[Atenolol in suspected acute myocardial infarction. The Danish experience of participation in an international multi-center study].
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Atenolol↗
Biomedical subjects
P Grande
Publications and source records attributed to P Grande.
Use of initial ST-segment deviation for prediction of final electrocardiographic size of acute myocardial infarcts.
The decision to administer thrombolytic therapy for limitation of acute myocardial infarction (AMI) size must occur when only the history, physical examination and 12-lead electrocardiogram of a patient are available. A method that could quickly assess the amount of jeopardized myocardium would greatly aid the physician. This study developed formulas from 68 anterior and 80 inferior AMI patients using the extent of initial ST-segment deviation (ST delta) to predict the final AMI size estimated by the Selvester QRS score in a population not receiving reperfusion therapy. Inclusion required: initial anterior or inferior AMI; admission electrocardiogram less than or equal to 8 hours after the onset of symptoms with evidence of epicardial injury; elevated creatine kinase-MB; a predischarge electrocardiogram taken greater than or equal to 72 hours after admission; and no AMI extension before the predischarge electrocardiogram. The extent of epicardial injury was quantified by counting the number of leads with greater than or equal to 0.1 mm ST delta, by the sum (sigma) of ST delta in all leads and by the sigma ST delta in the lead groups associated with each AMI location. These results were compared to the AMI size estimated from the predischarge electrocardiogram. Univariable and multivariable analyses generated these formulas for AMI size: anterior = 3[1.5 (number leads ST increases) - 0.4]; inferior = 3[0.6 (sigma ST increases II, III, aVF) + 2.0]. Thus, formulas based on quantitative measurements of ST delta on the admission electrocardiogram are predictive of final QRS-estimated AMI size, and may be useful in determining the efficacy of acute reperfusion therapy.
Electrocardiography↗
Transcutaneous pacing: experience with the Zoll noninvasive temporary pacemaker.
We investigated the effectiveness of noninvasive transcutaneous pacing in 35 patients. Pacing was achieved in 33 of 35 patients (94%). In 24 patients the indications were: acute sinoatrial block, atrioventricular block, or asystole with unconsciousness due to acute myocardial infarction in eight; sick sinus node syndrome in 12; and other indications in four patients. These patients were paced for 2 minutes to 14 hours; the median length of pacing was 15 minutes. The pacing thresholds varied from 30 to 110 mA; pacing was achieved in 22 patients without serious side effects. Nine patients needed sedation and six were unconscious; 12 later had a temporary or permanent transvenous pacemaker implanted. In 11 patients noninvasive transcutaneous pacing was performed prior to implantation of a permanent pacing catheter: in eight pacing was done just prior to catheter insertion, and in three the threshold was determined before a weekend on which the patient had to wait for implantation. Pacing thresholds were from 45 to 90 mA; the median was 55 mA. Seven of these eight patients felt chest pain. No serious side effects were seen. We conclude that transcutaneous pacing is effective and safe and can be used instead of inserting a transvenous catheter if this is impossible or until one can be inserted.
Adolescent↗
Patency rate of small caliber fibrous polyurethane vascular prostheses implanted in the dog carotid and femoral artery improved by use of acetylsalicylic acid and dipyridamol.
Segments of 3 mm diameter fibrous polyurethane vascular prosthesis of length 3-4 cm were prepared. They were bilaterally implanted in the carotid and femoral arteries of male and female beagles. Four groups consisting of animals receiving either no medication or thrombocyte aggregation drugs were studied: Group A (8 dogs), no medication: group B (19 dogs), 500 mg acetylsalicylic acid (ASA) once daily and 25 mg dipyridamol (DIP) three times daily orally for 6 weeks after the implantation operation; group C (14 dogs), 250 mg ASA and 25 mg DIP three times daily orally for 6 weeks after the implantation operation; group D (12 dogs), 250 mg ASA and 25 mg DIP three times daily orally for 25 weeks after the implantation operation. Medication was started one week prior to the implantation operation. In group A, all prostheses were occluded at week 6. There was a significant difference in patency rates between groups B-D and C-D. No significant differences in patency rates could be found between groups B and C. The best patency rates were obtained 25 weeks after implantation in group D for both the right and left carotid and right and left femoral implantation sites. Highest patency rates were observed when ASA and DIP were given for 25 weeks.
Animals↗
Implantation of 20 cm long polyurethane vascular prostheses in the femoral artery of dogs. Preliminary results.
In a preliminary experiment externally reinforced polyurethane prostheses measuring 20 cm in length, with an inner diameter of 3 mm, were implanted in a loop in the femoral artery of six dogs. The dogs received 250 mg acetylsalicylic acid and 25 mg dipyridamol three times a day as anti-thrombocyte aggregation therapy starting three weeks prior to surgery. Anti-thrombocyte aggregation therapy was continued throughout the study. All prostheses remained patent 8, 9, 15 and 17 months after implantation. Patency was confirmed by palpation and Doppler ultrasound measurements. Preliminary results suggest that in clinically relevant situations, these prostheses could function well over prolonged periods of time.
