[Effectiveness of depot diltiazem in stable effort angina: a double-blind study compared with placebo]. / Efficacia del diltiazem retard nell'angina stabile da sforzo: studio in doppio cieco in confronto a placebo.

AIM OF THE STUDY: The antianginal efficacy of slow-release (SR) Diltiazem and change in ergometric parameters during treatment were evaluated in patients with stable effort angina. METHODS: Forty eight patients with documented ischemic cardiopathy were studied. The study design was double blind randomised cross over versus placebo. After a 7 days run-in period of pharmacological washout, patients were randomised to treatment with diltiazem SR (120 mgs bid) or placebo for 1 week, followed by crossover of treatments. No concomitant antianginal therapy, except sublingual nitro-glycerine was allowed during the trial. Exercise tests were performed during the run-in period and at the end of each week of treatment. RESULTS: After diltiazem administration, exercise duration increased significantly in comparison with placebo (645.6 +/- 196.31 vs 563.9 +/- 244.52 s, p < 0.01). Similarly, time to onset of angina and time to ischemic threshold increased in comparison to placebo (603.78 +/- 198.50 vs 459.69 +/- 239.40 s, p < 0.01 and 576.06 +/- 208.88 vs 463.16 +/- 246.12 s, p < 0.01 respectively). No significant changes in heart rate, blood pressure and double product at ischemic threshold and peak exercise were detected. CONCLUSIONS: SR-diltiazem is effective and well tolerated in the treatment of patients with stable angina.

[Prognostic evaluation with invasive technics in patients with hyperkinetic ventricular arrhythmias]. / Valutazione prognostica con metodiche invasive di pazienti con aritmie ipercinetiche ventricolari.

The prognostic value of induction of ventricular tachycardia (VT) by programmed electrical stimulation (PES) was analyzed in 123 patients: 64 (Group I) with spontaneous recurrent VT and 59 (Group II) without a history of serious arrhythmias. Thirty-three patients with spontaneous VT underwent coronary and left ventricular angiography to compare electrical instability with the presence of ventricular disfunction and/or the extent of coronary artery disease (CAD). PES reproducibly induced VT in 49/64 patients with spontaneous VT (sensitivity = 77%) and in 6/59 patients without VT (specificity = 90%). Twenty-two patients (66%) had ventricular disfunction defined by an ejection fraction of less than or equal to 40% or regional wall motion abnormalities. Only 4 patients (33%) had proximal 3-vessel CAD. The mean follow-up period was 16 +/- 12 months. Eight of Group I patients died suddenly and 24 had recurrent symptomatic VT. Three of Group I patients died (1 cardiac failure, 2 non-cardiac deaths), all the survivors were free of serious arrhythmias. In Group I patients mortality was correlated with: recent anterior myocardial infarction, inducible sustained VT with PES, ejection fraction less than or equal to 0.40, ventricular ipoasynergy and or at least one coronary stenosis greater than or equal to 70%. This study suggests that inducible VT is a marker of the risk of sudden death. Electrical instability may occur independent from the etiology of cardiopathy, ventricular disfunction and extent of CAD, but these parameters are correlated to global and sudden mortality in the group of patients with spontaneous VT.

Chest thump and ventricular tachycardia.

Chest thump is a simple method of treatment of some paraxysmal arrhythmias. Its therapeutic efficacy, electrophysiological bases and clinical utility have been studied in 17 patients during 45 episodes of ventricular tachycardia (VT). Thumping the precordium interrupted the VT in 22 episodes. Three types of interruption of VT have been observed: (1) In 15 episodes, single ventricular premature beats induced by the blow, occurring randomly in the cycle, stopped the arrhythmia; (2) In 5 episodes, a run of premature beats, induced by a rapid succession of blows, interrupted the tachycardia; (3) In 2 episodes, chest thump caused a short period of asystole followed by sinus rhythm. Chest thump is an antiarrhythmic treatment of definite clinical utility. The complications are rare, although there is a possibility of ventricular fibrillation. Therefore, it should be performed only under careful supervision.