bluuebunny/crossref_metadata_2025_split huggingface dataset:
Accelerated plasminogen activator inhibitor may prevent late restenosis after coronary stenting in acute myocardial infarction
Authors: Inoue Teruo , Yaguchi Isao , Mizoguchi Keiichi , Uchida Toshihiko , Takayanagi Kan , Hayashi Terumi , Morooka Shigenori , Eguchi Yutaka 
Published: June 2007

AbstractBackground: Although acceleration of plasma plasminogen activator inhibitor‐1 (PAI‐1) level after emergent coronary angioplasty in acute myocardial infarction (AMI) has been documented, its pathophysiologic role is still unknown.Hypothesis: This study was designed to elucidate the role of PAI‐1 in the development of restenosis after primary coronary stenting in AMI.Methods: We selected for this study 66 patients with AMI, who underwent primary coronary stenting for infarct‐related coronary artery lesions in an emergent situation. In all patients, plasma PAI‐1 level was measured at admission, and at 3 h, 24 h, 48 h, and 1 month after coronary stenting.Results: At admission, the PAI‐1 level was equivalent in 24 patients who experienced restenosis and in 42 patients without restenosis (28 ± 4 vs. 29 ± 4 ng/ml). In patients with restenosis, the levels did not change during the course after coronary stenting. In patients without restenosis, however, the level significantly increased at 3 h (48 ± 9 ng/ml, p < 0.001), 24 h (42 ± 9, p < 0.01), and 48 h (38 ± 7, p < 0.05) after coronary stenting, and was restored to the level equivalent to that at admission (27 ± 2 ng/ml) 1 month after coronary stenting. The PAI‐1 level at 3 h after coronary stenting in patients without restenosis was significantly higher (p < 0.05) than the level (33 ± 6 ng/ml) in patients with restenosis. Multiple logistic regression analysis indicated that the PAI‐1 level 3 h after coronary stenting was an independent predictor of restenosis (Wald x2 = 3.826, p = 0.019, odds ratio 0.921, 95% confidence interval 0.866‐0.961).Conclusion: Accelerated PAI‐1 after coronary stenting in patients with AMI may protect against the development of late restenosis.
Diagnostic yield of automatic and patient‐triggered ambulatory cardiac event recording in the evaluation of patients with palpitations, dizziness, or syncope
Authors: Balmelli Nicola , Naegeli Barbara , Bertel Osmund 
Published: June 2007

AbstractBackground: Recent studies have shown that patient‐triggered cardiac event recorders (CER) have an increased diagnostic yield and are more cost effective than conventional 24‐h‐Holter electrocardiograms (ECGs) for the evaluation of sporadic, potentially arrhythmia‐related symptoms.Hypothesis: The aim of this study was to determine the diagnostic yield of a patient‐triggered CER combined with continuous automatic arrhythmia detection in the evaluation of sporadic dizziness/syncope or palpitations and its clinical relevance in assessing the further management.Methods: We investigated 101 consecutive outpatients (54 ± 20 years, 40 women), referred for evaluation of sporadic dizziness and syncope (36%) or palpitations (64%) of suspected rhythmogenic origin. All were monitored by patient‐triggered CER with continuous automatic arrhythmia detection.Results: After a mean monitoring period of 103 ± 38 h, 83 patients registered symptoms and 57 patients had diagnostic or therapeutic relevant arrhythmias (relA). A total of 196 episodes of relA were recorded; 31 (16%) episodes were patient‐triggered and 165 (84%) automatically recorded. Diagnostic relevant episodes (relA and/or typical symptoms) occurred in 94 patients, in 54% after the first 24 h of monitoring. According to the results of the CER, 80 patients needed no further diagnostic evaluation; 20 had additional diagnostic tests.Conclusions: Cardiac event recorders with a continuous automatic arrhythmia detection function are a well‐tolerated device for sporadic, potentially arrhythmia‐related symptoms. The patient‐triggered mode alone is not sufficiently reliable; the automatic continuous arrhythmia detection function has additional diagnostic and therapeutic consequences. In 54% of all patients, the first diagnostic event would not have been recorded with a single conventional 24‐h‐Holter ECG.
Increased oxidative stress with elevated serum thioredoxin level in patients with coronary spastic angina
Authors: Miwa Kunihisa , Kishimoto Chiharu , Nakamura Hajime , Makita Toshinori , Ishii Katsuhisa , Okuda Nobuaki , Taniguchi Ataru , Shioji Keisuke , Yodoi Junji , Sasayama Shigetake 
Published: June 2007

