bluuebunny/crossref_metadata_2025 huggingface dataset:
Ergonovine maleate test detects anginal patients with poorly reproducible exercise tests
Authors: Brunelli C. , Spallarossa P. , Ghigliotti G. , Lantieri P. , Iannetti M. , Caponnetto S.
Published: August 2009

The aim of the study is to evaluate the reproductability of exercise testing and to determine whether there any correlation between the reproducibility of exercise and response to the ergonovine maleate test. Thirty‐ patients with mixed angina and documented artery disease underwent an ergonovine maleate test four exercise tests on consecutive days in the same conditions. The ergonovine test was positive in 20 patients (Group I) and negative in 18 patients (Group II). There were no significant differences in the clinical and angiographic data of the two groups. All 152 exercise tests were positive. The variability of the response of the repeated tests was assessed by means of an analysis of the following parameters: heart rate, blood pressure, rate‐pressure product, watts, and minutes were recorded at the onset of ischemia (ST| ≥ 0.1 mV). Range (maximal‐minimal obtained value), ratio between range and maximal obtained value, and coefficient of variation (standard deviation/mean of the four parameters) were calculated for each patient. The analysis of these values demonstrated that while the test was reproducible in some patients, a high individual variability was present in others. Moreover, the individual variability results were higher in Group I than in Group II, with a statistically significant difference for all considered parameters. In conclusion, it is possible to have a poorly reproducible exercise test in patients with mixed angina. The correlation between a positive ergonovine test and a poorly reporducible exercise test suggests that abnormal coronary vasomotion may sometimes be present during exercise and may affect the reproducibility of the test.
Quinidine treatment of chronic lone atrial fibrillation
Authors: De Noouer C. , Sparling C. M.
Published: August 2009

Patients with chronic lone atrial fibrillation (LAF) were treated with quinidine according to a special schedule to establish sinus rhythm and prevent recurrences. Twenty‐seven patients following this schedule were identified retrospectively to prevent relapses, quinidine had been continued in 25 patients in doses 100 mg qid lower than those used for conversion. In 8 of the latter group, quinidine had to be discontinued or reduced. All patients converted to sinus rhythm. If well tolerated, quinidine prevented recurrence of LAF in 75% of those on long‐term (mean follow ‐ up 3.5 years) prophylaxis. After discontinuation of quinidine in 8 patients, LAF recurred in all but one patient. Side effects were observed in 22% of the patients and precluded continuation of the prophylaxis in 15%. No incidence of torsade de pointes was encountered.
Doppler assessment of interventricular pressure gradient across isolated ventricular septal defect
Authors: Garg A. , Shrivastava S. , Radhakrishanan S. , Dev V. , Saxena A.
Published: August 2009

Continuous wave Doppler ultrasound was used to estimate the pressure gradient between the right and left ventricle for assessment of pulmonary arterial systolic pressure in 30 patients with isolated ventricular septal defect and for subsequent comparison with similar data obtained on cardiac catheterization. The age of the patients ranged from 8 months to 45 years (6.8± 8.6 years).No Patient had right or left ventricular outflow tract obstruction. Doppler measurements were done within 24 h of cardiac catheterization. Pressure gradient across ventricular septal defect on cardiac catheterization ranged from 7 to 95 mmHg (48 ± 24 mmHg) and that on Doppler assessment ranged from 8 to 78 mmHg (42 ± 20 mmHg).Doppler measurements of interventricular pressure gradient correlated well with those obtained on cardiac catheterization (r=0.90, P<0.001). Correlation was better in patients with pressure gradient across ventricular septal defect <075 mmHg (r=0.96). Correlation was poor in three of five patients with very small ventricular septal defects (interventricular pressure gradient >75 mmHg) because the jet used was not ideal. Thus continuous wave Doppler ultrasound is an accurate noninvasive means of measuring pressure gradient across ventricular septal defect, which is a useful parameter for assessment of pulmonary artery systolic pressure in patients with isolated ventricular septal defect without right and left ventricular outflow tract obstruction.
Frequency analysis of the first heart sound for patients on chronic hemodialysis
Authors: Ishizuka T. , Furuya N.
Published: August 2009

According to Adolph et al., valuable information on the nature of myocardium can be obtained through frequency analysis of first heart sounds (SI) during the isometric contraction phase (ICP). We compared dominant frequencies (DF), which were defined as the frequency of maximum sound voltage, of SI among 37 outpatients undergoing chronic hemodialysis (HD group) and 28 outpatients with neurosis (control group). Heart sounds, which were obtained at apex by a sound microphone and polygraph, were analyzed into frequency spectra by the maximum entropy method through a computer. Left ventricular dimensions and wall thickness were measured by echocardiography. Histories of hemodialysis ranged from 4 to 164 months, with an average of 54 months. Age and body weight of patients before each hemodialysis were comparable with control subjects. Although systolic blood pressure, left ventricular mass (LVM), and combined left ventricular mass (CLVM), which means LVM and the blood it contains, showed higher values in the HD group, the ratio of LVM and CLVM and ejection fraction were almost equal in both groups. Therefore, if elastic tissue of myocardium of HD patients is less, lower DF is expected. However, DFs were 22.6 ± 7.8 Hz in the HD group and 22.6±9.6 Hz in the control group. It was concluded that (1) hypertension and overhydration were not primary causes of uremic cardiomyopathy, and (2) myocardium of HD patients received no significant damage if cardiac function remained intact, even through left ventricular hypertrophy and dilatation were induced.
Do antiarrhythmic drugs work? some reflections on the implications of the cardiac arrhythmia suppression trial
Authors: Singh B. N.
Published: August 2009

