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We evaluated left ventricular (LV) mechanical efficiency in 23 elderly patients (mean age 67 +/- 2) with coronary artery disease (CAD) and in 22 patients younger than 65 years (mean age 49 +/- 8) with similar severity of CAD (2.4 +/- 0.8 and 2.2 +/- 0.8 vessels per patient, respectively) and history of myocardial infarction (34% and 41%, respectively). LV mechanical efficiency was calculated as the ratio of LV work per minute and myocardial O2 consumption. LV stroke volume was calculated from left ventriculography. Coronary blood flow was measured by thermodilution. Older patients had lower values of LV stroke volume (49 +/- 16 vs 73 +/- 16 mL, p < 0.005), ejection fraction (41 +/- 17 vs 58 +/- 17%, p < 0.05), LV stroke work (93 +/- 26 vs 131 +/- 41 g.m., p < 0.02) and LV work per minute (6.7 +/- 2.6 vs 9.3 +/- 2.7 kg.m./min, p < 0.05). Since myocardial O2 consumption was similar in the two groups, LV mechanical efficiency was lower in older CAD patients (16.2 +/- 15 vs 23.8 +/- 12%, p < 0.05). Thus, elderly patients with CAD show a reduced LV mechanical pump performance and efficiency, compared with younger patients with similar disease severity and history of myocardial infarction. These observations may contribute to understanding the higher frequency of congestive heart failure in elderly patients with CAD.

Of 17 patients with mild to moderate essential hypertension, 8 showed echocardiographic evidence of left ventricular hypertrophy. Cardiac and renal function evaluated by glomerular filtration rate (GFR) were studied in all patients before and after 20 weeks of quinapril treatment. Systolic pressure decreased from 174.7 +/- 16.7 to 131.7 +/- 7.7 mmHg (p.0001) and diastolic pressure decreased from 101.8 +/- 9.8 to 80 +/- 4.3 mmHg (p.0001). Left ventricular mass index decreased in the eight patients with left ventricular hypertrophy (p.01). Basal values of GFR were lower than normal in 41% of all patients; GFR increased significantly after 20 weeks of treatment (from 96.5 +/- 32.3 to 108.6 +/- 31.12 ml/min, p.01); it decreased in only one patient. Patients reported few adverse effects to quinapril, and no important clinical laboratory abnormality was observed. Quinapril not only lowered arterial pressure, but it had a distinct effect on regression of left ventricular hypertrophy and favorable effects on renal function.

Objective: The contractile response to digitalis and β adrenoceptor agonists is lower in the senescent than in the adult myocardium, while the development of ventricular arrhythmias is increased. The aim of this study was to examine the effects of aging on cardiac response to digitalis and an adrenergic agonist used clinically. Methods: The electrical and mechanical responses were tested in isolated and perfused hearts from 3-24 month old rats receiving 15 min infusion of digitalis drug (ouabain, 6 × 10−5 M) alone, and after 5 min of β adrenoceptor agonist drug (epinine, 1.5 × 10−7 M). Results: Ouabain action was associated with a rise in left ventricular end diastolic pressure (p

"Federico II" University of Naples Hospital Management's Staff considered 47 informed consent forms in order to evaluate quality and quantity of the information transmitted to patients. Every form, distinguished by procedure (surgical, pharmacological, anesthesiologic or related to blood transfusions) was evaluated for the accuracy and validity of information related to: diagnosis, prognosis, diagnostic and therapeutic opportunities, expected benefits, adverse-side effects, iatrogenic risks, privacy policy on personal data. The forms were judged by information completeness criteria "conformed" or "not conformed" with standards. Our analysis demonstrate that physicians often are unaware of legal and ethical topics related to constructing informed consent forms. They usually omit crucial information or would use strict technical language. So far, we conclude Hospital Management's Staff definitively has a role in improving informed consent forms by establishing guidelines and promoting ethical issues. Final result could be to deserve stronger patient confidence in medical institutions.

