[Show abstract][Hide abstract] ABSTRACT: OBJECTIVES: To compare transesophageal echocardiography (TEE) and intracardiac echocardiography (ICE) for the diagnosis of cardiac device endocarditis (CDI). BACKGROUND: The diagnosis of infective endocarditis (IE) is established using the modified Duke criteria based mainly on echocardiography and blood cultures. No previous studies compared ICE to TEE for the diagnosis of IE. METHODS: We prospectively enrolled 162 patients (72±11 years; 125 male) who underwent transvenous lead extraction: 152 with CDI and 10 with lead malfunction (control group). Using the modified Duke criteria, we divided the patients with infection into 3 groups: 44 with "definite" diagnosis of IE (group 1), 52 with "possible" diagnosis of IE (group 2) and 56 with "rejected" diagnosis of IE (group 3). TEE and ICE were performed before the procedure. RESULTS: In group 1, ICE identified intracardiac masses (ICM) in all 44 patients; TEE identified ICM in 32 patients (73%). In group 2, 6 patients (11%) had ICE and TEE both positive for ICM, 8 patients (15%) had a negative TEE but a positive ICE and 38 patients (73%) had ICE and TEE both negative. In group 3, 2 patients (3%) had ICM both at ICE and TEE, 1 patients (2%) had an ICM at ICE and a negative TEE, 53 patients (95%) had no ICM at ICE and TEE. ICE and TEE were both negative in the control group. CONCLUSION: ICE represents a useful technique for the diagnosis of ICM, thus providing improved imaging of right-sided leads and increasing the diagnostic yield as compared to TEE.
Journal of the American College of Cardiology 03/2013; 61(13). DOI:10.1016/j.jacc.2012.12.041 · 16.50 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Experimental studies suggest that alcohol may have protective effects similar to that of ischemic preconditioning (IPC). The acute effects of alcohol on IPC in humans, however, are poorly known. In this study, we assessed the effect of alcohol administration on the warm-up phenomenon, as an expression of IPC, in patients with stable coronary artery disease (CAD). We randomized 45 stable CAD patients with positive (ST-segment depression > or =1 mm) exercise stress test to 1 of 3 groups of 15 patients each: (1) group 1 = 60 cc of gin (18.5 g of ethanol); (2) group 2 = 180 cc of red wine (18.9 g of ethanol); and (3) group 3 = placebo (120 cc of water). A first exercise test was performed 15 minutes after beverage administration. In those with a positive exercise test (13, 14, and 14 patients in the gin, wine, and placebo groups, respectively), a second exercise test was performed 15 minutes after the end of the first one. On the first test, there were no differences among groups in rate pressure product and time of exercise at 1-mm ST-segment depression, as well as in maximal ST segment depression. Furthermore, an improvement of the ischemic exercise variables was observed in each group, without any statistically significant differences among them. In conclusion, our data show that, in stable CAD patients, the acute intake of low doses of alcohol does not significantly influence IPC, as expressed by the warm-up phenomenon on exercise stress testing.
The American Journal of Cardiology 07/2008; 102(2):146-9. DOI:10.1016/j.amjcard.2008.03.025 · 3.28 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Recent data suggest that vagus nerve stimulation (VNS) can inhibit cytokine release by inflammatory cells. Accordingly, an association between impaired cardiac parasympathetic function, as assessed by heart rate variability (HRV), and increased markers of inflammation has recently been reported. In this study we assessed the effect of direct left VNS on inflammatory markers and HRV in patients with refractory epilepsy.
A 24-hour electrocardiogram Holter recording was performed both at baseline and after 3 months of left VNS in 8 patients (age 32 +/- 24 years, 2 men) who underwent implantation of a VNS device because of refractory epilepsy. Tumor necrosis factor-alpha, interleukin-6 and C-reactive protein serum levels were measured, as markers of inflammation, at the same times.
No significant changes were found after 3 months of left VNS, compared to baseline, both for HRV variables and inflammatory markers. Also, no consistent correlation could be demonstrated between HRV parameters and inflammatory markers in these patients.
Our data in epileptic patients without cardiovascular disease failed to show a significant effect of left VNS on cardiac autonomic function and on systemic inflammation at short-term follow-up.