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Biomedical subjects

R Salerni

Publications and source records attributed to R Salerni.

At least 19 recordsLinked to original sources
PubMed1993

Reversed closure sequence of the mitral and tricuspid valves in congestive heart failure.

OBJECTIVES: The purpose of this study was to evaluate functional and hemodynamic factors that determine the mitral-tricuspid and aortic-pulmonary valve closure sequence in patients with dilated cardiomyopathy. BACKGROUND: The physiologic factors determining closure sequence of cardiac valves in various forms of heart disease have been found to be complex. Few data exist for dilated cardiomyopathy, particularly for differentiating the effects of a conduction delay versus changes in ventricular performance. METHODS: A group of 64 patients were compared with 36 control subjects. Timing of valve closure and electromechanical intervals were determined by combined M-mode echocardiography, phonocardiography and apexcardiography. Hemodynamic data from right heart catheterization were available in 46 patients. RESULTS: In all control subjects, the aortic valve closed before the pulmonary valve and the mitral valve closed before the tricuspid valve. In the study group, 30 patients (49%) had reversed aortic-pulmonary valve closure and 27 (90%) of these had a left-sided conduction delay. There were 38 patients (60%) who had reversed mitral-tricuspid valve closure, but this was unrelated to the presence of a left-sided conduction delay. The presence of high ventricular filling pressures and poor systolic function was associated with delayed closure of both the mitral and the tricuspid valve. This caused the closure sequence to be related to the size of the difference between mean pulmonary artery wedge pressure and mean central venous pressure and also the magnitude of right ventricular dysfunction. Patients with a low wedge pressure (< 16 mm Hg) and a low central venous pressure (< 10 mm Hg) had a low prevalence of mitral-tricuspid valve closure reversal (30%). Those with a high wedge pressure (> 16 mm Hg) but a low central venous pressure had a high prevalence (86%) of reversal of mitral-tricuspid valve closure. Patients with high wedge and central venous pressures had a moderate prevalence (47%) of mitral-tricuspid valve closure reversal. Similar findings were observed for right ventricular dysfunction. If the right ventricle was normal or severely dysfunctional, a reversed closure sequence was less common (52% and 41%, respectively) than if moderate dysfunction was present (78%). CONCLUSIONS: Aortic-pulmonary valve closure sequence is strongly related to the presence of a left-sided conduction delay. The mitral-tricuspid valve closure sequence is unrelated to a conduction delay but can be reversed by relative differences in the severity of systolic dysfunction and filling pressures between the two ventricles.

Adolescent↗
PubMed1991

Comparison of ambulatory left ventricular ejection fraction and blood pressure in systemic hypertension in patients with and without increased left ventricular mass.

To evaluate the effects of long-standing systemic hypertension on left ventricular (LV) function during daily activities, ambulatory radionuclide monitoring of LV ejection fraction (EF) and blood pressure was performed during exercise and other structured activities in 31 hypertensive patients. Patients were divided into 3 groups based on the absence of LV hypertrophy (group 1 [n = 16], LV mass 107 +/- 12 g/m2), presence of LV hypertrophy without electrocardiographic changes (group 2 [n = 10], LV mass 141 +/- 8 g/m2) and LV hypertrophy with associated electrocardiographic changes (group 3 [n = 5], LV mass 158 +/- 9 g/m2). The groups were similar with respect to age, baseline medication, treated and untreated blood pressure, resting EF and treadmill exercise time. Patients in group 3 had the longest history of hypertension. Peak filling rate was normal in group 1 (2.9 +/- 0.4 end-diastolic volume/s), but reduced at rest in groups 2 (2.4 +/- 0.4) and 3 (2.1 +/- 0.3). Patients in group 1 had normal EF responses to exercise and mental stress testing, as well as during routine ambulatory activities. Patients in group 2 had a blunted EF response to exercise, and those in group 3 had a significantly abnormal response. Both group 2 and 3 patients demonstrated abnormal EF responses to mental stress, as well as cold pressor testing in association with significant increases in mean arterial pressure and marked reduction in diastolic filling rate. Decreases in EF were also observed during routine patient monitoring in 3 group 3 patients and 4 group 2 patients. These events were associated with significantly increased blood pressure.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Familial hypertrophic cardiomyopathy is a genetically heterogeneous disease.

