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E Moreyra

Publications and source records attributed to E Moreyra.

At least 19 recordsLinked to original sources
PubMed2000

Coronary angioplasty performed using the FullFlow mechanical dilatation-perfusion catheter: initial animal experience.

We report our initial experience with an animal model, using a new mechanical catheter-based dilatation system, the FullFlow (FF) catheter. The primary purpose of this study was to compare coronary flow achieved using the FF perfusion catheter and a traditional balloon angioplasty perfusion catheter. Baseline average peak velocity (APV) measurements were obtained using the FloWire Doppler guide wire. Either a Surpass Perfusion balloon (PB) or an FF catheter was advanced to a coronary segment. Doppler measurements were made before, during, and after full device expansion. Simultaneous heart rate, EKG, and blood pressure readings were recorded. Significant 36.1% and 29% reductions in mean APV were found for PB when comparing baseline to device-up measurements and when comparing device-down to device-up measurements, respectively. In contrast, significant 12.2% and 18.5% increases were seen in mean APV for the FF. No significant differences were found in heart rate, systolic blood pressure, diastolic blood pressure, or ST-segment changes. The FF system produces superior downstream coronary perfusion with side-branch coronary patency compared with results using a contemporary perfusion balloon angioplasty catheter.

Angioplasty, Balloon, Coronary↗
PubMed1999

A randomized trial comparing primary angioplasty with a strategy of short-acting thrombolysis and immediate planned rescue angioplasty in acute myocardial infarction: the PACT trial. PACT investigators. Plasminogen-activator Angioplasty Compatibility Trial.

OBJECTIVES: The study evaluated the efficacy and safety of a short-acting reduced-dose fibrinolytic regimen to promote early infarct-related artery (IRA) patency during the inherent delay experienced by infarct patients referred for angioplasty as the principal recanalization modality. BACKGROUND: Previous approaches using long-acting, full-dose thrombolytic infusions rarely showed benefit, but they did increase adverse event rates. METHODS: Following aspirin and heparin, 606 patients were randomized to a 50-mg bolus of recombinant tissue-type plasminogen activator (rt-PA) (alpha half-life 4.5 min) or to placebo followed by immediate angiography with angioplasty if needed. The end points included patency rates on catheterization laboratory (cath lab) arrival, technical results when PTCA (percutaneous transluminal coronary angioplasty) was performed, complication rates, and left ventricular (LV) function by treatment assignment and time to restored patency following angioplasty. RESULTS: Patency on cath lab arrival was 61% with rt-PA (28% Thrombolysis in Myocardial Infarction trial [TIMI]-2, 33% TIMI-3), and 34% with placebo (19% TIMI-2, 15% TIMI-3) (p = 0.001). Rescue and primary PTCA restored TIMI-3 in closed arteries equally (77%, 79%). No differences were observed in stroke or major bleeding. Left ventricular function was similar in both treatment groups, but convalescent ejection fraction (EF) was highest with a patent IRA (TIMI-3) on cath lab arrival (62.4%) or when produced by angioplasty within an hour of bolus (62.5%). However, in 88% of angioplasties, the delay exceeded 1 h: convalescent EF 57.3%. CONCLUSIONS: Tailored thrombolytic regimens compatible with subsequent interventions lead to more frequent early recanalization (before cath arrival), which facilitates greater LV function preservation with no augmentation of adverse events.

Aged↗
PubMed1998

Extended mortality benefit of early postinfarction reperfusion. GUSTO-I Angiographic Investigators. Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries Trial.

