Effects of severity of the residual stenosis of the infarct-related coronary artery on left ventricular dilation and function after acute myocardial infarction

AbstractObjectives. This study was designed to evaluate the relation between the severity of the residual stenosis of the infarct-related artery and changes in left ventricular volume and function after a first anterior myocardial infarction.Background. Although thrombolytic therapy improves clinical outcome after acute myocardial infarction, the relations between the severity of the residual stenosis of the infarct-related artery and postinfarction left ventricular remodeling and function are unclear.Methods. Fifty-eight patients with a first anterior myocardial infarction and significant disease only in the left anterior descending coronary artery on arteriography performed after 7 to 10 days were evaluated. All patients received thrombolytic therapy. Residual stenosis of the infarct-related artery was measured with quantitative coronary arteriography. Left ventricular volumes and ejection fraction were measured by echocardiography and radionuclide angiography, respectively, 7 to 10 days, 6 months and 1 year after infarction. End-diastolic and end-systolic left ventricular volumes were measured by two-dimensional echocardiography and normalized to body surface area. Patients were classified into three groups according to baseline residual stenosis severity: total occlusion (Group I), minimal lesion diameter <15 mm (Group II) and minimal diameter ≥1.5 mm (Group III).Results. Group I patients had significantly greater left ventricular end-diastolic and end-systolic volumes at 6 months and 1 year than did the other groups. Group II patients had greater end diastolic and end-systolic volumes than did Group III patients at 1 year. In addition, Group 1 patients had a lower ejection fraction at 1 year than that of the other groups. The minimal lesion diameter was significantly correlated with percent change in end-diastolic volume at 1 year.Conclusions. The severity of the baseline residual stenosis of the infarct-related artery is an important predictor of change in left ventricular volumes in the 1st year after infarction. Tolal occlusion of the infarct-related artery is associated with greater left ventricular dilation and functional impairment

Proceedings on Certificate Course in Coronary Artery Disease and Cardiac Rehabilitation 96

Includes bibliographical references.On cover: Hong Kong Convention & Exhibition Centre, 3-7 February 1996.Passed to HKC for analytical entry. 11/11/96.published_or_final_versio

Long-term oral nitrate therapy is associated with adverse outcome in diabetic patients following elective percutaneous coronary intervention

<p>Abstract</p> <p>Background</p> <p>To assess the impact of long-term oral nitrate therapy on clinical outcome following percutaneous coronary intervention (PCI) in patients with type II diabetes.</p> <p>Methods</p> <p>The incidence of major adverse cardiovascular events (MACEs) following elective PCI for stable coronary artery disease was evaluated in 108 patients with type II diabetes (age 64.6 ± 10.5 years, 67.7% men). Major adverse cardiovascular events were defined as the need for revascularization, non-fatal myocardial infarction or cardiovascular death. Multivariate Cox regression analysis was used to evaluate the predictive value of MACEs by clinical characteristics and the prescription of long-term nitrate therapy.</p> <p>Results</p> <p>Isosorbide mononitrate (ISMN) was prescribed to 46 patients with an average dose of 44.3 ± 15.2 mg/day. After a mean follow up of 25.3 ± 25 months, 16 patients developed MACEs. Patients who received ISMN were more likely to suffer from MACEs (26.1% vs. 6.5%, P = 0.01), mainly driven by a higher rate of acute coronary syndrome (13.0 vs 0%, P = 0.01). Average daily dose of nitrate and other cardiovascular medication was not associated with MACEs. Multivariate Cox regression analysis revealed that prescription of only ISMN (Hazard Ratio 3.09, 95% CI 1.10-10.21, P = 0.04) was an independent predictor for the development of MACEs.</p> <p>Conclusion</p> <p>Long-term oral nitrate therapy was associated with MACEs following elective coronary artery revascularization by PCI in patients with type II diabetes.</p

Improvement of myocardial perfusion reserve detected by cardiovascular magnetic resonance after direct endomyocardial implantation of autologous bone marrow cells in patients with severe coronary artery disease

<p>Abstract</p> <p>Background</p> <p>Recent studies suggested that bone marrow (BM) cell implantation in patients with severe chronic coronary artery disease (CAD) resulted in modest improvement in symptoms and cardiac function. This study sought to investigate the functional changes that occur within the chronic human ischaemic myocardium after direct endomyocardial BM cells implantation by cardiovascular magnetic resonance (CMR).</p> <p>Methods and Results</p> <p>We compared the interval changes of left ventricular ejection fraction (LVEF), myocardial perfusion reserve and the extent of myocardial scar by using late gadolinium enhancement CMR in 12 patients with severe CAD. CMR was performed at baseline and at 6 months after catheter-based direct endomyocardial autologous BM cell (n = 12) injection to viable ischaemic myocardium as guided by electromechanical mapping. In patients randomized to receive BM cell injection, there was significant decrease in percentage area of peri-infarct regions (-23.6%, <it>P </it>= <it>0.04</it>) and increase in global LVEF (+9.0%, <it>P </it>= <it>0.02</it>), the percentage of regional wall thickening (+13.1%, <it>P= 0.04</it>) and MPR (+0.25%, <it>P </it>= <it>0.03</it>) over the target area at 6-months compared with baseline.</p> <p>Conclusions</p> <p>Direct endomyocardial implantation of autologous BM cells significantly improved global LVEF, regional wall thickening and myocardial perfusion reserve, and reduced percentage area of peri-infarct regions in patients with severe CAD.</p

