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Biomedical subjects

Robert E Eckart

Publications and source records attributed to Robert E Eckart.

At least 19 recordsLinked to original sources
PubMed2006

Causes of sudden death in young female military recruits.

This study sought to examine the incidence of sudden death in a large, multiethnic cohort of young women. Approximately 852,300 women entered basic military training from 1977 to 2001. During this period, there were 15 sudden deaths in female recruits (median age 19 years, 73% African-American), occurring at a median of 25 days after arrival for training. Of the sudden deaths, 13 (81%) were due to reasons that may have been cardiac in origin. Presumed arrhythmic sudden death in the setting of a structurally normal heart was seen in 8 recruits (53%), and anomalous coronary origins were found in 2 recruits (13%). The mortality rate was 11.4 deaths per 100,000 recruit-years (95% confidence interval 6.9 to 18.9). The rate was significantly higher for African-American female recruits (risk ratio 10.2, p <0.001). Sudden death with a structurally normal heart was the leading cause of death in female recruits during military training.

Adolescent↗
PubMed2006

The cardiovascular patient's perceptions of complementary and alternative medicine.

BACKGROUND: Complementary and alternative medicine (CAM) use is common among patients with cardiovascular disorders and is generally underrecognized by physicians. The attitudes of these patients regarding these therapies and their perceptions of safety and efficacy have not been well defined. METHODS: A written survey was received from a cohort of outpatients seen at a large outpatient cardiovascular clinic in Texas. Over 75% of patients responded, with more than 90% of returned surveys adequate for analysis. RESULTS: Of the 210 respondents 113 admitted to CAM use, with Vitamins E and C being the most frequently utilized agents. Women were significantly more likely to take CAM than men (69 vs. 46%, p = 0.002), particularly those taking hormone replacement therapy. Over half of patients surveyed stated their cardiologist was unaware of their use of CAM. Only 15% of patients felt that CAM was more efficacious than their traditional medications, but almost half felt it was significantly safer. A similar number were unaware of any interactions between CAM and their other medications. CONCLUSIONS: Use of CAM is common in cardiology outpatients, and many patients remain unaware of potential health risks. Physicians should routinely question patients about use of CAM and attempt to educate users regarding potential health risks.

Aged↗
PubMed2006

Pulmonary arterial embolization of pacemaker lead electrode tip.

Complications with extraction of abundant endovascular systems increase with time since implantation. As the number of implanted devices increases, successful management of complications needs to be disseminated. We present a 46-year-old woman with endovascular leads placed 15 years previously requiring extraction. Using laser-assistance the leads were removed, although the passive lead tips were unable to be extracted, and were retained in the superior vena cava. One lead tip embolized to the distal pulmonary bed within 24 hours of her operative procedure. Computed tomography and pulmonary arteriography suggested a near immediate thrombogenic process. A multidisciplinary approach was utilized to identify management strategies that allowed for a satisfactory patient outcome.

Anticoagulants↗
PubMed2006

Myopotentials leading to ventricular fibrillation detection after advisory defibrillator generator replacement.

We present an unusual source of oversensing following an internal cardioverter-defibrillator generator change. The early appearance of reproducible myopotentials in the defibrillator sensing channel is usually due to a technical complication at the time of device implantation. Clues such as abrupt impedance change or reproduction with mechanical stimulation can help to localize a problem. Frequently the complication requires reoperation to examine the system. What do you do when everything seems to be working fine?

Action Potentials↗
PubMed2006

Mortality following defibrillator implantation in patients with renal insufficiency.

