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Biomedical subjects

M Metra

Publications and source records attributed to M Metra.

At least 73 records · Page 4Linked to original sources
PubMed1989

[Hemodynamic effects of the intravenous administration of captopril in patients with chronic congestive heart failure].

The aim of the present study was to evaluate the hemodynamic response to the intravenous administration of the angiotensin converting enzyme-inhibitor captopril. Plasmatic renin activity was also monitored. The study population included 10 patients with chronic congestive heart failure: 3 were in the second NYHA functional class, 5 in the third, and 2 in the fourth. The patients received a first dose of 5 mg of captopril followed, after 10 min, by a second bolus-dose of 15 mg. Hemodynamic and hormonal measurements were repeated in the following 4 hours. The greatest hemodynamic effect, considered as the time of maximal mean arterial pressure and systemic vascular resistances decrease, and cardiac index increase, was noted 20 min after the first bolus dose administration. Mean arterial pressure (MAP) decreased by 13% (p less than 0.01), mean pulmonary artery pressure (MPAP) by 14% (p less than 0.05), right atrial pressure (RAP) by 30% (NS), wedge pressure (WPP) by 23% (p less than 0.01), systemic vascular resistances (SVR) by 21% (p less than 0.05), pulmonary vascular resistances by 22% (NS); cardiac index (CI) increased by 12% (p less than 0.05), stroke volume index by 10% (NS). Heart rate didn't change. The plasmatic renin activity (PRA) increased by 339% (p less than 0.01) reaching the maximal level in concomitance with the greatest hemodynamic effect. Hemodynamic changes were already noted 5 min after the first dose and lasted up to 75 min later.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Prognostic significance of clinical, ergometric and coronarographic data in patients soon after myocardial infarction].

The relative prognostic value of the clinical evaluation (Clin), exercise testing (ET), and cardiac catheterization (Cath), was assessed in 167 consecutive patients who underwent these exams within 40 days after an acute myocardial infarction. Each patient was followed at least 24 months; 12 patients died and 59 presented major cardiac events (angina, reinfarction and death). All the parameters were analyzed by univariate and discriminant and Cox regression analysis. For purposes of analysis, the predictive power of 3 sets of variables was analyzed separately: Clin, Clin + ET, Clin + ET + Cath. In the prediction of major cardiac events, only previous myocardial infarction was selected among the Clin parameters by multivariate analysis while ST segment depression, maximal systolic blood pressure, exercise duration and, though less significantly, coronary artery disease extension were selected among the ET and Cath var. The percentage of patients correctly classified was very low using only the Clin variables (60%) and significantly improved when ET and, to a lesser degree, Cath were added (77% and 80%, respectively). Multivariate discriminant analysis selected, as significant predictors of cardiac death, digitalis therapy, appearance of bundle branch block, previous myocardial infarction and anterior location of the myocardial infarction among the Clin variables, while exercise duration and LV ejection fraction were selected among the ET and Cath variables, respectively. The predictive power of the Clin variables alone was only slightly improved by the use of ET and Cath as the percentage of patients correctly classified was 76%, 81% and 84% using only the Clin, the Clin + ET and the combination of the Clin + ET + Cath var, respectively. In conclusion, the variables associated with a depressed LV function are the best predictors of future death and cardiac events; coronary angiography can only slightly improve the specificity of the exercise testing in the prediction of major cardiac events.

Angiography↗
PubMed1988

Lack of tolerance development during chronic ibopamine administration to patients with congestive heart failure.

Beta-adrenergic agonists can progressively lose their efficacy during chronic therapy in patients with heart failure. Ibopamine is a new dopamine derivative, active on dopaminergic and beta-adrenergic receptors, whose hemodynamic activity has been acutely demonstrated. To assess whether any attenuation of its efficacy occurs, the variations of the cardiac output induced during chronic therapy were monitored by impedance cardiography in 15 patients with dilated cardiomyopathy who showed a significant increase of the cardiac output (20.7 +/- 10.0%) after acute ibopamine administration. The efficacy of ibopamine was also assessed after 6 and 12 months of therapy by echocardiography, exercise testing, and 24-hour dynamic electrocardiogram (EKG) monitoring. The cardiac output response to ibopamine did not show any significant attenuation (range 15% to 19%) in the evaluations at 1, 2, 3, 4, 8, and 12 months of therapy. No significant change, was noted, after 6 and 12 months, in the exercise capacity (505 vs. 602 and 604 seconds) and the fractional shortening (16.2 vs. 18.3 and 18.5) without any change of the diastolic diameter. Ventricular arrhythmias were significantly reduced after 6, but not 12, months of therapy. No significant change in the New York Association (NYHA) functional class was noted at 6 and 12 months of therapy (2.4 +/- 5 vs. 2.3 +/- 7 and 2.4 +/-0.6, respectively). Our results show that ibopamine can maintain its hemodynamic activity even during chronic therapy.

