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Biomedical subjects

Paolo Marino

Publications and source records attributed to Paolo Marino.

16 recordsLinked to original sources
PubMed2006

Inappropriate implantable cardioverter-defibrillator discharges unrelated to supraventricular tachyarrhythmias.

AIMS: The development of implantable cardioverter-defibrillators (ICDs) with QRS morphology discrimination and dual-chamber sensing capabilities has improved the differentiation of supraventricular from ventricular tachycardias (VTs). Inappropriate ICD discharges may result from extracardiac signals caused by electromagnetic interference (EMI), because of electric fields and leakage currents from domestic or medical electrical devices, damaged sensing leads, and various cardiac and extracardiac signals that mimic VT and/or ventricular fibrillation. The aim of our study was to determine retrospectively the incidence and clinical relevance of these ICD behaviours and offer possible therapeutic solutions. METHODS AND RESULTS: We have observed inappropriate discharges unrelated to supraventricular arrhythmias in 13 (3.9%) of the 336 patients implanted with ICDs in our centre from 1989 to 2005. Seven patients received inappropriate shocks following exposure to external EMI: improperly grounded electric stove, electrically powered watering system, hydro-massage bath, electrical pruner, electrocautery current during cardiac surgery, transcutaneous electric nerve stimulation. In four patients, spurious discharges were related to internal noise of the ICD system from inappropriate lead connections. In two cases, erroneous antitachycardia therapy was delivered following different body signals oversensing (T-wave oversensing, wide QRS double-counting and myopotentials). In nine patients, non-invasive solutions prevented further inappropriate therapies (avoidance of EMI, malfunctioning atrial lead exclusion, ventricular sensing reprogramming). In four patients, surgical revision of the system was required (lead connections or position revision). CONCLUSION: In our experience, inappropriate ICD discharges unrelated to supraventricular arrhythmias occurred in about 4% of ICD patients. A careful evaluation of clinical data and telemetric information (lead impedance, sensed R-wave, stored electrograms) is essential in order to understand the nature of inappropriate ICD discharges and to select the most appropriate solution.

Aged↗
PubMed2006

Prevention of ventricular desynchronization by permanent para-Hisian pacing after atrioventricular node ablation in chronic atrial fibrillation: a crossover, blinded, randomized study versus apical right ventricular pacing.

OBJECTIVES: The aim of our study was to evaluate the feasibility, the safety, and hemodynamic improvements induced by permanent para-Hisian pacing in patients with chronic atrial fibrillation and narrow QRS who underwent atrioventricular (AV) node ablation. BACKGROUND: Right ventricular apical pacing, inducing asynchronous ventricular contraction, may impair cardiac function; permanent para-Hisian pacing could preserve interventricular synchrony and improve left ventricular function. METHODS: After AV node ablation, 16 patients were implanted with a dual-chamber pacemaker connected to a screw-in lead positioned in close proximity to the His bundle and to a right ventricular apical lead. Clinical and echocardiographic data were collected at baseline and after two randomized six-month periods (with para-Hisian and conventional pacing). RESULTS: During para-Hisian pacing, the interventricular electromechanical delay improved as well (34 +/- 18 ms) as during right apical pacing (47 +/- 19 ms), p < 0.05. Para-Hisian pacing allowed an improvement in New York Heart Association functional class (1.75 +/- 0.4 vs. 2.33 +/- 0.6 at baseline and 2.5 +/- 0.4 during apical pacing, p < 0.05 for both), in quality-of-life score (16.2 +/- 8.7 vs. 32.5 +/- 15.0 at baseline, p < 0.05), and in the 6-min walk test (431 +/- 73 m vs. 378 +/- 60 m at baseline and 360 +/- 71 m during apical pacing, p < 0.5 for both). Mitral and tricuspid regurgitation improved during para-Hisian pacing (1.22 +/- 0.8 and 1.46 +/- 0.5 index, respectively, vs. 1.68 +/- 0.6 [p < 0.05] and 1.62 +/- 0.7 [p = NS] index at baseline, respectively), with a slight worsening during apical pacing (1.93 +/- 1 and 1.93 +/- 0.7 index, respectively, p < 0.05 for both). CONCLUSIONS: Permanent para-Hisian pacing is feasible and safe. Compared with conventional right apical pacing, it allows an improvement in functional and hemodynamic parameters over long-term follow-up.