Little is known to what extent spontaneous beat-to-beat changes in QT duration can contribute to its variations. Thus, the authors defined the amount of rate-independent changes in QT duration on continuous 24-hour electrocardiograms in 11 healthy subjects (6 M, 5 F, aged between 19 and 80 years). Mean daily QTc was 419 msec, with a mean daily standard deviation of 24 msec. Mean daily QTc variability was 29/spl plusmn/10 msec; the mean coefficient of variation for QTc was 5.6/spl plusmn/.8% Marked hour-to-hour variations in QT value at the same RR cycle length were evident specially at higher heart rates. These results indicate that there is a considerable beat to beat variability of the QTc interval. The casual importance of interventions inducing QT variations cannot be accurately assessed, unless the amount of the heart rate-independent QT variability is considered QT variations /spl les/39 msec (mean+1 SD) should be considered physiologic.

The effects of the angiotensin converting enzyme (ACE) inhibitor captopril (SQ 14225) on intraocular pressure (IOP) were studied. Four groups were analyzed: group A, ten control subjects; group B, ten hypertensive patients with normal IOP; group C, ten normotensive patients with primary open angle glaucoma (POAG); and group D, ten hypertensive patients with POAG. Systolic and diastolic blood pressure, heart rate, pupil diameter, IOP and total outflow facility were recorded at baseline and at 1-h intervals up to 3h after an oral dose of 25 mg captopril or placebo, given in a randomized, double-blind cross-over fashion. The alternative treatment was given a week later. Captopril significantly lowered IOP in all patients, with no effects on heart rate and pupil diameter. Blood pressure changed only in patients with hypertension (groups B and D). Total outflow facility, measured by conventional tonography, increased significantly in all groups. These findings indicate that oral captopril could represent a new antiglaucomatous compound.

We evaluated the efficacy and safety of gallopamil 150 mg daily in middle-aged and elderly patients with stable exertional ischemia, using a medium-term randomized double-blind cross-over placebo-controlled trial. Twenty middle-aged patients (52.8 +/- 6 years; range 38-61 years) and 14 elderly patients (67.4 +/- 2.8 years; range 65-73 years) with stable exertional ischemia underwent a bicycle exercise test. After a run-in period, both groups received treatment with either placebo or gallopamil 50 mg tid for 28 days. At the end of this time, each patient crossed over to the alternate regimen. Gallopamil significantly reduced heart rate, blood pressure and rate pressure product (from 15.37 +/- 2.7 to 13.65 +/- 4.16 U x 10(-3); p < 0.01) in elderly patients at submaximal exercise, but had no effect in middle-aged patients (from 14.52 +/- 4.45 to 13.49 +/- 3.77 U x 10(-3); p = NS). At peak exercise, none of the hemodynamic parameters was modified with gallopamil in either group. At peak exercise, both middle-aged and elderly patients achieved rate-pressure products similar to those reached during placebo at higher work loads. Exercise duration and maximal work load significantly increased in both groups. Electrocardiographic signs of ischemia were favorably influenced by gallopamil in both groups (from 1.39 +/- 0.5 mm to 0.76 +/- 0.73 mm; p < 0.001 in the middle-aged patients and from 1.5 +/- 0.34 mm to 1 +/- 0.76 mm; p < 0.01 in the elderly patients).(ABSTRACT TRUNCATED AT 250 WORDS)

We evaluated the acute therapeutic effects of the oral administration of nifedipine (10 mg) and diltiazem (120 mg) alone and in combination in 16 patients with effort angina. The 16 patients (13 men and three women; mean age 59 +/- 7 years) performed a symptom-limited bicycle exercise stress test 3 h after placebo or active substance administration. Maximal work load, exercise duration and time to 1 mm ST segment depression were significantly increased and ST depression at peak exercise was significantly decreased by the combination of drugs. Nifedipine and diltiazem alone similarly improved exercise duration as markedly as their combination. One patient stopped the test after all three treatments for angina associated with ST depression2 mm. The combination of drugs yielded the best symptomatic effect: only four patients complained of angina in comparison to eight and seven patients after diltiazem and nifedipine, respectively. Nifedipine and diltiazem are effective and safe antianginal drugs. Some patients respond better to one drug than to the other. Patients who remain symptomatic in spite of maximal doses of a single drug may derive some benefit from combination therapy.

