bluuebunny/crossref_metadata_2025 huggingface dataset:
Punctuated Equilibrium, Bureaucratization, and Budgetary Changes in Schools
Authors: Robinson Scott E.
Published: February 2004

For half of a century, models of nonrational behavior have grown in popularity for explaining the behavior of administrative organizations. However, models of nonrational behavior are notoriously difficult to test because nonrational behavior is often difficult to separate from fully rational behavior. Recent research has suggested that particular types of nonrational processes should produce “punctuated” equilibria rather than “instantaneous” equilibria. In these nonrational processes, a decision maker underresponds to changes for a long period of time. Once pressure for change becomes overwhelming, the decision maker adopts a radical change. This is called “punctuation.” The key to identifying this type of nonrationality of a process's rationality is the comparative success of fitting the observed behavior to “punctuated” rather than “instantaneous” equilibria.

True, Jones, and Baumgartner (1999) developed a method for comparing the distribution of decision outputs as a strategy for assessing the relative degree of “punctuation” in the decision processes. By assessing the kurtosis (or “peakedness”) of the distribution of decision outputs, one can get a sense of the excess (compared with a standard, normal distribution) of low and high rates of change–a sign of punctuated equilibrium.

This article extends these recent developments by adapting the method to a comparative kurtosis framework. The results suggest that bureaucracy in K–12 schools serves to reduce (rather than amplify) the punctuations in budgeting processes. The article concludes with a discussion of the potential extension of the empirical results and modifications to the testing procedure.
The Politics and Administration of Privatization: Contracting Out for Corrections Management in the United States
Authors: Nicholson‐Crotty Sean
Published: February 2004

Shrinking budgets and the emergence of “new public management” and other market‐based reforms have put increasing pressure on many governments and government agencies to use contracting as a means of service delivery. This essay suggests that contracting should be viewed as a multistage affair, in which both political and administrative actors make key decisions at different stages of the process. It also hypothesizes that these actors weigh the political and instrumental motivations for contracting differently and, therefore, that the relative importance of these factors varies depending on the stage of the contracting process. An empirical analysis of corrections management contracts in the American states provides significant evidence for these assertions.
Certainty, Severity, and Their Relative Deterrent Effects: Questioning the Implications of the Role of Risk in Criminal Deterrence Policy
Authors: Mendes Silvia M.
Published: February 2004

In the late 1960s, Gary Becker incorporated into his formal model of deterrence theory an explicit statement that the theory's components—certainty and severity of punishment—are more or less influential than the other depending on an individual's preference for risk. The certainty of punishment is more influential than the severity of punishment in the decision of whether or not to commit crime if an individual is risk acceptant; if a criminal is risk averse, then the severity of punishment is more important than the certainty of punishment. Many aggregate deterrence studies arrive at estimates that reveal varying effects of the certainty and severity components of deterrence theory, with the certainty of punishment carrying the greater, and many times the only, weight. Leaning on Becker's extension of deterrence theory, empiricists assume that criminals have a preference for risk. Assertions that arrests and convictions are greater deterrent tools imply important worldly consequences because they indicate to governmental authorities where resources should be invested to insure the best deterrent payoff. In this article, I question both the need to take risk into consideration in aggregate‐level deterrence studies and the empirical evidence that has been offered in support of attaching greater weight to the certainty of punishment. I show, first, that deterrence theory, from an applied policy standpoint, is encumbered through the explicit consideration of risk preferences. Next, I work through the algebra of the statistical formulations of deterrence models and demonstrate that the greater weight associated with certainty could well be an artifact of the model specification. Finally, I reanalyze data that appear to be consistent with the greater weight for certainty than severity argument and show that the evidence does not support that inference. Potential criminals mentally combine the three deterrence components—regardless of whether they are risk neutral, averse, or acceptant. I conclude by considering what it means to a worldly application of criminal deterrence theory to place equal weight on the certainty and the severity of punishment.
Short‐Term Versus Long‐Term Coalitions in the Policy Process: Automotive Pollution Control, 1963–1989
Authors: Zafonte Matthew , Sabatier Paul
Published: February 2004

Research on coalitions in the policy process has found evidence of both short‐term and long‐term coalitions. Two possible methodological reasons for the varied results are that (1) there has been little systematic longitudinal research on the topic, and (2) most scholars have not distinguished situations where fundamental versus secondary interests are at stake. This article addresses both points by first applying the Advocacy Coalition Framework (ACF), which distinguishes fundamental from secondary beliefs/interests, and then performing a quantitative analysis of the content of organizations’ testimonies regarding automotive pollution control over 26 years. Consistent with the ACF, we find that coalitions of interest groups, legislators, local governments, and agencies are relatively stable over time, despite two potentially disruptive events—the 1973–74 Oil Embargo and the 1980 Elections. On the other hand, there is little support for the ACF's hypothesis that broader beliefs will be more stable than narrower secondary beliefs. Our systematic methodology also enables us to separate the general pattern of stability from interesting exceptions of instability.
A Multipopulation Comparison of the Diffusion of Public Organizations and Policies across Space and Time
Authors: Jensen Jason L.
Published: February 2004

This study examined the longitudinal spatial diffusion of state government policies and their related implementation organizations in the American states. The impact of coercive, institutional, and competitive processes on policy and state agency adoption were considered, as well as how aspects of the underlying policy can impact the degree of spatial diffusion. The rises of 27 different policy populations were analyzed over time, each representing not only a different policy form but a distinct implementation organization.

