PubMed Health⌕ Search

Biomedical subjects

R Luise

Publications and source records attributed to R Luise.

7 recordsLinked to original sources
PubMed2001

The vasovagal Syncope and pacing (Synpace) trial: rationale and study design.

BACKGROUND: Though vasovagal syncope probably does not directly cause death, it is often associated with severe trauma and, when recurrent, significantly impairs the patient's quality of life. While drug therapy for vasovagal syncope is still controversial, recently two randomized studies revealed the efficacy of dual-chamber pacemaker implantation in decreasing recurrences in very symptomatic patients. However, since both studies were not placebo-controlled, the benefits observed might have been due to the placebo effect of the pacemaker. AIM OF THE STUDY: The aim of the vasovagal Syncope and pacing (Synpace) trial, a multicentre, prospective, randomized, double-blind, placebo-controlled trial, is to ascertain whether, in patients suffering from recurrent vasovagal syncope, the implantation of a dual-chamber pacemaker with rate drop response algorithm programmed to ON, will reduce syncope relapses compared with the implantation of a pacemaker programmed to OFF. Moreover, in order to evaluate the role of the haemodynamic response during tilt-induced syncope in identifying those patients who will benefit most from pacemaker implantation, enrolled patients will be divided into two groups on the basis of their haemodynamic behaviour during tilt-induced syncope: group 1, asystolic response (development of asystole >3 s), and group 2, mixed response (development of bradycardia <60 bpm, without asystole >3 s). The head-up tilt testing protocol will consist of 20 min at 60 degrees without drug potentiation, followed by 15 min at the same inclination after 400 microg of sublingual nitroglycerin. Results from the two groups will be analysed both separately and globally. The primary clinical endpoint of the study will be syncope. INCLUSION AND EXCLUSION CRITERIA: To be enrolled, patients will have to meet the following criteria: at least six syncopal episodes in the patient's lifetime; positive head-up tilt testing with asystolic or mixed response; at least one syncope recurrence following a positive head-up tilt test. The following constitute exclusion criteria: non-vasovagal syncope; other indications for pacing. SAMPLE SIZE: We hypothesize a risk of syncope recurrence of 70% after one year, and we estimate that--owing to the placebo effect alone--pacemaker will produce a 20% decrease in risk, which corresponds to a 50% risk of recurrence after one year, in those patients randomized to 'pacemaker OFF'. We calculate conservatively a risk decrease of 60% in patients with 'pacemaker ON'. This implies a 10% incidence of syncope recurrence after one year, vs 50% in patients with 'pacemaker OFF'. Fifty patients will need to be enrolled in the study: 25 patients for each group.

Databases as Topic↗
PubMed2000

Intravascular physiologic evaluation of the left anterior small thoracotomy operation: a novel approach to left anterior descending artery revascularization.

BACKGROUND: Efficacy and long-term patency rate of the left internal mammary artery (LIMA) conduits for revascularization of the left anterior descending coronary artery (LAD) has been demonstrated, with improved results as compared to the saphenous vein graft operation. Novel approaches to LAD revascularization including the use of the left anterior small thoracotomy (LAST) operation with persistence of the intercostal arteries compared to the traditional LIMA operation have not been reported. This study evaluated flow characteristics of LAST operation. METHODS: Phasic blood flow velocity in the proximal and distal arterial conduit segments was measured in 30 patients by intravascular Doppler flow wire after surgical revascularization of the LAD: 15 patients were revascularized by conventional operation using the LIMA (Group A), and 15 patients were submitted to the LAST operation (Group B). All patients underwent coronary angiography and ventriculography at 116 +/- 111 days after operation. Only angiographically normal grafts with normal left ventricular wall motion and coronary arteries free from significant distal stenosis were included for coronary flow velocity and reserve measurements. RESULTS: The diastolic/systolic velocity ratio in the proximal portion of the internal mammary artery was similar in the two groups (Group A 0.8 +/- 0.2 vs Group B 0.7 +/- 0.3, p = NS). Distal diastolic/systolic velocity ratio in Group A (1.7 +/- 0.1) was higher than Group B (0.9 +/- 0.3, p < 0.001). There were no differences in basal average peak velocity or coronary flow reserve between the proximal and distal segments for either groups. CONCLUSIONS: Although proximal phasic coronary flow patterns between the two groups were similar, distal diastolic/systolic velocity ratio was higher in the LIMA than in the LAST. This difference may be related to the persistence of the intercostal artery in the LAST operation. These data confirm the continued patency and similar functional flow patterns compared to the conventional LIMA operation, supporting further investigation and application of this novel approach to LAD revascularization.