AbstractBackground: Increased oxidative stress has been implicated in the pathogenesis of coronary vasospasm. Thioredoxin (TRX) is a redox‐active protein that is known to be induced by oxidative stress.Hypothesis: The serum TRX level may be high in patients with coronary vasospasm.Methods: The serum TRX level was determined using an enzyme‐linked immunosorbent assay in 21 patients with the active stage of coronary spastic angina (CSA), in 18 patients with the inactive stage of CSA (iCSA), in 24 control subjects without coronary artery disease (Control), and in 20 patients with stable effort angina (SEA).Results: Serum TRX levels (mean ± standard deviation ng/ml) were significantly higher in CSA (64 ± 44) than in iCSA (28 ± 26), in Control (34 ± 15), and in SEA (36 ± 16). In contrast, serum α‐tocopherol levels (mg/g lipids) were significantly lower in CSA (2.8 ± 0.7) than in Control (4.0 ± 1.2) and in SEA (3.2 ± 0.4). Current smoking was significantly more prevalent in CSA (76%) than in any of the other groups. No significant correlation was found between the serum level of TRX and α‐tocopherol in the study subjects. In nine patients with CSA, the serum TRX level decreased (93 ± 41 → 41 ±35 ng/ml) and the α‐tocopherol level increased (2.7 ± 0.6 → 3.2 ± 0.7 mg/g lipids) significantly under medication with calcium entry blockers after an at least 3‐month angina‐free period.Conclusions: Patients with coronary spastic angina had a higher serum TRX level associated with a lower serum level of antioxidant vitamin E, with redox equilibrium appearing to be related to the disease activity of coronary vasospasm in these patients. Oxidative stress may be related to the genesis of coronary vasospasm.
Clinical validation of technetium‐99m MIBI‐gated single‐photon emission computed tomography (SPECT) for avoiding false positive results in patients with left bundle‐branch block: Comparison with stress‐rest nongated SPECT
Authors: Demir Hakan , Erbay Güner , Kir K. Metin , Omurlu Kenan , Berk Fatma , Aktolun Cumali 
Published: June 2007

AbstractBackground: Septal perfusion defects are common on my‐ocardial perfusion single‐photon emission computed tomography (SPECT) slices in patients with left bundle‐branch block (LBBB) in the absence of coronary artery disease.Hypothesis: The use of gated myocardial perfusion SPECT imaging in such patients should be clinically validated. The aims of this study were, therefore, to validate clinically the use of gated myocardial SPECT imaging to avoid false positive septal perfusion defects in patients with LBBB and to compare nongated and gated SPECT imaging techniques in the same patients in the same imaging session.Methods: We performed stress‐rest myocardial perfusion SPECT and resting gated SPECT using Technetium‐99m MIBI in 25 patients with LBBB and in 6 control subjects. Stress‐rest SPECT images and end‐diastolic and end‐systolic gated SPECT slices were assessed visually and quantitatively (septum/lateral wall count ratio). Coronary angiography was performed in 15 patients with LBBB and in all 6 control subjects.Results: Stress‐rest (nongated) SPECT slices and end‐diastolic and end‐systolic gated SPECT images were normal in all control subjects. Stress‐rest (nongated) SPECT imaging revealed septal perfusion defect in 20 (11 reversible, 9 irreversible) patients with LBBB, whereas the figures were 15 and 5 for end‐systolic and end‐diastolic gated SPECT images, respectively. Coronary angiography results were normal in all control subjects and in 15 patients with LBBB. Quantitative analysis of gated SPECT images revealed no statistically significant difference between patients with LBBB and control subjects in end‐diastolic mean septum/lateral wall count values (0.86 ± 0.19 in LBBB vs. 0.98 ± 0.15 in normal subjects, p > 0.05), but the difference was statistically significant for end‐systolic, stress, and rest values (p < 0.001 for all).Conclusion: Gated SPECT imaging, particularly end‐diastolic images, revealed fewer false positive results and thus can be used to avoid false positive septal perfusion defects commonly seen in stress‐rest (nongated) myocardial perfusion SPECT in patients with LBBB.
Left atrial inflow propagation rate derived by transesophageal color M‐mode echocardiography is a promising index of preload
Authors: Stoddard Marcus F. , Calzada Norberto , Longaker Rita A. 
Published: June 2007

