[Management and prognosis of acute myocardial infarct in advanced age: comparison of the cardiac intensive care unit and the cardiology ward]. / Gestione e prognosi dell'IMA nell'età avanzata: confronto tra UTIC e reparto cardiologico.

The aim of this prospective study was to assess the prognostic and most suitable management of AMI in elderly patients (age > or = 75 years). From September 1988 to August 1991, 129 such patients (pts) were evaluated: 35 (27%) were admitted to CCU because of arrhythmias or severe hemodynamic complications; 94 (73%) were addressed, according to bed availability, to CCU (55 pts) or Cardiology Ward (39 pts), where all patients underwent continuous ECG monitoring for at least 72 hours. Age, gender, history of previous angina or myocardial infarction, presence of chest pain or ECG ischemia on admission, site and extent of AMI, delay on admission, CPK-MB peak, recurrent angina, arrhythmias, heart failure, emotional disorders, hospital mortality and length of hospital stay were compared. Our results show that elderly patients who suffered from complicated AMI were at high risk for death and severe in-hospital complications. No significant prognostic differences were observed between the two groups with uncomplicated AMI. Thus hospitalization in the Cardiology Ward seems to be valuable, safe and well tolerated in our population of elderly patients with AMI, and without initial complications.

[Thallium and echo- dipyridamole in the early selection of patients at risk after acute myocardial infarction. Which test? What dose?]. / Tallio ed eco dipiridamolo nella selezione precoce dei pazienti a rischio dopo infarto miocardico acuto. Quale test? Con quale dose?

UNLABELLED: The optimal iv dose of Dipyridamole (Dip) in echocardiography (echo) or Thallium scintigraphy (Tl) remains undetermined. To select the high-risk patients (pts) subset, we performed echo and Tl with standard dose (SD) and high dose (HD) Dip infusion (0.56 mg/Kg/4'-0.84 mg/Kg/10' respectively) in 40 pts 9 +/- 3 days after admission for acute myocardial infarction (AMI). Of these, 38 pts had coronary artery disease at angiography and 2 had no significant lesions. Worsening in regional wall motion on echo and reversible perfusion defects on Tl were considered abnormal patterns. SD had no side effects; only in one pt was ischemic ventricular dysfunction detected on echo, whereas Tl redistribution was found in 24 pts (12 had multivessel disease and 12 had one coronary stenosis greater than or equal to 70%). HD caused adverse reaction in 24 pts, did not enhance SD-Tl sensitivity, but induced abnormal echo in 18/24 pts with transient defects on SD-Tl. Eleven of the 16 Tl negative pts had occlusive disease, 3 had one vessel disease and 2 showed no evidence of coronary artery disease. IN CONCLUSION: SD is safe but often provokes a submaximal coronary vasodilation. Failure to detect ischemia on echo may be explained by this. SD-Tl is, however, able to identify high-risk pts who may benefit from early myocardial revascularization. HD does not enhance SD-Tl sensitivity, but it is necessary to induce echo abnormalities which are all too often undetectable at SD.

[Myocardial scintigraphy using 201-thallium and 2-dimensional echocardiogram after dipyridamole infusion in the early evaluation of post-infarct residual ischemia]. / La scintigrafia miocardica con tallio-201 e l'ecocardiogramma bidimensionale dopo infusione di dipiridamolo nella valutazione precoce dell'ischemia residua post-infartuale.

Dipyridamole thallium scintigraphy (TI-DP) and dipyridamole two-dimensional echocardiography (Echo-DP) were performed on 38 patients (pts), 11 +/- 4 days after acute myocardial infarction. Our study intends to assess whether or not imaging methods are useful both in identifying residual jeopardized myocardium and in selecting pts for coronary angiography. No serious side effects were induced during the DP test. In 11 pts angina was not induced, worsening of wall motion abnormalities was not detected on Echo-DP; no reversible defects were found on TI-DP. The remaining 27 pts who showed transient defects on TI-DP underwent coronary angiography. All pts had either multivessel coronary disease or severe single-vessel disease and myocardial revascularisation was performed in all of them. Of these 27 patients, only 5 suffered angina and showed ST-T depression; only in 15 dyskinetic wall motion development was detected on Echo-DP. Finally we can conclude: the DP-test can be safely performed in the early post-infarction period; both the reported imaging methods enable the identification of jeopardized myocardium even if with different ranges of sensitivity; pts negative to both TI-DP and Echo-DP can be safely followed without coronary angiography; pts with transient defects on TI-DP can be reasonably referred to coronary angiography.

