bluuebunny/crossref_metadata_2025 huggingface dataset:
Correlation between myocardial perfusion abnormalities detected with intermittent imaging using intravenous perfluorocarbon microbubbles and radioisotope imaging during high‐dose dipyridamole stress echo
Authors: Ronderos Ricardo E. , Boskis Mario , Chung Namsik , Corneli Diomedes B. , Escudero Eduardo M. , Ha Jong W. , Charlante Carlos , Rim Se‐Joon , Portis Marcelo , Fabris Nora , Camilletti Jorge , Mele Anibal A. , Otero Fernando , Porter Thomas R.
Published: June 2007

Background: The clinical accuracy of myocardial contrast echocardiography (MCE) using intermittent harmonic imaging and intravenous perfluorocarbon containing microbubbles during dipyridamole stress has not been evaluated in a multi‐center setting.

Hypothesis: The accuracy of dipyridamole stress contrast echo in the detection of coronary artery disease (CAD) using myocardial perfusion images is high in comparison with tech‐netium‐99 (99Tc) sestamibi single‐photon emission computed tomography (MIBI SPECT) and increases the accuracy of wall motion data.

Methods: In 68 consecutive nonselected patients (46 men; mean age 66 years) from three different institutions in two countries, dipyridamole stress echo and SPECT with 99mTc MIBI were compared. Continuous intravenous (IV) infusion of perfluorocarbon exposed sonicated dextrose albumin (PES‐DA) (2‐5 cc/min) was administered for baseline myocardial perfusion using triggered harmonic end systolic frames. Realtime digitized images were used for wall motion analysis. Dipyridamole was then injected in two steps: (1) 0.56 mg/kg for 3 min; (2) 0.28 mg/kg for 1 min, if the first step was negative for an inducible wall motion abnormality. After dipyridamole injection, myocardial contrast enhancement and wall motion were analyzed again by the same methodology.

Results: There were 35 patients with perfusion defects by SPECT. Wall motion was abnormal in 22, while MCE was abnormal in 32. Wall motion and MCE each had one false positive. The proportion of correctly assigned patients was significantly better with MCE than with wall motion (p = 0.03; chi square test).

Conclusions: Myocardial contrast echocardiography, using intermittent harmonic imaging and intravenous perfluorocarbon containing microbubbles, is a very effective method for detecting coronary artery disease during dipyridamole stress echo.
Myocardial infarction following the combined recreational use of viagra® and cannabis
Authors: McLeod A. L. , McKenna C. J. , Northridge D. B.
Published: June 2007

Sildenafil citrate (Viagra®,Pfizer, Inc., New York, N.Y.) is widely prescribed as a treatment for male erectile dysfunction. It is metabolized predominantly by the cytochrome P450 3A4 hepatic microsomal isoenzyme and effects can, therefore, be potentiated by such inhibitors. The vasodilatory effects of Viagra necessitate caution in its use in patients with cardiovascular disease and it is contraindicated in patients receiving nitrates. Previous literature has drawn attention to Viagra use and myocardial infarction. This paper reports the case of a young man who presented with a myocardial infarction after taking Viagra in combination with cannabis, a known inhibitor of the cytochrome P450 3A4 isoenzyme.
Clinical presentation, hospital length of stay, and readmission rate in patients with heart failure with preserved and decreased left ventricular systolic function
Authors: Malki Qahtan , Sharma Nagaraja D. , Afzal Adnan , Ananthsubramaniam Karthik , Abbas Ali , Jacobson Gordon , Jafri Syed
Published: June 2007

Background: Congestive heart failure is the leading cause of hospital admissions for adults in the United States. To our knowledge, there are limited data comparing the clinical presentation, hospital length of stay, and readmission in patients with preserved and decreased left ventricular (LV) systolic function.

Hypothesis: The goal of the study was to determine whether there are differences in clinical presentation, hospital length of stay, and readmission in patients with preserved (≥ 50%) and reduced (< 50%) systolic function.

Methods: We prospectively evaluated 187 patients admitted with congestive heart failure confirmed by the presence of pulmonary vascular congestion on chest x‐ray, and with recent (< 6 months) documentation of LV systolic function by two‐dimensional echocardiography. History and physical examination findings, patient demographics, comorbidities, discharge medications, and length of hospital stay data were documented. Readmission rate over a 6‐month follow‐up period was also documented.

Results: Of the 187 patients, 130 (70%) patients had an ejection fraction (EF) < 50%, and 57 (30%) patients had an EF ≥ 50%. Patients with EF < 50% were more likely to be men (54 vs. 37%, p = 0.03), African Americans (79 vs. 60%, p = 0.007), had a higher prevalence of previous stroke (17 vs. 5%, p = 0.03), and were more likely to carry no medical insurance at the time of admission (14 vs. 2%, p = 0.01) and to be discharged on digoxin (60 vs.30%, p<0.001). There were no significant differences in symptoms (exertional dyspnea, rest dyspnea, orthopnea, or paroxysmal nocturnal dyspnea), or in physical examination findings (S3, S4, elevated jugular venous pressure, rales, orperipheral edema). According to chest x‐ray, patients with EF < 50% had more frequent cardiomegaly (88 vs. 72% p = 0.008), but there were no differences in the presence of pleural effusion or pulmonary vascular congestion (p = NS). The mean length of stay was 5.9 and 5.2 days, respectively (p = 0.34). During the 6‐month follow‐up period, the readmission rates were 33% (43 patients) and 26% (15 patients), respectively (p = 0.36).

