bluuebunny/crossref_metadata_2025_split huggingface dataset:
Safety of transvenous right ventricular endomyocardial biopsy guided by two‐dimensional echocardiography
Authors: Blomström‐Lundqvist Carina , Noor Anne‐Marie , Eskilsson Jan , Persson Stig 
Published: February 2009

AbstractA total of 231 endomyocardial biopsy procedures performed in 74 consecutive patients were evaluated to compare the incidence and nature of complications in procedures guided by fluoroscopy versus those guided by echocardiography. Sixty biopsy procedures were guided by fluoroscopy and 171 by two‐dimensional echocardiography. The right interventricular septum was the target site for biopsy sampling in all patients. Clinical signs of myocardial perforation occurred during one (1.7%) procedure guided by fluoroscopy versus two (1.2%) procedures guided by echocardiography. Two cases of interventricular septal perforation were visualized during the echo‐guided procedures. The biopsy specimens were judged to be inadequate for diagnosis in 2.2% of the biopsy procedures, all of which were guided by fluoroscopy. The number of samples obtained during a procedure guided by fluoroscopy was lower (mean 2.3 ± 1.6) (mean ± 1 SD) than that taken during a procedure guided by echocardiography (mean 4.0 ± 1.2). Epicardial or pericardial tissue was present in 5.8% of the samples obtained under fluoroscopic guidance, versus 0.7% of the samples obtained using echocardiography (p = 0.0003). It is concluded that although echocardiography seems to provide more accurate and safer guidance for the positioning of the bioptome toward the septum, the presence of epicardium or pericardium in 0.7% of the samples indicates that inadvertent sampling from the right ventricular free wall cannot be avoided.
The noninvasive assessment of myocardial viability
Authors: Ragosta Michael , Beller George A. 
Published: February 2009

AbstractThe major objective of noninvasive imaging for detection of myocardial viability is to assist in the improved selection of patients with coronary artery disease and severe left ventricular dysfunction who would benefit most from revascularization. The techniques most commonly used to identify viable myocardium are thallium‐201 (TI) scintigraphy, positron emission tomography (PET) using a flow tracer in combination with a metabolic tracer, technetium‐99m (Tc) sestamibi imaging, and dobutamine echocardiography. On stress TI scintigraphy, asynergic regions showing normal thallium uptake, an initial defect with delayed redistribution at 3–4 h, late redistribution at 24 h, or defect reversibility after reinjection of a second dose of TI at rest all suggest preserved viability. The greater the final uptake of TI in areas of regional myocardial dysfunction preoperatively, the greater the improvement in ejection fraction after coronary revascularization. Demonstration of uptake of fluoro‐18 deoxyglucose (FDG) in regions of diminished blood flow on PET imaging also correlates well with improved systolic function after revascularization. Tc sestamibi may also be useful for assessment of myocardial viability, particularly after thrombolytic therapy for acute myocardial infarction. Dobutamine echocardiography has good positive predictive value for viability determination, but absence of systolic thickening in an akinetic zone in response to intravenous infusion of the drug may still be associated with viable myocardium in 25–50% of segments. Of all the techniques cited above, quantitative resting TI scintigraphy may be the best approach for distinguishing between viable and irreversibly injured myocardium.
Plasma brain natriuretic peptide and atrial natriuretic peptide concentrations correlate with left ventricular end‐diastolic pressure
Authors: Haug C. , Grünert A. , Metzele A. , Kochs M. , Hombach V. 
Published: February 2009

