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Biomedical subjects

P Giannuzzi

Publications and source records attributed to P Giannuzzi.

At least 73 records · Page 4Linked to original sources
PubMed1994

Doppler-derived mitral deceleration time of early filling as a strong predictor of pulmonary capillary wedge pressure in postinfarction patients with left ventricular systolic dysfunction.

OBJECTIVES: The aim of this study was to investigate the correlations between Doppler-derived transmitral flow velocity variables and pulmonary capillary wedge pressure in patients with severe left ventricular systolic dysfunction. 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 ability of Doppler recording to assess diastolic function and predict left ventricular filling pressure may be significantly compromised. METHOD: Pulmonary capillary wedge pressure and Doppler transmitral flow velocity profile were simultaneously recorded in 140 postinfarction patients with ejection fraction < or = 35%. RESULTS: Correlation between the ratio of mitral peak flow velocity in early diastole to peak flow velocity in late diastole (E/A ratio) and pulmonary capillary wedge pressure was weak (r = 0.65). Although the specificity of E/A > or = 2 in predicting > or = 20 mm Hg in pulmonary capillary wedge pressure was high (99%), its sensitivity was low (43%). Conversely, a very close negative correlation was found between mitral deceleration time of early filling and pulmonary capillary wedge pressure (r = -0.90). Sensitivity and specificity of < or = 120 ms in deceleration time in predicting > or = 20 mm Hg in pulmonary capillary wedge pressure were 100% and 99%, respectively. CONCLUSIONS: Doppler-derived mitral deceleration time of early filling provides a simple and accurate means of estimating pulmonary capillary wedge pressure that is particularly useful in patients with a normal or normalized mitral flow velocity pattern.

Adult↗
PubMed1994

Spontaneous delayed recovery of perfusion and contraction after the first 5 weeks after anterior infarction. Evidence for the presence of hibernating myocardium in the infarcted area.

BACKGROUND: In patients with ventricular dysfunction caused by stunning or hibernation, it is not clear when complete recovery of the salvaged myocardium occurs after acute myocardial infarction. The purpose of this study was to determine whether a delayed recovery of perfusion and contraction continues even after the subacute phase. METHODS AND RESULTS: We prospectively studied 71 consecutive male patients with first uncomplicated Q-wave anterior infarction. Resting regional blood flow distribution and contraction were assessed quantitatively 5 weeks and 7 months after the acute phase by serial sestamibi tomography and two-dimensional echocardiography. Coronary angiography also was performed in 52 patients. Overall, at 7 months there was an improvement in the perfusion defect severity (1019 +/- 811 versus 1365 +/- 821 at 5 weeks, P < .001) as well as in the extent of abnormal wall motion (28 +/- 19% versus 32 +/- 15%, P < .001) and left ventricular ejection fraction (53 +/- 14% versus 50 +/- 13%, P < .01). Among the 68 of 71 patients showing resting perfusion defects at 5 weeks, two groups were identified: 47 (group 1) who showed a significant (beyond the reproducibility limits) 7-month reduction of the resting perfusion defect, and 21 patients (group 2) in whom the perfusion defect remained unchanged. Ejection fraction and the extent of abnormal wall motion significantly (P < .01) improved in group 1 but not in group 2. Despite the presence of a comparable perfusion defect size between the two groups at 5 weeks after infarction, group 1 already showed a better regional and global ventricular function (P < .05). No significant differences were found between the two groups regarding age, medical therapy, the extent of underlying coronary disease, thrombolysis in the acute phase, Thrombolysis in Myocardial Infarction grade of the infarct-related vessel, and presence of collaterals on angiography. CONCLUSIONS: After anterior Q-wave infarction, the recovery of perfusion and wall motion may continue well after the subacute phase. Several patients exhibit relative hypoperfusion in viable tissue as late as 5 weeks after infarction, and a significant improvement of perfusion in the infarcted area commonly is observed between 5 weeks and 7 months. This delayed improvement of perfusion is associated with a delayed improvement of contractile function in the infarcted area after the first 5 weeks, which may continue for up to 7 months, suggesting the presence of hibernating myocardium in the infarcted area. Despite similar perfusion defect sizes, the level of regional function can be different at 5 weeks, and measurements taken around this time may not accurately estimate the eventual recovery of function.

