Background A deleterious effect of complete left bundle-branch block (LBBB) on left ventricular function has been established. Nevertheless, the independent effect of a widened QRS on mortality rate ...in congestive heart failure (CHF) is still controversial. Therefore, we carried out this analysis to determine whether LBBB is an independent predictor of mortality in CHF. Methods and Results We analyzed the large Italian Network on CHF Registry of unselected outpatients with CHF of different causes. The registry was established by the Italian Association of Hospital Cardiologists in 1995. Complete 1-year follow-up data were available for 5517 patients. The main underlying cardiac diagnosis was ischemic heart disease in 2512 patients (45.6%), dilated cardiomyopathy in 1988 patients (36.0%), and hypertensive heart disease in 714 patients (12.9%). Other causes were recorded in the remaining 303 cases (5.5%). LBBB was present in 1391 patients (25.2%) and was associated with an increased 1-year mortality rate from any cause (hazard ratio, 1.70; 95% confidence interval, 1.41 to 2.05) and sudden death (hazard ratio, 1.58; 95% confidence interval, 1.21 to 2.06). Multivariate analysis showed that such an increased risk was still significant after adjusting for age, underlying cardiac disease, indicators of CHF severity, and prescription of angiotensin-converting enzyme inhibitors and β-blockers. Conclusion LBBB is an unfavorable prognostic marker in patients with CHF. The negative effect is independent of age, CHF severity, and drug prescriptions. These data may support the rationale of randomized trials to verify the effects on mortality rate of ventricular resynchronization with multisite cardiac pacing in patients with CHF and LBBB. (Am Heart J 2002;143:398-405.)
In this paper we present the results of a 12-month double-blind clinical multicenter study assessing the effects of synthetic salmon calcitonin (CT) administration in a group of white postmenopausal ...osteoporotic women. Treated patients were given 100 MRC units of synthetic salmon CT injected i.m. in the morning every other day. Control patients received a placebo injection. All patients received 500 mg of elementary calcium p.o., b.i.d. Bone mineral content (BMC) was measured at the extreme distal radius of the nondominant arm by a dual photon bone densitometer which utilizes two radionuclides, 241Am and 125I, with energies of about 60 keV and 30 keV respectively. Biochemical parameters of calcium-phosphorus metabolism were also measured. After 12 months of treatment a significant mean increment of BMC and nondialyzable OHPr/creatinine values and a significant decrease of total OHPr/creatinine values were observed in the treated group, while controls showed a significant decrease in BMC values. These results, together with the observation that in some patients the decrease in total OHPr/creatinine values was not accompanied by an increment of BMC, show that long-term salmon CT treatment may be of benefit in postmenopausal osteoporosis and that the effects of CT on bone mass may be due not only to the inhibition of bone resorption but also to the stimulation of bone formation.
We evaluated the experiences of 19 Italian laboratories concerning 241 small supernumerary marker chromosomes (sSMCs) with the aim of answering questions arising from their origin from any ...chromosome, their variable size and genetic content, and their impact on the carrier's phenotype.
Conventional protocols were used to set up the cultures and chromosome preparations. Both commercial and homemade probes were used for the fluorescent in situ hybridization analyses.
A total of 113 of the 241 sSMCs were detected antenatally, and 128 were detected postnatally. There were 52 inherited and 172 de novo cases. Abnormal phenotype was present in 137 cases (57%), 38 of which were antenatally diagnosed. A mosaic condition was observed in 87 cases (36%). In terms of morphology, monocentric and dicentric bisatellited marker chromosomes were the most common, followed by monocentric rings and short-arm isochromosomes. The chromosomes generating the sSMCs were acrocentric in 132 cases (69%) and non-acrocentric chromosomes in 60 cases (31%); a neocentromere was hypothesized in three cases involving chromosomes 6, 8, and 15.
The presented and published data still do not allow any definite conclusions to be drawn concerning karyotype–phenotype correlations. Only concerted efforts to characterize molecularly the sSMCs associated or not with a clinical phenotype can yield results suitable for addressing karyotype–phenotype correlations in support of genetic counseling.
Objectives. This study sought to assess the relative prognostic power of dobutamine echocardiography and exercise electrocardiography after acute myocardial infarction.
Background. The prognostic ...value of dobutamine echocardiography early after acute myocardial infarction has not yet been reported.
Methods. One hundred seventy-eight patients (mean age 58 ± 9 years) with a first uncomplicated acute myocardial infarction underwent predischarge dobutamine echocardiography (5 to 40 μg/kg body weight per min, plus atropine if needed) and symptom-limited bicycle exercise electrocardiography and were followed up for 17 ± 13 months. Stress-induced dyssynergy and ST segment depression >1 mm were considered criteria of positivity for dobutamine echocardiography and exercise electrocardiography, respectively.
