bluuebunny/crossref_metadata_2025_split huggingface dataset:
Procedural variation in the performance of primary percutaneous coronary intervention for ST‐elevation myocardial infarction: A SCAI‐based survey study of US interventional cardiologists
Authors: Chiang Austin , Gada Hemal , Kodali Susheel K. , Lee Michael S. , Jeremias Allen , Pinto Duane S. , Bangalore Sripal , Yeh Robert W. , Henry Timothy D. , Lopez‐Cruz Georgina , Mehran Roxana , Kirtane Ajay J. 
Published: October 2013

BackgroundGreat strides have been made in improving outcomes for patients with ST‐elevation myocardial infarction (STEMI), predominately through initiatives focusing upon improving clinical processes “upstream” of percutaneous coronary intervention (PCI). The actual step‐by‐step mechanics of diagnostic angiography during STEMI and other aspects of the PCI procedure itself have received relatively little attention.Objectives and MethodsWe hypothesized that there would be significant variation in how primary PCI for STEMI is performed in the United States. In order to better understand current US practice, an electronic survey consisting of seven focused questions was forwarded to 2,910 US interventional cardiologists who were members of the Society for Cardiovascular Angiography and Interventions (SCAI).ResultsThree hundred sixty‐two responses were received (12.4%). Among respondents, the femoral artery was the preferred access site in 83% (vs. 17% radial). The use of a diagnostic catheter to visualize the non‐culprit artery prior to using a guiding catheter for the culprit artery was the preferred approach for 58% of respondents, and an additional 23% preferred complete angiography with diagnostic catheters prior to guide insertion. However, a significant minority (19%) preferred starting directly with a guide catheter for the culprit artery and performing PCI prior to contralateral non‐culprit artery visualization. Only 9% reported performing routine left ventriculography prior to PCI, with the majority (66%) choosing to perform ventriculography during/after PCI, and 25% reporting rare or no use of left ventriculography. Fewer than half of respondents (49%) reported routine aspiration thrombectomy use, despite a Class IIa ACC/AHA guidelines recommendation.ConclusionsThere is significant variability in the self‐reported mechanics of primary PCI by US interventional cardiologists. Some of this variability (e.g., sequence of catheters, and performance of left ventriculography prior to reperfusion) is not addressed by current guidelines/consensus documents, and may have clinical implications, reflecting the balance between the desire for timely reperfusion versus a more complete assessment of patient risk. © 2013 Wiley Periodicals, Inc.
Optimizing rotational atherectomy in high‐risk percutaneous coronary interventions: Insights from the PROTECT ΙΙ study
Authors: Cohen Mauricio G. , Ghatak Abhijit , Kleiman Neal S. , Naidu Srihari S. , Massaro Joseph M. , Kirtane Ajay J. , Moses Jeffrey , Magnus Ohman E. , Džavík Vladimír , Palacios Igor F. , Heldman Alan W. , Popma Jeffrey J. , O'Neill William W. 
Published: October 2013

ObjectiveTo study rotational atherectomy (RA) outcomes in patients undergoing high‐risk PCI randomized to receive hemodynamic support using either IABP or Impella 2.5 in the PROTECT II trial.BackgroundRA of heavily calcified lesions is often necessary for complex PCI but can be associated with slow‐flow, hypotension, and higher risk of periprocedural MI.MethodsWe compared baseline, angiographic, procedural characteristics, and outcomes of patients treated with and without RA. We examined also RA technique and outcomes.ResultsRA was used in 52 of 448 patients (32 with Impella vs 20 with IABP, P = 0.08). RA patients were older (72 vs. 67 yo, P = 0.0009), more likely to have prior CABG (48 vs. 32%, P = 0.017), higher STS (8.1 vs. 5.7, P = 0.012) and higher SYNTAX scores (37 vs. 29, P < 0.0001). At 90 days, RA use was associated with higher incidence of MI but no mortality difference. RA was used more aggressively with Impella resulting in higher rate of periprocedural MI (P < 0.01), with no difference in mortality between groups (P = 0.78). Repeat revascularization occurred less frequently with Impella (P < 0.001). There were no differences in 90‐day major adverse events between IABP and Impella in patients undergoing RA (P = 0.29). In patients not treated with RA, fewer MAEs were observed with Impella compared with IABP (P = 0.03).ConclusionsPatients who were treated with RA had more comorbidities, and more complex and extensive coronary artery disease. In patients with Impella, more aggressive RA use resulted in fewer revascularization events but higher incidence of periprocedural MI. © 2013 Wiley Periodicals, Inc.
Complications related to transhepatic venous access in the catheterization laboratory—A single center 12‐year experience of 124 procedures
Authors: Qureshi Athar M. , Prieto Lourdes R. , Bradley‐Skelton Sharon , Latson Larry A. 
Published: October 2013

