bluuebunny/crossref_metadata_2025 huggingface dataset:
Antecedent Aspirin Therapy Inhibits Baseline Platelet Activity in Patients Presenting with Acute Myocardial Infarction
Authors: Serebruany Victor L. , Bahr Raymond D. , O’Connor Christopher M. , Lowry David R. , Gurbel Paul A.
Published: April 2003

Aspirin therapy and platelet inhibition reduce the risk for the development of acute myocardial infarction (AMI). However, the effects of aspirin on baseline platelet activity in patients presenting with AMI are not known. We determined the effect of long-term aspirin use on baseline platelet activity in patients presenting with AMI, enrolled in the GUSTO-III Platelet Study. Platelet characteristics were investigated by aggregometry, flow cytometry and enzyme-linked immunosorbent assay in 23 patients before thrombolysis. Sixteen AMI patients were aspirin free, and 7 patients were using aspirin (81–500 mg/daily). The aspirin-treated patients exhibited a mild but consistent reduction of platelet activity which reached significance for 5 µM (p = 0.02), and 10 µM (p = 0.01) adenosine diphosphate induced aggregation. The surface expression of P-selectin (p = 0.02) and PECAM-1 (p = 0.03) and the plasma level of soluble P-selectin (p = 0.02) were also reduced. As previously observed in normal humans and patients with stable coronary artery disease, long-term aspirin therapy is also associated with diminished platelet activation in patients presenting with AMI. Long-term aspirin therapy mildly reduces baseline platelet activity; however, this degree of relative platelet inhibition does not appear to be cardioprotective.
Decreased Levels of β-Endorphin in Circulating Mononuclear Leukocytes from Patients with Acute Myocardial Infarction
Authors: Buratti Thomas , Schratzberger Peter , Dunzendorfer Stefan , Manfreda Susanne E. , Pechlaner Christoph , Joannidis Michael , Sacerdote Paula , Panerai Alberto E. , Wiedermann Christian J.
Published: April 2003

Lymphocytes can be activated to produce and release opioid peptides. We investigated the levels of immunoreactive β-endorphin in peripheral blood mononuclear cells from 11 patients with acute myocardial infarction. The concentrations of β-endorphin in mononuclear leukocytes of 30.2 ± 6.9 pg/106 cells on admission were in the normal range of 20–40 pg/106 cells and decreased significantly to 6.9 ± 1.9 pg/106 cells after 48 h (p < 0.05). Decreased levels of mononuclear leukocyte-associated β-endorphin in acute myocardial infarction may be due to the release of endogenous opioid after stimulation by stress and acute-phase reactants and play a role in inflammation and pain.
Directional Coronary Atherectomy in Acute Myocardial Infarction
Authors: Dangas George , Mehran Roxana , Duvvuri Srinivas , Vidhun Raghuraman , Ambrose John A. , Sharma Samin K.
Published: April 2003

Balloon angioplasty (percutaneous transluminal coronary angioplasty, PTCA) is an established common strategy in the treatment of acute myocardial infarction (MI) with high success rates but a 5–10% incidence of reclosure/reinfarction due to thrombus and/or intimal flaps. Directional coronary atherectomy (DCA) by removing plaque/thrombus and achieving larger postprocedural luminal diameter may further decrease the incidence of reclosure/reinfarction, with a resultant better in-hospital outcome in this setting. We analyzed the clinical, procedural and in-hospital outcome of patients who underwent DCA or PTCA within 48 h of MI. Long lesions (>20 mm), large angiographic intracoronary thrombus, lesions in a bend, heavy calcification, and vessel diameter <3.0 mm were excluded from the study. Although slow flow occurred more frequently during DCA (17 vs. 9% during PTCA, p = 0.04), procedural success (<50% final diameter stenosis with TIMI-3 flow) was achieved in 96% of DCA and 92% of PTCA group (nonsignificant). Acute closure occurred in 9% of the PTCA group versus 2% of the DCA (p = 0.05), and the composite endpoint of in-hospital reinfarction, reintervention, bypass surgery or death was present in 9% of PTCA cases versus none of DCA cases (p = 0.03). There were no major peripheral vascular complications requiring surgery in either group. Therefore, DCA appears safe and effective in selected patients with recent MI, and is associated with a low incidence of major clinical complications.
Low Prevalence of Hepatitis C Virus Antibodies and RNA in Patients with Myocarditis and Dilated Cardiomyopathy
Authors: Grumbach Isabella M. , Heermann Klaus-Hinrich , Figulla Hans R.
Published: April 2003

We investigated the prevalence of hepatitis C virus in patients with dilated cardiomyopathy (DCM) and myocarditis in comparison to a control group of patients suffering from noninflammatory cardiac diseases such as aortic stenosis. In contrast to the results of previous studies on small numbers of patients, no significant difference in the prevalence of hepatitis C infections was observed. Our data suggest that HCV is not an important causal agent for myocarditis and DCM.
Morphometric and Histologic Assessment of Remodeling Associated with Restenosis after Percutaneous Transluminal Coronary Angioplasty
Authors: Nakamura Yoichi , Zhao Hong , Yutani Chikao , Imakita Masami , Ishibashi-Ueda Hatsue
Published: April 2003

