bluuebunny/crossref_metadata_2025_split huggingface dataset:
Additional antianginal and anti‐ischemic efficacy of mibefradil in patients concomitantly treated with long‐acting nitrates for chronic stable angina pectoris
Authors: Frishman William H. , Bittar Neville , Glasser Stephen , Habib Gabriel , Smith William , Pordy Robert 
Published: February 2009

AbstractBackground: Mibefradil, a newly approved antihypertensive and antianginal drug, is the first member of a new class of calcium antagonists (CAs), the tetralol derivatives, that selectively blocks T‐type Ca2+ channels in contrast to classical CAs which, at therapeutic concentrations, block only L‐type Ca2+ channels. Since patients with chronic stable angina pectoris typically may be treated with the combination of a long‐acting nitrate and a CA, the additive efficacy and safety of mibefradil in combination with nitrate therapy needs to be determined.Hypothesis: This study was designed to assess the efficacy, tolerability, and safety of mibefradil when added to longacting nitrate therapy in patients with chronic stable angina pectoris.Methods: Following a 1 ‐week placebo run‐in period, patients were randomized to receive either mibefradil 50 mg (n = 96) or placebo (n = 93) once daily in addition to their nitrate therapy. After 2 weeks of active treatment, patients receiving the mibefradil were force titrated to 150 mg once daily for an additional 2 weeks. Exercise tolerance tests (ETTs) were per formed at the end of Weeks 2 and 4; patients also maintained an anginal diary during the 4‐week treatment period.Results: After 2 weeks of treatment with 50 mg mibefradil (within the current recommended dose range), a statistically significant but modest increase in total exercise duration was observed (treatment effect 16.4 s, p = 0.04). Similarly, there was a significant increase in time to onset of ischemia (treatment effect 26 s, p = 0.008). The adverse event profile of the 50 mg dose was indistinguishable from placebo, indicating that this dose was extremely well tolerated. At Week 4, the mibefradil‐treated patients were taking 150 mg, which is above the current recommended dose range. The increase in total exercise duration was larger for the mibefradil 150 mg group than for the placebo group. For the intent‐to‐treat population, this difference did not reach statistical significance, whereas in the standard population it did (treatment effect 21 s, p = 0.05). The other two ETT variables, time to onset of angina and time to onset of 1 mm ST‐segment depression, demonstrated significantly greater effect with mibefradil 150 mg (treatment effects 40 s, p = 0.002, and 55 s, p < 0.001, respectively, for the intent‐to‐treat population). Mibefradil 150 mg was associated with more adverse events than placebo, specifically, dizziness, leg edema, and postural hypotension.Conclusions: This study demonstrates that mibefradil 50 mg once daily in the setting of the background long‐acting nitrate therapy produces additive antianginal and anti‐ischemic effects and is extremely well tolerated.
Telemetry outside critical care units: Patterns of utilization and influence on management decisions
Authors: Sivaram Chittur A. , Summers John H. , Ahmed Naveed 
Published: February 2009

AbstractBackground: Guidelines for the use of telemetry in hospitalized patients have been proposed by the American College of Cardiology (ACC). However, there have been only a few studies which have investigated the usefulness of these guidelines in clinical practice.Hypothesis: This study assessed the role of telemetry in the decision making process outside the critical care units.Methods: The observational study, lasting 4 weeks, was conducted in the telemetry unit of a tertiary care teaching hospital and included 61 male patients (age range 40‐61 years). They had been directly admitted to the telemetry unit or transferred from a critical care unit and were followed for as long as telemetry was active. Indication for telemetry and the contribution of telemetry to management decisions were assessed by a physician not involved in the care of the patient.Results: Cumulative number of telemetry days was 379 with a mean of 6.2 days per patient. Total number of telemetry events was 297. According to the ACC classification, 14 patients (22.9%) had class I indication, 21 patients (34.4%) had class II indication, and 26 patients (42.6%) had class III indication. Telemetry events were seen in 18.2% of class I patients, in 39.7% of class II patients, and in 42.1% of class III patients. Only 12 telemetry events (4%) resulted in patient management, with none belonging to class III.Conclusion: Telemetry findings in patients outside the critical care units are not usually responsible for major therapeutic changes. The value of telemetry in such patients may be overrated.
An adult case of kawasaki disease with multiplex coronary aneurysms and0 myocardial infarction: The role of transesophageal echocardiography
Authors: Habon Tamas , Toth Kalman , Keltai Matyas , Lengyel Maria , Palik Imre 
Published: February 2009

