bluuebunny/crossref_metadata_2025_split huggingface dataset:
Platelet‐endothelial interactions in atherothrombotic disease: Therapeutic implications
Authors: Wilson James M. , Ferguson James J. 
Published: February 2009

AbstractThe role of the platelet and the endothelium in the pathogenesis of atherosclerosis and subsequent ischemic events has been the subject of extensive investigation. Arterial sites where endothelial function is severely impaired are often the sites of atheroma development. Lesion evolution impairs endothelial function, leading to a self‐perpetuating cycle of growth. During early lesion development, overt thrombotic events are rare. However, rupture of an advanced, necrotic plaque or intimal ulceration triggers arterial thrombosis, at which point the importance of platelet function may be seen clearly. The Antiplatelet Trialists' Collaboration meta‐analysis demonstrated the benefit of antiplatelet therapy to patients with atherosclerotic disease. Aspirin is the most widely studied agent and is considered the standard of antiplatelet therapy. Newer agents that intervene at different stages of the platelet activation pathway have been developed. Clopidogrel, a new adenosine diphosphate receptor antagonist, is more effective than aspirin in reducing vascular events in patients with prior myocardial infarction, stroke, or established peripheral arterial disease. The glycoprotein IIb‐IIIa antagonists such as abciximab have proven effective in the setting of active arterial thrombosis and percutaneous revascularization, but their value in secondary prevention remains unknown. All patients with atherosclerosis should be treated with an antiplatelet drug. Current evidence suggests that either aspirin or clopidogrel are appropriate first‐line agents. There is urgent need for an analysis of the risk/benefit ratio in various populations and clinical settings to determine the most appropriate type and intensity of therapy for a given patient.
Impaired endothelial function in patients with rapidly stabilized unstable angina: Assessment by noninvasive brachial artery ultrasonography
Authors: Bereziuk Eulalio , Bolaño Alberto L. , Suarez Daniel H. , Kura Marta , Esper Ricardo J. , Vilariño Jorge , Cacharrón José L. , Machado Rogelio , Ingino Carlos A. , GarcGuiñaz Carlos A. 
Published: February 2009

AbstractBackground:Endothelial dysfunction may contribute to symptoms of instability in patients with acute coronary syndromes. High‐resolution external ultrasound assessment of the brachial artery responses allows noninvasive determination of endothelial function.Hypothesis:This study was conducted to assess endothelial function in patients with unstable angina using a noninvasive technique.Methods:We studied 189 patients who were subdivided into three groups. Group 1:60 apparently healthy subjects with no cardiovascular risk factors or symptoms of coronary artery disease; Group 2: 105 subjects with cardiovascular risk factors—arterial hypertension, hypercholesterolemia, cigarette smoking, diabetes, and obesity, but no evidence of coronary artery disease; and Group 3: 24 patients with unstable angina (chest pain at rest within the 24 h preceding study entry). All patients underwent pre‐ and postischemic brachial artery test evaluation with measurements of internal arterial diameters and blood flow.Results:Results are expressed as percentage change from basal values. Subjects in Groups 1 and 2 showed a diameter increase of 19.1 and 11.9%, respectively, whereas patients in Group 3 showed a diameter change of 1.2% (p < 0.002 and < 0.0001, respectively). Calculated blood flow did not differ significantly in Groups 1 or 2 (74.4 and 56.4%), but was notably lower in Group 3 (18.4%, p<0.005 vs. Groups 1 and 2). In nine patients of Group 3, the brachial studies were repeated 4 weeks after symptom stabilization and showed values comparable with those in Group 2.Conclusions:Patients with unstable angina showed endothelial dysfunction compared with control individuals. It is of interest that in patients whose symptoms were stabilized by medical therapy, endothelial function was restored 4 weeks after hospital discharge.
The appearance of L‐selectinlow polymorphonuclear leukocytes in the circulating pool of peripheral blood during myocardial infarction correlates with neutrophilia and with the size of the infarct
Authors: Roth Arie , Keren Gad , Shapira Itzhak , Arber Nadir , Kassirer Michael , Zeltser David , Rotstein Rivka , Gluzman Boris , Leibovitz Eyal , Goldberg Yifaat 
Published: February 2009

