[Inflammatory mechanisms associated with acute coronary syndrome].
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Acute Disease↗
Biomedical subjects
M R Conte
Publications and source records attributed to M R Conte.
[Percutaneous transluminal coronary angioplasty for postinfarction residual ischemia: mid- and long-term results].
Aim of this study was to assess the long-term results of PTCA in patients with a recent myocardial infarction. The study population consisted of 244 consecutive patients who underwent a PTCA < or = 30 days after myocardial infarction either because of angina (116 patients), or because of provoked ischemia (62 patients), or in the absence of both (66 patients). "Simple" balloon angioplasty, without adjunctive devices, was performed. Most of the patients were seen at 1 year intervals at the outpatient clinic; otherwise information was gathered either from the family physician or by telephone. The following events were noted during a follow-up of 6-102 months (median 39 months): death, myocardial infarction, need for re-PTCA or surgical revascularization, recurrence of angina. Survival and event-free curves were calculated according to the method of Kaplan and Meier; statistical comparisons between the curves were obtained by the log-rank test. Periprocedural deaths, infarctions and surgical revascularizations are included in the actuarial curves. Differences were examined between patients with Q and non-Q wave infarctions, single vessel versus multivessel disease, left ventricular ejection fraction > or 50% versus < 50%. A clinical success was achieved in 85% of the procedures. Sixteen patients were lost at follow-up. Overall, within the first 30 days and during follow-up, 12 (4.9%) patients died, 19 (7.7%) suffered from myocardial infarction, 34 (13.9%) required re-PTCA or surgical revascularization, and 63 (25.8%) experienced angina again.(ABSTRACT TRUNCATED AT 250 WORDS)
Actuarial Analysis↗
[Does coexistence of involvement of the right dominant coronary artery differentiate clinical features of disease of the common trunk from disease of 3 coronary vessels?].
We have studied clinical and ECG stress features of 119 patients with left main disease and 113 matched patients with three vessels coronary disease. Clinical features and ECG stress test do not differentiate the two groups as a whole. Exercise time duration was shorter, ST criteria were more positive, and peak heart rate was lower in the subgroups of patients with left main and involvement of a right dominant coronary artery. However due to a large overlap these criteria do not seem to be clinically useful. In conclusion, in an individual patient angina and stress ECG criteria do not differentiate the patients with left main from those with three vessels coronary artery disease.
Angina Pectoris↗
[Study of cutaneous microcirculation using the laser-Doppler method in syndrome X].
Aim of the study was to verify the relationship between syndrome X and generalized microangiopathy. Three groups of patients were selected: Group A, 11 patients with typical syndrome X; Group B, 8 patients with atypical chest pain; Group C, 12 control normal subjects. Microvascular circulation was investigated with a laser Doppler Periflux PF3 at rest (15 min); during ischemia (3 min); during post-ischemic hyperemia on the plantar side of the big toe (where arterovenous anastomoses are particularly abundant) and on the dorsum of the foot (where these anastomoses are very scanty). During each recording we calculated: the mean flux value (FV); the mean concentration of moving blood cells (CMBC); the FV/CMBC ratio (which is related to the flow velocity); the mean percent increase of the three parameters during hyperemia. Patients with syndrome X as compared to the other subjects showed: 1) a significantly higher FV/CMBC ratio at rest and during hyperemia both on the plantar side of the big toe (respectively p = 0.01 and 0.015) and on the dorsum of the foot (respectively p = 0.011 and 0.006). These findings suggest a higher flow velocity in microvascular circulation; significantly lower percent increase of FV and CMBC during hyperemia in the plantar side of the big toe (respectively p = 0.04 and 0.014) but not on the dorsum. The increase of flow velocity at rest and low vasodilatatory reserve after ischemia in an area which is rich of arterovenous anastomoses in patients with syndrome X might be explained by the presence of a basal arterovenous hyperstomia.
Adult↗
Severe coronary artery disease after radiation therapy of the chest and mediastinum: clinical presentation and treatment.
