bluuebunny/crossref_metadata_2025_split huggingface dataset:
The role of strict metabolic control by insulin infusion on fibrinolytic profile during an acute coronary event in diabetic patients
Authors: Melidonis Andreas , Tournis Simeon , Stefanidis Alexander , Manoussakis Stavros , Handanis Stilianos , Zairis Michael , Foussas Stefanos , Dadiotis Loukas 
Published: February 2009

AbstractBackground: Many clinical and laboratory observations give support to the hypothesis that strict metabolic control by insulin infusion during acute coronary events may improve the ischemic damage and prognosis.Hypothesis: We investigated the impact of intensive insulin treatment on fibrinolytic parameters during an acute ischemic myocardial event (unstable angina or acute myocardial infarction) in patients with type 2 diabetes mellitus.Methods: The study group consisted of 48 type 2 diabetic patients, of whom 24 were randomized to conventional therapy plus intensive insulin treatment (Group 1) and 24 to conventional therapy only (Group 2). The two groups were comparable according to gender, age, body mass index, waist:hip ratio, duration of diabetes, previous antidiabetic treatment, type of ischemic events, concomitant therapy, and the classic risk factors for coronary disease. Insulin‐treated patients were excluded from the study. Plasma levels of fibrinogen, tissue plasminogen activator (t‐PA), and plasminogen activator inhibitor‐1 (PAI‐1) were measured on admission and discharge. Fibrinogen (fibr) was measured using the photometric method. PAI‐1 and t‐PA were measured by enzyme‐linked immunosorbent assays.Results: T‐PA increased in both groups during hospitalization (t‐PAadmission VS. t‐PAdischarge: Group 1: 15.42 ± 4.4 ng·ml−1 vs. 21.2 ± 5.74 ng·ml−1, p = 0.000037; Group 2: 14.47 ± 6.31 ng·ml−1 vs. 19.18 ± 6.88 ng·ml−1, p = 0,001). On the other hand, fibr and PAI‐1 levels increased remarkably in controls (Group 2, fibradmission vs. fibrdischarge: 2.98 ± 1.04 g·l−1 vs. 3.59 ± 1.01 g·l−1, p = 0.002, and PAI‐1admission vs. PAI‐1discharge: 30.6 ± 17.34 ng·ml−1 vs. 40.62 ± 23.48 ng·ml−1, p = 0.003). This finding was not observed in the intensive insulin treatment group (Group 1, fibradmission vs. fibrdischarge: 2.87 ± 0.73 g·l−1 vs. 2.67 ± 0.72 g·l−1, p = 0.101, and PAI‐1admission vs. PAI‐1discharge: 30.75 ± 15.81 ng·ml−1 vs. 27.75 ± 6.43 ng·ml−1, p = 0.484).Conclusion: Intensive insulin treatment during an acute coronary event improves fibrinolytic profile in patients with diabetes mellitus. This is a possible mechanism for the reduced short‐ and long‐term mortality in diabetic patients treated with intensive insulin treatment protocol.
Electropharmacologic effect of a standard dose of intravenous procainamide in patients with sustained ventricular tachycardia
Authors: Rials Seth J. , Britchkow David , Marinchak Roger A. , Kowey Peter R. 
Published: February 2009

AbstractBackground: Patients with inducible sustained ventricular tachycardia (VT) sometimes receive intravenous procainamide during electrophysiologic testing. Unfortunately, the responses to intravenous and subsequent oral drug therapy are variable and may be discordant.Hypothesis: It was the aim of this study to determine whether this variability might be explained by heterogeneity in the electropharmacologic response, even in a homogeneous population.Methods: We studied 42 patients who had spontaneous malignant ventricular arrhythmia and were inducible to sustained monomorphous VT during electrophysiologic testing. Each received 15 mg/kg of intravenous procainamide followed by a 2 mg/min infusion. Serum levels were drawn immediately following programmed stimulation. The mean procainamide level was 6.7 ± 1.4 mcg/ml with an N‐acetyl procainamide level of 1.0 ± 0.5 mcg/ml. The 14 procainamide responders (5 of whom were noninducible and 9 whose VT cycle length increased > 100 ms) and the 28 nonresponders had similar procainamide and NAPA levels (6.5 ± 1.4 vs. 6.7 ± 1.4 mcg/ml).Results: There was no significant difference in baseline clinical parameters, His to ventricular electrogram (HV) interval, effective refractory period, or VT cycle length. Prolongation of the effective refractory period and infra His conduction time occurred to a similar extent in responders and nonresponders.Conclusion: We conclude that procainamide has a consistent dose‐response relationship with respect to refractoriness and conduction in patients with malignant arrhythmias. However, acute antiarrhythmic efficacy of procainamide cannot be predicted by clinical factors, drug levels, or drug‐induced changes in common electrophysiologic parameters.
Changes of QT dispersion in patients with coronary artery disease dependent on different methods of stress induction
Authors: Hailer B. , Leeuwen P. , Sallner D. , Wehr M. , Lange S. 
Published: February 2009

