G-CSF treatment for STEMI: final 3-year follow-up of the randomised placebo-controlled STEM-AMI trial.

Objective: To assess whether granulocyte colony-stimulating factor (G-CSF) treatment induces a sustained benefit on adverse remodelling in patients with large anterior ST-elevation myocardial infarction (STEMI) and left ventricular (LV) dysfunction after successful reperfusion.

Methods: The STEM-AMI Trial was a prospective, placebo-controlled, multicentre study. Sixty consecutive patients with a first anterior STEMI, who underwent primary percutaneous coronary intervention 2-12 h after symptom onset, with LV ejection fraction (LVEF) ≤45% measured by echocardiography within 12 h after successful revascularisation (TIMI flow score ≥2), were randomised 1:1 to G-CSF (5 µg/Kg body weight b.

Severe Midventricular Hypertrophic Obstructive Cardiomyopathy and Apical Aneurysm.

A 40-year-old man was found to have hypertrophic cardiomyopathy (HCM) with severe mid ventricular obstruction. The obstruction produced two distinct left ventricular chambers with an estimated 60 mmHg continuous wave (CW) Doppler intraventricular gradient. Pulsed wave (PW) Doppler showed high velocity systodiastolic flow from apex to base and flow from base to apex confined mostly to the second half of diastole.

Cardiac Magnetic Resonance: One Slice, Two Different LGE Patterns.

A 56-years-old man with previous myopericarditis (10 months earlier, coronary angiography not performed) was admitted because of pericarditis pain and ST segment elevation, together with myocardial necrosis markers rise. Electrocardiogram (EKG) showed negative T waves in lateral and inferior leads; echocardiogram showed mild pericardial effusion and inferior and lateral basal hypokinesis. Cardiac magnetic resonance imaging (CMRI) on day 7 post-admission showed increased T2-short tau inversion recovery (T2-STIR) signal of inferior wall and two different noncontiguous late gadolinium enhancement (LGE) areas: Ischemic-like with about 75% transmural extension (inferior wall) and subepicardial (inferolateral wall) along with pericardial LGE (inferior and inferolateral wall).

Persistent Left Superior Vena Cava and Absent Right Superior Vena Cava: Not Only an Anatomic Variant.

Introduction: A 71 year old asymptomatic woman came for an echocardiogram because of a left bundle branch block. A much dilated coronary sinus (CS) with an entering large vessel was found along with a mild left ventricular systolic dysfunction. Cardiac Magnetic Resonance (CMR) showed a persistent left superior vena cava (PLSVC), and an absent right superior vena cava (ARSVC).

Granulocyte colony-stimulating factor attenuates left ventricular remodelling after acute anterior STEMI: results of the single-blind, randomized, placebo-controlled multicentre STem cEll Mobilization in Acute Myocardial Infarction (STEM-AMI) Trial.

Aims: The aim of this study was to assess the effect of granulocyte colony-stimulating factor (G-CSF) on left ventricular (LV) function and volumes in patients with anterior ST-elevation myocardial infarction (STEMI) and depressed LV ejection fraction (EF).

Methods And Results: Sixty consecutive patients with anterior STEMI, undergoing primary angioplasty percutaneous coronary intervention (PCI), with symptom-to-reperfusion time of 2-12 h and EF ≤45% after PCI, were randomized to G-CSF 5 μg/kg b.i.

Sudden ST elevation with angina-like pain in myocarditis. An uncommon course of a common disease: strategic role of cardiac magnetic resonance.

A case of a young man with myocarditis simulating acute coronary syndrome is reported. The possibility of vasospasm is discussed. The use of cardiac magnetic resonance imaging (MRI) is highlighted.

Thyroid cancer: possible role of telemedicine.

Telemedicine is extremely useful when distance could hinder diagnostic procedures, disease management, or when severe side-effects may occur in patients not within easy reach of medical care and requiring prompt action and specific therapies. Telemedicine has been successfully adopted in the management of chronic patients, particularly in those with cardiologic or oncologic diseases. In the treatment of differentiated thyroid cancer, requiring long-term check-ups and visits as well as administration of high doses of levothyroxine (TSH - thyroid-stimulating hormone - suppression), also in elderly patients, telemedicine seems particularly indicated.

Arrhythmic risk evaluation during exercise at high altitude in healthy subjects: role of microvolt T-wave alternans.

