Abstract:
CLINICAL SCENARIO:A 67-year-old man is referred to your cardiology clinic complaining of worsening angina and dyspnea on exertion. Physical examination reveals a harsh grade IV/VI late-peaking crescendo-decresendo systolic murmur, loudest at the upper sternal border. The aortic closure sound is diminished. Echocardiography demonstrates left ventricular hypertrophy, an ejection fraction of 50%, no evidence of mitral regurgitation, and severe aortic stenosis (AS) with a peak aortic gradient of 4.8 m/s (92 mm Hg) and a mean aortic gradient of 55 mm Hg. You schedule him for coronary angiography but wonder whether you should reevaluate his aortic valve gradient invasively. LITERATURE SEARCH:Combining the keywords "aortic valve stenosis" and "heart catheterization/adverse effects," you find 72 articles. From these you choose the following: Omran H, Schmidt H, Hackenbroch M, et al. Silent and apparent cerebral embolism after retrograde catheterization of the aortic valve in valvular stenosis: a prospective randomized study. Lancet 2003;361:1241-6. QUESTION:What is the stroke risk of retrograde catheterization of the aortic valve in patients with AS? DESIGN:The study was prospective and randomized; unblinded treatment but with blinded assessment of outcomes. SETTING:The study was conducted at a single center in Bonn, Germany. PATIENTS:A total of 152 patients with known or suspected AS undergoing cardiac catheterization were randomized to catheterization with or without retrograde passage of the aortic valve in a 2:1 randomization format. Patients underwent brain magnetic resonance imaging (MRI) the day before and within 48 hours after cardiac catheterization. Patients with unclear echo findings or contraindications to MRI or transesophageal echocardiography were excluded. There were no significant baseline differences between the 2 groups: mean age 70.5 years, left ventricular ejection fraction 62%, and mean aortic valve gradient 51 mm Hg. All patients were evaluated in the groups to which they had been randomized and, other than the experimental intervention, the 2 groups were treated similarly (with the exception of the administration of 5000 units of intravenous heparin to the group receiving retrograde aortic catheterization). A control group of 32 patients without aortic valvular stenosis was evaluated as well. INTERVENTION:The intervention consisted of retrograde passage of the aortic valve for the purpose of obtaining an invasive aortic valve pressure gradient. MAIN OUTCOME MEASURES:The main outcome measures were acute cerebral embolic events, defined by MRI findings within 48 hours after catheterization (as compared to precatheterization MRI) and by clinical examination. MAIN RESULTS:Twenty-two of 101 patients (22%) assigned to retrograde catheterization developed new focal MRI abnormalities consistent with acute cerebral embolic events. Three of these patients (3%) demonstrated clinically apparent neurologic deficits. None of the patients who did not undergo retrograde catheterization--and none of the control patients--had MRI or clinical evidence of cerebral embolism.
journal_name
Am Heart Jjournal_title
American heart journalauthors
Meine TJ,Harrison JKdoi
10.1016/j.ahj.2004.05.031subject
Has Abstractpub_date
2004-07-01 00:00:00pages
41-2issue
1eissn
0002-8703issn
1097-6744pii
S0002870304003254journal_volume
148pub_type
杂志文章abstract::It is unclear how agents designed to promote angiogenesis in the human heart affect the arteriographic appearance of the collateral circulation. Possible changes in collateral vessels include new collateral vessels arising from epicardial arteries, new branches emanating from existing collateral vessels, wider or long...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/s0002-8703(99)70473-4
更新日期:1999-01-01 00:00:00
abstract::A case of tricuspid atresia with unusual echocardiographic findings is presented. The echocardiogram was successful in defining great artery interrelationships, ventricular looping, and cavity sizes. An echo pattern resembling the motion of a small tricuspid valve was observed; this was proven to be spurious at cathet...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(78)90508-2
更新日期:1978-06-01 00:00:00
abstract:OBJECTIVES:The DANHEART trial is a multicenter, randomized (1:1), parallel-group, double-blind, placebo-controlled study in chronic heart failure patients with reduced ejection fraction (HFrEF). This investigator driven study will include 1500 HFrEF patients and test in a 2 × 2 factorial design: 1) if hydralazine-isoso...
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.2020.09.020
更新日期:2021-01-01 00:00:00
abstract::Patients with impaired glucose tolerance (IGT) have increased risk for developing type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). Lifestyle modification and medication can prevent or delay progression to diabetes (PD), but whether such interventions also reduce the risk of CVD has not been rigorously...
