bluuebunny/crossref_metadata_2025_split huggingface dataset:
Activation of leukocytes and of the kallikrein‐kinin system in patients with unstable angina pectoris
Authors: Hoffmeister Hans Martin , Beyer Martin E. , Engel Zwetana , Heller Wolfgang 
Published: February 2009

AbstractWe investigated the leucocyte‐elastase and the activity of the kallikrein system including kinin precursors and plasma inhibition levels in 14 patients with unstable angina pectoris (normal or only slightly elevated creatine kinase levels; no transmural myocardial infarction) and compared them with 10 controls. Leucocyte‐elastase levels and activity of the kallikrein system were significantly elevated in unstable angina pectoris. The bradykinin precursor high‐molecular‐weight kininogen was markedly decreased to 79 ± 16% indicating kinin generation. Except for a slight decrease in the beta factor Xlla inhibition, we observed no abnormalities in the plasma kallikrein inhibition or in the antithrombin III levels in patients with unstable angina pectoris. The findings indicate a significant activation of the plasma kallikrein‐kinin system, which is not associated with a considerable reduction in the plasma inhibitor levels. Kinin generation might influence vascular tone and leucocyte function and thus be involved in the pathophysiologic alterations occurring in patients with recurrent angina at rest.
A new approach to the management of infected pacemakers
Authors: Antinori Charles H. , Villanueva Dioscoro T. , Pierucci Louis , Manuel Victor J. , Kuchler Joseph A. 
Published: February 2009

AbstractManagement of infected pacemakers always presents a problem. This report describes a method of managing infected pacemakers, using the infected unit as a temporary pacer. This method has worked well in four patients.
General concepts in the morphologic assessment of operatively excised cardiac valves—part I
Authors: Waller Bruce , Howard Jane , Fess Stephen 
Published: February 2009

AbstractThis two‐part article discusses the general morphologic assessment of operatively excised cardiac valves and applies these principles to functional classifications. All cardiac valves are categorized into stenotic and purely regurgitant (no element of stenosis) groups based upon structural features: presence or absence of commissural fusion, calcific deposits, and degree and location of fibrosis. Of 2980 operatively excised cardiac valves reviewed between 1962 and 1992, the most common lesion was aortic stenosis, followed by mitral stenosis and the combination of aortic and mitral stenosis.
New evidence for improved survival in chronic heart failure
Authors: Clark Andrew L. , Coats Andrew J. S. 
Published: February 2009

AbstractChronic heart failure is a common clinical syndrome with high associated mortality and morbidity. Recent advances in therapy for the condition with vasodilators and, in particular, angiotensin‐converting enzyme inhibitors, have led to hopes for improvement in survival. Several large scale studies examining the role of vasodilators have reported over the last few years, and the role of vasodilators in the treatment and prevention of chronic heart failure is being delineated. There is new hope for patients with symptomatic heart failure; symptoms can be alleviated and prognosis improved. Increasingly, it appears as if there is a role for drug therapy in preventing the onset of chronic heart failure. In this paper, we examine the results of these studies and of some smaller studies in order to discuss the implications for current therapy and future research.
The optimal technique for electrical cardioversion of atrial fibrillation
Authors: Ewy Gordon A. 
Published: February 2009

AbstractThe optimal approach to electrical cardioversion of atrial fibrillation includes appropriate patient selection, anticoagulation, careful selection and monitoring of antiarrhythmic therapy, and proper electrical cardioversion technique. The optimal technique requires the use of metal electrodes, with one electrode of at least 8 cm in diameter placed in the anterior position, and the second of 12–13 cm diameter placed posteriorly just below the left scapulae, with generous amounts of the appropriate gel (such as Hewlett‐Packard Redux Paste) as the electrode‐skin interface and firm pressure to the paddle electrode with the patient in expiration. Thus the anterior‐posterior chest diameter is decreased and less air between the electrodes is assured. The initial shock strength should be 200 J. The shock is synchronized with the electrocardiographic QRS complex. This report reviews the justification for these recommendations.
The plasma concentration of N‐terminal proatrial natriuretic factor anf (1‐98) is related to prognosis in severe heart failure
Authors: Hall Christian , Kjekshus John , Eneroth Peter , Snapinn Steven 
Published: February 2009

