1. Ital Heart J. 2001 Aug;2(8):633-4. Diagnosis of the superior sinus venosus defect by intracard... more 1. Ital Heart J. 2001 Aug;2(8):633-4. Diagnosis of the superior sinus venosus defect by intracardiac echocardiography. Zanchetta M, Rigatelli G, Pedon L, Zennaro M, Onorato E, Maiolino P. Department of Cardiovascular Diseases, Cittadella General Hospital, PD, Italy. ...
1. Ital Heart J. 2001 Sep;2(9):715-6. Images in cardiovascular medicine. A new permanent and retr... more 1. Ital Heart J. 2001 Sep;2(9):715-6. Images in cardiovascular medicine. A new permanent and retrievable vena cava filter: its removal after five months. Zanchetta M, Rigatelli G, Pedon L, Zennaro M, Maiolino P. Department ...
We describe a 70-year-old woman who underwent successful percutaneous Inoue antegrade-technique m... more We describe a 70-year-old woman who underwent successful percutaneous Inoue antegrade-technique mitral valvuloplasty. Three months later, the patient developed right-sided heart failure. Color Doppler echocardiography and cardiac catheterization demonstrated an atrial septal defect with bidirectional shunting and no restenosis of the mitral valve (iatrogenic Lutembacher's syndrome). Percutaneous treatment was successfully accomplished using a 13 mm Amplatzer Septal Occluder (AGA Medical Corporation, Golden Valley, Minnesota). The causes of right-to-left shunting and the effects of body position on gas exchange in such patients are also discussed.
A case of endoluminal repair of vein and artery axillary rupture after reduction of shoulder disl... more A case of endoluminal repair of vein and artery axillary rupture after reduction of shoulder dislocation in an 83-year-old woman is reported. The lesions were repaired successfully with two cover stents (JOSTENT and Passager). Endovascular treatment of such vascular injuries seems to be feasible and safe, though further investigation is warranted.
Transthoracic (TTE) and transesophageal (TEE) echocardiography are the primary modalities for atr... more Transthoracic (TTE) and transesophageal (TEE) echocardiography are the primary modalities for atrial septal abnormalities assessment because of their proven utility, relatively low cost, and widespread availability. Some advantageous imaging characteristics of TEE include ...
To identify factors that influence plasma levels and assess the prognostic value of lipoprotein-a... more To identify factors that influence plasma levels and assess the prognostic value of lipoprotein-associated phospholipase A2 (Lp-PLA2) activity in a prospective, population-based survey of the epidemiology and pathogenesis of atherosclerosis. Methods and results The Bruneck study is a prospective, population-based survey initiated in 1990. Lp-PLA2 activity and baseline variables for the current analysis were measured in 765 subjects aged 45-84 years in 1995. Incident cardiovascular disease (CVD) (cardiovascular death, myocardial infarction, stroke, and transient ischaemic attack) and rates of non-CVD mortality were assessed between 1995 and 2005. Subjects with incident CVD had higher levels of Lp-PLA2 activity (884 + 196 vs. 771 + 192 mmol/min/L, P , 0.001). Increased Lp-PLA2 activity was significantly related to incident CVD [age-and sex-adjusted hazard ratio (95%CI) 2.9 (1.6-5.5); third vs. first tertile group; P , 0.001] and with vascular mortality but not with non-CVD mortality. Lp-PLA2 activity was enhanced in subjects with the metabolic syndrome and showed highly significant positive associations with LDL-C, apoB-100, ferritin, and HOMA-IR, and inverse associations with HDL-C and antioxidant levels. Conclusion Increased Lp-PLA2 activity is associated with metabolic syndrome and incident fatal and non-fatal CVD, but not with non-CVD mortality. Furthermore, Lp-PLA2 activity is strongly influenced by ferritin levels, LDL-C, and apoB-100 supporting its integral role in lipid peroxidation. Clinical utility of Lp-PLA2 activity for prediction of cardiovascular risk has to be explored in future studies.
