bluuebunny/crossref_metadata_2025_split huggingface dataset:
Detection of the “midband” lipoprotein in patients with coronary artery spasm
Authors: Miwa Kunihisa , Nakagawa Keiko , Suzuki Kayo , Inoue Hiroshi 
Published: February 2009

AbstractBackground: Dyslipidemia in patients with coronary vasospasm has been characterized by a low level of high‐density lipoprotein (HDL) cholesterol without elevation of low‐density lipoprotein (LDL) cholesterol, distinct from patients with organic coronary artery disease.Hypothesis: Disordered triglyceride‐rich lipoprotein metabolism may be linked to the genesis of coronary artery spasm.Methods: The incidence of the “midband” lipoprotein observed between very low‐density lipoprotein (VLDL) and LDL bands in the polyacrylamide disc gel electrophoretic analysis was determined in 48 patients with coronary spastic angina (CSA), in 50 patients with stable effort angina and a significant fixed coronary stenosis (SEA), and in 40 control subjects without coronary artery disease (Control).Results: The incidence was significantly (p<0.05) higher in CSA (71%) than in SEA (50%) and Control (25%). Smoking was significantly (p<0.05) more prevalent in CSA (77%) than in SEA (50%) and Control (50%). In SEA, serum levels of triglyceride and apoproteins C‐II, C‐III, and E were all significantly higher, and the serum level of HDL cholesterol was significantly lower in the midband‐positive than in the midband‐negative subgroup. In CSA, no significant differences were found in these serum levels between the midband‐positive and ‐negative subgroups, except for a significantly (p<0.05) lower level of HDL cholesterol in the former. However, a significantly (p<0.05) higher incidence of diabetes mellitus or impaired glucose tolerance was noted in the midband‐positive (41%) than in the midband‐negative subgroup (7%) in CSA. The incidence of the detected midband lipoprotein was significantly decreased in the blood samples obtained from 20 of CSA after a>6‐month angina‐free period (70 → 25%, p<0.05).Conclusions: The midband lipoprotein was frequently detected in patients with coronary vasospasm, suggesting that dyslipidemia with disordered triglyceride‐rich lipoprotein metabolism may be linked to the genesis of coronary artery spasm.
Dobutamine as bridge to angiotensin‐converting enzyme inhibitor‐nitrate therapy in endstage heart failure
Authors: Levine T. Barry , Levine Arlene B. , Elliott William G. , Narins Barbara , Stomel Robert J. 
Published: February 2009

AbstractBackground: Intravenous inotropic intervention in congestive heart failure is generally associated with a poor prognosis and is largely used as a “bridge” to mechanical support or heart transplantation.Hypothesis: We hypothesized that the inotropic support afforded by dobutamine may serve as a bridge to the introduction and intensification of angiotensin‐converting enzyme (ACE) inhibitor‐nitrate therapy.Methods: We studied the efficacy of transitioning inotrope‐dependent patients in endstage heart failure from intravenous dobutamine to high‐dose ACE inhibitor‐nitrates, with 1‐year follow‐up. Forty‐nine sequential dobutamine‐dependent patients with left ventricular ejection fraction (LVEF) 17 ± 17% were treated with increasing lisinopril (1.9 ± 1.5 to 46 ± 28 mg/day) and isosorbide dinitrate (7 ± 6 to 229 ± 161 mg/day). Outpatient dobutamine was continued or repeat infusions pursued, as indicated, and dobutamine was tapered when feasible.Results: During the following year, 14 of 49 patients required repeat dobutamine, with home treatment with dobutamine for 6.3 ± 3.7 months (n = 5). At 1 year, New York Heart Association (NYHA) classification improved from 3.6 ± 0.5 to 1.9 ± 1.0, p < 0.0001; yearly hospitalizations fell from 2.7 ± 2.3 to 1.2 ± 3.0, p = 0.02; and LVEF rose from 17 ± 7% to 24 ± 11%, p < 0.0001. At 1 year, 14 patients who remained dobutamine dependent had significantly more severe symptoms than dobutamine‐independent patients (n = 35). Transplant or death occurred in 7 of 14 patients with follow‐up dobutamine, and in 5 of 35 patients free of subsequent dobutamine, p = 0.03. Patients with poor outcome (transplant n = 10, death n = 12) continued to be more limited (NYHA 2.7 ± 0.9 vs. 1.7 ± 0.9, p = 0.0002), with more follow‐up hospitalizations (3.6 ± 5.4 vs. 0.6 ± 0.8, p = 0.0004), and no improvement in LVEF (17 ± 8 vs. 28 ± 11%, p = 0.003).Conclusions: Of the patients on dobutamine inotropic support, 70% were successfully transitioned to ACE inhibitor‐nitrate therapy, with improved symptoms and LVEF, and with reduced hospitalizations and follow‐up dobutamine or transplant. Thirty percent of patients with continued need for dobutamine had a significantly poorer 1‐year clinical outcome.
Elevated plasma levels of interleukin‐2 and soluble il‐2 receptor in ischemic heart disease
Authors: Simon Alan D. , Yazdani Shahram , Wang Weizheng , Schwartz Allan , Rabbani LeRoy E. 
Published: February 2009

