bluuebunny/crossref_metadata_2025_split huggingface dataset:
Circadian rhythm of autonomic activity in patients with obstructive sleep apnea syndrome
Authors: Noda Akiko , Yasuma Fumihiko , Okada Tamotsu , Yokota Mitsuhiro 
Published: February 2009

AbstractBackground and hypothesis: Although the immediate effects of sleep apnea on hemodynamics and the neurological system have been studied, little is known about the circadian rhythm of heart rate variability in patients with obstructive sleep apnea syndrome (OSAS). The purpose of the present study was to investigate the effects of sleep apnea on the autonomic activity during daytime, which may play some role in the pathogenesis of cardiovascular complications in OSAS.Methods: We studied 18 middle‐aged male patients with OSAS and 10 age‐matched control subjects. Patients with OSAS were classified according to the severity of OSAS: patients with an apnea index (AI) < 20 were considered to have mild OSAS (Group 1, n = 8) and patients with an AI≥ 20 were considered to have severe OSAS (Group 2, n = 10). Heart rate variability was calculated from the 24‐h ambulatory electrocardiograms by the Fourier transformation. Power spectra were quantified at 0.04‐0.15 Hz [low frequency power (LF)ln(ms2)] and 0.15‐0.40Hz [high frequency power (HF)ln(ms2)]. The HF component and the ratio of LF to HF were used as indices of the parasympathetic and sympathetic activity, respectively.Results: The circadian rhythms of the LF, HF, and LF/HF ratio differed significantly in Group 2 compared with Group 1 and control subjects (p<0.05). Hypertension (>160/95 mm Hg) was found in 7 (70.0%) of 10 patients in Group 2, and in 1 (12.5%) of 8 patients in Group 1. Echocardiographic evidence of left ventricular hypertrophy (LVH) (an interventricular septal thickness or a left ventricular posterior wall thickness ≥ 12 mm) was found in 3 (30.0%) of 10 patients in Group 2, and in 1 (12.5%) of 8 patients in Group 1. The mean HF from 4 A.M. to 12 noon was significantly lower in Group 2 than in Group 1 and the control group, and it correlated significantly with the lowest nocturnal SaO2 (r = 0.58, p<0.05). The mean LF/HF ratio during the same period was significantly higher in Group 2 than in Group 1 and the control group, and it correlated significantly with total time of the nocturnal oxygen saturation <90% (r = 0.64, p<0.005) and the lowest nocturnal SaO2 (r = 0.56, p<0.05). Ventricular tachycardia was found in the early morning in one patient, ST‐T depression in two patients, and sinus arrest in two patients in Group 2.Conclusion: These findings suggest that sleep‐disordered breathing associated with severe oxygen desaturation might influence heart rate variability not only during sleep but also during daytime. OSAS per se might contribute to altered circadian rhythm in autonomic activity leading to the development of cardiovascular diseases.
Influence of tissue affinity of angiotensin‐converting enzyme inhibitors on left ventricular remodeling after myocardial infarction
Authors: Konermann M. , Altmann C. , Laschewski F. , Josephs W. , Odenthal H. J. , Horstmann E. , Sanner B. 
Published: February 2009