ObjectivesTo identify complications and measures that can be undertaken to prevent complications from transhepatic central venous access.BackgroundUtility and safety data from a large experience of patients undergoing transhepatic venous access are lacking.MethodsThe records of patients who underwent transhepatic venous access between June 2000 and October 2012 at The Center for Pediatric and Congenital Heart Disease at The Cleveland Clinic were reviewed.ResultsOne hundred twenty‐four transhepatic procedures were performed in 81 patients. The median weight of the patients was 6.3 (2.2–94) kg at a median age of 7 months (2 weeks to 35 years). Diagnostic catheterizations were performed in 75, interventions in 39, and central venous line placement in 91 procedures. The median maximum sheath size inserted was 8 (4–14) French. There were 10 (8%) major adverse events in 8 procedures—bleeding related (n = 6 with 1 death as a result) or complete heart block with instability or requiring intervention (n = 4). Heart block persisted after the catheterization in three patients (2 days, 2 weeks, 1 month). Minor adverse events (transient heart block) occurred in 5 (4 %) procedures. Weight, age, and French size of sheath (P = 0.46, 0.84, and 0.18) were not associated with complications. In addition, time to gain access was not different between non‐complicated and complicated cases (median 19.5 versus 15.1 min, P = 0.72). Diagnostic and interventional procedures were not associated with more complications compared with procedures involving central venous line placement alone (P = 0.5).ConclusionsTranshepatic access is an extremely useful modality of access to the heart and vascular structures in some patients with complex heart disease. Prevention of complications should focus on minimizing bleeding risks and heart block. © 2013 Wiley Periodicals, Inc.
Silanol‐Assisted Aldol Condensation on Aminated Silica: Understanding the Arrangement of Functional Groups
Authors: Lauwaert Jeroen , De Canck Els , Esquivel Dolores , Thybaut Joris W. , Van Der Voort Pascal , Marin Guy B. 
Published: October 2013

AbstractFree silanol groups are known to promote the activity of aminated silica. In this work the effect of the silanol‐to‐amine ratio on the aldol condensation of 4‐nitrobenzaldehyde and acetone is investigated in a range from 0 to 2.4. Irrespective of the amine density, identical, moderate turnover frequencies are obtained if the silica exclusively has amines on its surface. The turnover frequency increases with increasing silanol‐to‐amine ratio until an upper limit is reached at a silanol‐to‐amine ratio of 1.7. At this upper limit the turnover frequency is a factor 5 higher than the turnover frequencies obtained with the monofunctional amine‐based catalysts. This increase is ascribed to hydrogen‐bridge interactions between the silanols and the carbonyl moiety of the reactants that provoke a more easy interaction between the carbonyl moiety and the amine as required for the aldol condensation. The observation that higher values than one for the silanol‐to‐amine ratio are required is rationalized by computer simulations. It was found that amine groups were grafted on the silica surface in a clustered manner, originating from positive deviations from ideality in the synthesis mixture, that is, from clustering of the amine precursor in the liquid phase.
Explosion Protection by Steam Inertization: Minimizing Emissions
Authors: Bierbaum Ralf , Franke Jürgen , Westphal Frank 
Published: October 2013

AbstractDie Inertisierung von chemischen Reaktoren, in denen brennbare organische Stoffe eingesetzt werden, erfolgt in der Regel mit Inertgasen wie Stickstoff. Die Inertisierung mit Wasserdampf ist ebenfalls möglich, aber auf Systeme beschränkt, in denen Wasser auch als Betriebsmedium vorliegt. Zudem sind die Einstellung einer gleichmäßigen Verteilung im System und die Vermeidung von Kondensation schwieriger. Es wird ein Anwendungsfall für eine Wasserdampf‐Inertisierung beschrieben, die neben Kosteneinsparungen vor allem auch zu deutlich geringeren Emissionen des organischen Lösemittels führt. Dabei werden auch die phlegmatisierenden Eigenschaften des Wasserdampfs genutzt, die u. a. zu höheren Sauerstoffgrenzkonzentrationen führen als beim Einsatz von Stickstoff.
Studies on the regulation of myocardial blood flow in man II. Effects of acute arterial hypoxia
Authors: Heiss H. W. , Töpfer M. , Barmeyer J. , Wink K. , Huber G. , Keul J. 
Published: October 2013