Conclusion: The clinical presentation, hospital length of stay, and readmission rate for congestive heart failure are similar in patients with preserved and decreased LV systolic function.
The impact of right atrial ischemia on inferior myocardial infarction with extension to right ventricle: Transesophageal echocardiographic examination
Authors: Vargas‐Barrón Jesús , López‐Meneses Mauricio , Roldán Francisco‐Javier , Romero‐Cardenas ÁNgel , Keirns Candace , Espinola‐Zavaleta Nilda , Peña‐Duque Marco , Martínez‐Sanchez Carlos , Ríos Marco‐Antonio Martinez
Published: June 2007

Background: The role of the right atrium in adaptation to the hemodynamic changes produced by extension of myocardial infarction (MI) of the left ventricular inferior wall to the right ventricle is fundamental.

Hypothesis: The aim of this study was analyze a group of patients with MI with extension of right chambers, and particularly right atrial alterations, by transesophageal echocardiography and to correlate it with clinical and angiographic variables.

Methods: Thirty patients with right ventricular (RV) MI involving obstruction of the right coronary artery without stenosis of the left coronary artery were included; 18 underwent early reperfusion. Transesophageal echocardiography was performed on all within 5 days of coronary angiography. Follow‐up was continued from hospitalization to the present.

Results: When patients withright atrial ischemia were compared with those with normal right atrium, the RV wall movement score was significantly greater in the group with right atrial ischemia, severe RV dilatation was more frequent, and association with proximal occlusion of the artery responsible for the MI, as well as absence of right atrial branches and poor collateral circulation, were significant. Hospitalization was more prolonged in this group, and there was a higher incidence of arrhythmias, complete atrioventricular block, and mortality.

Conclusions: Right atrial ischemia associated with RV infarction leads to a higher incidence of complications and higher mortality. Transesophageal echocardiography is a safe, reproducible technique that provides detailed anatomic information about right chambers and aids in the determination of prognosis and therapeutic decisions.
Severe aortic stenosis and mitral regurgitation in a woman with systemic lupus erythematosus
Authors: Moyssakis Ioannis , Tzioufas Athanasios , Triposkiadis Filippos , Strateges Nikolaos , Kyriakidis Michael
Published: June 2007

Libman‐Sacks endocarditis complicating systemic lupus erythematosus has rarely been reported to cause hemodynamically significant valvular lesions. This report presents a case of severe aortic stenosis combined with severe mitral regurgitation associated with systemic lupus erythematosus in a young woman who died while on the quota list for surgery.
Reevaluating the role of phosphodiesterase inhibitors in the treatment of cardiovascular disease
Authors: Feldman Arthur M. , McNamara Dennis M.
Published: June 2007

First developed for clinical use in the late 1980s, the phosphodiesterase inhibitors were found to increase the levels of the ubiquitous second messenger cyclic adenosine monophosphate and could effect changes invasculartone, cardiac function, and other cellular events. After several early studies using high doses of phosphodiesterase inhibitors in patients with severe heart failure suggested adverse consequences, they fell out of favor. However, recent investigations of phosphodiesterase inhibitors in patients with intermittent claudication have demonstrated profound benefits. Furthermore, these agents have proven useful in prevention of cerebral infarction and coronary restenosis, and their use in the treatment of heart failure is being reevaluated. The reemergence of phosphodiesterase inhibitors can be attributed to a better understanding of dosing and drug‐specific pharmacology, the use of concomitant medications, and a recognition of unique ancillary properties; however, their use still requires caution.
Comparison between transesophageal echocardiography and transthoracic echocardiography with harmonic tissue imaging for left atrial appendage assessment
Authors: Carerj Scipione , Trifró Maria Paola , Granata Antonio , Luzza Francesco , Arrigo Francesco , Oreto Giuseppe
Published: June 2007

Background: Transesophageal echocardiography (TEE) is the method of choice for evaluating both anatomy and function of left atrial appendage (LAA). In contrast, conventional transthoracic echocardiography (TTE) does not result in images of sufficient quality to explore LAA.

Hypothesis: The aim of this study was to evaluate the potential role of TTE with harmonic frequency imaging (HFI) for assessing LAA normal anatomy and function.

Methods: The study group comprised 25 patients, (9 men, 16 women, mean age 51 years, range 20–82). The TTE assessment of LAA both in fundamental frequency imaging (FFI) and HFI was performed using the apical two‐chamber view; the longitudinal two‐chamber view was used for TEE assessment of LAA. According to image quality, images were categorized into three classes: A: good quality, B: sufficient quality, C: poor quality.

Results: Transthoracic echocardiography conventional imaging allowed sufficient LAA visualization (class B) in only 5 of 25 patients (20%); the HFI resulted inadequate LAA visualization in 23 of 25 patients (92%). Images were of good quality (class A) in 18 of 23 patients and of sufficient quality (class B) in 5 of 23 patients. Transesophageal echocardiography achieved good quality images in 24 of 25 patients (96%). Average LAA maximum area determined by HFI and TEE was 3.46 ± 1.17 and 3.59 ± 1.16 cm2, respectively; LAA minimum area was 1.81 ± 0.98 and 1.77 ± 0.97 cm2, respectively. Percent LAA area change was 51 ± 16.5 and 50.9 ± 16% with HFI and TEE, respectively. Statistical analysis showed no difference between the data obtained with the two methods.

Conclusions: The results suggest that HFI TTE may be a useful tool for the exploration of LAA.
Lipoprotein(a) was an independent predictor for major coronary events in treated hypertensive men
Authors: Agewall Stefan , Fagerberg Björn
Published: June 2007

Background and Hypothesis: Lipoprotein(a) may play a part in the development of coronary heart disease. The purpose of this prospective study was to evaluate lipoprotein(a) as a predictor of major coronary events (fatal and nonfatal myocardial infarction and sudden death).

