bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of enalapril initiated early after acute myocardial infarction on heart failure parameters, with reference to clinical class and echocardiographic determinants
Authors: Edner Magnus , Bonarjee Vernon V. S. , Nilsen Dennis W. T. , Berning Jens , Carstensen Steen , Caidahl Kenneth 
Published: February 2009

AbstractBackground and hypothesis: Although the angiotensin‐converting enzyme inhibitor enalapril has recently been shown to reduce mortality and the need for hospitalization in patients with left ventricular dysfunction and congestive heart failure, this drug was found to have no significant impact on short‐term mortality after acute myocardial infarction (AMI) in the CONSENSUS II trial. The effect of enalapril initiated early after AMI on clinical and echocardiographic determinants of left ventricular (LV) function was studied in a subset of patients from CONSENSUS IIMethods: Symptoms and signs of heart failure were classified as NYHA and dyspnea classes. Echocardiography included LV end‐systolic volumes (ESV) and end‐diastolic volumes (EDV), as well as ejection fraction (EF). wall motion index (WMI), and mitral flow indices. In all, 428 patients were included and followed for an average of 5.1 months by serial examinations, starting 2–5 days after myocardial infarction (MI) and repeated after 1 month and at the completion of the study.Results: There was no beneficial effect of enalapril on clinically determined function. Changes (i.e. changes in NYHA class) in the functional status remained correlated with changes in echocardiographic determinants throughout the study in patients belonging to the placebo group: EDV index (r=0.36, p = 0.002, ESV index (r = 0.49, p < 0.001), EF (r = ‐0.41, p < 0.001), and WMI (r=0.29, p = 0.008). In a stepwise logistic regression model, the best baseline parameters to predict NYHA class at final visit in all patients were age (p = 0.014) and ESV index (p = 0.001).Conclusion: Enalapril treatment for an average period of 5.1 months following MI resulted in no clinically significant beneficial effects on NYHA and dyspnea class. Changes in clinical function class were correlated with changes in echocardiographic determinants in placebo‐treated patients, but not in patients given enalapril.
Coagulation and fibrinolytic parameters in patients with pulmonary hypertension
Authors: Altman Raul , Scazziota Aleiandra , Rouvier Jorge , Gurfinkei Enrique , Favaloro Roberto , Perrone Sergio , Fareed Jawed 
Published: February 2009

AbstractBackground: Vascular endothelium reacts to various patho‐physiologic stimuli by releasing several autocoids and cyto‐kines that can be used along with the coagulation and fibrinolytic markers for the diagnosis of hemostatic alterations. Several newer markers for vascular distress, such as tissue plasminogen activator (TPA), tissue plasminogen activator inhibitor‐ I (PAI‐1), TPA/PAI‐1 complex, and the newly reported inhibitor of the coagulation process, namely, tissue factor pathway inhibitor (TFPI), have been implicated in the pathogenesis of pulmonary hypertension.Methods: To investigate the behavior of endothelial cells at basal and time‐dependent venous stasis‐induced changes, various markers were measured in patients with primary and secondary pulmonary hypertension and compared with healthy human volunteers (controls) without any family history of thromboembolism or history of hypertensive disorders. The right atrial pressure (RAP) and pulmonary arterial pressure were measured and the hemostatic parameters were correlated to determine the relevance of these parameters with the alterations in the present indices.Results: A fibrinolytic deficit exists in patients with pulmonary hypertension, indicated by the prolongation of the euglobulin clot lysis time at basal conditions and after the venous occlusion test. This defect was mainly due to increased production of PAI‐1 by endothelium (patients 59.8 ± 22.3 AU/ml; controls 30.3 ± 14.5 AU/ml; p = 0.005). We also report for the first time that a decrease in tissue factor pathway inhibitor antigen was also observed in these patients when RAP was >9 mmHg [controls 95.6 ± 61.6 ng/ml; patients with RAP >9 mmHg 47.2 ± 19.2 ng/ml (p = 0.044); patients with RAP <9 mmHg 96.6 ± 32.4 ng/ml (p = 0.002 compared with patients with RAP > 9 mmHg)], indicating endothelial cell and hemostatic disturbances.Conclusions: We conclude that the euglobulin clot lysis time was prolonged in patients with pulmonary hypertension compared with controls. The impairment of the fibrinolytic system was due to an elevated concentration of PAI‐1. In RAP > 9 mmHg, an additional prothrombotic factor is the decrease in plasma tissue factor pathway inhibitor antigen. It appears from this study that antithrombotic treatment is indicated in these patients.
Influence of gender on survival, mode of death, reinfarction, use of medication, and aspects of well being during a period of five years after onset of acute myocardial infarction
Authors: Herlitz John , Bångr Angela , Hartford Marianne , Karlson Björn W. 
Published: February 2009