AbstractBackground: The demonstration of local renin‐angiotension systems has raised the question of whether angiotensinconverting enzyme (ACE) inhibitors with different tissue affinities differ with regard to their effects on postinfarction remodeling.Hypothesis: The study was undertaken to investigate the influence of ACE inhibitors with different tissue affinity on morphology and function of the infarcted left ventricle.Methods: In all, 52 patients (17 women, 35 men, 38‐73 years) with large acute myocardial infarction were randomized to receive either 25‐75 mg/day captopril or 10‐20 mg/day fosinopril beginning on the Day 7 after infarction. Of these, 28 had anterior and 24 had posterior wall infarctions. Infarct size was determined by the creatine kinase integral method. Fifty patients were examined by cinemagnetic resonance imaging (CMRI) 1 and 26 weeks after infarction. The following parameters were determined: left ventricular enddiastolic and end‐systolic volume index (LVEDVI, LVESVI), ejection fraction (LVEF), infarct weight, and muscle mass (LVMM). The volume‐to‐mass ratio (VMR) was calculated and the clinical status according to the guidelines of the New York Heart Association (NYHA) was documented at each examination time. The results were compared with those of a historical sample without ACE‐inhibitor therapy examined in an identical manner (n = 31, 10 women, 21 men, 36‐75 years).Results: LVEDVI and LVESVI increased in the first 6 months after infarction by 24.9 and 36.6%, respectively, in the historical sample; by 11.0 and 7.8%, respectively, under captopril; and by 13.1 and 10.7%, respectively, under fosinopril. LVEF decreased by 14.9% in the untreated sample, by 3.7% under captopril and by 5.0% under fosinopril. Infarct weight and LVMM increased by 12.7 and 15.3%, respectively, without ACE inhibition, by 5.7 and 10.1%, respectively, in patients treated with captopril, and by 6.1 and 9.3%, respectively, in patients treated with fosinopril. The VMR increased by 7.4% in the historical sample, by 3.5% in the captopril group, and by 1.8% in the fosinopril group. The NYHA clinical status improved by 18.2% without ACE inhibition, by 42.9% in the captopril group, and by 26.3% in the fosinopril group. The differences between the two ACE‐inhibitor groups and the reference group were all significant, while the differences between the captopril group and the fosinopril group were significant only for VMR (p<0.01) and NYHA class (p < 0.05).Conclusions: Both captopril and fosinopril have a comparable positive influence on postinfarction remodeling and on clinical status. Lipophilicity and tissue affinity do not seem to play a clinically important role in ACE‐inhibitor therapy after infarction.
Rupture of mitral chorda tendinea following blunt chest trauma
Authors: Grinberg Alejandro Rubén , Finkielman Javier Daniel , Piñeiro Daniel , Festa Hector , Cazenave Claudio 
Published: February 2009

AbstractAcute mitral insufficiency, originated from rupture of mitral chordae tendineae secondary to nonpenetrating thoracic trauma, is an unusual condition. This diagnosis is difficult to establish because physical examination, electrocardiogram, and cardiac enzymes are neither sensitive nor specific. The diagnosis of rupture must be quickly established because this disorder may be fatal. This paper reports the case of a patient with acute mitral insufficiency secondary to a mitral valve chord rupture a week after a nonpenetrating thoracic trauma.
Pulmonary embolism and impending paradoxical embolism: A role for transesophageal echocardiography?
Authors: Alexiou C. , Richens D. , Henderson R. A. 
Published: February 2009

AbstractThrombolysis is advocated as the treatment of choice for hemodynamically important pulmonary embolism. This paper reports the case of a patient with subacute massive pulmonary embolism in which thrombolysis was not considered appropriate because transesophageal echocardiography demonstrated a patent foramen ovale and impending paradoxical embolism.
Simultaneous manifestation of acute myocardial infarction and nephrotic syndrome
Authors: Meyer Thomas , Schulze Friederike , Kreuzer Heinrich , Grone Hermann‐Josef 
Published: February 2009

AbstractThis report describes the simultaneous manifestation of ischemic heart disease and nephrotic syndrome in a 37‐year‐old woman presenting with acute anterior myocardial infarction. Symptoms of nephrotic syndrome, such as facial and peripheral edema accompanied by proteinuria and hyperlipidemia, and onset of severe retrosternal pain developed within 24 h. Coronary angiography revealed a complete thrombotic occlusion of the proximal portion of the left anterior descending artery with no evidence of arteriosclerotic lesions. Histologic examination of renal biopsy, including electron microscopy, revealed evidence of minimal change glomerulonephritis. Ultrastructural studies demonstrated widespread effacement of epithelial foot processes. Elevated levels of circulating fibrinogen appeared to be an important factor for the hypercoagulable state in this patient, suggesting a causative relationship between coronary thrombosis and nephrotic syndrome.
Acute profound thrombocytopenia after abciximab therapy during coronary angioplasty
Authors: Joseph T. , Marco J. , Gregorint L. 
Published: February 2009

