bluuebunny/crossref_metadata_2025_split huggingface dataset:
Increased platelet activation and endothelial dysfunction in patients with atrial fibrillation immediately following percutaneous balloon mitral valvuloplasty
Authors: Goldsmith Ira R.A. , Li‐Saw‐Hee Foo Leong , Blann Andrew D. , Lip Gregory Y.H. 
Published: February 2009

AbstractBackground: Immediately following percutaneous balloon mitral valvuloplasty (PBMVP), patients have a 3% risk of systemic thromboembolism.Hypothesis: We hypothesized that this may in part be due to an increase in hypercoagulability (as indicated by abnormal coagulation, platelet activation, and endothelial dysfunction) in such patients.Methods: We measured indices of platelet activation [soluble P‐selectin (sPsel), ELISA], endothelial dysfunction [von Willebrand factor (vWf), ELISA], and coagulation (fibrinogen, modified Clauss) in 16 patients (15 women, mean age 59 ± 10 years) with chronic atrial fibrillation admitted for PBMVP, and 16 healthy age‐ and gender‐matched controls. Blood samples were obtained as follows: (1) peripheral venous samples prior to PBMVP, immediately following PBMVP, and 24 h after PBMVP; and (2) arterial samples prior to and immediately following PBMVP.Results: Patients with mitral stenosis and chronic atrial fibrillation demonstrated significantly higher mean levels of vWf [148 (SD24) vs. 102 (SD 37); t‐test, p<0.001] and plasma fibrinogen [4.2 (SD 0.8) vs. 3.3 (SD 0.8); p = 0.003] at baseline than matched healthy controls. There was a nonsignificant trend toward lower median sP‐sel levels in patients with mitral stenosis [64 (inter quartile range 47–91) vs. 109 (46–128); Mann‐Whitney test, p = 0.08]. Following PBMVP, there was a significant increase in venous sP‐sel levels immediately post procedure (paired Wilcoxon test, p = 0.03) and at 24 h afterward (p = 0.01). Arterial s‐Psel levels correspondingly increased immediately post procedure (p = 0.008). There was a significant increase in mean venous (at 24 h) but not arterial vWf levels post PBMVP. There were no significant changes in mean venous or arterial plasma fibrinogen levels following PBMVP.Conclusion: Patients with mitral stenosis and chronic atrial fibrillation have increased plasma levels of vWf and fibrinogen levels compared with healthy controls, suggesting increased endothelial dysfunction and coagulation at baseline in these patients. The increased levels of sP‐sel immediately post procedure and at 24 h, in association with increased vWf levels at 24 h after PBMVP, are in keeping with an increase in platelet activation and endothelial dysfunction following PBMVP. These changes may contribute to the increased risk of thromboembolism following PBMVP and suggest the need for adequate antithrombotic therapy following PBMVP.
Immediate and late clinical and angiographic outcomes after GFX coronary stenting: Is high‐pressure balloon dilatation necessary?
Authors: Park Seong‐Wook , Hong Myeong‐Ki , Lee Cheol Whan , Kim Jae‐Joong , Park Hoon‐Ki , Cho Goo‐Yeong , Kang Duk‐Hyun , Song Jae‐Kwan , Park Seung‐Jung 
Published: February 2009

AbstractBackground: The GFX stent is a balloon‐expandable stent made of sinusoidal element of stainless steel. The adjunct high‐pressure balloon dilatations were usually recommended in routine stenting procedure.Hypothesis: The aim of this study was to evaluate the immediate and long‐term clinical and angiographic outcomes and to investigate the necessity of high‐pressure balloon dilatation during GFX stenting.Methods: In all, 172 consecutive patients underwent single 12 or 18 mm GFX stent implantation in 188 native coronary lesions. Two types of stenting technique were used: (1) stent size of a final stent‐to‐artery ratio of 1:1 (inflation pressure > 10 atm, high‐pressure group), and (2) stent size of 0.5 mm bigger than reference vessel (inflation pressure ≤ 10 atm, low‐pressure group). The adjunct high‐pressure balloon dilatations were performed only in cases of suboptimal results.Results: The adjunct high‐pressure balloon dilatation was required in 11 of 83 lesions (13%) in the high‐pressure group and in 7 of 105 lesions (7%) in the low‐pressure group (p = 0.203). Procedural success rate was 100%. There were no significant differences of in‐hospital and long‐term clinical events between the two groups. The overall angiographic restenosis rate was 17.7%; 18.4% in the high‐pressure group and 17.1% in the low‐pressure group (p = 0.991).Conclusions: The GFX stent is a safe and effective device with a high procedural success rate and favorable late clinical outcome for treatment of native coronary artery disease. Further randomized trials may be needed to compare stenting techniques in GFX stent implantation.
Changes of the t‐wave amplitude and angle: An early marker of altered ventricular repolarization in hypertension
Authors: Dilaveris Polychronis , Gialafos Elias , Poloniecki Jan , Hnatkova Katerina , Richter Dimitris , Andrikopoulos George , Lazaki Elena , Gialafos John , Malik Marek 
Published: February 2009

