Abstract:
BACKGROUND:Chronotropic incompetence and left ventricular (LV) dilatation have both been shown to be markers of an adverse cardiovascular prognosis. Chronotropic incompetence has been described in patients with symptomatic LV dilatation and dysfunction, but the effect of asymptomatic LV dilatation and hypertrophy on exercise heart rate response has not been well characterized. METHODS AND RESULTS:Members of the Framingham Offspring Study underwent M-mode echocardiography and graded exercise testing as part of a routine evaluation. Subjects receiving beta-blockers and digitalis and subjects with preexisting coronary heart disease, heart failure, and baseline ST-segment abnormalities were excluded. Chronotropic incompetence was assessed in 2 ways: (1) failure to achieve an age--predicted target heart rate and (2) a low chronotropic index, a measure of heart rate response that takes into account effects of age, resting heart rate, and physical fitness. Echocardiographic variables studied included LV diastolic and systolic dimensions, LV wall thickness, LV mass, and fractional shortening. There were 1414 men and 1601 women eligible for analyses; failure to reach target heart rate occurred in 20% of men and 23% of women; a low chronotropic index was noted in 14% of men and 12% of women. In unadjusted categorical analyses, an abnormally high LV mass, as defined by exceeding the 90th percentile predicted value of a healthy reference group, was associated with failure to achieve target heart rate in men (31% vs 18%, odds ratio [OR] 2.05, 95% confidence interval [CI] 1.49 to 2.83) and women (34% vs 20%, OR 2.09, 95% CI 1.63 to 2.69). Similarly, an abnormally high LV mass was predictive of a low chronotropic index in men (18% vs 13%, OR 1. 47, 95% CI 1.01 to 2.14) and women (17% vs 10%, OR 1.78, 95% CI 1.29 to 2.45). When considered as a continuous variable, LV diastolic dimension predicted failure to achieve target heart rate in men (ageadjusted OR for 1 SD increase 1.30, 95% CI 1.00 to 1.33) and in women (age-adjusted OR 1.30, 95% CI 1.12 to 1.50). Similarly, LV diastolic dimension predicted low chronotropic index in men (age-adjusted OR 1.22, 95% CI 1.05 to 1.42) and in women (age-adjusted OR 1.18, 95% CI 1.01 to 1.39). After also adjusting for resting blood pressure, physical activity, and other potential confounders, LV mass, when considered as a continuous variable, remained predictive of failure to achieve target heart rate in men (adjusted OR 1.23, 95% CI 1.06 to 1.42) and a low chronotropic index in men (adjusted OR 1.26, 95% CI 1.06 to 1.49). Among women, LV diastolic dimension predicted failure to achieve target heart rate (adjusted OR 1.27, 95% CI 1.12 to 1.45) and low chronotropic index (adjusted OR 1.18, 95% CI 1.01 to 1.39), whereas in men it predicted low chronotropic index (adjusted OR 1.22, 95% CI 1.04 to 1.42). CONCLUSIONS:In this asymptomatic, population-based cohort, chronotropic incompetence was predicted by increased LV mass and cavity size; among men, it was also predicted by depressed systolic function.
journal_name
Am Heart Jjournal_title
American heart journalauthors
Lauer MS,Larson MG,Evans JC,Levy Ddoi
10.1016/s0002-8703(99)70415-1subject
Has Abstractpub_date
1999-05-01 00:00:00pages
903-9issue
5eissn
0002-8703issn
1097-6744pii
S0002870399001441journal_volume
137pub_type
杂志文章abstract::Oxygen free radical scavengers have been found to decrease infarct size in dogs subjected to myocardial ischemia-reperfusion injury. A baboon open-chest model was used to determine if superoxide dismutase (SOD), an oxygen free radical scavenger, together with catalase would be equally effective in subhuman primates (b...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(93)90697-8
更新日期:1993-10-01 00:00:00
abstract::This case report presents a young adult with asymmetric septal hypertrophy (ASH) and syncope. Infranodal complete heart block was demonstrated as his cause for syncope. Therapy consisted of implantation of a A-V sequential pacemaker. Cardiac output determinations and systolic time intervals demonstrated the beneficial...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(77)80177-4
更新日期:1977-01-01 00:00:00
abstract::This study was designed to evaluate the relative diagnostic values of transthoracic (TTE) and transesophageal (TEE) echocardiography in the assessment of congenitally corrected transposition of the great arteries in adult patients. Twelve patients (mean age 29 years, range 21 to 39 years) with congenitally corrected t...
journal_title:American heart journal
pub_type: 临床试验,杂志文章,多中心研究
doi:10.1016/s0002-8703(98)70341-2
更新日期:1998-01-01 00:00:00
abstract:BACKGROUND:Patients with recurrent forms of atrial fibrillation may receive dual-chamber pacemakers after atrioventricular junction ablation for refractory symptoms. These patients are at risk for chronic atrial fibrillation, which would negate the benefits of dual-chamber pacing. The purpose of this study was to exami...
