Comparison of incidence of cardiac rupture among patients with acute myocardial infarction treated by thrombolysis versus percutaneous transluminal coronary angioplasty.
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Aged↗
Biomedical subjects
A Solodky
Publications and source records attributed to A Solodky.
Insulin resistance is increased by transdermal estrogen therapy in postmenopausal women with cardiac syndrome X.
Estrogen has been reported to have both short- and long-term effects on the cardiovascular system. However, it remains to be examined how short-term transdermal estrogen therapy (TET) affects insulin sensitivity (SI) in patients with cardiac syndrome X (CSX), who are characterized by elevated insulin resistance. SI was assessed in a randomized, double-blind, placebo-controlled crossover study by minimal model analysis in seven postmenopausal women with CSX treated by TET. SI decreased by 32 +/- 8.3%, from 5.94 +/- 1.14 at baseline to 3.61 +/- 0.40 [(10(-4) x min(-1))/(microU/ml)] during TET (p = 0.03). Time to the onset of symptoms increased from 414.2 +/- 51.0 s at baseline to 450.0 +/- 53.2 s (p = 0.04). We conclude that TET increases SI in postmenopausal women with CSX. This effect is unrelated to the beneficial anti-ischemic effects on exercise duration.
Analysis of Variance↗
Relation between evolutionary ST segment and T-wave direction and electrocardiographic prediction of mycardial infarct size and left ventricular function among patients with anterior wall Q-wave acute myocardial infarction who received reperfusion therapy.
In the prethrombolytic era it was found that infarct size and left ventricular ejection fraction could be predicted using the Selvester QRS score. We evaluated whether infarct size and left ventricular ejection fraction could be predicted by the predischarge QRS score in patients who had received reperfusion therapy and whether considering the configuration of the ST segments and T waves would increase the accuracy of these predictions. We evaluated 51 patients with first anterior wall myocardial infarction who had received reperfusion therapy and predischarge resting technetium-99m-sestamibi scan. The electrocardiograms recorded on the same day of the scan were analyzed for the QRS score and were divided into 3 groups: A, isoelectric ST and negative T waves; B, ST elevation (> or =0.1 mV) and negative T waves; and C, ST elevation (> or =0.1 mV) and positive T waves. Groups A, B, and C included 12, 23, and 16 patients, respectively. The myocardial perfusion defect extent increased from groups A to C (median 21%, 37%, and 43.5% in groups A, B, and C, respectively; p = 0.023). Similarly, left ventricular ejection fraction decreased (44%, 38%, and 34%, respectively; p = 0.042) from groups A to C. Overall, the correlation between the QRS score and the myocardial perfusion defect extent (rho 0.249; p = 0.08) and ejection fraction (rho -0.229; p = 0.11) was poor. A statistically significant correlation between myocardial perfusion defect size and QRS score was found only in group A (rho 0.599, p = 0.04). Among patients with anterior myocardial infarction who received reperfusion therapy, the predischarge QRS score was predictive of infarct size only in those in whom ST elevation resolved completely. In patients with residual ST elevation there was no correlation between QRS score and infarct size.
Angioplasty, Balloon, Coronary↗
Coronary stenting without predilatation (SWOP): applicable technique in everyday practice.
To evaluate the feasibility of stenting without predilatation, we registered all interventional procedures over a 6-month period. Six hundred patients were registered, and 684 lesions were treated. Interventions were divided into four groups: stenting without predilatation (SWOP), 221 lesions (32.4%); primary stenting with predilatation (PDS), 161 lesions (23.5%); provisional stenting (PRS), 131 lesions (19.2%); and plain-old balloon angioplasty (POBA), 171 lesions (25%). Interventional strategy was at the discretion of the operator based on few simple angiographic criteria and his clinical judgment. Procedural success was similar in all stent groups. We conclude that when primary stenting is planned, about 60% of lesions can be treated by SWOP effectively with excellent procedural results and considerable cost saving.
Adult↗
Coronary air embolism treated by bubble aspiration.
We describe a case of coronary air embolism following cardiac catheterization, with all the signs and symptoms of an acute coronary event. Thanks to the rapid and effective aspiration of the air bubble from the distal artery, blood flow was restored and the clinical picture was resolved.
