bluuebunny/crossref_metadata_2025 huggingface dataset:
Usefulness of Radionuclide Ventriculography During Transesophageal Atrial Pacing in the Diagnosis of Coronary Artery Disease
Authors: Le Feuvre Claude , Georges Jean Louis , Metzger Jean Philippe , Etienne Dominique , Albarede Pierre , de Vernejoul Pierre , Vacheron André
Published: July 2008

Radionuclide ventriculography before, during, and after atrial transesophageal pacing was carried out in 15 patients with suspected coronary artery disease (CAD) and without myocardial infarction. All patients underwent coronary angiography. Ten patients (group 1) had a coronary lesion > 50% on at least one of the main coronary arteries. Five patients (group 2) had normal coronary arteries. Radionuclide left ventricular ejection fraction (LVEF) before pacing was 56 ±3% in group 1 and 59 ±3% in group 2 (NS). Radionuclide ventriculography during pacing was 45 ±4% in group 1 (P < 0.0001 vs basal in group 1) and 45 ±6% in group 2 (P < 0.01 vs basal in group 2, NS vs group 1 during pacing). Immediate postpacing ejection fraction did not differ in the two groups and was identical to the prepacing value. A quantitative regional wall motion analysis was performed in 105 segments. Regional radionuclide ventriculography was calculated in each segment as follows: end-diastolic counts — end-systolic counts/end-diastolic counts. The relative decrease in regional LVEF during pacing was more important in the 39 segments related to a narrowed vessel than in the 66 segments related to normal coronary artery (32 ± 13% vs 13 ±10%, P < 0.0001). A more than 20% relative decrease in at least one segment during pacing occurred in 10 patients in group 1 (sensitivity 100%) and in 2 patients in group 2 (specificity 60%).

In conclusion, global radionuclide ventriculography during transesophageal atrial pacing decreases in patients with and without CAD. In contrast, regional wall motion abnormalities during pacing are more important in segments related to a narrowed coronary artery and can be proposed for patients unable to exercise as an alternative to pharmacologic stress test in the diagnosis of CAD.
Complicated Marfan's Syndrome with Unusual Longevity
Authors: Schwartz J. , Madjar J. , Rosenfeld V.
Published: July 2008

The authors present a complicated case of Marfan's syndrome in an elderly woman with unusual longevity.
Effects of Intracoronary Infusion of Adenosine on Cumulative Deterioration of Regional Myocardial Wall Motion Induced by Repeated Brief Periods of Coronary occlusion in Anesthetized Dogs
Authors: Satani Arata , Kawashima Seinosuke , Iwasaki Tadaaki
Published: July 2008

The present study was performed to evaluate the effects of the intracoronary infusion of adenosine on regional wall motion in the canine heart subjected to repeated brief coronary occlusion and reperfusion. In anesthetized open-chest dogs, six episodes of five- minute coronary occlusion followed by a fifteen-minute reperfusion were performed. Animals received infusions of either adenosine or saline (control) into the coronary artery during the initial five minutes of each reperfusion. Changes in regional wall motion were studied by means of ultrasonic crystals. The authors prolonged the duration of hyperemic flow at each reperfusion in a third group by means of a roller pump to examine whether the increase in coronary flow during reperfusion itself might affect the process of the deterioration of regional wall motion. In the control dogs, wall thickening decreased progressively after each reperfusion. However, in the adenosine-treated animals, regional wall motion fifteen minutes after the sixth reperfusion did not differ from baseline. Prolongation of hyperemic flow did not improve the progressive decline in regional wall motion. Thus, adenosine prevented the cumulative decrease in the regional wall motion of the myocardium treated with a series of repeated transient coronary occlusions, most likely by a mechanism unrelated to its vasodilating action.
Failure of Captopril to Attenuate Myocardial Damage, Neutrophil Accumulation, and Mortality Following Coronary Artery Occlusion and Reperfusion in Rat
Authors: Leor Jonathan , Varda-Bloom Nira , Hasdai David , Ovadia Zehava , Battler Alexander
Published: July 2008

Captopril, a sulfhydryl-containing angiotensin-converting enzyme inhibitor, has been suggested as possessing antiischemic and antiinflammatory properties. To test the hypothesis that captopril may prevent neutrophil-induced myocardial injury during acute myocardial infarction (AMI), the authors subjected rats to coronary occlusion for thirty minutes and reperfusion for twenty-four hours (MI) or to sham operation (sham MI). Oral captopril (100 mg/kg) or vehicle was administered thirty minutes before coronary occlusion. The effect of captopril on mean arterial blood pressure was assessed in separate group of animals (n=8).

Infarct size and neutrophil accumulation in myocardium were determined by measuring creatine phosphokinase depletion and myeloperoxidase (MPO) activity, respectively, in the left ventricular free wall (LVFW). Animals treated with 100 mg/kg of captopril exhibited significant reduction in mean arterial blood pressure compared with vehicle-treated animals (P < 0.01). Compared with vehicle-treated animals, administra tion of 100 mg/kg of captopril to MI animals attenuated neither twenty-four-hour (continued on next page) mortality (56% vs 52%, respectively), nor infarct size (36 ± 7% vs 34% ± 7% respec tively), nor MPO activity (1.0 ±0.17 vs 1.26 ±0.19).