AbstractThe present study was designed to investigate whether brain natriuretic peptide (BNP) and atrial natriuretic peptide (ANP) plasma concentrations correlate with left ventricular end‐diastolic pressure (LVEDP), pulmonary capillary wedge pressure (PCWP), diastolic pulmonary arterial pressure (DPAP), right atrial pressure (RAP), or ejection fraction (EF). Plasma BNP and ANP levels were determined by commercial radioimmunoassays (Peninsula) after Sep Pak C18 extraction in blood samples withdrawn from the pulmonary artery and the left ventricle or from the left ventricle and the femoral vein in 85 patients undergoing diagnostic cardiac catheterization. Linear and nonlinear regression analysis and the paired sample f‐test were applied to the data. Pulmonary arterial plasma BNP and ANP levels showed a close nonlinear correlation with LVEDP (BNP: r=0.94, p < 0.001; ANP: r=0.81, p < 0.001), a significant linear correlation with PCWP, DPAP, and RAP, and a significant negative correlation with EE ANP concentrations decreased significantly from the pulmonary artery to the left ventricle and from the left ventricle to the femoral vein (p < 0.001). BNP levels also decreased significantly between the left ventricle and the femoral vein (p < 0.001), but there was no significant difference between pulmonary arterial and left ventricular BNP concentrations. BNP and ANP concentrations correlated significantly between pulmonary arterial and left ventricular blood samples (BNP: r = 0.99, ANP: r = 0.93, p < 0.001) and between left ventricular and peripheral blood samples (BNP: r=0.99, ANP: r=0.94, p<0.001). The present data suggest that peripheral plasma BNP and ANP levels are useful noninvasive indices of cardiac performance.
Prognosis in diabetics in whom the initial suspicion of acute myocardial infarction was not confirmed
Authors: Karlson Björn W. , Strömbom Ulf , Ekvall Hans‐Erik , Herlitz Johan 
Published: February 2009

AbstractFor 2,058 consecutive patients hospitalized for suspected acute myocardial infarction (AMI) but in whom AMI was later ruled out, we describe the prognosis with particular emphasis on diabetics. In all, a previous history of diabetes mellitus occurred in 290 (14%) of the patients. Compared with nondiabetics, they had a longer delay time between onset of symptoms and arrival in hospital. During 1 year of follow‐up, their mortality rate was 28% compared with 14% for nondiabetics (p < 0.001), and their reinfarction rate was 20% compared with 10% for nondiabetics. More diabetics died in association with a fatal myocardial infarction and more frequently had ventricular fibrillation preceding death. With the exception of re‐infarction, no clear difference in terms of morbidity was observed between the two groups. We conclude that the prognosis in diabetics in whom AMI is ruled out is poor, with between one‐quarter and one‐third not surviving 1 year.
Anatomy, histology, and pathology of the cardiac conduction system—part V
Authors: Waller Bruce F. , Gering Lawrence E. , Branyas Nancy A. , Slack John D. 
Published: February 2009

AbstractAlthough morphologic findings in many of the cardiac arrhythmias of acute and chronic disease have been elusive, the correlates of heart block (particularly atrioventricular block) are abundant. Pathologic features of sinoatrial, atrioventricular, and bundle‐branch block are reviewed. Lev and Lenegre diseases (idiopathic bilateral bundle‐branch fibrosis) are also reviewed.
Amlodipine once a day in stable angina: Double‐blind crossover comparison with placebo
Authors: Deedwania Prakash C. , Cheitlin Melvin D. , Das Sunil K. , Pool Peter E. , Singh Jang B. , Pasternak Richard C. 
Published: February 2009

AbstractAlthough calcium antagonists form a mainstay of therapy in patients with angina pectoris, the currently available agents have significant limitations. Nifedipine, diltiazem, and verapamil are all high‐clearance agents with significant hepatic extraction and rapid clearance, leading to limited and shortlived bioavailability necessitating frequent daily administration. In contrast, amlodipine, a dihydropyridine calcium antagonist, has a long half‐life of 35–50 h (compared with 3 to 4 h elimination half‐life of diltiazem, verapamil, and nifedipine).1 After oral doses, the relative bioavailability of amlodipine is high (64%) and absorption is smooth, with peak plasma levels being achieved 6–12 h postdose.1 Bioavailability is not affected by the consumption of food.2 In common with other dihydropyridine calcium antagonists, amlodipine is eliminated mainly by metabolism.3 None of the metabolites of amlodipine has significant calcium antagonist effects in humans.3 In contrast to verapamil or diltiazem, amlodipine has no effect on sinus or atrioventricular node4 and little or no effect on the resting heart rate.5 Amlodipine does not have any appreciable negative inotropic effect with the relevant clinical dose.6 Other clinical studies have shown amlodipine to be effective when used once‐daily in chronic stable angina and vasospastic angina.7 Comparative studies indicate that the antianginal efficacy of amlodipine is comparable to the beta blocker nadolol8 and the benzothiazepine calcium antagonist diltiazem.9 Amlodipine has also been found to provide improved antianginal effects when combined to treatment with beta blockers and/or long‐acting nitrates.10, 11 Treatment with amlodipine either as monotherapy or combined with other antianginal therapy for up to 26 weeks shows that efficacy is maintained, with no evidence of tolerance.11We evaluated the antianginal efficacy and safety of amlodipine in a placebo‐controlled multicenter randomized crossover study in patients with chronic stable angina.
Thrombolytic therapy for unstable angina
Authors: Borzak Steven , Bajwa Harpaul S. , Lesch Michael , Verier Joel 
Published: February 2009

