Cardiology RSS : Gourt

Metro Iowa Cardiology Group Will Accept H1's and J1's, Non-Invasive, Invasive and Interventional. H :: Iowa :: CompHealth Inc

Job 6510265 Well established, strong Cardiology group needs to bring on Non-Invasives, Non-Interventionalists and Interventional Specialists 2 Year Partnership Track Group has several locations throughout

Board Eligible / Board Certified Cardiologist to Join Large Physician Owned Multi-Specialty Group :: Iowa :: CompHealth Inc

Job 6511306 2 Year shareholder track 2 Year Salary Guarantee One of the Top 100 places to live by Money Magazine and ranked one of America's Top 5 cities to be married with children Collegial physician

Immediate Need - Board Certified Invasive Cardiologist - Lexington, KY Area :: Kentucky :: CompHealth Inc

Job 6511399 Join existing practice...Be Busy immediately...Help run practice!!!!!! Must be Board Certified...Do diagnostic caths Partnership possible in one year Salaried position Visa Candidates Welcome...Multi-cultural

A Growing Community, an hour away from Las Vegas, Seeks Cardiologist :: Nevada :: CompHealth Inc

Job 6510559 Board Eligible / Board Certified Cardiologist to join a Single Specialty Practice Cash collections guarantee Relocation Potential medical education debt assistance World-class golfing -

One of Tennessee's Fastest-Growing Communities Needs Cardidologists! :: Tennessee :: CompHealth Inc

Job 658211 Excellent income - $400K+ Your choices: solo-employed or group State-of-the-art, 270 bed medical center Booming suburb of Nashville Admit to one hospital Full benefit package Bonus/incentives

INVASIVE CARDIOLOGY...COME TO THE LAND OF ENCHANTMENT IN NEW MEXICO :: New Mexico :: CompHealth Inc

Job 659495 Hospital backed - 1 year guarantee Join 2 other successful Interventional Cardiologists Call 1:5 or better Excellent compensation No Visas. Use your Spanish skills (not mandatory) Admit

Join 1 other Pediatric Cardiologist in Physician Friendly Indiana :: Indiana :: CompHealth Inc

Job 3112293 B/C B/E in Pediatrics and Cardiology Call is 1 week on and 1 week off Salary to MGMA Standards Loan Repayment Sign On Bonus Relocation Malpractice Paid, Student Loan Repayment, Health, Life,

Cardiology Need in ATLANTA ... Heart Failure Experience Required :: Georgia :: CompHealth Inc

Job 6511325 Very good earnings potential Outstanding urban location Fantastic benefits Academic work available Nuclear and Echo on site M Incentives/Bonus Malpractice Paid 4 weeks vacation, 1 week CME

Non-Invasive Cardiologist Needed In Metro Santa Fe, New Mexico :: New Mexico :: CompHealth Inc

Job 6510271 Join one other cardiologist in an 8 member multispecialty group 7 Providers as referral base, No call, consultative practice (Hospitalist program) Great life / work balance Thirty minutes

Invasive Cardiology Need in Beautiful Sierra Nevada Foothills :: California :: CompHealth Inc

Job 6510105 $20,000 Sign On Bonus Hospital Based Single Specialty Practice Large Clinic with Echo on site Call 1:4 Established Patient Base 1 Year to Partnership Malpractice & Benefits All Reimbursed

Growing Community Needs Cardiologist - Northeast of Phoenix :: Arizona :: CompHealth Inc

Job 659726 Solo practice or hospital employed Office based and hospital based skills needed. EKG's - Echo - Nuclear 10 days of call/month Practice Support Package: Marketing Potential Medical Education

Excellent Cardiology Opportunity in Great Lakes States! :: Michigan :: CompHealth Inc

Job 659408 Employed position. Compensation $400K Admit to 1 hospital Start-up opportunity Camera and Lab on-site Full hospital system support 100 miles from Marquette, MI, 100 miles from Green Bay,

Brand New Cardiovascular Center Seeks Non-Invasive :: Minnesota :: CompHealth Inc

Job 514037 State-of-the-Art facility and Cath Lab General non-invasive cardiology Multi-specialty group has great reputation in area Terrific local amenities in community 1 hour to Twin cities Malpractice

Invasive Cardiology - Easy Access to Denver, CO :: Colorado :: CompHealth Inc

Job 6510213 Practice welcomes J-1 Candidates Confident, hard-working doctor needed for small, friendly community just east of Denver, Colorado Cathing a must; some training in Nuclear good Call is every

Wyoming - Perfect Blend of City and Country :: Wyoming :: CompHealth Inc

Job 659936 Seeking Board Eligible / Board Certified Invasive or Interventional Cardiologist Call 1:7 Admit to 1 hospital Excellent outdoor activities State-of-the-Art nuclear medicine system - echo/ultra

Interventional - One of a kind opportunity :: Montana :: CompHealth Inc

Job 659810 Ranked Top 100 Hospitals Brand new $85 million dollar expansion Employed opportunity with tremendous benefits Compensation above national average Top ranked schools Unique outdoor lifestyle

