bluuebunny/crossref_metadata_2025_split huggingface dataset:
Percutaneous transluminal coronary angioplasty by high‐volume and low‐volume operators
Authors: Finci L. , Meier B. , Steffenino G. , Urban P. , Noble J. , Gabathuler J. , Rutishauser W. 
Published: August 2009

AbstractWe retrospectively compared the results of percutaneous transluminal coronary angioplasty (PTCA) of three low‐volume opertors (1.3 PTCAs/month) to those of a relatively high‐volume operator (14.9 PTCAs/month) in 396 consecutive procedures (358 patients). PTCA for multiple vessels, total occlusions, or evolving acute myocardial infarction had been excluded. For low‐volume operators experienced assistance was considered present when the high‐volume operator participated as second operator. The three low‐volume operators performed 42, 38, and 24 PTCAs, respectively. Success rates per procedure for these operators were 88%, 84%, and 83%, and the complications rates 5%, 3%, and 13%, respectively. The success rates for assisted vs. nonassisted procedures were 89% vs. 88%, 100% vs. 78%, and 90% vs. 71%, and the complications rates were 6% vs. 4%, and 0% vs. 21%, respectively. The high‐volume operator performed 292 PTCAs, with a success rate of 93%, and a complication rate of 5%. The cumulated success rate of the three low‐volume operators of 85% was significantly (p<0.05) lower than the 93% success rate of the high‐volume operator, while the complication rates of 6% and 5%, respectively, were not significantly different. Low‐volume operators in an experienced center can perform PTCA safely even without assistance by a high‐volume operator. However, their success rate is lower.
The eccentric coronary atherosclerotic plaque: Morphologic observations and clinical relevance
Authors: Waller B. F. 
Published: August 2009

AbstractFive hundred consecutive coronary artery segments histologically narrowed 76 to 95% in cross‐sectional area by atherosclerotic plaque were classified into concentric and eccentric luminal types. Of the 500 segments, 365 (73%) were eccentric and 185 (27%) were concentric. Of the eccentric lesions, an are of disease‐free wall accounted for 2.3 to 32% (mean 16.6%) of the circumference of the internal elastic membrane. The average thickness of the coronary artery media was thinner in diseased segments (mean 88.4 μm) compared to disease‐free wall segments in the same vessel (mean 202.9 μm). The presence of disease‐free wall segments has clinical importance in at least three areas: (1) the accuracy with which angiography reflects the morphologic features of the diseased vessel, (2) coronary artery spasm, and (3) the mechanism of coronary balloon angioplasty and subsequent “restenosis” of previously dilated vessels.
Echocardiographic monitoring of mental stress test in ischemic heart disease
Authors: Modena M. G. , Corghi F. , Fantini G. , Mattioli G. 
Published: August 2009

AbstractMental stress testing can induce ischemia in coronary patients, but often may not induce chest pain and/or electrocardiographic changes. Therefore, we tested the utility of echocardiography to increase the sensitivity of the method. For this purpose, 56 patients under‐took arithmetic mental stress tests and then were subjected co coronary angiography. During the test we evaluated left ventricular function, electrocardiography results, and emotional involvement measured by STAI (State Trait Anxiety Inventory). Echocardiography was positive in 21 patients, and electrocardiogram only in 2 patients. No patient complained of chest pain. The remaining 35 patients were negative. Comparing echo data with coronary angiography, in all the cases, sensitivity was 73.5%, specificity 73.3%. Analysis of the STAI revealed that the negative we observed could be due to a low stressor efficacy. In conclusion, echocardiography in mental stress testing permits improved sensitivity, with loss of specificity in comparison with conventional electrocardiographic monitoring.
The relationship between intraoperatively assessed atrial and ventricular insertions of accessory pathways
Authors: Blomstrom P. , Jonsson R. 
Published: August 2009

