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Yehuda Adler

Publications and source records attributed to Yehuda Adler.

51 records · Page 3Linked to original sources
PubMed2003

Augmentation of low-frequency ultrasound-induced clot disruption by hydroxyethyl starch is dependent on the duration and intensity of ultrasound exposure; an in vitro study.

UNLABELLED: We investigated the synergistic effect between low-frequency ultrasound (US) and hydroxyethyl starch (HAES) on blood clot disruption, using different HAES concentrations, US duration and intensity. Human blood clots, 200 to 400 mg in weight, were placed in tubes containing 10 mL of normal saline alone or with HAES 0.1%, 1% or 2%. Clots were randomized to four intensities of US exposure: none, low, medium and high (maximal amplitude of motion at the tip of the horn: 0, 96, 144 and 192 micro m, respectively), and for three durations of US exposure (10, 20 and 40 s). After treatment, the clots were reweighed, and the percent differences in weights were calculated. US intensity, US duration and HAES concentration had a significant effect on the blood clot dissolution (p < 0.001 for all three variables). HAES augmented clot dissolution only when US intensity was medium or high. With low intensity, HAES did not augment clot lysis. CONCLUSIONS: microparticle-containing solutions, such as HAES, have a potential for augmenting clot disruption by US. This effect is highly dependent on US intensity.

Analysis of Variance↗
PubMed2003

Prospective study of Chlamydia pneumoniae IgG and IgA seropositivity and risk of incident ischemic stroke.

BACKGROUND AND PURPOSE: Chlamydia pneumoniae infection or exposure to C. pneumoniae was implicated as a risk factor for ischemic stroke. Our aim was to evaluate prospectively the association between the presence of antibodies to C. pneumoniae (IgG and IgA) and the risk of incident ischemic stroke among patients with pre-existing vascular disease. METHODS: Sera were collected from 3,090 coronary heart disease patients enrolled in a secondary prevention trial. We measured baseline antibodies (IgG and IgA) in the sera of patients who developed subsequent ischemic strokes (cases, n = 134) during follow-up (mean 8.2 years), and in 134 age- and gender-matched pairs without subsequent stroke or myocardial infarction. RESULTS: The crude relative odds (95%CI) of incident ischemic strokes in seropositive patients at baseline (>1.1 relative value units) were 1.29 (95%CI, 0.69-2.47) for IgG and 1.31 (95% CI, 0.69-2.55) for IgA by matched-pair analyses, and 1.42 (95%CI, 0.69-2.98) for IgG and 1.57 (95%CI, 0.76-3.35) for IgA after adjustments for conventional risk factors and the inflammatory marker, soluble intercellular adhesion molecule-1. We explored the possibility that the risk of ischemic stroke may increase in parallel to increasing antibody titers, but did not demonstrate any significant association. CONCLUSIONS: Serological evidence for prior infection with C. pneumoniae did not emerge as an independent risk factor for incident ischemic stroke among patients at high risk due to pre-existing vascular disease.

Aged↗
PubMed2003

Prognostic value of global myocardial performance indices in acute myocardial infarction: comparison to measures of systolic and diastolic left ventricular function.

STUDY OBJECTIVES: Assessment of global myocardial performance by a single index (ie, the myocardial performance index [MPI]) has been suggested as an appealing alternative to the individual assessment of systolic and diastolic left ventricular (LV) function We sought to test the prognostic value of MPI in comparison to clinical characteristics and echocardiographic parameters of LV filling and ejection in acute myocardial infarction (AMI). PATIENTS: Four hundred seventeen consecutive patients with AMI were examined within 24 h of hospital admission. INTERVENTIONS: Doppler echocardiographic measures of systolic, diastolic, and global myocardial performance were assessed within 24 h of hospital admission. In addition to MPI (ie, the sum of the isovolumic time intervals divided by ejection time), we determined the isovolumic/heterovolumic time ratio, which expresses the time "wasted" by the myocardium to generate and decrease LV pressure without moving blood. RESULTS: The end points of the study at 30 days were death (4.7%), congestive heart failure (23%), and recurrent infarction (4.8%), and occurred in 109 patients, who were compared as group B to 314 patients without an event (group A). Multivariate analysis identified only age (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.02 to 1.07), LV ejection fraction (LVEF) < or = 40% (OR, 3.82; 95% CI, 2.15 to 6.87), and E-wave deceleration time (EDT) of < or = 130 ms (OR, 2.29; 95% CI, 1.0 to 5.21) as independent predictors of adverse events. CONCLUSION: LVEF and EDT are powerful and independent echocardiographic predictors of poor outcome following AMI, and are superior to indexes of global LV performance. Both parameters should be taken into consideration when deciding about the management of these patients.

