bluuebunny/crossref_metadata_2025_split huggingface dataset:
Inflammatory predictors of mortality in the scandinavian simvastatin survival study
Authors: Crea Filippo , Monaco Cmlaudia , Lanza Gaetano A. , Maggi Elena , Ginnetti Francesca , Cianflone Domenico , Niccoli Giampaolo , Cook Thomas , Bellomo Giorgio , Kjekshus John 
Published: June 2007

AbstractBackground and hypothesis: The predictive value of specific markers of infection and autoimmunity for coronary events, such as the effects of statins on inflammation, is still controversial.Methods: A case‐control design was used to compare C‐reactive protein (CRP) levels, seropositivity for Chlamydia pneumoniae and Helicobacter pylori, and anti‐oxidized low‐density lipoprotein (oxLDL) antibody levels in prerandomization blood samples from 129 participants in the Scandinavian Simvastatin Survival Study who died (cases), and from 129 matched participants who were alive during 5‐year follow‐up (controls).Results: Patients with CRP levels in the highest quartile had an increased risk of death compared with those in the first through third quartile (odds ratio [OR] = 2.51, 95% confidence interval [CI] 1.3‐4.8). Seropositivity for Chlamydia pneumoniae or Helicobacter pylori and anti‐oxLDL antibody levels were similar in cases and controls (p = NS). At a 4‐month control, simvastatin reduced CRP levels (p = 0.009) while placebo did not (p = NS). However, the risk of death associated with high baseline CRP levels was similar in patients randomized to placebo (OR = 2.36, 95% CI 1.06‐5.26) or simvastatin (OR = 3.13, 95% CI 1.06‐9.21).Conclusions: Elevated CRP levels, but not seropositivity for Chlamydia pneumoniae or Helicobacter pylori, nor levels of anti‐oxLDL antibodies, predict the risk of death in patients with stable ischemic heart disease. Simvastatin treatment reduces CRP levels, but without affecting the increased risk conferred by higher CRP levels at baseline.
Does racial bias exist in the medical management of heart failure?
Authors: Harjai Kishore J. , Nunez Eduardo , Shah Mehul , Newman Jeff 
Published: June 2007

AbstractBackground: It is suspected that effective therapies are often underutilized in black compared with white patients with coronary artery disease (CAD).Hypothesis: We hypothesized that an unfavorable bias may exist against black patients in the medical management of heart failure.Methods: In 566 consecutive adult subjects who were discharged alive from the hospital with a principal discharge diagnosis of heart failure, we assessed the effect of patient race on utilization of classes of medications (angiotensin‐converting enzyme inhibitors [ACEI], digitalis, diuretic agents) and combinations of medications (effective vasodilators, i.e., ACEI or combined hydralazine and nitrate; effective combination therapy, i.e., effective vasodilator with digitalis and diuretic) known to be beneficial in symptomatic heart failure.Results: Compared with black patients (n = 182), white patients were older, had a higher incidence of coronary artery disease, lower incidence of hypertension, and lower serum creatinine and left ventricular end‐diastolic diameter. In crude analyses, the utilization of all medications was similar between white and black patients. After adjustment for clinical differences, black patients were more likely to receive ACEI (adjusted odds ratio [OR] = 1.84; 95% confidence interval [CI] 1.13–3.01), effective vasodilators (OR = 1.97; CI 1.20– 3.23), and effective combination therapy (OR = 1.66; CI 1.02–2.69) than white patients at the time of discharge from the hospital. No multivariate association was seen between patient race and use of digoxin or diuretics. In an analysis of subsets of patients with ejection fraction < 45% (n = 260), no association was seen between patient race and utilization of effective medical therapy.Conclusion: Our results show no unfavorable bias against black patients with decompensated heart failure.
Therapy to reduce risk of coronary heart disease
Authors: Rader Daniel J. 
Published: June 2007

AbstractRecent primary and secondary intervention studies have shown that reduction of low‐density lipoprotein cholesterol (LDL‐C) with statins significantly reduced coronary heart disease (CHD) morbidity and mortality. However, many patients with dyslipidemia who have or are at risk for CHD do not reach target LDL‐C goals. The recently updated National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III guidelines identify a group of patients at very high risk for CHD for more aggressive LDL‐C reduction and reaffirm the importance of high‐density lipoprotein cholesterol (HDL‐C) by raising the categorical threshold to 40 mg/dl. Lipid‐lowering therapy needs to be more aggressive in both primary and secondary prevention settings, and therapy should be considered to increase HDL‐C as well as lower LDL‐C in order to improve patient outcomes. Both combination therapy and the next generation of statins may provide improved efficacy across the dyslipidemia spectrum.
Oxidized low‐density lipoprotein and high‐density lipoprotein cholesterol modulate coronary arterial remodeling: An intravascular ultrasound study
Authors: Yoneyama Satoru , Arakawa Koh , Yonemura Atushi , Isoda Kikuo , Nakamura Haruo , Ohsuzu Fumitaka 
Published: June 2007

