bluuebunny/crossref_metadata_2025_split huggingface dataset:
Myocardial dna strand breaks are detected in biopsy tissues from patients with dilated cardiomyopathy
Authors: Seki Yukihiko , Kai Hisashi , Kai Mamiko , Muraishi Akihiko , Adachi Kyo , Imaizumi Tsutomu 
Published: February 2009

AbstractBackground: Progressive damage of cardiomyocytes with interstitial and replacement fibrosis accompanied by less inflammatory cell infiltration is observed in patients with dilated cardiomyopathy (DCM), suggesting some other mechanisms rather than necrotic cell death.Hypothesis: The aim of this study was to assess the possible involvement of apoptotic process in the pathogenesis of DCM and myocarditis.Methods: Endomyocardial biopsy was performed in patients with DCM (n = 9). myocarditis (n = 4), or atypical chest pain syndrome (as controls; n = 5). The TUNEL method was used for in situ detection of oligonucleosomal DNA strand breaks.Results: The TUNEL‐positive cells were observed in three of nine patients with DCM and in all four with myocarditis, but in none of the controls. The TUNEL‐positive nuclei were observed exclusively in cardiomyocytes in DCM, whereas in myocarditis they were detected mainly in interstitial cells and in a few myocytes. In DCM, interstitial fibrosis was greater in the TUNEL‐positive than in TUNEL‐negative patients (p<0.05). In either DCM or myocarditis, electron microscopic examination could not reveal morphologic features of apoptosis of cardiomyocytes.Conclusion: The DNA strand breaks were detected in cardiomyocytes in patients with DCM and mainly in interstitial cells in myocarditis. It is possible that the DNA strand breaks can be involved in mechanisms of progressive loss of functional cardiac units in these myocardial diseases.
Unrecognized major bleeding following thrombolysis for acute myocardial infarction presenting with syncope
Authors: Cohen Natan , Zaidenstein Ronit , Blatt Alex , Sarafian Dorit Almoznino , Litinsky Irena , Modai David 
Published: February 2009

AbstractComplete atrioventricular block and syncope sometimes are the presenting signs of acute myocardial infarction. In a presyncopal attempt to assume sitting position, the patient may fall and suffer consequent trauma. Once in hospital, this sequence of events may be overlooked by both the patient and admitting physicians. Moreover, physical examination initially may not be revealing. We report on two such patients who developed massive subcutaneous bleeding following thrombolytic and heparin treatment. We conclude that these patients constitute a specific group with a relatively high risk of trauma and bleeding at the gluteal region following thrombolytic therapy. Special attention must be given to these patients.
Mitral valve replacement in sickle cell disease
Authors: Sgambati Maria T. , Kon Neal D. , Cruz Julia M. 
Published: February 2009

AbstractCardiac dysfunction, including mitral valve regurgitation and congestive heart failure, can occur in patients with sickle cell disease. However, major surgery poses a greater risk in this population. This paper reports on the management of a patient with sickle cell disease who underwent successful replacement of the mitral valve.
Treatment of severe mitral stenosis with percutaneous balloon valvotomy in pregnant patients
Authors: Martínez‐Reding Jesus , Cordero Alejandro , Kuri Jorge , Martínez‐Ríos Marco A. , Salazar Eduardo 
Published: February 2009