AbstractThrombolytic therapy for unsTable angina has not gained acceptance as a primary treatment for unsTable angina (UA) despite the evidence showing a reduction in mortality when these agents are given for myocardial infarction. The purpose of this review is to examine the clinical value of thrombolytic therapy for UA. The multiple lines of evidence supporting intracoronary thrombus formation as a key mechanism in the pathogenesis of UA are reviewed. Studies examining the effect of thrombolytic therapy on angiographic endpoints have shown little effect on the extent of luminal narrowing, but do reveal a decrease in angiographically detected thrombus. Twelve randomized, controlled trials of thrombolytic agents in 611 UA patients with predefined clinical endpoints have been published. These trials varied widely in design and adjunctive therapy both in treated and control groups. Review of these trials shows a tendency to fewer clinical events such as death, infarction, and need for revascularization in treated patients, with a corresponding increase in bleeding complications. Clinical efficacy of thrombolytic therapy cannot be excluded by the available data, perhaps in part because of insufficient numbers of patients treated. Determination of the net clinical value of thrombolytic therapy must await larger and more definitive trials.
Silent ischemia and loss of reversible myocardial dysfunction following myocardial infarction
Authors: Scognamiglio Roldano , Fasoli Giuseppe , Nlstrl Stefano , Mlorelu Manuela , Frigato Nlcoletta , Pausi Monica , Miraglia Giuseppe , Dalla‐Volta Sergio 
Published: February 2009

AbstractSixty‐seven asymptomatic patients were enrolled after a first uncomplicated myocardial infarction (MI) so as to study the relevance of reversible myocardial dysfunction in determining left ventricular function soon after the acute episodes and 12 months later. Moreover, the potential role of silent ischemia in conditioning the evolutive aspects of contractile dysfunction has been investigated. Postextrasystolic potentiation during two‐dimensional echocardiographic (2‐D echo) monitoring has been used to detect the presence of viable myocardium in asynergic myocardial segments. Results of electrocardiographic (ECG) ambulatory monitoring at predischarge determined patient groups: Group A included 49 patients without ST changes during monitoring, while Group B included 18 patients with silent ischemia. Incidence of reversible myocardial dysfunction was similar in the two study groups (82 vs. 86%, p = NS). Group B patients were older (59.6 ± 6.7 vs. 50.6 ± 10.6 years, p < 0.015) and had lower ejection fractions (EFs, 43.4 ± 6.4% vs. 51.2 ± 8.3%, p = 0.026) and higher at‐rest wall‐motion scores (WMSs, 11.4 ± 5.9 vs. 7.2 ± 3.8, p = 0.019). Left ventricular end‐diastolic volume (LVEDV) and potentiated WMS did not differ. At 1‐year examination, Group B patients exhibited a greater LVEDV index (96 ± 6.5 vs. 70.7 ± 14 ml/m2, p < 0.002) with a worsening both in rest and in potentiated wall‐motion score index (12.8 ± 4.6 vs. 5.3 ± 1.8, p < 0.001; 9.2 ± 3.6 vs. 4.8 ± 2.2, p < 0.001, respectively). Left ventricular EF remained significantly depressed in Group B patients (42 ± 8.7% vs. 55.5 ± 8.1%, p < 0.002). Over the first year, spontaneous functional recovery of asynergic segments occurred in 60% of Group A patients with reversible myocardial dysfunction at early study. In Group B patients, only three (20%) showed functional recovery, and a small number (24%) maintained reversible contractile dysfunction. Thus, reversible contractile dysfunction is a common finding in asymptomatic patients without clinical ischemia soon after a first MI. The presence of silent ischemia during ambulatory ECG monitoring identifies a group of patients at high risk of further loss of myocardial viability and progressive left ventricular dilation over the first year.
Cutting balloon coronary angioplasty—initial clinical experience
Authors: Unterberg C. , Buchwald A. B. , Schmidt T. , Kreuzer H. , Wlegand V. , Barath P. 
Published: February 2009