AbstractTo gain insight into the complex problems regarding the extension of the atrial and ventricular insertions of anomalous pathways, the activation patterns obtained from intraoperative epicardial mapping in 23 patients with Wolff‐Parkinson‐White syndrome were carefully analyzed. The atrial and ventricular activation times along the atrioventricular groove were measured at 15 predefined anatomical landmarks. The width of the region of earliest atrial and ventricular activation times and the extent of atrial and ventricular overlap were assessed. The relationship between the atrial and ventricular insertions was studied by predicting the ventricular insertions from the observed atrial insertions and vice versa. The mean extension of an atrial and a ventricular insertion at surgery was 1.9±0.2 (SE) and 1.6±0.2 (SE) anatomical landmarks, respectively. The width of the region of early atrial and ventricular activation times measured 2.7±0.3 (SE) landmarks, thus indicating an overlap of the atrial and ventricular insertions. The lateral distance between the sites of earliest atrial and ventricular activation times was, on average, 1.7±0.3 (SE) landmarks. The predicted atrial insertion from a known ventricular insertion, and vice versa was found to cover 4 to 6 anatomical landmarks. These observations suggest that wide surgical dissections along the atrioventricular groove are warranted even if epicardial mapping discloses only a single accessory pathway.
Coronary artery spasm induced by anesthesia: A case report and review of the literature
Authors: Soto E. , Duvernoy W. F. C. , David S. , Small D. , Nair M. R. S. 
Published: August 2009

AbstractAnesthesia–induced coronary vasospasm has been reported only rarely. We report a case, without previous cardiac history, in which immediately after anesthesia induction a marked ST elevation was noted on the EKG monitor. Premature ventricular contractions as well as nonsustained ventricular tachycardia were noted. These changes resolved immediately after nitroglycerin infusion and 75 mg of lidocaine were given. A coronary angiogram revealed normal coronary arteries and left ventriculogram. Ergonovine stimulation was not performed. The patient was discharged home on calcium entry blockers and nitrates. Exercise stress test two weeks after discharge was negative for ischemia. Induction of anesthesia triggering coronary spasm has been reported rarely, and to our knowledge never in the presence of angiographically normal coronary anatomy. Coronary vasospasm with typical EKG changes——namely, ST elevation and ventricular arrhythmias——has to be included as a possible complication of general anesthesia. Recongnition of this syndrome allows prompt treatment and prevention of future episodes.
A pilot study of paramedic‐administered, prehospital thrombolysis for acute myocardial infarction
Authors: Sherrid M. , Greenberg H. , Marsella R. , Mathisen D. , Lynn S. , Dwyer E. 
Published: August 2009

AbstractWe have implemented a pilot program of supervised paramedic administration of thrombolysis in the field. This program was begun on a small scale by training and equipping one paramedic service of one hospital. Four patients with acute myocardial infarction were rapidly and appropriately treated in the field. We compared these patients with 21 patients who were brought to hospital by ambulance, but treated with thrombolysis conventionally in the emergency department. The patients in the field were treated an average of 86 minutes sooner than the patients treated in the emergency department.
Topography of atherosclerotic coronary artery disease
Authors: Waller Bruce , Waller B. F. 
Published: August 2009

AbstractThis article reviews several issues relevant to current interest in coronary angioplasty, acute reperfusion, and the use of new interventional devices (stents, probes, atherectomy devices, etc.): diffuse versus focal nature of plaque, the number of vessels severely diseased, quantitation of luminal stenosis and length of stenosis, and the distribution of plaque in the four major coronary arteries in various clinical ischemic subsets.
Left ventricular aneurysm associated with apical hypertrophic cardiomyopathy
Authors: Partanen J. , Kupari M. , Heikkilä J. , Keto P. 
Published: August 2009

AbstractA 47‐year‐old man with apical hypertrophic cardiomyopathy and an apical left ventricular aneurysm with palpitation as the initial manifestation is described. There was no intraventricular pressure gradient. The aneurysm is suggested to be a part of the myocardial disease or to be caused by myocardial bridging of the left anterior descending coronary artery demonstrated by angiography. The 24‐hour ambulatory ECG recording showed only isolated ventricular ectopic beats and the clinical course has been favorable during 20 months without therapy.
Pharmacological management of acute myocardial infarction
Authors: Jain Praveer , Vlay Stephen C. 
Published: August 2009

AbstractThe routine medical management of patients with acute myocardial infarction (AMI) has undergone major changes in the last decade. Several large‐scale trials have firmly established the effectiveness of thrombolytic therapy, beta blockers, and aspirin in the treatment of AMI. The critical issues include reducing myocardial oxygen demand and restoring adequate blood supply to the ischemic regions of the myocardium. As a result, the ability to intervence in patients with AMI has improved significantly. The purpose of this review is to discuss briefly the results of major trials of primary and secondary pharmacological intervention which had a direct impact on the care of patients with AMI. It concludes with current recommendations for the management of patients with AMI.
New approaches to noninvasive assessment of pulmonary artery pressure
Authors: Mirrakhimov M. M. , Tenenbaum A. M. , Moldotashev I. K. , Niazova Z. A. , Zlatkovsky M. L. 
Published: August 2009

