bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quantification of mitral regurgitation—Comparison of the proximal flow convergence method and the jet area method
Authors: Grossmann Georg , Giesler Martin , Schmidt Arnold , Kochs Matthias , Wieshammer Siegfried , Felder Carmen , Höher Martin , Hombach Vinzenz 
Published: February 2009

AbstractA total of 92 patients with mitral regurgitation (age 63 ± 13 years, 51 men, 41 women), quantified by angiography, were studied using color‐flow Doppler imaging of isovelocity surface areas in the flow convergence region proximal to the regurgitant orifice (PISAs) and of the regurgitant jet in the left atrium. The PISA radii for the flow velocities (aliasing borders) of 28 and 41 cm/s, jet area, jet length, and relation of jet area to left atrial area were measured. A proximal flow convergence region was imaged in 98% (85%) of all patients for a flow velocity of 28 (41) cm/s. A regurgitant jet could be visualized in all patients. The PISA radii for both flow velocities correlated more closely with the angiographic grade (rsp = 0.79 for both flow velocities) than the jet area (rsp = 0.43), jet length (rsp = 0.39), and relation of jet area to left atrial area (rsp = 0.37). A correct differentiation of grade I‐II from grade III‐IV mitral regurgitation was provided in 95% of the patients by the proximal flow convergence method for both flow velocities and in up to 78% of the patients by the jet area method using the uncorrected jet area. The PISA radii correlated weakly with the parameters from the regurgitant jet (r = 0.5–0.58). It can be concluded that the proximal flow convergence method and the jet area method reach comparable sensitivity for the detection of mitral regurgitation. The proximal flow convergence method is more suitable than the jet area method to determine the severity of mitral regurgitation and only it provides a reliable method to differentiate between grade I–II and grade III–IV mitral regurgitation.
Lipoprotein (a) is increased in acute coronary syndromes (unstable angina pectoris and myocardial infarction), but it is not predictive of the severity of coronary lesions
Authors: Brunelli Claudio , Spallarossa Paolo , Balbi Manrico , Barbara Cristina , Pastorini Carlo , Caponnetto Salvatore , Bertolini Stefano , Masturzo Paola , Lantieri Pasquale B. 
Published: February 2009

AbstractLipoprotein (a) [Lp(a)] concentrations were determined in 365 patients undergoing coronary angiography for stable angina (n = 159), unstable angina (n = 99), recent myocardial infarction (n = 45), and nonischemic heart disease (cardiomyopathy or valvular disease, n = 62, non‐IHD). Mean ± SD and median Lp(a) concentrations in stable angina (29.9 ± 29.2; 22 mg/dl) did not differ from those in non‐IHD (26.9 ± 26.3; 17), but were significantly lower than in patients with unstable angina (52.7 ± 36.6; 58) and myocardial infarction (44.8 ± 36.4; 34) (p < 0.01). Coronary angiography revealed that 261 patients, including 4 patients in the non‐IHD group, had significant (≥ 50%) coronary lesions. Lp(a) was higher in patients with (41 ± 35; 32) than in those without (28 ± 27; 19) angiographic evidence of significant coronary stenosis (p < 0.05) and showed a weak univariate correlation with the angiographic index (Total Score) of the severity of the disease (r = 0.106; p < 0.05). However, in the subgroup of 303 patients with stable/unstable angina or myocardial infarction, Lp(a) was predictive neither of angiographic presence nor of severity of coronary disease. Patients were then ranked according to the Total Score values. Among patients with comparable angiographic severity of coronary artery disease, Lp(a) appeared to be remarkably higher in patients with acute ischemic syndromes (unstable angina, myocardial infarction) than in patients with stable angina. In conclusion, Lp(a) was roughly twice as high in acute (unstable angina, myocardial infarction) than in chronic (stable angina) ischemic syndromes, but there was no difference between chronic stable angina and non‐IHD. Serum level determination of Lp(a) made a poor contribution in predicting the extent of coronary artery disease.
The effect of body position on a free‐floating ball thrombus as observed by transesophageal echocardiography
Authors: Miyamoto Shinii , Hadama Tetsuo , Mori Yoshiaki , Shigemitsu Osamu , Sako Hidenori , Soeda Tohru , Yoshimatsu Toshihide , Uchida Yuzo 
Published: February 2009

