bluuebunny/crossref_metadata_2025_split huggingface dataset:
The effect of beta‐blockade therapy on the response to exercise training in postmyocardial infarction patients
Authors: Pavia Leandro , Orlando Gaspare , Myers Jonathan , Maestri Maurizia 
Published: February 2009

AbstractCardiac rehabilitation after a myocardial infarction has been shown to improve exercise capacity. Beta blockade has been shown to be effective in treating angina and reducing mortality, but studies are controversial as to whether beta‐blockade therapy attenuates the effects of training. We attempted to study the effects of beta blockade (metoprolol) on the response to training in patients enrolled in a cardiac rehabilitation program after an uncomplicated myocardial infarction. We studied 27 patients with a recent uncomplicated myocardial infarction who were subdivided in two groups: Group 1 (13 patients) not taking a beta blocker, and Group 2 (14 patients) taking metoprolol (mean 142 ± 57 mg daily). All patients underwent a maximal cardiopulmonary exercise test before and after a 3‐month training program. The training intensity was designed to approximate the ventilatory threshold. Results showed an increase in peak VO2 in both Group 1 (27%, p<0.01) and Group 2 (33%, p<0.001), and an increase in VO2 at the ventilatory threshold (39% in Group 1 and 28% in Group 2, p<0.01). The mean changes in exercise capacity were not different between groups. It was concluded that metoprolol did not influence the beneficial effects of a cardiac rehabilitation program in postmyocardial infarction patients.
Pulmonary artery aneurysm: Review and case report
Authors: Lopez‐Candales Angel , Kleiger Robert E. , Aleman‐Gomez Jose , Kouchoukos Nicholas T. , Botney Mitchell D. 
Published: February 2009

AbstractAneurysms involving the main pulmonary artery and its branches are rare. Clinical experience is limited and current knowledge is mainly derived from autopsy findings. This case report describes a patient with a pulmonary artery aneurysm associated with a previous, partially corrected stenotic pulmonary valve. The patient presented with symptoms suggestive of aneurysm dissection three decades after commissurotomy. The diagnostic approach and therapeutic intervention are emphasized with a review of the literature.
Cardiovascular effects of commonly used ophthalmic medications
Authors: Shiuey Yichieh , Eisenberg Mark J. 
Published: February 2009

AbstractEye disease and cardiovascular disease frequently coexist. As a result, cardiologists and ophthalmologists often treat the same patients. Among ophthalmologists it is well known that topical ophthalmic medications are capable of producing serious cardiovascular effects, including congestive heart failure, arrhythmias, and death. However, cardiologists may not be aware of these potential complications. This article reviews the cardiovascular effects of commonly prescribed topical ocular medications and describes important contraindications to their use in patients with cardiovascular disease. Cardiologists, by making themselves and their patients more aware of the cardiovascular effects of topical ocular medications, may be able to avoid the adverse and potentially fatal complications of these agents.
Comparative efficacy of short‐term intravenous infusions of milrinone and dobutamine in acute congestive heart failure following acute myocardial infarction
Authors: Karlsberg Ronald P. , DeWood Marcus A. , DeMaria Anthony N. , Berk Martin R. , Lasher Keith P. , For The Milrinone‐Dobutamine Study Group  
Published: February 2009

AbstractThe purpose of this study was to compare the hemodynamic and clinical effects of milrinone, a vasodilating and positive inotropic agent, with those of dobutamine in patients with congestive heart failure (CHF) following acute myocardial infarction (AMI). Thirty‐three patients in Killip classification II or III within 12 h to 5 days after AMI were randomized in a multicenter, open‐label clinical trial to receive a 24‐h infusion of milrinone or dobutamine. Drugs were titrated to achieve at least a 30% increase in cardiac index (CI) from mean baseline or at least a 25% decrease in mean pulmonary capillary wedge pressure (MPCWP) from baseline. Both drugs improved CI, MPCWP, and other hemodynamic parameters. Criteria for decrease in MPCWP were met by 94% (15/16) of the milrinone‐treated patients and 57% (8/14) of dobutamine‐treated patients (p = 0.03). Both groups met the minimum efficacy criterion for CI. Maximal reduction in MPCWP over 0–3 h was greater in the milrinone group (‐53.2%) than in the dobutamine group (‐31.0%; p ≤ 0.01); reductions were sustained over 24 h. Both drugs improved echocardiographic global ejection fraction and were generally well tolerated. The short‐term infusion of milrinone may have a role in the management of CHF following AMI, especially when the aim is the rapid reduction of pulmonary congestion.
Prognostic significance of the initial electrocardiographic pattern in patients with inferior wall acute myocardial infarction
Authors: Hasdai David , Sclarovsky Samuel , Solodky Alejandro , Sulkes Jaqueline , Birnbaum Yochai 
Published: February 2009