AbstractDirect measurement of pulmonary artery pressure (PAP) was performed in 36 patients; right ventricular (RV) isovolumic relaxation time (IRT) and RV systolic output acceleration time (AcT) values were assessed by pulsed Doppler and 2‐M echocardiography. There was a fairly good correlation between RV IRT and systolic PAP (r=0.898; SEE=7.8 mmHg) and a somewhat weaker one between RV AcT and systolic PAP (r=‐0.880; SEE=8.37 mmHg). Correlation coefficients were the highest between systolic PAP and the(RVIRT/RVIRT+RV AcT)2 predictor.r:=145x2+14 (r=0.972; SEE=4.14), and also between mean PAP and the 10−RV AcT/100 predictor: y=158x + 6.7 (r=0.951; SEE = 3.48 mmHg). With ±5 mmHg deviations, systolic PAP measurements were accurate in 78% and those of mean PAP in 98% of the patients. The double‐blind assessment of the reproducibility of the suggested noninvasive PAP measurement was performed in 18 subsequent patients; the interstudy variability of the measurement was 0.88 ± 0.94 mmHg and 1.22 ± 1.23 mmHg (p>0.05), whereas interobserver variability was 1.90±1.70 mmHg and 1.67±1.63 mmHg, respectively (p>0.05). Thus, a combined use of the most informative intervals of RV cycle—IRT and AcT—contributes to the accuracy of noninvasive PAP measurement.
Fosinopril monotherapy: Relationship between blood pressure reduction and time of administration
Authors: Ford Neville F. , Fulmor I. Edgar , Nichola Peter S. , Alpin Pamela G. , Herron Jarry M. 
Published: August 2009

AbstractThe time to peak antihypertensive effect and the trough‐to‐peak ratio were determined in 64 Caucasian patients (19 men, 45 women) with mild to moderate hypertension [supine diastolic blood pressure (DBP) 95 to 115 mmHg]. They received placebo or fosinopril 10, 20, or 40 mg once daily for 4 weeks. The study consisted of a 4‐week placebo lead‐in, 4 weeks' double‐blind treatment, and a 1‐week placebo washout period. Vital signs were determined biweekly before dosing, and blood pressures were measured every 1 to 2 h during two 27‐h periods at the beginning and end of treatment. After the first and last doses of all three regimens, the peak effect on blood pressure occurred 5 to 7 h after all three dosages. Neither peak nor trough blood pressure changes showed a clear dose‐response relationship. Trough to peak ratios for the first dose, corrected for placebo effects, were 79% for fosinopril 10 mg, 48% for fosinopril 20 mg, and 74% for fosinopril 40 mg, and the trough‐to‐peak ratios for the last dose were 41% for fosinopril 10 mg, 32% for fosinopril 20 mg, and 44% for fosinopril 40 mg. In the 38 responders among the 48 patients receiving fosinopril (supine DBP decrease of at least 5 mmHg at 24 h postdose), trough‐to‐peak rations ranged from 50 to 81%, and the range indicates that fosinopril is efficacious when administered once daily. Adverse effects were mild to moderate, and no patient discontinued treatment. Changes in the laboratory test results, electrocardiograms, or the results of physical examinations were unremarkable. Once‐daily fosinopril 10, 20, or 40 mg effectively and safely controlled blood pressure in patients with mild to moderate essential hypertension.
The clinical distinction between regional postinfarction pericarditis and other causes of postinfarction chest pain: Ancillary observations regarding the effect of lytic therapy upon the frequency of postinfarction pericarditis, postinfarction angina, and reinfarction
Authors: Oliva Philip B. , Hammill Stephen C. 
Published: August 2009

AbstractRecently two types of atypical T‐wave evolution were recognized as electrocardiographic (ECG) markers of regional postinfarction pericarditis. The sensitivity and specificity of these of these changes for this condition were 100 and 77%, respectively. The major purpose of this investigation is to show how these ECG changes can be used to differentiate among postinfarction pericarditis, postinfarction angina, and reinfarction. Even appropriately constructed serial monitor lead ECGs can be used to make this distinction. The ease of correctly distinguishing among the three causes of postinfarction chest pain utilizing a carefully elicited history and ECG criteria is discussed. In addition, a secondary objective was to assess the effect of lytic therapy on the incidence of postinfarction pericarditis. Among the 200 patients in this study, lytic therapy halved the incidence of postinfarction pericarditis, which is in accord with the larger Gruppo Italiano per lo Studio della Streptochinasi nell'Infarto Miocardico (GISSI) study.
Pharmacologic treatment of congestive heart failure
Authors: Carson Peter 
Published: August 2009

