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Biomedical subjects

M Pozzoli

Publications and source records attributed to M Pozzoli.

At least 37 records · Page 2Linked to original sources
PubMed1996

Systemic thromboembolism in chronic heart failure. A prospective study in 406 patients.

In patients with heart failure the risk of systemic thrombo-embolism and the benefit of anticoagulation are uncertain. To assess the incidence of systemic thromboembolism and the factors associated with an increased risk, 406 consecutive patients with chronic heart failure were prospectively investigated. Their left ventricular ejection fraction was 23 +/- 8%, pulmonary wedge pressure 19 +/- 10 mmHg and cardiac index 2.3 +/- 1.41. min-1.m-2 of body surface area. Two hundred patients were in NYHA functional class III-IV. Two hundred and thirty-two patients were receiving oral anticoagulants. Over a follow-up period of 16 +/- 11 months, thromboembolism occurred in 11 patients (2.7%), seven of whom were on anticoagulants. Among clinical, echocardiographic and haemodynamic variables, atrial fibrillation, more severe haemodynamic impairment and low exercise capacity were associated with increased thromboembolic risk. No echocardiographic findings, including the presence of intracavitary thrombi, either at baseline or during follow-up, were related to subsequent thromboembolic events. The rate of embolism did not differ in patients receiving anticoagulants (4%) compared with those who did not receive anticoagulants (1%). No major bleeding occurred during follow-up. Thus, in patients with chronic heart failure and sinus rhythm the incidence of systemic thromboembolism is low regardless of anticoagulant treatment. Atrial fibrillation, particularly when associated with low cardiac index, identifies a subgroup of patients at high risk of events. In this subgroup, a moderate-intensity anticoagulant regimen provides unsatisfactory protection against thromboembolism.

Adult↗
PubMed1996

[Pulmonary venous flow in patients with chronic heart failure: feasibility and additional value compared to transmitral flow for non-invasive estimation of pulmonary wedge pressure].

BACKGROUND: In many cardiac conditions, Doppler of transmitral flow has been showed to be related to left ventricular filling pressure, but several factors may limit its practical value in estimating pulmonary wedge pressure in patients with chronic heart failure. Pulmonary venous velocities directly depend on the oscillations of left atrial pressure. Recent studies suggest that transthoracic Doppler of pulmonary venous flow provides a more accurate estimation of pulmonary wedge pressure. However the relative values of transmitral and pulmonary venous flow for assessing pulmonary wedge pressure in patients with chronic heart failure have not been fully classified until now. Accordingly, we performed this study to assess the feasibility of transthoracic Doppler of pulmonary venous flow in patients with chronic heart failure and to evaluate whether it provides additional information regarding pulmonary wedge pressure when compared with Doppler indices of transmitral flow. METHODS: Simultaneous Doppler echocardiographic examinations and right heart catheterizations were performed prospectively in 300 consecutive patients with chronic heart failure due to dilated cardiomyopathy. The correlations of mitral and pulmonary venous flow velocity variables, left atrial volumes, mitral regurgitation jet area and left ventricular ejection fraction with pulmonary artery wedge pressure were evaluated. RESULTS: A complete recording of transthoracic pulmonary venous flow including all components was obtained in 66% of patients, while only systolic and diastolic forward flow were recorded in 88% of patients. Several indices, derived from pulmonary venous flow, were correlated with pulmonary wedge pressure; the strongest correlation was between systolic fraction of peak velocities and pulmonary wedge pressure (r = -0.76). This value was similar to that obtained between deceleration rate (r = 0.78) and deceleration time (r = -0.67) of transmitral flow and pulmonary wedge pressure. A systolic fraction > 40% showed a greater positive predictive value than restrictive pattern of transmitral flow for identifying patients with pulmonary wedge pressure > 18 mmHg (95% vs 86% p < 0.05). This accuracy is confirmed also in patients who had a single peak of transmitral flow. CONCLUSIONS: Doppler of pulmonary venous flow can be performed in a high percentage of patients with chronic heart failure due to dilated cardiomyopathy. The indices derived from transthoracic pulmonary venous flow are strongly correlated with pulmonary wedge pressure and improve the noninvasive identification of patients with high pulmonary wedge pressure, even when transmitral flow pattern is difficult to be interpreted.

Aged↗
PubMed1995

Doppler evaluations of left ventricular diastolic filling and pulmonary wedge pressure provide similar prognostic information in patients with systolic dysfunction after myocardial infarction.