Journal of the American College of Cardiology, Nov 1, 2003
We assessed the use of intracardiac echocardiography (ICE) as the primary means for both selectio... more We assessed the use of intracardiac echocardiography (ICE) as the primary means for both selection of the Amplatzer Septal Occluder (ASO) and the guidance of transcatheter closure of secundum atrial septal defects (ASDs). BACKGROUND The standard method for transcatheter closure of ASDs requires balloon-sizing maneuver and transesophageal echocardiographic (TEE) monitoring. The role of ICE during transcatheter closure of ASDs has not yet been established. METHODS In 91 patients with ASDs, two standardized orthogonal sections were used to obtain ICE-derived measurements of the fossa ovalis and to assess optimal device deployment: the transverse section on the aortic valve plane, and the longitudinal section on the four-chamber plane. RESULTS In all patients, ICE planes were identified with excellent resolution, providing proper measurements of the fossa ovalis, from which to derive geometric assumptions for the selection of an appropriately sized device. The ASO waist diameter was chosen on the basis of the r value (r ϭ ͌ c 2 ϩ p 2 , where r is the radius of an ideal circle that intersects the elliptical fossa ovalis in its semi-latus rectum, c is the foci half-distance of the fossa ovalis, and p is its semi-latus rectum). During the procedure, the four-chamber plane allowed us to obtain easily interpretable images of all stages of device deployment. Midterm complete occlusion rate was 97.8%. No ICE-related complications occurred. CONCLUSIONS The ICE evaluation of ASDs allows quantitative and qualitative information for both proper ASO selection and optimal device placement, thus eliminating the cumbersome balloonsizing maneuver and the need for general anesthesia during TEE monitoring.
Echocardiography-a Journal of Cardiovascular Ultrasound and Allied Techniques, Aug 1, 2002
A detailed understanding of the anatomic structures of both atria is mandatory for successful cat... more A detailed understanding of the anatomic structures of both atria is mandatory for successful catheter‐based interventional techniques. Some of the drawbacks of transthoracic and transesophageal echocardiography can be overcome by intracardiac echocardiography (ICE). We present our ICE experience based on 70 out of 186 patients who were included in a multicenter registry of transcatheter interatrial communication closures. The ultrasound catheter was a 9‐Fr, 9 MHZ monoplane probe (Ultra ICE catheter) compatible with the motor drive unit and imaging console of the Clear View Ultra. Four slice selections in the axial plane and only one in the sagittal plane were needed in order to obtain a comprehensive guide to ICE interrogation. Their intracardiac ultrasound imaging presentation is an essential and nontrivial step. The anatomic coordinate system was maintained identical to a tomographic imaging plane as follows: Left/right and anterior/posterior in the axial planes and superior/inferior and anterior/posterior in the sagittal plane. In order to identify the imaging coordinates, two specific anatomic landmarks were used. The first one was the crista terminalis (at 10 o′clock) and the second one was the right atrial auricle (at 12 o′clock). Once the ultrasound images were orientated, their interpretation and spatial reconstruction were straightforward. In conclusion, a standardized ICE examination allows for a comprehensive evaluation of the right atrial anatomy and may be helpful in guiding therapeutic catheter‐based interventions. The major clinical advantages of ICE include optimal contrast between soft‐tissue structures, limited fluoroscopic exposure time, and good patient acceptance, thus avoiding general anesthesia.
