bluuebunny/crossref_metadata_2025 huggingface dataset:
Long‐term follow‐up by exercise radionuclide angiography of patients after valve replacement for aortic regurgitation
Authors: Lumia F. J. , Lamanna M. , ‐LAVIN L. Gonzalez , Maranhao V.
Published: February 2009

The long‐term effects of valve replacement for chronic isolated aortic regurgitation as assessed by first‐pass exercise radionuclide angiography have never been reported. We studied 20 males and 5 females before, 15 months postoperatively, and from 29 to 109 (mean 62±21) months following valve replacement with exercise radionuclide angiography. Mean peak heart rate did not change for the three studies. Peak systolic blood pressure decreased from 201 ± 42 mmHg to 185 ± 24 mmHg at 15 months and further declined to 177 ±32 mmHg by the long‐term study (p >0.03). The mean resting left ventricular ejection fraction improved from 44 ± 15 % preoper‐atively to 57 ± 18% at 15 months (p>0.002) with no further improvement by the long‐term evaluation. The postexercise ejection fraction improved from 42 ± 13% preoperatively to 61 ± 21% at 15 months (p>0.002) also with no change by the long‐term study. The duration of exercise improved from 9.7 ± 4.6 min to 11.9 ± 3.4 min (p>0.03) at 15 months with no additional improvement long term. Improvement in resting and postexercise ejection fraction and in exercise duration is maximal at 15 months. Accuracy and cost containment suggest that assessment of the maximal change in ejection fraction by exercise radionuclide angiography after aortic valve replacement in asymptomatic patients be limited to the 15‐month interval.
The natural history of cardiac involvement in myotonic dystrophy: An eight‐year follow‐up in 17 patients
Authors: Melacini P. , Buja G. , Fasoli G. , Scognamiglio R. , VOLTA S.Dalla , Angelini C. , Armani M.
Published: February 2009

We evaluated the progression of conduction system and myocardial disease in 17 asymptomatic myotonic dystrophy patients by clinical evaluation, electrocardiography, vector cardiography, and echocardiography. An exercise test was done in 10 patients. After 8 years, a follow‐up study of 12 of the 17 original patients was done with a similar protocol. During this period, 2 patients died: one of sudden death while the other had acute left ventricular failure. In our first control study, we found EKG abnormalities in IS of our patients, consisting mostly of conduction defects or pseudonecrotic patterns. In our second control, all patients had conduction system disease and, in addition, 3 of them had premature ventricular beats. One patient developed dilated cardiomyopathy. In 6 patients, structural involvement of the right ventricle was found. We conclude that even in asymptomatic myotonic dystrophy patients a conduction system deficit is present and progresses, and cardiac death may occur in about 12% of these patients.
An electrocardiographic criterion to detect av dissociation in wide qrs tachyarrhythmias
Authors: Curione M. , Fuoco U. , Borgia C. , Putini R. L. , Puletti M.
Published: February 2009

A study was carried out on 12 patients with wide QRS tachycardia, 8 of whom presented with atrioventricular (AV) dissociation (Group A) and 4 with 1:1 AV association (Group B). This investigation aimed at assessing whether significant variations occurred in the QRS amplitude between the two groups. Group A showed more marked variations in QRS amplitude (31.7±13%) compared to Group B patients (6.2±1.2%) (p>0.001). The amplitude changes observed in Group A patients are probably related to variations in telediastolic volume resulting from the occasional contribution of the atrial systole. The findings suggest that variability in QRS amplitude during wide QRS tachyarrhythmias is a reliable sign of the presence of an AV dissociation. The possibility of diagnosing an AV dissociation on a surface ECG without visible P waves is an important finding, which though not pathognomonic of ventricular tachycardia, is a valid ECG criterion for assessing the ventricular origin of arrhythmias. This ECG criterion can be usefully applied in clinical practice along with others already used for the differential diagnosis of wide QRS tachyarrhythmias.
Recurrence of myocardial infarction related to different vessels in a patient with diffuse coronary artery spasm without underlying severe organic stenosis
Authors: Takashiba K. , Matsuda Y. , Hamada Y. , Ohno H. , Hyakuna E. , Fujii M. , Ebihara H.
Published: February 2009

A 59‐year‐old man had a first myocardial infarction in the right coronary artery, followed by an another infarction in the left anterior descending coronary artery. Coronary thrombolysis for both occasions of acute myocardial infarction was successfully performed without severe residual stenosis. In the chronic phase after the second myocardial infarction, ergonovine test showed diffuse coronary artery spasm. The etiology of myocardial infarction is briefly discussed.
Detection of myocardial reperfusion by analysis of serum creatine kinase isoforms
Authors: Tsukamoto H. , Hashimoto H. , Matsui Y. , Okumura K. , Ito T. , Ogawa K.
Published: February 2009

