9 results on '"Betocchi, Sandro"'
Search Results
2. Effects of intravenous verapamil on left ventricular relaxation and filling in stable angina pectoris
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Betocchi, Sandro, Piscione, Federico, Perrone-Filardi, Pasquale, Pace, Leonardo, Cappelli-Bigazzi, Maurizio, Alfano, Bruno, Ciarmiello, Andrea, Salvatore, Marco, Condorelli, Mario, and Chiariello, Massimo
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Calcium channel blockers -- Physiological aspects ,Heart failure -- Causes of ,Angina pectoris -- Drug therapy ,Heart ventricle, Left -- Physiological aspects ,Verapamil -- Physiological aspects ,Health - Abstract
Left ventricular (LV) diastolic function is often impaired in coronary artery disease (CAD). To assess whether verapamil could improve LV diastolic properties, 12 patients with CAD undergoing right-and left-sided cardiac catheterization, as well as simultaneous radionuclide angiography, were studied before and during intravenous administration of verapamil (0.1 mg/kg as a bolus followed by 0.007 mg/kg/min). The heart rate was kept constant by atrial pacing in both studies. LV pressure-volume relations were obtained. Verapamil decreased LV systolic pressure (130 [+ or -] 22 to 117 [+ or -] 16 mm Hg, p (Am J Cardiol 1990;66:818-825), Left ventricular (LV) diastolic function refers to the relaxation phase of the heartbeat, specifically when the left atrium contracts and oxygenated blood flows into the relaxed LV chamber. Angina pectoris (chest pain caused by decreased blood flow to the heart) can impair this function by slowing ventricular relaxation and reducing early filling of the LV. This diastolic dysfunction may induce symptoms of congestive heart failure even when ventricular systolic function (the ability to pump oxygenated blood into the systemic circulation) is normal. The authors investigated whether treatment with verapamil, a calcium channel blocker usually used to treat angina, would reverse diastolic dysfunction. Verapamil is known to improve LV relaxation and filling for some conditions, and noninvasive studies had reported similar effects in patients with coronary artery disease (CAD). It was important to determine whether verapamil-related improvements in LV relaxation and filling were the result of improved diastolic function or increased filling pressure. Twelve patients with CAD, who were undergoing diagnostic heart catheterization and angiography (X-ray), were studied before and during intravenous administration of verapamil. When measurements were being taken, the heart rate was kept constant by a cardiac pacemaker. Comparison with a control group was not possible because healthy people could not be subjected to such invasive procedures. The results of the study indicate that administration of verapamil is useful in treating coronary artery disease. Its effects on the myocardium, or heart muscle, improved LV relaxation and, thereby, increased the peak filling rate. Verapamil also led to a higher preload, resulting in enhanced filling, and reduced afterload, resulting in improved relaxation. Therefore, verapamil affects LV function and early filling as a result of both direct action on the heart muscle and changes in load. (Consumer Summary produced by Reliance Medical Information, Inc.)
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- 1990
3. Improvement of diastolic function after reversal of left ventricular hypertrophy induced by long-term antihypertensive treatment with tertatolol
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Trimarco, Bruno, De Luca, Nicola, Rosiello, Giovanni, Ricciardelli, Bruno, Betocchi, Sandro, Perrone Filardi, Pasquale, Raponi, Massimo, and Condorelli, Mario
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Antihypertensive drugs -- Usage ,Heart ventricle, Left ,Adrenergic beta blockers -- Usage ,Health - Abstract
High blood pressure increases the resistance to the flow of blood. To compensate for diminished blood flow, the left ventricle (LV) must pump at a higher pressure, which causes the size of the ventricle to increase, resulting in a condition known as LV hypertrophy. The rate of blood filling the affected ventricle is also abnormal. The underlying physiologic mechanism of this effect is unknown. Fifteen previously untreated patients with LV hypertrophy were treated with the drug tertatolol, a beta-blocker, to lower blood pressure. The course of the reduction of LV hypertrophy was followed by physiologic measurements, ultrasound, and radioisotope studies. Once the drug had achieved a return to normal ventricle size or when a decrease of 20 percent in its mass was seen, the treatment was discontinued to determine the degree of change in LV thickness. Treatment with tertatolol decreased blood pressure, reduced heart rate and resulted in significant decreases in LV size and improved functioning of the ventricle. The rate of LV filling was significantly improved and followed the return of the size of the LV to more normal condition. When the drug therapy was discontinued, the blood pressure and cardiac rate returned to their pretreatment pathologic condition. The filling rate, although it declined, remained better than its pretreatment values. Thus, LV hypertrophy directly contributes to the abnormalities of function and LV filling with which this condition is associated. However, antihypertensive drug treatment appears to affect filling rates of the LV by means of a mechanism that is different from its effect on LV size.