Background: Altitude-induced sympathetic hyperactivity can elicit rhythm disturbances in healthy subjects, in particular during exercise.

Aim: To asses the real susceptibility of healthy myocardium to malignant ventricular arrhythmias during exercise at high altitude using microvolt T-wave alternans (MTWA).

Methods: We evaluated eight healthy trained participants (one female, 42 +/- 9 years) during a mountain climbing expedition on Gashembrum II (Pakistan, 8,150 m).

Atypical beta-adrenoceptors mediating relaxation in the human colon: functional evidence for beta3-rather than beta4-adrenoceptors.

The aim of the present functional study was to assess the role of beta3-adrenoceptors in the light of recent findings suggesting the existence of a putative fourth beta-adrenoceptor in adipose and heart tissue. The effect of the non-conventional beta3-adrenoceptor partial agonist CGP12177A is resistant to the effect of the beta3-adrenoceptor antagonist SR59230A. Under isotonic conditions in circular muscle strips of human distal colon, the concentration-effect relationship of CGP12177A and SR59104A (beta3-adrenoceptor agonists), alone and in the presence of CGP20712A (beta1-adrenoceptor antagonist) ICI118551 (beta2-adrenoceptor antagonist) and SR59230A, all 0.

In vivo characterization of the colonic prokinetic effect of erythromycin in the rabbit.

The motor effect of erythromycin was characterized in conscious rabbits chronically fitted with electrodes and strain-guage force transducers implanted along the proximal and distal colon. Fecal pellet output was also evaluated as an index of propulsive activity. In order to get an insight into the pathways involved in mediating the effect of erythromycin, the macrolide was also administered after pretreatment with atropine, nifedipine or ondansetron.

Functional evidence of atypical beta 3-adrenoceptors in the human colon using the beta 3-selective adrenoceptor antagonist, SR 59230A.

The role of beta 3-adrenoceptors in human colonic circular smooth muscle was assessed in vitro by use of the beta 3-selective antagonist SR 59230A. Isoprenaline, in the presence of the selective beta-adrenoceptor antagonists CGP 20712A (beta 1) and ICI 118551 (beta 2), both at 0.1 microM, concentration-dependently relaxed the preparation (pEC50 = 5.

Functional evidence for the presence of beta 3-adrenoceptors in the guinea pig common bile duct and colon.

To determine the existence of beta 3-adrenoceptors in functional assays in isolated preparations for which data are lacking, we compared the effects of SR 58611A, a selective beta 3-adrenoceptor agonist, and isoprenaline in the guinea pig common bile duct, distal colon and urinary bladder. SR 58611A and isoprenaline relaxed the common bile duct (EC50: 6.85 and 0.

Inhibitory effects of SR 58611A on canine colonic motility: evidence for a role of beta 3-adrenoceptors.

1. In order to clarify whether atypical or beta 3-adrenoceptors can modulate canine colonic motility in vivo, we studied the effects of SR 58611A (a selective agonist for atypical beta-adrenoceptors) alone and after pretreatment with beta-adrenoceptor antagonists on colonic motility in the conscious dog. The gastrocolonic response (postprandial increase in motility) was monitored by means of electrodes and strain-gauge force transducers chronically implanted along the distal colon.

[Comparison of amiodarone and quinidine in the conversion to sinusal rhythm of atrial fibrillation of recent onset].

The effectiveness of amiodarone and quinidine in converting atrial fibrillation of recent onset (less than three weeks) to sinus rhythm was compared in a randomized, open-label study. Patients with signs of heart failure determining a NYHA class 3 or 4, acute myocardial infarction, unstable angina pectoris, sick sinus syndrome, Wolff-Parkinson-White syndrome, conduction disturbances, dysthyroidism, or undergoing concomitant therapy with antiarrhythmic drugs, were excluded from the study. Sixty-eight consecutive patients were randomized to receive amiodarone (group A) or quinidine (group B).

Chronic effects of transdermal nitroglycerin in stable angina pectoris: a within-patient, placebo-controlled study.

The efficacy of transdermal nitroglycerin patches, releasing 20 mg of active substance over a period of 24 h (TDN 20), was investigated in 10 patients with stable exercise-induced angina pectoris. The study was divided into 3 periods: the first part was an acute, within-patient, crossover, double-blind, placebo-controlled study, in which patients performed a cycloergometric exercise test 4 and 24 h after the application of the patches (TDN 20 or placebo). During the 2nd period, patients were given TDN 20, in single blind conditions, for 4 weeks and another exercise test was performed, on the last day, 4 and 24 h after patch application.

