bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sarpogrelate, a specific 5ht2‐receptor antagonist, improves the coronary microcirculation in coronary artery disease
Authors: Satomura Kimio , Takase Bonpei , Hamabe Akira , Ashida Kazuhiro , Hosaka Haruhiko , Ohsuzu Fumitaka , Kurita Akira 
Published: June 2007

AbstractBackground: Serotonin (5‐hydroxytryptamine: 5‐HT) reduces the coronary blood flow (CBF) as a product of aggregating platelets. Sarpogrelate, a specific 5HT2‐receptor antagonist, has been reported to increase the coronary collateral flow in humans; however, its effect on the microcirculation is still not fully understood.Hypothesis: This study was undertaken to determine whether sarpogrelate might improve the microcirculation in coronary artery disease (CAD).Methods: To investigate the effect of sarpogrelate on the microcirculation in CAD, we measured CBF in 15 patients with CAD but no significant stenosis in the left anterior descending artery (LAD). The patients were randomly allocated to two groups, including those receiving oral administration of 200 mg of sarpogrelate (SPG, 8 patients, age 61 ± 6 years) and those receiving no medication (controls, 7 patients, age 57 ± 8 years). Prior to and 1 h after the administration of sarpogrelate, or in controls at 1‐h intervals, the average peak velocity (APV) at baseline and hyperemia was measured by an intracoronary Doppler guidewire. Systemic blood pressure (SBP) and cardiac output (CO) were also measured.Results: In the patients receiving SPG, the medication significantly increased the baseline (18 ± 9 to 19 ± 10 cm/s, p < 0.05) and maximal APV (55 ± 9 to 64 ± 31 cm/s, p < 0.05). However, no significant changes were observed in SBP and CO after the administration of SPG. In the control group, there were no significant differences in baseline and hyperemic APV.Conclusion: Sarpogrelate increased both baseline and maximal CBF without changing the systemic hemodynamics. These findings thus support that SPG improves the microcirculation by antagonizing the vasoconstrictive products of the aggregating platelets in CAD.
Gender differences in arrhythmias
Authors: Wolbrette Deborah , Naccarelli Gerald , Curtis Anne , Lehmann Michael , Kadish Alan 
Published: June 2007

AbstractElectrocardiographic and electrophysiologic differences between men and women have long been noted. Women have a higher intrinsic heart rate than men, along with a longer corrected QT interval and a shorter sinus nodal recovery time. The incidence of and risk factors for a variety of arrhythmias differ between men and women. Atrioventricular nodal reentry tachycardia has a 2:1 female‐to‐male predominance, while accessory pathways are twice as frequent in men. Although atrial fibrillation is more prevalent in men of all age groups, the absolute numbers of men and women with atrial fibrillation are equal, and the associated morbidity and mortality experienced by women with atrial fibrillation appear to be worse. Women have a lower incidence of sudden cardiac death, and female survivors of sudden cardiac death have a lower frequency of spontaneous or inducible ventricular tachycardia. On the other hand, drug‐induced torsade de pointes and symptomatic long QT syndrome have a female predominance. Therefore, greater caution should be used when prescribing QT‐prolonging drugs in women. The incidence of arrhythmias is increased during pregnancy, and management of pregnant patients poses a significant challenge. The mechanisms of these gender differences are unclear but may be related to hormonal effects and the shorter QT interval in adult males. Pharmacologic and nonpharmacologic therapies are usually equally efficacious, but the risks of pharmacologic therapy are different in men and women. Atrial fibrillation may be more difficult to treat in women.
Investigation of the predictors of transition to persistent atrial fibrillation in patients with paroxysmal atrial fibrillation
Authors: Koide Yasushi , Yotsukura Masayuki , Sakata Konomi , Yoshino Hideaki , Ishikawa Kyozo 
Published: June 2007

