Demetrio Tallarico

Noninvasive Assessment of Mitoxantrone Cardiotoxicity in Relapsing Remitting Multiple Sclerosis

Multiple sclerosis is the most common cause of neurologic disability in young adults. Recent reports have suggested that Mitoxantrone might be a candidate for clinical trials in multiple sclerosis patients. The authors studied 20 patients with relapsing remitting multiple sclerosis to evaluate cardiac toxicity during a one‐year follow‐up period. Patients were divided into 2 groups: group A, mitoxantrone treated patients (cumulative dose of 96 mg/m2); group B, placebo patients. The clinical course of multiple sclerosis was assessed using the Expanded Disability Status Scale and the number of relapses during the follow‐up. Each patient had an electrocardiogram and a spectral and color flow Doppler echocardiographic examination at enrollment, and 6 and 12 months later, to investigate cardiac toxicity. The mean exacerbation rate was reduced significantly in group A patients. No significant differences in the electrocardiograms or the echocardiographic parameters of systolic and diastolic function were noted between the two groups or in group A during the follow‐up. Mitoxantrone treatment seems able to improve the clinical course of relapsing remitting multiple sclerosis patients. It does not show any cardiac toxicity in selected patients at this dosage.

Left ventricular function, cardiac dysrhythmias, atrial activation, and volumes in nondipper hypertensive individuals with left ventricular hypertrophy

BACKGROUND Arrhythmic patterns and left ventricular geometric adaptations to pressure overload were investigated in 76 patients with untreated borderline-to-moderate sustained essential hypertension studied by 2-dimensional and M-mode echocardiography, 12-lead, Holter, and signal-averaged electrocardiography, and ambulatory blood pressure monitoring. METHODS AND RESULTS Sixty-two age- and sex-matched normal adults were chosen for data comparison. Hypertrophic hypertensive patients were subdivided into 2 subgroups: 44 patients with nocturnal blood pressure reduction (dippers) and 32 patients without it (nondippers). Common afterload and diastolic function indexes were found to be lower in combined nondipper and dipper groups, but only fractional shortening decreased in nondippers. The number of premature atrial and ventricular contractions per hour was high in dippers and nondippers, with no statistically significant differences between them; atrial and ventricular complex dysrhythmias were similar. Signal-averaged electrocardiography showed a prolonged P-wave duration in dipper and nondipper patients with high atrial volumes but no late ventricular potentials and no difference in quantitative P-wave analysis. Left atrial volumes, P-wave duration, and premature atrial contractions were found to be positively linked to left ventricular hypertrophy. In nondipper patients a linear correlation was observed between left atrial volume and P-wave duration, although supraventricular ectopic activity was connected to left atrial volume enlargement both in dipper and nondipper patients. CONCLUSIONS These data suggest that the nondipper pattern is not linked to a worse arrhythmogenic substrate; only atrial volume increase may be related to significant supraventricular activity and prolonged atrial activation in nondipper patients, but late ventricular potentials are uncommon in hypertrophic hypertensive patients.

Influence of Aging and Other Cardiovascular Risk Factors on Baroreflex Sensitivity

OBJECTIVES: To examine the influence of known cardiovascular risk factors (cholesterol, blood glucose levels, arterial pressures, heart rate, and aging) on baroreflex sensitivity.

Myocardial Cytoprotection by Trimetazidine Against Anthracycline-Induced Cardiotoxicity in Anticancer Chemotherapy

The ability of trimetazidine (2,3,4, trimethoxybenzylpiperazine dihydrochloride, TMZ) to protect the myocardium against anthracycline (ANT)-induced cardiotoxicity during chemotherapy has been evaluated in female patients with breast cancer. A clinical trial was conducted in 61 patients subdivided into three groups: group 1 (n = 15, G1) treated with standard ANT protocol and cardioprotection by dexrazoxane (DEX) plus TMZ (60 mg, daily dose); group 2 (n = 22, G2) treated with ANT and cardioprotection by TMZ only; and group 3 (n = 24, G3) scheduled to receive ANT therapy and DEX. All the patients submitted to an echocardiographic evaluation of diastolic function (E wave velocity, A wave velocity, isovolumetric relaxation time [IVRT], deceleration time [DT]) at enrollment (TO), at T1 time, at T2 time, and at T3 time. After a 12- month follow-up period, the patients showed a good conservation of diastolic function both in G1 and G2 groups. No statistically significant difference was observed in E wave and A wave velocity and E/A ratio after ANT treatment. TMZ produced a cardioprotective effect, compa rable to DEX protection, against subacute and chronic subclinical cardiotoxicity with no signif icant changes in diastolic function after 1 year of follow-up.

