bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nonlipid primary and secondary prevention strategies for coronary heart disease
Authors: Maron David J. 
Published: February 2009

AbstractWidespread application of proven primary and secondary preventive strategies for coronary heart disease would result in substantial savings of life and health care dollars. Proven strategies (excluding lipid therapy) include quitting smoking, treating hypertension, physical activity, aspirin therapy, and appropriate use of anticoagulants, beta blockers, and angiotensin‐converting enzyme inhibitors in survivors of myocardial infarction. Estrogen replacement therapy is currently under clinical investigation. Avoidance of obesity and tight control of diabetes are prudent interventions as yet unproved by clinical trials. Unfortunately, preventive strategies are frequently underutilized. The greatest challenge for preventive cardiology is to put into practice what we already know to prevent the development and progression of atherosclerosis.
Monitoring right‐sided chest leads during chest pain in patients with obstructive lung disease
Authors: Alidina Amyn , Jamal Nasiruddin M. 
Published: February 2009

AbstractIsolated nondominant right coronary artery stenosis causing significant angina and right ventricular infarction has been reported previously, but the importance of monitoring right‐sided precordial leads during chest pain in patients with obstructive lung disease has not been documented.
Intramural hematoma of the aorta caused by a penetrating atheromatous ulcer
Authors: Wann Samuel , Jaff Michael , Dorros Gerald , Sampson Cynthia 
Published: February 2009

AbstractAortic dissection is a life‐threatening condition which is difficult to diagnose because of its variable clinical presentation and diverse pathophysiologic manifestations. We present a case in which intramural hematoma of the thoracic aorta occurred in the absence of an intimal flap. Computed tomography and magnetic resonance imaging both showed hemorrhage in the wall of the aorta. Transesophageal echocar‐diography also revealed a penetrating atherosclerotic ulcer in the transverse aorta as a cause of the hematoma. A high index of clinical suspicion and a combination of diagnostic procedures resulted in proper diagnosis and successful surgical treatment.
Angina pectoris refractory for conventional therapy—Is neurostimulation a possible alternative treatment?
Authors: Hautvast R. W. M. , Dejongste M. J. L. , Blanksma P. K. , Lie K. I. , Ter Horst G. J. 
Published: February 2009

AbstractThe treatment of angina pectoris as a symptom of coronary artery disease usually is focused on restoring the balance between oxygen demand and supply of the myocardium by administration of drugs interfering in heart rate, cardiac pre‐ and afterload, and coronary vascular tone. For nonresponders to drug therapy or for those with jeopardized myocardium, revascularization procedures such as coronary bypass surgery and percutaneous transluminal coronary angioplasty are at hand. However, the atherosclerotic process is not stopped by these therapies and, at longer terms, angina may recur. It is not always possible to revascularize all the patients who do not positively react to medical treatment. Those with angina, not responding to adequate medication and who are not suitable anymore for revascularization, are considered to suffer from refractory angina pectoris. This group of patients has a poor quality of life, for their exercise tolerance is severely afflicted. For these patients, neurostimulation has been described repeatedly as an effective and safe therapy. The mechanism of action of neurostimulation is not completely known, but recent studies suggest an anti‐ischemic effect, exerted through changes in myocardial blood flow. As soon as its safety is sufficiently established, it may become a useful alternative in the treatment of refractory angina pectoris.
Markedly improved skeletal muscle function with local muscle training in patients with chronic heart failure
Authors: Gordon Allan , Sylven Christer , Tyni‐Lennaé Raua , Persson Helene , Kauser Lennart , Hultman Eric 
Published: February 2009

