bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intensity of antianginal therapy in patients referred for coronary angiography: A comparison of fee‐for‐service and health maintenance organization therapeutic strategies
Authors: Samuels Bruce A. , Diamond George A. , Denton Timothy A. , Mahrer Peter R. 
Published: February 2009

AbstractBackground: No formal criteria have been developed to guide medical therapy for angina prior to revascularization, and no comparisons have been made between health maintenance organization (HMO) and fee‐for‐service (FFS) hospitals with respect to angina treatment.Hypothesis: Using a literature‐based measure of medical intensity, we tested the hypothesis that there is no difference in anginal medical therapeutic intensity between HMO and FFS systems.Methods: For each antianginal drug, we developed a model from which an intensity score between 0 and 100 could be calculated. Average and maximal daily doses of drug were fit to a sigmoid curve such that they represented scores of 50 and 99, respectively. Overall intensity scores were obtained by weighted and unweighted averaging of three scores from nitrates, calcium‐channel blockers, and beta blockers. This model was applied to 199 patients undergoing angiography at an FFS and an HMO hospital.Results: HMO patients were taking more classes of antianginal drug (1.9 vs. 1.0, p < 0.001). Overall unweighted (17.7 vs. 11.7, p = 0.02) and weighted (27.3 vs. 16.9, p = 0.003) intensity scores for both HMO and FFS patients were low. HMO intensity scores for the use of beta blockers were greater than FFS scores (19.2 vs. 9.6, p = 0.002). The intensity scores for the use of nitrates and calcium blockers were similar.Conclusions: Models for the measurement of anginal medical therapy intensity can provide important information regarding medical therapy prior to revascularization. The overall intensity of medical therapy was low in both health care systems. These findings have important implications for patient management, guideline development, and national healthcare policy.
Severity of residual stenosis of infarct‐related lesion and left ventricular function after single‐vessel anterior wall myocardial infarction: Implication of st‐segment elevation in lead avl of the admission electrocardiograms
Authors: Yoshino Hideaki , Kachi Eisei , Shimizu Hisashi , Taniuchi Masato , Yano Kohei , Udagawa Hiroshi , Kajiwara Tatsuto , Shimoyama Katsuya , Ishikawa Kyozo 
Published: February 2009

AbstractBackground: The relationship between the severity of chronic‐phase stenosis of infarct‐related lesions (IRLs) and chronic left ventricular function in anterior acute myocardial infarctions (AMI) has not been adequately investigated.Hypothesis: This study investigated whether ST elevation in lead aVL of admission electrocardiogram (ECG) would be a determinant factor of the relationship between the severity of stenosis of the IRL and chronic left ventricular function after anterior wall AMI.Methods: One month after AMI, the IRL was evaluated by coronary angiography in 98 patients with anterior AMI, and left ventricular ejection fraction (LVEF) was determined using multigated radionuclide angiocardiography. Patients were classified according to the severity of the IRL: patients with 100% occlusion (Group O), patients with 90 to 99% stenosis (Group H), and patients with ≤ 75% stenosis (Group L). Patients with ST elevation ≥ 0.1 mV in the aVL lead on their admission ECG were included in the ST‐elevation group, and those with ST elevation < 0.1 mV were included in the non‐ST‐elevation group.Results: The LVEF was greater in the non‐ST‐elevation group than in the ST‐elevation group (p<0.0001), and the LVEF in a whole group as follows: Group L LVEF>Group H LVEF>Group O LVEF (p = 0.0160). In the ST‐elevation group, LVEF was higher in Group L than in the other groups (p = 0.0251). There were three independent predictors of a reduced LVEF: ST‐elevation in aVL [odds ratio (OR): 3.38, p = 0.0044], IRL stenosis ≥ 90% (OR: 2.90, p = 0.0044), and the IRL occurring in the left anterior descending artery proximal to the first diagonal branch (OR: 6.31, p = 0.0024).Conclusion: Left ventricular function was preserved, regardless of the severity of residual stenosis, in patients without ST elevation in aVL if the IRL was not totally occluded. In patients with ST elevation in aVL, LVEF was lower in patients with more severe stenosis, even if the IRL was patent.
Clinical and demographic determinants of heart rate variability in patients post myocardial infarction: Insights from the cardiac arrhythmia suppression trial (CAST)
Authors: Stein Phyllis K. , Kleiger Robert E. , Domitrovich Peter P. , Schechtman Kenneth B. , Rottman Jeffrey N. 
Published: February 2009

