bluuebunny/crossref_metadata_2025_split huggingface dataset:
Enhanced external counterpulsation as an adjunct to revascularization in unstable angina
Authors: Lawson William E. , Cohn Peter F. , Burger Lynn , Katz Jordan P. , Dervan John P. , Zheng Zhen Sheng , Oster Zvi H. , Cabahug Corazon , Hui John C. K. , Jiang Lixin , Soroff Harry S. 
Published: February 2009

AbstractEnhanced external counterpulsation (EECP) is an effective noninvasive treatment for chronic stable angina. Despite intensive risk factor modification, a patient required two surgical coronary revascularizations and seven multivessel angioplasties over a 26‐monfh period, demonstrating recurrent unstable angina and persistent thallium perfusion defects despite revascularization. Post EECP, angina was relieved, thallium defects were resolved, and the patient has remained asymptomatic for 36 months.
Heart rate variability as a measure of autonomic nervous system function in anorexia nervosa
Authors: Petretta Mario , Bonaduce Domenico , Themistoclakis Sakis , Ianniciello Angiolino , Scalfi Luca , De Filippo Emilia , Contaldo Franco , Marciano Fortunato , Migaux Marie‐Louise 
Published: February 2009

AbstractBackground and hypothesis: Alteration in sympathovagal balance may be a mechanism of increased cardiovascular mortality and sudden death of patients with anorexia nervosa. This study was undertaken to characterize cardiac autonomic control in patients with anorexia nervosa by means of heart rate variability analysis.Methods: Heart period variability by 24‐h Holter recording was evaluated in 13 young women with anorexia nervosa, 10 constitutionally thin women, and 10 women of normal weight.Results: High‐frequency power, a measure of parasympathetic modulation of heart rate, and all‐time domain measures of heart rate variability were higher in patients with anorexia nervosa than in thin women and in those of normal weight. Thin women showed lower values of total power and of most components of power spectrum.Conclusions: Our data demonstrate an increased vagal tone in young women with anorexia nervosa. The marked increase in parasympathetic activity, not in response to an increase in sympathetic activity, could be detrimental and may contribute to the higher cardiovascular mortality of these patients.
Cardiac dysfunction in patients with chronic progressive external ophthalmoplegia
Authors: Akaike Masashi , Kawai Hisaomi , Yokoi Kenji , Kunishige Makoto , Mine Hideki , Nishida Yoshihiko , Saito Shiro 
Published: February 2009

AbstractBackground: Chronic progressive external ophthalmoplegia (CPEO), which includes Kearns‐Sayre syndrome, is a mitochondrial disorder with large deletions of mitochondrial DNA. Recently, mtDNA deletions in cardiac muscle cells were thought to be a cause of dilated cardiomyopathy. However, the cardiac involvement in patients with CPEO is generally considered to be limited to the cardiac conduction system.Hypothesis: The purpose of this study was to evaluate left ventricular function in patients with CPEO.Methods: We evaluated the cardiac function of five patients with CPEO by means of carotid pulse recording and Doppler echocardiography.Results: The ratio of the pre‐ejection period to ejection time was increased to 0.67 in one patient and to 0.50 in another. Echocardiography showed left ventricular dilatation and diffuse hypokinetic wall motion in both cases. Left ventricular fractional shortening was decreased to 5 and 19%, respectively, and the mean rate of circumferential shortening was decreased to 0.12 and 0.63 circ/s, respectively. One of the two patients died of congestive heart failure 2 months after the study. The Doppler pattern of left ventricular filling in the three remaining patients showed a decrease in the ratio of peak flow velocity in early diastole to that in late diastole, with an increase in deceleration time.Conclusion: Although cardiac involvement in patients with CPEO is generally considered to be limited to the cardiac conduction system, left ventricular dysfunction may be present and should receive more attention in the management of patients with CPEO.
Association between psychiatric disorders and marfan's syndrome in a large sardinian family with a high prevalence of cardiac abnormalities
Authors: Mercuro Giuseppe , Ruscazio Massimo , Zoncu Sandra , Montisci Roberta , Cherchi Angelo , Carpiniello Bernardo , Rudas Nereide 
Published: February 2009