Adult↗
PubMed1993

Long-term physical training and left ventricular remodeling after anterior myocardial infarction: results of the Exercise in Anterior Myocardial Infarction (EAMI) trial. EAMI Study Group.

OBJECTIVES: The aim of this multicenter randomized study was to investigate whether long-term physical training would influence left ventricular remodeling after anterior myocardial infarction. BACKGROUND: Exercise is currently recommended for patients after myocardial infarction; however, the effects of long-term physical training on ventricular size and remodeling still have to be defined. METHODS: Patients with no contraindications to exercise were studied 4 to 8 weeks after anterior Q wave myocardial infarction and 6 months later by echocardiography at rest and bicycle ergometric testing. After the initial study, patients were randomly allocated to a 6-month exercise training program (n = 49) or a control group (n = 46). A computerized system was used to derive echocardiographic variables of ventricular size, function and topography. RESULTS: After 6 months, a significant (p < 0.01) increase in work capacity (from 4,596 +/- 1,246 to 5,508 +/- 1,335 kp-m) was observed only in the training group, whereas global ventricular size, regional dilation and shape distortion did not change in either the control or the training group. However, compared with patients with an ejection fraction > 40%, patients with an ejection fraction < or = 40% had more significant (p < 0.001) ventricular enlargement at entry and demonstrated further (p < 0.01) global and regional dilation after 6 months, in both the control and the training group (end-diastolic volume from 77 +/- 14 to 85 +/- 17 ml/m2 in the control group and from 74 +/- 11 to 77 +/- 15 ml/m2 in the training group; regional dilation from 46 +/- 18% to 57 +/- 21% in the control group and from 42 +/- 18% to 44 +/- 26% in the training group). Ventricular size and topography did not change in patients with an ejection fraction > 40%. CONCLUSIONS: Patients with poor left ventricular function 1 to 2 months after anterior myocardial infarction are prone to further global and regional dilation. Exercise training does not appear to influence this spontaneous deterioration. Thus, postinfarction patients without clinical complications, even those with a large anterior infarction, may benefit from long-term physical training without any additional negative effect on ventricular size and topography.

Electrocardiography↗
PubMed1992

Long-term adaptation of 24-h heart rate variability after myocardial infarction. The EAMI Study Group. Exercise Training in Anterior Myocardial Infarction.

To investigate the effects of physical training on neurovegetative profile of patients with previous anterior myocardial infarction (MI), we studied 38 patients out of the EAMI study at 4 to 6 weeks after anterior MI (test 1), who were then assigned randomly to a training group (n = 22) or to a control group (n = 16) and studied again 6 months later (test 2). Neurovegetative function was assessed by analyzing the heart rate variability (HRV) of 24 h, from ambulatory ECG recording, both in time domain, as standard deviation of sinus rhythm RR intervals (sdRR) and percentage of differences greater than 50 ms for successive sinus rhythm R-R intervals (pNN50), and in frequency domain, as low frequency (LF) and high frequency (HF) components of RR variability power spectrum. At test 1, HRV was almost in normal range or slightly decreased in few subjects. HRV increased on average at test 2: sdRR augmented significantly (p less than 0.05) without significant differences between training group and control group; mean LF/HF ratio increased slightly (p less than 0.05) at test 2. This might suggest a shift of neurovegetative balance toward a sympathetic rule, but the difference is too small and the patient population limited to reach firm conclusions. Analysis of 24-h dynamics of HRV in single patients showed different patterns and different adaptations during the time course of 6 months after anterior MI.

Adaptation, Physiological↗
PubMed1992

EAMI--exercise training in anterior myocardial infarction: an ongoing multicenter randomized study. Preliminary results on left ventricular function and remodeling. The EAMI Study Group.

