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G W Dec

Publications and source records attributed to G W Dec.

84 records · Page 5Linked to original sources
PubMed1985

Active myocarditis in the spectrum of acute dilated cardiomyopathies. Clinical features, histologic correlates, and clinical outcome.

We studied the clinical features and course (average follow-up time, 18 months) of 27 patients with acute dilated cardiomyopathy (symptoms for less than 6 months) who were referred for endomyocardial biopsy. Almost 40 per cent of the patients subsequently had a rise in left ventricular ejection fraction (on average, from 0.21 to 0.41) and substantial improvement in heart failure; the remainder died or had chronic dilated cardiomyopathy. Biopsy revealed myocarditis in 18 patients, and this finding was especially common (89 per cent) in patients who had been ill for less than four weeks. But the biopsy specimen was negative in four patients whose clinical features and later course were diagnostic of myocarditis. Nine patients received immunosuppressive drugs, and four improved--a rate that did not differ from the rate of spontaneous improvement. Neither the histologic features of the biopsy specimen nor the clinical features at presentation were clearly correlated with subsequent improvement, whether or not immunosuppressive drugs were given. We conclude that many cases of unexplained dilated cardiomyopathy result from myocarditis. Definitive histologic confirmation depends on the duration of illness. The efficacy of immunosuppressive treatment must still be established.

Acute Disease↗
PubMed1984

Trazodone-digoxin interaction in an animal model.

Serum digoxin concentrations have been reported to increase in two patients taking daily doses of trazodone. However, in a canine model, no elevation in serum digoxin concentration was found with combined trazodone-digoxin administration. The authors suggest that serum digoxin concentrations should be monitored in patients receiving trazodone and digoxin concomitantly.

Animals↗
PubMed1979

Contact dermatitis due to nitroglycerin ointment.

Topical nitroglycerin ointment is among the most effective long-acting vasodilators currently available. We report two cases of contact dermatitis in which patch testing showed allergy to nitroglycerin-containing compounds. The severity of this dermatitis necessitated the discontinuation of topical nitroglycerin therapy in both patients. A potent corticosteroid cream applied once to previous nitroglycerin application sites prevented or minimized this dermatitis and enabled continuation of topical nitroglycerin therapy. Contact dermatitis due to topical nitroglycerin preparations may be more common than is presently realized.

Aged↗
PubMedDate not supplied

Antimyosin uptake and myofibrillarlysis in dilated cardiomyopathy.

BACKGROUND: Although antimyosin scintigraphy detects myocyte necrosis associated with myocarditis, it has also been reported to yield positive results in a large number of patients with clinical dilated cardiomyopathy without histologic evidence of myocarditis. The question to be resolved is whether this discordance represents false-positive results of antimyosin scans or whether antimyosin scintigraphy more accurately identifies the presence of myocyte necrosis than does endomyocardial biopsy testing. METHODS AND RESULTS: Forty patients with the acute onset of dilated cardiomyopathy (left ventricular ejection fraction < 45%; mean 27% +/- 11%) but no endomyocardial biopsy evidence of myocarditis, were identified from a consecutive series of 50 patients who had undergone indium 111 antimyosin antibody scintigraphy and endomyocardial biopsy for suspected myocarditis. The endomyocardial biopsy specimens were analyzed to identify features correlating with antimyosin uptake or improvement in left ventricular ejection fraction (LVEF) over time. Twenty-five patients showed left ventricular myocardial uptake of radiolabeled antimyosin antibody by both planar and tomographic imaging. The remaining 15 patients had no antimyosin uptake. Of the 25, 22 (88%) patients with positive findings on antimyosin scans had degenerated, myofibrillarlytic myocytes in their biopsy specimens. Of the 15 patients with negative findings on antimyosin scans, only 6 (40%) had similar myofibrillarlytic myocytes (chi 2 = 8.13; p < 0.0047). No other histological feature correlated with the antimyosin positivity. Stepwise multiple regression analysis was performed for identification of predictors of short-term improvement in LVEF. Patients with positive findings on antimyosin scans showed a trend toward improvement with time (F = 3.97; p > 0.05). None of the histologic features predicted improvement in the LVEF. However, the combination of positive findings on an antimyosin scan and myofibrillarlysis did correlate significantly with spontaneous improvement in ejection fraction (F = 4.53; 0.01; < p < 0.05). CONCLUSIONS: This study identifies myofibrillarlysis as a common pathologic alteration in patients with recent onset of dilated cardiomyopathy and positive findings on antimyosin scan, who lack right ventricular biopsy evidence of myocarditis. Because myofibrillarlytic cell population may represent a histologic spectrum of viable to necrotic myocytes, it appears that antimyosin uptake detects necrotic myofibrillarlytic myocytes that are not identified by light microscopy.

Adolescent↗
PubMedDate not supplied

Diagnostic accuracy of antimyosin scintigraphy in suspected myocarditis.

