bluuebunny/crossref_metadata_2025_split huggingface dataset:
Screening for carotid artery disease before cardiac surgery: Is current clinical practice evidence based?
Authors: Archbold R. Andrew , Barakat Khalid , Magee Patrick , Curzen Nicholas 
Published: February 2009

AbstractBackground: There is no clear consensus as to the correct screening procedure to identify patients undergoing cardiac surgery and who are at greatest risk of stroke because of the presence of significant carotid artery stenosis. Such screening is important because some patients benefit from combined carotid and cardiac surgery and, regardless of this, the information gained puts the cardiac surgeon in a position to provide an accurate assessment of surgical risk. Our objective was to examine current clinical practice of carotid artery investigation prior to urgent cardiac surgery and to review this illustrative practice in the context of the world literature.Hypothesis: The study aimed to establish that current typical practice for screening cardiac surgical patients for carotid artery disease is illogical according to the evidence in the world literature.Methods: The study consisted of a retrospective assessment of all patients undergoing urgent cardiac surgery and a Medline‐derived literature review, and included all patients undergoing urgent cardiac surgery at a tertiary cardiothoracic center between January 1 and December 31, 1997.Results: Of 529 patients undergoing urgent cardiac surgery, 44 (8%) were screened preoperatively by duplex Doppler ultrasonography for carotid disease. The indications for screening were asymptomatic carotid bruit in 24 patients, history of stroke or transient ischemic attack (TIA) in 12 patients, and neither stroke, TIA, or bruit in 7 patients. The tests were requested either by the attending cardiologists or by the cardiac surgeon to whom they were referred. One patient had already been diagnosed as having carotid artery disease in the past. Thirteen patients underwent additional carotid investigations. Eleven patients were demonstrated to have internal carotid artery stenosis ≥ 60% and 3 patients underwent combined cardiac and carotid surgery. Review of the literature revealed the following groups to be at increased risk of future stroke unrelated to surgery, and of postoperative stroke: those with a history of stroke or TIA, those with carotid bruits, and, of importance, all patients with significant carotid stenosis. Recent data suggest that symptomatic patients and the elderly are at greatest risk.Conclusions: Only 8% of patients undergoing urgent cardiac surgery in a 1‐year period were screened for carotid artery disease. We suggest that screening should definitely be performed in all patients with a history of stroke or TIA, all patients with a bruit, and all patients aged > 65 years. The literature suggests, however, that significant reductions in stroke rate could be achieved by screening the whole cardiac surgical population, although there is a paucity of data that are specifically pertinent to this patient subgroup. Further data are therefore required for the construction of a scientifically valid and medicolegally sound policy.
Electrocardiographic criteria for predicting total occlusion of the proximal left anterior descending coronary artery in anterior wall acute myocardial infarction
Authors: Kosuge Masami , Kimura Kazuo , Ishikawa Toshiyuki , Endo Tsutomu , Shigemasa Tomohiko , Sugiyama Mitsugi , Tochikubo Osamu , Umemura Satoshi 
Published: February 2009

AbstractBackground: Patients with occlusion of the left anterior descending coronary artery (LAD) proximal to both the first septal branch and the first diagonal branch may benefit most from early reperfusion therapy due to extensive area at risk.Hypothesis: The aim of the study was to examine whether 12‐lead electrocardiograms (ECGs) in the acute phase of acute myocardial infarction (AMI) could identify total occlusion of the LAD proximal to both the first septal and the first diagonal branch.Methods: A 12‐lead electrocardiogram was recorded on admission in 128 patients with anterior AMI within 12h from symptom onset. Patients were divided into three groups according to the culprit lesion: 33 patients had total occlusion of the LAD proximal to both the first septal perforator and the first diagonal branch (Group P), in 51 it was proximal to either the first septal perforator or the first diagonal branch (Group D‐a), and in 44 it was distal to both the first septal perforator and the first diagonal branch (Group D‐b).Results: Sensitivity and specificity of a greater degree of ST‐segment depression in lead III than that of ST‐segment elevation in lead aVL were 85 and 95%, respectively, which was better than the results derived by all other ECG criteria (p< 0.001).Conclusions: We conclude that a greater degree of ST‐segment depression in lead III than that of ST‐segment elevation in lead aVL is a useful predictor of proximal LAD occlusion in patients with anterior AMI.
Silent ischemic interval on exercise test is a predictor of response to drug therapy: A randomized crossover trial of metoprolol versus diltiazem in stable angina
Authors: Dwivedi Sudhanshu Kumar , Saran Ram Kirti , Mittal Sanjay , Gupta Ripen , Narain Varun Shankar , Puri Vijay Kumar 
Published: February 2009

