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S Matteoli

Publications and source records attributed to S Matteoli.

At least 19 recordsLinked to original sources
PubMed2001

[Atrial fibrillation and thromboembolic events prevention. State of the art].

Atrial Fibrillation (AF) is a common cardiac arrhythmia and stroke is its most devasting complication. The rate of ischemic stroke among people with AF is approximately six times that of people without AF and varies importantely with coexistent cardiovascular diseases; therefore stratification of AF patients into those at high and low risk of thromboembolism has become a crucial determinant of optimal antithrombotic prophylaxis. Multivaria-te analyses of prospective studies consistently show prior TIA/stroke, diabetes, age, heart failure to be independently predictive of stroke; left ventricular dysfunction is also strongly associated with stroke risk. Several randomized clinical trials demonstrated that treatment with adjusted-dose warfarin reduces the risk of stroke in AF patients by about two thirds. The efficacy of aspirin for prevention of stroke is controversial, but supported by pooled results of 3 placebo-controlled trials yelding a 21% reduction in stroke. The inherent risk of stroke should be considered in selection of AF patients for lifelong anticoagulation. Patients with AF and a recent stroke or TIA or multiple risk factors for stroke are likely to benefit from anticoagulation therapy; at present a target INR 2,5 appears optimal for most patients, although INR closer to 2.0 may be safer for patients at increased risk for bleeding events. The addition of aspirin to low- dose warfarin regimen does not provide any significant benefits and should be avoided. Therapy with aspirin is appropriate for patients who are at low risk of stroke or are unable to receive anticoagulants. AF patients treated with aspirin, should be periodically evaluated for development of high-risk features favoring anticoagulation.

Age Factors↗
PubMed2001

[Circadian variations in the onset of acute myocardial infarction].

BACKGROUND: Several studies have observed a circadian pattern in the onset of acute myocardial infarction (AMI), with a peak incidence in the morning hours. It has been suggested that different circadian rhythms may exist in various subgroups of patients. METHODS: This study sought to determine whether the circadian incidence of AMI varied by sex, age, cardiovascular risk factors, previous history of ischemic accidents, the site of AMI, and the short-term outcome. These possibilities were examined in a population of 597 consecutive patients with AMI, admitted to the coronary care unit. 548 patients have been included in the study, 442 men (80.6%) and 106 women (19.4 %); mean age 64.5 years. RESULTS: A peak incidence of AMI was found between 06.01 a.m. and 12.00 a.m. (32.4%; p<0.0002). This peak was present in patients 65 years old (33.2%; p<0.005), in men (32.5%; p<0.0002) but not in women, in smokers (32.1%; p<0.0005) and in those that did not smoke (33.0%; p<0.04), in patients with hypercholesterolemia (34.9%; p<0.006 ) and without hypercholesterolemia (31.1%; p<0.03). A circadian rhythm was absent in diabetics, hypertensives and in patients with a history of previous cardiovascular events. Regarding the site of AMI, inferior AMI showed an increased incidence between 06.01 a.m. and 12.00 a.m. (36.2%; p<0.002), while the circadian distribution of anterior AMI, as well as non-Q wave AMI, did not show this incidence. Finally, higher mortality was reported in patients with an AMI onset at night (22.3%). CONCLUSIONS: These results give further clues in understanding the external and inner factors acting in the morning hours as triggers for AMI.

Adult↗
PubMed1997

Indobufen versus warfarin in the secondary prevention of major vascular events in nonrheumatic atrial fibrillation. SIFA (Studio Italiano Fibrillazione Atriale) Investigators.

