Papers by Lucia Mangiardi
Mayo Clinic Proceedings
Angiotensin-converting enzyme (ACE) inhibitors may induce cough and rhinopharyngeal inflammation.... more Angiotensin-converting enzyme (ACE) inhibitors may induce cough and rhinopharyngeal inflammation. Obstructive sleep apnea (OSA) is characterized by upper airway inflammation. We describe a patient who, during enalapril treatment, developed cough, upper airway symptoms, and diurnal sleepiness, with an increased number of obstructive apnea-hypopnea episodes (apnea-hypopnea index [AHI], 25) during sleep. Her symptoms and AHI improved 1 month after enalapril was discontinued and diuretic therapy (hydrochlorothiazide-spironolactone) was initiated. Similar findings were observed in 4 other patients with OSA who had ACE inhibitor-induced cough. The mean +/- SD AHI was 33.8+/-21.0 during enalapril treatment and 20.0+/-17.0 after withdrawal of this drug (P = .04). Exhaled nitric oxide, a marker of airway inflammation, was increased during enalapril treatment (15.0 +/- 4.3 parts per billion) and decreased after discontinuation of this drug (9.0 +/- 2.6; P = .03). No significant difference in ...
Mayo Clinic Proceedings, 2006
ABSTRACT Angiotensin-converting enzyme (ACE) inhibitors may induce cough and rhinopharyngeal infl... more ABSTRACT Angiotensin-converting enzyme (ACE) inhibitors may induce cough and rhinopharyngeal inflammation. Obstructive sleep apnea (OSA) is characterized by upper airway inflammation. We describe a patient who, during enalapril treatment, developed cough, upper airway symptoms, and diurnal sleepiness, with an increased number of obstructive apnea-hypopnea episodes (apnea-hypopnea index [AHI], 25) during sleep. Her symptoms and AHI improved 1 month after enalapril was discontinued and diuretic therapy (hydrochlorothiazide-spironolactone) was initiated. Similar findings were observed in 4 other patients with OSA who had ACE inhibitor-induced cough. The mean +/- SD AHI was 33.8+/-21.0 during enalapril treatment and 20.0+/-17.0 after withdrawal of this drug (P = .04). Exhaled nitric oxide, a marker of airway inflammation, was increased during enalapril treatment (15.0 +/- 4.3 parts per billion) and decreased after discontinuation of this drug (9.0 +/- 2.6; P = .03). No significant difference in the AHI and exhaled nitric oxide was observed in 4 patients with OSA who did not experience cough, before or after withdrawal of ACE inhibitor treatment. These findings suggest that ACE inhibitor treatment may contribute to OSA by inducing upper airway inflammation.
Progress in Cardiovascular Diseases, 1979
T HE object of this review can conveniently be divided into three major areas: (1) normal physiol... more T HE object of this review can conveniently be divided into three major areas: (1) normal physiology, i.e., the role played by the pericardium in cardiac function in the subject without disease of the heart or pericardium; (2) the contribution of the pericardium to abnormalities of cardiac function when the heart is diseased or working under abnormal loading conditions; and (3) the effects of diseases of the pericardium on cardiac function.
Pacing and Clinical Electrophysiology, 1990
GAITA, F., ET AL.: Relation between Spontaneous Atrial Fibrillation and Atrial Vulnerability in P... more GAITA, F., ET AL.: Relation between Spontaneous Atrial Fibrillation and Atrial Vulnerability in Patients witb WolfF-Parkinson-Wbite Syndrome. An intracavitary eiectrophysioiogicai study was carried out on 103 patients with Wolff-Parkinson-White (WPW), 23 symptomatic patients had documented episodes of atrial jibriilation, 54 symptomatic patients had atrioventricuiar reentrant tachycardias, and 26 asymptomatic. Patients were examined/or the reiation between spontaneous atrial /ibriliation and atrial vuinerabiiity, defined as the possibility to induce sustained (>I minute) episodes of atriai/lbriliation with a stimulation protocol exciuding atriai hursts. Atrial /ibriiiation induction was attempted by singie and double atrial extrastimuii during pacing at two different cycle lengths and incrementai atrial pacing. Sustained atrial fibrillation was induced in 65% of the patients with spontaneous atriai/ibriiiation, and in 13% of the symptomatic patients with documented episodes o/atrioventricuiar reentrant tachycardias and in 15% of the asymptomatic patients (P < 0.0005). Atrial vuinerabiiity was higher in patients with spontaneous alriai jibriiiation than in patients without this arrhythmia. No significant difference was observed between symptomatic without atriaJ jibriiiation and asymptomatic patients.
