bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sustained ventricular tachycardia as a marker of inadequate myocardial perfusion during the acute phase of myocardial infarction
Authors: Sala M. Fiol , Bárcena J. Pérez , Rota J. I. Ayestaran , Roca J. Velasco , López A. Carrillo , Puigdevall J. M. Raurich , Soldevilla J. Guindo , Bayés Luna A. De 
Published: June 2007

AbstractBackground: Sustained ventricular tachycardia (VT) complicating the acute phase of myocardial infarction (AMI) is a quite rare event but with short‐term unfavorable prognosis. The clinical characteristics as well as the therapeutic implications have not yet been well defined.Hypothesis: This paper attempts to prove that VT may be considered a marker of inadequate myocardial perfusion after thrombolysis.Methods: To assess the clinic‐electroangiographic characteristics and prognosis of patients with VT occurring within the first 4 days of an AMI, a case‐control study was carried out in 23 patients from a total of 1, 100 patients (1.9%) hospitalized with AMI between March 1993 and July 1997. These patients were compared with a control group of 131 patients hospitalized consecutively. A statistical analysis was made using the chi‐square test, t‐test, and logistic regression.Results: There were no differences among groups with regard to age, gender, and area of necrosis. Average time for the onset of VT was 26 h (range 0‐92 h). Sixteen patients underwent coronary angiography: 4 patients had left main coronary artery disease, 2 had single‐vessel disease, 8 had lesions in two vessels, and 2 had triple‐vessel disease. Univariate analysis showed that patients with VT had a higher incidence of creatine phosphokinase (CPK)‐MB peak > 300 UI/l (61 vs. 30%; p < 0.001), more frequent occurrence of previous AMI (48 vs. 17%; p < 0.001), and acute intraventricular conduction disorders (26 vs. 4%; p< 0.001). Furthermore, these patients suffered ischemia previous to VT more frequently (65 vs. 11%; p < 0.0001), and had a greater mortality rate than that in the control group (35 vs. 4%; p < 0.0001). In the multivariant analysis, the variables related to the occurrence of VT were CPK‐MB peak > 300IU/l (OR 5.9;95% CI1.6‐21), acute intraventricular conduction disorders (OR 9.02;95% CI 1.748), and ischemia immediately prior to VT (odds ratio [OR] 19.64;95% confidence interval [CI] 5.3‐73).Conclusions: Ventricular tachycardia may be considered a marker of inadequate myocardial perfusion after thrombolysis; therefore, a more aggressive revascularization treatment in these patients would be advisable. The profile of patients with AMI, hospitalized in the coronary care unit, who will likely suffer from VT is previous AMI, CPK‐MB peak > 300, acute intraventricular conduction disorders, Killip > I, and ischemia previous to VT.
Prolonged low‐dose thrombolytic therapy: A novel adjunctive strategy in the management of an infected right atrial thrombus
Authors: Chuang Sheila , Mehta Rajendra H. , Fay William P. 
Published: June 2007

AbstractAn 81‐year‐old man presented with a large, infected right atrial thrombus that was refractory to anticoagulants and several courses of antibiotics. The risk of surgical removal of the thrombus, which was associated with a pacemaker electrode, was considered prohibitive. The patient was treated for 7 days with low‐dose (40 mg/day) tissue‐type plasminogen activator (t‐PA). Hemostatic monitoring during infusion revealed (1) aplasma t‐PA antigen that was approximately 5% of that achieved during short‐course t‐PA for acute myocardial infarction, (2) biochemical evidence of prolonged clot lysis, and (3) no significant depletion of fibrinogen or plas‐minogen. Nearly complete dissolution of the thrombus was observed. His bacteremia was eradicated by intravenous penicillin despite the presence of the pacemaker lead. This case highlights the benefits of combined antibiotic and thrombolytic therapy and documents for the first time the response of the human hemostatic system to prolonged t‐PA infusion and the plasma t‐PA levels attained when thrombolytic therapy is administered in this manner. Prolonged courses of fibrinolytic agents may be a good alternative to surgical intervention in selected patients with infected, right‐sided intracardiac thrombi.
Long‐term prognostic value of an index of myocardial performance in patients with myocardial infarction
Authors: Szymański Piotr , Rezler Joanna , Stec Sebastian , Budaj Andrzej 
Published: June 2007

