bluuebunny/crossref_metadata_2025_split huggingface dataset:
Retrograde atrial kick in acute aortic regurgitation. study of mitral and pulmonary venous flow velocities by transthoracic and transesophageal echocardiography
Authors: Vilacosta Isidre , Castillo Juan Antonio , Arganda Lourdes , Rollán María Jesús , Peral Vicente , Sánchez‐Harguindey Luis , Román José Alberto San , Zarco Pedro 
Published: February 2009

AbstractBackground and hypothesis: The purpose of this study was the comprehensive evaluation of the changes in pulmonary venous and mitral flow velocities of patients with acute and chronic severe aortic regurgitation. Transmitral flow velocities obtained with pulsed‐wave Doppler echocardiography have been used to provide information on left ventricular (LV) filling and diastolic function. Pulmonary venous flow tracings are an important adjunct to LV inflow pattern in assessing LV diastolic function.Methods: Fourteen patients with severe aortic regurgitation (8 chronic and 6 acute) and in sinus rhythm were examined by transthoracic and transesophageal pulsed Doppler echocardiography. Mitral and pulmonary flow velocities were recorded and compared. All patients had ejection fractions > 40%.Results: Early mitral flow peak velocity was higher in patients with acute regurgitation (p<0.001). The mitral A wave was absent in five patients with acute regurgitation. In contrast, a prominent reverse atrial pulmonary systolic wave AR was demonstrated in these patients. Peak diastolic velocity of the pulmonary venous flow was greater in patients with acute aortic regurgitation (0.76 ± 0.13) than in patients with chronic aortic regurgitation (0.40 ± 0.09) (p<0.001). Peak systolic velocity did not differ significantly between the two groups. The systolic fraction of pulmonary venous flow in patients with acute aortic regurgitation was lower (0.43 ± 0.05) than that of patients with chronic regurgitation (0.63 ± 0.1) (p<0.01). All patients with acute aortic regurgitation had an S/D ratio < 1, while those with chronic regurgitation had an S/D >1 (p< 0.001) and an E/A<1.Conclusion: Patients with severe acute aortic regurgitation showed a retrograde atrial kick (absence of transmitral A wave with prominent pulmonary AR wave). These patients had an S/D ratio < 1 (restrictive Doppler pattern). Patients with chronic aortic regurgitation exhibited a Doppler pattern of abnormal LV relaxation (E/A <1, S/D > 1).
High‐rate cardiac pacing increases blood pressure and decreases right atrial pressure in patients with hemodynamic significant acute right ventricular myocardial infarction and bradyarrhythmia
Authors: Vrouchos G. T. , Kiulpalis A. , Trullakis G. A. , Stasinos P. G. , Ellinkakis S. G. , Koumatzias N. C. , Chatzakis G. K. 
Published: February 2009

AbstractBackground: In an 84‐year‐old patient with acute right ventricular myocardial infarction (RVI), complete heart block, and low cardiac output, a significant increase in blood pressure (BP) and decrease in right atrial pressure (RAP) were accidentally observed during the performance of high‐rate ventricular pacing.Methods: Based on that observation, the acute effects of high‐rate cardiac pacing (VVI or AAI) on BP and RAP were studied in 15 consecutive patients (67.4 ± 7.7 years), with hemodynamically significant RVI. Ten had advanced heart block and five had sinus bradycardia. Cardiac pacing with simultaneous recording of BP and RAP at intrinsic rhythm and at heart rates of 70,90,110,130 beats/min was performed.Results: Systolic BP (SBP) increased significantly from 94.6 ± 15 mmHg during intrinsic rhythm to 101.9 ± 13.8 mmHg‐127 ± 12.2 mmHg at heart rates 70–130 beats/min (p<0.0001). Diastolic BP (DBP) also increased from 48.2 ± 8.7 to 53.9 ± 3.7–69.1 ± 3 mmHg at heart rates 70–130 beats/min, (p<0.014–0.0001). Mean RAP decreased from 14.5 ± 5 to 14.1 ± 5 mmHg‐11.1 ± 4.1 mmHg at heart rates 70–130 beats/min (p = 0.16–0.0001). Significant elevation of SBP (p<0.007), DBP (p<0.0075), and decrease of RAP (p<0.038) were also detected by comparing the usual pacing rate at 70 beats/min with pacing rates at 90–130 beats/min.Conclusions: These findings, if demonstrated over a prolonged period during the acute state of RVI, may influence the management of patients with RVI to include high‐rate cardiac pacing, probably in the range of 80–110 beats/min.
Unmasking of fast and slow atrioventricular nodal pathways by successful radiofrequency ablation of two accessory atrioventricular connections
Authors: Centurión Osmar Antonio , Kaibara Muneshige , Isomoto Shojiro , Konoe Atsushi , Yano Katsusuke 
Published: February 2009