Journal of the American College of Cardiology, 1986
Journal of Electrocardiology, 1992
The spontaneous beat-to-beat variability of the ventricular repolarization duration was investiga... more The spontaneous beat-to-beat variability of the ventricular repolarization duration was investigated in 21 healthy subjects (age 25-71 years; mean, 40 years) during the basal state in a recumbent position. For each subject, approximately 1,000 consecutive cycles were analyzed with an automated technique. The time series of the RR, QT, and RT intervals generate histograms that approximate normal distributions and have mean standard deviations of 57.0 ms, 5.4 ms, and 4.3 ms, respectively. Spectral analysis was used to detect rhythmical oscillations in these time series. The power spectra densities of both heart rate and ventricular repolarization during show peaks in the same frequency bands: low frequency (0.05-0.12 Hz) and high frequency (0.2-0.4 Hz). The power distribution between these two bands observed in the ventricular repolarization duration spectra was found to be the reverse of that in heart rate spectra (p less than 0.005).
International Journal of Cardiology, 1989
A case is reported of congenital long QT interval associated with fixed 2: 1 atrioventricular blo... more A case is reported of congenital long QT interval associated with fixed 2: 1 atrioventricular block. The hradycardia was detected at 16 weeks of gestational age. The atrioventricular block was due to an extremely delayed ventricular repolarization. Early detection of bradycardia in fetal life and the demonstration of a normal positive correlation between QT duration and ventricular rate suggest that, in this case, the syndrome may be due to an anomaly of the myocardial cells rather than to imbalance of the sympathetic nervous system.
European Journal of Internal Medicine, 2003
Background: Pulmonary hypertension (PH) is an important limiting factor of exercise tolerance in ... more Background: Pulmonary hypertension (PH) is an important limiting factor of exercise tolerance in patients with mitral stenosis (MS). We wished to investigate the relationship between respiratory nitric oxide (NO), a potent vasodilator, and exercise tolerance in patients with moderate MS. In the same patients, we wondered whether acute change in pulmonary hemodynamics could affect respiratory NO. 2 Methods: Ten patients with moderate MS (valve area 1.460.2 cm) were studied at rest, during incremental cycle ergometry exercise, and 9 during dobutamine stress echocardiography (DSE). The concentration of NO in exhaled air (FE) and NO output (V) were measured NO NO at baseline, at the end of exercise, and at the end of DSE. Eight healthy subjects served as normal controls for NO output during exercise. 9 Results: During exercise, FE decreased both in patients and in controls, while V increased in both. At the end of exercise, both VO NO NO 2 9 9 max and V were significantly higher in controls than in patients. The increase in V during exercise was significantly correlated with NO NO VO max, both in patients and in controls. During DSE, cardiac output (CO), pulmonary artery pressure (PAP), and mitral valve gradient 2 9 increased. No changes in mean FE , V , or ventilation were observed during DSE. There was a significant inverse correlation between NO NO FE and mitral valve gradient at the end of DSE. Conclusions: In patients with moderate MS, exercise performance is correlated with NO respiratory NO output. In the same patients, during DSE, the increase in CO, which is not accompanied by an increase in ventilation, is 9 not associated with an increase in respiratory V. NO
Chest, 2000
primary isolated chylopericardium. This investigation can be performed either before or after per... more primary isolated chylopericardium. This investigation can be performed either before or after pericardiocentesis.