AbstractBackground: Oxidized low‐density lipoprotein (oxLDL) not only plays an important role in plaque formation, but also impairs the endothelium‐dependent relaxation. Constrictive remodeling rather than intimal hyperplasia mainly contributes to restenosis after balloon angioplasty. Probucol (powerful antioxidant) reduced restenosis rate by improving constrictive remodeling. Thus, oxLDL may modulate coronary arterial remodeling.Hypothesis: The study was designed for using intravascular ultrasound to test the hypothesis that arterial constrictive remodeling (CR) was associated with oxLDL in patients with coronary artery disease.Methods: Intravascular ultrasound was performed in 36 patients with de novo atherosclerotic coronary. Remodeling was defined and evaluated as follows: remodeling index (RI) = lesion vessel area (VA)/(proximal reference VA + distal reference VA)/2. Constrictive remodeling (CR) was defined as remodeling index (RI) < 0.9. Neutral and expansive remodeling (NER) was defined as RI ≥0.9. The level of plasma ox‐LDL was measured by sandwich ELISA using the monoclonal antibody (DLH3)‐recognized oxidatively modified lipoproteins and the antihuman apoprotein B monoclonal antibody.Results: Neutral and expansive remodeling was found in 24 lesions, and CR in 12 lesions. Remodeling index was significantly lower in the CR group than in the NER group (0.8 ± 0.1 vs. 1.0 ± 0.1, p< 0.001). The level of oxLDL in the CR group was significantly higher than that in the NER group (24.0 ± 12.1 vs. 16.4 ± 6.2 U/ml, p < 0.05). The level of high‐density lipoprotein‐cholesterol (HDL‐C) in the CR group was significantly lower than that in the NER group (40.5 ± 4.8 vs. 46.2 ± 10.6 mg/ml, p < 0.05). There was a statistically significant correlation between the value of HDL‐C/ ox‐LDL and the RI (r = ‐0.48, p< 0.005).Conclusions: Oxidized LDL and HDL‐C were associated with arterial remodeling in de novo atherosclerotic lesions.
Electrocardiographic and vectorcardiographic findings of patients undergoing reductive ventriculectomy (Batista operation)
Authors: Pastore Carlos Alberto , Tobias Nancy , Kaiser Elizabeth , Bacal Fernando F. , Aziz José Luiz , Moreira Luis Felipe , Stolf Noedir , Bocchi Edimar , Ramires José Franchini 
Published: June 2007

AbstractBackground: The Batista operation, or partial ventriculectomy, has been designed by the Brazilian surgeon Dr. Randas Batista as an alternative method for treating patients with idiopathic dilated cardiomyopathy.Hypothesis: This study aimed to analyze electro‐ and vectorcardiographic data obtained from patients who underwent such surgery, and to evaluate its electrical repercussions on the heart.Methods: Pre‐ and postoperative electrocardiography (ECG) and vectorcardiography (VCG) were performed 45 days apart in 15 patients undergoing reductive ventriculectomy.Results: All ECGs showed sinus rhythm, with unchanged QRS duration. Left atrial enlargement (86.6%) and left ventricular hypertrophy (100%) were the most common findings. Bundle‐branch blocks (BBBs) were often demonstrated on preoperative studies, predominantly (46.7%) left BBBs. Left anterior fascicular blocks were seen in four patients (26.6%), one associated with right BBB. Electrocardiographic changes suggestive of myocardial infarction (MI) were seen in four patients preoperatively; postoperatively, all had extended to or within the lateral wall. Five additional patients developed lateral MIs postoperatively, for a total of 9 patients (60%) with postoperative signs of infarction (p < 0.05). Electro‐ and vectorcardiography also showed significant postoperative lowering of QRS voltages (mean 40.74%) in all patients and a consequent difficulty to diagnose left ventricular hypertrophy, although the morphologic features did not change.Conclusions: These important ECG and VCG alterations are reflections of both the surgical technique and its clinical consequences.
Predischarge exercise electrocardiogram and stress echocardiography can predict long‐term clinically driven revascularization following acute myocardial infarction
Authors: Desideri Alessandro , Bigi Riccardo , Cortigiani Lauro , Rambaldi Riccardo , Sabbadin Daniela , Curti Gianpiero , Celegon Leopoldo 
Published: June 2007