Adult↗
PubMed1988

A randomized double-blind crossover study of nicardipine and nifedipine in patients with angina pectoris and concomitant essential hypertension.

The two dihydropyridine calcium antagonists, nicardipine and nifedipine, were compared in 12 patients with both stable angina pectoris and systemic hypertension using a double-blind, crossover protocol. After a 2-week placebo run-in period, each patient was randomized to either nicardipine or nifedipine; each drug was titrated up to either blood pressure normalization, appearance of adverse effects, or maximal dosage (40 mg, three times a day with nicardipine and 30 mg, three times a day with nifedipine) and then administered for 4 weeks. Maximal symptom-limited exercise tests were performed at the end of the placebo run-in and each treatment period, 3 and 8 hours after drug administration. Nicardipine and nifedipine were used at the mean doses of 100 +/- 20 mg/day and 57 +/- 20 mg/day, respectively. Both drugs reduced, significantly and similarly, standing and supine blood pressure, frequency of anginal episodes, and nitroglycerin consumption. At 3 hours after drug administration, exercise duration and time to 1-mm ST depression increased significantly from 402 +/- 84 and 306 +/- 108 seconds, respectively, with placebo; to 533 +/- 135 and 442 +/- 138 seconds during nicardipine; and to 518 +/- 118 and 437 +/- 133 seconds during nifedipine, with a concomitant reduction of peak ST depression. Both submaximal and maximal exercise diastolic blood pressure were significantly reduced by the two calcium antagonists whereas systolic blood pressure was decreased only at submaximal but not at maximal exercise; the heart rate was not significantly modified by the two drugs at any exercise stage.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Diagnostic accuracy of rest-exercise first pass ventriculography with a fast single crystal gamma camera in detecting coronary artery disease. Study of a group of male subjects without previous myocardial infarction.

Rest and exercise radionuclide ventriculograms were performed in 61 non infarcted, male, patients who underwent cardiac catheterization for chest pain and in 16 normal control subjects. Studies were performed using the first pass method with a fast single crystal gamma camera, which allowed a count rate of 140 +/- 19 Kcounts/sec to be reached during left ventricular filling; the count integral on left ventricular area was 10.8 +/- 1.6 Kcounts and the maximum count/pixel 155 +/- 16. We analyzed sensitivity, specificity, positive and negative predictive value of global ejection fraction (EF) and of the regional wall motion in identifying ventricular function abnormalities due to obstructive coronary artery disease. The regional wall motion was evaluated with four functional images: regional ejection fraction (REF), amplitude (A) and phase (PH) from Fourier analysis and systolic transit times (TT). Sensitivity was near 90% for EF, REF, A and TT, while PH was less sensitive (80%); all functional images were more specific (nearly 90%) than EF (80%). Both sensitivity and specificity were lower for the exercise EKG (59% and 63%, respectively) in this patient group. Significant differences between single vessel and multiple vessel disease were also observed either for the EF increase/decrease (-1.34 +/- 7.4 and -7.82 +/- 9.96; P less than 0.05) or for the number of segments which developed wall motion abnormalities during exercise (1.22 +/- 0.73 and 2.15 +/- 1.04; P less than 0.02). In conclusion, with our method, a fast single crystal gamma camera is suitable for obtaining optimal first pass radionuclide ventriculograms with a count density sufficient either for global or regional left ventricular function evaluation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

Multicenter study on the clinical efficacy of chronic ibopamine administration.

The purpose of this multicenter study was to evaluate the therapeutic efficacy of ibopamine (SB-7505), the 3,4-diisobutyrylester of N-methyldopamine, chronically administered to patients with severe congestive heart failure (CHF) in whom traditional therapy had been ineffective. 55 patients chronically treated with cardiac glycosides and diuretics were assigned to an investigation covering three stages each lasting 7 days. Stage A: continuation of traditional therapy (glycosides and diuretics). Stage B: addition of ibopamine to the glycoside/diuretic therapy. Stage C: withdrawal of ibopamine. Heart rate, blood pressure, body weight, diuresis and 8 target symptoms of CHF (clinical scores) and hematochemical parameters were recorded throughout the three stages. The addition of ibopamine to traditional therapy led to a significant improvement. By contrast, after ibopamine had been withdrawn patients worsened. No hematochemical parameters were modified during the trial. None of the patients experienced any significant side-effects.

