bluuebunny/crossref_metadata_2025_split huggingface dataset:
Unstable Angina of Crescendo Pattern vs New Onset: A Clinical, Coronary Arteriographic and Hemodynamic Study
Authors: Hussain K.M.A. , Gould L. , Bharathan T. , Abdelsayed G. , Karpov Yu. 
Published: July 2008

Unstable angina includes a variety of clinical presentations with a different level of risk for an unfavorable outcome. In this study the authors investigated the prognostic signif icance of crescendo angina and new-onset angina to discuss management strategies, paying attention to the relevance of baseline clinical characteristics, coronary artery lesions, and left ventricular function, as well as their alterations during atrial pacing. Accordingly coronary arteriographic anatomy and changes in left ventricular volumes and ejection fraction before and during atrial pacing were studied by means of digital subtraction ventriculography in 18 patients with crescendo angina and in 18 patients with new-onset angina. Triple-vessel disease was more frequently observed in crescendo angina (56%; P < 0.05) as compared with the patients with new-onset angina (11%). Complex coronary morphology was statistically more likely to be found in crescendo angina. The angiographic evidence of intracoronary thrombi was found in 33% (P < 0.05) patients with crescendo angina and in 4% patients with new-onset angina. Compared with the patients with new-onset angina, patients with crescendo angina had higher end-diastolic and end-systolic volumes and lower ejection fraction at rest. At peak pacing, ejection fraction was significantly (P < 0.05) lower in crescendo angina (0.48 ±0.06) than in new-onset angina (0.66 ±0.04). In crescendo angina, during pacing, the magnitude of velocity of circumferential fiber shortening was significantly decreased as compared with new-onset angina. Thus, our findings document more extensive coronary atherosclerosis and more severe left ventricular dysfunction in patients with crescendo angina than in patients with new-onset angina, which may explain the poorer outcome in the former subgroup of patients.
Origin and Pathophysiological Role of Increased Plasma Endothelin-1 in Patients with Acute Myocardial Infarction
Authors: Setsuta Koichi , Seino Yoshihiko , Tomita Yoshifumi , Nejima Jun , Takano Teruo , Hayakawa Hirokazu 
Published: July 2008

To investigate the origin and pathophysiological role of increased plasma endothelin-1 (endothelin-1) concentration in patients with acute myocardial infarction (AMI), the authors measured plasma endothelin-1 sequentially after the onset of AMI and analyzed the origin by the simultaneously obtained blood samples from the radial artery, right atrium, and pulmonary artery in 28 patients with AMI. The data were correlated with cardiovascular hemodynamics, infarct size, and coronary arteriographic findings. Arterial endothelin-1 at twenty-four and seventy-two hours significantly correlated with mean pulmonary arterial pressure (r=0.48, r=0.46, P < 0.05, respectively), central venous pressure (r=0.42 and 0.51, P < 0.05, respectively), and pulmonary vascular resis tance (r=0.42, r=0.42, P < 0.05), and endothelin-1 at one hundred twenty hours signif icantly correlated with peak creatine kinase (r=0.53, P < 0.05) and creatine kinase isozyme MB (r=0.58, P < 0.01). Simultaneous blood samples showed no significant difference in endothelin-1 concen trations among them. However, a subgroup of patients with endothelin-1 concentration higher in the radial artery than that in the right atrium showed a significantly higher mean pulmonary arterial pressure (25.2 ±6.5 vs 17.0 ±1.6 mmHg, P < 0.05), peak creatine kinase (3594 ±1597 vs 865 ±495 IU/L, P < 0.05), and peak creatine kinase MB (214 ±91 vs 69 ±22 IU/L, P < 0.05) as compared with those in patients in whom endothelin-1 was higher in the right atrium than in the radial artery. Increased plasma endothelin-1 concentration in the early stage of AMI reflects higher pulmonary artery pressure and elevated pulmonary vascular resistance, while that in the later stage is related to the infarct size. The production of endothelin-1 in patients with severe pump failure may be accere lated in the pulmonary vascular bed, left ventricle, or systemic arterial trees, and the main origin in the later stage is possibly coronary vasculature in the infarcted area.
Significant Differences Between Side-Mounted and End-Mounted Intracoronary Doppler Flow Probes for the Measurement of Blood Flow Velocity
Authors: Holdright Diana R. , Clarke Debbie , Ford David W. , Fox Kim M. , Poole-Wilson Philip A. , Collins Peter 
Published: July 2008

