Exercise is an important behavior for long-term weight control in overweight and obese patients. However, little evidence exists confirming such findings in patients with advanced heart failure(HF). Using a prospectiv...Exercise is an important behavior for long-term weight control in overweight and obese patients. However, little evidence exists confirming such findings in patients with advanced heart failure(HF). Using a prospective, experimental design, the effects of 24 weeks of a low-level, home-based walking program on weight loss were studied in overweight and obese(body mass index≥ 27 kg/m2) patients with advanced HF who were randomized to exercise(n=48) and control(n=51) groups. Weight changes between the 2 groups at baseline and 6 months were compared using repeated-measures analysis of variance. Patients were on average aged 53.3± 10.1 years and predominantly male(75% ), Caucasian(57% ), and married(55% ). Most patients were in New York Heart Association class III or IV(67% ), with a mean ejection fraction of 25% . Patients in the exercise group showed significant weight reduction from baseline to 6 months compared with those in the control group(-6.37± 11.7 vs -0.33± 9.3 kg, p=0.002). No significant differences were noted between the 2 groups in 6-minute walk distance or depression, although the changes were in the anticipated direction. Modest weight losses of >5% were associated with cardiopulmonary exercise test-documented workload levels at 6 months(r=0.331, p=0.006), as well as decreased depression(r=-0.315, p=0.01) and hostility(r=-0.355, p=0.005). The number of hospital admissions was significantly smaller for patients in the exercise group compared with those in the control group(0.63± 0.94 vs 1.07± 0.95, p< 0.05). In conclusion, the findings demonstrate the beneficial effects of a low-level, home-based walking program on weight loss in overweight and obese patients with advanced HF.展开更多
This study sought to establish the practice patterns of a diverse group of academic physicians, in the management of periprocedural anticoagulation for patients with mechanical heart valves, to study adherence to Amer...This study sought to establish the practice patterns of a diverse group of academic physicians, in the management of periprocedural anticoagulation for patients with mechanical heart valves, to study adherence to American College of Cardiology/ American Heart Association(ACC/AHA) guidelines. Physicians(n=140) were surveyed to assess strategies for the periprocedural anticoagulation of patients with bileaflet mechanical heart valves undergoing 2 common outpatient procedures. Six patient scenarios with graded risk profiles were presented for each valve location(mitral and aortic). In >90% of high-risk patient scenarios, for which the ACC/AHA guidelines recommend periprocedural anticoagulation, anticoagulation was recommended, with minimal differences between physician specialties. However, periprocedural anticoagulation was also recommended in >70% of non-high-risk scenarios, for which the ACC/AHA guidelines recommend no periprocedural anticoagulation. Noncardiologists recommended anticoagulation more often in non-high-risk patients(p< 0.01), especially for patients with aortic valve prostheses. Thus, academic physicians appropriately recommend periprocedural anticoagulation for high-risk patients with mechanical heart valves who undergo elective procedures. However, these data specifically suggest variability in practice for non-high-risk patients that are discordant with current ACC/AHA guidelines, with differences by treating specialty especially notable in this risk subset.展开更多
Cerebrovascular events occur frequently in patients who succumb to cancer, and nonbacterial thrombotic endocarditis(NBTE) is a frequent postmortem finding in these patients. Despite the excellent diagnostic accuracy o...Cerebrovascular events occur frequently in patients who succumb to cancer, and nonbacterial thrombotic endocarditis(NBTE) is a frequent postmortem finding in these patients. Despite the excellent diagnostic accuracy of transesophageal echocardiography(TEE)for cardiac sources of cerebral embolism, however, the prevalence of NBTE and other cardioembolic sources in patients with cancer and cerebral ischemia has not been investigated using this modality. This study examined the frequency of cardioembolic findings in consecutive patients with cancer referred to our institution for TEE evaluation of cerebrovascular events. The study cohort comprised 51 patients, of whom 18% had marantic vegetations, and 47% and 55% of whom had definite and definite or probable cardiac sources of embolism, respectively. The present study documents, for the first time, a high frequency of marantic endocarditis and other cardioembolic sources in patients with cancer and cerebrovascular events selected for TEE. This finding has important implications for evaluation and management in this patient population.展开更多
