[Show abstract][Hide abstract] ABSTRACT: Only scanty data are available in the literature on P-wave (PW) morphology at ECG in patients with history of vasovagal syncope undergoing diagnostic functional testing. In this study, we evaluated resting and head-up tilt testing (HUTT) related changes in PW voltage (PWV) and duration (PVD) and their relationship with triggered syncope.
55 patients, mean aged 41±19y (35 F), without patent heart disease or neuropathy, underwent potentiated HUTT according to the Italian protocol. Heart rate (HR), blood pressure (BP), PR-interval, PWV and PWD were measured at rest, 15min from passive position (15-min) and after nitroglycerine (peak-HR). PW peaking (PWP) was calculated as percent increase in PWV than baseline values. Patients were divided into 2 groups based on tilt-positive (group-A) or negative (group-B) response.
20 patients (36%) entered the group-A, whereas 35 (64%) the group-B. Higher PWV was observed at baseline in group-A (0.147±0.034mV vs 0.114±0.036mV in group-B, p=0.001), with no differences in the remaining ECG measurements. BP was lower in group-A than in B, both at 15-min and peak-HR. HUTT-related PWP in lead II (the most significant among all inferior leads) was 31±30% in group-A vs 95±54% in group-B (p<0.0001) at 15-min, and 52±44% vs 112±72% at peak-HR, respectively (p=0.002). 75% of patients with PWP ≤50% experienced HUTT-triggered syncope, vs 5% of those with PWP ≥100% (p<0.0001).
This study shows a potential relationship between HUTT-triggered syncope and low or absent PWP, suggesting a role for atrial chamber functional involvement in the mechanisms underlying the vasovagal syncope.
Full-text · Article · Apr 2014 · European Journal of Internal Medicine
[Show abstract][Hide abstract] ABSTRACT: Cardiac allograft vasculopathy (CAV) is an accelerated form of coronary artery disease affecting both intramyocardial and epicardial coronary arteries and is observed in patients during long-term survival after cardiac transplantation. We report a case of CAV complicated with silent transmural myocardial infarction and massive left ventricular thrombus formation associated with silent pericarditis and with ischemic and non-ischemic scar tissue, as detected by cardiac magnetic resonance imaging (CMRI). The authors suggest CMRI as an additional technique along with echocardiography during follow-up of heart transplant recipients. CMRI may contribute to the early identification of areas of myocardial wall abnormalities suggestive of CAV, thus guiding diagnosis and prompt percutaneous treatment.
[Show abstract][Hide abstract] ABSTRACT: Though a severe left ventricular systolic dysfunction has been described in most patients with Takotsubo-like (or Apical Ballooning) syndrome, the occurrence of intra-cavitary thrombus formation seems to be such an exceptional finding. However, no large studies but single case descriptions of this complication are available over the last decade in the literature.
By searching for the PubMed-Medline database we selected 14 studies that met our eligibility criteria.
Demographic, clinical and morphofunctional characteristics of 15 patients who where described to have left ventricular thrombosis as a complication of the Takotsubo-like syndrome are comprehensively described in this review. Cardioembolic complications (stroke in 3 cases, renal infarction or popliteal artery thrombosis in other two) occurred in 33.3% out of them. The incidence of thrombus formation and related systemic embolisms in the general population with this syndrome were established on the basis of such available historical data and reviews on this subject.
Left ventricular thrombus formation has been reported in at least 14 studies (15 patients) over the last decade until the end of 2007. This approximately results in about 2.5% of all the patients with documented Takotsubo-like syndrome. Cardioembolic complications occurred in 5/15 cases, corresponding to 0.8% of the whole known population.
No preview · Article · Sep 2008 · International journal of cardiology
[Show abstract][Hide abstract] ABSTRACT: To investigate autonomic nervous system (ANS) function in mitochondrial disorders (MD).
MD are characterized by a wide range of clinical features, including heart abnormalities and peripheral and central nervous systems involvement. Rarely autonomic symptoms have been reported.
22 patients with MD underwent a battery of cardiovascular reflex tests including five tests of parasympathetic function and four tests of sympathetic function. Power spectral analyses (PSA) of heart rate variability in the supine and upright positions were also evaluated. Plasma levels of adrenaline, noradrenaline and dopamine were determined in the standing and lying positions.
Only 4/22 patients referred symptoms related to ANS dysfunction. 46% of patients had a definite autonomic damage (i. e. an autonomic score >/= 4). 36% showed moderate alterations with an autonomic score in the range 2-3 and 18 % had a normal autonomic function. MD patients had a significantly (p <0.03) lower increase of adrenaline level after standing.
Our data indicate an autonomic dysfunction in more than 80% of MD patients, even in the absence of a clinically manifested autonomic involvement. Cardiovascular autonomic investigation might be systematically employed in the characterization of MD.
Full-text · Article · Nov 2007 · Journal of Neurology
[Show abstract][Hide abstract] ABSTRACT: In this report the authors analyzed the usefulness of live 3-dimensional echocardiography in association with conventional 2-dimensional method to improve the recognition of left ventricular midcavitary obliteration in a patient with hypertrophic cardiomyopathy.