The role of remodeling in restenosis of coronary arteries on which percutaneous transluminal coronary angioplasty (PTCA) had been performed was investigated. At autopsy, presence (n = 6) or absence of restenosis (n = 5) based on the cross-sectional area of stenosis was determined in 11 coronary lesions. Remodeling was defined as a ratio of the artery area at the PTCA site to that at the reference site of <1.0. According to this definition, remodeling had occurred in all of the lesions in the restenosis group, and in only 1 lesion in the group with no restenosis which had the least residual plaque (p < 0.05). Dense caps of collagen fibers in the adventitia in the vicinity of the disrupted internal elastic laminae were present in all of the remodeling lesions. We suggest that remodeling, which results in adventitial scarring, is one of the major causative factors of restenosis.
Transmyocardial Revascularization with Holmium Laser
Authors: García Corrales Francisco , García-Rubira Juan C. , Font J. Ignacio , Berjillos Mariano , de la Mata Manuel , Clavero Javier , Cruz José M. , Infantes Carlos A.
Published: April 2003

Sixteen patients with angina refractory to medical therapy who were not considered suitable for standard revascularization underwent transmyocardial revascularization with holmium laser. The average age of the patients was 63.2 ± 10.5 years. All of them had angina class 3 or 4, and 9 (56%) had previously undergone an aortocoronary bypass grafting. Four patients died during the 6-month follow-up period (25%). Among the survivors, anginal class decreased to class 2 or 1 at the 6th month (p = 0.002). Ejection fraction did not change. The ischemic burden by Holter decreased from 85.3 ± 656 to 5.5 ± 9.7 min (p = 0.046). Myocardial perfusion with 201Tl single photon emission computed tomography (SPECT) images at rest and after dipyridamole showed a significant improvement among the ischemic treated segments (p = 0.015). Baseline ejection fraction was somehow lower in nonresponsive than in responsive patients (33 ± 13 vs. 49 ± 10, p = 0.052). We conclude that transmyocardial laser revascularization with holmium laser is effective in treatment in ischemic patients not amenable to surgery or percutaneous procedures, as previously reported with CO2 laser. Further investigation is needed to determine which clinical profiles identify the patients for whom this therapy is suitable.
Impact of Early Risk Stratification on the Length of Hospitalization in Patients with Acute Q-Wave Myocardial Infarction
Authors: Schuster Stefan , Koch Armin , Schiele Rudolf , Burczyk Udo , Wagner Stefan , Zahn Ralf , Rustige Jörg , Limbourg Peter , Gülker Hartmut , Senges Jochen
Published: April 2003

An assessment of individual risk factors may identify a subgroup of postinfarction patients at low risk, i.e. patients appropriate for early discharge. Using a large unselected population of the national registry, ‘The 60-Minutes Myocardial Infarction Project’, we (1) attempted to provide a retrospective analysis of clinical factors and in-hospital mortality in a population living on the 6th hospital day following admission to define a low-risk patient group with a residual in-hospital mortality of less than 1% eligible for early discharge, and (2) to analyze the current impact of risk stratification based on these clinical factors on the length of hospitalization. The study group consisted of 12,045 survivors on the 6th day after admission out of 14,980 patients of the registry with proven Q-wave myocardial infarction. Risk modeling was performed with multiple logistic regression. Results: A total of 873 patients (7.3%) died after day 6 in hospital. The most important prognostic factors were cardiopulmonary resuscitation prior to admission (odds ratio, OR: 7.2, confidence interval, CI: 5.11–10.22), thrombolysis complicated by severe bleedings (OR: 6.2, CI: 1.2–31.2) and age >70 years (OR 4.7, CI 3.51–6.39). The other more significant independent predictors of increased mortality were end-stage renal disease, age between 56 and 70 years, systolic blood pressure <95 mm Hg on admission, history of trauma ≤2 months, cancer and left-bundle-branch block. Summarizing these nine groups of patients with the strongest association to in-hospital mortality, we defined a high-risk group comprising 79% of the AMI patients with a residual in-hospital mortality of 8.8%. On the other hand, by excluding these nine high-risk patient groups, a low-risk group of 21% of all AMI patients seems to be appropriate for early discharge (residual in-hospital mortality = 1.07%). However, in the current practice, there was no difference regarding the median length of hospital stay between the two risk groups. The low-risk patients were hospitalized 20 days compared to 22 days in the high-risk patients. Conclusion: Using a simple logistic regression model, which considers clinical factors of the early hospital phase, one fifth of the infarction patients can be stratified to be at low risk, and might be eligible for early hospital discharge. Currently, an individual risk stratification has no impact on the length of hospital stay in Germany.
Apolipoprotein A1 Gene Polymorphisms and Risk of Early Coronary Disease
Authors: Reguero Julián R. , Cubero Gustavo Iglesias , Batalla Alberto , Alvarez Victoria , Hevia Sergio , Cortina Arturo , Coto Eliecer
Published: April 2003