AbstractElectrophysiologic findings suggesting the coexistence of dual atrioventricular (AV) nodal pathways and accessory AV connections have been previously described. Anterograde conduction through the accessory pathway (AP) may preclude the diagnosis of AV nodal dual pathway physiology during atrial stimulation. This study reports on a patient with manifest Wolff‐Parkinson‐White syndrome with clinically documented paroxysmal atrial fibrillation, in whom dual AV nodal pathways were unmasked after successful radiofrequency ablation of two accessory AV connections. In spite of detailed investigation, fast and slow AV nodal pathways were not detected in the first electrophysiologic study 8 years before ablation, nor were they detected during preablation study because of exclusive anomalous anterograde conduction. The anterograde AP effective refractory period was shorter than that of the fast and slow AV nodal pathways, and was limited by atrial refractoriness at 190 ms. The present findings strongly suggest the necessity for a careful postablation electrophysiologic study before and after isoproterenol administration with specific evaluation of AV nodal conduction. This is the first documented report on the finding of AV nodal dual pathway physiology and reentry after successful radiofrequency ablation of two APs. This finding may be of great therapeutic significance in light of the feasibility of slow pathway ablation also during a single session, had AV nodal reentry been induced in a sustained manner after ablation of the AP to prevent late recurrence of tachycardia.
Paracardiac masses caused by a right coronary artery aneurysm and a saphenous vein graft aneurysm
Authors: Chalasani Prasad , Konlian Donna , Clements Stephen 
Published: February 2009

AbstractTwo unusual cases of large aneurysms, one located in the native right coronary artery and the other in a saphenous vein graft, are reported. Their size and mode of presentation as asymptomatic paracardiac masses on chest x‐ray films make them unique. It is proposed that these entities be considered as part of the differential diagnosis of paracardiac masses.
Unsuspected vasculitis and intracranial hemorrhage following thrombolysis
Authors: Srinivasan Gopalakrishnan , Boschman Cynthia , Roth Sanford I. , Hendel Robert C. 
Published: February 2009

AbstractTreatment with thrombolytic agents such as streptokinase or tissue plasminogen activator (TPA) is an accepted standard for the treatment of patients with acute myocardial infarction (MI)1–2 A devastating sequel of thrombolytic therapy may be the development of a hemorrhagic complication, particularly intracranial bleeding, which, although rare, is usually associated with significant neurologic sequelae or death.1–2 While various risk factors have been correlated with the development of intracranial hemorrhage following thrombolysis, a possible relationship between bleeding and a clinically unsuspected underlying vasculitis has not been previously reported. This report deals with the case of a 49‐year‐old man who died of multiple intracranial hemorrhages after thrombolytic therapy for acute MI and who was found at autopsy to have had polyarteritis nodosa of the coronary arteries and vasculitis of the meningeal vessels.
Surgery in patients with coronary artery disease—silent ischaemia during transurethral resection of tumors of prostate or bladder
Authors: Wacker Petra , Saborowski Friedhelm , Assenmacher Martin , Dieterich Hans Armin 
Published: February 2009

AbstractBackground: Asymptomatic episodes of myocardial ischemia in clinically stable patients seem to occur frequently and may hint at a worse prognosis.Hypothesis: This study was undertaken to determine whether surgical patients with coronary artery disease (CAD) have a higher risk of cardiac ischemia during the perioperative period compared with the late postoperative period and compared with patients without CAD.Methods: In all, 14 patients with and 14 patients without CAD were examined by Holter monitoring during the perioperative and three days later during the postoperative periods for the presence of ST‐segment depression as a marker of silent myocardial ischemia.Results: While patients without CAD did not show ST‐segment depression, patients with CAD were found to have had 143 episodes of ST‐segment depression, 49% in the perioperative and 51% in postoperative recordings.Conclusion: Though patients were asymptomatic with antianginal therapy, there were episodes of ST‐segment depression indicating silent myocardial ischemia in patients with CAD. Surgical interventions such as transurethral resection of tumors of prostate or bladder did not produce an increase of ischemic burden registered by Holter monitoring.
Effect of antibiotic treatment on vegetation size and complication rate in infective endocarditis
Authors: Rohmann Sven , Erbel Raimund , Darius Harald , Makowski Thomas , Meyer JÜRgen 
Published: February 2009