Animals↗
Normal myocardial enzymes and normal echocardiographic findings during noninvasive transcutaneous pacing.
Noninvasive transcutaneous pacing was performed for 30 minutes in 10 healthy volunteers. The pace rate was from 85 to 115 min-1, and the threshold for pacing was from 38 to 70 mA, median 59 mA. Echocardiography before and during pacing showed no changes in left ventricular end-diastolic diameter, in fractional shortening nor in contraction pattern. Also, blood pressure remained unchanged. Blood samples for determination of myoglobin, creatine phosphokinase, creatine kinase MB and lactate dehydrogenase were drawn prior to pacing and 1,2,3,4,6,8 and 24 hours after pacing. The serum concentrations were the same before and after pacing for all enzymes and myoglobin. We conclude that non-invasive transcutaneous pacing for 30 minutes causes no muscular or myocardial injury and that the left ventricular function remains normal.
Adult↗
[Insufficiency of the left ventricle in elderly patients with normal systolic function. Is ischemia a determinant of the disease?].
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Aged↗
A comprehensive estimation of acute myocardial infarct size using enzymatic, electrocardiographic and mechanical methods.
This prospective study compares the estimated size of acute myocardial infarction (AMI) by cumulative serum creatine kinase isoenzyme MB (CK-MB), Selvester QRS score, and 2-dimensional (2-D) echocardiographic dyssynergy of the left ventricle in 63 consecutive patients with their first anterior (n = 31) or inferior AMI (n = 32). The correlations among these parameters were good for patients with anterior AMI (r = 0.74 to 0.78, standard error of the estimate = 29 to 33%) but only fair for those with inferior AMI (r = 0.35 to 0.47, standard error of the estimate = 38 to 73%). Based on previous autopsy studies, estimates of CK-MB and QRS score were then converted to percent of infarcted left ventricle. Linear regression analyses between mean percent AMI size by cumulative CK-MB plus QRS score vs the number of dyssynergic segments by 2-D echocardiography were used to develop a comprehensive formula for estimating AMI size by a combination of all 3 techniques. Thus, a formula is proposed that may optimally estimate AMI size derived from leakage of cytosolic enzymes, changes in the sequence of myocardial depolarization, and irregularities of left ventricular contraction.
Adult↗
Cerebrospinal fluid creatine kinase isoenzyme BB levels do not predict the clinical outcome in patients unconscious following cardiac resuscitation.
It has recently been claimed that an increase in creatine kinase isoenzyme BB(CK-BB) in cerebrospinal fluid (CSF) is well correlated with the cerebral outcome in patients resuscitated after cardiac arrest. Twenty-one such patients consecutively admitted from outside this hospital participated in the study. The patients were divided into two groups: 6 survivors and 15 nonsurvivors. The median CSF-CK-BB value was 5 U/L among nonsurvivors and below detection limit among survivors (NS). However, the predictive value of a positive test is limited, since only 6 of 15 nonsurvivors (40%) had an increase in CSF-CK-BB (predictive value of positive test = 67%). The predictive value of a negative test is limited, since 3 of 6 survivors (50%) showed no rise in CSF-CK-BB (predictive value of negative test = 25%). No relationship between cerebral dysfunction and CSF-CK-BB values was revealed. Thus, CSF-CK-BB does not predict the clinical outcome in patients resuscitated after cardiac arrest.
Creatine Kinase↗
The influence of fenflumizole on platelet aggregation in patients with unstable angina pectoris.
We have studied the antiaggregatory effect of fenflumizole, a new non-steroidal antiinflammatory imidazole derivative, in ten patients with unstable angina pectoris. We have measured the aggregation induced by arachidonic acid (AA), ADP, and collagen, and serum or plasma concentrations of beta-thromboglobulin (beta-TG), platelet factor 4 (PF-4), thromboxane B2 (TXB2), and fenflumizole before, during, and after treatment with fenflumizole in two different regimens either as 10 mg b.i.d. for four days followed by 10 mg daily for six days (Group I, n = 5), or as 20 mg b.i.d. for four days followed by 20 mg daily for six days (Group II, n = 5). The threshold concentration of AA-induced platelet aggregation increased in both groups by the first day of treatment, the mean increase being significantly higher in Group II than in Group I. There was close correlation between serum fenflumizole and the threshold concentration of AA-induced platelet aggregation (r = 0.95). A significant fall in TXB2 occurred in both groups. In group I TXB2 concentrations subsequently increased to initial values during treatment, whereas it remained significantly reduced in Group II. There were no significant changes in collagen and ADP aggregation, and beta-TG and PF-4 concentrations remained unchanged during and after the administration of fenflumizole.
