bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of atenolol in patients with reciprocating supraventricular tachycardia
Authors: Pimenta J. , Britto Pereira C.
Published: February 2009

We studied 12 patients with crisis of paroxysmal reciprocating supraventricular tachycardia before and after intravenous injection of 5 mg of atenolol. The patients were then followed for periods ranging from 6 to 50 months (median 34 months). During this time, they received oral atenolol therapy, at 200 mg for the first two weeks, and 100 mg daily thereafter. Tachycardia was due to reciprocation within the atrioventricular node in 9 patients, and to pre‐excitation in 3 patients. Atenolol slowed the sinus rate, prolonged the atrioventricular conduction time, and increased the atrial cycle length at which atrioventricular nodal Wenckebach phenomenon occurred. During the tachycardia, atenolol increased the tachycardia cycle length, due to prolongation of the intranodal atrioventricular conduction time. Of the 11 patients who were observed for the full period, 7 had no further episodes of arrhythmia. One patient (with left‐sided pre‐excitation) failed to respond to any antiarrhythmic medication, one patient remained free of symptoms for two years, but received an atrial pacemaker for control of the tachycardia at the end of this period. Two patients (one with dual atrioventricular nodal pathways, and one with concealed left‐sided pre‐excitation) await other treatment for their tachycardia, after remaining free of symptoms for one and two years, respectively. These findings suggest that atenolol is an effective beta blocker for use in controlling arrhythmias in patients with reciprocating supraventricular tachycardia, for use in once daily dosage, and is a medication largely free of side effects.
An unusual complication of coronary bypass surgery
Authors: Lyons C. , Chaudhry M. , O'HERN J.
Published: February 2009

Four cases are discussed that had a preventable complication following coronary bypass surgery. Infection was associated with retained transthoracic pacemaker leads. These case reports should serve to remind us of the importance of removal of all possible foreign objects from our patients to prevent rare but serious complications.
Syncope secondary to ventricular asystole in an endurance athlete
Authors: Yerg II J. E. , Seals D. R. , Hagberg J. M. , Ehsani A. A.
Published: February 2009

Vasovagal syncope occurred in an endurance athlete prior to exercise as the result of a 22‐second episode of complete heart block with ventricular asystole and subsequent sinoatrial arrest. The subject suffered a head injury but recovered without sequelae. Noninvasive cardiac testing was unrevealing. Although lesser disturbances of cardiac rhythm and conduction in athletes are not uncommon, extreme changes as illustrated by this case are rare. Close supervision of athletes undergoing exercise testing is advised.
Plasma concentrations of high‐density lipoprotein (hdl)‐2 and hdl‐3 in myocardial infarction survivors and in control subjects
Authors: Brugger P. , Kullich W. C. , Klein G. , Kostner G. M.
Published: February 2009

The serum concentration of several lipids, including high‐density lipoprotein‐cholesterol (HDL‐C) and the HDL subfractions, HDL‐2‐C and HDL‐3‐C, were measured in 44 male and 26 female survivors of myocardial infarction and compared with those of a control group matched for age, sex, and body weight. Serum concentrations of total cholesterol (TC) and low‐density lipoprotein (LDL‐C) were significantly increased in patients as compared to control individuals. The total HDL‐C concentration was lower in patients than in controls. By differential quantitation of HDL subfractions with a new precipitation method using polyethylene glycol, it was found that HDL‐3‐C was not significantly different between female patients and controls. The reduction of HDL‐3‐C in male patients was only of borderline significance. HDL‐2‐C in contrast was highly significantly reduced in both male and female patients. The greatest difference between patients and controls was found in the HDL‐2/HDL‐3‐C ratio. It is therefore concluded that HDL‐2‐C quantitation is a valuable risk indicator for myocardial infarction yielding a better discrimination of patients from controls than total HDL‐C quantitation.
Exercise‐induced changes of left ventricular ejection time in noninvasive evaluation of chest pain
Authors: Romano M. , Chiariello M. , Carella G. , DiMaro T. , Cotecchia M. R. , Condorelli M.
Published: February 2009

Significance and clinical usefulness of exercise‐induced changes of noninvasive left ventricular ejection time, recorded by mechanocardiography, in detecting coronary artery disease is still controversial. We investigated the changes of the left ventricular ejection time (LVET), corrected for heart rate as ETI (LVET/√RR), after a standard 4‐min exercise by bicycle ergometer (50 W/min for 2 min, increased by 20 W after 2 min) in 56 male volunteers. They were invasively studied for typical or atypical chest pain. Thirty‐four had coronary artery disease (CAD) and the others served as controls. Immediately after exercise LVET shortened according to the rise in heart rate in both groups. ETI increased similarly. After 2 minutes from exercise ETI increased only in the CAD group, according to a longer LVET, in spite of the rise in heart rate. In contrast, ETI was unchanged in controls, according to a shortened LVET. Totally, 27/34 CAD patients and 9/22 controls had a greater ETI than at rest. Employing this Δ ETI as a “marker” of CAD we found a predictive accuracy of 74%. We suggest postexercise ETI could be a simple and inexpensive support to electrocardiogram in basic evaluation of subjects with chest pain.
Evidence of no interobserver variability in m‐mode echocardiography
Authors: De LEONARDIS V. , Cinelli P.
Published: February 2009