Thus, in the present experiment captopril did not reduce neutrophil-induced myocar dial damage following coronary occlusion and reperfusion. These findings may be partly explained by the negative effect of captopril on arterial blood pressure during AMI.
Management of the Coronary-Subclavian Steal Syndrome with Balloon Angioplasty
Authors: Stagg Samuel J. , Abben Richard P. , Chaisson Gary A. , Kowalski Joseph M. , Ladd William R. , Meldahl Ray V. , Manalo Elmer P. , Walker Craig M.
Published: July 2008

A fifty-two-year-old woman with angina pectoris due to coronary-subclavian steal syndrome through a left internal mammary artery graft placed distal to a left anterior descending artery stenosis is presented. Retrograde flow through the mammary artery graft due to severe left subclavian stenosis was observed angiographically. Accordingly, left subclavian balloon angioplasty was performed, restoring normal antegrade flow through the internal mammary artery graft and resulting in resolution of the patient's symptoms. The patient was subsequently discharged with no evidence of angina. Carotid- subclavian bypass surgery was avoided, reducing patient discomfort, procedural risk, and expense.
The Clinical Impact of Risk Factor Analysis and Prophylaxis on Pulmonary Embolism
Authors: Shabahang Mohsen , Neville Richard F. , Evans Stephen R. T. , Nauta Russell J.
Published: July 2008

Pulmonary emboli cause 50,000 deaths annually despite, recognized risk factors and methods of prophylaxis. To determine the impact of risk factor analysis and the use of prophylaxis, a retrospective chart review of patients suffering pulmonary embolism (PE) at Georgetown University Hospital was performed. During a fifty-month period, 25,000 surgical and 36,000 nonsurgical admissions included 171 cases of PE. The incidence of PE among surgical patients was 0.24% (n=61) and was 0.30% (n=110) among nonsurgical patients as confirmed in 82% by pulmonary angiography or high-probability ventilation/perfusion scans. PE prophylaxis included pneumatic stockings, low-dose heparin, combination low-dose heparin/stockings, and coumarin. However, prophylactic measures were absent in 23% of the surgical and in all the nonsurgical patients suffering PE. On the basis of established criteria (SVS/ISCVS), 57% of surgical patients suffering PE were considered at high risk as compared with 13% of nonsurgical patients. Conversely, 54% of nonsurgical patients suffering a PE were considered to be at low risk. Standard treatment modalities were instituted after nonfatal PE: anticoagulation (61%), inferior vena cava filter (14%), and anticoagulation/filter (6%) While risk factor analysis identifies high-risk surgical patients, it may be less effective in identifying nonsurgical patients at increased risk for PE.
Long-Term Outcome and Prognostic Factors in Dilated Cardiomyopathy
Authors: Fruhwald Friedrich M. , Dusleag Johann , Eber Bernd , Fruhwald Sonja , Zweiker Robert , Klein Werner
Published: July 2008

To investigate long-term follow-up and identify prognostic factors in patients with dilated cardiomyopathy (DCM) the authors investigated 167 consecutive patients on an outpatient basis. All patients underwent left- and right-heart catheterization; follow-up comprised clinical and echocardiographic investigations.

Results: After a mean follow-up period of ninety-three ± thirty-six months 82 patients (49%; 71 men, 11 women, mean age fifty-five ± eleven years) were alive. 29 of them (27 men, 2 women, mean age fifty-two ± nine) showed normal left ventricular ejection fraction (LVEF) after a mean follow-up period of one hundred four ± forty months. The remaining 53 patients (44 men, 9 women, mean age fifty-six ± eleven) revealed LVEF similar to that of the first examination. Eighty-five patients died (51%; 73 men, 12 women). Causes of death were the following: progressive heart failure, 24; sudden death, 23; stroke, 3; pulmonary embolism, 2; noncardiac death, 4; unknown causes, 29. The median period from the onset of first symptoms until definite diagnosis was two months in patients with stable conditions, three months in those with normalization of LVEF and twenty-four months in those who died, respectively (P < 0.01). At the time of diagnosis, patients with stable outcome had a mean LVEF (LVEF 1) of 37%, those who returned to normal had 40% (ns). Patients who died had a mean LVEF 1 of 32% and therefore differed significantly from both groups of survivors (P < 0.001). Left ventricular enddiastolic pressure (LVEDP) at the time of diagnosis was highest in patients who died (22 mmHg) and therefore differed significantly from both groups of survivors (normalization: 16 mmHg, stable patients: 18 mmHg, P < 0.001).

Conclusions: According to their results, time until diagnosis, LVEF, and LVEDP are prognostic indicators. No difference was noted between the groups concerning etiology, medical treatment, or functional classification according to the New York Heart Association.
Long-Term Effects of Ticlopidine on Lower Limb Blood Flow, Ankle/Brachial Index and Symptoms in Peripheral Arteriosclerosis
Authors: Fagher Birger ,   The Stims group in Lund
Published: July 2008

The aim was to test within a randomized double-blind trial whether the platelet inhibitor ticlopidine might improve peripheral blood flow and distal pressures in patients with aortofemoral arteriosclerosis. One hundred and one patients with intermittent claudication were studied after one year, after two to three years, and after five years of treatment with ticlopidine, 500 mg/day, or placebo. Analysis was performed according to years on treatment. Baseline flow values as assessed by venous occlusion plethysmography were significantly and similarly deranged in the ticlopidine and placebo groups as compared with a reference group of healthy subjects. Ankle/brachial index was unrelated to either leg blood flow variables or walking distance. After five years of treatment (median follow-up time) a slight tendency to a slower progression of disease was observed in the ticlopidine group as compared with placebo. However, intergroup differences were not significant. Therefore, the potential benefit of ticlopidine in this respect is from a clinical point of view certainly only marginal. Minor increases in claudication distances were found with no difference between groups. Smoking habits and lipoproteins were mainly unaltered at the end of the study It is concluded that platelet inhibition for up to five years has no clear beneficial effect on leg blood flow variables, ankle/brachial index, or walking distances and probably no clinically relevant retarding effect on the slow progression of atherosclerosis. This lack of influence must be distinguished from the antithrombotic effect of ticlopidine, shown as a decreased incidence of acute cardiovascular events and mortality in the authors' multicenter study, STIMS (the Swedish Ticlopidine Multicenter Study).
Exercise-Induced Inverted U Wave in Asymptomatic High-Risk Subjects
Authors: Salmasi A-Majeed , Abraham Ralph , Al-Kutoubi Aghiad , Nicolaides Andrew N.
Published: July 2008