Adenosine Diphosphate↗
Relation between electrocardiographic and enzymatic methods of estimating acute myocardial infarct size.
The extent of initial acute myocardial infarction (AMI) and subsequent patient prognosis were studied using 2 independent indicators of AMI size. Two inexpensive, readily available techniques, the complete Selvester QRS score from the standard 12-lead electrocardiogram and the peak value of the isoenzyme MB of creatine kinase (CK-MB), were evaluated in 125 patients with initial AMI. The overall correlation between peak CK-MB and QRS score was fair (0.57), with marked difference according to anterior (0.72) or inferior (0.35) location. The prognostic capabilities of each measurement varied. Peak CK-MB provided significant information concerning hospital morbidity or early mortality (within 30 days) for both anterior (chi 2 = 9.83) and inferior (chi 2 = 7.68) AMI locations; however, the QRS score was significant only for anterior AMI (chi 2 = 9.50). For total 24-month mortality, the QRS score alone provided the most information (chi 2 = 10.0, p = 0.0016), which was not improved with the addition of CK-MB (chi 2 = 0.07, p = 0.79). This study shows a good relation between these 2 independent estimates of AMI size for patients with anterior AMI location. Both QRS and CK-MB results are significantly related to early morbidity and mortality; however, only the QRS score is related to total 24-month prognosis.
Aged↗
[Extensive acute transmural myocardial infarction without change in the QRS complex].
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Aged↗
Diagnostic and prognostic implications of transient isolated negative T waves in suspected acute myocardial infarction.
The diagnostic and prognostic implications of transient isolated negative T waves were studied in 127 patients in whom acute myocardial infarction (AMI) was suspected. Eight-four patients with no AMI and no electrocardiographic changes served as the control group. The 2 groups were well matched. Twenty-nine patients (23%) with isolated negative T wave had a significant increase in serum creatine kinase (CK)-MB levels and fulfilled the diagnostic criteria for AMI. The increase in serum CK-MB levels did not predict a higher risk of hospital mortality, but during follow-up (median 31 months), a serum CK-MB level above 30 U/liter identified patients with a significantly increased risk of dying (p less than 0.05). Both the number of affected electrocardiographic leads and the sum of negative T-wave amplitudes were significantly related to the follow-up mortality rate (p less than 0.01). The comparison between control subjects and patients with negative T waves during follow-up showed more events among the patients: AMI (17% vs 8%, p less than 0.02); death (24% vs 12%, p less than 0.01); and AMI or death (31% vs 19%, p less than 0.01). Thus, only 25% of patients with aggravated chest pain and isolated negative T waves have AMI. However, the long-term prognosis for the entire group of patients with isolated negative T waves is poor, and any therapeutic intervention should be initiated immediately.
Adult↗
The inner prosthetic surface structure and re-endothelialization: an experimental study in the rat using two types of microvascular prostheses for aortic implantation.
Two types of microvascular prostheses were implanted in the rat infrarenal aorta. Operations were carried out with clean, nonsterile instruments under ether anesthesia. Anastomoses were made with a continuous 8-0 suture. In group A, a 1-cm-long piece of expanded polytetrafluorethylene (PTFE) and in group B a 1-cm-long fibrous polyurethane prosthesis were implanted. Both groups consisted of 18 rats. Three rats from each group were killed at days 3, 5, 10, 20, 40, and 60 postimplantation. Prostheses were examined by scanning electron and light microscopy for the re-endothelialization. All prostheses in both groups were patent at the time of death. Re-endothelialization started in both types of prostheses the fifth day after implantation and had advanced 1-3 mm in the PTFE prostheses at day 60. However, in the fibrous polyurethane prostheses, re-endothelialization progressed and a complete new lining was achieved between days 20 and 40 postimplantation. The endothelium/neointima in the fibrous prosthesis was firmly anchored onto the prosthetic wall by means of cellular protrusions between the polyurethane fibers. In contrast to this observation, the endothelium/neointima developed in the PTFE prostheses was not anchored to the wall of the prosthesis. It is emphasized that the development of a new lining in a prosthesis may reduce the risk of endogenous, hematogenous infections. From the results of this study, we have concluded that there is a correlation between the inner surface structure and the extent of the re-endothelialization of a prosthesis. A prosthesis with a fibrous structure is much more rapidly and completely re-endothelialized than an expanded PTFE prosthesis.
Animals↗
High-density lipoprotein cholesterol assay by magnesium dextransulphate precipitation.
