bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prolongation of the QT interval in children with liver failure
Authors: Fishberger Steven B. , Rossi Anthony F. , Pittman Nanci S. 
Published: February 2009

AbstractBackground: Alcoholic liver disease has been associated with QT prolongation and sudden cardiac death.Hypothesis: We evaluated children with hepatic failure to determine whether they have abnormalities of ventricular repolarization.Methods: Between October 1990 and January 1996, 38 pediatric patients (mean age 6.5 ± 7.2 years) underwent evaluation for liver transplantation, including a 12‐lead electrocardiogram and an echocardiogram. All patients had normal serum electrolytes, calcium, and magnesium at the time of cardiac evaluation and were not on any medications known to prolong repolarization. Follow‐up electrocardiograms were performed on all survivors with QT prolongation following liver transplantation.Results: Among those evaluated, seven (18%) were noted to have a prolonged QT interval corrected for rate (QTc> 450 ms; range 460–560 ms). All had a structurally normal heart, except one with an atrial and ventricular septal defect. When compared with patients with a normal QT interval, there was no significant difference in serum indices of liver function or indication for liver transplantation. None of the patients developed a ventricular arrhythmia. Two patients with a prolonged QTc died prior to transplant and another died immediately after surgery. All four survivors had normalization of the QTc following liver transplantation.Conclusion: QTc prolongation can be seen in a significant number of children with hepatic failure. While the mechanism is not known, it appears to be reversible following liver transplantation.
Spontaneous multivessel coronary artery dissection: Repeated presentation in a healthy postmenopausal woman
Authors: Judkins David A. , Capone Robert J. , Houghton Jan L. , Miller Stuart J. 
Published: February 2009

AbstractSpontaneous coronary artery dissection is a rare cause of acute myocardial infarction which is infrequently diagnosed antemortem. Most previously reported cases were found in women of whom a significant proportion presented during pregnancy or the postpartum period. We describe the first antemortem case of spontaneous coronary artery dissection, unrelated to pregnancy or the postpartum state, which ultimately resulted in diffuse involvement of both the left and right coronary arteries over a period of 4 months. Pathophysiology and case management of this disorder are discussed.
Clinical relevance of chest pain during dobutamine stress echocardiography in women
Authors: Sizemore Clay , Lewis Jannet F. 
Published: February 2009

AbstractBackground: Dobutamine stress echocardiography (DSE) is commonly used for diagnosis and management of patients with known or suspected coronary artery disease. Chest pain occurring during DSE potentially provides additional diagnostic accuracy. Our experience suggests that chest pain occurs frequently in women undergoing DSE.Hypothesis: It was the purpose of this study to determine the frequency with which chest pain occurs in women undergoing DSE and the relation to inducible ischemia or coronary artery stenosis.Methods: To determine the prevalence and clinical significance of chest pain during DSE, we reviewed the records of 154 consecutive women undergoing DSE in our laboratory. Of these, 59 patients (37.5%) also underwent coronary angiography. The presence or absence of chest pain was correlated with ECG changes, left ventricular wall motion abnormalities during DSE, and coronary stenosis by angiography.Results: Forty‐one women (26%) developed chest pain during DSE. Patients experiencing chest pain were older (58.5 ± 9.3 vs. 54.9 ± 12.6; p = 0.05), and had lower resting heart rates (71 ± 12.2 vs. 77.9 ± 14.9; p = 0.008), but received similar maximum doses of dobutamine and reached comparable peak heart rates (131.1 ± 17.4 vs. 133.5 ± 21.7; p = NS). Patients with chest pain more commonly exhibited ST‐segment depression ≥ 1 mm during dobutamine infusion (13/41, 32%, vs. 17/113, 15%; p = 0.02), but chest pain showed no statistically significant correlation with abnormal DSE or with coronary stenosis.Conclusions: In women undergoing DSE, chest pain occurs in 26% and does not appear to be related to inducible myocardial ischemia. Electrocardiographic changes occur more frequently in patients who experience chest pain, but are also often unrelated to inducible myocardial ischemia.
Stress long‐axis function in coronary artery spasm
Authors: Cooke Fiona J. , Clague Jonathan , Henein Michael Y. 
Published: February 2009