The sixteen-lead ECG chest wall mapping was used to investigate the significance of inverted U waves during exercise in diagnosing occult coronary artery disease (CAD) in asymptomatic high-risk subjects. For this purpose 100 patients with various types of hyperlipidemia and 33 patients with diabetes mellitus were studied. None of these patients had a history of angina pectoris or myocardial infarction and all had normal resting ECG. Exercise was carried out on a bicycle ergometer to an end point, and ECG recordings were made from all sixteen chest leads. Inverted U waves developed during the early minutes of exercise in 8 patients (6 hyperlipidemics and 2 diabetics), indicating disease in 11 coronary artery territories (7 in the left anterior descending/diagonal coronary artery, 3 in the circumflex, and 1 in the right coronary artery territories). Subsequent coronary arteriography confirmed the territorial distribution of the inverted U waves in all the cases. Following coronary artery bypass grafting in 2 of these patients no U wave inversion developed during stress testing.

It is concluded that exercise-induced inverted U wave is a reliable indicator of silent myocardial ischemia due to occult CAD in asymptomatic high-risk subjects. Its distribution on the ECG chest wall map is highly predictive of significant disease in the individual coronary artery territory. The disappearance of this ECG sign following myocardial revascularization is a further proof of its myocardial ischemic origin.
Embolization of a Renal Transplant Pseudoaneurysm Following Angiolipoma Resection
Authors: Theobald Michael R. , Contractor Farhad M. , Kiproff Paul M. , Khoury Maroon B. , Chao Stan H.
Published: July 2008

The development of a pseudoaneurysm in renal allografts is a well-known complication of percutaneous biopsy. However, the authors report a case of pseudoaneurysm formation in a renal cadaver allograft, following documented angiolipoma resection prior to transplantation. Treatment required superselective embolization with multiple platinum coils.
Carcinoma of the Lung with Invasion of the Left Atrium
Authors: Olearchyk Andrew S.
Published: July 2008

Three patients who had a nonsmall cell carcinoma of the lung with invasion of the left atrium without distal metastases (T4 N0-2 M0), underwent a radical pneumonectomy with a partial resection of the involved left atrium. Two of them had postoperative adjuvant therapy. The first patient died nine months after the operation from a ruptured thoracoabdominal aneurysm; the second patient died three months later from complications of adjuvant therapy; and the third patient is alive and free of metastases more than two years after the operation. Whenever technically feasible, nonsmall cell lung carcinoma that has invaded the left atrium without distal metastases should be resected in block with the left atrium.
Whole-Body Thallium Imaging in Coronary Artery Disease
Authors: Tellier P.
Published: July 2008

The aim of this study was to evaluate the incidence, type, and severity of asymptomatic leg perfusion abnormalities in 116 male patients with proven coronary artery disease (CAD) who performed near-maximal treadmill test. Interextremity asymmetry was observed in 60% of patients, but the incidence of this sign increased with age (from 35% below forty-five years of age to 72% over sixty-one years). Asymmetry was very marked or marked in 61% of all segments and moderate in 39% of them. A significant decrease in fractional uptake was observed in 21% of patients with CAD and in 25% of those with interextremity asymmetry. Myocardial ischemia, which was defined by reversible defects on myocardial tomoscintigraphy, was three times more frequent in patients with interex tremity asymmetry than in patients with normal results from exercise whole-body thallium scintigraphy. This observation, combined with type, extent, and location of asymmetry, is highly suggestive of silent peripheral arterial disease in most cases. Whole- body scan could easily be performed following an exercise myocardial thallium scan so as to provide information on multifocal atherosclerosis in patients with CAD or multiple and severe vascular risk factors. The prognostic value of these silent peripheral muscle perfusion abnormalities remains to be established.
Doppler Flow Velocity Measurements During Coronary Angioplasty
Authors: Dill Harald , Altstidl Robert , Regenfus Matthias , Lehmkuhl Hans , Bachmann Kurt
Published: July 2008

In addition to further studies using Doppler catheters to assess blood flow velocity during coronary angioplasty this study intends to evaluate the functional significance of coronary stenoses and to estimate their hemodynamic relevance prior to and after percutaneous transluminal coronary angioplasty (PTCA). Diameters of coronary artery stenoses were quantified by means of the cardiovascular angiographic analysis system (CAAS) both prior to and following successful PTCA in 37 patients. During coronary artery angioplasty a 12 M:Hz 0.018-in. Doppler-tipped guidewire was used to measure prestenotic and post stenotic parameters of coronary artery flow velocity both prior to and following PTCA. The minimal stenosis diameter was raised from 1.01 ±0.58 to 1.76 ±0.73 mm (P < 0.0001), the percent diameter stenosis decreased from 63 ±11 to 35 ±6% (P < 0.0001). Prestenotic average (APV) and maximum peak velocity (MPV), peak velocity integral (PVI), average systolic (ASPV) and diastolic (ADPV) peak velocity, systolic (SPVI) and diastolic (DPVI) peak velocity integral, and diastolic/systolic velocity ratio showed—in contrast to further studies—a considerably significant difference (P < 0.05), whereas poststenotic Doppler data (APV, MPV, PVI, ASPV, DSPV, SPVI, DPVI, DSVR) differed highly significantly (P < 0.0001) prior to and following PTCA. Prestenotic and poststenotic measurements of coronary artery flow velocity differed significantly before and after PTCA and offer the potential for estimating both the hemodynamic relevance of coronary artery stenoses and success of PTCA.
Bifascicular Block Complicating Blunt Cardiac Injury
Authors: Pontillo Daniele , Capezzuto Aldo , Achilli Augusto , Serraino Leonardo , Savelli Serena , Guerra Roberto
Published: July 2008

