bluuebunny/crossref_metadata_2025_split huggingface dataset:
QT dispersion plus st‐segment depression: A new predictor of restenosis after successful percutaneous transluminal coronary angioplasty
Authors: Aytemir Kudret , Özer Necla , Aksöyek Serdar , Özkutlu Hilmi , Oto Ali , Özmen Ferhan 
Published: February 2009

AbstractBackground: ST‐segment depression during exercise testing is frequently observed in the absence of restenosis after percutaneous transluminal coronary angioplasty (PTCA).Hypothesis: With the goal of improving the prediction of restenosis after PTCA, we evaluated the usefulness of ST‐segment depression plus QT dispersion (QTd = QT max ‐ QTmin) during treadmill stress test.Methods and results: Fifty‐six patients (37 men, 19 women, mean age 51 ± 14 years) were evaluated with treadmill exercise testing and coronary angiography 7 ± 5 months after PTCA. Treadmill test was positive in 30 patients and negative in 26 patients. At coronary angiography, restenosis was present in 16 patients with positive exercise electrocardiogram (ECG) and in 6 patients with negative exercise ECG. Fourteen patients with a positive stress test did not have restenosis. There was no difference in QTd values between groups at baseline (p> 0.05). Exercise QTd was 63 ± 9 ms in patients with positive exercise test, 54 ± 18 ms in patients with negative exercise test (p=0.003), 71 ± 13 ms in patients with restenosis, and 53 ± 17 ms in patients without restenosis (p=0.001). ST‐segment depression during the stress test determined restenosis with a sensitivity of 80% and a specificity of 58%. Sensitivity and specificity of QTd of ≥60 ms for prediction of restenosis were 83 and 61%, respectively. When QTd of ≥60 ms was added to ST‐segment depression as a condition for positive test, the sensitivity and specificity increased to 91 and 78%, respectively. QT dispersion plus ST‐segment depression had higher sensitivity and specificity than either QTd or ST‐segment depression alone (p <0.05).Conclusion: The addition of QTd to ST‐segment depression during exercise test improves the diagnostic value and can be used as a noninvasive tool in the diagnosis of restenosis after PTCA.
Coronary dissection and thrombosis associated with exercise testing three months after successful coronary stenting
Authors: Maraj Rajiv , Fraifeld Moises , Owen Alyson N. , Kotler Morris N. , Yazdanfar Shahriar 
Published: February 2009

AbstractExercise testing is commonly performed to assess the functional result of coronary revascularization procedures and is usually not associated with any complications. However, this report documents a rare case of coronary dissection and thrombosis, which resulted in an acute myocardial infarction, in a patient who underwent stress testing 3 months following successful coronary stent implantation.
Metastatic germ cell tumor to the heart presenting with syncope
Authors: Vohra Ameet , Saiz Enma , Davila Enrique , Burkle Jaime 
Published: February 2009

AbstractMalignant nonseminomatous germ cell tumors (NSGCT) rarely metastasize to the heart. The first such case presenting with syncope is described. Eight previously described cases of NSGCT with intracaval metastasis to the heart are reviewed and the literature to date is discussed. Transesophageal echocardiography is the diagnostic study of choice and treatment consists primarily of platinum‐based chemotherapy followed by surgical resection of residual deposits.
Predicting mitral regurgitation following percutaneous mitral valvotomy with the inoue balloon: Comparison of two echocardiographic scoring systems
Authors: Mezilis Nick E. , Salame Mohamed Y. , Oakley G. David G. 
Published: February 2009

