bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early deaths with thrombolytic therapy for acute myocardial infarction in corticosteroid‐dependent rheumatoid arthritis
Authors: Kotha Purushotham , Joseph Mcgreevy M. , Kotha Akther , Look Michelle , Weisman Michel H. 
Published: February 2009

AbstractIntravenous thrombolytic therapy has become standard treatment for acute myocardial infarction (AMI). We describe three patients with long‐standing seropositive rheumatoid arthritis (RA) on chronic corticosteroid therapy who experienced very early (1‐6 h) mortality after the use of intravenous thrombolytic therapy for the treatment of AMI. All three patients likely experienced electromechanical dissociation (EMD). Their charts were evaluated in depth, and the literature was reviewed in regard to possible etiopathologic mechanisms. Within 1‐6 h of apparently successful thrombolytic therapy for AMI, these three patients experienced sudden and profound bradycardia and hypotension and could not be resuscitated. The potential occurrence of EMD in all three patients raises the possibility of accelerated myocardial rupture, as EMD is one of the clinical hallmarks of this condition. As suggested by the three clustered cases, this heretofore undescribed association between sudden unexpected cardiac death and thrombolytic therapy for AMI in patients with seropositive, corticosteroid‐dependent RA suggests that further study and observation are needed. This deleterious association, if verified, has important implications for the treatment of AMI in patients who have RA and are corticosteroid dependent.
Salutary effects of aspirin in coronary artery disease are not limited to its platelet inhibitory effects
Authors: Mehta J. L. 
Published: February 2009

AbstractAspirin is widely used in the treatment and prevention of coronary artery disease (CAD). However, other platelet inhibitory agents, which inhibit platelet activation, have not been found to be effective or as effective as aspirin. The discrepancy between the efficacy of these compounds and aspirin suggests that the therapeutic efficacy of aspirin may not be limited to its platelet inhibitory effect. in this review, the basis for a unique place for aspirin in the therapy of patients with CAD is discussed. The author believes that the nonplatelet‐mediated effects of aspirin could be more important than the platelet inhibitory effect, or at least may complement the platelet inhibitory effects of aspirin in patients with acute myocardial ischemia and in others undergoing intra‐coronary procedures.
The effects of an angiotensin‐converting inhibitor (enalapril) on patients with mild cardiac failure—evaluating cardiac function based on the relationship between daily walking pace and heart rate
Authors: Ino‐Oka Eji , Umeda Showko , Kutsuwa Yoshiharu , Takahashi Takashi , Sagawa Kouichi , Takahashi Takayuki , Inooka Hikaru 
Published: February 2009

AbstractBackground: Heart failure has been evaluated by several methods, the New York Heart Association (NYHA) classification of heart failure based on symptoms being used most frequently. However, the degree of heart failure assessed by these criteria does not always correlate with cardiac function in daily life.Hypothesis: The aim of the study was to evaluate cardiac function based on the walking pace/heart rate (HR) relationship to assess the effects of enalapril, an angiotensin‐converting enzyme inhibitor, in patients with mild to moderate cardiac function.Methods: To evaluate cardiac function objectively, we developed a method using a pedometer to count the steps walked while simultaneously recording HR using a Holter electrocardiograph (ECG). Step‐count walk rate (WR) was recorded on the magnetic tape of the Holter apparatus, and both HR and walking pace were calculated automatically by the Holter ECG analysis system. Data were determined every hour, and mean pace and HR were plotted along the x and y axes, respectively. The slope of HR X WR was calculated using the least squares method. The slope and the total number of steps were regarded as indicators of cardiac function and quality of life, respectively. We analyzed 36 subjects, consisting of 8 normal volunteers, 8 patients in New York Heart Association (NYHA) class 1,11 in class II, and 9 in class III chronic mild heart failure, during maximal exercise work load by bicycle ergometer; furthermore, fractional shortening of the left ventricle on echocardiogram was determined in 14 patients with chronic mild heart failure and was compared with the slope of HR X WR. Enalapril was administered at a daily dose of 2.5‐10 mg for 1‐24 months (mean 6 months) in 60 patients to evaluate the effects of this drug on these parameters.Results: There was a significant inverse relationship between maximal work load and the HR X WR slope, and also between the fractional shortening and the slope, suggesting that the slope may reflect the severity of cardiac dysfunction. Furthermore, the slope decreased significantly from 1.8 ± 1.26 before enalapril to 1.0 ± 0.94 (mean ± standard deviation) after drug administration, while the total number of steps increased significantly from 4842 ± 3581 to 7804 ± 4793.Conclusion: The slope of the graph relating step count and HR proved to be a good, objective indicator of cardiac function, and enalapril therapy improved this parameter.
Prognostic implications of ventricular ectopy one week, one month, and sixteen months after an acute myocardial infarction
Authors: Vaage‐Nilsen Merrete , Rasmussen Verner , Hansen JøRgen Fischer , Hagerup Leif , Borring Sørensen Margit , Pedersen‐Bjergaard Ole , Mellemgaard Kresten , Holländer Niels H. , Nielsen Ingolf , Sigurd Bjarne M. 
Published: February 2009