Despite major advances in our understanding of the mechanisms of cardiac arrhythmias and how antiarrhythmic drugs appear to work, there remains much doubt whether these agents reduce arrhythmic mortality except in certain subsets of patients. The results of the Cardiac Arrhythmia Suppression Trial (CAST) have indicated that certain antiarrhythmic drugs not only “fail to work” but may substantially increase mortality. The effects of Class Ic agents in CAST and the meta‐analysis of randomized antiarrhythmic trials in the survivors of acute infarction suggest that drugs that act primarily by delaying conduction are particularly deleterious in the survivors of acute infarction. Whether these data have a wide applicability in terms of all ventricular arrhythmias is unclear, but beta‐blockers remain the only class of agents that in control trials have been shown to reduce sudden death. The effect appears to be related to beta‐blockade and not to suppression of premature ventricular contractions (PVCs). Beta blockers appear to act by preventing ventricular fibrillation. It is reasonable to assume that PVC suppression per se is unlikely to produce a reduction in sudden death. Uncontrolled data with amiodarone suggests that it has the potential to prolong survival by controlling arrhythmias. The effects of amiodarone and beta blockers, both significantly attenuating adrenergic stimulation, provide pharmacologic probes to define the crucial determinants of efficacy of a compound for mortality reduction in high risk survivors of myocardial infarction. The focus must now shift from antiectopic and antiarrhythmic agents that delay conduction to those that exert antifibrillatory actions by sympathetic antagonism and those that exhibit the added property of lengthening myocardial refractoriness.
Left ventricular free wall rupture following acute myocardial infarction and cardiac amyloid
Authors: Shirani J. , Bonin M. A. , Gould N. , Silver M. A.
Published: August 2009

A 74‐year‐old man died of left ventricular free wall rupture 6 days following an acute inferoposterior wall myocardial infarction. His hospital course was complicated by pump failure which proved resistant to inotropic support, diuresis, and percutaneous transluminal coronary angioplasty. At necropsy, extensive amyloid deposition was noted. This case constitutes an unusual clinical setting for myocardial rupture because of the severity of systolic left ventricular dysfunction as well as cardiac amyloidosis.
A case of biopsy‐proven myocarditis progressing to autopsy‐proven dilated cardiomyopathy
Authors: Matoba Y. , Matsumori A. , Ohtani H. , Tominaga M. , Fujiwara H. , Kawai C. , Toyokuni S. , Midorikawa O. , Takahashi K.
Published: August 2009

A 22‐year‐old man presented with congestive heart failure following flulike symptoms. The diagnosis of acute myocarditis was confirmed by endomyocardial biopsy, which revealed mild infiltration of inflammatory cells. A favorable response to beta‐adrenergic receptor blockade was seen, and the patient was discharged without symptoms. Five months later, however, congestive heart failure recurred, and intracardiac thrombi were demonstrated. The patient died after two months. Postmortem examination revealed left ventricular dilatation with slight interstitial fibrosis; the diagnosis was dilated cardiomyopathy. Thus, progression of biopsy‐proven myocarditis to dilated cardiomyopathy 10 months after the onset of disease was documented.
Ventricular tachycardia and ventricular aneurysm due to unrecognized sarcoidosis
Authors: Jain A. , Starek P. J. K. , Delany D. L.
Published: August 2009

Cardiac involvement due to sarcoidosis is well recognized. Arrhythmias have been recognized in up to 50% of patients who have cardiac involvement. We report on two patients with no systemic manifestations of sarcoidosis who presented with refractory ventricular tachycardia. Evaluation demonstrated atypical left ventricular “aneurysms” with normal coronary arteries. Surgical pathology demonstrated granulomas consistent with sarcoidosis. Despite extensive surgical resection, they continued to have symptomatic ventricular tachycardia requiring implantation of a defibrillator. Recognition of sarcoidosis as an etiology for ventricular tachycardia and aneurysm is important for possible avoidance of surgery.
Nitroglycerin‐induced hypotension, bradycardia, and asystole: Report of a case and review of the literature
Authors: Brandes W. , Santiago T. , Limacher M.
Published: August 2009

A 36‐year‐old man presented with a prolonged history of chest pain, and was given two sublingual nitroglycerin tablets. Subsequently, the patient became hypotensive, bradycardic, apneic, and lost consciousness. The bradycardia resolved spontaneously. No evidence for acute myocardial infarction or ischemic disease was found. Thirty‐four cases reported to date are reviewed, demonstrating that this response appears to be an independent effect of nitroglycerin taken in any form, in patients with and without myocardial infarction and to be unpredictable, especially without evidence of inferior or right ventricular infarction. Careful monitoring is warranted when administering nitroglycerin.
Role of lipoprotein peroxidation in the pathogenesis of atherosclerosis
Authors: Steinbrecher P.
Published: August 2009

Oxidative modification of low‐density lipoprotein (LDL) has been shown to alter its properties in a way that tends to increase its atherogencity. Cultured arterial endothelial cells and smooth muscle cells can promote LDL oxidation in vitro. Several recent studies have provided evidence for the presence of oxidized LDL in atherosclerotic lesions. Furthermore, treatment of atherosclerosisprone rabbits with an antioxidant was found to slow the progression of aortic lesions. Additional experimental work is required to determine if LDL oxidation is indeed an important causal step in atherogenesis in humans, but the preliminary data are encouraging and offer the potential for a new approach to the prevention and therapy of atherosclerosis.
The underlying coronary lesion in myocardial infarction: Implications f coronary angiography
Authors: Little William C. , Downes Thomas R. , Applegate Robert J.
Published: August 2009

