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Michele Galli

Publications and source records attributed to Michele Galli.

12 recordsLinked to original sources
PubMed2006

Intracoronary ST-segment shift soon after elective percutaneous coronary intervention accurately predicts periprocedural myocardial injury.

BACKGROUND: Elevation of cardiac biomarkers after coronary angioplasty (percutaneous coronary intervention [PCI]) reflects periprocedural myocardial damage and is associated with adverse cardiac events. We assessed whether periprocedural myocardial damage that occurs despite successful PCI could be rapidly and easily identified by intracoronary ST-segment recording with the use of a catheter guidewire. METHODS AND RESULTS: In 108 consecutive stable patients undergoing elective single-vessel PCI, we recorded unipolar ECG from the intracoronary guidewire in the distal coronary before PCI and 2 minutes after the last balloon inflation. After PCI, intracoronary ST-segment shift > or = 1 mm from baseline was considered significant. Troponin I levels were measured at baseline and at 8 and 24 hours after intervention, and myocardial damage was defined as troponin I increase above the upper normal value after intervention. All patients had normal cardiac marker values before PCI, and PCI was successful in all (residual stenosis < 20%, Thrombolysis in Myocardial Infarction grade 3 flow). After PCI, long-term follow-up data were collected; myocardial damage was detected in 50 patients (46%), although abnormal creatine kinase-MB values were documented in only 11 (10%). Significant intracoronary ST-segment shift after PCI was present in 40 patients (37%; group A) and absent in the remaining 68 (63%; group B). Procedural myocardial damage was documented in 37 group A patients (93%) and in 13 group B patients (19%; P<0.001); significant ECG changes were found on standard ECG after intervention in only 5 patients (13%) and 1 patient (1%) (P<0.05). Sensitivity of intracoronary ST-segment shift for predicting myocardial damage was 74%, and specificity was 95%, with positive and negative predictive values of 93% and 81%, respectively. On multivariate analysis, intracoronary ST-segment shift was the sole independent predictor of myocardial damage (odds ratio, 54.1; 95% confidence interval, 12.1 to 240; P<0.0001). At a median follow-up of 12+/-5 months, major coronary event-free survival was significantly worse in group A patients (log-rank test chi2=4.0; P<0.05). CONCLUSIONS: After successful single-vessel PCI, intracoronary ST-segment shift allows the prompt and inexpensive identification of patients developing myocardial injury, who may require adjunctive therapy and longer in-hospital stay.

Angioplasty, Balloon, Coronary↗
PubMed2005

Intracoronary ST segment evolution during primary coronary stenting predicts infarct zone recovery.

In patients with acute myocardial infarction (AMI), early ST segment elevation resolution on ECG predicts myocardial reperfusion and LV recovery. Intracoronary ECG is more sensitive than surface ECG to detect regional ischemia. In patients undergoing primary percutaneous coronary intervention (PCI), we investigated if failed myocardial reperfusion, despite successful infarct vessel recanalization, could be rapidly and easily identified by intracoronary ST segment monitoring from guidewire recording. We recorded intracoronary and standard ECG during primary coronary stenting (PCI) in 50 patients with AMI (59 +/- 11 years; anterior AMI in 66%). All patients had a successful PCI and underwent 2D echocardiography soon after PCI and 6 months later. Following PCI, intracoronary ST resolution >/= 50% from baseline was documented in 39 patients (78%; group A; from 11 +/- 8 to 1 +/- 2 mm) but not in 11 (22%; group B; from 11 +/- 8 to 8 +/- 5 mm). Group A had slightly shorter ischemic time (202 +/- 94 vs. 238 +/- 112 min in B; P = 0.2) and smaller peak CK values (2,752 +/- 2,038 vs. 4,802 +/- 3,671 U/L in B; P = 0.02). After PCI, ST resolution was found on standard ECG in 34 (87%) group A and in 3 (27%) group B patients. At 6-month follow-up, left ventricular ejection fraction was greater in group A (47% +/- 8% vs. 39% +/- 8% in B; P < 0.001) with improved wall motion score index (from 2.2 +/- 0.3 to 1.7 +/- 0.3 in A; from 2.3 +/- 0.4 to 2.1 +/- 0.4 in B; P < 0.001). There were no significant differences between intracoronary and standard ECG for sensitivity (92% vs. 86%) and specificity (62% vs. 57%) to predict improved infarct zone recovery after 6 months. ST elevation resolution on intracoronary recording during PCI predicts infarct zone recovery. Monitoring ST segment evolution by intracoronary ECG allows prompt and inexpensive identification in the catheterization laboratory of those patients without myocardial reperfusion, who may require adjunctive therapeutic interventions after successful infarct vessel recanalization.