Methods: This was a prospective study of 118 men, aged 56 to 77 years, with treated hypertension and at least one additional cardiovascular risk factor (hypercholesterolemia, diabetes mellitus, or smoking) were included in the study. Lipoprotein(a) was measured at entry and major coronary events were followed during follow‐up.

Results: The mean observation time was 3.0 years. Fourteen patients had a major coronary event during the follow‐up period. Subjects with coronary heart disease (previous myocardial infarction, angina pectoris, or major electrocardiographic changes) at entry (n = 27) had significantly higher lipoprotein(a) levels than subjects without (n = 91) known coronary heart disease (p < 0.05). Lipoprotein(a) was a significant predictor for major coronary events (p = 0.033). Furthermore, when coronary disease at entry was included into the Cox regression analysis, lipoprotein(a) was an independent predictorfor major coronary events (p = 0.044).

Conclusions: Among treated hypertensive men, lipoprotein(a) was an independent predictor of major coronary events.
Potential for use of pulse wave analysis in determining the interaction between sildenafil and glyceryl trinitrate
Authors: O'Rourke Michael F. , Nichols Wilmer W.
Published: June 2007

Background: The early part of the central aortic pressure pulse, with amplitude (PI – Pd), is generated by left ventricular ejection, while the latter part (or augmented pressure), with amplitude (Ps – Pi), is generated by the reflected wave arriving during systole. The effects of arterial vasodilator agents, especially nitrates, on central aortic systolic blood pressure are grossly underestimated by sphygmomanometric measurements of brachial artery pressure.

Hypothesis: The objective of this study was to investigate the potential for use of central arterial pulse wave analysis, obtained noninvasively from the radial pulse, in determining the interaction between sildenafil and the nitric oxide donor drug glyceryl trinitrate (GTN).

Methods: Central aortic pressure waveforms were generated from noninvasively measured radial artery pressure waveforms and subjected to pulse wave analysis to determine the interactionbetween sildenafil and transdermally applied GTN.

Results: Transdermal GTN (2.5, 5.0, and 15 mg per 24‐h patches) alone caused no consistent change in sphygmomanometer‐determined systolic or diastolic pressures, but there was a consistent, dose‐related fall in amplitude of the augmented systolic pressure, (Ps – Pi), of 4.0,7.0, and 11 mmHg, respectively, with little change in diastolic pressure. The 2.5 mg patch caused a fall of 4.0 mmHg in aortic systolic pressure, while augmentation index (AIx) fell from 20 to 11% and pulse pressure fell 18%. When oral sildenafil (50 mg) was administered after GTN (2.5 mg), aortic systolic pressure fell another 4.0 mmHg. This decrease in systolic pressure caused a fall in AIx to almost 0.0%; pulse pressure fell another 9.0%.

Conclusion: These modifications in aortic systolic and pulse pressure are due primarily to reduction in wave‐reflection amplitude and are not detected by sphygmomanometer‐measured brachial artery pressure.
Primary (isolated) meningococcal pericarditis
Authors: Morgan David R. , Spence Mark , Crowe Mary , O'Keeffe D. Barry
Published: June 2007

A 19‐year‐old man was admitted with a history and examination findings of probable bacterial pericarditis. Blood cultures produced Neisseria meningitidis Group C, sensitive to penicillin. The patient was initially treated with intravenous benzylpenicillin. Echocardiogram demonstrated the development of a pericardial effusion which was tapped, and benzylpenicillin was instilled into the pericardial space. Because of failure of clinical resolution, cefotaxime was substituted forbenzyl penicillin. Rapid clinical improvement then ensued. Repeat echocardiogram showed evidence of neither reaccumulation nor constrictive pericarditis. Primary (isolated) meningococcal pericarditis is a recognized though rare manifestation of meningococcal disease. It is most common in young adults and is associated with a good prognosis.
Diastolic subclinical primary alterations in marfan syndrome and marfan‐related disorders
Authors: Porciani Maria Cristina , Giurlani Letizia , Chelucci Andrea , Pepe Guglielmina , Giusti Betti , Brunelli Tamara , Attanasio Monica , Martinucci Pietro , Fattori Rossella , Abbatea Rosanna , Gensini Gian Franco
Published: June 2007

Background: The extracellular matrix tissue of the myocardium importantly contributes to left ventricular (LV) performance. Inherited connective tissue disorders related to the FBN1 gene could involve cardiac interstitium resulting in functional abnormalities.

Hypothesis: To disclose a primary involvement of myocardium, LV function was studied in 28 patients affected by Marfan syndrome or Marfan‐related disorders: 20 Marfan and 8 MASS (Mitral valve prolapse, Myopia, Aortic dilatation, Skeletal involvement, Skin striae) and in 28 healthy, age and gender‐matched controls. No valvular regurgitation or any other cardiac alterations were present.

Methods: Echocardiographic study was performed to investigate LV systolic and diastolic function.

Results: No statistically significant differences were observed between patients and the control group in LV dimensions, systolic function parameters (ejection and shortening fraction), and some diastolic function parameters (E peak, A peak, E/A), while statistically significant differences were found between patients and the control group in LV mass (128.7 ± 46.6 vs. 83.7 ± 14.5 g/m2, p < 0.008), in isovolumic relaxation time (102.0 ± 24.0 vs. 80.1 ± 11.2 ms, p<0.016), and in deceleration time of the E wave (127.5 ± 19.3 vs. 208.6 ± 24.5 ms, p < 0.001) and the A wave (66.4 ± 8.2 vs. 87.5 ± 23.4 ms,p< 0.008).

