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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.

75 patients with isolated mitral stenosis were studied. Particular attention was paid to the integration of the parametres VTD, FE, mitral area, pulmonary artery pressure and dynamic systolic and diastolic geometry of the left ventricle. The existence of isolated MS with alteration of the left ventricular function not depending on the alterations of the preload and the forms with raised FE, was demonstrated. A classification into 6 groups was made, each characterized by special geometric modalities of contraction and relaxation. A significant compensation of several of the parametres of systolic mecanism (hyperkinesia) and diastolic (SERP) dynamic geometry was observed. It was therefore concluded that a more precise definition of the interaction of ventricular function with left atrial function is necessary.

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%).