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3. Coronary angiographic patterns in hypertensive compared with normotensive patients

Author

De Cesare, Nicoletta, Polese, Alvise, Cozzi, Sergio, Apostolo, Anna, Fabbiocchi, Franco, Loaldi, Alessandro, Montorsi, Piero, and Guazzi, Maurizio D.

Subjects
Angiocardiography -- Methods, Coronary arteries -- Abnormalities, Hypertension -- Complications, Heart attack -- Risk factors, Atherosclerosis -- Complications, Health
Abstract

Hypertension, or high blood pressure, has a variety of adverse effects on health and longevity. Patients with hypertension are more likely to suffer acute myocardial infarction (heart attack), angina pectoris (heart-related chest pain), and sudden death than patients with normal blood pressure. Some, but perhaps not all, of this increased morbidity and mortality results from the higher incidence of coronary atherosclerosis (narrowing of the coronary arteries) among patients with high blood pressure. To investigate alterations in coronary artery function in hypertensive patients, a study was conducted with 320 normotensive and 320 hypertensive patients, all of whom underwent coronary angiography (an X-ray technique that uses a contrast dye in imaging arteries) because of abnormal exercise stress test results. In all the patients, angiography revealed 50 percent or greater stenosis (narrowing) of at least one major coronary artery. Single- and double-vessel stenosis was most prevalent in younger patients, and was evenly distributed between hypertensive and normotensive patients. In older patients, triple-vessel disease was more common; the percentage of hypertensive patients in their sixth and seventh decades with triple-vessel disease was significantly higher. Other variables, such as blood glucose, triglycerides, and cholesterol levels, and smoking habits, were similar in both groups. Hence, in younger patients, hypertension does not appear to be associated with more severe atherosclerosis; in older patients, hypertension is correlated with a greater narrowing of the coronary arteries. (Consumer Summary produced by Reliance Medical Information, Inc.)

Published
1991

6. Angiographic evolution of coronary atherosclerosis in patients receiving propranolol: a two-year follow-up

Author

Loaldi, Alessandro, Montorsi, Piero, Fabbiocchi, Franco, Polese, Alvise, Guazzi, Marco, De Cesare, Nicoletta, and Guazzi, Maurizio D.

Subjects
Coronary heart disease -- Development and progression -- Drug therapy -- Complications and side effects, Angina pectoris -- Drug therapy -- Development and progression -- Complications and side effects, Propranolol hydrochloride -- Complications and side effects, Hypertension -- Drug therapy -- Development and progression -- Complications and side effects, Atherosclerosis -- Development and progression -- Drug therapy -- Complications and side effects, Health, Drug therapy, Complications and side effects, Development and progression
Abstract

The beta-blockers were introduced into medicine for the treatment of angina pectoris, [1] but their most extensive use has been in hypertension. Millions of patients have been treated with them [...]

Published
1991

9. Microembolization During Carotid Artery Stenting in Patients With High-Risk, Lipid-Rich Plaque

Author

Montorsi, Piero, primary, Caputi, Luigi, additional, Galli, Stefano, additional, Ciceri, Elisa, additional, Ballerini, Giovanni, additional, Agrifoglio, Marco, additional, Ravagnani, Paolo, additional, Trabattoni, Daniela, additional, Pontone, Gianluca, additional, Fabbiocchi, Franco, additional, Loaldi, Alessandro, additional, Parati, Eugenio, additional, Andreini, Daniele, additional, Veglia, Fabrizio, additional, and Bartorelli, Antonio L., additional

Published
2011
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12. Comparison of nifedipine, propranolol and isosorbide dinitrate on angiographic progression and regression of coronary arterial narrowings in angina pectoris

Author

Loaldi, Alessandro, Polese, Alvise, Montorsi, Piero, De Cesare, Nicoletta, Fabbiocchi, Franco, Ravagnani, Paolo, and Guazzi, Maurizio D.

Subjects
Nifedipine -- Evaluation, Angina pectoris -- Drug therapy, Vasodilators -- Evaluation, Atherosclerosis -- Care and treatment, Propranolol hydrochloride -- Evaluation, Isosorbide dinitrate -- Evaluation, Health
Abstract