Left ventricular internal dimensions, septal and posterior wall thickness, aortic root diameter, and left atrial dimensions, were independently measured by two experienced interpreters on 50 consecutive routinely performed M‐mode echocardiograms. The purpose of this work was to evaluate the reproducibility of these measurements and to assess if a different “diagnostic effect” could be provided by the two readers. The extent of interobserver variability was calculated and expressed as a percent of the mean. No significant interobserver variability was found for all the measured echocardiographic parameters and the two interpreters gave rise to the same “diagnostic effects.” Therefore, the authors suggest following well stated guidelines to provide uniformity in the process of determining the boundaries of the structures to be measured and adjusting the actual measurements by multiplying by a conversion factor (representing the ratio between the number of 1 cm markers and the distance in centimeters between the first and the last marker), as opposed to interpolating between the marks on the recording paper.
The mitral valve mechanism with normal and prolapsed leaflets in the light of a dynamic model
Authors: Bryhn M. , Gåarding L.
Published: February 2009

A dynamic model was presented to explain some of the clinical and morphologic findings in primary mitral valve prolapse. In normal cases, the leaflets, chorda tendinae, the annular ring, and the papillary muscles represent a functional entity balanced by the pressure force acting upon the leaflets. When the leaflets are larger, as in primary mitral valve prolapse, a negative interference with this balance is achieved, causing an increased traction on the papillary muscles and a concomitant dilatation of the annular ring.
Magnetic resonance imaging (MRI) in different stages of myocardial infarction using the contrast agent gadolinium‐DTPA
Authors: Eichstaedt H. W. , Felix R. , Dougherty F. C. , Langer M. , Rutsch W. , Schmutzler H.
Published: February 2009

We investigated 26 patients admitted to our catheterization laboratory with a diagnosis of acute myocardial infarction. In each case acute revascularization was unsuccessful, but the diagnosis was confirmed by angiography. In 11 patients with an uncomplicated course of acute myocardial infarction magnetic resonance imaging was carried out within 7 days of the acute event. In three additional cases imaging was performed within 3 weeks, while a remaining 12 patients underwent studies more than 3 weeks after the onset of symptoms. We determined signal intensity at three points within the area of infarction and at three other points in adjacent myocardial tissue. Decreased signal intensity within the area of infarction was present in native scans in 60% of all cases. Application of 0.1 mmol/kg body weight gadolinium‐DTPA was followed by an average 70% increase in signal intensity within zones of acute infarction, as compared to a 20% increase in surrounding myocardial tissue. In cases of subacute and chronic infarction there was no significant signal enhancement after administration of gadolinium‐DTPA. Uptake of gadolinium‐DTPA in the area of acute myocardial infarction may be a positive marker of acute myocardial necrosis, which may be of potential clinical benefit.
Noninvasive findings in patients with hypertrophic and dilative cardiomyopathy: A combined echocardiographic and radionuclide angiographic study
Authors: Bryhn M. , Persson S.
Published: February 2009

Fifteen patients with hypertrophic (HCM) and 15 with dilative cardiomyopathy (DCM) were examined with radionuclide angiography and M‐mode echocardiography to evaluate the combination of two noninvasive methods for measuring left ventricular performance. The patients with HCM had delayed myocardial relaxation and rapid filling time with preserved peak rate of early ventricular filling. DCM patients, on the contrary, had low values of left ventricular systolic performance and low peak filling rate. Myocardial relaxation and rapid filling time, however, were short, indicating compensatory mechanisms in the failing ventricle improving rapid filling.
Prolonged survival with a thrombotically occluded tricuspid valve prosthesis
Authors: Harjula A. , VENTILATA M. , MATTILA S.
Published: February 2009

A 49‐year‐old man who had undergone tricuspid valve replacement with a Bjöork‐Shiley prosthesis in November 1974 was reoperated on in January 1985 due to prosthesis malfunction. The operation revealed a totally occluded prosthetic valve and a paravalvular defect which had served as the channel for atrioventricular blood flow. In retrospect, all evidence indicated that the valve had stuck as early as six months after the primary operation, when the patient had first noticed the loss of audible valve clicks and the reappearance of effort intolerance. Due to the gradual progression of the patient's symptoms and misinterpretation of the significance of absent valve clicks, the correct diagnosis was not made until a follow‐up study 10 years after the first operation when contrast echocardiography showed the absence of both disc movements and transvalvular contrast flow. Our experience indicates that thrombosis of a tricuspid valve prosthesis may present highly insidiously and that the loss of audible valve clicks should be relied on as a sign of prosthesis malfunction.
Recurrence of coronary artery spasm after successful percutaneous transluminal coronary angioplasty
Authors: Takashiba K. , Ebihara H. , Hamada Y. , Hyakuna E. , Matsuda Y.
Published: February 2009

A 47‐year‐old man presented with angina, and coronary angiograms showed a significant organic stenosis with spasm in the left anterior descending coronary artery. Percutaneous transluminal coronary angioplasty was successfully performed for the organic lesion in the left anterior descending coronary artery. Symptom of angina due to coronary artery spasm recurred, even without restenosis at the site of successful angioplasty.
Acute myocardial infarction during streptokinase therapy
Authors: Horn E. M. , Amin D. K. , Lew A. S.
Published: February 2009

A 45‐year‐old man developed sequential inferolateral and anterior myocardial infarctions within 10 hours of a possible allergic reaction to oral penicillin. The anterior myocardial infarction occurred during apparently successful streptokinase therapy for the initial inferolateral infarction. Subsequent coronary arteriography confirmed a subtotal stenosis of the left circumflex coronary artery and a complete thrombotic occlusion of the left anterior descending artery. This case documents the occurrence of three rare clinical phenomena; first, the occurrence of sequential acute myocardial infarctions in close temporal proximity; second, the occurrence of myocardial infarction during thrombolytic therapy; and third, the association of myocardial infarction with a possible allergic reaction.
Ventricular parasystole and ventricular couplets: A re‐entry within the parasystolic focus?
Authors: Santinelli V. , De Paola M. , Smimmo D. , Turco P. , Condorelli M.
Published: February 2009