AbstractBackground and hypothesis: There is no method available to predict the relative antianginal efficacy of beta blockers and calcium‐channel antagonists. The present study was undertaken to assess the role of silent ischemic interval (SII) on exercise treadmill test (ETT) as a predictor of response to therapy with metoprolol and diltiazem in patients with stable angina.Methods: Thirty‐four patients with stable angina were divided into two groups depending upon the presence or absence of an SII gap of at least 1 min between onset of ST depression and appearance of angina on ETT. Metoprolol (50–100 mg twice daily) and diltiazem (60–120 mg three times daily) were randomly assigned for 6 weeks to patients in each group, and then patients were crossed over for further 6 weeks after a washout period of 2 weeks. Antianginal efficacy was assessed by clinical and exercise parameters.Results: In patients with SII, the clinical responder rate was better with metoprolol than with diltiazem (90 vs. 60%, respectively), and on ETT, metoprolol produced significant improvement in the total exercise time (p<0.01), time to 1 mm ST depression (p < 0.01), time to angina (p < 0.01), and a significant decrease in peak rate‐pressure product (p<0.001), whereas diltiazem had no significant effect on exercise parameters. However, in patients without SII, metoprolol and diltiazem had a similar clinical responder rate (57%), and both produced a significant increase in total exercise time (p < 0.01), time to 1 mm ST depression (p < 0.01), and time to angina (p < 0.01). In addition, metoprolol had a significant effect on peak rate‐pressure product (p < 0.001).Conclusion: Silent ischemic interval on ETT can be a predictor of response to antianginal therapy in stable angina, as patients with SII respond better to metoprolol and those without SII respond equally to both metoprolol and diltiazem.
Length of stay and procedure utilization are the major determinants of hospital charges for heart failure
Authors: Philbin Edward F. , Mccullough Peter A. , Dec G William , Disalvo Thomas G. 
Published: February 2009

AbstractBackground: Most of the 10 billion dollars spent annually on heart failure (HF) management in this country is attributed to hospital charges. There are widespread efforts to decrease the costs of treating this disorder, both by preventing hospital admissions and reducing lengths of stay (LOS).Methods: Administrative information on all 1995 New York State hospital discharges assigned ICD‐9‐CM codes indicative of HF in the principal diagnosis position were obtained. Bivariate and multivariate statistical analyses were utilized to determine those patient‐ and hospital‐specific characteristics which had the greatest influence on hospital charges.Results: In all, 43,157 patients were identified. Mean hospital charges were $11,507 ± 15,995 and mean hospital LOS was 9.6 ± 14.5 days. With multivariate analyses, the most significant independent predictors of higher hospital charges were longer LOS, admission to a teaching hospital, treatment in an intensive care unit, and the utilization of cardiac surgery, permanent pacemakers, and mechanical ventilation. Age, gender, race, comorbidity score, and medical insurance, as well as treatment by a cardiologist and death during the index hospitalization were not among the most significant predictors.Conclusions: We conclude that LOS and procedure utilization are the major determinants of hospital charges for an acute episode of inpatient HF care. Reducing LOS and other initiatives to restructure hospital‐based HF care may reduce total health care costs for HF.
Heart rate‐lowering and ‐regulating effects of once‐daily sustained‐release diltiazem
Authors: Boden William E. , Vray Muriel , Eschwege Evelyne , Lauret Delphine , Scheldewaert Rudy 
Published: February 2009

