[The stress systolic time intervals in the diagnosis of ischaemic heart disease. Study of the recovery in patients with persistent ischemia (author's transl)]. / I tempi sistolici da sforzo nella diagnostica della cardiopatia ischemica.

The changes in systolic time intervals (STI) LVET, PEP/LVET) between rest conditions, maximal exercise and after seven minutes after upright bicycle stress test were measured in 31 consecutive subjects: 14 "control" normal subjects, and 17 subjects with ischemic heart disease. The purpose of this investigation was to evaluate the specificity and sensitivity of the stress - STI in the identification of patients with positive exercise ECG and of patients with markedly positive exercise ECG that shown a late recovery persistent ischemia. The changes of STI are different in the control group and in ischemic heart disease group pts with negative exercise stress test and pts with positive or markedly positive exercise ecg. In the literature the usefulness of stress STI in the diagnosis of coronary disease is not univocally accepted. Our results indicate that STI are not a parameters that have an available correlation ith the stress myocardial ischemia even at distance of haemodynamic variations of maximal exercise and recovery and in presence of late recovery persistent ischemia.

[Comparison between holter dynamic ECG and exercise stress test in the evaluation of ventricular arrhythmias in patients with ischaemic heart disease (author's transl)]. / Confronto tra l'ECG dinamico e il test da sforzo nello studio delle aritmie nell'infarto miocardico recente.

The Authors have examined the possibility for diagnostic and prognostic value of exercise stress test and of dynamic ecg in the identification of ventricular ectopic activity which represent a factor risk of sudden death. 41 male patients with IHD and Myocardial Infarction were given exercise stress test and Holter monitoring according to the usual methods. Both methods were useful to identify Pts with arrhythmias. The total incidence of ventricular ectopic beats was 78% with Holter and 46% with exercise test. Holter monitoring showed a major possibility to detect high degree arrhythmias (39%) against 9% of exercise test. Two methods are not comparable, not it was possible to demonstrate statistically significant incidence of ventricular ectopics with respect to the localization of M.I. 90% of Pts with positive exercise test (angina and/or ecg alterations) showed ventricular ectopic beats against 45% of Pts with negative exercise test. The association of ventricular ectopic beats in Holter and positive response to exercise test is highly predictable of sudden death. The results of investigation suggest the opportunity to evaluate Pts with MI by both methods, dynamic ecg and exercise stress test.

[Echocardiokymography: a new ultrasonic technique. Patterns in normal subjects (author's transl)]. / Ecocardiochimografia: una nuova tecnica ultrasonica. Aspetti nel soggetto normale.

A new echocardiographic technique is presented: echocardiokymography. Parietal and valvular motion patterns are condensed in a single, two-dimensional image, showing the sisto-diastolic excursions, while keeping the spatial relationships. 65 normal subjects were studied and 4 motion patterns were identified: parietal muscular, parietal vascular, atrio-ventricular valvular and aortic valvular.

[The problem of side-effects: cardiotoxicity (author's transl)]. / Etude de l'effet cardiotoxique des composés antidépresseurs tricycliques.

The cardiotoxicity of tricyclics is wellknown. The interpretations of such a mechanism are many: the tricyclic ring, the dimetilaminic group, the re-uptake NA mechanisms at myocardic level. A study was designed in order to answer the question. Four antidepressant drugs (a true quadricyclic: mianserin; a tricyclic with short later chain: amineptine; two tricyclic antidepressants with long chain: amitriptyline and chlorimipramine) were chosen in the double-blind cross-over study design in two different types of depression: anxious and retarded depression. A computerized cycloergometer test was performed at different times, together with ECG and depression evaluation. The patients with retarded depression were treated with amineptine (from 150 mg to 300 mg/day) and after a wash-out periods with chlorimipramine (150 mg/day). The patients with anxious depression were treated with mianserin (30-60 mg/day) for a fortnight and afterwards with amitriptyline (150 mg/day). The evaluation of the ergometric tests carried out at the fixed day have been carried out using the "Minnesota methodology". The results obtained show that the quadricyclic (mianserin) doesn't point out any cardiotoxicity. All tricyclics, especially amitriptyline, show cardiotoxicity signs.

[Echocardiographic evaluation of myocardial infarct patients undergoing rehabilitation]. / Valutazione ecocardiografica del paziente infartuato sottoposto a riabilitazione.

