bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does initial and delayed heart rate predict mortality in patients with acute coronary syndromes?
Authors: Kovar David , Cannon Christopher P. , Bentley Jane H. , Charlesworth Andrew , Rogers William J. 
Published: June 2007

AbstractBackground: Lower admission heart rate (HR) is known to predict favorable outcome in ST‐elevation acute myocardial infarction. However, there are limited short‐term and no long‐term data available regarding the prediction value of the initial HR in patients with the full spectrum of acute coronary syndromes (ACS). In addition, it is unknown whether the HR obtained later during hospitalization for ACS (i.e., Day 2 or 3) remains prognostically valuable.Hypothesis: The aim of this study was to investigate the utility of the initial and delayed HR in predicting outcome in patients with ACS.Methods: We examined mortality at 30 days and 10 months in 10,267 patients with ACS enrolled in the oral glycoprotein IIb/IIIa inhibition with Orofiban in Patients with Unstable coronary Syndromes‐Thrombolysis In Myocardial Infarction (OPUS‐TIMI) 16 trial. Patients were stratified by HR and day from onset of ACS into the following groups: (1) HR < 60 beats/min, (2) HR 60‐80 beats/min, (3) HR 80‐100 beats/min, (4) HR > 100 beats/min; and HR obtained on (1) Day 1, (2) Day 2, and (3) Day 3.Results: By univariate analysis, mortality at 30 days and at 10 months increased progressively with higher HR strata (1.4 vs. 1.6 vs. 2.3 vs. 5.6%, p < 0.001, and 2.6 vs. 4.2 vs. 6.5 vs. 11.8%, p < 0.001, respectively). Elevated HR remained associated with mortality irrespective of time from onset of ACS.Conclusions: Higher initial and delayed HR is highly predictive of higher short‐ and long‐term mortality in patients with ACS. This is a simple marker that could be easily used in risk assessment.
Trends in use of herbal and nutritional supplements in cardiovascular patients
Authors: Stys Tomasz , Stys Adam , Kelly Patricia , Lawson William 
Published: June 2007

AbstractBackground: Use of herbs and nutritional supplements (known as naturoceuticals) is increasing in the USA, with about 50% of Americans taking naturoceuticals and spending over $10 billion per year for them. This raises concerns regarding their use instead of proven therapies, their side effects, and drug interaction potential.Hypothesis: The study sought to characterize cardiology patients who used supplements and to examine whether their use was diagnosis or doctor dependent, whether it affected patients' compliance, and what supplements were used.Methods: In all, 187 patients attending our cardiology clinic were interviewed, examined, and followed for up to 1 year. The users and nonusers of naturoceuticals were compared.Results: Supplements were used in 106 patients (an average of 3.1 naturoceutical per patient). There were no significant differences in their use by gender, age, primary care doctor specialty, or cardiovascular medications prescribed (except for statins). Patients with a history of myocardial infarction, coronary revascularization, hyperlipidemia, and a family history of coronary artery disease were more likely to use the supplements. Average low‐density lipoprotein (106 vs. 108 mg/dl), average blood pressure (132/77 vs. 138/78 mmHg), and average hemoglobin (Hb)A1c (8.7 vs. 7.7%) showed no statistically significant differences between users and nonusers. Patients most commonly took multivitamins, vitamin E, vitamin C, vitamin B, folate, garlic, calcium, coenzyme Q10, and gingko.Conclusion: This study indicates that naturoceutical use is widespread among cardiovascular patients and it is difficult to predict clinically who the users are. Fortunately, according to our limited compliance measures, it appears that the naturoceutical use has not affected patients' compliance with traditional medications. Also, possibly a detrimental interaction potential between traditional medications and naturoceuticals has been demonstrated.
Effects of conventional and aggressive statin treatment on markers of endothelial function and inflammation
Authors: Hognestad Aina , Aukrust Pål , Wergeland Ragnhild , Stokke Oddvar , Gullestad Lars , Semb Annegrete , Holm torbjørn , Andreassen Arne K. , Kjekshus John K. 
Published: June 2007