AbstractBackground: Until now, no clinically useful indicators have existed that predict the transition from paroxysmal to persistent atrial fibrillation (AF).Hypothesis: The current prospective study was conducted for identifying predictors of progression to persistent AF over the long term.Methods: We studied 102 consecutive patients (mean age: 55 ± 10 years; 75 men and 27 women) diagnosed with paroxysmal AF. Standard 12‐lead electrocardiography, echocardiography, and P‐wave‐triggered signal‐averaged electrocardiography (P‐SAECG) were performed on all patients at the time of their entry into the study.Results: The mean follow‐up period was 61 ± 13 months. Group 1 (n = 66) comprised patients in whom paroxysmal AF did not progress to persistent AF, and Group 2 (n = 36) comprised those who developed persistent AF. In Group 2 the patients were significantly older, and P‐wave dispersion, filtered P‐wave duration (FPD), and left atrial dimension were significantly higher than in Group 1 (p < 0.05). The root mean square voltage for the last 30 ms of the filtered P‐wave was also significantly lower in Group 2 (p < 0.05). Multivariate logistic regression analysis using these five factors identified left atrial dimension (odds ratio [OR] 2.29; 95% confidence interval [CI] 1.16‐4.54; p = 0.02) and FPD (OR 2.71; 95% CI 1.78‐ 4.13; p< 0.01) as independent predictors of transition to persistent AF. Left atrial dimension ≤ 40 mm predicted progression to persistent AF with a sensitivity of 64%, specificity of 76%, positive predictive value of 59%, negative predictive value of 79%, and an accuracy of 71%. An FPD ≤ 150 ms predicted persistent AF with a sensitivity of 81%, specificity of 91%, positive predictive value of 88%, negative predictive value of 90%, and an accuracy of 87%. Filtered P‐wave duration was a significantly more sensitive and specific predictor than left atrial dimension (p < 0.05).Conclusion: We conclude that FPD is a clinically useful predictor of progression from paroxysmal to persistent AF over the long term.
Vitamin C preserves endothelial function in patients with coronary heart disease after a high‐fat meal
Authors: Liu Ling , Zhao Shui‐Ping , Gao Mei , Zhou Qi‐Chang , Li Yu‐Ling , Xia Bing 
Published: June 2007

AbstractBackground: It has been suggested that an oxidative mechanism is involved with the impaired endothelium‐dependent vasodilatation that occurs after a high‐fat meal.Hypothesis: The study was undertaken to evaluate the effect of a single oral dose of vitamin C (2 g) on postprandially impaired endothelium‐dependent vasodilatation in patients with coronary heart disease (CHD).Methods: This study included 74 patients with CHD and 50 subjects without CHD with risk factors. The two groups were divided into two subgroups that did or did not receive 2 g of vitamin C (CHD/VitC and CHD/control, n = 37; non‐CHD/VitC and non‐CHD/control, n = 25) after a high‐fat meal (800 calories, 50 g fat). Serum levels of triglyceride, total cholesterol, low‐density lipoprotein cholesterol, and high‐density lipoprotein cholesterol in the fasting state and at 2, 4, 5, and 7 h after the high‐fat meal were measured. Endothelial function was assessed in the brachial artery by high‐resolution ultrasound at baseline and at 4 h postprandially.Results: The postprandial serum triglyceride concentration increased significantly at 2‐5 h after the high‐fat meal in all groups. The fasting flow‐mediated dilatation (FMD) (p < 0.02) and nitroglycerin‐induced dilatation (NID) (p < 0.05) of patients with CHD were impaired compared with those of non‐CHD subjects. Postprandial FMD was significantly aggravated in the non‐CHD/control group (p<0.01) and the CHD/ control group (p < 0.001), but the postprandial FMD in patients and subjects taking vitamin C showed no significant change, although the CHD/VitC group had a mild tendency toward improvement (p = 0.064) and non‐CHD/VitC group had a mild tendency toward aggravation (p = 0.852). The change of NID after a high‐fat meal did not reach statistical significance in the four groups. The decrement of postprandial FMD correlated positively with the increment of 2‐h serum triglyceride concentration in the patients without vitamin C (n = 62, r = 0.545, p < 0.001).Conclusions: The postprandial state after a high‐fat meal is critical in atherogenesis, as it induces endothelial dysfunction through an oxidative stress mechanism. Vitamin C treatment has a promising benefit for patients with CHD.
Novel use of a short‐acting intravenous beta blocker in combination with inotropic therapy as a bridge to chronic oral beta blockade in patients with advanced heart failure
Authors: Hauptman Paul J. , Woods Daniel , Pritzker Marc R. 
Published: June 2007

