Angiotensin inhibition and coronary autoregulation in a canine model of LV hypertrophy.

In humans with hypertension and LV hypertrophy, beneficial effects of angiotensin inhibition may be associated with preserved autoregulatory capacity. We studied the effect of acute angiotensin converting enzyme (ACE) inhibition on coronary autoregulatory pressure-flow relations and transmural distribution of blood flow in sham and LV hypertrophy dogs. Heart/body weight ratio increased (p = 0.

Differential effect of right and left carotid sinus massage: implications for sudden rate drop pacing algorithm.

This present report describes a patient with syncope in whom asystole was triggered by right carotid sinus massage and complete atrioventricular block with slight bradycardia by left carotid sinus massage. A dual-chamber, rate-responsive, permanent pacemaker with 'sudden rate drop' algorithm was implanted. The present report underlines the pathophysiology and the clinical utility of carotid sinus massage on both sides.

Prevalence of 'hypertriglyceridemic waist' in men who participated in the Quebec Health Survey: association with atherogenic and diabetogenic metabolic risk factors.

Background: A triad of metabolic markers (high insulin and apolipoprotein B levels, and small, dense, low density lipoprotein particles) is associated with a substantially increased risk of coronary artery disease (CAD) in men. Also, the simultaneous presence of an elevated waist circumference (90 cm or greater) and moderate hypertriglyceridemia (triglyceride concentration 2.0 mmol/L or higher) in men has been shown to be associated with this atherogenic metabolic triad, with a probability of more than 80%.

Permanent pacemaker lead entrapment: role of the transesophageal echocardiography.

Numerous complications induced by pacemaker electrodes have been reported. Although mild tricuspid regurgitation is a well-documented complication of transvenous right ventricular pacemaker leads secondary to abnormal valve coaptation, severe tricuspid regurgitation resultingfrom perforation of the tricuspid valve itself is a rare complication. This case report details a patient with severe tricuspid regurgitation secondary to impingement of the tricuspid valve by a permanent pacing lead that was diagnosed by transesophageal echocardiography.

Is anteroseptal myocardial infarction an appropriate term?

Anteroseptal myocardial infarction is defined by the presence of electrocardiographic Q-waves limited to precordial leads V(1) to V(2), V(3), or V(4). We sought to determine whether this term is appropriate by correlating electrocardiographic, echocardiographic, and angiographic findings. We studied 50 consecutive patients admitted for a first acute myocardial infarction with Q-waves in precordial leads V(1) to V(2)-V(4), and who had undergone echocardiography and coronary angiography during hospitalization.

Double valve replacement through an aorto-annulo-atriotomy using an aortic-valved graft in a mitral position.

We present a modified technique for the reconstruction of the intervalvular fibrous body in double-valve replacement through an aorto-annulo-atriotomy. This technique allows the surgeon to enlarge and reconstruct both annuli by using a tailored aortic-valved conduit in a mitral position.

A new, simple, and accurate method for non-invasive estimation of pulmonary arterial pressure.

Objective: To develop and validate a new non-invasive method for the estimation of pulmonary arterial pressure (PAP) based on advanced signal processing of the second heart sound.

Design: Prospective comparative study.

Setting: Referral cardiology centre.

Does correction of the friedewald formula using lipoprotein(a) change our estimation of ischemic heart disease risk? The Quebec Cardiovascular Study.

Background: LDL-cholesterol is usually calculated using the Friedewald formula. This calculation method does not take into account the presence of Lp(a), which is associated with LDL-cholesterol. Dahlen has suggested that the Friedewald formula should be modified to account for Lp(a) associated cholesterol.

Pacemaker contact sensitivity: case report and review of the literature.

Pacemaker contact sensitivity is a rare condition. Less than 25 reports of pacemaker skin reaction have been described over the past 30 years. This report describes one patient who developed contact dermatitis after implantation of two subsequent pacemakers.

Myocardial blood flow after chronic cardiac decentralization in anesthetized dogs: effects of ACE-inhibition.

Coronary blood flow regulation was studied in dogs with an intact or chronically decentralized intrinsic cardiac nervous system. We also examined the effect of angiotensin-converting enzyme inhibition (ACEI) on coronary autoregulatory pressure-flow relations and distribution of blood flow since the renin-angiotensin system may play a critical role in vasoregulation. Myocardial oxygen demand was reduced in the chronic decentralized dogs compared to the control dogs.

Thrombus formation on guide wires during routine PTCA procedures: a scanning electron microscopic evaluation.

Background: Various coatings are used on catheters and guide wires to improve resistance to surface thrombus formation. However, little is known about the thrombogenicity of 0.014" angioplasty guide wires and the protection offered by these coatings.

Association of fibrinogen and lipoprotein(a) as a coronary heart disease risk factor in men (The Quebec Cardiovascular Study).

Fibrinogen has been prospectively found to correlate with coronary heart disease (CHD) but a similar association has not been well established for lipoprotein (a) (Lp(a)). Plasma lipids, Lp(a), and fibrinogen levels were measured in 2,125 men (aged 47 to 76 years) who were free of clinical CHD. During a 5-year follow-up period, 116 first CHD events were documented.

Impact of moderate aerobic exercise training on insulin sensitivity in type 2 diabetic men treated with oral hypoglycemic agents: is insulin sensitivity enhanced only in nonobese subjects?

Background: Few studies have evaluated the effect of aerobic physical training on insulin sensitivity in subjects with type 2 diabetes treated with oral hypoglycemic agents. Most studies that involved nonobese subjects showed enhanced insulin sensitivity whereas studies involving obese subjects with type 2 diabetes are inconsistent because of concomitant fat loss.