New Opportunities in the Jackson, TN area :: Tennessee :: CompHealth Inc

Job 658254 Interventional Call 1:5 Great lifestyle - expanding market Open salary - no state income tax Friendly community Two opportunities available Loan assist - up to $90,000 repayment available

Non-Invasive Cardiologist Needed in Iowa :: Iowa :: CompHealth Inc

Job 6510461 Board Certified / Board Eligible Invasive / Non:Interventional Starting bonus and full relocation Hospital 1:5 Outreach work to local communities Stand alone office on hospital campus Northeast

Texas is Calling All Cardiologists :: Texas :: CompHealth Inc

Job 659688 Interventional, Invasive or Non:Invasive Outstanding compensation, wonderful benefits Huge demand in the area! Join a large multi-specialty group This is true Texas! Incentives/Bonus Malpractice

Cardiologist needed in Nashville :: Tennessee :: CompHealth Inc

Job 656997 Partnership opportunity State of the art office Great compensation package with benefits 3 man group with a 1:4 call schedule All digital in-office echo lab Vacation, CME Moving expenses

Study Identifies Key Factor that Links Metabolic Syndrome

A new study led by researchers at Joslin Diabetes Center has identified insulin resistance in the liver as a key factor in the cause of metabolic syndrome and its associated atherosclerosis Additional topics at Heart Disease More research-related news at Consumer Information

CT Scans Effective in Detecting Artery Disease

Additional topics at Heart Disease More research-related news at Consumer Information

Cor triatriatum sinister.

Related Articles Cor triatriatum sinister. Acta Cardiol. 2009 Aug;64(4):574-6 Authors: Walpot J, Hokken R, Pasteuning WH PMID: 19725458 [PubMed - indexed for MEDLINE]

Cardiac myxoma: related to immunosuppression? A case report.

Related Articles Cardiac myxoma: related to immunosuppression? A case report. Acta Cardiol. 2009 Aug;64(4):571-3 Authors: Dadkhah R, Decoodt P Cardiac myxomas are the most common type of primary cardiac tumours. Nevertheless, it is still a rare tumour and its relation with immunosuppressive therapy, which is essential after organ transplantation, remains uncertain. We report the case of a 30-year-old woman, who underwent kidney and pancreatic transplantation for severe nephropathy due to type I diabetes mellitus and since then, under heavy immunosuppressive treatment. Four years after surgery, a left atrial myxoma was discovered. Three other cases of cardiac myxomas following transplantation and immunodepressive status have been reported in the literature, which raises the question of an association between immunosuppression and the development of cardiac myxomas. PMID: 19725457 [PubMed - indexed for MEDLINE]

Myotonic dystrophy as a potential killer.

Related Articles Myotonic dystrophy as a potential killer. Acta Cardiol. 2009 Aug;64(4):567-9 Authors: Brenner R, Joerg L, Rickli H A 19-year-old man suffered a cardiac arrest during a promenade with his friends. Cardiac resuscitation was started immediately. Anamnesis uncovered that the father as well as a cousin of the patient suffered from myotonic dystrophy (MD). Follow-up ECG monitoring showed intercurrent III degree AV-block as well as several asymptomatic episodes of ventricular tachycardias, atrial flutter with changing conduction and atrial fibrillation. Neuromuscular testing and genetic analyses confirmed the diagnosis of a myotonic dystrophy. Myotonic dystrophy (MD) is a chronic, slowly progressing, autosomal dominant inherited multisystemic disease.The clinical presentation is characterized by wasting of the muscles with delayed relaxation, cataracts and endocrine changes. MD is associated with both cardiac conduction disturbances and structural heart abnormalities. Electrocardiographic abnormalities include conduction disturbances or tachyarrhythmias. This case illustrates that potentially lethal arrhythmias inducing sudden cardiac death may occur in MD patients even in the absence of neurologic symptoms characterizing the systemic illness. PMID: 19725456 [PubMed - indexed for MEDLINE]

Giant R-waves associated with acute inferoposterior myocardial infarction.

Related Articles Giant R-waves associated with acute inferoposterior myocardial infarction. Acta Cardiol. 2009 Aug;64(4):565-6 Authors: Keuleers S, Ector H, Vydt T PMID: 19725455 [PubMed - indexed for MEDLINE]

Transcatheter patent foramen ovale closure: a treatment for refractory hypoxaemia.

Related Articles Transcatheter patent foramen ovale closure: a treatment for refractory hypoxaemia. Acta Cardiol. 2009 Aug;64(4):561-3 Authors: Faes D, Gilles R, Kefer J Right-to-left intracardiac shunt through a patent foramen ovale sometimes induces a significant arterial oxygen desaturation. We describe two cases of severe hypoxia due to a patent foramen ovale, treated successfully by transcatheter closure of the intracardiac shunt. One case occurred after implantation of a cardiac assist device, the other patient presented with a platypnoeaorthodeoxia syndrome. Clinical considerations are outlined. PMID: 19725454 [PubMed - indexed for MEDLINE]

Cardiac manifestation in Takayasu arteritis.