Genetic studies have identified polymorphisms at the apolipoprotein (Apo) A1 gene associated with HDL cholesterol and apolipoprotein levels, and a relationship between the severity of coronary artery disease and polymorphisms at the 5′-end of Apo A1 has been also reported. This study was designed to examine the relationship between polymorphism at the Apo A1 gene and the risk of early coronary artery disease. Furthermore, the association of the polymorphism with the classical risk factors was analyzed. A total of 176 male patients (mean age 43 ± 5 years) diagnosed as having unstable angina (53 cases) or myocardial infarction (123 cases) were prospectively evaluated. Data referring to hypertension, diabetes and tobacco consumption were recorded. The levels of total cholesterol, HDL cholesterol, Apo A1 and B and triglycerides were determined. DNA was obtained from the 176 patients and from 200 controls. In order to determine the Apo A1 genotypes at two polymorphic sites (G/A at –75 bp, and C/T at +83 bp), DNA was PCR amplified and digested with MspI. The frequency of carriers of the rare allele at the –75 bp site (M1–) was 0.34 in cases and 0.24 in controls (p < 0.05). The frequencies of the M1– allele among patients with angina and myocardial infarction were 0.43 (p = 0.009, angina vs. controls) and 0.30, respectively. No significant association between this polymorphism and other cardiovascular risk factors was found. No difference in the frequencies for carriers of the rare allele at the +83-bp polymorphism (M2) was observed among patients with angina (0.08 vs. 0.07) or myocardial infarction (0.04 vs. 0.07), and no association between this polymorphism and tobacco, hypertension and diabetes was noted. Patients carrying the rare M2– allele had a lower concentration of total cholesterol compared to those without this allele (183 ± 29 vs. 223 ± 54, p < 0.04) and HDL cholesterol was also lower among patients carrying the M2– (26 ± 4 vs. 33 ± 9, p < 0.02). In our community male patients with a diagnosis of coronary artery disease and age less than 50 years showed a higher frequency of the M1– allele at the –75-bp site of the Apo A1 gene. There was a significant increase in the frequency of the M1– allele in patients with unstable angina and no association with risk factors. In the +83-bp polymorphism there was no difference in the allelelic frequencies or the risk factors, except for the HDL cholesterol and total cholesterol where the patients with the allele M2– had lower levels than those homozygous for the M2+.
Pacemaker-Related Endocarditis
Authors: Laguno Montserrat , Miró Óscar , Font Carme , de la Sierra Alejandro
Published: April 2003

We report on 7 patients with pacemaker endocarditis diagnosed during the workup of long-standing fever. Persistent positive blood cultures and echocardiography led to the diagnosis in 6 patients whereas autopsy was diagnostic in another. Causative microorganisms were Staphylococcus epidermidis (3), Staphylococcus lugdunensis (1), Pseudomonas aeruginosa (1), Streptococcus bovis (1), and Streptococcus mitis-Streptococcus sanguis (1). Pulmonary embolism was present in nearly 50% of the cases, a figure clearly higher than previously reported. In all but 1 case the initial medical approach was not successful, and thus the pacing system was finally removed. None of the cases relapsed after the removal. We have reviewed the literature regarding pacemaker endocarditis, particularly with respect to treatment.
Early Development of High-Degree Atrioventricular Block in Inferior Acute Myocardial Infarction Is Predicted by a J-Point/R-Wave Ratio above 0.5 on Admission
Authors: Solodky Alejandro , Assali Abid , Herz Itzhak , Hasdai David , Kusniec Jairo , Sulkes Jaqueline , Sclarovsky Samuel , Birnbaum Yochai
Published: April 2003

This study assessed the ability of simple clinical and electrocardiographic (ECG) variables routinely obtained on admission to identify patients with inferior myocardial infarction who are at high risk of developing high-degree atrioventricular (AV) block within the first 24 h of hospitalization in 205 patients. The admission ECGs were classified into two patterns based on the J-point to R-wave amplitude ratio: pattern 1: those with J-point/R-wave ratio <0.5; pattern 2: patients with J-point/R-wave ratio ≥0.5 in ≥2 inferior leads (II, III and aVF). High-degree AV block was found in 10.2% of the patients (21 of 205 patients; 5 and 16% of the patients with initial patterns 1 and 2, respectively, p = 0.014). Multivariate logistic regression analysis revealed that the only variables independently associated with high-degree AV block were the initial ECG pattern 2 versus 1 (odds ratio, OR, 4.47, 95% confidence interval, CI, 1.18–16.9; p = 0.0276), age (OR 1.06, 95% CI 1.01–1.12; p = 0.0254); Killip class >1 (OR 2.33, CI 0.83–6.54; p = 0.1065) and thrombolytic therapy (OR 0.32, 95% CI 0.11–0.93; p = 0.037).
Aortic Stenosis and Coronary Artery Disease Caused by Alkaptonuria, a Rare Genetic Metabolic Syndrome
Authors: Vavuranakis Manolis , Triantafillidi Helen , Stefanadis Christodoulos , Toutouzas Pavlos
Published: April 2003

Alkaptonuria is a rare metabolic disease in which homogentisic acid deposits occur in various body tissues. We present a case of alkaptonuria which resulted in aortic stenosis and coronary artery disease due to homogentisic acid deposition.
Effect of Isosorbide-5-Mononitrate on Exercise Performance and Clinical Status in Patients with Congestive Heart Failure
Authors: Lewis Basil S. , Rabinowitz Babeth , Schlesinger Zwi , Caspi Abraham , Markiewicz Walter , Rosenfeld Tiberio , Sclarovsky Samuel , Ermer Wolfgang
Published: April 2003

Background and Aims: Nitrate therapy improves hemodynamics in patients with heart failure, but the chronic effects of oral nitrates on exercise performance and clinical status have not been well studied. Methods: Oral isosorbide-5-mononitrate (ISMN) (50 mg once daily) or placebo was administered to 136 patients (NYHA Class 2–3) treated for heart failure, all receiving captopril and most also furosemide. Endpoints were treadmill exercise time at 12 weeks by modified Naughton protocol (primary), with an additional 12-week follow-up period. Secondary endpoints included left ventricular dimensions, ejection fraction, cardiothoracic ratio, functional class, quality of life, hospitalizations and plasma norepinephrine and atrial natriuretic peptide in a four-center substudy. Results: Intention-to-treat analysis showed that mean change in treadmill exercise duration tended to be greater in patients receiving ISMN than placebo (treatment difference +42 s, 95% CI –5, +90 s at 12 weeks and +21 s, 95% CI –25, +74 s after 24 weeks) (NS). Treatment difference was greater in the prespecified subgroup with ejection fraction 31–40% (+55 s, 95% CI –11, +136 s at 12 weeks and +65 s, 95% CI +3, +147 s) (p = 0.035) at 24 weeks. No deleterious effects (i.e. hypotension) were observed with ISMN, although headache was reported in 19% of the active treatment group (p = 0.0001). Conclusions: ISMN added to captopril increased treadmill exercise time in patients with heart failure and a lesser reduction in baseline ejection fraction, although for the group as a whole, the increase in treadmill time was not significant.
Detection of Björk-Shiley Convexo-Concave Heart Valve Outlet Strut Single Leg Separations: Consensus Image Acquisition and Interpretation Using Two Different Cineradiographic Imaging Technologies
Authors: Hopper Kenneth D. , Gilchrist Ian C. , Landis J. Richard , Localio A. Russell , Wilson Ronald P. , Pae Jr. Walter E. , Kunselman Allen R. , Griffith James W. , Pierce William S. , Potok Paul S. , TenHave Thomas R.
Published: April 2003

