text
stringlengths 1
1.75k
| source
stringlengths 15
68
⌀ | title
stringlengths 1
794
| publication_title
stringclasses 376
values |
|---|---|---|---|
75 +/- 0.06; p less than 0.01) time points. The stress thallium scan IZ:NZ, however, was greater than that of the 30-second teboroxime scan as well as that of the stress distal : circumflex flow. | 10.1161/01.cir.84.4.1796
| Comparison of 99mTc-teboroxime with thallium for myocardial imaging in the presence of a coronary artery stenosis. | Circulation |
Accordingly, the data indicate that 1) myocardial imaging with 99mTc-teboroxime is valuable in the noninvasive assessment of relative coronary flow reserve and that 2) delayed washout of the tracer from the myocardium reflects reduced myocardial blood flow and, under conditions comparable to those of the present study, may be a marker of myocardial ischemia. | 10.1161/01.cir.84.4.1796
| Comparison of 99mTc-teboroxime with thallium for myocardial imaging in the presence of a coronary artery stenosis. | Circulation |
The goal of this study was to investigate the nature and electrophysiological mechanisms of the proarrhythmic effects of flecainide in Langendorff-perfused rabbit hearts. | 10.1161/01.cir.84.4.1808
| Proarrhythmic effects of flecainide. Experimental evidence for increased susceptibility to reentrant arrhythmias. | Circulation |
A thin layer of epicardium was obtained by an endocardial cryotechnique in 10 Langendorff-perfused rabbit hearts. Six other hearts were kept intact. Programmed electrical stimulation using up to three closely coupled premature stimuli and burst pacing was used to test the inducibility of arrhythmias both during control and administration of 1 micrograms/ml flecainide. During control, in the thin layer of epicardium, application of one to three premature stimuli induced nonsustained ventricular tachycardia in out of 10 hearts, and burst pacing induced nonsustained ventricular tachycardia in four hearts and sustained ventricular tachycardia in two hearts. During administration of 1 microgram/ml flecainide, application of one to three premature stimuli induced sustained ventricular tachycardia in five hearts, and burst pacing induced sustained ventricular tachycardia in nine hearts. All tachycardias were based on circus movement of the impulse around arcs of functional block. During administration of flecainide, different locations of the arc of block could be found in the same heart, leading to different reentrant circuits with different cycle lengths. In the control group of six intact hearts, application of up to three closely coupled premature stimuli in all cases induced ventricular fibrillation both during control and administration of flecainide. | 10.1161/01.cir.84.4.1808
| Proarrhythmic effects of flecainide. Experimental evidence for increased susceptibility to reentrant arrhythmias. | Circulation |
Flecainide alters propagation of the impulse in thin surviving layers of myocardium in a manner that facilitates the induction of functionally determined reentry. | 10.1161/01.cir.84.4.1808
| Proarrhythmic effects of flecainide. Experimental evidence for increased susceptibility to reentrant arrhythmias. | Circulation |
The prevalence of coronary heart disease (CHD) increases rapidly with advancing age and remains the major cause of death among elderly Americans. The number of elderly has doubled in the last 30 years and is projected to continue growing at more than twice the rate of the general population. The resources required in managing CHD in this population will reach astronomical levels during the next few decades and will severely tax our ability to provide adequate medical care to all citizens, unless cost effective diagnostic and therapeutic strategies are developed which do not severely compromise health care. Risk factors for CHD should be identified and modified as early in life as possible. Modification of risk factors begun at advanced age appears to confer benefit, however. Anti-ischemic drug therapy is the treatment of choice for patients with mild or moderate stable angina. Select elderly may be willing to accept the increased risks of coronary revascularization to achieve relief from debilitating angina or prolongation of life. Physicians must use care in planning diagnostic and therapeutic strategies. Quality of life and independence are often more important considerations than longevity in this age group. | 10.1002/clc.4960140804
| Management of coronary heart disease in the elderly. | Clinical cardiology |
The systemic hemodynamic and coronary dilative responses to sublingual nitroglycerin were studied in patients receiving transdermal nitroglycerin. A total of 48 patients with coronary artery disease were divided into 4 groups: 12 patients receiving 1 tablet of sublingual nitroglycerin without transdermal nitroglycerin (Group 1), 12 patients receiving 1 tablet of sublingual nitroglycerin with 12-hour-daily intermittent therapy of transdermal nitroglycerin (Group 2), 12 patients receiving 1 tablet of sublingual nitroglycerin with continuous therapy of transdermal nitroglycerin with continuous therapy of transdermal nitroglycerin (Group 3), and 12 patients receiving 2 tablets of sublingual nitroglycerin with continuous therapy of transdermal nitroglycerin (Group 4). Before and during administration of sublingual nitroglycerin, aortic pressure, left ventricular pressure, and coronary artery diameter were examined at diagnostic cardiac catheterization in all patients. During sublingual nitroglycerin, the decreases of aortic systolic pressure and left ventricular end-diastolic pressure were greater in Group 1, 2, and 4 than in Group 3 | 10.1002/clc.4960140805
| Effects of sublingual nitroglycerin in patients receiving transdermal nitroglycerin for coronary artery disease: prevention of cross-tolerance. | Clinical cardiology |
Dilation of coronary arteries by sublingual nitroglycerin tended to be greater in Group 1, 2, and 4 than in Group 3. Thus, the effects of sublingual nitroglycerin for the relief of ischemia might be more prominent in patients with intermittent therapy of transdermal nitroglycerin than in those with continuous therapy. The increased dose of sublingual nitroglycerin for the relief of ischemia might be more effective in patients with continuous therapy of transdermal nitroglycerin. | 10.1002/clc.4960140805
| Effects of sublingual nitroglycerin in patients receiving transdermal nitroglycerin for coronary artery disease: prevention of cross-tolerance. | Clinical cardiology |
A retrospective analysis was performed on 23 subjects with lone atrial fibrillation who were followed for an average of 6.2 years (1.1-12.8 years). In all patients, underlying organic heart disease was excluded based on history, physical exam, electrocardiogram, echocardiogram, and Doppler ultrasound interrogation. All patients had at least two echocardiographic studies during the period of observation. Atrial fibrillation was chronic in 11 subjects and paroxysmal in 12. All echocardiographic measurements were obtained by averaging the measurements of two blinded investigators. Left atrial size increased an average of 5.6 mm which translates into a 14.7% increase over the baseline measurement. This increase in size was not associated with a change in left ventricular mass or fractional shortening as determined by echocardiography. Subjects with chronic atrial fibrillation had a larger percent increase than subjects with paroxysmal atrial fibrillation (18.9 vs. 10.8%), although this relative change in size failed to reach statistical significance. The only variable which significantly contributed to the change in left atrial size was the duration of follow-up. We conclude that atrial fibrillation occurring in patients with lone atrial fibrillation may cause a slow and progressive increase in left atrial size independent of changes in left ventricular size or function. | 10.1002/clc.4960140806
| Changes in left atrial size in patients with lone atrial fibrillation. | Clinical cardiology |
Left ventricular diastolic dysfunction at rest was studied in 24 patients with coronary artery disease but no evidence of previous myocardial infarction. Seven patients with normal coronary arteries were studied as control. Diastolic filling was analyzed by the serial left ventricular volume and 14 radial axes from the gravity point of the left ventricle with cine left ventriculography. There were no differences in the systolic function between coronary artery disease and the normal control. Peak filling rate was decreased significantly in the groups with left anterior descending artery disease (LAD, p less than 0.05) and multivessel disease (MVD, p less than 0.05), but not in the group with right coronary artery disease (RCA). Time to peak filling rate was prolonged in each group of LAD (p less than 0.05), RCA (p less than 0.05), and MVD (p less than 0.001), compared with controls. The time-volume curve showed disturbed rapid filling in the LAD and RCA groups, and also both depressed rapid and slow filling in the MVD group | 10.1002/clc.4960140807
| Left ventricular diastolic filling in patients with coronary artery disease without myocardial infarction. | Clinical cardiology |
In the LAD group, the filling fraction was decreased significantly at the time of 25% of the diastolic period (p less than 0.001) and radial distension to the anterior wall was decreased at the time of 25%, 50%, and 75% of the diastolic period, compared with controls. In the RCA group, the filling fraction (p less than 0.001) and radial distension to the posterior wall were decreased only at the time of 25% of the diastolic period. In the MVD group, filling fraction and radial distension to the most wall were decreased at 25%, 50%, and 75% of the diastolic period.(ABSTRACT TRUNCATED AT 250 WORDS) | 10.1002/clc.4960140807
| Left ventricular diastolic filling in patients with coronary artery disease without myocardial infarction. | Clinical cardiology |
The impact of transient myocardial ischemia on left ventricular function was examined by digital subtraction left ventricular angiography. Contrast medium was injected into the right pulmonary artery before, at 60 seconds of balloon inflation, and 10 minutes after balloon deflation. A total of 69 patients completed the study. In 52 patients, the left anterior descending artery (LAD) was involved, and in 17, the right coronary artery (RCA) was the focus. Ejection fraction (EF) declined by balloon inflation and returned to baseline value after deflation of the balloon. There was tendency toward a lower EF and wider akinetic area for LAD dilatation. The linear correlation between resting EF and EF during balloon inflation suggested that the effect of momentary coronary occlusion on left ventricular function appears to be additive to pre-existing left ventricular dysfunction, and resting ejection fraction is an important parameter for estimating the degree of diminished left ventricular function during myocardial ischemia. | 10.1002/clc.4960140808
| Left ventricular function during transient coronary occlusion: digital subtraction left ventriculograms during coronary angioplasty. | Clinical cardiology |
The fourth heart sound (S4) has been associated with vigorous atrial contraction. However, the presence of S4 has not been previously correlated with quantitated left atrial filling fraction. In this study, the presence of an auscultatory S4 was compared with the Doppler echocardiographically quantitated left atrial filling fraction in 41 consecutive patients in whom S4 was judged to be present or absent according to the consensus of cardiologists. Left atrial filling fraction in patients with S4 was 49% and was significantly greater than 33% found in patients without S4 (p less than 0.005). Using atrial filling fraction of 35% as a dividing line, S4 had a sensitivity of 84% and a specificity of 75% for determining left atrial filling fraction greater than or equal to 35%. Furthermore, of 25 patients with S4, 21 (84%) had atrial filling fraction greater than or equal to or less than 35%, and of 16 patients without S4, 12 (75%) had atrial filling fraction less than 35%. Thus, the presence or the absence of S4 is quantitatively related to the left atrial filling fraction and appears to predict atrial filling fraction greater than or equal to or less than 35% reasonably well. | 10.1002/clc.4960140809