Calcium antagonists and [beta] blockers may retard or inhibit atherogenesis. This study investigated whether nifedipine or propranolol influences coronary atherosclerosis in humans. In selected patients with effort angina and prove coronary artery disease, the cineangiographic pattern after 2-year therapy with nifedipine (group 1, 39 patients), propranolol (group 2, 36 patients) or isosorbide dinitrate (group 3, 38 patients) was compared to that before treatment. The disease evolved to a different extent in the 3 groups. Patients with evidence of progression of old narrowings and appearance of new narrowings were significantly fewer in group 1 (31% and 10%) than in group 2 (53% and 34%) and group 3 (47% and 29%). The number of stenoses withe evidence of progression was significantly smaller after nifedipine (14), and larger after propanolol (39) compared with group 3 (24). Thus, nifedipine seemed more protective than the other 2 drugs against coronary atherosclerosis. The coronary risk factors were normal in the nifedipine group and remained so with treatment, suggesting that they were dissociated from influences on atherosclerosis. The evolution, as judged by the number of narrowings with progression, appeared significantly (p [is less than]0.01) worse with propranolol than with isosorbide dinitrate. Propranolol caused unfavorable modifications of serum lipids; there was a 28% increase in total triglycerides and a 25% decrease in high density lipoprotein cholesterol at 12 months in group 2. (Am J Cardiol 1989;64:433-439), The use of beta blockers and calcium antagonists (agents that are used in the control of blood pressure) has been found to prevent or slow the progress of atherogenesis, the formation of plaque along the walls of the arteries. The effectiveness of three drugs was examined: nifedipine (a calcium inhibitor), propranolol (a beta-block), and isosorbide dinitrate (a nitroglycerin derivative which opens passages of heart). One hundred thirteen patients with angina pectoris, a severe chest pain, and atherogenesis were matched for age and extent of disease. These individuals were then divided into three groups of approximately the same number, each group receiving treatment with one of these drugs over a two-year period. The group taking isosorbide dinitrate served as the control. Measurements were taken to determine how or if the disease had progressed. The group that took nifedipine was found to have less progression of atherogenesis where the arteries had previously become narrowed, and fewer incidents of new narrowings were observed. A lower incidence of progression of stenosis was recorded in this group as well, when compared with the group that took propranolol. The propranolol group not only compared poorly to the first group, but was found to have a 28 percent higher total triglyceride count and a 35 percent lower count of high density lipids (HDL) when measurements were made 12 months into the study. Clearly, nifedipine proved to be the superior treatment for atherogenesis. It was less clear if propranolol was merely less effective than the isosorbide dinitrate or if propranolol actually aggravated the existing condition. Further research into consequences of the increase in triglycerides and the decrease in HDLs which accompanied the use of propranolol was recommended.

Published
1989

13. Intracoronary hyperoxemic blood infusion following primary percutaneous coronary intervention in anterior acute myocardial infarction patients: Positive effects on cardiac enzyme kinetic, ST-segment changes, and left ventricular function recovery

Author

Trabattoni, Daniela, primary, Fabbiocchi, Franco, additional, Montorsi, Piero, additional, Marenzi, Giancarlo, additional, Loaldi, Alessandro, additional, Ravagnani, Paolo, additional, Celeste, Fabrizio, additional, Galli, Stefano, additional, Grancini, Luca, additional, and Bartorelli, Antonio L., additional

Published
2003
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14. Comparison of outcomes in women and men treated with coronary stent implantation

Author

Trabattoni, Daniela, primary, Bartorelli, Antonio L., additional, Montorsi, Piero, additional, Fabbiocchi, Franco, additional, Loaldi, Alessandro, additional, Galli, Stefano, additional, Ravagnani, Paolo, additional, Cozzi, Sergio, additional, Grancini, Luca, additional, Liverani, Antonio, additional, Leon, Maria E., additional, Robertson, Chris, additional, and Boyle, Peter, additional

Published
2002
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18. Use of a new diagnostic catheter for transradial internal mammary artery angiography early after minimally invasive coronary bypass

Author

Cozzi, Sergio, primary, Antona, Carlo, additional, Montorsi, Piero, additional, Fabbiocchi, Franco, additional, Loaldi, Alessandro, additional, Apostolo, Anna, additional, Teruzzi, Giovanni, additional, Galli, Stefano, additional, Ravagnani, Paolo, additional, Grancini, Luca, additional, Trabattoni, Daniela, additional, and Bartorelli, Antonio L., additional

Published
2000
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33. Changes in Systemic and Pulmonary Vascular Reactivity in Hypertension Following Nifedipine and Verapamil.

Author

Bailo, Mariangela, Fiorentini, Cesare, Folli, Andreina, Galli, Claudia, Loaldi, Alessandro, Maltagliati, Anna, Tosi, Elena, Tamborini, Gloria, and Guazzi, Maurizio D.

