bluuebunny/crossref_metadata_2025_split huggingface dataset:
Estimation of left ventricular systolic function by nonvolumetric echocardiographic analysis in subjects with poor left ventricular visualization: A pilot study
Authors: Cosme Octavio , Grodman Richard S. 
Published: February 2009

AbstractBackground: Accurate assessment of left ventricular (LV) systolic function is an essential requirement in clinical cardiology. Several echocardiographic methods provide quantitative analysis of LV volumes and ejection fraction (EF) based on the precise tracing of endocardial borders. Often, however, technically limited studies prohibit such direct analysis, and alternative techniques must be applied.Hypothesis: Nonvolumetric echocardiographic methods which do not require endocardial edge definition and tracing may accurately provide quantitative LV systolic function data.Methods: A pilot study was conducted to validate and compare two recently described indirect echocardiographic methods of LV systolic function analysis, with LVEF by radionu‐clear cardiac angiography (RNCA). Thirty‐two consecutive patients undergoing RNCA for clinical indications also underwent echocardiography within 24 h, with LV analysis performed by the techniques of (1) atrioventricular plane displacement (AVPD) and (2) mitral valve leaflet coaptation point to interventricular septum distance at end‐systole (MVC‐IVS).Results: Thirteen patients had an echocardiogram with poor two‐dimensional visualization of LV endocardial borders. One patient could not be evaluated by the MVC‐IVS method and two others by the AVPD method because of technical limitations. Chi‐square analysis to compare how each method could discriminate between an RNCA LVEF of < or ≥ 50% demonstrated high correlations for the AVPD method (r = 0.6530, p < 0.0005) and the MVC‐IVS method (r = –0.7029, p < 0.0001). Sensitivity, specificity, positive and negative predictive values, and test accuracy for the AVPD and MVC‐IVS methods were 85 and 80%, 88 and 94%, 85 and 92%, 82 and 83%, and 83 and 87%, respectively.Conclusion: This pilot study demonstrates that both alternative echocardiographic methods may be useful in the assessment of LV systolic performance, even in the setting of poor LV endocardial border visualization. A larger study is warranted to apply and contrast these methods in different patient subsets.
Circadian patterns in the onset of cardiogenic acute pulmonary edema
Authors: Buff Daniel D. , Calikyan Raffi , Neches Richard B. , Bavli Samuel Z. 
Published: February 2009

AbstractBackground: Circadian patterns of onset favoring the morning hours have been demonstrated for many cardiovascular disorders. Although much is known about cardiogenic acute pulmonary edema (CAPE), the relationship between time of day and CAPE episode onset has not been previously studied.Methods: We examined 154 consecutive episodes of CAPE treated at an urban community hospital to determine whether circadian patterns existed in the time these episodes began.Results: For all episodes, a significant circadian pattern existed, with peak onset between 6:00 and 11:59 A.M. (p<0.01). When CAPE episodes were analyzed by the most probable precipitant of pulmonary edema, only the pattern for patients with progressive symptoms, showing a peak in the 6:00 and 11:59 A.M. interval, was statistically significant (p<0.01). Although a similar trend existed for CAPE occurring in association with acute myocardial infarction, the pattern fell short of statistical significance (p=0.09).Conclusions: These data suggest that circadian patterns favoring the morning hours exist for episodes of CAPE, and that patterns may vary depending on the precipitant of the episode.
Comparative analysis of cardiac troponin i and creatine kinase‐MB as markers of acute myocardial infarction
Authors: Pervaiz Shazib , Waskiewicz Dave , Anderson F. Philip , Lawson Charlotte J. , Lohmann Thomas P. , Feng Yue‐Jin , Contois John H. , Wu Alan H.B. 
Published: February 2009