Previous studies have demonstrated that in patients with various types of cardiac diseases and left ventricular dysfunction, left ventricular filling patterns assessed by Doppler of mitral flow are correlated to ventricular filling pressure, the prognostic value of which is well known. The current study was carried out to determine the prognostic importance of a noninvasive evaluation of left ventricular filling by Doppler of mitral flow in patients with systolic dysfunction after myocardial infarction and to compare its value with that of pulmonary wedge pressure. One hundred seven patients with a left ventricular ejection fraction < 40% were studied 3 to 12 weeks after myocardial infarction. All patients underwent a complete clinical examination, a standard two-dimensional and Doppler echocardiographic examination, and right-sided heart catheterization at rest and during a cardiopulmonary bicycle exercise test. Early and late diastolic peak flow velocities, their ratio, and the deceleration time of early diastolic velocity were measured from pulsed-wave Doppler of mitral flow. Follow-up data were obtained for 101 patients. During a mean period of 25 (median 21, range 12 to 60) months cardiac events (death, heart transplantation, or heart failure requiring hospitalization) occurred in 43 (42%) patients. Patients with cardiac events during follow-up were in a worse functional class and had a more impaired exercise capacity and higher capillary pulmonary wedge pressure at baseline examination. Among Doppler echocardiographic variables, in patients with cardiac events a greater early to late diastolic peak velocity ratio of mitral flow (1.9 +/- 0.9 pl/min vs 1.2 +/- 0.8 pl/min, p < 0.001) and a shorter early diastolic deceleration time (112 +/- 35 vs 145 +/- 42 msec, p < 0.001) were found. Cox analysis revealed that the combination of early to late diastolic peak flow velocity ratio of mitral flow and New York Heart Association functional class were the strongest noninvasive independent predictors of cardiac events. One-year event-free probability of survival was 90% in patients with an early to late diastolic peak velocity ratio < or = 1 (all but 1 in New York Heart Association functional class I or II) but was significantly less in patients with an early to late diastolic peak velocity ratio > 1 (64% in functional class I or II and 36% functional class III). Similar results were obtained when mean pulmonary wedge pressure was considered instead of the ratio between peak flow velocities of mitral flow.(ABSTRACT TRUNCATED AT 400 WORDS)

Blood Flow Velocity↗
PubMed1995

Reproducibility of Doppler indices of left ventricular systolic and diastolic function in patients with severe chronic heart failure.

Doppler ultrasound has been utilized to evaluate cardiac output and left ventricular filling pressure in patients with various cardiac diseases. This method would be particularly useful for non-invasive haemodynamic monitoring in patients with severe chronic heart failure. However, few data exist on the reproducibility of Doppler indices in this population. To determine the magnitude of technical and biological variability of Doppler indices, serial Doppler echocardiographic studies were performed in 26 patients with severe heart failure in the usual clinical setting. Short-term intra- and inter-observer, mid-term and day-to-day variabilities of stroke volume, cardiac output, maximal early and late diastolic velocities of mitral flow, rate of decrease and deceleration time of flow velocity in early diastole and the colour Doppler area of the mitral regurgitant jet were evaluated by two cardiologists. For each source of variability, correlation coefficients with standard errors and mean differences between paired determinations with their standard deviations were calculated. Short-term (intra- and inter-observer) variability was small for each considered variable: the mean differences of measurements were within 10% of the mean value for most parameters and no systematic error was found. Stroke volume and cardiac output showed a significant increase in the afternoon. The standard deviations of differences between day-to-day measurements were 4.1 ml (9% of the mean value) and 39 ml (11% of the mean value), respectively. Doppler indices assessing diastolic filling and colour Doppler area of mitral regurgitant jet showed greater variations on a mid-term and day-to-day basis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Cardiac and vascular sources of peripheral thromboembolism in patients with atrial fibrillation. A combined transesophageal and vascular ultrasonographic study.

