bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of spinal cord stimulation on heart rate variability and myocardial ischemia in patients with chronic intractable angina pectoris—A prospective ambulatory electrocardiographic study
Authors: Hautvast Raymond W. M. , Brouwer Jan , Dejongste Mike J. L. , Lie K. I. 
Published: August 2009

AbstractBackground and hypothesis: Spinal cord stimulation is an effective treatment for chronic refractory angina pectoris. Its efficacy is related to an anti‐ischemic action, possibly as a result of modulation of the autonomic nervous system. Therefore, the influence of spinal cord stimulation on the autonomic nervous system and myocardial ischemia was prospectively studied in 19 consecutive patients with intractable angina pectoris.Methods: Patients were included when demonstrating > 0.1 m V STsegment depression on the exercise electrocardiogram (ECG) during two separate treadmill tests. After enrollment, heart rate variability together with ischemic indices were studied with 48 h ambulatory ECG monitoring. Assessments were made at baseline and after 6 weeks of spinal cord stimulation therapy.Results: After 6 weeks, no significant changes in heart rate variability were detected. However, ischemic indices on the ambulatory ECG, as well as anginal attacks and consumption of sublingual nitrate tablets, were significantly decreased.Conclusion: Autonomic modulation assessable with heart rate variability analysis may not be the explanatory mechanism of action for the decrease of anginal attacks and ischemia, exerted by spinal cord stimulation used as an adjuvant therapy in patients with chronic intractable angina pectoris.
Immunosuppressive therapy for peripartum‐type spontaneous coronary artery dissection: Case report and review
Authors: Kolle Patrick T. , Cliffe Charles M. , Ridley David J. 
Published: August 2009

AbstractBackground: A 35‐year‐old postpartum woman presented with myocardial infarction (MI) due to spontaneous coronary artery dissection (SCAD). In addition to conventional medical therapy, she was treated with immunosuppressive agents (prednisone and cytoxan) because of five noncontiguous coronary dissections, surgical inoperability, and postinfarction angina. Repeat angiography 94 days later demonstrated angiographically normal vessels.Methods: A literature review of 42 additional cases of peripartum SCAD was performed, and the results were compared with this patient.Results: Mortality was 48.8% (21/43). Sudden cardiac death was the initial presentation in 27.9% (12/43) of cases. The left coronary artery was involved in 78.6% (44/56) of dissections with left main segment dissection in 10 cases. In women who survived > 24 h post infarction, recurrent MI, usually due to a second coronary dissection, occurred in 20.8% (5/24). Histopathologic studies have often shown periadventitial inflammation (80%, 16/20), in which eosinophils predominate (68.8%, 11/16), and may be linked to the medial degeneration often found in these cases.Conclusions: The common observation of eosinophilic periadventitial inflammation suggests a role in the pathophysiology of this rare, yet serious condition. Aggressive immunosuppressive therapy in this case of multivessel dissection resulted in spontaneous angiographic healing of all lesions.
A Case of giant cell myocarditis and malignant thymoma: A postmortem diagnosis by needle biopsy
Authors: Kilgallen Clive M. , Salomon Robert N. , Jackson Elizabeth , Surks Howard K. , Bankoff Mark 
Published: August 2009

AbstractThis paper reports a case of fulminant giant cell myocarditis arising in association with a malignant thymoma causing death in a 46‐year‐old woman. Although the diagnosis was suspected in life, postmortem examination was required for confirmation of giant cell myocarditis. Consent was obtained only for percutaneous needle biopsy of the heart. In order to respect the family's wishes and harvest sufficient diagnostic myocardium, a simple needle‐based biopsy technique was devised. A bone marrow trephine needle was attached to a 20 ml syringe and, with suction, multiple passes were used to fill 15 tissue cassettes. The cores were placed immediately in formalin and B5 fixatives. High‐quality tissue preservation was obtained without crush artefact. Immunohistochemical studies of the biopsy tissue confirmed that the giant cells were of macrophage derivation.
Torsade de Pointes Secondary to d, I‐Sotalol after Catheter Ablation of Incessant Atrioventricular Reentrant Tachycardia—Evidence for a Significant Contribution of the “Cardiac Memory”
Authors: Haverkamp W. , Hördt M. , Breithardt G. , Borggrefe M. 
Published: August 2009