A thirty-five-year-old horse trainer presented to the emergency room of the authors' hospital with minimal nonpenetrating chest injury after having been kicked by a horse. No rib or sternum fractures were demonstrated. The admission ECG demonstrated a right bundle branch block and a left anterior hemiblock that were previously absent. The authors are aware of only two similar reports, but analogous conduction disturbances might have been classified as intraventricular conduction defects. The rarity of these defects may be explained by the anatomic pathways of the bundle of His and its bifurcations.
Acute Myocardial Infarction During Pregnancy and Puerperium in Athletic Women
Authors: Badui Elias , Rangel Alberto , Enciso Roberto , Espinosa Rafael , Bermudez Gerardo , Luna Pastor , Lepe Luis , Martinez Luis
Published: July 2008

The authors present 2 cases: 1 of a thirty-two-year-old woman and another of a thirty- eight-year-old woman, both Hispanic and athletic, with no identifiable precipitating or coronary risk factors, such as previous heart disease, hypertension, diabetes mellitus, cigarette smoking, hyperlipoproteinemia, oral contraceptive use, coagulation disorders, thyroid disease, collagen tissue disorder, or family history of premature myocardial infarc tion, who both developed an acute posteroinferior wall myocardial infarction with normal coronary arteries, one during pregnancy, from which normal twin girls were born, and another, during the postpartum period.

After reviewing the literature the authors consider the present cases as unique due to the rare association of pregnancy with intrapartum and postpartum acute myocardial infarction with normal coronary arteries in athletic women.
Infected Right Atrial Thrombus: Serious Complication of Intravenous Fluid Replacement Catheter
Authors: Jafari J. , Reisin L.H. , Mishael J.
Published: July 2008

The authors report a case of infected right atrial thrombus as a complication of an IV fluid replacement catheter, the first case of its kind in the English literature. Previously, this entity has been reported as a complication of parenteral nutrition catheters.
Evaluation of Short Axial Blood Flow Pattern in Thoracic Descending Aorta by Use of Tagging Cine Magnetic Resonance
Authors: Matsumoto Yuji , Honda Toshio , Hamada Mareomi , Toyama Takashi , Matsuoka Hiroshi , Hiwada Kunio
Published: July 2008

The authors, for the first time, evaluated the short axial blood flow profile by using tagging cine magnetic resonance (MR). Cine MR was performed on 15 healthy volunteers aged 51.5 ±23.1 (SD) years. The transverse plane of the thoracic descending aorta was imaged at the middle level of the left ventricle. Two or four radial tags, whose thickness was 3 mm width each, were established to the short axial image of the descending aorta at 2 msec and 300 msec following the R wave of the subjects' QRS complex on the elec trocardiogram. They observed the flow patterns and measured the rotating flow velocity of the thoracic descending aorta in early systole and late systole from the following formula: ν = d/t, (v = velocity, d = displacement of tags over the interval, t = time interval between the time of presaturation and the time of imaging).

In the short axial image of the descending aorta, 13 subjects showed the clockwise rotation of tags in the supine position from the foot side view. Flow image of the other 2 subjects showed as undefined. Rotating flow velocity was 1.63 ±0.88 cm/sec in early systole and was 1.37 ±1.11 cm/sec in late systole.

Tagging cine MR is useful to evaluate the blood flow profile in the thoracic descending aorta.
Venous Velocity Increase with a Pneumatic Foot Compression Garment
Authors: Ilgenfritz Frederick M. , Meiert Jack R.
Published: July 2008

Intermittent compression garments have been widely accepted for prophylaxis of deep venous thrombosis. They have broad applicability in both elective and emergent situa tions. Development of a new type of garment that acts to compress the plantar plexus of the foot provides a potential method of prophylaxis for patients with contraindications to the traditional calf- or thigh-high garments. Evaluation of the ability of the foot compres sion garment demonstrates a statistically significant increase in peak femoral venous velocity (40.6 cm/sec) as compared with the resting state (25.9 cm/sec). This increase in femoral venous velocity is comparable to that seen with single-cell compression socks. The authors conclude that the recently introduced foot garment produces increases in peak femoral venous velocity similar to those produced by existing garments and that use of the foot compression garment may provide deep venous thrombosis prophylaxis in patients who previously have not been candidates for a compression garment.
Antihypertensive Therapy with Isradipine in Patients with Special Safety Concerns
Authors: Blecker David
Published: July 2008

Treatment of hypertension in the complicated patient requires a specialized approach focusing on the treatment of the blood pressure and concurrent medical problems. Therapy must be chosen in consideration of the patient's age, multiple illnesses, declining organ function, and possible drug interactions. This requires that the antihypertensive agent chosen have a demonstrated safe profile.