AbstractKawasaki disease (mucocutaneous lymph node syndrome) is an acute inflammatory disease that primarily affects infants and young children. in spite of proper therapy, coronary aneurysms develop in 10 to 25% of cases. Adult diagnosis of coronary aneurysm, presumably caused by Kawasaki disease, is rare. A 37‐year‐old male patient with previous inferior wall myocardial infarction (MI) was admitted with an acute anterior wall MI. Coronary angiography, performed 2 weeks after successful thrombolytic therapy, showed right coronary artery occlusion and multiplex (left main, left anterior descending, left circumflex, right coronary artery) giant coronary aneurysms. Transthoracic echocardiography was unable to detect the aneurysms. Transesophageal echocardiography (TEE) visualized a large left main coronary aneurysm with an occlusive thrombus and measured low flow velocity (0.2 m/s) in the proximal left anterior descending artery. At 4 weeks control, TEE showed marked regression of the thrombus, and it was not detectable after 6 months of oral anticoagulation with acenocumarol (International Normalized Ratio: 3‐3.5) and standard postinfarction therapy. After 2 years of follow‐up, the patient has no symptoms, and myocardial ischemia could not be provoked by stress tests [treadmill, dipyridamole single‐photon emission computed tomography (SPECT)]. We conclude that, for diagnosis and follow‐up of adult Kawasaki disease, transesophageal echocardiography is indicated. The importance and efficacy of long‐term anticoagulant treatment should be emphasized in this disease.
The molecular genetics of arrhythmias and sudden death
Authors: Brugada Ramon , Roberts Robert 
Published: February 2009

AbstractThe current status of the research in genetics of cardiac diseases causing sudden death is reviewed. Few techniques will impact medicine as will those of molecular biology. The identification of the gene‐causing diseases will allow the use of better preventive, diagnostic, and therapeutic options. From genetic counseling at present to gene therapy in the future, the new challenge for the clinician will be to acquire the new information provided by molecular biology and apply it at the bedside to improve the quality of life for the patient.
Left ventricular function and exercise tolerance in patients with type ii diabetes mellitus
Authors: Irace Luigi , Iarussi Diana , Guadagno Immacolata , De Rimini Maria Luisa , Mansi Luigi , Lucca Pasqualijna , Spadaro Pasquale , Romano Ada , Iacono Aldo 
Published: February 2009

AbstractBackground: Left ventricular (LV) preload changes may alter exercise tolerance (ET), probably lessening activation of the Maestrini‐Starling mechanism. Reduced LV filling (preload) during the diastolic phase, usually impaired in diabetic patients, could affect ventricular function.Hypothesis: To evaluate the relationship between some echocardiographic LV function indices and ET, 24 patients (age 43‐75 years, mean 54 ± 13 years, Group A) with type II diabetes mellitus (DM), not suffering from other pathologies, and for whom the ergometric stress test (EST) resulted in an early interruption because of muscular fatigue and/or dyspnea, and 14 patients (age 38‐70 years, mean 53 ± 12 years, Group B) with type II DM and maximal ergometric stress test, used as control group, were studied.Methods: The EST was performed by increasing the load by 25 W every 2 min; its duration was used as an ET index and correlated with clinical parameters of LV function obtained with M‐mode, two‐dimensional, and Doppler echocardiography.Results: No patient in either Group A or Group B showed a high systolic blood pressure value at rest and/or an LV hypertrophy and/or an alteration of systolic functional indices. In neither group was there significant correlation between ET and duration of DM, basal heart rate, basal and max systolic blood pressure, and EF values. Linear regression analysis showed a significant correlation between Doppler parameters of the diastolic function and ET index in Group A, while there was no significant correlation inGroup B.Conclusion: From these data we can deduce that in absence of left systolic ventricular dysfunction the impairment of LV relaxation in DM can influence exercise tolerance, probably by limiting activation of the contractile reserve.
Right ventricular dysplasia with complete atrioventricular block: Necessity and limitation of left ventricular epicardial pacing
Authors: Akazawa Hiroshi , Ikeda Uichi , Minezaki Kenryo K. , Hayashi Yuji , Kuroki Shigehiro , Shimada Kazuyuki 
Published: February 2009

