bluuebunny/crossref_metadata_2025_split huggingface dataset:
Training Physicians and Health Care Providers to Accurately Read Coronary Arteriograms A Training Program
Authors: Fleming Richard M. , Fleming Diane M. , Gaede Ruth 
Published: July 2008

Patterns in visual interpretation of coronary arteriograms (CAs) frequently cause incorrect assessment of percent diameter stenosis (%DS). These errors result in overestimating the results of angioplasty as well as of the number of arteries significantly affected by coronary artery (CAD) disease. Methods. Forty-one physicians, nurses, and students participated in the standardization of 45 Kodachromes (39 arteries, 6 phantoms) and 5 photographic reproductions. Eleven of the 41 participated in a three-part training program designed to eliminate errors and improve accuracy of interpreting %DS from CAs. Results. Improvement in reading %DS was seen in 69% of CAs with statistical (P ≤ 0.05) improvement in one third of these cases, whose narrowings ranged from 4% to 84%DS. Variability of reporting was reduced in 26% of the cases. Skewing, representing an over-estimation of "severe" disease and underestimation of "less severe" disease, was reduced with statistical improvement (P ≤ 0.05) in reported %DS noted after training. Similar improvement was seen with phantoms but not in photographic images where the arterial edges were outlined. (Continued on next page) (Abstract continued) Conclusion. The outcomes of clinical management, invasive and interventional (mechanical, thrombolytic) procedures, as well as research studies depend in part upon the accuracy of reading %DS from CAs. Most studies to date have been completed using extremely unreliable estimates of %DS with resultant problems in data interpretation. The use of this standardized training program has led to significant improvement in accurately assessing CAD. CONDENSED ABSTRACT Visual interpretation of percent diameter stenosis (%DS) from coronary arteriograms results in underestimating stenosis severity for "mild" disease and overestimating "severe" disease. These patterns in reading stenosis severity yield misinterpretation of angioplasty results as well as of the number of vessels significantly diseased. Forty-one physicians, nurses, and students participated in a training program designed to reduce errors made while reading %DS from coronary arteriograms. Following the three-part training program, participants demonstrated improvement in 69% of the arteries, with statistical (P < 0.05) improvement in one third of these. The improved interpretation resulted in more accurate assessment of the severity of coronary artery disease present, both before and after interventions. Utilization of this training program in cardiology fellowship programs would result in better interpretation of disease severity by cardiologists.
Identification of Viable Myocardium by Nitrate Echocardiography After Myocardial Infarction: Comparison with Planar Thallium Reinjection Scintigraphy
Authors: Pontillo Daniele , Carboni Gian Piero , Capezzuto Aldo , Alessi Claudio , Achilli Augusto , Piccini Francesca , Guerra Roberto 
Published: July 2008

Background: The aim of this study was to validate a new diagnostic tool, nitrate echocar diography (NE), for the identification of viable noncontracting myocardium in patients with a history of prior myocardial infarction (MI). Nitroglycerin (NTG) may be useful for this purpose for its peculiar pharmacodynamic action and may represent an option other than dobutamine echocardiography for the detection of hibernating segments in the presence of severely reduced coronary reserve. Methods: Twenty selected patients (pts) with an old MI were studied with NE and planar thallium scintigraphy with reinjection. NE was performed by administering IV NTG starting at 0.4 mcg/kg/minute with equal increments every five minutes up to 2 mcg/kg/minute or to early interruption of the test (decrease of systolic blood pressure ≥ 20% or improvement of previously akinetic segments). Left ventricular wall motion was analyzed by dividing the left ventricle (LV) into 16 segments, and a wall motion score index (WMSI) was calculated. Thallium images were obtained at peak exercise, at four hours, and after reinjection. Myocardial viability was defined as an improvement in thallium uptake after reinjection in fixed defects. (continued on next page) Results: Basal echo demonstrated 74 akinetic segments; of these 21 (28%, 11 pts) showed improved contractility during NTG infusion at a mean dose of 0.87 ±0.33 mcg/kg/minute. WMSI decreased from 1.69 ±0.29 to 1.46 ±0.31 (P=.001). The only hemodynamic response was a drop in systolic blood pressure (136 mmHg to 124; P=.02). Thallium studies showed 29 segments with a four-hour reversible defect and 79 segments with a four-hour fixed defect; of the latter, 14 regions demonstrated improvement in tracer uptake after reinjection (17.7%; 10 pts). Nine pts had a positive echo and thallium study, while 8 showed no improvement either during NE or after thallium reinjection. Two pts had a false-positive nitrate echocardiogram. Therefore, according to an echo/thallium study match, sensitivity, specificity, and accuracy are 90%, 80%, 85%, respectively. Conclusion: NE is a reliable and low-cost method for the detection of viable noncon tracting myocardium in selected patients with CAD but needs further validation for wide spread application.
The Effect of Low Molecular Weight Heparin (Fragmin) on Myocardial Neutrophil Accumulation and Infarct Size in a Rat Model of Myocardial Infarction
Authors: Hasdai David , Varda-Bloom Nira , Blumberg Nehemia , Ohad Dan , Kornowski Ran , Battler Alexander 
Published: July 2008

