bluuebunny/crossref_metadata_2025 huggingface dataset:
Validation of a Clinical-Significance-Based Classification of Coronary Artery Anomalies
Authors: Rigatelli Gianluca , Docali Giorgio , Rossi Paolo , Bandello Attilio , Rigatelli Giorgio
Published: March 2006

The clinical significance and subsequent management of the various types of coronary artery anomalies (CAAs) are different, as is the relationship to sudden death, coronary artery disease, and myocardial ischemia. A practical global classification based on clinical significance has not yet been proposed. This retrospective study was aimed at evaluating the current clinical significance of CAAs and the effectiveness of a clinical-significance-based classification. In a single-center retrospective study at a public hospital, a review of the last 5,100 coronary angiographies was performed in order to select patients with CAAs. The CAAs were classified into 4 categories on the basis of a literature review according to angiographic appearance and clinical significance: benign (class I); relevant—associated with fixed myocardial ischemia (class II); severe—related to sudden death (class III); and critical—associated with superimposed coronary artery disease (CAD) (class IV). Clinical and instrumental records of the selected patients were reviewed as well as the occurrence of cardiovascular events from the date of diagnosis to July 2002. Sixty-two patients (1.2%, women/men 20/42, mean age 65.3 ±10.6 years) had CAA on coronary angiography. From the above-described classification, 40 patients were categorized in class I (64.5%), 9 in class II (14.5%), 7 in class III (11.3%), and 6 in class IV (9.7%). During the follow-up (mean duration 60.4 ±12.3 months) most cardiovascular events and death occurred in class III and IV patients (71.3% and 100% respectively). A high correlation was found between significance level and percentage of patients with cardiovascular events ( r =0.99). Actuarial survival at 5 years was 82.9%. CAAs can be practically classified on the basis of clinical presentation and significance. This clinical classification may be useful in managing patients with CAA and personalizing their follow-up and therapeutic options according to their class and case histories.
Relationship Between Adrenomedullin and Left-Ventricular Systolic Function and Mortality in Acute Myocardial Infarction
Authors: Katayama Toshiro , Nakashima Hiroshi , Honda Yukiharu , Suzuki Shin , Yano Katsusuke
Published: March 2006

The purpose of this study was to investigate the relationship between plasma adrenomedullin concentration levels and left-ventricular systolic function in patients with acute myocardial infarction (AMI), and to assess whether these findings can be used to predict clinical outcomes, including mortality. One hundred twenty-four consecutive first AMI attack subjects were successfully reperfused with primary percutaneous coronary intervention therapy. Plasma adrenomedullin concentrations were evaluated at 24 hours from onset. Left ventriculograms of all patients taken in the acute (soon after reperfusion therapy) and subacute (21 ±9 days after onset) phases were used to evaluate left-ventricular ejection fraction (LVEF), and the difference in LVEF (delta-LVEF) between the two stages calculated. There were significantly more patients with cardiogenic shock in the H-Adm group (above the median value of plasma adrenomedullin concentrations ≥3.5 Fmol/mL) than in the L-Adm (<3.5 Fmol/mL) group (p<0.0001). There was significantly higher mortality in the H-Adm group (p<0.01). Multivariate analysis identified plasma adrenomedullin concentrations alone as an independent predictor of mortality (p<0.05). There were no significant differences in acute-stage LVEF between the groups. LVEF in the subacute stage was, however, significantly lower in the H-Adm group than in the L-Adm group (52 ±12% vs 59 ±11%, p<0.05). Also, delta-LVEF was significantly lower in the H-Adm group than in the L-Adm group (1.9 ±9.7% vs 6.3 ±10.3%, p<0.01). Plasma adrenomedullin concentrations in the early phase of AMI correlate closely with the severity of heart failure, and may offer important prognostic information about the risk of mortality. Our data suggest that plasma adrenomedullin concentrations may be an independent predictor of the deterioration of left-ventricular systolic function.
Vascular Complications of the Intra-aortic Balloon Counterpulsation
Authors: Mand’ák Jiří , Lonsky Vladimír , Dominik Jan , Zácek Pavel
Published: March 2006

From September 1994 to December 2002, 6,274 cardiosurgery operations were performed at the Department of Cardiac Surgery, University Hospital, Hradec Králové, Czech Republic. Intraaortic balloon counterpulsation (IABP) was applied in 192 cases (3.1%). From this group of 192 counterpulsated patients 103 were successfully treated (53.6%); 89 counterpulsated patients (46.4%) died from the surgical procedure (30-day mortality rate). In 5 cases (2.6%) from the group of 192, the IABP was introduced before the operation. Ischemic changes of the limb were observed in 11 cases (5.7%). Significant bleeding occurred at the site of puncture in 6 cases (3.1%). Dissection of the femoral and iliac arteries was found in 2 patients (1.0%), perforation of the iliac artery in 1 case (0.5%). In 2 cases (1.0%) the balloon was led into the venous system. In case report No. 1 an introduction of the balloon under a sclerotic plaque of the descending aorta and iliac artery is described. In case report No. 2 a placement of the balloon in the venous bloodstream is reported.
Complications of Cardiac Catheterization: A Single-Center Study
Authors: Batyraliev Talantbek , Ayalp M. Resat , Sercelik Alper , Karben Zarema , Dinler Gurkan , Besnili Fikret , Ozgul Sami , Perchucov Igor
Published: March 2006