It has been previously reported that an increase in diastolic blood pressure greater than 15 mmHg comparing values at rest with those on treadmill exercise, with or without ST changes, enhances the probability of coronary artery disease. To investigate whether the diastolic blood pressure variation keeps its diagnostic value during upright bicycle exercise, we evaluated the diastolic blood pressure variations in 111 patients with angiographically documented coronary artery disease without previous myocardial infarction and in 53 patients with normal coronary arteries undergoing maximal stress testing on a bicycle ergometer. The sensitivity of diastolic blood pressure (DBP) variations to detect coronary artery disease was 66%, the specificity 32%, the positive predictive value 67%, the negative predictive value 31% and the predictive accuracy 55%. The respective values for ST depression were 83% (P less than 0.001 vs DBP variations), 53% (P less than 0.05 vs DBP variations), 64% (P less than 0.05 vs DBP variations) and 75% (P less than 0.001 vs DBP variations). Forty-nine of the 75 patients with multivessel coronary artery disease and 60 of the 89 patients without coronary artery disease or with single vessel disease had abnormal DBP variations (sensitivity 65; specificity 33%). The sensitivity of ST segment depression in predicting multivessel disease was 91% (P less than 0.001 vs DBP variations), and the specificity 42%. Thus, for bicycle ergometer exercise testing, ST segment depression seems to be more accurate than DBP variations in the diagnosis of coronary artery disease.

The response of coronary hemodynamics to the intracoronary (i.c.) bolus administration of gallopamil, 1.5 and 3.0 micrograms/kg, was evaluated in 14 patients with normal coronary arteries. Gallopamil, 3.0 micrograms/kg, induced a small and transient decrease in systolic and mean arterial pressure and a small increase in the preejection period. Coronary sinus blood flow increased significantly at 30 s (p less than 0.01) and returned to baseline 10 min after gallopamil administration. Coronary vascular resistance was still reduced at 10 min and returned to baseline at 15 min. Myocardial O2 consumption and extraction decreased significantly (p less than 0.01) at 30 s. While myocardial O2 consumption returned to baseline 15 min after gallopamil administration, myocardial O2 extraction was still significantly reduced at this time. Milder and more transient changes were observed after i.c. administration of the lower dose (1.5 micrograms/kg), and no significant changes were found after i.c. administration of saline. These data show that i.c. gallopamil, in patients with normal coronary arteries, induces direct, transient, and dose-related peripheral coronary vasodilation. The reduction of myocardial O2 consumption and extraction suggests a direct negative inotropic and metabolic effect of gallopamil.

We studied 40 subjects, 20 under 60 yrs old (10 normotensive and 10 hypertensive) and 20 over 60 yrs old (10 normotensive and 10 hypertensive). Each patient underwent a 24-hour ambulatory blood pressure monitoring (8:00 a.m. to 8:00 a.m.), by a noninvasive method using an ICR 5300 apparatus. Systolic blood pressure was significantly higher on random measurement and during the daytime in the older patients. Although comparison of the other parameters did not reveal significant differences, we noted a tendency to higher systolic values among the older group, and higher diastolic values in the younger one. The variability of the values was slightly higher, although not significantly, among the older patients. In both groups random systolic measurements, and in the younger group diastolic values as well, were significantly higher than mean 24 hour values. The incidence of abnormal systolic BP values ranged from 18.8% to 100% (mean 60.2% +/- 28.9) in younger hypertensives, and from 54% to 100% (mean 76.5% +/- 14.4) in older patients. The incidence of abnormal diastolic BP values ranged from 64.5% to 100% (mean 80.4% +/- 15.6) in younger patients and from 47.2% to 96% (mean 67.8% +/- 15.8) in older patients. The correlation between mean systolic and diastolic values recorded from 8:00 to 10:00 a.m., and mean 24-hour values was significant in young hypertensives, while in the older group there was a significant correlation only for diastolic BP. The lack of significance for systolic values is probably due to a greater variability in systolic pressure in elderly subjects during the morning.(ABSTRACT TRUNCATED AT 250 WORDS)

This study was designed to investigate whether the cholinergic system is involved in the genesis of the reflex vasodilatation which follows the systemic hypertension induced by fast intravenous injection of norepinephrine in the dog. Accordingly, in 7 dogs the gracilis muscle was isolated and perfused and the reflex evoked. The analysis of the integrated areas of vasodilatation after atropine pretreatment showed a significant decrease of the reflex response in the perfused circulation. In fact, the mean value of the integrated areas of vasodilatation which was 66 ± 8 mm Hg/min in the control condition, was reduced to 45 ± 4 mm Hg/min after administration of atropine in the gracilis artery; meanwhile the integrated areas of systemic hypertension did not show any change. Phentolamine intra-arterial administration completely abolished the reflex. These results suggest the existence of a cholinergic component in the reflex vasodilatation induced by transitory baroreceptorial stimulation.

