Diana Lama

Effectiveness of glibenclamide on myocardial ischemic ventricular arrhythmias in non-insulin-dependent diabetes mellitus

Glibenclamide, a hypoglycemic sulfonylurea, is a blocker of the adenosine triphosphatase-modulated potassium ion channels. The opening of these channels in the myocardial cells, induced by acute myocardial hypoxia, can be responsible for ischemic ventricular arrhythmias. To evaluate the antiarrhythmic effects of this drug 19 non-insulin-dependent diabetic patients were selected. They had coronary artery disease and evidence on Holter monitoring of ventricular premature complexes or nonsustained ventricular tachycardia, or both, induced by transient myocardial ischemia. In all patients, 24-hour electrocardiographic monitoring was performed to evaluate the number and duration of myocardial ischemic events, the frequency of ventricular premature complexes and nonsustained ventricular tachycardia per minute of ischemia and the percentage of ventricular premature complexes versus total ischemic beats. Selected patients were classified in 2 groups: group A (9 patients) received metformin (placebo) and group B (10 patients) was treated with glibenclamide. On the fourteenth day patients underwent 24-hour control monitoring. Then a crossover between the 2 groups was made and a new Holter monitoring sequence was performed at the end of the second phase. Results indicate that glibenclamide significantly (p less than 0.001) reduced both the frequency of ventricular premature complexes and the episodes of nonsustained ventricular tachycardia during transient myocardial ischemia, but did not change the number and duration of acute myocardial ischemic attacks and did not reduce the spontaneous ventricular arrhythmias. Thus, glibenclamide appears to have an antiarrhythmic effect in preventing ventricular arrhythmias induced by transient myocardial ischemia.

New standards in hypertension and cardiovascular risk management: focus on telmisartan.

Blockade of the renin–angiotensin system is an important approach in managing high blood pressure, and has increasingly been shown to affect cardiovascular disease processes mediated by angiotensin II throughout the cardiovascular and renal continua. Telmisartan is an angiotensin II receptor blocker (ARB) displaying unique pharmacologic properties, including a longer half life than any other ARB, that result in large and sustained reductions of blood pressure. In patients with mild-to-moderate hypertension, telmisartan has proved superior to other antihypertensive agents (valsartan, losartan, ramipril, perindopril, and atenolol) in controlling blood pressure particularly towards the end of the dosing interval. There is also clinical evidence that telmisartan reduces left ventricular hypertrophy, reduces arterial stiffness and the recurrence of atrial fibrillation, and confers renoprotection. The ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial (ONTARGET®) study has demonstrated that telmisartan has similar cardiovascular protective effects to ramipril in a large, high-risk patient population but was better tolerated. The powerful and sustained blood pressure control apparent in clinical trials, together with cardiovascular protection and tolerability demonstrated in ONTARGET® means that telmisartan may be a preferred option for patients with hypertension.

Progressive impairment of left ventricular diastolic filling with advancing age : a Doppler echocardiographic study

To identify the sequence and significance of left ventricular filling abnormalities associated with progressive aging in humans.

A multicentre, randomized study of telmisartan versus carvedilol for prevention of atrial fibrillation recurrence in hypertensive patients