In clinical trials, monotherapy with the calcium channel blocker (CCB) isradipine (ISR) at a recommended therapeutic dosage has controlled blood pressure with an excellent level of safety. In these studies, ISR had no significant effect on heart rate, cardiac conduction, or cardiac contractility and no negative effect on renal function. In hypertensive patients with both normal and impaired renal function, ISR significantly increased renal plasma flow while decreasing renal vascular resistance without decreasing glomerular filtration rate and filtration fraction. ISR has long-term natriuretic effects that may provide additional benefits in antihypertensive therapy. Most adverse effects associated with ISR are mild, transient, and related to vasodilation. The most frequently reported adverse reactions are headache, dizziness, and edema. ISR does not affect glycemic control or lipid metabolism in either diabetic or nondiabetic patients. It has no reported adverse interaction with some of the most commonly used medications for elderly patients, including digoxin, nitroglycerin, oral hypoglycemics, and hydrochlorothiazide. ISR may be used as a first-line agent for the treatment of hyper tension in complicated patients.
Plasma Levels of Tumor Necrosis Factor and Endothelial Response in Patients with Chronic Arterial Obstructive Disease or Raynaud's Phenomenon
Authors: Cimminiello Claudio , Arpaia Guido , Toschi Vincenzo , Rossi Florica , Aloisio Manuela , Motta Adele , Bonfardeci Giuseppe
Published: July 2008

Tumor necrosis factor alpha (TNF-alpha) is a cytokine that affects endothelial cells' function by changing their antithrombotic potential to a net procoagulant effect. Only a few data have so far been reported for the pathophysiologic role of TNF in vascular diseases in the involvement of microvessels and/or macrovessels and a prothrombotic state. In the present study the authors evaluated plasma TNF (and interleukin-1) levels in 20 patients with chronic arterial obstructive disease (CAOD) with intermittent claudi cation and 10 CAOD patients with more severe disease (pain at rest/skin ulcers). In addition, they studied 10 patients with Raynaud's phenomenon (RP), suspected to be secondary to a collagen disease. The control group consisted of 20 subjects matched for sex and age with the three groups of patients. TNF levels were assayed by enzyme-linked immunosorbent assay

The antigen levels of von Willebrand factor (vWF), tissue plasminogen activator (t- PA), and its inhibitor (PAI) were also determined as markers of release from the endothe lium, while the fragment 1+2 of prothrombin (F1+2) and thrombin-antithrombin III (TAT) complexes were assessed as indexes of systemic thrombin generation.

TNF levels were significantly higher in both groups of CAOD patients than in controls or RP patients, and the same was true for vWF. t-PA was significantly higher only in the CAOD subjects with more severe disease. No differences among groups were seen in PAI antigen/activity or thrombin generation. When data were corrected for age, TNF no longer differentiated CAOD patients from controls and RP subjects. There were strong direct correlations between TNF and age ( r=0.57, P=0.0001); TNF and t-PA (r=0.43, P=0.002); and TNF and vWF (r=0.52, P=0.0001). The association of TNF with vWF was indepen dent of other variables. The present study suggests that TNF plays an important role in the pathophysiology of arterial diseases of atherosclerotic origin, especially during aging.
Left Ventricular Remodeling and Function in Adult Aortic Stenosis
Authors: Faggiano Pompilio , Rusconi Cesare , Ghizzoni Giuseppe , Sabatini Tony
Published: July 2008

The aim of this study was to analyze the left ventricular (LV) geometric changes occurring in chronic pressure overload due to valvular aortic stenosis (AS). Fifty-six adult patients (30 women, 26 men, mean age seventy-two ±nine years, range forty-five to eighty-five years) with isolated AS (mean valve area by Doppler=0.6 ±0.2 cm2) underwent a complete Doppler echocardiographic examination. According to the value of relative wall thickness (RWT=2 x posterior wall thickness/LV end-diastolic diameter) and LV mass index (LVMI) in normal subjects (RWT ≤ 0.44, LUMI ≤ 125 gr/m2) AS patients were subdivided into four groups: Normal: no patients; Concentric Remodeling (RWT > 0.44, LVMI ≤ 125 gr/m2): 4 patients (7%); Concentric Hypertrophy (RWT > 0.44, LVMI > 125 gr/m2): 39 patients (70%); and Eccentric Hypertrophy (RWT ≤ 0.44, LVMI > 125 gr/m2): 13 patients [23%]. Eccentric hypertrophy patients had, as compared with those with concentric hypertrophy, a larger left ventricle (61 ± 6.5 mm vs 47.6 ±6 mm, P < 0.001), a smaller mean wall thickness (11.3 ± 1.2 vs 14.7 ± 1.7 mm, P ≤ 0.001), and reduced LV fractional shortening (FS%=22.9 ±11 vs 42.6 ±8.7%, P < 0.001). Furthermore, most patients (11/13) of the former group had heart failure due to LV systolic dysfunction, while only 16 of 39 patients of the latter group had heart failure and all but 2 had normal LV systolic function.

Conclusion: In patients with aortic stenosis, different forms of LV remodeling occur in response to chronic pressure overload. According to these results (and recent experi mental data), eccentric hypertrophy likely represents a late and more severe stage of LV remodeling in aortic stenosis.
Compressions of Carotid and Vertebral Arteries in Assessment of Intracranial Collateral Flow: Correlation Between Angiography and Transcranial Doppler Ultrasonography
Authors: Hedera Peter , Bujdáková Jarmila , Traubner Pavel
Published: July 2008

