bluuebunny/crossref_metadata_2025_split huggingface dataset:
Low Serum Cholesterol Levels Predict High Perioperative Mortality in Patients Supported by a Left-Ventricular Assist System
Authors: Richartz Barbara M. , Radovancevic Branislav , Frazier O. Howard , Vaughn William K. , Taegtmeyer Heinrich 
Published: April 2003

<b>Background:</b> Although the use of a left-ventricular assist system (LVAS) provides circulatory support for end-stage heart failure patients awaiting heart transplantation, this procedure is accompanied by a relatively high perioperative mortality. The aim of this retrospective study was to identify those patients preoperatively which have the highest perioperative mortality. <b>Methods and Results:</b> Forty-five consecutive patients undergoing LVAS implantation were evaluated for preoperative risk factors, including body mass index, hemodynamic data, and blood chemistry studies by multivariate analysis. They were divided into (1) patients who were successfully transplanted (n = 25) and (2) patients who died before transplantation (n = 20). The nonsurvivors were subclassified into patients who died within 14 days after surgery (n = 11) and patients who died after 2 weeks of device implantation (n = 9). Hemodynamic parameters were the same in both groups, but total cholesterol was significantly lower in the nonsurvivors than in the survivors (90 ± 7 vs. 144 ± 8 mg/dl, respectively, p < 0.0001). The sensitivity of predicting perioperative death with a serum cholesterol below 100 mg/dl was 100%, the specificity of predicting survival with a serum cholesterol above 120 mg/dl was 87%. <b>Conclusion:</b> In this small retrospective study, there was a correlation between total cholesterol levels and survival of patients with advanced heart failure on mechanical support. A cholesterol level below 100 mg/dl was accompanied by a high perioperative mortality. In contrast, a cholesterol level above 120 mg/dl was accompanied by a 87% chance of survival. The results suggest a predictive value of cholesterol which is independent of the hemodynamic status.
Assessment of Functional Results after Percutaneous Transluminal Coronary Angioplasty by Cardiopulmonary Exercise Test
Authors: Klainman Eliezer , Fink Gershon , Lebzelter Joseph , Zafrir Nily 
Published: April 2003

Twenty-nine patients with documented coronary artery disease underwent cardiopulmonary exercise tests before and following a percutaneous transluminal coronary angioplasty (PTCA). The patients medication regimen and exercise protocols remained the same in both cases. Following PTCA, significant improvement (p < 0.001–0.0001) was noted in oxygen consumption (1,526.8 ± 470.0 vs. 1,686.2 ± 390 ml/min), oxygen pulse (12.40 ± 2.73 vs. 13.44 ± 2.9 ml/beat), oxygen pulse score (7.62 ± 1.29 vs. 8.85 ± 1.26 points) and in the ventilatory anaerobic threshold (993.1 ± 177.6 vs. 1,089.8 ± 150.9 ml/min) but not (p > 0.05) in maximal heart rate (128.7 ± 16.9 vs. 132.0 ± 17.2 beats/min). Thus, a cardiopulmonary exercise test is an effective method to assess functional results following PTCA.
A Comparison of the Effects of Mibefradil and Atenolol on Regression of Left Ventricular Hypertrophy in Hypertensive Patients
Authors: Höglund Christer , Cifkova Renata , Mimran Albert , Tenczer Jozsef , Watt Andrew , Wilkins Martin R. , Lindberg Elisabeth 
Published: April 2003

<b>Objective:</b> This study was designed to compare the effect of mibefradil, a selective T-type calcium channel antagonist, with the β-blocker atenolol on regression of left ventricular (LV) hypertrophy in hypertensive patients. <b>Methods:</b> In this multicenter, double-blind, active-controlled, randomized, parallel-group comparison, 66 patients with mild-to-moderate hypertension (sitting diastolic blood pressure, SDBP, 95–114 mm Hg) and LV mass index >102 g/m<sup>2</sup> for males and >88 g/m<sup>2</sup> for females were randomized to an initial treatment with 50 mg of either mibefradil or atenolol for 4 weeks. Doses were increased to 100 mg/day if blood pressure was not normalized to ≤90 mm Hg, and, if needed, 25 mg of hydrochlorothiazide was added. Treatment continued for a total of 24 weeks. LV hypertrophy was assessed by echocardiography, and trough SDBP and adverse events were recorded. <b>Results:</b> Treatment with mibefradil or atenolol resulted in decreases from baseline in LV mass index of 11.1% (p < 0.001) and 9.1% (p < 0.001), respectively. The treatment difference (mibefradil vs. atenolol) was not statistically significant. Reductions in SDBP with mibefradil and atenolol were 14.3 and 10.7 mm Hg, respectively, again not statistically significant. Both drugs were well tolerated; however, overall there were more potentially drug-related adverse events reported with atenolol (48.5%) than with mibefradil (24.2%). <b>Conclusions:</b> The reductions in LV hypertrophy and blood pressure achieved with mibefradil were larger but statistically equivalent to those with atenolol, but a lower overall incidence of treatment-related adverse events was seen in the mibefradil-treated patients.
Plasma B-Type Natriuretic Peptide Measurement in a Multiphasic Health Screening Program
Authors: Niinuma Hiroyuki , Nakamura Motoyuki , Hiramori Katsuhiko 
Published: April 2003