AbstractBackground: The heterogeneity of ventricular repolarization is an important proarrhythmic factor. QT dispersion has been proposed to reflect the inhomogeneity of ventricular repolarization, but a poor reproducibility limits its clinical applicability. Reliable noninvasive methods to quantify abnormalities in ventricular repolarization are still lacking. The T‐loop morphology analysis is a novel method aimed at quantifying ventricular repolarization.Hypothesis: To test the ability of the T‐loop morphology analysis to discriminate between hypertensive patients and healthy subjects, 105 hypertensive patients (mean age 63.6 ± 12.3 years) and 110 healthy controls (mean age 49.7 ± 14.3 years) were evaluated.Methods: The maximum QT interval (QT maximum), the minimum QT interval (QT minimum), and their difference (QT dispersion) were calculated from a digitally recorded 12‐lead electrocardiogram (ECG) in both study groups. X, Y, and Z leads were reconstructed from the 12‐lead ECG, and the amplitude of the maximum T vector (T amplitude) and the angle between the maximum T vector and X axis (T angle) were calculated from the projection of the T loop in the frontal plane.Results: T amplitude (p < 0.001), T angle (p=0.05), and QT dispersion (p = 0.04) were significandy different between hypertensive patients and controls, while QT maximum (p = 0.14) and QT minimum (p = 0.35) did not differ between the groups. T amplitude was the only marker which differed between hypertensive patients without ECG criteria for left ventricular hypertrophy and controls (p = 0.002).Conclusions: T‐loop features and particularly T amplitude are significantly different between hypertensive patients and healthy controls and may serve as early markers of repolarization abnormalities in a hypertensive population.
Influence of angiotensin‐converting enzyme gene polymorphism on development of athlete's heart
Authors: Nagashima Junzo , Musha Haruki , Takada Hideomi , Awaya Toru , Oba Haruo , Mori Narumi , Ohmiya Kazuto , Nobuoka Sachihiko , Murayama Masahiro 
Published: February 2009

AbstractBackground and hypothesis: Genetic influence on development of athlete's heart is uncertain. This study investigated whether angiotensin‐converting enzyme (ACE) gene polymorphism influenced development of athlete's heart.Methods: Forty‐three participants in a 100‐km ultramarathon were classified on the basis of ACE gene polymorphism into a deletion group (n = 26) and an insertion group (n = 17). Echocardiograms were recorded to determine left ventricular end‐diastolic and end‐systolic diameters, interventricular septal thickness, left ventricular posterior wall thickness, left ventricular mass, and ejection fraction.Results: Left ventricular end‐diastolic diameter (65.5 ± 4.0 mm) and left ventricular mass (369.5 ± 73.9 g) were significantly larger in the subjects with deletion than in those with insertion (57.4 ± 4.2 mm, 306.5 ± 93.7 g). However, no significant differences in the other parameters were noted.Conclusions: In long‐distance runners, ACE gene polymorphism of the D/D and D/I genotypes has a stronger influence on left ventricular hypertrophy than polymorphism of the I/I genotype.
DDD and single‐lead VDD pacing: Evaluation of atrial signal dynamic changes
Authors: Boriani Giuseppe , Biffi Mauro , Branzi Angelo , Bandini Alberto , Moracchini Pier Vittorio , Capucci Alessandro , Sigliano Riccardo , Mininno Antonio 
Published: February 2009

