PubMed Health⌕ Search

Biomedical subjects

P Trambaiolo

Publications and source records attributed to P Trambaiolo.

17 recordsLinked to original sources
PubMed2006

A hand-carried cardiac ultrasound device in the outpatient cardiology clinic reduces the need for standard echocardiography.

OBJECTIVE: To assess the potential value and cost-effectiveness of a hand-carried ultrasound (HCU) device in an outpatient cardiology clinic. METHODS: 222 consecutive patients were prospectively enrolled in the study. When standard echocardiography (SE) was specifically indicated on the basis of clinical history, electrocardiogram and physical examination, the same cardiologist (level-2 or level-3 trained) immediately performed an HCU examination. The cardiologist then reassessed the clinical situation to confirm or cancel the SE request according to the information provided by HCU. The SE examination was performed by a sonographer and examined in a blinded fashion by a cardiologist expert in echocardiography. Findings from the two examinations were compared. RESULTS: HCU was performed in 108/222 patients, and a definite diagnosis was established in 34 of them (31%), making SE examination potentially avoidable. In the 74 patients with inconclusive HCU results and for whom SE was still indicated, the decision was mainly dictated by the lack of spectral Doppler modality in the HCU system. The overall agreement between HCU and SE for diagnosis of normal/abnormal echocardiograms was 73% (kappa = 0.4). On the basis of the potentially avoided SE examinations and the obviated need for a second cardiac consultation, a total cost saving of euro2142 per 100 patients referred for echocardiography was estimated. CONCLUSIONS: The use of a simple HCU device in the outpatient cardiology clinic allowed reliable diagnosis in one third of the patients referred for echocardiography, which translates into cost and time saving benefits.

Ambulatory Care↗
PubMed2003

[Emergency department ultrasonography: impact on patient management and cost effectiveness].

AIM: Ultrasonography is the most common noninvasive method for the evaluation of body organs and systems. However, the feasibility and potential advantages of ultrasound scanning by emergency physicians have not yet been fully explored. We therefore wanted to determine the impact of ultrasound scanning by emergency physicians on patient management in the Emergency Department, length of hospital stay, and related costs. METHODS: From a data-base search at our hospital we selected 111 patients and divided them into 3 groups according to symptoms: right hypochondriac region pain (Group A), flank pain (Group B), abdominal pain and hemodynamic instability (Group C). Patients were further stratified into 3 subgroups according to whether they were treated by an emergency physician or a radiologist or did not undergo ultrasonography. For each group the mean length of stay in the emergency department, the complications rate, the recurrence rate (defined as return visit to the emergency department for the same pathology) and the related costs were calculated. RESULTS: Of the 111 patients, 76 received ultrasound scanning, of which 43 were treated by an emergency physician. The length of hospital stay for this group was shorter than that of the other 2 subgroups. The recurrence rate was highest in the group that did not undergo ultrasonography. The costs were lower for the group that received ultrasound scanning by an emergency physician than for the group treated by a radiologist (Euro 20 vs Euro 38). CONCLUSION: Ultrasound scanning by emergency physicians can shorten length of hospital stay for emergency patients, reduce recurrence rates for the same pathology and lower patient management costs.

Adolescent↗
PubMed2002

Scurvy mimicking systemic vasculitis.

An 91 years old woman was hospitalized because of lethargy, shortness of breath and diffuse subcutaneous hemorrhage of legs. Clinical features were consistent with the diagnosis of vasculitis with systemic involvement. However dermatologic characteristics of the legs, in association with malnutrition, suggested vitamin C deficiency which was confirmed by laboratory test. Ascorbic acid supplement dramatically improved her clinical symptoms. This case remarks how scurvy may mimmick a systemic vasculitis.

Aged↗
PubMed2001

Doppler myocardial imaging in patients with heart failure receiving biventricular pacing treatment.