Related Articles Cardiac manifestation in Takayasu arteritis. Acta Cardiol. 2009 Aug;64(4):557-60 Authors: Weyn T, Haine S, Van den BF, Conraads V We present two case reports of young women with Takayasu arteritis and cardiovascular complications. The first case is a female patient suffering from significant aortic valve regurgitation, the second case is a woman who presents with amaurosis fugax and develops acute chest pain with heart failure. In this report we review cardiac involvement in Takayasu arteritis. PMID: 19725453 [PubMed - indexed for MEDLINE]

Hyperacute T-waves.

Related Articles Hyperacute T-waves. Acta Cardiol. 2009 Aug;64(4):555 Authors: Michiels V, Claeys M, Vrints C PMID: 19725452 [PubMed - indexed for MEDLINE]

False image of left ventricular diverticulum caused by local hypertrophy.

Related Articles False image of left ventricular diverticulum caused by local hypertrophy. Acta Cardiol. 2009 Aug;64(4):553-4 Authors: Haman L, Praus R, Parizek P PMID: 19725451 [PubMed - indexed for MEDLINE]

Safety of ultrasound contrast agents: "Primum non nocere"?

Related Articles Safety of ultrasound contrast agents: "Primum non nocere"? Acta Cardiol. 2009 Aug;64(4):547-52 Authors: Cosyns B, Pasquet A, Van Camp G, Hernot S, Droogmans S, Unger P, De Sutter J, Lancellotti P, PMID: 19725450 [PubMed - indexed for MEDLINE]

Implementation of reperfusion therapy in ST-segment elevation myocardial infarction. A policy statement from the Belgian Society of Cardiology (BSC), the Belgian Interdisciplinary Working Group on Acute Cardiology (BIWAC) and the Belgian Working Group on Interventional Cardiology (BWGIC).

Related Articles Implementation of reperfusion therapy in ST-segment elevation myocardial infarction. A policy statement from the Belgian Society of Cardiology (BSC), the Belgian Interdisciplinary Working Group on Acute Cardiology (BIWAC) and the Belgian Working Group on Interventional Cardiology (BWGIC). Acta Cardiol. 2009 Aug;64(4):541-5 Authors: Claeys MJ, Gevaert S, De Meester A, Evrard P, Legrand V, Vrints C, Berkenboom G, Desmet W, Van Langenhove G, Vranckx P, De Raedt H, Van de Werf F, Van den Branden F, , , PMID: 19725449 [PubMed - indexed for MEDLINE]

Belgian Society of Cardiology position paper on heart centres in Belgium.

Related Articles Belgian Society of Cardiology position paper on heart centres in Belgium. Acta Cardiol. 2009 Aug;64(4):537-9 Authors: Berkenboom G, Budts W, Claeys M, De Backer G, De Sutter J, Gevaert S, Goethals M, Heidbüchel H, Lancellotti P, Laruelle C, Legrand V, Mairesse G, Pasquet A, Purnode P, Vachiery JL, Van Camp G, Van den Branden F, Vandergoten P, Van Langenhove G, Vanoverschelde JL, Vrints C, PMID: 19725448 [PubMed - indexed for MEDLINE]

The association between cardiac calcification and coronary artery disease.

Related Articles The association between cardiac calcification and coronary artery disease. Acta Cardiol. 2009 Aug;64(4):531-5 Authors: Chu H, Chen J, Guo R OBJECTIVE: The objective of this study was to determine whether there is an association between mitral annular calcification (MAC), aortic valve annulus calcification (AVAC) and aortic valve calcification (AVC) with coronary artery disease (CAD) in subjects < or =65 years. METHODS: 386 patients under 65 years of age underwent transthoracic echocardiography and coronary arteriography at the same time. RESULTS: The following results were obtained: (I) The patients with calcium deposits were older than the patients without calcium deposits (P < 0.01). Hypertension (P < 0.05) and diabetes mellitus (P < 0.001) were significantly associated with MAC. Hypertension (P < 0.01), diabetes mellitus (P < 0.05) and a smoking history (P < 0.05) were significantly more prevalent in patients with AVC than in those without AVC. Hypertension was significantly more frequent in patients with AVAC (P < 0.05). (II) There was a positive correlation between age (P < 0.001), hypertension (P < 0.001), diabetes (P < 0.05) and the number of sites with calcium deposits. (III) Coronary arteriography was more frequently positive in patients with calcium deposits than in those without (P < 0.01). (IV) Multivariable logistic regression analysis identified multiple calcium deposits (P < 0.01), age (P < 0.05), male gender (P < 0.001), diabetes mellitus (P < 0.001), and hypercholesterolaemia (P < 0.05) as significant predictors for a positive coronary arteriography. Multiple calcium deposits (P < 0.001) and diabetes mellitus (P < 0.001) were also significant predictors in female patients. In patients aged < or =55 years, multiple calcium deposits (P < 0.05), diabetes mellitus (P <0.05), smoking history (P < 0.05) and male gender (P < 0.05) were statistically significant predictors of a positive coronary arteriography. CONCLUSION: There is a significant association between the presence of calcium deposits and coronary artery disease. The presence of multiple calcium deposits is an independent predictor of coronary artery disease. PMID: 19725447 [PubMed - indexed for MEDLINE]

Fibrinogen is associated with silent myocardial ischaemia in type 2 diabetes mellitus.