Angioplasty, Balloon, Coronary↗
Persistent ST segment depression in precordial leads V5-V6 after Q-wave anterior wall myocardial infarction is associated with restrictive physiology of the left ventricle.
OBJECTIVES: To examine the relationship between the persistence of ST segment depression in leads V5-V6 after Q-wave anterior wall myocardial infarction (MI) and the filling pattern of the left ventricle (LV). BACKGROUND: Precordial ST segment depression predominantly in leads V5-V6 is associated with increased in-hospital morbidity and mortality after acute myocardial ischemia, perhaps due to reduced diastolic distensibility of the LV. METHODS: We prospectively studied 19 patients after Q-wave anterior wall MI (>6 months). All patients underwent 12-lead ECG recording, symptom-limited treadmill exercise testing with single photon emission computed tomography thallium-201 imaging, transthoracic Doppler echocardiography, cardiac catheterization and measurement of circulating atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) levels. Patients were classified based on the presence of ST segment depression in leads V5-V6: Group I = ST segment depression <0.1 mV (n = 10); Group II = ST segment depression > or =0.1 mV (n = 9). RESULTS: Patients in Group II had greater LV end diastolic pressures (32.4 +/- 6.5 mm Hg vs. 14.8 +/- 6.1 mm Hg; p = 0.0001), higher plasma ANP (44.4 +/- 47.1 pg/ml vs. 10.7 +/- 14 pg/ml; p = 0.04) and BNP levels (89.4 +/- 62.7 pg/ml vs. 23.6 +/- 33.1 pg/ml; p = 0.01), greater left atrium area (20.6 +/- 3.1 cm2 vs. 17.8 +/- 2.4 cm2; p = 0.05), lower peak atrial (A), higher early (E) mitral inflow velocities, a higher E/A ratio and a lower deceleration time (167 +/- 44 ms vs. 220 +/- 40 ms; p = 0.05). Lung thallium uptake during exercise was more common in Group II (78% vs. 10%, p = 0.04). CONCLUSIONS: Persistent ST segment depression in leads V5-V6 in survivors of Q-wave anterior wall MI is associated with increased LV filling pressure and a restrictive LV filling pattern.
Atrial Natriuretic Factor↗
Correlation between electrocardiographic subtypes of anterior myocardial infarction and regional abnormalities of wall motion.
BACKGROUND: Examination of the electrocardiogram is the most widely used means for diagnosis and early stratification of risk of acute myocardial infarction (AMI). The classical classification of the subtypes of anterior AMI is based on results of studies comparing the electrocardiograms recorded at various stages, mostly in the subacute or chronic stage of AMI, with autopsy findings. Reports regarding the correlation between electrocardiographic findings in the acute phase and regional abnormality of wall motion (AWM) detected by echocardiographic evaluation are sparse. OBJECTIVE: To investigate the relationship between the electrocardiographic and two-dimensional echocardiographic findings regarding patients with their first anterior AMI. DESIGN AND METHODS: We studied 58 patients, 44 men and 14 women of mean age 61.5 +/- 14.6 years, with their first anterior AMI who had undergone two-dimensional echocardiographic evaluation within 48 h of admission. Deviation of ST-segment trace from baseline was measured manually 0.06 s after the J point for all leads on the admission electrocardiogram. ST-segment elevation in the various leads was correlated to the incidence of regional AWM detected by echocardiography. RESULTS: ST-segment elevations > or = 0.1 mV in V1 leads were found for 21 (36.2%) patients. Basal anterior, basal anteroseptal, and basal septal AWM were seen more often for patients with than they were for patients without ST-segment elevation in V1 (57 versus 16%, P=0.003; 43 versus 13.5%, P=0.03; 43 versus 11%, P=0.01 respectively). In contrast to ST-segment elevation in lead V1, the only statistically significant difference in prevalence in the presence of regional AWM between patients with (n = 48) and without (n = 10) ST-segment elevation > or = 0.2 mV in lead V2 was in the inferoapical region (87.5 versus 40%; P=0.003). ST-segment elevation > or = 0.1 mV in leads aVL and V5 was found for 11 (19%) and 23 (40%) patients, respectively. There was no correlation between either lateral or apical regional AWM and the presence of ST-segment elevation in the anterolateral leads except for mid-lateral AWM, which was more often detected for patients with than it was for patients without ST-segment elevation in aVL leads (36.3 versus 6.4%, P=0.026). CONCLUSIONS: ST-segment elevation in lead V1 during the acute phase of anterior AMI is associated with a high incidence of regional AWM in the basal anterior, anteroseptal, and anterior regions, whereas ST-segment elevation in lead V2 is more often associated with AWM in the inferoapical region. ST-segment elevation in aVL leads is related to mid-lateral regional AWM.