No preview · Article · Oct 2006 · Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography
[Show abstract][Hide abstract] ABSTRACT: Most patients with growth hormone deficiency (GHD) show high body mass index. Overweight subjects, but GHD patients, were demonstrated to have high left ventricular mass index (LVMi) and abnormal LV geometric remodeling. We sought to study these characteristics in a group of GHD patients, in an attempt to establish the BMI-independent role of GHD.
Fifty-four patients, 28 F and 26 M, aged 45.9 +/- 13.1, with adult-onset GHD (pituitary adenomas 48.2%, empty sella 27.8%, pituitary inflammation 5.5%, cranio-pharyngioma 3.7%, not identified pathogenesis 14.8%) were enrolled. To minimize any possible interferences of BMI on the aim of this study, the control group included 20 age- and weight-matched healthy subjects. The LV geometry was identified by the relationship between LVMi (cut-off 125 g/m2) and relative wall thickness (cut-off 0.45) at echocardiography.
There was no significant between-group difference in resting cardiac morphology and function, nor when considering age-related discrepancy. The majority of patients had normal-low LVM/LVMi, but about one fourth of them showed higher values. These findings correlated to relatively high circulating IGF-1 and systolic blood pressure at rest. The main LV geometric pattern was eccentric hypertrophy in 22% of GHD population (26% of with severe GHD) and in 15% of controls (p = NS).
Though the lack of significant differences in resting LV morphology and function, about 25% of GHD patients showed high LVMi (consisting of eccentric hypertrophy), not dissimilarly to overweight controls. This finding, which prognostic role is well known in obese and hypertensive patients, is worthy to be investigated in GHD patients through wider controlled trials.
Full-text · Article · Feb 2006 · BMC Endocrine Disorders
[Show abstract][Hide abstract] ABSTRACT: The assessment of coronary flow velocity is becoming crucial in the diagnosis and management of several cardiac dysfunctions and conventional Doppler echocardiography is currently the technique most widely used for detecting their abnormalities noninvasively.
We sought to evaluate the differences in coronary flow velocity using conventional transthoracic Doppler echocardiography, measuring both the left anterior descending and such intramural (IM) coronary arteries' flow, among the following 4 categories of patients with myocardial hypertrophy: group A, obstructive hypertrophic cardiomyopathy (n = 12); group B, nonobstructive hypertrophic cardiomyopathy (n = 10); group C, left ventricular hypertrophy (LVH) due to hypertension (n = 10); and group D, LVH due to aortic valve stenosis (n = 10).
No significant difference between the 4 groups was found with respect to the left anterior descending velocity. Diastolic peak (P < .01) and mean (P < .05) velocities in the IM arterioles were significantly higher in patients from groups A and D than in groups B and C. At multivariate analysis, both dynamic (group A) and fixed (group D) systolic peak gradients, measured by continuous wave Doppler sampling through the left ventricular (LV) outflow tract or the aortic valve, respectively, were found to be major determinants of the IM diastolic velocity, independently on the LV mass. About 75% of patients with obstructive hypertrophic cardiomyopathy showed IM peak and mean velocity >100 cm/s and >70 cm/s, respectively (P = .005).
These findings likely suggest [corrected] a role for the LV systolic obstruction within the intricate adaptive mechanisms of coronary blood flow to LVH.
Full-text · Article · Jun 2005 · American heart journal
[Show abstract][Hide abstract] ABSTRACT: Dyspnea and angina have been described in patients with hypertrophic cardiomyopathy (HCM). Given the complexity of the coronary microcirculation, the pathophysiological mechanisms of angina are discussed. The last generation of echo devices allows the investigation of epicardial coronary flow by means of the standard transthoracic approach (TTE). In the present study we describe 5 patients affected by HCM (with outflow tract dynamic obstruction in 2 cases, intraventricular dynamic obstruction in the other 2, no obstruction in the last one) in whom both the epicardial and intramyocardial coronary flows were assessed at high-resolution TTE. Regular flow velocities were shown in epicardial coronary arteries, while in intramyocardial branches the diastolic peak velocity was > 75 cm/s in all patients. Besides, the systolic flow was found to be inverted. Similar to what suggested by the few data presently available in the literature, the main findings of this study confirm the appropriateness of investigating the intramyocardial coronary circulation in patients with HCM by means of high-resolution Doppler echocardiography. In order to explain this clinical finding, an interesting hypothesis of a diastolic "milking-like" phenomenon associated with systolic "blood squeezing" in the intramural coronary arteries was taken into consideration. The noninvasive study of the intramyocardial coronary flow may be clinically relevant even in the evaluation of the effectiveness of the adopted therapeutic strategy in reducing myocardial wall stress in severe ventricular hypertrophy.
Full-text · Article · Oct 2002 · Italian heart journal: official journal of the Italian Federation of Cardiology