Programmed ventricular stimulation in survivors of an acute myocardial infarction.

The prognostic significance of programmed ventricular stimulation and its usefulness in relation to other forms of invasive and noninvasive testing was evaluated in 150 survivors of acute myocardial infarction. Ventricular tachyarrhythmias of 6 beats or more were induced in 35 (23%) patients. No significant differences existed between patients with inducible ventricular tachyarrhythmias and those without inducible ventricular tachycardia with respect to occurrence of spontaneous ventricular arrhythmias in the acute and early recovery phase of infarction or predischarge exercise-induced ischemia or arrhythmias, severity of coronary artery disease, or degree of left ventricular dysfunction.

Electrophysiologic effects of intravenous diltiazem in patients with recurrent supraventricular tachycardias.

The electrophysiologic effects of intravenous diltiazem were evaluated in 10 patients with recurrent supraventricular tachycardias. The tachycardia incorporated an accessory pathway in 7 patients and was due to AV nodal reentry in 3 patients. Diltiazem 0.

A logistic regression analysis of multiple noninvasive tests for the prediction of the presence and extent of coronary artery disease in men.

The incremental diagnostic yield of clinical data, exercise ECG, stress thallium scintigraphy, and cardiac fluoroscopy to predict coronary and multivessel disease was assessed in 171 symptomatic men by means of multiple logistic regression analyses. When clinical variables alone were analyzed, chest pain type and age were predictive of coronary disease, whereas chest pain type, age, a family history of premature coronary disease before age 55 years, and abnormal ST-T wave changes on the rest ECG were predictive of multivessel disease. The percentage of patients correctly classified by cardiac fluoroscopy (presence or absence of coronary artery calcification), exercise ECG, and thallium scintigraphy was 9%, 25%, and 50%, respectively, greater than for clinical variables, when the presence or absence of coronary disease was the outcome, and 13%, 25%, and 29%, respectively, when multivessel disease was studied; 5% of patients were misclassified.

Myocardial revascularization after failure of percutaneous transluminal coronary angioplasty.

From 1980 to 1983, 299 procedures for percutaneous transluminal coronary angioplasty were performed in 265 patients. The procedure failed in 88 patients, 72 of whom underwent myocardial revascularization within 1 week following the angioplasty attempt. Operation on an emergency basis was required in 35 patients because of a major complication during or after coronary artery dilatation, whereas the remaining 37 patients underwent elective operation following failure without complication.

Immunoreactive atrial natriuretic factor (IR-ANF) in human plasma.

A direct radioimmunoassay for ANF in human plasma was developed. A synthetic alpha-human atrial peptide (Ser 99-Tyr 126) was used for preparation of the iodinated tracer and the standards. The sensitivity of the method is 1.

Long-term oral administration of amrinone for congestive heart failure: lack of efficacy in a multicenter controlled trial.

A number of uncontrolled studies have indicated that oral administration of amrinone, a phosphodiesterase inhibitor with potent positive inotropic effects in experimental preparations, may be beneficial in patients with chronic congestive heart failure. The present multicenter trial was designed to prospectively evaluate clinical response and change in exercise tolerance during 12 weeks of amrinone therapy in a double-blind, placebo-controlled protocol. Ninety-nine patients with NYHA functional class 3 or 4 congestive heart failure on digitalis and diuretics, of whom 31 were also receiving captopril, were enrolled.

Failure of diltiazem to prevent restenosis after percutaneous transluminal coronary angioplasty.

This prospective randomized trial was carried out in 92 patients who underwent a successful percutaneous transluminal coronary angioplasty (PTCA) and had no evidence of coronary spasm before PTCA. All patients were premedicated with calcium antagonists and platelet inhibitors and received platelet inhibitors (aspirin and dipyridamole) for 6 months after PTCA. The diltiazem group (46 patients with 50 stenoses successfully dilated) received diltiazem, 90 mg three times a day by mouth for 3 months after PTCA; in the control group (46 patients, 53 stenoses), calcium antagonists were discontinued immediately after PTCA.

Percutaneous transluminal coronary angioplasty for the treatment of variant angina.