AbstractBackground: Percutaneous balloon mitral valvotomy (PBMV) has become the procedure of choice for many patients with symptomatic mitral stenosis. However, the development of significant mitral regurgitation (MR) remains an infrequent but very important complication. The echocardiographic scoring system described by Padial et al. has been successful in predicting the development of severe MR following PBMV using the double balloon technique.Hypothesis: We aimed to assess the applicability of this new scoring system in predicting a significant increase in MR with the Inoue balloon and to compare it with the established Wilkins score.Methods: The echocardiograms of 23 patients who had undergone PBMV for symptomatic mitral stenosis were analyzed retrospectively using both scoring systems, and the severity of MR was determined from pre‐ and postprocedure studies.Results: Post PBMV, significant MR occurred in four patients (17%) while severe MR occurred in two patients (9%). Padial scores [mean (standard error of the mean)] in the group of patients with and without significant MR were [9.1 (0.8)] and [6.0 (0.3)], respectively (p = 0.002), while the Wilkins score was [7.5 (1.0)] and [6.4 (0.5)], respectively (p = 0.3). Using 8 as a cutoff point, the sensitivity and specificity of the newer scoring system was 83 and 100%, respectively, while the sensitivity and specificity of the Wilkins score was 50 and 50%, respectively. The positive predictive value >8 was 100% (4/4) for the Padial and 25% (1/4) for the Wilkins system. Accordingly, the negative predictive value <8 was 89% (17/19) for the Padial and 73% (14/19) for the Wilkins system.Conclusion: The newer scoring system is better at reliably identifying patients at risk of developing significant MR from PBMV with the Inoue balloon.
Left ventricular filling in the hypertensive patient: Long‐Term course and influence of treatment
Authors: Gosse Philippe , Jullien Veronique , Jarnier Philippe , Lemetayer Philippe , Clementy Jacques 
Published: February 2009

AbstractBackground: Hypertension is accompanied by abnormalities in left ventricular filling; however, there is a lack of agreement on the extent of the influence of antihypertensive treatment on them.Hypothesis: The present study was designed to evaluate the long‐term course of these abnormalities in both treated and untreated hypertensive patients.Methods: Left ventricular filling assessed by pulsed Doppler echocardiography of mitral flow was studied over a long follow‐up period in both untreated and treated hypertensive patients. This retrospective study included 73 hypertensive patients who had not received any treatment. They had been followed up for at least 3 years and were divided a posteriori into two groups: Group 1 comprised the untreated patients, while Group 2 included the patients who had received antihypertensive treatment throughout the follow‐up period.Results: in the overall population, age and heart rate measured during the Doppler examination were the only parameters that correlated significantly with mitral flow. No significant changes in blood pressure or left ventricular mass were observed in Group 1 (14 patients) over the study period. There was a slight but nonsignificant decrease in E/A ratio of mitral flow. in the treated patients, there was a drop in heart rate‐adjusted E/A ratio, despite a reduction in blood pressure and left ventricular mass, at mean follow‐up of 5 years.Conclusion: Antihypertensive therapy did not arrest the long‐term reduction in E/A ratio in hypertensive patients despite reduction in blood pressure and left ventricular mass.
Influence of thrombolytic therapy on the incidence of left ventricular thrombi after acute anterior myocardial infarction: Role of successful reperfusion
Authors: Ileri Mehmet , Tandoǧan Izzet , Koşar Feridun , Yetkin Ertan , Büyükaşik Yahya , Kütük Emine 
Published: February 2009

AbstractBackground: Previous studies have reported controversial results regarding the effectiveness of systemic thrombolysis in preventing left ventricular (LV) thrombus after acute myocardial infarction (MI).Hypothesis: This study was performed to evaluate the influences of thrombolysis, and particularly successful reperfusion, on the incidence of LV thrombus formation after acute anterior MI.Methods: in all, 191 patients suffering from a first attack of acute anterior MI were prospectively evaluated by two‐dimensional echocardiography and coronary angiography, performed at the end of the first week and within the first two weeks of MI, respectively. Of these, 98 who presented within 12 h of onset of symptoms received intravenous streptokinase (1.5 million IU), while the remaining 93 patients who, either because of contraindications or late admission, did not receive thrombolytic treatment served as control group. All patients received aspirin and full‐dose anticoagulation with intravenous heparin. Successful reperfusion in the streptokinase group was assessed by enzymatic and electrocardiographic evidence.Results: The overall incidence of LV thrombi was 24.6% (47/191). When all patients were evaluated, no statistically significant difference was found between the frequency of LV thrombi in the patients who had thrombolysis (22.4%) and those who did not (26.8%), despite a trend toward the formation of fewer thrombi in the initial group (p > 0.05). However, the patients who had successful reperfusion with streptokinase (n = 64) had significantly reduced incidence of LV thrombi compared with those who did not receive thrombolytic therapy (20 vs. 26.8%, p < 0.05). Stepwise multivariate analysis suggested that LV abnormal wall motion score (p = 0.01) and presence of LV aneurysm were independent predictors of LV thrombus formation in patients with acute anterior MI.Conclusion: Not all patients who received streptokinase for acute anterior MI, but only those with successful reperfusion had reduced incidence of LV thrombi. The favorable effects of thrombolysis on LV thrombus formation are probably due to the preservation of global LV systolic function.
Percutaneous mitral balloon valvuloplasty
Authors: Mayes Charles E. , Cigarroa Joaquin E. , Lange Richard A. , David Hillis L. 
Published: February 2009

