Biomedical subjects

D O Hodge

Publications and source records attributed to D O Hodge.

96 records · Page 6Linked to original sources

PubMedDate not supplied

An estimate of the prevalence of reversible left ventricular dysfunction in patients referred for coronary artery bypass surgery.

BACKGROUND: The prevalence of reversible left ventricular function through revascularization has been difficult to assess because of the referral bias inherent in patients undergoing viability-targeted preoperative testing. METHODS AND RESULTS: Rest and exercise gated equilibrium radionuclide angiography was performed in 86 patients within 6 months before and any time after coronary artery bypass. Clinical characteristics were recorded for each patient before each of the two radionuclide ventriculograms. Global left ventricular ejection fraction (LVEF) was calculated for each patient at rest. A definite change in LVEF was defined as 0.08 or more points and a probable change as 0.04 or more points. Only patients with a resting LVEF of 0.50 or less were eligible for the study. There was no significant group change in LVEF (0.39 +/- 0.08 before surgery vs 0.38 +/- 0.11 after surgery; difference not significant). However, a definite improvement in LVEF was seen in 18 patients (21%) and a probable change in an additional 10 (12%). Consequently, one third of the patients had at least a probable improvement in resting left ventricular function. These prevalences were not related to any change in medical therapy. CONCLUSION: According to a test not specifically designed to evaluate myocardial viability, the prevalence of reversible left ventricular dysfunction is not uncommon, occurring in up to one third of patients referred for coronary revascularization.

Confounding Factors, Epidemiologic↗

PubMedDate not supplied

Prognosis in patients with spontaneous chest pain, a nondiagnostic electrocardiogram, normal cardiac enzymes, and no evidence of severe resting ischemia by quantitative technetium 99m sestamibi tomographic imaging.

BACKGROUND: There are limited data addressing the outcome of patients with normal or near normal myocardial perfusion during chest pain at rest. The purpose of this study was to determine the prognosis of patients with spontaneous chest pain, a normal or nondiagnostic electrocardiogram, no enzymatic evidence of myocardial infarction, and no evidence of severe resting ischemia by quantitative technetium 99m (99mTc) sestamibi imaging. METHODS: In the study, 111 patients who fulfilled the above criteria were injected with 99mTc sestamibi during resting chest pain and were followed for a median 2.7 years. Of the patients in the study group, 58% had coronary artery disease that was documented by clinical history or coronary angiography. Tomographic 99mTc perfusion images were interpreted with a quantitative threshold technique initially developed to detect severely hypoperfused myocardium. The images were also interpreted qualitatively to detect patients with milder degrees of hypoperfused myocardium. RESULTS: During follow-up 3 patients had cardiac deaths, 5 had nonfatal myocardial infarctions, and 21 underwent revascularization procedures (13 within 3 months and 8 more than 3 months after the sestamibi study). At 3 years, survival free of cardiac death was 97%, survival free of cardiac death or myocardial infarction was 91%, and survival of cardiac death, myocardial infarction, or late revascularization was 82%. Quantitative analysis of the scans revealed that 100% of patients without fixed defects had 3-year survival free of cardiac death versus 76% of patients who had fixed defects (p < 0.001). Mild to moderate resting ischemia by qualitative interpretation of the scans was present in 20% of patients, but this did not predict outcome. CONCLUSIONS: Patients with spontaneous chest pain and nonischemic quantitative 99mTc sestamibi images were at reasonably low risk for hard cardiac events although some patients (18%) required revascularization.

Aged↗

PubMedDate not supplied

Prediction of severe coronary artery disease and long-term outcome in patients undergoing vasodilator SPECT.

BACKGROUND: Vasodilator perfusion imaging has not been extensively evaluated for predicting severe coronary artery disease (CAD) or long-term prognosis. METHODS AND RESULTS: The goals of this study were to develop a model to predict left main/3-vessel CAD in patients undergoing vasodilator thallium 201 imaging and coronary angiography (angiographic population) and to test the long-term prognostic value of this model in a separate cohort of patients who were not referred for angiography (prognostic population). In the angiographic population (n = 653) the chi2 value of the clinical model (containing the variables age, sex, and prior myocardial infarction) in the prediction of severe CAD was 32. The addition of 3 vasodilator Tl-201 variables (magnitude of ST-segment depression, summed reversibility score, and increased lung uptake) increased the model chi2 value to 114 (P <.001). Only 9% of predicted low-risk patients versus 57% of predicted high-risk patients had severe CAD. In the prognostic population (n = 521) survival rates free of cardiac death or myocardial infarction at 7 years were 91%, 73%, and 51%, respectively, for patient groups predicted to be at low, intermediate, and high risk of severe CAD (P <.001). CONCLUSIONS: Clinical and vasodilator Tl-201 variables can accurately predict the risk of severe CAD. Stress Tl-201 variables add incremental information to clinical variables. The same model also predicts patient outcome.