Myocardial infarction is usually caused by sudden thrombotic occulusion of a coronary artery at the site of a fissured atherosclerotic plaque. Recent evidence suggests that coronary angiography may be insensitive in detecting and quantitaing atherosclerosis. Serial angiographic studies demonstrate that the majority of myocardial infarctions occur due to occlusion of arteries that previously did not contain angiographically significant (>50%) stenoses. Similarly, quantitative angiography performed after thrombolytic therapy indicates that the coronary lesion underlying the clot is frequently not severely stenotic. Thus, an angiographically apparent stenosis is not necessary for the development of a thrombotic occlusion resulting in an MI. These observations suggest that coronary angiography does not accurately predict the site of a subsequent, occlusion that will produce a myocardial infarction.
Prognosis in acute myocardial infarction in relation to development of Q waves
Authors: Karlson Biorn W. , Herlitz Johan , Richter Arina , Hjalmarson Åke
Published: August 2009

In a totally nonselected group of patients with acute myocardial infarction (AMI) (n=921) admitted from the emergency department to the coronary care unit or other hospital ward, the occurrence of non‐Q‐wave AMI and the prognosis in these patients was determined and compared with those in whom Q waves were developed. Fifty‐two percent had AMI without new Q waves. Patients with a non‐Q‐wave AMI differed from patients with Q‐wave AMI, more frequently having a previous history of AMI (p<0.001), angina pectoris (p<0.01), diabetes mellitus (p<0.05), congestive heart failure (p<0.001), and a higher mean age (p<0.001), whereas smoking was more common in Q‐wave AMI. Patients with non‐Q‐wave AMI had a 1‐year mortality of 31% compared with 26% in Q‐wave AMI (p>0.2) and a reinfarction rate of 20% compared with 12% for Q‐wave AMI (p<0.01). Among patients aged less than 75 years without a previous history of AMI, congestive heart failure, and diabetes mellitus, the 1‐year mortality rate was 16% for patients with Q waves versus 15% for those without Q waves (NS). Appearance of Q waves was not independently associated with death. We conclude that in a nonselected group of patients with AMI the occurrence of a non‐Q‐wave AMI is much higher than previously reported. The prognosis in AMI during one year of follow‐up is not associated with development of Q waves.
Different hemodynamic (24‐h ambulatory blood pressure monitoring) and renin‐inhibiting effect of a 1‐week treatment with enalapril and lisinopril
Authors: Cocco G. , Hari J.
Published: August 2009

Ambulatory blood pressure and heart rate monitoring were used for comparing the antihypertensive effect of a 1‐week treatment with enalapril and lisinopril 10 mg once daily (double‐blind crossover placebo‐controlled study). Twelve outpatients with mild to moderate hypertension were treated. Both drugs had a significant and identical hypotensive effect. Neither drug affected the diurnal rhythm of blood pressure or heart rate. Therefore the two drugs are equipotent antihypertensive agents. Both drugs inhibited ACE activity to a highly significant extent, but in this regard lisinopril was more effective than enalapril. However, lisinopril's greater ACE inhibition was not accompanied by a greater hypotensive effect. The clinical value of this difference is not yet established.
Painless myocardial ischemia in elderly patients compared with middle‐aged patients and its relation to treadmill testing and coronary hemodynamics
Authors: Kurita Akira , Takase Bonpei , Uehata Akimi , Maruyama Toshiharu , Nishioka Toshihiko , Sugahara Hiroko , Mizuno Kyoichi , Isojima Kazushige , Satomura Kimio
Published: August 2009

We compared painless ST‐segment depression (1 mm ≥ 80 ms and lasting ≥ 60 s) in elderly patients with coronary artery disease (≥ 65 years, mean 67 years; n = 22) and that of middle‐aged patients (<60 years, mean 54 years; n = 20) by Holter monitoring for 24 hours to determine the relationship between episodes of painless myocardial ischemia, findings of treadmill testing, and coronary hemodynamics. Coronary arteriographic findings (Gensini score) and ejection fraction (EF) did not differ between the two groups. Painless ST‐segment depression was found to be 77% in the older age group versus 45% in the middle‐aged group (p<0.05). However, treadmill exercise score, ST‐segment depression, and ST‐segment integral achieved did not differ significantly between the two groups. Within 2 weeks after the above testing, coronary hemodynamic study was performed. The increment of coronary sinus flow in the older age group was 1.4±0.3 versus 1.8±0.3 in the middle‐aged group (p<0.05), and the change of lactate extraction ratio from the basal condition in the older age group was −50±40% versus −2±15% in the middle‐aged group (p<0.05). We conclude that episodes of painless myocardial ischemia in elderly patients with aging may be associated with the impairment of the coronary vascular reserve and easier anaerobic myocardial metabolism by pacing stress despite similar findings of coronary artery disease and EF in both groups.
Evolution of the electrocardiographic changes in patients with hypertrophic cardiomyopathy
Authors: Tendera Michal , Polonski Lech , Wodniecki Jan , Kardaszewicz Piotr
Published: August 2009