The policy adoption/spatial diffusion relationship across all populations was examined and results showed that the degree of spatial diffusion varied greatly. Analysis of potential relationship moderators indicated that federal impetus (coercive processes) led to an absence of spatial diffusion. Policies with an institutional basis also showed an absence of spatial diffusion while competition‐based policies diffused spatially.
Does Diversity Matter? Measuring the Impact of High School Diversity on Freshman GPA
Authors: Tam Mo Yin S. , Bassett Gilbert W.
Published: February 2004

At the heart of arguments for affirmative action in university admissions are various claims about ethnic diversity. One assertion is that a diverse student body improves the quality of the educational experience: all students learn more. Further, a diverse educational experience better prepares students for the pluralistic society in which they will live. Previous studies examining these issues have been based on informal and survey methods. To better assess the impact of diversity we utilize a data set that allows us to measure student performance at the University of Illinois at Chicago (UIC) as a function of the diversity of a student's high school. Do students from diverse high schools do better in the ethnically diverse environment at UIC? After controlling for other factors that affect GPA, such as ACT, high school rank, and high school quality, we find significant diversity impacts. Depending on the diversity measure, a student from a very diverse high school has an expected first semester GPA that is a one‐fourth to one‐half point higher than a student from a nondiverse high school. The diversity impacts tend to be greater for students in the lower tail of the GPA distribution. There are also large gender differences with females helped most by diversity. Although the results represent outcomes at only one university, they nevertheless serve as a starting point for quantitatively assessing the impact of a diverse learning environment.
The Politics of European Union Immigration Policy: Institutions, Salience, and Harmonization
Authors: Givens Terri , Luedtke Adam
Published: February 2004

This article examines recent attempts to create a common European Union (EU) immigration policy. This “harmonized” policy has faced political blockages, despite being seen by most observers as necessary if the EU is to meet its goal of free movement of labor. Because of this resistance, immigration harmonization has lagged behind other EU policy areas. To explain national resistance to harmonizing immigration policy, our article develops a theoretical and conceptual model of how immigration policy is potentially harmonized at the EU level, but how this harmonization can be blocked or restricted. We explain these political blockages with a model of intergovernmental bargaining that focuses on political salience, political partisanship, and institutions that protect immigrant rights. We argue that these national‐level factors have determined the success and the nature of various harmonization proposals, by determining the positions of member states when negotiating in the European Council. Our primary hypothesis is that when the political salience of a given immigration issue is high, any harmonization that results is more likely to be restrictive toward immigrant rights. We also hypothesize that the impact of institutions that protect immigrant rights, and of political partisanship, is variable depending on the issue area and the national context. We use literature on European integration, immigration politics, agenda‐setting, venue‐shopping, and two‐level games to theorize, operationalize, and test these hypotheses. The article helps to advance scholarly work on immigration politics, but our model could also conceivably be applied to other high‐salience policy areas in the EU.
Reinventing Leeway: The President and Agenda Certification
Authors: JONES CHARLES O.
Published: February 2004

The separated system is designed for competitive invention and reinvention. Leeway is featured as a potential benefit for agenda setting, an inherently speculative activity. Presidents are well placed to certify agenda issues, to declare “Let's start here.” Often lacking overwhelming political capital, they perform this role most effectively by taking advantage of the leeway offered by separated institutions competing for shares of powers. The frequency of split‐party government in the postwar period has encouraged greater attention to leeway. Viewing competition in agenda setting as opportunity may appear counterintuitive. But that attribute exhibits the reinventive nature of a separated powers system. These points are illustrated with reference to the Clinton administration.
Strengthening Presidential Decision‐Making Capacity
Authors: HULT KAREN M.
Published: February 2004

Like the U.S. political system as a whole, the presidency has grown far more open to members of the public and, especially, to organised interests. Over roughly the same period, the presidency has become less permeable to much of the expertise and experience available within the executive branch. Together, these two features have contributed to weaknesses in the decision‐making capacity of the institution, with implications for policy effectiveness and perceived legitimacy. This article sketches the bases for the claim of attenuated decision capacity and its implications. After arguing that changes in rules and structuring may help strengthen presidential decision‐making capabilities, the article goes on to propose several such alterations.
Building Coalitions
Authors: EDWARDS GEORGE C.
Published: February 2004