AbstractRadiofrequency catheter ablation of a right septal accessory pathway was performed in a 66‐year‐old patient with incessant orthodromic atrioventricular reentrant tachycardia. Intravenous administration of flecainide, ajmaline, verapamil, and d, l‐sotalol had been ineffective in controlling the tachycardia. After the ablation procedure, precordial T‐wave inversion was observed during sinus rhythm. These repolarization abnormalities persisted and were suggested to represent “cardiac memory”. Three days later, atrial fibrillation with a fast ventricular response developed and oral d, l‐sotalol, which had been well tolerated previously on a long‐term basis, was started again. However, at this time, and in the presence of the persisting repolarization abnormalities, the T waves became deeper and broader within a few hours after the introduction of d, l‐sotalol. Marked QT prolongatio that was paralleled by the occurrence of repeated episodes of torsade de pointes developed. Serum electrolytes were nomal. Direct current cardioversion was necessary due to the degeneration of torsade de pointes into ventricular fibrillation. Further sustained arrhythmia episodes were suppressed by temporary endocardial ventricular pacing. The patient recovered without any sequela. This case demonstrates that replarization abnormalities after catheter ablation, which may be due, at least in part, to the “cardiac memory,” are not always benign but may contribute significantly to proarrhythmia.
Long‐term patency (9½ years) and atherosclerosis of a polytetrafluoroethylene (Gortex®) coronary artery bypass graft
Authors: Vlay Stephen C. , Malik Amir Z. 
Published: August 2009

AbstractThe patency of a polytetrafluoroethylene (Gortex®) graft 9½ years after coronary artery bypass graft surgery (CABG) is demonstrated. While this material is not commonly used as a conduit because of limited success in the past, this case demonstrates that, given the right circumstances, longterm patency is possible. Since available conduits for CABG are quite often limited, viable alternatives may be lifesaving and require further evaluation. In addition to mechanical considerations such as size, length, and material, anticoagulation and strict management of hyperlipidemia may be critical.
End organ protection by calcium‐channel blockers
Authors: Tzivoni Dan 
Published: August 2009

AbstractIn recent years, much attention has been given to end organ protection by antihypertensive, anti‐heart failure, and anti‐ischemic medications. This review describes the available information on end organ protection by calcium‐channel blockers (CCBs). In normotensive patients and patients with hypertension treated with long‐acting dihydropyridines, medial thickness was thinner than in patients treated with atenolol or in untreated hypertensive patients. Long‐term treatment was associated with significant reduction in left ventricular mass. Calcium‐channel blockers also improved endothelial‐dependent relaxation and reversed the vasoconstrictive response to nitric oxide inhibitors. In diabetic patients. CCBs were effective in preserving kidney function and microalbuminurea. The combination of angiotensin‐converting enzyme (ACE) inhibitors and CCBs was more effective than ACE inhibitors alone in preserving kidney function. In animal experiments, CCBs prevented development of coronary atheroschlerosis; however, in humans only limited data are available on their antiatherogenic effect. Some studies suggest that CCBs exert antiplatelets properties and may therefore be beneficial in patients with coronary artery disease.
Prognosis following acute myocardial infarction in patients with ST‐T abnormalities on electrocardiograms obtained before myocardial infarction
Authors: Ando Hiromi , Yotsukura Masayuki , Sakata Konomi , Yoshino Hideaki , Ishikawa Kyozo 
Published: August 2009

AbstractBackground: Many studies have examined the relationship between prognosis after myocardial infarction (MI) and electrocardiographic (ECG) findings at the time of or after the onset of MI. However, little work has been done concerning the association between ECG findings obtained before the onset of MI (pre‐MI) and the prognosis after MI.Hypothesis: The study was undertaken to determine whether ST‐T segment and T‐wave morphology on pre‐MIECGs provides useful information for prognosis after acute MI.Methods: Pre‐MIECGs of 212 patients recorded within the 6‐month period before MI were studied for the presence of high‐voltage R waves, ST‐segment depression, and negative T waves. The Kaplan‐Meier method and multivariate analysis were used to determine the relationship between these ECG findings and in‐hospital cardiac death.Results: In‐hospital cardiac death occurred in 32 (15.1%) patients. The in‐hospital mortality rate was 38.5% (5/13) for the patients with high‐voltage R waves, 54.5% (6/11) for patients with ST‐segment depression, and 45.6% (15/33) for patients with negative T waves. The in‐hospital mortality rate was 13.6% (27/199) for patients without high‐voltage R waves, 12.9% (26/201) for patients without ST‐segment depression, and 9.5% (17/179) for those without negative T waves. Multivariate analysis identified age and negative T waves as independent risk factors for cardiac death, with a hazard ratio for negative T waves of 3.1.
Intervention to improve adherence to ACC/AHA recommended adjunctive medications for the management of patients with an acute myocardial infarction
Authors: Axtell Sandra S. , Ludwig Elizabeth , Lopez‐Candales A. 
Published: August 2009