Among 268 patients undergoing percutaneous transluminal coronary angioplasty between February 1980 and January 1983, a total of 21 patients had variant angina, documented before angioplasty in 14 and after angioplasty in 7. Before angioplasty, all 21 patients had rest angina and 17 also had effort angina; single vessel coronary artery disease with 60 to 95% stenosis was present in all patients and the left anterior descending coronary artery was involved in all but 3 patients. Coronary angioplasty was successful in 19 patients (90%).

[Developmental atherosclerosis of the coronary arteries treated by successive transluminal angioplasties].

The authors present the case of a 62 year old patient with advanced coronary artery disease who underwent three successive percutaneous transluminal coronary angioplasties for five stenoses over a period of 30 months. Three of these stenoses appeared after the first operation. This case illustrates the advantage of this new technique of revascularisation which has an encouraging future in the field of "operative cardiology".

Comparison of receiver operating curves derived from the same population: a bootstrapping approach.

The receiver operating curve (ROC) gives a representation of sensitivity and specificity of a prediction model when varying the cutpoint of a decision rule on a whole spectrum. Evaluation of two models established (or tested) in the same population of patients warrants a valid statistical comparison of their ROC curves. Hanley et al.

Prognostic significance of progression of coronary artery disease.

Angiographically documented coronary artery disease (CAD) can progress. Although progression itself is frequently recognized in patients who have undergone repeat cardiac catheterization, its prognostic significance remains unclear. To evaluate the influence of progression on survival, 313 patients with CAD who underwent catheterization twice (39 +/- 25 months apart) were followed for 3 to 129 months (mean 41 +/- 30) after the second angiogram.

Haemodynamic and electrophysiologic effects of diltiazem.

This review describes the haemodynamic and electrophysiologic properties of diltiazem and shows how these effects may, in some clinical situations, favour the choice of this drug as an antianginal and antiarrhythmic agent. Compared to nifedipine and verapamil, diltiazem has the distinct advantage of being a negative chronotropic agent and thus has the potential of leading to a greater reduction in myocardial oxygen consumption; it does not affect cardiac output, left ventricular end diastolic pressure, and ejection fraction in patients with an adequately preserved left ventricular function; finally, it possesses a longer duration of action and fewer side effects, even at relatively high calcium entry blocking doses, than the other major calcium entry blockers.

Spontaneous regression of coronary artery obstructions: incidence in 313 consecutive repeat angiograms.

We studied the incidence of reversibility of coronary obstructions in a consecutive series of 313 patients with nonoperated coronary artery disease catheterized twice 3 to 118 (mean 38) months apart. Recanalization was observed in three patients and regression from an initial less than 100% obstruction in six patients. Progression in a different location occurred in six of the nine patients who demonstrated one recanalized or one regressive lesion.

Prostaglandin E1 increases myocardial contractility in the conscious dog.

The systemic and inotropic properties of prostaglandin E1 (PGE1) were investigated in 20 unanesthetized dogs. Pairs of ultrasonic dimension gauges and a micromanometer were implanted in the subendocardium and the apex of the left ventricle (LV), respectively. Seven to ten days later, increasing doses of PGE1 were infused into the left atrium.

Clinical experience with ioxaglate (Hexabrix) in selective coronary arteriography.

This prospective nonrandomized study was performed to evaluate the safety and efficacy of, as well as patient tolerance for, a new low osmolality contrast medium, ioxaglate (Hexabrix), in 90 adult patients of both sexes who were referred to our cardiac catheterization laboratory for angiocardiography including selective coronary arteriography. Ioxaglate did not cause any major adverse effects; side effects were rare and mild. Hemodynamic changes were minimal, even in patients with severe coronary artery disease, and no arrhythmias were seen.

Clinical and angiographic predictors of new total coronary occlusion in coronary artery disease: analysis of 313 nonoperated patients.

A new coronary artery occlusion was found in 98 of 313 consecutive patients (31%) with coronary artery disease treated medically who underwent catheterization twice, 39 +/- 25 months apart. Multivariate logistic regression displayed 8 independent predictors of new occlusion. Four were available at the time of the second angiogram: the interval between the 2 studies (p = 0.

Comparison of digital and radionuclide left ventriculography in patients at risk from conventional left ventriculography.

