bluuebunny/crossref_metadata_2025_split huggingface dataset:
Vasospastic angina induced by nonsteroidal anti‐inflammatory drugs
Authors: Mori Etsuo , Ikeda Hisao , Ueno Takafumi , Kai Hisashi , Haramaki Nobuya , Hashing Tatsuya , Ichiki Kazuya , Katoh Atsushi , Eguchi Hiroyuki , Ueyama Takahisa , Imaizumi Tsutomu 
Published: February 2009

AbstractWe report two cases of vasospastic angina associated with anaphylactic reaction caused by nonsteroidal antiinflammatory drugs (NSAIDs). Both patients exhibited anaphylactic manifestations, such as general rash and urticaria, along with angina pectoris with electrocardiographic ST‐segment elevations after suppository administration of diclofenac sodium or indomethacin, the most commonly used NSAIDs. Although these patients had normal coronary arteriograms, intracoronary administration of ergonovine or acetylcholine provoked diffuse coronary artery spasms accompanied by chest pain and ischemic ST‐segment changes. It is therefore suggested that an allergic mechanism may be involved as a causative factor of the coronary artery spasm induced by NSAIDs.
Propafenone‐induced drug fever in the absence of agranulocytosis
Authors: O' Rourke Daniel J. , Palac Robert T. , Holzberger Peter T. , Gerling Barbara R. , Greenberg Mark L. 
Published: February 2009

AbstractPropafenone is an antiarrhythmic drug used in the treatment of life‐threatening ventricular tachyarrhythmias. Adverse reactions necessitating discontinuation of the medication are common. Propafenone‐induced drug fever has not been definitively proven. We present a case report of drug fever secondary to propafenone, confirmed with rechallenge.
Safety and efficacy of angiography‐guided stent placement in small native coronary arteries of < 3.0 mm in diameter
Authors: Lau Kean‐Wah , He Qing , Ding Zee‐Pin , Johan Abdullah 
Published: February 2009

AbstractBackground and hypothesis: Increased operator experience, greater insight in stent deployment techniques, and improved poststent medication regimen have significantly reduced the risk of thrombotic stent closure following stent placement in large coronary arteries ( 3.0 mm in diameter). Whether equally favorable results are afforded by stent placement in small vessels (> 3.0 mm), however, remains unclear. Accordingly, the aim of this study was the specific examination of the risk of stent placement in small native coronary vessels, using stent deployment technique consisting of supplementary dilatations with larger balloons or high‐pressure inflations, and aggressive aspirin‐ticlopidine and short‐term oral anticoagulation poststent therapy.Methods: Forty‐seven balloon‐expandable stents (20 Gianturco‐Roubin, 21 NIR, 6 Palmaz‐Schatz) were successfully implanted without intravascular guidance in 45 native coronary arteries (mean reference diameter of 2.5 mm) in 44 consecutive patients (31 men, 13 women), the majority of whom (87%) were stented for the treatment of failed or suboptimal balloon angioplasty outcome.Results: Successful stent placement reduced the lesion diameter stenosis from 91 ± 9% to 3 ± 7% (p = 0.0001). There were no early stent thrombosis or major cardiovascular events prior to hospital discharge. During a 12‐month follow‐up period, most patients remained symptomatically improved and no myocardial infarction, stroke, or death was observed. Five‐month angiographic reassessment revealed an in‐stent restenosis rate of 41%, which was higher in vessels 2.5 mm in size (47 vs. 33% for vessels > 2.5 mm, p = 0.2747).Conclusions: In selected patients with small native coronary vessels < 3.0 mm in diameter, angiography‐guided optimal stent placement is associated with a low risk of stent thrombosis and bleeding complications. However, the in‐stent restenosis rate is high with the stents used in this study.
Atrial natriuretic peptide levels after different types of inferior wall myocardial infarction
Authors: Assali Abid , Gilad Irit , Herz Itzhak , Solodky Alejandro , Sulkes Jaqueline , Strasberg Boris , Sclarovsky Samuel 
Published: February 2009

