bluuebunny/crossref_metadata_2025_split huggingface dataset:
Left ventricular apical ballooning: Not an uncommon variant of acute myocardial infarction in women
Authors: Elian Dan , Osherov Azriel , Matetzky Shlomi , Hod Hanoch , Guetta Victor , Feinberg Micha S. , Segni Elio Di 
Published: June 2007

AbstractBackground: Left ventricular apical ballooning, anew syndrome recently described in Japan, is characterized by chest pain, electrocardiographic changes mimicking acute myocardial infarction, and transient apical dyskinesia with normal coronary arteries. Although several studies have defined the clinical characteristics, the prevalence of this syndrome remains unclear.Hypothesis: This study sought to determine the prevalence of left ventricular apical ballooning syndrome.Methods: From January 2002 to September 2004, clinical, echocardiographic, and angiographic data of hospitalization and follow‐up were collected from 638 consecutive patients referred to our Heart Institute for primary percutaneous intervention.Results: Thirteen patients (2%) were diagnosed with transient left ventricular apical ballooning. All but one patient were women, representing a 6% incidence for the female patients with acute myocardial infarction. A triggering factor was identified in eight. One patient died of cardiogenic shock. Left ventricular systolic function recovered completely within 4–5 weeks in the remaining 12 survivors.Conclusion: This syndrome is not uncommon and should be considered particularly in female patients presenting with acute myocardial infarction.
Effect of statins and white blood cell count on mortality in patients with ischemic left ventricular dysfunction undergoing percutaneous coronary intervention
Authors: Lipinski Michael J. , Martin Robert E. , Cowley Michael J. , Goudreau Evelyne , Malloy Walter N. , Johnson Robert E. , Vetrovec George W. 
Published: June 2007

AbstractBackground: While morbidity and mortality were shown to be increased in the setting of an elevated white blood cell (WBC) count for patients with acute coronary syndrome, the impact of statin therapy on mortality for patients with an elevated WBC count is unknown in high‐risk patients with coronary artery disease.Hypothesis: The goal of this study was to determine whether statin therapy improved survival in patients with elevated WBC count undergoing percutaneous coronary intervention (PCI) with preexisting left ventricular (LV) dysfunction, a population at high risk for adverse outcomes.Methods: We retrospectively evaluated consecutive patient procedures performed at our institution from 1996 through 1999. Patients had a technically adequate angiographic left ventriculogram with a calculated ejection fraction(EF) ≤ 50%. Patients with prior coronary artery bypass graft were excluded. Mortality data were retrieved using the U.S. Social Security Death Index. Follow‐up ranged from 3.5 to 6.5 years. Means are provided with ± standard deviation, and p values <0.05 were considered significant.Results: Of the study population of 238 patients (average EF 39 ± 9.8%, mean age 57.5 ± 12 years, 68% men) 61%un‐derwent PCI for a recent myocardial infarction, 68% received stents, and 65% were discharged on statins. Mean WBC count was 9,000 ± 3,100 cells/mm3, with 28% of patients having a WBC ≥ 10,000 cells/mm3. During follow‐up, 27% of our population died. Patients with a WBC ≥ 10,000 had worse survival than patients with WBC < 10,000 (1‐year survival: 86 vs. 96%, p<0.05; 3‐year survival: 79 vs. 89%, p<0.05). Survival was significantly improved in patients on statin therapy regardless of WBC count, but the greatest benefit tended to be in patients with WBC ≥ 10,000 (WBC ≥ 10,000; odds ratio [OR] 5.14, 95% confidence interval [CI] 1.44–19.0, WBC < 10,000; OR 2.79,95% CI 1.13–7.1). Proportional hazard regression analysis demonstrated that both statin therapy and WBC count predicted mortality.Conclusion: Patients undergoing PCI with LV dysfunction discharged on statins had improved survival regardless of WBC count, with a trend for greater improvement in patients with elevated WBC counts. In addition, WBC count predicts mortality in this high‐risk population with LV dysfunction undergoing PCI.
Use and side‐effect profile of spironolactone in a private cardiologist's practice
Authors: Williams Eric M. , Katholi Richard E. , Karambelas Marcey R. 
Published: June 2007