We report a 62‐year‐old man with a persistent ventricular rhythm originating in a parasystolic focus associated with frequent ventricular couplets with fixed coupling. Both intravenous (IV) procainamide (l g) and propafenone (70 mg IV) promptly suppressed only the second component of ventricular couplets, suggesting that re‐entry rather than enhanced automaticity was the mechanism of ventricular couplets. On the contrary, the nonresponse of ventricular rhythm and ventricular couplets to verapamil (10 mg IV) suggested that triggered activity should not play a role in the genesis of this ventricular rhythm. The mechanisms of the ventricular couplets (rapidly discharging parasystolic focus vs. re‐entry) are discussed.
Asynergy and left ventricular performance in dilative cardiomyopathy
Authors: Zucchi R. , Barsotti A. , Mariotti R. , Biadi O. , Balbarini A. , Mariani M.
Published: February 2009

The purpose of this work was to evaluate the presence and importance of asynergy in dilative cardiomyopathy. A semiautomatized analysis of left ventriculograms was performed in 18 cases, the morphology of longitudinal and transverse axes time‐length curves was evaluated, and mathematical indices of asynchrony and hypokinesis were defined. Ten normal subjects and 9 patients affected by aortic regurgitation were used as controls. In dilative cardiomyopathy, anomalous (polyphasic) time‐length curves were present in 55% of the cases, while they were absent in aortic regurgitation and in all normal subjects but one. In addition, the asynchrony index was slightly increased and the hypokinesis index significantly increased (28.8$$7.2% vs. 17.8$$7.1%, p<0.001). A negative correlation existed between the asynchrony index and the ejection fraction (r= −0.483, p<0.05) and both the ejection fraction and the maximum normalized velocity of contraction were reduced in the patients with the anomalous curves (29.7$$6.9% vs. 46.0$$11.5%, p<0.01; 1.66$$0.52 s−1 vs. 2.86$$1.33 s−1, p<0.02). It was concluded that asynergy, and especially asynchrony, is frequent in dilative cardiomyopathy and it is strongly associated with a major impairment of overall left ventricular function.
Changes of heart rate and QT interval at high altitude in alpinists: Analysis by holter ambulatory electrocardiogram
Authors: Horii M. , Takasaki I. , Ohtsuka K. , Tsukiyama H. , Takahashi A. , Hatori Y. , Hakuta. T.
Published: February 2009

The purpose of this study is to record continuously electrocardiograms of alpinists during different activities practiced in mountaineering, compare heart rate and QT interval at high altitude with those at sea level, and compare alpinists with nonalpinists. Analysis was attempted on 14 alpinists (9 male, 5 female, ages 26–45) to determine changes in heart rate and QT interval using continuous ambulatory electrocardiograms recorded at sea level and high altitude. Between 1983 and 1984, 9 of 14 alpinists (6 male, 3 female) were subjected to the study at high altitude, that is, at Mt. Kangchenjunga (Himalaya), Mt. Satopanth (Himalaya), and Mt. Jitudake (Butan), 4400 to 7800 m (mean 5710 m). The following were noted: (1) Heart rate at high altitude was significantly higher both in daytime and nighttime. The circadian rhythm of the heart rate disappeared at extremely high altitude in several al alpinists. (2) A high correlation was noted between measured QT interval (QT!m) and RR interval (r=0.81, p=0.005). Nighttime QTm at high altitude was prolonged in comparison with that of daytime so far as the RR interval remained the same. (3) At high altitude, the nighttime corrected QT interval (QTc) was also significantly prolonged in spite of shortened RR interval. The mechanism of QTc prolongation is not clear. Many factors may impact on the QT interval during mountaineering.
Thrombolysis of acute total occlusion of the left main coronary artery and long‐term survival
Authors: Biron Y. , Laurent M. , Bourdonnec C. , Coeurderoy A. , Almange C. , Le Helloco A.
Published: February 2009

A young woman was admitted with acute anterior myocardial infarction. Emergency coronary angiography showed a total occlusion of the LMCA. Selective infusion of streptokinase recanalized the left main coronary artery (LMCA), the circumflex artery, and the first diagonal, but not the entire left anterior descending artery (LAD). The right coronary artery was dominant and normal. The left‐sided congestive heart failure was severe; treatment improved the heart failure and the patient was discharged on Day 25. She was readmitted for control 28 months later: she was only moderately disabled and coronary angiography showed the same occlusion of the LAD; result on ejection fraction (right anterior oblique view 30d̀) was not significant, but circumflex artery recanalization probably preserved lateral wall contraction. The presence of a normal dominant right coronary artery seems to be a very important factor in contributing to initial survival.
Effects of propranolol, atenolol, and chlordesmethildiazepam on response to mental stress in patients with recent myocardial infarction
Authors: Mazzuero G. , Galdangelo F. , Zotti A. M. , Bertolotti G. , Tavazzi L.
Published: February 2009