AbstractBackground: Episodes of stress‐induced myocardial ischemia in patients with coronary artery disease (CAD) may cause increases of QT dispersion (QTd).Hypothesis: Aim of this study was to analyze the effect of increasing heart rates on QTd and to compare the effect of different methods of stress induction in patients with varying degrees of CAD when estimating QTd.Methods: We studied 58 patients, 22 with prior myocardial infarction (MI), 25 without MI or wall motion disturbances at rest, and 11 patients without evidence of CAD. Prior to coronary angiography, standard 12‐lead ECGs were obtained at rest as well as during dynamic exercise and pharmacologic stress using arbutamine simultaneously with echocardiography. QTd was determined at each stress level by subtracting minimal from maximal QT interval duration.Results: QTd values at rest were not consistently higher in the patients with CAD. At maximal heart rate, QTd was statistically significantly higher in patients with CAD with a better discrimination between groups for pharmacologic stress (p < 0.005 for exercise, p < 0.0001 for arbutamine). Patients after MI had higher QTd values under all conditions than did the groups without MI. As in patients with CAD, the values of this group changed more radically as a result of pharmacologic stress.Conclusion: Patients with CAD can be identified on the basis of QTd under stress. These changes were not as marked in patients with MI as their rest values were already increased. Overall, drug‐induced stress produced greater differences than dynamic exercise, suggesting that the ischemic threshold might be lower in the former.
Implantable cardioverter defibrillator discharge rates in patients with unexplained syncope, structural heart disease, and inducible ventricular tachycardia at electrophysiologic study
Authors: Menon Vend , Steinberg Jonathan S. , Carillo Luis , Akiyama Toshio , Beckman Karen , Kutalek Steven 
Published: February 2009

AbstractBackground and hypothesis: The implantable cardioverter defibrillator (ICD) is the best available strategy to protect patients from life‐threatening ventricular arrhythmia. Although unproven, it is commonly utilized to treat subjects with syncope, a negative clinical workup, structural heart disease, and inducible sustained monomorphic ventricular tachycardia (VT) on programmed electrophysiologic stimulation (EPS). The purpose of this paper was to validate this approach.Methods: We retrospectively identified 36 subjects who received primary ICD therapy for syncope in the setting of structural heart disease with inducible sustained monomorphic VT on EPS. The cohort was predominantly male (32/36) with underlying coronary artery disease (29/36). The mean left ventricular ejection fraction was 31 ± 12%, and a third of the patients (12/36) had undergone bypass surgery.Results: The study group was followed for a mean of 23 ± 15 months (range 3–81 months) and experienced an ICD event rate of 22% at 3 months, which increased to 55% at 36 months. This event rate was comparable with the 66% event rate seen in a group of patients with primary ICD therapy for spontaneous life‐threatening VT treated during the same time period. No future predictors of ICD events in the study group could be identified.Conclusion: Syncope patients with negative workup, structural heart disease, and sustained monomorphic VT at EPS are at high risk for future tachyarrhythmic events. Based on present evidence, primary ICD therapy in this group appears warranted and justified.
Paroxysmal atrial fibrillation and insidious neck pain
Authors: Nastri Marcio V. , Taricco Mario A. , Alves Venancio A. F. , Mansur Alfredo J. 
Published: February 2009

