bluuebunny/crossref_metadata_2025 huggingface dataset:
Electrocardiographic Changes Related to Parasympathetic Tone during Right Coronary Angioplasty
Authors: Nii Takanobu , Tsuchiya Yoshihiro , Shirai Kazuyuki , Arakawa Kikuo
Published: April 2003

The role of basal parasympathetic tone in reducing the heart rate and causing electrocardiographic (ECG) changes during right coronary angioplasty was evaluated in 19 patients with angina pectoris. To measure parasympathetic tone, time and frequency domain parameters of heart rate variability were assessed using 24 h of ambulatory ECG data recorded before angioplasty. There was an age-dependent reduction in heart rate. However, no parameters of heart rate variability were responsible for the changes in heart rate. In contrast, the degree of ST segment elevation during angioplasty correlated significantly with the high-frequency component of heart rate variability. Therefore, the increased parasympathetic tone, as assessed by spectral analysis, may augment the early ST segment elevation induced by right coronary occlusion.
Mortality and Risk Indicators for Death during Five Years after Acute Myocardial Infarction among Patients With and Without ST Elevation on Admission Electrocardiogram
Authors: Herlitz J. , Karlson B.W. , Bång A. , Sjölin M.
Published: April 2003

We related observations in the electrocardiogram (ECG) on admission to hospital among consecutive patients hospitalized in one single hospital with acute myocardial infarction (AMI) and related the prognosis during the following 5 years to these observations. Results: Of 863 patients, 63% had ECG signs of myocardial ischemia, but only 41% had ST elevation on ED admission. Patients with ST elevation had a 5-year mortality of 44% as compared with 58% in patients without ST elevation (p < 0.001). Patients with the highest mortality were those with a pathologic ECG including signs of previous AMI, bundle branch block and pacemaker ECG, but with no ECG sign of acute ischemia. Patients with the lowest mortality were those with a nonpathologic ECG on admission. Conclusion: Among consecutive patients hospitalized with AMI, less than half had ST elevation on admission to hospital. These patients had a lower mortality during 5 years of follow-up than patients without ST elevation.
Ergonovine-Testing-Directed Therapy and Long-Term Outcome of Sudden-Death Survivors withNo Apparent Heart Disease
Authors: Ritchie Michael E. , Hattemer Charles , Lenihan Daniel
Published: April 2003

Coronary artery vasospasm, the most common cause of sudden death in patients with structurally normal hearts, is not well recognized. We describe 2 survivors of sudden death with ergonovine-inducible coronary artery vasospasm successfully treated long term with calcium channel blockers. Of the reported (17 worldwide) patients with documented vasospasm-mediated sudden cardiac death treated with calcium blockers, none have had a recurrent event. This is substantially less than the 6-month sudden-death rate of 18% of untreated vasospasm. We advocate that ergonovine provocative testing of sudden-death survivors with structurally normal hearts, followed by appropriate therapy with calcium channel blockers, be the standard approach for these highly treatable patients.
Effects on Heart Rate Variability of Isosorbide-5-Mononitrate and Metoprolol in Patients with Recent Onset of Angina pectoris
Authors: Wennerblom Bertil , Lurje Leon , Westberg Staffan , Johansson Mats , Lomsky Milan , Vahisalo Rein , Hjalmarson Åke
Published: April 2003

Background: β-Blockers reduce sympathetic tone, increase vagal tone and improve prognosis in ischaemic heart disease. Nitroglycerin, being a vasodilator, may theoretically have an opposite effect and worsen the prognosis. The purpose of the present study was to analyse heart rate variability (HRV), which reflects autonomic tone, in angina patients on isosorbide-5-mononitrate (IS-5-MN) and/or metoprolol. Methods and Results: Thirty-two patients (32–81 years old), with recently developed angina (median duration: 3 months), showing no other disease and on no drugs, were Holter-monitored 24–48 h at baseline and after 4–5 days on IS-5-MN (mean daily dose: 33 mg), on metoprolol (mean daily dose: 184 mg) and on the combined treatment. Recordings were analysed on the Marquette Series 8000 Holter scanner. Both IS-5-MN and metoprolol significantly reduced myocardial ischaemia (ST integral) and ventricular tachycardias. Metoprolol induced significant changes in the following parameters (baseline versus metoprolol): high-frequency peak 9 ± 4 versus 11 ± 4 ms (p < 0.001), low-to-high frequency ratio 2.5 ± 0.6 versus 1.9 ± 0.6 (p < 0.0001), root mean square of RR interval difference 23 ± 7 versus 31 ± 9 ms (p < 0.0001), RR intervals differing more than 50 ms from the preceding one 4.8 ± 3.9 versus 10.0 ± 7.0% (p < 0.0001), mean of all 5-min standard deviations 50 ± 12 versus 56 ± 11 ms (p < 0.001) and mean RR interval 819 ± 90 versus 1,019 ± 120 ms (p < 0.00001). The combined treatment caused approximately the same HRV changes as metoprolol alone. IS-5-MN had no significant effect on any HRV parameter, neither alone nor in combination with metoprolol. Conclusion: A clinically effective dose of metoprolol had potentially positive effects on HRV with increase in vagal and decrease in sympathetic tone while IS-5-MN had no effect on HRV, neither positive nor negative, neither alone nor in combination with metoprolol.
Diffuse Narrowing of Coronary Arteries in Diabetic Patients: The Earliest Phase of Coronary Artery Disease
Authors: Mosseri Morris , Nahir Menachem , Rozenman Yoseph , Lotan Chaim , Admon Dan , Raz Itamar , Gotsman Mervyn S.
Published: April 2003