In 75 patients with hypertrophic cardiomopathy (HCM) followed for a mean period of 5.5 years (range 2‐20 years), evolution of the electrocardiographic (EKG) changes was assessed. Progression of EKG abnormalities occurred in 35 patients (47%). It was manifested by an increase in precordial QRS voltage in 33 patients, development of new P‐wave mitral in 11 patients, and development or disappearance of pathologic Q waves in 14 patients. With follow‐up times >5 years, 5‐8 years, and >8 years, EKG progression was present in 27, 41, and 80% of patients, respectively. Age <30 years at the beginning of study and left ventricular outflow obstruction predisposed to EKG progression within 5‐8 years. Patients with progressive EKG changes were more prone to experience clinical deterioration than those without EKG progression (63 vs. 15%, p<0.001). With chronic verapamil administration, progression of EKG abnormalities occurred insignificantly less often than with propranolol treatment (35 vs. 64%, p=0.20). It is concluded that with long‐term follow‐up, HCM tends to progress in a significant proportion of adult patients.
Subjective visual echocardiographic estimate of left ventricular ejection fraction as an alternative to conventional echocardiographic methods: Comparison with contrast angiography
Authors: Mueller X. , Stauffer J. C. , Jaussi A. , Goy J. J. , Kappenberger L.
Published: August 2009

Left ventricular ejection fraction (LVEF) is a measure of ventricular function with clinical and prognostic significance and can be reliably calculated with various M‐mode and two‐dimensional echocardiographic formulas in selected, good quality echocardiographic formulas in selected, good quality echocardiograms. Subjective visual echocardiographic estimate of LVEF is a potentially less time consuming and more widely applicable method. In order to test its reliability, we performed a prospective blind trial in 40 consecutive patients undergoing biplane contrast ventriculography (BCV), to compare the visual estimate of LVEF during a complete echocardiogram of three independent observers with (1) cubed M‐mode formula, (2) Teichholz M‐mode formula, (3) length‐area method from the four‐chamber view, and (4) Simpson's single plane formula. BCV was the reference method. The best correlation with BCV was obtained by visual estimate [r of the three observers, respectively=0.75; 0.84; 0.81] and M‐mode measurements [r (1)=0.8; r(2)=0.8], but the most sophisticated methods provided the poorest estimate [r (3)=0.54; r(4)=0.49]. All correlation coefficients improved when good studies, defined as a definition of the endocardial surface of more than 75%, were selected (n=23), but the differences persisted. One observer systematically estimated higher values than the other two (Friedman's test, p<0.01) and this interobserver variability suggests that each echocardiographer should test himself against BCV in his lab in order to apply the visual estimate method reliably.
Endomyocardial biopsy in infants and children with cardiomyopathy
Authors: Narayan R. , Menahem S. , Chow C. W. , Dennett X.
Published: August 2009

We reviewed our experience of endomyocardial biopsy performed on 21 symptomatic infants and children with cardiomyopathy. Clinical congestive cardiomyopathy was noted in 18 patients, 2 had hypertrophic cardiomyopathy, and 1 a restrictive cardiomyopathy. The biopsy findings led to a diagnosis of hemiochromatosis in one patient, Adriamycin cardiomyopathy in another, and lymphocytic myocarditis in a third. Five patients had features of endocardial fibroelastosis, one endomyocardial fibrosis, and a further one, a mitochrondrial abnormality. In 11 patients normal or nonspecific features were seen. There were 2 myocardial perforations, both patients being successfully resuscitated. Endomyocardial biopsy, although occasionally hazardous, may sometimes provide valuable information which may lead to a diagnosis, facilitate treatment, and be of prognostic value. Despite the low positive yield, it may still be indicated in selected patients, in view of the seriousness and often poor prognosis of this disorder: 5 of our study group subsequently died.
Beta Receptor Derangement in Postinfarction Left Ventricular Perianeurysm Tissue
Authors: Levett James M. , Mcgrath Lynn B. , Bianchi John M.
Published: August 2009

The purpose of this study was to evaluate alterations in adrenergic receptor density in patients with postinfarction left ventricular aneurysms. Resected specimens from 4 patients with left ventricular aneurysm were studied using standard techniques to evaluate beta receptors, alpha receptors, and muscarinic receptors in the border zone, perianeurysm tissue, Only the beta receptors demonstrated up‐regulation around the aneurysm (p=0.0003). This indicates that infarction with aneurysm formation can alter adrenergic receptor density, which may affect cellular response and predispose to arrhythmogenesis.
Comparison of respiratory response of jogging in place and bruce treadmill exercise test
Authors: Papazoglou N. , Loussidis P. , Giannoulopoulos A. , Tsarouchas P. , Kioussis A. , Karatzas N. B.
Published: August 2009

A comparison of the respiratory responses of jogging in place, an alternative exercise test we recently proposed, was made with those of the Bruce exercise test. We obtained on‐line measurements of heart rate, ventilation, oxygen uptake, and carbon dioxide production from 9 healthy subjects of mean age 25 years. There was a higher heart rate and ventilatory response with jogging than with the Bruce test, but by 10 minutes the responses of the two tests were similar. Oxygen consumption, while higher with jogging, rose in parallel with that of the Bruce test from the second to the seventh min, and the change of the ration of minute ventilation to oxygen consumption indicated that the anaerobic threshold occurred earlier during jogging. These results swhow that jogging in place is more vigorous than the graded exercise test and may produce ischemia earlier.
Single‐lead VDDpacing: Excellence or expedience?
Authors: Katritsis Demosthenes , Camm A. John
Published: August 2009

