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Biomedical subjects

S I Drăgulescu

Publications and source records attributed to S I Drăgulescu.

At least 19 recordsLinked to original sources
PubMed2005

Dual renin angiotensin system blockade in patients with acute myocardial infarction and preserved left ventricular systolic function.

UNLABELLED: The activation of the renin-angiotensin system (RAS) is a major determinant of ventricular remodeling. We prospectively assessed whether the dual RAS blockade (angiotensin II AT 1-receptor blocker and angiotensin-converting enzyme inhibitor therapy) in patients with acute myocardial infarction (AMI) who were treated by primary percutaneous coronary intervention (PCI) and stenting provides benefit on the improvement of the left ventricle function. A secondary aim is to demonstrate that triple therapy with angiotensin-converting enzyme (ACE) inhibitors, angiotensin II AT 1-receptor blockers (ARBs) and beta blockers does not increase cardiovascular morbidity, cardiovascular mortality and all cause mortality. METHODS: We investigated 44 patients with AMI with ST elevation undergoing primary PCI and stenting. All patients received standard therapy including an ACE inhibitor and a beta blocker. We divided the patients into two groups, A and B. Valsartan was added to the standard therapy within the first 6 hours from the onset of AMI in group A. We assessed cardiovascular and all cause mortality, incidence of major acute coronary events (MACE), incidence of non-fatal AMI, the evolution of left ventricle ejection fraction (LVEF), wall motion score index (WMSI) and left ventricle end-systolic and end-diastolic diameters. The follow-up period was one year. RESULTS: There were no statistically significant differences between groups regarding cardiovascular and all cause mortality, incidence of MACE, incidence of non-fatal MI. LVEF significantly increased at 1 year in both groups. In both groups the reduction of end-systolic and end-diastolic diameters at 1 year was statistically significant. Echocardiographic findings demonstrated also a significant decrease of WMSI at 1 year in both groups. CONCLUSIONS: The dual renin-angiotensin system blockade (ARBs and ACE inhibitor) has proved its beneficial effect on the improvement of left ventricular function, without increasing cardiovascular mortality and incidence of non fatal myocardial infarction (MI) in patients with AMI treated by primary PCI and stenting within a 1 year follow-up period.

Acute Disease↗
PubMed2005

Is age correlated with dynamic atrial decremental conduction properties?

UNLABELLED: Atrial fibrillation (AF) has been associated with premature beats and decreased atrial conduction velocities. On the other hand, prevalence of AF is increased in the elderly. The aim is to evaluate and analyze the relation between age, atrial size and a new index of dynamic interatrial conduction time (iaCT) in a homogeneous population of patients (pts) with structurally normal heart without AF. METHODS: 45 patients (pts) without structural heart disease aged 53 +/- 20 years referred for electrophysiologic study were analyzed. To examine the atrial electrophysiologic characteristics we studied interatrial conduction time (iaCT), double potentials and fragmented atrial activity during premature stimulation of high right atrium; prior to investigation, all antiarrhythmic drugs were withdrawn for an appropriate period of time. The following parameters were assessed: baseline iaCT (iaCTb) between high right atrium (HRA) and distal coronary sinus (CS), iaCT during HRA pacing S1S1 600ms (iaCTS1), maximum prolongation of iaCT during S2 and S3 delivery (iaCTS2, iaCTS3). We calculated a derived parameter: maximum prolongation iaCT/decremental index (DI)= iaCT S3-ia CTS1/iaCTS1%. The following echocardiograhic parameters were assessed: left atrial dimensions and surface (LAs), right atrial dimension and surface (RAs), total atrial surface (TAs=LAs+RAs) and left atrial volume (LAv) calculated using ellipse formula. RESULTS: iaCT ranged from 42 to 87ms; DI ranged from 16 to 52%. Simple regression analysis demonstrated a statistically significant linear correlation between the age of pts and HRA DI (r = 0.76, r2 = 0.55, p <0.0001). A trend toward a significant correlation was found between TAs and DI (r=0.64, r2=0.41, p<0.0001) LAv and DI (r=0.59, r2=0.35, p<0.0001). No significant correlation was found in this group between age and iaCT. Atrial double potentials and fragmentated electrograms were recorded using HRA stimulation in CS leads in 7 pts (15%) all aged >35 years. Pts were divided into two groups: 17 pts with normal electrophysiologic findings and 28 pts with junctional reentrant tachycardia. There were no significant differences between subgroups concerning the main studied parameters. CONCLUSIONS: This study shows a direct better correlation for age than atrial size in the relation with the dynamic behaviour interatrial conduction, suggesting that higher incidence in AF in the elderly might be also a consequence of the higher incidence of atrial conduction disturbances.