AbstractBackground: Epidemiologic evidence suggests that an elevated heart rate (HR) is an adverse and independent prognostic factor in arterial hypertension and other cardiovascular diseases. Although diltiazem is characterized as an HR‐lowering calcium antagonist, no studies have quantified the magnitude of HR changes in patients with angina or hypertension.Hypothesis: The study was undertaken to explore the magnitude of proportional HR reduction at varying levels of resting HR with the sustained‐release formulation of diltiazem (SR diltiazem) at the usual clinical doses of 200 or 300 mg once daily.Methods: This meta‐analysis was conducted on six comparative double‐blind studies including 771 patients with angina or hypertension in which SR diltiazem 200–300 mg once daily was compared either with placebo or with other agents known not to influence HR (angiotensin‐converting enzyme inhibitors, diuretics). Sustained‐release diltiazem decreases elevated baseline HR, with an increasing effect at higher initial rates.Results: Multiple comparisons by baseline HR category showed a significant difference between both groups for baseline HR of 74–84 beats/min and ≥ 85 beats/min (p = 0.001). Sustained‐release diltiazem had no significant HR‐decreasing effect on baseline HR ≤ 74 beats/min but appears to have a genuine regulating effect on HR: it reduces tachycardia without inducing excessive bradycardia. These findings are in contrast to those with dihydropyridine calcium antagonists, which tend to increase HR and have been associated with an adverse outcome in acute cardiovascular conditions. At the same time, there is evidence to suggest that HR‐lowering calcium‐channel blockers decrease cardiovascular event rates following myocardial infarction.Conclusion: When calcium antagonists are indicated for use in patients with angina or hypertension, an HR‐lowering agent, that is, diltiazem rather than dihydropyridine, should be recommended.
Can cocaine abuse exacerbate the cardiac toxicity of human immunodeficiency virus?
Authors: Soodini Geetha , Morgan James P. 
Published: February 2009

AbstractBoth cocaine use and human immunodeficiency virus (HIV) infection alone have been associated with an increased incidence of cardiac dysfunction. Concomitant exposure to cocaine and HIV infection may exacerbate the cardiac toxicity of either agent alone, a hypothesis that is examined in this review article. A possible unifying hypothesis based on enhancement of adrenergic stimulation is proposed.
Early prediction of 30‐day mortality after q‐wave myocardial infarction by echocardiographic assessment of left ventricular function— a pilot investigation
Authors: Smock Andrew L. , Larson Brad , Brown Chris , Conti C. Richard 
Published: February 2009

AbstractBackground: The GUSTO angiographic substudy demonstrated that left ventricular function measured 90 min after thrombolytic therapy was given had important prognostic implications at 30 days in patients with an acute myocardial infarction (MI).Hypothesis: Thirty‐day prognosis after Q‐wave MI can be determined by early echocardiographic assessment of left ventricular function.Methods: Using transthoracic echocardiography, semiquantitative ejection fraction and wall motion score index was assessed prospectively in 201 consecutive patients within 24 h following Q‐wave MI. Independent experts blinded to the patient's status performed the echocardiographic assessment. All patients received standard medical care as dictated by the attending cardiologist.Results: Of the 201 patients, 24 (11.9%) died within 30 days, with 70% of the deaths occurring within 10 days after the infarction. Three deaths occurred in the 120 patients with an ejection fraction ≥ 45% (2.5% mortality rate). In contrast, 21 deaths occurred among the 81 patients with an ejection fraction < 45% (25.9% mortality rate) p = 0.0003. Two of the three patients who died in the high ejection fraction group died as a result of intracerebral hemorrhage from thrombolytic therapy. Ejection fraction was lower in nonsurvivors (32.3 ± 10.3 vs. 46.3 ± 13%) than in survivors, p < 0.0002. Wall motion score index (WMSI) of < 1.4 was associated with a 2.9% 30‐day mortality (two deaths in 76 patients); WMSI of ≥ 1.4 was associated with a 17.6% 30‐day mortality (22 deaths in 125 patients), p = 0.0007. Average WMSI was higher in the nonsurvivors (1.95 ± 0.5) than in survivors (1.52 ± 0.45), p = 0.00001.Conclusions: Echocardiographic assessment of left ventricular function during the first 24 h after an acute Q‐wave MI can be performed in all patients regardless of stability. High‐risk patients are identified early in the hospital course, with relative ease, at no risk and at an acceptable cost. An ejection fraction < 45% or WMSI ≥ 1.4 identifies patients who are at a high risk of dying within 30 days. These are the patients who may benefit most from aggressive medical therapy and early angiography to assess coronary pathology.
Rescue use of abciximab improves regional left ventricular function after early incomplete reperfusion in acute myocardial infarction
Authors: Cho Goo‐Yeong , Lee Cheol Whan , Hong Myeong‐Ki , Kang Duk‐Hyun , Song Jae‐Kwan , Kim Jae‐Joong , Park Seong‐Wook , Park Seung‐Jung 
Published: February 2009