AbstractAlmost all mitral stenosis (MS) is rheumatic in etiology. The patient with MS who is symptomatic despite medical therapy should undergo percutaneous mitral balloon valvuloplasty or mitral valvular surgery (commissurotomy or replacement). The choice of procedure is determined by patient preference and the echocardiographic morphologic features of the valvular and subvalvular apparati. With balloon valvuloplasty, the rate of success is > 90%. At institutions where operators are experienced with balloon valvuloplasty and open surgical commissurotomy, their acute and long‐term results are comparable. Balloon valvuloplasty occasionally is associated with complications, including death in 0 to 1%, moderate or severe valvular regurgitation in 3 to 5%, and systemic embolization in 1 to 3%.
Prospective evaluation of the coronary sinus anatomy in patients undergoing electrophysiologic study
Authors: Weiss Christian , Willems Stephan , Meinertz Thomas , Kuck Karl‐Heinz , Cappato Riccardo 
Published: February 2009

AbstractBackground: Previous retrospective studies could find a predominant incidence of coronary sinus (CS) anomalies in patients with accessory pathways and a characteristic anatomy of the CS ostium in patients with atrioventricular nodal reentrant tachycardias (AVNRT).Hypothesis: In the present prospective study, CS angiograms were prospectively performed to analyze the incidence of CS anomalies and to measure the diameters of the CS ostium.Methods: The study included patients referred for electrophysiologic study and catheter ablation of various tachyarrhythmias. The anatomy of the CS and its side branches was visualized [left anterior oblique (LAO) 30°, right anteri‐ or oblique (RAO) 30°] by retrograde angiography in 204 consecutive patients (82 women, 122 men, age 45 ± 15 years); of these, 120 presented with 123 accessory pathways (45 left‐sided, 33 right‐sided, 45 septal). The diagnosis in the remaining patients was atrioventricular nodal reentrant tachycardia in 43 cases, atrial tachycardia or atrial fibrillation in 12, and ventricular tachycardia in 15. In 14 patients, the indication for the eletrophysiologic study was an unexplained syncope. The CS angiogram was evaluated for anomalies and the size of the CS ostium was manually measured in both projections.Results: Anomalies of the CS defined as diverticula, persistent left superior vena cava, or enlarged CS ostia were found in 18 patients (9%). Of those, CS diverticula were found in nine patients, all with a posteroseptal or left posterior manifest accessory pathway, which was abolished within the neck of the diverticulum in seven patients and at the posteroseptal tricuspid annulus in two patients. Persistence of the left superior vena cava was found in five patients, four had atrioventricular reentrant tachycardia secondary to five accessory pathways (left free wall in four, right midseptal in one), and one patient had atrioventricular nodal reentrant tachycardia (AVNRT). Enlargement of the CS ostium of > 25 mm width was detected in nine patients (5%), of whom four had AVNRT. However, the width of the CS ostium generally did not differ significantly between patients with AVNRT (LAO: 14.4 ± 5.6; RAO 9.3 ± 2.4 mm) compared with the control group (LAO 13.4 ± 4.1; 8.2 ± 1.9 mm).Conclusions: Anomalies of the CS as diverticula, persistent superior vena cava, or enlargement of the CS ostium are predominantly found in patients with accessory pathway‐related tachycardias. Diverticula of the proximal CS were found in 7% of patients with accessory pathways; in these cases, ablation succeeded mostly by radiofrequency (RF) current delivery in the neck of the diverticulum. Enlargement of the CS ostium was more often seen in patients with AVNRT than in all other patients. However, in general the measurements of the coronary sinus ostium did not significantly differ in patients with AVNRT compared with the control group.
Electron beam computed tomography: Screening for coronary artery disease
Authors: Budoff Matthew J. , Brundage Bruce H. 
Published: February 2009

