bluuebunny/crossref_metadata_2025_split huggingface dataset:
24‐hour efficacy of once‐daily diltiazem in essential hypertension
Authors: Massie Barry M. , Der Elaine , Herman Theodore S. , Topolski Pat , Park Glen D. , Stewart William H. 
Published: February 2009

AbstractThe safety and effectiveness of a once daily formulation of diltiazem hydrochloride (diltiazem CD) in the treatment of essential hypertension was assessed in a total of 127 patients with supine diastolic blood pressures (DBP) of 95 to 110 mmHg randomized to diltiazem CD (n=61) or placebo (n= 66). Patients were titrated to doses of 120, 240, or 360 mg to achieve DBP reduction to less than 90 mmHg. At end study diltiazem CD changed trough supine SBP and DBP by −8.4± 1.7 (p=0.0009) and −8.6± 1.1 mmHg (p=0.0075), respectively. Heart rate was not significantly changed (−1.3 ±1.1 beats/min, p=0.4362). The average dose of diltiazem CD was 268 mg with 69% achieving a clinical response. A subset of 47 patients underwent ambulatory blood pressure monitoring to assess the consistency of the effect over the full 24‐h dosing interval. Diltiazem CD lowered DBP and SBP throughout the dosing interval. The overall side effect profile was similar to placebo. This study provides evidence of 24‐h efficacy of this new, once daily formulation of diltiazem.
Diagnostic value of technetium‐99m‐MIBI as a myocardial perfusion imaging agent: Comparison of long and short intervals between rest and stress injections
Authors: Magriñà Jordi , Bosch Xavier , Roig Eulàlia , Lopez Francisco Navarro , Garcia Alicia , Pons Francesca , Moragas Mercè , Setoain Jordi 
Published: February 2009

AbstractTo assess the diagnostic value of technetium‐99m‐MIBI (99mTc‐MIBI) as a myocardial perfusion imaging agent, and if rest and exercise scans could be performed on the same day, 21 patients with coronary artery disease were studied. Qualitative planar 201‐thallium (201T1) scans, coronary angiography, or both were also performed (median between studies 11 days). In 10 patients an injection of 740 mBq of 99mTc‐MIBI at stress was followed by a second injection of 740 mBq at rest 24 h later (long interval) (LI). In 11 patients injection of 370 mBq at rest was followed 3 h later by an injection of 740 mBq at stress (short interval) (SI). Exercise scans were performed to similar maximal work load (LI = 6.6±1.8 METs; SI = 6.3±1.7 METs; 201T1 = 6.8±1.2 METs; p = NS) and double product (LI = 19551±7370; SI = 19900±6797; 201T1 = 19965 ±5282; p = NS). Overall, 99mTc‐MIBI and 201T1 agreed in 92% of the patients tested and in 165 of 180 (92%) left ventricular segments in both 99mTc‐MIBI protocols using short and long intervals between injections. In 15 patients with significant stenosis, 99mTc‐MIBI correctly identified 13 patients (sensitivity of 87%). Thus, 99mTc‐MIBI is a useful imaging agent with similar diagnostic value as 201T1. In spite of its lack of myocardial redistribution, 99mTc‐MIBI rest and exercise scans performed on the same day seem to have a similar concordance rate with 201T1 as when performed on separate days.
Acoustic appearance of atrial septal aneurysm
Authors: Kautzner Josef , Bëlohlávek Marek , Holm Františ Ek V. , Munclinger Miroslav J. 
Published: February 2009

AbstractAtrial septal aneurysm in the otherwise normal heart is a very rare and usually asymptomatic condition. A midsystolic click was described as the only clinical manifestation so far. A low‐pitched early‐to‐midsystolic acoustic phenomenon in a 39‐year‐old woman corresponding with maximal leftward motion of the aneurysmatic interatrial septum during early systole is the subject of this case report. Our experience, plus review of the literature, supports the suggestion that atrial septal aneurysm should be considered in the interpretation of added systolic sounds.
Electrophysiologic studies in atrial flutter
Authors: Cosio Francisco G. , Löapezgil Maria , Goicolea Antonio , Arribas Fernando , John Camm A. 
Published: February 2009

