E Racca

Azienda Sanitaria Ospedaliera S.Croce e Carle Cuneo, Coni, Piedmont, Italy

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Publications (15)8.86 Total impact

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    ABSTRACT: Cardiac resynchronization therapy (CRT) has been shown to improve the clinical status and survival in congestive heart failure (CHF) patients, but little is known about its influence on neurohormonal profile. Heart failure patients treated with CRT for moderate/severe heart failure were studied with echocardiography, cardiopulmonary test, and neurohormonal profile [brain natriuretic peptide (BNP), endothelin (END), big endothelin (big-END), epinephrine (EPI), tumor necrosis factor-alpha (TNF-alpha)] at baseline and after 1 year from the pacemaker implantation. 120 NYHA II-IV patients entered this study, all with an indication to CRT; 100 agreed to be implanted (group A), whereas 20 refused, identifying a control group (group B). In group A NYHA class (from 3.15+/-0.49-1.15+/-0.49, p=0.001), left ventricular ejection fraction (from 19.6+/-4.95-35.6+/-5.95%, p=0.001), severity of mitral regurgitation (from 13.3+/-4.19-6.09+/-4.11 cmq, p=0.001), and peak VO(2) (from 9.68+/-4.61-13.35+/-3.32 mL/kg/min, p=0.001) improved at 1-year follow-up. In the neurohormonal profile only plasma BNP (from 185.1+/-185.9-110.2+/-137.5 pg/mL, p=0.03) and big-END (from 1.8+/-1.5-0.87+/-0.7 fmol/mL, p=0.007) were reduced significantly. None of these parameters significantly changed in the control group at 1-year follow-up. In patients with moderate/severe heart failure, CRT improved clinical status and the functional parameters modifying the neurohormonal profile at 1-year follow-up.
    Archives of Medical Research 11/2008; 39(7):702-8. · 2.08 Impact Factor
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    ABSTRACT: Background: The value of the signal-averaged electrocardiogram (ECG) for prediction of arrhythmic events (AE) after myocardial infarction (MI) has been well established. The current incidence of AE in the first year after Ml is remarkably lower than that reported in the 1980s. In this study, we compared the prevalence and the predictive value of late potentials (LP) in patients with Ml treated with either conventional or reperfusion therapy.Methods: A total of 433 patients (age 62 ± 10 years, 350 men) recovering from acute Ml were prospectively analyzed. Two hundred seven patients had conventional therapy (group A), and 226 had reperfusion therapy (group B) within 12 hours of the onset of symptoms: 145 of group B patients received thrombolytic agents, whereas 81 underwent direct or rescue angioplasty. Standard signal-averaged variables were recorded (filter range 40–250 Hz) 10 ± 6 days (range 5–30 days) after Ml. LP were defined as being present if 2 of the following were met: fQRS <114 ms, RMS40 20 μV, LAS40 <38 ms (criterion 1), and if QRS 120 ms (criterion 2).Results: LP were found in 33% versus 21%, P = 0.004 (criterion 1) and in 13% versus 8%, P = 0.057 (criterion 2) of group A and group B patients, respectively. During a mean follow-up of 24 ± 19 months (range 5 days to 48 months), there were 22 AE (5%). The AE rate for patients with conventional therapy was significantly higher in those with LP than in those without LP: 12% versus 4%; P = 0.03 (criterion 1) and 30% versus 3%; P = 0.00003 (criterion 2). The AE rate for patients with reperfusion therapy was similar in patients with and without LP: 9% versus 3%, P = 0.09 (criterion 1) and 12% versus 3%, P = 0.14 (criterion 2). Multivariate analysis indicated that the presence of LP based on criterion 2 was the strongest independent predictor of AE in patients with Ml treated with conventional therapy.Conclusion: In this study, reperfusion therapy influenced the prevalence of LP. The predictive value of LP for serious AE in the postinfarction period was remarkably affected by thrombolysis and/or interventional catheter therapy.
    Annals of Noninvasive Electrocardiology 10/2006; 3(3):202 - 210. · 1.08 Impact Factor
  • European Journal of Heart Failure Supplements 01/2003; 2(1).
  • European Journal of Heart Failure Supplements 01/2003; 2(1).