Stress testing was carried out by two stressors, mental arithmetic and Sacks‐Levy's test in randomized sequence, in64 male patients with a mean age of 51±7 years in NYHA Classes I or II within 3 months after acute myocardial infarction. The stress profile was obtained after drug withdrawal by continuous recording of electrocardiogram, frontal electromyogram, and peripheral skin temperature and conductance. Blood pressure was measured each minute by cuff. The patients were subdivided into 4 groups of 16 each and were studied in an identical fashion aftera48‐h oral treatment with propranolol 120 mg daily, atenolol 100 mg daily, chlordesmethyldiazepam 2 mg daily, or placebo. During stress, signs of myocardial ischemia or pump failure were not observed; minor arrhythmias were recorded. Cardiovascular activation was observed with significant increments (p<0.001)in heart rate, systolic and diastolic blood pressures in all 4 groups for both stressors with a slightly greater effect of mental arithmetic; Sacks' test was more effective on the frontal electromyograph response. Following beta blockade the stress profile of heart rate was significantly lower and flattened. The stress profile of blood pressure was also lower, but the reduction in the increment during stress was not significant. No differences were observed in the effects of the two beta blockers; no significant changes were evident in the stress profile of the noncardiovascular psychophysiologic indexes. Stress profiles were not altered by the benzodiazepine. In conclusion beta‐blocker agents seem to be more useful than anxiolytic drugs in preventing cardiovascular activation induced by mental stress in patients with recent myocardial infarction.
Propafenone versus disopyramide: A double‐blind randomized crossover trial in patients presenting chronic ventricular arrhythmias
Authors: Libersa C. , Caron J. , Pladys A. , Beuscart R. , Kacet S. , Wajman A. , Connell C. , Dupuis B. , Lekieffre J.
Published: February 2009

In vitro and in vivo electrophysiological studies have shown that propafenone could be classified as a class I antiarrhythmic agent. The aim of this study was to investigate the short‐term antiarrhythmic efficacy and safety of propafenone in 10 patients compared to disopyramide in a double‐blind randomized protocol. Included patients suffered from ventricular arrhythmias with at least 60 ventricular premature beats (VPB) per hour refractory to at least two other antiarrhythmic agents. At the end of the control period and of the two treatment periods during which patients received either propafenone (300 mg three times a day) or disopyramide (200 mg three times a day), clinical examination, Holter recordings, electrocardiogram, and clinical laboratory tests were performed. The PR interval and the QRS interval were significantly increased with propafenone, but not with disopyramide. The cQT interval was not significantly changed by either propafenone or disopyramide. Heart rate was decreased with propafenone (p<0.05) with no change in the diurnal/nocturnal circadian ratio variation. Heart rate was significantly decreased with disopyramide only during the day. Five of nine patients in the propafenone group and two of nine patients in the disopyramide group showed a reduction in ventricular premature beats greater than 80%. Total resolution of severe arrhythmias (repetitive events) was seen in 5 of 8 patients with propafenone; 2 of 8 with disopyramide. Adverse events, when they occurred, were mild (visual disturbances, epigastric discomfort, changes in taste perception, transient atrioventricular block with propafenone, and photophobia with disopyramide), and did not require reduction or discontinuation of study drug. Considering these results, propafenone is expected to be an efficient antiarrhythmic drug in the treatment of severe ventricular arrhythmias.
Efficacy and tolerance of tocainide during long‐term treatment of malignant ventricular arrhythmias
Authors: Mohiuddin S. M. , Esterbrooks D. , Mooss A. N. , Dahl J. M. , Hilleman D. E.
Published: February 2009

A group of 51 patients with malignant ventricular arrhythmias refractory to standard oral antiarrhythmic agents were treated with oral tocainide. Antiarrhythmic efficacy was defined as total abolition of occurrences of ventricular tachycardia (VT) or ventricular fibrillation (VF) as assessed by hospital admissions for arrhythmias and the occurrence of sudden cardiac death (SCD). Of the 51 patients, 32 (63%) initially tolerated tocainide and were discharged from the hospital. Of the 19 patients not initially responding to tocainide, 6 (12%) had arrhythmia recurrence and 13 (25%) developed intolerable central nervous system or gastrointestinal side effects. Of these 19 short‐term nonresponders, 8 (42%) patients suffered SCD over an average follow‐up of 24 months (annual SCD rate of 21%). Two patients suffered SCD during the first week of tocainide therapy. Discounting the 2 patients with SCD on tocainide therapy, 6 of 17 (35%) patients initially withdrawn from tocainide suffered SCD (annual SCD rate of 18%). Twenty‐four of the 32 short‐term responders did not have arrhythmia recurrence over a mean follow‐up of 38 months resulting in an overall long‐term efficacy of 47% (24/51). Over an average follow‐up of 38 months for these 24 short‐term responders, 12 patients expired from nonarrhythmic causes, 3 patients were withdrawn for non‐drug‐related causes, and 9 patients remain on tocainide therapy. Of the 8 long‐term nonresponders, 3 patients had arrhythmia recurrence and died suddenly while 5 patients developed intolerable side effects. The annual SCD rate in short‐term responders was 3%. Eighteen of the 51 patients (35%) were withdrawn from the study because of adverse effects. We conclude that tocainide is a valuable addition to the limited number of antiarrhythmic agents effective for the management of patients with malignant ventricular arrhythmias. A reduction in SCD rates may be expected in patients who tolerate and respond to tocainide during acute therapy.
Malignant ventricular arrhythmia in the wolff‐parkinson‐white syndrome during amiodarone treatment
Authors: Perticone F. , Cuda G. , Spadea F. , Pintaudi C. , Tropea R.
Published: February 2009