AbstractBackground: Reduced heart pump function and skeletal muscle abnormalities are considered important determinants for the low physical exercise capacity in chronic heart failure. Because of reduced ventricular function, traditional physical rehabilitation may cause underperfusion and low local work intensity, thereby producing suboptimal conditions for skeletal muscle training.Hypothesis: The study was undertaken to determine the effects of local exercise training, designed as one‐ or two‐legged knee extensor training, on exercise capacity in patients with moderate chronic heart failure. Because such exercise models use only about one quarter to half the muscle mass used in cycle ergometer training, the influence of a restricted circulatory capacity should therefore be limited. Further, we aimed to determine whether or not chronic heart failure skeletal musculature abnormalities are counteracted with such training.Methods: Fourteen patients with chronic heart failure [age 58 ± 3 years, ejection fraction (EF) 28 ±4%] were randomized to two different training protocols three times a week for 8 weeks and compared with a nontraining control group (n = 7, age 62 ± 3, EF 27 ± 3%). Group 2L (n = 7) underwent simultaneous two‐legged knee extensor training (about 4 kg working muscle) for 15 min at 65–75% of VO2 max of the two‐legged kick. Group 1L (n = 7) trained each leg at a time for 15 min of continuous one‐legged dynamic knee extensor work with the same training load per muscle mass, that is, at 35% of VO2 max of the two‐legged kick (about 2 kg working muscle). Peak VO2 of two‐legged knee extensor exercise (1/min), two‐legged endurance (W), and strength (Nm) were determined before and after the training period. The activity of citrate syn‐thase (CS) was estimated in tissue samples from the quadriceps femoris muscle.Results: Peak VO2 did not change with training. Two‐legged knee extensor endurance exercise capacity increased by an average of 40–50% (p<0.01) in all training patients in both the 2L and 1L groups, while no change was observed in the control group. Depressed skeletal muscle CS activity increased by 25–35% in both training groups (p<0.01). Strength increased by 16% in the 2L group after training (p<0.05), while no change was seen in the 1L and control groups.Conclusions: Skeletal muscle changes in stable moderate chronic heart failure are not entirely irreversible. A major factor contributing to these changes and to exercise limitation is deconditioning. Local muscle training is efficient and can at least partially improve skeletal muscle function in these patients. Different degrees of local activation, that is, one‐ or two‐legged knee extensor exercise, do not seem to differ in terms of their effect on exercise capacity. Depressed skeletal muscle oxidative capacity adapts to such physical training with increased activity to an extent not different from that for healthy volunteers.
Cardiac electrophysiology: A cost‐effective approach
Authors: Dimarco John P. 
Published: February 2009

AbstractClinical cardiac electrophysiology is a relatively new discipline, heavily dependent upon new technology that is often expensive. In cardiac pacing, no effective alternative to permanent pacing usually exists for patients with Class I indications, so cost‐reduction strategies involve appropriate selection and utilization of hardware and facilities. Cost‐effective utilization of radiofrequency ablation and implantable cardioverter‐defibrillators requires that these techniques be compared with alternative therapies, usually antiarrhythmic drugs. Both ablation and defibrillator implantation can be shown to be cost effective in selected populations, but a cost‐conscious approach to procedures and patient selection can make them cost effective in a broad range of patients.
Computer errors in electrocardiography
Authors: Hurst J. Willis , Treasure Charles B. , Sathavorn Charn S. 
Published: February 2009

AbstractComputer interpretation of electrocardiograms is far from adequate. This paper highlights a particular type of computer error that is merely symbolic of the large number of errors the computer can make. In addition to computer errors in electrocardiography, it is likely that computer interpretation has diminished the ability of physicians to interpret electrocardiograms.
Factors limiting the enrollment of women in a randomized coronary artery disease trial
Authors: Steingart Richard M. , Gambino Anthony , Coglianese Mary Ellen , Forman Sandra , Knatterud Genell , Bittner Vera , Mueller Hiltrud , Frishman William , Handberg Eileen , Richard Conti C. 
Published: February 2009

AbstractBackground and hypothesis: Although it is recognized that women have been underrepresented in clinical trials of cardiovascular disease, the reasons for their limited enrollment have not been elucidated.Methods: A prospective tracking system was established in the Asymptomatic Cardiac Ischemia Pilot study (ACIP) to monitor recruitment and identify protocol issues that interfered with the recruitment of women. Patients with stress test evidence for ischemia during the course of routine clinical care were screened for asymptomatic ischemia with an ambulatory electrocardiogram (ECG).Results: Those with at least one episode of asymptomatic ischemia and angiographic evidence of coronary artery disease suited for revascularization could be randomized. Women comprised only 17% of the 1,820 patients screened for asymptomatic ischemia, and only 14% of the 558 patients randomized. The limited number of women screened for ischemia was largely due to the limited number of women (25% of all patients) found to have test evidence for ischemia or coronary artery disease suited for revascularization during the course of routine clinical care. Once patients were identified as having ischemia on stress test and ambulatory ECG, the major difference in eligibility was the difference in disqualifying angiograms, occurring 21/2 times as frequently in women as in men (p < 0.001).Conclusion: The percentage of women recruited was lower than the prevalence of ischemic heart disease in the general population because at participating centers (1) women were found to have ischemia less often than men during the course of routine clinical care, and (2) screening tests for ischemia were less predictive of protocol‐defined coronary disease in women than in men.
Relationship between late potentials and the predischarge electrocardiographic pattern in patients with acute anterior wall myocardial infarction
Authors: Kusniec Jairo , Solodky Alejandro , Strasberg Boris , Klainman Eliezer , Abboud Shimon , Imbar Shula , Sclarovsky Samuel 
Published: February 2009