AbstractBackground and hypothesis: This study was undertaken to describe prognosis during a period of 5 years after an acute myocardial infarction (AMI) in relation to gender.Methods: All patients studied were hospitalized in a single hospital during a period of 21 months due to AMI, regardless of age and whether they were admitted to the coronary care unit or another ward. A total of 862 AMI patients [581 (67%) men and 281 (33%) women] were prospectively evaluated. Males were younger and less frequently had a history of congestive heart failure and hypertension.Results: The overall 5‐year mortality rate was 48% among men compared with 61 % among women (p < 0.001). However, in a multivariate analysis considering age, gender, and a previous history of cardiovascular diseases, female gender was not independently associated with death. Revascularization in terms of coronary artery bypass grafting and percutaneous transluminal angioplasty did not differ significantly between men and women. The rate of reinfarction was 34% among men and 38% among women (p > 0.2).Conclusion: During 5 years of follow‐up in a consecutive series of 862 AMI patients, women had a worse prognosis than men, with a mortality of 61 % compared with 48% (p < 0.001). However, after controlling for a number of potentially confounding prognostic factors, female gender was not independently associated with mortality.
Intravenous amiodarone is safe and seems to be effective in termination of paroxysmal supraventricular tachyarrhythmias
Authors: Cybulski J. , Kulakowski P. , Makowska E. , Czepiel A. , Sikora‐Frąc M. , Ceremużyńki L. 
Published: February 2009

AbstractBackground: Paroxysmal atrial fibrillation (PAF) and paroxysmal supraventricular tachycardia (PSVT) leading to hemodynamic compromise are among the most common reasons for admission to the coronary care unit (CCU) and need prompt and efficient therapy. Direct current cardioversion is the therapy of choice, but if found contraindicated or unavailable some antiarrhythmie agents are usually given to restore sinus rhythm. Many of these drugs have obvious limitations, especially in patients with acute myocardial infarction and/or heart failure.Hypothesis: The aim of the present study was to assess the safety and efficacy of intravenous amiodarone in the acute termination of PAF or PSVT refractory to other antiarrhythmie agents in a large group of patients consecutively admitted to our CCU.Methods: In the present study, we evaluated the safety and efficacy of amiodarone given intravenously in 142 consecutive patients with PAF or PSVT lasting < 24 h. In 37% of patients no evidence of underlying heart disease which may have caused arrhythmias were defined. A median of two other antiarrhythmic agents given prior to the first amiodarone injection had been ineffective.Results: Sinus rhythm was restored in 91 patients (64%) (65% in the PAF group and 61% in the PSVT group). The mean time to rhythm conversion was 5.5 ± 6.1 h for patients with PAF and 1.2 ± 1.2 h for patients with PSVT. The mean dose of amiodarone administered up to conversion was 340 ± 220 mg for PAF and 220 ± 105 mg for PSVT. Except for transient first‐degree atrioventricular block in two patients, no adverse effects possibly related to amiodarone were observed (including proarrhythmia and incidence or aggravation of heart failure symptoms).Conclusion: Amiodarone given intravenously for acute termination of supraventricular tachyarrhythmias is completely safe and seems effective. The results of this study, which is the largest ever made, indicate a need of randomized, controlled trials for the ultimate assessment of the efficacy of amiodarone in this clinical setting.
Dose‐dependent appearance and disappearance of amiodarone‐induced skin pigmentation
Authors: Kounis Nicholas G. , Frangides Christos , Papadaki Paraskevi J. , Zavras George M. , Goudevenos John 
Published: February 2009

AbstractA 66‐year‐old man suffering from atrial flutter developed cutaneous blue‐gray pigmentation while receiving 600 mg of amiodarone daily for 15 months. With reduction of the dose to 100 mg, skin discoloration disappeared within 16 months, to reappear within 7 months after increasing the dose to 400 mg. Finally, the discoloration disappeared within 13 months with a dose reduction to 200 mg daily. It seems that a tissue threshold level for amiodarone exists in this patient, above which skin discoloration appears and below which it fades. Dose, duration, metabolism, macrophage transfer, and spillover saturation‐excretion may be relevant in amiodarone‐induced skin pigmentation.
Hemoptysis and unilateral intra‐alveolar hemorrhage complicating intravenous thrombolysis for myocardial infarction
Authors: Hammoudeh Ayman J. , Haft Jacob I. , Eichman Gerard T. 
Published: February 2009

