Real-Time High-Frame-Rate Cardiac B-Mode and Tissue Doppler Imaging Based on Multiline Transmission and Multiline Acquisition.

Cardiovascular diseases, the leading cause of death in the world, are often associated with the dysfunction of the left ventricle. Even if, in clinical practice, the myocardial function is often assessed through visual wall motion scoring on B-mode images, quantitative techniques have been introduced, e.g.

The Difficult Evolution of Intensive Cardiac Care Units: An Overview of the BLITZ-3 Registry and Other Italian Surveys.

Coronary care units, initially developed to treat acute myocardial infarction, have moved to the care of a broader population of acute cardiac patients and are currently defined as Intensive Cardiac Care Units (ICCUs). However, very limited data are available on such evolution. Since 2008, in Italy, several surveys have been designed to assess ICCUs' activities.

Impact of renal function impairment assessed by CKD estimated glomerular filtration rate on early and late outcomes after coronary artery bypass grafting.

Background: We explore the association between short- and long- term adverse outcomes following coronary artery bypass grafting (CABG) and the degree of preoperative renal dysfunction classified on glomerular fraction estimated with Chronic Kidney Disease-Epidemiology Collaboration equation (eGFR). We also try to identify cut-off values of eGFR able to predict post-CABG unfavorable events and assess whether a reclassification with new thresholds is necessary.

Methods: One-thousand-one-hundred-eighty-six consecutive patients undergoing CABG between 2005 and 2014 were categorized in 4 groups according to the eGFR: Group 1 (≥60ml/min/1.

Wide-Angle Tissue Doppler Imaging at High Frame Rate Using Multi-Line Transmit Beamforming: An Experimental Validation In Vivo.

Color tissue Doppler imaging (TDI) is a well-established methodology to assess local myocardial motion/deformation. Typically, a frame rate of ∼ 200 Hz can be achieved by imaging a narrow sector (∼ 30°, covering one cardiac wall) at moderate line density, using a dedicated pulse sequence and multi-line acquisition. However, a wide angle field-of-view is required in some clinical applications to image the whole left ventricle, which implies a drop in temporal resolution.

[Heart failure in Italian intensive cardiac care units: data from the BLITZ-3 survey].

Background: Only limited information about clinical characteristics, diagnostic procedures and therapeutic options is available in patients admitted to an intensive cardiac care unit (ICCU) for heart failure. The aim of this study was to evaluate causes of admission, clinical characteristics, diagnostic and therapeutic options, and outcome of patients admitted for heart failure in the ICCU network.

Methods: The BLITZ-3 Registry prospectively included patients admitted by 332 Italian ICCUs.

Elderly patients with acute coronary syndromes admitted to Italian intensive cardiac care units: a Blitz-3 Registry sub-analysis.

Background: Guideline-recommended therapies for acute coronary syndromes (ACS) derive from randomized trials in which elderly patients are underrepresented. Although numbers of this population are increasing, they are largely undertreated in the real world.

Objective: The study evaluates the impact of older age on care for patients with ACS admitted to the Italian Intensive Cardiac Care Units (ICCUs) network.

[Distribution and appropriateness of hospital admissions, resource utilization in the Italian intensive cardiac care units. The BLITZ-3 study].

Background: The BLITZ-3 study prospectively evaluated the epidemiology of hospital admissions, the patterns of care and the most important comorbidities in intensive cardiac care unit (ICCU) patients.

Methods: Distribution and level of appropriateness of hospital admissions in relation to type of ICCU were analyzed (type A, 32%, without cardiac cath lab or cardiac surgery; type B, 49%, with cath lab; type C, 19%, with both cath lab and cardiac surgery). The caseload was estimated on the basis of different levels of mortality risk during the ICCU stay: high (>5.

[Clinical competence in intensive cardiac care units: from practical needs to training programs].