AbstractIn a patient with prior myocardial infarction who had complained of frequent angina repeat arteriograms proved normal coronary arteries. Both ECG exercise testing and thallium scanning excluded ischemia. Resting echocardiogram showed increased distal septal and right ventricular apical myocardial echo intensity. Dobutamine stress echo demonstrated right ventricular and posteroseptal abnormalities consistent with ischemia. Repeat angiogram with ergonovine confirmed distal right coronary spasm.
Treatment of a coronary artery aneurysm with a novel stent
Authors: Kolettis Theofilos M. , Kyriakides Zenon S. , Kremastinos Dimitrios T. 
Published: February 2009

AbstractWe report a case of a prominent aneurysm of the right coronary artery secondary to atherosclerotic coronary artery disease. The aneurysm was complicated by recurrent myocardial infarction despite optimal medical treatment. It was successfully treated with coronary artery stenting, using a novel device, consisting of two stents with a layer of expandable graft material placed between them. Follow‐up angiography 6 months after the procedure showed a sustained excellent result.
Long‐term prognosis of late spontaneous reperfusion after failed thrombolysis for acute myocardial infarction
Authors: Ishihara Masaharu , Sato Hikaru , Tateism Hironobu , Kawagoe Takuji , Shimatani Yuji , Ueda Kentarou , Noma Kensuke , Yumoto Akihisa , Nishioka Kenji 
Published: February 2009

AbstractBackground: Early reperfusion improves left ventricular (LV) function and survival after acute myocardial infarction (MI). Thrombolytic therapy achieves early patency of the infarct artery in about two‐thirds of patients. In nearly half of the remaining patients, in whom early reperfusion was not achieved with thrombolytic therapy, the infarct artery might reopen by the time of predischarge angiography. However, the impact of such late spontaneous reperfusion after failed thrombolytic therapy on LV function and long‐term survival remained unclear.Hypothesis: This study was undertaken to assess implication of late spontaneous reperfusion after failed thrombolytic therapy on LV function and long‐term survival after acute MI.Methods: The study consisted of 198 patients with anterior acute MI who underwent thrombolytic therapy and predischarge angiography: 160 patients with infarct artery patent early and late after therapy (persistent patency), 17 patients with infarct artery occluded early after therapy but patent at predischarge angiography (late spontaneous reperfusion), and 21 patients with infarct artery occluded early and late after therapy (persistent occlusion).Results: Persistent patency was associated with enhanced improvement in LV ejection fraction (7.7 ± 11.8%) compared with late spontaneous reperfusion (0.0 ± 9.6%, p = 0.03) and persistent occlusion (‐1.4 ± 9.7%, p = 0.003). Persistent patency was associated with better long‐term survival than with late spontaneous reperfusion (p < 0.001) and persistent occlusion (p < 0.001). Multivariate analysis comparing persistent patency and late spontaneous reperfusion showed that early reperfusion was an independent predictor of long‐term survival.Conclusion: Late spontaneous reperfusion after failed thrombolytic therapy was associated with poor LV function and long‐term survival, emphasizing the importance of early reperfusion.
Serial circulating concentrations of c‐reactive protein, interleukin (il)‐4, and il‐6 in patients with acute left heart decompensation
Authors: Sato Yukihito , Takatsu Yoshiki , Kataoka Kazuaki , Yamada Tasuku , Taniguchi Ryoji , Sasayama Shigetake , Matsumori Akira 
Published: February 2009