Analyses of aortic specimens obtained from patients with tetralogy of Fallot(TOF) revealed elastic fiber fragmentation. This study sought to determine the prevalence of aortic root dilation and aortic regurgitation(AR...Analyses of aortic specimens obtained from patients with tetralogy of Fallot(TOF) revealed elastic fiber fragmentation. This study sought to determine the prevalence of aortic root dilation and aortic regurgitation(AR) in children after TOF repair and tested the hypothesis that aortic elastic properties are altered and related to aortic root dilation in these patients. Aortic dimensions, adjusted for body surface area and expressed as z scores, and AR were assessed echocardiographically in 67 children 8.3± 5.6 years after TOF repair. The aortic elastic properties were compared with those in 50 age-matched controls. The prevalence of aortic dilation(z score >2) was 88% , 87% , 61% , and 63% at the annulus, sinus of Valsalva, sinotubular junction, and ascending aorta, respectively. The z scores of the annulus(r=0.41, p< 0.001) and sinus(r=0.33, p< 0.01) were correlated with body surface area. Multivariate analysis identified the duration of follow-up after surgery as the only significant determinant of z scores of the annulus(β =0.41, p=0.001) and sinus(β =0.33, p=0.009). AR was present in 12% of patients who tended to have larger z scores at all aortic levels. Compared with controls, patients had significantly increased aortic stiffness(p< 0.001) and reduced strain(p< 0.001) and distensibility(p=0.002). Aortic stiffness was correlated positively, whereas aortic strain and distensibility were correlated negatively, with the aortic root z scores at all levels. In conclusion, this study shows a high prevalence of aortic root dilation in children after the repair of TOF. Aortic stiffening occurred in these patients and may play a role in progressive aortic root dilation.展开更多
Numerous trials have demonstrated survival benefits using implantable cardioverter defibrillators(ICDs) for primary prevention in selected patients with left ventricular(LV) systolic dysfunction. However, eligibility ...Numerous trials have demonstrated survival benefits using implantable cardioverter defibrillators(ICDs) for primary prevention in selected patients with left ventricular(LV) systolic dysfunction. However, eligibility criteria differed across these trials. Without a risk stratification scheme that clearly identifies those who will benefit, there remains debate about which patients with heart failure(HF) should receive ICDs for primary prevention. To explore the implications of applying different eligibility criteria, this study evaluated all patients seen in a specialized HF clinic from August 2003 to January 2004. Of the 309 consecutive patients in the cohort, 46 were excluded because their HF complicated recent myocardial infarcts(n=3); their LV ejection fractions were not measured(n=9); or their HF was due to valvular disease, myocarditis, or peripartum cardiomyopathy(n=34). The Multicenter Automatic Defibrillator Implantation Trial-II criteria were met by 85 patients(32% ), and 134 patients(51% ) met the Sudden Cardiac Death in Heart Failure Trial criteria. Even allocation decisions based on randomized trial evidence can have vastly different resource implications depending on which trial is chosen. Thus, the development and validation of a risk stratification scheme to identify those patients most likely to benefit from ICDs for primary prophylaxis should be a research priority.展开更多
This study evaluated the safety, tolerability, and efficacy of statin therapy in patients with heart failure secondary to inflammatory dilated cardiomyopathy and moderately elevated low-density lipoprotein cholesterol...This study evaluated the safety, tolerability, and efficacy of statin therapy in patients with heart failure secondary to inflammatory dilated cardiomyopathy and moderately elevated low-density lipoprotein cholesterol levels. Seventy- four patients were randomized to receive atorvastatin 40 mg/day or conventional treatment for heart failure. After 6 months of therapy, the predefined primary efficacy end point(an increase of >5% in the absolute left ventricular ejection fraction and< 2 selected criteria by echocardiography and a decrease in New York Heart Association functional class) was significant in the statin-treated patients(p=0.004). Among secondary efficacy parameters, the quality-of-life index showed a trend suggesting the benefit of statin therapy(p=0.055). In conclusion, the results of this study demonstrate that treatment with atorvastatin in addition to standard therapy for heart failure may significantly improve clinical outcomes in this cohort of patients.展开更多
