bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic significance of right ventricular dysfunction in patients with acute inferior myocardial infarction and right ventricular involvement
Authors: Serrano Carlos V. , Ant Ramires José Oanio F. , Ant César Lutz Oanio M. , Rati Miguel , Da Luz Protásio , Pileggi Fúlvio , Zweier Jay L. 
Published: February 2009

AbstractLittle is known about the influence of right ventricular (RV) dysfunction on prognosis of patients with acute inferior myocardial infarction (IMI) and RV involvement. Therefore, 99 consecutive patients (mean age 56.6 ± 3.4 years) with RV involvement during acute IMI were followed for a 12‐month period to clarify the influence of acute RV dysfunction on short‐ and long‐term survivals. Forty‐one patients with IMI evolved with severe arterial hypotension due to RV dysfunction, while 58 patients had no hemodynamic impairment due to RV involvement. Basal hemodynamic data (mean ± SD) for patients with RV dysfunction were blood pressure (BP) 92/59 ± 22/20 mmHg, systemic vascular resistance (SVR) 2314 ± 252 dynes·s·cm−5, and cardiac index (CI) 1.3 ± 0.31/min/m2. Patients without RV dysfunction demonstrated BP 113/74 ± 20/16 mmHg (p≤0.05), SVR 1324 ± 354 dynes·s·cm−5 (p≤0.01), and CI 2.6 ± 0.5 1/min/m2 (p≤0.05). Angiographic differences noted were that hemodynamically compromised patients showed lower RV ejection fractions (0.27 ± 0.08) than patients without hemodynamic disturbance [0.41 ± 0.11 (p≤0.05)]; however, left ventricular ejection fractions were 0.48 ± 0.10 and 0.52 ± 0.12, respectively. Short‐ and long‐term mortality rates were assessed during the follow‐up period. Patients with hemodynamic impairment due to RV infarction had a higher mortality rate for the first month and for 11 subsequent months post MI than patients without hemodynamic impairment, that is, 24.4 vs. 6.9 and 14.6 (p≤0.05) vs. 3.4% (p≤0.05), respectively. These data suggest that decreased RV ejection fraction possibly is linked with significantly reduced short‐ and long‐term survival in patients with RV involvement during acute IMI.
Effects of treatment with lovastatin and pravastatin on daytime cognitive performance
Authors: Gengo Fran , Cwudzinski Donna , Kinkel Peter , Block Gilbert , Stauffer Laura , Lines Chris 
Published: February 2009

AbstractThe HMG‐CoA reductase inhibitors lovastatin and pravastatin have both proven to be effective and well tolerated in the treatment of hypercholesterolemia. To evaluate whether lovastatin or pravastatin might affect daytime cognitive function, a double‐blind, placebo‐controlled, two‐period, incomplete block, crossover study was performed in 36 patients (24 per treatment) with primary hypercholesterolemia. Patients received placebo, Iovastatin (40 mg), or pravastatin (40 mg) for 4 weeks. Following a 1‐week washout period, patients were crossed over to either lovastatin, pravastatin, or placebo for an additional 4 weeks. Mental performance tests (digit symbol substitution, choice reaction time, auditory vigilance, selective reminding word recall, finger tapping), visual analogue rating scales, and the Profile of Mood States were administered before test drug administration and after 2 and 4 weeks of each treatment. After 4 weeks, no statistically significant differences between treatments in changes from baseline were observed on any parameter with the exception of digit symbol substitution, for which lovastatin and pravastatin were both significantly better than placebo but did not differ from each other. Low‐density lipoprotein cholesterol was reduced 38% by lovastatin and 30% by pravastatin. In summary, neither of these chemically distinct HMG‐CoA reductase inhibitors impaired daytime cognitive performance after 4 weeks of treatment in patients with primary hypercholesterolemia.
Transesophageal echocardiographically guided atrial transseptal catheterization in patients with normal‐sized atria: Incidence of complications
Authors: Hahn Kenneth , Gal Rami , Sarnoski Joseph , Kubota James , Schmidt Donald H. , Bajwa Tanvir K. 
Published: February 2009

