Abstract:
:The expansion of antiarrhythmic therapy beyond pharmacologic agents to include surgery, devices, and ablation procedures, plus the reaffirmation by the Cardiac Arrhythmia Suppression Trial (CAST) of the need for concurrent placebo-controlled trials to establish a mortality benefit, have resulted in the need to consider the requirements for evaluating therapy. Pharmacologic therapy may be used in three ways: (1) primary; (2) alternative; and (3) adjunctive. To accurately identify a mortality benefit from primary therapy, a placebo-controlled study is necessary. In contrast, control of symptoms may be identified without the same rigorous demands. Current data are limited by the absence of true negative controls for most interventions that claim a possible mortality benefit. Alternative therapy provides a choice between equally effective therapies, neither of which has necessarily been documented to have a mortality benefit. Adjunctive therapy is that which is used for control of symptoms, whereas another therapy is used to provide a presumed or proved mortality benefit. For any of these approaches, therapy must be further evaluated in terms of four modifying variables: (1) impact of therapy on the basis of both its efficacy and efficiency; (2) interpretation of outcome data based on analysis of competing risks; (3) measurement of efficacy in terms of extension of life; and (4) analysis of outcome as the equilibrium between antiarrhythmic benefit and proarrhythmic risk. With these approaches a rational analysis of the effect of therapy and its cost-based benefit can be achieved.
journal_name
Am Heart Jjournal_title
American heart journalauthors
Myerburg RJ,Kessler KM,Chakko S,Cox MM,Fernandez P,Interian A Jr,Castellanos Adoi
10.1016/0002-8703(94)90097-3subject
Has Abstractpub_date
1994-04-01 00:00:00pages
1111-8issue
4 Pt 2eissn
0002-8703issn
1097-6744pii
0002-8703(94)90097-3journal_volume
127pub_type
杂志文章,评审abstract::Left ventricular (LV) filling was examined by Doppler and M-mode echocardiography in 24 patients with LV hypertrophy (five with aortic stenosis, six with hypertrophic cardiomyopathy, and 13 with LV hypertrophy secondary to systemic hypertension) and in 18 normal subjects. Patients with LV hypertrophy had significantly...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(87)90657-0
更新日期:1987-06-01 00:00:00
abstract::We studied 16 patients with chronic aortic insufficiency to compare a method for measuring regurgitant volume with color Doppler flow mapping to stroke count ratio determined by radionuclide ventriculography and to ventricular volumes assessed by two-dimensional echocardiography. A real-time color flow map of the left...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(89)90868-5
更新日期:1989-05-01 00:00:00
abstract:BACKGROUND:Half of patients with hypertension have poor blood pressure (BP) control. Recent models for treating hypertension have integrated disease monitoring and telephone-based interventions delivered in patients' homes. This study evaluated the costs of the Hypertension Intervention Nurse Telemedicine Study (HINTS)...
journal_title:American heart journal
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.ahj.2012.03.016
更新日期:2012-06-01 00:00:00
abstract:BACKGROUND:Patients with an implantable cardioverter defibrillator (ICD) are at increased risk of anxiety disorders. In turn, anxiety has been identified as a precipitant of ventricular arrhythmias. Anxiety may in part be attributed to concerns about the ICD firing, but the relationship between ICD concerns, psychologi...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2004.06.031
更新日期:2005-04-01 00:00:00
abstract:BACKGROUND:The prognostic significance of ventricular flutter (VFL) induced during programmed electrical stimulation (PES) is currently unknown. METHODS:This study examined patients who had PES-induced VFL and assessed their long-term prognosis compared with patients who had inducible sustained monomorphic ventricular...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2003.11.012
更新日期:2004-04-01 00:00:00
abstract::In this study, we reviewed M-mode and two-dimensional (2DE) echocardiographic observations in 13 patients with pulmonary atresia with ventricular septal defect and in six patients with truncus arteriosus in order to attempt to identify echocardiographic features distinguishing these two abnormalities in which no anato...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(83)90528-8
更新日期:1983-02-01 00:00:00
abstract::The effects of captopril (CPT), an oral angiotensin-converting enzyme (ACE) inhibitor, on systemic failure (CHF). In 15 patients, CPT decreased mean arterial pressure from 75 +/- 3 to 60 +/- 3 mm Hg associated with a 16% increase in cardiac output, a 24% reduction in systemic vascular resistance, and a 36% decrease in...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(82)90052-7
更新日期:1982-11-01 00:00:00
abstract::The QRS complex and ST segment in the ECGs of 80 patients who died of an acute myocardial infarction (MI) were studied in relation to the extent of the MI (subendocardial vs. transmural). Changes in the QRS complex developed in nine out of the 15 cases with an acute subendocardial MI. Five of these cases fulfilled the...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(79)90219-9
更新日期:1979-08-01 00:00:00
abstract::The antiarrhythmic effects of mexiletine (n = 14) were compared to procainamide (n = 16) by a double-blind parallel protocol in 30 patients (group I) with frequent premature ventricular contractions (PVCs) (greater than 20/hr), and to amiodarone by an open-label sequential approach in 25 patients (mean left ventricula...