Previous studies have focused on the usefulness of systolic time intervals to assess changes of myocardial function. In a recent report, hyperlipoproteinemia (HLP) was shown to induce early signs of vascular disease in asymptomatic subjects. By means systolic time intervals (STI) we studied left ventricular function in normal subjects and asymptomatic patients with HLP, who showed normal response to exercise on a bicycle ergometer. The results showed mean values of STI for the population in the normal range, according to standards accepted in North American reports. Different values of STI were found when we compared the data of controls with the STI of HLP patients with higher values of PEPI and PEP/LVET and lower values of LVETI in HLP patients. These results suggest that hyperlipoproteinemia affects STI in asymptomatic patients, probably as a sign of early impairment of left myocardial function.

The influence of severity of coronary artery disease (CAD) on the duration of corrected electrical systole (QTc) and the prognostic value to predict sudden death of this index were retrospectively evaluated in 123 non-consecutive patients with history of stable angina who underwent cardiac catheterization. Fifteen patients had no angiographic evidence of CAD (O-V group). The 108 patients with a greater than or equal to 70% luminal diameter narrowing of a major coronary artery were further subdivided: 23 patients had 1-vessel (1-V group), 40 patients had 2-vessel (2-V group) and 45 had 3-vessel (3-V group) coronary artery disease; 26 patients showed normal left ventricular (LV) wall motion (A group), 57 patients showed asynergic contraction of 1 or 2 LV areas (B group) and 25 patients showed 3 or more areas of asynergy and/or aneurysm. Sixty-one patients had a previous myocardial infarction (MI). QT interval, calculated in the lead where it was longer, on 12-lead resting electrocardiograms recorded at a paper speed of 25 mm/sec, was corrected by the formula: QTc = QT/square root R-R. The follow-up was performed by telephone. At the time of angiography there was no significant difference in QTc duration between the different groups according to the severity of CAD (O-V, 1-V, 2-V and 3-V groups). Patients showing three or more areas of abnormal segmental wall motion and/or aneurysm (C group) had a significantly longer QTc (p less than 0.05) than patients with normal LV wall motion (A group).(ABSTRACT TRUNCATED AT 250 WORDS)

This study was undertaken to evaluate the efficacy of coronary artery by-pass grafting (CABG) in elderly patients with coronary artery disease. A consecutive series of 79 patients, 65 years of age and older, who underwent CABG from 1975 to 1981 was analysed and their follow up status ascertained. This group was compared with a consecutive series of 397 patients under the age of 65 who underwent CABG during the same period. The patients aged 65 years or greater had a higher incidence of unstable angina pectoris (p less than 0.05). Coronary angiographic and left ventriculographic features were comparable in both age groups; also comparable were the number of saphenous veins graft utilized and the number of left ventricular aneurysmectomies and mitral valve replacements performed. The hospital mortality rate for patients aged 65 years and older was 12.6%, for those aged less than 65, it was 8.3%; if the other cardiac procedures are excluded mortality rates become 12.5% and 6.0% respectively (n.s.). Survival at 6 years was 92% for patients in both age groups. However, the symptomatic status was less favourable in older patients, compared with that obtained in younger patients (p less than 0.05).

In order to evaluate the diagnostic value of exercise-induced Q wave changes and its relationship with the extent of coronary involvement and presence and location of a previous myocardial infarction, we examined the stress electrocardiograms of 188 consecutive patients with chest pain. Coronary arteriography shoved single vessel disease (SV) in 28 patients and multivessel disease (MV) in 130 patients; a previous myocardial infarction was present in 64 patients. The Q wave amplitude was measured as average of ten values in CM5 at rest and at peak exercise; a Delta-Q less than 0, i.e. reduction or no change of Q wave at peak exercise, was considered a positive response for coronary artery disease. The Delta-Q criterion shoved a significantly better sensitivity than ST depression, as a whole, but this improvement was nullified when patients with anterior myocardial infarction were excluded; as well specificity of Delta-Q although better than ST, did not allow a significant improvement for the diagnostic value of stress test. We also evaluated the diagnostic accuracy for multivessel coronary artery disease of both criteria positive was 78% whereas the negative predictive value of both criteria negative was 91%. We concluded that the exercise-induced Delta-Q less than 0 is a good indicator of coronary artery disease, although not superior to ST depression; the negativity of both criteria seems to be highly reliable for the exclusion of multivessel coronary artery disease.

