Detection of coronary artery disease by digital stress echocardiography: comparison of exercise, transesophageal atrial pacing and dipyridamole echocardiography.

OBJECTIVES: This study assessed and compared the diagnostic potential of exercise, transesophageal atrial pacing and dipyridamole stress echocardiography in a clinical setting. BACKGROUND: Although they have been widely studied, no data exist with regard to comparisons of these procedures in a head-to-head study in different clinical settings. METHODS: One hundred four consecutive patients with suspected coronary artery disease undergoing coronary angiography and with no previous myocardial infarction or rest left ventricular wall motion abnormalities underwent digital posttreadmill, transesophageal atrial pacing and dipyridamole echocardiography. RESULTS: Feasibility of digital exercise echocardiography was 84%; 8 of 88 remaining patients had a nondiagnostic exercise echocardiographic test (inadequate exercise or imaging). In 80 patients with feasible and diagnostic digital exercise echocardiography, sensitivity, specificity and accuracy were, respectively, 89%, 91% and 90%. Eighty of the 104 patients underwent transesophageal atrial pacing and dipyridamole echocardiography. Feasibility of the alternative stress procedures was 77% for transesophageal atrial pacing and 96% for dipyridamole. In 60 patients successfully undergoing both alternative stress procedures, sensitivity and specificity were 83% and 76% for atrial pacing and 43% and 92% for dipyridamole echocardiography, respectively. In the group of 24 patients with nondiagnostic exercise echocardiography and consequent indication to alternative stress procedures, accuracy of transesophageal atrial pacing was higher than that of dipyridamole echocardiography (73% vs. 45%, p = 0.06). CONCLUSIONS: Because of its higher diagnostic potential and additional functional information, exercise is the stress of choice when stress echocardiography is used to detect the presence of coronary artery disease. Alternative stresses can be used in patients with nondiagnostic exercise echocardiography. Transesophageal and dipyridamole echocardiography differ in feasibility and diagnostic reliability (higher sensitivity of transesophageal atrial pacing, higher specificity of dipyridamole). These characteristics must be considered when selecting procedures to be used as alternatives to exercise.

Synthesis and pharmacological activities of some 2,3,4,5-tetrahydro[1,5]benzo[f]thiazepines.

In search of new biological active agents in the series of [1,5]benzothiazepines, some 2,3,4,5-tetrahydro-N-(5-morpholinopentanoyl)-[1,5]benzo[f] thiazepines were synthesized and examined in vitro for their calcium antagonist activity compared to the Diltiazem one.

Furanocoumarins from the aerial parts of Dorstenia contrajerva.

A new glycosylated furanocoumarin, alpha-L-rhamnopyranosyl-(1-->6)-beta-D-glucopyranosyl-bergaptol (1), has been isolated from Dorstenia contrajerva together with three known furanocoumarins, catechin and epicatechin. Their structures were established using high field 2D NMR techniques.

Prognostic role of heart rate variability in patients with idiopathic dilated cardiomyopathy.

BACKGROUND: The aim of this study was to investigate whether heart rate variability may predict the outcome in patients with idiopathic dilated cardiomyopathy. METHODS: Time-domain and frequency-domain heart rate variability was analyzed on 24-hour Holter recordings of 56 patients with idiopathic dilated cardiomyopathy (70% males, mean age 49 +/- 16 years; left ventricular ejection fraction 28 +/- 6%). RESULTS: There were 8 cardiac deaths (14.3%) and 11 arrhythmic events (19.6%, either sudden death or sustained ventricular tachycardia) at a follow-up of 18.5 months (range 3-50 months). Furthermore, 6 patients were included in the list for cardiac transplantation, leading to a prevalence of total cardiac events of 37.5 % (21 patients). All time-domain and most frequency-domain heart rate variability parameters did not show any significant relationship with the end points. However, a low frequency to high frequency (LF/HF) ratio < 1.2 was associated with cardiac death (relative risk-RR 6.8, p < 0.03), arrhythmic events (RR 11.0, p < 0.004), and total cardiac events (RR 4.8, p < 0.002). On the multivariate Cox analysis, no variable showed an independent association with cardiac death, but an LF/HF ratio < 1.2 was the only variable independently predictive of arrhythmic events (RR 8.2, p < 0.02), and the most powerful predictor of total cardiac events (RR 3.8, p < 0.009). CONCLUSIONS: Our data show that, in patients with idiopathic dilated cardiomyopathy, a low LF/HF ratio, as assessed on 24-hour Holter recordings, is a powerful predictor of cardiac events.

Clinical, electrocardiographic and electrophysiological predictors of atrial fibrillation development in different cardiac substrates.

We performed a review of the current literature in order to evaluate clinical, electrocardiographic and electrophysiologic parameters predictive of atrial fibrillation development. Clinical parameters were obtained from two large observational studies (the Framingham heart study and the Cardiovascular health study). Different laboratoristic predictors were also reviewed: ECG-derived predictors, among which we separately evaluated those derived from the 12-lead surface ECG and those derived from the signal averaged P-wave, and other electrophysiologic predictors as atrial monophasic action potential analysis. We also evaluated the clinical value of these different parameters in atrial fibrillation in patients with no overt structural heart disease and in the most common clinical conditions known to be related to atrial fibrillation development such as hypertension, heart failure, cardiovascular surgery.

