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4781. Circadian variation in the efficacy of tissue-type plasminogen activator.
The frequency of onset of acute myocardial infarction follows a circadian pattern, with a peak incidence between 6:00 AM and noon. Circadian variations have been defined for platelet aggregation, plasminogen-activator inhibitor, and a number of hemostatic and physiological factors, all of which might predispose toward clotting in the late morning and thrombolysis in the evening. Thus, the hypothesis for this retrospective analysis was that tissue-type plasminogen activator (TPA) has greater efficacy when administered between noon and midnight, as measured by coronary patency 90 minutes after initiation of treatment.
4782. Intermittent transdermal nitroglycerin therapy. Decreased anginal threshold during the nitrate-free interval.
Intermittent transdermal nitroglycerin therapy is effective in the treatment of stable angina and prevents the development of tolerance. Previous investigations have suggested that removal of nitroglycerin patches may be associated with a decrease in anginal threshold. This study examines the effect of nitroglycerin patch removal on anginal threshold in a group of patients with stable angina.
4783. Cost of initial therapy in the Electrophysiological Study Versus ECG Monitoring trial (ESVEM).
作者: N A Omoigui.;F I Marcus.;J W Mason.;E A Hahn.;V L Hartz.;M A Hlatky.
来源: Circulation. 1995年91卷4期1070-6页
Patients randomized to either serial electrophysiological testing (EPS) or serial Holter monitoring (HM) to guide antiarrhythmic therapy for life-threatening ventricular arrhythmias had equivalent rates of mortality and arrhythmia recurrence in the ESVEM study. This report analyzes the effects of EPS, HM, and clinical factors on the charges for initial evaluation and management of patients with life-threatening ventricular arrhythmias.
4784. Differential effects of chronic oral antihypertensive therapies on systemic arterial circulation and ventricular energetics in African-American patients.
作者: B P Cholley.;S G Shroff.;J Sandelski.;C Korcarz.;B A Balasia.;S Jain.;D S Berger.;M B Murphy.;R H Marcus.;R M Lang.
来源: Circulation. 1995年91卷4期1052-62页
A comprehensive evaluation of arterial load characteristics and left ventricular energetics in systemic hypertension has been limited by the need for invasive techniques to access instantaneous aortic pressure and flow. As a consequence of this methodological limitation, no data exist on the effects of long-term antihypertensive therapy on global arterial impedance properties and indexes of myocardial oxygen consumption (MVO2). Using recently validated noninvasive techniques, we compared in hypertensive patients the effects of chronic oral treatment with ramipril, nifedipine, and atenolol on arterial impedance and mechanical power dissipation as well as indexes of MVO2.
4785. Current spectrum of cardiogenic shock and effect of early revascularization on mortality. Results of an International Registry. SHOCK Registry Investigators.
作者: J S Hochman.;J Boland.;L A Sleeper.;M Porway.;J Brinker.;J Col.;A Jacobs.;J Slater.;D Miller.;H Wasserman.
来源: Circulation. 1995年91卷3期873-81页
Cardiogenic shock remains the leading cause of death of patients hospitalized with acute myocardial infarction (MI). This study was conducted to examine (1) the current spectrum of cardiogenic shock, (2) the proportion of patients who are potential candidates for a trial of early revascularization, and (3) the apparent impact of early revascularization on mortality.
4786. Comparison of five antihypertensive monotherapies and placebo for change in left ventricular mass in patients receiving nutritional-hygienic therapy in the Treatment of Mild Hypertension Study (TOMHS).
作者: P R Liebson.;G A Grandits.;S Dianzumba.;R J Prineas.;R H Grimm.;J D Neaton.;J Stamler.
来源: Circulation. 1995年91卷3期698-706页
Increased left ventricular mass (LVM) by echocardiography is associated with increased risk of cardiovascular disease. Thus, it is of interest to compare the effects of both pharmacological and nonpharmacological approaches to the treatment of hypertension on reduction of LVM.
4787. Losartan in heart failure. Hemodynamic effects and tolerability. Losartan Hemodynamic Study Group.
作者: I Crozier.;H Ikram.;N Awan.;J Cleland.;N Stephen.;K Dickstein.;M Frey.;J Young.;G Klinger.;L Makris.
来源: Circulation. 1995年91卷3期691-7页
The aim of the present study was to assess the short- and long-term effects of multiple doses of the angiotensin II receptor antagonist losartan in heart failure.
