Exercise tolerance and quality of life in elderly patients with chronic atrial fibrillation.

Background: Atrial fibrillation is the most common arrhythmia affecting the elderly. Although the risk of cardioembolic stroke is well defined, the effects of chronic atrial fibrillation on exercise tolerance and quality of life have been less well quantified.

Methods: We compared a group of 52 elderly patients with chronic atrial fibrillation to a group of 48 control patients in sinus rhythm.

Executive Summary: Pivotal Research in Cardiovascular Syndromes in the Elderly.

The PRICE-1 conference was designed to identify near term priorities for funding cardiovascular research in the elderly. Twenty topics were identified with either break throughs in fundamental mechanisms of aging with cardiovascular systems or with critical importaance to cardiovascular carve of the elderly. (c) 2000 by CVRR, Inc.

Prevention of Stroke.

Patients with atrial fibrillation are at variable risks for developing a stroke. The risk is significantly increased among the elderly. Other risks factors include hypertension, diabetes, poor ventricular function, and a prior history of TIA or stroke.

Beneficial effect of glycoprotein IIb/IIIa inhibitor (AZ-1) on endothelium in Escherichia coli endotoxin-induced shock.

Objective: To investigate the effects of AZ-1, a murine monoclonal antiglycoprotein-IIb/IIIa antibody, on endothelium and on hemostasis in a rabbit endotoxic shock model.

Design: Prospective laboratory study.

Setting: University laboratory.

Central clinical research issues in electrophysiology: report of the NASPE Committee.

This article contains the results of an attempt by appointed members of the North American Society of Pacing and Electrophysiology to define the research frontier in electrophysiology and suggest areas of study as an aid in setting the research agenda.

Effects of atorvastatin on early recurrent ischemic events in acute coronary syndromes: the MIRACL study: a randomized controlled trial.

Context: Patients experience the highest rate of death and recurrent ischemic events during the early period after an acute coronary syndrome, but it is not known whether early initiation of treatment with a statin can reduce the occurrence of these early events.

Objective: To determine whether treatment with atorvastatin, 80 mg/d, initiated 24 to 96 hours after an acute coronary syndrome, reduces death and nonfatal ischemic events.

Design And Setting: A randomized, double-blind trial conducted from May 1997 to September 1999, with follow-up through 16 weeks at 122 clinical centers in Europe, North America, South Africa, and Australasia.

Atrial fibrillation: are there gender differences?

The incidence of atrial fibrillation is greater in men than in women, but this gap closes with advancing age. More women with atrial fibrillation have underlying valvular disease, and more men with this condition have underlying coronary artery disease. Atrial fibrillation increases mortality and the incidence of stroke in both sexes.

Approach to management of the patient over age 75 with atrial fibrillation.

This article will address the general approach to management of the typical patient >75 years of age with atrial fibrillation. Emphasis will be placed on optimizing the benefit and reducing the risk of anticoagulation in this important and expanding group of patients.

Local treatment with recombinant tissue factor pathway inhibitor reduces the development of intimal hyperplasia in experimental vein grafts.

Background: Tissue factor (TF)-initiated thrombin generation has been implicated in the development of intimal hyperplasia after arterial injury. An increase in intimal TF expression has been shown to precede the development of intimal hyperplasia in vein grafts. This study examines the effects of local treatment with recombinant human tissue factor pathway inhibitor (rTFPI) in experimental vein grafts.

Combination Hemotherapy and Mortality Prevention (CHAMP) Study Rationale and Design.

It is now agreed that the majority of acute myocardial infarctions result from intracoronary thrombosis at sites of atherosclerotic plaque that have been disrupted. In 1947 Nicol and Fassett published the first clinical paper suggesting that agents interfering with blood coagulation could prevent myocardial infarction in patients at risk. Scores of subsequent clinical trials were performed to assess the efficacy of anticoagulants and antiplatelet agents in preventing death and reinfarction in survivors of acute myocardial infarction.

Detection of deep venous thrombosis by DMP 444, a platelet IIb/IIIa antagonist: a preliminary report.

Background: We report a method for detection of deep venous thrombosis with a technetium 99m-labeled peptide (DMP 444). The N-methyl-arginine-glycine-aspartic acid sequence on DMP 444 binds the glycoprotein IIb/IIIa receptor on activated platelets (inhibition constant [IC50] for fibrinogen binding = 6 nmol/L).

Methods: DMP 444 (23 to 27 mCi) was injected into 11 patients with clinical suspicion of deep venous thrombosis, diagnostic confirmation by ultrasound, and a positive D-dimer test result.

Management of arrythmias.

The management of arrhythmias in elderly patients with congestive heart failure, including atrial fibrillation, ventricular tachyarrhythmias, and bradyarrhythmias, is described. Patients with atrial fibrillation can be treated with rate control anticoagulation for stroke prevention or by attempt at cardioversion and maintenance of sinus rhythm. Elderly patients remaining in atrial fibrillation benefit from anticoagulation provided that no contraindication exists.

In vitro evaluation of c7E3-Fab (ReoPro) eluting polymer-coated coronary stents.

Objective: Stent thrombosis and in-stent restenosis remain problematic in certain patient sub-groups. c7E3-Fab (ReoPro, abciximab) inhibits the platelet glycoprotein IIb/IIIa receptor as well as the smooth muscle cell alpha(v)beta3 receptor, and thus may influence both processes, especially if high local concentrations could be achieved. We have studied the adsorption and elution characteristics of c7E3-Fab on commercially available polymer-coated stents.

Basic fibroblast growth factor increases tissue factor expression in circulating monocytes and in vascular wall.

Background: Basic fibroblast growth factor (bFGF) promotes vascular repair and angiogenesis and can induce in vitro tissue factor (TF), a potent agent initiating thrombogenesis, which probably plays a role in angiogenesis. We investigated whether bFGF administration induced TF expression by monocytes and vascular cells.

Methods And Results: We studied TF expression in normally fed (n=16) and cholesterol-fed (2% for 6 weeks, n=16) rabbits.

Initiating and Maintaining Patients on Warfarin Anticoagulation: The Importance of Monitoring.

BACKGROUND: The VA Stroke Prevention in Nonrheumatic Atrial Fibrillation study was a prospective, randomized, double-blind study comparing low-dose warfarin with placebo in patients with nonrheumatic atrial fibrillation. The trial showed a 79% reduction in stroke rate in warfarin randomized patients without an increase in bleeding complications. We examined the need for frequent prothrombin time monitoring (international normalized ratios [INR] were not measured directly) in patients receiving warfarin.

Clinical implication of antiembolic trials in atrial fibrillation and role of transesophageal echocardiography in atrial fibrillation.

Risk for stroke in patients with atrial fibrillation (AF) is highly heterogeneous. Increasing age, history of diabetes, hypertension, previous transient ischemic attack or stroke, and poor ventricular function are independent risk factors for stroke in patients with AF. Accordingly, some groups of patients with AF have low risk and some have high risk.

Preventing stroke in patients with atrial fibrillation.

Context: Atrial fibrillation, a common disorder that affects nearly one sixth of the population aged 75 years and older, is a major risk factor for stroke.

Objectives: To review and evaluate the evidence supporting the use of warfarin and/or aspirin for stroke prevention in patients with atrial fibrillation.

Data Sources: Prospective, randomized trials of patients with atrial fibrillation evaluating either warfarin or aspirin or both, from MEDLINE from January 1, 1966, to February 23, 1999.