bluuebunny/crossref_metadata_2025_split huggingface dataset:
Safety and potential cost savings of same‐setting electrophysiologic testing and placement of transvenous implantable cardioverter‐defibrillators
Authors: Pires Luis A. , May Lynette M. , Ravi Srihari , Lal Vinit R. , Kahlon Jaskamal P. S. 
Published: February 2009

AbstractBackground: Separately, electrophysiologic study (EPS) and placement of a transvenous implantable cardioverter‐defibrillator (ICD) can be performed safely in the majority of patients. The safety and potential cost savings of same‐setting procedures have not been evaluated.Hypothesis: Electrophysiologic study and placement of transvenous ICDs can be performed safely in the same setting at reduced cost.Methods: in all, 160 (mean age 65 ± 10 years, 75% men) and 41 (mean age 66 ± 11 years, 73% men) consecutive patients who underwent same‐ versus separate‐setting procedures, respectively, were prospectively evaluated.Results: The two groups had similar clinical characteristics and indications for EPS and ICD therapy. Complications occurred in eight patients (5.0%, 95% confidence interval [CI] 2.3–10.3) who had same‐setting procedures (one hypotension during ICD testing, one pocket hematoma, two lead dislodgments, two pneumothoraces, one stroke, and one infection) and in two (4.9%, CI 0.60–16.5) who had separate‐setting procedures (one pocket hematoma and one infection). There were no procedure‐related deaths or long‐term ICD‐related complications in either group. The mean time from ICD implantation to hospital discharge was similar in the two groups (2.5 ± 2.4 vs. 2.7 ± 2.2 days, p = NS). The combined procedure cost was higher in patients who had separate‐setting procedures ($12,403 ± 1,386 vs. $10,242 ± 2,256, p = < 0.001), who incurred an additional hospital cost of $2,121 ± $2,125 for the waiting period (1.7 ± 1.6 days) between EPS and ICD implantation.Conclusions: in patients deemed candidates for ICD therapy based on EPS results, placement of transvenous defibrillators in the same setting as EPS is as safe as separate‐setting procedures and, if adopted, could further reduce the cost of providing ICD therapy.
Continuous long‐term dosing with oral slow‐release isosorbide dinitrate does not reduce incidence of cardiac events in patients with healed myocardial infarction
Authors: Kanamasa Ken , Hayashi Takahiro , Takenaka Toshihiko , Kimura Akio , Ikeda Akiko , Ishikawa Kinji 
Published: February 2009

AbstractBackground: in the short term, isosorbide dinitrate (ISDN) is considered to be therapeutically effective. The long‐term effects of treatment with slow‐release ISDN are less clear.Hypothesis: The study was undertaken to investigate the effects of continuous, long‐term dosing with oral slow‐release ISDN on the incidence of cardiac events in patients with healed myocardial infarction (MI). The study was carried out in accordance with the intention‐to‐treat principle.Methods: in all, 1,102 in‐ and outpatients, of either gender, with healed MI were randomly divided into groups treated with ISDN (n = 470) and not treated with ISDN (n = 632). Patients in the ISDN group received a continuous regimen of 20 mg of oral, long‐acting ISDN three times a day, after meals. The mean observation period was 15.0 ± 18.5 months. The primary endpoints were nonfatal and fatal recurrent MI, death from congestive heart failure, and sudden death.Results: There were no significant differences in the baseline characteristics of the patients in the ISDN and no‐treatment groups; nevertheless, significantly more patients in the ISDN group experienced cardiac events. in the ISDN group, 35 patients (7.4%) experienced cardiac events during the observation period, versus only 28 patients (4.4%) in the no‐treatment group (p<0.05; odds ratio 1.74; 95% confidence interval 1.04–2.90).Conclusion: Continuous long‐term dosing with oral, slow‐release ISDN does not reduce and probably increases the incidence of cardiac events among patients with healed MI.
The effect of thrombolytic therapy on left ventricular aneurysm formation in acute myocardial infarction: Relationship to successful reperfusion and vessel patency
Authors: Tikz H. , Balbay Y. , Atak R. , Terzi T. , Gençl Y. , Utüuk E. Kü 
Published: February 2009