Effects of a transdermal patch system containing nitroglycerin on exercise tolerance in patients with angina pectoris. Double-blind, placebo controlled, comparison with slow-release nifedipine and verapamil.

The antianginal efficacy of nitroglycerin (NTG), given in a new transdermal therapeutic system (TTS), was compared with that of nifedipine and verapamil, both in slow-release (SR) formulation, in a randomized, double-blind, placebo-controlled study, carried out in 8 patients with stable exercise-induced angina pectoris. TTS NTG 40 cm2 (releasing 20 mg of NTG over 24 hours), nifedipine 20 mg SR, verapamil 120 mg SR and placebo were given once on 4 consecutive days according to a 4 X 4 latin-square design, twice replicated. A cycloergometric symptom-limited exercise test was performed 4 and 8 hours after the administration of each drug.

[Electrophysiological evaluation of ventricular tachycardia by right and left ventricle endocardial mapping (author's transl)].

Eight patients with ventricular tachycardia (VT) have been studied by unipolar recordings of 7 endocardial points of the left ventricle (LV) and 6 endocardial points of the right ventricle (RV) in order to record if possible: 1) where the VT arose; 2) a continuous electrical activity during the sistodiastolic phase of the intracardiac ECG [late potentials (LP)], suggesting the reciprocating mechanism of VT. All the patients underwent cardiac catheterization with left and/or right ventriculography. A coronary arteriography was performed in four cases.

[Swallowing-induced supraventricular tachycardias in an asymptomatic young man (author's transl)].

Three patterns of swallowing-induced supraventricular tachycardia in an asymptomatic young man are described. The patient had no esophageal disease. The electrophysiologic mechanism of arrhythmias remains speculative.

[Observations on the sequence of endocardial activation in the left ventricle of the normal subject].

To obtain information on normal left ventricular activation, endocardial recordings with an electrode catheter were made a seven left ventricular sites in ten patients undergoing diagnostic heart catheterization. All the patients had: 1) sinus rhythm; 2) normal duration and shape of the QRS complex of left chest leads; 3) normal left ventriculography, i.e.

[The endocardial ventricular activation map in a case of intermittent BBS in phase III (author's transl)].

To obtain information on endocardial activation-sequence, unipolar recordings at seven left ventricular and six right ventricular points were performed in a 37-year-old man suffering from cardiomyopathy and tachycardia-dependent left bundle branch block (LBBB). Results were as follows: 1) the recovery time was longer in anterior than in posterior portion of left bundle branch fibers; 2) an high posterior left ventricular point was directly activated via posterior left bundle branch fibers; 3) the directly activated left ventricular zone was too small and relatively too late excited in respect of the right interventricular septum, from which the stimulus reached the left septum, to mask the LBBB electrocardiographic pattern; 4) in the presence of tachycardia-dependent LBBB the duration of left ventricular endocardial activation was about twice (62 msec) that found in the absence of tachycardia-dependent LBBB (28 msec).

[The effort test in the diagnosis of typical stable effort angina (author's transl)].

Among 173 patients with typical effort angina (159 men and 14 women) which underwent exercise test and coronary angiography, significant stenosis (greater than or equal to 70%) of one or more of important coronary branches were present in 93,1% of the cases (96,3% among the males and 57% among the females). In the same group the exercise test sensitivity was 88,8%; when 3 coronary branches were involved the sensitivity rises to 94,3%. The 96,6% of patients with positive exercise test had coronary lesions too (true positives).

[The significance of ventricular arrhythmias during muscular work: correlations with coronary heart disease (author's transl)].

The incidence of ventricular arrhythmias during muscular work in 400 patients hospitalized for clear or suspected coronary artery disease who underwent coronaroangiography and exercise test was studied. The correlations between the arrhythmias and some hemodynamic parameters and the coronaroangiogrphy patterns and left ventricle cineangiography were investigated. None of the factors that were supposed to be significant in the mechanism of the ventricular arrhythmias, such as high left ventricular end dyastolic pressure, modified myocardial contractility, previous myocardial infarct, or higher lesions of coronary arteries, gave significant correlations.