bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ergometric evaluation of the effects of enalapril maleate in normotensive patients with stable angina
Authors: Portaluppi F. , Cocco G. , Urso L. 
Published: July 2009

AbstractThe anti‐ischemic effect of a single oral dose of 10 mg of enalapril maleate (E) was investigated in 14 normotensive patients with coronary artery disease (CAD) and stable effort‐induced angina pectoris. An exercise stress test was performed three times in each patient at the same clock hour on three successive days: with no treatment (baseline), 6 h after administration of placebo (P), and 6 h after oral administration of a single 10 mg dose of E. The multistage nonstop effort tests were performed in the sitting position. Workload started at 25 W and was increased by 25 W every 2 min until an ischemic ST depression of more than 1.5 mm was observed. The following parameters were measured: heart rate (HR), systolic blood pressure (BP), rate‐pressure product (RPP), workload sustained (WS), elapsed time of effort (ET), and millimeters of ischemic ST depression. The values of the parameters observed with baseline, P, and E were compared at the moment of appearance of chest pain or ischemic ST depression, at the moment of maximal effort, maximal common WS (MCWS), and maximal common RPP (MCRPP). Enalapril delayed the appearance of the ischemic ST depression. At the MCWS, the RPP was significantly lower under E and the ST depression was less marked; this effect was the result of a lower BP level, in the absence of any significant change in HR response. The acute effects of E observed in normotensive patients with effort‐induced angina pectoris seems to be related to the inhibition of angiotensin at the coronary level and to its antiadrenergic action.
Cardiovascular effects of berberine in patients with severe congestive heart failure
Authors: Marin ‐ NETO J. A. , Maciel B. C. , Secches A. L. , Gallo L. 
Published: July 2009

AbstractBerberine, an alkaloid of the protoberberine family, has been shown to have strong positive inotropic and peripheral resistance‐lowering effects in dogs with and without heart failure. To determine the acute cardiovascular effects of berberine in humans, 12 patients with refractory congestive heart failure were studied before and during berberine intravenous infusion at rates of 0.02 and 0.2 mg/kg per min for 30 minutes. The lower infusion dose produced no significant circulatory changes, apart from a reduction in heart rate (14%). The 0.2 mg/kg per min dose elicited several significant changes: (a) Decreases in systemic (48%, p>0.01) and pulmonary vascular resistance (41%, p>0.01), and in right atrium (28%, p>0.05) and left ventricular end‐diastolic pressures (32%, p>0.01). (b) Increases in cardiac index (45%, p>0.01), stroke index (45%, p>0.01), and LV ejection fraction measured by contrast angiography (56%, p>0.01). (c) Increases in hemodynamic and echocardiographic indices of LV performance: peak measured velocity of shorten: ing (45%, p>0.01), peak shortening velocity at zero load (41%, p>0.01), rate of development of pressure at developed isovolumic pressure of 40 mmHg (20%, p>0.01), percent fractional shortening (50%, p>0.01), and the mean velocity of circumferential fiber shortening (54%, p>0.01). (d) Decrease of arteriovenous oxygen difference (28%, p>0.05) with no changes in total body oxygen uptake, arterial oxygen tension, or hemoglobin dissociation properties. These salutary acute effects show that berberine markedly improved cardiac performance in patients with heart failure refractory to conventional medical therapy with digitalis and diuretics. The improvement is probably subsequent to peripheral vasodilatation and to inotropic stimulation. Significant untoward effects appear to be the development of ventricular tachycardia with “torsades de pointes” morphology, detected in 4 patients 1‐20 h after the infusion of berberine. This possible association requires further elucidation before the administration of berberine may be extended to other patients in heart failure.
Pathophysiological aspects of predominant preload lowering on pulmonary circulation, gas exchange, and the biventricular function in patients with chronic obstructive lung disease
Authors: Seibold H. , Bunjes D. , Schmidt A. , Hombach V. 
Published: July 2009