AbstractBackground: Marfan's syndrome is an inherited disorder of connective tissue associated with characteristic abnormalities of the skeletal, ocular, and cardiovascular systems. Marked clinical variability and age dependency of all manifestations of Marfan's syndrome may render the unequivocal diagnosis difficult in mildly affected, young subjects.Hypothesis: The study and care of a 32‐year‐old woman with evidence of Manfan's syndrome, several cardiac abnormalities, and paranoid schizophrenia led to an investigation of her consenting relatives to verify the penetrance of Marfan's syndrome and the degree of comorbidity between the disease and psychiatric disorders.Methods: The patient and 12 subjects belonging to three generations of her family underwent cardiovascular, skeletal, ophthalmologic, and psychiatric examinations. Two‐dimensional and Doppler echocardiography were performed.Results: One female index patient and six of her first‐degree relatives were found to be affected by Marfan's syndrome. All seven patients were found to have mitral valve prolapse associated with other cardiac abnormalities. Four of these patients were affected by the following psychiatric disorders: generalized anxiety disorder, major depressive disorder, paranoid schizophrenia (two cases). Six more relatives without Marfan's syndrome showed mitral valve prolapse in association with other echocardiographic features. Two of these were found to be affected by a major depressive disorder.Conclusions: The present data support the hypothesis that a psychiatric condition, associated with a significantly high frequency of cardiac involvement, may be part of the phenotype of Marfan's syndrome.
Transesophageal echocardiographic detection of cardiac embolic source in cor triatriatum complicated by aortic saddle emboli
Authors: Huang Tsuei‐Yuen , Sung Ping‐Hsiun 
Published: February 2009

AbstractTransesophageal echocardiographic findings are described in a case of cor triatriatum with atrial fibrillation complicated with cerebral and aortic saddle emboli. A spontaneous echo contrast confined to the dilated proximal chamber of the left atrium was noted and was presumed to be the embolic source in cor triatriatum.
Diffuse pulmonary hemorrhage complicating thrombolytic therapy for acute myocardial infarction
Authors: Gopalakrishnan Deepika , Tioran Teresa , Emanuel Carlos , Clark Vivian L. 
Published: February 2009

AbstractDiffuse pulmonary hemorrhage has rarely been reported as a complication of thrombolytic therapy. Recently, two patients who developed this complication were observed at our institution. This diagnosis should be considered in any post‐thrombolytic patient with respiratory distress, diffuse pulmonary infiltrates, and an otherwise unexplained fall in hemoglobin.
Pericardial involvement in acute myocardial infarction in the post‐thrombolytic era: Clinical meaning and value
Authors: Correale Ernesto , Romano Salvatore , Ricciardiello Vincenzo , Battista Rossano , Maggioni Aldo P. , Santoro Eugenio 
Published: February 2009

AbstractPericardial involvement (PI) in acute myocardial infarction (AMI) is a complication usually considered benign and has therefore received less attention than those more severe. It may be easily missed because it presents few symptoms and signs, which in turn may be confused with those of AMI. Its path physiology, diagnosis, and pitfalls are discussed. The GISSI‐1 trial revealed a marked reduction of PI in the group treated with thrombolysis. This unexpected finding was later confirmed by the GISSI‐2 trial and by other studies, drawing attention to its meaning. Data from the GISSI as well as from other studies have been reviewed and seem to indicate that PI is associated with larger AMIs and with a significant increase in 6‐ and 12‐month mortality. This may be attributed to the consequences of late remodeling of a large infarction. These findings lead to the conclusion that PI should be granted more attention, and that it might identify patients with a poorer long‐term outcome.
Arrhythmogenic right ventricular cardiomyopathy: a survey of the investigations at the university of padua
Authors: Basso Cristina , Thiene Gaetano , Nava Andrea , Dalla Volta Sergio 
Published: February 2009

AbstractThe purpose of this paper is to review the history of the clinico‐pathologic investigations performed at the University of Padua on an old morbid entity (“parchment heart”), which, in the 1960s, led to the clinical description of the disease, in the 1980s to the revival of the scientific interest, and in the mid 1990s to the understanding of the genetic background. All the steps of the progressive knowledge are reviewed: necropsy of young people who died suddenly, in vivo diagnosis by ECG, echocardiography, angiocardiography, endomyocardial biopsy, nuclear magnetic resonance, and diagnostic criteria. Familial occurrence with autosomic dominant transmission and various penetrance was documented. Gene defects were recently mapped both to chromosome 14q23–q24 and 1q42–q43, thus providing evidence for genetic heterogeneity. The pathologic substrates of arrhythmogenic right ventricular cardiomyopathy pointed to an acquired progressive myocardial atrophy with fibro‐fatty replacement of dying myocytes. Nowadays the disease is definitively regarded as a primary myocardial disorder and it has been included in the revised WHO classification of cardiomyopathies.
Factors influencing heart rate variability in patients with severe aortic valve disease
Authors: Jung Jens , Heisel Armin , Butz Bernhard , Fries Roland , Schieffer Hermann , Tscholl Dietmar , Schäfers Hans‐Joachim 
Published: February 2009

