bluuebunny/crossref_metadata_2025_split huggingface dataset:
Primary percutaneous interventions for acute myocardial infarction in octogenarians: A single‐center experience
Authors: Skelding Kimberly A. , Mehta Laxmi S. , Pica Mark C , Finta Bohuslav , Shoukfeh Mazen , Grines Cindy L. , O'Neill William W. , Kahn Joel K. 
Published: June 2007

AbstractBackground: The majority of cardiovascular deaths occur in the elderly. The safety and results of primary infarct intervention in octogenarians is Not well characterized.Hypothesis: The purpose of this study was to compare the results of primary infarct intervention in octogenarians with those in younger patients during 1997‐1998 and to compare these results to those obtained in octogenarians treated in 1991‐1994.Methods: During 1997‐1998, 40 octogenarians were treated with primary infarct intervention and were compared with 60 randomly selected patients aged < 80 years treated during the same time period. The results in octogenarians were compared with the results in a group of 37 patients of similar age treated in 1991‐1994. The baseline characteristics, procedural results, and hospital outcome were obtained from a prospectively designed interventional database at a busy single‐center program.Results: There was No significant difference in hospital survival between the two groups of patients treated in 1997‐1998 although there was a trend toward higher mortality in the octogenarian group. Length of stay and use of intra‐aortic balloon pumps were greater in the octogenarian group. When the results in octogenarians treated in 1997‐1998 were compared with the group of 37 patients treated in 1991‐1994, the hospital mortality declined from 27 to 10% (p = 0.05).Conclusions: There has been improvement in hospital mortality over the past decade for patients aged ≥ 80 years treated with primary infarct intervention. Hospital resources and length of stay are greater for the octogenarian group. Ongoing research studies are comparing the results of thrombolytic therapy and primary intervention in aged patients.
Characteristics of cardiac myxoma with constitutional signs: A multicenter study in Japan
Authors: Endo Akihiro , Ohtahara Akira , Kinugawa Toru , Ogino Kazuhide , Hisatome Ichiro , Shigemasa Chiaki 
Published: June 2007

AbstractBackground: A relationship between constitutional signs in patients with cardiac myxoma and interleukin‐6 has been Noted. However, there is little information about characteristics of cardiac myxomas associated with constitutional signs.Hypothesis: The objective of this study was to clarify the characteristics of myxoma patients who had constitutional signs.Methods: Questionnaires were sent to cardiology or cardiovascular surgery divisions at university hospitals throughout Japan. Constitutional signs were considered present when a patient had fever, weight loss, or elevations of C‐reactive protein or gammaglobulin. In addition, interleukin‐6 concentrations were evaluated in some patients.Results: Data were obtained in 249 patients with primary cardiac tumors (204 myxomas, 15 other primary benign tumors, and 30 primary malignant tumors), confirmed histologically between 1993 and 1996. Fever and weight loss were observed in 15 and 6% of patients with myxoma, respectively, while C‐reactive protein and gammaglobulin were increased in 39 and 21%, respectively. This amounted to a prevalence of constitutional signs in 49%. All constitutional signs disappeared after tumor resection. Age, gender, tumor site, and frequency of thrombosis did Not differ between patients with and without constitutional signs. Tumors associated with constitutional signs were significantly more likely to be large, multiple, or recurrent than those unassociated with constitutional signs.Conclusions: Constitutional signs are present in about half of patients with myxoma. Large or multicentric tumors are likely to induce constitutional signs, which are reversible upon resection. These might suggest that constitutional signs result when interleukin‐6 concentrations exceed a certain threshold.
Limitation of infarct size and ventricular remodeling in patients with completely reperfused anterior acute myocardial infarction—the potential role of ischemia time
Authors: Miura Hiroshi , Kiuchi Kaname , Nejima Jun , Takano Teruo 
Published: June 2007