The interest in VDD pacemakers has been renewed by the introduction of single‐pass leads, and continuing modifications and technical developments promise significant improvement. However, convincing long‐term data confirming the reliability and the use of newer leads are not yet available. Compared with VVIR pacemakers VDD pacing has theoretical advantages over the VVIR mode, offering better hemodynamic and endocrine responses. However, its range of indications is narrow and rate adaptation is essential when sinus node chronotropic inadequacy is present or likely to occur. In addition, on certain occasions a VDD pacemaker may not maintain persistent atrial‐synchronous pacing, thus necessitating the use of a DDD unit.
Catheter balloon valvuloplasty of stenotic aortic valves—part II: Balloon valvuloplasty during life subsequent tissue examination
Authors: Waller Bruce F. , Van TASSEL James W. , Dorros G. , Lewin R. F. , King J. F. , Mckay Charles
Published: August 2009

This review discribes 23 patients with aortic valve stenosis who underwent balloon valvuloplasty during life and had subsequent valve tissue examined at the time of aortic valve replacement or at necropsy. Of 23 stenotic aortic valves, 17 were examined within 30 days (early) after balloon dilation. Of these 94% had non‐rheumatic (nonfused commissures) etiologies for the aortic stenosis. Of the 6 valves examined after 30 days (late) (restenosis), mechanisms of restenosis involve refusion of split commissures and probable elastic recoil. Clinical prediction of the aortic stenosis etiology prior to balloon valvuloplasty may help predict short‐and long‐term success of the dilation procedure.
Refractory cardiogenic shock and complete heart block after unsuspected verapamil‐sr and atenolol overdose
Authors: Frierson John , Bailly Daniel , Shultz Theodore , Sund Sheila , Dimas Alex
Published: August 2009

A 57‐year‐old female presented with complete heart block and then developed refractory hypotension despite temporary pacing. Moderate left ventricular dys‐function with focal wall motion abnormalities, as well as severe hypoxemia, were demonstrated. However, neither significant coronary disease nor evidence for pulmonary embolus or other lung disease could be determined. Hemodynamic stabilization was achieved with the use of an intra‐aortic balloon pump and multiple high‐dose pressor agents. A retrospective diagnosis of toxic verapamil‐SR and atenolol ingestion was confirmed, and the patient gradually recovered. The relevant literature is reviewed and various treatment approaches are discussed.
Role of echo/doppler in the diagnosis of pulmonary embolism
Authors: Torbicki Adam , Tramarin Roberto , Morpurgo Mario
Published: August 2009

Echocardiography supplemented with pulsed and continuous wave Doppler facilities is a potent diagnostic tool in many cardiovascular disorders. Its potential role in the management of patients with suspected pulmonary embolism, though less extensively studied, deserves attention. Benefits of echo/Doppler in these patients are as follows

Echo/Doppler is a noninvasive, relatively inexpensive technique, readily available and repeatable in critically ill patients at the bedside.

Echo/Doppler provides a number of independent parameters related to the pulmonary hemodynamics. These parameters include

Characteristics of blood flow velocity curves across the right heart valves as well as systolic and diastolic time intervals of the right ventricle

Motion pattern of the interventricular septum

Dimensions of the heart chambers and inferior vena cava

Thickness of the right ventricular free wall

Echocardiography allows detection of thrombi within right heart chambers or in major branches of the pulmonary artery in some patients.

Echo/Doppler may disclose alternative abnormalities explaining symptoms found in a patient with suspected pulmonary embolism such as pericardial disease, myocardial infarction, aortic dissection, hypovolemic shock, etc.
Pulmonary artery diastolic pressure: A simultaneous doppler echocardiography and catheterization study
Authors: Ge Zhiming , Duran C. M. G. , Zhang Yun , Ji Xiaoping , Fan Dongsheng
Published: August 2009

Pulmonary hypertension is an important determinant of the clinical presentation of and surgical approach to patients with heart disease. To confirm the utility of continuous wave Doppler echocardiography in assessing the pulmonary artery diastolic pressure in patients with pulmonary regurgitation, 51 patients representing the wide hemodynamic spectrum of pulmonary artery pressure underwent simultaneous determination of pulmonary artery diastolic pressure by continuous wave Doppler echocardiography and cardiac catheterization. Pulmonary artery diastolic pressure was estimated from the Doppler recordings by the end‐diastolic pressure gradient obtained by the modified Bernoulli equation plus the estimated right atrial pressure. A correlation was observed (r=0.935, SEE=7.4 mmHg) between Doppler and catheterization pulmonary artery diastolic pressure. In addition, comparison between the mean diastolic pressure. In addition, comparison between the mean diastolic pressure gradient across the pulmonary valve by Doppler and pulmonary artery diastolic pressure at catheterization yielded a high correlation (r=0.947, SEE=5.1 mmHg). These data demonstrate that continuous wave Doppler echocardiography is a useful noninvasive technique for evaluating the pulmonary artery diastolic pressure in patients with pulmonary regurgitation.
Coronary angiography using 4‐french preformed catheters‐percutaneous brachial approach
Authors: Kitazume Hidemasa , Kubo Ichiro , Ageishi Yoshio , Iwama Toru
Published: August 2009

4‐French preformed catheter systems were developed for coronary angiography. After several new technical features were introduced, these catheters were applied in 384 outpatients between January 1989 and December 1989. Diagnostic coronary angiography was performed in all cases without major complications. In the left coronary artery, 4.0 cm left Judkins catheters were generally used; however, 3.5 cm left Judkins catheters were used if the patient was ≤164 cm tall and left Amplatz catheters were employed for those ≥165 cm tall. Although 4.0 cm right Judkins catheters were mainly used for right coronary arteries, there were no predictive factors for subsequent catheter selection. This technique is believed to be suited to meet the increasing demand for coronary angiography.
Comparison of clinical, morphological, and prognostic features in hypertrophic cardiomyopathy between japanese and western patients
Authors: Chikamori Taishiro , Mckenna William J. , Doi Yoshinori L. , Akizawa Masashi , Yonezawa Yoshihiro , Ozawa Toshio
Published: August 2009