Background: Heparin molecules possess immunomodulating properties, which are thought to complement their established antithrombotic activity. The purpose of this study was to evaluate whether the antiinflammatory properties of low molecular weight heparin (LMWH) can attenuate polymorphonuclear neutrophil accumulation and infarct size in a rat model of myocardial infarction. Methods: Myocardial infarction was induced by ligating the left main coronary artery. LMWH (fragmin 500 anti-FXa u/kg) or vehicle (saline) were administered subcuta neously thirty minutes prior to coronary artery occlusion. Significant anticoagulant activity was attained with LMWH for more than eight hours. Twenty-four hours later, neutrophil accumulation and infarct size were determined by measuring left ventricular free wall myeloperoxidase and residual creatine kinase activity, respectively. Results: As compared with rats administered vehicle, myeloperoxidase activity was insignificantly decreased in rats treated with LMWH (1.24 ±0.28 u/g vs 1.66 ±0.15 u/g, P=0.16). Infarct size was also not significantly different between the groups (62.48 ±3.5% and 50.67 ±7.2% of left ventricular free wall with vehicle and LMWH, respec tively, P=0.1). Conclusion: The authors conclude that LMWH does not significantly reduce myocar dial neutrophil accumulation and infarct size twenty-four hours after myocardial infarc tion in the rat.
Peripheral Neuropathy Associated with Ischemic Vascular Disease of the Lower Limbs
Authors: Pasini F. Laghi , Pastorelli M. , Beermann U. , de Candia S. , Gallo S. , Blardi P. , Di Perri T. 
Published: July 2008

This paper deals with the possible identification of somatic and autonomic nerve damage in patients with peripheral obliterative arterial disease (POAD) at different stages of the disease, with a well-reproducible technique like electroneurographic evaluation of nerve conduction. In 64 patients with intermittent claudication, 19 patients with pain at rest, and 7 patients with trophic ulcers, electroneurographic evaluation of motor (tibial and peroneal) and sensory (superficial peroneal and sural) nerve conduction was performed. The median nerve (motor and sensory) was used as control. A severe impairment of sural and superficial peroneal nerve velocities was evident in many claudicant patients and in all patients with pain at rest and trophic ulcers, with a progression in the conduction abnormalities in advanced stages of the disease. Motor nerve conduction showed only minor reductions in patients with claudica tion and pain at rest, although some of them did show very poor velocity values. In 21 patients with intermittent claudication and sensory nerve abnormalities, the autonomic fibers activity, evaluated by the skin sympathetic response (SSR) test, was significantly depressed, thus suggesting an involvement of the local autonomic system in the ischemic disease. A correlation exists between the severity of the somatic nerve damage and the stage of the vascular insufficiency. However, in the group of claudicant patients, the evidence of similar ischemic threshold (claudication distance) may be associated with a marked difference in the amount of somatic nerve damage. The somatic and autonomic nerve alterations may play a relevant role in the progression of the disease toward critical limb ischemia.
The Influence of Angiographic Endpoints on the Outcome of Lipid Intervention Studies
Authors: Wouter Jukema J. , van Boven Ad J. , Zwinderman Aeilko H. , Bal Egbert T. , Reiber Johan H. C. , Bruschke Albert V. G. 
Published: July 2008