BACKGROUND: In patients with heart failure, biventricular pacing (BIV) improves left ventricular (LV) performance by counteracting LV unsynchronized contraction caused by the presence of left bundle branch block (LBBB). However, no data are yet available on regional long-axis function in patients with LBBB or on BIV effectiveness in improving such a function in patients with heart failure and LBBB. METHODS AND RESULTS: We studied with standard 2D echocardiography and tissue Doppler imaging (TDI) 21 nonischemic patients in New York Heart Association (NYHA) class III-IV, with LBBB and QRS >/=120 ms, receiving BIV. To assess long-axis function, TDI qualitative analysis at the basal level of each LV wall was performed in M-mode color and pulsed wave Doppler modalities before and after BIV. By analysis of the interventricular septum, the inferior, posterior, lateral, and anterior walls, of 105 basal segments, the following electromechanical patterns were identified: normal (pattern I), mildly unsynchronized (pattern IIA), severely unsynchronized (pattern IIB), reversed early in systole (pattern IIIA), reversed late in systole (pattern IIIB), and reversed throughout all the systole (pattern IV). After BIV, (1) 49 (46.7%) of 105 segments showed unsynchronized contraction of the same degree as before; (2) 36 (34.3%) of 105 and 20 (19%) of 105 showed unsynchronized contraction of lesser and greater degree, respectively, than before; and (3) a preexcitation pattern was found in 11 (10.5%) of 105, but no segment with pattern IV was observed. According to TDI analysis, patients were divided into group 1 (10 of 21), with less severe LV asynchrony than before BIV, and group 2 (11 of 21), with no change or more severe LV asynchrony than before BIV. In group 1, (1) the LV ejection fraction increased significantly (P =.01); (2) the exercise tolerance, expressed as time and work capacity on the bicycle stress testing, increased significantly (P =.01, P =.003, respectively); (3) the 6-minute walked distance increased significantly (P =.01); and (4) the NYHA class decreased significantly (P =.003). In group 2, no significant differences were found either in LV ejection fraction, in NYHA class, or in exercise tolerance data (P = not significant for all). Conversely, the QRS narrowing was significant in both groups (P =.003 in group 1 and P =.01 in group 2). CONCLUSIONS: TDI is useful in assessing the severity of LV asynchrony in patients with LBBB with heart failure as well as in evaluating the pacing effects on long-axis function in these patients. BIV reduced unsynchronized and/or dyskinetic contraction in at least one third of the LV basal segments, whereas it induced preexcitation in approximately 10%. Such changes were responsible for better LV synchrony in approximately one half of patients. After BIV, LV performance improved significantly in patients with better LV synchrony evaluated by TDI, whereas the QRS narrowing was not predictive of this functional improvement.

Bundle-Branch Block↗
PubMed2001

New insights into regional systolic and diastolic left ventricular function with tissue Doppler echocardiography: from qualitative analysis to a quantitative approach.

Tissue Doppler echocardiography is a variation of conventional Doppler flow imaging. This modality allows quantification of the Doppler shift within the range of myocardial tissue motion. The velocity at a variety of myocardial sites can be determined and distinguished very rapidly by using Doppler techniques. The velocity of moving tissue can be studied with pulsed wave tissue Doppler sampling, which displays the velocity of a selected myocardial region against time, with high temporal resolution. In addition, the velocities can be calculated with time-velocity maps and displayed as color-encoded velocity maps in either an M-mode or 2-dimensional format. This review will focus on the technical aspects and the different methods of tissue Doppler echocardiography for the analysis of regional systolic and diastolic left ventricular function. Whereas pulsed wave tissue Doppler echocardiography allows measurements of velocities of a selected myocardial region, color tissue Doppler gives the best overview of cardiac dynamics because the entire scanned color data are displayed simultaneously. However, there is an increasing need for objective evaluation of tissue Doppler information. Digital images and postprocessing of the data allow for quantitative off-line analysis, and the different approaches and parameters proposed from different centers are discussed.

Diastole↗
PubMed2001

Constrictive pericarditis after cardiac surgery.

Constrictive pericarditis is an infrequent complication of cardiac surgery. We report the case of a young woman who developed dyspnea and ascites 3 years after surgical closure of an atrial septal defect, and the findings at chest X-ray, computed tomographic scan and Doppler echocardiography are described. Epidemiology of the disease, new pathophysiologic concepts, diagnostic features, and therapeutic targets are reviewed.

Adult↗
PubMed2000

From digital image processing of colour Doppler M-mode maps to noninvasive evaluation of the left ventricular diastolic function: a dedicated software package.

