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C Richard Conti

Publications and source records attributed to C Richard Conti.

At least 19 recordsLinked to original sources
PubMed2006

Enhanced external counterpulsation treatment improves arterial wall properties and wave reflection characteristics in patients with refractory angina.

OBJECTIVES: To determine if arterial properties and wave reflection characteristics are favorably altered after enhanced external counterpulsation (EECP) treatment in patients with refractory angina. BACKGROUND: Early return of reflected waves from the lower body, resulting from increased arterial stiffness, augments central aortic pressure and increases left ventricular (LV) afterload and myocardial oxygen demand. EECP acutely enhances coronary perfusion (supply) and reduces LV afterload (demand). However, the mechanisms responsible for the sustained beneficial effects of EECP treatment are unclear. METHODS: Radial artery pressure waveforms were recorded by applanation tonometry and central aortic pressure waveforms generated using a mathematical transfer function in 20 patients with stable refractory angina. Data were collected before and after 34 1-h EECP sessions. Augmentation index (AI(a)) and timing of the reflected pressure wave were calculated from the aortic waveform. RESULTS: EECP treatment caused a decline in AI(a) and an increase in reflected wave travel time. These modifications in wave reflection characteristics caused a decrease in aortic systolic pressure and wasted LV pressure energy. The average number of angina episodes and Canadian Cardiovascular Society (CCS) class, both decreased in concordance with the physiologic changes due to EECP treatment. CONCLUSIONS: EECP treatment reduces arterial stiffness and improves wave reflection characteristics in patients with refractory angina. These changes decrease LV afterload and myocardial oxygen demand and reduce the number of angina episodes, therefore enabling patients to participate in continuous exercise programs which in turn may provide long-term benefits and sustained improved quality of life.

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PubMed2006

Dogma disputed: can aggressively lowering blood pressure in hypertensive patients with coronary artery disease be dangerous?

BACKGROUND: Because coronary perfusion occurs mainly during diastole, patients with coronary artery disease (CAD) could be at increased risk for coronary events if diastolic pressure falls below critical levels. OBJECTIVE: To determine whether low blood pressure could be associated with excess mortality and morbidity in this population. DESIGN: A secondary analysis of data from the International Verapamil-Trandolapril Study (INVEST), which was conducted from September 1997 to February 2003. SETTING: 862 sites in 14 countries. PATIENTS: 22 576 patients with hypertension and CAD. INTERVENTIONS: Patients from INVEST were randomly assigned to a verapamil sustained-release- or atenolol-based strategy; blood pressure control and outcomes were equivalent. MEASUREMENTS: An unadjusted quadratic proportional hazards model was used to evaluate the relationship between average on-treatment blood pressure and risk for the primary outcome (all-cause death, nonfatal stroke, and nonfatal myocardial infarction [MI]), all-cause death, total MI, and total stroke. A second model adjusted for differences in baseline covariates. RESULTS: The relationship between blood pressure and the primary outcome, all-cause death, and total MI was J-shaped, particularly for diastolic pressure, with a nadir at 119/84 mm Hg. After adjustment, the J-shaped relationship persisted between diastolic pressure and primary outcome. The MI-stroke ratio remained constant over a wide blood pressure range, but at a lower diastolic blood pressure, there were substantially more MIs than strokes. An interaction between decreased diastolic pressure and history of revascularization was observed; low diastolic pressure was associated with a relatively lower risk for the primary outcome in patients with revascularization than in those without revascularization. LIMITATIONS: This is a post hoc analysis of hypertensive patients with CAD. CONCLUSIONS: The risk for the primary outcome, all-cause death, and MI, but not stroke, progressively increased with low diastolic blood pressure. Excessive reduction in diastolic pressure should be avoided in patients with CAD who are being treated for hypertension.

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PubMed2006

Predictors of adverse outcome among patients with hypertension and coronary artery disease.

OBJECTIVES: We sought to determine predictors for adverse outcomes in hypertensive patients with coronary artery disease (CAD). BACKGROUND: Factors leading to adverse outcomes in hypertensive patients with CAD are poorly understood. The INternational VErapamil-trandolapril STudy (INVEST) compared outcomes in hypertensive patients with CAD that were assigned randomly to either a verapamil sustained-release (SR)- or an atenolol-based strategy for blood pressure (BP) control. Trandolapril and hydrochlorothiazide were used as added agents. During follow-up (61,835 patient-years), BP control and the primary outcome (death, nonfatal myocardial infarction, and nonfatal stroke) were not different between strategies. METHODS: We investigated risk for adverse outcome associated with baseline factors, follow-up BP, and drug treatments using Cox modeling. RESULTS: Previous heart failure (adjusted hazard ratio [HR] 1.96), as well as diabetes (HR 1.77), increased age (HR 1.63), U.S. residency (HR 1.61), renal impairment (HR 1.50), stroke/transient ischemic attack (HR 1.43), smoking (HR 1.41), myocardial infarction (HR 1.34), peripheral vascular disease (HR 1.27), and revascularization (HR 1.15) predicted increased risk. Follow-up systolic BP <140 mm Hg or diastolic BP <90 mm Hg (HRs 0.82 or 0.70, respectively) and trandolapril with verapamil SR (HRs 0.78 and 0.79) were associated with reduced risk. CONCLUSIONS: In hypertensive patients with CAD, increased risk for adverse outcomes was associated with conditions related to the severity of CAD and diminished left ventricular function. Lower follow-up BP and addition of trandolapril to verapamil SR each were associated with reduced risk.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed2006

Four left ventricular apical abnormalities.

