bluuebunny/crossref_metadata_2025_split huggingface dataset:
Heart rate variability in patients with orthotopic heart transplantation: Long‐term follow‐up
Authors: Folino Antonio Franco , Buja Gianfranco , Miorelli Manuela , Livi Ugolino , Nava Andrea , Thiene Gaetano , Dalla Volta Sergio 
Published: February 2009

AbstractTo evaluate heart rate variability (expressed as the standard deviation of RR intervals) within 5 years of follow‐up, we studied 20 patients (14 males, 6 females, mean age 44 ± 12 years) who underwent orthotopic heart transplantation. Six measurements were taken: one in the first 3 weeks after transplantation, and the others once annually, for 5 years. Twenty healthy subjects (mean age 44 ± 7 years) constituted the control group. Heart rate variability increased significantly in the first 3 years of follow‐up (7.2 ± 1 vs. 11.1 ± 4, p < 0.001; 11.1 ±4vs. 15.2±4, p<0.01; 15.2±4vs. 18.9±5, p< 0.05); in the following years this trend slackened and values did not reach a statistically significant difference (18.9 ± 5 vs. 21.4 ± 5; 21.4 ± 5 vs. 22.5 ± 5). The mean standard deviation was invariably greater in the control group (63.6 ± 12). These findings show that sinus rhythm variability in the denervated heart progressively increased over 5 years of follow‐up. The absence of presynaptic uptake, which is responsible for adrenergic hypersensitivity to circulating catecholamines and intrinsic cardiac reflexes, does not appear to cause this phenomenon, since these mechanisms are not able to evolve in time after cardiac transplantation. Therefore, an enhanced beta‐adrenergic receptors density or affinity to circulating catecholamines or a limited sympathetic reinnervation may be the more probable underlying mechanism.
Comparison between diurnal distribution of onset of infarction in patients with acute myocardial infarction and circadian variation of blood pressure in patients with coronary artery disease
Authors: Tsuda Makoto , Hayashi Hlroshi , Hayashi Hlroshi , Yoshikan Mari , Saito Hldehiko 
Published: February 2009

AbstractWe analyzed the diurnal distribution of the onset of infarction in 636 patients with acute myocardial infarction (MI) and compared it with the circadian variation of blood pressure in 57 patients with coronary artery disease (CAD). In addition, we studied the modification of the circadian blood pressure variation during treatment with antianginal medications in 20 patients with CAD. A marked diurnal periodicity (p < 0.05) was observed for the onset of MI, with peaks seen in the late morning, late evening, and very early morning. The blood pressure in the patients with CAD was elevated in the morning, reduced in the late evening, and was the lowest in the very early morning. The peaks of onset of infarction temporally corresponded to the characteristic feature of blood pressure profile observed in the patients with CAD, that is, the morning rise, the late evening decline, and the very early morning reduction. Antianginal medications significantly reduced the blood pressure, not only during the day (p < 0.02) but also at night (p < 0.05). These observations suggest that the decline in blood pressure, as well as the morning surge in blood pressure, may be closely related to the onset of MI. Therefore, when treating patients with CAD with antianginal medications which can potentially reduce blood pressure, the effects on the circadian variation of blood pressure should be considered.
Changes in pulmonary hemodynamics predict benefits in exercise capacity after ACE inhibition in patients with mild to moderate congestive heart failure
Authors: Pelliccia Francesco , Borghi Alberico , Ruggeri Augusto , Cianfrocca Cinzia , Morgagni Gian L. , Bugiardini Raffaele 
Published: February 2009