AbstractDue to its longer halflife, the N‐terminal of ANF prohormone, ANF( 1‐98), has plasma concentrations that exceed those of ANF itself by a factor of 10 or more. It is also less prone to rapid changes secondary to hemodynamic alterations. To evaluate the prognostic significance of ANF(1‐98) plasma levels in severe heart failure (NYHA IV), the peptide was measured by radioimmunoassay in plasma samples from patients randomized to additional treatment with enalapril (n = 78) or placebo (n = 61) (CONSENSUS study). In the placebo group there was a positive relation between mortality after 6 months and baseline ANF(1‐98) level. Because of a reduced mortality, especially among patients with high ANF(l‐98) levels, there was no such relation in the patients treated with enalapril. For both groups there was a positive relationship between increase in ANF(1‐98) after 6 weeks of treatment and mortality, while a decrease signaled a favorable prognosis. It is concluded that the magnitude and changes of plasma ANF(1‐98) provide information on prognosis and therapeutic effects with respect to mortality in patients with severe heart failure. Plasma ANF(1‐98) may serve as a useful clinical biochemical parameter in the treatment of heart failure.
General concepts in the morphologic assessment of operatively excised cardiac valves—Part II
Authors: Waller Bruce , Howard Jane , Fess Stephen 
Published: February 2009

AbstractThis 2‐part article discusses general morphologic assessment of operatively excised cardiac valves and applies these principles to functional classifications. All cardiac valves are categorized into stenotic and purely regurgitant (no element of stenosis) groups based upon structural features: presence or absence of commissural fusion, calcific deposits, and degree and location of fibrosis. Of 2,980 operatively excised cardiac valves reviewed between 1962 and 1992, the most common lesion was aortic stenosis, followed by mitral stenosis and the combination of aortic and mitral stenosis.
Efficacy of rapid atrial pacing for conversion of atrial flutter in medically treated patients
Authors: Baeriswyl Gérard , Zimmermann Marc , Adamec Richard 
Published: February 2009

AbstractTo determine factors affecting the success rate of rapid atrial pacing in converting atrial flutter to sinus rhythm in medically treated patients, we prospectively used this technique for 120 consecutive episodes in a total of 110 patients (94 male, 16 female, mean age 63 ± 14 years). Structural heart disease was present in 77%, and all patients were receiving antiarrhythmic drugs at the time of the procedure. Atrial flutter type I was present in 92 of 110 patients (84%), and atrial flutter type II in 18 of 110 (16%). Primary success rate (return to sinus rhythm either immediately or after < 10 min of atrial fibrillation) was 70% (71/102) for flutter type I, and 6% ( 1/18) for flutter type II (p < 0.001). Delayed success (conversion to sinus rhythm in > 10 min but < 24 h) was observed in 15 additional episodes of flutter type I (15%) and in 1 additional episode of flutter type II (6%). The only clinical factors predicting primary success were (a) characteristics of flutter waves on the 12‐lead surface electrocardiogram, (b) duration of flutter (primary success rate of 81 % if flutter < 1 month vs. 57% if > 1 month, p< 0.05), and (c) flutter rate (primary success rate of 78% if < 260/min vs. 56% if > 260/min, p< 0.05). In 6/71 episodes of flutter type I (8%), prolonged sinus pauses or severe bradyarrhythmias occurred after conversion to sinus rhythm. It was concluded that overdrive atrial pacing is an effective procedure to convert atrial flutter type I in sinus rhythm in medically treated patients; the primary success rate of the procedure depends on flutter type, duration, and rate. Because severe bradyarrhythmias are not uncommon at the time of conversion and because it does not require general anesthesia, this technique can be considered as a first‐step therapy in this particular population.
Double‐blind comparison of amlodipine and hydrochlorothiazide in patients with mild to moderate hypertension
Authors: S. Ram C. Venkata , Ames Richard P. , Applegate William B. , Burris James F. , Davidov Michael E. , Mroczek William J. 
Published: February 2009

AbstractIn the final analysis of this study at Week 26,26% of the patients randomized to receive amlodipine attained blood pressure control with amlodipine alone compared with 33% of the patients allocated to hydrochlorothiazide (HCTZ). Neither amlodipine nor HCTZ produced clinically significant changes in pulse rate or in the electrocardiogram. Amlodipine treatment did not appear to produce clinically significant changes in blood lipids; HCTZ, however, produced an increase in total plasma cholesterol (Δ22.9 ± 8.6 mg/dl). The incidence of side effects and the rate of patient withdrawal in the amlodipine and HCTZ groups were comparable. As expected, HCTZ therapy caused well‐recognized biochemical alterations in cholesterol and potassium levels, whereas amlodipine was metabolically neutral.
Effect of left ventricular contractile performance on passive left atrial filling—Clinical study using radionuclide angiography
Authors: Fujii Kaoru , Ozaki Masaharu , Yamagishi Takashi , Ishine Kenji , Furutani Yuhji , Nagano Hiroyuki , Yamamoto Kouzo , Saiki Atsusi , Matsuzaki Masunori 
Published: February 2009