AbstractBackground: Infective endocarditis is associated with significant morbidity and mortality, with valvular destruction, and with congestive heart failure. Embolic events are more common in patients with echocardiographically discernible vegetations, especially when vegetations are >10 mm in diameter.Hypothesis: The objective of the study was to follow vegetation morphology during native valve endocarditis, to compare it with the clinical course and antibiotic treatment chosen, and to evaluate whether the impact on vegetation size and complication rate of antibiotic regimens differed in patients with positive and negative blood cultures.Methods: The effect of different antibiotic regimes on vegetation size monitored by using transesophageal echocardiography was evaluated in 183 patients with echocardiographic evidence of infective endocarditis. A total of 223 vegetations attached to the aortic or mitral valves were detected using the transesophageal approach. The patients were followed for a mean of 76 weeks and underwent a minimum of two consecutive transesophageal echocardiographic examinations.Results: Treatment with different kinds of antibiotics corresponded with significant differences in vegetation size; vancomycin‐associated treatment was related to a 45% reduction, ampicillin to a 19% reduction, penicillin to a 5% reduction, penicillase‐resistant drugs to a 15% increase, and cephalosporin to a 40% increase in vegetation size. Multivariate analysis showed that penicillin, cephalosporin, and penicillase‐resistant drug treatments were associated with an increased embolic risk, vancomycin treatment with abscess formation, and cephalosporin medication with increased mortality. Plotting changes in vegetation size against the incidence of embolism and mortality, linear regression analysis suggested a 40–50% reduction in vegetation size, thereby greatly reducing the risk of embolism and mortality.Conclusion: Our study shows that different antibiotics have different effects on vegetation size. The highest complication rate was observed when vegetations significantly increased in size during antibiotic treatment. Especially in culture‐negati ve patients, monitoring vegetation size by means of transesophageal echocardiography may prove to be useful for estimating the efficacy of antibiotic treatment.
May age onset be relevant in the occurrence of left ventricular hypertrophy in Friedreich's ataxia?
Authors: Maione Stefania , Giunta Anna , Spinelli Letizia , Liucci Giovanni Antonio , Condorelli Mario , Filla Alessandro , De Michele Giuseppe , Campanella Giuseppe 
Published: February 2009

AbstractBackground: Although heart involvement has been widely reported in Friedreich's ataxia (FA), which is the most prevalent of the spino‐cerebellar degenerative diseases, the reason that cardiac abnormalities develop has not been yet established.Hypothesis: The investigation was undertaken to study the prevalence and characteristics of cardiac abnormalities in patients with FA and to evaluate whether the presence of left ventricular hypertrophy could be predicted.Methods: In all, 75 patients with FA and 16 patients with late onset FA (LOFA) disease were investigated for cardiac abnormalities using noninvasive methods.Results: A significant (p< 0.01) difference in the age onset (9.8 ±3.9 years) was found in 31 of the 75 patients with FA (41%) who showed left ventricular hypertrophy (LVH) at echocardiographic examination compared with the remaining 44 patients with FA without LVH (12.6 ± 4.3 years). Moreover, none of the 16 patients with LOFA (age onset 26.5 ± 4.2 years) showed abnormalities at echocardiographic examination. A significant (p<0.01) concordance in the familial distribution of hypertrophy was also found.Conclusion: These data suggest that the earlier the disease develops the more frequently LVH occurs.
Disparity between serotonin‐ and acetylcholine‐provoked coronary artery Spasm
Authors: Kanazawa Kenji , Suematsu Masakuni , Ishida Tatsuro , Hirata Ken‐Ichi , Kawashima Seinosuke , Akita Hozuka , Yokoyama Mitsuhiro 
Published: February 2009