Atrial fibrillation is associated with an increased risk of peripheral thromboembolism. Although emboli arising from the left atrium are the most probable causes of peripheral ischemic events, coexistent vascular mechanisms may play a role in the genesis of thromboembolism. To assess the prevalence and the relative role of cardiac and vascular sources of thromboembolism in patients with atrial fibrillation 101 consecutive patients with (group 1: 47 patients) and without (group 2: 54 patients) recent thromboembolism were studied by transesophageal echocardiography and ultrasound duplex scanning of carotid arteries. Left atrial thrombosis was found in 19 (40%) group 1 patients and in 3 (5%) group 2 patients. Left atrial thrombosis and/or spontaneous echocardiographic contrast were significantly more frequent in group 1 patients than in group 2 (70% vs 20%, p < 0.001). Stepwise regression analysis revealed that they were the only independent predictors of thromboembolism (p = 0.018, p = 0.0003 respectively). Among clinical and transthoracic echocardiographic variables, left atrial diameter (p = 0.022), rheumatic mitral stenosis (p = 0.0058) and absence of significant mitral regurgitation (p = 0.027) emerged as independent predictors of left atrial thrombosis and/or spontaneous echocardiographic contrast. When transesophageal parameters were also entered into the analysis, the only independent predictor was low blood flow velocity within the left atrial appendage (p = 0.0001). Vascular sources (obstructive carotid arteries plaques, non-obstructive ulcerated carotid plaques and thoracic aortic atherosclerotic debris) were found in 30.6% of patients. Their prevalence was not significantly different in the two groups (34% in group 1, 27% in group 2). Vascular and cardiac sources coexisted in 23% of patients with thromboembolism. Seven of the 10 patients with more severe vascular lesions (i.e., obstructive carotid artery lesions or pedunculated mobile aortic debris) were from group 1 and 5 of them had negative cardiac results. In conclusion, these results indicate that a cardioembolic mechanism due to blood stasis within the left atrium is involved in most of the atrial fibrillation-related thromboembolic events. In patients with atrial fibrillation vascular sources are not infrequent and may be involved in the genesis of ischemic events in some patients. Transesophageal echocardiography may be useful in identifying subgroups of patients with atrial fibrillation who are at high thromboembolic risk.

Adult↗
PubMed1994

[Usefulness of ultrasonographic techniques in catheterization of the internal jugular vein in patients with chronic heart failure].

BACKGROUND: The right internal jugular vein as a route for right heart catheterization and continuous infusion of drugs is increasingly used in patients with heart failure. Although this approach has several advantages, a small but definite number of unsuccessful vein punctures and/or of complications have been reported. This prospective study was designed to evaluate the usefulness of ultrasound techniques for cannulating internal jugular vein in a series of 310 consecutive patients with chronic heart failure. METHODS: In all patients a duplex scanning of internal jugular veins was performed before the cannulation. A subgroup of 62 patients was selected for having a "difficult" cannulation according to the following criteria: previous failure of cannulating the vein (3 unsuccessful needle advances); neck abnormalities; severe emphysema and respiratory insufficiency. In these patients a Doppler-guidance system, which consisted of a miniature ultrasound Doppler transducer inserted in a standard 19 gauge needle, was used. The needle was advanced under the skin following the maximal audio signal of the venous flow. The following variables were considered: success rate, number of needle advances to cannulate the vein, time elapsed from local anesthesia and the insertion of the catheter, minor and major complications. RESULTS: Duplex scanning showed that in 14 patients (4.5%) the right internal jugular vein was occluded or severely narrowed. In all patients the left internal jugular vein, which showed a compensatory dilatation, was successfully cannulated. In 294 of the remaining 296 patients the position of the vein was anterior to the carotid artery at a depth of 4-27 mm below the skin. With respect of the triangle formed by the two heads of the sternocleidomastoid muscle, the vein was central in 35%, medial in 15% and lateral in 60% of cases. Based on duplex scanning ultrasound data, 285 patients underwent internal jugular vein cannulation, which was achieved at the first attempt in 74% and within 3 attempts in 87% of cases. Minor and major complications occurred in 4 (1.4%) and in 1 (0.3%) respectively. By the Doppler guidance system, the cannulation was successfully achieved in 79% of patients at the first attempt and in 98% of patients (61/62) within 3 attempts. In one patient an uneventful puncture of the carotid artery occurred. The time to perform the cannulation was not significantly different using the two approaches (conventional approach: 4.4 +/- 3 minutes; Doppler guidance system: 4.2 +/- 2). Overall the internal jugular vein was successfully cannulated in 307/310 patients (99%). CONCLUSIONS: Ultrasound techniques provide useful information which facilitates the cannulation of the internal jugular vein in patients with heart failure. The Doppler guidance method allows a rapid and safe cannulation of the vein even in cases that are difficult using the conventional approach.

Adolescent↗
PubMed1993

[Skeletal and respiratory muscle strength in chronic heart failure].

