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See detailImpact of mitral regurgitation and myocardial viability on left ventricular reverse remodeling after cardiac resynchronization therapy in patients with ischemic cardiomyopathy.
Senechal, Mario; Lancellotti, Patrizio ULg; Magne, Julien ULg et al

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 ▲]

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See detailImpact of aortic valve stenosis on left atrial phasic function
O'Connor, K.; Magne, Julien ULg; Rosca, M. et al

in American Journal of Cardiology (2010), 106(8), 1157-1162

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See detailEffects of valve replacement for aortic stenosis on mitral regurgitation.
Unger, Philippe; Plein, Daniele; Van Camp, Guy et al

in American Journal of Cardiology (2008), 102(10), 1378-82

We aimed to prospectively and quantitatively assess the effects of aortic valve replacement (AVR) for aortic stenosis (AS) on mitral regurgitation (MR) and to examine the determinants of the changes in MR ... [more ▼]

We aimed to prospectively and quantitatively assess the effects of aortic valve replacement (AVR) for aortic stenosis (AS) on mitral regurgitation (MR) and to examine the determinants of the changes in MR. Fifty-two patients with AS scheduled for AVR were included if holosystolic MR not being considered for replacement or repair was detected. MR was quantified using the proximal isovelocity surface area method before and 8 +/- 4 days after surgery. Mitral valvular deformation parameters did not change significantly, but the mitral effective regurgitant orifice (ERO) and regurgitant volume decreased from 11 +/- 6 mm(2) to 8 +/- 6 mm(2) and from 20 +/- 10 ml to 11 +/- 9 ml, respectively (both p <0.0001). Using multiple linear regression analysis, preoperative severity of MR, mitral leaflet coaptation height, and end-diastolic volume decrease were independently associated with postoperative reduction in MR, whereas changes in mitral valve morphology after surgery were not. MR etiology did not predict the reduction in MR. In conclusion, the decrease in MR observed in most patients after AVR is associated with the magnitude of acute left ventricular reverse remodeling. As the reduction in left ventricular systolic pressure contributes to the decrease in regurgitant volume, the preoperative quantitative assessment of MR should best be performed by measurement of the ERO. [less ▲]

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See detailA statement on ethics from the HEART Group.
HEART Group; LANCELLOTTI, Patrizio ULg

in American Journal of Cardiology (2008), 101(9), 1345-6

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See detailLong-term prognostic significance of high-sensitivity C-reactive protein before and after coronary angioplasty in patients with stable angina pectoris
Gach, Olivier ULg; Legrand, Victor ULg; Biessaux, Yves ULg et al

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 ▲]

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See detailEffect of dynamic left ventricular dyssynchrony on dynamic mitral regurgitation in patients with heart failure due to coronary artery disease
Lancellotti, Patrizio ULg; Stainier, P. Y.; Lebois, Florence ULg et al

in American Journal of Cardiology (2005), 96(9), 1304-1307

In patients with heart failure, exercise-induced increases in mitral regurgitation (MR), which convey a poor prognosis, are related to the dynamic distortion of mitral valve geometry. It was hypothesized ... [more ▼]

In patients with heart failure, exercise-induced increases in mitral regurgitation (MR), which convey a poor prognosis, are related to the dynamic distortion of mitral valve geometry. It was hypothesized that dynamic MR may also be related to intermittent changes in left ventricular synchronicity during exercise. (c) 2005 Elsevier Inc. All rights reserved. [less ▲]

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See detailGlobal and regional parameters of dyssynchrony in ischemic and nonischemic cardiomyopathy
Van de Veire, N.; De Sutter, J.; Van Camp, G. et al

in American Journal of Cardiology (2005), 95(3), 421-423

In this study, color tissue Doppler imaging was used to assess global and regional mechanical dyssynchrony in patients with ischemic cardiomyopathy and those with idiopathic dilated cardiomyopathy ... [more ▼]

In this study, color tissue Doppler imaging was used to assess global and regional mechanical dyssynchrony in patients with ischemic cardiomyopathy and those with idiopathic dilated cardiomyopathy. Potential differences in the area of latest mechanical activation could have practical implications regarding lead positioning and the success rate of biventricular pacemaker implantation.. (C) 2005 by Excerpta Medica Inc. [less ▲]

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See detailPredictors of rapid QRs widening in patients with coronary artery disease and left ventricular dysfunction
LANCELLOTTI, Patrizio ULg; Kulbertus, Henri ULg; Pierard, L. A.