AbstractBackground: Pulmonary capillary wedge pressure (PCWP) is a useful index of preload and an important determinant of cardiac function.Hypothesis: We postulated that the rate of blood propagating into the left atrium (LAIF‐PR) would be a useful measure of PCWP in critically ill patients.Methods: Fifty‐two critically ill patients (36 men/16 women) receiving mechanical ventilation were studied by multiplane transesophageal echocardiography (TEE). Left atrial inflow propagation rate was measured in systole and diastole as the slope of the color M‐mode signal entering the left atrium from the right upper pulmonic vein.Results: Systolic and diastolic LAIF‐PRs were feasible in 49 and 44 patients, respectively. Mean (± 1 standard deviation) LAIF‐PR in systole was 40 ± 26 cm/s (range 11‐132) and in diastole 34 ± 22 cm/s (range 5‐102). Negative correlations with PCWP (mean 19 ± 9 mmHg; range 3‐40) were good for LAIF‐PR in systole (r = −0.71, standard error of estimate [SEE] = 6 mmHg; p< 0.0001) and diastole (r = −0.71, SEE = 6 mmHg; p < 0.0001). Mean ejection fraction was 52 ± 22% (range 15‐88) and cardiac output was 6.97 ±3.52 l/min (range 2.26‐17.93). Multivariate regression showed PCWP as the only independent predictor of systolic (p < 0.0001) and diastolic (p < 0.0001) LAIF‐PR among age, heart rate, cardiac output, ejection fraction, or left atrial diameter.Conclusions: Left atrial inflow propagation rate derived by color M‐mode TEE aligned with the right upper pulmonic vein is a promising new index of preload. Future studies addressing the determinants of LAIF‐PR, such as left atrial compliance, are needed.
The prognostic value of QTC interval and QT dispersion following myocardial infarction in patients treated with or without dofetilide
Authors: Brendorp Bente , Elming Hanne , Jun Li , Køber Lars , Torp‐Pedersen Christian 
Published: June 2007

AbstractBackground: Acute myocardial infarction (MI) is associated with an increased risk of death, with a 1‐year mortality close to 10% in patients discharged from hospital alive. During the first year following MI, close to 50% of deaths are assumed to be due to arrhythmic events.Hypothesis: The study was undertaken to determine the interaction between dofetilide treatment and pretreatment QTc interval and QT dispersion regarding mortality in patients with left ventricular (LV) dysfunction and a recent MI.Methods: The study population consisted of 894 patients with a recent MI and LV systolic dysfunction, who were randomized to receive dofetilide or placebo. The study was a sub‐study of the Danish Investigations of Arrhythmia and Mortality on Dofetilide‐MI (DIAMOND‐MI).Results: During a minimum of 1‐year follow‐up, 261 (29%) patients died. Baseline QTc interval did not hold any prognostic value on mortality for placebo‐treated patients. When pretreatment QTc interval was < 429 ms, dofetilide resulted in a 45% reduction of mortality (hazard ratio 0.55, 95% confidence limits 0.34–0.88, p < 0.02) compared with placebo. When QTc interval was > 429 ms, dofetilide did not influence mortality significantly. This study revealed no statistically significant relation between QT dispersion, dofetilide treatment, and mortality.Conclusion: In patients with a recent MI, LV dysfunction, and a short baseline QTc interval, dofetilide is associated with significant survival benefit. This benefit is not seen with a longer QTc interval. QT dispersion is not a risk factor in this population.
Guideline implementation in a multicenter study with an estimated 44% relative cardiovascular event risk reduction
Authors: Onat Altan , Soydan Inan , Tokgözoǧlu Lale , Sansoy Vedat , Koylan Nevres , Domaniç Nergiz , Ural Dilek 
Published: June 2007

