bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sensitivity and specificity of left ventricular ejection fraction by echocardiographic automated border detection: Comparison with radionuclide ventriculography
Authors: Lucariello Richard J. , Sun Ying , Doganay Guldene , Chiaramida Salvatore A. 
Published: February 2009

AbstractBackground: Echocardiographic automated border detection (ABD) provides on‐line, beat‐to‐beat estimation of left ventricular (LV) ejection fraction (EF). Sensitivity and specificity of using ABD‐EF for diagnosing LV dysfunction in routine clinical situations have not been previously studied.Hypothesis: Analysis of ABD‐EF data based on receiver operating characteristic (ROC) should provide useful information about sensitivity and specificity for clinical diagnosis of LV function based on ABD‐EF.Methods: The study group included 50 consecutive patients with EF measured by both ABD and radionuclide ventriculography (RVG). ABD‐EF was recorded for 25 consecutive heart beats in the apical four‐chamber view. Data were analyzed statistically by linear regression, Bland‐Altman plot, and ROC. In ROC analysis, abnormal LV function was defined RVG‐EF ≤ 40%.Results: ABD and RVG showed a moderate correlation in the EF measurements: slope=0.93, intercept=17%, r=0.79 (n = 50). Interbeat variability in ABD was diminished by averaging consecutive beats; standard error of estimate (SEE) decreased from 15.6% without averaging to 12.5% with 25‐beat averaging. Bland‐Altman analysis indicated that ABD‐EF compared unfavorably with RVG‐EF, with limits of agreement from ‐11% to 39%. ABD‐EF showed a systematic overestimation (p<0.005), which was compensated by increasing the threshold for abnormal ABD‐EF to 56%. With the optimized threshold, ABD‐EF provided 89% sensitivity and 89% specificity (85% overall diagnostic accuracy) for diagnosing abnormal LV function.Conclusion: This study explored the limitations of on‐line echocardiographic measurement of EF in a clinical setting and provided useful data for assessing interbeat variability, sensitivity, and specificit.
Symptomatic improvement and reduced hospitalization for patients attending a cardiomyopathy clinic
Authors: Smith Larry E. , Fabbri Sharon A. , Pai Ramdas , Ferry David , Heywood J. Thomas 
Published: February 2009

AbstractBackground: The major costs associated with the management of congestive heart failure (CHF) are inpatient costs. Outcome studies are therefore important to establish whether intensive outpatient care for heart failure can reduce these costs while at the same time improving outcomes in this disabling disorder.Hypothesis: Care delivered in a cardiomyopathy clinic might result in objective improvement in cardiac function and symptoms while reducing hospital admissions and emergency department visits.Methods: The outcomes of 21 patients treated for 6 months in a cardiomyopathy clinic are evaluated. New patients referred to the clinic with ejection fraction (EF) <0.45 were enrolled. The Minnesota Living with Heart Failure questionnaire was completed at initial and final visits. All patients underwent baseline and final echocardiogram, radionuclide left ventriculogram, and cardiopulmonary exercise testing. Patients were followed by a nurse practitioner and a cardiologist with maximization of standard treatment. Congestive heart failure‐related hospitalizations and clinic and emergency room visits for both 6‐month periods before and during the study were determined.Results: There was significant (p<0.05) improvement in these parameters: Heart failure score increased 23 points; New York Heart Association class decreased from 2.6 to 2.2; EF increased from 0.24 to 0.36; diastolic and systolic left ventricular dimensions decreased from 65 to 59 mm and from 57 to 50 mm, respectively. The number of clinic visits increased 5‐fold, whereas there were 86% (14 to 2, p = 0.017) and 100% (8 to 0, p = 0.002) reductions in the number of CHF hospitalizations and emergency visits. There was one death during follow‐up.Conclusion: Managing patients in a cardiomyopathy clinic may result in a better quality of life, with both symptomatic improvement and decreased hospitalizations.
Aortic valve aneurysm after acute endocarditis
Authors: Plein D. , Van Camp G. , Derluyn M. , Vandenbossche J.‐L. 
Published: February 2009

AbstractEndocarditis at the aortic level is usually characterized by the presence of a vegetation or an abscess on echocardiography. This paper reports on what is believed by the authors to be the first case of endocarditis presenting as an aneurysmal deformation of one aortic cusp without a vegetation.
Long‐term prognosis of young patients after myocardial infarction in the thrombolytic era
Authors: Füllhaas Jörg‐Uwe , Rickenbacher Peter , Pfisterer Matthias , Ritz Rudolf 
Published: February 2009

