bluuebunny/crossref_metadata_2025_split huggingface dataset:
Characteristics and outcome of patients with ST‐elevation infarction in relation to whether they received thrombolysis or underwent acute coronary angiography: Are we selecting the right patients for coronary angiography?
Authors: Herlitz Johan , Ekström Lars , Hartford Marianne , Karlson Björn W. , Karlsson Thomas , Grip Lars 
Published: June 2007

AbstractBackground: During the last decade, there has been an ongoing debate with regard to whether percutaneous coronary intervention (PCI) or thrombolysis should be preferred in patients with ST‐elevation acute myocardial infarction (AMI). Some studies clearly advocate PCI, while others do not.Hypothesis: The study aimed to describe the characteristics and to evaluate outcome of patients with suspected ST‐elevation or left bundle‐branch block infarction in relation to whether they received thrombolysis or had an acute coronary angiography aiming at angioplasty.Methods: The study included all patients admitted to Sahlgrenska University Hospital in Göteborg, Sweden, with suspected acute myocardial infarction who, during 1995‐1999, had ST‐elevation or left bundle‐branch block on admission electrocardiogram (ECG) requiring either thrombolysis or acute coronary angiography. A retrospective evaluation with a follow‐up of 1 year after the intervention was made.Results: In all, 413 patients had thrombolytic treatment and 400 had acute coronary angiography. The patients who received thrombolysis were older (mean age 70.3 vs. 64.1 years). Mortality during 1 year of follow‐up was 20.9% in the thrombolysis group and 16.6% in the angiography group (p = 0.12). Among patients in whom acute coronary angiography was performed, only 85% underwent acute percutaneous coronary intervention (PCI). There was a mortality of 12.1 vs. 41.7% among those who did not undergo acute PCI. Development of reinfarction, stroke, and requirement of rehospitalization was similar regardless of type of initial intervention. The thrombolysis group more frequently required new coronary angiography (36.9 vs. 20.6%; p < 0.0001) and new PCI (17.8 vs. 11.9%; p = 0.01). Despite this, after 1 year symptoms of angina pectoris were observed in 27% of patients in the thrombolysis group and in only 14% of those in the angiography group (p = 0.0002).Conclusion: In a Swedish university hospital with a high volume of coronary angioplasty procedures, we found no significant difference in mortality between patients who had thrombolysis and those who underwent acute coronary angiography. However, requirement of revascularization and symptoms of angina pectoris 1 year later was considerably less frequent in those who had undergone acute coronary angiography. However, distribution of baseline characteristics was skewed and efforts should be focused on the selection of patients for the different reperfusion strategies.
The relative utility of cardiac troponin i, creatine kinase‐mbmass, and myosin light chain‐1 in the long‐term risk stratification of patients with chest pain
Authors: Hillis Graham S. , Taggart Pamela , Wardlaw Delana , Hillis Lorraine , Zhao Ning , Dalsey William C. , Mangione Antoinette 
Published: June 2007

AbstractBackground: Sensitive and specific cardiac markers convey important short‐term prognostic information about patients with an acute coronary syndrome. There are, however, few data assessing their value as long‐term predictors.Hypothesis: The aim of the current study was to assess the relative value of three such markers and clinical characteristics in determining the long‐term prognosis of patients with chest pain.Methods: Cardiac troponin I (cTnI), myosin light chain‐1 (MLC‐1), and creatine kinase‐MBmass levels were obtained on admission (0 h) and at 4, 8, 16, and 24 h in 208 patients with chest pain. Eligible subjects were determined, at the time of hospital admission, to be at > 7% risk of acute myocardial infarction (MI), but without new ST‐segment elevation on their presenting electrocardiogram. Follow‐up was performed a median of 28 (range 1‐46) months later. The primary study endpoint was death or nonfatal MI, subsequent to the index admission.Results: Cardiac TnI levels ≥ 0.2 ng/ml (odds ratio [OR] 1.93, 95% confidence interval [CI] 1.09‐3.40) and MLC‐1 levels ≥ 1 ng/ml (OR 3.24, 95% CI 1.83‐5.73) were both significant predictors of death or MI during long‐term follow‐up; MLC‐1 was, however, the only independent biochemical predictor (OR 2.11, 95% CI 1.14‐3.93).Conclusions: Both cTnI and MLC‐1 predict the long‐term outcome of patients with chest pain, but, in this cohort, MLC‐1 proved to be a better predictor of mortality and nonfatal acute MI.
Evaluation of serial QT dispersion in patients with first non‐Q‐wave myocardial infarction: Relation to the severity of underlying coronary artery disease
Authors: Lyras T. G. , Papapanagiotou V. A. , Foukarakis M. G. , Panou F. K. , Skampas N. D. , Lakoumentas J. A. , Priftis C. V. , Zacharoulis A. A. 
Published: June 2007

