bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Effects of Right Ventricular Involvement on Heart Rate Variability and Ventricular Late Potentials in Acute Inferior Myocardial Infarction
Authors: Ülgen Mehmet S. , Toprak Nizamettin 
Published: July 2008

Depressed heart rate variability and presence of ventricular late potentials in acute myocardial infarction are associated with a poor prognosis. Although it is known that the abnormalities vary according to anterior or inferior location of acute myocardial infarction, the relationship with right ventricular acute myocardial infarction is not clear. The effects of right ventricular myocardial infarction on heart rate variability and ventricular late potentials are studied. The study was performed with a total of 46 patients (38 males; aged 56 ± 13 yr, range, 33 to 70 yr). Twenty-six patients had isolated inferior myocardial infarction while 20 patients had accom panying right ventricular involvement. For all patients, ambulatory Holter recordings between 24 and 48 hours following myocardial infarction, echocardiography in first 48 hours, and signal- averaged electrocardiography with submaximal exercise at average day 6 (range, 5 to 8 days) were performed. Heart rate variability and signal-averaged electrocardiography recordings were repeated after discharge (average, 39 days). During the first 24 to 48 hr, time domain parameters (SDNN, and SD1) were significantly lower (SDNN1: 62 ± 17 vs 100 ±20 ms, p = 0.001; SD: 37 ± 10 vs 50 ± 16 ms, p = 0.03) in patients with isolated inferior MI than in those with right ventricular involvement, whereas root-mean- square voltage (RMS-SD1) showed no significant difference in both groups (28 ±7 vs 35 ±8 ms). In post-discharge heart rate variability recordings, there were no significant differences (SDNN2 : 86 ± 13 vs 95 ± 15 ms; SD2: 48 ± 11 vs 57 ± 13 ms; RMS-SD 2: 32 ± 14 vs 35 ±9 ms). In pre-discharge tests, the mean value of low-amplitude signals (LAS1) was higher (26 ±9 vs 33 ± 11 ms, p = 0.03) in patients with isolated inferior myocardial infarction than in those with right ventricular involvement, while other signal-averaged electrocardiography parameters were not significantly different (filtered QRS1 102 ±5 vs 105 ± 10 ms, RMS-40, : 44 ± 13 vs 26 ± 10 μ V; incidence of ventricular late potentials: 23% vs 30%, p = NS, respectively). In post- discharge tests, all of signal-averaged electrocardiography parameters were similar in both groups (filtered QRS2: 112 ± 12 vs 114 ±8 ms, LAS2: 28 ±9 vs 32 ± 13 ms, RMS-402: 36 ± 10 vs 34 ± 11 μV, and frequency of ventricular late potentials2: 23% vs 30%, p = NS). These data suggest that right ventricular involvement in an acute inferior myocardial infarction is associated with improved heart rate variability parameters but not ventricular late potentials in pre-discharge period. However, the influence of right ventricular involvement on heart rate variability parameters fades away in the post-discharge period.
Acute Hemodynamic Effects and Angina Improvement with Enhanced External Counterpulsation
Authors: Stys Tomasz , Lawson William E. , Hui John C. K. , Lang Gudrun , Liuzzo John , Cohn Peter F. 
Published: July 2008

Enhanced external counterpulsation (EECP) is an effective noninvasive treatment for coronary artery disease. The mechanism of action is felt to be hemodynamic. The complex hemody namic effects have been simply quantified by calculating a previously described effectiveness ratio (ER). The EECP Clinical Consortium, a clinical registry of 37 centers, prospectively enrolled 395 chronic stable angina patients (79 women, 316 men, mean age 66 years) to examine the relation of the ER to posttreatment improvement in Canadian Cardiovascular Society angina class (CCS). Women and the elderly underwent planned subgroup analysis. The ER was calcu lated during the first and last hours of a 35-hour course of EECP treatment. After EECP, CCS improved by at least 1 class in 88% of patients, 87% of men and 92% of women (p = NS), and in 89% of patients ≤ 66 years and 88% of patients > 66 years old (p = NS). The initial and final ER were similar in patients with and without improvement in CCS. Significant first-hour ER differences were seen between men and women (0.96 ±0.03 vs 0.76 ±0.04, p < 0.005), and between ages ≤ 66 and > 66 years old (1.04 ±0.04 vs 0.81 ±0.03, p < 0.0001). However, all subgroups responded equally well to EECP treatment. EECP is effective in improving CCS in chronic stable angina patients; it has comparable effects in men and women and across a broad range of ages. The hemodynamic effect of EECP (ER) does not predict improvement in CCS and may indicate that other factors, such as neuro- hormonal changes, may have a significant role in mediating the observed EECP benefits.
Biochemical Risk Factors for Cardiovascular Disease in an Aged Male Population: Emerging Vascular Pathogens
Authors: Lippi Giuseppe , Arosio Enrico , Prior Manlio , Guidi Giancesare 
Published: July 2008