BACKGROUND: The aim of this study was to investigate limb and respiratory muscle strength in chronic heart failure (CHF). METHODS: Our study population consisted of 45 male CHF patients, 25 in NYHA Class II and 20 in NYHA Class III, and 22 male post-MI patients without left ventricular dysfunction (LVEF > 50%). All patients underwent assessment of respiratory muscle strength by maximal inspiratory (MIP) and expiratory (MEP) pressures, of handgrip force and peak torque developed during isokinetic Knee extension (EX) (quadriceps) and flexion (hamstring) at 120 degrees/sec. RESULTS: CHF patients showed a significant decrease in all limb and respiratory muscle strength compared to control patients. Moreover, NYHA Class III patients showed significantly reduced values of MIP, handgrip, and EX forces, as well as significantly reduced exercise tolerance in terms of METS (2.8 +/- 0.9 vs 4.4 +/- 1.2, p < .05) and anaerobic threshold level (9.4 +/- 3 vs 12.8 +/- 1.7 mlO2/Kg, p < .05), as compared to those patients in NYHA Class II, while no significant differences were observed in LVEF, cardiac index and pulmonary capillary wedge pressures. Weak, but significant (p < .05) were the correlations between limb muscle and respiratory muscle strength. No correlations were found between muscle force and hemodynamic parameters. Significant correlations (from p < .05 to p < .0001) were found among exercise tolerance and limb muscle strength, but not between exercise tolerance and respiratory muscle strength. In summary: 1) respiratory and skeletal muscle strength is impaired in CHF; 2) respiratory and limb muscle strength reductions are partially related to each other; 3) the degree of central hemodynamic impairment is not correlated with muscle force. Deconditioning could be a major determinant of skeletal but not respiratory muscle weakness. Other factors link limb and respiratory weakness in CHF.

Adult↗
PubMed1993

[Heart failure unit: 1 year experience].

Many factors such as aging and pharmacologic and surgical progress contribute to the growing of organizational problems of health care for patients with severe chronic heart failure. Since March 16, 1992, in the Medical Center of Montescano, an experimental model (Heart Failure Unit) of health assistance has been in development, taking into account the assistance and observational needs of such patients. During the first year of activity, 173 patients were treated in the Unit, for a total of 307 admissions. In-hospital complications were 5 deaths, 91 severe heart decompensations, 25 severe ventricular tachyarrhythmias, 17 infections, 11 severe bradyarrhythmias, 6 instances of acute heart failure due to atrial arrhythmias, 5 unstable angina episodes, 3 thromboembolisms, and 3 neuropsychiatric disorders. During the follow-up until August 15, 1993, 27 patients died and 19 underwent heart transplantation. Our experience focused on realizing the following goals: 1) to organize a fit hospital environment and adequate nursing; 2) to pursue the autonomy and independence of the patients; 3) to routinely cooperate in a multidisciplinary team; 4) to offer continuity of care to patients.

Cardiology Service, Hospital↗
PubMed1992

Left ventricular filling pattern and pulmonary wedge pressure are closely related in patients with recent anterior myocardial infarction and left ventricular dysfunction.

To determine whether mitral flow velocity can be used to estimate mean pulmonary wedge pressure (PWP) in patients with left ventricular dysfunction, 50 patients with recent Q-wave anterior infarction and a reduced ejection fraction (less than 40%) underwent simultaneous pulsed-wave Doppler measurements of mitral flow and right heart catheterization. Doppler tracings and PWP were recorded at rest, after passive leg lifting (45 degrees) and (in 15 patients with increased PWP) after 5 mg sublingual ISDN. Significant correlations were found between the ratio of peak early to peak late diastolic velocity (E/A) and PWP (r = 0.83). Early diastolic deceleration and the ratio of the time velocity integral of atrial contribution to the total time velocity integral were also correlated to PWP (r = 0.80 and r = 0.79 (respectively). The E/A ratio was less than 1 in 25 patients and more than 1 in the remaining 25. An E/A ratio of at least 1 predicted a PWP of more than 20 mmHg with a sensitivity of 100% and a specificity of 86%. In all five patients, in whom the PWP was less than 20 mmHg at baseline and became greater with leg lifting, the E/A ratio changed from less than 1 to more than 1. After ISDN, changes in E/A ratio from more than 1 to less than 1 identified all 12 patients with a PWP falling below 20 mmHg. In conclusion, patients with recent Q-wave anterior infarction and a reduced ejection fraction mitral flow velocity-derived variables correlate with PWP representing a reliable index for the diagnosis of markedly increased PWP.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[Echocardiographic assessment of segmental kinetic changes of the left ventricle during ischemic attacks induced by slow hyperventilation].