Coronary arteries in diabetic patients appear to be narrower than in normal subjects, but this has not been examined systematically. To investigate this hypothesis we reviewed the data of 711 consecutive patients with angiographically ‘normal coronary arteries’. Excluded were patients with valvular, myocardial or pericardial disease, and patients with hypertension or hyperlipidemia. Thirteen diabetic patients (10 men) and 22 nondiabetic persons (8 men) constituted the study and control groups, respectively. The diameters of the coronary arteries and their branches were measured and adjusted for body surface area. The sum of the proximal left anterior descending (LAD), circumflex and right coronary arteries (RCA) was calculated and defined as total coronary diameter (TCD). The sum of the distal LAD, first diagonal, first marginal and distal RCA was calculated and defined as total distal coronary diameter (dTCD). The clinical data of both groups were comparable. Adjusted TCD for body surface area was 5.4 ± 1.1 and 6.5 ± 1.1 mm/m2 (p < 0.05) in diabetics and nondiabetics, respectively, and adjusted dTCD was 4.9 ± 1.2 and 6.1 ± 1.2 mm/m2 (p = 0.01) in diabetics and normal subjects, respectively. Specific arteries and branches that were significantly smaller in diabetics included: left main coronary artery, distal LAD, first diagonal, proximal RCA, distal RCA, right ventricular branch, and posterolateral and posterior descending artery of RCA origin. Gender was not a confounding factor since the control group had a larger proportion of women and still larger arteries than the diabetic group. In conclusion, coronary arteries and their branches in diabetic patients have smaller diameters than normal subjects. This may be due to increased coronary tone, diffuse mild atherosclerosis or both.
The Effects of Antihypertensive Agents on Atherosclerosis-Related Parameters of Human Aorta Intimal Cells
Authors: Orekhov Alexander N. , Tertov Vladimir V. , Pivovarova Elena M.
Published: April 2003

Four antihypertensive agents – amlodipine, verapamil, propranolol and perindoprilat – were studied in human cell cultures. Antiatherogenic activity was investigated using uninvolved human aortic smooth muscle intima cells and atherogenic serum obtained from patients with coronary atherosclerosis. Amlodipine and verapamil significantly inhibited serum-induced increases in cholesterol content, cell-proliferative activity and protein synthesis in the cultured cells. Propranolol increased all three parameters, while perindoprilat had no effects. In addition, amlodipine and verapamil significantly lowered the intracellular cholesterol content of smooth muscle cells derived from atherosclerotic plaque and inhibited cell proliferation and protein synthesis. Propranolol increased all of these parameters, while perindoprilat produced no effects. The antiatherogenic and antiatherosclerotic actions of verapamil and amlodipine were confirmed in an ex vivo model. These studies demonstrated a beneficial antiatherosclerotic effect of amlodipine that was greater than that of verapamil. Perindoprilat had a neutral effect on atherosclerotic parameters, while the action of propranolol appeared to be potentially detrimental.
Diagnosis and Management of Partial Anomalous Pulmonary Venous Connection
Authors: Hijii Takayuki , Fukushige Junichiro , Hara Toshiro
Published: April 2003

Medical records, angiograms and operative records of 28 patients with partial anomalous pulmonary venous connection (PAPVC) were reviewed. Twenty patients had one anomalous pulmonary vein (APV), and 8 had more than two APVs. Twenty-five patients (89%) had APVs originating from the right lung, 2 (7%) from the left lung and 1 (4%) from both lungs. In the 25 patients with APVs originating from the right lung, 9 had APVs draining into the superior vena cava (SVC), 13 into the right atrium (RA), 1 into the inferior vena cava (IVC) and 2 into both the SVC and RA. In the 2 patients with APVs originating from the left lung, 1 had APVs draining into the RA, and the other had APVs draining into the innominate vein. The patient with APVs originating from both lungs had connection to the IVC. Twenty-three patients (82%) had additional cardiovascular defects. Surgery was performed in 13 patients who had pulmonary/systemic flow ratios greater than 2.0. The patients have done well after surgery. In 7 patients, we were unable to accurately determine the number or sites of drainage of APVs prior to surgery. We conclude that selective pulmonary angiography is indispensable for the accurate diagnosis of PAPVC.
Myocardial Turnover of Endogenous Opioids and Calcitonin-Gene-Related Peptide in the Human Heart and the Effects of Spinal Cord Stimulation on Pacing-Induced Angina Pectoris
Authors: Eliasson Tore , Mannheimer Clas , Waagstein Finn , Andersson Bert , Bergh Claes-Håkan , Augustinsson Lars-Erik , Hedner Thomas , Larson Göran
Published: April 2003

Earlier studies have shown that spinal cord stimulation (SCS) has antianginal and anti-ischemic effects in severe coronary artery disease. In the present study, 14 patients were subjected to right-sided atrial catheterization and atrial pacing. The patients were paced to angina during a control session and during spinal cord stimulation. Myocardial extraction of β-endorphin (BE) during control pacing (8 ± 22%) changed to release at the maximum pacing rate during treatment (–21 ± 47%, a negative value representing release). Furthermore, the results indicate local myocardial turnover of leuenkephalin, BE and calcitonin-gene-related peptide. In addition, it is implied that SCS may induce myocardial release of BE which could explain the beneficial effects in myocardial ischemia.
Clinical Application of Two Novel Rapid Bedside Tests for the Detection of Cardiac Troponin T and Creatine Kinase-MB Mass/Myoglobin in Whole Blood in Acute Myocardial Infarction
Authors: Lüscher Michael S. , Ravkilde Jan , Thygesen Kristian
Published: April 2003

