The effect of open-chest cardiac resuscitation on mitral regurgitant flow: an on-line transesophageal echocardiographic study in dogs.

Introduction: We sought to determine the effect of cardiac massage on a pre-existing regurgitant mitral valve during open-chest cardiopulmonary resuscitation (OCCPR) in an animal experiment.

Methods: Our study included 29 dogs that were used as experimental models. We anesthetized them and inserted a transesophageal echocardiographic (TEE) probe.

The concurrence of microalbuminuria and retinopathy with cardiovascular risk factors; reliable predictors of asymptomatic coronary artery disease in type 2 diabetes.

People with diabetes mellitus type 2 (DM2) have a greater risk for premature morbidity and mortality due to cardiovascular disease than the general population: cardiovascular disease accounts for 75% of deaths in this population group. We examined whether or not the association of clinical cardiovascular risk factors (RF) with both microalbuminuria (MA) and diabetic retinopathy (DR) constitutes reliable evidence for the existence of asymptomatic coronary artery disease (CAD), as assessed by positive myocardial thallium scintiscan using the SPECT method (Tl-scan) in patients with DM2. The study included 76 individuals with DM2 (54 men and 22 women, aged 46-70 years), with a negative history for infarction and negative clinical or ECG findings of CAD.

Prognostic significance of microalbuminuria in non-diabetic patients with acute myocardial infarction.

Background: The aim of this study was to examine whether the presence of microalbuminuria (20-200 microg/min) can predict in-hospital morbidity and mortality in non-diabetic patients with acute myocardial infarction.

Methods: Two hundred twenty-three (172 men and 51 women) non-diabetic patients with acute myocardial infarction were studied prospectively. The main outcome measures of the study were based on a comparison of in-hospital mortality and major non-fatal in-hospital events (pulmonary edema, post-infarction angina, infarct extension, mechanical complications, conduction disturbances and ventricular arrhythmias) between microalbuminuric and normoalbuminuric patients.

Microalbuminuria: a strong predictor of 3-year adverse prognosis in nondiabetic patients with acute myocardial infarction.

Background: The aim of this study is to evaluate the significance of microalbuminuria (MA) as a 3-year prognostic index in nondiabetic patients with acute myocardial infarction (AMI).

Methods: One hundred seventy-five patients with AMI were followed prospectively for 3 years. The study end point was cardiac death or rehospitalization for an acute coronary event.

Comparison of the extent and severity of coronary artery disease in patients with acute myocardial infarction with and without microalbuminuria.

The extent and severity of coronary atherosclerosis were compared between 43 microalbuminuric and 87 normoalbuminuric nondiabetic patients with acute myocardial infarction. Patients with microalbuminuria had significantly greater scores of the severity (Gensini score) and extent (Hamsten score) of coronary artery disease (p <0.001).

Comparative haemodynamic responses to the first dose of short- and long-acting ACE inhibitors in patients with congestive heart failure.

Background: Angiotensin Converting Enzyme inhibitors (ACEi's) confer significant mortality and morbidity benefits in all functional grades of chronic heart failure (CHF). However, physicians' concerns regarding the possible occurrence of first-dose hypotension appear to be a contributing factor to their under-utilisation in both hospital and primary care settings. We investigated whether long-acting and short-acting ACEi's differ in their haemodynamic responses to the first-dose in patients with CHF.

Functional and prognostic significance of silent ischemia during dobutamine stress echocardiography in the elderly.

Background: The functional and prognostic significance of silent ischemia relative to symptomatic ischemia during non-invasive testing remains controversial.

Design: The aim of this prospective study was to assess whether the presence of dobutamine-induced silent ischemia was associated with the amount of myocardial ischemic burden and to determine the prognostic significance of painless ischemia in elderly people with stable coronary artery disease.

Methods: A cohort of 289 patients > or =70 years of age with positive dobutamine stress echocardiography result and significant coronary artery disease proven by coronary arteriography, were followed up during a 35 +/- 13 month period for the development of cardiac events.

Outcome of patients with congestive heart failure treated with standard versus high doses of enalapril: a multicenter study. High Enalapril Dose Study Group.

Objectives: We sought to prospectively and randomly compare survival with clinical and hemodynamic variables in patients with congestive heart failure (CHF) treated with standard versus high doses of enalapril.

Background: Angiotensin-converting enzyme (ACE) inhibitors produce hemodynamic and symptomatic benefits in patients with CHF, but there is still controversy about the optimal dose in this clinical setting.

Methods: Two hundred and forty-eight patients with advanced CHF (age 56.

Leptin serum levels in cachectic heart failure patients. Relationship with tumor necrosis factor-alpha system.

Cachexia is a strong predictor for mortality in patients with congestive heart failure. To investigate the role of leptin and regulators of apoptosis in cardiac cachexia we compared leptin concentrations and their relation to the TNF system, interleukin 1-beta (IL-1b), and soluble Fas in patients with heart failure with and without cachexia. Patients with cardiac cachexia have increased levels of interleukin-1b compared to non-cachectic heart failure patients [mean(S.

Combined dynamic cardiomyoplasty and transvenous implantable cardioverter defibrillator system.

