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Biomedical subjects

S Nodari

Publications and source records attributed to S Nodari.

At least 37 records · Page 2Linked to original sources
PubMed1992

Combined invasive and noninvasive study of left ventricular systolic and diastolic function following acute administration of cicloprolol to subjects with normal cardiac function.

Cicloprolol is a new beta-blocking agent with high selectivity for beta 1 receptors and high intrinsic sympathomimetic activity. We studied the acute hemodynamic effects of cicloprolol in nine subjects with no evidence of left ventricular dysfunction who underwent cardiac catheterization for the evaluation of chest pain. All patients had normal coronary angiography and left ventriculography. Left ventricular pressure was determined throughout the cardiac cycle using a Millar 8Fr Minotip catheter; an echocardiogram, phonocardiogram, and ECG were simultaneously recorded to obtain left ventricular pressure-diameter loops. All the measurements were repeated before and after the intravenous administration of cicloprolol. Cicloprolol was administered at increasing doses of 0.05, 0.10, and 0.25 mg/kg until a cardiac output increase of at least 15% over basal values was achieved. A decrease of mean arterial pressure or cardiac output after cicloprolol was not observed in any patient. Cicloprolol administration significantly increased cardiac output (24%), stroke volume (22%), and peak positive dP/dt (25%); no significant changes in heart rate, systemic blood pressure, right atrial pressure, or pulmonary artery pressures were observed. No significant change in the echocardiographic parameters occurred. Among the indices of left ventricular diastolic function, the time constant of isovolumetric relaxation was significantly decreased (-43%) after cicloprolol; moreover, the left ventricular pressure-diameter loop in the protodiastolic phase was shifted to the left following cicloprolol infusion. This study confirms that in subjects with normal left ventricular function cicloprolol can improve resting left ventricular systolic function, and it shows that this action can also be attended by a more rapid isovolumetric relaxation, similar to what has been observed with other sympathomimetic amines.

Adrenergic beta-Agonists↗
PubMed1991

[Effects of amrinone on isolated heart preparations: comparative study with other inotropic agents].

We compared the effects of the phosphodiesterase inhibitor amrinone, the beta-adrenergic partial agonist xamoterol and the digitalis glycoside, ouabain, on isolated rabbit hearts perfused with the Langendorff technique. Heart rate, left ventricular pressure, as an index of myocardial contractility and coronary perfusion pressure, as an index of coronary resistances, were assessed before and after each drug. Perfusion with concentrations of each agent varying from 10(-9) to 10(-4) M induced a dose-dependent increase of left ventricular systolic pressure averaging 32.5 +/- 1.5% after amrinone (10(-5) M), 46.2 +/- 0.5% after xamoterol (10(-5) M) and 19.0 +/- 2.1% after ouabain (10(-4) M). Among the 3 agents, only amrinone was able to reduce basal coronary perfusion pressure (18.4 +/- 1.2% at the dose of 10(-5) M) and inhibit vasopressin-induced coronary spasm (86.8 +/- 2.5% inhibition at 10(-5) M); no significant change of coronary perfusion pressure was noted with either xamoterol or ouabain. Heart rate was not significantly modified by amrinone whereas, at the doses of 10(-5)-10(-4) M, xamoterol increased it by 21.6 +/- 0.7% and ouabain reduced it by 12.3 +/- 1.1%. Our results show that amrinone, in comparison with digitalis glycosides and beta-adrenergic agonists, presents the unique property to increase myocardial contractility with concomitant coronary vasodilation without significant changes of heart rate. Ouabain has a less potent positive inotropic activity and a slight negative chronotropic action, whereas xamoterol inotropic effect is accompanied by an increase of heart rate.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic beta-Agonists↗
PubMed1991

[Hemodynamic and clinical effects and treatment tolerance with low-dose iv amrinone in patients with refractory heart failure: a multicenter study. The Group for Research on Amrinone in the Treatment of Refractory Heart Failure].