AbstractBackground: Pregnancy can cause life‐threatening complications in women with mitral stenosis. Frequently, there is an urgent need to increase the mitral valve area mechanically. In selected cases, percutaneous mitral balloon valvotomy (PMBV) has emerged as a safe and effective alternative to surgical commissurotomy.Hypothesis: The study evaluates the effects of PMBV by the Inoue technique in nine pregnant patients with severe symptomatic mitral stenosis.Methods: The patients were in New York Heart Association (NYHA) functional class II to IV and had echocardiographic scores of ≤ 8. The mean gestational age was 24.8 ± 6.1 weeks. The patient's pelvic and abdominal regions were covered with a lead apron to protect the fetus from radiation. A stepwise dilatation technique was used. Fluoroscopy time was kept to 10 to 15 min.Results: One patient developed severe mitral regurgitation requiring emergency valve replacement. The remaining eight patients showed marked immediate symptomatic and hemodynamic improvement. After dilatation, the transmittal pressure gradient decreased from 20.8 ± 6.5 to 7.3 ± 1.4 mmHg (p = 0.001) and the calculated mitral valve area increased from 0.9 ± 0.1 to 1.8 ± 0.4 (p < 0.001). All patients had uneventful term deliveries of normal babies. On follow‐up they were in NYHA functional class I.Conclusions: Percutaneous mitral balloon valvotomy is a safe and effective procedure for selected pregnant patients with severe mitral stenosis. The procedure is well tolerated by the fetus. Severe mitral regurgitation requiring immediate surgery may occur occasionally. The possible harmful effects to the fetus from its exposure to radiation during PMBV are unknown.
Constrictive pericarditis after coronary artery bypass surgery as a cause of unexplained dyspnea: A report of five cases
Authors: Dardas Petros , Tsikaderis Dimitris , Ioannides Efstathios , Bisbos Apostolos , Smirlis Dimitris , Arditis Iakovos , Spanos Panagiotis 
Published: February 2009

AbstractConstrictive pericarditis after coronary artery bypass grafting (CABG) is rare and can present as unexplained dyspnea. We report five consecutive cases of post‐CABG constrictive pericarditis seen within a period of 17 months at our institution. All patients presented with heart failure of unknown etiology within a period of 8‐84 months after surgery. During the initial post‐CABG period, two patients had developed postcardiotomy syndrome that was successfully treated with steroids. They were all assessed noninvasively and invasively. In all patients, the diagnosis of constriction was initially suspected clinically (symptoms, high jugular venous pressure with deep “X” and “Y” descents, pericardial knock). Echocardiography showed transmural flow typical of constriction in all patients and hepatic venous flow in two. Two patients showed rapid left ventricular relaxation. In all patients, hemodynamic assessment showed diastolic equalization of pressures in all chambers, “W” shape waveform in right atrial pressure, and “dip and plateau” configuration in right and left ventricular pressure waveforms. Diagnosis was confirmed surgically in four patients who were subjected to pericardiectomy‐pericardial stripping (three survived, one died). One patient refused surgery. We conclude that constrictive pericarditis, although rare, should be suspected in every case of unexplained dyspnea post CABG. It can appear early or late after surgery, and clinical examination plays an important role in its early recognition. It requires a full noninvasive and invasive assessment in case of clinical suspicion.
Unstable angina: Prognosis of the individual patient
Authors: Bugiardini Rafhaele , Richard CONTI C. 
Published: February 2009

AbstractNot all patients diagnosed with unstable angina have the same outcome. Thus, it is incumbent on the physician caring for these patients to try to identify factors that will risk‐stratify them. These factors include the degree of coronary angiographic stenosis, the lesion morphology, severity of symptoms, presence or absence of transient myocardial ischemia, and state of left ventricular function. In addition, many other factors including the patient's age, gender, and coexisting medical disorders must be considered when trying to prognosticate an individual patient. Clinical experience indicates that clinical indices that combine information provided by all of the above related variables should have more powerful prognostic significance than any individual variable.
Improved risk stratification in unstable angina: Identification of patients at low risk for in‐hospital cardiac events by admission echocardiography
Authors: Stein James H. , Neumann Alex , Preston Lynn M. , Vandenberg Betsy J. , Parrillo Joseph E. , Calvin James E. , Marcus Richard H. 
Published: February 2009

AbstractCurrent protocols for risk stratification of patients with acute chest pain syndromes rely on clinical parameters and are oriented toward identification of patients at high risk for adverse cardiac events; however, this paradigm for risk stratification does not adequately address the observation that adverse cardiac events are relatively uncommon in this population. In an era of cost containment, consideration also should be given to identification of patients at low risk for adverse cardiac events, who may be safely discharged without expensive inpatient hospitalization.
Atrial natriuretic peptide augments coronary collateral blood flow: A study during coronary angioplasty
Authors: Kyriakides Zenon S. , Sbarouni Eftihia , Antoniadis Aias , Iliodromitis Efstathios K. , Mitropoulos Dimitrios , Kremastinos Dimitrios T. 
Published: February 2009