Aged↗
PubMed2006

Ventricular capture by anodal pacemaker stimulation.

This report describes the case of an 86-year-old male with syncopal paroxysmal 2:1 atrioventricular block and a single chamber VVI pacemaker programmed to bipolar sensing and unipolar pacing. After recurrence of syncope, a complete loss of ventricular capture with regular ventricular sensing was observed on ECG; fluoroscopic examination suggested perforation of the right ventricle by the helix of the implanted screw-in lead. Reprogramming the pacemaker to bipolar pacing/sensing resulted in regular ventricular capture and sensing, suggesting effective anodal stimulation from the ring electrode permitting complete non-invasive palliation.

Aged, 80 and over↗
PubMed2006

Aortic stiffness correlates with an increased extracellular matrix turnover in patients with dilated cardiomyopathy.

BACKGROUND: An increased extracellular matrix (ECM) turnover has been associated with poor survival in patients with chronic heart failure (CHF) due to dilated cardiomyopathy (DCM). However, the influence of the accelerated collagen turnover on the progressive large artery stiffening process characterizing CHF has not been clarified. This is relevant because aortic stiffening imposes an additional systolic load and impairs exercise tolerance in CHF patients. Therefore, we investigated whether the serum aminoterminal propeptide of type III collagen (PIIINP), an established marker of ECM turnover and tissue fibrosis in DCM, was associated with aortic stiffness in DCM patients. METHODS AND RESULTS: A total of 89 patients with clinical diagnosis of DCM (age 62 +/- 9 years, 80% men, mean ejection fraction 34% +/- 8%) were selected. Aortic pulse-wave velocity (PWV), a well-established marker of aortic stiffness, was measured by Doppler ultrasonography. Serum concentration of PIIINP was determined by radioimmunoassay. Mean aortic PWV was 5.7 +/- 2.3 m/s, and PIIINP was 5.0 +/- 1.3 microg/L. The variables correlated with aortic PWV were age (r = 0.33, P = .002), PIIINP (r = 0.30, P = .005), heart rate (r = 0.27, P = .02), stroke volume (r = -0.24, P = .03) and New York Heart Association class (r = 0.25, P = .02). In a multivariate analysis, age (P = .02) and PIIINP (P = .01) were independently related with aortic PWV, accounting for 27% of its variance. CONCLUSIONS: Higher serum PIIINP levels are independently associated with a stiffer aorta in DCM patients. This suggests that abnormalities in the ECM turnover might involve the proximal elastic vasculature and could partially explain the progressive large artery stiffening process characterizing CHF.

Aged↗
PubMed2006

Upgrade of a single chamber endo-epicardial to a triple chamber biventricular implantable cardioverter-defibrillator.

In patients with heart failure implanted with conventional pacemakers, cardiac resynchronization therapy results in significant benefits. The upgrade of previously implanted devices to biventricular pacing may be technically challenging. We report one case of upgrade to biventricular pacing and describe the related technical implications and the therapeutic solutions adopted.

Aged↗
PubMed2006

[Aortic pseudoaneurysm and aorta-right atrium fistula: a case report].

The development of an aortic pseudoaneurysm of the ascending aorta is described as a potential complication after composite graft surgery for combined disorders that simultaneously affect the aortic valve and ascending aorta; in the literature it has been reported to range from 7 to 25%. The aorta-right atrial fistula is an infrequent complication of aortic dissection and it is rarely diagnosed in association with aortic pseudoaneurysm. The pathophysiological mechanism of the first seems to be related to dehiscence of the suture line at the anastomosis site; in the second to anatomic contiguity between the aorta and right atrium. Our report refers to a 72-year-old man with a 3-year history of a Bentall composite aortic root replacement (modified by Kouchoukos), who presented with epigastric and chest pain accompanied with severe dyspnea. The diagnosis of aortic pseudoaneurysm complicated by right atrial fistula was made by the combination of transthoracic and transesophageal echocardiographic examination.

Acute Disease↗
PubMed2006

[Electrical storms in patients with implantable cardioverter-defibrillator: incidence and clinical management].

