bluuebunny/crossref_metadata_2025_split huggingface dataset:
Unusual echocardiographic appearances attributable to submitral calcification simulating left ventricular “masses”
Authors: D'CRUZ I. A. , Devaraj N. , Hirsch L. J. , Glick G. 
Published: February 2009

AbstractUsing M‐mode and cross‐sectional echocardiography, we visualized in five patients abnormal large echos attributable to anterior submitral calcification or sclerosis (on or near the ventricular aspect of the anterior mitral leaflet). Such abnormal echos on M‐mode echocardiography could have been mistaken for a mass in the left ventricular chamber. Autopsy in two cases confirmed the presence of nonrheumatic anterior submitral calcification. Echocardiographic features of anterior submitral calcification which are helpful in differentiating it from neoplastic or thrombotic ventricular masses include (1) less diastolic mobility and more echo density; (2) continuity with the base of the anterior mitral leaflet and/or the posterior aortic root region, whereas tumors or thrombi are attached to the left ventricular wall; and (3) calcification in the region of posterior “mitral annulus.” Cross‐sectional long‐axis views and M‐mode scanning from the left ventricle to the aortic root were particularly helpful in making the differentiation.
Salvage of acutely ischemic myocardium by emergency coronary artery bypass grafting
Authors: Muller J. E. , Antman E. , Green L. H. , Koster J. K. 
Published: February 2009

AbstractAfter cardiac catheterization a 53‐year‐old patient developed widespread myocardial ischemia that produced electromechanical dissociation and cardiogenic shock. The administration of methylprednisolone, the initiation of cardiopulmonary bypass and hypothermia within 40 min of the onset of ischemia, and reperfusion within 90 min of the onset of ischemia were sufficient to salvage a major portion of the ischemic myocardium.
Evidence for transient limitations in coronary blood flow during unstable angina pectoris: hemodynamic changes with spontaneous pain at rest versus exercise‐induced ischemia following stabilization of angina
Authors: Smitherman T. C. , Hillert M. C. , Narahara K. A. , Burden L. L. , Lipscomb K. M. , Shapiro W. , Nixon J. V. 
Published: February 2009

AbstractThe pathophysiologic basis for the deterioration of patients with stable angina pectoris to unstable angina is unclear. Central to this issue is the question of whether myocardial ischemia occurs at the same or at a lower myocardial oxygen demand during unstable periods as during stable periods. Consequently, we compared myocardial oxygen demand in 12 patients at the onset of spontaneous pain during unstable angina to myocardial oxygen demand during exercise‐induced ischemia after resumption of stable angina, 6–12 weeks later. Myocardial oxygen demand was estimated from values for heart rate (HR), systolic blood pressure (BP), and the rate‐pressure product (RPP). Rate‐pressure product is the heart rate × systolic blood pressure × 10‐2 (mmHg/min/102). There was definite evidence for coronary artery spasm for only one patient. There was no difference in heart rate, blood pressure, or rate‐pressure product during pain‐free intervals in the hospital and just before the start of exercise testing. Mean H R (71.2± 11.1 beats/min; mean ± standard deviation) and RPP (95.8±20.0 mmHg/min/102) just before spontaneous angina during the unstable period were significantly lower (p<0.001) than at the termination of bicycle ergometry in both the supine (HR, 96.9±10.5 beats/min; RPP, 141.8±25.0 mmHg/min/102) and upright (HR, 98.1±13.6 beats/min; RPP, 143.0±32.2 mmHg/min/102) positions. Blood pressure (134.5 ± 17.6 mmHg) just before spontaneous angina was significantly lower than at the conclusion of both supine (145.6±13.3 mmHg) and upright (145.1 ±18.6 mmHg) ergometry. The observation that myocardial oxygen demand was lower at the threshold of ischemia with spontaneous angina than with exercise‐induced ischemia is consistent with the hypothesis that there were transient, reversible limitations in coronary blood flow during the period of unstable angina. There was also a moderate but significant rise in estimated myocardial oxygen demand just before spontaneous angina in these patients, but the nature of the data do not allow us to distinguish whether or not this rise was part of the cause or an effect of ischemia. While the results of this study did not identify the cause for the transient limitations in coronary flow, coronary artery spasm without ST‐segment elevation, intracoronary platelet aggregates, and hemorrhage into atherosclerotic plaques are possibilities that are consistent with these hemodynamic observations.
Sympathetic nervous system activity during sodium restriction in essential hypertension
Authors: Warren S. E. , Vieweg W. V. R. , O'Connor D. T. 
Published: February 2009