The ventricular rate during rapid atrial rhythms is related in Wolff‐Parkinson‐White (WPW) syndrome to antegrade effective refractory period of the accessory pathways. Among the many antiarrhythmic drugs available, amiodarone is most commonly used for its large therapeutic window and very long half‐life. We report a case of cardiac pre‐excitation syndrome in a young male patient in whom amiodarone therapy (3000 mg/weekly) was instituted to modify the dangerous ventricular response during atrial fibrillation (shortest R‐R interval 190 ms, ventricular rate 210 beats/min). Four months later, starting pharmacological treatment, a new electrophysiological study documented a malignant ventricular arrhythmia: during atrial fibrillation the minimum R‐R interval was 160 ms and the ventricular rate 280 beats/min. Finally, the possible mechanism of paradoxical effect observed in our patient is hypothesized. Amiodarone could favor conduction over the accessory pathways by slowing or blocking conduction into the atrioventricular node and decreasing concealed retrograde conduction into the accessory bypass tract by normally conducted beats.
The Nature of ventricular arrhythmias during ergonovine‐induced vasospastic angina pectoris
Authors: Nakaya Y. , Hiasa Y. , Fujino K. , Aihara T. , Mori H.
Published: February 2009

The peak incidence of ventricular fibrillation in acute myocardial infarction usually occurs during the first hours after the onset. Electrophysiological changes immediately after the onset have been studied in animal models, but are still incompletely understood in humans. For clarification of the characteristic features of ventricular arrhythmias during acute myocardial ischemia, ventricular arrhythmias were studied in 81 patients with vasospastic angina pectoris induced by ergonovine. Ventricular arrhythmias occurred in 45 of these patients, including ventricular tachycardia in 15, and ventricular fibrillation requiring repeated DC defibrillation in two patients. Most ventricular extrasystoles occurred before the ST segment reached maximum elevation, while reperfusion arrhythmias were less common. In many patients the coupling intervals varied, and the configuration was multiform. It is concluded that ventricular arrhythmias occurring during ergonovine‐induced coronary spasm show different characteristics from those occurring during chronic ischemia. As the arrhythmias in this study seem, in some ways, to resemble arrhythmias occurring at the onset of myocardial infarction, the results might provide useful information on ventricular arrhythmias in myocardial ischemia in humans.
Early diastolic time intervals during hypertensive pregnancy
Authors: Spinelli L. , Ferro G. , Talarico G. , Cinquegrana G. , Condorelli M. , Nappi C. , Farace M. J.
Published: February 2009

Early diastolic time intervals have been assessed by means of the echopolycardiographic method in 17 pregnant women who developed hypertension during pregnancy (HP) and in 14 normal pregnant women (N). Systolic time intervals (STI), stroke volume (SV), ejection fraction (EF), and mean velocity of myocardial fiber shortening (VCF) were also evaluated. Recordings were performed in the left lateral decubitus (LLD) and then in the supine decubitus (SD). In LLD, isovolumic relaxation period (IRP) was prolonged in the hypertensive pregnant women compared with normal pregnant women (HP 51±12.5 ms, N 32.4±15 ms p<0.05), whereas time of the mitral valve maximum opening (DE) was not different in the groups. There was no difference in SV, EF, and mean VCF, whereas STI showed only a significant (p<0.05) lengthening of pre‐ejection period (PEP) in HP. When the subjects shifted from the left lateral to the supine decubitus position, left ventricular ejection time index (LVETi) and SV decreased significantly (p<0.05) in both normotensive hypertensive pregnant women. IRP and PEP lengthened significantly (p<0.05) only in normals, whereas they were unchanged in HP. DE time did not vary in either group. In conclusion, hypertension superimposed on pregnancy induces lengthening of IRP, as well as of PEP, and minimizes the effects of the postural changes in preload on the above‐mentioned time intervals.
Arm position as a source of error in blood pressure measurement
Authors: Mariotti G. , Alli C. , Avanzini F. , Canciani C. , Di Tullio M. , Manzini M. , Salmoirago E. , Taioli E. , Zussino A. , Radice M.
Published: February 2009

The present study was designed to assess the value of correct positioning of a patient's arm when measuring blood pressure (BP). A total of 181 subjects were examined, 141 hypertensives on treatment, 25 untreated hypertensives, 15 normotensives. All the subjects underwent three BP measurements after a 5‐min resting period in supine position. Then two BP readings were recorded in standing position with the arm either positioned by the patient's side or supported passively at patient's heart level. Average systolic BP (SBP) in standing position were 144.6±20.2 mmHg with the arm at the side and 136.4±21.1 mmHg with the arm at the heart level (p<0.001); average diastolic pressures were 99.0±12.0 mmHg and 90.2±12.3 mmHg (p<0.001), respectively. A fall in SBP ± 20 mmHg from the supine to the upright position was detected in 18.2% of cases when measurement was performed at heart level; such a reduction was inapparent in two‐thirds of cases when the arm was placed at the patient's body side. Incorrect positioning of a patient's arm during BP measurements in standing position leads to overestimation of BP values and masks the presence of postural hypotension.
Influence of acute hyperglycemia on left ventricular function in diabetics assessed by echocardiography
Authors: Frati A. C. , Espinoza M. , Ariza C. R. , Díaz M. E. , Rivera C.
Published: February 2009