AbstractThe clinical electrophysiologic approaches to atrial flutter (F) have been activation mapping and the observation of changes induced by programmed stimulation. Sequential endocardial activation mapping has recently yielded information indicating that common F is produced by a large right atrial (RA) reentry circuit, with counterclockwise rotation in the frontal plane, including the inferior vena cava in its center. Functional block in the crista terminalis and conduction slowing in the approaches to the atrioventricular node seem to be important to support reentry. F inscribing positive deflections in the inferior leads usually follows the same path, but in a clockwise direction. Atypical F may be produced by left atrial circuits. Atrial stimulation during F entrains the circuit, resetting it with each stimulus. Collision between antidromic and orthodromic activation during entrainment produces fusion that can be identified in the surface electrocardiogram. The last paced activation restarts F, unless circuit penetration has been enough to modify it by block or disorganization. Entrainment may result in F acceleration, with changes in activation sequence, suggesting a different type of reentry, possibly based on functional factors.
The usefulness of echocardiography in the surgical management of infants with congenital heart disease
Authors: Sharma Shiva , Anand Rajani , Kanter Kirk R. , Williams Willis H. , Dooley Kenneth J. , Jones David W. , Vincent Robert N. 
Published: February 2009

AbstractBetween January 1988 and August 1991, at The Children's Heart Center, Atlanta, 83 infants with congenital heart defects were diagnosed by echocardiography and underwent surgery without cardiac catheterization. The diagnostic categories included 46 infants with left heart obstructive lesions, 19 infants with cyanotic heart lesions, and 18 infants with miscellaneous lesions. Forty‐five infants (55%) underwent surgery under cardiopulmonary bypass. There were three errors in diagnosis, yielding a diagnostic accuracy of 95%. Many infants with congenital heart disease can be accurately and completely diagnosed by echocardiography and can safely undergo surgery without cardiac catheterization.
Acute ischemic exacerbation of rheumatic mitral regurgitation
Authors: Simpson Iain A. , Sneddon James , Millane Teri , Pepper John R. , Ward David E. 
Published: February 2009

AbstractThis report describes a patient who developed acute severe exacerbation of mild rheumatic mitral regurgitation caused by ischemia in the territory of a small, non‐dominant circumflex coronary artery without myocardial infarction.
New directions in myocardial perfusion imaging
Authors: Beller George A. 
Published: February 2009

AbstractIn recent years, substantial progress has been made in the field of nuclear cardiology. Pharmacologic stress perfusion imaging with intravenous administration of dipyridamole or adenosine provides comparable sensitivity and specificity values for detection of coronary artery disease (CAD) as exercise imaging and has been employed successfully for risk stratification prior to peripheral vascular or aortic surgery and after myocardial infarction. Detection of myocardial viability can be enhanced utilizing reinjection of a second dose of thallium‐201 (T1‐201) at rest after acquisition of redistribution images with the single photon emission computerized tomography (SPECT) technique. Imaging solely in the resting state with T1‐201 can also provide information concerning presence of viable myocardium in asynergic regions that are stunned or hibernating. New technetium‐99m (Tc‐99m) perfusion agents have emerged in the clinical setting and have provided excellent predictive value for detection of CAD in patients with chest pain and permit simultaneous assessment of function and regional blood flow. Tc‐99m Sestamibi, one of these agents, is also a valid marker of viability when assessing myocardial salvage after coronary reperfusion in acute myocardial infarction.
Late thrombotic obstruction of an aortic bioprosthetic valve: Successful treatment by oral anticoagulation
Authors: Juliard Jean‐Michel , Paillole Catherine , Dahan Michel , Gabriel Steg P. , Himbert Dominique , Aumont Marie‐Claude 
Published: February 2009

AbstractThrombotic obstruction of aortic bioprostheses is rare. Few cases have been reported involving the use of the Carpentier‐Edwards (CE) prosthesis, the Hancock bioprosthesis, or the Medtronic Intact porcine valve.1, 4 Thrombolytic therapy for mechanical valve thrombosis has been used frequently even though it is known to carry a high risk of embolism and recurrence.5 However, the use of this therapy was reported for the first time only recently,1 in a case of acute aortic thrombosis which occurred 3 1/2 months after bioprosthesis insertion. We report a case of late progressive thrombotic obstruction of a CE aortic valve 3 years after insertion. The case was successfully treated with Coumadin therapy, as confirmed by serial Doppler echocardiographic examinations and a 3‐year follow‐up.
Effects of intracoronary administration of nitroglycerin on contralateral intracoronary acetylcholine test results
Authors: Miwa Kunmisa , Fujita Masatoshi , Yamanishi Kazuto , Igawa Akihiko , Sasayama Shigetake 
Published: February 2009