AbstractBackground: Clinical and demographic determinants of heart rate variability (HRV), an almost universal predictor of increased mortality, have not been systematically investigated in patients post myocardial infarction (MI).Hypothesis: The study was undertaken to evaluate the relationship between pretreatment clinical and demographic variables and HRV in the Cardiac Arrhythmia Suppression Trial (CAST).Methods: CAST patients were post MI and had ≥ 6 ventricular premature complexes/h on pretreatment recording. Patients in this substudy (n = 769) had usable pretreatment and suppression tapes and were successfully randomized on the first antiarrhythmic treatment. Tapes were rescanned; only time domain HRV was reported because many tapes lacked the calibrated timing signal needed for accurate frequency domain analysis. Independent predictors of HRV were determined by stepwise selection.Results: Coronary artery bypass graft surgery (CABG) after the qualifying MI was the strongest determinant of HRV. The markedly decreased HRV associated with CABG was not associated with increased mortality. Ejection fraction and diabetes were also independent predictors of HRV. Other predictors for some indices of HRV included beta‐blocker use, gender, time from MI to Holter, history of CABG before the qualifying MI, and systolic blood pressure. Decreased HRV did not predict mortality for the entire group. For patients without CABG or diabetes, decreased standard deviation of all NN intervals (SDANN) predicted mortality. Clinical and demographic factors accounted for 31% of the variance in the average of normal‐to‐normal intervals (AVGNN) and 13–26% of the variance in other HRV indices.Conclusions: Heart rate variability post MI is largely independent of clinical and demographic factors. Antecedent CABG dramatically reduces HRV. Recognition of this is necessary to prevent misclassification of risk in patients post infarct.
L‐Arginine reduces heart rate and improves hemodynamics in severe congestive heart failure
Authors: Bocchi Edimar Alcides , De Moraes Alvaro Vilella , Esteves‐Filho Antonio , Bacal Fernando , Auler José Otavio , Carmona Maria José , Bellotti Giovanni , Ramires Antonio Franchini 
Published: February 2009

AbstractBackground: Stimulated endothelium‐derived relaxing factor‐mediated vasodilation and conduit artery distensibility are impaired in congestive heart failure (CHF). L‐arginine could have a potentially beneficial role in CHF, acting through the nitric oxide (NO)‐L‐arginine pathway or by growth hormone increment.Hypothesis: This study was undertaken to investigate the effects of L‐arginine on heart rate, hemodynamics, and left ventricular (LV) function in CHF.Methods: In seven patients (aged 39 ± 8 years) with CHF, we obtained the following parameters using echocardiography and an LV Millar Mikro‐Tip catheter simultaneously under four conditions: basal, during NO inhalation (40 ppm), in basal condition before L‐arginine infusion, and after L‐arginine intravenous infusion (mean dose 30.4 ± 1.9 g).Results: Nitric oxide inhalation increased pulmonary capillary wedge pressure from 25 ± 9 to 31 ± 7 mmHg (p < 0.05), but did not change echocardiographic variables or LV contractility by elastance determination. L‐arginine decreased heart rate (from 88 ± 15 to 80 ± 16 beats/min, p < 0.005), mean systemic arterial pressure (from 84 ± 17 to 70 ± 18 mmHg, p < 0.007), and systemic vascular resistance (from 24 ± 8 to 15 ± 6 Wood units, p < 0.003). L‐arginine increased right atrial pressure (from 7 ± 2 to 10 ± 3 mmHg, p < 0.04), cardiac output (from 3.4 ± 0.7 to 4.1 ± 0.8 l/min, p < 0.009), and stroke volume (from 40 ± 9 to 54 ± 14 ml, p < 0.008). The ratios of pulmonary vascular resistance to systemic vascular resistance at baseline and during NO inhalation were 0.09 and 0.075, respectively, and with L‐arginine this increased from 0.09 to 0.12.Conclusion: L‐arginine exerted no effect on contractility; however, by acting on systemic vascular resistance it improved cardiac performance. L‐arginine showed a negative chronotropic effect. The possible beneficial effect of L‐arginine on reversing endothelial dysfunction in CHF without changing LV contractility should be the subject of further investigations.
Evaluation of coronary subclavian steal syndrome using sestamibi imaging and duplex scanning with observed vertebral subclavian steal
Authors: Rossum Alfred C. , Steel Susan R. , Hartshorne Michael F. 
Published: February 2009

