antonio fazi - Academia.edu (original) (raw)
Papers by antonio fazi
Expert Review of Medical Devices, 2021
ABSTRACT Objectives The aim of this study is to demonstrate how Electrophysiology activity has be... more ABSTRACT Objectives The aim of this study is to demonstrate how Electrophysiology activity has been impacted by the pandemic Coronavirus disease 2019 (COVID-19). Methods In this multicenter retrospective study, we analyze all consecutive patients admitted for electrophysiological procedures during the COVID-19 lockdown in the Tuscany region of Italy, comparing them to patients hospitalized in the corresponding period of the previous year. Results The impact of COVID-19 on cardiac arrhythmia management was impressive, with a reduction of more than 50% in all kinds of procedures. A gender gap was observed, with a more relevant reduction for female patients. Arrhythmic urgencies requiring a device implant showed a reduced time from symptoms to first medical contact but the time from first medical contact to procedure was significantly prolonged. Conclusion Hospitals need to consider how outbreaks may affect health systems beyond the immediate infection. Routine activity should be based on a risk assessment between the prompt performance of procedure and its postponement. Retrospective observational analysis such as this study could be decisive in evidence-based medicine of any future pathogen outbreak. Nonstandard Abbreviations and Acronyms PM= pacemakerICD= implantable cardioverter defibrillatorECV= electrical cardioversionEPS= electrophysiological studyAP= ablations proceduresCIED= cardiac implantable electronic devicesWCD= wearable cardioverter defibrillatorEP Lab= Electrophysiology LaboratoriesAVNRT =atrioventricular nodal reentry tachycardiaAVRT= atrioventricular reentry tachycardiaAFL= atrial flutterAF= atrial fibrillationVT= ventricular tachycardiaAT= atrial tachycardia
Oxford medical case reports, 2018
Right-sided intracardiac thrombi are potential causes of right ventricular (RV) failure, particul... more Right-sided intracardiac thrombi are potential causes of right ventricular (RV) failure, particularly when tricuspid or pulmonary obstruction occurs. In most cases, RV thrombus develops in patients with RV dysfunction and concomitant thrombosis in the systemic veins. However, RV thrombosis can rarely present as an isolated mass and despite preserved RV function, particularly in patients with thrombophilic states. In this report, we describe an unusual case of giant isolated RV thrombus presenting with acute RV failure secondary to dynamic RV outflow tract obstruction in a patient with renal carcinoma. Bedside echocardiography allowed a rapid assessment of the hemodynamic effects of the mass. The possibility of a thrombotic RV outflow obstruction should be considered in patients with acute RV failure, even in those with no evidence of thrombosis in the venous district. This may be particularly important in patients with prothrombotic states, where the effectiveness of routine thrombo...
European Heart Journal: Acute Cardiovascular Care, 2017
Background: Estimated glomerular filtration rate (eGFR) is a predictor of outcome among patients ... more Background: Estimated glomerular filtration rate (eGFR) is a predictor of outcome among patients with non-ST-elevation acute coronary syndrome (NSTE-ACS), but which estimation formula provides the best long-term risk stratification in this setting is still unclear. We compared the prognostic performance of four creatinine-based formulas for the prediction of 10-year outcome in a NSTE-ACS population treated by percutaneous coronary intervention. Methods: In 222 NSTE-ACS patients submitted to percutaneous coronary intervention, eGFR was calculated using four formulas: Cockcroft–Gault, re-expressed modification of diet in renal disease (MDRD), chronic kidney disease epidemiology collaboration (CKD-Epi), and Mayo-quadratic. Predefined endpoints were all-cause death and a composite of cardiovascular death, non-fatal reinfarction, clinically driven repeat revascularisation, and heart failure hospitalisation. Results: The different eGFR values showed poor agreement, with prevalences of ren...
Case Reports in Cardiology, 2015
We report an unusual case of infective endocarditis (IE) in an 88-year-old woman, occurring on a ... more We report an unusual case of infective endocarditis (IE) in an 88-year-old woman, occurring on a prolapsing mitral valve and characterized by an atypical vegetation shape resembling a spiral-like appearance. After the patient refused surgical correction, persistent IE despite prolonged antibiotic therapy was observed, resulting in an ischemic stroke probably secondary to septic embolus. The importance of vegetation shape in the management of patients with IE was classically related to the increased risk of embolization associated with pedunculated, irregular, and multilobed masses. We hypothesize that the unusual spiral-like vegetation shape in our patient may have favored IE persistence by two mechanisms, namely, a decrease of the exposed vegetation surface with creation of an internal core where the penetration of antimicrobial agents was obstacled and the creation of blood turbulence within the vegetation preventing a prolonged contact with circulating antibiotics. These consider...