Serum creatine kinase (CK) MM isoforms were determined by chromatofocusing in 22 patients with acute myocardial infarction undergoing intracoronary thrombolysis. In 13 patients with successful coronary recanalization within 3.6±1.0 (SD) h after onset, time to peak CK activity occurred 13±3 h after onset which was significantly shorter (p>0.01) than that in 9 patients without coronary recanalization (20 ±4 h). The proportion of CK MM‐A, the myocardial isoform, in serum in the reperfused group at 6, 10, and 14 h after onset (53 ±9, 38±5, and 27±4%, respectively) was always significantly lower (p>0.01) than that in the nonreperfused group (69±7, 59±8, and43±4%). During the same period, the proportions of CK MM‐B and CK MM‐C, the converted isoforms derived intravascularly from MM‐A by circulating carboxypeptidase, in the reperfused group were always significantly higher (p>0.01) than those in the nonreperfused group. The ratios of MM‐A% to MM‐B% and MM‐A% to MM‐C% amplified the differences between the two groups. At 10 h after onset, these ratios clearly differentiated the reperfused and the nonreperfused group at the values of 1.0 (MM‐A/MM‐B) and 3.0 (MM‐A/MM‐C) with the diagnostic sensitivity of 85% and 92%, respectively. Thus, myocardial reperfusion was detectable noninvasively by analysis of serum CK MM isoforms during the early stage of acute myocardial infarction.
The relationship between hypertrophy and dilatation in the postmortem heart
Authors: Murphy M. L. , White H. J. , Straub K. D. , Meade J. , Meade J.
Published: February 2009

Confusion may exist at the time of postmortem examination as to whether the diseased heart is dilated, hypertrophied, or both. Ventricular dilatation and ventricular hypertrophy were therefore evaluated by cardiac partition techniques in 441 subjects at autopsy to determine their relationship. Specific weight and surface area of each ventricle were obtained and patients were divided into categories of disease. Wall thickness measurements, a parameter routinely used in the ordinary autopsy, were found to be unreliable in defining hypertrophy. Ventricular surface area (an index of dilatation) was highly correlated with ventricular weight in most disease categories. Exceptions were cardiomyopathy and aortic stenosis, in which hypertrophy predominated. We conclude from these data that dilatation and hypertrophy occur proportionately in the postmortem heart in most disease categories except in cardiomyopathy and aortic stenosis. These findings clarify the relationship of dilatation and hypertrophy at the time of autopsy in most cases. Therefore, uncertainty as to whether cardiac dilatation or hypertrophy is present or which predominates is usually related to the inability to assess these states critically at the time of autopsy when the ordinary pathological methods are used.
Effect of aging on doppler echocardiography filling parameters in normal subjects and in patients with coronary artery disease
Authors: Kuecherer H. , Ruffmann K.
Published: February 2009

This study was performed investigate and to investigate the influence of age on left ventricular diastolic filling parameters, as assessed by pulsed Doppler echocardiography. The study population consisted of 67 normal healthy subjects (Group I, age 15–66 years) and 117 patients (Group II, age 24–79 years), with angiographically proven coronary artery disease. Transmural flow velocities were obtained by pulsed Doppler measurements at the level of the mitral annulus. Peak early and late diastolic filling velocities as well as integrated velocities during early and late filling phases were investigated for their relation to aging and a possible alteration with coronary artery disease. In normal subjects, a reduction of early filling velocities and a compensatory increase in late filling velocities were found with increasing age. In patients with coronary artery disease, however, there was no significant correlation of filling parameters with age. In addition, a comparison of filling parameters between age‐matched normals and patients with coronary artery disease showed a further reduction of the contribution of early filling in patients with coronary artery disease. Thus, factors other than age may influence left ventricular diastolic filling behavior in patients with coronary artery disease. This can be demonstrated noninvasively using pulsed Doppler technique.
Sensitivity and specificity of programmed atrial stimulation for induction of supraventricular tachycardias
Authors: Manolis A. S. , Manolis A. S. , Deering T. , Han E. H. , Estes N. A. M.
Published: February 2009

The sensitivity and specificity of two programmed atrial stimulation protocols were studied in 92 consecutive patients undergoing electrophysiologic studies both with (35 patients) and without (57 patients) clinical supraventricular arrhythmias. Protocol I (P I) consisted of incremental atrial pacing to 2:1 atrioventricular (AV) block and a single atrial extrastimulus scanned by 10 ms decrements through diastole to the atrial effective refractory period at a single drive‐cycle length. Protocol II (P II) included a second atrial extrastimulus scanned by 10 ms decrements through diastole at a single drive‐cycle length with the first extrastimulus set 20 ms from the atrial effective refractory period. Rapid atrial pacing at cycle lengths of 350, 300, and 250 ms was then performed with PII. P I was employed in all patients while P II was studied in the final 48 patients only. Of the 35 patients with clinical atrial arrhythmias, 26 (74%) of their arrhythmias were induced with either P I (18/35; sensitivity = 51%) and/or P II (12/17; sensitivity = 71%). Of the 57 patients without clinical atrial arrhythmias (control group), atrial arrhythmias were induced in 11 (19%), 3 with PI (specificity 95%, 54/57) and 8 with P II (specificity 74%, 23/31). The sensitivity of P II was higher (71%), but its specificity was lower (74%) than P I (51% and 95%, respectively; p>0.05). The positive predictive value of P II was lower (60%) than that of P I (86%) (p>0.05), but the negative predictive value (82%) and predictive accuracy (73%) were comparable to those of P I (76% and 78%, respectively). In conclusion, protocol II (P II) including double extrastimuli and rapid atrial pacing can enhance sensitivity of programmed atrial stimulation in inducing atrial tachyarrhythmias, but results in lower specificity when compared to protocol I (P I).
Nisoldipine: A replacement therapy for nifedipine in the treatment of severe hypertension
Authors: Grossman E. , Rosenthal T.
Published: February 2009

