bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effects of Transdermal Estradiol Alone or with Cyclical Dydrogesterone on Markers of Cardiovascular Disease Risk in Postmenopausal Women with Type 2 Diabetes: A Pilot Study
Authors: Stojanovic N.D. , Kwong P. , Byrne D.J. , Arnold A. , Jagroop I.A. , Nair D. , Press M. , Hurel S. , Mikhailidis D.P. , Prelevic G.M.
Published: July 2008

The objective of this open, longitudinal, controlled study was to assess the effect of trans dermal estradiol alone or combined with cyclical dydrogesterone on the markers of cardiovas cular disease (CVD) risk in postmenopausal women with type 2 diabetes. The control group consisted of postmenopausal diabetic women who declined menopausal hormone replacement therapy (HRT). Twenty-eight postmenopausal women (19 on HRT and 9 controls) with type 2 diabetes were followed up for 12 months. From the active treatment group 14 women with a uterus in situ had 80 μg/24 hr transdermal estradiol (Fematrix 80; Solvay Healthcare Ltd, Southampton, UK) and oral dydrogesterone 10 mg daily for the first 12 days of the calendar month, whereas 5 women with previous hysterectomy had 80 μg/24 hr transdermal estradiol (Fematrix 80) alone. CVD risk markers were measured before and at regular intervals after starting HRT. The main outcome measures were weight, systolic and diastolic blood pressure, fasting plasma glucose, glycated hemoglobin (HbA1c), glucose/insulin ratio, total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, triglyc erides, lipoprotein (a), high-sensitivity C-reactive protein (hs-CRP), fibrinogen, and endothelin-1. Transdermal estradiol with or without dydrogesterone in women with type 2 diabetes did not adversely affect any of the measured markers of cardiovascular risk. There was a significant decrease in HbA 1c, total cholesterol, and LDL cholesterol at 6 months in women receiving HRT. Some of the cardiovascular disease risk markers may improve in postmenopausal women with type 2 diabetes with transdermal estradiol. This effect may have important clinical implications and it deserves further investigation in appropriately designed trials.
Antihypertriglyceridemic Effect of Walnut Oil
Authors: Zibaeenezhad M.J. , Rezaiezadeh M. , Mowla A. , Ayatollahi S.M.T. , Panjehshahin M.R.
Published: July 2008

Hyperlipidemia is an important modifiable risk factor of coronary heart diseases. So far, several studies, have indicated the beneficial effects of nuts on plasma lipid profile. Previously, in a pilot study the authors have shown that administration of 20 g/day of Persian walnut (Juglans regia L.) for 8 weeks could decrease plasma triglyceride (TG) concentration by 17% (p value < 0.05). Walnut also increased the plasma HDL-cholesterol level markedly (p value < 0.05). To make the measurements more reliable and to avoid the unwanted walnut side effects (eg, rash, pruritus), this randomized, double blind case-control study was conducted to evaluate the lipid-lowering effect of Persian walnut oil in the population of southern Iran. Sixty hyper lipidemic subjects were randomized into 2 groups; group A patients (n = 29) received walnut oil encapsulated in 500 mg capsules, 3 g/day, for 45 days. Group B patients (n=31) received placebo and served as the control group. Lipid profiles of both groups were checked before; on days 15, 30, and 45 after the beginning; and 15 days after termination of the study. Plasma TG concentrations decreased by 19% to 33% of baseline in group A patients (p value < 0.05). No statistically significant change was observed in other measured parameters. It was concluded that walnut oil is a good antihypertriglyceridemic natural remedy and should be further explored in more detail.
Relation of Thoracic Aorta Calcification on Computed Tomography and Coronary Risk Factors to Obstructive Coronary Artery Disease on Angiography
Authors: Watanabe Kazuo , Hiroki Tadayuki , Koga Nobuhiko
Published: July 2008

The aim of this study was to investigate whether thoracic aorta calcification (TAC) on computed tomography (CT) and coronary risk factors had any correlation with obstructive coronary artery disease (CAD) on angiography. A total of 225 consecutive Japanese patients underwent both thoracic conventional helical CT and coronary angiography. The thoracic aorta was divided into 4 locations according to the aortic anatomy (inner curve of the aortic arch, aortic arch but not on the inner curve, ascending aorta, and thoracic descending aorta). The classified TAC and coronary risk factors were evaluated for the presence or absence of obstructive CAD. TAC was detected in 185 patients; 141 of 225 patients had significant obstructive CAD. All of the 13 patients with no TAC and no coronary risk factors had no CAD. The obstructive CAD rate with 1 thoracic calcified location and with no, 1, or 2 coronary risk factors was 10%, 58%, and 90%, respectively, and each showed a significant difference (p < 0.0001). The combinations of TAC and coronary risk factors with obstructive CAD were 1 or 2 thoracic calcified locations with 3 coronary risk factors, and 3 thoracic calcified locations with more than 2 coronary risk factors. Increasing thoracic calcified locations and increasing coronary risk factors indicated a higher likelihood of CAD.
Power Thrombectomy in Acute Ischemic Coronary Syndromes
Authors: Topaz On , Perin Emerson C. , Jesse Robert L. , Mohanty Pramod K. , Carr Marc , Rosenschein Uri
Published: July 2008

