[Cardiovascular risk of androgen deprivation therapy for treatment of hormone-dependent prostate cancer : Differences between GnRH antagonists and GnRH agonists]. / Kardiovaskuläres Risiko unter Androgendeprivationstherapie zur Behandlung des hormonabhängigen Prostatakarzinoms : Unterschiede zwischen GnRH-Antagonisten gegenüber GnRH-Agonisten.

BACKGROUND: Several studies have indicated that reduction of testosterone levels in patients with prostate cancer undergoing androgen deprivation therapy (ADT) with gonadotropin-releasing hormone (GnRH) agonists can be associated with an increased risk of cardiovascular events. The GnRH antagonists have a different mode of action compared with GnRH agonists and may be preferred in ADT for patients with cardiovascular disease. OBJECTIVE: This review article discusses potential mechanisms underlying the development of cardiovascular events associated with ADT when using GnRH agonists and explains the differences in mode of action between GnRH agonists and GnRH antagonists. Additionally, relevant studies are presented and practical recommendations for the clinical practice are provided. MATERIAL AND METHODS: A literature search was performed. Full publications and abstracts published in the last 10 years up to September 2015 were considered to be eligible. RESULTS: The GnRH antagonists were associated with a decreased risk of cardiovascular events compared with GnRH agonists in prostate cancer patients undergoing ADT and particularly in patients with cardiovascular risk factors or a history of cardiovascular disease. This decrease may be due to the different mode of action of GnRH antagonists compared with GnRH agonists. CONCLUSION: Prostate cancer patients with either cardiovascular disease or an increased risk of experiencing a cardiovascular event undergoing ADT should be preferentially treated with GnRH antagonists.

[The effects of multimodal intervention for the primary prevention of cardiovascular diseases on depression, anxiety, and Type-D pattern: initial results of the randomized controlled PreFord trial]. / Effekte einer multimodalen Intervention zur Primärprävention kardiovaskulärer Krankheiten auf Depressivität, Angst und Typ-D-Muster: Erste Ergebnisse der randomisierten, kontrollierten PräFord-Studie.

Depression, anxiety, and Type-D pattern are associated with the earlier development and faster progression of cardiovascular disease (CVD). The aim of the randomized controlled PreFord trial was to improve multiple biological and psychosocial risk factors in the primary prevention of CVD. A total of 447 women and men with an ESC risk score >5% were randomly assigned to either multimodal or routine care groups. Somatic and psychosocial variables (HADS, DS-14) were assessed before and after the intervention, and annually for 2 years thereafter. The intervention showed no significant effects on the symptoms of depression, anxiety, and type D personality, either in the whole sample or in those with elevated scores at baseline. Thus, our study did not provide evidence that symptoms of depression, anxiety, or Type D personality can be effectively treated by multimodal behavioral interventions for the primary prevention of CVD.

Prognostic impact of electrocardiographic signs in patients with Type 2 diabetes and cardiovascular disease: results from the PROactive study.

AIMS: Although a resting electrocardiograph is broadly applied in clinical practice for evaluating patients with Type 2 diabetes and cardiovascular disease, the independent prognostic relevance of electrocardiographic signs has not thoroughly been examined. METHODS: Baseline 12-lead electrocardiographs available in 5231 of the 5238 participants of the PROactive trial were analysed for heart rate, heart rate corrected QT-interval, presence of atrial fibrillation/flutter, left axis deviation, right and left bundle branch block. The association of electrocardiographic signs with total mortality, the principal secondary composite endpoint (death, myocardial infarction and stroke) and serious adverse heart failure events was examined by Cox-regression analysis. RESULTS: Two hundred and twenty-three (4.3%) patients showed atrial fibrillation/flutter, 213 (4.1%) patients had right bundle branch block, 111 (2.1%) patients had left bundle branch block and 706 (13.5%) patients had left axis deviation. Mean cQT-interval was 418 ms (± 25 ms) and mean heart rate was 72/min (± 14/min). In multivariate adjusted analyses, heart rate and cQT-interval were significantly associated with mortality, the composite secondary endpoint and heart failure, whereas right and left bundle branch blocks were significantly associated with heart failure only. Left axis deviation was associated with heart failure and atrial fibrillation/flutter was associated with mortality and heart failure in univariate but not multivariate analyses. CONCLUSION: Easily assessable electrocardiographic signs such as heart rate, cQT-interval and bundle branch blocks were predictive for adverse outcome independently of multiple risk factor adjustment and should be considered in clinical care.