AbstractBackground: Although there is increasing evidence for the beneficial effect of thrombolytic therapy on global left ventricular (LV) function in acute myocardial infarction (AMI), the data concerning the early effect of thrombolytic therapy on the incidence of left ventricular aneurysm (LVA) formation and its relationship to clinical and angiographic determinants are limited.Hypothesis: The study aimed to determine the independent factors involved in the development of LVA and to evaluate whether thrombolytic therapy has any preventive effect on the development of LVA in AMI.Methods: In all, 350 consecutive patients suffering from a first attack of AMI were included. Of these, 205 who arrived within 12 h of onset of symptoms received thrombolytic therapy (thrombolytic group) and the remaining 145 patients served as control group. All patients received aspirin and maximal‐dose anticoagulation with intravenous heparin therapy. Early successful reperfusion was assessed by enzymatic and electrocardiographic evidence, and late vessel patency was evaluated according to Thrombolysis in Myocardial Infarction (TIMI) classification. Patients with TTMI grade 2 or 3 flow were considered to have vessel patency.Results: The overall incidence of LVA was 11.7% (41/350), and no statistical difference was found between the incidence of LVA between the two groups (11.7 vs. 11.7%, p>0.05). However, the patients receiving thrombolytic therapy and exhibiting a patent infarct‐related artery (PIRA) (n = 125, 61%), had a significantly reduced incidence of LVA compared with those who did not (7.2 vs. 18.8%, p=0.015). In univariate analysis, vessel patency, proximal left anterior descending artery (LAD) stenosis, total LAD occlusion, multivessel disease, and hypertension were found to be important factors in LVA formation after AMI. After adjustment for other clinical and angiographic variables, total LAD occlusion (odds ratio [OR] 3.62,95% confidence interval [CI] 2.45–8.42, p = 0.0014), absence of PIRA (OR 2.92, 95% CI 1.41–09, p = 0.0037) and proximal LAD stenosis (OR 2.11, 95% CI 1.05–4.71, p = 0.045) remained the independent determinants of LVA formation after AMI.Conclusion: Our data indicate that not all patients who received thrombolytic therapy, but only those with PIRA had evidently reduced the incidence of LVA. Patients with total LAD occlusion, with proximal LAD stenosis, and without PIRA were found to have increased risk for formation of LVA after AMI. These findings indicate that the presence of vessel patency has a preventive effect on LVA formation in AMI.
Left ventricular systolic and diastolic function after anthracycline chemotherapy in childhood
Authors: Iarussi Diana , Galderisi Maurizio , Ratti Gennaro , Tedesco Michele Adolfo , Indolfi Paolo , Casale Fiorina , Tullio Maria Teresa Di , De Divitiis Oreste , Iacono Aldo 
Published: February 2009

AbstractBackground: In childhood, late cardiotoxicity is characterized by inappropriately thin wall and consequent increased end‐systolic wall stress, but the associations of impaired left ventricular geometry and function occurring under these circumstances need further investigation.Hypothesis: The purpose of this study was to assess anthracycline late effects on the relationships occurring between increased end‐systolic stress (ESS) and changes in both M‐mode systolic measurements (i.e., endocardial and midwall fractional shortening) and Doppler diastolic indices in the pediatric age.Methods: The population consisted of 101 children treated with anthracyclines for at least 12 months and 91 healthy children. Using M‐mode echocardiography, end‐systolic wall stress was calculated as index of afterload, and endocardial and midwall fractional shortening as systolic indices. Doppler transmitral measurements were made as diastolic indices.Results: Patients treated with anthracyclines showed significantly lower relative wall thickness and left ventricular mass index, greater end‐systolic wall stress, reduced endocardial and midwall fractional shortening and peak E/A ratio, prolonged deceleration, and isovolumic relaxation times. Direct relationships were found between end‐systolic wall stress and both endocardial and midwall shortening. The use of midwall shortening in the relation showed a greater, but not significant increase (from 3 to 6%) in the proportion of patients with depressed systolic function than did endocardial shortening. In the anthracycline group, end‐systolic wall stress was also inversely related to relative wall thickness and directly to isovolumic relaxation time.Conclusions: In childhood, reduced myocardial thickness and increased afterload explain much of systolic and diastolic dysfunction of late anthracycline toxicity. Midwall fractional shortening does not seem to add useful information for identifying subsets of children more prone to the development of heart failure.
Magnetocardiographic mapping of QRS fragmentation in patients with a history of malignant tachyarrhythmias
Authors: Göudde P. , Agrawal R. , Müuller H.‐P. , Czerski K. , Endt P. , Steinhoff U. , Oeff M. , Schultheiss H.‐P. , Behrens S. 
Published: February 2009

