bluuebunny/crossref_metadata_2025_split huggingface dataset:
Anticoagulants for atrial fibrillation: Why is the treatment rate so low?
Authors: Buckingham Thomas A. , Hatala Robert 
Published: June 2007

AbstractThe incidence of atrial fibrillation (AF) is increasing in many countries along with aging demographics. Atrial fibrillation is clearly associated with an increased rate of stroke. Numerous large clinical trials have shown that dose‐adjusted warfarin can reduce the stroke rate in these patients, particularly in the elderly, and clear guidelines for the use of anticoagulants in such patients have been published. However, many studies show that treatment rates remain disappointingly low (≤50%). Numerous barriers to the use of dose‐adjusted warfarin exist, including practical, patient‐, physician‐, and healthcare system‐related barriers. These include the complex pharmacokinetics of warfarin, the need for continuous prothrombin time monitoring and dose adjustments, bleeding events, noncompliance, drug interactions, and increased costs of monitoring and therapy. Possible solutions to this problem are discussed and include improved patient and physician education, the use of anticoagulation clinics, new approaches to AF, and potential treatment improvements through use of newer anticoagulants.
A stratified approach to the treatment of a symptomatic myocardial bridge
Authors: Gomberg‐Maitland Mardi , Kim Michael C. , Fuster Valentin 
Published: June 2007

AbstractA case of symptomatic myocardial bridge requiring intracoronary stent complicated by in‐stent restenosis is reported. A stratified approach for the treatment of a symptomatic myocardial bridge is proposed.
Hemodynamic changes and prognosis in patients with hypertrophic cardiomyopathy and abnormal blood pressure responses during exercise
Authors: Nagata Mitsuru , Shimizu Masami , Ino Hidekazu , Yamaguchi Masato , Hayashi Kenshi , Taki Junichi , Mabuchi Hiroshi 
Published: June 2007

AbstractBackground: An abnormal blood pressure response (BPR) during exercise has been proposed as a risk factor for sudden cardiac death in patients with hypertrophic cardiomyopathy (HCM). Some patients with HCM show systolic dysfunction during exercise.Hypothesis: The aim of this study was to clarify the hemo‐dynamic response during exercise and prognosis in patients with HCM and abnormal BPR.Methods: Sixty‐five patients with HCM underwent radionuclide monitoring of left ventricular function and measurement of blood pressure during supine ergometer exercise. Thereafter, cardiac events were recorded for an average period of 76 months.Results: Seven of 65 patients had abnormal BPR, while the others had normal BPR. Changes of heart rate and systemic vascular resistance during exercise did not differ between the two groups. Stroke volume did not increase in the abnormal BPR group but did in the normal BPR group. During a mean follow‐up period of 76 months, three of the seven patients (43%) with abnormal but only one patient (2%) with normal BPR suffered a malignant arrhythmia.Conclusions: Abnormal BPR occurred in about 11% of patients with nonobstructive HCM and was associated with a high prevalence of cardiac events. The predictor of abnormal BPR during exercise may not be an abnormal response of systemic vascular resistance and heart rate, but the lack of an appropriate increase in stroke volume.
Systolic, diastolic, and pulse pressures as coronary risk factors in a population with low cholesterol levels: A prospective 10‐year evaluation
Authors: Onat Altan , Ceyhan Käksal , Erer Burak , Basar Ämer , Uysal Ämer , Sansoy Vedat 
Published: June 2007

AbstractBackground: Pulse pressure (PP) has recently been found to be predictive of subsequent cardiovascular, particularly coronary, events in some middle‐aged and elderly populations.Hypothesis: The aim of this prospective population‐based study was to evaluate the roles of systolic (SBP), diastolic blood pressure (DBP), and PP in predicting coronary heart disease (CHD) morbidity and mortality in both genders in a population of a wide age span and a setting of low levels of low‐density lipoprotein (LDL) and high‐density lipoprotein (HDL) cholesterol.Methods: Of participants in the Turkish Adult Risk Factor Study aged ⩾ 20 years, those free of CHD at baseline examination in 1990 were followed up for a mean of 9.3 years. Coronary heart disease was diagnosed based on clinical findings and Minnesota coding of resting electrocardiograms (ECGs). In 2,601 men and women (mean age at baseline 41.4 ± 15 years), deaths from CHD developed in 80 and nonfatal CHD in 158 patients.Results: In a logistic regression analysis for predictors of composite endpoint of coronary mortality and morbidity, individually, DBP was not significantly and independently associated, while SBP was an independent risk predictor in both genders (relative risk [RR] 1.016). When two of three blood pressure components were entered jointly into the multivariable model, PP had a value inferior to that of SBP among men and women, but was of greater value than DBP in men in predicting both the composite endpoint and death from CHD. Among women, the predictive values of PP and DBP were similar. Within the categories of SBP ⩾ 120 mmHg in men, PP contributed significantly to the predictive power of SBP in overall CHD risk over and above that supplied by SBP, whereas DBP remained noncontributory.Conclusion: Although inferior to the predictive power of SBP, PP was an important determinant of CHD risk in a population of a diverse age span and a better predictor than DBP in men.
Pulsus paradoxus in cardiac tamponade: A pathophysiologic continuum
Authors: Swami Ashwin , Spodick David H. 
Published: June 2007