| Relationship of auscultatory fourth heart sound to the quantitated left atrial filling fraction. | Clinical cardiology |
A large-scale, prospective, 8-week, office-based study was conducted to evaluate the effects of adding captopril to a therapeutic regimen of diuretic and digoxin or diuretic alone in the management of patients with mild to moderate congestive heart failure (CHF). A total of 2218 primary care physicians evaluated 6669 patients over the study period for efficacy parameters, which included changes in a modified New York Heart Association (NYHA) functional classification, symptomatology, and daily activity levels. Overall, 63.8% of evaluated patients improved with regard to functional ability, with 19% improving two or more modified NYHA classes. Symptoms of CHF, including dyspnea on exertion, fatigue, and orthopnea and signs, including rales and peripheral edema, were reduced in 86% of these patients: 41.5% demonstrated mild improvement; 30.0%, moderate improvement; and 14.5%, marked improvement. Three parameters, with which patients reported having difficulty at study entry, were assessed serially to evaluate changes in functional capacity; 78.5% of patients reported an increased walking distance, 72 | 10.1002/clc.4960140810
| A large-scale trial of captopril for mild to moderate heart failure in the primary care setting. | Clinical cardiology |
5% of patients reported an increased walking distance, 72.3% had increased capacity for climbing stairs, and 60.2% had improved capacity for individual recreational activities. Adverse experiences were reported in 18.1% of all patients; 4.9% of patients withdrew from the study because of an adverse effect. Combination therapy with captopril and diuretic for CHF was shown to be safe and effective regardless of patient age (less than 70 years vs. greater than or equal to 70 years), duration of heart failure (less than 1 year vs. greater than 1 year), presence of digoxin treatment, or the dosing schedule employed.(ABSTRACT TRUNCATED AT 250 WORDS) | 10.1002/clc.4960140810
| A large-scale trial of captopril for mild to moderate heart failure in the primary care setting. | Clinical cardiology |
After acute myocardial infarction, cardiac autonomic, and particularly parasympathetic, activity decreases, followed by a gradual return toward normal over the next few weeks and months. The easiest measurable index of autonomic activity is heart rate variability, which can be assessed in a number of different ways. Where heart rate variability is low after myocardial infarction, long-term survival is considerably reduced, independent of other known risk factors. This may be caused by patchy autonomic denervation, rendering the heart more susceptible to potentially fatal arrhythmias. Prophylactic drug therapy might reduce mortality in patients with low heart rate variability. | 10.1002/clc.4960140811
| Heart rate variability: an important new risk factor in patients following myocardial infarction. | Clinical cardiology |
During the last several years, dilating balloons have been applied in the treatment of stenotic cardiac valves. This interest has recently been extended to stenotic porcine bioprosthetic valves. Part I of this review discusses the pathologic processes responsible for degeneration of porcine prostheses: intrinsic calcification (mineralization), cuspal tears and perforations, and cuspal thrombosis (non-infective). These changes form the basis of applied balloon valvuloplasty techniques. | 10.1002/clc.4960140812
| Catheter balloon valvuloplasty of stenotic porcine bioprosthetic valves: Part I: Anatomic considerations. | Clinical cardiology |
A 34-year-old woman presented with her fourth occurrence of an atrial myxoma and a right lower lung field mass. Her surgical history was extensive. In addition to resection of three previous atrial myxomas, she had undergone resection of her adrenal glands as a teenager because of Cushing's syndrome, and a hysterectomy at age 26 revealed a myxoid leiomyoma. Family history was remarkable as a maternal uncle and daughter died from embolic complications of left atrial myxomas and her sister previously had a left atrial myxoma resected. The patient underwent uncomplicated removal of the myxoma, and resection of the lung mass revealed a granuloma. A review of typical and atypical aspects of cardiac myxomas is provided including a rare and recently described syndrome of familial cardiac myxoma associated with Cushing's syndrome, spotty skin pigmentation and other myxoid tumors. | 10.1002/clc.4960140813
| Familial recurring cardiac myxoma. | Clinical cardiology |
We present 2 cases in whom repetitive rapid ventricular tachycardia (VT) was the initial manifestation of metastatic cardiac disease. In one patient, repetitive VT appeared during chemotherapy for stage IV paratesticular rhabdomyosarcoma which led to the diagnosis of cardiac metastases. In the other, it led to the diagnosis of malignant pericardial effusion 17 years after successful therapy for a breast carcinoma. In conclusion, in patients with present or past history of malignancy, the appearance of life-threatening VT should raise the suspicion of cardiac metastases. | 10.1002/clc.4960140814
| Life-threatening ventricular tachycardia as the presenting symptom of metastatic cardiac disease. | Clinical cardiology |
Vasospasm-related myocardial infarction in young women with normal coronary arteries has infrequently been reported and vasospasm-related paroxysmal atrial fibrillation (PAF) has rarely been described. We present a 33-year-old woman with old inferior myocardial infarction and postinfarction angina at rest; the angina was accompanied by PAF and electrocardiographic ST-segment elevation in the inferior leads. Coronary angiography revealed normal coronary arteries and intracoronary acetylcholine provoked an intense and diffuse spasm of the right and left coronary artery. The spasm of the right coronary artery was associated with PAF and ST-segment elevation in the inferior leads. Frequently documented PAF, accompanied by chest discomfort and ST-segment elevation in the inferior leads, was more effectively removed with isosorbide dinitrate than with disopyramide. These data suggest that coronary vasospasm is a likely cause of myocardial infarction and even PAF, although the precise mechanism leading to PAF remains unknown. | 10.1002/clc.4960140815
| Coronary vasospasm as a potential cause of myocardial infarction and paroxysmal atrial fibrillation in a relatively young woman. | Clinical cardiology |
Jeremiah Stamler has had a major impact on the primary and secondary prevention of cardiovascular disease. His work began in the animal experimental laboratory and shifted to large-scale epidemiologic studies and clinical trials, resulting in nearly 800 contributions to the world medical literature. His influence is felt, not only through these publications and his innumerable lectures, but also... "through the hundreds of young people he has helped train (in the U.S. and abroad), and through the leadership role he has played locally, nationally, and internationally in preventive cardiology... The spirit imbuing the work of Dr. Stamler is a deep concern for human welfare, for the prevention of unnecessary disease, and for the prolongation of healthy life. This same spirit has made his name synonymous also with preservation of civil liberties, international cooperation among scientists of all countries, and efforts to avoid the catastrophe of nuclear holocaust." According to Dr | 10.1002/clc.4960140816
| Jeremiah Stamler. | Clinical cardiology |
" According to Dr. Geoffrey Rose, Dr. Stamler "... confronted the most devastating health problem of Western Society, cardiovascular disease. He espoused the belief that diet holds the key to its control at a time when that belief was widely considered to be false and its proponents a little crazy. That is now accepted wisdom, and the fact that in many countries at last the problem is in decline is due to this man more than to any other." | 10.1002/clc.4960140816
| Jeremiah Stamler. | Clinical cardiology |
Over the last 10 years, our knowledge of immunologically mediated processes involving the myocardium appears to have made quantum leaps. New and important disease entities such as AIDS have appeared and the cardiologist now becomes an important member of the "AIDS team." Our understanding of "older diseases" such as sarcoidosis, Lyme disease, systemic lupus and other connective tissue syndromes has significantly increased. The concept of high-dose steroid therapy for these processes may, in fact, turn out to be futile and more selective, as less dangerous immunosuppression is being introduced. This concept has significantly advanced in the field of cardiac transplantation where immunosuppression has now been usurped by specific immunotherapy aimed at selective aspects of the immune sequence. New and exciting concepts will emerge from the molecular biology laboratory that will have direct bearing on the management of patients with cardiovascular disorders. This information explosion will force the cardiovascular physician to become more in tune with the world of immunology and molecular biology. Many obvious, significant problems remain, such as accelerated atherosclerosis in the transplant patient and the role of myocarditis in the patient with heart failure | 10.1016/0146-2806(91)90029-a
| The heart as a target organ of immune injury. | Current problems in cardiology |
However, it will truly be an exciting decade in which to work and watch the unraveling of these mysteries and hopefully, the study of today's problems will give way to solutions and a clearer understanding of the heart as a target of immune injury. | 10.1016/0146-2806(91)90029-a
| The heart as a target organ of immune injury. | Current problems in cardiology |
Fifty-four patients with a posteroseptal accessory connection and symptomatic tachycardias underwent catheter ablation of the anomalous pathway. Eight had the permanent form of reciprocating tachycardias (long RP' tachycardia) and 46 had a left posteroseptal preexcitation marked by a prominent R wave in lead VI. In 14 of 19 patients, ventriculoatrial conduction time during tachycardia lengthened in conjunction with functional left bundle branch block; this behaviour was significantly different from a series of patients with right posteroseptal preexcitation in which functional left bundle branch block lengthened the ventriculoatrial time in only one of 12 patients. A quadripolar electrode catheter was left within the proximal coronary sinus in order to locate the earliest atrial or ventricular activation site. The appropriate bipole was used as the radiographic and electrophysiological reference of the insertion of the accessory pathway. A catheter was then positioned on the septal side of the right atrium, outside the coronary sinus, so that atrial activity during reciprocating tachycardia and ventricular activity during preexcitation were synchronous with or earlier than that recorded within the proximal coronary sinus. Accessory pathway potential was not recorded in any patient | 10.1093/eurheartj/12.8.845
| Catheter ablation of left posteroseptal accessory pathways and of long RP' tachycardias with a right endocardial approach. | European heart journal |