journal_title:American heart journal
pub_type: 杂志文章,多中心研究
doi:10.1016/s0002-8703(99)70223-1
更新日期:1999-04-01 00:00:00
abstract:BACKGROUND:The Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) study showed that cholesterol-lowering therapy prevented further events in patients with coronary heart disease and average cholesterol levels. The aim of this subgroup analysis was to assess the effects of pravastatin in women. METHOD...
journal_title:American heart journal
pub_type: 临床试验,杂志文章,meta分析
doi:10.1067/mhj.2003.1
更新日期:2003-04-01 00:00:00
abstract:BACKGROUND:We aim to validate the diagnostic performance of the first fully automatic, electronic heart failure (HF) identification algorithm and evaluate the implementation of an HF Dashboard system with 2 components: real-time identification of decompensated HF admissions and accurate characterization of disease char...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2016.10.001
更新日期:2017-01-01 00:00:00
abstract:BACKGROUND:Cardiovascular (CV) disease is the leading cause of morbidity and mortality in patients with type 2 diabetes mellitus (T2DM). Furthermore, patients with T2DM and acute coronary syndrome (ACS) have a particularly high risk of CV events. The glucagon-like peptide 1 receptor agonist, lixisenatide, improves glyc...
journal_title:American heart journal
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/j.ahj.2015.02.002
更新日期:2015-05-01 00:00:00
abstract:BACKGROUND:Exercise training is now an accepted component of the therapeutic regimen in patients with heart failure and underlying ischemia, but few data are available on the effects of training in patients with nonischemic dilated cardiomyopathy. METHODS:Twenty-four patients (mean age 55 +/- 9 years, mean ejection fr...
journal_title:American heart journal
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1067/mhj.2002.124401
更新日期:2002-10-01 00:00:00
abstract::In 10 treated and 2 control dogs, the short-term effects of intravenous propafenone (2 mg/kg/10 minutes, followed by 1 mg/min [n = 2] or 25 micrograms/kg/min [n = 8]) on the internal ventricular defibrillation energy requirements (DER) were investigated. Multiple stored energy levels were randomly tested and the perce...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(91)90577-5
更新日期:1991-11-01 00:00:00
abstract:BACKGROUND:Myxomas, the most common cardiac tumor in adults, occur in the atria and are prone to embolization. Obstructive valvular tumors in infants occur in pulmonic and aortic valves and generally have a more benign course. METHODS:We conducted a review of our experience in infants with tumors obstructing the right...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1067/mhj.2002.121736
更新日期:2002-05-01 00:00:00
abstract::Atrial pacing-induced changes in the sum of R-wave amplitude were measured in leads V5, X, Y, and Z at rates of 100 bpm (phase I), 150 bpm (phase II), and immediately after pacing (phase III) in 33 patients undergoing cardiac catheterization for evaluation of chest pain. Seventeen (51%) patients showed evidence of isc...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(84)90133-9
更新日期:1984-01-01 00:00:00
abstract:BACKGROUND:Multidisciplinary disease management programs (MDMP) have demonstrated reduced hospitalizations in motivated pretransplant heart failure populations, but little is known about their effectiveness in largely indigent patients who are not transplant candidates. METHODS AND RESULTS:We studied 35 patients with ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1067/mhj.2001.111956
更新日期:2001-02-01 00:00:00
abstract:BACKGROUND:High-sensitivity C-reactive protein (hsCRP) is promoted as an independent predictor of atherosclerotic risk. In addition, cardiorespiratory fitness is inversely related to hsCRP in single-sex cross-sectional analyses. Our objective was to determine if modulating fitness with exercise training imposes changes...