AbstractCoronary subclavian steal is defined as retrograde blood flow from the myocardium through the internal mammary artery graft, secondary to a proximal subclavian artery stenosis. The incidence of this syndrome in patients undergoing internal mammary artery grafts for coronary artery bypass is estimated to be 0.44%. Angiography remains the definitive diagnostic test for confirming this condition. We describe a noninvasive method for evaluating coronary subclavian steal syndrome in a 57‐year‐old man, with a 50–55% subclavian stenosis confirmed by angiography. Noninvasive evaluation using duplex scanning demonstrated normal vertebral artery blood flow. Technetium 99m‐sestamibi (99mTc) imaging confirmed a fixed anterolateral defect. When left‐arm isometric exercise was employed, retrograde vertebral artery blood flow was observed by Doppler imaging. A repeat 99mTc‐sestamibi study documented an increase in tracer distribution in the anterolateral defect confirming reperfusion of the myocardium through the left internal mammary artery graft. The use of duplex scanning and 99mTc‐sestamibi may serve as an adjunct in evaluating coronary subclavian steal syndrome as well as documenting transient vertebral subclavian steal in this patient population.
Current status of stress echocardiography
Authors: Lewis Jannet F. 
Published: February 2009

AbstractStress echocardiography is a widely applied technique for the evaluation of individuals with known or suspected coronary artery disease. The technique combines echocardiographic imaging with exercise testing or pharmacologic stress. Advances in digital image acquisition and harmonic imaging have substantially improved the quality of echocardiographic images, and have therefore increased general applicability of stress echocardiography.
Seropositivity against chlamydia pneumoniae in patients with coronary atherosclerosis
Authors: Romeo Francesco , Cerabino Luigia Maria , Martuscelli Eugenio , Chirieolo Gaetano , Ericson Katharina , Saldeen Tom G. P. , Mehta Jawahar L. 
Published: February 2009

AbstractBackground: Results of therapy in patients with unstable coronary syndromes with antibiotics directed against Chlamydia pneumoniae have been variable, perhaps due to the heterogeneity of patients in these trials.Hypothesis: The aim of the present study was to correlate the severity of coronary artery disease (CAD) with seropositivity against C. pneumoniae prospectively.Methods: We measured the frequency of seropositivity (IgG levels ≥ 1/64 and IgA levels ≥ 1/16 against Chlamydia pneumoniae) in 110 patients with CAD and in 49 controls.Results: As expected, traditional CAD risk factors were seen more often in patients with CAD than in controls. Mean values of total cholesterol (184 ± 52 and 166 ± 44 mg/dl, respectively) and triglyceride (143 ± 60 and 112 ± 63 mg/dl, respectively) in serum were significantly higher in patients with CAD than in controls (both p < 0.04). There were no significant differences between the two groups in serum high‐density lipoprotein cholesterol (34 ± 13 and 32 ± 14 mg/dl, respectively) and lipoprotein (a) (Lp(a):241 ± 247 and 223 ± 263 mg/l, respectively) levels. The rate of IgG seropositivity was 52% (28/54) in patients with stable CAD, 41% (23/56) in patients with unstable CAD, and 35% in controls (p = NS). The rate of IgA seropositivity was 25% (14/54) in patients with stable CAD, 12% (6/49) in patients with unstable angina, and 12% (6/49) in controls (all p = NS).Conclusions: Only a small percentage of patients with CAD demonstrate seropositivity against Chlamydia pneumoniae. Antibiotic therapy in these selected patients, but not in the remaining patients, may be considered rational. These considerations may underlie the failure to see consistent benefits of antibiotic therapy in patients with CAD.
Angiotensin‐converting enzyme and apolipoproteins genes polymorphism in coronary artery disease
Authors: Mansur Antonio P. , Favarato Desidério , Avakian Solange D. , César Lufz A. M. , Ramires José A. F. , Annicchino‐Bizzacchi Joyce 
Published: February 2009

AbstractBackground: Association between angiotensin‐converting enzyme (ACE) as well as apolipoprotein (apo) AI, B, and E polymorphisms and dyslipidemia and coronary artery disease (CAD) is controversial.Hypothesis: This study assessed the distribution of ACE insertion/deletion, apo AI A/G mutation, apo B signal peptide insertion/deletion, apo B XbaI restriction fragment length, and apo E polymorphisms in 388 nondiabetic patients.Methods: The study population included 112 patients with stable CAD, 139 patients with acute myocardial infarction (AMI), and 137 age‐matched control subjects.Results: Univariate analysis showed higher prevalence of XbaI X+/X+ genotype in patients with CAD (p = 0.02). Angiotensin‐converting enzyme and apo polymorphisms were not associated with lipid levels or severity of CAD. When all genotypes known to be related to CAD, such as ACE DD, apo AI GG, apo B del/del, and XbaI X+X+, and E4 allele of apo E, were pooled, again no significant differences among groups were seen. Multivariate regression analysis disclosed traditional risk factors and elevated levels of apo B for men and reduced levels of apo AI for women as independent variables for CAD.Conclusions: In addition to traditional coronary risk factors, apo B and AI could be considered predictors of CAD. No association between either form of CAD and polymorphisms was noted.
Ethnicity does not affect outcomes of coronary angioplasty
Authors: Mastoor Momina , Iqbal Uzma , Pinnow Ellen , Lindsay Joseph 
Published: February 2009

