PubMed Health⌕ Search

Biomedical subjects

A G Wasserman

Publications and source records attributed to A G Wasserman.

At least 37 records · Page 2Linked to original sources
PubMed1987

Multiple cardiac myxomas with multiple recurrences: unusual presentation of a "benign" tumor.

A 20-year-old woman with a two-week history of palpitations and constitutional symptoms was found to have right atrial and left ventricular myxomas. The myxomas were excised, but the patient had two recurrences of the tumor in the left atrium four and a half years after the initial presentation. The recurrent myxoma was locally aggressive, and removal required excision of the aortic valve. This patient demonstrates the need for careful follow-up for recurrences of myxoma.

Adult↗
PubMed1986

Congenital aneurysm of the left sinus of Valsalva. Report of a patient with 19-year survival without surgery.

An unruptured aneurysm of the left sinus of Valsalva was diagnosed by angiography in a 16-year-old male subject 19 years ago. A recent repeated angiographic study documented no change in the aneurysm over the 19-year interval, and the patient has remained asymptomatic. We are aware of no other long-term follow-up reports of patients with this lesion who have not had surgical correction. This case emphasizes the controversy regarding the need for prophylactic surgical correction of an unruptured aneurysm.

Adult↗
PubMed1986

Exercise-induced ST-segment depression and elevation in the same patient. A case for mixed angina.

A patient with significant left anterior descending coronary disease is presented who developed significant ST segment elevation and depression at different times under similar testing conditions. Currently proposed explanations for exercise-induced ST segment elevation are discussed. This patient likely represents a case of spasm superimposed on significant obstructive disease, so-called mixed angina.

Aged↗
PubMed1985

Lipoprotein and apolipoprotein levels in angiographically defined coronary atherosclerosis.

Recent studies suggest that apolipoproteins and subfractions of high-density lipoprotein (HDL) cholesterol may be better predictors of atherosclerotic coronary artery disease (CAD) than are plasma cholesterol and total HDL cholesterol. To examine this hypothesis, plasma cholesterol and triglyceride, cholesterol of low-density lipoprotein, HDL and its subfractions 2 and 3, apolipoprotein A-I, the apolipoprotein B of low-density lipoprotein, the ratio of apolipoprotein EII to EIII, and ratios of several of these variables were measured in a selected series of 126 patients (83 men and 43 women) who underwent coronary angiography for suspected CAD. Mean values of many of these variables differed significantly between the men with CAD and the men without significant CAD, when controlled for age, use of beta blockers and diuretic drugs. Using multivariate logistic regression analysis, the only variable that made a significant independent contribution in predicting CAD in men was the ratio of HDL cholesterol to total plasma cholesterol (p less than 0.0001). The mean of this ratio was 0.17 +/- 0.01 mg/dl in the men with CAD and 0.23 +/- 0.02 mg/dl in the male controls. All men with ratios of less than 0.15 mg/dl had significant CAD, defined as 50% or greater luminal diameter narrowing of 1 or more of the major coronary arteries. No measurement was a significant univariate or multivariate predictor of CAD in the women, but the power to detect such predictors was reduced because of small group sizes. In conclusion, the ratio of HDL cholesterol to plasma cholesterol may be superior to many of the more recently described lipoprotein and apolipoprotein-derived predictors of CAD.

Apolipoprotein A-I↗
PubMed1985

Arteriographic predictors of spontaneous improvement in left ventricular function after myocardial infarction.

To better characterize the changes in left ventricular ejection fraction after myocardial infarction, we compared radionuclide ventriculograms obtained acutely and 2 weeks after acute myocardial infarction in 40 patients. These patients underwent angiography within a mean of 4 hr and 20 min after the onset of symptoms of infarction and either received no therapy (32 patients who were control subjects in a thrombolysis trial) or did not experience reperfusion (eight patients) despite receiving streptokinase infusions. In all 40 patients, the change in left ventricular ejection fraction over 2 weeks was small (+2.6%). Patients were then grouped according to the presence or absence of residual flow on their angiograms. Residual flow was considered to be present in 21 patients, in 12 by virtue of subtotal occlusion of the artery supplying the area of infarct and in nine because of well-developed coronary collaterals to the distal infarct artery. Mean change in ejection fraction for patients with residual flow was +6.9 +/- 2.3% vs -2.2 +/- 1.7% for patients without residual flow (p less than .01). Fourteen of 21 (67%) patients with residual flow had a spontaneous rise in ejection fraction of greater than 5%, as compared with two of 19 (11%) patients without residual flow (p less than .01). Time to peak level of creatine kinase (CK) was significantly shorter in the residual flow group (15 vs 23 hr, p less than .01), while the peak level of CK was lower (1550 vs 2220 IU) in these patients. This latter difference did not reach statistical significance (p = .10).(ABSTRACT TRUNCATED AT 250 WORDS)

Angiography↗
PubMed1985

Radionuclide ventriculography for evaluation and prevention of doxorubicin cardiotoxicity.