The Authors have researched to adapt Orthomyxovirus, subtype A/equi-2 (Naples/213/67, Andria/60/68 and Miami/63), by serial passages on kidney calf cells, chick embryo cells and RK-13 cell line or by one or two passages on these colture media alternated with one passage "in ovo". The results obtained show that only kidney calf cells are most suitable because the viruses replicate for eleven passages. On the chick embryo cells and RK-13 cell line the viruses replicate only for two passages and these results are not modified when one or two passages are alternated with one passage "in ovo". The Authors have observed the production of infectious but not haemadsorbing and haemagglutining virus. The phenomenon is discussed and integrated with collateral tests.

The Authors have presented the clinical, hemodynamic, coronary arteriographic and left ventriculographic findings, and the results of medical and surgical treatment in 17 patients with main left coronary artery disease (MLCA). Clinically MLCA disease can only be suspected, in the AA's experience, if a patient presents with markedly positive exercise stress test and/or unstable angina. Coronary arteriography and left ventriculography confirmed the high incidence of associated 2-3 vessel coronary artery disease and of severe left ventricular segmental wall motion abnormalities. Surgical results and clinical follow up have indicated a better prognosis and quality of life in operated, compared with medically treated patients. Our experience confirms that MLCA disease is a dangerous clinical entity, which, when suspected, must be managed with proper indication to coronary arteriography and aorto-coronary bypass surgery, both associated, in our experience, with acceptable morbidity and mortality and good long term results.

This study was performed to determine if QT prolongation before and during early exercise is related to the occurrence of exercise-induced ventricular arrhythmias (EIVA). EIVA occurred in 47 of 142 patients with angiographic evidence of coronary artery disease (CAD); no EIVA occurred among the 22 patients without CAD (OV). Resting QTc and QT intervals during early exercise were similar in patients without EIVA, irrespective of the presence or absence of CAD; however resting QTc was significantly longer in CAD patients who showed EIVA (443 +/- 40 ms; P less than 0.01) than in CAD patients without EIVA (424 +/- 37 ms) and in OV patients (421 +/- 32 ms). During early exercise, the QT interval remained significantly longer in patients with than in those without EIVA. There was a trend toward increasing resting QTc in patients who exhibited EIVA more severe than grade 3. When resting QTc was longer than 440 ms, subsequent EIVA were correctly predicted in CAD patients with a sensitivity of 43%, a specificity of 72% and a predictive accuracy of 63%. Thus, a trend toward longer resting QTc values exists in CAD patients who develop EIVA; however, a long resting QTc (greater than 440 ms) appears to be only a weak predictor of subsequent EIVA.

Study was performed to assess if the increase of age can affect heart rate (HR) and systolic time intervals (STI) in a population of children, adolescents and young adults. We made polygraphic recordings in 66 normal subjects (5-25 years old) and regression equations were obtained for STI and age, HR and age and STI and HR. We found a significant relationship of HR and STI with age. Equally STI were correlated with HR. PEP/LVET ratio was unaffected by age or HR. We considered moreover mean values of HR and STI in four age-groups (5-10, 11-15, 16-20, 21-25). Data comparison showed higher LVET and lower HR in elder subjects. These had moreover higher PEP versus younger groups. The Authors believe that the relationship of HR, STI and age, undemonstrated by several other studies, can be found if we consider a large of age. Because other authors studied a little range of age, our demonstration of no statistically significant different values of HR and STI between 5-10 and 11-15 groups, authorize us to consider that the effect of age is highly significative on HR and STI among children, adolescents and young adults.

In order to assess the vectorcardiographic pattern of the athlete's heart, we evaluated the vectorcardiograms of 17 professional footballers; the signs of ventricular hypertrophy were particularly studied. 9 athletes had left ventricular hypertrophy, 3 showed VCgraphic signs of combined ventricular hypertrophy and 5 had normal vectorcardiograms. In all athletes with left ventricular hypertrophy the initial forces had normal spatial orientation (I A left ventricular hypertrophy). Likely, the combined right ventricular hypertrophy explains these VCgraphic patterns. The QRS loop did not show abnormal morphology, only the high magnitude of the spatial maximum QRS vectors was significant for diagnosis of left ventricular hypertrophy. The increase of the cardiac volumes induced by training might explain the high magnitude of the QRS loop.