Introduction: Atrial remodelling, leading to atrial fibrillation (AF), is mediated by the renin–angiotensin–aldosterone system. Methods: Mild hypertensive outpatients (systolic/diastolic blood pressure 140–159/90–99 mmHg) in sinus rhythm who had experienced ≥ 1 electrocardiogram (ECG)-documented AF episode in the previous six months received randomly telmisartan 80 mg/day or carvedilol 25 mg/day. Blood pressure and 24-hour ECG were monitored monthly for one year; patients were asked to report symptomatic AF episodes and to undergo an ECG as early as possible. Results: One hundred and thirty-two patients completed the study (telmisartan, n=70; carvedilol, n=62). Significantly fewer AF episodes were reported with telmisartan versus carvedilol (14.3% vs. 37.1%; p<0.003). Left atrial diameter, assessed by echocardiography, was similar with telmisartan and carvedilol (3.4±2.3 cm vs. 3.6±2.4 cm). At study end, both regimes significantly reduced mean left ventricular mass index, but the reduction obtained with telmisartan was significantly greater than with carvedilol (117.8±10.7 vs. 124.7±14.5; p<0.0001). Mean blood pressure values were not significantly different between the groups (telmisartan 154/97 to 123/75 mmHg; p<0.001; carvedilol 153/94 to 125/78 mmHg; p<0.001). Conclusions: Telmisartan was significantly more effective than carvedilol in preventing recurrent AF episodes in hypertensive AF patients, despite a similar lowering of blood pressure.

Hemodynamic changes in pulmonary circulation induced by effort in the elderly

Abstract Age-related changes in vascular tissue were previously reported. 1,2 Moreover, mild diffuse connective tissue proliferation of the aging lung can contribute to reduced reserve of the pulmonary vascular bed. 3 These morphologic changes may induce some hemodynamic impairment of the aging pulmonary circulation. Unlike the systemic circulation, relatively little is known regarding the effects of effort on pulmonary hemodynamics in healthy, elderly subjects. Difficulties in selecting elderly subjects without pulmonary vascular, cardiac and lung disease, and the absence of an effective, noninvasive method for the measurement of pulmonary hemodynamics are the causes for this poor knowledge. 4 In the present study, we evaluated the pulmonary hemodynamics in an elderly cohort, free of cardiovascular and lung disease, at rest and during submaximal supine exercise.

Science, Art, and Mistery in the Statues and in the Anatomical Machines of the Prince of Sansevero: The Masterpieces of the "Sansevero Chapel" †

During the 18th century in Naples, Raimondo di Sangro, Prince of Sansevero, completed works on the family chapel, the so‐called “Cappella Sansevero.” The chapel houses statues of extraordinary beauty and spectacularly detailed but also, in the basement, two human skeletons known as the “Anatomical Machines” (“Macchine Anatomiche”). These two skeletons, a man and a pregnant woman, are entirely surrounded by their circulatory systems, just as if these were suddenly fixed. Legend, believed as truth until few years ago, says that Prince Raimondo had prepared and injected an unknown embalming substance in the blood vessels of two of his servants convicting them to eternal fixity. Recent investigations have demonstrated that, while the bones are authentic, the blood vessels are actually extraordinary artifacts that also reproduce some congenital malformations. The dreadful aspect of these two skeletons appears to be in strident contrast with the classic beauty of the statues which glorify and celebrate the ideal of morphology. Conversely, the two Anatomical Machines, protagonists of legends and superstitions since centuries, represent a marvelous example of science mixed with art.

Ibopamine versus digoxin in the long-term treatment of congestive heart failure in the elderly: A doppler echocardiographic study

Abstract Twenty-seven elderly patients with congestive heart failure underwent pulsed Doppler echocardiography in order to define the hemodynamic effects of ibopamine and digoxin. A 48-hour electrocardiogram and dynamic exercise test were also performed. After a baseline examination, the patients were divided into two groups in a double-blind, cross-over, random fashion. Group A received ibopamine 100 mg TID plus furosemide 12.5 mg once daily; group B was treated with digoxin 0.25 mg once daily plus furosemide 12.5 mg once daily. After crossover and at the end of the study, which lasted for 6 months, selected parameters were measured. Both treatments induced a significant increase ( P

Impaired left ventricular relaxation and hyperinsulinemia in patients with primary hypercholesterolemia