AbstractTwo cases of free‐floating left atrial ball thrombi (FLABT) in association with mitral stenosis were observed by transesophageal echocardiography (TEE). Our report describes the relation between body position and thrombi kinetics. Both cases demonstrated similar kinetics. In the supine and right lateral decubitus positions, the thrombi recoiled from and sometimes became entrapped within the mitral valve. In the sitting and left lateral decubitus positions, the thrombi appeared to be nearly fixed and did not contact with the mitral valve. Our results indicate that the latter two positions prevent thrombi disintegration and incarceration into the mitral valve. Finally, TEE is an extremely useful tool for assessing the safest position for individuals with FLABT.
Assessment of cardiac risk in noncardiac surgery
Authors: Forgosh Les B. , Movahed Assad 
Published: February 2009

AbstractSurgical techniques have been refined so that complications directly resulting from surgical procedures are relatively small. However, with the high prevalence of coronary artery disease in the United States, many surgical patients have concomitant coronary artery disease. Anesthesia as well as the surgical procedure induce stresses on the heart and circulatory system which could result in perioperative cardiac morbidity and mortality. Assessing patients prior to surgical procedures by history, physical examination, laboratory data, and newer cardiovascular diagnostic procedures can stratify the cardiac risk and help to predict the incidence of perioperative cardiac morbidity and mortality. If great risk exists, an alternative therapy or cancellation of the surgical procedure may be considered. In certain subgroups of patients, coronary artery revascularization, valvular heart surgery, or beginning medical therapy of the underlying cardiac pathology could be performed prior to the surgical procedure. If this cannot be arranged for the high‐risk patients, more intensive and invasive hemodynamic monitoring and optimal medical management perioperatively might reduce cardiac complications.
Intracardiac thrombi: Frequency, location, etiology, and complications: A morphologic review—Part III
Authors: Waller Bruce F. , Mclaughlin Todd , Grider Larry , Rohr Todd M. , Taliercio Charles P. , Fetters Julie 
Published: February 2009

AbstractIntracardiac thrombus may develop as a consequence of multiple underlying cardiac disorders. Left ventricular (LV) aneurysm following acute myocardial infarction has been associated with intra‐aneurysmal thrombus and emboli. Part III of this 5‐part article on intracardiac thrombus focuses on the frequency and consequence of thrombus associated with LV aneurysm.
Pitfalls in the diagnosis and management of papillary muscle rupture: A study of four cases and review of the literature
Authors: Samman Bashar , Korr Kenneth S. , Katz Alan S. , Parisi Alfred F. 
Published: February 2009

AbstractFour cases of papillary muscle rupture occurring in the setting of acute myocardial infarction are presented, which illustrate the following points: the diagnosis may not be apparent at presentation, a mitral regurgitant murmur may be absent, transesophageal echocardiography may establish the diagnosis when transthoracic echocardiography does not, and appropriate surgical correction can lead to excellent functional recovery.
Non‐visualized left anterior descending artery revealed on selective conus artery catheterization
Authors: Feld Steven , Epstein Menashe , Ayzenberg Oded , Caspi Avi 
Published: February 2009

AbstractCardiac catheterization of a man with severe angina and anterior ischemia on exercise testing with perfusion imaging demonstrated normal anterior wall motion on resting left ventriculography, but failed to visualize the left anterior descending (LAD) or conus artery on left and right coronary angiography. Selective contrast injection of a large conus artery originating from a separate ostium in the right aortic sinus demonstrated extensive collateral circulation to an LAD occluded at its origin from the left main coronary artery, thus providing essential information for subsequent patient management.
Transesophageal echocardiography in diagnosing cardioembolic stroke
Authors: Husain Aatif M. , Alter Milton 
Published: February 2009

AbstractStroke is a disease with high morbidity and mortality that afflicts older people. The most common type of stroke is ischemic, and 15–20% of these strokes are cardioembolic. Because clinical features are not very specific for the type of stroke, diagnostic aides are needed to identify the mechanism of stroke so that appropriate therapy can be initiated. Numerous studies have shown that transesophageal echocardiography (TEE) is a more sensitive tool for diagnosing cardioembolic stroke than transthoracic echocardiography (TTE). However TTE and TEE are still considered complementary as they both provide unique information. The many abnormalities that can be identified by TEE and their therapy are discussed in this review, along with indications and complications of TEE. TEE has demonstrated that cardioembolic causes of stroke are much more common than previously thought. With a more precise diagnosis, appropriate therapy can be provided to help prevent cardiogenic stroke.
Vascular dynamics in isolated systolic arterial hypertension
Authors: Meaney Eduardo , Soltero Enrique , Samaniego Virginia , Alva Felix , Moguel Rafael , Vela Agestin , Gonzalez Vidal 
Published: February 2009