Intracoronary thrombi are commonly found in patients with acute coronary syndromes. A large thrombus burden or a platelet-rich thrombus frequently resists pharmacologic therapy ("throm bolytic ceiling"). In such cases restoration of adequate antegrade coronary flow necessitates application of a mechanical force. Power thrombectomy is a revascularization strategy incor porating a mechanical device for removal of occlusive coronary thrombi in conjunction with or following administration of either platelet glycoprotein IIb/IIIa receptor inhibitors or thrombolytic agents, or both. Mechanical devices for power thrombectomy include ultrasound sonication, rheolytic thrombectomy (Angiojet), laser, transluminal extraction catheter, aspiration catheter, and to a limited extent, balloon angioplasty. In acute coronary syndromes the strategy of power thrombectomy aims to achieve the clinical advantages of more nearly complete vessel patency, improved antegrade flow, and enhanced preservation of myocardial tissue.
Acute Branch Retinal Arterial Embolism Successfully Treated with Intravenous Prostaglandin E1
Authors: Steigerwalt Robert D. , Pescosolido Nicola , Corsi Marcello , Cesarone M. Rosaria , Belcaro Gianni V.
Published: July 2008

The purpose of this paper is to report the use of intravenous prostaglandin E1' a potent vasodilator, to rapidly restore blood flow and vision in a patient with an acute branch retinal arterial occlusion. An 82-year-old woman with an acute decrease in the visual acuity of her left eye due to an acute superior temporal branch retinal arterial embolus was treated with 140 μg of intravenous prostaglandin E1. The medicine was repeated the following day. At the onset of the branch arterial occlusion her vision in the left eye was 20/50, the embolus could be seen in the superior temporal branch, and a white retinal edema extended down into the macula. At her first eye examination 4 days after treatment, her visual acuity had returned to 20/20, the retinal embolus was still present, but the white macular edema had disappeared. Intravenous prostaglandin E1 is a safe, potent vasodilator for the peripheral vascular system. If used imme diately to treat acute branch arterial retinal occlusions, it can restore good vision. The authors report the first case of the use of intravenous prostaglandin E1 to treat a spontaneous acute branch retinal arterial embolus.
Left Ventricular Intracavitary Mass and Pericarditis Secondary to Metastatic Renal Cell Carcinoma
Authors: Safi Arshad M. , Rachko Maurice , Sadeghinia Sharon , Zineldin Amadeldin , Jinwen Dong  , Stein Richard A.
Published: July 2008

Cardiac metastases from renal cell carcinoma are a well-recognized entity. However, this phenomenon is extremely rare in the absence of vena caval extension. The authors report a patient who after successful resection of renal cell carcinoma presented with left ventricular mass causing left ventricular outflow tract obstruction. There was also metastatic pericardial and intramyocardial involvement. Such a unique combination of cardiac metastasis, in the same patient, has not been reported previously.
Acute Pericarditis Following Percutaneous Transluminal Coronary Intervention
Authors: Hung Ming-Jui , Kuo Li-Tang , Cherng Wen-Jin
Published: July 2008

A 68-year-old man underwent percutaneous transluminal coronary angioplasty for unstable angina. During the balloon inflation, coronary artery dissection with total occlusion was noted and recanalized by coronary stenting. The serial electrocardiograms revealed ST segment and T wave changes without elevation of the cardiac isoenzyme, which is suggested to represent acute pericarditis following the coronary intervention.
Subclinical Hypothyroidism and Lipid Abnormalities in Older Women Attending a Vascular Disease Prevention Clinic: Effect of Thyroid Replacement Therapy
Authors: Ganotakis Emmanouil S. , Mandalaki Kiriaki , Tampakaki Maria , Malliaraki Niki , Mandalakis Emmanouil , Vrentzos George , Melissas John , Castanas Elias
Published: July 2008

The authors evaluated the frequency and type of lipid disorders associated with subclinical hypothyroidism (SH) in older women referred to their university vascular disease prevention clinic. They also assessed the results of thyroid replacement therapy. Fasting serum lipid profiles and thyroid function tests were measured in 333 apparently healthy women (mean age: 71.8 ±7 years). These women were divided into 3 groups: group I: 60-69 years old (n =132); group II: 70-79 years old (n =153); group III: 80-89 years old (n = 48). SH was defined as a serum thyrotropin concentration higher than 3.20 mIU/mL with a normal free thyroxine concentration. The prevalence of SH was 7.5%. Thyrotropin was higher than 3.20 mU/mL in 25 women; 7 (5.3%), 14 (9.2%), and 4 (8.3%) in groups I, II, and III, respectively. Low-density lipoprotein cholesterol (LDL-C) concentrations were higher in the women with SH (p = 0.037). The mean values of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), TC/HDL- C ratio, lipoprotein (a) (Lp[a]), apolipoprotein A-I (apo AI) apolipoprotein B100 (apo B) and apo B/apo A ratio were higher and triglycerides (TG) were lower, compared with those with normal levels of thyrotropin. However, none of these differences reached significance. Restoration of euthyroid status (thyroxine: 50-100 μg/day) in 17 SH women significantly improved TC (p=0.017), LDL-C (p=0.014), TC/HDL-C (p=0.05), LDL-C/HDL-C (p=0.03), apo B (p=0.013), and Lp(a) (p= 0.0005) values. SH is relatively common in older women attending a vascular disease prevention clinic. Thyroid hormone replacement therapy significantly improved serum lipids. In particular, the reduction in LDL-C and Lp(a) concentrations may be of clinical benefit.
In-Hospital Complications of Percutaneous Intraaortic Balloon Counterpulsation
Authors: Arceo Adalberto , Urban Philip , Dorsaz Pierre-André , Chatelain Pascal , Verin Vitali , Suilen Caroline , Rombaut Emmanuel , Chevrolet Jean-Claude
Published: July 2008

