bluuebunny/crossref_metadata_2025_split huggingface dataset:
Spontaneous coronary artery dissection
Authors: Almeda Francis Q. , Barkatullah Sameer , Kavinsky Clifford J. 
Published: June 2007

AbstractSpontaneous coronary artery dissection (SCAD) is an unusual cause of acute myocardial ischemia with complex pathophysiology. This paper reviews the major diagnostic and therapeutic issues of this rare but important disease. The diagnosis of SCAD should be strongly considered in any patient who presents with symptoms suggestive of acute myocardial ischemia, particularly in young subjects without traditional risk factors for coronary artery disease (especially in young women during the peripartum period or in association with oral contraceptive use). Urgent coronary angiography is indicated to establish the diagnosis and to determine the appropriate therapeutic approach. The decision to pursue medical management, percutaneous coronary intervention, or surgical revascularization is based primarily on the clinical presentation, extent of dissection, and amount of ischemic myocardium at risk.
A systolic murmur is a common presentation of aortic regurgitation detected by echocardiography
Authors: Heidenreich Paul A. , Schnittger Ingela , Hancock Stsven L. , Atwood J. Edwin 
Published: June 2007

AbstractBackground: The finding of aortic regurgitation at a classical examination is a diastolic murmur.Hypothesis: Aortic regurgitation is more likely to be associated with a systolic than with a diastolic murmur during routine screening by a noncardiologist physician.Methods: In all, 243 asymptomatic patients (mean age 42 ±10 years) with no known cardiac disease but at risk for aortic valve disease due to prior mediastinal irradiation (≥ 35 Gy) underwent auscultation by a noncardiologist followed by echocardiography. A systolic murmur was considered benign if it was grade ≤ II/VI, not holosystolic, was not heard at the apex, did not radiate to the carotids, and was not associated with a diastolic murmur.Results: Of the patients included, 122 (49%) were male, and 86 (35%) had aortic regurgitation, which was trace in 20 (8%), mild in 52 (21%), and moderate in 14 (6%). A systolic murmur was common in patients with aortic regurgitation, occurring in 12 (86%) with moderate, 26 (50%) with mild, 6 (30%) with trace, and 27 (17%) with no aortic regurgitation (p < 0.0001). The systolic murmurs were classified as benign in 21 (78%) patients with mild and 8 (67%) with moderate aortic regurgitation. Diastolic murmurs were rare, occurring in two (14%) with moderate, two (4%) with mild, and three (2%) with no aortic regurgitation (p = 0.15).Conclusions: An isolated systolic murmur is a common auscultatory finding by a noncardiologist in patients with moderate or milder aortic regurgitation. A systolic murmur in patients at risk for aortic valve disease should prompt a more thorough physical examination for aortic regurgitation.
Interleukin‐1 receptor antagonist levels correlate with extent of myocardial loss in patients with acute myocardial infarction
Authors: Patti Giuseppe , Mega Simona , Pasceri Vincenzo , Nusca Annunziata , Giorgi Gabriele , Zardi Enrico Maria , D'Ambrosio Andrea , Dobrina Aldo , Di Sciascio Germano 
Published: June 2007

