bluuebunny/crossref_metadata_2025_split huggingface dataset:
Coronary risk factors, endothelial function, and atherosclerosis: A review
Authors: Vogel Robert A. 
Published: February 2009

AbstractThe traditional risk factors for coronary heart disease, which include hypercholesterolemia, hypertension, cigarette smoking, diabetes mellitus, and high‐fat diet, have all been associated with impairments in endothelial function. Impaired endothelium function may promote the development of atherosclerosis through its effects on vasoregulation, platelet and monocyte adhesion, vascular smooth muscle cell growth, and coagulation. Increased oxidative stress may be another mechanism by which endothelial dysfunction contributes to atherosclerosis, although controversy exists on this issue. Risk factor modification, particularly lowering elevated concentrations of low‐density lipoprotein cholesterol, improves endothelial function. At least seven clinical studies have demonstrated improved endothelial function with cholesterol reductions in patients with markedly elevated or even borderline elevations in cholesterol concentrations, whether or not coronary heart disease is present. Other interventions that improve endothelial function include blood pressure reduction, smoking cessation, and administration of estrogen to postmenopausal women.
Cannulation of the coronary sinus via the femoral vein—A new technique
Authors: Katritsis Demosthenes , Webb‐Peploe Michael M. 
Published: February 2009

AbstractBackground: Cannulation of the coronary sinus usually has been accomplished by advancing a catheter through the subclavian or internal jugular veins.Hypothesis: We have developed a new technique for cannulation of the coronary sinus with a modified 6F Judkins L5 coronary catheter positioned through the femoral vein.Results: The technique was tried successfully in 20 consecutive patients by the same operator and the average fluoroscopy time for coronary sinus cannulation was 1.6 ± 1.0 min.Conclusion: Analysis of the results showed evidence of a learning curve with improvement of time with an increasing number of patients. The method provides a safe and inexpensive solution for catheterization of the coronary sinus, easily accessible to every catheter laboratory.
Increased ventricular sialylation in patients with heart failure secondary to ischemic heart disease
Authors: Robert Crook J. , Goldman Jonathan H. , Madden Brendan , Mckenna William J. , Dalziel Martin 
Published: February 2009

AbstractBackground: Elevated serum sialic acids are associated with increased cardiovascular mortality, but sialic acid levels have not been studied in cardiac tissue.Methods: Myocardial samples were obtained at the time of transplantation from 23 patients (age 54 ± 12 years) with heart failure secondary to ischemic heart disease and 16 patients (age 51 ± 7 years) with idiopathic dilated cardiomyopathy (DCM). A control group comprised postmortem samples obtained from 14 patients (age 70 ± 5 years) who died of non‐cardiovascular causes. Ventricular sialylation was quantitated using the sialic acid‐specific lectins Maackia amurensis agglutinin (MAA) and Sambucus nigra agglutinin (SNA) using a chemiluminescence assay. Results are expressed as the percentage (± standard error of the mean) of the binding of lectin to a standardized control sample of human myocardium.Results: Ventricular sialylation recognized by MAA was 55 ± 7% in patients with heart failure secondary to ischemic heart disease compared with 26 ± 7% for DCM (p = 0.006) and 32 ±8% for controls (p = 0.04), and that recognized by SNA was 69 ± 7% in patients with heart failure secondary to ischemic heart disease compared with 42 ± 6% for DCM (p = 0.006) and 38 ± 7% for controls (p = 0.006). No significant difference in ventricular sialylation was observed between patients with DCM and controls.Conclusion: Myocardial levels of sialic acids are significantly increased in patients with heart failure secondary to ischemic heart disease compared with patients with idiopathic dilated cardiomyopathy and controls. Our findings are important in view of recent reports of an association between serum sialic acid concentration and cardiovascular mortality and require further investigation.
Immediate and chronic results of cutting balloon angioplasty: A matched comparison with conventional angioplasty
Authors: Kondo Taizo , Kawaguchi Katsuhiro , Awaji Yoshifumi , Mochizuki Mitsuhiro 
Published: February 2009