AbstractThe role for beta blockers in advanced heart failure (New York Heart Association class IV) remains undefined because of concerns about tolerability and uncertainty about efficacy. We report the use of a short‐acting intravenous beta blocker in combination with inotropic therapy as a means to bridge five patients with advanced heart failure to chronic oral beta blockade; two of these patients had been chronically managed with intravenous inotrope. At 4 months' follow‐up, all patients remained on beta‐blocker therapy and none was hospitalized for heart failure or had received intravenous diuretics. Given the early separation of survival curves in the randomized clinical trials of beta blockers in heart failure, it is possible that these patients will accrue a survival benefit. We conclude that some patients with advanced heart failure can be offered oral beta‐blocker therapy by bridging with a combination of intravenous inotrope and short‐acting intravenous beta blocker.
T‐peak to T‐end interval may be a better predictor of high‐risk patients with hypertrophic cardiomyopathy associated with a cardiac troponin i mutation than qt dispersion
Authors: Shimizu Masami , Ino Hidekazu , Okeie Kazuyasu , Yamaguchi Masato , Nagata Mitsuru , Hayashi Kenshi , Itoh Hideki , Iwaki Taku , Oe Kotaro , Konno Tetsuo , Mabuchi Hiroshi 
Published: June 2007

AbstractBackground: Patients with hypertrophic cardiomyopathy (HCM) associated with a deletion of lysine 183 (K183del) in the cardiac troponin I (cTnI) gene suffer sudden cardiac death at all ages. However, the correlation between QT variables and sudden cardiac death in these patients remains uncertain.Hypothesis: We evaluated the correlation between QT variables and sudden cardiac death and/or ventricular tach‐yarrhythmia (SCD/VT) in patients with HCM associated with the cTnI mutation.Methods: We analyzed 10 probands with HCM associated with the cTnI gene K183del and their family members. The subjects were divided into three groups: Group A (n = 7), mutation carriers with SCD/VT; Group B (n = 16), mutation carriers without SCD/VT; Group C (n = 24), no mutation carriers. QT intervals were corrected using Bazett's formula.Results: Maximum QTc and corrected QT dispersion were significantly longer in Groups A and B than in Group C. However, there were no differences in either parameter between Groups A and B. On the contrary, the peak‐to‐end interval of T wave/QT interval in V5 (Tpe) in Group A was significantly longer than that in Groups B and C. Logistic regression analysis revealed that Tpe was a good clinical predictor for SCD/VT in patients with HCM in this study.Conclusions: These results suggest that Tpe rather than QT dispersion may be one of the best predictors for SCD/VT in patients with HCM associated with the K183del mutation in the cTnI gene.
Coronary collaterals during single‐vessel coronary angioplasty: Effects of nitroglycerin
Authors: Eriksen Ulrik Hedegaard , Nielsen Torsten Toftegaard , Egeblad Henrik , Bagger Jens Peder 
Published: June 2007

AbstractBackground: Although the protective role of collaterals in coronary artery disease (CAD) is well known, the influence of drugs on collateral function remains controversial.Hypothesis: We aimed to investigate prospectively the prevalence of spontaneously visible and recruitable coronary collaterals in consecutive patients with single‐vessel CAD and the effect of systemic administration of nitroglycerin on these types of collaterals during percutaneous transluminal coronary angioplasty (PTCA).Methods: Ipsi‐ and contralateral coronary artery contrast injections were performed before and during PTCA. Simultaneously with balloon occlusion, we measured coronary artery occlusion pressure via the balloon catheter. All measurements were repeated after administration of 0.5 mg of nitroglycerin intravenously.Results: Of 101 consecutive patients, 24% had spontaneously visible and 30% had recruitable collaterals. Contra‐lateral collaterals were five times more frequent than ipsilateral collaterals. Presence of collaterals was highly associated with the degree of coronary stenosis. Coronary occlusion pressure was higher in patients with than in those without collaterals. Collaterals prevented pain and ischemia during PTCA, and in this respect spontaneously visible collaterals were more effective than recruitable collaterals. There was no effect of systemic administration of nitroglycerin on appearance or occlusion pressure of coronary collaterals.Conclusion: Coronary collaterals were found in more than half of patients with single‐vessel CAD, as the prevalence of recruitable collaterals was slightly higher than that of spontaneously visible collaterals. Nitroglycerin did neither recruit nor augment coronary collaterals.
Ventricular dyssynchrony in dilated cardiomyopathy: The role of biventricular pacing in the treatment of congestive heart failure
Authors: Aranda Juan M. , Schofield Richard S. , Leach Dana , Conti Jamie B. , Hill James A. , Curtis Anne B. 
Published: June 2007