AbstractA group of 21 patients with various degrees of chronic obstructive pulmonary disease underwent radionuclide ventriculography with hemodynamic monitoring to assess the extent to which pulmonary artery pressures and pulmonary vascular resistance can be lowered by the vasodilator molsidomine. Molsidomine (N‐carboxy‐3‐morpholino‐sydnonimin‐ethylester) is similar to nitroglycerin in its mode of action. After hemodynamic and radionuclide data acquisition, at rest and during sub‐maximal exercise in the steady state, 2 mg molsidomine was injected intravenously. Rest and exercise measurements were repeated 45 min after molsidomine injection. in patients with mild to moderate disease (group 1), pulmonary artery resting pressures decreased by 12% (p<0.05) at rest and by 22% (p<0.01) during exercise after the administration of the drug. Total pulmonary resistance during exercise decreased significantly (p <0.01) as a result of a marked decrease of pulmonary artery pressure (PAP) compared with a minimal decrease in cardiac index (CI). in patients with severe disease (group 2), only the resting values of PAP decreased while the relationship between pressure and flow was unchanged. During the exercise period, the preload parameters of the right and left ventricles decreased by an average of 30%. With regard to gas exchange, only the arterial PO2 at rest decreased slightly but significantly (p<0.05) after molsidomine, while the coefficient of oxygen delivery was not affected by the drug. However, in four patients arterial PO2 was markedly reduced by the drug. Right ventricular ejection fraction increased significantly (p<0.01) both at rest and during exercise in group 1 and during exercise in group 2 after administration of molsidomine. The left ventricular ejection fraction increased at rest (p<0.05) and during exercise (p<0.01) only in group 1. in conclusion, our results show that only a few patients with advanced lung disease and hypoxia benefit from this vasodilator with predominant preload lowering effect. The lowering of total pulmonary vascular resistance in the exercise state and the marked lowering of preload and afterload of the right ventricle in patients with mild to moderate lung disease after administration of molsidomine might be relevant to patients during surgical stress. in these patients, the net effect of the drug may be beneficial despite a slight reduction of cardiac output in most patients.
Pericardial effusion early in acute myocardial infarction
Authors: Charlap S. , Greenberg S. , Greengart A. , Budzilowicz L. , Gelbfish J. , Hollander G. , Shani J. , Lichstein E. 
Published: July 2009

AbstractThe incidence and significance of pericardial effusions early in acute myocardial infarction remain unclear. Using two‐dimensional echocardiography, 172 patients with an acute myocardial infarction were evaluated within 72 h of presentation. Thirty patients (17%) had a pericardial effusion (29 small, 1 moderate) while 142 (83%) did not. No patient developed cardiac tamponade or required pericardiocentesis. Patients with pericardial effusions had higher peak creatine kinase as compared to patients without effusions (2036 ± 1466 vs. 1483 ± 1241, p>0.05) and a greater number of aneurysms (20% vs. 6%, p>0.05). In‐hospital mortality was higher in the patients with pericardial effusions (10% vs. 2%, p > 0.05). In conclusion, pericardial effusions are common in the early AMI period but are generally small and hemodynamically insignificant. They are associated with larger infarcts and greater mortality.
Awareness, treatment, and control of hypertension in the elderly in a general practice experience
Authors: Pirone F. , Radice M. , Avanzini F. , Alli C , Bettelli G. , Colombo F. , Conforti L. , Devoto M. A. , Di TULLIO M. , Marchioli R. , Mariotti G. , Spagnoli A. , Taioli E. , Tognoni G. , Villella M. , Zussino A. ,   and the participating physicians of the Study Group on Hypertension in the Elderly
Published: July 2009

AbstractIn 3858 ambulatory elderly people (age >65 years) prevalence of hypertension was 67.8%. The hypertensive status was unknown to both the doctor and the patient in 21.4 % of cases. More than 90 % of known hypertensives were treated, but hypertension could be considered as controlled in less than 30% of them.
Pathophysiology and management of unstable angina
Authors: Von Dohlen T. W. , Rogers W. B. , Frank M. J. 
Published: July 2009

AbstractSignificant progress has been made in recent years in unraveling the dynamic mechanisms involved in the production of unstable angina. This knowledge, and advances in medical and interventional therapy allow the formulation of treatment strategies aimed at specific pathogenic mechanisms and promise to reduce mortality and morbidity. This review covers the diagnosis, pathogenesis, risk stratification, and therapy of unstable angina.
Outpatient cardiac catheterizations: Analysis of patients requiring admission
Authors: Pink S. , Fiutowski L. , Gianelly R. E. 
Published: July 2009