The necessity of forming coalitions is inevitable in a large, diverse nation in which political power is fragmented both vertically and horizontally. Presidents invest substantial time and effort building supporting coalitions for themselves and their polices among the public and within Congress. The author explores the president's ability to build coalitions, examines the relationship between the institutional presidency and obstacles to coalition building, and inquires whether the presidency as an institution is adequate to the task of building the coalitions necessary for governing. He concludes that (1) the president has great difficulty building coalitions for governing among the public and within Congress, (2) the institutional structure of the presidency (and Congress) is at the core of the difficulty of building coalitions in Congress but does not inhibit obtaining public support, and (3) the changes required to notably improve presidential coalition building are so fundamental that they are unlikely to occur.
The Presidency, the Bureaucracy, and Reinvention: A Gentle Plea for Chaos1
Authors: LOWERY DAVID
Published: February 2004

The relative influences of the unique and traditional elements of the Clinton‐Gore National Performance Review (NPR) episode of bureaucratic reform are examined here as a means of exploring the underlying dynamics of executive‐bureaucratic relationships. The first section of the article outlines the reinvention theory underlying NPR. This is followed by an analysis of how NPR deviated from that theory. The third section of the article considers what reforms might have been proposed by NPR had it taken reinvention theory more seriously. And fourth, the author discusses the deeper problems of presidential implementation of any reform not founded on enhanced hierarchical control of the bureaucracy by the White House. Finally, a unidirectional cycle of presidential reform is described, a cycle that seems impervious to and unconnected with scholarly work on management.
Domestic Policy Making
Authors: LIGHT PAUL C.
Published: February 2004

This article asks how changes in the presidential policy‐making process have affected domestic policy in general and the agenda‐setting process in particular. The past forty years have witnessed two roughly parallel but possibly unrelated trends. First, the presidential policy‐making process has become more formalized as presidents have added staff and capacity to the institutional presidency. Second, the number of proposals on the president's domestic policy agenda has declined in both number and newness. Simply stated, the president's agenda has declined in significance even as the policy process has increased in capacity. This article examines the possible explanations for the trends while suggesting that institutionalization may not have been the wisest organizational response to the political pressures that led to a shrinking of the president's agenda.
Reinventing What for Whom? President and Congress in the Making of Foreign Policy
Authors: ROCKMAN BERT A.
Published: February 2004

Strengthening the presidency in foreign policy usually means weakening others who may be a president's competitors. Before pursuing such a path it is important to know what problems are present and whether we wish to invest more power in the president to deal with them. An inventory of these problems suggests the following: (1) Congress traditionally has had and continues to exercise influence over the financing of international commitments, (2) the Senate recently has been more actively resisting presidential nominees for extraneous reasons and typically doing so through dilatory and minority obstructing tactics rather than through floor votes, yet (3) presidential willingness to embark unilaterally on foreign policy and defense commitments is rarely successfully resisted. It is dubious that structural reinvention will resolve matters that arise from strong political difference, nor is it the case that presidents, under the present system, find themselves paralyzed from acting.
The Law: The Clinton Theory of the War Power
Authors: ADLER DAVID GRAY
Published: February 2004

President Bill Clinton frequently has engaged in unilateral acts of executive war making in defiance of the war clause of the Constitution, which vests in Congress the exclusive authority to initiate hostilities on behalf of the American people. Recently, Clinton ordered in concert with NATO allies a massive air and missile assault against the Federal Republic of Yugoslavia, an attack that ranks as the most intensive and sustained military campaign conducted by the United States since the Vietnam War. This article analyses the administration's legal and constitutional justifications, and concludes that Clinton's action violates the fundamental requirement of the war clause—authorization of hostilities by both houses of Congress. Clinton's “presidential war” against Yugoslavia marks the first time in our history that a president has waged war in the face of a direct congressional refusal to authority the war. The war clause, it appears, has become a dead letter.
The Polls: The Components of Presidential Favorability
Authors: COHEN JEFFREY E.
Published: February 2004

This article uses a February 1997 Gallup Poll to address at the individual level the connections between presidential job approval and favorability as well as to look at the sources of favorable attitudes toward the president. The analysis found that an overwhelming number of people hold consistent and favorable job performance assessments of the president. However, sources of inconsistency, in which a person might view the president favorably but disapprove of his job (or visa versa), are not randomly distributed. The analysis also looked at factors that may structure people's favorability toward the president, focusing on presidential traits. While one can conceptually organize the traits into two sets that one can distinguish as character and competence, the public seems not to make such a distinction, lumping all into one set.
The Qualities of Effective Presidents: An Overview from FDR to Bill Clinton
Authors: GREENSTEIN FRED I.
Published: February 2004

The highly personalized nature of the modern American presidency makes the strengths and weaknesses of the White House incumbent of the utmost importance. This article summarizes the conclusions of an interpretative study of the eleven American presidents from Franklin Roosevelt to Bill Clinton. It discusses the qualities that have served well and poorly in the Oval Office under six headings: communication to the public, organizational capacity, political skill, policy vision, cognitive style, and emotional intelligence.
Measuring Congressional Support for the President: Evaluating NOMINATE Scores
Authors: HIXON WILLIAM , WICKS AARON E.
Published: February 2004