Journal of the American College of Cardiology, Mar 1, 2003
We investigated the association of polymorphisms in the promoter region and exon 7 endothelial ni... more We investigated the association of polymorphisms in the promoter region and exon 7 endothelial nitric oxide synthase (eNOS) gene with coronary artery disease (CAD). BACKGROUND Endothelial dysfunction foretells cardiovascular events and can be genetically determined. METHODS We genotyped for the promoter (T-786 C) and exon 7 (Glu298Asp, G 894 T) polymorphisms in 1,225 subjects; 1,106 were consecutive patients undergoing coronary angiography and 119 control subjects without any cardiovascular risk factors. Genotyping was performed with melting curve analysis of polymerase chain reaction products from allele-specific acceptor and donor probes that were 5Ј-and 3Ј-end labeled with LCRed640 and fluorescein, respectively; CAD was assessed by quantitative coronary angiography. We performed multiple logistic regression analysis for the effect of the T-786 C, the missense Glu298Asp variant, and other coronary risk factors on two-and three-vessel CAD. RESULTS The overall genotype distribution of T-786 C (CC ϭ 17.7%, CT ϭ 40.4%, and TT ϭ 41.9%) and Glu298Asp (GG ϭ 43.3%, GT ϭ 37.0%, and TT ϭ 19.7%) was consistent with the Hardy-Weinberg equilibrium. The regression analysis showed that the T-786 C, but not the missense Glu298Asp variant, significantly predicted CAD, independent of other risk factors. Compared with TT homozygous, subjects carrying the C allele had a significant (p ϭ 0.002) increase in the odds ratio of harboring two-or three-vessel CAD of 1.672 (95% confidence interval, 1.062 to 2.527). A subgroup analysis confirmed this effect of the T-786 C polymorphism in men (p ϭ 0.007), cigarette smokers (p ϭ 0.001), subjects older than 60 years of age (p ϭ 0.007), with hypercholesterolemia (p ϭ 0.011), low high-density lipoprotein cholesterol (p ϭ 0.006), and overweight or with obesity (p ϭ 0.041). CONCLUSIONS The C allele at the T-786 C endothelial nitric oxide synthase polymorphism is associated with a higher risk of multivessel CAD in Caucasians.
A 64 years old patient performed a maximal exercise testing 13 days after inferoposterior myocard... more A 64 years old patient performed a maximal exercise testing 13 days after inferoposterior myocardial infarction (no thrombolytic treatment had been performed). The patient presented at days 1-4 an intermittent Mobitz 1 and 2:1 heart block, with normal ventricular rate. No other complications were present. The ECG at entry and before stress test showed a complete right bundle block. The test was stopped at 30 sec of 75 watts. The systolic blood pressure increased from 130 to 155 mm Hg and heart rate from 84 to 145/min (93% of predicted heart rate). No arrhythmias and anginal pain were noted. The leads with pathologic Q wave showed elevation of the ST segment, whereas V1-V2 and aVL leads a depression of the ST segment. During recovery the patient developed electromechanical dissociation. The echocardiogram showed significant pericardial effusion. Cardiopulmonary resuscitation and pericardiocentesis were ineffective. Necropsy confirmed left ventricular inferior wall rupture and haemope...
The first case of combined procedure of catheter-based balloon pulmonary valvuloplasty and atrial... more The first case of combined procedure of catheter-based balloon pulmonary valvuloplasty and atrial septal defect closure using Amplatzer Septal Occluder, in a patient with Noonan syndrome, is reported. The literature regarding prevalence, genetics, pattern of involvement, symptoms, diagnosis, and treatment of this syndrome is reviewed.
In order to assess the efficacy and tolerability of gallopamil (D-600, CAS 16662-47-8) by long-te... more In order to assess the efficacy and tolerability of gallopamil (D-600, CAS 16662-47-8) by long-term venous infusion in the treatment of spontaneous angina, 15 consecutive patients were studied in a single-blind, self-controlled trial versus placebo. Following a 24-h Holter ECG recording of the patients receiving a saline infusion (run-in phase), i.v. administration of gallopamil was started at a dose of 0.02 mg/kg/h preceded by a 0.03 mg/kg bolus. After 24 h, the dosage was increased to 0.03 mg/kg/h and the infusion was maintained for another 48 h. The Holter ECG recording was repeated in the last 24 h of treatment and after 6 h from withdrawal (washout phase). The reduction in the number of angina attacks, as shown by a comparison between the average of the two placebo periods (run-in and washout phases) and the three days of treatment, was 68.2%, 92.5%, and 87%, respectively. Consumption of glyceryl trinitrate decreased by 92.5% on each one of the three days of treatment. The redu...
