Search

To elucidate how symptoms and signs of chronic heart failure are related to the filling pressure and cardiac output at rest, 58 patients (55 males, 3 females, mean age 57 +/- 9 years, range 30-75) with left ventricular ejection fraction (LVEF)or = 30% and a lesionor = 50% on a major coronary branch have been selected from patients submitted in 1985-1993 to a complete right and left cardiac catheterization including ventriculography and coronary angiography. Patients with recent myocardial infarction (MI), unstable angina, associated heart diseases or recent changes in body weight and in diuretic therapy were excluded. Clinical data were obtained at cardiac catheterization time from history, physical examination, chest X-ray and ECG. Patients with angina as limiting symptom were excluded from NYHA functional classification. Pulmonary venous congestion (PVC) was defined on X-ray as: absent, venous redistribution, interstitial pulmonary edema (IPE). Mean pulmonary capillary wedge pressure (PCWP) was recorded under fluoroscopy and cardiac index was measured by the Fick method. On the whole group, 96% of patients had had one or more MI (on ECG necrosis was anterior in 58%, inferior in 9%, anterior and inferior in 26%), 69% were in NYHA functional class III or IV, 54% had IPE and 45% had mitral regurgitation. 71% were under treatment with digitalis, 74% with diuretics and 39% with ACE-inhibitors. PCWP was correlated with LVEDV (r = 0.34; p0.001) but neither with LV mass nor with LV mass/volume ratio. It was significantly higher (p0.01) in patients with mild-moderate mitral regurgitation, in patients with necrosis involving both anterior and inferior walls (26 +/- 6 vs 21 +/- 8 mmHg in patients with single wall necrosis, p0.05) and in patients with multiple MI (26 +/- 7 vs 20 +/- 8 mmHg in patients with no or single MI, p0.02). Moreover, it was neither correlated with functional classification nor with PVC: of patients with PCWP24 mmHg, 14% were in II NYHA functional class and 21% had no PVC while of patients with PCWP15 mmHg, 36% were in NYHA functional class IV and 7% had IPE. Cardiac index was reduced below 2.3 l/min/m2 in 21% of patients: these patients had increased pulmonary (p0.0002) and systemic (p0.0001) vascular resistance, increased systolic (p0.001) and diastolic (p0.01) pulmonary artery pressure and reduced LVEF (p0.01) and right ventricular ejection fraction (p0.03). Furthermore, on the whole patients an inverse correlation was found between cardiac index and functional classification (r = -0.42; p0.01). The reliability of NYHA functional class IV, physical signs of heart failure and IPE for estimating PCWP24 mmHg and cardiac index2.3 l/min/m2 was rather limited although high specificity was shown for gallop sounds (92 and 97%) and jugular vein distension (88 and 97%). In conclusion, in coronary patients with chronic severe LV systolic dysfunction a mismatch between clinical data and central hemodynamics is not rare. The reliability of functional class, X-ray PVC and physical signs to predict central hemodynamics in fairly limited.

The object of the study was to define spreading and quantitative criteria of left ventricular hypertrophy in echocardiography by using a "score"--for this, the left ventricle has been divided into 11 regions and a "score" attributed to each one of them--and to find the correlation with the vectocardiogram (VCG) in 42 patients with hypertrophic myocardiopathy (HM). The results obtained show the following: 1) the left ventricular hypertrophy aspect on the ECG and the VCG is very sensitive for the identification of a diffuse HM; 2) the necrosis, hemiblock or septal hypertrophy indicate a hypertrophy located in the forepart septum or the whole of the septum; 3) the giant T waves indicate a hypertrophy of the apex; 4) a left ventricular hypertrophy associated with a necrosis or a hemiblock indicate a global myocardiopathy, with the basal region of the septum largely affected.

Smooth and interrupted curves of AV conduction, generated with an atrial extrastimulus technique, are seen in man, suggesting the involvement of two physiological AV pathways named "alpha" and "beta" and leading to a final common pathway (FCP). In view of this knowledge, the effects of some representative antiarrhytmic agents (Atropine, Verapamil, Ajmaline) were studied in eight patients in order to elucidate the physiological role of the various components of AV junction. Verapamil decreased conduction velocity of both "alpha" and "beta" pathways and increased their refractoriness; Atropine decreased "alpha" and "beta" pathways' refractory periods and increased their conduction velocity; further studies are required to clarify the effects of Ajmaline on AV conduction.