AbstractThe need to detect coronary atherosclerosis early in its course has been well recognized by clinicians and epidemiologists for decades. The ability to identify populations with a greater prevalence of coronary disease prior to manifestation of illness would greatly reduce cardiac morbidity and mortality. Electron beam computed tomography (EBCT) uniquely combines the characteristics of speed and excellent density resolution that have led to a rebirth of interest in detecting coronary calcium as a means of screening asymptomatic populations for coronary atherosclerosis. Electron beam computed tomography is noninvasive and widely applicable. It can both detect and quantitate the presence of coronary atherosclerosis. A positive test has diagnostic and prognostic significance, predicting future cardiac events and the extent of atherosclerosis, including the probability of obstructive coronary artery disease (CAD). Multiple studies demonstrate a 6‐ to 35‐fold increased risk of developing a cardiac event with elevated calcium scores. A negative test is highly predictive for excluding obstructive CAD. The cost ranges from $300 to $400, similar to that of an exercise treadmill test. Moreover, scanning for coronary calcium does not require injection of contrast medium, requiring no patient preparation or exercise; therefore, a CT technician can perform the study without supervision. The entire procedure takes < 10 min to perform. These features make EBCT a potential screening test for occult CAD in symptomatic and asymptomatic persons.
Predictors of early and late ventricular remodeling after acute myocardial infarction
Authors: Sanchis Juan , Insa Luis D. , Berenguer Alberto , Chorro Francisco J. , Llácer Angel , López‐Lereu María Pilar , López‐Merino Vicente , Bodí Vicente 
Published: February 2009

AbstractBackground: The determinants of the early and late stages of the ventricular remodeling process after infarction are not well defined.Hypothesis: The study was undertaken to evaluate the factors that condition the time course of left ventricular dilation during the first 6 months after infarction.Methods: The study group consisted of 74 patients with a first intermediate‐large (≥ 4 Q waves) acute myocardial infarction. Contrast left ventricular and coronary angiograms were performed at 7 ± 1 and 175 ± 25 days after infarction. Left ventricular volumes, regional function and infarction artery status were quantified. Percutaneous transluminal coronary angioplasty (PTCA) was performed in the early angiogram in 31 patients.Results: in the early angiogram, 13 patients showed ventricular remodeling (end‐diastolic volume > 90 ml/m2). A larger extent of dysfunction was the only predictor (p < 0.002) of early remodeling. At 6 months, a smaller, early end‐diastolic volume (p < 0.0001) and a poorer regional function recovery (p < 0.05) were independently related to late diastolic enlargement, and a poorer regional function recovery (p < 0.0001) and a smaller, early end‐systolic volume (p < 0.009) were independently related to late systolic enlargement. One patient with compared with 20 patients without early remodeling (p < 0.04) presented with late remodeling (increment of the end‐diastolic volume > 20% at 6 months). in patients with early remodeling, the end‐diastolic volume did not change significantly (101 ± 13 vs. 94 ± 22 ml/m2, NS) at 6 months; despite this, they maintained larger diastolic volumes than patients with late remodeling (81 ± 12 ml/m2, p < 0.04) at 6 months. Infarction artery status did not influence the evolution of ventricular volumes and regional function.Conclusions: (1) A large infarct size is the main determinant of postinfarction remodeling. (2) Such infarct size‐dependent ventricular dilation occurs early and does not tend to increase in late stage; in contrast, some cases of intermediate‐large size infarcts without early remodeling exhibit late remodeling associated with a poor late recovery of regional function. (3) Recovery of regional function (indicating myocardial viability) rather than infarction artery status plays a role in the late ventricular remodeling process.
Effect of angiotensin‐converting enzyme gene polymorphism on left ventricular remodeling after anteroseptal infarction
Authors: Nagashima Junzo , Kunishima Tomoyuki , Nobuoka Sachihiko , Murayama Masahiro , Musha Haruki , So Takehiko 
Published: February 2009

