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Biomedical subjects

V Fuster

Publications and source records attributed to V Fuster.

At least 451 records · Page 25Linked to original sources
PubMed1981

The natural history of idiopathic dilated cardiomyopathy.

Between 1960 and 1973, a total of 104 patients at the Mayo Clinic had a diagnosis of idiopathic dilated cardiomyopathy on the basis of clinical and angiographic criteria; these patients were followed up for 6 to 20 years. Twenty-one percent of the patients had a history of excessive consumption of alcohol, 20 percent had had a severe influenza-like syndrome within 60 days before the appearance of cardiac manifestations and 8 percent had had rheumatic fever without involvement of cardiac valves several years before; thus, possible etiologic risk factors of infectious-immunologic type may be important. Eighty patients (77 percent) had an accelerated course to death, with two thirds of the deaths occurring within the first 2 years. Twenty-four patients (23 percent) survived, and 18 of them had clinical improvement and a normal or reduced heart size. Univariate analysis at the time of diagnosis revealed three factors that were highly predictive (p less than 0.01) of the clinical course: age, cardiothoracic ratio on chest roentgenography and cardiac index. Systemic emboli occurred in 18 percent of the patients who did not receive anticoagulant therapy and in none of those who did; thus, anticoagulant agents should probably be prescribed unless their use is contraindicated.

Alcohol Drinking↗
PubMed1981

Role of platelets in the development of atherosclerotic disease and possible interference with platelet inhibitor drugs.

During the last two decades, significant advances have been made in the understanding of atherosclerotic disease. The pathogenesis of atherosclerosis appears to depend on a precise sequence of critical events based on the interaction of blood elements and lipids with the arterial wall. The major critical events and their sequence appears to be as follows: hemodynamic stress and endothelial injury; arterial wall-platelet interaction; smooth muscle cell proliferation; lipid entry and accumulation; significant arterial narrowing with fibrosis and development of thrombi; and complications in the form of calcification, ulceration, aneurysm, acute thrombotic occlusion and embolization. This sequence of critical events starts at a young age and in all geographic racial groups. Their evolution into advanced symptomatic lesions takes many years and varies in incidence and extent among different geographic and ethnic groups. It appears that in promoting and accelerating this process into the advanced stage of the disease, the presence at a young age of the so-called risk factors of atherosclerotic disease is most important. The recent advances in the understanding of the atherosclerotic process will be highlighted in this chapter with particular attention being focused on the role of platelets and thrombosis in the development of the disease and the possible role of platelet inhibitor drugs on the prevention of coronary atherosclerotic disease.

Arteriosclerosis↗
PubMed1981

Coronary artery thrombosis in patients with unstable angina.

This report describes the clinical course, coronary artery anatomy, and ventricular function of 16 patients in whom coronary artery thrombosis was detected at the time of cardiac catheterisation. All patients had an unstable clinical course in which accelerated angina occurred a mean of four weeks (range four days to 12 weeks) before catheterisation, and four patients had recent subendocardial myocardial infarction. In all patients severe coronary artery disease was documented at catheterisation. Fifteen patients had segmental wall motion abnormalities involving the left ventricular wall that was supplied by the coronary artery in which there was thrombus. Three patterns of coronary artery thrombus were noted: (1) Thrombus proximal to high-grade coronary artery stenosis; (2) thrombus distal to high-grade coronary artery stenosis; and (3) thrombus in segments of the arterial tree in which there was no high-grade coronary artery stenosis. Though the precise cause of the coronary artery thrombosis in our patients is unknown, it may have been a result of stasis, a ruptured atherosclerotic plaque, or coronary spasm. The common clinical course with unstable angina of acute onset suggests the possibility that the thrombus may have been responsible for the abrupt change in clinical condition or may have been a contributing factor in the patients' course.

Aged↗
PubMed1981

Distribution and dosimetry of 111In-labeled platelets.

The distribution of 111In-labeled platelets was studied in five young, healthy men. The radioactivity in the lungs, heart, liver, spleen, kidneys, and testes was determined from areas-of-interest in computed gamma-camera scans at intervals up to 75 hours after injection. After the first four hours, the activity in each organ studied except the liver and kidney decreased at roughly the physical decay rate. In the liver and kidney, the curves were relatively flat, indicating continued accumulation of the radiotracer. The calculated mean radiation absorbed dose per unit administered activity was 0.60 +/- 0.07 rad/mCi (0.16 +/- 0.02 Gy/GBq) for the total body, and was 34 +/- 6 rad/mCi (9.0 +/- 1.5 Gy/GBq) for the spleen.

