bluuebunny/crossref_metadata_2025_split huggingface dataset:
The imbalance between coronary reserve and wall stress explains the severity of ventricular dysfunction in hypertension
Authors: Frimm Clovis De Carvalho , Pereira Valéria F. A. , Rodrigues Ana Clara T. , Tsutsui Jeane M. , Cúri Mariana 
Published: June 2007

AbstractBackground: The pathophysiologic role of coronary reserve impairment in hypertensive cardiac dysfunction is still debated. Previously, we demonstrated that satisfactory coronary vasodilatation may coexist with ventricular systolic dysfunction. It is conceivable that coronary reserve might otherwise be inappropriate for enhanced myocardial oxygen demand and may thus affect cardiac performance negatively.Hypothesis: Myocardial supply‐demand imbalance contributes to the severity of ventricular dysfunction in hypertension (HTN).Methods: Fractional shortening (%) and end‐systolic stress (103·dyn·cm−2) were determined using echocardiography, and coronary reserve was calculated using trans‐esophageal Doppler echocardiography. Coronary reserve/ stress (cm2·dyn−1) was utilized as a measure of supply‐demand. Groups NL (20 healthy subjects), HTN1 (15 patients, fractional shortening ≥ 30), HTN2 (19 patients, 20 ≤ fractional shortening <30), and HTN3 (21 patients, fractional shortening < 20) were constituted.Results: Compared with NL and HTN1, groups HTN2 and HTN3 had significantly (p < 0.05) greater end‐systolic stress (NL = 72 ± 16, HTN1 = 72 ± 23, HTN2 = 143 ± 32, HTN3 = 186 ± 70). Coronary reserve was impaired in HTN3 alone (NL = 3.5 ± 0.6, HTN1 = 3.4 ± 1.0, HTN2 = 3.1 ± 1.0, HTN3 = 2.6 ±1.1), but coronary reserve/stress was reduced in both HTN2 andHTN3 (NL = 50 ± 12, HTN1 = 53 ± 21, HTN2 = 22 ± 7, HTN3 = 15 ± 7). Stepwise regression analysis identified diastolic internal dimension, end‐systolic stress, and coronary reserve/stress as independently associated with fractional shortening.Conclusion: The imbalance between supply‐demand explains the severity of hypertensive cardiac dysfunction and adds information to cardiac enlargement and elevated wall stress.
Heart rate response to graded exercise correlates with aerobic and ventilatory capacity in patients with heart failure
Authors: Vallebona Alessandro , Gigli Guido , Orlandi Sandro , Reggiardo Giorgio 
Published: June 2007

AbstractBackground: Autonomic dysfunction and reduced exercise tolerance are typical features of patients with congestive heart failure (CHF). Baro‐chemoreflex balance and organ response may have a common role in conditioning exercise tolerance, ventilation, and chronotropic competence in patients with CHF.Hypothesis: We tested the hypothesis that there is a relationship between functional capacity and chronotropic competence to exercise in CHF.Methods: In all, 48 stable outpatients with CHF (age 65 ± 10 years, 41 men, NYHA class 2.1 ± 0, ejection fraction 31 ± 7%, peak VO2 16 ± 4 ml/kg/min) performed cardiopulmonary exercise testing (CPX). Heart rate (HR) response to exercise was assessed by the chronotropic index (CRI). The CRI was calculated by the following formula: CRI = peak HR ‐ rest HR/220 ‐ age ‐ rest HR × 100 (normal value > 80%). The relationship of CRI to peak oxygen consumption (VO2) and ventilation/carbon dioxide production (VE/VCO2) ratio was examined. A group of 33 healthy controls underwent CPX as well.Results: The CRI correlated directly with peak VO2 (r = 0.638, p<0.001) and inversely with VE/VCO2 (r = −0.492, p < 0.001) in patients with CHF. A CRI< 78% identified patients with CHF and a peak VO2 < 20 ml/kg/min, area under the receiver operating curve (AUROC): 0.76,95% confidence interval (CI) 0.60–0.92. A CRI< 74% predicted exercise hyperventilation in CHF (AUROC: 0.71 for VE/VCO2 >30, 95% CI 0.53–0.88). The CRI was not significantly related either to peak VO2 or to VE/VCO2 in the control group.Conclusions: In patients with mild to moderate CHF, CRI correlates with functional capacity. This relationship adds new data on pathophysiologic grounds and supports the routine incorporation of CRI into CPX interpretation.
Are patients with isolated chronic aortic regurgitation operated in time? Analysis of survival data over a decade
Authors: Tamás Éva , Nylander Eva , Olin Christian 
Published: June 2007

