bluuebunny/crossref_metadata_2025 huggingface dataset:
Arylnitrenium‐Ionen bei der Umlagerung von O‐(Arylsulfonyl)phenylhydroxylaminen
Authors: Gutschke Dieter , Heesing Albert
Published: June 2007

Bei der Umlagerung von O‐Arylsulfonyl‐N‐benzoylphenylhydroxylaminen zu O‐Arylsulfonyl‐o‐benzamidophenolen treten bevorzugt, aber nicht ausschließlich, die Sulfonyl‐O‐Atome in die o‐Stellung des Kerns. Temperatur‐, Lösungsmittel‐ und Substituenten‐Effekte lassen sich durch eine Heterolyse der N–O‐Bindung zu einem inneren Ionenpaar aus Arylnitrenium‐ und Tosylat‐Ion deuten. Infolge der sehr schnellen Rekombination zeigt letzteres nur beschränkte Beweglichkeit im Lösungsmittelkäfig.
Abfangreaktionen kurzlebiger Radikale, XI. Über die radikalische Substitution am Stickstoff: Der induzierte Zerfall von 2‐Tetrazenen
Authors: Hollaender Jochen , Neumann Wilhelm P. , Lind Heinrich
Published: June 2007

Der radikalische Zerfall von Tetraphenyl‐2‐tetrazen (1a) und 1,4‐Dicyclohexyl‐1,4‐diphenyl‐2‐tetrazen (1b) wird durch Trialkylzinnhydrid beschleunigt. Beim Angriff von Stannyl‐Radikalen an N‐1 oder N‐4 entstehen in einer SH2α‐Reaktion N2, Stannylamin und ein Radikal ·N(R)R′, das durch R3SnH zum Amin abgefangen wird oder mit einem Stannyl‐Radikal bei niedriger Hydrid‐Konzentration rekombiniert. Auch Dicarbazolyldiazen 1c reagiert analog, nicht jedoch Dipiperidinodiazen (1d). Einflüsse der Stabilisierung von Grund‐ und Übergangszustand auf den Spontan‐ wie den induzierten Zerfall werden diskutiert, Werte für t1/2, k, ΔH* und ΔS* angegeben. Auch Tetraphenylhydrazin wird durch Stannyl‐Radikale beschleunigt gespalten.
1,3‐Dipolare Cycloadditionen, 70. Additionen des Benzonitriloxids an olefinische und acetylenische Dipolarophile
Authors: Bast Klaus , Christ Manfred , Huisgen Rolf , Mack Wilhelm , Sustmann Reiner
Published: June 2007

Benzonitriloxid (2) bildet mit monosubstituierten Äthylenen und Acetylenen 2‐Isoxazoline (3–10) und Isoxazole (29, 42), bei denen der Rest in der 5‐Position erscheint. Ein Gemisch der beiden möglichen Orientierungsisomeren (17/18, 19/20) geht aus den Additionen an β‐substituierte Styrole hervor. Abweichend verhielt sich β‐Pyrrolidinostyrol, aus dem mit Benzonitriloxid nur 3,4‐Diphenyl‐5‐pyrrolidino‐2‐isoxazolin (22) entsteht. Auch bei anderen Enaminen diktiert die Aminfunktion ungeachtet sterischer Effekte diese Additionsrichtung. Die Stereospezifität der Cycloaddition wurde an den cis‐trans‐isomeren 2‐Butenen und Stilbenen dargetan (13–16). Neben Cyclopenten wurde auch das reaktionsträgere Cyclohexen zur Reaktion gebracht (36, 37). Das labile bicyclische Primäraddukt des Cyclooctatetraens (38) erleidet einen elektrocyclischen Ringschluß zum tricyclischen Produkt 39.
1,3‐Dipolare Cycloadditionen, 72. Reaktionen der Knallsäure mit ungesättigten Verbindungen
Authors: Huisgen Rolf , Christl Manfred
Published: June 2007

Die langsame Freisetzung der Knallsäure (2), des Grundkörpers der Nitriloxide, aus Formohydroximoyljodid (15) mit Triäthylamin im organischen Medium ermöglicht in situ‐Cycloadditionen an aktive olefinische und acetylenische Dipolarophile. Die NMR‐Spektren erschließen die Strukturen der dabei entstehenden 2‐Isoxazoline und Isoxazole. Die beobachteten Additionsrichtungen entsprechen weitgehend denen des Benzonitriloxids. — Bei Verwendung von Dipolarophilen geringerer Aktivität konkurriert die Oligomerisation des Formonitriloxids mit der Cycloaddition; in einigen Fällen wurde das Dimere, das (Hydroxyimino)acetonitriloxid (12), von Dipolarophilen aufgenommen. — Die bisher kaum bekannten, in 3‐Position unsubstituierten 2‐Isoxazoline erleiden unter Basen‐Katalyse Ringöffnung zu den formalen Addukten von HO und CN an die Doppelbindung des Dipolarophils. — Bei der Bildung des (Phenylcarbamoyl)formonitriloxids (43) aus Nitromethan und Phenylisocyanat unter Triäthylamin‐Katalyse tritt freie Knallsäure nicht auf, wie Konkurrenzversuche erwiesen.
Über Aminosäuren und Peptide, VIII. Asymmetrische Synthese aromatischer α‐Aminosäuren und N‐Methyl‐α‐aminosäuren. — Synthese von L‐Dopa. — Über die katalytische Hydrierung ungesättigter Cyclodipeptide
Authors: Poisel Hans , Schmidt Ulrich
Published: June 2007

Die katalytische Hydrierung von Arylidenderivaten des Glycyl‐L‐prolin‐anhydrids wie 9a–e verläuft mit hoher asymmetrischer Induktion. Diese Reaktion, gefolgt von der sauren Hydrolyse des gesättigten Dioxopiperazins, kann zur Darstellung aktiver aromatischer Aminosäuren, wie L‐Dopa oder L‐Phenylalanin, herangezogen werden. Da die N‐Methylierung von Arylidendioxopiperazinen (z. B. 9e) mit Natriumhydrid/Methyljodid ohne Racemisierung möglich ist, sind durch stereoselektive Hydrierung von N‐Methylarylidendioxopiperazinen, die L‐Prolin enthalten, auch aktive aromatische N‐Methylaminosäuren zugänglich.