Aged↗
PubMed2003

Transthoracic echocardiographic assessment of proximal ascending aorta elasticity in familial heterozygous hypercholesterolemia patients.

BACKGROUND: Decreased elasticity of the aorta is associated with aging and several risk factors of atherosclerosis. The data regarding this phenomenon in patients with familial hypercholesterolemia are rather sparse. OBJECTIVES: To evaluate non-invasively the elasticity of the proximal ascending aorta of 51 heterozygous FH patients compared to 42 normal age and gender-matched controls. METHODS: Aortic elasticity was estimated by transthoracic echocardiography using the "pressure-strain" elastic modulus and aortic strain formulas. RESULTS: The elastic modulus score was higher in the FH group than in the controls (1.12 +/- 0.91 10(6) dynes/cm2 vs. 0.65 +/- 0.46 10(6) dynes/cm2 respectively, P = 0.01). This was consistent in both the pediatric (0.5 +/- 0.2 10(6) dynes/cm2 vs. 0.4 +/- 0.1 10(6) dynes/cm2 respectively, P = 0.009) and adult subgroups (1.3 +/- 1.0 10(6) dynes/cm2 vs. 0.8 +/- 0.5 10(6) dynes/cm2 respectively, P = 0.0004). Aortic strain was significantly lower in patients with FH than in controls (6 +/- 4% vs. 9 +/- 5% respectively, P = 0.0002). These findings reflected decreased elasticity of the proximal ascending aorta in the FH patients. In multivariate analysis, age, serum cholesterol level and serum triglycerides level were the independent predictors of the elastic modulus score, whereas age was the predictor of aortic strain. CONCLUSIONS: The elasticity of the proximal ascending aorta is decreased in heterozygous FH patients.

Adolescent↗
PubMed2002

The incidence, pathophysiology, treatment and prognosis of Cheyne-Stokes breathing disorder in patients with congestive heart failure.

DEFINITION: Cheyne-Stokes respiration is a breathing disorder characterized by recurrent central sleep apneas, mainly during sleep, alternating with a crescendo-decrescendo pattern of tidal volume. PATHOPHYSIOLOGY AND PROGNOSIS: The pathophysiology of Cheyne-Stokes respiration, involving the cardiovascular, pulmonary and sympathetic nervous systems, is still not well understood. Although 50% of moderate to severe congestive heart failure patients suffer from significant Cheyne-Stokes respiration, studies been undertaken to determine the prevalence of this phenomenon and its implications regarding patients' life expectancy and quality of life were conducted only in recent years. Other studies suggest that Cheyne-Stokes respiration has a negative prognostic value upon congestive heart failure patients. TREATMENT: Novel therapeutic approaches have been attempted in order to treat Cheyne-Stokes respiration; they include oxygen delivery, various pharmaceutical treatments aimed to stabilize the ventilatory system and other pharmaceutical treatments aimed to improve the left ventricular ejection fraction. However, none of them was effective. OBJECTIVES: This review summarizes some of the current knowledge regarding Cheyne-Stokes respiration pathophysiology, prevalence, prognostic implication and available treatments.

Cardiotonic Agents↗
PubMed2002

Colchicine for the prevention of postpericardiotomy syndrome.

BACKGROUND: Postpericardiotomy syndrome (PPS) is a troublesome complication of cardiac surgery, occurring in 10-45% of cases. Accepted modalities of treatment include nonsteroidal anti-inflammatory drugs, corticosteroids, and pericardiectomy in severe cases. The optimal method for prevention of PPS has not been established. Recent trial data have shown that colchicine is efficient in the secondary prevention of recurrent episodes of pericarditis. The aim of the present study was to evaluate the possible benefit of colchicine for the primary prevention of PPS in patients after cardiac surgery. To the best of our knowledge, this is the first study addressing this issue. PATIENTS AND METHODS: A prospective, randomized, double-blind design was used. The initial study group included 163 patients who underwent cardiac surgery in two centers in Israel between October 1997 and September 1998. On the 3rd postoperative day, the patients were randomly assigned to receive colchicine (1.5 mg/day) or placebo for 1 month. All were evaluated monthly for the first 3 postoperative months for development of PPS. RESULTS: 52 of the 163 patients were excluded because of postoperative complications, noncompliance, or gastrointestinal side effects of treatment. Of the 111 patients who completed the study, 47 (42.3%) received colchicine and 64 (57.7%) placebo. There was no statistically significant difference between the groups in clinical or surgical characteristics. PPS was diagnosed in 19 patients (17.1%), 5/47 cases (10.6%) in the colchicine group and 14/64 (21.9%) in the placebo group. The difference showed a trend toward statistical significance (p < 0.135). CONCLUSIONS: Colchicine may be efficacious for the prevention of PPS in patients after cardiac surgery. Further evaluations in larger clinical trials are warranted.