AbstractMany invasive and noninvasive methods have been used to study the cardiac atria; however, few allow quantitative measurement of atrial function. To determine the interaction between left ventricular (LV) contraction and left atrial (LA) filling, gated radionuclide angiography was conducted in 30 normal subjects (24 men and 6 women, mean age 58 ± 10 years, range 26‐68). LV and LA time‐activity curves and their firstderivative curves were obtained simultaneously by using the method of Bough et al. The LV ejection fraction (64 ± 18%) and LV peak ejection rate (LVPER; 3.42 ± 0.27 EDV/s) were computed from these curves. As indices of LA filling, LA fractional emptying (38 ± 12%) and LA peak filling rate (LAPFR; 2.86 ± 0.17 LAVmax/s)—the latter being defined as the peak rate of LA filling during the LA filling phase—were also computed from these curves. In all subjects, the timing of the LVPER coincided with the occurrence of LAPFR, and there was a significant positive correlation between the LVPER and LAPFR (r= 0.81, p < 0.001 ), indicating that the LAPFR was strongly affected by the degree of LVPER. Thus, these results indicate that LV contractile performance plays an important role in determining LA passive filling during ventricular systole.
Familial cardiac and skeletal myopathy associated with desmin accumulation
Authors: Porcu Maurizio , Mereu Dionigi , Muntoni Francesco , Catani Gualtiero 
Published: February 2009

AbstractWe describe the case of a mentally retarded young man with marked biventricular hypertrophy, skeletal myopa thy, and bilateral pes cavus, in whom desmin accumulation was documented in cardiac and skeletal muscle biopsies. Hemodynamic assessment showed a restrictive profile. A brother of the proband was similarly affected and died at the age of 24 of cardiac failure. Sudden death occurred in other six members of this family. Pedigree analysis suggested an X‐linked inheritance. This observation and previous reports suggest that desmin accumulation is probably less rare than was thought in patients with unexplained hypertrophic or restrictive cardiomyopathies.Desmin accumulation should be systematically searched for in these types of cardiomyopathies, although its specificity needs to be investigated in further studies.
Transplantation and the problems afterward including coronary vasculopathy
Authors: Mills Roger M. 
Published: February 2009

AbstractThe clinical success of cardiac transplantation requires clinical cardiologists to become familiar with care of the post‐transplant patient. This review emphasizes five major post‐transplant problems: (1) infection/immunosuppression, (2) metabolic problems, (3) post‐transplant hypertension, (4) exercise intolerance, and (5) graft coronary disease. The evolution of these problems after transplantation is emphasized, so that clinical cardiologists and internists sharing the management of these patients can develop a context in which to work.
Efficacy and safety of amlodipine in hypertensive patients with renal dysfunction
Authors: Saruta Takao , Ishii Masao , Abe Keishi , Iimura Isamo 
Published: February 2009

AbstractAmlodipine, a dihydropyridine calcium antagonist, was administered at 2.5‐5.0 mg/day for 8 weeks to 35 hypertensive patients with renal dysfunction, and its efficacy and safety were evaluated. The target reduction in blood pressure was achieved in 28 of the 35 patients (80%), while blood pressure was decreased in 4 patients (11.4%) and unchanged in 3 patients (8.6%). A side effect of mild headache was reported by one patient (2.9%). In addition, abnormal changes in laboratory values were observed in five patients, but all of the changes were mild. Blood urea nitrogen and serum creatinine levels both increased in two of these five patients, and serum creatinine levels increased in another two patients. Serum amlodipine concentration was 4.86 ± 2.57 ng/ml (n = 8) and 3.01 ± 1.02 ng/ml (n = 8) in patients receiving a daily dose of 2.5 mg for 2‐5 weeks and 8‐10 weeks, respectively. Serum concentration in patients receiving 5 mg from Weeks 2‐6 was 9.72 ± 6.89 ng/ml (n = 6) after 7‐9 weeks, suggesting no tendency for the accumulation of this drug. The drug was rated as of clinical benefit in 27 of the 35 patients (77.1%), and as slightly beneficial in another 5 patients (14.3%). Thus, amlodipine significantly decreased the blood pressure while causing little or no aggravation of renal dysfunction in hypertensive patients with renal impairment.
Signal‐averaged electrocardiographic late potentials in children with complete heart block
Authors: Hayabuchi Yasunobu , Matsuoka Suguru , Kubo Masahiro , Aktta Hiroshi , Kuroda Yasuhiro 
Published: February 2009