Aged↗
PubMed1986

Monitored long-term treatment with ibopamine in patients suffering from severe congestive heart failure.

50 patients with congestive heart failure underwent monitored long-term treatment aimed at evaluating the effect of ibopamine (SB-7505), the 3,4-diisobutyryl ester of N-methyldopamine, on their condition. Ibopamine was administered alone or in combination with traditional therapy mainly at a dose of 100 mg t.i.d. Clinical scores and NYHA (New York Heart Association) functional classes improved. Biochemical parameters showed no adverse modifications. Mild transient side-effects probably related to ibopamine occurred in two patients.

Adult↗
PubMed1985

Hemodynamic advantage of combined administration of oral ibopamine and nitroprusside in patients with ischemic and idiopathic congestive cardiomyopathy.

The hemodynamic effects of combined administration of ibopamine (Ib) (150 mg orally) with nitroprusside (NP) (50-150 micrograms/min intravenously) were compared with those of NP alone in 17 patients with severe congestive heart failure due to coronary artery disease (7 patients) or idiopathic cardiomyopathy (10 patients). Hemodynamic measurements were obtained using a Swan-Ganz thermodilution catheter and a bedside thermodilution cardiac output computer. Nitroprusside alone produced a significant decrease (-12.4%) in mean arterial pressure, mean pulmonary arterial pressure (-28.3%), and systemic vascular resistance (-22.6%), and a significant increase in stroke volume index (23.1%). The administration of combined NP and Ib produced a further significant increase of stroke volume index (20.1%) with a concomitant and significant reduction of systemic vascular resistance (-19.4%); heart rate, mean systemic and pulmonary arterial pressures did not change significantly from the values observed with NP alone. Moreover, stroke work index, although not significantly modified with the vasodilator alone, was significantly increased over control values with NP + Ib association. Although NP alone induced similar effects in both the ischemic and idiopathic cardiomyopathies, the association of Ib gave a more favorable, though not significant, hemodynamic response in the subjects with primitive cardiomyopathy than in the ischemic ones. Thus, the association of Ib to NP therapy, in patients with congestive heart failure, further increases stroke volume index and stroke work index with a concomitant reduction of systemic vascular resistance, without any significant change in mean systemic and pulmonary arterial pressures, or heart rate. These results point out the possibility of associating Ib with other orally active vasodilators in the chronic treatment of congestive heart failure.

Adult↗
PubMed1985

Acute haemodynamic effects of ibopamine in patients with severe congestive heart failure.

Ten patients with congestive heart failure (CHF), in III and IV NYHA Class, were treated orally with a single dose of ibopamine ranging from 1.2-3.3 mg/kg, and were studied using the Swan-Ganz catheter and thermodilution technique. Cardiac index (CI) and stroke volume index (SVI) were increased, and mean pulmonary pressure (PAP), systemic vascular resistances (SVR) were lowered. Ibopamine increased CI (+33%) and SVI (+26%), and decreased PAP (-17%) and SVR (-24%). All changes were statistically significant. The maximum haemodynamic effect occurred 180 min after ibopamine administration. Blood pressure and heart rate were unaffected. Tolerability was good. This study shows that ibopamine when orally administered to human subjects improves cardiac performance and further investigations on its use as a therapeutic agent in the long term treatment of CHF are recommended.

Adult↗
PubMedDate not supplied

Angiotensin-converting-enzyme gene polymorphism and heart failure: a case-control study.

Heart failure (HF) is the final outcome of virtually all cardiovascular diseases and is a major and increasingly serious public health problem. The renin-angiotensin system plays an important role in the pathogenesis of cardiovascular disease. Insertion/deletion (I/D) polymorphism of the angiotensin-converting enzyme (ACE) has attracted significant attention; it has been extensively investigated in a spectrum of cardiovascular phenotypes because of its correlation with serum ACE activity. There is controversy regarding the association of ACE I/D polymorphism with cardiovascular disease. The aim of this study was to investigate whether ACE genotype is associated with HF by comparing cases and controls. The study sample consisted of 229 cases with HF due to coronary heart disease or idiopathic dilated cardiomyopathy and 230 controls recruited from the general population. The ACE I/D genotype was identified using a polymerase chain reaction assay. No evidence was found to support an association between ACE genotype and HF.

Case-Control Studies↗