Accessory pathway potential was not recorded in any patient. Early ventricular potential occurring --1.5 +/- 8 ms relative to delta wave onset was present at that site. In 38 patients, including 5 with permanent junctional tachycardia, high current (14 mA) pacing yielded direct ventricular paced QRS complexes (no delay spike-QRS) with a morphology similar to left posteroseptal maximal preexcitation. Slight movements of catheter position yielded significantly different pace-maps. One to eight 160 J cathodal shocks (510 +/- 213 J cumulative per patient) were delivered at this site in 61 sessions. Following fulguration, tachycardia recurred without drugs in only one patient over a follow-up period of 20 +/- 13 months. Asymptomatic intermittent preexcitation recurred in two patients. In all patients with long RP' tachycardia, the ablation procedure was successful without the need for drugs or permanent cardiac pacing | 10.1093/eurheartj/12.8.845
| Catheter ablation of left posteroseptal accessory pathways and of long RP' tachycardias with a right endocardial approach. | European heart journal |
A long-term follow-up electrophysiological study in 18 patients demonstrated that conduction through the anomalous pathway was absent in 16 and deeply altered in the two patients with intermittent preexcitation; no tachycardia was inducible in any patient. In conclusion, catheter ablation of left posteroseptal accessory pathways is a feasible procedure using a right atrial approach outside the coronary sinus. This technique is also effective for the treatment of the permanent form of reciprocating tachycardia. | 10.1093/eurheartj/12.8.845
| Catheter ablation of left posteroseptal accessory pathways and of long RP' tachycardias with a right endocardial approach. | European heart journal |
In 25 patients undergoing diagnostic cardiac catheterization, a catheter-tip electromagnetic velocity transducer was used to evaluate maximum velocity and acceleration of blood in the ascending aorta. All patients underwent a complete haemodynamic evaluation, including high-fidelity recording of intraventricular pressures and calculation of the derived indices, left ventriculography and coronary angiography. Nineteen patients with critical coronary stenoses were divided according to the presence of signs of left ventricular dysfunction, while the control group consisted of six subjects with chest pain, but without cardiac abnormalities detectable by cardiac catheterization. Maximum aortic acceleration was significantly lower in coronary patients (378 +/- 130 vs 562 +/- 82 in the control group P less than 0.01) and also in the selected subgroup of coronary patients with normal haemodynamic and angiographic indices of left ventricular systolic function (310 +/- 102 vs 562 +/- 82, P less than 0.01). No relationship could be observed between maximal blood acceleration and left ventricular peak systolic pressure, +dP/dt, left ventricular end-systolic volume index and ejection fraction | null | Peak aortic blood acceleration: a possible indicator of initial left ventricular impairment in patients with coronary artery disease. | European heart journal |
Our results suggest that maximal blood acceleration from the left ventricle may detect an initial myocardial impairment in patients with definite coronary artery disease but with normal conventional indices of left ventricular function. The clinical interest of this index, however, is limited by overlapping values in patients with and without coronary artery disease and the inability of a further separation of ischaemic patients in accordance with the severity of left ventricular impairment and the extension of coronary artery involvement. | null | Peak aortic blood acceleration: a possible indicator of initial left ventricular impairment in patients with coronary artery disease. | European heart journal |
The relationship between coffee consumption and serum lipid levels was studied in a randomly selected sample of 395 young and 385 elderly adults in the Federal Republic of Germany. Analyses were done separately for men and women and for young and older people. After adjustment for body mass index, activity level, smoking, total energy intake, dietary fat, fish, milk, tea and alcohol consumption and oral contraceptive use a statistically significant increase in total serum- and LDL-cholesterol levels with increased coffee consumption was observed in the group of young men only. In this subgroup a difference of 0.11 mmol.l-1 serum cholesterol and of 0.10 mmol.l-1 LDL cholesterol for each additional cup of coffee consumed daily was calculated. This is one of the few studies that includes elderly people. No significant trend was seen between coffee consumption and serum- or LDL-cholesterol levels in the elderly. | 10.1093/eurheartj/12.8.869
| The relationship between coffee consumption and lipid levels in young and older people in the Heidelberg-Michelstadt-Berlin study. | European heart journal |
In view of the growing incidence of degenerative origin among the aetiologies of aortic regurgitation, we felt it interesting to report our experience of the surgical treatment of such patients. Out of 313 patients operated on for isolated chronic aortic regurgitation between 1974 and 1989, 102 (32.6%) had aortic regurgitation of degenerative origin and form the basis of this study. The patients were divided into group I (n = 48) without aneurysm of the ascending aorta and group II (54 patients) with anulo-aortic ectasia. The first group was further subdivided according to the diameter of the ascending aorta: in group Ia (23 patients) the aorta was normal with a root diameter of less than 40 mm, while in group Ib (25 patients) the aorta was enlarged (root diameter between 40 and 54 mm). There was no statistically significant difference between the pre-operative and operative parameters of patients in groups Ia and Ib. All underwent aortic valve replacement without associated surgery of the ascending aorta. During a mean follow-up of 58 months, five patients from group Ib had aortic dissection and in another three, an ascending aorta aneurysm developed | null | Degenerative aortic regurgitation. | European heart journal |
Reoperation was performed in six cases. No such complications occurred in group Ia. At 6 years, the proportion of patients free from complications related to the ascending aorta was 100% in group Ia vs 63 +/- 6% in group Ib (P less than 0.05). In group II, all the patients underwent aortic valve replacement. The modalities of repair of the ascending aorta differed with time.(ABSTRACT TRUNCATED AT 250 WORDS) | null | Degenerative aortic regurgitation. | European heart journal |
Full rehabilitation of a patient following myocardial infarction (MI) involves resumption of work and the restoration of quality of life. Two groups of patients (87 Israeli and 98 Swedish) were admitted to the CCU and followed up after their first MI. To evaluate the patients' own perception of events ('causal attribution theory'), sequential interviews were scheduled. Physical risk factors correlated poorly with rehabilitation outcome at 6 months. However, two patient clusters were pinpointed according to the patients' subjective explanation of the factors contributing to their MI. These 'causal attribution scores' had a predictive value, independent of culture, age, education, disease severity and depression. It is therefore concluded that evaluation of patient perception may assist in planning intervention for high risk psychologically debilitated patients, and thus favourably enhance their rehabilitation outcome. | null | The relationship between causal attribution and rehabilitation in patients after their first myocardial infarction. A cross cultural study. | European heart journal |
Twenty-four patients (one female, 23 male) with mild to moderate heart failure were randomly and double-blindly assigned to an oral treatment with 5 mg enalapril twice daily or 5 mg pimobendan (UDCG 115) twice daily. After the first tablet intake, blood pressure and heart rate were measured for 6 h. Therapy continued over 6 months. Systolic arterial blood pressure dropped from 126 +/- 20 mmHg to 111 +/- 14 mmHg (P less than 0.05) after the first enalapril tablet and from 123 +/- 16 mmHg to 112 +/- 13 mmHg (P less than 0.05) after the first pimobendan tablet. After 6 months, no important changes in blood pressure were observed in the pimobendan group and only a minor decrease in the enalapril group. There was no significant change in heart rate either after the first dose or after long-term therapy with either medication. After 6 months, cardiac index increased from 2.73 +/- 0 | 10.1093/eurheartj/12.8.889
| Comparison of hormonal and haemodynamic changes after long-term oral therapy with pimobendan or enalapril--a double-blind randomized study. | European heart journal |
73 +/- 0.75 l.min-1.m-2 to 3.38 +/- 0.69 l.min-1.m-2 (P less than 0.01) after pimobendam, but did not change after enalapril (2.95 +/- 0.75 l.min-1.m-2 to 2.96 +/- 0.89 l.min-1.m-2, NS). Pulmonary capillary wedge pressure decreased during pimobendan long-term therapy from 16 +/- 8 mmHg to 14 +/- 8 mmHg (NS) and during enalapril from 21 +/- 7 to 14 +/- 7 mmHg (P less than 0.01). Exercise capacity increased in the pimobendan group from 17 | 10.1093/eurheartj/12.8.889
| Comparison of hormonal and haemodynamic changes after long-term oral therapy with pimobendan or enalapril--a double-blind randomized study. | European heart journal |
Exercise capacity increased in the pimobendan group from 17.2 +/- 5.4 kJ to 23.0 +/- 9.6 kJ (P less than 0.05), and in the enalapril group from 20.4 +/- 11.9 kJ to 24.8 +/- 18.5 kJ (NS) during long-term therapy over 6 months. Plasma renin activity increased from 0.96 to 3.6 ng.ml-1.h-1 (P less than 0.05) during enalapril long-term therapy, but remained unchanged (1.38 vs. 1.32 ng.ml-1.h-1, NS) during pimobendan | 10.1093/eurheartj/12.8.889
| Comparison of hormonal and haemodynamic changes after long-term oral therapy with pimobendan or enalapril--a double-blind randomized study. | European heart journal |
h-1, NS) during pimobendan. The new inotrope, pimobendan, exerted favourable long-term effects without haemodynamic or humoral signs of tolerance development. | 10.1093/eurheartj/12.8.889
| Comparison of hormonal and haemodynamic changes after long-term oral therapy with pimobendan or enalapril--a double-blind randomized study. | European heart journal |
One hundred and three patients with a history of ventricular arrhythmia were screened by baseline 24-h Holter monitoring for a minimal mean number of 30 premature ventricular beats (PVB) per hour. One hundred and one patients were subsequently enrolled in a double-blind, cross-over trial, including four 4-day periods with administration of placebo (PL) or nicainoprol (N.) in doses of 200, 400, 600 mg three times daily in randomized order. Antiarrhythmic efficacy could be evaluated in 61 patients who met all requirements of the protocol, including a complete sequence of valid Holter recordings (greater than 18 h each). Total PVBs were significantly reduced by the 400-mg dose (65%) and the 600-mg dose (71%) as compared to baseline. Two hundred mg N. and PL led to a non-significant reduction of PVBs by 41% and 24%, respectively | null | Dose-related antiarrhythmic effects of nicainoprol in patients with chronic ventricular arrhythmias--a double-blind, placebo-controlled, cross-over multicentre trial. Nicainoprol Study Group. | European heart journal |