AbstractBackground: Ventricular ectopy early after an acute myocardial infarction (AMI) has previously been demonstrated to predict mortality. Less information is available about the prognostic implications of ventricular ectopy occurring late after an AMI, and no information is available about the prognostic implication of the development of ventricular ectopy during the first year after an AMI.Hypothesis: The purpose of the present prospectively conducted trial, a part of the Danish Verapamil Infarction Trial II (DAVIT II), was to evaluate the prognostic implication of (1) ventricular premature complexes (VPCs) recorded by 24‐h Holter monitoring 1 week, 1 month, and 16 months after an AMI; and (2) development of > 10 VPCs/h or of any complex ventricular ectopy, that is, pairs, more than two types of VPCs, ventricular tachycardia, or > 10 VPCs/h during follow‐up after an AMI.Methods: Patients were monitored 1 week (n = 250), 1 month (n = 210), and 16 months (n = 201) after AMI.Results: Multivariate analyses based on history, clinical findings, and ventricular ectopy showed the following results: After 1 week, > 10 VPCs/h (p = 0.0006) and heart failure (p< 0.007); after 1 month, >10 VPCs/h (p = 0.003) and resting heart rate (p < 0.02); and after 16 months, ventricular tachycardia (p = 0.002) independently predicted long‐term mortality. Mortality was significantly predicted by the development of > 10 VPCs/h from 1 week to 1 month (p = 0.003) and 16 months (p = 0.03), and from 1 to 16 months (p = 0.007) after AMI, as well as by the development of any complex ventricular ectopy from 1 week to 1 month (p = 0.02) and 16 months (p = 0.01), and from 1 to 16 months (p = 0.04) after AMI.Conclusion: The present study demonstrated that 1 week and 1 month after an AMI the quantity of VPCs, that is, >10 VPCs/h, predicted mortality, whereas 16 months after an AMI the quality of VPCs, that is, ventricular tachycardia, predicted mortality.
Endovascular stenting of an unprotected left main coronary artery stenosis in a heart transplant patient
Authors: Weston Mark W. , Spoto Edward , Aranda Juan , Sears Nicholas 
Published: February 2009

AbstractEndoluminal revascularization of left main coronary artery vessels is considered to be relatively contraindicated because of a high procedural mortality and restenosis rate. This report describes the first successful case of endovascular stenting in an unprotected left main coronary artery stenosis in a heart transplant patient.
The importance of randomized clinical trials and evidence‐based medicine: A clinician's perspective
Authors: Kennedy Harold L. 
Published: February 2009

AbstractClinical evaluation of therapies for patient care has evolved during the twentieth century from a variety of scientific methods. As a result of medical, political, and economic changes that occurred in the 1990s, randomized clinical trials and evidence‐based methods are presently in the forefront of the physician's thinking in the decision‐making process for therapeutic interventions. A new standard of patient care has emerged during this process. This report provides a clinician's viewpoint of the importance and interpretation of evidence‐based methods and suggests a strategy when such evidence does not exist.
Effect of balloon inflation‐induced acute ischemia on QT dispersion during percutaneous transluminal coronary angioplasty
Authors: Aytemir Kudret , Bavafa Veli , Ozer Necla , Aksoyek Serdar , Oto Ali , Ozmen Ferhan 
Published: February 2009

