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Biomedical subjects

D D Sugrue

Publications and source records attributed to D D Sugrue.

At least 37 records · Page 2Linked to original sources
PubMed1993

Indices of obesity and body fat distribution in arteriographically defined coronary artery disease in men.

Anthropometric measurements descriptive of obesity, body fat distribution and body build were made in 186 males undergoing diagnostic coronary arteriography. Using stepwise multiple logistic regression analysis, two indices of body fat distribution were independently associated with coronary disease, while the widely used indices of obesity, namely body mass index and percentage body fat, were not. A significant association with disease was found for the ratio of waist to thigh circumferences (waist/thigh ratio), which emerged in the first step of the multivariate model (p < 0.005). The ratio of waist to hip circumferences (waist/hip ratio), a widely used index of body fat distribution, was found to have a negative association with disease (p < 0.05). This study suggests that use of body fat distribution indices may assist in the assessment of the risk factor profile of cardiac patients.

Adipose Tissue↗
PubMed1992

The clinical course of idiopathic dilated cardiomyopathy. A population-based study.

OBJECTIVE: To describe the prognosis of individuals with idiopathic dilated cardiomyopathy in a population-based sample and to compare this with the prognosis of patients in a previous referral center case series of idiopathic dilated cardiomyopathy. DESIGN: Cohort study. SETTING: Population-based in Olmsted County, Minnesota. PATIENTS: Forty residents of Olmsted County, Minnesota with idiopathic dilated cardiomyopathy initially diagnosed between 1975 and 1984 who were followed through 1 July 1989 and 104 patients from a Mayo Clinic referral case series from 1960 to 1973. MEASUREMENTS: Survival for the population-based cohort at 1 year and 5 years. RESULTS: Survival at 1 year differed dramatically between the population-based cohort and the referral case series at 1 year (95% compared with 69%, respectively) and at 5 years (80% compared with 36%, respectively) (P less than 0.001). Long-term survival for the population-based cohort was nonetheless impaired when compared with an age- and sex-matched cohort, that is, the 1980 Minnesota white population (8-year survival: observed, 58% compared with expected, 83%; P less than 0.001). Among community patients, older age (adjusted Cox model hazard ratio for 10-year increase in age, 1.59; 95% CI, 1.08 to 2.35) and lower left ventricular ejection fraction (adjusted hazard ratio for 10% decrease, 1.90; CI, 1.04 to 3.50) were independently associated with impaired survival. CONCLUSIONS: These population-based data challenge the clinical perception of the clinical course of idiopathic dilated cardiomyopathy based on referral practice prognostic studies and suggest that the clinical course of this condition may be more favorable than previously recognized.

Cardiomyopathy, Dilated↗
PubMed1989

T-lymphocyte subsets in patients with idiopathic dilated cardiomyopathy.

T-cell subsets were measured in the peripheral blood of 33 patients with heart failure from idiopathic dilated cardiomyopathy, 22 patients with heart failure from other causes, and 33 normal controls. Mean T-suppressor cell percentage was 30% in normals, 21% in patients with idiopathic dilated cardiomyopathy whose duration of symptoms was less than 1 year (P = 0.0005), and 26% in those with symptoms for greater than 1 year (P = 0.05). Similarly, percentage of T-suppressor cells in the group with heart failure from causes other than idiopathic dilated cardiomyopathy was significantly lower (23%; P = 0.005) in those with short duration of symptoms. When both heart failure groups were combined those with symptoms for less than 1 year had significantly lower T-suppressor frequencies (22%) than those with symptoms for more than 1 year (P = 0.015). Multivariate analysis identified duration of symptoms and age as the only independent predictors of T-suppressor cell frequencies. Decreased percentage of T-suppressor cells in patients with idiopathic dilated cardiomyopathy may be an epiphenomenon related to duration of heart failure. This should be taken into account in assigning an etiologic mechanism for T-suppressor cells in idiopathic dilated cardiomyopathy.

Adult↗
PubMed1989

Malignant melanoma of the right atrium: antemortem diagnosis by transvenous biopsy.

