bluuebunny/crossref_metadata_2025_split huggingface dataset:
Myocardial bridging increases the risk of coronary spasm
Authors: Teragawa Hiroki , Fukuda Yukihiro , Matsuda Keiji , Hirao Hidekazu , Higashi Yukihito , Yamagata Togo , Oshima Tetsuya , Matsuura Hideo , Chayama Kazuaki 
Published: June 2007

AbstractBackground: Myocardial bridging (MB) has been associated with cardiac events. Whether coronary spasm is one factor contributing to those events is unknown.Hypothesis: This study investigated whether the likelihood of coronary spasm is increased in patients with MB.Methods: A spasm‐provocation test was performed by infusing acetylcholine into the left coronary artery in 114 Japanese patients with chest pain. The test result was defined as positive when the diameter of the coronary artery was reduced by > 50% and ST‐segment changes were documented. Myocardial bridging was defined as a > 15% reduction in coronary arterial diameter during systole after intracoronary injection of nitroglycerin.Results: Myocardial bridging was identified in 41 patients (36%) and was located in the mid‐segment of the left anterior descending coronary artery (LAD) in all patients. Patients with MB experienced coronary spasm more frequently than patients without MB (MB+: 73%; MB —: 40%, p = 0.0006). Furthermore, among patients with a positive spasm‐provocation test, coronary spasm occurred more frequently in the midsegment of the LAD in patients with MB than in those without MB (MB+: 73%; MB — : 45%, p = 0.0259). Multivariate regression analysis demonstrated that MB was a predictor of coronary spasm (odds ratio: 3.478, p = 0.0088).Conclusions: These results suggest that MB increases the risk of coronary spasm and that coronary spasm may be the proximate etiology of cardiac events associated with MB.
Exercise electrocardiography after acute coronary syndromes: Still the first testing modality?
Authors: Hurst J. Willis , Bigi Riccardo , Cortigiani Lauro , Desideri Alessandro 
Published: June 2007

AbstractRecent diagnostic and therapeutic advances have been questioning the role of exercise electrocardiography (ECG) for risk stratification of patients recovering from an acute coronary syndrome. The aim of this review was to verify whether evidence still exists supporting the use of exercise ECG as first choice stress testing modality in this clinical setting in the light of the most recent prognostic data and of cost effectiveness considerations. It was concluded that a large body of evidence supports the use of exercise ECG as a cost‐effective tool for prognostic purposes and for quality of life assessment following acute coronary syndromes.
Correlation between myocardial perfusion abnormalities detected with intermittent imaging using intravenous perfluorocarbon microbubbles and radioisotope imaging during high‐dose dipyridamole stress echo
Authors: Ronderos Ricardo E. , Boskis Mario , Chung Namsik , Corneli Diomedes B. , Escudero Eduardo M. , Ha Jong W. , Charlante Carlos , Rim Se‐Joon , Portis Marcelo , Fabris Nora , Camilletti Jorge , Mele Anibal A. , Otero Fernando , Porter Thomas R. 
Published: June 2007

AbstractBackground: The clinical accuracy of myocardial contrast echocardiography (MCE) using intermittent harmonic imaging and intravenous perfluorocarbon containing microbubbles during dipyridamole stress has not been evaluated in a multi‐center setting.Hypothesis: The accuracy of dipyridamole stress contrast echo in the detection of coronary artery disease (CAD) using myocardial perfusion images is high in comparison with tech‐netium‐99 (99Tc) sestamibi single‐photon emission computed tomography (MIBI SPECT) and increases the accuracy of wall motion data.Methods: In 68 consecutive nonselected patients (46 men; mean age 66 years) from three different institutions in two countries, dipyridamole stress echo and SPECT with 99mTc MIBI were compared. Continuous intravenous (IV) infusion of perfluorocarbon exposed sonicated dextrose albumin (PES‐DA) (2‐5 cc/min) was administered for baseline myocardial perfusion using triggered harmonic end systolic frames. Realtime digitized images were used for wall motion analysis. Dipyridamole was then injected in two steps: (1) 0.56 mg/kg for 3 min; (2) 0.28 mg/kg for 1 min, if the first step was negative for an inducible wall motion abnormality. After dipyridamole injection, myocardial contrast enhancement and wall motion were analyzed again by the same methodology.Results: There were 35 patients with perfusion defects by SPECT. Wall motion was abnormal in 22, while MCE was abnormal in 32. Wall motion and MCE each had one false positive. The proportion of correctly assigned patients was significantly better with MCE than with wall motion (p = 0.03; chi square test).Conclusions: Myocardial contrast echocardiography, using intermittent harmonic imaging and intravenous perfluorocarbon containing microbubbles, is a very effective method for detecting coronary artery disease during dipyridamole stress echo.
Myocardial infarction following the combined recreational use of viagra® and cannabis
Authors: McLeod A. L. , McKenna C. J. , Northridge D. B. 
Published: June 2007