Aged↗
PubMed2005

Heart involvement in T cell lymphoma through hypereosinophilic syndrome: a common complication of a rare condition.

This case describes a 42-year-old male affected by hypereosinophilic syndrome associated with angioimmunoblastic lymphoma. Heart involvement was suspected at ECG mimicking left ventricular hypertrophy. MRI clarified the extensive endomyocardial fibrosis, confirming the role of this technique in in-vivo tissue characterization. Finally, the study investigates the association of T cell lymphoma, hypereosinophilic syndrome, and Loeffler endomyocardial disease.

Adult↗
PubMed2004

Transvenous cardioverter-defibrillator implantation with a double coil lead via persistent left superior vena cava.

A dual-coil defibrillation lead was inserted in a 64-year-old male through a persistent left superior vena cava draining into the coronary sinus. The lead, connected to a cardioverter-defibrillator (ICD) implanted in the left pectoral area, was looped in the right atrium positioning the proximal and distal lead coils in the coronary sinus and right ventricular outflow track respectively and resulting in a low and stable defibrillation threshold. Because of its relative ease and effectiveness, this procedure may be recommended in patients with persistent left superior vena cava requiring an ICD implant.

Angiography↗
PubMed2002

[Periprocedural myocardial damage: chronicle of a (cellular) death foretold].

Cardiac marker monitoring after percutaneous coronary intervention (PCI) is now widespread; thus, the recognition of just how frequently myocardial enzyme elevations result from even successful PCI has become increasingly important, despite some physician's interest in minimizing the significance of isolated asymptomatic creatine phosphokinase elevations without an angiographically apparent cause. The meaningfulness of elevated cardiac enzymes after revascularization procedures is one of the most controversial issues in interventional cardiology. The rate of periprocedural damage detection is highly dependent on the intensity of enzyme and ECG measurement. With the use of more sensitive and specific cardiac markers of myocardial necrosis, the traditional definition of "acute myocardial infarction" has been expanded to include even small and asymptomatic biomarker elevations. On the other hand, most debate has focused on the clinical relevance of an elevation in CK-MB levels to 1 to 3 times the upper limit of normal, and many cardiologists argue that the appropriate cut-off point after PCI is even higher. Doubts whether "small" cardiac marker elevations have per se any impact on survival after uncomplicated procedures, as well as the excess of fideism on the effectiveness of contemporary coronary stenting couple with the mistaken equation "excellent angiographic result = excellent clinical outcome". Pre and postprocedural ECG recording and serial cardiac marker measurement should be incorporated into clinical pathways, and routine CK-MB levels tracking is now mandatory even in asymptomatic subjects having successful PCI. A consensus about how to check myocardial damage after PCI (i.e. which and how serum markers should be measured and reported) is eagerly awaited. A broader agreement will contribute to a better understanding of pathophysiology and long-term prognostic implications of "minor" periprocedural myocardial damage, allowing to improve our strategies to prevent and treat it.

Attitude of Health Personnel↗
PubMed2002

[Evaluation of the appropriateness of prescribing non-invasive cardiologic tests].

BACKGROUND: We evaluated the appropriateness of the prescription of echocardiography, exercise testing, Holter monitoring and vascular sonography for ambulatory patients, performed during 4 weeks in 21 outpatient laboratories in Tuscany and Umbria, Italy. METHODS: We collected the following data: the appropriateness of the prescription (according to the guidelines of the Italian Federation of Cardiology), the prescribing physician (cardiologist vs noncardiologist), the synthetic result (normal vs abnormal) and the clinical utility (useful vs useless) of each exam. RESULTS: We evaluated 5614 prescriptions (patients: 3027 males, 2587 females; mean age 63 years, range 14-96 years). The indication to the test was of class I (appropriate) in 45.3%, of class II (doubtfully appropriate) in 34.8% and of class III (inappropriate) in 19.9% of the cases. The test was abnormal in 58.3% of class I exams vs 17% of class III exams (p < 0.05). The test was useful in 72.4% of class I exams vs 17.1% of class III exams (p < 0.05). The test was prescribed by a cardiologist in 1882 cases (33.5%). Cardiologist-prescribed exams were of class I in 57.3%, of class II in 32.4% and of class III in 10.3% of the cases vs 39.2, 36.1 and 24.7% of non-cardiologist-prescribed exams (p < 0.05). Cardiologist-prescribed exams were abnormal in 53.4% of the cases vs 39% of those of non-cardiologists' (odds ratio 1.76, 95% confidence interval 1.58-1.97; p < 0.05). Cardiologist-prescribed exams were useful in 64.7% of the cases vs 44.4% of those of non-cardiologists' (odds ratio 2.26, 95% confidence interval 2.02-2.53; p < 0.05). CONCLUSIONS: In Tuscany and Umbria, Italy, less than half of the prescriptions for non-invasive diagnostic tests are appropriate: appropriately prescribed exams more often provide abnormal and useful results; cardiologist-prescribed exams are more often appropriate, abnormal and useful.