The use of nisoldipine (10–20 mg b.i.d.) was evaluated as a replacement therapy for long‐acting nifedipine (40–120 mg/day) in 21 patients with severe hypertension, who were resistant to or intolerant of nifedipine. Except for one patient with specific contraindications, all participants received an individually determined constant dose of beta blocker throughout the 8‐month study. Results indicated a significant decrease in blood pressure after four weeks of treatment with nisoldipine (173 ± 5/98 ± 4 to 156 ± 3/91 ± 2 mmHg, p>0.05) without an associated change in pulse rate in 19 patients; only 5 of the 21 patients showed no further benefit from nisoldipine. No significant biochemical changes were noted in any of the patients during the study. In three patients, leg edema that had developed as a consequence of previous nifedipine therapy resolved completely following nisoldipine administration. Two patients withdrew from the study before term because of headaches and palpitations. An additional two patients suffered headaches, but tolerated the drug and continued the study. One patient suffered from polyuria. Nisoldipine appears to be an effective substitute treatment for nifedipine in severely hypertensive patients sensitive or resistant to nifedipine.
Study of the left ventricular function in pregnancy‐induced hypertension
Authors: Escudero E. M. , Favaloro L. E. , Moreira C. , Plastino J. A.
Published: February 2009

Left ventricular (LV) morphological and functional characteristics in 9 women suffering from pregnancy‐induced hypertension (PIH) were studied by means of echocardiograms. In order to distinguish which changes depended on the pressure values and which were the result of pregnancy, 10 nonpregnant control women with no heart disease and 10 normal pregnant women (NP) were studied and the results of each of the groups compared. To evaluate the structure, left ventricular systodiastolic diameters and wall thickness were measured. The only statistically significant difference was in the diastolic diameters between the PIH (4:7 ±0.3 cm) and the control group (4.4±0.2 cm) p>0.01. Left ventricular mass was significantly increased (p>0.01) in the PIH patients (185±53.1 g) compared to the NP patients (161 ±29.6 g) and the control group (125±17.4 g). No statistically significant differences were found in the radius thickness ratio in the three groups. The systolic function assessed by the shortening percentage was significantly lower (p>0.05) in the control group (32.8±4.4%) and in the NP patients (37.8±5.2%) than in the PIH group (39±6.5%). Afterload assessed by isovolumic period stress was significantly greater (p>0.01) in the PIH patients (157 ± 10.6 dyne/cm2) compared with the NP group (118.9±7.01 dyne/cm2). There were no significant differences between the first group and the control group (134.09± 8.7 dyne/cm2). As evidence of the diastolic function, analysis was made, on the one hand, of diastolic isovolumic period length (DIP). Values in the control group were 50±8.1 ms, in NP 54 ±14.2 ms, and in PIH 50±12.2 ms. There were no significant differences between the groups. On the other hand, peak velocity diameter diastolic changes were determined: that of the control group was 18±3.8 cm/s; for the NP group, 18±5.9 cm/s; and for the PIH group, 21 ±5.3 cm/s. There were no statistically significant differences here either. The foregoing results lead us to the conclusion that PIH does not produce evident structural changes in the left ventricular cavity beyond those already caused by adaptation to pregnancy. The changes in systolic function may be secondary to the effects of an added adrenergic activity, suggested in turn as being responsible for this hypertension. Diastolic function is not altered despite the increase in the left ventricular mass in this group of patients.
Abnormal pharmacokinetics of flecainide in a “Nonresponder”
Authors: Tsukamoto H. , VAN Gelder I. C. , Crijns H. J. G. M. , VAN Wijk L. M. , Lie K. I.
Published: February 2009

Flecainide is well absorbed after oral administration. Following rapid infusion of flecainide, there is a short distribution phase. Plasma levels of flecainide are proportional to dose. Both QRS durations and flutter wave intervals are lengthened after flecainide administration. We report an abnormal pharmacokinetic response to oral as well as intravenous flecainide in a patient who was treated with flecainide for several episodes of atrial flutter. In contrast to the usual pattern, this patient did not show a significant increase in QRS duration, flutter wave interval, or plasma concentration. We could not explain this abnormal pharmacokinetic response, but excluded a rapid and complete renal clearance, an excessively high rate of metabolization, and an abnormal binding mechanism as possible mechanisms. We concluded that flecainide may produce abnormal pharmacokinetic mechanisms, preventing appearance of unbound substance in plasma, thereby preventing occurrence of electrophysiological effects.
Persistent painless st‐segment depression after exercise testing and the effect of age
Authors: Flugelman M. Y. , Halon D. A. , Shefer A. , Peer M. , Dagan T. , Lewis B. S. , Schneeweiss A.
Published: February 2009