AbstractThe success of percutaneous transluminal coronary angioplasty is limited by acute occlusion and late restenosis. In 25 patients (20 men, 5 women, age range 36–81 years) coronary angioplasty was performed using a new cutting balloon into which 3–4 longitudinally orientated blades are incorporated so as to reduce the rate of severe dissections. In 12 patients stenoses were reduced from 83.9 ± 7.8% to 28.4 ± 10.7% (mean ± SD) by the cutting balloon alone, using predilatation with a small conventional balloon in two cases. Thirteen other patients were additionally dilated with a conventional balloon because of a residual stenosis > 50% after cutting balloon angioplasty. Here the stenoses could be reduced from 78.1 ± 8.7% to 29.1 ± 11.3%. Six months follow‐up angiography in 14 patients showed > 50% restenosis in two of seven patients dilated with a conventional balloon in addition to the cutting balloon, and in one of seven patients dilated with the cutting balloon alone but predilated with a small conventional balloon. These results show that coronary angioplasty by the new cutting balloon results in a stenosis reduction comparable with conventional balloons at a low complication rate. Available 6 months follow‐up data show three restenoses in patients either pre‐ or postulated by a conventional balloon and none in stand‐alone cutting balloon cases.
Electrocardiogram signal variance analysis in the diagnosis of coronary artery disease—A comparison with exercise stress test in an angiographically documented high prevalence population
Authors: Nowak Jacek , Yléan Marco , Hagerman Inger , Nyquist Olof , Sylven Christer 
Published: February 2009

AbstractVariance electrocardiography (variance ECG) is a new resting procedure for detection of coronary artery disease (CAD). The method measures variability in the electrical expression of the depolarization phase induced by this disease. The time‐domain analysis is performed on 220 cardiac cycles using high‐fidelity ECG signals from 24 leads, and the phase‐locked temporal electrical heterogeneity is expressed as a nondimensional CAD index (CAD‐I) with the values of 0–150. This study compares the diagnostic efficiency of variance ECG and exercise stress test in a high prevalence population. A total of 199 symptomatic patients evaluated with coronary angiography was subjected to variance ECG and exercise test on a bicycle ergometer as a continuous ramp. The discriminant accuracy of the two methods was assessed employing the receiver operating characteristic curves constructed by successive consideration of several CAD‐I cutpoint values and various threshold criteria based on ST‐segment depression exclusively or in combination with exertional chest pain. Of these patients, 175 with CAD (≥ 50% luminal stenosis in 1 + major epicardial arteries) presented a mean CAD‐I of 88 ± 22, compared with 70 ± 21 in 24 nonaffected patients (p < 0.01). Variance ECG provided a stochastically significant discrimination (p < 0.01) which was matched by exercise test only when chest pain variable was added to ST‐segment depression as a discriminating criterion. Even then, the exercise test diagnosed single‐vessel disease with a significantly lower sensitivity. At a cutpoint of CAD‐I ≥ 70, compared with ST‐segment depression ≥ 1 mm combined with exertional chest pain, the overall sensitivity of variance ECG was significantly higher (p < 0.01) than that of exercise test (79 vs. 48 %). When combined, the two methods identified 93% of coronary angiography positive cases. Variance ECG is an efficient diagnostic method which compares favorably with exercise test for detection of CAD in high prevalence population.
Antiplatelet therapy in the treatment of cerebrovascular disease
Authors: Couch James R. 
Published: February 2009

AbstractAspirin and the new agent ticlopidine have been the most thoroughly evaluated of the platelet‐antiaggregating drugs used for the prevention of stroke and other vascular events. Numerous trials have shown aspirin to be effective in reducing the risk of myocardial infarction (MI), recurrent transient ischemic attacks, stroke, and vascular death in men at high risk for these events. Primary prevention trials have shown that aspirin reduces the risk of MI in healthy men over 50 years of age but does not reduce the risk of stroke. Two large, multicenter trials have shown that ticlopidine is effective in reducing the risk of fatal and nonfatal stroke in both men and women. Ticlopidine may also be effective in reducing the risk of recurrent stroke in patients who have had a completed thromboembolic stroke.
Use of a latex cover sheath for transesophageal echocardiography (TEE) instead of regular disinfection of the echoscope?
Authors: Fritz Stephan , Hust Martin H. , Ochs Christel , Gratwohl Isolde , Staiger Mathias , Braun Bernd 
Published: February 2009