UNLABELLED: The detection of stress-induced wall motion abnormalities by means of 2D Echo represents a reliable marker of ischemia. Few reports about two-dimensional echocardiography and provocative tests in patients suffering from primary angina are available in the literature. Twenty patients with electrocardiographically documented ischemic transitory attacks at rest underwent hyperventilation test 2-15 days after a spontaneous episode. A new wall motion abnormality and/or a worsening of an asynergy already present at rest occurred in ten patients; eight of them also showed diagnostic ECG changes. Wall motion abnormalities arose significantly earlier (from the end of hyperventilation: 1.7 +/- .84 vs 2.16 +/- 1.15 min, p less than .05). Three patients had angina, which, in all patients started after echocardiographic and ECG changes. All patients experienced paresthesia, and two patients tinnitus due to blood alkalosis. No clinical adverse reaction resulted from the test. Only one patient had ventricular arrhythmias in the recovery phase of the ischemia. IN CONCLUSION: As concerns hyperventilation test, echocardiography has proven useful in identifying myocardial ischemia, comparable to electrocardiography. Moreover, in this study some patients had echocardiographic but not electrocardiographic changes as ischemic manifestations. Events after induction of ischemia with hyperventilation seem to follow the same sequence already observed in spontaneous attacks.

Adult↗
PubMed1990

Pulsed Doppler evaluation of left ventricular filling in subjects with pathologic and physiologic third heart sound.

Haemodynamic studies suggest that the rapid deceleration of left ventricular inflow at the end of early diastole may play an important role in the genesis of the third heart sound (S3). To confirm this hypothesis noninvasively, pulsed Doppler of transmitral flow was used. Mitral flow velocity wave was recorded in 20 post-infarction patients with audible S3 (Group 1), in 20 young healthy individuals with physiologic S3 (Group II), in 20 postinfarction patients without S3 (Group III) and in 20 normal adults (Group IV). Peak flow velocity in early diastole (Ev), peak flow velocity during atrial systole (Av), the Ev/Av ratio, the deceleration of early diastolic flow (EF slope), the ratio of the time velocity integral of early diastole to the total time velocity integral (TVle/TVlt) and the isovolumic relaxation time (IVRT) were measured from Doppler recordings. The time relation between S3, the mitral valve motion on M-mode tracing, and the mitral flow velocity wave were analysed comparing the intervals from the second sound to Ev (A2-Ev), to the E point of mitral valve motion (A2-Em) and to the S3 (A2-S3). In groups I and II Ev/Av ratio was higher (respectively 4.4 +/- 2.2 and 2.8 +/- 1.1) than in group III (0.8 +/- 0.4) and IV (1.3 +/- 0.3). Similar results were found for the TVle/TVlt ratio. In both groups with S3, EF slope was significantly steeper (respectively 9 +/- 1.8 and 7.5 +/- 1.1 m s) than in normal adults (4.4 +/- 1.1 m s) and patients without S3 (3.6 +/- 1.1 m s).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Hemodynamic effects of negative-pressure ventilation in patients with COPD.

In order to evaluate the hemodynamic effects of INPV, eight patients with COPD (FEV1/FVC, 54 +/- 6 percent; mean +/- SD), respiratory failure (PaO2, 52 +/- 6 mm Hg; PaCO2, 56 +/- 4 mm Hg), and clinical signs of inspiratory muscle fatigue underwent right cardiac catheterization while performing 20 minutes of INPV by a cuirass ventilator at a pressure (-20 to -40 cm H2O) able to reduce the diaphragmatic electromyographic activity. Patients showed a mild basal pulmonary artery hypertension. During INPV, no changes in the mean values of HR (from 79 +/- 20 to 80 +/- 18 beats per minute), systolic BP (141 +/- 19 to 139 +/- 16 mm Hg), CO (5.2 +/- 0.8 to 5.1 +/- 1.3 L/min), mean PAP (23.8 +/- 3.8 to 23.9 +/- 4.4 mm Hg), RAP (4.3 +/- 2.6 to 5.5 +/- 2.5 mm Hg), PWP (10.3 +/- 4.5 to 9.4 +/- 2.9 mm Hg), TPR (369 +/- 76 to 392 +/- 124 dynes.s.cm-5), and PVR (199 +/- 51 to 233 +/- 94 dynes.s.cm-5) were observed. Direct systemic BP monitoring could be performed in six patients. During INPV, three patients showed "pulsus paradoxus," as assessed by an inspiratory fall in systolic BP of 11, 13, and 20 mm Hg, respectively. We conclude that INPV by cuirass ventilator does not induce adverse hemodynamic effects in patients with COPD who have pulmonary artery hypertension.