AbstractBackground: Myocardial infarction (MI) in young adults is a rare event. In the Framingham study, the 10‐year incidence rate of MI per 1,000 was 12.9 in men 30–34 years old. Overall, 4–8% of patients with acute MI are ≤ 40 years old.Hypothesis: It was the purpose of this study to assess the in‐hospital and long‐term morbidity and mortality in patients ≤40 years old with acute myocardial infarction compared with older patients in the thrombolytic era.Methods: A consecutive series of 75 patients aged ≤40 years (mean 35.0 ± 4.8) with acute myocardial infarction was compared with an equally sized group of patients aged >40 years (mean 65.1 ± 9.8).Results: Thrombolysis or direct percutaneous transluminal coronary angioplasty was performed in 52 versus 24% (p = 0.0004) and 5.3 versus 2.7% (p = NS) in younger and older patients, respectively. Significantly fewer young patients had multivessel disease (28 vs. 64%, p < 0.004). No in‐hospital mortality was observed in patients with reperfusion therapy irrespective of age. After a mean followup time of 47 ± 35 months, cardiac mortality was 0 and 11% (p < 0.03), respectively, in young and older patients with, and 3 versus 24% (p < 0.02) without reperfusion therapy, respectively. In addition, significantly fewer patients in the younger age group developed recurrent angina pectoris (12 vs. 39%, p = 0.0004) or congestive heart failure (9 vs. 34%, p = 0.0005) irrespective of reperfusion therapy.Conclusion: Our observations demonstrate that long‐term prognosis after myocardial infarction in young patients is excellent in the thrombolytic era.
Heparin dosing for percutaneous coronary angioplasty: Use of body surface area to improve initial activated clotting time values
Authors: Pesola Gene R. , Pesola David A. 
Published: February 2009

AbstractBackground: Activated clotting time (ACT) values during percutaneous transluminal coronary angioplasty (PTCA) after the initial 10,000 U heparin bolus are often below target values of 350 or 400 s (Hemochron) and have to be supplemented with additional heparin. This study evaluated the initial 10 min post‐heparin bolus clotting time value using a body surface area (BSA)‐adjusted heparin bolus versus the traditional 10,000 U heparin bolus.Hypothesis: Body surface area adjustment of initial heparin dosing prior to PTCA will be more effective in reaching target ACT values compared with the 10,000 U heparin bolus method.Methods: Twenty‐seven patients receiving the BSA‐adjusted heparin bolus were compared with 27 age‐ and gender‐matched controls who had received the traditional heparin bolus. The adjusted heparin bolus formula used was [BSA(m2)/1.3m2] X 10,000 U of heparin.Results: The success rate at reaching the target value of 400 s was 13 of 27 (48.1%) and 2 of 27 (7.4%) for the BSA‐guided and 10,000 U heparin‐guided groups, respectively (p < 0.01). The success rate at reaching the 350 s target value was 25 of 27 (92.6%) and 6 of 27 (22.2%) for the BSA‐guided and 10,000 U heparin‐guided groups, respectively (p < 0.01). The 95% confidence intervals for the difference in success between the BSA‐guided and 10,000 U heparin‐guided groups were 0.19–0.62 and 0.52–0.89 for the 400 s and 350 s ACT targets, respectively.Conclusion: Body surface area adjustment of initial heparin dosing is a more effective method of reaching the initial ACT target values of 350 and 400 s compared with the traditional method prior to PTCA. This conclusion applies to the Hemochron ACT device and arterial samples, and adjustments may need to be made for other devices and/or venous samples.
Feasibility of intravascular ultrasound studies: Predictors of imaging success before coronary interventions
Authors: Alfonso Fesc Fernando , , Goncalves Manuel , Goicolea Fesc Javier , , Hernandez Rosana , Segovia Javier , Rodriguez Pedro , Fernandez‐Ortiz Antonio , Najar Sergio , Bañuelos Camino , Macaya Carlos 
Published: February 2009