AbstractCongestive heart failure is a clinical syndrome producing symptomatic deterioration, functional impairment, and shortened life span. The syndrome is complex in that it includes both peripheral and cardiac effects which contribute to the progression of heart failure. In the periphery, elevations in thesympathetic nervous system and renin‐angiotensin system increase afterload and contribute to further salt and water retention. The central cardiac abnormalities include remodeling of the heart and downregulation of beta receptors. Traditional heart failure therapy has included treatment of fluid retention with diuretics, although their effect on mortality has never been addressed. The most proven therapy in heart failure is treatment with vasodilators, particularly angiotensin‐converting enzyme (ACE) inhibitors. Improved survival with ACE‐inhibitor therapy has been demonstrated in patients with severe heart failure (CONSENSUS), mild to moderate heart failure (SOLVD), and in comparison with vasodilator therapy with hydralazine isosorbide dinitrate (VHeFT II). Improved survival has also been noted in postmyocardial infarction when the ejection fraction is decreased (SAVE). The ACE inhibitors have now become standard therapy for heart failure regardless of severity. Additive vasodilator therapy with calcium‐channel antagonists is under investigation. Inotropic therapy is controversial at present because of disappointing mortality results. The clinical mainstay digitalis remains without convincing mortality reduction data. Other inotropic agents, particularly phosphodiesterase inhibitors, have shown uniformly negative survival results. However, the new mixed action agents vesnarinone and pimobenden have shown favorable data, with vesnarinone demonstrating a mortality reduction effect. Beta‐blocker therapy in heart failure has also found renewed interest, particularly with the new agents carvedolol and bucindolol which also have vasodilating properties.
Evaluation of left ventricular diastolic function from the pattern of left ventricular filling
Authors: Little William C. , Warner James G. , Rankin Kevin M. , Kitzman Dalane W. , Cheng Che‐Ping 
Published: August 2009

AbstractThe pattern of left ventricular (LV) filling can be determined by Doppler echocardiography. Normally most LV filling occurs early in diastole, with some additional filling occurring during atrial systole, late in diastole. In the absence of mitral stenosis, three patterns of LV filling indicate progressively greater diastolic dysfunction: (1) Reduced early diastolic filling with a compensatory increase in importance of atrial filling, termed a pattern of “impaired relaxation;” (2) “pseudo‐normalization” with most filling early in diastole but with rapid deceleration of mitral flow; and (3) “restricted filling” with almost all filling of the LV occurring very early in diastole in association with very rapid deceleration of mitral flow. A large, prolonged atrial regurgitant flow in the pulmonary veins also indicates impaired diastolic performance. The time for early filling deceleration is predominantly determined by LV stiffness: the shorter the deceleration time, the stiffer the LV. Patients with short deceleration time have a poor prognosis.
Angioplasty decreases prolonged QT dispersion in patients with angina pectoris but not in patients with prior myocardial infarction
Authors: Takase Bonpei , Tujimoto Tetuya , Hamabe Akira , Satomura Kimio , Ohsuzu Fumitaka , Kurita Akira , Kitamura Katuhiro , Uehata Akimi , Kazusige Isojima 
Published: August 2009

AbstractBackground and hypothesis: Prolonged QT dispersion (QTd) is shortened by successful percutaneous transluminal coronary angioplasty (PTCA) in patients with ischemic heart disease. Particularly, QTd plays an important role in the prognostication in patients with prior myocardial infarction (MI). However, whether the effect of PTCA on QTd differs in patients with and without prior MI is not clear, and this study sought to clarify this question.Methods: In 41 consecutive patients with ischemic heart disease, we measured QTd from a routine 12‐lead electrocardiogram taken at 72 h before and after successful PTCA. Patients were divided into two groups based on the presence or absence of prior MI: Group 1 consisted of 24 patients with angina (61 ± 11 years old) without prior MI and Group 2 was comprised of 17 patients (69 ± 10 years old) with prior MI. QTd was calculated as the difference between the maximum and minimum QT and QT corrected for heart rate (QTc), using Bazett's formula for calculating QTcd. All measurements were obtained manually and blindly.Results: In Group 1,15 of 24 patients (63%) demonstrated multivessel disease and 16 of 24 (67%) patients had high QTd > 60 ms. Percutaneous transluminal coronary angioplasty decreased QTd and QTcd in Group 1 (QTd, from 83 ± 35 to 57 ± 19 ms, p < 0.05; QTcd, from 89 ± 37 to 63 ± 33 ms, p < 0.05), whereas no changes were observed in Group 2 (QTd, from 73 ± 25 to 69 ± 22 ms, NS; QTcd, from 80 ± 30 to 79 ± 28 ms, NS). QTd is more sensitive to decrease by successful PTCA in patients with angina than in patients with prior MI.Conclusions: The effect of successful PTCA on inhomogeneity of ventricular repolarization reflected by QTd in patients with prior MI is different from that in patients without prior MI.
Clinical characteristics of acute pulmonary thromboembolism in Japan: Results of a multicenter registry in the japanese society of pulmonary embolism research
Authors: Nakamura Mashio , Fujioka Hirofumi , Yamada Norikazu , Nakano Takeshi , Sakuma Masahito , Okada Osamu , Kuriyama Takayuki , Nakanishi Norifumi , Miyahara Yoshiyuki , Kunieda Takeyoshi , Sugimoto Tsuneaki 
Published: August 2009