AbstractSildenafil citrate (Viagra®,Pfizer, Inc., New York, N.Y.) is widely prescribed as a treatment for male erectile dysfunction. It is metabolized predominantly by the cytochrome P450 3A4 hepatic microsomal isoenzyme and effects can, therefore, be potentiated by such inhibitors. The vasodilatory effects of Viagra necessitate caution in its use in patients with cardiovascular disease and it is contraindicated in patients receiving nitrates. Previous literature has drawn attention to Viagra use and myocardial infarction. This paper reports the case of a young man who presented with a myocardial infarction after taking Viagra in combination with cannabis, a known inhibitor of the cytochrome P450 3A4 isoenzyme.
Clinical presentation, hospital length of stay, and readmission rate in patients with heart failure with preserved and decreased left ventricular systolic function
Authors: Malki Qahtan , Sharma Nagaraja D. , Afzal Adnan , Ananthsubramaniam Karthik , Abbas Ali , Jacobson Gordon , Jafri Syed 
Published: June 2007

AbstractBackground: Congestive heart failure is the leading cause of hospital admissions for adults in the United States. To our knowledge, there are limited data comparing the clinical presentation, hospital length of stay, and readmission in patients with preserved and decreased left ventricular (LV) systolic function.Hypothesis: The goal of the study was to determine whether there are differences in clinical presentation, hospital length of stay, and readmission in patients with preserved (≥ 50%) and reduced (< 50%) systolic function.Methods: We prospectively evaluated 187 patients admitted with congestive heart failure confirmed by the presence of pulmonary vascular congestion on chest x‐ray, and with recent (< 6 months) documentation of LV systolic function by two‐dimensional echocardiography. History and physical examination findings, patient demographics, comorbidities, discharge medications, and length of hospital stay data were documented. Readmission rate over a 6‐month follow‐up period was also documented.Results: Of the 187 patients, 130 (70%) patients had an ejection fraction (EF) < 50%, and 57 (30%) patients had an EF ≥ 50%. Patients with EF < 50% were more likely to be men (54 vs. 37%, p = 0.03), African Americans (79 vs. 60%, p = 0.007), had a higher prevalence of previous stroke (17 vs. 5%, p = 0.03), and were more likely to carry no medical insurance at the time of admission (14 vs. 2%, p = 0.01) and to be discharged on digoxin (60 vs.30%, p<0.001). There were no significant differences in symptoms (exertional dyspnea, rest dyspnea, orthopnea, or paroxysmal nocturnal dyspnea), or in physical examination findings (S3, S4, elevated jugular venous pressure, rales, orperipheral edema). According to chest x‐ray, patients with EF < 50% had more frequent cardiomegaly (88 vs. 72% p = 0.008), but there were no differences in the presence of pleural effusion or pulmonary vascular congestion (p = NS). The mean length of stay was 5.9 and 5.2 days, respectively (p = 0.34). During the 6‐month follow‐up period, the readmission rates were 33% (43 patients) and 26% (15 patients), respectively (p = 0.36).Conclusion: The clinical presentation, hospital length of stay, and readmission rate for congestive heart failure are similar in patients with preserved and decreased LV systolic function.
The impact of right atrial ischemia on inferior myocardial infarction with extension to right ventricle: Transesophageal echocardiographic examination
Authors: Vargas‐Barrón Jesús , López‐Meneses Mauricio , Roldán Francisco‐Javier , Romero‐Cardenas ÁNgel , Keirns Candace , Espinola‐Zavaleta Nilda , Peña‐Duque Marco , Martínez‐Sanchez Carlos , Ríos Marco‐Antonio Martinez 
Published: June 2007