AbstractBackground: QT dispersion (QTd = QTmax ‐ QTmin) measured as interlead variability of QT interval reflects the spatial inhomogeneity of ventricular repolarization times, and increased QTd may provide a substrate for malignant ventricular arrhythmias. Ischemia is associated with regional abnormalities of conduction and repolarization.Hypothesis: This study aimed to investigate the effect of acute ischemia on QTd during successful percutaneous transluminal coronary angioplasty (PTCA).Methods: Forty‐three patients (10 women, 33 men, mean age 56 years) were enrolled in the study. Electrocardiogram (ECG) recordings were taken before PTCA and during balloon inflation period. QT maximum (QTmax), QT minimum (QTmin), and QTd (QTmax ‐ QTmin) values were calculated from the surface ECG.Results: There was no difference among QTmax values (p = 0.6). Mean QTmin during balloon inflation was lower than before PTCA (368 ± 45 vs. 380 ± 41 ms, p = 0.002). The difference between QTd values before and during balloon inflation was statistically important (65 ± 9 vs. 76 ± 10 ms, p = 0.001). This difference is caused by a decrease in QTmin during balloon inflation.Conclusion: Acute reversible myocardial ischemia induced by balloon inflation causes an increase in QTd value, and this increment is the result of a decrease in QTmin interval. Therefore, QTd may be a marker of reversible myocardial ischemia.
Long‐Term safety of pravastatin‐gemfibrozil therapy in mixed hyperlipidemia
Authors: Iliadis Elias A. , Rosenson Robert S. 
Published: February 2009

AbstractBackground: Combined HMG‐CoA reductase inhibitor and fibric acid derivative therapy is often necessary for the effective reduction of concentrations of low‐density lipoprotein (LDL) cholesterol and triglycerides in patients with mixed hyperlipidemia; however, the potential risk of myopathy has limited the use of these agents.Hypothesis: This study evaluated long‐term safety and efficacy of combined pravastatin and gemfibrozil therapy.Methods: Eighty‐three patients with hyperlipidemia were treated with combined pravastatin and gemfibrozil therapy for a median of 44 months (range 9–78 months). Plasma lipids, serum liver function tests, creatinine, and creatinine kinase (CK) levels were measured every 3 to 4 months.Results: One patient developed myalgia with a normal CK level after 4 months of combination therapy. Three patients had transient elevations in CK levels that ranged from 3 to 5 times the upper limits of “normal” and that returned to normal upon repeat testing. Liver function tests did not change significantly from baseline. in a subset of 26 previously untreated patients, combined pravastatin (mean daily dose 22 mg) and gemfibrozil (mean daily dose 1,154 mg) therapy lowered total cholesterol by 25% (p<0.001), triglycerides by 53% (p = 0.0001), LDL cholesterol by 14% (p = 0.24), and increased high‐density lipoprotein (HDL) cholesterol by 20% (p = 0.012).Conclusion: Pravastatin and gemfibrozil therapy is safe and efficacious in patients with mixed hyperlipidemia. The long‐term safety results are consistent with other reports on follow‐up of shorter duration.
Assessing the appropriateness of coronary revascularization: The university of maryland revascularization appropriateness score (ras) and its comparison to rand expert panel ratings and american college of cardiology/american heart association guidelines with regard to assigned appropriateness rating and ability to predict outcome
Authors: Ziskind Andrew A. , Vogel Robert A. , Lauer Michael A. , Bishop Gregory 
Published: February 2009

AbstractBackground:Significant regional variation in procedural frequencies has led to the development of the RAND and American College of Cardiology/American Heart Association (ACC/AHA) guidelines; however, they may be difficult to apply in clinical practice. The University of Maryland Revascularization Appropriateness Score (RAS) was created to address the need for a simplified point scoring system.Hypothesis:The study was undertaken to compare revascularization appropriateness ratings yielded by the RAND Expert Panel Ratings, ACC/AHA guidelines, and the University of Maryland RAS.Methods:We applied these three revascularization appropriateness scoring systems to 153 catheterization laboratory patients with a variety of cardiac diagnoses and treatments. For each patient, appropriateness scores assigned by each of the three systems were compared with each other and with the actual treatment delivered. Concordance of care with appropriateness score was then correlated with outcome.Results:There were significant differences among all three scoring systems in their ratings and in the concordance of treatment with appropriateness rating. When treatment provided was concordant with RAND rating, there was a lower occurrence of subsequent coronary artery bypass grafting (CABG), the composite end point of either CABG or percutaneous transluminal coronary angioplasty (PTCA), and the composite end point of death, myocardial infarction (MI), or revascularization. When treatment was concordant with the ACC/AHA guidelines, there was lower occurrence of all‐cause mortality, PTCA, the composite end point of either CABG or PTCA, and the composite end point of death, MI, or revascularization. When treatment provided was concordant with the RAS, there was lower occurrence of cardiac death, all‐cause death, CABG, the composite end point of either CABG or PTCA, and the composite end point of death, MI, or revascularization.Conclusions:The RAS is a simple scoring system to assess revascularization appropriateness. When the RAND, ACC/AHA, and RAS systems are compared in a catheterization laboratory population, they rate the same patient differently and vary in their correlation of appropriateness rating with outcome.
An Electrocardiographic Algorithm for the Prediction of the Culprit Lesion Site in Acute Anterior Myocardial Infarction
Authors: Kim Thomas Y. , Alturk Najib , Shaikh Nasir , Kelen George , Salazar Manny , Grodman Richard 
Published: February 2009