Aged↗
PubMed1997

Persistence of mammary artery branches and blood supply to the left anterior descending artery.

BACKGROUND: Partial harvesting of the left internal mammary artery (LIMA) is a widespread technique used during minimally invasive coronary operations performed through a left anterior small thoracotomy. The influence of persisting LIMA branches was investigated to evaluate their effect on the blood flow of the left anterior descending artery. METHODS: Thirty patients, 15 with totally (group A) and 15 with partially (group B) harvested LIMAs, were evaluated. All the patients underwent postoperative angiography, during which a flow map of the LIMA was performed. The average peak velocity and the diastolic-to-systolic peak velocity ratio were recorded. The LIMA graft flow pattern was recorded in the proximal and distal thirds of the artery. Intramammary adenosine (12 to 14 microg) was injected and the average peak velocities before and after injection were calculated. RESULTS: The average peak velocity was similar in both groups in the proximal and distal thirds of the LIMA (25 +/- 7 and 26 +/- 5 cm/sec, respectively, in group A versus 27 +/- 5 and 25 +/- 5 cm/sec, respectively in group B; p = NS). The diastolic-to-systolic peak velocity ratio was similar proximally (0.78 +/- 0.3 in group A versus 0.69 +/- 0.3 cm/s in group B; p = NS), but not distally (1.72 +/- 0.1 in group A versus 0.97 +/- 0.3 in group B; p < 0.0005). The LIMA graft flow reserve was similar both proximally and distally (2.6 +/- 0.6 and 2.5 +/- 0.3 cm/s, respectively, in group A versus 2.6 +/- 0.5 and 2.6 +/- 0.3 cm/s, respectively, in group B; p = NS). CONCLUSIONS: The persistence of LIMA branches does not influence the blood flow of the left anterior descending artery after acute adenosine-induced myocardial hyperemia. If a left anterior small thoracotomy is used in left anterior descending artery direct revascularization, complete LIMA harvesting is not mandatory and depends on the personal preference of the surgeon.

Aged↗
PubMed1990

[Idiopathic restrictive cardiomyopathy. Description of 4 cases].

The clinical and instrumental characteristics of four patients suffering from idiopathic restrictive cardiomyopathy are analysed. Patients were diagnosed following hemodynamic and histological tests. The major clinical symptom was cardiac decompensation and/or hyperkinetic or hypokinetic (3rd degree BAV) supraventricular arrhythmia (atrial fibrillation). Electrocardiographic and radiological alterations were not specific. The most typical echocardiographic symptom was the association of: biatrial dilation, dilation and hypertrophy of the right ventricle, normal left ventricular size, normal fractional shortening of the left ventricle. Septal hypertrophy was also observed in one case. Abundant pericardial effusion was present in all cases. When performed, echo-Doppler showed a relatively typical shortened deceleration time through the A-V valve. Catheterism revealed increased ventricular telediastolic pressures and a bi-plateau morphology of the ventricular pressure curve. Heart index was depressed in one patient and the ejection fraction was reduced in one case. Histological tests revealed interstitial fibrosis, cellular hypertrophy and, in one patient, myocardial amyloidosis. One patient underwent a heart transplant, two patients died while waiting for a transplant, one patient is still alive 13 years after the start of 3rd class symptoms.

Adult↗