AbstractBackground and hypothesis: In vitro studies have shown that atrial natriuretic peptide (ANP) causes relaxation of pre‐constricted blood vessel strips and inhibits the contraction of isolated vessels in response to norepinephrine and angiotensin II. The present study examined the effects of exogenous ANP on the coronary collateral blood flow during angioplasty.Methods: We studied 15 patients undergoing elective balloon angioplasty during the second and third balloon inflations. A Doppler flow guidewire was advanced distal to the lesion and used for the estimation of coronary blood flow velocity. After the second balloon inflation, 25 ng/kg/min of ANP were administered intracoronarily for 8 min. Electrocardiogram, pressure, and flow velocity were recorded immediately before each balloon deflation. Fourteen other patients served as controls and received normal saline infusion.Results: Velocity time integral increased from 65 ± 40 to 79 ± 46 mm (p < 0.05) during the third balloon inflation, whereas ST deviation decreased from 1.3 ± 0.9 to 0.7 ± 1.0 mV (p< 0.05). These variables did not change in the control group during the two tested balloon inflations.Conclusion: Exogenous ANP augments coronary collateral blood flow and ameliorates myocardial ischemia during angioplasty.
Comparison of adenosine effects on atrioventricular node reentry and atrioventricular reciprocating tachycardias
Authors: Kevin DONAHUE J. , Orias David , Berger Ronald D. , Tomaselli Gordon F. , Lawrence John H. , Calkins Hugh 
Published: February 2009

AbstractBackground: Adenosine is an established first line therapy for the treatment of narrow complex tachycardias. The two most common etiologies of paroxysmal supraventricular tachycardia (SVT) are atrioventricular node reentry tachycardia (AVNRT) and atrioventricular reciprocating tachycardia (AVRT).Hypothesis: We postulated that adenosine might have different effects on the termination of AVNRT vs. AVRT, and that these differences might assist in the noninvasive differentiation between these diagnoses.Methods: Fifty‐nine patients referred for the diagnosis and treatment of SVT were included in the study. All patients had SVT induced during electrophysiology testing, and each patient received adenosine during SVT. The adenosine dose, time to tachycardia termination, and site of tachycardia termination were recorded. Seventeen patients required isoproterenol administration to initiate SVT. This subset of patients was compared with those not requiring isoproterenol.Results: There was no statistically significant difference in the adenosine dose or time to tachycardia termination when comparing patients with AVNRT with those with AVRT. All patients with AVNRT had termination of tachycardia in the antegrade direction with final activation in the atria. Patients requiring isoproterenol for tachycardia initiation experienced tachycardia termination significantly faster than those not requiring isoproterenol, although there was no difference in the dose of adenosine required for termination.Conclusion: These data demonstrate that patients with dual AV node physiology and AVNRT do not have altered sensitivity to adenosine compared with patients with AVRT and normal AV nodes. Further investigation will be required to determine the clinical utility of the significantly shorter time to tachycardia termination for patients receiving isoproterenol.
Clinical implications of endothelial dysfunction
Authors: Pepine Carl J. 
Published: February 2009

AbstractEndothelial dysfunction is increasingly recognized as an early event in the pathogenesis of cardiovascular disease. This observation is consistent with the growing appreciation of the role of endothelium in maintaining cardiovascular health. Endothelial dysfunction and coronary artery disease are both linked to hypertension, hypercholesterolemia, diabetes mellitus, and cigarette smoking. Modification of these conditions improves both endothelial function and coronary artery disease outcomes. Dietary and lifestyle modifications and antioxidant vitamin supplementation have a beneficial effect on endothelial function, as do angiotensin‐converting enzyme inhibitors and lipid‐lowering agents. Future studies will determine whether interventions that specifically target endothelial dysfunction can reduce rates of clinical disease.
Treatment with ramipril improves systolic function even in patients with mild systolic dysfunction and symptoms of heart failure after acute myocardial infarction
Authors: Kongstad‐Rasmussen Ole , Blomstrand Peter , Broqvist Mats , Dahlström Ulf , Wranne Bengt 
Published: February 2009