Noninvasive estimation of diastolic pressure gradients has recently been validated using the space-temporal velocity distribution available from colour Doppler M-mode (CDM). However, the methods currently applied for analysing CDM patterns of left ventricular (LV) filling have limitations, such as lack of automation, subjective variability and limited use of digital velocity map. For this reason, we have developed software able to acquire and process the CDM maps; thus, providing an easily interpretable graphical and numerical display. The pressure field is obtained by approximating the derivatives with centred finite differences via the incompressible Navier-Stokes equations. After digital filtering of the noise and the removal of the colour black spots, the velocity field is utilised to compute the pressure gradient field and the pressure values by spatial integration. It is concluded that automatic quantification of colour CDM patterns is feasible and will be a strategic tool in the investigation of one of the most intriguing topics in cardiology.

Blood Flow Velocity↗
PubMed2000

[Tissue Doppler: the physical principles, representational and analytical modalities and clinical applications].

Tissue Doppler imaging or myocardial velocity imaging is a variation of conventional Doppler. This modality allows the quantification of the Doppler shift within the range of myocardial tissue motion. The velocity of motion at a variety of myocardial sites can be determined and distinguished very rapidly using Doppler techniques. The velocity of moving tissue can be studied with pulsed wave tissue Doppler sampling, which displays the velocity of a selected myocardial region against time, with high temporal resolution. In addition, the velocities can be calculated with time velocity maps and displayed as color coded velocity maps in either M-mode or two-dimensional format. This review will focus on the technical aspects and the different methods of tissue Doppler for regional systolic and diastolic left ventricular function analysis. While pulsed wave tissue Doppler allows us to measure the velocities of a selected myocardial region, color tissue Doppler gives the best overall view of cardiac dynamics because the whole scanned color data are displayed simultaneously. However, there is an increasing need for objective evaluation of tissue Doppler information. Digital images and data post-processing allow for quantitative off-line analysis, and the different approaches and parameters proposed from different centers are discussed. In recent years, tissue Doppler imaging has been applied for accurate evaluation of diastolic function, quantifying regional function particularly during stress, pre-excitation syndrome, and left ventricular hypertrophy. The results of these experiences indicate that tissue Doppler imaging is a promising technique for quantifying the response of the myocardium and endocardium during both normal and abnormal function. Again, there is a significant learning curve concerning its application, but with experience it will be a useful and reproducible technique.

Biophysical Phenomena↗
PubMed1999

Multisite stimulation in refractory heart failure.

Since the early nineties, the employment of DDD pacing from a right ventricular site with a short AV delay in patients with severe heart failure has led to considerable conflicting results, so that the real benefit of this method remains to be defined even in selected patients, such as those with first-degree AV block, QRS duration > 140 ms due to left bundle branch block (LBBB), mitral regurgitation time > or = 450 ms and diastolic filling time < or = 200 ms. Indeed, the asynchronous activation induced by pacing the right apex is the most important limitation to the technique, particularly in patients without an LBBB pattern or in those with an incomplete LBBB pattern. Recent studies have also shown that pacing of the right interventricular septum provides no better results than pacing of the right apex, at least in selected patients with no LBBB pattern and no significant mitral regurgitation. Today, it has been suggested that permanent biventricular pacing could be proposed as a feasible and reliable approach to improving ventricular function through the synchronization of the septum and the apex of the left ventricle, particularly in patients with a marked delay in ventricular activation sequence. This technique may be performed by means of transvenous leads inserted through the coronary sinus into the cardiac veins to stimulate both ventricles simultaneously, starting from the right apex and left lateral wall. Consequently, this approach supplies a strong basis for initiating further studies to examine the chronic effects of left ventricular pacing in patients with severe heart failure. We also suggest that the new tissue Doppler imaging techniques could usefully be applied to accurately select candidates to biventricular pacing.

Cardiac Pacing, Artificial↗
PubMed1998

New modalities of regional and global left ventricular function analysis: state of the art.