in American Journal of Cardiology (2004), 93(11), 1410-1412

To assess the predictors of rapid QRS widening in patients with chronic ischemic left ventricular dysfunction, 82 patients who underwent greater than or equal to2 electrocardiograms and exercise Doppler ... [more ▼]

To assess the predictors of rapid QRS widening in patients with chronic ischemic left ventricular dysfunction, 82 patients who underwent greater than or equal to2 electrocardiograms and exercise Doppler echocardiography were studied. In a multivariate analysis, left ventricular end-diastolic Volume, a large increase in mitral regurgitant volume during exercise, and diabetes emerged as independent predictors of QRS widening. (C)2004 by Excerpta Medica, Inc. [less ▲]

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See detailEffect of cardiac resynchronization therapy on functional mitral regurgitation in heart failure.
Lancellotti, Patrizio ULg; MELON, Pierre ULg; SAKALIHASAN, Natzi ULg et al

in American Journal of Cardiology (2004), 94(11), 1462-5

Cardiac resynchronization therapy (CRT) reduces functional mitral regurgitation (MR) at rest. This study assessed exercise-induced changes in MR in patients with heart failure who were helped by CRT. The ... [more ▼]

Cardiac resynchronization therapy (CRT) reduces functional mitral regurgitation (MR) at rest. This study assessed exercise-induced changes in MR in patients with heart failure who were helped by CRT. The determinants of these exercise-induced changes in MR were analyzed in asynchronous and resynchronized left ventricles. [less ▲]

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See detailPersistent negative T waves in the infarct-related leads as an independent predictor of poor long-term prognosis after acute myocardial infarction
Lancellotti, Patrizio ULg; Gerard, P. L.; Kulbertus, Henri ULg et al

in American Journal of Cardiology (2002), 90(8), 833-837

This study sought to determine the long-term prognostic significance of persistent or transient, negative T waves in infarct-related leads. After acute myocardial infarction (AMI), QRS and T wave ... [more ▼]

This study sought to determine the long-term prognostic significance of persistent or transient, negative T waves in infarct-related leads. After acute myocardial infarction (AMI), QRS and T wave alterations may resolve. No clinical study has investigated the prognostic importance of persistent versus transient negative T waves. We studied 147 consecutive patients with first AMI and greater than or equal to2 negative T waves in the infarct-related leads on the electrocardiogram. One hundred twenty patients developed Q waves. Patients were followed clinically for 60 +/- 21 months. T-wave normalization was observed early (before hospital discharge) in 34 patients and late (at 4 +/- 1 months) in 65. Thirty patients had Q-wave regression. Adverse outcome occurred in 57 patients. There were 23 hard events (cardiac death in 12 patients and nonfatal AMI in 11). Patients with early or late T-wave normalization had similar event-free survival curves that diverged rapidly from that of patients with persistent negative T waves, who had a worse outcome (p <0.0001). Patients with or without Q-wave regression had similar survival curves. Using multivariate Cox regression analysis, higher end-systolic volume (hazard ratio [HR] 1.01, p = 0.007), the presence of multivessel disease (HR 3.33, p = 0.009), and persistent negative T waves (HR 2.92, p = 0.024) predicted hard events. Persistent negative T waves 4 months after first AMI were independently associated with a worse outcome, whereas Q-wave regression has no long-term prognostic importance. (C) 2002 by Excerpta Medica, Inc. [less ▲]

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See detailSignificance of Dobutamine-Induced Changes in Qt Dispersion Early after Acute Myocardial Infarction
LANCELLOTTI, Patrizio ULg; Bilge, A. R.; Mipinda, J. B. et al

in American Journal of Cardiology (2001), 88(9), 939-43

This study sought to examine the effects of graded dobutamine infusion on QT dispersion early after acute myocardial infarction (AMI) and to investigate the relation of dobutamine-induced changes in QT ... [more ▼]