AbstractThis report deals with a patient who developed hemoptysis due to unilateral intra‐alveolar hemorrhage after receiving tissue‐type plasminogen activator (TPA) for acute myocardial infarction; the patient had sustained an ipsilateral lung injury 2 years earlier.
Oversensing of atrial flutter in the recipient atrium of a heart transplant patient with a permanent atrial pacemaker
Authors: Woodard David A. , Conti Jamie B. , Curtis Anne B. 
Published: February 2009

AbstractSinus node dysfunction requiring permanent pacemaker implantation is a common problem following heart transplantation. There are unique problems to consider in pacing the transplanted heart. This report describes a case of far‐field sensing of atrial flutter in the recipient atrial remnanl, with resultant inhibition of the atrial pacemaker in the donor atrium, and symptomatic bradycardia. Although postulated to be a potential problem, oversensing of the recipient atrium has not been reported prior to this case. Awareness of this problem will provide for more effective pacemaker troubleshooting.
The use of dobutamine stress echocardiography for the determination of myocardial viability
Authors: Hansen Todd H. , Segar Dogglas S. 
Published: February 2009

AbstractDetermining the presence of viable myocardium has prognostic and therapeutic implications in the treatment of ischemic heart disease. Dobutamine stress echocardiography (DSE) is one possible technique to help identify both hibernating and stunned but viable myocardium. Low‐dose dobutamine infusion has an increased inotropic effect, while higher doses cause both inotropic and chronotropic effects. Thus, at lower doses cardiac augmentation occurs, and at higher doses regions of ischemia may be produced in the presence of significant coronary artery disease. This is manifested echocardiographically as changes in segmental wall motion. in theory, therefore, areas of viable myocardium should show improved wall motion at low doses, and areas of irreversible myocardial damage will remain akinetic. Five studies have investigated DSE for determining viability in the setting of acute myocardial infarction, thus looking for stunned but viable myocardium. DSE was shown to compare favorably with positron emission tomography and was highly sensitive and specific for predicting functional myocardial recovery. Five additional studies examined DSE for determining the presence of hibernating myocardium. The sensitivity and specificity of DSE were found to range from 71 to 92% and from 73 to 93%, respectively. The benefits of DSE include lower cost, convenience to both patient and physician, additional ancillary information, and determination of the possible need for urgent revascularization. Limitations of DSE include occasional technical difficulty in obtaining and interpreting studies and the need for larger volumes of viable myocardium to detect changes predictive of functional recovery. Larger trials are currently underway to confirm DSE as a reliable technique for determining myocardial viability.
Effects of heart rate on coronary circulation and external mechanical efficiency in elderly hypertensive patients with left ventricular hypertrophy
Authors: Ishibashi Yutaka , Shimada Tosfflo , Umeno Tetsuhiro , Yoshitomi Hiroyuki , Morioka Shigefumi , Sano Kazuya , Oyake Nobuyuki , Nosaka Susumu , Kobayashi Shigeo 
Published: February 2009

