showed that the progressive shortening of atrioventricular delay induced a gradual increase in early peak velocity (median value 46 to 53 to 61.5 cm/sec, respectively, at 200, 150, and 100 msec intervals) and a gradual decrease in isovolumic relaxation time (median 92.6 to 81.5 to 69.7 msec at 200, 150, and 100 msec, respectively), atrial peak velocity (59 to 52 to 44.5 cm/sec at 200, 150, and 100 msec, respectively), atrial filling fraction (50.5% to 40% to 23.5% at 200, 150, and 100 msec, respectively), and atrial ejection force (17.2 to 14.7 to 8.5 kilodynes at 200, 150, and 100 msec, respectively). For every atrioventricular delay value detected, we found a significant correlation between isovolumic relaxation time and early peak velocity with atrial filling fraction and atrial ejection force. In addition, atrial ejection force was related directly to atrial filling fraction at studied atrioventricular delays. The two indexes of atrial systolic performance showed a parallel decrease by shortening the atrioventricular delay, and they can quantify atrial systolic performance equally in sequentially paced patients. Furthermore, our results are in accordance with the hypothesis that the interaction between the effectiveness of active left atrial emptying and isovolumetric relaxation time may play an important role in maintaining an ideal ventricular filling despite changes in atrial systolic function.

Aged↗
PubMed1997

[Changes in serum levels of N-terminal procollagen type III propeptide as an index of postinfarction ventricular remodeling].

The levels of aminoterminal propeptide of type III procollagen (PIIINP) can be used as an index of collagen breakdown. The aim of our study was to evaluate modifications in serum concentration of PIIINP (PIIINPs) in patients with a first episode of myocardial infarction. We examined 70 patients admitted at our Institution for acute myocardial infarction and 10 normal subjects. PIIINPs dosage was obtained by radioimmunoassay method utilizing a commercial available kit. All patients underwent three PIIINPs dosages: within 24 hours after admission, at 6 and 12 months after myocardial infarction. Control values were 0.4 +/- 0.1 U/ml. In 38 patients (Group I) PIIINPs levels increased at 6 and 12 months after infarction: 0.53 +/- 0.2, 0.75 +/- 0.2 and finally 0.76 +/- 0.1 U/ml. In the remaining 32 patients (Group II) PIIINPs values increased at 6 months and then returned to baseline at 12 months: 0.56 +/- 0.2, 0.75 +/- 0.1 and then 0.46 +/- 0.1 U/ml. The end-diastolic volume index did not change significantly in Group I (from 93.7 +/- 21 to 79.7 +/- 20 ml/m2) while it decreased after 12 months in Group II (from 88.9 +/- 13 to 58.6 +/- 11 ml/m2; confidence interval 95% from 2 to 55 ml/m2; p = 0.03). Similarly, there was no significant variation in end-systolic volume index (ESVI, from 39.7 +/- 11 to 36.9 +/- 11 ml/m2) and ejection fraction (from 60 +/- 10 to 59 +/- 15%) in Group I; while in Group II ESVI decreased significantly (from 33.6 +/- 13 to 20 +/- 5 ml/m2, confidence interval 95% from 3 to 24 ml/m2; p = 0.02) and ejection fraction improved (from 62 +/- 11 to 72 +/- 15%; confidence interval 95% from -20 to -1%; p = 0.04). In conclusion, patients with elevated levels of PIIINPs at 12 months did not improve ventricular function while patients with PIIINPs returning to baseline at 12 months had an improvement. Our results suggest an active participation of newly formed collagen in post-infarct ventricular remodeling. Therefore PIIINPs may be a marker of this process.

Collagen↗
PubMed1996

The importance of different atrioventricular delay for left ventricular filling in sequential pacing: clinical implications.

We assessed the influence and clinical consequences of different AV delay on ventricular filling in 30 patients (mean age 60 +/- 5 years) who had DDD pacemakers for AV block. All 30 patients presented a normal ejection fraction, but in 18 cases (Group I), an echo-Doppler examination revealed ventricular hypertrophy (mean end-diastolic wall thickness of 1.4 +/- 0.16 cm, LV mass index 155 +/- 17 g/m2), and an abnormal relaxation pattern (isovolumetric relaxation time = 124.72 +/- 11.82; early to late peak velocity = 0.6 +/- 0.03; deceleration time = 296.83 +/- 34.02 ms). Group II included the remaining 12 patients who had a normal filling pattern. In all 30 patients, the pattern was reassessed following modification of the AV delay (200, 150, 100, and 75 ms). Patients at baseline (AV delay of 200 ms) also underwent an exercise test with determination of respiratory gas exchange. In Group I, 13 (72.5%) patients were classified as Weber class B (VO2 Max 16.8 +/- 1.7 mL/min per kg); and 5 (27.5%) were Class A (VO2 Max 22.5 +/- 1.4 mL/min per kg). In Group II, all 12 patients were classified as Weber Class A. In Group II, changes in AV delay caused no consistent variations in filling pattern, and therefore AV delay was not modified. In Group I patients, since reduction to 100 ms resulted in normalization of the filling pattern, the AV delay was programmed to 100 ms. A graded exercise test repeated after 6 months' follow-up showed an improved Weber class in 13 patients (from B to A) and greater VO2 Max in the remaining five already in Class A. We concluded that, in sequential paced patients with normal ejection fraction but abnormal relaxation pattern, modification in AV delay can induce normalization of filling and improvement in cardiac functional capacity.

