bluuebunny/crossref_metadata_2025_split huggingface dataset:
Echocardiographic assessment of wall motion in ST‐segment alternans during coronary angioplasty
Authors: Kerensky Richard A. , Lewis Jannet F. , Azar Gordon J. , Franco Elizabeth A. , Hill James A. 
Published: February 2009

AbstractST alternans occurs in the setting of severe and extensive myocardial ischemia. In this particular case, ST alternans occurred well after the onset of ischemia‐induced left ventricular dysfunction. There is no echocardiographic evidence of beat‐to‐beat variation in contractility to correspond to this ST‐segment phenomenon. Further studies of left ventricular function during ST alternans in patients are needed to determine whether this finding applies to all patients with is‐chemic heart disease.
Elevated serum Lp (a) concentration and the rare apo (a) phenotype in a patient with myocardial infarction
Authors: Hibino Takeshi , Sakuma Nagahiko , Hashimoto Takeshi , Ohte Nobuyuki , Yoneyama Akihiko , Satoh Takaaki , Fujinami Takao 
Published: February 2009

AbstractLp (a) is considered to be an independent risk factor for the development of cardiovascular disease. A case of myocardial infarction with elevated serum Lp (a) concentration and the rare apo (a) phenotype and its successful recanal‐ization using tissue plasminogen activator is reported.
Increased frequency of organ‐specific cardiac antibodies in healthy relatives of patients with dilated cardiomyopathy: Evidence for autoimmunity in polish families
Authors: Bilińska Z.T. , Kuśmierczyk‐Droszcz B. , Michalak E. , Grzybowski J. , Rydlewska‐Sadowska W. , Ruzyłło W. , Caforio A.L.P. , Goldman J.H. , Haven A.J. , Mckenna W.J. 
Published: February 2009

AbstractBackground and hypothesis: Autoantibodies represent markers of autoimmune involvement and are found with increased frequency in patients and their symptom‐free relatives at risk compared with normal controls. Cardiac‐specific autoantibodies, detected by immunofluorescence, were found in 20% of symptom‐free relatives of patients with dilated cardiomyopathy (DCM) from England and Italy. The role of autoimmunity may vary in DCM patients from Poland due to ethnic differences in genetic susceptibility to autoimmune disease.Methods: We assessed the frequency of the organ‐specific cardiac autoantibodies in 162 symptom‐free relatives of DCM patients [85 male, mean (SD) age 27 (18) years] and 80 control subjects from Poland. Familial DCM (>1 affected member) was present in 4 families, nonfamilial DCM in the remaining 24 pedigrees. We performeResults: The frequency of cardiac‐specific autoantibodies was higher among patients with documented DCM (probands and relatives) (50%) and their symptom‐free relatives (38%) than in unrelated normal subjects (10%;p=0.0001). In 24 (86%) of the pedigrees studied, autoantibodies were found in the proband and/or in at least one family member and tended to be more common in familial than in nonfamilial DCM (50 vs. 35%, p=NS). Echocardiographic indices of left ventricular size and function were similar in relatives with and without detectable antibodies.d antibody screening and noninva‐sive cardiological assessment in the whole group.Conclusions: The presence of cardiac‐specific autoantibodies in symptom‐free relatives of DCM patients provides evidence for autoimmunity in the majority (86%) of our pedigrees, including both familial and nonfamilial forms of DCM.
Comparison of time domain and spectral turbulence analysis of the signal‐averaged electrocardiogram for the prediction of prognosis in idiopathic dilated cardiomyopathy
Authors: Yi Gang , Keeling Philip J. , Goldman Jonathan H. , Hnatkova Katerina , Malik Marek , Mckenna William J. 
Published: February 2009

