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P Faggiano

Publications and source records attributed to P Faggiano.

At least 19 recordsLinked to original sources
PubMed2002

[Finally a highly specific test for the differential diagnosis of dyspnea: BNP determination].

A simple blood test useful to the diagnosis and follow-up of congestive heart failure would have a favorable impact on the management of a large populations of patients. Several recent studies have demonstrated that blood levels of Brain Natriuretic Peptide (BNP) may be useful for differentiating heart failure from lung disease in patients presenting to emergency department with dyspnea. Furthermore, BNP might serve as screening test for left ventricular dysfunction (systolic and diastolic), correlates with severity of congestive heart failure and is an independent predictor of outcome. Finally, BNP changes correlate with variations of hemodynamic profile induced by therapy and can be used for a noninvasive tailoring of treatment. These findings make this peptide a potential "white count" for patients with suspected or confirmed heart failure.

Diagnosis, Differential↗
PubMed2001

Mechanisms and immediate outcome of in-hospital cardiac arrest in patients with advanced heart failure secondary to ischemic or idiopathic dilated cardiomyopathy.

To differentiate patients with congestive heart failure who are more prone to develop malignant ventricular tachyarrhythmias or severe bradyarrhythmias as the terminal event, we retrospectively evaluated a group of 48 patients with advanced heart failure who experienced a monitored cardiac arrest during hospital stay. We found no significant differences with respect to several variables, apart from clinical status, which was worse in patients whose cardiac arrest was precipitated by severe bradycardia or electromechanical dissociation.

Adult↗
PubMed2001

Prevalence of isolated left ventricular diastolic dysfunction in hypertension as assessed by combined transmitral and pulmonary vein flow Doppler study.

In a relatively large population of patients with treated systemic hypertension and normal left ventricular systolic function, prevalence of abnormalities of left ventricular diastolic function, as assessed by Doppler echocardiographic study of mitral and pulmonary vein flow, was high, with 51% of patients showing indirect signs of increased left ventricular end-diastolic pressure. Furthermore, our data documented that a "normal" mitral flow profile does not exclude the presence of an abnormality of left ventricular filling, which could be otherwise identified by combined analysis of a pulmonary vein flow profile.

Adult↗
PubMed2001

Relative contribution of resting haemodynamic profile and lung function to exercise tolerance in male patients with chronic heart failure.

OBJECTIVE: To clarify the relative contribution of resting haemodynamic profile and pulmonary function to exercise capacity in patients with heart failure. SETTING: Cardiology department and cardiac rehabilitation unit in a tertiary centre. DESIGN: 161 male patients (mean (SD) age 59 (9) years) with heart failure (New York Heart Association class II-IV, left ventricular ejection fraction 23 (7)%) underwent spirometry, alveolar capillary diffusing capacity (DLCO), and mouth inspiratory and expiratory pressures (MIP, MEP, respectively, in 100 patients). Right heart catheterisation and a symptom limited cardiopulmonary exercise test were performed in 137 patients within 3-4 days. RESULTS: Mean peak exercise oxygen consumption (VO(2)) was 13 (3.9) ml/kg/min. Among resting haemodynamic variables only cardiac index showed a significant correlation with peak VO(2). There were no differences in haemodynamic variables between patients with peak VO(2) </= or > 14 ml/kg/min. There was a moderate correlation (p < 0.05) between several pulmonary function variables and peak VO(2). Forced vital capacity (3.5 (0.9) v 3.2 (0.8) l, p < 0.05) and DLCO (21.6 (6.9) v 17.7 (5.5) ml/mm Hg/min, p < 0.05) were higher in patients with peak VO(2) > 14 ml/kg/min than in those with peak VO(2) </= 14 ml/kg/min. Using a stepwise regression analysis, the respiratory and haemodynamic variables which correlated significantly with peak VO(2) were DLCO, MEP, and cardiac index, with an overall R value of 0.63. CONCLUSIONS: The data confirm previous studies showing a poor correlation between resting indices of cardiac function and exercise capacity in heart failure. However, several pulmonary function variables were related to peak exercise VO(2). In particular, lung diffusing capacity and respiratory muscle function seem to affect exercise tolerance during heart failure.

Adult↗
PubMed2001

[Recurrent episodes of acute non-cardiogenic pulmonary edema caused by ingesting hydrochlorothiazide].