AbstractBackground: The most recent published guidelines regarding management of patients surviving an acute myocardial infarction (AMI) advocate the administration of aspirin (ASA), beta blockers (BB), and angiotensin‐converting enzyme inhibitors (ACEi) and discourages the use of calcium‐channel blockers (CCB). Previous data collected in our region from the National Registry (NR) showed a dismal compliance with these guidelines. In an attempt to increase physician awareness and to optimize implementation of recommended guidelines, a cardiac and pharmacy steering committee was created.Methods: The pharmacist assigned to the project identified all patients admitted with an AMI using troponin‐I and creatine kinase‐MB (CK‐MB) reports. The pharmacist then contacted physicians to make recommendations if an adjunctive medication was not prescribed for a patient with no apparent contraindications. Administration rates for ASA, BB, ACEi, and CCB were then assessed and compared with the previously obtained baseline data from the NR.Results: At admission, the use of ASA increased from 70 to 72%, BB from 45 to 72%, and ACEi from 12 to 44%. In terms of medications at discharge, ASA use increased from 74 to 88%. BB from 55 to 76%, and ACEi from 30 to 40%. In addition, the prescription rates for CCB at discharge decreased from 36 to 21%.Conclusions: An interdisciplinary approach for disease management is an effective method for improving adherence to treatment guidelines simply with pharmacy intervention. the percentage of patients receiving the recommended adjunctive medications increased significantly. We propose that these guidelines should be periodically inserviced to physicians. Furthermore, patient counseling sessions should also be instituted to help reinforce the importance of compliance with the medications after discharge, as well as lipid management and smoking cessation.
Reduced incidence of clinical restenosis with newer generation stents, stent oversizing, and high‐pressure deployment: Single‐operator experience
Authors: Manolis Antonis S. 
Published: August 2009

AbstractBackground: Over the last 4 years, several newer generation stents have become available, promising to change the scenery of coronary angioplasty (PTCA) with its attendant restenosis rate.Hypothesis: The aim of this study was to review prospectively the results of a single operator adopting a uniform approach with approximately 0.5 mm stent oversizing and high‐pressure (≥ 12‐16 bar) deployment and compare them with conventional PTCA in a series of 244 consecutive patients.Methods: The study included 203 men and 41 women, aged 59 ± 11 years, who presented with stable angina and/or positive exercise testing (n = 75), unstable angina (n = 161), or acute myocardial infarction (n = 8). Dilated vessels included the left anterior descending artery (n = 139), the right coronary artery (n = 86), the left circumflex artery (n = 47), the ramus branch (n = 4), or venous grafts (n = 2). Stents were implanted for dissection, suboptimal PTCA result, and electively. Two groups were compared: 83 patients who underwent balloon PTCA alone and 161 patients who also received stent(s).Results: The two groups had similar demographics, age (58 ± 10 vs. 59 ± 11 years), initial vessel stenosis (92 ± 7 vs. 93 ± 6%), and left ventricular ejection fraction (51 ± 9 vs. 51 ± 8%). Procedural success was also similar (97.6 vs. 99.4%), but as expected the residual stenosis was much lower in the stent group (≤ 0 vs. 17%). The following stents were employed: J & J (n = 1), NIR (n = 117), ACS (n = 59), AVE (n = 9), Inflow GoldFlex (n = 9), Crossflex (n = 5), Wictor (n = 1), Jostent (n = 16), R stent (n = 9), Seaquence (n = 2) and Wallstent (n = 1). Single stents were used in 118 patients, two stents in 31 patients, three in 6 patients, and four in 6 patients. There was one in‐hospital death at 3 days unrelated to the procedure. There were no events of subacute stent thrombosis; all patients in the stent group received combined therapy with aspirin and ticlopidine, the latter for 1 month. During 18 ± 14 months, the clinical rèstenosis rate was significantly lower in the stent group (6.9%) than in the PTCA group (28.4%) (p = 0.001).Conclusion: In a series of 244 consecutive patients, newer generation stents and a consistent approach of stent oversizing and high‐pressure stent deployment by a single operator resulted in high procedural success (99%), lack of stent thrombosis (0%), and a very low clinical restenosis rate (7%).
Accelerated dobutamine stress testing: Safety and feasibility in patients with known or suspected coronary artery disease
Authors: Lu David , Little Raymond , Malik Qudsia , Fernicola Daniel J. , Greenberg Michael D. , Weissman Neil J. 
Published: August 2009

