Computer probability estimates of angiographic coronary artery disease: transportability and comparison with cardiologists' estimates.

A computer algorithm for estimating probabilities of any significant coronary obstruction and triple vessel/left main obstructions was derived, validated, and compared with the assessments of cardiac clinician angiographers. The algorithm performed at least as well as the clinicians when the latter knew the identity of the patients whose angiograms they had decided to perform. The clinicians were more accurate when they did not know the identity of the subjects but worked from tabulated objective data.

[The clinical diagnosis of heart failure].

Clinical diagnosis is easily established at bedside or in the doctor's cabinet. Four clinical symptoms have to be considered: 1) functional impairment of the left ventricle, 2) intolerance to physical stress, 3) congestion and 4) ventricular arrhythmia (not covered in this paper). History provides the keys for 1, 2 and 3, physical examination for 1 and 3, electrocardiography under exercise for 2 and chest X-ray for 3.

Exercise-induced ST depression and ST/heart rate index to predict triple-vessel or left main coronary disease: a multicenter analysis.

The aim of this investigation was to determine the difference in accuracy between two frequently published noninvasive indicators of severity of coronary artery disease (exercise-induced ST segment depression and heart rate-adjusted ST depression [ST/HR index]). The study was designed as a survey of consecutive patients undergoing exercise electrocardiography and coronary angiography. There were a total of 2,270 patients without prior myocardial infarction or cardiac valvular disease referred for angiography from eight institutions in three countries; 401 of these patients had triple-vessel or left main coronary artery disease.

Algorithm to predict triple-vessel/left main coronary artery disease in patients without myocardial infarction. An international cross validation.

Logistic regression was applied to the clinical, risk factor, and exercise data of consecutive angiographic referrals without prior myocardial infarction to determine an algorithm predicting the probability of triple-vessel/left main coronary artery disease. These data were obtained from a total of 1,074 such subjects from patient populations at four centers (Cleveland Clinic Foundation, Cleveland, Ohio; Hungarian Institute of Cardiology, Budapest, Hungary; the university hospitals, Zurich and Basel, Switzerland; and the Veterans Administration Medical Center, Long Beach, Calif.) and used to derive four separate probability algorithms.

[Isolated spontaneous coronary dissection].

Spontaneous coronary artery dissection is a rare cause of myocardial infarction. It occurs most commonly in young, otherwise healthy women, especially in the peripartum period. Dissections are most often located in the proximal part of the left coronary artery.

International application of a new probability algorithm for the diagnosis of coronary artery disease.

A new discriminant function model for estimating probabilities of angiographic coronary disease was tested for reliability and clinical utility in 3 patient test groups. This model, derived from the clinical and noninvasive test results of 303 patients undergoing angiography at the Cleveland Clinic in Cleveland, Ohio, was applied to a group of 425 patients undergoing angiography at the Hungarian Institute of Cardiology in Budapest, Hungary (disease prevalence 38%); 200 patients undergoing angiography at the Veterans Administration Medical Center in Long Beach, California (disease prevalence 75%); and 143 such patients from the University Hospitals in Zurich and Basel, Switzerland (disease prevalence 84%). The probabilities that resulted from the application of the Cleveland algorithm were compared with those derived by applying a Bayesian algorithm derived from published medical studies called CADENZA to the same 3 patient test groups.

[Fibrinolysis in acute myocardial infarct. Treatment rate, assessment and follow-up treatment in the Zürich hospitals].

We report the results of i.v. fibrinolysis in patients with acute myocardial infarction treated in four major hospitals in Zürich.

[The Sanz method of cardiogoniometry].

Cardiogoniometry (CGM), an orthogonal lead system using four chest leads, was performed in a population of 120 healthy volunteers. The measurements were taken simultaneously with the conventional ECG at rest, after upright bicycle exercise at 50 watts, and immediately and 6 minutes after maximal symptom limited exercise. The results of these tests are the normal values for CGM.

[Cardiogoniometry in coronary heart disease. A clinical study].

Maximal vectors of depolarization (QRS) and repolarization (ST/T), and the initial QRS-vector of CGM, were measured simultaneously with conventional ECG at rest and during exercise in a population of 85 patients with suspected coronary artery disease (CAD). Coronary angiography served as standard, luminal narrowing of at least 50% in a proximal segment of one or more major coronary arteries being taken to define CAD. CGM showed sensitivity of 0.

[Prolonged course in patients with symptomatic ventricular tachycardia].

In a retrospective study we analyzed the long-term course in 77 patients (71 males and 6 females) with symptomatic ventricular tachycardias. Initially all patients had undergone an electrophysiological examination. 56/77 patients received drug therapy and 19/77 underwent surgery (implantation of an automatic defibrillator in 2 patients).

[Percutaneous transluminal coronary angioplasty (PTCA): long-term results].

The authors report on the longterm follow-up after PTCA in 130/165 (79%) patients seen approximately 3 years after angioplasty. Primary success rate in the years 1980-84 was 79%. Emergency bypass surgery was necessary in 7%.

Does exercise-induced myocardial ischaemia cause enhanced platelet activation and fibrin formation in patients with stable angina and severe coronary artery disease?