We describe a case of a patient presenting repeated episodes of sudden-onset pulmonary edema each occurring immediately after the ingestion of hydrochlorothiazide. The close temporal relationship between the ingestion of hydrochlorothiazide and the onset of symptoms together with the rapid and full clinical recovery after the interruption of therapy, allowed the diagnosis of drug-induced pulmonary edema and a possible anaphylactoid hypotension. The initially low white blood cell count, associated with hemoconcentration, and the increase in white blood cells during the following 24 hours, is consistent with the hypothesis of intrapulmonary sequestration of granulocytes causing pulmonary edema. The pathogenesis and the cause of the increased pulmonary sensitivity are reviewed and discussed.

Diuretics↗
PubMed2000

Pulmonary artery hypertension in adult patients with symptomatic valvular aortic stenosis.

Pulmonary hypertension (PH) has been reported in patients with valvular aortic stenosis (AS) and has been found to be associated with a more severe clinical picture and a poor prognosis after aortic valve replacement. The aim of this study was to assess the prevalence of PH in adult patients with symptomatic AS undergoing cardiac catheterization, and to evaluate the relation between pulmonary artery (PA) systolic pressure and hemodynamic and clinical variables to further clarify the pathogenetic mechanisms. We assessed right-sided heart hemodynamics during cardiac catheterization in 388 patients with symptomatic isolated or predominant AS. PA systolic pressure between 31 and 50 mm Hg was used to define mild to moderate PH, whereas PA systolic pressure >50 mm Hg was used to define severe PH. PA systolic pressure showed no significant difference according to age and sex, although it was significantly higher in patients in New York Heart Association functional classes III and IV and in patients with coexistent systemic hypertension than in the others. PH was absent in 136 patients (35%, group 1), mild to moderate in 196 patients (50%, group 2), and severe in 58 patients (15%, group 3). Only the prevalence of overt heart failure was significantly higher in group 3 patients. AS severity was similar among the 3 groups, and PA systolic pressure showed no relation to aortic valve area in the entire population. Also, a poor correlation was found between PA pressure and left ventricular (LV) ejection fraction (r = -0.28), with several patients having moderate or severe PH despite a preserved LV systolic function. PA systolic pressure significantly correlated with LV end-diastolic pressure (r = 0.50) and with PA wedge pressure (r = 0.84). Furthermore, transpulmonary pressure gradient, an index of resistance across the pulmonary vascular bed (obtained as the difference between PA mean and PA wedge pressure), was significantly higher in patients with PH, especially in those with a marked increase in PA systolic pressure, suggesting a reactive component of PH.

Aged↗
PubMed2000

[Heart failure with conserved systolic function. Therapeutic potential with beta blocking agents].

It is increasingly recognized that the syndrome of congestive heart failure may occur in the absence of any abnormality of left ventricular systolic function. In this situation, the clinical picture of heart failure, particularly the presence of symptoms and/or signs of pulmonary congestion, is usually considered a consequence of an abnormal diastolic function of the left ventricle (diastolic heart failure). However, in the individual patient, several other potential causes should be taken into account before attributing to an isolated diastolic dysfunction of the left ventricle the pathogenetic role of clinical presentation. In fact, due to the current lack of validated criteria for diagnosis of diastolic heart failure, it still represents an exclusion diagnosis in the clinical setting. Prevalence of heart failure with preserved left ventricular systolic function is widely variable among the different studies, from 13% to over 70%, with most reports showing a prevalence of 30-40%. These differences depend on several factors, such as the criteria used for diagnosis of heart failure, as well as those used for recognizing a normal systolic function or the clinical setting considered (for example hospital versus community). According to an analysis of the studies published, heart failure with preserved left ventricular systolic function seems to be more common in the female sex and in elderly patients, and it is associated with hypertension and electrocardiographic or echocardiographic evidence of left ventricular hypertrophy. Atrial fibrillation, either paroxysmal or chronic, is common and may represent a precipitating factor of clinical deterioration. According to most studies, patients with preserved left ventricular systolic function show, compared to patients with reduced left ventricular systolic function, a better prognosis, as indicated by a lower mortality and hospital readmission rates. Regarding the therapy of these patients, it is known that there are virtually no well-controlled studies of the effect of pharmacological treatment on outcome. Accordingly, the therapeutic approach of heart failure with preserved systolic function is currently based on a careful pathophysiological interpretation of clinical picture in the individual patient.

Adrenergic beta-Antagonists↗
PubMed2000

[Functional mitral insufficiency].