Adult↗
PubMed2002

Nonobstructive aortic valve calcification: a window to significant coronary artery disease.

BACKGROUND: Aortic valve calcification without obstruction (AVC) is common in the elderly and is associated with increased cardiovascular mortality and morbidity. We hypothesized that AVC detected by transthoracic echocardiography (TTE) is a marker for significant coronary artery disease in patients undergoing coronary angiography. METHODS: The study group included 388 patients with AVC (259 males, 129 females; mean age 72.2+/-9 years) who underwent coronary angiography for various indications. Data were compared with 320, age- and sex-matched patients without AVC who underwent coronary angiography for the same indications. AVC was detected in TTE as focal areas of increased echogenicity and thickening of the aortic-valve leaflets without restriction in motion. Significant obstructive coronary artery disease was defined as either a > or = 70% reduction of the internal diameter of the left anterior descending, right coronary, or left circumflex artery distribution or a > or = 50% reduction of the internal diameter of the left main coronary artery. Risk factors for atherosclerosis including hypertension, smoking, hypercholesterolemia and diabetes were also investigated. RESULTS: Compared with control group, the AVC group had a higher prevalence of significant coronary artery disease (90 vs. 85%, P=0.019), and a trend for lower frequency of coronary arteries without obstruction (6 vs. 9%, P=0.l1); a trend was also noted for 3-vessel disease (38 vs. 33%, P=0.14). Multivariate analysis identified age (P=0.000l), sex (P=0.000l), hypercholesterolemia (P=0.005) and AVC (P=0.02) as independent predictors for significant coronary artery disease. CONCLUSIONS: There is a significant association between AVC and significant coronary artery disease in patients undergoing coronary angiography. Thus AVC can serve as a window to atherosclerosis of the coronary arteries. These results reinforce a previous observation regarding association between AVC and increased risk of cardiovascular morbidity.

Adult↗
PubMed2002

Combined coronary and mitral annulus calcium detection in the non-invasive diagnosis of coronary artery disease in patients with systemic hypertension.

BACKGROUND: Although the presence of coronary calcium (CC) on fast spiral computed tomography (FSCT) is a powerful predictor of coronary artery disease (CAD), both the specificity and positive predictive value (PPV) of CC in CAD diagnosis are modest. Since previous studies have shown an association between mitral annular calcification (MAC) and coronary atherosclerosis, we aimed to investigate whether combined coronary and MAC detection could improve the non-invasive diagnosis of CAD. DESIGN AND METHODS: Our study comprised 522 patients (284 men and 238 women, age ranged from 52-80 years, mean 65 +/- 6 years) who underwent FSCT of the coronaries as well as echo-Doppler examination. Among them, 97 patients had prior diagnosis of prevalent proven CAD (CAD group) while 425 patients were without clinically manifested CAD (the No CAD group). RESULTS: The prevalence of CC in the CAD group was 95 versus 68% in the No CAD group (P = 0.001). The prevalence of MAC in CAD group was 63 versus 51% in No CAD group (P = 0.03). Sensitivity and negative predictive value (NPV) of CC as a predictor of CAD were 95 and 96% respectively, but specificity and PPV were low: 32 and 24% respectively. Sensitivity and NPV of MAC as predictors of CAD were 63 and 85% respectively; specificity and PPV, 49 and 22% respectively. Using of combined CC and MAC evaluation in the prediction led to some specificity improvement at the expense of a similar sensitivity reduction, without a considerable gain in the total accuracy of the method. CONCLUSIONS: Coronary calcium detection on FSCT in hypertensive patients yields excellent sensitivity and NPV but relatively low specificity and PPV for clinically manifested CAD. Mitral annular calcification assessment yields a low sensitivity and specificity and its addition to CC evaluation does not improve non-invasive diagnosis of CAD.

Aged↗
PubMed2002

Aortic valve calcium on spiral computed tomography (dual slice mode) is associated with advanced coronary calcium in hypertensive patients.