AbstractWith a growing elderly population, the incidence of isolated systolic hypertension (ISH) has increased. This study characterizes dynamic vascular changes that occur with advanced age and with ISH. Fifty‐five healthy individuals and seven with ISH were distributed in seven age groups from the second to the seventh decade. An index of aortic stiffness (ΔP/ΔV) was derived using a mercury sphygmomanometer to obtain pulse pressure, and ultrasonographic measurements were used to estimate aortic volumes applying the “cylinder formula.” The mathematic derivation of this formula is explained in detail. Pulse pressure showed no significant change with age, but showed a significant increase with ISH. A decrease in volume change from systole to diastole was found with advanced age. Normotensive subjects aged 65 ± 2 years had a 2.6‐fold increase in aortic stiffness compared with young individuals. Elderly patients with ISH had a 7‐fold increase in aortic stiffness compared with Group 1 (15 ± 2 years) (p<0.001) and a 2.7‐fold increase compared with Group 6 (normotensive subjects aged 65 ± 2 years). A strong correlation between systolic pressure and arterial stiffness was observed (r = 0.953) (p<0.001). The proposed stiffness index was compared with the one described by Hirai, obtaining a high correlation, that is, r = 0.989 (p<0.001). When compared with Stefanadis's index of distensibility, our index showed a correlation of r = 0.932 (p<0.003). It is concluded that while systolic pressure is a main determinant of arterial stiffness, the ΔP/ΔV is a more sensitive method to estimate dynamic changes in elastic arteries such as the aorta.
Visual estimation of ejection fraction by two‐dimensional echocardiography: The learning curve
Authors: Akinboboye Olakunle , Sumner John , Gopal Aasha , King Donald , Shen Zhanging , Bardfeld Philip , Blanz Lisa , Brown Edward J. 
Published: February 2009

AbstractOur purpose was to determine the learning curve of visual estimation of ejection fraction (EF) by echocardiography. Sixty consecutive patients, who had clinically indicated echocardiography and radionuclide ventriculography (RVG) within 1 month were selected. Five standard views were reviewed independently by a first‐year cardiology fellow, a private cardiologist, and an experienced echocardiographer. Observers were given feedback of the RVG EFs immediately after estimating the EF on each study. To assess the effect of learning, the echocardiographic studies were divided into three groups of 20 and were read successively by each observer. A statistical comparison of the two methods was performed for each group. The correlation between the two techniques for the first group of studies was marginal. There was a significant improvement in the correlation with subsequent groups. The correlation did not change significantly with the last group of studies compared with the second group. In conclusion, visual estimation of EF by two‐dimensional echocardiography can be learned, with a learning curve of approximately 20 studies if immediate feed‐back is available.
Echocardiographic diagnosis of partial anomalous pulmonary venous connection from right upper lobe to the coronary sinus
Authors: Otsuji Y. , Kisanuki A. , Arima S. , Shimokawa S. , Taira A. , Tanaka H. 
Published: February 2009

AbstractA 36‐year‐old woman was admitted because of an enlarged right heart. Echocardiographic examination revealed an abnormal vessel connecting to the dilated coronary sinus. The abnormal vessel traveled in the direction from the right axillary to the left epigastric region. Partial anomalous pulmonary venous connection (PAPVC) from the right upper lobe to the coronary sinus was initially considered as a possible diagnosis by echocardiography. At surgery, diagnosis of an isolated PAPVC of the right upper pulmonary vein to the coronary sinus was confirmed.
Continuing medical education
Authors: Kaplan Samuel , Schlant Robert C. 
Published: February 2009

AbstractCongenital Heart Disease in Adults: A Practical Guide By Andrew Redington, Darryl Shore, and Paul Oldershaw W. B. Saunders Company, Ltd., London (1994) 270 pages, illustrated, $59.00 ISBN: 0–7020–1913–5The History of Cardiology By Louis J. Acierno The Parthenon Publishing Group, London (1994) 758 pages, illustrated, 98.00 ISBN: 1–85070–339–6
Functional significance of alterations in cardiac contractile protein isoforms
Authors: Kitsis Richard N. , Scheuer And James 
Published: February 2009

AbstractMultiple closely related, yet distinct, isoforms exist for each of the cardiac contractile proteins. The isoform composition of the heart changes in response to developmental and physiologic cues. This paper reviews the molecular basis for cardiac contractile protein isoform diversity and the functional consequences of isoform shifts.
This section edited by Marek Malik, M. D. Heart rate variability during repeated incremental head‐up tilt discloses time dependence of individual autonomic dynamics
Authors: Bootsma Marianne , Swenne Cees A. , Bruschke Albert V. G. 
Published: February 2009