AbstractBackground:Although the 12‐lead electrocardiogram (ECG) has been found useful in identifying the left anterior descending (LAD) coronary artery as the infarct‐related artery in acute myocardial infarction (MI), it has traditionally been felt to be incapable of localizing the culprit lesion within the LAD itself. Such a capability would be important, because anterior MI due to proximal LAD lesions carry a much worse prognosis than those due to more distal or branch vessel lesions.Hypothesis:This study investigated whether certain ECG variables—especially an ST‐segment injury pattern in leads aVL and/or V1—would correlate with culprit lesion site, and an ECG algorithm was developed to predict culprit lesion site.Methods:The initial ECGs of 55 patients who had undergone cardiac catheterization after an anterior or lateral MI were reviewed to identify the leads with an ST‐segment injury pattern; the corresponding catheterization films were then reviewed to identify the location of the culprit lesion; and these separate findings were then compared.Results:The sensitivity and specificity of an ST‐injury pattern in a VL in predicting a culprit lesion before the first diagonal branch were 91 and 90%, respectively; the same values in predicting a lesion prior to the first septal branch were 85 and 78%. ST‐segment elevation in V1, on the other hand, was a much less sensitive and specific predictor of a preseptal lesion. Overall, our algorithm correctly identified the culprit lesion location in 82% of our patients.Conclusion:Based on our findings, we conclude that an ST‐segment injury pattern in a VL during an anterior myocardial infarction predominantly reflects a proximal LAD lesion and therefore constitutes a high‐risk finding.
Lack of association between prior infection with chlamydia pneumoniaeand acute or chronic coronary artery disease
Authors: Altman Raul , Rouvier Jorge , Scazziota Alejandra , Gonzalez Claudio , Absi Ruben S. 
Published: February 2009

AbstractHypothesis: The study was designed to establish a lack of relationship between chronic C. pneumoniae infection and CHD.Methods: Chlamydia‐specific IgG‐antibody was assayed using an indirect immunofluorescence test in the serum of 159 patients with severe arterial disease and 203 patients with a heart valve prostheses and no demonstrable CHD. Fatal and nonfatal vascular events and systemic thromboembolism were recorded over a 2‐year period.Results: In the arterial group 107 patients (67.3%) and in the valvular group 120/203 (59.1%) were positive for C. pneumoniae antibody. The number of patients with fatal or nonfatal vascular events (double end point) in the arterial and valvular groups was 23 and 2, respectively (p<.0001). Triple end points (fatal plus nonfatal vascular events plus thromboembolism) were also more frequent in the arterial group (p< 0.002). The prevalence of chlamydia antibody positivity was the same in the arterial and valvular groups, and the occurrence of clinical events was also the same for chlamydia‐positive (227 patients) as for chlamydia‐negative (135 patients). After adjustment for confounding variables, only arterial disease was a predictive factor for double (OR 17.0; 95% CI 3.94–73.3) or triple (OR 3.12; 95% CI 1.56–6.25) end points.Conclusion: We find C. pneumoniae chronic infection not to be an independent risk factor for acute or chronic arterial disease.
Effect of aprindine on heart rate variability indices in patients with ischemic heart disease
Authors: Takase Bonpei , Arakawa Koh , Satomura Kimio , Ohsuzu Fumitaka , Uehata Akimi , Nishioka Toshihiko , Kurita Akira 
Published: February 2009