AbstractBackground: Increased QT dispersion (QTD) has been correlated with ventricular arrhythmias. Recent reports suggest that it may serve as a marker of the severity of underlying coronary artery disease (CAD).Hypothesis: The aim of this study was to examine in‐hospital changes of QTD and their possible correlation with the severity of underlying CAD in patients with first non‐Q‐wave myocardial infarction.Methods: In 62 patients we estimated QTD, precordial QTD, as well as their values corrected for heart rate on Days 3 and 7 after admission. The severity of underlying ischemic burden was estimated by means of the number of diseased vessels as well as by the jeopardy score.Results: On Day 3, patients with jeopardy score ≥ 6 exhibited greater QTD, corrected QTD, precordial QTD, and corrected precordial QTD (p = 0.001, p = 0.003, p = 0.02, p = 0.036, respectively); patients with multivessel disease had greater QTD (p = 0.007). On Day 7, patients with jeopardy score ≥6 and multivessel disease exhibited greater QTD, corrected QTD, precordial QTD, and corrected precordial QTD (p < 0.001 for all). Multiple regression analysis revealed a jeopardy score of ≥ 6 as the most significant independent predictor for QTD variables. From Days 3 to 7, only patients with none or one diseased vessel or jeopardy score < 6 had shortened QTD (p = 0.01 and p = 0.015, respectively) and corrected QTD (p < 0.001 for both).Conclusions: In patients with first non‐Q‐wave myocardial infarction, QTD variables and their in‐hospital changes reflect the severity of underlying CAD.
Sustained use of nesiritide to aid in bridging to heart transplant
Authors: Hill James A. , Hsu Kevin , Pauly Daniel F , Schofield Richard , Aranda Juan M. 
Published: June 2007

AbstractPatients with end‐stage heart failure awaiting heart transplant are often maintained on continuous intravenous inotropic therapy. However, this therapy alone is often inadequate for maintenance of appropriate pulmonary artery pressure and stable clinical course. Nesiritide, B‐type natriuretic peptide, is a recently released intravenous vasodilator for short‐term use in patients with decompensated heart failure. This report details experience in four patients in whom this agent was used to bridge to transplant for prolonged periods (11–35 days) with added clinical benefit and without obvious tolerance. This suggests that new strategies for pretransplant management may be needed.
Oral platelet glycoprotein IIb/IIIa receptor inhibitors—part II
Authors: Cannon Christopher P. 
Published: June 2007

AbstractAlthough the hypothesis of benefit from prolonged oral IIb/IIIa inhibition was appealing, the large Phase III trials have uniformly shown there was no improvement in outcome. In addition, there was an increased mortality seen in patients treated with the oral IIb/IIIa inhibitor. This latter finding is not adequately explained, but is likely a multifactorial problem of this strategy of platelet inhibition. The trials found that, even with no improvement in efficacy, there was increased bleeding, meaning that for chronic therapy with IIb/IIIa inhibition there does not appear to be a therapeutic window. Accordingly, chronic oral IIb/IIIa inhibition appears to have been well tested but has not worked. Fortunately, there are several other oral antiplatelet agents available that have shown beneficial results, including clopidogrel. In addition, other newer classes of antiplatelet agents are in earlier stages of development. Thus, agents targeted more “upstream” in platelet activation pathways may offer a more tolerable and efficacious approach to long‐term antiplatelet therapy.
Reversal of heart failure remodeling: Is it maintained?
Authors: Levine T. Barry , Levine Arlene B. , Bolenbaugh Janet , Green Pamela R. 
Published: June 2007