We report the results of a multicenter study performed on 70 patients with severe congestive heart failure of different etiology (ischemic, idiopathic, alcoholic, valvular and secondary to antiblastic drugs) to evaluate the clinical and hemodynamic effects and tolerability of low dose amrinone iv (0.75 mg bolus followed by a continuous 48-hour infusion at the dose of 5-10 mcg/kg/min). Forty-one patients underwent invasive hemodynamic monitoring with right heart Swan-Ganz catheterization. Heart rate (HR), systolic (SBP) and diastolic blood pressure (DBP), mean arterial pressure (MAP), cardiac index (CI), stroke volume index (SVI), stroke work index (SWI), right atrial pressure (RAP), pulmonary wedge pressure (PWP), mean arterial pulmonary pressure (PAP), systemic vascular resistance (SVR), pulmonary vascular resistance (PVR) and total pulmonary resistance (TPR) were evaluated before and after 1, 4, 6, 24 and 48 hours of amrinone infusion and 2 and 4 hours after amrinone withdrawal. Clinical parameters (dyspnea, orthopnea, pulmonary congestion) were quantitated using a score; diuresis was assessed hourly; hematochemical parameters were evaluated before and 48 hours after amrinone infusion. HR and MAP were not significantly changed; CI, SVI and SWI presented, respectively, a significant 31.6, 55.1 and 72% increment, which peaked 48 hours after amrinone infusion. Concomitantly RAP, PAP, PWP, SVR, PVR and TPR were significantly reduced to 36.6, 22, 23.6, 9.4, 39.2 and 37.7% of the basal values, respectively. Two and 4 hours after amrinone withdrawal, hemodynamic changes similar to those observed acutely, were still present. Diuresis increased from 58.25 ml/hr to 113.18 ml/hr after 24 hours (+95%) and to 88.9 ml/hr (+53%) after 48 hours.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[The acute, chronic continuous after treatment and chronic intermittent with a variable therapeutic window (4 and 6 hours) hemodynamic effects induced with transdermal nitroglycerin in patients with congestive heart failure].

The aim of this study was to assess the minimum time interval necessary to avoid the development of tolerance during nitroglycerin patch application. We studied 24 patients, aged 23 to 73 years, with ischemic or idiopathic dilated cardiomyopathy (LV EF less than 0.40) and stable clinical conditions during 30 days before the study. All patients had significant reduction of systemic and pulmonary arterial pressure after sublingual nitroglycerin. After the hemodynamic assessment of the response to the first dose of the nitroglycerin patch, the patients were randomized to 1 of 3 chronic treatment groups: continuous patch application (Group A), intermittent application with 4 hours intervals (Group B), intermittent application with 6 hours intervals (Group C). All patients were studied by right heart Swan-Ganz catheterization; the hemodynamic response to a 10 mg multilayer matrix nitroglycerin patch was assessed before and every hour, in the next 4 hours, after both the first application of the patch and after 1 month of therapy; after chronic intermittent therapy, hemodynamic parameters were also measured 24 hours after drug withdrawal. Hemodynamic parameters were significantly changed after the first nitroglycerin patch application: particularly, mean systemic arterial (MAP), right atrial (RAP) and pulmonary wedge pressures (PWP) declined from 96 +/- 10, 8.9 +/- 1.8 and 20.1 +/- 5 to 81 +/- 6, 4.7 +/- 1.5 and 12.2 +/- 3 mmHg (-15.6, -47.2 and -59.3%, respectively); systemic vascular resistance (SVR) and heart rate (HR) were reduced from 1645 +/- 121 to 1288 +/- 89 dyne.s.cm-5 and from 85 +/- 7 to 81 +/- 7 b/min; lastly, cardiac index (CI), stroke volume (SVI) and stroke work index (SWI) increased from 2.3 +/- 0.3, 28.2 +/- 5 and 28.7 +/- 9 to 2.7 +/- 0.3 l/min/m2, 33.3 +/- 5 ml/min/m2 and 31.5 +/- 8 g.m/m2 (+17.4, 18.1 and 9.7%). After 1 month of either continuous or intermittent patch application with 4 hours intervals, hemodynamic parameters returned to control values with no significant change after patch application. In contrast, after intermittent patch application with 6 hours intervals, a persistent hemodynamic response to nitroglycerin patches was still present.(ABSTRACT TRUNCATED AT 400 WORDS)

Administration, Cutaneous↗
PubMed1989

Efficacy of ibopamine treatment in patients with advanced heart failure: purpose of a new therapeutic scheme with multiple daily administrations.