AbstractBackground: The World Health Organization (WHO) criteria for the diagnosis of acute myocardial infarction (AMI) includes presentation of chest pain over 20 min, evolutionary changes on the electrocardiogram (ECG), and abnormal levels of cardiac enzymes.Hypothesis: A multicenter study was conducted to evaluate the efficacy of cardiac troponin I (cTnI) in detecting and ruling out AMI.Methods: The normal range for cTnI in 149 apparently healthy subjects without known history of cardiac or other diseases was 0 to 0.5 ng/ml. Cutoffs of 2.5 ng/ml for cTnI and 5.0 ng/ml for creatine kinase‐MB (CK‐MB) were used.Results: The diagnostic sensitivity of blood collected from 291 consecutive patients with suspicion of AMI was 95.0 and 96.4%, respectively, for samples obtained at 4–48 h after AMI onset. CK‐MB was more sensitive during the early 4–8 h interval (84 vs. 74%); both had 100% sensitivity from 12–36 h. CTnI remained at 100% for 72 h, while CK‐MB declined to 57%. The clinical specificity was 97.4 vs. 85.8%, respectively, on non‐AMI patients with cardiac and noncardiac diseases, and those with renal disease.Conclusion: cTnI is an excellent marker for detecting and ruling out AMI, because it has better specificity and a wider diagnostic window than the accepted standard, CK‐MB.
Patient datasheets and generic evaluation sheets: Tools for improving patient care, patient satisfaction, and chart documentation while decreasing physician frustrations
Authors: Ewy Gordon A. 
Published: February 2009

AbstractA medical record system that utilizes a patient datasheet and pretyped generic patient evaluation sheets is described. When completed, the patient datasheet facilitates quick access to all of the pertinent patient medical information, improves transmission of instructions to the patient, simplifies record‐keeping of patient visits, prevents the rewriting of repetitive information (such as a long list of medications and dosages and instructions after each visit), facilitates the tracing of the patient medication history, and improves communication with the patient and with other physicians. The “generic evaluation sheets” have a near‐complete medical history and physical examination already typed with areas where information can be easily added or deleted and provides a place for the patient assessment and medical treatment plan. This approach to outpatient medical record‐keeping not only results in the ready availability of patient medical information, thus decreasing some of the frustrations of patient care, but also markedly improves patient care documentation while facilitating referral letters and in‐hospital patient records.
Conservative treatment for brucella endocarditis
Authors: Cohen Natan , Golik Ahuva , Alon Irena , Zaidenstein Ronit , Dishi Victor , Modai David , Karpuch Julio , Zyssman Itzchak 
Published: February 2009

AbstractEndocarditis is the most devastating complication of brucellosis. The accepted treatment for Brucella endocarditis (BE) is a combination of valve replacement and antibiotics. Conservative antibiotic treatment alone is not recommended by most authors, as it is considered ineffective, risking fatality. We describe a patient with BE, in whom antibiotic treatment alone resulted in complete recovery. On reviewing the literature, we found 12 additional such cases. We compared this group of 13 patients with data from 49 published cases treated with a combination of surgery and antibiotics, with afavorable outcome. Absence of congestive heart failure or a prosthetic valve, relatively mild extravalvular cardiac involvement, and a somewhat shorter disease history until initiation of treatment were characteristic of the group treated conservatively in comparison with patients who underwent surgery. In selected patients with BE, conservative antibiotic treatment may be a valid alternative to surgery.
Bronchiolitis obliterans organizing pneumonia during low‐dose amiodarone therapy
Authors: Jessurun Gillian A.J. , Crijns Harry J.G.M. , Hoogenberg Klaas 
Published: February 2009

AbstractTwo cases of amiodarone‐induced pulmonary toxicity during a relatively short period of low‐dose amiodarone treatment are reported. The toxicity risk of amiodarone is determined by cumulative factors in individual patients.
Percutaneous balloon catheter closure of a patent foramen ovale in a patient with pulmonary disease, profound hypoxemia, and normal right heart pressures
Authors: Allan John J. , Marinelli Carlos , Dellsperger Kevin C. , Winniford Michael D. 
Published: February 2009

AbstractRight‐to‐left intracardiac shunting across a patent foramen ovale (PFO) has been reported in patients with pulmonary embolism, right ventricular (RV) infarction, positive pressure ventilation with positive end‐expiratory pressure, heart failure with left ventricular assist devices, cardiac tamponade, and unilateral diaphragmatic paralysis. The primary driving force for these shunts is a reduction in the compliance of the pulmonary bed or right ventricle; right atrial pressure is usually elevated and pulmonary hypertension is frequently present. Significant shunting and hypoxemia are unusual in the absence of these diseases. We encountered a patient with normal pulmonary pressures, severe hypoxemia, pulmonary disease, and intracardiac shunting across a PFO in whom it was difficult to determine how great a role intracardiac shunting was playing in his hypoxemia. To assess this, we performed percutaneous balloon catheter occlusion of the PFO, using transthoracic echocardiography with contrast to confirm closure of the PFO. Therapeutic balloon occlusion has been reported in severe hypoxemia due to shunting across a PFO in a patient with RV infarction. Our case is unique, however, in two respects. First, this patient had normal right‐sided cardiac pressures and normal RV function and, thus, no obvious driving force for a significant right‐to‐left shunt. Second, transthoracic echocardiography with contrast was used before and after balloon inflation to confirm closure of the PFO. This technique helped to answer the important clinical question of whether surgical closure of the PFO in this patient with both lung disease and intracardiac shunting would significantly improve his oxygenation.
The design of the mortality assessment in congestive heart failure trial (MACH‐1, Mibefradil)
Authors: Barry Levine T. 
Published: February 2009

