bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Heart in Scleroderma: Noninvasive assessment
Authors: Montanes P. , Lawless C. , Black C. , Oakley C. M. , Hughes G. 
Published: February 2009

AbstractSummary: Myocardial fibrosis is found at postmortem examination in up to 80% of patients with scleroderma, yet many such patients have an entirely normal cardiovascular examination. Isometric handgrip exercise is a useful provocative test for the detection of subclinical left ventricular abnormality. By this method 15 patients with scleroderma (American Heart Association criteria) were compared with 15 sex and age‐matched normals. Results showed that scleroderma patients had a depressed heart rate response to handgrip (p<0.05) and abnormal systolic and diastolic time intervals. They showed a decreased shortening of the ratio pre‐ejection period to ejection time (p<0.05) and a lengthening of the isovolumic relaxation time compared with the control group who steadily shortened this period (p<0.01). These findings indicate increased stiffness and impaired contractility of the left ventricle as would be caused by an underlying fibrotic process otherwise undetectable. Immunohistological studies give support to this concept. Staining with monospecific antibodies to collagens types I to V of cardiac muscle from patients who, in life, had no overt cardiac disease, showed an excess deposition of collagens type I, III, and IV. In conclusion isometric exercise may provide a noninvasive method of unmasking subclinical fibrosis of the left ventricle in scleroderma, and immunopathological studies support these findings.
Asymptomatic myocardial ischemia in patients with stable and typical angina pectoris
Authors: Cocco G. , Strozzi C. , Leishman B. , Chu D. , Rochat N. , Braun S. 
Published: February 2009

AbstractThe existence of transient myocardial ischemia (TMI) and the value of the serial dynamic electrocardiogram (DCG) in patients with variant or unstable angina pectoris are known. However, less information is available on the frequency and characteristics of TMI in patients with stable angina pectoris. For this study, we selected 40 patients with stable and typical angina pectoris. The presence of coronary artery disease and the ejection fraction were evaluated by means of angiocardiography. The DCG monitoring was performed with bichannel portable recorders for three 24‐h periods at 7‐day intervals. The patients were on optimal doses of beta blockers and isosorbidilate throughout the study. We detected 788 episodes of TMI in 22 of the 40 patients. The ejection fraction was poorer in the 22 patients with ST‐T changes than in the 18 without such changes. The repolarization changes were: (1) ST elevation (55 symptomatic and 87 asymptomatic episodes, (2) ST depression (138 symptomatic and 236 asymptomatic episodes, and (3) T‐wave changes (83 symptomatic and 164 asymptomatic episodes). All 22 patients with TMI presented a combination of the above changes. It appears, therefore, that ST‐T changes are more frequent in patients with stable angina pectoris than was hitherto suspected. The DCG is valuable in assessing these changes, especially when one considers that the asymptomatic episodes are almost twice as frequent as the symptomatic ones. The asymptomatic episodes lasted a mean of 1.8±1.3 min (mean±SD), while the symptomatic episodes lasted 3.8±2.7 min (p <0.02, by sign test). Heart rate was unchanged during the episodes of TMI, and did not show any significant difference between asymptomatic and symptomatic episodes. Additional investigation is necessary, however, to determine the clinical implications of these findings.
Use of end‐systolic volume changes with exercise to detect left ventricular dysfunction in patients with coronary artery disease
Authors: Greenberg P. S. , Berge R. D. , Johnson K. D. , Bible M. , Ellestad M. H. , Hayes M. , Messenger J. C. 
Published: February 2009