Complications related to intraaortic balloon counterpulsation pumping (IABP) remain a problem despite the development of small caliber balloon catheter shafts and introducer sheaths. The authors report their experience in counterpulsation-related complications of 201 consecutive patients who underwent 212 percutaneous counterpulsation balloon insertions from June 1989 to June 1996 by use of balloons with 8-9.5 French shafts. Of these, 82% were men and 36 (18%) were women, with a mean age of 61 ±12 years. Indications for counterpulsation were acute myocardial infarction (AMI) (67%), severe left ventricular failure without AMI (20%), dilated cardiomyopathy (4%), unstable angina (3%), high-risk supported percutaneous coronary angioplasty (2%), and others (4%). IABP was instituted at the bedside in the intensive care unit in 82 patients (39%) and in the catheterization laboratory in 130 (61%). Median duration of counterpulsation was 48 hours (range 30 minutes to 25 days) with successful weaning from counterpulsation in 70% (148 of 212) of procedures. Overall in-hospital mortality rate was 45% (90 of 201). The overall complication rate was 22/212 (10.4%). Major complications were present in 10/212 procedures (4.7%): 6 patients with limb ischemia (1 death directly attributed to this complication, 1 with associated septicemia and limb amputation, 3 requiring surgical thromboembolectomy, and 1 with persistent limb ischemia treated medically until his death caused by intractable left ventricular failure), 2 with important bleeding (1 fatal despite vascular surgical repair and 1 requiring blood transfusion) and 2 with balloon rupture requiring vascular surgery. Minor complications were present in 12 procedures (5.7%), 6 with limb ischemia, 3 with local bleeding, and 3 with catheter dysfunction. All of these resolved after balloon removal and required no further intervention. When limb ischemia did develop it occurred after a median delay of 24 hours following balloon insertion (range 2 to 98 hours). The only predictor of limb ischemia among baseline clinical and procedure-related variables was an age greater than 60 years. Compared with previous recent studies, the rate of complications observed in this study performed with small balloon catheters was acceptably low. Limb ischemia was the most frequent complication, often occurred early, and required further inter vention in half the cases.
Clinical Logistics in 24-Hour Ambulatory Electrocardiographic Monitoring
Authors: RuDusky Basil M.
Published: July 2008

In total, 493 ambulatory ECG recordings were studied. Women were preponderant (62.3% vs 37.7%). The average age of women and men patients was 66.9 and 64.7 years, respectively. Of the ECGs studied, 71.4% showed abnormalities and 28.6% appeared completely normal. Urgent abnormalities were noted in 1.4% of the recordings and significant abnormalities were present in 14.6%. Subjective complaints were noted in their logbooks by 18.8% of patients, but correlation of complaints with the electrocardiographic abnormalities was noted in only 1.2% of cases. The attending cardiologist concluded that 23.9% of the tests supported reasons of valid necessity for performance. Two hundred seventy-three recordings were clas sified as electrocardiographically abnormal (55.4%) but were clinically insignificant. General practitioners requested 59.8% of the tests versus 40.2% by specialists. Preponderant abnor malities included premature atrial and ventricular contractions, supraventricular tachycardia, and atrial fibrillation. Less frequent abnormalities included ventricular tachycardia (4.6%), atrial flutter, atrioventricular block, artificial pacemaker rhythm, nodal rhythm, and intermit tent bundle branch block.
Contrast Transesophageal Echocardiography in Diagnosing Congenital Enlargement of the Right Atrium
Authors: Yukiiri Kazushi , Mizushige Katsufumi , Ohmori Koji , Wada Yoshihiro , Tanimoto Kojiro , Ueda Takashi , Takagi Yuichiro , Kohno Masakazu
Published: July 2008

Congenital malformation of the right atrium or the coronary sinus is rare, and cases are clas sified into 1 of the following 4 categories: (1) congenital enlargement of right atrium, (2) single diverticulum, (3) multiple diverticula of the right atrium, and (4) diverticulum of the coronary sinus. This report presents a 63-year-old man with cardiomegaly and no chest symptoms. A chest radiograph revealed an enlarged cardiac silhouette with a prominent right heart border. Although a transesophageal echocardiography revealed marked enlargement of the right atrium, neither further anomaly nor massive regurgitation was observed. The systolic pulmonary artery pressure derived from the peak velocity of mild tricuspid regurgitation was 38 mm Hg. Secondary enlargement of the right atrium due to atrial septal defect or pulmonary venous connection anomaly was deemed negligible by use of transesophageal contrast echocardiography, and primary enlargement of the right atrium was confirmed. Trans esophageal echocardiography using ultrasound contrast was determined to be feasible for diagnosing congenital malformation of the right atrium.
Congestive Heart Failure Due to Traumatic Arteriovenous Fistula
Authors: Cakmak Mahmut , Cakmak Nazmiye , Arikan Erdinc , Sert Ahmet , Say Ayse Emre , Ersek Birsen
Published: July 2008

Arteriovenous fistulas are abnormal connections between the high-pressure and high-resis tance arterial system and the venous system with opposite features. Due to its lower resis tance, the blood preferentially flows via the fistula rather than through the capillary bed. The amount of shunt flow depends on its size and proximity to the heart. Due to the increase in circulating volume, progressive dilation develops in the whole vascular system proximal to the shunt. Cardiomegaly and venous distention may return to normal after surgical repair of this vascular abnormality. Two cases are presented of heart failure due to traumatic arteriove nous fistula, one of which was between the right renal artery and inferior vena cava and the other between the left renal artery and renal vein.
The Degree of Albuminuria Is Related to Left Ventricular Hypertrophy in Hypertensive Diabetics and Is Associated with Abnormal Left Ventricular Filling: A Pilot Study
Authors: Salmasi Abdul-Majeed , Jepson Ewart , Grenfell Ana , Kirollos Camelia , Dancy Mark
Published: July 2008