Background: Conventional cineradiology has been used clinically to detect partially broken outlet struts (single leg separations, SLSs) in normally functioning Björk-Shiley convexo-concave (C/C) heart valves. The value of radiographic screening has, however, been debated in the medical literature. This study uses the same radiographic technique in sheep implanted with known-status C/C valves in combination with a newly developed geometric image magnification radiography system. This study was designed to test whether sensitivity and specificity of radiographic screening of C/C valves in detecting SLSs could be improved through the combination of readers and imaging modalities. Methods: Twenty-one sheep with mitral C/C valves were studied on both systems. Five were used for extensive scanning training. When operators were expert on both systems, 16 blinded study valves (4 intact and 12 with outlet strut SLSs) were scanned twice on both systems, first on a modified conventional and then a prototype geometric image magnification (FeinfocusTM) cineradiographic system by two expert physicians working together. Results: Among the 32 scanned valves, the two combined expert physicians were required to evaluate 40 intact legs and 24 with an SLS. For all SLS valves, the conventional and Feinfocus systems separately detected 50 (12/24) and 54% (13/24), respectively. When the two systems were combined, the final consensus score was correct in 67% (16/24) of all SLS valves. Conclusions: Combined modality, paired expert physicians detected 67% of all SLSs. The Feinfocus system might be best reserved for those patients in whom the Siemens screening study demonstrates in minimally suspicious (grade 2) or suspicious (grade 3) appearance of a C/C valve outlet strut leg.
Antihyperglycemic Treatment in Diabetics with Coronary Disease: Increased Metformin-Associated Mortality over a 5-Year Follow-Up
Authors: Fisman Enrique Z. , Tenenbaum Alexander , Benderly Michal , Goldbourt Uri , Behar Solomon , Motro Michael
Published: April 2003

Mortality rates are considerably higher in chronic ischemic heart disease (IHD) patients with non-insulin-dependent diabetes mellitus (NIDDM) than in those who are nondiabetics. The relationship between different types of antihyperglycemic pharmacological therapy and mortality rate in this NIDDM population is uncertain. We aimed to examine the survival in NIDDM patients with IHD using various types of oral antidiabetic treatments over a 5-year follow-up period. The study sample comprised 11,440 patients with a previous myocardial infarction and/or stable anginal syndrome, aged 45–74 years, who were screened, but not included in the Bezafibrate Infarction Prevention study. Among them, 9,045 were nondiabetics and 2,395 diabetics. The diabetic patients were divided into four groups on the basis of their therapeutic regimen at screening: diet alone (n = 990), sulfonylureas (n = 1,041), metformin (n = 78) and a combination of a sulfonylurea and metformin (n = 266). All NIDDM groups were similar with regard to age, gender, hypertension, smoking, heart failure, angina and prior myocardial infarction. Crude mortality rate was lower in the nondiabetic group (11.21 vs. 21.8%; p < 0.001). In the diabetic group, mortality was 18.5% for patients on diet alone, 22.5% for those on sulfonylureas, 25.6% for patients on metformin, and 31.6% for the combined sulfonylurea/metformin group (p < 0.01). When analyzing age-adjusted mortality rate and actuarial survival curves, the lowest mortality was found in patients on diet alone and the highest in patients on metformin (alone or in combination with sulfonylureas). After adjustment for variables connected with long-term prognosis, the use of metformin was associated with increased relative risk (RR) for all-cause mortality of 1.42 (95% CI 1.10–1.85), whereas the use of sulfonylureas alone was not [RR 1.11 (95% CI 0.90–1.36)]. NIDDM patients with IHD using metformin, alone or in combination with sulfonylureas, exhibited a significantly increased mortality. Until the results of problem-oriented prospective studies on oral control of NIDDM will be available, alternative therapeutic approaches should be investigated in these patients.
Bradycardia, Reversible Panconduction Defect and Syncope following Self-Medication with a Homeopathic Medicine
Authors: Guha Santanu , Dawn Buddhadeb , Dutta Goutam , Chakraborty Tapas , Pain Shantashil
Published: April 2003

Alkaloid extracts from the plant Aconitum species have been used in various forms of herbal remedies predominantly as anti-inflammatory and analgesic agents. Many of these alkaloids are extremely potent cardiotoxins and documented cases of various arrhythmias with fatal outcomes have been reported. We report a case of self-medication with ‘tincture of aconite’ resulting in severe bradycardia, reversible panconduction defect evidenced by sinus inactivity, atrioventricular dissociation with idiojunctional rhythm and left bundle branch block pattern resulting in hypotension and syncope. Complete reversal of ECG findings with marked improvement in symptoms was noted within a few hours. Herbal medicines containing aconite alkaloids may result in severe cardiotoxicity, and strict regulatory measures are warranted to curb unsupervised use for therapeutic purposes.
Fixed Subaortic Stenosis Revisited
Authors: Tentolouris Konstantinos , Kontozoglou Theodosios , Trikas Athanasios , Brilli Styliani , Chlapoutakis Emanouel , Exadactylos Nikolaos , Pitsavos Christos , Toutouzas Pavlos
Published: April 2003