AbstractSince the extensive use of abciximab, a potent antiplatelet agent directed against GP IIb/IIIa platelet receptors, to prevent ischemic complications of percutaneous transluminal coronary angioplasty, few cases of thrombocytopenia have been observed. This paper reports a case of acute profound thrombocytopenia (platelet count: 800/mm3) occurring 16 h after abciximab therapy during coronary angioplasty. As thrombocytopenia occurrence is not predictable, platelet count should be evaluated periodically after drug administration. Mechanisms of this adverse effect remain unknown. Platelet transfusion results in a rapid and sustained improvement of platelet count, avoiding the occurrence of major hemorrhagic complications.
The role of cardiac Troponin‐I (cTnI) in risk stratification of patients with unstable coronary artery disease
Authors: Tanasijevic Milenko J. , Cannon Christopher P. , Antman Elliott M. 
Published: February 2009

AbstractIn patients with chest pain at rest but no ST‐segment elevation on the electrocardiogram, the diagnoses of unstable angina and non‐Q‐wave myocardial infarction (MI) are usually considered together because they cannot be differentiated clinically or angiographically. Since the extent of myocardial necrosis is an important determinant of the risk of death, it is important to identify serum markers with which to predict prognosis, in order to initiate appropriate medical treatment and/or invasive procedures in these patients. Cardiac troponin‐I (cTnI), one of the subunits of the troponin regulatory complex, binds to actin and inhibits interactions between actin and myosin. The presence of elevated cTnI in serum is a significant prognostic indicator in patients with unstable angina and non‐Q wave MI. Its independent prognostic potential persists even after adjustment for independent baseline variables known to be significantly associated with an increased risk of cardiac events. The use of cTnI in the triage of patients with unstable coronary disease may identify those at greater risk for adverse cardiac events.
Constrictive pericarditis
Authors: Mehta Anurag , Mehta Mahaveer , Jain Abnash C. 
Published: February 2009

AbstractThe diagnosis of constrictive pericarditis remains a challenge because its physical findings and hemodynamics mimic restrictive cardiomyopathy. Various diagnostic advances over the years enable us to differentiate between these two conditions. This review begins with a case report of constrictive pericarditis, followed by a brief history and discussions of etiologies. Clinical features, radiologic, electrocardiographic, angiographic findings, and hemodynamics of constrictive pericarditis are reviewed. The echocardiographic findings are detailed and the recent advances in Doppler flow velocity patterns of pulmonary, mitral, tricuspid valves and hepatic veins are reported. Nuclear ventriculograms depict rapid ventricular filling in constrictive pericarditis and differentiate it from restrictive cardiomyopathy. Endomyocardial biopsy helps further in recognizing the various types of restrictive cardiomyopathies. Computed tomography and magnetic resonance imaging delineate abnormal pericardial thickness in constrictive pericarditis. Association of characteristic hemodynamic changes and abnormal pericardial thickness >3 mm usually confirms the diagnosis of constrictive pericarditis. Effusive and occult varieties of constrictive pericarditis are briefly described. This review concludes with emphasizing the importance of pericardial resection.
Diagnostic potential of combined transthoracic echocardiography and x‐ray computed tomography in suspected aortic dissection
Authors: Kodolitsch Yskert V. , Krause Norbert , Nienaber Christoph A. , Spielmann Rolf 
Published: February 2009

AbstractBackground: Transesophageal echocardiography (TEE) and magnetic resonance imaging (MRI) are considered optimal diagnostic methods in the setting of suspected aortic dissection. However, although less sensitive as single modalities, transthoracic echocardiography (TTE) and contrast‐enhanced computed tomography (x‐ray CT) are more widely available and less costly.Hypothesis: This study was undertaken to compare the diagnostic performance and reliability of the combined use of TTE and x‐ray CT with TEE and/or MRI findings in the setting of suspected aortic dissection.Methods: The diagnostic power of combined TTE and x‐ray CT was compared with both single use of TTE and x‐ray CT and with TEE and/or MRI in a series of 168 consecutive patients with suspected aortic dissection (AD). Of these, 28 women and 58 men (mean age 53 ± 16 years) underwent TTE and x‐ray CT prior to TEE (n = 52) and/or MRI (n = 69). Diagnostic results of combined TTE/x‐ray CT were retrospectively but independently reevaluated in blinded fashion; diagnostic findings were validated by angiography (n = 63), surgery (n = 52), or autopsy (n = 7).Results: Type A dissection was found in 29 patients (34%), type B dissection in 10(12%), whereas aortic dissection was excluded in 47 (55%). With 95%, the sensitivity of TTE and x‐ray CT was significantly enhanced when used in a combined access compared with 67 and 79%, respectively, when used as single methods (95%; p < 0.05). Sensitivity and specificity (95 and 91%, respectively) of combined TTE/x‐ray CT evaluation were not different from TEE and/or MRI (100 and 96%, respectively; NS). Thrombus formation, side‐branch involvement, aortic regurgitation, pericardial effusion or mediastinal hematoma were also detected with similar sensitivities and specificities both by combined TTE/x‐ray CT and TEE and/or MRI.Conclusion: This first controlled study comparing the combined information of TTE and x‐ray CT with TEE and/or MRI revealed a similar diagnostic potential of both diagnostic strategies in the setting of suspected aortic dissection. Thus, in an environment with access to color Doppler TTE and x‐ray CT only, the information from both tests should be combined to decide on diagnostic management of these patients.
Weight gain and insulin resistance during nicotine replacement therapy
Authors: Assali A. R. , Beigel Y. , Schreibman R. , Shafer Z. , Fainaru M. 
Published: February 2009