AbstractBackground: The identification of patients at increased risk for ventricular tachycardia or ventricular fibrillation (VT/VF) and sudden cardiac death has consequences for therapeutic options and thus may reduce mortality in patients with coronary artery disease (CAD).Hypothesis: We hypothesized that the intra‐QRS fragmentation in magnetocardiographic recordings is increased in patients with CAD and with a history of VT/VF.Methods: Multichannel magnetocardiography (MCG) was carried out in 34 healthy controls, 42 patients with CAD without a history of VT/VF, and 43 patients with CAD and with a history of VT/VF. The intra‐QRS fragmentation was quantified by a new fragmentation score. Its spatial distribution was investigated using two‐dimensional (2‐D) contour maps according to the sensor position of the 49‐channel magnetogradiometer.Results: Patients with CAD and with a history of VT/VF had significantly increased QRS fragmentation compared with patients with CAD without VT/VF or controls (72.9 ± 37.5,48.5 ± 14.3, and 42.5 ± 7.8, respectively; p< 0.05). The area of high fragmentation in 2‐D contour maps was twice as large in patients with than in those without a history of VT/VF (represented by the number of MCG channels with high fragmentation: 26.3 ± 15.5 vs. 12.4 ± 9.9, p<0.0001). Patients prone to VT/VF could be identified with a sensitivity of 64% and a specificity of 90%.Conclusion: In patients with CAD and with a history of VT/VF, intra‐QRS fragmentation is increased and the area of high fragmentation in 2‐D contour maps is enlarged. These findings may be helpful in identifying patients with CAD at risk for malignant tachyarrhythmias.
Interleukin‐6 and acute coronary syndrome
Authors: Ikeda Uichi , Ito Takayuki , Shimada Kazuyuki 
Published: February 2009

AbstractThe designation of atherosclerosis as a chronic inflammatory process represents an exciting and logical paradigm shift for cardiologists. Plasma concentrations of interleukin‐6 (IL‐6) and its hepatic by‐product C‐reactive protein (CRP) appear to reflect the intensity of occult plaque inflammation and by inference may determine vulnerability to rupture. Indeed, circulating IL‐6 levels are elevated in patients with acute myocardial infarction (AMI), and also in patients with unstable, but not with stable angina. Coronary sinus IL‐6 concentrations are also increased after percutaneous coronary intervention (PCI), and late restenosis correlates with an increase in IL‐6 concentration after the procedure, indicating that IL‐6 expression may be not only related to instability of atheromatous plaques, but also to the formation of restenotic lesions after PCI. These observations suggest the advantage of screening for circulating IL‐6 concentration and the use of anti‐inflammatory treatment for those thought be at high risk to reduce the risk of future AMI.
Effects of low‐dose aspirin on endothelial function in hypertensive patients
Authors: Monobe Hideaki , Yamanari Hiroshi , Nakamura Kazufumi , Ohe Tohru 
Published: February 2009

AbstractBackground: It has been reported that administration of low‐dose aspirin significantly reduces the frequency of major cardiovascular events in patients with hypertension and coronary artery disease. It is generally considered that the preventative effects of long‐term aspirin administration on major cardiovascular events are due to the inhibition of platelet aggregation.Hypothesis: It is not known whether administration of low‐dose aspirin restores endothelium‐dependent vasodilatation, and this study was undertaken to prove or disprove this question in patients with hypertension.Methods: Flow‐mediated endothelium‐dependent dilatation and glyceryl trinitrate‐induced endothelium‐independent dilatation were investigated in 18 hypertensive patients and 10 normotensive control subjects. In the hypertensive patients, flow‐mediated dilatation was investigated and cyclic guano‐sine monophosphate plasma (cGMP) was measured before and at 8 weeks after the administration of 162 mg of aspirin.Results: Flow‐mediated dilatation before aspirin administration was more reduced in the hypertensive patients than in the control subjects (6.4 ± 2.0% vs. 11.3 ± 2.3%, p< 0.0001). Glyceryl trinitrate‐induced dilatation before aspirin administration was similar in hypertensive patients and control subjects. Flow‐mediated dilatation after aspirin administration was improved compared with that before aspirin administration (10.4 ± 3.5% vs. 6.4 ± 2.0%, p<0.0004). The cGMP product after aspirin administration was significantly higher than that before aspirin administration.Conclusions: Administration of low‐dose aspirin may restore the endothelium‐dependent vasodilatation in hypertensive patients. Furthermore, increased nitric oxide production may play a partial role in the improvement in endothelial function induced by administration of low‐dose aspirin.
Soy protein diet significantly improves endothelial function and lipid parameters
Authors: Yildirir Aylin , Tokgozoglu S. Lale , Oduncu Tulay , Oto Aytekin , Haznedaroglu Ibrahim , Akinci Devrim , Koksal Gulden , Sade Elif , Kirazli Serafettin , Kes Sirri 
Published: February 2009

