Transesophageal dipyridamole echocardiography for diagnosis of coronary artery disease.

The value of transthoracic dipyridamole echocardiography has been extensively documented. However, in some patients, because of a poor acoustic window, the rest transthoracic examination is not always feasible and the transesophageal approach is more convenient. Therefore, transesophageal echocardiography with high dose dipyridamole (up to 0.84 mg/kg body weight over 10 min) was performed in 32 patients in whom the transthoracic dipyridamole test either was not feasible (n = 29) or yielded ambiguous results (n = 3). The transesophageal echocardiographic test results were considered abnormal when new dipyridamole-induced regional wall motion abnormalities were observed. All 32 patients underwent coronary angiography; significant coronary artery disease was defined as greater than or equal to 70% lumen diameter narrowing in at least one major vessel. All patients also performed a bicycle exercise test 1 day before transesophageal dipyridamole echocardiography. Transesophageal stress studies were completed in all patients, with a maximal imaging time (in tests with a negative result) of 20 min. No side effects or intolerance to drug or transducer was observed. The left ventricle was always visualized in the four-chamber and transgastric short-axis views. High quality two-dimensional echocardiographic images were obtained in all patients both at rest and at peak dipyridamole infusion and were digitally analyzed in a quad-screen format. Coronary angiography showed coronary artery obstruction in 24 patients: 6 had single-, 9 double- and 9 triple-vessel disease. The transesophageal dipyridamole test showed a specificity of 100% and an overall sensitivity of 92%. The sensitivity of this test for single-, double- and triple-vessel disease was 67%, 100% and 100%, respectivel

Influence of residual perfusion within the infarct zone on the natural history of left ventricular dysfunction after acute myocardial infarction.

This study used myocardial contrast echocardiography to investigate the extent of residual perfusion within the infarct zone in a select group of patients with recently reperfused myocardial infarction and evaluated its influence on the ultimate infarct size. BACKGROUND: Limited information is available on the status of myocardial perfusion within postischemic dysfunctional segments at predischarge and on its influence on late regional and global functional recovery. METHODS: Twenty patients with acute myocardial infarction were selected for the study. Patients met the following inclusion criteria: 1) single-vessel coronary artery disease; 2) patency of infarct-related artery with persistent postischemic dysfunctional segments at predischarge; 3) stable clinical condition up to 6 months after hospital discharge. All selected patients underwent coronary angiography and myocardial contrast echocardiography before hospital discharge and repeated the echocardiographic examination 6 months later. Patients were grouped according to the pattern of contrast enhancement in predischarge dysfunctional segments. RESULTS: In nine patients (group I), the length of segments showing abnormal contraction coincided with that of the contrast defect segments. In the remaining 11 patients (group II), postischemic dysfunctional segments were partly or completely reperfused. There was no difference between the two groups in asynergic segment length at predischarge (7.3 +/- 2.5 vs. 7.2 +/- 4.3 cm, p = NS). At follow-up study, asynergic segment length was significantly reduced in group II patients, whereas no changes were observed in group I patients (from 7.2 +/- 4.3 to 4.7 +/- 3.7 cm, p < 0.005; and from 7.3 +/- 2.5 to 7.5 +/- 2.9 cm, p = NS, respectively). CONCLUSIONS: Among patients with a predischarge patent infarct-related artery, further improvement in regional and global function may be expected during follow-up when residual perfusion in the infarct zone is present

Direct, extended, and mass-mediated contact with immigrants in Italy: Their associations with emotions, prejudice, and humanity perceptions

Two correlational studies investigated the associations between different forms of intergroup contact, on the one hand, and Italians' prejudice and humanity attributions toward immigrants in Italy, on the other. Study 1 examined the effects of direct contact, extended contact, and parasocial contact through mass-media, assessing separately contact through TV news and newspapers and contact through entertainment programs. Study 2 analyzed the distinct effects of positive and negative episodes of the contact forms considered in Study 1. Across the studies, we tested the mediational role of intergroup anxiety, empathy, and trust. Overall, results showed the importance of taking into account different forms of contact and considering the emotional processes during contact experiences to understand intergroup attitudes

Prediction of long-term ischemic events by noninvasively assessed coronary flow reserve

Background Coronary flow reserve (CFR) by adenosine echocardiography in left anterior descending (LAD) or posterior descending coronary arteries may predict clinical outcome. Methods We used models accounting (Cox's model) or not (logistic regression and neural network) for time to event and either considered (forced models) or not (stepwise logistic regression and neural network models) all among 21 covariates to predict 1-year composite events after LAD CFR. Results There were 553 consecutive patients with coronary artery disease (CAD): 89 patients had also posterior descending CFR. During 1-year follow-up 328 patients were event-free, 35 had composite ischemic events and 190 underwent short-term revascularization. LAD and posterior descending CFR (respectively, 1.53 +/- 0.83, N=225 and 1.84 +/- 0.80, N=42) were significantly (P0.91) and the role of LAD CFR among predictors was overwhelming. Other indices of myocardial ischemia and the presence of coronary stenoses or previous infarction did not modify the multivariable predictive role of LAD CFR. When patients with revascularization were discounted, the LAD CFR predictive role was the same. Conclusions Thus, adenosine echocardiography-based LAD CFR predicts 1-year composite ischemic events in patients with CAD, independent of the multivariable model adopted. Posterior descending CFR also has a role