bluuebunny/crossref_metadata_2025_split huggingface dataset:
Isolated left ventricular abnormal trabeculation in adults is associated with neuromuscular disorders
Authors: Finsterer Josef , Blazer Gerhard , Stöllberger Claudia , Valentin Andreas , Tscholakoff Dimiter 
Published: February 2009

AbstractBackground: Isolated left ventricular abnormal trabeculation (ILVAT) is defined as < 3 coarse trabeculations of the left ventricular wall, apically to the papillary muscles, in hearts without congenital malformations.Hypothesis: The aims of the study were to assess by echocardiography the prevalence of ILVAT, to confirm the diagnosis by cardiac magnetic resonance imaging (CMRI), to look for cardiac findings in ILVAT, and to determine whether ILVAT is familial and associated with neurological disorders.Methods: During a 1‐year period (July 1995 to July 1996) all patients in whom transthoracic echocardiography visualized ILVAT, were included in the study. The examination and measurements were performed according to established guidelines.Results: During 1 year, ILVAT was found in 6 of 3,397 patients (0.2%). When applied, CMRI confirmed ILVAT. Four patients had heart failure, all had electrocardiographic (ECG) abnormalities. None of the investigated relatives showed ILVAT. One patient had Becker's muscular dystrophy, three had mitochondrial myopathy, one had polyneuropathy, and one had muscle wasting of unknown origin.Conclusions: Isolated left ventricular abnormal trabeculation is rare, visible on echocardiography and CMRI, associated with ECG abnormalities, sometimes with heart failure, and always with neuromuscular disorders. Thus, when ILVAT is found, the cardiologist should consider a neurology referral.
Multiple coronary occlusions associated with ST‐segment elevation
Authors: Dhond Milind R. , Kang June , Wentzien Thomas , Amsterdam Ezra A. 
Published: February 2009

AbstractWe describe the case of a patient with rapid sequential ST‐segment elevation in different areas on the electrocardiogram (ECG) associated with lesions of differing etiologies in the corresponding coronary arteries. Prior reports of ST‐segment elevations in multiple areas on the ECG have been from obstructions of single coronary vessels whose distribution overlapped separate areas on the ECG or spasm of multiple coronary arteries. We could find no prior reports of such rapid sequential ST‐elevation in different areas on the ECG caused by two differing etiologies.
Potential proarrhythmic effects of implantable cardioverter‐defibrillators
Authors: Duru Firat , Candinas Reto 
Published: February 2009

AbstractImplantable cardioverter‐defibrillator (ICD) interventions have the potential to be proarrhythmogenic. New arrhythmias can occur in the setting of clinically appropriate therapies, as well as during a cardiac rhythm for which therapy is not intended. Cardioversion/defibrillation therapies, antitachycardia pacing, and antibradycardia pacing are potential triggers for the development of new arrhythmias. Newer ICDs allow better recognition and interpretation of the arrhythmias that are induced by delivered therapies. Two cases of ICD‐induced proarrhythmias are described. Based on the course of these patients and review of previous reports, proarrhythmic effects of ICD interventions along with prevention and management strategies are discussed.
NC100100, a new echo contrast agent for the assessment of myocardial perfusion—safety and comparison with technetium‐99m sestamibi single‐photon emission computed tomography in a randomized multicenter study
Authors: Binder Thomas , Assayag Patrick , Baer Frank , Flachskampf Frank , Kamp Otto , Nienaber Christoph , Nihoyannopoulos Petros , Pi érard Luc , Steg Gabriel , Vanoverschelde Jean‐Louis , Wouw Poll Van Der , Meland Nils , Marelli Claudio , Lindvall Kaj 
Published: February 2009