About half of all patients with malignant melanoma have cardiac metastases. Histological confirmation antemortem of a secondary malignant melanoma of the heart is difficult. The diagnosis of a secondary melanoma in the right atrium was confirmed by transvenous biopsy in a 46 year old woman who had had a melanoma excised from her right leg two years before.

Biopsy↗
PubMed1989

Epidemiology of idiopathic dilated and hypertrophic cardiomyopathy. A population-based study in Olmsted County, Minnesota, 1975-1984.

Using the records linkage system of the Mayo Clinic and of the Rochester Epidemiology Project, which accesses diagnostic data on the entire population of Olmsted County, Minnesota, we identified 45 new cases of idiopathic dilated cardiomyopathy (DCM) and 19 new cases of hypertrophic cardiomyopathy (HCM) among county residents for the years 1975-1984. Overall age- and sex-adjusted incidence rates were 6.0/100,000 and 2.5/100,000 person-years, respectively. The incidence of DCM doubled from 3.9/100,000 in the first 5 years to 7.9/100,000 person-years in the last 5 years of study. The corresponding change for HCM was from 1.4 to 3.6/100,000 person-years. Age- and sex-adjusted prevalence rates as of January 1, 1985, for DCM and HCM were 36.5/100,000 and 19.7/100,000 population, respectively. The prevalence of DCM in persons less than 55 years old was 17.9/100,000, over a third of whom were New York Heart Association functional Class III or IV at diagnosis. These estimates may be of value in determining the potential use of health care resources, particularly cardiac transplantation.

Age Factors↗
PubMed1988

Results of percutaneous transluminal coronary angioplasty for unstable angina pectoris in patients 70 years of age and older.

Between November 1980 and November 1985, 54 patients ages greater than or equal to 70 years underwent percutaneous transluminal coronary angioplasty for unstable angina, defined as recent-onset (less than 1 month) angina, new onset of rest angina (greater than or equal to 2 episodes) or accelerating class III or IV angina. In these 20 men and 34 women, disease was 1-vessel in 34 (63%) and multivessel in 20 (37%). The mean (+/- standard deviation) ejection fraction was 0.62 +/- 0.12. Angioplasty was successful in 43 patients (80%). In the 11 unsuccessful cases, emergency coronary artery bypass grafting for acute occlusion was performed in 3 and elective coronary artery bypass surgery in 8. There were no deaths. Two patients (4%) sustained Q-wave myocardial infarctions. The mean duration of follow-up for the total group was 37 months (6 to 73 months). Of the 43 patients with successful dilation, 4 died, 1 had an non-Q-wave myocardial infarction and 8 had symptomatic restenosis (4 underwent successful repeat angioplasty, 1 had repeat percutaneous transluminal coronary angioplasty and then bypass surgery, 1 had repeat bypass surgery alone and 2 had medical therapy). At last follow-up, 3 patients had stable class III or IV angina and 31 patients (72%) were angina-free.

Aged↗
PubMed1987

Role of invasive electrophysiologic testing in patients with symptomatic bundle branch block.

Electrophysiologic testing was performed in 112 symptomatic patients with bundle branch block. Abnormalities included HV interval 70 ms or longer (35 patients), infra-Hisian block with atrial pacing (6 patients) and sinus node dysfunction (23 patients). Inducible ventricular tachycardia occurred in 47 patients (42%). Therapy was based on the electrophysiologic test result: group I--16 patients with no therapy (normal study results); group II--34 patients with permanent pacing alone; group III--39 patients with antiarrhythmic therapy alone; and group IV--21 patients with both antiarrhythmic therapy and permanent pacing. Cumulative 4-year survival rates were 83% in group I, 84% in group II, 63% in group III and 84% in group IV (mean follow-up 2.5 years). Recurrent syncope occurred in 19% of group I, 6% of group II, 33% of group III and 19% of group IV. In symptomatic patients with bundle branch block and normal electrophysiologic test results, prognosis is good without treatment. In patients undergoing permanent pacing based on electrophysiologic testing, survival is good and rate of symptom recurrence is low. Electrophysiologic testing identifies patients with inducible ventricular tachycardia for whom antiarrhythmic therapy is indicated but who nevertheless have a poor prognosis.