Journal of the American College of Cardiology, 1996
Speclrel turbulence analysis (STA) of the signal.averaged ECG (SAECG) combines spectral analynis ... more Speclrel turbulence analysis (STA) of the signal.averaged ECG (SAECG) combines spectral analynis with a statistical evaluation of spectrograms in indivfdual parts of the QRS comprex. It has been suggested that it may be superior to conventional time-domain analysis (TDA) of the SAECG, Methods: We compared the power of TeA (40-250 Hz) and STA of the SAECG for prediction of cardiac death, vent~'icular tachysardia, sudden arrhythmtc death, and arrbythmio events after myocardial infarction in 603 patients, The population excluded patients with bundle branch block and other conduction abnormal|ties. Results: During the first 2 years of follow-up, there were 40 cardiac deaths, 21 ve.ntricular tachycan:lia, 11 sudden arrbylhmic deaths, and 29 arrhythmic
Journal of the American College of Cardiology, 1996
G Ital Aritmol Cardiostim, 2002
Cardiology, 1987
We performed a 24-hour Holter monitoring study on 45 patients affected by coronary artery disease... more We performed a 24-hour Holter monitoring study on 45 patients affected by coronary artery disease (CAD) with different degrees of left ventricular impairment, and on 15 controls, in order to observe heart rate (HR) changes. According to the ejection fraction (EF) determined by cardiac angiography, CAD patients were divided into 3 groups of 15 each: the first with EF greater than 0.5; the second with EF between 0.35 and 0.5 and the third with EF less than 0.35. Spontaneous HR variation during 24 h did not differ among controls and CAD patients with normal EF values. On the contrary, with the reduction of ventricular function, CAD patients showed increasingly higher values of HR only during the night. Patients with markedly reduced EF values showed higher values of HR than controls even during some hours of the day. During the night EF and HR showed a good linear correlation with the highest r value at 5 a.m. (r = 0.7, p less than 0.001). Present data show that a reduction in left ventricular performance results in an altered 24-hour HR pattern with a reduced HR slowing at night proportional to the extent of left ventricular dysfunction.
The American Journal of Cardiology, 1991
American Heart Journal, 1987
Right ventricular dysplasia (RVD) is a rare cardiac disease frequently associated with ventricula... more Right ventricular dysplasia (RVD) is a rare cardiac disease frequently associated with ventricular arrhythmias. In this condition, areas of fatty and fibrous tissue replace the normal right ventricular myocardium.'-4 This disease is
American Heart Journal, 1986
Thirty-four patients with unstable angina and 14 patients with stable effort angina were investig... more Thirty-four patients with unstable angina and 14 patients with stable effort angina were investigated for cardiac prostacyclin and prostaglandin E, (PGE,) biosynthesis, under resting conditions and after cold pressor testing. Twenty-seven patients undergoing cardiac catheterization and coronary angiography for congenital or acquired heart diseases other than coronary artery disease were studied as a control group. Prostacyclin (as 6-keto-PGF,,) and PGEI were measured by specific radioimmunoassay of blood from the coronary sinus and aorta. During resting conditions no significant differences in plasma 6-keto-PGF,, and PGE? concentrations were found between coronary sinus and aortic blood, and no transcardiac gradient existed either in control subjects or in patients with stable and unstable angina, respectively. In control subjects cold pressor testing induced a significant increase in 6-keto-PGF,, and PGE, levels in blood from the different sampling sites, and a significant transcardiac gradient occurred (+11.2 t 6.4 pg/ml for 6-keto-PGF,, and +5.1 + 3.4 pg/ml for PGEp). However, in angina patients no significant increase in 6-keto-PGF,, and PGE, plasma levels was found and no transcardiac gradient was formed after cold pressor testing. These results indicate impaired cardiac prostacyclin and POE2 biosynthesis both in patients with stable and unstable effort angina. (AM HEART J 112:472, 1966.