AbstractBackground and hypothesis: Intrinsic vasoactive substances, such as serotonin and acetylcholine, are known to provoke coronary artery spasm in patients with vasospastic angina. It remains unclear, however, whether these different agents, which activate different receptors, produce spasms at the same sites in these patients. The present study was designed to clarify the disparity of receptor agonist‐induced coronary artery spasms in the same patients.Methods: We conducted sequential provocative tests of coronary artery spasm by acetylcholine, serotonin, and ergonovine in 20 patients with rest angina examined with quantitative coronary angiography.Results: Coronary artery spasms were provoked in all patients at 27 spastic sites. In 13 patients, ergonovine provoked spasms and in 10 of 13 patients who were diagnosed with variant angina, both acetylcholine and serotonin provoked spasms at the same sites where ergonovine also did. In 4 of 13 patients, spasms were provoked by serotonin but not by acetylcholine. In the remaining seven patients, whose spasms were induced by ergonovine, spasms were produced by acetylcholine but not by serotonin. On coronary angiography, the spastic sites for both acetylcholine and serotonin, and those for serotonin alone, were located in the proximal segments of coronary arteries, whereas the spastic sites for acetylcholine alone were located in the distal segments.Conclusions: This study documented the disparity between serotonin‐ and acetylcholine‐induced spasms. Provocative tests using agents that activate different receptors may produce coronary artery spasms at the same and/or different sites, and this disparity may reflect the clinical heterogeneity of vasospastic ischemic syndrome.
Catheter ablation of ventricular tachycardia in chagasic cardiomyopathy
Authors: Rosas Fernando , Velasco Victor , Arboleda Felipe , Santos Hernando , Orjuela Hernando , Sandoval Nestor , Caicedo Victor , Correa Juan , Fontaine Guy 
Published: February 2009

AbstractThere is a limited experience with catheter ablation for treatment of ventricular tachycardia (VT) in Chagasic cardiomyopathy. A 30‐year‐old woman experienced episodes of palpitations and syncope due to attacks of VT. A diagnosis of Chagas disease was established on a biological basis. Two‐dimensional echo and contrast ventriculography showed an apical aneurysm with thrombus. Surgery was indicated to resect the aneurysm and ablate the VT. Ventricular tachycardia recurred 1 month later despite therapy, including amiodarone. Two clinical frequent and well‐tolerated tachycardias were identified. The site of origin was located in the right ventricular apex and in the apical‐lateral wall of the left ventricle, respectively. Catheter ablation was performed at two sites with DC shocks (total energy 600 J) after unsuccessful radiofrequency ablation. Holter recordings performed during the postoperative period showed only infrequent extrasystoles. After follow‐up of 24 months the patient remains asymptomatic. Drug‐refractory VT in Chagasic cardiomyopathy can be ablated by medium‐energy DC shocks after failure of radiofrequency ablation.
Echocardiographic diagnosis of papillary fibroelastoma of the mitral and tricuspid valve apparatus
Authors: Lund Gunnar K. , Koschyk Dietmar H. , Nienaber Christoph A. , öder SÖRen 
Published: February 2009

AbstractPapillary fibroelastomas are rare and normally benign cardiac tumors typically attached to cardiac valves. This report describes two patients who were evaluated for intermittent dyspnea in one case and for the source of cerebral embolism in the other. In both patients transthoracic echocardiography revealed a pedunculated mobile mass adjacent to an atrioventricular valve, suggestive of papillary fibroelastoma. Postoperative histology was confirmatory of papillary fibroelastoma with a typical hyalinized hypocellular stroma covered by a single layer of endocardial cells.
Predictive value of dobutamine radionuclide ventriculography in detection of functional improvement after acute anterior wall infarction and thrombolytic therapy
Authors: Zafrir Nili , Bassevich Roni , Zlotikamien Bruria , Sulkes Jaqueline , Sclarovsky Shmuel , Lubin Ernesto 
Published: February 2009

AbstractBackground: Prolonged postischemic ventricular dysfunction (stunned myocardium) may prevent the assessment of myocardial salvage early after thrombolysis. Dobutamine in conjunction with radionuclide ventriculography has been proposed for the early assessment of myocardial viability and prediction of functional recovery.Hypothesis: This study was designed to investigate the effects of low‐dose dobutamine infusion on early global and regional function of reperfused myocardium after acute anterior wall myocardial infarction (MI). In particular, our purpose was to examine whether this response can predict late recovery of left ventricular function and correlate with the reperfused status (patency of infarct‐related artery).Methods: In all, 29 consecutive patients with first uncomplicated anterior wall MI, and who had received thrombolytic therapy, underwent radionuclide ventriculography at rest and 2 min after each dose increment of dobutamine infusion (5–15 m̈g/kg/min) on the third day after the infarction, at discharge, and at 3 months' follow‐up. Global and regional ejection fraction were calculated at each stage. Four patients with complications were dropped from the study. A significant response to dobutamine was defined as an increase of at least ≥7% in global or regional ejection fraction at the infarct zones.Results: Of the 25 patients, 18 (72%) fulfilled these criteria. Of these, 10 patients (56%) had a significant improvement in global or regional ejection fraction at discharge and 13 patients (72%) at 3‐month follow‐up. The overall sensitivity of the dobutamine test in predicting left ventricular improvement was 100% at discharge and 93% at 3‐month follow‐up. However, the positive and negative predictive values were 56 and 100% at discharge and 72 and 86%, respectively, at 3‐month follow‐up.Conclusion: Low‐dose dobutamine radionuclide ventriculography is a safe and useful test for assessing myocardial viability and may predict late functional improvement in patients with anterior wall MI.
Comparison of transesophageal coronary sinus and left anterior descending coronary artery doppler measurements for the assessment of coronary row reserve
Authors: Mundigler Gerald , Zehetgruber Manfred , Christ Günter , Siostrzonek Peter 
Published: February 2009

