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1.
Eur Rev Med Pharmacol Sci ; 24(17): 9112-9115, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32965001

RESUMEN

OBJECTIVE: Duchenne muscular dystrophy (DMD) is an inherited X-linked recessive neuromuscular disease caused by mutations of the dystrophin gene, leading to early and progressive muscle deterioration and dilated cardiomyopathy. The aim of this investigation was to assess whether treatment with sacubitril/valsartan (S/V) is well tolerated and may have beneficial effects in DMD patients with left ventricle (LV) dysfunction. PATIENTS AND METHODS: We administered S/V to 3 DMD patients (19-29 yeard old) with LV ejection fraction <35% at echocardiography but no symptoms of heart failure. All patients were on optimal medical therapy. S/V was initiated at a very low dose of 12/13 mg/die, after withdrawal of angiotensin-converting enzyme inhibitor therapy, and slowly titrated to the dose of 49/51 mg twice daily or the maximally tolerated dose. Clinical and echocardiographic follow-up was performed after 3, 6 and 12 months. RESULTS: At baseline, the LV ejection fraction was 32±1%. A significant improvement of LV ejection fraction was observed at 3 months (44.0±6.0%; p<0.05), which was maintained at 6 (45.7±5.0%) and 12 (43.3±3.2%) months (p<0.05 for both). No relevant side effects were reported throughout the period of the study. CONCLUSIONS: Our preliminary data suggest that, in DMD patients with reduced LV ejection fraction, S/V is safe and may improve LV function.


Asunto(s)
Aminobutiratos/uso terapéutico , Antagonistas de Receptores de Angiotensina/uso terapéutico , Compuestos de Bifenilo/uso terapéutico , Distrofia Muscular de Duchenne/tratamiento farmacológico , Valsartán/uso terapéutico , Disfunción Ventricular Izquierda/tratamiento farmacológico , Adulto , Aminobutiratos/administración & dosificación , Antagonistas de Receptores de Angiotensina/administración & dosificación , Compuestos de Bifenilo/administración & dosificación , Combinación de Medicamentos , Ecocardiografía , Humanos , Dosis Máxima Tolerada , Distrofia Muscular de Duchenne/fisiopatología , Valsartán/administración & dosificación , Disfunción Ventricular Izquierda/fisiopatología , Adulto Joven
2.
Eur Rev Med Pharmacol Sci ; 23(2): 826-832, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30720191

RESUMEN

OBJECTIVE: We investigated whether echocardiography may help identify, among patients admitted with a suspect of non-ST-segment elevation acute myocardial infarction (NSTEMI), those with athero-thrombotic coronary artery disease (CAD). PATIENTS AND METHODS: We studied consecutive patients admitted with a clinical suspect of first NSTEMI. Echocardiography was assessed within 24 hours from admission. Patients were divided into two groups, according to the results of coronary angiography: 1) patients with obstructive stenosis (≥ 50%) and/or images of thrombosis in one or more coronary arteries (CAD group); 2) patients with no evidence of obstructive coronary arteries (NOCAD group). RESULTS: Of 101 patients enrolled in the study, 53 (52.5%) showed obstructive CAD and 48 (47.5%) NOCAD. At echocardiographic examination, regional wall motion abnormalities were found in 52.8% of patients in the CAD group and 43.7% in the NOCAD group (p=0.43). Left ventricle ejection fraction was 56.4±6.8 vs. 54.7±9.8% (p=0.30) and wall motion score index was 1.16±0.26 vs. 1.21±0.32 (p=0.39) in the two groups, respectively. A multivariable logistic regression independent predictors of obstructive CAD included age, male gender, typical angina, diabetes and hypertension. CONCLUSIONS: Our data showed that, in patients with acute chest pain and increased serum troponin T concentration, routine standard echocardiography does not significantly improve the diagnostic accuracy for the presence of obstructive CAD.