One-hundred and eighty-nine patients who underwent cardiac catheterization for suspected ischemic heart disease were assigned to four different groups depending on the number of diseased vessels (0, 1, 2, 3), the dominant artery and the presence of left main coronary stenosis. Among the 45 parameters obtained from history, physical examination, E.C.G., and exercise test multivariate analysis identified (positive stress test, maximal systolic blood pressure, documented myocardial infarction, maximal heart rate, ipercholesterolemia, lateral myocardial infarction, angina during stress test) that were statistically significant. A score system was devised on the basis of the summed-up value of the seven parameters. When the patients were assigned, according to the score, to one of the previously mentioned 4 groups, the classification proved to be correct in 54% of the cases. When we divided the patients in two groups with or without coronary artery disease so that the attribution turned out to be correct in 92% of the cases (sensitivity 94%, specificity 77%), whereas when based on ST segment depression only, the classification was correct in 85% of the cases (sensitivity 84%, specificity 88%).

Seventy-seven patients with dilated cardiomyopathy (50 M and 27 F, aged 38 +/- 16 yrs) were followed up until Dec 31, 1985. Haemodynamic investigation was performed in all cases, and all pressure and left ventricular quantitative angiography parameters were collected. In no case did the coronary angiogram show significant lesions. Mean values of haemodynamic parameters for surviving and deceased patients were compared. Forty-six patients survived and 28 died during the follow-up period. Although all patients had an enlarged left ventricle and depressed contractility, survivors had either greater pressure/end systolic volume ratio or a greater stress/end systolic volume ratio. Survival curves confirm a particularly severe prognosis for patients with Suga index less than 1 or stress to end systolic volume ratio less than 2.5. Mass to volume ratio seems to affect two-year but not late survival. NYHA class does not indicate early survival. In conclusion, left ventricular function is obviously related to prognosis in these patients, but it seems still difficult to assess life expectancy from these parameters alone.

One thousand coronary arteriography performed in the catheterization laboratory of the Department of Cardiology (University of Padua) from 1973 to 1978 were reviewed. Indication to perform a coronary arteriography was established in 668 patients with clinically suspected coronary artery disease and in 332 patients affected by different heart disease in whom the study of coronary arteries was judged to be usefull. The percutaneous technique was usually employed. The overall mortality rate was 0.2%; there were no death in the last three years. The overall morbility was 3.5% (2.3 from 1976 to 1978). The anterior descending artery appeared to be the most frequently and precociously affected area. There was a good correlation between severity of the atherosclerotic lesions and age or sex of the patients. We could recognize coronary disease, when present, on the basis of clinical evaluation in patients without different heart disease.

Organ- and disease-specific cardiac autoantibodies, detected by indirect immunofluorescence, represent markers of autoimmunity in a subgroup (25-35%) of patients with dilated cardiomyopathy or myocarditis from Northern Europe and the United States of America. Autoantibody frequencies, as well as associations between clinical and immunological features, may vary in patients from different countries, due to ethnically related differences in genetic susceptibility to autoimmune disease.We assessed the frequency of cardiac autoantibodies in a series from Italy, including 91 subjects with idiopathic dilated cardiomyopathy (61 male, aged 49 +/- 11 years) and 11 with biopsy-proven (Dallas criteria) myocarditis (7 male, aged 23 +/- 16), including 2 cases of giant cell myocarditis. Controls were 160 patients with other cardiac disease, 141 with ischemic heart failure and 270 normals Cardiac antibody test was performed blindly by indirect immunofluorescence on normal human myocardium and skeletal muscle.The frequency of organ-specific cardiac autoantibodies was higher (p = 0.0001) in myocarditis (45%) and in dilated cardiomyopathy (20%) than in other cardiac disease (1%), in ischemic heart failure (1%), or in normals (2.5%). Cross-reactive antibodies were detected in similar proportions of study patients and controls. Both patients with giant cell myocarditis were antibody positive. Myocarditis patients with cardiac antibodies had shorter duration of symptoms compared to those who were antibody negative (0.4 +/- 0.3 vs 4 +/- 1 months, p = 0.004). In dilated cardiomyopathy, antibody status was not associated with any clinical or diagnostic feature.Autoimmunity is involved in a subset of patients with myocarditis and with dilated cardiomyopathy, regardless of their geographical origin or immunogenetic background. The antibody frequency in our dilated cardiomyopathy series from Italy tended to be lower than in other countries. This may reflect reduced antibody levels with disease progression and/or the recognised feature that Mediterranean populations are often less susceptible to autoimmune disease.