Left Ventricular Pseudoaneurysm Echocardiographic and Intraoperative Images

A 44-year-old hypertensive woman with fever for 1 week and a history of apical myocardial infarction (1 month before) was transferred to our institution with chest pain and dyspnea. On physical examination, her heart rate was 115 bpm, her arterial blood pressure was 85/50 mm Hg, and peripheral cyanosis was present. The ECG showed sinus tachycardia and Q waves in the V1 to V2 leads. …

Echocardiographic and macroscopic images: aortic cusp laceration.

A 70-year-old man was admitted to our department for non–ST-segment elevationmyocardial infarction. His risk factors were hypertension, diabetes, dyslipidemia, and smoking. On admission, physical examination and enzymatic markers of myocardial injury were normal. The ECG revealed T-wave inversion in leads V1–V6. Transthoracic echocardiography showed mild left ventricular hypertrophy. Cardiac catheterization revealed severe triple coronary artery disease. Three days after coronary angiography, the patient had dyspnea at rest, and, on physical examination, tachycardia and a diastolic murmur were present. A second transthoracic …

Transesophageal echocardiography through nasal way as a guide to percutaneous closure of patent foramen ovale.

Percutaneous device closure of patent foramen ovale (PFO) has become an effective and safe alternative to medical or surgery treatment. Transesophageal echocardiography (TEE), as commonly used to guide this procedure, has the limitation to require general anesthesia. Recently, intracardiac echocardiography (ICE) with AcuNav probe was used to guide percutaneous PFO closure. We report a 42 year‐old man with two previous cryptogenetic strokes in whom both diagnosis and guidance of PFO closure were performed by means of TEE using the AcuNav catheter introduced through nasal way (TEENW). This technique, that does not require general anesthesia, provided adequate and complete view of the Amplatzer procedure. TEENW might offer a feasible and equivalent echocardiographic alternative either to standard TEE or ICE as a guide to percutaneous PFO closure

Images in cardiovascular medicine. Left ventricular pseudoaneurysm: echocardiographic and intraoperative images.

A 44-year-old hypertensive woman with fever for 1 week and a history of apical myocardial infarction (1 month before) was transferred to our institution with chest pain and dyspnea. On physical examination, her heart rate was 115 bpm, her arterial blood pressure was 85/50 mm Hg, and peripheral cyanosis was present. The ECG showed sinus tachycardia and Q waves in the V1 to V2 leads. …

Contrast Echocardiography in the ICU and OR

Ultrasound contrast agents can be divided into first-generation and second-generation agents. First generation hand-agitated saline solutions contain large and unstable air microbubbles which cannot pass through the pulmonary microcirculation and are used only for the opacification of the right side of the heart. These agents have been used for about 40 years to rule out a shunt at the level of the fossa ovalis. Second-generation agents are made of smaller, more standardized and stable microbubbles containing a low-diffusable gas. They can easily cross the pulmonary circulation and provide left ventricular cavity and left ventricular myocardial opacification. These agents are used for better delineation of the endocardial contour and for myocardial perfusion studies.

Left Ventricular Pseudoaneurysm

A 44-year-old hypertensive woman with fever for 1 week and a history of apical myocardial infarction (1 month before) was transferred to our institution with chest pain and dyspnea. On physical examination, her heart rate was 115 bpm, her arterial blood pressure was 85/50 mm Hg, and peripheral cyanosis was present. The ECG showed sinus tachycardia and Q waves in the V1 to V2 leads. …