NT-pro-BNP predicts worsening renal function in patients with chronic systolic heart failure.

BACKGROUND: Worsening renal function (WRF) is frequently observed in patients with heart failure and is associated with worse outcome. The aim of this study was to examine the association of the cardiac serum marker N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) and WRF. METHODS: A total of 125 consecutive patients of a tertiary care outpatient clinic for heart failure prospectively underwent evaluation of renal function every 6 months. The association of baseline NT-pro-BNP with WRF was analysed during a follow up of 18 months. RESULTS: Twenty-eight (22.4%) patients developed WRF (increase in serum creatinine ≥0.3 mg/dL). Patients with WRF (2870 pg/mL, interquartile range (IQR) 1063-4765) had significantly higher baseline NT-pro-BNP values than patients without WRF (547 pg/mL, IQR 173-1454). The risk for WRF increased by 4.0 (95% CI 2.1-7.5) for each standard deviation of log NT-pro-BNP. In multivariable analysis including age, baseline renal function, ejection fraction, New York Heart Association class and diuretic dose, only NT-pro-BNP and diabetes were independent predictors of WRF. At a cut-off level of 696 pg/mL, NT-pro-BNP showed a sensitivity of 92.9% and a negative predictive value of 96.4% for WRF. CONCLUSION: NT-pro-BNP is a strong independent predictor of WRF within 18 months in patients with systolic heart failure with a high negative predictive value. Further studies are needed to evaluate reno-protective strategies in patients with elevated NT-pro-BNP.

Delta-glycated hemoglobin: a novel independent risk factor for cardiovascular events in patients without diabetes mellitus.

BACKGROUND: A single measurement of glycated hemoglobin (HbA1c) is a weak predictor for cardiovascular events in patients without Type 2 diabetes mellitus. We hypothesized that dynamic changes in HbA1c (Delta-HbA1c) would better predict cardiovascular outcome than a single value. METHODS: In 99 consecutive patients with stable coronary artery disease (CAD) and without diabetes mellitus who were seen twice in our outpatient clinic (4-6 months apart) in 1998, Delta-HbA1c (follow-up HbA1c--baseline HbA1c) was assessed. Between August and September 2007 (mean observation period 9.1 yr), patients and their physicians were contacted by telephone to evaluate the incidence of cardiovascular endpoints. The combined primary endpoint of our study was defined as the incidence of myocardial infarction, stroke or death from any cause. The endpoints were validated by chart review. RESULTS: Multivariate analysis demonstrated that the change of HbA1c between first and second examination in 1998 was the most powerful parameter for prediction of the combined primary endpoint in the next 9 yr. The hazard ratio was 5.03 [95% confidence interval (CI) 1.4-17.9] for any increase in HbA1c and 1.99 (95%CI 1.3-3.0) for an HbA1c increase of 0.3%. In addition, Kaplan-Meier survival analysis showed a significant association between endpoint-free survival and dynamic changes in HbA1c. CONCLUSIONS: Hence, changes in the glucometabolic milieu within 4-6 months calculated by the difference of two values of HbA1c affect the long-term prognosis of patients with CAD but without diabetes mellitus.

An increase in HbA1c after percutaneous coronary intervention raises the risk for restenosis in patients without Type 2 diabetes mellitus.

AIMS: The influence of dynamic changes in glycated haemoglobin (HbA(1c)) on restenosis after elective percutaneous coronary intervention (PCI) in patients without diabetes has not been analysed. Therefore, the rate of restenosis was investigated after elective PCI in 101 consecutive patients without diabetes mellitus in relation to dynamic changes of HbA(1c) levels. METHODS: Follow-up angiography was performed in all patients 4-6 months after intervention. RESULTS: Multivariate analysis demonstrated that the change in HbA(1c) between first and second coronary angiography was the most powerful metabolic parameter for prediction of restenosis. The odds ratio for restenosis was 3.0 (95% CI 1.0-9.0) for any increase in HbA(1c) and 1.9 (95% CI 1.1-3.5) for an HbA(1c) increase of 0.2%. CONCLUSIONS: Hence, chronic changes in the glucometabolic environment influence the incidence of restenosis after PCI in patients without diabetes.