4788. Role of cardiac beta 2-receptors in cardiac responses to exercise in cardiac transplant patients.
In healthy human hearts, beta 2-receptor-mediated chronotropic and inotropic responses contribute to the cardiac responses to beta-agonists. A (patho)physiological relevance for beta 2-receptor-mediated responses has so far not been demonstrated, in part because beta 1-receptor-mediated responses to cardiac neuronally released norepinephrine can mask beta 2-receptor-mediated responses.
4789. Endothelin-1 in pulmonary hypertension associated with high-altitude exposure.
作者: S Goerre.;M Wenk.;P Bärtsch.;T F Lüscher.;F Niroomand.;E Hohenhaus.;O Oelz.;W H Reinhart.
来源: Circulation. 1995年91卷2期359-64页
Endothelin-1 is involved in chronic pulmonary hypertension. Its role in acute pulmonary hypertension due to hypoxia in humans is not clear. We therefore studied the influence of hypoxia caused by exposure to high altitude on plasma endothelin-1 levels, arterial blood gases, and pulmonary arterial pressure in subjects taking nifedipine or placebo.
4790. Dose-dependent effects of the renin inhibitor zankiren HCl after a single oral dose in mildly sodium-depleted normotensive subjects.
作者: J Ménard.;R S Boger.;D M Moyse.;T T Guyene.;H N Glassman.;H D Kleinert.
来源: Circulation. 1995年91卷2期330-8页
Zankiren HCl (A-72517) is a potent renin inhibitor shown to have substantial bioavailability in several animal species and to produce dose-related reductions in blood pressure, plasma renin activity, and angiotensin II (Ang II) in salt-depleted dogs. The present study was designed to evaluate the hemodynamic effects of oral zankiren HCl administration in healthy volunteers and to characterize the response of the renin-angiotensin system (RAS) to specific blockade by this new renin inhibitor.
4791. Myocardial perfusion imaging with 99mTc tetrofosmin. Comparison to 201Tl imaging and coronary angiography in a phase III multicenter trial. Tetrofosmin International Trial Study Group.
作者: B L Zaret.;P Rigo.;F J Wackers.;R C Hendel.;S H Braat.;A S Iskandrian.;B S Sridhara.;D Jain.;R Itti.;A N Serafini.
来源: Circulation. 1995年91卷2期313-9页
Our objective was to compare the sensitivity and specificity of tetrofosmin, a new 99mTc-labeled myocardial perfusion imaging agent for the detection of myocardial perfusion abnormalities, with those of 201Tl and coronary angiography. Our hypothesis was that same-day stress/rest tetrofosmin imaging could provide data comparable to those of 201Tl imaging. Myocardial perfusion imaging plays an important role for the evaluation of coronary artery disease. Newer 99mTc-labeled agents offer several advantages over 201Tl, the conventional myocardial perfusion imaging agent. Tetrofosmin is a new 99mTc-labeled agent with promising results in preliminary studies.
4792. Effect of cigarette smoking on outcome after thrombolytic therapy for myocardial infarction.
作者: C L Grines.;E J Topol.;W W O'Neill.;B S George.;D Kereiakes.;H R Phillips.;J D Leimberger.;L H Woodlief.;R M Califf.
来源: Circulation. 1995年91卷2期298-303页
Smoking is known to be a strong risk factor for premature atherosclerosis, myocardial infarction, and sudden cardiac death. Unexpectedly, in the reperfusion era, investigators have reported that patients who smoke have a more favorable prognosis after thrombolysis compared with non-smokers. Since smoking is associated with a relatively hyper-coagulable state, we hypothesized that the coronary occlusion responsible for infarction may be primarily thrombotic, with improved outcome relating to enhanced patency or the absence of a residual stenosis after thrombolytic therapy.
4793. A prospective randomized comparison in humans of biphasic waveform 60-microF and 120-microF capacitance pulses using a unipolar defibrillation system.
作者: G H Bardy.;J E Poole.;P J Kudenchuk.;G L Dolack.;R Mehra.;P DeGroot.;M H Raitt.;G K Jones.;G Johnson.
来源: Circulation. 1995年91卷1期91-5页
Improving unipolar implantable cardioverter-defibrillator (ICD) effectiveness has favorable implications for ICD safety, efficacy, and size. Advances in defibrillation efficacy would accelerate ICD ease of use by decreasing device size and by minimizing morbidity and mortality related to an improved defibrillation safety margin. The specific purpose of the present study was to determine whether unipolar defibrillation efficacy could be improved further in humans by lowering biphasic waveform capacitance.