AbstractBackground: Despite the advances in therapy for heart failure with the use of angiotensin‐converting enzyme inhibitors, heart failure remains a major medical problem, impacting on well‐being and survival.Hypothesis: Mibefradil is a member of new class of agents that, due to its unique mechanism of action and pharmacologic and physiologic profile, may offer a significant advance in the treatment of heart failure. Mibefradil is a nonvoltage‐regulated T‐channel calcium blocker that differs from all the other currently available L‐channel calcium blockers. The drug is a potent peripheral and coronary vasodilator, with no clinical negative inotropic activity. Furthermore, because of its long half‐life, it can be given once a day and appears to be free of the common side effects seen with other calcium‐channel blockers. The trial was designed to investigate whether the addition of mibefradil to standard therapy for heart failure will reduce mortality in patients with symptomatic heart failure.Methods: This manuscript describes the design, organization, and status of MACH‐1 (Mortality Assessment in Congestive Heart Failure), a double‐blind, placebo‐controlled study. It is to be a 2,400‐patient international trial assessing the ability of mibefradil to impact upon survival and symptoms of heart failure in patients who are in NYHA classes II–IV and who were already treated with standard therapy.
Usefulness of laboratory mental stress test in patients with stable coronary artery disease
Authors: Wong Cheuk‐Kit , Ben Freedman S. 
Published: February 2009

AbstractBackground and hypothesis: Many episodes of ischemia in daily life are silent occurring during sedentary activities and may be related to mental stress. In 35 patients with stable angina and positive exercise test awaiting bypass surgery, we investigated whether laboratory mental stress tests would trigger ischemia of a comparable severity to that occurring in daily life and attempted to elucidate some of the underlying mechanisms.Methods: All patients underwent exercise testing, personality assessment, 2‐day Holter monitoring, and laboratory mental stress tests while on their usual medications.Results: Only four patients (12%) had positive mental stress test (ST depression ≥0.1 mV). All episodes were silent and usually associated with fast heart rate (>90 beats/min). In contrast, ambulatory ischemia was common (average duration of 51 min per 24 h), and at least one episode was recorded in 27 patients (77%) including the 4 with positive test. Patients with positive mental stress test had a higher heart rate during testing (124 ± 24 vs. 86 ± 16 beats/min, p<0.01), and a shorter exercise time and time to 1 mm ST depression on cycle ergometry than those with negative mental stress test. None of the four patients were on beta blockers. There was no difference in personality inventory between the two groups. Comparisons between patients with and without positive mental stress test revealed no difference in the duration and frequency of ambulatory ischemia, or in the occurrence of silent ischemia. However, the heart rate at onset of ambulatory ischemia tended to be higher in the patients with positive mental stress test (96 ± 9 vs. 62 ± 43, p = 0.07). Further subgroup analysis in patients without beta blockers (4 mental stress test positive and 18 negative) showed similar results.Conclusions: Laboratory mental stress test is a weak inducer of ischemia detected by electrocardiographic monitoring in patients with frequent ambulatory ischemia. Wall motion evaluation during mental stress test may improve sensitivity. While larger scale studies may determine its clinical role, the present study illustrated that patients with heightened heart rate response to mental stress were identified in whom beta blockers could be the drug of choice.
Coronary artery stenting with high‐pressure post‐dilation followed by adjunctive thrombolysis after failed coronary angioplasty for acute myocardial infarction: Report of three cases
Authors: Iwasaki Kohichiro , Yamasaki Satoshi , Takeuchi Kazuteru , Matono Sigeru , Kita Toshimasa , Kusachi Shozo 
Published: February 2009