A transvenous implantable cardioverter defibrillator (ICD) was implanted in a patient with drug refractory ventricular fibrillation who had undergone latissimus dorsi cardiomyoplasty. The skeletal muscle was stimulated by a pulse train generator (cardiostimulator) implanted at the time of cardiomyoplasty. With proper programming of the devices neither adverse ICD-cardiostimulator interactions nor device malfunction were observed.

Detection of coronary artery disease in patients with severe aortic stenosis with noninvasive methods.

Exercise stress ECG testing is not generally recommended in patients with severe aortic stenosis. Analysis of the utility of exercise testing, both with and without the use of myocardial thallium-201 scintigraphy for the diagnosis of coronary artery disease (CAD), yielded low specificity. A noninvasive, safe, and accurate diagnostic modality to ascertain the presence of CAD is not available to date for patients with severe aortic stenosis.

Non-invasive evaluation of coronary reserve. Assessment of coronary reserve in patients with coronary artery disease by transesophageal-Doppler echocardiography.

We assessed coronary flow reserve using transesophageal Doppler echocardiography in patients with coronary artery disease. The study included 33 coronary artery disease patients who were undergoing coronary arteriography. The blood flow velocities of the left anterior descending artery before and after intravenous infusion (0.

Echocardiographic detection of the extent of coronary artery disease in the elderly using dobutamine and adenosine infusion.

Background: The high prevalence of asymptomatic multivessel disease in the elderly and the fact that most of them can not carry out an exercise stress testing renders the application of other stress modalities necessary. The aim of this study is to compare the diagnostic value of dobutamine and adenosine stress echocardiography and their accuracy in determining the extent of coronary artery disease in elderly people.

Methods: Dobutamine and adenosine stress echocardiography were performed in 128 consecutive patients > or = 70 years-of-age with known or suspected coronary artery disease.

Transesophageal echocardiographic Doppler study of coronary flow in a patient with myocardial bridging--a case report.

A case report of myocardial bridging of the left anterior descending artery is described. Coronary flow proximal to the myocardial bridge was studied with transesophageal echo Doppler. The patient, a 62-year-old farmer who sustained an anterior myocardial infarction, underwent thrombolysis and was admitted.

Coronary microcirculation evaluation with transesophageal echocardiography Doppler in type II diabetics.

Evaluation of coronary microvascular function can be obtained through coronary flow reserve measurements. The aim of this study was to evaluate the coronary microvascular function by using transesophageal-Doppler echocardiographic assessment of coronary flow reserve. The study included 32 normotensive patients with type II diabetes mellitus (group A) of short duration (6.

Stress echocardiography using adenosine combined with nitroglycerin-dobutamine in the detection of viable myocardium in patients with previous myocardial infarction.

The aim of this study was to assess the value of adenosine (A) and the combination of nitroglycerin (N) with dobutamine (D) stress echocardiography (SE) in the identification of viable myocardium. The clinical and electrocardiographic (ECG) effects of both tests were also evaluated. Fifty-two coronary artery disease patients, aged 56.

Torsades de pointes following radiofrequency catheter His ablation.

A case of polymorphic ventricular tachycardia torsade de pointes type, appearing in a 70-year-old female following radiofrequency catheter His ablation, is presented. The substrate was slow rate with ventricular bigeminy and QT prolongation which appeared after ablation. The same phenomenon reappeared after permanent VVIR pacemaker implantation with a basal rate of 55 beats/min.

Detection of myocardial viability in the prediction of improvement in left ventricular function after successful coronary revascularization by using the dobutamine stress echocardiography and quantitative SPECT rest-redistribution-reinjection 201TI imaging after dipyridamole infusion.

The aim of this study was to assess the feasibility, safety, and respective diagnostic accuracy of low-dose dobutamine infusion and rest-redistribution-reinjection thallium 201 single photon emission computed tomography (SPECT) after dipyridamole infusion (Th-DIP), in the prediction of functional improvement of asynergic infarcted zones, after successful revascularization in patients with chronic ischemic heart disease. Thirty-one patients with a previous myocardial infarction and left ventricular dysfunction (mean ejection fraction: 41 +/- 5.8%) were studied.

Fifteen year surveillance of echinococcal heart disease from a referral hospital in Greece.

Ten cases of hydatid heart disease were treated over a 15-year period (1980-1995). Cysts were located in the left ventricular wall (four patients), right ventricular wall (one patient), interventricular septum (one patient), interatrial septum (one patient), right atrium (one patient), pericardial cavity (one patient) and in multiple loci (one patient). Apart from two asymptomatic cases, clinical manifestations included chest pain (four patients), anaphylactic shock (one patient), constrictive pericarditis (one patient), congestive heart failure (one patient) and arterial embolism (one patient).

Stress echocardiography in elderly patients with coronary artery disease: applicability, safety and prognostic value of dobutamine and adenosine echocardiography in elderly patients.

Objectives: Our aim was to determine the applicability, safety and prognostic value of adenosine and dobutamine stress echocardiography in patients > or = 70 years old.

Background: These tests are sometimes mandatory because of difficulties and inaccuracies in interpreting traditional electrocardiographic stress tests. Furthermore, if these tests could be used to avoid coronary arteriography and cardiac catheterization, they would become essential in the care of the elderly, whose numbers are increasing.