The objective of this study was to determine whether two novel rapid bedside assays for whole-blood detection of cardiac troponin T and creatine kinase (CK)-MB mass/myoglobin could rule out or rule in acute myocardial infarction in patients with acute chest pain. Ninety-two patients with chest pain <12 h prior to admission were investigated. No difference in the cumulative sensitivity of the TropT test and the CARDIAC STATus test (CK-MB mass and myoglobin in combination) was found 6 h after admission (94 vs. 97%). The cumulative positive predictive value of the TropT test and CARDIAC STATus test 6 h after admission was 97 and 76%, respectively. The negative predictive value was 97% for the TropT test and 98% for the CARDIAC STATus test at this time point. Our data show that the rapid assays provide diagnostic as well as prognostic information shortly after admission.
Topographic Pattern of Advanced Atherosclerotic Lesions in Carotid Arteries
Authors: Khatibzadeh Mehran , Sheikhzadeh Abdolhamid , Gromoll Bernd , Stierle Ulrich
Published: April 2003

Ulcers in extracranial carotid arteries are a known source of cerebral embolism. However, there are no data available on the prevalence of ulcerations located at the origin of these vessels in the aortic arch. Therefore, in this pathological study the topographic distribution of ulcerated lesions were determined in these arteries. One hundred and one consecutively autopsied patients composed the study group. Ulcerated plaques were sought for in both carotid arteries, from their origin in the arch up to the carotid canal, and also in the aortic arch and ascending aorta. The two anatomical sites mostly affected by atherosclerosis were the region of the carotid sinus and the orifices of cervical arteries in the aortic arch. More than one third of all ulcers were at the orifices of cervical arteries in the arch. Interestingly, ulcers at the orifice of the left common carotid artery in the arch were accompanied with other ulcers located elsewhere in the remaining segments of the left carotid system, whereas ulcerations at the orifice of brachiocephalic trunk were not accompanied with other concomitant lesions in the right carotid system. Furthermore, there was no symmetric distribution of ulcerated plaques in both carotid systems.
Absence of a Seasonal Variation in Myocardial Infarction Onset in a Region without Temperature Extremes
Authors: Ku Chang-Sheng , Yang Chi-Yu , Lee Wen-June , Chiang Hung-Ting , Liu Chun-Peng , Lin Shoa-Lin
Published: April 2003

To evaluate whether the incidence of acute myocardial infarction (AMI) attack would have circadian, weekly and monthly variations in a subtropical area, 540 consecutive patients with AMI who were admitted to our coronary care units were analyzed. Six-hour intervals over 24 h, daily intervals in a week (7 days) and monthly intervals in a year (12 months) were studied, respectively. Results showed that there was a circadian variation in the onset of AMI with a morning (6 a.m. to noon) peak (34%, p < 0.01) but no secondary late evening (18–24 p.m.) peak. The incidence of AMI was significantly lower on Sundays (9%) than on the other weekdays (Monday through Saturday; p < 0.05). However, no monthly and seasonal variations in the incidence of AMI (no winter or summer peaks) were observed in this series. This study demonstrated a circadian variation in the onset of AMI attack with a predominant morning peak. The fewer AMI cases on Sundays compared to the other weekdays suggested that freedom from ‘stress’ or ‘work-load’ on Sundays might have an important impact on this low incidence of AMI. Unlike the large ranges in cold or hot weather found in temperate regions, the warm climate of a subtropical region does not affect the frequency of AMI.
Physical Exercise Increases Survival after an Experimental Myocardial Infarction in Rats
Authors: Lundeberg Thomas , Kohler Robin , Bucinskaite Violeta , Eriksson Sven V.
Published: April 2003

To directly evaluate the effect of physical exercise on survival, 80 rats were randomly assigned to either sedentary life (n = 40) or physical exercise 7 days/week during 6 weeks (n = 40), starting 2 weeks after coronary ligation. All animals were followed daily for 183 days. Size of myocardial infarction was determined by planimetry of serial histologic sections of the left ventricle. Physical exercise had no effect on survival in the total treatment group. However, rats with large myocardial infarctions, randomized to physical exercise, had significantly (p = 0.03) better survival (50%) after 6 months than control rats (17%) with large infarctions.
Rescue Coronary Angiography after Failed Thrombolysis: A Real-Life Experience
Authors: Gruberg L. , Di Segni E. , Agranat O. , Har Zahav Y. , Freimark D. , Kaplinsky E. , Hod H.
Published: April 2003

Failed thrombolysis in acute myocardial infarction (AMI) patients is associated with a high risk of morbidity and mortality. Rescue or salvage percutaneous transluminal coronary angioplasty (PTCA) in this group of patients is still controversial. We report our experience with early emergency angiography and rescue PTCA in 27 patients who were hemodynamically unstable or had a large area of myocardium at risk after failed thrombolysis. Rescue PTCA was successful in 95% of attempted PTCA. Three patients were referred to emergency CABG. Early ‘rescue angiography’ with or without rescue PTCA after failed thrombolysis in a selected patient population, is an important tool for early risk stratification and decision-making during the hyperacute phase of AMI, while it may also serve in restoring coronary artery patency of the infarct-related artery with a high success rate.
Parasympathetic Tone Affects Electrocardiographic Preconditioning during Right Coronary Angioplasty
Authors: Tsuchiya Yoshihiro , Nii Takanobu , Shirai Kazuyuki , Saku Keijiro , Arakawa Kikuo
Published: April 2003