The relation between the duration of ischemic ST‐segment depression (1 mm or more 60 ms after the J point) and the clinical awareness of chest pain was studied in 31 patients (aged 39–73 years) undergoing symptom‐limited, graded treadmill exercise testing. The response of these patients to nitrate therapy (spray or sublingual tablet) given immediately on cessation of exercise was also studied. During exercise, angina pectoris appeared at an estimated workload of 4.6±2.2 metabolic equivalents (METS) (mean±SD), and pathological ST‐segment depression at 4.9 ± 1.9 METS (p=NS.) On cessation of exercise, angina disappeared after 3.0±1.9 min, but ST‐segment depression persisted for more than twice as long (6.6 ± 4.1 min) (p < 0.0001). The ratio of time to ST‐segment recovery/time to relief of pain (a quantitative measure of silent ischemia during recovery) increased with age (r = 0.49, p = 0.002), and in 16 patients over 60 years of age was higher than in 15 younger patients (3.6 ± 2.5 vs. 2.1 ± 1.4) (p < 0.04). The silent ischemia ratio after exercise tended to decrease, although not significantly so (p = 0.2), in patients who received oral nitrates; there was no difference in the response to spray or tablet in this regard. We conclude that ST‐segment depression frequently persists after relief of exercise‐induced angina pectoris and more so in elderly patients.
Systemic and coronary hemodynamic effects of combined oral alpha‐ and beta‐adrenergic blockade (labetalol) in normotensive patients with stable angina pectoris and positive exercise stress tests
Authors: Feldman R. L. , Prida X. E. , Hill J. A.
Published: February 2009

The systemic and coronary hemodynamic effects of combined alpha‐ and beta‐adrenergic blockade produced by oral labetalol were assessed in 12 normotensive patients with angina pectoris and an ischemic electrocardiographic response to exercise stress. At rest, labetalol (200 mg, orally) produced systemic vasodilation (systemic vascular resistance ‐9%, p < .01) as aortic pressure fell and cardiac output was unchanged. Left ventricular (LV) end‐diastolic pressure also fell slightly (17%, p = .05). Systemic vasodilation was not accompanied by reflexly mediated increases in heart rate. Coronary flow and resistance and myocardial oxygen uptake were unchanged. Before labetalol, supine bicycle exercise produced angina in 10 patients. After labetalol, exercise duration was prolonged in 6 of these 10 (average 56%). During exercise, tachycardia was blunted (‐7%, p < .05) as were increases in aortic pressure (‐12 %, p < .01) and coronary sinus flow (‐25%, p = .03). Cardiac output and LV end‐diastolic pressure were similar to control period values. These hemodynamic effects of oral labetalol appeared beneficial, differed from those expected of classic beta‐adrenergic blocking agents, and were, in general, similar to those we have observed after intravenous labetalol. The clinical response was good and the drug safe. Labetalol should undergo further evaluation in normotensive as well as hypertensive patients with ischemic heart disease.
Etiology and prognostic implications of a large pericardial effusion in men
Authors: Colombo A. , Olson H. G. , Egan J. , Gardin J. M.
Published: February 2009

To assess the etiology and prognosis of a large pericardial effusion, we reviewed 25 consecutive patients who presented with a large pericardial effusion and underwent a drainage procedure. Large pericardial effusion was defined as: (1) an echo‐free space > 10 mm anteriorly and posteriorly by M‐mode echocardiography and (2) removal of > 350 ml of fluid at pericardial drainage. The etiologies of large pericardial effusion were: neoplastic (36%), idiopathic (32%), uremic (20%), postmyocardial infarction (8%), and acute rheumatic fever (4%). Of our patients, 44% presented with cardiac tamponade, while 25% of patients with idiopathic pericarditis had hemorrhagic effusion and cardiac tamponade. At follow‐up, 37 ± 17 months after pericardial drainage, 68% had died from complications of their underlying disease. There were no deaths attributed to pericardial disease. While 88% of patients with idiopathic large pericardial effusion were alive at follow‐up, none of the neoplastic large pericardial effusion patients survived longer than 5 months after initial pericardial drainage (p < 0.001). Additionally, the survival of patients with uremic large pericardial effusion was better than patients with neoplastic large pericardial effusion (p < 0.05). We conclude: (1) neoplastic, idiopathic, and uremic pericarditis are the most common causes of large pericardial effusion in men, (2) idiopathic pericarditis can be hemorrhagic and cause cardiac tamponade, and (3) the prognosis of large pericardial effusion is related to patients' underlying disease.
Comparison of auscultation with two‐dimensional and doppler echocardiography in patients with suspected mitral valve prolapse
Authors: Barron J. T. , Manrose D. L. , Liebson P. R.
Published: February 2009

Auscultation was compared to two‐dimensional echocardiography (2D echo) and Doppler ultrasonography in 140 consecutive patients referred for evaluation for suspected mitral valve prolapse (MVP) to assess the precision of the two diagnostic methods. Ninety patients (64%) had midsystolic clicks, of which 42 (47%) had MVP by echocardiography; 6 patients (4%) had MVP by 2D echo but no click on examination. In 15 (17%) of the 90 patients, a click was heard only in the standing or squatting positions and 2D echo did not detect prolapse in the supine position in 10 (67%) of the 15. With auscultation as the reference standard for MVP, 2D echo has a sensitivity of 47% and a specificity of 89%. Of the 140 patients, 51 (36%) had systolic murmurs; Doppler detected mitral and/or tricuspid regurgitation in 26 (50%). In 23 (16%) patients, there was Doppler evidence of mitral or tricuspid regurgitation even though systolic murmurs were not heard. Auscultation shows a 53% sensitivity and 73% specificity for systolic murmurs, using Doppler ultrasonography as the reference standard. Of 48 patients with MVP by 2D echo, 15 (13%) had associated mitral regurgitation by Doppler. The results indicate that 2D echo and Doppler ultrasonography should be interpreted in concert with auscultation for the diagnosis of mitral valve prolapse and for therapeutic decision making.
Systolic time intervals in duchenne muscular dystrophy: evaluation of left ventricular performance
Authors: Chenard A. A. , Becane H. M. , Tertrain F. , Weiss Y. A.
Published: February 2009