AbstractBackground: Atherosclerosis is considered to be a chronic inflammatory disorder. Several large‐scale clinical studies demonstrate that markers of inflammation, such as high‐sensitivity C‐reactive protein (hsCRP), fibrinogen, and soluble CD40 ligand, are potent and independent predictors of vascular risk.Hypothesis: The study was undertaken to investigate the effect of increasing the statin dose from conventional to aggressive treatment on lipids levels, inflammation, and endothelial function in patients with coronary artery disease (CAD).Methods: We randomized 97 patients to either 20 mg simvastatin or 80 mg atorvastatin. Plasma levels of lipids, hsCRP, fibrinogen, soluble adhesion molecules, and nitric oxide‐total were analyzed at baseline and after 6 months of treatment.Results: Lipid values were significantly reduced in both treatment groups, but with significantly greater reduction in the aggressively treated group. Furthermore, aggressive statin treatment significantly decreased hsCRP and fibrinogen, while only small reductions were seen in the conventionally treated group, resulting in significant differences between the two treatment groups (p < 0.001). Nitric oxide‐total increased significantly in both treatment groups, although the increase was more pronounced in the aggressively treated group (22.6 vs. 15.6%).Conclusion: Aggressive statin treatment significantly improved lipid status and reduced markers of inflammation and improved endothelial function compared with conventional treatment in patients with CAD. No interaction was observed, and high‐dose treatment did not offer additional benefit compared with standard‐dose treatment with respect to soluble adhesion molecules.
Dynamic 123I‐BMIPP single‐photon emission computed tomography in patients with congestive heart failure: Effect of angiotensin ii type‐1 receptor blockade
Authors: Takeishi Yasuchika , Minamihaba Osamu , Yamauchi Sou , Arimoto Takanori , Hirono Osamu , Takahashi Hiroki , Akiyama Hideyuki , Miyamoto Takuya , Nitobe Joji , Nozaki Naoki , Tachibana Hidetada , Okuyama Masaki , Fukui Akio , Kubota Isao , Okada Akio , Takahashi Kazuei 
Published: June 2007

AbstractBackground: Heart failure is a major and growing public health problem with a high mortality rate. Although recent studies have demonstrated that a variety of metabolic and/or neurohumoral factors are involved in the progression of this syndrome, the precise mechanisms responsible for this complex condition are poorly understood.Hypothesis: To examine 123I‐β‐methyl‐iodophenylpentadecanoic acid (BMIPP) kinetics in the early phase soon after tracer injection in patients with congestive heart failure (CHF), we performed dynamic single‐photon emission computed tomography (SPECT).Methods: Twenty‐six patients with CHF and eight control subjects were examined. The consecutive 15 images of 2‐min dynamic SPECT were acquired for 30 min after injection. In the early phase after injection (0‐4 min), a significant amount of radioactivity existed in the blood pool. After 6 min, the myocardial 123I‐BMIPP image was clear and thus the washout rate of 123I‐BMIPP from 6 to 30 min was calculated.Results: The washout rate of 123I‐BMIPP from the myocardium was faster in patients with CHF than in the controls (8 ± 4 vs. −5 ± 3%, p<0.01). The washout rate of 123I‐BMIPP demonstrated positive correlation with left ventricular (LV) end‐diastolic volume index (R = 0.54, p < 0.02) and inverse correlation with LV ejection fraction (R = 0.53, p < 0.02). Patients were given the angiotensin II type‐1 receptor antagonist candesartan for 6 months, and dynamic SPECT was repeated. The enhanced washout rate of 123I‐BMIPP in CHF was reduced after treatment with candesartan (p < 0.05).Conclusion: These data suggest that (1) enhanced washout of 123I‐BMIPP was observed soon after injection in patients with CHF, (2) the activation of angiotensin II signaling pathway is involved as an intracellular mechanism for enhanced 123I‐BMIPP washout in heart failure, and (3) improvement in fatty acid metabolism may represent a new mechanism for beneficial effects of angiotensin II receptor blockade on cardiac function and survival in patients with heart failure. 123I‐BMIPP washout in the early phase obtained from dynamic SPECT may be a new marker for evaluating the severity of heart failure and the effects of medical treatment.
C‐reactive protein plasma levels but not factor VII activity predict clinical outcome in patients undergoing elective coronary intervention
Authors: Grander Wilhelm , Dichtl Wolfgang , Prokop Wolfgang , Roithinger Franz X. , Moes Nicolas , Friedrich Guy , Weidinger Franz , Pachinger Otmar 
Published: June 2007