AbstractSeveral causes may affect the efficacy of angiotensin‐converting enzyme (ACE) inhibitors in congestive heart failure (CHF). The present study was undertaken to identify what factors might predict benefits in exercise capacity after ACE inhibition in 22 patients with mild to moderate CHF. All patients underwent hemodynamic evaluation before and following an oral dose of quinapril (20 mg). They were then treated daily with 20 mg of quinapril and underwent exercise stress test off‐drugs 1 day and 6 months later. Patients were grouped according to their relative changes in vascular resistances after quinapril: Group A (n=15) showed a greater decrease in pulmonary vascular resistance (PVR) than in systemic vascular resistance (SVR) (%ΔPVR/%ΔSVR>1). The opposite occurred in Group B (n = 7). Comparison of pretreatment baseline features revealed that the two groups had similar biochemical and hormonal variables, cardiac index, and SVR. Conversely, Group A patients had higher (p<0.05) pulmonary artery pressure and PVR compared with Group B patients. Following quinapril, Group A patients showed a greater (p<0.05) increase in cardiac index than Group B patients, despite a similar reduction in SVR. Accordingly, 1‐day drug treatment significantly (p<0.001) increased exercise duration in Group A (+29%), but not in Group B patients (+7%). Benefits in exercise capacity were still significant (p<0.001) 6 months later. It is concluded that (1) ACE inhibitors may significantly increase exercise capacity in most but not all CHF patients; (2) these salutary effects occur predominantly in patients with abnormal pulmonary hemodynamics; (3) although there are many possible mechanisms by which these drugs may benefit CHF, these data favor the effects on veins and/or pulmonary vasculature as being the most clinically important factor.
Structural and dynamic changes in the elastic arteries due to arterial hypertension and hypercholesterolemia
Authors: Alva Felix , Samaniego Virginia , Gonzalez Vidal , Moguel Rafael , Meaney Eduardo 
Published: February 2009

AbstractFive groups of 20 patients each were studied to analyze the vascular dynamics and structure of the elastic arteries. Group I consisted of healthy young individuals (27±4 years); Group II of healthy adults (46±9 years); Group III of normotensive hypercholesterolemic adults (45±12 years and serum cholesterol >239 mg/dl); Group IV of hypertensive normocholesterolemic adults (56±13 years); and Group V of hypertensive hypercholesterolemic adults (56±9 years). The differential arterial pressure was estimated and divided by the volume change (delta P/delta V) of the aorta and the carotid and brachial arteries. The volume change was calculated using the “cylinder formula,” measuring the radius from the ultrasonographic vessel image and assigning the cylinder a height of 1 cm. The A/E index of the Doppler transmitral spectrum and the maximum velocity flow using Doppler in the above arteries were calculated. The presence of carotid atherosclerosis was observed and given an arbitrary scoring grade of 0, 1, or 2. A higher arterial and ventricular stiffness was found in the hypertensive patients regardless of the presence of hypercholesterolemia. A higher fall in Doppler velocity and an increase in atherosclerosis lesions were found in Group V. Based on the results of this study, it was concluded that vascular and left ventricular stiffness have a close relationship with arterial hypertension but not with hypercholesterolemia. The hypercholesterolemic patients had a higher prevalence of carotid atherosclerosis and a higher scoring grade of severity.
Concomitant occurrence of a left atrial myxoma and an adenocarcinoma of the lung
Authors: Canver Charles C. , Plehn Jonathan F. 
Published: February 2009

AbstractA 72‐year‐old previously healthy woman was found to have both a left atrial myxoma and a left lung mass during the evaluation for two cerebrovascular events. Resection of the atrial myxoma and a biopsy of the left lung mass were performed. Six weeks later she underwent a left upper lobectomy for adenocarcinoma of the lung. This case illustrates the concomitant occurrence of a left atrial myxoma and a primary lung cancer in a patient who underwent a successful staged treatment for both diseases.
Patterns of radiofrequency catheter ablation of left free‐wall accessory pathways: Implications for accessory pathway anatomy
Authors: Tai Yau‐Ting , Lau Chu‐Pak 
Published: February 2009

AbstractDespite the abundance of literature on the electrophysiology of accessory pathways, clinical data on their anatomic properties remain infrequent. The small and discrete nature of lesions generated by radiofrequency (RF) energy may allow better characterization of accessory pathway anatomy in the intact heart. RF catheter ablation was performed on 40 left free‐wall accessory pathways in 39 consecutive patients with a unipolar endocardial approach. The patterns of accessory pathway ablation were identified. Spatial‐electrophysiologic information provided by the ablation catheter at individual sites of RF application and corresponding data from the coronary sinus catheter were correlated with the effects of RF energy on accessory pathway conduction. Of 39 accessory pathways permanently (n = 37) or transiently (n = 2) ablated, 24 had “simple” ablation, with abolition of conduction by one individual RF application. In 15 of 24 pathways that could be crossed by the coronary sinus catheter, the concordance in anatomic and electrophysiologic information between the site of earliest retrograde atrial activation and the effective ablation position (ventricular approach) suggested a perpendicular fiber course. Fifteen pathways had “complex” ablations; of these, eight had spatial‐electrophysiologic discordance between the atrial and ventricular insertions, suggesting an oblique fiber orientation. Seven pathways had modification or transient suppression of conduction, with or without subsequent abolition of conduction at identical or physically disparate (1 cm apart) sites; four pathways had sequential ablation of antegrade and retrograde conduction. These raised possibilities of broad fiber span and functional longitudinal dissociation of accessory pathway conduction. Accessory pathways with simple and complex ablations did not differ in clinical and electrophysiologic parameters. Complex ablations demanded more lengthy and difficult procedures. In conclusion, 38% of left free‐wall accessory pathways in this series had complex patterns of RF ablation. The results of this study raised interesting implications in regard to accessory pathway anatomy and provided information that might facilitate electrophysiologic guidance of RF accessory pathway ablation.
Diagnosis of papillary muscle rupture after acute myocardial infarction by transthoracic and transesophageal echocardiography
Authors: Zotz Rainer J. , Genth Sabine , Erbel Raimund , Meyer Jorgen , Dohmen Guido 
Published: February 2009

