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James L Vacek

Publications and source records attributed to James L Vacek.

9 recordsLinked to original sources
PubMed2006

A dilated inferior vena cava is a marker of poor survival.

BACKGROUND: The inferior vena cava (IVC) morphology is often used to estimate right atrial pressure; however, the association of IVC morphology and outcome is poorly described. METHODS: We evaluated 4383 consecutive outpatients (98% men) undergoing echocardiography at 1 of 3 Veterans Affairs laboratories. RESULTS: Of the 3729 with adequate images, 3295 (88%) had a normal IVC (< 2 cm), 358 (10%) had a dilated IVC that collapsed at least 50% with inspiration, and 76 (2%) had dilated IVC that did not collapse. Compared with patients with a normal IVC, those with a dilated IVC were older (66 +/- 13 vs 69 +/- 12 years if dilated with collapse and 70 +/- 12 years if dilated without collapse, P = .0005) and were more likely to have a history of heart failure (11% vs 18% if dilated with collapse and 38% if dilated without collapse, P < .0001). The 90-day and 1-year survival rates were 99% and 95% for those with a normal IVC, 98% and 91% for those with a dilated IVC with collapse, and 89% and 67% for those with a dilated IVC without collapse (P < .0001). After adjustment for clinical and echocardiographic characteristics including left and right ventricular function and pulmonary artery pressure, a dilated IVC without collapse remained associated with increased mortality: hazard ratio 1.43 (1.29-1.57 compared with a normal IVC, P < .0001). CONCLUSION: A dilated IVC without collapse with inspiration is associated with worse survival in men independent of a history of heart failure, other comorbidities, ventricular function, and pulmonary artery pressure.

Aged↗
PubMed2005

Differences in outcomes between patients treated with single- versus dual-chamber implantable cardioverter defibrillators: a substudy of the Multicenter Automatic Defibrillator Implantation Trial II.

OBJECTIVES: We sought to evaluate the influence of single- versus dual-chamber implantable cardioverter defibrillators (ICDs) on the occurrence of heart failure and mortality as well as appropriate and inappropriate ICD therapy in the Multicenter Automatic Defibrillator Implantation Trial II (MADIT-II). BACKGROUND: In MADIT-II, ICD therapy in patients with a prior myocardial infarction and ejection fraction < or =0.30 was associated with a 31% reduction in risk of mortality when compared to conventionally treated patients. An unexpected finding was an increased occurrence of hospitalization for heart failure in the ICD group. METHODS: Data from 717 patients randomized to ICD therapy with single- or dual-chamber pacing devices in MADIT-II were retrospectively analyzed. Endpoints selected for analysis included death from any cause, new or worsening heart failure requiring hospitalization, death or heart failure, appropriate therapy for ventricular tachycardia (VT) or ventricular fibrillation (VF), and inappropriate ICD therapy for atrial fibrillation or supraventricular tachycardia. RESULTS: A total of 404 single-chamber ICDs (S-ICDs) and 313 dual-chamber ICDs (D-ICDs) were implanted. Patients receiving D-ICDs were at a higher risk at baseline than those receiving S-ICDs, with older age, higher NYHA class, more frequent prior CABG, wider QRS complex, more LBBB, higher BUN level, a history of more atrial arrhythmias requiring treatment, and a longer time interval from their index myocardial infarction to enrollment. While there was a trend toward an increase in adverse outcomes in the D-ICD group, no statistically significant differences in heart failure or mortality were observed between S-ICD versus D-ICD groups. CONCLUSIONS: Patients with D-ICDs had a nonsignificant trend toward higher mortality and heart failure rates than patients with S-ICDs.

Arrhythmias, Cardiac↗
PubMed2005

Hemolytic anemia produced by regurgitation through transposed chordae tendineae.

Hemolytic anemia after mitral repair and annuloplasty ring placement is very uncommon, and rarely described. The case is presented of a 53-year-old woman who developed severe mitral regurgitation and transfusion-dependent hemolytic anemia following mitral valve repair with a Carpentier-Edwards annuloplasty ring, which included transposition of chordae tendineae from the posterior leaflet to the anterior leaflet. Transesophageal echocardiography suggested that the transposed chordae tethered the anterior leaflet, causing malcoaptation of the leaflets. This resulted in central regurgitation divided by the chordae tendineae, producing two turbulent flow jets causing hemolysis. At reoperation, these chordae were removed and two longer Gortex neochordae to the anterior leaflet were placed with subsequent resolution of the anemia. To the authors' knowledge, this is the first case of hemolytic anemia caused by transposed mitral valve chordae tendineae from the posterior to the anterior leaflet.