AbstractBackground: It is assumed that not only leukocytosis, but also the activation of white blood cells (WBC) may play a role in the pathogenesis and prognosis of patients with myocardial infarction (MI). Activation of WBC includes upregulation of CD11b∖CD18 and downregulation of CD62L (L‐selectin) antigens.Hypothesis: The activation of WBC is associated with the appearance of a larger MI.Methods: CD11b∖CD18 and CD62L were measured on the surface of WBC on Day 1 and Day 3 from the onset of MI. The size of the infarct was estimated by calculating the area under the curve of the creatine kinase enzyme, which was measured every 6 h.Results: A negative correlation was noted between the absolute polymorphonuclear count and the availability of the CD62L on these cells during Day 1 (r = ‐0.46, p = 0.003) and Day 3 (r = ‐0.35, p = 0.05). There was a positive correlation between the size of MI and the WBC count (r = 0.46, p = 0.004) and a negative correlation with CD62L on polymorphonuclears (r = ‐0.35, p = 0.03). During Day 3, the CD11b∖CD18 on the polymorphonuclears increased despite a decrement in the absolute number of these cells.Conclusion: The neutrophilia during the early phases of acute MI correspond to the appearance of the L‐selectinlow population of polymorphonuclear leukocytes. There is a correlation between the appearance of this population and the size of the infarct.
The effect of specific inspiratory muscle training on the sensation of dyspnea and exercise tolerance in patients with congestive heart failure
Authors: Weiner Paltiel , Magadle Rasmi , Berar‐Yanay Noa , Pelled Benny 
Published: February 2009

AbstractBackground:It has been previously shown that the inspiratory muscles of patients with congestive heart failure (CHF) are weaker than those of normal persons. This weakness may contribute to the dyspnea and limit exercise capacity in these patients. The respiratory muscles can be trained for both strength and endurance.Hypothesis:The present study was designed to evaluate the effect of specific inspiratory muscle training (SIMT) on inspiratory muscle performance, lung function, dyspnea, and exercise capacity in patients with moderate heart failure.Methods:Twenty patients with CHF (NYHA functional class II‐III) were recruited for the study. The subjects were randomized into two groups: 10 patients were included in the study group and received SIMT and 10 patients were assigned to the control group and received sham training. Subjects in both groups trained daily, 6 times/week, for one‐half h, for 3 months. The subjects started breathing at a resistance equal to 15% of their PImax for 1 week and the resistance was then increased incrementally to 60%. Spirometry, inspiratory muscle strength (assessed by measuring the PImax at residual volume), and endurance (expressed by the relationship between PmPeak and PImax), the 12‐min walk test, and peak VO2 were performed before the beginning and at the end of the training period.Results:All patients in the training group showed an increase in the inspiratory muscle strength [mean (± standard error of the mean) PImax increased from 46.5 ± 4.7 to 63.6 ± 4.0 cm H2O, p < 0.005], and endurance (mean PmPeak/PImax from 47.8 ± 3.6 to 67.7 ± 1.7%, p < 0.05), while they remained unchanged in the control group. This was associated in the training group with a small but significant increase in forced vital capacity, a significant increase in the distance walked (458 ± 29 to 562 ± 32 m, p < 0.01), and an improvement in the dyspnea index score. No statistically significant change in the mean peak VO2 was noted in either group.Conclusions:Specific inspiratory muscle training resulted in increased inspiratory muscle strength and endurance. This increase was associated with decreased dyspnea, increase in submaximal exercise capacity, and no change in maximal exercise capacity. This training may prove to be a complementary therapy in patients with congestive heart failure.
Myocardial ischemia due to vasospasm of small coronary arteries detected by methylergometrine maleate stress myocardial scintigraphy
Authors: Shimada Toshio , Ishibashi Yutaka , Murakami Yo , Sano Kazuya , Tsukihashi Hironori , Okada Seiji , Kawakami Koichi , Murakami Rinji 
Published: February 2009