AbstractBackground: Dobutamine pharmodynamics require approximately 10 min to reach steady state. Despite this, standard dobutamine stress echo typically uses 3‐min stages of advancing dobutamine doses because of safety concerns.Hypothesis: In patients with a high pretest probability of coronary artery disease (CAD), a continuous infusion of high‐dose dobutamine is a feasible and safe method for performing a dobutamine stress test.Methods: Forty‐seven consecutive patients (mean age 64 ± 11 years) with 3.0 ± 1.4 cardiac risk factors underwent dobutamine stress testing utilizing a single, high‐dose (40 mcg/kg/min), continuous dobutamine infusion. The 40 mcg/kg/min infusion was continued for up to 10 min or until a test end‐point had been reached. If a test endpoint was not achieved, atropine (up to 1.0 mg) was added.Results: Heart rate rose from 71 ± 12 to 137 ± 18 beats/min at peak (p< 0.0001) with a concomitant change in systolic blood pressure (143 ± 35 vs. 167 ± 38 mmHg; p = 0.001) but no change in diastolic blood pressure (74 ± 19 vs. 75 ± 18 mmHg; p = NS). Target heart rate was achieved in 20 of 47 (43%) patients with accelerated dobutamine alone and in 34 of 47 (72%) with the addition of atropine. An average of 11.6 ± 3.7 min was required to obtain target heart rate. Subjective sensations from the dobutamine occurred in 49% of patients (palpitations 21%, nausea 6%, chest pain 6%, headache 6%, dizziness 13%), mild arrhythmia in 48% of patients (ventricular premature beats 38%, supraventricular tachycardia 10%), and one patient had nonsustained ventricular tachycardia.Conclusion: A single, high‐dose (40 mcg/kg/min) dobutamine‐atropine protocol provides an efficient means of performing dobutamine stress echocardiography with a similar symptom profile as conventional dobutamine infusion protocols in patients with a high pretest probability of CAD. Randomized, controlled studies will be necessary to assess the sensitivity and specificity of this accelerated dobutamine echo protocol.
Sleep‐disordered breathing in patients referred for angina evaluation—association with left ventricular dysfunction
Authors: Sanner Bernd M. , Konermann Martin , Doberauer Claus , Weiss Thomas , Zidek Walter 
Published: August 2009

AbstractBackground: Clinical observations have linked sleep‐disordered breathing to cardiovascular morbidity and mortality, and especially to coronary artery disease.Hypothesis: The study was undertaken to determine the prevalence of sleep‐disordered breathing in consecutive patients referred for angina evaluation, and analyzed the parameters influencing the severity of sleep‐disordered breathing.Methods: In all, 68 consecutive patients (53 men, 15 women, aged 63.4 ± 10.0 years) referred for angina evaluation were studied. Coronary angiography, selective left ventriculography, and a polygraphic study with a validated six‐channel monitoring device were performed. Full‐night polysomnography was used to reevaluate patients with an apnea/hypopnea index ≥ 10/h. Results: Sleep‐disordered breathing as defined by an apnea/hypopnea index > 10/h was found in 30.9% of patients; its prevalence was not increased in patients with and without coronary artery disease (26.5 vs. 42.1%). Multiple stepwise linear regression analysis revealed that the severity of sleep‐disordered breathing was significantly and independently associated with left ventricular ejection fraction (r = −0.38; p = 0.002), but not with age, body mass index, gender, diabetes mellitus, hypertension, hyperuricemia, hypercholesterolemia, smoking habits, or coronary artery disease. In this group of patients, multiple logistic regression analysis could not demonstrate sleep‐disordered breathing to be an independent predictor of coronary artery disease.Conclusions: Sleep‐disordered breathing is common in patients referred for angina evaluation. The degree of sleep‐disordered breathing is mainly determined by the extent of left ventricular dysfunction.
Oral antidiabetic treatment in patients with coronary disease: Time‐related increased mortality on combined glyburide/metformin therapy over a 7.7‐year follow‐up
Authors: Fisman Enriqe Z. , Tenenbaum Alexander , Adler Yehuda , Motro Michael , Boyko Valentina , Benderly Michal , Friedensohn Aharon , Kohanovski Mira , Rotzak Rene , Schneider Hanan , Behar Solomon 
Published: August 2009