Conclusions: These data show an unusual pattern of transmitral diastolic flow in which a decreased ventricular compliance and reduced myocardial relaxation coexist. Thus, in Marfan syndrome and in Marfan‐related disorders, subclinical diastolic alterations are present independent of valvular disease and might represent an early marker of primary myocardial involvement.
Medical treatment of patients with stable angina pectoris referred for coronary angiography: Failure of treatment or failure to treat
Authors: Carasso Shemy , Markiewicz Walter
Published: June 2007

Background: Patients referred for elective coronary arteriography because of stable angina pectoris frequently do not receive appropriate medical therapy prior to arteriography. Persistence of symptoms due to lack of appropriate therapy may influence the decision to catheterize and the treatment chosen following catheterization.

Hypothesis: The present study evaluates whether patients with stable angina pectoris referred for cardiac catheterization received optimal therapy prior to the procedure. We also evaluated whether medical therapy was optimized as a result of the hospitalization for catheterization.

Methods: We evaluated prospectively the adequacy of medical therapy in 333 consecutive patients undergoing elective coronary arteriography. Of these, 160 had stable angina pectoris as their main problem and constituted the study group.

Results: Mean duration of angina was 7.5 ± 6.3 months. Canadian Cardiovascular Society angina grade 1 was present in 20, grade 2 in 77, grade 3 or 4 in 63 patients. Arteriography showed a > 50% coronary stenosis in 141 of 160 patients. Aspirin was used by 96%, and 86% received at least one drug aimed at relieving anginal symptoms: beta blockers in 69%, calcium blockers in 30%, and long‐acting nitrates in 29%. Antianginal drugs and drugs aimed at treating risk factors were usually taken at a low, subtherapeutic dosage. Only 35 of 110 patients taking beta blockers had a resting heart rate of ≥ 60/min. Following catheterization, 88 of 141 patients with coronary stenosis of ≤ 50% underwent percutanous intervention and 5 had urgent surgery. Optimization of treatment was advised in only 7 of 48 patients for whom medical therapy or elective surgery was recommended.

Conclusion: Patients with stable angina pectoris are frequently referred for cardiac catheterization without making a serious attempt to control their symptoms by medical therapy. Risk factors are undertreated. With proper pharmacotherapy, many patients might have become asymptomatic and have chosen not to undergo catheterization and subsequent percutaneous interventions.
Inflammatory predictors of mortality in the scandinavian simvastatin survival study
Authors: Crea Filippo , Monaco Cmlaudia , Lanza Gaetano A. , Maggi Elena , Ginnetti Francesca , Cianflone Domenico , Niccoli Giampaolo , Cook Thomas , Bellomo Giorgio , Kjekshus John
Published: June 2007

Background and hypothesis: The predictive value of specific markers of infection and autoimmunity for coronary events, such as the effects of statins on inflammation, is still controversial.

Methods: A case‐control design was used to compare C‐reactive protein (CRP) levels, seropositivity for Chlamydia pneumoniae and Helicobacter pylori, and anti‐oxidized low‐density lipoprotein (oxLDL) antibody levels in prerandomization blood samples from 129 participants in the Scandinavian Simvastatin Survival Study who died (cases), and from 129 matched participants who were alive during 5‐year follow‐up (controls).

Results: Patients with CRP levels in the highest quartile had an increased risk of death compared with those in the first through third quartile (odds ratio [OR] = 2.51, 95% confidence interval [CI] 1.3‐4.8). Seropositivity for Chlamydia pneumoniae or Helicobacter pylori and anti‐oxLDL antibody levels were similar in cases and controls (p = NS). At a 4‐month control, simvastatin reduced CRP levels (p = 0.009) while placebo did not (p = NS). However, the risk of death associated with high baseline CRP levels was similar in patients randomized to placebo (OR = 2.36, 95% CI 1.06‐5.26) or simvastatin (OR = 3.13, 95% CI 1.06‐9.21).

Conclusions: Elevated CRP levels, but not seropositivity for Chlamydia pneumoniae or Helicobacter pylori, nor levels of anti‐oxLDL antibodies, predict the risk of death in patients with stable ischemic heart disease. Simvastatin treatment reduces CRP levels, but without affecting the increased risk conferred by higher CRP levels at baseline.
Does racial bias exist in the medical management of heart failure?
Authors: Harjai Kishore J. , Nunez Eduardo , Shah Mehul , Newman Jeff
Published: June 2007

Background: It is suspected that effective therapies are often underutilized in black compared with white patients with coronary artery disease (CAD).

Hypothesis: We hypothesized that an unfavorable bias may exist against black patients in the medical management of heart failure.

Methods: In 566 consecutive adult subjects who were discharged alive from the hospital with a principal discharge diagnosis of heart failure, we assessed the effect of patient race on utilization of classes of medications (angiotensin‐converting enzyme inhibitors [ACEI], digitalis, diuretic agents) and combinations of medications (effective vasodilators, i.e., ACEI or combined hydralazine and nitrate; effective combination therapy, i.e., effective vasodilator with digitalis and diuretic) known to be beneficial in symptomatic heart failure.

Results: Compared with black patients (n = 182), white patients were older, had a higher incidence of coronary artery disease, lower incidence of hypertension, and lower serum creatinine and left ventricular end‐diastolic diameter. In crude analyses, the utilization of all medications was similar between white and black patients. After adjustment for clinical differences, black patients were more likely to receive ACEI (adjusted odds ratio [OR] = 1.84; 95% confidence interval [CI] 1.13–3.01), effective vasodilators (OR = 1.97; CI 1.20– 3.23), and effective combination therapy (OR = 1.66; CI 1.02–2.69) than white patients at the time of discharge from the hospital. No multivariate association was seen between patient race and use of digoxin or diuretics. In an analysis of subsets of patients with ejection fraction < 45% (n = 260), no association was seen between patient race and utilization of effective medical therapy.

