Elio Disegni - Academia.edu (original) (raw)
Papers by Elio Disegni
Journal of the American Society of Echocardiography, 1997
Blood volume shifts cause changes in preload, commonly estimated by the measurement ofventricular... more Blood volume shifts cause changes in preload, commonly estimated by the measurement ofventricular filling pressures (right atrial and capillary wedge pressure). The limitations of the hcmodynamic parameters in estimating preload are well lmown ~,2 and recent studies have stressed the limitations of capillary wedge pressure, once considered an accurate reflection of the left ventricular (LV) preload, in mcchanically ventilated patients. 2 4 Echocardiography, especially transesophageal
Journal of Clinical Epidemiology, 1995
The purpose of this study was to assess the predictive value of admission heart rate (HR) for in-... more The purpose of this study was to assess the predictive value of admission heart rate (HR) for in-hospital and 1 year post-discharge mortality in a large cohort of patients hospitalized for acute myocardial infarction (MI). Data were derived from the SPRINT-2 secondary prevention study population, and included 1044 patients (aged 5&79), hospitalized in 14 coronary care units in Israel with acute MI in the years 1985-1986, before the beginning of thrombolytic therapy in acute MI. Demographic, historical and medical data were collected for each patient. All deaths during initial hospitalization and 1 year post-discharge were recorded. In-hospital mortality was 5.2% for 294 patients with HR ~70 beats/min, 9.5% for 532 patients with HR 7&89 beats/min, and 15.1% for 323 patients with HR 290 beats/min (p < 0.01). One year post-discharge mortality was 4.3% for patients with HR < 70 beats/min, 8.7% for patients with HR 70-80 beats/min and 11.8% for patients with HR 2 90 beats/min (p < 0.01). An increasing trend of mortality with higher HR was confined to patients with mild CHF (p = 0.02) and likely to patients with absent CHF (p = 0.06), but this post hoc observation requires confirmation in larger groups. The combination of high admission HR (290 beats/min) and a systolic blood pressure < 120 mmHg was a powerful predictor of in-hospital mortality. Multivariate analysis showed that admission HR was an independent risk factor for in-hospital and 1 year post-discharge mortality. An increase in HR of 15 beats/min was associated with average estimated increases of in-hospital and 1 year post-discharge mortality of 36 and 45%, respectively. This study demonstrates that elevated admission HR is an independent predictor of in-hospital and subsequent mortality in patients with acute MI. Admission HR is associated with mortality in patients with mild CHF and likely also in counterparts without CHF. The association is clearly seen in men and is of similar magnitude, although not statistically significant for l-year mortality, in women. Heart rate Acute myocardial infarction Infarct mortality
Journal of Electrocardiology, 1980
A newborn with long QT interval and repetitive ventricular tachycardia of the "torsade de pointes... more A newborn with long QT interval and repetitive ventricular tachycardia of the "torsade de pointes" type was seen at the age of one day. The arrhythmia was resistant to lidoeaine, propranolol and atropine, but was controlled by isoproterenol infusion. A transvenous pacemaker, inserted at three days of age, suppressed the ventricular tachycardia at stimulation rates above ll0/minute. At 19 days of age a permanent pacemaker at pulse rate of 119 beats/minute was implanted. At one year of age the infant was thriving and was completely free of ventricular arrhythmia. Prolongation of the QT interval is often complicated by ventricular arrhythmias and in particular by the "torsade de pointes" type of ventricular tachycardia. 1-3 The acquired long QT syndrome, generally induced by drugs or by electrolyte imbalance, is transient and well controlled by temporary overdrive pacing. 1 In contrast, beta blocking agents are considered to be the treatment of choice in cases of congenital prolongation of the QT interval. 4 Left stellate gangliectomy is also sometimes performed in these cases. 5 Temporary or permanent cardiac pacing has been attempted only in a few patients with the congenital long QT syndrome, and with variable success. ~9 The case described below demonstrates that temporary, followed by permanent, overdrive pacing resulted in long-term suppression of malignant ventricular arrhythmias in a newborn affected by the long QT syndrome which was complicated by recurrent ventricular tachycardia of the "torsade de pointes" type.