The term "functional mitral regurgitation" is generally used to indicate the presence of mitral regurgitation in patients with left ventricular systolic dysfunction in the absence of structural abnormalities of mitral leaflets and chordal or papillary muscle rupture. Functional mitral regurgitation is commonly found in heart failure, and its presence and severity seem to contribute to exercise intolerance and poor prognosis observed in heart failure patients. Several pathogenetic mechanisms have been proposed to explain the pathophysiology of functional mitral regurgitation, in particular a) mitral annular dilation, b) geometric changes in the left ventricle from a typical ellipsoidal shape to a more spherical shape, with apical and outward displacement of papillary muscles and restriction of valve motion ("leaflet tethering hypothesis"), and c) reduction of closing force of the mitral valve ("leaflet closing force hypothesis"), as a consequence of a lower difference between left ventricular systolic pressure (reduced from left ventricular dysfunction) and left atrial pressure (increased). The relative contribution of these mechanisms to the appearance of mitral regurgitation and its severity may differ in the single patient, depending on the extent of left ventricular geometric changes and degree of systolic dysfunction. The Doppler echocardiographic examination plays an important role in assessing the presence and hemodynamic relevance of functional mitral regurgitation, allowing both a semiquantitative (color Doppler flow imaging) and a quantitative approach (PISA, regurgitant volume and fraction by Doppler). Furthermore, echocardiography may contribute to clarify the pathophysiology of mitral incompetence and to evaluate the effects of treatment, pharmacological or surgical, currently available.

Echocardiography, Doppler↗
PubMed2000

[Is a totally non-invasive assessment of the hemodynamic profile possible in patients with chronic heart failure?].

Relevant hemodynamic information can be obtained by a comprehensive Doppler echocardiographic examination in patients with various cardiac diseases. The assessment of left heart hemodynamics by Doppler echocardiography has been addressed by several investigators. The feasibility and the accuracy of methods for the estimation of left ventricular filling pressure and cardiac output have been validated by comparative right heart catheterization. Studies have shown that Doppler echocardiography can allow the measurement of pulmonary artery pressures from the pressure gradients across the tricuspid and pulmonary valves. The possibility of completely characterizing cardiac hemodynamics noninvasively has recently been documented: in patients with acute myocardial infarction, automated cardiac output measurement along with the assessment of left ventricular filling by Doppler echocardiography may be used for the identification of hemodynamic subsets. Although Doppler echocardiography can provide noninvasive measures of hemodynamic indices, its value has been disputed since the technique is patient-dependent, time-consuming and requires meticulous acquisition and interpretation by skilled operators. The use of contrast agents may improve the accessibility of both right-sided and left-sided Doppler signals, potentially increasing the number of patients to whom the noninvasive hemodynamic assessment could be applied.

Chronic Disease↗
PubMed1999

Use of cardiopulmonary exercise testing with hemodynamic monitoring in the prognostic assessment of ambulatory patients with chronic heart failure.

OBJECTIVES: We studied whether direct assessment of the hemodynamic response to exercise could improve the prognostic evaluation of patients with heart failure (HF) and identify those in whom the main cause of the reduced functional capacity is related to extracardiac factors. BACKGROUND: Peak exercise oxygen consumption (VO2) is one of the main prognostic variables in patients with HF, but it is influenced also by many extracardiac factors. METHODS: Bicycle cardiopulmonary exercise testing with hemodynamic monitoring was performed, in addition to clinical evaluation and radionuclide ventriculography, in 219 consecutive patients with chronic HF (left ventricular ejection fraction, 22 +/- 7%; peak VO2, 14.2 +/- 4.4 ml/kg/min). RESULTS: During a follow-up of 19 +/- 25 months, 32 patients died and 6 underwent urgent transplantation with a 71% cumulative major event-free 2-year survival. Peak exercise stroke work index (SWI) was the most powerful prognostic variable selected by Cox multivariate analysis, followed by serum sodium and left ventricular ejection fraction, for one-year survival, and peak VO2 and serum sodium for two-year survival. Two-year survival was 54% in the patients with peak exercise SWI < or = 30 g x m/m2 versus 91% in those with a SWI >30 g x m/m2 (p < 0.0001). A significant percentage of patients (41%) had a normal cardiac output response to exercise with an excellent two-year survival (87% vs. 58% in the others) despite a relatively low peak VO2 (15.1 +/- 4.7 ml/kg/min). CONCLUSIONS: Direct assessment of exercise hemodynamics in patients with HF provides additive independent prognostic information, compared to traditional noninvasive data.

Adult↗
PubMed1999

Doppler echocardiographic assessment of hemodynamic progression of valvular aortic stenosis over time: comparison between aortic valve resistance and valve area.