AbstractBackground: A sulfonylurea —usually glyburide—plus metformin constitute the most widely used oral antihyperglycemic combination in clinical practice. Both medications present undesirable cardiovascular effects. The issue whether the adverse effects of each of these pharmacologic agents may be additive and detrimental to the prognosis for coronary patients has not yet been specifically addressed.Hypothesis: This study was designed to examine the survival in type 2 diabetics with proven coronary artery disease (CAD) receiving a combined glyburide/metformin antihyperglycemic treatment over a long‐term follow‐up period.Methods: The study sample comprised 2,275 diabetic patients, aged 45–74 years, with proven CAD, who were screened but not included in the bezafibrate infarction prevention study. In addition. 9,047 nondiabetic patients with CAD represented a reference group. Diabetics were divided into four groups on the basis of their therapeutic regimen: diet alone (n = 990), glyburide (n = 953), metformin (n = 79), and a combination of the latter two (n = 253).Results: The diabetic groups presented similar clinical characteristics upon recruitment. Crude mortality rate after a 7.7‐year follow‐up was lower in nondiabetics (14 vs. 31.6%, p<0.001). Among diabetics, 720 patients died: 260 on diet (mortality 26.3%). 324 on glyburide (34%), 25 on metformin alone (31.6%), and 111 patients (43.9%) on combined treatment (p<0.000001). Time‐related mortality was almost equal for patients on metformin and on combined therapy over an intermediate follow‐up period of 4 years (survival rates 0.80 and 0.79, respectively). The group on combined treatment presented the worst prognosis over the long‐term follow‐up, with a time‐related survival rate of 0.59 after 7 years, versus 0.68 and 0.70 for glyburide and metformin, respectively. After adjustment to variables for prognosis, the use of the combined treatment was associated with an increased hazard ratio (HR) for all‐cause mortality of 1.53 (95% confidence interval [CI] 1.20–1.96), whereas glyburide and metformin alone yielded HR 1.22 (95% CI 1.02–1.45) and HR 1.26 (95% CI 0.81–1.96), respectively.Conclusions: We conclude that after a 7.7‐year follow‐up, monotherapy with either glyburide or metformin in diabetic patients with CAD yielded a similar outcome and was associated with a modest increase in mortality. However, time‐related mortality was markedly increased when a combined glyburide/metformin treatment was used.
Effects of stent coating on platelets and endothelial cells after intracoronary stent implantation
Authors: Atalar Enver , Aytemir Kudret , Aksöyek Serdar , Övünç Kenan , Oto Ali , özmen Frhan , Haznedaro ǧlu Ibrahim 
Published: August 2009

AbstractBackground: Adhesion molecules are known to be important in the regulation of endothelial cell and platelet functions. Increased platelets P‐selectin expression is a marker of stent thrombosis after uncoated stent placement.Hypothesis: The aim of this study was to compare the effects of intracoronary placement of phosphorylcholine (PC)‐coated, versus heparin‐coated, versus uncoated stents on platelets and endothelial activity.Methods: Thirty patients (age 55 ± 10, 27 men) with significant proximal left anterior descending coronary artery stenoses were randomized to elective implantation of PC‐coated. versus heparin‐coated. versus uncoated stents. Following stent placement, intravenous heparin and aspirin plus ticlopidine were administered. Venous plasma soluble E‐selectin, sP‐sclectin, and intercellular adhesion molecule‐1 levels were measured before the procedure and 24 and 48 h thereafter as markers of platelet and endothelial cell activation. Patients were excluded if they had a disease known to influence platelet and endothelial cell function.Results: Plasma sP‐selectin levels decreased significantly after implantation of PC‐ and heparin‐coated stents (p = 0.04), hut remained unchanged in patients randomized to uncoated stents. Plasma sE‐selectin levels increased significantly after uncoated stent placement (p = 0.04) and remained unchanged after coated stent implantation.Conclusion: In patients treated with combined antiplatelet therapy, implantation of PC‐ and heparin‐coated stents decreased platelet activity without activating endothelial cells, whereas placement of uncoated stents led to endothelial activation without changing platelet activity. These results suggest that PC‐coated and heparin‐coated stents may be advantageous in limiting thrombotic complications.