Chest, 1985
Eleven patients with implanted pervenous pacemakers were found to have unusual QRS morphology res... more Eleven patients with implanted pervenous pacemakers were found to have unusual QRS morphology resembling right bundle branch block (RBBB) on the 12-lead electrocardiogram. In nine patients, the tip of the electrode catheter was established with certainty to be in the right ventricular apex. In eight of the nine, the standard leads showed a left bundle branch block pattern (LBBB), whereas only the precordial leads V1 and V2 resembled RBBB. In only one of the nine was the RBBB pattern also seen in the standard leads. In all nine, recording the precordial leads one intercostal space below the usual space eliminated the RBBB pattern in V1-V2 and resulted in inscription of a QS complex, whereas recording the leads one space higher than usual enhanced the height of the R wave. This is explained by the marked superior and slight anterior orientation of the main QRS complex in right ventricular pacing. It is suggested that the pattern of RBBB in V1-V2 + LBBB in lead 1 be named pseudo RBBB pattern since it does not represent left prior to right ventricular activation.
Archives of internal …, 1980
Prolongation of QT interval is associated with repetitive paroxysm of a particular ventricular ta... more Prolongation of QT interval is associated with repetitive paroxysm of a particular ventricular tachycardia. It is a typical complication of quinidine therapy but may occur in various other conditions. We used endocardial pacing in nine patients with prolongation of the QT interval who suffered from bouts of ventricular tachycardia and fibrillation. In six patients, the syndrome was due to quinidine and in three, to prenylamine. Acceleration of heart rate resulted in immediate suppression of all arrhythmias. Pacing was continued until the condition producing the QT prolongation disappeared. In one case, a permanent pacemaker was implanted, as the QT prolongation was congenital and permanent. The absolute QT interval was shortened by overdrive pacing from a mean value of 0.65 s to 0.50 s. The corrected QT interval remained prolonged (about 0.56 s). Thus, the arrhythmia was associated with the duration of the actual QT interval, and overdrive pacing was able to suppress it without shortening the corrected QT interval.
Archives of Internal Medicine, 1978
Two patients with a ruptured interventricular septum complicating acute myocardial infarction wer... more Two patients with a ruptured interventricular septum complicating acute myocardial infarction were treated with isosorbide dinitrate. The first patient recovered from cardiogenic shock after sublingual administration of 5 mg of isosorbide dinitrate every two hours and was successfully operated on. The second patient recovered from severe pulmonary edema during the acute stage of the infarction with sublingual isosorbide dinitrate. Moreover, she experienced a considerable symptomatic improvement when a 5 mg sublingual dose of isosorbide dinitrate every three hours was added to her long-term treatment. Analysis of hemodynamic data showed that the most striking change following administration of the drug was the substantial reduction of pulmonary wedge pressure. The striking symptomatic and hemodynamic improvement was achieved by the favorable effect of afterload reduction on left ventricular performance and not by reduction in left to right shunt.
Archives of Internal Medicine, 1978
Two patients with a ruptured interventricular septum complicating acute myocardial infarction wer... more Two patients with a ruptured interventricular septum complicating acute myocardial infarction were treated with isosorbide dinitrate. The first patient recovered from cardiogenic shock after sublingual administration of 5 mg of isosorbide dinitrate every two hours and was successfully operated on. The second patient recovered from severe pulmonary edema during the acute stage of the infarction with sublingual isosorbide dinitrate. Moreover, she experienced a considerable symptomatic improvement when a 5 mg sublingual dose of isosorbide dinitrate every three hours was added to her long-term treatment. Analysis of hemodynamic data showed that the most striking change following administration of the drug was the substantial reduction of pulmonary wedge pressure. The striking symptomatic and hemodynamic improvement was achieved by the favorable effect of afterload reduction on left ventricular performance and not by reduction in left to right shunt.