Chemotherapy with doxorubicin often leads to congestive heart failure, particularly after cumulative doses of 550 mg/m2 have been reached. Certain risk factors, however, may predispose the patient to development of cardiomyopathy at lower doses. Radionuclide ventriculography with determinations of resting and exercise ejection fractions has emerged as the most reliable noninvasive screening procedure to detect subclinical cardiotoxicity. Before embarking on a course of doxorubicin therapy, patients should be stratified into low-risk and high-risk groups. Those in the high-risk group should undergo frequent monitoring by means of radionuclide ventriculography. For patients in the low-risk group, such monitoring could be postponed until they are ready to cross into the high-risk group by virtue of cumulative doxorubicin dose. Doxorubicin should be discontinued if the ejection fraction drops to less than or equal to 45% at rest or fails to increase with exercise.

Doxorubicin↗
PubMed1984

Exercise radionuclide ventriculographic responses in hypertensive patients with chest pain.

The effectiveness of exercise-treadmill testing in diagnosing coronary-artery disease in hypertensive patients is limited by a high rate of false positivity. Exercise radionuclide ventriculography, however, relies on different criteria (ejection fraction and wall motion), and we have evaluated this procedure in 37 hypertensive and 109 normotensive patients with chest pain, using coronary arteriography as an indicator of coronary disease. In the hypertensive cohort there was no difference in the ejection fraction at rest between the 17 patients with coronary disease and the 20 without it. Neither group had a significant mean (+/- S.E.M.) change in ejection fraction from rest to exercise (-1.9 +/- 2 and - 1.4 +/- 1 per cent, respectively). A wall-motion abnormality developed during exercise in 5 of the 17 hypertensive patients with coronary disease (29 per cent) and in 4 of the 20 without it (20 per cent) (P = not significant). In the normotensive cohort, however, the peak-exercise ejection fractions were significantly different. The 71 patients with coronary disease had a mean decrease of 3.6 +/- 1 per cent, in contrast to the patients without coronary disease, who had an increase of 6 +/- 1 per cent (P less than 0.001). An exercise-induced wall-motion abnormality was seen in 35 of the 71 patients with coronary disease (48 per cent), as compared with 3 of the 38 without it, (8 per cent) (P less than 0.001). We conclude that exercise radionuclide ventriculography is inadequate as a screening test for coronary atherosclerosis in hypertensive patients with chest pain.

Adult↗
PubMed1984

Detection of left ventricular wall motion abnormalities for the diagnosis of coronary artery disease: a comparison of exercise radionuclide and pacing intravenous digital ventriculography.

Intravenous digital ventriculography before and after pacing was compared with equilibrium gated nuclear ventriculography at rest and after exercise. Specifically, the relative abilities of the 2 techniques to detect resting and stress-related wall motion abnormalities were tested. Twelve normal patients and 28 patients with coronary artery disease (CAD) were tested. Neither technique produced a new wall motion abnormality in a patient with normal coronary arteries. Six patients with CAD had a history of a myocardial infarction (MI); an abnormality at rest was present in all 6 by both techniques. Of the 22 patients with CAD and a normal baseline ventriculogram, a wall motion abnormality developed in 18 during digital ventriculography with pacing; a wall motion abnormality developed in 15 with exercise nuclear ventriculography. Wall motion abnormalities by nuclear ventriculography (performed in the left anterior oblique projection) tended to be apical; digital ventriculography (performed in the right anterior oblique projection) more often produced an abnormality of the anterior or inferior wall, which could be predictive of coronary anatomy. Thus, the 2 techniques are substantially equivalent for the detection of wall motion abnormalities in CAD.

Adult↗
PubMed1984

A randomized, angiographically controlled trial of intracoronary streptokinase in acute myocardial infarction.

Fifty-five patients with acute myocardial infarction evaluated within 4 hours of the onset of symptoms were entered into an angiographically controlled trial of intracoronary streptokinase (IC STK). Forty-three patients with total occlusion of their infarct artery were randomized to either IC STK or intracoronary nitroglycerin (IC NTG), and 12 patients with less-than-complete occlusion received only IC NTG. Reperfusion of a totally occluded vessel was achieved in 69% of STK patients and 17% of IC NTG patients. Time from onset of symptoms to peak CK activity was significantly shorter in reperfused patients and patients with subtotal occlusion on initial angiography than in patients with total occlusion who were not reperfused (p less than 0.0001). Comparison of radionuclide ejection fractions (EF) determined acutely and 10 to 14 days after infarction failed to show improvement in either the STK or IC NTG group (mean decrease of 2.8% and 0.4%, respectively). In contrast, patients with subtotal occlusion on baseline angiography demonstrated a significant (p = 0.05) spontaneous improvement in EF over 2 weeks (7.3% increase).