  • Journal of Nuclear Cardiology 01/2001; 8(1). · 2.85 Impact Factor
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    ABSTRACT: The purpose of the study was to assess the usefulness of single photon computed tomography (SPECT) with adenosine in the diagnosis of coronary artery disease (CAD) in patients (pts) with hypertension, heart failure and left bundle branch block (LBBB). Twenty consecutive hypertensive pts (12 male; age 64 ± 5.4 years) were admitted to our Hospital with chest pain (9 angina and 11 atypical chest pain) and dyspnea (NYHA II–IV). All pts had complete LBBB and no history of previous myocardial infarction. All pts underwent adenosine TC99 tetrofosmin SPECT and coronary angiography. Adenosine was infused at a constant rate of 140 μg/kg body weight per min for 6 min. The results of SPECT were analysed qualitatively and semiquantitatively (dividing the left ventricle into 20 segments, score from 0 = normal to 4 = absence of detectable tracer uptake in one segment). Four (20%) pts were diabetics, 7 (35%) had hyperlipidemia and 9 (45%) were cigarette smokers. The mean ejection fraction was 37.4 ± 7.9%. The qualitative analysis of SPECT showed: 3 (15%) normal scans; 11 (55%) fixed defects (8 in LAD territory, 2 in LAD + RCA and 1 in RCA territory) and 6 (30%) reversible perfusion defects (1 three-vessel distribution, 3 in RCA; 1 in LAD + RCA and 1 in LAD territory). The summed rest score (SRS) and the summed stress score (SSS) were calculated as 11.1 ± 8.5 and 12.7 ± 8.5 (p = 0.5) respectively. Four (20%) pts had critical stenosis (>70% narrowing) at coronary angiography: 2 had three-vessel disease and 2 had single-vessel disease (1 LAD and 1 RCA). The sensitivity of SPECT in these pts was 75% and the specificity 62%. The positive predictive value was 33%, and the negative predictive value was 91%.It is confirmed that fixed perfusion defects in the septal wall do not usually correspond to coronary stenosis of the LAD. The high negative predictive value of SPECT could be useful for the exclusion of CAD in hypertensive pts with heart failure and LBBB.
  • Journal of Nuclear Cardiology 01/1999; 6(1). · 2.85 Impact Factor
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    ABSTRACT: Concomitant anterior ST-segment depression is a marker of severe prognosis in inferior myocardial infarction. Prospective observational study in patients with inferior acute myocardial infarction and ST-segment depression > or = 4 mm in the anterior leads, who were treated with primary angioplasty. Angiography was performed at hospital discharge and at six months, and a clinical follow-up was obtained at one year after the infarction. Sixty-three patients were included in the study. Pre-hospital and in-hospital delay were 147 +/- 70 minutes (20-355) and 54 +/- 11 minutes (18-80), respectively. Angioplasty was successful in all patients and 48 stents were implanted in 36 patients (57%). Angiography was performed at hospital discharge in 55 patients (87%) and showed a TIMI grade 3 coronary flow in the infarct-related artery in all cases. The left ventricular ejection fraction was 0.55 +/- 0.09 (0.4-0.8). One patient (1.6%) died before discharge, two (3.2%) had ischemic complications (one had non-fatal reinfarction, another had recurrent angina at rest), and three (4.9%) had local vascular complications. At the six-month follow-up, none of the patients had died. One had suffered reinfarction (1.6%) and another had been readmitted for recurrence of angina at rest (1.6%); none had symptoms of stable angina. The ejection fraction was 0.56 +/- 0.12 and eight patients (14%) showed angiographic restenosis. At twelve months, two patients had died (1.6%) and five (8%) had required readmission to hospital. Primary angioplasty yielded favorable results in this group of patients. Our data confirm the efficacy of primary angioplasty for the treatment of acute myocardial infarction, with a low rate of clinical (3.2%) and angiographic (14%) restenosis at six months, and a high rate (87%) of event-free survival at one year follow-up.
    Giornale italiano di cardiologia 07/1998; 28(7):781-7.
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    ABSTRACT: The early invasive diagnostic approach with extensive use of myocardial revascularization in patients with unstable angina is a matter of debate. Both the advantages of this strategy and the choice of the best candidates are controversial. The widespread applicability of this approach in Italian hospitals is also questionable, due to limited availability of facilities for interventional cardiology. A prospective, observational study was done on a cohort of consecutive patients, who were admitted with a diagnosis of unstable angina and treated with an early aggressive approach at a center with interventional cardiology facilities without cardiac surgery. The aim of the study was to evaluate both the immediate and long-term clinical outcome of patients and the efficiency of our therapeutic approach. Two-hundred and two patients were enrolled and 85% were in Braunwald class III. Coronary angiography was performed in 171 patients (85%) at 2.1 +/- 2.4 days after admission: it showed one-, two- and three-vessel disease in 40, 29 and 22% of cases, respectively; 9% of patients had no severe coronary lesion. Left ventricular ejection fraction was 0.58 +/- 0.13. Medical treatment, coronary by-pass surgery and percutaneous myocardial revascularization were chosen in 36, 24 and 40% of cases, respectively. Coronary angioplasty was performed in our center in 58 (73%) of 80 patients at 6.8 +/- 5.6 days after admission and stents were used in 42 cases (74%). Overall hospital stay was 10.4 +/- 4 days. Cumulated adverse events (death and non-fatal myocardial infarction) occurred in 2.5 and 7% of patients during the initial admission and in the following year, respectively. An early aggressive approach to patients with unstable angina is feasible in a hospital with interventional cardiology in the absence of cardiac surgical facilities. The immediate favorable clinical results of this strategy in an intermediate-risk cohort seem to persist at one-year follow-up.