INTRODUCTION: Patients with renal insufficiency have an increased risk of atherosclerotic coronary artery disease, cardiovascular events, and sudden cardiac death. Due to under-representation of patients with renal disease in large clinical trials, outcomes of implantable cardioverter defibrillator (ICD) implantation in this group remain unclear. METHODS AND RESULTS: Inpatient and ambulatory records were reviewed for 741 consecutive patients undergoing 947 defibrillator implants or replacements at Department of Defense Medical Facilities. Demographics, medical history, and mortality were reviewed. The mean age of the cohort was 64 +/- 14 years and 599 (80.8%) were male. There were 173 patients (23.3%) with chronic renal insufficiency, 22 (3.0%) undergoing hemodialysis, and 546 (73.7%) without reported renal disease. The mean number of annual hospital admissions for heart failure among patients with and without renal failure was 3.8 +/- 4.0 versus 1.2 +/- 1.9 (P < 0.0001), respectively. The 1-year survival for those without renal insufficiency was 96.6%, compared to 87.8% for those with chronic renal insufficiency, and 88.7% for those undergoing hemodialysis. Multivariate analysis demonstrated a significant association between mortality among ICD patients and renal insufficiency, independent of coexisting congestive heart failure, ischemic cardiomyopathy, and diabetes mellitus (P < 0.0001). CONCLUSIONS: Among ICD recipients, those with renal insufficiency have a significantly higher mortality rate than those without renal insufficiency. Among a cohort of patients with ICDs, those with known renal insufficiency have higher rates of health care resource utilization and more heart failure admissions. Development of a national registry for ICDs should include data with regard to renal function.

Aged↗
PubMed2006

Direct admission to cardiology for patients hospitalized for atrial fibrillation reduces length of stay and increases guideline adherence.

OBJECTIVE: We hypothesized that a clinical pathway for inpatient management of atrial fibrillation on a cardiology service would result in improved resource utilization. METHODS: In July 2002, an evidence-based pathway was developed for treatment of patients hospitalized for atrial fibrillation. Guidelines directed patient care from admission from the emergency department to inpatient management on a cardiology service. Ancillary testing, anticoagulation, and inpatient length of stay were then compared before and after institution of the pathway. RESULTS: The overall length of stay was significantly shorter for patients admitted through the pathway (43.0 hours vs. 82.0 hours, p < 0.01). After the pathway, there was increased use of transesophageal echocardiography and a trend toward increased use of warfarin. CONCLUSIONS: Patients requiring hospitalization for symptomatic atrial fibrillation had a nearly 50% reduction in length of stay, with a trend toward increased utilization of risk-appropriate antithrombotic therapy, if they were directly admitted through cardiology via a clinical pathway.

Aged↗
PubMed2006

Peripheral blood levels of matrix metalloproteinases in patients referred for percutaneous balloon mitral valve commissurotomy.

BACKGROUND AND AIM OF THE STUDY: Inflammation may play a central role in the progression of stenotic valvular heart disease. Serum levels of matrix metalloproteinases (MMPs), markers of extracellular matrix (ECM) turnover and potential markers of active inflammation, have been recently demonstrated in several inflammatory processes. The present study was designed to examine whether systemic evidence of ECM turnover was present in advanced stenotic mitral valve disease. METHODS: Serum levels of MMP-1, -3 and -9 were measured in 114 patients with mitral stenosis referred for percutaneous balloon mitral valve commissurotomy, and compared to those in 48 healthy, age- and gender-matched controls. RESULTS: Serum levels of MMP-1, -3 and -9 did not vary according to hemodynamic profile or heart failure class at the time of blood sampling. Levels of MMP-1 and -3 were not significantly different between those patients with mitral stenosis and controls. The level of MMP-9 was significantly higher in patients with mitral stenosis than in controls, and did not appear to be altered by commissurotomy. CONCLUSION: Serum levels of MMP-9 were elevated in patients with mitral stenosis, providing further evidence that inflammation and ECM remodeling plays an important role in the pathophysiology of valvular heart disease.

Adult↗
PubMed2005

Usefulness of programmed ventricular stimulation in predicting future arrhythmic events in patients with cardiac sarcoidosis.