journal_title:American heart journal
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.ahj.2006.04.019
更新日期:2006-10-01 00:00:00
abstract::Angina pectoris before and after MI was evaluated in a sample of 729 men and women from a general population in whom MI developed during a 36-year period of follow-up. Relations of AP to subsequent CHD events and mortality after initial MI were analyzed by proportional hazards regression models and were adjusted for c...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(96)90406-8
更新日期:1996-07-01 00:00:00
abstract:BACKGROUND:hypertrophic cardiomyopathy (HCM) is a major cause of sudden death in young athletes and one of the most common inherited cardiovascular diseases, affecting 1 in 500 individuals. Often viewed as a disease of the cardiac sarcomere, mutations in genes encoding myofilament proteins are associated with disease p...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2010.08.001
更新日期:2011-01-01 00:00:00
abstract::The clinical usefulness of cardiac imaging modalities that rely upon the detection of perfusion defects and wall motion disturbances requires conditions that provoke a heterogeneity of coronary flow and a myocardial oxygen imbalance, respectively. Traditionally, this has been achieved by exercise stress testing. Many ...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/0002-8703(92)90614-2
更新日期:1992-08-01 00:00:00
abstract::Intravascular thrombus often occurs when the rupture or fissure of an atherosclerotic plaque exposes procoagulant elements lying below the plaque surface. This process of plaque rupture is the result both of passive mechanical forces and an active cell-mediated mechanism. Recently a number of investigators have develo...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1053/hj.1998.v135.90300
更新日期:1998-06-01 00:00:00
abstract::The prevention of major bleeding during percutaneous coronary intervention is one of the most widely discussed and often controversial topics within interventional cardiology. The choice of arterial access should be considered a mechanism for bleeding avoidance, and various strategies have been proposed to prevent or ...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/j.ahj.2015.04.023
更新日期:2015-07-01 00:00:00
abstract::The efficacy of aspirin to prevent ischemic cardiovascular disease has received considerable attention recently. To determine the prevalence of aspirin use for cardiovascular disease prevention, the Minnesota Heart Survey examined population-based samples of Twin Cities' adults in 1981 to 82 and 1985 to 86. Over the 4...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(88)90344-4
更新日期:1988-09-01 00:00:00
abstract:BACKGROUND:The follow-up of patients with mitral and tricuspid regurgitation is important for their clinical treatment. We aimed to evaluate the reproducibility of the flow convergence method in mitral and tricuspid regurgitation. METHODS:The proximal flow convergence region was imaged with color Doppler ultrasound sc...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2003.11.006
更新日期:2004-04-01 00:00:00
abstract::A 17-year-old man with staphylococcal endocarditis of the mitral valve developed an infective aneurysm of the posterior left ventricular wall. Echocardiography revealed an echo-free space posterior to the posterior left ventricular wall. This echo-free space undoubtedly represented the aneurysmal sac, because it could...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(78)90051-0
更新日期:1978-09-01 00:00:00
abstract::The purpose of this study were to determine the specificity of the head-up tilt test in normal subjects when a graded isoproterenol infusion is used, and to evaluate the role of dynamic ventricular volume change during head-up tilt as a mechanism of syncope. We prospectively studied 12 normal volunteers, each of whom ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(94)90016-7
更新日期:1994-07-01 00:00:00
abstract::The 2,000 heart donors available annually continue to be inadequate for the 50,000 patients with end-stage congestive heart failure who require heart transplantation to survive. This discrepancy has led to the successful use of long-term implantable LVADs as a bridge to transplantation and has raised the issue of perm...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(95)90056-x
更新日期:1995-01-01 00:00:00
abstract:BACKGROUND:We aimed to study the comparative safety and effectiveness of various antithrombotic treatment strategies among older adults with non-ST elevation myocardial infarction (NSTEMI) and atrial fibrillation (AF). METHODS:Using the CRUSADE registry linked to longitudinal Medicare claims data, we examined NSTEMI p...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2012.01.017
更新日期:2012-04-01 00:00:00
abstract::The hemodynamic effects of intravenous and intracoronary prostacyclin (PGI2) were evaluated in anesthetized, open-chest instrumented dogs. Coronary artery and aortic blood flows, aortic and left ventricular (LV) diastolic pressure, and heart rate were measured continuously. With intravenous PGI2 both left anterior des...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(81)90033-8
更新日期:1981-11-01 00:00:00
abstract:BACKGROUND:Only limited data from large randomized clinical trials have been published on the long-term performance of second-generation drug-eluting stents in bifurcation lesions. METHODS:We investigated in patients in the randomized TWENTE trial the long-term safety and efficacy of treating bifurcation lesions with ...
journal_title:American heart journal
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.ahj.2014.10.011
更新日期:2015-01-01 00:00:00
abstract::The long-term efficacy and safety of flecainide (100 to 200 mg twice a day) were evaluated in 21 patients with high-grade, chronic ventricular arrhythmias who responded to and tolerated flecainide at a preliminary evaluation (200 mg, single oral dose). Antiarrhythmic response was evaluated at 3 days and 3, 6, 12, 18, ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(89)90404-3
更新日期:1989-06-01 00:00:00
abstract:BACKGROUND:Single nucleotide polymorphisms of vitamin K epoxide reductase complex subunit 1 (VKORC1) was reported to have association with arterial vascular disease. We investigated whether single nucleotide polymorphism of VKORC1 +2255 is associated with clinical outcomes among patients who underwent drug-eluting sten...
journal_title:American heart journal
pub_type: 杂志文章,多中心研究
doi:10.1016/j.ahj.2009.02.001
更新日期:2009-05-01 00:00:00
abstract::Angiographic evidence of coronary dissection after angioplasty is found in 25% to 30% of cases. Although patients are usually asymptomatic, in a small percentage angioplasty-induced coronary dissection results in luminal impairment and ischemic complications. The present study was undertaken to identify factors respon...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(07)80008-1
更新日期:1993-07-01 00:00:00
abstract:BACKGROUND:Studies have shown that cigarette smokers constitute a substantial proportion of patients with acute coronary syndromes (ACS) and have platelet-rich coronary thrombi. We characterized the influence of smoking status on outcome of patients with ACS without persistent ST-segment elevation and tested the hypoth...
journal_title:American heart journal
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1016/s0002-8703(00)90089-9
更新日期:2000-03-01 00:00:00