The progressive increase of deaths and morbidity from cardiovascular disease (CVD) in most developed societies has led to the formulation of preventive strategies and application of several diagnostic guidelines. However, there is emerging evidence that most panels and algo rithms are inadequate and require urgent revision and updating. Therefore, the aim of this study was the evaluation of a wide cardiovascular risk profile in elderly male patients with acute myocardial infarction (AMI) or peripheral occlusive disease (POD). The risk profile was assessed by measuring conventional serum lipid and lipoprotein levels and emerging parame ters : lipoprotein(a) (Lp[a]), homocysteine (Hcy), and C-reactive protein (CRP). The concentration of triglycerides, Lp(a), Hcy and the total cholesterol/high-density lipoprotein (TC/HDL) ratio were significantly higher in both classes of patients than in a popu lation of matched healthy controls and, similarly, patients with CVD displayed lower plasma values of HDL. No significant differences were observed for TC, low-density lipoprotein (LDL), and CRP. Patients with POD exhibited a marked atherogenic profile, as attested by substan tially increased values of Hcy, Lp(a), triglycerides, and TC/HDL ratio. The frequency distribu tions of Lp(a) and Hcy concentrations were markedly shifted toward upper values in both classes of patients than in controls. In multivariate regression analysis, Lp(a) and Hcy were the best predictors for AMI, whereas Lp(a), Hcy, and the TC/HDL ratio were the best predic tors for POD. Taken together, these data suggest that Lp(a) and Hcy excesses might exert a central role in the development of atherosclerotic disease in elderly male patients. Thereby, the inclusion of those tests, along with the TC/HDL ratio and other more conventional analyses in panels for the evaluation of the cardiovascular risk might be profitable in terms of effectual prevention.
Ischemic Renal Disease in Kuwait
Authors: Sheikh M. , Nampoory M.R.N. , Sinan T. , Al-Ali A. , Johny K.V. 
Published: July 2008

Ischemic renal disease (IRD) is a frequent cause of end-stage renal disease. Its prevalence is mainly known from autopsy or retrospective arteriographic studies. This prospective study was conducted in 115 subjects selected from 732 patients with advanced chronic renal failure (CRF). Only patients with clinical features suggestive of IRD were selected for this study. In addition to detailed clinical and laboratory evaluation, captopril renal scintigraphy was performed in selected cases. All subjects underwent renal arteriog raphy and all were followed up for 18.4 ± 11.4 months. Renovascular disease was seen in 15 patients and significant bilateral renal artery disease leading to IRD was observed in 13 (11.3%). Hence the prevalence of IRD in the advanced CRF patients was 1.7%. The majority of patients with IRD (8 [61%]) were above 46 years of age and there were more men than women (10:3). Atherosclerotic renovascular disease was the most common (10 [77%]), even though arthritis (1 [7.6%]), and fibromuscular dysplasia (2 [15.3%]) were also observed. Serum crea tinine at time of presentation was significantly higher in patients with IRD (784 ±292, p = 0.043) compared to those who did not have IRD (359 ± 126). Corrective procedures were performed in 5 patients. After treatment the improvement in serum creatinine in patients with IRD at 3 and 6 months (166 ±32 and 173 ±47, respectively) was significantly different (p≤0.05) compared to those who were not treated (610 ± 194 and 645 ±220, respectively). Hyper lipidemia, coronary artery disease and peripheral vascular disease were more prevalent in patients who had IRD compared to those with renal failure. The incidence of diabetes mellitus were similar in both groups. This study denotes a lower prevalence of IRD in the advanced CRF population; they had more severe renal failure at presentation but specific corrective treatment delayed progression of renal disease significantly.
Incidence of Arteriosclerotic Lesions of the Carotid Arteries in Chronic Peripheral Arterial Disease and Myocardial Infarction
Authors: Spürk P. , Angelkort B. , Selter P. 
Published: July 2008