Adult↗
PubMed1987

Repeat balloon coronary angioplasty for symptomatic restenosis: a note of caution.

Of 694 patients in whom percutaneous transluminal coronary angioplasty was attempted for palliation of symptomatic coronary artery disease, 74 subsequently underwent a repeat procedure because of symptomatic restenosis. The repeat dilatation was successful in 55 patients (74%). The primary success rate and the incidence of major complications were similar for initial and repeat procedures. Complications of the repeat procedure included major dissection (14%), acute occlusion (7%) and emergency coronary bypass surgery (12%). After a mean follow-up period of 113 weeks (range, 15-309 weeks), 33 patients (60%) were asymptomatic; angina recurred in 22 (40%). In our hands, the success rate, complication rate, and long-term results of repeat percutaneous transluminal coronary angioplasty were similar to those associated with the initial procedure.

Angioplasty, Balloon↗
PubMed1987

Impact of intracardiac electrophysiologic testing on the management of elderly patients with recurrent syncope or near syncope.

Seventy-five patients, 75 years of age and over, experienced recurrent syncope, with the etiology remaining unclear but presumably cardiogenic, after cardiac and neurologic examinations and noninvasive laboratory testing (including an electrocardiogram and ambulatory electrocardiographic monitoring). The mean number of previous syncopal spells was 14 (range, 1 to 64) over a mean of 36 months (range, 1 to 480 months). These patients underwent invasive electrophysiologic testing and a potential cause for syncope was identified in 68%. Abnormal findings at electrophysiologic testing included: sinus node dysfunction (55%); abnormal His-bundle conduction (39%); and ventricular tachycardia (14%), with some patients having more than one abnormality. No major complications were associated with the electrophysiologic testing. Patients were subsequently treated with permanent cardiac pacing or antiarrhythmic drugs or both, depending upon results of the electrophysiologic study. Follow-up examinations (mean of 26 months; range, 1 to 70) were possible in 90% of patients. No further syncope occurred in 84% of patients with an abnormal electrophysiologic study who received subsequent therapy to prevent the identified abnormality. Thus, in this difficult group of patients with recurrent syncope of uncertain etiology, electrophysiologic testing was safe and indicated abnormalities of conduction or rhythm in 68% of patients; treatment to correct these abnormalities prevented recurrent syncope in 84%.

Aged↗
PubMed1987

Out-of-hospital cardiac arrest in patients without clinically significant coronary artery disease: comparison of clinical, electrophysiological, and survival characteristics with those in similar patients who have clinically significant coronary artery disease.

Fifty nine survivors of out-of-hospital cardiac arrest unassociated with an acute myocardial infarction were referred for intracardiac electrophysiological study. Thirty patients who had no clinically significant coronary artery disease (group 1) were compared with 29 who did (group 2). Ventricular tachycardia or fibrillation was induced in significantly more patients in group 2 than in group 1 (69% vs 40%). Median duration of follow up, which was achieved in all patients, was 31 months in group 1 and 14 months in group 2. In group 1, an effective treatment was identified electrophysiologically in seven patients, and none died; an arrhythmia was induced, but no effective treatment was identified in five patients, and one patient died subsequently; an arrhythmia was not induced in 18 patients, 15 of whom were treated empirically with anti-arrhythmic drugs, and one died. In group 2, effective treatment was identified electrophysiologically in seven patients and three died (two of pump failure) during follow up. In 13 an arrhythmia was induced but no effective drug was identified, and six died or had a recurrence; in another nine patients without inducible arrhythmias, six subsequently died or had a recurrence. A Cox proportional hazards analysis identified previous myocardial infarction as the only predictor of recurrence. Patients without coronary artery disease who suffer an out-of-hospital cardiac arrest have a low inducibility rate at electrophysiological study and an excellent prognosis compared with patients who have coronary artery disease. Electrophysiological testing seemed to be of value in predicting the response to antiarrhythmic drugs, but non-inducibility of arrhythmias in patients with coronary artery disease was of no predictive value.