Asunto(s)
Angina de Pecho/diagnóstico , Enfermedad de la Arteria Coronaria/complicaciones , Ecocardiografía/estadística & datos numéricos , Servicio de Urgencia en Hospital/estadística & datos numéricos , Infarto del Miocardio/diagnóstico , Adulto , Factores de Edad , Anciano , Angina de Pecho/sangre , Angina de Pecho/etiología , Angiografía Coronaria/estadística & datos numéricos , Enfermedad de la Arteria Coronaria/sangre , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Vasos Coronarios/diagnóstico por imagen , Electrocardiografía/estadística & datos numéricos , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/sangre , Infarto del Miocardio/epidemiología , Infarto del Miocardio/etiología , Pronóstico , Estudios Prospectivos , Factores de Riesgo , Factores Sexuales , Troponina T/sangre
3.
Eur Rev Med Pharmacol Sci ; 22(19): 6545-6550, 2018 10.
Artículo en Inglés | MEDLINE | ID: mdl-30338825

RESUMEN

OBJECTIVE: About one-third of patients undergoing percutaneous coronary interventions (PCIs) for flow-limiting coronary stenosis continue to develop signs of myocardial ischemia (MI) during exercise stress test [EST], despite successful coronary revascularization. Coronary microvascular dysfunction is a likely major cause of the persistence of EST-induced MI in these patients. PATIENTS AND METHODS: We studied 15 patients (14 men, age 67±5 years) fulfilling the following strict inclusion criteria: (1) recent PCI (<6 months), with drug-eluting stent, of coronary artery stenoses for stable angina, with evidence of full success (no residual stenosis >20% in any vessel); (2) persistence of ST-segment depression induction during EST. After a basal investigation, patients received either ranolazine (375 mg bid) or isosorbide-5-mononitrate (ISMN, 20 mg bid) for 3 weeks in a single-blind, randomized crossover study. Clinical assessment, symptom-limited EST, echocardiographic color-Doppler, with tissue-Doppler examination, and coronary microvascular dilator response to adenosine (CFR-ADO) and cold pressor test (CFR-CPT), assessed by transthoracic echo-Doppler, were obtained at baseline and the end of the 3-week therapy with each drug. RESULTS: Compared to both baseline and ISMN, ranolazine showed a longer time to 1 mm ST-segment depression (404±116 s vs. 317±98 and 322±70 s, respectively; p<0.01). No differences were observed in coronary microvascular function and diastolic left ventricular function between the 2 drugs and compared to baseline. CONCLUSIONS: Our data show that ranolazine, but not ISMN, improved time to ischemia during EST. This effect, however, was independent of any effects on coronary microvascular and diastolic function.


Asunto(s)
Estenosis Coronaria/terapia , Vasos Coronarios/efectos de los fármacos , Dinitrato de Isosorbide/análogos & derivados , Microvasos/efectos de los fármacos , Intervención Coronaria Percutánea , Ranolazina/uso terapéutico , Vasodilatadores/uso terapéutico , Anciano , Circulación Coronaria/efectos de los fármacos , Estenosis Coronaria/diagnóstico por imagen , Estenosis Coronaria/fisiopatología , Vasos Coronarios/diagnóstico por imagen , Vasos Coronarios/fisiopatología , Estudios Cruzados , Femenino , Humanos , Dinitrato de Isosorbide/efectos adversos , Dinitrato de Isosorbide/uso terapéutico , Masculino , Microcirculación/efectos de los fármacos , Microvasos/diagnóstico por imagen , Microvasos/fisiopatología , Persona de Mediana Edad , Intervención Coronaria Percutánea/efectos adversos , Ranolazina/efectos adversos , Ciudad de Roma , Método Simple Ciego , Factores de Tiempo , Resultado del Tratamiento , Vasodilatadores/efectos adversos
4.
Eur Rev Med Pharmacol Sci ; 18(3): 374-9, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-24563437