AbstractSympathetic nervous system activity was studied in 38 patients with essential hypertension during high‐ and low‐sodium diets. Salt restriction was associated with a modest (6 mmHg) decline in mean arterial pressure, while the urinary excretion of catecholamines, metanephrines, and vanillylmandelic acid increased significantly. Plasma renin activity also increased, it is concluded that short‐term low‐sodium diet therapy for essential hypertension results in only small decrements in mean arterial pressure and may be limited in hypotensive effect by activation of the sympathetic nervous system. Support is offered for the rationale of sympatholytic drug therapy as an initial step in the management of hypertensive patients requiring arterial pressure reductions greater than those afforded by diet alone.
Total occlusion of the left main coronary artery: clinical and catheterization findings
Authors: Trnka K. E. , Febres‐ROMAN P. R. , Cadigan R. A. , Crone R. A. , Williams T. H. 
Published: February 2009

AbstractIn this report clinical and angiographic data on three patients with total occlusion of the left main coronary artery is presented. Two of our cases demonstrated rich collateralization with good preservation of left ventricular (LV) function. The third case, with initial subtotal occlusion and no collaterals, sustained a severe anterolateral myocardial infarction (MI) responding to the use of the intra‐aortic balloon pump (IABP).This report is consistent with the findings of others who suggest the possible beneficial effect of collaterals in preserving myocardial contractility in this unusual situation. We suggest that the IABP may be of benefit in patients with total occlusion of the left main coronary artery and sparse collaterals who remain unstable and cannot be operated on immediately.
Observations on exercise testing and coronary arteriography
Authors: Balcon R. , Cattell M. R. , Feurelicht J. 
Published: February 2009

AbstractExercise tests were performed on 551 patients with a clinical diagnosis of coronary artery disease during their admission for angiography. A computer‐generated index (CI, 0–100%) was used to describe the coronary anatomy, and additional data on left ventricular contraction abnormalities were recorded. Significant correlations exist between exercise performance and angina grade, coronary pathology, left ventricular function, and prognosis.
Antiarrhythmic effect of the calcium antagonist tiapamil (ro 11–1781) by intravenous administration in patients with coronary heart disease
Authors: Nowak F. G. , Cocco G. , Chu D. , Gasser D. F. 
Published: February 2009

AbstractTwenty coronary patients with a median age of 76 years were treated in the coronary care unit with tiapamil, a new Ca2+ antagonist, by intravenous infusion (until December, 1979, the generic name was dimeditiapramine). The following arrhythmias were identified: atrial fibrillation with ventricular rate >95 beats/min (5 patients); supraventricular premature complexes (SVPC) (4 patients); and ventricular premature complexes (VPC), Lown grades 2–4 (15 patients). Electrocardiograms and hemodynamic parameters were continuously monitored prior to, during, and after the therapy. In patients with atrial fibrillation, sinus rhythm was not restored, but tiapamil decreased the ventricular rate by 54%.In patients with VPC, the median frequency of VPC decreased from 310.5 before tiapamil to 32.5 beats/h at the fourth hour of therapy (p<0.01). The median ectopic/sinus beat ratio decreased from 0.083 (pretreatment) to 0.008 at the fourth hour of infusion (p<0.10). In one of the patients with an insufficient decrease in the number of VPC, the VPC changed from class 4a (pretreatment) to class 2 (during the therapy), returning to class 4a after the infusion was stopped.Tiapamil reduced the median systolic and diastolic blood pressures by 8.3 and 7.1%, respectively (p<0.05), the third hour. Hypotension and bradycardia were observed in 5/20 patients. The results show that tiapamil is effective against both supraventricular and ventricular arrhythmias, and thus its spectrum of action differs from that of other calcium antagonists.
Left ventricular volume and ejection fraction determination by cross‐sectional echocardiography in patients with coronary artery disease: A prospective study
Authors: Erbel R. , Schweizer P. , Meyer J. , Grenner H. , Krebs W. , Effert S. 
Published: February 2009