BACKGROUND: Radiolabeled antibody specific for cardiac myosin administered intravenously has been used to define noninvasively regions of myocardial necrosis. Inflammatory heart disorders such as myocarditis and heart transplant rejection demonstrate diffuse and often faint myocardial uptake of antimyosin antibody. This study was undertaken to evaluate the reproducibility and diagnostic accuracy of antimyosin antibody imaging for the detection of patients with suspected myocarditis. METHODS AND RESULTS: Fifty antimyosin scans, performed consecutively in patients with suspected myocarditis, were evaluated by one independent observer and two panels of observers. Antimyosin scan interpretations were compared with endomyocardial biopsy results and also with serial changes in left ventricular function. An independent observer (A) and a panel of five observers (A through E) interpreted the antimyosin scans as positive or negative on the basis of both planar images and tomographic reconstructions. Three of the five observers (A through C) again interpreted the scans but based interpretation only on planar images. Blinded random sequence evaluation of antimyosin scans based on the planar and tomographic interpretations revealed moderate agreement between the independent observer (A) and the group of observers (A through E) (kappa = 0.58). There was also moderate agreement between interpretations based on planar images alone and interpretations based on both planar and tomographic images (kappa [A through E]/[A through C] = 0.57; kappa [A through C]/A = 0.48). Comparison of antimyosin scan results with histologic evidence of myocarditis in endomyocardial biopsy specimens demonstrated that all scan results obtained from the individual or the panels of observers had a very high sensitivity (91% to 100%) and a high negative predictive value (93% to 100%). The specificity (31% to 44%) and positive predictive value (28% to 33%) were less impressive. We also compared the scan and biopsy results with the composite clinical standard of significant left ventricular functional improvement. Endomyocardial biopsy demonstrated poor sensitivity (35%) compared with antimyosin scans (82% to 94%) but had superior specificity (endomyocardial biopsy, 79%; antimyosin scan, 25% to 42%). The specificity of interpretations based on planar and tomographic interpretations (38% to 42%) was better than the planar images alone (25%). If reversible left ventricular dysfunction is considered clinical evidence of myocarditis, this study suggests that a negative endomyocardial biopsy significantly misses the presence of the disease. On the other hand, a negative antimyosin scan almost invariably excludes myocarditis. CONCLUSIONS: This study demonstrates a high degree of interobserver reproducibility of antimyosin interpretation. Comparison of the scintigraphic results with histologic and clinical standards indicates a high sensitivity of antimyosin scans for the detection of myocarditis. The antimyosin scan is also not likely to miss clinically or pathologically diagnosed myocarditis, in contrast to the endomyocardial biopsy, which missed clinically validated myocarditis 65% of time. The combination of high sensitivity and negative predictive value suggests that antimyosin scintigraphy may be an effective screening procedure for obviating biopsies in patients with suspected myocarditis.

Anti-Inflammatory Agents↗
PubMedDate not supplied

Cardiovascular findings in adolescent inpatients with anorexia nervosa.

Left ventricular function, resting electrocardiograms, and Holter recordings were systematically examined in 25 consecutively hospitalized, seriously ill, emaciated adolescents with anorexia nervosa. We failed to observe serious arrhythmias, abnormal prolongation of QT interval, conduction abnormalities, or depression in left ventricular systolic function.

Adolescent↗
PubMedDate not supplied

Palpitations and cardiac awareness after heart transplantation.

OBJECTIVE: The aim of this study was to examine the awareness of resting heartbeat in heart transplantation recipients, compare it with that found in other medical populations, and determine whether clinical characteristics are associated with accurate heartbeat awareness. METHODS: Eligible patients underwent a research battery consisting of a heartbeat detection task and self-report questionnaires assessing cardiac symptoms, psychosocial variables, and cognitive function. The accurate awareness of resting heartbeat was determined by presenting the patients with auditory stimuli at each of six different delays following the R wave on the ECG. Patients then selected the tones that they thought coincided with the sensation they had of their heart beating. The patients' physicians rated their cardiac morbidity. The results were contrasted with comparable data obtained in previous work with other ambulatory medical populations. RESULTS: Forty-one consecutive heart transplantation recipients who survived for at least 3 months after surgery were eligible. Thirty-four (82.9%) of them were studied and complete data were obtained on 26 (63.4%). Nine patients (34.6%) were reliably able to detect their resting heartbeat. When compared with the 17 patients who were not accurately aware of their heartbeat, the two groups did not differ significantly in cardiac morbidity, cognitive brain dysfunction, generalized psychiatric distress, depression, somatization, or hypochondriacal attitudes. A significantly higher proportion of heart transplantation recipients were accurately aware of their heartbeat than was found in a sample of general medical outpatients and in asymptomatic, nonpatient volunteers. CONCLUSIONS: One-third of heart transplant recipients are accurately aware of resting heartbeat, despite the absence of cardiac innervation.

Adult↗
PubMedDate not supplied

Lymphoma mimics cytomegalovirus-induced hepatitis in a heart transplant recipient.

A 56-year-old diabetic man underwent heart transplantation for end-stage ischemic heart disease; fever, progressive thrombocytopenia, and hepatitis developed 8 weeks after transplantation. Cytomegalovirus was cultured from the serum buffy coat. In spite of therapy with high-dose ganciclovir sodium, the patient died on the seventy-seventh postoperative day. Autopsy revealed a previously unsuspected high-grade B-cell lymphoma with extensive hepatic replacement.