AbstractBackground: Atrial natriuretic peptide (ANP) is released from cardiac atrium secondary to increased atrial pressure. The plasma levels of ANP have been found to be related to short‐and long‐term prognosis after acute myocardial infarction (MI). The purpose of the present study was to investigate the plasma levels of ANP in three groups of patients with inferior wall acute MI classified according to ST‐segment depression in the precordial leads.Methods: The study population consisted of 18 patients with inferior wall acute MI classified into three types: Type 1 = no precordial ST‐segment depression (7 patients), Type 2 = sum of ST‐segment depression in leads V1 to V3 equal to or more than the sum of ST‐segment depression in leads V4 to V6 (4 patients), and Type 3 = maximal precordial ST‐segment depression in leads V4 to V6 (7 patients).Results: Radioimmunoassay showed that plasma ANP levels were significantly higher in patients with Type 3 acute inferior wall myocardial infarction compared with those with Types 1 and 2 (313.1 ± 233, 73.0 ± 27.5), and 84 ± 32.7 pg/ml, respectively, p = 0.018).Conclusions: Plasma ANP levels are higher in patients with Type 3 acute inferior wall MI compared with patients with Types 1 and 2. These findings, together with earlier ones, may contribute to our understanding of the pathophysiology of the presence of ST‐segment depression in the precordial leads in inferior wall acute MI.
Chronic infection in the etiology of atherosclerosis‐the case for chlamydia pneumoniae
Authors: Gupta Sandeep , Camm A. John 
Published: February 2009

AbstractEstablished cardiovascular risk factors do not fully explain the variations in the prevalence and severity of coronary heart disease. Recent evidence suggests that common chronic infections may contribute, either by direct or indirect mechanisms, to the etiology and/or progression of coronary atherosclerosis. Of the candidate infectious agents implicated, Chlamydia pneumoniae has emerged as the most likely pathogen to have a causal role. Evidence for this is based on seroepidemiologic, pathologic, and laboratory‐based evidence, in addition to recent small‐scale antibiotic intervention studies. Concerted efforts are now focused on the design of large prospective trials with antibiotics active against C. pneumoniae in the secondary prevention of coronary heart disease.
Lack of association between the insertion/deletion polymorphism of the angiotensin‐converting enzyme gene and vasospastic angina
Authors: Kuroki Shigehiro , Ikeda Uichi , Maeda Yoshikazu , Sekiguchi Hiromichi , Shimada Kazuyuki 
Published: February 2009

AbstractBackground and hypothesis: It has been suggested that the insertion/deletion (I/D) polymorphism of the angiotensin‐converting enzyme (ACE) gene is an independent risk factor for coronary atherosclerosis and myocardial infarction, but its relation to vasospastic angina has not been fully proven. In the present study, we investigated the possible relationship between the ACE I/D genotype and vasospastic angina.Methods: We explored the distribution of the ACE genotype in 20 patients with vasospastic angina without fixed coronary artery stenosis, 55 angina patients with fixed coronary artery stenosis, and 30 control subjects without coronary artery disease.Results: The frequency of the DD genotype in patients with vasospastic angina (DD: 30.0%, ID: 20.0%, II: 50.0%) did not differ from that in the control subjects (DD: 23.3%, ID: 26.7%, II: 50.0%), while the frequency in patients with coronary artery stenosis (DD: 43.7%, ID: 21.8%, II: 34.5%) was significantly higher than that in the control subjects. The frequency of the D allele also did not differ between patients with vasospastic angina (0.40) and control subjects (0.37), while the frequency was significantly higher in patients with coronary artery stenosis (0.55).Conclusions: These findings suggest that the ACE DD genotype is a potent genetic risk factor for organic coronary artery disease, while it confers no appreciable increase in risk of vasospastic angina. These results also suggest the diversity of the pathogenesis of vascular lesions in these two types of coronary artery disease.
Termination and suppression of idiopathic left ventricular tachycardia by diltiazem
Authors: Lin Lang , Conti Jamie Beth , Curtis Anne B. 
Published: February 2009

AbstractIdiopathic left ventricular tachycardia is known to be responsive to verapamil in many cases. However, the role of other calcium‐channel blockers, such as diltiazem, in treating this specific type of ventricular tachycardia is unknown. We report a case of idiopathic left ventricular tachycardia in a patient with a structurally normal heart, which was terminated and suppressed in the electrophysiology laboratory by a single dose of diltiazem intravenously, and was subsequently suppressed long‐term with sustained‐release diltiazem. Our finding suggests that idiopathic left ventricular tachycardia may be managed effectively with diltiazem in both the acute and chronic settings.
Venous thrombosis causing arterial embolization to the same limb through a patent foramen ovale
Authors: Herity N. A. , Dalzell G. W. N. 
Published: February 2009