NT-pro-BNP measured at discharge predicts outcome in multimorbid diabetic inpatients with a broad spectrum of cardiovascular disease.

The prognostic value of NT-pro-BNP has not been thoroughly evaluated in diabetic inpatients with manifest cardiovascular disease. NT-pro-BNP was measured in 156 patients with type 2 diabetes mellitus hospitalised due to cardiovascular disease. The association of NT-pro-BNP with mortality and the combined endpoint (CE) of death, heart failure decompensation, stroke and myocardial infarction was analysed during a median follow-up time of 1183 days. Patients who died (1669 IQR 788-5640 vs. 398, IQR 158-990 pg/ml) and patients with CE (1353, IQR 730-4289 vs. 304, IQR 128-784 pg/ml, both p=0.0001) had significantly elevated NT-pro-BNP compared to patients without the corresponding endpoint. Patients with supramedian NT-pro-BNP (>518 pg/ml) had significantly worse outcome regarding mortality (HR 5.5, 95%CI 2.0-14.8) and CE (HR 5.0, 95%CI 2.2-11.2) than patients with inframedian values even after adjustment for age, NYHA class and renal function. At a cut-off of 422 pg/ml, NT-pro-BNP showed a sensitivity of 89.6% and a negative predictive value of 92.8% for detection of patients with future CE. In this sample of diabetic patients with a broad spectrum of cardiovascular disease, NT-pro-BNP was a strong predictor of long-term outcome. NT-pro-BNP measured at discharge identifies high-risk patients independently of the underlying heart disease.

Activation of the calcineurin/NFAT signalling cascade starts early in human hypertrophic myocardium.

Cardiac hypertrophy is an independent risk factor for heart failure. Recent studies on gene regulation of proteins have involved intracellular Ca2+ homeostasis. The Ca2+-sensitive phosphatase, calcineurin, is one potential regulator of the hypertrophic response, so we aimed to investigate the calcineurin-dependent signal pathway at different stages of hypertrophy in human myocardium. We found the calcineurin pathway to be significantly activated in hypertrophic compared with non-hypertrophic myocardium as demonstrated by increased calcineurin activity and expression of calcineurin A-beta and B, and GATA-4, and a shift of phosphorylated cytoplasmic NFAT-3 into the nucleus as dephosphorylated nuclear NFAT-3. There was a tendency for these changes to be more pronounced in the decompensated compared with the compensated hypertrophic myocardium. The present study provides evidence for significant activation of the Ca2+-triggered calcineurin pathway in hypertrophic humans. Already present in compensated hypertrophy it showed a tendency to a further increase following transition to decompensated hypertrophy.

Assessment of viable myocardium by dobutamine transesophageal echocardiography and comparison with fluorine-18 fluorodeoxyglucose positron emission tomography.

OBJECTIVES: The aim of this study was to assess whether dobutamine transesophageal echocardiography can identify viable myocardium in patients with chronic myocardial infarction. BACKGROUND: Experimental and clinical studies have shown that dobutamine can recruit a contraction reserve in postischemic viable but akinetic segments, indicating that dobutamine-induced functional recovery is a potential ultrasound marker of myocardial viability. METHODS: Forty patients underwent rest and dobutamine transesophageal echocardiography (dobutamine 5, 10 and 20 micrograms/kg body weight per min) and fluorine-18 (F-18) fluorodeoxyglucose positron emission tomography at rest. Three representative short-axis tomograms and a transverse four-chamber-view were used for wall motion and F-18 fluorodeoxyglucose-uptake analysis in corresponding myocardial regions. A basally asynergic segment was considered viable by transesophageal echocardiography if dobutamine-induced systolic wall motion could be observed. Viability by positron emission tomography was defined as F-18 fluorodeoxyglucose uptake > or = 50% of the maximal uptake in a region with normal wall motion by left ventriculography. RESULTS: Functional recovery within the infarct region was found in 21 (53%) of 40 patients during dobutamine infusion. Infarct region-related viability by F-18 fluorodeoxyglucose uptake was diagnosed in 25 (63%) of 40 patients, yielding a diagnostic agreement between both techniques in 90% of patients. In 210 (89%) of 235 akinetic segments at rest, data on myocardial viability were concordant by the two techniques. The positive and negative predictive accuracy of dobutamine transesophageal echocardiography for viability defined by F-18 fluorodeoxyglucose uptake was 81% and 97%, respectively. Such uptake was significantly different (p < 0.001) between segments remaining akinetic (mean +/- SD 45 +/- 9%) during dobutamine infusion and segments with a dobutamine-induced contraction reserve (68 +/- 11%). CONCLUSIONS: Dobutamine transesophageal echocardiography provides a promising low cost and widely available approach to unmask myocardial viability in patients with chronic myocardial infarction, and results compare favorably with those of F-18 fluorodeoxyglucose positron emission tomography.