AbstractBackground: At the initial stages of percutaneous transluminal coronary angioplasty (PTCA), several studies reported on the feasibility of coronary artery incision and dilatation leading to the extension of the PTCA technique.Hypothesis: This study was designed to determine the immediate and chronic results of cutting balloon (CB) angioplasty.Methods: This procedure was performed on 127 lesions in 110 patients (male 83%, age 61.8 ± 9.3 years).Results: The overall procedural success rates for the CB were 93.7% (119 lesions) and 92.7% (102 patients), while solitary CB without pre‐ and/or postdilatation was 76.4% (91 lesions). There was one major in‐hospital complication (Q‐wave myocardial infarction, 0.9%), but there were no deaths or emergency coronary artery bypass graftings. Significant angiographic dissections (≥ grade C) occurred in four patients, and coronary perforation occurred in one. The successfully treated CB group (95 lesions) was matched with the successful conventional angioplasty group (PTCA group) for chronic result assessment in regard to reference vessel size and lesion characteristics. In the CB group, postprocedural minimal luminal diameters were significantly larger and the percentage of stenosis at the stenotic site was significantly lower compared with the PTCA group. Restenosis occurred in 22 lesions (23.1%). This showed a significantly lower restenosis rate compared with the PTCA group (42.1%). In addition, the restenosis rate of the CB without inclusion of the pre‐ and/or postdilatation‐treated lesions was 19.7%.Conclusions: (1) Cutting balloon angioplasty procedures can be performed with high success rates with few major in‐hospital events. (2) The restenosis rate in the CB group was significantly lower compared with the PTCA group.
Resolution of late potentials with improvement in left ventricular systolic function in patients with first acute myocardial infarction
Authors: Masui Akira , Tamura Koji , Tarumi Noritaka , Kamihata Hiroshi , Karakawa Masahiro , Takehana Kazuya , Sugiura Tetsuro , Iwasaka Toshui , Inada Mitsuo 
Published: February 2009

AbstractBackground: Ventricular late potentials predict subsequent arrhythmic events and sudden death in postinfarction patients. Late potentials are recorded in the infarcted area, but it should be pointed out that they probably represent micropotentials in the area of delayed conduction found among isolated areas of scar tissue and normal myocardium.Hypothesis: The study was undertaken to investigate the relationship between chronic reversible myocardial ischemia, such as stunned or hibernating myocardium, and late potentials in 38 patients with a first myocardial infarction.Methods: The patients were divided into two groups, one with (Group 1) and one without (Group 2) resolution of late potentials recorded by signal‐averaged electrocardiogram at 6 months after onset of myocardial infarction. We investigated the clinical, echocardiographic, and signal‐averaged electrocardiographic characteristics of Groups 1 and 2.Results: In the chronic phase of myocardial infarction, a higher incidence of patency of the infarct‐related artery and an improvement of wall motion score were found in Group 1, and left ventricular ejection fraction was better preserved in Group 1 than in Group 2.Conclusions: These results suggest that the resolution of late potentials was influenced by the improvement of left ventricular systolic function and patency of the infarct‐related artery. We concluded that chronic reversible myocardial ischemia, such as stunned or hibernating myocardium, might be the substrate that generated late potentials.
Contraction‐excitation feedback in human atrial fibrillation
Authors: Antoniou Anna , Milonas Dimitris , Kanakakis John , Rokas Stelios , Sideris Dmitris A. 
Published: February 2009

AbstractBackground: Contraction‐excitation feedback, that is, electrophysiologic changes that are caused or preceded by mechanical changes of the myocardium, has been extensively studied in the ventricles. The role of contraction‐excitation feedback in the atria, and more particularly in the genesis and maintenance of atrial fibrillation, has been less adequately investigated.Hypothesis: The aim of the present study was to determine whether increased right atrial pressure (RAP) facilitates the induction of atrial fibrillation (AF) in patients with a history of lone AF.Methods: Sixteen patients with a history of paroxysmal AF but without structural heart disease were included in the study. All patients underwent electrophysiologic study at both a lower (3.1 ± 2.0 mmHg) and (in 13 cases) a higher (6.4 ± 2.5 mmHg) RAP. “Higher” was considered the pressure following rapid (in about 30 min) intravenous administration of normal saline or before the administration of a diuretic.Results: Rapid atrial pacing induced AF in 19 of 29 attempts. At a lower pressure, rapid pacing induced brief (3 s to 3 min) AF in 3 of 16 patients, long‐lasting (>3 min) AF in 3 of 16 patients, and no AF in 10 of 16 patients. At a higher pressure, brief AF was induced in 3 of 10 patients in whom no AF could be induced at a lower pressure, and long‐lasting AF in 10 patients in whom either brief AF (3 cases) or no AF (7 cases) was induced at a lower pressure. In 11 patients, in whom Wenckebach periodicity was determined at both higher and lower pressure, the critical cycle length at which atrioventricular block appeared was significantly (p<0.001, paired t‐est) longer(349.1 ± 44.4 ms, i.e.,+15.5 ± 11.3 ms)at higher than at lower atrial pressure (333.6 ±41.0 ms). In nine patients, in whom Wenckebach periodicity was determined and two rhythms occurred at different pressures, the critical cycle length was 332.2 ± 45.8 ms when associated with sinus rhythm, and significantly (p<0.01) longer (344.4 ± 48.0 ms, i.e., +12.2 ± 8.3 ms) when associated with induction of AF.Conclusion: In patients with lone atrial fibrillation, modest increases in atrial pressure may facilitate the induction of atrial fibrillation.
Abnormalities of the S‐T segment—Part I
Authors: Willis Hurst J. 
Published: February 2009