AbstractThe incidence of cardiac complications from atrial transseptal catheterization has never been quantified in patients with normal‐sized atria. Series defining the complication rate are derived from diseased hearts with structural changes that may alter the complication rate of the procedure. The generation of a standardized incidence of perforation in a population of structurally normal atria has important implications. A total of 46 atrial transseptal catheterizations guided by transesophageal echocardiography (TEE) for radiofrequency ablation of left‐sided accessory pathways was performed in 42 patients during a 3‐year period (1990–1993). Clinical and echocardiographic data were analyzed, with special attention given to TEE reports pre‐ and post‐transseptal catheterization. Only one complication occurred in the 46 procedures (2.2%): a perforation of the left atrium that led to pericardial effusion and cardiac tamponade. In a small series of patients with normal sized atria, we have demonstrated that TEE‐guided transseptal catheterization is a procedure with a low complication rate.
Effect of simvastatin on Lp(a) concentrations
Authors: Haffner Stevhn , Orchard Trevor , Stein Evan , Schmidt Donald , Labelle Patrice 
Published: February 2009

AbstractThe effect of HMG‐CoA reductase inhibitors on Lp(a) concentrations is controversial, with some studies showing an increase and others showing no effect on Lp(a) concentrations. Many of these studies have been limited by small sample size and the lack of a prospective design. We evaluated the effect of four treatments: (1) placebo, (2) simvastatin 10 mg PO QPM, (3) simvastatin 20 mg PO QAM, and (4) simvastatin 20 mg PO QPM on Lp(a) concentrations in a prospective, randomized, controlled clinical trial of 24 weeks in 343 subjects in 28 clinical sites in the United States. Simvastatin was not associated with a change in Lp(a) concentrations relative to placebo. These results were not affected by controlling for race, initial Lp(a) level, or urinary albumin excretion. Simvastatin significantly reduced low‐density lipoprotein (LDL) cholesterol levels (10 mg PO QPM: ‐ 27.6%; 20 mg PO QAM: ‐ 28.1%; and 20 mg PO QPM: ‐ 34.3%, all p<0.001). It was concluded that in a large, randomized, controlled trial, simvastatin does not affect Lp(a) levels but markedly lowers LDL cholesterol levels.
High‐density lipoprotein cholesterol level and smoking modify the prognosis of patients with coronary vasospasm
Authors: Miwa Kunihisa , Fujita Masatoshi , Miyagi Yuko , Inoue Hiroshi , Sasayama Shigetake 
Published: February 2009

AbstractA cardiovascular event analysis was performed in a subset of 80 consecutive patients with vasospastic coronary artery disease. During the follow‐up period (30 ± 2 months, mean ± SD), 9 patients had vascular accidents, including acute myocardial infarction, unstable angina, and stroke (Group A), while the remaining 71 patients were eventfree (Group B). Serum total‐cholesterol, low‐density lipoprotein cholesterol, and triglyceride levels were not different between the two groups at the baseline as well as after follow‐up. However, the HDL‐C level at baseline was significantly lower in Group A (33.5 ± 2.6 mg/dl) than in Group B (41.9 ± 1.7 mg/dl, p < 0.05). The HDL‐C level increased significantly during the follow‐up in Group B (ΔHDL‐C: 6.2 ± 1.2 mg/dl, p < 0.01), but not in Group A (ΔHDL‐C: ‐ 3.2 ± 2.7 mg/dl). The HDL‐C level after follow‐up was significantly lower in Group A (30.3 ± 2.9 mg/dl) than in Group B (48.1 ± 1.5 mg/dl, p < 0.01). Current smokers at the end of the follow‐up period were more prevalent in Group A (67%) than in Group B (11%, p < 0.01). Cardiovascular accidents occurred more often in current smokers (6/14, 43%) at the end of the followup than in current nonsmokers, including quitters (3/66, 5%; p < 0.05). The HDL‐C level was increased significantly (ΔHDL: 6.2 ± 1.3 mg/dl, p < 0.01) in the latter patients, but not in the former (ΔHDL: –0.4 ± 2.9 mg/dl). Cardiovascular accidents were significantly (p < 0.01) more common in patients with lower (< 40 mg/dl) HDL‐C levels (7/23, 30%) than in those with higher HDL‐C levels (2/57, 4%) after followup, although this difference was not significant when patients were divided according to these levels at baseline. These results indicated that a low HDL‐C level after follow‐up is more predictive of subsequent cardiovascular events than at baseline. The increase in HDL‐C level attained by smoking cessation appears important for a favorable prognosis.
Torsade de pointes caused by high‐dose intravenous haloperidol in cardiac patients
Authors: Di Salvo Thomas G. , O'Gara Patrick T. 
Published: February 2009