Apical hypertrophic cardiomyopathy appears to be more common in Japan than in the West. Explanations for this difference include variable methods and criteria for the diagnosis. To assess morphological, clinical, and prognostic differences, 45 consecutive Japanese and 45 age‐ and gender‐matched Western patients with hypertrophic cardiomyopathy were evaluated in two referral institutions by the same individuals. The diagnosis of hypertrophic cardiomyopathy was based on the echocardiographic demonstration of unexplained left ventricular hypertrophy. Patients were aged 8 to 64 years (mean 50); there were 66 males and 24 females. The pattern of left ventricular hypertrophy was similar in Japanese and Western patients: asymmetric septal 64 vs. 76%, concentric 22 vs. 13%, and apical 13 vs. 11% (p = NS). The incidence of an echocardiographic or Doppler calculated left ventricular gradient of >30mmHg was similar (11 vs. 18%; p = NS). The maximal left ventricular wall thickness was greater in Western patients (23 ± 7 vs. 20 ± 4 mm; p = 0.03), but was not different when adjusted for body surface area. Clinical features including incidence of family history and ventricular tachycardia during 24‐h ambulatory electrocardiography were similar. During follow‐up (4.9 ± 4.0 years for Western vs. 4.4 ± 2.0 years for Japanese), disease‐related mortality was worse in Western patients (p < 0.05; 10 versus 2 patients). This evaluation, using the same diagnostic methods and criteria, reveals a worse prognosis in Western patients despite a similar clinical and morphological spectrum of hypertrophic cardiomyopathy.
Syncope and seizures of psychogenic origin: Identification with head‐upright tilt table testing
Authors: Grubb Blair P. , Gerard Gary , Wolfe Douglas A. , Samoil Daniela , Davenport Charles W. , Homan Richard W. , Temesy‐Armos Peter
Published: August 2009

Psychogenic seizures and psychogenic syncope are common disorders but are difficult to identify. Head‐upright tilt table testing has emerged as a promising means of evaluating vasovagally mediated syncope and convulsive syncope. Of a total of 42 patients evaluated by head‐up tilt for recurrent syncope and 10 evaluated for recurrent idiopathic seizures, a total of 5 patients experienced syncope and 3 had tonic‐clonic seizure activity unaccompanied by any significant changes in blood pressure, heart rate, transcranial Doppler cerebral blood flow velocity, and electroencephalographic monitoring. Psychiatric evaluation revealed that seven patients suffered from conversion reactions and one from probable malingering. We conclude that patients who pass out or convulse during head‐upright tilt without any change in physiologic parameters can be presumed psychogenic in origin and may be referred for psychiatric evaluation without further expensive diagnostic studies.
Diastolic left ventricular function after renal transplantation in patients with normal and hypertrophied myocardium
Authors: Hüting Jürgen
Published: August 2009

While diastolic left ventricular (LV) dysfunction is frequent and associated with cardiovascular complications in end‐stage renal disease treated with dialysis, controversial information exists on diastolic LV function after renal transplantation. Therefore, Doppler echocardiographic parameters of LV diastolic filling were analyzed in 17 transplanted patients with normal LV mass (< 150 g/m2; mean: 128 ± 17 g/m2) and 24 transplanted patients with LV hypertrophy (>150 g/m2; mean: 197 ± 36 g/m2) and compared with 28 normal controls without and 11 controls with LV hypertrophy. Mean age (normal vs. increased LV mass: 46 ± 13 vs. 48 ± 11 years; p = NS) and transplantation duration (60 ± 35 vs. 50 ± 37 months; p = NS) were comparable between renal patients, while systolic blood pressure (136 ± 12 vs. 149 ± 14 mmHg; p < 0.02) and serum creatinine (1.55 ± 0.45 vs. 1.98 ± 0.76 mg/dl; p < 0.05) were higher in patients with than without LV hypertrophy. In transplanted patients with LV hypertrophy, peak early/atrial filling velocity ratios were decreased (1.17 ± 0.34 vs. 0.94 ± 0.34; p < 0.05), mean atrial filling fractions were increased (37 ± 7% vs. 42 ± 7%; p < 0.05), and isovolumic relaxation periods were prolonged (86 ± 23 vs. 106 ± 26 ms; p < 0.02) compared with transplanted patients with normal LV mass. The frequency of pathologic peak early/atrial filling velocity ratios (12 vs. 42%; p < 0.05), atrial filling fractions (12 vs. 25%; p = NS) and isovolumic relaxation periods (6 vs. 29%; p = NS) was higher in transplanted patients with than without LV hypertrophy. Individual ratios of peak early/atrial filling velocity were inversely correlated with age in transplanted patients with normal LV mass (p < 0.002), and atrial filling fractions were correlated with LV mass index in transplanted patients with LV hypertrophy (p < 0.01). Diastolic LV function was comparable in both groups of transplanted patients with their corresponding non‐renal controls. It is concluded that, in transplanted patients, diastolic LV filling is comparable to nonrenal controls; it is age‐dependent in patients with normal LV mass and mass‐dependent in those with LV hypertrophy.
Incidence of sudden atheltic deaths between 1985 and 1990 in marion county, indiana
Authors: Waller Bruce F. , Waller Bruce F. , Hawley Dean A. , Clark Michael A. , Pless John E.
Published: August 2009