AbstractPulsus paradoxus has interested physicians for more than a century. Since McGregor's comprehensive New England Journal of Medicine article in 1979,1 there have been no updated reviews; accordingly, we review pulsus paradoxus based on the clinical and physiologic literature and personal experience.2
Bone marrow stimulation and left ventricular function in acute myocardial infarction
Authors: Tomoda Haruo , Aoki Naoto 
Published: June 2007

AbstractBackground: Experimental studies have demonstrated that bone marrow stem cells can migrate into peripheral blood and regenerate damaged myocardium.Hypothesis: Bone marrow stimulation might improve myocardial functional recovery after acute myocardial infarction (AMI).Methods: In all, 104 consecutive patients with anterior wall AMI treated by primary coronary angioplasty and stenting within 12 h after onset, and who underwent left ventriculography on admission and 6 months after discharge, were studied. Among these, 23 patients (Group 1) demonstrated transient appearance of immature blood cells including myelocytes, promyelocytes, and myeloblasts during hospital stay. Thirty‐eight matched patients in whom no immature blood cells were detected were studied as a control group (Group 2).Results: There was no significant difference in baseline characteristics between the two groups. There was no significant difference in left ventricular ejection fraction (EF) on admission between Group 1 (33 ± 12%) and Group 2 (34 ± 8%). In contrast, EF was significantly better in Group 1 (47 ± 12%) than in Group 2 (40 ± 10%, p = 0.016) 6 months after discharge.Conclusion: The study suggests significantly greater improvement in left ventricular function in patients with AMI with sign of bone marrow stimulation than in matched patients with no sign of bone marrow stimulation.
Thyroid function is associated with presence and severity of coronary atherosclerosis
Authors: Auer J. , Berent R. , Weber T. , Lassnig E. , Eber B. 
Published: June 2007

AbstractBackground: Overt hypothyroidism has been found to be associated with cardiovascular disease. Moreover, subclinical hypothyroidism is a strong indicator of risk for aortic atherosclerosis and myocardial infarction.Hypothesis: We hypothesized that variation of thyroid function within the normal range may influence the presence and severity of coronary atherosclerosis.Methods: We studied a total of 100 consecutive men and women (59 men, 41 women, age 63.7 ± 11.0 years) who underwent coronary angiography. Blood was tested for serum thyrotropin concentrations and for free tri‐iodothyronine and free thyroxine concentrations. In addition to the assessment of thyroid function, conventional risk factors for coronary artery disease (CAD), clinical characteristics, serum lipid levels, fasting total homocysteine, and angiographic results of coronary artery assessment were obtained. Two experienced cardiologists blinded to clinical and laboratory data reviewed the cine‐films. The severity of CAD was scored as 0 for those with smooth normal epicardial coronary arteries, 0.5 for plaquing (< 50% diameter stenosis), and 1,2, or 3 for those with single‐, double‐, or triple‐vessel epicardial coronary artery stenosis of > 50%, respectively.Results: The severity of CAD was scored as 0,0.5,1,2, and 3 in 14,26,25,22, and 13 patients, respectively. Higher levels of serum‐free thyroid hormone concentrations were associated with decreased severity of coronary atherosclerosis. Serum‐free tri‐iodothyronine was 2.99 ±0.33 pg/ml in patients with a CAD severity score of 0 to 1 and 2.74 ± 0.49 pg/ml in patients with CAD severity scores of 2 and 3 (p <0.01). Moreover, serum‐free thyroxine concentrations showed a trend toward higher levels in patients with CAD severity score 0 to 1 compared with patients with CAD severity scores 2 and 3 (11.65 ± 1.87 pg/ml vs. 10.9 ± 2.3 pg/ml; p = 0.09). Higher levels of serum thyrotropin concentrations were associated with increased severity of coronary atherosclerosis (1.37 ± 1.02 mU/l vs. 1.98 ± 2.13 mU/l in patients with CAD severity score 0 to 1 versus CAD severity scores 2 and 3; p=0.049). When grouped into three subsets according to their serum free tri‐iodothyronine levels (<2.79, 2.8 to 3.09, and ± 3.1 pg/ml), the prevalence of CAD scores 2 and 3 was significantly higher in the subset of patients with low serum free tri‐iodothyronine levels (48.5%) than in the subsets of patients with medium or high tri‐iodothyronine concentrations (32.25 and 25%, respectively, p for trend < 0.05).Conclusion: These data in patients referred for coronary angiography suggest that variation of thyroid function within the statistical normal range may influence the presence and severity of coronary atherosclerosis.
Mortality and rate of stroke or embolism in atrial fibrillation during long‐term follow‐up in the embolism in left atrial thrombi (ELAT) study
Authors: Stöllberger Claudia , Chnupa Pavel , Abzieher Christine , Länger Thomas , Finsterer Josef , Klem Igor , Hartl Elisabeth , Wehinger Cornelius , Schneider Barbara 
Published: June 2007