AbstractBackground: Both vascular inflammation as determined by C‐reactive protein (CRP) and extrinsic coagulation as measured by factor VII activity (F VII) may predict clinical restenosis rate in patients with stable angina pectoris undergoing elective percutaneous coronary intervention (PCI).Hypothesis: The primary objective of this study was to investigate the associations between baseline CRP levels, F VII activity, and restenosis rate after elective PCI in a 6‐month follow‐up period.Methods: This prospective study included 81 patients aged ≥19 years undergoing PCI for angiographically significant (⩾70%) stenosis, with or without stenting, and 49 controls. Factor VII activity and CRP were measured in samples collected at angiography and 16‐24 h post procedure after overnight fast. Successful PCI was defined as final diameter of < 50% with TIMI 3 flow and no complication within 1 h. After 6 months all patients who had undergone PCI were evaluated via a standardized questionnaire. Clinical restenosis was defined as the occurrence of a major adverse coronary events (MACE), within the follow‐up period.Results: Diagnostic angiography led to a significant increase in CRP levels after 16–20 h in patients with discrete CAD (n = 22) but not in patients without any signs of coronary atherosclerosis (n = 27). During a 6‐month follow‐up after PCI, 17 of 81 (21%) patients developed MACE. Tertiles of CRP levels independently predicted clinical restenosis, as it developed in 33.3% of patients with the highest CRP levels (0.7–4.8 mg/dl), in 16.6% of patients with second tertile CRP levels (0.23–0.69 mg/dl), and in 7.4% of patients with lowest tertile CRP levels (0.0–0.22 mg/dl). There was a significant difference in the restenosis rate between patients from the first and the third tertiles (p = 0.018). Successful PCI was associated with a significant decrease of mean CRP levels after 6 months, whereas PCI in patients suffering from MACE led to no change in CRP levels. There was no association between factor VII activity and clinical outcome after PCI, and F VII activity did not change over a 6‐month period.Conclusions: In patients with stable angina pectoris undergoing elective PCI, increased preprocedural and 6‐month follow‐up CRP plasma levels are associated with clinical restenosis. Factor VII plasma activity lacks such correlations.
Ventricular tachyarrhythmia associated with cardiac sarcoidosis: Its mechanisms and outcome
Authors: Furushima Hiroshi , Chinushi Masaomi , Sugiura Hirotaka , Kasai Hidehiro , Washizuka Takashi , Aizawa Yoshifusa 
Published: June 2007

AbstractBackground: Cardiac sarcoidosis is increasingly recognized and is associated with poor prognosis. Ventricular tachycardia (VT) associated with cardiac sarcoidosis is the most likely cause of sudden death in most patients, but the mechanism has not been well established.Hypothesis: This study investigated the mechanisms and outcome of VT associated with cardiac sarcoidosis.Methods: The study included eight consecutive patients (five men, three women, aged 54 ± 19 years) who had sustained monomorphic VT associated with cardiac sarcoidosis in our hospital.Results: The average ejection fraction was 43 ± 11%. Twenty‐two VTs were observed in these patients, and mean heart rate during VT was 192 ± 29 beats/min (range 144–259). The phenomenon of transient entrainment was documented in 10 of 22 (45%) VTs by ventricular pacing (eight in the active phase). Another five (23%) VTs could not be entrained, but could be initiated by programmed stimulation and terminated by rapid pacing, reproducibly. In 3 of the 22 (14%) VTs, cardioversion was required urgently because of the fast rate, while the remaining 4 (18%) could be induced during electrophysiologic study.Conclusions: In this study, there was a high possibility that the mechanism of 15 (68%) VTs was reentry. Reentrant substrate is formed not only in association with the healing of cardiac granulomas in the inactive phase of cardiac sarcoidosis but also in the active phase. Ventricular tachycardia with cardiac sarcoidosis, even if this mechanism is reentry, has different inducibility between the active and inactive phases in an electrophysiologic study. This makes the therapy for cardiac sarcoidosis (e.g., corticosteroids, antiarrhythmic agents, and catheter ablation) difficult. The implantable cardioverter‐defibrillator is an effective treatment for ventricular tachyarrythmia with cardiac sarcoidosis.
Effect of chronic stress and sleep deprivation on both flow‐mediated dilation in the brachial artery and the intracellular magnesium level in humans
Authors: Takase Bonpei , Akima Takashi , Uehata Akimi , Ohsuzu Fumitaka , Kurita Akira 
Published: June 2007