journal_title:American heart journal
pub_type: 临床试验,杂志文章
doi:10.1016/0002-8703(85)90186-3
更新日期:1985-11-01 00:00:00
abstract:BACKGROUND:Case fatality rates after acute myocardial infarction (MI) have decreased markedly over the last 3 decades. Some subgroups may have benefited more than others, but this hypothesis has not been evaluated in a large nationally representative cohort. Accordingly, we sought to assess long-term temporal trends in...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2008.04.009
更新日期:2008-09-01 00:00:00
abstract::Of 26,294 consecutive patients monitored in a comprehensive drug surveillance program, 1067 (4 per cent) received methyldopa for treatment of hypertension. Adverse reactions attributed to methyldopa were reported in 149 patients (14 per cent), the most frequent being hypotension. Life-threatening adverse effects were ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(78)90192-8
更新日期:1978-11-01 00:00:00
abstract:BACKGROUND:Endothelin 1 is a potent endogenous vasoconstrictor neurohormone, and endothelin 1 plasma concentrations predict adverse outcomes in patients with acute heart failure (AHF). Tezosentan, an intravenous endothelin receptor antagonist, improved hemodynamics in patients with AHF; however, its effects on morbidit...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2005.04.035
更新日期:2005-07-01 00:00:00
abstract::CHD remains the leading cause of death in most developed countries; therefore, elucidation of risk factors and associated mechanisms for atherosclerosis and development of CHD has been a high priority. Data from the Framingham Heart Study and other large-scale epidemiologic studies have identified major risk factors a...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/s0002-8703(96)90096-4
更新日期:1996-06-01 00:00:00
abstract::To assess the influence of viscosity and iodine concentration, three matched and standardized left coronary arteriograms were obtained in 20 patients using iopamidol (Isovue-370), ioversol (Optiray-320), and iohexol (Omnipaque-350). The order of contrast media was randomized and the administration of contrast was doub...
journal_title:American heart journal
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/0002-8703(92)90760-s
更新日期:1992-01-01 00:00:00
abstract:BACKGROUND:The nested case-control study is an efficient epidemiological design whereby a case-control approach is employed within an established cohort. The large number of recent prospective studies and randomized trials conducted in cardiology provide cohorts within which the nested case-control approach is increasi...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/S0002-8703(03)00512-X
更新日期:2003-10-01 00:00:00
abstract::To evaluate the potential for hyperbaric oxygen (HBO) to produce transient improvement in function in areas of myocardium ischemic at rest (hibernating myocardium), 24 patients were studied within 1 week of acute myocardial infarction. Results were compared with single-photon emission computed tomography (SPECT) thall...
journal_title:American heart journal
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/0002-8703(92)90394-b
更新日期:1992-11-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to determine in pediatric Duchenne (DMD) and Becker muscular dystrophy (BMD) or other dilated cardiomyopathies (ODCM) whether outcomes differ by diagnosis. BACKGROUND:Children with dilated cardiomyopathy are treated as a single undifferentiated group. METHODS:This cohort study of 1...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2008.01.018
更新日期:2008-06-01 00:00:00
abstract:BACKGROUND:Hypertrophic cardiomyopathy (HCM) is histopathologically characterized by myocyte hypertrophy, disarray, interstitial fibrosis, and small intramural coronary arteriole dysplasia, which contribute to disease progression. Longitudinal systolic and early diastolic strain rate (SR) measurements by speckle tracki...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2013.06.011
更新日期:2013-09-01 00:00:00
abstract:BACKGROUND:Several studies have shown that patency of the epicardial vessel does not guarantee optimal myocardial perfusion in patients undergoing primary angioplasty for ST-segment elevation myocardial infarction (STEMI). The aim of the current study was to identify clinical and angiographic correlates of unsuccessful...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2004.10.044
更新日期:2005-09-01 00:00:00
abstract::In order to properly advise cardiac patients in the regulation of their sexual activity, more basic physiologic information is needed concerning the cardiovascular effects of sexual intercourse. This study examined the effects of the male's position during sexual intercourse on heart rate and blood pressure responses....