Conclusion: Our results show no unfavorable bias against black patients with decompensated heart failure.
Therapy to reduce risk of coronary heart disease
Authors: Rader Daniel J.
Published: June 2007

Recent primary and secondary intervention studies have shown that reduction of low‐density lipoprotein cholesterol (LDL‐C) with statins significantly reduced coronary heart disease (CHD) morbidity and mortality. However, many patients with dyslipidemia who have or are at risk for CHD do not reach target LDL‐C goals. The recently updated National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III guidelines identify a group of patients at very high risk for CHD for more aggressive LDL‐C reduction and reaffirm the importance of high‐density lipoprotein cholesterol (HDL‐C) by raising the categorical threshold to 40 mg/dl. Lipid‐lowering therapy needs to be more aggressive in both primary and secondary prevention settings, and therapy should be considered to increase HDL‐C as well as lower LDL‐C in order to improve patient outcomes. Both combination therapy and the next generation of statins may provide improved efficacy across the dyslipidemia spectrum.
Oxidized low‐density lipoprotein and high‐density lipoprotein cholesterol modulate coronary arterial remodeling: An intravascular ultrasound study
Authors: Yoneyama Satoru , Arakawa Koh , Yonemura Atushi , Isoda Kikuo , Nakamura Haruo , Ohsuzu Fumitaka
Published: June 2007

Background: Oxidized low‐density lipoprotein (oxLDL) not only plays an important role in plaque formation, but also impairs the endothelium‐dependent relaxation. Constrictive remodeling rather than intimal hyperplasia mainly contributes to restenosis after balloon angioplasty. Probucol (powerful antioxidant) reduced restenosis rate by improving constrictive remodeling. Thus, oxLDL may modulate coronary arterial remodeling.

Hypothesis: The study was designed for using intravascular ultrasound to test the hypothesis that arterial constrictive remodeling (CR) was associated with oxLDL in patients with coronary artery disease.

Methods: Intravascular ultrasound was performed in 36 patients with de novo atherosclerotic coronary. Remodeling was defined and evaluated as follows: remodeling index (RI) = lesion vessel area (VA)/(proximal reference VA + distal reference VA)/2. Constrictive remodeling (CR) was defined as remodeling index (RI) < 0.9. Neutral and expansive remodeling (NER) was defined as RI ≥0.9. The level of plasma ox‐LDL was measured by sandwich ELISA using the monoclonal antibody (DLH3)‐recognized oxidatively modified lipoproteins and the antihuman apoprotein B monoclonal antibody.

Results: Neutral and expansive remodeling was found in 24 lesions, and CR in 12 lesions. Remodeling index was significantly lower in the CR group than in the NER group (0.8 ± 0.1 vs. 1.0 ± 0.1, p< 0.001). The level of oxLDL in the CR group was significantly higher than that in the NER group (24.0 ± 12.1 vs. 16.4 ± 6.2 U/ml, p < 0.05). The level of high‐density lipoprotein‐cholesterol (HDL‐C) in the CR group was significantly lower than that in the NER group (40.5 ± 4.8 vs. 46.2 ± 10.6 mg/ml, p < 0.05). There was a statistically significant correlation between the value of HDL‐C/ ox‐LDL and the RI (r = ‐0.48, p< 0.005).

Conclusions: Oxidized LDL and HDL‐C were associated with arterial remodeling in de novo atherosclerotic lesions.
Electrocardiographic and vectorcardiographic findings of patients undergoing reductive ventriculectomy (Batista operation)
Authors: Pastore Carlos Alberto , Tobias Nancy , Kaiser Elizabeth , Bacal Fernando F. , Aziz José Luiz , Moreira Luis Felipe , Stolf Noedir , Bocchi Edimar , Ramires José Franchini
Published: June 2007

Background: The Batista operation, or partial ventriculectomy, has been designed by the Brazilian surgeon Dr. Randas Batista as an alternative method for treating patients with idiopathic dilated cardiomyopathy.

Hypothesis: This study aimed to analyze electro‐ and vectorcardiographic data obtained from patients who underwent such surgery, and to evaluate its electrical repercussions on the heart.

Methods: Pre‐ and postoperative electrocardiography (ECG) and vectorcardiography (VCG) were performed 45 days apart in 15 patients undergoing reductive ventriculectomy.

Results: All ECGs showed sinus rhythm, with unchanged QRS duration. Left atrial enlargement (86.6%) and left ventricular hypertrophy (100%) were the most common findings. Bundle‐branch blocks (BBBs) were often demonstrated on preoperative studies, predominantly (46.7%) left BBBs. Left anterior fascicular blocks were seen in four patients (26.6%), one associated with right BBB. Electrocardiographic changes suggestive of myocardial infarction (MI) were seen in four patients preoperatively; postoperatively, all had extended to or within the lateral wall. Five additional patients developed lateral MIs postoperatively, for a total of 9 patients (60%) with postoperative signs of infarction (p < 0.05). Electro‐ and vectorcardiography also showed significant postoperative lowering of QRS voltages (mean 40.74%) in all patients and a consequent difficulty to diagnose left ventricular hypertrophy, although the morphologic features did not change.

Conclusions: These important ECG and VCG alterations are reflections of both the surgical technique and its clinical consequences.
Predischarge exercise electrocardiogram and stress echocardiography can predict long‐term clinically driven revascularization following acute myocardial infarction
Authors: Desideri Alessandro , Bigi Riccardo , Cortigiani Lauro , Rambaldi Riccardo , Sabbadin Daniela , Curti Gianpiero , Celegon Leopoldo
Published: June 2007

Background: Predischarge stress testing provides suboptimal prediction of spontaneous hard events following uncomplicated acute myocardial infarction (AMI).