AbstractIn a prospective study the accuracy of cross‐sectional echocardiography for determination of left ventricular (LV) volume and ejection fraction (EF) was analyzed in 53 patients with coronary artery disease and compared to that of cineangiocardiography (angio). From the apex of the heart phased‐array wide‐angle (84°) electronic echocardiograms were received in the RAO‐equivalent view. Angios were obtained in a 30° RAO view. Using Simpson's rule, end‐diastolic (EDV) and end‐systolic (ESV) LV volumes were calculated, and the EF derived. Left ventricular long axis was transected in eight segments, yielding seven diameters. In 50 of the 53 patients cross‐sectional echocardiograms could be recorded. The correlation between cineangiocardiography and cross‐sectional echocardiography for EDV was highly significant: r = 0.936, y = 0.667x + 27.1, standard error of estimate (syx) ± 22.2 ml; for ESV: r = 0.970, y = 0.699x + 14.7, syx ± 14.5 ml; for stroke volume: r = 0.721, y = 0.503x + 11.3, syx ± 15.3 ml; for EF: r = 0.909, y = 0.740x + 11.3, syx ±6.0%. Angio mean long axis was 10.2± 1.2 cm, cross‐sectional echocardiographic long axis 8.7 ± 1.3 cm. Mean LV diameter determined by cineangiocardiography was longer than when determined by cross‐sectional echocardiography. The mean difference reached 2.0 cm in the middle of the LV. Our prospective comparative study revealed that LV volumes and EF were underestimated by cross‐sectional echocardiography compared to cineangiocardiography because of a methodological systematic error caused by a tangential cut of the heart. In the RAO‐equivalent view the “true” long axis was missed. The high correlation coefficients, however, indicate that the “true” LV volume and EF can be calculated from the given regression equations. Serial measurements should be legitimated.
Heart rate responses in patients with sinus node disease compared to controls: Physiological implications and diagnostic possibilities
Authors: Vallin H. O. , Edhag K. O. 
Published: February 2009

AbstractThe autonomic regulation of heart rate was examined in 30 patients with symptoms of sinus node disease (SND) and 18 control subjects. Heart rate, expressed as sinus cycle length, was determined after injection of isoprenaline (0.1 μg/kg), propranolol (0.1 mg/kg), and atropine (0.02 mg/kg); heart rate was also determined at maximal exercise and during carotid sinus stimulation. In addition, heart rate responses, expressed as the absolute change in sinus cycle length, were calculated.Mean heart rates after the applied maneuvers were all significantly different in the patient group, but so was the mean spontaneous heart rate. None of the induced changes differed significantly between the groups. Thus, although all these patients had impaired sinus node automaticity no uniform decrease in responsiveness to adrenergic or cholinergic stimulation or to inhibition of autonomic influences could be detected. The response patterns were heterogeneous, indicating diversity of the underlying mechanisms.No single heart rate reaction provided a satisfying diagnostic capacity for SND. However, the combined sensitivity of the three tests—isoprenaline stimulation, carotid sinus pressure, and autonomic inhibition—was 97% with a specificity of 50%. Clinically, normal findings in all these three tests, i.e., with resulting heart rates greater than 100, 55, and 70 beats/min, respectively, strongly suggest absence of SND.
Coronary arteriovenous fistulas: Collective review and management of six new cases—changing etiology, presentation, and treatment strategy
Authors: Said S. A. M. , El Gamal M. I. H. , Van Werf T. Der 
Published: February 2009

AbstractWe considered it worthwhile to review the literature of the last decade (1985–1995) to answer the question whether the etiology and the clinical picture of coronary arteriovenous fistulas (CAVFs) have changed. Furthermore, new therapeutic modalities such as percutaneous transcatheter embolization have been developed. We tried to define the place of these techniques in the therapeutic arena. Clinical presentation and management of six patients with eight congenital CAVFs and 76 subjects with 96 congenital and acquired CAVFs taken from a review of the recent literature are presented. Sixty‐three review subjects (78%) were treated medically, with one fatal case. Ligation of the fistula was achieved by surgical techniques in 10% of review subjects, while percutaneous transcatheter embolization (PTE) was performed in nine patients (12%). Percutaneous transcatheter embolization techniques are being increasingly used in the treatment of CAVFs. The etiology of CAVFs has a tendency to show alterations toward the acquired pathogenesis. In 64% of the review subjects the fistula was congenital in origin, and in 36% it had an acquired cause. Among the patients of the current review, the clinical presentations were 55% asymptomatic, 34% chest pain (anginal or atypical), and 13% congestive heart failure. The CAVFs of our six patients are all congenital in origin. In the current review, the clinical presentation showed a trend toward increasing chest complaints (34%) compared with the review (10%) published in the mid 1970s. This may be due to a higher mean age, and hence increased concurrent coronary artery disease due to aging compared with the review population of two decades ago.
The risk of coronary artery disease after heart transplantation is increased in patients receiving low‐dose cyclosporine, regardless of blood cyclosporine levels
Authors: Gamba Amando , Mamprin Filippo , Fiocchi Roberto , Senni Michele , Troise Gianni , Ferrazzi Paolo , Ferrara Roberto , Corbetta Giuseppe 
Published: February 2009