European heart journal, 1995
Insulin-like growth factor II (IGF-II) promotes cardiac myocyte growth and contractility in vitro... more Insulin-like growth factor II (IGF-II) promotes cardiac myocyte growth and contractility in vitro. This study was designed to investigate the effect of exogenous IGF-II on regional myocardial function at the area of infarct in the pig. Myocardial infarction was induced in 12 female anaesthetized pigs by affigel blue beads, embolizing microvessels of the left anterior descending coronary artery distribution. In the experimental group (n = 6), IGF-II (0.12 microgram.kg-1 in two animals and 0.6 microgram.kg-1 in four) was incorporated into the beads and delivered by them to the infarct area. Myocardial function was followed echocardiographically, and the excised heart was analysed immunohistochemically and histopathologically. Myocardial function in injured zones, inversely related to an echocardiographic segmental wall motion score (mean +/- SEM), was similar between the two groups at baseline, but at 4 weeks post-infarction was significantly (P = 0.008) reduced in the control group (...
Journal of Clinical Epidemiology, 1995
The purpose of this study was to assess the predictive value of admission heart rate (HR) for in-... more The purpose of this study was to assess the predictive value of admission heart rate (HR) for in-hospital and 1 year post-discharge mortality in a large cohort of patients hospitalized for acute myocardial infarction (MI). Data were derived from the SPRINT-2 secondary prevention study population, and included 1044 patients (aged 50-79), hospitalized in 14 coronary care units in Israel with acute MI in the years 1985-1986, before the beginning of thrombolytic therapy in acute MI. Demographic, historical and medical data were collected for each patient. All deaths during initial hospitalization and 1 year post-discharge were recorded. In-hospital mortality was 5.2% for 294 patients with HR < 70 beats/min, 9.5% for 532 patients with HR 70-89 beats/min, and 15.1% for 323 patients with HR > or = 90 beats/min (p < 0.01). One year post-discharge mortality was 4.3% for patients with HR < 70 beats/min, 8.7% for patients with HR 70-80 beats/min and 11.8% for patients with HR > or = 90 beats/min (p < 0.01). An increasing trend of mortality with higher HR was confined to patients with mild CHF (p = 0.02) and likely to patients with absent CHF (p = 0.06), but this post hoc observation requires confirmation in larger groups. The combination of high admission HR (> or = 90 beats/min) and a systolic blood pressure < 120 mmHg was a powerful predictor of in-hospital mortality. Multivariate analysis showed that admission HR was an independent risk factor for in-hospital and 1 year post-discharge mortality.(ABSTRACT TRUNCATED AT 250 WORDS)
Journal of the American Society of Echocardiography, 1997
Blood volume shifts cause changes in preload, commonly estimated by the measurement ofventricular... more Blood volume shifts cause changes in preload, commonly estimated by the measurement ofventricular filling pressures (right atrial and capillary wedge pressure). The limitations of the hcmodynamic parameters in estimating preload are well lmown ~,2 and recent studies have stressed the limitations of capillary wedge pressure, once considered an accurate reflection of the left ventricular (LV) preload, in mcchanically ventilated patients. 2 4 Echocardiography, especially transesophageal
Journal of Clinical Epidemiology, 1995
The purpose of this study was to assess the predictive value of admission heart rate (HR) for in-... more The purpose of this study was to assess the predictive value of admission heart rate (HR) for in-hospital and 1 year post-discharge mortality in a large cohort of patients hospitalized for acute myocardial infarction (MI). Data were derived from the SPRINT-2 secondary prevention study population, and included 1044 patients (aged 5&79), hospitalized in 14 coronary care units in Israel with acute MI in the years 1985-1986, before the beginning of thrombolytic therapy in acute MI. Demographic, historical and medical data were collected for each patient. All deaths during initial hospitalization and 1 year post-discharge were recorded. In-hospital mortality was 5.2% for 294 patients with HR ~70 beats/min, 9.5% for 532 patients with HR 7&89 beats/min, and 15.1% for 323 patients with HR 290 beats/min (p < 0.01). One year post-discharge mortality was 4.3% for patients with HR < 70 beats/min, 8.7% for patients with HR 70-80 beats/min and 11.8% for patients with HR 2 90 beats/min (p < 0.01). An increasing trend of mortality with higher HR was confined to patients with mild CHF (p = 0.02) and likely to patients with absent CHF (p = 0.06), but this post hoc observation requires confirmation in larger groups. The combination of high admission HR (290 