AbstractThis paper reports a case of right ventricular dysplasia, in which the patient presented with atrioventricular block and was followed for more than 8 years under left ventricular epicardial pacing. Five years after first epicardial pacemaker implantation, loss of capture occurred. Replacement of the epicardial leads was performed.
Acute ischemic syndromes following coronary artery bypass graft surgery
Authors: Hirsch William S. , Ledley Gary S. , Kotler Morris N. 
Published: February 2009

AbstractCoronary artery bypass graft (CABG) surgery, performed for the control of angina pectoris, leads to postoperative relief from symptoms in most patients. Amelioration of ischemia and improvement in exercise capacity after CABG are well documented. However, patients currently undergoing CABG are more complex than in the past—they are older and are maintained on medical therapy for longer periods. A large number of these patients have had one or more previous myocardial revascularization procedures. The postoperative period would appear to be a time of vulnerability for coronary events. However, previous investigators have focused on the pre‐ and intraoperative aspects of peri‐CABG ischemia. Outcome data suggest that the postoperative interval is at least equally important as a determinant of short‐ and long‐term morbidity and mortality. We discuss the epidemiology, etiology, pathophysiology, and treatment of ischemic syndromes in the postoperative period after CABG. In addition, we review recent data from a series of 14 patients, observed at our institution, who underwent cardiac catheterization and, in some cases, angioplasty of the culprit vessel in the immediate postoperative period.
Verapamil use in patients with cardiovascular disease: An overview of randomized trials
Authors: Pepine Carl J. , Faich Gerald , Makuch Robert 
Published: February 2009

AbstractBackground: Several reports have questioned the lack of safety data on calcium antagonists as a drug class. Because this drug class is heterogeneous, unique features of certain calcium antagonists may set them apart in terms of safety and efficacy.Hypothesis: With in excess of 7,000 person‐years of observation from randomized clinical trials, verapamil was selected to evaluate whether there was evidence of harm in patients with cardiovascular disease.Methods: MEDLINE search of English‐language articles, Science Citation Index, Current Contents, manual review of cited references, pharmaceutical files, and investigator correspondence was performed. Independent review of 66 articles identified 14 randomized, parallel‐group studies for inclusion. Independent, duplicate assessments were made of patient outcomes and trial characteristics (including study design, treatment dosage and schedule, duration of treatment, inclusion criteria, and sample size). Standard meta‐analytic techniques were employed for analysis and interpretation of results.Results: Based on over 4,000 person‐years of observation, patients with acute myocardial infarction (MI) treated with verapamil had a decreased risk of nonfatal reinfarction compared with placebo (relative risk 0.79; 2‐sided 95% confidence interval 0.65, 0.97; p = 0.024). Verapamil had no significant effect on overall mortality compared with placebo (relative risk ranged from 0.93; 2‐sided 95% confidence interval 0.78, 1.10; p = 0.40 to 0.86; 2‐sided 95% confidence interval 0.71, 1.04; p = 0.13) depending on rules used to include or exclude patients from the pooling process. For the combined outcome of death or reinfarction, verapamil use was associated with a decreased risk compared with placebo (relative risk 0.82; 2‐sided 95% confidence interval 0.70, 0.97; p = 0.016).In patients with angina involving a wide spectrum of disease severity, data were limited to 2,900 person‐years of observation, and verapamil use did not appear to be associated with an apparent effect on mortality or MI. Data available from randomized studies of verapamil in patients with hypertension were too limited to reach conclusions (50 person‐years of observation, with no deaths or MIs reported). Subgroups of hypertensive patients in two of the largest post‐MI studies and the largest angina study, involving over 600 patients, yielded little useful added information.Conclusions: In patients with MI, the risks of both nonfatal reinfarction and the combined outcome of death or nonfatal MI were reduced over intermediate‐term follow‐up among patients treated with verapamil compared with controls (p = 0.024 and p = 0.016, respectively). In patients with angina, no evidence for harm was noted, but in hypertension the data were too limited to draw conclusions. These findings support the need to distinguish among different calcium antagonist compounds and to emphasize the need for more data in patients with hypertension.
A comparative study of eccentric and concentric coronary stenosis vasomotion in patients with prinzmetal's variant angina and patients with stable angina pectoris
Authors: Tousoulis Dimitris , Daves Graham , Kaski Juan Carlos 
Published: February 2009