Dobutamine magnetic resonance imaging predicts contractile recovery of chronically dysfunctional myocardium after successful revascularization.

OBJECTIVES: This study sought to evaluate whether myocardial viability, as assessed by magnetic resonance imaging (MRI), reliably predicts postrevascularization left ventricular (LV) recovery. BACKGROUND: Compared with positron emission tomographic findings, MRI has proved to be a reliable technique for the identification of residual myocardial viability. However, the predictive accuracy of MRI-assessed preserved end-diastolic wall thickness (DWT) and dobutamine-induced systolic wall thickening (SWT) for LV functional recovery has not yet been evaluated. METHODS: Rest and low dose dobutamine MRI was performed in 43 patients with a chronic infarct (> or =4 months since ischemic event) and LV dysfunction who had undergone revascularization of the infarct-related vessel. On the basis of segmental evaluation of corresponding short-axis tomograms, infarct regions were graded viable by MRI if 1) DWT was > or =5.5 mm, and 2) dobutamine-induced SWT was > or =2 mm in > or =50% of dysfunctional segments related to the infarct region. Functional recovery was defined as SWT > or =2 mm in > or =50% of infarct-related segments at rest 4 to 6 months after successful revascularization. RESULTS: Recovery of regional SWT could be observed in 27 (63%) of 43 patients. Comparison MRI grading before and after revascularization indicated that dobutamine-induced SWT was a better predictor of LV functional recovery (sensitivity 89%, specificity 94%) than was preserved DWT (sensitivity 92%, specificity 56%). Segments that remained akinetic after revascularization had significantly lower DWT (6.0+/-3.1 mm [n = 219] vs. 9.8+/-2.6 mm [n = 188], p < 0.001) than those with improved SWT. Left ventricular ejection fraction increased significantly in patients with dobutamine-induced SWT than in those with no contractile reserve (14+/-9% vs. 3+/-9%, p < 0.0002), and the magnitude of this increase was correlated with the number of dobutamine-responsive segments per infarct region (r = 0.68, p < 0.0001). CONCLUSIONS: Quantitative assessment of dobutamine-induced SWT in chronic infarcts by MRI is a highly accurate predictor of LV functional recovery, and the presence of significantly reduced DWT reliably indicates irreversible myocardial damage. Therefore, dobutamine stress testing for the assessment of myocardial viability can be restricted to patients with preserved DWT.

Predictive value of low dose dobutamine transesophageal echocardiography and fluorine-18 fluorodeoxyglucose positron emission tomography for recovery of regional left ventricular function after successful revascularization.