The association of albuminuria and left ventricular (LV) hypertrophy (LVH) in diabetics aggra vates the prognosis. The authors studied the relation between LVH and the degree of albu minuria in diabetics and investigated the relationship of albuminuria to LV filling. A comparison was made between 30 hypertensive diabetics, 10 of whom had microalbuminuria (MIC) and 20 had macroalbuminuria (MAC), and 18 diabetics who were normotensive and normalbuminuric (NOR). LV mass index (LVMI) and LV ejection fraction (LVEF) were measured during echocar diography. LV filling pattern at rest and at peak standardized isometric exercise (IME) using handgrip was assessed by measuring E/A (peak velocity of the early/atrial filling waves) of the transmitral flow during Doppler and echocardiography. Each patient underwent a stress ECG test. LVMI was higher in MAC (132.3 ±55.4) than in MIC (115.6 ±32.5) or NOR (90.0 ±31.8) (p<0.01). There were more patients in MAC with LVH (n = 13) and abnormal filling (n = 9 at rest and 16 with IME) than in MIC (LVH = 5, abnormal filling = 1 at rest and 10 during IME) or NOR (LVH = 3, abnormal filling = 1 at rest and 9 during IME) (p < 0.02). LVMI was not related to LVEF. Although blood pressure was not different between MAC and MIC groups, it was signif icantly higher than in the NOR group. This study suggests that a high degree of albuminuria in hypertensive diabetics is associated with greater value for LVMI and an increased incidence of LVH independent of blood pressure level or systolic LV function. LVH is associated with abnormal LV filling. The degree of albuminuria may predict LVMI and LVH, which are associated with abnormal LV filling. This association of abnormal LV filling with albuminuria in hypertensive diabetic patients may account for their high risk of cardiovascular events.
Division or Occlusion of Patent Ductus Arteriosus?
Authors: Rangel Alberto , Pérez-Redondo Héctor , Farell Javier , Basave Marcelo Noé , Zamora Carlos
Published: July 2008

The traditional and most effective form of treatment of persistent ductus arteriosus is surgical ductal division. New therapeutic techniques such as intraluminal ductal occlusion are currently recommended to replace the traditional treatment procedure. The purpose of this paper is to analyze the state of the art of these new therapeutic modalities. From reports in the medical literature, the authors analyzed the indications, results, and complications of the intraluminal ductal occlusion procedures. They applied the Student's t test for independent samples to evaluate the results of intraluminal patent ductus arteriosus occlusion by means of umbrellas, buttons, coils, and Gianturco-Grifka and Amplatzer occluders, respectively, in 2,691 patients collected from the medical literature. According to their analysis the results of intraluminal ductal occlusion with coils were as follows: success 83.7 ±12.2%, failure 3.9 ±2.8%, incom plete ductal occlusion 17.5 ±15.3%, need for surgery 2.8 ±3.8%, need for a second intraluminal procedure 5.8 ±9.9%, and device embolization 6.2 ±7.2%. The use of the Gianturco-Grifka device showed the following results: success 96.0 ±5.6%, failure 4.0 ±5.6%, incomplete ductal occlusion 4.0 ±5.6%, need for surgery 0%, need for a second intraluminal procedure 4.0 ±5.6%, and device embolization 4.0 ±5.6%. The Amplatzer occluder showed the following results: success 92.8 ±6.1%, failure 7.2 ±6.1%, incomplete ductal occlusion 2.0 ±4.3%, need for surgery 0%, need for a second intraluminal procedure 0.8 ±1.7%, and device embolization 0.5 ±1.3%. According to the state of the art, intraluminal ductal occlusion with Gianturco-Grifka device and Amplatzer occluder reduces the proportion of incomplete obstructions and need for surgery. Additionally, the use of the Amplatzer occluder reduces need for a second procedure and the embolization rate. Although the results obtained with the new procedures are better than those obtained previously, they are still not totally satisfactory.
Effect of Intracoronary Estradiol on Postischemic Microvascular Damage in a Porcine Model: A Myocardial Contrast Echocardiographic Study
Authors: Nishino Masami , Youn Ho-Joong , Gheorghevici Dorina , Zellner Christian , Chou Tony M. , Sudhir Krishnankutty , Redberg Rita F.
Published: July 2008

Coronary microvascular damage can occur in the presence of myocardial ischemia even if epicardial vessels are patent, a phenomenon known as "no-reflow." Estrogens have favorable effects on coronary conductance and resistance arteries, and may have therapeutic value in ischemic syndromes. Myocardial contrast echocardiography (MCE) is a promising method for evaluating microvascular damage. In this study, the authors hypothesized that acute intra coronary 17β-estradiol administration can reduce postischemic microvascular damage, which is evaluated by MCE, in a porcine model. Sixteen male pigs were randomized into 2 groups: the treatment group (n = 9) received intracoronary estradiol in increasing doses, and the control group (n = 7) received intracoronary vehicle (dimethylsulfoxide, DMSO). Microvascular damage was induced by balloon catheter occlusion followed by reperfusion of the left circumflex coronary artery (LCX). MCE using Levovist with harmonic imaging was performed before and during 15-minute balloon occlusion of the proximal LCX to determine perfusion areas of the left anterior descending artery (LAD) and LCX. MCE was performed immediately postocclusion and after each injection of estradiol (1, 10, and 100 nmol/L) or DMSO. Videodensitometry measure ments were performed as a quantitative marker for myocardial microvascular damage. Videodensitometry results were expressed as peak intensity ratios. Intracoronary estradiol induced a significant reduction in myocardial microvascular damage after ischemic episode by videodensitometry measurements when compared to intracoronary DMSO. The authors conclude that intracoronary injection of estradiol reduces postischemic microvascular damage measured by MCE in a porcine model.
Warfarin and Aspirin Versus Aspirin Alone in Patients with Acute Myocardial Infarction: A Pilot Study
Authors: Zibaeenezhad M.J. , Mowla A. , Sorbi M.H.
Published: July 2008