Cytomegalovirus Infections↗
PubMedDate not supplied

Results of heart transplantation for active lymphocytic myocarditis.

To determine whether the heart-specific immunoreactivity associated with active myocarditis affects outcome after heart transplantation, we retrospectively analyzed the outcome of 12 patients with active lymphocytic myocarditis in their explanted native hearts identified by the Registry of the International Society for Heart Transplantation. The patients were 38 +/- 10 years of age and predominantly female (75%). In nine patients (75%), endomyocardial biopsy showed active myocarditis before transplant; eight of these patients also received immunosuppression before transplant. Recipient hemodynamic study before transplantation demonstrated an ejection fraction of 0.18 +/- 0.06, cardiac index of 1.7 +/- 0.4 L/min/m2, pulmonary artery pressure of 41 +/- 6/23 +/- 6 mm Hg, and mean pulmonary capillary wedge pressure of 30 +/- 5 mm Hg. Left ventricular end-diastolic dimension by echocardiography was 6.0 +/- 1.4 cm. Four of the patients were dependent on intravenous inotropes, and six required mechanical assistance. Over a 36-month follow-up period, 2.9 +/- 2.4 episodes of rejection occurred per patient. Sixty percent of the first episodes occurred within 2 weeks of transplantation. These patients experienced a 2.2 +/- 1.1-fold increase in rejection compared with institutional average rejection rates. Survival was significantly shorter than that of age-matched or female control subjects. This study is limited by its retrospective nature and the unusual pretransplant characteristics of the subjects. It indicates that active myocarditis may predispose patients to early severe rejection and a high mortality rate after heart transplantation.

Adult↗
PubMedDate not supplied

Evaluation of ischemic heart disease in potential lung transplant recipients.

BACKGROUND: The prevalence of coronary artery disease in potential lung transplant recipients has not been extensively studied. Given the limited donor supply, a high degree of sensitivity for detecting occult disease is essential. METHODS: This retrospective study examined both the clinical indications for coronary angiography and the extent of coronary arteriosclerotic disease in 105 consecutive potential lung transplant candidates. RESULTS: Fifty-one patients (49%) underwent angiography to either exclude asymptomatic atherosclerosis (n = 46) or define the extent of known symptomatic ischemic heart disease (n = 5). The perceived risk of occult disease according to a semiquantitative coronary risk assessment score that included hypertension, hyperlipidemia, diabetes, smoking, a family history of coronary artery disease, and electrocardiographic or echocardiographic abnormalities influenced the decision to perform angiography: 4 of 44 patients (9%) with two or fewer risk factors underwent angiography versus 42 of 56 patients (75%) with more than two risk factors (p < or = 0.05). A higher risk factor score also correlated with angiographic evidence of coronary artery disease. In the 46 patients without symptoms who were studied, two hemodynamically significant but unsuspected coronary lesions were identified. Six other patients without symptoms had noncritical (< 50%) lesions. Among the five patients with angina or a prior myocardial infarction, coronary angiography showed either minimal atherosclerosis (n = 2) or non-life threatening anatomy (n = 3). Angiographic findings did not exclude any patient from transplant listing. CONCLUSION: Coronary angiography appears most useful in patients without symptoms with multiple coronary risk factors and in a subset of patients who might otherwise be excluded from lung transplantation because of a history of symptomatic cardiovascular disease.

Adult↗
PubMedDate not supplied

Actinomycin D is an effective adjunctive immunosuppressive agent in recurrent cardiac allograft rejection.

BACKGROUND: Actinomycin D is a potent cytotoxic agent which inhibits DNA transcription by DNA-dependent RNA polymerases and has previously been used as adjunctive immunosuppressive agent for refractory renal allograft rejection. METHODS: To assess the efficacy of actinomycin D in cardiac allograft rejection, we studied seven patients with recurrent cellular or humoral rejection. All patients received intravenous actinomycin D 5 micrograms/kg every 6 weeks. RESULTS: During the 6-months after initiation of actinomycin D treatment, the mean number of treated cellular or humoral rejection episodes per patient (0.14) and the mean number of International Society for Heart and Lung Transplantation grade 2 or higher endomyocardial biopsy specimens per patient (0.3) were lower compared with those observed during the 6-month pre-actinomycin D period (1.6 and 2.6, respectively). By 6 months after initiation of actinomycin D, all seven patients were receiving lower daily maintenance doses of corticosteroids. The mean total corticosteroid dose after actinomycin D administration per patient per month (615 +/- 177 mg) was significantly lower than the pre-actinomycin D dose (1012 +/- 347 mg; p = 0.019). No patient had significant adverse effects. CONCLUSIONS: Actinomycin D is an effective immunosuppressive agent for prevention of recurrent cellular or humoral rejection after cardiac allograft rejection. The corticosteroid sparing effect of actinomycin D may be of particular benefit.

Biopsy↗