To determine the effects of a 6-month exercise training program on left ventricular (LV) function and remodeling, 49 consecutive patients (pts) with first Q anterior myocardial infarction (51 +/- 8 years), in I-II NYHA class, were studied 4 to 8 weeks after the acute episode and 6 months later by 2D-ECHO and upright bicycle ergometric test. At entry, pts were randomly allocated to physical training (T = 25pts) or control (C = 24pts). Global endocardial surface area (ESA), LV volumes and EF, extent of abnormal wall motion (%WMA), of regional dilatation (%REG DIL), and the shape distortion (DIST) index were analyzed. After 6 months, a significant increase in work capacity (4,589 +/- 1,417 to 5,379 +/- 1,485 KPM/min, p less than 0.03) and in lactic anaerobic threshold (45 +/- 13 to 63 +/- 15 W, p less than 0.01) was observed only in T. Initial ESA, EDV, EF, %WMA, %REG DIL, and DIST index were similar and they did not change after 6 months in both groups. However, pts with less than 40%EF had greater (p less than 0.0001) EDV and %WMA with marked DIST index at entry and showed further (p less than 0.01) deterioration after 6 months both in C and in T (EDV, ml/m2: 68 +/- 12 to 77 +/- 18 in C, 71 +/- 12 to 74 +/- 18 in T; %REG DIL: 39 +/- 20 to 49 +/- 24 in C, 32 +/- 12 to 35 +/- 23 in T; DIST index: 0.16 +/- 0.07 to 0.21 +/- 0.09 in C, 0.2 +/- 0.07 to 0.22 +/- 0.1 in T). These variables did not change in pts with greater than 40%EF. Thus, from these preliminary data, pts with less than 40%EF at entry are prone to further global and regional LV deterioration. Physical training does not seem to increase this spontaneous deterioration.

Anaerobic Threshold↗
PubMed1991

Effects of mental exercise in patients with dilated cardiomyopathy and congestive heart failure. An echocardiographic Doppler study.

To assess the effects of mental stress on left ventricular diastolic function in patients with congestive heart failure, nine patients aged 57 +/- 12 years with dilated cardiomyopathy (end-diastolic volume, more than 110 ml/m2; ejection fraction, less than 40%; mean, 28 +/- 8%) and congestive heart failure in New York Heart Association functional class II or III and 14 normal volunteers (mean age, 49 +/- 8 years) were studied during mental arithmetic lasting 10 minutes with echocardiographic Doppler monitoring of transmitral flow velocity. During mental arithmetic, the ratio of peak flow velocity in early versus late diastole (E/A) and deceleration time of early diastole did not change in normal controls. However, E/A increased significantly (from 1.6 +/- 1.5 to 1.9 +/- 1.7; p less than 0.01) and deceleration time markedly decreased (from 156 +/- 49 to 108 +/- 31 msec; p less than 0.001) in patients with congestive heart failure. In 16 postinfarct patients with ejection fraction of less than 40% studied during mental arithmetic with simultaneous hemodynamics and Doppler recordings, good correlations were found between pulmonary wedge pressure and Doppler parameters (wedge pressure versus E/A, r = 0.89; wedge pressure versus deceleration time, r = -0.87). During mental arithmetic, the pulmonary wedge pressure-E/A correlation was weaker (r = 0.67), whereas the correlation between pulmonary wedge pressure and deceleration time was stronger (r = 0.91). The value of 153 msec in deceleration time was the best cutoff point in predicting 12 mm Hg pulmonary wedge pressure, both at rest and during mental arithmetic: the higher the deceleration time, the lower the pulmonary wedge pressure, and vice versa. Among patients with congestive heart failure, five showed normal baseline deceleration time (195 +/- 21 msec; pattern 1), and the remaining four showed a short (less than 153 msec) deceleration time (108 +/- 13 msec; pattern 2). During mental arithmetic, deceleration time markedly decreased to as short as 119 +/- 20 msec in all patients except one with baseline pattern 1. Deceleration time further decreased to 75 +/- 6 msec in all patients with baseline pattern 2. Mental arithmetic induces changes in left ventricular diastolic function in patients with congestive heart failure. Transmitral echocardiographic Doppler provides a simple noninvasive method of estimating and monitoring pulmonary wedge pressure in patients with severe left ventricular dysfunction.

Cardiomyopathy, Dilated↗
PubMed1989

Inaccuracy of various proposed electrocardiographic criteria in the diagnosis of apical myocardial infarction--a critical review.

