Giornale italiano di cardiologia
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Comparative Study
[The surgical treatment of chronic ischemic mitral insufficiency].
Operative correction of chronic ischemic mitral regurgitation (CIMR) is associated with a high-risk approach. The objective of this retrospective study was to evaluate the short- and long-term results of surgical treatment of CIMR. ⋯ While long-term follow-up is mandatory, our results suggest that: a) surgical treatment of CIMI is feasible with acceptable operative risks; b) mid-term functional and clinical results are favorable; c) the choice of treatment--valve replacement or repair--is still debatable.
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Comparative Study
[Compromise of the cardiac autonomic nervous system in patients with Fontan-type circulation: preliminary data].
Rhythm disturbances are frequent after Fontan operations. Arrhythmias related to reduced heart rate variability (HRV) have been described in various cardiovascular diseases. ⋯ Patients with Fontan circulation had a significantly reduced HRV and particularly abnormal sympatho-vagal balance. Surgery on the caval veins and the atria alters the intracardiac ganglia that are abundant at the cavo-atrial junction and in the myocardium of the right atrium. Abnormalities of HRV in Fontan patients may act as a co-factor in the initiation of arrhythmia in these patients.
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Randomized Controlled Trial Comparative Study Clinical Trial
Effects of early treatment with captopril and metoprolol singly or together on six-month mortality and morbidity after acute myocardial infarction. Results of the RIMA (Rimodellamento Infarto Miocardico Acuto) study. The RIMA researchers.
The RIMA (Rimodellamento Infarto Miocardico Acuto) study was designed to assess the relative effects of angiotensin-converting enzyme (ACE) inhibition by captopril, beta-blocker therapy by metoprolol, and their combination in patients with a first acute myocardial infarction on: 1. echocardiographically detected left ventricular remodeling; 2. prognosis. The second goal will be the argument of the present paper. Two-hundred fifty < or = 75 years consecutive patients (mean age: 58 yrs, males = 203) with acute myocardial infarction were randomly allocated to receive for > or = 3 months captopril (up to 75 mg/day, Group 1), metoprolol (up to 200 mg/day, Group 2) or captopril + metoprolol (Group 3) starting in the first 24 hours after the onset of symptoms. Intravenous beta-blockers in the acute phase of myocardial infarction and all other cardioactive drugs were allowed. The effect of the randomized therapy at six months from admission to the coronary care unit was considered in relation to: 1. recurrence of spontaneous cardiac events and of elective revascularization procedures; 2. adverse reactions (hypotension, atrioventricular block, cough, allergy, need of beta-blockers in Group 1, need for ACE inhibition in Group 2) requiring treatment modification based on physician's decision. ⋯ In a randomized early post-infarction treatment strategy, ACE inhibition with captopril alone or in combination with metoprolol demonstrated an increased protection against spontaneous cardiac events at six months in comparison with metoprolol alone. On the other hand, the beta-blocker treatment was associated with a lower number of elective revascularization procedures and appeared better tolerated than ACE inhibition.
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Comparative Study
Clinical impact of local implementation of agreed guidelines for the management of patients with acute myocardial infarction.
This study sought to assess the impact of local implementation of clinical practice guidelines on the pattern of care and outcome in patients admitted to the Coronary Care Unit (CCU) with acute myocardial infarction. ⋯ Patients with myocardial infarction managed after local implementation of clinical practice guidelines were more likely to receive evidence-based effective pharmacotherapies, and to have earlier mobilization and earlier discharge from CCU. This study strongly supports the role of local implementation of clinical practice guidelines to optimize management of patients with acute myocardial infarction.