AbstractTo determine whether adjustment of myocardial blood flow (MBF), myocardial oxygen consumption (MVO2) and myocardial substrate uptake (MSU) to acute arterial hypoxia is influenced by training effects on the heart, 7 trained and 7 untrained healthy individuals were investigated. MBF (argon method), MVO2 and MSU of glucose, lactate and free fatty acids were measured at rest during normoxia and two different stages of acute arterial hypoxia: a) 12.82 vol% O2; b) 8.74 vol% O2. Measurements were carried out during hemodynamic and respiratory steady state conditions.Myocardial flow and metabolism of athletes were significantly (p<0.01) lower compared to untrained subjects. In the trained cohort, MBF increased from 65 ± 19 to 73 ± 16 (a) and 98 ± 23 (b) ml/min·100 g. MVO2 remained at normoxic control level of 8.00 ± 2.27 ml/min·100g. In the untrained group, MBF increased from 77 ± 15 to 84 ± 20 (a) and 108 ± 18 (b) ml/min · 100g. Again, there was no significant deviation in MVO2 from the normoxic level of 10.11 ± 1.90 ml/min·100g. Decrease in arterial oxygen content was overcompensated by an increase in coronary conductance resulting in a significantly improved efficiency of myocardial perfusion during severe hypoxia. MSU of glucose, lactate and free fatty acids as well as calculated ATP production did not change significantly during hypoxia.It is concluded that training effects on the heart do not influence regulation of MBF, MVO2 and MSU during moderate or severe acute arterial hypoxia. Reaction of coronary smooth muscle tone to a decrease in oxygen partial pressure is independent from training effects. However, both acute arterial hypoxia and physical training exert synergetic effects on the heart by reducing myocardial oxygen consumption per heart beat. Thus, it is assumed that adaptive properties of myocardial blood flow and metaboüsm to severe hypoxia are more pronounced in trained than in untrained individuals.
Persistent atrial standstill developed in a patient with rheumatic heart disease: Electrophysiological and histological study
Authors: Yoneda S. , Murata M. , Ueda A. , Sato M. , Takahashi M. , Ito T. , Sada T. , Matsumoto S. , Ito Y. , Furuta S. , Kamiyama A. , Akaike A. 
Published: October 2013

AbstractA case with persistent atrial standstill is presented which developed from atrial fibrillation associated with rheumatic combined valvular heart disease. In addition to clinical and electrocardiographic findings, electrophysiological and histological studies by using microelectrode technique and electron microscopy, respectively, were carried out on specimens from the right atrial appendage resected at mitral valve surgery.Scattered but severe loss of myocardial cells in the atria and deterioration of the action potential of these poorly sustained myocardial cells were confirmed. The suggestive evidence is also shown that the deteriorated action potential observed by micro‐electrode technique in this case may be composed of calcium current.
Myocardial imaging with extractable cations and inert tracers: The effects of flow and metabolism
Authors: Selwyn A. P. , Fox K. , Shillingford J. P. 
Published: October 2013

AbstractThe physical and biological properties of 201thallium (Tl) have been investigated and are discussed in this review.A new technique using the ultra‐short lived 81mkrypton (81mKr) as a continuous infusion into the aortic root in dogs and man is described. This provides a dynamic assessment of changes in regional myocardial perfusion. Experiments using 201Tl and 81mKr in dogs have shown that regional decreases in myocardial perfusion alone cannot be detected in images of the heart using 201Tl. The effects of perfusion and a variety of factors on the energy dependent cellular uptake of 201Tl are discussed as being of primary importance in changing the regional myocardial distribution of this tracer.The constant infusion of 81mKr in patients with anginal chest pain provides continuous measurement of regional myocardial perfusion in high spatial resolution images. This dynamic method provides a physiological assessment of stenosed coronary arteries at rest and during stress.
Non‐parenteral combined afterload and preload reduction therapy in congestive heart failure
Authors: Mehta J. , Pepine C. J. , Conti C. R. , Sollaway R. H. 
Published: October 2013