AbstractBackground: Patients suffering from chronic isolated aortic regurgitation have a less favorable outcome than patients with aortic stenosis. According to international recommendations, these patients should undergo surgery as soon as left ventricular function begins to deteriorate, that is, surgery is not to be postponed until clinical symptoms become relevant.Hypothesis: The study was undertaken to evaluate how satisfactory our timing of surgery was, as reflected by survival data.Methods: Survival was studied retrospectively in a consecutive series of patients undergoing surgery for chronic isolated aortic regurgitation during a 10‐year period in our institution. Results were compared with data from the literature. By excluding patients with aortic aneurysms and acute endocarditis, we formed a homogeneous patient group of 88 subjects.Results: Thirty‐day mortality was 1% and late mortality after a mean follow‐up period of 6 years was 11%. Compared with survival data from an earlier study in which the patient population was similar and resided in the same geographic area, the results in our patient group seem to be better. It is noteworthy that despite a strong effort to recommend surgery at an earlier stage of the disease than previously, 35% of the patients had moderate or severe left ventricular dysfunction pre‐operatively because of late referrals.Conclusion: This stresses the importance of early detection and careful preoperative follow‐up with noninvasive methods in patients with aortic regurgitation.
Effectiveness of nesiritide on dialysis or all‐cause mortality in patients undergoing cardiothoracic surgery
Authors: Beaver Thomas M. , Winterstein Almut G. , Shuster Jonathan J. , Gerhard Tobias , Martin Tomas , Alexander James A. , Johnson Richard J. , Ejaz Ahsan , Hartzema Abraham G. 
Published: June 2007

AbstractBackground: Natriuretic peptides have been shown to have favorable renal effects. However, recent evidence suggests potential renal side effects in patients with congestive heart failure.Hypothesis: This study examined the effect of nesiritide (human B‐type natriuretic peptide) on hemodialysis or death in patients undergoing cardiothoracic surgery.Methods: This retrospective cohort study included patients (n = 940) undergoing nontransplant adult cardiothoracic surgery between July 2001 and February 2004. Patients receiving nesiritide within 3 days after and not before surgery (n = 151) were compared with those not given nesiritide (n = 789) for incidence of hemodialysis or in‐hospital death by Day 21 (HD/death). Patients with preexisting dialysis and intraoperative deaths were excluded. Forward inclusion multiple logistic regression was used based on published risk factors for HD/death.Results: Of 940 patients (318 coronary artery bypass graft, 348 valve, and 274 thoracic aorta), 36 required dialysis and 60 patients died (HD/death; n= 77). Adjusted for significant confounders (gender, age, procedure, intra‐aortic balloon, baseline serumcreatinine mg/dl [SCr], 1 day % SCr increase), nesiritide showed a statistically nonsignificant HD/death reduction (odds ratio [OR], 0.58; 95% confidence interval [CI], 0.29–1.17; p = 0.129) in the group as a whole. When stratified by baseline SCr, a significant benefit was noted in patients with SCr >1.0 (OR, 0.35; 95% CI 0.14–0.87; p = 0.024), while no significant effect was found in patients with SCr < 1.0 (OR, 1.55; 95% CI 0.48–5.07, p = 0.465).Conclusions: Nesiritide appears promising in reducing the risk of dialysis or death in patients with SCr > 1.0 undergoing cardiothoracic surgery; however, no effect was noted with SCr < 1.0. This study provides strong rationale for a randomized trial.
Relationship between true fasting plasma insulin level and angiographic characteristics of coronary atherosclerosis
Authors: Jia En‐Zhi , Yang Zhi‐Jian , Yuan Biao , Zang Xiao‐Ling , Wang Rong‐Hu , Zhu Tie‐Bing , Wang Lian‐Sheng , Chen B. O. , Cao Ke‐Jiang , Huang Jun , Ma Wen‐Zhu 
Published: June 2007