We investigated whether parasympathetic tone may affect ischemic preconditioning in terms of ST segment alteration during coronary angioplasty. Coronary balloon angioplasty was performed in 19 patients with angina and isolated right coronary artery disease. Parasympathetic tone was assessed by frequency domain parameters of heart rate variability using 24-hour electrocardiographic recordings obtained before angioplasty. Logistic regression analysis showed the high frequency component to be an independent predictor of the change in ST elevation induced by the second balloon inflation. An increase in parasympathetic tone was related to ischemic preconditioning with respect to the electrocardiographic alterations observed in these patients.
The Four-Chamber View and Its Sensitivity in Detecting Congenital Heart Defects
Authors: Fernandez Carlos O. , Ramaciotti Claudio , Martin Lisa B. , Twickler Diane M.
Published: April 2003

We sought to determine the sensitivity of detecting congenital heart defects with routine antenatal ultrasound including the four-chamber view in a population at low risk for cardiac anomalies. Neonatal outcome and anomaly databases were reviewed to identify cases of morphologic cardiac defects from 1988–1992. Of 176 cases identified, 62 (35%) had routine antenatal ultrasound including the four-chamber view. Thirteen of these 62 (21%) were diagnosed by ultrasound and 18 of the 116 (15%) total defects present were seen. Of these, only 16 of 25 (64%) defects reasonably expected to be seen by the four-chamber cardiac view alone were detected. The routine ultrasound four-chamber cardiac evaluation is limited and detection depends on the type of cardiac defect present.
Prior Cytomegalovirus Infection Does Not Predict Clinical Outcome after Percutaneous Transluminal Coronary Angioplasty
Authors: Tiran Andreas , Tio Rene A. , Oostenveld Esther , Harmsen Martin C. , Tiran Beate , den Heijer Peter , Monnink Stefan H.J. , Wilders-Truschnig Martie M. , The T.Hauw
Published: April 2003

Background: A direct association between human cytomegalovirus (HCMV) infection and the development of restenosis after coronary angioplasty has been suggested. The aim of this prospective study was to evaluate the value of HCMV serology in predicting the clinical outcome after percutaneous transluminal coronary angioplasty (PTCA). Methods and Results: 112 patients undergoing elective PTCA were included in the study. HCMV antibody levels were measured by ELISA. Cardiac events within a follow-up period of 6 months after PTCA were defined as (1) progression or recurrence of anginal complaints and/or a positive exercise test; (2) restenosis that required repeat revascularization. 73% of PTCA patients were seropositive for HCMV. Successful PTCA was achieved in a total of 94 patients, who were followed for 6 months. In 31/94 patients (33%) cardiac events occurred and in 15/94 (16%), this could be related to restenosis. We found no statistically significant difference between seropositive and negative patients with respect to anginal complaints or the need for revascularization. There was no evidence of acute reactivation, since titers of anti-HCMV antibodies did not increase after PTCA. Conclusion: This study shows that the clinical outcome after PTCA is not related to the HCMV serostatus of the patient. Therefore, our data do not support the hypothesis that serological markers of HCMV infection are of clinical importance for the assessment of a patient’s individual risk after PTCA. This does not preclude a role for local reactivation of HCMV at the site of angioplasty.
Superiority of Combined CK-MB and Troponin I Measurements for the Early Risk Stratification of Unselected Patients Presenting with Acute Chest Pain
Authors: Meyer Thomas , Binder Lutz , Graeber Tobias , Luthe Hilmar , Kreuzer Heinrich , Oellerich Michael , Buchwald Arnd B.
Published: April 2003

Background: Recent studies have suggested that positive troponin I tests are associated with an increased risk of cardiac death during short-term follow-up. However, it is unknown if troponin I tests alone or in addition to CK-MB measurements are superior to predict unfavorable outcome during long-term follow-up. Patients and Methods: In a prospective, double-blind study we assessed the prevalence and prognostic value of combined troponin I and CK-MB tests in an unselected cohort of patients (n = 292) admitted to the emergency department for acute chest discomfort. Patients were grouped according to the diagnosis on discharge in those with acute myocardial infarction (1), unstable angina (2), and noncardiac chest pain (3). Six months after enrollment, death rates were obtained and follow-up interviews were performed with respect to survival, recurrence of chest pain, and myocardial infarction. Results: In patients with evidence of coronary heart disease, the mortality rate for abnormal troponin I and normal CK-MB levels was 5.0%. Baseline troponin I and elevated CK-MB levels were associated with a mortality rate of 4.0%. However, the mortality rate was significantly higher (11.1%) in patients presenting with elevated troponin I and CK-MB values. In patients without myocardial infarction on admission, 10.5% with positive troponin I tests died compared to 1.6% with negative tests. The mortality rate in patients without myocardial infarction was 2.7% for patients with elevated CK-MB but normal troponin I values. In patients with both markers elevated a significantly higher mortality rate (16.7%) was found, representing a 6-fold increase in the death event rate. With the additional knowledge of troponin I values, it could be demonstrated that certain cases were misclassified as having noncardiac chest pain. At least some of the latter patients with above-normal values of troponin I were retrospectively to be reclassified as unstable angina. Acute non-Q-wave myocardial infarctions were occasionally misdiagnosed as either angina pectoris or nonischemic chest pain. Conclusions: Our data suggest the superiority of combined CK-MB and troponin I measurements in clinical practice for the early risk stratification of patients presenting with acute chest pain. In nonmyocardial infarctions, both CK-MB and troponin I convey independent prognostic information with regard to fatal outcome. Troponin I tests in addition to CK-MB measurements contribute to a lower rate of misdiagnoses.
Fuzzy Cluster Analysis of Positive Stress Tests: Comparison with Stress Echocardiography and Nuclear Perfusion Imaging in Patients with Triple Vessel and Left Main Coronary Disease
Authors: Peters Robert M.
Published: April 2003