AbstractParoxysmal atrial fibrillation (AF) is an arrhythmia usually secondary to autonomic imbalance, and it may occur in the absence of any structural heart disease. The case of a patient with paroxysmal AF, in whom the arrhythmia may have been a presenting symptom of a later diagnosed cervical schwannoma, is reported.
Acetylcholine‐ and ergonovine‐induced coronary microvascular spasm reflected by increased coronary vascular resistance and myocardial lactate production
Authors: Horimoto Masashi , Igarashi Keiich , Takenaka Takashi , Inoue Hitoki , Yamazaki Kohko , Sakuragi Hitoshi 
Published: February 2009

AbstractDiagnosis of coronary microvascular spasm remains largely speculative because it has been mostly based on chest pain and electrocardiographic ST‐segment shift with slow filling of contrast medium into the coronary artery. A patient with resting chest pain and normal coronary angiograms underwent provocative tests with intracoronary acetylcholine (ACh) and ergonovine. During the tests, coronary diameter and flow velocity in the left anterior descending (LAD) coronary artery were measured with quantitative coronary angiography and intracoronary Doppler guide wire, respectively. Vascular resistance of the LAD and lactate production were determined separately. With injections of 100 μg of ACh and 20 μg of ergonovine, chest pain occurred with ST‐segment elevation in the precordial leads in the absence of epicardial coronary spasm. Coronary vascular resistance increased by 2.2‐ and 1.6‐fold of the baseline value with ACh and ergonovine, respectively. Myocardial lactate production was noted during the ST‐segment elevation. Coronary microvascular spasm was verified by the increment in coronary vascular resistance and myocardial lactate production with concomitant ST‐segment elevation in the presence of normal coronary angiograms.
Risk factors related to the occurrence of silent myocardial ischemia in mexicans
Authors: Unzueta‐Montoya Alberto , Rubio Arturo Torres‐Y Gutiérrez , Unzueta Alberto , Ordonez‐Toquero Guillermo , Hernández Héctor Hernández‐Y , De La Peña Jorge Escobedo , Pérez‐Reyes Patricia 
Published: February 2009

AbstractBackground: Silent myocardial ischemia is a growing world health problem. It has been related to factors that promote an increase in myocardial oxygen demand or affect coronary vasomotor tone. Coronary artery disease has shown an increasing trend in Mexico in this century.Hypothesis: The aim of the study was to estimate the strength of the association between some risk factors and the occurrence of silent myocardial ischemia.Methods: A cross‐sectional study was conducted and 249 individuals were screened by 24‐h Holter electrocardiogram. Silent myocardial ischemia was diagnosed in patients with painless transient ST‐segment depression. All subjects were interviewed for coronary risk factors and total serum cholesterol was measured.Results: Silent ischemia was diagnosed in 115 patients (46%), who were older (59±9 vs. 57±11 years; p=0.01). In a logistic regression analysis, a lower risk for silent ischemia was found in patients with thrombolysis [odds ratio (OR) 0.28; 95% confidence interval (CI 95%) 0.14–0.53], or those who followed their medical treatment (OR 0.16; CI 95% 0.04–0.68). The major risk factors were hypercholesterolemia (OR 1.6; CI 95% 0.9–2.9) and more severe coronary artery disease (OR 2.5; CI 95% 1.1–5.7).Conclusions: Some coronary risk factors are related to silent ischemia. It is still important to diagnose this entity, but modification of its related risk factors should be kept in mind to diminish its occurrence and its severe consequences.
Long‐term prognosis of patients with angina treated with enhanced external counterpulsation: fiVe‐ year follow‐up study
Authors: Lawson William E. , Hui John C. K. , Cohn Peter F. 
Published: February 2009

