The effect of verapamil on left ventricular remodelling and diastolic function after acute myocardial infarction (the Verapamil Infarction Study on Remodelling and Relaxation--VISOR).

The VISOR is a double blind, randomized, placebo-controlled study aimed to assess the effects of early and prolonged administration of verapamil on the left ventricular geometry and diastolic function in patients with anterior acute myocardial infarction treated with thrombolysis. Patients with heart failure or ejection fraction < 45% were excluded. Within 12 hours from starting thrombolysis, 70 patients were given verapamil (5 mg/hour intravenously for the first 24 hours, followed by 120 mg t.i.d. perorally for 6 months) or equivalent placebo. Echocardiograms were performed on admittance, before discharge, after 3 months and 6 months. The following parameters were calculated: left ventricular volumes, ejection fraction, sphericity index, early (E) and late (A) transmitral peak flow velocities and time-velocity integrals with their ratios, deceleration time and half-time of E, isovolumic relaxation time (IVRT), and non-invasive time constant of ventricular relaxation (tau). The basal and the last available parameters were considered for statistical analysis. The effects of the treatment on the left ventricular volumes, ejection fraction, and sphericity index were not statistically relevant. Conversely, a reduction of E/A ratio (P < .05) and increases of A integral (P < .01), deceleration time and half-time of E, IVRT and tau (P < .05) were found in the placebo group and not in the verapamil group. No significant changes in the blood pressure, heart rate, PQ interval, and biochemical parameters were observed in the two groups. In conclusion, in patients with a thrombolysed anterior acute myocardial infarction and preserved systolic function, verapamil can prevent alterations of the diastolic function in absence of effect on ventricular remodelling, and has a good safety profile.

[The incidence and clinical implications of left ventricular thrombosis in 769 patients with acute myocardial infarct treated with antithrombotics and fibrinolytics]. / Incidenza e implicazioni cliniche della trombosi ventricolare sinistra in una casistica di 769 pazienti con infarto miocardico acuto trattati con antitrombotici e fibrinolitici.

Seven hundred sixty-nine patients (pts) admitted to the Coronary Care Unit (CCU) between January 1987 and January 1990 suffering from first acute myocardial infarction (AMI) were studied. The presence of left ventricular thrombosis (LVT) was evaluated by two-dimensional echocardiography (2D-echo). The relation of LVT to site, size and intra-CCU clinical outcome of AMI, in terms of systemic embolic events, Killip class and mortality, was also assessed. AMI was transmural in 707 pts (92%), anterior in 446 pts (58%) and inferior in 261 pts (34%), non-Q in 62 pts (8%). Two hundred sixty-one pts (34%) were treated with IV thrombolytic therapy followed by IV heparin 1000 IU/h over 12 hrs and then calcium heparin (CH) 12500 IU s.c. bid; 508 pts (66%) were given only antithrombotic therapy (CH 12500 IU s.c. bid). 2D-Echo was performed within 48 hours and on day 5-7 from the onset of AMI. In 41 pts (5.3%) LVT was observed: 39 had anterior AMI (8.7% of all anterior AMI pts), one had inferior AMI (0.4% of all inferior AMI pts), and one had non-Q AMI (1.6% of all non-Q AMI pts) [p less than 0.001 for anterior AMI vs inferior and non-Q AMI]. Pts with LVT had a greater infarct size (number of akinetic plus dyskinetic segments/total number of segments x 100) compared to pts without LVT (32.3 +/- 12.6% vs 16.4 +/- 5.7%, p less than 0.001). In pts treated with thrombolytic therapy, LVT incidence was not significantly different from that of pts treated with antithrombotic therapy (4.2% vs 5.9%) alone.(ABSTRACT TRUNCATED AT 250 WORDS)

Use of defibrotide in the treatment of acute myocardial infarction.

The results of this preliminary clinical trial confirm the thrombolytic effect of defibrotide demonstrated in preclinical models; demonstrate the positive influence of the product on the natural history of early AMI; suggest that the optimal dosage range should include not less than 1.6 gm of defibrotide during the first hour of treatment; and justify further commitment in the study of defibrotide also beyond the scope of treating AMI.

[Kinetics of intravenously administered flecainide in patients with acute myocardial infarct]. / Cinetica della flecainide per via endovenosa in pazienti affetti da infarto miocardico acuto.

Flecainide (F) is a new antiarrhythmic agent recently introduced into clinical practice. The above study was aimed at evaluating its intravenous (iv) pharmacokinetics in patients (pts) with acute myocardial infarction (AMI) on 1st and 2nd day, complicated by complex ventricular premature beats (VPBs). 2 mg/kg F was given iv as bolus injection, followed by 300 mg/24 hrs iv infusion. Plasma F values were evaluated by HPLC. Plasma F levels increased progressively, in a non uniform but predictable manner: in pts with large AMI and cardiac failure, F plasma levels, although remaining within the therapeutic range, were greatly increased after the 2nd hour (P less than 0.05) in comparison with pts without cardiac insufficiency. Negative side effects, both cardiac and extracardiac, were not observed: F appeared a handy and effective agent in post-AMI arrhythmias, especially when plasma drug levels are controlled; plasma F level monitoring is anyway recommended in pts with cardiac failure, owing to the wide interindividual variations.

[Sick sinus syndrome in childhood. A case report (author's transl)]. / Un caso di malattia del nodo del seno nell'infanzia.

The case of an eight-year old child suffering from sick sinus syndrome (SSS) is reported. The patient showed S-A conduction disturbances (Mobitz 1 sinoatrial exit block) as noted in two sequential 24-hour recording periods, and a pathologic response to atropine test. An involvement of the A-V node was also present, made clear by a first and a second degree Mobitz 1 block. The clinical, laboratory and noninvasive data excluded an organic cardiopathy. Idiopathic SSS was, therefore, diagnosed. The rare occurrence of this syndrome in the childhood, and the usefulness of Holter monitoring in its detection is emphasized.

[The course of hypertrophic obstructive cardiomyopathy. A preliminary study of 40 cases (author's transl)]. / Evoluzione della cardiomiopatia ipertrofica ostruttiva. Osservazioni preliminari in 40 casi.

The course of hyperthrophic obstructive cardiomyopathy in 40 patients was studied. The average follow-up of the patients (anamnestic and prospective) was 8 years. The age of the first diagnosis, the age of the first observation and the age of the detection of the first symptom, were considered. A prospective follow-up study was carried out in 31 patients, the average period of observation being 8 years. Functional capacity modifications, symptoms, clinical and electrocardiographic signs and the mortality rate were analyzed. Functional class unchanged in the most part of the patients; the overall mortality was 16% with high incidence of sudden and unexpected death. From our results it appeared that the prognosis could be related to the old age, heart failure and arrhythmias.