The benefits of anticoagulant therapy and antiplatelet agents in secondary prevention of myocardial infarction (MI) are well known. Administration of combined warfarin and aspirin (ASA) has not been well studied. The objective of this study was to compare the effect of coadministration of warfarin and ASA with administration of ASA alone on outcome of patients after MI. One hundred forty age- and sex-matched survivors of MI were randomized to receive either 100 mg/day ASA plus enough warfarin to reach a target: international normalized ratio of 2.5 (range: 2-3) (group A, n = 70), or only 100 mg/day ASA (group B, n = 70). The patients were examined for several variables including development of hemorrhage, reinfarction, and rehospitalization for 1 year post MI. Of the variables studied, minor hemorrhagic episodes were observed significantly (p = 0.002) more in group A than in group B patients. Rehospitalization and reinfarction rates, although occurring with lower frequencies in group A than in group B, did not reach the statistical significance level. In postmyocardial infarction patients, warfarin plus ASA did not provide a clinical benefit beyond that achievable with aspirin monotherapy, and for the observed markedly higher incidence of minor hemorrhage in combination therapy, antiplatelet therapy alone seems to be a more reasonable approach.
Evaluation of a Doppler-Derived Index Combining Systolic and Diastolic Left Ventricular Function in Acute Myocardial Infarction
Authors: Karvounis Haralambos I. , Nouskas Ioannis G. , Farmakis Thomas M. , Vrogistinos Kostas M. , Papadopoulos Christodoulos E. , Zaglavara Theodora A. , Parharidis Georgios E. , Louridas Georgios E.
Published: July 2008

Assessment of left ventricular (LV) function is crucial in the immediate postinfarction period. The authors evaluated the clinical applicability of the Doppler-derived myocardial performance index (MPI, defined as the sum of isovolumic contraction and relaxation times divided by LV ejection time) in patients with acute myocardial infarction (AMI) as to whether this index reflects the severity of LV dysfunction in this subgroup of patients. Post-AMI patients (n = 33) were compared with age- and sex-matched healthy subjects (n = 35). Within 24 hours of the AMI and 1 month thereafter, patients underwent 2D and Doppler echocardiography. Patients were divided into group A (Killip Class I, n = 22) and group B (Killip Class II-III, n = 11). The authors measured the LV ejection fraction (EF), diastolic indices (transmitral E and A waves, E/A ratio, deceleration time [DT], isovolumic contraction time [IVCT], isovolumic relaxation time [IVRT], MPI, LV end-systolic and end-diastolic volume indices [ESVi and EDVi] and wall motion score index [WMSi]). One-year mortality was also assessed. There was no significant difference concerning E and A waves, E/A ratio, and IVRT between the 2 groups. There were highly statistical differences at day 1 for EF (59.3 ± 6.7% vs 36.8 ± 4.5%, p<0.0001), DT (0.160 ± 0.030 sec vs 0.127 ± 0.022, p < 0.005), MPI (0.344 ± 0.084 vs 0.686 ± 0.120, p < 0.0001), ESVi (28.4 ± 3.9 mL/m2 vs 46.2 ± 8.4, p < 0.001), and WMSi (1.58 ± 0.06 vs 1.88 ± 0.35, p = 0.05), which persisted after 1 month. One-year mortality was significantly (0 vs 27.3%, p<0.01) lower in group A patients. This study shows that the MPI, reliably indicated LV dysfunction post-AMI, significantly correlated with clinically determined functional class, and possibly has some prog nostic implication.
Are Coronary Artery Anomalies an Accelerating Factor for Coronary Atherosclerosis Development?
Authors: Rigatelli Gianluca , Gemelli Marzio , Zamboni Alberto , Docali Giorgio , Rossi Paolo , Rossi Daniele , Grazio Mirella , Franco Gianfranco , Rigatelli Giorgio
Published: July 2008

The relevance of benign congenital coronary anomalies (CAAs) in the atherosclerotic process is still confused despite the number of single reports of coronary artery disease in CAAs. The present study is aimed at assessing the role of CAAs on the progression of coronary artery disease (CAD). A review of the last 15,000 coronary angiographies was performed to select patients with CAAs, and they were divided into 2 groups on the basis of the presence (group I) or the absence (group II) of CAD. Clinical and instrumental records of the selected patients were reviewed and the numbers of cardiovascular events for each group (acute myocardial infarct, unstable angina, silent ischemia, bypass or percutaneous transluminal coronary angio plasty (PTCA) interventions, and cardiovascular death) were recorded from the date of diagnosis to July 2002. Group I (22 patients, mean age 64.1 ±9.1 years, F/M = 10/12) and group II (17 patients, mean age 66.5 ± 10.6 years, F/M = 7/10) were similar for age and ejection fraction values. The presence of risk factors was statistically higher in group I. The number of patients with cardiovascular events was significantly higher in group I: 50% (11 patients) in group I vs 12% (2 patients) in group II, p<0.05). Repeated coronary angiography in 8/11 patients of group I and in the 2 patients of group II confirmed that the causes of the events were precedent atherosclerotic lesions in 7 patients and newly developed lesions in 3. At a mean follow-up of 60.4 ± 12.3 months, mean actuarial survival was lower in group I than in group II (74.8% vs 100%, p=0.045), whereas mean event-free survival was 41.7% in group I and 88.7% in group II (p = 0.02). Benign CAAs do not seem per se to be an accelerating factor for coronary atherosclerosis development in patients with no or few classical risk factors.
Effect of Left Bundle Branch Block on Systolic and Diastolic Function of Left Ventricle in Heart Failure
Authors: Özdemir Kurtuluş , Altunkeser Bülent Behlül , Korkut Bayram , Tokaç Mehmet , Gök Hasan
Published: July 2008