AbstractBackground and hypothesis: Heart rate variability (HRV) is an accepted tool for the assessment of cardiovascular autonomic tone. There are no sufficient data concerning its application to patients with severe aortic valve disease (AVD) requiring cardiac surgery.Methods: It was the aim of this study to examine HRV and its physiologic correlates in patients with severe aortic valve disease requiring cardiac surgery. The correlates of time domain indices of HRV obtained from 24‐h Holter electrocardiographic recordings were analyzed in 36 consecutive patients (23 men and 13 women, mean age 62 ± 11 years) with AVD prior to cardiac surgery (aortic stenosis: 17 patients, aortic valve regurgitation: 3 patients, combined aortic valve disease: 16 patients).Results: Low values of HRV were found in the entire study group: SDNN 96.8 ± 30.9 ms, SDNNI 39.3 ± 14.4 ms, SDANN 86 ± 28.9 ms, and RMSSD 30 ± 18.1 ms. In a univariate analysis, there was no significant correlation between the time domain measures of HRV and age, gender, medication, left ventricular ejection fraction, peak aortic pressure gradient, fraction of aortic valve regurgitation, and left ventricular mass assessed by echocardiography. Patients in advanced functional classes of heart failure [New York Heart Association (NYHA) III or IV] had significantly lower values for SDNN (83.8 ± 33.6 vs. 107.3 ± 24.7 ms; p<0.05) and SDANN (72.7 ± 29.4 vs. 96.6 ± 24.3 ms; p<0.05) than patients in NYHA class I or II. Reassessment of HRV 1 week after aortic valve replacement was performed in 17 patients and showed a significant further decrease of SDNN (102.4 ± 29.7 vs. 61.5 ± 23.5 ms; p<0.001), SDNNI (40.7 ± 13.6 vs. 23.4 ± 12.4 ms; p<0.001) and SDANN (91.8 ±29.2 vs. 54.2 ± 22.8 ms;p<0.001).Conclusion: Patients with AVD requiring cardiac surgery reveal reduced time domain indices of HRV. This observation is pronounced in patients with a progressed clinical class of heart failure, whereas hemodynamic and echocardiographic parameters seem to have no significant influence on HRV parameters in this population. In addition, there is evidence of a further reduction of HRV time domain indices 1 week after uncomplicated aortic valve replacement.
Culprit lesion and jeopardized myocardium: Correlation between coronary angiography and single‐photon emission computed tomography
Authors: Candell‐Riera Jaume , Domingo Enric , Permanyer‐Miralda GaietÀ , Soler‐Soler Jordi , Olona‐Cabases Montserrat , Santana‐Boado CÁSar , Castell‐Conesa Joan , Aguadá‐Bruix Santiago 
Published: February 2009

AbstractBackground: The term “culprit lesion” is used to designate the coronary stenosis responsible for the symptoms of the patient with coronary artery disease. Its detection is essential when partial revascularization is contemplated. The term “jeopardized myocardium” is commonly used to mean the amount of myocardium put in danger by all the stenotic lesions; however, it should be restricted to the amount of myocardium that could become infarcted if only the most severe stenoses were occluded.Hypothesis: The aim of this study was to investigate (1) the agreement between coronary myocardial single‐photon emission computed tomography (SPECT) and coronary angiography for the identification of the culprit lesion, and (2) the correlation of the two studies in the quantification of jeopardized myocardium.Methods: In all, 159 patients with coronary artery disease without previous myocardial infarction were included in the study. A score for myocardial SPECT was correlated with the angiographic scores by Califf and Gensini and with the authors' score which includes adjustment for collateral circulation.Results: The agreement between coronary angiography and SPECT for the diagnosis of the culprit lesion was 84% (87/104). The correlations between the scores of angiography and SPECT to assess jeopardized myocardium when all coronary stenoses were taken into account were significant (p<0.0001), but their coefficients were suboptimal (r = 0.48 for Califf, r = 0.48 for Gensini, and r = 0.65 for the authors' score). When only the jeopardized myocardium resulting from the culprit lesion was considered, the correlation clearly improved (r=0.85).Conclusion: Thus, in 84% of patients with multivessel disease, an agreement between coronary angiography and myocardial SPECT for the diagnosis of the culprit lesion was observed. The correlation between these techniques for the quantification of jeopardized myocardium from the culprit lesion was satisfactory.
Comparison between dobutamine echocardiography and thallium‐201 scintigraphy in detecting residual stenosis, ischemia, and necrosis in patients with prior myocardial infarction
Authors: Macieira‐Coelho Eduardo , Dionísio Isabel , Garcia‐Alves MÁRio , Cantinho Guilhermina , Da Costa Brás B. , Gouveia AntÓNio , De Pádua Fernando 
Published: February 2009