AbstractBackground and hypothesis: In patients with stable angina pectoris, eccentric stenoses have a greater potential for dynamic changes of caliber in response to vasoactive stimuli than concentric lesions. It is not known whether in patients with coronary artery spasm the degree of coronary vasoconstriction differs in eccentric versus concentric stenoses. Therefore, we examined the relationship between coronary stenosis morphology and the vasomotor response to vasoactive stimuli in patients with variant angina.Methods: Computerized quantitative angiography was used to measure minimum luminal diameter of eccentric and concentric stenoses before and after the administration of ergonovine and isosorbide dinitrate in 22 patients with Prinzmetal's variant angina and in 20 patients with chronic stable angina.Results: In patients with variant angina, mean stenosis diameter reduction with ergonovine was ‐0.85 ± 0.38 and ‐1.12 ±0.69 mm in eccentric and concentric stenoses, respectively (p = NS). Isosorbide dinitrate promptly relieved spasm in all patients and increased the diameter of eccentric stenoses by 0.26 ± 0.34 mm and that of concentric stenoses by 0.24 ± 0.32 mm (p = NS). In patients with chronic stable angina, mean diameter reduction with ergonovine was ‐0.23 ±0.12 and ‐0.12 ± 0.10 mm for eccentric and concentric stenoses, respectively (p < 0.05). Isosorbide dinitrate increased coronary diameter by 10% from baseline in 70% of eccentric and 38% of concentric stenoses (p < 0.01).Conclusion: In patients with variant angina pectoris, eccentric and concentric spastic stenoses react similarly in response to vasoactive stimuli. In patients with chronic stable angina, eccentric stenoses are more likely to show vasomotor responses than concentric stenoses.
Maximizing the hemodynamic benefit of enhanced external counterpulsation
Authors: Suresh Krishnamurthy , Simandl Susan , Lawson Wiliiam E. , Hui JOHN C.K. , Lillis Oneida , Burger Lynn , Guo Tong , Cohn Peter F. 
Published: February 2009

AbstractBackground: Enhanced external counterpulsation (EECP) has been demonstrated to be an effective treatment for angina and exertional ischemia in patients with coronary disease.Hypothesis: It is hypothesized that the ability of EECP to enhance the recruitment or development of coronary collaterals in coronary artery disease may be determined by the relative magnitude of diastolic augmentation (DA) and systolic unloading (SU). This study examines the relation between the proposed EECP effectiveness ratio (DA/SU), as assessed by finger plethysmography, and changes in descending aortic flow as assessed by Doppler echocardiography in 15 patients during EECP.Methods: Varying external cuff pressures (0‐275 mmHg) were used to generate a range of DA/SU ratios. The effect on aortic antegrade systolic and retrograde diastolic flow was assessed by Doppler echocardiography to determine whether there was an optimal EECP effectiveness ratio that maximizes the hemodynamic effects of EECP. With increasing DA/SU there was an initial positive linear increase in both systolic and diastolic flow volume. Systolic flow maximized at an effectiveness ratio of 1.5 and diastolic flow at a ratio of 2.0.Result: Therefore, effectiveness ratios (DA/SU) in the range of 1.5‐2.0 are optimal for maximizing the hemodynamic effects of EECP.
Serum amyloid type a may be a predictor of restenosis
Authors: Blum Arnon , Laniado Shlomo , Miller Hylton , Kaplan Giora , Vardinon Nurit , Yust Israel , Burke Michael 
Published: February 2009

AbstractBackground: Elevation of acute phase proteins [C‐reactive protein (CRP) and serum amyloid type A (SAA)] has been demonstrated in unstable angina with an adverse clinical prognosis.Hypothesis: The study was undertaken to determine the effect of angioplasty on the levels of SAA and the correlation with postangioplasty restenosis.Methods: In a university‐affiliated tertiary medical center, a prospective case study was undertaken in 55 patients who underwent successful percutaneous transluminal coronary angioplasty (PTCA) of a single coronary lesion for angina pectoris. Three groups of patients were clinically characterized according to Braunwald's classification of anginal syndrome: Group A: class III; Group B: class I; Group C: stable angina. Serum amyloid type A was measured by an ELISA method before PICA and after 24 h, 1, and 3 months. Patients were followed clinically for 12 months. A thallium stress perfusion scan was performed 3 months after PTCA and coronary angiography was repeated in patients with an abnormal thallium perfusion scan.Results: Serum amyloid type A levels >100 m̈/ml could identify Group A patients with a high sensitivity and specificity (r = 0.85 and 0.86, respectively). Of the patients studied. 75% increased their SAA level 24 h after angioplasty. An increase of SAA by >100% was associated with an increased risk of restenosis, with a relative risk of 6.4 (p < 0.05).Conclusion: Increased levels of SAA characterize patients with unstable angina pectoris with a high specificity and sensitivity. Levels of SAA that increase > 100% 24 h after angioplasty may serve as a marker of restenosis.
Symmetric and asymmetric left ventricular hypertrophy in patients with end‐stage renal failure on long‐term hemodialysis
Authors: Straumann Edwin , Meyer Beat , Misteli Max , Blumberg Alfred , Jenzer Hansrudolf , Bertel Osmund , Weiss Philip 
Published: February 2009