A single-blind study (n = 59) was performed to assess the effect of long-term (4 week) orally administered molsidomine (2 mg 4 X daily), isosorbide dinitrate (10 mg 4 X daily), and placebo on exercise tolerance performed on the bicycle ergometer by patients with stable angina on effort and with significant coronary artery disease. Isosorbide dinitrate had similar effects to placebo, both failed to modify the pressure-rate product, the sustained work load, and the ST segment depression, but slightly decreased, although not significantly, the incidence of angina. Although not affecting the pressure-rate product and the mean blood pressure, molsidomine decreased significantly the ST segment depression (p less than .05). In conclusion, by markedly reducing preload and because of its long-lasting effect (up to 6 h), the new vasodilator drug molsidomine plays a useful role in the long-term management of stable angina on effort.

The purpose of our research was to evaluate the relationship between the severity of ventricular arrhythmias in the first hours of myocardial infarction and the duration of electrical systole (QT). Twelve-lead resting electrocardiograms (ECGs) of 66 non-consecutive patients admitted to our Coronary Care Unit for myocardial infarction were retrospectively evaluated. Criteria for retrospective selection of patients were the following: 1) admission to the coronary care unit within 12 hours from the onset of myocardial infarction symptoms; 2) appropriate ECG changes suggesting acute transmural infarction (pathologic Q waves, envolving ST changes) and diagnostic elevation of serum enzymes activity; 3) good-quality ECG recordings with sinus rhythm and no conduction defects, recorded before the beginning of therapy and within the first hours after the onset of symptoms. After this first selection, the following criteria of exclusion were applied: 1) abnormal values of serum Ca++ and K+; 2) historical and/or electrocardiographic findings of a previous myocardial infarction; 3) chronic treatment with antiarrhythmic or beta-blocking drugs, digitalis or other drugs affecting the QT interval; 4) administration of drugs affecting the QT interval before admission; 5) clinical signs of left ventricular failure or cardiogenic shock at admission or during the hospitalization; 6) development of severe ventricular arrhythmias after 24 hours from the onset of symptoms. Three subgroups were individuated : group A: 39 patients with non life-threatening ventricular arrhythmias; group B: 12 patients with episodes of ventricular tachycardia within the first 12 hours of myocardial infarction; group C: 15 patients with episodes of ventricular fibrillation within the first 12 hours of myocardial infarction.(ABSTRACT TRUNCATED AT 250 WORDS)

New ecgraphic criteria has been proposed to improve diagnostic availability of R wave changes (delta R) and algebra summation of delta R and ST segment depression (delta RST) in comparison to the criterion of ST depression (ST). The AA. considered as a positive test for a diagnosis of coronary artery disease (CAD): delta R and delta RST values greater than or equal to 0. In 69 patients with stenosis, 75% of at least one major coronary vessel, delta RST showed correct diagnosis in 87% of cases, R in 81% and ST in 73%. RST sensitivity was better than that of ST (P = 0,02). In 44 patients with normal coronaries delta RST was able to correct diagnosis in 52% of cases, delta R in 57% and ST in 73%. ST specificity was better than that of delta RST (P = 0,04). Predictive accuracy was comparable for the three criteria. In normal healthy subjects everyone with an exercise test negative for CAD, with ST analysis, delta R and delta RST was 0 in 16% of cases. New ecgraphic criteria, also showing a better sensitivity in comparison with ST segment analysis, have a worsened specificity. The Authors do not consider these methods a significant improvement in ecgrahic evaluation of exercise test.

This study was designed to investigate whether the cholinergic system is involved in the genesis of the reflex vasodilatation which follows the systemic hypertension induced by fast intravenous injection of norepinephrine in the dog. Accordingly, in 7 dogs the gracilis muscle was isolated and perfused and the reflex evoked. The analysis of the integrated areas of vasodilatation after atropine pretreatment showed a significant decrease of the reflex response in the perfused circulation. In fact, the mean value of the integrated areas of vasodilatation which was 66 +/- 8 mm Hg/min in the control condition, was reduced to 45 +/- 4 mm Hg/min after administration of atropine in the gracilis artery; meanwhile the integrated areas of systemic hypertension did not show any change. Phentolamine intra-arterial administration completely abolished the reflex. These results suggest the existence of a cholinergic component in the reflex vasodilatation induced by transitory baroreceptorial stimulation.