A method for determination of high-density lipoprotein cholesterol (HDL-C) is evaluated: after precipitation of low and very low lipoprotein cholesterol in serum by magnesium dextransulphate, HDL-C is determined by an enzymatic method. The precision of the method was good: coefficient of variation 4%. The accuracy was good, evaluated by correlating HDL-C results from the present assay to the results obtained from three other HDL-C assays (n = 17): ultracentrifugation r = 0.91, phosphotungstate/MgCl2 r = 0.98, and alpha-lipoprotein determination by electrophoresis r = 0.91 (p less than 0.01). Repeated analysis showed that serum may be kept at 4 degrees C for 1 month, at -20 degrees C for 2 months, and requires -80 degrees C for longer storage. Ten patients with acute myocardial infarction showed significantly lower HDL-C from day 4 in the acute phase and during the first 3 months follow up (p less than 0.05). Eighty patients with peripheral vascular disease, who were compared to a group of matched controls, also showed significantly decreased serum HDL-C (p less than 0.01). The present HDL-C assay is easy, fast and reliable and is considered a valuable clinical test.
Adult↗
Diagnostic and prognostic significance of minimally elevated creatine kinase-MB in suspected acute myocardial infarction.
CK-MB changes were studied using agarose gel electrophoresis in 244 patients admitted to a coronary care unit for suspected acute myocardial infarction (AMI). A range of minimally elevated CK-MB levels, from 1 to 24 IU/liter, was identified as representing uncertain AMI events. Positive AMI events were defined by elevations of 25 IU/liter or more documented in patients with new Q waves or abnormalities in all enzyme and isoenzyme levels. Negative AMI events were defined by elevation of 0 IU/liter, observed in all control subjects. The 1-year cardiac mortality rates in the "positive"-AMI (n = 91) and "uncertain"-AMI (n = 22) groups were identical (22%), and significantly higher than that in the "negative"-AMI group (n = 93) (6%) (p less than 0.05). However, when a larger uncertain-AMI group of 115 patients was compiled by 2 collaborating centers, the 1-year cardiac mortality rate in the 39 patients with chest pain alone was 0%, vs 33% in the 76 patients with accompanying severe medical problems such as cardiac or respiratory failure. Whether minimal CK-MB elevations represent AMI of limited extent is not clear. These elevations occur most often in association with severe medical problems, and in patients without such problems, they may not indicate a poor prognosis.
Adult↗
Three years experience with experimental implantation of fibrous polyurethane microvascular prostheses in the rat aorta.
The results of a 3-year study in which a series of 355 implantations of 1-cm-long fibrous polyurethane microvascular prostheses into the infrarenal aorta of the rat (group A) were evaluated with respect to patency and formation, structure, and fate of the neo-intima. Rats were sacrificed at various intervals from 1 day to 2 years in order to obtain a time-related impression of the re-endothelialization and stability of the neo-intima. A second series of 51 implants was done with prostheses 10 cm in length, placed in a 1.5-cm loop in the abdominal aorta (group B). An overall patency rate of 92.7% was achieved in group A. Initially, eight technical failures caused early thrombosis of the prostheses. Sixteen prostheses became infected and subsequently occluded. The overall patency in group B was 52.9%, due to kinking from adhesion formation and normal growth of the rat. In both the long and short prostheses, a continuous multilayered neo-intima developed, growing from the aortic stumps into the prosthesis from both sides. According to the growth rate of 0.3 mm/day, a 1-cm prosthesis was re-endothelialized after +/- 20 days and a 10-cm prosthesis after +/- 9 months. Once developed, the neo-intima, consisting of myofibroblasts and smooth muscle cells covered with a flat endothelium, remained stable and continuous, throughout the observation period. The neo-intima was firmly anchored onto the prosthetic wall by means of cellular protrusions extending between the polyurethane fibres. The significance of rapid healing of an implanted prosthesis is emphasized with respect to preventing (late) hematogenous, endogenous infection of the prosthesis.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
Quantitative influence of serum creatine kinase isoenzyme MB estimated infarct size and other prognostic variables on one year mortality after acute myocardial infarction.
The aim of the present study was to determine the strength of the relation between serum creatine kinase isoenzyme MB estimated infarct size, other prognostic variables, and mortality after acute myocardial infarction. Serum creatine kinase MB estimated infarct size and 11 other prognostic variables were obtained in 317 patients. By Cox regression analysis the prognostic variables significantly related to mortality were identified: congestive heart failure, estimated infarct size, New York Heart Association class, number of previous infarcts, and age. Congestive heart failure and estimated infarct size were most strongly related to mortality. The relation between the prognostic variables and mortality was non-linear, and the variables influenced each others' relation to mortality. A prognostic index based on all five prognostic variables provided the best means of estimating the probability of survival after acute myocardial infarct. Neither serum creatine kinase MB estimated infarct size nor any of the other prognostic variables had a significant independent influence on mortality, and the probability of survival was high in the absence of any of the prognostic variables in combination.
Age Factors↗