Adolescent↗
PubMed2002

[Evaluation of the appropriateness of prescribing Holter dynamic electrocardiography].

BACKGROUND: We evaluated the appropriateness of indications to Holter monitoring performed on ambulatory patients during 4 weeks in 21 laboratories in Tuscany and Umbria, Italy. METHODS: We collected the following data: the appropriateness of the prescription (according to the guidelines of the Italian Federation of Cardiology), the prescribing physician (cardiologist vs non-cardiologist), the synthetic result (normal vs abnormal) and the clinical utility (useful vs useless) of each exam. RESULTS: We evaluated 863 prescriptions (population: 435 males, 428 females; mean age 64 years, range 15-90 years). The indications to the test were of class I (appropriate) in 59.6%, of class II (doubtfully appropriate) in 11.7%, and of class III (inappropriate) in 28.7% of the cases. In 33% of the cases the exam was considered abnormal. In particular, an abnormal result was found in 37.9% of class I, in 36.7% of class II, and in 24.5% of class III exams (p < 0.05). The exam was considered useful in 46.7% of the cases. In particular, a useful result was found in 59.2% of class I, in 45.5% of class II, and in 21% of class III exams (p < 0.05). Cardiologists prescribed 373/863 tests (43.2%). Their indications were of class I in 67.6%, of class II in 12% and of class III in 24% of the cases vs 53.7, 11.4 and 34.9% of non-cardiologists' prescriptions (p < 0.05). Abnormal findings were found in 40% of cardiologist- vs 27.6% of non-cardiologist-prescribed examinations (odds ratio 1.74, 95% confidence interval 1.31-2.32; p < 0.05); similarly, clinically useful information could be derived from 59.8% of cardiologist- vs 36.7% of non-cardiologist-prescribed examinations (odds ratio 2.56, 95% confidence interval 1.94-3.37; p < 0.05). CONCLUSIONS: In Tuscany and Umbria, Italy, about 40% of Holter exams are inappropriate; appropriately prescribed exams are more often abnormal and useful; cardiologist-prescribed exams are significantly more appropriate, abnormal and useful.

Adolescent↗
PubMedDate not supplied

Differential systolic and diastolic effects of beta-adrenergic stimulation in patients with severe left ventricular dysfunction: a radionuclide ventriculographic study.

BACKGROUND: An attenuated inotropic response to beta-adrenergic stimulation has been documented in patients with severely depressed left ventricular (LV) function. Scant data exist regarding the effect of beta-adrenergic stimulation on LV diastolic function in human beings. Our objective was to evaluate the effect of dobutamine infusion on LV systolic and diastolic function in patients with severe ventricular dysfunction. METHODS AND RESULTS: We studied 26 patients (60 +/- 9 years) in stable condition with healed myocardial infarction and LV ejection fraction (EF) less than 35% by radionuclide ventriculography. LVEF, volumes, peak ejection rate (PER), peak filling rate (PFR), and peak systolic pressure-to-end-systolic volume ratio were calculated at the infusion rate of 5 and 10 gamma x kg(-1) x min(-1). At 5 gamma x kg(-1) x min(-1), no changes were observed in heart rate (75 +/- 16 beats/min vs 75 +/- 15 beats/min at rest), LVEF (23% +/- 8% vs 22% +/- 7%), and PER (1.40 +/- 0.48 end-diastolic volume per second [EDV/s] vs 1.30 +/- 0.48 EDV/s); however, a significant increase in PFR was observed (1.11 +/- 0.36 EDV/s vs 0.86 +/- 0.30 EDV/s, P < .01). At 10 gamma x kg(-1) x min(-1), an increase in LVEF (25% +/- 10%, P < .01) and PER (1.60 +/- 0.57 EDV/s, P < .01) was observed; PFR (1.25 +/- 0.36 EDV/s, P < .05) also increased, whereas heart rate (78 +/- 18 beats/min) was unchanged. No significant changes in LV volumes or in indices of LV contraction synchronicity were observed during infusion. Finally, the peak systolic pressure-to-end-systolic volume ratio was unchanged at 5 gamma x kg(-1) x min(-1) and significantly increased at 10 gamma x kg(-1) x min(-1). CONCLUSIONS: In stable patients with ischemic heart disease and severe LV dysfunction, beta-adrenergic stimulation may still induce a positive lusitropic response, despite attenuated inotropic and chronotropic responses; moreover, the effects on diastolic function occur earlier than those on systolic function.

Adrenergic beta-Agonists↗