We demonstrate that familial hypertrophic cardiomyopathy (FHC), an autosomal dominant disorder of heart muscle, is a genetically heterogeneous disease. The locus responsible for FHC in members of one large kindred was recently mapped to chromosome 14q11-12 (FHC-1). We have characterized three additional unrelated families in which the gene for FHC segregates as an autosomal dominant trait to determine if these disease loci also map to FHC-1. All family members were clinically studied by physical examination, electrocardiogram, and two-dimensional echocardiography. Genetic studies were performed using DNA probes which are derived from loci that are closely linked to FHC-1. In one family the genetic defect maps to the previously identified FHC-1 locus. However, the loci responsible for FHC in two other families were not linked to FHC-1. We conclude that FHC can be caused by defects in at least two loci and is a genetically heterogeneous disorder.

Cardiomyopathy, Hypertrophic↗
PubMed1987

Electrocardiographically discrete right and left ventricular QRS complexes: a case report.

A patient with congestive cardiomyopathy manifested a right ventricular QRS followed after 80 msec. by a left ventricular QRS in response to a single atrial depolarization. The ventricular sequence was reversible when the left ventricle was paced directly. Virtually the entire ipsilateral ventricular ejection period occurred during diastolic filling of the contralateral ventricle. Triggered left ventricular pacing, using the right ventricular electrogram as trigger, shortened the QRSRV-QRSLV interval and resulted in a reduction of left ventricular filling pressure and a significant rise in cardiac output. These findings indicated an independent contribution of this unique form of interventricular conduction disturbance to deterioration in hemodynamic performance.

Atrial Flutter↗
PubMed1986

Extent of mitral calcific deposits determined by cineangiography in mitral stenosis and their effect on valve motion, hemodynamics and clinical signs.

The relation between the degree of leaflet calcium in a stenotic mitral valve and several parameters of valve mobility, hemodynamics and clinical signs was determined in 105 patients with relatively pure mitral stenosis (MS). The amount of mitral valve calcific deposits was determined by grading cineangiograms. Compared to 71 patients with no or minimal valvular calcium, the 23 patients with heavy valve leaflet calcium were significantly older, more likely to be men and more likely to be in atrial fibrillation. These patients also had a significant reduction of valve mobility in that their M-mode measurements of valve excursion and rate of valve opening were significantly reduced compared to those of patients without heavy valvular calcium. Two-dimensional echocardiograms also documented a significant reduction in valve mobility and progressive restriction in doming of the anterior mitral leaflet as the level of calcium increased. The prevalence of an opening snap was significantly decreased in patients with heavy vs no or light valvular calcium, and patients without an opening snap had reduced valve mobility. However, a considerable number of patients with moderate to heavy valve calcium retained an opening snap.

Adult↗
PubMed1986

Noninvasive evaluation of systolic and diastolic function in severe congestive heart failure secondary to coronary artery disease or idiopathic dilated cardiomyopathy.

The usefulness of systolic time intervals, diastolic time intervals and echocardiography in evaluating left ventricular (LV) function was determined in 69 patients with severe congestive heart failure. All systolic time intervals were markedly abnormal (preejection period/LV ejection time 0.59 +/- 0.18 vs 0.30 +/- 0.04, preejection period index 170 +/- 37 vs 117 +/- 11, LV ejection time index 372 +/- 26 vs 410 +/- 17; patients vs control subjects, p less than 0.05). Diastolic time intervals in patients were not different from those in control subjects. Echocardiographic measurements were all markedly abnormal (LV end-diastolic dimension 6.9 +/- 1.0 vs 4.8 +/- 0.4 cm, patients vs control subjects, p less than 0.05). No pattern of abnormalities distinguished ischemic cardiomyopathies from idiopathic dilated cardiomyopathies. The presence of LV conduction delay did not substantially alter results, except that exclusion of patients with LV conduction delay normalized the total time of systole (QA2) index (from 542 +/- 40 to 531 +/- 31 ms) and reduced but did not normalize prolongation in the preejection period index (from 170 +/- 37 to 162 +/- 29 ms). No systolic or diastolic interval strongly correlated with any hemodynamic or other independent measure of LV performance. Twenty-four patients were given inotropic or unloading agents, which significantly improved hemodynamic values. Systolic and diastolic intervals were measured at baseline and at maximal hemodynamic effect. The correlation of changes in hemodynamics with changes in systolic and diastolic intervals was only modest. Thus, although systolic time intervals and associated echocardiographic measurements can detect abnormal LV function, they cannot reliably detect a change in LV function or distinguish gradations of abnormality.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