Related Articles Fibrinogen is associated with silent myocardial ischaemia in type 2 diabetes mellitus. Acta Cardiol. 2009 Aug;64(4):523-30 Authors: Guardado-Mendoza R, Jimenez-Ceja L, Pacheco-Carrasco MF, Aguayo-Godinez A, Molina-Padilla J, Villa-Godinez G, Aleman-Mireles A, Escobedo-De la Peña J, Majluf-Cruz A OBJECTIVE: Because traditional risk factors only partially explain coronary events, it is necessary to search for new ones like fibrinogen which has been related with coronary disease in healthy middle-aged adults. We attempted to determine the impact of fibrinogen on silent myocardial ischaemia (SMI) in diabetic patients. METHODS AND RESULTS: In a cross-sectional study, 134 type 2 diabetes patients with no history of cardiovascular disease were assessed for SMI. A personal history and physical evaluation of each patient was conducted as well as evaluation of cholesterol, glucose, fibrinogen, blood cell counts, glycated haemoglobin, urine albumin quantification, and urinalysis. A modified Bruce test was performed on all study participants to evaluate the presence of SMI. RESULTS: Eleven patients had SMI (8.2%) that was associated with systolic, diastolic and mean blood pressure, hypertension, and fibrinogen. The correlation coefficient was obtained for quintiles of fibrinogen with the percentage of patients with SMI in that quintile (r = 0.97; 95% = 0.66-0.99). Fibrinogen levels were associated with SMI. A receiver-operator curve analysis showed that the cutoff value for fibrinogen to predict SMI was 400 mg/dL (82% sensitivity, 81% specificity). A cutoff value of 306 mg/dL of fibrinogen would rule in the diagnosis of SMI (100% sensitivity, 17% specificity), while fibrinogen cutoff of 682 mg/dL would rule out SMI (100% specificity, 9% sensitivity). CONCLUSIONS: Fibrinogen strongly predicts SMI in diabetic patients and may identify individuals with high cardiovascular risk. Fibrinogen should be evaluated in diabetic patients for a more accurate cardiovascular evaluation. PMID: 19725446 [PubMed - indexed for MEDLINE]

Proteomic analysis identifies mitochondrial metabolic enzymes as major discriminators between different stages of the failing human myocardium.

Related Articles Proteomic analysis identifies mitochondrial metabolic enzymes as major discriminators between different stages of the failing human myocardium. Acta Cardiol. 2009 Aug;64(4):511-22 Authors: Urbonavicius S, Wiggers H, Bøtker HE, Nielsen TT, Kimose HH, Østergaard M, Lindholt JS, Vorum H, Honoré B OBJECTIVES: Our aim was to identify patterns in differentially regulated proteins associated with the progression of chronic heart failure. We specifically studied proteomics in chronic reversibly (RDM) and irreversibly dysfunctional myocardium (IRDM), as well as end-stage failing myocardium (ESFM). METHODS: We studied biopsies from 9 patients with stable chronic heart failure undergoing coronary artery bypass surgery (CABG) (EF 34% +/- 3%) and from 4 patients with ESFM undergoing heart transplantation (EF 17% +/- 5%). In CABG patients paired echocardiographic studies before and 6 months after revascularization classified dysfunctional myocardium as RDM or IRDM. Regions with preserved contractile function served as control. We used two-dimensional gel electrophoresis (2D-PAGE) and computerized image analysis to investigate myocardial protein expression. Proteins were identified by in-gel digestion and subsequent liquid chromatography-tandem mass spectrometry (LC-MS/MS). RESULTS: Among 3 significantly altered protein spots in RDM we identified 2 up-regulated glycolytic enzymes. In IRDM 15 proteins were signficantly altered of which we identified 10, among these 6 were down-regulated mitochondrial enzymes. In ESFM 9 of 12 significantly altered protein spots were identified. Six were down-regulated mitochondrial enzymes. CONCLUSION: Myocardial metabolism may be involved in the progression of heart failure to irreversible dysfunction and end-stage heart failure. PMID: 19725445 [PubMed - indexed for MEDLINE]

The influence of a tilt training programme on the renin-angiotensin-aldosterone system activity in patients with vasovagal syncope.