Assessing presidential influence in Congress requires accurate measures of legislators' baseline preferences. Common strategies extract preferences from roll‐call votes. One approach selects votes most likely to reveal uncorrupted, sincere preferences, and the other, NOMINATE, derives summaries of members' positions from large samples of votes. This article finds that NOMINATE scores do not accurately recover the relative positions of members in simulated legislatures. Errors increase with the number of policy dimensions and do not depend on agenda control or on vote trading. However useful NOMINATE is for summarizing voting patterns, this article cautions against this approach to measuring legislators' preferences.
Divided Government and Democratic Presidents: Truman and Clinton Compared
Authors: CONLEY RICHARD S.
Published: February 2004

This article compares the experiences of President Truman in the 80th Congress and President Clinton in the 104th Congress. The impact of divided government is measured by examining presidential involvement on significant legislation in the two periods, presidential floor success rates, and congressional support for the president on domestic policy and veto override attempts. The article concludes that innovative legislation in both periods was largely congressionally driven, while voting alignments in Congress ultimately affected each president's ability to control policy outcomes through the use of the veto. Regional fragmentation in the Democratic Party and Republican unity combined to undercut Truman's ability to marshal strong support on his legislative stands or on veto override attempts, contributing to a series of successful anti–New Deal measures. Democratic Party cohesion in the 104th Congress allowed Clinton to ward off veto override attempts and stifle much of the Republican agenda outlined in the Contract with America.
The President as Opposition Leader
Authors: CROCKETT DAVID A.
Published: February 2004

This article explores the nature of presidential opposition leadership. Presidents aligned with a minority party are opposed to the reigning governing philosophy. Such presidents can be considered “opposition leaders,” and the nature of the conflict they face differs from that of other presidents. All opposition presidents face roughly the same type of leadership situation—governing in an era in which they do not control the power to define politics. That problem influences the actions of administrations. Studying the presidency in such a political context enables us to break free of the one‐size‐fits‐all model of presidential leadership. Leadership strategies are contingent and context bound. If an opposition leadership strategy can be generalized to all such presidents, the article will demonstrate the need to be more nuanced in our examination of this branch.
Fiscal Policy and Presidential Elections: Update and Extension
Authors: CUZÁN ALFRED G. , BUNDRICK CHARLES M.
Published: February 2004

This article updates, deepens, and extends previous articles published in this journal on the relation between fiscal policy and presidential elections. It presents evidence that is consistent with the view that voters reward fiscal frugality and punish fiscal expansion. The relationship is robust with respect to economic conditions, presidential incumbency, number of consecutive terms in the White House by presidents of the same party, and war. An intriguing finding is that, when fiscal policy is controlled for, incumbency advantage practically disappears. It is hoped that these findings will stimulate more political scientists, especially students of the presidency, to pay more attention to the role of fiscal policy in presidential elections.
Lincoln, Machiavelli, and American Political Thought
Authors: DANOFF BRIAN F.
Published: February 2004

The author argues that Machiavelli's political theory provides us with a framework that can be used to illuminate the words and deeds of Abraham Lincoln. He draws primarily on the competing interpretations of Machiavelli offered by J.G.A. Pocock, on one hand, and Harvey Mansfield on the other. According to the author, Pocock's and Mansfield's very different readings of Machiavelli can both be employed to shed light on Lincoln's multifaceted statesmanship. This conclusion is at odds with the interpretation of Lincoln offered by John Patrick Diggins in The Lost Soul of American Politics. According to Diggins, there may be some similarities between Lincoln and Machiavelli, but “such similarities… are far less telling than the contrasts.” The author hopes to convince the reader that a Machiavellian interpretation of Lincoln is, in fact, far more compelling than Diggins would have us believe.
Theodore Roosevelt, Congress, and the Military: U.S. Civil‐Military Relations in the Early Twentieth Century
Authors: OYOS MATTHEW M.
Published: February 2004

The presidency of Theodore Roosevelt marked a time of considerable tension in civil‐military affairs. Roosevelt made the modernization of the armed services a top priority, but frequently he complicated civil‐military relations in the process. Members of Congress worried about the executive treading on legislative prerogatives, and military officers actually found many presidential initiatives disruptive. In addition, Roosevelt's cultivation of popular support for his military programs reshaped civil‐military relations. The press regularly rewarded the president with favorable coverage, but sometimes Roosevelt endured controversies that were largely his own making. Roosevelt and the other participants in civil‐military debates lavished so much attention on reporters that the press essentially became a fourth member of the established civil‐military troika of president, Congress, and military. This development, along with Roosevelt's work to modernize the military and the demands of great power responsibilities, formed the broad outlines of modern civil‐military relations in the United States.
The Forgotten Legacy of the New Deal: Fiscal Conservatism and the Roosevelt Administration, 1933‐1938
Authors: ZELIZER JULIAN E.
Published: February 2004