Single-vessel coronary disease has been considered so far a benign condition, for which the medic... more Single-vessel coronary disease has been considered so far a benign condition, for which the medical therapy may represent the optimal treatment. In order to assess the effectiveness of this approach, we studied 323 patients who had come to our attention for ischemic heart disease and resulted affected by single-vessel coronary artery disease. From our data it appears that single-vessel coronary artery disease is frequently associated with myocardial infarction and post-infarction aneurysm. Coronary angiography indicated that left anterior descending coronary artery is the most frequently affected vessel, and that its involvement is often associated with lethal outcome. Forty-two out of the 323 patients underwent coronary artery bypass surgery; the remaining patients were medically treated. Surgical patients showed a better improvement respect to the medical group, while survival was not statistically different. An unexpected result was the relatively high risk in circumflex artery l...
The study group consisted of 47 consecutive patients (38 men and 9 women) aged between 16 and 56 ... more The study group consisted of 47 consecutive patients (38 men and 9 women) aged between 16 and 56 years with dilated cardiomyopathy studied invasively between January 1980 and December 1986. Follow-up observation (40 +/- 29 months) showed that 28 patients were mildly symptomatic (group 1) and 19 patients were severely symptomatic (group 2: eight of them died due to intractable congestive heart failure). At univariate analysis, group 2 was characterized by higher pulmonary vascular resistance, larger end-diastolic and end-systolic left ventricular volumes, increased left ventricular mass, lower ratio of mass to volume index, depressed angiographic ejection fraction, lower ratio of end-systolic stress and peak systolic pressure to volume index. Multivariate analysis was used to determine which combination of factors might be a better effective predictor of prognosis in these patients: the most important factors were mass to volume index ratio (M/V) and end-systolic stress to volume ind...
1. Ital Heart J. 2001 Aug;2(8):633-4. Diagnosis of the superior sinus venosus defect by intracard... more 1. Ital Heart J. 2001 Aug;2(8):633-4. Diagnosis of the superior sinus venosus defect by intracardiac echocardiography. Zanchetta M, Rigatelli G, Pedon L, Zennaro M, Onorato E, Maiolino P. Department of Cardiovascular Diseases, Cittadella General Hospital, PD, Italy. ...
1. Ital Heart J. 2001 Sep;2(9):715-6. Images in cardiovascular medicine. A new permanent and retr... more 1. Ital Heart J. 2001 Sep;2(9):715-6. Images in cardiovascular medicine. A new permanent and retrievable vena cava filter: its removal after five months. Zanchetta M, Rigatelli G, Pedon L, Zennaro M, Maiolino P. Department ...
We describe a 70-year-old woman who underwent successful percutaneous Inoue antegrade-technique m... more We describe a 70-year-old woman who underwent successful percutaneous Inoue antegrade-technique mitral valvuloplasty. Three months later, the patient developed right-sided heart failure. Color Doppler echocardiography and cardiac catheterization demonstrated an atrial septal defect with bidirectional shunting and no restenosis of the mitral valve (iatrogenic Lutembacher's syndrome). Percutaneous treatment was successfully accomplished using a 13 mm Amplatzer Septal Occluder (AGA Medical Corporation, Golden Valley, Minnesota). The causes of right-to-left shunting and the effects of body position on gas exchange in such patients are also discussed.
A case of endoluminal repair of vein and artery axillary rupture after reduction of shoulder disl... more A case of endoluminal repair of vein and artery axillary rupture after reduction of shoulder dislocation in an 83-year-old woman is reported. The lesions were repaired successfully with two cover stents (JOSTENT and Passager). Endovascular treatment of such vascular injuries seems to be feasible and safe, though further investigation is warranted.