American Heart Journal, 1988
Decrease in frequency of angina1 episodes by control of thrombin generation with low-dose heparin... more Decrease in frequency of angina1 episodes by control of thrombin generation with low-dose heparin : A controlled cross-over randomized study increased thrombin generation is frequently associated with an increase in anginai activity. A cross-over, single-blind, completely randomized study was planned in order to evaluate whether the control of thrombin generation affected the increase in angina1 activity. After discharge from the hospital, 24 patients (18 men and 6 women, aged 40 to 69 years) suffering from spontaneous angina were followed up to 12 months and were alternatively treated during two consecutive 6-month periods with calcium heparin, 12,500 IlJ by the subcutaneous route, or with placebo by the intramuscular route, in addition to the usual antianginal medications. Thrombin generation and clinical activity of angina were assessed every 15 days by measuring fibrinopeptide A (FPA) plasma levels and by grading in three classes (symptomless, mildly symptomatic, and severely symptomatic) the angina1 activity on the basis of the number and the time concentration of the ischemic attacks and EGG changes. Low-dose heparin treatment significantly reduced both the FPA plasma level (from 4.1 + 3.7 to 2.3-+ 1.8 rig/ml, p < 0.001) and the clinical activity of angina. During heparin treatment, the frequency of the observations in the severely and mildly symptomatic classes decreased, respectively, by 53% and by 30%, whereas that in the symptomless class increased by 23% (p < 0.001) in comparison with the period on placebo. Present results indicate that the control of thrombin generation obtained by low-dose heparin treatment favorably affects the degree of angina1 activity in patients with spontaneous angina.
American Heart Journal, 1987
Thirty-seven patients affected by spontaneous angina and 15 comparable control subjects were enro... more Thirty-seven patients affected by spontaneous angina and 15 comparable control subjects were enrolled in a 12-month prospective study to evaluate the relatIonship between blood clotting activation (assessed by tlbtlnopeptlda A [WA] plasma concentration) and the occurfanca of myocardlal ischamk attacks. FPA measurements and cllnlcai axamhmtions In patients were performed every 2 weeks. In control sublects blood sampling was performed every 4 weeks. Data from 28 patients who completed the study and from the 15 control subjects were analyzed. The clinical activity of anglna was divided into three classes (asymptomatlo, mildly symptomatic, and severely symptomatic) on the basis of the number and time-concentration of the ischemic attacks and ECG changes during the 15 days preceding each cltnlcal axamtnatlon. In all but one patient, a cyclic pattern of activtty of coronary artery disease was observed. During follow-up studies, 824 FPA measurements were performed In pattents and 173 in control subjects. Mean values were 4.88 ? 4.53 and 1.32 f 0.80 rig/ml, respectively (p < 0.001). FPA levels dlffered markedly In relation to the activity of angina. A ralatlonship between FPA levels and activity of disease (r = 0.54, p < 0.01) was found in time course. Bohr8 heparhi admlnlstratton (100 IU/kg) during the active phase of angina sharply but incompletely lowered FPA plasma levels, indicating thrombin formation both intravascularly and extravascularly. Present results indkata that a marked blood clotting activation occurs simultaneously with the outbursts of clinical activity of spontaneous angina.