AbstractBackground: The Tei index of myocardial performance (IMP), which combines parameters of both systolic and diastolic ventricular function, is a useful prognostic factor in many clinical settings.Hypothesis: This study assessed the long‐term prognostic value of IMP in patients discharged from hospital after acute myocardial infarction (AMI).Methods: Doppler/echocardiographic studies were recorded in 90 consecutive patients on Day 14 ± 2 following an AMI. The IMP was calculated from the Doppler recordings, as a sum of isovolumetric contraction time and isovolumetric relaxation time, divided by the ejection time.Results: The patients were followed for an average (SD) of 57.8 (16.1) months. During this period there were 22 (24%) cardiac events, defined as cardiac deaths (10) or Nonfatal recurrent myocardial infarctions (12). After multivariate Cox analysis, Tei index > 0.55 (relative risk [RR] 4.45; 95% confidence interval [CI] 1.28‐15.45; p = 0.019), LV end‐systolic volume > 65 ml (RR 3.23; 95% CI 1.34‐7.79; p = 0.009), and mitral E wave deceleration time ⩽ 0.145 s (RR 2.94; 95% CI 1.24‐6.92; p = 0.014) were the only independent predictors of cardiac events during the follow‐up period. In a subgroup of patients with preserved LV systolic function (ejection fraction > 0.40), IMP was the only predictor of cardiac events (RR 6.37; 95% CI 1.32‐30.77, p = 0.02).Conclusions: The Tei index of myocardial performance, which is simple and easy to calculate, is a useful tool for risk assessment in patients following myocardial infarction, and in a subgroup of patients with Normal or only mildly impaired systolic function.
Clinical and angiographic follow‐up after long versus short stenting in unselected chronic coronary occlusions
Authors: Choi Si‐Wan , Lee Cheol Whan , Hong Myeong‐Ki , Lee Jae‐Hwan , Kim Jae‐Joong , Park Seong‐Wook , Park Seung‐Jung 
Published: June 2007

AbstractBackground: Few data are available on the efficacy of long stenting for lesions in unselected chronic total occlusion (CTO).Hypothesis: The study was undertaken to evaluate the angiographic restenosis and long‐term clinical outcomes after long stent implantation in patients with CTO.Methods: Our retrospective analysis includes a consecutive series of stent implantation in 220 patients with CTO. We compared angiographic restenosis, target lesion revascularization, and long‐term clinical outcomes of short stenting (< 20 mm, Group 1, n = 113) with a concurrent series of long stenting (≥ 20 mm, Group 2, n = 107).Results: Angiographic follow‐up was obtained in 174 patients (79.5% of those eligible), and the rates of angiographic restenosis were 19.3% in Group 1 and 33.7% in Group 2 (p < 0.05). In multivariate analysis, the postinterventional minimal lumen diameter was the only independent predictor of restenosis (odds ratio = 0.20, 95% confidence interval 0.08‐0.49, p < 0.01). The angiographic restenosis rate was significantly lower in Group 1 than in Group 2 in patients with final minimal lumen diameter < 3.0 mm (28.9 vs. 55.9%, respectively, p < 0.05). However, the angiographic restenosis rate was not significantly different between the two groups in patients with final minimal lumen diameter ≥ 3 mm (12.0 vs. 19.2%, respectively, p = NS). During the follow‐up (29.1 ± 10.8 months), there was no difference between the two groups in death, nonfatal myocardial infarction, and target lesion revascularization.Conclusions: The use of long (≥20 mm) versus short (< 20 mm) stents in patients with CTO is associated with a higher angiographic restenosis rate, but there is an equivalent risk of restenosis in selected patients with relatively large‐sized vessels.
Secondary prognosis after cardioembolic stroke of atrial origin: The role of left atrial and left atrial appendage dysfunction
Authors: Panagiotopoulos Konstantinos , Toumanidis Savvas , Vemmos Konstantinos , Saridakis Nikolaos , Stamatelopoulos Stamatis 
Published: June 2007