AbstractBackground: Enhanced external counterpulsation (EECP) is a noninvasive treatment for coronary artery disease (CAD) that has been used successfully in patients not responding to medical and/or surgical therapy.Hypothesis: The study was undertaken to evaluate the effect of EECP on long‐term prognosis in such patients.Methods: Major adverse cardiovascular events (MACE) were tracked in 33 patients with CAD treated with EECP. Patients were subgrouped based on whether or not they demonstrated an early improvement in radionuclide stress perfusion imaging (Responders vs. Nonresponders) and followed for MACE over a mean follow‐up of 5 years. Patient population characteristics included 73% with multivessel disease; 45% with prior myocardial infarction(s); and 61% who had undergone either coronary artery bypass grafting (CABG) or percutaneous transluminal coronary angioplasty (PTCA), or both.Results: There were 26 of 33 (79%) Responders, and 7 of 33 (21%) Nonresponders. Subsequent MACE over the 5‐year follow‐up included four deaths and eight patients with cardiovascular events [acute myocardial infarct (4), new CABG or PTCA (6), valve replacement (1), unstable angina (1)]. Nonresponders had significantly (p <0.01) more MACE (6/7 or 86%) than Responders (6/26 or 23%). Overall, 21 of the 33 (64%) patients remained alive and without MACE and the need for revascularization 5 years post EECP treatmentConclusion: This study suggests that, particularly for the majority of patients demonstrating improvement in radionuclide stress perfusion post treatment, EECP may be an effective long‐term therapy.
Plasma big‐endothelin levels, cardiac autonomic neuropathy, and cardiac functions in patients with insulin‐dependent diabetes mellitus
Authors: Erbas Tomris , Gedik Olcay , Koray Zehra , Erbas Belkis , Kabakci Giray , Aksöyek Serdar 
Published: February 2009

AbstractBackground: The alteration of endothelin (ET) levels in diabetic patients with cardiac autonomic neuropathy (CAN) has not been studied extensively and its correlation with cardiac function parameters has not been discussed.Hypothesis: The aim of the present study was to discuss the correlation between the degree of cardiac autonomic neuropathy, plasma big‐ET levels, and cardiac functions in diabetic patients who were clinically free of cardiovascular disease.Methods: Twenty subjects (32.1 ± 7.8 years, 11 men, 9 women) with insulin‐dependent diabetes mellitus (IDDM) were studied to evaluate the relationship between circulating big‐endothelin (big‐ET1) levels, CAN, and cardiac functions. The severity of CAN was scored according to Ewing's criteria. Cardiac functions were assessed using Doppler echocardiography.Results: Left ventricular systolic function in the patient group was within normal limits and comparable with the values of the control group (n = 10). The mean E/A values of diabetics with CAN (1.15 ± 0.33, p = 0.004) and without CAN (1.34 ± 0.17) were significantly lower than those of controls (1.57 ± 0.27). Diabetics with CAN had significantly higher big‐ET1 values (81.1 ± 94 pg/ml) compared with others (12.4 ± 5.9 and 21.1 ± 17.7 pg/ml, p = 0.04). Circulating big‐ET1 levels showed a significant correlation with E/A values in the control group (p = 0.01, r = ‐ 0.7) and with peak A values (p = 0.003, r = 0.64) in diabetics. The CAN score correlated negatively with E/A values (p = 0.01, r = 0.54).Conclusions: High big‐ET levels might have an important role in the pathogenesis or consequences of diastolic dysfunction in diabetics with CAN. Their role in cardiac autonomic neuropathy and diastolic dysfunction should be investigated further.
Potential reduction of costs and hospital emergency department visits resulting from prehospital transtelephonic triage—the shahal experience in israel
Authors: Roth Arie , Laniado Shlomo , Malov Naomi , Carthy Ziv , Golovner Michal , Naveh Rachel , Alroy Iki , Kaplinsky Elieser 
Published: February 2009

AbstractBackground: The rising cost of services provided by hospital emergency departments is of major concern. Attempts to reduce the costs of emergency cardiac care have thus far focused primarily on medical and administrative management in the hospital. The role of the patient in appropriate prehospital decision‐making has been generally ignored.Hypothesis: Membership in “Shahal” (an integrative telemedicine system) may have beneficial effects on patient decision‐making and national health costs.Methods: During a 6‐month period, a random group of subscribers who had called for medical assistance during the previous 24 h were asked what action they would have taken had they not been Shahal subscribers. All study patients were followed for at least 7 days.Results: In all, 1,608 subscribers (age 71 ± 13 years) were included. Of these, 514 replied that they “would have waited,” 363 “would have contacted their physicians,” and 731 “would have sought emergency department care.” Of the presenting medical problems, 86% were resolved without utilizing hospital facilities. A mobile intensive care unit was dispatched in 412 (26%) cases. A cost estimate of abuse indicated that the service resulted in a savings to the national economy of approximately $830,000 per 10,000 members per year.Conclusions: This study demonstrated that Shahal membership can reduce costs of medical care and the number of hospital emergency department visits.
Enhanced detection of ischemic but viable myocardium by qt interval dispersion on treadmill exercise electrocardiograms of patients with healed anterior wall myocardial infarcts
Authors: Koide Yasushl , Yotsukura Masayuki , Tajino Kazuhiro , Yoshino Hideaki , Ishikawa Kyozo 
Published: February 2009

