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Biomedical subjects

L David Hillis

Publications and source records attributed to L David Hillis.

At least 19 recordsLinked to original sources
PubMed2006

Predictors of coronary artery disease in patients with left bundle branch block undergoing coronary angiography.

Patients with left bundle branch block (LBBB) and concomitant coronary artery disease (CAD) have a worse prognosis than those with LBBB without CAD. In addition, subjects with CAD and concomitant LBBB have a higher cardiovascular mortality than those with a similar extent of CAD but without LBBB. Because the presence of LBBB makes the noninvasive identification of CAD problematic, patients with LBBB often are referred for coronary angiography to assess the presence and severity of CAD. To determine the clinical and demographic variables that might help identify those with CAD, we analyzed data from 336 consecutive patients with LBBB referred for coronary angiography. Of the 336, 54% had CAD. In conclusion, those with CAD were likely to be older, Caucasian, and men; they were more likely to have angina pectoris, myocardial infarction, and diabetes mellitus; and they were more likely to have a left ventricular ejection fraction <0.50. In contrast, patients with heart failure were less likely to have CAD.

Aged↗
PubMed2006

Intra-aortic balloon counterpulsation.

Intra-aortic balloon counterpulsation (IABP) is sometimes used in critically ill patients with cardiac disease. By increasing diastolic arterial pressure and decreasing systolic pressure, it reduces left ventricular afterload. IABP may be beneficial in subjects with cardiogenic shock, mechanical complications of myocardial infarction, intractable ventricular arrhythmias, or advanced heart failure or those who undergo "high-risk" surgical or percutaneous revascularization, but the evidence to support its use in these patient groups is largely observational. Contraindications to IABP include severe peripheral vascular disease as well as aortic regurgitation, dissection, or aneurysm. The potential benefits of IABP must be weighed against its possible complications (bleeding, systemic thromboembolism, limb ischemia, and, rarely, death).

Animals↗
PubMed2006

Percutaneous coronary interventions: guidelines, short- and long-term results, and comparison with coronary artery bypass grafting.

An ever-growing number of patients are being referred for coronary revascularization in an attempt to reduce morbidity or to reduce mortality. Multiple randomized trials comparing percutaneous and surgical coronary revascularization have been performed. The decision to proceed with percutaneous or surgical revascularization should be based ona thorough understanding of the short- and long-term risks and benefits of each procedure in conjunction with the individual patient's coronary arterial anatomy and clinical risk profile.

Angina Pectoris↗
PubMed2005

Infarct-related coronary artery patency and medication use prior to ST-segment elevation myocardial infarction.

In patients who have ST-segment elevation myocardial infarction (STEMI), a patent infarct-related artery on the initial angiogram is associated with improved clinical outcomes, including decreased mortality. The present study assessed the influence of administering aspirin, beta blockers, statins, and angiotensin-converting enzyme inhibitors before STEMI on infarct-related artery patency. Our data demonstrate that patients who have STEMI and receive these medications on an outpatient basis before the event have a higher likelihood of having a patent infarct-related artery compared with patients who do not receive these medications. Further, our data demonstrate a graded association according to the number of such medications being administered: the likelihood of a patent infarct-related artery increased to >50% as the number of these medications increased.

Adrenergic beta-Antagonists↗
PubMed2004

Presence and extent of angiographic coronary narrowing in patients with left bundle branch block.

Patients with coronary artery disease (CAD) and concomitant left bundle branch block have increased mortality compared with those with CAD but without left bundle branch block. We retrospectively analyzed the extent of CAD in 200 patients with left bundle branch block referred for coronary angiography. Only 13% had left main or 3-vessel CAD. These findings were irrespective of left ventricular (LV) function. Of the 65 patients with normal LV function, only 5 (8%) had left main or 3-vessel disease, and of the 135 patients with depressed LV function, only 21 (16%) had left main or 3-vessel disease.

Bundle-Branch Block↗
PubMed2004

Hyperhomocysteinemia measured by immunoassay: a valid measure of coronary artery atherosclerosis.

CONTEXT: Homocysteine is emerging as a novel marker of atherothrombosis. Its role as an independent risk factor for cardiovascular disease is generally accepted. There is scanty data correlating homocysteine levels measured by immunoassay with cardiovascular disease. We previously validated a fluorescence polarization immunoassay for measuring homocysteine, which compared favorably with high performance liquid chromatography. OBJECTIVE: To determine if homocysteine levels measured by immunoassay correlate with extent of atherosclerotic burden, as represented by degree of coronary artery stenosis determined by coronary angiography. DESIGN: Fasting plasma samples were obtained from patients undergoing coronary angiography (N = 165). Homocysteine levels were measured by immunoassay and coronary artery stenosis was determined by coronary angiography. RESULTS: Median coronary artery stenosis for the 3 homocysteine subgroups, less than 1.35, 1.35 to 6.75, and greater than 6.75 mg/L (<10, 10-15, and >15 micromol/L), was 75%, 90%, and 99%, respectively (P = .01 for trend). Also, folate and vitamin B12 levels decreased with increasing homocysteine levels (P = .01 and .04, respectively, for trend). Spearman's correlation showed a significant association between homocysteine level and coronary artery stenosis (r = 0.20; P = .009). When men and women were examined separately, the correlation was significant only for women (r = 0.30; P = .01). CONCLUSION: Homocysteine levels, as measured by immunoassay, show a positive correlation with cardiovascular disease in women. Thus, this is a valid measure of atherosclerotic burden and, therefore, a reliable addition to the established laboratory repertoire for the assessment of cardiovascular disease.

Adult↗
PubMed2004

Theodore E. Woodward award: cardiovascular complications of cocaine abuse.

As cocaine abuse has become widespread, it has been associated with various cardiovascular complications, including angina pectoris, myocardial infarction, and sudden cardiac death. Cocaine's principal effects on the cardiovascular system are mediated via alpha-adrenergic stimulation and include (a) an increase in the determinants of myocardial oxygen demand (heart rate and systemic arterial pressure) and (b) a concomitant decrease in myocardial oxygen supply (caused by vasoconstriction of the epicardial coronary arteries). Cocaine-induced coronary arterial vasoconstriction is enhanced at sites of atherosclerotic narrowing. Delayed or recurrent vasoconstriction of the coronary arteries may occur hours after the serum cocaine concentration has declined and appears to be caused by cocaine's major metabolites. Beta-adrenergic blocking agents may exacerbate cocaine-induced coronary arterial vasoconstriction, thereby increasing the magnitude of myocardial ischemia. Concomitant cigarette smoking exacerbates the deleterious effects of cocaine on myocardial oxygen supply and demand substantially.

Adrenergic beta-Antagonists↗