AbstractWe describe a patient who presented with acute ischemia affecting the left lower limb. Because a transthoracic echocardiogram was abnormal, a transesophageal study was arranged. This demonstrated an atrial septal aneurysm and right‐to‐left shunting of contrast, raising the possibility of paradoxical embolism. The diagnosis was confirmed by contrast venography, which showed extensive thrombosis in the deep veins of the left thigh, and a ventilation‐perfusion scan which was consistent with multiple pulmonary emboli. Among the lessons from this case was the finding that in patients with arterial embolism the likely origin of the embolus should be considered and, in the absence of common risk factors (atrial fibrillation, rheumatic heart disease, left ventricular dilatation, widespread atheroma), occult venous thrombosis and a right‐to‐left shunt should be sought. In this select group of patients, transesophageal echocardiography is significantly more sensitive than transthoracic study and should be the investigation of choice. Second, in the patient described in this report the clinical signs of deep venous thrombosis (DVT) were masked by the more prominent features of acute arterial ischemia. Without the incidental echocardiographic abnormality, it is likely that the important diagnoses of DVT, pulmonary embolism, and paradoxical embolism would not have been made.
Postinfarction Left Ventricular Pseudoaneurysm
Authors: Csapo Kalman , Voith Laszlo , Szuk Tibor , Edes Istvan , Kereiakes Dean J. 
Published: February 2009

AbstractLeft ventricular wall rupture after myocardial infarction is a mechanical complication that may result in a pseudoaneurysm. Between January 1994 and October 1996, false or pseudoaneurysms were detected in 6 (0.0026%) of 2,600 consecutive patients (4 women, 2 men; mean age 59.4 years) undergoing cardiac catheterization at University Medical School, Debrecen, Hungary. All patients had a history of cardiovascular disease, with diagnosis of pseudoaneurysm confirmed by echocardiography. The average time from the occurrence of acute infarction to diagnosis was 37.0 days (range 3–80 days). All patients were in New York Heart Association functional class IV congestive heart failure; in four patients cardiogenic shock was present. Five patients underwent coronary angiography, which demonstrated multivessel disease and occlusion of the infarct–related artery (TIMI 0) without adequate collateral circulation (grade 0–1). Five patients had surgical repair of the false aneurysm, and, in three patients, concomitant coronary bypass grafting was performed. The 2‐year mortality rate for all patients was 50%. Early diagnosis of false aneurysm is facilitated by echocardiography, and coronary angiography is required before surgery. Early surgical correction with coronary revascularization is advised.
Detection of left ventricular systolic and diastolic abnormalities in patients with coronary artery disease by color kinesis
Authors: Vitarelli Antonio , Sciomer Susanna , Schina Mauro , Luzzi Marco Ferro , Dagianti Armando 
Published: February 2009

AbstractBackground: Color kinesis (CK) is a recently developed echocardiographic technique based on acoustic quantification that automatically tracks and displays endocardial motion in real time and has been used in initial studies to improve the evaluation of global and regional wall motion.Hypothesis: For further validation of the use of CK for analysis of segmental ventricular dysfunction, we assessed its sensitivity and specificity for detection of regional systolic and diastolic wall motion abnormalities in patients with coronary artery disease (CAD).Methods: Two‐dimensional (2‐D) echocardiography and CK were used to study 15 normal subjects and 63 patients with technically good quality echocardiographic tracings, who underwent coronary arteriography within 1 month of echocardiography. Significant (>70% luminal diameter stenosis) CAD was present in 50 patients (79%).Results: Color kinesis tracked endocardial motion accurately in 93% of left ventricular segments. Wall motion score, systolic segmental endocardial motion (SEM), and the time of systolic SEM (tSEM) and diastolic (tDEM) segmental endocardial motion were calculated. Intra‐ and interobserver variability were within narrow limits. SEM and tSEM were significantly lower and tDEM was significantly higher in the patient population than in the control group (p< 0.001). Comparison between CK and 2‐D echocardiography showed a correlation coefficient of 0.81 between the two techniques. The score was identically graded in 74% of segments, with concordance of 82% in diagnosing segments as abnormal. Interobserver concordance was 86% for CK (r=0.85) and 81% for 2‐D echocardiography (r=0.80). The sensitivity and specificity of systolic and diastolic CK parameters for the detection of CAD were 88 and 92% and 77 and 85%, respectively. The positive predictive values were 93 and 96%, respectively, the negative predictive values were 63 and 73%, respectively, and the overall accuracy was 86 and 91%, respectively.Conclusions: Our data suggest that CK is a feasible and sensitive technique for identifying regional systolic as well as diastolic wall motion abnormalities in patients with CAD.
The role of cardiac troponin t and other new biochemical markers in evaluation and risk stratification of patients with acute chest pain syndromes
Authors: Solymoss B. Charles , Bourassa Martial G. , Wesolowska Ewa , Dryda Ihor , Th$Earoux Pierre , Mondor Louise , Perrault Danielle , Gilfix Brian Mark 
Published: February 2009