Transthoracic (TTE) and transesophageal (TEE) echocardiography are the primary modalities for atr... more Transthoracic (TTE) and transesophageal (TEE) echocardiography are the primary modalities for atrial septal abnormalities assessment because of their proven utility, relatively low cost, and widespread availability. Some advantageous imaging characteristics of TEE include ...
To identify factors that influence plasma levels and assess the prognostic value of lipoprotein-a... more To identify factors that influence plasma levels and assess the prognostic value of lipoprotein-associated phospholipase A2 (Lp-PLA2) activity in a prospective, population-based survey of the epidemiology and pathogenesis of atherosclerosis. Methods and results The Bruneck study is a prospective, population-based survey initiated in 1990. Lp-PLA2 activity and baseline variables for the current analysis were measured in 765 subjects aged 45-84 years in 1995. Incident cardiovascular disease (CVD) (cardiovascular death, myocardial infarction, stroke, and transient ischaemic attack) and rates of non-CVD mortality were assessed between 1995 and 2005. Subjects with incident CVD had higher levels of Lp-PLA2 activity (884 + 196 vs. 771 + 192 mmol/min/L, P , 0.001). Increased Lp-PLA2 activity was significantly related to incident CVD [age-and sex-adjusted hazard ratio (95%CI) 2.9 (1.6-5.5); third vs. first tertile group; P , 0.001] and with vascular mortality but not with non-CVD mortality. Lp-PLA2 activity was enhanced in subjects with the metabolic syndrome and showed highly significant positive associations with LDL-C, apoB-100, ferritin, and HOMA-IR, and inverse associations with HDL-C and antioxidant levels. Conclusion Increased Lp-PLA2 activity is associated with metabolic syndrome and incident fatal and non-fatal CVD, but not with non-CVD mortality. Furthermore, Lp-PLA2 activity is strongly influenced by ferritin levels, LDL-C, and apoB-100 supporting its integral role in lipid peroxidation. Clinical utility of Lp-PLA2 activity for prediction of cardiovascular risk has to be explored in future studies.
Journal of the American College of Cardiology, Nov 1, 2003
We assessed the use of intracardiac echocardiography (ICE) as the primary means for both selectio... more We assessed the use of intracardiac echocardiography (ICE) as the primary means for both selection of the Amplatzer Septal Occluder (ASO) and the guidance of transcatheter closure of secundum atrial septal defects (ASDs). BACKGROUND The standard method for transcatheter closure of ASDs requires balloon-sizing maneuver and transesophageal echocardiographic (TEE) monitoring. The role of ICE during transcatheter closure of ASDs has not yet been established. METHODS In 91 patients with ASDs, two standardized orthogonal sections were used to obtain ICE-derived measurements of the fossa ovalis and to assess optimal device deployment: the transverse section on the aortic valve plane, and the longitudinal section on the four-chamber plane. RESULTS In all patients, ICE planes were identified with excellent resolution, providing proper measurements of the fossa ovalis, from which to derive geometric assumptions for the selection of an appropriately sized device. The ASO waist diameter was chosen on the basis of the r value (r ϭ ͌ c 2 ϩ p 2 , where r is the radius of an ideal circle that intersects the elliptical fossa ovalis in its semi-latus rectum, c is the foci half-distance of the fossa ovalis, and p is its semi-latus rectum). During the procedure, the four-chamber plane allowed us to obtain easily interpretable images of all stages of device deployment. Midterm complete occlusion rate was 97.8%. No ICE-related complications occurred. CONCLUSIONS The ICE evaluation of ASDs allows quantitative and qualitative information for both proper ASO selection and optimal device placement, thus eliminating the cumbersome balloonsizing maneuver and the need for general anesthesia during TEE monitoring.
