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Biomedical subjects

W L Proudfit

Publications and source records attributed to W L Proudfit.

At least 19 recordsLinked to original sources
PubMed1998

Long-term survival in patients with mild or moderate impairment of left ventricular contractility during routine diagnostic left ventriculography.

Long-term survival in patients with mild to moderate impairment of left ventricular contractility in the absence of coronary artery disease has not been studied extensively but the prognosis is assumed to be good. One hundred sixty-eight patients with angiographic evidence of mild or moderate impairment of left ventricular contractility and no other significant cardiac disease at the time of routine diagnostic cardiac catheterization were studied to determine long-term survival and event-free survival. Clinical characteristics, electrocardiograms, chest X-rays, laboratory data, and hemodynamics including end-diastolic volume, end-systolic volume, stroke volume, ejection fraction, and regional wall motion at the time of catheterization were examined. Patients with moderate impairment were more likely to have dyspnea (P = 0.005) and an abnormal electrocardiogram (P = 0.006) than patients with mild impairment. Mean ejection fraction was 57% (P = 0.0001 vs. normal) in patients with mild impairment and was 47% (P = 0.0001 vs. normal) in patients with moderate impairment. Wall motion studies showed impairment to be generalized and more significantly abnormal in patients with moderate impairment. Survival at a mean of 138 months could be determined in 162 of the 168 patients (96%). Fourteen year actuarial survival was 92% for patients with mild impairment compared to 75% for patients with moderate impairment (P = 0.01). Long-term prognosis is good in patients found to have mild generalized impairment at the time of routine diagnostic cardiac catheterization. In patients with moderate impairment, closer follow-up to prevent arrhythmia and the onset of congestive heart failure appears to be warranted.

Adult↗
PubMed1990

Ten-year survival of patients with mild angina or myocardial infarction without angina: a comparison of medical and surgical treatment.

Ten-year survival percentages were calculated for groups of 407 initially medically treated patients and for 390 patients who had early coronary bypass surgery; all had either mild angina pectoris or myocardial infarction without subsequent angina pectoris. Uncensored actuarial survival was 77% for medical patients and 83% for the surgical group. For 179 patients who had internal thoracic (mammary) artery grafting as part of their procedures, survival was 91% in contrast to 76% for those who had vein grafts only. A sharp drop of the survival curve for the vein graft group after the seventh year was not shown for those who had internal thoracic artery grafts. Survival was 71% for 280 patients treated medically only.

Angina Pectoris↗
PubMed1989

Late follow-up of 781 patients undergoing percutaneous transluminal coronary angioplasty or coronary artery bypass grafting for an isolated obstruction in the left anterior descending coronary artery.

Seven hundred eighty-one patients with isolated left anterior descending coronary atherosclerosis treated with either coronary artery bypass grafting or percutaneous transluminal coronary angioplasty between January 1980 and December 1984 were studied to determine late survival and event-free survival. Follow-up was complete in 775 patients (99.4%). Actuarial survival at 5 years was 98% for surgical patients and 95% for angioplasty patients (p = 0.02). Five-year event-free survival (freedom from myocardial infarction, bypass grafting, angioplasty, and death) was 93% for surgical patients and 62% for angioplasty patients. This study suggests that the higher initial cost and complexity of bypass surgery may be justified by superior long-term results.

Angioplasty, Balloon, Coronary↗
PubMed1989

Does coronary bypass surgery improve long-term survival?

The question posed by the title implies comparison of coronary bypass surgery with some alternative therapeutic approach. At present, there are three principal alternatives: no treatment, medical therapy, and percutaneous transluminal coronary angioplasty. Admitting that definitive data on long-term survival are lacking, the clinician is faced with a choice based on incomplete knowledge--a common dilemma in clinical practice. This discussion is restricted to symptomatic coronary artery disease.

Angioplasty, Balloon, Coronary↗
PubMed1989

Long-term status and survival in Wolff-Parkinson-White syndrome.

