Patent foramen ovale screening by ear oximetry in divers.

The aim of this study was to test the hypothesis that ear oximetry immediately after the release of a sustained Valsalva maneuver accurately detects patent foramen ovale (PFO). One hundred sixty-five scuba divers underwent transesophageal echocardiography (TEE; reference method) for PFO assessment. Ear oximetry of the right earlobe was performed in a different room within a time frame of 2 hours before or after TEE.

Effect of sexual activity on cycle ergometer stress test parameters, on plasmatic testosterone levels and on concentration capacity. A study in high-level male athletes performed in the laboratory.

Background: The purpose of this study was to investigate the effect of sexual activity on cycle ergometer stress test parameters, on plasmatic testosterone levels and on concentration capacity in high-level male athletes.

Methods: Experimental design. Analysis of two days of testing accomplished in a laboratory setting, comparing a day with to a day without sexual activity (control day).

[Economic evaluation of different treatment strategies in patients with stable angina pectoris or asymptomatic myocardial ischemia on basis of results from the Asymptomatic-Cardiac-Ischemia Pilot study (ACIP)].

Background: In patients with stable angina pectoris or silent myocardial ischemia, who had signs of ischemia in ECG during exercise, the Asymptomatic Cardiac Ischemia Pilot (ACIP) study compared 2 types of medication strategies (ischemia-guided and angina-guided) and a strategy of primary revascularization by PTCA or CABG. ACIP substantiated, after 2 years of observation, a clear advantage of the revascularization strategy compared to both drug strategies in terms of clinical effectiveness. This advantage is even more distinct in patients with very severe angiographic results.

The Denolin Lecture 1998. Towards measurement of coronary blood flow in patients and its alteration by interventions.

Aim: Several methods of measuring coronary blood flow in intact conscious man are reviewed, on the basis of personal contributions or the experiences of our teams.

Methods And Results: It is important to distinguish between global, regional and transmural blood flow measurements. The advantages and limitations of the following methods are discussed: diffusible inert and radioactive tracers, dye dilution, roentgendensitometry, magnetic resonance imaging and contrast echocardiography.

[What is the value of palpation and auscultation?].

In the diagnosis of heart disease--as in other domains of medicine--an integral approach to the patient complaints is essential. Careful observation and evaluation of his personality during medical history taking as well as an optimal clinical examination by palpation and auscultation of the heart, great vessels and lungs may lead to a semiquantitative diagnosis specially in valvular and congenital heart disease. The results of select imaging techniques may therefore be anticipated in these conditions by skilled clinical judgment alone.

C-reactive protein as a marker for acute coronary syndromes.

Background: For several years, acute coronary syndromes have been perceived as causing the most hospital admissions, and even hospital mortality. The syndrome of unstable angina frequently progresses to acute myocardial infarction but its pathogenesis is poorly understood, and prognosis determination is still problematic. We tested the hypothesis that measurement of the C-reactive protein in patients admitted for chest pain could be a marker for acute coronary syndromes.

Is the indicator dilution theory really the adequate base of many blood flow measurement techniques?

The indicator dilution theory is the underlying model of many blood flow measurement techniques used daily in hospitals, for instance in cardiac catheterization laboratories. The basic version of this theory applies to a "stationary" flow system with one inlet and one outlet, into which a small amount M of indicator is injected "suddenly" at time t = 0 at the inlet. The quintessence of the theory consists in three equations, which themselves result from some apparently simple assumptions about the considered flow systems.

Long-term prognostic significance of ventricular late potentials after a first acute myocardial infarction.

Ventricular late potentials (VLP) have been shown to be independent predictors of arrhythmic events after myocardial infarction. However, many studies have had one or more limitations: limited follow-up period, small study group, possible selection bias, inadequate statistical analysis, or inclusion of patients with previous infarction. The purpose of this study was to assess the long-term prognostic value of VLP in a large group of unselected patients after a first acute myocardial infarction.

A new technique for improved densitometric quantification of coronary artery stenoses in angiographic images.

In vitro studies have demonstrated that densitometric quantification of coronary artery stenoses is superior to geometric methods to assess non-circular lumens. However, in patients, several authors have reported significant discrepancies between area reduction percentages obtained densitometrically from two different imaging projections. Some of the factors causing the discrepancies can be reduced by simple precautions taken during image acquisition.