AbstractBackground: Coronary artery disease (CAD) of allografted hearts is the main cause of late mortality after cardiac transplant, but its etiology is still undetermined.Hypothesis: This study was undertaken to evaluate the relevance of several risk factors, including cyclosporine (CsA) dose and blood CsA levels, to the incidence of CAD.Methods: In 163 heart transplants performed between November 1985 and August 1994 at our Institution, CAD was diagnosed by coronary angiography or at postmortem examination. Patients in whom postmortem examination or coronary angiography was not performed, as well as those < 15 years of age and those who died within 1 month of surgery, were excluded from the study. The following risk factors were analyzed: recipient age, gender, pretransplant diagnosis, donor age, number of human leukocyte antigen (HLA)‐AB mismatches, cytomegalovirus serology, mean serum cholesterol and triglyceride levels, the number of treated acute rejections, mean weighted CsA dose (CsA dosew) and weighted blood CsA levels (blood CsA levelw).Results:Coronary artery disease was diagnosed in 32 patients (19.6%). A low mean CsA dosew was the only significant predictor for CAD at multivariate analysis (p<0.01); there was no correlation with blood CsA levelw. In the patients receiving a CsA dosew > 4 mg/kg/day, the 8.9 year probability of their remaining CAD free was 69% [confidence interval (CI) 50–87%] in comparison with 31% (CI0–65%) in patients receiving a CsA dosew < 4 mg/kg/day.Conclusion:In our experience, a low CsA maintenance dose is the main risk factor for CAD, irrespective of blood CsA levels.
Exercise technetium 99m sestamibi single‐photon emission computed tomography late after coronary artery bypass surgery: Long‐term follow‐up
Authors: Desideri Alessandro , Candelpergher Giovanni , Suzzi Gianleone , Terlizzi Raffaele , Colangeli Giovanna , Daskalakis Cosmas , Celegon Leopoldo , Zanco Pierluigi , Borsato Nicoletta , Chierichetti Franca 
Published: February 2009

AbstractBackground and hypothesis: The prognostic value of exercise technetium 99m sestamibi single‐photon emission computed tomography (SPECT) imaging in patients with previous bypass surgery is unknown. The aim of our study was to assess the prognostic information obtained with exercise scintigraphy performed for routine follow‐up or reappearance of symptoms.Methods: We studied 75 patients referred to our Center at a mean of 38 ± 53 months from the revascularization procedure and prospectively followed them for 38 ± 24 months.Results: Fifteen patients (20%) had events at follow‐up: there were 4 cardiac deaths, 3 nonfatal acute myocardial infarctions, 8 late revascularization procedures (4 percutaneous transluminal angioplasty and 4 repeat bypass surgery). Univariate analysis identified a history of typical angina (p = 0.001), a clinically positive ergometric test (p = 0.009), peak exercise heart rate (p = 0.0003), percentage of maximal predicted heart rate (p = 0.0001), peak exercise double product (p = 0.048), therapy during exercise (p = 0.003), scintigraphic summed reversibility score (i.e., the summation of the segmental differences between stress and rest) (p = 0.014), as significant predictors of events. Three multivariate models were built, with clinical variables (Model 1, chi square 15.97), ergometric variables (Model 2, chi square 19.66), and with scintigraphic variables added to clinical/ergometric variables (Model 3, chi square 31.13). The scintigraphic variable selected in the model as significant predictor of events was the summed reversibility score (p = 0.008).Conclusions: Exercise sestamibi SPECT scintigraphy provides optimal prognostic information after clinical and ergometric parameters in patients with previous bypass surgery.
Nonneoplastic diseases of aorta and pulmonary trunk—Part II
Authors: Waller Bruce F. , Clary James D. , Rohr Todd 
Published: February 2009

AbstractThis five‐part review focuses on selected nonneoplastic diseases of the aorta and pulmonary trunk. Because many more diseases affect the aorta compared with the pulmonary trunk and right and left main pulmonary arteries, most of this review will be devoted to disorders of the aorta. Part II of this five‐part series discusses complications of aortic dissection and aortic aneurysm.
Calculating vascular resistances
Authors: Skimming Jeffrey W. , Cassin Sidney , Nichols Wilmer W. 
Published: February 2009