AbstractTo determine if end‐systolic volume changes (ΔESV) in response to exercise were of value in detecting left ventricular dysfunction and compare it with other presently used criteria, 41 normal subjects and 122 patients with coronary artery disease (≥70 percent cross sectional luminal narrowing) were studied. All had upright maximal bicycle stress tests using equilibrium ra‐dionuclide imaging in the left anterior oblique (LAO) projection. The sensitivity, specificity, and predictive value were determined for several criteria which included the following defined as normal responses: ΔEF≤5 absolute units, ΔEF>0, ΔESV<0, and a combination criterion of ΔEF>0 and ΔESV<0. The ΔESV criterion had a greater sensitivity than the ΔEF>0 criterion at 83% (101/122) and 66% (80/122) (p≤0.001), respectively, and was comparable to the EF≥5 criterion at 85% (104/122). The specificity of the ΔESV criterion was superior to the ΔEF≥5 criterion at 93% (38/41) and 80% (33/41) (p<0.01), respectively, and comparable to the ΔEF>0 criterion at 95% (39/41). This relationship was also apparent when those patients with infarctions were excluded. The end‐systolic volume response to stress has a high sensitivity, specificity, and predictive value for detecting left ventricular dysfunction, perhaps due to the fact that it is a measure of left ventricular contractility. The end‐systolic volume response to stress is superior in specificity to the ΔEF≥5 criterion and superior in sensitivity to the ΔEF>0 criterion. A combination of ΔEF>0 and AESV<0 appears to be a promising criterion for detecting left ventricular dysfunction.
Postoperative monitoring of myocardial oxygen tension: Experience in 51 coronary artery bypass patients
Authors: Wiener L. , Santamore W. P. , Venkataswamy A. , Plzak L. , Templeton J. 
Published: February 2009

AbstractFollowing a preliminary feasibility report, polarographic monitoring of myocardial tissue O2 tension (PmO2) in 51 coronary bypass patients has been accomplished. In this context, the influence of rapid atrial pacing (RAP), O2 inhalation, and intra‐aortic balloon assistance (IAB) was statistically analyzed using Wilcoxon sign‐rank and Student's t‐tests. Electrodes were implanted in revascularized and nonrevascularized areas for comparison (24.0 ± 1.1; and 26.3 ± 1.8 mmHg PmO2, p, not significant). Increasing myocardial O2 demand with RAP caused a 6% PmO2 drop (p<0.01). A 70% O2 inhalation increased Pmo2 by 30% (p<0.01). In 5 cases the benefit of IAB was confirmed by a 41% increase in Pmo2 (p = 0.02). These data support the clinical usefulness of polarographic PmO2 as a measure of regional myocardial oxygenation. In addition to early recognition of intraoperative or postoperative graft failure previously reported, the efficacy of various therapeutic interventions can be more precisely determined.
Ambulatory blood pressure monitoring in diabetic males: A method for detecting blood pressure elevations undisclosed by conventional methods
Authors: Rubler S. , Abenavoli T. , Greenblatt H. A. , Dixon J. F. , Cieslik C. J. 
Published: February 2009

AbstractTwenty‐one diabetic males, ages 20 to 61 years (mean 48.4±10.5) and 14 healthy males, 22 to 59 years (mean 42.5±10.4) consented to participate in a study during which 24‐h recordings of systolic and diastolic blood pressures, heart rates, and rhythm were obtained. The diabetic subjects were considered nor‐motensive except for two patients, who had been observed to have rare insignificant elevations in blood pressure and were untreated. Diabetic subjects had a higher mean maximal systolic blood pressure (160.7±49.8 mmHg) than the normal controls (132.4±12.1 mmHg) (p<0.05). They also had a higher frequency (15.1%) of systolic blood pressure readings ≥ 150 mmHg compared to normal men (0.2%) (p<0.01). The frequency of diastolic blood pressure readings ≥90 mmHg was 22.1% in the former and 9.2% in the latter group (p<0.01). Of 21 diabetic males, 14 (66.7%) had systolic pressures ≥ 150 mmHg, diastolic pressures ≥100 mmHg, or both. In the normal men, 3 (21.4%) of the 14 had such pressures. Twenty‐four hour monitoring of ambulatory blood pressures revealed elevations not detected by routine casual readings in patients with diabetes.
Radionuclide ventriculographic findings in pericardial effusion
Authors: Hakki A‐H. , Iskandrian A. S. , Mintz G. S. 
Published: February 2009

AbstractWe present a patient with a large pericardial effusion, in whom the first‐pass radionuclide ventricu‐logram demonstrated rocking motion of the left ventricle and apparent asynergy of the inferior wall. These abnormalities disappeared after removal of the fluid. Inspection of the cinematic display of the images was useful in explaining the apparent asynergy of the inferior wall.
A new formula for the measurement of diastolic mitral valve orifice area
Authors: Morise A. P. 
Published: February 2009