OBJECTIVES: This study was designed to assess the predictive value of myocardial viability diagnosed by dobutamine transesophageal echocardiography and fluorine (F)-18 fluorodeoxyglucose positron emission tomography for left ventricular functional recovery after revascularization in patients with chronic left ventricular dysfunction. BACKGROUND: The identification of akinetic but viable myocardium is of particular importance for the selection of patients with a compromised left ventricle who will benefit from coronary revascularization. METHODS: Multiplane rest and dobutamine transesophageal echocardiography (dobutamine, 5 and 10 microg/min per kg) studies and F-18 fluorodeoxyglucose positron emission tomographic studies at rest were performed in 2 patients with 1) previous myocardial infarction and regional akinesia, 2) a stenosed infarct-related coronary artery, and 3) a patent infarct-related vessel after revascularization. A basally akinetic segment was considered viable by transesophageal echocardiography if dobutamine-induced contractile reserve could be observed. Viability by positron emission tomography was defined as F-18 fluorodeoxyglucose uptake > or = 50% of the maximal uptake in a region with normal wall motion. Recovery of regional left ventricular function 4 to 6 months after revascularization was diagnosed by transesophageal echocardiography if > or = 50% of segments akinetic at baseline had improved wall thickening. RESULTS: Dobutamine transesophageal echocardiography identified viable infarct regions in 25 (59%) of 42 patients, and F-18 fluorodeoxyglucose positron emission tomography in 30 (71%) of 42 patients, yielding diagnostic agreement in 86% of patients. Sensitivity and specificity for prediction of left ventricular functional recovery in individual patients was 92% and 88%, respectively, for dobutamine transesophageal echocardiography versus 96% and 69% for F-18 fluorodeoxyglucose positron emission tomography. Segments remaining akinetic after revascularization had a significantly lower (p < 0.001) F-18 fluorodeoxyglucose uptake (48 +/- 15%) than that (73 +/- 15%) of segments with recovery of regional left ventricular function. CONCLUSIONS: Both dobutamine transesophageal echocardiography and F-18 fluorodeoxyglucose positron emission tomography were highly sensitive in predicting functional recovery of chronically kinetic or dyskinetic myocardium after successful revascularization. Thus, dobutamine transesophageal echocardiography is a clinically valuable alternative to F-18 fluorodeoxyglucose positron emission tomography for assessing residual viability and predicting functional recovery after revascularization.

Significance of rest technetium-99m sestamibi imaging for the prediction of improvement of left ventricular dysfunction after Q wave myocardial infarction: importance of infarct location adjusted thresholds.

OBJECTIVE: The value of rest technetium-99m (Tc-99m) sestamibi scintigraphy under oral nitrate medication to predict myocardial viability was examined in patients with chronic infarcts. BACKGROUND: The value of rest Tc-99m sestamibi to predict viability in infarct regions has not been fully established because significant underestimation of viability, especially in the inferior myocardial wall, has been reported. METHODS: Forty patients with Q wave myocardial infarction underwent Tc-99m sestamibi single-photon emission computed tomography under nitrate medication before revascularization of the infarct-related artery. Wall motion was quantified from paired angiograms before and 4 months after revascularization. Tracer uptake was quantified in the central infarct region identified on the angiogram. RESULTS: The average Tc-99m sestamibi uptake in the central infarct region of patients with anterior infarcts and improvement of left ventricular function was significantly higher (68+/-12%, mean+/-SD) than in patients without improvement of function (40+/-14%, p < 0.02). The average Tc-99m sestamibi uptake in the central infarct region of patients with improvement of function and inferior infarcts was significantly lower (43+/-7%) than in patients with anterior infarcts (68+/-12%, p < 0.003), but was significantly higher than in patients with inferior infarction and no improvement of function (31+/-7%, p < 0.02). Using an infarct location adjusted optimal threshold (50% for anterior infarcts, 35% for inferior infarcts), Tc-99m sestamibi had a positive predictive value of 90% and a negative predictive value of 91% for improvement of left ventricular function. CONCLUSION: Quantitative rest Tc-99m sestamibi scintigraphy after oral nitrates reliably predicts improvement of left ventricular function after revascularization if infarct location adjusted thresholds are used.

Improvement of myocardial blood flow to ischemic regions by angiotensin-converting enzyme inhibition with quinaprilat IV: a study using [15O] water dobutamine stress positron emission tomography.

OBJECTIVES: This study was designed to analyze the effects of acute angiotensin-converting enzyme (ACE) inhibition on myocardial blood flow (MBF) in control and ischemic regions. BACKGROUND: Although animal studies indicate an improvement of MBF to ischemic regions after ACE inhibition, this effect has not been conclusively demonstrated in patients with coronary artery disease. METHODS: Myocardial blood flow was analyzed in ischemic and nonischemic regions of 10 symptomatic patients with coronary artery disease using repetitive [15O] water positron emission tomography at rest and during maximal dobutamine stress before and after ACE inhibition with quinaprilat 10 mg i.v. To exclude the possibility that repetitive ischemia may cause an increase in MBF, eight patients underwent the same protocol without quinaprilat (placebo patients). RESULTS: Rate pressure product in control and quinaprilat patients was comparable. In placebo patients, repetitive dobutamine stress did not change MBF to ischemic regions (1.41 +/- 0.17 during the first stress vs. 1.39 +/- 0.19 ml/min/g during the second stress, p = 0.93). In contrast, MBF in ischemic regions increased significantly after acute ACE inhibition with quinaprilat during repetitive dobutamine stress (1.10 +/- 0.13 vs. 1.69 +/- 0.17 ml/min/g, p < 0.015). Dobutamine coronary reserve in ischemic regions remained unchanged in placebo patients (1.07 +/- 0.11 vs. 1.10 +/- 0.16, p = 0.92), but increased significantly after quinaprilat (0.97 +/- 0.10 vs. 1.44 +/- 0.14, p < 0.002). Total coronary resistance decreased after ACE inhibition (123 +/- 19 vs. 71 +/- 10 mm Hg x min x g/ml, p < 0.02). CONCLUSIONS: Angiotensin-converting enzyme inhibition by quinaprilat significantly improves MBF to ischemic regions in patients with coronary artery disease.

