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4701. The etiology of syncope in patients with negative tilt table and electrophysiological testing.
Patients with syncope of unknown etiology after negative noninvasive and electrophysiological testing may suffer from recurrent disability. Syncopal episodes are often too infrequent and unpredictable for detection by conventional ambulatory monitoring techniques.
4702. Effects of increasing maintenance dose of digoxin on left ventricular function and neurohormones in patients with chronic heart failure treated with diuretics and angiotensin-converting enzyme inhibitors.
作者: M Gheorghiade.;V B Hall.;G Jacobsen.;M Alam.;H Rosman.;S Goldstein.
来源: Circulation. 1995年92卷7期1801-7页
Despite almost three centuries of use, the appropriate dosage of digitalis in patients with chronic heart failure and normal sinus rhythm has not been well studied.
4703. Some coronary risk factors related to the insulin resistance syndrome and treatment with gemfibrozil. Experience from the Helsinki Heart Study.
Coronary risk factors related to the insulin resistance syndrome tend to cluster in the same individual. Our previous studies have shown that the dyslipidemia characteristic of this syndrome--low HDL cholesterol and high triglyceride (TG) levels--responds well to treatment with gemfibrozil. Most factors related to insulin-resistance syndrome decrease fibrinolytic capacity, whereas a recent study showed that gemfibrozil improves it and thus may attenuate thrombotic events. To discover whether subjects with clustering of factors related to this resistance might in particular benefit from gemfibrozil, we reanalyzed the Helsinki Heart Study data.
4704. Kuopio Atherosclerosis Prevention Study (KAPS). A population-based primary preventive trial of the effect of LDL lowering on atherosclerotic progression in carotid and femoral arteries.
作者: R Salonen.;K Nyyssönen.;E Porkkala.;J Rummukainen.;R Belder.;J S Park.;J T Salonen.
来源: Circulation. 1995年92卷7期1758-64页
The atherosclerotic progression-reducing effect of LDL cholesterol (LDL-C) lowering has been established in subjects with severe atherosclerotic disease but not in persons with elevated LDL cholesterols without severe atherosclerosis. KAPS (Kuopio Atherosclerosis Prevention Study) is the first population-based trial in the primary prevention of carotid and femoral atherosclerosis.
4705. A comparison of quality of life scores in patients with angina pectoris after angioplasty compared with after medical therapy. Outcomes of a randomized clinical trial. Veterans Affairs Study of Angioplasty Compared to Medical Therapy Investigators.
Evaluations of therapy for the treatment of angina have traditionally consisted of a combination of objective measures, such as exercise tolerance, and subjective markers, such as angina attack rate. Recently, the need to assess "how patients feel"--their quality of life (QOL)--has been regarded with increasing importance. Standard instruments are available to assess QOL and its change after therapeutic intervention. Although QOL instruments have been used to assess the efficacy of percutaneous transluminal coronary angioplasty (PTCA), they have not been used previously to compare the impact of PTCA with that of medical therapy in patients with angina pectoris. We report on the changes in self-assessed QOL among patients randomly assigned to treatment by PTCA or medical therapy and relate these measurements to changes in exercise performance and coronary angiograms.
4707. Efficacy and safety of d-sotalol, a pure class III antiarrhythmic compound, in patients with symptomatic complex ventricular ectopy. Results of a multicenter, randomized, double-blind, placebo-controlled dose-finding study. The d-Sotalol PVC Study Group.
作者: S H Hohnloser.;T Meinertz.;P Stubbs.;H J Crijns.;J J Blanc.;P Rizzon.;B Cheuvart.
来源: Circulation. 1995年92卷6期1517-25页
There is increasing interest in pure class III antiarrhythmic compounds, ie, drugs in which the electrophysiological effect is confined to the propensity for producing an isolated lengthening of action potential duration. d-Sotalol represents the prototype of such pure class III agents. This double-blind, placebo-controlled, randomized dose-finding study evaluated the antiarrhythmic efficacy and safety of d-sotalol in patients with symptomatic chronic ventricular ectopy.