In Turkey as well as in the whole world, cardiac catheterization is an invasive intervention that is being increasingly used both for diagnosis and treatment. With technological and pharmacologic development and experience, the indications for this intervention are ever increasing. This invasive intervention brings, of course, some complications with it. These may range from local ones to death. In this study the authors analyzed the local cardiac complications and those related to other systems that they encountered in 10,445 catheterizations conducted for diagnosis and treatment in their clinic over a 26-month period. They found the rate of all complications to be 3.54% (2.05% diagnostic, 9.1% therapeutic). Of these complications, 1.89% (0.80% diagnostic, 6.02% therapeutic) were cardiac, 1.27% (0.97% diagnostic, 2.4% therapeutic) local. They found that the ratios of death were 0.09% for diagnostic interventions, 1.13% for therapeutic interventions, and 0.31% altogether. In the diagnostic group 0.02% required urgent coronary bypass surgery, and 0.41% needed urgent coronary bypass surgery in the therapeutic group. In conclusion, despite the noticeable changes in patient profile and application, the ratios for cardiac catheterization have changed little over the years.
Evaluation of the Hemodynamic Performance of St.Jude Mitral Prostheses: A Pilot Study by Dobutamine-Stress Doppler Echocardiography
Authors: Rezaian Gholam Reza , Aghasadeghi Kamran , Kojuri Javad
Published: March 2006

In contrast to the widespread use of dobutamine stress Doppler echocardiography in the hemodynamic evaluation of the prosthetic valves in aortic position, it has been rarely, if ever, used for assessment of these valves in mitral position. Therefore, this pilot study was done to assess the hemodynamic performance of St. Jude prosthetic mitral valves (functional orifice area 25-31) with dobutamine-stress Doppler echocardiography. Twenty consecutive patients (13 women and 7 men, aged 23 to 42 years) who had undergone mitral valve replacement 6 to 4745 days previously and 16 healthy volunteers (5 women and 11 men, aged 18 to 42 years) underwent dobutamine-stress Doppler echocardiography. Dobutamine infusion was started at a rate of 5 µg/kg per minute and was increased by 5 µg increments at 3-minute intervals. Maximum and mean gradients as well as pressure halftime were measured at rest and at the end of each stage. The correlation between Doppler-derived variables versus the heart rate was assessed and a regression equation was obtained for each of them. A significant increase in blood pressure, heart rate, maximum and mean gradients was noted during dobutamine infusion in both groups. There was a significant positive linear correlation between the increasing transprosthetic mitral valvular maximum and mean gradients and the increments in the heart rate (Gmax = 4.47+ 0.093 [HR], r=0.474, p<0.05) and (Gmean = 3.0+0.003 [HR], r=0.2697, p<0.05), respectively, indicating the heart rate dependency of these parameters. Pressure halftime, on the other hand, had an inverse but linear relationship with the heart rate (PHT= 142 - 0.55 [HR], r=-0.577, p<0.05). Similar findings were found for the control group as well. Standard dobutamine-stress echocardiography can safely be performed in patients with St. Jude mitral valve prostheses. Single Doppler measurements of the pressure gradients and pressure halftime may yield erroneous conclusions regarding the function and size of these valves unless corrected for the patients simultaneous, online heart rate. The use of the regression equations obtained in this pilot study may help to partly overcome some of these difficult issues.
Iliac Vein Compression and Pulmonary Embolism in a Long Distance Runner: Computed Tomography and Magnetic Resonance Imaging
Authors: Cauley Keith , Wright Peter
Published: March 2006

Iliac vein compression is invoked as the explanation for deep venous thrombosis occurring more often in the left iliofemoral system than the right. The authors report a previously undescribed variant of iliac compression whereby a left iliac arterial aneurysm caused venous compression and resultant thrombosis. In this case the patient suffered a pulmonary embolism without symptoms of lower extremity venous thrombosis.
Supply of the Unilateral Circulation of the Brain by an Occipital Artery Anastomosis
Authors: Holodny Andrei I.
Published: March 2006

The author presents a case of occlusion of the right internal carotid artery in which the vertebral artery, the basilar artery and the entire right-sided anterior and posterior circulations were supplied by the right external carotid artery by way of an occipital-vertebral artery anastomosis. In this case, the usually small muscular branches of the occipital artery developed into collaterals capable of supplying the entire right side of the brain.
Pseudo-pseudoaneurysm of the Left Ventricle: A Rare Complication of Acute Myocardial Infarction
Authors: Lakkireddy Dhanunjaya R. , Khan Ijaz A. , Nair Chandra K. , Korlakunta Hema L. , Sugimoto Jeffrey T.
Published: March 2006

Rupture of the cardiac wall is usually a fatal complication of acute myocardial infarction within the first 2 weeks. However, in certain cases a ruptured ventricular wall is contained by overlying adherent pericardium called pseudoaneurysm, whereas a true aneurysm is one that is caused by scar formation resulting in thinning of the myocardium. The patients with pseudoaneurysm may survive until the aneurysm ruptures. In exceedingly rare instance, the rupture of the myocardium is not transmural but remains circumscribed within the ventricular wall itself, but in communication with the ventricular cavity. This finding is defined as pseudo-pseudoaneurysm. The authors report a case of postinfarction posterobasal pseudo-pseudoaneurysm along with review of the literature on the subject.
Malignant Cerebral Infarction Secondary to Internal Carotid Injury in Closed Head Trauma: Good Outcome with Aggressive Treatment
Authors: Çagavi Ferda , Tekkök Ismail H. , Akpınar Gökhan
Published: March 2006

A 25-year-old male patient in whom occlusion of the internal carotid artery developed secondary to a skull base fracture is presented. The diagnosis of internal carotid artery occlusion was reached 12 hours after the admission and 17 hours after the injury. The patient was initially treated for ischemic edema and when the patient showed signs of cerebral herniation, decompressive craniectomy was necessary. The outcome was good. The clinical and radiologic characteristics of internal carotid artery occlusion in closed head injury are highlighted and treatment options are reviewed in light of pertinent literature.
A Rare Type of Alternating Bundle Branch Block in a Patient with Cardiac Sarcoidosis
Authors: Konno Tetsuo , Shimizu Masami , Ino Hidekazu , Araki Tsutomu , Yamaguchi Masato , Inoue Masaru , Tofuku Yohei , Mabuchi Hiroshi
Published: March 2006