AbstractBackground and hypothesis: Increased serum creatinine kinase (CK) and CK‐MB enzyme levels have been used for years to detect myocardial infarction (MI). However, serum myoglobin and CK‐MB mass or protein levels may indicate MI earlier; cardiac troponin T is the most specific marker of myocardial injury and it can detect even minor myocardial necrosis. The diagnostic and prognostic utility of the traditional and new markers of cardiac injury in the emergency evaluation of patients with acute chest pain syndromes were therefore compared.Methods: One hundred and fifteen consecutive patients with an acute coronary syndrome, and 64 controls recruited during the same period, were examined. The time elapsed from onset of symptoms to blood collection was recorded. Cardiac markers were measured in specimens collected upon arrival (0 h), and 2 and 5–9 h, and later in cases of longer observation. The major cardiac events occurring up to 40 months after the index examination were recorded.Results: cTnT levels provided unique information: they were the most specific indicators of myocardial damage and identified unstable angina patients at high risk of future major events. Up to 6 h after the onset of chest pain, the new markers were elevated more frequently than the traditional ones and permitted earlier MI recognition. The worst prognosis (nonfatal myocardial infarction or death) was noted in subjects with chest pain at rest within 48 h before the index examination and elevated cTnT levels.Conclusions: The new markers, particularly cardiac troponin T, offer considerable advantages and they should be more widely used in the diagnosis and risk stratification of acute coronary syndromes.
Left ventricular mass assessed by three‐dimensional echocardiography using rotational acquisition
Authors: Rodevand Olaf , Bjornerheim Reidar , Kolbjornsen Odd , Ihlen Halfdan , Kjekshus John 
Published: February 2009

AbstractBackground: The reproducibility of left ventricular (LV) mass measurement by two‐dimensional (2‐D) echocardiography is inadequate for individual assessments.Hypothesis: This study was undertaken to evaluate the potential of LV mass determination with a new three‐dimensional (3‐D) echocardiographic method compared with 2‐D measurement.Methods: Porcine agarose‐filled left ventricles (n = 15, true mass 61–511 g) of different shapes were measured by a multiplane 3‐D method based on 90 images acquired by probe rotation axis (1) perpendicular and (2) parallel to the ventricular long axis [“parasternal” (the left sternal border was not present as a reference point in this study) and apical views]. Mass was also obtained using (3) the biplane truncated ellipsoid and (4) area‐length methods, as well as (5) the modified cube formula. Five hearts were not analyzed with the apical 3‐D technique because of insufficient image quality.Results: Systematic deviation from true mass was small with all methods (< 5.3%). Accuracy, expressed as 1 standard deviation of individual estimates around this systematic bias, was 7.7, 13.6, 8.2, 11.9, and 11.9% of true mass for the methods 1–5, respectively. Interobserver reproducibility, expressed as the coefficient of variation, was 4.7, 8.8, 8.1, 8.9, and 9.4% for the same methods.Conclusion: Limits for individual accuracy and reproducibility of LV mass estimates are nearly doubled using apical compared with “parasternal” 3‐D echocardiography in vitro. A main advantage of “parasternal” 3‐D compared with 2‐D LV mass estimates is better reproducibility, but at the expense of greater time consumption. Apical 3‐D technique is not superior to simpler 2‐D methods based on “parasternal” short axis imaging.
Results of electrophysiologic studies in patients with acute chagasic myocarditis
Authors: Fuenmayor Abde I. J. , Fuenmayor Abdel M. , Carrasco Hugo , Parada Henry , Fuenmayor Carmen , Jugo Diego 
Published: February 2009