An individual response, assumed where there was simultaneous reduction of total PVBs greater than 75%, of ventricular pairs greater than 90% and elimination of ventricular runs, was found in 6 (10%), 10 (16%), 21 (34%), and 22 (36%) patients with PL, 200 mg N., 400 mg N. and 600 mg N., respectively. Four hundred and 600 mg N, significantly prolonged the PR interval (0.17 s and 0.18 s; median values) as compared with baseline (0.16 s), while the QRS duration was significantly increased only by the 600-mg dose (from 0.10 to 0.11 s). Heart rate, mean blood pressure, QT and JTc intervals were not significantly influenced by any dose of N.(ABSTRACT TRUNCATED AT 250 WORDS) | null | Dose-related antiarrhythmic effects of nicainoprol in patients with chronic ventricular arrhythmias--a double-blind, placebo-controlled, cross-over multicentre trial. Nicainoprol Study Group. | European heart journal |
In order to determine the significance of predischarge stress-induced ST segment changes after a first non-complicated acute myocardial infarction, a dobutamine stress test was performed in 104 patients. Dobutamine was infused in doses of 5, 10, 15 and 20 micrograms.kg-1.min-1 every 5 min with ECG and blood pressure control. It induced a substantial increase in heart rate and systolic blood pressure. The patients were divided into 4 groups: (1) anterior (n = 28); (2) inferior (n = 32); (3) posteroinferior (n = 27) and (4) high lateral plus anterior or anterolateral (n = 17) infarction. They were followed for 2 to 18 months (mean 7.5 +/- 5). In basal conditions the ST segment was elevated in 49 patients and depressed in 20. Combined ST elevation and depression was seen in 11. After dobutamine there was ST elevation in 80 patients, depression in 71 and combined elevation and depression in 60 | 10.1093/eurheartj/12.8.909
| Significance of ST segment changes induced by dobutamine stress test after acute myocardial infarction. Which are reciprocal? | European heart journal |
The magnitude of the maximal ST elevation was correlated with the magnitude of the maximal ST depression in each group of patients. There was a good inverse linear correlation between ST segment shifts in inferior vs high lateral leads, and ST depression was considered as a benign mirror image of opposite ST elevation in such leads. In patients with posterior infarction, anterior ST depression was considered as a mirror image of posterior ST elevation. In the remaining cases ST depression was a criterion of positivity.(ABSTRACT TRUNCATED AT 250 WORDS) | 10.1093/eurheartj/12.8.909
| Significance of ST segment changes induced by dobutamine stress test after acute myocardial infarction. Which are reciprocal? | European heart journal |
Angiotensin-converting enzyme inhibitors suppress plasma concentrations of the sodium retaining hormones angiotensin II and aldosterone. This action should potentiate the natriuretic and diuretic effects of loop diuretics. Some studies indicate, however, that the introduction of angiotensin-converting enzyme inhibitors for the treatment of cardiac failure is associated with transient weight gain and the development of oedema. We have compared the natriuretic and diuretic response to intravenous frusemide 40 mg alone with the natriuretic and diuretic response to intravenous frusemide 40 mg following the administration of a single dose of captopril in 12 supine male patients with stable chronic cardiac failure. Captopril lowered the 4 h diuretic response to frusemide from 1160 (60) to 685 (77) ml (P less than 0.05) and the natriuretic response from 120 (9.6) to 68 (11.7) mmol (P less than 0.05). Creatinine clearance fell after captopril from 91 (7.2) to 57 (7.7) ml min-1 (P less than 0 | 10.1093/eurheartj/12.8.924
| Acute administration of captopril lowers the natriuretic and diuretic response to a loop diuretic in patients with chronic cardiac failure. | European heart journal |
7) ml min-1 (P less than 0.05). Systolic and diastolic blood pressures were lower after the administration of captopril but these changes were not significant. Plasma renin activity rose from 3.8 (1.04) to 12.34 (2.94) ng ml h-1 (P less than 0.05) and plasma angiotensin II was reduced from 24.9 (5.05) to 8.14 (1.8) pg ml-1 (P less than 0.05). Plasma aldosterone concentrations were not significantly lower following captopril. Angiotensin-converting enzyme inhibitors cause an acute fall in creatinine clearance which may reduce the effects of loop diuretics and attention must be paid to diuretic dosage when initiating angiotensin-converting enzyme inhibitors for the treatment of cardiac failure. | 10.1093/eurheartj/12.8.924
| Acute administration of captopril lowers the natriuretic and diuretic response to a loop diuretic in patients with chronic cardiac failure. | European heart journal |
Haemodynamics and plasma catecholamine responses to isometric exercise were evaluated invasively in 11 orthotopic heart transplant recipients and seven control subjects. Differences in haemodynamic responses between the two groups were already apparent after one min of handgrip at 30% of maximal voluntary contraction, and very pronounced at the end of the fourth minute. At this point transplanted patients showed smaller increments in heart rate (4.8 +/- 3.2 vs 20.4 +/- 14.1 beats.min-1, P less than 0.001), mean arterial pressure (13.7 +/- 7.2 vs 31.5 +/- 12.2 mmHg, P less than 0.001) and cardiac index (0.51 +/- 0.22 vs 1.02 +/- 0.53 L.min-1.m-2, P less than 0 | null | Left ventricular dynamics and plasma catecholamines during isometric exercise in patients following cardiac transplantation. | European heart journal |
min-1.m-2, P less than 0.01), whereas left ventricular end-diastolic pressure increased to a greater extent (8.8 +/- 4.9 vs 2.2 +/- 1.8 mmHg, P less than 0.01). Stroke volume index increased similarly (3.8 +/- 1.8 vs 2.0 +/- 3.5 ml beat-1.m-2, NS) and systemic vascular resistance remained unchanged in both groups. The slopes of the left ventricular function curves (ratio of change in left ventricular work to change in left ventricular end-diastolic pressure) indicated depressed left ventricular function in the transplanted patients. The two groups showed similar increments in mixed venous plasma norepinephrine and epinephrine indicating normal sympathoadrenal activation in the transplanted patients | null | Left ventricular dynamics and plasma catecholamines during isometric exercise in patients following cardiac transplantation. | European heart journal |
In conclusion, transplanted hearts respond to handgrip with attenuated increases in heart rate, cardiac output and arterial pressure and by increasing left ventricular filling pressure, suggesting a poor contractile reserve probably due to denervation. Circulating catecholamines, especially epinephrine, probably contribute to the cardiac responses to isometric exercise. | null | Left ventricular dynamics and plasma catecholamines during isometric exercise in patients following cardiac transplantation. | European heart journal |
In man the early onset of fibrocellular tissue reaction, which leads to restenosis following an initial successful percutaneous transluminal coronary angioplasty, has been poorly documented because of limited opportunities to study this phenomenon. The present study focused on early changes in seven patients who died within 20 days of a percutaneous transluminal coronary angioplasty procedure. Differences in the mode of laceration were noted between concentric and eccentric plaques. In the former, tears occur at the thinnest site of the plaque or within an already attenuated fibrous cap. The injury usually remains limited to the plaque. In eccentric lesions lacerations tend to occur in the non-atherosclerotic wall segment, affecting the musculoelastic layers and the media. A further site of predilection is the border zone between the non-affected wall and the plaque. Early tissue response is characterized by fibrin-platelet depositions, and a proliferation of macrophages and spindle-shaped cells. The latter express the immunocytochemical characteristics of smooth muscle cells. However, differences occur according to the type of tissue injured | null | The early phenomena of restenosis following percutaneous transluminal coronary angioplasty. | European heart journal |
However, differences occur according to the type of tissue injured. Laceration of the musculoelastic layers or media causes a rapid and extensive cellular response. Injury to an atheroma, on the other hand, mainly causes plaque fissures with either mural thrombosis and total luminal obstruction, extensive plaque haemorrhage or a 'wash-out' of the atheromatous debris. In the latter case the lining of the 'crater' shows an accumulation of macrophages and, once more, a proliferation of spindle-shaped cells. The present observations support the concept that the early response is due to an interaction of platelet-fibrin thrombus and smooth muscle cells, with a possible role for macrophages.(ABSTRACT TRUNCATED AT 250 WORDS) | null | The early phenomena of restenosis following percutaneous transluminal coronary angioplasty. | European heart journal |
Severe vascular complications are an inherent risk of percutaneous transluminal coronary angioplasty (PTCA). Data from 100 emergency aortocoronary bypass operations required after 2850 interventions (3.5%) were retrospectively analysed in order to identify factors that determine postoperative infarct size. Large infarctions were assumed if the patient died of cardiogenic shock (n = 12), if postoperative angiography demonstrated a decrease in left ventricular ejection fraction of more than 20% of if R-waves in the ECG decreased by more than 40% and a QRS-score increased by more than 5. According to these definitions, 29 patients experienced large infarctions, while 71 experienced no or only small infarctions. The following factors differentiated the two groups: age (58 vs 53 years, P = 0.008), pre-PTCA exercise work load (88 vs 118 Watts, P = 0.0001), exercise ischaemia score (2.7 vs 1.9, P = 0.045), degree of pre-PTCA stenosis (83 vs 86%, P = 0 | null | Analysis of 100 emergency aortocoronary bypass operations after percutaneous transluminal coronary angioplasty: which patients are at risk for large infarctions? | European heart journal |
03), coronary multivessel versus single vessel disease (60 vs 38%, P = 0.02), collaterals to the target vessel (10 vs 34%, P = 0.05), total vascular occlusion during PTCA (76 vs 56%, P = 0.035), and long duration of ischaemia after onset of the complication (253 vs 179 min, P = 0.012). Data from patients with large postoperative infarctions who survived ranged between those with no or small infarctions and those who died of cardiogenic shock. Higher age (P = 0.04), reduced exercise tolerance (P = 0.0004), absence of collaterals (P = 0.04), and duration of ischaemia until reperfusion (P = 0.001) were independent predictors of large postoperative myocardial infarctions.(ABSTRACT TRUNCATED AT 250 WORDS) | null | Analysis of 100 emergency aortocoronary bypass operations after percutaneous transluminal coronary angioplasty: which patients are at risk for large infarctions? | European heart journal |
Numerous observational and intervention studies have shown that total (and LDL) cholesterol levels correlate positively with progression of atherosclerosis. It has also been shown that a mean low HDL cholesterol level is a potent predictor of CHD (coronary heart disease) in populations in which atherosclerotic diseases are prevalent. Recently, studies based on repeat angiographic examination, which are reviewed here, have shed new insight on the different roles that total cholesterol (or LDL) and HDL-cholesterol play on progression and regression of coronary atherosclerosis, respectively. From an epidemiological viewpoint, based on observational as well as intervention studies, the theory emerges that progression correlates best with total (and LDL-) cholesterol and that regression correlates best with HDL-cholesterol. The working hypothesis, if confirmed, will have practical implications for primary and secondary preventive measures. | 10.1093/eurheartj/12.8.952