AbstractThe sensitivity of transthoracic echocardiography to visualize the structural abnormality of papillary muscle rupture (PMR) after acute myocardial infarction can be anticipated to average about 50%; therefore, we evaluated five patients exhibiting the condition with both transthoracic and transesophageal echocardiography. The use of the two imaging techniques resulted in the fact that no instance of PMR was missed. Using transthoracic echocardiography in two patients and transesophageal echocardiography in four, the ruptured papillary muscle was visualized directly. Mitral insufficiency as an indirect sign was observed in all patients. In one patient the papillary muscle rupture developed in a mitral valve previously affected by endocarditis. All patients underwent mitral valve replacement and coronary artery bypass grafting. The diagnosis was confirmed at surgery in all patients. Four patients died in hospital, the fifth 5 months later. We recommend that transesophageal echocardiography be performed in patients with suspected PMR if transthoracic echocardiography does not provide an unequivocal diagnosis.
Torsade de pointes
Authors: Roden Dan M. 
Published: February 2009

AbstractThe polymorphic ventricular tachycardia torsade de pointes can occur in the congenital long QT syndromes or as a consequence of therapy with QT‐prolonging drugs. The latter can include not only antiarrhythmic drugs such as quinidine, but also a number of drugs which are not usually considered to have major cardiovascular effects: these include nonsedating antihistamines, such as terfenadine; antibiotics such as erythromycin; and neuroleptics such as thioridazine. The electrocardiographic hallmark of both the congenital and acquired forms of the long QT syndrome is marked QT(U) lability, particularly as a function of heart rate. The underlying mechanism is thought to be triggered activity arising as a consequence of early afterdepolarizations. An understanding of the basic mechanism has led to an understanding of the effective forms of therapy, which include maneuvers to include the heart rate (pacing, isoproterenol) as well as maneuvers which may not necessarily alter the QT interval but may prevent the arrhythmia (magnesium, beta blockers). Intensive study of the clinical features and basic mechanisms underlying torsade de pointes has led to the definition of a new mechanism for cardiac arrhythmias; understanding such mechanisms may ultimately lead to the development of safer antiarrhythmic therapy.
Coronary artery bypass grafting for left main trunk coronary artery lesion associated with essential thrombocythemia
Authors: Momiyama Takuya , Hiranaka Toshiyuki , Nomura Fumikazu , Tominaga Harumi , Nishioka Takehiko 
Published: February 2009

AbstractEffort angina due to left main trunk (LMT) lesion was diagnosed in a 58‐year‐old man. Platelet count was markedly increased and essential thrombocythemia was also diagnosed. Because of LMT disease, coronary artery bypass grafting (CABG) was performed prior to medication for essential thrombocythemia. There were no complications during the operation or in the early postoperative period. Melphalan was administered postoperatively resulting in the decrease of platelet count. Postoperative coronary angiography demonstrated that both grafts were patent; however, immediately after coronary angiography, the patient suffered from a sudden onset of myocardial infarction and cerebral infarction. The therapeutic problems associated with hematological disorder in such patients are discussed in this report.
Coronary anomalies: Incidence and importance
Authors: Ciesunski G. , Rapprich B. , Kober G. 
Published: February 2009