OBJECTIVE: To define the clinical and angiographic features and the therapeutic problems in patients with coronary artery disease after therapeutic irradiation of the chest. DESIGN: An observational retrospective study. SETTING: The cardiac catheterisation laboratory, university medical school. PATIENTS: 15 subjects (8 men and 7 women, aged 25-56 years, mean 44) examined in the cardiac catheterisation laboratory, who had significant coronary artery disease years after having radiation treatment to the chest and anterior mediastinum. In the early stages of the study angiography was performed because of typical symptoms of ischaemic heart disease. Later on it was performed because of a high index of suspicion in people with signs of extensive radiation heart damage. MAIN OUTCOME MEASURES: Clinical and electrocardiographic evidence of ischaemic heart disease; echocardiographic signs of pericardial, myocardial or valvar involvement; angiographic evidence of coronary arterial stenosis, with special attention to the ostia; haemodynamic and angiographic signs of pericardial, myocardial, and valvar disease. Survival and symptomatic and functional status were ascertained after medical or surgical treatment. RESULTS: The patients were relatively young and had no risk factors. Seven patients had no signs or symptoms of ischaemic heart disease. Ten patients had ostial stenosis, which was associated with extensive involvement of other cardiac structures in nine of them. Seven required surgical treatment for coronary artery disease. Two died, one at surgery and the other one six months later. Five patients had complications associated with irradiation. CONCLUSIONS: Coronary arterial disease can be reasonably ascribed to the effects of chest irradiation when the patients are young and free from risk factors, especially if the obstructions are ostial and there is important damage to other cardiac structures. In patients with damage to other cardiac structures angina and infarction are often absent and coronary angiography seems to be mandatory. Patients often require surgical treatment and postoperative complications are common.
Adult↗
Identification, characterization, and analysis of cDNA and genomic sequences encoding two different small heat shock proteins in Hordeum vulgare.
In vitro translation of mRNAs prepared from barley (Hordeum vulgare) seedlings (cv. Onice) exposed at 40 degrees C directed the synthesis of major heat shock proteins (HSPs) with molecular masses of 80-90, 70, 42 and 16-22 kDa. A cDNA library prepared from the 40 degrees C mRNAs and screened by differential hybridization led to the isolation of heat shock specific sequences. One of these (Hv hsp18) was confirmed by hybrid-arrested and hybrid-released translation as encoding for an 18-kDa HSP. The barley hsp18 sequence has an open reading frame encoding a 160 amino acid residue 18-kDa protein that is 63% identical to wheat 16.9-kDa HSP (clone C5-8), 54% identical to soybean (Glycine max) 17.5-kDa HSP, and 49% identical to Arabidopsis thaliana 17.6-kDa HSP. Lower similarities were found with class II plant small HSPs such as soybean 17.9-kDa HSP (27%), Pisum sativum 17.7-kDa HSP (30%), wheat (Triticum aestivum) 17.3-kDa HSP (clone Ta hsp 17.3) (30%), and with animal small HSPs and alpha-crystallins. The Hv hsp18 sequence was used to pick up Hv hsp17 genomic sequence encoding for another class I 17-kDa HSP. By computer analysis of the nucleotide sequence the TATA box, two heat shock promoter elements, a metal-ion response element, and the polyadenylation signals were identified. Barley HSP18 has an additional cysteine-rich region when compared with HSP17 mapping at the carboxy terminal end.
Amino Acid Sequence↗
[Another case of dissecting aortic aneurysm with familial incidence].
Several authors have reported aortic dissection in Marfan's syndrome with familial incidence. Cases of dissecting aortic aneurysms have likewise been described in families whose members had severe systemic arterial hypertension. We report 4 cases of familial aortic aneurysm, 3 of whom had a dissection, in the absence of Marfan's phenotype but with histologic findings and genetic transmission similar to those previously described as formes frustes of Marfan's syndrome.
Aortic Dissection↗
[ Bacterial endocarditis of the pulmonary valve damaged by thoracic radiotherapy (in Hodgkin's disease)].
It is well known that radiation therapy to the anterior mediastinum may induce lesions of all cardiac structures. The pericardium is most frequently involved, but atrioventricular conduction disorders, cardiomyopathy, coronary stenosis may also be produced. Aortic, mitral and tricuspid lesions have been described. However, clinical evidence of pulmonic valve involvement has not been reported. Only at necropsy has fibrotic thickening of the pulmonic cusps occasionally been found. We report a case of infective endocarditis of the pulmonic valve in a 53-year-old patient who had undergone thoracic radiation therapy for Hodgkin's disease 31 years previously. Four years prior to the endocarditis he had also been submitted to myocardial revascularisation for critical lesions of the left main and right coronary ostia, and to aortic valve replacement because of stenosis and insufficiency. At that time, the pulmonic valve was fibrotic on echo examination. It is noteworthy that, of all the cardiac valves, the infective process involved only the pulmonic one, which is seldom the target of an infection. To our knowledge this is the first case of bacterial endocarditis of a heart valve that had been previously damaged by radiation therapy.