AbstractBackground: Single‐lead VDD pacing systems are an alternative to conventional DDD pacemakers in patients with atrioventricular (AV) block and normal sinus function.Hypothesis: The aim of this study was to assess changes of P‐wave amplitude occurring in dynamic conditions in two groups of patients with a single‐lead VDD and with a DDD pacing system, respectively.Methods: Twenty‐eight patients with second‐ or third‐degree AV block and normal sinus function were enrolled prospectively into the study. Seventeen patients were implanted with a single‐lead VDD pacing system and 11 with a DDD pacemaker. Patients were evaluated at 3 months (all patients) and at 6 months (26 patients) at supine and in dynamic conditions (postural changes, hyperventilation, and during exercise).Results: Mean P‐wave values at supine were 1.92 ± 1.10 mV at 3 months and 1.76 ± 1.01 mV at 6 months for VDD systems, and 4.63 ± 2.18 mV at 3 months and 4.58 ± 2.80 mV at 6 months for DDD pacemakers. In dynamic conditions, P‐wave amplitude changes compared with supine condition ranged between —74 and +226% in VDD, and between —53 and +138% in DDD; however P‐wave amplitudes showed no significant changes compared with baseline. Moreover, changes in atrial signal amplitudes did not occur randomly, and in both systems P‐wave amplitudes remained significantly correlated with supine values.Conclusions: A wide range of P‐wave amplitude variations occurs in different postural conditions or during exercise, both with single‐lead VDD and DDD pacing systems. However, with appropriate programming of atrial sensitivity based on supine values, constant atrial tracking can be maintained.
Effect of cibenzoline on regional left ventricular function in hypertrophic obstructive cardiomyopathy
Authors: Kondo Isao , Mlzusfflge Katsufumi , Nozaki Shiro , Hirao Kenichi , Iwado Yasuyoshi , Ohmori Koji , Matsuo Hirohide 
Published: February 2009

AbstractBackground: Cibenzoline, a class la antiarrhythmic drug, can be used to relieve left ventricular (LV) outflow obstruction in hypertrophic obstructive cardiomyopathy (HOCM). However, the mechanism of this agent in HOCM has been controversial.Hypothesis: This study was designed to investigate the effect of cibenzoline on regional LV function and the acoustic properties in HOCM using ultrasonic integrated backscatter.Methods: Ten patients with HOCM and 16 healthy volunteers were examined. In patients with HOCM, wall thickening (%WT) and the magnitude of cyclic variation of integrated backscatter (mag‐CVIBS) in the interventricular septum (IVS) and LV posterior wall were measured before and after oral administration of cibenzoline. To assess asynchrony of contractile elements, the phase difference between CVIBS and%WT were measured from the LV posterior wall. Pressure gradients at the LV outflow tract were estimated using continuous‐wave Doppler echocardiography.Results: Although%WT decreased significantly in the LV posterior wall, %WT and mag‐CVIBS remained unchanged in the IVS. The phase difference in the LV posterior wall was significantly greater in patients with HOCM than in healthy volunteers (HOCM:healthy volunteers, 1.57 ± 0.23:1.00 ± 0.03, p < 0.001) at baseline. After administration of cibenzoline, the phase difference shifted to normal value (from 1.57 ± 0.23 to 1.28 ± 0.27, p = 0.0382), and pressure gradients at the LV outflow tract decreased (from 109 ± 55 to 58 ± 48 mmHg, p = 0.0063). Changes in pressure gradients at the LV outflow tract and the phase difference were closely related.Conclusions: Regional function and the acoustic properties of myocardium in HOCM were altered by cibenzoline in the LV posterior wall but remained unchanged in the IVS. The normalization of the phase difference in the LV posterior wall was closely related to the decrease in pressure gradients at the LV outflow tract. These findings suggest that negative inotropic action and the improvement of asynchrony in the LV posterior wall rather than in the IVS may contribute to the reduction of pressure gradients at the LV outflow tract in HOCM.
Fast platelet suppression by lysine acetylsalicylate in chronic stable coronary patients. Potential clinical impact over regular aspirin for coronary syndromes
Authors: Gurfinkel Enrique P. , Altman Raul , Scazziota Alejandra , Heguilen Ricardo , Mautner Branco 
Published: February 2009