Successful reversal by chelation therapy of congestive cardiomyopathy due to iron overload.

A patient who developed severe iron overload cardiomyopathy is described. Venesection could not be performed because the patient had chronic anemia. Deferoxamine mesylate, a chelating agent, was administered daily for more than 2 years and produced significant improvement in ventricular function which was associated with a biopsy-proven decrease in myocardial iron stores. This is the first reported case in which a severe cardiomyopathy due to iron overload was reversed by chelation therapy alone.

Adult↗
PubMed1986

Venous systolic thrill and murmur in the neck: a consequence of severe tricuspid insufficiency.

A palpable venous systolic thrill and murmur at the base of the neck are described as new physical findings in five patients with severe tricuspid regurgitation. In two of these patients, the tricuspid valve had been resected as treatment for infective endocarditis related to intravenous drug abuse. The third patient had severe chronic pulmonary disease with right heart failure. The fourth patient had a complex congenital defect in which the mitral valve served as the venous atrioventricular valve and was severely incompetent. The fifth patient suffered from long-standing rheumatic mitral and tricuspid disease with pulmonary hypertension 10 years after placement of a mitral prosthesis. From these observations, it is apparent that pulsatile retrograde flow in the cervical veins resulting from severe right-sided atrioventricular valve incompetence can produce a palpable systolic thrill and murmur at the base of the neck.

Adolescent↗
PubMed1986

Phonoechocardiography and intracardiac phonocardiography in hypertrophic cardiomyopathy.

The salient phonoechocardiographic features of patients having hypertrophic cardiomyopathy (HCM) with or without left ventricular outflow tract (LVOT) gradients are reviewed. Intracardiac sound and pressure recordings from high fidelity catheter-tipped micromanometers have documented that the precordial murmur is the summation of both the systolic ejection murmur (SEM) arising from the LVOT, as well as the mitral regurgitant murmur recorded from the left atrium. The intensity of the precordial murmur varies directly with the LVOT gradient, which in turn is determined primarily by the contractility and loading conditions of the left ventricle. Reversed splitting of the second heart sound (S2) with paradoxical respiratory movement is a common finding in HCM, and when present, almost always denotes a significant LVOT gradient. It is due to marked lengthening of the left ventricular ejection time secondary to prolongation of the contraction and relaxation phases of left ventricular systole. The presence of a fourth heart sound (S4) is the rule in HCM when normal sinus rhythm is present, and is a reflection of a forceful left atrial contraction into a hypertrophied noncompliant left ventricle. A third heart sound (S3) is also common in HCM, and often the initial vibrations occur before the 0 point of the apexcardiogram (ACG) and continue giving the auscultatory impression of a diastolic rumble. When associated with a loud S1, which is frequently present, the clinical presentation may mimic mitral stenosis. This is particularly true when the patient has chronic atrial fibrillation. Careful attention to evidence of marked left ventricular hypertrophy as well as the typical echocardiographic findings of HCM preclude this diagnosis. In conclusion, phonoechocardiography is a simple non-invasive technique which almost always makes the definitive diagnosis of HCM.

Cardiomyopathy, Hypertrophic↗
PubMed1986

Noninvasive graphic evaluation: phonocardiography and echocardiography.

