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P Giannuzzi

Publications and source records attributed to P Giannuzzi.

At least 55 records · Page 3Linked to original sources
PubMed1998

[The usefulness of the clinical interview in the psychological evaluation of the patient with heart failure].

AIM: To develop a model for assessing cognitive-behavioral dysfunction in patients with heart failure, through the analysis of data gathered from clinical interviews. SAMPLE: One hundred sixty-six consecutive inpatients with previous or current heart failure: 125 males and 41 females, mean age 59 +/- 9.3 yrs. METHOD: Three professional psychologists independently analyzed the clinical reports of the interviews. The cognitive-behavioral dysfunction recorded was correlated to age and sex, history of heart failure and cardiac function indices (ejection fraction, NYHA Class). RESULTS: The concordance index among the three psychologists was 97%. Illness management was found to be more difficult for younger subjects (p = 0.03), in those with a longer history of heart failure (p = 0.04) and in those with advanced NYHA class (p = 0.008). An incorrect behavioral style, as defined by the variables "type A", "risk factors", and "vital exhaustion", was significantly correlated with the level of cardiac impairment (ejection fraction) (p = 0.04) and with inadequate illness management (p = 0.02). CONCLUSIONS: Clinical interviews seem to be a simple and accurate tool for assessing cognitive behavioral dysfunction in patients with heart failure and for detecting the areas that require further investigation and more adequate psychological support. The key element that emerges with regard to both diagnosis and treatment is a dysadaptive behavioral style, as defined by the "type A" variables, "risk factors" and "vital exhaustion".

Aged↗
PubMed1998

[Pulmonary uptake of thallium-201 at rest and diastolic function in patients with ischemic cardiopathy and left ventricular dysfunction].

An elevated thallium-201 lung uptake after stress is currently considered a marker of severe coronary artery involvement and related to adverse prognosis. The meaning of this scintigraphic finding on rest thallium-201 images is yet poorly investigated. We compared the thallium-201 lung uptake and the left ventricular diastolic function from mitral Doppler in 24 patients (64 +/- 10 years) with ischemic heart disease and severe left ventricular dysfunction (ejection fraction 28 +/- 10%). All patients underwent a 3-view planar rest-redistribution thallium-201 and 2D-echo studies within 6 days, while clinically stable. The amount of thallium-201 lung uptake was quantified as the ratio (L/H) between the activity in a left lung region of interest (L) and that observed in the left ventricle (H). From mitral Doppler, early (E) and late (A) filling velocities, the E/A ratio and the deceleration time of early filling (DecT) were calculated. An elevated L/H (> or = 0.54) was observed in 9 patients (37%). They showed a lower ejection fraction (20 +/- 4% vs 33 +/- 10% in patients with normal L/H; p < 0.01) and a higher wall motion score index (2.5 +/- 0.4 vs 2.1 +/- 0.4, p < 0.05). A significant inverse linear relation was observed between L/H and the left ventricular ejection fraction (r = -0.70); no significant relation was observed between L/H and left ventricular end-diastolic volumes or wall motion score index. A significant linear relation was also observed between L/H and E/A (r = 0.74; p < 0.001) as well as L/H and DecT (r = -0.61; p < 0.001); an even stronger, inverse, relation was found between L/H and A (r = -0.81; p < 0.001). An abnormal L/H identified 80% of patients with a restrictive filling pattern (specificity 93% and accuracy 88%, respectively). In conclusion, in stable patients with ischemic heart disease and ventricular dysfunction, L/H on rest thallium-201 images is closely correlated with Doppler indexes of left ventricular diastolic filling dynamic; an abnormal L/H is highly predictive of a restrictive filling pattern.

Aged↗
PubMed1997

Attenuation of unfavorable remodeling by exercise training in postinfarction patients with left ventricular dysfunction: results of the Exercise in Left Ventricular Dysfunction (ELVD) trial.