AbstractBackground: Although the incidence of acute pulmonary thromboembolism (APTE) has been increasing in Japan, patient characteristics, management strategies, and outcome have not yet been assessed in large series.Hypothesis: The present study was designed to investigate the current status of APTE in Japan.Methods: Of a total of 533 registry patients with pulmonary thromboembolism, 309 with APTE were analyzed with respect to clinical symptoms and signs, predisposing factors, diagnostic procedures, estimation of deep venous thrombosis, treatment, and clinical course.Results: Main risk factors were recent major surgery, cancer, prolonged immobilization, and obesity; only a few patients had coagulopathy and 36% were in cardiogenic shock at presentation. The majority of registry patients underwent lung scans or pulmonary angiography; 30% were diagnosed only by lung scanning. Venous ultrasonography was used in only 34 patients, while 188 patients underwent at least one diagnostic procedure for deep venous thrombosis. Thrombolysis was more frequently performed in patients with cardiogenic shock, and only a few patients received thromboembolectomy. In‐hospital mortality rate was 14%. In patients with cardiogenic shock, the mortality rate was reduced by thrombolysis. The predictors of in‐hospital mortality were male gender, cardiogenic shock, cancer, and prolonged immobilization.Conclusions: The patients in this registry had almost the same findings as those in Western patients, except for some points that had the possibility of demonstrating a difference between Westerners and Japanese in the development of APTE. These results can prove especially helpful in planning prospective, randomized trials that will clarify the impact of widely used treatment modalities on the outcome of patients with APTE.
Native aortic valve tissue systemic embolization complicating bacterial endocarditis
Authors: Garg Mukesh , Quick Annette , Depond William , Schroder William , Chowdhry Shaheen , Spertus John 
Published: August 2009

AbstractSystemic embolic events are known complications of bacterial endocarditis. Embolization of prosthetic valves has previously been reported in the literature. We report a case of embolization of native aortic valve tissue to the popliteal artery as the presenting event in a patient with subacute bacterial endocarditis. To our knowledge, this rare complication has not been previously reported.
Optimization of Thienopyrrole‐Based Finger‐Loop Inhibitors of the Hepatitis C Virus NS5B Polymerase
Authors: Martin Hernando Jose Ignacio , Ontoria Jesus Maria , Malancona Savina , Attenni Barbara , Fiore Fabrizio , Bonelli Fabio , Koch Uwe , Di Marco Stefania , Colarusso Stefania , Ponzi Simona , Gennari Nadia , Vignetti Sue Ellen , del Rosario Rico Ferreira Maria , Habermann Jörg , Rowley Michael , Narjes Frank 
Published: August 2009

AbstractInfections caused by the hepatitis C virus (HCV) are a significant world health problem for which novel therapies are in urgent demand. The NS5B polymerase of HCV is responsible for the replication of viral RNA and has been a prime target in the search for novel treatment options. We had discovered allosteric finger‐loop inhibitors based on a thieno[3,2‐b]pyrrole scaffold as an alternative to the related indole inhibitors. Optimization of the thienopyrrole series led to several N‐acetamides with submicromolar potency in the cell‐based replicon assay, but they lacked oral bioavailability in rats. By linking the N4‐position to the ortho‐position of the C5‐aryl group, we were able to identify the tetracyclic thienopyrrole 40, which displayed a favorable pharmacokinetic profile in rats and dogs and is equipotent with recently disclosed finger‐loop inhibitors based on an indole scaffold.