AbstractBackground: The role of the right atrium in adaptation to the hemodynamic changes produced by extension of myocardial infarction (MI) of the left ventricular inferior wall to the right ventricle is fundamental.Hypothesis: The aim of this study was analyze a group of patients with MI with extension of right chambers, and particularly right atrial alterations, by transesophageal echocardiography and to correlate it with clinical and angiographic variables.Methods: Thirty patients with right ventricular (RV) MI involving obstruction of the right coronary artery without stenosis of the left coronary artery were included; 18 underwent early reperfusion. Transesophageal echocardiography was performed on all within 5 days of coronary angiography. Follow‐up was continued from hospitalization to the present.Results: When patients withright atrial ischemia were compared with those with normal right atrium, the RV wall movement score was significantly greater in the group with right atrial ischemia, severe RV dilatation was more frequent, and association with proximal occlusion of the artery responsible for the MI, as well as absence of right atrial branches and poor collateral circulation, were significant. Hospitalization was more prolonged in this group, and there was a higher incidence of arrhythmias, complete atrioventricular block, and mortality.Conclusions: Right atrial ischemia associated with RV infarction leads to a higher incidence of complications and higher mortality. Transesophageal echocardiography is a safe, reproducible technique that provides detailed anatomic information about right chambers and aids in the determination of prognosis and therapeutic decisions.
Severe aortic stenosis and mitral regurgitation in a woman with systemic lupus erythematosus
Authors: Moyssakis Ioannis , Tzioufas Athanasios , Triposkiadis Filippos , Strateges Nikolaos , Kyriakidis Michael 
Published: June 2007

AbstractLibman‐Sacks endocarditis complicating systemic lupus erythematosus has rarely been reported to cause hemodynamically significant valvular lesions. This report presents a case of severe aortic stenosis combined with severe mitral regurgitation associated with systemic lupus erythematosus in a young woman who died while on the quota list for surgery.
Reevaluating the role of phosphodiesterase inhibitors in the treatment of cardiovascular disease
Authors: Feldman Arthur M. , McNamara Dennis M. 
Published: June 2007

AbstractFirst developed for clinical use in the late 1980s, the phosphodiesterase inhibitors were found to increase the levels of the ubiquitous second messenger cyclic adenosine monophosphate and could effect changes invasculartone, cardiac function, and other cellular events. After several early studies using high doses of phosphodiesterase inhibitors in patients with severe heart failure suggested adverse consequences, they fell out of favor. However, recent investigations of phosphodiesterase inhibitors in patients with intermittent claudication have demonstrated profound benefits. Furthermore, these agents have proven useful in prevention of cerebral infarction and coronary restenosis, and their use in the treatment of heart failure is being reevaluated. The reemergence of phosphodiesterase inhibitors can be attributed to a better understanding of dosing and drug‐specific pharmacology, the use of concomitant medications, and a recognition of unique ancillary properties; however, their use still requires caution.
Comparison between transesophageal echocardiography and transthoracic echocardiography with harmonic tissue imaging for left atrial appendage assessment
Authors: Carerj Scipione , Trifró Maria Paola , Granata Antonio , Luzza Francesco , Arrigo Francesco , Oreto Giuseppe 
Published: June 2007

AbstractBackground: Transesophageal echocardiography (TEE) is the method of choice for evaluating both anatomy and function of left atrial appendage (LAA). In contrast, conventional transthoracic echocardiography (TTE) does not result in images of sufficient quality to explore LAA.Hypothesis: The aim of this study was to evaluate the potential role of TTE with harmonic frequency imaging (HFI) for assessing LAA normal anatomy and function.Methods: The study group comprised 25 patients, (9 men, 16 women, mean age 51 years, range 20–82). The TTE assessment of LAA both in fundamental frequency imaging (FFI) and HFI was performed using the apical two‐chamber view; the longitudinal two‐chamber view was used for TEE assessment of LAA. According to image quality, images were categorized into three classes: A: good quality, B: sufficient quality, C: poor quality.Results: Transthoracic echocardiography conventional imaging allowed sufficient LAA visualization (class B) in only 5 of 25 patients (20%); the HFI resulted inadequate LAA visualization in 23 of 25 patients (92%). Images were of good quality (class A) in 18 of 23 patients and of sufficient quality (class B) in 5 of 23 patients. Transesophageal echocardiography achieved good quality images in 24 of 25 patients (96%). Average LAA maximum area determined by HFI and TEE was 3.46 ± 1.17 and 3.59 ± 1.16 cm2, respectively; LAA minimum area was 1.81 ± 0.98 and 1.77 ± 0.97 cm2, respectively. Percent LAA area change was 51 ± 16.5 and 50.9 ± 16% with HFI and TEE, respectively. Statistical analysis showed no difference between the data obtained with the two methods.Conclusions: The results suggest that HFI TTE may be a useful tool for the exploration of LAA.
Lipoprotein(a) was an independent predictor for major coronary events in treated hypertensive men
Authors: Agewall Stefan , Fagerberg Björn 
Published: June 2007