AbstractBackground: T‐lymphocytes are present in significant numbers in the atherosclerotic plaque, but their role in the progression and pathogenesis of coronary syndromes remains poorly understood.Hypothesis: We sought to determine the relationship between T‐lymphocyte activation and ischemic heart disease by measuring plasma levels of cytokines related to T‐lymphocyte function in patients with stable and unstable angina.Methods: Plasma levels of interleukin‐2 (IL‐2) and soluble IL‐2 receptor (sIL‐2R) were measured in 105 patients: 66 with stable angina, 24 with unstable angina, and 15 healthy controls. Patients who presented to the cardiac catheterization laboratory with unstable or stable anginal syndromes for coronary angiography or percutaneous coronary intervention enrolled in the study.Results: Mean levels of IL‐2 were significantly higher in patients with stable angina than in those with unstable angina. The differences between stable angina and control groups, or between unstable angina and control groups, were not statistically significant. Mean levels of sIL‐2R were significantly higher in patients with stable angina than in either patients with unstable angina or control patients.Conclusions: Levels of IL‐2 and sIL‐2 receptor are significantly elevated in patients with stable angina, but not in patients with unstable angina. The contribution of T‐lymphocytes to the development of both stable and unstable angina requires further investigation.
Prognostic significance of bundle‐branch block in acute myocardial infarction: The importance of location and time of appearance
Authors: Melgarejo‐Moreno Antonio , Galcerá‐Tomás Josa , Garcia‐Alberolam Arcadio 
Published: February 2009

AbstractBackground: The presence of bundle‐branch block (BBB) is associated with high mortality rates and is considered an important predictor of poor outcome in patients with acute myocardial infarction (AMI).Hypothesis: The objective of this study was to assess the prognostic significance of BBB in patients with AMI depending on its form of presentation.Methods: A multicenter prospective 1‐year follow‐up study involving 1,239 consecutive patients diagnosed with AMI was performed.Results: Bundle‐branch block was present in 177 cases (14.2%), associated with worse clinical characteristics, lower rate of thrombolytic therapy, and higher mortality: in‐hospital (23.8 vs. 9.7%, p < 0.01) and 1‐year (40.9 vs. 16.9%, p < 0.01). Compared with right BBB (n = 135), left BBB (n = 42) was more often associated with female gender and higher prevalence of cardiovascular diseases, but had a similar 1 ‐year mortality. In the absence of heart failure or complete atrioventricular (AV) block, there was no difference in in‐hospital mortality of patients with BBB (n = 76) and without BBB (n = 786) (2.6 vs. 3.9%). Compared with existing BBB (n = 113), BBB of new appearance (n = 64) was more often accompanied by complete AV block and heart failure and higher in‐hospital and 1‐year mortality rates. Only BBB of new appearance was an independent predictor of mortality: in‐hospital (odds ratio [OR] 2.3, 95% confidence interval [CI] 1.1–4.7) and 1‐year mortality (OR 3.2, 95% CI, 1.7–9.1).Conclusions: In patients with AMI, the classification of BBB according not only to location but also to time of appearance is of practical interest. New BBB is an independent predictor of short‐ and long‐term mortality.
Relief of symptoms and improvement of health‐related quality of life five years after coronary artery bypass graft in women and men
Authors: Herlitz Johan , Wiklund Ingela , Sjöland Helén , Karlson Björn W. , Karlsson Thomas , Haglid Maria , Hartford Marianne , Caidahl Kenneth 
Published: February 2009

