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High-resolution electrocardiography has been used as a non-invasive method for the study of delayed potentials in order to evaluate the risk of the onset of ventricular arrhythmia first in ischaemic cardiopathy and then in various cardiopathies, generally using XYZ orthogonal derivations. The aim of this study was to compare the results obtained with those using standard precordial leads, in particular V4 and V6 leads. A group of 28 patients, males and females, aged between 15 and 55 years of age, was examined. All patients were suffering from different cardiopathies. Subjects with delayed right and left ventricular activation on the surface ECG tracing were excluded from the study. A 60-200 Hertz bandpass filter and time averaging of 300 consecutive complexes were used to analyse tracings. Dual recordings were performed for each patient. The following parameters were examined: total duration of filtered QRS complex and root-mean-square voltage of potentials in the last 40 msec of filtered QRS (RMS). In particular, the comparison between RMS using Frank's method and those obtained using V4 and V6 precordial leads provided a coefficient of correlation of r = 0.91 with p < 0.001 and r = 0.92 with p < 0.001 respectively, and the comparison between QRS obtained using the same method and that obtained using V4-V6 precordial leads gave a coefficient of correlation of R = 0.80, p < 0.001 and r = 0.77 and p < 0.001 respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

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We have studied with the echocardiography M-Mode, 2-D, Doppler three groups of 15 subjects for testing the presence of cardiac abnormalities probably related to primary collagen defect in patients with autosomal dominant polycystic kidney disease (ADPKD) The first group was made up of patients with ADPKD and normal renal function, the second of patients with ADPKD in hemodialysis (HD), the last one of patients in HD for other renal disease. In the first group we found no cardiovascular abnormalities while we found an increased incidence of valvular disease (p = 0.016) in patients with ADPKD in HD and an increased incidence in valvular disease (p = 0.016) and left atrial dilatation (p = 0.006) in patients in HD for different renal disease. When we estimated the cases on the ground of dialytic age uncorrelated with the initial renal disease, only the incidence of valvular calcifications was increased in patients on HD more than 3 years (p = 0.034). In our group of patients the echocardiographic abnormalities seem to be related more to uremic cardiomyopathy even if we cannot deny the existence of primary cardiac disease in patients with ADPKD.

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Recently published reports have highlighted the presence of a high incidence of late potentials in patients with mitral valve prolapse. In order to verify this observation 29 patients suffering from this pathology were studied using high-resolution electrocardiography. Late potentials were present in 24% of patients with mitral valve prolapse in comparison to 5% of control subjects (p less than 0.05); no correlation was found however in patients with mitral valve prolapse between the presence of late potentials and Holter's ventricular hyperkinetic tachycardia. At a follow-up after 16 +/- 4 months no patient presented persistent ventricular tachycardia or sudden death. The presence of late potentials might be yet symptom of the mitral prolapse syndrome whose prognostic role, although not yet clear, does not appear to represent a negative factor in relation to major tachycardia attacks.

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We mechanocardiographically evaluated 50 patients with acute myocardial infarction, invasively monitored by Swan-Ganz catheters, in order to assess if mechanocardiography could provide reliable hemodynamic informations. The last 25 subjects were also studied by pulsed Doppler echocardiography. Our results confirm the high precision of apexcardiography in assessing mean pulmonary capillary wedge pressure (r = 0.91) while Doppler echocardiography proved itself better than mechanocardiography in assessing cardiac output (r = 0.82 vs r = 0.78). Moreover, Doppler echocardiography allowed a good estimation of mean pulmonary artery pressure (r = 0.81) which cannot be assessed by other noninvasive methods. However, we could not find any clinically useful relationship between Doppler mitralic flow characteristics and mean pulmonary capillary wedge pressure. Therefore noninvasive methods could represent a valid alternative to right heart catheterization provided that an integrated Doppler echocardiographic and mechanocardiographic approach is used.

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We calculated the QRS score using both the simplified Selvester's method and the Hills' one, extended to the 12 standard leads, from the electrocardiograms registered on the fifth and thirtieth day from the ischemic event from 50 infarcted patients whose radionuclide left ventricular ejection fraction was known. The analysis of our results showed a very good correlation existing between the early and the late scores (r = 0.91 Hillis's method) as well as the equivalence of the two methods as witnessed by a correlation coefficient of 0.86 on the fifth day electrocardiogram and of 0.84 on the thirtieth day E.C.G. However the correlation between QRS score and left ventricular ejection fraction was quite weak ranging from -0.36 to -0.48 depending upon the method and the moment selected for the acquisition of the data. Even the attempt to correctly select patients with a higher risk identifying a QRS score able to predict a reduced left ventricular ejection fraction (i.e. less than 40%) failed because of the low sensitivity and specificity of the method. We therefore believe that the QRS score or, at least the simplified one, is not useful to assess the residual left ventricular function after a myocardial infarction and its use should be reduced to the evaluation of the infarct size.

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Two cases of hypothermia in the elderly are described. The different clinical evolution shows how the concurrent presence of Diabetes Mellitus can be considered as an adverse prognostic factor. It is also confirmed that the Osborn's wave electrocardiographic presence, given up a specific and pathognomonic diagnostic parameter in this disease. The observation that the electrocardiographic J wave can regress after body's temperature normalization suggests the hypothesis that this wave reflects reversible delay of depolarization, or early repolarization.

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