Zur Klärung des Zusammenhanges zwischen Struktur und Stereospezifität wurde auch die katalytische Hydrierung von Alkylidenderivaten des Glycyl‐L‐prolin‐anhydrids wie 13b oder c untersucht, in diesem Falle aber keine asymmetrische Induktion gefunden. Andererseits führte auch eine Wasserstoffanlagerung an l‐Acetyl‐6‐benzyliden‐3‐isobutyl‐2,5‐dioxopiperazin, welches gegenüber 9d L‐Leucin an Stelle von L‐Prolin enthält, zu racemischem Phenylalanin.
Fliegenpilzfarbstoffe, II. Isolierung und Chromophore der Farbstoffe aus Amanita muscaria
Authors: Döpp Heinrike , Musso Hans
Published: June 2007

Aus der roten Huthaut des Fliegenpilzes werden durch Chromatographie an verschiedenen Sephadex‐Typen mehrere sehr empfindliche Farbstoffe isoliert; zwei orangefarbene: Musca‐aurin‐I und ‐II, ein gelber: Muscaflavin, ein rotbrauner: Muscarubrin und das violette Muscapurpurin. Die Elektronenspektren zeigen an, daß diese Farbstoffe die gleichen Chromophore besitzen wie die Betalaine2).
Struktur eines aus Menschenharn isolierten C19‐Terpenoids — 2β‐Hydroxy‐15‐oxoatractylan‐4α‐carbonsäure
Authors: Ohermann Hugo , Spiteller Gerhard , Hoyer Georg‐A
Published: June 2007

Aus Menschenharn wurde eine als Glucuronid vorliegende Säure der Bruttoformel C19H28O4 isoliert, die nach Abbauversuchen als Terpenoid‐Carbonsäure vom Kaurantyp erkannt wurde. Der Methylester 10a des Oxidationsproduktes der Säure ist identisch mit einem Abbauprodukt 10 des Atractyligenins (9). Die spektroskopische Untersuchung weiterer Reaktionsprodukte ermöglicht es, der Säure die Konstitution 2β‐Hydroxy‐15‐oxoatractylan‐4α‐carbonsäure (11) zuzuschreiben. Sie wird in Tagesmengen von 2–40 mg im Urin des Menschen ausgeschieden.
Anwendungen der 13C‐Resonanz‐Spektroskopie, X. 13C,13C‐Kopplungskonstanten in Methylencycloalkanen
Authors: Günther Harald , Herrig Wolfgang
Published: June 2007

13C,13C‐Kopplungskonstanten über eine Bindung sind für die Methylencycloalkane bis zum Methylencyclooetan sowie für 1,1‐Di‐tert‐butyläthylen bestimmt worden. Die Ergebnisse lassen sich auf der Grundlage der bekannten einfachen s‐Charakter‐Korrelation 1J(13C,13C) equals; K s(i)s(j) befriedigend interpretieren. Für K wird em Wert von 550 ± 50 Hz abgeleitet.
Chemische Synthese von Desoxyoligonucleotiden mit 5′‐Phosphatgruppe am polymeren Träger
Authors: Sommer Hans , Cramer Friedrich
Published: June 2007

Zwei neue Methoden zur Verknüpfung von Nucleotiden über die 5′‐Phosphatgruppe mit einem polymeren Träger werden beschrieben: Im einen Falle dient ein Ribocytidin als Zwischenglied und erfolgt die Wiederabspaltung durch Hydrolyse mit Trifluoressigsäure, Perjodat‐Oxidation und β‐Eliminierung, im zweiten Falle wird ein Nucleosid‐5′‐phosphorothioat mit einem Chlormethylpolystyrol unter S‐Alkylierung umgesetzt, und die Abspaltung gelingt unter milden Bedingungen mit Jod/Wasser.

Die Brauchbarkeit beider Konzepte für die Darstellung von Oligonucleotiden mit 5′‐Phosphatgruppe wurde durch die Synthese der Oligonucleotide (pdT)5, pdTpdApdT, pdTpdCpdT und pdTpdGpdT demonstriert.
Heterocyclisierungen, XII. Synthese von Benzimidazo[1,2‐a]‐s‐triazinen
Authors: Capuano Lilly , Schrepfer H. Jürgen , Jaeschke M. Elisabeth , Porschen Heidi
Published: June 2007

Die basenkatalysierte Reaktion von 2‐Guanidinobenzimidazol (7) mit Benzoyl‐ und Äthoxycarbonylisothiocyanat (2a, b) führt über die unbeständigen Zwischenstufen 8, 9, 11 unter HSCN‐Eliminierung aus der Seitenkette zu neuen 2‐Aminobenzimidazo[1,2‐a]‐s‐triazinen 10 bzw. 13. Letzteres entsteht auch aus 7 und Benzoyl‐ bzw. Äthoxycarbonylisocyanat (2c, d) über die Addukte 12, 14 durch formale Benzamid‐ bzw. Urethan‐Eliminierung. 2‐Aminobenzimidazol (15) liefert unter analogen Bedingungen die Oxo‐ bzw. Dioxo‐benzimidazo‐triazine 17, 19 über die Addukte 16, 18.
15,16‐Methylensteroide
Authors: Hoyer Georg‐A. , Cleve Gerhard , Wiechert Rudolf
Published: June 2007

An 54 15,16‐Methylensteroiden wurden Untersuchungen mit NMR, MS und CD durchgeführt, um allgemeine Gesetzmäßigkeiten für ihre Zuordnung zur α‐oder β‐Reihe aufzufinden. Nach NMR lassen sich die Verbindungen über die Signallagen der 13‐Methyl‐gruppe mit den Inkrementen der 15,16‐Methylengruppe (β: Δ δ 18‐H 0.04 bis 01.11 ppm; α: Δ δ 18‐H 0.18 bis 0.29 ppm), bei 17β‐Hydroxy‐ und 17β‐Acetoxyverbindungen auch über die Signallagen des 17α‐H und dessen Aufspaltung eindeutig zuordnen. Im CD besitzen die 17‐Keto‐15β,16β‐ einen negativen, die −15α, 16α‐methylensteroide einen positiven Cottoneffekt. Die MS‐Daten weisen zwar Unterschiede auf, lassen eine unabhängige Zuordnung mit Sicherheit jedoch nicht zu.
Acylymine, III. Zur Reaktion der Acylimoniumsalze mit Grignard‐Verbindungen
Authors: Bartfeld Horst D. , Flitsch Wilhelm , Gurke Klaus
Published: June 2007