Hypothesis: This study was aimed at assessing whether soft cardiac ischemic events requiring late revascularization could be predicted more accurately.

Methods: In all, 428 patients undergoing exercise electro‐cardiography (ECG) and stress echocardiography (SE, 345 dobutamine and 83 dypiridamole) within 15 days of uncomplicated AMI were followed up for 425 (range 20‐2220) days. Soft ischemic events (effort angina > class II [Canadian Cardiovascular Society Classification] and unstable angina) driving late (> 6 months) revascularization were regarded as endpoints.

Results: A total of 58 events (29 effort and 29 unstable angina with subsequent 47 coronary artery bypass grafts and 11 percutaneous transluminal coronary angioplasties) occurred: 26 in patients with positive exercise ECG and 34 in patients with positive SE. Univariate predictors of revascularizations were positive exercise ECG (p = 0.0001), peak wall motion score index (WMSI) (p = 0.0009), low workload (p = 0.0018), rest WMSI (p = 0.02) and positive SE (p = 0.02). Cox multivariate analysis selected peak WMSI, positive exercise ECG, and low workload positive exercise ECG as independent predictors of late revascularizations.

Conclusions: Predischarge stress testing identifies the long‐term occurrence of soft ischemic events driving late revascularization after uncomplicated AMI.
C‐reactive protein and rapidly progressive coronary artery disease is there any relation?
Authors: Zairis Michael N. , Manousakis Stavros J. , Svtefanidis Alexander S. , Vitalis Denis P. , Tsanis Evangelos M. , Hadjigeorgiou Seraphim M. , Fakiolas Constantine N. , Pissimissis Evangelos G. , Olympios Christopher D. , Foussas Stefanos G.
Published: June 2007

Background: High plasma C‐reactive protein (CRP) levels have been associated with an unfavorable outcome in patients with coronary artery disease (CAD), and a direct participation of CRP in the atherosclerotic process has been postulated.

Hypothesis: The aim of this study was to evaluate the possible relationship of high plasma CRP levels with the rapid progression of coronary atherosclerosis (RPCAD).

Methods: In all, 194 patients who were readmitted and underwent repeat coronary angiography because of recurrence of symptoms following successful percutaneous coronary intervention were studied. Median angiographic follow‐up time was 6 months. Rapid progression CAD was defined as the presence of a new lesion, > 25% in luminal diameter stenosis, in a previously nondiseased vessel, or deterioration of a known, nontreated lesion by at least 25%.

Results: By multivariate analysis, patients with high plasma CRP levels upon first admission were at higher risk of RPCAD. In particular, odds ration (OR) = 1.8; 95% confidence interval (CI) = 1.3‐3.6; p value = 0.02 in patients with CRP = 0.5‐2 mg/dl versus patients with CRP < 0.5 mg/dl, and OR = 7.1; 95% CI = 3.8‐9.5; p value < 0.001 in patients with CRP > 2 mg/dl versus patients with CRP < 0.5 mg/dl.

Conclusion: Increased plasma CRP levels could possibly identify patients at high risk for the development of RPCAD.
A dose‐ranging study of a new, once‐daily, dual‐component drug product containing niacin extended‐release and lovastatin
Authors: Hunninghake Donald B. , McGovern Mark E. , Koren Michael , Brazg Ronald , Murdock David , Weiss Stuart , Pearson Thomas
Published: June 2007

Background: Combination therapy for dyslipidemia holds promise as effective treatment for patients with multiple lipid disorders, especially those at high risk.

Hypothesis: This study evaluated dose‐response relationships and safety of a new dual‐component drug product containing niacin extended‐release (niacin ER) and lovastatin.

Methods: The 28‐week double‐blind multicenter trial randomized 237 patients with type IIA or IIB hyperlipidemia to one of four escalating‐dose treatment groups: niacin ER/lovastatin 1,000/20 mg, niacin ER/lovastatin 2,000/40 mg, niacin ER 2,000 mg, or lovastatin 40 mg.

Results: Niacin ER/lovastatin was more effective than each of its components for improving levels of low‐density lipoprotein cholesterol (LDL‐C), high‐density lipoprotein cholesterol (HDL‐C), and triglycerides (TG), and exhibited a clear dose‐response effect and additivity across the dosage range. The 2,000/40 dose achieved greater mean reductions in LDL‐C (‐42%) than 1,000/20 (‐28%, p<0.001), lovastatin 40 mg (‐32%, p<0.05), or niacin ER 2,000 mg (‐14%, p<0.05). The 2,000/40 dose was significantly more effective in increasing HDL‐C levels (+ 30%) than the 1,000/20 dose (+ 21%, p = 0.016). The decrease in TG was greater with 2,000/40 (‐43%) than with 1,000/20 (‐26%, p = 0.009). All three niacin‐containing treatments were more effective than lovastatin monotherapy in reducing lipoprotein (a) [Lp(a)] levels. Flushing caused 12 (11%) patients receiving niacin ER/lovastatin and 1 patient receiving lovastatin alone to withdraw. No drug‐related myopathy was noted. One patient each in the 2,000/40 group and the lovastatin 40‐mg group had reversible elevations in liver transaminases.