Related Articles The influence of a tilt training programme on the renin-angiotensin-aldosterone system activity in patients with vasovagal syncope. Acta Cardiol. 2009 Aug;64(4):505-9 Authors: Gajek J, Zyśko D, Krzemińska S, Mazurek W OBJECTIVE: We assessed the influence of short-term and long-term tilt training on the activity of the renin-angiotensin-aldosterone system (RAAS) in vasovagal patients. METHODS AND RESULTS: Thirty-nine patients (28 F, 11 M) aged 39.7 +/- 11.2 years with a history of vasovagal syncope and a positive head-up tilt test (HUT) were studied. Blood samples for plasma renin activity (PRA) and aldosterone (ALDO) concentration were drawn at the baseline, immediately after HUT and 10 min after HUT, during the diagnostic, the negative short-term (2-5 days) follow-up HUT and long-term (1-3 months) follow-up HUT. Tilt training was started after diagnostic HUT. In diagnostic HUT, PRA increased significantly immediately after HUT comparing to the baseline, during recovery the values did not change. ALDO concentration increased after HUT comparing to baseline and further increased during recovery. After short-term tilt training, PRA and ALDO concentrations did not significantly change compared to their corresponding values in diagnostic HUT. After long-term tilt training, PRA did not significantly change compared to the values in the diagnostic and short-term follow-up HUT. ALDO concentration also did not change significantly at the baseline and immediately after HUT, and 10 min after HUT ALDO concentration was significantly lower than after diagnostic HUT. CONCLUSIONS: Tilt training changes the response of RAAS to the prolonged orthostasis in vasovagal patients. The coupling between PRA and ALDO after diagnostic HUT has been found to be altered and the physiological relationship was restored after long-term tilt training. The beneficial effect of tilt training depends partially on changed RAAS activation. PMID: 19725444 [PubMed - indexed for MEDLINE]

Type A aortic dissection manifesting as acute myocardial infarction: still a lesson to learn.

Related Articles Type A aortic dissection manifesting as acute myocardial infarction: still a lesson to learn. Acta Cardiol. 2009 Aug;64(4):499-504 Authors: Luo JL, Wu CK, Lin YH, Kao HL, Lin MS, Ho YL, Chen MF, Chao CL OBJECTIVE: Type A aortic dissection manifesting as acute myocardial infarction (AMI) is relatively rare but could be catastrophic if the management is not appropriate. This study investigated the incidence, outcome and potential diagnostic pitfalls of patients with such manifestations, and proposes a useful diagnostic paradigm. METHODS AND RESULTS: From 1 January 1995 to 31 July 2006, 531 patients admitted to our hospital with the initial or later diagnosis of acute aortic dissection were reviewed. Two hundred and thirty-nine patients were diagnosed as Stanford type A aortic dissection with a mortality rate of 17% (41/239). Eleven (5%) of the 239 patients had initial presentation of AMI (chest pain and elevation of cardiac enzymes, with or without ST-segment elevation) and a high mortality rate of 36% (4/11). All six patients with ST-segment elevation underwent coronary angiography without awareness of type A aortic dissection; three patients were detected to have eccentric aortic regurgitation by transthoracic echocardiography (TTE) before angiography but type A aortic dissection was neglected at that time. Three of the five patients without ST-segment elevation also had eccentric aortic regurgitation by TTE before the confirmative diagnosis was made; prompt suspicion of type A aortic dissection was assisted with an elevation of D-dimer value in one of these three patients. The presence of eccentric aortic regurgitation by TTE, and the increased D-dimer value provided hints of the coexistence of AMI and type A aortic dissection. CONCLUSIONS: Type A aortic dissection manifesting as AMI is a catastrophe in disguise. Prompt checks of TTE and the D-dimer value would bring the hidden diagnosis of acute aortic dissection more to the forefront. PMID: 19725443 [PubMed - indexed for MEDLINE]

Basilar artery steno-occlusive disease is associated with structural changes in the left ventricle.

Related Articles Basilar artery steno-occlusive disease is associated with structural changes in the left ventricle. Acta Cardiol. 2009 Aug;64(4):493-8 Authors: Kang K, Lee SH, Yoon BW OBJECTIVES: Structural changes in the extracranial carotid artery are associated with an increase in left ventricular (LV) mass and relative wall thickness. The present study was performed to determine the relation of LV mass index and relative wall thickness to suspected atherosclerotic steno-occlusive disease of the intracranial arteries on magnetic resonance angiography (MRA) in noncardioembolic ischaemic stroke patients. METHODS: We retrospectively analysed the records of acute ischaemic stroke patients who underwent echocardiography and intracranial MRA. Patients with potential sources of cardioembolism, or known causes of vascular steno-occlusive disease including dissection, vasculitis, and moyamoya disease, were excluded from the study. LV mass indexes and relative wall thicknesses were estimated using echocardiography. Patients were divided into four groups according to their LV mass index and relative wall thickness: concentric LV hypertrophy, eccentric LV hypertrophy, concentric LV remodelling, and normal geometry. MRA was used to evaluate steno-occlusive disease in the basilar artery (BA) and the horizontal portion of the middle cerebral artery. RESULTS: A total of 212 patients were included, and logistic regression analysis revealed that BA steno-occlusive disease was related to LV relative wall thickness, but not LV mass index. The prevalence of BA disease was significantly higher in the concentric LV hypertrophy group than in the normal geometry group. Steno-occlusive disease of the middle cerebral artery was not closely related to the structural changes in the left ventricle. CONCLUSION: Increased LV relative wall thickness may be an independent risk factor for BA stenoocclusive disease or may share pathogenic mechanisms with BA disease. PMID: 19725442 [PubMed - indexed for MEDLINE]

Safety and efficacy of doxazosin as an "add-on" antihypertensive therapy in mild to moderate heart failure patients.