AbstractBackground and Hypothesis: Lipoprotein(a) may play a part in the development of coronary heart disease. The purpose of this prospective study was to evaluate lipoprotein(a) as a predictor of major coronary events (fatal and nonfatal myocardial infarction and sudden death).Methods: This was a prospective study of 118 men, aged 56 to 77 years, with treated hypertension and at least one additional cardiovascular risk factor (hypercholesterolemia, diabetes mellitus, or smoking) were included in the study. Lipoprotein(a) was measured at entry and major coronary events were followed during follow‐up.Results: The mean observation time was 3.0 years. Fourteen patients had a major coronary event during the follow‐up period. Subjects with coronary heart disease (previous myocardial infarction, angina pectoris, or major electrocardiographic changes) at entry (n = 27) had significantly higher lipoprotein(a) levels than subjects without (n = 91) known coronary heart disease (p < 0.05). Lipoprotein(a) was a significant predictor for major coronary events (p = 0.033). Furthermore, when coronary disease at entry was included into the Cox regression analysis, lipoprotein(a) was an independent predictorfor major coronary events (p = 0.044).Conclusions: Among treated hypertensive men, lipoprotein(a) was an independent predictor of major coronary events.
Potential for use of pulse wave analysis in determining the interaction between sildenafil and glyceryl trinitrate
Authors: O'Rourke Michael F. , Nichols Wilmer W. 
Published: June 2007

AbstractBackground: The early part of the central aortic pressure pulse, with amplitude (PI – Pd), is generated by left ventricular ejection, while the latter part (or augmented pressure), with amplitude (Ps – Pi), is generated by the reflected wave arriving during systole. The effects of arterial vasodilator agents, especially nitrates, on central aortic systolic blood pressure are grossly underestimated by sphygmomanometric measurements of brachial artery pressure.Hypothesis: The objective of this study was to investigate the potential for use of central arterial pulse wave analysis, obtained noninvasively from the radial pulse, in determining the interaction between sildenafil and the nitric oxide donor drug glyceryl trinitrate (GTN).Methods: Central aortic pressure waveforms were generated from noninvasively measured radial artery pressure waveforms and subjected to pulse wave analysis to determine the interactionbetween sildenafil and transdermally applied GTN.Results: Transdermal GTN (2.5, 5.0, and 15 mg per 24‐h patches) alone caused no consistent change in sphygmomanometer‐determined systolic or diastolic pressures, but there was a consistent, dose‐related fall in amplitude of the augmented systolic pressure, (Ps – Pi), of 4.0,7.0, and 11 mmHg, respectively, with little change in diastolic pressure. The 2.5 mg patch caused a fall of 4.0 mmHg in aortic systolic pressure, while augmentation index (AIx) fell from 20 to 11% and pulse pressure fell 18%. When oral sildenafil (50 mg) was administered after GTN (2.5 mg), aortic systolic pressure fell another 4.0 mmHg. This decrease in systolic pressure caused a fall in AIx to almost 0.0%; pulse pressure fell another 9.0%.Conclusion: These modifications in aortic systolic and pulse pressure are due primarily to reduction in wave‐reflection amplitude and are not detected by sphygmomanometer‐measured brachial artery pressure.
Primary (isolated) meningococcal pericarditis
Authors: Morgan David R. , Spence Mark , Crowe Mary , O'Keeffe D. Barry 
Published: June 2007

