Cardiovascular effects of high-dose growth hormone treatment in growth hormone-deficient children.

Growth hormone (GH) hypersecretion is associated with an increased incidence of cardiac hypertrophy and subclinical abnormalities of left ventricular (LV) function. The unlimited availability of biosynthetic GH has led to progressively increased dosage when treating GH-deficient children, raising the question of its cardiovascular effects during long-term therapy. We compared 22 children (8 girls, 14 boys), mean age 12.

[Planar myocardial scintigraphy with technetium-99m-sestamibi in acute myocardial infarct treated with thrombolytic therapy].

Background: Nuclear cardiology permits the estimation of the myocardial infarction size and the result of the thrombolytic therapy. The aim of the study was to demonstrate the feasibility of the planar myocardial scintigraphy with Technetium-99-m-sestamibi in the coronary intensive care unit for the early identification of the infarct size and the result of the thrombolytic therapy.

Materials And Methods: We considered 10 patients affected by a first myocardial infarction (5 anterior and 5 inferior wall) then treated with thrombolytic therapy (APSAC 30 U.

[Left ventricular remodelling at 3 months from a first transmural infarct: the effect of physical activity and of the patency of the necrotic artery on changes in volume and segmental kinetics].

Objective: Aim of this perspective study was to assess in patients (pts) with a recent first transmural myocardial infarction (MI) the influence of a physical training, of MI location and of the patency of the infarct-related coronary artery on the modification of the left ventricle volumes and wall motion score.

Methods: One hundred and four consecutive pts with a first transmural MI without clinical contraindication (heart failure, moderate or severe mitral regurgitation, severe postinfarction angina, claudication or severe orthopedic problems) were randomly assigned to a rehabilitation group (A) and to a control group (B). Ten days after acute MI all pts underwent a coronary angiography.

[Exercise 201-thallium myocardial scintigraphy in left bundle branch block].

Background: Reduced septal uptake of 201-Thallium in patients with left bundle branch block is reported in literature as having a variable frequency (between 14% and 100%) and in such patients the value of exercise Thallium-scintigraphy for the diagnosis of the left anterior descending coronary artery disease is limited by the great number of false-positive tests. The aim of this study was to assess the prevalence and the diagnostic sensitivity of this septal defect in a group of patients with left bundle branch block.

Methods: We evaluated the exercise 201-Thallium myocardial scintigraphy of 54 patients with a stable left bundle branch block.

[Long-term follow-up in patients operated on for aortic coarctation. The echo-Doppler and MRI assessment of left ventricular function and the transisthmic gradient].

Background: Hyperdynamic left ventricular function and increased left ventricular mass has been recently reported in the long-term follow-up of patients after successful repair of aortic coarctation (AoCo).

Methods: We studied 35 patients, mean age 22.7 years (range 1-47), following repair of AoCo in order to evaluate: 1) left ventricular mass and systolic function by M-mode echocardiography in comparison with 20 healthy control subjects; 2) the prevalence of systemic hypertension; 3) systolic blood pressure and the trans-isthmic gradient by CW Doppler at rest and after exercise; 4) subjects with a hypertensive response and/or with a significant trans-isthmic gradient during exercise, correlating such parameters with indexes of left ventricular function and the ratio of aortic isthmus/aortic diaphragmatic diameters (AOI/AOD) by means of Magnetic Resonance (MR).

[Acute myocardial infarction in a young adult with multiple coronary aneurysms resulting form Kawasaki disease].

A young male patient with no risk factors for atherosclerotic disease suffered from an acute myocardial infarction at the age of 22 years, and was subsequently found to have multiple coronary artery aneurysms by coronary angiography. The transthoracic echocardiography was unable to identify coronary anomalies, whereas the transesophageal approach did show aneurysmatic lesions of the left anterior descending artery. These could have been caused by a previous episode of Kawasaki disease, a pathological finding that should be considered in any young adult presenting with proximal discrete coronary artery aneurysms.

[Magnetic resonance with the spin-echo technic in the noninvasive evaluation of the patency of aortocoronary bypasses: preliminary data].