Myocardial dysfunction in diabetes mellitus is reversed by proper correction of metabolic changes. To assess the role of hyperglycemia on cardiac dysfunction, 50 g of dextrose were intravenously infused to 15 subjects with stable type 2 diabetes. Echocardiographic measurements were made at 0, 60, 120, 180, and 240 minutes. In spite of the high levels of blood glucose reached in diabetics, left ventricular ejection fraction, fractional shortening, and stroke volume did not experience significant changes. Moreover, cardiac output significantly (p<0.01) increased in diabetics secondary to an increase in heart rate. No cardiac changes were noticed in 7 healthy subjects studied in a similar fashion. However, their induced hyperglycemia was not as elevated as in the diabetic patients. These results suggest that acute induced hyperglycemia per se does not appear to impair left ventricular contractility in diabetics at resting conditions.
Inverted U wave in ergonovine‐induced vasospastic angina
Authors: Yano H. , Hiasa Y. , Aihara T. , Nakaya Y. , Mori H.
Published: February 2009

The relationship between inverted U wave in leads V5 and II and the location of myocardial ischemia was studied in 52 positive patients and in 50 negative patients with ergonovine provocation test. Development of a biphasic or negative U wave, or increased negativity of U wave (inverted U wave) was observed in 15 of 17 patients with spasm in only the right coronary artery (RCA), in 6 of 8 with spasm in only the left anterior descending artery (LAD), in 2 of 8 with spasm in only the left circumflex artery (LCx), and in 23 of 24 with spasm in two or more vessels. Of 52 positive patients in the ergonovine provocation test, 46 (88.5%) had inverted U wave. Of these, 17 (32.7%) had inverted U wave without discernible ST deviation. Of 50 negative patients, 2 had inverted U wave. Inverted U wave in lead V5 was frequently seen in patients with spasm of LAD, but this finding was not uncommon in spasm of RCA or LCx. On the other hand, inverted U wave in lead II was frequently seen in spasm of RCA and LCx, but not in spasm of LAD. These findings suggest that inverted U wave in lead V5 is not specific for myocardial ischemia due to spasm of LAD and that inverted U wave in lead II is specific for spasm of RCA and LCx.
Right ventricular thrombus and pulmonary emboli in a patient with emphysema: An echocardiographic and doppler documentation
Authors: Gur H. , Levo Y. , Keren G.
Published: February 2009

Pulmonary hypertension is a known complication of chronic obstructive pulmonary disease (COPD). A worsening dyspnea in a patient with COPD is usually a sequela of the pulmonary disease. However, it may be due to pulmonary embolism, a complication which is difficult to diagnose in such patients. We present a patient with COPD in whom two‐dimensional and Doppler echocardiography confirmed the diagnosis of pulmonary emboli by documenting right ventricular thrombus and pulmonary hypertension. This case report emphasizes the usefulness of these noninvasive cardiac imaging techniques in the detection and evaluation of pulmonary embolism in patients with COPD.
Arrhythmogenic properties of disordered breathing during sleep in patients with cardiovascular disorders
Authors: Otsuka K. , Sadakane N. , Ozawa T.
Published: February 2009

The purpose of this study was twofold: to establish an ECG respiration monitoring system, and to evaluate the clinical usefulness of this system. Our purpose was to determine how many patients with cardiovascular disorders may have unrecognized sleep apnea and whether such apneic episodes are an important cause of cardiac arrhythmias. The study group included 81 patients, age range 40–95 years, and 13 healthy males, age range 52–72 years. The 24‐h ECG respiration recordings were obtained with the two‐channel Holter recorder. Airflow at the nose using a nasal thermister or chest wall movement by impedance pneumography was recorded as respiration record on the second channel. Sleep apnea was observed 69% and 77–100% in the control subjects and patients with cardiovascular disorders, respectively. Episodes of sleep apnea were most frequent in the patients with old myocardial infarction. Grading of apneas was defined according to the length of apnea. Short duration apneas were observed only in the control subjects, but longer apneic episodes were observed in patients with cardiovascular disorders. Bradyarrhythmias observed were to be relative to apneic episodes longer than 20 s, while ventricular arrhythmias were observed only in the patients with old myocardial infarction, coincident with apneas lasting longer than 40 s. Atrioventricular conduction disturbances were also observed to be related to the occurrence of sleep apnea. These results suggest that 24‐h ECG respiration monitoring is useful not only for the observation of sleep apneic episodes, but also in clarifying the relationship between cardiac arrhythmias and apneic episodes.
Effects of unloading and positive inotropic interventions on left ventricular function in asymptomatic patients with chronic severe aortic insufficiency
Authors: Scognamiglio R. , Fasoli G. , Visintin L. , Dalla‐Volta S.
Published: February 2009

The effect of an unloading (nifedipine, 20 mg sublingually) and of a combined unloading and positive inotropic intervention (nifedipine plus digoxin, 0.5 mg intravenously) on left ventricular performance was assessed in 48 patients with chronic severe aortic insufficiency. The left ventricular pump function‐myocardial contractility relation (ejection fraction, EF vs. peak arterial pressure to end‐systolic volume ratio, PAP/ESV), and the pump function‐afterload relation (EF vs. mean systolic wall stress, MWS) were constructed by means of quantitative M‐mode and two‐dimensional echocardiography. In patients with normal control pump function (n=14), nifedipine markedly decreased MWS, moving the patients to a new, more advantageous EF‐MWS relation. In the 34 patients with abnormal pump function, the myocardial contractility level was the mean factor conditioning the response to pharmacological intervention. Patients with a value of PAP/ESV greater than 2.5 (n=22) had normalization of EF after nifedipine and were upgraded to a more advantageous outlook for left ventricular mechanics EF‐MWS and EF‐PAP/ESV relations. Of the 12 patients without normalization of EF after nifedipine, only the 4 patients with PAP/ESV greater than 2 had normalization of pump function indices after combined administration of nifedipine and digoxin.
Correlation between left ventricular wall thickness and qrs voltages in Nigerians
Authors: Odia O. J.
Published: February 2009