Während acyclische Acylimine und cyclische Acylimoniumsalze ohne substituent am Kohlen stoffatom der Funktionsgruppe (4a aud 4b) metallorganisch Verbindungen an der Cn‐Doppelbindung addieren, reagiert 1‐Oxo‐2,3‐diphenyl‐1H‐isoindol‐2‐ium‐Salze 4c addieren Phenylmagnesiumbromid an der Co‐Doppeldbindung, Methylmagnesiumjodid hingegen an der CN‐Doppelbindung. Das deutet auf sterische Faktoren. Die Umsetzung des 3‐Chlor‐3‐phenyl‐1‐isoindolinous (9) mit Phenylmagnesiumbromid entspricht der der salze 4c.
Austauschreaktionen an komplexgebundenen Liganden von Elementen der V. Hauptgruppe, IV. Darstellung und Reaktion von Dicarbonylcyclpontadienyl‐(dipseudohalogenphenylphosphin)mangan(I)‐Komplexen
Authors: Höfler Mathias , Schnitzler Manfred
Published: June 2007

Durch Chlor/pseudohalogen‐Austausch am CpMn(CO)2PPhCl2 (1) werden die entsprechenden CpMn(CO)2PPhX2‐Komplexe (2–5) (XCN, NCO, NCS, N3) dargestellt. 3 (XNCO) addiert leicht Alkohole und Amine unter Bildung von Carbamidsäure‐ und Harnstoff‐Derivaten CpMn(CO)2PPh(NHCO2R)2 (6 und 7) bzw. CpMn(CO)2PPh[NHC(O)Nät2]2 (8). Bei Umsetzung von 5 (XN3) mit CO bzw. PPh3 wird 3 (XNCO) bzw. CpMN(CO)2‐PPh(N3)(NPPh3) (10) erhalten. Die IR‐ und Massenspektren der Verbindungen 2–10 werden diskutiert.
Eine neue Methode Zur Addition von Aldehyden an aktivierte Doppelbindungen, III. Addition von aromatischen und heterocyclischen Aldehyden an α, β‐ungesättigte Nitrile
Authors: Stetter Hermann , Schrekenberg Manfred
Published: June 2007

Aromatische und heterocyclische Aldehyde addieren unter dem katalytischen Einfluß von Cyanid‐Ionen glatt an α,β‐ungesättigte Nitrile, Wobei γ‐Oxonitrile werden.
Metallkomplexe mit anionischen Liganden von Elementen der 4. Hauptgruppe, III. Homogene und heterogene (Trichlorstannido)metallat(0)‐Komplexe von Chrom, Molybdän und Wolfram
Authors: Kruck Thomas , Breuer Herbert
Published: June 2007

Das Trichlorstannid‐Ion, [SnCl3]−, zeigt ein ausgeprägtes Komplexbildungsvermögen gegenüber Übergangsmetallen in niedrigen Oxidationsstufen. Mit den Hexacarbonylen M(CO)6 (MCr, Mo, W) bildet es die Monosubstitutionsprodukte [M(CO)5SnCl3]− (2a–4a). Die trisubstituierten Derivate [M(CO)3(SnCl3)3]3− (2c, 3c) sind leicht aus den Halbsandwich‐Komplexen M(CO)3(C6H6) zugänglich. Die Hexakis(trichlorstannido)metallat(0)‐Komplexe, [M(SnCl3)6]6− (MCr, Mo) (2e, 3e) deren Existenz bereits ein beachtliches Rückbindungsvermögen des [SnCl3]−‐Liganden aufzeigt, bilden sich bei der Umsetzung von M(C6H6)2 mit [SnCl3]− in Tetrahydrofuran bzw. Aceton. Lediglich CO‐Substitution zum [(π‐C5H5)V(CO)2‐(SnCl3)2]2− (5) findet selbst unter UV‐Bedingungen am π‐C5H5V(CO)4 statt. Lösungsmittelfreie Salze sämtlicher (Trichlorstannido)metallat‐Komplexe erhält man mit voluminösen Kationen, z. B. [NR4]+ (RCH3, C2H5).
Benzothiazol‐N‐oxide, II. Über eine neue Synthese substituierter 2‐Benzothiazolone
Authors: Wagner Klaus , Oehlmann Linthard
Published: June 2007

2‐Carbamoylbenzothiazol‐N‐oxide gehen in Gegenwart von Phosphoroxychlorid eine neuartige intramolekulare Redoxreaktion unter Bildung von 2‐Benzothiazolonen ein. In zwei untersuchten Fällen unterliegen unterliegen auch 2‐Äthoxycarbonylbenzothiazol‐N‐oxide dieser Umlagerung. Spektroskopische Daten werden diskutiert.
Photoelektronenspektren und Moleküleigenschaften, XXVII. Chlor‐ und Bromäthylene — Beispiele für Änderungen in π‐ und σ‐Systemen
Authors: Wittel Klaus , Bock Hans
Published: June 2007

Die Photoelektronen (PE)‐Spektren der mono‐ und disubstituierten Chlor‐ und Bromäthylene zeigen bis zu 9 isolierte Banden. Die Zuordnung anhand qualitativer MO‐Modelle wird durch Spektrenvergleich, Perfluor‐Effekte und Schwingungsfeinstrukturen gesichert. Aus den zugeordneten Spektren lassen sich MO‐Parameter ablesen. Diese erlauben, die π‐Systeme der verschiedenen Substitutionstypen mit induktiven und konjugativen Effekten der Halogene zu beschreiben.
Natürlich vorkommende Terpen‐Derivate, XLII. Neue Sesquiterpene der Gattung Othonna
Authors: Bohlmann Ferdinand , Zdero Christa , Grenz Michael
Published: June 2007

Die Untersuchung von Vertretern aus fünf Sektionen der Gattung Othonna zeigt, daß hier relativ stark oxidierte Furanoeremophilane charakteristisch sind. Die Konstitutionen von 20 neuen Vertretern (1, 2, 6, 7, 9, 11, 12, 14, 16, 18, 28, 31, 34 und 37–43) werden durch ihre Spektren sowie durch chemische Reaktionen geklärt. Daneben werden einige Sequiterpene (24, 35, 36) sowie eine Nor‐Verbindung (22) isoliert und ihrer Struktur geklärt. Die engen chemotaxonomischen Beziehungen zu den Nachbargattungen werden diskutiert.
Multi‐way prediction in the presence of uncalibrated interferents
Authors: Rinnan Åsmund , Riu Jordi , Bro Rasmus
Published: June 2007