AbstractBackground: Patients with atrial fibrillation (AF) have a higher mortality and risk of stroke/embolism than patients with sinus rhythm.Hypothesis: The aim of the study was to assess the association of clinical and echocardiographic characteristics with mortality and stroke/embolism and the use of antithrombotic medicationin the year 2000 in patients who participated 1990‐1995 in the Embolism in Left Atrial Thrombi (ELAT) study.Methods: The study included 409 outpatients with non‐rheumatic AF (62 ± 12 years, 36% women, 39% intermittent AF). Patients with thrombi received anticoagulation, patients without thrombi aspirin until follow‐up in 1995; thereafter, anticoagulation according to clinical risk factors was recommended. Primary events were death and secondary events were stroke/embolism. All patients were contacted during the year 2000.Results: Mean follow‐up was 102 months. Mortality was 4%/year; the cause of death was cardiac (n=84), fatal stroke (n = 26), malignancy (n = 23), sepsis (n = 5), and unknown (n = 24). Multivariate analysis identified age (p < 0.0001), heart failure (p = 0.0013), and reduced left ventricular systolic function (p = 0.0353) as predictors of mortality. Stroke/embolism occurred in 83 patients, with a rate of 3%/year. Multivariate analysis identified age (p = 0.0006) and previous stroke (p = 0.0454) as predictors of stroke/embolism. In the year 2000, 51 (21%) of the 247 surviving patients received no antithrombotic medication, 88 received (36%) oral anticoagulants, 102 (41%) acetylsalicylic acid, and 6 (2%) low‐molecular heparin.Conclusions: Therapy for heart failure and oral anticoagulation in AF should be seriously considered, especially in elderly patients and in those with previous stroke.
Patients with uncontrolled hypertension or concomitant hypertension and benign prostatic hyperplasia
Authors: Zusman Randall 
Published: June 2007

AbstractAt optimal doses, individual antihypertensive agents lower blood pressure (BP) by an average of 10 mmHg. Many patients with hypertension, including those with stage 3 hypertension, target organ damage, or those at high risk for cardiovascular events and/or adverse effects of high‐dose monotherapy, are likely to require combination antihypertensive drug treatment to achieve the recommended systolic/diastolic BP (< 140/90 mmHg). Two studies, a placebo‐controlled, double‐blind trial (n = 70) and a community‐based, open‐label trial (n = 491) investigated the antihypertensive efficacy of doxazosin, a long‐acting selective α1‐adrenoceptor blocker, as add‐on therapy for uncontrolled hypertension with other antihypertensive medications and in patients with concomitant benign prostatic hyperplasia (BPH) and treated but inadequately controlled hypertension, respectively. The addition of doxazosin to baseline antihypertensive medication(s) significantly lowered BP and had a significantly positive effect on the serum lipid profile. In patients with concomitant BPH, doxazosin significantly improved all BPH symptom scores, regardless of initial symptom severity. Add‐on doxazosin sufficiently reduced systolic/diastolic BP such that many patients whose hypertension was previously uncontrolled by other antihypertensive medications were able to reach goal BP (< 140/90 mmHg). Doxazosin as add‐on therapy was well tolerated. In conclusion, doxazosin as add‐on therapy improves BP control in hypertensive patients not at goal BP and improves lower urinary tract symptoms in patients with concomitant BPH.
The accuracy of electrocardiographic Q waves for the detection of prior myocardial infarction as assessed by a novel standard of reference
Authors: Hurst Willis , Sandler Leonard L. , Pinnow Ellen E. , Lindsay Joseph 
Published: June 2007

