| 1. |
- Bjorkander, Inge, et al.
(author)
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Differential Index : A Simple Time Domain Heart Rate Variability Analysis with Prognostic Implications in Stable Angina Pectoris
- 2008
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In: Cardiology. - : S. Karger AG. - 0008-6312 .- 1421-9751. ; 111:2, s. 126-133
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Journal article (peer-reviewed)abstract
- OBJECTIVES: To examine the usefulness of time domain heart rate variability (HRV) measurements by a simple graphical method, the differential index (DI), in prognostic assessments of patients with chronic stable angina pectoris. METHODS: HRV measurements in the time domain by DI were compared to conventional measurements of standard deviation of all normal-to-normal intervals (SDNN), percent of differences between adjacent normal RR intervals >50 ms (PNN50) and square root of the mean of the sum of squares of differences between adjacent normal RR intervals (RMSSD) from 24-hour ambulatory electrocardiographic recordings in 678 patients in the Angina Prognosis Study in Stockholm. The patients received double-blind treatment with metoprolol or verapamil. Main outcome measures were cardiovascular death or non-fatal myocardial infarction during follow-up (median 40 months). RESULTS: Patients suffering cardiovascular death (n = 30) had lower DI, SDNN and PNN50 (all p < 0.001). In a multivariate Cox model, DI below median independently predicted cardiovascular death (p = 0.002), as did SDNN (p = 0.016) and PNN50 (p = 0.030), but not RMSSD (p = 0.10). The separation of survival curves was most pronounced and specificity was slightly better with DI. DI and PNN50 increased with metoprolol but not verapamil treatment. Short-term treatment effects were not related to prognosis. CONCLUSIONS: Low time domain HRV carries independent prognostic information regarding cardiovascular death in stable angina pectoris. The simple DI method provided equally good or better prognostic information than conventional, more laborious HRV methods.
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| 2. |
- Faergeman,, et al.
(author)
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Efficacy and Tolerability of Rosuvastatin and Atorvastatin when Force-Titrated in Patients with Primary Hypercholesterolemia. Results from the ECLIPSE Study.
- 2008
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In: Cardiology. - : S. Karger AG. - 1421-9751 .- 0008-6312. ; 111:4, s. 219-228
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Journal article (peer-reviewed)abstract
- Background: Patients at high risk of cardiovascular disease frequently fail to reach recommended low-density lipoprotein cholesterol (LDL-C) goals, partly because statin doses are not titrated to optimal effect. The ECLIPSE study was designed to compare the efficacy and safety of force-titrated treatment with rosuvastatin (10-40 mg) with that of atorvastatin (10-80 mg) in high-risk patients with hypercholesterolemia. Methods: In this 24-week, open-label, randomized, multinational, parallel-group study, 1,036 patients were randomized to rosuvastatin (n = 522) or atorvastatin (n = 514). Results: At all time points, a significantly greater percentage of patients on rosuvastatin treatment achieved the NCEP ATP III LDL-C goal of <100 mg/dl (2.5 mmol/l), the 2003 European LDL-C target of <2.5 or 3.0 mmol/l (100 or 115 mg/dl) and the LDL-C goal of <70 mg/dl (1.8 mmol/l), a goal suggested for very high-risk patients (p < 0.001 for all). Rosuvastatin also achieved significantly greater improvements in components of the atherogenic lipid profile versus atorvastatin. Both treatments were well tolerated. Conclusion: Rosuvastatin titrated across its recommended dose range provides a more favorable effect on lipoprotein variables than atorvastatin, enabling more high-risk patients to achieve recommended LDL-C goals.
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| 3. |
- Ferrari, R, et al.
(author)
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The BEAUTIFUL study: andomized trial of ivabradine in patients with stable coronary artery disease and left ventricular systolic dysfunction - baseline characteristics of the study population
- 2008
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In: Cardiology. - : S. Karger AG. - 0008-6312 .- 1421-9751. ; 110, s. 271-82
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Journal article (peer-reviewed)abstract
- <i>Objectives:</i> Ivabradine is a selective heart rate-lowering agent that acts by inhibiting the pacemaker current <i>I</i><sub>f</sub> in sinoatrial node cells. Patients with coronary artery disease and left ventricular dysfunction are at high risk of death and cardiac events, and the BEAUTIFUL study was designed to evaluate the effects of ivabradine on outcome in such patients receiving optimal medical therapy. This report describes the study population at baseline. <i>Methods:</i> BEAUTIFUL is an international, multicentre, randomized, double-blind trial to compare ivabradine with placebo in reducing mortality and cardiovascular events in patients with stable coronary artery disease and left ventricular systolic dysfunction (ejection fraction <40%). <i>Results:</i> A total of 10,917 patients were randomized. At baseline, their mean age was 65 years, 83% were male, 98% Caucasian, 88% had previous myocardial infarction, 37% had diabetes, and 40% had metabolic syndrome. Mean ejection fraction was 32% and resting heart rate was 71.6 bpm. Concomitant medications included beta-blockers (87%), renin-angiotensin system agents (89%), antithrombotic agents (94%), and lipid-lowering agents (76%). <i>Conclusions:</i> Main results from BEAUTIFUL are expected in 2008, and should show whether ivabradine, on top of optimal medical treatment, reduces mortality and cardiovascular events in this population of high-risk patients.
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| 4. |
- Govind, Satish C., et al.