The aim of this study was to determine whether measurement of plasma levels of atrial natriuretic peptide (ANP) and B-type natriuretic peptide (BNP) is an efficacious method to predict patients with heart disease irrespective of left ventricular function in a multiphasic health screening program. We have examined whether patients with various heart disease selected by physical examination, ECG, and chest X-rays can be identified by plasma levels of ANP and BNP. We examined 481 consecutive subjects who visited our checkup clinic for a multiphasic health screening test. By routine methods, among the 481 subjects, 13 were found to have some form of heart disease (old myocardial infarction, 2; cardiomyopathy, 2; valvular heart disease, 2; hypertensive heart disease, 5, and lone atrial fibrillation, 2). Sensitivity, specificity, and quintile analysis for identification of the patients with heart disease were determined by various cutoff levels of plasma ANP and BNP. Receiver operating characteristic (ROC) curves were constructed for the identification of these patients. A plasma BNP level of 40 pg/ml had a sensitivity of 85% and a specificity of 92% for heart disease detection. The area under the ROC curve for BNP was significantly greater than that for ANP (0.94 vs. 0.81; p < 0.001). A plasma BNP level of 13 pg/ml or less gave a 100% negative prediction value for heart disease. Plasma BNP concentration is a useful biochemical marker for the screening of asymptomatic patients with heart disease due to various etiologies from large population samples.
Thallium-201 for Detection of Myocardial Viability: Comparison of Early Postexercise Reinjection and Imaging with 4 and 18–24 Hours Redistribution Imaging
Authors: Antonopoulos Athanassios , Georgiou Evangelos , Kyriakidis Michael , Nikolopoulos Dimitrios , Proukakis Charalambos , Toutouzas Pavlos 
Published: April 2003

To evaluate the efficacy of an early <sup>201</sup>Tl reinjection and imaging protocol for reducing the need for conventional 4-hour or optimal 24-hour redistribution imaging (RI) and detecting of myocardial viability, we compared the results of early postexercise Tl reinjection and imaging with those of 4- and 24-hour RI in 74 consecutive patients aged 55 ± 9 years (mean ± SD) who were assessed for myocardial ischemia. One millicurie of Tl was injected promptly after completion of the initial postexercise imaging (PEX) and three additional sets of images were acquired 1, 4 and 18–24 h later. A total of 2,368 segments were evaluated. On PEX, 390 (17%) segments showed defects, of which 287 (74%) showed enhanced Tl uptake at 1-hour RI; 89 (23%) did not change and 14 (4%) showed reverse redistribution. Of the 103 persistent defects, only 27 (7%) showed further fill-in of Tl; 62 (16%) segments showed reverse redistribution at 4-hour RI while at 18- to 24-hour RI 17 (4%) and 47 (12%) segments showed further fill-in of Tl and reverse redistribution, respectively. Finally, after analysis of 4- and 18- to 24-hour RI, the diagnosis changed from myocardial necrosis to ischemia in only 2 (3%) patients. In conclusion, these results suggest that by eliminating the need for an additional delayed set of images for detection of myocardial viability, this protocol reduces the total investigation procedure, is more convenient for the patient, increases patient turnover and expedites the decision-making process.
Extracellular Amino Acids as Markers of Myocardial Ischemia during Cardioplegic Heart Arrest
Authors: Kennergren Charles , Mantovani Vittorio , Lönnroth Peter , Nyström Britta , Berglin Eva , Hamberger Anders 
Published: April 2003