BACKGROUND: Exercise is currently recommended for patients after myocardial infarction; however, the effects of regular exercise on the remodeling process remain to be defined. The aim of this multicenter, randomized study was to investigate whether a long-term physical training program influences left ventricular size and function in postinfarction patients with systolic dysfunction. METHODS AND RESULTS: Consecutive patients with <40% ejection fraction after a first Q-wave myocardial infarction were randomly assigned to a 6-month exercise training program (n=39) or control group (n=38). After 6 months, a significant increase in work capacity was observed only in the training group (from 4.462+/-1.095 to 5.752+/-1.749 kilopond-meters [Kp-m], P<.01), not in the control group (from 4.375+/-1.143 to 4.388+/-1.199 Kp-m), whereas left ventricular volumes had increased in the control group (end-diastolic volume, from 94+/-26 to 99+/-27 mL/m2, P<.01; end-systolic volume, from 62+/-20 to 67+/-23 mL/m2, P<.01) but not in the training group (end-diastolic volume, from 93+/-28 to 92+/-28 mL/m2, P=NS; end-systolic volume, from 61+/-22 to 57+/-23 mL/m2, P=NS). Conversely, ejection fraction had improved in the training group (from 34+/-5% to 38+/-8%, P<.01) but not in the control group (from 34+/-5% to 33+/-7%, P=NS). CONCLUSIONS: In postinfarction patients with systolic dysfunction, long-term exercise training may attenuate the unfavorable remodeling response and even improve ventricular function over time.

Adult↗
PubMed1997

ECG-manifest and ECG-silent dipyridamole technetium-99m sestamibi SPET perfusion defects in patients with ischaemic heart disease.

At dipyridamole myocardial scintigraphy, perfusion defects are seldom backed up by significant ECG changes. This would suggest myocardial blood flow heterogeneity, rather than true ischaemia, as the cause of the scintigraphic abnormalities. Electrocardiographic surface mapping has been documented to be more accurate than standard 12-lead ECG in the detection of provoked ischaemia. Thus, to investigate the relationship between ECG changes and perfusion abnormalities, body surface maps were recorded during dipyridamole infusion in 55 subjects (11 normals and 44 patients with ischaemic heart disease) undergoing dipyridamole technetium-99m sestamibi single-photon emission tomography (SPET). All had a normal resting ECG. The extent and severity of the sestamibi defect were quantified. New negative areas in the isointegral maps and rest-dipyridamole map differences >2 SD from normal limits were considered abnormal. After dipyridamole in normals, neither perfusion defects nor >/=1 mm ST segment depression on 12-lead ECG nor new negative areas in isointegral maps occurred. In patients, dipyridamole induced new perfusion defects in 35 (80%) but ST segment depression in only 18 (41%, P<0.001). Of the 35 patients with perfusion defects, 17 (49%, group 1) showed ST segment depression, while the other 18 (51%, group 2) did not. Abnormal body surface maps were found in 100% of group 1 and 88% of group 2 patients (NS). In group 1, the provoked hypoperfusion was of greater extent (P=0.007) and severity (P=0.01) and the onset of map abnormalities was significantly earlier (P<0. 001) than in group 2; time to map abnormalities was also significantly shorter than time to ST segment depression (P=0.01). In the 35 patients with complete scintigraphic, body map and angiographic data, the severity of reversible perfusion defect proved to be the strongest correlate of ST segment depression upon logistic regression analysis. Thus, sestamibi SPET abnormalities after dipyridamole are almost always associated with electrical changes on body surface maps, suggesting myocardial ischaemia as their cause. The much less common 12-lead ECG changes are slower to appear and reflect a more severe hypoperfusion.

Body Surface Potential Mapping↗
PubMed1997

Ischemic burden in silent and painful myocardial ischemia: a quantitative exercise sestamibi tomographic study.