Adolescent↗
PubMed2004

Inflammatory response after dexamethasone eluting coronary stent implantation.

UNLABELLED: C-reactive protein (CRP) elevation after coronary stent implantation is a predictor for recurrence. We prospectively evaluated the inflammatory response after dexamethasone eluting stent implantation in a native coronary artery by serial measurement of plasma level C-reactive protein. METHODS: We investigated patients undergoing primary successful implantation of a single dexamethasone stent (Dexamet, Abbott Vascular Devices, Redwood City, CA, USA) in a native coronary artery. We analyzed plasma concentrations of CRP by immunoturbidimetric assay before stent implantation and 12, 24, 48 and 72 hours after the procedure. Patients on anti-inflammatory drugs or with evidences of inflammatory conditions were excluded. RESULTS: Seventeen patients (mean age 62+/-9 years, 12 males) were enrolled. The presentation was unstable angina in 13 patients and stable angina in 4 patients. Eighteen stents were implanted as follows: 16 type B lesions (88%), 1 type C lesions (6%) and 1 type A lesion (6%), located in LM in 2 patients (11%), LAD in 8 (44%), LCX/OM in 7 (39%), and RCA in 1 patient (6%). The mean CRP increased from 5.6+/-2.2 mg/l at baseline to a maximum of 6.7+/-2.1 mg/l and than decreased to 5.0+/-1.2 mg/l at 72 hours. At 72 hours plasma concentration of CRP was lower than baseline in 11 patients (65%) and higher in 6 (35%). CONCLUSIONS: Inflammatory response to dexamethasone stent implantation in a native coronary artery is low and peaks at 24 hours. At 72 hours after stent implantation, mean CRP decreased comparing with baseline, CRP becoming lower in 65% patients. Using the stent itself as a platform for drug delivery may be an opportunity to modulate the inflammatory response to coronary stent implantation.

Anti-Inflammatory Agents↗
PubMed2004

Echocardiographic evidences of increased left ventricular pressure and atrial dilatation in patients with drug-resistant paroxystic atrial fibrillation and structurally normal heart.

UNLABELLED: Global myocardial index (GMI) has been significantly related to left ventricular filling pressure. We hypothesized that GMI and echographic indicators of atrial dilatation were significantly different in pAF pts compared to normals. METHODS: 39 patients (pts) without structural heart disease, aged 52+/-10 years with pAF were compared to 36 control-matched pts aged 48+/-16 years. Following parameters were assessed: P-wave duration (Pd), GMI, left atrial dimensions (LAd=M-mode, parasternal, LAt and LAI are measurements of short and long-axis apical four chamber view), surface (LAs), volume (LAv), total ejection fraction (LA EF), right atrial dimension (RAd) and surface (RAs), total atrial surface (TAs=LAs+RAs). LAv was calculated using ellipse formula pi/6 (LAdxLAlxLAt). RESULTS: There was no difference between the 2 groups concerning Pd (p=0.1), LA EF (p=0.23), LAd (p=0.08) and LAt (p=0.06) while the rest of the parameters were significantly higher in pAF pts: GMI: 0.5+/-0.17 vs 0.36+/-0.06 (p=0.001); LAI: 5.4+/-0.5 vs 4.5+/-0.3 cm2 (p=0.001); LAs was founded increased in pAF pts (20.6+/-5.7 vs 16.3+/-2.1 cm2, p=0.001); TAs: 40.6+/-6.9 vs 30.6+/-5.1 cm2, p=0.0001; LAv: 51.6+/-10.4 vs 37.2+/-9.3 ml (p=0.0001). CONCLUSIONS: Although apparently without structural heart disease, pAF pts presented evidence of increased filling pressions in left ventricle and indirect markers of atrial stretch. The role of increased intra-atrial pressure in pts pFA and predictive value of these parameters need to be evaluated in a larger number of patients.

Atrial Fibrillation↗
PubMedDate not supplied

The value of intermittent inotropic therapy in unhospitalized patients with refractory heart failure.