AbstractBackground: The rapid utilization of fibrinolytics following Q‐wave myocardial infarction has clearly modified the evolution of this disease. However, it is still not known whether the immediate inhibition of platelet aggregation (PA) during the coronary event improves outcomes.Hypothesis: The present study was designed to test, in patients with known coronary artery disease (chronic stable angina), whether the particular kinetic pattern of lysine acetyl‐salicylate (LA) compared with aspirin may affect the time to onset of inhibition of platelet aggregation.Methods: Ten patients suffering from chronic stable angina participated in this study to compare the efficacy and speed of the inhibition of PA with 320 mg of LA versus 320 mg of aspirin. All patients discontinued the use of aspirin and any other anti‐inflammatory agents for 15 days prior to the beginning of the study. They were randomly assigned to LA or aspirin. Blood specimens were obtained to measure the PA at admission, and 5,10,20,30, and 60 min after ingestion. Patients continued to take the assigned drug once a day for the following 4 days. On Day 5, a new blood sample was taken. After this, patients underwent a 15‐day wash‐out period, and then crossed over to the opposite drug. The samples were analyzed immediately using platelet‐rich plasma stimulated with adenosine diphosphate (ADP) 2 μmol/l, collagen 1 μg/ml, epinephrine 20 μmol/l, and sodium arachidonate acid 0.75 mm/l.Results: The same level of PA inhibition after 30 and 60 min of aspirin administration can be obtained with LA 5 min following ingestion (sodium arachidonate acid: LA: 16.3 ± 25.9 vs. aspirin 57.6 ± 8.2; p = 0.00014; collagen: LA 18.9 ± 20.1 vs. aspirin 47.2 ± 10.5; p = 0.00092; ADP: LA 27.3 ± 18.4 vs. aspirin 39.7 ± 21.8, p = 0.18; epinephrine: LA 22.0 ± 9.9 vs. aspirin 55.4 ± 10.9, p = 0.00002.Conclusions: Platelet aggregation inhibition immediately following LA may have significant clinical implications for the treatment of coronary syndromes.
Relationship between mean right atrial pressure and doppler parameters in patients with right ventricular infarction
Authors: Mattioli Anna Vittoria , Castelli Annadele , Mattioli Giorgio 
Published: February 2009

AbstractBackground: The incidence of an inferior left ventricular infarction involving the right ventricle is very high, ranging from 14 to 84%. Isolated right ventricular infarction accounts for < 3% of all cases of infarction.Hypothesis: The aim of the present study was to assess the relationship between Doppler parameters of hepatic vein and tricuspid inflow, as well as mean right atrial (RA) pressure in patients with right ventricular infarction.Methods: In all, 59 consecutive patients with inferior left ventricular infarction involving the right ventricle were selected for the study. All patients underwent Doppler echocardiographic evaluation of tricuspid and hepatic vein parameters and catheterization of the right side of the heart. Patients were divided into two groups according to the presence or absence of severe tricuspid regurgitation.Results: In patients with severe tricuspid regurgitation, a significant correlation (r = 0.64; p < 0.001) between RA maximal volume and mean right atrial pressure (RAP) was found, and the sensitivity of RA maximal volume in identifying mean RAP > 7 mmHg was 64% with a specificity of 78%. In patients without severe tricuspid regurgitation, the most significant relationship was observed between mean RAP and inferior vena cava collapse index. Significant correlations between maximal and minimal diameters of the inferior vena cava were also observed.Conclusions: Echocardiography and Doppler parameters may be useful for evaluating mean RAP in patients with right ventricular infarction. In patients with severe tricuspid regurgitation, the more important parameters are maximal and minimal RA volumes. In patients without severe tricuspid regurgitation together with right atrial volume, the important parameters are acceleration and deceleration time of the tricuspid inflow peak E velocity and hepatic systolic and diastolic venous flow.
Increased arterial wave reflection may predispose syncopal attacks
Authors: Chen Chen‐Huan , Hu Han‐Hwa , Lin Yao‐Ping , Chern Chang‐Ming , Hsu Tsei‐Lieh , Ding Philip Yu‐An 
Published: February 2009

AbstractBackground: The incidence of syncope increases with age, while aging is also associated with increased arterial wave reflection.Hypothesis: The study was undertaken to determine whether increased arterial wave reflection is a predisposing factor of syncope.Methods: We recruited 38 patients (28 men and 10 women, mean age 57.2 ± 20.3 years, range 17–87 years) with a history of syncope within 6 months of entry. The etiology of syncope was documented for each patient by a complete assessment of vasomotor function and cerebral flow. All patients received a comprehensive echocardiographic evaluation of cardiac structure and function. Carotid augmentation index (AI) was estimated noninvasively with the tonometry technique. The results were compared with those from 54 age‐and gender‐matched controls.Results: The most frequent diagnoses of syncope were postural hypotension (13 patients) and cerebrovascular dy sauto‐regulation (10 patients), and the cause could not be determined in 9 patients. Compared with the control group, the syncope group had a greater AI (20 ± 21 vs. 10 ± 15%, p = 0.013). Subgroup analysis of 20 patients aged > 50 years and with the aforementioned diagnoses showed even more striking results: AI, 29 ± 10 vs. 11 ± 15%, p < 0.001. The enhanced augmentation in the patients remained when age, systolic blood pressure, height, and heart rate were accounted for. Analysis of the carotid pulse wave suggested that both the timing and intensity of wave reflection were enhanced in patients with a history of syncope compared with controls.Conclusions: Our results support the hypothesis that enhanced arterial wave reflection is associated with the occurrence of syncope, especially in the elderly.
Predictors of ventricular tachycardia recurrence in 100 patients receiving tiered therapy defibrillators
Authors: Costeas Xenophon F. , Link Mark S. , Foote Caroline B. , Homoud Müunther K. , Wang Paul J. , Estes III N. A. Mark 
Published: February 2009