Since the early 1970s, intensive cardiac care is applied in coronary care units (CCUs), initially developed to treat lethal arrhythmias in patients with acute myocardial infarction. In the last decades, treatments offered within the CCUs have greatly expanded. Thus, these units have been called intensive cardiac care units (ICCUs) to reflect such evolution of care and the different epidemiology of patients admitted (subjects with acute coronary syndromes, acute and advanced heart failure, rhythm disturbances or severe valve dysfunction).

Epidemiology and patterns of care of patients admitted to Italian Intensive Cardiac Care units: the BLITZ-3 registry.

Background: Intensive cardiac care units (ICCUs) have shifted from the observation of patients with myocardial infarction to the care of different acute cardiac diseases. However, few data on such an evolution are available.

Methods And Results: From 7 to 20 April 2008, 6986 consecutive patients admitted to 81% of Italian ICCUs were prospectively enrolled.

Clinical implications and management of bleeding events in patients with acute coronary syndromes.

In the past decades, there has been a significant development in the management of patients with acute coronary syndromes (ACS), largely driven by advances in antithrombotic and antiplatelet agents. Despite significant improvements in efficacy end points such as death, myocardial infarction and repeated revascularization, these therapies are still associated with a significant risk of bleeding. Such bleedings are independent predictors of long-term adverse clinical events.

Severe hypoplasia of the posterior mitral leaflet.

A rare case of a 14-year-old child with congenital mitral insufficiency secondary to hypoplasia of the posterior leaflet is reported. Echocardiography revealed the almost complete absence of the posterior mitral leaflet, which determined massive regurgitation. At surgical inspection the posterior leaflet was almost completely absent, represented only by tags of fibrous tissue that strictly adhered to the posterior annulus with a total absence of chordae inserting into the hypoplastic leaflet.

Coronary embolism following valve surgery.

A 55-year-old man experienced chest pain on the seventh day after valve surgery. Coronary angiography showed embolic occlusion of the left anterior descending coronary artery. The lesion was treated successfully with thrombectomy using the angiojet rheolytic thrombectomy system, resulting in rapid mechanical thrombolysis and removal via the effluent lumen of the catheter.

[Verapamil-responsive ventricular tachycardia in small children: a case report and review of the literature].

A case of verapamil-responsive incessant ventricular tachycardia in a 4-year-old girl is reported. Oral verapamil alone failed in maintaining stable sinus rhythm. With association of oral verapamil and betablockers (nadolol) the patient remained asymptomatic without recurrence of ventricular tachycardia over a follow-up of 1 year.

Effects of long-term vasodilator therapy in patients with carotid sinus hypersensitivity.

Background: In patients affected by carotid sinus hypersensitivity, long-term vasodilator therapy might increase the risk of syncopal episodes by reducing systolic blood pressure and venous return to the heart.

Methods And Results: Thirty-two patients (mean age 73 +/- 9 years; 20 men) who met all the following criteria were included: (1) one or more episodes of syncope occurring during long-term (>6 months) treatment with angiotensin-converting enzyme inhibitors, long-acting nitrates, calcium antagonists, or a combination of these; (2) a positive response to carotid sinus massage, defined as the reproduction of spontaneous syncope in the presence of ventricular asystole > or =3 seconds or a fall in systolic blood pressure > or =50 mm Hg; (3) negative workup for other causes of syncope. The patients were randomly assigned to continue or to discontinue use of vasodilators; carotid sinus massage was repeated 2 weeks after randomization.

Pheochromocytoma crisis caused by contemporary ergotamine, caffeine, and nimesulide administration.

Pheochromocytoma is a rare tumor that secretes excess catecholamines. Pheochromocytoma crises may be precipitated by the use of several drugs. This article describes the case of a patient affected by pheochromocytoma in whom multiple organ failure developed after contemporary administration of ergotamine, caffeine, and nimesulide.

[Unstable angina in coronary intensive care units without hemodynamics: is admissible a strategy limiting the indications for coronarography?].