    Giornale italiano di cardiologia 02/1998; 28(2):112-9.
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    ABSTRACT: The presence of late potentials (LP) after myocardial infarction (MI) is related to an occluded infarct-related coronary artery (IRA). However, the effects of the signal-averaged electrocardiogram (SAECG) of systemic thrombolysis are contradicting. Reperfusion in the IRA is more frequently observed after primary percutaneous transluminal coronary angioplasty (PTCA) than after systemic thrombolysis. The aim of this prospective study was to compare the prevalence of LP in survivors of acute MI treated with either systemic thrombolysis or primary PTCA. Between October 1994 and January 1997, 134 patients (pts) with acute MI were treated with reperfusion therapy within 12 hours of the onset of symptoms: seventy-four pts received systemic thrombolysis and 60 underwent primary PTCA. All pts (mean age 61 +/- 10 years, 120 males) had a control coronary angiography 9 +/- 5 and 10 +/- 4 days after acute MI, respectively. The recorded signals were amplified, averaged and filtered with bi-directional Butterworth filtering (band-pass filter range of 40-250 Hz). LPs were defined as the presence of 2 or 3 of the following criteria: filtered duration of the QRS complex > 114 ms, root mean square voltage of signals in the last 40 ms of the QRS < or = 20 mV and duration of the low amplitude signals > 38 ms. The two groups of pts did not differ significantly with respect to age, gender, presence of either diabetes or hypertension, site of MI, previous MI, Killip class, time to treatment, peak CK-MB level, incidence of reinfarction, extent of coronary artery disease and left ventricular ejection fraction. One hundred pts (75%) had patency (TIMI 3 grade flow) of the IRA at control coronary angiography. Twenty-seven pts (20%) had LP: 16 pts (22%) among those treated with systemic thrombolysis and 11 pts (18%) among those treated with primary PTCA (p = ns). Pts treated with primary PTCA had higher patency rates [95% (57/60) vs 58% (43/74); p = 0.00002] and less severe residual stenosis (19 +/- 15% vs 72 +/- 18%; p = 0.0001) in the IRA. LP were found in 15 pts (15%) with TIMI 3 grade flow and in 12 pts (35%) with TIMI 0-2 grade flow (p = 0.017). By multivariate analysis, including 18 clinical and electrocardiographic variables, an occluded IRA was the only independent predictor of the development of LP (Wald chi 2: 6.1453; p = 0.0132). Results of this prospective study suggest that primary PTCA alone does not reduce the prevalence of LP when compared to systemic thrombolysis. Only the patency of the IRA, as determined before the hospital discharge, affected the development of LP after acute MI.
    Giornale italiano di cardiologia 01/1998; 28(1):3-11.
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    ABSTRACT: The lower prevalence of ventricular late potentials (LPs) in signal-averaged electrocardiograms (SAECG) observed in patients (pts) treated with systemic thrombolysis, as compared with SAECGs in conventionally treated pts, has been attributed to the patency of the infarct-related artery. Mechanical reperfusion, achieved by means of either primary or rescue percutaneous transluminal coronary angioplasty (PTCA), is associated with higher permeability rates and reduced residual stenosis in the infarct-related artery, when compared to systemic thrombolysis. The aim of this retrospective study was to assess the prevalence of LPs in pts recovering from a first high-risk acute myocardial infarction (AMI) treated with primary or rescue PTCA. Fifty-nine pts (48 pts with clinical signs or electrocardiographic evidence of high-risk AMI or in whom systemic thrombolysis was inadvisable, and 11 pts in whom systemic thrombolysis failed) underwent emergency PTCA within 10 hours of the onset of symptoms. All pts (mean age 61 +/- 9 years, 48 M) were monitored via coronary angiography 9 +/- 4 days after AMI. The SAECG was obtained 10 +/- 4 days after AMI. LPs were defined as the presence of 2 or 3 of the following criteria: filtered duration of the QRS complex > 114 ms, duration of the low amplitude signals > 38 ms and mean square-root voltage of signals in the last 40 ms of the QRS < or = 20 microV. Primary and rescue PTCA were performed 3 +/- 1.7 and 6.3 +/- 2 hours after AMI, respectively (p = 0.000). Fifty-six pts (95%) had patency (TIMI 3 grade flow) of the infarct-related artery (mean residual stenosis: 18.3 +/- 14.2%) confirmed by control coronary angiography, while the infarct-related artery was occluded in three pts. Sixteen out of 59 pts (27%) had LPs: 14/56 (25%) with TIMI 3 grade flow and 2/3 (67%) with TIMI 0 grade flow. Pts with and without LPs were comparable for age, sex, infarct