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L S Griffith

Publications and source records attributed to L S Griffith.

At least 37 records · Page 2Linked to original sources
PubMed1990

Life stress and social support in diabetes: association with glycemic control.

The interrelationship of life stress, social support, and glucose regulation was studied in eighty patients with diabetes mellitus (insulin-dependent = 40, non-insulin-dependent = 40). Glucose control was measured using glycosylated hemoglobin (HbA1); stress and social support were determined by the Social Readjustment Rating Scale and a Visual Analog Scale of social support. A two-way analysis of variance [social support (high/low) by life stress (high/low)] revealed that neither social support nor life stress was independently associated with HbA1. However, a significant interaction between these parameters was found. When reported stress was low, the HbA1 means were not statistically different for both high and low social support groups. As stress increased, variations in social support were associated with differences in glucose control. Under conditions of high stress, low social support subjects had significantly higher HbA1 than subjects with high social support (mean = 11.8% vs. mean = 9.9%, p = .04). These data suggest that during stressful times social support may insulate patients with diabetes from the adverse physiologic and behavioral consequences of stress and thereby foster better glucose control.

Adult↗
PubMed1989

Serum reverse T3 and amiodarone efficacy.

The use of serum reverse T3 (rT3) levels in the assessment of amiodarone efficacy is controversial. We prospectively studied 10 patients with frequent ventricular ectopy and symptomatic ventricular tachycardia (VT) treated with amiodarone. Serial 24-h Holter monitor, thyroid function studies including serum rT3, and 12-lead electrocardiogram were performed on each patient at baseline, and at 1, 4, 12, and 24 weeks of oral amiodarone therapy. Serial Holter monitors on therapy were analyzed for 100% suppression of VT, 90% suppression of couplets, and 85% suppression of ventricular ectopic beats (VEBs) compared with baseline Holter, defining patient groups VT-, Co-, and VEB-, respectively. Lack of arrhythmia suppression to this degree defined groups as VT+, Co+, and VEB+. There were no statistically significant differences in rT3 levels between VT+ and VT- groups, Co+ and Co- groups, or the VEB+ and VEB- groups. VT suppression could not be predicted at any rT3 level. We conclude that serum rT3 is an insensitive means of assessing amiodarone efficacy.

Adult↗
PubMed1989

Serial lung function testing in patients treated with amiodarone: a prospective study.

PURPOSE: Amiodarone has proven to be effective in many cases of cardiac arrhythmias, refractory ventricular tachycardia, and ventricular fibrillation. Pulmonary toxicity is a possible side effect of the drug, with a reported incidence of 2 to 15 percent per year. To determine the effect of amiodarone on lung function, we prospectively studied serial lung function tests in a cohort of 91 patients with refractory cardiac arrhythmias treated with this agent. PATIENTS AND METHODS: Spirometry and carbon monoxide diffusing capacity (DLCO) were measured at zero, three, six, 12, 18, and 24 months, with a mean follow-up of 351 days. RESULTS: For the whole population taking a mean dose of amiodarone of 367 mg daily (range: 136 to 512 mg), there was no accelerated rate of decline in spirometric indices or DLCO. Analysis of lung function changes by multivariate analysis demonstrated that an accelerated decline in DLCO values occurred in elderly patients (p less than 0.05) but not in patients with pre-existing lung disease or cigarette smokers. In four patients (4.5 percent), clinical evidence of amiodarone pulmonary toxicity developed that was associated with a fall in DLCO of greater than 20 percent. All four patients recovered after the drug was stopped. Another 15 patients, without clinical evidence of pulmonary toxicity, had a sustained decline in DLCO of greater than 20 percent. These 15 patients remained asymptomatic over the next 11 months without interruption of therapy. A greater than 20 percent fall in DLCO was a sensitive test for clinically evident amiodarone pulmonary toxicity, but had a positive predictive value of only 21 percent. CONCLUSION: An isolated fall in DLCO, in the absence of clinical evidence of toxicity, does not necessitate stopping amiodarone. An unchanged DLCO value appears to be a reliable negative predictor of pulmonary toxicity.

Adult↗
PubMed1989

Relation of baseline characteristics to suppression of ventricular arrhythmias during placebo and active antiarrhythmic therapy in patients after myocardial infarction.