Use of the intracoronary Doppler flow probe is an established method for the assessment of coronary blood flow velocity. The aim of this study was to perform an in vitro compar ison of two commonly used Doppler probes, which differ in the location of the piezo electric crystal (end-mounted vs side-mounted). Blood flow velocity was measured over a wide range of flow rates in a flow simulator using heparinized whole blood. Measurements were made with both Doppler probes assessed in two positions (supported and unsupported) within the tubing. The results were compared with estimated true velocities. Further measurements were made with six side-mounted probes, correcting for the assumed crystal mounting angle and for the angle calculated from magnified images of the individual crystals. Mean velocities for end- and side-mounted probes correlated highly with predicted velocities (all r ≥ 0.99), but the side-mounted probes significantly overestimated velocity by >100%. Estimation of the true crystal mounting angle of the side-mounted probe revealed considerable variability (range 30-42°) and was lower than the recommended angle correction factor of 60 ° . Velocities corrected for the individual crystal mounting angles agreed more closely with predicted mean velocities. Although both probes are adequate for the assessment of relative changes in flow, the side-mounted probe considerably overestimates mean velocity, which is partly explained by the variable mounting angle of the crystal. The demonstrated limitations of the side- mounted Doppler flow probe in vitro should be considered in undertaking measurement of intracoronary blood flow velocity.
Heart Rate-Corrected Ankle-to-Arm Index in the Diagnosis of Moderate Lower Extremity Arterial Disease
Authors: Abraham Pierre , Desvaux Benedicte , Colin Denis , Leftheriotis Georges , Saumet Jean-Louis 
Published: July 2008

Although the ratio of ankle-to-arm systolic pressures (AAI) at rest is widely used in the clinical diagnosis of peripheral arterial disease, the heart rate (HR) at which the measure ments are performed is rarely reported. The relation of ankle-to-arm index (AAI) to HR was studied in a normal population (n=65) and in a population of patients (n=101) suspected of moderate lower extremity arterial disease (LEAD). In the normal population, a significant inverse correlation was found between AAI and HR at rest: AAI=-0.277 x HR/100 + 1.303; r=-0.52, P < 0.001. In the second population suspected of LEAD, the authors recorded AAI and HR at rest on both legs: 80 normal legs, 110 diseased legs. Thereafter, with normal limits as superior to 0.8, 0.9, and 0.95, sensitivity was respectively 16, 39, and 46%, and specificity was 100, 100, and 98%. In defining normal limit as superior to -2 standard deviations of the AAI-HR relation found in the normal population, sensitivity and specificity were 57 and 100%, respectively. In conclusion: In screening for LEAD in the general population with the use of AAI at rest, the authors suggest that the heart rate at which arterial pressure measurements are performed should be reported.
The Effect of Ageing on Platelet Function and Fibrinolytic Activity
Authors: Gleerup G. , Winther K. 
Published: July 2008

Twelve healthy young male volunteers, mean age twenty-five, range twenty-one to thirty years, and 12 healthy middle-aged male volunteers mean age fifty-eight, range forty- four to seventy-two years, were tested regarding platelet aggregation induced by adenosine diphosphate and fibrinolytic activity, estimated as euglobulin clot lysis time (ECLT), tissue plasminogen activator (t-PA), and the fast-acting inhibitor against t-PA normally referred to as (PAI-1). Platelet aggregation increased significantly in the middle-aged group as compared with the young, as shown by a decrease in ADP thresholds for irreversible aggregation (P < 0.01). In healthy young volunteers, vigorous cycling exercise by itself caused platelet aggregability to decrease (P < 0.05). Such changes were not observed in the elderly. Fibrinolytic activity decreased significantly in the middle-aged group as shown by a prolongation of the ECLT (P < 0.01) and PAI-1, although not significantly, increased by approximately 100%, whereas t-PA significantly increased in the middle-aged group (P < 0.01). The present results suggest that increasing age is associated with not only increased platelet aggregability but also decreased fibrinolytic activity.
Dynamic Exercise Induces Elevation of Plasma Levels of Endothelin-1 in Patients with Coronary Artery Disease
Authors: Letizia C. , Barillà F. , Cerci S. , D'Ambrosio C. , Coassin S. , De Ciocchis A. , Mastroianni M.A. , Campa P.P. , Scavo D. 
Published: July 2008