AbstractBackground: Although the cessation of smoking reduces the increased risk for ischemic heart disease, it is associated with marked weight gain and presumably insulin resistance, both of which heighten the risk of coronary heart disease.Hypothesis: We investigated the isolated effect of nicotine on body weight and insulin resistance during smoking cessation.Methods: Eleven healthy, middle‐aged heavy smokers were studied. Insulin sensitivity was assessed by an insulin‐enhanced, frequently sampled intravenous glucose tolerance test with minimal model analysis. The subjects were studied at baseline (last day of smoking) (phase 1), at the end of the 6‐week nicotine replacement program (phase 2), and after 8 weeks without smoking or nicotine replacement (phase 3).Results: The subjects started to gain weight during nicotine replacement (phase 2) (0.3 ± 0.2 kg/week, mean ± standard deviation) and continued to do so at a steady rate after nicotine replacement was stopped (0.2 ± 0.2 kg/week) (p = 0.3). Insulin sensitivity decreased by 14 ± 2.6% during nicotine replacement but increased by 16 ± 5.1% (compared with phase 2) during phase 3, even though the weight gain continued (p = 0.047; 95% confidence interval: 0.05–5.73).Conclusions: Smoking cessation is associated with weight gain and improvement in insulin resistance. Nicotine is the main ingredient in cigarette smoke causing insulin resistance, but the withdrawal of another, unknown ingredient in cigarette smoke is responsible for the weight gain associated with smoking cessation.
Spontaneous coronary artery dissection: Favorable outcome illustrated by angiographic data
Authors: Longheval G. , Badot V. , Najioullah S. , Cosyns B. 
Published: February 2009

AbstractSpontaneous coronary artery dissection is a rare cause of acute myocardial infarction. It typically occurs in young women receiving oral contraceptive therapy or during the peripartum period. in the case presented here, spontaneous complete healing at angiography and the favorable outcome may support the role of conservative treatment in such patients.
Surgical repair of tetralogy of fallot in adults today
Authors: Dittrich Sven , Vogel Michael , Dähnert Ingo , Berger Felix , Lange Pete R. E. , Alexi‐Meskishvili. Vladimir 
Published: February 2009

AbstractBackground: Today, corrective surgery of native tetralogy of Fallot beyond childhood is a rare exception. in the years following the fall of the Berlin wall, 22 adults with uncorrected tetralogy presented to our center, mostly from former Eastern Block countries.Hypothesis: Our aim was to examine whether adults with tetralogy of Fallot benefit from late surgical repair. Nineteen patients underwent corrective surgery; hospital mortality was 16%. Follow‐up examination 3.5 (0.3–9.7) years postoperatively consisted of chart review and a written questionnaire. Incidence of ventricular arrhythmias was 32% before surgery and increased to 50% 3.5 years after surgery. Clinical status and New York Heart Association classification were clearly improved. This was not reflected in an improvement of the patients' socioeconomic status, as none of the 9 patients in our group of 19, who were jobless before the surgery, experienced a change in employment status. Marital status did not change in any patient and, in particular, the number of single male patients remains high. Except for one nearly asymptomatic younger woman who had delivered four children, only one of the seven married women had delivered a child before and one of the younger women after cardiac repair, which we consider to be a positive effect of this surgery. Surgical correction of adult patients with tetralogy of Fallot carries a higher risk compared with correction in childhood. It improves quality of life but does not change socioeconomic habits.
Reactivity of peripheral blood lymphocytes to oxidized low‐density lipoprotein: A Novel system to estimate atherosclerosis employing the cellscan
Authors: Zurgil N. , Levy Y. , George J. , Gilburd B. , Shoenfeld Y. , Deutsch M. , Kaufman M. , Harats D. 
Published: February 2009