AbstractMost patients with coronary anomalies are asymptomatic. The knowledge of those variations could be important in regard to invasive catheter treatment or bypass surgery. In a retrospective study, the angiographic findings based on 4, 016 patients (1985‐1989) were analyzed concerning coronary anomalies and malformations. Of the patients studied, 39 (0.97%) had coronary anomalies, and in 26 of these patients it was an anomalous circumflex branch. In 14 cases, the circumflex branch arose from a separate origin in the left aortic sinus. In 11 patients the origin was from the proximal segment of the right coronary artery. A singular coronary artery was found in five patients, originating from the right aortic sinus in two patients and from the left aortic sinus in three patients. An origin of the left coronary artery from the pulmonary artery, a coronary fistula, or an origin of the left anterior descending coronary artery from the RCA could be found in only one patient. Unexpected findings during invasive procedures would suggest a possibly existing coronary anomaly, especially when main branches cannot be opacified by selective contrast medium injection.
SIN‐1 has no direct myocardial anti‐ischemic action
Authors: Kober G. , Bender M. , Vallbracht C. , Sievert H. , Klepzig H. 
Published: February 2009

AbstractAnti‐ischemic drugs may develop their cardiac activity via peripheral (reduction in preload and/or afterload) or cardiac (coronary vasculature, myocardial cell metabolism) effects. The aim of the study was to investigate whether SIN‐1, the active metabolite of molsidomine, develops a direct myocardial anti‐ischemic property. Three groups of seven patients each were treated with 0.4 mg SIN‐1 administered via either the intracoronary (IC) or intravenous (IV) route, or with placebo in a double‐blind randomized investigation. SIN‐1 had no influence on either the ischemic parameters in the surface electrocardiogram (ECG) or the intracoronary ECG. There was also no change in peripheral or central hemodynamics or in the severity of angina following this low IC or IV dosage. There is no evidence of a direct myocardial anti‐ischemic response of SIN‐1. The well known anti‐ischemic activity of SIN‐1 or molsidomine has to be attributed to the proven peripheral and cardiac vascular responses.
Echocardiographic study of left atrial thrombi in mitral stenosis
Authors: Conradie C. , Marx J. D. , Schall R. 
Published: February 2009

AbstractSixty‐nine patients with predominant mitral stenosis were examined by echocardiographic means to detect the presence of left atrial thrombi. Forty‐nine of these patients were in sinus rhythm and twenty in atrial fibrillation. Four percent of patients in the sinus rhythm group and 45% of those in the atrial fibrillation group had left atrial thrombi. The two risk factors identified for left atrial thrombi in mitral stenosis were atrial fibrillation and left atrial enlargement.
An integrated software system for quality assurance‐related kappa coefficient analysis of intraoperative transesophageal echocardiography interpretive skills
Authors: Rafferty T. , Edwards B. , Judd J. , Swamy V. , Workman R. , Lippmann H. , Harris S. , Cohen I. , Prokop E. , Ezekowitz M. 
Published: February 2009

AbstractThis report describes the development of a quality assurance‐oriented integrated software system designed for an anesthesiology‐based intraoperative transesophageal echocardiography service. Entry data include patient and operation demographics, two‐dimensional echocardiographic, saline‐contrast, and color flow/pulsed Doppler assessments of the heart and great vessels, presented in a defined sequence. A statistical analysis component (kappa coefficient analysis) allows for comparison of intraoperative real‐time interpretations with laboratory interpretations made by experienced full‐time echocardiographers on a field‐by‐field basis. This provides a means of quantifying expertise in each individual aspect of the patient examination sequence. We believe that such self‐appraisal data are essential for delineating the status and tracking the progress of service being provided.
Quality of life and circadian variation of heart rate and heart rate variability in short‐term survivors and nonsurvivors after acute myocardial infarction
Authors: Kümmell Hans Christoph , Van Leeuwen Peter , Heckmann Christian , Engelke Peter , Resting Gisela , Kremer Heidemarie , Becher Andreas 
Published: February 2009

AbstractThe purpose of this study was the simultaneous examination of the quality of life and changes in heart rate (HR) variables of patients immediately following acute myocardial infarction (AMI). Quality of life, estimated on a rating scale assessing the patients' well‐being, as well as the circadian rhythm of their HR and HR variability, were determined within the first 3 days and at approximately 3 weeks after admission and the results were related to survival. The quality of life within the first 3 days post AMI was low in both the surviving (n = 42) and the nonsurviving (n = 5) patients but only the scores of the survivors increased significantly over the following three weeks. The HR of the survivors, initially lower than that of the nonsurvivors, decreased significantly at 3 weeks and a normal circadian pattern had developed. The HR variability of the survivors within the first 3 days was significantly higher than that of the nonsurvivors and had developed a clear circadian pattern after 3 weeks. It is concluded that in patients with AMI such diverse clinical aspects as quality of life and circadian patterns of HR and HR variability can be assessed meaningfully immediately post AMI and may find common expression in changes in sympathovagal balance.
Evolution of cardiac changes in young insulin‐dependent (type 1) diabetic patients—one more piece of the puzzle of diabetic cardiopathy
Authors: Raev Dlmitar Christov 
Published: February 2009