The aims of this study were to evaluate the influence of different coronary angiographic endpoints on the outcome of lipid intervention studies and to formulate a proposal for angiographic endpoint standardization. In recent angiographic intervention studies a confusing diversity in angiographic endpoints has been used to determine the outcome. In addition, differences in study populations (eg, bypass patients included or not) could influence results. This makes comparisons between studies cumbersome and raises the question to what extent the results of various studies may be subject to the selection of angiographic endpoints. The investigators compared three frequently used endpoints (mean segment diameter, minimum obstruction diameter, and % stenosis) in a group of 505 patients who had just finished a trial designed to assess the effect of cholesterol lowering by pravastatin. To exclude a potential bias this analysis was carried out at the time that the study was still blinded. (continued on next page) They found poor intercorrelation coefficients for mean segment diameter calculated in different ways, ranging from 0.55 to 0.95, dependent on inclusion or exclusion of segments influenced by coronary angioplasty or bypass grafting and on whether or not a value of 0 was assumed for occluded segments and segments distal to occlusions. The correlation between mean segment diameter and minimum obstruction diameter was 0.79; between minimum obstruction diameter and % stenosis, 0.85; and between mean segment diameter and % stenosis, only 0.64. Different endpoints sometimes correlate poorly. This may lead to differences in results of angiographic intervention trials. The authors propose standardization by (1) using both mean segment diameter and minimum obstruction diameter as endpoints and (2) excluding from the primary analysis segments influenced by mechanical interven tions.
Common Carotid Artery Wall Properties in Takayasu's Arteritis
Authors: Wada Takashi , Kodaira Kuniyasu , Fujishiro Kentaro , Maie Ken-ichi , Tsukiyama Eiji , Fukumoto Tsutomu , Uchida Tomoko , Yamazaki Sayaka 
Published: July 2008

The vessel wall properties of the common carotid artery have been noninvasively and quantitatively assessed with an ultrasonic instrument. Stiffness parameter β, which repre sents the mechanical properties of the vessel, was calculated from the relationship between blood pressure and the diameter of the artery. There are no reports that quan titatively assess wall properties in Takayasu's arteritis. The authors compared, in vivo, the vessel wall properties of the common carotid artery in 14 patients with Takayasu's arteritis versus those in 60 normal subjects (controls). They measured changes in the inner diameter of the artery between systole and diastole with an ultrasonic, phase-locked, echo-tracking system. β was significantly higher in Takayasu's arteritis than in normal subjects (better than a 99% confidence interval). The findings for each decade were as follows: 3rd decade (20s): 35.7 ±28.9 vs 5.01-6.46, P=0.0001; 4th decade (30s): 19.5 ±9.71 vs 6.09-7.80, P=0.02; 5th decade (40s): 26.2 ±11.3 vs 7.26-9.28, P=0.0001; 6th decade (50s): 19.1 ±4.27 vs 8.66-11.25, P=0.0001. Takayasu's arteritis significantly impaired the mechanical performance of the common carotid artery. Thus, β shows promise as a useful diagnostic indicator of Takayasu's arteritis.
Nitrate-Induced Headache in Patients with Stable Angina Pectoris: Beneficial Effect of Starting on a Low Dosage
Authors: Cleophas Ton J. M. , Niemeyer Menco G. , van der Wall Ernst E. , van der Meulen Jan 
Published: July 2008