OBJECTIVES: We sought to determine whether the amount of myocardial ischemic burden differs in patients with painful or silent myocardial hypoperfusion during exercise testing. BACKGROUND: Whether a lack of symptoms during ischemia reflects an alteration in pain perception or less myocardium in jeopardy remains a controversial issue. METHODS: We studied 300 consecutive patients with a well established history of ischemic heart disease and reversible hypoperfusion on exercise sestamibi tomography. Rest and stress sestamibi defects were quantitatively assessed and indexes of exercise left ventricular dilation derived. RESULTS: Painful and silent reversible ischemia was observed in 97 (32%) and 203 (68%) patients, respectively. Patients with painful ischemia had lower values for work load, exercise time and peak rate-pressure product (p < 0.01) and more frequently showed significant ST segment depression during exercise than did patients with silent ischemia (69% vs. 40%, p < 0.001). On sestamibi tomography, patients with painful ischemia had more reversible hypoperfusion than did patients with silent ischemia (mean +/- SD 16 +/- 10% vs. 11 +/- 7%, p < 0.001), despite a comparable extent of stress hypoperfusion (22 +/- 12% vs. 22 +/- 13%); they also had a higher endocardial dilation index (1.32 +/- 0.32 vs. 1.10 +/- 0.26, p < 0.001). By multivariate logistic analysis, the most powerful correlate of painful ischemia was a history of effort angina; the extent of reversible perfusion defect was the sole independent scintigraphic correlate of painful ischemia. CONCLUSIONS: To our knowledge, this is the largest study comparing the degree of hypoperfusion and the presence of symptoms during exercise stress testing in a consecutive cohort of patients with ischemic heart disease and reversible hypoperfusion. The results suggest that the ischemic burden is greater in painful than in silent ischemia.

Adult↗
PubMed1996

Reproducibility of wall motion score and its correlation with left ventricular ejection fraction in patients with acute myocardial infarction.

The inter- and intraobserver variability, as well as the relation to left ventricular (LV) function indexes, of LV wall motion score calculated using the 16- and 11-segment models of LV segmentation were assessed in 105 patients with acute myocardial infarction who were examined at 36 +/- 7 hours from onset of symptoms. In these patients, the use of the 16-segment model of LV segmentation portends to a significantly higher inter- and intraobserver reproducibility of segmental wall motion score than the use of the 11-segment model. In addition, wall motion score assessed with the more detailed 16-segment model of LV segmentation showed a significantly higher correlation with LV ejection fraction than the wall motion score assessed using the 11-segment model.

Adult↗
PubMed1996

Independent and incremental prognostic value of Doppler-derived mitral deceleration time of early filling in both symptomatic and asymptomatic patients with left ventricular dysfunction.

OBJECTIVES: This study sought to investigate the relative and incremental prognostic value of demographic, historical, clinical, echocardiographic and mitral Doppler variables in patients with left ventricular systolic dysfunction. BACKGROUND: The prognostic value of diastolic abnormalities as assessed by mitral Doppler echocardiography has yet to be defined. METHOD: A total of 508 patients with left ventricular ejection fraction < or = 35% were followed up for a mean (+/- SD) period of 29 +/- 11 months. RESULTS: During the follow-up period, 148 patients (29.1%) were admitted to the hospital for congestive heart failure, and 100 patients (19.7%) died. By Cox model analysis, Doppler-derived mitral deceleration time of early filling < or = 125 ms (relative risk [RR] 1.93, 95% confidence interval [CI] 1.4 to 3.7), New York Heart Association functional class III or IV (RR 1.49, 95% CI 1.4 to 2.3), ejection fraction < or = 25% (RR 1.85, 95% CI 1.6 to 2.9), third heart sound (RR 2.06, 95% CI 1.8 to 3.2), age > 60 years (RR 1.95, 95% CI 1.8 to 3.1) and left atrial area > 18 cm2 (RR 1.73, 95% CI 1.6 to 2.7) were all found to be independent and additional predictors of all-cause mortality, and deceleration time was the single best predictor (chi-square 37.80). When all these significant variables were analyzed in hierarchic order, after age, functional class, third sound, ejection fraction and left atrial area, deceleration time still added significant prognostic information (global chi-square from 9.2 to 104.7). Also, deceleration time was the strongest independent predictor of hospital admission for congestive heart failure (RR 4.88, 95% CI 3.7 to 6.9) and cumulative events (congestive heart failure or all-cause mortality, or both; RR 2.44, 95% CI 2.0 to 3.8) in both symptomatic and asymptomatic patients. CONCLUSIONS: Deceleration time of early filling is a powerful independent predictor of poor prognosis in patients with left ventricular systolic dysfunction, whether symptomatic or asymptomatic. A short (< or = 125 ms) deceleration time by mitral Doppler echocardiography adds important prognostic information compared with other clinical, functional and echocardiographic variables.