| Progression and regression of atherosclerosis, what roles for LDL-cholesterol and HDL-cholesterol: a perspective. | European heart journal |
Congestive heart failure (CHF) is characterized by activation of (i) vasopressor and antinatriuretic influences (ii) and by counter-activation of vasodilator natriuretic systems. The former comprise the sympathoadrenal, renin-angiotensin-aldosterone and arginine vasopressin systems, and possibly endothelin and withdrawal of endothelium dependent relaxing factor respectively. The latter include the prostaglandins (PGE-2, PGI-2), dopamine and atrial natriuretic factor. The response of the kidney to chronic heart failure, i.e. vasoconstriction and antinatriuresis, resembles the renal reaction to volume depletion. The adverse renal effects of ACE inhibitors in some patients with advanced congestive heart failure may be explained by lowering of renal perfusion pressure and dependence of glomerular filtration rate on angiotensin II. | 10.1093/eurheartj/12.suppl_c.14
| The kidney in congestive heart failure. | European heart journal |
The circulatory compensatory mechanisms designed to cope quickly with physiological stress (e.g. sympathetic nervous system and the Frank-Starling mechanism) are less effective when there is chronic pathological stress, such as congestive heart failure (CHF). Other mechanisms come into play that operate over a longer time (e.g. activation of the renin-angiotensin-aldosterone system, myocardial hypertrophy and physiological deconditioning). Changes in blood vessels and skeletal muscle metabolism that result from inadequate delivery of oxygenated blood to working muscles belong to the group of mechanisms that develop slowly. When CHF therapy is successful, the abnormalities produced by this latter group of mechanisms will improve, but slowly. The concept that compensatory mechanisms have either short or long time constants for activation and reversal may explain why exercise tolerance improves much later than haemodynamics, which can be reversed acutely with vasodilator therapy. | 10.1093/eurheartj/12.suppl_c.2
| Time-constant adaptations in heart failure. | European heart journal |
A model of heart failure produced by rapid ventricular pacing in the conscious dog instrumented with a conductance catheter to monitor instantaneous left ventricular volume has been developed. This experimental model is capable of analysis of the left ventricular pressure-volume relationship on a beat-to-beat basis, and has been used to assess ventricular function serially in the progress of heart failure and effects of pharmacological intervention. In seven dogs the magnitude of cardiotonic effects were significantly attenuated after development of heart failure. These findings support the concept that in the failing heart there is subsensitivity to beta-adrenergic stimulation in proportion to the severity. The failing heart was characterized by incomplete left ventricular relaxation. Dobutamine improved left ventricular early relaxation but did not affect chamber distensibility. In contrast new phosphodiesterase inhibitor, E-1020, improved ventricular distensibility with less marked changes in active relaxation; improved left ventricular relaxation appeared to be mediated by increased systolic shortening with enhancement of internal restoring forces, and improved distensibility by accelerated function of sarcoplasmic reticulum through increased intracellular cyclic AMP. | 10.1093/eurheartj/12.suppl_c.35
| Mechanics of contraction and relaxation of the ventricle in experimental heart failure produced by rapid ventricular pacing in the conscious dog. | European heart journal |
Despite an increasingly wide range of therapeutic options in heart failure management, fatality rates and morbidity remain high and new and better drugs are still needed. Assessing drug efficacy, and comparing two drugs, is difficult. Studies with mortality as an endpoint need to be large and long-term, and studies using exercise tolerance as an endpoint have inherent problems of design and execution. Although haemodynamic measurements are useful in assessing acute drug effects they are not helpful in the chronic state and a 'surrogate' endpoint for assessing heart failure is needed. Measurements of calf blood flow at rest and after exercise provide results that correlate with the patient's clinical state and response to therapy. Measurements of calf blood flow and treadmill exercise time were found to be useful in comparing the effects of ibopamine with captopril in patients with chronic heart failure. | 10.1093/eurheartj/12.suppl_c.42
| Perspectives of drug therapy in heart failure. | European heart journal |
Since the introduction of the bioptome in 1962, examination of fresh endomyocardial tissue has been undertaken progressively in many centres despite the misgivings of some investigators. In my own experience, I have examined biopsies from 3225 patients, of whom 1978 were suspected to have dilated cardiomyopathy. Of these patients, 549 showed evidence of myocarditis. Categorization into active (acute), resolving (healing) and resolved (healed) stages is important because of therapeutic implications. It is concluded that endomyocardial biopsies are of immense value in dilated cardiomyopathy where the relationship with myocarditis has become established. Even though in many cases only non-specific features are found, biopsy excludes those conditions that can result in a hypertrophied, dilated heart. Biopsy also forms the baseline for further investigations, such as virological, immunological, morphometric analyses and distinction from alcohol effects, all of which have thrown light on the pathogenetic mechanism of dilated cardiomyopathy. | 10.1093/eurheartj/12.suppl_d.10
| The value of endomyocardial biopsies in myocarditis and dilated cardiomyopathy. | European heart journal |
In order to determine the presence or absence of myocarditis in cases with viral or idiopathic pericarditis, a study was conducted as one of our series on endomyocardial biopsy. There were two groups of patients, pericarditis cases (n = 8), and patients with perimyocarditis (n = 6). In the former group, it was confirmed that cardiac sarcoplasmic enzymes were not released during the acute stage of the disease. In the latter, there was positive evidence of the enzyme release. Also, employing our method of categorizing the possibility of myocarditis at the histopathological level, we found that the category 'highly suggestive' of myocarditis was absent in all eight cases with pericarditis. However, in cases with perimyocarditis, this category was assigned in four out of six cases (67%), indicating a high incidence. The category, 'slightly suggestive', was seen in three cases of the former (38%) and two cases of the latter group (33%) | 10.1093/eurheartj/12.suppl_d.13
| Endomyocardial biopsy findings in cases with pericarditis or perimyocarditis. | European heart journal |
It is concluded that in patients with pericarditis, the release of cardiac sarcoplasmic enzyme is an important diagnostic element in the diagnosis of perimyocarditis even if the clinical features reveal a predominance of pericarditis. In patients with perimyocarditis, progression to residual cardiac disease, such as conduction disturbance or congestive heart failure, is likely. | 10.1093/eurheartj/12.suppl_d.13
| Endomyocardial biopsy findings in cases with pericarditis or perimyocarditis. | European heart journal |
This study looked for the presence of abnormal contractile protein antigens and alterations in contractile protein expression in dilated cardiomyopathy (DCM). Monoclonal antibodies were raised to extracts from hearts removed at cardiac transplantation from two patients with dilated cardiomyopathy (DCM), and one with myocarditis. The specificities of the antibodies were assessed on cryostat sections from eight hearts with DCM. Although an extensive search was made for DCM-specific antibodies among over 1500 clones, none were found. However, a panel of antibodies was prepared and characterized, including antibodies to human adult myosin heavy chain beta, actin and troponin-I, which were selected for their value as reagents for immunocytochemical studies on cardiac, skeletal and smooth muscle. No significant alteration in the distribution of the epitopes recognized by these antibodies was found in DCM although more atrial myocytes in patients with DCM contained myosin adult heavy chain-beta. As a similar increase was found in atria from patients with other diseases who had a normal filling pressure, it was concluded that this alteration was unrelated to filling pressure, and was not specific for DCM. Further work with well defined monoclonal antibodies to other cardiac components in DCM could be useful in defining the alterations which lead to the functional defects in DCM and other cardiac diseases of unknown cause. | 10.1093/eurheartj/12.suppl_d.130
| Dilated cardiomyopathy and myocarditis: monoclonal antibodies to diseased heart tissues. | European heart journal |
In myocarditis and dilated cardiomyopathy a secondary immunopathogenesis is likely, since alterations to the humoral and cellular immune system have been repeatedly demonstrated. In rejection after heart transplantation activation of the immune system has been clearly seen. This may be comparable to myocarditis and thus could be a model for inflammatory heart disease. This study was set up to investigate whether an increased expression of antigens of the major histocompatibility complex and of the Il2 receptor in endomyocardial biopsies of patients after cardiac transplantation, myocarditis and dilated cardiomyopathy takes place. Cryostat sections were investigated immunohistologically by the immunoperoxidase test. There was an expression of class II antigens (HLA-DR, HLA-DP, HLA-DQ) in acute rejection and in myocarditis and in some patients with dilated cardiomyopathy on endothelial cells, interstitial cells but not on the myocytes. The results for class I (HLA-A, B, C) are similar, but in addition an expression on myocytes was observed in myocarditis and rejection. A second immunopathogenesis is most likely in some patients with dilated cardiomyopathy. The expression of the Il2 receptor on interstitial cells as a specific marker of cell activation was only seen in acute rejection and in some cases of myocarditis. | 10.1093/eurheartj/12.suppl_d.137
| Expression of MHC class I and II antigens and the Il-2 receptor in rejection, myocarditis and dilated cardiomyopathy. | European heart journal |
The role of endothelial cells in inflammatory heart disease and rejection after heart transplantation is only partly understood. To determine whether an immune reaction against endothelial cells occurs we examined endomyocardial biopsies from patients with myocarditis (n = 13), dilated cardiomyopathy (n = 23), no clinical rejection (n = 10) and moderate to severe rejection after heart transplantation (n = 10). These were compared to 'normal' donor hearts with monoclonal endothelial-specific antibodies EN4, Pal-E and F VIII-related antigen. Nearly all endothelial cells were stained positively with EN4. There were no significant changes in the binding of the antibodies except in rejection when Pal-E and F VIII-related antigen were significantly increased. It is concluded that apart from their possible role as antigen-presenting cells, endothelial cells are important targets in rejection after heart transplantation. Damage or cytolysis of endothelial cells may cause both altered transendothelial permeability and functional decrease in antigen presentation. | 10.1093/eurheartj/12.suppl_d.144