AbstractBackground: Severe coronary artery disease can be successfully treated with coronary artery bypass graft (CABG), with considerable improvement in the symptoms of angina pectoris. Approximately three of four patients are free of ischemic events for 5 years; however, increased survival is demonstrated only in selected subgroups with advanced coronary artery disease, and this effect has not been established in elderly patients.Hypothesis: The study was undertaken to determine the relief of symptoms and improvement in other aspects of health‐related quality of life (QoL) during 5 years after CABG in women and men.Methods: Patients who underwent CABG in western Sweden were approached prior to and 5 years after surgery. Health‐related QoL was estimated with Physical Activity Score (PAS), Nottingham Health Profile, and Psychological General Well‐Being Index.Results: Women (n = 381) had a 5‐year mortality of 17% compared with 13% for men (n = 1,619; NS). After 5 years, 1,719 patients (survivors) were available for the survey; of these, 876 (51%) answered the inquiry both prior to and after 5 years. Both women and men improved markedly and highly significantly, both with respect to symptoms and other aspects of health‐related QoL. Women suffered more than men in terms of limitation of physical activity, dyspnea, chest pain, and others aspects of health‐related QoL. There was a significant interaction between time and gender, with more improvement in men with regard to chest pain when walking uphill or quickly on level ground, when walking on level ground at the speed of other persons their own age, when under stress, and in windy and cold weather. For those parameters as well as for PAS, improvement was more marked in men than in women. In the other aspects of health‐related QoL, there was no interaction between time and gender.Conclusion: Five years after CABG, limitation of physical activity, symptoms of dyspnea, and chest pain were reduced, and various aspects of health‐related QoL had improved in both women and men. In general, women suffered more than men both prior to and after CABG; however, in some aspects the improvement was more pronounced in men. Because of the limited response rate, the results may not be applicable to a nonselected population who had undergone CABG.
Low clinical utility of routine angiographic surveillance in the detection and management of cardiac allograft vasculopathy in transplant recipients
Authors: Clague Jonathan R. , Cox Ian D. , Murday Andrew J. , Charokopos Nick , Madden Brendan P. 
Published: February 2009

AbstractBackground: Cardiac allograft vasculopathy (CAV), a form of accelerated atherosclerosis, is the major cause of late death in heart transplant recipients. Routine annual coronary angiography has been used as the standard surveillance technique for CAV in most transplant centers.Hypothesis: The aim of this study was to investigate the clinical utility of routine angiographic surveillance in the detection and management of CAV in transplant recipients.Methods: We reviewed the case notes and angiograms of 230 patients who underwent cardiac transplantation in our unit between January 1986 and January 1996 and survived beyond the first year post transplantation.Results: Significant complications secondary to angiography arose in 19 patients (8.2%). Cardiac allograft vasculopathy was present on none of angiograms performed 3 weeks post transplantation, but was identified in 9 patients (4%) at the first annual angiogram and an additional 25 patients by the fifth annual angiogram. A target lesion suitable for angioplasty was only identified in two patients, and only limited procedural success was achieved in both cases. Twenty‐five patients (11%) died during the study period, and the most common cause of late death was graft failure which occurred in 10 patients. All patients who died from graft failure had significant CAV at autopsy, but the most recent coronary angiogram had been normal in eight of these patients.Conclusions: These data clearly illustrate the limited clinical utility of routine angiographic surveillance for CAV in heart transplant recipients and prompted us to abandon this method of surveillance in our unit.
Cardiac tamponade masking pulmonary embolism
Authors: Jairath Umesh C. , Benotti Joseph R. , Spodick David H. 
Published: February 2009

AbstractThis report describes a patient admitted with shortness of breath due to cardiac tamponade, which masked concomitant pulmonary embolism that was diagnosed only after right heart pressures failed to decrease after successful pericardiocentesis. The patient was found to have widely metastatic adenocarcinoma of colon (with metastases to pericardium) and a paraneoplastic syndrome of deep vein thrombosis.
A double‐blind, multicentered study comparing the accuracy of diagnostic markers to predict short‐ and long‐term clinical events and their utility in patients presenting with chest pain
Authors: Fromm Robert , Meyer Denise , Habib Gabriel , Roberts Robert , Zimmerman Janice , Boudreaux Ann , Smalling Richard , Wun Chuan‐Chuan C. , Davis Barry 
Published: February 2009