Conclusions: Niacin ER/lovastatin is well tolerated and effective for patients with multiple lipid disorders.
Factors determining early improvement in mitral regurgitation after aortic valve replacement for aortic valve stenosis: A transthioracic and transesophageal prospective study
Authors: Tassan‐Mangina Sophie , Metz Damien , Nazeyrollas Pierre , Torossian Frédé Ric , Pop Camelia , Jamet Bertrand , Baehrel Bernard , Elaerts Jacques
Published: June 2007

Background: Mitral regurgitation (MR) is frequently associated with aortic stenosis. Previous reports have shown that coexisting mitral insufficiency can potentially regress after aortic valve replacement.

Hypothesis: This study sought to assess the frequency and severity of MR before and after aortic valve replacement for aortic stenosis and to define the determinants of its postoperative evolution.

Methods: For this purpose, 30 adult patients referred for aortic valve surgery underwent pre‐ and postoperative transthoracic and transesophageal echocardiography and color Doppler examination.

Results: Mean preoperative left ventricular ejection fraction was 57 ± 16% and remained unchanged postoperatively. Preoperative MR was usually mild to moderate and correlated with aortic stenosis severity and left ventricular systolic dysfunction. The color Doppler mitral regurgitant jet area significantly decreased during the postoperative period (p = 0.016) as left ventricular loading conditions returned to normal, suggesting an early decrease of the functional part of MR. On the other hand, the mitral regurgitant jet width at the origin remained unchanged. Statistical analysis found pulmonary artery pressure (p = 0.02) and indexed left ventricular mass (p = 0.009) to be preoperative predictive factors of postoperative MR improvement. Predictive factors of postoperative MR severity were left atrial diameter (p = 0.02), pulmonary artery pressure (p = 0.003), and the presence of mitral calcifications (p = 0.004).

Conclusion: In our cohort of patients with normal left ventricular ejection fraction, the majority of moderate MR, associated with severe aortic stenosis, regresses early after aortic valve replacement. Mitral calcifications and/or left atrial dilation seem to be predictive factors of fixed MR.
Utilization of intraoperative transesophageal echocardiography during repair of congenital cardiac defects: A survey of north american centers
Authors: Stevenson J. Geoffrey
Published: June 2007

Background: Intraoperative transesophageal echocardiography (TEE) has been increasingly utilized during repair of congenital cardiac defects.

Hypothesis: The aim of this study was to assess the practice of TEE in this setting.

Methods: A survey was sent to 70 centers in the United States and Canada; replies were obtained from 65 centers (93%). Responses were grouped into four categories: (1) Performance of intraoperative echocardiography, (2) performance practices, (3) equipment and probe issues, (4) billing and reimbursement. Data were available from all responding centers unless specified below.

Results: All responding centers employed intraoperative echocardiography, with 98% employing TEE. All responding centers employed intraoperative echocardiography. The majority of centers (72%) utilized intraoperative echocardiography in all cases or all open cases except atrial septal defects, while the remainder employed it selectively. The average duration of TEE experience at responding centers was 6.1 years. Transesophageal echocardiography was primarily the responsibility of cardiologists, with most centers having individuals meeting published TEE training guidelines. The large majority of centers performed both pre‐ and postbypass TEE studies. Equipment and probes were widely available. All centers disinfected the TEE probe between studies, but for longer times than recommended.

Conclusion: Utilization of intraoperative TEE during surgery for congenital heart disease is widespread; the results of this survey may be useful to individual institutions as they evaluate their utilization of intraoperative echocardiography.
Pregnancy in patients with heart disease: Experience with 1,000 cases
Authors: Avila Walkiria Samuel , Rossi Eduardo Giusti , Ramires José Antonio Franchini , Grinberg Max , Bortolotto Maria Rita Lemos , Zugaib Marcelo , Luz Protasio Lemos Da
Published: June 2007

Background: Previously, the high maternal mortality in cardiac patients who became pregnant prompted the assertion: Women with an abnormal heart should not become pregnant. This long‐standing notion needs to be revised today.

Hypothesis: The study was undertaken to ascertain the experience with a large series of pregnant women with cardiac disease cared for in the same referral center.

Methods: From 1989 to 1999, 1,000 pregnant women with heart disease were followed by the same clinical and obstetric team. The cardiac diseases included rheumatic heart disease (55.7%), congenital heart disease (19.1%), Chagas' disease (8.5%), cardiac arrhythmias (5.1%), cardiomyopathies (4.3%), and others (7.3%).

Results: Of the pregnant women studied, 765 (76.5%) experienced no cardiovascular events during the study; 235 (23.5%) patients had the following cardiovascular complications: congestive heart failure (12.3%), cardiac arrhythmias (6%), thromboembolism (1.9%), angina (1.4%), hypoxemia (0.7%), infective endocarditis (0.5%), and other complications (0.7%). Clinical treatment allowed adequate management in 161 (68.8%) patients; however, 46 (19.6%) patients underwent interventional procedures because of refractory complications. The general maternal mortality rate was 2.7%. Of the 915 (91.5%) infants who were discharged, 119 (13%) were premature.

Conclusion: Pregnancy in women with heart disease is still associated with considerable morbidity and mortality rates, which strongly correlate to maternal underlying disease. Strict prenatal care and early risk stratification during gestation are fundamental measures to improve the prognosis of pregnancy in women with heart disease.
Technetium‐99m sestamibi cavity/myocardium count ratio in the detection of left ventricular hypertrophy
Authors: Altun Gulay Durmus , Akdemir Osman , Ustun Funda , Altun Armagan , Sarikaya Ali , Berkarda Sakir
Published: June 2007

Background and hypothesis: Left ventricular hypertrophy (LVH) is an independent risk factor for cardiovascular mortality and morbidity. This study was designed to assess whether technetium‐99m (99mTc) sestamibi cavity‐to‐myocardium count (c/m) ratio would differentiate LVH from normal geometry, and discriminate between the two patterns‐concentric and eccentric‐of LVH.