In this study, betathromboglobulin (BTG) and fibrinopeptide A (FPA) in peripheral venous blood were measured in 20 patients with stable angina pectoris before and immediately after exercise-induced myocardial ischaemia; in 5 of the 20 patients stable angina was associated with typical peripheral artery disease. A total of 10 patients with angiographically documented peripheral artery disease without angina and 10 normal volunteers were taken as control groups. BTG and FPA in the 15 patients with stable angina before exercise were 41 +/- 14 ng ml-1 and 2.

Anomalous origin of the left thyrocervical trunk as a cause of residual pain after myocardial revascularization with internal mammary artery.

A patient with successful implantation of an internal mammary artery graft in the left anterior descending coronary artery complained of residual but different anginal pain after operation. Ischemia was demonstrated during a manual stress test. Angiography revealed anomalous origin of the thyrocervical trunk from the internal mammary artery.

[Indications and limitations of the exertion ECG in the diagnosis of left ventricular aneurysms].

By retrospective analysis of 1415 bicycle ergometer exercise stress tests, 108 patients were selected for coronary angiography and left ventriculograms at least 3 months after acute anterior wall myocardial infarction. The ECG of 55/108 showed elevation of the ST-segment of 1 mm or more during exercise. 82% displayed an aneurysm defined by diastolic and/or systolic bulge (dyskinesis) of the anterior ventricular wall: sensitivity 82%, specificity 96%, positive predictive value 97%.

[The significance of ST elevation in the exercise ECG].

In contrast to ST-segment depression during exercise, the mechanism for ST-segment elevation - a more unusual finding - is controversial and poorly understood. Exercise induced ST-segment elevation of 2 mm and more was observed in 80 of 3000 consecutive patients (2.6%) undergoing bicycle exercise testing using 6 of 12 ECG leads.

[Transcutaneous application of nitroglycerin and isosorbide dinitrate versus placebo: effect in myocardial ischemia].

The effect of nitroglycerin ointment (30 mg) and isosorbide dinitrate ointment (100 mg) versus placebo on exercise capacity has been investigated in 12 patients. All had angina pectoris and coronary artery disease documented by coronary angiography. Nitroglycerin and isosorbide dinitrate ointment produced a significant increase in exercise capacity, without any significant difference in the beneficial effect of the two.

[Transluminal removal of intravascular foreign bodies].

Removal of catheter tip or guide wire emboli is needed for most cases with this complication. An alternative to surgery is transvenous retrieval. The authors present their experience with a simple self-made loop-catheter, which in 11 of 12 cases proved successful for extraction of 9 catheter tips and 3 guide wires located in the central venous system, the right ventricle and the pulmonary artery in 10 patients, and in the aorta in 2.

Platelet inhibitors versus anticoagulants for prevention of aorto-coronary bypass graft occlusion.

The effects of the antiaggregant substance ticlopidine and of the anticoagulant acenocoumarol on patency rates of aorto-coronary bypass grafts were compared in a prospective randomized trial. Ticlopidine, 250 mg b.i.

Huge left coronary artery aneurysm associated with multiple arterial aneurysms.

Natural history of an aneurysm at the bifurcation of the left coronary artery is reported. A gradual increase in its size occurred over an 18-year period until it was a huge and partially thrombosed sac. It was associated with ectasia of the right coronary artery, aneurysms of the left subclavian artery and thoracic aorta, and calcified dilatations of the branches of the celiac trunk.

[Ergometrically determined work capacity in chronic hemodialysis treatment].

To evaluate the degree of physical activity in hemodialysis patients, working capacity was assessed by bicycle ergometry in 16 hemodialysis patients (mean age 47 +/- 12 [SD] years). The mean length of dialysis treatment was 21 +/- 17 months. The laboratory and clinical findings were as follows (mean values +/- SD): urea 34 +/- 6 mmol/l; creatinine 1127 +/- 169 mumol/l; potassium 5.

Efficacy of amiodarone in the Wolff-Parkinson-White syndrome with rapid ventricular response via accessory pathway during atrial fibrillation.

Sudden death in Wolff-Parkinson-White syndrome (WPW) is related to a very fast ventricular response to spontaneous atrial fibrillation (AF) conducted via accessory pathway (AP). The effect of oral amiodarone was studied in 12 patients with WPW syndrome and life-threatening rapid ventricular response via an AP during spontaneous AF. The effective refractory period of the AP in the anterograde direction was 280 ms or less during control study in all patients.

[Outcome after hospital rehabilitation of patients with myocardial infarct].

A series of follow-ups were carried out in 947 patients who had 12 to 28 months previously (average 16.6 months) undergone a period of rehabilitation at this clinic in Gais . 17 patients were not traced, but from the remaining 930 patients, 35 (3.

[Binodal disease: diseased sinus node and atrioventricular block].

Atrioventricular (AV) conduction disturbances in patients (pts) with sick sinus syndrome (SSS) are well known, but sinus node function (SNF) in AV block is not well documented. We therefore performed electrophysiological tests to evaluate SNF in 30 pts with high-degree AV block (group 1) and AV conduction in 15 pts with SSS (group 1). These measurements were repeated after vagolysis with atropine in group 2.