AbstractBackground: Millions of patients present annually with chest pain, but only 10% have myocardial infarction (MI). We recently reported comparative sensitivity and specificity of available markers in the diagnosis of MI; however, optimum interpretation of marker results requires prognostic follow‐up data.Hypothesis: The study was undertaken to study the accuracy of CK‐MB subforms, troponin I and T, myoglobin, and CK‐MB in predicting clinical events at 30 days and 6 months.Methods: in all, 955 consecutive patients with chest pain were enrolled in a prospective, multicenter, double‐blind study to test the prognostic accuracy of these markers.Results: Myocardial infarction was diagnosed in 119 by CK‐MB mass criteria and unstable angina (UA) in 203 patients by clinical criteria. Follow‐up at 30 days and 6 months was available in 824 and 724 patients, respectively, with mortalities of 2.8 and 4.14%, respectively. Cumulative 6‐month mortality was 5.6% in MI, 4.4% in UA, and 3.0% in others. Revascularization was reported in 9.3% of patients by 6 months. A positive test on each of the markers except myoglobin was predictive of revascularization. The composite endpoint of death or revascularization occurred in 107 patients by 6 months and a positive result on each of the markers was predictive of this composite endpoint (p < 0.05). The relative risk of death or revascularization for patients who did not have MI but tested positive on each of the markers was > 1.0 but did not reach statistical significance.Conclusions: With the possible exception of myoglobin, each of the diagnostic markers displayed similar prognostic performance in patients with chest pain presenting to emergency departments. The most appropriate markers to triage patients with chest pain, which has both adequate early diagnostic sensitivity and prognostic accuracy, are the CK‐MB subforms.
Ibutilide: Efficacy and safety in atrial fibrillation and atrial flutter in a general cardiology practice
Authors: Eversole Amy , Hancock William , Johns Thomas , Lopez Larry M. , Richard Conti C. 
Published: February 2009

AbstractBackground: Published experience with ibutilide (IB) in randomized clinical trials reveals that conversion to sinus rhythm (SR) occurs in 31% of patients with atrial fibrillation (AF) and in 63% of patients with atrial flutter.Hypothesis: The study was undertaken to test the efficacy and safety of IB in patients with AF and with atrial flutter and to compare them with those reported in previous studies.Methods: in a general cardiology practice, 54 consecutive patients with AF or atrial flutter, no contraindication to IB, and a normal QTc interval, were treated with intravenous IB (0.4–2.0 mg). Duration of arrhythmia, left atrial (LA) size, ejection fraction (EF), time to conversion, QTc interval, and adverse drug events were determined. Patients were observed for a minimum of 6 h. Successful cardioversion was defined as arrhythmia termination within 6 h.Results: Twenty‐four of 34 (70.6%) patients with AF and 15 of 20 (75%) patients with atrial flutter converted to SR. Conversion of AF to SR was more likely to occur if duration of AF was ˜ 96 h compared with > 96 h (81 vs. 17%, respectively; p = 0.006). The mean time to arrhythmia termination was 68.8 min. Left atrial size, determined by echocardiogram, was 44 ± 13 mm in 43 patients. Patients with LA size > 45 mm had a conversion rate of 55% in both AF and flutter, compared with a conversion rate of 72% in patients with LA size < 45 mm. Ejection fraction was not a predictor of drug success. The QTc intervals were significantly prolonged after IB administration, with a mean change of 47.1 ms for successfully treated patients. Sustained polymorphic ventricular tachycardia occurred in one patient within 1 min of IB infusion, requiring electrical cardioversion to SR. This patient's serum electrolytes and QTc interval were normal prior to IB infusion; however, the QTc increased by 160 ms (from 387 to 547 ms) during drug infusion. No systemic or pulmonary emboli occurred.Conclusion: The efficacy of IB for conversion of AF to SR in this prospective observational study was considerably better than previously reported. Duration of AF remains an important predictor of conversion to SR. Complications are rare and without long‐term adverse effects.
C‐Reactive protein is a marker for a complex culprit lesion anatomy in unstable angina
Authors: Moukarbel George V. , Arnaout M. Samir A. , Alam Samir E. 
Published: February 2009