Fuzzy cluster analysis (FCA) was used to classify 166 outpatient positive treadmill stress tests as mildly, moderately, or severely abnormal. The method combines ST-segment change with five other stress test variables, and then computes a similarity measure to determine how closely each patient’s stress test resembles a prototypical mildly, moderately, or severely abnormal stress test. All patients had coronary angiography within 1 month of their stress tests. For the 45 patients with triple vessel disease (TVD), FCA classified 34 of these stress tests as severely abnormal (sensitivity = 75%). For the 22 patients with left main disease (LM), FCA classified 19 stress tests as severely abnormal (sensitivity = 86%). For the combined group with high-grade disease (TVD + LM), the sensitivity was 79%. A literature review shows that for stress echocardiography, multiple exercise-induced wall motion abnormalities have a sensitivity in the 70–80% range for patients with high-grade disease. For nuclear stress testing, the high-risk pattern of multiple reversible defects, with or without increased lung uptake, has a sensitivity in the range of 70–80% for patients with high-grade disease. Thus classification of a positive stress test as severely abnormal by FCA has a sensitivity comparable to high-risk patterns on stress echocardiography and nuclear stress testing in patients with TVD or LM.
Is There an Association of Atrial Septal Aneurysm with Arrhythmias?
Authors: Schneider Birke , Hofmann Thomas , Meinertz Thomas
Published: April 2003

An association of atrial septal aneurysm (ASA) with cardiac arrhythmias has been described, and it has been suggested that undulating movements of the aneurysm initiate these arrhythmias, thereby causing arterial embolism. In this prospective study, all available electrocardiograms were reviewed and Holter monitoring was performed in 50 consecutive patients with echocardiographic diagnosis of ASA in order to assess the relationship between the occurrence of arrhythmias, morphologic characteristics of ASA and arterial embolism. Significant arrhythmias were identified in 26 (52%) patients (supraventricular n = 15, ventricular n = 6, both n= 5). Patients with arrhythmias were older (65 ± 12 vs. 54 ± 13 years, p = 0.005), frequently had palpitations (21/26 vs. 1/24, p < 0.0001) and an abnormal resting electrocardiogram (18/26 vs. 5/24, p < 0.001). By echocardiography, patients with arrhythmias had a larger left atrial (42.8 ± 7.4 vs. 35.3 ± 4.6 mm, p < 0.0001) and left ventricular enddiastolic diameter (53.8 ± 5.6 vs. 49.7 ± 4.1, p < 0.01) and a higher prevalence of associated mitral valve prolapse (12/26 vs. 4/24, p = 0.05). Potential cardiovascular causes for arrhythmia other than ASA were present in the great majority of patients with documented arrhythmias (24/26 vs. 7/24, p < 0.0001). The base diameter of ASA was larger in patients with arrhythmias (25.5 ± 6.2 vs. 21.4 ± 3.4, p < 0.01) and correlated with a larger left atrial diameter (r = 0.72, p < 0.0001). Concerning the mobility of ASA (maximal protrusion or phasic excursion), there was no significant difference between the two patient groups. Arterial embolism, however, predominantly occurred in ASA patients without arrhythmias (16/24 vs. 9/26, p < 0.05). In conclusion, the majority of patients with ASA and arrhythmias has underlying structural heart disease other than ASA which may be responsible for the arrhythmias observed. Arrhythmias in association with ASA do not play a major role as a mechanism for arterial embolism.
Incomplete Expansion of Palmaz-Schatz Stents despite High-Pressure Implantation Technique: Impact on Target Lesion Revascularization
Authors: Blessing Erwin , Hausmann Dirk , Sturm Matthias , Wolpers Hans-Georg , Amende Ivo , Mügge Andreas
Published: April 2003

Improved expansion of stents using high-pressure implantation technique with subsequent antiplatelet therapy has improved patient outcome regarding the incidence of subacute stent thrombosis, bleeding complications and restenosis. Whether high-pressure implantation per se guarantees adequate stent expansion remains unclear. The aim of the study was to determine (1) stent expansion after high-pressure implantation technique and (2) whether stent expansion influences rate of target lesion revascularization within 6 months of follow-up. One hundred Palmaz-Schatz stents were implanted in 98 lesions (91 native vessels, 7 graft vessels) of 94 patients using high-pressure implantation technique (balloon pressure 12–20 atm). Stent expansion was investigated using intravascular ultrasound imaging (IVUS). Clinical follow-up of the patients was performed for 6 months. After implantation, stent/mean reference ratio was 0.81 ± 0.16. Noncompliant balloons used for implantation were chosen by angiographic criteria. Mean balloon/reference ratio was 1.08 ± 0.22; therefore balloons were not undersized. Additional balloon dilataion using higher pressures and/or larger balloons based on IVUS criteria and subsequent IVUS measurements was performed in 52 patients (55%); in these patients, stent expansion improved from 79 ± 16 to 91 ± 15% (mean ± SD) of average reference areas (p < 0.002). Within the 6 months’ clinical follow-up, target lesion revascularization was performed in 19 patients (20%). The only prognostic factors for the development of in-stent restenosis requiring target lesion revascularization were the vessel size (p < 0.05) and the extent of plaque distal to the stents (p < 0.05). Implantation of Palmaz-Schatz stents using high-pressure technique does not guarantee adequate stent expansion. Additional dilatation with higher pressures and/or larger balloons improves stent expansion. The size of the stented vessel and the extent of plaque at the distal stent end (residual outflow stenosis) but not the degree of stent expansion were predictors for target lesion revascularization within 6 months’ follow-up.
Infarct Size Is Reduced and the Frequency of Non-Q-Wave Myocardial Infarctions Is Increased in Patients Using Aspirin at the Onset of Symptoms
Authors: Abdelnoor Michael , Landmark Knud
Published: April 2003