AbstractBackground and hypothesis: Myocardial contrast echocardiography using second‐generation agents has been proposed to study myocardial perfusion. A placebo‐controlled, multi‐center trial was conducted to evaluate the safety, optimal dose, and imaging mode for NC100100, a novel intravenous second‐generation echo contrast agent, and to compare this technique with technetium ‐ 99m sestamibi (MIBI) single‐photon emission computed tomography (SPECT).Methods: In a placebo‐controlled, multicenter trial, 203 patients with myocardial infarction > 5 days and < 1 year previously underwent rest SPECT and MCE. Fundamental and harmonic imaging modes combined with continuous and electrocardiogram‐ (ECG) triggered intermittent imaging were used. Six dose groups (0.030, 0.100, and 0.300 μl particles/kg body weight for fundamental imaging; and 0.006, 0.030, and 0.150 μl particles/kg body weight for harmonic imaging) were tested. A saline group was also included. Safety was followed for 72 h after contrast injection. Myocardial perfusion by MCE was compared with myocardial rest perfusion imaging using MIBI as a tracer.Results: NC100100 was well tolerated. No serious adverse events or deaths occurred. No clinically relevant changes in vital signs, laboratory parameters, and ECG recordings were noted. There was no significant difference between adverse events in the NC100100 (25.7%) and in the placebo group (17.9%, p=0.3). Intermittent harmonic imaging using the intermediate dose was superior to all other modalities, allowing the assessment of perfusion in 76% of all segments. Eighty segments (96%) with normal perfusion by SPECT imaging also showed myocardial perfusion with MCE. However, a substantial percentage of segments (61–80%) with perfusion defects by SPECT imaging also showed opacification by MCE. This resulted in an overall agreement of 66–81% and a high specificity (80–96%), but in low sensitivity (20–39%) of MCE for the detection of perfusion defects.Conclusion: NC100100 is safe in patients with myocardial infarction. Intermittent harmonic imaging with a dose of 0.03 μl particles/kg body weight can be proposed as the best imaging protocol. Myocardial contrast echocardiography with NC 100100 provides perfusion information in approximately 76% of segments and results in myocardial opacification in the vast majority of segments with normal perfusion as assessed by SPECT. Although the discrepancies between MCE and SPECT with regard to the definition of perfusion defects requires further investigation, MCE with NC 100100 is a promising technique for the noninvasive assessment of myocardial perfusion.
Assessment of quality of life in patients with chest pain and normal coronary arteriogram (syndrome x) using a specific questionnaire
Authors: Atienza Felipe , Velasco José A. , Ridocci Francisco , Brown Sue , Kaski Juan Carlos 
Published: February 2009

AbstractBackground: Prognosis in patients with syndrome X (chest pain and normal coronary arteriograms) is good; however, persistent chest pain and functional disability are common in these patients. Accurate assessment of quality of life may be useful for patient management.Aim: The quality of life status in patients with syndrome X was assessed using a specific questionnaire. This questionnaire was developed and validated for the assessment of quality of life in patients with typical chest pain despite normal coronary arteriograms.Methods: Ninety consecutive patients were invited to complete both the questionnaire (on two occasions within 2 weeks) and a standardized angina diary. Fully completed questionnaires were received from 66 (73%) patients (mean age 58±8 years, 55 women).Results: Answers were scored according to a grading system where higher scores indicate worse quality of life. We observed that total scores increased with severity of angina (Canadian Class I, 38±16, II: 93±29, III–IV, 119±23; p<0.001) and correlated with both the number and the severity of chest pain episodes (r=0.50–0.66: p<0.001). In patients who remained clinically stable (n=37) during the 2‐week assessment, test‐retest analysis showed no score differences (87±30 vs. 81±30; p=0.1), while total score increased in patients (n=24) whose symptoms worsened (108±31 vs. 116±31; p < 0.02) and was reduced in those (n=5) whose symptoms improved (55±37 vs. 39±28; p<0.04).Conclusion: Our study shows that quality of life is significantly impaired in patients with syndrome X and that the specific questionnaire used for assessment is a reliable and sensitive tool for the evaluation of quality of life in patients with chest pain and normal coronary arteriograms.
Antigens of the major histocompatibility system in ischemic heart disease and idiopathic dilated cardiomyopathy
Authors: Osa Ana , Almenar Luis , Palencia Miguel , Puig Nieves , Montoro Jose , Chirivella Melitina 
Published: February 2009

