Anna Giunta

Diastolic Time during Exercise in Normal Subjects and in Patients with Coronary Artery Disease

Percent diastole (%D) was evaluated at rest and during effort (submaximal upright exercise) in 13 normal subjects and in 14 age-matched patients with coronary artery disease (CAD). Systolic time intervals were also simultaneously recorded by using the thermistor pulse transducer. At rest, in both groups, a positive linear regression was found between %D and cycle length (RR) (%D = 19.1 + 0.044RR, r = 0.83 in normals; %D = 21.2 + 0.044RR, r = 0.88 in CAD). During effort, while in normals no correlation was found between %D and RR values, in CAD patients %D and RR were linearly related (%D = -12.81 + 0.087RR, r = 0.67). These results prove that diastolic time is differently affected by the exercise in the two examined groups and that in CAD patients an abnormal reduction of %D occurs during stress test.

Unusual intracardiac metastasis of a testicular embryonal carcinoma

In this report, we present a case of a metastasis of an embryonal carcinoma, unusually located in the right atrium, which was clinically revealed by a systemic paradox embolism through an atrial septal defect. The primary tumor was found in an undescended testis.

Two-Dimensional Echocardiography in Idiopathic Enlargement of the Right Atrium

A 36-year-old woman was admitted to our hospital with exertional dyspnea, palpitation and cardiac enlargement on standard chest X-ray. Physical examination did not reveal any significant abnormality and routine laboratory tests were normal. ECG showed atrial fibrillation and negative T waves in lead III and a VF, with a stiffened ST segment. M-mode echocardiography showed absence of pericardial effusion and normal size of both ventricular chambers. Two-dimensional echocardiography showed a large saccular dilation of the right atrium without significant enlargement of other cardiac chambers. A slight displacement of tricuspid valve leaflets was also present. Cardiac catheterization was effective in the diagnosis of idiopathic enlargement of the right atrium. Although two-dimensional echocardiography has some limitations in the diagnosis of this unusual malformation, it may prove useful in the noninvasive follow-up of these patients, in order to monitor the eventual increase of atrial size and to promptly detect late complications.

Cardiac hypertrophy in the absence of pressure overload: an experimental and clinical report.

1. A simulated altitude of 7000 m was applied in rats chronically exposed to hypoxia in a hypobaric chamber. In these experimental conditions the contralateral ventricle not exposed to pressure overload (that is, the left) showed a significant degree of hypertrophy. The hypoxic stimulus did not affect systemic artery pressure or the heart rate.

Long-term effects of felodipine in patients with mild heart failure treated chronically with enalapril: A randomized, placebo-controlled study

Abstract Although the introduction of angiotensin-converting enzyme (ACE) inhibitors in the treatment of congestive heart failure has led to improved management and outcome of the disease, the progression of ventricular dysfunction remains a major problem. The present study was designed to examine the long-term effects of felodipine, a calcium channel blocker, on the progression of ventricular dysfunction in patients with mild ischemic heart failure treated chronically with the ACE inhibitor enalapril. A total of 23 patients with a history of myocardial infarction and mild heart failure (New York Heart Association [NYHA] functional class I or II; mean ejection fraction, 30.5 ± 1.6%), who had received long-term treatment with enalapril 5 to 10 mg/d, were randomized to receive felodipine 5 mg/d (n = 12) or placebo (n = 11) for 12 months. At baseline, the study groups had similar hemodynamic and clinical characteristics as well as similar hormonal profiles. In contrast, during the study, ejection fraction decreased progressively from 30.1 ± 1.9% to 29.6 ± 1.9% in the placebo group but increased progressively from 30.8 ± 2.5% to 36.3 ± 2.1% in the felodipine group. Consistently, plasma atrial and brain natriuretic peptide levels were higher at 12 months in the placebo group than in the felodipine group. At baseline and at 12 months, 2 patients were in NYHA class I and 9 patients in class II in the placebo group; in the felodipine group, 4 patients were in class I and 8 patients in class II at baseline, and 7 patients in class I and 5 patients in class II at 12 months. Left ventricular adaptations to volume loading measured after 3 months of treatment were significantly improved only in the felodipine group. Similarly, peak oxygen consumption during cardiopulmonary testing increased significantly only in the felodipine group. These results show that the long-term addition of felodipine to treatment with ACE inhibitors significantly improves ventricular function and may reduce the progression of disease in patients with mild ischemic heart failure.

Systolic Time-Interval Evaluation by Thermistor Plethysmography during Uninterrupted Dynamic Stress Test in Normals and in Patients with Coronary Artery Disease

18 patients with coronary artery disease (CAD) and 21 normal subjects underwent a triangular bicycle exercise test. Systolic time intervals (STI) were calculated at rest and every 2 min during exercise. Under resting conditions, STI were similar in the two groups. During exercise, the ejection time index (ETI), i.e. left ventricular ejection time (LVET) corrected for HR, rose significantly more in CAD patients, as compared to normals. Pre-ejection period (PEP) was also differently affected by exercise in CAD patients, who showed a more shortened PEP (p less than 0.001) in the early stage of dynamic stress. PEP/LVET ratio, which in the control group decreased continuously, in CAD patients fell during exercise at lower work loads (p less than 0.001), whilst rose during strenuous exercise. Finally, significant differences (p less than 0.001) were found in the percent change (% delta) PEP/LVET ratio between the two groups during the early phase of exercise, in which no superimposition of single values was present. Therefore, this last parameter seems the most reliable to differentiate clearly CAD patients from normal subjects, but its use must be limited at early exercise.

Echocardiography evaluation of acute administration of oxyfedrine in patients with coronary artery disease

In order to assess the effects of oxyfedrine in ischaemic heart disease, echocardiographic evaluation of left ventricular function was performed 2,5,10,15 and 20 minutes after the intravenous administration of 12 mg oxyfedrine in 15 patients with coronary artery disease without angiographic abnormalities of left ventricular wall motion. The following parameters were measured: heart rate, mean arterial blood pressure, internal dimension in diastole (LVIDd) and in systole (LVIDs) of the left ventricule and the percentage shortening of the LVID (%LVID). There was a significant increase in %LVID (peak 10 minutes after drug administration; p less than 0.001) indicating improved left ventricular function, associated with slight changes in pre-load (LVIDd) and in heart rate, and no variation in mean blood pressure. No abnormalities of contraction were observed after the administration of oxyfedrine. These results suggest that oxyfedrine exerts a direct positive inotropic effect of the myocardium in patients with significant coronary artery stenoses.