Impact of mitral regurgitation and myocardial viability on left ventricular reverse remodeling after cardiac resynchronization therapy in patients with ischemic cardiomyopathy.

in American Journal of Cardiology (2010), 106(1), 31-7

This study investigated the impact of ischemic mitral regurgitation (MR) severity and viability on left ventricular (LV) reverse remodeling after cardiac resynchronization therapy (CRT) in patients with ... [more ▼]

This study investigated the impact of ischemic mitral regurgitation (MR) severity and viability on left ventricular (LV) reverse remodeling after cardiac resynchronization therapy (CRT) in patients with ischemic cardiomyopathy. Severe MR and ischemic cardiomyopathy have been associated with lack of LV reverse remodeling after CRT. Fifty-seven consecutive patients with ischemic MR, LV ejection fraction < or =35%, QRS duration > or =120 ms, and intraventricular dyssynchrony > or =50 ms were prospectively included. Stress echocardiography was performed before CRT implantation. Viability in the region of the LV pacing lead was defined as the presence of viability in 2 contiguous segments. Response to CRT at 6 months was defined by evidence of > or =15% LV decrease in end-systolic volume. Severe MR was defined by an effective regurgitant orifice (ERO) area > or =20 mm(2). Thirty-three patients (58%) were responders at follow-up. Baseline ERO area and prevalence of severe MR were not different between responders and nonresponders (19 +/- 11 vs 21 +/- 13 mm(2), p = 0.67; 52% vs 53%, p = 0.84). In responders, MR was decreased by 58% (ERO 19 +/- 12 to 8 +/- 6 mm(2)). In the presence of viability in the region of the pacing lead, 74% (n = 29 patients) were responders (sensitivity 88%, specificity 58%); in the subgroup of patients with viability in the region of the pacing lead and severe MR, 83% (n = 17 patients) were responders. In conclusion, LV remodeling is frequent and ischemic MR decrease important in patients with viability in the region of the pacing lead without regard to MR severity. [less ▲]

Prognostic Effect of Long-Axis Left Ventricular Dysfunction and B-Type Natriuretic Peptide Levels in Asymptomatic Aortic Stenosis

in American Journal of Cardiology (2010), 105(3), 383-388

Long-term prognostic significance of high-sensitivity C-reactive protein before and after coronary angioplasty in patients with stable angina pectoris

in American Journal of Cardiology (2007), 99(1), 31-35

We examined whether an increase in high-sensitivity C-reactive protein (hs-CRP) after percutaneous coronary intervention (PCI) predicts long-term prognosis in patients with stable angina pectoris. hs-CRP ... [more ▼]

We examined whether an increase in high-sensitivity C-reactive protein (hs-CRP) after percutaneous coronary intervention (PCI) predicts long-term prognosis in patients with stable angina pectoris. hs-CRP is an inflammatory marker that predicts future cardiovascular events in healthy subjects and patients with unstable and stable coronary syndromes. Long-term evaluation of pre- and postprocedural inflammatory markers has not been widely reported. In particular, the effect of the magnitude of increase in hs-CRP after PCI in stable patients is unknown. We prospectively analyzed 89 stable patients treated by PCI for stable angina pectoris. Patients were recruited between August 1998 and May 1999, and the population was followed until August 2005 (mean follow-up 79.5 +/- 10.3 months). A major adverse cardiac event (MACE) was defined as the occurrence of cardiac death, myocardial infarction, or recurrent angina requiring repeat PCI or coronary artery bypass grafting. During the follow-up period, 36 patients presented with > or =1 MACE. In multivariate analysis, independent predictors of the occurrence of MACEs were previous myocardial infarction and a significant increase in hs-CRP after PCI (p = 0.004 and 0.003, respectively). A significant increase in hs-CRP after PCI was found to be more predictive of MACEs than hs-CRP before and after PCI. In conclusion, in stable coronary artery disease, inflammation is associated with long-term adverse events, but the magnitude of the inflammatory reaction after PCI appears more predictive than the baseline value. [less ▲]

Effect of Spinal Cord Stimulation on Regional Myocardial Perfusion Assessed by Positron Emission Tomography

in American Journal of Cardiology (1992), 69(14), 1143-9

Spinal cord stimulation (SCS) can relieve symptoms in patients with severe angina pectoris refractory to conventional medical or surgical therapy. This symptomatic improvement may result from decreased ... [more ▼]