Adenosine↗

PubMedDate not supplied

Development of an adjustable prosthesis for the treatment of gastroesophageal reflux: preliminary results in a porcine model.

Dysphagia and recurrent gastroesophageal reflux complicate use of the Angelchik prosthesis. The authors developed an inflatable silicone device, similar to the Angelchik prosthesis, that may allow for the adjustment of the total pressure exerted around the gastroesophageal junction after implantation. To estimate its potential to prevent gastroesophageal reflux in humans, we used a short-term porcine model in which we measured the effective lower esophageal sphincter pressure in 10 anesthetized pigs using a computerized, three dimensional pressure vector volume analysis. Anesthesia and mobilization of the gastroesophageal junction did not modify the three dimensional pressure vector volume at the lower esophageal sphincter. Implantation of the deflated device significantly increased effective lower esophageal sphincter three dimensional pressure vector volume compared with baseline. Inflation of the device with 30 ml of saline further increased lower esophageal sphincter pressure significantly. Deflation of the device returned the pressure to the pre-inflation values. Using an animal model and short-term implantation, this new antireflux device appeared to offer the potential ability to adjust the pressure selectively at the gastroesophageal junction postoperatively. An added future feature of this device may be the ease of insertion using laparoscopic techniques. Long-term animal implantation studies and clinical trials are required to help establish the safety and efficacy of this device in humans.

Animals↗

PubMedDate not supplied

Predictive power of the relative lymphocyte concentration in patients with advanced heart failure.

BACKGROUND: The physiological stress suffered by patients with heart failure results in an increased production of cortisol and a shift in the leukocyte differential toward a decreased percentage of lymphocytes (%L). The purpose of this study was to determine the prognostic significance of a low %L in advanced heart failure. METHODS AND RESULTS: Patients evaluated in our cardiac transplantation clinic between April 1988 and July 1995 were retrospectively reviewed (n=263). Fifty-two patients were excluded because they had recent trauma, infection, surgery, myocardial infarction, corticosteroid use, or history of malignancy. In the remaining 211 patients, we used Cox proportional hazards analysis to examine the association between survival and transplant-free survival with baseline variables. Univariate analysis showed a significant association between time to death and %L (P=.004), New York Heart Association (NYHA) class (P=.002), and maximal oxygen uptake (P=.05). Univariate analysis of the end point of survival free from transplantation yielded similar results. One- and 4-year survival rates for patients with a low %L (<20.3%) were 78% and 34% compared with 90% and 73% for those with a normal %L. Multivariate analysis showed NYHA class (P<.008) and %L (P<.01) were independent predictors of survival and survival free from cardiac transplantation. CONCLUSIONS: The relative lymphocyte concentration is an inexpensive, readily available, simple prognostic marker in patients with symptomatic heart failure who do not have recent trauma, infection, surgery, myocardial infarction, corticosteroid use, or history of malignancy. It could be incorporated into clinical models to predict patient outcome and to aid in the selection of patients for cardiac transplantation.

Analysis of Variance↗

PubMedDate not supplied

Keratometric results during the first year after keratoplasty: adjustable single running suture technique versus double running suture technique.

BACKGROUND AND OBJECTIVE: To compare the 3-month and 1-year postoperative keratometric results in a retrospective sequential series of corneal grafts performed with either a double running suture technique or an adjustable single running suture technique. MATERIALS AND METHODS: Keratometry values obtained 3 months and 1 year after penetrating keratoplasty, when sutures were still present, were compared between 31 grafts with double running sutures and 27 grafts with single running sutures, 15 of which had been adjusted postoperatively. RESULTS: No significant difference in mean keratometry between the 2 groups was found either 3 months or 12 months after keratoplasty. Mean keratometric astigmatism was significantly less in the single running group at both 3 months (2.2 +/- 1.9 vs 4.5 +/- 2.8, mean +/- SD, P <0.001) and 12 months (3.0 +/- 2.2 vs 4.2 +/- 2.1, P = 0.03). Within groups, there was no significant change from 3 months to 12 months in either mean keratometry or keratometric astigmatism. CONCLUSION: The single running suture technique, with postoperative adjustments, produced less keratometric astigmatism during the first postoperative year, when sutures were still in place.

Astigmatism↗