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.2008.05.017
更新日期:2008-10-01 00:00:00
abstract:BACKGROUND:Clinical outcomes and the effects of oral anticoagulants among patients with acute coronary syndrome (ACS) and either a history of or acute heart failure (HF) are largely unknown. We aimed to assess the relationship between prior HF or acute HF complicating an index ACS event and subsequent clinical outcomes...
journal_title:American heart journal
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.ahj.2014.12.022
更新日期:2015-04-01 00:00:00
abstract:BACKGROUND:Endothelial progenitor cells (EPCs) are present in peripheral blood and can promote postnatal angiogenesis. The number and function of circulating EPCs are altered in diabetics. This study sought to investigate whether the number and functional properties of EPCs from patients with type II diabetes could be ...
journal_title:American heart journal
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.ahj.2006.07.029
更新日期:2006-12-01 00:00:00
abstract::We analyzed the long-term outcome of 198 patients after unsuccessful percutaneous transluminal coronary angioplasty. Forty-nine percent underwent emergency coronary artery bypass grafting surgery, 17% had elective bypass surgery, and 34% were treated medically. The in-hospital mortality rate was 4%, and myocardial inf...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(05)80313-8
更新日期:1990-04-01 00:00:00
abstract:BACKGROUND:The presence of depression after an acute coronary syndrome (ACS) is associated with worse prognosis and lower adherence to risk-reducing behaviors. We reported earlier that an enhanced depression care intervention reduces depression symptoms and major adverse cardiac events. This study evaluates the impact ...
journal_title:American heart journal
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.ahj.2012.07.024
更新日期:2012-10-01 00:00:00
abstract::The stent delivery system (SDS) is a sheath-covered Palmaz-Schatz stent mounted on a 3.0, 3.5, or 4.0 mm compliant polyethylene balloon catheter; the balloon resists maximal inflation pressures of 5.7, 6.2, or 6.0 atm, respectively. It is postulated that these pressures are too low to obtain optimal stent deployment. ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(95)90308-9
更新日期:1995-04-01 00:00:00
abstract:BACKGROUND:We aimed to characterize the clinical and pathologic findings of aortic dissection (AD) over a nearly 60-year period. METHODS:The Jesse E. Edwards Registry of Cardiovascular Disease database was queried for cardiac specimens from autopsies with AD as a diagnosis and compared 2 cohorts: early (1956-1992) and...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2018.11.006
更新日期:2019-03-01 00:00:00
abstract:OBJECTIVE:To determine the effect of exercise training on cardiac autonomic modulation in normal older adults by using analysis of heart rate variability. SUBJECTS:The exercise group consisted of 7 men and 9 women aged 66 +/- 4 years. The comparison group consisted of 7 men and 9 women also aged 66 +/- 4 years. METHO...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(99)70162-6
更新日期:1999-09-01 00:00:00
abstract:BACKGROUND:This study was designed to investigate the efficacy of alteplase double-bolus dosing compared with the front-loaded 90-minute infusion regimen in patients with acute myocardial infarction. Recent pilot studies have suggested that bolus dosing may provide improved efficacy in establishing early, complete, and...
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(98)70024-9
更新日期:1998-10-01 00:00:00
abstract:BACKGROUND:Anemia is now recognized as being a common finding in CHF and is associated with increased mortality and morbidity. However, it is uncertain whether the anemia is actually causing the worse prognosis or is merely a marker of more severe cardiac disease. Previous intervention studies with subcutaneous (s.c.) ...
journal_title:American heart journal
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.ahj.2006.08.005
更新日期:2006-12-01 00:00:00
abstract:BACKGROUND:Acute myocardial infarction (AMI) is a leading cause of mortality in Asia. However, quantitative risk scores to predict mortality after AMI were developed without the participation of Asian countries. METHODS:We evaluated the performance of the Global Registry of Acute Coronary Events (GRACE) in-hospital mo...
journal_title:American heart journal
pub_type: 杂志文章,多中心研究
doi:10.1016/j.ahj.2011.05.016
更新日期:2011-08-01 00:00:00
abstract:BACKGROUND:The CAPTIM trial suggested a survival benefit of prehospital fibrinolysis (FL) compared to primary percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI) with a presentation delay of <2 hours. We examined the relationship between reperfusion strategy and time fro...