Nephrology Dialysis …, 1998
Conclusions. LP were detected in a significant proportion of dialysis patients, probably related ... more Conclusions. LP were detected in a significant proportion of dialysis patients, probably related to Background. Late potentials (LP) on the signalaveraged electrocardiogram (SAECG) are predictive underlying CAD with left ventricular dysfunction. Prolongation of fQRS after dialysis could be explained of malignant ventricular arrhythmias and sudden cardiac death in patients with ischaemic and non-by the acute reduction in serum potassium levels. ischaemic cardiomyopathy. Cardiac dysfunction, both regional and global, as well as supraventricular and Key words: echocardiography; haemodialysis; potasventricular arrhythmias are reported in a high percentsium; signal-averaged ECG; ventricular function age of patients with end-stage renal failure (ESRF). The aim of the study was to assess the prevalence of LP and the effects of haemodialysis on the SAECG of ESRF patients. Introduction Methods. SAECG was recorded immediately before and within 30 min after the end of dialysis in 48 Ventricular late potentials are low-amplitude, highpatients in sinus rhythm, free of conduction disturbfrequency waveforms in the terminal portion of the ances on ECG and of signs of congestive heart failure. QRS complex which can be detected by the signal-Serum electrolytes were sampled together with the averaged electrocardiogram (SAECG). They are SAECG recordings. An echo-Doppler exam was perthought to originate from abnormal areas of ventricuformed within 2 weeks of the study. SAECGs were lar myocardium where activation is delayed by slow adequate for analysis in 45/48 patients. LP were present conduction, thus predisposing to re-entrant tachycarwhen at least two of the following criteria were fulfilled: dia [1-5]. A number of reports have demonstrated QRS duration ∏115 ms, LAS 40 ∏38 ms, RMS 40 Á that the detection of an abnormal signal-averaged 38 mV at 40 Hz high pass bidirectional filter, and noise ECG can identify a group of patients at risk of serious <0.7 mV. arrhythmic events and sudden cardiac death [6-11]. Results. LP were detected in 12/45 patients (25%) Cardiac abnormalities often occur in patients with on the SAECG before dialysis; of these 12 patients, end-stage renal disease undergoing chronic haemodiaseven had a history of a previous myocardial infarction lysis treatment [12-20]. These abnormalities are left and two had documented coronary artery disease ventricular hypertrophy with increased fibrosis content (CAD). A significant greater wall motion score indexand deposition of calcium and aluminium salts within calculated on a 16 segment model-was reported in the heart tissue [15,21-22]. Such histologic changes patients with LP (1.20±0.20 vs 1.01±0.03, P<0.01), could represent a potential substrate for an abnormally while left ventricular mass was comparable in the two delayed and fractionated electrical conduction leading groups of patients. At the end of dialysis, a significant to the appearance of late potentials on the SAECG. prolongation of fQRS duration was found both at 25 It has been established that haemodialysis treatment and 40 Hz filters (from 98±11 to 106±16 ms and from can induce supraventricular and ventricular arrhy-97±12 s to 102±13 ms, respectively, P<0.001). A thmias and acute changes on standard ECG wavesignificant inverse relationship was seen between the forms due to the concomitant changes in serum percentage of dialysis-induced serum potassium reducelectrolyte levels, acid-base balance and body fluid tion and fQRS changes at 40 Hz (r=−0.68, P<0.001). content [23-28]. Most of the clinical studies performed in dialysis patients have focused on QRS amplitude
Expert Review of Medical Devices, 2021
ABSTRACT Objectives The aim of this study is to demonstrate how Electrophysiology activity has be... more ABSTRACT Objectives The aim of this study is to demonstrate how Electrophysiology activity has been impacted by the pandemic Coronavirus disease 2019 (COVID-19). Methods In this multicenter retrospective study, we analyze all consecutive patients admitted for electrophysiological procedures during the COVID-19 lockdown in the Tuscany region of Italy, comparing them to patients hospitalized in the corresponding period of the previous year. Results The impact of COVID-19 on cardiac arrhythmia management was impressive, with a reduction of more than 50% in all kinds of procedures. A gender gap was observed, with a more relevant reduction for female patients. Arrhythmic urgencies requiring a device implant showed a reduced time from symptoms to first medical contact but the time from first medical contact to procedure was significantly prolonged. Conclusion Hospitals need to consider how outbreaks may affect health systems beyond the immediate infection. Routine activity should be based on a risk assessment between the prompt performance of procedure and its postponement. Retrospective observational analysis such as this study could be decisive in evidence-based medicine of any future pathogen outbreak. Nonstandard Abbreviations and Acronyms PM= pacemakerICD= implantable cardioverter defibrillatorECV= electrical cardioversionEPS= electrophysiological studyAP= ablations proceduresCIED= cardiac implantable electronic devicesWCD= wearable cardioverter defibrillatorEP Lab= Electrophysiology LaboratoriesAVNRT =atrioventricular nodal reentry tachycardiaAVRT= atrioventricular reentry tachycardiaAFL= atrial flutterAF= atrial fibrillationVT= ventricular tachycardiaAT= atrial tachycardia
Oxford medical case reports, 2018
Right-sided intracardiac thrombi are potential causes of right ventricular (RV) failure, particul... more Right-sided intracardiac thrombi are potential causes of right ventricular (RV) failure, particularly when tricuspid or pulmonary obstruction occurs. In most cases, RV thrombus develops in patients with RV dysfunction and concomitant thrombosis in the systemic veins. However, RV thrombosis can rarely present as an isolated mass and despite preserved RV function, particularly in patients with thrombophilic states. In this report, we describe an unusual case of giant isolated RV thrombus presenting with acute RV failure secondary to dynamic RV outflow tract obstruction in a patient with renal carcinoma. Bedside echocardiography allowed a rapid assessment of the hemodynamic effects of the mass. The possibility of a thrombotic RV outflow obstruction should be considered in patients with acute RV failure, even in those with no evidence of thrombosis in the venous district. This may be particularly important in patients with prothrombotic states, where the effectiveness of routine thrombo...