Blood Platelets↗
PubMed1981

Platelet survival and the development of coronary artery disease in the young adult: effects of cigarette smoking, strong family history and medical therapy.

Cigarette smoking or a strong family history of coronary disease was present in 46 of 50 symptomatic patients with coronary artery disease who were younger than 50 years of age. We recorded a shortened platelet survival half-life (less than 92 hours) with 51Cr in 60% of these patients, in 56% of apparently normal persons of the same age who smoked or had a strong family history of coronary disease, and in only 14% of normal persons who did not smoke and had no family history (p less than 0.01). Lengthening of the shortened platelet survival toward normal occurred in coronary patients given dipyridamole plus aspirin and in apparently normal smokers who discontinued smoking (p less than 0.01). The study suggests a possible relationship among cigarette smoking, strong family history of coronary disease and platelet activation in the process of coronary atherogenesis in the young adult.

Adult↗
PubMed1981

Antithrombotic therapy: role of platelet-inhibitor drugs. I. Current concepts of thrombogenesis: role of platelets. (first of three parts).

Definite evidence has confirmed that platelets play a major role in thrombus formation and embolization, especially in the arterial system. In addition, increasing evidence has now shown that platelet deposition and thrombus formation can contribute to the growth and progression of atherosclerotic plaques. For these reasons, considerable attention has been focused recently on the question of whether drugs that inhibit certain platelet functions can prevent or modify the course of arterial thromboembolic disease and atherosclerotic disease in humans. In this first part, we review the current understanding of the role of platelets in thrombus formation, especially in the arterial system. This section comprises (1) the phases of arterial thrombus formation and its ultrastructural and biochemical basis, (2) the clinicopathologic presentation and fate of the arterial thrombus, and (3) the role of laboratory tests in its detection.

Animals↗
PubMed1981

10. Antithrombotic therapy: role of platelet-inhibitor drugs. II. Pharmacologic effects of platelet-inhibitor drugs (second of three parts).

In this three-part series, the first part described the role of platelets in thrombogenesis, this second part considers the pharmacologic effects of platelet-inhibitor drugs, and the third part will discuss their clinical application. This second article comprises (1) the physiologic contribution of the vessel wall to the prevention of thrombosis, particularly the role of prostacyclin, (2) the mechanisms of action of platelet-inhibitor drugs in the prevention of thrombosis, (3) the ideal dose and ideal therapeutic combinations of conventional platelet-inhibitor drugs, (4) other agents and new agents that inhibit platelet function, and (5) drug side effects.

Aspirin↗
PubMed1981

Series on pharmacology in practice. 10. Antithrombotic therapy: role of platelet-inhibitor drugs. III. Management of arterial thromboembolic and atherosclerotic disease (third of three parts).

As already mentioned in the first two parts of this series, the evidence that platelets play an important role in arterial thromboembolic and atherosclerotic disease has led to numerous studies designed to test the possible efficacy of platelet-inhibiting drugs in various cardiovascular conditions in animals and in humans. Although the number of such published studies today probably exceeds 500, for practicality we comment only on those large prospective trials in humans that have followed the strict criteria of drug trials. We specifically refer to patients with valvular heart disease and prosthetic heart valves, patients with cerebrovascular disease, and patients with coronary artery disease.

Anticoagulants↗
PubMed1980

Long-term evaluation (12 to 22 years) of open heart surgery for tetralogy of Fallot.

Four hundred seventy-five patients underwent repair of tetralogy of Fallot from 1955 to 1964; 396 of these were hospital survivors and were followed up for 12 to 22 years. An excellent late clinical result was maintained by 87 percent of the 396 hospital survivors. A less than excellent result in the remaining 13 percent of hospital survivors was caused by late mortality in 7 percent (sudden death in 3 percent, death due to cardiac causes in 2 percnt and death due to noncardiac causes in 2 percent), required reoperation in 4 percent (mainly because of residual ventricular septal defect) and development of symptoms in 2 percent. Postoperative cardiomegaly (cardiothoracic ratio greater than 0.55) was observed in 60 (25 percent) of 246 patients who had a follow-up chest roentgenogram, and was more common among those who died late or remained symptomatic. Among the few patients with inadequate surgical relief of right ventricular hypertension who did not have transanular patch repair, the hypertension did not tend to decrease progressively, whereas it did decrease in patients who had patch repair. No late sudden deaths were encountered in 20 patients shown to have postoperative right bundle branch block plus left axis deviation (bifascicular block pattern). Pulmonary valve incompetence appeared to have relatively little harmful influence on the late result, causng cardiac disability in 1 percent of the patients and appeared to be the main contributing factor of postoperative cardiomegaly in 13 (5 percent) of the 246 patients who had a follow-up chest roentgenogram. Most late deaths and complicatins appeared within 2 years of operation, and accelerating deterioration in late results did not occur as the follow-up extended beyond 2 decades.