AbstractBackground: The beneficial effects of spironolactone on the treatment of cardiovascular diseases are well known, but translating these benefits into private practice can be difficult because of the drug's side‐effect profile.Hypothesis: When patients are monitored over the long term, spironolactone can be used safely with an acceptable side‐effect profile.Methods: We retrospectively studied 762 patients taking spironolactone over a 7‐year period in a cardiologist's referral‐based practice and monitored them for side effects from the medication.Results: Data were available on 762 patients. The average age of our patients when started on the medication was 67.2 ±0.5 years. Of these, 585 (76.8%) patients were treated for heart failure and 155 (20.3%) for hypertension. An average dose of 3 8.4 ± 1.4 mg of spironolactone was used for treatment of all conditions. Of the 762 patients, 81 (10.6%) experienced side effects while using the medication; 40 had hyperkalemia (5.3%), 14 had gynecomastia (1.8%), and 15 had gastritis (2%). Of the patients with hyperkalemia, average creatinine clearance decreased from 64.6 ±5.8 ml/min at therapy start to 50.3 ±5.5 ml/min at the time of onset of side effects.Conclusion: Spironolactone can be used with an acceptable side‐effect profile as long as patients are monitored long‐term while receiving the medication.
Depression and thyroid axis function in coronary artery disease: Impact of cardiac impairment and gender
Authors: Bunevicius Robertas , Varoneckas Giedrius , Prange Arthur J. , Hinderliter Alan L. , Gintauskiene Vilte , Girdler Susan S. 
Published: June 2007

AbstractBackground: Increased rates of depression are reported in coronary artery disease (CAD). In heart disease, depression increases disability, reduces quality of life, and increases mortality.Hypothesis: The study was undertaken to examine the relationship between depression and thyroid axis function in patients with CAD.Methods: In all, 73 patients with CAD, consecutively admitted to a cardiac rehabilitation hospital, were assessed for depression using the Hospital Anxiety and Depression scale (HADS). Blood was drawnfor assessment of thyroid axis hormones and the N‐amino terminal fragment of the pro‐B‐type natriuretic peptide (NT‐pro BNP).Results: The patients with CAD with depressive symptoms had a higher prevalence of cardiac failure (p = 0.04), higher NT‐pro BNP concentrations (p = 0.02), and lower free tri‐iodothyronine (T3) concentrations (p = 0.04) than patients with CAD but without depressive symptoms. They also showed a strong trend (p = 0.058) toward a higher incidence of the low T3 syndrome. Higher NT‐pro BNP concentrations were related to lowertotal T3 concentrations (r = ‐0.294, p = 0.011) and to higher reverse T3 concentrations (r = 0.353, p = 0.002). In men, higher scores of depression were related to lower total T3 concentration (r = ‐0.289, p = 0.034) and to higher NT‐pro BNP concentration (r = 0.380, p = 0.005).Conclusion: These findings suggest that symptoms of depression in patients with CAD are associated with changes in thyroid axis function and with cardiac impairment, especially in men.
Prevention of vascular events in patients with cerebrovascular disease: Efficacy and appropriate duration of antiplatelet therapy
Authors: Habib Gabriel B. 
Published: June 2007

AbstractAntiplatelet therapy has shown consistent benefit in the prevention of secondary stroke. The paucity of head‐to‐head studies of different antiplatelet regimens, assessment of comparative efficacy, and optimal treatment duration requires evaluation and comparison of clinical studies that vary extensively in design and follow‐up. Evidence for aspirin benefit in secondary stroke prevention is strong, but existing studies provide little guidance with regard to treatment duration. The efficacy of clopidogrel in secondary event prevention is significantly greater than that of aspirin for patients with a history of peripheral artery disease, but does not differ from that of aspirin for patients with a history of stroke or myocardial infarction. Relative to clopidogrel alone, the addition of aspirin to clopidogrel results in increased risk for life‐threatening bleeding episodes similar in absolute magnitude to the reduction of secondary event risk in patients with stroke. Benefits associated with clopidogrel occur early in the course of therapy; few data support clopidogrel use for longer than 1 year after stroke. Monotherapy with extended‐release dipyridamole (ER‐DP) provides reduction in secondary stroke risk similar to aspirin; however, the combination of aspirin plus ER‐DP significantly reduces risk relative to either agent alone. Compared with placebo and monotherapy with either agent, risk reduction for the aspirin plus ER‐DP combination continued through 24 months, with no concomitant increase in bleeding risk. Additional clinical studies should provide needed comparisons of efficacy and guidance with regard to optimal duration of therapy.
In‐hospital mortality among women undergoing contemporary elective percutaneous coronary intervention: A reexamination of the gender gap
Authors: Narins Craig R. , Ling Frederick S. , Fischi Michael , Peterson Derick R. , Bausch Janice , Zareba Wojciech 
Published: June 2007

