[Clinical course of hypertrophic cardiomyopathy in a non selected population. The Experience of the Italian Multicenter Cardiomyopathy Study]. / Decorso clinico della cardiomiopatia ipertrofica in una popolazione non selezionata. Lésperienza dello Studio Policentrico Italiano Cardiomiopatie (SPIC).

BACKGROUND: Most of the information available on the clinical course and prognosis of hypertrophic cardiomyopathy (HCM) is based on data generated from international referral centres and as a result, it constitutes a potentially biased perspective of the disease process in this complex and diverse condition. A multicentric study was therefore set up with the aim of providing information on unselected patient populations with HCM. METHODS: The study group comprised 330 patients from 5 non-referral hospitals (mean age 42 +/- 16 years, M/F 226/104, 74-22%-obstructive, 299-91%-in NYHA class I-II) who were followed up regularly for 9.5 +/- 5.6 years. RESULTS: The vast majority of patients (n = 272, 82%) remained asymptomatic or mildly symptomatic during the follow-up period, whereas the remaining patients (n = 58, 18%) experienced clinical deterioration or died. Of the 18 patients (5%) who died of cardiovascular causes related to hypertrophic cardiomyopathy, 14 had progressive congestive heart failure and only 4 died suddenly. The annual mortality rate for cardiovascular disease was 0.57%, while the mortality rate due to sudden cardiac death was only 0.1%. The cumulative survival rate was 98, 95 and 93%, at 5, 10 and 15 years of follow-up respectively. Atrial fibrillation proved to be a relatively common (n = 81, 24%) and particularly unfavourable clinical feature, with higher mortality rate for cardiovascular causes related to hypertrophic cardiomyopathy. Syncope occurred in 47 patients (14%) but did not appear to have prognostic significance. CONCLUSIONS: In an unselected population, hypertrophic cardiomyopathy had a relatively benign prognosis that was inconsistent with its prior characterization as a generally progressive disorder, based primarily on the experience of selected referral institutions. Sudden unexpected cardiac death was distinctly uncommon, although a sizable proportion of patients, particularly the subset prone to atrial fibrillation, did experience clinical deterioration.

[Clinical and prognostic significance of echocardiographic parameters in dilated cardiomyopathy: a prospective study on 225 patients. The Italian Multicenter Study of Cardiomyopathies Group]. / Significato clinico e prognostico dei parametri ecocardiografici nella cardiomiopatia dilatativa: studio prospettico su 225 pazienti. Gruppo SPIC.

To assess the prognostic role of echocardiographic indexes and their relation to clinical conditions, 225 patients with dilated cardiomyopathy were studied prospectively. All cases had a normal coronary angiogram and non specific endomyocardial biopsy findings. 163 men (72.4%) and 62 women (27.6%), mean age 41.5 +/- 12.3 (range 8-61), were studied. Clinical, electrocardiographic and echocardiographic parameters, normalized for body surface area, were tested according to NYHA class and presence of segmental or diffuse wall motion abnormalities. One hundred-four patients were in NYHA class I-IIa, 94 were in class IIb-III and 27 were in class IV. Left ventricular end systolic diameter index, right ventricular end diastolic diameter index, left atrial diameter index, left ventricular fractional shortening and ejection fraction, and radius to wall thickness ratio were significantly more impaired in patients with more severe symptoms. Twenty-eight patients (13%) showed segmental wall motion abnormalities and had smaller left ventricular end systolic and left atrial diameter index and higher left ventricular fractional shortening and ejection fraction. During a mean follow up of 23 +/- 15 months (range 1-67 months), 25 patients (11.1%) died from cardiac causes and 16 (7.1%) underwent heart transplant because of refractory heart failure. Prognostic evaluation was performed separately for cardiovascular mortality alone and for cardiac events (cardiovascular mortality and heart transplantation). At Cox multivariate analysis only right ventricular end diastolic diameter index (p < 0.005) predicted cardiovascular mortality, while left atrial diameter index (p < 0.001), right ventricular end diastolic diameter index (p < 0.01) and left ventricular ejection fraction (p < 0.05) were significant independent predictors of cardiac events.