This article examines the role of fiscal conservatives in Franklin Roosevelt's New Deal administration. Unlike most existing scholarship on the New Deal, which downplays the importance and complexity of fiscal conservatism in Roosevelt's administration, this article argues that the tradition was crucial to the development of the New Deal state. Through the New Deal, it demonstrates how the histories of liberalism and fiscal conservatism are intimately related. The article focuses on two key advisers—Lewis Douglas, Director of Budget from 1933 to 1934, and Henry Morgenthau Jr., Secretary of Treasury from 1934 to 1945—who were instrumental in making fiscal conservatism a part of President Roosevelt's agenda. While Douglas's rigid orthodox approach eventually isolated him from policy making, Morgenthau's entrepreneurship produced a new vision of moderate fiscal conservatism that could coexist with the New Deal.
Usefulness of Transthoracic Echocardiography to Detect Coronary Aneurysm in Young Adult: Two Cases of Acute Myocardial Infarction Due to Kawasaki Disease
Authors: Shiraishi Jun , Harada Yoshiaki , Komatsu Sumio , Suzaki Yoko , Hosomi Yasuo , Hirano Shinji , Sawada Takahisa , Tatsumi Tetsuya , Azuma Akihiro , Nakagawa Masao , Matsubara Hiroaki
Published: February 2004

Transthoracic echocardiography is useful for evaluation of the coronary arteries in infants and children with Kawasaki disease. In adults, however, transthoracic echocardiography often cannot detect or accurately estimate coronary artery lesions. We describe two young adults admitted for a diagnosis of acute myocardial infarction ascribed to Kawasaki disease and treated by angioplasty. Coronary aneurysms were not evident in either patient at the time of angioplasty. However, follow‐up transthoracic echocardiography revealed coronary aneurysms at the culprit lesions. On follow‐up angiograms, we identified a new coronary aneurysm in the first patient, and a regressed coronary aneurysm in the second, confirmed by intravascular ultrasound imaging. These cases suggest that transthoracic echocardiography plays an important role in the diagnosis and treatment of young adults with acute myocardial infarction due to Kawasaki disease. (ECHOCARDIOGRAPHY, Volume 21, February 2004)
Double‐Chambered Right Ventricle Associated with Mural and Pulmonic Valve Endocarditis: Description of a Clinical Case and Review of the Literature
Authors: López‐Pardo Francisco , Aguilera Almudena , Villa Manuel , Granado Carlos , Campos Ana , Cisneros José M.
Published: February 2004

A double‐chambered right ventricle is a relatively uncommon congenital cardiac defect characterized by the presence of anomalous muscle bundles dividing the right ventricle into a high‐pressure proximal chamber and a low‐pressure distal chamber. This pathology is often wrongly diagnosed in adult patients. We report the first case of a patient with double‐chambered right ventricle associated with a mural and pulmonic valve endocarditis caused by Streptococcus parasanguis diagnosed with two‐dimensional echocardiography. During the course of treatment, the patient suffered from a septic pulmonary embolism, and subsequently required surgical intervention, which confirmed the echocardiographic findings. (ECHOCARDIOGRAPHY, Volume 21, February 2004)
Extension of Bronchogenic Carcinoma Through Pulmonary Vein into the Left Atrium Detected by Echocardiography
Authors: Desai Milind Y , Mankad Sunil
Published: February 2004

This is the case of a 46‐year‐old female recently diagnosed with a squamous cell bronchogenic carcinoma that spread through the pulmonary veins into the left atrium. This mass was initially seen on surface echocardiography as emanating from the pulmonary vein and subsequently confirmed to be arising from the right superior pulmonary vein by transesophageal echocardiography. (ECHOCARDIOGRAPHY, Volume 21, February 2004)
Three‐Dimensional Echocardiography of Intracardiac Masses
Authors: Lokhandwala Juzar , Liu Zheng , Jundi Majd , Loyd Amy , Strong Michael , Vannan Mani
Published: February 2004

We describe two cases in which three‐dimensional echocardiography provided unique anatomical data. This information enhanced the diagnostic power of two‐dimensional echocardiography by improving confidence in interpretation and by providing distinctive spatial insights. (ECHOCARDIOGRAPHY, Volume 21, February 2004)
Remodeling of Coronary Arteries in Diabetic Patients—An Intravascular Ultrasound Study
Authors: Reddy Hanumanth K. , Koshy Santhosh K.G. , Foerst Jason , Sturek Michael
Published: February 2004