Preparation/analysis of chromatin replicated in vivo and in isolated nuclei.

This article outlined biochemical methodologies for the labeling, detection, and analysis of newly replicated and newly assembled nucleosomes. The isolation of specific vertebrate factors that may be involved in chromatin assembly in vivo, such as nucleoplasmin, CAF-1, and NAP-1 and their counterparts in Drosophila and yeast add a further dimension to the study of nucleosome assembly in living cells. In particular, the ability to genetically manipulate the yeast system, together with the identification of yeast enzymes that acetylate newly synthesized H4, will certainly provide exciting new avenues for the investigation of chromatin assembly in vivo.

Hypertension guidelines and their limitations--the impact of physicians' compliance as evaluated by guideline awareness.

OBJECTIVE: The initial step of an optimal therapeutic strategy for patients with arterial hypertension is the recognition and acceptance of new recommendations by the physicians themselves. This guideline awareness of the physicians has never been evaluated in detail. DESIGN: The awareness of content of current recommendations in hypertension diagnosis, treatment and treatment control was therefore assessed in primary care physicians using a questionnaire. The guidelines of the German Hypertension Society were used as the reference standard. PARTICIPANTS: A total of 24 899 German physicians, including all internists, all cardiologists and 22% of general practitioners were contacted in a nationwide survey. MAIN OUTCOME MEASURES: The number of answers in agreement with the guideline was used as a measure of guideline awareness. Adequate awareness of content of guideline recommendations was defined as the correct answer to five out of eight questions; the correct answers had to include the appropriate definition of hypertension. RESULTS: The analysis was based on 11 547 returned questionnaires (47.1%). An adequate guideline awareness was found in 23.7% of the total study population, especially in 37.1% of cardiologists, in 25.6% of internists and in 18.8% of general practitioners. While the guideline awareness was significantly influenced by the duration of private practice, regional and municipal factors had only minor influence on the results. CONCLUSION: The impact of hypertension guidelines on actual medical knowledge is modest. Thus, the information strategies about current treatment guidelines must be improved and tailored to the needs of physicians in clinical practice to ultimately improve patient care.

Morphologic correlate of pathologic Q waves as assessed by gradient-echo magnetic resonance imaging.

To assess the morphologic correlate of the presence and absence of pathologic Q waves in the electrocardiogram, 30 patients with and 17 patients without pathologic Q waves and chronic myocardial infarction (infarct age > 4 months) and 15 patients without previous myocardial infarction but significant coronary artery disease (> 70% diameter stenoses) were studied by gradient-echo magnetic resonance imaging (MRI). Short-axis MRI tomograms were evaluated on a segmental basis by calculating end-diastolic wall thickness and systolic wall thickening. All segments were graded transmural scar (end-diastolic wall thickness < end-diastolic wall thickness of a healthy control group [n = 21]-2.5 SD and lack of systolic wall thickening), hypokinetic (end-diastolic wall thickness > or = end-diastolic wall thickness of the control group-2.5 SD and systolic wall thickening < or = 2 mm), or normal (end-diastolic wall thickness > or = end-diastolic wall thickness of the control group-2.5 SD and systolic wall thickening > 2 mm) by MRI criteria. Myocardial infarcts were defined as transmural if at least 1 segment fulfilled the MRI criteria for transmural scar. Of 30 patients with Q-wave infarction, 26 (87%) had a transmural defect, and 6 of 17 patients (35%) with non-Q-wave infarction had a transmural infarct. Segmental evaluation yielded 129 of 480 scar segments (27%) for patients with Q-wave infarction, 20 of 272 scar segments (7%) for patients with non-Q-wave infarction, and no scar segments for patients without previous myocardial infarction.(ABSTRACT TRUNCATED AT 250 WORDS)

In vivo uptake of azithromycin in human coronary plaques.