AbstractBackground: Clinical signs of heart failure such as pulmonary rales and dyspnea, ventricular dysfunction, and ventricular arrhythmia are independent predictors of a poor prognosis after acute myocardial infarction (AMI).Hypothesis: The study aimed to assess the effect of ramipril treatment on mildly depressed left ventricular (LV) systolic function, assessed by atrioventricular (AV) plane displacement in patients with congestive heart failure after AMI.Methods:The study was a substudy in the Acute Infarction Ramipril Efficacy Study, a double‐blind, randomized, placebo‐controlled trial of ramipril versus placebo in patients with symptoms of heart failure after AMI. In all, 56 patients were included in the main study, 4 refused to participate in the substudy, and 4 were excluded for logistical reasons. Echocardiography was performed at entry and after 6 months. Patients who underwent coronary artery bypass grafting during the follow‐up period were excluded.Results: At baseline, the patients had modest LV dysfunction, and mean AV plane displacement of 9.7 mm. During follow‐up, AV plane displacement increased in ramipril‐treated patients from 9.5 to 10.9 mm (p < 0.01). No statistically significant changes were seen in the placebo group.Conclusions: Ramipril improves LV systolic function in patients with clinical signs of heart failure and only modest systolic dysfunction after AMI. Measurement of AV plane displacement is a simple and reproducible method for detection of small changes in systolic function and may be used instead of ejection fraction in patients with poor image quality.
Aneurysms of the ascending aorta: Diagnostic features and prognosis in patients with marfan's syndrome versus hypertension
Authors: Kodolitsch Yskert V. , Simic Ognjen , Nienaber Christoph A. 
Published: February 2009

AbstractBackground: In Marfan's syndrome progressive dilation of the sinuses of Valsalva, the supra‐aortic ridge and the ascending aorta are well characterized abnormalities likely to set the stage for severe aortic sequelae accounting for 70% of lethal complications. However, the specific anatomical, clinical, and prognostic profiles of aortic pathology are less well characterized in the setting of patients with Marfan's syndrome symptomatic from aortic complications.Hypothesis: The study was designed to characterize the spectrum of anatomical, clinical, and prognostic profiles of thoracic aortic disease in symptomatic patients with Marfan's syndrome compared with patients with arterial hypertension. Noninvasive imaging techniques were used for comprehensive mapping of aortic pathology associated with Marfan's syndrome.Methods: Thirty‐five consecutive patients with Marfan's syndrome (16 women, 19 men; mean age 35± 12 years) were imaged by transthoracic (TTE; n = 26) and transesophageal echocardiography (TEE; n = 11), contrast enhanced computed tomography (XCT; n = 16), or magnetic resonance techniques (MRI; n = 14). Diagnostic results were compared with both in‐traoperati ve or angiographic findings and also with a group of 85 consecutive patients with aortic pathology associated with arterial hypertension.Results: Aortic pathology was more frequently confined to the ascending aorta (p<0.05) and aortic regurgitation was more prevalent in Marfan's syndrome than in arterial hypertension (p < 0.05). In 23 cases (66%) of dissection and 12 cases (34%) of nondissecting aneurysms, no Marfan‐specific aortic macropathology was identified when compared with arterial hypertension. Diagnostic results of TEE, XCT, and MRI were all excellent; however, in contrast to the transesophageal ultrasound approach, transthoracic ultrasound was not useful in the detection of aortic dissection and intramural hemorrhage. Both 30‐day (100 vs. 70%; p<0.05) and 5‐year survival rates (91 vs. 57%; NS) were higher in patients with Marfan's syndrome than in those with arterial hypertension. Repeat surgery, however, was more frequently required in patients with Marfan's syndrome (25% vs. none in aortic aneurysm; p < 0.05).Conclusions: There are no macropathologic findings of the aorta specific for Marfan's syndrome. In patients with Marfan's syndrome with an inherently high rate of aortic complications, serial noninvasive imaging should be encouraged, preferably utilizing TEE or MRI.
Modulation of ventricular rate in permanent atrial fibrillation: Randomized, crossover study of the effects of slow‐release formulations of gallopamil, diltiazem, or verapamil
Authors: Bottoe Giovanni L. , Bonini Walter , Broffoni Tiziana 
Published: February 2009

