Non-pegylated liposomal doxorubicin in older adjuvant early breast cancer patients: cardiac safety analysis and final results of the COLTONE study.

Aims: To explore the cardiac safety of adjuvant Non-Pegylated Liposomal Doxorubicin (NPL-DOX) plus Cyclophosphamide (CTX) followed by weekly Paclitaxel, in elderly women (≥ 65 years) with high-risk breast cancer. Previously, we described no symptomatic cardiac events within the first 12 months from starting treatment. We now reported the updated results after a median follow-up 76 months.

Constrictive epicarditis: turtle cage or waffle operation?

A 72-year-old man, presenting with signs of pericarditis, was found at operation to have constrictive epicarditis. Operation consisted of pericardiectomy and creation of multiple longitudinal and transverse incisions of the epicardium.

[Appropriateness of prescription of exercise stress test, echocardiography, Holter monitoring and vascular echography].

Background: The aim of this study was to evaluate the appropriateness of prescription of non-invasive cardiological tests (exercise stress test, echocardiography, Holter monitoring and vascular echography), consecutively performed in our outpatient laboratory during 4 weeks.

Methods: We collected the following data: the appropriateness of prescription (according to the Italian Federation of Cardiology guidelines); test indications; the prescribing physician (cardiologist/non-cardiologist); type of prescription (elective/urgent); clinical utility (useful/useless) and result (normal/abnormal) of each test.

Results: We evaluated 960 prescriptions (320 exercise tests; 282 echocardiograms; 158 Holter tests; 200 vascular echographies).

[Acute antineoplastic drug cardiotoxicity: a case report of life-threatening left ventricular failure associated with severe hyperglycemia].

Anthracyclines represent an established therapy for various hemopoietic and solid tumors; however the cardiotoxicity of these agents continues to limit their therapeutic potential in many cancer patients. Acute life-threatening cardiac toxicity which occurs immediately after a single dose of therapy is very rare under current treatment protocols. This form of toxicity occurs unexpectedly owing to a large variation in individual sensitivity.

[Feasibility and accuracy of a rapid evaluation of the abdominal aorta during routine transthoracic echocardiography].

Background: Mass screening for occult abdominal aortic aneurysm is not realistic for the low prevalence of this condition in the general population. Screening in a high-risk population, especially during standard echocardiographic examination, could be more cost-effective than a separate screening program. The aim of this study was to evaluate the feasibility and accuracy of a rapid evaluation (examination arbitrary time-limit of 2 min) of the abdominal aorta at the end of a routine transthoracic echocardiographic examination.

[Thrombocytopenia induced by heparin: report of a clinical case].

Heparin-induced thrombocytopenia (HIT) is a possible complication of heparin administration consequent to an immunological reaction. It usually resolves without clinical sequelae with discontinuation of the drug. However, sometimes it causes severe platelet activation with thrombosis.

Hyperkinetic ventricular arrhythmias in very elderly people with and without cardiac disease. Correlation with left ventricular echocardiographic parameters.

Background: Morphological and functional changes induced by aging can hamper a clear distinction between pathological or paraphysiological phenomena in very old people. The incidence of hyperkinetic ventricular arrhythmias, for example, progressively increases in the elderly, even in the absence of overt cardiac disease.

Methods: One-hundred fifty-two clinically stable patients older than 80 years, submitted within 15 days to clinical evaluation, 24-hour continuous ambulatory ECG monitoring and echo Doppler examination, in the absence of antiarrhythmic treatment, were retrospectively selected in order to evaluate the incidence of ventricular arrhythmias, in patients with and without significant heart disease.

Diastolic function in the different patterns of left ventricular adaptation to essential hypertension.