AbstractBackground: The electrocardiogram (ECG) is valuable for the identification of prior myocardial infarction (MI) in individuals participating in epidemiologic studies or undergoing screening examinations. Although the Minnesota Code, a set of criteria for the interpretation of ECGs in such situations, is commonly used to identify MI in these settings, its accuracy is incompletely understood.Hypothesis: We sought to test the accuracy of the Minnesota Code Q and QS criteria for MI against a new standard of reference, the presence of a perfusion defect on a resting myocardial scintigraphic image.Methods: The resting myocardial scintigrams of all patients studied in our nuclear cardiology laboratory during 7 consecutive months were screened for the presence of perfusion defects. For each patient with such a defect, two individuals examined on the same day, who had no perfusion defect, were selected as controls. Electrocardiograms recorded within 30 days of the scintigraphy were read blindly by two of the authors using the Minnesota Code criteria for Q or QS waves indicative of MI.Results: For 214 patients selected on the basis of their scintigraphic findings, a satisfactory ECG recorded within a month of the scintigraphy was also available. The overall sensitivity of the Q or QS criteria was 0.58 and the specificity was 0.75. As might be expected when only the most stringent criteria were applied, sensitivity was least and the specificity best.Conclusions: As in previous studies, in which necropsy material served as the standard of reference, sensitivity of the Q and QS criteria contained in the Minnesota Code is relatively modest and specificity is reasonable but not outstanding.
Relation of lateral ST‐segment elevation pattern to myocardial salvage in patients with recanalized anterolateral acute myocardial infarction
Authors: Kosuge Masami , Kimura Kazuo , Ishikawa Toshiyuki , Endo Tsutomu , Sugano Teruyasu , Nakagawa Takeshi , Hibi Kiyoshi , Nakatogawa Tomoyori , Okuda Jyunn , Toda Noritaka , Tsukahara Kengo , Takamura Takeshi , Tahara Yoshio , Umemura Satoshi 
Published: June 2007

AbstractBackground: Although anterior acute myocardial infarction (AMI) with ST‐segment elevation in lateral leads is associated with a poor prognosis, the significance of the pattern of lateral ST‐segment elevation has not been examined.Hypothesis: The aim of the study was to examine the relation of the pattern of lateral ST‐segment elevation to myocardial reperfusion and infarct size in patients with AMI.Methods: We studied 111 patients who had a first AMI presenting with anterolateral ST‐segment elevation and Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow of the left anterior descending coronary artery within 6 h from symptom onset. Patients were classified into two groups according to the pattern of lateral ST‐segment elevation on the admission electrocardiogram: Group 1, 42 patients with equivalent or greater ST‐segment elevation in lead I than in lead aVL, and Group 2, 69 patients with lesser ST‐segment elevation in lead I in than in lead aVL. Left ventricular ejection fraction (LVEF) was measured by predischarge left ventriculography.Results: There were no differences between the two groups in age, gender, time from onset to recanalization, culprit lesion, or collateral development. Group 1 patients had a higher probability of impaired myocardial reperfusion as indicated by a myocardial blush grade of 0 or 1 after recanalization, a higher peak creatine kinase level, and a lower LVEF than Group 2 patients (p = 0.0001, respectively).Conclusions: We conclude that equivalent or greater ST‐segment elevation in lead I than in lead aVL is associated with impaired myocardial reperfusion and less myocardial salvage in patients with recanalized AMI who present with anterolateral ST‐segment elevation on the admission electrocardiogram.
Ethnic differences in utilization of invasive cardiac procedures and in long‐term survival following acute myocardial infarction
Authors: Mak Koon‐Hou , Kark Jeremy D. , Chia Kee‐Seng , Tan Caren , Foong Bok‐Huay , Chew Suok‐Kai 
Published: June 2007