BACKGROUND: Reperfusion therapy for myocardial infarction, understood to reduce mortality by preserving left ventricular function, was initially expected to provide increasing benefits over time. Surprisingly, large controlled thrombolysis trials demonstrated maximum benefit at 4 to 6 weeks with no subsequent increased treatment advantage. Such studies, however, compared groups by assigned treatment, not physiological effectiveness. METHODS AND RESULTS: We calculated 2-year survival differences among 2431 myocardial infarction patients according to early infarct artery patency and outcome left ventricular ejection fraction using Kaplan-Meier curves. Hazard ratios for significant survival determinants were derived from Cox regression models. Two-year vital status (minimum, 688 days) was determined in 2375 patients (97.7%). A substantial mortality advantage for early complete reperfusion (Thrombolysis in Myocardial Infarction [TIMI] grade 3) and for preserved ejection fraction occurred beyond 30 days. The unadjusted hazard ratio for the TIMI 3 group compared with lesser grades at 30 days was 0.57 (95% confidence interval [CI], 0.35 to 0.94) and 30 days to > or = 688 days was 0.39 (95% CI, 0.22 to 0.69). Consequently, early TIMI 3 flow was associated with approximately a 3 patient per 100 mortality reduction the first month with an additional 5 lives per 100 from 30 days to 2 years. For ejection fraction >40% compared with < or = 40%, the unadjusted hazard ratio was 0.25 (95% CI, 0.16 to 0.37) at 30 days and 0.22 (95% CI, 0.15 to 0.33) after 30 days through 2 years (lives saved, approximately 9 and 11 per 100, respectively). CONCLUSIONS: Successful reperfusion and myocardial salvage produce significant mortality benefits that are amplified beyond the initial 30 days.

Female↗
PubMed1995

Limitations of transesophageal echocardiography in the risk assessment of patients before nonanticoagulated cardioversion from atrial fibrillation and flutter: an analysis of pooled trials.

Recent studies have proposed that the exclusion of an atrial thrombus by transesophageal echocardiography (TEE) would allow for the safe cardioversion from atrial fibrillation or flutter without the need of prophylactic anticoagulation. Because all of the TEE trials have been small and descriptive and have lacked randomized, conventionally treated control groups, the pooled risk of embolic events from TEE trials was compared with that of a control group pooled from the literature on cardioversion both with and without conventional anticoagulation. Studies were identified from a MEDLINE search, references in review articles, and recent cardiology abstracts and were included if there were > 10 patients and if atrial fibrillation or flutter was of > 48 hours' duration. Where > 1 study had been published by the same group only the largest study was used. Studies were not selected by cause of arrhythmia, by predisposing risk factors for atrial fibrillation and flutter, or by method of cardioversion. The only patients excluded from TEE reports were those with atrial thrombi diagnosed on the precardioversion TEE or those documented to have adequate standard precardioversion anticoagulation. Seven TEE and 18 control studies met the inclusion criteria. More patients in the control studies had rheumatic valvular disease. Embolic events were significantly more frequent in the TEE group than in the anticoagulated control group (1.34% vs 0.33%, respectively; p = 0.04), whereas there was no significant difference between the TEE group and the nonanticoagulated control group (2.00%; p = 0.26). Thus the use of TEE screening to exclude patients with atrial thrombi before cardioversion does not identify patients who can safely undergo this procedure without anticoagulation.

Anticoagulants↗
PubMed1987

Beneficial effects of timolol on infarct size and late ventricular tachycardia in patients with acute myocardial infarction.

This investigation was undertaken to study the effects of beta-adrenergic blockade with timolol on infarct size and on the incidence of late ventricular tachycardia in patients with acute myocardial infarction of less than 6 hr of evolution. Patients were assigned randomly either to a placebo-treated group (98 patients) or to a timolol-treated group (102 patients). The patients were treated with 5.5 mg iv timolol (or matched placebo) as a bolus divided into four doses during the first 2 hr followed by 10 mg orally twice daily for 1 month. Cumulative total creatine kinase (CK) release, which reflects the amount of myocardial necrosis was 1677 +/- 132 IU/liter in the placebo group (n = 83) and 1274 +/- 73 IU/liter in the timolol group (n = 81, p less than .01), a 24% reduction. Cumulative release of CK-MB was 138 +/- 8 IU/liter in the placebo group and 106 +/- 8 IU/liter in the timolol group (p less than .01), a 23% reduction. Twenty-four hour Holter electrocardiograms were obtained on days 7, 14, 21, and 28 after the onset of the acute myocardial infarction in 80 patients in the placebo group and 82 patients in the timolol group. The incidence of ventricular tachycardia was lower in the timolol than in the placebo group (7 vs 16 patients, p = .05). We conclude that early administration of intravenous timolol followed by oral treatment in patients with acute myocardial infarction reduces infarct size as assessed by CK and CK-MB serum activity, and decreases the occurrence of late ventricular tachycardia.