European Heart Journal: Acute Cardiovascular Care, 2017
Background: Estimated glomerular filtration rate (eGFR) is a predictor of outcome among patients ... more Background: Estimated glomerular filtration rate (eGFR) is a predictor of outcome among patients with non-ST-elevation acute coronary syndrome (NSTE-ACS), but which estimation formula provides the best long-term risk stratification in this setting is still unclear. We compared the prognostic performance of four creatinine-based formulas for the prediction of 10-year outcome in a NSTE-ACS population treated by percutaneous coronary intervention. Methods: In 222 NSTE-ACS patients submitted to percutaneous coronary intervention, eGFR was calculated using four formulas: Cockcroft–Gault, re-expressed modification of diet in renal disease (MDRD), chronic kidney disease epidemiology collaboration (CKD-Epi), and Mayo-quadratic. Predefined endpoints were all-cause death and a composite of cardiovascular death, non-fatal reinfarction, clinically driven repeat revascularisation, and heart failure hospitalisation. Results: The different eGFR values showed poor agreement, with prevalences of ren...
Case Reports in Cardiology, 2015
We report an unusual case of infective endocarditis (IE) in an 88-year-old woman, occurring on a ... more We report an unusual case of infective endocarditis (IE) in an 88-year-old woman, occurring on a prolapsing mitral valve and characterized by an atypical vegetation shape resembling a spiral-like appearance. After the patient refused surgical correction, persistent IE despite prolonged antibiotic therapy was observed, resulting in an ischemic stroke probably secondary to septic embolus. The importance of vegetation shape in the management of patients with IE was classically related to the increased risk of embolization associated with pedunculated, irregular, and multilobed masses. We hypothesize that the unusual spiral-like vegetation shape in our patient may have favored IE persistence by two mechanisms, namely, a decrease of the exposed vegetation surface with creation of an internal core where the penetration of antimicrobial agents was obstacled and the creation of blood turbulence within the vegetation preventing a prolonged contact with circulating antibiotics. These consider...
Journal of the American College of Cardiology, 1996
Speclrel turbulence analysis (STA) of the signal.averaged ECG (SAECG) combines spectral analynis ... more Speclrel turbulence analysis (STA) of the signal.averaged ECG (SAECG) combines spectral analynis with a statistical evaluation of spectrograms in indivfdual parts of the QRS comprex. It has been suggested that it may be superior to conventional time-domain analysis (TDA) of the SAECG, Methods: We compared the power of TeA (40-250 Hz) and STA of the SAECG for prediction of cardiac death, vent~'icular tachysardia, sudden arrhythmtc death, and arrbythmio events after myocardial infarction in 603 patients, The population excluded patients with bundle branch block and other conduction abnormal|ties. Results: During the first 2 years of follow-up, there were 40 cardiac deaths, 21 ve.ntricular tachycan:lia, 11 sudden arrbylhmic deaths, and 29 arrhythmic
Journal of the American College of Cardiology, 1996
G Ital Aritmol Cardiostim, 2002
Cardiology, 1987
We performed a 24-hour Holter monitoring study on 45 patients affected by coronary artery disease... more We performed a 24-hour Holter monitoring study on 45 patients affected by coronary artery disease (CAD) with different degrees of left ventricular impairment, and on 15 controls, in order to observe heart rate (HR) changes. According to the ejection fraction (EF) determined by cardiac angiography, CAD patients were divided into 3 groups of 15 each: the first with EF greater than 0.5; the second with EF between 0.35 and 0.5 and the third with EF less than 0.35. Spontaneous HR variation during 24 h did not differ among controls and CAD patients with normal EF values. On the contrary, with the reduction of ventricular function, CAD patients showed increasingly higher values of HR only during the night. Patients with markedly reduced EF values showed higher values of HR than controls even during some hours of the day. During the night EF and HR showed a good linear correlation with the highest r value at 5 a.m. (r = 0.7, p less than 0.001). Present data show that a reduction in left ventricular performance results in an altered 24-hour HR pattern with a reduced HR slowing at night proportional to the extent of left ventricular dysfunction.