Seventy-two patients aged 2–65 years (mean 20.2) with fixed subaortic stenosis (FSS) are reported. All patients underwent echocardiography and angiography prior to surgical intervention. Sixty-four (89%) had discrete subaortic stenosis (DSS) and 8 (11%) tunnel type stenosis (TSS). Patients with DSS aged 2–65 years (mean 29) while patients with TSS aged 10–34 years (mean 19) and had a distinct female preponderance (7:1). Twenty-five patients (39%) with DSS had other congenital abnormalities of which aortic stenosis associated with bicuspid aortic valve was slightly more common than ventricular septal defect (7:6). Five patients with TSS had a small aortic annulus and hypoplastic aorta. Our data and those in the literature indicate that TSS although related to DSS has certain features that may set it apart as a distinct entity. In addition DSS appears to be associated with aortic stenosis and bicuspid aortic valve as frequently as with ventricular septal defect.
Cholesterol Paradox in Patients with Paroxysmal Atrial Fibrillation
Authors: Annoura Miyuki , Ogawa Masahiro , Kumagai Koichiro , Zhang Bo , Saku Keijiro , Arakawa Kikuo
Published: April 2003

Hypercholesterolemia is a major risk factor for coronary heart disease (CHD), but the associations among lipids, lipoproteins and paroxysmal atrial fibrillation (PAF) have not yet been reported. The associations among lipids, lipoproteins and PAF were examined in a case-control study, in which cases and controls were defined as those with/without definite ECG-detectable PAF, respectively. CHD patients were excluded from the study. The mean values of serum total cholesterol (TC), triglyceride (TG) and high density lipoprotein-cholesterol (HDL-C), after adjusting for age and gender, in patients with PAF were lower than those in patients without PAF (175 ± 4 mg/dl vs. 190 ± 3 mg/dl, 104 ± 7 mg/dl vs. 123 ± 6 mg/dl, 46.0 ± 1.7 mg/dl vs. 51.8 ± 1.4 mg/dl, respectively), as assessed by an analysis of covariance. After controlling for age and gender, TC, TG and HDL-C (all in quartiles) were inversely and linearly (p < 0.05) associated with the percentage of patients with PAF, as assessed by a multiple logistic regression analysis. The associations between TC or TG and PAF varied with the HDL-C level: significant when HDL-C was low (p < 0.05), but not when HDL-C was high. The odds ratio (relative risk of PAF) for patients with both low TC or TG and low HDL-C was 4.08 (95% CI: 1.81–9.57) times or 9.40 (3.25–32.0) times higher (p < 0.01) than that for patients with high TC or TG and high HDL-C, respectively. In conclusion, low serum levels of TC and TG were found in PAF patients, while reduced HDL-C may cause PAF. Hypolipoproteinemia including low HDL-C may affect atrial vulnerability and cause atrial fibrillation.
Outcome of Patients with Malignant Hypertension and End-Stage Renal Failure Treated by Long-Term Hemodialysis
Authors: De Lima José Jayme Galvão , da Fonseca João Américo , Godoy Anibal , Bortolotto Luis Aparecido , Krieger Eduardo M.
Published: April 2003

Malignant hypertension is associated with high mortality and morbidity usually caused by cardiovascular events. The course and prognosis of malignant hypertension patients treated with renal replacement therapy has not been thoroughly investigated. In the present work, we compared the clinical evolution and survival of 24 end-stage renal failure malignant hypertension patients with that of a group of individually matched renal failure patients admitted to the same dialysis center during a period of 21 years. Survival rates at 1, 5 and 8 years were 87, 82 and 50% for malignant hypertension patients and 87, 75 and 65% for controls, respectively (p = 0.766, NS). Nonfatal cardiovascular complications occurred in 2 individuals of each group. The most important cause of death in both groups was cardiovascular. The frequency of fatal cardiovascular events was similar in the two groups: 64% of deaths for malignant hypertension and 71% for controls (NS). In conclusion, previous malignant hypertension did not increase the risk of patients in long-term hemodialysis in our series.
Pearls and Pitfalls in the Use and Abuse of Diuretics for Chronic Congestive Heart Failure
Authors: Constant Jules
Published: April 2003

The main purpose of using diuretics is usually lost sight of, i.e. it is for the relief of dyspnea by using the least amount of a diuretic. The production of a low output state and hypercoagulation in an attempt to achieve dry weight by lowering blood volume excessively are among the hazards of using more diuretic than is absolutely necessary to achieve the goal of relieving dyspnea. The use of jugular venous pressure measurement and the status of dyspnea should have precedence over body weight in determining diuretic dose adjustment. Often forgotten in using diuretics is that potassium without magnesium will not enter cells and that the almost universal preference for furosemide over thiazides threatens to increase the incidence of osteoporosis. Also, the tendency to ignore loss of the water-soluble vitamins thiamine and ascorbic acid may result in refractory edema and the inability to manage the stresses of congestive heart failure.
Role of Coronary Angiography in Myxoma Patients: A 14-Year Experience in One Medical Center
Authors: Li Ai-Hsien , Liau Chiau-Suong , Wu Chau-Chung , Chien Kuo-Liong , Ho Yi-Lwun , Huang Chieng-Hua , Chen Ming-Fong , Lee Yuan-Teh
Published: April 2003