AbstractBackground: Predischarge stress testing provides suboptimal prediction of spontaneous hard events following uncomplicated acute myocardial infarction (AMI).Hypothesis: This study was aimed at assessing whether soft cardiac ischemic events requiring late revascularization could be predicted more accurately.Methods: In all, 428 patients undergoing exercise electro‐cardiography (ECG) and stress echocardiography (SE, 345 dobutamine and 83 dypiridamole) within 15 days of uncomplicated AMI were followed up for 425 (range 20‐2220) days. Soft ischemic events (effort angina > class II [Canadian Cardiovascular Society Classification] and unstable angina) driving late (> 6 months) revascularization were regarded as endpoints.Results: A total of 58 events (29 effort and 29 unstable angina with subsequent 47 coronary artery bypass grafts and 11 percutaneous transluminal coronary angioplasties) occurred: 26 in patients with positive exercise ECG and 34 in patients with positive SE. Univariate predictors of revascularizations were positive exercise ECG (p = 0.0001), peak wall motion score index (WMSI) (p = 0.0009), low workload (p = 0.0018), rest WMSI (p = 0.02) and positive SE (p = 0.02). Cox multivariate analysis selected peak WMSI, positive exercise ECG, and low workload positive exercise ECG as independent predictors of late revascularizations.Conclusions: Predischarge stress testing identifies the long‐term occurrence of soft ischemic events driving late revascularization after uncomplicated AMI.
C‐reactive protein and rapidly progressive coronary artery disease is there any relation?
Authors: Zairis Michael N. , Manousakis Stavros J. , Svtefanidis Alexander S. , Vitalis Denis P. , Tsanis Evangelos M. , Hadjigeorgiou Seraphim M. , Fakiolas Constantine N. , Pissimissis Evangelos G. , Olympios Christopher D. , Foussas Stefanos G. 
Published: June 2007

AbstractBackground: High plasma C‐reactive protein (CRP) levels have been associated with an unfavorable outcome in patients with coronary artery disease (CAD), and a direct participation of CRP in the atherosclerotic process has been postulated.Hypothesis: The aim of this study was to evaluate the possible relationship of high plasma CRP levels with the rapid progression of coronary atherosclerosis (RPCAD).Methods: In all, 194 patients who were readmitted and underwent repeat coronary angiography because of recurrence of symptoms following successful percutaneous coronary intervention were studied. Median angiographic follow‐up time was 6 months. Rapid progression CAD was defined as the presence of a new lesion, > 25% in luminal diameter stenosis, in a previously nondiseased vessel, or deterioration of a known, nontreated lesion by at least 25%.Results: By multivariate analysis, patients with high plasma CRP levels upon first admission were at higher risk of RPCAD. In particular, odds ration (OR) = 1.8; 95% confidence interval (CI) = 1.3‐3.6; p value = 0.02 in patients with CRP = 0.5‐2 mg/dl versus patients with CRP < 0.5 mg/dl, and OR = 7.1; 95% CI = 3.8‐9.5; p value < 0.001 in patients with CRP > 2 mg/dl versus patients with CRP < 0.5 mg/dl.Conclusion: Increased plasma CRP levels could possibly identify patients at high risk for the development of RPCAD.
A dose‐ranging study of a new, once‐daily, dual‐component drug product containing niacin extended‐release and lovastatin
Authors: Hunninghake Donald B. , McGovern Mark E. , Koren Michael , Brazg Ronald , Murdock David , Weiss Stuart , Pearson Thomas 
Published: June 2007