AbstractBackground: Reports about the relationships between specific insulin concentration and coronary heart disease risk are controversial.Hypothesis: The objective of this study was to examine the association between insulin level and the severity of coronary atherosclerosis.Methods: The study population consisted of 507 consecutive patients (376 men and 131 women) who underwent coronary angiography for suspected or known coronary atherosclerosis. The patients' habits of smoking and drinking were investigated, and anthropometric measurements including body mass index, systolic and diastolic blood pressures, as well as plasma measurements including lipids and blood glucose were taken. The true insulin level was measured using a highly sensitive two‐site sandwich ELISA. The severity of coronary atherosclerosis was defined by the Gensini score system. The statistical methods including Kruskal‐Wallis test, chi‐square analysis, Spearman correlation analysis, and multivariate stepwise linear regression analysis were employed to explore the relationship between specific insulin level and coronary atherosclerosis.Results: When the Gensini score was examined as a categorical variable classified by tertile values, subjects with a high Gensini score had significantly higher values of fasting plasma specific insulin level (p = 0.022). The Spearman correlation analysis suggest that the Gensini score correlated significantly with true insulin (mIU/l) (r = 0.095, p = 0.033). However, the results from the multivariate stepwise linear regression analysis show that the association between specific insulin level and severity of coronary atherosclerosis lost its significance.Conclusions: The level of plasma fasting specific insulin was associated significantly with the severity of coronary atherosclerosis, as measured by Gensini score, but hyperinsulinemia showed no association with the severity of coronary atherosclerosis in multivariate analyses.
Assessment of markers of thrombin generation in patients with acute myocardial infarction complicated by ventricular fibrillation
Authors: Elmas Elif , Kaelsch Thorsten , Wolpert Christian , Sueselbeck Tim , Bertsch Thomas , Dempfle Carl Erik , Borggrefe Martin 
Published: June 2007

AbstractBackground: In most cases, sudden cardiac death is triggered by ischemia‐related ventricular tachyarrhythmias and accounts for 50% of deaths from cardiovascular disease in developed countries. Chronic elevation of indicators of coagulation activation has been found in patients with coronary heart disease, but a role of coagulation activation as a potential risk factor for ventricular fibrillation (VF) during acute myocardial infarction (MI) has not been investigated.Methods: We enrolled 50 patients with a history of MI, of whom 26 presented with VF in the acute phase of myocardial ischemia; 24 patients had an acute MI without ventricular tachyarrhythmias. Levels of thrombin‐antithrombin complexes (TAT), prothrombin fragment F1 + 2 (F1 + 2), fibrinopeptide A (FPA), plasmin‐antiplasmin complexes (PAP), protein C, antithrombin, activated partial thromboplastin time (aPTT), thromboplastin time, D‐Dimer, fibrinogen, and high‐sensitivity C‐reactive protein (hs‐CRP) were measured in plasma samples of all patients. Blood collection was obtained sequentially in two separate settings. Patients were studied at a median of 3 51 days after the acute coronary event.Results: Higher levels of TAT complexes (13.4 ± 22.2 vs. 3.03 ± 4.3 μg/1; p = 0.02), FPA (79.7 ± 132.3 vs. 24.04±41.3 ng/ml; p = 0.04), and F1+2 (1.89 ± 1.3 vs. 1.16 ± 0.5 nmol/l; p = 0.01) were observed in patients with VF compared with patients without ventricular tachyarrhythmias during the acute phase of MI. D‐Dimer levels displayed a trend without reaching statistical significance (0.69 ± 0.48 vs. 0.48 ± 0.24 mg/l; p = 0.06). No differences were found in hs‐CRP (3.25 ± 4.5 vs. 4.4 ± 8.8 mg/l; p = 0.5) and fibrinogen (2.8 ± 0.9 vs. 2.7 ± 0.9 g/l; p = 0.6) measurements. Repeat assessment of markers of coagulation activation atamedian of 847 days revealed a highly significant decrease in patients with VF.Conclusions: Markers of thrombin generation are transiently increased in patients with VF during the acute phase of MI. These findings have implications for risk assessment and genetic screening of patients prone to VF during acute myocardial ischemia.
Postpartum dissection of the left main coronary artery
Authors: Rogers Ian S. , Rinaldi Michael J. , Humphrey Chester B. , Boden William E. , Dougherty James E. 
Published: June 2007