The second‐order advantage states that predictions are possible for new samples even if they contain new interferents not taken into account in the calibration model. Traditionally generalised rank annihilation has been widely used for second‐order calibration, but alternative models and algorithms such as PARAFAC is known to often be more accurate when many samples are available. While the calibration step of second‐order calibration has received considerable attention in the literature, the procedure of how to predict has not been investigated in detail when PARAFAC is used. In this paper we test the second‐order advantage using different calibration approaches based on PARAFAC with both simulated and real datasets, focussing on prediction quality as a function of the size of the calibration set, the number and degree of overlap of new interferents and the type and magnitude of noise. Guidelines are given on how to implement predictions in PARAFAC‐based second‐order calibration. Copyright © 2007 John Wiley & Sons, Ltd.
Panic disorders and agoraphobia: Side effects of treatment with an implantable cardioverter/defibrillator
Authors: Godemann Frank , Butter Christian , Lampe Felix , Linden Michael , Schlegl Michael , Schultheiss Hans‐Peter , Behrens Steffen
Published: June 2007

Background: Implantable cardioverter/defibrillator (ICD) treatment has reduced the mortality of patients with a high risk of sudden cardiac death. However, ICD discharges may cause anxiety with respect to new discharges and lead to preventive, for example, phobic, behavior. This study evaluated the frequency of panic disorders and agoraphobia in patients with ICD and assessed the risk factors in their development.

Hypothesis: Treatment with ICD represents a risk factor in the development of anxiety disorders.

Methods: Ninety patients with ICD were examined using a standardized lifetime Diagnostic Interview of Psychiatric Syndromes (DIPS). This interview makes it possible to estimate the incidence of panic disorders and agoraphobia. The impact of the severity of the underlying cardiac disease, the number of ICD discharges, and the subjective appraisal of the shock experience on the development of panic disorders and agoraphobia was assessed.

Results: Fifteen patients (16.7%) developed anxiety disorders after ICD implantation. The incidence was 21% in patients with and 6.9% in patients without ICD discharge. In patients with two or more ICD discharges annually, the incidence of panic disorders and agoraphobia was higher than that in patients with a single ICD discharge annually (62 vs. 10%, p < 0.01). The intensity of self‐observation of their body was significantly related to the development of anxiety disorders (p < 0.001).

Conclusion: Panic disorders and agoraphobia are frequent side effects of ICD treatment. Risk factors in the development of these disorders are two or more ICD discharges annually and a negative cognitive appraisal of ICD discharges. Therapeutic efforts should aim at reducing the number of ICD discharges and provide early psychological treatment.
Beta1‐adrenergic receptor gene polymorphisms and response to Beta1‐adrenergic receptor blockade in patients with essential hypertension
Authors: Karlsson J. , Lind L. , Hallberg P. , Michaëlsson K. , Kurland L. , Kahan T. , Malmqvist K. , Öhman K. P. , Nyström F. , Melhus H.
Published: June 2007

Background: Studies suggest that the Ser49Gly and Arg389Gly polymorphisms in the β1‐adrenergic receptor might be of functional importance for the cardiovascular system. Both have been associated with altered receptor activity in vitro, and with hypertension and cardiac failure in vivo.

Hypothesis: The aim of this study was to test whether these polymorphisms were associated with the change in heart rate or blood pressure in patients with essential hypertension and left ventricular (LV) hypertrophy treated with the β1‐adrenergic receptor blocker atenolol.

Methods: Blood pressure and heart rate were measured in 101 hypertensive patients with echocardiographically verified LV hypertrophy, randomized in a double‐blind study to treatment with either the β1 ‐adrenergic receptor blocker atenolol or the angiotensin II type I receptor antagonist irbesartan. Changes in blood pressure and heart rate were evaluated after 12 weeks. Beta1‐adrenergic receptor genotyping was performed using polymerase chain reaction and restriction fragment length polymorphism.

Results: We found no significant associations between the changes in the measured variables and either of the two polymorphisms. However, carriers of the 49Gly allele showed a tendency toward a greater reduction in heart rate compared with patients with the Ser/Ser49 genotype (p = 0.06).

Conclusions: The Ser49Gly and Arg389Gly β1‐adrenergic receptor polymorphisms do not seem to exert a major effect on the changes in heart rate and blood pressure during 12 weeks of treatment with atenolol in patients with essential hypertension and LV hypertrophy.
Percutaneous mitral commissurotomy using the metallic valvulotome technique in a critically ill adult
Authors: Ward David E. , Tanner Mark A.
Published: June 2007

A 25‐year‐old man presented with cardiogenic shock secondary to rheumatic mitral stenosis. Despite aggressive medical treatment he continued to deteriorate. This report describes the successful use of the metallic valvulotome technique for mitral commissurotomy in the context of a critically ill patient.
Bail‐out stenting for left main coronary artery dissection during catheter‐based procedure: Acute and long‐term results
Authors: Lee Seung‐Whan , Hong Myeong‐Ki , Kim Young‐Hak , Park Jae‐Hyeong , Rhee Kyoung‐Suk , Lee Cheol Whan , Han Ki‐Hoon , Song Jong‐Min , Kang Duk‐Hyun , Song Jae‐Kwan , Kim Jae‐Joong , Park Seong‐Wook , Park Seung‐Jung
Published: June 2007

Background: The optimal treatment of patients with left main coronary artery (LMCA) dissection during catheter‐based procedure remains uncertain.

Hypothesis: In cases with significant LMCA dissection occurring during catheter‐based procedure, prompt stent implantation may be safe and associated with favorable clinical outcome.

Methods: We evaluated the acute and long‐term results of bail‐out stenting for LMCA dissection occurring during a catheter‐based procedure in 10 patients.

Results: Initially, there was no significant stenosis of LMCA segments in these patients. Catheter‐induced dissection occurred in eight patients (during diagnostic angiography in three patients and during guiding catheter manipulation in five patients). Two patients suffered dissection in the setting of stent deployment in other vessels. Therefore, bail‐out stenting for LMCA dissection was performed in a total of 10 patients. In four patients, hypotension developed and an intra‐aortic balloon pump was placed during the procedure. Stents were successfully deployed in all patients; there was no in‐hospital mortality. Six‐month angiographic follow‐up was performed in eight patients. No angiographic restenosis (diameter stenosis ≥50%) was observed in any patient at follow‐up study. During a mean follow‐up of 31 ± 25 months after hospital discharge, there was no major adverse cardiac event (death, myocardial infarction, and target lesion revascularization).

Conclusions: Bail‐out LMCA stenting is technically feasible and showed good acute and long‐term results in a small series of patients.
Effectiveness of enhanced external counterpulsation in patients with left main disease and angina
Authors: Lawson William E. , Hui John C. K. , Barsness Gregory W. , Kennard Elizabeth D. , Kelsey Sheryl F.
Published: June 2007

Background: Enhanced external counterpulsation (EECP) is a noninvasive device that uses three pairs of sequentially inflated pneumatic cuffs applied to the lower extremities and synchronized with the heart beat to provide diastolic augmentation, increase coronary blood pressure and flow, venous return and cardiac output, and decrease afterload.