In the Cardiac Arrhythmia Pilot Study (CAPS), patients early (6-60 days) after acute myocardial infarction (MI) with ventricular premature complexes (VPCs) of over 10 per hour were randomized to receive, unaware, therapy with one of four antiarrhythmic drugs (n = 402) or placebo (n = 100). Treatment success was defined as 70% or more decrease in VPC rate and 90% or more decrease in VPC runs. If the first active drug was ineffective, a second drug was given. If placebo was ineffective, a second placebo was given. To determine whether or not baseline clinical characteristics predict the response to antiarrhythmic therapy, 10 baseline variables were selected for investigation: age, prior MI, time from CAPS MI to randomization, ejection fraction, baseline VPC frequency, presence of runs (greater than or equal to 3 consecutive VPCs, greater than or equal to 100 beats/min), beta-blocker therapy, digitalis therapy, MI transmurality, and MI location. At the end of the first drug treatment, apparent treatment success in patients receiving placebo was associated on univariate analysis with absence of prior MI, with trends for younger age and Q wave MI, whereas in patients receiving active therapies, higher ejection fraction and younger age were associated with better suppression. In the encainide and flecainide treatments, where the greatest response was observed, absence of prior MI, higher ejection fraction, and younger age were associated with more successful treatment. In a multivariate analysis with these variables, ejection fraction and age remained significant for all active therapies, absence of prior MI and ejection fraction remained significant in the encainide and flecainide treatments, and absence of prior MI in the placebo treatment. Few variables except ejection fraction were associated with VPC suppression during the 1-year follow-up, and only lower ejection fraction and older age related to loss of long-term suppression. Thus, there are only a few independent baseline clinical variables (notably, ejection fraction) that substantially affect antiarrhythmic drug efficacy in suppressing VPCs in patients early after MI. Some variables, however, may be associated with spontaneous arrhythmia variability, leading to an apparent (placebo) response. These findings will be helpful in designing and interpreting treatment studies in patients after MI.

Anilides↗
PubMed1988

Correlation of coronary arteriography after acute myocardial infarction with predischarge limited exercise test response.

This study of post-acute myocardial infarction (AMI) patients compared the extent and distribution of coronary narrowings and left ventricular dysfunction in 45 patients who had greater than or equal to 1 mm ST-segment depression on a predischarge low-level exercise test (positive-result group) with those found in 78 patients who had less than 1 mm ST depression (negative-result group). Cardiac catheterization was done 50 +/- 20 days (mean + standard deviation) after AMI. Patients with positive responses more often had multivessel coronary artery disease (80 vs 47%, p = 0.001) and a greater than or equal to 75% narrowing in the left anterior descending (LAD) (87 vs 62%, p = 0.003) and left circumflex (71 vs 37%, p = 0.001) arteries, as well as in the proximal LAD segment before the first septal branch (58 vs 29%, p = 0.002). Among patients with positive responses 93% had normal or hypokinetic wall motion in the vascular territory of a severely diseased coronary artery (viable but potentially ischemic myocardium) while 63% of the negative-result group had these findings (p = 0.001). No difference in ejection fraction could be identified between the 2 groups (54 +/- 15% vs 54 +/- 16%). Prior studies of AMI patients have shown that ST-segment depression on a predischarge low-level exercise test will identify patients at higher risk of subsequent cardiac death. Our observations have identified differences in cardiac angiographic findings between patients with positive and negative responses to this test that may explain this difference in outcome.

Coronary Angiography↗
PubMed1988

Prognostic cardiac catheterization variables in survivors of acute myocardial infarction: a five year prospective study.

The prognostic variables from predischarge coronary angiography and left ventriculography in survivors of acute myocardial infarction during the years 1974 to 1978 were evaluated in 143 patients (less than or equal to 66 years of age) with documented myocardial infarction who were then followed up prospectively for 5 years. One half of the study population had triple vessel coronary disease (greater than or equal to 50% stenosis). However, only 7% of patients had severely depressed left ventricular function with an ejection fraction less than or equal to 29%. Evaluation of the contribution of many clinical and angiographic variables to a first cardiac event (death, nonfatal reinfarction or coronary artery bypass surgery) was considered with Kaplan-Meier actuarial curves and multivariate Cox's hazard function analysis. A risk segment was defined as an area of contracting myocardium supplied by a coronary artery with a greater than 50% stenosis. Multivariate analysis demonstrated that right plus left anterior descending coronary artery stenoses (p less than 0.01), ejection fraction (p less than 0.01) and the presence of risk segments (p less than 0.05) were significant predictors of outcome. Furthermore, on separate multivariate analyses, the angiographic variables added significantly to the clinical variables to predict cardiac events over 5 years of follow-up. Therefore, in survivors of acute myocardial infarction who undergo cardiac catheterization, additive prognostic information is obtained that can be used to stratify risk over 5 years.