This study was designed to examine the effect of left bundle branch block (LBBB) on systolic and diastolic function of the left ventricle (LV) in patients with heart failure and in normal subjects. Thirty-six patients with heart failure and LBBB (group I), 36 patients with heart failure with normal conduction (group II), and 41 subjects with isolated LBBB (group III) were compared. Coronary angiography was performed and LV end diastolic pressure was calculated. Echocardiography was performed on all patients. LV ejection fraction and mean rate of circum ferential shortening were calculated. The following Doppler parameters were evaluated: peak rapid filling velocity (E wave), peak atrial filling velocity (A wave), E- and A-wave integrals, E- wave acceleration time and deceleration time (EDT) and rates (EAR and EDR), the E/A ratio and its integral, and diastolic flow time (DT). The ejection time, isovolumetric relaxation time (IRT), and preejection period were measured using the aortic and mitral flow. LV end diastolic pressure was calculated as 28 ±4 mm Hg, 22 ±5 mm Hg, and 15 ±3 mm Hg in groups I, II, and III, respectively. Although the systolic function parameters in group III patients were different, the diastolic function parameters of group II were found to be quite similar to those of group III patients. Comparison of group I patients with group II patients showed that there was a similarity between LV systolic function parameters while the diastolic function parameters were different (E/A, p = 0.004; EAR, p<0.001; EDR, p<0.001; EDT, p<0.001; IRT, p = 0.024; DT, p=0.03). In conclusion, this study evaluating the effects of LBBB in normal subjects (isolated LBBB) and patients with heart failure showed that LBBB causes diastolic function impairment in normal subjects similar to those of patients with heart failure, and also increases impairment of diastolic function in patients with heart failure.
Pulmonary Endarteritis and Subsequent Embolization to the Lung as a Complication of a Patent Ductus Arteriosus
Authors: Bilge Mehmet , Üner Abdurrahman , Özeren Ali , Aydin Mustafa , Demirel Fatma , Ermiş Bahri , Özkökeli Mehmet
Published: July 2008

The authors describe a case of pulmonary endarteritis and subsequent embolization to the lungs as a complication of a patent ductus arteriosus (PDA). Although 2-dimensional echocar diography has been shown to be of great value in the diagnosis of patients with infective endocarditis, echocardiographic detection of vegetation within the pulmonary artery and subsequent embolization to the lung is extremely rare and, to our knowledge, has been previ ously reported only in a few cases. In brief, our case not only shows the importance of echocar diography in making this rare diagnosis but also emphasizes the role of echocardiography as an effective means of following up such a case.
Left Atrial Thrombosis in Achalasia
Authors: Ueda Takashi , Mizushige Katsufumi , Ueda Keishi , Yukiiri Kazushi , Kohno Masakazu
Published: July 2008

An 81-year-old woman came to the clinic with aphasia and gait disturbance. A transthoracic echocardiogram showed left atrial (LA) thrombus at the posterobasal site, which was compressed by a large mass with high echo intensity. A chest computed tomography scan revealed dilatation of the esophagus, compressing the LA from the posterior side. An endoscopy showed a bolus and much foulness in the distended esophagus, which were imme diately eliminated by an endoscopic procedure. The LA thrombus, as shown by transesophageal echocardiography, spontaneously resolved without any neurologic signs. The authors assumed that the dilatated esophagus compressed the LA, and this may have produced the abnormal flow dynamics in the LA. The injury of endocardial surface produced by the distension or turbulent flow, in addition to dehydration, may have augmented a coagulability in the LA.
Effects of Physical Training on Peripheral Vascular Disease: A Controlled Study
Authors: Mannarino Elmo , Pasqualini Leonella , Menna Marina , Maragoni Giorgio , Orlandi Ugo
Published: July 2008

The effects of physical exercise on 8 stage II peripheral vascular disease (PVD) patients were observed after a six-month training program. Doppler velocimetry (including the treadmill test), strain gauge plethysmography, and transcutaneous oxygen pressure were used to quantify the results, which were compared with those obtained in a control group of another 8 stage II PVD patients, under placebo therapy for six months. The results show physical exercise increased the walking capacity, both the pain-free walking time and the maximum walking time. No significant difference was observed in the other parameters studied, in either the exercise patients or the control group.
Clinical Experience of Percutaneous Coronary Angioscopy in Cases with Coronary Artery Disease
Authors: Konishi Tokuji , Inden Masaaki , Nakano Takeshi
Published: July 2008

Direct visualization of the coronary arteries was performed by using a new ultrathin angioscopic catheter system in experimental animals and 4 patients with coronary artery disease during percutaneous transluminal coronary angioplasty (PTCA). In this catheter system, inspection of the coronary arteries was achieved during washout of blood by bolus infusion of 8-10 ml of saline into the coronary artery through the guide catheter. In the preliminary experience with this coronary angioscopic system, there were some limitations. In 2 patients, removal of coronary blood by manual injection of saline was not adequate, and diagnostic TV images could not be obtained. In 2 patients with tortuous coronary arteries, the catheter could not pass to the atheromatous plaques owing to lack of flexibility of the fiberoptic catheter. Furthermore, angina pectoris occurred in 2 patients during angioscopy, owing probably to interference with coronary blood flow by the guide catheter and/or fiberoptic catheter itself. For future clinical applications of coronary angioscopy, further improvements in the instrument are necessary.
The Acute Effects of Cigarette Smoking on Treadmill Exercise Distances in Patients with Stable Intermittent Claudication
Authors: Waller P.C. , Solomon S.A. , Ramsay L.E.
Published: July 2008

The hypothesis that smoking has an acute effect on treadmill exercise per formance in patients with peripheral vascular disease was investigated in a crossover trial. Twelve patients with stable intermittent claudication who were regular smokers attended on two occasions within one week and treadmill tests were performed after 1/2, 1, 1½, and 2 hours. Immediately before the second exercise test, two standard cigarettes were smoked or an unlit cigarette was "sham-smoked." Because participants could not be blinded, an attempt to con trol for patient bias was made. Half were told that we expected smoking to make no difference or possibly cause some improvement, and half were told that we expected it to make no difference or possibly cause some deterioration. These explanations and the order of study days were determined by balanced random ization.