AbstractBackground: Previous studies have indicated that, compared with men, women are at increased risk for in‐hospital mortality following percutaneous coronary intervention (PCI); however, angioplasty techniques and mortality rates have improved since earlier reports.Hypothesis: We sought to reevaluate and explore further the relationship between gender and angioplasty outcomes in contemporary “real world” practice.Methods: The influence of gender and other covariates on in‐hospital mortality and other adverse events among all patients who underwent elective coronary angioplasty in New York State from 1999 to 2001 (n= 106,262) was examined.Results: In‐hospital mortality rates for elective angioplasty were low; however, women demonstrated a two‐fold mortality excess compared with men (0.6vs. 0.3%, p<0.0001). Women were older and more likely than men to demonstrate certain higher‐risk features (heart failure, class III‐IV angina, renal failure, vascular disease); however, men were more likely to have depressed ejection fraction, prior myocardial infarction, and prior coronary revascularization. Using multivariate analysis adjusting for clinical risk factors, gender remained an independent predictor of in‐hospital mortality at all ages. Women were also more likely to experience nonfatal adverse events following PCI, including more frequent need for emergency bypass surgery.Conclusions: Despite improvements in angioplasty outcomes with time, women remain at significantly higher risk of in‐hospital death than men after elective PCI. This increased mortality is observed in every age group, even after adjusting for other significant comorbidities.
Insufficient treatment of hypercholesterolemia among patients hospitalized with chest pain
Authors: Howell Eric E. , Wright Scott M. , Bush David E. , Chandra‐Strobos Nisha , Henrikson Charles A. 
Published: June 2007

AbstractBackground: Although morbidity and mortality from coronary artery disease can be improved with a variety of pharmacologic interventions, many patients remain undertreated.Hypothesis: This study sought to assess whether hospitalization for possible coronary artery disease would prompt initiation of appropriate lipid‐lowering therapy.Methods: This prospective, observational study was conducted on consecutive patients with active chest pain admitted to the Emergency Department of the hospital for suspected myocardial ischemia. Elevated cholesterol, defined as low‐density lipoprotein (LDL), was > 100 mg/dl with a prior history or a new diagnosis of coronary artery disease, or an LDL > 130 mg/dl without known coronary artery disease. Data were recorded at the time of admission, discharge, and at 4‐month follow‐up.Results: Of the patients with hyperlipidemia, 65% men and 55% women were on medication at the time of admission (p = 0.30), while at discharge, 79% men and 60% women were on treatment (p = 0.002), with similar rates of treatment at 4‐monthfollow‐up (p = 0.030). At discharge, two variables were independently associated with patients receiving lipid‐lowering therapy: age ≥ 65 years (odds ratio = 2.3; 95% confidence interval 1.2–4.5) and male gender (2.7; 15–5.0).Conclusions: In patients hospitalized with chest pain, particularly in women, the initiation of treatment of hyperlipidemia frequently does not happen. This oversight represents a lost opportunity for making an impact on the health of this population.
Arterial baroreflex sensitivity is a good predictor of inotropic responses to a phosphodiesterase inhibitor in human heart failure
Authors: Sato Naoki , Yamamoto Takeshi , Akutsu Koichi , Fujita Nobuhiko , Asai Kuniya , Takayama Morimasa , Takano Teruo , Tanaka Keiji 
Published: June 2007

