Showing papers in "The Cardiology in 2005"
TL;DR: Patients with OSA have elevated morning fibrinogen levels and a higher plasma viscosity, which correlate positively with indices of sleep apnea severity, and these changes in blood rheology are independent of cardiovascular risk factors, and therefore, might be specific mechanisms of OSA.
Abstract: Background: Cardiovascular complications are common in patients with obstructive sleep apnea (OSA). Blood rheology is a major determent of coagulation and an established risk factor
108 citations
TL;DR: The combination of OAC and aspirin appears an acceptable treatment after PCI-S in patients in whom long-term OAC is deemed mandatory, due to the low AR of adverse events.
Abstract: The combination of oral anticoagulation (OAC) and aspirin was the antithrombotic treatment initially adopted after coronary stenting (PCI-S). Although dual antiplatelet therapy with aspirin and a thienopyridine subsequently proved safer and more effective, OAC and aspirin combination is still used in patients with an indication for long-term OAC undergoing PCI-S. The absolute (AR) and relative (RR) risk of cardiac events and hemorrhagic/vascular complications of OAC and aspirin versus antiplatelet therapy were evaluated in a meta-analysis of four historical clinical trials. In 2,436 patients, the RR of a 30-day primary composite endpoint of death, myocardial infarction and the need for revascularization was significantly reduced by antiplatelet therapy (RR 0.41; 95% CI 0.25-0.69), whereas the RR of stent thrombosis (RR 0.26; 95% CI 0.06-1.14) and major bleeding (RR 0.36; 95% CI 0.14-1.02) was not statistically different. The 30-day AR of death, myocardial infarction, need for revascularization, major bleedings and vascular complications with OAC and aspirin were 0.65, 3.8, 4.2, 6.4 and 6.6%, respectively. In conclusion, due to the low AR of adverse events, the combination of OAC and aspirin appears an acceptable treatment after PCI-S in patients in whom long-term OAC is deemed mandatory.
101 citations
TL;DR: Left ventricular hypertrabeculation/noncompaction by itself does not seem to be a risk factor for stroke or embolism and thus is not an indication for oral anticoagulation, however, if LVHT is associated with systolic dysfunction, oral antICOagulation should be considered.
Abstract: Left ventricular hypertrabeculation/noncompaction (LVHT) is reported to be associated with embolism. This retrospective study assessed the number of strokes/embolisms in 62 patients with LVHT and in 62 control patients matched with regard to age, sex and left ventricular systolic function. The incidence of strokes or embolism was 10% in patients with LVHT and 15% in controls. LVHT by itself does not seem to be a risk factor for stroke or embolism and thus is not an indication for oral anticoagulation. However, if LVHT is associated with systolic dysfunction, oral anticoagulation should be considered.
100 citations
TL;DR: It is proposed that mitochondrial dysfunction, besides endothelial dysfunction, represents an important early step in the chain of events leading to atherosclerotic disease.
Abstract: It is now widely accepted that oxidant stress and the ensuing endothelial dysfunction play a key role in the pathogenesis of atherosclerosis and cardiovascular diseases. The mitochondrial respiratory chain is the major source of reactive oxygen species as byproducts of normal cell respiration. Mitochondria may also be important targets for reactive oxygen species, which may damage mitochondrial lipids, enzymes and DNA with following mitochondrial dysfunction. Free cholesterol, oxidized low-density lipoprotein and glycated high-density lipoprotein are further possible causes of mitochondrial dysfunction and/or apoptosis. Moreover, in patients with mitochondrial diseases, vascular complications are commonly observed at an early age, often in the absence of traditional risk factors for atherosclerosis. We propose that mitochondrial dysfunction, besides endothelial dysfunction, represents an important early step in the chain of events leading to atherosclerotic disease.
87 citations
TL;DR: Evidence from fibric acid trials that individuals with insulin resistance or diabetes benefit the most from these drugs, consistent with their anti-inflammatory and antithrombotic properties are reviewed.