Aortic Valve↗
[Incidence and significance of ventricular arrhythmia after surgical correction of Fallot's tetralogy].
Patients may die suddenly after surgical repair of tetralogy of Fallot. Ventricular arrhythmias (VA) have been considered the possible cause of sudden death in such patients by many Authors. We evaluated the incidence and severity of VA in a group of 65 patients (25 females and 40 males) after surgical repair of tetralogy of Fallot. The age at the time of follow-up varied between 8 and 47 years. We divided our population into 4 groups (A, B, C, D) according to the surgical results (poor and good) and to the age of total correction (less than 12, greater than 12 years). We tested the presence and severity of VA in the different groups of patients and we found a significant difference in the incidence of VA between patients who underwent surgery before and after the age of 12 years (p = 0.0083). The surgical result did not show a significant relation with VA (p = 0.47). Among the patients submitted to surgical repair in the adult age, however, more serious VA are present in those with poor surgical result, and both our cases of sudden death occurred in this kind of patient. We speculate that postoperative ventricular arrhythmias are related to right ventricular function, which in turn appears to be worse in patients who underwent surgical correction at a later age. At last only perspective trials will be able to assess the significance of VA and their relationship with sudden death in this kind of patient.
Adolescent↗
[Angiographic findings in arrhythmogenic dysplasia of the right ventricle].
Arrhythmogenic right ventricular dysplasia is characterized by fibrous and adipose replacement of the right ventricular myocardium and recurrent ventricular arrhythmias of left bundle branch block morphologic pattern. Sometimes the diagnosis is difficult because not all the clinical and instrumental findings are present and the separation between arrhythmogenic right ventricular dysplasia and other right ventricular cardiopathies is uncertain. In such cases the angiographic appearance of the right ventricle has been considered the "gold standard". To assess the diagnostic value of right ventricular morphology in identifying arrhythmogenic right ventricular dysplasia, we compared the angiographic findings of 8 patients with arrhythmogenic right ventricular dysplasia, 10 with biventricular dilated cardiomyopathy and 10 with Ebstein's anomaly. The following aspects were considered: deep fissuring of the anterior or inferior wall, outflow tract enlargement, contrast persistence in the right ventricle during the levophase, regional wall motion abnormalities including aneurysmal formations and tricuspid regurgitation. Aneurysmal formations of the right ventricle were found only in arrhythmogenic right ventricular dysplasia whereas the other angiographic findings were common to all the above mentioned diseases. Right ventricular angiography is an important adjunct to the clinical and instrumental diagnosis of arrhythmogenic right ventricular dysplasia, but most of its angiographic features are common to other diseases which cause right ventricular dilatation.
Adult↗
Results of total correction of tetralogy of Fallot performed in adults.
Today, total correction of tetralogy of Fallot is rarely performed in adults. In a 10-year period, 40 patients aged 20 to 67 years underwent intracardiac repair in our institution. Twenty-eight of them had had a palliative procedure 11 to 30 years earlier. Preoperatively, 23 patients were in New York Heart Association (NYHA) Functional Class II, 14 were in Class III, and 3 were in Class IV. Operative mortality was 2.5% (1/40). Follow-up ranged from 1 year to 11 years (average, 3 years). One patient died of a noncardiac cause 4 years after operation. Residual cardiac defects were observed in 4 patients. Postoperatively, 30 patients were in NYHA Functional Class I, 8 were in Class II, and 1 was in Class III. Major ventricular arrhythmias were recorded in 7 (35%) of 20 patients. Radionuclide angiography demonstrated impaired right ventricular function in 8 patients. Left ventricular impairment was present in 2. Total correction of tetralogy of Fallot can be performed safely in adults with low mortality and good functional improvement. The incidence of residual cardiac defects is low. The long-term importance of impaired ventricular function and arrhythmias remains to be ascertained.