AbstractThe purpose of the study was to determine whether the initial electrocardiographic pattern is predictive of in‐hospital mortality in inferior wall acute myocardial infarction. It is commonly perceived that patients with acute myocardial infarction presenting with greater ST elevation have a worse prognosis. The initial electrocardiogram of patients (n = 213) with inferior wall myocardial infarction was categorized based on the pattern of ST‐segment elevation in inferior leads: (A) ST< 1 mm with tall T waves, (B) ST ≥ 1 mm with normal terminal QRS, and (C) ST≥ 1 mm with distortion of terminal QRS. ST deviation from baseline was calculated for all leads. Patients with maximal precordial ST depression in V4‐V6 and pattern A had an in‐hospital mortality rate of 68.8% compared with 16.9% for the entire study group. By univariate analysis, only pattern A was significantly predictive of in‐hospital mortality [odds ratio = 2.91,95% confidence interval (CI) 1.22–6.93], but by multivariate analysis adjusted for (1) age, (2) diabetes mellitus, (3) previous myocardial infarction, (4) thrombolytic therapy, (5) precordial ST‐depression pattern, and (6) patterns of ST elevation, maximal ST depression in V4‐V6 was significantly predictive (odds ratio = 4.93, 95% CI 1.79–13.56), whereas pattern A was not (odds ratio = 1.12, 95% CI 0.36–3.52). Contrary to popular perception, patients with inferior wall myocardial infarction presenting with minimal ST‐segment elevation are at highest risk for in‐hospital mortality, especially if accompanied by maximal precordial ST depression in V4‐V6.
Changes in left ventricular inflow and pulmonary venous flow velocities during preload alteration in dilated heart
Authors: Kiyoshige Koichi , Oki Takashi , Fukuda Nobuo , Iuchi Arata , Tabata Tomotsugu , Fujimoto Takashi , Manabe Kazuyo , Kageji Yoshimi , Sasaki Miwa , Ito Susumu 
Published: February 2009

AbstractThe aim of the present study was to assess the changes of left ventricular inflow (LVIF) and pulmonary venous flow (PVF) velocities during preload alteration in 30 patients with dilated heart (LV end‐diastolic dimension ≥ 6.0 cm) and impaired LV systolic function (% fractional shortening of the LV ≤ 25%). We performed transesophageal pulsed Doppler echocardiography during lower body negative (LBNP, ‐40 mmHg) and positive pressure (LBPP, +40 mmHg) in 10 patients with dilated cardiomyopathy, in 20 with old myocardial infarction, and in 22 healthy controls. Eight of the patients showed a pseudonormalization (compliance failure) pattern, and 22 showed a decreased early diastolic wave and compensatorily increased atrial systolic wave (relaxation failure) pattern of LVIF in the control state. Mean pulmonary capillary wedge pressure (PCWP) was greater in the compliance failure group than in the relaxation failure group in the control state. LVIF in 6 of the 22 patients with the relaxation failure pattern changed to the compliance failure pattern during LBPP, and that in 3 of 8 patients in the compliance failure group changed to the relaxation failure pattern during LBNP. The 6 patients with a change from the relaxation failure to the compliance failure pattern showed significantly higher peak diastolic and atrial systolic PVFs during LBPP than in the control state, and significantly higher PCWPs in the control state than the 16 patients with no change in LVIF. These find ings suggest that the compliance failure and relaxation failure patterns of LVIF are readily interchangeable in various hemo‐dynamic conditions, and that pattern analysis of LVIF and PVF during preload alteration is useful for understanding the hemodynamic severity and for evaluating preload reduction therapy in the dilated heart.
Prediction of recovery after abstinence in alcoholic cardiomyopathy: Role of hemodynamic and morphometric parameters
Authors: Vecchia Luigi La , Bedogni Francesco , Bozzola Loredana , Bevilacqua Pierantonio , Ometto Renato , Vincenzi Mario 
Published: February 2009