AbstractBackground: Intravascular ultrasound (IVUS) is currently used to study lesions during transcatheter coronary therapy. However, before dilation some lesions cannot be reached or crossed with the imaging catheter.Hypothesis: This study seeks to elucidate which factors determine the feasibility of IVUS examination before coronary interventions.Methods: Accordingly, 100 consecutive patients undergoing IVUS examination before coronary angioplasty were prospectively studied. The clinical and angiographic characteristics of 77 patients with a successful IVUS study (Group A) were compared with those of 23 patients in whom IVUS was attempted but the target lesion could not be interrogated (Group B). The echogenic characteristics of the target lesion [before (n = 77) or after intervention (in 18 patients in Group B)] were also studied.Results: Patients in Group B were significantly older (62 ± 7 vs. 57 ± 10 years, p < 0.05) and more frequently had stable angina [8 (35%) vs. 9 (11%), p < 0.05]. The distribution of lesions within the coronary tree and angiographic lesion characteristics including length, eccentricity, calcification, bend location, and the American College of Cardiology/American Heart Association classification were similar in both groups. However, proximal tortuosities (>45° at end diastole) were more frequently found in Group B [20 (87%) vs. 47 (61%), p < 0.05]. In addition, by quantitative angiography, patients in Group B had smaller arteries (reference diameter 2.8 ± 0.4 vs. 3.1 ± 0.4 mm, p < 0.05) and more severe lesions (minimal lumen diameter 0.46 ± 0.24 vs. 0.65 ± 0.34 mm, p < 0.05). On IVUS, calcified lesions were more frequently visualized in Group B (61 vs. 38%, p < 0.05). On multivariate analysis, catheter size, baseline minimal lumen diameter, angiographic proximal tortuosities, and lesion calcification on imaging were independent predictors of the feasibility of IVUS studies.Conclusions: Unsuccessful IVUS studies before intervention occur more frequently (1) in vessels with proximal tortuosities or severe lumen narrowing, (2) in lesions that are calcified on IVUS, and (3) when large imaging catheters are used.
Continuing medical education
Authors: Defeyter P.J. , Abrams Jonathan 
Published: February 2009

AbstractHandbook of Cardiovascular Interventions Edited by Ulrich Sigwart, Michel Bertrand, and Patrick W. Serruys Churchill Livingstone, New York (1996) 950 pages, illustrated, $225.00 ISBN: 0‐443‐979706Prevention of Myocardial Infarction Edited by JoAnn E. Manson, Paul M. Ridker, J. Michael Gaziano, and Charles H. Hennekens Oxford University Press, New York (1996) 564 pages, illustrated, $65.00 ISBN: 0‐19‐508582‐5
Cardiogenic shock: Therapy and prevention
Authors: Barry William L. , Sarembock Ian J. 
Published: February 2009

AbstractCardiogenic shock is defined as profound circulatory failure resulting in insufficient tissue perfusion to meet resting metabolic demands. It occurs in approximately 7.5% of patients with acute myocardial infarction. Treatment strategies include inotropic agents, use of intra‐aortic balloon counterpulsation, and revascularization. Current evidence supports the use of primary angioplasty. Surgery should be considered in patients with triple‐vessel disease. If early catheterization is not available, thrombolytic therapy should be given to eligible patients and transfer to an interventional facility should be considered. Effective therapy for shock must also include a prevention strategy. This requires identification of patients at high risk for shock development and selection of patients who are candidates for aggressive intervention.
Clinical and detailed angiographic findings in patients with ambulatory electrocardiographic ischemia without critical coronary narrowing: Results from the asymptomatic cardiac ischemia pilot (ACIP) study
Authors: Sharaf Barry L. , Mcmahon Robert P. , Pepine Carl J. , Chaitman Bernard R. , Williams David O. , Daves Richard F. , Proschan Michael , Richard Conti C. , Bourassa Martial G. ,   For the ACIP investigators
Published: February 2009

AbstractBackground: Patients with ambulatory electrocardiographic (AECG) ST‐segment depression and critical coronary narrowing are known to be at increased risk for adverse outcome, but little is known about patients with AECG ST‐segment depression without critical coronary narrowing.Hypothesis: The objectives of this study were to characterize the coronary angiographic pathology in patients with AECG ST‐segment depression but without critical (< 50% di‐ameter stenosis) coronary narrowing and to compare demographic and clinical findings in these patients with those enrolled in the Asymptomatic Cardiac Ischemia Pilot Study with AECG ST‐segment depression and critical (≥50% diameter stenosis) coronary narrowing.Methods: Coronary angiograms from patients with AECG ST‐segment depression were reviewed in a central laboratory and quantitative measurement of percent stenosis was performed. Clinical and angiographic comparisons were made between patients with and without critical coronary narrowing.Results: Patients without critical coronary narrowing (n = 64) were younger (p = 0.02), less likely to be male (p < 0.001) or to have risk factors for coronary atherosclerosis or a history of myocardial infarction (p < 0.001), and had fewer ischemic episodes per 24 h on the screening AECG (p = 0.02) than patients with critical coronary narrowing (n = 441). Of patients without critical narrowing, one half had angiographic evidence for coronary artery disease (≥ 20% stenosis) and 60% had an ejection fraction > 70%.Conculsions: Patients with AECG ST‐segment depression without critical coronary narrowing are heterogeneous, with half having measurable coronary artery disease. Demographically and clinically, they appear to be different than patients with AECG ST‐segment depression with critical coronary narrowing.
Association of ventricular ectopy with nuclear scintigraphic perfusion defects during dipyridamole stress testing
Authors: Rabin David L. , Ali Amjad , Barron John T. 
Published: February 2009