AbstractBackgrvund: The putative theory is that the clinical syndrome of unstable angina is caused by rupture of the atherosclerotic plaque with superimposed thrombus formation. It is characterized by angiographically complex coronary lesions in the majority of patients.Hypothesis: This study aimed at assessing the correlation between C‐reactive protein (CRP) and the complexity of culprit coronary lesions in unstable angina.Methods: We identified culprit lesion complexity in 96 patients with unstable angina and normal creatine kinase (CK) and CK‐MB mass. Serum concentrations of CRP (N < 5.0 mg/1) and cardiac troponin T (cTnT; N < 0.1 ng/ml) were measured on admission.Results: There was a trend toward a higher grade of anatomical complexity of the culprit lesion in patients with elevated CRP (p=0.007) and cTnT levels (p=0.027). Patients who had intermediate‐ or high‐grade lesion severity had a higher level of CRP (8.5 ±5.7 mg/1) and cTnT (0.118 ± 0.205 ng/ml) on admission than those who had normal or low‐grade lesions (5.7 ± 4.0 mg/1,0.017 ±0.021 ng/ml, respectively); Mann‐Whitney U, p=0.002 and p < 0.001, respectively. Furthermore, the likelihood of having intermediate‐ or high‐grade complexity of the culprit lesion was higher when CRP levels were elevated in all patients (p = 0.007, odds ratio [OR] = 4.286; 95% confidence interval [CI] 1.492–12.310) and in those with normal cTnT levels (p = 0.025, OR = 3.876; 95% CI 1.185–12.678). Also, higher CRP levels strongly correlated with the need for revascularization interventions (p < 0.0005).Conclusion: Elevated CRP level on admission is a marker for anatomic complexity of culprit lesions and need for revascularization interventions in unstable angina.
Event‐free survival in patients after an acute coronary event with exercise‐induced normalization of the T‐wave
Authors: Bednarz Bronislaw , Wolk Robert , Mazurek Tomasz , Stec Sebastian , Chamiec Tomasz 
Published: February 2009

AbstractBackground: Risk stratification of patients with unstable angina or non‐Q‐wave myocardial infarction (MI) is an unresolved clinical problem. The prognostic value of T‐wave normalization (TWN) during exercise has not been studied in this group of patients.Hypothesis: Event‐free survival in clinically stable patients after an acute coronary event without ST‐segment elevation can be predicted by the presence of exercise‐induced TWN.Methods: Sixty‐five patients (43 men and 22 women, mean age 62 ± 10 years) entered the study. The diagnosis of unstable angina and non‐Q‐wave MI was made in 40 and 25 patients, respectively. A treadmill exercise test was performed in all patients after clinical stabilization. The patients were divided into three groups: those with negative baseline T waves and exercise‐induced TWN (Group 1); those with negative baseline T waves, but without TWN (Group 2); and those with positive baseline T waves (Group 3). The patients were followed up for 6 months.Results: During follow‐up, serious cardiovascular complications occurred in 15 (23%) patients. These included exacerbation of ischemic heart disease (14 patients) and acute MI (1 patient). Event‐free survival was greater in patients in Group 1 (95%) than in those in Group 2 (68%, p < 0.034) or Group 3 (71%, NS). Among all patients studied, exercise‐induced TWN was predictive of event‐free survival with a sensitivity of 38% and a specificity of 93%.Conclusions: In clinically stable patients after an acute coronary event without ST‐segment elevation, exercise‐induced TWN is a specific but not sensitive predictor of event‐free survival after 6 months.
Issues in the assessment of the safety and efficacy of tenecteplase (TNK‐tPA)
Authors: Gibson C. Michael , Marble Susan J. 
Published: February 2009

AbstractWhile thrombolytic agents have demonstrated improved mortality over the use of placebo, this has come at the expense of bleeding complications such as intracranial hemorrhage (ICH). Tenecteplase (TNK‐tPA) is a novel thrombolytic agent engineered to improve upon the ease of use and safety of alteplase (t‐PA). Given its longer half‐life, TNK‐tPA can be administered as a single bolus. The dosing of TNK‐tPA has been weight optimized to enhance both safety and efficacy outcomes. Weight‐optimized TNK‐tPA dosing requires body weight estimation, which may introduce the potential for medication error. However, data from TNK‐tPA clinical trials suggest that body weight estimates can err by up to 20 kg (44 lb) without an increased risk of ICH or death. Furthermore, the results of TNK‐tPA clinical trials showed that even at the highest weight‐optimized dosage of 50 mg, ICH rates were among the lowest reported in clinical trials of thrombolytics for acute myocardial infarction. in elderly female patients of low body weight, the use of weight‐optimized TNK‐tPA lowered the risk of ICH compared with the use of t‐PA, expanding the potential use of thrombolytics to this high‐risk patient population. Tenecteplase has demonstrated clinical equivalence to t‐PA, but with a wider therapeutic margin of safety.