The prevalence of atrial fibrillation in incident stroke cases and matched population controls in Rochester, Minnesota: changes over three decades.

Objectives: We sought evidence of a change in the prevalence of atrial fibrillation (AF) over a 30-year period among residents of Rochester, Minnesota.

Background: Atrial fibrillation is increasingly encountered in clinical practice, but there is limited data on secular trends of AF over time.

Methods: Within a longitudinal case-control study of ischemic stroke, the prevalence of AF and of selected comorbid conditions among incident stroke cases and age- and gender-matched controls between 1960 and 1989 was determined.

Varicella susceptibility and validity of history among U.S. Coast Guard recruits: an outbreak-based study.

During a varicella outbreak among U.S. Coast Guard recruits, we examined varicella susceptibility serologically and evaluated validity of disease history.

Impact of early changes in left ventricular filling pattern on long-term outcome after acute myocardial infarction.

Background: In patients with heart failure due to chronic ischemic heart disease improvement of diastolic function indicates improved survival and a reduced morbidity, but whether this is also the case after acute myocardial infarction is not known.

Methods: To assess the prognostic importance of changes in left ventricular filling pattern, assessed with mitral deceleration time and colour M-mode flow propagation velocity, on cardiac death and readmission due to heart failure serial Doppler echocardiography was carried out in 103 patients with a first myocardial infarction. Based on echocardiography on hospital admission and after 1 month, patients were divided into three groups: group A (n=29) comprised patients with normal filling at either examination, group B (n=29) comprised patients with improvement of initially abnormal filling, and group C (n=45) patients with deterioration or no change of an abnormal filling pattern.

Hand-carried ultrasound-guided pericardiocentesis and thoracentesis.

To date, ultrasound-guided centeses have required the use of large, diagnostic ultrasound equipment that can be cumbersome and not readily available. In this study, we sought to evaluate the use of portable, hand-carried ultrasound devices in guidance of pericardiocentesis and thoracentesis. Hand-carried ultrasound was used to define location of the maximal extent of the effusion and its proximity to the skin surface, confirm needle entry and site, and to evaluate postprocedural result.

Single-plane and biplane echocardiography: use of targeted scan planes improves the estimates of left ventricular volume and shape for analysis of postinfarction remodeling.

Objective: Acute myocardial infarction and subsequent left ventricular (LV) remodeling induce complex geometric changes quantifiable by 3-dimensional (3D) echocardiography. Our objective was to determine accurate 2-dimensional echocardiographic techniques for analysis of diastolic and systolic LV volume and shape in remodeled hearts.

Methods: We obtained 3D apical scans from 16 patients at the acute stage, and at 1 and 6 months after acute myocardial infarction.

Left atrial volume: a powerful predictor of survival after acute myocardial infarction.

Background: After acute myocardial infarction (AMI), diastolic function assessed by Doppler echocardiography provides important prognostic information that is incremental to systolic function. However, Doppler variables are affected by multiple factors and may change rapidly. In contrast, left atrial (LA) volume is less influenced by acute changes and reflects subacute or chronic diastolic function.

Metastatic melanoma presenting as cardiac mass and hemobilia.

We present a rare case of malignant melanoma of unknown primary origin presenting as cardiac and cholecystic masses. In this 72-year-old man, a cardiac lesion caused right ventricular outlet obstruction, and gallbladder lesions led to hemobilia. Right atrial and gallbladder metastases were resected.

Factors associated with progression of carcinoid heart disease.

Background: By releasing vasoactive substances into the circulation, carcinoid tumors can cause right-sided valvular heart disease. Factors associated with the progression of carcinoid heart disease are poorly understood. We conducted a retrospective study to identify such factors.

Outcomes of clinically significant idiopathic pericardial effusion requiring intervention.