AbstractBackground: Access to high quality medical care and especially to complex procedures may be adversely affected in members of a minority ethnic group or a lower socioeconomic class. For example, Caucasians undergo coronary artery bypass grafting (CABG) or percutaneous transluminal coronary interventions (PTCI) twice as frequently as African‐Americans. Data exist to suggest that African‐Americans derive less benefit than Caucasians from CABG.Hypothesis: We investigated the possibility that outcomes of catheter‐based coronary angioplasty might also be less favorable in minority populations.Methods: We analyzed in‐hospital outcomes in 6,559 consecutive patients who underwent PTCI in our laboratory. In 37 ethnicity was classified as “other,” 5,203 (79.8%) were identified as Caucasians, 863 (13.2%), as African‐Americans, and 456 (7.0%), as Hispanics. Twelve baseline clinical, angiographic, and procedural characteristics were entered into a computerized data base. Hospital complications were identified by trained quality assurance nurses.Results: Substantial differences in baseline characteristics existed between the populations. Despite these differences, on univariate comparison of ethnicity and outcome, no differences between ethnic groups were found with a single exception. Mortality in Hispanics was higher than in the other two populations. (2.0 vs. 0.7 and 0.8%, respectively, p=0.008). However, when this was adjusted for baseline characteristics, the difference was not significant.Conclusions: In contrast to previous studies suggesting less favorable outcomes of CABG in African‐American patients, this analysis demonstrates an equal frequency of procedural success and rate of hospital complications for PTCI in that population, in Hispanics, and in Caucasians.
Fungal endocarditis at the aortotomy site after aortic valve replacement
Authors: Sorrell Vincent L. , Koutlas Theodore C. , Ohl Christopher 
Published: February 2009

AbstractThis brief report presents a patient with fungal endocarditis involving the suture location in the ascending aorta after aortotomy to replace a stenotic aortic valve. It emphasizes the importance of expanding the diagnostic investigation for endocarditis beyond the prosthesis, which was normal in this case. It also reiterates the value of transesophageal echocardiography during the evaluation of prosthetic valves and reminds the echocardiographer to visualize the aortotomy site carefully.
Mortality, risk indicators for death, and mode of death in younger and elderly patients during five years after coronary artery bypass graft
Authors: Herlitz Johan , Brandrup‐Wognsen Gunnar , Karlson Björn W. , Sjöland Helén , Karlsson Thomas , Caidahl Kenneth , Hartford Marianne , Haglid Maria 
Published: February 2009

AbstractBackground: The number of elderly patients who may be candidates for coronary artery bypass graft (CABG) for severe coronary artery disease has increased. Cardiac surgery in the elderly is a high‐risk procedure because many of these patients have concomitant systemic disease and other disabilities.Hypothesis: The study was undertaken to evaluate mortality, risk indicators for death, and mode of death in younger and elderly patients during 5 years after CABG.Methods: The study included all patients in western Sweden who underwent CABG without concomitant valve surgery and without previously performed CABG between June 1988 and June 1991. In all, 2,000 patients, of whom 953 (48%) were ≥ 65 years, were divided into two age groups (< 65 years and ≥ 65 years).Results: Compared with the younger patients, the elderly had a relative risk of death of 2.3 (95% confidence interval 1.8–3.0). The increased risk of death in the elderly was significantly more marked in men, in patients with more severe angina pectoris, and in patients without a history of cerebrovascular diseases. The mode and place of death appeared similar regardless of age; neither was there marked difference in symptoms of angina pectoris among survivors 5 years after CABG.Conclusion: Compared with patients < 65 years, the elderly have more than twice as high a risk of death during the subsequent 5 years, and this risk is higher in men, in patients with severe symptoms of angina pectoris, and in those with no history of cerebrovascular disease.
Response to changing plasma concentrations of isosorbide‐bound no2 during acute and sustained treatment with isosorbide dinitrate in patients with coronary artery disease
Authors: Jørgensen Lars H. , Thaulow Erik , Refsum Harald E. , Bredesen Jan 
Published: February 2009