Adult↗
PubMed1990

Simultaneous Doppler and thermodilution assessment of pulmonary artery flow during acute interventions in patients with chronic obstructive pulmonary disease.

Subcostal pulsed wave Doppler echocardiography of the right ventricular outflow tract was used to assess pulmonary arterial flow at basal conditions and during interventions in 20 patients with chronic obstructive pulmonary disease. The changes in the pulmonary flow induced by interventions ranged from -1.5 l/min to +4.18 l/min (73% to 183% of the basal value). When considered alone, heart rate changes induced by the interventions could explain 53% of the changes in pulmonary flow measured with thermodilution. When Doppler-assessed right ventricular stroke volume changes were also considered the coefficient of determination (R) increased to 77% (r = 0.88, p less than 0.001, SEE = 12%). Doppler echocardiography was less precise in predicting absolute basal values of pulmonary artery flow (r = 0.70, p less than 0.001, SEE = 1.00 l/min), probably indicating inaccurate assessment of the diameter of the right ventricular outflow tract.

Administration, Sublingual↗
PubMed1988

Spontaneous and polyclonal Ig secretion by circulating B cells after surgery.

Abnormalities of the immune response are commonly observed after surgery. In many cases, they are part of a physiologic rather than of a pathologic response to trauma. In this study we show that after elective surgery in otherwise healthy subjects the B cell compartment is deeply affected, as documented by the appearance, 7 days after the intervention, of circulating lymphoblastoid B cells spontaneously secreting in vitro IgG and IgA antibodies. Analogous lymphoblastoid B cells have been described after in vivo immunization and represent a sensitive marker of the B cell response against the immunizing antigen. To better understand the origin of the reaction, we have analyzed the specificity of the antibodies secreted in culture supernatants. We show that the antibody response is polyclonal, since low titers of antibodies against several different bacterial antigens--such as tetanus toxoid, pneumococcal capsular polysaccharides (PCPs), and the lipopolysaccharides (LPSs) of several enteropathogenic strains of Escherichia coli--are detected. This response seems to reflect the previous immunologic experience of the single patient and to be caused by antigens released from traumatized tissues or absorbed through breaches in skin or mucous membranes.

Adolescent↗
PubMed1987

Exercise tolerance in patients with and without ventricular aneurysm.

To assess the role of a left ventricular aneurysm (VA) in affecting cardiac pump function, 36 patients with an echo-proved postmyocardial infarction (MI) VA underwent maximal symptom limited exercise testing. A control group was formed of 36 patients with a previous MI without VA. The two groups were matched for age, sex, and site of MI. No difference was found in maximal work capacity (MWC), heart rate (HR), systolic blood pressure (BP), delta HR/k rho m, delta BP and VO2max/kg during exercise. MWC in patients with VA and anterior MI was lower as compared to patients with VA and inferior MI (2,839.3 +/- 1,340.9 vs. 4,537.5 +/- 1,453.7, p less than 0.05) while no difference was found between anterior and inferior MI without VA. Patients with VA and anterior MI tolerated lower workloads as compared to those with anterior MI without VA (2,839.3 +/- 1,340.9 vs. 3,996.4 +/- 2,347.1, p less than 0.05). No difference was found between patients with inferior MI with or without VA. No major adverse cardiovascular events occurred during or after the tests. Patients were grouped for echo-estimated ejection fraction (EF) less than 30%, 30-50% and greater than 50%. Only 1 patient without VA was found among patients with EF less than 30%. In both groups MWC increased with the increase of EF. Patients with VA, anterior MI and EF less than 30% showed the lowest exercise tolerance (2,216.6 +/- 529.1), and no patient with VA and inferior MI exhibited EF less than 30%. In conclusion, in patients with VA, exercise testing is a safe and useful tool to evaluate the functional capacity of the residual 'non-aneurysmatic' myocardium.

Exercise Test↗