Cardiac Catheterization↗
PubMed1988

Impending sudden cardiac death: treatment with myocardial revascularization and the automatic implantable cardioverter defibrillator.

Myocardial revascularization and implantation of the automatic implantable cardioverter defibrillator (AICD) have individually been shown to improve survival in patients after sudden cardiac death. Their combined role has not been well defined. Twenty-three survivors of sudden death underwent revascularization and AICD implantation at an average age of 59 years. The initial arrest was caused by ventricular fibrillation in 15 and ventricular tachycardia in 8. Exercise stress tests, ambulatory ECGs, and electrophysiological monitoring with programmed electrical stimulation were done preoperatively and postoperatively. Follow-up averaged 24 months with a two-year survival of 91%. Eight patients (35%) required AICD resuscitation an average of 8 months postoperatively, and electrophysiological testing did not accurately predict arrhythmia recurrence. The addition of AICD implantation to revascularization substantially improves survival of patients with sudden cardiac death.

Adult↗
PubMed1988

The automatic implantable cardioverter defibrillator: T wave sensing in the newest generation.

The AICD uses an automatic gain control amplifier for detecting the small electrograms during ventricular fibrillation. The latest generation of the AICD appears to have a more sensitive lock on gain amplifier, as 6 of 76 patients implanted with the new AICD had double counting of the QRS-T wave complex resulting in asymptomatic discharges. Solutions to the problem of limiting these asymptomatic discharges are difficult and include slowing of the heart rate with beta blockers, changing the lead system, or replacement of the device. One of the six patients was treated with beta blockers. Three patients had their device changed, two patients requested the inactivation of their device until a rate programmable unit was available. The potential for T wave sensing in a lock on gain amplifier represents the unique dilemma between detecting small electrograms of ventricular fibrillation, and detecting diastolic events which occur shortly after the QRS complex.

Adult↗
PubMed1988

Implantation of the automatic implantable cardioverter defibrillator.

Since February 1980 the automatic implantable cardioverter defibrillator has been implanted in over 1,500 patients. Sudden death rates have been reduced to 2%-4% annually. This report reviews the implantation techniques, their indications, and our clinical experience in 200 patients.

Arrhythmias, Cardiac↗
PubMed1988

Depression in adults with diabetes. Results of 5-yr follow-up study.

Little is known about the course of affective illnesses in patients with diabetes or in other physically ill patients. We report a follow-up study of 37 diabetic adults with major depression (according to DSM-III), 28 (76%) of whom were located and reinterviewed 5 yr after the index evaluations. At follow-up, 18 (64%) of the 28 depressed patients had experienced an episode of major depression within the previous 12 mo; 12 of these patients satisfied diagnostic criteria for depression at the time of reevaluation. The 18 patients with recurrent depression had a mean of 4.2 depressive episodes over the 5-yr period. An additional 4 patients met criteria for current dysthymic disorder, bringing the number to 22 (79%) of the total patients ill with affective disorder during the 5-yr follow-up period. In contrast, the likelihood of symptomatic affective disorder was only 10% over the same follow-up period in a comparison group of diabetic subjects without depression at the index evaluation (P less than .001). Occurrence of depressive episodes appeared independent of diabetes complications because both the depressed and comparison groups had similar rates of neuropathy, retinopathy, and nephropathy. These data suggest that the natural course of depression in diabetes is malevolent, possibly more so than depression in the medically well.

Adult↗
PubMed1987

Success of chronic defibrillation and the role of antiarrhythmic drugs with the automatic implantable cardioverter/defibrillator.