AbstractBackground: The mechanisms behind development of tolerance to nitrate effects during sustained, asymmetric isosorbide dinitrate (ISDN) therapy are not fully understood.Hypothesis: The study was undertaken to investigate the changes of the relationships between left ventricular (LV) function and plasma concentrations of ISDN and its vasoactive metabolites (2‐ and 5‐ISMO) during acute and sustained, asymmetric ISDN therapy.Methods: Left ventricular function and plasma concentrations of ISDN, 2‐ and 5‐isosorbide mononitrates (P‐ISDN, P‐2‐and 5‐ISMO) were measured at rest and at supine exercise before and for 4 h after peroral 30 mg ISDN in 15 patients with coronary artery disease, all with initial exercise pulmonary artery wedge pressure (PAWP) > 25 mmHg. Seven patients were untreated (acute group), while eight received 30 mg ISDN b.i.d. for 2 weeks before the invasive study. P‐ISDN and the concentration of available isosorbide‐bound nitrate (NO2) in plasma (P‐ISDN‐2 + P‐2‐ISMO + P‐5‐ISMO) (P‐NO2) were used as measures of the nitric oxide (NO) offer to the tissues.Results: Throughout the study, after administration of medication, all plasma concentrations, in particular P‐ISDN, were higher in the chronic than in the acute group. Peak P‐ISDN was reached after 15 min in the chronic group and after 25 min in the acute group, while P‐2‐ and 5‐ISMO reached maximum only after 40 min in both groups. At rest, the full effect on PAWP was observed after 10 min in both groups, but at markedly higher levels of P‐ISDN and P‐NO2 in the chronic group. Afterward, no further changes in PAWP were observed. During exercise, 1 h after medication, PAWP and stroke index to PAWP ratio (SI/PAWP) were normal in both groups. Thereafter, at slowly declining P‐NO2, PAWP rose and SI/PAWP declined toward the initial level in the chronic group, but remained unchanged in the acute group, in spite of higher P‐NO2 and greater NO release in the former.Conclusions: Patients receiving sustained, asymmetric 30 mg ISDN b.i.d. dosing had the same immediate beneficial effects on LV function during exercise after a morning dose as did untreated patients. However, in spite of higher P‐NO2 and higher rate of NO release during sustained treatment, the effects deteriorated gradually 2 to 3 h after medication. The changes in metabolism and/or distribution of isosorbide‐bound NO2 may possibly be part of the tolerance induced by long‐term treatment, even with asymmetric dosing.
Normalization of left ventricular dysfunction in systemic hypertension
Authors: Frimm Clovis De Carvalho , De Moraes Álvaro Villela , Medeiros Caio César Jorge , Filho Antǒnio Esteves , Marino Júlio César 
Published: February 2009

AbstractBackground: In hypertensive heart disease, it is uncertain whether the impairment of left ventricular (LV) systolic function might be reverted by antihypertensive treatment.Hypothesis: This study was undertaken to address the likelihood of recovery of LV dysfunction and to identify factors potentially related.Methods: Twenty‐six patients with primary (n = 16) and renovascular (n = 10) hypertension participated in the study and were classified into Groups A (n = 12) and B (n = 14) according to normalization or persistent left ventricular dysfunction (fractional shortening <0.30) after 36 weeks of follow‐up. All patients received standard medical therapy and appropriate procedures for renovascular disease correction. Logistic regression analysis was used to identify variables associated with recovery.Results: Patients in Group A compared with those in Group B were younger (41±14 vs. 52 ± 10 years; p<0.05), had a greater frequency of renovascular hypertension (8 vs. 2; p<0.05), showed shorter LV end‐diastolic (54±5 vs. 61±8 mm; p<0.05) and end‐systolic dimensions (41±6 vs. 49±9 mm; p<0.05), and lower mass index (215±64 vs. 261±47 g.m‐2; p<0.05) before treatment, whereas fractional shortening (0.24±0.4 vs. 0.20±0.5;p>0.05) and diastolic blood pressure (116±12 vs. 122±19 mmHg; p>0.05) were similar. On follow‐up, Group A patients showed lower diastolic blood pressure (89±15 vs. 105±20 mmHg; p<0.05) and mass index (142±34 vs. 222±40 g.m2; p<0.05). Logistic regression analysis identified systolic dimension and renovascular hypertension as factors associated with fractional shortening normalization.Conclusion: The recovery of LV dysfunction is expected to occur most likely in patients with renovascular hypertension and the shortest systolic dimensions.