AbstractBackground: Abciximab was shown to have important beneficial effects beyond the maintenance of epicardial coronary artery patency. However, it remains uncertain whether abciximab may lead to a better functional outcome in patients with acute myocardial infarction (AMI) and with incomplete reperfusion after primary angioplasty (PA).Hypothesis: The study aimed to evaluate whether rescue use of abciximab may lead to a better functional outcome in such patients.Methods: The study included 25 patients with first AMI who met the following criteria: (1) total occlusion of the infarct‐related artery, (2) PA within 12 h of symptom onset, (3) postprocedural diameter stenosis < 30%, and final Thrombolysis in Myocardial Infarction (TIMI) flow grade 2. Echocardiographic examination was performed before and on Days 7 and 30 after PA. The study population was divided into two groups: Group 1 (usual care, n = 13) and Group 2 (rescue use of abciximab, n = 12). Baseline characteristics were similar between the two groups.Results: Peak level of creatine kinase was higher in Group 1 than in Group 2 (5,800 ± 2,700 vs. 3,800 ± 2,000 U/l, p < 0.05). At 1 month follow‐up, infarct zone wall motion score index (2.71 ± 0.26 vs. 2.05 ± 0.63, p < 0.01) and left ventricular (LV) volume indices were smaller in Group 2 than in Group 1, whereas LV ejection fraction was higher in Group 2 than in Group 1 (52.1 ± 7.8 vs. 42.1 ± 6.4, p < 0.01). At 1‐month, abciximab was the only independent predictor of wall motion recovery index by multiple regression analysis.Conclusions: Rescue use of abciximab may reduce the infarct size in patients with AMI and TIMI grade 2 flow after PA, which may improve the recovery of regional LV function.
Myocardial bridging of the left anterior descending coronary artery in acute inferior wall myocardial infarction
Authors: Yano Kohei , Yoshino Hideaki , Taniuchi Masato , Kachi Eisei , Shimizu Hisashi , Watanuki Atsushi , Ishikawa Kyozo 
Published: February 2009

AbstractBackground: We observed marked myocardial bridging of the left anterior descending coronary artery (LAD) in the acute stages of inferior wall myocardial infarction (MI) in a group of patients who developed shock despite successful reperfusion of the infarct‐related lesion (IRL).Hypothesis: The purpose of this study was to elucidate the clinical significance of myocardial bridging in patients with inferior wall MI and shock.Methods: The study group consisted of 53 patients with single‐vessel disease of the right coronary artery, who underwent coronary angiography for acute inferior wall MI. Clinical characteristics, coronary angiographic findings, and left ventricular function during the chronic phase were compared between the patients who developed shock (the shock group) and those who did not (the non‐shock group). In addition, a multiple logistic analysis was performed to identify independent predictors of shock in patients with acute inferior wall MI.Results: Reperfusion of the IRL was obtained in all 53 patients. The incidence of myocardial bridging of the LAD, the incidence of right ventricular MI, the peak creatine phospho‐kinase (CPK‐MB), the pulmonary capillary wedge pressure, and the prevalence of pulmonary congestion seen on chest roentgenogram were significantly higher in the shock group than in the non‐shock group. Myocardial bridging (p = 0.0018), right ventricular MI (p = 0.0374), and peak CPK‐MB (p = 0.0189) were identified as independent predictors of shock in acute inferior wall MI.Conclusion: This study suggests that myocardial bridging plays a role in left ventricular function in the acute stage of inferior wall MI.
Efficacy of balloon valvuloplasty in patients with critical aortic stenosis and cardiogenic shock—the role of shock duration
Authors: Buchwald Arnd B. , Meyer Thomas , Scholz Karlheinz , Unterberg Christina , Schorn Bernd 
Published: February 2009