BACKGROUND: Electrical storm in implantable cardioverter-defibrillator (ICD) recipients is a dramatic experience for the patient and a hard emergency for the cardiology team. The aim of our study was to evaluate the incidence and the clinical significance of electrical storm in a standard population of ICD patients. METHODS: We considered retrospectively 262 consecutive ICD patients (86% males, mean age 65+/-10.7 years). Patients were divided into three groups: 88 patients without appropriate ICD therapy (group A); 140 patients with isolated ICD therapies (group B); 34 patients with electrical storm episodes (> or = 3 appropriate ICD therapies/24 h) (group C). Survival study (endpoint death) was performed for each group of patients. RESULTS: There was no difference in age, sex, heart disease, ejection fraction or NYHA functional class among the three groups. ICD implant was performed for secondary prevention in 79% of group C patients and in 74.3 % of group B patients, but only in 39.8 % of group A patients (p < 0.0001). Mean follow-up was 31.1+/-29.8 months in group A, 55.1+/-38 months in group B, and 71.1+/-51.7 months in group C. The endpoint was reached by 16 patients (18%) of group A, by 53 patients (38%) of group B, and by 20 patients (58%) of group C. Comparison of the survival curves of the three groups did not show significant differences. In group C patients, 54 electrical storm episodes were recorded (mean 1.5/patient). CONCLUSIONS: In our population of ICD patients, we observed electrical storm in 34 patients (12.9%). Survival in group with episodes of electrical storm was comparable to patients without electrical storm; thus, in our experience, electrical storm could not represent a negative prognostic factor.

Aged↗
PubMed2005

[Tako-tsubo-like syndrome without emotional stress: a case report].

The tako-tsubo-like syndrome (also named left ventricular apical ballooning) is an unusual cardiomyopathy with a high incidence in the Japanese female population, following an emotional stress. The clinical features (typical chest pain), electrocardiographic (negative T wave and persistent ST-segment elevation in anterior leads), echocardiographic (transient left ventricular apical dysfunction with hyperkinesis of basal segments) are suggestive of an acute anterior myocardial infarction; nevertheless all reports in the literature show coronary arteries without angiographic lesions. We report the case of a 77-year-old female (without cardiovascular risk factors) with two prior episodes of paroxysmal atrial fibrillation, who arrived to the emergency department with chest pain, electrocardiographic and echocardiographic features, suggestive of an acute anterior myocardial infarction, not preceded by any emotional stress. Coronary angiography showed coronary arteries without atherosclerotic lesions; left ventriculography showed an anteroapical dysfunction. The follow-up performed with transthoracic echocardiography (2 months later) showed complete regression of regional wall motion abnormalities. The pathophysiological determinant seems to be related to the release of catecholamines (such as epinephrine and norepinephrine) able to create a transient board of ischemic cardiomyopathy through a direct cellular damage.

Aged↗
PubMed2004

Early mitral deceleration and left atrial stiffness.

Left ventricular (LV) filling deceleration time (DT) is determined by the sum of atrial and ventricular stiffnesses (KLA + KLV). If KLA, however, is close to zero, then DT would reflect KLV only. The purpose of this study was to quantify KLA during DT. In 15 patients, KLV was assessed, immediately after cardiopulmonary bypass, from E wave DT as derived from mitral tracings obtained by transesophageal echocardiography and computed according to a validated formula. In each patient, a left atrial (LA) volume curve was also obtained combining mitral and pulmonary vein (PV) cumulative flow plus LA volume measured at end diastole. Time-adjusted LA pressure was measured simultaneously with Doppler data in all patients. KLA was then calculated during the ascending limb of the V loop and during DT. LA volume decreased by 7.3 +/- 6.5 ml/m2 during the first of mitral DT, whereas LV volume increased 9.4 +/- 8.4 ml/m2 (both P < 0.001). There was a small amount of blood coming from the PV during the same time interval, with the cumulative flow averaging 3.2 +/- 2.4 ml/m(2) (P < 0.001). Mean LA pressure was 10.0 +/- 5.1 mmHg, and it did not change during DT [from 7.8 +/- 4.3 to 8.0 +/- 4.3 mmHg, not significant (NS)], making KLA, which averaged 0.46 +/- 0.39 mmHg/ml during the V loop, close to zero during DT [KLA(DT): from -0.002 +/- 0.08 to -0.001 +/- 0.031 mmHg/ml, NS]. KLV, as assessed noninvasively from DT, averaged 0.25 +/- 0.32 mmHg/ml. In conclusion, notwithstanding the significant decrement in LA volume, KLA does not change and can be considered not different from zero during DT. Thus KLA does not affect the estimation of KLV from Doppler parameters.