AbstractIntravenous haloperidol is the agent of choice for controlling severe agitated delirium in seriously ill cardiac patients in many institutions. Prior reports have proposed that high‐dose intravenous haloperidol may be without untoward effects in these patients. Recently, however, a few reports of significant QTc prolongation and torsade de pointes as complications of high‐dose intravenous haloperidol therapy have appeared. The present report describes three patients with definite haloperidol‐induced QTc prolongation and torsade. In each case, QTc prolongation preceded the arrhythmia and disappeared following the discontinuation of haloperidol. Neither electrolyte imbalance, therapy with other cardiac drugs, bradycardia, ischemia, left ventricular dysfunction, nor other known cause of torsade was present in these patients. It is hypothesized that QTc prolongation and torsade likely are idiosyncratic, unpredictable reactions to high‐dose haloperidol in select patients. Careful serial electrocardiographic monitoring and prompt discontinuation of the drug should suffice to prevent this relatively uncommon, life‐threatening complication of high‐dose intravenous haloperidol.
Update on the treatment of hypercholesterolemia, with a focus on hmg‐coa reductase inhibitors and combination regimens
Authors: Ginsberg Henry N. 
Published: February 2009

AbstractNumerous studies involving patients with hypercholesterolemia have demonstrated that reduction of lipid levels markedly reduces morbidity and mortality from cardiovascular disease. Diet alone may enable patients without established disease to attain target lipid levels, but pharmacotherapy generally is necessary for those with coronary artery disease. Choice of a suitable agent for monotherapy—a bile acid resin, niacin, or an HMG‐CoA reductase inhibitor—may be determined by patient phenotype. For resistant cases, therapy combining an HMG‐CoA reductase inhibitor with another agent generally is effective and well tolerated.
Constrictive pericarditis: Its history and current status
Authors: Fowler Noble O. 
Published: February 2009

AbstractThe diagnosis of constrictive pericarditis remains a challenge because it is often mimicked by restrictive cardiomyopathy. The last few years have seen numerous advances in our ability to differentiate between these two conditions which often have similar physical findings and hemodynamics. This review begins with a brief history of constrictive pericarditis; this is followed by an extensive discussion of newer etiologies, and then the classical clinical history and physical examination findings are described. Radiologic, electrocardiographic, and angiographic findings are discussed. The hemodynamics of constrictive pericarditis are reviewed. Recent results of echocardiographic and echo‐Doppler investigations are presented. Emphasis is placed upon the limitations of M‐mode echocardiography in the diagnosis of constrictive pericarditis. The value of echocardiographic Doppler studies of mitral and tricuspid flow velocity patterns, as well as of those in the pulmonary veins and hepatic veins, is described. Nuclear ventriculograms and angiocardiograms tend to show more rapid ventricular filling in constrictive pericarditis than in restrictive cardiomyopathy. Although only a small number of patients has been studied, these evaluations seem to have merit in separating restrictive cardiomyopathy from constrictive pericarditis. The role of computed tomography scanning and magnetic resonance imaging studies of pericardial thickness in confirming the presence of constrictive pericarditis is discussed. Abnormal pericardial thickening (> 3 mm) confirms the diagnosis of constrictive pericarditis, but only if the characteristic hemodynamic pattern is present. The usefulness of endomyocardial biopsy in recognizing specific varieties of restrictive cardiomyopathy is presented. The topic of occult constrictive pericardial disease is discussed briefly. A discussion of the timing of pericardial resection for the treatment of constrictive pericarditis ends the review.
Anatomical definition of aortic root abscesses by transesophageal echocardiography: Planning a surgical strategy using homograft valves
Authors: Brecker Stephen J. D. , Jin Xu Y. , Yacoub Magdi H. 
Published: February 2009

AbstractInfective endocarditis of the native or a prosthetic aortic valve may be complicated by abscess cavity development in the aortic root, and successful treatment depends upon early diagnosis, clear anatomical definition preoperatively, and maintaining sterility of the second implant. Homograft valves offer many advantages in this setting. Timing of surgery and the choice of the particular technique depends on accurate characterization of the anatomical details of the abscess. Five cases of paravalvular aortic root abscess in the setting of prosthetic valve endocarditis are described. In each case the diagnosis was made with transesophageal echocardiography, and the information was used in planning the operative procedure of homograft valve replacement. This strategy is proposed as optimal management of this potentially lethal condition.
Electrolyte disturbances in chronic heart failure: Metabolic and clinical aspects
Authors: Dei Cas Livio , Metra Marco , Leier Carl V. 
Published: February 2009