journal_title:American heart journal
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.ahj.2010.10.033
更新日期:2011-02-01 00:00:00
abstract::To investigate the significance and mechanism of dilatation of the left ventricular cavity on dipyridamole thallium-201 imaging, we performed both dipyridamole thallium-201 imaging and dipyridamole radionuclide angiography on 83 patients with known angiograms. The dipyridamole/delayed ratio of the left ventricular dim...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(91)90713-r
更新日期:1991-02-01 00:00:00
abstract::Meta-analyses of major outcome trials have demonstrated that the benefits of antihypertensive treatment for reduction of the incidence of stroke are entirely consistent with the benefits predicted from epidemiologic data; however, there remains a shortfall in the expected reduction of the incidence of coronary heart d...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:
更新日期:1996-07-01 00:00:00
abstract:BACKGROUND:The same electrocardiographic (ECG) criteria that have been used for detection of left ventricular hypertrophy (LVH) have recently been recognized as predictors of adverse clinical outcomes, but this predictive ability is inadequately explored and understood. METHODS:A total of 14,984 participants from the ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2015.04.004
更新日期:2015-07-01 00:00:00
abstract::A multiprogrammable automatic antitachycardia pacemaker (Cybertach-60), connected to a tined "J" wire electrode, was positioned in the right atrial appendage in three patients with recurrent supraventricular tachycardia (SVT). Mechanisms of SVT included atrioventricular (AV) nodal reentry (two patients) and reciprocat...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(83)90648-8
更新日期:1983-11-01 00:00:00
abstract::Because of its unique ability to demonstrate the metabolic consequences of myocardial ischemia, positron emission tomography (PET) is extremely valuable in assessing myocardial viability. PET imaging can identify the myocardial segments that are likely to improve after revascularization and may be more sensitive and s...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/0002-8703(91)90803-p
更新日期:1991-07-01 00:00:00
abstract:BACKGROUND:The conventional use of 16-slice multidetector computed tomography (MDCT) remains somewhat limited for evaluating stenoses in vein graft distal anastomotic sites and in coronary arteries. We investigated the diagnostic accuracy of 64-slice MDCT for assessment of both grafts and coronary arteries in patients ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2007.04.054
更新日期:2007-09-01 00:00:00
abstract::The long-term prognosis of patients successfully resuscitated from cardiac arrest who do not have acute precipitating factors and in whom ventricular arrhythmias cannot be induced during baseline electrophysiologic testing is controversial. The purpose of this investigation was to evaluate the long-term risk of recurr...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(90)90245-s
更新日期:1990-12-01 00:00:00
abstract:BACKGROUND:Previous research suggests that after coronary artery bypass graft (CABG) surgery, women fare worse than men. This study investigates sex differences in depression during recovery from CABG surgery. METHODS:We followed 137 patients (72 men, 65 women) undergoing elective isolated first CABG surgery between J...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2005.05.005
更新日期:2005-11-01 00:00:00
abstract:OBJECTIVES:We aim to review the studies comparing coronary calcification across different ethnic groups. BACKGROUND:There is still uncertainty regarding ethnic differences in the prevalence, progression, and risk of coronary artery disease. Clues to possible racial differences in rates of coronary heart disease (CHD) ...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/j.ahj.2006.08.008
更新日期:2006-11-01 00:00:00
abstract:BACKGROUND:Observational studies have shown apparently lower ischemic coronary disease risk in postmenopausal women receiving hormone replacement therapy (HRT). However, several recent studies have shown an increase in ischemic cardiac events when HRT is initiated in postmenopausal women with known coronary artery dise...
journal_title:American heart journal
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.ahj.2004.10.028
更新日期:2005-09-01 00:00:00
abstract:BACKGROUND:The oxygen uptake efficiency slope (OUES) is a new submaximal parameter which objectively predicts the maximal exercise capacity in children and healthy subjects. However, the usefulness of OUES in adult patients with and without advanced heart failure remains undetermined. The present study investigates the...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2004.07.004
更新日期:2005-01-01 00:00:00
abstract:BACKGROUND:Aldosterone antagonist therapy is recommended for selected patients with heart failure and reduced ejection fraction. Adherence to therapy in the transition from hospital to home is not well understood. METHODS:We identified patients with heart failure and reduced ejection fraction who were ≥65 years old, e...
journal_title:American heart journal
pub_type: 杂志文章,多中心研究
doi:10.1016/j.ahj.2013.03.007
更新日期:2013-06-01 00:00:00
abstract::We compared the pauses that followed the spontaneous termination of supraventricular tachyarrhythmias with the pauses that followed the cessation of atrial overdrive pacing in 21 patients. In 10 patients with abnormal sinus node function and in 11 patients with normal sinus node function we recorded the spontaneous te...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(83)90515-x
更新日期:1983-02-01 00:00:00
abstract::The acute effects of diltiazem on coronary reactive hyperemia were studied in 12 patients with flow-limiting coronary stenosis. Reactive hyperemia was elicited by injection of 8 ml contrast medium into the left coronary artery, while coronary sinus blood flow and left ventricular and aortic pressures were continuously...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(86)90353-4
更新日期:1986-12-01 00:00:00
abstract:BACKGROUND:The effect of raloxifene on aortic elasticity in healthy postmenopausal women is unknown. The purpose of the present study was to examine the effect of raloxifene on aortic elasticity and cardiovascular structure and function in healthy postmenopausal women. METHODS:A randomized, crossover, double-blind, pl...
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.2005.02.020
更新日期:2005-12-01 00:00:00