BACKGROUND: Doppler-derived aortic valve resistance (AVR), i.e. the ratio between pressure gradient and flow rate, has been proposed as an alternative parameter to valve area (AVA) for assessing the hemodynamic severity of aortic stenosis (AS). There are no data on the evaluation of hemodynamic progression of AS using AVR. METHODS: Forty-five adult patients (24 women and 21 men, mean age 72 +/- 10 years) with AS were followed up for 18 months (range 6 to 45 months) with serial Doppler-derived AVR (Isaaz, JACC 1991; 18: 1661) and AVA (continuity equation). Rates of change of AVR and AVA over time were indexed for year of follow-up; furthermore, variations of these parameters during follow-up were expressed as percent change from baseline. RESULTS: During the follow-up period, AVA decreased from 0.74 +/- 0.28 to 0.6 +/- 0.17 cm2 (p < 0.05), with a rate of change of -0.1 +/- 0.13 cm2/year; AVR increased from 349 +/- 187 to 462 +/- 180 dyne/s/cm-5 (p < 0.05), with a rate of change of 79 +/- 69 dyne/s/cm-5/year. Variations observed in AVR, expressed as percent change from baseline, were larger than those observed in AVA (51 +/- 62% versus -16.5 +/- 15%). AVR percent change from baseline significantly correlated with AVA percent change from baseline (r = 0.83, p < 0.05). During follow-up, 6 patients showed no change in AVA: AVR was unchanged in 3 and increased in the remaining 3 patients (6, 11 and 58%, respectively), indicating a progression of AS severity that could not be appreciated from AVA alone. CONCLUSIONS: Serial changes in AVR, as assessed by Doppler echocardiography, significantly correlate with changes in AVA. Thus, the noninvasive assessment of AVR may be utilized in the evaluation of hemodynamic progression of AS and, in conjunction with AVA, may also provide complementary information for the management of these patients.

Adult↗
PubMed1998

Dobutamine-induced changes in pulmonary artery pressure in patients with congestive heart failure and their relation to abnormalities of lung diffusing capacity.

Short-term infusion of dobutamine may determine a mild, statistically significant increase in pulmonary artery pressure from baseline in 30% of patients with moderate to severe heart failure despite systemic effects (changes in cardiac index and systemic vascular resistance) similar to those observed in patients showing a large reduction in right heart pressures. The increase in pulmonary artery pressure observed seems to be associated with a lower pulmonary diffusing capacity, probably reflecting a reduction in recruitment and distension capacity of pulmonary circulation.

Adult↗
PubMed1998

Effects of maximally tolerated oral therapy on the six-minute walking test in patients with chronic congestive heart failure secondary to either ischemic or idiopathic dilated cardiomyopathy.

In patients with heart failure, therapy with "maximally tolerated" oral doses of diuretics, vasodilators, and digitalis results in a significant increase in the distance walked during the 6-minute walking test, compared with conventional therapy at "standard" doses, indicating an improvement in exercise tolerance. The 6-minute walk test is a simple, inexpensive, and well-tolerated test to measure changes in exercise tolerance induced by pharmacologic interventions, even on a short-term basis.

Administration, Oral↗
PubMed1998

Hemodynamic profile of submaximal constant workload exercise in patients with heart failure secondary to ischemic or idiopathic dilated cardiomyopathy.

Constant workload exercise on an upright bicycle at submaximal levels of exercise intensity is frequently used in physical training programs. Nevertheless, only a few data are currently available on the hemodynamic changes induced by constant workload exercise in patients with heart failure. The aim of this study was to assess the hemodynamic response during submaximal constant-workload exercise at 2 different work rates in patients with heart failure. The hemodynamic profile was assessed by means of right-sided cardiac catheterization in 21 men with moderate heart failure during submaximal-constant workload exercise performed on an upright bicycle for 15 minutes. The intensity of constant work rate exercise was selected during a previous symptom-limited or maximal test. The first submaximal test was performed at the level of the anaerobic threshold workload, corresponding to 64% of peak work rate, and the other test at 70% of anaerobic threshold workload (42% of peak work rate). During both submaximal tests, a marked increase in right heart pressure was observed as compared with baseline. The increase in systolic pulmonary artery pressure was statistically not different between the 2 tests (from 40 +/- 18 to 66 +/- 20 mm Hg during exercise at the anaerobic threshold workload, and from 39 +/- 16 to 63 +/- 21 mm Hg during exercise under anaerobic threshold). The increase in pulmonary arterial wedge pressure was similar (from 20 +/- 10 to 35 +/- 13 mm Hg during exercise at the anaerobic threshold, and from 19 +/- 9 to 32 +/- 12 mm Hg during the other test). Cardiac output and heart rate were significantly higher during submaximal exercise at a higher workload, paralleling the behavior of oxygen uptake. Finally, the hemodynamic profile during submaximal exercise at the anaerobic threshold workload was quite similar to that observed during symptom-limited exercise. Thus, in patients with heart failure, submaximal exercise performed at a constant workload, even at low exercise intensity, may determine relevant pressure changes in pulmonary circulation.

Aged↗