AbstractBackground: Following the first attempts to detect myocardial ischemia with two‐dimensional echocardiography stress testing, pharmacologic stress using dobutamine infusion has become an alternative to echocardiography exercise testing for evaluation of coronary artery disease. It has been shown that stress echocardiography has a diagnostic accuracy similar to that of an exercise thallium test. Other studies, however, indicated that radionuclide myocardial perfusion imaging was more sensitive than exercise or pharmacologic stress echocardiography for detection of ischemia or jeopardized myocardium.Hypothesis: The aim of the present study was to determine the ability of dobutamine stress echocardiography in comparison with thallium‐201 scintigraphy to identify multivessel disease and the presence of myocardial scar and ischemia in 60 consecutive patients who suffered a first myocardial infarction (MI).Methods: Patients were evaluated by coronary angiography and ventriculography, thallium‐201 (201Tl) tomographic scintigraphy, and dobutamine echocardiography within 3 months of a first MI. Forty‐seven had Q‐wave MI and 13 had non‐Q‐wave MI. Eleven patients were excluded from final analysis—7 because of failure to achieve target heart rate in spite of the use of atropine, and 4 because of high blood pressure following the infusion of dobutamine.Results: Dobutamine echocardiography showed an overall sensitivity of 43% for detection of coronary artery lesions of 50–74% diameter stenosis and 201Tl scintigraphy showed a sensitivity of 71%. For detection of lesions of ≥75% diameter stenosis, dobutamine echocardiography showed a sensitivity of 52% and 201Tl a sensitivity of 70%. Overall agreement between wall motion and myocardial perfusion for detection of necrosis and/or ischemia in the infarct area was 40.4% with a kappa coefficient of 0.09 (p = 0.13). For detection of ischemic myocardium outside the infarct zone, overall agreement was 78.6% with a kappa coefficient of 0.49 (p<0.0001).Conclusion: Dobutamine echocardiography results showed a lower sensitivity than myocardial perfusion images in predicting multivessel coronary artery disease, and there was poor agreement between both methods in identifying necrosis or ischemia.
Long‐term low‐dose amiodarone therapy in the management of ventricular and supraventricular tachyarrhythmias: Efficacy and safety
Authors: Lee KäThy L. , Tai Yau‐Ting 
Published: February 2009