AbstractBackground: Recently, several case reports have implicated vasospasm of small coronary arteries in vasospastic angina pectoris. Vasospasm of small coronary arteries was also considered from angiographic findings in patients with atypical chest pain. In Syrian hamster, vasospasm in small coronary arteries was considered to be the cause of dilated cardiomyopathy.Hypothesis: This study was undertaken to determine whether vasospasm in small coronary arteries can be induced by methylergometrine maleate stress thallium‐201 (201T1) myocardial scintigraphy.Methods: Twenty‐five patients with chest pain, all of whom had intact coronary arteries, were studied. After intracoronary methylergometrine maleate injection, coronary arteriograms also looked normal in all cases. Thallium‐201 myocardial scintigraphy was carried out immediately after intracoronary methylergometrine maleate injection in four patients with chest pain. In the remaining 21 patients with chest pain, methylergometrine maleate was given intravenously within up to 2 weeks before 201T1 myocardial scintigraphy.Results: In the intracoronary injection study, one patient had chest discomfort after methylergometrine maleate injection, and ST‐segment elevation was observed on electrocardiogram (ECG). Of the 21 patients with chest pain, 11 patients felt angina‐like chest pain after intravenous injection of methylergometrine maleate, but their ECGs showed no ischemic changes. Stress 201T1 myocardial scintigrams showed methylergometrine maleate‐induced perfusion defects with complete redistribution in 3 of 4 patients in the intracoronary injection study and in 12 of 21 patients in the intravenous injection study. These findings suggest that vasospasm in small coronary arteries caused myocardial ischemia in 15 of 25 patients (60%) with chest pain.Conclusion: Vasospasm in small coronary arteries may be involved in the myocardial ischemia of some patients with chest pain who do not show any large coronary artery vasospasm.
Anomalies in the dosing of diltiazem
Authors: Pool Peter E. 
Published: February 2009

AbstractFrom early research, investigators understood that the dose of diltiazem required for the treatment of hypertension (commonly 360 mg/day) was greater than that required for the treatment of angina (commonly 240 mg/day). Nonetheless, studies of recent prescribing practices show that the 240 and 180 mg capsule strengths constitute more than 70% of the diltiazem prescriptions for hypertension. Physicians became accustomed to the lower antianginal doses of diltiazem for 7 years before a hypertension indication was approved. Subsequently, these dosing levels were reinforced by the production of once‐a‐day formulations with highest capsule strengths of 240 mg and 300 mg. These strengths were dictated by the sheer bulk of the formulations, which limited how much diltiazem could be inserted into the #00 capsule, the largest capsule that can be comfortably administered. An examination of the combined data from the six randomized, blinded, and placebo‐controlled trials submitted to the FDA for the original new drug applications of the three formulations of diltiazem available in the United States shows a clear linear dose‐response relationship between diltiazem dose and blood pressure lowering through the 480‐‐540 mg/day range. It also demonstrates that the 90‐‐120 mg/day range is the “no‐effect dose.” These conclusions are supported by a MEDLINE review of all other studies of multilevel dosing of higher dose levels of diltiazem. The data support the conclusion that diltiazem is generally underdosed, but when properly dosed may be the single most potent antihypertensive overall.
Incomplete ventricular septal rupture following blunt chest trauma
Authors: Tsikaderis D. , Dardas P. , Hristoforidis H. 
Published: February 2009

AbstractNonpenetrating cardiac trauma should be considered in the diagnosis of electrocardiographic changes after road traffic accidents. Transesophageal echocardiography is the most useful noninvasive technique for the diagnosis of cardiac trauma. This paper reports the case of a patient with traumatic contusion of the ventricular septum following a fall from a 20 m height onto the roof of a car.
Brain natriuretic peptide increases acutely and much more prominently than atrial natriuretic peptide during coronary angioplasty
Authors: Kyriakides Zenon S. , Michalis Lambros , Antoniadis Aias , Nikolaou Nikolaos I. , Kremastinos Dimitrios T. , Markianos Manolis 
Published: February 2009

