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Biomedical subjects

V Runco

Publications and source records attributed to V Runco.

15 recordsLinked to original sources

Calcific valvular aortic stenosis with and without mitral anular calcium.

Seventy-six consecutive patients, mean age 66 +/- 9 years (+/- standard deviation), with isolated aortic valve replacement for calcific valvular aortic stenosis (AS) were studied. Mitral anular calcium (MAC) was detected by echocardiography in 45 patients (59%). Patients with MAC were older (p less than 0.01), had greater peak systolic aortic valve gradients (p less than 0.025), lower cardiac indexes (p less than 0.025) and smaller valve areas (p less than 0.05) than patients without MAC. Thirty-three percent of patients (15 of 45) with MAC required permanent pacemaker implantation after aortic valve replacement, compared with only 10% of patients (3 of 31) without MAC (p less than 0.025). During the follow-up of 7 years (mean 3.8 +/- 1.6), 27% of patients (12 of 45) with MAC died from cardiac causes, compared to only 7% (2 of 31) without MAC (p less than 0.025). Thus, patients with AS and MAC are older, have more severe AS, more frequently undergo permanent pacemaker implantation after aortic valve replacement and more frequently die of cardiac causes than patients with AS and no MAC during follow-up.

Adult↗

Diagnostic and prognostic significance of exercise-induced premature ventricular complexes in men and women: a four year follow-up.

Two hundred eighty patients (197 men and 83 women) with normal rest electrocardiograms and no history of prior myocardial infarction were referred for evaluation of chest pain. It was found that exercise-induced premature ventricular complexes had a lower sensitivity, specificity, positive predictive value and negative predictive value in predicting significant coronary artery disease than exercise-induced ST segment depression greater than or equal to 1 mm. The incidence of exercise-induced premature ventricular complexes was not significantly different in patients with no significant coronary artery disease, single vessel disease or multivessel disease. The site of origin of exercise-induced premature ventricular complexes was not helpful in predicting the presence or severity of coronary artery disease. At a mean follow-up period of 47.1 months, exercise-induced premature ventricular complexes did not predict coronary events (cardiac death or nonfatal myocardial infarction) in men or women.

Adult↗

High prevalence of symptomatic bradyarrhythmias due to atrioventricular node-fascicular and sinus node-atrial disease in patients with mitral anular calcification.

Mitral anular calcification (MAC) is associated with high frequency of conduction defects. To delineate this association in patients with symptomatic bradyarrhythmias, 68 consecutive patients requiring pacemakers (group I) and 56 matched controls (group II) were studied. The patients comprised 41 men and 27 women, whose ages ranged from 24 to 92 years (mean 68). The control group consisted of 56 subjects without bradyarrhythmias, whose ages ranged from 30 to 86 years (mean 70); there were 36 men and 20 women. MAC was detected in 59 patients (87%) with symptomatic bradyarrhythmias compared with 8 subjects (14%) in the control group. In group I, 15 patients (22%) had complete atrioventricular block, 23 patients (34%) had atrial fibrillation with slow ventricular response, and 30 patients (44%) had intermittent sinus arrest. The incidence of MAC was similar among these subgroups (93%, 83%, and 87%, respectively). Thus the present study confirms the strong association of MAC with symptomatic bradyarrhythmias.

Adult↗

Automated and nomographic analysis of exercise tests.

A study was conducted to evaluate the validity and usefulness of a commercially available microprocessor for automated exercise ECG analysis and to develop a nomogram for estimating the severity of coronary artery disease. Results of visual analysis, automated analysis, and coronary arteriography were correlated for the 107 patients studied. Automated analysis was shown to be valid and useful. The ST integrals (area of ST depression) recorded after exercise were superior to those recorded during exercise because they manifested higher specificity and predictive value, even though their sensitivity was slightly lower. Using postexercise integrals, it was possible to differentiate mild and severe disease. From multiple-regression analysis of ST integrals, duration of exercise, and the severity of coronary artery disease, a nomogram was derived to estimate severity of coronary artery disease.

Angiography↗

LDH isoenzymes and myocardial infarction in patients undergoing coronary bypass surgery: an excellent correlation.

To evaluate the efficacy of LDH isoenzymes in the detection of myocardial infarction in patients undergoing coronary bypass surgery, 73 patients were studied pre- and postoperatively by ECG, CPK, SGOT, total serum LDH, and LDH isoenzyme measurements. A reversal of the LDH1:LDH2 ratio was considered indicative of myocardial necrosis. Accordingly, the patients were separated into two groups: Group A (23 patients) who demonstrated an LDH1:LDH2 ratio exceeding 1.0 and Group B (50 patients) who failed to reveal an LDH1;LDH2 reversal. The two groups were similar in regard to preoperative evaluation and operative procedure performed. The postoperative ECG findings were significantly different. In Group A 18 of 23 patients (78 per cent) developed significant new Q waves. This occurred in only one patient in Group B. Significant arrhythmias occurred in 70 per cent of the patients in Group A as compared to 14 per cent of those patients in Group B. Severe congestive heart failure and/or clinical evidence of shock occurred in 39 per cent of Group A patients and in none in Group B. The results of our study indicate that the reversal of the LDH1:LDH2 ratio is a valuable tool for the evaluation of postoperative myocardial infarction.

Aspartate Aminotransferases↗

Hereditary progressive atrioventricular conduction defect.

New data on genetics, including an extensive pedigree and certain aspects of natural history, have been compiled on Family S, which is characterized by a hereditary progressive atrioventricular (A-V) conduction defect. Concordance analysis of heart block in affected parents and their offspring suggests as a working hypothesis transmission of diathesis for the defect by means of a Mendelian autosomal dominant factor. Regression of the defect in several relatives, including reversion from first degree heart block to normal A-V conduction, defies explanation at this time. However, rapport established with the unusually large (1,067 members) and cooperative kindred will permit longitudinal evaluation of these findings.

Adolescent↗

Significant sex differences in the correlation of electrocardiographic exercise testing and coronary arteriograms.

Two hundred fifty-one patients (195 male and 56 females) referred for evaluation of chest pain were studied by multistage submaximal stress testing and selective coronary arteriography. In men with positive exercise tests the incidence rate of true positive exercise test results--that is, positive tests associated with 75 percent of greater coronary stenosis--was 89 percent in contrast to a 33 percent incidence rate of true positive exercise test results in women. The incidence rate of false positive excercise test results--that is, positive tests associated with no coronary stenosis or less than 50 percent stenosis--was 8 percent in men in contrast to 67 percent in women. Conversely, the incidence rate of false negative exercise test results (that is, negative exercise tests associated with 75 percent or greater coronary stenosis) was higher in men (37 percent) than in women (12 percent). It is concluded that in men a positive multistage stress test is useful in predicting the presence of significant coronary artery disease although a negative stress test cannot be relied upon to rule out the presence of significant disease. In women, a positive exercise test is of little value in predicting the presence of significant coronary artery disease, whereas a negative test is quite useful in ruling out the presence of significant disease. New criteria should be developed for stress testing of women.

Adult↗

Atrial dissociation.

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Arrhythmias, Cardiac↗