The authors report a rare type of alternating bundle branch block observed in a patient with cardiac sarcoidosis. Not only alternation of complete right and left bundle branch block but also narrow QRS complexes were observed on electrocardiogram. The mechanism of these unusual findings is briefly discussed.
Severe Lower Limbs Lymphedema Following Breast Carcinoma Treatment Revealing Radiation-Induced Constrictive Pericarditis
Authors: Granel B. , Gaudy C. , Serratrice J. , Ene Nicoleta , Mesana T. , Bonnet J. L. , Lepidi H. , Disdier P. , Piana L. , Weiller P. J.
Published: March 2006

In patients treated for breast carcinoma, unilateral lymphedema of the upper limb is usual. However, to the authors’ knowledge, lower limb lymphedema has never been reported as a complication of breast carcinoma therapy. They report here the first case of a radiation-induced constrictive pericarditis revealed by severe lower limbs lymphedema. A 60-year-old woman was treated for left breast carcinoma with quadrantectomy, axillary lymphadenectomy, and combined radio chemotherapy (60 grays). Three and a half years later she suffered from a diffuse and increasing lower limbs lymphedema, which became huge and disabling. Radiation-induced constrictive pericarditis was evidenced by right cardiac cavities catheterization. A dramatic improvement was rapidly obtained after pericardectomy. Histopathologic analysis of the pericardium did not reveal neoplastic cells. Radiation-induced constrictive pericarditis is usually responsible for lower limbs edema, but lymphedema is exceptional. This case highlights the need to search for a constrictive pericarditis also in the case of lower limbs lymphedema, particularly in a patient treated with mediastinal radiotherapy or combined radio chemotherapy.
Management of Cardiogenic Shock Due to Acute Coronary Syndromes
Authors: Bouki Konstantina P. , Pavlakis Georgios , Papasteriadis Evaggelos
Published: March 2006

Despite advances in the treatment of patients with acute coronary syndromes, there has been no significant decrease in the incidence of cardiogenic shock, while its mortality remains frustratingly high. Shock is a progressive state of hypotension (systolic blood pressure <90 mm Hg) lasting at least 30 minutes, which leads to systemic hypoperfusion. It is more common in patients with ST-segment elevation myocardial infarction than in patients with other acute coronary syndromes. Revascularization is associated with better outcomes than intensive medical therapy, especially in patients <75 years of age with cardiogenic shock. Adjunctive therapies include inotropes, vasopressor therapy, intra-aortic balloon pump counterpulsation, and IIb/IIIa blockade to prevent no-reflow phenomenon during primary percutaneous transluminal coronary angioplasty. Other adjunctive therapies which are investigated are improved mechanical support devices, and as medical therapy for myocyte protection nicorandil, glucose/insulin/potassium infusions and direct inhibition of Na+/H+ exchanger.
Effect of Direct Stent Implantation on QTc Dispersion
Authors: Atmaca Yusuf , Ozdol Cagdas , Ertas Fatih , Altın Timucin , Gülec Sadi , Oral Dervis
Published: March 2006

The aim of this study was to evaluate whether direct stenting is superior to conventional stent implantation technique with respect to QTc dispersion in prospectively selected patients with simple lesion morphology and class II stable angina undergoing elective coronary stenting. One hundred thirty-four consecutive patients were divided into 2 groups based on the stenting technique used: the direct stenting without predilation group, group I (n=64), and the stenting with predilation group, group II (n=70). All patients had single-vessel disease. The primary end point of the study was the QTc dispersion at the 24th hour and at the first month after the procedure and the secondary end point of the study was the major clinical events (MCEs) rate in the hospital period and up to 1 month. Baseline maximum QTc, minimum QTc, and QTc dispersion were not different between the 2 groups. QTc dispersion decreased from 47 ±8 msec before stent implantation to 41 ±11 msec at 24 hours and 37 ±7 msec 1 month after angioplasty in group I (p<0.006 and p<0.01, respectively), whereas QTc dispersion decreased from 49 ±9 msec before stent implantation to 46 ±8 msec at 24 hours and 42 ±10 msec 1 month after angioplasty in group II (p<0.03 and p<0.01, respectively). Compared with group II, the decrease in QTc dispersion was significantly greater at the 24th hour and at the first month after the procedure in group I (p<0.003 and p<0.001, respectively). There was a decreased trend toward MCE rate in group I in relation to that of group II, but the statistical difference was not significant. Direct stenting is a feasible and safe technique. It is superior to conventional stenting technique in decreasing the QTc dispersion at the 24th hour and at the first month after the procedure, whereas it is equivalent to single-vessel conventional stent implantation technique with respect to MCEs rate in the short-term period.
Safety and Efficacy of Enalapril in Multivalvular Heart Disease with Significant Mitral Stenosis—SCOPE-MS
Authors: Chockalingam Anand , Venkatesan S. , Dorairajan Smrita , Chockalingam V. , Subramaniam T. , Jaganathan V. , Elangovan S. , Alagesan R. , Gnanavelu G. , Arul A. S.
Published: March 2006