Echocardiography↗
Correlation of predischarge electrocardiographic patterns with left ventricular function in patients with anterior wall myocardial infarction.
The aim of this prospective study was to assess the correlation between different predischarge electrocardiographic patterns and left ventricular function, evaluated by physical examination and echocardiography, in patients with first Q wave anterior acute myocardial infarction. A positive correlation was found between the electrocardiographic pattern and wall motion score assessed by echocardiography, reflecting a gradual worsening in left ventricular function among the different patterns. Patients with an isoelectric ST segment and negative T waves had a 73% decrease in the risk of clinical heart failure compared to those who continued to have ST elevation. Thus, a predischarge electrocardiogram can be used as a simple, noninvasive method for the risk stratification of patients with acute myocardial infarction.
Adult↗
Correlation between the admission electrocardiogram and regional wall motion abnormalities as detected by echocardiography in anterior acute myocardial infarction.
We correlated ST elevation in various leads on admission and regional dysfunction in 132 patient with first anterior acute myocardial infarction using echocardiography. ST elevation in leads I and a VL and II, III and aVF was not associated with a specific pattern of regional dysfunction. Basal anterior and septal regional dysfunction were seen more often in patients with ST elevation in V1 (49 vs. 25%, p = 0.006; 35 vs. 17%, p = 0.048, respectively). Patients with ST elevation in V2 had more regional dysfunction of the apical inferior region (84 vs. 53%; p = 0.01). ST elevation in V5 and V6 was not associated with more apical or lateral wall motion abnormalities. ST elevation in lead V1 in anterior myocardial infarction is associated with a high incidence of regional dysfunction of the basal anterior, anteroseptal and septal regions.
Aged↗
Electrocardiographic criteria for predicting the culprit artery in inferior wall acute myocardial infarction.
Two patterns of the QRS complex in the lateral lead aVL on the admission electrocardiograms of patients with inferior wall acute myocardial infarction (AMI) were correlated with the culprit artery. S/R wave ratio < or =1/3 with ST depression < or =1 mm was found to be a sensitive and specific marker for left circumflex artery AMI, whereas S/R-wave ratio >1/3 with ST-segment depression >1 mm was suggestive of right coronary artery AMI.
Cineangiography↗
Effectiveness of coronary stent deployment without predilation.
The feasibility of coronary stenting without predilation is demonstrated in 240 patients. In all, 249 stents were placed. Primary implantation was successful in 93% of cases. In 17 lesions the stents could not be advanced through the stenotic lesion. The unexpanded stents were removed through the guiding catheter, and stenting was performed after prediction. Minor complications (side branch compromise and intimal dissection), which were successfully treated, occurred in 26 patients (10.6%).
Angioplasty, Balloon, Coronary↗
Double-blind, placebo-controlled study to evaluate the effect of organic nitrates in patients with chronic heart failure treated with angiotensin-converting enzyme inhibition.