AbstractThe purpose of this study was to examine signalaveraged electrocardiographic (SA‐ECG) late potentials to predict ventricular arrhythmias during intrinsic cardiac rhythm and during ventricular pacing in children with complete heart block (CHB). Recordings of SA‐ECG were obtained from eight patients (aged 3‐18 years) with documented CHB. The etiology of CHB was congenital in four cases and acquired in four cases. Six of these patients underwent permanent pacemaker implantation. Comparisons of the SA‐ECG were made before and during ventricular pacing. Abnormalities of SA‐ECG during intrinsic cardiac rhythm were noted in four patients, all of whom were older than 14 years. Although there was no significant difference in SA‐ECG parameters between patients with congenital CHB and acquired CHB, abnormal SA‐ECG was noted in one of four patients with congenital CHB and in three of four patients with acquired CHB. Two patients without permanent pacemaker implantation had normal SA‐ECG, but four of six patients with permanent pacemaker implantation had abnormal SA‐ECG. Three of the four patients had abnormal SA‐ECG during ventricular pacing, but the abnormal SA‐ECG in one patient had normalized during ventricular pacing. It is important to record SA‐ECG before and during ventricular pacing to detect late potentials in patients with CHB. It may be useful to record SA‐ECG while changing the pacing site to find ideal sites for electrode implantation for the potential prevention of ventricular arrhythmias.
Pathology of mitral valve stenosis and pure mitral regurgitation—Part I
Authors: Waller Bruce F. , Howard Jane , Fess Stephen 
Published: February 2009

AbstractThis two‐part article examines the histologic and morphologic basis for stenotic and purely regurgitant mitral valves. In Part I, conditions producing mitral valve stenosis are reviewed. In over 99% of stenotic mitral valves, the etiology is rheumatic disease. Other rare causes of mitral stenosis include congenitally malformed valves, active infective endocarditis, massive annular calcium, and metabolic or enzymatic abnormalities. In Part II, conditions producing pure mitral regurgitation will be discussed. In contrast to the few causes of mitral stenosis, the causes of pure (no element of stenosis) mitral regurgitation are multiple. Some of the conditions producing pure regurgitation include floppy mitral valves, infective endocarditis, papillary muscle dysfunction, rheumatic disease, and ruptured chordae tendineae.
Radiofrequency catheter ablation of both atrial ventricular nodal reentrant and atrial ventricular reentrant tachycardia in a single session
Authors: Schläpfer Jürg , Goy Jean‐Jacques 
Published: February 2009

AbstractRadiofrequency catheter ablation is a new therapeutic approach to treat patients with symptomatic drug‐resistant paroxysmal supraventricular tachycardia. Ablation of two accessory atrioventricular pathways in a single session has been frequently described previously. However, ablation in a single session of both the fast pathway, involved in atrial ventricular nodal reentrant tachycardia, and a concealed atrioventricular accessory pathway involved in a circus movement tachycardia has rarely been reported. A 57‐year‐old man with a grade III aortic incompetence had the infrequent association of atrial ventricular nodal reentrant tachycardia and orthodromic circus movement tachycardia due to a concealed accessory pathway. He presented with drug‐resistant reentrant supraventricular tachycardia and, in a single session, underwent a successful radiofrequency catheter ablation of the fast atrial ventricular nodal pathway and a concealed posteroseptal accessory pathway. During a 10‐month follow‐up he was free of palpitations without any antiarrhythmic therapy and underwent elective aortic valve replacement.
Activated clotting‐time variability in patients undergoing coronary angioplasty
Authors: Warner Mark F. , Shahbaz MIAN M. , Missri Jose C. 
Published: February 2009