AbstractHypothesis: The presence of late potentials on the signalaveraged electrocardiogram (SAECG) identifies patients at high risk for development of ventricular tachyarrhythmias after myocardial infarction (MI).Methods: The electrocardiogram and left ventricular function in 65 patients recovering from a first acute anterior wall MI were analyzed. We compared the pattern of the ST segment (isoelectric or elevated) and of the T wave (positive or negative) with the SAECG using an orthogonal bipolar lead configuration (X, Y, Z) with bidirectional Butterworth filtering (Simson's method).Results: Abnormal SAECG was found in 17 (26%) patients; 11 of 18 patients with ST elevation had abnormal SAECG, and only 6 of 47 patients with isoelectric ST segment developed abnormal SAECG (p<0.0001, odds ratio = 10.74). Of 19 patients with positive T waves, 10 had abnormal SAECG, and abnormal SAECG was found in 7 of 46 patients with negative T waves (p<0.003, odds ratio = 5.27). When both parameters were considered together, 9 of 12 patients with ST elevation and positive T wave developed abnormal SAECG, and 35 of 40 patients with isoelectric ST and negative T wave had normal SAECG (p<0.0002). Left ventricular ejection fraction was similar in patients with abnormal SAECG (43 ± 14%) and normal SAECG (46 ± 11 %).Conclusion: These findings suggest that patients with anterior wall MI and a predischarge pattern of ST elevation and positive T wave have a higher incidence of abnormal SAECG and therefore may have a worse prognosis, especially related to the subsequent development of ventricular arrhythmias.
Cost‐Effective treatment of coronary artery disease—the new imperative
Authors: Robert Superko H. 
Published: February 2009

AbstractLarge lipid‐lowering clinical trials have demonstrated a significant reduction in cardiovascular events and the need for cardiovascular procedures. These clinical end point trials used relatively weak treatment modalities, and when the cost savings of the reduced number of events is balanced against the estimated cost of treatment, the average difference is approximately $ 1,500 per patient per year. Arterio‐graphic trials have used similar or more aggressive lipoprotein therapy over shorter periods of time. Estimates of cost savings from reduced clinical events balanced against the cost of treatment in these studies indicate a wide spectrum of estimated patient costs. These estimates range between a cost of $2,273 per patient per year to a cost savings of—$ 901 per patient per year. Extrapolation to the United States population with coronary artery disease (CAD) suggests that greater than one billion dollars per year could be saved if patients with CAD received similar treatment and responded in a similar manner. volves both excellence in medicine and attention to cost containment issues. The need to practice medicine in a cost‐effective manner creates a challenge and an opportunity to provide a better cardiovascular treatment service that reduces costs and at the same time provides patients with a treatment arm previously relegated to a second or third level of importance. Preventive cardiology has now achieved a status that makes it an essential part of a complete cardiovascular service. Disorders of lipoprotein metabolism is one component of preventive cardiology, and recent investigations have demonstrated that proper diagnosis and treatment directed at the specific underlying disorder can significantly reduce the number of cardiovascular events, as well as the rate of arteri‐ographically determined progression. This article will focus on the potential cost savings that may accrue if appropriate diagnosis and treatment is undertaken.
Directional coronary atherectomy for coronary artery spasm refractory to medical therapy
Authors: Hilton Thomas C. , Blackshear Joseph L. , Utset Bernardo , Kern Morton J. 
Published: February 2009

