Are the Duke criteria really useful for the early bedside diagnosis of infective endocarditis? Results of a prospective multicenter trial.

Background: To date, no studies have evaluated the usefulness of the Duke vs the modified Duke criteria for the early diagnosis of infective endocarditis (IE), nor is it known whether a probabilistic approach may be useful in establishing an early clinical diagnosis of IE. The aim of this study was (1) to assess and compare the clinical usefulness of the Duke vs the modified Duke criteria for the early diagnosis of IE, and (2) to evaluate the diagnostic utility of a probabilistic approach based on the echocardiographic criterion.

Methods: From January 2000 to December 2001, 267 consecutive patients with suspected IE were enrolled in a prospective multicenter trial.

Main pulmonary artery aneurysm: a case report and review of the literature.

Main pulmonary artery aneurysms are a rare entity with few available published data. As reported in the literature, operative treatment is commonly recommended but the relation between the size of the aneurysm, its localization, and the risk of rupture is not as well defined as for aortic aneurysms. Proximal lesions that involve the main branches of the pulmonary artery are usually apparent on chest radiographs and must be taken into consideration in the differential diagnosis of mediastinal masses.

Brugada syndrome: a case report of an unusual association with vasospastic angina and coronary myocardial bridging.

This report describes a case of an unusual association between vasospastic angina, coronary myocardial bridging, and Brugada syndrome. The patient complained of chest pain followed by rhythmic palpitation and syncope. Brugada syndrome ECG markers were documented with transient ST-segment elevation in lateral leads.

Acute myocardial infarction in young adults: prognostic role of angiotensin-converting enzyme, angiotensin II type I receptor, apolipoprotein E, endothelial constitutive nitric oxide synthase, and glycoprotein IIIa genetic polymorphisms at medium-term follow-up.

Background: A number of reports have investigated the association between various gene polymorphisms and the phenotypic expression of myocardial infarction. No investigations have evaluated the prognostic role of genetic factors in young people with premature coronary disease. The aim of this study was to investigate the influence of genetic factors compared with that of conventional risk factors on follow-up events in a population of Italian young adults with myocardial infarction.

Subacute left ventricular free-wall rupture in early course of acute myocardial infarction. Clinical report of two cases and review of the literature.

Left ventricular free wall rupture (LVFWR) may complicate an acute myocardial infarction (AMI); its frequency ranges from 1 to 6 percent. In the era of coronary care units, LVFWR is the second cause of in-hospital death, after pump failure. The subacute presentation accounts for 2-3 percent of total hospital admissions for AMI.

Lack of relationship between the P1A1/P1A2 polymorphism of platelet glycoprotein IIIa and premature myocardial infarction.

Background: The P1A1/P1A2 polymorphism of the platelet glycoprotein IIIa has been variably associated with an increased risk of coronary thrombosis.

Materials: We investigated the linkage between the P1A1/P1A2 polymorphism and the risk of myocardial infarction in 98 patients who suffered their first myocardial infarction at the age of 45 years or less and 98 well-matched control subjects without coronary artery disease. Lipid parameters were measured using conventional methods of clinical chemistry; P1A genotypes were determined by polymerase chain reaction and restriction enzyme digestion.

[Female sex is not an independent risk factor in mortality during myocardial revascularization].

To assess if female sex is an independent risk factor for perioperatory mortality and morbidity, we have evaluated 971 consecutive patients (16% women) undergoing coronary artery bypass graft surgery at the Cardiovascular Disease Institution of the University of Turin from 1988 to 1990. In this study at baseline women were older and more likely to have diabetes, lower ventricular score and body surface area than men. As compared to men, women underwent surgery with delay: the surgical mortality rate and prevalence of arrhythmias were higher, and the size of the left anterior descending was smaller.

Fixed subaortic stenosis associated with hypertrophic cardiomyopathy: report of a rare familial occurrence.

Introduction: Fixed subaortic stenosis is considered to be an acquired condition. It is often associated with congenital heart disease, creating a turbulence in the left ventricle outflow tract. Familial forms of fixed subaortic stenosis are very unusual.

Diagnostic value of echocardiography in infective endocarditis: a probabilistic approach.

The high sensitivity and specificity of echocardiography in the diagnosis of infective endocarditis have been well established for a number of years. However, little is known yet about the incremental value of this technique over the clinical and serological findings already available in subsets of patients presenting different initial probabilities in infective endocarditis. In this report, sensitivity and specificity of echocardiography were calculated in 173 consecutive patients with suspected infective endocarditis who underwent echocardiography within 5 days following admission.

Ischemic chest pain and global T-wave inversion in women with normal coronary angiograms.

Patients presenting with ischemic chest pain and electrocardiographic evidence of global T-wave inversion are most frequently women with intact left ventricular function and no critical stenosis of major coronary vessels. Hence, this syndrome has a good immediate and long-term prognosis.

New diagnostic criteria for infective endocarditis. A study of sensitivity and specificity.

Objective: The purpose of this study was to determine the sensitivity and specificity of new criteria proposed by Duke University for case definition of infective endocarditis as compared to the previously accepted Von Reyn criteria.

Patients: A total of 143 consecutive suspected cases of infective endocarditis in 137 febrile patients were included. Of these, 69 had infective endocarditis, pathologically proven in 28, but with only a clinical diagnosis in 41.

[Differences in pharmacologic treatment after acute myocardial infarction. The role of treatment effectiveness].

Background: Despite growing interest concerning the prescription of different drugs in different clinical settings, no explanatory variables have been determined. The aim of this study was to verify if there are any differences in drug prescription at the time of hospital release following myocardial infarction and if any of these differences can be explained by scientific evidence concerning treatment efficacy.

Methods: All drugs prescribed to 430 patients discharged from three different cardiology departments after acute myocardial infarction were analyzed.

Heart rate variability in the early hours of an acute myocardial infarction.

The occurrence of an autonomic disturbance early in acute myocardial infarction (AMI) has been reported: signs of sympathetic activation were mainly observed in relation to an anterior localization, whereas signs of vagal overactivity were more frequent in inferior wall AMI. Information is limited in relation to the persistence of these alterations during the early hours of AMI. We studied 33 patients with an AMI within 188 +/- 16 minutes from the onset of symptoms and 1 week after hospital admission.

Regional sympathetic denervation after myocardial infarction: a follow-up study using [123I]MIBG.

Previous studies in dogs have shown that experimental infarction produces myocardial sympathetic denervation not only in the infarcted area, but also in a region apical to the infarction. In these dogs MIBG myocardial scintigraphy detected denervation but returned to normal in a few months at which time reinnervation was shown to have occurred. Myocardial sympathetic denervation was studied with MIBG scintigraphy in ten patients after their first acute transmural myocardial infarction; scans were repeated at 4 months, one year and 30 months to follow the time course of possible reinnervation.

[Hypertrophic obstructive cardiomyopathy in a patient with Turner syndrome].

A case of hypertrophic obstructive cardiomyopathy in a patient with Turner syndrome is reported. The most frequently associated cardiac anomalies are coarctation of the aorta and bicuspid aortic valve. Hypertrophic cardiomyopathy has never been reported in this syndrome but is frequent in Noonan syndrome.