Because the automatic internal cardioverter defibrillator's long-term ability to reduce arrhythmic mortality in patients with ventricular tachycardia/fibrillation is unknown, it is important to determine whether the threshold for defibrillation changes over time. Serial defibrillation thresholds were measured in 23 patients over a mean replacement time of 24.8 +/- 7.5 months. In all cases the lead system was a superior vena cava coil to a left ventricular epicardial patch. The defibrillation threshold for the entire group increased from 12.3 +/- 4.7 J to 16.9 +/- 5.9 J (p less than 0.05). Striking increases in the defibrillation threshold were seen in the subgroup of patients taking amiodarone (from 10.9 +/- 4.3 J at implantation to 20.0 +/- 4.7 J at replacement, p less than 0.05). Defibrillation threshold decreased in patients taking no antiarrhythmic drugs or taking class I agents. Thus, the increase in mean defibrillation threshold was the result of an increase in the patients taking amiodarone. These data suggest that at initial implantation lead systems associated with the lowest defibrillation threshold should be used and the defibrillation threshold should be measured at generator change to guarantee an adequate margin of safety.

Aged↗
PubMed1987

Refractory symptomatic ventricular tachycardia and ventricular fibrillation in elderly patients.

The problem of refractory life-threatening ventricular tachyarrhythmias in elderly patients has not been previously studied. To determine if clinical, anatomic, or electrophysiologic variables and prognosis are significantly different in elderly subjects, 49 elderly (68 to 84 years) and 44 younger (44 to 53 years) survivors of refractory symptomatic ventricular tachycardia and/or ventricular fibrillation secondary to coronary artery disease were studied. Elderly patients displayed more extensive anatomic coronary artery disease, with 80 percent having three-vessel disease in comparison with 30 percent of the younger patients (p less than 0.001). Prior myocardial infarction, heart failure, and cardiomegaly were more common in the elderly group (p less than 0.01, p less than 0.001, and p less than 0.034, respectively), whereas angina was more common in the younger group (p less than 0.001). In 55 percent of the elderly patients and 58 percent of the younger patients, electrophysiologic testing demonstrated inducible sustained ventricular tachycardia that required treatment with an investigative antiarrhythmic drug and/or cardiac surgery, including implantation of an automatic defibrillator. Elderly patients tolerated aggressive evaluation as well as did younger patients, and despite the difference in clinical and anatomic findings, long-term survival curves were similar, although the probability of survival at 20 months was 62 percent in the elderly and 80 percent in the younger patients. This difference in early survival is explained by eight surgical deaths in the elderly group, compared with two in the younger group.

Age Factors↗
PubMed1987

Low-dose trazodone for symptomatic patients with esophageal contraction abnormalities. A double-blind, placebo-controlled trial.

Twenty-nine patients with esophageal symptoms and contraction abnormalities of the esophageal body completed a 6-wk, double-blind, placebo-controlled trial of trazodone (100-150 mg/day). Measures of esophageal and psychologic symptoms were completed at entry and at each follow-up visit. Esophageal manometry was repeated at the termination of the trial. Upon completion of the treatment, patients receiving trazodone (n = 15) reported a significantly greater global improvement than those receiving placebo (n = 14; p = 0.02). Although a variable clinical response was observed, the trazodone group had less residual distress over esophageal symptoms compared with the placebo group (59% +/- 9% vs. 108% +/- 19%, p = 0.03). Manometric changes observed during the course of the trial were not influenced by treatment nor by clinical response. Remarkable reductions in ratings of chest pain were reported by both treatment groups, emphasizing the importance of controlled trials when studying this patient population. We conclude that low-dose trazodone therapy can be of benefit in the management of symptomatic patients with esophageal contraction abnormalities. In addition, our findings support recent observations that manometric abnormalities characterizing this patient group may not be solely responsible for symptoms.

Adolescent↗
PubMed1987

Pathologic findings related to the lead system and repeated defibrillations in patients with the automatic implantable cardioverter-defibrillator.