AbstractBackground: The presence of ischemic but viable myocardium in infarcted areas is an important indication for coronary revascularization, but is often difficult to detect with the use of treadmill exercise electrocardiography (ECG).Hypothesis: QT interval dispersion (QTd) is a sensitive method for detecting myocardial ischemia and may improve the accuracy of treadmill exercise ECG testing for detecting ischemic but viable myocardium in infarcted areas.Methods: Forty‐five patients with Q‐wave anterior wall myocardial infarctions who underwent treadmill exercise ECG, exercise reinjection thallium‐201 (201T1) scintigraphy, radionuclide angiocardiography, and coronary angiography 1 month after infarction were enrolled in this study. The presence of viable myocardium in the infarct area was determined by exercise reinjection 201T1 scintigraphy. Patients who had no redistribution in the infarct area after reinjection were included in Group 1, and those with redistribution were included in Group 2.Results: QTd immediately after exercise, and the difference between QTd before and immediately after exercise, were significantly greater in Group 2 than in Group 1. The sensitivity, specificity, and accuracy of conventional ST‐segment depression criteria for detecting viable myocardium in the infarct area were 48,64, and 56%, respectively. The measurement of QTd immediately after exercise (abnormal: ≥ 70 ms; normal: < 70 ms) improved the sensitivity, specificity, and accuracy to 78,82, and 80%, respectively.Conclusions: This novel diagnostic method using QTd‐based criteria significantly improves the clinical usefulness of treadmill exercise ECG testing for detecting ischemic but viable myocardium in infarct areas in patients with healed Q‐wave anterior wall myocardial infarctions.
Tricuspid valve group b streptococcal endocarditis after an elective termination of pregnancy
Authors: Kangavari Simon , Collins Jennifer , Cercek Bojan , Atar Shaul , Siegel Robert 
Published: February 2009

AbstractA patient developed fever, chills, and shortness of breath after an elective first trimester dilation and curettage. Blood cultures grew Group B streptococcus, and a transesophageal echocardiogram revealed a 2 × 2 cm vegetation on the tricuspid valve and global left ventricular hypokinesis. A 6‐week course of parenteral antibiotics and vasodilator therapy resulted in resolution of the valvular vegetation as well as of the left ventricular dysfunction.
Should interventional cardiac catheterization procedures take place at the time of diagnostic procedures?
Authors: Panchamukhi Varadendra B. , Flaker Greg C. 
Published: February 2009

AbstractBackground: In many cardiac catheterization laboratories interventional procedures are performed at a date later than the diagnostic study, causing increased hospital days and costs. Few data exist which compare procedural success, complications, and costs between procedures performed at the time of diagnostic study and those performed later.Hypothesis: The purpose of this study was to evaluate the safety and success of same‐day interventional procedures and to quantitate hospital cost savings with this strategy.Method: In all, 357 consecutive patients who underwent an elective interventional procedure of a native coronary artery either at the time of diagnostic study (same day, n = 244) or later (delayed, n = 113) were reviewed. Procedural success [< 30% residual lesion post‐percutaneous transluminal coronary angioplasty (PTCA) or 0% residual lesion post‐stent], major complications [death, emergent coronary artery bypass grafting (CABG), myocardial infarction, and ventricular fibrillation], hospital days, and costs were analyzed. Procedural expense, including the diagnostic and interventional procedure in the cardiac catheterization laboratory, and hospital expense were analyzed.Results: Both groups were similar in terms of age, gender, coronary risk factors, indications (myocardial infarction, unstable angina, abnormal stress test), the culprit coronary artery, type of intervention (PTCA, stent), and lesion complexity (type A, B, C). The average hospital stay for the two groups was 4.37 ± 2 and 6.55 ± 2.4 days, respectively (p < 0.0001). The procedural charges were $ 8,207.99 and 10,581.87, respectively (p<0.0001).Conclusion: Catheter intervention performed at the same time as the diagnostic cardiac catheterization procedure is as successful and as safe as that performed at a later date. Hospital stay and costs, as well as procedural expenses are significantly reduced by this practice.