The diagnostic accuracy of the standard electrocardiogram (ECG) in apical myocardial infarction (MI) was evaluated in 112 consecutive patients with recent MI and wall-motion abnormalities limited to the left ventricular (LV) apex on two-dimensional echocardiography, performed at rest 21 to 84 days after MI. The following patterns of abnormal (greater than or equal to 30 ms) Q waves were found: anteroseptal (Q V1-V4) in 44 patients (39.3%), anterolateral (Q V1-V6 and/or I, aVL) in 22 (19.6%), inferior (Q III, aVF or II, III, aVF) in five (4.5%), lateral (Q I, aVL and/or V5-V6) in five (4.5%), anteroinferior in six (5.3%); non-Q MI was present in 30 patients (26.8%). By applying various proposed ECG criteria, the presence of apical MI was correctly identified in very few (24, 21%) patients. LV apex was extensively asynergic in 85 patients (76%) and partially asynergic in 27 (24%). All the patients with Q waves in lateral leads and 47% of the patients with non-Q MI had partially asynergic LV apex, while in the other ECG patterns, extensively asynergic LV apex was predominant. The presence of both greater than or equal to 30 ms Q waves and loss of R in left precordial leads and I strongly suggests extensive apical asynergy; normal QRS in the same leads, however, does not exclude extensive apical involvement.(ABSTRACT TRUNCATED AT 250 WORDS)

Diagnostic Errors↗
PubMed1989

[Echocardiographic and electrocardiographic aspects indicative of necrosis caused by isolated disease of the right and circumflex coronary artery].

The value of 12-lead electrocardiogram (ECG) and two-dimensional echocardiography (2D-ECHO, wall motion abnormalities) in recognizing myocardial infarction due to left circumflex and right coronary artery disease was evaluated in 75 patients (aged 26-69 years, within 3 months of myocardial infarction) with single vessel disease (luminal stenosis greater than or equal to 70%). Twenty-five patients (pts) had left circumflex disease and 50 right coronary artery disease. In the group of pts with left circumflex disease, 13 (52%)--group I--showed asynergy limited to the postero-lateral wall and 12 pts (48%)--group II--had more extensive asynergy involving both the postero-lateral and the infero-posterior wall. No pts with left circumflex disease demonstrated asynergy of the interventricular septum. Good correlations were found between the site and extent of asynergy and the location of left circumflex narrowings: 9--group I pts--(69.2%) had obtuse marginal branch disease and 8--group II pts--(67%) had proximal left circumflex disease. Patients with right coronary artery disease were subdivided as follows: group I: 35 pts (70%) with asynergy of infero-posterior wall and posterior septum; group II: 11 pts (22%) with extensive asynergy of infero-posterior, postero-lateral walls and posterior septum; group III: 4 pts (8%) with asynergy limited to the infero-posterior wall. The location of right coronary artery narrowings had no relation to the site and extent of infarct asynergy in pts with single right coronary artery disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Feasibility of physical training in post-infarct patients with left ventricular aneurysm: a haemodynamic study.

To investigate the haemodynamic changes after physical training in patients with left ventricular aneurysm, 60 uncomplicated patients, mean age 51 +/- 10 years, underwent a maximal ergometric test in the supine position with haemodynamic monitoring (Swan-Ganz catheter) 37 +/- 10 days from acute myocardial infarction and after a 4-week period of supervised physical training. The size of aneurysmatic dilatation (aneurysm area-total end-diastolic area ratio %) and resting left ventricular ejection fraction (Dodge's method) were obtained from a two-dimensional echocardiogram (apical approach) performed on the same day of the pre-training ergometric test. On average, left ventricular ejection fraction was reduced (39 +/- 11%), with values below 35% in 25 patients. Resting pulmonary wedge pressure was greater than 12 mm Hg in 42 patients and greater than 20 mm Hg at peak exercise in 48 subjects. The entity of aneurysmatic dilatation was significantly related to left ventricular ejection fraction (r = 0.60, less than 0.001), but not to the values of pulmonary wedge pressure at rest (r = 0.22) or at peak exercise (r = 0.11). No complication during the physical training period was observed. After training, maximal work capacity increased (77 +/- 29 vs 94 +/- 35 W, P less than 0.001) as well as cardiac output and stroke volume with a slight change in pulmonary wedge pressure (24 +/- 7 vs 28 +/- 7 mm Hg, P less than 0.05). At matched submaximal exercise, heart rate decreased (P less than 0.05), stroke volume and arterio-venous oxygen difference increased (P less than 0.05) without significant changes in cardiac output and left ventricular filling pressure.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Haemodynamic implications of exercise-induced myocardial ischaemia in patients with recent inferior myocardial infarction.