The authors examined 61 subjects with carotid angiography and 50 with vertebral angiography Angiograms were evaluated for collateral flow through the ophthalmic, anterior communicating, and posterior communicating arteries. The authors evaluated the patency of collateral vessels directly using trancranial Doppler ultrasonography; they made indirect detection after the compression of carotid and vertebral arteries while monitoring flow velocities in the middle cerebral artery. They established criteria for the hemodynamic significance of tested collateral vessels. A combination of carotid compres sions and transcranial Doppler ultrasonography detected the patency of the ophthalmic and anterior communicating arteries with a specificity and sensitivity of 1.00. Examination of the posterior communicating artery had a sensitivity of 0.97 and speci ficity of 0.98. Indirect evaluation of collateral vessels can not only detect their presence but also establish their hemodynamic significance with high accuracy
Digital Blood Flow Response to Body Warming, Cooling, and Rewarming in Patients with Raynaud's Phenomenon
Authors: Lau C.S. , Khan F. , Brown R. , Belch J.J.F.
Published: July 2008

Although the diagnosis of Raynaud's phenomenon (RP) is usually made easily from a careful history, the assessment of RP severity is difficult, for the vasopastic attacks are not easily induced under experimental conditions. In this study, the laser Doppler flowmetry (LDF) technique was used to quantify digital blood flow, which was standardized by body cooling and warming in patients with RP. Twenty-one healthy subjects and 56 RP patients were studied: 7 had primary RP, 22 had suspected secondary Raynaud's syndrome (susp RS), and 27 had systemic sclerosis (SSc)-associated secondary Raynaud's syndrome (SSc RS). The inherent variability in the acral cutaneous circulation was minimized by whole-body warming and cooling. Digital blood flow values at environmental temperatures of 40°C, 12°C, and after rewarming, to 40°C were recorded, as was the time taken for blood flow to reach 25%, 50%, and 75% of the full effects of whole-body cooling and rewarming.

Patients with primary RP and susp RS had normal blood flow values at ambient temperatures of 40°C, 12°C, and after rewarming to 40°C when compared with controls, but they had significantly faster vasoconstrictor responses to whole-body cooling, suggesting a heightened sympathetic activity. Additionally, they had slower vasodilator responses with longer 25%max response time to whole-body rewarming. Patients with SSc RS had significantly lower blood flow values at 40°C after initial warming and following subsequent rewarming, and despite a normal vasoconstrictor response to cooling, it took longer for them to vasodilate during rewarming, suggesting that poor digital blood flow in these patients may be more related to digital vasculature abnormalities and not an increase in sympathetic activity.

In conclusion, our assessment technique can be used to quantify digital blood flow in patients with RP and may be potentially useful in the investigation of the etiologic role of the sympathetic nervous system in RP.
Comparative Diagnostic Value of Ankle-to-Brachial Index and Transcutaneous Oxygen Tension at Rest and After Exercise in Patients with Intermittent Claudication
Authors: de Groote Pascal , Millaire Alain , Deklunder Guislaine , Marache Philippe , Decoulx Eric , Ducloux Gerard
Published: July 2008

Background: Few studies have compared sensitivities of ankle-to-brachial index (ABI) and transcutaneous oxygen tension (TcPO2) in a large group of patients with Leriche stage II intermittent claudication.

Method and Results: 111 patients (138 limbs) with a stable chronic (> three months) intermittent claudication and significant peripheral vascular disease (PVD) proved by angiography were studied. They performed a treadmill test (10%, 3 km/hr) limited by limb pain. ABI and TcPO2 were measured before, just after exercise, and after three and ten minutes of recovery in supine position.

Sensitivities per patient for ABI and TcPO2 were respectively at rest: 82.9% and 28.8%, and after exercise: 88.3% and 62.2%. Sensitivities per leg (n=138) for ABI and TcPO2 were respectively at rest: 73.9% and 26.8%, and after exercise: 82.6% and 34%. The sensitivity of TcPO2 increased to 56.5% after three minutes of recovery but was always less than that of ABI, which was maximal just after exercise (82.6%). The sensi tivity of the regional perfusion index was similar to that of TcPO2. The sensitivity of TcPO2 increased with respect to the Leriche stage and the number of lesions but was always lower than that of ABI. There was a weak correlation between TcPO2 and ABI after exercise, but no correlation was noted between maximal walking distance, ABI, and TcPO2.

Conclusion: TcPO 2 is not required in patients with Leriche stage II intermittent clau dication but might be useful either in severely affected patients (Leriche stage III or IV) or in selected patients.
Multiinfarct Dementia vs Alzheimer's Disease: Sonographic Criteria
Authors: Biedert Stefan , Förstl Hans , Hewer Walter
Published: July 2008

Primary degenerative dementia of the Alzheimer type (DAT) and multiinfarct dementia (MID) exhibit differences in cerebrovascular blood flow velocity profiles, which were investigated by means of transcranial Doppler sonography The pulsatility indices, as angle-independent parameters of peripheral vascular resistance, measured in middle cerebral and basilar arteries of patients with MID, were significantly increased (P < 0.005) with respect to cases of primary DAT and to healthy age-matched controls. Approximately 75% of all MID patients exhibited small-vessel disease rather than throm boembolism from the extracranial arteries and the heart, as judged by extracranial and transcranial Doppler sonographies, computerized cerebral tomographies, EEGs, and, if necessary, 2-D echocardiographies.
A New Echocardiographic Formula to Calculate Ejection Fraction by Using Systolic Excursion of Mitral Annulus
Authors: Çevik Y. , Degertekin M. , Başaran Y. , Turan F. , Pektaş O.
Published: July 2008

The correlation between echocardiographically and angiographically calculated ejection fraction and systolic excursion of the mitral annulus was studied in 81 patients. Knowing that the mitral annulus changes its size, shape, and position during the cardiac cycle, the authors measured systolic excursion of the annulus by 2D echocardiography. Displacement of the mitral annulus was measured from four different points (medial, lateral, anterior, posterior) by apical four-chamber and apical two-chamber approaches. Patients with and without regional wall motion abnormalities were included. Left ventric ular volumes and ejection fraction (EF) were calculated in the standard manner intro duced by Teichholz et al and also with biplane left ventriculography.

