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The epidemiology of HDV infection in Italy was assessed in a retrospective study involving 1556 HBsAg chronic carriers on their first presentation at one of the 35 Liver Units in 1987. Total anti-HD was detected in 23.4% of HBsAg carriers and was significantly more frequent in southern than in northern Italy (26.6% vs. 19.1%, p less than 0.01). Age distribution showed that 73% of the anti-HD-positive subjects, but only 56% of the anti-HD-negative subjects, were under 40 years of age (p less than 0.01). Anti-HD prevalence increased with the severity of the liver disease from 3.8% in healthy carriers to 42.5% in cirrhosis. No geographical statistical difference was found among HBsAg healthy carriers or subjects with chronic persistent hepatitis (CPH), while among patients with chronic active hepatitis (CAH) or cirrhosis anti-HD prevalence was much higher in the south (p less than 0.01). The various potential risk factors were evaluated by multiple logistic regression analysis. HDV infection was independently related to young age, residence in the south, i.v. drug abuse, a large family and household contact with an anti-HD-positive carrier. No association was found with blood transfusion or male homosexuality. These findings confirm that HDV infection is endemic in Italy, particularly in some southern areas, where intrafamily contact probably at a young age may favour the spread of the infection.

Background. The variation between rest and peak stress end-systolic pressure-volume relation (ΔESPVR) is an index of myocardial contractility, easily obtained during routine stress echocardiography and never tested during dipyridamole stress-cardiac magnetic resonance (CMR). We assessed the ΔESPVR index in patients with known/suspected coronary artery disease (CAD) who underwent dipyridamole stress-CMR.Methods. One-hundred consecutive patients (24 females, 63.76±10.17 years) were considered. ESPVR index was evaluated at rest and stress from raw measurement of systolic arterial pressure and end-systolic volume by biplane Simpson’s method. Results. The ΔESPVR index showed a good inter-operator reproducibility. Mean ΔESPVR index was 0.48±1.45 mmHg/mL/m2. ΔESPVR index was significantly lower in males than in females. ΔESPVR index was not correlated to rest left ventricular end-diastolic volume index or ejection fraction. Forty-six of 85 patients had myocardial fibrosis detected by the late gadolinium enhancement technique and they showed significantly lower ΔESPVR values. An abnormal stress CMR was found in 25 patients and they showed significantly lower ΔESPVR values. During a mean follow-up of 56.34±30.04 months, 24 cardiovascular events occurred. At receiver-operating characteristic curve analysis, a ΔESPVRConclusions. The noninvasive assessment of the ΔESPVR index during a dipyridamole stress-CMR exam is feasible and reproducible. The ΔESPVR index was independent from rest LV dimensions and function and can be used for a comparative assessment of patients with different diseases. ΔESPVR by CMR can be a useful and simple marker for additional prognostic stratification.

The authors present a case of coronary sinus spasm during left ventricular lead implantation for biventricular pacing relieved by direct infusion of nitroglycerin.

Aims The aim of our study was to evaluate the effect of cardiac resyncronization therapy on QT dispersion (QTd), JT dispersion (JTd), and transmural dispersion of repolarization (TDR), markers of heterogeneity of ventricular repolarization in a study population with severe heart failure. Methods and results Fifty patients (43 male, 7 female, age 60.2+3.1 years) suffering from congestive heart failure (n ¼ 39 NYHA class III; n ¼ 11 NYHA class IV) as a result of coronary artery disease (n ¼ 19)or of dilated cardiomyopathy (n ¼ 31), with sinus rhythm (SR), QRS duration .120 ms (mean QRS duration ¼ 156+21 ms), an ejection fraction ,35%, left ventricular end-diastolic diameter .55 mm, presence of atrioventricular asynchrony, intra- and inter-ventricular asynchrony, underwent permanent biventricular pacemaker implantation. A 12-lead standard electrocardiogram was performed at baseline, during right-, left-, and biventricular pacing (BiVP) and QTd, JTd, and TDR were assessed. BiVP significantly reduced QTd (73.93+19.4 ms during BiVP vs. 91+6.7 ms in SR, P ¼ 0.004), JTd (73.18+17.16 ms during BiVP vs. 100.72+39.04 at baseline, P ¼ 0.003), TDR (93.16+15.60 vs.101.55+19.08 at baseline, P , 0.004), compared with SR. Right ventricular endocardial pacing and left ventricular epicardial pacing both increased QTd (RVendoP 94+51 ms, P , 0.03; LVepiP 116+71 ms, P , 0.02), and TDR (RVendoP 108.13+19.94 ms, P , 0.002; LVepiP 114.71+26.1, P , 0.05). There was no effect on JTd during right and left ventricular stimulation. Conclusions BiVP causes a statistically significant reduction of ventricular heterogeneity of repolarization and has an electrophysiological anti-arrhythmic influence on the arrhythmogenic substrate of dilated cardiomyopathy.

Purpose: The use of electrophysiologic studies (EPS) for the localization of accessory atrioventricular connections in Wolff-Parkinson-White syndrome (WPW) requires accurate evaluation of the site of bypass tract insertion. Doppler myocardial imaging (DMI) is a new ultrasound technique that allows the detection of abnormal and early regional myocardial depolarization. The purpose of this study was to identify an abnormal pathway site in WPW patients. Methods: Twenty-one patients with ventricular preexcitation were studied by DMI. Two-dimensional color DMI, velocity maps, acceleration maps, and pulsed-wave applications were used. A subsequent diagnostic EPS was performed. The results of EPS were taken as the gold standard diagnostic procedure. Radiofrequency catheter ablation therapy was then performed on all patients. Results: The anomalous pathway was detected by DMI in 16 (76%) of 21 patients (9 [90%] of 10 with left pathways and 7 [64%] of 11 with right pathways), with respect to results of the EPS. Pathway detection was better with pulsed-wave DMI (76%) with its higher temporal resolution as compared with M-mode velocity map (57%) and acceleration map (47%). In most of the patients with successful radiofrequency ablation, an immediate resolution of the abnormal ventricular depolarization occurred and was detectable by DMI. Conclusions: Our findings demonstrate the feasibility of DMI to assess the early ventricular contraction associated with atrioventricular accessory pathways. Therefore, DMI appears to be a clinically useful adjunct to noninvasive evaluation of abnormal myocardial depolarization in WPW and to evaluate the results after radiofrequency ablation, even though its accuracy is considerably better for left-sided accessory pathways than for right-sided ones.

Junctional ectopic tachycardia (JET) is a rare arrhythmia presenting either as a primary form1 or more often as a transient phenomenon immediately after heart surgery.2 Congenital JET usually occurs in the first six months of life as a persistent arrhythmia, associated in up to 60% of cases with cardiomegaly and/or heart failure.1 Congenital JET has been described in sporadic case reports or larger multicentre populations. The purpose of this study is to examine retrospectively the clinical presentation and outcome of a cohort of nine patients with congenital JET referred during a 20 year period time to a single unit and all medically treated. Nine patients (two male, seven female) suffering from persistent sustained JET were referred to our hospital between 1980 and 1999. All the patients underwent a complete medical history, physical examination, 12 lead ECG, 24 hour Holter recording, and echocardiogram. The diagnosis of JET was based on electrocardiographic evidence of a narrow complex tachycardia and atrioventricular dissociation. All the patients underwent medical treatment according to the following regimen: A Ic antiarrhythmic drug (propafenone or flecainide) was administered in combination with amiodarone when the latter proved ineffective alone in controlling the arrhythmia. This combination of drugs was also used in an attempt to reduce the dose of amiodarone, and prevent signs of …