AbstractBackground: Reversal of heart failure remodeling has been observed with intensive heart failure therapy.Hypothesis: We hypothesized that reversal of heart failure remodeling may not be sustained in long‐term follow‐up.Methods: Sixty‐one sequential patients with heart failure and left ventricular ejection fraction ≤ 35%, who improved their ejection fraction by ≥ 10% over baseline at follow‐up, were prospectively followed and retrospectively analyzed. Each patient underwent echocardiography at baseline and biannually thereafter.Results: In all patients, left ventricular ejection fraction increased from 18±7% to 42 ± 12% on uptitrated medical therapy. At follow‐up over 20 ± 8 (± standard deviation) months, this improvement was sustained in 38 patients (“Improved”). A relapse in remodeling occurred in the remaining 23 patients (“Relapsed”), with ejection fraction falling to 24 ± 7%.For Improved and Relapsed patients, baseline echocardiographic and clinical parameters were equivalent. However, Improved patients tended to be younger, with shorter heart failure duration. Improved patients had more effective improvement inejection fraction than Relapsed patients (45 ± 13% vs. 36 ± 8%, p = 0.005), with greater reductions in chamber size and mitral regurgitation.Conclusion: Reversal of heart failure remodeling may be sustained in only two‐thirds of patients at long‐term follow‐up. In contrast to Relapsed patients, Improved patients tended to be younger, with shorter heart failure duration and a more complete recovery of left ventricular systolic function.
Right atrial sensing for VDD pacing through a persistent left superior Vena Cava
Authors: Trigano J.‐A. , Caucino K. , Sbragia P. , Paganelli F. , Levy S. 
Published: June 2007

AbstractThis report describes a pacing lead insertion through a persistent left superior vena cava in the VDD pacing mode, with a large retrograde lead course allowing the optimal positioning of the sensing electrodes in the right atrium.
Diagnosis of coronary vasospasm by detection of postischemic regional left ventricular delayed relaxation using echocardiographic evaluation with color kinesis
Authors: Ishii Katsuhisa , Miwa Kunihisa , Makita Toshinori , Okuda Nobuaki , Aoyama Takeshi 
Published: June 2007

AbstractBackground: Coronary vasospasm has been diagnosed by invasive provocative procedures during coronary arteriography. It would be useful to have a reliable, noninvasive, and safe diagnostic method for coronary vasospasm. Regional left ventricular (LV) diastolic dysfunction may persist without systolic dysfunction after an episode of coronary vasospasm. Color kinesis (CK) has been recently developed to facilitate the echocardiographic evaluation of regional wall motion.Hypothesis: Color kinesis may be useful for diagnosis of coronary vasospasm by detection of postischemic regional LV diastolic wall motion abnormality.Methods: Fifty‐one consecutive patients with the last chest symptom within 2 weeks (4 ± 3 days) were studied echocardiographically. Regional fractional area change during the first 30% of LV filling time in percentage of the segmental end‐diastolic area change (CK diastolic index) was used to identify diastolic endocardial motion asynchrony.Results: After diagnostic coronary arteriography with spasm provocation, 26 patients were diagnosed with coronary spastic angina (CSA) and the other 25 with chest pain syndrome (CPS). Regional delayed relaxation (CK‐diastolic index ≤ 50%) or diastolic asynchrony had been observed in at least one region in 25 (96%) patients with CSA, whereas it had been noted in 2 (8%) patients with CPS. In 17 (65%) patients with CSA, it had been detected in multiple vascular territories, suggesting multivessel spasm. The diastolic asynchrony disappeared in CSA after a month of angina‐free period.Conclusion: Analysis of CK images allows identification of regional LV delayed relaxation or diastolic asynchrony in patients with coronary vasospasm, differentiating them from patients with chest pain syndrome (sensitivity 96%, specificity 92%).
Practicability and limitations of enhanced external counterpulsation as an additional treatment for angina
Authors: Werner Dierk , Kropp Joachim , Schellong Sebastian , Friedel Chris , Voigt Jens‐Uwe , Ludwig Josef , Daniel Werner G. , Flachskampf Frank A. 
Published: June 2007

