bluuebunny/crossref_metadata_2025_split huggingface dataset:
The “open artery hypothesis” in survivors of myocardial infarction
Authors: Pitts William R. , Cigarroa Joaquin E. , Lange Richard A. , David Hillis L. 
Published: February 2009

AbstractIn survivors of acute myocardial infarction, the restoration of antegrade flow in the infarct‐related coronary artery may improve prognosis by a mechanism independent of its effect on left ventricular function. Survival may be enhanced even when restoration of flow is accomplished days or weeks after the acute event. In a series of retrospective studies of survivors of a first myocardial infarction, it was shown that long‐term survival is significantly better in those with than in those without antegrade flow in the infarct‐related artery. It is hypothesized that late restoration of antegrade flow in the infarct‐related artery renders the border zone of the infarction more electrically stable, thereby diminishing the incidence of ventricular tachyarrhythmias and sudden death.
Imaging techniques for coronary artery disease: Current status and future directions
Authors: Noel Merz C. Bairey , Berman Daniel S. 
Published: February 2009

AbstractWe review the current status and future directions of sestamibi single‐photon emission‐computed tomography (SPECT), positron emission tomography (PET), magnetic resonance imaging (MRI), and contrast perfusion echocardiography (CPE) for coronary artery disease evaluation. Diagnostic accuracy and adjunctive assessment of ventricular function make sestamibi SPECT the currently favored stress imaging radioisotope technique. Tissue attenuation correction will likely enhance these capabilities of SPECT in the near future. PET potentially offers valuable diagnostic information, as it may be a superior technique where body habitus limits cardiac imaging. We project that it is unlikely to become routinely used for cardiac imaging because of improvements in routine radionuclide imaging and the lack of evidence that the small resolution gain with PET is of importance, given the much larger cost. Cardiac MRI for assessing cardiac function, perfusion, and coronary angiography is an exciting new modality at an early stage of development. The possible comprehensive nature of MRI for coronary artery disease evaluation, potential cost savings related to utilization of a single, noninvasive test, and availability of scanning equipment in current community settings all project an important role for MRI in the future. Contrast perfusion echocardiography is also a relatively new and untested imaging modality which offers great future promise. The recent development of intravenous contrast agents and the current widespread availability of echocardiographic expertise and equipment throughout the country suggest that the speed of development as well as the dispersion of technologic advances will be rapid. We project that these techniques will play important roles in future coronary artery disease testing and will result in improved diagnostic efficacy and possibly cost utility.
Use of cardiac troponin t rapid assay in the diagnosis of a myocardial injury secondary to electrical cardioversion
Authors: Garré Luis , Álvarez Ángel , Rubio Mariá , Pellegrini Alejandro , Caridi Mariá , Berardi Alfredo , Lázzaro Carmen , Blanco Patricia , Menehem Claudia , Díaz MóNica 
Published: February 2009

AbstractBackground and hypothesis: This study was carried out to determine whether cardiac troponin T test in rapid assay gives positive results in patients previously submitted to cardioversion or electrical defibrillation.
Methods: Forty patients with supraventricular tachyarrhythmias lasting no more than 2 days were treated with electrical cardioversion. The total creatine phosphokinase (CPK)‐MB isoenzyme and troponin T in rapid assay were measured at baseline and at 6, 12, and 24 h thereafter.
Results: Total CPK baseline levels were normal in all cases; within 4 h, the serum CPK levels increased by 98%, at 6 h by 111.5%, at 12h by 168%, and at 24 h by 225% (p<0.01). The CPK‐MB isoenzyme showed no percentage increase of total CPK higher than 5%, measured at 6, 12, and 24h after the shock, independent of the number of attempts of cardioversion. The troponin T test was also negative in all cases at baseline and at 6, 12, and 24 h after cardioversion.
Conclusion: We conclude that the absence of elevations in CPK‐MB levels and cardiac troponin T levels matched clinical and electrocardiographic results showing absence of myocardial damage after electrical cardioversion.
The prognostic significance of angina pectoris experienced during the first month following acute myocardial infarction
Authors: Jespersen Christian M. 
Published: February 2009