AbstractThe aim of the study is to describe the hemodynamic and morphometric characteristics of patients with alcoholic cardiomyopathy (ACM) and to evaluate whether these parameters can identify the subgroup of patients in whom recovery of cardiac function after abstinence will occur. Nineteen male patients (mean age 52.4 years, range 39–64 years) with symptomatic left ventricular dysfunction (LVD) [ejection fraction (EF) < 50%] and a history of chronic heavy alcohol intake were submitted to a full invasive work‐up including right ventricular endomyocardial biopsy (EMB). Counseling aimed at obtaining abstention and clinical follow‐up were regularly performed in all patients. The two requisites necessary to define recovery were (1) an increase in left ventricular EF, and (2) improvement of symptoms. The former was defined as a gain in left ventricular EF > 15% from baseline; the latter, as a gain of at least one New York Heart Association (NYHA) functional class. Using these criteria, 9 alcoholic patients (48%) (Group A) improved significantly, while 10 (52%) (Group B) either stabilized or deteriorated at 2 years' follow‐up. Group A patients had significantly lower pulmonary artery mean pressure (27.8 mmHg ± 13.3 vs. 40.3 mmHg ± 12.4; p < 0.05) and pulmonary capillary wedge pressure (18.4 mmHg ±8.9 vs. 26.5 mmHg ± 7.7; p < 0.05) compared with Group B. All other hemodynamic data did not show statistically significant differences in the two groups. Quantitative evaluation of myocardial hypertrophy and interstitial fibrosis performed on EMB tissue samples using the morphometric approach was not predictive of recovery. Improvement in cardiac performance and functional class was detected in about one‐half of patients with ACM who abstained from alcohol, and occurred even in cases presenting with severe LVD. Recovery is associated with significantly lower pulmonary artery and pulmonary wedge pressures. The morphometric evaluation of EMB does not provide adjunctive prognostic information in these patients.
QT interval in cardiac amyloidosis
Authors: Parthenakis Frangiskos I. , Vardas Panos E. , Ralidis Loukianos , Dritsas Athanasios , Nihoyannopoulos Petros 
Published: February 2009

AbstractThe aim of the study was to investigate whether cardiac amyloidosis is associated with QT interval abnormalities and ventricular arrhythmias. A controlled study of 30 patients was undertaken at a university cardiology department in a large referral hospital. Thirty patients (18 men, 12 women, mean age 56 ± 12 years) with systemic amyloidosis verified by biopsy and strong indications of cardiac amyloidosis comprised the study group, with 30 healthy age‐ and sex‐matched individuals serving as controls. Complete M‐mode and two‐dimensional echocardiographic study was undertaken and QT interval and QTc were calculated. All patients and controls underwent 24‐h Holter monitoring for arrhythmias. Left ventricular (LV) wall thickening was found in all patients with cardiac amyloidosis. The LV mass in the patients with cardiac amyloidosis was significantly greater than that of the control group, as was the ratio LVmass/body surface area (p < 0.001). There was no significant difference in the max QT interval or in QTc dispersion between the two groups, although the max QTc was greater in the patients with cardiac amyloidosis. Patients with cardiac amyloidosis did not have a higher incidence of arrhythmias than the controls. Although patients with thickened cardiac walls due to cardiac amyloidosis have a prolonged QTc in comparison with controls, they do not show an increase in interlead QTc dispersion which might suggest the possibility of regional disturbances of the uniformity of repolarization. Patients with cardiac amyloidosis do not have a higher incidence of arrhythmias than controls.
Mechanisms of cardiopulmonary resuscitation in a patient with right ventricular dilatation—an echocardiographic contribution
Authors: Gilon Dan , Geist Michael , Rein Azaria J.J.T. , Gotsman Mervyn S. , Hasin Yonathan 
Published: February 2009