Spinal cord stimulation (SCS) can relieve symptoms in patients with severe angina pectoris refractory to conventional medical or surgical therapy. This symptomatic improvement may result from decreased myocardial ischemia. To test this hypothesis, positron emission tomography (PET) and potassium-38 as a flow tracer were used in 8 patients for the quantitative evaluation of regional myocardial perfusion at rest and after exercise, before and during SCS. Potassium uptake was evaluated as myocardial clearance (flow times net extraction) in ml/min/100 g. Tomographic segments were categorized as nonaffected and affected on the basis of the absence or presence of arterial stenosis on coronary angiography and on the basis of thallium scintigraphic data. In nonaffected segments, before SCS, regional myocardial clearance significantly increased from rest (28 +/- 4) to exercise (47 +/- 13 clearance units; p less than 0.004). A similar increase occurred after SCS. In affected segments, before SCS, regional myocardial clearance barely increased (p = 0.065) from rest (26 +/- 6) to exercise (33 less than or equal to 12). In comparison, after SCS, the resting regional myocardial clearance was slightly elevated (29 +/- 8) reflecting an increased double product, but did not increase (p = 0.192) with exercise (34 +/- 12). However, the magnitude and duration of ST-segment depression decreased during treatment with SCS. Anginal pain occurred in all patients during control exercise, but was attenuated in all but one with SCS. These results indicate that SCS improves exercise-induced angina and electrocardiographic signs of ischemia but this influence does not appear to be mediated by changes in regional myocardial perfusion. [less ▲]

Characteristics associated with early (less than or equal to 3 months) versus late (greater than 3 months to less than or equal to 3 years) mortality after acute myocardial infarction.

in American Journal of Cardiology (1989), 64(5), 315-8

To define the independent variables predictive of early versus late mortality after acute myocardial infarction (AMI), 420 consecutive patients were studied and divided into 3 groups: the 45 patients who ... [more ▼]

To define the independent variables predictive of early versus late mortality after acute myocardial infarction (AMI), 420 consecutive patients were studied and divided into 3 groups: the 45 patients who died within the initial 3 months (group 1), the 45 patients who died greater than 3 months and less than or equal to 3 years after AMI (group 2) and the 330 greater than 3-year survivors (group 3). The stepwise logistic discrimination method was applied to clinical and laboratory variables recorded during hospitalization to distinguish among the 3 groups. Six independent variables were found to be predictive of early mortality: left ventricular function score (chi-square 26.2; p less than 0.00001), ventricular fibrillation (chi-square 9.3; p = 0.002), bundle branch block (chi-square 9.0; p = 0.003), history of previous AMI (chi-square 8.7; p = 0.003), age (chi-square 5.8; p = 0.02) and atrioventricular block (chi-square 3.8; p = 0.05). Three independent variables were found predictive of late mortality: age (chi-square 13.8; p = 0.0002), anterior location of the AMI (chi-square 4.0; p = 0.04) and a low peak creatine kinase-MB level (chi-square 3.8; p = 0.05). Only 2 variables were able to distinguish between early and late nonsurvivors: peak creatine kinase-MB level (chi-square 8.7; p = 0.003) and ventricular fibrillation (chi-square 4.6; p = 0.03). Thus, the sets of independent risk factors for early and late mortality after AMI are substantially different--suggesting that differing mechanisms are responsible for outcome. [less ▲]

Characteristics associated with early (less than or equal to 3 months) versus late (greater than 3 months to less than or equal to 3 years) mortality after acute myocardial infarction.

in American Journal of Cardiology (1989), 64(5), 315-8

To define the independent variables predictive of early versus late mortality after acute myocardial infarction (AMI), 420 consecutive patients were studied and divided into 3 groups: the 45 patients who ... [more ▼]