AbstractBackground: Interleukin (IL)‐6 has recently been shown to have negative inotropic effects, and several studies have reported increases in circulating concentrations of this cytokine in patients with depressed left ventricular ejection fraction and chronic left heart failure. However, most previous clinical studies have measured cytokines in compensated chronic heart failure.Hypothesis: The purpose of this study was to examine the temporal evolution of circulating concentrations of C‐reactive protein (CRP) and cytokines in patients with cardiomyopathy and acute cardiac decompensation, free of infection and unstable angina.Methods: The time course of circulating concentrations of CRP, an anti‐inflammatory cytokine interleukin (IL)‐4, and a proinflammatory cytokine IL‐6 were studied in eight patients with cardiomyopathy and acute cardiac decompensation in the absence of infection or unstable angina. Control samples were obtained from eight age‐matched asymptomatic subjects.Results: Increased circulating concentrations of CRP (2.6 ± 0.8 mg/dl), IL‐4 (164.6 ± 36.5 pg/ml), and EL‐6 (17.1 ± 5.1 pg/ml) were found in all eight patients during acute cardiac decompensation; these values decreased significantly with the resolution of symptoms of cardiac decompensation (0.5 ±0.1 mg/dl, 77.8 ± 23.6 pg/ml, 2.3 ± 0.1 pg/ml, respectively, p< 0.05 for both). There was a significant correlation between peak CRP and peak IL‐6 (p<0.05).Conclusions: In patients with acute left heart decompensation in the absence of infection or coronary events, CRP, IL‐4, and IL‐6 increased and returned toward normal levels as the symptoms of heart failure resolved. Since the changes in concentrations of CRP, IL‐4, and IL‐6 in patients with heart failure are dynamic, the distinction between compensated and decompensated state is important when discussing the significance of acute reactive proteins or cytokines in the pathogenesis of heart failure.
Rest and exercise hemodynamics before and after valve replacement‐A combined doppler/catheter study
Authors: Inselmann G. , Jahns R. , Capell A. J. , Eigel P. , Nellessen U. , Ludwig J. 
Published: February 2009

AbstractBackground: Hemodynamic improvement is a common finding following valve replacement. However, despite a normally functioning prosthesis and normal left ventricular ejection fraction, some patients may show an abnormal hemodynamic response to exercise.Methods: In a combined catheter/Doppler study, rest and exercise hemodynamics were evaluated in 23 patients following aortic (n = 12) (Group 1) or mitral valve (n = 11) (Group 2) replacement and compared with preoperative findings. Patient selection was based on absence of coronary artery disease and left ventricular failure as shown by preoperative angiography. Cardiac output, pulmonary artery pressure, pulmonary capillary pressure, and pulmonary resistance were measured by right heart catheterization, whereas the gradient across the valve prosthesis was determined by Doppler echocardiography. Postoperative evaluation was done at rest and during exercise. The mean follow‐up was 8.2 ± 2.2 years in Group 1 and 4.2 ± 1 years in Group 2.Results: With exercise, there was a significant rise in cardiac output in both groups. In Group 1, mean pulmonary pressure/capillary pressure decreased from 24 ± 9/18 ± 9 mmHg preoperatively to 18 ± 2/12 ± 4 mmHg postoperatively (p < 0.05), and increased to 43 ± 12/30 ± 8 mmHg with exercise (p < 0.05). The corresponding values for Group 2 were 36 ± 12/24 ± 6 mmHg preoperatively, 24 ± 7/17 ± 6 mmHg postoperatively (p < 0.05), and 51 ± 2/38 ± 4 mmHg with exercise (p < 0.05). Pulmonary vascular resistance was 109 ± 56 dyne·s·cm‐5 preoperatively, 70 ± 39 dyne·s·cm‐5 postoperatively (p < 0.05), and 70 ± 36 dyne·s·cm‐5 with exercise in Group 1. The corresponding values for Group 2 were 241 ± 155 dyne·s·cm‐5, 116 ± 39 dyne·s·cm‐5 (p < 0.05), and 104 ± 47 dyne·s·cm‐5. There was a significant increase in the gradients across the valve prosthesis in both groups, showing a significant correlation between the gradient at rest and exercise. No correlation was found between valve prosthesis gradient and pulmonary pressures.Conclusion: Exercise‐induced pulmonary hypertension and abnormal left ventricular filling pressures seem to be a frequent finding following aortic or mitral valve replacement. Both hemodynamic abnormalities seem not to be determined by obstruction to flow across the valve prosthesis and may be concealed, showing nearly normal values at rest but a pathologic response to physical stress.
John B. Barlow: Master clinician and compleat cardiologist
Authors: Cheng Tsung O. 
Published: February 2009