Blood Pressure↗
PubMed1985

Abnormal left ventricular diastolic function in chronic Chagas' disease: an echocardiographic study.

Simultaneous M-mode echocardiograms and phonocardiograms were recorded in 19 patients with chronic Chagas' disease, and were digitised and compared with normal in order to study systolic and diastolic left ventricular function. Five of the patients were in New York Heart Association class 1, 9 in class 2, and 5 in class 3. Left ventricular cavity dimensions were increased in 3 and shortening fraction reduced in 1. Peak velocity of circumferential fibre shortening was below the 95% confidence limit of normal in 9. In contrast to previous echocardiographic studies, diastolic abnormalities were common, with prolongation of isovolumic relaxation time in 9 patients and reduced rate of dimension increase in 11. However, in spite of regional disease, documented angiographically in 5 of 6 patients, there was no evidence of asynchronous wall motion during relaxation seen in patients with coronary artery disease and comparable segmental abnormalities of wall motion. The relative timing of aortic valve closure and minimum cavity dimension was normal in all but 3 patients, and a significant dimension change during isovolumic relaxation in only one. Thus diastolic disturbances are common at all stages of Chagas' disease, and may represent a fundamental aspect of the pathological process as it affects the left ventricle.

Adolescent↗
PubMed1984

Secondary hypertrophic cardiomyopathy in infancy and childhood.

In 12 infants and children with hypertrophic cardiomyopathy (HCM), seen during a 5-year period, the incidence of the idiopathic or primary form was similar to that secondary to systemic disease. Five of the six patients with secondary HCM are reported. Pompe's disease, Friedreich's ataxia, and Noonan's syndrome were seen in one each. There were two patients with lentiginosis. The diagnosis of HCM and of the metabolic disorder was made simultaneously in the patient with Pompe's disease. In two patients, one with Friedreich's ataxia and the other with lentiginosis, the diagnosis of HCM preceded the manifestations of the associated disorder. The other two patients were referred to rule out heart disease. The diagnosis of HCM in infancy and childhood should be considered with the possibility of being a secondary form, and patients with known associations with HCM should be referred for early diagnosis of heart conditions.

Adolescent↗
PubMed1980

Phentolamine and IHSS.

Explore the source record for details and available documents.

Cardiomyopathy, Hypertrophic↗
PubMed1976

Cardiomyopathy complicated by left ventricular aneurysms in children.

Ventricular aneurysms in children are unusual. Three patients with cardiomyopathy associated with angiographically proved left ventricular aneurysms in this age group are reported. Two of them were girls. The ages were 20 months, 7 years, and 14 years. Heart failure was present in all patients. There was radiological evidence of cardiomegaly in all three, and the electrocardiogram showed signs of necrosis in two of them. Selective left ventricular angiography disclosed generalized hypokinesis in all patients. One child had an aneurysm of the diaphragmatic wall. In another the aneurysm was localized in the muscular ventricular septum, causing severe subpulmonary stenosis by encroaching in the right ventricular outflow tract during systole. The third patient had an aneurysm of the left ventricular free wall partly encircling the left ventricle. The coronary arteries appeared normal in all cases. The clinical features of the underlying disease were not altered by the presence of the aneurysm except in the patient with the septal aneurysm and subpulmonary stenosis. In this patient the aneurysm was successfully resected.

Adolescent↗
PubMed1976

Mobitz II AV block within the His bundle, with progression to complete heart block.

A case of a 48-year-old woman with frequent syncopal episodes is reported. The electrocardiogram showed high degree AV block with narrow QRS complexes. The His bundle electrogram displayed a split His deflection indicating impairment of conduction within the His bundle of the Mobitz II type. The AH interval was prolonged and Wenckebach phenomenon occurred at the same atrial pacing rate before and after atropine administration. During spontaneous or induced high grade AV block an escape rhythm originating in the distal His bundle was observed. A secondary study performed one year later showed progression to complete AV block. Both His potentials were present, one following the atrial and the other preceding the ventricular deflection. The H'V interval was prolonged and a further lengthening was seen after ajmaline. All these findings indicated proximal, mid, and distal disease of the His trunk.

Ajmaline↗