Aged↗
PubMed1984

Intraoperative retrograde balloon-catheter dilatation to augment myocardial revascularization.

When bypass graft surgery is planned, it is appreciated that sequential coronary artery stenoses often entrap the origins of arterial branches that have a significant, but subgraftable, diameter. These branches are routinely not perfused by saphenous vein grafts implanted beyond the second lesion. Data are presented on improving perfusion of such branches in 26 patients by the technique of retrograde intraoperative balloon-catheter dilatation. During coronary artery surgery, specially designed angioplasty catheters, 2 to 3 mm in diameter, were introduced through the coronary arteriotomy and passed retrogradely across the distal lesion. Balloon inflation was performed two to four times at 4 to 7 atm. Lesion size was assessed before and after angioplasty with the use of graduated coronary probes. Probe-determined lesion diameter increased from 1.1 +/- 0.4 to 2.0 +/- 0.4 mm (percent increase, 109 +/- 8). In selected patients, intraoperative balloon-catheter dilatation is a promising technique adjunctive to coronary surgery. Clinical significance and long-term effectiveness of this procedure require further evaluation.

Aged↗
PubMed1984

Temporal evolution of the human coronary collateral circulation after myocardial infarction.

An analysis of the coronary collateral circulation in a consecutive series of 116 postinfarction angiograms from patients with persistent 100% occlusion of their infarct artery is reported. Patients were classified into four groups according to the interval between acute infarction and angiography. Of 42 patients studied within 6 hours of infarction (Group I), 52% had no evidence of any coronary collateral development as compared with only 8% (1 of 16 patients) studied 1 day to 2 weeks after infarction (Group II). Virtually all patients studied beyond 2 weeks after myocardial infarction (14 to 45 days, Group III) and later than 45 days (Group IV) had visible collateral flow. Angiographically "well developed" collateral channels were seen in only 16% of Group I patients compared with 62, 75 and 84% of patients in Groups II to IV, respectively. Of six patients studied twice, on the day of the infarction and 2 weeks later, only one patient had collateral vessels on the day of infarction, whereas all six patients did at follow-up study. Group I patients were studied as part of a randomized acute myocardial infarction reperfusion trial, whereas the other patients were referred for angiography primarily because of post-infarction ischemia. Within the limitations imposed by the patient selection process, it is concluded that well developed coronary collateral vessels are rarely present at the time of infarction. After infarction, they develop rapidly and are generally demonstrable within 2 weeks. It may also be inferred that the preservation of ischemic myocardium by well developed coronary collateral vessels at the time of myocardial infarction may be an uncommon occurrence.

Collateral Circulation↗
PubMed1983

Anterior ST segment depression during acute inferior myocardial infarction: evidence for the reciprocal change theory.

We evaluated the recently proposed concern that ECG anterior ST segment depression in patients with acute inferior wall myocardial infarction represents an additional area of ischemia and therefore implies worsened prognosis. We studied patients enrolled in the Aspirin Myocardial Infarction Study (AMIS), ages 30 to 69 years, who sustained an inferior myocardial infarction within 6 months from the start of the study. Two hundred nineteen patients who met those criteria were followed for an average of 38.2 months. One hundred ten patients had significant anterior lead ST depression (greater than or equal to 0.1 mV) during their acute inferior infarction and their 3-year mortality rate was 9.1%. One hundred nine patients had no anterior ST abnormality and a mortality rate of 10.1% (p = ns). Only one patient with significant depression had a subsequent anterior wall myocardial infarction. Anterior ST depression correlated closely with the magnitude of inferior ST segment elevation. Since ST depression does not alter long-term mortality but relates to magnitude of ST elevation, it probably represents a reciprocal change.

Adult↗
PubMed1983

Intravenous digital left ventriculography at rest and with atrial pacing as a screening procedure for coronary artery disease.

Digital subtraction left ventriculography using intravenous contrast injection was evaluated as a screening diagnostic method for coronary heart disease. Intravenous ventriculography was performed in 61 patients with 35 cc of contrast medium injected into a central vein (usually the inferior vena cava). Recognition of regional wall motion abnormalities by this technique was shown to be comparable with direct left ventriculography in 40 patients who underwent both imaging modalities at rest. If the rest digital ventriculogram was normal, it was repeated after incremental atrial pacing to the onset of chest pain or to a maximal heart rate of 150 beats/min. Forty-four of the 61 patients had significant coronary artery disease, of whom 10 had a wall motion abnormality at rest on intravenous ventriculography. With pacing, 28 of the 34 remaining patients developed a new wall motion abnormality. Thus, 38 (86%) of 44 patients with coronary heart disease were identified by wall motion abnormalities. One of the 17 patients without coronary artery disease had an abnormal rest study and was incorrectly assigned a diagnosis of coronary disease. Intravenous digital ventriculograms approximate those obtained by direct ventriculography. When combined with atrial pacing they are a sensitive and specific means of detecting coronary artery disease.

Adult↗