AbstractThis paper reports the case of a 76‐year‐old man in whom atrial flutter with varying atrioventricular block and intermittent right bundle‐branch block was found. This is the first report on tachycardia‐dependent right bundle‐branch block associated with supernormal conduction in a case of atrial flutter. When an impulse is conducted to the ventricles beyond 0.72 s after a QRS complex of right bundle‐branch block configuration, the impulse falls after the abnormally long effective refractory period of the right bundle branch and passes through the right bundle branch. When the conducted impulse occurs within 0.72 s after a QRS complex of right bundle‐branch block configuration, the impulse usually falls in the refractory period and is blocked in the right bundle branch; however, only when the impulse occurs 0.48 or 0.49 s after that does it fall in the supernormal period and passes through the right bundle branch. The findings in the present report strengthen our previous suggestion that the presence of supernormal conduction plays an important role in the initiation of reentrant ventricular tachycardia.
Amiodarone: What have we learned from clinical trials?
Authors: Naccarelli Gerald V. , Wolbrette Deborah L. , Dell'Orfano Joseph T. , Patel Hemantkumar M. , Luck Jerry C. 
Published: February 2009

AbstractAmiodarone is an antiarrhythmic agent commonly used in the treatment of supraventricular and ventricular tachyarrhythmias. This paper reviews clinical trials in which amiodarone was used in one of the treatment arms. Key post‐myocardial infarction trials include EMIAT and CAMIAT, both of which demonstrated that amiodarone reduced arrhythmic but not overall mortality. In patients with congestive heart failure (CHF), amiodarone was associated with a neutral survival in CHF/STAT and improvement in survival in GESICA. In patients with nonsustained ventricular tachycardia, the MADIT trial demonstrated that therapy with an implantable cardioverter‐defibrillator (ICD) improved survival compared with the antiarrhythmic drug arm in such patients, most of whom were taking amiodarone. In sustained VT/VF patients, the CASCADE trial demonstrated that empiric amiodarone lowered arrhythmic recurrence rates compared with other drugs guided by serial Holter or electrophysiologic studies. Several trials including AVID, CIDS, and CASH have demonstrated the superiority of ICD therapy compared with empiric amiodarone in improving overall survival. Clinical implications of these trials are discussed.
Intravenous optison® (FS069) enhances pulmonary vein flow velocity signals: A multicenter study
Authors: Ellahham Samer , Hausnerova Eva , Gottdiener John 
Published: February 2009

AbstractBackground: Pulmonary vein spectral Doppler signals to characterize ventricular diastolic and systolic function, though often difficult to obtain, can be enhanced using contrast agents.Hypothesis: The objective of this study was to determine the efficacy of the intravenous contrast agent Optison® for enhancement of Doppler signals in patients with poor signals on two‐dimensional echocardiographic examinations.Methods: Enhancement of pulmonary venous flow was evaluated in 191 patients at 0.2, 0.5, 3.0, and 5.0 ml per injection.Results: Greatest contrast enhancement for right and left pulmonary veins was observed at the highest doses. At 0.5 ml, conversion from inadequate to adequate was observed in right and left pulmonary veins in 48.0 and 79.3% of patients, respectively, while any degree of improvement was 54.4 and 65.8%, respectively. The adverse event rate (6.5%) was similar to a first‐generation agent.Conclusion: The results demonstrate that Optison is a safe and effective contrast agent for improving visualization of pulmonary Doppler signals, especially the left pulmonary vein.
The effect of amlodipine and enalapril on blood pressure and neurohumoral activation in hypertensive patients with ribbing's disease (multiple epiphysal dystrophy)
Authors: Cocco Giuseppe , Ettlin Thierry , Baumeler Hans Ruedi 
Published: February 2009