location, Killip Class, mean peak CK-MB, time to control coronary angiography, time to SAECG, left ventricular ejection fraction, presence of multivessel disease, infarct-related artery and mean residual stenosis in infarct-related artery. LPs were observed more frequently after rescue PTCA than after primary PTCA (64 vs 19%; p = 0.005). Time to treatment was significantly longer in pts with LPs than in those without (4.9 +/- 2.6 vs 3.2 +/- 1.7 hours; p = 0.025). Multivariate analysis indicated that the type of PTCA (primary vs rescue PTCA) was the only independent predictor for the development of LPs. In this study, the prevalence of LPs in pts with patency of the infarct-related artery after primary or rescue PTCA was surprisingly high. Delay to treatment and type of PTCA affected the presence of LPs. The association between infarct-related artery status and prevalence of LPs has not been analyzed, due to the low number of pts with coronary artery occlusion in the control coronary angiography.
    Giornale italiano di cardiologia 11/1997; 27(11):1144-52.
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    ABSTRACT: Several studies showed that time domain analysis of the signal-averaged ECG may identify groups of patients with low and high risk for arrhythmic events after myocardial infarction (MI). However, the signal averaging methods were not uniform and the definition of abnormal signal-averaged ECG was empiric. To identify the best quantitative signal-averaged variable in predicting arrhythmic events (sustained ventricular tachycardia, ventricular fibrillation and witnessed, instantaneous death) 262 patients surviving acute MI were prospectively evaluated. Twelve clinical variables, left ventricular ejection fraction (LVEF), complex ventricular arrhythmias (CVA) on Holter monitoring and three conventional signal-averaged variables (either at 25-250 or 40-250 Hz) were entered in a Cox proportional hazards regression model. During a mean follow-up of 20.3 +/- 13.7 months 16 (6.1%) patients had arrhythmic events. All six signal-averaged variables were independent predictors of arrhythmic events and the filtered QRS duration (fQRSD) > or = 120 ms at 40 Hz high pass filtering resulted the most predictive. In a regression analysis, including the best signal-averaged variable, LVEF and CVA, only fQRSD > or = 120 ms at 40 Hz and LVEF independently predicted arrhythmic events. Sensitivity, specificity, positive predictive value and odds ratio for fQRSD > or = 120 ms at 40 Hz were 63, 90, 29 and 11%, respectively, and for the combination of fQRSD > or = 120 ms at 40 Hz and LVEF < 40%, were 73, 95, 47 and 39%, respectively. In conclusion, the fQRSD > or = 120 ms at 40 Hz best predicts arrhythmic events in the post-infarction period. The combination of signal-averaged ECG and LVEF is recommended to stratify patients at risk of arrhythmic events after MI.
    Cardiologia (Rome, Italy) 12/1996; 41(12):1183-92.
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    ABSTRACT: We report our experience of Quality Assurance in a Cardiac Catheterization Laboratory of the National Health Service. An attempt was made to apply these criteria to the medical activities as well as to the management and economic aspects of our work. Limits and perspectives of this experience are discussed as a contribution to ongoing debate among cardiologists and public health Authorities.
    Giornale italiano di cardiologia 10/1994; 24(9):1055-67.
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    ABSTRACT: A bus driver came to our observation after an occupational traffic accident due to a syncopal event. The positive result of the tilt testing demonstrated the neurally-mediated nature of the syncope. The accident involved approximately 40 people (all the bus passengers), fortunately without severe injuries or deaths. The described episode indicates the need for a procedural algorithm, commonly approved, applicable in the field of prevention, for those occupational categories with severe accident risk. Indeed, the possibility exists to identify at least a part of the subjects predisposed to neurally-mediated syncope. Fundamental steps for such screening are history taking (looking for previous events, familiarity), the physical examination (useful, for example, to exclude orthostatic hypotension or carotid sinus syncope), and, in particular, the tilt testing, a diagnostic investigation recommended for all the workers who have had a previous syncope and are at high occupational accident risk. Moreover, the reported case recalls the need to strengthen the collaboration between the cardiologist and the occupational health physician.
    Giornale italiano di medicina del lavoro ed ergonomia 29(2):166-9.