Matrix metalloproteinase expression in nonrheumatic aortic stenosis.

Background: Nonrheumatic aortic stenosis (NAS) is considered to be a degenerative process characterized by valve thickening, fibrocalcific masses, collagen disarray, and an inflammatory infiltrate. The matrix metalloproteinases (MMPs) are a family of zinc- and calcium-dependent enzymes produced by inflammatory cells that are capable of degrading collagen, elastin, and proteoglycans. This study sought to test the hypothesis that MMPs are involved in the pathogenesis of NAS.

Effect of early revascularization on mortality from cardiogenic shock complicating acute myocardial infarction in California.

Recent retrospective analyses of treatment of cardiogenic shock suggest that early revascularization reduces mortality. All nonfederal hospital admissions in California for 1994 with a diagnosis of acute myocardial infarction (AMI) were identified. From that cohort, patients who developed cardiogenic shock were selected to determine demographic features, procedure utilization, and outcomes of their admission compared with patients with AMI without cardiogenic shock.

Self-reported differences between cardiologists and heart failure specialists in the management of chronic heart failure.

Background: Heart failure (HF) is responsible for considerable mortality morbidity rates and resource utilization. Recently, several studies have reported improved outcomes when patients are managed by special HF clinics, but it is uncertain whether this improvement reflects differences in physician practices or other aspects of the operation of these clinics.

Objectives: This study was designed to identify differences in HF management practices between general cardiologists and cardiologists specializing in the treatment of patients with HF.

Differences in TIMI frame count following successful reperfusion with stenting or percutaneous transluminal coronary angioplasty for acute myocardial infarction.

The Thrombolysis In Myocardial Infarction (TIMI) flow grade achieved in the infarct-related artery (IRA) during reperfusion therapy for acute myocardial infarction (AMI) is directly related to myocardial salvage. Recently, several series have demonstrated the safety of stenting in AMI and documented a larger postprocedure luminal diameter than that found at angioplasty, although no study has compared the effect of PTCA and stenting in AMI on flow characteristics of the IRA. The residual stenosis and the number of frames required to opacify standardized angiographic landmarks normalized for vessel length (corrected TIMI frame count) or compared with flow in a corresponding normal coronary artery (TIMI frame count index) were determined for the IRA of 39 patients who underwent angioplasty or stenting for AMI.

Differences between primary care physicians and cardiologists in management of congestive heart failure: relation to practice guidelines.

Objectives: This study was designed to characterize physician practices in the management of congestive heart failure (CHF) and to determine whether these practices vary by specialty and how they relate to guideline recommendations.

Background: Congestive heart failure is responsible for considerable mortality, morbidity and health care resource utilization. Although there have been important advances in the diagnostic evaluation and treatment of CHF, little information is available on physician practices in this area.