The purpose of this study was to evaluate the prevalence of latent cardiac heart failure in Duchenne's muscular dystrophy (DMD). Systolic time intervals (STI) were measured in a cross‐sectional study of a group of 177 patients 6‐21 years old. Total electromechanical systole (QS2), left ventricular ejection time (LVET), and pre‐ejection period (PEP), were corrected for heart rate by means of regression equations obtained from 33 normal subjects (QA2 I, LVET I, PEP I). Mean STI values were significantly different from those observed in an age‐matched control group. PEP I was prolonged, LVET I was abbreviated, while QS2 I remained unaltered. STI varied significantly with age. Abnormal values were uncommon before age 10 years. The most critical period was 14–16 years, with an abrupt increase in prevalence from 35 to 72%. Such changes point to the practical use of the STI for clinical decision making especially for surgery.
Acute renal failure following low osmolality radiocontrast dye
Authors: Elliott C. , Reger M.
Published: February 2009

It is hoped that recently released low osmolality radiocontrast agents (RCAs) will have a lower nephrotoxic potential, since dye nephropathy may be related to hyperosmolality. We report here 2 cases of typical oliguric dye nephropathy in patients without risk factors for dye nephropathy. These cases show that these new agents do have nephrotoxic potential.
Cardiac dysfunction associated with the acquired immunodeficiency syndrome (aids)
Authors: Webb J. G. , Chan‐Yan C. , Kiess M. C.
Published: February 2009

Five patients with acquired immune deficiency syndrome (AIDS) developed clinical evidence of mild to severe cardiac dysfunction confirmed by nuclear angiography and echocardiography. In 4 patients who were studied postmortem there was no evidence of myocarditis, valvular, or ischemic heart disease. Cardiac involvement in patients with AIDS may include pericardial and myocardial involvement by opportunistic pathogens or Kaposi's sarcoma, subclinical myocardial dysfunction, or an as‐yet unexplained cardiomyopathy.
Extraction of an intracardial catheter embolus using combined radiography and transesophageal echocardiography
Authors: Neumann H. P. H. , Hofmann T. , Koester W. , Billmann P. , Kauffmann G. W.
Published: February 2009

Embolism of a fragment of a central venous catheter is a serious clinical complication, especially when the fragment cannot be made visible by radiological methods. We report a case where such a fragment could only be localized by transesophageal echocardiography (TEE). With combined use of x‐rays and TEE, the catheter embolus was successfully extracted using a conventional Dormia catheter. For similar situations the described procedure is recommended.
Aspergillus endocarditis in association with a false aortic aneurysm
Authors: Corrigan C. , Horner S. M.
Published: February 2009

A 32‐year‐old man was admitted with an intracerebral hematoma and subsequently with bilateral femoral emboli five months after aortic valve replacement. Blood cultures for bacteria and fungi were negative but microscopy of the embolus revealed Aspergillus fumigatus. At operation a large false aneurysm of the ascending aorta and vegetations on the prosthetic aortic valve were found. Aspergillus endocarditis is diagnosed antemortem in only 23% of fatal aortic aneurysms: blood cultures are positive in only 8%. Clinically a large vessel embolus is characteristic, being present in 83% and microscopy and culture of such an embolus if present are vital investigations.
Coronary artery bypass surgery in women
Authors: Becker R. C. , Corrao J. M. , Alpert J. S.
Published: February 2009

Coronary bypass surgery is performed more frequently in men than in women. A selection bias in favor of men may exist in currently utilized evaluation precesses for patients with both chest pain syndromes and documented coronary artery disease. Surgery should be considered in women with significant left main coronary artery stenosis, “left main equivalent” coronary disease, severe three‐vessel coronary disease with/without left ventricular dysfunction, two‐vessel coronary disease (including a proximal left anterior descending artery stenosis), and unstable angina pectoris with decreased left ventricular function. Women and men undergoing coronary bypass surgery seem to benefit from internal mammary artery grafts used alone or in combination with saphenous vein grafts. Surgical mortality, incomplete revascularization, early and late graft occlusion, and recurrent angina are more prevalent in women who undergo surgery. However, long‐term mortality following surgery is similar in men and women.
Ultrafiltration in the treatment of refractory congestive heart failure
Authors: Dileo M. , Bergerone S. , Pozzi R. , Pacitti A. , Tognarelli G. , Segoloni G. , Vercellone A. , Brusca A.
Published: February 2009