AbstractBackground and hypothesis: Genetic influence on cardiac remodeling is uncertain. The purpose of this study is to determine the effects of polymorphism of the angiotensin‐converting enzyme (ACE) gene on cardiac remodeling after myocardial infarction.Methods: The subjects were 43 patients with old anteroseptal myocardial infarction. Based on the polymorphism of the ACE gene, they were classified into a deletion group of 25 patients (D/D genotype in 4 and D/I genotype in 21) and an insertion group of 18 patients (all I/I genotype). Echocardiograms were used to determine left ventricular end‐diastolic and end‐systolic diameters, interventricular septal and posterior wall thicknesses, left ventricular mass, left atrial diameter, and left ventricular ejection fraction. Blood concentrations of atrial and brain natriuretic peptide were also measured.Results: Left ventricular end‐systolic and end‐diastolic dimensions, left ventricular mass, and levels of both atrial and brain natriuretic peptide were significantly higher in the deletion group. in contrast, septal thickness, posterior wall thickness, and ejection fraction showed no differences between the two groups.Conclusions: in patients with old anteroseptal infarction, ACE gene polymorphism of the D/D and D/I genotypes has a stronger influence on left ventricular remodeling than polymorphism of the I/I genotype.
Determinants of collateral development in patients with acute myocardial infarction
Authors: Fujita Masatoshi , Otsuka Ken‐Ichi , Nakae Izuru , Ueda Kinzo , Tamaki Shun‐Ichi , Kihara Yasuki , Hasegawa Koji , Nohara Ryuji , Sasayama Shigetake 
Published: February 2009

AbstractBackground: The presence or absence of collateral circulation to the infarct‐related coronary artery in acute myocardial infarction (AMI) significantly impacts on infarct size and resulting left ventricular function. However, the determinants of collateral development have not been clarified.Hypothesis: The purpose of this study was to elucidate the determinants of collateral development in humans.Methods: The study group consisted of 248 patients (178 men, 70 women; mean age 63 years) undergoing coronary angiography within 12 h after the onset of a first AMI. All patients exhibited complete occlusion of the infarct‐related artery. The extent of collateral circulation to the area perfused by the infarct‐related artery was graded as none, or poorly or well developed, depending on the degree of opacification of the occluded coronary artery on the contralateral injection of contrast.Results: Well‐developed collateral circulation was observed in 92 of the 248 patients (37.1%). The prevalence of well‐developed collaterals was 57% in patients with a history of angina pectoris prior to AMI, which was significantly (p < 0.0001) higher than the 26% in those without a history of angina. Multivariate stepwise logistic regression analysis was then applied to identify predictors of collateral development. Possible determinants of collateral development were long‐standing preinfarction angina, severity of coronary artery disease, age, gender, and coronary risk factors (hypertension, diabetes, hypercholesterolemia, smoking). This analysis revealed that only the presence of a history of angina pectoris prior to AMI was a significant predictor of collateral development (p < 0.0001).Conclusions: A history of angina pectoris prior to AMI is a clinical marker for coronary stenoses. Since severe coronary stenoses can provide stimuli that lead to collateral development, it is reasonable that a history of angina would also be a clinical marker for collateral vessels.
Global t‐wave inversion: Limited QT dispersion despite qtc prolongation—a correlate of benignity in patients with strikingly abnormal electrocardiograms
Authors: Desai Sweta A. , Mehrok Sandeep , Spodick David H. 
Published: February 2009

AbstractBackground: The global T‐inversion (GTI) electrocardiogram (ECG) is strikingly abnormal with major QTc prolongation, but with a surprisingly good prognosis by Kaplan‐Meier curve. This contrasts with most significant QTc prolongations.Hypothesis: This study was undertaken to ascertain QT interval dispersion (QTd) in global T wave inversion, a clinically benign long QTc ECG.Methods: Longest and shortest QT intervals in all 12 leads in 35 consecutive patients with GTI were determined by two mutually blinded observers. QTd was determined by subtraction (maximum – minimum) and QTc was calculated using the Bazett formula.Results: There was a 2:1 female preponderance. QTc was prolonged and equal for men (0.471) and women (0.469). Observer variability of under 2% permitted averaging of QT measurements. Composite mean QTd was 55 ms. The literature revealed a range of QTd in normal subjects of 39 to 59 ms (mostly 49 to 59 ms). Patient series with abnormal QTd were well above this level.Conclusion: Despite a strikingly abnormal ECG with marked QTc prolongation, QT dispersion was limited in global T inversion, consistent with its previously demonstrated benignity.