AbstractThis study evaluated the accuracy of a new formula for the calculation of mitral valve area. Fifty‐two patients with mitral stenosis who underwent cardiac catheterization were evaluated by the standard Gorlin and the new formulas. The correlation between the two formulas was excellent (r = 0.89) for valve areas of 0–1.5 cm2. When the new valve area formula yielded an area greater than 1.5 cm2, there was no correlation with the Gorlin formula. However, the likelihood of the Gorlin mitral valve area being less than 1.0 cm2 was low (10%). The results of the new formula do not appear to be affected by atrial fibrillation and are probably subject to the same limitations when used in the presence of a regurgitant lesion. Therefore, with moderate to severe mitral stenosis, this new formula shows a good correlation. However, with mild stenosis, further work is needed to determine the accuracy and limitations of the new formula.
The influence of heart rate on echocardiographic assessment of aerobic training
Authors: Conrad J. A. , Nagle F. J. , Corliss R. J. 
Published: February 2009

AbstractThe purpose of this investigation was to determine if echocardiographic measures of ventricular structure and function ascribed to aerobic training might be an artifact of heart rate (HR) differences between trained and untrained subjects. Comparisons were made at rest, of 10 young, male, aerobically well‐trained athletes [((VO2)max 65>ml/kg/min] and 10 young, healthy controls [((VO2)max<56ml/kg/min]. Additionally, the echocardiographic responses to low (HR=80 beats/min) and moderate intensity (HR=120 beats/min) supine cycling exercise were analyzed. Echocardiographic measures were made as described by Sahnet al. (1978). Results of echocardiographic comparisons between groups, both during supine rest and at a constant heart rate of 80 beats/min during supine cycling confirmed that athletes had significantly greater left ventricular mass (LV mass) and end‐diastolic size per square meter of body surface area (p<0.05). When supine cycling loads were increased to elevate HR to 120 beats/min in groups of 7 athletes and 5 controls, athletes exhibited a progressive and significant (p<0.05) enlargement of left ventricular end‐diastolic size (LVEDS), while left ventricular end‐systolic size (LVESS) showed negligible change. The control group showed little change in LVEDS, but decreased LVESS significantly (p<0.05). Contractility measures, i.e., estimated ejection fraction (EF) and velocity of circumferential shortening ( (Vcf) increased in both groups in a similar manner. It was concluded that echocardiographic differences in ventricular structure and function observed between aerobically trained and untrained subjects are not an artifact of heart rate differences. Clearly, aerobic training results in increased LV mass and diastolic size which allows for further dilitation with supine exercise. Aerobic training does not appear to alter indices of myocardial contractility.
Coronary paraganglioma
Authors: Levi B. , Cain A. S. , Dorzab W. E. 
Published: February 2009

AbstractThe clinical, angiographic, and anatomical features of an uncommon primary cardiac tumor, a paraganglioma, are presented. The angiographic appearance appears unique. These tumors are slow growing and troublesome primarily because of their firm adherence to underlying cardiac structures. Treatment is complete surgical excision.
Total coronary occlusion in chronic coronary artery disease
Authors: Buda A. J. , Dubbin J. D. , Orr S. A. 
Published: February 2009

AbstractThe hemodynamic consequence of chronic total occlusion of a coronary artery and the association of collaterals has not been well established. To examine this, 75 patients with at least one total occlusion of a major coronary artery were identified from among 267 patients undergoing selective coronary angiography. There was evidence of previous myocardial infarction in 49 (65%) of these patients. There was no intergroup (myocardial infarction versus no infarct) difference in terms of age, chronicity of angina prior to or stability of angina at selective coronary angiography, the number and distribution of total occlusions, or the extent of coronary disease. Furthermore, there was a high prevalence of angiographically demonstrated collaterals in both myocardial infarction and noninfarct patients (96% versus 98%). However, significantly greater left ventricular dysfunction, as determined by larger end‐diastolic and end‐systolic volumes (p<0.001), higher left ventricular end‐diastolic pressure (p<0.05), and lower ejection fraction (p<0.001) was found in the myocardial infarct group. We conclude that total occlusion of the major coronary artery occurs commonly in patients with chronic coronary disease, but is associated with myocardial infarction in only 65%. The presence of collaterals, the distribution of occlusion, and the extent of associated coronary disease do not distinguish patients with and without myocardial infarction. This suggests that the temporal course of oclusion and collateral development is a more important factor in the pathogenesis of iinfarction and its hemodynamic consequences.
Noninvasive markers of intravenous streptokinase coronary thrombolysis
Authors: Udall J. A. 
Published: February 2009