AbstractBackground: Currently used methods for assessment of coronary flow reserve are invasive and require extensive laboratory equipment. Recently, noninvasive assessment of coronary flow reserve by transesophageal Doppler evaluation of coronary sinus (CS) or left anterior descending coronary artery (LAD) flow has been proposed. Direct comparison between these two techniques is lacking.Methods: Doppler recordings of CS and LAD flow velocity were obtained before and after 0.6 mg/kg/5 min dipyridamole in 16 patients with significant stenosis of the LAD (Group A) and in 14 control patients (Group B). Flow recordings and all measurements were performed in a blinded manner. For assessment of coronary flow reserve, Doppler measurements after dipyridamole were divided by the respective baseline values.Results: Doppler studies of the CS and LAD were feasible in 30 of 30 (100%) and 23 of 30 (71%) patients, respectively. Analyzing the maximum flow velocities, coronary flow reserve in Groups A and B was 1.18 ± 0.28 and 1.68 ± 0.53 with CS recordings and 1.78 ± 0.83 and 2.51 ± 0.76 with LAD recordings, respectively. Analyzing the velocity time integrals, coronary flow reserve in Groups A and B was 1.53 ± 0.68 and 2.59 ± 0.74 with CS recordings and 1.77 ± 0.38 and 2.68 ± 0.93 with LAD recordings, respectively. Correlation between LAD and CS recordings was 0.69 (p<0.001), when coronary flow reserve was calculated from the velocity time integral and 0.68 (p<0.001) when the maximum flow velocities were used.Conclusion: Both transesophageal Doppler techniques might be useful for noninvasive assessment of coronary flow reserve.
Autonomic responses to orthostatic stress in head‐up tilt testing: Relationship to test‐induced prolonged asystole
Authors: Takase Bonpei , Nagai Tomoo , Uehata Akimi , Katushika Syuichi , Isojima Kazushige , Hakamata Naohiro , Ohtomi Shingo , Ota Satoshi , Kurita Akira , Nakamura Haruo 
Published: February 2009

AbstractBackground: Prolonged asystole is sometimes an extreme manifestation of neurally mediated syncope.Hypothesis: To investigate the mechanism of head‐up tilt testing‐induced prolonged (life‐threatening) cardiac asystole, we measured temporal changes in frequency domain heart rate variability indices in 25 patients with syncope of undetermined etiology.Methods: Head‐up tilt testing (80°) was performed in 25 patients for up to 40 min or until asystole or syncope occurred. Three patients (Group 1; 37 ±13 years, 1 man, 2 women) had an episode of prolonged cardiac asystole (≥ 10 s) during testing, necessitating cardiopulmonary resuscitation. Syncope, but no asystole, was induced in 10 patients (Group 2; 48 ± 31 years, 6 men, 4 women), and 12 patients (Group 3; 55 ± 20 years, 5 men, 7 women) failed to show asystole or syncope during testing. Power spectra of low (0.04–0.15 Hz) and high (0.15–0.40 Hz) frequency, and total (0.01–1.00 Hz) frequency spectra were measured in consecutive 2 min segments throughout the test.Results: Maximally changed values in heart rate, systolic blood pressure, and heart rate variability indices during testing were compared among the three groups (maximally changed values did not include the values during tilt‐induced symptoms). High frequency spectra in Groups 2 and 3, but not in Group 1, decreased during the test. High frequency spectra, low frequency spectra, and total spectra in Group 1 were significantly higher than those in Groups 2 and 3 during testing. In Group 1 patients, findings at test‐induced asystole were consistent with exaggerated sympathetic and concurrent persistent parasympathetic activity.Conclusion: Unusual autonomic responses to orthostatic stress can cause prolonged asystole, and this autonomic nerve dysregulation may relate to asystolic episodes associated with cardiovascular collapse.