AbstractBackground and hypothesis: No information is available regarding the significance of ventricular ectopic activity induced during dipyridamole nuclear scintigraphic stress testing. This study tested the hypothesis that dipyridamole‐induced ventricular ectopy predicts a thallium‐201 or technetium‐99m sestamibi perfusion defect.Methods: A group of 186 consecutive patients with premature ventricular contractions and/or couplets occurring during dipyridamole stress testing (ventricular tachycardia did not occur) was compared with a control group of 194 patients without ventricular ectopy during dipyridamole stress testing.Results: The results indicated that ventricular ectopy induced during dipyridamole infusion occurred more frequently in patients demonstrating either a fixed or reversible perfusion defect on scintigraphic imaging (p <0.01). The higher frequency of perfusion defects in this group of patients was attributable to a higher frequency of “fixed” compared with “reversible” defects (p<0.05). This finding is consistent with the additional observation that ventricular ectopy induced by dipyridamole was associated with the presence of Q waves on the resting ECG (p<0.05). The positive and negative predictive values of the presence of ventricular ectopy in predicting a fixed myocardial perfusion defect were 59 and 54%, respectively.Conclusions: Ventricular ectopy induced during dipyridamole infusion suggests the presence of a fixed myocardial perfusion defect.
Factors determining angiotensin‐converting enzyme inhibitor underutilization in heart failure in a community setting
Authors: Philbin Edward F. 
Published: February 2009

AbstractBackground: Angiotensin‐converting enzyme (ACE) inhibitors were underprescribed for patients with congestive heart failure (CHF) treated in the community setting in the early 1990s despite convincing evidence of benefit.Hypothesis: We postulated that (1) the prevalence of ACE inhibitor use has increased, and (2) prescribing biases have narrowed, as community physicians have gained additional clinical experience with these drugs for treatment of CHF.Methods: We examined rates of ACE inhibitor use among 1, 150 patients with CHF hospitalized at 10 community hospitals in 1995, evaluated determinants of ACE inhibitor prescription, and compared the results with survey data gathered among similar patients during 1992.Results: Compared with 1992, ACE inhibitor use prior to hospital admission was increased among all patients (42 vs. 33%, p < 0.001) and the subset with a history of CHF (53 vs. 39%, p< 0.0005). Angiotensin‐converting enzyme inhibitor prescription at hospital discharge also increased among all survivors (64 vs. 51%, p < 0.00005) and the subset eligible for ACE inhibitor treatment based on clinical trial criteria (77 vs. 66%, p = 0.04). Multivariate analysis suggested no change in the prescribing biases previously observed; ACE inhibitor use was related to lower ejection fraction, lower serum creatinine, documentation of left ventricular systolic function, younger patient age, prescription of any diuretic drug, and nonprescription of alternate vasodilators and calcium blockers. In multivariate analyses, physician specialty did not predict ACE inhibitor use.Conclusions: Angiotensin‐converting enzyme inhibitor use among patients with CHF is increasing but remains below the 80‐90% rates of drug tolerance documented in randomized clinical trials. This discrepancy is partially explained by the prevalence of renal impairment and “diastolic” heart failure in the community setting. However, age bias, use of alternative vasodilators, and substandard quality of care may also play a role.
Left atrial abnormality by electrocardiogram predicts left ventricular hypertrophy by echocardiography in the presence of right bundle‐branch block
Authors: Mehta Anurag , Jain Abnash C. , Morise Anthony P. , Mehta Mahaveer C. , Billie Mike 
Published: February 2009