AbstractBackground: Angina pectoris accompanied by transient ST‐segment changes during the in‐hospital phase of acute myocardial infarction (AMI) is a well established marker of subsequent cardiac death and reinfarction.Hypothesis: This study was undertaken to record the prognostic significance of angina pectoris experienced during the first month following discharge from AMI.Methods: In all, 803 patients included in the placebo arm of the Danish Verapamil Infarction Trial II were followed up for 18 months in 20 coronary care units in Denmark. The patients were randomized to placebo and were still on study treatment 1 month after discharge. Of these patients, 311 (39%) reported chest pain during the first month following discharge.Results: Patients with angina pectoris had a significantly increased risk of reinfarction [hazard 1.71; 95%‐confidence limit (CL): 1.09, 2.69] and increased mortality risk which, however, only reached borderline statistical significance (hazard 1.52; 95%‐CL: 0.96, 2.40). When patients were subdivided according to both angina pectoris and heart failure, those with one or both of these risk markers had significantly increased mortality (p 0.03) and reinfarction (p 0.02) rates compared with patients free of both angina pectoris and heart failure.Conclusion: Patients with postinfarction angina pectoris have a significantly increased morbidity risk.
The benefit of low‐dose dopamine during vigorous diuresis for congestive heart failure associated with renal insufficiency: Does it protect renal function?
Authors: Varriale Philip , Mossavi Ahmad 
Published: February 2009

AbstractBackground: Low‐dose dopamine, a renal vasodilator, has been used empirically to improve renal function or outcome in critically ill patients with oliguria or acute renal failure.Hypothesis: This study was designed to investigate the efficacy of low‐dose dopamine (2 μg/kg/min) as a renal‐protective agent during vigorous diuresis for congestive heart failure (CHF) associated with mild or moderate renal insufficiency.Methods: Of 20 study patients (mean age 74.3 ± 15 years) with severe CHF, 10 (Group A) were randomized to a treatment strategy of intravenous bumetanide (1 mg b.i.d.) alone and another 10 (Group B) to low‐dose dopamine and a similar diuretic regimen for a duration of 5 days or less if clinical edema remitted.Results: Group B patients showed a significant improvement in renal function and urinary output: serum blood urea nitrogen 48.9 ± 10.3 to 32.1 ± 14.4 mg/dl (p<0.05); serum creatinine 1.97 ± 0.24 to 1.49 ± 0.39 mg/dl (p“0.05); creatinine clearance 35.6 ± 11.6 to 48.8 ± 12.3 ml/min (p“0.05); and indexed urinary output 0.56±0.16 to 2.02±0.72 ml/kg/h (p“0.05). Group A patients showed a significant increase in urinary output but nonsignificant renal functional deterioration.Conclusion: The renal‐protective effect of low‐dose dopamine in the setting of CHF and vigorous diuresis is supported by this study.
Post‐traumatic ventricular septal defect following coronary bypass surgery
Authors: Bortolotti Uberto , Milano Aldo , Scioti Giovanni , Tartarini Giuseppe 
Published: February 2009

AbstractA 60‐year‐old patient underwent triple coronary artery bypass grafting following an inferoseptal myocardial infarction and early onset of exertional angina. Four years later he was involved in a car accident during which he sustained an abdominal and thoracic trauma. Approximately 1 month after discharge, a ventricular septal defect was diagnosed by two‐dimensional Doppler echocardiography with patency of all grafts at coronary angiography. Closure of the septal defect was successfully accomplished through a right atrial approach. Rupture of the ventricular septum following blunt chest trauma in a patient with previous myocardial revascularization has not been previously reported.
Dofetilide in patients with left ventricular dysfunction and either heart failure or acute myocardial infarction: Rationale, design, and patient characteristics of the DIAMOND studies
Authors: Mosller M 
Published: February 2009