AbstractBased on our recent reports that increased myocardial contractility has been found in newly diagnosed diabetic patients, and that diastolic (D) dysfunction precedes systolic (S) dysfunction, we suggested that the development of diabetic cardiopathy passes through the following stages: (I) increased myocardial contractility, (II) intact S and D function, (III) intact S function and D dysfunction, and (IV) S and D dysfunction. The aim of this pilot study was to test this hypothesis. One hundred fifty‐seven young (26.2 ± 7.4 years) cardiac‐asymptomatic patients with type 1 diabetes and 54 healthy subjects were studied using M‐mode echocardiography. The presence of at least one of the variables for systolic function (ejection fraction, mean velocity of circumference, fiber shortening, and stroke index) or diastolic function [left atrium emptying index (LAEI), EFo slope of anterior mitral leaflet, and isovolu‐metric relaxation time (IRT)] outside the control mean ± 2 SD was interpreted as an increased or depressed myocardial contractility, and diastolic dysfunction, respectively. The severity of diabetic complications (retinopathy, nephropathy, and cardiac autonomic neuropathy) was evaluated by the diabetic complication index (DCI=0 + 6 scores). Our hypothesis was confirmed significantly (p< 0.001) in 148 (94%) patients with diabetes. Duration of diabetes and DCI progressed significantly (ANOVA: F = 36.6, p<0.001; F=70.8, p<0.001) with hypothetical stages. Diastolic dysfunction was more pronounced in stage IV than in stage HI: IRT (80.5 ± 18.6 ms vs. 62.5 ± 16.4, p<0.001), EFo (63 ± 15 mm/s vs. 72 ± 21, p<0.05), LAEI (0.58 ± 0.13 vs. 0.8 ± 0.15, p < 0.001). End‐diastolic volume/LV muscle mass ratio was reduced in stage III (0.73 ±0.16 ml/g) compared with the control value (0.83 ± 0.17, p < 0.01), but was higher than that in stage IV (0.65 ± 0.16, p < 0.05). The left atrium in stage HI (18.2 ± 3.7 mm/m2) was dilated compared with the control value (16.2 ± 3.3, p < 0.01) and more dilated in stage IV (19.6 ± 3.1, p<0.001).The present study demonstrates the following stage development of specific diabetic cardiac changes: (I) increased myocardial contractility; (II) intact S and D function; (III) initial D dysfunction, LV restriction and LA dilation with normal S function; and (IV) progression of the previous changes and appearance of S dysfunction.
Cor pulmonale caused by recurrent pulmonary emboli
Authors: Hackel Donald B. , Peter Robert H. , Wagner Galen S. 
Published: February 2009

AbstractA 53‐year‐old black man developed femoral thrombophlebitis in 1983 following a Harrington nail implantation in his first lumbar vertebral region. There was evidence of pulmonary embolization at that time and recurrently until he developed ventricular fibrillation and died in 1987. The terminal event followed a hypotensive episode during the course of a right ventricular catheterization. Autopsy confirmed the clinical impression that he had multiple recurrent thromboemboli to his lungs. After several years of embolization, the pulmonary arterial circulation was sufficiently occluded to result in pulmonary hypertension. Cor pulmonale was produced, with congestive heart failure leading to a progressively downhill course in the 4 months before his death.
Thrombolytic retreatment with tissue plasminogen activator for threatened reinfarction and thrombotic coronary reocclusion
Authors: Becker Richard C. 
Published: February 2009

AbstractFollowing successful coronary arterial thrombolysis, thrombogenic substrate persists, increasing the risk of recurrent thrombosis, reocclusion, and reinfarction. The preferred treatment in this setting has not been established. Although many patients receive mechanical revascularization, it is conceivable that repeat thrombolysis. primarily with tissue plasminogen activator, represents the most readily available and effective alternative.