In a long-term follow-up study of 103 patients who had Wolff-Parkinson-White syndrome, four died suddenly; two men had previously experienced paroxysmal atrial fibrillation and two women, both elderly, had paroxysmal tachyarrhythmias, one documented as atrial paroxysmal tachycardia on one occasion. Sixty-six (64%) of the patients had histories of paroxysmal tachyarrhythmias. Of 88 survivors, 10 of the 35 (29%) who did not have a history of arrhythmias on entry developed tachyarrhythmias, and 20 of 33 (38%) who did have symptomatic arrhythmias on entry had no symptoms at last follow-up. Thirteen (15%) of the survivors had frequent attacks of symptomatic arrhythmias.

Actuarial Analysis↗
PubMed1988

Survival of patients with mild angina or myocardial infarction without angina: a comparison of medical and surgical treatment.

A group of 390 patients with mild angina pectoris or myocardial infarction without subsequent angina had early coronary bypass operation. Five year survival was significantly higher (95.4%) than in a similarly selected medically treated group (88.5%) reported before. One death occurred in the 30 day postoperative period. Five year survival in the 179 patients who had internal mammary artery grafts was 98.9%. Survival for patients with mild angina and satisfactory left ventricular function (96.2%) was significantly higher than in the medical subset (91.3%). In the patient population studied, five year survival was higher in patients who had early bypass operations than in those who did not.

Adult↗
PubMed1986

Survival of non-surgical patients with mild angina or myocardial infarction without angina.

A group of 408 catheterised patients who had mild angina or myocardial infarction without angina was selected in conformity with the criteria for entry into a previously reported randomised trial. Medical treatment had been chosen initially by the cardiologist, referring physician, or the patient, although 27% had late operation. Five year survival rates were 91% and 72% for mild angina with high or low ejection fractions and 85% for those who had myocardial infarction without subsequent angina. Survival rates were 95%, 88%, and 80% for one, two, and three artery disease respectively. For patients who had ejection fractions of at least 0.50, five year survivals were 95%, 89%, and 83% for one, two, and three artery involvement respectively. Good left ventricular function, single artery disease, and a short history were favourable prognostic variables in multivariate analysis of patients who had angina pectoris. Statistical methods of dealing with patients who had late operation influenced calculated survival, especially for patients at relatively high risk. The lower survival rates for the whole group and most subsets compared with survival rates in the randomised trial may be of clinical importance.

Angina Pectoris↗
PubMed1985

Symptomatic coronary artery disease in patients aged 21 to 30 years.

One hundred one young people (88 men, 13 women) aged 30 years or younger with arteriographically proved obstructive coronary artery disease (CAD) were identified and reviewed for risk factor prevalence. The men were compared with an age and date-of-catheterization matched control group who were arteriographically normal. Significant risk factors were cigarette smoking (p = 0.001), familial CAD (p = 0.002) and familial CAD manifested by age 50 years or younger (p = 0.005). Serum cholesterol values were significantly higher in the CAD group (p = 0.0001), but in most (54%) were still less than 250 mg/dl. Arteriography showed a spectrum of CAD: 1-vessel in 57, 2-vessel in 21 and 3-vessel in 22. One patient had significant left main CAD. Follow-up was obtained for all of the 94 American subjects. One-year mortality was 3% and 5-year mortality was 20%. The causes of death were predominantly cardiac: myocardial infarction in 10 patients, congestive heart failure in 2 and sudden death in 6; 3 patients died of noncardiac causes.

Actuarial Analysis↗
PubMed1985

Electrocardiographic evidence suggestive of myocardial infarction without significant organic heart disease.

One hundred nineteen catheterized patients had ECG evidence of myocardial infarction in the absence of significant narrowing of coronary arteries or localized contractile abnormalities of the left ventricle. Eighty-seven had organic heart disease, but 32 had no demonstrable abnormality. ECG alterations in the latter group were almost equally divided between those in lead aVF and in the right precordial leads. Although certain depolarization defects are highly suggestive of myocardial infarction, similar changes may rarely be seen in normal people.

Adult↗