Acceleration↗
PubMed2003

Feasibility and safety of transeophageal atrial pacing stress echocardiography in patients with known or suspected coronary artery disease.

To investigate the feasibility and safety of the transesophageal atrial pacing stress test combined with echocardiography (TAPSE) 1,727 TAPSE tests were performed on 1,641 patients consecutively referred to our echocardiographic laboratory for nonexercise stress testing (1,319 men; mean age 60 +/- 9 years; 34% of whom were outpatients). Wall motion abnormalities were present at baseline echocardiography in 975 cases (56%). TAPSE was feasible in 1,648 cases (95.4%). It was not feasible in 79 patients due to failure of positioning the transnasal catheter (n=11), the patient's intolerance of esophageal stimulation (n=24), failure to obtain any or stable atrial capture (n=36), or because the echocardiogram could not be evaluated at the peak of the test (n=8). TAPSE was diagnostic in 1,584 cases (96% of the feasible tests, 92% of all attempts). TAPSE was nondiagnostic in 64 cases (4% of the feasible tests) due to second-degree atrioventricular type I block resistance to atropine administration with failure to achieve 85% of the age-predicted maximum heart rate (n=59) or due to side effects, such as arrhythmias (n=3) or hypertension (n=2), which required premature interruption of the test. There were no major complications (death, myocardial infarction, or life-threatening arrhythmias). There were 28 instances of minor complications that comprised transient arrhythmias, including atrial fibrillation (n=8), paroxysmal supraventricular tachycardia (n=6), automatic atrial tachycardia (n=1), sinus arrest (n=1), atrioventricular junctional rhythm (n=2), ectopic atrial rhythm (n=2), nonsustained ventricular tachycardia (maximum 6 beats, n=3), hypotension (n=1), and hypertension (n=4) leading to interruption of the test. Only 5 complications hampered a diagnostic result, whereas 18 occurred during or after a positive test and 5 during a negative, but diagnostic, test. Thus, TAPSE is a highly feasible and very safe stress test. It gives high percentage of diagnostic tests and may represent a valid alternative to pharmacologic stressors.

Adolescent↗
PubMed2003

Aortic distensibility independently affects exercise tolerance in patients with dilated cardiomyopathy.

BACKGROUND: Peak exercise oxygen consumption (VO2) is crucial for the prognostic stratification of patients with congestive heart failure, but its hemodynamic determinants are still not completely understood. Aortic wall elasticity modulates left ventricular function and coronary blood flow. Whether an increased aortic pulse-wave velocity (PWV), a known marker of arterial stiffness, may predict peak VO2 in patients with dilated cardiomyopathy (DCM) has to be clarified. METHODS AND RESULTS: A total of 78 patients with clinical diagnosis of DCM (aged 62+/-11 years; female 29%; mean ejection fraction 34+/-9%) were selected. All patients underwent a complete echocardiographic-Doppler evaluation. Aortic PWV was measured by Doppler ultrasonography immediately before the exercise. A bicycle exercise test with expiratory gas exchange monitoring was performed to determine VO2 . Plasma concentration of the amino-terminal propeptide of type III procollagen (PIIINP), a marker of extracellular matrix turnover, was determined. Mean PWV was 5.7+/-2.2 m/s, and VO2 was 16.5+/-4.5 mL x kg(-1) x min(-1). The hemodynamic variables correlated with VO2 were PWV (r=-0.39, P=0.0007) and stroke volume (r=0.38, P=0.002). In a multivariate analysis, PWV (P=0.04) and stroke volume (P=0.05) were independently correlated with VO2 , accounting for 34% of its variance. PIIINP levels correlated with PWV (r=0.35, P=0.002) and a more restrictive diastolic filling pattern (r=0.40, P=0.02). CONCLUSIONS: Increased aortic stiffness measured by PWV is an independent predictor of peak VO2 and could partially explain exercise intolerance in patients with DCM.