Background: Nitrates, although important for the management of angina pectoris, cause significant headache in many patients. Methods: In a randomized, double-blind, crossover study, 89 patients with stable angina pectoris were studied to compare two different dosage strategies of isosorbide-5-monon itrate (5-ISMN). Patients were randomized to either 60 mg 5-ISMN once daily (od) for two weeks or to 30 mg 5-ISMN od for one week followed by 60 mg 5-ISMN od for one week. Then, there was a two-week placebo washout, after which the alternative treatment was given. The authors assessed the occurrence of angina pectoris and headache by diary cards while taking into account the numbers of isosorbide dinitrate sublingual puffs and paracetamole tablets required. Data were assessed for carryover and time effects. Results: The two dosage regimens were equally efficient for the relief of angina pectoris without development of tolerance. Thirty percent of the patients never experienced headache from the given dosages. In the remainder of them there was a highly significant time effect: the overall numbers of headache attacks in the first period of active treatment versus the second were 2,380 vs 1,400 (P < 0.003). Yet significantly fewer patients had headache on low dosage than on high dosage (45 vs 57, P < 0.02). Conclusions: (1) Starting on a low dosage was associated with a reduced frequency and severity of headache and did not notably influence the beneficial effect on angina pectoris. (2) One in 3 patients never experienced headache from the given dosages. (3) The overall number of headache attacks in the first period of active treatment was signif icantly higher than in the second period irrespective of the dosages given.
Persisting Effect of Ca2+-Channel Blockers on Left Ventricular Function in Hypertrophic Cardiomyopathy After 14 Years' Treatment
Authors: Hartmann Andreas , Schnell Joachim , Hopf Rüdiger , Kneissl Georg 
Published: July 2008

Ca2+-channel blockers of the verapamil type have been reported to exert a beneficial effect on clinical symptoms and survival rates in hypertrophic cardiomyopathy. The effects of verapamil have been attributed predominantly to an improved diastolic filling. It is unknown whether an effect on diastolic filling persists in these patients after long-term treatment. Fourteen patients (12 men, 2 women, median age fifty-one [thirty-two to fifty-five] years) with hypertrophic cardiomyopathy were included in the study. Patients had been treated with verapamil 240-480 mg/d or gallopamil 150-200 mg/d for fourteen (seven to seventeen) years. The effect of a withdrawal of Ca2+-channel blockers on parameters of left ventricular diastolic function was evaluated at rest and during exercise in patients with hypertrophic cardiomyopathy after long-term therapy. Investigations were performed at rest and during supine ergo metric exercise during ongoing Ca2+-channel blocking therapy and after five (four to nine) days' withdrawal (control). Pulsed Doppler echocardiography was used to record diastolic mitral flow profiles from an apical four-chamber view. Withdrawal of Ca2+-channel blockers of the phenylalkylamine type after long-term treatment of hypertrophic cardiomyopathy resulted in a significant reduction of early diastolic inflow velocity at rest and during exercise. In conclusion, these results indicate a persistent improvement of early diastolic filling by Ca2+-channel blockers even after long-term treatment.
Geometry of the Carotid Arteries and Tilt-up Hypotension in Subjects with Essential Arterial Hypertension
Authors: Ciccone Marco , Antonelli Gianfranco , Di Venere Nicola , Campaniello Maurizio , di Noia Domenico , Rizzon Paolo 
Published: July 2008

Dysfunction of the baroreceptor structures located in the carotid bulb is considered responsible for hypotensive responses to orthostatic posture in hypertensive subjects. Because of a recurrent vascular impairment in essential hypertensives, the authors hypothesized that in these cases the baroreceptive dysfunction could be related to some peculiar vascular disarrangement of the carotid arteries, at the level of the bulb. To test this, they compared two groups of mild essential hypertensives, divided into group A— 15 subjects considered hyporeacting because of a decrease in mean blood pressure ≥ 10 mmHg at the first minute of a passive orthostatic stress—and group B—15 subjects considered normoreacting because of an increase in mean blood pressure ≥ 5 mmHg. They evaluated by high definition echo Doppler ultrasonography: (1) an arterial compli ance index, (2) the volume of the carotid bulb, and (3) a score expressing the degree of arteriopathy at the level of the carotid arteries. In group A, results demonstrated a significant impairment of the carotid artery structure, expressed by an increase in volume of the carotid bulb (389.4 ± 134.7 vs 233.2 ± 116.5 mm3, P < 0.05) and a higher vascular score (2.7 vs 1, P < 0.001), while the index of arterial compliance was similar in the two groups. In conclusion, in mild essential hypertension a baroreceptor dysfunction could be strictly linked to a derangement of the carotid artery structure, while arterial compli ance does not seem to involve the baroreceptor function.
Changes in Cardiac Autonomic Activities in Patients with Syndrome X
Authors: Wen Lieng Lee  , Chen Jaw-Wen , Chi Woon Kong  , Jiann Jong Wang  , Ting Chih-Tai , Wan Leong Chan  , Wang Shih-Pu , Chang Mau-Song 
Published: July 2008