AbstractBackground: Despite significant advances in the treatment of heart failure, the prognosis of patients with idiopathic dilated cardiomyopathy remains poor. Although several of prognostic variables have been shown to be useful in risk stratification of patients with idiopathic dilated cardiomyopathy, their predictive accuracy is low and clinical usefulness uncertain.Hypothesis: This study was undertaken to assess the signal‐averaged electrocardiogram (SAECG) in patients with idiopathic dilated cardiomyopathy and to compare the ability of time domain and spectral turbulence analytic techniques to predict clinical outcome.Methods: SAECG analysis was performed in 80 patients with idiopathic dilated cardiomyopathy. Nineteen patients had left bundle‐branch block and eight were taking low‐dose ami‐odarone for life‐threatening arrhythmias. Conventional time domain and spectral turbulence analyses of the SAECG were performed using Del Mar 183 software.Results: During a follow‐up of 27 ± 19 months, 24 patients developed progressive heart failure, while the others remained clinically stable. Late potentials were detected in 28% of patients and were equally frequent in patients with and without progressive heart failure (38 vs. 23%, p = 0.20). Spectral turbulence analysis was abnormal in 34% of patients, and patients with abnormal results developed progressive heart failure more frequently than those with normal results (50 vs. 17%, p = 0.01). All spectral turbulence analysis parameters were significantly different in patients with progressive heart failure compared with those who remained clinically stable (p≤0.01). Furthermore, progressive heart failure‐free survival at 2 years was significantly lower in patients with abnormal compared with normal results (63 vs. 87%;p<0.05), but was similar in patients with and without late potentials (72 vs. 83%;p = 0.30). The relative risk for developing progressive heart failure using spectral turbulence analysis was 3.4 (95% confidence interval 1.2–9.7) and 2.8 (95% confidence interval 1.1–8.7) using time domain analysis. The sensitivity, specificity, and the positive and negative predictive accuracy for identifying patients who developed progressive heart failure were 50,83,50, and 83%, respectively, (p = 0.01) for spectral turbulence analysis, and 36,85,45 and 80%, respectively, (p = 0.09) for time domain analysis.Conclusion: Abnormalities in the SAECG of patients with idiopathic dilated cardiomyopathy are common and appear to provide a noninvasive marker for development of progressive heart failure.
Analyses of cost effectiveness in the management of essential hypertension: What they can and what they do not teach us
Authors: Massie Barry M. 
Published: February 2009

AbstractThere are approximately 50 million hypertensive individuals in the United States, and their treatment is often life‐long. Most are asymptomatic, so the goal of treatment is to prevent complications, which often occur decades after the condition is detected. Although the management of hypertension is potentially very costly, it is now clear that antihyperten‐sive therapy can substantially reduce cardiovascular mortality and morbidity. This constellation of an asymptomatic process with a very high prevalence capable of producing severe and potentially costly complications is precisely the circumstance under which cost effectiveness of therapy becomes an important consideration. Several such analyses have been performed, examining the question of which patients should be treated, what procedures should be used in their evaluation, and which therapeutic agents should be used. These studies highlight important issues, but also illustrate the potential pitfalls and fallacies of such analyses, particularly when outcome data are unavailable or inadequate. This article reviews the literature concerning cost‐effectiveness analyses in the management of hypertension and discusses the value of this approach.
Coronary artery and saphenous vein graft remodeling: A review of histologic findings after various interventional procedures—Part II
Authors: Waller Bruce F. , Orr Charles M. , Vantassel James , Peters Thomas , Fry Edward , Hermiller James , Grider Larry D. 
Published: February 2009

AbstractCatheter balloon angioplasty is a well accepted form of nonsurgical treatment of acutely and chronically obstructed coronary artery vessels. It is also the centerpiece for various new intervention techniques. Their morphologic effects on the site of obstruction has been termed “remodeling.” Part II of this six‐part series focuses on morphologic causes of acute closure after remodeling and discusses findings late after successful balloon angioplasty remodeling.
Cardiac aspergillosis presenting as myocardial infarction
Authors: Cishek Mary Beth , Schaefer Saul , Yost Barbara 
Published: February 2009

AbstractImmunosuppression can allow organisms which are not usually pathogenetic to cause disease. Invasive fungal disease is becoming increasingly prevalent because of the growing numbers of patients who are immunosuppressed. Aspergillus species frequently form large masses of fungal elements, thrombin, and fibrin, within the vasculature. These masses can then embolize, leading to organ infarction. Reported herein is a case of aspergillosis invading the myocardium and causing widespread necrosis and infarction. Although the epicardial coronary arteries were free of disease, the patient ultimately died in cardiogenic shock.
Abrupt (<1 day), acute (<1 week), and early (<1 month) vessel closure at the angioplasty site. Morphologic observations and causes of closure in 130 necropsy patients undergoing coronary angioplasty
Authors: Waller Bruce F. , Fry Edward T.A. , Peters Thomas F. , Hermiller James B. , Orr Charles M. , Vantassel James , Pinkerton Cass A. 
Published: February 2009