beats/min) and a systolic blood pressure < 120 mmHg was a powerful predictor of in-hospital mortality. Multivariate analysis showed that admission HR was an independent risk factor for in-hospital and 1 year post-discharge mortality. An increase in HR of 15 beats/min was associated with average estimated increases of in-hospital and 1 year post-discharge mortality of 36 and 45%, respectively. This study demonstrates that elevated admission HR is an independent predictor of in-hospital and subsequent mortality in patients with acute MI. Admission HR is associated with mortality in patients with mild CHF and likely also in counterparts without CHF. The association is clearly seen in men and is of similar magnitude, although not statistically significant for l-year mortality, in women. Heart rate Acute myocardial infarction Infarct mortality
Journal of Electrocardiology, 1980
A newborn with long QT interval and repetitive ventricular tachycardia of the "torsade de pointes... more A newborn with long QT interval and repetitive ventricular tachycardia of the "torsade de pointes" type was seen at the age of one day. The arrhythmia was resistant to lidoeaine, propranolol and atropine, but was controlled by isoproterenol infusion. A transvenous pacemaker, inserted at three days of age, suppressed the ventricular tachycardia at stimulation rates above ll0/minute. At 19 days of age a permanent pacemaker at pulse rate of 119 beats/minute was implanted. At one year of age the infant was thriving and was completely free of ventricular arrhythmia. Prolongation of the QT interval is often complicated by ventricular arrhythmias and in particular by the "torsade de pointes" type of ventricular tachycardia. 1-3 The acquired long QT syndrome, generally induced by drugs or by electrolyte imbalance, is transient and well controlled by temporary overdrive pacing. 1 In contrast, beta blocking agents are considered to be the treatment of choice in cases of congenital prolongation of the QT interval. 4 Left stellate gangliectomy is also sometimes performed in these cases. 5 Temporary or permanent cardiac pacing has been attempted only in a few patients with the congenital long QT syndrome, and with variable success. ~9 The case described below demonstrates that temporary, followed by permanent, overdrive pacing resulted in long-term suppression of malignant ventricular arrhythmias in a newborn affected by the long QT syndrome which was complicated by recurrent ventricular tachycardia of the "torsade de pointes" type.
Chest, 1985
Eleven patients with implanted pervenous pacemakers were found to have unusual QRS morphology res... more Eleven patients with implanted pervenous pacemakers were found to have unusual QRS morphology resembling right bundle branch block (RBBB) on the 12-lead electrocardiogram. In nine patients, the tip of the electrode catheter was established with certainty to be in the right ventricular apex. In eight of the nine, the standard leads showed a left bundle branch block pattern (LBBB), whereas only the precordial leads V1 and V2 resembled RBBB. In only one of the nine was the RBBB pattern also seen in the standard leads. In all nine, recording the precordial leads one intercostal space below the usual space eliminated the RBBB pattern in V1-V2 and resulted in inscription of a QS complex, whereas recording the leads one space higher than usual enhanced the height of the R wave. This is explained by the marked superior and slight anterior orientation of the main QRS complex in right ventricular pacing. It is suggested that the pattern of RBBB in V1-V2 + LBBB in lead 1 be named pseudo RBBB pattern since it does not represent left prior to right ventricular activation.
Archives of internal …, 1980
Prolongation of QT interval is associated with repetitive paroxysm of a particular ventricular ta... more Prolongation of QT interval is associated with repetitive paroxysm of a particular ventricular tachycardia. It is a typical complication of quinidine therapy but may occur in various other conditions. We used endocardial pacing in nine patients with prolongation of the QT interval who suffered from bouts of ventricular tachycardia and fibrillation. In six patients, the syndrome was due to quinidine and in three, to prenylamine. Acceleration of heart rate resulted in immediate suppression of all arrhythmias. Pacing was continued until the condition producing the QT prolongation disappeared. In one case, a permanent pacemaker was implanted, as the QT prolongation was congenital and permanent. The absolute QT interval was shortened by overdrive pacing from a mean value of 0.65 s to 0.50 s. The corrected QT interval remained prolonged (about 0.56 s). Thus, the arrhythmia was associated with the duration of the actual QT interval, and overdrive pacing was able to suppress it without shortening the corrected QT interval.