AbstractBackground: Replacement of animal protein with soy protein in the diet is associated with decreased cholesterol levels. However, the effects of soy protein diet on endothelial function are not well known.Hypothesis: The aim of the study was to investigate the effects of soy protein diet on plasma lipids and endothelial function parameters assessed by two different methods.Methods: Twenty hypercholesterolemic, nonsmoker male patients (age 50.1 ± 11.8 years), with a normal body mass index, were included. After calculating their daily requirements, a diet with 25–30% of energy from fats, 10–12% from proteins, and the rest from carbohydrates was instituted. Sixty percent of the animal source proteins of the diet were substituted by soy. The anthropometric measures, lipid parameters, and endothelial functions of the subjects were assessed at baseline and 6 weeks after soy protein diet. Flow‐mediated endothelium‐dependent dilatation (EDD) and plasma thrombomodulin (TM) levels were evaluated as endothelial function parameters.Results: After diet, plasma total cholesterol, low‐density lipoprotein cholesterol, apolipoprotein B, and triglyceride levels decreased significantly (p < 0.001, p < 0.001, p=0.039, and p = 0.001, respectively). The mean plasma TM levels were also significantly reduced with diet (p = 0.004). Studies of the brachial artery indicated a borderline dilatation in baseline brachial artery diameter (p=0.05), however the diameter at reactive hyperemia was significantly larger after diet (p < 0.001), resulting in a significant improvement of EDD (p = 0.002).Conclusion: Soy protein diet significantly improves plasma lipid profile in patients with hypercholesterolemia. Furthermore, the endothelial function, as judged by two different methods (EDD and plasma TM levels), also improves with soy protein diet.
Possible ethnic differences in plasma homocysteine levels associated with coronary artery disease between south asian and east asian immigrants
Authors: Senaratne Manohara P. J. , Macdonald Karen , De Silva Dilshana 
Published: February 2009

AbstractBackground: Hyperhomocysteinemia has been identified as a risk factor for coronary artery disease (CAD). South Asians appear to have a high incidence of CAD, while East Asians have a very low incidence.Hypothesis: The present study was undertaken because the relative association of plasma homocysteine levels (PH) with CAD in South Asians (SA = Indian, Pakistani, Sri Lankan) and East Asians (EA = Chinese, Japanese) is not known.Methods: Fasting PH were drawn on all patients with CAD of SA (age 62.4 ± 1.1 years, 72 men, 14 women) and EA (age 61.8 ± 3.0 years, 13 men, 4 women) descent. These were compared with PH available from Caucasian (CA) patients (age 61.1 ± 1.1 years, 89 men, 17 women) with CAD.Results: The PH in SA, EA, and CA patients were 11.0 ± 0.5, 7.6 ± 0.5, and 10.8 ± 0.6 μmol/l, respectively (p < 0.001 between EA and SA/CA). Percentages of SA, EA, and CA with elevated PH (> 12.0 μmol/l) were 33.7, 5.9, and 28.2%, respectively. There were no significant differences in the lipid subtractions between the SA and EA group. History of smoking was significantly higher in the EA (52.9 vs. 26.2%), while hypertension and diabetes mellitus had similar prevalences.Conclusion: Significant differences in PH of SA versus EA patients with CAD exist. The relative contribution of homocysteine in the development of CAD appears to be less in EA immigrants. In contrast, the association between CAD and PH in SA immigrants appears to be similar to that of Caucasians.
Carvedilol in the failing heart
Authors: Lombardi William L. , Gilbert Edward M. 
Published: February 2009