Angiotensin-converting enzyme inhibitors (ACEI) are often used in preventing and treating heart failure due to regurgitant valve disease. The majority of patients with symptomatic rheumatic heart disease (RHD) have significant mitral stenosis (MS) and are denied ACEI therapy, because of the fear of hypotension in the presence of fixed obstruction. The authors assessed the safety and efficacy of ACEI in 109 consecutive patients with RHD and with significant mitral stenosis (mitral valve orifice, MVO <1.5 cm2) and with NYHA class III or IV heart failure symptoms. Mean age was 33.1 ±12 years, systolic blood pressure (BP) was 111 ±10, and diastolic BP was 73 ±8 mm Hg. MS was significant in 100 patients with mitral regurgitation in 46, aortic regurgitation in 19, and pulmonary hypertension in 60 patients. After initial stabilization, enalapril 2.5 mg bid was started in hospital and titrated up to 10 mg bid over 2 weeks. NYHA status, Borg score, and 6-minute walk test were assessed at baseline, and at 1, 2, and 4 weeks. Seventy-nine of the 100 patients who completed the study had severe MS (MVO <1.0 cm2). Enalapril was well tolerated by all study patients without hypotension or worsening of symptoms. NYHA class (3.2 ±0.5 baseline vs 2.3 ±0.5 at 4 weeks, p<0.01) Borg Dyspnea Index (7.6 ±1.3 vs 5.6 ±1.3, p<0.01), and 6-minute walk distance (226 ±106 vs 299 ±127 m, p<0.01) improved significantly with enalapril. Patients with associated regurgitant lesions showed more improvement in exercise capacity (120 ±93 vs 39 ±56 m, p<0.001). Enalapril was well tolerated in patients with RHD with moderate and severe MS. Irrespective of the valve pathology, enalapril improved functional status and exercise capacity with maximum benefit in patients with concomitant regurgitant valvular heart disease.
Clinical, Echocardiographic, and Hemodynamic Characteristics of Rheumatic Mitral Valve Stenosis and Atrial Fibrillation
Authors: Kabukçu Mehmet , Arslantas Esin , Ates Ismail , Demircioglu Fatih , Ersel Filiz
Published: March 2006

Chronic atrial fibrillation (AF) is associated with an increased frequency of embolic events and negative impact on cardiac function, and therefore, an increased morbidity and mortality risk in patients with rheumatic mitral valve stenosis (RMS). In the present study, the clinical, 2-D and Doppler echocardiographic, and left- and right-heart hemodynamic data were evaluated for 92 patients (68 women) with RMS and AF and compared with data from 118 patients (88 women) with RMS with sinus rhythm. The clinical, echocardiographic, and hemodynamic evaluations were performed within 1 to 7 days of each other. Patients with AF were older (45.7 ±13.4 vs 38.6 ±12.0 years, p<0.01) and had a longer symptomatic period (108.2 ±117.9 vs 50.6 ±53.1 months, p<0.01) compared with those with sinus rhythm. Most of the patients with AF were in NYHA functional capacity 3-4 (74% vs 19%), whereas most of the patients with sinus rhythm were in NYHA functional capacity 2. Patients with AF had a higher mitral valve score based on morphologic features ranging from 4 to 16 depending on the severity of disease (8.3 ±2.1 vs 6.5 ±1.9, p<0.01) and greater left ventricular end-diastolic diameter (LVEDD) (52.3 ±8.7 vs 47.7 ±8.7 mm, p<0.02), and end-systolic diameter (LVESD) (34.4 ±7.5 vs 30.9 ±7.5 mm, p<0.01). Organic tricuspid valve involvement was diagnosed more frequently in patients with AF (61% vs 32%, p<0.01). Mild mitral regurgitation was also more frequent in patients with AF (71% vs 51%, p<0.03). The mitral valve area was similar in patients with and without AF (1.30 ±0.39 vs 1.39 ±0.41 cm2, p>0.05). Mean diastolic mitral valve gradient and pulmonary artery pressure did not differ in patients with and without AF. Right atrial pressures were higher in patients with AF (7.6 ±3.3 vs 6.3 ±1.9 mm Hg, p<0.02). The authors suggest that (1) AF occurred in older patients, who had a longer disease process and more serious symptoms; (2) hemodynamic derangements (mitral valve gradient, pulmonary artery pressure) did not differ in patients with and without AF; (3) greater mitral valve score, more tricuspid valve involvement, higher LVEDD, which are suggestive of greater rheumatic activity process were more frequently seen in patients with AF than in those without AF. These findings support the opinion that AF is a marker of widespread rheumatic damage in patients with RMS.
HR, 0-(Beta-Hydroxyethyl)-Rutosides; (Venoruton®): Rapid Relief of Signs/Symptoms in Chronic Venous Insufficiency and Microangiopathy: A Prospective, Controlled Study
Authors: Cesarone M. R. , Belcaro G. , Pellegrini L. , Ledda A. , Vinciguerra G. , Ricci A. , Gizzi G. , Ippolito E. , Fano F. , Dugall M. , Acerbi G. , Cacchio M. , Di Renzo A. , Stuard S. , Corsi M.
Published: March 2006

The aim of this independent study was to demonstrate the rapidity of the clinical action of HR 0-(beta-hydroxyethyl)-rutosides, Venoruton® (Novartis Consumer Health) in patients with chronic venous insufficiency (CVI). Two groups of patients with venous hypertension and microangiopathy were treated with HR (1 or 2 g/day, for 8 weeks). Twelve patients (age 56.4; range 44-66; M:F = 6:6) were included in group 1 (1 g/day) (moderate CVI and microangiopathy); 10 patients (age 57.4; range 42-67; M:F = 5:5) in group 2 (2 g/day) with more severe CVI and microangiopathy. Average ambulatory venous pressure (AVP) was 58.6 (range 50-65) with a refilling time (RT) shorter than 10 seconds. There were no significant differences in AVP and RT between the 2 groups, but the duration of the disease was longer in group 2: 3.5 years (SD 2.0) in group 1 and 6.4 years (SD 3.3) in group 2. All included subjects completed the study and no dropouts were observed. In both dose groups there was a progressive decrease in laser Doppler resting flux (RF), indicating improvement in microangiopathy and a significant decrease in capillary filtration (RAS) associated with a significant improvement in analogue scale line score (ASLS) and edema. Although the effect in the 2 g dose group was more rapid on the microcirculatory parameters with a significant effect on RF and RAS after 4 days (effect of 1 g per day after 8 days and 6 days, respectively), there was no difference in the time to onset of a significant clinical improvement (ie, the ASLS and the edema score): 4 days in both groups. Venous microangiopathy and edema were improved by the treatment with HR within a few days. The effects were visible with both dosages, in both severity groups.
Matrix Metalloproteinases and Diabetic Vascular Complications
Authors: Kadoglou Nikolaos P. , Daskalopoulou Stella S. , Perrea Despina , Liapis Christos D.
Published: March 2006