Suggestion had a significant influence on claudication distance immediately after smoking (p < 0.01) but no significant effect on walking distance. Combin ing data from both groups assumes that no overall bias was introduced by the explanations given. Immediately after smoking, small, nonsignificant increases in claudication distance (+10%, 95% CI-7%, +27%) and walking distance (+9%, 95% CI-2%, +19%) were observed. Smoking caused a mean increase in heart rate of 9 beats per minute, which persisted for one hour, but no consistent change in blood pressure. The results show that suggestion may have a signifi cant influence on treadmill exercise distances. Smoking is unlikely to have an important acute effect on exercise performance in claudicants.
Resting Ankle-Arm Pressure Index in Vascular Diseases of the Lower Extremities
Authors: Piecuch Telesfor , Jaworski Roman
Published: July 2008

The authors calculated 442 values of resting ankle-arm indices in 222 pa tients, of whom 114 reported exercise pain of the lower extremities (51.3%) and 34 reported rest pain (15.3%). Tissue necrosis was diagnosed in 55 patients (24.8%) and other disorders in 19 (8.6%). Obliterating atherosclerosis was found in 186 patients (83.8%), Buerger's disease in 16 (7.2%), and other vascu lar diseases in 20 patients (9%). The studied index value in 262 examined lower extremities was 1.3-1.0 in 54, 0.9-0.8 in 29, 0.7-0.6 in 66, 0.5-0.4 in 55, and 0.3- 0.0 in 58 lower extremities. Respective values for contralateral lower extremi ties (180) were the following: 69, 54, 33, 14, and 10.
Reduced Myocardial Neutrophil Accumulation and Infarct Size Following Thromboxane Synthetase Inhibitor or Receptor Antagonist
Authors: Nichols Wilmer W. , Mehta Jawahar , Wargovich Thomas J. , Franzini Daisy , Lawson Daniel
Published: July 2008

Since thromboxane A2 (TXA2) re lease may relate to the extension of myocardial injury following coro nary ligation, the authors examined the effects of pretreatment with a se lective TXA 2synthetase inhibitor U- 63,557A, or a TXA2receptor anta gonist SQ-29,548, on myocardial in farct size forty-eight hours following left coronary ligation in rats. Myocardial infarct size (as percent of left ventricle, LV) was decreased from 44±3% in saline-treated con trol animals to 34±4% (P < 0.05) in U-63,557A-treated animals and to 32±4% (P < 0.05) in SQ-29,548 treated animals (U-63,557A-treated vs SQ-29,548-treated, P=NS). LV creatine kinase (CK) was 5.08 ± 0.42 IU/mg protein in noninfarcted un treated rats and 1.79 ± 0.21 IU/mg protein in saline-treated infarcted rats. LV CK was 2.86 ± 0.40 IU/mg protein in U-63,557A-treated rats and 3.11 ± 0.51 IU/mg protein in SQ-29,548-treated infarcted rats (both P < 0.05 compared with saline- treated rats). The beneficial effects of U-63,557A and of SQ-29,548 were not accompanied by reduction in in dices of myocardial oxygen demand (heart rate and arterial pressure). However, neutrophil accumulation in the infarcted myocardium was mark edly decreased by U-63,557A and SQ-29,548 pretreatment. Myocardial myeloperoxidase activity, a specific marker of neutrophil infiltration, was also decreased (P < 0.02) in U- 63,557A- and SQ-29,548-treated ani mals (0.09 ± 0.03 and 0.07 ± 0.02 units/100 mg, respectively) compared with saline-treated infarcted rats (0.19 ± 0.04 units/100 mg). In vitro incubation of U-63,557A and SQ- 29,548 caused a significant and simi lar reduction in f-MLP-induced neu trophil chemotaxis, and U-63,557A increased prostacyclin formation in whole blood. These data suggest that reduction in the extent of myocardial injury by TXA2synthetase or recep tor inhibitors may, in part, relate to a decrease in neutrophil accumulation in the infarcted tissue. In spite of dif ferences in mechanisms of action of U-63,557A and SQ-29,548, both agents exert a similar protective ef fect on the extent of myocardial in jury following coronary ligation. Reduction in neutrophil accumula tion in the infarcted zone, as well as in f-MLP-directed chemotaxis in vi tro, suggests that TXA2inhibition may modulate neutrophil migration.
The Clinical Pharmacokinetics of Quinapril
Authors: Olson Stephen C. , Horvath Ann Marie , Michniewicz Barbara M. , Sedman Allen J. , Colburn Wayne A. , Welling Peter G. , Olson Stephen C.
Published: July 2008