In this investigation the response of endothelin-1 plasma levels to dynamic exercise in patients with coronary artery disease (CAD) was studied. The study population consisted of 20 patients with CAD, 16 men and 4 women (mean age 53 ±8.6 years). Seven normal volunteers all men (mean age 53.4 ±4.4 years) were studied as a control group. Seven patients had prior myocardial infarction. All patients and controls exercised on a multi stage bicycle ergometer; plasma endothelin-1 levels and hemodynamic indices were measured at rest, at peak exercise, and at two and six minutes after exercise. Of the 20 patients examined, 7 (35%) showed electrocardiographic (ECG) signs of myocardial ischemia during the stress test. The mean plasma endothelin-1 concentration increased significantly from 7.8 ±3.0 to 13.6 ±3.5 pg/mL at exercise peak (P < 0.05) only in patients who did not show ECG signs of myocardial ischemia and returned to baseline values during recovery (six minutes) (9.4 ±2.1 pg/mL). In normal subjects baseline endothelin-1 levels (9.4 ±4.2 pg/mL) were not significantly altered at peak exercise (10.8 ±4.7 pg/mL) and at recovery (11.3 ±3.6 pg/mL). The hemodynamic parameters were not correlated with the plasma endothelin-1 levels before, during, and after exercise in all groups. The present study demonstrated that the plasma levels of endothelin-1 in patients with CAD increased significantly during stress testing.
Treating Hyperlipidemia in the Elderly
Authors: Fleming Richard M. , Ketchum Kristy , Fleming Diane M. , Gaede Ruth 
Published: July 2008

Background: Determination of the effects of dietary modification and hyperlipidemic medications in the elderly (> sixty-five years of age) patient has not been significantly investigated to date despite knowledge that elevated cholesterol (TC) and triglyceride (TG) levels increase the risk of coronary artery disease (CAD). Methods: Twenty-seven individuals were placed into one of three treatment groups and longitudinally followed up to examine the effects of diet and hyperlipidemic medications on TC and TG levels. Group 1 (n = 14) received neither dietary nor drug therapy. Group 2 (n = 9) received dietary counseling without concomitant hyperlipidemic medications. Subjects in group 3 (n = 4) underwent dietary instruction for six months and hyperlipi demic medication(s) for eighteen months. Results: Subjects in group 1 demonstrated a statistical increase in TC (P ≤ 0.001) during the study. Patients in groups 2 (P ≤ 0.001) and 3 (P ≤ 0.05) demonstrated statistical improvement in TC reduction during dietary counseling. The effect on TC was blunted in group 3 after dietary counseling was discontinued. Reductions in TG levels were signifi cant (P ≤ 0.001) only for patients in group 2. Conclusion: Elderly individuals were able to significantly reduce both TC and TG levels by dietary modification alone. Minimal improvement was seen with the addition of hyper lipidemic medications.
Efficacy and Issues of Emergent Percutaneous Transluminal Coronary Angioplasty
Authors: Yabe Yoshimasa , Muramatsu Toshiya , Nakano Hajime , Wagatsuma Kenji 
Published: July 2008

The authors investigated the efficacy and prognosis of emergency percutaneous trans luminal coronary angioplasty (PTCA) in elderly patients. A study was conducted on the early and late prognosis of the study group composed of 66 younger patients < sixty-five years in Group A and 46 elderly patients ≥ seventy years in Group B who underwent reperfusion therapy, including PTCA, for acute myocardial infarction (AMI). No difference was seen in the initial success rate of 82% for Group A and 85% for Group B, or in the vessel patency in the predischarge coronary arteriogram (CAG) with 84% for Group A and 87% for Group B. However, in-hospital mortality was 3% for Group A and 11% for Group B. The patient restenosis rate in the 4.2 months follow-up CAG was 28% for Group A and 50% for Group B. The lesion restenosis rate was 30% for Group A and 53% for Group B (P < 0.05), and the late period mortality rate was 3% for Group A and 11% for Group B. Although there was no difference in the initial success rate of reperfusion through PTCA for AMI in the elderly as compared with the younger patient group, poorer results were seen in the restenosis rate and mortality rate.
Efficacy of Femoral Intra-arterial Administration of Teicoplanin in Gram-Positive Diabetic Foot Infections
Authors: Dorigo Bruno , Cameli Anna Maria , Trapani Maurizio , Raspanti Dinella , Torri Marco , Mosconi Giorgio 
Published: July 2008