AbstractThe pathophysiology of congestive heart failure (CHF) includes conditions (e.g., activation of the renin‐angiotensin‐aldosterone system) which, when combined with CHF therapies, make patients afflicted with this syndrome quite susceptible to electrolyte disturbances. The most commonly encountered are hyponatremia, hypokalemia, and hypomagnesemia. These derangements are of vast clinical importance; their development not only represents an immediate threat to the CHF patient (e.g., dysrhythmias secondary to hypokalemia), but are also indicative of underlying pathophysiologic events, an unfavorable clinical course, and occasionally an adverse therapeutic response. The optimal care of the CHF patient includes the recognition and management of these electrolyte disturbances.
Neuroendocrine changes in heart failure and their clinical relevance
Authors: Parmley William W. 
Published: February 2009

AbstractThe pathophysiology of heart failure is closely associated with neuroendocrine changes. Activation of these humoral systems apparently serves as a compensatory mechanism for the failing circulation. However, overshoot of such mechanisms may further depress cardiac function by increasing afterload, resulting in a vicious cycle of reflex neuroendocrine activation. Corollary decreases in renal function activate the renin‐angiotensin‐aldosterone system as well, which further contributes to the cycle of downward‐spiralling cardiac function. Many hormonal factors are increased in congestive heart failure. While some influences are vasodilatory, the net effect is marked vasoconstriction. The level of activation of these systems apparently corresponds to the severity of heart failure. Furthermore, elevated levels of these hormones, including norepinephrine, atrial natriuretic factor, plasma renin, and plasma arginine vasopressin, may play a more direct role in worsening heart failure. In fact, elevated catecholamine levels are directly related to prognosis. Catecholamines increase myocardial oxygen demand and are also arrhythmogenic. Oral catecholamines and phosphodiesterase inhibitors, which work by similar mechanisms, have yielded increased mortality rates in heart failure trials. In contrast, mortality rates are reduced in patients treated with angiotensin‐converting enzyme inhibitors. Thus, it is clear that neuroendocrine changes are not only a marker of the severity of heart failure, but also directly worsen it. Interventions that antagonize or diminish these neuroendocrine changes apparently benefit patients with heart failure.
Early hemodynamic effects at rest with acute and chronic isosorbide dinitrate treatment in patients with ischemic heart disease
Authors: Jørgensen Lars H. , Thaulow Erik , Refsum Harald E. 
Published: February 2009

AbstractAsymmetric dosage regimens are used to circumvent development of nitrate tolerance and are believed to restore totally the hemodynamic responsiveness to an acute dosage of nitrates. This study assessed invasively the hemodynamics during supine rest before and for 50 min after peroral 30 mg isosorbide dinitrate (ISDN) in 16 patients with stable ischemic heart disease; 8 previously untreated patients (NT group) and 8 patients treated asymmetrically b.i.d. with 30 mg ISDN for 14 days prior to the invasive investigation (T group). Before initiation of treatment, both groups had identical mean arterial pressure (MAP) and heart rate (HR). On the day of invasive investigation, before intake of ISDN, MAP was higher in the T group but unchanged in the NT group. After the intake of ISDN, right atrial pressure (RAP), mean pulmonary arterial pressure, and pulmonary arterial wedge pressure declined markedly within 10 to 15 min in both groups, while MAP showed a more protracted decline, reaching a new level only after 25 to 30 min. In the NT group, HR accelerated markedly and remained elevated throughout the observation period, whereas in the T group HR showed no significant alteration after ISDN intake. At the end of the observation period, the cardiac index (CI) was definitely reduced in the NT group, but remained unchanged in the T group, while the systemic vascular resistance index was unchanged in the former and was clearly reduced in the latter. It is concluded that the fall in MAP in the NT group was solely due to a fall in CI, and that the decline in RAP and venous return in the NT group induced neurohumoral reflexes leading to a rise in HR and prevention of arterial dilation, whereas in the T group, already influenced by chronic treatment, such acute counterregulatory responses were markedly attenuated or absent.
Advanced cardiac life support: Update on recent guidelines and a look at the future
Authors: Tucker Kelly J. , Larson James L. , Idris Ahamed , Curtis Anne B. 
Published: February 2009