Background: Coronary artery remodeling is a structural change in the vessel wall and typically in response to atherosclerotic plaque. The nature of coronary remodeling has been described in different clinical situations. However, remodeling characteristics of coronary arteries of diabetic patients have never been studied. Hypothesis: We tested the hypothesis that positive remodeling of coronary artery in response to atherosclerotic plaque in diabetic patients would be less compared to nondiabetic patients. Methods: Coronary intravascular ultrasound analysis of data in 26 consecutive patients (12 diabetic and 14 nondiabetic) was performed. Linear regression analyses of vessel area versus plaque area were carried out to establish a relation between the degree of plaque and the extent of remodeling in diabetic and nondiabetic groups. Results: The positive remodeling quantified as the slope of the regression line was similar in both the groups (diabetic group 1.32 and nondiabetic group 0.80) when all segments with different plaque areas were considered (P > 0.05). However, the diabetic group had greater positive remodeling in segments with plaque area less than 55%, as the slope for diabetic group was 2.01 and nondiabetic group was 1.40 (P < 0.05). Conclusions: Both the diabetic and nondiabetic patients had positive remodeling in response to atherosclerotic plaque formation. Diabetics had greater positive remodeling in the early stages of atherosclerosis compared to nondiabetics, thus providing evidence against our hypothesis. The adverse clinical outcomes in diabetics may not be due to inadequate positive remodeling of coronary arteries as previously thought. (ECHOCARDIOGRAPHY, Volume 21, February 2004)
Spontaneous Echocardiographic Contrast in the Ascending Aorta Mimicking the Appearance of Aortic Dissection in a Patient with a Left Ventricular Assist Device
Authors: Nicolson Dermot G. , Porto Italo , Westaby Stephen , Boardman Phil , Banning Adrian P.
Published: February 2004

We describe a patient with a previously implanted Jarvik 2000 left ventricular assist device (LVAD), who presented with bacteraemia and with features suspected for aortic dissection at the CT scan. However, transesophageal echocardiography showed competition in the ascending aorta between the retrograde pump flow and the anterograde transaortic output, which mimicked true aortic dissection and could be resolved by lowering the pump speed. As patients with LVAD are increasing in number, clinicians should be aware of this possible effect. (ECHOCARDIOGRAPHY, Volume 21, February 2004)
Quantitative Intravenous Myocardial Contrast Echocardiography Predicts Recovery of Left Ventricular Function After Revascularization in Chronic Coronary Artery Disease
Authors: Fukuda Shota , Hozumi Takeshi , Muro Takashi , Watanabe Hiroyuki , Hyodo Eiichi , Yoshiyama Minoru , Takeuchi Kazuhide , Yoshikawa Junichi
Published: February 2004

Background: Quantitative intravenous myocardial contrast echocardiography (MCE) has been shown to measure regional myocardial blood flow velocity noninvasively.

Purpose: To determine whether quantitative intravenous MCE could be used clinically to predict functional recovery after revascularization in patients with chronic coronary artery disease. Methods: Twenty‐eight patients with chronic stable coronary artery disease and resting regional left ventricular dysfunction were included in this study. The study permits myocardial perfusion analysis by intravenous MCE before revascularization with continuous infusion of Levovist and intermittent ultrasonic exposure. Wall motion assessment by echocardiography at rest was repeated after long‐term follow‐up period (7 ± 2 months). In dysfunctional segments, we analyzed myocardial perfusion quantitatively by fitting to an exponential function, Y = A(1 − e−βt) to obtain the rate of rise (β) of background‐subtracted intensity, which represented myocardial blood flow velocity. Results: Of the 101 revascularized dysfunctional segments, MCE was adequately visualized in 91 (90%) segments, and wall motion was recovered in 45 (49%) segments. The value of β in the recovery segments was significantly higher than that in nonrecovery segments (0.80 ± 0.50 vs 0.39 ± 0.24, P < 0.001). The value of β > 0.5 predicted recovery of segmental function with a sensitivity of 71%, specificity of 78%. Conclusion: Quantitative intravenous MCE can predict functional recovery after revascularization in patients with chronic coronary artery disease. (ECHOCARDIOGRAPHY, Volume 21, February 2004)
Value of Tissue Doppler Imaging to Predict Left Ventricular Filling Pressure in Patients with Coronary Artery Disease
Authors: Mansencal Nicolas , Bouvier Erik , Joseph Thierry , Farcot Jean‐Christian , Pillière Rémi , Redheuil Alban , Lacombe Pascal , Jondeau Guillaume , Dubourg Olivier
Published: February 2004

Assessment of left ventricular (LV) diastolic filling pressure provides important information on the hemodynamic status in the general population. The aim of our study was to investigate the reliability of tissue Doppler imaging (TDI) in estimating left ventricular filling pressure in patients with coronary artery disease (CAD). We prospectively studied 32 consecutive CAD‐patients, mean age 64 ± 12 years, in sinus rhythm. All patients underwent cardiac catheterization and echocardiography within the same hour. Catheterization investigated pre‐A‐wave pressure (preA) and LV ejection fraction (LVEF). Echocardiographic LVEF was calculated using wall motion indexes (WMI) with segmental division of LV wall. The following Doppler parameters were assessed: (1) PW Doppler signals from the mitral inflow (E), (2) PW TDI of the mitral annulus (E′), thus allowing to obtain the mitral inflow to annulus ratio (E/E′). The best correlation between invasive and echocardiographic LVEF was observed using WMI (r = 0.91). The correlations between preA and E, E′, and E/E′ were significant (r = 0.36, r = 0.38, and r = 0.60, respectively). In patients with LVEF >50%, no correlation between E/E′ and preA was found (r = 0.18, P = 0.44), whereas with LVEF <50%, this correlation was strong (r = 0.76, P < 0.001). In patients with myocardial infarction, the correlation between E/E′ and preA was significant whatever the localization of myocardial infarction (r > 0.71, P < 0.05). ROC curve analysis identified an E/E′>9 to be the best cut‐off value related to preA > 15 mmHg. We conclude that the mitral inflow‐to‐annulus ratio is a reliable method in CAD patients and allows determination of LV filling pressure when LVEF <50%. (ECHOCARDIOGRAPHY, Volume 21, February 2004)
Spontaneous Coronary Artery Dissection, Aneurysms, and Pseudoaneurysms: A Review
Authors: Aqel Raed A. , Zoghbi Gilbert J. , Iskandrian Ami
Published: February 2004