BACKGROUND AND PURPOSE: The results of a large prospective randomized trial have shown the efficacy of oral anticoagulation in the secondary prevention of major vascular events in patients with nonrheumatic atrial fibrillation (NRAF); less well established is the role of antiplatelet agents. The present study compared the effects of indobufen, a reversible inhibitor of platelet cyclooxygenase, with those of warfarin in this setting. METHODS: A total of 916 patients with NRAF and a recent (< or = 15 days) cerebral ischemic episode were admitted to this multicenter, randomized study, during which they were treated with either indobufen (100 or 200 mg BID) or warfarin (to obtain an international normalized ratio of 2.0 to 3.5) for 12 months. The two groups (462 on indobufen and 454 on warfarin) were well balanced in terms of their main baseline characteristics. The primary outcome of the study was the combined incidence of nonfatal stroke (including intracerebral bleeding), pulmonary or systemic embolism, nonfatal myocardial infarction, and vascular death. RESULTS: At the end of follow-up, the incidence of primary outcome events was 10.6% in the indobufen group (95% confidence interval, 7.7% to 13.5%) and 9.0% in the warfarin group (95% confidence interval, 6.3% to 11.8%), with no statistically significant difference between treatments. The frequency of noncerebral major bleeding complications was low: only four cases (0.9%) of gastrointestinal bleeding were observed, all of them in the warfarin group. CONCLUSIONS: We conclude that, within the limitations of its design, this study may help the medical community in devising appropriate antithrombotic strategies for NRAF patients for whom oral anticoagulants are contraindicated or do not represent a feasible approach to treatment.

Adult↗
PubMed1996

[Cigarette smoking and acute myocardial infarct].

UNLABELLED: Cigarette smoking is commonly considered as a major risk factor for Acute Myocardial Infarction (AMI). Although AMI has a high incidence in smokers, it doesn't seem to correlate with a worse in hospital prognosis. In order to investigate if cigarette smoking does affect the in-hospital prognosis in patients with AMI, 590 consecutive patients (451 males and 139 females; mean age 63.4 years) admitted to the Coronary Care Unit (CCU) with definite AMI have been studied. Patients were divided in two groups: Group A (303 patients, 269 males and 34 females) smokers till AMI and Group B (287 patients, 182 males and 105 females) nonsmokers or smokers till a month before AMI. RESULTS: The mean age of nonsmokers was higher than smokers (68.4 years vs 58.8 years; p < 0.001). In addition they showed more frequently hypertension (48.8% vs 38%; p < 0.001), diabetes (31.3% vs 16.3%; p < 0.001), and healed infarction or angina (45.6% vs 37.5%). Among Group B higher global mortality rate was observed (22.6% vs 7.6%; p < 0.001) either among thrombolysed patients (10.1% vs 4.4%; p < 0.001) either among not thrombolysed (26.9% vs 4.4%; p < 0.001). The grading in age classes confirmed a higher mortality in nonsmokers patients (6.7% vs 4.9% age > or = 40 and < or = 65 years; 32.5% vs 13.3% > 65 years). They also presented more frequently arrhythmias (15.3% vs 12.2%), ischemic complications (25.4% vs 18.7%), and congestive heart failure (46% vs 34.2%). CONCLUSIONS: According to other authors the results of this study confirm a better prognosis in smokers with AMI. Up to authors hypothesis this outcome could be related either to the younger age, a to a different pathogenetic mechanism of coronaric occlusion to raised thrombosis.

Adult↗
PubMed1995

[The peak of creatine phosphokinase level in the acute phase of myocardial infarction in patients with and without ischemic precedents].

Two hundred and one patients admitted to Coronary Care Unit with documented acute myocardial infarction, whose chest pain had occurred within 12 hours of hospital admission non thrombolised, were studied. The peak of creatine kinase (CK) was examined and compared between patients without previous manifestations of myocardial ischemia (group A, 106 patients) and patients with/history angina pector or healed myocardial infarction (group B, 95 patients). The mean peak creatine kinase level in the negative history group was higher (2261 +/- 226 U/L vs 1779 +/- 97 U/L p < 0.001), especially in patients aged less than 65. No significant difference was observed in patients aged more than 64 of the two groups. Patients with a positive history presented more frequently ischemic complications (p < 0.05) while the frequency of hemodynamic disturbances and arrhythmias was not significantly different. Total mortality was similar in the two groups (22.6% vs 21%) and more frequently occurred in older patients with congestive heart failure. The authors form the hypothesis that the higher mean peak creatine level in patients without previous myocardial ischemia is the result of absence of coronary collateral circulation. The presence of collateral vessels permits less extensive myocardial infarction but it does not change the prognosis.

Aged↗
PubMed1994

[Effects of carbamazepine on heart conduction in young patients: a serial study using ambulatory ECG].