The purpose of the present study was to examine at autopsy the effect of multiple defibrillations on the myocardium and the pathologic consequences of short- and long-term placement of the intravascular and interpericardial leads of the automatic implantable cardioverter-defibrillator. Twenty-five patients were examined at autopsy; 8 of them underwent lead implantation only and 17 received both leads and the automatic implantable cardioverter-defibrillator. Twelve patients (48%) died of ventricular tachycardia or ventricular fibrillation; seven (28%) died of other causes. Acute pericarditis occurred in all patients, resulting in a localized, progressive fibrosis around the apical patch lead without giving rise to pericardial restriction. Thrombus formation was associated with the superior vena cava spring electrode in four patients (17%) and the right ventricular rate-sensing electrode in one patient (4%). Asymptomatic pulmonary emboli occurred in two patients (8%). In one patient who underwent defibrillation 59 times, superior vena cava changes consisted of vein wall destruction, fibrosis and thrombus formation. Pathologic changes under the apical patch related to defibrillation were observed in seven patients; two of these had fewer than 5 defibrillations, one had 8 defibrillations and four had 21 to 74 defibrillations. These changes consisted of contraction band necrosis in four patients, vacuolar cytoplasmic clearing and loss of myocytes confined to the myocardium under the patch electrode in five patients who had multiple defibrillations. The observed pathologic changes were estimated to affect less than 2% of the total myocardial mass. Thus, the automatic implantable cardioverter-defibrillator lead system and multiple defibrillations result in localized myocardial injury confined to the tissue under the patch electrode.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

Treatment of malignant ventricular arrhythmias with endocardial resection and implantation of the automatic cardioverter-defibrillator.

Although ventricular resection guided by endocardial mapping has been a successful treatment for drug-refractory ventricular arrhythmias, 20 to 30 percent of patients still have postoperative sustained ventricular tachycardia or sudden death. To improve the outcome of the procedure, we implanted an automatic cardioverter-defibrillator in conjunction with endocardial resection in 28 patients, all of whom had had previous myocardial infarctions and between one and five cardiac arrests. There were three perioperative deaths. During follow-up of 8 to 51 months (mean, 25), 4 of the 25 survivors had recurrences of hypotensive ventricular tachycardia, which in all instances were automatically terminated by the implanted device. One patient, whose automatic cardioverter-defibrillator was not functional, died suddenly. We conclude that patients undergoing mapping-directed endocardial resection can be provided with additional protection against recurrent ventricular tachyarrhythmias or sudden death by implantation of an automatic cardioverter-defibrillator.

Adult↗
PubMed1986

De novo refractory ventricular tachyarrhythmias after coronary revascularization.

Twelve of 1,675 patients who underwent coronary artery bypass grafting during a 2.5-year period had new onset, recurrent, sustained ventricular tachyarrhythmia a mean of 27 days (range 2 to 150) postoperatively. No patient had an intra- or perioperative myocardial infarction and all patients were hemodynamically stable and had normal metabolic and electrolytic indexes at the time of ventricular tachyarrhythmia. Preoperative ejection fraction was 39 +/- 10% (mean +/- standard deviation) and all patients had Lown grade II or less ventricular ectopic activity on ambulatory monitoring. Postoperative angiography demonstrated occluded saphenous vein grafts in 3 of 7 patients studied, none of whom had symptoms suggestive of myocardial ischemia. Treatment with conventional antiarrhythmic therapy was unsuccessful in all but 1 patient, and 10 patients were treated with amiodarone and 1 patient with propafenone. Four of these patients also received an automatic implantable defibrillator. Thus, de novo ventricular tachyarrhythmia can occur unexpectedly after coronary artery bypass grafting and may be the result of several factors related to either subclinical graft occlusion or increased dispersion of repolarization secondary to reperfusion.

Aged↗
PubMed1986

Psychiatric illness in diabetes mellitus. Relationship to symptoms and glucose control.

The lifetime prevalence of psychiatric illness was determined in 114 patients with diabetes mellitus (types I and II) who were selected randomly from patients undergoing diabetes evaluations at a large medical center. The relationship of psychiatric illness to diabetic control was studied using glycosylated hemoglobin (HbA1) and self-report measures of metabolic symptoms. Seventy-one percent of the patients had a lifetime history of at least one criteria-defined psychiatric illness; affective and anxiety disorders were the most common diagnoses. A significant difference (p = .02) in mean glycosylated hemoglobin levels was observed comparing patients with a recent psychiatric illness (mean = 10.8%) to those never psychiatrically ill (mean = 9.6%). These psychiatrically ill patients also reported more symptoms of poor metabolic control and more distress associated with these symptoms than did patients never psychiatrically ill (p less than .0001 for both). The overall report of diabetes symptoms was unrelated to HbA1 (p = .25) and was influenced primarily by the recent presence of psychiatric disorder (p less than .0001). We conclude that emotional illness is associated with both poorer metabolic control and the increased report of clinical symptoms of diabetes.

Adult↗