AbstractBackground: Chronic mental and physical stress has been suggested to be a trigger for cardiovascular events. In addition, a reduction in levels of intracellular magnesium has been reported to cause vasoconstriction while enhancing platelet‐dependent thrombosis.Hypothesis: The purpose of this study was to investigate whether chronic stress affects endothelial function and intra‐cellular magnesium levels in humans.Methods: Flow‐mediated dilation (endothelium‐dependent vasodilation) and sublingual nitroglycerin‐induced dilation (0.3 mg, endothelium‐independent vasodilation) were measured in the brachial artery in 30 healthy male college students, aged 22 ± 1 years, using high‐resolution ultrasound both before and immediately after a 4‐week final term examination period. Erythrocyte magnesium concentration was measured simultaneously. All students had chronic sleep deprivation for 4 weeks, during which sleep lasted < 80% of that on ordinary days; in addition, the students were under great stress to pass the examination. This condition was considered to be chronic stress.Results: Chronic stress decreased flow‐mediated dilation and erythrocyte magnesium concentration (from 7.4 ± 3.0 to 3.7 ± 2.3%, p < 0.05; from 5.7 ± 0.4 to 5.5 ± 0.4 mg/ml, p < 0.05, respectively). The change in flow‐mediated dilation correlated significantly with that of the erythrocyte magnesium concentration (r = 0.43, p < 0.05), but not with nitroglycerin‐induced dilation.Conclusions: Chronic stress was found to attenuate endo‐thelial function, which may also be associated with a reduction in the intracellular magnesium level in humans.
Rapid screening of cardiac patients with a miniaturized hand‐held ultrasound imager‐comparisons with physical examination and conventional two‐dimensional echocardiography
Authors: Xie Tianrong , Chamoun Antonio J. , McCulloch Marti , Tsiouris Nick , Birnbaum Yochai , Ahmad Masood 
Published: June 2007

AbstractBackground: Rapid screening of cardiac patients with a hand‐held ultrasound imager (SonoHeart™ [SH]) could provide valuable clinical information.Hypothesis: Whether the use of this device yields additional information to a carefully conducted physical examination and comparable findings to those of conventional two‐dimensional echocardiography (2‐D) during inpatient rounds is not well established and is the subject of this study.Methods: In all, 100 consecutive telemetry patients underwent rapid screening with 2‐D and color Doppler SH during inpatient rounds. SonoHeart findings were compared with results from conventional 2‐D and physical examination conducted by an attending cardiologist.Results: All patients had interpretable images. Mean scanning time with SH was 5.0 ± 1.2 min; 2‐D and SH findings were comparable. The parameters studied included chamber sizes, left ventricular (LV) systolic function, presence of LV hypertrophy (LVH), wall motion abnormalities (WMA), peri‐cardial effusion (PE), and valvular regurgitations. Mild to moderate valvular regurgitation and LV systolic dysfunction were reliably diagnosed by SH in a number of patients whose symptoms were unrelated to the abnormalities detected.Conclusions: Rapid screening with SH provides accurate and valuable information that would otherwise be undetected during physical examination. Its introduction into clinical practice may redefine the initial approach to patients with cardiovascular disease.
Importance of a history of hypertension for the prognosis after acute myocardial infarction‐‐‐for the bucindolol evaluation in acute myocardial infarction trial (BEAT) study group
Authors: Ali Irma , Akman Dilek , Bruun Niels Eske , Køber Lars , Brendorp Bente , Ottesen Michael , Møller Jacob , Torp‐Pedersen Christian 
Published: June 2007

AbstractBackground: Arterial hypertension is a major risk factor for cardiovascular events. The prognosis for hypertensive patients after acute myocardial infarction (MI) is uncertain because of the sparse and somewhat contradictionary data.Hypothesis: Our study aimed to investigate the importance of hypertension to prognosis after an MI in patients receiving contemporary medical therapy.Methods: We performed a retrospective study using a large register from the Bucindolol Evaluation in Acute myocardial infarction Trial (BEAT). The register comprised 3,326 patients admitted between June 1998 and August 1999 with an enzyme‐verified MI to 33 Danish coronary care units. Hypertension was considered present when a previous diagnosis of hypertension was accompanied by relevant medical therapy. Survival information for all patients was obtained in January 2002.Results: Of the 3,326 patients studied, 825 were hypertensive. Overall, 28.4% had died by January 2002. The unadjusted hazard ratio associated with hypertension was 1.2 (95% confidence limit [CI] 1.1‐‐1.4, p = 0.004). Hypertensive patients were older, and after adjustment for age the hazard ratio associated with hypertension was 1.04 (CI 0.9‐‐1.2, p = 0.6). Adjustment for further covariates did not change the result.Conclusion: Our study showed that after an acute MI the survival rate of patients with and without a history of hypertension was identical when they received contemporary medical therapy.
Beneficial effect of candesartan treatment on cardiac autonomic nervous activity in patients with chronic heart failure: Simultaneous recording of ambulatory electrocardiogram and posture
Authors: Tambara Keiichi , Fujita Masatoshi , Sumita Yoshiyuki , Miyamoto Shoichi , Sekiguchi Hiroyuki , Eiho Shigeru , Komeda Masashi 
Published: June 2007