Quinapril (Q) and quinaprilat (QT) pharmacokinetics are dose pro portional following single oral 2.5- to 80-mg Q doses. Q absorption and hy drolysis to QT is rapid with peak Q and QT concentrations occurring one and two hours postdose, respectively. Peak plasma QT concentrations were approximately fourfold higher than those of Q (923 vs 207 ng/mL follow ing 40-mg Q). Dose-proportional QT area under the curve and dose-inde pendent percent of dose excreted in urine as QT demonstrate that the ex tent of Q conversion to QT is con stant over the dose range studied. Q and QT were eliminated from plasma with apparent half-lives of 0.8 and 1.9 hours and apparent plasma clear ances of 1,850 and 220 mL/min, re spectively, over the 2.5- to 80-mg dose range. Following oral 14C-Q, 61% and 37% of radiolabel was recovered in urine and feces, respectively. Q plus QT accounted for 46% of radioactiv ity circulating in plasma and 56% of that excreted in urine. Metabolism to compounds other than QT is not extensive. Two diketo piperazine metabolites of Q have been identified in plasma and urine, with approximately 6% of an admin istered dose excreted in urine as each of these metabolites. Peak plasma concentrations of these metabolites are similar to that of Q, and each is eliminated rapidly with a half-life of approximately one hour. Urinary ex cretion profiles indicate the presence of other minor metabolites. In summary, the absorption of Q and conversion to QT is rapid and dose-proportional, subsequent clear ance of both Q and QT is independ ent of dose, and metabolism to compounds other than QT is not ex tensive.
Myocardial Infarction Caused by Blunt Chest Injury: Possible Mechanisms Involved — Case Reports
Authors: Foussas Stefanos G. , Athanasopoulos Georgios D. , Cokkinos Dennis V.
Published: July 2008

Two cases are reported in which blunt chest trauma caused myocardial in farction. Coronary angiography revealed apical aneurysms in both patients with normal coronary arteries in the first and total occlusion of left anterior descending artery in the other.

The main possible mechanisms of myocardial infarction after blunt chest trauma are discussed.
Nonbacterial Thrombotic Endocarditis Complicating Mitral Valve Prolapse Presenting as Parinaud's Syndrome — A Case Report
Authors: Cook Deborah J. , Tanser Paul H.
Published: July 2008

Nonbacterial thrombotic endocarditis is the most common form of endocar ditis found at autopsy. Systemic embolization may complicate this condition in patients with mitral valve prolapse. The authors report a case of mitral valve prolapse and nonbacterial thrombotic endocarditis in which the presenting fea ture was Parinaud's syndrome.
Responses of Myocardial Blood Flows to Whole-Body Vibration in the Dog
Authors: Matoba Tsunetaka , Chiba Michio
Published: July 2008

Experimentally acute exposure to whole-body vibration resulted in changes in myocardial blood flows in the in vivo dog. Regional myocardial blood flows measured by a hydrogen gas clearance method were increased at a vibration frequency of 120 Hz and decreased at 50 Hz. No appreciable changes were found in presence of a beta-adrenergic blocker. The values of plasma cyclic nucleotides were increased at both frequencies of vibration, more at 50 Hz than at 120 Hz. No significant changes were observed in heart rates and arterial pressure during and after vibration load. These findings suggest that increased myocardial blood flows in response to vibration may be related more to the frequency of vibration than to beta-adrenergic actions.
Paroxysmal Supraventricular Tachycardia: Experience with Propafenone
Authors: Santinelli Vincenzo , De Paola Mario , Turco Pietro , Smimmo Domenico , Chiariello Massimo
Published: July 2008

The authors studied the efficacy of intravenous (IV) (1.5-2 mg/kg) and oral propafenone (450 to 900 mg/day) in 16 patients with paroxysmal, sus tained, recurrent supraventricular tachycardia (SVT). In 5 patients IV propafenone was not given, because of intolerant SVT. Nine patients had Wolff-Parkinson-White syndrome.

IV propafenone immediately stopped and prevented reinduction of SVT in 9/11 patients. Oral propa fenone prevented SVT induction in 3 of 5 patients. In the 9 patients re sponsive to IV propafenone, oral pro pafenone was effective: in particular, in 6 patients SVT tachycardia was not induced by serial transesophageal pacings, and in the remaining 3 pa tients the arrhythmia was still in duced but was slower and of brief duration (3-5 seconds). In 11/12 pa tients responsive to oral propafenone the minimum effective dosage in pre venting the induction of the arrhyth mia was 600 mg/day. In only 1 patient was the dose of 450 mg/day equally effective.

Propafenone administration was not associated with major side ef fects. In conclusion, propafenone is very effective in the control of parox ysmal supraventricular tachycardia; intravenous propafenone can predict the efficacy of oral therapy.
Pressure-Controlled Reperfusion Improves Postischemic Recovery of LV-Hypertrophied Rat Hearts
Authors: Müller Christian , Isselhard Wolf , Sturz Josef , Wahle Alfred , Witmanowski Henryk , Armas-Molina Jose V. , Saad Stefano
Published: July 2008

The influence of pressure-con trolled postischemic reperfusion (Rp) on functional and metabolic parame ters in hearts of sham-operated rats and hypertrophied hearts of rats with aortic constriction were studied. Hy pertrophied hearts are considered to be more susceptible to ischemia.

The hearts were perfused in the Langendorff-technique for thirty minutes at 35°C with Krebs-Hense leit bicarbonate buffer at a perfusion pressure (PP) of 75 mmHg and for five minutes at 15°C with St. Thomas' Hospital cardioplegic solu tion at a PP of 60 mmHg. After a per iod of global ischemia of forty min utes' duration at 15 ° C, reperfusion was started either abruptly (aRp: PP 75 mmHg immediately) or gently (gRp: PP 75 mmHg within thirty minutes); it lasted for forty-five min utes. Intraventricular peak systolic pressure (ISP) was monitored and en ergy-rich compounds (ATP, ADP, AMP, CrP, free Cr) were analyzed.

In normal hearts, metabolic re covery was not affected by the mode of reperfusion, but functional recov ery (ISP) averaged 88% of the preis chemic control value after gRp as compared with 73% after aRp.

In hypertrophied hearts, gentle reperfusion ameliorated both meta bolic and functional recovery. At forty-five minute recovery, CrP aver aged 5.1 μmol/g ww after aRp and 6.6 μmol/g ww after gRp (p < 0.01), and ISP amounted to 73% of the pre ischemic control after aRp and to 85% after gRp.