E Moscarelli

Transient changes in left ventricular mechanics during attacks of Prinzmetal's angina: An M-mode echocardiographic study

M-mode echocardiograms were recorded in 12 patients with Prinzmetals angina during 29 episodes of transient myocardial ischemia at rest (18 spontaneous and 11 ergonovine-induced). At peak ST segment elevation a regional mechanical impairment was observed in the interventricular septum during 23 episodes of angina and in the posterior wall during six episodes. In the 18 spontaneous episodes the left ventricular ischemic wall, when compared to the basal state, was found to have a significant reduction in motion (-76.3 +/- 9.1%) (mean +/- SEM), in diastolic thickness (-11.7 +/- 2.5%), and in percent systolic thickening (-88.0 +/- 5.6%). Increase in left ventricular end-diastolic diameter (+13.1 +/- 2.1%) and decrease in percent fractional shortening (-38.1 +/- 3.7%) were also observed. When ST segment was back to the isoelectric line, a transient overshoot in regional left ventricular function was observed. In induced episodes statistically significant changes could be detected by M-mode echocardiography even before appearance of ST segment elevation and anginal pain. No significant difference was found in type or degree of mechanical impairment between induced and spontaneous episodes. Therefore, in patients with Prinzmetals angina: (1) M-mode echocardiography allows detection of mechanical changes due to transient myocardial ischemia; and (2) mechanical impairment occurs earlier than clinical (pain) and electrocardiographic (ST segment elevation) signs of transmural ischemia.

Transient myocardial ischemia with minimal electrocardiographic changes: An echocardiographic study in patients with Prinzmetal's angina

Kn patients with Prinzmetals angina, episodes of transient T wave abnormalities (T abn) are often documented in addition to the typical episodes of ST segment elevation (ST). As the interpretation of these minor ECG changes is still uncertain, we investigated if transient T abn are associated with reversible ventricular asynergies, similar to episodes with ST. For this purpose an ECG lead and a two-dimensional echocardiographic projection, which showed clear-cut changes during previous episodes of ST, were simultaneously monitored in five patients with Prinzmetals angina for a total of 13 hours and 20 minutes. In all patients, the 30 episodes of ST recorded were all accompanied by reversible ventricular asynergies. Furthermore, in four of these patients, 14 episodes of T abn (peaking, flattening, or the appearance of a diphasic T wave) were recorded. All T abn were associated with reversible asynergies, as detected by three independent observers. The mechanical impairment occurred in the same ventricular wall both during ST and during T abn. During T abn the degree of mechanical impairment appeared less severe (hypokinesia in 12 and akinesia in two episodes) than during ST (hypokinesia in one, akinesia in 25, and dyskinesia in four episodes) (p less than 0.001). The duration of asynergies was less during T abn (107 +/- 76 seconds) than during ST (169 +/- 83 seconds) (p less than 0.05). Chest pain was reported in 5 of 14 episodes of T abn (36%) and in 20 of 30 (66%) episodes of ST (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Pharmacological Methods Instead of Exercise for the Assessment of Coronary Artery Disease

Due to new knowledge of pathophysiology, diagnosis, and treatment, the clinical approach to the patient with suspected coronary artery disease has deeply changed over the last few years. The central role of functional factors‐independent from or in association with organic stenosis‐are important in the genesis of myocardial ischemia. On the diagnostic side, the widespread use of new methodologies permits detection of ischemia by means of perfusion, mechanical, and metabolic markers. Drugs such as beta blockers, nitrates, and calcium antagonists, and procedures such as coronary angioplasty, have fostered a new era in which it is crucial not only to document ischemia, but also to understand the underlying mechanism. The present article deals with the most important pharmacological tests that can fit into a modern approach to noninvasive ultrasonic diagnosis of coronary artery disease. (ECHOCARDIOGRAPHY, Volume 8, January 1991)

Oral Isosorbide 5-Mononitrate Can Protect from Myocardial Ischemia Induced by Ergonovine Test and by Isometric Effort

Isosorbide 5-mononitrate (IS 5-MN) has favourable pharmacodynamic properties, such as the specific half-life (close to 5 h) and the bioavailability (100% after oral ingestion). The efficacy of IS 5-MN (20 mg t.i.d.) in the treatment of stable angina has been documented in previous studies. In the present acute study, two subsets of patients were evaluated: the first group consisted of 10 patients with coronary vasospasm in whom oral IS 5-MN was effective in preventing myocardial ischaemia due to an abrupt reduction in coronary blood flow; the second group regarded 8 patients with a mixed form of angina, where the responsible mechanism for ischaemia can be considered a combination of increased myocardial oxygen demand and reduction of coronary blood flow due to vasoconstriction of large vessels. In all these patients, IS 5-MN was able to protect against transient myocardial ischaemia induced by isometric test. In conclusion, from the data available in our studies, IS 5-MN appears to be a useful drug in anginal patients: the beneficial effect is likely based on its capability both to prevent the abnormal vasoconstriction of diseased coronary vessels and to reduce myocardial oxygen demand.

Ultrasounds in Cardiology: Recent Results, Limitations and Future Needs

Ultrasonic techniques represent today such an unique combination of “information and safety” that, in some clinical settings, they are used for conclusive assessment before surgical procedures. After clinical evaluation, chest X-Ray and electrocardiogram, the safety factor makes echocardiography an attractive technique in situations where other existing procedures offer “competitive” information but involve either the invasive approach or the use of radiation doses that cannot be administered repeatedly, to the patient.