[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to assess the differential response in left ventricular mass and resistive index (RI) of renal and carotid arteries in mild to moderate essential hypertensive patients after 1 year of ACE inhibitor therapy. Twenty-six patients (mean age 42.9 +/- 10.9 years) underwent 24-hour ambulatory blood pressure monitoring, echocardiography and renal and carotid echo-Doppler (by measuring RI, as an expression of arterial impedance) after a placebo period and 12 months of fosinopril treatment (20 mg/day). Our study showed a significant decrease in 24-hour BP (p < 0.05), left cardiac mass (p < 0.05) and RI of common carotid and hilum renal arteries (p < 0.05). In contrast, there were no significant reductions in the interlobar renal RI (as an expression of unchanged intrarenal resistance) and in the internal carotid artery RI. While the 24-hour BP decrease was strongly correlated with the left cardiac mass modifications (r = 0.73, p < 0.005), no significant relationship was observed with the renal and carotid artery parameters. In conclusion, the present study demonstrated that long-term treatment with fosinopril produced a differential response in left ventricular mass and arterial RI in patients with mild to moderate essential hypertension. In addition, the arterial impedance modifications of common carotid and hilum renal artery were largely unrelated to the 24-hour BP reduction.
No preview · Article · Feb 1998 · Clinical Drug Investigation
[Show abstract][Hide abstract] ABSTRACT: Allograft coronary artery disease is the leading cause of mortality after cardiac transplant. Although angiography is considered the gold standard for diagnosis, it tends to underestimate the extent of vasculopathy, because it cannot detect microvascular involvements. Dobutamine stress echocardiography identifies myocardial hypoperfused areas inducing local hypokinesia or akinesia. From 1990 to 1996 162 patients underwent cardiac transplantation in our Institution. In the period 1993-1996 47 patients (mean age 45.2 ± 6 years, mean duration since surgery 33.2 ± 24 months) had a standard echo-stress test evaluation (dobutamine infusion schedule 5, 10, 20, 30, 40 mcg/kg/min at 5 min step). An 11 segment wall motion score model was used (modified American Society of Echocardiography criteria) and positive test was defined as a new or worsening left ventricular regional wall motion abnormality. Ejection fraction, end-diastolic and end systolic volumes, and wall motion score index were calculated at rest and at each step. Results were compared with angiographic (Gao's criteria) and endomyocardial bioptic data. In 39 patients (Group 1) angiography, endomyocardial biopsy and dobutamine stress echocardiography were negative for allograft coronary artery disease. In 6 patients (Group 2) angiography and stress echocardiography were positive for allograft coronary disease. In 2 patients (Group 3) angiography was negative and stress echocardiography positive for coronary disease. In 2 patients with normal angio-dobutamine test resulted positive. In conclusion, 1) results suggest that dobutamine-stress echocardiography is a reliable noninvasive test to detect epicardial vascular involvement; 2) repeated echo-dobutamine tests enabled us to detect the onset of allograft coronary artery disease (transition from normal to pathologic test), and was useful in early diagnosis of the disease.
[Show abstract][Hide abstract] ABSTRACT: Pericardial heart valve bioprostheses have been utilized for 20 years. In spite of encouraging initial results, long-term follow-up showed a higher incidence of structural failures and primary tissue failures than porcine bioprostheses. Pericarbon represents the newest generation of bovine pericardial bioprostheses. Aim of this study is the long-term evaluation with echocardiographic and color Doppler technique of an innovative bioprostheses, in particular, its morfological and functional characteristics. From 1985 to 1989, 78 consecutive patients (21 males, 57 females, mean age 56.5 +/- 8.16 years) underwent mitral valve replacement with Pericarbon 29, by the same operator, who preserved the mitral posterior leaflet. One month after operation, 21 of these patients underwent echo-color Doppler evaluation, in normalized hemodynamic conditions (normality ranges). In 1995, at the end of the followup, 30 of the remaining 54 patients underwent new echo-color Doppler evaluation and these data were compared with normality ranges values. Leaflets' thickness increased from 0.98 +/- 0.09 to 2.87 +/- 0.73 mm (anterior leaflet; p < 0.0001) and from 1.02 +/- 0.08 to 2.71 +/- 0.45 mm (posterior leaflet; p < 0.0001) 43.3% of anterior leaflet and 53.3% of posterior leaflet showed fibrocalcic lesions. Mean transvalvular gradient increased from 3.4 +/- 0.2 to 6.6 +/- 3.4 mmHg (p < 0.0001); also functional area decreased (p < 0.0001). We have found no paraprosthetic regurgitation and a very low number of central prosthetic regurgitation. Left ventricular function, evaluated by ejection fraction and regional kinesis, remained substantially preserved.