AbstractBackground and hypothesis: Programmed electrical stimulation (PES) is a time‐honored diagnostic tool in patients with ventricular tachyarrhythmias. The response to PES can be used to assess efficacy of pharmacologic or electrical therapy, as well as to obtain prognostic information. Reproducible induction of ventricular tachycardia with invasive electrophysiologic testing, or stimulation through defibrillator lead systems, can help optimize antiarrhythmic drug therapy and device programming during clinical follow‐up.Methods: We present our experience with 100 patients who had inducible sustained monomorphic ventricular tachycardia (SMVT) during invasive PES at baseline, and received a third‐generation implantable cardioverter‐defibrillator (ICD) alone, or in combination with antiarrhythmic drug therapy. Noninvasive programmed stimulation (NIPS) was performed prior to hospital discharge in 61 patients.Results: The inducibility of SMVT was concordant between the invasive study and NIPS in a subgroup of 40 (82%) patients who had invasive PES on the same drug regimen. During a mean follow‐up of 16 months, there were 12 nonar‐rhythmic deaths and recurrence of spontaneous SMVT in 36 (40%) of the surviving patients. Using a Cox proportional hazards model, the following variables were associated with early arrhythmia recurrence: persistent inducibility of SMVT during the MPS session (relative risk 11, range 2.6–47); induction of SMVT with a cycle length > 280 ms during invasive baseline PES (2.5, 1.2–5) and presence of prior inferior myocardial infarction (2.1, 1–4.2). Timing to initial recurrence of spontaneous tachycardia was unaffected by other clinical variables or concomitant antiarrhythmic drug use.Conclusion: Programmed electrical stimulation techniques offer insight into the patterns of spontaneous ventricular tachycardia recurrence and have significant practical utility in the management of patients receiving third‐generation ICDs.
Effect of Heart Failure Program on Cardiovascular Drug Utilization and Dosage in Patients with Chronic Heart Failure
Authors: Ramahi Tarik M. , Longo Marcella D. , Rohlfs Kate , Sheynberg Natalie 
Published: February 2009

AbstractBackground: Utilization and dosage of angiotensin‐converting enzyme (ACE) inhibitors in patients with chronic heart failure (CHF) remain low. Recent data suggest that care of patients with CHF in specialized heart failure programs is associated with improved clinical outcomes.Hypothesis: Specialized heart failure care is associated with better utilization and higher dose of cardiovascular drugs.Methods: Data from 133 patients with CHF referred to a heart failure program were analyzed. Mean functional class 3.1 ± 0.5, left ventricular ejection fraction 19 ± 8. Utilization and doses of cardiovascular drugs were examined at initial evaluation and at last visit, after an average period of 17 ± 14 months. Hospitalization and survival data were determined.Results: Utilization of ACE inhibitors and angiotensin‐receptor blockers increased from 87 to 100% (p< 0.001). Average daily dose increased by 60%, from the equivalent of captopril 105 ± 78 mg to 167 ± 86 mg (p < 0.001). Utilization of the following drugs increased significantly: beta blockers (16–37%, p< 0.001), metolazone (10–23%, p = 0.007), spironolactone (l‐36%, p<0.001), amiodarone (7–15%, p=0.05), hydralazine (1–9%, p = 0.004), and nitrates (20–33%, p = 0.03). One‐year survival was 90%. The 3‐ and 6‐month hospitalization rates for heart failure were 4 and 7%, and for all cardiovascular causes they were 6 and 11%, respectively.Conclusions: Care of patients with CHF in a specialized heart failure program was associated with significant increase in the utilization and doses of all beneficial cardiovascular drugs, especially ACE inhibitors. It was also associated with excellent clinical outcomes.