Hypothesis: This study examines the safety and effectiveness of EECP therapy in patients with significant left main coronary artery disease (LMD).

Methods: In all, 2,861 patients enrolled in the International EECP Patient Registry (IEPR) were divided into three groups, those without LMD (n = 2,377), those with LMD and prior CABG (n = 431), and those with unbypassed LMD (n = 53).

Results: Patients with LMD, with or without prior CABG, were significantly more likely to have triple‐vessel disease (98.1 and 88.7%, respectively) than patients without LMD (41.9%). Post‐EECP, 74% without LMD, 75% with LMD with prior CABG, and 65% with unbypassed LMD improved their Canadian Cardiovascular Society (CCS) angina by at least one class (p = NS). There were no differences in the mean decrease in weekly angina episodes (7.1 vs. 8.0 vs. 7.6) and in the mean frequency of weekly nitroglycerinuse (6.6 vs. 8.1 vs. 8.9). At 6‐month follow‐up, the CCS class improved further in all three groups, and there was a further reduction in mean weekly angina episodes (4.7 vs. 4.6 vs. 5.3) and nitroglycerinuse (6.5 vs. 6.8 vs. 8.2). Kaplan‐Meier life table analysis 8 months after starting EECP demonstrated a major cardiovascular event rate of 11.2% in patients without LMD, 15.6% in LMD with CABG, and 24.3% in LMD without prior CABG. Late mortality in unbypassed LMD was 13.2% (confidence interval [CI] 3.3‐23.1) versus 4.8% (CI 2.7‐7.1) in LMD with CABG, and 2.8% (CI 2.1‐3.5) without LMD (p = 0.0039 by log‐rank test).

Conclusion: Enhanced external counterpulsation is equally effective in relieving angina in patients with or without LMD. However, the significantly increased late mortality in patients with LMD without prior CABG suggests that early revascularization should be considered in these patients.
Depletion of antioxidants is associated with no‐reflow phenomenon in acute myocardial infarction
Authors: Matsumoto Hidenari , Inoue Nobutaka , Takaoka Hideyuki , Hata Katsuya , Shinke Toshiro , Yoshikawa Ryohei , Masai Hiroyuki , Watanabe Satoshi , Ozawa Toru , Yokoyama Mitsuhiro
Published: June 2007

Background: No‐reflow phenomenon is observed in approximately one‐third of patients after percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI), and is associated with poor functional and clinical outcomes. On the other hand, the formation of free radicals in vasculature exerts deleterious effects on coronary microcirculation.

Hypothesis: We hypothesized that redox state in coronary circulation may play a crucial role in no‐reflow phenomenon in AMI.

Methods: Consecutive 26 patients with first AMI who underwent primary PCI<24 h after onset were enrolled. Before PCI, blood samples were obtained from coronary sinus to measure plasma or serum antioxidative vitamins (vitamin C, vitamin E, and beta‐carotene) and antioxidative enzymes (extracellular glutathione peroxidase [GPX], superoxide dismutase, and catalase). After PCI, the corrected Thrombolysis In Myocardial Infarction (TIMI) frame count (CTFC) was measured in the target vessel. Patients with TIMI ≤2 flow despite an optimal PCI result were designated as no‐reflow group (Group NR, n = 6) and the others as reflow group (Group R,n = 20).

Results: Levels of vitamin C, vitamin E, and GPX before PCI were significantly lower in Group NR than in Group R. The CTFC correlated inversely with levels of vitamin C, vitamin E, and GPX (p < 0.05).

Conclusions: Depletion of antioxidants is associated with no‐reflow phenomenon in AMI. These findings strongly suggest that the redox state in coronary circulation plays an important role in the pathogenesis of no‐reflow phenomenon.
Serum carboxyl‐terminal propeptide of procollagen type I in exercise‐induced left ventricular hypertrophy
Authors: Escudero Eduardo M. , Tufare Ana L. , Rebolledo Oscar , Pellegrini Laura , Lobrutto Carlos
Published: June 2007

Background: Left ventricular hypertrophy (LVH) induced by exercise is considered to be a physiologic adaptive mechanism without fibrogenic hyperactivity, as occurs in pathologic hypertrophy.

Hypothesis: This study investigated serum markers of collagen synthesis and echo parameters of left ventricular diastolic function (LVdf) in 22 male athletes.

Methods: Twenty‐two highly competitive male athletes (10 cyclists, 12 soccer players) were studied with full history, clinical examination, Doppler echocardiogram, and serum concentration of the carboxyl‐terminal propeptide of collagen type I (PIP). They were divided into two groups: normal left ventricular mass (N) with left ventricular mass index (LVMI) < 125 g/m2 (14 athletes) and LVH with LVMI > 125 g/m2 (8 athletes).

Results: Age, body surface area, blood pressure, heart rate, and systolic function were not different between the groups. Serum concentration of PIP (N: 163±44.1 μg/1,LVH: 172.7 ± 61.2 μg/1—NS) and LVdf (early to atrial peak mitral flow velocity ratio: [E/A]N: 1.77 ± 0.47, LVH: 1.98 ± 0.70—NS, and early to atrial peak mitral annulus velocity ratio: [Ea/Aa] N: 2.63 ± 0.70, LVMI: 2.55 ± 0.90 LV1.61—NS) were similar in both groups.

Conclusions: Normal serum concentration of PIP in athletes with LVH in association with normal LVdf indicates the possibility that in this type of physiologic hypertrophy there is mainly an increase of myocyte size without interstitial fibrosis.
Therapeutic strategies, immediate and mid‐term outcomes in non‐ST‐segment elevation acute coronary syndromes with respect to age: A single‐center registry of 488 consecutive patients
Authors: Leoncini Mario , Maioli Mauro , Bellandi Francesco , Galvani Marcello , Ottani Filippo , Toso Anna , Vincenzo Emilio Di , Gallopin Michela , Dabizzi Roberto Piero
Published: June 2007

Background: Elderly patients with non‐ST‐elevation acute coronary syndromes (NSTE‐ACS) may receive benefit from an early invasive strategy. However, aged patients often suffer from comorbidities that may contraindicate an invasive approach and affect prognosis adversely. The impact of comorbidities on an invasive approach to NSTE‐ACS in the elderly has not been fully investigated.

Hypothesis: This study sought to examine the outcome of an unselected population of patients with NSTE‐ACS stratified according to age and treatment approach.