Aorta↗
PubMed2003

Beneficial effects of angiotensin-converting enzyme inhibitor and nitrate association on left ventricular remodeling in patients with large acute myocardial infarction: the Delapril Remodeling after Acute Myocardial Infarction (DRAMI) trial.

BACKGROUND: In the large-scale trial, Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico-3 (GISSI-3), patients receiving the combination of lisinopril and glyceryl trinitrate benefited most from experimental therapy. Therefore, a multicenter, randomized, double-blind study, Delapril Remodeling After Acute Myocardial Infarction (DRAMI), was designed to assess (1) the possible additive beneficial effect on left ventricular remodeling of nitrates when combined with an angiotensin-converting enzyme inhibitor (ACEI), and (2) the tolerability of a new ACEI, delapril, in respect to lisinopril in patients with large myocardial infarction (MI). METHODS: A total of 177 patients were randomized to receive delapril plus isosorbide-5-mononitrate (IS5MN) placebo, delapril plus IS5MN, lisinopril plus IS5MN placebo, or lisinopril plus IS5MN starting within the first 36 hours after the onset of symptoms and continuing for 3 months. RESULTS: More than 80% of the patients showed extensive ST-segment changes and 36.7% had signs or symptoms of heart failure during the first 36 hours. Over 3 months, IS5MN reduced, by 76%, the increase in LVEDV (17.4 +/- 5.0 mL placebo vs 4.2 +/- 4.4 mL IS5MN, P =.0439), reversed the increase in LVESV (7.5 +/- 3.9 mL placebo vs -5.5 +/- 2.9 mL IS5MN, P =.0052), and increased the recovery of LVEF (1.9% +/- 1.3% placebo vs 6.7% +/- 1.2% IS5MN, P =.0119). Overall, 3-month mortality was 10.2%; the most frequent clinical events were new episodes of severe heart failure (18.1%), persistent hypotension (10.7%), and post-MI angina (18.1%), with no differences between treatment groups. CONCLUSIONS: Administration for 3 months of IS5MN combined with an ACEI, both started within 36 hours from the onset of symptoms, was safe and effective in reducing LV dilation and dysfunction after MI. The 2 ACEIs, delapril and lisinopril, appeared to be equally well tolerated.

Aged↗
PubMed2002

Long-term, dose-dependent effects of spironolactone on left ventricular function and exercise tolerance in patients with chronic heart failure.

OBJECTIVES: This study was designed to assess the effects of spironolactone (SP) on left ventricular (LV) function and exercise tolerance in patients with chronic heart failure (CHF). BACKGROUND: In severe heart failure (HF), SP improves survival, but the underlying mechanisms are not clear. METHODS: We randomized 106 outpatients with HF to SP (12.5 to 50 mg/day) (group 1) or control (group 2). Complete echocardiography and cardiopulmonary exercise testing were performed at baseline and 12 months after randomization. RESULTS: Left ventricular end-systolic volume at baseline and at follow-up was 188 +/- 94 ml and 171 +/- 97 ml in group 1 and 173 +/- 71 ml and 168 +/- 79 ml in group 2 (treatment group-by-time interaction, p = 0.03). Left ventricular ejection fraction at baseline and at follow-up was 33 +/- 7% and 36 +/- 9% in group 1 and 34 +/- 7% and 34 +/- 9% in group 2 (treatment group-by-time interaction, p = 0.02). At baseline, 9 patients in group 1 and 3 patients in group 2 had a restrictive mitral filling pattern, a marker of severe diastolic dysfunction; at follow-up, 3 patients in group 1 and no patient in group 2 improved their pattern. No patient in group 1 and 4 patients in group 2 worsened their pattern (chi-square, p = 0.02). Peak oxygen consumption increased significantly in patients treated with 50 mg of SP and decreased in group 2 (17.7 +/- 5.2 vs. 18.5 +/- 5.9 and 19.1 +/- 5.6 vs. 17.9 +/- 5.3, respectively; analysis of variance, p = 0.01). CONCLUSIONS: Spironolactone improves LV volumes and function; furthermore, it improves exercise tolerance at the highest administered dose. Our data might explain the mortality reduction during aldosterone antagonism in patients with HF.