AbstractEarly creatine kinase (CK) enzyme peaking, rapid electrocardiographic (EKG) changes toward normal, reperfusion arrhythmias, pain disappearance, and201 thallium myocardial scintigraphy appear useful to identify the success or failure of intravenous (i.v.) thrombolytic therapy in patients with acute myocardial infarction (AMI). Most patients with AMI are treated currently in community hospitals which do not possess coronary angiographic capabilities. Recent evidence indicates that early intravenous Streptokinase results in coronary thrombolysis in the majority of patients treated. A composite of noninvasive markers of coronary reperfusion was assessed in two similar patients with transmural AMI. One received intravenous streptokinase (STK) 750,000 U 90 min after AMI onset; the other received intracoronary (i.c.) STK 4000 U/min 140 min after onset. Within one hour each showed a sudden change in elevated EKG ST segments toward normal, followed by frequent premature ventricular beats and pain disappearance. Posttreatment angiograms documented recanalization of each infarct‐related artery. Early CK peaking occurred at 10 hours after the onset of chest pain in the first patient and at 12 hours in the second. This contrasts with delayed CK peaking at 26.4 hours among 384 patients reviewed with untreated AMI. Early CK peaking appears the most accurate indirect marker of successful coronary thrombolysis.
Echocardiographic identification of prolapsing leaflet of a malfunctioning aortic porcine xenograft
Authors: Nicholson W. J. , Gracey J. G. , Martin C. E. 
Published: February 2009

AbstractA patient with a Hancock aortic bioprosthetic valve presented with congestive heart failure and a murmur. M‐Mode and two‐dimensional echocardiography clearly delineated the diagnosis of prosthetic valve dysfunction with severe aortic regurgitation. Echocar‐diography can be a helpful technique in the diagnosis of prosthetic dysfunction. significant in children and in young adults (Ferrans et al., 1980). Prompt diagnosis of prosthetic dysfunction is extremely important in this group of patients so that corrective measures can be taken. M‐mode and two‐dimensional echocardiography promptly and accurately delineated the type of dysfunction present in this case of aortic porcine bioprosthesis malfunction.
Effect of metoprolol on cardiac and pulmonary function in chronic obstructive pulmonary disease
Authors: Fenster P. E. , Hasan F. M. , Abraham T. , Woolfenden J. 
Published: February 2009

AbstractWe evaluated the effects of oral metoprolol, 200 mg daily, on cardiac and pulmonary function in 6 patients with chronic reversible airways obstruction and no cardiac dysfunction. The patients were clinically stable. In all patients, baseline forced expiratory volume in 1 second (FEV1) was less than 60% predicted, and increased at least 15% after isoproterenol inhalation. Resting control first pass right and left ventricular radionuclide ejection fractions were normal or only slightly depressed. Compared to placebo Metoprolol did not significantly affect FEV1 or forced vital capacity. Metoprolol did not significantly alter left or right ventricular ejection fraction Measured by first pass radionuclide technique. One patient experienced increased dyspnea on metoprolol, which was not accompanied by changes in clinical exam, spirometry, or ejection fraction. We conclude that metoprolol may be safely administered to a subset of stable patients with chronic reactive airways disease.
Unusual cardiovascular manifestations in a case of pheochromocytoma
Authors: Sheikhzadeh A. , Fatourechi V. , Paydar D. , Nazarian I. 
Published: February 2009

AbstractA case of proven pheochromocytoma is reported of a patient who presented with attacks of apparent hypotension, pulmonary edema, and myocardial injury with typical ECG and enzyme change. In spite of unmeasurably low peripheral blood pressure recordings during the attack, central aortic pressure was well above 240/140 mmHg. A clinical shocklike state was in effect due to severe arterial vasoconstriction. The pulmonary artery pressure was 48/26 mmHg during attacks, wedge pressure was 26 mmHg, and cardiac index 1.8 liters/min/m2. The coronary angiogram showed abnormal pooling of dye in the myocardial capillary network. It is concluded that: (1) Apparent hypotensive episodes in pheochromocytoma may be misleading and central arterial measurements may be needed to demonstrate the hypertensive crisis. (2) The abnormal coronary angiogram in our patient may be due to myocardial necrosis and damage to the intact arteriolar and microvascular system of the myocardium.
A comparison of conventional contrast ventriculography and digital subtraction ventriculography
Authors: Felix R. , Eichstädt H. , Kempter H. , Kewitz A. , Banzer D. , Schmutzler H. , Marhoff P. 
Published: February 2009