AbstractIt has been shown that hydralazine is beneficial in chronic heart failure by virtue of its afterload reducing effect. Nitroglycerin paste results in venodilation and fall in left ventricular filling pressure (LVFP). Thirteen patients with chronic heart failure were given a combination of oral hydralazine and nitroglycerin paste. With oral hydralazine (75 to 100 mg every 8 h), left ventricular stroke work increased and LVFP slightly fell. Following addition of 2% nitroglycerin paste, an additional decline in mean pulmonary artery and LVFP was observed without significant changes in heart rate and arterial pressure. There were no untoward side effects from either therapy. Eight patients followed for three to eight months (mean five months) reported subjective improvement in shortness of breath and other symptoms related to ventricular dysfunction. This study shows that in certain patients with chronic heart failure, hydralazine and nitroglycerin paste combination produces salutary clinical effects on long term probably through afterload and preload reduction, respectively.
The role of cross‐sectional echocardiography in the diagnosis of flail mitral leaflet
Authors: Ogawa S. , Mardelli T. J. , Hubbard F. E. , Meixell L. , Dreifus Leonard S. 
Published: October 2013

AbstractCross‐sectional echocardiography was performed on two patients with mitral regurgitation in whom M‐mode echocardiographic findings were not specific for the etiology of mitral regurgitation. In one patient, flail motion of the free edge of the anterior mitral leaflet into the left atrium was demonstrated only by cross‐sectional echocardiograms. In the second patient, the flail posterior mitral leaflet was suggested to be a result of bacterial endocarditis. Cross‐sectional echocardiograms clearly identified a flail motion of a mass of vegetation attached to the posterior mitral leaflet.Thus, cross‐sectional echocardiography can provide critical information in recognizing patients with a flail mitral leaflet.
Differences in platelet aggregation in coronary sinus and aortic blood in patients with coronary artery disease: Effect of propranolol
Authors: Mehta J. , Mehta P. , Pepine C. J. , Burger C. 
Published: October 2013

AbstractPlatelet aggregation was studied in aortic and coronary sinus blood samples obtained from 18 patients with coronary artery disease (CAD). Using epinephrine and ADP as aggregating agents, platelet aggregation was lower in coronary venous blood than in aortic blood. In nine patients on long‐term propranolol therapy, platelet aggregation was lower in both aortic and coronary venous blood compared to the nine patients not taking propranolol. Four other subjects without angiographic evidence of coronary disease exhibited no difference in platelet aggregation in aortic and coronary sinus blood. These data suggest that platelet aggregation is lower in the coronary venous blood of certain patients with coronary disease and chronic propranolol treatment may reduce aggregation in both aortic and coronary sinus blood.
Acute coronary occlusion with impending infarction as an angiographic complication relieved by a guide‐wire recanalization
Authors: Rentrop P. , de Vivie E. R. , Karsch K. R. , Kreuzer H. 
Published: October 2013

AbstractIn a 45 year old male patient with a history of previous inferior myocardial infarction and unstable angina pectoris, coronary angiography revealed two‐vessel disease: a 60‐70% lesion in the middle third of the LAD, and a 90% lesion in the middle third of the very large RCA. There was only a small akinetic segment in the posterobasal region of the left ventricle. During angiography total occlusion of the RCA occurred, followed by clinical and electrocardiographic signs of impending inferior reinfarction.Recanalization of the occluded vessel was accomplished by using a guide‐wire, which was passed through a Sones catheter, placed in the RCA. The patient's symptoms subsided and the electrocardiographic signs of acute ischemia reverted within eight minutes.Aortocoronary bypass surgery with revascularization of the LAD and RCA was performed within 3 hours after recanalization. Postoperatively there was no evidence of major tissue loss by enzyme or electrocardiographic criteria. Control angiography, performed on the ninth day postoperatively, revealed the graft to the RCA to be widely patent. Left ventricular function was unchanged.It is concluded, that the combined approach of early transluminal recanalization of the acutely occluded RCA, followed by successful construction of a graft to this vessel, has averted necrosis of a major portion of the left ventricle. However, general use of this technique does not seem advisable at the present time.
Therapeutic implications of the use of selective beta‐adrenoceptor antagonists in clinical cardiology — A current review
Authors: Comerford M. B. 
Published: October 2013

AbstractDuring the last five years of the beta‐blocker era, there has been a slow but steadily increasing interest in the clinical aspects of the selective compounds. A critical appraisal of the works published in the various fields of angina, hypertension, metabolic disorders, respiratory function, stress and exercise responses, suggests a therapeutic progress worthy of the clinician's attention.
Initial experience with transluminal recanalization of the recently occluded infarct‐related coronary artery in acute myocardial infarction — Comparison with conventionally treated patients
Authors: Rentrop K. P. , Blanke H. , Karsch K. R. , Kreuzer H. 
Published: October 2013