AbstractBackground: Interleukin‐1 receptor antagonist (IL‐1 Ra) levels are elevated early in patients with acute myocardial infarction (MI) and often precede release of markers of necrosis; however, IL‐1Ra levels did not correlate previously with infarct size and prognosis in such patients.Hypothesis: The goal of our study was to evaluate prospectively the correlation between IL‐1Ra levels upon emergency department (ED) presentation and the extent of myocardial necrosis and prognosis in patients with ST‐segment elevation MI.Methods: Levels of IL‐1Ra were measured upon ED presentation in 44 consecutive patients (40 men, aged 55 ± 10 years). Peak values of creatine kinase (CK) and CK‐MB were determined during hospitalization, and left ventricular ejection fraction (LVEF) was evaluated by echocardiography before discharge. All patients were followed prospectively and underwent clinical and echocardiographic assessment at 42 ± 3 months after the infarction.Results: Levels of IL‐1Ra upon ED presentation correlated directly with CK (p = 0.002) and CK‐MB (p = 0.01) peak levels and correlated inversely with LVEF before discharge (p = 0.009). Patients with in‐hospital adverse events had significantly higher IL‐1Ra levels upon ED admission (n = 10,2620 ± 4706 pg/ml) than those without events (n = 34, 598 ± 457 pg/ml)(p = 0.015).Conclusions: In patients with MI, levels of IL‐1Ra upon ED presentation correlated significantly with the extent of myocardial necrosis, as measured by cardiac enzymes peak and reduction of LVEF, and are predictive of in‐hospital events. Results of this study may influence early therapeutic approach in patients with acute MI.
Study on changes of heme oxygenase‐1 expression in patients with coronary heart disease
Authors: Chen S. M. , Li Y. G. , Wang D. M. 
Published: June 2007

AbstractBackground: Heme oxygenase (HO) is a rate‐limiting enzyme of endogenetic carbon monoxide (CO) that degrades heme into carbon monoxide, bilirubin, and iron. These products have important physiologic effects: bilirubin is a potent antioxidant that can act against ischemia/reperfusion injury; there is a negative correlation between the content of HO‐1 and the incidence of coronary heart disease (CHD).Hypothesis: This study was undertaken to investigate the changes of HO‐1 in patients with CHD.Methods: Thirty‐five patients with acute myocardial infarction (AMI), 40 patients with unstable angina pectoris (UAP, diagnosed by coronary angiography), and 30 patients with stable angina pectoris (AP, diagnosed by coronary angiography) were selected for the study; another 30 patients with normal coronary artery (diagnosed by coronary angiography) were selected as controls. The levels of HO‐1 protein expression in monocyte and lymphocyte in the subjects were tested by immunohistochemistry and western blot. Computer picture analyzing systems were also used to measure the levels of HO‐1 protein expression.Results: Heme oxygenase‐1 protein is located in cell plasma. The levels of HO‐1 protein expression in patients with CHD were significantly higher than in those without CHD (p<0.01). There were significant differences of HO‐1 expression among the three groups of patients with CHD. The group with AMI was the highest, followed by the group with UAP and finally by the group with AP.Conclusions: There is a higher expression of HO‐1 in patients with CHD. The levels of HO‐1 protein are associated with the severity of CHD.
Long‐term efficacy and stability of atrial sensing in VDD pacing
Authors: Huang Chun‐Yao , Tuan Ta‐Chuan , Lee Wen‐Shin , Cheng Chien‐Ming , Lin Shing‐Jong , Kong Chi‐Woon 
Published: June 2007

AbstractBackground: The efficacy and stability of atrial electrode sensing function is essential in maintaining atrioventricular (AV) synchrony and activity response in VDD pacing. Studies to evaluate the relationship between atrial sensing efficacy, stability, and implantation strategy are few.Hypothesis: This study sought to determine the possible predictors, among the recipients' underlying clinical conditions and the implantation strategies used, of achieving the most stable and effective atrial sensing.Methods: Eighty consecutive adults implanted with VDD pacemakers were studied retrospectively. Atrial electrodes were positioned where the optimal atrial potentials (APs) were measured during implantation. Interrogation parameters, including AV‐synchrony ratio, were acquired immediately post implantation, at 1 year, and at 2 years after pacemaker implantation. Appropriate atrial sensing efficacy was defined as AV‐synchrony ratio ≥ 90%. The stability of atrial sensing was evaluated by the variation ranges of measured APs.Results: The measured APs showed no statistical difference when age, gender, orcomorbidity was considered. However, with pacing‐lead bending angles ≤ 90°, patients may have presented with larger APs and narrower AP variation than patients with obtuse angles. There were no clinical parameters in our study that could have predicted the proper atrial sensing efficacy with an AV‐synchrony ratio ≥ 90%.Conclusions: The long‐term sensing efficacy and stability of VDD pacing is reliable. More sophisticated implantation strategies may further improve the atrial sensing stability and efficacy in VDD pacing.
Global differences in blood pressure control and clinical outcomes in the INternational VErapamil SR‐Trandolapril Study (INVEST)
Authors: Zineh Issam , Cooper‐Dehoff Rhonda M. , Wessel Timothy R. , Arant Christopher B. , Sleight Peter , Geiser Edward A. , Pepine Carl J. 
Published: June 2007