Background: Patients with previous coronary artery bypass graft surgery often develop chest pain due to ischemic or nonischemic causes. Noninvasive evaluation of graft patency is thus of obvious potential importance.

Methods: In order to assess the efficacy of magnetic resonance imaging (MRI) in evaluating graft patency after coronary artery bypass graft surgery, 16 patients with prior surgery and history of chest pain were studied prospectively by coronarography and MRI.

[The adenosine test in association with 99m-technetium sestamibi tomoscintigraphy in the diagnosis of coronary pathology].

Background: The exogenous adenosine is able to provoke a coronary vasodilation, which is the same as the one provoked by the papaverine and greater than the one provoked by the dipyridamole. We report our experience in using exogenous adenosine in association with technetium-99m-sestamibi tomoscintigraphy for a diagnostic test on the coronary artery disease (CAD).

Methods: We considered 22 patients (18 male and 4 female, mean age 57 years) affected by angiographically demonstrated coronary artery disease (stenoses > or = 50%).

[Role of echo-doppler in programming of sequential pacemakers. Evaluation of optimal atrioventricular delay in patients with normal or hypertrophic left ventricle].

2D-echocardiography, together with simultaneous measurement of systolic blood pressure and pulsed doppler examination of the transmitral flow were used to assess the left ventricular (LV) systolic and diastolic function during sequential pacing at 4 different atrioventricular (AV) intervals (50, 100, 150, 200 msec), and VVI pacing under the same rate of 90 beats/min in 13 patients (pts), mean age 61.25 +/- 8.26 years with DDD pacemakers implanted for complete AV block.

[Immediate results of percutaneous mitral valvuloplasty using Inoue catheter. Personal experience in the first 15 cases].

Mitral valvuloplasty with an Inoue balloon catheter was performed at our institution in 15 patients affected by mitral stenosis. All were severely symptomatic (class NYHA III or IV). Transthoracic and transesophageal echocardiography showed a mitral score less than 10 (Wilkins criteria).

[Transesophageal echocardiography in the diagnosis of cor triatriatum in the adult].

Cor triatriatum (CT) is a rare congenital defect, surgically correctable, and sometimes difficult to diagnose by cardiac catheterization. This report describes three young patients with this particular defect, one of whom was sent to us because of signs of right ventricular failure. The diagnosis of CT was made by transesophageal echocardiography and confirmed by cardiac catheterization and surgical data.

[Myocardial involvement in granulomatous vasculitis (Churg-Strauss disease)].

We report the case of a 44-year-old woman affected by Churg-Strauss syndrome (systemic vasculitis with eosinophilia, bronchial asthma and pulmonary infiltrations). Congestive heart failure developed, caused by severe myocardial and pulmonary involvement. Conventional treatment and steroids induced remission of symptoms.

[Quantitative evaluation of left ventricular systolic function using bidimensional echocardiography: comparison with cineangiography].

The aim of the study was to compare the evaluation of the left ventricular systolic function performed both by angiography and 2D-echocardiography on 80 subjects (31 with coronary artery disease, 18 with left ventricular volume overload, 10 with left ventricular pressure overload, 14 with mitral valve disease and 7 normal controls). The 2D-echocardiograms of the left ventricle with simultaneous measurement of the right arm systolic blood pressure was performed within 24 hours of the angiographic examination. The following parameters were obtained using the two methods: end-diastolic volume index, end-systolic volume index, ejection fraction, left ventricular mass index, mass/volume ratio, end-systolic circumferential stress, contractility expressed as end-systolic circumferential stress/end-systolic volume ratio; the end-systolic circumferential stress/ejection fraction ratio was calculated only by 2D-echocardiography.

[Value of the isovolumetric index in the diagnosis of ischemic cardiopathy with normal left ventricular volume and ejection fraction].

Purpose of this study was to assess if the isovolumic index (IVI%) was able to detect the presence of critical coronary artery disease (CAD) in a group of 43 patients with anginal chest pain and normal left ventricular volumes and ejection fraction. The left ventricular function was before evaluated with invasive method and then the IVI% was allowed in every patient. The IVI% was able to recognize early abnormalities of isovolumetric phases of the left ventricle and differentiated normal subjects (IVI% = 40.