AbstractBackground: Ethnic differences in coronary mortality have been documented, and South Asians from the Indian subcontinent are particularly vulnerable.Hypothesis: This study sought to determine whether there was a difference in the utilization of invasive cardiac procedures and long‐term mortality in survivors of myocardial infarction (MI) among Chinese, Malays, and South Asians in Singapore.Methods: All MI events in the country were identified and defined by the Singapore Myocardial Infarction Register, which uses modified procedures of the World Health Organization MONICA Project. Information on utilization of coronary angiography, coronary angioplasty, coronary artery bypass graft, and survival was obtained by data linkage with national billing and death registries. Hazard ratios (HR) were calculated using the Cox proportional hazards model with adjustment for baseline characteristics.Results: From 1991 to 1999, there were 10,294 patients who survived ≥3 days of MI. Of these, 40.6% underwent coronary angiography and 16.5% a revascularization procedure ≤28 days. Malays received substantially less angiography (34.0%) and revascularization (11.4%) than Chinese (41.9%, 17.9%) and South Asians (40.0%, 16.3%). The ethnic disparity increased during the 1990s, particularly in the performance of coronary angiography (p = 0.038). While fatality declined during the study period for Chinese and South Asians, the rate remained stable for Malays. After a median follow‐up period of 4.1 years, survival was lowest among Malays (adjusted HR, 1.28; 95% confidence interval, 1.15‐‐1.42, compared with Chinese).Conclusion: Ethnic inequalities in invasive cardiac procedures exist in Singapore and were exacerbated in the 1990s. Inequalities in medical care may contribute to the poorer long‐term survival among Malays.
The importance of gender on coronary artery size: In‐vivo assessment by intravascular ultrasound
Authors: Kim Sang‐Gon , Apple Sue , Mintz Gary S. , McMillan Taya , Caños Daniel A. , Maehara Akiko , Weissman Neil J. 
Published: June 2007

AbstractBackground: It remains controversial whether women have smaller coronary arteries than men because of a gender‐specific trait, or whether the observed differences are primarily due to a difference in body size. Intravascular ultrasound (IVUS), with its ability to provide unique coronary images that allow precise measurement of arterial size in vivo, is ideally suited to address this issue.Hypothesis: Female gender, independent of body size, is associated with smaller coronary artery size as measured by intracoronary ultrasound.Methods: Intravascular ultrasound images of normal left main arteries were identified retrospectively from a single center database. Associations between demographic and clinical characteristics (including body size) and left main coronary dimensions were assessed with univariant and multivariate regression analyses.Results: We identified 257 completely normal left main arteries. Mean left main arterial areas were smaller in women than in men (17.2 vs. 20.6 mm2, p < 0.001), as were mean luminal areas (14.0 vs. 16.7 mm2, p < 0.001). By multiple regression analysis, the independent predictors of left main lumen were body surface area (p < 0.001) and gender (p = 0.003).Conclusions: Body surface area and gender are both independent predictors of coronary artery size, although body size has a greater influence than gender.
Coenzyme Q10 in patients with end‐stage heart failure awaiting cardiac transplantation: A randomized, placebo‐controlled study
Authors: Berman Marius , Erman Arie , Ben‐Gal Tuvia , Dvir Dan , Georghiou Georgios P. , Stamler Alon , Vered Yaffa , Vidne Bernardo A. , Aravot Dan 
Published: June 2007

AbstractBackground: The number of patients awaiting heart transplantation is increasing in proportion to the waiting period for a donor. Studies have shown that coenzyme Q10 (CoQ10) has a beneficial effect on patients with heart failure.Hypothesis: The purpose of the present double‐blind, placebo‐controlled, randomized study was to assess the effect of CoQ10 on patients with end‐stage heart failure and to determine if CoQ10 can improve the pharmacological bridge to heart transplantation.Methods: A prospective double‐blind design was used. Thirty‐two patients with end‐stage heart failure awaiting heart transplantation were randomly allocated to receive either 60 mg U/day of Ultrasome™‐‐‐CoQ10 (special preparation to increase intestinal absorption) or placebo for 3 months. All patients continued their regular medication regimen. Assessments included anamnesis with an extended questionnaire based partially on the Minnesota Living with Heart Failure Questionnaire, 6‐min walk test, blood tests for atrial natriuretic factor (ANF) and tumor necrosis factor (TNF), and echocardiography.Results: Twenty‐seven patients completed the study. The study group showed significant improvement in the 6‐min walk test and a decrease in dyspnea, New York Heart Association (NYHA) classification, nocturia, and fatigue. No significant changes were noted after 3 months of treatment in echocardiography parameters (dimensions and contractility of cardiac chambers) or ANF and TNF blood levels.Conclusion: The administration of CoQ10 to heart transplant candidates led to a significant improvement in functional status, clinical symptoms, and quality of life. However, there were no objective changes in echo measurements or ANF and TNF blood levels. Coenzyme Q10 may serve as an optional addition to the pharmacologic armamentarium of patients with end‐stage heart failure. The apparent discrepancy between significant clinical improvement and unchanged cardiac status requires further investigation.