Subjects
PULMONARY blood vessels, BLOOD-vessel physiology, CHEMICAL reactions, HYPERTENSION, CARDIOVASCULAR diseases, NIFEDIPINE, VASODILATORS, VERAPAMIL, CARDIOVASCULAR agents, THERAPEUTICS
Abstract

Excessive vascular tone and overresponsiveness to adrenergic stimuli characterize the hemodynamics of the greater and the lesser circulation in hypertension. We tested whether calcium entry blockade with verapamil (11 cases) or nifedipine (11 cases) may improve the vascular regulation in high blood pressure. Mental arithmetic and cold were used as adrenergic activators. The former stimulus produced obvious elevation of epinephrine plasma concentration, increase of cardiac output (CO), slight systemic vasodilatation, pulmonary vasoconstriction, and rise of blood pressure in both circuits. After calcium antagonists, the epinephrine reaction to the arithmetic test was significantly attenuated, variations in CO and systemic blood pressure were unchanged, pulmonary vasoconstriction was abolished, and the pressure rise in the lesser circuit was halved. The cold pressor test increased norepinephrine plasma concentration (NE pc), systemic and pulmonary blood pressure, and vascular resistance and did not alter CO. The attained NE pc during cold was unvaried after verapamil and significantly enhanced after nifedipine; pressure and resistance responses of the two circuits were almost unchanged after the former, whereas systemic and pulmonary vascular resistance rises were importantly attenuated after the latter compound, resulting in much lower pressure reactivity. A modulation of the sympathoadrenal reaction, per se, can explain changes in the systemic and in the pulmonary vasomotion with calcium blockade during arithmetic. It would seem that after verapamil the sympathetic system was still activated during cold to such an extent as to maintain the same vasoconstrictor potency. NE pc suggests that the sympathetic discharge was not reduced by nifedipine. The impressive attenuation of the constrictor reaction in the two circuits would imply the existence of a shared vascular disorder in which calcium ions are involved, which is more sensitive to nifedipine. [ABSTRACT FROM AUTHOR]

Published
1987
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34. Microembolization During Carotid Artery Stenting in Patients With High-Risk, Lipid-Rich Plaque A Randomized Trial of Proximal Versus Distal Cerebral Protection

Author

Montorsi, Piero, Caputi, Luigi, Galli, Stefano, Ciceri, Elisa, Ballerini, Giovanni, Agrifoglio, Marco, Ravagnani, Paolo, Trabattoni, Daniela, Pontone, Gianluca, Fabbiocchi, Franco, Loaldi, Alessandro, Parati, Eugenio, Andreini, Daniele, Veglia, Fabrizio, and Bartorelli, Antonio L.

Subjects
embolic protection, carotid stenting, cerebral embolization
Abstract

ObjectivesThe goal of this study was to compare the rate of cerebral microembolization during carotid artery stenting (CAS) with proximal versus distal cerebral protection in patients with high-risk, lipid-rich plaque.BackgroundCerebral protection with filters partially reduces the cerebral embolization rate during CAS. Proximal protection has been introduced to further decrease embolization risk.MethodsFifty-three consecutive patients with carotid artery stenosis and lipid-rich plaque were randomized to undergo CAS with proximal protection (MO.MA system, n = 26) or distal protection with a filter (FilterWire EZ, n = 27). Microembolic signals (MES) were assessed by using transcranial Doppler during: 1) lesion wiring; 2) pre-dilation; 3) stent crossing; 4) stent deployment; 5) stent dilation; and 6) device retrieval/deflation. Diffusion-weighted magnetic resonance imaging was conducted before CAS, after 48 h, and after 30 days.ResultsPatients in the MO.MA group had higher percentage diameter stenosis (89 ± 6% vs. 86 ± 5%, p = 0.027) and rate of ulcerated plaque (35% vs. 7.4%; p = 0.019). Compared with use of the FilterWire EZ, MO.MA significantly reduced mean MES counts (p < 0.0001) during lesion crossing (mean 18 [interquartile range (IQR): 11 to 30] vs. 2 [IQR: 0 to 4]), stent crossing (23 [IQR: 11 to 34] vs. 0 [IQR: 0 to 1]), stent deployment (30 [IQR: 9 to 35] vs. 0 [IQR: 0 to 1]), stent dilation (16 [IQR: 8 to 30] vs. 0 [IQR: 0 to 1]), and total MES (93 [IQR: 59 to 136] vs. 16 [IQR: 7 to 36]). The number of patients with MES was higher with the FilterWire EZ versus MO.MA in phases 3 to 5 (100% vs. 27%; p < 0.0001). By multivariate analysis, the type of brain protection was the only independent predictor of total MES number. No significant difference was found in the number of patients with new post-CAS embolic lesion in the MO.MA group (2 of 14, 14%) as compared with the FilterWire EZ group (9 of 21, 42.8%).ConclusionsIn patients with high-risk, lipid-rich plaque undergoing CAS, MO.MA led to significantly lower microembolization as assessed by using MES counts. (Carotid Stenting in Patients With High Risk Carotid Stenosis [“Soft Plaque”] [MOMA]; NCT01274676)

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35. Nifedipine and Angina Pectoris

Author

Cesare, Nicoletta De, Bartorelli, Antonio, Fabbiocchi, Franco, Loaldi, Alessandro, Montorsi, Piero, Polese, Alvise, and Guazzi, Maurizio D.