Cardiac myxoma is the most common form of primary heart tumor and often treated with surgical resection without a preoperative angiographic examination for fear of potential risk of sudden death. During the last 14 years, 24 of 38 patients with myxoma underwent coronary angiography. Coronary artery disease (CAD) and other abnormalities were found in 5. Our findings indicated that CAD is not uncommon among the myxoma patients, and coronary angiography should be performed preoperatively in all cases.
Clinical Utility of Available Methods for Determining Platelet Function
Authors: McKenzie Marcus E. , Gurbel Paul A. , Levine Douglas J. , Serebruany Victor L.
Published: April 2003

Determination of platelet function has become increasingly important as new antiplatelet drugs are being developed. Objective means to monitor the pharmacological effects of these agents, in order to maximize efficacy and minimize toxicity, is needed. The available methods for determination of platelet function at the current time are reviewed, including platelet aggregometry, the PFA-100, flow cytometry, platelet contractile force, the rapid platelet function assay, the clot signature analyzer, Sonoclot, and thromboelastography. The principle, advantages, disadvantages, and clinical utility of each method is presented. The uses of the various methods of determining platelet function reported in the literature are summarized, in an effort to provide information regarding the applicability of those different methods.
Elevated Cardiac Troponin Levels Do Not Predict Adverse Outcomes in Hospitalized Patients without Clinical Manifestations of Acute Coronary Syndromes
Authors: Barasch Eddy , Kaushik Vinod , Gupta Richa , Ronen Pinky , Hartwell Beth
Published: April 2003

The prognostic significance of elevated cardiac troponin levels (CTL) in hospitalized patients with no other evidence of myocardial ischemia or injury is largely unknown. Fifty patients (mean age 61 ± 15 years, 15 women) out of 580 consecutive hospitalized patients were selected based on normal CK-MB and at least 3-fold increase of CTL. The medical charts of these patients were reviewed and a 1-year follow-up was performed. The most frequent admission diagnoses were exacerbation of congestive heart failure (22%), stroke (20%) followed by respiratory failure (6%), cirrhosis (6%), gastrointestinal bleeding (6%), end-stage renal disease (4%), atrial fibrillation (4%) and metastatic malignancies (4%). Abnormal CTL prompted a cardiology consult in 48% of patients, an echocardiogram in 44%, myocardial perfusion study in 10% and coronary angiography in 1 patient. Of 21 deaths, only 1 was related to an acute coronary event. The measurement of CTL in patients without definite clinical or electrocardiographic evidence of myocardial ischemia and with a wide spectrum of clinical diagnoses does not predict in-hospital and at 1 year cardiovascular complications and/or cardiac death.
Increased Urinary Cortisol and Androgen Metabolites in a Young Female with Hypertension: Partial Glucocorticoid Resistance Syndrome
Authors: Shamim Waqar , Bakhai Ameet , Yousufuddin Mohammed , Coats Andrew J.S.
Published: April 2003

A 21-year-old woman with hypertension confirmed on ambulatory blood pressure monitoring and unresponsive to β-blockers, diltiazem and amiloride was found to have serum potassium, renin and aldosterone levels at or just below the lower end of normal. Urinary glucocorticoid metabolite analysis revealed high excretion of cortisol and androgen metabolites, with normal serum cortisol levels. This pattern suggests a partial glucocorticoid resistance syndrome; such patients are more responsive to ACE inhibitors and spironolactone.
Phenotypic Variation of Familial Hypertrophic Cardiomyopathy Caused by the Phe110→Ile Mutation in Cardiac Troponin T
Authors: Lin Tong-Lang , Ichihara Sahoko , Yamada Yoshiji , Nagasaka Tetsuo , Ishihara Hitoshi , Nakashima Nobuo , Yokota Mitsuhiro
Published: April 2003

Mutation of the cardiac troponin T (cTnT) gene is a genetic determinant of familial hypertrophic cardiomyopathy (HCM). A Japanese family of 14 individuals, including 6 with HCM, was subjected to genetic and clinical assessment. Five exons of the cTnT gene were sequenced in all family members. A heterozygous or homozygous T340→A (Phe110→Ile) mutation in exon 9 of the cTnT gene was detected in 11 subjects. Morphological and functional evaluation of the left and right ventricles by echocardiography revealed that 4 of 9 individuals heterozygous for the mutant allele exhibited HCM with moderate cardiac hypertrophy. Cardiac hypertrophy and other clinical features in the 2 subjects homozygous for the mutation were more severe than were those in heterozygous individuals with HCM. Thus, the clinical features of HCM due to the Phe110→Ile mutation in the cTnT gene appear to be modified by a gene dosage effect.
Prognostic Value of Ischemia Monitoring with On-Line Vectorcardiography in Patients with Unstable Coronary Artery Disease
Authors: Lundin Peter , Jensen Jens , Lindahl Bertil , Wallentin Lars , Eriksson Sven V.
Published: April 2003

Aim: The aim of this study was to determine whether on-line vectorcardiography (VCG) gives independent prognostic information, regarding death, myocardial infarction (MI), and revascularization in patients with unstable coronary artery disease, i.e. unstable angina or non-Q-wave MI. Methods and Results: One hundred and fifty patients (mean age 69 ± 10), participating in a randomized study of low-molecular-weight heparin in unstable coronary artery disease, were studied with on-line VCG recordings for 24 h. During a 5–6-month follow-up, 11 patients died, 14 suffered a nonfatal MI and 31 were revascularized. Univariate predictors of death were diabetes mellitus (p < 0.01), maximum ST vector magnitude (ST-VM; p < 0.001), maximum ST change vector magnitude (STC-VM; p < 0.001), number of ST-VM (p < 0.01) and STC-VM episodes (p < 0.001). In multivariate analysis, the number of STC-VM episodes (p < 0.01) and diabetes mellitus (p < 0.02) each gave independent prognostic information regarding death. When all cardiovascular events were combined, the inhability to perform an exercise test (p < 0.05), maximum value of ST-VM (p < 0.01) and STC-VM (p < 0.001), the number of episodes of STC-VM (p < 0.001) and ST-VM (p < 0.001) all gave prognostic information. In multivariate analysis, the inability to perform an exercise test and the number of STC-VM episodes were independent predictors. Conclusion: VCG monitoring during the first 24 h of hospitalization for unstable coronary artery disease gives independent prognostic information.
Evolution of Left Ventricular Involvement in Arrhythmogenic Right Ventricular Cardiomyopathy
Authors: Horimoto Masashi , Akino Masatoshi , Takenaka Takashi , Igarashi Keiichi , Inoue Hitoki , Kawakami Yoshikazu
Published: April 2003