AbstractBetter visualization of cardiac structures is an advantage of transesophageal echocardiography (TEE). Because of this, the transesophageal approach is an essential window in the assessment of various cardiovascular disorders. Quick consecutive access to this instrument should not be delayed by time‐consuming cleansing procedures of the probe. In this study we used a sterile latex condom in routine TEE examinations as a barrier to contamination of the echoscope, observing practical use and the incidence of perforations. Defects were detected after the procedure by visual inspection and by an airtightness test. Maneuvers or situations associated with an increased likelihood of injury were checked for. In 180 studies a total of 168 patients were consecutively examined; insertion was feasible in all but one case (99.5%). We found 8 of 181 (4.4%) sheaths defective following the procedure. Visual inspection was less sensitive (only 3 of 8) for finding defects than an airtight‐ness test (8 times). Teeth in situ and/or a bite guard are the only sharp edges during insertion and removing the probe; these seem to be the main risk factors in latex perforation. Application of a cover sheath for each examination saves approximately two‐thirds of the time otherwise necessary for a cleansing bath, and easy handling of cover sheaths for TEE make them an alternative to regular disinfection in general. For reasons of safety we recommend checking each used cover sheath after examination for holes so as not to jeopardize the following patient by the possible spread of germs from contaminated probes. Not only visual inspection but also a second method, for example, an airtightness test, is mandatory.
Head‐upright tilt table testing for recurrent, unexplained syncope
Authors: Samoil Daniela , Grubb Blair P. 
Published: February 2009

AbstractRecurrent episodes of unexplained syncope are a common and often frustrating problem for the practicing physician. Although vasovagally mediated episodes of hypotension and bradycardia have been felt to be a common cause of these idiopathic events, traditionally this was a diagnosis of exclusion. Recently, head‐upright tilt table testing has emerged as a method both for confirming the diagnosis of vasovagal syncope and for better understanding the mechanisms by which these events occur. This paper reviews current understanding of the pathophysiology of vasovagal syncope, the development and role of head‐upright tilt table testing in its evaluation, and potential therapeutic modalities that can be helpful for the prevention of recurrent episodes.
Assessment of right ventricular diastolic filling in patients with coronary artery disease
Authors: Yamagishi Takashi , Matsuda Yasuo , Nakatsuka Masami , Maeda Junya , Matsuda Masako 
Published: February 2009

AbstractTo assess right ventricular (RV) diastolic filling in coronary artery disease (CAD), with special reference to the involved lesions of the coronary arteries and left ventricular (LV) systolic function, gated radionuclide ventriculography was performed at rest in 106 patients with single‐vessel CAD. Based on the site of coronary arterial involvement, patients were classified into three groups: left anterior descending CAD, right CAD, and left circumflex CAD. Patients in each group were further subdivided according to normal or decreased LV ejection fraction, resulting in six groups. Seventeen normal subjects were examined as a control group. Tune‐activity and its first‐derivative curves were computed for the right and left ventricles. RV systolic function was normally preserved in all six groups, even when LV systolic function was damaged severely. The ratio of peak RV filling rate to peak RV ejection rate was significantly decreased in all six groups compared with that in control subjects, indicating that RV filling was impaired in patients with CAD. The ratio was below the lower limit of normal in 14 (23%) of 62 patients with normal LV systolic function and in 13 (30%) of 44 patients with impaired LV systolic function. None of the control subjects showed a decreased ratio of peak RV filling rate to peak RV ejection rate. Thus, in patients with CAD, RV filling is impaired, which may be independent of the site of coronary arterial involvement and of the LV or RV systolic function.
A case of tachycardia‐induced cardiomyopathy due to chronic ectopic atrial tachycardia
Authors: Hayano Motonobu , Kawasaki Tomomro , Egucm Yoshiki , Tsuji Shinsuke , Tokushima Takasw , Ogata Tohru , Eguchi Swnji , Matsunaga Moronari , Matsunaga Kazuyo , Matsuo Shuzo 
Published: February 2009

AbstractOnly a few reports exist that chronic supraventricular tachycardia causes ventricular dilation and poor left ventricular contraction—so‐called “tachycardia‐induced cardiomyopathy.”1‐4 Clinical and electrophysiologic features of chronic supraventricular tachycardia including chronic persistent ectopic atrial tachycardia (EAT)5‐7 in adults have also been described by a few investigators.5‐9 We report a rare case of long follow‐up of chronic EAT‐induced severe cardiomyopathy and mitral regurgitation that was well controlled after medical treatment.