AbstractBackground: The INternational VErapamil SR‐Trandolapril Study (INVEST), a prospective, randomized, antihypertensive trial, found that two different medication regimens produced similar blood pressure (BP) control with equivalent cardiovascular (CV) outcomes (death from any cause, nonfatal myocardial infarction [MI], or nonfatal stroke).Hypothesis: The study was undertaken to investigate whether differences exist by global regions in demographics, treatment, and outcomes in the INVEST trial.Methods: Data were analyzed for 22,576 patients with stable coronary artery disease (CAD) enrolled in INVEST. We investigated differences in patient characteristics, treatment approaches, BP control, and clinical outcomes by creating three global regions based on geographical location: Northern Americas (NA), Caribbean (CA), and Eurasia (EA).Results: We observed significant regional differences in patient characteristics, treatment patterns, BP control, and CV outcomes. At baseline, patients from NA were older and had greater body mass index, higher rates of diabetes, peripheral vascular disease, and coronary revascularization, but lower rates of MI or left ventricular hypertrophy than patients in CA and EA. At 24 months, there were regional differences in both study and nonstudy antihypertensive drug use. Despite having higher mean baseline BP, patients from CA and EA achieved lower mean systolic BP throughout study follow‐up. Furthermore, patients from both CA and EA had lower rates of all‐cause mortality, fatal or nonfatal MI, fatal or nonfatal stroke, and newly diagnosed diabetes than patients from NA.Conclusions: In INVEST, regional differences in medication utilization, BP control, and CV outcomes were identified. These disparities warrant further investigation to define appropriate care for patients with hypertension and stable CAD from an international public health perspective.
Adjunctive handgrip during dobutamine stress echocardiography: Invasive assessment of myocardial oxygen consumption in humans
Authors: Khan Ijaz A. , Otero F. Javier , Font‐Cordoba Jose , McCulloch Marti , Sheahan Richard G. , Parmar Rohit , Defilippi Christopher R. 
Published: June 2007

AbstractBackground: Adjunctive isometric exercise in the form of sustained submaximal handgrip (HG) is considered to increase the sensitivity of dobutamine stress echo (DSE) for detection of functionally significant coronary artery disease.Hypothesis: The study was undertaken to quantify invasive‐ly the impact of HG in humans on hemodynamics and myocardial oxygen consumption (MVO2) during DSE.Methods: An invasive hemodynamic evaluation was performed during DSE and with addition of adjunctive HG in 11 subjects. Coronary sinus (CS) blood flow, right‐sided and systemic pressures, oxygen saturations, and transthoracic two‐dimensional echocardiography were obtained at each 3‐min stage and after adding HG at peak DSE. Myocardial oxygen consumption was calculated by the Fick method and circumferential end‐systolic wall stress (ESWS) by Mirsk's formula.Results: At peak DSE, heart rate, left ventricular ejection fraction, CS flow, and MVO2 increased, whereas pulmonary capillary wedge pressure (PCWP) and circumferential end‐systolic wall stress (ESWS) decreased from baseline. Compared with peak DSE, the addition of isometric HG at peak DSE caused an increase in PCWP (7 ± 3 vs. 8.4 ± 3 mmHg, p < 0.05), ESWS (112 ± 25 × 103 vs. 125 ± 32 × 103 dyne·s·cm2, p = 0.02), and CS flow (260 ± 92 vs. 301 ± 105 ml/min, p < 0.05). There was a minimal increase in left ventricular volumes, heart rate, and systolic blood pressure. The MVO2 increased from 29 ± 8 ml/min at peak DSE to 31 ± 9 ml/min with adjunctive HG (p = 0.03).Conclusion: Handgrip adjunctive to peak DSE results in a modest increase in MVO2, primarily by an increase in end‐systolic wall stress.
Prevalence of amiodarone‐related hepatotoxicity in 720 Chinese patients with or without baseline liver dysfunction
Authors: Kum Leo C. C. , Chan Winnie W. L. , Hui Helen H. Y. , Wong Grace W. M. , Ho Susan S. S. , Sanderson John E. , Yu Cheuk‐Man , Fung Jeffery W. H. 
Published: June 2007