AbstractBackground: Although dilated cardiomyopathy (DCM) is a disease of unknown and probably multifactorial etiology, a change in immune mechanisms is presumably significant, with many abnormalities in humoral and cellular responses having been reported. The heart thus becomes the target organ for an initial episode of myocardial damage that triggers an autoimmune response.Hypothesis: The purpose of this study was to analyze the frequency of different human leukocyte antigens in patients with a diagnosis of well‐advanced DCM and ischemic heart failure, comparing them with a control group of presumably healthy subjects.Methods: The group with dilated cardiomyopathy consisted of 50 patients (7 women and 43 men), aged from 14 to 64 years. The group with ischemic heart disease included 76 patients (4 women and 72 men), with ages ranging from 34 to 64. The control group, consisting of 1,337 presumably healthy subjects from the Spanish Mediterranean area, was recruited based on paternity studies.Results: Compared with the control group, we found in DCM a greater incidence of B15 (20 vs. 6%) and DQ 3 (83 vs. 50%) antigens. In ischemic heart disease we found a lower incidence of A1 (3 vs. 22%), B8 (5 vs. 12%), and DQ2 (16 vs. 50%) in comparison with the control group.Conclusions: In the Spanish Mediterranean area, the presence of antigens B‐15 and DQ3 would be associated with advanced DCM. The absence of antigens A1, B8, and DQ2 would be associated with the occurrence of severe ischemic heart disease.
Acquired coronary cameral fistulas: Are these collaterals losing their destination?
Authors: Said SalahA. M. , Werf Tjeerd Van Der 
Published: February 2009

AbstractBackground: The majority of coronary cameral fistulas (CCFs) are congenital in origin. On the other hand, acquired coronary cameral fistulas, having various etiopathogenic origins, are increasingly recognized.Hypothesis: The aim of this study was to assess the possible involvement of coronary atherosclerosis in the pathogenesis of acquired coronary cameral fistulas.Methods: Between 1993 and 1996 coronary cameral fistulas were detected in seven adults patients with coronary atherosclerosis (n = 4) and following myocardial infarction (n = 3) with a mean age of 59.3 years (range 40–77). They were analyzed at our hospital.Results: Myocardial infarction (MI) was documented in six patients and was localized at the same territory of the fistula‐related artery in three of them. All patients remained asymptomatic after the detection of the fistula. Five patients had associated cardiac disorders. Two patients were treated conservatively with medical therapy. Coronary artery bypass grafting (CABG) was performed in three patients. One patient died while awaiting CABG. Thirty‐four adult cases with acquired CCFs were collected from the current literature. The right coronary artery was the origin of the fistula in 37% and they terminated into the right heart‐side in 72% of cases. They remained asymptomatic in 62% of cases.Conclusions: It could be concluded that acquired CCFs may complicate the course of severe atherosclerosis or myocardial infarction in certain adult patients. The symptomatology and treatment strategy is comparable in the congenital and acquired types. The distribution of involvement of the right or left coronary arteries is equally divided in both the acquired and congenital types. Further studies are needed to investigate the precipitating factors for the occurrence of and incidence of acquired CCFs in patients with severe atherosclerosis or post‐MI subjects.
Digital assessment of the epicardial electrocardiogram: Novel methodology for a core laboratory for clinical studies
Authors: Willis Hurst J. , Bertolet Barry E. , Boyette Alice F. , Handberg‐Thurmond Eileen M. , Wolf Robert A. , Deitchman David , Blumenthal Mel , Pepine Carl J. 
Published: February 2009

AbstractBackground: The epicardial electrocardiogram (ECG) is a sensitive marker for cardiac ischemia and has been used as a measure of ischemia in clinical trials. We sought to examine the utility of a central ECG laboratory for determining ischemic‐type ST‐segment shifts from epicardial ECG recordings obtained from multiple clinical sites.Hypothesis: We speculated that an operator‐assisted digital ECG core laboratory is feasible, reliable, and efficient, with the ability for rapid and accurate interpretation of the epicardial ECG.Methods: The epicardial ECG was recorded via an angioplasty guidewire placed in a coronary artery of a patient undergoing angioplasty. Site investigators visually determined the time‐to‐onset of 0.1 and 0.3 mm ST‐segment elevation, and the maximal ST‐segment elevation during balloon inflation, and then compared the measurements with those made at an operator‐assisted digital ECG core laboratory.Results: Agreement between the two methods occurred in 78% of the time‐to‐onset measurements, but in only 39% of the maximal ST‐segment measurements. Overall, the visual measurements of the clinical investigators of time‐to‐onset differed from the digital core laboratory by 11.8 ± 11.6 s for 0.1 mV, and 15.8 ± 20.6 s for 0.3 mV. Recorded maximal ST‐segment shifts differed by a mean of 0.47 ± 0.69 mV.Conclusion: The magnitude of inconsistency between the ECG core laboratory results using an operator‐assisted digital method and the interpretations of clinical investigators using manual caliper‐type analysis was surprisingly large. These results support the need for an ECG core laboratory in clinical trials where ECG ST‐segment shifts are used as a response variable.
Transient effusive‐constrictive pericarditis due to chemotherapy
Authors: Woods Timothy , Vidarsson Brynjar , Mosher Deane , Stein James H. 
Published: February 2009