Related Articles Safety and efficacy of doxazosin as an "add-on" antihypertensive therapy in mild to moderate heart failure patients. Acta Cardiol. 2009 Aug;64(4):485-91 Authors: Spoladore R, Roccaforte R, Fragasso G, Gardini C, Palloshi A, Cuko A, Arioli F, Salerno A, Margonato A OBJECTIVE: Doxazosin treatment has been discouraged in hypertensive patients in order to prevent heart failure (HF) development. However, this drug is still prescribed as an "add-on" medication to achieve a better blood pressure (BP) control. The aim of this study was to evaluate the safety and efficacy of doxazosin as an "add-on" medication in HF patients with uncontrolled hypertension. METHODS AND RESULTS: We reviewed our HF clinic files to collect patient variables recorded at baseline and during follow-up visits in patients receiving, or not, doxazosin. We compared HF-related hospitalization rates and all-cause and cardiovascular mortality rates between patients on doxazosin and those not on doxazosin. We constructed cumulative risk curves for time to first event (HF-related hospitalization and/or death) for both groups of patients. Fifty-two HF patients had been prescribed doxazosin. At baseline, several relevant variables were unevenly distributed between patients receiving doxazosin and those not receiving doxazosin (N=122), such as left ventricular ejection fraction (LVEF) and NYHA class. HF-related hospitalization and death rates were similar between patients on doxazosin and those not on doxazosin at the end of the follow-up. Even after adjustment for all potentially confounding variables, doxazosin was not associated with HF-related hospitalization and/or death. Doxazosin significantly reduced BP, but did not affect NYHA class. CONCLUSIONS: Doxazosin, "on top" of other antihypertensive treatments was safe and effective, and did not appear to be associated with HF-related hospitalization and mortality rates in our patients with mild/moderate HF. PMID: 19725441 [PubMed - indexed for MEDLINE]

Potential-guided versus anatomic-guided approach for slow pathway ablation of the common type atrioventricular nodal reentry tachycardia: a randomized study.

Related Articles Potential-guided versus anatomic-guided approach for slow pathway ablation of the common type atrioventricular nodal reentry tachycardia: a randomized study. Acta Cardiol. 2009 Aug;64(4):477-83 Authors: Efremidis M, Sideris A, Letsas KP, Alexanian IP, Pappas LK, Mihas CC, Manolatos D, Xydonas S, Gavrielatos G, Filippatos GS, Kardaras F OBJECTIVE: The present study aimed to compare the effectiveness and safety of the potential- and the anatomic-guided approach for slow pathway ablation in patients with recurrent episodes of symptomatic common type atrioventricular (AV) nodal reentrant tachycardia. METHODS: Two hundred and twenty-eight patients were randomly assigned to undergo either a potential- (n=114, 47% men, mean age 52.85 +/- 14.04 years) or an anatomic-guided approach (n=114, 50% men, mean age 52.45 +/- 14.46 years) for radiofrequency ablation of the slow pathway.The mean duration of the follow-up period was 26.7 +/- 7.9 and 24.8 +/- 7.6 months in the potential- and anatomic- guided approach, respectively (P > 0.05). RESULTS: The success rate for slow pathway ablation was 100% in both ablative methods.The mean duration of atrial electrograms at the successful ablation sites of the potential- and the anatomic-guided approaches was 69 +/- 14 msec and 57 +/- 10 msec, respectively (P = 0.001).There were no significant differences between the potential- and the anatomic-guided approach regarding the duration of the procedure (121.13 +/- 56.83 vs. 109.93 +/- 57.12 min, P = 0.139), the duration of fluoroscopic exposure (6.12 +/- 3.32 vs. 6.64 +/- 3.33 min, P = 0.239) or the mean number of radiofrequency applications delivered (3.96 +/- 2.77 vs. 4.33 +/- 2.73, P = 0.311). Residual dual AV nodal pathway following successful ablation was observed in 9.6% of patients who underwent the potential-guided approach and in 23.7% of patients who underwent the anatomic method (P = 0.004). During followup, arrhythmia recurrence was observed in four patients (1.8%), two in each group (P > 0.05). CONCLUSIONS: The efficacy and safety of the slow pathway ablation is very high using either the potential- or the anatomic-guided approach. PMID: 19725440 [PubMed - indexed for MEDLINE]

Initial experience with remote magnetic navigation for left ventricular lead placement.