Abstract: Atherosclerosis is an inflammatory process triggered by the presence of lipids in the vascular wall and encompasses a complex interaction between inflammatory cells, vascular elements and lipoproteins through the expression of several adhesion molecules and cytokines. Activation of the nuclear receptor peroxisome proliferator-activated receptor-α (PPAR-α) has been demonstrated to modulate many aspects of lipoprotein metabolism and inflammation in vitro as well as in animal and human studies. The tissue distribution of PPAR-α is extensive and it is abundantly present in the vascular wall where it may mediate many of anti-inflammatory and antiatherogenic effects. Major clinical trials, such as the Veterans Affairs High-Density Lipoprotein Intervention Trial, the Helsinki Heart Study and the Diabetes Atherosclerosis Intervention Study, have demonstrated the beneficial effects of synthetic agonists of PPAR-α, specifically fibric acid derivatives, on cardiovascular disease outcome. Although fibric acid trials have reported cardiovascular risk reduction in patients with dyslipidemia, the favorable alterations in plasma lipids can only partially explain the reduction in cardiovascular events in these studies. One common link among these trials was a cohort with a high prevalence of insulin resistance or diabetes, conditions associated with heightened systemic inflammation and increased risk for development and progression of atherosclerosis. In this paper, we will review the many antiatherogenic effects of PPAR-α ligands and evidence from fibric acid trials that individuals with insulin resistance or diabetes benefit the most from these drugs, consistent with their anti-inflammatory and antithrombotic properties.
81 citations
TL;DR: Surgical LAA closure was incomplete in most patients, resulting in blood stagnation and an increased likelihood of clot formation, and incomplete surgical LAAclosure, therefore, may promote rather than reduce the risk of stroke.
Abstract: Background: Closure of the fibrillating left atrial appendage (LAA) has been recommended during valve surgery to decrease the risk of arterial embolism. However, patients undergoing
74 citations
TL;DR: The ankle-brachial index (ABI) was correlated with the severity of coronary artery disease (CAD) in 273 patients, mean age 71 years, with peripheral arterial disease and angiographically obstructive CAD.
Abstract: The ankle-brachial index (ABI) was correlated with the severity of coronary artery disease (CAD) in 273 patients, mean age 71 years, with peripheral arterial disease and angiographically obstructive C
55 citations
TL;DR: Implementation of the ACC/AHA guidelines for cardiac risk assessment prior to noncardiac surgery in an internal medicine preoperative assessment clinic led to a more appropriate use of preoperative stress testing and β-blocker therapy while preserving a low rate of cardiac complications.
Abstract: Background: The American College of Cardiology/American Heart Association (ACC/AHA) publishes recommendations for cardiac assessment of patients undergoing noncardiac surgery with t
45 citations
TL;DR: The screened heart transplant recipients suffering from dilated cardiomyopathy with a positive family history of LMNA mutations were identified and the involvement ofLMNA mutations in patients with DCM is confirmed and the mutational spectrum of LM NA is extended.
Abstract: Lamin A and C are components of the nuclear envelope, located at the nucleoplasmatic surface of the inner nuclear membrane within cells. Recently, mutations within LMNA encoding lam
43 citations
TL;DR: A more effective restoration of endothelial function with the statin/ezetimibe combination compared to statin monotherapy in patients with the metabolic syndrome is suggested.
Abstract: We compared the effect of statin therapy (either alone or combined with ezetimibe) on the inhibition of cholesterol resorption and endothelial function by measuring forearm blood flow in male patients with the metabolic syndrome. Compared to 40 mg atorvastatin alone, combination therapy with 10 mg ezetimibe and 10 mg atorvastatin for 8 weeks resulted in significantly decreased total serum cholesterol and triglycerides levels (n = 14). Endothelium-dependent, acetylcholine-mediated vasodilation was significantly better with combination therapy (p < 0.05). In contrast, endothelium-independent forearm blood flow response to sodium nitroprusside was comparable in both groups. Our data suggest a more effective restoration of endothelial function with the statin/ezetimibe combination compared to statin monotherapy in patients with the metabolic syndrome.
43 citations
TL;DR: A 40-year-old homeless man presented on a cold winter night with unconsciousness, and was found to have a core body temperature of 85°F (26 °C), and an ECG obtained was normal and the Osborn waves had disappeared, and the patient survived with no adverse consequences.