The American Journal of Cardiology, 1991
American Heart Journal, 1987
Right ventricular dysplasia (RVD) is a rare cardiac disease frequently associated with ventricula... more Right ventricular dysplasia (RVD) is a rare cardiac disease frequently associated with ventricular arrhythmias. In this condition, areas of fatty and fibrous tissue replace the normal right ventricular myocardium.'-4 This disease is
American Heart Journal, 1986
Thirty-four patients with unstable angina and 14 patients with stable effort angina were investig... more Thirty-four patients with unstable angina and 14 patients with stable effort angina were investigated for cardiac prostacyclin and prostaglandin E, (PGE,) biosynthesis, under resting conditions and after cold pressor testing. Twenty-seven patients undergoing cardiac catheterization and coronary angiography for congenital or acquired heart diseases other than coronary artery disease were studied as a control group. Prostacyclin (as 6-keto-PGF,,) and PGEI were measured by specific radioimmunoassay of blood from the coronary sinus and aorta. During resting conditions no significant differences in plasma 6-keto-PGF,, and PGE? concentrations were found between coronary sinus and aortic blood, and no transcardiac gradient existed either in control subjects or in patients with stable and unstable angina, respectively. In control subjects cold pressor testing induced a significant increase in 6-keto-PGF,, and PGE, levels in blood from the different sampling sites, and a significant transcardiac gradient occurred (+11.2 t 6.4 pg/ml for 6-keto-PGF,, and +5.1 + 3.4 pg/ml for PGEp). However, in angina patients no significant increase in 6-keto-PGF,, and PGE, plasma levels was found and no transcardiac gradient was formed after cold pressor testing. These results indicate impaired cardiac prostacyclin and POE2 biosynthesis both in patients with stable and unstable effort angina. (AM HEART J 112:472, 1966.
American Heart Journal, 1988
Decrease in frequency of angina1 episodes by control of thrombin generation with low-dose heparin... more Decrease in frequency of angina1 episodes by control of thrombin generation with low-dose heparin : A controlled cross-over randomized study increased thrombin generation is frequently associated with an increase in anginai activity. A cross-over, single-blind, completely randomized study was planned in order to evaluate whether the control of thrombin generation affected the increase in angina1 activity. After discharge from the hospital, 24 patients (18 men and 6 women, aged 40 to 69 years) suffering from spontaneous angina were followed up to 12 months and were alternatively treated during two consecutive 6-month periods with calcium heparin, 12,500 IlJ by the subcutaneous route, or with placebo by the intramuscular route, in addition to the usual antianginal medications. Thrombin generation and clinical activity of angina were assessed every 15 days by measuring fibrinopeptide A (FPA) plasma levels and by grading in three classes (symptomless, mildly symptomatic, and severely symptomatic) the angina1 activity on the basis of the number and the time concentration of the ischemic attacks and EGG changes. Low-dose heparin treatment significantly reduced both the FPA plasma level (from 4.1 + 3.7 to 2.3-+ 1.8 rig/ml, p < 0.001) and the clinical activity of angina. During heparin treatment, the frequency of the observations in the severely and mildly symptomatic classes decreased, respectively, by 53% and by 30%, whereas that in the symptomless class increased by 23% (p < 0.001) in comparison with the period on placebo. Present results indicate that the control of thrombin generation obtained by low-dose heparin treatment favorably affects the degree of angina1 activity in patients with spontaneous angina.