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- 1989
4. Determinants of atrial fibrillation development in patients with hypertrophic cardiomyopathy
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Losi, Maria-Angela, Betocchi, Sandro, Aversa, Mariano, Lombardi, Raffaella, Miranda, Marianna, D'Alessandro, Gianluigi, Cacace, Alessandra, Tocchetti, Carlo-Gabriele, Barbati, Giovanni, and Chiariello, Massimo
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CARDIOMYOPATHIES , *HEART failure , *PATIENTS , *ATRIAL fibrillation - Abstract
Predictors of the development of atrial fibrillation (AF) in patients who have hypertrophic cardiomyopathy (HC) have not been extensively studied, although, in these patients, AF contributes to the exacerbation of symptoms and the development of heart failure. The present study determined the role of left atrial (LA) function in the development of AF in patients who have HC. One hundred fifty consecutive patients who had HC, had no history of AF, and who were followed for 5.2 ± 2.9 years constituted the study population. Using M-mode echocardiography, we measured LA function as global LA fractional shortening and LA diameter. LA volume was measured from 2-dimensional 4-chamber views by the method of disks. During follow-up, 20 patients developed AF. LA function was an independent predictor of AF (odds ratio 0.716, p = <0.001), whereas LA diameter and volume were predictors in addition to age. Kaplan-Meier analysis showed that LA dysfunction carried a high risk of AF. Thus, in patients who have HC, LA function is a strong predictor of AF development and is independent of age. [Copyright &y& Elsevier]
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- 2004
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5. Comparison of hemodynamic adaptation to orthostatic stress in patients with hypertrophic cardiomyopathy with or without syncope and in vasovagal syncope
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Manganelli, Fiore, Betocchi, Sandro, Ciampi, Quirino, Storto, Giovanni, Losi, Maria Angela, Violante, Anna, Briguori, Carlo, Tocchetti, Carlo Gabriele, Lombardi, Raffaella, Cuocolo, Alberto, and Chiariello, Massimo
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CARDIOMYOPATHIES , *SYNCOPE - Abstract
This study was designed to investigate whether, in patients with hypertrophic cardiomyopathy (HC), tilt-induced volume unloading triggers a peripheral reflex similar to that seen in patients with a history of vasovagal syncope or rather acts through an intrinsic cardiac mechanism secondary to diastolic dysfunction. Thirty-seven patients with HC (10 with and 27 without a history of syncope), 10 patients with vasovagal syncope, and 9 controls underwent 70° head-up tilt for 45 minutes during continuous radionuclide monitoring of left ventricular function. We focused on the initial 5 minutes into the tilt test, well before symptoms occurred, to exclude that the observed hemodynamic changes were the consequence rather than the cause of syncope. HC patients with previous syncope and vasovagal patients experienced significant hypotension after the initial 5 minutes of tilt. Only HC patients with a history of syncope had a significant decrease in cardiac output, which began at the initial stage of the test. Systemic vascular resistance decreased in vasovagal patients, but increased in the HC syncopal group. Baseline peak filling rate was lower (2.4 ± 0.5 vs 3.3 ± 1.1 stroke counts/s, p = 0.03) and a “pseudonormal” or a restrictive pattern of left ventricular filling was more frequent (70% vs 26%, p = 0.02) in HC patients with than without a history of syncope. Thus, significant hypotension or frank syncope during orthostatic stress in HC patients with a history of syncope is due to an early decrease in cardiac output, which occurs well before the onset of symptoms; such impaired hemodynamic adaptation seems to be related to diastolic dysfunction. [Copyright &y& Elsevier]
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- 2002
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6. Exercise capacity in hypertrophic cardiomyopathy depends on left ventricular diastolic function.
