Effects of an Intervention to Improve Evidence-Based Care for People With Diabetes and Cardiovascular Disease Across Sex, Race, and Ethnicity Subgroups: Insights From the COORDINATE-Diabetes Trial.

Background: Results from the COORDINATE-Diabetes trial (Coordinating Cardiology Clinics Randomized Trial of Interventions to Improve Outcomes - Diabetes) demonstrated that a multifaceted, clinic-based intervention increased prescription of evidence-based medical therapies to participants with type 2 diabetes and atherosclerotic cardiovascular disease. This secondary analysis assessed whether intervention success was consistent across sex, race, and ethnicity.

Methods: COORDINATE-Diabetes, a cluster randomized trial, recruited participants from 43 US cardiology clinics (20 randomized to intervention and 23 randomized to usual care).

Effects of ischemic preconditioning and arterial collateral flow on ST-segment elevation and QRS complex prolongation in a canine model of acute coronary occlusion.

Background: During acute myocardial infarction, both ST elevation and QRS distortion on the initial electrocardiogram (ECG) have been correlated with poorer prognosis. Studies in dogs and humans suggest that these ECG markers provide information about myocardial protection from both collateral blood flow and ischemic preconditioning.

Methods: In a protocol designed to precondition the heart with ischemia, we examined both ST-segment elevation and QRS complex prolongation in lead II of the ECG in 23 mongrel dogs during the first and fourth episode of 5 minutes of left circumflex artery occlusion.

The value of both ST-segment and QRS complex changes during acute coronary occlusion for prediction of reperfusion-induced myocardial salvage in a canine model.

Background: Analysis of ST-segment elevation for assessment of patients with suspected acute coronary occlusion is in widespread use for diagnostic and prognostic purposes. In this study, changes in the QRS complex also were analyzed to determine if these changes that are seldom used clinically can provide additional prognostic information. An acute coronary occlusion canine model, in which direct measurements of myocardial salvage were made, was used to assess whether ST-segment and QRS complex changes during coronary occlusion yielded independent estimates of the amount of salvage provided by reperfusion with arterial blood.

Hand-held echocardiographic examination of patients with symptoms of acute coronary syndromes in the emergency department: the 30-day outcome associated with normal left ventricular wall motion.

Background: Acute chest pain is a common complaint for patients presenting to emergency departments. Electrocardiography (ECG) results and biochemical markers have strong positive predictive value, but an equally available, inexpensive, and non-invasive test with strong negative predictive value is needed. Hand-held echocardiography (HHE) might serve this purpose.

The supplementary effect of QRS changes on the inverse relationship between ST changes and salvage: testing the Sclarovsky/Birnbaum clinical method in the basic Jennings/Reimer model.

Acute complete occlusion of a major epicardial coronary artery typically causes sufficient ischemia in the dependent myocardial cells to produce the electrocardiogram change called "epicardial injury". There is sufficient shift of the ST baseline toward, and of the TP/PR baseline away from the involved region to provide the clinical diagnosis. Relationships between the quantities of this baseline shift and etiologic ischemia have previously been shown to provide clinical value.