As a result, EF calculated by cineangiography, was moderately correlated with the Teichholz method (r=0.66) while it was highly correlated with measurements of mitral annular motion (MAM) (r=0.87). The correlation can be expressed by the regression equation, EF (angiography) =5.7 MAM (in mm) - 6.5. They conclude that measurements of annular motion is an easy and reliable index of left ventricular function as an alter native to traditional methods.
Angiographic Pattern Change in Fibromuscular Dysplasia
Authors: Sell James J. , Seigel Robert S. , Orrison William W. , Roberts William S.
Published: July 2008

Fibromuscular dysplasia (FMD) is an angiopathy that commonly affects the renal arteries but may affect other medium to large arteries, including the carotid artery. It has a variety of angiographic appearances, the most common of which is a string-of-beads pattern consisting of a segment of alternating stenoses and dilatations. This case documents that these patterns are not necessarily fixed. An initial angiogram in a patient with neurologic symptoms shows a string-of-beads pattern in the carotid artery. Later, this pattern is seen to convert to a smooth tubular form on follow-up arteriography. FMD may present angio graphically as a dynamic process.
Irregularity of the Left Hemidiaphragmatic Contour Caused by the Dilatated Left Inferior Phrenic Vein
Authors: Erden G. Ayşe , Maviş Ahmet V. , Cumhur Turhan
Published: July 2008

A patient with segmental narrowing of the inferior vena cava in whom the dilatated and tortuous left inferior phrenic vein was apparent on a plain chest radiogram as an irregu larity of the left hemidiaphragmatic contour is described.
Two Concurrent Spinal Dural Arteriovenous Fistulae in a Patient with Rapidly Progressive Myelopathy
Authors: Chaloupka John C. , Gobin Y. Pierre , Guglielmi Guido , Steichen John D. , Vinuela Fernando
Published: July 2008

A rare case of two separate spinal dural arteriovenous fistulae (DAVFs) occurring concurrently in a patient with a rapidly progressive myelopathy is reported. Although concurrent spinal DAVFs may be "well known," their occurrence has been only anec dotally reported. To the authors' knowledge, this well documented case of a presumably rare variant of spinal DAVFs is the first to appear in the literature and is instructive for reconsidering approaches to optimal diagnosis and evaluation of posttherapeutic efficacy of these lesions.
Safety of Echo-Dipyridamole Test in Elderly Patients with Coronary Artery Disease
Authors: Cicatiello A.M. , Landino P. , Simonelli P. , Del Mastro L. , Ferrara P. , Cioppa A. , Ciaburri F.
Published: July 2008

The authors prospectively studied the feasibility and safety of high-dose dipyridamole echocardiography in 166 patients (77 younger and 89 elderly patients) referred for clinical evaluation of coronary artery disease. Echocardiographic examinations were adequate for analysis of parameters considered in 135 of the 166 patients (81.3%; 73 elderly, 62 younger patients). The feasibility of dipyridamole echocardiography test was 80.5% in young and 82% in elderly patients (P = ns). The incidence of side effects during dipyridamole echocardiography was similar in the two groups, except for dyspnea, which was observed in 20.5% of older and 3.2% of younger patients (p<0.05). These data demonstrate that the dipyridamole test combined with echocardiographic monitoring of regional myocardial contractility may be considered a valid noninvasive method of eval uating coronary artery disease in the elderly.
Diagnosis of Right Pulmonary Artery Embolism by Transesophageal Echocardiography
Authors: Edasery B. , Arunabh  , Singh B. , Arunabh S.
Published: July 2008

The authors report a case of a fifty-one-year-old man undergoing rehabilitation therapy following a stroke who suddenly developed right-sided pleuritic chest pain with dyspnea. Transesophageal echocardiography was used to demonstrate a nonoc clusive right pulmonary artery embolus, when other investigative modalities failed to establish the diagnosis.
Skin Oxygen Pressure Histograms in Patients with Peripheral Arterial Occlusive Disease During Intraarterial and Intravenous Prostaglandin E1 Infusions of Different Dosages and Their Prognostic Value
Authors: Creutzig Andreas , Arnold Andreas , Caspary Ludwig , Thum Joachim , Alexander Klaus
Published: July 2008

Skin surface oxygen pressure fields (tcPO2 [37°C]) reproducibly characterize skin microcirculation in patients with peripheral arterial occlusive disease. These appear suited for investigation of short- and long-term effects of vasoactive drug treatment. The authors studied whether skin surface oxygen pressure histograms change depending on dosage and route of administration of prostaglandin E1 (PGE1), whether they are of predictive value for patients' clinical outcome, and whether they normalize after therapy with PGE1 . The authors investigated 15 patients with various degrees of disease and measured forefoot oxygen histograms consisting of at least 80 single tcPO2 (37°C) values before and during intraarterial infusion (1.5, 3, or 6 ng/kg/minute) and intravenous infusion (4.5, or 9 ng/kg/minute). The measurements were repeated two and six hours after the end of intraarterial application of 1.5 ng/kg/minute. Furthermore, the orthostatic vasoconstrictor response was tested. Skin oxygen pressure histograms were controlled after a period of twenty-two (mean) days of intraarterial PGE1 therapy.