Feasibility and safety of beta irradiation in human coronary arteries.

We have developed a technique of endoluminally centred endovascular beta irradiation aimed at preventing restenosis after PTCA. The source consists of a pure metallic 90-Yttrium coil that can be positioned within the lumen at the target site by the use of a centering device and an afterloading console. Experimental evaluation of this approach showed that a dose of 18 Gy delivered at the inner arterial surface was highly effective in preventing fibrointimal hyperplasia in rabbit carotid and iliac arteries.

A new densitometric approach to the assessment of mean coronary flow.

Rationale And Objectives: The authors present an angiographic method to measure absolute coronary blood flow in patients.

Methods: The left or right coronary tree is three-dimensional (3D)-reconstructed from biplane coronary angiograms. This allows the determination of the intravascular volumes needed for flow measurement.

Feasibility of intracoronary beta-irradiation to reduce restenosis after balloon angioplasty. A clinical pilot study.

Background: With the aim of decreasing the incidence of restenosis after coronary balloon angioplasty, we developed a technique of intracoronary beta-irradiation using an endoluminally centered pure metallic 90Y source. The purpose of the present study was to evaluate the clinical feasibility and safety profile of this approach with a dose of 18 Gy delivered to the inner arterial surface.

Methods And Results: Between June 21 and November 15, 1995, fifteen patients (6 women and 9 men; mean age, 71 +/- 5 years) underwent intracoronary beta-irradiation immediately after a conventional percutaneous transluminal coronary angioplasty (PTCA) procedure.

[Dynamic three-dimensional cardiac reconstruction by transesophageal echocardiography. A clinical experience apropos of 100 cases].

Three-Dimensional (3D) echocardiography was performed during routine transesophageal examinations in 100 patients to identify the most promising applications. The approach used was based on the integration of multiple two-dimensional images recorded with a multiplane probe to achieve 3D reconstruction. A series of 90 cardiac cycles was recorded from a fixed position during computer-controlled rotation of the transducer.

Long-term (10 years) prognostic value of a normal thallium-201 myocardial exercise scintigraphy in patients with coronary artery disease documented by angiography.

In order to assess the prognostic significance of normal exercise thallium-210 myocardial scintigraphy in patients with documented coronary artery disease, we studied the incidence of cardiac death and non-fatal myocardial infarction in 69 symptomatic patients without prior Q wave myocardial infarction, who demonstrated one or more significant coronary lesions (stenosis > or = 70%) on an angiogram performed within 3 months of scintigraphy (Group 1). These patients were compared to a second group of 136 patients with an abnormal exercise scintigram, defined by the presence of reversible defect(s) and angiographically proven coronary artery disease (Group 2), and to a third group of 102 patients with normal exercise scintigraphy without significant coronary lesions (stenosis < or = 30%) or with normal coronary angiography (Group 3). In contrast to coronary lesions observed in Group 2, patients in Group 1 presented more frequently with single-vessel disease (83% vs 35%, P < 0.

The impact of vessel orientation in space on densitometric measurements of cross sectional areas of coronary arteries.

Under ideal conditions, densitometric measurement of a coronary arterial cross section in biplane angiographic images should result in nearly equal cross sectional areas for both planes. However, quite appreciable discrepancies have been found by some authors in patients. In this study, the role of inadequate spatial orientation of the vessel axes relatively to the x-rays was assessed by use of a 3D technique applied to 60 stenoses (45 pre PTCA and 15 post PTCA) in simultaneously acquired digital biplane coronary angiograms of 27 CAD patients.

A novel system for intracoronary beta-irradiation: description and dosimetric results.

Purpose: A dosimetric evaluation of a new device dedicated to intravascular irradiation, associating a beta source and a centering device, was carried out before initiation of a clinical pilot study.

Methods And Materials: A 29-mm-long 90Y coil, coated with titanium and fixed to the end of a thrust wire, was introduced into the inner lumen of purpose-built centering balloons of different diameters (2.5, 3, 3.

Impact of a public campaign on pre-hospital delay in patients reporting chest pain.

Objective: To decrease pre-hospital delay in patients with chest pain.

Design: Population based, prospective observational study.

Setting: A province of Switzerland with 380000 inhabitants.