Material/methods: Thirteen men with type 2 diabetes (6 nonobese and 7 obese) treated with oral hypoglycemic agents carried out a 12-week ergocycle program at 60% VO2 peak, one hour thrice a week.

A single center experience with the freestyle bioprosthesis: midterm results at the Québec Heart Institute.

Stentless bioprostheses show excellent early hemodynamic performance. However, longevity still remains unknown. This study reports midterm follow-up in 419 patients in which a Freestyle bioprosthesis (Medtronic Heart Valves, Minneapolis, MN) was inserted between January 1993 and January 2000 at the Quebec Heart Institute (Ste-Foy, Québec, Canada).

Expression and intracellular localization of an SCN5A double mutant R1232W/T1620M implicated in Brugada syndrome.

Brugada syndrome is an inherited cardiac disorder caused by mutations in the cardiac sodium channel gene, SCN5A, that leads to ventricular fibrillation and sudden death. This study reports the changes in functional expression and cellular localization of an SCN5A double mutant (R1232W/T1620M) recently discovered in patients with Brugada syndrome. Mutant and wild-type (WT) human heart sodium channels (hNa(v)1.

Total cholesterol/HDL cholesterol ratio vs LDL cholesterol/HDL cholesterol ratio as indices of ischemic heart disease risk in men: the Quebec Cardiovascular Study.

Background: Total cholesterol (TC)/high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C)/HDL-C ratios are used to predict ischemic heart disease risk. There is, however, no consensus on which of these 2 indices is superior. The objective of the present study was to present evidence that the LDL-C/HDL-C ratio may underestimate ischemic heart disease risk in overweight hyperinsulinemic patients with high triglyceride (TG)-low HDL-C dyslipidemia.

Reduction of discomfort at sheath removal during transradial coronary procedures with the use of a hydrophilic-coated sheath.

Some patients experience discomfort at sheath removal during transradial procedures. We hypothesized that the use of a hydrophilic-coated sheath (HCS) would reduce the traction force needed at withdrawal and therefore the pain experienced by patients. Patients referred for coronary intervention were randomized to undergo transradial procedure with the use of HCS or with nonhydrophilic sheath (NHS).

Effect of a low-glycaemic index--low-fat--high protein diet on the atherogenic metabolic risk profile of abdominally obese men.

It has been suggested that the current dietary recommendations (low-fat-high-carbohydrate diet) may promote the intake of sugar and highly refined starches which could have adverse effects on the metabolic risk profile. We have investigated the short-term (6-d) nutritional and metabolic effects of an ad libitum low-glycaemic index-low-fat-high-protein diet (prepared according to the Montignac method) compared with the American Heart Association (AHA) phase I diet consumed ad libitum as well as with a pair-fed session consisting of the same daily energy intake as the former but with the same macronutrient composition as the AHA phase I diet. Twelve overweight men (BMI 33.

Health consequences of visceral obesity.

Visceral obesity is associated with metabolic abnormalities that increase the risk of type 2 diabetes and coronary heart disease. Obese patients with a substantial accumulation of visceral adipose tissue are characterized by higher insulinaemic and glycaemic responses during an oral glucose challenge as well as by a deteriorated plasma lipoprotein-lipid profile compared with individuals with normal body weights or obese subjects with low levels of visceral adipose tissue. Results of the Quebec Cardiovascular Study have shown that the cluster of metabolic disturbances observed among subjects with visceral obesity (hyperinsulinaemia, hyperapolipoprotein B and small, dense low-density lipoprotein (LDL) particles) is associated with a 20-fold increase in the risk of coronary heart disease in a sample of middle-aged men followed over 5 years.

The endocarditis that was not: an unusual case of heparin-induced thrombocytopenia with unusual complications.

The complications of heparin-induced thrombocytopenia have been well described previously. However, evidence of the possibility that heparin-induced thrombocytopenia can trigger a thyroid storm has never been published before. A catastrophic evolution of a man referred with a high endocarditis suspicion previously treated with heparin, who successively developed arterial thrombosis and thyroid storm, is described.

Ethanol delays and reverses lysophosphatidylcholine-induced calcium overload in neonatal rat heart cells.

Increased lysophosphatidylcholine (LPC) production by the ischemic heart is associated with tissue damage. In vitro, LPC produces an increase in cytosolic [Ca2+], usually followed by cell contracture and lysis. Since ethanol reportedly protect cells during ischemia-reperfusion, we wished to determine whether ethanol could protect heart cells against LPC-induced Ca2+ overload.

Effect of estrogen replacement therapy on distribution of myocardial blood flow in female anesthetized rabbits.

Estrogen replacement therapy reduces risk of cardiovascular events by altering coronary vasoregulation and distribution of blood flow. Vessel reactivity and blood flow distribution were assessed in anesthetized female rabbits in the following groups: 1) sham, 2) ovariectomy, 3) ovariectomy + 17beta-estradiol, and 4) ovariectomy + dehydroepiandrosterone. After a 2-wk treatment, cardiac hemodynamics, vascular reserve, and blood flow were evaluated during the following infusions: 1) NaCl, or vehicle (0.

Effects of ramipril on coronary events in high-risk persons: results of the Heart Outcomes Prevention Evaluation Study.

Background: In trials of patients with left ventricular dysfunction or heart failure, ACE inhibitor use was unexpectedly associated with reduced myocardial infarction (MI). Using the Heart Outcomes Prevention Evaluation (HOPE) trial data, we tested prospectively whether ramipril, an ACE inhibitor, could reduce coronary events and revascularization procedures among patients with normal left ventricular function.

Methods And Results: In the HOPE trial, 9297 high-risk men and women, >/=55 years of age with previous cardiovascular disease or diabetes plus 1 risk factor, were randomly assigned to ramipril (up to 10 mg/d), vitamin E (400 IU/d), their combination, or matching placebos.