AbstractBackground and hypothesis: Mechanisms of heart failure in elderly hypertensive patients with hypertrophy have not been studied sufficiently. We hypothesized that impaired increment of coronary blood flow in response to increases in heart rate could be responsible for the occurrence or aggravation of heart failure.Methods: To test this hypothesis, we measured coronary hemodynamics and lactate balance during basal conditions and atrial pacing in 21 elderly patients aged ≥ 65 years (mean 74 ± 6 years) without coronary arterial disease: 7 normoten‐sive control patients (Group 1), 7 hypertensive hypertrophic patients without a history of congestive heart failure (Group 2), and 7 patients with such history (Group 3). Coronary sinus blood flow (CSBF) was measured in coronary sinus using a thermodilution catheter.Results: During basal conditions, heart rate did not differ among the three groups (67 ± 3 in Group 1,65 ±11 in Group 2, and 63 ± 6 beats/min in Group 3). CSBF was significantly higher in the two hypertrophic groups than in the control group, but CSBF normalized by left ventricular mass was significantly lower in both hypertrophic groups. External mechanical efficiency (EME) obtained as left ventricular work divided by myocardial oxygen consumption did not differ among groups during basal conditions (36 ± 9% in Group 1, 35 ± 8% in Group 2, and 29 ± 9% in Group 3, NS). During atrial pacing to increase heart rate by 25 ± 5% (lower) and 54 ± 6% (higher), the increases in CSBF were markedly limited in both hypertrophic groups, and the response in Group 3 was more depressed than that in Group 2. EME did not change in the control group or in Group 2, but did decrease to 21 ± 5% in Group 3 during the higher pacing rate (p <0.01 vs. basal conditions). in this group, the relationship between EME and heart rate showed a significant negative correlation (r = —0.56, p = 0.02). Lactate balance in coronary sinus blood showed a tendency to production in Group 3 during the higher pacing rate, suggesting myocardial ischemia.Conclusion: These findings suggest that in hypertensive hypertrophic patients with a history of heart failure, the coronary circulation system is vulnerable to increasing heart rate. in medical treatment of elderly hypertensive patients, control of heart rate in addition to blood pressure control should be considered to minimize the occurrence or aggravation of heart failure.
Myocardial infarction in men aged 40 years or less: A prospective clinical‐angiographic study
Authors: Fournier J. A. , Sanchez A. , Quero J. , Fernandez‐Cortacero J. A. P. , González‐Barrero A. 
Published: February 2009

AbstractHypothesis: The study was undertaken to characterize acute myocardial infarction (AMI) in young patients.Methods: in all, 108 consecutive Mediterranean patients with AMI (102 men and 6 women), aged ≤ 40 years, were prospectively included in this study over a period of 6.5 years. Coronary angiography was carried out within the first month and data from these patients with normal or diseased coronary arteries were compared. Clinical features, risk factors, and in‐hospital and late morbidity and mortality were evaluated.Results: Young patients with AMI represent 4.1 % of the 2,644 patients admitted because of definite AMI during this period. The most common risk factors were cigarette smoking (94.5%) and hypercholesterolemia (48%). Location of the AMI was anterior in 37%, inferior in 57.5%, and non‐Q in 5.5%. A history of previous angina was present in 42.5% of the patients, including all seven patients with previous myocardial infarction (6.5%). However, in 52% of the patients the anginal episodes started in the week prior to the AMI. in hospital mortality and mortality during a mean follow‐up of 41 ± 23 months were 3.7 and 3.8%, respectively. The Kaplan‐Meier actuarial curve assessed on 97 of 104 survivors was 100 and 94% at 1 and 5 years, respectively. Coronary arteries were angiographically normal in 17 (20%) of 87 survivors. Compared with young patients who had obstructive lesions, this subset had a lower age and fewer risk factors, reinfarction (p<0.05), and late angina (p<0.01), but development of congestive heart failure and survival were similar in both groups.Conclusion: These data suggest that young patients with AMI are very frequently heavy smokers, have a high incidence of angiographically normal coronary arteries, and that the short‐ and long‐term prognosis is excellent.
Nonatherosclerotic causes of coronary artery narrowing—Part III
Authors: Waller Bruce F. , Fry Edward T. A. , Hermiller James B. , Peters Thomas , Slack John D. 
Published: February 2009

AbstractApproximately 5% of patients with acute myocardial infarction do not have atherosclerotic coronary artery disease but have other causes for their luminal narrowing. The third part of this three‐part review of nonatherosclerotic causes of coronary narrowing focuses on coronary vasculitis, infectious diseases, Kawasaki's disease, metabolic disorders, metastatic disease, and substance abuse (cocaine). coronary arteritis: (1) focal artery necrosis with or without calcification, (2) acute coronary artery thrombosis or recanal‐ized thrombus unassociated with underlying atherosclerotic plaque, (3) rupture of the vessel wall unassociated with trauma or an interventional procedure, (4) coronary artery wall thickening with secondary luminal narrowing, and (5) wall thinning with aneurysm formation.3 Specific coronary lesions also may be seen in specific systemic diseases (e.g., pol‐yarteritis nodosa).
Sustained ventricular tachycardias associated with myotonic dystrophy
Authors: Tamura Koji , Tsuji Hisako , Matsui Yumie , Masui Akira , Hikosaka Makoto , Karakawa Masahiro , Iwasaka Toshiji , Inada Mitsuo 
Published: February 2009