BACKGROUND: Aortic valve calcium (AVC) is common in the elderly and is associated with an increase risk of death from cardiovascular causes and of myocardial infarction. The goal of the present study was to determine whether an association exists between the presence of AVC and coronary calcium (CC) in high-risk hypertensive patients as detected by spiral computed tomography (dual slice mode) (DHCT). DESIGN AND METHODS: Three hundred and seventy-six hypertensive patients participating in the International Nifedipine Gastrointestinal Therapeutic System (GITS) Study of Intervention as a Goal in Hypertension Treatment (INSIGHT) in our region were included (197 men and 179 women, age range 55-79 years). All underwent DHCT of the heart for CC scoring using previously published methods. A positive test for the presence of CC was defined as the presence of at least one lesion with an area of 0.5 mm and DHCT density above 90 Hounsfield units (total CC score >0). CC was considered advanced when total calcium score was >300. AVC was defined by DHCT as any detected calcified deposit in the region of the aortic valve. Patients without AVC served as the control group. RESULTS: AVC was documented in 70 patients (36 men, 34 women; mean age 66 +/- 5 years, range 57-79 years). The age- and sex-matched non-AVC group (control group) included 306 patients (161 men, 145 women; mean age 67 +/- 5 years, range 55-75 years). There were no intergroup differences in risk factors for atherosclerosis. Significant differences were found between AVC and the control groups for mean CC score (388 +/- 754 compared with 147 +/- 307, P< 0.001) and between the presence of advanced CC and the control group (27 compared with 15%, P= 0.02). Significant differences were also found for the presence of three-vessel calcification (36 compared with 21%, P= 0.01) and the number of vessels involved (1.8 +/- 1.1 compared with 1.4 +/- 1.1, P= 0.01). Stepwise logistic regression found age [odds ratio (OR) 1.08, 95% confidence intervals (CI) 1.03-1.15), gender (OR 0.45, 95% CI 0.25-0.82) and AVC (OR 2.07, 95% CI 1.06-4.02)] to be the only variables that predict advanced CC. CONCLUSIONS: Our study demonstrated a significant association between the presence of AVC and advanced CC on spiral computed tomography. These results strengthen earlier findings of a high association between AVC and increased risk of death from cardiovascular causes.

Age Factors↗
PubMed2002

Association between electrocardiographic pattern and level of C-reactive protein in patients with first anterior wall acute myocardial infarction.

BACKGROUND: Studies of prognostic markers after first anterior wall acute myocardial infarction (AMI) have reported an association between persistent ST segment elevation on the electrocardiogram (ECG) and increased levels of C-reactive protein (CRP) and worse outcome. The aim of the present study was to determine the nature of the relationship between these two factors. METHODS: Twenty-three consecutive patients admitted with AMI underwent 12-lead ECG on days 1, 2, 3 and 7 and were classified into two groups according to the findings on each day's recording: pattern A - isoelectric ST segment, or pattern B - ST segment elevation with or without a negative T wave. Serum CRP levels measured on the same days were also compared between the groups. RESULTS: The number of patients classified as pattern A increased over time, from 8 on day 1 after AMI to 11 on day 2, 12 on day 3 and 14 on day 7, with a corresponding decrease in pattern B patients. Most of the patients with pattern B on day 1 showed a persistent pattern on day 7. For each day studied, the pattern A and pattern B patients showed a statistically significant difference in serum CRP levels on the second and third days after AMI, respectively. Values for the day 7 groups were: 3.1 +/- 3.4 versus 9.6 +/- 3.8 mg% (p = 0.001) (day 2) and 3.1 +/- 1.2 versus 7.9 +/- 3.6 mg% (p = 0.0005) (day 3). CONCLUSION: There was a significant association between high CRP levels on the second and third day following first AMI and ECG pattern B (ST elevation). This conclusion strengthens our earlier findings that pattern B is predictive of poor outcome in this patient population.

Adult↗
PubMed2002

Oscillations in peripheral arterial tone in congestive heart failure patients: a new marker for Cheyne-Stokes breathing.

Cheyne-Stokes breathing (CSB), which is a prevalent finding in congestive heart failure (CHF) patients, has been shown to be of prognostic value. The oscillations in respiration were shown to be associated with oscillations in sympathetic nerve activation. We tested the hypothesis that the peripheral arterial tone (PAT) as measured by a novel finger plethysmograph can be used to detect CSB. Using a novel technique to measure the PAT, we monitored 10 patients with advanced CHF simultaneously with conventional polysomnographic recordings for either 1 or 2 nights. Records were scored for CSB during 3-min periods based on either respiratory effort and nasal-buccal airflow or on the PAT signal alone. The PAT sensitivity and specificity for the detection of periods containing CSB were 91 and 91% for the entire recording, 90.7 and 92.9% for non-REM sleep, 90.7 and 70% for REM sleep, and 73 and 97.3% for awake periods, respectively. PAT is a reliable marker of CSB in CHF patients. The novel finger plethysmograph can be used for screening and monitoring CSB.