In coronary care units (CCU) without cardiac catheterization facilities, coronary angiography is rarely carried out when a successful medical treatment in the acute phase of unstable angina has been obtained. However, the unstable angina still has an uncertain prognosis when the remission of pain is obtained with drugs. This study presents a follow-up of 147 consecutive patients (aged 66.

[Right atrial metastasis as an initial clinical manifestation of adenocarcinoma of the colon].

We report the case of a young woman suffering from colonic mucinous adenocarcinoma with the unusual clinical presentation as a right atrial metastasis. The tumor was successfully resected, and after histopathological characterization, the primary lesion was searched for and discovered. The tumor had the clinical appearance and echocardiographic pattern of a pedunculated atrial myxoma.

[Efficacy of intravenous and per os propafenone in the ambulatory treatment of recent-onset atrial fibrillation].

Propafenone efficacy in conversion of atrial fibrillation to sinus rhythm has been well documented. In this study we considered propafenone efficacy according to a graduated protocol of administration. Forty-two patients with recent-onset atrial fibrillation, without left ventricular failure, ischemic symptoms and in absence of antiarrhythmical treatment, were treated according to the following protocol: propafenone 1 mg/kg i.

Propafenone versus amiodarone in field treatment of primary atrial tachydysrhythmias.

Thirty-nine patients with paroxysmal atrial fibrillation or supraventricular tachycardia randomly received amiodarone or propafenone intravenously at home. Fifteen patients received amiodarone and 24 received propafenone; 87.5% of the patients who received propafenone and 40% of the patients who received amiodarone were converted at home to sinus rhythm (P less than .

[Significance of QT interval as a premonitory sign of severe ventricular arrhythmia in the early phase of myocardial infarct].

In order to evaluate the relationship between the length of the corrected QT interval (QTc), calculated according to Bazett's formula, and the incidence of ventricular fibrillation (V.F.) in the early phase of acute myocardial infarction (A.

Effects of pharmacologic autonomic blockade on atrial electrophysiologic properties in normal subjects and in patients with sinus node disease.

In order to elucidate the influence of autonomic nervous system on atrial electrophysiologic properties, we studied 10 patients with sinus node dysfunction and 10 age-matched normal subjects. In each of them effective and functional refractory periods of the right atrium (near its junction with the superior caval vein) were measured, during atrial pacing (100/min) and using variable current strengths (2, 3, 4, 5, 7, 10, and 15 mA), before and after pharmacologic autonomic blockade (using intravenous propranolol 0.2 mg/kg and atropine 0.

Anterograde sinuatrial conduction evaluated by sinus node electrogram in atropine blocked retrograde atrial conduction.

Two cases are described where atropine induced the disappearance of reset zone as response to premature atrial stimulation for blocked retrograde atrial conduction. Because of this, sinuatrial conduction time could not be estimated. The sinus node electrogram allowed the direct measurement of sinuatrial conduction and showed a facilitated anterograde conduction through the perinodal fibers after administration of the drug.

Clinical electrophysiological effects of chronic administration of verapamil: the phenomenon of overdrive excitation of junctional pacemaker.

The electrophysiological effects of chronic administration of verapamil were studied in 10 patients with normal sinus node function, who received 160 mg of the drug every eight hours for at least two weeks. Uncorrected and corrected sinus node recovery time, sino-atrial conduction time, effective and functional refractory periods were normal in each case. In three patients, at the cessation of atrial pacing, an overdrive excitation of junctional pacemaker with short lasting A-V dissociation was observed.

Effects of atropine on atrial refractoriness and its dispersion in humans.

To evaluate the influence of atropine on atrial refractoriness and its dispersion, we studied ten subjects with sinus bradycardia who were otherwise healthy. Effective and functional refractory periods were measured at three sites of the right atrium (high, middle, and low in the lateral wall), in sinus rhythm and during atrial pacing (120/min), before and after i.v.