Relatively little information is available concerning the incidence of sudden death in athletes in the United States. The present study provides annual incidence rates of sudden athletic deaths in Marion County, Indiana, home of Indianapolis, the “amateur sports capital of the world.” The overall incidence was 0.04% (18 athletic deaths in 44,481 forensic necropsies). This incidence varied slightly over the 6‐year study period: 1985 (0.06%), 1986 (0.03%), 1987 (0.04%), 1988 (0.09%), 1989 (0%), 1990 (0.01%). Of the 18 sudden athletic deaths, 88% were cardiac in origin. A retrospective analysis of preparticipation screening efforts suggests that most of the cardiac conditions responsible for death could have been detected.
Congenital absence of pericardium as unusual cause of T wave abnormalities in a young athlete
Authors: Di Pasquale G. , Ruffini M. , Piolanti S. , Pinelli G. , Gambari P. I. , Roversi R.
Published: August 2009

The congenital absence of pericardium is a rare condition which may determine electrocardiographic ST‐T abnormalities. The case of 16‐year‐old athlete who presented T‐wave abnormalities at standard electrocardiogram performed during a physical checkup is reported. Ventricular repolarization tended to normalize during exercise and in right lateral decubitus. Chest x‐ray and echocardiography showed typical signs of complete absence of the left pericardium. The definite diagnosis was made by computer tomography (CT) scan. The importance of a complete investigation of athletes with T‐wave abnormalities is emphasized. Diagnostic and therapeutic features of the congenital absence of pericardium are discussed.
Shoshin beriberi in an AIDS patient with end‐stage renal disease
Authors: Cage John Bright , Wall Barry M.
Published: August 2009

Asymptomatic cardiomegaly and subsequent fulminant pulmonary edema developed in an AIDS patient with end‐stage renal disease who had no prior history of cardiac disease. Intravenous thiamine administration led to dramatic resolution of both obtundation and cardiovascular collapse within 4 hours. Prolonged thiamine administration led to decreased cardiomegaly. These findings are consistent with Shoshin beriberi.
Moricizine‐induced proarrhythmia
Authors: Seaborg Susan M. , Cowan Mark D.
Published: August 2009

Moricizine is a Class I antiarrhythmic drug currently approved for the treatment of life‐threatening ventricular arrhythmias. The drug has received significant attention because of its role in the Cardiac Arrhythmia Suppression Trial. Previous data suggested that the agent has a relatively low proarrhythmic potential1 This may lead clinicians to use the drug empirically for less significant ventricular arrhythmias. We report a case of life‐threatening late proarrhythmia caused by moricizine and comment on our experience with this agent. We feel that this drug has significant proarrhythmic potential and should not be used empirically to treat ventricular ectopy especially in patients with underlying structural heart disease.
Intravenous thrombolytic therapy in myocardial infarction: An analytical review
Authors: Shammas Nicolas W. , Fitzpatrick Patricia , Zeitler Rodney
Published: August 2009

The properties and physiological effects of three currently FDA‐approved thrombolytic agents, streptokinase (SK), tissue plasminogen activator (tPA), and anisoylated plasmminogen activator complex (APSAC) are reviewed. All thrombolytic agents have been shown to reduce mortality postmyocardial infarction (MI). Comparative trials have failed to demonstrate a difference between the effects of tPA, SK, and APSAC on mortality. In addition, no consistent difference between the three agents on ejection fraction (EF) has been found despite a superior reperfusion rate with tPA at 90 min. Further‐more, reinfarction and interventional procedure rates were significantly higher after thrombolytic treatment, and the incidence of total strokes was higher with tPA than SK in some comparative studies. Based on analysis of the published megatrials, SK is a more cost‐effective thrombolytic agent for patients with acute MI than tPA or APSAC.
Treatment of hypertension with felodipine in patients with concomitant diseases
Authors: Gradman Alan H.
Published: August 2009

Coexisting medical conditions often complicate the selection of antihypertensive drugs. Felodipine, a new vascular‐selective calcium antagonist with demonstrated antihypertensive efficacy, has not been found to alter lipid profiles in hypertensive patients. Studies in additional patient populations have yielded insights into the effects of the drug on other diseases that may coexist with hypertension. In individuals with stable angina pectoris or congestive heart failure, acute administration of felodipine reduces systemic vascular resistance and increases cardicac output and total coronary blood flow; myocardial contractility is not depressed at doses that produce a clinically significant reduction in vascular resistance. In patients with coronary stenoses, the drug increases vessel diameter in the vicinity of obstructive lesions. Single‐dose and long‐term studies in patients with exertional angian have found that felodipine reduces anginal frequency and improves exercise tolerance. In patients with congestive heart failure, chronic dosing with felodipine produces a persistent reduction in vascular resistance and an increase in cardiac output, both at rest and during exercise. Symptomatic improvement and increased exercise tolerance have been noted in some studies. In patients with Raynaud's phenomenon, felodipine has been assoicated with a dose‐dependent improvement in symptomatology. Among individuals with exercise‐induced bronchospasm, the drug has no effect on resting bronchial tone and may exert some positive effects during exercise. In hypertensive patients with Type II diabetes, felodipine has not been found to raise glucose levels significantly. The data obtained thus far suggest that felodipine is safe for use in hypertensive patients with a variety of concomitant diseases.
Dose‐ranging study with a new two‐chain rt‐PA in patients with acute myocardial infarction: A multicenter trial
Authors: Dewood Marcus A. , Kurnik Peter B. , Jolly Michael K. , Jain Abnash C. , Khaja Fareed , Gorfinkel H. Joel , Morris D. Lynn , Satler Lowell , Littlejohn Judith
Published: August 2009