AbstractBackground: Combination therapy for dyslipidemia holds promise as effective treatment for patients with multiple lipid disorders, especially those at high risk.Hypothesis: This study evaluated dose‐response relationships and safety of a new dual‐component drug product containing niacin extended‐release (niacin ER) and lovastatin.Methods: The 28‐week double‐blind multicenter trial randomized 237 patients with type IIA or IIB hyperlipidemia to one of four escalating‐dose treatment groups: niacin ER/lovastatin 1,000/20 mg, niacin ER/lovastatin 2,000/40 mg, niacin ER 2,000 mg, or lovastatin 40 mg.Results: Niacin ER/lovastatin was more effective than each of its components for improving levels of low‐density lipoprotein cholesterol (LDL‐C), high‐density lipoprotein cholesterol (HDL‐C), and triglycerides (TG), and exhibited a clear dose‐response effect and additivity across the dosage range. The 2,000/40 dose achieved greater mean reductions in LDL‐C (‐42%) than 1,000/20 (‐28%, p<0.001), lovastatin 40 mg (‐32%, p<0.05), or niacin ER 2,000 mg (‐14%, p<0.05). The 2,000/40 dose was significantly more effective in increasing HDL‐C levels (+ 30%) than the 1,000/20 dose (+ 21%, p = 0.016). The decrease in TG was greater with 2,000/40 (‐43%) than with 1,000/20 (‐26%, p = 0.009). All three niacin‐containing treatments were more effective than lovastatin monotherapy in reducing lipoprotein (a) [Lp(a)] levels. Flushing caused 12 (11%) patients receiving niacin ER/lovastatin and 1 patient receiving lovastatin alone to withdraw. No drug‐related myopathy was noted. One patient each in the 2,000/40 group and the lovastatin 40‐mg group had reversible elevations in liver transaminases.Conclusions: Niacin ER/lovastatin is well tolerated and effective for patients with multiple lipid disorders.
Factors determining early improvement in mitral regurgitation after aortic valve replacement for aortic valve stenosis: A transthioracic and transesophageal prospective study
Authors: Tassan‐Mangina Sophie , Metz Damien , Nazeyrollas Pierre , Torossian Frédé Ric , Pop Camelia , Jamet Bertrand , Baehrel Bernard , Elaerts Jacques 
Published: June 2007

AbstractBackground: Mitral regurgitation (MR) is frequently associated with aortic stenosis. Previous reports have shown that coexisting mitral insufficiency can potentially regress after aortic valve replacement.Hypothesis: This study sought to assess the frequency and severity of MR before and after aortic valve replacement for aortic stenosis and to define the determinants of its postoperative evolution.Methods: For this purpose, 30 adult patients referred for aortic valve surgery underwent pre‐ and postoperative transthoracic and transesophageal echocardiography and color Doppler examination.Results: Mean preoperative left ventricular ejection fraction was 57 ± 16% and remained unchanged postoperatively. Preoperative MR was usually mild to moderate and correlated with aortic stenosis severity and left ventricular systolic dysfunction. The color Doppler mitral regurgitant jet area significantly decreased during the postoperative period (p = 0.016) as left ventricular loading conditions returned to normal, suggesting an early decrease of the functional part of MR. On the other hand, the mitral regurgitant jet width at the origin remained unchanged. Statistical analysis found pulmonary artery pressure (p = 0.02) and indexed left ventricular mass (p = 0.009) to be preoperative predictive factors of postoperative MR improvement. Predictive factors of postoperative MR severity were left atrial diameter (p = 0.02), pulmonary artery pressure (p = 0.003), and the presence of mitral calcifications (p = 0.004).Conclusion: In our cohort of patients with normal left ventricular ejection fraction, the majority of moderate MR, associated with severe aortic stenosis, regresses early after aortic valve replacement. Mitral calcifications and/or left atrial dilation seem to be predictive factors of fixed MR.
Utilization of intraoperative transesophageal echocardiography during repair of congenital cardiac defects: A survey of north american centers
Authors: Stevenson J. Geoffrey 
Published: June 2007

AbstractBackground: Intraoperative transesophageal echocardiography (TEE) has been increasingly utilized during repair of congenital cardiac defects.Hypothesis: The aim of this study was to assess the practice of TEE in this setting.Methods: A survey was sent to 70 centers in the United States and Canada; replies were obtained from 65 centers (93%). Responses were grouped into four categories: (1) Performance of intraoperative echocardiography, (2) performance practices, (3) equipment and probe issues, (4) billing and reimbursement. Data were available from all responding centers unless specified below.Results: All responding centers employed intraoperative echocardiography, with 98% employing TEE. All responding centers employed intraoperative echocardiography. The majority of centers (72%) utilized intraoperative echocardiography in all cases or all open cases except atrial septal defects, while the remainder employed it selectively. The average duration of TEE experience at responding centers was 6.1 years. Transesophageal echocardiography was primarily the responsibility of cardiologists, with most centers having individuals meeting published TEE training guidelines. The large majority of centers performed both pre‐ and postbypass TEE studies. Equipment and probes were widely available. All centers disinfected the TEE probe between studies, but for longer times than recommended.Conclusion: Utilization of intraoperative TEE during surgery for congenital heart disease is widespread; the results of this survey may be useful to individual institutions as they evaluate their utilization of intraoperative echocardiography.
Pregnancy in patients with heart disease: Experience with 1,000 cases
Authors: Avila Walkiria Samuel , Rossi Eduardo Giusti , Ramires José Antonio Franchini , Grinberg Max , Bortolotto Maria Rita Lemos , Zugaib Marcelo , Luz Protasio Lemos Da 
Published: June 2007