ECG voltage criteria for left ventricular hypertrophy are based on the assumption that a thicker ventricle generates higher QRS voltages. In order to test this assertion, a study of the correlation between echocardiographically determined left ventricular wall thickness and ECG QRS voltages was carried out in 89 subjects, consisting of 35 hypertensives, 20 patients with mitral/aortic valve incompetence, and 34 controls. The results show that there was no statistically significant correlation between QRS voltages and left ventricular wall thickness. This shows that a thicker ventricle does not necessarily generate higher QRS voltages on the electrocardiogram. This may explain the already documented less than satisfactory degree of accuracy of the various ECG voltage criteria for the diagnosis of left ventricular hypertrophy.
“Torsades de pointes” and atrioventricular block
Authors: Moroe K. , Saku K. , Tashiro N. , Hiroki T. , Arakawa K.
Published: February 2009

In order to elucidate the trigger factor of the production of torsades de pointes (TdP), electrophysiological study was conducted in 15 patients with atrioventricular (AV) block; 6 with TdP (TdP group) and 9 without TdP (control group). In the TdP group, all had an episode of syncope and frequent ventricular premature beats (VPBs) on routine ECG, while four (44%) had syncope and three (33%) had VPBs in the control group. Aging, QRS width, ventricular cycle length, QT interval, and block site from His bundle electrogram were similar in both groups, however the QTc interval was significantly (p<0.01) longer in the TdP group than in the control group (580±112 vs. 459±37, respectively). Furthermore, four patients (67%) in the TdP group showed advanced AV block in which a slow ventricular rate and an irregular rhythm were characteristic, whereas only one control (11%) showed advanced AV block and all other control patients (89%) had complete AV block. These data indicate that patients with advanced atrioventricular block associated with prolonged QTc interval and frequent ventricular premature beats might induce torsades de pointes.
Hemodynamic effects of metoprolol and nifedipine in angina pectoris measured by isotope technique
Authors: Boström P.‐Å.
Published: February 2009

In order to evaluate the therapeutic effects of metoprolol, nifedipine, and their combination, 11 patients with secondary angina pectoris and with thallium tomographic findings indicating coronary artery disease were studied before and after these three treatment regimes in a single‐blind cross‐over study. The therapeutic effect was measured by standardized working test and isotope angiocardiography, which enabled evaluation of left ventricular ejection fraction, stroke volume, and phase analysis of left ventricular contraction. Treatment with metoprolol and combination therapy increased work performance. Ejection fraction did not differentiate the treatment regimes, whereas stroke volume was significantly lower at work and heart rate higher at rest and at work during nifedipine treatment compared to either metoprolol or combination treatment (p<0.05). Cardiac output was significantly reduced during nifedipine and metoprolol treatment during work (p<0.05). Phase improved after all therapeutic regimes, but reached significance only during the metoprolol treatment period at rest (p<0.05).
Coronary arterial embolism due to valvular debris after percutaneous valvuloplasty of calcific mitral stenosis
Authors: Wiegand V. , Tebbe U. , Helmchen U. , Kreuzer H.
Published: February 2009

A 74‐year‐old woman with refractory congestive heart failure due to long‐standing calcific mitral stenosis who refused surgical intervention was treated with percutaneous balloon valvuloplasty. After an uneventful procedure, hemodynamic results were satisfactory with an increase in the mitral valve area from 0.4 to 1.1 cm2. Five hours after the procedure, the patient had a bout of vomiting followed by pulmonary aspiration. Electrocardiography, and in the further course, creatine kinase MB elevation, showed anterior myocardial infarction. Necropsy disclosed embolic material in the mid left anterior descending artery which unequivocally consisted of valvular material. This case demonstrates embolism of valvular debris as a life‐threatening, procedure‐related complication of percutaneous valvuloplasty of calcific mitral stenosis.
Multiform accelerated idioventricular rhythm (AIVR) in a child with acute myocarditis
Authors: Nakagawa M. , Hamaoka K. , Okano S. , Shiraishi I. , Sawada T.
Published: February 2009

Acute myocarditis is complicated by various types of conducting disturbances and heart failure. We describe the case of a school boy with acute myocarditis, who developed various types of conduction disturbances, including multiform accelerated idioventricular rhythm (AIVR), during convalescence from severe pump failure. Multiform AIVR has been reported mostly in adults but, to the best of our knowledge, not in children. The arrhythmia noted in our patient persisted for only 2 days and disappeared with recovery.
Effect of ethnicity and hypertension on atrial conduction: Evaluation with high‐resolution p‐wave signal averaging
Authors: Madu Ernest C. , Baugh Dainia S. , David GBADEBO T. , Dhala Anwer , Cardoso Sergio
Published: February 2009

Background: Measurements by P‐wave signal‐averaged electrocardiogram (P‐SAECG) of P‐wave duration and P‐wave voltage integral are higher in patients with atrial fibrillation (AF) than in those with sinus rhythm. Hypertension is perhaps the most common cardiovascular antecedent cause of AF, and particularly a disproportionate cause of morbidity and mortality among blacks. The purpose of this study was to examine the effect of hypertension and ethnicity on P‐SAECG parameters in patients without AF.

Hypothesis: It was hypothesized that P‐SAECG parameters can identify hypertensives, and are disproportionately higher in hypertensive blacks.