Diabetes mellitus (DM) is associated with an increased incidence of cardiovascular events and microvascular complications. These complications contribute to the morbidity and mortality associated with DM. There is increasing evidence supporting a role for matrix metalloproteinases (MMPs) and their inhibitors (tissue inhibitors of matrix metalloproteinases—TIMPs) in the atherosclerotic process. However, the relationship between MMPs/TIMPs and diabetic angiopathy is less well defined. Hyperglycemia directly or indirectly (eg, via oxidative stress or advanced glycation products) increases MMP expression and activity. These changes are associated with histologic alterations in large vessels. On the other hand, low proteolytic activity of MMPs contributes to diabetic nephropathy. Within atherosclerotic plaques an imbalance between MMPs and TIMPs may induce matrix degradation, resulting in an increased risk of plaque rupture. Furthermore, because MMPs enhance blood coagulability, MMPs and TIMPs may play a role in acute thrombotic occlusion of vessels and consequent cardiovascular events. Some drugs can inhibit MMP activity. However, the precise mechanisms involved are still not defined. Further research is required to demonstrate the causative relationship between MMPs/TIMPs and diabetic atherosclerosis. It also remains to be established if the long-term administration of MMP inhibitors can prevent acute cardiovascular events.
Effect of Cholesterol Lowering and Cardiovascular Risk Factors on the Progression of Aortoiliac Arteriosclerosis: A Quantitative Cineangiography Study
Authors: Campeau Lucien , Lespérance Jacques , Bilodeau Luc , Fortier Annik , Guertin Marie-Claude , Knatterud Genell L.
Published: March 2006

The post-Coronary Artery Bypass Graft (Post-CABG) trial has shown that aggressive compared to moderate lowering of low-density lipoprotein cholesterol (LDL-C) delayed the progression of obstructive disease in aortocoronary saphenous vein grafts and in the left main coronary artery. Patients had been allocated to high- and low-dose lovastatin therapy for a 4-5 year period. The present study evaluated the effect of LDL-C lowering and the role of cardiovascular risk factors on the progression of arteriosclerosis in the distal abdominal aorta and common iliac arteries. From one of the participating centers of the post-CABG trial, 145 patients who had adequate imaging of the aortoiliac arteries at baseline and follow-up were included. Angiographic outcomes, presumed to reflect progression of arteriosclerosis and obtained from lumen diameter (LD) measurements using quantitative cineangiography, were as follows: significant decrease of the minimum lumen diameter (LD) and increase of the maximum LD, percent lumen stenosis, and percent lumen dilatation. These outcomes were not significantly less frequent in patients randomly allocated to aggressive compared to moderate LDL-C lowering. Of 9 cardiovascular risk factors, only 2 were significantly related to progression of aortoiliac arteriosclerosis. Current smoking predicted both percent lumen stenosis increase and, to a lesser degree, percent lumen dilatation increase (p=0.010 and p=0.055, respectively). Abnormally high body mass index (BMI ≥25 kg/m2) correlated with percent lumen dilatation increase (p=0.006). Aggressive compared to moderate LDL-C lowering did not prevent or delay the progression of aortoiliac arteriosclerosis. Smoking predicted both lumen narrowing and dilatation presumably caused by arteriosclerosis. Abnormally high BMI, reflecting overweight or obesity, was strongly associated with vessel dilatation.
Fractions of Total Plasma Homocysteine in Patients with Ischemic Stroke Before the Age of 55 Years
Authors: Sobol Anna B. , Bald Edward , Loba Jerzy
Published: March 2006

The mechanism responsible for the association between elevated circulating homocysteine levels and ischemic stroke remains unclear. Therefore, the authors assessed total plasma homocysteine (tHcy) and its fractions (free [fHcy] and protein-bound [bHcy] homocysteine) in patients with ischemic stroke before the age of 55 years. Fifty patients (23 men, mean age 46.8 ±7.6 years) with ischemic stroke or transient ischemic attacks, with symptoms lasting <72 hours were enrolled. In this group: 32 (64%) patients had hypertension; 12 (24%), ischemic heart disease (IHD); and 20 (40%), type 2 diabetes mellitus (DM). The control group consisted of 30 matched healthy individuals (17 men, mean age 44.6 ±6.2 years). The tHcy, fHcy, and bHcy levels were determined by high-performance liquid chromatography. tHcy and its fractions did not differ significantly between patients and controls. However, stroke patients with hypertension had significantly higher concentrations of tHcy and bHcy compared to stroke patients without hypertension (tHcy 13.0 ±3.3 vs 10.7 ±3.2 µmol/L, p<0.05; bHcy 9.7 ±2.6 vs 7.8 ±2.3 µmol/L, p<0.01, respectively); fHcy was borderline significant: 3.1 (1.5-6.5) vs 2.5 (1.8-5.3) µmol/L, p=0.05. The presence of IHD, DM, hyperlipoproteinemia, clinical subtypes of stroke, smoking, and family history of stroke did not influence these parameters. In the group of 50 patients, tHcy correlated with mean systolic blood pressure (BP) ( r =0.3, p<0.05) and bHcy correlated with mean systolic and mean diastolic BP ( r =0.3, p<0.05). These findings suggest an association between hypertension and redox status of Hcy in patients with ischemic stroke before the age of 55 years. This observation supports the hypothesis that elevated BP may contribute to Hcy-related vascular injury.
Hyperthyroidism and Complete Atrioventricular Block
Authors: Topaloglu Serkan , Topaloglu Oya Yanık , Ozdemir Ozcan , Soylu Mustafa , Demir Ahmet Duran , Korkmaz Sule
Published: March 2006