AbstractWhile abundant clinical and angiographic data are available regarding features of acute or abrupt closure at the site of balloon angioplasty, little morphologic information is available. This study discusses morphologic‐histologic causes for acute closure after angioplasty in 130 necropsy patients. Intimal‐medial flaps, elastic recoil, and primary thrombosis were the three leading morphologic causes for closure. Data were subdivided into time categories: abrupt (<1 day), acute (<1 week), and early (<1 month). Intimal‐medial flaps remained the most common cause for angioplasty closure despite time from angioplasty to documented occlusion. Morphologic recognition of types and frequencies of angioplasty closure are discussed, and specific mechanical, phar‐macologic, or combined treatments are reviewed.
Transcatheter closure of the patent ductus arteriosus in adults using the gianturco coil
Authors: Ing Frank F. , Muluns Charles E. , Rose Marion , Shapir Yehuda , Bierman Fredrick Z. 
Published: February 2009

AbstractBackground and hypothesis: Although results of surgical ligation of the patent ductus arteriosus (PDA) in the pediatric age group are excellent, surgical management of the adult with a PDA may be more problematic. The PDA that presents in adulthood may be calcified and friable, rendering simple ligation via a thoracotomy difficult, inadequate, and hazardous. Patch closure of the ductus arteriosus from either the aortic or pulmonary artery orifice using cardiopulmonary bypass or transient aortic cross‐clamping is necessary but increases surgical risks. Furthermore, older patients with diseases unrelated to their PDA and patients with Down's syndrome may have higher risks with intubation, general anesthesia, and surgery. Early results of percutaneous transcatheter occlusion of the PDA with Gianturco coils performed under sedation and local anesthesia are promising.Methods: Six adults with mean age of 39.1 years (range 23.1–62.0 years) were found to have an isolated PDA with mean minimum diameter of 2.7 mm (range 1.0–5.0 mm) at cardiac catheterization. All underwent percutaneous transcatheter occulsion of the PDA using Gianturco coils.Results: Coil implantation was successful in all patients. There were no complications and all were discharged home within 24 hours. Complete ductal occlusion was seen immediately in 4 of 6 patients (67%) while 2 of 6 (33%) had small residual leaks. However, complete occlusion was achieved in all patients by 6 months following the procedure.Conclusion: Transcatheter occlusion of the PDA using coils is safe and efficacious in adults.
The medial precordial leads: Overburdened and underinvestigated
Authors: Spodick David H. , Bishop Richard L. 
Published: February 2009

AbstractLeads V1, V2, and sometimes V3 are omnibus leads that are “overburdened” because they monitor the left ventricular anterior wall, the left ventricular posterior wall, and the right ventricle because they are the only leads normally expressing the ventricular gradient (QRS —T discordance);and because they consequently reflect numerous anatomic and electrical abnormalities and apparently normal variants. These require familiarity with and differentiation among a variety of pathologic and normal conditions.
Coronary artery and saphenous vein graft remodeling: A review of histologic findings after various interventional procedures‐Part III
Authors: Waller Bruce F. , Orr Charles M. , Vantassel James , Peters Thomas , Fry Edward , Hermiller James , Grider Larry D. 
Published: February 2009

AbstractCatheter balloon angioplasty is a well accepted form of nonsurgical treatment of acutely and chronically obstructed coronary artery vessels. It is also the centerpiece for various new intervention techniques. Their morphologic effects on the site of obstruction has been termed “remodeling.” Part III of this six‐part series focuses on intimal proliferation and chronic recoil in patients undergoing previous remodeling techniques by balloon angioplasty.
Atheroembolic disease following administration of tissue plasminogen activator (TPA)
Authors: Aggarwal Kul , Tjahja Imam E. 
Published: February 2009

AbstractAtheroembolic disease is an uncommon condition with many interesting manifestations and has been reported following various procedures. Its occurrence following thrombolytic therapy is extremely rare, with only a few case reports in the literature. However, with the widespread application of thrombolysis in patients with acute myocardial infarction, its incidence is likely to increase and therefore this entity needs to be recognized. Early recognition of the illness may help avoid further expensive and unnecessary investigations. We report two cases of atheroembolic disease following the administration of human recombinant tissue plasminogen activator (TPA).
Uniquely abnormal intracavitary row during late systole and relaxation in hypertrophic obstructive cardiomyopathy with midventricular obstruction
Authors: Yamanari Hiroshi , Morita Hiroshi , Mouta Satoshi , Sakuragi Satoru , Ohe Tohru 
Published: February 2009