AbstractDespite advances in pharmacologic therapy, the prognosis of patients with advanced congestive heart failure (CHF) remains poor. Many of these patients have cardiac conduction abnormalities, such as left bundle‐branch block or interventricular conduction delays, that can lead to ventricular dyssynchrony (abnormal ventricular activation that results in decreased ventricular filling and abnormal ventricular wall motion). Biventricular pacing is an alternative, Nonpharmacologic therapy under active investigation for the treatment of CHF. Resynchronization devices with transvenous leads in the right atrium, right ventricle, and left ventricle (via the coronary sinus) have been implanted in patients to provide atrial triggered biventricular pacing. The use of such devices has been associated with improvement in ejection fraction, dP/dt, stroke work, and functional class. The proposed mechanisms involved in improving ventricular function with biventricular pacing include improved septal contribution to ventricular ejection, increased diastolic filling times, and reduced mitral regurgitation. This article reviews the pathophysiology of ventricular dyssynchrony and examine insights from clinical trials that are evaluating cardiac resynchronization therapy for CHF.
Persistent st‐segment elevation after primary stenting for acute myocardial infarction: Its relation to left ventricular recovery
Authors: Lee Sang‐Gon , Cheong Jong‐Pil , Shin Je‐Kyoun , Kim Jin‐Woo , Park Jae‐Hoo 
Published: June 2007

AbstractBackground: Early restoration of coronary artery patency in acute myocardial infarction (AMI) has been linked to improvement in survival. However, early recanalization of an occluded epicardial coronary artery by either thrombolytic agents or percutaneous transluminal coronary angioplasty (PTCA) does Not Necessarily lead to left ventricular (LV) function recovery.Hypothesis: The aim of this study was to evaluate the relation between persistent ST elevation shortly after primary stenting for acute myocardial infarction (AMI) and LV recovery.Methods: Thirty‐one patients with primary stenting for AMI were prospectively enrolled. To evaluate the extent of microvascular injury, serial ST‐segment analysis on a 12‐lead electrocardiogram recording just before and at the end of the coronary intervention was performed. Persistent ST‐segment elevation (Persistent Group, N = 11) was defined as ≥50% of peak ST elevation and resolution (Resolution Group, N = 20) was defined as < 50% of peak ST elevation. Echocardiography was performed on Day 1 and 3 months after primary stenting.Results: At 3 months, infarct zone wall‐motion score index (WMSI, 2.1 ± 0.6 vs. 2.7 ± 0.3, p < 0.05) was smaller in the Resolution Group than in the Persistent Group, whereas wall motion recovery index (RI, 0.4 ± 0.3 vs. 0.1 ± 0.2, p < 0.05) and ejection fraction (58 ± 5 vs. 43 ± 10%, p < 0.05) were larger in the Resolution Group than in the Persistent Group. The extent of persistent ST elevation (% ST) shortly after successful recanalization of the infarct‐related artery was significantly related to RI at 3 months (r = −0.4, p < 0.05). However, time to reperfusion was Not related to RI at 3 months. There was also significant correlation between corrected TIMI frame count and %ST (r = 0.4, p < 0.05).Conclusions: Persistent ST‐segment elevation shortly after successful recanalization (≥ 50% of the peak value), as a marker of impaired microvascular reperfusion, predicts poor LV recovery 3 months after primary stenting for AMI.
Catheter ablation of atrial fibrillation
Authors: Ng Fu Siong , Camm Ajohn 
Published: June 2007

AbstractFollowing the advent of the surgical maze procedure, several catheter techniques have been developed to provide permanent prophylaxis against atrial fibrillation. These Noninvasive techniques work by compartmentalizing the atria, by ablating the arrhythmogenic foci, or by isolating the atria from these foci. Although still at an early stage of development, preliminary results using focal ablation and circumferential ablation show extreme promise.
Quadricuspid aortic valves
Authors: Timperley Jonathan , Milner Robert , Marshall Andrew J. , Gilbert Timothy J. 
Published: June 2007