American Journal of Otolaryngology, 2012
It is posted here by agreement between Elsevier and the University of Turin. Changes resulting fr... more It is posted here by agreement between Elsevier and the University of Turin. Changes resulting from the publishing process-such as editing, corrections, structural formatting, and other quality control mechanisms-may not be reflected in this version of the text. The definitive version of the text was subsequently published in
The American Journal of Cardiology, 1989
Noninvasive stress and pharmacologic tests with procainamide and propafenone were studii as metho... more Noninvasive stress and pharmacologic tests with procainamide and propafenone were studii as methods to identify patients with Wolff-Parkinson-White syndrome (WPW) who would otherwise be judged at risk of sudden death on the basis of electrophysiologlc criteria: the shortest RR interval during induced atrial fibrillation I2!JO ms or accessory pathway anterograde effective refractery period 250 ms. sixty-five patients were studied. Twenty-four patients fulftlled the electrophysiologii risk criteria (group A) and 41 patients fuffilled none of these criteria (group B). Persistence of preexcitation during stress test showed a sensltivity of 96% and a specificity of 17% to identlfy group A patientq its posJtive predictive value was 40% and negative predktive value 33%. with both procainamide and propafenone tests persistence of preexcitation Identified group A patients with a sensitlvlty of 36% and a speclflcity of 51%; their positive and negative predictive value were, respectively, 53 and 95%. Stress and pharmacologic tests have good sensltlvRy and negative predictive value, but low speclflcity and positive predictive value.
The American Journal of Cardiology, 1976
American Heart Journal, 1986
T: Coronary venous retroinjection of procainamide has more pronounced effects on ischemic myocard... more T: Coronary venous retroinjection of procainamide has more pronounced effects on ischemic myocardium than the intravenous systemic injection. PACE lBH6;9::110. Clinical and electrocardiographic features and long-term results of electrical therapy in patients with isolated His bundle disease The clinical, ECG, and electrophysiologic findings of 35 consecutive patients with second-and third-degree intra-His block with normal QRS complexes were examined. The follow-up period varied between 12 and 120 months (mean 45). Seventy-seven per cent of the patients were women. Underlylng heart disease was present in 43% of the patlents. ECGs were characterized by both second-degree type I and type II atrioventricular block, normal or slightly prolonged PR interval of the conducted beats or of the flrst conducted beat of a Wenekebach sequence, and by subtle changes In the initial forces of the QRS complexes of the escape beats. Electrophysiologlc study showed normal sinus and atrioventricular node function and normal infra-His conduction in all patients. In four patfents repetitive bradycardia-dependent intra-His block was Induced. Thfrty-two patients were permanently paced soon after the initial evaluation and three during the follow-up period. Total long-term mortality rate was 23%. None of the patients developed bundle branch block.
Italian heart journal : official journal of the Italian Federation of Cardiology, 2004
Successful reperfusion therapy in patients with acute myocardial infarction (AMI) improves surviv... more Successful reperfusion therapy in patients with acute myocardial infarction (AMI) improves survival. Indeed, after AMI myocardial dysfunction may be reversible (hibernating or stunned myocardium). Low-dose dobutamine stress echocardiography (LDDSE) provides us with the possibility of evaluating viable myocardial segments, while myocardial contrast echocardiography (MCE) allows the study of the microcirculation in the same myocardial areas. The aim of our study was to compare LDDSE and MCE, in the prediction of the recovery of segments in patients with AMI who were submitted to primary coronary angioplasty (PTCA). We studied 14 patients with AMI. Both LDDSE and MCE with Levovist were performed after primary PTCA. The viability gold standard was a recovery of contractility detected at echocardiography 2 months later. For LDDSE, the sensitivity was 91%, the specificity 71% and the positive and negative predictive values were 93 and 64% respectively. For MCE, the sensitivity was 94%, th...
The American Journal of Cardiology, 1982
The study group comprised 15 patients (group A) with intra-His bundle block and 10 patients (grou... more The study group comprised 15 patients (group A) with intra-His bundle block and 10 patients (group B) with intranodal block documented in a His bundle recording. Drug-induced block was excluded in all.