Eighteen patients with severe unstable heart failure who presented with hemodynamic deterioration after withdrawal of i.v. dopamine were treated with high doses of ibopamine (100 mg eight times a day, orally) in association with digitalis, diuretic, and vasodilator therapy. Ibopamine, used at these dosages, could effectively substitute for the i.v. infusion of dopamine in 15 of the 18 studied patients. Each patient was studied by right heart Swan-Ganz catheterization and two-dimensional echocardiography before and during ibopamine infusion, after dopamine withdrawal, and after acute ibopamine administration; measurements were then made after 3 months of chronic ibopamine treatment (100 mg eight times a day). Blood samples for plasma dopamine and epinine concentrations were obtained at the time of the hemodynamic measurements. Both drugs did not induce any significant change in arterial pressure whereas heart rate was slightly reduced after dopamine and chronic ibopamine. Cardiac index and stroke volume index were significantly increased by dopamine (from 1.81 to 2.24 L/min/m2 and from 20.3 +/- 6.5 to 27.7 +/- 8.1 ml/beat/m2) and acute and chronic ibopamine (from 1.80 to 2.15 and 2.23 L/min/m2 and from 22.4 +/- 6.8 to 28.2 +/- 7.5 and 30.3 +/- 7.0 ml/beat/m2, respectively); these changes were attended by a decrease in systemic vascular resistance; pulmonary pressures were not significantly modified. No significant change of the echocardiographic parameters was noted. During dopamine infusion, mean dopamine plasma concentrations were 211.8 +/- 32.4 pmol/ml; after acute and repeated administration of ibopamine, free epinine plasma concentrations averaged 45.1 +/- 14.5 and 62.2 +/- 12.7 pmol/ml, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed1989

[Prognostic significance of clinical, ergometric and coronarographic data in patients soon after myocardial infarction].

The relative prognostic value of the clinical evaluation (Clin), exercise testing (ET), and cardiac catheterization (Cath), was assessed in 167 consecutive patients who underwent these exams within 40 days after an acute myocardial infarction. Each patient was followed at least 24 months; 12 patients died and 59 presented major cardiac events (angina, reinfarction and death). All the parameters were analyzed by univariate and discriminant and Cox regression analysis. For purposes of analysis, the predictive power of 3 sets of variables was analyzed separately: Clin, Clin + ET, Clin + ET + Cath. In the prediction of major cardiac events, only previous myocardial infarction was selected among the Clin parameters by multivariate analysis while ST segment depression, maximal systolic blood pressure, exercise duration and, though less significantly, coronary artery disease extension were selected among the ET and Cath var. The percentage of patients correctly classified was very low using only the Clin variables (60%) and significantly improved when ET and, to a lesser degree, Cath were added (77% and 80%, respectively). Multivariate discriminant analysis selected, as significant predictors of cardiac death, digitalis therapy, appearance of bundle branch block, previous myocardial infarction and anterior location of the myocardial infarction among the Clin variables, while exercise duration and LV ejection fraction were selected among the ET and Cath variables, respectively. The predictive power of the Clin variables alone was only slightly improved by the use of ET and Cath as the percentage of patients correctly classified was 76%, 81% and 84% using only the Clin, the Clin + ET and the combination of the Clin + ET + Cath var, respectively. In conclusion, the variables associated with a depressed LV function are the best predictors of future death and cardiac events; coronary angiography can only slightly improve the specificity of the exercise testing in the prediction of major cardiac events.

Angiography↗
PubMed1988

Lack of tolerance development during chronic ibopamine administration to patients with congestive heart failure.