AbstractBackground: The prevalence of hepatotoxicity after longterm oral amiodarone therapy in Chinese patients with or without elevated liver enzymes at baseline is unknown.Hypothesis: Amiodarone may still be safely prescribed for Chinese patients who have baseline liver dysfunction.Methods: This is a retrospective cross‐sectional study. Significant liver dysfunction (SLD) was defined as alanine aminotransferase (ALT) > 2 times upper limit of normal range.Results: Baseline liver function was checked in 628 of the 720 Chinese patients identified. The mean duration of amiodarone use was 615.9 ± 703.1 days. Ninety patients (14.3%) had elevated baseline ALT. The prevalence of SLD was 3.7% (confidence interval [CI] 2.1–5.3%) and 4.4% (CI 0.2–8.6%) in patients with normal (n = 53 8) and elevated (n = 90) baseline ALT, respectively (p = 0.765). Therapy was continued in 42 patients with elevated baseline ALT until final follow‐up. Eight of these (19.0%) had elevated ALT upon final follow‐up, but the derangement was mild (mean ALT 134.8 ± 145.9 IU/l, median 76 IU/l). During follow up, 24 patients developed SLD and half of these subsequently withdrew from therapy. The ALT levels at final follow‐up had improved overtime in both groups, but the mean difference was not significant (255.1 ± 706.4 vs. 131.0 ±207.5 IU/l, p = 0.312).Conclusion: The prevalence of SLD in Chinese patients taking oral amiodarone with or without elevated baseline ALT was similar (4.4 vs. 3.7%). It seems that amiodarone may be safely prescribed in patients with elevated baseline ALT.
Association between Pro12Ala polymorphism of peroxisome proliferator‐activated receptor‐gamma 2 and myocardial infarction in the Chinese Han population
Authors: Li Lin , Cheng Long‐Xian , Nsenga Ripen , He Mei‐An , Wu Tang‐Chun 
Published: June 2007

AbstractBackground: Peroxisome proliferator‐activated receptor‐gamma 2 (PPAR‐gamma 2) is a nuclear receptor that plays an important role in adipocyte differentiation, energy metabolism, and homeostasis. The Pro12Ala polymorphism of PPAR‐gamma 2 is associated with decreased risk of diabetes mellitus. Presumably, it may have a protective effect on myocardial infarction (MI).Hypothesis: The purpose of the study was to explore the association between the Pro12Ala polymorphism and the risk of MI in the Chinese population.Methods: The Pro12Ala polymorphism was detected by polymerase chain reaction‐restriction fragment length polymorphism among 844 subjects, including 218 patients with MI and 626 controls. Clinical parameters such as fasting serum total cholesterol, triglycerides, and plasma glucose were detected by autoanalyzer assay. Waist circumference, weight, height, and blood pressure (BP) were measured and body mass index (BMI) was calculated.Results: The frequencies of the Ala allele in the MI and control groups were 0.053 and 0.032, respectively. There was a significant difference in genotype and allele frequency distribution between the two groups (after adjustment for age, gender, BP, fasting plasma glucose, total cholesterol, triglycerides, and smoking, odds ratio [OR] = 2.51,95% confidence interval [CI]: 1.26–5.00, p = 0.009). In the group with MI, the difference in frequency of the Ala allele in women (0.241) compared with that of men (0.056) was significant (OR = 4.29, 95% CI: 1.96–9.37, p<0.001). There was no relationship between the Pro12Ala polymorphism and waist circumference, weight, BMI, BP, or triglycerides (p>0.05).Conclusions: Our study suggests that Pro12Ala polymorphism is associated with increased risk of MI.
Is there a better way to predict death using heart rate recovery?
Authors: Gorelik Dmitry David , Hadley David , Myers Jonathan , Froelicher Victor 
Published: June 2007