AbstractBackground: Experimental study has shown that blunted arterial baroreflex function markedly attenuated inotropic responses to a phosphodiesterase inhibitor (PDEI) even in normal hearts. However, whether arterial baroreflex function is related to the inotropic responsiveness to a PDEI has not been clarified in human heart failure (HF).Hypothesis: The goal of this study was to examine the relationship between inotropic responses to a PDEI and arterial baroreflex sensitivity in human HF.Methods: Twelve patients with HF were examined, and hemodynamic responses to milrinone (12.5,25, and 50 μg/kg, intravenous injection) and arterial baroreflex sensitivity were assessed by pulse interval‐left ventricular (LV) systolic pressure slope using nitroglycerin and phenylephrine.Results: Milrinone (25 μg/kg) significantly increased LV dP/dt. Arterial baroreflex sensitivity was only one predictor of inotropic responses to milrinone by multivariate analysis; a strong positive correlation was also found between LV dP/dt and baroreflex sensitivity (y = 6.656× ‐ 3.326, r = 0.93, p = 0.000).Conclusion: Inotropic effects of milrinone, a PDEI, correlated significantly with arterial baroreflex sensitivity, suggesting that the more baroreflex function was impaired, the more the inotropic effect of a PDEI was depressed in human HF.
Role of angiographic coronary artery collaterals in transient ischemic left ventricular cavity dilatation during stress echocardiography
Authors: Bangalore Sripal , Yao Siu‐Sun , Chaudhry Farooq A. 
Published: June 2007

AbstractBackground: The role of coronary artery collaterals in transient ischemic left ventricular (LV) dilatation (TID) during stress echocardiography is not well defined.Hypothesis: Transient ischemic LV dilatation is a marker for extensive and severe coronary artery disease and represents patients without good collaterals.Methods: We evaluated 212 consecutive patients (57 ± 16 years, 70% male) who had coronary angiography and stress echocardiography within a 3‐month period. This cohort of patients was divided into three groups based on type of collaterals: Group A: no collaterals; Group B: collaterals supplied by vessels without flow‐limiting stenosis (good collaterals); Group C: collaterals supplied by vessels with flow‐limiting stenosis (bad/jeopardized collaterals). In all patients, angiographic jeopardy score (AJS), ejection fraction (EF), and wall motion score index (WMSI) at rest and during stress were evaluated. Transient ischemic LV dilatation was defined as transient increase in the end‐systolic dimensions from rest to peak stress.Results: Transient ischemic LV dilatation was present in 42 (20%) patients. Patients with TID had a lower EF, higher AJS, greater number of ischemic segments, and higher peak WMSI. Patients with TID in Group A (no collaterals) and Group C (jeopardized collaterals) had a greater percentage of multivessel disease than those in Group B (good collaterals). Presence of Group A or Group C collaterals was a predictor of TID even after controlling for multivessel disease, rest and peak WMSI, and left anterior descending artery disease.Conclusions: Transient ischemic LV dilatation on stress echocardiography is a marker for extensive and severe coronary artery disease and represents patients with angiographically absent collaterals or those with jeopardized coronary collaterals.
Cardiac event rate in a lifestyle modification program for patients with chronic coronary artery disease
Authors: Kappagoda C. Tissa , Ma Amy , Cort Douglas A. , Paumer Linda , Lucus Debbie , Burns Jill , Amsterdam Ezra 
Published: June 2007

AbstractBackground: Several clinical trials have shown that intensive lifestyle modification programs have a significant impact on cardiovascular risk factors.Hypothesis: This paper is a retrospective analysis to determine the effect of participation in a 2‐year lifestyle management program on long‐term clinical outcome in patients outside the setting of a clinical trial.Methods: Patients with angiographically confirmed coronary artery disease (CAD) enrolled in a 2‐year program of exercise training, dietary counseling, stress management, and therapeutic education. They were accepted into the program from 1991 through December 2002. Follow‐up after completion of the program ranged from 10 to 2 years.Results: In all, 134 patients enrolled in the program; of these, 77 completed the program and 57 failed to do so. Those who completed the program improved their effort tolerance and reached recommended goals for serum lipid and blood pressure levels. The cumulative event rate (cardiac death, myocardial infarction, and stroke) over 10 years in the patients who completed the program was 1.5%. The corresponding eventrate in patients who dropped out was 18% (p < 0.02).Conclusions: It is suggested that patients who complete a 2‐year lifestyle modification program appear to have a favorable prognosis over an extended period of time.
Acute aortic dissection in children and adolescents: Diagnostic and after‐event follow‐up obligation to the patient and family
Authors: Fikar Charles R. 
Published: June 2007