AbstractThe usual normal S‐T segment of the surface electrocardiogram (ECG) contributes little to the diagnostic procedure. When the S‐T segment is too long or too short, or when it is displaced upward or downward, it is commonly abnormal. Under such circumstances, an S‐T segment abnormality usually contributes considerable diagnostic information. When the Grant method of ECG interpretation is used, it is possible to perceive abnormalities of the S‐T segment that may otherwise be ignored or misinterpreted. This paper describes the method of identification and the significance of primary and secondary S‐T segment abnormalities. When a mean vector constructed for the S‐T segment displacement seen in 12 ECG leads is relatively parallel with a mean vector representing the T wave, it is, with a few exceptions, part of the repolarization process and is therefore part of the T wave. This may be called a secondary S‐T segment abnormality. When a mean vector constructed for the S‐T segment displacement seen in 12 ECG leads is not relatively parallel with a mean vector representing the T wave, it is, with a few exceptions, not part of the repolarization process and is therefore not part of the T wave. This may be called a primary S‐T segment abnormality.
Isolated and preclinical impairment of left ventricular filling in insulin‐dependent and non‐insulin‐dependent diabetic patients
Authors: Astorri Ettore , Fiorina Paolo , Astorri Annalisa , Contini Giovanni Andrea , Albertini Daniela , Magnati Giuseppe , Lanfredini Mario 
Published: February 2009

AbstractBackground: Diabetes mellitus can induce a pattern of myocardial pathology known as specific diabetic cardiomyopathy, even if this is not clearly specified.Hypothesis: The aim of our study was to evaluate the presence of preclinical myocardial damage in insulin‐ and non‐insulin‐dependent diabetic patients and controls by assessment with Doppler echocardiography.Methods: Twenty insulin‐dependent diabetic (IDDM) patients, 10 non‐insulin‐dependent diabetic (NIDDM) patients, and 12 healthy individuals (C) as controls, matched for age, gender, and without overt cardiovascular disease, were assessed in this study.Results: Systolic function parameters presented normal values in the three groups, with the exception of a slight reduction in ventricular volume indices in the NIDDM group. Diastolic function was clearly impaired in both groups of patients versus that in healthy controls. In particular, ventricular filling was impaired in the NIDDM compared with the IDDM patients, especially the peak early filling rate E (p<0.001). Moreover, in the IDDM group, the duration of diabetes (p<0.01) and glycosilated hemoglobin value (HbA1C, p<0.02) were higher than in the NIDDM group. Multiple regression analysis showed a significant inverse correlation between HbA1C and peak late filling rate A (R2 = 0.28) in both groups of patients and a direct correlation between velocity time integral E and age, duration of diabetes, and HbA1C (R2 = 0.46). The two groups presented a small, homogeneous number of cases with initial microangiopathy and borderline autonomic neuropathy, associated with microalbuminuria. Doppler echocardiography showed an early impairment of left ventricular filling, as well as an early preclinical alteration of myocardial function in diabetic patients, especially in the NIDDM group.Conclusion: These early signs of cardiomyopathy could constitute a predisposing condition toward the high cardiac morbidity and mortality rate in diabetic patients.
Routine arterial oxygen saturation monitoring is not necessary during transesophageal echocardiography
Authors: Kassimatis Antonis , Tsoukas Athanasios , Ikonomidis Ignatios , Joshi Jayshree , Nihoyannopoulos Petros 
Published: February 2009