Methods: The feasibility and efficacy of an invasive strategy for NSTE‐ACS and the 6‐month outcome were assessed in 253 unselected consecutive patients ≥ 70 years (elderly) and compared with those of 235 unselected consecutive patients < 70 years.

Results: Angiography was not performed in 69 patients (86% ≥ 70 years) because of contraindications. In the whole population, the 6‐month event rate was significantly higher in elderly compared with younger patients (22 vs. 14%; odds ratio 1.8, 95% confidence interval 1.1‐2.9; p<0.02). This difference was driven by the high event rate observed in the elderly with contraindications to angiography (47 vs. 16% in the elderly treated invasively; p < 0.002). On the other hand, no significant difference was observed in the 6‐month event rate between elderly and younger patients undergoing an invasive approach (16 vs. 13%; p=0.36). Contraindications to angiography—namely, creatinine ≥ 1.5 mg/dl and elevated troponin I at admission—were the only independent predictors of 6‐month outcome.

Conclusions: The invasive approach was feasible in 77% of patients ≥ 70 years. Those with contraindications to angiography showed a poor mid‐term prognosis. The early invasive strategy was associated with more favorable outcomes regardless of age.
Effect of quinapril on the attenuated heart rate recovery of type 2 diabetic subjects without known coronary artery disease
Authors: Sipahi Ilke , Tekin Goknur , Yigit Zerrin , Guzelsoy Deniz , Guven Ozen
Published: June 2007

Background: Heart rate (HR) recovery at 1 minis a measure of the vagal reactivation that occurs after cessation of exercise. Despite ample evidence about the association of attenuated HR recovery with increased mortality, pharmacologic modification of this predictor has not been shown. On the other hand, angiotensin‐converting enzyme (ACE) inhibitors are known to have vagomimetic activity.

Hypothesis: We hypothesized that ACE inhibition would increase HR recovery in a group of subjects known to have reduced HR recovery, namely diabetics.

Methods: Maximal treadmill exercise stress test was performed in 31 type 2 diabetic and 31 nondiabetic male subjects with similar age, body mass index, and hypertensive status. None of the subjects had known heart disease or evidence of myocardial ischemia during the test. The diabetic subjects, after 2 weeks of treatment with quinapril, underwent a second exercise test. A third test was performed 2 to 3 weeks after cessation of quinapril treatment.

Results: At baseline, despite similar exercise capacity, the diabetics had a lower HR recovery at 1 min than nondiabetics (25 ± 8 vs. 31 ± 8 beats/min, p<0.01). Quinapril significantly increased HR recovery at 1 min in diabetics (25 ± 8 beats/min at baseline vs. 28 ± 8 beats/min with quinapril vs. 25 ± 7 beats/min off‐therapy, p < 0.01 by analysis of variance).

Conclusions: The attenuated HR recovery of type 2 diabetics can be improved by quinapril. Whether the improvement in HR recovery with ACE inhibition can lead to decreased mortality is currently unknown.
B‐type natriuretic peptide measurement in heart failure
Authors: Spevack Daniel M. , Schwartzbard Arthur
Published: June 2007

Serum testing for the hormone B‐type natriuretic peptide (BNP) may have clinical utility in congestive heart failure (CHF). This hormone is secreted predominantly by the left ventricular myocardium in patients with CHF. Measurement of serum BNP may improve diagnosis of CHF and may also help guide therapy in patients with CHF. The literature regarding the clinical utility of BNP measurement in CHF is reviewed.
Weight changes and obesity predict impaired resting and endothelium‐dependent myocardial blood flow in postmenopausal women
Authors: Martin Julie W. , Briesmiester Kerri , Bargardi Anita , Muzik Otto , Mosca Lori , Duvernoy Claire S.
Published: June 2007

Background: Obesity has been associated with impaired endothelial function, but the influence of lifetime weight patterns on endothelial function has not been studied.

Hypothesis: We hypothesized that coronary vascular reactivity would be diminished in postmenopausal women with a history of obesity and frequent weight swings.

Methods: We performed dynamic N‐13 ammonia positron emission tomography in 18 postmenopausal women with cardiac risk factors. Myocardial blood flow (MBF) was measured at rest, after the cold pressor test (CPT), and after adenosine infusion in order to determine baseline and endothelium‐dependent and ‐independent flows, respectively. Myocardial blood flow was corrected for cardiac work by normalizing to the rate‐pressure product. Weight history was obtained by standardized questionnaire.

Results: Normalized rest (n‐rest) MBF correlated negatively with current weight (r=‐0.52, p= 0.026) and weight at age 18 (r = −0.47, p = 0.047). Normalized CPT (n‐CPT) MBF correlated inversely with current weight (r = −0.55, p = 0.018), weight at age 18 (r= −0.605, p = 0.008), and highest weight (r = −0.62, p = 0.006). Higher waist circumference predicted lower n‐rest MBF (r= −0.52, p = 0.028) and n‐CPT MBF (r = −0.48, p = 0.04). The same association was found with hip circumference (r = −0.52, p = 0.028; r = −0.49, p = 0.038, respectively), whereas higher body mass index (BMI) predicted lower n‐CPT MBF (r =‐0.53, p = 0.02). Women with at least four significant weight swings had lower MBF during rest, CPT, and n‐CPT (0.88 vs. 1.19 ml/g/min, p = 0.008; 0.76 vs. 1.23 ml/g/min, p< 0.001; 0.74 vs. 1.10 ml/g/ min, p = 0.009, respectively).

Conclusions: Increased waist and hip circumference, weight, and frequent weight swings are associated with impaired resting and endothelium‐dependent MBF in postmenopausal women. These data suggest that lifetime weight patterns may influence cardiovascular risk in women.
The imbalance between coronary reserve and wall stress explains the severity of ventricular dysfunction in hypertension
Authors: Frimm Clovis De Carvalho , Pereira Valéria F. A. , Rodrigues Ana Clara T. , Tsutsui Jeane M. , Cúri Mariana
Published: June 2007

Background: The pathophysiologic role of coronary reserve impairment in hypertensive cardiac dysfunction is still debated. Previously, we demonstrated that satisfactory coronary vasodilatation may coexist with ventricular systolic dysfunction. It is conceivable that coronary reserve might otherwise be inappropriate for enhanced myocardial oxygen demand and may thus affect cardiac performance negatively.

Hypothesis: Myocardial supply‐demand imbalance contributes to the severity of ventricular dysfunction in hypertension (HTN).