AbstractPatients with chronic heart failure due to left ventricular systolic dysfunction of ischemic or nonischemic etiology have shown improvement in morbidity and mortality with carvedilol therapy. In patients with symptomatic (New York Heart Association class II–IV) heart failure, carvedilol improves left ventricular ejection fraction and clinical status, and slows disease progression, reducing the combined risk of mortality and hospitalization. Despite the overwhelming evidence for their benefit, there continues to be a large treatment gap between those who would derive benefit and those who actually receive the drug. In this article, the pharmacology, clinical trial evidence, and the potential differences between carvedilol and other beta blockers are discussed. Carvedilol provides powerful therapy in the treatment of chronic heart failure caused by a variety of etiologies and in a wide array of clinical settings.
Digoxin withdrawal in patients with dilated cardiomyopathy following normalization of ejection fraction with beta blockers
Authors: Shammas Nicolas W. , Harris Melodee L. , Mckinney Dawn , Hauber William J. 
Published: February 2009

AbstractBackground: The effect of withdrawal of digoxin on left ventricular function in patients with a history of idiopathic dilated cardiomyopathy (IDCM) following normalization of left ventricular ejection fraction (LVEF) with beta blockers remains unknown.Hypothesis: This study was undertaken to determine the effect of digoxin withdrawal on left ventricular function in patients with IDCM.Methods: In 8 consecutive patients with IDCM (5 men, 3 women) who had normalization of LVEF following beta‐blocker treatment, digoxin was withdrawn as part of an office protocol, and LVEF was followed. Baseline EF prior to beta blocker initiation (carvedilol = 6, atenolol = 1, metoprolol = 1) was measured with isotope ventriculography (IVG), echocardiography, or left ventriculography. Post beta blocker ejection fraction (post BB EF) was measured in all patients with IVG at a mean of 17.25 ± 5.38 months. Follow‐up EF was measured using IVG after digoxin withdrawal at a mean of 6.99±4.34 months.Results: An experienced blinded reader interpreted the IVG scans. Baseline EF was 28.5 ± 8.26; post BB EF and follow‐up EF were 56.1 ± 4.65 and 51.0 ± 7.35, respectively (p = 0.05).Conclusion: These data provide potential evidence that digoxin withdrawal can result in a small but significant reduction in LVEF in patients with IDCM who had normalization of LVEF after treatment with beta blockers. Mean LVEF, however, remained within normal (> 50%) on beta‐blocker therapy and without digitalis. Large, randomized controlled trials are needed to confirm these findings.
Body mass index and risk of ovarian cancer
Authors: Leitzmann Michael F. , Koebnick Corinna , Danforth Kim N. , Brinton Louise A. , Moore Steven C. , Hollenbeck Albert R. , Schatzkin Arthur , Lacey James V. 
Published: February 2009

AbstractBACKGROUND:Convincing epidemiologic evidence links excess body mass to increased risks of endometrial and postmenopausal breast cancers, but the relation between body mass index (BMI) and ovarian cancer risk remains inconclusive. Potential similarities regarding a hormonal mechanism in the etiology of female cancers highlight the importance of investigating associations according to menopausal hormone therapy (MHT) use. However, to the authors' knowledge, data addressing whether the relation between BMI and ovarian cancer differs by MHT use are very sparse.METHODS:The authors prospectively investigated the association between BMI and ovarian cancer among 94,525 US women who were followed between 1996 through 1997 to December 31, 2003. During 7 years of follow‐up, 303 epithelial ovarian cancer cases were documented.RESULTS:Compared with normal weight women (BMI of 18.5‐24.9 kg/m2), the multivariate relative risk (MVRR) of ovarian cancer for obese women (BMI of ≥30 kg/m2) in the cohort as a whole was 1.26 (95% confidence interval [95% CI], 0.94‐1.68). Among women who never used MHT, the MVRR for obese versus normal weight women was 1.83 (95% CI, 1.18‐2.84). In contrast, no relation between BMI and ovarian cancer was apparent among women who ever used MHT (MVRR = 0.96; 95% CI, 0.65‐1.43; P interaction = 0.02). Exploratory analyses also suggested a positive association between BMI and ovarian cancer among women without a family history of ovarian cancer (MVRR comparing obese vs normal weight women = 1.36; 95% CI, 1.00‐1.86), but no relation with BMI was apparent among women with a positive family history of ovarian cancer (MVRR = 0.74; 95% CI, 0.34‐1.62 [P interaction = .02]).CONCLUSIONS:Based on the results of the current study, the authors suspect that obesity is associated with enhanced ovarian cancer risk through a hormonal mechanism. Cancer 2009. Published 2009 by the American Cancer Society.