(author)
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Isolated Type 2 Diabetes mellitus Causes Myocardial Dysfunction That Becomes Worse in the Presence of Cardiovascular Diseases : Results of the Myocardial Doppler in Diabetes (MYDID): Study 1
- 2005
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In: Cardiology. - : S. Karger AG. - 0008-6312 .- 1421-9751. ; 103:4, s. 189-195
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Journal article (peer-reviewed)abstract
- Aims: Patients with type 2 diabetes mellitus (DM) often suffer disproportionately and have a worse outcome when burdened with cardiovascular complications compared with those without DM. A specific heart muscle disease reportedly caused by DM per se may explain this. We sought to investigate whether an echo Doppler diagnosis of such a myocardial disease is clinically relevant in DM with or without coexistent coronary artery disease (CAD) and/or hypertension ( HTN). Subjects and Methods: Two hundred subjects (127 males, 73 females, 56 +/- 10 years) including controls (n=23), patients with HTN (n=20), CAD (n=35), uncomplicated DM (n=59), DM+HTN (n=27), DM+ CAD (n=16) and DM+CAD+HTN (n=20) underwent tissue Doppler-enhanced dobutamine stress echocardiography. Myocardial function was assessed by measuring left ventricular myocardial peak systolic velocity (PSV) and early diastolic velocity at rest and during peak stress, besides measurements of standard Doppler variables. Results: Average left ventricular PSV at rest was significantly lower in CAD (4.7 +/- 1.5) compared with controls (5.7 center dot +/- 1.2) and in DM+CAD+HTN (4.6 +/- 1.4) compared with DM (5.6 +/- 1.3; all p < 0.05). During peak stress, lower PSV persisted in CAD (9.5 +/- 3.1) and DM+CAD+HTN (8.1 +/- 2.7), while appearing de novo in DM (11.3 +/- 2.6) and HTN (11.0 +/- 2.3) unlike in the controls (12.5 +/- 2.5; all p < 0.001). When pooled together, DM subjects with CAD and/or HTN or both had significantly lower PSV (9.1 +/- 2.7) than those without (10.0 +/- 2.8; p < 0.001). Early diastolic velocity response was equally lower in both groups compared with the controls. Conclusion: The results suggest that dobutamine stress unmasks myocardial functional disturbances caused by uncomplicated DM. The discrete disturbances become quantitatively more pronounced in the presence of coexistent cardiovascular diseases.
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| 5. |
- Helgason, Hrodmar, 1950, et al.
(author)
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Sizing of atrial septal defects in adults
- 2005
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In: Cardiology. - : S. Karger AG. - 0008-6312 .- 0008-6312 .- 1421-9751. ; 104:1, s. 1-5
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Journal article (peer-reviewed)abstract
- In a retrospective study of 51 consecutive patients undergoing transcatheter closure of secundum type atrial septal defects (ASDs), we examined the reliability of transesophageal echocardiography (TEE) prior to catheterization and compared the diameter with that obtained by balloon measurement during catheterization. The TEE diameter was 16.3+/-4.6 mm compared with 22.5+/-6.0 mm for the stretched diameter obtained during catheterization (p<0.001). There was no gender difference. The degree of left-to-right shunting correlated poorly with the size of the defect. We conclude that although TEE is accurate for diagnosis of an ASD, the measurement of its size to determine the size of the closure device is at best inaccurate.
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| 6. |
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| 7. |
- Herlitz, Johan, 1949, et al.
(author)
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Rate of admission and long-term prognosis among patients with acute chest pain in the 1990s compared with the 1980s
- 2005
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In: Cardiology. - : S. Karger AG. - 0008-6312 .- 1421-9751. ; 104:1, s. 51-6
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Journal article (peer-reviewed)abstract
- We describe the incidence of acute chest pain (requiring admission to the emergency department) and the prognosis during two time periods in all patients admitted to the emergency department at Sahlgrenska University Hospital in Goteborg, Sweden, with acute chest pain 1986 and 1987 (period 1) and 1996 and 1997 (period 2). The rate of admission for chest pain/100,000 inhabitants was 4.7/day during period 1 and 5.0/day during period 2. The risk ratio for death adjusted for eight risk factors during period 2 in relation to period 1 was 0.88 (95% CI 0.79-0.97). There was a significant interaction between time period and the severity of the final diagnosis (p=0.02), indicating a greater reduction in mortality among patients with acute myocardial infarction.
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| 9. |
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| 10. |
- Odell, Annika, et al.
(author)
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The impact of general usage of stents on short- and long-term health care costs following percutaneous coronary intervention
- 2008
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In: Cardiology. - : S. Karger AG. - 0008-6312 .- 1421-9751. ; 109:2, s. 85-92
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Journal article (peer-reviewed)abstract
- Background: The general usage of stents during percutaneous coronary intervention (PCI) reduces the need for subsequent repeated revascularizations when compared with balloon dilatation. The aim was to evaluate the impact of stenting on short- and long-term in-hospital care costs after PCI. Method and Results: Patients who underwent PCI from July 1992 to June 1993 (group A, n = 166; 4.2% stents) and from July 1996 to June 1997 (group B, n = 233; 61.4% stents) were included. The clinical outcome and all in-hospital care costs during 2.5 years following the procedures were analyzed. During the study period the number of deaths and acute myocardial infarctions was similar in the groups, but repeated revascularization occurred more often in group A than in group B (53.6 vs. 39.5%; p = 0.007). The initial procedural cost per patient was higher in group B than in group A (EUR 7,653 +/- 5,071 vs. EUR 6,048 +/- 3,242; p = 0.002), but after 2.5 years the costs were similar in the 2 groups (not significant). Conclusion: General usage of stents increases immediate health care cost compared with balloon dilatation, but despite reduction in subsequent revascularization, there is no reduction in long-term in-hospital costs.
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