AbstractBackground: The extent of cardiovascular risk reduction by implementing coronary prevention guidelines needs to be documented in various population samples.Hypothesis: This is a multicenter study to assess the impact of risk reduction in cardiovascular events upon implementation of coronary prevention guidelines in patients with or at high risk for coronary heart disease (CHD) in the setting of clinical practice.Methods: Enrolled volunteers numbered 2,021. Inclusion criteria postulated a minimum of 20–40% cardiovascular event risk in the subsequent 10 years as estimated from the risk table of the European Society of Cardiology (ESC) Guidelines. The estimated CHD risk reduction was assessed in terms of the Framingham risk scores at baseline and at 12 months, computed from the data of each individual. Data of the compliant group (making up half of the initial participants) at the end of the study, along with absolute and relative risk reductions in the compliant group, were analyzed.Results: Mean global risk burden was 25.9% at baseline, reduced through multilateral preventive measures in absolute terms by 9.4% at 6 months and by 11.7% at 12 months; the latter represents a relative risk reduction of 44%. Independent variables determining the (enhanced) reduction in risk level at the end of 12 months included (high) level of baseline risk, (high) degree of compliance with treatment, younger age, female gender, smoking, and (high) baseline triglyceride/high‐density lipoprotein cholesterol (TC/HDL‐C) ratio.While the relative reduction in patients with CHD amounted to 43%, a reduction of 46% (p < 0.001) was obtained in the setting of primary prevention. Diabetes emerged as a factor modestly limiting the extent of risk reduction. While subjects without hypertension revealed a decline of coronary risk by merely 8.7%, those with hypertension showed a decline by 12.7% (p < 0.001). Risk reductions were accompanied by a decrease of mean low‐density lipoprotein cholesterol (LDL‐C) level of 25.4%, a rise in mean HDL‐C level of 5 mg/dl, a decrease in mean systolic blood pressure of 26 mmHg. Forty‐five percent of smokers succeeded in discontinuing the habit.Conclusion: By implementing standard prevention guidelines in the Turkish population among 1,000 compliant high‐risk men and women and among 1,000 patients with CHD, prevention of cardiovascular events could be expected in 117 persons in the subsequent 10 years.
Hyperhomocysteinemia in patients with heart failure referred for cardiac transplantation: Preliminary observations
Authors: Schofield Richard S. , Wessel Timothy R. , Walker Tracy C. , Cleeton Timothy S. , Hill James A. , Aranda Juan M. 
Published: June 2007