AbstractThe purpose of this study was to review the results of the first 1,000 outpatient cardiac catheterizations performed at our hospital with special emphasis on patients who were hospitalized. Nearly all patients had percutaneous femoral artery catheterization using #8F catheters. There were no deaths. The major complications included two myocardial infarctions and four cerebral emboli. Surgery on the femoral artery was required in 2 patients (1 occlusion and 1 pseudoaneurysm), 7 patients developed unstable angina without subsequent infarction, and 4 patients had ventricular tachycardia or fibrillation. Complications requiring admission were found in 39 patients. Another 59 were admitted, 51 for revascularization procedures. Of the latter 51 patients, 27 had main left coronary stenosis of 50% of greater. We have found outpatient catheterization to be a safe procedure. Complications requiring admission occurred in 3.9% of the patients. The most common reason for admission was to perform urgent bypass surgery in patients with main left coronary stenosis in excess of 50%.
Leaflet entrapment causing acute severe aortic insufficiency during balloon aortic valvuloplasty
Authors: Treasure C. B. , Schoen F. J. , Treseler P. A. , Bittl J. A. 
Published: July 2009

AbstractCusp entrapment is a previously unreported mechanism of aortic insufficiency after balloon aortic valvuloplasty. In a patient who developed severe acute aortic insufficiency and expired after balloon aortic valvuloplasty, pathologic evaluation revealed a large, solitary, fractured, calcific nodule in the noncoronary cusp in which the malaligned, irregular fracture surfaces of the nodule had entrapped the leaflet in an open position. The ease with which the entrapped leaflet was reduced by manipulation on postmortem examination suggests that further manipulation of the cusp might restore valve competence in some cases when aortic insufficiency occurs after balloon valvuloplasty in calcific aortic stenosis.
Hypertrophic cardiomyopathy: Two‐dimensional echocardiographic score versus clinical and electrocardiographic findings
Authors: Melacini P. , Fasoli G. , Canciani B. , Buja G. , Mammola C. , Dalla Volta S. 
Published: July 2009

AbstractThe severity and site of hypertrophy is important in determining the clinical picture and the natural history of hypertrophic cardiomyopathy (HCM). We evaluated left ventricular hypertrophy by means of two‐dimensional echocardiographic score and score index, and correlated these findings with symptoms, electrovector‐cardiographic data, and ventricular arrhythmias. A total of 42 patients with HCM were studied by clinical examination, ECG, VCG, M‐mode and 2D echocardiography, and 24‐h Holter monitoring. The extent and severity of the hypertrophic process were calculated by a score system. The left ventricle was divided into 11 segments and a hypertrophic score (HS) was given to each segment. A hypertrophy score index (HSI) was also calculated by dividing the number of hypertrophied segments by 13. No correlation was found between symptoms and HS and HSI, nor ECG‐VCG abnormalities and HS and HSI. A statistically significant relationship between the severity of ventricular arrhythmias and HS and HSI was found (p<0.01). The mechanism responsible for ventricular tachyarrhythmias in severe and diffuse hypertrophy might reside in the high intraventricular pressures which produce or worsen areas of myocardial ischemia.
Current concepts of left ventricular pseudoaneurysm: Pathophysiology, therapy, and diagnostic imaging methods
Authors: March K. L. , Sawada S. G. , Tarver R. D. , Kesler K. A. , Armstrong W. F. 
Published: July 2009

AbstractLeft ventricular pseudoaneurysm represents a cardiac rupture which is temporarily confined by pericardium and is amenable to curative surgical treatment. The case described illustrates several atypical features of its presentation and diagnosis, highlighting the importance of maintaining a sufficient clinical index of suspicion for this relatively uncommon, but potentially lethal entity. The use of various diagnostic imaging methods is described, including the first description of magnetic resonance imaging of ventricular pseudoaneurysm. The prospect of medical therapies directed toward the prevention of cardiac rupture, and thus pseudoaneurysm, is discussed in the context of its pathophysiology which involves alterations in the cardiac fibroskeletal support.
Left ventricular diastolic function in normotensive adolescents with different genetic risk of hypertension
Authors: Alli C. , Avanzini F. , Ditullio M. , Mariotti G. , Salmoirago E. , Taioli E. , Radice M. 
Published: July 2009

