Current status of coronary angioplasty.
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Biomedical subjects
Publications and source records attributed to J C Missri.
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Dilated cardiomyopathy (DCM) carries a poor prognosis. This study examined the non-invasive parameters that may be predictive of survival in two groups of patients, short-term survivors who died within one year of onset of symptoms (Group I, 6 patients) and long-term survivors who survived greater than one year of presentation (Group II, 16 patients). The M-mode echocardiogram (E), resting radionuclide ventricular function study (RNA) and electrocardiogram (ECG) were reviewed for factors that would differentiate between Group I and II. The E mean ventricular wall thickness in Group I was 0.6 cm and Group II 0.9 cm (p less than 0.05), a hypertrophy-dilation index (mean thickness/LVDd) was 0.09 for Group I and 0.12 for Group II (p less than 0.05). There was no significant difference between Groups I and II in LVDd by E, RNA, LV ejection fraction, ECG (LVH, ventricular ectopy, conduction abnormalities). Thus, the finding of a mean ventricular wall thickness of 0.9 cm and a hypertrophy-dilation index of greater than 0.10 by E was predictive of survival longer than one year. The ECG and RNA LV ejection fraction did not predict outcome.
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Although it is certain that thrombolytic therapy is effective in achieving reperfusion in an acutely thrombosed coronary artery, the ability of such restoration of flow to preserve myocardial function must be demonstrated. It must also be determined if the gains in contractile function are of sufficient magnitude to reduce morbidity and deaths after infarction. The patient population that can potentially benefit from this procedure is largely unknown. However, it is certain that the institution of thrombolytic therapy must begin in the early hours of acute infarction. The vast majority of patients with MI are cared for in hospitals that do not perform cardiac catheterizations. Thus the question of efficacy of intravenous fibrinolytic therapy is very important. Randomized clinical trials are already in progress and answers to important questions are forthcoming.
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Doppler echocardiography is a relatively new non-invasive technique which provides direct hemodynamic data that is complementary to M-Mode and 2-Dimensional echocardiography. This technique allows measurement of peak flow velocity through a stenotic valve and allows accurate prediction of the pressure gradient across the valve. It is a promising technique for screening patients with suspected pulmonic and aortic stenosis. It allows quantitation of gradient and valve area in patients with mitral stenosis. Doppler techniques are also valuable in detecting and semi-quantitating valvular regurgitation. Pulsed Doppler echocardiography is accurate in evaluating patients with multi-valvular disease. Finally, Doppler techniques are finding an important role in the evaluation of suspected prosthetic valve malfunction. In summary, Doppler echocardiography offers a complementary approach for direct evaluation of intracardiac hemodynamics in patients with valvular heart disease.