Controle de arritmias atriais com período refratário atrial controlado por sensor e mudança automática de modo em pacientes portadores de marcapasso dupla-câmara com sensor de ventilaçao por minuto

Apesar de um longo período refratário atrial pós evento ventricular (PVARP) poder prevenir a ocorrência de taquicardias mediadas pelo marca passo e também o sincronismo inapropriado com arritmias atriais na estimulaçao dupla-câmara (DDD) a limitaçao da freqüência máxima será necessariamente comprometida. Testamos a possibilidade de utilizar um marca passo dupla-câmara com sensor de ventilaçao por minuto (DDDR) e com capacidade de encurtar o PVARP durante o exercício em 13 pacientes com bradicardia (PVARP em repouso = 463 ± 29 ms) a fim de prevenir a limitaçao prematura da freqüência máxima. O teste de esforço em esteira nos modos DDD e DDDR com este PVARP resultou em freqüências máximas de 98 bpm ± 8 bpm e 142 bpm ± 3 bpm respectivamente (P < 0,DDD1). Estes resultados foram obtidos graças à incompetência cronotrópica e à limitaçao da freqüência máxima no modo DDD, ambas contornadas pelo uso do sensor. Com a finalidade de simular arritmias atriais, foi aplicada estimulaçao na parede torácica por 30 segundos, a uma freqüência de 250 bpm e com uma sensibilidade atrial uni polar média de 0,82 mV. No modo DDD, ocorreu uma resposta ventricular irregular (as freqüências com um PVARP de 280 ms e 463 ms ± 29 ms foram respectivamente 92 bpm ± 5 bpm e 66 bpm ± 3 bpm (P < 0,DDD1). No modo DDDR, com um PVARP de 463 ms ± 29 ms, ocorreu uma estimulaçao ventricular regular a 53 bpm ± 2 bpm, devida à mudança de mDDD para VVIR, na presença de eventos repetitivos captados dentro do PVARP. Um paciente desenvolveu fibrilaçao atrial espontânea durante o seguimento, que foi corretamente identificada pelo algoritmo do marcapasso, resultando na mudança de modo de DDDR para WIR e na preservaçao da resposta em freqüência. Em conclusao, o PVARP controlado pelo sensor permite a utilizaçao de um PVARP mais longo durante o repouso, sem comprometer a freqüência máxima durante o exercício. Adicionalmente, ao oferecer em proteçao contra conduçao retrógrada, o PVARP longo e a mudança automática de mDDD também limitam a freqüência durante as arritmias atriais, permitindo uma resposta ventricular de acordo com a demanda fisiológica

Prevalence and significance of Exit Block During Arrhythmias Arising in Pulmonary Veins

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74819/1/j.1540-8167.2000.tb00332.x.pd

Association Between Raised Blood Pressure and Dysglycemia in Hong Kong Chinese

OBJECTIVE—To investigate the association between raised blood pressure and dysglycemia

Estimated incidence of previously undetected atrial fibrillation on a 14-day continuous electrocardiographic monitor and associated risk of stroke

Aims There is uncertainty about whether and how to perform screening for atrial fibrillation (AF). To estimate the incidence of previously undetected AF that would be captured using a continuous 14-day ECG monitor and the associated risk of stroke. Methods and results We analysed data from a cohort of patients >65 years old with hypertension and a pacemaker, but without known AF. For each participant, we simulated 1000 ECG monitors by randomly selecting 14-day windows in the 6 months following enrolment and calculated the average AF burden (total time in AF). We used Cox proportional hazards models adjusted for CHA(2)DS(2)-VASc score to estimate the risk of subsequent ischaemic stroke or systemic embolism (SSE) associated with burdens of AF > and 6 min was 3.10% (95% CI 2.53-3.72). This was consistent across strata of age and CHA(2)DS(2)-VASc scores. Over a mean follow-up of 2.4 years, the rate of SSE among patients with 6 min of AF. Conclusions Approximately 3% of individuals aged >65 years with hypertension may have more than 6 min of AF detected by a 14-day ECG monitor. This is associated with a stroke risk of over 2% per year. Whether oral anticoagulation will reduce stroke in these patients is unknown