4794. Association between ease of suppression of ventricular arrhythmia and survival.
作者: S Goldstein.;M M Brooks.;R Ledingham.;H L Kennedy.;A E Epstein.;Y Pawitan.;J T Bigger.
来源: Circulation. 1995年91卷1期79-83页
We tested the hypothesis that patients whose ventricular arrhythmias are easy to suppress have a lower rate of arrhythmic death, defined as arrhythmic death and nonfatal cardiac arrest, the primary end point in the Cardiac Arrhythmia Suppression Trials (CAST-I and CAST-II), than patients whose ventricular arrhythmias are hard to suppress. In addition, we evaluated the association between ease of suppression of ventricular arrhythmias and mortality of all causes.
4795. Previous angina alters in-hospital outcome in TIMI 4. A clinical correlate to preconditioning?
作者: R A Kloner.;T Shook.;K Przyklenk.;V G Davis.;L Junio.;R V Matthews.;S Burstein.;M Gibson.;W K Poole.;C P Cannon.
来源: Circulation. 1995年91卷1期37-45页
Ischemic preconditioning has been shown to reduce myocardial infarct size in experimental models, but its role in patients remains unclear. Angina before myocardial infarction reflects brief episodes of ischemia and may be a marker of preconditioning. As part of the Thrombolysis in Myocardial Infarction (TIMI) 4 study, we performed an analysis on the effect of a history of previous angina on in-hospital outcomes for patients with acute myocardial infarction.
4796. Value of physical signs in the diagnosis of ventricular tachycardia.
作者: C J Garratt.;M J Griffith.;G Young.;N Curzen.;S Brecker.;A F Rickards.;A J Camm.
来源: Circulation. 1994年90卷6期3103-7页
Although the use of physical signs for the diagnosis of ventricular tachycardia (VT) was described in the early 1900s, their value in this role has never been systematically assessed.
4797. Relation between physical training and ambulatory blood pressure in stage I hypertensive subjects. Results of the HARVEST Trial. Hypertension and Ambulatory Recording Venetia Study.
作者: P Palatini.;G R Graniero.;P Mormino.;L Nicolosi.;L Mos.;P Visentin.;A C Pessina.
来源: Circulation. 1994年90卷6期2870-6页
This study was undertaken to assess whether ambulatory blood pressure (BP) in a population of stage I hypertensive individuals was lower in the subjects performing regular exercise training.
4798. Interaction of baseline characteristics with the hazard of encainide, flecainide, and moricizine therapy in patients with myocardial infarction. A possible explanation for increased mortality in the Cardiac Arrhythmia Suppression Trial (CAST).
作者: J L Anderson.;E V Platia.;A Hallstrom.;R W Henthorn.;T A Buckingham.;M D Carlson.;P E Carson.
来源: Circulation. 1994年90卷6期2843-52页
The Cardiac Arrhythmia Suppression Trial (CAST) was designed to test the hypothesis that suppression of ventricular ectopy with antiarrhythmic drugs after a myocardial infarction reduces the incidence of sudden arrhythmic death. Patients in whom ventricular ectopy could be suppressed with encainide, flecainide, or moricizine were randomly assigned to receive either active drug or placebo. The encainide and flecainide arms of the study were discontinued in 1989 (CAST-I) and the moricizine arm in 1991 (CAST-II) because of excess mortality. To explore the mechanisms of these adverse outcomes, we examined the interaction of baseline characteristics with the hazard of therapy with encainide, flecainide, or moricizine compared with their respective placebos.
4799. Results and efficiency of programmed ventricular stimulation with four extrastimuli compared with one, two, and three extrastimuli.
作者: J D Hummel.;S A Strickberger.;E Daoud.;M Niebauer.;O Bakr.;K C Man.;B D Williamson.;F Morady.
来源: Circulation. 1994年90卷6期2827-32页
Conventional programmed ventricular stimulation protocols are inefficient compared with more recently proposed protocols. The purpose of the present study was to determine if additional efficiency could be derived from a 6-step programmed ventricular stimulation protocol that exclusively uses four extrastimuli.
4800. Cardiac hypertrophy, aortic compliance, peripheral resistance, and wave reflection in end-stage renal disease. Comparative effects of ACE inhibition and calcium channel blockade.
作者: G M London.;B Pannier.;A P Guerin.;S J Marchais.;M E Safar.;J L Cuche.
来源: Circulation. 1994年90卷6期2786-96页
We wished to assess the respective roles of the antihypertensive and blood pressure (BP)-independent effects of antihypertensive drugs on arterial hemodynamics and left ventricular hypertrophy (LVH) in end-stage renal disease (ESRD) patients.
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