The antianginal effects of 360 mg/day of diltiazem were evaluated, using intrapatient comparisons, in a double/blind, randomized, placebo/controlled trial in 24 young patients (50 +/- 7 years) and in 16 elderly patients (67 +/- 3 years) with stable effort angina. All patients had angiographic documentation of significant coronary artery disease. An open-labelled, randomized, crossover design was employed. For 1 week prior to beginning the study, the patient was on no medication except sublingual nitrates. The study consisted of an initial 2-week single-blind placebo run-in period followed by a 4-week randomized double-blind crossover between diltiazem, 120 mg t.i.d., and placebo. A diary of chest pain and nitroglycerin usage was kept during this period and run-in. Exercise tests were carried out during the run-in period (2 tests) and at the end of the 4-week treatment. After diltiazem 12 of the 24 young patients stopped the exercise test because of angina. A similar number (9/16) of elderly patients stopped the exercise test because of angina. During diltiazem treatment, weekly angina frequency was significantly reduced in the young patients (1.25 +/- 0.67 vs 3.87 +/- 1.19-run-in, 4.08 +/- 1.24-placebo; p less than 0.01) and in the elderly patients (0.87 +/- 0.71 vs 4.06 +/- 1.48-run-in, 4.12 +/- 1.5-placebo; p less than 0.01). Weekly TNT consumption significantly decreased in both groups of patients.(ABSTRACT TRUNCATED AT 250 WORDS)

The Authors studied correlations between angiocardiography and changes of R wave amplitude (delta R) during effort in 113 patients. They showed coronarographic evidence: 69 with stenosis greater than or equal to 70% of at least one major coronary vessel and 44 with no significant lesions. delta R values greater or equal than 0 were considered as pathologic. delta R appeared greater than or equal to 0 in 8 of 14 patients (57%) with single stenosis, 4 (28%) with abnormal wall motion (AWM). delta R increase or unchanged in 26 of 31 (84%) patients with double stenoses, 25 of them (81%) with AWM. delta R was greater than or equal to 0 in 22 of 24 (92%) with triple stenoses. In subjects with milk coronary artery disease (CAD) R wave increased or unchanged in 47% (19/44). Pathologic changes of R wave are highly frequent in CAD patients, especially in those with severe impairment. These changes, however, are not specific or costant because they appeared enough frequently in subjects with normal doronary vessels, and, moreover, R wave may decrease also in CAD patients with severe impairment. The Authors consider that evidence of delta R values greater than or equal to 0 may not be considered as a sign of CAD, but it must be evaluated with the other data showed by ergometric tests.

The relationship between QT/QS2 ratio and angiographic severity of coronary heart disease (CHD) was determined in 99 patients who underwent coronary arteriography because of chest pain. Sixteen control patients with normal coronary arteriograms and normal left ventricular function and 83 patients with angiographic evidence of CHD were studied. QT/QS2 ratio and systolic time intervals were calculated from poligraphic recordings taken at rest. In control subjects QT/QS2 ratio was significantly shorter (0.91 +/- 0.04) than in patients with double (0.95 +/- 0.07; p less than 0.05 versus control subjects) and triple vessel coronary artery disease (0.95 +/- 0.05; p less than 0.05 versus control subjects). QT/QS2 ratio was significantly higher (p less than 0.01) in patients with 3 areas or more of left ventricular abnormal wall motion (LV AWM) (0.98 +/- 0.05) than in patients with none (0.92 +/- 0.06) or just 1-2 areas (0.93 +/- 0.06) of LV AWM. Multiple regression analysis revealed no relation between the number of coronary stenoses and QT/QS2 (t = 0.86; p = NS), while a relation was identified between the number of asynergic segments and QT/QS2 (t = 1.99; p less than 0.05). A significant correlation was found between QT/QS2 and PEP/LVET (r = 0.39; p less than 0.001). Setting the upper normal limit at 2 standard deviations from the mean of control subjects (QT/QS2 = 0.99), QT/QS2 criterion yielded a 30% sensitivity, a 94% specificity and a 96% predictive accuracy in diagnosing CHD. We conclude that in CHD patients QT/QS2 ratio is influenced by the extension of LV AWM. Although a low sensitivity may limit its use, a QT/QS2 value higher than 0.99 in a patient with chest pain strongly suggests CHD and thus this criterion may be diagnostically useful.