BACKGROUND: Organic nitrates are widely used in the treatment of chronic heart failure (CHF). No information, however, is available regarding their effect in patients already treated with ACE inhibitors. METHODS AND RESULTS: In a randomized, double-blind, crossover design, we studied the effects of high-dose (50 to 100 mg) transdermal nitroglycerin (NTG) and placebo given daily for 12 hours in 29 patients with CHF (NYHA functional classes II to III). Exercise time (4 hours after patch application) showed a progressive improvement during NTG administration, with an increase of 38+/-35 seconds (9+/-7%) at the end of the first month (P=NS), 76+/-28 seconds (16+/-6%) at the end of the second month (P=0.01), and 117+/-34 seconds (27+/-6%) at the end of the third month (P=0.003). No significant change was seen during placebo administration (12+/-20, 5+/-26, and 19+/-28 seconds, all P=NS). Exercise time 8 hours after NTG application measured at 3 months was also significantly longer, with a difference of 87+/-28 seconds (P=0.006), but not with placebo (23+/-36 seconds, P=0.53). Assessment of quality of life and need for additional diuretics or hospitalizations for CHF failed to demonstrate a significant difference between the 2 treatment periods. In contrast, NTG decreased left ventricular end-diastolic (-2.1+/-0.1%, P<0.05) and end-systolic (-3.2+/-1.3%, P<0.05) dimensions and augmented LV fractional shortening (24.7+/-10.5%, P<0.03). The effect of placebo on these parameters was not statistically significant. CONCLUSION: High-dose nitrate therapy significantly improves exercise tolerance and left ventricular size and systolic function in patients with chronic, mild to moderate CHF already treated with ACE inhibitors. These findings support the role of organic nitrates as an adjunctive therapy to ACE inhibitors in patients with chronic CHF.
Angiotensin-Converting Enzyme Inhibitors↗
Coronary artery-main pulmonary artery fistula.
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Aged↗
Coronary stent deployment without predilation in acute myocardial infarction: a feasible, safe, and effective technique.
Direct percutaneous transcatheter revascularization (PTCR) is becoming an acceptable therapy for acute myocardial infarction (AMI). Stenting in the setting of AMI, once considered contraindicated, is emerging as a suitable option in this situation. Coronary stenting without predilation (SWOP) may potentially shorten the procedure and radiation time, reduce costs, and decrease procedural complications such as coronary dissection and distal embolization. It is expected to cause less vascular injury, with a reduction in the rate of in-stent restenosis. In this preliminary study the authors evaluated the feasibility of the SWOP procedure in 22 selected patients with AMI. Indications for catheter-based myocardial reperfusion were the following: extensive anterior wall MI (68%), inferior wall and right ventricular MI (23%), and inferior wall MI with contraindication for thrombolytic therapy (9%). Patients with cardiogenic shock or with contraindications for aspirin or ticlopidine were excluded. SWOP was successful in 21 attempts (95%), and final procedural success was achieved in all. Proximal or distal dissections were seen in three cases and were treated by additional three stents. Thrombolysis in myocardial infarction (TIMI) flow 3 was restored in all patients. There were no distal embolizations, side branch occlusions, coronary perforations, procedure-related emergency bypass operations, or deaths. It is concluded that in selected patients with AMI, coronary artery stenting without predilation is feasible and safe and does not introduce additional risk to the patients.
Adult↗
Comparison of patients with inferior wall acute myocardial infarction with versus without ST-segment elevation in leads V5 and V6.
One hundred forty-one patients with first acute inferior wall myocardial infarction were examined. ST-segment elevation in precordial leads V5 to V6 was found in 34; 94% of them had "mega-artery" compared with 2% in those without ST-segment elevation in precordial leads V5 to V6.
Aged↗
Acute anterior wall myocardial infarction entailing ST-segment elevation in lead V1: electrocardiographic and angiographic correlations.
BACKGROUND: The correlation between ST elevation in lead V1 during anterior wall acute myocardial infarction (AMI) and the culprit lesion site in the left anterior descending (LAD) coronary artery is poor. HYPOTHESIS: The study was undertaken to assess the electrocardiographic (ECG) characteristics and angiographic significance of ST-segment elevation in lead V1 during anterior wall acute myocardial infarction (AMI). METHODS: Data from 115 patients with anterior wall AMI, who underwent coronary angiography within 14 days of hospitalization, were studied. The admission 12-lead ECG was examined and the coronary angiogram was evaluated for the nature of the conal branch of the right coronary artery (RCA) and for the culprit lesion site in the left anterior descending (LAD) coronary artery. RESULTS: Mean ST-segment deviation and the frequency of patients with ST-segment elevation > 0.1 mV were significantly lower in lead V1 than in lead V2 (0.136 +/- 0.111 mV vs. 0.421 +/- 0.260 mV, and 37 vs. 96%, for leads V1 and V2, respectively). A small conal branch not reaching the interventricular septum (IVS) was more prevalent among patients with ST-segment elevation > 0.1 mV in lead V1 (67%), whereas a large conal branch was more prevalent in patients with ST-segment deviation (1 mV in that lead (83%, p < 0.001). No relation was found between ST-segment deviation in lead V1 during anterior wall AMI and the culprit lesion site in the LAD. CONCLUSION: ST-segment elevation in lead V1 during first anterior wall AMI was found in one third of the patients, and its magnitude was lower than that in the other precordial leads. ST-segment elevation in lead V1 favors the presence of a small conal branch of the RCA that does not reach the IVS.