Methods: in all, 234 normotensives and 84 hypertensives underwent P‐SAECG analysis. in an ancillary study group of 34 hypertensive black men, the relationship between severity of hypertension and measured parameters of P‐SAECG was evaluated.

Results: Mean filtered P‐wave duration and total P‐wave voltage integral for normotensives of both ethnic groups were similar. Hypertensive blacks had greater increase in P‐wave duration (138 ± 16 vs. 132 ± 12 ms; p< 0.01, N 42:42) and total P‐wave voltage integral (922 ± 285 vs. 764 ± 198 μV‐ms; p < 0.001) than white hypertensives. Filtered P‐wave duration and total P‐wave voltage integral increased with severity of hypertension.

Conclusions: Patients at very early stages of hypertension have demonstrable evidence of prolonged atrial conduction by P‐SAECG and, thus, cardiac electrical remodeling. P‐wave duration and total P‐wave voltage integral increase with severity of hypertension. Hypertensive blacks manifest a greater increase in P‐SAECG parameters than whites. This may portend an increased cardiovascular risk for black patients with hypertension.
Prognostic significance of the expression of vascular endothelial growth factors A, B, C, and D and their receptors R1, R2, and R3 in patients with nonsmall cell lung cancer
Authors: Carrillo de Santa Pau Enrique , Arias Fernando Carrillo , Caso Peláez Enrique , Muñoz Molina Gemma María , Sánchez Hernández Ignacio , Muguruza Trueba Ignacio , Moreno Balsalobre Ramón , Sacristán López Silvia , Gómez Pinillos Alejandro , del Val Toledo Lobo María
Published: February 2009

BACKGROUND:

Lung cancer is the leading cause of cancer death in the world. The objective of this study was to investigate the expression of vascular endothelial growth factors (VEGFs) and their receptors (VEGFRs) in patients with nonsmall cell lung cancer (NSCLC) and its correlation with the prognosis for patients with lung cancer.

METHODS:

The expression status of VEGFs and VEGFRs was examined in 48 nonconsecutive specimens of primary lung cancer by immunohistochemistry. Correlations between the expression of VEGFs and VEGFRs and clinicopathologic parameters were analyzed.

RESULTS:

Nineteen of 48 samples (39.6%) were moderately/highly immunoreactive for VEGF‐A, 6 samples (12.5%) were reactive for VEGF‐B, 14 samples (29.2%) were reactive for VEGF‐C, 11 samples (22.9%) were reactive for VEGF‐D, 20 samples (41.7%) were reactive for VEGFR1, 26 samples (54.2%) were reactive for VEGFR2, 20 samples (41.7%) were reactive for VEGFR3, and 19 samples (39.6%) were reactive for nuclear expression of VEGFR3. Patients with moderate/high VEGF‐C, VEGFR1, and VEGFR2 expression had worse survival, whereas patients with moderate/high VEGF‐D and nuclear VEGFR3 expression had better survival. After adjusting according to tumor stage, VEGF‐B and VEGF‐D expression had a significant correlation with worse survival in patients with stage I and II disease. Patients with stage III and IV disease who had VEGFR1 and VEGFR2 expression had worse survival, whereas the expression of VEGF‐D was correlated significantly with better survival. Finally, stage, VEGF‐D expression, and VEGFR1 expression were significantly independent prognostic predictors.

CONCLUSIONS:

The results of the current study indicated that the over‐expression of VEGFs and VEGFRs plays an important role in the survival of patients with NSCLC. The inclusion of angiogenic factors in the standard pathologic study of lung cancer may improve the clinical evaluation of patients with NSCLC. Cancer 2009. © 2009 American Cancer Society.
Assessing the color of red wine like a taster's eye
Authors: Hernández Begoña , Sáenz Carlos , de la Hoz Javier Fernández , Alberdi Coro , Alfonso Santiago , Diñeiro José M.
Published: February 2009

Color of 33 commercial red wines and five‐color reference wines was measured in the same conditions in which visual color assessment is done by wine tasters. Measurements were performed in the two distinctive regions, center and rim, which are the regions assessed by wine tasters when the wine sampler is tilted. Commercial wines were classified into five color categories using the color specifications in their taste cards. The five color categories describe the spread of red hues found in red wines from the violet to brown nuances. The performance of CIELAB color coordinates in terms of their ability to reproduce the observed classification has been established using discriminant analysis. The CIELAB hue angle, hab, measured in the rim, where wine thickness is of the order of few millimeters, gives the best results classifying correctly 71.1% of the samples. Classification results are not significantly improved when additional color coordinates are considered. Moreover, ΔE* color differences with color reference wines do not provide good classification results. The analysis of reference and commercial wines supports the fact that hue is the main factor in the classification done by wine tasters. This is reinforced by the linear correlation found between hab in the rim and the wine age (R2 = 0.795) in accordance with the fact that wines change their hues from violet to brown tints with ageing. © 2009 Wiley Periodicals, Inc. Col Res Appl, 34, 153–162, 2009
Synthesis of Dimethyl Carbonate by Transesterification of Ethylene Carbonate over Activated Dawsonites
Authors: Stoica Georgiana , Abelló Sònia , Pérez‐Ramírez Javier
Published: February 2009

Basic instinct: Basic aluminates derived from the activation of Na‐ and K‐dawsonites are highly active and reusable catalysts for the transesterification of ethylene carbonate and methanol to dimethyl carbonate. The product is obtained in about 65 % yield in 6 h even when the reaction is scaled up 100‐fold to a 2 L reactor.

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