Tissue‐type plasminogen activator (t‐PA) derived from a melanoma cell line was first used in patients with acute myocardial infarction in the early 1980s. Recombinant DNA technology then allowed production of large amounts of t‐PA. The TIMI‐I trial used a two‐chain recombinant (rt‐PA) product. A predominantly single‐chain rt‐PA (alteplase) was used in the majority of the TIMI II trial. The present study used a different form of two‐chain rt‐PA (duteplase) to determine the effective dose for thrombolysis at 60 min, and to evaluate time to reperfusion, reocclusion at 72‐96 h, coagulation profiles, and bleeding events. Duteplase was given intravenously to 75 patients a mean of 3.8±1 h after the onset of myocardial infarction. Following angiography demonstrating coronary occlusion, 23 patients received a low dose of duteplase [0.16‐0.29 million international units per kilogram (MIU/kg)] over 60 min followed by a 5‐h infusion in conjunction with heparin, 25 patients received a middle dose (0.30‐0.41 MIU/kg) and 23 patients received a high dose (0.43‐0.74 MIU/kg). Angiography was then performed every 15 min × 4. Progressive recanalization occurred over 60 min (median 45 min) with an overall success rate of 59% (mean 60‐min dose: 0.37 MIU/kg). No dose‐response relationship was observed. The reocclusion rate was 9% at 72‐96 h. Reductions in fibrinogen and plasminogen correlated with dose, but clinical events did not. These data are important because this form of rt‐PA was employed in the recently reported ISIS‐3 trial and the mean dose of duteplase in the present trial is the same as the 60‐min dose employed in ISIS‐3.
Single site experience with high‐speed coronary rotational atherectomy
Authors: Gilmore Paul S. , Bass Theodore A. , Conetta Donald A. , Percy Robert F. , Chami Youssef G. , Kircher Barbara J. , Miller Alan B.
Published: August 2009

This report describes a single site experience as part of a multicenter clinical trial with high‐speed rotational atherectomy in human coronary arteries. A total of 108 patients with 143 lesions had interventions, were grouped by success or failure, and were analyzed by patient, lesion, and procedural variables. Satisfactory results were achieved in 131 of 143 lesions (92%) and 99 of 108 (92%) patients. Neither patient‐related variables (age, gender, diabetes, hypertension, cigarette use, restenosis, previous myocardial infarction, and left ventricular function) nor lesion characteristics (length, ostial or bifurcation location, calcification, lesion classification, and coronary location) were predictive of poor outcome. Tears, acute closure, percentage stenosis after rotational atherectomy and after adjunctive balloon angioplasty were the procedural variables that were statistically associated with outcome by univariate methods. Multivariate analysis isolated postintervention residual stenosis as the only variable that was statistically different between groups. Serious complications included one death in the catheterization laboratory, one Q‐wave myocardial infarction, three non‐Q myocardial infarctions, and three emergency coronary bypass operations for sustained vessel closure. One patient required emergency surgery for a pacing wire perforation not related to the use of the device. The potential benefits of high‐speed rotational atherectomy include increased safety in complex lesions, the ability to address lesions not amenable to balloon techniques, and the possibility of reducing the incidence of restenosis.
Simvastatin in severe primary hypercholesterolemia: Efficacy, safety, and tolerability in 595 patients over 18 weeks
Authors: Simons Leon A.
Published: August 2009

We report the results of an open multicenter study which evaluated the efficacy, safety, and tolerability of simvastatin in a large cohort of patients with primary hypercholesterolemia. Against a background of standard dietary advice, the study enrolled 595 patients with total cholesterol ≥ 6.5 mmol/l and triglycerides < 6.0 mmol/l across 20 centers. After 4 weeks on placebo, treatment began with simvastatin 10 mg each night, titrating to 20 mg after 6 weeks, and then to 40 mg after 12 weeks if cholesterol levels still exceeded 5.5 mmol/l. By Week 18, 70% of patients were using 40 mg/day. After 18 weeks of treatment, the mean reductions (95% confidence interval) in total and low density lipoprotein (LDL) cholesterol were 30% (29‐31%) and 38% (37‐39%), respectively. There was a mean increase in high density lipoprotein (HDL) cholesterol of 12% (10‐13%), while triglycerides were reduced by a median 19% (16‐23%). From a mean entry total cholesterol of 9.31 ± 2.15 mmol/l, 52% of patients achieved cholesterol levels ± 6.2 mmol/l on treatment. The changes noted were essentially independent of gender, age, or lipid phenotype (IIa vs. IIb). Compliance with prescribed medication was very good and the drug was well tolerated; only 3% of patients manifested a clinical adverse experience requiring discontinuation or a clinical adverse experience described as serious (associated with hospitalization or serious disability). Isolated laboratory adverse experience required discontinuation in 0.2% of patients. One in 3 patients manifested a clinical adverse experience and 1 in 10 a laboratory adverse experience. Adverse experiences occurred in the digestive system (10% of patients), nervous system/psychiatric (6%), skin/appendages (5%), musculoskeletal (4%), elevated muscle enzymes (5%), and elevated transaminases (2%). In the absence of a parallel control group, the proportion of the events attributable to simvastatin could not be ascertained. Simvastatin appears to be a well tolerated and highly efficacious drug for the management of severe primary hypercholesterolemia.