AbstractAbnormalities of the diastolic function of the left ventricle are the first sign of cardiac involvement in arterial hypertension. We have studied the diastolic function in a group of normotensive adolescents with confirmed family history of hypertension. M‐mode echocardiography was performed in 86 normotensive males aged 14‐19 years: 41 sons of at least one hypertensive parent (SHT) and 45 sons of normotensive parents (SNT). Cross‐sectional area of the left ventricle and left ventricular (LV) mass index were significantly greater in the SHT than in the SNT group (10.05 ± 1.84 vs. 8.9 ± 1.56 cm/m2, p < 0.01 and 129.3 < 29.3 vs. 109.23 ± 25.7 g/m2, p < 0.002, respectively). No significant difference between the two groups was observed in the indices of left ventricular diastolic function, except for mitral valve opening rate (463.51 ± 90.45 in SHT vs. 416.71 ± 78.84 mm/s in SNT; p ± 0.02). From the analysis of the subgroup of adolescents having left ventricular mass greater than the upper normal value, we observed that they showed mean time of rapid filling significantly longer than SNT: this could represent an early marker of the pathological character of such hypertrophy. Our results suggest that the higher LV mass observed in the SHT is not associated with chamber and myocardial stiffness abnormalities.
Giant P wave in a patient with right ventricular cardiomyopathy
Authors: Martini B. , Nava A. , Buja G. F. , Canciani B. , Bigolin E. , Dalla Volta S. 
Published: July 2009

AbstractA P wave of 7.5 mm in lead I and 12.5 in V, was detected in a 28‐year‐old man, with a progressive cardiomegaly since the age of 14 years. At last admission he had minor symptoms, and a systolic murmur consistent with tricuspid regurgitation. The electrocardiogram showed an extremely tall P wave and a QRS of a very low amplitude; T waves were inverted on the precordial leads. These ECG features, and subsequent investigations, were consistent with right ventricular cardiomyopathy with massive tricuspid regurgitation, and right atrial abnormality.
Radionuclide assessment of left ventricular function during dobutamine infusion in patients with coronary artery disease: Comparison with ergometer exercise
Authors: Konishi T. , Koyama T. , Aoki T. , Yada T. , Futagami Y. , Nakano T. , Yamamuro M. , Watanabe K. 
Published: July 2009

AbstractThe effects of dobutamine on left ventricular function were assessed employing radionuclide ventriculography (RNV) in 7 normal subjects (Group 1) and 21 patients with coronary artery disease (Group 2). After routine bicycle ergometer exercise RNV, dobutamine infusion was started at 5 μg/kg/min and the dosage was increased by 5 μg/kg/min every 4 minutes to a total of 15 μg/kg/min. In Group 1, left ventricular ejection fraction (LVEF) increased by both ergometer exercise and dobutamine infusion. In Group 2, LVEF did not increase during exercise, but increased during dobutamine infusion without evidence of significant myocardial ischemia. Only 2 patients in Group 2 had new regional wall motion abnormality. Left ventricular end‐diastolic volume (LVEDV) in Group 2 increased from 191 ± 19 to 210 ± 18 ml during ergometer exercise, but decreased from 193 ± 18 to 153 ± 19 ml during dobutamine infusion. Short‐term low‐dose infusion of dobutamine may be used in patients without evidence of significant myocardial ischemia, but probably cannot be substituted for exercise testing in patients with mild to moderate coronary artery disease.
Clinical approach to paroxysmal atrial fibrillation
Authors: Coumel P. 
Published: July 2009

AbstractIn addition to the role of the electrophysiological substrate, paroxysmal atrial fibrillation depends on the modulation of the atrial tissues by the autonomic nervous system. Experimentally, models of atrial fibrillation can be based on either adrenergic or vagal stimulations that provoke the arrhythmia by disturbing in a different way conduction and refractory periods of the atrium. Clinically, the role of the autonomic nervous system can be suspected from the clinical history, and paroxysmal attacks can typically be observed either at daytime or at night, at exercise or at rest. Careful attention should be paid to the changes of heart rate that occur in the minutes or tens of minutes prior to the attacks, and the trend of acceleration or slowing of cardiac frequency observed in Holter tracings provides reliable indications of the state of the vago‐sympathetic balance in these patients. During the attacks, the electrocardiographic aspect of atrial flutter alternating with a pattern of atrial fibrillation is typical of vagally dependent arrhythmias, whereas atrial tachycardia is more frequently observed at the onset of adrenergic atrial fibrillation. When the paroxysmal forms of arrhythmia are resistant to usual pure antiarrhythmic therapy including type IA agents and flecainide or en‐cainide, one should take into account the role of the autonomic nervous system. Propafenone, or beta‐blockers combined with type I drugs, are very effective every time an adrenergic factor is involved, but prevent the beneficial role of other agents if a vagal mechanism is predominant. Amiodarone, a complex drug with multiple facets, can be active in many different situations but its use should be reserved to definitely resistant cases, in combination with other agents, in order to limit its potential long‐term side effects. Digitalis and verapamil mainly address the tolerance to arrhythmias, rather than their prevention.
Diurnal change of giant negative T wave in patients with hypertrophic cardiomyopathy
Authors: Iida K. , Sugishita Y. , Yukisada K. , Ito I. 
Published: July 2009