AbstractBackground: Increased levels of plasma brain natriuretic peptide (BNP) are observed in patients with congestive heart failure, hypertension, left ventricular hypertrophy, and acute myocardial infarction. However, there are no data on serial changes in plasma levels of BNP in patients undergoing coronary angioplasty.Hypothesis: The study was undertaken to examine plasma concentrations of BNP together with those of atrial natriuretic peptide (ANP) in patients undergoing percutaneous transluminal coronary angioplasty (PTCA).Methods: Plasma concentrations of BNP and ANP were examined in 13 patients with stable angina pectoris and good left ventricular function undergoing PTCA. Blood samples were taken from the femoral vein at baseline, after the first balloon inflation, after the end of the procedure, and 4 h thereafter.Results: Plasma BNP levels were 14 ± 4 at baseline, 22 ± 10 after the first balloon inflation, 28 ± 12 at the end of the procedure, and 15 ± 4 pgr/ml 4 h thereafter (F = 13.05, p < 0.00001). Plasma ANP levels were 80 ± 15, 86 ± 14, 90 ± 24, and 75 ± 6 fmol/l (F = 5.95, p = 0.002), respectively. The increase of BNP at the end of the procedure was related to the increase of ANP (r = 0.78, p = 0.002).Conclusion: Plasma BNP levels increase acutely and much more prominently than those of plasma ANP during coronary angioplasty; however, plasma BNP levels return to baseline values shortly after the end of the procedure.
Ortnery's syndrome in association with mitral valve prolapse
Authors: Kishan C. V. , Wongpraparut N. , Adeleke K. , Frechie P. , Kotler M. N. 
Published: February 2009

AbstractThe case of an 83‐year‐old woman with a history of hypertension, valvular heart disease, atrial fibrillation, and cardiomegaly is presented. The patient also had progressive hoarseness of her voice and intermittent dysphagia. Ear, nose, and throat examination revealed left vocal cord paralysis. Echocardiography revealed severely dilated left (LA) and right atria (RA), moderate mitral regurgitation, severe tricuspid regurgitation, and prolapse of both these valves. A review of literature of Ortner's or cardiovocal syndrome is presented. Ortner's syndrome due to mitral valve prolapse has not been reported previously.
Correlation of coronary angiography with “tombstoning” electrocardiographic pattern in patients after acute myocardial infarction
Authors: Guo Xiao Hua , Guan Yee , Chen Li Jia , Huang Jian , John Camm A. 
Published: February 2009

AbstractBackground: It has been suggested that a specific pattern of electrocardiographic (ECG) changes following acute myocardial infarction (AMI), the so‐called “tombstoning,” predicts a poorer outcome, although the cause and associations of such changes are not known. To address the possible cause and implications, we correlated angiographic findings with tombstoning in patients following AMI.Methods: The study investigated 124 patients with AMI, whose ECGs were taken within 24 h of onset of symptoms and who subsequently underwent angiography. In this population, 24 (19%) patients had a definite tombstoning pattern on their admission ECG.Results: Compared with non‐tombstoning ECGs, the significant differences in the tombstoning group are as follows: (1) All patients, including those with inferior infarction, had either total or partial occlusion of the left anterior descending (LAD) artery (100 vs. 44%, p < 0.0001); (2) LAD occlusions were significantly more severe and mostly proximal (100% occlusion: 50 vs. 20.5%, p = 0.02; <50% occlusion: 0 vs. 15.9% p = 0.039; proximal occlusion: 92 vs. 65%, p = 0.017); (3) patients with tombstoning ECGs had a significantly greater incidence of occlusion of all three coronary arteries (54.1 vs. 22%, p = 0.001); (4) tombstoning ECGs were more strongly associated with anterior than with inferior infarction (83.3 vs. 33%, p < 0.0001).Conclusions: The patients with a tombstoning pattern on the admission ECG, who underwent angiography, were associated with occlusion of a high‐grade stenosis of the proximal LAD artery (usually with involvement of more than one artery) and were predominantly seen in association with anterior infarction.
Angina induced by excessive bradycardia
Authors: Shaheen Joseph , Wanderman Aryeh , Tzivoni Dan 
Published: February 2009

AbstractAngina pectoris usually occurs in patients with significant coronary artery disease during periods of increased coronary demand such as increased heart rate. Bradycardia is a rare and unusal cause of angina pectoris that should be considered during the evaluation of patients with agnia. This paper reports three cases of bradycardia‐induced angina.
The incidence and consequences of mental disturbances in elderly patients post cardiac surgery—a comparison with younger patients
Authors: Heijmeriks J. A. , Dassen W. , Prenger K. , Wellens H. J. J. 
Published: February 2009