AbstractBackground: Transesophageal echocardiography (TEE) is now an established adjunct to routine echocardiography, its diagnostic impact making it an invaluable first‐line diagnostic procedure in many cardiac conditions. However, there is no unanimity in the way the transesophageal procedure is carried out, especially with regard to the need for antibiotic prophylaxis, sedation, and the monitoring of oxygen saturation.Hypothesis: This study was prospectively undertaken (1) to determine the presence and magnitude of oxygen desaturation and (2) the changes in heart rate and blood pressure following sedation for routine TEE in an unselected and consecutive group of patients to identify those at high risk.Methods: Arterial oxygen saturation, heart rate, and systolic, diastolic, and mean blood pressure were monitored in 106 consecutive patients undergoing routine transesophageal echocardiography. Ninety‐four (89%) patients received intravenous sedation with midazolam.Results: Three min after midazolam administration there was a drop in oxygen saturation from 97 ± 2.5 to 95 ± 2.9 (p<0.001), in systolic blood pressure from 139 ± 19.5 to 124.8 ± 22.2 mmHg (p<0.001), in diastolic blood pressure from 86.6 ± 19.9 to 77.5 ± 17.7 mmHg (p<0.001), and in mean blood pressure from 108.3 ± 18 to 95.6 ± 28.8 mmHg (p<0.001). After introduction of the transesophageal probe and during the examination, there was a further drop in oxygen saturation with a maximum drop at the 15th min of the examination (93.7 ± 3.7 vs. 97 ± 2.5, p<0.001). The maximum blood pressure drop occurred at the 12th min into recovery: systolic blood pressure dropped from 139 ± 19.5 to 118 ± 20.8 mmHg (p<0.001), diastolic blood pressure from 86.6 ± 16.9 to 75.8 ± 17.9 mmHg (p<0.005), and mean blood pressure from 108.3 ± 18 to 92.5 ± 19.4 mmHg (p<0.01). Patients with congestive heart failure had a greater drop in oxygen saturation compared with patients who were not in heart failure (p<0.01). Twelve patients did not receive any sedation; however, they all showed a drop in oxygen saturation from 97.8 ± 2.3 to 94.6 ± 3.4 (p<0.001), with a maximum drop at the 15th min during the transesophageal examination.Conclusion: In patients with no chronic obstructive airway disease who are not in congestive heart failure, routine oxygen saturation monitoring is not deemed necessary during transesophageal examination. The cause of hypoxemia during the procedure is not only related to sedation but also to esophageal intubation.
Detection of significant residual stenosis of the infarct‐related artery after thrombolysis by high‐dose dipyridamole echocardiography test: Is it detected often enough?
Authors: Nešković Aleksandar N. , Bojić Milovan , Popović Aleksandar D. 
Published: February 2009

AbstractBackground and hypothesis: It has been reported that high‐dose dipyridamole echocardiography test (DET) can be successfully used for the detection of critical residual stenosis of the infarct‐related artery (IRA). However, we have recently noticed low sensitivity of DET for the detection of residual IRA stenosis in patients with single‐vessel disease. This study sought to determine the value of DET for the detection of significant residual stenosis of the IRA after thrombolysis.Methods: Dipyridamole echocardiography test was performed in 55 consecutive patients after a first acute myocardial infarction before hospital discharge. All patients underwent coronary angiography 23 ± 6 days after infarction.Results: Nine of 19 patients with positive DET revealed new adjacent asynergy and all of the patients had patent and significantly stenotic IRA. Sensitivity and specificity of DET in identifying significant residual stenosis of the IRA were 24 and 100%, respectively. Among 49 patients with significantly stenotic or occluded IRA, 40 patients without adjacent asynergy during DET had higher baseline wall motion score index (WMSI) compared with 9 patients who revealed adjacent asynergy during DET (1.45 ± 0.30 vs. 1.24 ± 0.18; p<0.05). When all patients with positive DET (adjacent or remote asynergy) were compared with those with negative DET, no difference in baseline WMSI was found (1.37 ± 0.24 vs. 1.44 ±0.24;p>0.05).Conclusions: Our data indicate that sensitivity of DET in detecting significant residual stenosis of the IRA after thrombolysis is low. It seems that the extent of myocardial infarction affects the ability of DET to detect adjacent, but not remote asynergy.
Role of transesophageal echocardiography in the clinical management of a patient with a giant coronary artery aneurysm
Authors: Wolford David C. , Jost Charles M.T. , Madu Ernest C. , Ramanathan K. B. , Walker William 
Published: February 2009