This study sought to examine the effects of graded dobutamine infusion on QT dispersion early after acute myocardial infarction (AMI) and to investigate the relation of dobutamine-induced changes in QT dispersion to wall motion responses. Seventy-eight patients with a first AMI underwent dobutamine-atropine stress echocardiography 5 +/- 2 days after admission. Contractile reserve was identified in 45 patients and ischemic myocardium in 40. Sixteen patients had persistent akinesia. The best cut-off value of QT dispersion on the baseline electrocardiogram for predicting myocardial viability was 65 ms (sensitivity and specificity of 68%). Dobutamine infusion increased QT dispersion only in patients with viable myocardium (61 +/- 18 to 83 +/- 19 ms, p = 0.003) and/or ischemia (72 +/- 16 to 112 +/- 25 ms, p < 0.0001). No change was observed in patients with persistent akinesia (84 +/- 10 to 87 +/- 15 ms, p = NS). QT dispersion increased by 22 +/- 12 ms with administration of low-dose dobutamine in patients who had viable myocardium and by 47 +/- 21 ms with administration of low- to high-dose dobutamine in patients with ischemic myocardium. An increase in QT dispersion of > or = 20 ms from at rest to low-dose dobutamine infusion was associated with myocardial viability with a sensitivity of 78% and a specificity of 79%, whereas an increase in QT dispersion of > or = 10 ms from low- to high-dose dobutamine infusion predicted ischemic myocardium with a sensitivity of 85% and a specificity of 82%. In conclusion, (1) low QT dispersion on the baseline electrocardiogram is determined by the presence of viable myocardium, (2) a dobutamine-induced increase in QT dispersion is associated with viable and jeopardized myocardium, and (3) unchanged QT dispersion during dobutamine stress is a simple marker of extensive necrosis. [less ▲]

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See detailEffect of Spinal Cord Stimulation on Regional Myocardial Perfusion Assessed by Positron Emission Tomography
de Landsheere, Christian ULg; Mannheimer, C.; Habets, A. et al

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 ▲]

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See detailIdentification of patients at high risk for recurrence of sustained ventricular tachycardia after healing of acute myocardial infarction.
Rodriguez, L M; Oyarzun, R; Smeets, J et al

in American Journal of Cardiology (1992), 69(5), 462-4

A prognostic index for nonfatal recurrences of ventricular tachycardia (VT) was developed using a retrospective analysis of a group of 206 patients with sustained monomorphic VT or ventricular ... [more ▼]

A prognostic index for nonfatal recurrences of ventricular tachycardia (VT) was developed using a retrospective analysis of a group of 206 patients with sustained monomorphic VT or ventricular fibrillation (VF) after healing of acute myocardial infarction. 74 patients (36%) (64 with VT and 10 with VF) had recurrences of sustained monomorphic VT during 3.4 +/- 9 years of follow-up. Three clinical variables were selected and weighted by stepwise logistic discriminant analysis of the study group. They were coded as follows: interval of myocardial infarction to arrhythmia (less than 2 months = 1; 2 to 6 months = 2; greater than 6 months = 3), drug therapy with or without sotalol (with = 1, without = 2), and VT or VF as the presenting arrhythmia (VT = 1, VF = 2). The prognostic index was: 3.41 - (0.56 x interval) - (1.94 x therapy) + (0.86 x arrhythmia). This index was validated prospectively in a test group of 158 consecutive patients with VT or VF after healing of acute myocardial infarction. Patients were allocated into different classes with decreasing prognostic index values associated with increasing risk for recurrences of VT. In the test group, 27 of 158 (17%) patients (22 with VT and 5 with VF) had recurrences of VT (follow-up of 2 +/- 2 years). Two risk classes of patients were identified: high risk for recurrences of VT (61%) corresponding to patients with a negative index; and low risk (4%) consisting of those with a positive index. Thus, using O as the cutoff point, the sensitivity, specificity, and positive and negative predictive values were 81, 89, 62 and 96%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS) [less ▲]

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See detailCharacteristics 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.
Pierard, Luc ULg; Chapelle, Jean ULg; Albert, Adelin ULg et al

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 ▲]

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See detailPrognostic significance of a low peak serum creatine kinase level in acute myocardial infarction
Pierard, Luc ULg; Dubois, Christophe ULg; Albert, Adelin ULg et al

in American Journal of Cardiology (1989), 63(12), 792-6

To assess the prognostic significance of a low peak creatine kinase (CK) level, 723 consecutive patients admitted with acute myocardial infarction (AMI) within 16 hours after onset of symptoms were ... [more ▼]