AbstractThis study examined the question of whether intracoronary administration of nitroglycerin modifies contralateral intracoronary acetylcholine test results. Acetylcholine was injected separately into both left and right coronary arteries in 63 patients with coronary spastic angina. Acetylcholine (20 and 50 μg) was injected first into the coronary artery responsible for the documented regional ischemia during spontaneous or induced attacks, and then into the other coronary artery. Coronary spasm was defined as severe transient coronary artery vasoconstriction with chest pain and/or electrocardiographic ischemic ST‐segment deviation. Spasm was induced in either coronary artery in 60 patients (95%) and in both coronary arteries in 23 patients (37%). The frequency of induced spasm was 67% (42 of 63) in the coronary artery first challenged by acetylcholine. The coronary artery spasm subsided with the intracoronary injection of nitroglycerin (250‐750 μg) in 19 patients. In the second challenge of intracoronary acetylcholine injection into the contralateral coronary artery, coronary spasm was induced in 29 (66%) of 44 patients. This was done without intracoronary administration of nitroglycerin in the first challenge and in 12 (63%) of 19 patients who had been given intracoronary nitroglycerin. The sensitivity for spasm induced by intracoronary acetylcholine appeared to be unaffected by nitro‐glycerin. Coronary spasm with ST‐segment elevation by intracoronary acetylcholine in the second challenge was significantly less frequent in the patients receiving intracoronary acetylcholine in the second challenge was significantly less frequent in the patients receiving intracoronary nitroglycerin (first: 89%, second: 26%, p > 0.05) as well as in those not receiving intracoronary nitroglycerin for the spasm in the first challenge (first: 52%, second: 13%, p > 0.05). Our results suggest that intracoronary nitroglycerin administered for prompt relief of coronary spasm exerts no significant influence on the results of the contralateral intracoronary acetylcholine test.
New and combined sensors for adaptive‐rate pacing
Authors: Katritsis Demosthenes , F. Shakespeare Carl , Camm A. John 
Published: February 2009

AbstractA new potential indication for cardiac pacing is chronotropic incompetence, that is, an inadequate cardiac rate response to exercise and other metabolic demands. Many patients who have been paced for indications such as complete heart block or sick sinus syndrome also have chronotropic incompetence. Such patients are not adequately treated when fitted with a constant rate pacemaker. Adaptive‐rate pacemakers increase the pacing rate in proportion to signals derived from a biosensor which is sensitive to exertion and possibly to other metabolic requirements. These pacemakers have proven valuable for patients with overt chronotropic incompetence. However, no single sensor/algorithm is ideal and improvement has been sought by introducing new sensors, adjusting the algorithms by which biosensor signals are converted to the most appropriate pacing rate, or by combining sensors in such a way that a composite biosensor signal is derived which bears a close linear relationship with the appropriate heart rate. An example of a new sensor is the accelerometer, which is sensitive to a fuller range of movements than the piezo crystal. A successful new algorithm is the rate augmentation algorithm for use with minute ventilation, which provides a better initial pacing rate response. A combination of minute ventilation sensed by impedance changes and movement sensed with piezo crystals maintains the rapid response from the piezo crystal and overcomes its lack of proportionality. Another successful new combination of sensors is QT sensing from the evoked ventricular potential and motion sensing with a piezo crystal. As yet, these innovations have not been exhaustively tested and shown to confer clinical benefit but the improvements are such that an advantage can be expected.
Spontaneous secure reimplantation of a dislodged pacemaker electrode onto the right ventricular outflow tract, reestablishing a sufficient pacing condition
Authors: Nawa Sugato , Shimizu Nobuyoshi , Kino Khichi , Hayashi Kenji 
Published: February 2009

AbstractA 62‐year‐old woman underwent cardiac pacemaker implantation for sick sinus syndrome with bradycardia, and the tip of an endocardial tined lead was positioned to the right ventricular apex. On the fifth postoperative day, an incomplete pacing failure, lasting about 10 min, was observed transiently on 24‐h monitoring. This event, however, was not considered to be a clinical manifestation of the ensuing complication until the patient visited our pacemaker clinic 2 months postoperatively. At that time, a chest x‐ray demonstrated that the electrode tip had migrated markedly to the right ventricular outflow tract (RVOT), but presented a sufficient pacing condition. The reimplantation site appeared to be very insecure for pacing, raising the potential risk of repeat dislodgment since the lead was not provided with a helix. At the second operation, performed to assess the problem, the ventricular excitation threshold measured at 1.3 V with a 0.5 ms pulse width. Furthermore, it was unexpectedly disclosed that the electrode tip was so tightly anchored at the site that it could not be withdrawn, eliminating the possibility of repeat dislodgment. Consequendy, the entire original pacing system could be used as before and no further complications were observed. Although the situation encountered was very rare and seemed to be problematic, careful observation might be an alternative to surgical intervention even when a tined tip without helix has been used.
Anomalous inferior vena cava mimicking aortic dissection on transesophageal echocardiography
Authors: Torbicki Adam , Jakubowska‐Najniger Maria , Stanislawska Jolanta , Gorecki Aleksander , Kalinowski Roman , Sakai Kichiro , Hosoda Saichi , Shimamoto Ken 
Published: February 2009