Methods: In all, 72 patients including 32 hypertensive patients with both normal 99mTc sestamibi single‐photon emission computed tomography imaging and good‐quality echocardiographic recordings were studied retrospectively. Four different patterns of left ventricular (LV) geometry were defined: normal (n = 47), concentric remodeling (n = 3), eccentric LVH (n = 13), and concentric LVH (n = 9).

Results: Left ventricular hypertrophy was detected in 22 of 32 hypertensive patients. The c/m ratio calculated on midventricular short‐axis slices of dipyridamole‐stress 99mTc sestamibi images was significantly decreased in patients with LVH compared with subjects with normal geometry (0.05 ± 0.02 vs. 0.17 ± 0.08, p = 0.001). A c/m ratio of < 0.124 yielded a sensitivity of 86%, a specificity of 64%, and an overall diagnostic accuracy of 68% for detecting LVH. Negative correlations of c/m ratio were found to LV mass‐index (r = −0.44, p = 0.004), septal width (r = −0.42, p = 0.008), posterior wall thickness (r = ‐ 0.39, p = 0.001), and relative wall thickness (r = −0.40, p = 0.001). Multiple linear regression analysis revealed that LV mass index was the single independent predictor of c/m ratio. Although both groups with concentric and eccentric LVH had a significantly lower mean c/m ratio than those with normal geometry (p = 0.01 and p = 0.01, respectively), no significant difference of c/m ratio was found between the two patterns of LVH.

Conclusion: A new index, c/m ratio on 99mTc sestamibi images, has a potential to discriminate between LVH and normal geometry in subjects free of myocardial ischemia.
Accelerated plasminogen activator inhibitor may prevent late restenosis after coronary stenting in acute myocardial infarction
Authors: Inoue Teruo , Yaguchi Isao , Mizoguchi Keiichi , Uchida Toshihiko , Takayanagi Kan , Hayashi Terumi , Morooka Shigenori , Eguchi Yutaka
Published: June 2007

Background: Although acceleration of plasma plasminogen activator inhibitor‐1 (PAI‐1) level after emergent coronary angioplasty in acute myocardial infarction (AMI) has been documented, its pathophysiologic role is still unknown.

Hypothesis: This study was designed to elucidate the role of PAI‐1 in the development of restenosis after primary coronary stenting in AMI.

Methods: We selected for this study 66 patients with AMI, who underwent primary coronary stenting for infarct‐related coronary artery lesions in an emergent situation. In all patients, plasma PAI‐1 level was measured at admission, and at 3 h, 24 h, 48 h, and 1 month after coronary stenting.

Results: At admission, the PAI‐1 level was equivalent in 24 patients who experienced restenosis and in 42 patients without restenosis (28 ± 4 vs. 29 ± 4 ng/ml). In patients with restenosis, the levels did not change during the course after coronary stenting. In patients without restenosis, however, the level significantly increased at 3 h (48 ± 9 ng/ml, p < 0.001), 24 h (42 ± 9, p < 0.01), and 48 h (38 ± 7, p < 0.05) after coronary stenting, and was restored to the level equivalent to that at admission (27 ± 2 ng/ml) 1 month after coronary stenting. The PAI‐1 level at 3 h after coronary stenting in patients without restenosis was significantly higher (p < 0.05) than the level (33 ± 6 ng/ml) in patients with restenosis. Multiple logistic regression analysis indicated that the PAI‐1 level 3 h after coronary stenting was an independent predictor of restenosis (Wald x2 = 3.826, p = 0.019, odds ratio 0.921, 95% confidence interval 0.866‐0.961).

Conclusion: Accelerated PAI‐1 after coronary stenting in patients with AMI may protect against the development of late restenosis.
Diagnostic yield of automatic and patient‐triggered ambulatory cardiac event recording in the evaluation of patients with palpitations, dizziness, or syncope
Authors: Balmelli Nicola , Naegeli Barbara , Bertel Osmund
Published: June 2007

Background: Recent studies have shown that patient‐triggered cardiac event recorders (CER) have an increased diagnostic yield and are more cost effective than conventional 24‐h‐Holter electrocardiograms (ECGs) for the evaluation of sporadic, potentially arrhythmia‐related symptoms.

Hypothesis: The aim of this study was to determine the diagnostic yield of a patient‐triggered CER combined with continuous automatic arrhythmia detection in the evaluation of sporadic dizziness/syncope or palpitations and its clinical relevance in assessing the further management.

Methods: We investigated 101 consecutive outpatients (54 ± 20 years, 40 women), referred for evaluation of sporadic dizziness and syncope (36%) or palpitations (64%) of suspected rhythmogenic origin. All were monitored by patient‐triggered CER with continuous automatic arrhythmia detection.

Results: After a mean monitoring period of 103 ± 38 h, 83 patients registered symptoms and 57 patients had diagnostic or therapeutic relevant arrhythmias (relA). A total of 196 episodes of relA were recorded; 31 (16%) episodes were patient‐triggered and 165 (84%) automatically recorded. Diagnostic relevant episodes (relA and/or typical symptoms) occurred in 94 patients, in 54% after the first 24 h of monitoring. According to the results of the CER, 80 patients needed no further diagnostic evaluation; 20 had additional diagnostic tests.

Conclusions: Cardiac event recorders with a continuous automatic arrhythmia detection function are a well‐tolerated device for sporadic, potentially arrhythmia‐related symptoms. The patient‐triggered mode alone is not sufficiently reliable; the automatic continuous arrhythmia detection function has additional diagnostic and therapeutic consequences. In 54% of all patients, the first diagnostic event would not have been recorded with a single conventional 24‐h‐Holter ECG.