To assess the prognostic significance of a low peak creatine kinase (CK) level, 723 consecutive patients admitted with acute myocardial infarction (AMI) within 16 hours after onset of symptoms were studied. Thrombolytic therapy was not attempted during the study. Patients were dichotomized according to their peak CK levels, determined from a cluster analysis of peak CK distribution among the population of patients who died within 3 years after hospital discharge. The 139 patients with low peak CK (less than or equal to 650 IU/liter) (group 1) were compared to the 584 patients with high peak CK (greater than 650 IU/liter) (group 2). Patients in group 1 were older and had a higher incidence of previous AMI, angina pectoris before AMI and non-Q-wave AMI. Despite a lower incidence of in-hospital complications and a nonsignificantly lower hospital mortality rate (4 vs 9%) the group 1 three-year posthospital mortality rate was higher (26 vs 17%; p less than 0.02), especially in the subgroup of patients with a Q-wave infarct (mortality 31% in group 1 vs 16% in group 2; p less than 0.001). Among the 491 patients who had a first Q-wave AMI, 55 had a peak CK less than or equal to 650 IU/liter. Compared to the 436 patients with a higher peak CK, these 55 patients had a higher incidence of early postinfarction angina (31 vs 14%; p less than 0.01), a similar hospital mortality (4 vs 7%) but a higher 3-year posthospital mortality (23 vs 12%; p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS) [less ▲]

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See detailAction of Rilmenidine on Locus Ceruleus and Dorsal Raphe Cells in Vivo and in Vitro
Dresse, Albert ULg; Scuvée-Moreau, Jacqueline ULg; Seutin, Vincent ULg

in American Journal of Cardiology (1988), 61(7), 32-34

The effect of rilmenidine (S 3341) and clonidine on the firing rate of locus ceruleus (LC) and dorsal raphe (DR) cells was studied in vivo after systemic and microiontophoretic administration. The effect ... [more ▼]

The effect of rilmenidine (S 3341) and clonidine on the firing rate of locus ceruleus (LC) and dorsal raphe (DR) cells was studied in vivo after systemic and microiontophoretic administration. The effect of the 2 drugs was also studied in vitro on brain slices containing LC cells. Rilmenidine and clonidine inhibited the firing of LC and DR neurons. Complementary experiments performed with yohimbine and prazosin demonstrated that the effect of LC is related to an agonistic action on alpha 2 somatodendritic receptors, whereas the effect observed on DR cells is indirect. On LC cells, clonidine is 30 to 60 times as potent as rilmenidine. These observations may be related to less sedative effects of rilmenidine than of clonidine. [less ▲]

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See detailShort-Term Risk Stratification at Admission Based on Simple Clinical Data in Acute Myocardial Infarction
DUBOIS, Christophe ULg; PIERARD, Luc ULg; Albert, Adelin ULg et al

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 ▲]

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See detailUsefulness of Thromboendarterectomy in Association with Coronary Artery Bypass Grafting
Larock, Marie-Paule; Burguet, Willy; Grenade, Thierry et al

in American Journal of Cardiology (1987), 60(13), 1025-9

Thromboendarterectomy is sometimes performed in association with coronary artery bypass graft surgery (CABG). Right coronary arteries and severely narrowed coronary arteries mainly undergo ... [more ▼]

Thromboendarterectomy is sometimes performed in association with coronary artery bypass graft surgery (CABG). Right coronary arteries and severely narrowed coronary arteries mainly undergo thromboendarterectomy, but perioperative acute myocardial infarctions (AMI) are possible complications. One hundred seventy-six consecutive patients with rest and stress thallium-201 scintigraphy and angiography were studied before and after surgery. To compare patients with and without thromboendarterectomy, 48 patients who had undergone thromboendarterectomy and whose characteristics matched closely those of patients who had not were selected. Twenty patients had previous AMI before CABG in each group. Analysis accounted for the severity of vessel lesion (complete or incomplete) and for the patency of the graft and of the native coronary artery. In these 96 patients, graft patency was lower than in the overall group and similar among patients with and without thromboendarterectomy among the 56 patients without previous AMI. In patients with previous AMI and thromboendarterectomy, however, reperfusion was achieved more often through the native vessel than through the graft. New AMI or residual ischemia occurred in 32% of the areas undergoing thromboendarterectomy and in only 5% of the standard grafts (p less than 0.001). Best results were obtained in patients with incomplete occlusion after AMI. Patients without previous AMI had worse results. Thus, thromboendarterectomy can yield 64 to 75% good results in selected subgroups when CABG is otherwise impossible, but should be avoided in mildly or moderately stenotic arteries perfusing noninfarcted myocardium. [less ▲]

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See detailHemodynamic profile of patients with acute myocardial infarction at risk of infarct expansion.
Pierard, Luc ULg; Albert, Adelin ULg; Gilis, F et al

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 ▲]

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