Related Articles Initial experience with remote magnetic navigation for left ventricular lead placement. Acta Cardiol. 2009 Aug;64(4):467-75 Authors: Mischke K, Knackstedt C, Schmid M, Hatam N, Becker M, Spillner J, Fache K, Kelm M, Schauerte P BACKGROUND: A novel magnetic navigation system allows remote steering of guidewires and catheters. This system may be used for left ventricular lead placement for cardiac resynchronization therapy (CRT). We sought to evaluate the feasibility and safety of magnetic guidewire navigation for CRT procedures. METHODS: 123 consecutive patients underwent CRT implantation/revision procedures (including pacemaker upgrades in n=22 and left ventricular lead placement after dislocation in n=4 patients). Left ventricular lead placement in a coronary sinus side branch was performed either conventionally or using magnetic navigation. The magnetic navigation system (Niobe) consists of two permanent magnets creating a steerable magnetic field. Guidewires with integrated magnets align to the magnetic field and were used for over-the-wire implantation of pacemaker leads in the coronary sinus. Patients were assigned to conventional (n=93) or magnetic (n=30) navigation according to room availability. Venography of the coronary venous system was performed to select a target vessel for lead implantation. RESULTS: Guidewire access to the target vessel was achieved in 100% using magnetic navigation compared to 87% with the conventional approach (P < 0.05). Implantation success rates, total procedure and fluoroscopy times did not differ significantly between groups. No periprocedural death and no intraoperative device dysfunction occurred in either group.The magnetic guidewire ruptured in one patient. CONCLUSION: Left ventricular lead placement using magnetic guidewire navigation to engage the desired coronary sinus side branch can be successfully performed for CRT. PMID: 19725439 [PubMed - indexed for MEDLINE]

Clinical relevance of syncope and presyncope induced by tilt testing.

Related Articles Clinical relevance of syncope and presyncope induced by tilt testing. Acta Cardiol. 2009 Aug;64(4):461-5 Authors: Zyśko D, Gajek J, Koźluk E, Agrawal AK, Smereka J, Checiński I OBJECTIVE: The authors investigated the relation between presyncope and syncope induced by tilt testing (HUTT) and demographics, medical history and HUTT data.The demographics, syncopal burden, data regarding the spontaneous syncope and reproduction of symptoms during HUTT were compared among patients with induced syncope and presyncope. The study group consisted of 574 patients (371 women, 203 men), aged 43.7 +/- 18.5 years. METHODS AND RESULTS: Patients with syncope induced by HUTT (418 patients, 63.9% women) had a higher number of syncopal episodes in their medical history. Stepwise logistic regression revealed that syncope provocation was independently related to the cardiodepressive type of neurocardiogenic reaction (OR 7.8, CI 4.2-14.4, P < 0.001), NTG use (OR 1.7, CI: 1.0-2.7, P < 0.05), the reproduction of the symptoms during HUTT (OR 2.0, CI: 1.3-3.1, P < 0.01) and the higher number of syncopal episodes (OR 2.0, CI: 1.3-3.0, P < 0.01). In patients with positive HUTT during a passive phase it was related to the cardiodepressive type of reaction (OR 26.5, CI: 5.9-118.5, P < 0.001). In the group with positive HUTT after NTG syncope was related to the cardiodepressive type (OR 5.7, CI: 2.9-11.2, P < 0.001), vasovagal history (OR 2.0, CI: 1.2-3.3, P < 0.01), reproduction of the spontaneous symptoms (OR 1.9, CI: 1.1-3.1, P < 0.05) and higher number of syncopal episodes (OR 2.1, CI: 1.3-3.3, P < 0.01). CONCLUSIONS: Syncope is more frequently a HUTT outcome than presyncope. The provocation of syncope in the passive phase of HUTT depends only on the cardiodepressive type of neurocardiogenic reaction. The induction of presyncope after nitroglycerin provocation is related to the possibility of a false positive reaction. PMID: 19725438 [PubMed - indexed for MEDLINE]

Clinical efficacy and safety of enoxaparin in unselected Swiss patients undergoing primary or elective percutaneous coronary intervention: analysis of the RIVIERA study.