AbstractBackground: An increasing number of clinical studies indicates reduction of angina and myocardial ischemia by enhanced external counterpulsation (EECP) therapy. However, given the wide range of contraindications and the long duration of treatment, eligibility and practicality issues have not been addressed systematically.Hypothesis: Of all candidates for EECP (patients with drug‐refractory angina without possibility of revascularization), the majority either have contraindications or have practical problems complying with the time demands that this therapy imposes. In the rest, EECP leads to satisfactory results.Methods: During 18 months, every consecutive patient with angina despite medical and interventional therapy was evaluated for EECP at one center. Treated patients underwent a bicycle exercise test and perfusion imaging before and after the standard course of 35 h of EECP. In addition, patients were asked about frequency of angina and nitroglycerin usage before and after EECP, and all patients filled out a final questionnaire 1 year after the end of therapy.Results: Overall, 48 patients were considered candidates for EECP. Of these, 24 were excluded for medical reasons: poor ejectionfraction (4), peripheral artery disease (4), anticoagulation (4), and atrial fibrillation (3). Eight further patients declined EECP for lack of time or accommodation. Another 3 of the 16 remaining patients dropped out because of side effects. In the 13 patients who finished the treatment course, weekly anginal episodes were reduced by 48% (p < 0.05), on‐demand nitroglycerin puffs were reduced by 51% (p<0.05), work capacity was improved by 22% (p <0.05), and the number of reversible perfusion defects in perfusion scans decreased non‐significantly (‐28%). However, 4 of 13 treated patients determined 1 year later that the detriment of loss of time exceeded the benefits of EECP.Conclusion: Similar to previous reports, our study confirms the reduction of angina and improvement of work capacity after EECP. However, using established contraindications, approximately two‐thirds of patients considered to be candidates had to be excluded, and one‐third of the treated patients regarded EECP therapy retrospectively as too time consuming.
Autopsy findings in siblings with hypertrophic cardiomyopathy caused by Arg92Trp mutation in the cardiac troponin T gene showing dilated cardiomyopathy‐like features
Authors: Shimizu Masami , Ino Hidekazu , Yamaguchi Masato , Terai Hidenobu , Uchiyama Katsuharu , Inoue Masaru , Ikeda Masatoshi , Kawashima Atsuhiro , Mabuchi Hiroshi 
Published: June 2007

AbstractBackground: Hypertrophic cardiomyopathy (HCM) is caused by mutations in the genes that encode sarcomeric proteins. Although some patients with HCM have shown dilated cardiomyopathy (DCM)‐like features, the relationship between genotype and histologic findings is not well known.Hypothesis: Family members with the same gene mutation may show the same histopathologic changes and clinical manifestations.Methods: Siblings with HCM caused by an Arg92Trp mutation in the cardiac troponin T gene, showing DCM‐like features, were examined.Results: The patients were a 69‐year‐old woman and her 57‐year‐old brother who both died from congestive heart failure. Their autopsies revealed the same histopathologic findings in the heart. The anterior walls and interventricular septa of their hearts were replaced with extensive fibrosis and showed thinning. Myocyte hypertrophy, disarray, and thickened medial walls of the intramural coronary arteries were found. On electron microscopy, the number of mitochondria was seen to be increased and they formed many clusters.Conclusions: Patients with HCM caused by an Arg92Trp mutation in the cardiac troponin T gene may have the same histopathologic findings, whichmay result in DCM‐like features.
The association of homocysteine and coronary artery disease
Authors: Gauthier Gregory M. , Keevil Jon G. , McBride Patrick E. 
Published: June 2007

AbstractHyperhomocysteinemia has been associated with increased risk of atherosclerosis and myocardial infarction by a number of prospective case‐control studies. A variety of genetic mutations, nutritional deficiencies, disease states, and drugs can elevate homocysteine concentrations. Treatment with folic acid with or without B‐complex vitamins effectively lowers homocysteine levels. Whether therapy corresponds with decreased risk of coronary events is unknown, but may be promising. This article reviews the biochemistry of homocysteine metabolism, pathogeneisis, and etiology of hyperhomocysteinemia, along with its association with coronary artery disease, screening, and treatment.
Increased plasma thioredoxin in patients with acute myocardial infarction
Authors: Soejima Hirofumi , Suefuji Hisakazu , Miyamoto Shinzo , Kajiwaram Ichiro , Kojima Sunao , Hokamaki Jun , Sakamoto Tomohiro , Yoshimura Michihiro , Nakamura Hajime , Yodoi Junji , Ogawa Hisao 
Published: June 2007

AbstractBackground and hypothesis: Thioredoxin is an important biomarker for oxidative stress. We investigated whether thioredoxin levels were elevated in patients with acute myocardial infarction (AMI) and were associated with the results of coronary reperfusion.Methods: The present study determined plasma thioredoxin levels in 51 patients with AMI, 30 patients with stable exertional angina (SEA), and 30 patients with chest pain syndrome (CPS). Plasma sampling was performed on admission, at 12 h, 1 week, 2 weeks, and 4 weeks in patients with AMI, and after admission in patients with SEA and CPS.Results: Plasma thioredoxin levels on admission were higher in patients with AMI than in those with SEA and CPS. Plasma thioredoxin levels in patients with AMI were decreased in 12 h without further change thereafter. However, thioredoxin levels in patients with AMI remained higher than in those with SEA. In multivariate analysis, higher levels of thioredoxin on admission were a risk factor for failure in emergent reperfusion therapy in patients with AMI independent of other factors.Conclusion: Plasma thioredoxin levels are elevated in patients with AMI, and higher thioredoxin levels may predict subsequent failed coronary reperfusion therapy in patients with AMI.
Potential application of tissue doppler imaging to assess regional left ventricular diastolic function in patients with hypertrophic cardiomyopathy: Comparison with 123I‐β‐methyl iodophenyl pentadecanoic acid myocardial scintigraphy
Authors: Yamada Hirotsugu , Oki Takashi , Yamamoto Takashi , Tanaka Hideji , Tabata Tomotsugu , Wakatsuki Tetsuzo , Nomura Masahiro , Ito Susumu , Thomas James D. 
Published: June 2007