Adolescent↗
PubMed1986

Clinical intracardiac electrophysiologic testing: technique, diagnostic indications, and therapeutic uses.

Clinical cardiac electrophysiologic testing has evolved rapidly since 1968, when the technique was first described. In an electrophysiologic study, electrode catheters are positioned within the heart to record electrical activity from the atrium, atrioventricular conduction tissue, and ventricle. Programmed stimulation is then performed, which involves pacing of the atrium or ventricle and introducing critically timed premature stimuli during sinus rhythm or paced rhythm. The use of programmed stimulation in conjunction with intracardiac recordings in electrophysiologic studies has facilitated the diagnosis of mechanisms of arrhythmias and the assessment of therapy. Electrophysiologic testing is useful in selected patients with sinus node dysfunction, conduction system disorders, supraventricular tachycardia, ventricular tachycardia, or ventricular fibrillation and in survivors of out-of-hospital cardiac arrest and patients with symptomatic but unsubstantiated rhythm disturbances. Therapeutic approaches that can be assessed by electrophysiologic testing include serial drug testing to determine the effectiveness of antiarrhythmic agents, antitachycardia pacing, the implantable defibrillator, transcatheter ablation, and electrophysiologically guided surgical procedures. In this review, we discuss the methods of electrophysiologic testing, its clinical applications in diagnosing the various cardiac rhythm disturbances, and its use in assessing various therapeutic modalities.

Anti-Arrhythmia Agents↗
PubMed1986

Propafenone for the treatment of refractory complex ventricular ectopic activity.

The results of therapy with propafenone were evaluated in 45 patients with complex ventricular ectopic activity that had been refractory to a mean of 3.8 antiarrhythmic drugs. The cardiac diagnoses were ischemic heart disease (in 16 patients), cardiomyopathy (in 7), mitral valve prolapse (in 7), mitral valve prolapse (in 7), idiopathic ventricular ectopic beats (in 6), valvular heart disease (in 5), and hypertension (in 4). The frequency of ventricular ectopic beats was established after therapy with antiarrhythmic agents had been discontinued. Patients then received propafenone during a dose-ranging protocol. An effective response was defined as a reduction in total ventricular ectopic beats of 80% or more. During dose ranging, therapy failed in four patients because of side effects, in eight because of a reduction in ventricular ectopic beats of less than 80%, and in three because of an aggravation of the arrhythmia. Thirty patients had a reduction in total ventricular ectopic beats of 80% or more. During a mean follow-up of 12.4 months, therapy failed in 1 patient because of sustained ventricular tachycardia and in 7 because of intolerable side effects; 22 patients continued to receive propafenone. PR and QRS intervals were significantly prolonged (P = 0.001), but the corrected QT interval and the heart rate were unchanged. The mean trough plasma level of propafenone associated with an effective response was 756 ng/ml, and that associated with intolerable side effects was 920 ng/ml. Thus, in patients with refractory complex ventricular ectopic beats, propafenone was effective and well tolerated initially in 67% of patients and during long-term administration in 49%, and toxicity was minor in most patients.

Adult↗
PubMed1986

Symptomatic "isolated" carotid sinus hypersensitivity: natural history and results of treatment with anticholinergic drugs or pacemaker.

Because syncope may occur intermittently in patients with carotid sinus hypersensitivity, a knowledge of its natural history is needed as a basis for interpreting the usefulness of therapy. Fifty-six consecutive patients are described (47 men and 9 women; mean age 61 years) with carotid sinus hypersensitivity and syncope in whom 24 hour ambulatory monitoring and intracardiac electrophysiologic study revealed no other cause for the syncope. The mean duration of symptoms was 44 months (range 1 to 480) and the mean number of episodes was 4.0 (range 1 to 20). During a follow-up period of 6 to 120 months (median 40), syncope recurred in 3 of 13 patients who received no treatment, in 2 of 23 patients who received a pacemaker and in 4 of 20 patients who received anticholinergic drugs (incidences corrected for totals available at follow-up: 27, 9 and 22%, respectively). Two-thirds of the patients receiving no treatment were asymptomatic compared with all nine of the patients with syncope and a pure cardioinhibitory response to carotid sinus massage who received an atrioventricular (AV) sequential pacemaker. Although pacing was effective in abolishing syncope, its use should be reserved for recurrent episodes because of the high rate of spontaneous remission of symptoms.