AbstractThe mechanism of cardiopulmonary resuscitation is still debated. Two different theories have been proposed: direct cardiac compression versus intrathoracic pressure. A patient with dilated right cardiac chambers, who underwent a transesophageal echocardiography study during cardiopulmonary resuscitation, is reported. The direct compression mechanism was clearly demonstrated.
Left Ventricular Mural Thrombus after Acute Myocardial Infarction
Authors: Keeley Ellen C. , David Hillis L. 
Published: February 2009

AbstractLeft ventricular mural thrombus is a well‐recognized complication of acute myocardial infarction. In survivors of infarction, the incidence with which mural thrombus occurs is influenced by the location and magnitude of infarction, so that it occurs commonly in those with large anterior Q‐wave infarctions, particularly in the presence of a left ventricular aneurysm. Echocardiography, radionuclide imaging with indium‐111 labeled platelets, computerized tomography, and magnetic resonance imaging may be used to identify a left ventricular mural thrombus. Acute and chronic anticoagulation with heparin and warfarin, respectively, is given to prevent further thrombus formation and to reduce the incidence of systemic embolization.
Intracoronary ultrasound: Insights into mechanisms and results of coronary interventions
Authors: Schreiter Steven W. , Tenaglia Alan N. , Buda Andrew J. 
Published: February 2009

AbstractIntracoronary ultrasound imaging is a modality which allows in vivo cross‐sectional visualization of coronary arteries similar to that obtained by pathology. Compared with coronary angiography, intracoronary ultrasound provides more detail on plaque morphology and topography and more accurate quantification of lumen and plaque area. Thus, it has evolved into a valuable research tool. For example, intracoronary ultrasound imaging has increased understanding of the mechanisms of action of balloon angioplasty and new interventions such as atherectomy and laser treatment. It may prove to have clinical utility by helping to individualize device selection and sizing and by assessing treatment results more accurately. Coronary imaging may be performed at low risk. Future developments will include smaller catheters, combined ultrasound and therapeutic catheters, and three‐dimensional reconstruction of images.
Increased adhesiveness of peripheral blood leukocytes corresponds to the appearance of expansion following anterior wall myocardial infarction
Authors: Solodky A. , Zafrir N. , Kuzniec J. , Lifshitz A. , Sclarovsky S. , Berliner S. , Winder A. , Arber N. 
Published: February 2009

AbstractThe appearance of increased leukocyte adhesiveness/aggregation as an inflammatory marker in the peripheral blood of patients with anterior wall myocardial infarction was monitored. Of the 26 patients included in the study, 7 had infarct expansion as shown by an enlargement of left ventricular end‐diastolic volume. The percent of aggregated leukocytes in the peripheral blood of patients with expansion (29.7 ± 15.5%) was significantly higher (p = 0.01) than that obtained from patients with no expansion (18.5 ± 6.8%). The lack of significant differences in peak creatine kinase concentrations between patients with and without expansion suggests that infarct size is not necessarily the main determinant for the appearance of expansion; an increased inflammatory reaction could be a contributory factor.
Reduction of left ventricular spontaneous echo contrast in cardiomyopathy by acute inotropic intervention or aggressive therapy
Authors: Patel Vijay G. , Weisse Allen B. , Feuerman Martin 
Published: February 2009