Artificial subtraction of fluids and solutes was evaluated in the course of acute and chronic heart failure when it became refractory to standard intensive medical treatment. A group of 19 patients (mean age 57 years), 9 with ischemic, 2 amyloidotic, 4 valvular, and 4 idiopathic cardiomyopathy, were treated. In 17 patients extracorporeal ultrafiltration (UF) by means of a polysulfonate ultrafilter was adopted along 125 sessions (105 assisted by a roller pump and 20 as a slow continuous ultrafiltrate). In two patients continuous peritoneal dialysis was adopted. In every case UF was well tolerated. Ultrafiltrate volumes ranged from 1680 to 3500 ml for every session with corresponding Na losses ranging from 194 to 434 mEq/session. Improved clinical and functional status with reduction of edema was observed in 17 of 19 patients. In 12 patients UF could be discontinued due to restored response to diuretics; 5 of these patients could subsequently undergo heart surgery (1 transplant, 3 valve replacement, 1 coronary bypass). The remaining 7 patients survived on medical therapy alone for an average of 228 days. In 7 of 19 cases, UF could not be discontinued, and these patients died after an average of 23 days of treatment. In conclusion, UF proved to be effective in eliminating salt‐fluid overload and restoring response to medical treatment. Patients who are potential surgical candidates seem to be the most suitable for UF.
Comparative cardiac effects of intravenous bolus of ipratropium bromide (itrop) and atropine sulfate in 22 patients
Authors: Libersa C. C. , Caron J. F. , Dupuis B. A. , Kacet S. , Lesenne M. , Werquin S. , Danays T. , Lekieffre J. P.
Published: February 2009

At the present time, there is no satisfactory pharmacological treatment for arrhythmia or conduction disorders induced by or aggravated by vagal hypertonia. The limited duration of action of the atropine derivatives currently available justifies the development of new compounds with expected longer acting duration. The aim of this study was to compare the effects of a single blind intravenous injection of ipratropium bromide to those of atropine sulfate in 22 patients. These patients were studied with continuous Holter recordings for three days. During the second and the third nights (patient sleeping), boluses of atropine (0.03 mg/kg) and of ipratropium bromide (0.03 mg/kg), respectively, were added to a continuous saline intravenous infusion. Accurate ECG analysis allowed determination of maximal heart rate peak, timing of maximal heart rate, variations in sinus cycle length, atrioventricular conduction, and durations of drug action. A nonsuggestive questionnaire was presented to patients to detect possible occurrence of side effects. The mean maximal heart rate rose significantly (p<0.001) for atropine (+46.2%) and for ipratropium bromide (+57.4%). The effects obtained with ipratropium bromide on the heart rate lasted nearly twice as long as those obtained with atropine (respectively, 120±38.4 min and 70±30 min‐ for the pharmacological half‐life). Common minor muscarinic side effects (dryness of the mouth) were noted with the two drugs. In conclusion, this comparative intraindividual study confirmed the prolonged vagolytic effects of intravenous ipratropium bromide, which may be valuable in the treatment of patients with vagally mediated automaticity and conduction disturbances.
Monotherapy of hypertension with darodipine: A new calcium‐channel blocker
Authors: Chrysant S. G. , Chrysant C. , Trus J. , Hitchcock A.
Published: February 2009

Calcium‐channel blockers are increasingly used as single agents for the treatment of essential hypertension. Following three weeks of single‐blind placebo therapy, 43 patients with essential hypertension were randomized into four groups. Group 1 (10 patients) received placebo twice a day, Group 2 (13 patients) received darodipine (PY 108‐068) 50 mg twice a day, Group 3 (9 patients) received darodipine 100 mg twice a day, and Group 4 (11 patients) received darodipine 150 mg twice a day. Patients were seen in the clinic weekly for 4 weeks. Clinical and laboratory evaluations were done on each patient. Darodipine caused a sustained decrease in the supine and standing systolic and diastolic blood pressure (p<.001) and there were no significant pressure differences between the three drug dosages. The effects of the drug on heart rate were not consistent. Placebo had no effect on either blood pressure or heart rate. Side effects were few, mild, and consisted of headaches and peripheral edema, and did not necessitate discontinuation of the drug. No metabolic abnormalities were seen with either low or high doses of the drug. We conclude that: (1) darodipine is effective, safe, and well tolerated; (2) its antihypertensive effectiveness is similar at high and low doses, although the higher doses seemed to have a slightly greater effect on the diastolic arterial pressure; (3) the low dose may be preferable since side effects were dose related.
Efficacy and safety of intravenous amiodarone in acute refractory arrhythmias
Authors: Schmidt A. , König W. , Binner L. , Mayer U. , Stauch M.
Published: February 2009

Few data are available on intravenous amiodarone therapy in refractory arrhythmias. This retrospective study in 50 patients (14 with supraventricular and 36 with ventricular tachyarrhythmias) revealed a favorable effect of intravenous amiodarone in the treatment of life‐threatening arrhythmias with an overall success rate of 76%. In the subgroup of patients with ventricular fibrillation and concomitant severe congestive heart failure success rate was low (25%, 2/8), whereas effectiveness in patients with ventricular tachycardias was high (>90%) and proved to be independent of left ventricular function. If patients with recurrent ventricular fibrillation were excluded from the analysis, successful treatment with intravenous amiodarone was achieved in 90%, even in those patients with severely compromised myocardium.
The role of the chest x‐ray in the evaluation of chronic severe heart failure: Things are not always as they appear
Authors: Costanzo W. E. , Fein S. A.
Published: February 2009