Although cardiovascular manifestations in thyroid disorders are frequently encountered in clinical practice, atrioventricular (AV) conduction disorders, especially in hyperthyroidism, are rare. There are some proposed mechanisms for AV blocks in hyperthyroidism but the exact mechanism is still unknown. The authors report 2 cases with thyroid function disorders and complete AV block, and the electrophysiologic characteristics of these 2 patients, and they review and speculate on similar reported cases.
Severe Aortic Regurgitation in Von Recklinghausen’s Disease
Authors: Pantazopoulos N. J. , Moyssakis I. , Perakis A. , Votteas V.
Published: March 2006

A 71-year-old man with von Recklinghausen’s disease presented with NYHA class II exertional dyspnea and easy fatigability since about 20 days. Echocardiography and angiography demonstrated dilatation of aortic root, ascending aorta, and left ventricle, together with severe aortic regurgitation. Because of very few cases of cardiovascular abnormalities having been reported with von Recklinghausen’s disease, it is logical to concur that this is simply co-existence, whereas other possible mechanisms are endothelial dysfunction or sympathetic denervation.
Thrombocytopenia, Immunoglobulin Treatment, and Acute Myocardial Infarction
Authors: Amit Guy , Yermiyahu Tikva , Gilutz Harel , Ilia Reuben , Zahger Doron
Published: March 2006

Platelets play a pivotal role in the pathophysiology of the acute coronary syndromes, and platelet inhibition is a cornerstone in the management of these patients. Patients with profound thrombocytopenia who present with an acute coronary syndrome present a difficult challenge. The authors report a patient with immune thrombocytopenic purpura who presented with acute myocardial infarction despite a very low platelet count and who sustained recurrent infarction after receiving immune globulin treatment. The best management of thrombocytopenic patients with acute coronary syndromes is uncertain, but extreme caution is needed before efforts are made to raise the platelet count in order to allow conventional treatment.
Graft Infection of Thoracic Aorta Due to Group Cb-Hemolytic Streptococcus
Authors: Arima Hisatomi , Nagata Masaharu , Fujisaki Kiichiro , Gushima Masaki , Matsumura Kiyoshi , Fujii Koji , Tsuchihashi Takuya , Hirakata Hideki , Eguchi Takashi , Moroi Yoichi , Furue Masutaka , Yasui Hisataka , Tsuneyoshi Masazumi , Iida Mitsuo
Published: March 2006

A fatal case of late-onset graft infection of the thoracic aorta due to group C b-hemolytic streptococcus is described. A 37-year-old male patient, who had a history of total aortic arch replacement for acute aortic dissection 8 years before, was admitted to the department. He suffered from toxic shock syndrome, disseminated intravascular coagulation (DIC), and acute renal failure. Group C b-hemolytic streptococcus was detected from his blood; however, echocardiography, computed tomography (CT), and magnetic resonance imaging (MRI) failed to detect the focus of the infection. In spite of intensive care, including antibiotic therapy, artificial ventilation, and continuous hemodiafiltration, he died on the 18th day of hospitalization. Autopsy revealed that a small abscess was present at the proximal anastomotic segments of the patient’s graft. A bite inflicted by his dog, 14 days before admission, was suspected to be the source of this bacterium. A rare case of graft infection of thoracic aorta in terms of causative organism, long period from graft replacement to graft infection, and site of infection is presented and discussed.
Increased Fasting Plasma Insulin Concentrations are Associated with the Severity of Angiographic Coronary Artery Disease
Authors: Sukhija Rishi , Aronow Wilbert S. , Nayak Devraj , Ahn Chul , Weiss Melvin B.
Published: March 2006

Fasting plasma insulin concentrations were obtained in 82 patients (51 men and 31 women), mean age 60 ±11 years, with a body mass index >25 kg/m2 who had coronary angiography because of suspected symptomatic coronary artery disease (CAD). Obstructive CAD was diagnosed if there was >50% obstruction of ≥1 vessel. Of 82 patients, 37 (45%) had left main or 3-vessel CAD, 22 (27%) had 2-vessel CAD, 9 (11%) had 1-vessel CAD, and 14 (17%) had no obstructive CAD. Among the 4 groups, there was no significant difference in gender, age, dyslipidemia, and smoking. Hypertension (p=0.0003), diabetes mellitus (p=0.035), and increased fasting plasma insulin concentration (p<0.0001) were significantly associated with the severity of CAD. Stepwise ordinal logistic regression analysis identified increased fasting plasma insulin concentrations in these obese subjects as a significant independent risk factor for the severity of angiographic CAD (p<0.0001).
Homocysteine, Lipid Profile, Nitric Oxide, Vitamin B12, and Folate Values in Patients with Premature Coronary Artery Disease and Their Children
Authors: Pac Feyzanur Ayse , Ozerol Elif , Ozerol Ibrahim Halil , Temel Ismail , Ege Erdal , Yologlu Saim , Sezgin Nurzen , Sahin Kazim , Emmiler Mustafa , Pac Mustafa , Aslan Halil
Published: March 2006

