Maintenance of sinus rhythm with metoprolol CR initiated before cardioversion and repeated cardioversion of atrial fibrillation: a randomized double-blind placebo-controlled study.

Aims: To assess the effect of metoprolol in combination with repeated cardioversion on maintenance of sinus rhythm (SR).

Methods And Results: Consecutive outpatients with persistent atrial fibrillation (AF) were randomized to treatment with metoprolol CR or placebo in a double-blind fashion. Study treatment was started at least one week before direct current (DC) cardioversion.

High-degree atrioventricular block during anti-arrhythmic drug treatment: use of a pacemaker with a bradycardia-detection algorithm to study the time course after drug withdrawal.

Aim: This study examines the recurrence of high-degree atrioventricular block (AVB) during a follow-up period of 2 years in patients with restored AV node function after antiarrhythmic drug withdrawal at implantation of a pacemaker.

Methods: Nine men and eight women (77 +/- 7 years) taking antiarrhythmic drugs (beta-receptor blockers in 15) and presenting with high-degree AVB were followed for 2 years after being taken off drugs upon receiving a permanent pacemaker with special bradycardia detection software.

Results: At inclusion, surface ECG identified two subsets of patients: a QRS duration < 120 ms (n = 5) and those with a QRS duration > or =120 ms (n = 12).

Detection of abnormal left ventricular function by Doppler tissue imaging in patients with a first myocardial infarction and showing normal function assessed by conventional echocardiography.

Aims: The aim of the study was to characterize left ventricular (LV) function by Doppler tissue imaging (DTI) after a first myocardial infarction (MI) where the conventional echo-Doppler parameters showed no abnormalities.

Methods: Out of 202 patients who were referred for an echocardiogram, 19 patients were previously healthy and had a normal ejection fraction and no wall motion abnormalities at echocardiogram. These 19 patients were compared with 16 age-matched healthy subjects (HS).

CRP, IL-6 and endothelin-1 levels in patients undergoing coronary artery bypass grafting. Do preoperative inflammatory parameters predict early graft occlusion and late cardiovascular events?

Background: Inflammation is a major contributor to atherosclerotic vascular disease. Inflammatory parameters such as C-reactive protein (CRP) and Interleukin-6 (IL-6) have been shown to be strong predictors of cardiovascular events. The association between preoperative inflammatory parameters and early graft occlusion as well as cardiovascular events after coronary artery bypass grafting (CABG) has not, however, been fully elucidated.

Rate of conversion and recurrence after sotalol treatment in patients with direct current-refractory atrial fibrillation.

Background: A number of patients with persistent atrial fibrillation (AF) will not have sinus rhythm (SR) restored by direct current (DC) cardioversion.

Hypothesis: In patients with DC-refractory AF, oral pretreatment with sotalol increases the success rate at DC cardioversion.

Methods: Consecutive patients with persistent AF, refractory at a first DC cardioversion, were prospectively included.

Mortality and morbidity remain high despite captopril and/or Valsartan therapy in elderly patients with left ventricular systolic dysfunction, heart failure, or both after acute myocardial infarction: results from the Valsartan in Acute Myocardial Infarction Trial (VALIANT).

Background: The elderly constitute an increasing proportion of acute myocardial infarction patients and have disproportionately high mortality and morbidity. Those with heart failure or impaired left ventricular left ventricular function after acute myocardial infarction have high complication and mortality rates. Little is known about outcomes with contemporary therapies in these patients.

Improvement in diastolic left ventricular function after coronary artery bypass grafting as assessed by recordings of mitral annular velocity using Doppler tissue imaging.

Aims: The aim of the study was to evaluate the changes in diastolic function after coronary artery bypass grafting (CABG), using pulsed-wave Doppler tissue imaging (DTI).

Methods: Fifty-three patients with coronary artery disease were studied before and 3 and 12 months after CABG. Using pulsed-wave DTI, the mitral annular velocities were determined at 4 sites in the left ventricle (LV).

Prehospital identification of acute coronary syndrome/myocardial infarction in relation to ST elevation.

Aim: To evaluate factors that identify patients with an acute coronary syndrome/myocardial infarction prior to hospital admission among patients with a suspected acute coronary syndrome who were transported by ambulance with and without ST elevation on the ambulance electrocardiogram (ECG).

Methods: This was a prospective observational study in the part of Stockholm that is served by South Hospital ambulance organisation and the Municipality of Goteborg. All the patients who called for an ambulance due to acute chest pain or other symptoms raising the suspicion of an acute coronary syndrome took part.

Relation between renal dysfunction and cardiovascular outcomes after myocardial infarction.

Background: The presence of coexisting conditions has a substantial effect on the outcome of acute myocardial infarction. Renal failure is associated with one of the highest risks, but the influence of milder degrees of renal impairment is less well defined.