AbstractA patient with severe medically refractory coronary artery spasm was treated successfully with coronary atherectomy of a mild (40%) left anterior descending artery stenosis. Before the procedure, the patient was dependent on intravenous nitroglycerin because of daily episodes of angina with ST‐segment elevation despite receiving multiple combinations of antianginal therapies. Clinical response to coronary atherectomy was prompt and dramatic.
Ventricular tachycardia initiated solely by reduced pacing rate during routine pacemaker follow‐up
Authors: Alt Eckhard , Coenen Martin , Baedeker Wolfgang , Schmitt Claus 
Published: February 2009

AbstractVentricular arrhythmias during a pacemaker follow‐up have been previously reported, usually in conjunction with temporary asynchronous stimulation of a demand pacemaker through magnet application or by increased myocardial excitability, for example, following a myocardial infarction. The subject of this report, an 82‐year‐old pacemaker patient, had been VVI‐paced without problems for the past 11 years. As an aid in determining the sensing threshold, the pacemaker lower rate was reduced from 70 to 40 beats/min. A ventricular tachycardia of 240 beats/min was induced, most likely following short‐long cycles; syncope resulted. To our knowledge, this is the first report of induction of a ventricular tachycardia during pacemaker follow‐up solely by reduction of pacing rate and not by asynchronous pacing. This case demonstrates an additional potential risk associated with pacemaker rate manipulation during pacemaker follow‐up.
Monotherapy with hMG‐CoA reductase inhibitors and secondary prevention in coronary artery disease
Authors: Rackley Charles E. 
Published: February 2009

AbstractAlthough thrombolytic drugs, percutaneous transluminal coronary angioplasty, and coronary artery bypass grafting have provided major advances in the treatment of coronary artery disease, the use of lipid‐lowering drugs for secondary prevention has significantly reduced cardiovascular events in the population with coronary artery disease. Secondary prevention trials using HMG‐CoA reductase inhibitors include the Familial Atherosclerosis Treatment Study (FATS), the Monitored Atherosclerosis Regression Study (MARS), the Canadian Coronary Atherosclerosis Intervention Trial (CCAIT), the Asymptomatic Carotid Artery Progression Study (ACAPS), the Multi Anti‐Atheroma Study (MAAS), the Scandinavian Simvastatin Survival Study (4S), the Pravastatin Limitation of Atherosclerosis in Coronary Arteries (PLAC I), the Regression Growth Evaluation Statin Study (REGRESS), the Pravastatin Multinational Study, and the Pravastatin, Lipids, and Atherosclerosis in Carotids (PLAC II). Mean changes from baseline of lipid fractions in these trials included: total cholesterol 18 to 35% reduction low‐density lipoprotein (LDL) cholesterol 26 to 46% reduction high‐density lipoprotein (HDL) cholesterol 5 to 15% increase and triglyceride 7 to 22% reduction. Angiographic regression or lack of progression was statistically demonstrated in the FATS, MARS, CCAIT, MAAS, PLAC I, and REGRESS trials. Cardiovascular events decreased 25 to 92% in all trials, and there was a significant reduction in both cardiovascular and total mortality in the 4S. The greater reduction in cardiovascular events than in anatomic changes suggests that the HMG‐CoA reductase inhibitors stabilized the surface of plaques. Monotherapy with HMG‐CoA reductase inhibitors provides the clinical opportunity to modify the natural history of coronary artery disease.
Systemic side effects of topical beta‐adrenergic blockers
Authors: Stewart William C. , Castelli William P. 
Published: February 2009

AbstractGlaucoma, a disease that affects between 1 and 3% of the population above the age of 60, is most commonly treated by topical beta‐adrenergic blockers. Although effective in lowering intraocular pressure and helping to preserve sight, beta blockers also may have adverse influences on the cardiac, pulmonary, and central nervous systems, and on endocrine functions. Clinicians' awareness that their patients may be treated with topical beta blockers will help them to elicit this information and the history, prescribe the medicine correctly, and be cognizant of a possible role this medicine may have in any deterioration of a patient's systemic clinical status.
Hemodynamic effects of creatine phosphate in patients with congestive heart failure: A double‐blind comparison trial versus placebo
Authors: Ferraro Sergio , Codella Cinzia , Palumbo Fabrizio , Desiderio Alfonso , Trimigliozzi Pasquale , Maddalena Giovanni , Chiariello Massimo 
Published: February 2009