UNLABELLED: Two hundred and forty patients with recent inferior myocardial infarction were studied by a symptom-limited ergometric test with haemodynamic monitoring (triple lumen tip-thermistor Swan-Ganz catheter) in order to investigate and quantify the haemodynamic effects of exercise-induced myocardial ischaemia in post-infarct patients and to assess whether the ST-segment changes give any indication of the degree of ventricular impairment. One hundred and thirteen patients showed no ST-segment changes during excercise; ST-segment elevation in leads with abnormal Q wave occurred in 14 patients, ST-segment depression was recorded in 88 subjects, and both ST-segment elevation and depression were found in 27 patients. In subjects with no ST-segment shift, as well as in those with exercise-induced ST-segment elevation, the resting and exertional haemodynamic patterns were normal or nearly normal. In subjects showing ST-segment depression or both ST-segment elevation and depression during exercise the mean pulmonary wedge pressure was abnormally elevated (at peak exercise 25 +/- 8 and 24 +/- 7 mm Hg, respectively). However, 31% of these showed a normal haemodynamic pattern either at rest or during exercise. The number of leads with ST-segment depression and the sum of ST-segment depressions in standard ECG does not reliably indicate the degree of ischaemia-dependent left ventricular impairment. In contrast, in patients grouped on the basis of time of ST depression appearance, the lower the ischaemic threshold the more severe was the left ventricular impairment. Finally, to assess the relative role of both scar and ischaemia in producing left ventricular dysfunction, the haemodynamic patterns of patients with and without exercise-induced ST-segment depression were compared in subsets with similar echocardiographic wall asynergy extent (inferior, infero-apical, infero-septo-apical). Among patients with small or medium-sized scar, the exertional left ventricular filling pressure was normal in patients with no ST-segment depression and abnormally elevated in those with ST-segment depression. In patients with large infarct, the exercise pulmonary wedge pressure was similarly elevated in both the ischaemic and non-ischaemic group, but in the latter cardiac output increase during exercise was limited. IN CONCLUSION: in patients with recent inferior myocardial infarction exercise-induced ST-segment depression is a marker of left ventricular impairment when the ischaemic threshold is low. The impairment consists of an abnormal elevation of left ventricular filling pressure in all subjects, associated with a reduced increase in cardiac output in patients with large infarct.

Adult↗
PubMed1987

Reliability of standard electrocardiogram in detecting left ventricular asynergy in 315 patients with recent myocardial infarction.

The relationship between asynergy of the left ventricular wall detected by two-dimensional echocardiography and ECG signs of necrosis (number of Q waves greater than or equal to 40 ms, Wagner's score) was evaluated in 315 patients (NYHA I-II) 23-90 days after a first Q-wave myocardial infarction (MI). Poor correlations were found between asynergy and ECG parameters. An ECG anterior MI is an apicoseptal MI by echo (independently of the ECG extent of Q waves) and the ECG is of little or no help in predicting the extent of asynergy to the inferior wall and proximal segments of the septum. An ECG inferior MI is inferoposterior by echo and the ECG has very limited value in predicting the extent of asynergy to the apex and septum. Patients with Q waves in leads II, III, and aVF had more extensive asynergy than those with either 2Q or greater than 3Q. R/S greater than or equal to 1 in V1 and/or V2 was present in 44% of patients with inferior MI while asynergy of at least one segment of the posterior wall was observed in 94%. In conclusion, standard ECG is sensitive in identifying anterior versus inferior infarct but it is unreliable in predicting the real extent of asynergy of the left ventricle, particularly in inferior infarcts.

Adult↗
PubMed1987

Influence of left ventricular cavity dimension on electrocardiographic estimation of the extent of wall motion abnormalities.

To estimate the influence of left ventricular cavity dimension on the electrocardiographic estimation of the extent of wall motion abnormalities, two-dimensional echocardiograms and standard 12-lead electrocardiograms (ECG) were carried out on 221 patients within 3 months after acute myocardial infarction (MI). Among the patients with anterior MI (96 patients; 43.4%) both the extent of asynergy (% of asynergic segments, an echo index taking into account the type of asynergy) and the electrocardiographic signs of necrosis (number of Q waves greater than or equal to 40 ms, Wagner's score) were significantly greater (p less than 0.001) in those with left ventricular dilatation (60 patients) than in those with normal ventricular size (36 patients); within the latter group, the ECG-asynergy correlations were good (r value 0.67-0.79). In patients with left ventricular dilatation no correlation was found. In inferior MI (108 patients, 48.9%), asynergy was more extensive in patients with left ventricular dilatation (p less than 0.001) than in those with normal left ventricle. However, the electrocardiographic extent of necrosis was similar in the two groups and no significant ECG-asynergy correlation was found. Likewise, in anteroinferior MI (17 patients; 7.7%), the ECG-asynergy correlations were statistically insignificant in both groups. In conclusion, the electrocardiographic patterns of necrosis are poorly related to the extent of asynergy and are greatly influenced by left ventricular dimensions.