AbstractBackground: Secondary prevention studies for cardioembolic strokes show a remarkable variability in stroke recurrence rates. Various reports have raised questions regarding differences in baseline clinical characteristics and in methodology to explain this wide variability.Hypothesis: The purpose of the present study is to examine the 2‐year outcome after first cardioembolic stroke of atrial origin and to correlate secondary prognosis with left atrial and left atrial appendage dysfunction.Methods: Baseline evaluation included computed tomographic and/or magnetic resonance scanning, Doppler scanning, digital subtraction angiography, and transthoracic and transesophageal echocardiography to establish the diagnosis of atrial source of emboli. Twenty‐six patients in nonrheumatic atrial fibrillation and 13 in sinus rhythm were followed for recurrent stroke and vascular death as endpoints (event ±).Results: Patients in sinus rhythm had a total of 23% (standard deviation ± 12%) recurrence rate. All event (+) patients were on aspirin and died from this second cardioembolic stroke. Of patients in nonrheumatic atrial fibrillation, 50% were event (+) at the end of the first year (death rate 46%). Patients on warfarin therapy had 20% recurrence rate versus 70% on aspirin (relative risk 0.18, 95% confidence interval, 0.05‐0.48, p 0.041). Inward peak velocity of left atrial appendage was the only echocardiographic variable significantly reduced in event (+) patients (21 ± 7 vs. 31 ± 17 cm/s, p 0.048).Conclusions: Patients with nonrheumatic atrial fibrillation and first atrial origin cardioembolic stroke are at increased risk for recurrence if severe dysfunction of the left atrial appendage is present and if they do not receive warfarin treatment. Patients with sinus rhythm and first atrial origin cardioembolic stroke form a small stroke subgroup, in which recurrences are accompanied by a remarkably high death rate.
Nonsurgical septal reduction therapy for hypertrophic obstructive cardiomyopathy: Short‐term results in 50 consecutive procedures
Authors: Nielsen Christopher D. , Killip Donna , Spencer William H. 
Published: June 2007

AbstractBackground: Nonsurgical septal reduction therapy (NSRT) has been shown to improve left ventricular outflow tract (LVOT) gradients, decrease septal thickness, and improve symptoms in patients with hypertrophic obstructive cardiomyopathy (HOCM). The major complication of this procedure has been the development of complete heart block (CHB) requiring permanent pacemaker implantation, which has been reported in up to 33% of patients in early studies. Since this procedure was first reported, there have been refinements in the technique such as the use of echocardiographic contrast material to localize the site of infarction, slower injection of alcohol, as well as improvement in balloon technology.Hypothesis: We sought to determine the results of NSRT using echocardiographic contrast localization, slow injection of alcohol, and short balloon length. We theorized that the incidence CHB would be lower than earlier reported results using these refined techniques.Methods: We performed 50 NSRT procedures on 46 patients using echocardiographic contrast localization, slow alcohol injection, and currently available balloons. Patients had an echocardiogram before, immediately after NSRT, and at 3 months, and a treadmill test before and at 3 months after NSRT. In the hospital, patients were observed for the development of CHB or other complications, and infarct size was determined by serial creatine kinase (CK) measurements.Results: There was a decrease in the LVOT gradient from 84.2 (± 30.8) mmHg at baseline, to 18.5 (± 14.8) mmHg immediately after NSRT (p < 0.001). At 3 months, the gradient was not statistically different at 22.7 (± 22.2) mmHg (p = 0.27). The septal thickness decreased from 2.21 (± 0.66) cm at baseline, to 1.67 (± 0.51) cm at 3 months (p < 0.001). New York Heart Association symptom class improved from 3.2 (± 0.4) at baseline, to 1.1 (± 0.6) at 3 months (p < 0.001). Mean treadmill time in 30 patients was 235 (± 142) s at baseline, to 367 (± 159) s at 3 months (p < 0.001). Of the 50 procedures, 45 were performed in patients without a previously placed permanent pacemaker or intracardiac cardioverter defibrillator; only 3 (6.7%) of the 45 developed complete heart blocks required permanent pacing. While only three patients in the series had a preexisting left bundle‐branch block (LBBB), two of the three patients who required a permanent pacemaker had an LBBB before the procedure.Conclusion: Using contrast echocardiographic localization, slow injection of alcohol, and shorter balloon catheters, there continues to be excellent improvement in LVOT gradients, septal thickness, and symptoms, with a reduced incidence of CHB requiring permanent pacemaker implantation. Left bundle‐branch block appears to be a strong predictor for the development of CHB after NSRT.
Patients with large myocardial infarction gain a greater improvement in exercise capacity after exercise training than those with small to medium infarction
Authors: Sakuragi Satoru , Takagi Shuichi , Suzuki Shoji , Sakamaki Fumio , Takaki Hiroshi , Aihara Naohiko , Yasumura Yoshio , Goto Yoichi 
Published: June 2007