AbstractBackground: Hyperhomocysteinemia is becoming recognized as a risk factor for cardiovascular disease, yet there are limited data on the prevalence of hyperhomocysteinemia in patients with heart failure.Hypothesis: The purpose of this study was to examine the prevalence of hyperhomocysteinemia in patients with severe heart failure and to correlate serum homocysteine levels with factors that may affect homocysteine metabolism.Methods: Serum homocysteine levels were measured at the time of cardiac transplant evaluation in 89 consecutive patients with severe heart failure. Homocysteine levels for patients with ischemic cardiomyopathy (ICM) were compared with levels obtained in patients with nonischemic cardiomyopathy (NICM), and homocysteine levels were correlated with demographic and hemodynamic parameters as well as functional status.Results: The mean plasma homocysteine level was increased (14.3 ± 5.3 μmol/l, normal <9.0 μmol/l) and was equivalent between patients with ICM versus NICM (14.7 ± 5.8 μmol/l vs. 13.8 ± 4.5 μmol/l, p = 0.44). Elevated homocysteine levels were seen in a large proportion (89%) of patients and were equally common to patients with NICM (94%) and ICM (85%). Serum homocysteine levels correlated with serum creatinine (r= 0.51, p<0.001), with a history of diabetes (p = 0.028), and with a history of peripheral vascular disease (p = 0.045). Only 6% of patients were receiving folic acid therapy at the time of transplant referral.Conclusion: Hyperhomocysteinemia is common in patients with severe heart failure, and plasma homocysteine levels are uniformly elevated regardless of the etiology of heart failure. Elevated plasma homocysteine levels are likely a consequence of heart failure‐related renal insufficiency.
Predictors of cause‐specific hospital readmission in patients with heart failure
Authors: Babayan Zaruhi V. , McNamara Robert L. , Nagajothi Nagaprasad , Kasper Edward K. , Armenian Haroutune K. , Powe Neil R. , Baughman Kenneth L. , Lima João A. C. 
Published: June 2007

AbstractBackground: Repeated hospital readmissions are frequent and increasing over time in patients with heart failure (HF). The predictors for readmission in patients with HF are not completely understood.Hypothesis: The study was undertaken to investigate the time course of readmission by specific cause in patients with HF, and to examine the independent effects of HF etiology and left ventricular (LV) function on cause‐specific readmissions.Methods: A retrospective cohort of 493 consecutive patients with HF was followed for readmission for 16.5 ± 12.3 months. Ischemic etiology of HF was defined as history of myocardial infarction (MI), coronary artery bypass graft (CABG), percutaneous transluminal coronary angioplasty (PTCA), or > 70% coronary stenosis. Left ventricular function was assessed echocardiographically. Cause‐specific readmissions were classified as HF, cardiovascular disease (CVD) other than HF, and other non‐CVD.Results: The annual readmission rate was 56.6%. Median time to readmission was 91 days, with 18.3%patients readmitted within 1 month after discharge. Ischemic etiology independently predicted all‐cause readmission: Cox hazard ratio (95%confidence interval): 1.40 (1.11‐1.79). This relationship was significant in women (1.83 [1.31‐2.55]), but not in men (1.15 [0.82‐1.62]), while readmissions were equally frequent in both genders. Similarly, ischemic etiology significantly predicted readmission for CVD in women (4.18 [2.14‐8.19]), but not in men (1.49 [0.83‐2.67]). However, LV dysfunction independently predicted readmission for recurrent HF (2.44 [1.46‐4.08]), while ischemic etiology was not predictive in either gender.Conclusions: Readmissions for recurrent HF comprise only one‐third of total hospital readmissions in patients with HF. Ischemic etiology is a significant predictor of readmission, and most of this effect is mediated through a four‐fold increased risk of readmission for CVD other than HF in women. Readmission for recurrent HF is predicted by LV dysfunction but not by ischemic etiology. Patients with HF can be accurately risk stratified for cause‐specific readmission with available clinical data.
Effects of acute angiotensin‐converting enzyme inhibition on diastolic ventricular interaction in the dilated heart
Authors: Pepi Mauro , Tamborini Gloria , Maltagliati Anna , Guazzi Marco , Berna Giovanni , Susini Francesca , Muratori Manuela , Celeste Fabrizio 
Published: June 2007