The utility of programmed ventricular stimulation to predict future arrhythmic events in patients with cardiac sarcoidosis is unknown. Similarly, the long-term benefit of implantable cardioverter-defibrillators (ICDs) in cardiac sarcoidosis has not been established. Thirty-two consecutive patients with cardiac sarcoidosis underwent programmed ventricular stimulation. Patients with spontaneous or inducible sustained ventricular arrhythmias (n = 12) underwent ICD insertion. All study patients were followed for the combined arrhythmic event end point of appropriate ICD therapies or sudden death. Mean length of follow-up to sustained ventricular arrhythmia or sudden death was 32 +/- 30 months. Five of 6 patients (83%) with spontaneous sustained ventricular arrhythmias and 4 of 6 patients (67%) without spontaneous but with inducible sustained ventricular arrhythmias received appropriate ICD therapy. Two of 20 patients (10%) with neither spontaneous nor inducible sustained ventricular arrhythmias experienced sustained ventricular arrhythmias or sudden death. Programmed ventricular stimulation predicted subsequent arrhythmic events in the entire population (relative hazard 4.47, 95% confidence interval [CI] 1.30 to 15.39) and in patients who presented without spontaneous sustained ventricular arrhythmias (relative hazard 6.97, 95% CI 1.27 to 38.27). No patient with an ICD died of a primary arrhythmic event. In patients with spontaneous or inducible sustained ventricular arrhythmias, mean survival from first appropriate ICD therapy to death or cardiac transplant was 60 +/- 46 months, with only 2 patients dying or reaching transplant at study end. In conclusion, programmed ventricular stimulation identifies patients with cardiac sarcoidosis at high risk for future arrhythmic events. ICDs effectively terminate life-threatening arrhythmias in high-risk patients, with significant survival after first appropriate therapy.

Adult↗
PubMed2005

Comparison of clinical presentation of acute myocarditis following smallpox vaccination to acute coronary syndromes in patients <40 years of age.

Smallpox vaccine-associated myopericarditis may have a similar presentation to acute coronary syndrome (ACS). The clinical records of 78 young patients (<40 years of age) presenting with ACS (n = 16) or myocarditis after smallpox vaccination (n = 62) were reviewed. Comparisons were made among clinical presentation, cardiac enzymes, echocardiographic findings, and electrocardiographic changes. The presence of cardiac risk factors or focal wall motion abnormalities on echocardiography were associated with a diagnosis of ACS. There was a trend toward earlier elevation of troponin-I and creatine kinase in patients with myocarditis compared with ACS.

Acute Disease↗
PubMed2005

Relation of QTc duration heterogeneity to mortality following orthotopic heart transplantation.

Studies of heart failure patients have demonstrated that serial QT prolongation and abnormally prolonged QT intervals are associated with greater mortality. Serial QT interval measurements in patients who undergo orthotopic heart transplantation (OHT) may quantify the degree of myocardial repolarization heterogeneity and serve as a marker of arrhythmogenic substrate. In this study, the mean survival for those with "stable" QT(c) intervals (a change of -10 to 10 ms/year) was 124 +/- 8 months versus 63 +/- 25 months in those with annual QT(c) changes of >10 ms (p = 0.009). Ventricular repolarization heterogeneity may serve as a marker of identifying high-risk patients after OHT.

Electrocardiography↗
PubMed2005

Fluoroscopic localization of the femoral head as a landmark for common femoral artery cannulation.

We sought to determine the reliability of frequently used landmarks for femoral arterial access in patients undergoing cardiac catheterization. The common femoral artery (CFA) is the most frequently used arterial access in cardiac catheterization. Arterial sheath placement into the CFA has been shown to decrease vascular complications. Some authors recommend locating the inferior border of the femoral head using fluoroscopy due to the relationship of the femoral head and the bifurcation of the CFA. We performed a descriptive study in a prospective design of 158 patients undergoing catheterization from the femoral approach. A femoral angiogram was performed, and the CFA bifurcation location was recorded in relation to the inguinal ligament, middle and inferior border of the femoral head, and the inguinal skin crease. The CFA bifurcation was distal to the inguinal ligament, middle femoral head, and inferior femoral head in most patients with mean distances (cm +/- SD) of 7.5 +/- 1.7, 2.9 +/- 1.5, and 0.8 +/- 1.2, respectively. The inguinal skin crease was below the bifurcation in 78% of patients (-1.8 +/- 1.6 cm). The CFA overlies the femoral head in 92% of cases. The femoral head has a consistent relationship to the CFA, and localization using fluoroscopy is a useful landmark.

Catheterization↗
PubMed2005

Unusual QRS morphology on ECG: a rare condition and an interesting response to pacing.

We present the interesting case of a young man with borderline wide QRS complexes noted on electrocardiogram (ECG). The diagnosis of an unusual form of preexcitation was reached using observations from intracardiac tracings at electrophysiology study. Atrial pacing consistently resulted in further widening of the first conducted QRS complex, and the physiology underlying this unusual finding is explored.