The present study was designed to assess cardiac autonomic activities, coronary microvas cular function, and their relationship in patients with syndrome X. Control of coronary blood flow is complex, and impaired coronary flow reserve has been attributed as the cause of myocardial ischemia in patients with syndrome X. It is unknown whether cardiac autonomic activities are altered in the presence of coronary microvascular dysfunction in patients with syndrome X. Eighteen patients with syndrome X were studied. Great cardiac vein flow was measured by the thermodilution method and the coronary flow reserve was determined by intravenous dipyridamole (0.56 mg/kg) infusion. Twenty-four-hour ambu latory electrocardiograms were obtained in a drug-free state. Another 14 age- and sex- matched normal subjects served as a control group. The amplitude (in ms) of ultralow (ULF), very-low (VLF), low (LF), and high (HF) frequency bands and total spectra of heart rate variability were measured for twenty-four-hour and every four-hour interval of the day. The mean coronary flow reserve was 2.12 ±0.57 (range 1.33-2.94) in 15 syndrome X patients. Compared with those in control subjects, mean LF and HF oscillations were lower in patients with syndrome X, especially in the morning and evening hours and the twenty-four-hour analysis. Circadian HF and LF activities were blunted. The LF/HF ratio tended to be higher. Among patients with syndrome X, ULF, VLF, HF bands, and total spectra were significantly lower in the morning and/or evening hours in the subgroup presenting a higher mean daily heart rate (n = 9) than in the other subgroup with a lower rate (n=9). There was a positive correlation between coronary flow reserve and ULF activities in the morning ( r=0.47-0.48, P=0.07-0.08) and evening hours ( r=0.67, P=0.006). The LF/HF ratio negatively correlated with coronary flow reserve in hours 1200-1600 ( r=-0.55, P=0.03). Coronary microvascular function and cardiac autonomic activities were impaired in patients with syndrome X. The predominant parasympathetic withdrawal suggests loss of cholinergic vasodilation in coronary microvasculatures, especially as sympathetic tone was activated. Abnormal cardiac autonomic activities could either play a role in the pathogenesis or just be a mark of coronary microvascular dysfunction in these patients.
Risk Factors That Predict Development of Microalbuminuria in Treated Hypertensive Men
Authors: Agewall Stefan , Fagerberg Björn 
Published: July 2008

The aim of this prospective study was to investigate the risk factors for development of microalbuminuria in treated hypertensive men with and without diabetes mellitus. Two hundred and ninety-seven treated hypertensive men, aged fifty to seventy-two years, with at least one of the following: serum cholesterol ≥6.5 mmol/L, smoking, or diabetes mellitus, were included in the study. Patients with elevated overnight urinary albumin excretion (> 17 mg/12 hr) were excluded. Urinary albumin excretion (UAE), blood pressure, and various well-established risk factor levels were measured. Two hundred thirteen nondiabetic patients and 40 patients with diabetes mellitus completed the three- year follow-up. Development of microalbuminuria was more prevalent in those with diabetes mellitus at baseline compared with the group without diabetes mellitus, 25% and 10.3%, respectively (P = 0.02). Nondiabetic patients who developed microalbu minuria had higher UAE, 10.2 mg ±3.7 and 5.7 ±3.2, respectively (P < 0.0001), and higher systolic blood pressure 160 mm Hg ±27 and 152 ±17, respectively (P = 0.043), at baseline compared with whose who remained normoalbuminuric. In the group with diabetes mellitus, a higher UAE, 9.8 ±2.7 and 7.1 ±3.6, respectively (P = 0.036), at baseline was observed in whose who developed microalbuminuria compared with whose who remained normoalbuminuric. In conclusion, concomitant diabetes mellitus significantly increased the risk for devel opment of microalbuminuria during the three-year follow-up in treated hypertensive men. Patients who progressed to microalbuminuria had higher UAE at baseline, but still within the normoalbuminuric range, compared with those who remained normoalbu minuric. Systolic blood pressure at baseline was higher in those who progressed to microalbuminuria, although reaching statistically significance only in the larger nondia betic group.