AbstractPeripartum coronary artery dissection is rare, but it is an increasingly recognized risk to women of childbearing age. Literature reviews reveal that about 80% of the population with spontaneous coronary artery dissections (SCAD) are female, and approximately 25–33% of cases occurred while the woman was pregnant or in the peripartum phase. Most cases have presented within 2 weeks of delivery. The left anterior descending is the most commonly affected vessel. The etiology is poorly understood, but many reports suggest that SCAD occurs as a result of protease release secondary to an eosinophilic vasculitis resulting in vessel lysis. Many investigators have examined the correlation between peripartum SCAD and estrogen levels; however, case studies have shown conflicting results regarding estrogen levels as the putative causative factor. Optimal treatment remains controversial. Presently, stenting appears to be best employed in the patients who have single‐vessel dissection not involving the left main coronary artery (LMCA). Surgical revascularization via coronary artery bypass graft remains the optimal therapy in patients whose dissection involves the LMCA, in patients with concurrent multi‐vessel dissection, and in patients with disease refractory to medical management. It is important to consider coronary artery dissection in the differential of any young woman who presents with signs or symptoms consistent with acute coronary syndrome, particularly if she is peripartum. Furthermore, once suspected, it is imperative that a definitive diagnostic study, that is, coronary angiography, be completed prior to the initiation of treatment whenever possible.
An early revascularization strategy is associated with a survival benefit for diabetic patients in cardiogenic shock after acute myocardial infarction
Authors: Farkouh Michael E. , Ramanathan Krishnan , Aymong Eve D. , Webb John G. , Harkness Shannon M. , Sleeper Lynn A. , Hochman Judith S. 
Published: June 2007

AbstractBackground: The role of diabetes mellitus (DM) in cardiogenic shock (CS) complicating an acute myocardial infarction (AMI) is not well understood. Previous studies have reported an in‐hospital mortality rate for patients with DM and CS of about 60%.Objectives: This study compares the 1‐year mortality rates of patients with DM and those without (NDM) and evaluates early revascularization (ERV) compared with initial medical stabilization (IMS) in patients with DM and CS.Methods: Baseline characteristics, clinical and hemodynamic measures, and management were compared for 90 patients (31%) with DM and 198 with NDM (69%) who were randomized to ERV or IMS in the SHOCK Trial.Results: When compared with NDM, patients with DM were of similar age but had higher rates of prior MI (44.4 vs. 27.8%, p = 0.007) and hypertension (56.2 vs. 42.5%, p = 0.04). The DM group had a lower rate of fibrinolytic therapy (44.4 vs. 60.1%, p = 0.02). In patients randomized to ERV, patients with DM had a higher rate of coronary artery bypass grafting (CABG) (50.0 vs. 30.9%, p = 0.03) despite similar rates of triple‐vessel disease. The 1‐year mortality rates in both groups were equivalent (58.9%). One‐year mortality was not associated with diabetes (hazard ratio [HR] 1.02, 95% CI, 0.73‐1.42, p = 0.91). The benefit of an ERV strategy was similar (HR [DM] 0.62; HR [NDM] 0.75, p = 0.58). Even after adjusting for the imbalance in CABG rates, 1‐year mortality was not associated with DM.Conclusion: Diabetes mellitus is not a predictor of 1‐year mortality in CS after AMI. The benefit from an ERV strategy is similar for DM and NDM. The management strategies and influence of DM on mortality in CS deserve further evaluation.
Implantable cardiac arrhythmia devices—Part II: Implantable cardioverter defibrillators and implantable loop recorders
Authors: Kusumoto Fred , Goldschlager Nora 
Published: June 2007

AbstractImplantable cardiac devices have become firmly entrenched as important therapeutic tools for a variety of cardiac conditions. The second part of this two‐part review discusses the contemporary use and follow‐up of implantable cardioverter defibrillators (ICD) and the implantable loop recorder. The ICD has become the standard therapy for protecting patients against sudden cardiac death. Two recent trials, the Multicenter Automatic Defibrillator Trial II (MADIT II) and the Sudden Cardiac Death Heart Failure Trial (SCD‐HEFT), demonstrated that the ICD is associated with a significant survival benefit for patients with reduced ejection fraction (<0.30–0.35), particularly if heart failure symptoms are present. The ICD has an important role in the management of other conditions associated with a high risk for sudden death, such as hypertrophic cardiomyopathy, long QT syndrome, and Brugada syndrome. The implantable loop recorder has become an important diagnostic tool for the patient with unexplained syncope.
Association of statin therapy and the risk of atrial fibrillation in patients with a permanent pacemaker
Authors: Amit Guy , Katz Amos , Bar‐on Shikma , Gilutz Harel , Wagshal Avraham , Ilia Reuven , Henkin Yaakov 
Published: June 2007