A new class of pyrrolidin-2-ones: synthesis and pharmacological study. II.

The anticonvulsant activity of a second series of pyrrolidin-2-ones (1-2a, 1-4b, 1-9c) was tested on pentylenetetrazole (PTZ) treated mice. The compounds were obtained by acylation of N-(3'-aminopropyl)-2-pyrrolidinone with the suitable acid chloride.

Sepsis and organ dysfunction: an ongoing challenge.

In recent years the problem of infection has become increasingly significant, especially in intensive care hospital wards such as Intensive Care Units (ICU), emergency medicine, surgery and critically ill patient care departments. Sepsis is a complex, multifactorial syndrome that can develop into conditions of different severity, described as severe sepsis or septic shock. In these conditions the triggering event may coincide with the functional impairment of one or more vital organs or systems, thus leading to poorer prognosis in patients with overt signs of sepsis or systemic inflammation syndromes. The available data are quite alarming, as most prevention and treatment is performed empirically and requires considerable human and technological resources. Clinical signs are often misleading and, in some circumstances, it may be difficult or even impossible to identify the source of the infection which might otherwise be removed relatively simply, using proper antimicrobial treatment or a less invasive surgical removal of the area from which the infection originates based on needle-guided radiology. In addition, the complex pathophysiological mechanisms involved can be an obstacle to gaining a full understanding of the various biohumoral interactions or mediators action mechanisms. It may not be easy to enroll patients belonging to homogeneous groups in terms of age, underlining disease, immune profile or genetic predisposition, although the use of specific severity indexes has proved helpful also to establish the prognosis. Although the interpretation of generalised inflammation as a warning sign also in the absence of clear signs of infection or a state of overt inflammation has to rely largely on simple intuition, it has helped to drive experimental and clinical research work towards the investigation of interaction between different factors such as infection and sepsis, or inflammation and coagulation. An additional useful tool is the possibility of modulating the endothelial response which may support the process of disseminated thrombosis typical of sepsis evolution. In this context the improvement of standards of care can shed light on the efficacy of different treatments.

[Research on substances with antiblastic activity. LVIII. Synthesis and antineoplastic activity of derivatives of pyrrolo-(1,2-a)quinoxaline]. / Ricerche su sostanze ad attivitá antiblastica LVIII - Sintesi ed attivitá antineoplastica di derivati della pirrolo[1,2-a]chinossaline

Some derivatives of pyrrolo[1,2-a]quinoxaline and 7,8-dimethoxypyrrolo[1,2-a]quinoxaline, structurally related to two antitumoral antibiotics, mitomycin C and anthramycin, have been prepared. The synthesis of the two nuclei was carried out starting from the required nitroaniline and 2,5-diethoxytetrahydrofuran; formylation of the pyrrole derivative and successive reduction gave the heterocyclic compound directly. Antineoplastic activity was evaluated on mice treated intraperitoneally with leukemia L 1210.

An improved immunoelectrophoretic methodology for the evaluation of protein caloric malnutrition.

An improved technique of two dimensional immunoelectrophoresis of serum proteins on gelatinized cellulose acetate for routine evaluation of protein nutritional state is described. The method, which allows the estimation of more than 30 protein fractions, proves extremely useful in monitoring the effectiveness of total parenteral nutrition and protein metabolic conditions. Sera samples from healthy subjects and cachectical neoplastic patients have been examined and preliminary results are reported.

Echo Doppler evaluation of right ventricular dysplasia.

Two-dimensional echocardiography (2D echo) and Doppler were performed in a group of patients who had a high probability of having right ventricular (RV) dysplasia (left bundle branch block arrhythmias, no signs of cardiopulmonary diseases) and in a group of age-matched normals. 2D echo showed RV morphofunctional abnormalities (free wall and apical irregularities, wall motion abnormalities) in 25% of patients with suspected RV dysplasia but in none of the normals. Concordance with angiography was good (75% of cases with positive 2D echo study had a positive angiography, while only 33% of the patients with suspected RV dysplasia and negative 2D echo had a positive angiography). In patients with high probability of RV dysplasia (positive 2D echo and angiography) left ventricular filling was similar to that of normal subjects whereas RV filling was markedly rearranged, as demonstrated by the significant decrease in RV early-to-atrial peak flow velocities.

[Reaction between 2-nitrobenzoylaminomalonate and acrylic aldehyde for the synthesis of compounds with the pyrrolo/2,1-ch h 1,4/benzodiazepine structure]. / La reazione tra 2-nitrobenzoilaminomalonato ed aldeide acrilica per la sintesi di composti a struttura pirrolo (2,1-c) (1,4) benzodiazepinica

The synthesis of 5,11-dioxo-1,2,3,10,11,11a-hexahydro-5H-pyrrolo (2,1-c) (1,4)benzodiazepine and 2-bromo-5,11-dioxo-1,10,11,11a-tetrahydro-5H-pyrrolo (2,1-c) (1,4)benzodiazepin-11a-ethylcarboxylate, structurally related to anthramycin and tomaymycin, was achieved by forming in situ the pyrrolidine nucleus instead of using proline or its derivatives. The most important intermediate was 1-(2-nitrobenzoyl)-delta4-pyrrolin-2,2-dicarboxylate which was then easily transformed into the above-mentioned tricyclic systems, starting with catalytic reduction or bromination.