AbstractA 19‐year‐old man was admitted with a history and examination findings of probable bacterial pericarditis. Blood cultures produced Neisseria meningitidis Group C, sensitive to penicillin. The patient was initially treated with intravenous benzylpenicillin. Echocardiogram demonstrated the development of a pericardial effusion which was tapped, and benzylpenicillin was instilled into the pericardial space. Because of failure of clinical resolution, cefotaxime was substituted forbenzyl penicillin. Rapid clinical improvement then ensued. Repeat echocardiogram showed evidence of neither reaccumulation nor constrictive pericarditis. Primary (isolated) meningococcal pericarditis is a recognized though rare manifestation of meningococcal disease. It is most common in young adults and is associated with a good prognosis.
Diastolic subclinical primary alterations in marfan syndrome and marfan‐related disorders
Authors: Porciani Maria Cristina , Giurlani Letizia , Chelucci Andrea , Pepe Guglielmina , Giusti Betti , Brunelli Tamara , Attanasio Monica , Martinucci Pietro , Fattori Rossella , Abbatea Rosanna , Gensini Gian Franco 
Published: June 2007

AbstractBackground: The extracellular matrix tissue of the myocardium importantly contributes to left ventricular (LV) performance. Inherited connective tissue disorders related to the FBN1 gene could involve cardiac interstitium resulting in functional abnormalities.Hypothesis: To disclose a primary involvement of myocardium, LV function was studied in 28 patients affected by Marfan syndrome or Marfan‐related disorders: 20 Marfan and 8 MASS (Mitral valve prolapse, Myopia, Aortic dilatation, Skeletal involvement, Skin striae) and in 28 healthy, age and gender‐matched controls. No valvular regurgitation or any other cardiac alterations were present.Methods: Echocardiographic study was performed to investigate LV systolic and diastolic function.Results: No statistically significant differences were observed between patients and the control group in LV dimensions, systolic function parameters (ejection and shortening fraction), and some diastolic function parameters (E peak, A peak, E/A), while statistically significant differences were found between patients and the control group in LV mass (128.7 ± 46.6 vs. 83.7 ± 14.5 g/m2, p < 0.008), in isovolumic relaxation time (102.0 ± 24.0 vs. 80.1 ± 11.2 ms, p<0.016), and in deceleration time of the E wave (127.5 ± 19.3 vs. 208.6 ± 24.5 ms, p < 0.001) and the A wave (66.4 ± 8.2 vs. 87.5 ± 23.4 ms,p< 0.008).Conclusions: These data show an unusual pattern of transmitral diastolic flow in which a decreased ventricular compliance and reduced myocardial relaxation coexist. Thus, in Marfan syndrome and in Marfan‐related disorders, subclinical diastolic alterations are present independent of valvular disease and might represent an early marker of primary myocardial involvement.
Medical treatment of patients with stable angina pectoris referred for coronary angiography: Failure of treatment or failure to treat
Authors: Carasso Shemy , Markiewicz Walter 
Published: June 2007

AbstractBackground: Patients referred for elective coronary arteriography because of stable angina pectoris frequently do not receive appropriate medical therapy prior to arteriography. Persistence of symptoms due to lack of appropriate therapy may influence the decision to catheterize and the treatment chosen following catheterization.Hypothesis: The present study evaluates whether patients with stable angina pectoris referred for cardiac catheterization received optimal therapy prior to the procedure. We also evaluated whether medical therapy was optimized as a result of the hospitalization for catheterization.Methods: We evaluated prospectively the adequacy of medical therapy in 333 consecutive patients undergoing elective coronary arteriography. Of these, 160 had stable angina pectoris as their main problem and constituted the study group.Results: Mean duration of angina was 7.5 ± 6.3 months. Canadian Cardiovascular Society angina grade 1 was present in 20, grade 2 in 77, grade 3 or 4 in 63 patients. Arteriography showed a > 50% coronary stenosis in 141 of 160 patients. Aspirin was used by 96%, and 86% received at least one drug aimed at relieving anginal symptoms: beta blockers in 69%, calcium blockers in 30%, and long‐acting nitrates in 29%. Antianginal drugs and drugs aimed at treating risk factors were usually taken at a low, subtherapeutic dosage. Only 35 of 110 patients taking beta blockers had a resting heart rate of ≥ 60/min. Following catheterization, 88 of 141 patients with coronary stenosis of ≤ 50% underwent percutanous intervention and 5 had urgent surgery. Optimization of treatment was advised in only 7 of 48 patients for whom medical therapy or elective surgery was recommended.Conclusion: Patients with stable angina pectoris are frequently referred for cardiac catheterization without making a serious attempt to control their symptoms by medical therapy. Risk factors are undertreated. With proper pharmacotherapy, many patients might have become asymptomatic and have chosen not to undergo catheterization and subsequent percutaneous interventions.