In this study the efficacy and safety femoral intra-arterial administration of teicoplanin in the treatment of diabetic foot infections caused by gram-positive bacteria were evaluated. Twenty-five hospitalized diabetic patients with foot ulcers or with foot ulcers and metatarsophalangeal osteomyelitis were included in the study. In the ulcers Staphylococcus aureus was present alone in 16 patients and was associ ated with Pseudomonas aeruginosa in 2 patients, with Candida albicans in 2, and with coagulase-negative Staphylococcus in 1 patient. In 4 patients other gram-positive bacteria were isolated. All isolated strains were resistant to various antibiotics tested. Teicoplanin, 200 mg, was administered once a day by femoral intra-arterial injection for an average period of 14.72 ±7.16 days (range ten to thirty-six days). Six patients were treated with an additional antibiotic intramuscularly or intravenously because of a mixed infection. At the end of the therapy microbiological assessment confirmed that gram-positive infection was eliminated in all patients. Clinical outcome demonstrated that healing occurred in 18 patients (72%) and improvement in 7 patients (28%). No adverse drug reactions were observed during the treatment. The results demon strate that femoral intra-arterial administration of teicoplanin was highly effective in skin- and bone-infected lesions in the diabetic foot. This method may represent a further advantage in management of this severe diabetic complication.
Power Spectral Analysis of Heart Rate in Elderly Hypertensive Subjects With or Without Silent Coronary Disease
Authors: Piccirillo Gianfranco , Fimognari Filippo L. , Santagada Elvira , Munizzi Maria Rita , Viola Emanuela , Monteforte Gabriella , Bucca Carmela , Durante Michele , Di Gioacchino Carlo , Tarantini Sabrina , Lo Verde Andrea , Cacciafesta Mauro , Marigliano Vincenzo 
Published: July 2008

Much evidence indicates an involvement of the sympathetic nervous system in the genesis of silent myocardial ischemia. The authors assessed autonomic system activity by power spectrum analysis of heart rate variability in 21 elderly hypertensive men with and without angiographically confirmed coronary artery disease and compared the results with those from an age-matched control group. In the analysis an autoregressive algorithm was used to determine the power spectrum from an electrocardiographic recording of 512 consecutive RR intervals. The autonomic nervous system induces two distinct sinusoids: a low-frequency signal attributable to sympathetic activity and a high-frequency vagal response. In the hypertensive patients with coronary disease the authors also evaluated sympathetic activation after double-blind, placebo-controlled administration of metoprolol (100 mg/day), followed by amlodipine (10 mg/day), quinapril (20 mg/day), and amlodipine (5 mg/day) plus quinapril (10 mg/day). (continued on next page) Spectrum analysis showed significantly increased sympathetic activity in the hypertensive patients with coronary disease (low frequency: 58.4 ±2.0, P < 0.001) as compared with controls (36.21 ± 1.0, P < 0.001) and hypertensive subjects without coronary disease (low frequency: 25.2 ±0.6 , P < 0.001) but significantly reduced parasympathetic activity (39.4 ±2.0, P < 0.001) with respect to hypertensive patients without heart disease (42.5 ±2.0, P < 0.001) and controls (60.3 ±2.0). Treatment with metoprolol, quinapril, and amlodipine plus quinapril significantly reduced sympathetic tone (P < 0.05).
Orthostatic Vasoconstrictor Response in Patients with Occlusive Arterial Disease Assessed by Laser Doppler Flux and Transcutaneous Oximetry
Authors: Caspary Ludwig A. , Creutzig Andreas , Alexander Klaus 
Published: July 2008