The treatment of intractable heart failure (New York Heart Association--NYHA IV) with inotropic support is a well established adjunct in the control of clinical status of end-stage heart failure patients but usually needs many admissions and a long period of hospitalization. In this study we report on the follow-up findings of 64 patients for 18 months who were seen in an outpatients congestive heart failure program. All patients had their full standard oral drug treatment, received intensive patient teaching and weekly inotropic infusions. We assess the effects of this comprehensive therapeutic approach on: 1) the number of hospital admissions, 2) length of stay and 3) the number of emergency room visits during the ensuing year. These data were compared with similar data from the year before entry in the program for each patient. All our patients showed NYHA class IV heart failure and received dobutamine to manage their chronic heart failure in an outpatient setting. The cause of heart failure was ischaemic in 34 (53.12%), idiopathic in 14 (21.87%), hypertension in 10 (15.62%), pulmonary hypertension in 7 (10.93%) and valvular heart disease in 6 (9.37%) patients. The mean period of observation was 382 days. For the period before entry in the program patients had 67 emergency room visits, 184 admissions, and 832 days spent in the hospital. After enrollment all these figures significantly decreased (p<0.001), patients heading 35 emergency room visits, 112 admissions and 518 days spent in the hospital. In conclusion, the intermittent inotropic therapy as an outpatient setting may be a valuable cost-effective therapeutic method, in patients with refractory heart failure and is associated with the reduction of emergency room visits, admissions and days spent in the hospital.

Adult↗
PubMedDate not supplied

Mitral regurgitation and left ventricular outflow tract obstruction in hypertrophic cardiomyopathy. Analysis by Doppler echocardiography.

In a group of five patients with asymmetric septal hypertrophy, the presence of the mitral regurgitation and the left ventricular outflow tract gradient were studied by the Doppler echocardiographic technique. By means of Bernoulli's formula 4V2 = P1-P2, left ventricular maximal systolic pressure was assessed using mitral regurgitant and left ventricular outflow tract jets. Aortic systolic and diastolic blood pressures were measured by cuff sphygmomanometry, and simultaneous carotid pulse tracings were recorded. All patients had outflow tract pressure gradients (peak 84 +/- 11.7 mmHg) and mild mitral regurgitation. Continuous wave Doppler study recorded peak flow velocities in the outflow tract (4.6 +/- 0.26 m/sec) and mitral regurgitant (6.5 +/- 0.51 m/sec) jets. The values for ventricular systolic pressures by both methods were similar (180 +/- 24.2 vs 186 +/- 13.5 mmHg). This study confirms the presence of mitral regurgitation and actual obstruction in hypertrophic cardiomyopathy with asymmetric septal hypertrophy.

Arrhythmia, Sinus↗
PubMedDate not supplied

Prevalence of arrhythmias during exercise stress testing in patients with hypertrophic cardiomyopathy.

To identify the patients with hypertrophic cardiomyopathy at high risk of morbid events we investigated 25 patients with echocardiographic evidence of hypertrophic cardiomyopathy. All the patients were subjected to submaximal exercise test under electrocardiographic monitoring. More than 50% of the patients developed ventricular arrhythmias, about half of them presenting multiform or repetitive premature ventricular depolarizations; two patients presented ventricular tachycardia. Our results suggest the value of exercise test in identifying the patients at high risk of developing severe arrhythmias.

Adolescent↗
PubMedDate not supplied

[Doppler echocardiography in mitral insufficiency].

The Doppler method (pulsatile and continuous) was used for finding out and semiquantitatively evaluating the mitral insufficiency of various etiologies: inflammatory (rheumatic); prolapse of mitral valve; obstructive hypertrophic cardiomyopathy; dilatative cardiomyopathy; calcification of valvular ring. The Doppler parameters obtained after automatic processing of the image (speed transvalvular pressure gradient, flow period and acceleration) offer data on the diastolic performance of the left ventricle. Registration of the aortic flow makes possible the calculation of the cardiac flow (the diameter of the aorta is measured in echo-B), and of the aortic flow permits the noninvasive evaluation of the lung arterial pressure. The method offers a large vista in the noninvasive evaluation of the patients suffering from mitral insufficiency.

Diagnostic Errors↗
PubMedDate not supplied

[Echocardiographic parameters in the follow-up of left ventricular performance before and after the surgical correction of mitral and aortic regurgitation].

The present study investigates 16 patients with aortic regurgitation (AR), and 10 patients with mitral regurgitation (MR). Before operation, all the 26 patients had increased telediastolic and telesystolic diameters. The patients were divided into two groups, as a function of the postoperative values of the telediastolic diameter: group A--with the telediastolic diameter within normal limits; group B--with the persistence of the increased values of the telediastolic diameter. In the case of the patients with AR, the following postoperative situation was noticed: in group A: the peak systolic stress (PSS) was increased, the shortening fraction (SF) in the telesystolic stress (TSS) within normal limits; in group B: PSS and TSS were increased, and ST depressed. 8 months after the valvular correction, in group A: PSS, TSS and SF were normal; in group B: the changes in PSS and TSS continued and was lowered. In the case of the patients with MR, before operation, in group A: PSS was slightly increased while TSS and SF were normal; in group B: PSS was slightly increased, TSS, increased and SF depressed. 8 months after the surgical correction: in group A: PSS and SF decreased; in group B: echocardiographic changes continued. Therefore, in the group B patients with MR and AR, the persistence of the increased values of PSS, TSS leads to the postoperative decrease of SF (post-charge in excess).