AbstractBackground: Attempts to prolong life with antiarrhythmic drugs in patients at increased risk of sudden cardiac death have so far been disappointing or inconclusive.Hypothesis: The Danish Investigations of Arrhythmia and Mortality ON Dofetilide (DIAMOND) encompass two survival studies testing the prophylactic use of the selective potassium‐channel blocker, dofetilide, in patients at high risk of sudden death.Methods: The first study includes patients admitted to hospital with congestive heart failure (CHF), the other includes patients with acute myocardial infarction (MI) within the previous 7 days. In both studies patients must have left ventricular systolic dysfunction (ejection fraction 35%) determined by echocardiography. Each of the two studies are planned to enroll 1500 patients. Consecutive hospitalized patients with MI or CHF are screened in 37 Danish hospitals. Eligible patients are randomized to receive dofetilide or matching placebo. All patients are continuously monitored by telemetry for the first 3 days of the study to detect possible arrhythmic events and to ensure resuscitation in case of serious arrhythmias. Minimum duration of follow‐up is 12 months.Results: Between November 1993 and July 1996, a total of 5812 consecutive patients with CHF and 8688 consecutive patients with MI was screened for entry. Of these, 1518 patients were included in the CHF study and 1510 patients in the MI study. Overall 1‐year mortality of randomized patients were 28 and 22%, respectively.Conclusion: DIAMOND will provide important data on the safety and efficacy of dofetilide in high‐risk patients with left ventricular dysfunction and either CHF or MI, as well as evaluate tolerability in these populations.
Early and long‐term outcome of aortic valve replacement with homograft versus mechanical prosthesis—8‐year follow‐up study
Authors: Waszyrowski Tomasz , Kasprzak JarosłAW D. , Ńska‐Pakuła Maria Krzemi , Dziatkowiak Antoni , ZasLonka Janusz 
Published: February 2009

AbstractBackground: Aortic valve disease is an important and frequent clinical problem with a mortality rate as high as 50–80% in a 5‐year natural history of patients with severe aortic valve disease. Biological or mechanical prosthesis implantation is the only way to improve prognosis.Hypothesis: The aim of our study was to assess the clinical outcome of aortic valve replacement according to the underlying valve pathology and the type of replacement device, that is, aortic homografts versus mechanical prostheses.Methods: The study group consisted of 143 patients with a mean follow‐up period of 4.1 ± 2.7 years. All patients had annual clinical and Doppler echocardiographic evaluation.Results: Total 8‐year mortality was 4.9% (7/143) including early mortality of 1.4%. Eight‐year survival probability was not significantly higher in the homograft than in the mechanical prosthesis recipients. No differences were found among subgroups with aortic stenosis, insufficiency, and combined disease. Overall early and late complication rate (13.3 and 24.8%, respectively) was similar in homograft and mechanical valve recipients. The most common late complications were ventricular arrhythmia (10%) (Lown class I–III), pre‐dominantly in the homograft recipients (17.7 vs. 3.7%), and heart failure (9.2%), more frequent in mechanical valve recipients (14.8 vs. 1.6%). Thromboembolic events occurred in 6.3%, infective endocarditis in 4.2% (more common in mechanical valve recipients), serious bleeding in 3.7% (only in mechanical valve recipients). There was no significant difference in early and late complication rate among subgroups (aortic stenosis, insufficiency, and combined disease). Of the patients studied, 91.6% improved in functional status after surgery, with significantly better outcome in homograft recipients. The type of preexisting valve disease did not influence clinical improvement.Conclusion: Early and late mortality as well as estimated probability of survival and hemodynamic improvement at 8‐year follow‐up after aortic valve replacement are independent of the type of implanted valve. Complication rate does not depend upon the type of preexisting valve pathology, but severe late complications are more common after mechanical valve implantation than after homograft implantation.
Molecular evaluation of enteroviruses in the pathogenesis of idiopathic dilated cardiomyopathy
Authors: Jeffery S. , Kelling P. J. , Lukaszyk A. , Mckenna W. J. , Boriskin Y. S. , Booth J. C. , Hodgson J. , Davies M. J. 
Published: February 2009

AbstractBackground: There is great disparity in the literature as to the presence and relevance of enterovirus in heart tissue from patients with dilated cardiomyopathy (DCM). Published estimates of enteroviral positive tissue in DCM range from 0 to 50%. Very little sequence information is so far available on those samples which are positive.Hypothesis: Re‐examination of fresh biopsy material from patients previously tested, plus 13 new cases of DCM, and sequencing the products would yield information on the validity of the technique and on the type of virus being detected.Methods: RNA from biopsy or explant tissue was tested for the presence of enterovirus using reverse transcriptase polymerase chain reaction (PCR). The nucleotide sequences of all positive PCR products were determined by direct sequencing.Results: Positive PCR signals were found in 10% of samples from patients with DCM and in 16% of control tissues. Two DCM and 12 control samples gave the same nucleotide sequence, which was different from the CB3 used as a positive control. The other 4 DCM samples all produced multiple bands on sequencing.Conclusion: The results do not support a major role for enterovirus in DCM. There is need for some caution, however, as a review of the literature shows that studies using single biopsies, such as this one, produce consistently lower estimates for enterovirus than do those wherein multiple biopsies are examined.
Biochemical characterization of myocardial damage in chronic chagas' disease
Authors: Carrasco G. Hugo A. , Olmos Leopoldo , Dipaolo Alberto , Alarcon Marino , Burguera José , Burguera, Marcela , Carrasco V. Hugo R. 
Published: February 2009