BACKGROUND: Carbamazepine (CBZ) is a first-line drug in the treatment of epileptic seizures and neuralgia. CBZ is also a cardioactive drug and sometimes induces sinusal dysfunction or AV conduction defects. METHODS: In order to investigate the effect of CBZ on sinus node function and AV conduction, long-term ECG recording (24 hours) and determination of plasma concentration of CBZ were carried out in 10 epileptic patients without heart disorders (5 males and 5 females, mean age 31 years), in the basal state, during steady-state (7th day) and after 30th day of CBZ treatment. The number of total cardiac beats, mean heart rate, P-Q and Q-T interval, sinus-atrial node and atrioventricular dysfunction and intraventricular conduction delay were evaluated. RESULTS: Plasma CBZ concentration was always in the therapeutic range (5-12 micrograms/ml): 9.5 micrograms/ml in the 7th day and 7.8 micrograms/ml in the 30th day. No significant differences in the number of cardiac beats, or P-Q and Q-T intervals were found; there was no depression of sinus node function nor delay of AV conduction. In the basal state, ectopic supraventricular beats (105 +/- 20/24 hours) were observed in 7 patients and repetitive in five of them. In the first Holter ECG recording during CBZ treatment, a strong reduction of ectopic supraventricular beats (6 +/- 3/24 hours) and disappearance of the bursts was observed. In the second control, when the CBZ concentration was lower, the number of ectopic supraventricular beats were moderately increased (30 +/- 8/24 hours) and in one patient supraventricular tachycardia reappeared. CONCLUSIONS: In young epileptic subjects without signs of heart disease, CBZ seems to have no significant effect on conduction, yet has a possible antiarrhythmic effect.

Adolescent↗
PubMed1993

[Italian Study on Atrial Fibrillation (SIFA): status report].

Non-valvular atrial fibrillation increases the risk of stroke by a factor of 5 and is present in about 15% of patients with acute stroke. Its prevalence in the general population increases from 0.5% at 50-59 years to > 10% at 80-99 years. In patients with non-valvular atrial fibrillation the risk of stroke increases with age, blood pressure and other evidence of cardiac disease. In addition, non-valvular atrial fibrillation is associated with a greater early mortality and a greater risk of recurrent stroke. The anticoagulant therapy to prevent early recurrent embolism is likewise controversial. Anticoagulant therapy appears to reduce this risk, but there is the danger of accentuating hemorrhagic infarction, especially in patients with large strokes. The effectiveness of antiplatelet drugs in patients with cardioembolic stroke is also not defined. The Studio Italiano Fibrillazione Atriale (SIFA) is a multicentric, randomized trial to assess the efficacy and safety of anticoagulant, warfarin, versus antiplatelet treatment, indobufen, a reversible inhibitor of platelet cyclo-oxygenase, in the prevention of recurrent cerebral ischemia and other systemic embolisms in non-valvular atrial fibrillation patients. Patients of both sexes, aged > 30 years with non-valvular atrial fibrillation, who have presented in the last 2 weeks an ischemic cerebral event (transitory ischemic attack or non-disabling stroke) and who have given their informed consent, were eligible. Patients with hemorrhagical diseases or contraindications to anticoagulant therapy were excluded. Patients were randomly given either indobufen (400 mg/die) or oral warfarin to an international normalized ratio of 2.0-3.5. The primary end-points were: recurrence of cerebral ischemia, systemic embolisms, intracranial or fatal hemorrhage, acute myocardial infarction, vascular death.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[The measurement of CoQ10 in the acute phase of a myocardial infarct].

The authors have studied the behaviour of ubidecorenone (Co Q10) in the acute phase of myocardial infarction in 24 patients, 19 male and 5 female, mean age 56.8 +/- 3.3. Ubidecorenone level was determined on admittance, after 48 hours and on the 7th and 30th days. A significant decrease was observed from the first to the 3rd day (mean values 0.90 +/- 0.18 microgram/ml vs 0.72 +/- 0.22, p less than 0.01). Thereafter a progressive rise was observed, but at the 30th day mean values were still below the basal ones. No significant differences were observed between patients treated with fibrinolytic agents and those not so treated, nor between those in whom reperfusion was obtained and the others. Nor was there a proven correlation with changes in creatinkinase. The behaviour of ubidecorenone may be associated with increased consumption for metabolic needs and increased destruction in scavenger action, and also to a lesser extent to decreased production due to lower food intake.