AbstractWe successfully implanted coronary stents into refractory reoccluded lesions after failed coronary angioplasty in three patients with acute myocardial infarction (AMI). Lesion location was the proximal left anterior descending coronary artery in two patients and the dominant right coronary artery in one patient. The reference diameters of the lesions were 3.64, 3.33, and 3.50 mm, respectively. A stent with a luminal diameter of 3.0 mm was implanted in all patients. Poststenting dilation of the stent was performed at high pressure (18 atm), and urokinase was administered immediately thereafter. Heparin was administered for 24 h with maintenance of activated coagulation time within 180–200 s. Warfarin was then administered to keep the international normalized ratio within 2.5–3.5. Luminal diameters immediately after stenting were 3.14, 2.89, and 3.26 mm, and those at 1 month after stenting were 3.09, 2.81, and 3.12 mm, respectively, indicating good patency. Our experience in these cases suggests that coronary stenting can be applied after unsuccessful coronary angioplasty in selected patients with AMI. The present report includes informative reference data on diameter, postdilation, adjunctive thrombolytic agent administration, and adequate anticoagulation therapy in coronary stenting in this acute application.
Severe ventricular dysfunction secondary to subarachnoid hemorrhage
Authors: Soman P. , Senior R. 
Published: February 2009

AbstractA 39‐year‐old man was brought to the emergency department in a coma. The electrocardiogram showed partial left bundle‐branch block and ST elevation in precordial leads, and serum creatinine kinase activity was elevated. Two‐dimensional echocardiography revealed severe biventricular dysfunction. Autopsy demonstrated the presence of subarachnoid hemorrhage. Coronary arteries and the myocardium were macroscopically normal.
“Tombstone” anterior st‐segment elevations secondary to acute pericarditis: the role of two‐dimensional echocardiogram
Authors: Jain Avanindra 
Published: February 2009

AbstractPrompt and appropriate administration of thrombolytic therapy is important for patients with acute myocardial infarction. However, in addition to contraindications, alternative causes of ST‐segment elevation should be considered before thrombolytic therapy is instituted. A patient with marked ST‐segment elevation in the anterior leads suggestive of acute ischemia is presented. Because of lack of ischemic symptoms, an echocardiogram was performed. This showed mild generalized hypokinesis, and thrombolytic therapy was not administered. Subsequent ECGs demonstrated evolutionary findings consistent with pericarditis. In selected patients a two‐dimensional echocardiogram, which can be easily performed at patient bedside, will help in appropriate patient management.
Incomplete bundle‐branch block and st‐segment elevation: Syndrome associated with sustained monomorphic ventricular tachycardia in patients with apparently normal heart
Authors: Brembilla‐Perrot BÁAtrice , Beurrier Daniel , Jacquemin Laurent , Kubler Luc , Brouant BenoÎOt , Demoulin StÁPhane , Lucron Hugues , Danchin Nicolas 
Published: February 2009

AbstractThis paper reports on three cases of patients with an apparently normal heart admitted for sustained monomorphic ventricular tachycardia. The only abnormal finding showed in the electrocardiogram (ECG) in sinus rhythm that exhibited an entity associated with incomplete right bundle‐branch block and persistent ST‐segment elevation. The ECG entity was variable and disappeared transiently. Spontaneous ventricular tachycardia in one patient was inducible by programmed stimulation. There was no underlying heart disease. The origin of the ventricular tachycardia in one patient was located by pace mapping in the left ventricle at the left ventricular basal septum. The follow‐up (from 6 months up to 6 years) demonstrated a good prognosis. This particular ECG entity associated with monomorphic ventricular tachycardia could have been missed because of the variations in the ECG in sinus rhythm and was associated with a favorable prognosis.
Observer bias in the interpretation of dobutamine stress echocardiography
Authors: Tighe John F. , Steiman David M. , Vernalis Marina N. , Taylor Allen J. 
Published: February 2009