4708. Double-blind, placebo-controlled study of the long-term efficacy of carvedilol in patients with severe chronic heart failure.
作者: H Krum.;J D Sackner-Bernstein.;R L Goldsmith.;M L Kukin.;B Schwartz.;J Penn.;N Medina.;M Yushak.;E Horn.;S D Katz.
来源: Circulation. 1995年92卷6期1499-506页
Clinical trials have shown that beta-adrenergic blocking drugs are effective and well tolerated in patients with mild to moderate heart failure, but the utility and safety of these drugs in patients with advanced disease have not been evaluated.
4709. Intramural hemorrhage of the thoracic aorta. Diagnostic and therapeutic implications.
作者: C A Nienaber.;Y von Kodolitsch.;B Petersen.;R Loose.;U Helmchen.;A Haverich.;R P Spielmann.
来源: Circulation. 1995年92卷6期1465-72页
Intramural hemorrhage (IMH) was recently identified at necropsy and anecdotally in vivo as a unique aortic syndrome (without entry and with no flap-like intraluminal component, such as overt aortic dissection). However, little is known about diagnosis, prognosis, and outcome of IMH.
4710. Blockade of vasospastic attacks by alpha 2-adrenergic but not alpha 1-adrenergic antagonists in idiopathic Raynaud's disease.
Idiopathic Raynaud's disease is characterized by cold-induced digital vasospasms, but its origin has not been established. Previous research has shown that peripheral vascular alpha 2-adrenergic receptors are hypersensitive to local cooling in these patients, but the role of alpha 1-adrenergic receptors is not clear. Moreover, the role of adrenergic receptors in the production of actual vasospastic symptoms has not been investigated.
4711. Effectiveness of EDTA chelation therapy.4712. Chelation therapy.4713. Morning peak in ventricular tachyarrhythmias detected by time of implantable cardioverter/defibrillator therapy. The CPI Investigators.
作者: G H Tofler.;O C Gebara.;M A Mittleman.;P Taylor.;W Siegel.;F J Venditti.;C A Rasmussen.;J E Muller.
来源: Circulation. 1995年92卷5期1203-8页
A morning peak in occurrence of sudden cardiac death has been identified in epidemiological studies, but the studies are subject to selection bias, with the exclusion of unwitnessed deaths, which are more likely to occur at night. The recent availability of implantable cardioverter/defibrillators that record the time of ventricular tachyarrhythmias requiring either pacing or shock therapy provides an opportunity to clarify the timing of ventricular tachyarrhythmias predisposing to sudden cardiac death. Analysis of the timing of arrhythmias in different patient subgroups, such as patients with poor left ventricular function, may provide further insight into the mechanism of onset of sudden cardiac death.
4714. Correlation of temperature and pathophysiological effect during radiofrequency catheter ablation of the AV junction.
Accelerated junctional rhythms have been observed before the development of AV nodal block during radiofrequency (RF) catheter ablation of the AV junction. However, the time course and temperatures required to induce an accelerated junctional rhythm and AV nodal block during this procedure have not yet been characterized.
4715. Regional heterogeneity of human myocardial infarcts demonstrated by contrast-enhanced MRI. Potential mechanisms.
作者: J A Lima.;R M Judd.;A Bazille.;S P Schulman.;E Atalar.;E A Zerhouni.
来源: Circulation. 1995年92卷5期1117-25页
Myocardial reperfusion is pivotal to the prognosis of patients with acute myocardial infarction. In these patients, coronary flow is generally assessed by angiography and tissue perfusion by tracer scintigraphy. This study was designed to examine whether magnetic resonance imaging (MRI) provides information on myocardial perfusion and damage beyond that supplied by angiography and thallium scintigraphy after acute myocardial infarction.
4716. Benefit of thrombolytic therapy is sustained throughout five years and is related to TIMI perfusion grade 3 but not grade 2 flow at discharge. The European Cooperative Study Group.