American Heart Journal, 1987
Thirty-seven patients affected by spontaneous angina and 15 comparable control subjects were enro... more Thirty-seven patients affected by spontaneous angina and 15 comparable control subjects were enrolled in a 12-month prospective study to evaluate the relatIonship between blood clotting activation (assessed by tlbtlnopeptlda A [WA] plasma concentration) and the occurfanca of myocardlal ischamk attacks. FPA measurements and cllnlcai axamhmtions In patients were performed every 2 weeks. In control sublects blood sampling was performed every 4 weeks. Data from 28 patients who completed the study and from the 15 control subjects were analyzed. The clinical activity of anglna was divided into three classes (asymptomatlo, mildly symptomatic, and severely symptomatic) on the basis of the number and time-concentration of the ischemic attacks and ECG changes during the 15 days preceding each cltnlcal axamtnatlon. In all but one patient, a cyclic pattern of activtty of coronary artery disease was observed. During follow-up studies, 824 FPA measurements were performed In pattents and 173 in control subjects. Mean values were 4.88 ? 4.53 and 1.32 f 0.80 rig/ml, respectively (p < 0.001). FPA levels dlffered markedly In relation to the activity of angina. A ralatlonship between FPA levels and activity of disease (r = 0.54, p < 0.01) was found in time course. Bohr8 heparhi admlnlstratton (100 IU/kg) during the active phase of angina sharply but incompletely lowered FPA plasma levels, indicating thrombin formation both intravascularly and extravascularly. Present results indkata that a marked blood clotting activation occurs simultaneously with the outbursts of clinical activity of spontaneous angina.
Nephrology Dialysis …, 1998
Conclusions. LP were detected in a significant proportion of dialysis patients, probably related ... more Conclusions. LP were detected in a significant proportion of dialysis patients, probably related to Background. Late potentials (LP) on the signalaveraged electrocardiogram (SAECG) are predictive underlying CAD with left ventricular dysfunction. Prolongation of fQRS after dialysis could be explained of malignant ventricular arrhythmias and sudden cardiac death in patients with ischaemic and non-by the acute reduction in serum potassium levels. ischaemic cardiomyopathy. Cardiac dysfunction, both regional and global, as well as supraventricular and Key words: echocardiography; haemodialysis; potasventricular arrhythmias are reported in a high percentsium; signal-averaged ECG; ventricular function age of patients with end-stage renal failure (ESRF). The aim of the study was to assess the prevalence of LP and the effects of haemodialysis on the SAECG of ESRF patients. Introduction Methods. SAECG was recorded immediately before and within 30 min after the end of dialysis in 48 Ventricular late potentials are low-amplitude, highpatients in sinus rhythm, free of conduction disturbfrequency waveforms in the terminal portion of the ances on ECG and of signs of congestive heart failure. QRS complex which can be detected by the signal-Serum electrolytes were sampled together with the averaged electrocardiogram (SAECG). They are SAECG recordings. An echo-Doppler exam was perthought to originate from abnormal areas of ventricuformed within 2 weeks of the study. SAECGs were lar myocardium where activation is delayed by slow adequate for analysis in 45/48 patients. LP were present conduction, thus predisposing to re-entrant tachycarwhen at least two of the following criteria were fulfilled: dia [1-5]. A number of reports have demonstrated QRS duration ∏115 ms, LAS 40 ∏38 ms, RMS 40 Á that the detection of an abnormal signal-averaged 38 mV at 40 Hz high pass bidirectional filter, and noise ECG can identify a group of patients at risk of serious <0.7 mV. arrhythmic events and sudden cardiac death [6-11]. Results. LP were detected in 12/45 patients (25%) Cardiac abnormalities often occur in patients with on the SAECG before dialysis; of these 12 patients, end-stage renal disease undergoing chronic haemodiaseven had a history of a previous myocardial infarction lysis treatment [12-20]. These abnormalities are left and two had documented coronary artery disease ventricular hypertrophy with increased fibrosis content (CAD). A significant greater wall motion score indexand deposition of calcium and aluminium salts within calculated on a 16 segment model-was reported in the heart tissue [15,21-22]. Such histologic changes patients with LP (1.20±0.20 vs 1.01±0.03, P<0.01), could represent a potential substrate for an abnormally while left ventricular mass was comparable in the two delayed and fractionated electrical conduction leading groups of patients. At the end of dialysis, a significant to the appearance of late potentials on the SAECG. prolongation of fQRS duration was found both at 25 It has been established that haemodialysis treatment and 40 Hz filters (from 98±11 to 106±16 ms and from can induce supraventricular and ventricular arrhy-97±12 s to 102±13 ms, respectively, P<0.001). A thmias and acute changes on standard ECG wavesignificant inverse relationship was seen between the forms due to the concomitant changes in serum percentage of dialysis-induced serum potassium reducelectrolyte levels, acid-base balance and body fluid tion and fQRS changes at 40 Hz (r=−0.68, P<0.001). content [23-28]. Most of the clinical studies performed in dialysis patients have focused on QRS amplitude