AbstractBackground: In patients with Ribbing's disease (RD)—a form of multiple epiphysal dystrophy—hypertension is frequent, often severe, and accompanied by a relevant cardiac dysfunction.Hypothesis: This study was undertaken to evaluate the contribution of the calcium antagonist amlodipine and of the angiotensin‐converting‐enzyme inhibitor enalapril to blood pressure regulation by studying their effect on neurohormonal activation.Methods: Fifty hypertensive patients with RD were studied. After a placebo run‐in period of 4 to 6 weeks, patients were randomly assigned to receive either amlodipine (10 mg once daily) or enalapril (20 mg once daily) for 6 months.Results: Both drugs significantly lowered blood pressure. Enalapril did not result in activation of the sympathetic system (as determined by measurement of the plasma norepinephrine level). On the other hand, the hypotensive effect of amlodipine occurred with an increase in heart rate and in the levels of plasma norepinephrine and angiotensin II.Conclusion: It is unclear whether amlodipine may reduce cardiac dysfunction in patients with RD.
Comparison of left ventricular diastolic filling with myocyte bulk modulus using doppler echocardiography and acoustic microscopy in pressure‐overload left ventricular hypertrophy and cardiac amyloidosis
Authors: Masugata Hisashi , Mizushige Katsufumi , Kinoshita Aki , Sakamoto Seiji , Matsuo Hirohide , Senda Shoichi , Sakamoto Haruhiko 
Published: February 2009

AbstractBackground: The myocardial bulk modulus has been described as the constitutive properties of the left ventricular (LV) wall and is measured as ρV2 (ρH = density, V = sound speed) using acoustic microscopy.Hypothesis: The study was undertaken to assess the relationship between the myocyte bulk modulus and transmitral inflow patterns in patients with pressure‐overload LV hypertrophy (LVH) and cardiac amyloidosis (AMD).Methods: In 8 patients with LVH, 8 with AMD, and 10 controls without heart disease, the transmitral inflow pattern was recorded by Doppler echocardiography before death, and myocardial tissue specimens were obtained at autopsy. The tissue density and sound speed in the myocytes were measured by microgravimetry and acoustic microscopy, respectively. The diameters of the myocytes were measured on histopathologic specimens stained by the elastica Van Gieson method.Results: In the subendocardium, the myocyte bulk modulus was larger in LVH (2.98 X 109N/m2,p<0.001) and smaller in AMD (2.61 X 109N/m2,p<0.001) than in the controls (2.87 X 109N/m2). The myocyte diameter in LVH (26±1 m̈m) was larger than that in the control (21±1 m̈m, p<0.001) and AMD (20±1 m̈m, p<0.001). The bulk modulus in the subendocardial myocyte significantly correlated with the deceleration time (DT) of the early transmitral inflow (r=0.689, p=0.028 in control, r=0.774, p=0.024 in LVH, and r=0.786, p=0.021 in AMD).Conclusion: The changes in the myocyte elasticity as represented by the bulk modulus were limited to the subendocardial layers and may be related to relaxation abnormalities in LVH and a reduction in LV compliance in AMD.
Aortic valve replacement for patients with mild to moderate aortic stenosis undergoing coronary artery bypass surgery
Authors: Hilton Thomas C. 
Published: February 2009

AbstractAortic valve replacement (AVR) is not normally recommended in asymptomatic patients, even if aortic stenosis is severe. However, as the population ages, an increasing number of patients with mild or moderate aortic stenosis will require coronary artery bypass grafting (CABG). In these cases, risk of “prophylactic” AVR needs to be weighed against risks of subsequent worsening of the mildly or moderately diseased aortic valve. If unoperated, aortic stenosis will worsen at an average of 6–8 mmHg per year (‐0.1 cm2/year valve area), and one‐quarter of such patients will require late AVR with a high operative mortality (14–24%). If AVR is performed at the time of CABG, operative risk is increased only slightly (from 1–3% to 2–6%), as are late mortality (1–2% per year) and morbidity (1–2% per year), mainly from hemorrhagic complications. Intrinsic gradients of most prosthetic valves are sufficiently low that even patients with low aortic valve gradients are likely to derive hemodynamic benefit from AVR. Thus, if there is a measurable (> 20–25 mmHg) gradient across the aortic valve in a patient who requires CABG, the patient is at considerable risk for developing symptomatic aortic stenosis prior to reaching the end of expected benefit from CABG; in this case AVR should be considered. It may be reasonable in patients with very mild gradients (< 25 mmHg) to defer aortic valve surgery; however, it should be noted that aortic stenosis progression is generally more rapid when the initial gradient is small.