| Immune response to the endothelium in myocarditis, dilated cardiomyopathy and rejection after heart transplantation. | European heart journal |
Measurement of neopterin in biological fluids is a sensitive and specific tool for detecting activation of the T cell/macrophage system. Serum neopterin level, detected by radioimmunoassay, and data from morphological investigations of myocardium were compared in 29 patients with a clinical diagnosis of dilated heart muscle disease. According to the results of endomyocardial biopsy (22 cases) and autopsy (seven cases), 14 patients had morphological features of myocarditis, 13 dilated cardiomyopathy and two a fibrotic subtype of dilated cardiomyopathy (DCMP). The mean neopterin level in all patients (12 +/- 9 nM l-1) was higher than in the control group (5 +/- 2 nM l-1) (P less than 0.05). Also, the mean neopterin level was significantly higher in patients with myocarditis and fibrotic subtype of DCMP (16 +/- 11 nM l-1) than in patients with a morphological diagnosis of DCMP (9 +/- 6 nM l-1) (P less than 0.05) | 10.1093/eurheartj/12.suppl_d.151
| Serum neopterin--possible immunological marker of myocardial inflammation in patients with dilated heart muscle disease. | European heart journal |
05). The highest neopterin levels in both groups were found in those who subsequently died during follow-up (mean level 23 +/- 10 nM l-1). There was a correlation between neopterin and beta 2-microglobulin (r = 0.83, P less than 0.05). Our study suggests that the raised serum neopterin level may be a marker of myocardial inflammation and unfavourable prognosis in patients with a clinical diagnosis of dilated heart muscle disease. | 10.1093/eurheartj/12.suppl_d.151
| Serum neopterin--possible immunological marker of myocardial inflammation in patients with dilated heart muscle disease. | European heart journal |
The generation of oxygen free radicals (OFR) by peripheral blood monocytes and neutrophils of patients with rheumatic fever (RF) and rheumatic heart disease (RHD) has been studied using the luminol-enhanced chemiluminescence technique. The mechanism of OFR generation was studied by measuring NADPH oxidase enzyme activity. The effect of substrate was studied by measuring the hexose monophosphate (HMP) shunt enzymes: glucose-6-phosphate dehydrogenase and 6-phosphogluconate dehydrogenase. Three groups of patients [i) recurrent rheumatic activity, (ii) chronic RHD, (iii) acute pharyngitis) and normal controls were studied at day 0 and followed-up serially at 15, 90 and 180 days. The release of OFR, was significantly higher (P less than 0.001) in patients with recurrent rheumatic activity than in those with acute pharyngitis or chronic RHD, throughout the study period. A significant decline (P less than 0.001) in OFR release was observed from day 0 to day 180 in these patients, whereas no such change was observed in the chronic RHD group | 10.1093/eurheartj/12.suppl_d.163
| Release of oxygen free radicals by macrophages and neutrophils in patients with rheumatic fever. | European heart journal |
This study raises the possibility that these phagocytic cells, which infiltrate the myocardium, may through generation of OFR, have a role in the pathogenesis of cardiac damage seen in patients with RHD. | 10.1093/eurheartj/12.suppl_d.163
| Release of oxygen free radicals by macrophages and neutrophils in patients with rheumatic fever. | European heart journal |
To identify a cardiac protein that could cause a serious autoimmune myocarditis, membranous proteins and myosin as antigens were investigated. In mice immunized with membranous proteins, the lesions induced were limited on the histological level. On the other hand, in Lewis rats immunized with cardiac myosin, serious myocarditis was induced. Every rat showed evidence of heart failure which was fatal in a few. Histology disclosed extensive cell infiltrates and myocardial necrosis. Among those lesions, giant cells were present. This myocarditis could be also transferred adoptively by lectin-activated spleen cells, T-lymphocytes, but not by IgG fraction. Thus, cardiac myosin can induce autoimmune giant cell myocarditis in Lewis rats. | 10.1093/eurheartj/12.suppl_d.166
| Experimental giant cell myocarditis induced by cardiac myosin immunization. | European heart journal |
The most frequent muscle diseases affecting the heart are muscular dystrophies and myotonic dystrophy. Apart from congenital heart diseases, various metabolic disorders are characterized by cardiac involvement. Potent candidates are carnitine deficiency, beta-oxidation deficiencies, and mitochondrial myopathies such as Kearns-Sayre syndrome. A typical example of an anaerobic metabolic myopathy causing cardiomyopathy is acid maltase deficiency. For diagnosis, ECG and echocardiography as well as cardiac catheterization should be performed and, if indicated, a heart muscle biopsy should be carried out. Diagnosis of the underlying disease should be possible from skeletal muscle biopsy. Besides routine staining, histology should include specific stainings for glycogen, lipids and mitochondrial activity or dystrophin. If certain histochemical abnormalities are found indicating a metabolic disorder, biochemistry is helpful for final diagnosis. | 10.1093/eurheartj/12.suppl_d.169
| Myopathies and cardiomyopathies: histochemical and biochemical analyses. | European heart journal |
Myocardial catecholamine concentrations were determined in endomyocardial biopsies from patients with heart failure to assess if tissue catecholamine levels relate to the severity of myocardial damage or the aetiology of the underlying disease. Methodological studies revealed a good reproducibility of catecholamine determinations in biopsies; the variance between paired biopsies was below 17% when myocardial catecholamines were related to non-collagen protein (NCP). Myocardial norepinephrine (in pg micrograms-1 NCP) levels were comparable in patients with dilated cardiomyopathy (DCM, 5.3 +/- 3.4, n = 22) and in patients with coronary or valvular heart disease (5.6 +/- 4.7, n = 14). In both groups, a significant reduction of myocardial norepinephrine was found (controls 12.0 +/- 3.4, P less than 0.0006). In a subgroup of patients with heart failure and a LVEF less than 30% (3.9 +/- 3 | 10.1093/eurheartj/12.suppl_d.171
| Myocardial catecholamine concentrations in dilated cardiomyopathy and heart failure of different origins. | European heart journal |
9 +/- 3.5, n = 17) myocardial norepinephrine content was lower than in patients with heart failure and LVEF of 31-55% (6.6 +/- 3.4, n = 19) (both P less than 0.05 against controls: 12.0 +/- 3.4, n = 16). A correlation between myocardial norepinephrine and LVEF was found in DCM (P less than 0.001, r = 0.70). The loss of myocardial norepinephrine is a characteristic feature of heart failure. It is independent of the origin of failure, but correlates with the impairment of LV function. | 10.1093/eurheartj/12.suppl_d.171
| Myocardial catecholamine concentrations in dilated cardiomyopathy and heart failure of different origins. | European heart journal |
Many studies on the natural history of dilated cardiomyopathy show high probability of death or of cardiac transplantation in a large percentage of patients. These studies have several methodological limitations. Our prospective study, carried out from 1971, and which evaluated 120 patients, showed improved survival in more recent years. Survival 3 years after diagnosis changed from 30% (1971-6/1981) to 88.4% (7/1986-1/1989). Thirty patients were investigated by haemodynamic exercise test to assess their haemodynamic behaviour during exercise, to evaluate the effects of pharmacological treatment and to define parameters of prognostic value. Different haemodynamic behaviours were observed. Haemodynamic investigation during exercise is useful to assess the effect of treatment and may have prognostic value. Myocarditis presents a spectrum of clinical symptoms and echocardiographic abnormalities. In patients with congestive heart failure left ventricular dysfunction is common. Patients with atrioventricular block or chest pain usually have good left ventricular function. During follow-up, improvement is possible but persistent left ventricular dysfunction is associated with a high mortality rate. When left ventricular function is good at presentation and does not deteriorate during follow-up the prognosis is good. | 10.1093/eurheartj/12.suppl_d.193
| Clinical aspects and haemodynamics in the follow-up of dilated cardiomyopathy and myocarditis. | European heart journal |
Pericardioscopy is a new diagnostic tool to visualize macroscopically alterations in both the epicardium and pericardium. The first experience in 30 patients is reported, after pilot investigations were carried out in experimental animals. After puncture of the pericardial effusion a 9F sheath was introduced under echocardiographic and/or x-ray control. The fluid was removed by aspiration and 100-150 ml of body warm saline were infused in the pericardial sack. A flexible 8F fiberglass instrument (Vantec, Baxter or Storz) and a rigid 110 degree 8F endoscope (Storz) were used for visualization of peri- and epicardium and for video documentation. Complementary to visualization, optically-guided and controlled epicardial and pericardial biopsies were performed and analysed further. Specific diagnosis of pericardial effusion is thus greatly facilitated by the triad, pericardioscopy, cytology and epicardial as well as pericardial biopsy. | 10.1093/eurheartj/12.suppl_d.2
| Pericardioscopy--a new diagnostic tool in inflammatory diseases of the pericardium. | European heart journal |
52 patients thought to have sarcoid heart involvement have been followed up. By administration of a standardized glucocorticoid therapy we demonstrated improvement of patients' symptoms, ECG disturbances, thallium scan defects of left heart muscle and there was 60-70% regression of pulmonary sarcoidosis. There was a low death rate. We conclude that our diagnostic measures are reliable, and that glucocorticoid therapy is efficacious in the early stages of the disease. | 10.1093/eurheartj/12.suppl_d.26
| Sarcoid heart disease--results of follow-up investigations. | European heart journal |
Forty-one endomyocardial biopsies of the right interventricular septum have been investigated in 24 immunosuppressed patients after orthotopic heart transplantation. Monoclonal antibodies 27E10, 25F9, and RM3/1, which react with different macrophage phenotypes, and antisera MRP-8 and MRP-14, specific for proteins expressed on endothelial and monocyte cell surfaces in inflammation as well as markers for CD4+ and CD8+ T-lymphocytes, were employed in an indirect immunoperoxidase staining technique. This methodology permits more physiological recognition of the inflammatory process within the myocardium. It was possible to verify and to distinguish acute early, late and down-regulatory stages of inflammation in 33 biopsies (80%). No evidence of inflammation was found in seven biopsies (17%). Conventional histopathology with haematoxylin-eosin and Masson's trichrome was performed simultaneously, and demonstrated inflammation to be present in 23 of 41 biopsies (56%). An important findings is that CD4+ and CD8+ lymphocytes were absent in 15 of 41 specimens (37%) although there was inflammation proven by the presence of different macrophage phenotypes | 10.1093/eurheartj/12.suppl_d.32
| Diagnostic assessment of macrophage phenotypes in cardiac transplant biopsies. | European heart journal |
The results indicate the necessity of long-term serial investigations of the physiological role of specific inflammatory macrophage phenotypes during the rejection process. It is concluded that the phenotyping of macrophage and endothelial cell differentiation antigens offers a sensitive approach to assess diagnosis of myocardial inflammation as a consequence of ongoing rejection in cardiac allografts. | 10.1093/eurheartj/12.suppl_d.32