Cardiomegaly↗
PubMed1980

Evaluation of cardiac murmurs.

We have attempted to review the evaluation of cardiac murmurs as we approach the patient in the office setting. It is obvious that although the character and location of the murmurs themselves are a clue to the genesis of the murmur, it is only by combining the history with a complete cardiovascular examination that we can truly establish the origin of the murmur in virtually every patient. If we combine these findings with selective noninvasive tests, then we will need to resort to the more expensive and invasive studies only on a selective basis.

Adolescent↗
PubMed1980

Noninvasive radioisotopic technique for detection of platelet deposition in mitral valve prosthesis and renal microembolism in dogs.

At 24 hrs after implantation of Björk-Shiley mitral prosthesis in 5 dogs, in vivo images were obtained with a gamma camera after intravenous administration (0.5-0.6 mCi) one hour postoperatively of autologous Indium-111-labeled platelets. The site of platelet deposition in the teflon ring and perivascular damaged cardiac tissue is clearly delineated in the scintiphoto. In vitro biodistribution (mean % +/- SD of injected dose) at 24 hrs after injection of the 5 implanted and 7 normal dogs performed with a gamma counter demonstrated that (45.1 +/- 10.6)% and (0.7 +/- 0.4)% were in blood and kidneys in normal dogs and (28.5 +/- 6.8)%, (1.6 +/- 0.6)%, (0.3 +/- 0.1)%, and (0.2 +/- 0.1)% were in blood, kidneys, teflon rings, and perivascular damaged cardiac tissue, respectively. The strut and pyrolytic carbon-coated disc retained only (0.0033 +/- 0.0004)% and (0.0031 +/- 0.0003)%, respectively. There was a 2.3-fold increase of labeled platelets in kidneys of implanted dogs due to renal trapping of microembolism. Also, three- to fivefold increase in ratios of lung, brain, cardiac, and skeletal muscle to blood indicates that internal organs and whole body work as filter for microembolism generated by cardiovascular surgery and mitral prosthesis. Twenty percent of the administered platelets are consumed in surgical repair of damaged tissue. Indium-111-labeled platelets thus provide a sensitive marker for noninvasive imaging of Björk-Shiley mitral prosthesis, thromboembolism after implantation of prosthetic device, and in vitro quantitation of surgical consumption.

Animals↗
PubMed1980

Preoperative M-mode echocardiography as a predictor of surgical results in chronic aortic insufficiency.

A group of 80 patients were studied retrospectively to determine whether preoperative echocardiography is useful in predicting operative results in patients with aortic valve replacement for chronic aortic insufficiency. One year after operation, percent change of left ventricular dimension (%delta D) and ejection fraction (EF) were higher and end-systolic left-ventricular internal dimension was smaller in patients with good results than in those who had poor results (p less than 0.05). Regarding probability of 5 year survival, patients with a %delta D of more than 35% had good prognosis, those with 31% to 35% had a fairly good prognosis, and those with 30% or less had increased risk of death, especially if they were in New York Heart Association (NYHA) Functional Class III or IV. All deaths occurred in patients with preoperative values of 31% or less. Patients with EF of 60% or more had a better prognosis than those with a value of less than 60%. In addition, 10 early postoperative echocardiographic studies showed no correlation between early regression of end-diastolic left ventricular internal dimension and long-term operative results; 18 late postoperative studies showed reduction in this dimension in patients with good surgical results, and the only one with a poor result had an enlarged dimension. Thus echocardiographic indices of left ventricular function (%delta D) and EF) may be useful as prognostic indicators in patients undergoing aortic valve replacement for aortic insufficiency.

Adolescent↗