Aims: The aim of this study was to evaluate the diagnostic accuracy in the ass essment of coronary artery bypass grafts using 64-slice computed tomography(CT) technology. Methods and results: CT coronary angiography w...Aims: The aim of this study was to evaluate the diagnostic accuracy in the ass essment of coronary artery bypass grafts using 64-slice computed tomography(CT) technology. Methods and results: CT coronary angiography was performed for 96 b ypasses in 31 patients with suspected coronary artery disease using a Siemens Se nsation 64-slice CT-scanner and compared with invasive coronary angiography(IC A). Patients with an irregular or fast heart rate despite β-blocker administra tion were not excluded from the study. All bypass grafts and 94%of the distal b ypass anastomoses could be visualized by CT, nonevaluable distal arterial anasto moses were either due to clip material or calcification artefacts. Forty-two by pass graft occlusions and three significant stenoses were detected by CT and con firmed by ICA. Two venous grafts were missed and one arterial graft was not eval uable with ICA, but both were clearly depicted by multi-slice CT. One false neg ative and two false positive CT-findings resulted in a sensitivity of 97.8%, a specificity of 89.3%, a positive predictive value of 90%, and a negative pred ictive value of 97.7%. Conclusion: State-of-the-art 64-slice CT coronary angiography demonstrates high diagnostic accuracy in the assessment of arterial and venous bypass graft stenoses.展开更多
文摘Exercise is an important behavior for long-term weight control in overweight and obese patients. However, little evidence exists confirming such findings in patients with advanced heart failure(HF). Using a prospective, experimental design, the effects of 24 weeks of a low-level, home-based walking program on weight loss were studied in overweight and obese(body mass index≥ 27 kg/m2) patients with advanced HF who were randomized to exercise(n=48) and control(n=51) groups. Weight changes between the 2 groups at baseline and 6 months were compared using repeated-measures analysis of variance. Patients were on average aged 53.3± 10.1 years and predominantly male(75% ), Caucasian(57% ), and married(55% ). Most patients were in New York Heart Association class III or IV(67% ), with a mean ejection fraction of 25% . Patients in the exercise group showed significant weight reduction from baseline to 6 months compared with those in the control group(-6.37± 11.7 vs -0.33± 9.3 kg, p=0.002). No significant differences were noted between the 2 groups in 6-minute walk distance or depression, although the changes were in the anticipated direction. Modest weight losses of >5% were associated with cardiopulmonary exercise test-documented workload levels at 6 months(r=0.331, p=0.006), as well as decreased depression(r=-0.315, p=0.01) and hostility(r=-0.355, p=0.005). The number of hospital admissions was significantly smaller for patients in the exercise group compared with those in the control group(0.63± 0.94 vs 1.07± 0.95, p< 0.05). In conclusion, the findings demonstrate the beneficial effects of a low-level, home-based walking program on weight loss in overweight and obese patients with advanced HF.
文摘This study sought to establish the practice patterns of a diverse group of academic physicians, in the management of periprocedural anticoagulation for patients with mechanical heart valves, to study adherence to American College of Cardiology/ American Heart Association(ACC/AHA) guidelines. Physicians(n=140) were surveyed to assess strategies for the periprocedural anticoagulation of patients with bileaflet mechanical heart valves undergoing 2 common outpatient procedures. Six patient scenarios with graded risk profiles were presented for each valve location(mitral and aortic). In >90% of high-risk patient scenarios, for which the ACC/AHA guidelines recommend periprocedural anticoagulation, anticoagulation was recommended, with minimal differences between physician specialties. However, periprocedural anticoagulation was also recommended in >70% of non-high-risk scenarios, for which the ACC/AHA guidelines recommend no periprocedural anticoagulation. Noncardiologists recommended anticoagulation more often in non-high-risk patients(p< 0.01), especially for patients with aortic valve prostheses. Thus, academic physicians appropriately recommend periprocedural anticoagulation for high-risk patients with mechanical heart valves who undergo elective procedures. However, these data specifically suggest variability in practice for non-high-risk patients that are discordant with current ACC/AHA guidelines, with differences by treating specialty especially notable in this risk subset.
文摘Cerebrovascular events occur frequently in patients who succumb to cancer, and nonbacterial thrombotic endocarditis(NBTE) is a frequent postmortem finding in these patients. Despite the excellent diagnostic accuracy of transesophageal echocardiography(TEE)for cardiac sources of cerebral embolism, however, the prevalence of NBTE and other cardioembolic sources in patients with cancer and cerebral ischemia has not been investigated using this modality. This study examined the frequency of cardioembolic findings in consecutive patients with cancer referred to our institution for TEE evaluation of cerebrovascular events. The study cohort comprised 51 patients, of whom 18% had marantic vegetations, and 47% and 55% of whom had definite and definite or probable cardiac sources of embolism, respectively. The present study documents, for the first time, a high frequency of marantic endocarditis and other cardioembolic sources in patients with cancer and cerebrovascular events selected for TEE. This finding has important implications for evaluation and management in this patient population.