AbstractTransesophageal echocardiography (TEE) is considered an excellent method for the diagnosis of aortic dissection, especially that involving the descending aorta. It has also proved useful in the evaluation of conditions mimicking aortic dissection, usually disclosing in these situations other types of severe aortic disease. We are not aware of any report dealing with venous abnormalities which presented diagnostic problems in a patient evaluated with TEE because of a suspected aortic dissection.Left ventricular (LV) free wall rupture complicated with acute myocardial infarction (AMI) usually occurs in the early phase of AMI. True aneurysm of the LV is sometimes a complication of AMI but rarely ruptures. In our patient, a 72‐year‐old woman, the LV free wall ruptured on Day 49 after the onset of AMI and the ruptured site was the thinnest wall of large true aneurysm of the LV. The large aneurysmal formation probably was due to corticosteroids used for pericarditis. More attention should be paid to late cardiac rupture and the use of corticosteroids.
The effect of extracorporeal high blood flow rate on left ventricular function during hemodialysis—an echocardiography study
Authors: Alfurayh Osman , Galal Omar , Sobh Mohamed , Fawzy Mohamed , Taher Saadi , Qunibi Wajeh , Almeshari Khalid , Philipp Thomas 
Published: February 2009

AbstractThe effect of increased extracorporeal blood flow rate on left ventricular (LV) function has been studied during volume‐controlled bicarbonate hemodialysis. Ten stable patients on chronic hemodialysis, with a mean age of 28 years (range 19‐38) were studied using two‐dimensional and Doppler echocardiography. The mean time on hemodialysis was 32 months (range 3‐60). All patients were investigated during three dialysis sessions on the first day of the week for 3 consecutive weeks. The blood flow rate was chosen randomly as 250, 350, or 450 cc/min. Apart from the time of hemodialysis and blood flow rate, other parameters of the hemodialysis were kept stable during all three sessions. Echocardiographic studies were done before, at mid dialysis, and during the last 15 min of each dialysis session. The following parameters were evaluated: heart rate, mean blood pressure, shortening fraction, ejection fraction, cardiac output, and pre‐ejection period/LV ejection time ratio. The changes of the measured cardiac parameters at the beginning, middle and end of each session were not significantly different. Furthermore, the differences in changes between the three different sessions were comparable. Our results indicate that an increase in dialysis blood flow rate up to 450 cc/min does not have an adverse effect on the left ventricle in patients on maintenance hemodialysis and with stable cardiovascular function.
The heart in polymyositis: A prospective evaluation of 26 patients
Authors: Taylor Allen J. , Wortham Dale C. , Robert Burge J. , Rogan Kevin M. 
Published: February 2009