Abstract: Accessible online at: www.karger.com/crd A 40-year-old homeless man presented on a cold winter night with unconsciousness, and was found to have a core body temperature of 85°F (26 °C). The initial electrocardiogram (ECG) showed sinus bradycardia and prolonged QTc interval (533 ms) as well as prolonged QRS complex which displayed the typical Osborn waves of hypothermia, most pronounced in leads II, III, aVF, and V3–V6 (fig. 1). Laboratory examination revealed normal values of serum electrolytes. After the patient was rewarmed by conventional means (warmed air and infusions) to 98°F (37 °C) an ECG obtained was normal and the Osborn waves had disappeared (fig. 2). No serious cardiac rhythm disturbances occurred during rewarming and the patient survived with no adverse consequences. Hypothermia is defined as a core body temperature ^95°F (35°C). Hypothermia can adversely affect the electrical system of the heart leading to cardiac arrhythmias, Osborn waves, and conduction abnormalities. In the initial stages, sinus tachycardia develops as a part of the stress reaction. As the temperature drops below 90 °F, sinus bradycardia supervenes. Characteristic ECG changes are due to decreased impulse conduction, which results in prolonged intervals, including RR, PR, QRS, and QT (table 1). In addition J point elevation can be seen causing a characteristic Osborne wave that represents distortion of the earliest phase of membrane repolarization. Around 86°F, atrial ectopic activity is often noted, which can progress to atrial fibrillation. With temperatures !86°F, a progressive widening of the QRS complex increases the risk of ventricular fibrillation and below 60 °F asystole supervenes.
TL;DR: Both groups exhibited excellent in-hospital and 6-month outcomes with no significant differences between them.
Abstract: We performed this study in order to compare the immediate and mid-term outcomes of sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES) in lesions of the unprotected left main coronary a
TL;DR: Obese patients withmoderate or severe OSA have a higher prevalence of moderate or severe LVDD than obese patients with no or mild OSA, and obese patients without OSA are more likely to suffer from left ventricular diastolic dysfunction.
Abstract: We investigated prior to gastric bypass surgery the prevalence of left ventricular diastolic dysfunction (LVDD) by Doppler and tissue Doppler echocardiography in 14 obese women and in 6 obese men, mea
TL;DR: Assessment of the timing of cardiovascular events occurring during the activity and the long-term safety of a medically supervised cardiac rehabilitation program performed in the community, in a large cohort concluded that special caution should be undertaken during the first sessions of the program.
Abstract: The time to occurrence of cardiovascular complications after the beginning of an exercise rehabilitation program is variable. It is not clear whether such complications are related to the duration in the program. The aim of the present study was to assess the timing of cardiovascular events occurring during the activity and the long-term safety of a medically supervised cardiac rehabilitation program performed in the community, in a large cohort. We retrospectively evaluated 3,511 patients with a history of myocardial infarction, coronary artery bypass grafting and risk factors for coronary artery disease, participating in exercise training, for 69 months. The total number of patient-hours was 338,688 with an event rate of 1/58,902 patient-hours/year (0.02%). Non-fatal events occurred in 11 patients and fatal cardiovascular events in 2 patients; 1 was successfully resuscitated. Most of the non-fatal events (62%) occurred during the first 4 weeks from the beginning of the exercise program. One third of the patients who experienced cardiovascular events, resumed the exercise program with no further complications. Medically supervised cardiac rehabilitation program is accompanied by a very low incidence of cardiovascular events. Nevertheless, special caution should be undertaken during the first sessions of the program.
TL;DR: Two simple parameters (exercise duration and peak SBP) that are easily measured by standard exercise testing are the strongest independent predictors of mortality which outperform LVEF and N-BNP in ambulatory patients with mild-moderate CHF.
Abstract: Background and Aims: It is a prevailing concept in chronic heart failure (CHF) that ventricular remodelling (evaluated via imaging) and neurohormonal activation (via biomarkers) exe
TL;DR: Almost 4.5% of ACS patients underwent CABG during their initial hospitalization, with a greater likelihood among non-ST elevation ACS patients, indicating that CABGs remains an effective and safe means to achieve revascularization among ACS patients in current clinical practice.