Left ventricular (LV) involvement in arrhythmogenic right ventricular cardiomyopathy (ARVC) is fairly well known, but the evolution of LV involvement during long-term follow-up has not been well documented. We describe such evolution in a patient followed for 9 years. Evolution was confirmed by a progressive perfusion defect of the LV wall in myocardial scintigrams and by the development of LV asynergy with ventricular aneurysm formation in left ventriculograms. As the right ventricle progressively enlarged, we concluded that ARVC is a diffuse and progressive myocardial disease that affects both ventricles.
Exercise-Induced ST Segment Elevation in Q Wave Leads in Postinfarction Patients: Defining Its Meaning and Utility in Today’s Practice
Authors: Gussak Ihor , Wright R. Scott , Kopecky Stephen L. , Hammill Stephen C.
Published: April 2003

Most attempts to identify qualitative and quantitative techniques for assessing myocardial viability and the likelihood of improved function after revascularization in patients with healed myocardial infarcts have focused on treatment strategies and prognosis. This review examines the true value of the electrocardiographic phenomenon of exercise-induced ST segment elevation (EISTE) in Q wave leads as a diagnostic tool for the assessment of myocardial viability. The prognostic potential and clinical utility of the EISTE phenomenon are inhibited both by the heart’s electrophysiologic response to exercise-induced metabolic and hemodynamic changes, and by the ECG’s limited facility in assessing myocardial preservation. The use of EISTE as an independent indicator for surgical intervention is proscribed by these limitations. The EISTE phenomenon could serve as a useful tool in the first line of discrimination in patients with healed Q wave myocardial infarction, and may justify further diagnostic work-up in patients under consideration for a revascularization procedure. In the era of sophisticated nuclear and echo techniques, accurate imaging studies should not be replaced by ECG analysis alone in the search for viable tissue, except when financial costs are of major importance.
The Utility of Four Biochemical Markers in the Triage of Chest Pain Patients
Authors: Ellestad Myrvin H. , Startt-Selvester Ronald , Stanton Eric , VanNatta Bruce , Ahmad Javed , Gawad Yehia , Swiger Florence
Published: April 2003

Four biochemical markers, creatine kinase (CK)-MB isoenzyme, myoglobin, myosin light chains and troponin I, were studied in 1,338 patients presenting to the emergency department with chest pain suggestive of coronary artery disease (CAD). One hundred and eighty-seven patients had an acute myocardial infarction (MI). At least one of the four markers was over the threshold on the first sample in 78% of MI patients, as compared to only 40% with an elevated CK-MB. After 4 h, 88% had at least one marker elevated. None of the 69 patients with atypical chest pain, no history of CAD, no markers over threshold on the first sample and a normal electrocardiogram had an acute MI or unstable angina. If we had discharged this group, we would have saved USD 264,000, estimating a cost of USD 2,000 per day. Using four biochemical markers improved the early diagnosis of CAD and may help identify groups suitable for early discharge.
Effects of Spinal Cord Stimulation and Coronary Artery Bypass Grafting on Myocardial Ischemia and Heart Rate Variability: Further Results from the ESBY Study
Authors: Norrsell Henrik , Pilhall Martin , Eliasson Tore , Mannheimer Clas
Published: April 2003

In the present study, 24-hour ECG recordings were analyzed from the Electrical Stimulation versus Coronary Artery Bypass Surgery (ESBY) Study where spinal cord stimulation was compared to CABG (coronary artery bypass grafting) in selected patients with severe angina pectoris. During the monitoring period, the spinal cord stimulation was discontinued to evaluate possible long-term effects of this treatment. The number of ischemic episodes and the duration of ischemia decreased in the CABG group at the follow-up when compared to spinal cord stimulation (p < 0.05). In spite of this, the number of anginal attacks decreased (p < 0.0001) in both groups. The fact that the anginal symptoms decreased in the spinal cord stimulation group in spite of discontinued stimulation and lack of effects on ischemic ST changes could indicate a long-term primary analgesic effect of this treatment in addition to the well-documented acute anti-ischemic effect.
Treatment Benefit in the Enhanced External Counterpulsation Consortium
Authors: Lawson William E. , Hui John C.K. , Lang Gudrun
Published: April 2003

The present study utilized a cohort of 2,289 consecutive patients enrolled in the Enhanced External Counterpulsation (EECP) Consortium to evaluate whether results of university studies showing EECP safety and effectiveness in treating angina can be generalized. EECP was found to be safe and well tolerated with a 4.0% rate of adverse experiences. Angina class improved in 74% of patients with limiting angina (Canadian Cardiovascular Society, CCS, functional class II–IV), with patients most impaired at baseline demonstrating the greatest improvement (39.5% of patients in CCS III and IV improved 2 or more classes). Efficacy was independent of provider setting or experience, women responded as well as men, and although younger patients demonstrated a greater likelihood of improvement, EECP was effective in patients ranging from 19 to 97 years. Extending the benefit of EECP treatment to a wider range of patients may be indicated based on these findings.
Effects of a Slow-Release Nifedipine on 24-Hour Ambulatory Blood Pressure and Ischemic Changes on 24-Hour Ambulatory Electrocardiogram in Patients with Severe Coronary Artery Disease
Authors: Matsumoto Naomichi , Ideishi Munehito , Sasaguri Manabu , Nii Takanobu , Nakashima Yoshiyuki , Arakawa Kikuo
Published: April 2003

