[Exercise stress test and dobutamine stress echocardiography for the prognostic stratification after uncomplicated acute myocardial infarction]. / ECG da sforzo ed eco-stress dobutamina nella stratificazione del rischio dopo infarto miocardico acuto non complicato.

BACKGROUND: Exercise stress test and dobutamine stress echocardiography are usually performed early after an uncomplicated acute myocardial infarction in the prognostic stratification of patients to define the optimal diagnostic and therapeutic procedure. The aim of this study was to evaluate if the association of an imaging test could increase exercise test capability to identify patients with residual ischemia and patients at high risk of events in the follow-up. METHODS: Four hundred and forty-two consecutive patients underwent exercise stress testing and dobutamine stress echocardiography before discharge and subsequently coronary angiography within 30 days. In case of submaximal negative result at the exercise test, this was repeated 20 days after discharge. The follow-up lasted 26.8 +/- 9 months. The endpoints were death, reinfarction, and unstable angina requiring hospitalization or revascularization intervention. RESULTS: Both tests and their association showed a higher sensitivity in males; in females dobutamine stress echocardiography had a higher specificity. In females, the addition of dobutamine stress echocardiography increased either the negative or the positive prognostic values of exercise stress test by 31% and 5.6%, respectively. In males, the negative prognostic value increased by 15.5%, whereas the positive prognostic value decreased by 12%. A low exercise capability (<6 METs) showed an event predictive value independent of test results and any other variables. The event-free survival curves correlated with exercise capability differed shortly after the first months both in males and females. CONCLUSIONS: These results suggest different stratification procedures with regard to gender: in males, the exercise stress test might be sufficient at discharge, to be repeated 20 days later, if submaximal negative. In females, it seems to be useful to associate an imaging test at discharge. In any case, the exercise stress test remains the main step in the stratification procedure also for its capability to identify patients who are at high risk of events in the follow-up.

[Risk stratification after acute myocardial infarction: limitations of dobutamine stress echocardiography in females]. / Stratificazione del rischio dopo infarto miocardico acuto: limiti dell'eco-stress dobutamina nel sesso femminile.

BACKGROUND: Dobutamine stress echocardiography (DSE) is an imaging test widely used for risk stratification of patients after acute myocardial infarction. METHODS: We evaluated the sensitivity of DSE with respect to the gender and the stenotic coronary artery in patients who survived a myocardial infarction and with angiographic evidence of single-vessel coronary artery disease. RESULTS: The sensitivity of DSE was generally low. In particular, it was significantly lower in the presence of stenosis of the left circumflex and right coronary arteries with respect to the left anterior descending coronary artery. In females it was lower, especially when the stenosis involved the right coronary and left circumflex arteries. CONCLUSIONS: Our data suggest that in female gender the use of other imaging tests and particularly of coronarography should be strongly recommended for risk stratification after acute myocardial infarction.

[Infusion of flecainide in a patient with atrial fibrillation and latent Brugada's syndrome has determined modifications of the electrocardiogram similar to those of a septal myocardial infarct]. / L'infusione di flecainide in un paziente con fibrillazione atriale e sindrome di Brugada latente ha determinato modificazioni dell'elettrocardiogramma simili a quelle di un infarto miocardico settale.

ST-segment elevation in the presence of typical chest pain is a fundamental criterion for the diagnosis of acute myocardial infarction. We describe the case of a 62-year-old male with latent Brugada syndrome in whom the intravenous infusion of flecainide for paroxysmal atrial fibrillation caused ECG abnormalities similar to those of an acute septal myocardial infarction. The patient was not submitted to systemic thrombolysis since accurate echocardiographic evaluation was not suggestive of the presence of any wall motion abnormality and blood analysis did not reveal any increase in the levels of myocardial enzymes. The clinical outcome was not complicated and the patient was finally discharged.

In vitro and in vivo Characterization of the Anti-Inflammatory Effects of Cyclosporin A.

Cyclosporin A (CsA) a cyclic undecapeptide extracted from Tolypodadium inflatum Gams, is effective in the prevention/treatment of graft rejection and in an increasing number of autoimmune and inflammatory disorders. The immunosuppressive effect of CsA was initially attributed to inhibition of lymphokine mRNA transcription. We have demonstrated that pharmacological concentrations of CsA (10-100 ng/ml) also inhibit the in vitro immunologic release of preformed (histamine) and de novo synthesized (leukotriene C4 and prostaglandin D2) mediators of inflammatory reactions from human basophils and mast cells. Furthermore the administration of a single dose of CsA (7 mg/ kg) to 8 normal donors caused a rapid and significant (20-40%) inhibition of histamine release from basophils obtained ex vivo from these subjects and challenged in vitro with anti-IgE, f-Met-Leu-Phe and A23187. The inhibitory effect of CsA peaked at 1-5 h, slowly decreased up to 13 h, and was associated with a sharp increase in blood CsA levels. Thus, CsA exerts remarkable anti-inflammatory effects on the immunologic release of mediators from human basophils and mast cells - properties that may contribute to the drug's therapeutic effects.

Modulation of Human Lung Mast Cell Function by the c-kit Receptor Ligand.

The gene product of the steel locus is a growth factor for mast cells and a ligand for the c-kit proto-oncogene receptor, a member of the tyrosine kinase receptor class of oncogenes. We studied the effect of recombinant human c-kit receptor ligand stem cell factor (rhSCF) on the release of preformed (histamine) and de novo synthesized mediators [prostaglandin D2 (PGD2) and peptide leukotriene C4 (LTC4)] from mast cells purified from human lung parenchyma (HLMC). rhSCF (0.01-10 ng/ml) concentration-dependently induced histamine release from HLMC. rhSCF also induced the de novo synthesis of PGD2, whereas it did not induce the release of LTC4. The release of mediators from HLMC caused by rhSCF was extremely rapid, and was Ca2+- and temperature-dependent.