[The isovolumetric index: a new index of left ventricular function].

The isovolumic index (IVI%), a new parameter of left ventricular function defined as (isovolumic contraction + isovolumic relaxation time)/left ventricular ejection time, is easily obtained from a routine echocardiogram. By simultaneous recordings of an electrocardiogram, a carotid arterial pulse tracing and the mitral valve echocardiogram, we calculated the IVI% as (time from R wave to MV opening-LVET)/LVET %. 90 normal subjects, mean age 38.

[Preclinical changes in left ventricular function in myotonic muscular dystrophy. Value of the isovolumetric index].

Nine patients, 7 males, 2 females, mean age 36 years, with myotonic muscular dystrophy who had no cardiac symptoms underwent M-mode echocardiography (e.), systolic time intervals (STI) measurement by simultaneous recordings of the electrocardiogram, phonocardiogram and carotid arterial pulse, and single-pass radionuclide angiocardiography (RNA) in order to assess the left ventricular function. The ejecting phase indexes measured by echocardiography (fractional shortening, mean velocity of circumferential fiber shortening) were slightly depressed in 1 case and an abnormal PEP/LVET ratio was found in 3 cases.

[A contribution to the electrogenetic interpretation of left ventricular hypertrophy caused by volume overload].

The purpose of the present study is to make a contribution to the understanding of the electrogenetic interpretation of left ventricular hypertrophy caused by volume overload. Thirty-two cases of isolated aortic valve regurgitation with electrocardiographic evidence of left ventricular hypertrophy were studied by vectorcardiography in order to measure the 20 msec vector both in the spatial and horizontal plane, and by M-Mode echocardiography to obtain the interventricular septal and posterior wall thickness and the end diastolic dimension of the left ventricle. The following relations were analyzed: a) between the interventricular septal thickness and the amplitude of the 20 msec vector in the spatial and horizontal plane; b) between the end diastolic dimension of the left ventricle and the amplitude of the 20 msec vector.

[Anomalous origin of the left coronary circumflex branch from the pulmonary artery].

We report the case of a 45-year-old man with acquired aortic regurgitation and anomalous origin of the left circumflex coronary artery from the pulmonary artery.

[Value of mono- and bi-dimensional contrast echocardiography in the diagnosis of inter-atrial defect with left-to-right shunt].

Thirteen patients with atrial septal defect (ASD), 12 ostium secundum type, 1 ostium primum type and left-to-right shunt were studied by M-mode and two-dimensional echocardiography and then by intravenous contrast study. Diagnostic confirmation was obtained in 12 cases by cardiac catheterization and angiocardiography. The purpose of the study was to assess the value of contrast echocardiography in the diagnosis of ASD without pulmonary hypertension, since it is known that the standard echocardiographic investigation is rather unsatisfactory in this type of malformation.

[Verapamil in effort angina: a multi-centre study].

We have performed a multi-centre study with 47 outpatients in order to evaluate the efficacy of Verapamil (V) in the treatment of stable effort angina, and to compare the effect of two different doses of the drug (240 and 360 mg/die). The protocol consisted of a first period of Placebo, followed by the double-blind randomized cross-over administration of Placebo (P) and Verapamil (V) in doses of 240 and 360 mg/die. The symptomatology, the consumption of TNG, the ECG pattern at rest and during exercise, the maximum exercise tolerance during exercise and the rate of recovery were evaluated at the end of each 1 month period.

[Secondary pauses in sinus node dysfunction].

Frequency and importance of secondary pauses (SP) following termination of high rate artrial pacing were evaluated in 64 patients. The maximal values of the first 10 post-pacing cycles, resulting from series of pacing between 70/min--160/min, were compared with the normal post-pacing values of Benditt. SP were present in 1 case (4%) of 23 patients without electrocardiographic signs of sinus node dysfunction (SDF), but in 21 cases (51%) of 41 patients with SDF (p less than 0.