Extracellular levels of amino acids in the myocardial interstitium are sensitive indicators of myocyte function. Lowered ATP leads to a rapid extracellular appearance of amino acids with a high intra- to extracellular concentration ratio, such as taurine and glutamate. Nitrogen fluxes are reflected by glutamine, while alanine, glycine, serine and leucine are markers of proteolysis. In addition, degradation of membrane phospholipids is reflected by other primary amines, such as phosphoethanolamine. The time course of these changes was determined before, during and after cardioplegic heart arrest. Two regions of the heart were monitored in 20 patients by means of microdialysis sampling. After only 20 min of heart arrest, extracellular taurine, glutamate and phosphoethanolamine increased transiently up to 25 times the basal level. Ten–20 min later, glutamine increased by 6 times. A doubling of alanine, glycine, serine and leucine levels took place 30 min after release of the aortic cross-clamp. After 2 h, all were at levels similar to those recorded 15–30 h later. Levels of taurine and glutamate in the anterior wall of the heart correlated significantly with those of its lateral wall. The response to surgery and heart arrest was studied in a group of patients with ischemic heart disease as well as in another group of patients, who underwent heart surgery for nonischemic reasons. The response of taurine and glutamine was significantly higher for the patients with ischemic heart disease, in spite of a shorter mean time of heart arrest. No sex differences were recorded. High levels of amino acids coincided frequently with clinical events, which were suggestive of ischemia, but were also recorded in a few patients without diagnosed events. We conclude that monitoring of extracellular amino acids is valuable for evaluation and development of cardioprotective strategies.
Time Course of Endothelin-1 Plasma Level in Patients with Acute Coronary Syndromes
Authors: Vojáček Jan , Kolář Jiří , Lisý Ondřej , Hraboš Vladimír , Šimek Stanislav , Jindra Jr. Antonín , Jáchymová Marie 
Published: April 2003

An elevated plasma level of endothelin-1 was reported in several cardiovascular conditions including unstable angina pectoris and myocardial infarction. The present study was designed to evaluate the time course of the endothelin-1 release in unstable angina pectoris and to assess its relationship to the development of myocardial infarction and coronary vessel occlusion. The cohort studied included 32 patients with the clinical diagnosis of unstable angina pectoris who had been admitted to the coronary care unit and subsequently underwent coronary angiography (group A). Fourteen patients with chronic stable angina pectoris referred to routine diagnostic coronary angiography served as the control group (group B). A significant difference in the endothelin-1 plasma level was found between both groups, the values being 10.2 ± 5.3 and 6.0 ± 3.1 pg/ml (p < 0.01), respectively. There were, however, no significant differences between the following subdivisions of group A: patients with and without subsequent myocardial infarction; those with angiographically documented occlusion of at least one major branch of the coronary artery and no occlusion; and finally, those with persisting symptoms of angina pectoris and with favorable response to treatment. Neither was there any difference found among the subgroups differing in the time interval between the onset of chest pain and blood sampling. The time course of endothelin plasma concentrations showed elevated values lasting for more than 96 h after the index episode of prolonged chest pain. No correlation with the subsequent clinical course could be inferred. Thus, plasma endothelin level was elevated in patients with unstable angina pectoris and myocardial infarction and the increase persisted for several days after the onset of symptoms.
Asymptomatic Intracardiac Thrombi and Primary Antiphospholipid Syndrome
Authors: Granel B. , Garcia E. , Serratrice J. , Christides C. , Swiader L. , Pache X. , Caus T. , Disdier P. , Weiller P.J. 
Published: April 2003

Intracardiac thrombi have rarely been reported in patients with the antiphospholipid syndrome. We describe a new case revealed by systematic echocardiography in an asymptomatic woman who consulted for mild thrombocytopenia. Our case is characterized by a past history of migraine, fetal loss and psychiatric disturbances and by a high level of antiphospholipid antibodies (anticardiolipin, anti-β<sub>2</sub>-glycoprotein I and lupus anticoagulant). Echography, in the absence of any cardiovascular symptom, showed bulky right intra-atrial thrombi requiring surgical excision. Histopathological analysis revealed the fibrino-cruoric nature of the lesion without myxoma. This case shows that, when faced with a mild thrombocytopenia associated with antiphospholipid antibodies, echocardiography may reveal a life-threatening and completely asymptomatic intracardiac thrombosis.
Scintigraphic Predictor of Left Ventricular Size after Acute Myocardial Infarction
Authors: Abe Yoshiteru , Sugiura Tetsuro , Suga Yutaka , Takehana Kazuya , Kamihata Hiroshi , Karakawa Masahiro , Inada Mitsuo , Iwasaka Toshiji 
Published: April 2003