AbstractBackground: The use of metabolic drugs effective in addition to conventional therapy represents a significant challenge in patients with left ventricular dysfunction.Hypothesis: The aim of this double‐blind, placebo‐controlled study was to investigate the hemodynamic effects of acute intravenous (IV) administration of creatine phosphate (CP) and of short‐term treatment in patients with congestive heart failure (CHF) from ischemic heart disease (IHD) or dilated cardiomyopathy in addition to conventional therapy.Methods: We compared the hemodynamic effects of exogenous creatine phosphate (CP) and placebo in a double‐blind, crossover design study in 13 hospitalized patients (12 men, 1 woman, mean age 52 ± 8 years) with CHF. All patients were in New York Heart Association (NYHA) class II‐III and received conventional pharmacologic therapy for CHF this was not changed during the study period. The study design consisted of two treatment periods (CP or placebo and placebo or CP, respectively) of 4 days each, separated by a 2‐day washout interval. The intravenous infusion consisted of 6 g CP or placebo (acute treatment) or 6 g CP or placebo daily for 4 days (short‐term treatment) diluted in 50 ml of NaCl 0.9%;infusion duration was about 10 min. Mono‐bidimensional echocardiographic examination (Hewlett Packard So‐nos 1000, with a 2.5 MHz transducer) was performed at baseline, after acute infusion, and 12 h after the end of short‐term treatment. Data were analyzed by ANOVA and Student's t‐test for paired data the results obtained after acute and short‐term therapy were compared with the baseline values.Results: After placebo therapy, no significant change was observed. The results after treatment with CP showed a significant reduction of end‐systolic diameter [baseline: 4.5 ± 0.6;acute: 4.2 ± 0.5, (p<0.001);short‐term 4.3 ± 0.6 cm, (p<0.05)] and systemic vascular resistance (baseline: 1064.9 ± 483.7;acute: 947.5 ± 390.2 (p<0.05);short‐term: 950.7 ± 394.3 dynescm‐5 (p<0.05);moreover, a significant increase of percent ejection fraction [baseline:48 ± 12%;acute 53 ± 12% (p<0.01);short‐term 52 ± 11 % (p<0.01)], and of percent fractional shortening [baseline: 25 ± 7;acute 28 ± 8 (p<0.05);short‐term 28 ± 7% (p<0.05)] was observed.Conclusion: CP was shown to improve cardiac function, even in the presence of a conventional CHF pharmacologic therapy.
Pathophysiologic significance of left ventricular hypertrophy in dilated cardiomyopathy
Authors: Iida Keiji , Sersi Magdi El , Fujieda Katusuji , Kawano Satoru , Tabei Fumiko , Iwasaki Yuko , Masumi Tomoko , Yamaguchi Iwao , Sugishita Yasuro 
Published: February 2009

AbstractBackground and hypothesis: Patients with dilated cardiomyopathy (DCM) with left ventricular hypertrophy (LVH) have been found to have a better prognosis than patients without LVH. However, the pathophysiologic mechanism for that has not been investigated. We sought to clarify the pathophysiologic significance of LVH in DCM.Methods: We performed isoproterenol infusion echocar‐diography (0.02 m̈g/kg/min) in 17 patients with DCM, and measured plasma epinephrine and norepinephrine levels at rest and at the end of ergometer exercise in 14 of the 17 patients. Patients were classified into groups according to the presence (9 patients) (LVH+) or absence (8 patients) (LVH‐) of LVH. Left ventricular hypertrophy was defined as an inter‐ventricular thickness or posterior wall thickness ≥13 mm.Results: Although there was no significant difference between groups in fractional shortening at rest during isoproterenol infusion, fractional shortening was significantly higher in the LVH (+) group than in the LVH (‐) group (29 ± 9 vs. 17 ± 8%;p<0.025). Although there was no significant difference in plasma norepinephrine level, it was significantly lower in the LVH (+) group than in the LVH (‐) group (233 ± 169 vs. 519 ± 258 pg/ml;p<0.05) at the end point of the exercise.Conclusion: Systolic reserve, represented by the response to isoproterenol, is greater in patients with DCM with LVH than in those without LVH, and a lower plasma level of norepinephrine is needed to activate the myocardium during ex ercise in patients with DCM with LVH. This pathophysiologic characteristic could be one of the mechanisms which explain a better prognosis in patients with DCM with LVH.