RESUMEN

BACKGROUND: Classical anti-ischemic drugs are the first-line form of treatment in patients with microvascular angina (MVA), but they often fail to achieve a satisfactory control of angina symptoms. It is unknown whether there is any relation between improvement of angina status and changes in microvascular function induced by classical anti-ischemic drugs in MVA patients. AIM: To assess whether, in MVA patients, the effects of classical anti-ischemic drugs on symptoms and quality of life (QoL) are related to changes in coronary microvascular function. PATIENTS AND METHODS: We studied 51 patients (59±10 years; 15 men) with MVA. Coronary blood flow (CBF) response to adenosine (ADO) and to cold pressor test (CPT), Seattle Angina Questionnaire (SAQ) and EuroQoL scale were assessed at baseline, in pharmacological washout, and after 12 months under anti-ischemic therapy. Patients were divided into 2 groups: (1) Group 1 included patients with no improvement of QoL (EuroQoL score change < 10 points); (2) Group 2 included patients with QoL improvement (increase in EuroQoL score ≥ 10 points). RESULTS: At baseline, the 2 groups were similar in age, gender, cardiovascular risk factors, CBF response to ADO and to CPT, SAQ and EuroQoL scores. At follow-up the 2 groups differed only for beta blockers use (27% vs. 88% in group 1 and 2, respectively; p < 0.001). A significant improvement in SAQ score was observed only in group 2. CBF response to both ADO and CPT showed a similar improvement in the 2 groups. No relation was found between changes in coronary microvascular function and in angina status. CONCLUSIONS: In MVA patients beta-blockers are more effective than other anti-ischemic drugs in improving angina symptoms. The improvement of angina status does not seem to be mediated by changes in coronary microvascular function.


Asunto(s)
Antagonistas Adrenérgicos beta/uso terapéutico , Angina Estable/tratamiento farmacológico , Angina Estable/fisiopatología , Vasos Coronarios/fisiología , Microcirculación/efectos de los fármacos , Microvasos/efectos de los fármacos , Antagonistas Adrenérgicos beta/administración & dosificación , Anciano , Antagonistas de Receptores de Angiotensina/administración & dosificación , Antagonistas de Receptores de Angiotensina/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/administración & dosificación , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Bloqueadores de los Canales de Calcio/administración & dosificación , Bloqueadores de los Canales de Calcio/uso terapéutico , Circulación Coronaria/efectos de los fármacos , Circulación Coronaria/fisiología , Vasos Coronarios/efectos de los fármacos , Femenino , Humanos , Masculino , Microcirculación/fisiología , Microvasos/fisiología , Persona de Mediana Edad , Calidad de Vida
5.
Heart ; 95(7): 550-4, 2009 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-19164330

RESUMEN

OBJECTIVE: To assess whether abnormalities in cardiac uptake of (123)I-metaiodobenzylguanidine (MIBG) correlate with coronary microvascular dysfunction in patients with cardiac syndrome X (CSX). SETTING: University hospital. PATIENTS: 29 patients (aged 59 (SD 7) years, 11 men) with typical CSX and a matched group of 20 healthy subjects (aged 56 (7) years, 8 men) were studied. INTERVENTIONS: Planar and single photon emission computed tomography (SPECT) MIBG myocardial scintigraphy was performed in all subjects. Coronary flow response (CFR) to adenosine and to cold pressor test (CPT) in the left anterior descending (LAD) coronary artery was assessed in all CSX patients and in 12 controls by transthoracic Doppler echocardiography. MAIN OUTCOME MEASURES: Abnormalities in cardiac MIBG scintigraphy were observed in 25 CSX patients (86.2%), but in no healthy control (p<0.001). Compared to controls, CSX patients showed a lower heart/mediastinum (H/M) ratio of MIBG uptake (1.69 (0.24) vs 2.2 (0.3), p<0.001) and a higher cardiac MIBG defect score (25 (22) vs 4 (2), p = 0.002). Both CFR to adenosine (3.31 (1.1) vs 1.94 (0.6), p<0.001) and CFR to CPT (2.35 (0.5) vs 1.63 (0.4), p<0.001) were lower in CSX patients than in controls. In CSX patients, however, no correlation was found between MIBG H/M ratio and CFR to adenosine (r = 0.17; p = 0.38) and to CPT (r = -0.28; p = 0.13), as well as between MIBG uptake score in the LAD territory and CFR to adenosine (r = 0.14; p = 0.47) and to CPT (r = 0.06; p = 0.73). CONCLUSION: Our data show striking abnormalities in cardiac adrenergic nerve function and in coronary microvascular function in CSX patients. However, no significant relation between the two abnormalities was found. Further studies are needed to clarify the mechanisms and the role of MIBG defects in CSX patients.