AbstractBackground: Experimental studies suggest that coronary reperfusion does not result in appreciable myocardial salvage beyond 3 to 4 h.Hypothesis: The present study was undertaken to examine the potential role of ischemia time as a determinant of infarct size and cardiac function in humans.Methods: Ninety patients (69 men, 21 women, aged 61 ± 1 years) presented within 24 h of onset of a first anterior infarct had ST‐segment elevation on electrocardiogram. All patients underwent coronary intervention within 24 h of onset of symptoms and obtained complete reperfusion of the infarct‐related artery.Results: Infarct size expressed as a percentage of the area at risk (IS/RA) and left ventricular end‐diastolic volume (LVEDV) were significantly (p < 0.017) smaller and left ventricular ejection fraction (LVEF) assessed by left ventriculography (35 ± 4 days) was significantly higher in patients treated within 4 h after onset (IS/RA:55 ± 4%, LVEDV: 127 ± 7 ml, LVEF: 62 ± 2%) than in those treated 4 to 12 h (97 ± 2%, 140 ± 13 ml, 52 ± 3%) and 12 to 24 h (93 ± 2%, 163 ± 14 ml, 49 ± 5%) after symptom onset. Left ventricular end‐diastolic volume was significantly smaller in patients treated 4 to 12 h after onset than in those treated 12 to 24 h after onset.Conclusions: Patients with < 4 h of myocardial ischemia exhibited significant myocardial salvage and better left ventricular function and patients with 4 to 12 h of myocardial ischemia exhibited significantly smaller LVEDV than those with more prolonged ischemia, although there was no difference in final infarct size.
Exercise capability and myocardial perfusion in chronic angina patients treated with enhanced external counterpulsation
Authors: Tartaglia J. , Stenerson J. , Charney R. , Ramasamy S. , Fleishman B. L. , Gerardi P. , Hui J. C. K. 
Published: June 2007

AbstractBackground: Enhanced external counterpulsation (EECP) has been shown to improve treadmill times and myocardial perfusion. However, improvement in perfusion defects has been demonstrated only in patients exercised to the same cardiac workload on the post‐EECP as the pre‐EECP stress test.Hypothesis: This study was to determine the effect of EECP on exercise capacity and myocardial perfusion by comparing results of maximal exercise radionuclide testing pre‐ and post‐EECP treatment.Methods: This prospective study included 25 patients with angina who had performed maximal symptom‐limited exercise tolerance tests (ETT) with Bruce protocol and radionuclide perfusion single‐photon emission computed tomography (SPECT) study prior to and at completion of EECP treatment.Results: After 35 h of EECP, 23 patients (93%) improved by at least one functional angina class. There is a significant improvement in their total treadmill times (357 ± 93 to 449 ± 97 s, p < 0.001). There was a significant change in their peak double products, from 18,891 ± 3,939 pre‐EECP to 20,464 ± 4,305 post‐EECP ETT (p < 0.03). Pre EECP, 16 patients had ST‐segment depression on their initial ETT. After EECP, 13 of these patients (80%) either no longer had ST depression or had a significant increase in their time to ST depression (229 ± 52 to 315 ± 60 s, p < 0.001). The radionuclide perfusion scores also showed a significant reduction in ischemic segments (16.36 ± 10.52 to 14 ± 10.9, p < 0.05).Conclusions: Patients treated with EECP demonstrated a reduction in angina symptoms, improvement in exercise capacity, increase in time to ST‐segment depression, and decrease in perfusion defects despite performing at a higher workload.
Modulating atherosclerosis through inhibition or blockade of angiotensin
Authors: Rosenson Robert S. 
Published: June 2007

AbstractAngiotensin‐converting enzyme (ACE) inhibitors are well recognized for their benefits in treating hypertension and congestive heart failure and preventing postmyocardial infarction heart failure or left ventricular (LV) dysfunction. Recently, blockade of the angiotensin II type 1 (AT1) receptor was shown to reduce cardiovascular events in hypertensive subjects with LV hypertrophy. Several lines of evidence are now converging to show that ACE inhibitors may affect the atherosclerotic process itself. Emerging clinical data indicate that angiotensin‐receptor blockers (ARBs) may possibly modulate atherosclerosis as well. The antiatherogenic properties of ACE inhibitors and ARBs may derive from inhibition or blockade of angiotensin II, now recognized as an agent that increases oxidative stress. Angiotensin‐converting enzyme inhibition and angiotensin‐receptor blockade also increase endothelial nitric oxide formation, which improves endothelial function. In contrast to the effects of ARBs, the vascular effects of ACE inhibitors may, in part, be mediated by an increase in bradykinin. This article reviews some of the biologic mechanisms whereby ACE inhibitors and ARBs may modulate atherosclerosis.
Increased TIMI frame counts in cocaine users: A case for increased microvascular resistance in the absence of epicardial coronary disease or spasm
Authors: Kelly Russell F. , Sompalli Vineel , Sattar Payman , Khankari Kishore 
Published: June 2007