Methods: Fractional shortening (%) and end‐systolic stress (103·dyn·cm−2) were determined using echocardiography, and coronary reserve was calculated using trans‐esophageal Doppler echocardiography. Coronary reserve/ stress (cm2·dyn−1) was utilized as a measure of supply‐demand. Groups NL (20 healthy subjects), HTN1 (15 patients, fractional shortening ≥ 30), HTN2 (19 patients, 20 ≤ fractional shortening <30), and HTN3 (21 patients, fractional shortening < 20) were constituted.

Results: Compared with NL and HTN1, groups HTN2 and HTN3 had significantly (p < 0.05) greater end‐systolic stress (NL = 72 ± 16, HTN1 = 72 ± 23, HTN2 = 143 ± 32, HTN3 = 186 ± 70). Coronary reserve was impaired in HTN3 alone (NL = 3.5 ± 0.6, HTN1 = 3.4 ± 1.0, HTN2 = 3.1 ± 1.0, HTN3 = 2.6 ±1.1), but coronary reserve/stress was reduced in both HTN2 andHTN3 (NL = 50 ± 12, HTN1 = 53 ± 21, HTN2 = 22 ± 7, HTN3 = 15 ± 7). Stepwise regression analysis identified diastolic internal dimension, end‐systolic stress, and coronary reserve/stress as independently associated with fractional shortening.

Conclusion: The imbalance between supply‐demand explains the severity of hypertensive cardiac dysfunction and adds information to cardiac enlargement and elevated wall stress.
Heart rate response to graded exercise correlates with aerobic and ventilatory capacity in patients with heart failure
Authors: Vallebona Alessandro , Gigli Guido , Orlandi Sandro , Reggiardo Giorgio
Published: June 2007

Background: Autonomic dysfunction and reduced exercise tolerance are typical features of patients with congestive heart failure (CHF). Baro‐chemoreflex balance and organ response may have a common role in conditioning exercise tolerance, ventilation, and chronotropic competence in patients with CHF.

Hypothesis: We tested the hypothesis that there is a relationship between functional capacity and chronotropic competence to exercise in CHF.

Methods: In all, 48 stable outpatients with CHF (age 65 ± 10 years, 41 men, NYHA class 2.1 ± 0, ejection fraction 31 ± 7%, peak VO2 16 ± 4 ml/kg/min) performed cardiopulmonary exercise testing (CPX). Heart rate (HR) response to exercise was assessed by the chronotropic index (CRI). The CRI was calculated by the following formula: CRI = peak HR ‐ rest HR/220 ‐ age ‐ rest HR × 100 (normal value > 80%). The relationship of CRI to peak oxygen consumption (VO2) and ventilation/carbon dioxide production (VE/VCO2) ratio was examined. A group of 33 healthy controls underwent CPX as well.

Results: The CRI correlated directly with peak VO2 (r = 0.638, p<0.001) and inversely with VE/VCO2 (r = −0.492, p < 0.001) in patients with CHF. A CRI< 78% identified patients with CHF and a peak VO2 < 20 ml/kg/min, area under the receiver operating curve (AUROC): 0.76,95% confidence interval (CI) 0.60–0.92. A CRI< 74% predicted exercise hyperventilation in CHF (AUROC: 0.71 for VE/VCO2 >30, 95% CI 0.53–0.88). The CRI was not significantly related either to peak VO2 or to VE/VCO2 in the control group.

Conclusions: In patients with mild to moderate CHF, CRI correlates with functional capacity. This relationship adds new data on pathophysiologic grounds and supports the routine incorporation of CRI into CPX interpretation.
Are patients with isolated chronic aortic regurgitation operated in time? Analysis of survival data over a decade
Authors: Tamás Éva , Nylander Eva , Olin Christian
Published: June 2007

Background: Patients suffering from chronic isolated aortic regurgitation have a less favorable outcome than patients with aortic stenosis. According to international recommendations, these patients should undergo surgery as soon as left ventricular function begins to deteriorate, that is, surgery is not to be postponed until clinical symptoms become relevant.

Hypothesis: The study was undertaken to evaluate how satisfactory our timing of surgery was, as reflected by survival data.

Methods: Survival was studied retrospectively in a consecutive series of patients undergoing surgery for chronic isolated aortic regurgitation during a 10‐year period in our institution. Results were compared with data from the literature. By excluding patients with aortic aneurysms and acute endocarditis, we formed a homogeneous patient group of 88 subjects.

Results: Thirty‐day mortality was 1% and late mortality after a mean follow‐up period of 6 years was 11%. Compared with survival data from an earlier study in which the patient population was similar and resided in the same geographic area, the results in our patient group seem to be better. It is noteworthy that despite a strong effort to recommend surgery at an earlier stage of the disease than previously, 35% of the patients had moderate or severe left ventricular dysfunction pre‐operatively because of late referrals.

Conclusion: This stresses the importance of early detection and careful preoperative follow‐up with noninvasive methods in patients with aortic regurgitation.
Effectiveness of nesiritide on dialysis or all‐cause mortality in patients undergoing cardiothoracic surgery
Authors: Beaver Thomas M. , Winterstein Almut G. , Shuster Jonathan J. , Gerhard Tobias , Martin Tomas , Alexander James A. , Johnson Richard J. , Ejaz Ahsan , Hartzema Abraham G.
Published: June 2007

Background: Natriuretic peptides have been shown to have favorable renal effects. However, recent evidence suggests potential renal side effects in patients with congestive heart failure.

Hypothesis: This study examined the effect of nesiritide (human B‐type natriuretic peptide) on hemodialysis or death in patients undergoing cardiothoracic surgery.

Methods: This retrospective cohort study included patients (n = 940) undergoing nontransplant adult cardiothoracic surgery between July 2001 and February 2004. Patients receiving nesiritide within 3 days after and not before surgery (n = 151) were compared with those not given nesiritide (n = 789) for incidence of hemodialysis or in‐hospital death by Day 21 (HD/death). Patients with preexisting dialysis and intraoperative deaths were excluded. Forward inclusion multiple logistic regression was used based on published risk factors for HD/death.

Results: Of 940 patients (318 coronary artery bypass graft, 348 valve, and 274 thoracic aorta), 36 required dialysis and 60 patients died (HD/death; n= 77). Adjusted for significant confounders (gender, age, procedure, intra‐aortic balloon, baseline serumcreatinine mg/dl [SCr], 1 day % SCr increase), nesiritide showed a statistically nonsignificant HD/death reduction (odds ratio [OR], 0.58; 95% confidence interval [CI], 0.29–1.17; p = 0.129) in the group as a whole. When stratified by baseline SCr, a significant benefit was noted in patients with SCr >1.0 (OR, 0.35; 95% CI 0.14–0.87; p = 0.024), while no significant effect was found in patients with SCr < 1.0 (OR, 1.55; 95% CI 0.48–5.07, p = 0.465).