AbstractTransthoracic echocardiography (TTE) has substantial limitations for the study of abnormalities of the coronary tree. Transesophageal echocardiography (TEE) allows a more complete examination of the coronary arteries, particularly the proximal segments. This report describes the use of TEE after cardiac catheterization in the clinical management of a patient with unstable angina. While angiography first showed the giant aneurysm of the left circumflex coronary artery, TEE, by revealing an active thrombus of the lumen, prompted an immediate surgical resolution.
Eustachian valve endocarditis: Detection with multiplane transesophageal echocardiography
Authors: Palakodeti Vachaspathi , Keen William D. , Rickman Leland S. , Blanchard Daniel G. 
Published: February 2009

AbstractRight‐sided involvement is fairly common in infective endocarditis, but involvement of the eustachian valve is distinctly rare. We present the case of a 36‐year‐old intravenous drug user with staphylococcal bacteremia and septic pulmonary emboli. Transthoracic echocardiography was normal, but transesophageal echocardiography revealed a large eustachian valve vegetation. This case illustrates the utility of multiplane transesophageal echocardiography in the evaluation of eustachian valve pathology.
Ischemic preconditioning: Clinical relevance and investigative studies
Authors: Schlaifer Jay D. , Kerensky Richard A. 
Published: February 2009

AbstractExperimental animal studies have shown that repetitive brief coronary occlusions render the heart resistant to myocardial infarction from subsequent, more prolonged, coronary occlusions. This phenomenon in animal models has been called ischemic preconditioning. In a number pf clinical scenarios, the second in a series of ischemic episodes appears to be less severe than the first, suggesting that ischemic preconditioning also occurs in humans. If the mediator of preconditioning could be identified, it is conceivable that this agent could be administered to patients with coronary artery disease as a myocardial protectant. However, the definite clinical relevance of this interesting experimental finding remains unknown. Unlike the case in animal models subjected to an abrupt occlusion, preconditioning is difficult to study in the clinical setting. This article reviews the findings and limitations of the relevant clinical studies looking for ischemic preconditioning in humans.
Comparison of the histopathology of culprit lesions in chronic stable angina, unstable angina, and myocardial infarction
Authors: Haft Jacob I. , Mariano Domenic L. , Goldstein Jonathan , Waller Bruce 
Published: February 2009

AbstractBackground: The etiology of unstable angina (UA) and myocardial infarction (MI) both involve rupture of an atherosclerotic plaque in a coronary artery. It has been suggested that the two syndromes differ because MI results if a red occlusive permanent thrombus occurs and UA occurs only if a nonocclusive platelet (white) thrombus occurs.Hypothesis: The purpose of this study was to determine the differences between coronary lesion pathology in MI and UA and compare them with lesions of chronic stable angina (CSA).Methods: We reviewed the pathologic specimens of culprit lesions obtained by directional coronary atherectomy in 27 patients with MI, 29 patients with UA, and 16 patients with CSA.Results: The incidence of ruptured plaque was high and identical in patients with MI (77.8%), and UA (75.8%), and significantly lower in patients with CSA (25.0%) (p « 0.001). Similarly, the incidence of red thrombus was the same in MI (92.6%) and UA (82.7%), and significantly less in CSA (p “0.001).Conclusions: The underlying pathophysiology of both UA and MI appears to be the same, with red thrombus playing an important role in both syndromes. The only difference is in the degree of occlusiveness of the red thrombus on the ruptured plaque and whether the occlusion is transient (UA) or persistent (MI). The balance between thrombosis and endogenous clot lysis determines which syndrome occurs. Lytic therapy is not effective in UA, probably because the clot is not occlusive or because endogenous lysis has already achieved the degree of coronary opening that eventuates from tissue plasminogen activator or streptokinase administration. Prompt catheterization and revascularization may be as indicated in patients with MI if there remains viable myocardium as in patients with UA.