In an observational study we wanted to investigate whether ongoing use of aspirin in a cohort of 753 patients with acute myocardial infarction was able to (1) reduce infarct size as assessed by peak creatine kinase and lactate dehydrogenase, (2) increase the number of non-Q-wave myocardial infarctions, and (3) to what extent thrombolytic treatment at admission could modify these outcomes. We used an exposed (aspirin+)/nonexposed (aspirin–) cohort design, adjusting for the effects of confounders (age, previous coronary heart disease, current smoking, and the prior use of β-blockers and long-acting nitrates) as well as for the modifying effect of thrombolytic treatment. Crude and adjusted effects showed that aspirin reduced infarct size only in patients not receiving thrombolytic treatment at admission to hospital (n = 411 patients). In analyzing the occurrence of non-Q-wave versus Q-wave myocardial infarctions, the outcome was dichotomized. Crude odds ratio (OR) for developing a non-Q-wave myocardial infarction in aspirin users was 2.63 (2p < 0.001), in the restricted cohort of patients receiving thrombolytic treatment, OR was 3.46 (2p = 0.002), whereas in those not receiving such treatment, OR was 1.81 (2p = 0.007). Adjusting for the effects of confounders, retained aspirin was an independent predictor of non-Q-wave myocardial infarctions, an effect that was probably increased (from 51 to 128%) in those who received thrombolytic treatment. Thus, aspirin seems to produce a shift to less severe manifestations of myocardial infarction, an effect that was increased in patients given thrombolytic treatment at admission to hospital.
Clinical Course of Patients with Coronary Ectasia
Authors: Takahashi Keiko , Ohyanagi Mitsumasa , Ikeoka Kiyomitsu , Tateishi Jun , Iwasaki Tadaaki
Published: April 2003

Objective: To compare the clinical prognosis between patients with diffuse coronary ectasia and those with localized coronary ectasia. Design: Patients with coronary ectasia were divided into two groups based on the Markis classification (group D: types I–III and group L: type IV), and the clinical manifestations and prognosis were compared between the two groups. Results: Group D patients (52.1 ± 4 years) were significantly younger than group L patients (62.5 ± 7 years). During the study, 4 patients in group D died suddenly. Three of the patients had type I coronary ectasia, and 1 had left main coronary ectasia. Conclusion: The results of the present study indicate that patients with diffuse coronary ectasia and left main coronary ectasia should be followed carefully.
Stroke in Paced Patients with Sick Sinus Syndrome: Influence of Left Atrial Function and Size
Authors: Mattioli Anna Vittoria , Tarabini Castellani Emma , Mattioli Giorgio
Published: April 2003

Patients with sick sinus syndrome have a high prevalence of cerebral ischemia. The present study was designed to establish the prevalence of stroke in patients with sick sinus syndrome and the role of atrial size and function. This prospective study analyzed 100 consecutive patients with sick sinus syndrome without atrial fibrillation who received either dual chamber or ventricular pacemakers. Patients underwent a cranial CT scan at the time of enrollment and again at the end of the study 24 months later. Endpoint of the study was cerebral ischemia. Clinical and echocardiographic features were assessed at the beginning of the study. A multivariate regression analysis was applied to all variables that had at least a marginal univariate predictive value. Cerebral ischemia occurred in 18 patients. Univariate predictors for embolism were age >65 years (p < 0.001), low atrial ejection force (p < 0.01) and a dilated left atrium with spontaneous echo contrast (p < 0.05). These findings identified patients at high risk for the development of peripheral embolism among the group of patients paced for sick sinus syndrome.
Long-Term Site-Related Differences in the Progression and Regression of the Idiopathic Mitral Valve Prolapse Syndrome
Authors: Kamei Fujito , Nakahara Norifumi , Yuda Satoshi , Kobayashi Naoko , Tsuchihashi Kazufumi , Shimamoto Kazuaki
Published: April 2003

The natural history of uncomplicated mitral valve prolapse (MVP) is not clearly understood. To determine the site-related differences in regression and progression of MVP, 112 patients with idiopathic MVP were enrolled in this echocardiographic follow-up study. Cardiovascular complications, including dysarrhythmias (n = 3, 2.7%), overt congestive heart failure (n = 4, 3.6%), progression of mitral regurgitation over one grade (n = 28, 25.0%), newly confirmed chordal rupture (n = 1, 0.9%), and surgical repair (n = 2, 1.8%), were observed in these patients during a follow-up period of 1–13 years (mean, 4.0 ± 2.8 years). Multivariate analysis and Kaplan-Meier analysis revealed that posterior leaflet prolapse and significant mitral regurgitation (grade ≥2) were considerable risks for cardiovascular complications. Regression of MVP was seen in 17 (18.7%) of the anterior prolapse patients; however, new prolapse was observed in 40 (35.7%) patients, mainly in posterior prolapse patients. These results suggest that site-related differences exist in uncomplicated MVP prognosis and that MVP in the posterior leaflet has a poor outcome compared to that in the anterior leaflet.
Central Venous Catheter Mechanical Irritation of the Right Atrial Free Wall:A Cause for Thrombus Formation
Authors: Fuchs Shmuel , Pollak Arthur , Gilon Dan
Published: April 2003