Adult↗
PubMed2002

Soluble intercellular adhesion molecule-1 and risk of future ischemic stroke: a nested case-control study from the Bezafibrate Infarction Prevention (BIP) study cohort.

BACKGROUND AND PURPOSE: Inflammation is considered to be involved in the pathogenesis of ischemic stroke. Our purpose was to assess the role of soluble intercellular adhesion molecule-1 (sICAM-1) concentration, a marker of inflammation, in predicting future ischemic stroke among patients at risk because of chronic coronary heart disease. METHODS: We obtained baseline serum samples from patients with chronic coronary heart disease enrolled in the Bezafibrate Infarction Prevention trial (n=3090), which assessed the efficacy of bezafibrate in secondary prevention. Using a prospective nested case-control design, we measured baseline sICAM-1 concentration in sera of patients who developed ischemic stroke during a mean follow-up of 8.2 years (cases, n=134) and in age- and sex-matched controls without any subsequent cardiovascular events (n=134). RESULTS: Baseline serum concentrations of sICAM-1 were significantly higher in cases compared with controls (379 versus 350 ng/mL, P<0.05). sICAM-1 concentration at the highest quartile (>394 ng/mL) was associated with significantly higher relative odds of ischemic stroke compared with the lower concentrations after adjustment for potential confounding variables (relative odds, 2.1; 95% CI, 1.1 to 4.3). After fibrinogen and total white blood cell count were added to the multivariable model, the relative odds were 2.1 (95% CI, 1.1 to 4.2) and 2.2 (95% CI, 1.1 to 4.8), respectively. The risk associated with raised concentrations of sICAM-1 seemed to be highest for large disabling strokes of cardioembolic origin. CONCLUSIONS: Elevated concentrations of sICAM-1, a marker of inflammation, are associated with increased risk of ischemic stroke, independent of other traditional cerebrovascular risk factors and of plasma fibrinogen, among patients at increased risk because of manifest coronary heart disease.

Bezafibrate↗
PubMed2002

Severity of angina pectoris and risk of ischemic stroke.

BACKGROUND AND PURPOSE: Ischemic stroke and coronary heart disease (CHD) share risk factors and pathogenic process, ie, atherosclerosis and thrombosis. We examined the relationship between severity of angina pectoris and its accompanying characteristics and the risk of incident ischemic stroke. METHODS: We traced 3122 patients with stable CHD, included in a secondary prevention trial of lipid modification, the Bezafibrate Infarction Prevention trial. CHD was documented by a history of myocardial infarction > or =6 months and < 5 years before enrollment and/or stable angina pectoris with evidence of ischemia confirmed by ancillary diagnostic testing. Severity of angina pectoris was assessed according to the Canadian Cardiovascular Society angina classification, and heart failure functional class according to the New York Heart Association (NYHA) classification. Patients with severe heart failure or unstable angina on enrollment were excluded. RESULTS: During a mean follow-up period of 8.2 years, 186 patients developed an ischemic stroke. The cumulative rate of ischemic stroke increased in a dose-response manner from 4.7% in patients with no angina to 5.7%, 8.4%, and 12.9% in patients with angina classes 1, 2, and 3, respectively (P<0.001). Patients with NYHA functional class 1 had a 5.5% rate of ischemic stroke versus 7.3% and 9.6% in patients with classes 2 and 3, respectively (P=0.05). In a Cox proportional-hazard model adjusting for conventional risk factors and potential confounders, the hazard ratio associated with angina class 1 was 1.20 (95% CI, 0.83 to 1.74); class 2, 1.66 (95% CI, 1.12 to 2.45); and class 3, 2.35 (95% CI, 1.08 to 5.13), as compared with patients with no angina. Hazard ratios of ischemic stroke associated with conventional risk factors were 1.55 for a 10-year age increment, 2.16 for diabetes mellitus, 1.81 for current smoking, and 1.29 for a 20 mm Hg increase in systolic blood pressure. CONCLUSIONS: Severity of angina pectoris in patients with stable CHD predicts an increased risk of subsequent ischemic stroke. The association between angina class and incident ischemic stroke is independent of traditional vascular risk factors.

Aged↗