Aged↗
PubMed2002

Can left ventricular diastolic stiffness be measured noninvasively?

BACKGROUND: A noninvasive estimation of left ventricular (LV) diastolic chamber stiffness (K(LV)) is still a challenge. Experimental data suggests that K(lv) can be obtained by using Doppler mitral flow deceleration time (DT) as the only variable: K(lv) = (70/[DT-20])(2) mm Hg/mL. We assessed the accuracy of this noninvasive estimate of K(lv) by comparing it with invasive measurement of K(lv) in intact patients with a wide range of LV size and function under varying loading conditions. METHODS: Twenty-five patients (age 54 +/- 12 years) with ischemic heart disease (n = 19) or primary LV dysfunction (n = 6), with a wide range of DT (79-324 ms) and ejection fraction (8%-57%), underwent simultaneous assessment of LV pressure by micromanometer and volume by 2-dimensional (2D) echocardiography-guided Doppler mitral flow velocity (where volume = mitral flow velocity integral x annular area) calibrated to 2D echocardiography stroke volume. Invasive K(lv) [delta pressure (from minimum to end-diastolic)/delta volume (during the same time interval)] was obtained at baseline and in 23 patients after LV unloading by prostaglandin E(1) (30-60 ng/kg/min) (n = 12), nitroglycerin (0.2 mg) (n = 9) or magnesium (1 g) (n = 2). Noninvasive K(lv) was estimated according to the above formula. RESULTS: In this set of patients with normal mitral annular area (3.9 +/- 1.1 cm(2)/m(2)), multivariate analysis showed that DT is inversely related to K(lv) (P <.001) but not to left atrial chamber stiffness, LV volume, relaxation time constant, mitral valve opening pressure, or area. The relation between noninvasively calculated and directly measured K(lv) was close to the line of identity under all conditions, (y = 0.93x + 0.05, r = 0.67, n = 48, P <.001), although with a wide standard error of the estimate (0.26 mm Hg/mL). CONCLUSION: We conclude that K(lv) can be calculated +/- 0.5 mm Hg/mL from noninvasively measured DT in patients.

Adult↗
PubMedDate not supplied

Imaging of early postoperative complications after polypropylene mesh repair of inguinal hernia.

PURPOSE: We report our experience with the use of US and CT in postoperative complications of inguinal hernioplasty using a prosthetic polypropylene mesh. MATERIALS AND METHODS: This study was divided into two parts. In the first we evaluated the in-vitro sonographic and CT appearance of a fragment of prosthetic mesh. In the second, we retrospectively reviewed the imaging findings in 31 patients (aged 42 to 75 years) examined after inguinal hernia repair between December 2000 and December 2002. Seventeen hernias had been repaired with a laparoscopic approach, and the others with the anterior tension-free technique proposed by Lichtenstein (12 cases) and Trabucco (2 cases). Sonography was performed to assess suspected complications between the second and the fourth postoperative day. Both high-resolution 7.5-10 MHz linear transducers and a 3.5 MHz convex probe were employed to ensure complete evaluation of superficial and deep structures. Eight obese patients also underwent CT for confirmation of the US results. RESULTS: At sonography the prosthetic mesh appeared as a linear hyperechoic image measuring about 2 mm in thickness, with posterior acoustic shadow and a finely irregular surface. Only one of the 17 patients examined after laparoscopic inguinal hernioplasty had a seroma; in the other 14 repaired with the anterior tension-free technique we identified 2 abscesses, 3 seromas, 2 "foldings" of the prosthetic mesh, and 2 mesh displacements with associated recurrence of hernia. CT confirmed the US results as to the presence of fluid collections, and visualised the prosthetic mesh in only 2/8 cases. CONCLUSIONS: Sonography is a useful means of assessing postoperative changes in laparoscopic and in anterior tension-free hernia repair. It can differentiate these complications from recurrences of hernia. Colour-Doppler US can also correctly detect normal blood flow of the testes. Sonography is the only technique that can easily demonstrate the prosthetic mesh in the abdominal wall.

Abscess↗