AbstractBackground: Decreased heart rate variability indices (HRV) are associated with untoward outcome of patients with ischemic heart disease (IHD). Most class I antiarrhythmic agents decrease HRV, but aprindine (a new class I antiarrhythmic agent) is reported to increase HRV in patients without ischemia.Hypothesis: The study was undertaken to determine whether aprindine might increase HRV in patients with IHD.Methods: To investigate the effect of aprindine on HRV in patients with IHD, we performed 24‐h ambulatory electrocardiogram (ECG) at the end of placebo and aprindine (60 mg daily) treatment phases on 38 patients with IHD and at least isolated premature ventricular contractions (PVC). The study protocol utilized a single blind, 4‐week, placebo‐controlled design. Heart rate variability from ambulatory ECG included SDNN (ms), SDANN (ms), SD (ms), rMSSD (ms), pNN50 (%); frequency analysis of HRV consisting of total (ms, 0.01–1.00 Hz), low (ms, 0.04–0.15 Hz), and high (ms, 0.15–0.40 Hz) components.Results: Study patients were divided into three groups according to the severity of IHD and antiarrhythmic efficacy of aprindine. Group 1 consisted of 15 patients with angina with single‐vessel disease, and Group 2 was composed of 10 patients with either multivessel disease or post myocardial infarction; PVCs decreased in both groups as a result of aprindine treatment. Group 3 consisted of 13 patients who showed no decreased PVC after aprindine treatment. RMSSD increased, and pNN50 and high‐frequency spectra tended to increase in Group 1, while SD, rMSSD, pNN50, and total and low‐frequency spectra decreased in Group 3; no significant changes were observed in Group 2. Aprindine significantly augments vagal activity, as reflected by the increase of rMSSD, pNN50, and high‐frequency spectra in mild IHD.Conclusion: These salutary effects are less in more severe IHD, but aprindine does not aggravate HRV. Thus, if there are salutary effects on arrhythmias and no proarrhythmic effects, aprindine could be prescribed to patients with IHD without concern about decreasing HRV.
Differential hormonal profiles of adrenomedullin and proadrenomedullin n‐terminal 20 peptide in patients with heart failure and effect of treatment on their plasma levels
Authors: Etoh Takuma , Kato Johji , Takenaga Makoto , Imamura Takuroh , Kitamura Kazuo , Koiwaya Yasushi , Eto Tanenao 
Published: February 2009

AbstractBackground: Adrenomedullin (AM) is a potent vasodilatory peptide discovered in human pheochromocytoma tissue. Proadrenomedullin N‐terminal 20 peptide (PAMP) processed from an AM precursor is also a novel hypotensive peptide which inhibits catecholamine secretion from sympathetic nerve endings.Hypothesis: The present study sought to examine the relationships between the two peptides and other clinical parameters by measuring the plasma AM and PAMP concentrations in 98 patients with heart failure.Methods: In all, 98 patients [65 men and 33 women, aged 58.2 ± 11.0 years, mean ± standard deviation (SD)] with heart failure and 26 healthy volunteers (12 men and 14 women, aged 54.1 ± 8.6 years) were examined in this study. Heart failure was secondary to previous myocardial infarction in 58 patients, valvular disease in 28, cardiomyopathy in 9, and congenital heart disease in 3. All patients were classified into two groups of class I or II (Group 1) and class III or IV (Group 2) according to the New York Heart Association (NYHA) functional classification.Results: Both plasma AM and PAMP concentrations in the patients were significantly higher than those in healthy volunteers. In addition, plasma AM and PAMP concentrations in patients in class III or IV of New York Heart Association (NYHA) classification were significantly higher than those in NYHA class I or II. The elevated plasma concentrations of these peptides in patients in NYHA class III or IV significantly decreased in response to the treatment for 7 days. There was a significant correlation between plasma AM and PAMP, though the plasma concentration of PAMP was one‐fifth to one‐seventh of that of AM in patients and controls. The plasma AM concentration correlated significantly with the plasma concentrations of atrial and brain natriuretic peptides, epinephrine, and right atrial pressure, whereas such a relationship was not noted for the plasma PAMP concentration.Conclusions: Judging from the difference in not only the biological actions but also the hormonal profiles between AM and PAMP, they may differentially modulate the cardiovascular system in patients with heart failure, although they are processed from the same precursor.