Resting histograms were left shifted with median tcPO2 (37 ° C) between 1 and 7 mm Hg. During intraarterial application, histograms were shifted to lower tcPO 2 (37 ° C) values in most patients. Only in 3 diabetic subjects with proximal or acral obliterations was a marked increase observed. The alterations were detectable at least two hours after the end of the infusion. During intravenous infusion, histograms did not change in most cases. After long-term therapy, histograms were substantially unchanged. A pathologic vasoconstrictor response, which was present in 10 patients, could not be restored. Despite a marked deterioration of the histograms the clinical outcome was favorable in 7 patients. Patients with a high resting tcPO2 (37 ° C) (median 4 mm Hg and more) and those with a vasoconstriction on orthostasis are likely to respond to PGE1 therapy.
The Effects of Metformin on the Capillary Permeability to Albumin in Women Patients with Cyclic Edema
Authors: Valensi Paul , Behar Abraham , Andre Philippe , Wiernsperger Nicolas , Attali Jean-Raymond
Published: July 2008

An experimental work has suggested the efficacy of metformin, an oral antidiabetic agent, on capillary permeability. This agent has been tested in 10 women patients with cyclic edema, 7 of them being obese. The capillary permeability to albumin studied by an isotope test derived from Landis's method was initially increased. After a mean of six-weeks of treatment the albumin retention and an index demonstrating the interstitial protein elimination through the lymph route were significantly improved. Concomitantly, the swelling feelings were reduced in 8 cases and the lower limb edema had decreased or disappeared in 8 of 9 patients who initially presented these symptoms. The effects of metformin are beneficial and have been observed to be independent of glycemic change. The results suggest a special effect of this agent on the microcirculation. Nevertheless, a controlled study is required.
Predicting the Growth of Aortic Aneurysms: A Comparison of Linear vs Exponential Models
Authors: Hirose Yoshiaki , Hamada Seiki , Takamiya Makoto
Published: July 2008

The aim of the present study was to determine whether the growth curve of aortic aneurysms had a predictable pattern, specifically whether the growth pattern was better defined by a linear or exponential rate of growth. A twelve-year retrospective review was undertaken. The authors studied 59 patients with aortic aneurysm who have been followed up nonoperatively for more than three years with sequential computed tomographic (CT) scans. There was a total of 74 aortic aneurysms (thoracic aortic aneurysm [TAA] : 30, abdominal aortic aneurysm [AAA]: 44). The diameter of the aortic aneurysm was normalized by dividing by the initial diameter. Exponential ( y= A exp [ Bt]) and linear ( y= C + Dt) regression curves of growth of aneurysmal diameters were calculated, where y is the normalized diameter and t is the time after first CT examination in months. In regression analysis, the values fit well to the exponential growth curves, giving high regression coefficients. Exponential regression equations of TAA and AAA were y=1.0192 exp(0.0032t), r=0.720 andy=1.0129 exp(0.0045t), r=0.789, respectively. The results in favor of the exponential curve analysis were slightly higher than those favoring the linear curve.

This is the first study that showed the growth curves of aortic aneurysms. Aortic aneurysms may grow exponentially rather than linearly with time, and the growth curves might be useful for estimating the natural history or predicting the timing of surgery.
Effect of the Number of Ventricular Leads on Right Ventricular Hemodynamics in Patients with Permanent Pacemaker
Authors: Postaci Nursen , Ekşi Kenan , Bayata Serdar , Yeşil Murat
Published: July 2008

During pacemaker replacement most of the old leads are not suitable for recent needs or may show signs of dysfunction. These leads are difficult to extract and are therefore left-in situ.

In this study 32 patients with one ventricular lead (Group I) were compared echocardiographically with 18 patients with two ventricular leads (Group II) in regard to their right ventricular (RV) hemodynamics. Mean age of the patients in each group was sixty-one years. Patients were evaluated echocardiographically after two years of lead implantation. Two groups were compared for right atrial (RA) area, RA and RV diameters, tricuspid insufficiency (TI), and intravascular and intracardiac thrombosis.

There were no significant differences between the two groups in terms of RA and RV diameters, RA area, and venous and intracardiac thrombosis. In group I, 15 patients with (46.9%) grade I, 14 (43.7%) with grade II, and 3 (9.4%) with grade III TI were detected. In group II 2 patients (11.1%) with grade I, 6 (33.3%) with grade II, and 10 (55.6%) with grade III TI were detected.

In conclusion, the incidence of TI was more frequent and of higher degree in group II than in group I, but this finding was hemodynamically insignificant.
The Prevalence of Rheumatologic Disorders in Patients with Chest Pain and Angiographically Normal Coronary Arteries
Authors: Mukerji Basanti , Mukerji Vaskar , Alpert Martin A. , Selukar Rajesh
Published: July 2008

The purpose of this study was to determine the prevalence of musculoskeletal disorders in patients with chest pain and angiographically normal coronary arteries. The authors studied 40 consecutive patients with chest pain presenting at an Internal Medicine Clinic who had undergone coronary angiography and were found to have < 30% stenosis of all major coronary arteries. Patients with any known noncardiac cause of chest pain were excluded from the study. Each patient underwent a complete rheumatologic examination with x-rays and blood tests when indicated. The diagnosis of fibromyalgia was based on the presence of at least eight paired tender points. The diagnosis of costochondritis was made when palpation of the costal cartilages elicited tenderness. In the normal coronary artery group, 30% of the patients had fibromyalgia and 10% had costochondritis. In the control group of 40 patients with coronary artery disease, only 1 patient had fibromyalgia and none had costochondritis (P < 0.04). Other rheumatologic disorders were uncommon, with no statistical difference between the two groups. The authors conclude that many patients with chest pain and angiographically normal coronary arteries suffer from rheumatologic disorders with fibromyalgia being the most common.