Prognostic value of exercise EKG testing in asymptomatic normotensive subjects. A prospective matched study.

We prospectively studied 135 asymptomatic normotensive subjects with exercise-induced ST ischemic depression of 1 mm or more and compared them with 379 controls. At least two controls with negative responses on the exercise electrocardiographic (EKG) test were selected for each case and were matched for age, sex, work, community, and coronary-risk-factors index. The end points considered were the following coronary events: angina pectoris, myocardial infarction, and sudden death. After a median follow-up period of 6.0 years for the cases and 6.4 years for the controls, the relative risk was 5.55 (95 per cent confidence limits, 2.75 to 11.22). Coronary events occurred significantly earlier in the cases than in the controls. Our data also suggest that the exercise EKG response is a particularly good prognostic indicator for myocardial infarction. In addition, our analysis has confirmed the predictive roles of age, smoking, blood pressure, and the coronary-risk-factors index and suggests that the exercise EKG response is an additional independent risk indicator for coronary events.

[Presence of bites in VCGrams of a high coronary risk population (author's transl)]. / Presenza di bites nel vettocardiogramma di una popolazione ad alto rischio coronarico.

The association between the presence of areas of myocardial fibrosis and the appearance of unexpected DEVIATIONS OF THE QRS loop-outline on the vectorcardiographic tracing (bites) has been reported. In order to re-evaluate the correlation between the presence of bites and the possible existence of scars we have studied 511 patients. On the basis of clinical data, laboratory data, rest and exercise electrocardiograms, the subjects have been divided into four groups; 195 normal subjects; 267 with ischemic heart disease, 16 with arterial hypertension and 33 with diabetes mellitus (the last two groups as representative of subjects with higher risk for myocardial ischemia). Bites in at least one plane were detected in 9.7% of normal subjects, 27.8% of ischemic patients, 56.3% of hypertensive patients and 18.2% of diabetics (less than 0.001). The genesis of bites and reliability of the diagnostic criteria are discussed. With more restrictive criteria the frequency in the normal subjects falls to 1%, while in the other three groups it remains much higher (10.1%-12.5%-6.1%).

[The bicycle electrocardiographic test for secondary prevention of coronary insufficiency. Results of a screening on 11,362 Italian workers (author's transl)]. / Valutazione dell'impiego del test cicloergometrico diagnostico. Screening effettuato su 11.362 lavoratori delle provincie di Milano e Varese ai fini della prevenzione secondaria dell'insufficienza coronarica.

A series of multi-phase mass screenings has been carried out in a number of working communities for locating, in their early stage, some socially important disease. The bicycle electrocardiographic test has been used for diagnostical purposes in order to single out all subjects affected by latent coronary heart disease and to evaluate the method as a means of prevention for the population. In the whole case-history, consisting of subjects free from coronary disease and with normal blood-pressure, mostly young or middle aged, the prevalence of positive electrocardiographic tests has been of 0.96%. The incidence of ischemic heart disease in 39 subjects with positive exercise test controlled after two-five years has been of 19%. Since the percentage of subjects with positive exercise test is extremely low on account of the not high occurrence of ischemic heart disease in our country as well as of the limited sensitivity of this method, it is believed that the electrocardiographic exercise test is not a satisfactory tool for secondary prevention of coronary disease in the Italian population.

[Evaluation of cardiac performace in 222 patients with pulmonary sarcoidosis (author's transl)]. / Studio di alcuni aspetti della funzione cardiaca in 222 pazienti affetti da sarcoidosi polmonare

Electrocardiogram at rest, blood pressure, systolic intervals (PEP/LVET), cardiothoracic ratio and circulation time were evaluated in 222 sarcoidotic subjects without cardiac symptoms and with no past or present history of cardiac disease. Very few, slight alterations were observed and were probably not the result of sarcoidotic myocardial involvement. Abnormalities distribution according to stage on the basis of chest-x-rays findings and the duration of sarcoidosis did not appear significantly different. Prospective study is being undertaken to determine which of the observed abnormalities may represent precursors or symptoms of sarcoidotic cardiac involvemenet.