| Diagnostic assessment of macrophage phenotypes in cardiac transplant biopsies. | European heart journal |
Sera positive for antimyolemmal antibodies (AMLAs) from patients with acute biopsy-proven myocarditis exerted a cytotoxic effect on cardiocytes stimulated in vitro. Using an edge-detecting system, contraction amplitude and contraction velocity were altered after the addition of AMLA-positive sera when compared to sera from healthy controls. Antibodies alone did not change the functional parameters. Only the presence of complement and heart-reactive antibodies mediated the detrimental effects. This suggests that a complement-mediated antibody-dependent immune mechanism is operative in human myocarditis. | 10.1093/eurheartj/12.suppl_d.36
| Impaired myocyte function in vitro incubated with sera from patients with myocarditis. | European heart journal |
Single cardiac myocytes isolated from failing and non-failing human ventricles were superfused at 32 degrees C and electrically stimulated at 0.2 Hz. Their contraction amplitude and velocities of contraction and relaxation were continuously during challenge with isoprenaline or high extracellular calcium. Action potentials were monitored with intracellular microelectrodes, and calcium transients followed using the fluorescent dye fura-2. Changes in contractility were correlated with severity of disease, as defined by New York Heart Association class, dose of diuretics, left ventricular ejection fraction and left ventricular end-diastolic pressure. Beta-adrenoceptor desensitization was detected in these cells as a decreased response to isoprenaline relative to that of calcium in the same cell. Significant correlations were obtained between reduction of beta-adrenoceptor sensitivity and all four indicators of disease severity. No correlation between the maximum contraction amplitude in high extracellular calcium and severity of disease was observed, the same was true for contraction and relaxation velocity in high calcium. Some significant decline in contractility with age of the patient was noted. Analysis with respect to aetiology of disease showed a subpopulation with dilated or hypertrophic cardiomyopathy where relaxation of the single cells was impaired | 10.1093/eurheartj/12.suppl_d.44
| Contractile responses of myocytes isolated from patients with cardiomyopathy. | European heart journal |
This was related to a prolonged calcium transient and action potential. Isoprenaline accentuated the lengthened second phase of relaxation, whereas high extracellular calcium reduced it. These interventions had similar effects on action potential duration. The actions of isoprenaline and calcium were similar on cells from failing and non-failing human hearts and on normal guinea-pig myocytes.(ABSTRACT TRUNCATED AT 250 WORDS) | 10.1093/eurheartj/12.suppl_d.44
| Contractile responses of myocytes isolated from patients with cardiomyopathy. | European heart journal |
Pericardiectomy today is an accepted therapeutic concept in patients with different pericardial disorders. The postoperative outcome of patients is mainly influenced by two factors. First, diagnosis has to be established early to avoid myocardial deterioration and secondary organ failure, especially of liver and kidneys. Second, the whole accessible surface of atria and ventricles has to be freed from diseased and calcified pericardium. To achieve this, we prefer a total median sternotomy for the surgical approach. In selected cases of acute pericardial effusion or as a palliative procedure, a small infrasternal incision or anterolateral thoracotomy is used for pericardiocentesis and creation of a pericardio-pulmonary window. Between January 1969 and March 1990 we treated 187 patients with different pericardial disorders. Mortality was 4.8% overall, and was especially low (2.8%) among the 106 patients with acute and chronic pericardial effusion. Out of 67 patients with constrictive pericarditis, four died during hospital stay (5.9%). The prognosis is still poor for patients with primary or secondary malignant pericardial tumours, in whom surgery is mostly restricted to palliative resection, and a special group with constrictive and mostly calcified epicarditis, for whom no surgical option is available. | 10.1093/eurheartj/12.suppl_d.7
| The role of pericardiectomy in pericardial disorders. | European heart journal |
Lyme borreliosis (LB) is a multisystem disorder that may cause self-limiting or chronic diseases of the skin, the nervous system, the joints, heart and other organs. The aetiological agent is the recently discovered Borrelia burgdorferi. In 1980, cardiac manifestations of LB were first described, including acute conduction disorders, atrioventricular block, transient left ventricular dysfunction and even cardiomegaly. Pathohistological examination showed spirochaetes in cases of acute perimyocarditis. Recently, we were able to cultivate Borrelia burgdorferi from the myocardium of a patient with long-standing dilated cardiomyopathy. In this study, we have examined 54 consecutive patients suffering from chronic heart failure for antibodies to Borrelia burgdorferi. On ELISA, 32.7% were clearly seropositive. The endomyocardial biopsy of another patient also revealed spirochaetes in the myocardium by a modified Steiner's silver stain technique. These findings give further evidence that LB is associated with chronic heart muscle disease. | 10.1093/eurheartj/12.suppl_d.73
| Lyme borreliosis as a cause of myocarditis and heart muscle disease. | European heart journal |
In this study from two specialized centres 85 patients with histologically proven myocarditis (n = 10) and clinically ascertained perimyocarditis (pericardial effusion and cardiomegaly or segmental wall motion abnormality; n = 75) were followed up for 4.5 + 1.9 years. Immunosuppressive treatment was not applied. After a mean follow-up period of 4.5 + 1.9 years 55% of patients had improved clinically and 35% of patients were completely free of symptoms. Relapses had occurred up to three times. Chronic forms were found in 20% of patients, mostly in those with pericarditis and effusions. Eighteen percent of the patients deteriorated gradually. In 20% of the chronic or deteriorating patients congestive heart failure developed (postmyocarditic heart muscle disease). Fifteen percent of the patients died, mainly from bacterial perimyocarditis and to a lesser extent from inflammatory heart disease from enteroviruses. Patients who succumbed after more than 6 months died either suddenly or from progressive heart failure | 10.1093/eurheartj/12.suppl_d.81
| Prognostic determinants in conventionally treated myocarditis and perimyocarditis--focus on antimyolemmal antibodies. | European heart journal |
A favourable outcome was often accompanied by a decrease in titre, but this decrease was less impressive in those who had antimyolemmal and antisarcolemmal antibodies. The persistence of these antibodies in high titres predominated in patients with poor prognosis and postmyocarditic dilated heart muscle disease, as did cytolytic serum activity. | 10.1093/eurheartj/12.suppl_d.81
| Prognostic determinants in conventionally treated myocarditis and perimyocarditis--focus on antimyolemmal antibodies. | European heart journal |
Sensitive and highly specific ELISA assays were developed to determine humoral immune response against actin and myosin in 122 patients suffering from various cardiovascular diseases: acute viral myocarditis (n = 10, MYO), acute myocardial infarction (n = 28, AMI), valve surgery (n = 35, VALVE), coronary bypass surgery (n = 35, CABG), and peripheral vascular surgery (n = 14, VASC). Anti-actin and anti-myosin antibodies were determined on admission and serially during a period of 90 days. Anti-actin and anti-myosin immune response (IgG, IgM) was expressed comparing absorbance of the patients' serum with a reference serum. In the different patient groups significantly (P less than 0.01) higher anti-actin and anti-myosin antibody concentrations were found on admission compared with age-matched control groups. During follow-up, all patient groups except the vascular surgery group showed a significant immune response against actin and myosin, with an immune response ratio (peak/admission) for AMA IgG and IgM respectively of 2.12 and 2.40 in the VALVE group, 1 | 10.1093/eurheartj/12.suppl_d.88
| Humoral immune response against contractile proteins (actin and myosin) during cardiovascular disease. | European heart journal |
12 and 2.40 in the VALVE group, 1.30 and 1.99 in the CABG group, 1.42 and 1.48 in the AMI group and 1.66 and 1.25 in the MYO group; and for AAA IgG and IgM respectively of 1.57 and 3.00 in the VALVE group, 1.54 and 1.64 in the CABG group, 1.25 and 1.07 in the AMI group, and 1.42 and 1.42 in the MYO group. A significant correlation between pre-cardiac injury and peak post-cardiac injury anti-myosin and anti-actin autoantibody levels could be demonstrated suggesting that pre-injury sensitization to these antigens plays an important role in evoking post-cardiac injury immune response.(ABSTRACT TRUNCATED AT 250 WORDS) | 10.1093/eurheartj/12.suppl_d.88
| Humoral immune response against contractile proteins (actin and myosin) during cardiovascular disease. | European heart journal |
Advances have been made rapidly in the field of cardiac pacing. The most significant technologic advance is that of pacemakers capable of rate-adaptive pacing. Multiple types of sensors are now used for rate-adaptive pacing; some are commercially available and many are undergoing clinical investigation. In the near future, clinical investigation will begin on pacemakers that incorporate dual simultaneous sensors for rate-adaptive pacing. Significant improvement has been made in electrode design. Electrodes with low thresholds allow improved battery longevity. Steroid-eluting leads have proven reliable and capable of avoiding the early threshold rise seen with other electrodes. Standardization of pacemaker connector dimensions is now under way. The International Standards Organization has established the guidelines for connector standardization, and the guidelines have been adopted by the major manufacturers. The ultimate "smart" pacemaker would be capable of autoprogramming most or all of its programmable features. Many autoprogramming features have already been incorporated, and several others such as automatic programming of output and sensitivity are under investigation. | 10.1016/0167-5273(91)90326-k
| Advances in pacing therapy for bradycardia. | International journal of cardiology |
On the basis of our recent embryologic work concerning the separation process of the outflow tract, together with our study of the morphology of specimens from the Leiden Collection of malformed hearts, we have reconsidered, in conjunction with the pertinent literature, the morphogenesis of common arterial trunk and tetralogy of Fallot. The constant characteristics of common arterial trunk, namely a common trunk, a common arterial orifice and a ventricular septal defect, can be explained simply by absence of the aorto-pulmonary septum, or its complete failure to contribute to the process of separation. The nature of the variable morphologic features, however, is not always clear. Presence of such variation is not contradictory to the explanation of the main characteristics in this malformation. Tetralogy of Fallot, in contrast, can be considered to result from anterior displacement of the columns of the aorto-pulmonary septum relative to the outlet segment and its proximal boundary, the primary fold. Our findings, and suggestions, diverge considerably from conventional theories concerning the morphogenesis of these malformations. | 10.1016/0167-5273(91)90329-n