Aged↗
PubMed1989

[Incidence and prognostic significance of anterior precordial ST segment depression in acute inferior myocardial infarct].

In order to evaluate the incidence and prognostic significance of anterior precordial ST segment depression (decreases ST) in acute inferior myocardial infarction (MI), 158 patients with inferior MI were selected. In 90 patients (56.9%) an anterior decreases ST was associated with inferior lesion wave (group A), and in 68 patients (43.1%) only an ecg pattern of inferior myocardial infarction (group B) was present. No significant statistical differences were observed in mortality (group A 10% vs group B 10.2%), in compliances (group A 54.4% vs group B 47.0%) and in higher peak serum ck-levels (group A 83.3% vs group B 69.1%) in two groups during hospitalization period. In conclusion the anterior decreases ST during inferior MI should not be considered a negative prognostic sign. These favourable results are probably related to stringent criteria for ecg diagnosis of inferior myocardial infarction used and to exclusion of all patients with non contemporary evolution of anterior decreases ST and inferior lesion wave.

Adult↗
PubMed1988

[Evaluation of peak filling rate for the early identification of daunorubicin cardiotoxicity].

UNLABELLED: Anthracyclines are potent anticancer agents and their use is limited because of their cardiotoxicity which differs from one patient to another and is also dependent on other concurring risk factors. The radionuclide ventriculography is the non-invasive trasteale method used to detect early variations in the Left Ventricular Function (LVF) using Anthracyclines. The LVF in 13 pts, with acute non lymphoblastic leukaemia, was analyzed using a Nuclear Stethoscope before and after induction therapy with daunorubicin (DNR) at the total dosage of 135 mg/m2. The mean age of this group was 59 +/- 5 years; 4 of these were female and 9 were male. In all pts the Ejection Fraction (EF) for the systolic phase and the Peak Filling Rate (PFR) for the diastolic phase were evaluated. Results. Before therapy: 1) normal value of EF (74 +/- 4%) in all pts; 2) normal value of PFR in 10 pts and a slightly reduced value in 3 pts (PFR middle 3.30 +/- 0.74 EDV/sec). After therapy: 1) no significant changes in EF (72 +/- 4%); 2) significant reduction of PFR values in all pts (PFR middle 2.71 +/- 0.48 EDV/sec; p less than 0.05). CONCLUSIONS: the results show an early involvement of the diastolic phase (reduction of PFR) in patients who underwent DNR induction therapy. This is also evident from the normal EF values.

Acute Disease↗
PubMed1986

[Reliability of the ejection fraction determined with the nuclear stethoscope. Comparison with angiocardiography].

The purpose of this investigation was to compare the Ejection Fraction values simultaneously obtained with the Nuclear Stethoscope and with Cineangiography, in 25 patients (17M-8W) subjected to diagnostic cardiac catheterization. In all patients the determination of Ejection Fraction with the Nuclear Stethoscope always preceded the Cineangiography. Ejection Fraction values obtained with Nuclear Stethoscope change from 32 to 75%; those calculated with Cineangiography, between 18 and 88%. The average Ejection Fraction values obtained with Nuclear Stethoscope (59 +/- 13%) doesn't differ significantly from Cineangiography (59 +/- 21%). There was a direct relationship between Ejection Fraction determined by the Nuclear Stethoscope and Cineangiography (r = 0.93; p less than 0.001). In the obtained results the Authors point out that the Ejection Fraction with Nuclear Stethoscope gives assurance in most patients, although in some particular conditions Nuclear Stethoscope provides Ejection Fraction values which differ from those obtained with Cineangiography. They conclude that Nuclear Stethoscope, for its safe, repeating and simple application, is a methodology of useful employment for Ejection Fraction determination in the single patient, which allows a correct definition of the prognosis and a conforming therapeutic strategy.

Adolescent↗
PubMed1981

[Neurological complications of the acute myocardial infarction (author's transl)].

In a consecutive series of 750 patients with acute myocardial infarction, 11 (1.46%) suffered neurological complications. The pathogenesis of these neurological incidents (embolia or hypotension) remained uncertain in all the cases presented here. Neurological incidents (3 TIA, 8 strokes) were more frequent in elderly patients, in which they represented a very serious complication with high fatality. No clear relationship could be established with infarct size nor with the anticoagulant therapy.

Aged↗