Ten patients with symptomatic coronary artery disease received oral azithromycin for 3 days and underwent directional atherectomy on the third day. Azithromycin was found in all plaque samples with a median concentration of 284 ng/ml (95% confidence interval 163 to 517 ng/ml).

Significance of exercise-induced ST-segment elevation and T-wave pseudonormalization for improvement of function in healed Q-wave myocardial infarction.

Exercise-induced ST-segment elevation and pseudonormalization of negative T waves (ST-T segment changes) in infarct leads indicate myocardial viability after Q-wave myocardial infarcts in some patients and may therefore identify patients who will benefit from revascularization. Global left ventricular ejection fraction and wall motion abnormalities of the left ventricle were analyzed in 34 patients with healed myocardial infarction (11 patients with ST-segment elevation, 3 patients with pseudonormalization of the negative T wave (group 1), and in 20 patients without ST-T segment changes during an exercise electrocardiogram (group 2)) before and 4 months after successful revascularization. Wall motion abnormality in the central infarct region at baseline was similar in both groups (-3.1 +/- 0.6 SD vs 3.0 +/- 0.8 SD; NS). At repeat angiography, wall motion abnormality improved significantly from -3.1 +/- 0.6 SD to -2.1 +/- 0.6 SD (p <0.01) in group 1 and was unchanged in group 2 (-3.0 +/- 0.8 SD vs -2.9 +/- 0.7 SD; NS). Similarly, ejection fraction at control angiography had increased from 54 +/- 14% to 66 +/- 12% (p <0.01) in group 1, but decreased from 56 +/- 9% to 55 +/- 9% in group 2 (NS). Exercise-induced ST-T segment changes yielded a sensitivity of 80% and a specificity of 89% to predict significant improvement of the left ventricular ejection fraction. Exercise-induced changes of the ST-T segment identify patients with a high probability of improvement of myocardial function after revascularization in patients with healed myocardial infarcts.

Comparison of dobutamine transesophageal echocardiography and dobutamine magnetic resonance imaging for detection of residual myocardial viability.

A dobutamine-induced contraction reserve in akinetic but viable myocardium, observed by echocardiography or magnetic resonance imaging (MRI), is a reliable indicator of myocardial viability. However, the comparative diagnostic accuracy of these 2 techniques is unknown. Therefore, 43 patients with myocardial infarction (infarct age > or = 4 months) and regional akinesia underwent dobutamine transesophageal echocardiography (TEE) and dobutamine MRI (10 microg dobutamine/ min/kg). Both imaging techniques were compared with the reference standard 18F-fluorodeoxyglucose positron emission tomography (FDG PET). An infarct region was considered viable if a dobutamine contraction reserve could be assessed visually by TEE or quantitatively by MRI in > or = 50% of segments graded "a" or dyskinetic at rest. Infarct regions were graded viable by PET if FDG uptake was > or = 50% of the maximal FDG uptake in a region with normal wall motion by left ventriculography. A dobutamine contraction reserve was found in 21 of 43 patients (49%) by TEE and MRI. A viable infarct region by FDG PET was diagnosed in 26 of 43 patients (60%). FDG uptake and dobutamine TEE were concordant in 36 of 43 patients (84%) and dobutamine MRI and FDG PET were concordant in 38 of 43 patients (88%). Sensitivity and specificity of dobutamine TEE and dobutamine MRI for FDG PET-defined myocardial viability were 77% versus 81% and 94% versus 100%, respectively. Both imaging techniques yielded similar results for the detection of myocardial viability as defined by FDG uptake, with a slightly higher sensitivity and specificity for the quantitatively evaluated dobutamine contraction reserve by MRI.

Thrombus formation after transcatheter closure of atrial septal defect.

Thrombotic layers and/or atrial thrombi were detected by transesophageal echocardiography as a usual finding after transcatheter closure of atrial septal defects with the ASDOS device. The size of the thrombotic structures regularly decreased within 6 months without any clinical signs of embolization.