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Briguori, Carlo, Betocchi, Sandro, Briguori, C, Betocchi, S, Romano, M, Manganelli, F, Angela Losi, M, Ciampi, Q, Gottilla, R, Lombardi, R, Condorelli, M, and Chiariello, M
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HYPERTROPHIC cardiomyopathy , *DOPPLER echocardiography - Abstract
Some studies have demonstrated that left ventricular (LV) diastolic function is the principal determinant of impaired exercise capacity in hypertrophic cardiomyopathy (HC). In this study we sought the capability of echocardiographic indexes of diastolic function in predicting exercise capacity in patients with HC. We studied 52 patients with HC while they were not on drugs;12 of them had LV tract obstruction at rest. Diastolic function was assessed by M-mode and Doppler echocardiography by measuring: (1) left atrial fractional shortening, and the slope of posterior aortic wall displacement during early atrial emptying on M-mode left atrial tracing; and (2) Doppler-derived transmitral and pulmonary venous flow velocity indexes. Exercise capacity was assessed by maximum oxygen consumption by cardiopulmonary test during cycloergometer upright exercise. Maximum oxygen consumption correlated with the left atrial fractional shortening (r = 0.63, p <0.001), the slope of posterior aortic wall displacement during early atrial emptying (r = 0.55, p <0.001), age (r = -0.50; p <0.001), pulmonary venous diastolic anterograde velocity (r = 0.41, p <0.01), and the systolic filling fraction (r = -0.43; p <0.01). By stepwise multiple linear regression analysis, left atrial fractional shortening and the pulmonary venous systolic filling fraction were the only determinants of the maximum oxygen consumption (multiple r = 0.70; p <0.001). Exercise capacity did not correlate with Doppler-derived transmitral indexes. Thus, in patients with HC, exercise capacity was determined by passive LV diastolic function, as assessed by the left atrial M-mode and Doppler-derived pulmonary venous flow velocities. [ABSTRACT FROM AUTHOR]
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- 1999
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7. Influence of left ventricular cavity size on clinical presentation in hypertrophic cardiomyopathy.
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Manganelli, Fiore, Betocchi, Sandro, Manganelli, F, Betocchi, S, Losi, M A, Briguori, C, Pace, L, Ciampi, Q, Perrone-Filardi, P, Salvatore, M, Finizio, F, Pezzella, E, and Chiariello, M
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HYPERTROPHIC cardiomyopathy , *CARDIOMYOPATHIES - Abstract
The aim of this study was to assess whether left ventricular (LV) cavity size relates to functional impairment and syncope in patients with hypertrophic cardiomyopathy (HC). LV diastolic dysfunction influences functional limitation in HC. A reduced LV end-diastolic dimension may underlie impaired diastolic properties and be implicated in hemodynamic syncope. Eighty-two consecutive patients with HC (off drugs, in sinus rhythm) underwent echocardiography to measure LV end-diastolic dimension in the short-axis view (indexed to the body surface area) and radionuclide angiography (n = 50) to calculate peak filling rate (normalized to stroke counts/s). Patients in New York Heart Association functional classes II to IV had smaller LV end-diastolic dimension (23.2 +/- 2.6 vs 25.5 +/- 2.5 mm/M2, p = 0.0001) and lower peak filling rate (4.3 +/- 1.4 vs 5.1 +/- 1.3 stroke counts/s, p = 0.036) than those in New York Heart Association class I. LV end-diastolic diameter was correlated to peak filling rate (r = 0.37; p = 0.008). The most potent predictors of functional limitation were LV end-diastolic dimension (relative risk [RR] 0.63, confidence interval [CI] 0.45 to 0.88; p = 0.008), age (RR 1.09, CI 1.03 to 1.17; p = 0.003), and LV thickness score (RR 1.08, CI 1.02 to 1.13; p = 0.003). LV cavity size was smaller in patients with functional limitation irrespective of obstruction and hypertrophy. Patients with differed from those without a history of syncope for a smaller LV end-diastolic dimension (23.2 +/- 2.5 vs 25.0 +/- 2.7 mm/M2, p = 0.008), which was the only independent predictor of syncope (RR 0.77, CI 0.63 to 0.95; p = 0.013). Thus, a small LV cavity size is associated with functional limitation and history of syncope in HC. [ABSTRACT FROM AUTHOR]
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- 1999
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8. Noninvasive evaluation of left ventricular diastolic function in hypertrophic cardiomyopathy.