Arteriosclerotic lesions in the carotid arteries are the main cause of ischemic cerebral infarction. Only a few studies of the incidence of carotid lesions in patients with chronic peripheral arterial disease (CPAD) and myocardial infarction (MI) have been made. Thus the aim of this study was to investigate the pathoanatomy of the carotid arteries in a representative number of patients suffering from CPAD or MI by using highly sensitive and specific noninvasive methods. Results by other authors are discussed. The authors' own study of cerebrovascular disease (CD), which covers epidemiologic aspects, is presented. Methods: "duplex scanning" and continuous-wave Doppler ultrasound. Pa tients: myocardial infarction, N = 73; chronic peripheral arterial disease, N =112; cerebrovascular disease, N = 73. Results: MI: stenosis > 50% N = 31 (42.4% of cases) - in the case of recurring infarction 67.8% of cases; CPAD: stenosis > 50% N=54 (48.2%); CD: stenosis > 50% N=35 (48%).
Intrinsic Sympathomimetic Activity Counteracts Beta-Blocker Inhibition of Renin Activation
Authors: Ruddy Michael C. , Bialy Grace B. , Kostis John B. 
Published: July 2008

Enzymatically inactive renin (IR) is the predominant circulating form of renin. Sympathetic activity may influence plasma renin activity (PRA) by regulation of the conversion of IR to active renin (AR, PRA). It has been demonstrated previously that beta blockade lowers PRA at least partly through inhibition of this conversion process. The authors hypothesized that beta blockade and intrinsic sympathomimetic activity (ISA) would have opposing effects on production of AR from its inactive precursor. Eighteen primary hypertensives (12 male, 6 female, mean age 57.7 ± 2.7) were entered in a placebo-controlled, double-blind crossover study of the effects of equipotent doses of pindolol and propranolol on mean ± SEM systolic BP, diastolic BP, heart rate, active renin (AR), total renin (TR), inactive renin (IR), and % AR/TR. Drug dose was titrated to achieve a goal DBP of 90 mmHg or less. Active renin was defined as the rate of generation of angiotensin I in 37°C plasma at pH 5.7. Total renin was determined by preincubation of plasma aliquots with 1.5 mg/mL trypsin in the presence of 5 mM benzamadine for one hour at -4°C prior to assay of renin activity. Inactive renin was calculated as TR minus AR. The BP responses achieved by dose titration of propranolol and pindolol were virtually identical at rest, indicating equivalent depressor effects of the two beta blockers. Heart rate and active renin were, however, lowered to a much greater extent with propranolol as compared with pindolol. The lack of significant pindolol-induced fall in % AR/TR suggests that this drug has little net effect on the formation of AR from IR. These findings indicate that the presence of ISA attenuates the inhibitory action of beta blockade on AR. This effect may be a result of ISA-mediated partial disinhibition of conversion of inactive prorenin at renal or extrarenal sites.
Clinical Pharmacology of Quinapril in Healthy Volunteers and in Patients with Hypertension and Congestive Heart Failure
Authors: Sedman Allen J. , Posvar Edward , Sedman Allen J. 
Published: July 2008

Quinapril is converted to quina prilat, a long-acting angiotensin con verting enzyme (ACE) inhibitor, and is currently being studied for the treatment of hypertension and con gestive heart failure. In studies of healthy volunteers, single quinapril doses of 0.625 mg to 80 mg inhibited plasma ACE activity for up to forty- eight hours. Dose-related inhibition of angiotension I pressor response oc curred after administration of quina pril doses of 0.625 mg to 20 mg. In addition, plasma renin activity in creased and aldosterone and an giotensin II concentrations decreased following single or multiple doses of quinapril. Subsequently, dose-ranging stud ies were conducted in patients with mild to moderate hypertension and congestive heart failure. Pilot studies suggested that 5 mg of quinapril given once daily had minimal antihy pertensive effect. Therefore, a defini tive, multiple-dose, placebo-con trolled, double-blind study of 5, 10, and 20 mg once daily doses of quina pril was performed. Quinapril doses of 10 mg and 20 mg were statistically significantly superior to placebo (p < 0.05) in lowering sitting diastolic blood pressure (DBP), whereas 5 mg of quinapril had only marginal clini cal effectiveness. A twenty-four-hour blood pressure monitoring study in dicated that quinapril administered once or twice daily effectively low ered DBP in patients with mild to moderate hypertension. This study suggested, however, that some pa tients may not achieve sustained re ductions in DBP over the entire twenty-four-hour interval with quinapril administered once daily and may require twice daily therapy. In studies of patients with refractory congestive heart failure, acute favor able hemodynamic effects were dem onstrated after the administration of quinapril. Quinapril doses of 2.5 mg to 10 mg increased cardiac index by 30% and decreased peripheral vascu lar resistance and pulmonary capil lary wedge pressure by 20% to 30%.
New Ultrasonic Femoropopliteal and Tibiofemoral Tests in the Study of Patency of the Deep Venous System
Authors: Barták Jaroslav Vladimir 
Published: July 2008