Thromboembolism is a major complication of long-term central venous catheter, usually associated with catheter or venous occlusion. Intracavitary right atrial thrombosis is currently considered to result from line-tip thrombosis extension. We report three adult patients in whom repeated mechanical trauma to the right atrial wall was probably the main mechanism. Transesophageal echocardiography revealed back and forth movement of the central catheter into a thrombus attached to the right atrial wall, thus suggesting a mechanism of catheter-associated thrombus formation, not previously visualized or suggested. Catheter removal and anticoagulation administration were undertaken with an uneventful clinical course and almost complete disappearance of the thrombi on transesophageal echocardiography follow-up.
Is the Blood Flow in the Left Ventricle during the Isovolumic Relaxation Period a Useful Parameter of Left Ventricular Systolic and Early Diastolic Performance?
Authors: Ohte Nobuyuki , Narita Hitomi , Hashimoto Takeshi , Hayano Junichiro , Akita Sachie , Kurokawa Kazuyuki
Published: April 2003

Left ventricular (LV) early diastolic performance is determined by LV behavior in the late systole to early diastole and may relate to the physical potential of patients. Isovolumic relaxation flow (IRF) velocity was obtained by continuous Doppler echocardiography in the left ventricle from the apex in 26 patients with atypical chest pain and 63 patients with coronary artery disease (CAD) with or without prior myocardial infarction (MI) who underwent cardiac catheterization. In each patient, a time constant of LV relaxation (τ) was calculated from the LV pressure waves obtained by a catheter-tipped micromanometer. The LV end-systolic volume index was measured using contrast left ventriculography. IRF velocity in patients having CAD with prior MI (24.8 ± 5.4 cm/s) was significantly less than in those with atypical chest pain (41.2 ± 9.6 cm/s). It was also significantly less than in patients having CAD without prior MI (37.3 ± 6.8 cm/s). IRF velocity significantly correlated with the time constant τ (r = –0.42, p < 0.001) and LV end-systolic volume index (r = –0.84, p < 0.001). This study indicates that IRF velocity obtained by continuous Doppler echocardiography in the left ventricle provides important information regarding LV systolic performance and early diastolic performance.
Concomitant Reentrant Tachycardias from Concealed Accessory Atrioventricular Bypass Tract and Atrioventricular Nodal Reentry in a Patient with Williams Syndrome
Authors: Kantharia Bharat K. , Mittleman Robert S.
Published: April 2003

Williams syndrome is characterized by a constellation of features including mental retardation and supravalvular aortic stenosis. Other cardiovascular abnormalities including arrhythmias contributing to sudden death have been described in these patients. In this report we describe a case of a 49-year-old female with Williams syndrome who presented with severe symptomatic supraventricular tachycardia. Cardiac electrophysiology study identified a left posteroseptal concealed accessory bypass tract responsible for atrioventricular reentrant tachycardia and a concomitant typical atrioventricular nodal tachycardia. Such unusual association of combination of two different types of supraventricular tachycardia and Williams syndrome has not been previously reported. Radiofrequency ablation was successfully performed to cure these arrhythmias.
CD40L Activation in Circulating Platelets in Patients with Acute Coronary Syndrome
Authors: Lee Yoon , Lee Won-Ha , Lee Sang-Chol , Ahn Kyoung-Ju , Choi Yoon-Ho , Park Seung-Woo , Lee Sang-Hoon , Seo Jung-Don , Park Jeong-Euy
Published: April 2003

The CD40-CD40L interaction, which was initially shown to have important roles in the T cell-mediated activation of B cells during humoral immune responses, is now known to have roles in activation of endothelial cells, smooth muscle cells, and macrophages within atherosclerotic plaques. Recently, CD40L expression was found in activated platelets in the thrombus in vivo and CD40L was reported to be responsible for the platelet-mediated activation of endothelial cells in vitro. To investigate the activation status of platelets in coronary artery disease patients, we tested expression levels of CD40L, and platelet-endothelial cell adhesion molecule-1 (PECAM-1/CD31) in platelets isolated from peripheral blood, using flow cytometric analysis. Twenty-nine patients with acute coronary syndrome (10 acute myocardial infarction and 19 unstable angina patients) were compared with 14 normal subjects or 14 stable angina patients. In platelets isolated from normal subjects, the expression of CD40L was not detected in all subjects. In the patients with acute coronary syndrome, the average level of CD40L showed a significant increase (p = 0.0028), while stable angina patients did not have any increase when compared to normal subjects. Patients with more complex lesions or vessel occlusion tended to have a high platelet CD40L level compared to patients who do not. The expression levels of CD31 were increased in a small portion of the ACS patients. These data indicate that the rupture of plaque and subsequent formation of thrombus may lead to the activation of CD40L expression in circulating platelets of ACS patients.
Reversal of Left Ventricular Hypertrophy following Once Daily Administration of Felodipine for Two Years to Elderly Subjects with Isolated Systolic Hypertension
Authors: De Rosa M.L. , Giordano A. , Della Guardia D. , Maddaluno G. , Lionetti F. , Marsicani N. , Vigorito C.
Published: April 2003