AbstractBackground: Because of limited long‐term success, aortic balloon valvuloplasty is considered to be a palliative procedure, including patients at excessive risk for standard therapy—aortic valve replacement—that is, those in cardiogenic shock.Hypothesis: The study was undertaken to evaluate the outcome of balloon valvuloplasty for critical aortic stenosis complicated by cardiogenic shock.Methods: Over a 10‐year‐period, we followed 14 patients (age 74 ± 11 years, range 50–91) presenting in cardiogenic shock and critical aortic stenosis, who underwent valvuloplasty, together with 19 patients with critical aortic stenosis requiring urgent major noncardiac surgery.Results: In patients in shock, calculated aortic valve area could be increased successfully by at least 0.3 cm2, from 0.38 ± 0.09 to 0.81 ± 0.12 cm2, with an insignificant increase in cardiac index from 1.89 ± 0.33 to 2.01 ± 0.41 1/min *m2. In‐hospital mortality was 71% (10 patients). Two patients underwent valve replacement within 16 days and survived after 1 year, as did two patients refusing surgery. By multivariate logistic regression analysis, only an interval between onset of shock symptoms and valvuloplasty of > 48 h was significantly associated with fatal outcome (p < 0.01). In those patients requiring noncardiac surgery, this was possible after valvuloplasty in 95% who survived 1 year after hospital discharge. One patient in this group died of pulmonary embolism the day after the procedure.Conclusion: These data support the concept of causal treatment in patients with cardiogenic shock, as well as in the setting of cardiogenic shock and critical aortic stenosis, at the earliest possible convenience.
Implications of the absence of st‐segment elevation in lead V4R in patients who have inferior wall acute myocardial infarction with right ventricular involvement
Authors: Kosuge Masami , Kimura Kazuo , Ishikawa Toshiyuki , Hongo Yoichiro , Shigemasa, Tomohiko , Sugiyama Mitsugi , Tochikubo Osamu , Umemura Satoshi 
Published: February 2009

AbstractBackground: ST‐segment elevation of ± 1.0 mm in lead V4R has been shown to be a reliable marker of right ventricular involvement (RVI), a strong predictor of a poor outcome in patients with inferior acute myocardial infarction (IMI). However, patients with no ST‐segment elevation in lead V4R despite the presence of RVI have received little attention.Hypothesis: The study was undertaken to study the clinical features of patients with no ST‐segment elevation in lead V4R despite the presence of RVI, which means false negative, as such patients have received little attention in the past.Methods: We studied 62 patients with a first IMI. who had total occlusion of the right coronary artery (RCA) proximal to the first right ventricular branch and successful reperfusion within 6 h from symptom onset, to examine the implications of the absence of ST‐segment elevation in lead V4R despite the presence of RVI.Results: A standard 12‐lead electrocardiogram (ECG) and right precordial ECG (lead V4R) were recorded on admission, and three posterior chest ECGs (leads V7 to V9) were additionally recorded in 34 patients. Patients were classified according to the absence (Group 1, n = 18) or presence (Group 2, n = 44) of ST‐segment elevation of ± 1.0 mm in lead V4R on admission. Patients in Group 1 had a greater ST‐segment elevation in leads V7 to V9 (2.9 ± 2.4 vs. 1.4 ± 3.0 mm, p < 0.05), a higher frequency of a dominant RCA (defined as the distribution score ≥ 0.7) (72 vs. 11%, p < 0.001), and a higher peak creatine kinase level (3760 ±; 1548 vs. 2809 ± 1824 mU/ml, p < 0.05) than those in Group 2.Conclusions: In patients with IMI caused by the occlusion of the RCA proximal to the first right ventricular branch, no ST‐segment elevation in lead V4R can occur because of concomitant posterior involvement. In such patients, the incidence of RVI may be underestimated on the basis of ST‐segment elevation in lead V4R.
histamine—can it cause an acute coronary event?
Authors: Gupta Mahendra Kumar , Gupta Parul , Rezai Feridoun 
Published: February 2009

AbstractMyocardial infarction (MI) occurring during the course of an allergic urticarial reaction in the absence of systemic hypotension has been rarely reported. This paper reports the case of a 28‐year‐old woman with no significant risk factors for coronary artery disease who presented with generalized urticaria associated with chest pain and had electrocardiographic and enzymatic evidence of an acute MI. Review of the literature suggests that local histamine release may induce spasm of the coronary vasculature, thus leading to myocardial ischemia and infarction.
Transluminal endovascular stent grafting of aortic dissections and aneurysms: A concise review of the major trials
Authors: Dieter Robert S. 
Published: February 2009

AbstractTransluminal endovascular repair of the vascular system is rapidly emerging as a leading therapeutic modality for aortic dissections and aneurysms. The use of transluminal endovascular stent grafting has been used to intervene successfully on the aorta and its major branch vessels. There have been several studies examining transluminal endovascular stent grafting of thoracic aortic aneurysms, dissections, and abdominal aortic aneurysms. This paper reviews some of the major trials of transluminal endovascular stent grafting as well as its major limitation, endoleak.