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(76)80106-8
更新日期:1976-09-01 00:00:00
abstract:BACKGROUND:The study aimed to compare the short-term costs and long-term cost-effectiveness of 2 antithrombotics, fondaparinux and enoxaparin, for non-ST-elevation acute coronary syndrome in the United States. METHODS:It was based on a large randomized trial of 20,078 patients Fifth Organization to Assess Strategies i...
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.2009.02.017
更新日期:2009-05-01 00:00:00
abstract::The effects of atrial pacing on the signal-averaged electrocardiogram were studied in 14 patients with remote myocardial infarction and a history of cardiac arrest or sustained ventricular tachycardia (group I) and in 13 patients with coronary artery disease and no history of sustained ventricular tachyarrhythmia (gro...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(05)80077-8
更新日期:1990-01-01 00:00:00
abstract:BACKGROUND:The acute benefits of platelet glycoprotein IIb/IIIa inhibitors for non-ST-segment elevation acute coronary syndromes (NSTE ACS) remain unclear. METHODS:In this pilot trial, 311 patients with NSTE ACS were randomly assigned in the emergency department to double-blinded therapy with eptifibatide or placebo f...
journal_title:American heart journal
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/S0002-8703(03)00517-9
更新日期:2003-12-01 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:BACKGROUND:A strategy using coronary artery calcium (CAC) screening to refine coronary heart disease risk assessment in moderately high risk (MHR) subjects (10-year risk 10%-20%) has been suggested. The potential impact of this strategy is unknown. METHODS:Coronary artery calcium screening strategies focused on MHR su...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2009.03.018
更新日期:2009-06-01 00:00:00
abstract:BACKGROUND:Diabetes is associated with a high rate of events after acute coronary syndrome and percutaneous coronary intervention despite aspirin treatment. Once daily aspirin might not provide 24-hour stable biological efficacy in patients with diabetes. We compared the biological efficacy of the same daily dose of as...
journal_title:American heart journal
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.ahj.2012.06.008
更新日期:2012-10-01 00:00:00
abstract::In prior studies, we have shown that the antikaliuretic drugs, triamterene and amiloride, through a direct cardiac effect reduce the loss of cardiac potassium induced by the administration of digitalis. Since loss of myocardial potassium is thought to underlie digitalis arrhythmias, this study was performed to determi...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(75)90257-4
更新日期:1975-07-01 00:00:00
abstract:BACKGROUND:Previous studies have suggested that thrombolysis is used less often in blacks than in whites. However, whether the greater prevalence of contraindications or less specific electrocardiographic manifestations of myocardial infarction (MI) account for this difference is unclear. METHODS AND RESULTS:We studie...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1067/mhj.2000.107173
更新日期:2000-08-01 00:00:00
abstract:OBJECTIVES:We analyzed the antiplatelet effects of different P2Y(12) receptor blockers with VerifyNow P2Y12 assay (VN-P2Y12) and light transmittance aggregometry (LTA). BACKGROUND:The point-of-care VN-P2Y12 has been used to assess the antiplatelet effects in clopidogrel-treated patients but has not been evaluated in d...
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.2012.03.022
更新日期:2012-07-01 00:00:00
abstract:BACKGROUND:Our purpose was to study the effects of atrial natriuretic peptide (ANP) on cardiorenal functions when it is used to manage patients with heart failure who are receiving an angiotensin-converting enzyme inhibitor (ACEi) or in acute saline solution loading. METHODS:Seventeen patients with mild to moderate he...
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.2001.112782
更新日期:2001-03-01 00:00:00