In phlebology, every new noninvasive examining method is of great importance. Now there are new femoropopliteal and tibiofemoral tests, described originally by Odisio in Argentina and, in a modified form applying ultrasound, introduced in Europe by Krcilek and Barták. An experiment with 25 patients was performed to verify the conclusive evidence of the tests. The diagnosis of deep venous thrombosis was examined here by clinical and femoropopliteal and tibiofemoral tests according to Odisio. Finally the diagnosis was verified by the Doppler ultrasonic method. The principle of the femoropopliteal test is the palpative perception, when the fingertips of the left hand applied to the inguen somewhat medially from the femoral artery detect the deep venous wave caused by a repeated percussion of the right hand in the fossa poplitea. Getting some experience enables one to practice simple examinations leading to verification of a suspected diagnosis of femoral thrombosis. Replacing the palpating hand by a sonde of an ultrasonic detector gave substantial precision to examinations in the test modification. Similarly the diagnosis of deep venous thrombosis of the calf was verified by the percussional tibiofemoral test, when the right hand repeatedly percussed on the calf in the course of crural veins, while the left hand palpated the transmission of the wave to the inguen. Both modifications of the femoropopliteal and tibiofemoral tests were verified by the classical ultrasonic examination method. The results were compared with those from a control group of 25 patients without clinical and phlebologic symptoms of disease of the lower limbs.
Attenuation of the Vasoconstrictor Action of Neuropeptide-Y by Calcium-Channel Blockers
Authors: Aizawa Yoshifusa , Niwano Siniti , Aizawa Masami , Tamura Makoto , Shibata Akira 
Published: July 2008

Neuropeptide-Y (NPY) was administered intracoronarily in dogs to see the modification of its vasoconstrictor action by the calcium (Ca)-channel blockers nisoldipine (0.1 μg/kg) and nifedipine (1 μg/kg). Dogs were anesthetized and the left circumflex artery was cannulated with out opening the chest by using a specially designed cannula perfused at constant pressure. The change in coronary flow due to NPY was determined before and after the systemic administration of the two Ca-channel blockers. With adminis tration of 1 to 2 nmol of NPY, coronary blood flow decreased maximally by 23.4±7.8% without changes in perfusion pressure or central venous pressure and it became significantly less after nisoldipine: 16.0±5.7% (p < 0.02). A simi lar attenuation in the decrease in coronary flow was observed in the nifedipine study: 23.2±7.5% to 12.0±6.7% (p < 0.02). A fall in systemic arterial blood pressure was observed after administration of both Ca-channel blockers, but it was significant only after nisoldipine (p < 0.01). Nonsignificant increases in heart rate were observed after both drugs. Nisoldipine seemed to attenuate the NPY-induced vasoconstriction in dogs, and its equimolar potency is about ten times that of nifedipine.
Clinical Results of Epidural Spinal Cord Electrical Stimulation in Patients Affected with Limb-Threatening Chronic Arterial Obstructive Disease
Authors: Mingoli Andrea , Sciacca Vincenzo , Tamorri Marco , Fiume Dario , Sapienza Paolo 
Published: July 2008