Methods: As part of the Valsartan in Acute Myocardial Infarction Trial (VALIANT), we identified 14,527 patients with acute myocardial infarction complicated by clinical or radiologic signs of heart failure, left ventricular dysfunction, or both, and a documented serum creatinine measurement.

Decreased right ventricular function after coronary artery bypass grafting and its relation to exercise capacity: a tricuspid annular motion-based study.

Background: Decreased right ventricular (RV) function is a known echocardiographic finding after coronary artery bypass grafting (CABG). For patients with heart failure, RV dysfunction is a predictor of poor exercise capacity. The significance and time course of RV dysfunction and its relation to exercise capacity after CABG have not been elucidated, however.

Right ventricular function before and after an uncomplicated coronary artery bypass graft as assessed by pulsed wave Doppler tissue imaging of the tricuspid annulus.

Background: Right ventricular (RV) function using myocardial velocities before and after a coronary artery bypass graft (CABG) is not known.

Methods: Using pulsed wave Doppler tissue imaging, RV function was studied in 35 patients before and after CABG. Patients were followed-up for 1 year after the CABG.

Safety and delay time in prehospital thrombolysis of acute myocardial infarction in urban and rural areas in Sweden.

Sixteen hospitals in Sweden, including those in urban and more sparsely populated areas, and the associated ambulance organizations were enrolled in a prospective evaluation of the feasibility of treating patients with a ST-elevation infarction with a thrombolytic agent (reteplase) before hospital admission. A physician staffed the ambulances in 1% of cases, a nurse in 67%, and a staff nurse in 32% of cases. In all, 64 patients in urban areas and 90 patients in rural areas were included.

Implementation of prehospital thrombolysis in Sweden: components of delay until delivery of treatment and examination of treatment feasibility.

Objective: To evaluate the feasibility of prehospital thrombolysis in Sweden in terms of safety and to examine the various components of the delay between onset of symptoms and start of treatment.

Setting: A total of 16 hospitals in Sweden in both urban and less populated areas and the associated ambulance organisations.

Design: Prospective evaluation of patients with an ST-elevation infarction treated with reteplase.

Predictors of myocardial damage prior to hospital admission among patients with acute chest pain or other symptoms raising a suspicion of acute coronary syndrome.

Aim: To evaluate factors which, prior to hospital admission, predict the development of acute coronary syndrome or acute myocardial infarction among patients who call for an ambulance due to suspected acute coronary syndrome.

Design: Prospective observational study.

Methods: All the patients who called for an ambulance due to suspected acute coronary syndrome in South Hospital's catchment area in Stockholm and in the Municipality of Göteborg between January and November 2000, were included.

Assessment of left ventricular function using mitral annular velocities in patients with congestive heart failure with or without the presence of significant mitral regurgitation.

Myocardial velocities in patients with congestive heart failure (CHF) were studied using pulsed wave Doppler tissue imaging. Velocities were recorded at the mitral and tricuspid annulus. Four sites at the mitral annuli were selected corresponding to the septal, lateral, inferior, and anterior walls of the left ventricle from apical 4- and 2-chamber views.

[Chest pain unit--viable option when risk of cardiac etiology is modest. Multitudinous patient population brought together for structured survey and care at appropriate level].

Chest pain is a common reason for visiting emergency wards. It is often difficult to confirm or exclude ischemic heart disease even without objective signs and atypical symptoms. These patients are usually admitted to the hospital for a variable number of days and the investigational plan can vary even in the same hospital.

Acute effects of smoking on diastolic function in healthy participants: studies by conventional doppler echocardiography and doppler tissue imaging.

The acute effects of smoking on left ventricular (LV) function were studied in 36 healthy participants (mean age 38 +/- 10 years). The studies were made before and immediately and 30 minutes after smoking a cigarette. From apical 4- and 2-chamber views, the mitral annular velocities, determined by pulsed wave Doppler tissue imaging, were measured at 4 LV sites corresponding to the septum and the anterior, lateral, and inferior walls.

Left Ventricular Regional Diastolic Dysfunction in Patients with First Myocardial Infarction Determined by Diastolic Motion of the Atrioventricular Plane.

Motion of the left ventricular [left ventricle (LV)] atrioventricular (AV) plane has been used to assess systolic LV function. The method has not been used properly to assess diastolic function, especially after a first myocardial infarction (MI). The diastolic function was assessed in 47 previously healthy patients with a first MI assessed by echocardiographic diastolic motion of the LV AV plane.

Changes in Systolic and Diastolic Function Indexes Throughout Dobutamine Stress Echocardiography in Healthy Volunteers and Patients with Ischemic Heart Disease.

BACKGROUND AND HYPOTHESIS: Dobutamine stress echocardiography is a well-established diagnostic method for investigating patients with suspected ischemic coronary disease. A positive test result is based on systolic parameters, but left ventricular filling parameters also are affected by myocardial ischemia. The aim of the present study was to study changes in both systolic and diastolic left ventricular variables throughout the test, including the period following it.