29 patients with a recent myocardial infarction underwent a M-mode echocardiographic study before and after an ergometric training in order to study the training effects on the left ventricular function and on the cardiac chambers dimensions. 25 patients in the same clinical conditions and no trained acted as a control group and were evaluated with the same procedure. Our results show, in the trained group, a significant reduction of the diastolic (-5.6%) and systolic (-6.5%) diameters of the left ventricle and of the diameter of the left atrium (-7.5%). Moreover we observed an improvement of the left ventricular kinesis, as showed by the increased systolic movement of left posterior wall and of the interventricular septum and by the increased ventricular performance, as it results from increased systolic movement of the aortic root. In the control group no significant variation of the examined data was observed. The reduction of the diameters and the improvement of the kinesis and of ventricular performance could be explained by the reduced after-load and it shows the presence of direct beneficial effects of the exercise training on the heart, consisting both of improved cardiac mechanics and of a reduced MVO2.

[Exercise test in women with abnormal ecg (author's transl)]. / Il test ergometrico in donne con elettrocardiogramma a riposo alterato.

114 women with abnormal resting electrocardiograms underwent exercise test on bicycle ergometry; they were grouped as follows: --group I: 40 asymptomatic females; --group II: 67 cases with atypical chest pain; --group III: 7 cases with typical angina. The exercise test was always maximal or submaximal SL. The only criteria used for positive stress was a 1 mm or more ischemic ST segment depression below the resting level, for at least 0.08 sec. The test was positive in 11 subjects (10.7%): 5 women of group II (7.5%) and 6 of group III (85.7%). Our results suggest that repolarisation abnormalities, not caused by hypertrophy, conduction disturbances and drugs, do not modify the outcomes of stress test. Ischemic patterns during exercise test are more frequently seen when flat or diphasic T waves are present in control ECG. In the majority of patients in all groups the T wave either does not change or becomes more positive or less negative after exercise. A greater prevalence of resting hypertension and arrhythmias is present in patients with positive tests.

[Hypertension in young man. Epidemiologic investigation in students of an Italian secondary school (author's transl)]. / Ipertensione arteriosa giovanile. Indagine epidemiologica in un liceo di Roma.

The investigation carried out on a group of 1221 students (aged 13-19) of an Italian secondary school shows (19.6%) prevalence of high blood pressure. The prevalence was calculated assuming as hypertensive people with blood pressure higher than an arbitrary limit of 140/90 mmHg. The means, standard deviations and 95th percentiles for systolic and diastolic pressure for each age and sex were also calculated. In a follow up of 6 months the percentage of students with BP > 140/90 mmHg decreased from 6.5% to 3.5%. Statistical analysis of 19 items of a questionnaire distributed to be filled to the students shows interesting correlations between BP values, hypertension in relatives and obesity.

[The exercise stress test in patients with intraventricular conduction troubles (author's transl)]. / Il test ergometrico nelle anomalie della conduzione intraventricolare.

The results of exercise stress test in 86 patients with intraventricular conduction troubles (BBBand or Emiblock) are discussed in order to asses the meaning of exercise induced ECG alterations and possibly of an etiopathogenetic interpretation. The AA. examined the following parameters during stress test and recovery: max heart rate, percent of teoric max heart rate, max BP, max heart rate x BP product, AQRS at rest and during recovery immediately after exercise test, QRS duration, ST depression, T amplitude. The majority (91,67%) of isolated RBBB patients had negative test; 30,43% of RBBB + LAEmiblock patients had ECG signs and clinical symptoms of myocardial ischemia. In LBBB patients the test was considered positive only if present ST depression and precordial pain. The AQRS tends during exercise to the right; in the 60% of RBBB + LAEmiblock patients it can be seen a tendency to left axis deviation; the amplitude of T-wave is increasing in more than 50% in LBBB. The conclusions are that in patients with intraventricular conduction troubles the interpretation of results is always difficult; the presence of clinical symptoms like precordial pain may give an aide when associated to the ECG variations.

[Prospectives for rehabilitation of subject with pacemakers (author's transl)]. / Prospettive di riabilitazione dei portatori di pacemaker.

The research performed in the last ten years has allowed important knowledge related to cardiocirculatory physiopathology concerning subjects treated with artificial pacemakers. Relying upon available data, one may today state with certainty that subjects treated with artificial pacemakers may afford an activity very often quite near to the physiologic one: it ensues that every attempt must be made (particularly referring to subjects under 50 years) in order to resume work adaptation correlated with similar efficient possibilities about peripheral circulation. A rehabilitation treatment, on a valid functional evaluation ground, is today possible and desirable, as is demonstrated by some patients who have again resumed their activity.