Anemia, Hemolytic↗
PubMed2004

Death certificate completion: how well are physicians trained and are cardiovascular causes overstated?

PURPOSE: To determine the ability of residents in completing death certificates correctly. METHODS: A total of 4800 residents were asked to complete a survey and cause-of-death statement using a sample case of in-hospital death due to urosepsis, of whom 590 residents (12%) responded. A scoring scale designed based on instructions from the National Association of Medical Examiners and the American College of Pathologists was used to measure responses quantitatively. RESULTS: Overall performance was poor, with only 23% (n = 137) of responses in the optimal scoring range. The average score was influenced significantly by level of residency training, as well as previous experience, prior formal training, and awareness of the guidelines regarding death certificate completion. Optimal scores correlated with level of residency training and prior formal training in death certificate completion, suggesting the benefits of experience and instruction. Forty-five percent (n = 267) of respondents incorrectly identified a cardiovascular event as the primary cause of death. CONCLUSION: The residents in this study demonstrated suboptimal performance in death certificate completion. Cardiovascular events were often incorrectly identified as the primary cause of death. Formal training can improve performance and should be emphasized in medical schools and residencies.

Analysis of Variance↗
PubMed2004

Catheter-induced left internal mammary artery dissection: a report of two cases and review of the literature.

Coronary artery dissection is a well-described but rare complication of diagnostic angiography. With increased numbers of patients undergoing coronary artery bypass grafting, the number of patients undergoing repeat angiography for chest pain should likewise increase. The authors report two cases of catheter-induced left internal mammary (LIMA) dissection and review the existing literature.

Adult↗
PubMed2004

Practical strategies for cardiac disease prevention. Basic steps to ensure better heart health.

Primary care physicians are deluged with medical information from many sources: medical literature, public media and the Internet, the pharmaceutical and medical device industries, and patients themselves. How can a physician best deal with the volume of data provided by scientific research, medical education, drug promotion, popular opinion, government regulation, and payer constraints?

Heart Diseases↗
PubMed2002

Classic Q wave myocardial infarction. Aggressive, early intervention has dramatic results.

One of the most dramatic interventions in modern medicine is the treatment of acute myocardial infarction. The sustained occlusion that occurs with Q wave infarction can result in extensive damage unless coronary flow is restored early. Dr Vacek discusses the rapid response to acute Q wave infarction, including diagnostic techniques, reperfusion, patient monitoring, and ongoing medical therapy.

Adrenergic beta-Antagonists↗
PubMedDate not supplied

Differential benefits and outcomes of tirofiban vs abciximab for acute coronary syndromes in current clinical practice.

Little comparative data exist for glycoprotein IIb/IIIa inhibitors in acute coronary syndromes (ACS). Two hundred twenty-eight patients were studied: 114 received tirofiban (TI) and 114 received abciximab (AB) for either unstable angina (UA) or myocardial infarction (MI). All patients received aspirin, heparin, and ticlopidine or clopidogrel. Baseline characteristics were similar between the 2 groups for admitting diagnosis (UA vs MI), age, gender, ejection fraction, diabetes mellitus, prior coronary artery disease, prior myocardial infarction (MI), prior bypass surgery, hypertension, congestive heart failure, hyperlipidemia, MI type (Q vs non-Q), or location. Drug administration time (mean) was 13 hours (AB) and 24 hours (TI). All AB was administered in the catheterization laboratory as compared to TI (34% in laboratory and 66% before laboratory). More AB patients received angioplasty or stent (92% vs 80%, p = 0.008) while more TI patients had CABG (10% vs 3%, p = 0.027). In-hospital complications including death, MI, urgent revascularization, cerebrovascular accidents or transient ischemic attacks, and access site bleeding were similar (p = NS). Multivariate predictors of events (odds ratios) were prior coronary artery bypass graft (2.3), diabetes (1.7), and prior percutaneous transluminal coronary angioplasty (1.7), but not the agent used. Over a mean follow-up of 13 months, the individual endpoints of death, MI, revascularization, or hospitalization were similar for both groups. The AB patients had improved freedom from revascularization (100% vs 81%, p = 0.015) in an emergent setting and TI patients had improved freedom from revascularization (93% vs 77%, p = 0.038) with elective procedures. Tirofiban and abciximab appear effective and safe when used for ACS when recommended dosing and precautions are followed. Major adverse outcomes are rare and bleeding complications uncommon.

Abciximab↗