There is a paucity of outcome data on patients with idiopathic pericardial effusion requiring intervention. All patients who had clinically significant pericardial effusion confirmed by echocardiography and requiring interventions between 1979 and 2000 were identified through the Echo-guided Pericardiocentesis Registry and Echocardiography and Surgical Databases. Clinical data and outcomes were obtained by review of medical records and surveys.

Varicella in Americans from NHANES III: implications for control through routine immunization.

At the time of varicella vaccine introduction in the United States, an estimated 4 million episodes of varicella occurred annually. This survey of varicella seroprevalence is the first to describe immunity to a vaccine-preventable disease prior to vaccine introduction in the United States population. The objective of this analysis is to describe patterns of naturally-acquired varicella and understand characteristics associated with infection in the varicella vaccine-naive United States population.

Length of stay in skilled nursing facilities is longer for patients with dementia.

Studies estimate prolonged stays in acute and sub-acute facilities for patients with dementia. Actuarial projections suggest prolonged stays in long term care facilities for patients with dementia. To test these predictions, we assessed whether patients with dementia stay in skilled nursing facilities (SNF) longer than patients without dementia.

Prediction of mortality in patients with left ventricular hypertrophy by clinical, exercise stress, and echocardiographic data.

Objectives: This study evaluated the clinical, exercise stress test, and echocardiographic predictors of mortality and cardiac events in patients with left ventricular hypertrophy (LVH).

Background: Left ventricular hypertrophy is associated with an increased risk of cardiovascular morbidity and mortality.

Methods: Symptom-limited treadmill exercise echocardiography was performed for evaluation of coronary artery disease in 483 patients (age, 66 +/- 11 years; 281 men) with LVH.

Pharmacoepidemiologic implications of erroneous varicella vaccinations in pregnancy through confusion with Varicella zoster immune globulin.

A series of case reports to the varicella vaccine Pregnancy Registry described inadvertent administrations during pregnancy of this live virus product instead of the intended Varicella zoster immune globulin. Cases continued to accrue despite an early publication about the pattern. The persistent problem warrants specific educational efforts to prevent further repetitions.

Left atrial volume as a morphophysiologic expression of left ventricular diastolic dysfunction and relation to cardiovascular risk burden.

Left ventricular (LV) diastolic dysfunction is prevalent in the community. Current assessment of diastolic function can be complex, involving Doppler evaluation of an array of hemodynamic data. The relation between left atrial (LA) volume and diastolic function, and between LA volume and cardiovascular risk and disease burden are not well known.

Outbreak of varicella at a day-care center despite vaccination.

Background: In seven studies of the effectiveness of the varicella vaccine conducted since it was licensed, the effectiveness was 71 to 100 percent against disease of any severity and 95 to 100 percent against moderate and severe disease. We investigated an outbreak of varicella in a population of children with a high proportion of vaccinees who were attending a day-care center in a small community in New Hampshire.

Methods: Using standardized questionnaires, we collected information about the children's medical and vaccination history from parents and health care providers.

Left ventricular diastolic dysfunction as a predictor of the first diagnosed nonvalvular atrial fibrillation in 840 elderly men and women.

Objectives: The objective of this study was to determine whether diastolic dysfunction is associated with increased risk of nonvalvular atrial fibrillation (NVAF) in older adults with no history of atrial arrhythmia.

Background: Few data exist regarding the relationship between diastolic function and NVAF.

Methods: The clinical and echocardiographic characteristics of patients age > or =65 years who had an echocardiogram performed between 1990 and 1998 were reviewed.

Epicardial ultrasound guidance of coronary catheter placement in an experimental animal model.

We evaluated epicardial ultrasonography with a 10-MHz transducer for coronary catheter guidance in 18 normal pigs. A modified long-axis view of the aortic root was used to direct a coronary catheter into the root, and then with a short-axis view of the aortic root, the catheter tip was placed selectively into either the right or the left main coronary artery. Subsequently, with modified coronary views, an angioplasty infusion catheter was guided with precision to the exact location desired in the coronary artery.