The aim of this study was to evaluate the relation between thallium-201 scintigraphic indices and left ventricular size after acute myocardial infarction. Forty-seven patients with acute myocardial infarction underwent rest-redistribution thallium-201 scintigraphy at 2 weeks and left ventriculography at 4 weeks, after the onset of myocardial infarction. Percent (%) fixed defect, %redistribution and %reverse redistribution, calculated as a percentage of whole left ventricular area, were quantified with computer-generated unfolded map method of the myocardial radioactivity. Despite no significant difference in peak plasma creatine phosphokinase between the two groups, patients with anterior myocardial infarction (28 patients) had larger %fixed defect (p < 0.01), which was associated with higher end-diastolic pressure (p < 0.05) and larger end-diastolic volume index (p < 0.01) than those with inferior myocardial infarction (19 patients). End-diastolic volume index was not related to %redistribution and %reverse redistribution, but there was a good relation between end-diastolic volume index and %fixed defect in anterior (r = 0.79, p < 0.001) and in inferior (r = 0.73, p < 0.001) myocardial infarction. However, left ventricular end-diastolic volume index in anterior myocardial infarction was larger than that of inferior myocardial infarction at any given %fixed defect. Thus, site as well as size of fixed defect at 2 weeks after the onset of acute myocardial infarction was related to left ventricular end-diastolic volume at chronic phase.
The Prognostic Implications of Negative T Waves in the Leads with ST Segment Elevation on Admission in Acute Myocardial Infarction
Authors: Herz Izhak , Birnbaum Yochai , Zlotikamien Bruria , Strasberg Boris , Sclarovsky Samuel , Chetrit Angela , Wagner Galen S. , Barbash Gabriel I. 
Published: April 2003

We assessed the prognostic significance of negative T waves on admission in leads with ST elevation in 2,853 patients with acute myocardial infarction treated with thrombolysis. Patients were classified into 2 groups based on the presence of negative (T–) or positive (T+) T waves in the leads with ST elevation on admission. T+ and T– waves on admission were detected in 2,601 (91%) and 252 (9%) patients, respectively. T– waves were observed in 6.7 and 9.6% of patients admitted ≤2 and 2–6 h after onset of infarction, respectively. There was a difference in prognosis between patients admitted ≤2 and >2 h after symptom onset. T– patients admitted ≤2 h after onset had no hospital mortality (0/52 patients), as compared to a 5.0% mortality rate in T+ patients (36/726 patients; p = 0.19). T– patients treated >2 h after onset suffered higher mortality (20/196 patients; 10.2%) than T+ patients (100/1,836 patients; 5.4%; p = 0.01). Multivariate analysis of the data on patients treated >2 h after onset demonstrated T– waves to be associated with mortality (OR 1.86; 95% CI 1.07–3.25; p = 0.017). T– waves in leads with ST elevation upon admission are associated with adverse prognosis in patients presenting >2 h after symptom onset, whereas in patients presenting ≤2 h after first symptoms, T– waves may be associated with better prognosis.
Early Time Course of Heart Rate Variability after Thrombolytic and Delayed Interventional Therapy for Acute Myocardial Infarction
Authors: Lotze Ulrich , Özbek Cem , Gerk Ulrich , Kaufmann Holger , Heisel Armin , Bay Wolfgang , Figulla Hans Reiner 
Published: April 2003

In 89 of 97 consecutive patients with myocardial infarction (MI) undergoing thrombolysis and delayed early coronary angiography with PTCA, if indicated, heart rate variability (HRV) in time domain was evaluable 40 ± 11 h after the onset of chest pain using 24-hour ECG recordings. Patients with anterior MI (n = 40) had lower values for HRV and left ventricular ejection fraction (p < 0.05). The mean of all 5-min standard deviations of RR intervals (SDNNi) and the root-mean-square difference of successive RR intervals (rMSSD) decreased significantly (p < 0.001 each), whereas the standard deviation of all normal RR intervals and the percentage of absolute differences between successive RR intervals only showed a tendency to lower values 4 weeks after MI (p = 0.20 and 0.08, respectively). The decreases in SDNNi and rMSSD were more evident in inferior than in anterior MI. The time course of HRV following MI was similar in patients with and without PTCA. These results indicate an initial vagal hyperactivity in inferior MI, which is quickly predominated by sympathetic activation and a prolonged recovery of the cardiac autonomic imbalance after MI despite a successful combined reperfusion therapy.
Extensive Thrombus Formation in the Right Ventricle due to a Rare Combination of Arrhythmogenic Right Ventricular Cardiomyopathy and Heterozygous Prothrombin Gene Mutation G20210 A
Authors: Attenhofer Jost Christine H. , Bombeli Thomas , Schrimpf Carsten , Oechslin Erwin , Kiowski Wolfgang , Jenni Rolf 
Published: April 2003