AbstractBackground: Heart rate recovery (HRR) during exercise testing is an independent predictor of prognosis. The relative predictive power of computational analysis of HRR as a function of resting and maximum heart rate (HR) compared with direct measurement of the drop in HR has not been determined.Hypothesis: We aimed to improve on the prognostic value of HRR by the use of mathematical representations of HRR kinetics.Methods: In all, 2,193 patients who underwent exercise testing, coronary angiography, and clinical evaluation were followed up for 10.2 ±3.6 years. Mathematical functions were used to model HRR as a function of resting (HRRest), maximum HR (HRPeak) and time (t):
HRR = HRRest + (HRPeak ‐ HRRest)× e−kt and
HRR = HRRest + (HRPeak ‐ HRRest)× e−kt
Results: Equation (b) provided the best fit of the recovery HR curve. An abnormal HRR at 2 min was a better predictor of mortality than HRR at 1, 3, or 5 min. At 2 min, HRR also predicted mortality better than computational models of HRR, relating HRR as a function of maximum and resting HRs. After adjusting for univariately significant predictors of mortality, HRR, age, exercise capacity, and maximum HR were chosen in order as the best predictors of mortality.Conclusion: Even though the computational models of HRR and the determination of HRR at different time intervals were significant predictors of mortality, the simple discrete measure of HRR at 2 min was the best predictor of mortality. At 2 min, HRR outperformed age, METs, and maximum exercise HR in predicting all‐cause mortality.
Coronary anomalies by cardiac computed tomographic angiography
Authors: Budoff Matthew J. , Ahmed Vasi , Gul Khawar M. , Mao Song S. , Gopal Ambarish 
Published: June 2007

AbstractBackground: Early identification of an anomalous coronary anatomy is quite relevant because of the increased incidence of sudden cardiac death or related symptoms of myocardial ischemia in the patients. Invasive coronary angiography (ICA) is not only invasive, but expensive, and cannot always adequately provide the required information about the abnormal coronary anatomy. Cardiac computed tomographic angiography (CTA) is a robust noninvasive imaging modality that has several clinical applications and is now being used increasingly in practices across the nation. It not only provides high‐resolution anatomical information of the coronary artery tree but also helps define other aspects of the cardiovascular anatomy, be it normal or abnormal.Hypothesis: This study sought to determine the clinical role played by CTA in the evaluation of different types of coronary arterial anomalies by reviewing CTA studies since 1997.Methods: We reviewed 6,089 case studies of contrast CTA conducted at our institution. There were 53 coronary anomalies in 39 patients (0.64%).Results: Computed tomographic angiography correctly identified the course of coronary arteries in all cases.Conclusion: The results of this study support the use of CTA as a safe and effective noninvasive imaging modality for defining coronary arterial anomalies in an appropriate clinical setting, providing detailed three‐dimensional anatomic information that may be difficult to obtain with invasive angiography.
Effect of concordance between sites of left ventricular pacing and dyssynchrony on acute electrocardiographic and echocardiographic parameters in patients with heart failure undergoing cardiac resynchronization therapy
Authors: Bedi Maninder , Suffoletto Matthew , Tanabe Masaki , Gorcsan John , Saba Samir 
Published: June 2007