In this study, two alternative methods of assessing left ventricular (LV) sequential wall motion and ejection fraction (EF) were used in 28 consecutive patients in whom an unstable clinical condition (unstable angina pectoris or severe LV dysfunction) precluded the use of high volume contrast cineventriculography. A new approach, direct small volume contrast digital ventriculography, was compared to radionuclide blood pool ventriculography considered as a "standard" and reliable technique. The qualitative analysis of regional LV contraction by three independent observers showed a complete agreement in 64% of segments studied in the left anterior oblique (LAO) projection and in 69% in the right anterior oblique (RAO) projection; a one-degree disagreement was observed in 13% and 19% respectively, and a discrepancy of two degrees or more in 23% and 12% respectively.

Usefulness of digital subtraction left ventriculography in patients with ischemic heart disease: comparison with cineangiography.

Digital subtraction and computer enhancement of left ventriculography allow the injection of small amounts of contrast medium into the left ventricle. Image quality measurements of cardiac volumes, and ejection fraction and evaluation of regional wall motion were compared following digital subtraction and cine ventriculography in 30 patients undergoing coronary arteriography for suspected or proven ischemic heart disease. At concentrations of 13% to 19% (iodine contents: 2.

The relation of risk factors to the development of atherosclerosis in saphenous-vein bypass grafts and the progression of disease in the native circulation. A study 10 years after aortocoronary bypass surgery.

We examined 82 patients 10 years after saphenous-vein aortocoronary bypass surgery to determine their angiographic status and to relate those findings to the risk factors for coronary-artery disease. Of 132 grafts shown to be patent 1 year after surgery, only 50 were unaffected at 10 years. The remainder were narrowed (43) or occluded (39).

Comparison of late changes in internal mammary artery and saphenous vein grafts in two consecutive series of patients 10 years after operation.

Postoperative angiographic studies were carried out at 1 month, 1 year, and 10 years in two groups of patients: 238 patients with saphenous vein (SV) grafts and 40 patients with internal mammary artery (IMA) grafts. Cumulative patency was better in IMA grafts, both at 1 year (88.5% vs 76.

Diagnostic impact of thallium scintigraphy and cardiac fluoroscopy when the exercise ECG is strongly positive.

We studied 83 men, who had a chest pain syndrome, no prior history of myocardial infarction, and exercise-induced horizontal or downsloping ST segment depression greater than or equal to 0.2 mV. The 38 patients unable to complete Bruce stage II had a significant increased risk of coronary (0.

Noninvasive diagnostic test choices for the evaluation of coronary artery disease in women: a multivariate comparison of cardiac fluoroscopy, exercise electrocardiography and exercise thallium myocardial perfusion scintigraphy.

Several diagnostic noninvasive tests to detect coronary and multivessel coronary disease are available for women. However, all are imperfect and it is not yet clear whether one particular test provides substantially more information than others. The aim of this study was to evaluate clinical findings, exercise electrocardiography, exercise thallium myocardial scintigraphy and cardiac fluoroscopy in 92 symptomatic women without previous infarction and determine which tests were most useful in determining the presence of coronary disease and its severity.

Progression of atherosclerosis in coronary arteries and bypass grafts: ten years later.

Progression of atherosclerosis in aortocoronary saphenous vein grafts is frequent and is the predominant cause of late graft closure after CABG. Only approximately 60% of grafts remain patent between 10 and 12 years after surgery. Of patent grafts, 45% show angiographic evidence of atherosclerosis between 10 and 12 years after surgery and 70% of the atherosclerotic lesions reduce the graft lumen diameter by 50% or more.

Exercise, electrocardiographic and functional responses after percutaneous transluminal coronary angioplasty.

Exercise testing after successful PTCA showed improved cardiac functional status on examination of electrocardiographic and symptomatic responses, myocardial perfusion and global and regional left ventricular function. Sixty-six patients were studied before and after persistently successful PTCA. Follow-up studies an average of 8 months after the successful procedure showed an incidence of abnormal testing of only 7% using both electrocardiographic and subjective symptomatic criteria during treadmill studies and no abnormal studies with thallium scintigraphy.