| Morphogenetic considerations on congenital malformations of the outflow tract. Part 1: Common arterial trunk and tetralogy of Fallot. | International journal of cardiology |
We analyzed the short-term and long-term outcome of 42 patients with distal type aortic dissection. Twenty-eight patients underwent intensive medical therapy within two weeks after the onset of pain (acute dissection). The remaining 14 patients had chronic dissection. The goals of medical treatment were to control blood pressure and to attain a negative C-reactive protein test result. Hospital survival rate in the patients with acute dissection was 96% (27/28). In-hospital complications included changes in mental status, renal dysfunction, bradycardia, orthostatic hypotension, and liver dysfunction, all of which were managed medically. Three of these patients underwent surgical therapy in the chronic phase and were discharged uneventfully. Fifteen (62.5%) of the 24 medically treated patients were discharged with negative C-reactive protein tests. Spontaneous resolution of a dissection was demonstrated by radiological examinations in 8 cases. Five-year survival rates in 24 medically treated patients was 93%. Hospital survival rate in the patients with chronic dissection was 100% (14/14) | 10.1016/0167-5273(91)90330-r
| The role of medical treatment of distal type aortic dissection. | International journal of cardiology |
Hospital survival rate in the patients with chronic dissection was 100% (14/14). The rigorous control of blood pressure in the acute phase, and subsequent meticulous evaluation of the dissection by radiological tests and C-reactive protein test provides acceptable short-term and long-term outcomes of patients with acute distal dissection without the need for emergency surgical intervention. | 10.1016/0167-5273(91)90330-r
| The role of medical treatment of distal type aortic dissection. | International journal of cardiology |
Eighty-eight patients (84 men and 4 women; mean age 59.3 years) with stable exercise-induced angina pectoris were enrolled in this within-patient, placebo-controlled study aimed at comparing the efficacy of the continuous and intermittent (12 hour on, 12 hour off) application of transdermal nitroglycerin. Eighty-one patients completed the study. After a 1-week placebo run-in period, during which the stability of angina was assessed on a bicycle ergometer, the patients received continuous treatment (two 10 mg/24 hour patches twice daily, at 8 a.m. and 8 p.m.), intermittent treatment (two 10 mg/24 hour patches at 8 a.m. and two placebo patches at 8 p.m.) and placebo (two placebo patches twice daily, at 8 a.m. and 8 p.m | 10.1016/0167-5273(91)90331-i
| Efficacy of continuous and intermittent transdermal treatment with nitroglycerin in effort angina pectoris: a multicentric study. The Collaborative Nitro Group. | International journal of cardiology |
m. and 8 p.m.), each given for one week in a double-blind randomised sequence, according to a 3 x 3 latin-square design. A cycloergometric exercise test was performed at the end of each period of treatment, 4 and 10 hours after the application of the morning patch. In comparison with placebo, both schedules of the active treatment induced a significant increase in both the ischemic (duration of exercise to 1 mm ST segment depression) and the angina threshold (duration of exercise to mild angina) at the 4th and at the 10th hours after-dosing. A significant difference was also found between continuous and intermittent treatment at the same times of observation, in favour of the intermittent schedule. The limited number of anginal attacks recorded during placebo prevented any clinical evaluation of the treatments. This study shows that the efficacy of transdermal nitroglycerin is more pronounced when it is given following an intermittent schedule.(ABSTRACT TRUNCATED AT 250 WORDS) | 10.1016/0167-5273(91)90331-i
| Efficacy of continuous and intermittent transdermal treatment with nitroglycerin in effort angina pectoris: a multicentric study. The Collaborative Nitro Group. | International journal of cardiology |
A 7-week infant admitted with bronchiolitis proven to be caused by respiratory syncytial virus developed a supraventricular tachycardia which responded to digitalization. She has remained well and no longer requires medication 6 months later, her electrocardiogram now being normal. The course of the illness suggests an association between infection with respiratory syncytial virus and the development of the tachycardia. | 10.1016/0167-5273(91)90332-j
| Respiratory syncytial virus and supraventricular tachycardia in an infant. | International journal of cardiology |
A left atrioventricular valve having a double orifice is a rare congenital abnormality, and is most commonly described in association with atrioventricular septal defect. We report the Doppler echocardiographic findings of this abnormality and present a case where limited surgical repair has resulted in a favourable outcome. | 10.1016/0167-5273(91)90334-l
| Doppler echocardiography of double orifice of the left atrioventricular valve in atrioventricular septal defect. | International journal of cardiology |
Reversal of flow in the pulmonary veins during atrial contraction was detected by transthoracic pulsed Doppler echocardiography in a patient with bicuspid aortic valve and heart failure. The flow reversal disappeared after his recovery from heart failure. Flow reversal during atrial contraction detected by transthoracic Doppler may be a sign of congestive heart failure. | 10.1016/0167-5273(91)90335-m
| Pulmonary venous atrial systolic flow reversal detected by transthoracic Doppler as a sign of congestive heart failure: a case report. | International journal of cardiology |
Reconstructive surgery was performed in a 57-year old woman in whom initially the left coronary artery had originated from the pulmonary trunk, producing progressive symptoms of congestive heart failure. Recurrence of shunting was documented by Doppler echocardiography and contrast angiography, necessitating a second surgical intervention 17 months after the first procedure. | 10.1016/0167-5273(91)90336-n
| Angiographic appearance and re-operation in an adult patient with the Bland-Garland-White syndrome. | International journal of cardiology |
A patient with a free-floating ball thrombus in the left atrium complicating mitral stenosis is described. The pathological features and clinical implications are discussed. | 10.1016/0167-5273(91)90337-o
| Free-floating ball thrombus in left atrium: pathological features and clinical implications. | International journal of cardiology |
The pattern of contractions elicited after rest periods of 0.25-10 min duration was investigated in right ventricular papillary muscles from control and hypertrophied rabbit hearts. Hypertrophy was induced by pressure overload following coarctation of the pulmonary artery. In control hearts, the first post-rest contraction was always of a smaller amplitude than the preceding steady-state (0.5 Hz stimulation) contractions, and the amplitude of this first post-rest contraction decreased as the rest interval increased. In contrast, the amplitude of the first post-rest contraction of muscles from hypertrophied hearts exceeded the steady-state amplitude for rest durations of up to at least 2 min. In the hypertrophied muscles, force in the first post-rest contraction (expressed as a percentage of the pre-rest steady-state) was potentiated compared to the control muscles at all rest intervals studied. There was no significant difference in the second post-rest contraction between control and hypertrophied muscles at any rest interval. Following the second post-rest contraction, force increased monotonically toward the steady-state levels in all the muscles | 10.1007/BF02058279
| Altered pattern of post-rest contractions in hypertrophied rabbit ventricle. | Heart and vessels |
The recovery of force was, however, somewhat faster in the hypertrophied muscles. Upon resumption of 1-Hz stimulation following rest intervals of 2 min or greater, pulsus alternans were invariably observed in the hypertrophied muscles but never in the control muscles. These differences in the non-steady-state contractile behavior of ventricular muscle from normal and hypertrophied hearts are suggestive of some alteration in the normal pattern of Ca2+ translocation in pressure overload hypertrophy of rabbit ventricle.(ABSTRACT TRUNCATED AT 250 WORDS) | 10.1007/BF02058279
| Altered pattern of post-rest contractions in hypertrophied rabbit ventricle. | Heart and vessels |
A 63-year-old female with chronic stable effort angina underwent percutaneous transluminal coronary angioplasty (PTCA) for a donating coronary artery of the collateral circulation to the jeopardized region. Because of the inefficacy of the procedure in increasing the collateral flow reserve, the patient was then put on an exercise regimen and also received heparin pretreatment. Her exercise tolerance improved remarkably with the development of improved collateral circulation. | 10.1007/BF02058284
| Heparin exercise treatment following percutaneous transluminal coronary angioplasty in a patient with effort angina. | Heart and vessels |
To define the clinical, angiographic and procedural correlates of quantitative coronary dimensions after directional coronary atherectomy, 400 lesions in 378 patients were analyzed with use of qualitative morphologic and quantitative angiographic methods. Successful atherectomy, defined by a less than 75% residual area stenosis, tissue retrieval and the absence of in-hospital ischemic complications, was performed in 351 lesions (87.7%). After atherectomy, minimal cross-sectional area increased from 1.2 +/- 1.1 to 6.6 +/- 4.4 mm2 (p less than 0.001) and percent area stenosis was reduced from 87 +/- 10% to 31 +/- 42% (p less than 0.001). By univariate analysis, device size (p less than 0.001) and left circumflex artery lesion location (p = 0.004) were associated with a larger final minimal cross-sectional area. Conversely, restenotic lesion (p = 0 | 10.1016/0735-1097(91)90534-g
| Clinical, angiographic and procedural correlates of quantitative coronary dimensions after directional coronary atherectomy. | Journal of the American College of Cardiology |
Conversely, restenotic lesion (p = 0.002), lesion length greater than or equal to 10 mm (p = 0.018) and lesion calcification (p = 0.035) were quantitatively associated with a smaller final minimum cross-sectional area. With use of stepwise multivariate analysis to control for the reference area, atherectomy device size (p = 0.003) and left circumflex lesion location (p = 0.007) were independently associated with a larger final minimal cross-sectional area, whereas restenotic lesion (p = 0.010), diffuse proximal disease (p = 0.033), lesion length greater than or equal to 10 mm (p = 0.026) and lesion calcification (p = 0.081) were significantly correlated with a smaller final minimal cross-sectional area. The number of specimens excised, the number of atherectomy passes and atherectomy balloon inflation pressure did not correlate with the final minimal cross-sectional area | 10.1016/0735-1097(91)90534-g
| Clinical, angiographic and procedural correlates of quantitative coronary dimensions after directional coronary atherectomy. | Journal of the American College of Cardiology |
Thus, directional atherectomy results in marked improvement of coronary lumen dimensions, at least in part correlated with the presence of certain clinical, angiographic and procedural factors at the time of atherectomy. | 10.1016/0735-1097(91)90534-g
| Clinical, angiographic and procedural correlates of quantitative coronary dimensions after directional coronary atherectomy. | Journal of the American College of Cardiology |