Dilatation, Pathologic↗
PubMed1986

Is post-infarction angina related to poor residual left ventricular function?

To investigate the relationship between left ventricular function and presence and type of myocardial ischaemia in the post-acute phase of myocardial infarction (MI) 313 patients admitted consecutively to our Center of Rehabilitation were studied. In all subjects a good quality two-dimensional echocardiogram, 24-h ambulatory electrocardiogram and in 308 of them a symptom-limited exercise test were performed. Clinical observation was for 3 months since MI occurrence. Transient episodes of post-MI ischaemia were observed in 164 patients (52%). No differences in left ventricular asynergy or ejection fraction were noted among patients with and without post-MI ischaemia as a whole, nor in subsets identified on the basis of occurrence of pain or ischaemia characteristics (at rest or exercise-induced). Episodes of left ventricular failure occurred more frequently in patients with silent, myocardial ischaemia at rest. Sublingual isosorbide dinitrate (5 mg), administered to 20 patients, did not differently change asynergy and ejection fraction in patients with and without documented post-MI ischaemia. In conclusion, extent of asynergy and degree of left ventricular dysfunction at rest seem to be: unrelated to the risk of post-MI ischaemia occurrence; related to the infarct size and not to the presence of stunned myocardium.

Aged↗
PubMed1984

[Hemodynamic significance of an anatomo-functional classification of myocardial infarction].

Recently we proposed a topographical classification of myocardial infarction (MI) based on the site and extension of left ventricular asynergy (AS) detected by Two-dimensional Echocardiography (2D ECHO) at rest: a) Anterior MI: 1) apical MI with AS of apical segments only, 2) apico-septal MI with AS of apex and septum, 3) apico-septo-lateral MI with involvement of septum, apex and antero-lateral wall. b) Inferior MI: 1) isolated inferior MI with involvement of infero-dorsal wall segments; 2) infero-apical MI with AS of inferior wall and apex, 3) infero-apico-septal MI with kinetic abnormalities of inferior wall, apex and septum and finally c) antero-inferior MI with large AS of septum, apex, antero-lateral and inferior wall. In order to validate the functional significance of this classification, 2D ECHO at rest and symptom limited bicycle ergometric test (E) in supine position with EC-Graphic and hemodynamic monitoring (Swan-Ganz cath.), were performed in the same day within two months after a first transmural MI, in 259 patients, I-II NYHA classes. Among anterior MIs, diastolic pulmonary arterial pressure (PAedP) at rest was normal and similar in apical and apico-septal MIs (11 +/- 3 mmHg). It was significantly (p less than .001) higher 14 +/- 5 mmHg in apico-septo-lateral MIs. Left ventricular stroke work index (LVSWI) was higher in apical MIs (55 +/- 14) than in apico-septal (47 +/- 12, p less than .01) and in apico-septo-lateral MIs (38 +/- 9, p less than .001). Maximal work load during E was 86 +/- 31 watt in apical MIs, 77 +/- 29 watt in apico-septal MIs and 70 +/- 25 in apico-septo-lateral MIs with significant difference (p less than .05) only between the last ones and apical MIs. The PAedP during E was normal (20 +/- 7 mmHg) in apical MI, but increased abnormally in apico-septal (24 +/- 7 mmHg) and in apico-septo-lateral (27 +/- 7 mmHg) with a significant difference (p less than .01) only between apical and apico-septo-lateral MIs. In inferior MIs, hemodynamic data at rest were similar in pts with isolated inferior, infero-apical and infero-apico-septal MIs. Maximal work load, similar in inferior and infero-apical MI (88 +/- 30 W) was higher (p less than .01) than in infero-apico-septal (68 +/- 22W).(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