AbstractWe describe a patient with hypertrophic cardiomyopathy who had a uniquely abnormal jet from the base to the apex during late systole and the relaxation period. This 48‐year‐old woman was admitted with exertional dyspnea and palpitations. Two‐dimensional echocardiography revealed asymmetric septal hypertrophy and a left midventricular obstruction at the level of the papillary muscles. A high‐ velocity ejectional jet (peak velocity 4.8 m/s) directed toward the base during systole and an abnormal jet (peak velocity 2.2 m/s) directed toward the apex during late systole and the relaxation period were demonstrated through the midventricular obstruction site using Doppler echocardiography. The peak systolic pressure gradient between the apical and the basal chamber was 91 mmHg, and the peak systolic pressure was higher in the apical chamber than in the basal chamber. However, a reverse pressure gradient was revealed between the two chambers during late systole and the relaxation period when the abnormal jet was demonstrated.
Correlative studies of heart rate and heart rate variability indices from five consecutive ambulatory electrocardiogram recordings in patients with coronary artery disease
Authors: Madias John E. , Wijetilaka Rohan , Erteza Sayed , Easow Mathai , Mahjoub Mazen , Khan Mujtaba , Sbahi Subhi , Gujral Interpal , Manyam Bose 
Published: February 2009

AbstractBackground: Reproducibility of heart rate (HR) and heart rate variability (HRV) indices from ambulatory electrocardiograms (AECGs) is a prerequisite for their use as predictors or monitors of disease progression, or response to therapeutic interventions.Hypothesis: This study sought to determine the stability over time of HR and HRV indices in patients with coronary artery disease.Methods: Five AECGs, recorded at 1‐week intervals in 21 clinically stable patients, were used to calculate minimum, average, and maximum HR, and three commonly used HRV indices in data samples of 15,30,60,120, daytime and nighttime intervals (complete data were available on 17 patients).Results: All parameters studied were stable over time (p = NS). Diurnal variation was found only for the average and maximum HR, with values being higher for daytime than for nighttime. Intercorrelations of the HR and HRV indices were poor and varied among the five AECGs, suggesting that these parameters reflect different aspects of HRV. The HR and HRV variables calculated from short‐time intervals correlated poorly with the corresponding information from 24‐h recordings, and such relationships varied among the five AECGs.Conclusions: Thus, HR and HRV indices from five consecutive AECGs recorded at 1‐Week intervals are reproducible. The poor intercorrelations between pairs of the studied indices suggest that none of these parameters can be used as surrogate of the others. Finally, the poor performance of HR and HRV indices, deriving from short‐time intervals, indicate that they cannot be employed in lieu of parameters calculated from 24‐h AECGs.
Atrial flutter with 1: 1 conduction after administration of the antimalarial drug mefloquine
Authors: Fonteyne Winoc , Bauwens Anja , Jordaens Luc 
Published: February 2009

AbstractAntimalarial drugs are well known for their cardiovascular toxicity. Quinine, the most famous antimalarial agent, mostly causes bradycardia. Quinidine, its dextrorotatory isomer, may cause 1: 1 atrioventricular (AV) conduction during atrial flutter. The newly developed drug mefloquine was reported to have fewer cardiac side effects. We describe a 63‐year‐old male patient with atrial flutter in whom mefloquine use was associated with 1: 1 AV conduction, and who then responded to therapy with digoxin and sotalol. The patient had a history of palpitations. This case report emphasizes that mefloquine should be used with caution in patients with a history of palpitations or underlying heart disease.
Angiotensin‐II receptors: new targets for antihypertensive therapy
Authors: Oliverio Michael I. , Coffman Thomas M. 
Published: February 2009

AbstractThe renin–angiotensin system regulates blood pressure and sodium homeostasis through a series of coordinated substrate–enzyme interactions. These interactions result in the production of angiotensin II (AII), which exerts a number of diverse biologic effects mediated through AII cell‐surface receptors. Dysregulation of this system is implicated in the pathogenesis of various forms of hypertension. Traditional therapy for hypertension has included angiotensin‐converting enzyme inhibitors, which block the production of AII. However, a new class of drugs, AT1‐receptor blockers, now offers a number of benefits by specifically blocking the effects of AII at its physiologically relevant receptor.
Variability in the measurement of intracoronary ultrasound images: implicatioNs for the identification of atherosclerotic plaque regression
Authors: Foster Gary P. , Mittleman Murray A. , Koch Michael , Abela George , Zarich Stuart W. 
Published: February 2009