AbstractAlthough the activated clotting time (ACT) is commonly used to assess adequacy of anticoagulation during percutaneous transluminal coronary angioplasty (PTCA), there is uncertainty whether measurements on samples from the arterial and venous circulations are directly comparable. We performed ACT determinations on 115 patients undergoing PTCA at our institution. Blood samples were drawn in a sequential fashion from the arterial and femoral venous sheaths at the conclusion of each case, and ACT determinations were performed in the catheterization laboratory immediately thereafter. The venous ACT exceeded the arterial value in 63 patients (55%), and was identical in only 2 instances. The arterial and venous ACT differed by more than 100 s in 10 patients. in 23 patients (20%) one ACT determination was ≥ 300 s, while the value from the other circulation was < 300 s. We conclude that there is substantial variability between arterial and venous ACT determinations in heparinized patients undergoing PTCA.
Left atrial thrombi despite anticoagulant and antiplatelet therapy
Authors: Zotz Rainer J. , Pinnau Uwe , Genth Sabine , Erbel Raimund , Meyer Jürgen 
Published: February 2009

AbstractTo investigate risk factors for embolization in patients with echocardiographically detected left atrial thrombi and to evaluate thrombus development, we examined 29 patients with transesophageal and transthoracic echocardiography at two points during a follow‐up of 18 months. We compared patients with a history of possible arterial embolization0 (n = 13) with those without (n = 16) in regard to age, gender, left atrial dilatation, localization of the thrombus in the left atrial cavity, spontaneous echo contrast, and atrial fibrillation. Eight patients were treated with aspirin, 20 with phenprocoumon. Only left atrial spontaneous contrast was associated with thrombembolism (10/15 patients with spontaneous contrast experienced arterial embolism; p = 0.038). in six patients arterial embolism occurred after thrombus detection (14% per patient per year). Four of these patients were treated with phenprocoumon, two with aspirin. At reexamination, one thrombus was detected in the patient without anticoagulant treatment and one thrombus was detected in the 8 patients treated with aspirin (13%), compared with ten thrombi detected in the 20 patients (50%) treated with phenprocoumon (p = NS). in 17 patients no thrombus was seen at reexamination. Since only 2 patients had undergone thrombectomy and 3 experienced arterial embolism during follow‐up, thrombi disappeared under medical therapy in 12 patients. Patients with left atrial thrombi have a high risk of arterial embolization despite proper anticoagulative or antiplatelet treatment. Embolization occurs significantly more often if spontaneous echo contrast can be visualized. Left atrial thrombi can be reduced in size by the administration of antiplatelet and anticoagulative agents. Detection of left atrial thrombi with transesophageal echocardiography identifies this patient population at an increased risk of embolization.
Electrophysiologic characteristics at initiation of ventricular tachycardia and ventricular fibrillation in a canine infarct model
Authors: Moroe Kazuo , Coelho Aldo , Sampsell Ronald N. , Chun Yeong‐Hwa , Mayrovitz Harvey N. , Gosselin Arthur J. 
Published: February 2009

AbstractLocal ventricular activation time and the conduction time during sinus rhythm at the induction of ventricular tachycardia (VT) and ventricular fibrillation (VF) were investigated using a canine model of chronic myocardial infarction. Of 26 dogs studied, 15 had inducible VT, 10 had inducible VF, and 1 had no inducible arrhythmias. Bipolar local ventricular electrograms were recorded during sinus rhythm from 136 sites in 10 dogs with VT and 164 sites in 11 dogs with VF. Mean activation time in dogs with inducible VT was significantly longer than in dogs with inducible VF. Furthermore, simultaneous local ventricular electrograms were recorded during the induction of VT (74 episodes) or VF (38 episodes) from the infarct border zone at the endocardium (B‐EN), the epicardium (B‐EP), and normal sites (N‐EN, N‐EP). During VT induction, the activation time at N‐EN and N‐EP was significantly longer than during VF induction (N‐EN: 94 ± 21, 70 ± 19 ms; N‐EP: 83 ± 21, 64 ± 10 ms; p < 0.05). Conduction time was measured at the initiation of VT or VF induced by orthodromic or antidromic pacing. The conduction times of the last paced beat between N‐EN and B‐EP (35 ± 11, 62 ± 24 ms), N‐EN and N‐EP (35 ± 12, 14 ± 13 ms), B‐EN and B‐EP (16 ± 10, 38 ± 25 ms), and B‐EP and N‐EP (77 ± 27, 44 ± 12 ms) were significantly different in dogs with inducible VT (p < 0.05), but not in dogs with VF. Dispersion of effective refractory period was also observed in dogs with VT. Percent infarct in inducible VT was larger than in inducible VF (VT: 16 ± 5%; VF: 10 ± 2%; p < 0.001). These studies suggest that dogs with inducible VT have prolonged ventricular activation time and significantly different bidirectional conduction time during VT induction. This may serve as a substrate for reentry.