AbstractBackground: Amiodarone hydrochloride has been in use for two decades for the control of ventricular and supraventricular arrhythmias. Established and emerging evidence indicates that amiodarone has an antiarrhythmic efficacy superior to that of most other drugs.Hypothesis: The study was undertaken to evaluate the efficacy and acceptability of low‐dose amiodarone therapy in the long‐term management of supraventricular and ventricular tachyarrhythmias.Methods: A total of 124 patients with symptomatic drug‐refractory or life‐threatening arrhythmias managed with low‐dose oral amiodarone therapy over a 10‐year period was analyzed retrospectively. Of these, 45 patients (36%) had ventricular arrhythmias, 52 (42%) had atrial arrhythmias, and 27 (22%) had atrioventricular reentry tachycardia. Loading doses of amiodarone 600 mg daily for 1 week were administered for supraventricular arrhythmias and 600–1200 mg daily for 2 weeks for ventricular arrhythmias. Maintenance daily doses were 194 ± 48 and 206 ± 55 mg, respectively. Mean treatment duration was 32 ± 28 months, with 326.3 patient years of therapy.Results: Of 39 patients with sustained ventricular tachyarrhythmias, the actuarial incidence of satisfactory arrhythmia control (absence of sudden cardiac death or nonfatal arrhythmia recurrence) was 78% at 1 year and 71 % at 2 years. Satisfactory control of supraventricular arrhythmias (mean ventricular rate < 100/min with significant symptomatic improvement for sustained atrial arrhythmias and < 1 attack per year for paroxysmal atrial or atrioventricular arrhythmias) was achieved in 73, 65, and 62% of patients at 1, 2, and 3 years, respectively. The cumulative incidence of amiodarone‐related adverse effects was 5.8 per 100 patient years, with drug withdrawal required in 12 patients (9.7%). Fifteen patients had thyroid dysfunction, 2 had hepatic toxicity, and 1 developed nonfatal pulmonary fibrosis. Overall, the incidence of successful use of amiodarone (satisfactory arrhythmia control and freedom from side effects) was 67, 59, and 53% at 1, 2, and 3 years, respectively.Conclusions: The results of this study suggest that the efficacy of low‐dose amiodarone therapy in the management of serious ventricular and supraventricular arrhythmias would be similar to those achieved with higher doses, but with a much more acceptable side effect profile.
Natural history of asymptomatic valvar pulmonary stenosis diagnosed in infancy
Authors: Anand Rajani , Mehta Ashok V. 
Published: February 2009

AbstractBackground and hypothesis: Valvar pulmonary stenosis is a common congenital heart defect. Progression of stenosis over time, even when mild initially, has been shown by serial cardiac catheterization studies in children and adults. We studied the natural history of asymptomatic valvar pulmonary stenosis diagnosed in infancy with two‐dimensional echocardiography and Doppler method.Methods: Between November 1986 and March 1993, 51 infants in the Northeast Tennessee and Southwest Virginia region were clinically diagnosed to have isolated valvar pulmonary stenosis. In 40 patients, the diagnosis was confirmed by two‐dimensional echocardiogram/Doppler and color‐flow mapping study at the time of presentation, and only their course is reported. Of 40 infants, six asymptomatic infants (15%) showed rapid progression of pulmonary stenosis over a relatively short period of time. Within the first 6 months of life, three of the six infants showed worsening of the stenosis needing intervention (one had surgical valvectomy and the others had percutaneous balloon valvuloplasty). The three other infants showed a more gradual increase of pulmonary stenosis over the first 2 years of life.Results: Pulmonary stenosis even when mild can worsen in infancy, and it is not possible to predict which patients will follow this course. In our group of asymptomatic infants with initial mild pulmonary stenosis, 15% developed significant stenosis that needed intervention.Conclusion: We recommend frequent follow‐up of asymptomatic infants with mild pulmonary stenosis during the first 2 years of life to detect rapid progression that may need intervention.
Is computer interpretation of the exercise electrocardiogram a reasonable surrogate for visual reading?
Authors: Malik Marek , Mickelson Judith K. , Bates Eric R. , Hartigan Pamela , Folland Edward D. , Parisi Alfred F. 
Published: February 2009

AbstractBackground: Interpretation of exercise tests as positive or negative is primarily based upon exercise‐induced ST segment changes. Consistently accurate measurements are difficult to obtain during exercise.Hypothesis: This study compared on‐line computer‐generated electrocardiographic (ECG) analysis with visual interpretation. The goals were to document the extent of agreement, establish reasons for disagreements, characterize ST‐segment depression (extent, onset, duration), and determine the sensitivity and ability to localize coronary artery disease for each method.Methods: Comparisons were made in 120 patients at eight Veterans Affairs Medical Centers. An exercise test was considered positive if > 1.0 mm horizontal or downsloping ST‐segment depression was detected 0.08 s after the J point during exercise or recovery. The ST‐segment depression had to be present on at least two successive ECG recordings 15 s apart. Computer interpretation was based on median averaged beats.Results: There was an 88% agreement of visual and computer interpretations [106/120 (both positive, n = 62; both negative, n = 44)]. The disagreements involved visual negative, computer positive in 10 cases and visual positive, computer negative in 4 cases. Correlation was excellent between methods for characterization of ST‐segment depression (p<0.0001). Sensitivity for detecting and the ability to localize coronary artery disease (≥70% stenosis) were similar for both methods.Conclusion: This computer algorithm using median averaged beats is a reasonable surrogate for visual interpretation of the exercise ECG, making it a valuable source of confirmation of physician readings in large research trials and in clinical settings.