Asunto(s)
3-Yodobencilguanidina/farmacocinética , Fibras Adrenérgicas/metabolismo , Angina Microvascular/metabolismo , Miocardio/metabolismo , Radiofármacos/farmacocinética , Adenosina , Fibras Adrenérgicas/diagnóstico por imagen , Fibras Adrenérgicas/fisiología , Anciano , Estudios de Casos y Controles , Frío/efectos adversos , Circulación Coronaria/efectos de los fármacos , Electrocardiografía/efectos de los fármacos , Femenino , Corazón/diagnóstico por imagen , Humanos , Masculino , Microcirculación/efectos de los fármacos , Angina Microvascular/diagnóstico por imagen , Angina Microvascular/fisiopatología , Persona de Mediana Edad , Tomografía de Emisión de Positrones , Vasodilatadores
6.
Minerva Cardioangiol ; 55(6): 703-10, 2007 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-18091639

RESUMEN

AIM: Several studies showed that primary percutaneous coronary interventions (PCI) have a favourable impact on left ventricular remodeling and heart rate variability (HRV) both at short- and long-term follow-up in patients suffering an acute myocardial infarction (AMI). However, no previous study investigated the relationship between left ventricular remodeling and changes in HRV during follow-up in AMI patients treated by primary PCI. METHODS: We studied 28 patients with AMI (57+/-8 years, 27 men), treated by PCI within 12 hours of symptom onset. Patients underwent a 24-hour ECG Holter recording and left ventricular ejection fraction (LVEF) echocardiographic assessment before discharge, and at 1-month and 6-month follow-up. HRV was measured in the time- and frequency-domain. RESULTS: A significant improvement of both time- and frequency-domain HRV variables was observed at 1-month and at 6-month follow-up with the most significant changes being found for standard deviation of normal-normal beat intervals (SDNN) in the time-domain (95.5+/-26.1 ms vs 125.5+/-29.8 ms vs 142.8+/-28.8 ms, respectively; P<0.001) and for very low frequency (VLF) amplitude in the frequency-domain (36.7+/-9.8 ms vs 44.1+/-11.1 vs 48.9+/-12.2 ms, respectively; P<0.001). In contrast, compared to basal values, LVEF was substantially unchanged at 1-month and 6-month follow-up (48.8+/-8.5% vs 50.8+/-10% vs 49.6+/-9%, respectively; P=0.25). At 6-month follow-up 11 patients showed an improvement of >or= 5% of LVEF, whereas 17 patients did not show any improvement of LVEF. HRV variables significantly improved in a similar way in these two subgroups both at 1-month and at 6-month follow-up. CONCLUSION: Our data demonstrate that, in AMI patients treated by primary PCI, HRV improves over time, independent of changes in LVEF. The clinical implications of these findings deserve to be addressed in future studies.


Asunto(s)
Angioplastia Coronaria con Balón , Frecuencia Cardíaca/fisiología , Infarto del Miocardio/terapia , Remodelación Ventricular , Interpretación Estadística de Datos , Electrocardiografía , Electrocardiografía Ambulatoria , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/diagnóstico por imagen , Infarto del Miocardio/fisiopatología , Volumen Sistólico , Factores de Tiempo , Ultrasonografía
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