AbstractQuadricuspid aortic valves (QAV) are a rare but well recognized cause of significant aortic regurgitation. The first case was found reported in 1862. Since then there have been 110 reported cases of QAV and we report 4 more. Previously, these were diagnosed at the time of surgery or postmortem examination. With advances in echocardiography, including harmonic imaging, and also the advent of trans‐esophageal echocardiography, more cases are being diagnosed prior to surgery. We describe four more cases, three diagnosed preoperatively and one at the time of surgery, and then review the previously reported cases. Of the 114 cases reported, 46 had the aortic valve replaced, most commonly in the 5th and 6th decade of life. Hurwitz and Roberts classified quadricuspid valves according to the size of the leaflets. It has previously been believed that QAVs with four equal sized leaflets were less likely to develop significant aortic regurgitation; however, on review of the available cases, this would not appear to be the case. The preoperative diagnosis of QAVs is important as they can be associated with abnormally placed coronary ostium. Of the 114 cases reported, there are 10 reports of abnormally placed ostia. There has been at least one reported case of death occurring because of obstruction of an abnormally placed right coronary ostium by a prosthetic aortic valve.
QT‐interval dispersion in acute myocardial infarction is only shortened by thrombolysis in myocardial infarction grade 2/3 reperfusion
Authors: Nikiforos Savas , Hatzisavvas John , Pavlides Gregory , Voudris Vassilis , Vassilikos Vassilis P. , Manginas Athanassios , Hatzeioakim George , Foussas Stefanos , Iliodromitis Efstathios K. , Hatseras Demetrios , Kremastinos Demetrios T. , Cokkinos Dennis V. 
Published: June 2007

AbstractBackground: Increased QT interval dispersion (QTd) has been found in patients with acute myocardial infarction (AMI). In previous studies this has been shown to decrease with thrombolysis.Hypothesis: The aim of this study was to compare the effects of reperfusion by primary percutaneous transluminal coronary angioplasty (PTCA) and by thrombolysis on QTd and correlate these results with the degree of reperfusion.Methods: We studied 60 patients with a first AMI. The study cohort included 40 consecutive patients who had received thrombolysis (streptokinase or rt‐PA); 20 additional consecutive patients with successful primary PTCA, all with preselected Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow by predefined selection criteria (12 stents); and 20 controls. A 12‐lead ECG for QTd calculation was recorded before thrombolysis or PTCA and immediately after the procedure. All values were corrected according to Bazett's formula (QTcd). QTd and QTcd values before and after each procedure in three groups and the respective percent changes of ΔQTd and ΔQTcd were compared separately.Results: QTd and QTcd were significantly increased before thrombolysis/PTCA versus normals. An angiogram performed after thrombolysis showed adequate reperfusion (TIMI grade 2/3) in 20 patients, while in the other 20 only TIMI 0/1 reperfusion was achieved. Thrombolysis‐TIMI flow 2/3 and PTCA significantly reduced QTd (from 68 ± 10 to 35 ± 8 ms, p < 0.001, ΔQTd = 48 ± 11%, in the Thr‐TIMI flow 2/3 group, and from 79 ± 11 to 38 ± 9 ms, p < 0.001, ΔQTd = 52 ± 9%, in the PTCA group), while in the Thr‐TIMI flow 0/1 group no significant changes were recorded. A percent QTd decrease > 30 s had 96% sensitivity, 85% specificity, and 93% positive and 94% negative predictive value, respectively, for TIMI 2/3 flow.Conclusions: A significant decrease in QT dispersion may provide an additional electrocardiographic index for successful (TIMI 2/3) reperfusion.
Oral platelet glycoprotein IIb/IIIa receptor inhibitors—part I
Authors: Cannon Christopher P. 
Published: June 2007

AbstractWith the central importance of antiplatelet therapy in patients with coronary artery disease and the numerous positive trials with glycoprotein (GP) IIb/IIIa inhibitors given intravenously, it was hoped that one could extend the benefit of IIb/IIIa inhibition to long‐term treatment. Although the hypothesis that prolonged oral IIb/IIIa inhibition was appealing, many issues have been identified in the initial Phase II trials that would limit the usefulness of these compounds. Variability of the level of platelet inhibition was one major culprit that distinguished the oral compounds from intravenous ones. The problems that arose were that increased bleeding has been seen when levels of platelet inhibition are high (e.g., > 90%) and that, conversely, efficacy would likely be limited when levels of platelet inhibition were low. If further development of this class of drugs is undertaken, formal dosing studies would have to establish an oral dosing strategy that achieves appropriately high (80–95% inhibition) and steady levels of inhibition.