AbstractBackground: The normal and dilated heart behaves as a single functional unit during preload reduction; volume unloading in the setting of diastolic ventricular interaction allows for increased left ventricular (LV) filling.Hypothesis: We hypothesized that reduction of venous return induced by a physiologic stimulus (tilting) or by acute angiotensin‐converting enzyme (ACE) inhibitors in dilated heart is likely to have a marked and similar effect on ventricular chamber geometry and filling. This study was designed to assess how the normal and dilated heart adapts to preload reduction.Methods: Twenty normal subjects and 20 patients with moderate heart failure due to dilated cardiomyopathy were studied with two‐dimensional and Doppler echocardiography in supine position (B) and after 40° of head‐up tilting (T). The following day, patients repeated supine (C) and tilting test (TC) after administration of captopril (25 mgs.1.). Right ventricular (RV) and LV dimensions, LV geometry, and tricuspid, mitral, and pulmonary venous flow patterns were recorded at each step of the study.Results: In the two groups, T was associated with reduction of RV area and LV volumes; C and TC produced a similar effect on RV and LV. Changes in LV septal‐lateral diameter and anterior‐posterior diameter were different at each step of the study: during T (both groups) and after C and TC, the septallateral diameter increased slightly while the anterior‐posterior diameter decreased. During T, mitral and tricuspid peak flow velocities decreased, peak late velocities were unchanged, and the deceleration time of mitral flow increased; the systolic forward flow of pulmonary venous flow decreased, the diastolic forward flow did not change, and the difference in duration between reverse pulmonary flow and mitral peak late flow decreased; C and CT induced similar changes.Conclusion: Preload reduction induced by tilting or by ACE inhibitors induces profound and similar effects on LV and RV dimensions, LV geometry, and biventricular filling. Reduction of RV dimension is associated with adaptation of LV geometry and decrease of LV diastolic pressure, which facilitates LV filling and pulmonary venous drainage; ACE inhibition associated with tilting exerts an additional effect on these changes. These data confirm the role of ventricular interaction in modulating LV filling in heart failure.
Detection of patients with hypertrophic cardiomyopathy at risk for paroxysmal atrial fibrillation during sinus rhythm by P‐wave dispersion
Authors: Köse Sedat , Aytemir Kudret , Sade Elif , Can Ilknur , Özer Necla , Amasyali Basri , Aksöyek Serdar , Övünç Kenan , Özmen Ferhan , Atalar Enver , Işik Ersoy , Kes Sirri , Demirtaş Ertan , Oto Ali 
Published: June 2007

AbstractBackground: Paroxysmal atrial fibrillation (PAF) in hypertrophic cardiomyopathy (HCM) is associated with poor prognosis. Previous studies have shown good correlation between P‐wave dispersion (Pd) and occurrence of PAF. However, Pd in patients with HCM for predicting PAF has not been studied.Hypothesis: The aim of the study was to determine whether Pd could identify patients with HCM who are likely to suffer from PAF.Methods: Twenty‐two patients with HCM with a history of PAF (Group 1) and 26 patients with HCM without a history of PAF (Group 2) were studied. Maximum (Pmax) and minimum (Pmin) P‐wave durations, as well as P‐wave dispersion (Pd = Pmax‐Pmin) were calculated from 12‐lead surface electrocardiograms (ECG).Results: P‐wave dispersion was significantly different between the groups (Group 1:55 ± 6 msvs. Group 2:37 ± 8 ms; p<0.001), while Pmax (Group 1: 134 ± 11 ms vs. Group 2: 128 ± 13 ms; p = 0.06) and Pmin (Group 1: 78 ± 9 ms vs. Group 2: 81 ± 7 ms; p = 0.07) was not significantly different. Patients with a history of PAF had higher left atrial diameter than the patients without PAF (Group 1:52 ± 8 mm vs. Group 2:48 ± 10 mm; p = 0.02). A cut‐off value of 46 ms for Pd had a sensitivity of 76% and a specificity of 82% in discriminating between patients with and without PAF.Conclusion: This study suggests that P‐wave dispersion could identify patients withHCM who are likely to develop PAF.