AbstractBackground: Left ventricular hypertrophy (LVH) on the electrocardiogram (ECG) may be masked in the presence of complete right bundle‐branch block (RBBB). Left bundle‐branch block on the ECG is associated with LVH at autopsy in 93% of hearts studied. However, RBBB does not predict LVH and the usual ECG criteria applied for LVH may not be reliable in the presence of RBBB.Hypothesis: The study was undertaken to evaluate left atrial (LA) abnormality as a criterion for the diagnosis of LVH in the presence of RBBB.Methods: Left atrial abnormality in the ECG was assessed by two independent observers as a criterion of LVH in the presence of RBBB in 100 patients, and data were compared with those of 50 patients without LA abnormality.Results: Left ventricular hypertrophy was confirmed by echocardiographic determination of left ventricular (LV) mass in both groups. Observers reliably differentiated between hy‐pertrophied and normal‐sized LV in the presence of RBBB by using LA abnormality as an ECG criterion when correlated with LV mass determined by echocardiography. Observer 1 correctly detected LVH in 88% and Observer 2 in 82% of patients. False positive diagnosis was made in 12 and 18% of patients by Observers 1 and 2, respectively. Observers' performance of recognition of LA abnormality in the present study was 94%. Results showed sensitivity of 76 and 70% and specificity of 84 and 92% for Observers 1 and 2, respectively. Left ventricular mass increased significantly and was diagnostic of LVH in 92% of patients with LA abnormality. Left ventricular mass was high in 84% of patients when corrected by body surface area. LVH in the presence of RBBB by the ECG was found in only seven patients (5%) when six commonly used conventional criteria of diagnosis of LVH by ECG were employed. Regression analysis found LA abnormality to be a strong independent predictor of increased LV mass. Multiple regression analysis revealed that age, body mass index, body surface area, and frontal axis are also significant predictors of LV mass.Conclusion: The results obtained by the correlation of LA abnormality by ECG and LVH by echocardiography conclude that LA abnormality by ECG was significantly diagnostic of LV hypertrophy in the presence of RBBB.
Prevalence of atrial fibrillation and stroke in paced patients without prior atrial fibrillation: A prospective study
Authors: Mattioli Anna Vittoria , Castellani Emma Tarabini , Vivoli Daniela , Sgura Fabio Alfredo , Mattioli Giorgio 
Published: February 2009

AbstractBackground: Several reports suggest that the incidence of stroke and atrial fibrillation is reduced in patients receiving physiologic pacemakers, compared with patients receiving a ventricular pacemaker.Hypothesis: The study was undertaken to address the impact of different pacing modalities on the incidence of stroke and atrial fibrillation.Methods: We prospectively analyzed 210 consecutive patients. Those with previous episodes of cerebral ischemia and/ or atrial fibrillation were excluded from the study. The study population included 100 patients paced for total atrioventricular (AV) block or second‐degree AV block (type II Mobitz) and 110 patients paced for sick sinus syndrome (SSS). The pacing mode was randomized. All patients underwent a brain computed tomography (CT) scan at the date of enrollment and after 1 and 2 years. Patients were followed for 2 years, and the incidence of atrial fibrillation and stroke was evaluated.Results: The incidence of atrial fibrillation was 10% at 1 year and 11% at 2 years. Comparing the different pacing modalities, we reported an increase in the incidence of atrial fibrillation in patients receiving ventricular pacing (p<0.05). On the other hand, no difference was found between patients paced for AV block and those paced for SSS. At the end of follow‐up, we reported 29 cases of cerebral ischemia: 9 patients had AV block while 20 had SSS (p<0.05). Comparing the different pacing modalities, there was an increase in the incidence of stroke in patients receiving ventricular pacing (p< 0.05).Conclusion: There was an increase in the incidence of stroke and atrial fibrillation in patients with ventricular pacing.
A novel source of enterococcal endocarditis
Authors: Milbrandt Eric 
Published: February 2009

AbstractAn important element of the evaluation of patients with infective endocarditis is the determination of an infectious source. In approximately 20‐45% of cases, no source is identified. Often the specific organism involved implicates the source, as is classically described by the association of S. bovis with colonic neoplasia. Other gut organisms have been reported to infect heart valves when colorectal pathology is present, but at far less frequency than S. bovis. This report deals with the case of a 75‐year‐old man with Enterococcus faecalis endocarditis of an unusual source‐a cecal carcinoma that was causing intermittent appendiceal obstruction and infection. This case adds to previous case reports which suggest that the occurrence of enterococcal endocarditis in the absence of a classic infectious source should lead to a search for occult colorectal pathology.