作者: T Lenderink.;M L Simoons.;G A Van Es.;F Van de Werf.;M Verstraete.;A E Arnold.
来源: Circulation. 1995年92卷5期1110-6页
Long-term follow-up in patients treated with thrombolysis for acute myocardial infarction thus far has been reported in a few studies only, and no long-term follow-up is available for patients who underwent additional percutaneous transluminal coronary angioplasty (PTCA). This report describes 5-year survival as collected in patients who received placebo, recombinant tissue plasminogen activator (rTPA), or rTPA with additional immediate PTCA in two European Cooperative Study Group trials. Determinants for long-term survival were assessed in 1043 patients discharged alive.
4717. Effect of infarct artery patency on prognosis after acute myocardial infarction. The Survival and Ventricular Enlargement Investigators.
作者: G A Lamas.;G C Flaker.;G Mitchell.;S C Smith.;B J Gersh.;C C Wun.;L Moyé.;J L Rouleau.;J D Rutherford.;M A Pfeffer.
来源: Circulation. 1995年92卷5期1101-9页
In patients with acute myocardial infarction (MI), early restoration of patency of the infarct-related artery (IRA) leads to preservation of left ventricular function and improved clinical outcome. However, there is evidence that the benefits associated with a patent IRA are out of proportion to the observed improvement in ventricular function and may result not only from salvage of ischemic myocardium but also from the opening of the IRA beyond a narrow postinfarct time window. The objectives of this study were (1) to assess the effect of IRA patency on outcome of patients after acute MI with left ventricular dysfunction while controlling for differences in left ventricular ejection fraction and the extent of coronary disease and (2) to determine the effect of angiotensin-converting enzyme (ACE) inhibitor therapy on patients with patent as well as occluded infarct arteries.
4718. Endovascular stents in the pulmonary circulation. Clinical impact on management and medium-term follow-up.
作者: R Fogelman.;D Nykanen.;J F Smallhorn.;B W McCrindle.;R M Freedom.;L N Benson.
来源: Circulation. 1995年92卷4期881-5页
The use of endovascular stents to relieve obstructions in the setting of non-balloon dilatable pulmonary artery stenosis has been encouraging. The benefits in management and the potential for restenosis, however, have not been defined. This study attempts to assess the impact of such implants on clinical outcomes and the pattern of stent incorporation within the vessel wall.
4719. Additive effects of combined angiotensin-converting enzyme inhibition and angiotensin II antagonism on blood pressure and renin release in sodium-depleted normotensives.
作者: M Azizi.;G Chatellier.;T T Guyene.;D Murieta-Geoffroy.;J Ménard.
来源: Circulation. 1995年92卷4期825-34页
Angiotensin-converting enzyme (ACE) inhibitors do not decrease plasma angiotensin (Ang) II levels 24 hours after drug intake to the same extent as at peak. This intermittent partial "escape" is explained either by a renin-mediated reactive rise in plasma Ang I or by non-ACE-dependent Ang II generation. We therefore tested the hypothesis that a combination of ACE inhibition and Ang II blockade may have additive biological and hemodynamic effects.
4720. Predictors and sequelae of distal embolization during saphenous vein graft intervention from the CAVEAT-II trial. Coronary Angioplasty Versus Excisional Atherectomy Trial.
作者: J Lefkovits.;D R Holmes.;R M Califf.;R D Safian.;K Pieper.;G Keeler.;E J Topol.
来源: Circulation. 1995年92卷4期734-40页
The purpose of this study was to identify the predictors and sequelae of distal embolization from a multicenter, randomized trial of saphenous vein graft intervention. The CAVEAT-II trial demonstrated that saphenous vein graft directional coronary atherectomy (DCA) was associated with greater angiographic success and less need for repeat intervention compared with percutaneous transluminal coronary angioplasty (PTCA) but at the cost of more acute complications--notably distal embolization.
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