Abstract

Changes induced by nifedipine (10 mg sublingually) in the residual luminal diameter of significant (>50 percent) coronary lesions were assessed angiographically in 69 patients with effort-induced angina (group 1), in 22 patients with mixed angina (group 2),and in 14 patients with Prinzmetal's angina (group 3). These changes were related to the clinical response to treatment with the same drug, as evaluated through diary records and Holter monitoring in the mixed (spontaneous component) and Prinzmetal forms and through exercise testing in effort-induced and mixed (effort-associated component) angina. In groups 1 and 2, segments of stenotic vessels showed either an increase or decrease or no change in diameter with the calcium antagonist; in group 3, the majority of the lesions had compliant portions which invariably responded with dilatation. Nifedipine failed to improve cases with exertional (20 percent [14/69] unchanged; 19 percent [13/69] worsened) and mixed (41 percent [9/22] exacerbated) forms; 100 percent of the 14 patients with the Prinzmetal form had relief of the anginal episodes. In group 1, the response to exercise tests was dissociated from the short-term vasomotor pattern, and the pressure-rate product failed to explain the clinical results. Forty-five percent (ten) of the patients in group 2 showed significant short-term widening of critical stenoses, as well as obvious improvement; patients who did worse with treatment in this group had reacted to nifedipine with narrowing of critical stenoses. These data suggest that the response to nifedipine of classic effort-induced angina is probably the net result of an interaction of changes in myocardial oxygen consumption and supply; coronary vasomotion has a role in mixed angina, and influences of nifedipine may be either favorable or unfavorable; stenotic lesions in the Prinzmetal form are quite sensitive to the relaxant action of calcium blockade, and this probably represents a background to the highly positive clinical response to treatment.

Published
1988
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41. Comparison of outcomes in women and men treated with coronary stent implantation.

Author

Trabattoni D, Bartorelli AL, Montorsi P, Fabbiocchi F, Loaldi A, Galli S, Ravagnani P, Cozzi S, Grancini L, Liverani A, Leon ME, Robertson C, and Boyle P

Subjects
Age Factors, Aged, Angina Pectoris diagnostic imaging, Coronary Angiography, Female, Humans, Male, Middle Aged, Retrospective Studies, Sex Factors, Time Factors, Angina Pectoris surgery, Blood Vessel Prosthesis Implantation adverse effects, Outcome Assessment, Health Care, Postoperative Complications, Stents adverse effects
Abstract

Worse outcomes have been observed in women after PTCA. The present study was undertaken to compare clinical and angiographic results of coronary stenting among women and men. We retrospectively analyzed acute and 6-month results in a consecutive series of 940 men and 160 women undergoing coronary stent implantation between May 1992 and January 1998. Women were older (63 vs. 57 years; P = 0.001), more often hypertensive (46.9% vs. 31.4%; P < 0.001) and diabetic (13.2% vs. 8.3%; P = 0.05), and less often smokers than men (32.5% vs. 70.5%; P < 0.001). A previous history of Q-wave MI was less frequently present in women (28.2% vs. 40.2%; P = 0.003) who more often underwent coronary revascularization because of unstable angina (37.5% vs. 27.1%; P = 0.027). No difference was observed in coronary artery disease extension, lesion complexity, and stented vessel between the sexes. Bailout stenting was more frequently needed in women (28% vs. 17.8%; P = 0.001). No difference was observed in the number of stent implanted per vessel and per patient and average maximal inflation pressure used for stent postdilation. However, a smaller final balloon size was used in women. Procedural and clinical success was achieved in 94.4% and 92.5% of women and 96.7% and 94.5% of men (P = NS), respectively, without differences regarding in-hospital major adverse cardiac events. Bleeding complications occurred more often in women when anticoagulation was used (OR = 2.87; 95% CI = 1.38-5.74). At 6-month clinical follow-up, TLR was similar between the sexes and event-free survival was 75.5% in women and 81.5% in men (P = NS). Angiographic follow-up, performed in 71% of the patients, showed that restenosis was 64% higher in women (OR = 1.64; 95% CI = 1.02-2.61). Despite older age, higher incidence of comorbidities, and more unstable presentation, women treated with coronary stenting showed acute and mid-term clinical results similar to those observed in men. However, they were significantly more likely to develop angiographic restenosis., (Copyright 2003 Wiley-Liss, Inc.)

Published
2003
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