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Yoseph Rozenman

Publications and source records attributed to Yoseph Rozenman.

14 recordsLinked to original sources
PubMed2006

Coronary angiography in the elderly with acute myocardial infarction.

BACKGROUND: Despite the high mortality rate in elderly patients with acute myocardial infarction (AMI), the value of coronary angiography (CA) in the elderly has been questioned due to a less favorable outcome. The aim of the study was to determine the prognostic significance of CA on mortality of elderly patients AMI in "real world" practice. METHODS: The study cohort comprised 1009 elderly (age > or = 75 years) patients with AMI who were derived from three prospective national surveys between 1996 and 2000 in all 25 CCUs operating in Israel. Baseline characteristics, hospital course, management and outcome of 274 (27%) elderly patients who underwent CA during the index hospitalization were compared with 735 (73%) counterpart patients who did not. RESULTS: Patients who underwent CA were on average 2.2 years younger, and were more often with hyperlipidemia (p<0.0001 for each) and with a history of previous percutaneous coronary intervention (p<0.03) than the control group. They had a more favorable clinical presentation: a higher systolic blood pressure (p<0.04), a better Killip class (p<0.03) and an increased frequency of non-Q wave MI (p<0.03). They developed more often recurrent MI (p=0.002) and re-ischemia (p<0.0001). Variables associated with CA use during the index hospitalization were re-infarction, re-ischemia, the year of the index AMI and the availability of an on-site a catheterization laboratory in the hospital, while a higher age and fibrinolytic therapy decreased the likelihood of CA use. Of the patients who underwent CA, 67% underwent coronary revascularization (either PCI and/or CABG). Crude and adjusted mortality rates at 1 year were significantly lower in patients who underwent CA, as compared to counterparts who did not: 21% vs. 37.3%, respectively (p<0.0001), hazard ratio=0.52 (95% confidence interval 0.38-0.71). The benefit of CA was noted in a wide range of subgroups analyzed. CONCLUSIONS: In "real world" practice, elderly patients with AMI who undergo CA during hospitalization have a better prognosis at 1 year. Age alone should not be a deterrent to performing CA in elderly patients with AMI. Further large randomized trials are needed to confirm that an invasive approach is beneficial in high-risk elderly patients with AMI. CONDENSED ABSTRACT: To determine the prognostic significance of coronary angiography (CA) during the course of acute myocardial infarction (AMI) in "real world" practice on mortality of elderly patients, 1009 such patients were studied. Re-infarction, re-ischemia, the year of the index AMI and the availability of an on-site a Cath. Lab. were variables which increased the likelihood of undergoing CA, while a higher age and fibrinolytic therapy decreased this likelihood. The crude and covariate adjusted mortality rates at 1 year were significantly lower in patients who underwent CA in comparison to counterparts who did not: 21% vs. 37.3%, respectively (p<0.0001), hazard ratio 0.52 (95% confidence interval 0.38-0.71). The benefit of CA was noted across a wide range of subgroups analyzed.

Aged↗
PubMed2006

BNP in septic patients without systolic myocardial dysfunction.

BACKGROUND: We tested our hypothesis that serum BNP levels rise in sepsis and septic shock patients as a result of an inflammatory state and not only because of left ventricular dysfunction. METHODS: Twenty-one patients with sepsis or septic shock were enrolled in the study. Echocardiography was performed in every patient on admission and at discharge. Laboratory data were evaluated on admission, during hospitalization, and at discharge. Serum IL-1beta, IL-6, TNFalpha, and BNP concentrations were determined. RESULTS: BNP values on admission (r=0.47, p=0.03), during hospitalization (r=0.64, p=0.014), and on the day of discharge (r=0.54, p=0.015) were all positively correlated with CRP values. Mean BNP (r=0.07, p=0.006) and BNP level at discharge (r=0.68, p=0.001) were also positively associated with IL-1 at discharge. Mean CRP (17.7 mg/dL+/-1.5 vs. 9.2 mg/dL+/-3.6, p=0.002), IL-6 (46.6 pg/mL+/-2.2 vs. 25.6 pg/mL+/-16.3, p=0.003), and SAPS II levels (41.3+/-4.7 vs. 33.9+/-6.5 p=0.01) were also higher in patients who died versus those who survived. No difference in BNP levels was recorded in subjects who died versus those who survived. There was no clinical or echocardiographic evidence of left ventricular systolic dysfunction (mean EF% on admission 55.1+/-21.7 vs. 61.3+/-8.6 on discharge, p=0.123). Serum BNP levels at discharge were inversely associated with EF values on admission (r=-0.475, p=0.046) and positively associated with E/A ratio on admission (r=0.565, p=0.028). No association was found between BNP values and death. CONCLUSION: BNP is positively correlated with CRP levels in septic patients without clinical or echocardiographic evidence of systolic dysfunction. No association was found between death and BNP values. It seems that, in septic patients, BNP is less accurate as a measure of ventricular dysfunction.

Journal Article↗
PubMed2006

[Patients with recurrent malignant ventricular arrhythmias--therapeutic challenge].

Patients with malignant refractory ventricular arrhythmias present a unique therapeutic challenge. In recent years, this challenge has become even more complex due to the wide spread use of implantable cardiac defibrillators. If, in the past, a majority of the patients succumbed due to these arrhythmias, today, due to the defibrillators, they survive and then need further treatment. The defibrillators treat the arrhythmias when they occur but in most cases do not prevent their initiation. In many cases we need to resort to other modalities. We present three patients who exemplify various options of dealing with this complex issue.