Abstract: Aim: To determine the frequency and outcomes of coronary artery bypass graft (CABG) surgery in patients with a wide spectrum of acute coronary syndromes (ACS). Methods and Results: We prospectively enrolled 10,484 ACS patients from 103 hospitals in 25 countries across Europe and the Mediterranean basin. Of the 10,204 patients with complete data, 460 (4.5%) underwent CABG while in hospital; 3.4% had ST elevation ACS, 5.4% had non-ST elevation ACS, and 4.4% had undetermined ECG ACS (p = 0.001 for non-ST elevation ACS vs. others). In general, patients who underwent CABG were more likely to be males, to have diabetes mellitus, hyperlipidemia, a positive family history of premature coronary disease, and prior angina pectoris, but had less often prior heart failure. While in hospital, all CABG patients underwent coronary angiography and 15.2% also underwent percutaneous revascularization, as compared with 51.3 and 33.1% in the remaining patients, respectively. The in-hospital mortality was 3.7% for ACS patients who underwent CABG and 4.8% for non-CABG ACS patients (p = nonsignificant) with an adjusted odds ratio of in-hospital death for CABG patients of 1.00 (95% CI 0.59–1.61). Conclusions: Approximately 4.5% of ACS patients underwent CABG during their initial hospitalization, with a greater likelihood among non-ST elevation ACS patients. Of the CABG patients, 15.2% also underwent percutaneous revascularization. The outcome of CABG patients was as good as non-CABG patients, indicating that CABG remains an effective and safe means to achieve revascularization among ACS patients in current clinical practice.
TL;DR: The factors that affect the reduction of angina class at 1 year are examined, especially in patients who do not demonstrate an initial response, and multivariate predictors of 1-year benefit are initial response to treatment and no history of congestive heart failure.
Abstract: Enhanced external counterpulsation (EECP) has been shown to reduce Canadian Cardiovascular Society angina class. This study examines the factors that affect the reduction at 1 year, especially in patients who do not demonstrate an initial response. The data of 2,007 consecutive patients enrolled in the International EECP Patient Registry were analyzed. After 36.6 ± 4.9 h of EECP, angina was reduced by at least one class in 82.7%. At 1 year, 35.4% of initial nonresponders and 70.6% of responders remained improved by at least one angina class and free of major adverse cardiovascular events. Multivariate predictors of 1-year benefit are initial response to treatment (odds ratio 4.5, 95% CI 3.5–5.8), baseline angina class compared with class IV (odds ratios: class I 2.1, CI 0.93–4.81; class II 0.62, CI 0.43–0.87; class III 0.80, CI 0.62–1.01) and no history of congestive heart failure (odds ratio 1.41, CI 1.14–1.74).
TL;DR: Aneurysmal dilatation of saphenous vein graft (SVG), first reported in 1975, is secondary to true aneurysm or pseudoaneurysm, and is more common than pseudoaneURysm by a 6:1 ratio.
Abstract: Aneurysmal dilatation of saphenous vein graft (SVG), first reported in 1975, is secondary to true aneurysm or pseudoaneurysm. We report 1 case and review 107 cases published since 1975. Severe SVG dil
TL;DR: In a 42-year-old patient with MD1, manifesting as weakness and wasting of the facial and distal limb muscles, clinical myotonia, transthoracic echocardiography revealed thickening of the left ventricular myocardium and LVHT, both confi rmed by cardiac MRI.