Adult↗
PubMed2005

Review of subacute stent thrombosis following percutaneous coronary intervention at a low-volume catheterization laboratory.

BACKGROUND: The frequency of coronary stent subacute thrombosis (SAT) following percutaneous coronary intervention (PCI) with uncoated stents in recent studies is 0.5%-0.9%. Prior studies have indicated that complication rates are significantly higher when performed in low-volume centers. We sought to determine the incidence and outcomes of SAT following PCI with stent placement at a low-volume catheterization laboratory. METHODS: We reviewed the Brooke Army Medical Center Interventional Database for all consecutive PCIs with stent implantation performed from January 1998 to December 2002. Clinical outcomes were obtained primarily through hospitalization records and clinic follow-up visits. RESULTS: There were 789 interventions with stenting on 750 patients over the specified time period, for an average of 158 procedures on 150 patients per year. There were seven cases of SAT, representing a rate of 0.89%. There was no difference in the clinical characteristics, procedural technique, or postprocedural antithrombotic therapy of the subjects with and without SAT. Of those with SAT, there were no subjects requiring surgical revascularization during index hospitalization, and all survived to index hospital discharge. Six of these seven subjects with SAT (85.7%) were alive at one year, with the single death noncardiovascular related. CONCLUSIONS: The incidence of thrombosis occurring within 30 days of intracoronary stent implantation is similar in low- and high-volume catheterization laboratories. In our low-volume laboratory experience, these events were not associated with significantly increased adverse outcomes.

Angioplasty, Balloon, Coronary↗
PubMed2005

Surface electrocardiography and histologic rejection following orthotopic heart transplantation.

BACKGROUND: Intraventricular conduction delay and QT interval dispersion may be related to electrical instability and the risk of ventricular arrhythmogenesis. The interlead variability of the QT interval on a surface 12-lead electrocardiogram (ECG) has been associated with an increased likelihood of sudden death in patients with long QT syndromes, in patients recovering from myocardial infarction, and dilated cardiomyopathy. We sought to determine the incidence of increased QT(c) dispersion (QT(c-d)) relative to biopsy grade of severity of rejection. METHODS: Records of patients having undergone orthotopic heart transplantation (OHT) were reviewed focusing specifically on surface ECGs performed in temporal proximity to endomyocardial biopsy. RESULTS: Seventy-five patients were evaluated on 1573 occasions, to include 999 surface ECGs, and 847 endomyocardial biopsies. There were 269 interpretable surface ECGs and endomyocardial biopsies performed within 1.1 +/- 4.6 days. There were no identifiable trends in atrioventricular or intraventricular conduction abnormalities (to include right bundle branch block) when comparing those with and without significant rejection on endomyocardial biopsy. The mean QT(c-d) of those with none (n = 34), mild (n = 194), moderate (n = 39), and severe (n = 2) rejection was 49 +/- 29, 49 +/- 35, 57 +/- 38, 81 +/- 7 ms, respectively (P = 0.28 by ANOVA of means). When comparing those with significant rejection so as to change management there was a trend toward increased dispersion (no to mild rejection, 49 +/- 34 ms vs moderate to severe rejection, 59 +/- 37 ms, P = 0.09). CONCLUSIONS: In this study investigating noninvasive ventricular depolarization/repolarization and correlation to histologic manifestation of rejection, there was suggestion, but no statistical significance, of QT(c-d) and severity of rejection. QT(c-d) should not be considered a sensitive marker for OHT rejection.

Analysis of Variance↗
PubMed2004

Sudden death in young adults: a 25-year review of autopsies in military recruits.