AbstractIn 7 patients, the recently occluded infarct‐related vessel was recanalized by transluminal catheter techniques during acute myocardial infarction (Group A). 4 patients had single‐vessel disease, 2 patients two‐vessels disease and one, involvement of three vessels. Control angiography was performed in 6 patients, 8 days to 7 months later. Changes of coronary artery anatomy and left ventricular function were compared with a group of 9 conventionally treated patients, who were found to have occlusion of the infarct‐related vessel in the acute stage (Group B). Five Group B patients had one‐vessel disease, 3 patients two‐vessel disease and 1 patient, involvement of all three vessels. In the chronic stage, all transluminally recanalized vessels were found to be patent in Group A. There was spontaneous recanalization of the infarct vessel in 4 of 9 Group B patients. In Group A, the length of the akinetic segment (AKS) decreased significantly (p < 0.05) from 145.4±48.5 mm to 73.2 ± 73.4 mm (mean ± SD). Volume parameters did not change significantly. In Group B, length of the AKS did not change significantly, EDVI increased significantly from 81.1 ±19.8 to 106.8±40.6 ml/m2 (p < 0.05); ESVI increased significantly from 41.7 ± 13.7 ml/m2 to 66.8 ± 37.9 ml/m2 (p < 0.01). In the acute stage, length of the AKS and volume parameters did not differ significantly between the two groups. In the chronic stage, AKS was significantly shorter (A: 73.2 ± 63.4 mm; 144.9 ± 59 mm (p < 0.0025)) and EF was significantly higher (A: 54.6 ±11.6%; B: 40.9 ±14.5% (p < 0.05)) in Group A. Peak CPK was lower in Group A (A: 1009 ± 827 U/l; B: 1324 ± 655 U/l), but this difference did not achieve statistical significance. Results of this pilot study suggest that transluminal recanalization in the early phases of acute myocardial infarction might result in limitation of myocardial injury. However, further research will be needed to improve the technique and to test its results.
Nitroglycerin in acute myocardial infarction X. Effect of small and large doses of nitroglycerin on sigma ST segment deviation — Experimental and clinical results
Authors: Bussmann W.‐D. , Schöfer H. , Kurita A. , Ganz W. 
Published: October 2013

AbstractThe purpose of the present study was to investigate the effect of the dose of nitroglycerin (NTG) on myocardial ischemic injury. In 20 closed chest dogs the anterior descending branch of the left coronary artery was occluded by inflating a balloon in its lumen. Compared with the untreated control group the Z ST elevation was significantly lower when NTG was applied at a rate of 0.02 mg/min, but significantly higher when NTG was administered at a rate of 0.10 mg/min. In 12 patients with acute myocardial infarction NTG was infused at a rate of 3 mg in the first hour (0.05 mg/min) and 6 mg in the second hour (0.1 mg/min). Σ ST elevation and Σ ST depression decreased during the lower infusion rate (p < 0.001). When the rate of NTG infusion was raised to 6 mg/hr, the improvement in ST segment deviation was partially reversed. This effect, particularly evident in patients not in heart failure, was associated with a significant rise in heart rate (p < 0.05) and a fall in diastolic arterial pressure (p < 0.025). Patients with left ventricular failure were less sensitive to higher doses of NTG than those without failure. Thus, the effect of NTG on myocardial ischemic injury depends on the NTG dose and on the functional state of the injured left ventricle.
Dimeditiapramine (Ro 11‐1781), a new calcium antagonist, in the management of supraventricular tachyarrhythmias in patients with acute myocardial infarction
Authors: Cocco G. , Chu D. , Strozzi C. 
Published: October 2013

Abstract18 patients with acute myocardial infarction and sustained arrhythmias were treated with a new Ca2+ antagonist, Ro 11‐1781, at the dose of 1.0 mg/kg i.v. The drug was effective in reducing heart rate to less than 90 beats/min in 9/10 patients with atrial fibrillation, in 3/4 patients with atrial flutter and in 3/4 patients with supraventricular tachycardia. The peak effect was observed within 2‐5 min after the intravenous administration of Ro 11‐1781. In cases with recurring tachyarrhythmias, the drug was also effective in repetitive administration. Systolic blood pressure was reduced, but severe hypotension (< 90 mm Hg) was not observed. The atrioventricular conduction in these patients remained unimpaired and asystole did not occur. The drug appears to be an effective and a well tolerated antiarrhythmic agent.