AbstractTo examine the diurnal change of negative T wave (deeper than 10 mm in precordial leads) in apical hypertrophic cardiomyopathy and the mechanism of giant negative T wave, 24‐h ambulatory electrocardiographic monitoring was performed in 8 patients with apical hypertrophic cardiomyopathy, and effect of atropine on electrocardiogram was studied. The mean depth of negative T wave at 1, 2, and 3 P. M. was 9.3±3.0 mm, and that at 1, 2, and 3 A. M. was 12.6 ± 4.8 mm. The mean R‐R interval at 1, 2, and 3 P. M. was 792 ± 113 ms and that at 1, 2, and 3 A. M. was 1055 ± 94 ms. In seven patients (88%), negative T wave was deeper during the night than during the daytime. There was a positive correlation between R‐R interval and depth of negative T wave in 6 patients (75%). Despite significant shortening of R‐R interval (879 ± 116 to 804 ± 110 ms, p < 0.05), atropine did not significantly change the depth of negative T wave (14 ± 5 to 14 ± 5 mm). In conclusion, negative T wave is not fixed, but is variable, diumally, probably due to the change of sympathetic tone.
Electrophysiologic effects of bepridil in patients with refractory ventricular tachycardia assessed by programmed electrical stimulation
Authors: Schmitt C. , Brachmannm J. , Hölzel C. , Waldecker B. , Schöls W. , Beyer T. , Kübler W. 
Published: July 2009

AbstractThe effect of intravenous bepridil, a new calcium antagonist with class I and III properties, was tested in 21 patients with sustained ventricular tachyarrhythmias refractory to a mean of five antiarrhythmic agents as assessed by programmed right ventricular stimulation. At control electrophysiologic study without antiarrhythmic agents, sustained monomorphic ventricular tachycardia (VT) was initiated in 20 patients and ventricular fibrillation (VF) was initiated in one patient. After 3 mg/kg of bepridil was administered, VT was still inducible in 19 patients (3 patients had self‐terminating VT); the other 2 patients had no inducible VT after bepridil. Bepridil prolonged significantly the QTc interval, the effective refractory period, and the cycle length of induced ventricular tachycardia. Two patients with no inducible VT after intravenous bepridil were placed on oral bepridil (300 mg/day). One patient died suddenly and one patient died of progressive heart failure. The results seem to indicate that the efficacy of bepridil in patients with refractory ventricular tachycardia is limited.
On the segmentation of vascular geometries from medical images
Authors: Radaelli A. G. , Peiró J. 
Published: July 2009

AbstractA comprehensive analysis of vascular morphology and the application of generic models of vascular biomechanics to specific patients require the ability of extracting a geometrical representation of the vascular anatomy from medical images. Owing to the wide range of clinical manifestations of vascular disease and associated imaging modalities and protocols, several segmentation methods have been proposed over the last 20 years and are available in the literature. In this paper, we review the methods of segmentation of angiographic medical images and identify major advantages and disadvantages of state‐of‐the‐art techniques. We further discuss the performance of some of the most popular intensity‐based and gradient‐based methods using a set of images of peripheral by‐pass grafts acquired with magnetic resonance angiography (MRA). We then propose a threshold front method for the segmentation of MRA images and assess its performance using two anatomic scale replica models, reproducing a normal and a stenotic peripheral artery. The threshold front algorithm is a simple, fast and parameter‐free (still adaptive) method achieving segmentation errors below pixel resolution. Copyright © 2009 John Wiley & Sons, Ltd.
An optimizing finite difference scheme based on proper orthogonal decomposition for CVD equations
Authors: Du Juan , Zhu Jiang , Luo Zhendong , Navon I. M. 
Published: July 2009

AbstractIn this article, an optimizing reduced finite difference scheme (FDS) based on singular value decomposition (SVD) and proper orthogonal decomposition (POD) for the chemical vapor deposit (CVD) equations is presented. And the error estimates between the usual finite difference solution and the reduced POD solution of optimizing FDS are derived. At last, some examples of numerical simulation are given to demonstrate the consistency of the numerical and theoretical results. It is shown that the optimizing reduced FDS based on POD method is of great feasibility and efficiency. Copyright © 2009 John Wiley & Sons, Ltd.