Conclusions: Nesiritide appears promising in reducing the risk of dialysis or death in patients with SCr > 1.0 undergoing cardiothoracic surgery; however, no effect was noted with SCr < 1.0. This study provides strong rationale for a randomized trial.
Relationship between true fasting plasma insulin level and angiographic characteristics of coronary atherosclerosis
Authors: Jia En‐Zhi , Yang Zhi‐Jian , Yuan Biao , Zang Xiao‐Ling , Wang Rong‐Hu , Zhu Tie‐Bing , Wang Lian‐Sheng , Chen B. O. , Cao Ke‐Jiang , Huang Jun , Ma Wen‐Zhu
Published: June 2007

Background: Reports about the relationships between specific insulin concentration and coronary heart disease risk are controversial.

Hypothesis: The objective of this study was to examine the association between insulin level and the severity of coronary atherosclerosis.

Methods: The study population consisted of 507 consecutive patients (376 men and 131 women) who underwent coronary angiography for suspected or known coronary atherosclerosis. The patients' habits of smoking and drinking were investigated, and anthropometric measurements including body mass index, systolic and diastolic blood pressures, as well as plasma measurements including lipids and blood glucose were taken. The true insulin level was measured using a highly sensitive two‐site sandwich ELISA. The severity of coronary atherosclerosis was defined by the Gensini score system. The statistical methods including Kruskal‐Wallis test, chi‐square analysis, Spearman correlation analysis, and multivariate stepwise linear regression analysis were employed to explore the relationship between specific insulin level and coronary atherosclerosis.

Results: When the Gensini score was examined as a categorical variable classified by tertile values, subjects with a high Gensini score had significantly higher values of fasting plasma specific insulin level (p = 0.022). The Spearman correlation analysis suggest that the Gensini score correlated significantly with true insulin (mIU/l) (r = 0.095, p = 0.033). However, the results from the multivariate stepwise linear regression analysis show that the association between specific insulin level and severity of coronary atherosclerosis lost its significance.

Conclusions: The level of plasma fasting specific insulin was associated significantly with the severity of coronary atherosclerosis, as measured by Gensini score, but hyperinsulinemia showed no association with the severity of coronary atherosclerosis in multivariate analyses.
Assessment of markers of thrombin generation in patients with acute myocardial infarction complicated by ventricular fibrillation
Authors: Elmas Elif , Kaelsch Thorsten , Wolpert Christian , Sueselbeck Tim , Bertsch Thomas , Dempfle Carl Erik , Borggrefe Martin
Published: June 2007

Background: In most cases, sudden cardiac death is triggered by ischemia‐related ventricular tachyarrhythmias and accounts for 50% of deaths from cardiovascular disease in developed countries. Chronic elevation of indicators of coagulation activation has been found in patients with coronary heart disease, but a role of coagulation activation as a potential risk factor for ventricular fibrillation (VF) during acute myocardial infarction (MI) has not been investigated.

Methods: We enrolled 50 patients with a history of MI, of whom 26 presented with VF in the acute phase of myocardial ischemia; 24 patients had an acute MI without ventricular tachyarrhythmias. Levels of thrombin‐antithrombin complexes (TAT), prothrombin fragment F1 + 2 (F1 + 2), fibrinopeptide A (FPA), plasmin‐antiplasmin complexes (PAP), protein C, antithrombin, activated partial thromboplastin time (aPTT), thromboplastin time, D‐Dimer, fibrinogen, and high‐sensitivity C‐reactive protein (hs‐CRP) were measured in plasma samples of all patients. Blood collection was obtained sequentially in two separate settings. Patients were studied at a median of 3 51 days after the acute coronary event.

Results: Higher levels of TAT complexes (13.4 ± 22.2 vs. 3.03 ± 4.3 μg/1; p = 0.02), FPA (79.7 ± 132.3 vs. 24.04±41.3 ng/ml; p = 0.04), and F1+2 (1.89 ± 1.3 vs. 1.16 ± 0.5 nmol/l; p = 0.01) were observed in patients with VF compared with patients without ventricular tachyarrhythmias during the acute phase of MI. D‐Dimer levels displayed a trend without reaching statistical significance (0.69 ± 0.48 vs. 0.48 ± 0.24 mg/l; p = 0.06). No differences were found in hs‐CRP (3.25 ± 4.5 vs. 4.4 ± 8.8 mg/l; p = 0.5) and fibrinogen (2.8 ± 0.9 vs. 2.7 ± 0.9 g/l; p = 0.6) measurements. Repeat assessment of markers of coagulation activation atamedian of 847 days revealed a highly significant decrease in patients with VF.

Conclusions: Markers of thrombin generation are transiently increased in patients with VF during the acute phase of MI. These findings have implications for risk assessment and genetic screening of patients prone to VF during acute myocardial ischemia.
Postpartum dissection of the left main coronary artery
Authors: Rogers Ian S. , Rinaldi Michael J. , Humphrey Chester B. , Boden William E. , Dougherty James E.
Published: June 2007

Peripartum coronary artery dissection is rare, but it is an increasingly recognized risk to women of childbearing age. Literature reviews reveal that about 80% of the population with spontaneous coronary artery dissections (SCAD) are female, and approximately 25–33% of cases occurred while the woman was pregnant or in the peripartum phase. Most cases have presented within 2 weeks of delivery. The left anterior descending is the most commonly affected vessel. The etiology is poorly understood, but many reports suggest that SCAD occurs as a result of protease release secondary to an eosinophilic vasculitis resulting in vessel lysis. Many investigators have examined the correlation between peripartum SCAD and estrogen levels; however, case studies have shown conflicting results regarding estrogen levels as the putative causative factor. Optimal treatment remains controversial. Presently, stenting appears to be best employed in the patients who have single‐vessel dissection not involving the left main coronary artery (LMCA). Surgical revascularization via coronary artery bypass graft remains the optimal therapy in patients whose dissection involves the LMCA, in patients with concurrent multi‐vessel dissection, and in patients with disease refractory to medical management. It is important to consider coronary artery dissection in the differential of any young woman who presents with signs or symptoms consistent with acute coronary syndrome, particularly if she is peripartum. Furthermore, once suspected, it is imperative that a definitive diagnostic study, that is, coronary angiography, be completed prior to the initiation of treatment whenever possible.