Recent reports have shown that four distinct left ventricular anatomical patterns, with different hypertension severity and hemodynamic features, are associated with sustained arterial hypertension (normal anatomy, concentric remodeling, concentric hypertrophy and eccentric hypertrophy). The aim of this study was to evaluate left ventricular diastolic function in these different left ventricular anatomic patterns. To achieve this aim, 94 borderline-to-severe essential hypertensive patients (60 never treated before, 34 off treatment for at least 3 weeks before the study) underwent an echo-Doppler study; left ventricular thickness, dimension and mass index were obtained.

Echo Doppler diastolic function and exercise tolerance.

Objective: To investigate the possible association between Doppler left ventricular filling pattern and exercise capacity in a group of normotensives to severe hypertensive patients.

Background: Invasive left ventricular filling indexes evaluated at rest are reported to be related to exercise capacity in heart failure. Whether exercise capacity is limited by abnormalities of left ventricular filling also in other less severe conditions is however unclear.

[Relationship of Doppler indexes of left ventricular filling and exertion tolerance].

The aim of this study was to evaluate if Doppler indexes of left ventricular filling are related to exercise capacity. Since a correlation between left ventricular filling pattern and causal blood pressure has been recently reported along a wide range of pressure values, a group of subjects with blood pressure ranging from normal to severely elevated values was studied. Twenty-four subjects (11 normotensives, 13 mild to severe hypertensive patients) underwent an echo-Doppler study and a maximal multistage cycloergometric exercise test.

Casual, ambulatory and stress blood pressure: relationships with left ventricular mass and filling.

In arterial hypertension, casual blood pressure seems to be weakly related to the level of cardiac involvement. The aim of the present study was to assess if blood pressure during ambulatory monitoring, and during different stress tests, is a stronger predictor of anatomical and functional changes observed in hypertensive heart disease. To this aim, 29 untreated patients with borderline-to-moderate essential hypertension underwent an echo-Doppler evaluation to determine left ventricular thickness and mass.

Left ventricular filling: relationship with arterial blood pressure, left ventricular mass, age, heart rate and body build.

The relationships of age, heart rate, body build and, in particular, of arterial blood pressure and left ventricular mass to several Doppler indexes of diastolic function were evaluated in a series of 80 subjects with a wide range of blood pressure levels (106-217/68-144 mmHg). Body build and age results were inversely correlated to the indexes, reflecting the early contribution to left ventricular filling, whereas the increase in heart rate was associated with an increase in late diastolic contribution. Strong correlations (in most instances, P less than 0.

Reduced cardiovascular efficiency and increased reactivity during exercise in borderline and established hypertension.

In this study, exercise capacity was evaluated in patients with borderline and established, uncomplicated, essential hypertension as compared to normal subjects. To this aim, the response of blood pressure, heart rate and cardiac work to a multi-stage exercise test was investigated by analyzing the results of linear regression fitting of cardiovascular parameters (ie, heart rate, systolic blood pressure and rate-pressure product (RPP)) versus time of exercise. Compared to normal patients, both essential and borderline hypertensive patients had a shorter average duration of exercise test (ie, a decreased exercise capacity), always negative for transient myocardial ischemia.

Echo-Doppler assessment of left ventricular filling in borderline hypertension.

The aim of this study was to evaluate left ventricular anatomy and diastolic function in borderline essential hypertension. To this aim, 16 borderline hypertensive patients underwent echocardiographic and pulsed-wave Doppler evaluation. As control groups, 20 normotensive controls and 20 patients with established hypertension were evaluated by the same procedure.

Seasonal influences on blood pressure in high normal to mild hypertensive range.

To investigate the seasonal influences on various arterial blood pressure measurements, 22 subjects in the high normal to mild hypertensive range were examined twice following the same protocol. In one group (13 subjects), measurements were first done in warm conditions and repeated 5-7 months later in cold conditions; in the second group (nine subjects) a reverse sequence was followed. Blood pressure was measured under casual conditions during a hand grip exercise test, mental arithmetic test, and submaximal multistage bicycle exercise test; during the following 24 hours, blood pressure was measured serially with a noninvasive ambulatory blood pressure recorder.