Cohort Studies↗
PubMed1996

[Exertion-induced myocardial ischemia has little influence on ventricular remodeling in post-infarction patients with preserved systolic function].

BACKGROUND: The effects of acute and recurrent ischemia on ventricular function are well documented. However, the role of residual exertional ischemia in the remodelling process after infarction has not yet been established. In this study, we investigated whether exercise-induced myocardial ischemia influences left ventricular remodelling in patients with recent myocardial infarction and preserved left ventricular function and volumes. METHODS: Sixty-four patients with a first anterior Q wave myocardial infarction were studied at 5 weeks by rest echocardiography and exercise scintigraphy; the echocardiographic examination at rest was repeated 6 months later. Based on the presence and extent of reversible perfusion defects on exercise scintigraphy, patients were classified as having no exertional ischemia (group 1, n = 13 [20%]), mild to moderate ischemia (group 2, n = 32 [50%]) and severe exertional ischemia (group 3, n = 19 [30%]). RESULTS: At 5 weeks after infarction left ventricular volumes, ejection fraction, percent wall motion abnormalities and regional dilatation were similar in the three groups. After 6 months, end-diastolic and end-systolic volumes and regional dilatation did not change in patients in all groups, while ejection fraction and percent wall motion abnormalities showed a slight but significant (p < 0.01) improvement in all groups. CONCLUSIONS: Exercise-induced myocardial ischemia, either mild or severe, does not affect ventricular remodelling and function after myocardial infarction in patients with preserved ejection fraction.

Adult↗
PubMed1996

[A paradigmatic case of partial agenesis of the pericardium].

Complete or partial absence of the pericardium is an uncommon congenital abnormality. Since its first description, several cases have been reported. Although the clinical and instrumental features of this defect are well described, at present it is often overlooked. We report a case of a 19-year old boy referred to our Echocardiography laboratory because of a suspected interatrial septal defect. For this reason it has been recommended to undergo cardiac catheterization. The patient, completely asymptomatic, had a negative physical examination. The echocardiogram excluded the presence of an interatrial septal defect, but some abnormalities, regarding overall right-sided heart, were found (paradoxical interventricular septal movement, apparent right-sided heart enlargement, with unusual bulging of the apex of the right ventricle, an excessive basculant heart movement). In the absence of any other heart disease, we thought that these abnormalities reflected a congenital absence of the pericardium. Indeed, the chest X-ray showed some features, considered patognomonic for congenital absence of the pericardium (levoposition of the heart, lung interposition between the diaphragm and the base of the heart and between the aorta and pulmonary artery). Nuclear magnetic resonance study showed the absence of the pericardium in the posterior and posterolateral wall, confirming our suspicion. Furthermore, the posterior wall of the heart leaned to herniate through the pericardial defect. Since the partial absence of the pericardium can lead to severe complications, surgery was recommended. The correct diagnosis of this disease is very important because of its prognostic implications; this case represents a further contribution to the understanding of this defect.

Adult↗
PubMed1995

Technetium-99m sestamibi tomographic evaluation of residual ischemia after anterior myocardial infarction.