Aortic Valve Insufficiency↗
PubMedDate not supplied

The effects of captopril in severe congestive heart failure. An echocardiographic study.

In 12 patients with severe congestive heart failure (CHF), captopril in doses of 25 to 150 mg, every 8 hours, was given for a period of 2 months, in addition to cardiac glycoside and diuretic drugs. After this treatment left ventricular end-diastolic diameter (EDD) decreased from 6.4 +/- 0.5 to 6.2 +/- 0.6 cm (p less than 0.05), left-ventricular end-systolic diameter (ESD) decreased from 5.7 +/- 0.5 to 5.4 +/- 0.6 cm (p less than 0.001), the ejection fraction increased from 30.8 +/- 7.0 to 36.2 +/- 6.9% (p less than 0.005) and mean velocity of circumferential fiber shortening (Vcf) increased from 0.51 +/- 0.12 to 0.62 +/- 0.13 circ/sec (p less than 0.001). Captopril markedly relieved dyspnea and fatigue. Three patients improved from class IV to class III, 4 patients from class IV to class II and 3 patients from class III to class II. These data suggest that captopril may be effective in the treatment of severe chronic CHF.

Adult↗
PubMedDate not supplied

Left ventricular relaxation time index and left atrial emptying index as early echocardiographic indicators in predicting hypertensive heart disease.

To study the earliest changes in left ventricular structure and function appearing in response to hypertensive heart disease the study was started with an initial group of subjects detected for the first time in their lives with elevated levels of systemic blood pressures. A careful follow up of these subjects during the next year allowed the division of these subjects into a group of healthy not hypertensive subjects and a group of subjects with mild essential systemic hypertension detected in an early phase. The next six years of repeated controls (arterial blood pressure measurement, clinical examination, routine chest X-ray pictures, standard 12 leads ECG and M-mode echocardiography) allowed a further division of the hypertensive subjects into two groups of patients: one correctly treated and the other treated incorrectly or not at all. It was found that left ventricular diastolic functions expressed by left ventricular relaxation time index (LVRTI) and left atrial emptying index (LAEI) are the earliest indicators of hypertensive heart disease due to mild essential systemic hypertension.

Adult↗
PubMedDate not supplied

Correlations of electrocardiography and echocardiography in assessment of left ventricular wall thickness in hypertensive patients.

Posterior wall thickness (PW) and interventricular septal thickness (IVS), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), ejection fraction (EF) and left ventricular mass (LV mass) were determined by the echocardiogram. These were compared with the sum of the S wave in lead V1 plus the R wave in lead V6(SV1 + RV6) determined by electrocardiogram (ECG) in 21 hypertensive patients. A significant increase in PW (p less than 0,05), IVS (p less than 0.05) and LV mass (p less than 0.01) was found in all the 21 patients. PW was highly correlated with SV1 + RV6(r = 0,76; p less than 0.01) in 12 patients. LV mass was correlated with LVEDD (r = 0,60; p less than 0.05) and LVESD (r = = 0.66; p less than 0.05) in the same patients mentioned before. We conclude that LV mass increases early in hypertensive patients and can be better assessed by echocardiography than ECG. The PW has a greater influence on the SV1 + RV6 sum than the echocardiographically assessed IVS.

Adolescent↗
PubMedDate not supplied

Evaluation of pulmonary hypertension by echocardiographic right ventricular systolic time intervals.

Pulmonary valve echogram and right cardiac catheterization were simultaneously performed in 18 patients suffering from heart disease in whom pulmonary hypertension was suspected. Echocardiography was employed to measure right preejection period (RPEP), right ventricular ejection time (RVET) and RPEP/RVET ratio. Cardiac catheterization was used to determine pulmonary artery diastolic pressure (PADP), pulmonary artery systolic pressure (PASP), pulmonary artery mean pressure (PAMP) and right ventricular and diastolic pressure (RVDP). Each of these pressures was compared to each of the echo-date by means of regression analysis. The best correlation (r = 0.970; p less than 0.0005) was between PADP and RPEP/RVET ratio. We also found that RPEP/RVET ratio and RVET were each good predictors for the pulmonary artery pressures.

Adolescent↗