AbstractBackground: In the early asymptomatic stages of cardiomyopathy in chronic Chagas' disease, septal endomyocardial biopsies disclose multiple evidence of evolving myocardial damage. Detection of signs of an active myocardiopathic process may allow a better understanding of the evolution of this and other related dilated cardiomyopathies and provide a means for evaluation of the result of future therapeutic schemes.Hypothesis: This study was designed to explore whether cellular damage caused by Chagas' disease is reflected by changes of certain serum electrolytes, enzymes, and glycoproteins associated with myocardial metabolism, especially in the coronary sinus into which the blood just metabolized by the heart is drained.Methods: The study included 47 patients (35 men and 12 women, average age 40 years) with positive complement fixation reaction and hemagglutination test for Chagas' disease. The study protocol included medical records, electrocardiographic (ECG) recordings, routine laboratory analysis, chest x‐rays, noninvasive cardiac examinations, and cardiac catheterization.Results: In this study, we determined the concentration or activity of 9 electrolytes, 5 glycoprotein fractions, and 12 enzymes related to cardiac metabolism in blood from the coronary sinus, the superior vena cava, the pulmonary and femoral arteries, and found early release of inorganic phosphorus (p<0.01) and isocitrate dehydrogenase (p<0.01) from the heart and increased activity of serum alkaline phosphatase and aldolase (p<0.05). Discriminant analysis suggested that the combination of the clinical picture, electrocardiographic findings, and peripheral activity of serum aldolase might be useful for the recognition of 86% of patients with Chagas' disease without segmental myocardial damage, 80% of those with early segmental abnormalities, and all patients with advanced myocardial damage or congestive heart failure.Conclusion: These results would make the application of more invasive techniques, such as left cineventriculography for detection of early myocardial compromise, unnecessary.
Polymorphism in apolipoprotein(a) kringle IV 37 (Met/Thr): Frequency in a London population and its association with coronary artery disease
Authors: Syrris Petros , Jeffery Steve , Carter Nick , Schwartzman Raul , Kaski Juan Carlos 
Published: February 2009

AbstractBackground: A raised concentration of lipoprotein(a) [Lp(a)] in human plasma has been considered as a risk factor for coronary artery disease (CAD). Apolipoprotein(a) and plasminogen genes are exceptionally similar to a variable number of plasminogen‐like kringle IV repeats in the apo(a) gene. Polymorphisms have been previously identified in the apolipoprotein(a) kringle IV 37.Hypothesis: In order to determine the frequency of the apolipoprotein(a) kringle IV 37 Met66→Thr polymorphism in a London‐based population and to assess the relationship of this polymorphism with CAD in Caucasian patients, we geno‐typed two groups of people of different ethnic origin (Caucasian and Afro‐Caribbean) for the mutation using standard polymerase chain reaction (PCR) techniques.Methods: The first group consisted of 182 unrelated Caucasian patients (107 men and 75 women, mean age 59.7 ± 10.2 years) recruited at St. George's Hospital. They were defined as patients with 0, 1 or ≥ 2 vessel disease patients depending on the degree of stenosis in none, one, or several major epicardial arteries. The second group comprised 64 unrelated patients of Afro‐Caribbean origin attending a hypertension clinic at St. George's Hospital.Results: It was shown that the prevalence of the Met66→Thr mutation is markedly higher in Caucasians than in Afro‐Caribbeans and that this mutation is not associated with either Lp(a) levels or severity of CAD.
Nonneoplastic diseases of aorta and pulmonary trunk—Part III
Authors: Waller Bruce F. , Clary James D. , Rohr Todd 
Published: February 2009