AbstractBackground: Patients with end‐stage renal disease on regular hemodialysis have an increased prevalence of left ventricular (LV) hypertrophy that is associated with morbidity and mortality. Asymmetric septal hypertrophy and impairment of LV outflow can occur in these patients and may contribute to adverse outcomes. More insight into the prevalence, extent, geometry, and promoting factors of LV hypertrophy is important.Methods: An unselected group of 62 patients (31 women), aged 55 ± 14 years, on maintenance hemodialysis was investigated by Doppler echocardiography. Eight patients with valvular heart disease were excluded from further analysis. We assessed prevalence of LV hypertrophy and asymmetric septal hypertrophy, as well as parameters of LV geometry and LV filling and outflow dynamics.Results: Prevalence of LV hypertrophy was 65%. Patients were analyzed according to LV mass and geometry. Mean LV mass index was normal (105 ± 17 g/m2) in Group 1 without LV hypertrophy (n = 19); it was markedly elevated in Group 2 (symmetric hypertrophy, n = 22) and Group 3 (asymmetric hypertrophy with systolic anterior movement of mitral valve, n = 7), and highest (191 ± 54 g/m2) in Group 4 (asymmetric hypertrophy without systolic anterior movement of mitral valve, n = 6, p < 0.001). Age, body mass index, and duration of hypertension were associated with LV hypertrophy and asymmetric septal hypertrophy (p = 0.01). Group 3 with systolic anterior motion of mitral valve had the smallest end‐diastolic LV diameters (p = 0.02); increased heart rates, and increased ejection velocities in the LV outflow tract (p = 0.03, and p = 0.005, respectively, vs. Groups 1,2, and 4) which pointed to an impairment of LV outflow.Conclusions: Symmetric LV hypertrophy and asymmetric septal hypertrophy are frequent in patients on maintenance hemodialysis. Predictors for LV hypertrophy were age and body mass index, and, particularly for asymmetric septal hypertrophy, age and hypertension duration. Volume withdrawal during hemodialysis may lead to symptomatic hypotension due to dynamic obstruction in some patients with severe asymmetric septal hypertrophy.
Incidence and prognostic value of electrocardiographic abnormalities after heart transplantation
Authors: Golshayan Dela , Seydoux Charles , Berguer Danièle Gillard , Von Segesser Ludwig , Goy Jean‐Jacques , Stumpe Frank , Hurni Michel , Ruchat Patrick , Fischer Adam , Mueller Xavier , Sadeghi Hussein 
Published: February 2009

AbstractBackground: The improvement of surgical techniques and the use of immunosuppressive drugs within the past 15 years has made heart transplantation an increasingly performed procedure and an accepted treatment for end‐stage cardiac failure.Hypothesis: The aim of this study was to describe the changes of the 12‐lead electrocardiogram (ECG) after heart transplantation and to determine their prognostic value on complications such as rejection or graft coronary artery disease during follow‐up.Methods: The ECGs of 62 consecutive patients were analyzed for 5 years at follow‐up periods of 1,2,3,6 months and yearly after transplantation.Results: The most prevalent abnormality was the presence of complete or incomplete right bundle‐branch block (RBBB). New RBBB appeared in 69% (43/62) of the patients, mainly during the first month (21/43). There was no left bundle‐branch block. We detected nine episodes of supraventricular arrhythmias: one atrial fibrillation, six atrial flutter, one junctional tachycardia, one orthodromic tachycardia on a Wolff‐Parkinson‐White syndrome; all appearing during the first 3 months. Three of the six episodes of atrial flutter occurred during an episode of acute rejection. There was no relation between RBBB and the gender and age of recipients and donors, nor with the graft ischemic time and the pre‐transplantation hemodynamic values. Right bundle‐branch block was not associated with acute rejection nor with graft coronary artery disease.Conclusion: The ECG abnormalities after heart transplantation have no predictive value on the long‐term evolution. Right bundle‐branch block is very frequent and is not associated with adverse prognosis.