OBJECTIVES: This study investigated the value of sestamibi scintigraphy in assessing residual ischemia after anterior myocardial infarction. BACKGROUND: Serial imaging with sestamibi, the uptake and retention of which correlate with regional myocardial blood flow and viability, has been used to estimate salvaged myocardium and risk area after acute infarction. We recently documented that recovery of perfusion and contraction in the infarcted area may continue well after the subacute phase, suggesting myocardial hibernation. Some underestimation of viability in the setting of hibernating myocardium by sestamibi imaging has been reported. METHODS: We studied 58 patients in stable condition after Q wave anterior infarction. Regional perfusion and function were quantitatively assessed by sestamibi tomography and two-dimensional echocardiography at 4 to 6 weeks and at 7 months after infarction. In sestamibi polar maps, abnormal areas with tracer uptake > 2.5 SD below our reference values were computed at rest and after symptom-limited exercise. On two-dimensional echocardiography the ejection fraction and extent of rest wall motion abnormalities were assessed by a computerized system. All patients had coronary angiography between the two studies. RESULTS: At 7 months the extent of rest sestamibi defect was significantly reduced in 40 patients (69%, group 1) and unchanged in 18 (31%, group 2). Rest wall motion abnormalities and ventricular ejection fraction significantly improved in group 1 but not in group 2. Underlying coronary disease, patency of the infarct-related vessel and rest sestamibi defect extent at 5 weeks were comparable between the two groups. At 7 months, an increase in the reversible (stress-rest defect) tracer defect was observed in group 1 (p < 0.05) despite a smaller stress-induced hypoperfusion (p < 0.05). Reversible sestamibi defects and stress hypoperfusion were unchanged in group 2. In 38 (95%) of 40 group 1 patients, the area showing reversible sestamibi defects at 7 months matched the area showing fixed hypoperfusion at 5 weeks. CONCLUSIONS: The reduction in the rest tracer uptake defect that can occur late after infarction may affect the assessment of ischemic burden by sestamibi imaging early after anterior myocardial infarction.

Adult↗
PubMed1995

Residual exertional ischemia and unfavorable left ventricular remodeling in patients with systolic dysfunction after anterior myocardial infarction.

OBJECTIVES: This study investigated whether exercise-induced myocardial ischemia influences left ventricular remodeling after anterior myocardial infarction. BACKGROUND: The effects of acute and recurrent ischemia on ventricular function are well established. However, to our knowledge the role of exertional ischemia in the remodeling response after infarction has not been investigated. METHODS: Ninety-one patients with a first anterior Q wave myocardial infarction were studied at 5 weeks by rest echocardiography and exercise scintigraphy. The echocardiographic examination was repeated 6 months later. On the basis of the presence and extent of reversible perfusion defects on exercise scintigraphy, patients were assigned to groups with no exertional ischemia (group 1, n = 20 [22%], mild to moderate ischemia (group 2, n = 45 [49%]) and severe exertional ischemia (group 3, n = 26 [29%]). RESULTS: Initial left ventricular volumes were similar, and no differences were found among the three groups in the remodeling response over the 6-month period of the study. However, patients in groups 2 and 3 with an ejection fraction < or = 40% showed significant (p < 0.01) ventricular enlargement over time, which was similar between the two groups (end-diastolic volume [mean +/- SD] from 74 +/- 13 to 80 +/- 17 ml/m2 in group 2 and from 72 +/- 11 to 81 +/- 19 ml/m2 in group 3; regional dilation from 42 +/- 16% to 52 +/- 22% in group 2 and from 38 +/- 18% to 46 +/- 27% in group 3). In contrast, ventricular dimensions did not change in group 1 patients with an ejection fraction < or = 40% as well as in patients in all three groups with an ejection fraction > 40%. CONCLUSIONS: Exercise-induced myocardial ischemia may contribute to progressive ventricular enlargement in patients with poor left ventricular function after a large anterior myocardial infarction.

Analysis of Variance↗
PubMed1995

[Estimate of lung capillary pressure and identification of the "pseudonormal" transmitral flow pattern in patients with severe systolic dysfunction of the left ventricle].