Posturally induced microvascular constriction normally causes a decrease of transcutaneous oxygen pressure (tCPO2) and laser Doppler flux (LDF) measured on the forefoot at 37°C. The authors used both methods to assess the vasoconstrictor response (VCR) in 31 patients with various degrees of peripheral arterial occlusive disease (PAOD) and analyzed factors that could have influenced the response. Disturbed VCR was indicated by a signal increase following leg dependency, which occurred significantly more often in tCPO2 than in LDF measurements (69% vs 32%, P < 0.001). Correspondingly the median sitting/supine ratio was 2.4 for tcPO 2 and 0.7 for LDF (P < 0.0001). Age and clinical stage had no influence on the VCR. With ankle artery pressures below 50 mmHg an increase of LDF was more probable. TcPO2 predominantly increased with ankle artery pressures up to 100 mmHg, though the sitting/supine ratio of tcPO2 was correlated with ankle artery pressure. In nondiabetics the response of tcPO2 but not of LDF was influenced by the values at rest. Differences between the two methods may be explained in part by their different sample volumes. The authors assume that tcPO2 is predominantly monitoring a local myogenic response while LDF is reflecting venoarteriolar response.
ACE Inhibition with Spirapril Improves Diastolic Function at Rest Independent of Vasodilation During Treatment with Spirapril in Mild to Moderate Hypertension
Authors: Petersen Jan Roland , Drabaek Hans , Gleerup Gitte , Mehlsen Jesper , Juhl Petersen Lars , Winther Kaj 
Published: July 2008

The effects of the ACE inhibitor spirapril and of hydrochlorothiazide on left ventricular diastolic function were studied. Thirteen patients with mild to moderate essential hypertension completed this randomized, double-blinded, placebo-controlled, crossover study. After a three-week run-in period the patients entered three periods lasting four weeks each, wherein they were treated with placebo, spirapril, or hydrochlorothiazide. Blood pressure, hemodynamic variables (stroke volume, heart rate, cardiac output, index of contractility, and systemic vascular resistance), echocardiography (left ventricular mass), and Doppler-derived atrial to early (A/E)-ratio velocity time integrals (VTI) were measured at the end of each of the four periods. Spirapril lowered the A/E-ratio VTIs (0.57, 0.12-1.00) (P < 0.02) as compared with both placebo (0.80, 0.50-2.67) and hydrochlorothiazide (0.83, 0.44-1.25), and the drug normalized the A/E-ratio VTI in those patients with elevated values. The hemodynamic variables, left ventricular mass, and end-systolic wall stress were unchanged during all three treatments. There were no significant changes in mean blood pressure during the treatment periods. These results indicate that spirapril lowers A/E ratio within four weeks in patients with mild to moderate essential hypertension. It thereby seems able to improve left ventricular diastolic function. The effect is not dependent upon changes in hemodynamic variables, blood pressure, left ventricular mass, or end-systolic wall stress.
Quality of Life in a Group of Patients with Intermittent Claudication
Authors: Ponte Euro , Cattinelli Sergio 
Published: July 2008

In view of the increasing importance of chronic diseases in recent years, not only quantity but also quality of life has been taken into consideration. The aim of this study was to verify the quality of life in patients with peripheral obstructive arteriopathies of second degree according to the Leriche-Fontaine classification. Therefore, the authors administrated three different questionnaires to patients selected among those who came to the Angiology Ambulatory Care of the Medical Clinic of the University of Trieste. The questionnaires used were the following: McMaster Health Index Questionnaire (MHIQ), "Squibb" Quality of Life, General Health Index Questionnaire (GHIQ). The analysis of the results of the questionnaires shows the severe limitation of physical capacities of this kind of patients (overall mean functional limitation of 69% of the maximum value of 1, corresponding to an ideal state of well-being, with negative peaks of 50%). A negative tendency regarding social life and relationship is represented by different scores (from 52% to 66% of ideal maximum) from different items and questionnaires. Also the items concerning somatic disorders, sleeplessness, and states of anxiety gave results near the percentage of 70% and for this reason were indicative of a state of unwell-being. The data obtained from the items regarding the presence of a state of depression gave a result less predictable: a score of 87% with peaks over 90% could be indicative of a positive tendency. This last result, consistent with others of analogous studies in the literature, seems to indicate that peripheral arterial disease, even if physically restricting, does not have a strong impact on the psychological and emotional equilibrium of the patients.