AbstractBackground: Limited data exist about the incidence and consequences of mental confusion following open heart surgery in different age groups. Likewise, little is known about preoperative predictors of mental confusion.Methods: Two‐hundred consecutive patients, aged şş75 years (Group 1), and 400 procedure‐ and gender‐matched younger patients (Group 2) who underwent coronary or valvular surgery were included in a prospective study. The relation between postoperative mental confusion, mortality, morbidity, and quality of life was studied.Results: Mental confusion was present in 11.8% Group 2 and 22.6% Group 1 patients. The incidence was higher after valvular surgery. Preoperative risk factors in Group 1 patients were diabetes mellitus, a history of heart failure, weak carotid pulsations, and repeat surgery. Late mortality, after a median follow‐up duration of 31 months, was significantly worse in patients who were confused, which was related to the underlying disease. Recovery of quality of life was clearly diminished in elderly patients with confusion in contrast to younger patients.Conclusion: Postoperative mental confusion has a high incidence in the elderly population and is associated with a diminished quality of life.
Endothelial dysfunction, subangiographic atheroma, and unstable symptoms in patients with chest pain and normal coronary arteriograms
Authors: Clague Jonathan R. , Bagger Jens‐Peder , Ward David E. , Cox Ian D. , Kaski Juan‐Carlos 
Published: February 2009

AbstractBackground: Patients with chest pain and normal coronary arteriograms (CPNA) may present with unstable symptoms and other evidence of ischemia during clinical follow‐up. Although repeat angiography usually proves negative, functional assessment of coronary vasomotor abnormalities may provide additional pathophysiologic information.Hypothesis: The study was undertaken to evaluate the relationship between endothelial dysfunction and subangiographic atheroma in patients with CPNA undergoing repeat angiography because of unstable symptoms.Methods: We investigated nine patients with CPNA (8 women, mean age 57 ± 9 years) undergoing repeat angiography because of unstable anginal symptoms. After normal angiography, simultaneous coronary epicardial and microvascular vasomotor responses to intracoronary vasodilators [acetylcholine (10−6 M), adenosine (18 μg) and nitroglycerin (300 μg)] were investigated in the left anterior descending artery using quantitative angiography and Doppler flow measurements. The presence of subangiographic atheroma was assessed by intravascular ultrasound.Results: Three patients demonstrated proximal and distal epicardial vasoconstriction and a reduction in coronary flow in response to acetylcholine, indicating concordant epicardial and microvascular endothelial dysfunction. These changes were associated with chest pain and ischemic electrocardio‐graphic changes in two patients. None of the remaining patients suffered chest pain in response to intracoronary acetylcholine. Six patients had significant subangiographic disease (intimal thickness >0.3 mm) on intravascular ultrasound imaging, and multivariate analysis indicated a significant relationship (R2 = 0.89, overall p = 0.001) between the extent of subangiographic disease and both plasma cholesterol concentration and hypertensive history. No significant relationship was demonstrated between endothelial dysfunction and the extent of subangiographic disease.Conclusion: Concordant epicardial and microvascular endothelial dysfunction may be pathophysiologically and clinically significant in unstable patients with CPNA but does not appear to be directly related to the extent of subangiographic atheroma.
New and emerging pharmacologic strategies in the management of chronic heart failure
Authors: Krum Henry 
Published: February 2009

AbstractChronic heart failure (CHF) is a complex syndrome involving activation of multiple cellular, metabolic, and neurohumoral pathways following the initial myocardial insult. Recently, there have been considerable advances in the pharmacologic management of CHF. The current approach to treatment recognizes the need to target neurohormonal activation, and the use of angiotensin‐converting enzyme (ACE) inhibitors and beta blockers should now be regarded as part of standard therapy in many patients with CHF. However, because of the complexity of the disease, blockade of additional pathways is likely to be required to maximize the therapeutic benefit of intervention. To this end, there are several agents under active late‐phase clinical evaluation. The most advanced of these new strategies (beyond renin‐angiotensin‐aldosterone blockade) is inhibition of the endothelin system. There is a substantial body of evidence that this system is intimately involved in CHF disease progression. Early‐phase clinical data are very encouraging and support the potential utility of long‐term endothelin inhibition. Other novel approaches involve the use of cytokine antagonists (e.g., agents that block tumor necrosis factor‐α activity) and the augmentation of natriuretic peptides. If all these potential agents prove to be of benefit in CHF, the question of which agent or combination of agents to use in which patients will arise. There is therefore a need to develop scientific approaches in order to be able to identify more accurately patients who will obtain benefit from specific classes or combinations of drugs.