AbstractAlthough cardiac abnormalities have been reported in patients with idiopathic polymyositis‐dermatomyositis (PM), the nature and extent of these abnormalities have varied. The purpose of this study was to determine the prevalence and to obtain a better description of the spectrum of cardiac abnormalities in a cohort of patients with PM by use of a thorough noninvasive cardiac evaluation. Accordingly, we studied 26 patients with a history of PM and clinically inactive myositis (22 polymyositis, 4 dermatomyositis) between June 1984 and June 1991. Examination included history, physical examination, 12‐lead electrocardiography, 24‐h ambulatory electrocardiographic monitoring, chest radiography, transthoracic echocardiography, and radionuclide ventriculography. Of the patients studied, 77% were taking corticosteroid medications at a mean dose of 39 ± 27 mg at the time of their evaluation. All 26 patients were identified as having two or more cardiac abnormalities. Cardiac symptoms and signs were common (62 and 81%, respectively), but were generally nonspecific. Electrocardiographic findings were most common (in 85% of cases), followed by findings on ambulatory monitoring (77%), echocardiography (42%), and radionuclide ventriculography (15%). The prevalence of mitral valve prolapse (8%) and hyperkinetic left ventricular contraction (12%) was significantly lower than previously reported. A secondary aim of this study was to determine associations between demographic variables including age, disease duration, cardiovascular symptoms, immunosuppressive therapy, autoantibody status, and creatinine phosphokinase level, and the presence of cardiac abnormalities. Of these patient variables, only increasing patient age was associated with an increased likelihood of cardiac abnormalities on noninvasive testing. In conclusion, abnormalities on noninvasive cardiac testing, many of which are minor and nonspecific, are prevalent in patients with PM. Our findings differ from previous reports in the demonstration of a low prevalence of mitral valve prolapse and hyperkinetic left ventricular contraction. In this population of patients with stable PM, only increased patient age was associated with a greater likelihood of abnormal cardiac findings.
Beta‐blocker infusion did not improve left ventricular diastolic function in myocardial infarction: A doppler echocardiography and cardiac catheterization study
Authors: Caramelli Bruno , Santos Raul Dias Dos , Abensur Henry , Gebara Otavio Celso Eluf , Tranchesi Bernardino , Bellotti Giovanni , Pileggi Fulvio 
Published: February 2009

AbstractLeft ventricular (LV) diastolic function changes after myocardial infarction. It has been suggested that beta blockers may improve diastolic function in hypertensive and heart failure patients. Doppler echocardiographic filling patterns and invasive hemodynamic indices have been used to analyze LV diastolic function. To determine the effect of beta blockers on LV diastolic function, we studied 32 patients with anterior wall myocardial infarction with a mean age of 53 years. Peak early and late flow velocities, peak early‐to‐late flow velocities ratio, pressure half time, diastolic filling period, isovolumic relaxation time, cardiac index, mean arterial pressure, wedge pressure, and systemic and pulmonary vascular resistance indices were obtained simultaneously before and after an intravenous infusion of 10 mg of atenolol. Cardiac index decreased from 4.27 ± 0.97 to 3.19 ± 0.911/min/m2 (p=0.0001); mean arterial pressure decreased from 85 ± 10 to 80 ± 11 mmHg (p=0.004); wedge pressure increased from 11 ± 5 to 13 ± 4 rnmHg (p = 0.002); systemic vascular resistance index increased from 1586 ± 409 to 1980 ± 634 dynm2s/cm5 (p = 0.0002); pulmonary vascular resistance index increased from 115 ± 58 to 163 ± 72 dynm2s/cm5 (p = 0.0004); peak late flow velocity decreased from 64 ± 15 to 49 ± 14 cm/s (p = 0.0001); early‐to‐late ratio increased from 0.95 ± 0.35 to 1.29 ± 0.36 (p = 0.0001); diastolic filling period increased from 300 ± 108 to 400 ± 110 ms (p=0.0001) and isovolumic relaxation time increased from 133 ± 29 to 143 ± 29 ms (p = 0.009). No significant changes were observed for peak early flow velocity and pressure half‐time. Multivariate regression analysis suggests that significant changes observed on Doppler echocardiographic parameters can be attributed in part to beta‐blocker effect on heart rate analyzed as diastolic filling period. We concluded that beta‐blocker infusion changes LV diastolic function analyzed by Doppler echocardiography in patients with anterior wall myocardial infarction. Moreover, the increase observed on wedge pressure suggests deterioration in cardiac function.
Unplanned admissions after outpatient cardiac catheterization
Authors: Clark Vivian L. , Dolce Joseph 
Published: February 2009

AbstractIncreasing numbers of patients are undergoing diagnostic catheterization as outpatients; however, a small proportion of patients requires hospital admission following the procedure. Unplanned admissions after consecutive outpatient cardiac catheterizations performed during 1 year were prospectively reviewed to determine the incidence of and reasons for admission. Among 847 patients undergoing outpatient cardiac catheterization, 130 patients (15%) required hospital admission after the procedure. Admitted patients were divided into four groups: patients undergoing immediate percutaneous transluminal coronary angioplasty (PTCA) (Group 1; 33%), patients with severe cardiac disease requiring urgent intervention (Group 2; 48%), patients suffering complications or hemodynamic instability (Group 3; 15%), and patients whose procedures were completed too late to allow same‐day discharge (Group 4; 4%). Patients over 65 were more likely to require admission and women were more likely to be admitted with complications or hemodynamic instability. Findings are compared with results of other outpatient series, and implications regarding appropriate setting for outpatient catheterization are discussed.