AbstractBackground and hypothesis: Serial coronary angiography cannot reliably detect the small changes in arterial dimensions. Measurement of arterial dimensions by intracoronary ultrasound (ICUS) may be a superior method to determine the extent of atherosclerotic burden since it directly images the diseased portion of the vessel.Methods: To quantify inter‐ and intraobserver variability of ICUS measurements, 27 images of atherosclerotic coronary lesions were measured by two study physicians and repeated 14 days later.Results: Interobserver correlation coefficients for external elastic lamina, lumen, and effective plaque area were 0.96, 0.99, and 0.91, respectively. Intraobserver correlation coefficients for external elastic lamina, lumen, and effective plaque area were 0.99, 0.99, and 0.97, respectively. To determine progression or regression in effective plaque area, a minimal difference of 2.77 mm2 (which represents a 23% change in plaque area) is needed.Conclusions: Direct visualization of the extent of atherosclerosis by ICUS can be accomplished with a low degree of inter‐ and intraobserver variability. ICUS may be a preferable alternative to angiography in atherosclerosis regression trials.
Early predictors of late dilation and remodeling after thrombolized anterior transmural myocardial infarction
Authors: Modena Maria Grazia , Rossi Rosario , Sgura Fabio Alfredo , Muia Nicola , Molinari Rosella , Mattioli Giorgio 
Published: February 2009

AbstractBackground and hypothesis: Dilation of the left ventricle after myocardial infarction is associated with an adverse prognosis. There are no clinical studies on the role viable myocardium in the infarcted area assumes in relation to the development of late ventricular remodeling. The hypothesis of this study was to define the relation between remodeling and the presence of viable but akinetic myocardium in the infarct area and to identify early predictors of left ventricular (LV) dilation at 1 year.Methods: In all, 92 consecutive patients with myocardial infarction were divided into two groups according to their ventricular volumes. Group I included 57 patients with normal volumes at discharge (9 ± 3 days after acute infarction) and after 12 months or with LV dilation at discharge who had a normalization of their volumes over a 12‐month period. Group II included 35 patients who, independent of their initial volumes, developed LV dilation during follow‐up. Low‐dose dobutamine infusion was utilized at discharge for echocardiographic evaluation of contractile recovery of viable myocardial segments.Results: At the first control, patients in Group I presented an end‐diastolic volume index (EDVI) of 100 ± 7 ml/m2 which decreased to 68.8 ± 6.5 ml/m2 12 months later (p < 0.0001), and an end‐systolic volume index (ESVI) of 47.6 ± 6.7 ml/m2 at the first control and 30.5 ± 8.8 ml/m2 after 12 months (p< 0.001). Patients in Group II presented a mean EDVI of 116.2 ± 8.1 ml/m2 at the first control and 138.8 ± 8 ml/m2 12 months later (p < 0.001), and a mean ESVI of 68.8 ± 6.5 ml/m2 at the first control and 79.5 ± 5.4 after 12 months (p < 0.01). Ventricular mass index (VMI) in Group I increased from 106.4 ± 11 to 122.3 ± 15 g/m2 (p<0.01), while in Group II it decreased from 101.1 ± 10 to 98.7 ± 8 g/m2 (p = NS). In Group I, mass‐to‐volume ratio was 1.15 ± 0.1 g/ml at the first control and 1.67 ± 0.1 12 g/ml 12 months later (p < 0.001), while in Group II it declined from 0.88 ± 0.1 to 0.69 ± 0.1 g/ml (p<0.01). The multivariate analysis revealed that ejection fraction ≤ 40%, restrictive filling pattern, wall motion score index >2.5 in response to dobutamine infusion, and mass‐to‐volume ratio ≤ 1 g/ml, all at discharge, as well as an occluded left anterior descending artery discriminate in favor of late LV dilation and remodeling.Conclusions: Correct use of noninvasive strategies should result in early identification of postinfarct patients who are at risk of developing LV remodeling.