AbstractCommonly used chemotherapeutic agents, specifically cytarabine and daunorubicin, can cause effusive‐constrictive pericarditis. We describe a case of transient effusive‐constrictive pericarditis in a patient with acute myelogenous leukemia. This is the first case report of a patient with transient effusive‐constrictive pericarditis due to chemotherapy.
ILEAD‐ischemia of the lower extremities due to aortic dissection: The isolated presentation
Authors: Spodick David 
Published: February 2009

AbstractBackground and hypothesis: Lower extremity symptoms accompanying dissecting hematomas of the aorta are well described. Isolated lower extremity ischemia as the presenting syndrome of aortic dissection is rare and frequently misinterpreted so that the diagnosis of aortic dissection is delayed or missed, often with catastrophic results. This study was undertaken to determine its common characteristics and to reinforce recognition of this life‐threatening phenomenon.Methods: After the first patient in our series presented with isolated lower extremity ischemia due to aortic dissection, a prospective search for similar presentations was undertaken over 2 years. We also conducted a retrospective search for all aortic dissections at our hospital for the past 10 years and a MEDLINE search for all reported aortic dissections in the literature of the past 20 years, as well as for all reports of isolated ischemia of the lower extremities due to aortic dissection.Results: Three patients with isolated ischemia of the lower extremities due to aortic dissection were found prospectively after the index case. Over 10 years, 40 patients with acute aortic dissection were diagnosed at our hospital. The MEDLINE search revealed 1,751 aortic dissections of which 10% had lower extremity symptoms. Only 10 cases of aortic dissection were reported as lower extremity ischemia with symptoms isolated to one or both lower extremities. Smoking, hypertension, male gender, hypercholesterolemia, and recent history of coronary artery bypass grafting were common predisposing risk factors for this rare presentation.Conclusion: Symptomatic isolated ischemia of the lower extremities due to aortic dissection is rare and often missed. Awareness of its characteristics, aided by the acronym ILEAD, made it possible to suspect the true origin of this misleading syndrome.
Antianginal and anti‐ischemic effects of nisoldipine and ramipril in patients with syndrome X
Authors: Özçelik Fatih , Altun Armaǧan , Özbay Gultaç 
Published: February 2009

AbstractBackground: Syndrome X is defined as typical angina pectoris, positive treadmill exercise test, negative intravenous ergonovine test, and angiographically normal coronary arteries.Hypothesis: in the present study, we investigated the anti‐ischemic and antianginal effects of nisoldipine and ramipril in patients with syndrome X.Methods: After 2 weeks of the first wash‐out period, 18 patients (7 men, 11 women, age 46 ± 10 years) were given nisoldipine (NIS) 5 mg twice daily for 4 weeks, and after 2 weeks of the second wash‐out period, the same patients were given ramipril (RAM) 2.5 mg once daily for 4 weeks. A treadmill exercise test with modified Bruce protocol was performed at the end of each period.Results: The time to angina in exercise (607 ± 115 s‐650 ± 117 s, p = 0.006, vs. 630 ± 114 s‐660 ± 123 s, p = 0.02), total exercise time (612 ± 110 s‐656 ± 114 s, p = 0.0008, vs. 630 ± 114 s‐660 ± 123 s, p = 0.02), and maximum MET value (11.09 ± 2.08–11.86 ± 2.04, p = 0.0016, vs. 11.42 ± 2.09–12.2 ± 2.26, p = 0.01) were increased significantly with both therapy modalities. The time to 1 mm ST‐segment depression (123 ± 93 s ‐ 220 ± 172 s, p = 0.002) was increased significantly with NIS therapy. The time to ST‐segment recovery (434 ± 268 s‐330 ± 233 s, p = 0.016 vs. 443 ± 289 s‐370 ± 278 s, p = 0.012), the frequency of anginal attacks per week (1.27 ± 1.4–0 ± 0.38, p = 0.005, vs. 1 ± 1.32–0.33 ± 0.59, p = 0.028), and the need for sublingual nitroglycerin (1.16 ± 1.29–0.11 ± 0.32, p = 0.005, vs. 0.94 ± 1.16–0.27 ± 0.57, p = 0.012) were decreased significantly with both drugs.Conclusion: We observed that 10 mg daily NIS and 2.5 mg daily RAM have similar anti‐ischemic and antianginal effects in patients with syndrome X.
Physician risk assessment and apache scores in cardiac care units
Authors: Pierpont Gordon L. , Parenti Connie M. 
Published: February 2009