AbstractBackground: Previously, the high maternal mortality in cardiac patients who became pregnant prompted the assertion: Women with an abnormal heart should not become pregnant. This long‐standing notion needs to be revised today.Hypothesis: The study was undertaken to ascertain the experience with a large series of pregnant women with cardiac disease cared for in the same referral center.Methods: From 1989 to 1999, 1,000 pregnant women with heart disease were followed by the same clinical and obstetric team. The cardiac diseases included rheumatic heart disease (55.7%), congenital heart disease (19.1%), Chagas' disease (8.5%), cardiac arrhythmias (5.1%), cardiomyopathies (4.3%), and others (7.3%).Results: Of the pregnant women studied, 765 (76.5%) experienced no cardiovascular events during the study; 235 (23.5%) patients had the following cardiovascular complications: congestive heart failure (12.3%), cardiac arrhythmias (6%), thromboembolism (1.9%), angina (1.4%), hypoxemia (0.7%), infective endocarditis (0.5%), and other complications (0.7%). Clinical treatment allowed adequate management in 161 (68.8%) patients; however, 46 (19.6%) patients underwent interventional procedures because of refractory complications. The general maternal mortality rate was 2.7%. Of the 915 (91.5%) infants who were discharged, 119 (13%) were premature.Conclusion: Pregnancy in women with heart disease is still associated with considerable morbidity and mortality rates, which strongly correlate to maternal underlying disease. Strict prenatal care and early risk stratification during gestation are fundamental measures to improve the prognosis of pregnancy in women with heart disease.
Technetium‐99m sestamibi cavity/myocardium count ratio in the detection of left ventricular hypertrophy
Authors: Altun Gulay Durmus , Akdemir Osman , Ustun Funda , Altun Armagan , Sarikaya Ali , Berkarda Sakir 
Published: June 2007

AbstractBackground and hypothesis: Left ventricular hypertrophy (LVH) is an independent risk factor for cardiovascular mortality and morbidity. This study was designed to assess whether technetium‐99m (99mTc) sestamibi cavity‐to‐myocardium count (c/m) ratio would differentiate LVH from normal geometry, and discriminate between the two patterns‐concentric and eccentric‐of LVH.Methods: In all, 72 patients including 32 hypertensive patients with both normal 99mTc sestamibi single‐photon emission computed tomography imaging and good‐quality echocardiographic recordings were studied retrospectively. Four different patterns of left ventricular (LV) geometry were defined: normal (n = 47), concentric remodeling (n = 3), eccentric LVH (n = 13), and concentric LVH (n = 9).Results: Left ventricular hypertrophy was detected in 22 of 32 hypertensive patients. The c/m ratio calculated on midventricular short‐axis slices of dipyridamole‐stress 99mTc sestamibi images was significantly decreased in patients with LVH compared with subjects with normal geometry (0.05 ± 0.02 vs. 0.17 ± 0.08, p = 0.001). A c/m ratio of < 0.124 yielded a sensitivity of 86%, a specificity of 64%, and an overall diagnostic accuracy of 68% for detecting LVH. Negative correlations of c/m ratio were found to LV mass‐index (r = −0.44, p = 0.004), septal width (r = −0.42, p = 0.008), posterior wall thickness (r = ‐ 0.39, p = 0.001), and relative wall thickness (r = −0.40, p = 0.001). Multiple linear regression analysis revealed that LV mass index was the single independent predictor of c/m ratio. Although both groups with concentric and eccentric LVH had a significantly lower mean c/m ratio than those with normal geometry (p = 0.01 and p = 0.01, respectively), no significant difference of c/m ratio was found between the two patterns of LVH.Conclusion: A new index, c/m ratio on 99mTc sestamibi images, has a potential to discriminate between LVH and normal geometry in subjects free of myocardial ischemia.