Echocardiography-a Journal of Cardiovascular Ultrasound and Allied Techniques, Aug 1, 2002
A detailed understanding of the anatomic structures of both atria is mandatory for successful cat... more A detailed understanding of the anatomic structures of both atria is mandatory for successful catheter‐based interventional techniques. Some of the drawbacks of transthoracic and transesophageal echocardiography can be overcome by intracardiac echocardiography (ICE). We present our ICE experience based on 70 out of 186 patients who were included in a multicenter registry of transcatheter interatrial communication closures. The ultrasound catheter was a 9‐Fr, 9 MHZ monoplane probe (Ultra ICE catheter) compatible with the motor drive unit and imaging console of the Clear View Ultra. Four slice selections in the axial plane and only one in the sagittal plane were needed in order to obtain a comprehensive guide to ICE interrogation. Their intracardiac ultrasound imaging presentation is an essential and nontrivial step. The anatomic coordinate system was maintained identical to a tomographic imaging plane as follows: Left/right and anterior/posterior in the axial planes and superior/inferior and anterior/posterior in the sagittal plane. In order to identify the imaging coordinates, two specific anatomic landmarks were used. The first one was the crista terminalis (at 10 o′clock) and the second one was the right atrial auricle (at 12 o′clock). Once the ultrasound images were orientated, their interpretation and spatial reconstruction were straightforward. In conclusion, a standardized ICE examination allows for a comprehensive evaluation of the right atrial anatomy and may be helpful in guiding therapeutic catheter‐based interventions. The major clinical advantages of ICE include optimal contrast between soft‐tissue structures, limited fluoroscopic exposure time, and good patient acceptance, thus avoiding general anesthesia.
Journal of the American College of Cardiology, Mar 1, 2003
We investigated the association of polymorphisms in the promoter region and exon 7 endothelial ni... more We investigated the association of polymorphisms in the promoter region and exon 7 endothelial nitric oxide synthase (eNOS) gene with coronary artery disease (CAD). BACKGROUND Endothelial dysfunction foretells cardiovascular events and can be genetically determined. METHODS We genotyped for the promoter (T-786 C) and exon 7 (Glu298Asp, G 894 T) polymorphisms in 1,225 subjects; 1,106 were consecutive patients undergoing coronary angiography and 119 control subjects without any cardiovascular risk factors. Genotyping was performed with melting curve analysis of polymerase chain reaction products from allele-specific acceptor and donor probes that were 5Ј-and 3Ј-end labeled with LCRed640 and fluorescein, respectively; CAD was assessed by quantitative coronary angiography. We performed multiple logistic regression analysis for the effect of the T-786 C, the missense Glu298Asp variant, and other coronary risk factors on two-and three-vessel CAD. RESULTS The overall genotype distribution of T-786 C (CC ϭ 17.7%, CT ϭ 40.4%, and TT ϭ 41.9%) and Glu298Asp (GG ϭ 43.3%, GT ϭ 37.0%, and TT ϭ 19.7%) was consistent with the Hardy-Weinberg equilibrium. The regression analysis showed that the T-786 C, but not the missense Glu298Asp variant, significantly predicted CAD, independent of other risk factors. Compared with TT homozygous, subjects carrying the C allele had a significant (p ϭ 0.002) increase in the odds ratio of harboring two-or three-vessel CAD of 1.672 (95% confidence interval, 1.062 to 2.527). A subgroup analysis confirmed this effect of the T-786 C polymorphism in men (p ϭ 0.007), cigarette smokers (p ϭ 0.001), subjects older than 60 years of age (p ϭ 0.007), with hypercholesterolemia (p ϭ 0.011), low high-density lipoprotein cholesterol (p ϭ 0.006), and overweight or with obesity (p ϭ 0.041). CONCLUSIONS The C allele at the T-786 C endothelial nitric oxide synthase polymorphism is associated with a higher risk of multivessel CAD in Caucasians.