AbstractWe studied 46 patients with a history of transmural myocardial infarction or angiographic evidence of coronary artery stenosis with both conventional contrast ventriculography and digital subtraction ventriculography from May to September 1982. Urografin 76®, 30 ml, was administered at a flow rate of 18 ml/s, by means of a catheter in the superior vena cava during digital subtraction ventriculography (DSV). Results of the latter were compared with conventional contrast ventriculograms. The correlation coefficient was r = 0.938 (p<0.001) for determination of ejection fraction with both methods. The data in individual cases suggest that DSV is more sensitive than conventional contrast ventriculography in determination of severely reduced ejection fractions. The methods are practically identical in qualitative evaluation of disorders of regional wall motion in the anterolateral region, while DSV is more sensitive than conventional ventriculography in evaluating the apical region. Sensitivity was 85.7% when the two methods were compared in evaluation of the inferior region of the left ventricle. Both methods are identical in demonstration of severely deformed ventricles. Digital subtraction ventriculography may replace conventional contrast ventriculography in some of the situations discussed above.
The use of the hepatic pressure maneuver to identify the murmur of tricuspid regurgitation
Authors: Gooch A. S. , Cha S. D. , Maranhao V. 
Published: February 2009

AbstractTo enhance the bedside diagnosis of tricuspid regurgitation, the influence of manual pressure applied below the liver on lower left sternal border murmurs was determined in 23 patients. All 23 subjects had right ventriculograms and right atrial phonocardiograms. The sign was positive in 13 cases, including 3 who were without a Carvallo sign. The application of manual pressure below the liver is a simple and valid additional maneuver for identifying the murmur of tricuspid regurgitation.
Detection of diastolic left ventricular function abnormalities in patients with coronary artery disease and normal systolic function
Authors: Schabelman S. E. , Schabelman F. , Brundage B. H. , Willis W. H. 
Published: February 2009

AbstractWe angiographically calculated left ventricular (LV) filling in 50 patients, all of whom had normal systolic LV function and 21 (42%) of whom had coronary artery disease. Five volume determinations were made: at end systole (ESV), first third (DV 1/3, half (DV 1/2), and second third of diastole (DV 2/3), and at the end of diastole (EDV). To assess different modalities of filling, we calculated filling fractions in the first third (FF 1/3) as the ratio of volume filled in the first third diastole (DV 1/3‐ESV) over total diastolic filling (EDV‐ESV). Similar filling fractions (FF) were calculated at half (FF 1 /2), second third (FF 2/3), and last third (FF 3/3) of diastole. We found significant differences between normal and coronary artery disease patients as follows: FF 1/3: 37.4± 14.9 versus 23.8±11.9%, respectively (p<0.002); FF 1/2: 58.6±14.7 versus 45.3±15.1% (p<0.005); FF 2/3: 33.8±15.2 versus 39.0±10.4% (NS), and differences in the opposite direction in the FF 3/3: 28.8± 15.2 versus 37.2±11.9% (p<0.02), respectively. We conclude that LV filling is accomplished differently in patients with coronary artery disease even if they have normal systolic function.
The mechanism of mitral regurgitation in dilated left ventricle
Authors: Ballester M. , Jajoo J. , Rees S. , Rickardsm A. , Mcdonald L. 
Published: February 2009

AbstractTo assess the mechanism of mitral regurgitation in ventricular dilatation, 24 patients with dilated cardiomyopathy (13 with and 11 without mitral regurgitation) and 10 normal individuals were studied by two‐dimensional echocardiography. Left ventricular dimensions and mitral ring diameters in systole and diastole were measured in the long‐axis section, and systolic interpapillary muscle distance in the short‐axis section. The results showed: (1) Mitral ring diameter is increased in most patients with dilated cardiomyopathy. (2) Neither increased ring diameter, reduced ring contraction, nor decreased interpapillary muscle distance determine the presence of mitral regurgitation. (3) The only difference between those patients with and without mitral regurgitation was the degree of left ventricular dilatation (p<0.05).