The plasma concentrations of homocysteine and lipoprotein A are independent risk factors for atherosclerotic vascular disease. Nitric oxide (NO) and folate values are also important in atherogenesis. The authors aimed to evaluate these parameters in patients having coronary artery bypass surgery (CABS) before 50 years of age and in their children. In 31 patients having CABS, 47 children of these patients, and 28 normal control subjects, homocysteine, NO, vitamin B12, folate, lipoprotein A, triglyceride, total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, apolipoprotein A1, and apolipoprotein B values were determined. Homocysteine values of the patients with premature coronary heart diseases and their children were significantly higher than those of controls (p<0.031 and p<0.006, respectively). Also, NO levels were significantly higher in both groups than in controls (p<0.001 and p<0.031, respectively). B12 values were significantly higher in both groups (p<0.05 and p<0.033, respectively). Lipoprotein A levels were higher in both groups but not significantly so.
Exercise-Induced QRS Amplitude Changes in Patients with Isolated Myocardial Bridging: A Marker of Myocardial Ischemia
Authors: Turkmen Muhsin , Barutcu Irfan , Esen Ali Metin , Karakaya Osman , Esen Ozlem , Basaran Yelda
Published: March 2006

Myocardial bridging (MB) of coronary arteries has been considered as an incidental angiographic finding; however, several reports suggest its association with angina pectoris, myocardial ischemia, and even infarction. In this study the authors aimed to assess exercise-induced QRS changes in patients with isolated MB and to compare those with coronary artery disease (CAD) and healthy subjects. The study population consisted of 17 patients with angiographically proven MB (group 1), 16 patients with left anterior descending (LAD) artery stenosis (group 2), and 14 healthy subjects (group 3). Each subject underwent treadmill exercise testing according to Bruce protocol. In each subject amplitude of the Q, R, and S waves in leads aVF and V5 was measured manually before and immediately after exercise. The Athens QRS score was calculated by subtracting the Q-, R-, and S-wave differences in leads aVF and V5. Baseline characteristics of each group were similar. There was no difference among the groups with respect to exercise testing parameters (peak heart rate, blood pressure, test duration, etc). In group 1, ST-segment depression ratio was found to be higher than that of group 3 but lower than that of group 2. In group 1, exercise QRS score was found to be lower than that of group 3 while it was higher than that of group 2 (2.9 ±2.3 vs 6.5 ±3.2 p=0.001 and 2.9 ±2.3 vs 2.6 ±2.4 p=0.001, respectively). In patients with MB exercise, QRS score was significantly lower than in those with normal coronary flow while it was higher in those with CAD. This may result from exercise-induced ischemia at the area perfused by the bridged artery.
Increased Levels of Soluble Adhesion Molecules E-Selectin and P-Selectin in Patients with Cardiac Syndrome X
Authors: Senen Kubilay , Ileri Mehmet , Alper Aysin , Yetkin Funda , Atak Ramazan , Hisar Ismet , Yetkin Ertan , Turhan Hasan , Bardakçı Haşmet , Demirkan Deniz
Published: March 2006

The role of endothelial dysfunction and platelet activation in patients with cardiac syndrome X is controversial. The aim of this study was to investigate the plasma levels of circulating E- and P-selectin molecules in patients with syndrome X. The study included 21 patients with cardiac syndrome X (11 men and 10 women, mean age = 56 ±5 years) and 20 patients with significant coronary artery disease who had stable angina pectoris (11 men and 9 women, mean age = 60 ±8 years). Twenty-two age- and sex-matched subjects (12 men and 10 women, mean age = 58 ±8 years) undergoing diagnosis of atypical chest pain in whom coronary arteries were found normal and exercise test had no signs of ischemia served as the control group. Syndrome X was defined as presence of typical chest pain on exertion or at rest with positive exercise test and angiographically normal epicardial coronary arteries with no evidence of coronary spasm after intracoronary infusion of ergonovine maleate. The mean plasma concentrations of P-selectin were significantly elevated both in patients with coronary artery disease and syndrome X as compared with control subjects (49.15 ±7.47 and 42.80 ±8.93 vs 22.63 ±6.47 ng/mL, p<0.001). Similarly, both patients with coronary artery disease and syndrome X had higher plasma concentrations of E-selectin than the control group (78.85 ±16.69 and 68.38 ±15.30 vs 36.43 ±4.72 ng/mL, p<0.001). In conclusion, patients with syndrome X had increased plasma concentrations of soluble adhesion molecules, E-selectin and P-selectin, reflecting an ongoing chronic inflammation involved with endothelial dysfunction and enhanced platelet activation/damage in this setting.
Prevention of Edema and Flight Microangiopathy with Venoruton ® (HR), (0-[Beta-Hydroxyethyl]Rutosides) in Patients with Varicose Veins
Authors: Cesarone M. R. , Belcaro G. , Ricci A. , Brandolini R. , Pellegrini L. , Dugall M. , Di Renzo A. , Vinciguerra G. , Gizzi G. , Cornelli U. , Errichi B. M. , Corsi M. , Ippolito E. , Adovasio R. , Cacchio M. , Stuard S. , Larnier C. , Candiani C. , Cerritelli F.
Published: March 2006

The aim of this open study was the evaluation of the effects of HR (Venoruton®) at a dose of 1 g/day on the prevention and control of flight microangiopathy and edema in subjects with varicose veins and moderate chronic venous insufficiency flying for more than 11 hours. Patients with varicose veins, edema, but without initial skin alterations or complications, were included. Measurements of skin laser Doppler (LDF) resting flux (RF) venoarteriolar response (VAR), ankle swelling (RAS), and edema were made within 12 hours before and within 3 hours after the flights. The resulting edema after the flights was evaluated with a composite edema score (analogue scale line). A group of 20 subjects was treated with HR (1 g/day, starting 2 days before the flight and 1 g for every 12 hours on day of travel). Another group of 18 subjects formed the control group. The length of the flights was between 11 and 13 hours; all seats were in coach class. Fifty patients were enrolled and 38 patients were evaluable at the end of the trial. The 2 groups (treatment and control) were comparable for age and sex distribution. The decrease in RF was significant in both groups with a higher flux at the end of the flight in the HR group (p<0.05). The venoarteriolar response was decreased at the end of the flights; the decrease was lower in the HR group (p<0.05). The increase in RAS and the edema score were significantly lower in the HR group. In conclusion HR is useful for reducing the level of microangiopathy and the increased capillary filtration and in controlling edema in patients with venous disease in long flights. The higher level of flux and VAR and the reduction in edema indicate a positive effect of HR on the microcirculation. This study confirms that HR prophylaxis is effective to control flight microangiopathy associated with edema.
Aminophylline: Exploring Cardiovascular Benefits Versus Medical Malcontent
Authors: RuDusky Basil M.
Published: March 2006