Calcium antagonists have long been used as first-line drugs for hypertension and angina. However, deleterious effects have also been reported in patients treated with calcium antagonists. Thus, we evaluated the effect of a slow-release twice-daily formulation of nifedipine in 10 patients with severe coronary artery disease. Twenty-four-hour ambulatory electrocardiography (AECG) and blood pressure monitoring (ABPM) were performed simultaneously to detect any association between ischemic episodes on the ECG and changes in blood pressure (BP) and heart rate with and without nifedipine. Increased oxygen demand due to an increased systolic BP and heart rate was associated with ischemic episodes without nifedipine, while those with nifedipine were accompanied by a fall in diastolic BP and a rapid increase in heart rate. This slow-release twice-daily formulation of nifedipine may induce myocardial ischemia through a heart-rate increase and a decrease in coronary blood flow due to lower diastolic BP in patients with severe coronary artery disease. A once-daily formulation of nifedipine might be of great value for such patients.
Isolated Left Ventricular Abnormal Trabeculation Is a Cardiac Manifestation of Neuromuscular Disorders
Authors: Stöllberger Claudia , Finsterer Josef , Blazek Gerhard
Published: April 2003

Objectives: Isolated left ventricular abnormal trabeculation (ILVAT) is defined as >3 coarse trabeculations of the left ventricular wall, apically to the papillary muscles, in hearts without congenital malformations. The aims of the study were to assess by echocardiography the prevalence of ILVAT, look for cardiac findings in ILVAT and find out if ILVAT is associated with neuromuscular disorders. Design and Results: In the course of 3 years, ILVAT was found in 15/17, 648 patients (0.08%). Twelve patients had heart failure, all had ECG abnormalities. All patients had neuromuscular disorders. A definite diagnosis could be established in 10 patients (metabolic myopathy, n = 9; Becker’s muscular dystrophy, n = 1). The remaining 5 patients refused further neurological investigations. Conclusions: ILVAT is a rare disorder associated with ECG abnormalities, heart failure and neuromuscular disorders, which is a reason why both cardiologists and neurologists should be involved.
Taxol Resistance
Authors: Sangrajrang Suleeporn , Fellous Arlette
Published: April 2003

Background: Taxol has gained considerable attention in cancer therapy in recent years and is successfully used in treating a variety of tumors, including those of the breast, ovary and lung. Despite its preclinical and clinical success, the ability of tumors to develop an acquired resistance to drugs used for treatment remains a major obstacle to cancer cure. A better understanding of the various mechanisms of Taxol resistance may have important implications for strategies designed for cancer treatment. Method: This review summarizes the information available to date concerning the effects of Taxol and the development of drug resistance, focusing particularly on alterations in microtubules. Results and Discussion: Acquired resistance to Taxol is a function of multiple adaptations. Although the cellular transport of Taxol appears to be an important mechanism of resistance to Taxol, altered transcription and posttranslational modification of microtubular changes may be involved in the mechanism of drug resistance.
Comparison of Epidermal Growth Factor and TransformingGrowth Factor-β1 Expression in Hormone-Induced Acute Pancreatitis in Rats
Authors: Konturek Peter Ch. , Dembinski Artur , Warzecha Zygmunt , Ihlm Astrid , Ceranowicz Piotr , Konturek Stanislaw J. , Stachura Jerzy , Hahn Eckhart G.
Published: April 2003

Overexpression of transforming growth factors (TGF) in acute pancreatitis (AP) suggested that these substances play an important role in pancreatic repair and remodeling but the contribution of epidermal growth factor (EGF), that is well known to promote cell growth and regeneration, has not been investigated. The aim of this study was to compare the gene and immunohistochemical expression of EGF and TGF-β1, cell proliferation, and biochemical parameters in AP induced by infusion of a supramaximal dose of caerulein in rats. The rats were sacrificed at 0, 12, 24, 48, 72 h, 5 and 10 days after the termination of caerulein infusion. Pancreatic tissue DNA synthesis, cell proliferation, histological and immunohistochemical assessments and plasma amylase were estimated following induction of AP. The mRNA expression for EGF and TGF-β1 was evaluated by reverse transcription-polymerase chain reaction. During 10 days of the study after induction of AP a gradual normalization of biochemical and histological parameters was observed. DNA synthesis and cell proliferation which were significantly decreased at 0 and 24 h, increased significantly at 48 and 72 h, and then gradually decreased reaching at day 10 the values similar to those of vehicle-treated control rats. In these control rats the EGF mRNA or immunohistochemical expression was not detected, while the TGF-β1 expression was weak. After induction of AP, the mRNA and immunohistochemical expression of EGF showed an increase during the initial 5 days, while those of TGF-β1 showed a marked increase between 0 and 48 h and then again at day 10. We confirm that: (1) the expression of TGF-β1 during AP is biphasic with an initial increase probably related to pancreatic damage and inhibition of cell proliferation and with the later phase of increase accompanied by the stimulation of the synthesis of extracellular matrix components and (2) AP is accompanied by an induction of synthesis of EGF that occurs in the initial phase of AP, probably limiting the extent of AP, and enhancing the stimulation of the pancreatic repair and regeneration.