AbstractBackground: The management of permanent atrial fibrillation (PAF) consists primarily of long‐term anticoagulation with either aspirin or warfarin to prevent systemic embolization, and modulation of ventricular rate (VR) to improve cardiac function by prolonging the ventricular diastolic filling time.Hypothesis: The effects of slow‐release formulations of gallopamil (100 mg b.i.d.), diltiazem (120 mg bid.), or verapamil (120 mg b.i.d.) on VR were evaluated in 18 patients with PAF without organic heart disease.Methods: In all patients, each treatment was administered randomly, was compared with oral digoxin, and was assessed by 24‐h Holter monitoring during daily life and by a 6‐min walk ing test.Results: There were no significant differences in mean and minimum VR recorded during 24‐h Holter monitoring among the four treatments. Peak heart rates recorded during the 6‐min walking test with digoxin treatment was 167 ± 12 beats/min. This was significantly reduced by gallopamil (149 ± 23 beats/ min, p = 0.01), diltiazem (142 ± 4 beats/min, p< 0.001), and verapamil (137 ± 30 beats/min, p < 0.001). There were no significant differences in peak VR during the walking test among the three calcium antagonists. Pauses of ≥ 3 s were observed in 3 of 18 (17%) patients who received digoxin (max 3.4 s) and in 5 of 18 (28%) patients who received diltiazem (max 3.4 s); p = NS. Periods of bradycardia < 30 beats/min were observed in 5 of 18 (28%) patients during digoxin treatment, and in 3 of 18(17%) patients during treatment with gallopamil, diltiazem, and verapamil; p = NS.Conclusion: Gallopamil, diltiazem, or verapamil are superior to digoxin in controlling VR during mild exercise in patients with PAF without organic heart disease. The reduction of peak VR is obtainable without further slowing of resting VR. However, gallopamil appears to be the least effective calcium blocker at controlling resting and exercise VR; thus, there are no advantages over the other calcium blockers in its use in the clinical setting.
Prior revascularization increases the effectiveness of enhanced external counterpulsation
Authors: Lawson William E. , Hui John C.K. , Guo Tong , Burger Lynn , Cohn Peter F. 
Published: February 2009

AbstractBackground and hypothesis: Enhanced external counterpulsation (EECP) is an effective noninvasive treatment for chronic angina. However, its usefulness has been felt to be limited in patients with angiographically demonstrated triplevessel coronary artery disease (CAD), in accord with the hypothesis that a patent vessel is necessary for transmission of the EECP‐augmented coronary artery pressure and volume to the distal coronary vasculature.Methods: The effect of revascularization [coronary artery bypass grafting (CABG)] prior to EECP was examined in 60 patients with CAD and chronic angina (35 without and 25 with prior CABG). Patients were grouped by the extent of CAD (single‐, double‐, triple‐vessel disease in the unrevascularized group) and by the extent of residual disease (number of stenotic native vessels unbypassed or supplied by a stenotic graft in the CABG group). Significant CAD or graft stenoses were defined as stenoses demonstrating ≥ 70% luminal diameter narrowing. Benefit was assessed by improvement in postEECP treatment over pretreatment radionuclide stress testing.Results: Radionuclide stress testing demonstrated a comparable favorable response (80 vs. 71 %; p = NS) in patients with prior CABG versus unrevascularized patients. Enhanced external counterpulsation was highly and comparably effective in patients with unrevascularized native single‐ and double‐vessel CAD and in patients with CABG with residual single‐and double‐vessel CAD (88 vs. 80%; p = NS). Most notably, CABG significantly increased the beneficial response to EECP in those patients with triple‐vessel CAD and stenotic grafts compared with unrevascularized patients with triplevessel CAD (80 vs. 22%; p < 0.05 by chi‐square test).Conclusion: The results suggest a new role for EECP as an effective treatment for post CABG ischemia, despite extensive CAD and even in the presence of stenotic grafts.
Pregnancy‐induced severe left ventricular systolic dysfunction in a patient with hypertrophic cardiomyopathy
Authors: Kazimuddin Mohammed , Vashist Aseem , Basher Abul W. , Brown Edward J. , Alhaddad Imad A. 
Published: February 2009

AbstractThis paper reports the first case of hypertrophic cardiomyopathy (HCM) that developed postpartum congestive heart failure (CHF) and severe left ventricular (LV) systolic dysfunction. Review of the literature and clinical implications are discussed.