AbstractBackground: The need to correct outcome data for case mix is well recognized, but risk assessment for coronary care unit (CCU) patients remains problematic.Hypothesis: This study determined the feasibility of using physicians' opinions to predict mortality for CCU patients and compared their results to Acute Physiology and Chronic Health Evaluation II (APACHE II) scores.Methods: A prospective observational study was performed on consecutive patients admitted to a university‐affiliated Veterans Affairs Medical Center CCU over a 2‐month period. Physician assessment of likely mortality during hospitalization, obtained using an MD Prognosis Score ranging from 1 (best) to 7 (worst), was compared with APACHE II scores.Results: MD Prognosis Scores were obtained on 122 of the 237 eligible patients (51% response rate) and averaged 2.3 ± 1.4 (mean ± standard deviation). APACHE II scores on these patients averaged 9.9 ± 4.8 (range 2‐29) with very poor correlation between the two methods (r = 0.3). Of the four patients who died, three had MD prognosis scores of 7. None of the survivors had scores of 7 and only three had scores of 6. APACHE II did not predict a high likelihood that any of the patients would die (none with > 90% likelihood of mortality).Conclusions: APACHE scores are inadequate for cardiac patients. Although physicians can identify CCU patients most likely to die, reliance on physicians scoring systems is limited by difficulties in obtaining their opinion. A new method of risk assessment for acutely ill cardiac patients is needed if CCU outcomes are to be compared across institutions.
The use of the New york heart association's classification of cardiovascular disease as part of the patient's complete problem list
Authors: Hurst J. Willis , Morris Douglas C. , Alexander R. Wayne 
Published: February 2009

AbstractThis paper extols the value of combining two systems in order to improve learning, teaching, communication, patient care, and clinical research in patients with heart disease. This is accomplished by using Weed's recommendation regarding the creation of a complete Problem List and, within this context, characterizing the cardiac or vascular problem according to the recommendations of the New York Heart Association.
QRS prolongation on the signal‐averaged electrocardiogram versus st‐segment changes on the 12‐lead electrocardiogram: Which is the most sensitive electrocardiographic marker of myocardial ischemia?
Authors: Michaelides Andreas P. , Dilaveris Polychronis E. , Psomadaki Zoi D. , Richter Dimitris J. , Andrikopoulos George K. , Pitsilides Nikolaos , Stefanadis Christodoulos , Toutouzas Pavlos K. , Dounis Vasilios 
Published: February 2009

AbstractBackground: ST‐segment changes and QRS prolongation are electrocardiographic (ECG) markers of myocardial ischemia.Hypothesis: This study was undertaken to investigate the appearance of QRS duration changes with or without concomitant ST‐segment changes during a typical anginal episode.Methods: For this purpose, 126 patients underwent 12‐lead surface ECG and signal‐averaged electrocardiogram (SAECG) during typical anginal pain as well as at the time the patient was asymptomatic. In both periods, QRS duration and ST‐segment changes were evaluated. All patients underwent cardiac catheterization.Results: Of the 126 patients, 108 (86%) had coronary artery disease (CAD), whereas the remaining 18 (14%) patients had normal coronary arteriograms. During typical anginal pain, 75 of the 108 (70%) patients with CAD and 2 of the 18 (11%) patients with normal coronary arteriograms developed QRS prolongation, whereas 60 of the 108 (56%) patients with CAD and 2 of the 18 (11%) patients with normal coronary vessels developed ST‐segment changes. Thus, the sensitivities of QRS prolongation measured by SAECG and of ST‐segment changes on the surface ECG for the detection of myocardial ischemia were found to be 70 and 56%, respectively, (p <0.01), whereas the specificities were both found to be 89% (p=NS).Conclusions: During typical anginal pain, QRS prolongation on the SAECG is more sensitive than are ST‐segment changes on the ECG for the detection of myocardial ischemia.