AbstractBackground and hypothesis: Blinded image analysis is typically utilized in published studies evaluating the accuracy of dobutamine stress echocardiography (DSE). However, in clinical settings, practical considerations may limit the use of blinded interpretations and thus the potential for observer bias arises. This study evaluated the relationships between clinical and blinded interpretations of DSE.Methods: Wall motion analysis from clinical and blinded DSE interpretations were compared and factors associated with their concordance were investigated in 115 consecutive patients with known or suspected coronary artery disease.Results: Clinical and blinded interpretations agreed on the presence or absence of inducible ischemia in 102 of 115 cases (88.7% k = 0.76, p<0.00001). In studies in which the clinical and blinded interpretations were in agreement, there was greater ST‐segment depression (STD) in echocardiographically positive compared with negative studies (mean STD 0.73 ± 0.65 vs. 0.42 ± 0.67 mm; p = 0.008). In contrast, studies in which there was disagreement had significantly less ST‐segment changes (mean STD 0.19 ± 0.56 mm; p = 0.012) despite comparable results on blinded wall motion analysis. Multiple logistic regression for factors related to the results of clinical and blinded wall motion analysis disclosed that angina pectoris and ST‐segment changes were related to clinical interpretations, whereas only angina pectoris was related to the findings on blinded analysis.Conclusions: Clinical interpretations of echocardiographic images during DSE overall demonstrate good agreement with the results of blinded analysis. Ancillary testing data may influence the analysis of wall motion abnormalities, and thus the potential for observer bias exists unless these interpretations are performed blinded to other clinical data.
The role of “Ischemic ST‐segment Counterpoise” in rendering the response of exercise electrocardiogram falsely negative
Authors: Madias John E. , Khan Mujtaba , Manyam Bose 
Published: February 2009

AbstractExercise electrocardiogram (ECG) has a high rate of false negative results in comparison with simultaneously performed thallium‐201 perfusion scintigraphy, particularly in patients with single‐vessel coronary artery disease, low exercise workload, inadequate heart rate rise, and resting ECG abnormalities. We present the case of a patient in whom thallium‐201 SPECT scintigram revealed equally extensive and severe myocardial ischemia in two myocardial planes opposite each other. The accompanying exercise ECG did not disclose ischemic changes despite the adequacy of heart rate rise in this patient with severe right and left anterior descending coronary artery disease. We propose, as an explanation for this phenomenon, that in this patient the ischemic ST‐segment vectors of equal magnitude and direction but of opposite sense, generated during stress, cancelled each other (“ischemic ST‐segment counterpoise”), thus rendering the exercise ECG normal.
Nonsecretory immunoglobulin‐derived amyloidosis of the heart: Diagnosis by immunohistochemistry of the endomyocardium
Authors: Chau Elaine M.C. , Cheung Stephen C. W. , Chow Simon L. , Fu Kin‐Hang 
Published: February 2009

AbstractPrimary amyloid light chain (AL) amyloidosis of the heart is a rare cause of congestive heart failure. Approximately 15% of patients with primary AL amyloidosis demonstrate no monoclonal proteins on serum or urine immunoelectrophoresis (so‐called nonsecretory immunoglobulin‐derived amyloidosis). The histologic findings of endomyocardial biopsy from these patients may be indistinguishable from those with senile cardiac amyloidosis. However, the AL type may respond favorably to chemotherapy while the latter type does not. The prognosis is also better in the senile cardiac amyloid type. The precise diagnosis in the present case was made by applying immunohistochemical techniques on cardiac tissues.
Non‐hodgkin's lymphoma of the heart in patients infected with human immunodeficiency virus
Authors: Duong Michel , Dubois Claudine , Buisson Marielle , Grappin Michelle , Chavanet Pascal , Portier Henri , Eicher Jean Christophe 
Published: February 2009

AbstractA case of HIV‐associated cardiac non‐Hodgkin's lymphoma (NHL) is described, and the epidemiologic and clinicopathologic features of 21 cases previously reported in the literature are analyzed. All patients were homosexual males, and the cardiac NHL was the first acquired immune deficiency syndrome‐defining condition in the majority. Patients were referred with nonspecific clinical findings including dyspnea and tachycardia, but rapid progression of cardiac dysfunction was frequent after symptoms appeared. Echocardiography constitutes the most useful noninvasive procedure in the diagnosis of cardiac NHL. Most of the patients had disseminated disease at initial presentation; pathologically, the lymphomas were of B lymphocyte origin and of high‐grade subtypes. Prognosis of HIV‐associated cardiac NHL is generally poor, although clinical remission has been observed with combination chemotherapy. Cardiac lymphomas in HIV‐associated patients are typically high‐grade and often disseminate early. Although the prognosis is poor, patients in whom dissemination has not occurred could have longer survival under systemic chemotherapy.