AbstractBackground: Cocaine produces adverse cardiovascular effects, some of which cannot be explained by epicardial coronary artery disease (CAD) or spasm.Hypothesis: The hypothesis of this study was that cocaine users would have increased coronary microvascular resistance, even in the absence of recent myocardial infarction (MI), CAD, or spasm.Methods: Microvascular resistance was assessed by the corrected Thrombolysis in Myocardial Infarction (TIMI) frame count (cTFC) method in a consecutive series of 59 cocaine users without acute or recent MI or angiographically significant epicardial stenosis (> 50%) or spasm. The cTFCs in these patients were compared with 21 normal controls and with published normal cTFC values.Results: The cTFC was significantly elevated (by 26‐54%) in cocaine users. The cTFCs in the left anterior descending (LAD), circumflex (LCx), and right coronary (RCA) arteries in cocaine users were 30.0 ± 10.9, 34.1 ± 11.5, and 28.6 ± 11.8, respectively, compared with values in normal controls of 21.3 ± 4.3 (p = 0.001), 24.4 ± 7.2 (p = 0.001), and 22.7 ± 5.1 (p = 0.04), respectively, and published normal cTFC values (all p < 0.01). An abnormally high cTFC was present in 61% of patients in the LAD, 69% in the LCx, and 47% in the RCA.Conclusions: Markedly decreased coronary blood flow velocity, indicating increased microvascular resistance, is present in cocaine users, even in the absence of acute or recent MI, or significant epicardial CAD or spasm. Increased microvascular resistance may explain many important cardiovascular manifestations of cocaine use and has therapeutic implications. Slow coronary filling may also suggest the possibility of cocaine use in patients in whom it was not otherwise suspected.
Association of cholesterol levels and occurrence of angiographically detectable endothelial disruption during coronary angioplasty
Authors: Rubboli Andrea , Euler David E. , Sangiorgio Pietro , Casella Gianni , La Vecchia Luigi , Fontanelli Alessandro , Bracchetti Daniele 
Published: June 2007

AbstractBackground: Disruption of the atherosclerotic plaque is a common feature of both acute coronary syndromes and balloon dilatation of coronary artery stenoses.Hypothesis: The study was undertaken to evaluate whether the known association of cholesterol levels and acute coronary syndromes also exists for the occurrence of angiographically detectable endothelial disruption (ED) following coronary angioplasty.Methods: For this purpose, we examined 79 consecutive patients (men/women 58/21; mean age: 62 ± 11 years), with a noncalcified, de novo, significant stenosis in a single native coronary artery, undergoing elective coronary intervention because of stable effort angina. Coronary angioplasty was performed using regular balloon catheters, aiming for a balloon/ artery ratio of 1, with stent implantation allowed only provisionally. Following balloon dilatation, patients were divided into two groups according to the presence or absence of angio‐graphically detectable ED.Results: Endothelial disruption occurred in 28 patients (35%). The two groups with and without ED were comparable with respect to clinical, angiographic, and procedural parameters. A history of hypercholesterolemia was significantly more frequent in patients with ED (93 vs. 2%; p < 0.001). Total and low‐density lipoprotein (LDL) cholesterol levels were significantly higher in the group with ED (230.1 ± 46.5 vs. 204.4 ± 30.2 mg/dl, p < 0.05; and 150.6 ± 39.2 vs. 125.8 ± 26 mg/dl, p < 0.03, respectively). A cut‐off value of LDL cholesterol ≥135 mg/dl identified patients at higher risk of developing ED.Conclusion: High cholesterol levels appear to favor the occurrence of ED during coronary angioplasty. Aggressive lipid‐lowering therapy and a more careful procedural approach may be warranted in patients with hypercholesterolemia undergoing coronary interventions in order to decrease the occurrence of ED and the associated clinical (acute ischemia) and procedural (stent implantation) consequences.
Measuring treatment effects of Cilostazol on clinical trial endpoints in patients with intermittent claudication
Authors: Smith James A. M. 
Published: June 2007