Archives of Internal Medicine, 1978
Two patients with a ruptured interventricular septum complicating acute myocardial infarction wer... more Two patients with a ruptured interventricular septum complicating acute myocardial infarction were treated with isosorbide dinitrate. The first patient recovered from cardiogenic shock after sublingual administration of 5 mg of isosorbide dinitrate every two hours and was successfully operated on. The second patient recovered from severe pulmonary edema during the acute stage of the infarction with sublingual isosorbide dinitrate. Moreover, she experienced a considerable symptomatic improvement when a 5 mg sublingual dose of isosorbide dinitrate every three hours was added to her long-term treatment. Analysis of hemodynamic data showed that the most striking change following administration of the drug was the substantial reduction of pulmonary wedge pressure. The striking symptomatic and hemodynamic improvement was achieved by the favorable effect of afterload reduction on left ventricular performance and not by reduction in left to right shunt.
Archives of Internal Medicine, 1978
Two patients with a ruptured interventricular septum complicating acute myocardial infarction wer... more Two patients with a ruptured interventricular septum complicating acute myocardial infarction were treated with isosorbide dinitrate. The first patient recovered from cardiogenic shock after sublingual administration of 5 mg of isosorbide dinitrate every two hours and was successfully operated on. The second patient recovered from severe pulmonary edema during the acute stage of the infarction with sublingual isosorbide dinitrate. Moreover, she experienced a considerable symptomatic improvement when a 5 mg sublingual dose of isosorbide dinitrate every three hours was added to her long-term treatment. Analysis of hemodynamic data showed that the most striking change following administration of the drug was the substantial reduction of pulmonary wedge pressure. The striking symptomatic and hemodynamic improvement was achieved by the favorable effect of afterload reduction on left ventricular performance and not by reduction in left to right shunt.
European heart journal, 1995
Insulin-like growth factor II (IGF-II) promotes cardiac myocyte growth and contractility in vitro... more Insulin-like growth factor II (IGF-II) promotes cardiac myocyte growth and contractility in vitro. This study was designed to investigate the effect of exogenous IGF-II on regional myocardial function at the area of infarct in the pig. Myocardial infarction was induced in 12 female anaesthetized pigs by affigel blue beads, embolizing microvessels of the left anterior descending coronary artery distribution. In the experimental group (n = 6), IGF-II (0.12 microgram.kg-1 in two animals and 0.6 microgram.kg-1 in four) was incorporated into the beads and delivered by them to the infarct area. Myocardial function was followed echocardiographically, and the excised heart was analysed immunohistochemically and histopathologically. Myocardial function in injured zones, inversely related to an echocardiographic segmental wall motion score (mean +/- SEM), was similar between the two groups at baseline, but at 4 weeks post-infarction was significantly (P = 0.008) reduced in the control group (...
Journal of Clinical Epidemiology, 1995
The purpose of this study was to assess the predictive value of admission heart rate (HR) for in-... more The purpose of this study was to assess the predictive value of admission heart rate (HR) for in-hospital and 1 year post-discharge mortality in a large cohort of patients hospitalized for acute myocardial infarction (MI). Data were derived from the SPRINT-2 secondary prevention study population, and included 1044 patients (aged 50-79), hospitalized in 14 coronary care units in Israel with acute MI in the years 1985-1986, before the beginning of thrombolytic therapy in acute MI. Demographic, historical and medical data were collected for each patient. All deaths during initial hospitalization and 1 year post-discharge were recorded. In-hospital mortality was 5.2% for 294 patients with HR < 70 beats/min, 9.5% for 532 patients with HR 70-89 beats/min, and 15.1% for 323 patients with HR > or = 90 beats/min (p < 0.01). One year post-discharge mortality was 4.3% for patients with HR < 70 beats/min, 8.7% for patients with HR 70-80 beats/min and 11.8% for patients with HR > or = 90 beats/min (p < 0.01). An increasing trend of mortality with higher HR was confined to patients with mild CHF (p = 0.02) and likely to patients with absent CHF (p = 0.06), but this post hoc observation requires confirmation in larger groups. The combination of high admission HR (> or = 90 beats/min) and a systolic blood pressure < 120 mmHg was a powerful predictor of in-hospital mortality. Multivariate analysis showed that admission HR was an independent risk factor for in-hospital and 1 year post-discharge mortality.(ABSTRACT TRUNCATED AT 250 WORDS)