AbstractAccording to the Rosenblueth‐Simeone model, the heart rate (HR) is proportional to the sympathovagal balance. The individual proportionality constant is the intrinsic HR, which can be determined only invasively. The percentage low‐frequency spectral HR variability power, relative to the low‐ plus high‐frequency spectral power (%LF) has been raised as a noninvasive alternative. We previously studied young healthy male subjects, in whom gradual autonomic changes were induced by incremental head‐up tilt (0–10–20–30–40–45–50–55–60–65–70–75–80° ). At each tilt angle we computed HR and %LF. Linear regressions of %LF on HR, characterizing individual autonomic dynamics, confirmed that, within a subject, changes in %LF were proportional to changes in HR. For the current study, we made repeated measurements in 19 subjects after 1 to 8 months. in six subjects, the session 1 and session 2 regression lines differed significantly (t‐test, p < 0.05), demonstrating the time dependence of the autonomic dynamics. in such cases, similar HR values on different days are to be associated with different %LF values. We also determined the reproducibility of the supine HR and %LF values. For all 19 subjects, the coefficients of variation were 7 and 22%, respectively: HR reproduces better than %LF. Hence, time‐dependent autonomic dynamics contribute systematically to the inferior reproducibility of %LF.
Exercise‐induced syncope and holter‐documented asystole in an endurance runner with moderate aortic stenosis
Authors: Shapira Yaron , Kusniec Jairo , Birnbaum Yochai , Strasberg Boris 
Published: February 2009

AbstractThe case of an endurance runner with moderate aortic stenosis, who had recurrent syncope, is reported. A Holter recording during syncope revealed asystole lasting 57 s. Head‐up tilt table test with isoproterenol was abnormal. No important abnormality was found in sinus or atrioventricular nodal functions. It was postulated that the syncope was due to exaggerated left ventricular baroreflex response, probably aggravated by the increased vagal tone in an endurance runner. The patient was given a beta‐adrenergic blocker, and a pacemaker was implanted because of the profound cardio‐inhibi‐tory response. The arguments for this approach are discussed.
Giant right coronary artery aneurysm with fistulous connection to the coronary sinus: Diagnosis and management
Authors: Shammas Nicolas W. , Murphy Gerald W. , Risher William H. , Shapiro Janine R. , Latouf Sean E. , Pomerantz Richard M, 
Published: February 2009

AbstractThis report describes the case of a giant aneurysmal right coronary artery connecting to the coronary sinus near its opening into the right atrium in a 70‐year‐old woman who presented with a recent onset of congestive heart failure. By coincidence, a secundum atrial septal defect was also present. The diagnosis and surgical management of this uncommon pathology are described.
Infarct size limitation: Acute N‐acetylcysteine defense (ISLAND trial): Preliminary analysis and report after the first 30 patients
Authors: Šochman Jan , Vrbská Jana , Musilová Blanka , Roček Miroslav 
Published: February 2009

AbstractOur previous experimental research and initial clinical observations regarding the use of N‐acetylcysteine in the treatment of ischemic and reperfusion injury in acute myocardial infarction gave rise to a study entitled the Infarct Size Limitation: Acute N‐acetylcysteine Defense (ISLAND) trial. Today, this randomized, echocardiographically and angio‐graphically controlled study includes the first 30 patients with a first anterior wall myocardial infarction: Group A (n = 10) consisting of patients with successful recanalization of the in‐farct‐related left anterior descending artery by streptokinase without any further treatment, Group B (n = 10) consisting of patients with failed infarct‐related artery recanalization, and Group C (n = 10) comprising patients who had successful streptokinase‐induced recanalization of the left anterior descending artery plus N‐acetylcysteine administration at a dose of 100 mg/kg body weight. The parameters monitored in our study include changes in global and regional left ventricular ejection fraction of the infarct‐related segment using echocar‐diography and, using electrocardiograms and the Wagner QRS scoring system, the amounts of acutely jeopardized and finally infarcted myocardium. In Group A, global left ventricular ejection fraction rose nonsignificantly within 2 weeks from 37.5 ± 9.6% to 38.5 ± 13.8%; it declined significantly in Group B from 36.2 ± 6.1% to 30.1 ±6.7% (p < 0.05), while it considerably improved in Group C from 41.7 ± 4.1 % to 59.6 ±8.1 % (p < 0.001). Regional left ventricular ejection fraction changed significantly only in Group C: from — 4.5 ± 27.3 to 45.6 ± 16.3 (p < 0.001). In Group A, in which the amount of acutely jeopardized myocardium was 21.7 ± 7.2, infarction actually occurred in 20.4 ± 9.7% (practically no myocardial salvage). In Group B, risk area was 18.1 ± 4.3%, but infarct size rose to a resulting 29.1 ±6.0%. Significant myocardial salvage was accomplished only in Group C: of 26.2 ±8.1% of jeopardized myocardium, infarct size was reduced to 10.8 ± 7.1% (salvage by 58.8%). Also, basic division of patients by therapy showed that, although those with nonidentical findings on their coronary arteries were included into the same groups, patients treated with streptokinase plus N‐acetylcysteine had significantly more favorable values of the monitored parameters than those treated with streptokinase alone. We conclude our interim analysis suggests that N‐acetylcysteine has a beneficial effect, reducing the functional and structural impacts of myocardial infarction.
Chronic‐intermittent urokinase therapy in patients with end‐stage coronary artery disease and refractory angina pectoris—A pilot study
Authors: Schoebel F. C. , Leschke M. , Jax T. W. , Stein D. , Strauer B. E. 
Published: February 2009