AbstractIntermittent claudication (IC) comprises the most common presenting symptoms of peripheral arterial disease (PAD), which itself is a manifestation of systemic atherosclerosis. Typical symptoms of IC are aching pain, numbness, and fatigue in the lower extremities. Symptoms are induced by walking or exercise and usually resolve with rest. The cornerstone of treating IC is risk‐factor reduction and a supervised exercise regimen. Pharmacotherapy specifically indicated for the treatment of IC includes a new drug, cilostazol, and the traditional drug, pentoxifylline. Cilostazol also has antiplatelet, antithrombotic, and vasodilatory activity, as well as a positive effect on serum lipids. Eight multicenter clinical trials, seven in the U.S. and one in the U.K., used objective and subjective clinical endpoints to assess the treatment efficacy of cilostazol. Objective endpoints included maximal and pain‐free walking distance (MWD and PFWD, respectively), the ankle‐brachial index, peripheral hemodynamic measurements, and serum lipid levels. Subjective endpoints, assessed by patient questionnaires, included perceived functional status and health‐related quality of life. Cilostazol treatment showed statistically significant increases in MWD and PFWD within 4 weeks, as well as improvements in physical functional status at 24 weeks, compared with placebo and pentoxifylline. Increases in high‐density lipoprotein cholesterol and decreases in plasma triglycerides were also noted. Subjective assessments appeared to match objective parameters.
A comparison of treadmill scores to diagnose coronary artery disease
Authors: Fearon William F. , Gauri Andre J. , Myers Jonathan , Raxwal Vinod K. , Atwood J. Edwin , Froelicher Victor F. 
Published: June 2007

AbstractBackground: Recently, several treadmill scores have been proposed as means for improving the diagnostic accuracy of the exercise treadmill test (ETT). Questions remain regarding the diagnostic accuracy of treadmill scores when applied to a different patient population than that from which they were derived; furthermore, many treadmill scores have not been compared with one another in the same population.Hypothesis: The diagnostic accuracy of treadmill scores may not be the same.Methods: A retrospective analysis of data collected prospectively was performed on consecutive patients referred for evaluation of chest pain. All patients underwent a standard ETT followed by coronary angiography. Using angiographic evidence of coronary artery disease (CAD) as a reference, the area under the curve (AUC) of receiver operator characteristic (ROC) plots of the ST response alone, the Duke Treadmill Score (DTS), the Morise score, the Detrano score, the VA score, and a Consensus score consisting of the Morise, Detrano, and VA scores together were calculated and compared. The predictive accuracies of the DTS and the Consensus score to stratify patients for the likelihood of CAD were calculated and compared.Results: In all, 1,282 patients without a prior myocardial infarction had an ETT and coronary angiography. The AUC (± standard error) was 0.67 ± 0.01 for the ST response, 0.73 ± 0.01 for DTS, 0.76 ± 0.01 for Detrano score, 0.77 ± 0.01 for Morise score, 0.78 ± 0.01 for VA score, and 0.78 ± 0.01 for Consensus score. The AUC for each treadmill score was significantly higher (z‐score > 1.96) than for the ST response alone. The AUC of DTS was significantly lower than all other treadmill scores (z‐score > 1.96). The predictive accuracy (± 95% confidence interval) of the DTS to risk stratify patients into high and low likelihood for CAD was 71 (65‐77)%, versus 80 (74‐86)% for the Consensus score (p < 0.0001).Conclusion: In this population, the DTS remains useful for diagnosing CAD and stratifying for the likelihood of CAD, although it is less accurate than other treadmill scores.
Exaggerated carotid sinus massage responses are related to severe coronary artery disease in patients being evaluated for chest pain
Authors: Tsioufis Costas P. , Kallikazaros Ioannis E. , Toutouzas Konstantinos P. , Stefanadis Christodoulos I. , Toutouzas Pavlos K. 
Published: June 2007

AbstractBackground: Previous studies have reported that carotid sinus massage responses are associated with advancing age and carotid or coronary artery disease.Hypothesis: This study was undertaken to investigate the potential role of carotid sinus hypersensitivity as a marker for the presence of coronary artery disease, and especially left main stem disease, in patients who were referred for evaluation of chest pain.Methods: Toward this end, carotid sinus stimulation with simultaneous recordings of the electrocardiogram and aortic pressure was performed before coronary arteriography in 150 selected consecutive patients (mean age 59.4 ± 9 years) who were referred for evaluation of chest pain.Results: Coronary artery disease was present in 118 patients (78.7%); of these, 35 had single‐vessel disease, 35 had double‐vessel disease, 33 had triple‐vessel disease, and 15 had left main stem with or without such vessel disease. Carotid sinus hypersensitivity was found in 40 patients (26.6%). The incidence of hypersensitivity in patients with single‐, double‐, or triple‐vessel disease and left main stem disease was 8.5, 14.2, 57.5, and 73.3%, respectively. Stepwise multiple logistic regression analysis revealed that left main stem disease was significantly and independently related to the presence of carotid sinus hypersensitivity (p < 0.05). In addition, the presence of hypersensitivity had 73.3% sensitivity, 86.2% specificity, and 96.3% negative predictive value for the presence of left main stem disease.Conclusion: In patients being evaluated for suspected ischemic heart disease, carotid sinus massage responses are related to severe coronary disease. The absence of hypersensitivity may reflect absence of left main stem disease.
Conjugated estrogen administration improves common carotid artery elastic properties in normotensive postmenopausal women
Authors: Kallikazaros Ioannis , Tsioufis Costas , Zambaras Panagiotis , Stefanadis Christodoulos , Toutouzas Pavlos 
Published: June 2007