AbstractVascular resistance calculations often affect decisions regarding therapeutic options encountered by physicians and their patients. However, many of the terms, units, and methods used when calculating vascular resistances are ambiguous. This report attempts to clarify some of these ambiguities and suggests methods for predicting normal vascular resistances.
Transesophageal echocardiographic evaluation of aortitis
Authors: Harris Kevin M. , Malenka David J. , Plehn Jonathan F. 
Published: February 2009

AbstractAortitis is an uncommon infection which may occur in patients with preexisting atherosclerotic disease of the aorta. The clinical features in two patients presenting with fever and nonspecific symptoms are reviewed. In these patients, transesophageal echocardiographic features of wall thickening and false aneurysm formation were suggestive of the diagnosis of aortitis. Both patients were taken for surgical excision of the descending aorta and subsequently improved.
Right ventricular involvement in hypertrophic cardiomyopathy: A case report and literature review
Authors: Mozaffarian Dariush , Caldwell James H. 
Published: February 2009

AbstractAlthough hypertrophic cardiomyopathy (HCM) is classically considered a disease of the left ventricle, right ventricular (RV) abnormalities have also been reported. However, involvement of the right ventricle in HCM has not been extensively characterized. The literature regarding prevalence, genetics, patterns of involvement, histologic findings, symptoms, diagnosis, and treatment of RV abnormalities in HCM is reviewed. To highlight the salient points, a case is presented of apical HCM with significant RV involvement, with an RV outflow tract gradient and near obliteration of the RV cavity, in the absence of a left intraventricular gradient. Right ventricular involvement in HCM appears to be as heterogeneous as that of the left ventricle. The spectrum extends from mild concentric hypertrophy to more unusual severe, obstructive disease. While in some cases the extent of RV involvement correlates with left ventricular (LV) involvement, predominant RV disease can be seen as well. While the genetics of RV involvement have not been well characterized, histologic findings appear to be similar to those in the left ventricle, suggesting similar pathogenesis. Significant RV involvement may result in RV outflow obstruction and/or reduced RV diastolic filling, with potentially increased incidence of severe dyspnea, supraventricular arrhythmias, and pulmonary thromboembolism. The optimal treatment for patients with significant RV disease is unknown. Medical and surgical therapies have been attempted with variable success; experience with newer techniques such as percutaneous catheter ablation has not been reported. Further characterization of RV involvement in HCM is necessary to elucidate more clearly the clinical features and optimal treatments of this manifestation of HCM.
Association between calcific aortic stenosis and hypercholesterolemia: Is there a need for a randomized controlled trial of cholesterol‐lowering therapy?
Authors: Chui Michele C. K. , Newby David E. , Panarelli Mauritzio , Bloomfield Peter , Boon Nicholas A. 
Published: February 2009

AbstractBackground: Calcific aortic stenosis may have common etiological factors with atherosclerosis.Hypothesis: In this retrospective, case‐control study, we aimed to determine whether there is an association between hypercholesterolemia and calcific aortic valve stenosis.Methods: Consecutive patients undergoing single aortic or mitral valve replacement in a regional cardiothoracic surgical center were reviewed and preoperative patient characteristics were recorded: demographics, comorbidity (including coronary artery disease and associated risk factors), serum total cholesterol, lipid‐lowering therapy, and serum creatinine.Results: Serum total cholesterol concentrations were significantly higher in patients with calcific aortic stenosis than in controls (6.2 ± 1.1 vs. 5.3 ± 1.1 mmol/l;p< 0.001). The significant difference in serum cholesterol concentrations remained following correction for gender and body mass index (p = 0.02) and when patients with coronary artery disease were excluded (6.3 ± 1.1 vs. 5.3 ± 1.4 mmol/l; p < 0.001). Subgroup analysis demonstrated that the association between elevated serum cholesterol concentrations and calcific aortic stenosis was particularly strong in patients with tricuspid aortic valves (6.4 ± 1.2 vs. 5.3 ± 1.1 mmol/l; p < 0.001) compared with those with bicuspid valves (5.9 ± 1.1 vs. 5.3 ± 1.1 mmol/l; p = 0.06).Conclusions: We conclude that hypercholesterolemia is associated with calcific aortic stenosis and may be implicated in its pathogenesis and progression. We believe that there is now a need for a randomized, controlled trial of cholesterol‐lowering therapy in patients with calcific aortic stenosis.