Adult↗
PubMed1986

Increased vagal tone as an isolated finding in patients undergoing electrophysiological testing for recurrent syncope: response to long term anticholinergic agents.

Features suggestive of an isolated increase in vagal tone during electrophysiological study were found in 12 patients with recurrent near syncope or syncope. Results at neurological and cardiac evaluation were otherwise normal. The increased tone or heightened sensitivity to vagal tone was manifested by abnormal atrioventricular nodal refractoriness and conduction that were reversed with atropine. The patients underwent long term treatment with an anticholinergic agent (propantheline bromide) and 75% improved. Before treatment they had experienced a median of seven episodes (range 3-28) of near syncope or syncope during 10.5 months (range 1-60). During treatment these episodes decreased to a median of one (range 0-15) during 22.5 months (range 3-67); six patients experienced no further symptoms. Three patients continued to have syncope while on treatment, and one of these required permanent cardiac pacing. No additional cause for syncope was identified in any patient. During electrophysiological assessment of patients with syncope, evidence may be obtained pointing to an increase in vagal tone. In many of these patients treatment with anticholinergic drugs seemed to improve or eliminate the symptoms.

Adolescent↗
PubMed1986

Coronary artery thrombus as a risk factor for acute vessel occlusion during percutaneous transluminal coronary angioplasty: improving results.

Early experience with percutaneous transluminal coronary angioplasty (from October 1979 to March 1983 inclusive) showed that pre-existing coronary artery thrombus was associated with a significant increase in the incidence of acute coronary occlusion during angioplasty. Acute occlusion occurred in 11 (73%) of 15 patients with pre-existing thrombus compared with 18 (8%) of 223 patients without thrombus. The effect of improved technology (steerable guiding systems) and altered dilatation strategy (full intravenous heparinisation for 24 hours after the procedure and more intensive use of antiplatelet medications) was studied by review of angiograms from 297 consecutive patients without evidence of acute myocardial infarction who underwent angioplasty from April 1983 to March 1985 inclusive. Coronary artery thrombus was present in 34 (11%) patients, eight (24%) of whom had complete occlusion during or immediately after the procedure compared with 34 (13%) of 263 patients without thrombus. Patients with pre-existing coronary artery thrombus continue to be at greater risk of complete occlusion than patients without thrombus, but this risk has declined significantly since the modification of the angioplasty procedure.

Acute Disease↗
PubMed1986

Radionuclide assessment of left ventricular function in hypertrophic cardiomyopathy.

To determine the relationship of left ventricular function and ventricular tachycardia, 48 hour ECG monitoring and technetium-99m gated equilibrium radionuclide angiography were performed in 84 consecutive patients with hypertrophic cardiomyopathy and sinus rhythm. Measurements of ejection fraction (EF), peak ejection rate (PER, edv/s), peak filling rate (PFR, edv/s) and time to peak filling rate (PFR, ms) were derived from radionuclide activity time curves generated from data acquired in list-mode. Left ventricular function was compared in patients with and without ventricular tachycardia. Left ventricular ejection fraction was significantly lower in 16 patients with ventricular tachycardia compared to 68 patients without (67 +/- 17 vs 78 +/- 10, P less than 0.05) and time to peak filling rate was significantly prolonged (152 +/- 32 vs 120 +/- 36, P less than 0.05). Thus patients with hypertrophic cardiomyopathy at greatest risk of sudden death had significant impairment of systolic and diastolic left ventricular function.

Adolescent↗