The chest x‐ray has become a standard clinical test to aid in the evaluation of patients with chronic severe heart failure. To evaluate just how useful this tool is in the routine assessment of pulmonary venous hypertension secondary to heart failure, we compared the radiologist's interpretation of the chest x‐ray with hemodynamic data obtained from right heart catheterization in a group of patients undergoing protocol evaluation of an experimental treatment for heart failure. Of 23 patients with pulmonary venous hypertension (pulmonary capillary wedge pressure > 20 mmHg) and a complete data base, only 11 had chest x‐rays showing evidence of pulmonary venous congestion or interstitial or alveolar edema. The sensitivity of the chest x‐ray in selecting patients with a pulmonary capillary wedge pressure over 20 mmHg in this setting was only 48%. In other studies, where the radiologist was aware that his or her reading was being compared to hemodynamic assessments, the sensitivity of the chest film has approached 85%. We feel our analysis more closely parallels routine clinical practice. Clinicians should be aware that the chest x‐ray may not be a very sensitive tool for the assessment of pulmonary hemodynamics in patients with severe heart failure.
Spontaneous recovery of left ventricular function following acute anterior myocardial infarction
Authors: Preuss K. C. , Chapman P. D. , Ptacin M. J. , Keelan M. H. , Bamrah V. S.
Published: February 2009

Four patients with acute anterior wall myocardial infarction showing spontaneous and marked improvement in systolic left ventricular function are described. All 4 patients showed abnormal Q waves and severe wall motion abnormalities soon after acute infarction. In all 4 patients, at least some regeneration of R‐wave forces occurred and the regional wall motion in the involved area of the left ventricle improved dramatically without coronary angioplasty or surgical revascularization during the intervening period. The improvement in left ventricular function was attributed to spontaneous increase in nutrient flow to the involved area. It is concluded that Q waves and severe wall motion abnormalities do not necessarily indicate irreversible scar formation.
Risk factors and in‐hospital course of first myocardial infarction in the elderly
Authors: Robinson K. , Conroy R. M. , Mulcahy R.
Published: February 2009

We studied 980 patients with a first episode of unstable angina or myocardial infarction (MI), to examine age‐related differences in risk factors and in‐hospital complications and mortality. Of the total group, 52.9% were over 60 years of age and 24.3% over 70 years. The proportion of females rose with increasing age, as did the proportion of ex‐smokers, while the proportion of current smokers fell. Age correlated negatively with total cholesterol levels, and positively with high‐density lipoprotein cholesterol levels. The proportion of hypertensives rose with age, as did in‐hospital systolic, but not diastolic, blood pressure. Older patients were more likely to have diabetes, and to have had chronic angina. There was no relation between age and either size or site of infarction. The proportion admitted with unstable angina fell with age, and, among infarctions, the proportion developing complications rose. Mortality rose from 3.1% in the under 60 subjects to 20.0% in those over 70. Cardiogenic shock tended to become more lethal with advancing age, but the outcome of ventricular fibrillation was not influenced by age. With the current aging coronary care population, management and secondary prevention methods derived from studies confined to younger subjects may be inappropriate.
Coronary hemodynamics during left and right coronary arteriography with an ionic and nonionic contrast medium
Authors: SCHRäDER R. , SIEVERT H. , FREY G. , SCHMIDT T. , KALTENBACH M. , KOBER G.
Published: February 2009

The direct effects of ionic amidotrizoate (iodine content 370 mg/ml, osmolality 2.1 osmol/kg) and nonionic iopamidol (iodine content 370/ml, osmolality 0.8 osmol/kg) on the coronary circulation were intraindividually compared in 10 patients suffering from coronary heart disease. In accordance with a double‐blind, crossover protocol, both contrast media were injected into the left and right coronary arteries (8 ml and 5 ml per injection, respectively). Injections of both dyes into the left coronary artery caused a similar decrease in heart rate. The prolongation in the QT interval was significantly greater after amidotrizoate (p<0.05). Systolic (p<0.01) and diastolic (p<0.05) aortic pressures decreased to a greater extent following amidotrizoate injection. Each contrast agent produced a similar increase in coronary sinus flow, but iopamidol resulted in a smaller decrease in coronary vascular resistance (p<0.05). After right coronary artery injections, both contrast media caused bradycardia and prolongation of the QT interval, a decrease in systolic and diastolic aortic pressure, a rise in coronary sinus flow, and a lowering of coronary vascular resistance. Though most changes were more pronounced following amidotrizoate injection, the differences in the ionic and the nonionic agent were not statistically significant. Thus, after selective coronary arteriography, both contrast media caused a transient drop in coronary vascular resistance and a rise in coronary sinus flow despite a decrease in aortic pressure. The effects of amidotrizoate were more marked, which might be attributed to the higher osmolality of this ionic contrast medium. Coronary hemodynamics, however, usually returned to baseline values within 1 minute. The clinical significance of the differences in the ionic and nonionic agents appears questionable.
Myocardial contractility and performance capacity after magnesium infusions in young healthy persons: A double‐blind, placebo‐controlled, cross‐over study
Authors: Rasmussen H. S. , Videbaek R. , Melchior T. , Aurup P. , Cintin C. , Pedersen N. T.
Published: February 2009