Critical analysis of the vectorcardiogram's reliability in the quantitative diagnosis of old myocardial infarction.

The purpose of this work is to verify if the vectorcardiogram (VCG) can be used for the quantification of old myocardial infarction (OMI). 50 cases of acute myocardial infarction were studied by mean of seriate determination of MB-CK isoenzyme and Sobel Index (SI); 4 weeks later, Frank's VCG was recorded. The studied cases did not show any conduction disturbances or other electrical abnormalities besides the sign of OMI. The 50 cases were divided into two groups according to the site of the necrosis: Group A, including 27 cases of inferior and/or posterior infarction and Group B, including 23 cases of septal and/or anterior infarction. On the VCG records, the variables related to OMI and to the general shape of ventricular depolarization and repolarization were measured. The electrical variables and the SI were compared by means of the methods of linear regression and of principal components analysis. No significant correlations were detected. Therefore, we conclude that the VCG is useless in the quantitative assessment of OMI; that such terms as "extensive, localized" and so on, at present widely used in electro- and vector-cardiography, are misleading if based only on surface electrical records obtained at distance from the acute phase of infarction and should therefore be avoided; that the work is consistent with the hypothesis that the electrical pattern of OMI could depend mainly upon peripheral intraventricular conduction disturbances.

[Vectorcardiographic analysis of atrial activation in isolated mitral valve prolapse. Atrial vectorcardiography in prolapsed mitral valve]. / Analisi vettorcardiografica della attivazione atriale nel prolasso mitralico isolato. VCG atriale nel prolasso mitralico.

The purpose of our work is to study atrial depolarization in primary mitral prolapse (MVP), since, as far as we know, such a study has never been performed. Thirty patients with MVP were studied: 23 females, aged 37,3 +/- 15,5 years and 7 males, aged 45.1 +/- 18.1 years. MVP was diagnosed by M-mode echocardiography. Atrial depolarization was analysed on photographically recorded Frank's vectorcardiograms. On PsE loops, magnitude and direction of maximum planar vector (VMax) in the frontal (F) and left sagittal (LS) planes, magnitude and direction of anterior (HV1) and posterior (HV2) vectors in the horizontal (H) plane, HV1 to HV2 amplitude ratio and total atrial activation time (T) were measured. This last value (T), measured on vectorcardiographic records, was confirmed by high-speed (200 mm/sec) electrocardiograms. These data were compared, by mean of Student's test, with those measured on records obtained from a similar group of normals. The following statistically significant (P less than 0.05) differences were detected: decreased amplitude of VMax in F (0.11 +/- 0.03 vs. 0.080 +/- 0.03) and LS (0.11 +/- 0.03 vs. 0.085 +/- 0.03), backward shift of HV2 (+65 degrees +/- 39 degrees vs. + 11 degrees +/- 35 degrees) and decreased T (98 +/- 25 vs. 85 +/- 17). The decrease of total atrial activation time, about 13% less than in normals, is the most interesting finding of our research. Such an alteration of atrial depolarization can be explained by inter- and/or intra-atrial conduction disturbance, on anatomical or functional base. Therefore, our findings are consistent either with the hypothesis that MVP is secondary to widespread pathological changes or with the one that MVP is a consequence of neurovegetative imbalance.

[Statistical evaluation of vectorcardiographic criteria for the diagnosis of posterior myocardial necrosis (author's transl)]. / Valutazione statistica dei criteri vettorcardiografici per la diagnosi di necrosi miocardica posteriore.

85 vectorcardiograms, characterized by anteriorly oriented horizontal ventricular loop, were analized in order to evaluate if this pattern can be considered diagnostic at all for strictly posterior myocardial infarction. Records were divided into two groups according to positivity or negativity of clinical history for myocardial infarction. Records consistent with right ventricular hypertrophy were ruled out. Nine parameters related to ventricular depolarization and repolarization were measured and the values were submitted to statistical analysis. The study showed that:--selection of the two groups was correct, because of first group's homogeneity and control group's unhomogeneity;--mean values of the nine parameters did not differ significantly in the two groups;--single parameter into each group was unrelated to others. As a consequence, criteria at the time in use for diagnosis of strictly posterior myocardial infarction seem not to be useful, as other conditions beside myocardial infarction or right ventricular hypertrophy are able to determine the same vectorcardiographic pattern.