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Briguori, Carlo, Betocchi, Sandro, Losi, Maria Angela, Manganelli, Fiore, Piscione, Federico, Pace, Leonardo, Boccalatte, Marco, Gottilla, Rossella, Salvatore, Marco, Chiariello, Massimo, Briguori, C, Betocchi, S, Losi, M A, Manganelli, F, Piscione, F, Pace, L, Boccalatte, M, Gottilla, R, Salvatore, M, and Chiariello, M
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LEFT heart ventricle , *DIASTOLE (Cardiac cycle) - Abstract
Diastolic dysfunction is common in hypertrophic cardiomyopathy (HC). Previous studies suggest that Doppler transmitral flow velocity profiles, and the left atrial (LA) M-mode echogram can be used noninvasively to evaluate left ventricular (LV) diastolic function. However, this has not been proved in HC. In this study we determined the relation of Doppler transmitral flow velocity profiles and the LA M-mode echograms to invasive indexes of LV diastolic function in patients with HC. We studied 25 patients with HC, while off drugs, and calculated LA global and active fractional shortening and the slope of both early and late displacement of the posterior aortic wall during LA emptying by M-mode echocardiography. We calculated peak velocity of early (E) and atrial (A) filling, E to A ratio, and E-wave deceleration time by pulsed Doppler echocardiography, and simultaneous radionuclide angiography, LV pressures, time constant of isovolumic relaxation tau, and the constant of chamber stiffness k by cardiac catheterization. The time constant of isovolumic relaxation tau correlated with the slope of early posterior aortic wall displacement (r = 0.59; p <0.01). LV end-diastolic pressure correlated with global LA fractional shortening (r = -0.75; p <0.001); the constant of chamber stiffness k correlated with active LA fractional shortening (r = -0.53; p <0.02). In a subset of 13 patients, in whom echocardiography and cardiac catheterization were performed simultaneously, similar results were found. LA M-mode recordings provide a more reliable noninvasive assessment of diastolic function in HC than mitral Doppler indexes. [ABSTRACT FROM AUTHOR]
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- 1998
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9. Prognostic Significance of Left Atrial Size in Patients With Hypertrophic Cardiomyopathy (from the Italian Registry for Hypertrophic Cardiomyopathy)
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Nistri, Stefano, Olivotto, Iacopo, Betocchi, Sandro, Losi, Maria Angela, Valsecchi, Grazia, Pinamonti, Bruno, Conte, Maria Rosa, Casazza, Franco, Galderisi, Maurizio, Maron, Barry J., and Cecchi, Franco
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MORTALITY , *CARDIOMYOPATHIES , *ATRIAL fibrillation - Abstract
This study assessed left atrial (LA) dimension as a potential predictor of outcome in hypertrophic cardiomyopathy (HC). From the Italian Registry for Hypertrophic Cardiomyopathy, 1,491 patients (mean age 47 ± 17 years; 61% men; 19% obstructive), followed for 9.4 ± 7.4 years after the initial echocardiographic evaluation, constituted the study group. The mean LA transverse dimension was 43 ± 9 mm and was larger in patients with severe symptoms (48 ± 9 mm for New York Heart Association classes III and IV vs 42 ± 9 mm for classes I and II, p <0.001), atrial fibrillation (47 ± 9 vs 42 ± 8 mm in sinus rhythm, p <0.001), and left ventricular outflow obstruction (46 ± 9 mm for ≥30 mm Hg at rest vs 42 ± 9 mm for <30 mm Hg at rest, p <0.001). On univariate analysis, each 5-mm increase in LA size was associated with a hazard ratio (HR) of 1.2 for all-cause mortality (p <0.0001). On multivariate analysis, a LA dimension >48 mm (the 75th percentile) had a HR of 1.9 for all-cause mortality (p = 0.008), 2.0 for cardiovascular death (p = 0.014), and 3.1 for death related to heart failure (p = 0.008) but was unassociated with sudden death (p = 0.81). Similar results were obtained after the exclusion of patients with atrial fibrillation (HR 1.7, p = 0.008) or outflow obstruction (HR 1.8, p = 0.003). The predictive power of LA dimension >48 mm was also validated in an independent HC cohort from the United States, with similar HRs (1.8 for all-cause mortality, p = 0.019). In conclusion, in a large cohort of patients with HC from a nationwide registry, a marked increase in LA dimension were predictive of long-term outcome, independent of co-existent atrial fibrillation or outflow obstruction. LA dimension is a novel and independent marker of prognosis in HC, particularly relevant to the identification of patients at risk for death related to heart failure. [Copyright &y& Elsevier]
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- 2006
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