Although aminophylline/theophylline has been relegated to third- and fourth-line status in the cardiopulmonary armamentarium, its use in specific pathophysiologic states, especially those of cardiac etiology, can be of significant benefit. The consulting clinician should maintain an awareness of its potential as adjunctive therapy in cases of atrioventricular block, cardiac arrest, heart failure, and bradyarrhythmias in particular. It should not yet be shelved as an archaic agent.
Heparin-Induced Thrombocytopenia—A Potential Iatrogenic Complication for Patients with Cardiac and Vascular Disease
Authors: Sanfelippo Peter M.
Published: March 2006

Physicians involved in the care of patients with cardiac and vascular problems regularly employ heparin in treatment regimens of inpatients and outpatients. Heparin-induced thrombocytopenia is an important complication that can result in significant morbidity and mortality. It is reasonable, therefore, to review the pathogenetic mechanisms involved, the identification of heparin-induced thrombocytopenia, and the management to minimize morbidity and mortality.
Cardiovascular Effects of Type 1 Diabetes Mellitus in Children
Authors: Stakos Dimitrios A. , Schuster Dara P. , Sparks Elizabeth A. , Wooley Charles F. , Osei Kwame , Boudoulas Harisios
Published: March 2006

Previous studies have shown that type 1 diabetes mellitus (DM) is associated with cardiovascular abnormalities. Early detection and treatment of these abnormalities may help to prevent the natural progression of the disease. The present study was undertaken to define early cardiovascular abnormalities in children with type 1 DM. Simultaneous evaluation of multiple cardiovascular parameters was performed in 14 children with type 1 DM and 14 age- and gender-matched normal subjects. Measurements of carotid artery intima-media thickness (cIMT, echocardiography), carotid and aortic (ascending and abdominal) distensibility (echocardiography, brachial artery blood pressure), aortic pulse wave velocity (carotid to femoral artery, Doppler), and left ventricular dimensions, mass, and function (echocardiography) were performed. Diabetic children demonstrated a greater cIMT (0.36 ±0.04 mm vs 0.31 ±0.03 mm, p=0.002) and decreased carotid artery distensibility (4.4 ±1.6 cm2·dynes-1·10-6 vs 6.0 ±1.9 cm2·dynes-1·10-6, p<0.01) compared to control. Aortic pulse wave velocity was increased in DM (6.70 ±0.39 vs 6.30 ±0.31, p=0.02) compared to control. Left ventricular diameters, mass, and systolic and diastolic function did not differ between the 2 groups. Simultaneous assessment of multiple cardiovascular parameters in children with type 1 DM revealed impaired carotid artery structure and function, and decreased elastic properties of the aorta, before demonstrable changes in left ventricular structure and function could be detected.
Feasibility of Dual-Chamber (DDD) Pacing via a Single-Pass (VDD) Pacing Lead Employing a Floating Atrial Ring (Dipole): Case Series, Future Considerations, and Refinements
Authors: Kassotis John , Voigt Louis , Mongwa Mbu , Reddy C. V.R.
Published: March 2006

The objective of this study was to assess the feasibility of DDD pacing from a standard single-pass VDD pacemaker system. Over the past 2 decades significant advances have been made in the development of single-pass VDD pacing systems. These have been shown in long-term prospective studies to effectively preserve atrioventricular (AV) synchrony in patients with AV block and normal sinus node function. What remains problematic is the development of a single-pass pacing system capable of DDD pacing. Such a lead configuration would be useful in those patients with peripheral venous anomalies and in younger patients with congenital anomalies, which may require lead revisions in the future. In addition, with the increased use of resynchronization (biventricular pacing) therapy, the availability of a reliable single-pass lead will minimize operative time, enhance patient safety, and minimize the amount of hardware within the heart. The feasibility of DDD pacing via a Medtronic Capsure VDD-2 (Model #5038) pacing lead was evaluated. Twenty patients who presented with AV block and normal sinus node function were recruited for this study. Atrial pacing thresholds and sensitivities were assessed intraoperatively in the supine position with various respiratory maneuvers. Five patients who agreed to participate in long-term follow-up received a dual-chamber generator and were evaluated periodically over a 12-month period. Mean atrial sensitivity was 2.35 ±0.83 mV at the time of implantation. Effective atrial stimulation was possible in all patients at the time of implantation (mean stimulation threshold 3.08 ±1.04 V @ 0.5 ms [bipolar], 3.34 ±0.95 V @ 0.5 ms [unipolar]). Five of the 20 patients received a Kappa KDR701 generator, and atrial electrical properties were followed up over a 1-year period. There was no significant change in atrial pacing threshold or incidence of phrenic nerve stimulation over the 1-year follow-up. A standard single-pass VDD pacing lead system was capable of DDD pacing intraoperatively and during long-term follow-up. Despite higher than usual thresholds via the atrial dipole, pacemaker telemetry revealed <10% use of atrial pacing dipole over a 12-month period, which would minimally deplete the pacemaker’s battery. In addition, the telemetry confirmed appropriate sensing and pacing of the atrial dipole throughout the study period. At this time such systems can serve as back-up DDD pacing systems with further refinements required to optimize atrial thresholds in all patients.