Beta-adrenergic agonists can progressively lose their efficacy during chronic therapy in patients with heart failure. Ibopamine is a new dopamine derivative, active on dopaminergic and beta-adrenergic receptors, whose hemodynamic activity has been acutely demonstrated. To assess whether any attenuation of its efficacy occurs, the variations of the cardiac output induced during chronic therapy were monitored by impedance cardiography in 15 patients with dilated cardiomyopathy who showed a significant increase of the cardiac output (20.7 +/- 10.0%) after acute ibopamine administration. The efficacy of ibopamine was also assessed after 6 and 12 months of therapy by echocardiography, exercise testing, and 24-hour dynamic electrocardiogram (EKG) monitoring. The cardiac output response to ibopamine did not show any significant attenuation (range 15% to 19%) in the evaluations at 1, 2, 3, 4, 8, and 12 months of therapy. No significant change, was noted, after 6 and 12 months, in the exercise capacity (505 vs. 602 and 604 seconds) and the fractional shortening (16.2 vs. 18.3 and 18.5) without any change of the diastolic diameter. Ventricular arrhythmias were significantly reduced after 6, but not 12, months of therapy. No significant change in the New York Association (NYHA) functional class was noted at 6 and 12 months of therapy (2.4 +/- 5 vs. 2.3 +/- 7 and 2.4 +/-0.6, respectively). Our results show that ibopamine can maintain its hemodynamic activity even during chronic therapy.

Adult↗
PubMed1988

A randomized double-blind crossover study of nicardipine and nifedipine in patients with angina pectoris and concomitant essential hypertension.

The two dihydropyridine calcium antagonists, nicardipine and nifedipine, were compared in 12 patients with both stable angina pectoris and systemic hypertension using a double-blind, crossover protocol. After a 2-week placebo run-in period, each patient was randomized to either nicardipine or nifedipine; each drug was titrated up to either blood pressure normalization, appearance of adverse effects, or maximal dosage (40 mg, three times a day with nicardipine and 30 mg, three times a day with nifedipine) and then administered for 4 weeks. Maximal symptom-limited exercise tests were performed at the end of the placebo run-in and each treatment period, 3 and 8 hours after drug administration. Nicardipine and nifedipine were used at the mean doses of 100 +/- 20 mg/day and 57 +/- 20 mg/day, respectively. Both drugs reduced, significantly and similarly, standing and supine blood pressure, frequency of anginal episodes, and nitroglycerin consumption. At 3 hours after drug administration, exercise duration and time to 1-mm ST depression increased significantly from 402 +/- 84 and 306 +/- 108 seconds, respectively, with placebo; to 533 +/- 135 and 442 +/- 138 seconds during nicardipine; and to 518 +/- 118 and 437 +/- 133 seconds during nifedipine, with a concomitant reduction of peak ST depression. Both submaximal and maximal exercise diastolic blood pressure were significantly reduced by the two calcium antagonists whereas systolic blood pressure was decreased only at submaximal but not at maximal exercise; the heart rate was not significantly modified by the two drugs at any exercise stage.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1982

Evaluation of an automatic oscillometric method and of various cuffs for the measurement of arterial pressure in the neonate.

We compared simultaneous measurement of aortic, direct (Dir) and of indirect (Ind) systolic (S), mean (M) and diastolic (D) arterial pressure (AP) determined by an automatic oscillometric instrument (DINAMAP) in neonates with birthweight of 1000-3680 g. DINAMAP measurements were performed with cuffs of increasing width and length, recommended by the manufacturer for increasing arm circumference, and with a Standard sized cuff (2.5 X 15 cm), previously considered as suitable for neonates of any body size. In addition, we compared simultaneous measurements of Dir SAP and of Ind SAP determined by a Doppler technique and the Standard cuff. In DINAMAP SAP measurements with the Standard cuff, a statistically significant correlation between arm circumference and delta Ind-Dir SAP values (i.e. the difference between simultaneous Ind and Dir SAP measurements) was found. In DINAMAP MAP measurements with the cuff recommended for arm circumference, a statistically significant difference of the mean delta Ind-Dir MAP values was observed in infants whose arm was or was not completely encircled by the bladder of the cuff. In SAP as well as in MAP DINAMAP determinations, the overall error of measurement with the Standard cuff was smaller than with the recommended cuff. The Doppler method was found considerably more accurate than the DINAMAP method for the determination of SAP. In spite of these limitations, the DINAMAP method with the Standard cuff was considered to be reasonably accurate for the clinical determination of SAP and MAP, provided that several consecutive measurements are performed and averaged in order to minimize the error of measurement. When considering DAP measurements the error was so unacceptably high that the DINAMAP method cannot be recommended for clinical use. The need for a careful consideration of the cuff characteristics when evaluating new methods for the indirect measurement of AP in the neonate is emphasized.

Blood Pressure Determination↗