Aged↗
PubMed1996

[Shortening of atrioventricular interval improves ventricular filling and clinical outcome in patients with DDD pacemaker and left ventricular hypertrophy].

The influence and clinical consequences of different atrioventricular delays on ventricular filling have been studied in 30 patients (mean age 60 +/- 5 years) who implanted DDD pacemaker for complete A-V block. All patients presented a normal ejection fraction: 63.9 +/- 6.5%. In 18 subjects (Group I) an echo-Doppler examination revealed ventricular hypertrophy (mean end-diastolic wall thickness of 1.4 +/- 0.16 cm; left ventricular mass index 155 +/- 17 g/m2) and an abnormal relaxation pattern (isovolumic relaxation time 124 +/- 11: early to late peak velocity 0.6 +/- 0.03; deceleration time of the early diastolic peak 296 +/- 34 ms). Group II included the remaining 12 patients without left ventricular hypertrophy and normal filling pattern. In all 30 patients the filling pattern was reassessed following modification of the A-V delay (200, 150, 100 and 75 ms). Patients at baseline (200 ms of A-V delay) underwent an exercise test with determination of respiratory gas exchange. In Group I, 13 (72.5%) patients were classified as Weber class B (VO2 max 16.8 +/- 1.7 ml/min/kg) and 5 (27.5%) as class A (VO2 max 22.5 +/- 1.4 ml/min/kg). In Group II, all 12 patients were classified as Weber class A (VO2 max 23.1 +/- 1.1 ml/ min/kg). In Group II, changes in A-V delay caused no homogeneous variation in filling pattern. A-V delay was not modified in this group. In Group I, the reduction of A-V delay to 100 ms resulted in filling normalization. In this group A-V delay was programmed definitely to 100 ms. Graded exercise test repeated at 6 months follow-up showed an improved Weber class in 13 patients (from B to A) and greater VO2 max in the remaining 5 already in class A. We conclude that, in sequential paced patients with normal ejection fraction but abnormal relaxation pattern, a modification of A-V delay can induce filling normalization and improve cardiac functional capacity.

Atrioventricular Node↗
PubMed1994

Evaluation of the effectiveness of isradipine SRO in the treatment of hypertensive patients with left ventricular hypertrophy.

Myocardial hypertrophy is a response to many diseases, above all hypertension, that involves morphological and functional damage and may be the basis for the development of myocardial dysfunction. We attempted to verify the effectiveness of a new calcium antagonist, isradipine 5 mg SRO, on the reversal of left ventricular hypertrophy. For this purpose 13 hypertensive patients (pts) were treated for 12 weeks, which is the minimum period described in the literature for the regression of hypertrophy. At the end of the study, blood pressure in all patients returned to normal levels (mean blood pressure from 120.15 +/- 4.4 to 108 +/- 6.4 mmHg, p < 0.001); end-systolic stress (from 128 +/- 30 to 65 +/- 14 g/cm2, p < 0.001), and left ventricular mass index (from 142 +/- 31 to 97 +/- 23 g/m2, p < 0.001) showed significant reduction. Moreover, Doppler-derived indexes of left ventricular filling improved, particularly early to late peak velocity of the mitral valve (E/A ratio) and deceleration time (from 235 +/- 37 to 198 +/- 17 msec, p < 0.001), which were normalized after 12 weeks. In conclusion isradipine shows rapid effects in the reversal of morphofunctional damage in hypertension. For this reason it also appears to be useful for the treatment of myocardial hypertrophy in the absence of chronic hypertension.

Aged↗
PubMed1994

[Possible influence of hemodynamic and neurohormonal factors on the heart's response to arterial hypertension].