To evaluate the effect of intravenous magnesium (Mg) treatment on the inotropic state of the heart and maximal work capacity, 9 healthy volunteers were entered in a double‐blind, placebo‐controlled, cross‐over study. Separated by an interval of three weeks, the volunteers were tested twice, each time randomly allocated to receive either an intravenou s injection of 10 mmol magnesium chloride dissolved in 100 ml isotonic sodium chloride or placebo of isotonic sodium chloride only. Before and after each infusion myocardial inotropism was evaluated by echocardiography. Mitral‐septal distance (MSA) was used as a measure for ejection fraction. On each test day an ergometer bicycle exercise test was performed, and maximal work capacity was calculated. Magnesium treatment reduced the MSA (from 4.2 to 2.9 mm, p=0.07), while no difference was found after placebo treatment. Likewise, a tendency toward increasing fractional shortening after magnesium treatment was detected, although this difference was not statistically significant (p=0.1). No difference in maximal work capacity between the magnesium and placebo periods was found. Serum magnesium concentrations rose significantly after the infusions (from 0.82 to 1.38 mmol/1, p<0.001). It is concluded that intravenous magnesium does not exert a negative inotropic effect on the myocardium as previously stated. On the contrary, we found a tendency toward a positive inotropic effect. However, the observed differences are of borderline statistical significance and a more extended study, employing invasive measurements of cardiac inotropism appears to be necessary.
Diagnostic accuracy of 2‐D echocardiography for detection of exercise‐induced wall motion abnormalities in patients with coronary artery disease: Comparison to biplane cineventriculography
Authors: Voelker W. , Jacksch R. , Dittmann H. , Karsch K. R.
Published: February 2009

To determine the accuracy of two‐dimensional echocardiography (2‐D echo) for assessment of exercise‐induced wall motion abnormalities in patients with coronary artery disease, the results of stress echocardiography were compared with exercise cineventriculography. In 56 consecutive patients, biplane cineventriculography at rest and immediately after supine bicycle exercise was performed. Cross‐sectional echo was obtained using the apical two‐ and four‐chamber‐views for left ventricular imaging under identical conditions. In 6 of the 56 patients 2‐D echo, in 8 patients cineventriculogram, and in 2 patients both methods were of inadequate quality at rest or during exercise. Of the remaining 40 patients, 34 had coronary artery disease. Local wall motion in 360 wall segments from these patients was analyzed. In 49 segments (14%) in 24 of these patients exercise‐induced ischemic wall motion abnormalities were evident during cineventriculography. Only 24 of these 49 asynergies (49%) were also recognized by 2‐D echo. Using cross‐sectional echocardiography, ischemia‐related wall motion abnormalities were best detected septal, whereas apical asynergies were identified in only 3 of 12 segments (25%). Thus, the clinical value of exercise 2‐D echo as a screening method in patients suspected of having coronary artery disease is limited and restricted to patients where excellent visualization of the left ventricular endocardium is possible.
Accuracy of m‐mode and two‐dimensional echocardiography in the diagnosis of aortic dissection: An experience with 128 cases
Authors: Roudaut R. P. , Billes M. A. , Gosse P. , Deville C. , Baudet E. , Fontan F. , Besse P. , Bricaud H. , Dallocchio M.
Published: February 2009

The accuracy of combined M‐mode and two‐dimensional echocardiography in the diagnosis of aortic dissection was evaluated in 673 patients with a clinical suspicion of aortic dissection, over a six‐year period. In 128 cases, the diagnosis of aortic dissection was confirmed by angiographic, tomographic (CT scan), or autopsy findings, or during surgery. Two echocardiographic features were found to support a diagnosis of aortic dissection: a dilation of at least one segment of the aorta (sensitivity 95%, specificity 51%) and a typical abnormal linear intraluminal echo corresponding to the intimal flap (sensitivity 67%, specificity 100%). This pathognomonic intimal flap was observed in 86 cases, of which three types could be distinguished: (1) a long oscillating flap (n=15), (2) a long but minimally mobile linear echo which was duplicated and parallel to one or two aortic walls (n=64), (3) a short, double linear image with a rapid systolic motion and high frequency oscillations. These features were found to have a high sensitivity in type I aortic dissection (88%), although in types II and III the sensitivity was much lower. In some cases, a fourth type of abnormal image could be detected: a small intraluminal echo moving in parallel to the aortic wall. This feature should be interpreted with caution since its predictive value for a positive examination was low (48%). Out of 23 cases in which the diagnosis of aortic dissection was suspected on the basis of this doubtful abnormal echo, it was confirmed in only 11 patients. The results in these 128 cases of aortic dissection indicate that two‐dimensional echocardiography, which is easily performed at the patient's bedside, could take priority in investigations of this condition. It is extremely sensitive in the diagnosis of ascending aortic dissection, but much less so in the diagnosis of descending aortic dissection.
Thalassemic cardiomyopathy: Echocardiography difference between major and intermediate thalassemia at rest and during isometric effort: Yearly follow‐up
Authors: Canale C. , Terrachini V. , Vallebona A. , Bruzzone F. , Masperone M. A. , Caponnetto S.
Published: February 2009

Left ventricular (LV) performance was studied in young patients with severe chronic anemia due to β‐thalassemia major, intermedia, and in healthy control subjects. M‐mode echocardiograms were recorded in each patient and semiautomatic computerized analysis of the tracings provided data relating to LV performance. Then a statistical analysis of the difference between each specific thalassemic group and the normal subjects was made using Student's t‐test for unpaired data. The study showed that cardiac dysfunction is more serious in major than in intermediate β thalassemia. A follow‐up one year later showed a progressive deterioration of the cardiac indices, in spite of treatment with desferrioxamine. A handgrip test was performed in the follow‐up study, which permitted us to distinguish different groups relative to the changes in LV performance indices. Our findings indicate that echocardiography provides a simple noninvasive means for assessing changes in the cardiac structure and function, which should also prove useful in the serial evaluation of patients at risk of developing myocardial iron deposition.