Diagnostic and prognostic value of dipyridamole and dobutamine stress echocardiography in patients with Q-wave acute myocardial infarction.

The aim of this study was to compare dipyridamole and dobutamine stress echocardiography, performed early in patients with acute myocardial infarction (AMI) to evaluate residual ischemia, viability, and prognosis. Fifty patients (mean age 55 +/- 9 years, 47 men, 3 women) with AMI, all treated with thrombolytic therapy, underwent standard dipyridamole and dobutamine tests, within the fifth day of the event. Wall motion score index and the 16 segments model were used to evaluate contractility. Forty-seven patients underwent coronary angiography within the tenth day of the event. The mean follow-up was 24 +/- 12 months. No side effects occurred during both tests. Both dipyridamole and dobutamine tests were positive for ischemia, in 32 and 33 of 47 patients, respectively (sensitivity 73% and 75%; specificity 67% and 67%); these tests induced an improvement of contractility in 23 and 38 of 139 abnormal segments at baseline, respectively (sensitivity 52% and 86%; specificity 100% and 100%). Cardiac events occurred in 26 of 50 patients, 22 with a positive dipyridamole test and 21 with positive dobutamine test. Thus, both tests were feasible, safe, and useful to evaluate residual ischemia, viability, and prognosis. No significant differences were found in sensitivity and specificity between tests.

[Adverse effects of drugs: syncope due to prenylamine (author's transl)]. / Effetti sfavorevoli dei farmaci: sincope da prenilamina

The authors report on 4 Intensive Care Unit cases, hospitalized for syncopes due to serious ventricular arrhythmias. They all presented long Q-T and were receiving treatment with prenylamine. Improvements were observed on suspension of the drug, suggesting therefore that during this treatment, frequent electrocardiographic checks, especially for elderly patients, should be carried out. Caution should also be exercised in associations with other chinidinosimiles and hypokaliemic drugs

[Natural history of unstable angina. Observations on 157 cases (author's transl)]. / Decorso dell'angina instabile. Osservazioni su 157 casi

157 cases affected with "unstable angina" and hospitalized were observed over a period of from 8 to 24 months (average observation time: 16 1/2 months). The patients were treated with: nitroderivates, beta blocking drugs (when not contra-indicated); treatment of side affects (hypertension; arrhythmias, decompensation, associated pathology, correction of risk factors of coronary heart disease). 9 cases were lost and 148 were studied for the course of the illness. 10.6% died from cardiopathy (2.8% through sudden death; 7.4% from myocardial infarction); there was a 12.1% total incidence of myocardial infarction; 50% of the cases were alive but with sumptoms of stabilized angina, whilst 32.4% were completely asymptomatic. Coronographic alterations and myocardial contractility negatively affect the course of the illness. Negative effects (disease or infarction) were not checked in the cases of stenosis of only one coronary branch. In the casuistry, there were no negative effects in patients with stenosis of one coronary branch, and in cases of two or more branches, negative effects were 28%. 41% of patients with alterations of ventrical contractility gave negative results. An asymptomatic course of the illness was checked more frequently in the intermediate stages than in angina cases.

[Effectiveness of two Ca-antagonistic drugs on angina pectoris: nifedipine and verapamil versus nitroderivative and beta-blocking drugs (author's transl)]. / Azione antianginosa di due farmaci calcio-antagonisti: nifedipina e verapamil in confronto a nitroderivato e a beta-bloccante.

The Authors, using cycle ergometer tests, assess the effectiveness of two Ca-antagonistic drugs, nifedipine and verapamil, administered full strength to patients suffering from typical angina from effort. The true effectiveness of these drugs was tested by comparing the results with those obtained with placebo, isosorbide dinitrate and propranolol. The effect of nifedipine proved statistically significant (p less than 0.01) with respect to the parameters: double product, time of insurgence of angor and time of appearance of electrocardiographic anomalies. Verapamil proved slightly significant (p less than 0.05) only with regard to time of appearance of electrocardiographic anomalies. There follows a brief discussion of the differences between these results. Isosorbide dinitrate and propranolol increase tolerance to effort with respect to placebo treatment. These results are statistically significant on all parameters used.