AbstractBackground: Tissue Doppler imaging (TDI) has been utilized to evaluate left ventricular myocardial dysfunction in patients with hypertrophic cardiomyopathy (HCM); however, no clear explanation for the abnormality of TDI variables has been forthcoming.Hypothesis: Peak negative myocardial velocity gradient (MVG) derived from TDI may correlate with a disorder of fatty acid metabolism in patients with HCM.Methods: Tissue Doppler imaging and 123I‐β‐methyl iodophenyl pentadecanoic acid (123I‐BMIPP) myocardial scintigraphy were performed in 15 patients with asymmetric septal hypertrophy (mean age 47 ± 18 years) and in 12 healthy controls (mean age 43 ± 10 years).Results: In early 123I‐BMIPP images, accumulation defects were observed in the ventricular septum in 12 patients and in the posterior wall in 8 patients with HCM. Peak negative MVG in the ventricular septum (1.1 ± 0.5 vs. 2.8 ± 0.5, p<0.0001) and posterior wall (5.2 ± 1.4 vs. 6.7 ± 0.8, p< 0.01) was significantly lower in the HCM group than in the controls; also, these parameters were significantly lower in patients with than in those without a defect in the region in question. The peak negative MVG in the ventricular septum and posterior wall correlated inversely with the washout rate in all subjects.Conclusions: Peak negative MVG according to TDI is related to disorder of fatty acid metabolism in the regional left ventricular myocardium of patients with HCM.
A population‐based evaluation of the thrombolysis in myocardial infarction risk score for unstable angina and non‐ST elevation myocardial infarction
Authors: Bartholomew Beth A. , Sheps David S. , Monroe Stephen , McGorray Susan , Smith Karen , Pepine Carl J. 
Published: June 2007

AbstractBackground: The Thrombolysis in Myocardial Infarction risk score (TIMI‐RS) for unstable angina/non‐ST elevation myocardial infarction (MI) was developed in patients presenting with unstable angina accompanied by high‐risk features or non‐ST elevation MI to determine early risk stratification.Hypothesis: The validity in patients presenting for emergency care with symptoms suggestive of acute coronary syndrome (ACS) has not been well established, and the present study sought to do so by evaluating the TIMI‐RS in a prospective fashion.Methods: A prospective TIMI‐RS using seven variables was calculated in 245 patients admitted to the hospital with symptoms suggestive of ACS: (1) age > 65, (2) three or more cardiac risk factors, (3) ST deviation, (4) aspirin use within 7 days, (5) two or more anginal events over 24 h, (6) history of coronary stenosis, and (7) elevated troponin. Patients were contacted at 30 days and data were collected concerning major adverse cardiac events.Results: In patients presenting with chest pain, a higher TIMI‐RS was associated with an increase in major adverse cardiac events within 30 days. We found that the 30‐day event rate was 0% for a score of 1, 20% for a score of 2, 24% for a score of 3, 42% for a score of 4, 52% for a score of 5, and 70% for a score of 6 or 7 (p < 0.0001).Conclusions: The TIMI‐RS successfully differentiates early risk for major adverse cardiac events in a general population presenting with symptoms suggestive of acute coronary syndrome. A simple bedside calculation of the TIMI‐RS provides rapid risk stratification, allowing facilitation of therapeutic decision making in patients with symptoms suggestive of ACS.
Evolving targets for risk reduction in diabetes
Authors: Caputo Gregory M. , Braunstein Joel B. , Blumenthal Roger S. 
Published: June 2007

AbstractRecent evidence shows that target low‐density lipoprotein cholesterol should be less than 100 mg/dl in patients with diabetes, and that even those with initially low levels benefit from pharmacologic therapy. Recent studies document that blood pressures lower than the previous target of 140/90 mmHg are beneficial, in addition to providing observational evidence against a lower threshold of benefit. Evidence that addresses the effect of blood glucose on macrovascular disease risk in patients with diabetes is reviewed. Finally, recommendations are made regarding systematic changes in healthcare delivery that will facilitate risk reduction strategies in diabetes.