AbstractThe objectives of this article are to provide an update of the American Heart Association (AHA) 1992 National Conference guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiac care and to review the investigation and development of new methods of CPR which may be considered in future recommendations. Despite an organized approach to sudden cardiac arrest, survival in patients receiving CPR is in the range of 5–15%. The new AHA guidelines recommend standard manual CPR performed at a rate of 80–100 compressions/min and organized algorithms of advanced cardiac life support. These guidelines stress widespread community training and rapid response in the following sequence: (1) recognition of early warning signs, (2) activation of the emergency medical system (EMS), (3) basic CPR, (4) early defibrillation, (5) intubation, and (6) intravenous medication. Several new recommendations pertain specifically to in‐hospital care and are, therefore, particularly relevant to physician management of cardiac arrest. The best predictor of survival in patients requiring circulatory support after cardiac arrest is attainable coronary and cerebral perfusion. Unfortunately, the minimal levels of end‐organ perfusion required to sustain life are often difficult or impossible to achieve with standard manual cardiopulmonary resuscitation and several new techniques have therefore been introduced. The most promising of these techniques are (1) interposed abdominal compression, (2) pneumatic vest, and (3) active compression‐decompression resuscitation. Each of these techniques offers unique advantages when compared with standard manual cardiopulmonary resuscitation. The 1992 National Conference recommendations provide a rational framework for the resuscitation of cardiac arrest victims. New methods of cardiopulmonary resuscitation are now available and investigation into these methods continues. In the future, these modalities may be incorporated in newer guidelines and be available on a widespread basis to supplement our current approach to cardiac arrest.
Left ventricular outflow tract pulmonary artery fistula in endocarditis
Authors: Mizock Barry A. , Nachman Sami A. , Varquez Mir 
Published: February 2009

AbstractPatients with infective endocarditis are at risk for the development of a fistulous communication between chambers or great vessels of the heart. The presence of a continuous murmur may suggest the diagnosis. The first case of aortic valve endocarditis complicated by the development of a fistulous communication between the left ventricular outflow tract and the pulmonary artery is reported. Transesophageal Doppler echocardiography did not detect the defect preoperatively. However, pulmonary artery catheterization revealed very high mixed venous oxygen saturation which supported the presence of a left‐to‐right shunt.
Antiphospholipid antibodies in heart transplant recipients
Authors: Mcintyre John A. , Waoenknecht Dawn R. , Page Faulk W. 
Published: February 2009

AbstractAntiphospholipid antibodies (aPA) are found in patients with systemic lupus erythematosus, aPA syndrome, myocardial infarction, and stroke. The presence of aPA may predict recurrent events in certain victims of heart attack and stroke. Blood samples from 105 cardiac transplant recipients (81 men. 24 women) were tested by enzyme‐linked immunosorbent assay (ELISA) for the presence of IgG, IgM, and IgA aPA to phosphatidylserine (PS), cardiolipin (CL), and phosphatidylethanolamine (PE). Patients' ages ranged from 17 to 70 years (mean 51 years). Collection times ranged from Day 1 to 9 years post transplant (mean 36 months). All patients received triple immunosuppressive therapy. We report our aPA ELISA results in multiples of the normal median (MoM) of the OD405 values calculated for 252 healthy individuals. A positive MoM is greater than the MoM that encompasses 95% of the controls; for example, above 3 MoM is considered positive for IgG anti‐CL, IgA anti‐PS, and CL. Above 4 MoM is positive for IgG anti‐PS and PE and IgM anti‐PS and CL. Thirty‐nine patients had IgG anti‐PS (range 4.1–14.8 MoM), 63 had IgG anti‐CL (3.1–9.4 MoM), 7 had IgM anti‐PS (4.1–12.1 MoM), 1 had IgM anti‐CL (14 MoM), 47 had IgA anti‐PS (3.1–13.1 MoM), and 58 had IgA anti‐CL (3.1–11.5 MoM). In our patient population, the incidence of IgG and/or IgA aPA was significantly higher (p < 0.001) than IgM. Few patients showed specificity for either PS, CL, or PE, and many were positive with more than one antibody iso‐type. Because aPA were elevated in these patients, we investigated pretransplant serum samples which were available from 79 of the 105 recipients, and found aPA in 52 of 79 (66%) patients before transplantation. Longitudinal studies were done in three patients: two had increasing IgA aPA, beginning on Days 13 and 26 post transplant, whereas the third patient showed an increased aPA on Day 8 but a decrease on Day 23. Studies are in progress to determine whether a correlation exists between the presence of aPA, immunocytochemical (biopsy) findings, and clinical outcome.