Chest, 2007
Upper airway edema might contribute to pharyngeal collapsibility and account for the high prevale... more Upper airway edema might contribute to pharyngeal collapsibility and account for the high prevalence of obstructive sleep apnea (OSA) in patients with heart disease. The aim of this study was to evaluate if intensive unloading with diuretics improves sleep-disordered breathing and increases pharyngeal caliber in patients with severe OSA and diastolic heart failure. Fifteen patients with severe OSA, hypertension, and diastolic heart failure were hospitalized to receive IV furosemide, 20 mg, and spironolactone, 100 mg, bid for 3 days. Polysomnography was performed for assessment of apnea-hypopnea index (AHI), acoustic pharyngometry was performed for assessment of the oropharyngeal junction (OPJ) area, and forced midinspiratory flow (FIF(50)), forced midexpiratory flow (FEF(50))/FIF(50) percentage, and exhaled nitric oxide (FeNO) were measured before and after diuretic treatment. Diuretic treatment produced a significant decrease in body weight, BP, and AHI (from 74.89 +/- 6.95 to 57.17 +/- 5.40/h, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), associated with an improvement in OPJ area (from 1.33 +/- 0.10 to 1.78 +/- 0.16 cm(2), p = 0.007), FIF(50) (from 3.16 +/- 0.4 to 3.94 +/- 0.4 L/s, p = 0.006), and FEF(50)/FIF(50) percentage (from 117.9 +/- 11.8 to 93.15 +/- 10.1%, p = 0.002). Weight loss was significantly related to the decrease of AHI (R = 0.602; p = 0.018), to the increase of FIF(50) (R = 0.68; p = 0.005), and to the decrease of FEF(50)/FIF(50) (R = 0.635; p = 0.011). These findings suggest that pharyngeal edema contributes to sleep-disordered breathing in obese patients with severe OSA, hypertension, and diastolic heart failure. Upper airway edema may contribute to the frequent occurrence of OSA in patients with heart disease.
European Journal of Internal Medicine, 2003
BACKGROUND: Pulmonary hypertension (PH) is an important limiting factor of exercise tolerance in ... more BACKGROUND: Pulmonary hypertension (PH) is an important limiting factor of exercise tolerance in patients with mitral stenosis (MS). We wished to investigate the relationship between respiratory nitric oxide (NO), a potent vasodilator, and exercise tolerance in patients with moderate MS. In the same patients, we wondered whether acute change in pulmonary hemodynamics could affect respiratory NO. METHODS: Ten patients with moderate MS (valve area 1.4+/-0.2 cm(2)) were studied at rest, during incremental cycle ergometry exercise, and during dobutamine stress echocardiography (DSE). The concentration of NO in exhaled air (FE(NO)) and NO output (V&amp;amp;amp;amp;amp;amp;#39;(NO)) were measured at baseline, at the end of exercise, and at the end of DSE. Eight healthy subjects served as normal controls for NO output during exercise. RESULTS: During exercise, FE(NO) decreased both in patients and in controls, while V&amp;amp;amp;amp;amp;amp;#39;(NO) increased in both. At the end of exercise, both VO(2) max and V&amp;amp;amp;amp;amp;amp;#39;(NO) were significantly higher in controls than in patients. The increase in V&amp;amp;amp;amp;amp;amp;#39;(NO) during exercise was significantly correlated with VO(2) max, both in patients and in controls. During DSE, cardiac output (CO), pulmonary artery pressure (PAP), and mitral valve gradient increased. No changes in mean FE(NO), V&amp;amp;amp;amp;amp;amp;#39;(NO), or ventilation were observed during DSE. There was a significant inverse correlation between FE(NO) and mitral valve gradient at the end of DSE. CONCLUSIONS: In patients with moderate MS, exercise performance is correlated with respiratory NO output. In the same patients, during DSE, the increase in CO, which is not accompanied by an increase in ventilation, is not associated with an increase in respiratory V&amp;amp;amp;amp;amp;amp;#39;(NO).
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Papers by Lucia Mangiardi