This editorial reviews the clinical presentation, electrocardiographic manifestations, appearance of the left ventricle by imaging techniques, and the state of the coronary arteries in four left ventricular apical abnormalities (Table I). Three of these conditions, namely, noncompaction, apical hypertrophy, and left ventricle aneurysm, can be somewhat malignant. The fourth condition--tako-tsubo--is generally benign. Treatment depends on the clinical condition of the patient.

Cardiomegaly↗
PubMed2006

Heart hospice.

Explore the source record for details and available documents.

Cardiovascular Diseases↗
PubMed2006

Cardiac resynchronization therapy for chronic heart failure: why does it not always work?

Since coronary angiography and ventriculography are performed in all of these patients with LV dysfunction and symptoms of heart failure, it seems silly to waste the opportunity to study this technique and its value in identifying patients who will respond to CRT, at least in the immediate post-CRT state. The critical factors that may result in a successful long-term positive result of CRT in patients with optimal device programming and optimized medical therapy for heart failure are these: (1) Venous anatomy suitable for electrical stimulation of the LV free wall. (2) Viable myocardium in the septum and the LV free wall. (3) Adequate perfusion of the microcirculation in the distribution where the leads are being placed.

Cardiac Pacing, Artificial↗
PubMed2006

Inherited long QT syndrome: phenotype and therapy to use and avoid.

Patients with long QT syndrome are most commonly of three types. It is important to understand several points about this potentially lethal syndrome: 1. What precipitates the syndrome? 2. What channelopathies are involved? 3. What are the characteristic T-wave abnormalities seen in patients with long QT syndrome? 4. What therapy should be initiated? 5. Who needs an ICD? Table I summarizes several key features of the different long QT syndromes.

Acetanilides↗
PubMed2006

Treatment options for refractory angina in patients who are not candidates for revascularization.

Patients with refractory angina are those for whom medical therapy has failed to eradicate the angina completely and who have persistent symptoms that are stable but limit their activities of daily living. Approach to management must include the elimination of the secondary causes of this condition and maximum medical therapy, and if angina persists, the consideration of other strategies. Controversy exists regarding the value of transmural myocardial laser revascularization. Enhanced external counterpulsation is clinically effective in approximately 70% of patients. Spinal cord stimulation is not being used clinically in the United States. In the United States, it is still an investigational procedure that is currently being evaluated prospectively in a randomized trial. Ranolazine, an inhibitor of sodium-dependent calcium overload, may prove to be useful in patients with refractory angina.

Acetanilides↗
PubMed2006

Blood pressure control and cardiovascular outcomes in high-risk Hispanic patients--findings from the International Verapamil SR/Trandolapril Study (INVEST).

BACKGROUND: People of Hispanic origin are the fastest growing ethnic minority in the United States and often have hypertension and other comorbidities which increase the risk associated with coronary artery disease (CAD). METHODS AND RESULTS: An analysis of the 8045 Hispanic patients enrolled in INVEST was conducted, and comparisons were made to the 14,531 non-Hispanic patients. INVEST was a prospective, randomized, open, blinded end point study in CAD patients with hypertension. After 61,835 patient-years of follow-up, treatment with either a verapamil sustained release (SR) or atenolol antihypertensive strategy resulted in greater blood pressure control in Hispanic patients, and Hispanic patients were at significantly lower risk of experiencing a nonfatal myocardial infarction, nonfatal stroke, or death (hazard ratio [HR] 0.87, 95% CI 0.78-0.97). Hispanic ethnicity was associated with an increase (HR 1.19, 95% CI 1.04-1.36), and randomization to the verapamil SR strategy was associated with a decrease (HR 0.85, 95% CI 0.76-0.95), in the risk of new-onset diabetes. Use of trandolapril in the verapamil SR strategy was associated with reduced risk of new-onset diabetes, whereas increasing doses of atenolol and hydrochlorothiazide in the atenolol strategy were associated with increased risk of new-onset diabetes. CONCLUSIONS: The Hispanic cohort of INVEST had better blood pressure control and lower risk of adverse cardiovascular outcomes compared with the non-Hispanic cohort. A verapamil SR strategy is an alternative to an atenolol strategy for the treatment of Hispanic patients with hypertension and CAD and can reduce the risk of new-onset diabetes.

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PubMed2006

An academic-community cardiovascular service line affiliation: design, implementation, and performance.

Both affiliation with an academic medical center and implementation of service line management may be effective management strategies for community health care organizations. The authors describe the design, implementation, and performance of a unique combination of these two distinct strategies for cardiovascular program development in the affiliation of the University of Florida Health Science Center with Health First, a regional community-based integrated delivery system.

Academic Medical Centers↗
PubMed2005

Use of cardiac resynchronization therapy to optimize beta-blocker therapy in patients with heart failure and prolonged QRS duration.

A retrospective analysis was performed on 52 patients with heart failure to determine the change in beta-blocker therapy after cardiac resynchronization therapy (CRT). After 6 months of CRT, the number of patients receiving beta-blocker therapy increased from 36 to 44, with improved clinical outcomes and larger beta-blocker doses, indicating that these 2 therapies may work together to improve outcomes by allowing the use of larger doses of beta blockers while correcting ventricular dyssynchrony.

Adrenergic beta-Antagonists↗