AbstractPatients with myotonic dystrophy are reported to have a higher frequency of sudden death than the general population. Although causes of sudden death in myotonic dystrophy are suggested to be due to conduction defects progressing, the HV interval cannot predict whether conduction system disease would develop or progress. We report two cases of myotonic dystrophy complicated with sustained monomorphic ventricular tachycardias (VT), which can cause sudden death. in Case No. 1, although the patient was treated successfully for sustained VT with verapamil in elec‐trophysiologic studies, another sustained VT was confirmed 2 years later. in Case No. 2, the patient showed decreased left ventricular ejection fraction and late potentials, and induced sustained VT that was identical to clinically documented VT. Although VT is believed to be rare in patients with myotonic dystrophy, these cases suggest that VT is a possible cause of sudden death.
Evaluation of left ventricular relaxation using the continuous‐wave doppler velocity profile of aortic regurgitation: Noninvasive measurement of left ventricular negative dP/dt and time constant
Authors: Honda Yuka , Yokota Yoshiyuki , Yokoyama Mitsuhiro 
Published: February 2009

AbstractBackground: The maximal negative dP/dt [max (‐)dP/dt] and time constant (T) are useful indices for evaluating left ventricular (LV) relaxation, but they require invasive procedures.Hypothesis: The purpose of this study was to obtain max (‐)dP/dt and T using the continuous‐wave Doppler aortic regurgitation velocity curve (AR‐CW) noninvasively. Using the Bernoulli equation, the AR‐CW allows accurate determination of the pressure gradients (PG) between the aorta and the left ventricle.Methods: In 10 patients with trivial to mild AR, the rising segment of the AR‐CW reflecting LV pressure decrease was digitized with the cardiac image analysis system. Transpulmonary contrast‐enhanced Doppler echocardiography was used in three patients to obtain intense velocity envelope. The PG curve and the first derivative curve were reconstructed and the maximal point of the first derivative curve, which is consistent with max (‐)dP/dt, was termed as maximal rate of pressure fall (maxRPF). As T (calculated according to the method of Weiss) can be obtained from T=Pm/max (‐)dP/dt [Pm: LV pressure at the phase of max (‐)dP/dt], we calculated T from Pm/maxRPF (Pm=dicrotic notch pressure ‐ 4Vm2) (Vm: AR velocity at the phase of maxRPF).Results: The Doppler‐derived maxRPF and T (Td) approximated the catheter‐derived max (‐;)dP/dt and T (y=0.85x+ 245, r=0.97, p<0.001, y=0.79x+4, r=0.87, p<0.001). In addition, dobutamine echocardiography was performed in nine patients showing increased maxRPF and decreased Td, indicating improvement of LV relaxation.Conclusion: These Doppler‐derived new indices are sufficiently useful to evaluate LV relaxation noninvasively.
Hemodynamic time course of acute and chronic isosorbide dinitrate treatment at rest and during exercise in patients with stable ischemic heart disease
Authors: Jørgensen Lars H. , Thaulow Erik , Refsum Harald E. 
Published: February 2009

AbstractHypothesis: The study was undertaken to establish differences between venous and arterial isosorbide dinitrate (ISDN) effects during acute and chronic treatment, hemodynamics at rest, and during supine exercise.Methods: These effects were assessed invasively in 16 patients with stable ischemic heart disease before and at hourly intervals for 4 h after administration of peroral 30 mg ISDN. Eight patients were previously untreated (acute group), and eight were treated with 30 mg ISDN asymmetrically b.i.d. for two weeks (chronic group).Results: Prior to ISDN administration, right atrial, mean pulmonary artery, pulmonary artery wedge, and mean arterial pressure (RAP, MPAP, PAWP, and MAP) rose from normal resting to pathologic values during exercise. One h after ISDN administration, all exercise pressures were normalized (p<0.001). During the following 3 h, exercise RAP rose similarly in both groups (p<0.01), while MPAP rose particularly in the chronic group (p<0.001). Exercise PAWP and MAP, however, remained low in the acute group, but increased markedly in the chronic group (p<0.01), particularly from the third to the fourth hour after ISDN.Conclusion: The daily, asymmetric administration of 30 mg ISDN b.i.d. maintained beneficial, anti‐ischemic effects for 2 to 3 h after a morning dose of the drug, but thereafter attenuation of the effects occurred in the arteries but not in the veins.