Results. Dobutamine echocardiography was positive in 83 patients and exercise electrocardiography in 60. At follow-up there were 5 deaths, 6 nonfatal myocardial infarctions (11 hard events) and 20 cases of unstable angina. Dobutamine echocardiography and exercise electrocardiography had similar negative predictive values both for all events (88% and 86%, respectively) and for hard events (98% and 95%, respectively). The hard events rate was significantly higher in patients with positive rather than negative dobutamine echocardiography (relative risk RR 5.15, 95% confidence interval CI 1.14 to 23.16), although there was no difference between patients with positive and negative exercise electrocardiograms. When Cox analysis was performed, dobutamine echocardiography had an independent prognostic value both for all events (RR 2.88, 95% CI 1.37 to 6.08) and for hard events (RR 6.56, 95% CI 1.42 to 30.46).
Conclusions. After uncomplicated acute myocardial infarction, dobutamine echocardiography and exercise electrocardiography have a similar high negative predictive value for both all events and hard events only. Positive dobutamine echocardiography, but not positive exercise electrocardiography, identifies a group of patients at higher risk of subsequent cardiac events.
(J Am Coll Cardiol 1997;29:261–7)
This study has been carried out in order to evaluate both serum osteocalcin levels in primary hyperparathyroidism and their changes following surgery. Twenty-one consecutive patients were studied (12 ...females and 9 males, aged 46 +/- 17 years). Preoperatively, a better correlation was found between serum osteocalcin and serum alkaline phosphatase activity (r = 0.79, p less than 0.001) than between serum osteocalcin and the 24-hour urinary hydroxyproline/creatine ratio (r = 0.55, p less than 0.05). Following the surgical removal of hyperfunctioning parathyroid tissue, a modest but significant decrease was observed in the serum levels of osteocalcin; this reached a nadir during the 1st or 2nd day after the removal of the adenoma. The mean levels then tended to rise, so that the values measured on the 7th day after parathyroidectomy (12.4 +/- 2.5 ng/ml) were not significantly different in respect to basal values (13.6 +/- 2.7 ng/ml). A parallel pattern was also noted as concerns the serum alkaline phosphatase activity. On the contrary, mean values of serum immunoreactive parathyroid hormone (243 +/- 78 vs. 58 +/- 11 pmol/l; p less than 0.02) and serum calcium (12.4 +/- 0.5 vs. 9.2 +/- 0.3 mg/dl; p less than 0.01) were significantly reduced and mean values of serum phosphorus (2.4 +/- 0.2 vs. 3.1 +/- 0.2 mg/dl; p less than 0.001) significantly higher in comparison to basal values.
Three patients with recurrent hyperparathyroidism (15, 8 and 3 years respectively, after the first operation) are described in order to establish the causes and define the clinical characteristics of ...the disease. The observation that in the present series recurrent hyperparathyroidism was associated either with an adenoma (two cases) or a carcinoma (one case), appears to stress the possibility of the pathological involvement of one gland even though recurrent hyperparathyroidism should be considered due to the chronic extrinsic stimulation of the parathyroid glands. The severity of the clinical and metabolic picture observed at the time of the first diagnosis and/or at the time of recurrence together with the simultaneous presence of bone and stone disease in the patients described is of particular interest. The cases reported underline the importance of carrying out careful metabolic investigations in patients with hyperparathyroidism not only before but also for a prolonged period of time after operation.
Calcium and phosphate metabolism has been studied in eight patients with active acromegaly. Plasma calcium, phosphate, alkaline phosphatase, creatinine and parathyroid hormone levels were in the ...normal range in all patients, while urinary calcium excretion, calcium/creatinine ratio and hydroxyproline were higher than in controls (p less than 0.01, p less than 0.01, p less than 0.02, respectively). Basal plasma calcitonin levels were in the normal range and stimulation with calcium (3 mg/kg body weight in 10 min) showed similar calcitonin responses in acromegalic and normal subjects. Our data show that in normocalcemic acromegaly with high bone turnover calcitonin secretion is not abnormal.
To investigate calcitonin secretion in primary hyperparathyroidism, basal and stimulated (3 mg Ca++/kg body weight/10 min) immunoreactive calcitonin plasma levels were studied before ...parathyroidectomy. Plasma calcitonin levels were raised in 50% of patients regardless of sex, but a significant correlation between basal plasma calcium and calcitonin was found only in males. A reduced calcitonin response to calcium infusion was observed in all patients. Parathyroidectomy invariably induced a normalization of calcitonin basal levels. Our findings confirm the existence of a decreased parafollicular cell reserve probably as a consequence of the persistent hypercalcemic state in hyperparathyroid patients and suggest that it is more frequent in females.
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