AbstractBackground: Various vascular effects of estrogens have been proposed to explain further the beneficial effect of replacement therapy in cardiovascular events.Hypothesis: The study was undertaken to assess the effect of conjugated estrogen on the elastic properties of the large arteries innormotensive, healthy, postmenopausal women.Methods: Toward this end, we investigated the acute effect of conjugated estrogen on the elastic properties of the common carotid artery (CCA) in 20 normotensive, healthy, postmenopausal women (age 54 ± 3 years) at baseline and 20 min after the intravenous administration of 1.25 mg conjugated estrogens. The CCA distensibility was derived by a combination of surface ultrasonographic data and simultaneous blood pressure measurements at the brachial artery. The carotid pulsatility index, a measure of brain impedance, was determined electronically by tracing the CCA Doppler waveform.Results: At baseline, CCA distensibility had a negative correlation with both patients' age and time since menopause (r= −0.57andr= −0.48, p< 0.05 for both cases). After estrogen administration, estradiol and estrone plasma levels were restored to the range of usual premenopausal values. Estrogen induced a significant increase in CCA distensibility by 0.92 ± 0.005 dyne−1 · cm2 · 10−6 (from 2.03 to 2.95 dyne−1 · cm2 · 10−6) and a significant reduction in CCA pulsatility index by 0.24 ± 0.06, (from 2.17 to 1.93) (p<0.001 for both cases). The improvement in CCA distensibility had a negative correlation with both patients' age and time since menopause (r=−0.46 and r=−0.44, respectively, p< 0.05 forboth cases).Conclusions: Acute conjugated estrogen administration induced an improvement in CCA elasticity and a reduction in brain impedance in normotensive, postmenopausal women. As the age of women and the time since menopause increased, the improvement in carotid distensibility decreased in such selected subjects.
Detection of occult left ventricular dysfunction in patients without prior clinical history of myocardial infarction by technetium‐99m sestamibi myocardial perfusion gated single‐photon emission computed tomography
Authors: Yao Siu‐Sun , Nichols Kenneth , DePuey E. Gordon , Rozanski Alan 
Published: June 2007

AbstractBackground: In the absence of a prior history of myocardial infarction (MI), left ventricular (LV) dysfunction is commonly due to hypertension, valvular heart disease, or hibernating myocardium.Hypothesis: Since technetium‐99m sestamibi gated single‐photon emission computed tomography (SPECT) may be used to determine both stress/rest myocardial perfusion and resting LV function, we attempted to evaluate the ability of gated SPECT imaging to detect occult LV dysfunction.Methods: We evaluated the ability of this technique to detect occult LV dysfunction among 179 patients without history MI and angiographically documented coronary artery disease (CAD). All patients underwent both gated SPECT and cardiac catheterization within a 6‐month time period. Left ventricular volume and ejection fraction (EF) values were determined according to a previously validated technique using Simpson's rule. Normal limit values for LV volumes and EF were derived from a control population of 93 patients with normal coronary angiograms.Results: Based on normal limit‐derived criteria, 15% of the CAD study cohort had occult LV dysfunction (> 2 standard deviations below gender‐specific normal limit means for LVEF). Mean LV end‐diastolic volume index (EDVi) was significantly increased (p < 0.05) and LVEF decreased (p < 0.05) in patients with triple‐vessel CAD. End‐diastolic volume index was also increased in the cohort of patients with both hypertension and LV hypertrophy (LVH) (p < 0.05). However, multivariate logistic regression analysis revealed that only CAD extent, but not hypertension or LVH, was a significant predictor of occult LV dysfunction (p = 0.009).Conclusion: Occult LV dysfunction can be detected in patients with CAD by gating technetium‐99m sestamibi SPECT studies, and its presence may signify the presence of extensive CAD.