BACKGROUND: Sudden death among military recruits is a rare but devastating occurrence. Because extensive medical data are available on this cross-sectional and diverse population, identification of the underlying causes of sudden death may promote health care policy to reduce the incidence of sudden death. OBJECTIVE: To determine the causes of nontraumatic sudden death among a cohort of military recruits. DESIGN: Retrospective cohort study using demographic and autopsy data from the Department of Defense Recruit Mortality Registry. SETTING: Basic military training. PATIENTS: All nontraumatic sudden deaths from a monitored 6.3 million men and women age 18 to 35 years. MEASUREMENTS: Descriptive analysis, crude mortality rates of causes of sudden death, and frequency of events as a function of cause of death. RESULTS: Of 126 nontraumatic sudden deaths (rate, 13.0/100,000 recruit-years), 108 (86%) were related to exercise. The most common cause of sudden death was an identifiable cardiac abnormality (64 of 126 recruits [51%]); however, a substantial number of deaths remained unexplained (44 of 126 recruits [35%]). The predominant structural cardiac abnormalities were coronary artery abnormalities (39 of 64 recruits [61%]), myocarditis (13 of 64 recruits [20%]), and hypertrophic cardiomyopathy (8 of 64 recruits [13%]). An anomalous coronary artery accounted for one third (21 of 64 recruits) of the cases in this cohort, and, in each, the left coronary artery arose from the right (anterior) sinus of Valsalva, coursing between the pulmonary artery and aorta. LIMITATIONS: This cohort underwent a preenlistment screening program that included history and physical examination; this may have altered outcomes. CONCLUSIONS: Cardiac abnormalities are the leading identifiable cause of sudden death among military recruits; however, more than one third of sudden deaths remain unexplained after detailed medical investigation.

Adolescent↗
PubMed2004

Myopericarditis following smallpox vaccination.

Myopericarditis has been a rare or unrecognized event after smallpox vaccinations with the New York City Board of Health strain of vaccinia virus (Dryvax; Wyeth Laboratories, Marietta, Pennsylvania). In this article, the authors report an attributable incidence of at least 140 clinical cases of myopericarditis per million primary smallpox vaccinations with this strain of vaccinia virus. Fifty-eight males and one female aged 21-43 years with confirmed or probable acute myopericarditis were detected following vaccination of 492,730 US Armed Forces personnel from December 15, 2002, through September 30, 2003. The cases were identified through sentinel reporting to military headquarters, active surveillance using the Defense Medical Surveillance System, or reports to the Vaccine Adverse Event Reporting System. The observed incidence (16.11/100,000) of myopericarditis over a 30-day observation window among 347,516 primary vaccinees was nearly 7.5-fold higher than the expected rate of 2.16/100,000 (95% confidence interval: 1.90, 2.34) among nonvaccinated, active-duty military personnel, while the incidence of 2.07/100,000 among 145,155 revaccinees was not statistically different from the expected background rate. The cases were predominantly male (58/59; 98.3%) and White (51/59; 86.4%), both statistically significant associations (p = 0.0147 and p = 0.05, respectively).

Acute Disease↗
PubMed2004

Glycoprotein IIb/IIIa inhibitor-associated thrombocytopenia: clinical predictors and effect on outcome.

Glycoprotein IIb/IIIa inhibitors are used as an adjunct to antiplatelet therapy in percutaneous coronary intervention to reduce postprocedural enzyme elevations. Previous studies have shown a risk for thrombocytopenia that is associated with these agents. We sought to evaluate the incidence and outcomes of glycoprotein IIb/IIIa inhibitor-associated thrombocytopenia in an unselected series of patients undergoing percutaneous coronary intervention. We reviewed 984 interventions performed on 908 subjects over a specific time period. Glycoprotein IIb/IIIa inhibitors were used in 58.8% of cases. Their use increased from 38 to 82% during the study period (p < 0.0001). The incidence of glycoprotein IIb/IIIa inhibitor-associated thrombocytopenia was 5.4%. The occurrence of thrombocytopenia was not associated with higher age, gender or ethnicity. The preprocedural platelet count was not associated with induced thrombocytopenia (237 +/- 76 vs. 209 +/- 68 x 10(3), p > 0.05). The occurrence of thrombocytopenia was not associated with increased in-hospital mortality, 1-year mortality, myocardial infarction or revascularization, but was associated with a hospital stay twice as long as in those patients without thrombocytopenia (5.6 +/- 11.3 vs. 2.1 +/- 2.2 days, p < 0.001). Of the 5.4% of patients who developed thrombocytopenia, only 2 patients (7.1%) required platelet or blood cell transfusion.

Aged↗