文摘Analyses of aortic specimens obtained from patients with tetralogy of Fallot(TOF) revealed elastic fiber fragmentation. This study sought to determine the prevalence of aortic root dilation and aortic regurgitation(AR) in children after TOF repair and tested the hypothesis that aortic elastic properties are altered and related to aortic root dilation in these patients. Aortic dimensions, adjusted for body surface area and expressed as z scores, and AR were assessed echocardiographically in 67 children 8.3± 5.6 years after TOF repair. The aortic elastic properties were compared with those in 50 age-matched controls. The prevalence of aortic dilation(z score >2) was 88% , 87% , 61% , and 63% at the annulus, sinus of Valsalva, sinotubular junction, and ascending aorta, respectively. The z scores of the annulus(r=0.41, p< 0.001) and sinus(r=0.33, p< 0.01) were correlated with body surface area. Multivariate analysis identified the duration of follow-up after surgery as the only significant determinant of z scores of the annulus(β =0.41, p=0.001) and sinus(β =0.33, p=0.009). AR was present in 12% of patients who tended to have larger z scores at all aortic levels. Compared with controls, patients had significantly increased aortic stiffness(p< 0.001) and reduced strain(p< 0.001) and distensibility(p=0.002). Aortic stiffness was correlated positively, whereas aortic strain and distensibility were correlated negatively, with the aortic root z scores at all levels. In conclusion, this study shows a high prevalence of aortic root dilation in children after the repair of TOF. Aortic stiffening occurred in these patients and may play a role in progressive aortic root dilation.
文摘Numerous trials have demonstrated survival benefits using implantable cardioverter defibrillators(ICDs) for primary prevention in selected patients with left ventricular(LV) systolic dysfunction. However, eligibility criteria differed across these trials. Without a risk stratification scheme that clearly identifies those who will benefit, there remains debate about which patients with heart failure(HF) should receive ICDs for primary prevention. To explore the implications of applying different eligibility criteria, this study evaluated all patients seen in a specialized HF clinic from August 2003 to January 2004. Of the 309 consecutive patients in the cohort, 46 were excluded because their HF complicated recent myocardial infarcts(n=3); their LV ejection fractions were not measured(n=9); or their HF was due to valvular disease, myocarditis, or peripartum cardiomyopathy(n=34). The Multicenter Automatic Defibrillator Implantation Trial-II criteria were met by 85 patients(32% ), and 134 patients(51% ) met the Sudden Cardiac Death in Heart Failure Trial criteria. Even allocation decisions based on randomized trial evidence can have vastly different resource implications depending on which trial is chosen. Thus, the development and validation of a risk stratification scheme to identify those patients most likely to benefit from ICDs for primary prophylaxis should be a research priority.
文摘This study evaluated the safety, tolerability, and efficacy of statin therapy in patients with heart failure secondary to inflammatory dilated cardiomyopathy and moderately elevated low-density lipoprotein cholesterol levels. Seventy- four patients were randomized to receive atorvastatin 40 mg/day or conventional treatment for heart failure. After 6 months of therapy, the predefined primary efficacy end point(an increase of >5% in the absolute left ventricular ejection fraction and< 2 selected criteria by echocardiography and a decrease in New York Heart Association functional class) was significant in the statin-treated patients(p=0.004). Among secondary efficacy parameters, the quality-of-life index showed a trend suggesting the benefit of statin therapy(p=0.055). In conclusion, the results of this study demonstrate that treatment with atorvastatin in addition to standard therapy for heart failure may significantly improve clinical outcomes in this cohort of patients.
文摘Aims: The aim of this study was to evaluate the diagnostic accuracy in the ass essment of coronary artery bypass grafts using 64-slice computed tomography(CT) technology. Methods and results: CT coronary angiography was performed for 96 b ypasses in 31 patients with suspected coronary artery disease using a Siemens Se nsation 64-slice CT-scanner and compared with invasive coronary angiography(IC A). Patients with an irregular or fast heart rate despite β-blocker administra tion were not excluded from the study. All bypass grafts and 94%of the distal b ypass anastomoses could be visualized by CT, nonevaluable distal arterial anasto moses were either due to clip material or calcification artefacts. Forty-two by pass graft occlusions and three significant stenoses were detected by CT and con firmed by ICA. Two venous grafts were missed and one arterial graft was not eval uable with ICA, but both were clearly depicted by multi-slice CT. One false neg ative and two false positive CT-findings resulted in a sensitivity of 97.8%, a specificity of 89.3%, a positive predictive value of 90%, and a negative pred ictive value of 97.7%. Conclusion: State-of-the-art 64-slice CT coronary angiography demonstrates high diagnostic accuracy in the assessment of arterial and venous bypass graft stenoses.