Related Articles Clinical efficacy and safety of enoxaparin in unselected Swiss patients undergoing primary or elective percutaneous coronary intervention: analysis of the RIVIERA study. Acta Cardiol. 2009 Aug;64(4):455-9 Authors: Weber K, Spirk D, Pieper M, Kucher N BACKGROUND: Appropriate antithrombotic therapy during percutaneous coronary intervention (PCI) reduces major cardiovascular events and bleeding complications. The objective of the present analysis of the multinational, prospective, observational Registry on IntraVenous anticoagulation In the Elective and primary Real world of Angioplasty (RIVIERA) was to prospectively evaluate in-hospital death, myocardial infarction (MI), major and minor bleeding, and angiographic complications of enoxaparin-guided primary or elective PCI. METHODS: In Switzerland, 255 consecutive patients from the Herz-Neuro-Zentrum Bodensee Kreuzlingen were enrolled in the RIVIERA study. The mean age of the patients was 64 years and 77% were men; 18% had primary PCI for acute ST-segment elevation myocardial infarction.The mean dose of intravenous enoxaparin was 1 mg/kg. RESULTS: The in-hospital mortality rate was 1.2%; MI occurred in 5.5% patients, and major and minor bleeding 0.8% and 2.7%, respectively.Angiographic complications occurred in 8.6% of patients, mainly coronary dissection (3.9%) and thrombus at the treated lesion site (1.6%). CONCLUSIONS: In a real-world setting, the clinical efficacy and safety of intravenous enoxaparin during acute and elective PCI in a Swiss heart centre is comparable with the results of randomized controlled trials. PMID: 19725437 [PubMed - indexed for MEDLINE]

The Belgian Eisenmenger syndrome registry: implications for treatment strategies?

Related Articles The Belgian Eisenmenger syndrome registry: implications for treatment strategies? Acta Cardiol. 2009 Aug;64(4):447-53 Authors: Van de Bruaene A, Delcroix M, Pasquet A, De Backer J, De Pauw M, Naeije R, Vachiéry JL, Paelinck B, Morissens M, Budts W OBJECTIVE: Pulmonary arterial hypertension (PAH), associated with congenital heart disease (CHD), usually results from a systemic-to-pulmonary shunt. Eisenmenger syndrome (ES) is characterised by severe irreversible PAH and reversal of a previous systemic-to-pulmonary shunt. A national registry of ES patients was initiated to optimise patient care and to provide epidemiological information regarding PAH and CHD in Belgium. METHODS: All ES patients, older than 18 years, were selected through the local databases of ten centres in Belgium. After written informed consent, demographic, clinical, biochemical, technical, and treatment data were entered into the web-based registry. RESULTS: Ninety-one patients were included in the registry. Mean age was 36 +/- 11 years (range 18-59 years). Complete atrioventricular septal defect (N=26, 28.6%), followed by ventricular septal defect (N=25, 27.5%) were the commonest defects. Forty-five percent were patients with Down syndrome. Down patients were younger (32 +/- 9 versus 40 +/- 12 years; P = 0.039), had worse functional capacity (class II/III ratio: 15/16 versus 21/8; P = 0.035) and received significantly less specific PAH treatment (7% versus 38%; P = 0.002). CONCLUSION: Through the national Eisenmenger registry, 91 adult patients with ES were identified (estimated prevalence II per million inhabitants). Almost half of them were Down patients. Although having worse functional capacity, significantly less Down patients were receiving specific PAH treatment. PMID: 19725436 [PubMed - indexed for MEDLINE]

Management and outcomes of Middle Eastern patients admitted with acute coronary syndromes in the Gulf Registry of Acute Coronary Events (Gulf RACE).

Related Articles Management and outcomes of Middle Eastern patients admitted with acute coronary syndromes in the Gulf Registry of Acute Coronary Events (Gulf RACE). Acta Cardiol. 2009 Aug;64(4):439-46 Authors: Zubaid M, Rashed WA, Almahmeed W, Al-Lawati J, Sulaiman K, Al-Motarreb A, Amin H, Al Suwaidi J, Alhabib K OBJECTIVES: To identify the characteristics, management and hospital outcomes of acute coronary syndrome (ACS) patients in the Gulf region of the Middle East. METHODS AND RESULTS: Overall, 8176 consecutive patients with the final diagnosis of ACS were recruited in 6 months, from 64 hospitals in 6 countries. The mean age of patients was 56 years. At presentation, 40% of patients had diabetes and 38% were current smokers. Of 2268 patients eligible for reperfusion, 183 (8%) underwent primary percutaneous coronary intervention, 1856 (82%) received thrombolytic therapy and 219 patients (10%) did not receive any reperfusion. The median door-to-needle time was 45 minutes. The majority of patients received aspirin (96%), beta-blockers (77%), angiotensin-converting enzyme inhibitors (77%) and statins (83%) at discharge. Less than I in 5 patients received coronary angiography (19%). Low-risk patients were more likely to undergo coronary angiography than high-risk patients (odds ratio 1.35, 95% confidence interval 1.15 to 1.58, P < 0.001). Patients with recurrent ischaemia were 4 times more likely to undergo coronary angiography than those without; and patients who lived in UAE and Bahrain were about 3-4 times more likely to undergo this procedure than those who lived in other participating countries (P < 0.001 for both).The overall hospital mortality was 3.6%. CONCLUSIONS: Patients with ACS in the Arab Middle East are younger than in developed countries and have higher rates of diabetes and smoking. There is good adherence to evidence-based medications; however, improvement in door-to-needle time and utilisation of interventional procedures is needed. PMID: 19725435 [PubMed - indexed for MEDLINE]