Left ventricular mass sometimes decreases during the treatment of hypertension. In a two-year open study, we investigated the ability of extended release (ER) felodipine (5 or 10 mg), plus chlorthalidone (25 mg), given once daily, to reduce left ventricular mass in 84 elderly patients with isolated systolic hypertension. Drug dosage was determined in an initial stepped-care titration phase lasting six weeks. Mean systolic blood pressure decreased after two years of treatment with 5 or 10 mg of felodipine (p < 0.001) and the left ventricular mass index decreased too (p < 0.0001). One or two weeks after withdrawal of therapies, blood pressure returned to pretreatment values. We concluded that left ventricular mass can be reduced in elderly patients with isolated systolic hypertension and ventricular hypertrophy who receive felodipine 5–10 mg once daily. This treatment was generally well tolerated.
Obstructive Sleep Apnea as a Risk Marker in Coronary Artery Disease
Authors: Schäfer Harald , Koehler Ulrich , Ewig Santiago , Hasper Ekkhard , Tasci Selcuk , Lüderitz Berndt
Published: April 2003

Study Objectives: Obstructive sleep apnea (OSA) is associated with a range of cardiovascular sequelae and increased cardiovascular mortality. The aim of our study was to assess the prevalence of OSA in patients with symptomatic angina and angiographically verified coronary artery disease (CAD). In addition, we analyzed the association of OSA and other coronary risk factors with CAD and myocardial infarction. Methods: Overnight non-laboratory-monitoring-system recordings for detection of OSA was performed in 223 male patients with angiographically verified CAD and in 66 male patients with exclusion of CAD. A logistic regression analysis was performed to assess associations between risk factors and CAD and myocardial infarction. Results: CAD patients were found to have OSA in 30.5%, whereas OSA was found in control subjects in 19.7%. The mean apnea/hypopnea index (AHI) was significantly higher (p < 0.01) in CAD patients (9.9 ± 11.8) than in control subjects (6.7 ± 7.3). Body-mass-index (BMI) was significantly higher in patients with CAD and OSA than in patients with CAD without OSA (28.1 vs. 26.7 kg/m2; p < 0.001). No significant difference was found with regard to other risk factors and left ventricular ejection fraction (LVEF) between both groups. Hyperlipidemia (OR 2.3; CI 1.3–3.9; p < 0.005) and OSA defined as AHI ≥20 (OR 2.0; CI 1.0–3.8, p < 0.05) were independently associated with myocardial infarction. Conclusions: There is a high prevalence of OSA among patients with angiographically proven CAD. OSA of moderate severity (AHI ≥20) is independently associated with myocardial infarction. Thus, in the care of patients with CAD, particular vigilance for OSA is important.
Cardiac Involvement in Werdnig-Hoffmann’s Spinal Muscular At rophy
Authors: Finsterer J. , Stöllberger C.
Published: April 2003

Despite the increasing interest in cardiac involvement (CI) of neuromuscular disorders, only few data are available on CI in spinal muscular atrophy (SMA). We tried to determine the cardiac manifestations of SMA, their incidence rates and the necessity of cardiac therapy in patients with SMA and CI. Eight patients with SMA, aged 10–79 years, underwent clinical cardiologic examination, ECG, echocardiography and ambulatory ECG. The most frequent findings were angina pectoris, palpitations, exertional dyspnea, ST abnormalities, couplets, thickened myocardium and diastolic dysfunction. In conclusion, cardiac manifestations of SMA mainly comprise ECG abnormalities and thickened myocardium. CI in SMA frequently necessitates cardiac therapy.
Myocardial Perfusion and Angiographic Findings in Patients with Paradoxical Sinus Deceleration during Dobutamine Technetium-99m Sestamibi-Gated SPECT Imaging
Authors: Emre Ayşe , Ersek Birsen , Gürsürer Metin , Aksoy Mehmet
Published: April 2003

Aims: Dobutamine-gated SPECT imaging allows simultaneous perfusion and function assessment and is an alternative stress method for evaluating coronary artery disease in patients unable to perform treadmill exercise. In some patients, a paradoxical decrease in heart rate has been observed during high dose dobutamine infusion. The purpose of this study was to describe the paradoxical decrease in heart rate observed during dobutamine perfusion scintigraphy and determine its relation to inducible ischemia and angiographic coronary artery disease. Methods and Results: We studied 52 patients who underwent dobutamine-gated 99mTc sestamibi SPECT imaging and coronary angiography within 30 days. Paradoxical deceleration was defined as a decrease in heart rate ≥5 beats/min lasting at least 3 min during dobutamine infusion. Perfusion was graded on a five-point scale (0 = normal; 4 = absent uptake) and wall motion on a four-point scale (0 = akinesia/dyskinesia; 3 = normal) using the 20-segment model. Significant coronary artery disease was defined as ≥50% narrowing of lumen diameter of a major epicardial artery. Paradoxical deceleration occurred in 10 patients (19%, 95% CI 8–30%). A decrease in systolic blood pressure [8 patients (80%), 95% CI 56–92%] with angina [5 patients (50%), 95% CI 23–71%] often accompanied the decrease in heart rate. All 10 patients with sinus deceleration had an inferior wall perfusion defect and 8 of them had a corresponding wall motion abnormality on gated images. Significant coronary artery disease was present in all 10 patients with sinus deceleration, with an increased incidence of right coronary artery stenosis (p = 0.007). Conclusions: Paradoxical deceleration observed during dobutamine perfusion scintigraphy is associated with inducible ischemia and angiographic coronary artery disease and the underlying mechanism for this phenomenon may be the activation of the Bezold-Jarisch reflex.