Study of left ventricular (LV) regional and global function represents a main point of the cardiologic evaluation. This article presents an overview of the state of the art in quantitative analysis of ventricular wall motion and describes the different techniques available in clinical settings; we also present the personal experience of the authors in comparing conventional 2-dimensional (2D) echocardiography with other recently developed, more sophisticated techniques. Conventional 2D echocardiography mainly depends on the operator's ability. Moreover, the physiologic regional pattern of myocardial wall motion in different segments of left ventricle is still not completely known as well as the heart's rotational and translational movements. Qualitative and quantitative transesophageal echocardiography allows a better and more accurate evaluation of regional wall motion, and improves the on-line border detection feasibility even in patients with poor transthoracic echocardiographic window. The automated system for on-line endocardial border detection, color kinesis, and the power Doppler are, at the moment, promising techniques. Using magnetic resonance imaging as a "gold standard" for the study of global and regional left ventricular function, the investigators describe personal experiences with tissue Doppler imaging and a new computerized system for tissue Doppler images postprocessing analysis.

Adolescent↗
PubMed1998

Three-dimensional echocardiographic assessment of the extension of dysfunctional mass in patients with coronary artery disease.

Two-dimensional (2D) echocardiographic estimation of infarcted mass is limited by having only a few selected nonparallel views for data analysis. Volume-rendered three-dimensional (3D) echocardiography may be able to overcome the above limitations, because it uses multiple, parallel 2D images to derive quantitative data. Previous experimental studies demonstrated that 3D echocardiography is an accurate and reproducible method to assess dysfunctional mass. To estimate the accuracy of 3D echocardiography in humans, we evaluated 10 patients who had a single myocardial infarction. All patients underwent 2D and 3D echocardiography using the transesophageal approach, and contrast (gadolinium) magnetic resonance imaging (MRI), considered a reference standard for infarcted tissue detection. The mean extent of dysfunctional mass by MRI was 28 +/- 13 g and by 3D echocardiography was 30 +/- 12 g; the mean difference was 1.9 +/- 2.3 g (p = not significant). Linear regression analysis between the 2 measurements was y = 0.97x - 1.12, r = 0.98. Dysfunctional mass derived from 3D echocardiography reflects the real site and extension of damaged myocardium.

Coronary Disease↗
PubMed1996

[Left ventricular volumetric and contractility behavior during stress echocardiography with dobutamine].

Aim of this study was to assess the behaviour of left ventricular volumes during dobutamine echocardiography in patients with coronary artery disease (CAD) compared to subjects with normal coronary angiograms. We have measured the end-diastolic and end-systolic volumes and a non invasive index of myocardial contractility (the ratio between systolic blood pressure and end-systolic volume index, SBP/ESVI) in 67 patients undergoing dobutamine echocardiography and quantitative coronary angiography. Patients were divided into 3 groups: Control group (n = 10) without CAD; Group I (n = 30) with CAD but normal resting wall motion; Group II (n = 27) with CAD and resting wall motion abnormalities. Volumetric response to dobutamine was deemed abnormal when percent changes of left ventricular volumes from baseline to peak infusion were below 2 standard deviations of the mean values obtained in the control group. The normal or pathological volumetric response was compared with the extent of significant ( > 70% lumen stenosis) coronary artery disease. In the control group, dobutamine produced a significant decrease in both end-diastolic and end-systolic volumes, with percent changes from rest to peak of 24 +/- 5% and 29 +/- 5% respectively, and an average increase of 70 +/- 20% in the SBP/ESVI ratio. Among the 22 Group I patients who showed dobutamine-induced asynergies, volumetric response in those with multivessel disease was normal in 5/14 (36%) and abnormal in 7/8 (87%, p < 0.05), whereas among the remaining 8 patients who had no dobutamine-induced asynergies, an abnormal volumetric response was always associated with multivessel disease (n = 3/3, 100%). In Group II, the prevalence of abnormal volumetric responses in the presence (n = 15) or absence (n = 12) of dobutamine-induced new or worsening asynergies was respectively 92% and 87% in patients with multivessel disease, whereas in those with single vessel disease the prevalence was lower, although not significantly (8 and 13%, p = 0.08 vs multivessel CAD). Predictive accuracy of an abnormal volumetric response for identifying multi-vessel coronary artery disease in Groups I and II was not significantly different (77 and 85%, respectively, NS). Our preliminary data indicate that the evaluation of left ventricular volumes during dobutamine echocardiography yields additional information on myocardial intropic reserve, useful for diagnostic and functional assessment of patients with coronary artery disease. Moreover, this study emphasizes the importance of defining the "normal" left ventricular performance during DE to be able to regard an abnormal volumetric behaviour as a reliable marker of impaired inotropic reserve.

Cardiac Volume↗