Effects of transdermal nitroglycerin on left ventricular function after acute myocardial infarction.

Progressive left ventricular dysfunction in acute myocardial infarction patients is associated with a poor prognosis. It has been shown that some therapeutic measures which have the potential for limiting the infarct size and preserving ventricular function, are also able to reduce the incidence of congestive heart and improve survival. The aim of this protocol was to assess the effects of transdermal nitroglycerin administered within 72 hours after the onset of acute myocardial infarction and for the following 6 months, on left ventricular function. A total of 98 consecutive acute myocardial infarction patients were randomly allocated, within 72 hours of onset of symptoms, to a double-blind 6-month-therapy with either 10 mg/24 hour transdermal nitroglycerin or placebo. Patients underwent two-dimensional echocardiography at entry, after 2 weeks, 3 months and 6 months. In the nitroglycerin group, end-diastolic volume increased during the follow-up (+6.7%, p < 0.05) while end-systolic volume remained nearly unchanged; ejection fraction and stroke volume increased progressively (+6.3%, p < 0.05, +14.2%, p < 0.05, respectively) and a important reduction of percent of dyssynergic segments was present (-19.2%, p < 0.005). In the placebo group end-diastolic volume and end-systolic volume slightly increased during the follow-up (+2% and +4.9% respectively); ejection fraction and stroke volume remained nearly unchanged during the study; percent of dyssynergic segments showed an important decrease after 2 weeks and 6 months (-21.3%, p < 0.005). A clinically relevant increase (> 20%) in ejection fraction was present more frequently in the nitroglycerin than in the placebo group (p < 0.001). In conclusion, the early (within 72 hours) and prolonged (6 months) administration of transdermal nitroglycerin in acute myocardial infarction improves ejection fraction and stroke volume but does not modify ventricular remodeling.

[The development of tolerance to continuous transdermal nitroglycerin therapy in patients with angina of effort and mixed angina]. / Studio sullo sviluppo di tolleranza alla terapia continua con nitroglicerina transdermica in pazienti con angina da sforzo e mista.

The present multicentre study, conducted in patients with angina pectoris on chronic therapy with continuous 24-hour transdermal nitroglycerin was aimed at investigating: (1) the actual incidence of nitrate tolerance; (2) the clinical features that characterize those who do not develop tolerance; (3) whether the evidence of clinical and ergometer benefits at 1-month assessment predicts their long-term maintenance. Eligible patients (n = 110; average age 56 +/- 5 yrs) had stable angina pectoris (78 effort angina, 32 mixed angina) with symptom-limited, reproducible cycloergometer tests and were responsive to s.l. nitroglycerin. After a 7-day washout period and a placebo run-in week, all patients were assigned to continuous 10 mg/24-hour nitroglycerin patches (T0). Exercise tests were performed again after 1 month (T1) and 6 months (T6) of treatment. At T1, ergometric data in each patient were compared with those at T0 and showed an increase (> or = 15%) in exercise tolerance in only 61/110 patients: 38 (49%; Group A) of the 78 patients with effort angina and 23 (72%; Group B) of the 32 patients with mixed angina (p < 0.05). Those patients with no significant change in exercise tolerance were assigned to conventional antianginal therapy and were excluded from the study. At T6, both group A and B patients maintained the favourable effects on total exercise duration, time and maximum workload at ischemic threshold and maximal ST depression recorded at T1 vs T0. The weekly attacks of angina and nitroglycerin s.I. consumption decreased significantly in both Group A and Group B patients from the beginning of therapy and throughout the study. These results show that: 1) tolerance to continuous 24-hour transdermal nitroglycerin therapy is not constant phenomenon, but occurs only in a subgroup of patients; 2) patients with mixed angina are more resistant to develop tolerance than those patients with effort angina; 3) the 1-month evidence of clinical and ergometric benefits predicts their maintenance during long-term treatment, as well. These results allow one to hypothesize that the loss of nitrate efficacy on venous pooling capability, but not on arterial tone, might constitute the more frequent cause of tolerance.

[Behavior of systolic blood pressure during recovery phase after bicycle ergometric test. Its value in the diagnosis of ischemic heart disease]. / Comportamento della pressione arteriosa sistolica nella fase di recupero dopo sforzo al cicloergometro. Suo valore nella diagnosi di cardiopatia ischemica.

The diagnostic utility of an abnormal decrease in systolic blood pressure (PAS) after exercise, have been evaluated by an index obtained by the ratio between PAS at the maximal stage of exercise and PAS at the 1', 3' and 5' of recovery (PAS index). The 58 patients studied have been divided in two groups: group A, 32 patients, aged 33-66 (means 51.5) with angina pectoris and significant coronary stenosis; group B, 26 subjects, aged 27-39 (mean 34.7), asymptomatic, without coronary stenosis (control group). PAS index at 1' of recovery have been 0.82 +/- 0.08 in the group B and 0.94 +/- 0.07 in the group A (p less than 0.0005); at the 3' of recovery 0.72 +/- 0.07 in the group B and 0.86 +/- 0.11 in CAD group (p less than 0.0005); at 5' of recovery 0.66 +/- 0.07 in the group B and 0.79 +/- 0.11 in the group A (p less than 0.0005). Diagnostic accuracy have been of 60%, 75% and 75% for PAS index respectively at first, third and fifth minute of recovery, while ST depression diagnostic accuracy have been of 88%.

[A computerized system for the management of clinical data in a cardiology service]. / Un sistema computerizzato per la gestione dei dati clinici di un servizio di cardiologia.

The authors describe a computerized system for medical records built in order to obtain rapid information about the data of the overall patients and to quickly manage the clinical research of the Institution. The hardware, an Olivetti M 19 personal computer with a 10 Mbyte hard disk, can manage the clinical data on 3000 patients or more; the software, DBase III Plus, by Ashton-Tate, has a programming language easy to use, even by non-experts. The system allows immediate statistical analysis of all patients and of all 350 parameters included in the database.