To define the independent variables predictive of early versus late mortality after acute myocardial infarction (AMI), 420 consecutive patients were studied and divided into 3 groups: the 45 patients who died within the initial 3 months (group 1), the 45 patients who died greater than 3 months and less than or equal to 3 years after AMI (group 2) and the 330 greater than 3-year survivors (group 3). The stepwise logistic discrimination method was applied to clinical and laboratory variables recorded during hospitalization to distinguish among the 3 groups. Six independent variables were found to be predictive of early mortality: left ventricular function score (chi-square 26.2; p less than 0.00001), ventricular fibrillation (chi-square 9.3; p = 0.002), bundle branch block (chi-square 9.0; p = 0.003), history of previous AMI (chi-square 8.7; p = 0.003), age (chi-square 5.8; p = 0.02) and atrioventricular block (chi-square 3.8; p = 0.05). Three independent variables were found predictive of late mortality: age (chi-square 13.8; p = 0.0002), anterior location of the AMI (chi-square 4.0; p = 0.04) and a low peak creatine kinase-MB level (chi-square 3.8; p = 0.05). Only 2 variables were able to distinguish between early and late nonsurvivors: peak creatine kinase-MB level (chi-square 8.7; p = 0.003) and ventricular fibrillation (chi-square 4.6; p = 0.03). Thus, the sets of independent risk factors for early and late mortality after AMI are substantially different--suggesting that differing mechanisms are responsible for outcome. [less ▲]

Short-Term Risk Stratification at Admission Based on Simple Clinical Data in Acute Myocardial Infarction

in American Journal of Cardiology (1988), 61(4), 216-9

Simple clinical data, available in all coronary care units, were recorded in 1,013 consecutive patients with acute myocardial infarction (AMI). In order to identify the patients at highest and lowest risk ... [more ▼]

Simple clinical data, available in all coronary care units, were recorded in 1,013 consecutive patients with acute myocardial infarction (AMI). In order to identify the patients at highest and lowest risk of mortality during hospital stay, a prognostic index was established from a stepwise logistic discriminant analysis of 10 clinical variables obtained at admission in a consecutive series of 477 patients hospitalized in 1 of 2 coronary care units admitting new patients on alternate days and treating them similarly. This prognostic index was applied to a comparison group of 536 consecutive patients admitted to the other coronary care unit. In the experimental group, 57 of the 477 patients (12%) died during hospital stay; 60 of the 536 patients (11%) died in the comparison group. As individual variables, age, previous history of AMI, anterior site and left ventricular function on admission were associated with increased mortality. Three variables were selected from the stepwise logistic discriminant analysis of the experimental group: age; site (anterior = 1, other = 0); and grade of left ventricular function (0 to 4). Prognostic index = 5.9019 - 0.8961 function - 0.5708 location - 0.0369 age. This index was validated in the comparison group. Patients were allocated into different classes with increasing index values associated with decreasing risk. Three subgroups of patients were identified: high risk of hospital mortality (index less than or equal to 1; mortality: 51%), intermediate risk (index 1 to 3; mortality: 18%) and low risk (index greater than 3; mortality: 4%). The use of this simple prognostic index may improve clinical management and selection of patients for intervention trials. [less ▲]

Hemodynamic profile of patients with acute myocardial infarction at risk of infarct expansion.

in American Journal of Cardiology (1987), 60(1), 5-9

To identify patients at risk of cardiac expansion during hospital stay for a first acute myocardial infarction (AMI), 41 patients underwent right-sided cardiac catheterization soon after admission and ... [more ▼]

To identify patients at risk of cardiac expansion during hospital stay for a first acute myocardial infarction (AMI), 41 patients underwent right-sided cardiac catheterization soon after admission and serial 2-dimensional echocardiography on days 1, 3 or 4 and between days 7 and 10. Infarct expansion was recognized by echocardiography in 11 patients (27%), most often on the second recording (day 3 or 4). Age, sex, time from onset of pain to catheterization, peak levels of creatine kinase and creatine kinase-MB isoenzyme, heart rate, mean pulmonary artery wedge pressure and left ventricular stroke work index were similar in the 2 groups. Patients in whom infarct expansion developed had a higher incidence of previous systemic hypertension (73% vs 27%, p less than 0.01) and anterior AMI (91% vs 30%, p less than 0.001) and a higher mortality rate at 1 year (73 vs 7%, p less than 0.001) than those who did not. They also had higher systolic (139 +/- 24 vs 126 +/- 18 mm Hg, p less than 0.05) and diastolic (91 +/- 14 vs 75 +/- 13 mm Hg, p less than 0.001) arterial pressures, lower stroke volume index (31 +/- 10 vs 40 +/- 10 ml/m2, p less than 0.01) and much higher systemic vascular resistance (SVR) values (1,713 +/- 380 vs 1,253 +/- 264 dynes s cm-5, p less than 0.0001). In the subgroups of patients with anterior AMI, differences were significant for diastolic arterial pressure, stroke volume index, SVR and mortality.(ABSTRACT TRUNCATED AT 250 WORDS) [less ▲]