Microalbuminuria and casual and ambulatory blood pressure monitoring in normotensives and in patients with borderline and mild essential hypertension.

Several reports suggest that urinary albumin excretion may be elevated in patients with essential hypertension and that this index may be a good predictor for cardiovascular complications. The aim of this study was to compare 24-hour urinary albumin excretion in a group of normotensives, borderline, and untreated mild hypertertensives and to assess, in a subgroup of them, the possible relations between microalbuminuria and arterial blood pressure. Fifteen normotensives, 16 borderline, and 19 mild hypertensive patients were studied.

Different determinants of left ventricular filling in normotensive subjects and essential hypertensive patients.

The aim of the study was to evaluate the relationships between left ventricular (LV) filling and age, heart rate (HR), blood pressure (BP), and LV mass in three groups of subjects with different casual blood pressure. Twenty normotensive subjects (NT: age 39.2 +/- 7.

Left ventricular mass in borderline hypertension, assessed by echocardiography. Relationships with resting and stress blood pressure.

The relationship between clinical measurement of blood pressure (BP) and left ventricular hypertrophy in arterial hypertension appears to be weak in most studies. On the contrary, stronger correlations with target organ damage in general, and left ventricular hypertrophy in particular, have been reported for blood pressure measurements obtained by ambulatory monitoring; this finding may indicate a possible role for blood pressure response to naturally occurring stresses in determining left ventricular hypertrophy. Aim of this study was to investigate, in 18 patients with borderline arterial hypertension, the relationships between echocardiographically assessed left ventricular mass and, respectively, casual BP and BP responses to some standardized stress tests.

Long-term reproducibility and evaluation of seasonal influences on blood pressure monitoring.

The aim of this study was to evaluate the long-term reproducibility and the possible seasonal influences on casual blood pressure and ambulatory blood pressure monitoring in patients with borderline or mild arterial hypertension. Two sets of measurements were performed at 6-month intervals, one set in the warm and one in the cold season, using the same protocol, consisting of measurements of casual and ambulatory blood pressures, together with the recording of outdoor temperatures. Casual blood pressure was measured by an automatic recorder and 24-h ambulatory blood pressure monitoring was performed by a non-invasive device.

Relationship between pain sensitivity, cardiovascular reactivity to cold pressor test and indexes of activity of the adrenergic and opioid system.

An association between increased blood pressure levels and hypoalgesia has been reported in the experimental animal and in man. The relation between pain perception and cardiovascular function is however still obscure. In order to gain some insight into this aspect, normotensive subjects with low and high tolerance to pain, as assessed by tooth pulp stimulation, were compared for blood pressure and heart rate during cold pressor test, 24 hr urinary catecholamines, supine and upright PRA and plasma beta-endorphin levels.

Cardiovascular reactivity to physical and psychologic stress during long-term treatment with nitrendipine in essential hypertension.

Nitrendipine is a second-generation dihydropyridine calcium antagonist selective for hypertension. The aim of this study was to assess whether, in addition to reduce resting blood pressure, nitrendipine also affects the cardiovascular reactivity to physical and psychologic stress. Ten essential hypertensive patients, out of treatment for at least 2 weeks, underwent a symptom-limited dynamic maximal exercise and a mental arithmetic stress test (MAT) after placebo (1 week) and 1 and 5 weeks of active treatment with nitrendipine (20 mg q.

Medium-term reproducibility of stress tests in borderline arterial hypertension.

Stress tests are commonly used for an evaluation of blood pressure reactivity, but few data exist in the literature about interindividual variability and intraindividual medium-term reproducibility of blood pressure responses to these tests in borderline hypertension. To this aim we have studied 20 borderline hypertensive patients (age range, 33-59, mean 45). Our data suggest that borderline hypertensive patients cannot be considered a homogeneous group with regard to blood pressure reactivity because they tend to have widely different blood pressure responses to various stress tests.