Spontaneous coronary artery dissection is a rare cause of myocardial ischemia and sudden death. Coronary aneurysms and pseudoaneurysms, which may occur after percutaneous coronary interventions, rarely occur spontaneously. We review the pertinent medical literature and describe the intravascular findings of spontaneous coronary artery dissection, aneurysms, and pseudoaneurysms. (ECHOCARDIOGRAPHY, Volume 21, February 2004)
Role of Dobutamine‐Atropine Stress Echocardiography in Prognostic Evaluation of 300 Women
Authors: Cordovil Adriana , Júnior Wilson Mathias , Andrade José Lázaro , Filho Orlando Campos , Moisés Valdir Ambrósio , Gil Manoel Adán , Machado Cristiano Vieira , Arruda Adelaide Maria , Paiva Marcelo Goulart , Carvalho Antonio C. , De Paola Angelo A.V.
Published: February 2004

Background: Dobutamine‐atropine stress echocardiography (DASE) is a safe and accurate method to diagnose coronary artery disease (CAD), and can identify individuals at high risk for cardiac events such as myocardial infarction and cardiac‐related death. The literature is limited regarding the prognostic value of DASE in women. Objective: The objective was to determine the prognostic value of DASE in 300 women with known or suspected CAD. Results: The 300 women underwent DASE and were followed up for 65 months (mean: 27 months). Ninety‐five women had positive tests and 205 had negative tests. We demonstrated that women with negative tests had a 94% hard‐event‐free survival rate at follow‐up (myocardial infarction and death), and in those with positive tests the event‐free survival rate was 27% (P = 0.0003). The difference between women with positive and negative tests was also significant when minor events and total events were considered. Women with positive tests had 16.7 times more chance of having events than women with negative tests. Furthermore, women with positive tests but without cardiac events at follow‐up (mean of peak WMSI – rest WMSI = 0.24 ± 0.16) had less ischemic myocardium than women with positive tests and cardiac events at follow‐up (mean of peak WMSI – rest WMSI = 0.34 ± 0.26)(P < 0.04). Conclusion: Dobutamine‐atropine stress echocardiography has good prognostic value for cardiac events in women. Women with negative tests have low probability for follow‐up infarction or death. Women with positive tests and higher severity of induced ischemia have the highest incidence of cardiac events. (ECHOCARDIOGRAPHY, Volume 21, February 2004)
Giant Vegetation of the Mitral Valve Simulating Primary Cardiac Tumor
Authors: Auriti Antonio , Chieffi Mara , Cianfrocca Cinzia , Manente Liborio , Podda Ignazio , Guido Vincenzo , Galeazzi Marco , Giannantoni Paride , Santini Massimo
Published: February 2004

A case of a giant vegetation of the mitral valve causing sudden death of the patient is reported. The case underlines that urgent removal of a big mass must always be considered because of the risk of sudden death or catastrophic embolism. Echocardiographic differential diagnosis of a mass is discussed and is crucial for the choice of the strategy. (ECHOCARDIOGRAPHY, Volume 21, February 2004)
The Effect of Time and of Vasoactive Drugs on Capillary Leakage Induced During Myocardial Contrast Echocardiography
Authors: Miller Douglas , Li Peng , Armstrong William F.
Published: February 2004