AbstractBackground: Reclining in the right lateral decubitus position in chronic heart failure (CHF) is a self‐protective mechanism for normalizing impaired cardiac autonomic nervous activity (CANA).Hypothesis: Candesartan, an angiotensin II receptor blocker, exerts beneficial effects on CANA and postural preferences in patients with CHF.Methods: We studied 15 patients with CHF due to coronary artery disease. Cardiac autonomic nervous activity was assessed using spectral heart rate variability (HRV) analysis based on 24‐h ambulatory electrocardiogram monitoring before and after an 8‐week treatment with candesartan. The patients' posture was simultaneously recorded using a specially devised detector, as the right (R) or left (L) lateral decubitus or supine (S) positions, to evaluate postural modulations of CANA. Normalized high‐frequency (0.15 to 0.40 Hz) power (nHF) and the low‐frequency (0.04 to 0.15 Hz)/high‐frequency power ratio (LF/HF) were used as indices of vagal activity and sympathovagal balance, respectively.Results: When HRV was analyzed in each position, CANA was changed in L and S, but not in R, from sympathetic to parasympathetic prevalence by the treatment (R, nHF, 50 ± 20 vs. 52 ± 19 nu, p = 0.87; LF/HF, 1.39 ± 1.11 vs. 1.32 ± 1.32, p = 0.93; L, nHF, 28 ± 13 vs. 47 ± 19 nu, p = 0.019; LF/HF, 3.34 ± 2.48 vs. 1.56 ± 1.39, p = 0.029; S, nHF, 38 ± 17 vs. 53 ±16 nu, p = 0.0023; LF/HF, 2.43 ± 2.21 vs. 1.03 ± 0.59, p = 0.025). The fractions of the time in R and L were decreased and increased, respectively, by the treatment (R, 40 ± 30 vs. 18 ± 24%, p = 0.0018; L, 11 ± 20vs. 27 ± 26%, p = 0.025).Conclusions: In patients with CHF, candesartan treatment improves cardiac autonomic balance, and the preference for the right lateral decubitus position disappears afterthe treatment.
Serum levels of cardiac enzymes before and after renal transplantation
Authors: Bozbas Huseyin , Korkmaz Mehmet Emin , Atar Ilyas , Eroglu Serpil , Ozin Bülent , Yildirir Aylin , Muderrisoglu Haldun , Colak Turan , Karakayali Hamdi , Haberal Mehmet 
Published: June 2007

AbstractBackground: Cardiac troponins are very sensitive and specific indicators of myocardial damage; however, they are sometimes found to be increased in patients with end‐stage renal disease (ESRD).Hypothesis: The aim of this study was to determine cardiac troponin I (cTpI) and creatine kinase myocardial isoform (CK‐MB) levels and to assess their diagnostic and prognostic importance before and after renal transplantation.Methods: Thirty‐four patients with ESRD (mean age 31.8 ± 8.6 years, 11 women) were enrolled. Serum levels of cTpI and CK‐MB were measured pre‐ and postoperatively on Days 1, 7, and 30. Patients were followed up for cardiac events, and possible myocardial damage was investigated by exercise thalli‐um‐201‐labeled myocardial perfusion scintigraphy. Mean cTpI levels were 0.24 ± 0.11 ng/ml (preoperative), and 0.34 ± 0.27 ng/ml (Day 1), 0.26 ± 0.11 ng/ml (Day 7), and 0.28 ± 0.30 ng/ml (Day 30).Results: Compared with preoperative levels, cTpI was increased in 16 (47%), decreased in 6 (17.6%), and did not change in 12 (35.4%) patients. However, the increase did not exceed the myocardial infarction reference level of 2.3 ng/ml in any patient. Mean CK‐MB levels were 12.6 8.7U/l (preoperative), and 16.8 ± 9.2U/l (Day 1), 16.3 ± 8.1U/l (Day 7), and 13.3 ± 6.6U/l (Day 30). Creatine kinase‐MB was increased to above normal levels of 24 U/l in 13 (38.2%) patients on postoperative Days 1 or 7, and decreased to normal at the end of Month 1. No cardiac events occurred, and there was no abnormality in any patient on thallium scintigraphy.Conclusion: There was no significant difference in the levels of cTpI in patients with ESRD without cardiac events before and after renal transplantation (p > 0.05). Our findings show that cTpI has very high sensitivity and specificity for detecting cardiac damage in patients with ESRD after renal transplantation.