Between 1982 and 1990, 76 patients (33 women, 43 men, mean age 71.4±10 years) affected with limb-threatening peripheral vascular disease (claudication < 20 m: 3 patients; rest pain: 10 patients; necrosis1 smaller than 3 cm2: 28 patients ; necrosis2 larger than 3 cm2: 35 patients) not amenable to medical and/or surgical therapy, were treated by epidural spinal cord electrical stimulation (ESES). Effectiveness of ESES was evaluated by consideration of pain control, walking distance, and healing of ischemic lesions. At a mean follow-up of twenty-six months (range: one to seventy-six) 44 limbs (58%) were amputated (rest pain 2; necrosis1 13; necrosis 2 29) and 39% of necrotic lesions smaller than 3 cm2 healed. The overall limb salvage rate was 42%. Pain control was obtained in 80% of patients at the one-year and 75% at the two-year follow-up, with infrequent use of pain relievers. Despite the poor clinical results observed, the limb salvage rate testifies to the effectiveness of ESES in limb-threatening ischemia. Moreover, the authors noticed a good ESES effect on pain relief, maximal in the early and intermediate postimplant periods. In conclusion ESES must be considered the last resort in peripheral vascular disease in patients in whom medical and/or surgical therapies are ineffective or impossible. Necrotic lesions larger than 3 cm2 contraindicate, in their opinion, ESES implant.
Incidence of Carotid Artery Atherosclerosis in Patients with Coronary Artery Disease
Authors: Sanguigni Valerio , Gallù Mariacarla , Strano Antonio 
Published: July 2008

The natural history of coronary artery disease (CAD) is often complicated by cerebrovascular accidents. The real incidence of atherosclerotic lesions of carotid arteries in coronary patients is not well established. In order to detect a high-risk group for stroke development, 184 patients affected by CAD, either partially symptomatic or asymptomatic for carotid artery stenosis, underwent Echo-Doppler ultrasonography (duplex scanning) of supra-aortic branches. Significant carotid stenosis (>50%) was demonstrated in 51 subjects (27.7%); 21 subjects (41.2%) were partially symptomatic (dizziness, vertigo, lipothymia, etc), and 30 subjects (58.8%) were completely asymptomatic. The authors' data suggest that carotid disease can develop concurrently with coronary disease in a significant proportion of patients, even though completely asymptomatic. In order to obtain optimal long-term results, both coronary and carotid artery disease require appropriate evaluation and either medical or surgical management. For these reasons they recommend duplex scanning as a routine screening procedure in patients affected by CAD.
The Risk of Emergency Intestinal Bleeding Among Users of Acenocoumarin: A Population-Based Cohort Study
Authors: Cleophas Ton J. M. , Tavenier Piet , Niemeyer Menco G. 
Published: July 2008

In spite of a 10-13 fold increased risk of bleeding, standard doses of coumarin with a target prothrombin time of 2.7-4.5 INR (International Normalized Ratio) are chronically used in the Netherlands by 4-5% of the adult population forty to eighty years old, mainly for the secondary prevention of myocardial infarction. The Dutch Thrombosis Services, who monitor these patients, use less rigorous criteria than the standard studies do. It would not, therefore, be too much of a surprise if the numbers of bleeding complications in practice would be much higher than expected from the standard papers so far. To answer this question the authors studied emergency intestinal bleedings in a population-based cohort study of chronic acenocoumarin users (813 person years) and their age-matched and population-based controls (17,620 person years). Of 142 first bleedings serious enough to require immediate sigmoidoscopy, 35 were connected with acenocoumarin (25%). The overall incidences in the acenocoumarin cohort and the age-matched controls were, respectively, 4.3 and 0.6 bleedings/100 person years, RR (relative risk) 7.09, p < 0.0001. The acenocoumarin bleeders and their controls had symmetric clinical diagnoses and levels of hemoglobin. However, acenocoumarin bleeders were significantly older and more frequently males. The sex- and age-adjusted RRs were, however, only slightly different from the crude data, suggesting no major influence of these asymmetries on the overall results. Prothrombin times in the acenocoumarin bleeders were frequently higher than the target range. In the subjects initially excluded from the controls because they used alternative compounds that enhance bleedings, incidences of bleedings were calculated as well. The incidences were 0.6 bleeding/100 person years (RR 1.01, ns) for the patients receiving NSAIDS (nonsteroidal antiinflammatory drugs); 1.5 (RR 2.50, p < 0.05) for aspirin; and 1.6 (RR 2.67, 0.05 < p < 0.1) for dipyridamole. The authors conclude that in an adult population of 5% acenocoumarin users, about 25% of the emergency intestinal bleedings are connected with coumarin. The numbers of coumarin bleedings are 4-6 times higher than reported so far. They also demonstrate that the risk of bleeding from coumarin far exceeds the risks from alternative oral antithrombotic agents, such as aspirin and dipyridamole.