AbstractBackground: It remains unclear whether patients with large‐size myocardial infarction (MI) achieve the same benefit from exercise training as do those with small‐ to medium‐size MI.Hypothesis: This study was designed to determine the magnitude and mechanisms underlying improvement in exercise capacity in patients with large‐size MI after cardiac rehabilitation.Methods: In all, 296 patients who participated in a cardiac rehabilitation program after acute MI were divided into two groups according to the peak serum creatine phosphokinase (CPK) level: the group with large infarction (Group 1) (≥ 5000 U/l peak CPK, 64 patients) and the group with less extensive infarction (Group 2) (< 5000 U/l, 232 patients). Exercise capacity was assessed before and after a 3‐month cardiac rehabilitation program that included exercise training.Results: Before exercise training, both the peak work rate (p < 0.05) and peak oxygen uptake (VO2) (p < 0.01) were significantly lower in Group 1 than in Group 2. After exercise training, the changes in peak work rate and peak VO2 were significantly greater in Group 1 than in Group 2 (both p < 0.01). The infarction size measured by the peak CPK level correlated significantly with both the baseline exercise capacity and its improvement after exercise training, although these correlations were insignificant in a multivariate analysis. In the multivariate analysis, the improvement in exercise capacity is determined by age and baseline exercise capacity, which is determined by the duration of inactivity, minute ventilation (VE)/ VCO2 slope and left ventricular end‐diastolic pressure.Conclusions: Compared with patients with small‐ to medium‐size myocardial infarction, patients with large infarction gain a greater improvement in exercise capacity after exercise training due to reversal of physical deconditioning and improvement in congestive heart failure.
Type of alcoholic beverage and first acute myocardial infarction: A case‐control study in a mediterranean country
Authors: Fernández‐Jarne E. , Martínez‐Losa E. , Serrano‐Martínez M. , Prado‐Santamaría M. , Brugarolas‐Brufau C , Martínez‐González M. A. 
Published: June 2007

AbstractBackground: Although international comparisons have consistently found an inverse association between wine and coronary heart disease, few epidemiologic studies are available in Southern Europe. We assessed the association of wine, red wine, and the pattern of drinking wine during meals with the risk of myocardial infarction.Hypothesis: We specifically evaluated three hypotheses: (1) Is the protection against incidence of nonfatal myocardial infarction stronger for wine than for other alcoholic beverages? (2) Does the wine consumed during meals represent a more beneficial pattern of alcohol consumption? (3) Is red wine more advantageous than other types of wine?Methods: A case‐control study (171 cases, 171 matched controls) was conducted in Spain. Multiple dietary and nondietary potential confounders were assessed.Results: Exposure to wine, red wine, and wine during meals was associated with risk reductions similar to those of other alcoholic beverages (point estimates of the odds ratio for low and high intake were 0.48 and 0.38 for wine; 0.42 and 0.55 for other beverages). However, after controlling for total alcohol intake, wine consumption (g/day) improved the prediction of a myocardial infarction.Conclusions: Our data showed that red wine or drinking wine during meals was similar to alcohol from other sources for reducing coronary risk. However, an additional benefit of wine, keeping constant overall alcohol intake, deserves further research.
Intravenous amiodarone for cardioversion of recent‐onset atrial fibrillation
Authors: Cybulski Jacek , Kułakowski Piotr , Budaj Andrzej , Danielewicz Henryk , MacIejewicz Janusz , Kawka‐Urbanek Teresa , Ceremuzyński Leszek 
Published: June 2007

AbstractBackground: Atrial fibrillation (AF) is one of the most common causes of hospital admission, with a prevalence of up to 5% of the population, increasing with advancing age. Emergency direct current cardioversion is the therapy of choice when arrhythmia leads to hemodynamic compromise, but in patients who are hemodynamically stable, antiarrhythmic drugs are usually given to restore sinus rhythm.Hypothesis: The study was undertaken to assess the efficacy of intravenous amiodarone in cardioversion of recent‐onset paroxysmal atrial fibrillation (AF). No standard antiarrhythmic therapy has been accepted for pharmacologic cardioversion of AF. Amiodarone seems to be a promising candidate, but only few randomized trials are available and the results are inconsistent.Methods: In all, 160 patients with AF lasting < 24 h were randomly assigned (2:1 fashion) to the amiodarone group (n = 106) receiving 5 mg/kg as a 30 min intravenous (IV) infusion, followed by IV infusion of 10 mg/kg during 20 h diluted in 1000 ml of 10% glucose with 20 IU of rapid‐action insulin, 80 mEq of potassium chloride, and 8 g of magnesium sulphate (GIKM), or to the control group (n = 54) receiving 1000 ml of GIKM alone. Treatment was continued up to 20 h independent of sinus rhythm restoration.Results: Sinus rhythm was restored 20 h after initiation of therapy in 88 (83%) patients in the amiodarone group and in 24 (44%) patients in the control group (p < 0.0001). The difference between efficacy of the two treatment modalities became significant already after 8 h of therapy (53 vs. 14 patients with sinus rhythm, respectively, p < 0.05). The mean dose of amio‐darone administered until sinus rhythm restoration was 740 ± 296 mg. The presence and the type of underlying heart disease did not influence the conversion rate in either group. In two patients (1.8%) treated with amiodarone, the return of sinus rhythm was preceded by asystole.Conclusion: Amiodarone is effective in the termination of AF lasting < 24 h. It may be particularly useful in patients with organic heart disease in whom class I antiarrhythmic agents may be contraindicated. During treatment, the heart rhythm should be monitored continuously.
Differences in the morphology and duration between premature P waves and the preceding sinus complexes in patients with a history of paroxysmal atrial fibrillation
Authors: Dilaveris Polychronis E. , Pantazis Antonios , Zervopoulos George , Tzannetis George , Kallikazaros John , Stefanadis Christodoulos , Toutouzas Pavlos K. 
Published: June 2007