OBJECTIVES: Aim of this study was to investigate whether Doppler-derived transmitral flow velocity variables would allow a reliable estimate of pulmonary capillary wedge pressure in patients with left ventricular systolic dysfunction and normal mitral flow velocity pattern, and would then predict the presence of a "pseudonormal" transmitral flow velocity profile. BACKGROUND: Abnormal relaxation and increased chamber stiffness have opposing effects on the left ventricular filling pattern. When both abnormalities are present at the same time, as often occurs in patients with systolic dysfunction, the mitral pattern may appear to be normal: in this case the ability of Doppler recording to assess diastolic function and predict left ventricular filling pressure may be significantly compromised. METHOD: Pulmonary capillary wedge pressure (PWP) and Doppler transmitral flow velocity profile were simultaneously recorded in 70 postinfarction patients with ejection fraction < or = 35% and mitral flow velocity pattern apparently normal (E/A ratio between 1 and 2). Doppler traces were analyzed using a microcomputer-based digitizing system, and the following variables were measured: peak flow velocity in early diastole (E) and during atrial contraction (A), peak E/A wave velocity ratio and the deceleration time (Dec T) of early diastolic flow. RESULTS: Mean E/A ratio was 1.3 +/- 0.2 and mean PWP was 17 +/- 7 mm Hg. Forty-two patients had a PWP < 20 mm Hg and the remaining 28 patients (40%) had PWP > or = 20 mm Hg. Peak E, peak A and E/A ratio were similar in the two groups, whereas Dec T was significantly (p < 0.001) lower in patients with > or = 20 mm Hg PWP (93 +/- 15 vs 146 +/- 19 msec). A very weak correlation was found between PWP and both E and A velocity (r = 0.14 and r = 0.09, respectively). Furthermore, no correlation was found between E/A ratio and PWP (r = 0.08). Conversely, a very close negative correlation was observed between Dec T of early filling and PWP (r = -0.96). Sensitivity and specificity of < or = 120 ms in Dec T in predicting > or = 20 mm Hg in PWP were 100% and 99%, respectively. CONCLUSIONS: These data point out the relevant role of Doppler-derived deceleration time of early diastole in predicting left ventricular filling pressure. In patients with left ventricular systolic dysfunction an apparently normal diastolic filling pattern is often associated with elevated PWP. Through the estimate of increased PWP, early deceleration time seems to provide an important means of differentiating a real normal from a pseudonormal or masked abnormal filling pattern caused by increased left ventricular filling pressure.

Adult↗
PubMed1995

[Psychological, behavioral and occupational status changes after an aortocoronary bypass intervention].

BACKGROUND. Studies on the quality of life after coronary artery by-pass grafting (CABG) have yielded discordant results. Several studies have described psychological and social improvements while others have reported a lack of change in behavioural risk factors and return to work. There have been no reports on Italian patients, and, because of the wide range of psychological measures used in previous studies, it is difficult to draw any general conclusions. The aim of this study was to assess the psychological sequelae of CABG. METHODS. A total of 164 patients (142 men and 22 women, aged 60 years) with myocardial ischemia, completed the CBA-H Questionnaire 3-5 days before elective CABG and again after 6 months. RESULTS. State anxiety scores were lower after surgery (p < .000) as were health fears (p < .000), depression (p < .009) and life stress (p < or = .000) scores. There were also improvements in well-being (p < .003), affective relationships (p < .000) and sexual relations (p < .0007). There was a decline in behavioural risk factors, namely: smoking behaviour (p < .09), alcohol consumption (p < .002), over-eating (p < .0000) and sedentary life-style (p < .02). Clinical post-operative complications did not negatively influence patients' psychological state and return to work. Preoperative health fears (p < .04) and social anxiety (p < .02) did influence patients' return to work. CONCLUSIONS. In conclusion, psychosocial function, health state and quality of the life generally improved after elective CABG. Return to work was found to be an unreliable measure of the success of surgery. Pre- and post-operative data revealed a general denial trait which identifies patients at greater risk of cardiovascular events after CABG.

Adult↗
PubMed1995

Evaluation of technetium-99m-sestamibi lung uptake: correlation with left ventricular function.

UNLABELLED: Lung uptake of 201Tl is a reliable marker of left ventricular dysfunction. The goal of our study was to establish whether the evaluation of lung-to-heart uptake ratios (LHR) with 99mTc-sestamibi imaging may provide valuable information. METHODS: We studied 72 male subjects with recent anterior myocardial infarction undergoing 99mTc-sestamibi first-pass ventriculography and SPECT perfusion imaging. A group of 46 gender-matched subjects with low pre-test likelihood of CAD and normal exercise and rest 99mTc-sestamibi perfusion images was used as a control. The lung-to-heart count ratios (LHR) were calculated on planar projections from the sets of SPECT images. RESULTS: Both groups were studied at rest and after a symptom-limited exercise tolerance test. In the control group a significant decrease in LHR was observed during stress (p < 0.001). The infarcted group showed significantly higher LHR values both at rest and at stress. Exercise and rest LHR values did not differ significantly. A positive correlation was observed between LHR values and left ventricular ejection fraction at rest and stress. CONCLUSION: LHR, measured by 99mTc-sestamibi imaging, gives clinically useful information. Both resting and postexercise values are correlated with ejection fraction and should predict left ventricular dysfunction.