AbstractThis five‐part review focuses on selected nonneoplastic diseases of the aorta and pulmonary trunk. Because many more diseases affect the aorta compared with the pulmonary trunk and right and left main pulmonary arteries, most of this review will be devoted to disorders of the aorta. Part III of this five‐part series discusses the etiology of aortic aneurysms and aortitis.
Coronary embolism complicating aortic valve endocarditis: Treatment with placement of an intracoronary stent
Authors: Glazier James J. , Mcginnity John G. , Spears J. Richard 
Published: February 2009

AbstractA 37‐year‐old man, who had received 3 weeks of antimicrobial therapy for aortic valve endocarditis, presented with an acute anteroseptal wall myocardial infarction. Coronary angiography demonstrated occlusion of the mid left anterior descending artery, thought to have been caused by embolization of a sterile vegetation. Following failure of balloon dilation to achieve vessel patency, this was achieved by placement of an intracoronary stent.
Coronary artery vasomotion after percutaneous transluminal coronary angioplasty
Authors: Misra Vijay K. , Agirbasli Mehmet , Fischell Tim A. 
Published: February 2009

AbstractSubstantial evidence of postangioplasty vasoconstriction is available, both at the dilated site and distal to balloon injury, demonstrating its frequent occurrence. It is likely that even mild or moderate vasoconstriction at the site of balloon injury may create flow turbulence, promoting platelet aggregation and contributing to thrombotic vessel closure. The regulation of arterial smooth muscle tone is a complex process and should be distinguished from elastic recoil, which occurs at the site of balloon injury due to passive elastic properties of the artery, generally immediately after balloon deflation. The contribution of a variety of messengers generated by humoral, neurogenic, myogenic, and endothelium‐derived factors in this regulatory process has been implicated. The possible mechanisms of post‐percutaneous transluminal coronary angioplasty vasoconstriction at the dilated site (local) and in segments of coronary artery beyond the dilated site (distal) are reviewed in this article.
Doppler echocardiography distinguishes between physiologic and pathologic “silent” mitral regurgitation in patients with rheumatic fever
Authors: Minich L. Luann , Tani Lloyd Y. , Pagotto Luciana T. , Shaddy Robert E. , Veasy L. George 
Published: February 2009

AbstractBackground: The diagnosis of rheumatic fever is based on physical findings (major) and supporting laboratory evidence (minor) as defined by the Jones criteria. Rheumatic carditis is characterized by auscultation of a mitral regurgitant murmur. Doppler echocardiography, however, may detect mitral regurgitation when there is no murmur (“silent” mitral regurgitation), even in normal individuals.Hypothesis: The hypothesis of this study was that physiologic mitral regurgitation can be differentiated from pathologic “silent” mitral regurgitation by Doppler echocardiography.Methods: The study group consisted of 68 patients (2–27 years) with normal two‐dimensional imaging and Doppler evidence of mitral regurgitation but no murmur. Patients with rheumatic fever (n = 37) met Jones criteria (chorea in 20, arthritis in 17). Patients without rheumatic fever (n = 31) were referred for innocent murmur (n = 7), abnormal electrocardiogram (n = 13), and chest pain (n = 11). Echoes were independently reviewed by two cardiologists blinded to the diagnosis. Pathologic mitral regurgitation was defined as meeting the following four criteria: (1) length of color jet > 1 cm, (2) color jet identified in at least two planes, (3) mosaic color jet, and (4) persistence of the jet throughout systole. Jet orientation was also noted.Results: Using the above criteria, there was agreement in echo interpretation of pathologic versus physiologic mitral regurgitation in 67 of 68 patients (interobserver variability of 1.5%). Pathologic regurgitation was found in 25 (68%) patients with rheumatic fever but in only 2 (6.5%) patients without rheumatic fever (p<0.001). The specificity of Doppler for detecting pathologic regurgitation was 94% with a positive predictive value of 93%. The color mitral regurgitant jet was posteriorly directed in all 25 patients with rheumatic fever.Conclusion: Pathologic “silent” mitral regurgitation of rheumatic fever can be distinguished from physiologic mitral regurgitation using strict Doppler criteria, particularly when the jet is directed posteriorly. These data support the use of Doppler echocardiography as a minor criterion for evaluating patients with suspected rheumatic fever.