Fifteen non-obese patients with familial hypercholesterolemia and fifteen normocholesterolemic subjects matched for age, body mass index, waist/hip ratio, arterial blood pressure and sedentary life style underwent blood sampling for determination of fasting plasma glucose, insulin, total-, LDL-, HDL-cholesterol, triglycerides, free fatty acids, apolipoprotein A1 and B. In both groups of subjects we determined erythrocyte membrane microviscosity and performed an echocardiographic study. We demonstrated that hypercholesterolemic patients had a significant increase in fasting plasma total cholesterol (8.9 +/- 0.5 vs. 5.5 +/- 0.3 mmol/l, P less than 0.001), insulin (79 +/- 4 vs. 58 +/- 4 pmol/l, P less than 0.05) and apolipoprotein B (2.2 +/- 0.5 vs. 1.3 +/- 0.5 g/l P less than 0.01). In the echocardiographic study we found a significant impairment in left ventricular relaxation (isovolumic relaxation time (IRT) 106 +/- 6 vs. 73 +/- 7 ms, P less than 0.01). Erythrocyte membrane microviscosity (0.253 +/- 0.004 vs. 0.225 +/- 0.003, P less than 0.05) was also increased in hypercholesterolemic patients. Finally we found that erythrocyte membrane microviscosity correlated with fasting plasma insulin levels (r = -0.46, P less than 0.03) and IRT (r = -0.52, P less than 0.01).

The role of ivabradine in diastolic heart failure with preserved ejection fraction. A doppler-echocardiographic study

Background: Ivabradine (IVA) is effective in patients with coronary artery disease (CAD) or systolic heart failure in sinus rhythm. Its action consists in reducing heart rate (HR) and improving the time of left ventricular (LV) diastolic filling. The aim of this study was to evaluate the effects of IVA added to conventional therapy on patients with diastolic heart failure (DHF) and preserved ejection fraction (HFpEF). Methods: We evaluated 25 patients with DHF in the New York Heart Association (NYHA) Class II-III and sinus rhythm. In these, IVA per os (5 mg/twice a day) was added to the conventional medical therapy and given for 12 weeks. Immediately before the beginning of IVA therapy and 3 months later, patients underwent echocardiographic evaluation by two-dimensional (2D) ultrasound and tissue Doppler imaging (TDI). The patterns of diastolic mitral inflow and pulmonary venous flow were recorded using 2D echocardiography, while the diastolic phase of mitral flow was recorded by TDI, from the lateral mitral annulus. Results: Three months after the addition of IVA to conventional treatment, HR significantly decreased in comparison to the baseline values. On the contrary, the echocardiographic indexes of LV diastolic dysfunction improved. Conclusions: These results testify that the addition of IVA to conventional therapy in patients with HFpEF can improve LV diastolic function evaluated by 2D and tissue Doppler-echocardiographic patterns. These Doppler-echocardiographic results match with the clinical improvement of patients evaluated.

Regressing Left Ventricular Hypertrophy: The Role of Telmisartan and Other ARBs

Left ventricular hypertrophy (LVH) is a common form of target organ damage associated with hypertension that increases the risk for cardiovascular morbidity and mortality. Regression of left ventricular mass (LVM) substantially reduces this risk, and antihypertensive treatment is associated with reduction in LVM. Identifying the optimal therapeutic strategy that brings effective BP reductions and superior LVM regression is therefore important for the effective management of patients with LVH. Hypertension, both mean load and variability (for example, the early morning blood pressure [BP] surge), causes LVH. LVH also results from abnormalities in neurohormonal systems (such as the renin-angiotensinaldosterone system [RAAS]), and metabolic abnormalities. Agents that block the RAAS (angiotensin receptor blockers [ARBs], angiotensin-converting enzyme inhibitors) have particular efficacy. Telmisartan is a long-acting ARB that has shown regression of LVH and improved diastolic function in several clinical trials. Compared with carvedilol, telmisartan induces more regression of LVM for the same degree of BP control, and compared with hydrochlorothiazide the regression of LVM for a given degree of BP lowering is greater. As part of the ONTARGET study that compares telmisartan, ramipril, and the combination, a substudy will assess the effects of the three therapeutic strategies on the regression of LVH