Hypertrophy represents a frequent but inconstant response of the heart to hypertension and probably other nonhemodynamic factors are involved. We have performed 2D and Doppler echocardiography and assessed of neurohumoral pattern in 85 untreated patients with hypertension (diastolic blood pressure: 101 +/- 12.8 mmHg). Left ventricular hypertrophy was defined as a mass index greater than 134 g/m2 in males and 110 g/m2 in females. Doppler evaluation of left ventricular filling pattern was performed to detect the possible association of hypertrophy and diastolic dysfunction. In all patients the following neurohumoral substances were sampled and tested: plasmatic renin activity (PRA), aldosterone and norepinephrine. At Doppler echocardiography, 27 patients had hypertrophy and diastolic dysfunction, 15 only hypertrophy and 43 only diastolic dysfunction. The presence or absence of morpho-functional anomalies were independent of age, duration of hypertension and blood pressure levels. The mean value of neurohumoral substances were: norepinephrine 323.3 +/- 245 pg/ml, PRA 2.5 +/- 4 ng/ml/h, aldosterone 153.58 +/- 102 pg/ml. A significant correlation was found between PRA and blood pressure, and between aldosterone and all the Doppler-derived parameters of diastolic dysfunction. In conclusion, left ventricular hypertrophy seems to be related to alteration in ventricular geometry rather than to hemodynamic factors. Among nonhemodynamic factors, aldosterone may be the most responsible for abnormal filling, presumably through the activation of collagen matrix growth.

Adult↗
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

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

[Left ventricular remodelling].

An acute myocardial infarction, particularly one that is large and transmural, can produce expansion and alterations in the topography of both the infarcted and non-infarcted regions or the ventricle. This remodelling can importantly affect the function of the ventricle and the prognosis. Side-to-side slippage of myocytes in the myocardium occurring in association with ventricular dilatation is responsible for wall thinning. The increased internal load that is sustained through the cardiac cycle is thought to promote further stress, dilatation and hypertrophy of the non-infarcted area. The collagen network has been showed to be high responsible for the remodelling of the interstitium and therefore for the scar formation involved in the expansion. The process for ventricular enlargement can be influenced by infarct size, healing end ventricular wall stresses. The process of scarification can be interfered with during the acute infarct period by the administration of glucorticosteroids and non-steroidal anti-inflammatory agents, which results in thinner infarct and further expansion. A most effective way to prevent or minimize the increase in ventricular size is to limit the initial insult. Acute thrombolytic reperfusion therapy may work in this way. Finally early and long-term therapy with an angiotensin converting enzyme inhibitor can favorably alter the loading conditions of the left ventricle, reducing progressive enlargement with a prolongation in survival.

Animals↗
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↗
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

[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↗
PubMed1986

Autosomal-dominant dystrophy with humeroperoneal weakness and cardiopathy: a genetic variant of Emery-Dreifuss disease?

Two females mother and daughter, were affected by a neuromuscular disorder, characterized by slow progression, humeroperoneal weakness and wasting, limited neck flexion, elbow and ankle joint contractures, cardiopathy and myopathic pattern on EMG. Muscle histology and histochemistry showed type I fiber atrophy and predominance in both. Cardiac abnormalities, in the first case, were suggestive of a hypertrophic cardiomyopathy while in the second hypotension and chronic bradycardia were present. Neurological signs, EMG and morphology seemed to point to a genetic variant of the form of dystrophy named Emery-Dreifuss disease. The mode of transmission and cardiac abnormalities, however, raise the problem of variability even in this well-defined, usually X-linked, disorder.

Adolescent↗
PubMed1986

The efficacy of ibopamine in long-term treatment of dilated cardiomyopathy. A clinical and instrumental evaluation.

The aim of this study was to investigate whether long-term treatment with ibopamine (SB-7505), the 3,4-diisobutyryl ester of N-methyldopamine, in patients with severe symptomatic congestive cardiomyopathy is associated with an improvement in cardiovascular conditions. The investigation was carried out in 18 outpatients with idiopathic or post-ischemic dilated cardiomyopathy and chronic severe heart failure (NYHA (New York Heart Association) Class III-IV). Patients were randomly assigned to a protocol in which either digitalis and diuretics (8 patients, Group 2) or the same treatment plus ibopamine (10 patients, Group 1) were given. There were no significant differences between the two groups in age, weight, height, functional class and duration of symptoms. The results obtained showed that cardiovascular conditions worsened dramatically in the group of controls during the 10-week period, irrespective of the treatment with digitalis and diuretics. Some of the parameters deteriorated significantly (p less than 0.05 or less than 0.01) such as systolic and diastolic left ventricular diameters, fractional shortening, end-systolic stress and pressure/diameter ratio, and other parameters showed a tendency to become worse (exercise time, cardiothoracic ratio). On the contrary, in patients of group 1, ibopamine in association with digitalis and diuretics appeared to preserve left ventricle function from a progressive worsening. None of the parameters deteriorated with ibopamine by contrast with a sharp decrease in the control group. Some of the parameters (fractional shortening, pressure/diameter ratio, exercise time) showed a tendency to improve although not significantly. The data suggest than 10 weeks treatment with ibopamine may prevent any deterioration or even produce a mild improvement in patients with very severe congestive heart failure.

Adult↗