AbstractPatients with coronary artery disease and severe angina pectoris refractory to conventional medical treatment (beta Mockers, nitrates, calcium antagonists) and without the option for invasive revascularization procedures represent an increasing clinical problem. For these patients, chronic‐intermittent urokinase therapy has been developed. Twenty patients received 500,000 IU urokinase as intravenous bolus injection 3 times a week over a period of 12 weeks. The average reduction in anginal symptoms in 19 patients was 74%, from 23.5 ± 10.8 to 5.2 ±4.8 events/week (p< 0.001); 1 patient was excluded from further treatment because of an increase of > 66 % in anginal events. Fibrinogen decreased by 34% from 370 ± 57 to 244 ± 44 mg/dl (p< 0.001), the rheological parameters plasma viscosity by 6.1 % from 1.39 ± 0.04 to 1.31 ± 0.03 mPas (< 0.001), and red blood cell aggregation by 18% from 13.9±2.4 to 11.2±2.2 (p<0.001). Exercise tolerance increased by 51%. Average ST‐segment depression decreased from 0.16 ±0.10 to 0.12 ± 0.09 (p<0.01). After 12 weeks of follow‐up, angina pectoris and fibrinogen levels were still significantly reduced compared with baseline values. Chronic‐intermittent urokinase therapy represents an effective anti‐ischemie and antianginal approach in patients with refractory angina pectoris and end‐stage coronary artery disease. Improvement of rheological blood properties and thrombolytic effects are likely therapeutic mechanisms.
Excessive myocardial contraction in vasovagal syncope demonstrated by echocardiography during head‐up tilt test
Authors: Lee Tsung‐Ming , Chen Ming‐Fong , Chao Chia‐Lun , Liau Chiau‐Suong , Lee Yuan‐Teh , Su Sheng‐Fang 
Published: February 2009

AbstractThe purpose of this study was to gain insight into the mechanism of vasovagal syncope and to test the efficacy of theophylline to prevent syncope. Twenty‐six patients with vasovagal syncope underwent two‐dimensional echocardiography and theophylline test during head‐up tilt test. A standard parastemal short‐axis view of echocardiography at the level of the papillary muscle was recorded to measure fraction shorting of the left ventricle, and left ventricular end‐diastolic and end‐systolic dimensions. Heart rate, blood pressure, and symptoms were recorded. There were three groups; Group 1: no syncope with and without isoproterenol (n = 5); Group 2: syncope only after the infusion of isoproterenol (n = 16); Group 3: syncope without isoproterenol (n = 5). Groups 2 and 3 proceeded to theophylline injection (250 mg). The study showed that the 80° tilt induced an increase in heart rate of 6.6 ± 4.0,12.4 ± 6.6, and 25.4 ± 4.5 beats/min in Groups 1,2, and 3, respectively (p < 0.05 in Groups 1 and 2, p < 0.05 in Groups 1 and 3). The addition of isoproterenol during posture change from supine to an 80° tilt made the significant change of fractional shortening from 0.4 ± 5% to 6 ± 13% in Group 2 (p = 0.05), compared with no significant change in Group 1. There were no significant differences in left ventricular end‐diastolic dimension and end‐systolic dimension in each group between baseline and isoproterenol infusion during posture change. Vasovagal syncope was associated with vigorous myocardial contraction, rather than with contraction against an empty left ventricle. The acute loading of theophylline was not effective in preventing vasovagal syncope.