AbstractBackground: Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice. Experimental and human mapping studies have demonstrated that perpetuation of AF is due to the presence of multiple reentrant wavelets with various sizes in the right and left atria.Hypothesis: Atrial fibrillation may be induced by atrial ectopic beats originating in the pulmonary veins, and premature P‐wave (PPW) patterns may help to identify the source of firing.Methods: To evaluate the morphology and duration of PPWs, 12‐lead digital electrocardiogram (ECG) strips containing clearly definable PPWs not merging with the preceding T waves were obtained in 25 patients with AF history (9 men, mean age 59.5 ± 2.2 years) and 25 subjects without any previous AF history (11 men, mean age 53.6 ± 2.5 years). The polarity of PPWs was evaluated in all 12 ECG leads. Previously described indices, such as P maximum, P dispersion (= P maximum –P minimum), P mean, and P standard deviation were also calculated.Results: Premature P‐wave patterns were characterized by more positive P waves in lead V1. All P‐wave analysis indices were significantly higher in patients with AF than in controls when calculated in the sinus beat, whereas they did not differ between the two groups when calculated in the PPW. P‐wave indices did not differ between the PPW and the sinus P wave in either patients with AF or controls, except for P mean, which was significantly higher in the sinus (110.1 ± 1.7 ms) than in the PPW (100 ± 2 ms) only in patients with AF (p = 0.001).Conclusion: The evaluation of PPW patterns is only feasible in a small percentage of short‐lasting digital 12‐lead ECG recordings containing ectopic atrial beats. Premature P wave patterns are characterized by more positive P waves in lead V1, which indicates a left atrial origin in the ectopic foci. The observed differences in P‐wave analysis indices between patients with AF and controls and between sinus beats and PPWs may be attributed to the presence of electrophysiologic changes in the atrial substrate.
Coronary arterial remodeling in differing clinical presentations of unstable angina pectoris—an intravascular ultrasound study
Authors: Iwami Takahiro , Nishioka Toshihiko , Fishbein Michael C. , Luo Huai , Jeon Doo‐Soo , Miyamoto Takashi , Wakeyama Takatoshi , Iida Hiroshi , Takaki Akira , Oda Tetsuro , Mochizuki Mamoru , Ogawa Hiroshi , Siegel Robert J 
Published: June 2007

AbstractBackground: Coronary arterial remodeling influences the clinical presentation of ischemic heart disease; however, there is little information on the relationship between coronary arterial remodeling and the type of angina pectoris that patients manifest.Hypothesis: The study was undertaken to determine the difference of coronary arterial remodeling in patients with different types of angina pectoris.Methods: We analyzed 100 patients with ischemic heart disease using intravascular ultrasound (IVUS). Intracoronary IVUS images of proximal reference (PR), distal reference (DR), and target lesion were recorded, and intraluminal area (LA) and external elastic membrane (EEM) were measured. We defined a remodeling index as 100 × (lesion EEM — [PR‐EEM + DR‐EEM]/2) / ([PR‐EEM + DR‐EEM]/2). Cases were classified into three groups according to the clinical history (Group 1a: de novo unstable angina pectoris, Group 1b: accelerating unstable angina pectoris, and Group 2; stable angina pectoris).Results: The remodeling index in Group 1a was significantly larger than that in Groups 1b and 2 (18.6 ±28.5 vs. 5.3 ± 27.1 and 18.6 ± 28.5 vs. —2.7 ± 17.6, p = 0.0347 and p = 0.0005, respectively), but there was no statistical difference in remodeling index between Groups 1b and 2.Conclusions: Our results indicate that positive coronary arterial remodeling is more prevalent in patients with new onset of angina pectoris. The specific type of coronary arterial remodeling may affect the clinical presentation of patients with coronary artery disease.