AbstractBackground: Wide QRS complexes are associated with left ventricular (LV) dyssynchrony, but an optimal site of LV pacing has not been established.Hypothesis: We hypothesized that concordance between the sites of LV pacing and of latest LV mechanical activation during cardiac resynchronization therapy (CRT) is associated with more favorable acute echocardiographic changes.Methods: An analysis of 28 consecutive patients (64 ± 15 years, 46% male, 52% ischemic heart disease, LV ejection fraction 0.24 ± 0.07, QRS 163 ± 22 ms, New York Heart Association > 3 93%) implanted with biventricular (BIV) defibrillators was performed. Sites of latest LV activation were determined by tissue Doppler imaging (TDI) and speckle tracking (ST). The site of LV pacing was determined by fluoroscopy in two views. A concordance score (0‐5) was created to describe the proximity of the pacing site to the site of the latest mechanical activation.Results: Compared with the worst concordance score, a perfect score was associated with shorter QRS width with LV (187 ± 40 vs. 246 ± 8 ms, p = 0.048) and BIV (134 ± 19 ms vs. 179 ± 39 ms, p = 0.05) but not with right ventricular pacing. A perfect concordance score was also associated with a greater acute reduction in LV volumes in systole (42 ± 36 ms 16 ± 22 ms, p = 0.068) and diastole (47 ± 37 vs. 8 ± 31 ml, p = 0.043) 24 h after CRT device implantation.Conclusions: A high concordance is associated with shorter QRS width with LV and BIV pacing and greater acute reduction in LV volumes. The effect of concordance on the intermediate and long‐term response to BIV pacing deserves further evaluation.
Bendamustine hydrochloride in patients with refractory soft tissue sarcoma
Authors: Hartmann Joerg T. , Mayer Frank , Schleicher Jan , Horger Marius , Huober Jens , Meisinger Ines , Pintoffl Jan , Käfer Gabriele , Kanz Lothar , Grünwald Viktor 
Published: June 2007

AbstractBACKGROUND.For patients with advanced soft tissue sarcoma (STS), no standard treatment is established after previous chemotherapy with anthracyclines and ifosfamide. Bendamustine hydrochloride is a bifunctional alkylating agent that is not cross‐resistant to other DNA‐interacting substances including anthracyclines and oxazaphosphorines. It has shown single‐agent activity in refractory lymphoma, myeloma, and some solid tumors. A phase 2 study was initiated to evaluate the efficacy of bendamustine in previously treated patients.METHODS.Thirty‐six of 44 screened patients were included and received a total of 101 cycles (median, 2 cycles; range, 1–8 cycles), 21 as second‐line treatment and 15 as third‐line treatment. The median age was 55 years (range, 18–79 years). Bendamustine was given as an intravenous infusion over 30 minutes at a dose of 100 mg/m2 on 2 consecutive days and repeated every 28 days. Eighty‐eight percent of cycles could be given without dose or schedule modification.RESULTS.The toxicity profile was mild, consisting of National Cancer Institute Common Toxicity Criteria (CTC) grade 3 neutropenia in 11% and grade 3 anemia in 9% of patients. Nonhematologic toxicities were noticed with CTC grade 3 fever in 3% of patients. No other grade 3 toxicity and no treatment‐related toxic deaths were observed. The best overall response according to Response Evaluation Criteria in Solid Tumors (RECIST) criteria was 1 partial remission (3%) and disease stabilizations in 31% of patients. Six of 15 patients (40%) with leiomyosarcoma histology achieved stable disease. The estimated 3‐month and 6‐month progression‐free survival rates were 35.3% and 23.5%, respectively, for all histologic subtypes included.CONCLUSIONS.In patients with refractory STS, bendamustine is well tolerated and appears moderately effective, particularly in patients with leiomyosarcoma histology. Cancer 2007. © 2007 American Cancer Society.