AbstractBackground: The assumption that atherosclerosis involves an autoimmune response to oxidized LDL (oxLDL) is based on the presence of immunocompetent cells and immunoglobulin deposition in the atherosclerotic lesions by successful immunomodulation of the atherosclerotic process and by inhibition of experimental atherosclerosis by antioxidants. The Cellscan system is a multiparameter laser‐based static cytometer that enables repeated monitoring of the fluorescence intensity (FI) and polarization (FP) of individual living cells. Analysis of intracellular fluorescein fluorescence polarization (IFFP) has previously been used to define activated lymphocyte population.Hypothesis: In this study, the Cellscan apparatus has been used to monitor cellular response to oxLDL in patients with atherosclerosis and in controls.Methods: The FI and FP of fluorescein diacetate (FDA)‐labeled peripheral lymphocytes were measured following exposure to oxLDL in vitro. Using cluster analysis we were able to identify subpopulations of cells that were characterized by their FI and FP. Forty‐two subjects were studied: 22 patients with severe coronary heart disease and 22 control individuals, either healthy or with other diseases.Results: Fluorescence intensity of fluorescein‐labeled peripheral blood lymphocytes (PBL) was markedly decreased upon exposure to high doses (> 25 m̈g/ml) of oxLDL concurrently with an increase in FP. A specific and dose‐dependent reduction in FP of the high‐intensity cell subpopulations, accompanied by higher FI, was evident in patients with ischemic heart disease upon exposure to low doses of oxLDL (up to 25 m̈g/ml). Maximal depolarization was shown upon triggering with 2 m̈g/ml oxLDL. The polarization ratio (the mean polarization value of the specific cell population with and without activation) obtained for patients' lymphocytes was significantly lower (p < 0.01) than that of the control group (0.936 ± 0.05 and 1.028 ± 0.055, respectively).Conclusion: These data suggest that PBL from patients with active ischemic heart disease show an increased reactivity to oxLDL. A 73% positivity rate was found for ischemic heart disease patients compared with 5% in the control subjects. One of the future prospects of this study might be the advent of a simple and rapid noninvasive test that could assess the extent of atherosclerosis, and possibly even the response to therapy, by monitoring the reactivity of PBL to oxLDL.
Procedural results of coronary angioplasty but not late mortality have improved in patients with depressed left ventricular function
Authors: Lindsay Joseph , Grasa Gabriela , Pinnow Ellen E. , Plude Gail , Pichard Augusto D. 
Published: February 2009

AbstractBackground: Published experience with coronary angioplasty in patients with severely depressed left ventricular (LV) ejection fraction indicates that procedural complications are more frequent in such patients than in those with normal or near normal LV function. Although the immediate outcomes of transcatheter revascularization in unselected populations have improved substantially since the procedures upon which these reports were based were performed, outcomes with this subset of patients has not been recently reviewed.Hypothesis: This study was undertaken to document the results of the application of current transcatheter technology to this patient subset.Methods: We analyzed data from 194 consecutive patients with a visually estimated LV ejection fraction < 30%, who underwent coronary angioplasty in this institution between January 1, 1995, and April 30, 1996, and compared their outcomes with those of 1,390 patients with normal LV function treated concurrently.Results: Angiographic success in the two groups was similar. The hospital mortality of the patients with low ejection fraction was higher (2.6 vs. 0.6%, p=0.02) than in concurrently treated patients with normal LV function. Other procedural complications were no more frequent than in such patients. Late mortality in patients with low ejection fraction was 16%, a similar value to that in older reports.Conclusion: Compared with older reports, current hospital outcomes of coronary angioplasty are improved in patients with severely depressed LV function. Unfortunately, late outcomes are not demonstrably better.