AbstractAcute aortic dissection in childhood and adolescence is a rare but life‐threatening condition with many known risk factors, most of which are heritable. The importance of determining the presence of any predisposing disorders is stressed, since all close relatives can then be screened for any such inherited trait that would make them at risk for a similar catastrophic event. Even with no obvious predisposing disorder, it may still be prudent to evaluate close kin for the presence of aortic root dilatation, since some genetic disorders have no manifestation other than acute aortic dissection secondary to aortic medial pathology. Close monitoring for at‐risk family members, including the index patient, may need to be a life‐long process.
The effect of a six‐week program of yoga and meditation on brachial artery reactivity: Do psychosocial interventions affect vascular tone?
Authors: Sivasankaran Satish , Pollard‐Quintner Suzanne , Sachdeva Rajesh , Pugeda Jaime , Hoq Sheik M. , Zarich Stuart W. 
Published: June 2007

AbstractBackground: Chronic stress is estimated to increase the risk of cardiovascular (CV) events two‐fold. Although stress reduction has been linked to a reduction in CV events, little is known regarding its exact mechanism of benefit.Hypothesis: Yoga and meditation will improve parameters of endothelial function.Methods: We examined the effects of yoga and meditation on hemodynamic and laboratory parameters as well as on endothelial function in a 6‐week pilot study. Systolic and diastolic blood pressures, heart rate, body mass index (BMI), fasting glucose, lipids, hs C‐reactive protein (CRP), and endothelial function (as assessed by brachial artery reactivity) were all studied at baseline and after 6 weeks of yoga practice.Results: A course in yoga and meditation was given to the subjects for 1.5 h three times weekly for 6 weeks and subjects were instructed to continue their efforts at home. This prospective cohort study included 33 subjects (mean age 55 ± 11 years) both with (30%) and without (70%) established coronary artery disease (CAD). There were significant reductions in blood pressure, heart rate, and BMI in the total cohort with yoga. None of the laboratory parameters changed significantly with yoga. For the total cohort there was no significant improvement in endothelial‐dependent vasodilatation with yoga training and meditation compared with baseline (16.7% relative improvement from 7.2‐8.4%; p = 0.3). In the group with CAD, endothelial‐dependent vasodilatation improved 69% with yoga training (6.38‐10.78%; p = 0.09).Conclusion: Yoga and meditation appear to improve endothelial function in subjects with CAD.
Relation of body fluid status to B‐type natriuretic peptide levels in patients with chronic heart failure during long‐term follow‐up
Authors: Kataoka Hajime 
Published: June 2007

AbstractBackground: Little is known about the relationship of body fluid status with the levels and fluctuations of B‐type natriuretic peptide (BNP) over the long term.Hypothesis: If BNP is to become useful for monitoring of patients with chronic heart failure (HF), the levels should reliably reflect both decompensation and improvement in the patient's condition.Methods: Forty‐six patients with chronic HF who were stable at study entry but had previous decompensation were recruited and followed up between June 2003 and September 2005. At each visit, they were examined for BNP level and HF‐related signs of body fluid retention based on physical evaluation and pleural ultrasonography.Results: During the study period 26 patients developed decompensation and 20 maintained a stable clinical course. In the 26 decompensated patients, BNP levels fluctuated widely (110 ±73.7 pg/ml; range 25‐290 pg/ml) even during stable periods. In all but three patients in this group, the maximum BNP level during decompensation was higher than that reached during stable periods. The BNP levels also fluctuated widely (180 ± 123 pg/ml; range 16‐489 pg/ml) in the 20 stable patients with HF. In all but one patient in this group, the BNP level was lower than the maximum BNP level obtained during the previous decompensation.Conclusions: In patients with chronic HF with previous decompensation, there was a strong link between the appearance of clinical HF sign(s) of fluid retention and an increased BNP level despite wide intraindividual fluctuations in BNP over time. Thus, BNP levels reliably reflect both decompensation and improvement.
Nitric oxide synthase inhibitors in post‐myocardial infarction cardiogenic shock—an update
Authors: Kaluski Edo , Hendler Alberto , Blatt Alex , Uriel Nir 
Published: June 2007

AbstractCardiogenic shock (CS) in acute myocardial infarction, after successful coronary angioplasty, still carries a case fatality rate of 50%. These patients succumb to a systemic metabolic storm, superimposed on extensive myocardial necrosis and stunning. Nitric oxide (NO) overproduction contributes to the pathophysiology of this morbid state. Current data regarding the physiologic effects of NO and nitric oxide synthase (NOS) inhibitors on the cardiovascular system are reviewed. Clinical trials assessing the safety and efficacy of NOS inhibitors in CS are summarized.