Aged↗
Value of T-wave direction with lead III ST-segment depression in acute anterior wall myocardial infarction: electrocardiographic prediction of a "wrapped" left anterior descending artery.
BACKGROUND: Lead III ST-segment depression during acute anterior wall myocardial infarction (AMI) has been attributed to reciprocal changes. However, the value of the T-wave direction (positive or negative) in predicting the site of obstruction and type of the left anterior descending (LAD) artery is not clear and has not been studied before. HYPOTHESIS: The aim of the study was to assess retrospectively the correlation between two patterns of lead III ST-segment depression, and type of LAD artery and its level of obstruction during first AMI. METHODS: The study group consisted of 48 consecutive patients, admitted to the coronary care unit for first AMI, who showed ST-segment elevation in lead a VL and ST-segment depression in lead III on admission 12-lead electrocardiogram. The patients were divided by T-wave direction into Group 1 (n = 31), negative T wave, and Group 2 (n = 17), positive T wave. The coronary angiogram was evaluated for type of LAD ("wrapped", i.e., surrounding the apex or not), site of obstruction (pre- or postdiagonal branch), and other significant coronary artery obstructions. RESULTS: Mean lead III ST-segment depression was 1.99 +/- 1.32 mm in Group 1 and 1.13 +/- 0.74 mm in Group 2 (p = 0.004); mean ST-segment elevation in a VL was 1.35 +/- 0.84 mm and 1.23 +/- 0.5 mm, respectively (p = 0.5). A wrapped LAD was found in 12 patients (38.7%) in Group 1 and in 13 in Group 2 (76.4%) (p = 0.02). The sensitivity of lead III ST-segment depression with positive T wave to predict a wrapped LAD was 52%, and the specificity was 82% with a positive predictive value of 76%. On angiography, 25 patients (80%) in Group 1 and 13 (76%) in Group 2 had prediagonal occlusion of the LAD (p = 0.77). No significant difference between groups was found for right and circumflex coronary artery involvement or incidence of multivessel disease. CONCLUSIONS: The presence of lead III ST-segment depression with positive T wave associated with ST-segment elevation in a VL in the early course of AMI can serve as an early electrocardiographic marker of prediagonal occlusion of a "wrapped" LAD.
Case-Control Studies↗
Early development of high-degree atrioventricular block in inferior acute myocardial infarction is predicted by a J-point/R-wave ratio above 0.5 on admission.
This study assessed the ability of simple clinical and electrocardiographic (ECG) variables routinely obtained on admission to identify patients with inferior myocardial infarction who are at high risk of developing high-degree atrioventricular (AV) block within the first 24 h of hospitalization in 205 patients. The admission ECGs were classified into two patterns based on the J-point to R-wave amplitude ratio: pattern 1: those with J-point/R-wave ratio <0.5; pattern 2: patients with J-point/R-wave ratio >/=0.5 in >/=2 inferior leads (II, III and aVF). High-degree AV block was found in 10.2% of the patients (21 of 205 patients; 5 and 16% of the patients with initial patterns 1 and 2, respectively, p = 0.014). Multivariate logistic regression analysis revealed that the only variables independently associated with high-degree AV block were the initial ECG pattern 2 versus 1 (odds ratio, OR, 4.47, 95% confidence interval, CI, 1.18-16.9; p = 0.0276), age (OR 1.06, 95% CI 1.01-1.12; p = 0.0254); Killip class >1 (OR 2.33, CI 0.83-6. 54; p = 0.1065) and thrombolytic therapy (OR 0.32, 95% CI 0.11-0.93; p = 0.037).
Adult↗