Adult↗
[2 cases of arrhythmogenic dysplasia of the right ventricle of familial occurrence].
Cases of familial arrhythmogenic right ventricular dysplasia (ARVD) have been reported by many authors, and a genetic mechanism of transmission has been hypothesized. Both autosomal dominant and autosomal recessive mechanism of inheritance were suggest. We present a father and a daughter affected by arrhythmogenic right ventricular dysplasia, belonging to a family with many cases of sudden death. Both of them presented with an episode of ventricular tachycardia with left bundle branch block. The clinical diagnosis was made according to electrocardiographic, echocardiographic, angionuclear and hemodynamic criteria of ARVD. The familia analysis suggest an autosomal dominant mechanism of transmission.
Adolescent↗
Clinical and electrocardiographic features and long-term results of electrical therapy in patients with isolated His bundle disease.
The clinical, ECG, and electrophysiologic findings of 35 consecutive patients with second- and third-degree intra-His block with normal QRS complexes were examined. The follow-up period varied between 12 and 120 months (mean 45). Seventy-seven per cent of the patients were women. Underlying heart disease was present in 43% of the patients. ECGs were characterized by both second-degree type I and type II atrioventricular block, normal or slightly prolonged PR interval of the conducted beats or of the first conducted beat of a Wenckebach sequence, and by subtle changes in the initial forces of the QRS complexes of the escape beats. Electrophysiologic study showed normal sinus and atrioventricular node function and normal infra-His conduction in all patients. In four patients repetitive bradycardia-dependent intra-His block was induced. Thirty-two patients were permanently paced soon after the initial evaluation and three during the follow-up period. Total long-term mortality rate was 23%. None of the patients developed bundle branch block.
Adult↗
Atypical chest pain: coronary or esophageal disease?
Retrosternal pain can be caused both by cardiac and esophageal disease. This work presents the results of cardiac and esophageal investigations in 55 patients, who had atypical chest pain. Isolated esophageal disease was found in 45% of the subjects while 14.5% had significant coronary arterial disease. Both diseases were found in 10.9% of the patients and neither disease in 29%. We conclude that esophageal disease is very frequent in patients with atypical chest pain but it does not always completely account for the symptoms. Such patients should, in our opinion, be submitted to an electrocardiographic stress test. If the result is positive or non-diagnostic, coronary cineangiography should be performed, irrespective of the results of esophageal investigations. If the electrocardiographic stress test is negative, coronary investigations can be deferred. Esophageal investigations can account for the symptoms in about half of such cases.
Adult↗
[Amiodarone in paroxysmal supra-ventricular tachycardias associated with sinus bradycardia].
The efficacy of amiodarone in the prevention of atrial tachycardia is well recognised. However, there remains some controversy over its use in patients with a basal sinus bradycardia because of the risk of further depression of sinus node function. We studied the effects of acute and chronic amiodarone therapy in 13 patients with paroxysmal supraventricular tachycardia and intercritical sinus bradycardias of between 40 and 50/min. All patients underwent electrophysiological investigation under basal conditions and after 5 mg/kg IV amiodarone. Five patients were excluded from chronic oral amiodarone therapy after IV amiodarone for the following reasons : sinus bradycardia of less than 30/min; sinus node recovery times greater than 2 s; 2nd or 3rd degree sino-atrial block. The other 8 patients were administered oral amiodarone on a long term basis. They were followed up clinically with dynamic ECGs every three months over a period of 1 to 3 years. All symptoms regressed in 6 patients. In one patient, the daily attacks of palpitations decreased to one a week. One patient did not improve. No cases of sino-atrial standstill were observed, although the sinus rate remained unchanged. The results of our study show that amiodarone may be administered for long periods in patients with sinus bradycardia and attacks of paroxysmal supraventricular tachycardia if the dynamic ECG during the waking hours shows a heart rate of no less than 40/min, and if electrophysiological investigations do not show significant depression of sinus node function after acute intravenous administration of the drug.
Adult↗
[Anamnestic study of chest pain: comparison of angina and gastroesophageal reflux].
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Adult↗
[Amiodarone in the bradycardia-tachycardia syndrome. 2-year follow-up].
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Adult↗
[Anamnestic study of thoracic pain: comparison of angina and gastroesophageal reflux].
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Adult↗