Anti-Arrhythmia Agents↗
PubMed2004

Family history of coronary artery disease and prognosis after first acute myocardial infarction in a national survey.

A positive family history (FH) of coronary artery disease (CAD) is considered an independent risk factor for developing CAD. However, the natural history, coronary angiographic findings and prognosis of patients with a positive FH developing first acute myocardial infarction (AMI) are not well defined. A cohort of 2,690 consecutive patients with first AMI from two prospective nationwide surveys conducted during 1996 and 1998 in all coronary care units operating in Israel was studied. Baseline characteristics, hospital course, management and outcome of 405 patients with first AMI and a positive FH were compared with 2,285 controls without a positive FH. Coronary angiograms of patients with and without a positive FH were reviewed and compared. Patients with a positive FH were younger (53 vs. 64 years), more often male, current smokers and patients with hyperlipidemia, but less often patients with diabetes or hypertension than patients without a positive FH. Patients with a positive FH developed heart failure during hospital stay less frequently. Thrombolytic therapy was similarly administered to both groups. During the hospital stay, coronary angiography, percutaneous coronary intervention or coronary artery bypass grafting were more frequently performed in patients with a positive FH. The coronary anatomy and the extent of the CAD were similar in patients with and without a positive FH. Crude and covariate-adjusted mortality rates were significantly lower in patients with a positive FH than in patients without a positive FH on day 30 (2.2 vs. 9.6%, p < 0.001; odds ratio 0.50, 95% confidence interval 0.22-0.99) and at 1 year (3.5 vs. 14%, p < 0.001; hazard ratio 0.58, 95% confidence interval 0.42-0.80). Patients with a positive FH developed their first AMI more than 1 decade earlier in comparison to those without such a history. The extent of their coronary disease is similar to the older patients without a positive FH. The better prognosis of patients with a positive FH is mostly explained by their younger age.

Adult↗
PubMed2004

Anomalous origin of the left coronary artery from the pulmonary artery accompanied by mitral valve prolapse and regurgitation: Surgical implication of dobutamine stress echocardiography.

A young woman with bileaflet mitral valve prolapse and anomalous left coronary artery arising from the pulmonary artery, accompanied by significant mitral regurgitation (MR), underwent dobutamine stress echocardiography to assess the effect of anomalous left coronary artery arising from the pulmonary artery on MR severity. On the basis of the dobutamine stress echocardiography-induced ischemia, which exacerbated the degree of MR, a revascularization operation sparing the mitral valve was performed, resulting in significant improvement of the MR. We suggest that dobutamine stress echocardiography could be used to assess the relative contribution of each syndrome to the pathophysiology of MR, directing the surgical procedure.

Adult↗
PubMed2003

Extension of adrenocortical carcinoma into the right atrium--echocardiographic diagnosis: a case report.

BACKGROUND: Adrenocortical carcinoma is a rare, highly malignant tumor. Cardiac involvement of the tumor is very rare. Echocardiography facilitates the evaluation of the cardiac involvement of the tumor. CASE PRESENTATION: We describe a patient with an adrenal tumor. Transthoracic echo showed its extension into the right atrium. Accordingly, a combined abdominal and cardiac operation was performed, monitored by transesophageal echocardiography. CONCLUSION: This case highlights the importance of echocardiography in revealing the cardiac involvement by this tumor and in planning the operative procedure.

Adrenal Gland Neoplasms↗
PubMed1995

Percutaneous Transluminal Coronary Angioplasty in Octogenarians.

Revascularization is a theoretically ideal technique for treating repeated angina pectoris in elderly patients. Coronary angioplasty is an attractive option if it can be performed safely. In this report, we describe our experience with 80 angioplastic procedures in 72 patients older than 80 years. Seventy-two of these procedures (90%) were performed after 1990 using the currently available, improved angioplasty equipment. A third of these patients did not have any risk factors for coronary artery disease and 45% had only 1 risk factor. A history of previous myocardial infarction or coronary bypass surgery was present in 48 (67%) patients. In most patients (72%), angioplasty was performed during an admission for unstable angina or acute myocardial infarction. Single-vessel disease was present in 22% of patients. Successful angioplasty was performed in 92% of patients and major complications occurred in 8% of patients. Four patients (6%) died; in all of them, angioplasty was performed emergently to treat cardiogenic shock. None of 68 patients who underwent elective angioplasty for stable angina or a semielective procedure for unstable angina died during the hospitalization. We conclude that angioplasty can be performed safely in the carefully selected octogenarian. There is a low-risk subgroup of patients with limited disease in whom angioplasty is an attractive treatment strategy.

Journal Article↗
PubMedDate not supplied

Ruptured sinus of Valsalva aneurysm complicated by myocardial ischemia: pathogenetic mechanisms.

Significant left-to-right shunt in combination with severe aortic regurgitation (AR) accelerates the development of symptoms after rupture of congenital sinus of Valsalva aneurysm (SVA) in spite of intact coronary arteries. We depict a rare description of a situation where acute coronary syndrome was the first manifestation of such an occurrence. We believe that the progress of the myocardial ischemia after ruptured SVA depends on the severity of AR and the quantity of the left-to-right shunt. Prompt recognition and surgical repair are indicated to prevent complications of myocardial infarction.

Aortic Aneurysm↗