AbstractBackground: Recent studies have shown conflicting results regarding a protective effect of statin therapy on atrial fibrillation (AF).Hypothesis: We sought to determine whether statins are effective in reducing the risk of developing arrhythmia in a cohort of 264 patients (49% women, mean age [± standard deviation] 71 [± 12] years) with permanent pacemakers who are at high risk for AF.Methods: All patients who underwent implantation of a permanent pacemaker over a 3 ‐year period were eligible for inclusion in the study. We excluded patients with AF at implantation, incomplete medication information, or less than a yearly follow‐up visit. Atrial fibrillation was diagnosed by ECG documentation, pacemaker interrogation, and Holter monitoring. Statin treatment was verified through a central pharmacy‐computerized database (for most patients) or by chart review. Of the 264 patients, 36% had coronary artery disease.Results: Atrial fibrillation developed in 70 patients (26%) at a median of 359 days post pacemaker implantation. The incidence rate for the first occurrence of AF post pacemaker implantation among patients treated and not treated with statins was 10.5 versus 9.8 events per 100 patient‐years, respectively (p = 0.81). Even after controlling for baseline differences, the hazard ratio (HR) for developing AF among statin users did notachieve statistical significance (HR = 0.59 [0.31‐1.12]).Conclusions: We could not demonstrate that statin therapy had a protective effect against the risk of AF in patients implanted with a permanent pacemaker. The low prevalence of coronary artery disease in our patients may partly explain our results.
Effect of cardiopulmonary bypass on cytokine network and myocardial cytokine production
Authors: Gasz B. , Lenard L. , Racz B. , Benko L. , Borsiczky B. , Cserepes B. , Gal J. , Jancso G. , Lantos J. , Ghosh S. , Szabados S. , Papp L. , Alotti N. , Roth E. 
Published: June 2007

AbstractBackground: In addition to the well‐investigated proinflammatory cytokine expression, there is an ever increasing interest in the field of anti‐inflammatory response to cardiopulmonary bypass (CPB). Evidence suggests that myocardium serves as an important source of cytokines during reperfusion and application of CPB. The effect of coronary artery bypass graft (CABG) without CPB on myocardial cytokine production has not as yet been investigated.Hypothesis: Cardiopulmonary bypass can cause long‐term disturbance in pro‐ and anti‐inflammatory cytokine balance, which may impede a patient's recovery following surgery. Therefore, the effect of CPB on the balance of the pro‐/anti‐inflammatory cytokines network and myocardial cytokine outflow was assessed throughout a longer period after surgery.Methods: Twenty patients were scheduled for CABG with CPB and 10 had off‐pump surgery. Blood samples were taken before, during, and over the first week following surgery. Coronary sinus blood samples were collected during surgery. The ratio of pro‐ and anti‐inflammatory cytokines was calculated and the cytokine concentration of peripheral and coronary sinus blood were compared in both groups.Results: Pro‐/anti‐inflammatory cytokine ratio decreased early after CPB followed by a delayed and marked increase. A more balanced ratio was present following off‐pump surgery. Coronary sinus levels of certain cytokines exceeded the concentration of systemic blood in the course of CPB but not during off‐pump operation.Conclusion: Patients show pro‐inflammatory predominant cytokine balance at a later stage after CPB in contrast to those without CPB. The heart produces a remarkable amount of cytokines only in the course of surgery with CPB.
Difficulties in maintaining potassium homeostasis in patients with heart failure
Authors: Dursun Ihsan , Sahin Mahmut 
Published: June 2007

AbstractPotassium (K) concentration plays a significant role in cell metabolism and membrane excitability. The imbalance of serum potassium is important because it can lead to life‐threatening events. Potassium balance may be lost both through the neurohormonal mechanisms involved in cardiovascular diseases and through the drugs used in the treatment of this illness. Avoiding both hypo‐ and hyperkalemia is beneficial in several cardiovascular diseases, especially heart failure. Electrolyte abnormalities are frequently seen complications in subjects with heart failure. Malignant ventricular arrhythmias and sudden cardiac death are particularly feared complications in K+ instability.
Transient global left ventricular dysfunction in a localized myocardial infarction related to occlusion of the distal left anterior descending artery
Authors: Yoon Seong Bo , Lee Sang Hak , Choi Seonghoon , Jung Jae‐Hun , Lee Namho 
Published: June 2007

AbstractIn some patients with acute myocardial infarction (MI), wall motion in the noninfarcted area declines globally despite localized myocardial damage. In most, an infarct‐related lesion is the proximal part of the left anterior descending artery (LAD). Previous studies have reported that hypo‐kinesis of remote myocardium may be related to multivessel disease, impaired coronary flow, or coronary flow reserve in nonculprit arteries. This report describes the case of a 53‐year‐old man who presented with severe global left ventricular (LV) dysfunction after an acute MI associated with distal LAD occlusion. Follow‐up echocardiographic examination revealed nearly normalized LV function 5 days after the episode. We discuss a plausible mechanism of dysfunction of noninfarcted myocardium.