Noninvasive graphic techniques are an invaluable tool in the diagnosis, management, and followup of patients with valvular heart disease. They are both sensitive and specific and therefore often eliminate the need for more invasive and more expensive diagnostic procedures. When cardiac catheterization and/or cineangiography are necessary to obtain definitive hemodynamic or anatomic information, prior noninvasive graphic evaluation frequently directs the cardiologist to the appropriate type of study to be performed. This is especially true of subtle tricuspid valvular disease, unsuspected silent stenotic valvular lesions, or unusual causes of aortic regurgitation. Because these studies are noninvasive and can be repeated as often as necessary, they are ideal techniques for the longitudinal followup of the patient. Additionally, these techniques are excellent teaching tools, and they allow cardiologists to continually check and refine their clinical skills, which are the foundation of the bedside evaluation of the patient with valvular heart disease.

Aortic Valve Insufficiency↗
PubMed1985

Echophonocardiographic estimates of pulmonary artery wedge pressure in mitral stenosis.

The efficacy of noninvasive indexes for predicting pulmonary artery wedge (PAW) pressure was reviewed in 77 patients with mitral stenosis. M-mode echocardiography and phonocardiography were used to measure the aortic valve closure-mitral valve E-point interval (A2-E) and the electrocardiographic Q wave-mitral valve closure interval (Q-C) close to the time of diagnostic cardiac catheterization. During catheterization, in 65 patients PAW pressure was measured and in 12 left atrial (LA) pressure was measured. The A2-E and Q-C intervals taken alone had only modest correlation with PAW pressure (r = -0.54 and r = 0.46, respectively). The correlation was weakest in patients with atrial fibrillation and best in sinus rhythm when heart rate variation between invasive and noninvasive studies was within +/- 5 beats. Substitution of V-wave pressure for mean PAW pressure and correction for variation in blood pressure improved the A2-E correlation (r = -0.64), as did combining the A2-E and Q-C intervals into a ratio [(Q-C)/(A2-E)] (r = 0.62). However, the best results were obtained in patients where LA pressure was measured directly (r = -0.91 for A2-E), suggesting the PAW pressure is not always an accurate reflection of LA pressure. In conclusion, many factors in addition to LA pressure affect the Q-C and A2-E intervals which, in many situations, decrease their predictive value. However, if used appropriately, these intervals may allow an estimation of PAW pressure.

Adult↗
PubMed1984

Acute hemodynamic effect of oral MDL 17,043 in severe congestive heart failure.

MDL 17,043, when administered intravenously in humans, produces a significant and salutary hemodynamic response. To determine its acute effect when administered orally (3 mg/kg), 10 patients with severe congestive heart failure were studied by right-sided cardiac catheterization for 8 hours. At 4 hours after drug ingestion, there was significant improvement in several hemodynamic measurements. Cardiac index increased 38% over baseline (from 1.9 +/- 0.4 to 2.6 +/- 0.4 liters/min/m2, p less than 0.01), arteriovenous oxygen difference decreased by 30% (from 8.0 +/- 1.4 to 5.6 +/- 1.2 vol%, p less than 0.01), heart rate increased by 8% (from 85 +/- 16 to 92 +/- 16 beats/min, p less than 0.05), stroke volume index increased by 22% (from 23 +/- 5 to 28 +/- 4 ml/beat/m2, p less than 0.05), left ventricular stroke work increased by 24% (from 18 +/- 5 to 22 +/- 5 g-m/m2, p less than 0.01), mean arterial pressure decreased by 10% (from 79 +/- 6 to 71 +/- 9 mm Hg, p less than 0.01), mean right atrial pressure decreased by 40% (from 10 +/- 5 to 6 +/- 4 mm Hg, p less than 0.01), and mean pulmonary artery wedge pressure decreased by 36% (from 22 +/- 5 to 14 +/- 6 mm Hg, p less than 0.01). Cardiac index, arteriovenous oxygen difference, mean arterial pressure, right atrial pressure, and pulmonary artery wedge pressure remained significantly improved at 8 hours. These findings indicate that MDL 17,043 is active when administered orally and produces beneficial hemodynamic effects for as long as 8 hours.

Aged↗