Background: Premature ventricular contractions (PVC), capillary leakage, and petechial hemorrhage can occur during myocardial contrast echocardiography (MCE). The effects occur as a result of the interaction of contrast agent microbubbles and the ultrasound, but the detailed etiology of the effects is not yet clear. This study tested the hypothesis that the capillary leakage results from a physiological response to injury, which might be protracted and modulated by vasoactive drugs. Methods: Hairless rats were anesthetized and transthoracically scanned with a diagnostic ultrasound system (GE Vingmed System V) at 1.7 MHz with 1:4 triggered frames at end systole. The scan head and rats were mounted in a 37°C water bath to assure free‐field conditions and placement of the heart at a similar focal distance as humans. A tail vein was cannulated for injections of Optison® contrast agent, vasoactive medications, and Evans Blue dye (EB). EB was injected as a marker of capillary leakage before or after scanning. Results: PVCs, petechia, and capillary leakage occurred during ultrasound exposure of microbubbles in myocardium, with no effects detected in shams. The influence of the vasoactive medications propranolol and isoproterenol on the effects did not support the hypothesis. Capillary leakage occurred during and postexposure, but diminished for EB injection 20 minutes after scanning with or without isoproterenol pretreatment. Conclusion: MCE induced PVCs, petechia, and capillary leakage, all of which ended immediately or within 20 minutes after the examination. Contrary to the hypothesis of a physiological mechanism, the capillary leakage appears to be primarily a mechanical effect rather than a physiological response. (ECHOCARDIOGRAPHY, Volume 21, February 2004)
The Use of Contrast Echocardiography in the Diagnosis of an Unusual Cause of Congestive Heart Failure: Achalasia
Authors: Stoupakis George , Fuhrman Michael A. , Dabu Leticia , Knezevic Dusan , Saric Muhamed
Published: February 2004

Extrinsic compression of the left atrium is a potentially life‐threatening but unusual cause of congestive heart failure. Achalasia is a motility disorder characterized by impaired relaxation of the lower esophageal sphincter and dilation of the distal two‐thirds of the esophagus. We report only the third known case in the world literature of massive left atrial compression by a dilated esophagus in a patient with achalasia. The use of contrast echocardiography with perflutren protein‐type A microspheres allowed for differentiation between a compressive vascular structure and the esophagus. This resulted in prompt treatment leading to hemodynamic stability after nasogastric decompression and Botulinum toxin injection at the gastroesophageal junction. (ECHOCARDIOGRAPHY, Volume 21, February 2004)
Left Ventricular Long‐Axis Function Is Reduced in Patients with Rheumatic Mitral Stenosis
Authors: Özer Necla , Can İlknur , Atalar Enver , Sade Elif , Aksöyek Serdar , Övünç Kenan , Aytemir Kudret , Tokgözoğlu Lale , Özmen Ferhan , Kes Sirri
Published: February 2004

Left ventricular long‐axis function evaluated by M‐mode or tissue Doppler echocardiography has been shown to be useful indexes of left ventricular systolic function; however it has not been evaluated in patients with mitral stenosis. We examined the left ventricular long‐axis function of the patients with pure mitral stenosis and normal global systolic function as assessed by fractional shortening of the left ventricle (LV). Fifty‐two patients with pure mitral stenosis and twenty‐two healthy controls were evaluated by echocardiography. Although there was no statistically significant difference in global systolic function, M‐mode derived systolic motion of the septal side and (12 ± 3 vs 14.4 ± 1.5 mm, P = 0.016) the lateral side of mitral annulus (13.2 ± 3 vs 16.8 ± 2 mm, P = 0.001) were both significantly lower in the patients with mitral stenosis than control subjects. Similarly tissue Doppler systolic velocity of the septal annulus (7.6 ± 1.1 vs 10.4 ± 3.2 cm/s, P = 0.03) and lateral mitral annulus (7.6 ± 1.1 vs 10.4 ± 3.2 cm/s, P = 0.003) were also significantly lower in patients with mitral stenosis than in controls. There was a statistically significant correlation between septal annular motion and annular velocity (r = 0.643, P = 0.002). Septal annular motion and annular velocity were also correlated with left atrial ejection fraction (r = 0.338, P = 0.005 and r = 0.676, P = 0.001, respectively). Thus, patients with mitral stenosis had significantly impaired long‐axis function evaluated by M‐mode or tissue Doppler echocardiography despite normal global systolic function. (ECHOCARDIOGRAPHY, Volume 21, February 2004)
Multiple Fistulae Connecting the Right Coronary Artery to the Coronary Sinus
Authors: Mirza Saema , Nanda Navin C. , Baweja Gurpreet , Misra Vijay , Pacifico Albert
Published: February 2004

Right coronary artery to coronary sinus fistula is a rare anomaly. We present a unique case of an adult patient with multiple fistulae from the right coronary artery draining into the coronary sinus near the posterior left atrium–left ventricle junction, first suspected by transthoracic two‐dimensional echocardiography. The multiple openings were not seen by any invasive or noninvasive techniques and were noted only at the time of surgery. To our knowledge, this is the first case of multiple fistulae connecting the right coronary artery to the coronary sinus that has been reported in the English literature. (ECHOCARDIOGRAPHY, Volume 21, February 2004)
Unusually Large Left Atrial Myxoma Presenting with Severe Mitral Valve Obstruction Symptoms
Authors: Yilmaz Mustafa , Gurlertop Yekta , Kocaturk Hasan , Karakelleoglu Sule , Kocak Hikmet
Published: February 2004

A 13‐year‐old girl with the complaint of severe mitral valve obstruction symptoms was diagnosed as having an unusually large left atrial tumor by echocardiography. The giant mass was surgically removed and the postoperative course was uneventful. Histologic examination confirmed the mass was a benign atrial myxoma. (ECHOCARDIOGRAPHY, Volume 21, February 2004)