Arrhythmogenic right ventricular cardiomyopathy is a rare heart muscle disease characterized by right and often left ventricular myocardial atrophy and fibrofatty replacement. Heart failure, arrhythmias and sudden death are characteristic complications. We observed a female in whom arrhythmogenic right ventricular cardiomyopathy was diagnosed due to presyncopes and dyspnea on exertion. A left ventricular thrombus was found echocardiographically, which disappeared with oral anticoagulation. Subsequently, however, extensive thrombus formation in the dilated akinetic right ventricle occurred which was resistant to combined treatment with heparin and oral anticoagulation. Thrombophilia screening showed a mutant prothrombin 20210A allele which is an inherited coagulopathy associated with increased plasma levels of prothrombin and increased risks of mainly venous thrombosis. The patient developed endstage biventricular heart failure and underwent heart transplantation within 3 months after thrombus formation in the right ventricle was diagnosed. In the explanted heart, the thrombus in the right ventricle was impressively large and calcified. In patients with unusual thrombus formation in the heart, coagulopathy may be associated and should be excluded.
Impact of Blood Pressure Control on Prevalence of Left Ventricular Hypertrophy in Treated Hypertensive Patients
Authors: Cuspidi C. , Lonati L. , Sampieri L. , Macca G. , Michev I. , Salerno M. , Fusi V. , Leonetti G. , Zanchetti A. 
Published: April 2003

<i>Aim:</i> The aim of the present study was to evaluate (1) the prevalence and patterns of left ventricular hypertrophy (LVH) and (2) the impact of blood pressure (BP) control, assessed by clinical and 24-hour ambulatory BP monitoring (ABPM) criteria on the persistence of LVH in a representative sample of treated patients attending our Hypertension Clinic. <i>Methods:</i> One hundred consecutive essential hypertensives (61 m/39 f, age 56± 9 years) regularly followed up by the same medical team (average period 52 months, 12–156 months) were included in the study and underwent 24-hour ABPM and complete echocardiographic examination. <i>Results:</i> Twenty-eight of the 100 patients were found to have LVH [left ventricular mass index (LVMI) >125 g/m<sup>2</sup> in men and >110 g/m<sup>2</sup> in women]; LVH was eccentric in 20 patients and concentric in the remaining 8. LVMI did not correlate with clinical BP values but only with ABPM values (mean 24 h systolic r = 0.34, p <0.01; diastolic r = 0.37, p <0.01). The prevalence of LVH in patients controlled according to clinical BP criteria (n = 43, BP <140/90 mm Hg) was 19%, in patients controlled according to ABPM criteria (n = 30, BP during daytime <132/85 mm Hg) 17%, and in those controlled with both criteria (n = 16) 6% (p <0.01). <i>Conclusions:</i> The results of this study suggest that the eccentric type of LVH is the prevalent pattern in chronically treated patients. The persistence of LVH is significantly dependent on BP levels achieved during treatment; indeed the prevalence of LVH is very low in patients with an optimal BP control, whereas it is elevated (37%) in uncontrolled patients.
Circulating Interleukin-6 and Interleukin-6 Receptors in Patients with Acute and Recent Myocardial Infarction
Authors: Kanda Tsugiyasu , Inoue Masahiro , Kotajima Nobuo , Fujimaki Shuku , Hoshino Yoichi , Kurabayashi Masahiko , Kobayashi Isao , Tamura Jun’ichi 
Published: April 2003

Interleukin-6 (IL-6), a proinflammatory cytokine, plays a key role in the pathogenesis of coronary artery disease (CAD). We investigated circulating IL-6 and its receptors in patients with CAD. We evaluated 39 Japanese patients with CAD (30 males and 9 females aged 36–79 years), measuring their plasma levels of IL-6 and IL-6 receptors α and β (IL-6Rα, IL-6Rβ). Circulating levels of IL-6, IL-6Rα and IL-6Rβ were measured by an enzyme-linked immunosorbent assay. Blood was sampled immediately after admission and again after 1, 2, 3, 6 and 9 h, then every 12 h for 5 days. Atrial natriuretic peptide (ANP) and B-type natriuretic peptide (BNP) were measured on day 3 after symptom onset. Plasma levels of IL-6 and IL-6Rs were significantly increased in 28 patients with acute myocardial infarction (AMI) compared with 15 normal controls. However, neither IL-6 nor IL-6Rs showed an increase in 6 patients with angina pectoris. We observed two peaks for circulating IL-6 in AMI, the first of which showed a significant correlation with ANP as well as BNP. These results may help to explain why the amount of IL-6 produced is closely related to the severity of myocardial dysfunction in patients with CAD.