Adult↗
PubMed1994

Effects of nitroglycerin by technetium-99m sestamibi tomoscintigraphy on resting regional myocardial hypoperfusion in stable patients with healed myocardial infarction.

Myocardial sestamibi uptake reflects regional flow distribution and cellular integrity; however, some segments showing reduced tracer uptake at rest may consist of viable, although hypoperfused, myocardium. It is speculated that the administration of nitroglycerin (NTG) before the sestamibi injection would improve the tracer uptake in resting hypoperfused regions. Thirty-six stable patients with previous myocardial infarction (56 +/- 2 years; mean ejection fraction 42 +/- 2%), in whom perfusion defects could be seen at resting sestamibi tomography, repeated the scintigraphic study 2 to 6 days later, receiving NTG (0.3 to 0.6 mg sublingually) before the tracer injection. The size of the tracer uptake defect was quantified from circumferential profiles in 3 short-axis slices by integrating the area below the lower normal limit (mean -2 SD). After NTG, the mean perfusion defect significantly decreased (from 6,324 +/- 619 to 5,365 +/- 516, p < 0.01). The defect was reduced beyond the reproducibility limits in 20 patients (56%, group 1) and was unchanged or increased in 16 (44%, group 2). The resting sestamibi defect size was comparable between the 2 groups. The average percent reduction of the perfusion defect after NTG was 29 +/- 4% (range 7 to 74).(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary Circulation↗
PubMed1994

A simple electrocardiographic predictor of the outcome of patients with acute myocardial infarction treated with a thrombolytic agent. A Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico (GISSI-2)-Derived Analysis.

OBJECTIVES: This analysis aimed to evaluate in a large patient cohort the relation between ST segment alterations after fibrinolytic therapy for acute myocardial infarction and 1) the combined end point of in-hospital mortality plus clinical congestive heart failure or extensive left ventricular damage, and 2) mortality 30 and 180 days after randomization. BACKGROUND: Angina relief, enzyme release acceleration and ST segment normalization are related to coronary artery reperfusion and prognosis. Electrocardiographic (ECG) evaluation before and after fibrinolytic drug administration has been used to predict short- and long-term clinical outcome in acute myocardial infarction. METHODS: Patients enrolled in the Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico (GISSI-2) trial underwent a standard ECG on admission and after 4 h of alteplase or streptokinase therapy; 7,426 recordings were suitable for ST segment analysis. A decrease > or = 50% in the sum of ST segment elevation in all ECG leads was adopted as the cutoff for predicting coronary artery patency. Recanalization was deemed to have occurred in 4,951 patients (group A) versus 2,475 patients without reperfusion (group B). RESULTS: Group A patients experienced a lower incidence of the combined end point than did group B patients (16.2% vs. 22.9%, respectively), as well as of all its components (death, clinical heart failure, ejection fraction < 35%, injured myocardial segment > 45%, QRS score > 10). Thirty- and 180-day mortality rates were lower in group A than group B (3.5% and 5.7% vs. 7.4% and 9.9%, respectively); relative risk (Cox) was 0.46 (95% confidence interval [CI] 0.37 to 0.57) for 30-day and 0.58 (95% CI 0.48 to 0.70) for 180-day mortality. Patients in group A had significantly less ventricular fibrillation and sustained ventricular tachycardia but more ischemic episodes (early recurrent angina plus myocardial infarction recurrence). CONCLUSIONS: A simple, inexpensive instrumental evaluation, unaffected by different epidemiologic and clinical characteristics of the population analyzed, can allow early assessment of the effectiveness of fibrinolytic treatment with respect to the main clinical outcomes.

Aged↗