AbstractThe purpose of this study was to determine whether improvement of left ventricular (LV) systolic function could reduce the severity or eliminate LV spontaneous echo contrast found with transthoracic echocardiography in a group of patients with advanced cardiomyopathy. A successful reduction of this by hemodynamic means might indicate an additional beneficial method of helping prevent thromboembolism in advanced cardiomyopathy. Six patients with advanced cardiomyopathy and demonstrating spontaneous echo contrast on transthoracic echocardiography were treated with acute inotropic drug infusions or aggressive medical therapy to improve LV systolic function to determine whether reduction in spontaneous contrast could be achieved by such means. A spontaneous echo contrast scoring system was devised: 0 to 4, indicating absent to severe. Six observers, unacquainted with the study plan, were blinded as to the source of the 12 pre‐and post‐ therapy two‐dimensional echocardiograms obtained and re‐recorded in a random sequence, and were asked to grade the degree of spontaneous echo contrast. In all six patients. LV spontaneous echo contrast was reduced by improvement in LV systolic function (average score lowered from 2.94 to 1.25, p<0.005). Among patients with cardiomyopathy at high risk for LV thromboembolism, as indicated by the presence of LV spontaneous echo contrast, improvement in LV systolic function may serve as an adjunct to anticoagulation or, in some cases, as a substitute when the latter is contraindicated in the prevention of thromboembolism. The results obtained suggest merit in prospective, long‐term studies of a larger group of such patients.
Clinical significance of the apical late systolic ejection murmur: A new phonocardiographic sign indicating dynamic mid‐left ventricular obstruction
Authors: Fukuda Nobuo , Oki Takashi , Iuchi Arata , Tabata Tomotsugu , Manabe Kazuyo , Kageji Yoshimi , Sasaki Miwa , Yamada Hirotsugu , Ito Susumu 
Published: February 2009

AbstractSystolic ejection murmurs of the left heart usually have their peak during early to mid‐systole. Few reports have addressed ejection murmurs with their peak at late systole. We evaluated the clinical significance of an apical systolic ejection murmur with a peak intensity during late systole using Doppler and two‐dimensional (2‐D) echocardiography and phonocardiography. The apical late systolic ejection murmur was observed in 9 of 13 consecutive patients with mid‐left ventricular obstruction. We investigated the ejection flow velocity and the timing of maximum velocity at the three different sites of the left ventricle, the left ventricular cavity shape, and the timing of the peak murmur intensity in these nine patients (late‐murmur group). The same parameters were also examined in 8 consecutive patients with mid‐systolic ejection murmurs (mid‐murmur group), 10 with early systolic ejection murmurs (early‐murmur group), and 7 controls without murmurs. Patients with aortic stenosis were excluded. The mid‐ventricular ejection flow velocity was significantly higher in the late‐murmur group than in the other three groups; that of the outflow tract was markedly higher in the mid‐murmur group. The ejection flow velocity at the aortic orifice of patients in the early‐murmur group was significantly high compared with that of the controls. The timing of the peak murmur intensity in each group correlated with that of the peak flow signal at the corresponding site with maximum velocity. In all patients in the late‐murmur group, 2‐D echocardiography revealed a systolic narrowing of the cavity at the mid‐ventricle. Amyl nitrite inhalation induced a marked increase in the intensity of the murmur without evidence of appearing or increasing mitral regurgitation. It was concluded that the apical ejection murmur with a late systolic peak intensity is a new phonocardiographic sign indicative of dynamic, mid‐left ventricular obstruction. This murmur should be differentiated from the mitral regurgitant murmur.
Usefulness of the 12‐lead electrocardiogram in detection of myocardial infarction: Electrocardiographic‐anatomic correlations—Part II
Authors: Parker Alton B. , Waller Bruce F. , Gering Lawrence E. 
Published: February 2009

AbstractPart II of this two‐part series on electrocardiographic‐necropsy correlation of infarct location focuses on lateral and posterior (“inferior”) infarctions. The value of infarct location regarding complications and prognosis is also discussed.
Vascular reactivity of arterial coronary artery bypass grafts—implications for their performance
Authors: Dzimiri Nduna , Duran Carlos , Chester Adrian H. , Allen Sean P. , Yacoub Magdi H. 
Published: February 2009

AbstractSpecific properties of the vessel wall of arteries employed as coronary bypass grafts are thought to play an important role in the short‐ and long‐term performance of these conduits. Heterogeneity in the endothelial and smooth muscle cell function between different arteries may provide particular vessels with properties which will favor them for use as bypass conduits. The aim of this review is to provide an insight into how the vascular reactivity of presently used arterial conduits varies and to discuss the clinical implications of these findings both in terms of flow modulation in response to physiologic and exogenous vasoactive mediators and long‐term patency.