Implantable Loop Recorder: Diagnostic Yield And Possible Therapeutic Effect In Patients With Neurally Mediated Reflex Syncope.

Through a retrospective study concerning the experience of our center in patients affected by Neurally Mediated reflex Syncope (NMS) we wanted to verify not only the diagnostic yield of the Implantable Loop Recorder (ILR) but its possible placebo therapeutic effect. In the context of patients affected by a severe clinical presentation of NMS identified through a careful clinical evaluation, we selected those who followed a diagnostic iter using the ILR. We analysed 84 patients (39 male and 45 female, mean age 71 years), during the period 2009-2013.

Combined Diagnostic Yield of Tilt Table Test And Implantable Loop Recorder to Identify Patients Affected by Severe Clinical Presentation of Neurally-Mediated Reflex Syncope who Could Respond to Cardiac Pacing.

In this study we wanted to verify the diagnostic value of tilt table test (TTT) to predict the efficacy of cardiac pacing (PM) for preventing recurrences of neurally mediated reflex syncope (NMS) in patients with cardioinhibitory activity (CI) documented by implantable loop recorder (ILR). Among patients selected by ILR in the context of severe clinical presentation of NMS, we analysed those who underwent PM implantation. In this observational and retrospective study we wanted to verify the results of TTT in the groups of treated patients with and without recurrences.

Cardiac pacing in patients with neurally mediated syncope and documented asystole: effectiveness analysis from the Third International Study on Syncope of Uncertain Etiology (ISSUE-3) Registry.

Aims: The randomized, double-blind Third International Study on Syncope of Uncertain Etiology (ISSUE-3) showed that dual-chamber permanent pacing was effective in reducing the recurrence of syncope in patients ≥ 40 years with severe asystolic, probably neurally mediated syncope (NMS), documented by implantable loop recorder (ILR). Analysis in ISSUE-3 was performed according to the intention-to-treat principle. In the present study, we performed an on-treatment analysis, which included additionally those non-randomized patients followed up in the ISSUE registry to evaluate in a better manner the effectiveness of cardiac pacing therapy.

Diagnosis of neurally mediated syncope at initial evaluation and with tilt table testing compared with that revealed by prolonged ECG monitoring. An analysis from the Third International Study on Syncope of Uncertain Etiology (ISSUE-3).

Objective: According to the guidelines of the European Society of Cardiology, a presumed diagnosis of neurally mediated syncope (NMS) can be made when patients have a consistent history and competing diagnoses are excluded. In the present study, we compared the initial diagnosis of NMS by means of implantable loop recorder (ILR) documentation.

Methods: In this prospective multicentre observational study which involved 51 hospitals in nine countries in Europe and Canada, 504 NMS patients ≥40 years, who had suffered ≥3 syncopal episodes in the previous 2 years received an ILR and were followed up for a mean of 15±11 months.

Genesis and acoustic quality of the physiological fourth heart sound.

The genesis of the fourth heart sound (S4) is commonly related to the rapid set in vibration of the left ventricular walls, resulting from the rapid inflow of the blood due to the atrial contraction (Nishimura et al., 1989). S4 can be recorded in normal young subjects as an expression of physiologic atrial dynamics but it is more common in pathologic conditions characterized by decreased ventricular distensibility (Tavel, 1978).

The response of the ageing heart to regular physical exercise. An echo and Doppler study.

In upper middle age healthy subjects the functional cardiac reserve is known to be decreased (Port et al., 1980; Aubert et al., 1994).

Acute and chronic nitrendipine administration in essential hypertension: a chronobiologic study.

To evaluate the chronobiologic pattern of the hypotensive effect of nitrendipine, 10 patients with mild-to-moderate arterial hypertension were studied. They received a randomized single dose (20 mg) of nitrendipine and placebo, and 20 mg of nitrendipine daily for 2 months. Systolic and diastolic blood pressure (SBP and DBP, respectively) and heart rate (HR) were measured for 24 h using an automatic noninvasive device.

Peripheral vascular circulation in trained athletes.

Modifications in the neurogenic control are important in cardiovascular adaptation to physical training. To examine the influence of such variations on arterial blood pressure, heart rate and limb blood flow the Authors have studied the reaction to cardiovascular stress tests of soccer players and sedentary controls. No difference was found in the blood flow response between athletes and sedentary subjects.

Circadian rhythm of blood pressure and calcium entry blockade: a chronobiologic study with nitrendipine in essential hypertension.

In order to evaluate the chronobiologic effect of nitrendipine, 27 patients with mild-to-moderate arterial essential hypertension were studied. After randomized administration of 20 mg of nitrendipine and placebo, systolic and diastolic blood pressure (SBP and DBP, respectively) and heart rate (HR) were measured for 24 h using an automatic noninvasive device. The data of the time series were statistically analyzed by single and mean cosinor methods (obtaining mesor, amplitude, and acrophase) and by ANOVA and Student's paired t test.

The effect of captopril on peripheral hemodynamics in patients with essential hypertension: comparison between oral and sublingual administration.

A comparative study of the effects of oral and sublingual captopril on the hemodynamics of the peripheral musculocutaneous vasculature was carried out on ten patients with essential hypertension. Both routes of administration of captopril lead to lower blood pressure and decreased regional resistance, and to an increased arterial blood flow at rest. The first measurable effect and the peak effect on blood pressure and peripheral hemodynamics appear slightly earlier with sublingual administration.

Clinical value of the pitch of the third heart sound in ischemic heart disease.

The study investigates the genesis of the third heart sound (S3) in ischemic heart disease based on a mass-spring model. In such a system, the natural frequency of vibration, Fn, depends on the elastic constant, k, and the mass, m, according to the following relationship: Fn = 1/2 pi square root of k/m. To identify the cardiac structures representing k and m, the correlations between the energy of the S3 spectrum and the echocardiographic parameters were searched for.