Abstract: The number of CTG repeats in the myotonic dystrophy protein kinase gene on chromosome 19q13.3 was 5 for the normal allele and 300 for the expanded allele. The daughter of the patient was clinically unaffected, but carried an expanded allele as well. Except for atrial fl utter, which was successfully converted into sinus rhythm, no Left ventricular hypertrabeculation/ noncompaction (LVHT) is a rare subtype of hypertrophic cardiomyopathy, affecting the left ventricular myocardium distal to the papillary muscles [1] . LVHT is frequently associated with neuromuscular disorders [2, 3] . LVHT has not been described on cardiac MRI in myotonic dystrophy type 1 (MD1). In a 42-year-old patient with MD1, manifesting as weakness and wasting of the facial and distal limb muscles, clinical myotonia, generally reduced deep tendon refl exes, hyper-CK-emia, myogenic electromyography with fi brillations and pseudomyotonic discharges at most of the investigated sites, frontal baldness, hypacusis, bradydiadochokinesia, ataxia, dysphagia and dysarthria, transthoracic echocardiography revealed thickening of the left ventricular myocardium and LVHT, both confi rmed by cardiac MRI ( fi g. 1 ). The abnormal trabeculations were typically located in the apex and the adjacent ventricular walls. Received: August 24, 2004 Accepted: September 13, 2004 Published online: March 18, 2005
TL;DR: The incidence of all types of arrhythmia and conduction disturbances was similar in ambulatory and hospitalized children, and these data can be taken as a basis for the analysis of 24-hour electrocardiogram monitoring in ambulanceatory but also in hospitalized children.
Abstract: Our aim was to underline possible differences in heart rate and rhythm patterns between ambulatory and hospitalized children. Holter monitoring was performed on 264 healthy ambulatory children and on 112 children who were hospitalized for noncardiotoxic conditions. Maximal, mean and minimal heart rates decreased with age. Maximal heart rate was significantly higher in ambulatory schoolchildren and adolescents than in hospitalized ones. Sinus arrhythmia was noted on every recording. Some children had episodes of first- or second-degree atrioventricular block while sleeping. Supraventricular and uniform ventricular extrasystoles were common. The incidence of all types of arrhythmia and conduction disturbances was similar in ambulatory and hospitalized children. These data can be taken as a basis for the analysis of 24-hour electrocardiogram monitoring in ambulatory but also in hospitalized children.
TL;DR: This is the first study to show the relation between P< sub>max, Pd and anxiety, and STAI-1 and STai-2 are associated with an increase in P d sub and P max.
Abstract: Background: P wave dispersion (Pd), defined as the difference between the maximum (Pmax) and the minimum P wave duration (Pmin), and Pmax
TL;DR: The RV wall motion is nonuniform in contour area change, strain, and timing of motion.
Abstract: Background/Aim: Patients with ventricular ectopy from the right ventricular (RV) outflow tract (RVOT) are often referred for RV angiography to exclude disorders such as arrhythmogen
TL;DR: QTc interval >440 ms and diffuse T wave inversion were significantly more common in patients with lithium over range, and were good predictors of lithium overrange.
Abstract: Background: Lithium compounds have been widely used in the treatment of manic-depressive illness. Several electrocardiogram (ECG) abnormalities, including ventricular arrhythmias, a
TL;DR: In patients following an acute myocardial infarction, no difference in either global or regional LVEF was observed between baseline and 12 months when treatment with carvedilol was compared with atenolol.
Abstract: Background: β-Blockers have been found to reduce mortality and morbidity in postmyocardial infarction patients. However, it is not fully understood whether all β-blockers have simil
TL;DR: The analysis of ECG pattern makes it possible to guide the management of patients with idiopathic VT in predicting the arrhythmias that can be safely targeted with RF ablation from the RVOT with high success rates.
Abstract: Background: Idiopathic ventricular tachycardia (VT) often originates from the right ventricular outflow tract (RVOT), but foci deep to the endocardium, in the epicardium, or in the
TL;DR: CI in genetically confirmed FSHMD may manifest not only as ECG abnormalities but also as left ventricular myocardial thickening, which is found in patients with genetically confirmed facioscapulohumeral muscular dystrophy.
Abstract: Cardiac involvement (CI) in form of myocardial thickening in a patient with genetically confirmed facioscapulohumeral muscular dystrophy (FSHMD) has not been reported. The patient is a 50-year-old mal
TL;DR: The results of this study indicate that aortic distensibility was increased by prolonged training in endurance athletes, particularly in those with the ACE II genotype, which represents an extracardiac adaptation to chronic prolongedTraining in athletes.