A 64 years old patient performed a maximal exercise testing 13 days after inferoposterior myocard... more A 64 years old patient performed a maximal exercise testing 13 days after inferoposterior myocardial infarction (no thrombolytic treatment had been performed). The patient presented at days 1-4 an intermittent Mobitz 1 and 2:1 heart block, with normal ventricular rate. No other complications were present. The ECG at entry and before stress test showed a complete right bundle block. The test was stopped at 30 sec of 75 watts. The systolic blood pressure increased from 130 to 155 mm Hg and heart rate from 84 to 145/min (93% of predicted heart rate). No arrhythmias and anginal pain were noted. The leads with pathologic Q wave showed elevation of the ST segment, whereas V1-V2 and aVL leads a depression of the ST segment. During recovery the patient developed electromechanical dissociation. The echocardiogram showed significant pericardial effusion. Cardiopulmonary resuscitation and pericardiocentesis were ineffective. Necropsy confirmed left ventricular inferior wall rupture and haemope...
The first case of combined procedure of catheter-based balloon pulmonary valvuloplasty and atrial... more The first case of combined procedure of catheter-based balloon pulmonary valvuloplasty and atrial septal defect closure using Amplatzer Septal Occluder, in a patient with Noonan syndrome, is reported. The literature regarding prevalence, genetics, pattern of involvement, symptoms, diagnosis, and treatment of this syndrome is reviewed.
In order to assess the efficacy and tolerability of gallopamil (D-600, CAS 16662-47-8) by long-te... more In order to assess the efficacy and tolerability of gallopamil (D-600, CAS 16662-47-8) by long-term venous infusion in the treatment of spontaneous angina, 15 consecutive patients were studied in a single-blind, self-controlled trial versus placebo. Following a 24-h Holter ECG recording of the patients receiving a saline infusion (run-in phase), i.v. administration of gallopamil was started at a dose of 0.02 mg/kg/h preceded by a 0.03 mg/kg bolus. After 24 h, the dosage was increased to 0.03 mg/kg/h and the infusion was maintained for another 48 h. The Holter ECG recording was repeated in the last 24 h of treatment and after 6 h from withdrawal (washout phase). The reduction in the number of angina attacks, as shown by a comparison between the average of the two placebo periods (run-in and washout phases) and the three days of treatment, was 68.2%, 92.5%, and 87%, respectively. Consumption of glyceryl trinitrate decreased by 92.5% on each one of the three days of treatment. The redu...
Single-vessel coronary disease has been considered so far a benign condition, for which the medic... more Single-vessel coronary disease has been considered so far a benign condition, for which the medical therapy may represent the optimal treatment. In order to assess the effectiveness of this approach, we studied 323 patients who had come to our attention for ischemic heart disease and resulted affected by single-vessel coronary artery disease. From our data it appears that single-vessel coronary artery disease is frequently associated with myocardial infarction and post-infarction aneurysm. Coronary angiography indicated that left anterior descending coronary artery is the most frequently affected vessel, and that its involvement is often associated with lethal outcome. Forty-two out of the 323 patients underwent coronary artery bypass surgery; the remaining patients were medically treated. Surgical patients showed a better improvement respect to the medical group, while survival was not statistically different. An unexpected result was the relatively high risk in circumflex artery l...
The study group consisted of 47 consecutive patients (38 men and 9 women) aged between 16 and 56 ... more The study group consisted of 47 consecutive patients (38 men and 9 women) aged between 16 and 56 years with dilated cardiomyopathy studied invasively between January 1980 and December 1986. Follow-up observation (40 +/- 29 months) showed that 28 patients were mildly symptomatic (group 1) and 19 patients were severely symptomatic (group 2: eight of them died due to intractable congestive heart failure). At univariate analysis, group 2 was characterized by higher pulmonary vascular resistance, larger end-diastolic and end-systolic left ventricular volumes, increased left ventricular mass, lower ratio of mass to volume index, depressed angiographic ejection fraction, lower ratio of end-systolic stress and peak systolic pressure to volume index. Multivariate analysis was used to determine which combination of factors might be a better effective predictor of prognosis in these patients: the most important factors were mass to volume index ratio (M/V) and end-systolic stress to volume ind...
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Papers by Luigi Pedon