AbstractBackground: As the acute stage of Chagas' myocarditis is rarely detected, little is known about the electrophysiologic characteristics of that stage.Methods: We studied eight patients who had positive xenodiagnosis, positive mice culture, and positive complement fixation test for Chagas' disease.Results: Trypanosoma cruzi were identified in all of the patients' stained blood samples. Right ventricular endomyocardial biopsies were obtained, evidencing a distinct infiltrate of lymphocytes that confirmed the diagnosis of acute myocarditis. The cardiac dimensions and the ventricular systolic and diastolic function were preserved in all patients. The electrocardiogram evidenced conduction defects in two patients. The signal‐averaged electrocardiogram displayed late potentials in three patients. In the electrophysiologic study, atrial fibrillation or flutter was induced in four patients. When compared with control patients, Chagasic patients were found to have greater values of atrial threshold, A‐H interval, and atrioventricular (AV) nodal effective refractory period. The H‐V interval was mildly prolonged in two patients, but the dynamic AV nodal conduction was preserved (1:1 conduction during right atrial stimulation at a cycle length of 400 ms) in all the Chagasic patients. The ventricular parameters were within normal limits, and no sustained ventricular arrhythmia could be induced.Conclusions: Patients with mild acute Chagasic myocarditis may suffer from electrical abnormalities and arrhythmias that are more evident at the supraventricular level and the AV junction.Hypothesis: This investigation was undertaken to conduct an electrophysiologic study of the properties of the heart during the acute phase of Chagasic myocarditis.
Thrombolytic therapy guided by a decision analysis model: Are there potential benefits for patient management?
Authors: Kellett John , Ryan Breda 
Published: February 2009

AbstractBackground: Although thrombolytic therapy improves the outcome of myocardial infarction, it is associated with increased risks of stroke and bleeding; these risks may outweigh the benefits of therapy. The risks and benefits of thrombolysis, for any individual clinical situation, can be explicitly estimated by means of decision analysis.Hypothesis: The aim of this study was to compare the actual use of thrombolytic agents for suspected acute myocardial infarction (AMI) with the management preferred by a decision analysis model.Methods: Admission data prospectively obtained in 262 consecutive patients admitted to a rural community hospital's coronary care unit with suspected AMI, as well as clinical decisions and outcomes, were reviewed and analyzed.Results: Seventeen deaths from AMI and no major strokes were observed, compared with 18.30 deaths and 0.85 major strokes predicted by a decision analysis model. Forty‐seven of 84 patients with confirmed AMI and 3 of 178 without AMI were given a thrombolytic agent, compared with 65 patients with and 7 without AMI who had decision analysis‐guided therapy. Decision analysis‐guided therapy could have saved 3.7 additional lives and gained 29.6 life years, but produced 0.4 extra strokes. Changing the quality adjustment for stroke or heart failure would not have altered the treatment preferred by decision analysis in any of the 262 cases studied. Some patients were predicted to benefit considerably from thrombolysis with little extra risk of stroke and vice versa: all cases must, therefore, be assessed individually.Conclusions A decision analysis model can guide thrombolytic therapy by promptly defining its risks and benefits.
Echocardiographic detection of kaposi's sarcoma causing cardiac tamponade in a patient with acquired immunodeficiency syndrome
Authors: Chyu Kuang‐Yuh , Birnbaum Yochai , Naqvi Tasneem , Siegel Robert J. , Fishbein Michael C. 
Published: February 2009

AbstractPericardial effusions are common in patients with acquired immunodeficiency syndrome (AIDS). The differential diagnosis is diverse, and in most cases the etiology cannot be established. A cardiac tamponade was diagnosed in a 32‐year‐old male with AIDS and systemic Kaposi's sarcoma. Transthoracic echocardiography revealed a large pericardial effusion with right atrial collapse and a mobile multilobular mass at the apex protruding into pericardial space. Autopsy showed that this mass was Kaposi's sarcoma confined to the epicardial fat. This is the first case of cardiac Kaposi's sarcoma detected premortem by echocardiography.