Abstract: Background: Physiologic adaptations in an athlete’s heart include increased left and right ventricular chamber size, left ventricular wall thickness and mass. Angiotensin-converting
TL;DR: It is reasonable to speculate that the metabolic syndrome is possibly related to AF and that these processes might facilitate the development of AF in the context of metabolic syndrome.
Abstract: [8] . Recently, in a prospective study from the Framingham cohort it was demonstrated that obesity is an important independent risk factor for AF [9] raising serious concerns about the epidemic of both conditions that affect each other [10] . Taking into account the aforementioned epidemiological evidence, it is reasonable to speculate that the metabolic syndrome is possibly related to AF. Even though some components of this syndrome have been separately associated with AF, no epidemiological study has examined the association of metabolic syndrome, as an independent entity, with AF. Further support to our hypothesis can be obtained by current pathophysiological evidence. In particular, hypertension and obesity have been clearly correlated with atrial stretch and dilatation (major characteristics of the structural remodeling) [6, 9] . Furthermore, the metabolic syndrome as well as its constituents is clearly related to infl ammation and increased oxidative stress [11–13] . Considering that infl ammation and oxidative stress have been recently implicated in the pathophysiology of atrial remodeling [14] , it is reasonable to assume that these processes might facilitate the development of AF in the context of metabolic syndrome. Despite these epidemiological and pathophysiological considerations, well-designed studies are needed in order to eluciDear Sir, Atrial fi brillation (AF) represents the most common arrhythmia encountered in clinical practice while its prevalence is continuously increasing [1, 2] . AF is no longer being considered a benign arrhythmia since it is responsible for a 3to 5-fold increased risk of thromboembolic events and a 2-fold increased risk of mortality [2] . Atrial electrical and structural remodeling possibly accounts for the propensity of AF to become sustained over time [3] . In other words, atrial remodeling seems to be the most signifi cant pathophysiological process underlying the AF recurrence and perpetuation [3] . On the other hand, the metabolic syndrome refers to a combination of atherosclerotic risk factors including insulin resistance, obesity, hypertension, and dyslipidemia [4, 5] . The prevalence of metabolic syndrome among US adults is estimated at 22% [5] . It is widely accepted that hypertension is one of the major predisposing factors leading to AF development [6] ; it has been estimated that for men and women with hypertension the risk of AF increases by 1.5 and 1.4 times respectively [7] . Even though reported results examining the association between diabetes and AF are confl icting, a recent study showed a novel association between AF and the presence of type 2 diabetes and hypertension [8] . The authors suggested the insulin resistance as a contributing mechanism for the development of AF Received: March 7, 2005 Accepted: March 15, 2005 Published online: August 22, 2005
TL;DR: The results demonstrate the feasibility of using NIRS tissue pH in freshly excised atherosclerotic plaques in light of marked pH heterogeneity and warrants future in-vivo investigations on pH measurement of atherosclerosis plaques.
Abstract: Detection of vulnerable plaques as the underlying cause of myocardial infarction is at the center of attention in cardiology. We have previously shown that infiltration of inflammatory cells in atherosclerotic plaques renders these plaques relatively hot and acidic, with substantial plaque temperature and pH variation. The objective of this investigation was to determine whether near-infrared diffuse reflectance spectroscopy (NIRS) could be used to non-destructively measure the tissue pH in atherosclerotic plaques. NIRS and tissue pH electrode measurements were taken on freshly excised carotid plaques maintained under physiological conditions. The coefficient of determination between NIRS and the pH microelectrode measurement was 0.75 using 17 different areas. The estimated accuracy of the NIRS measurement was 0.09 pH units. These results demonstrate the feasibility of using NIRS tissue pH in freshly excised atherosclerotic plaques in light of marked pH heterogeneity and warrants future in-vivo investigations on pH measurement of atherosclerotic plaques.
TL;DR: In patients with CAD, baPWV, which is a simple marker of aortic stiffness, increases with CAD severity and correlates with left ventricular systolic function independent of CAD severity.
Abstract: Although aortic stiffness plays an important role in patients with coronary artery disease (CAD), the influence of aortic stiffness on left ventricular systolic function has not yet been fully evaluat