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Biomedical subjects

V S Behar

Publications and source records attributed to V S Behar.

At least 37 records · Page 2Linked to original sources
PubMed1983

Outcome in one-vessel coronary artery disease.

We analyzed the clinical outcomes in 688 patients with isolated stenosis of one major coronary artery. The survival rate among patients with disease of the right coronary artery (RCA) was higher than that among patients with left anterior descending (LAD) or left circumflex coronary artery (LCA) disease. The survival rate among patients in all three anatomic subgroups exceeded 90% at 5 years. The presence of a lesion proximal to the first septal perforator of the LAD was associated with decreased survival compared with the presence of a more distal lesion. For the entire group of one-vessel disease patients, total ischemic events (death and nonfatal infarction) occurred at similar rates regardless of the anatomic location of the lesion. Left ventricular ejection fraction was the baseline descriptor most strongly associated with survival, and the characteristics of the angina had the strongest relationship with nonfatal myocardial infarction. No differences in survival or total cardiac event rates were found with surgical or nonsurgical therapy. The relief of angina was superior with surgical therapy, although the majority of nonsurgically treated patients had significant relief of angina. The survival rate of patients with one-vessel coronary disease is excellent, and the risk of nonfatal infarction is low. Clinical strategies for the care of these patients must consider the long-term clinical course of one-vessel coronary disease.

Angina Pectoris↗
PubMed1983

Functional improvement of jeopardized myocardium following intracoronary streptokinase infusion in acute myocardial infarction.

The effect of reperfusion on regional left ventricular performance following acute myocardial infarction in man was determined. Intracoronary streptokinase was administered in 24 patients within 6 h of the onset of symptoms. 15 patients (62%) were successfully recanalized during the initial study. Mean percent radial shortening (%RS) in both the jeopardized and compensatory regions were determined using 23 radii from the centroid of diastolic and systolic angiographic silhouettes. Sequential measurements were obtained during repeat cardiac catheterization studies at 24 h in 19 patients and before discharge from the hospital (16 +/- 11 d) in 15 patients. At the time of the predischarge study, each acutely reperfused patient showed improvement in %RS in the jeopardized region (P = 0.01) with 56% returning to the normal range. Despite the uniform improvement in the contractile function of the jeopardized region in each reperfused patient, the global ejection fraction showed no improvement or a decrease at the time of the chronic study in 44%. This was due to a decrease in the compensatory wall motion in the uninvolved segments between the acute and chronic study in each case. Neither the %RS nor the ejection fraction changed significantly at the time of the chronic study in the patients who could not be acutely recanalized. These data indicate (a) significant salvage of jeopardized myocardium associated with recovery of contractile function in patients reperfused during the first 6 h of chest pain following acute myocardial infarction; (b) no improvement in regional or global left ventricular performance in patients who could not be reperfused acutely; and (c) the ejection fraction is strongly influenced by changes in the compensatory wall motion of the uninvolved segments and does not accurately reflect changes in the contractile function of the jeopardized myocardium.

Adult↗
PubMed1982

Aneurysm of a saphenous vein bypass graft associated with aneurysms of native coronary arteries.

Aneurysm formation in saphenous vein aortocoronary bypass grafts is an extremely rare complication of coronary artery bypass surgery. Aneurysms of native coronary arteries are found in a small percentage of patients at autopsy. Reported is a case with multiple coronary artery aneurysms in which a dissecting aneurysm of the saphenous vein bypass graft also developed following coronary artery bypass surgery. This is the first report of such association.

Aneurysm↗
PubMed1982

Prognostic implications of ventricular arrhythmias during 24 hour ambulatory monitoring in patients undergoing cardiac catheterization for coronary artery disease.

The prognostic importance of ventricular arrhythmias detected during 24 hour ambulatory monitoring was evaluated in 395 patients with and 260 patients without significant coronary artery disease. Ventricular arrhythmias were found to be strongly related to abnormal left ventricular function. A modification of the Lown grading system (ventricular arrhythmia score) was the most useful scheme for classifying ventricular arrhythmias according to prognostic importance. When only noninvasive characteristics were considered, the score contributed independent prognostic information, and the complexity of ventricular arrhythmias as measured by this score was inversely related to survival. However, when invasive measurements were included, the ventricular arrhythmia score did not contribute independent prognostic information. Furthermore, ejection fraction was more useful than the ventricular arrhythmia score in identifying patients at high risk of sudden death.

Adrenergic beta-Antagonists↗
PubMed1980

The diagnostic and prognostic significance of coronary artery calcification. A report of 800 cases.

The significance of coronary artery calcification was assessed in 800 patients who underwent cardiac fluoroscopy and selective coronary cineangiography. Calcification was shown by fluoroscopy in 250, of whom 236 (94%) had greater than or equal to 75% stenosis of one or more major coronary arteries at angiography. Among patients with significant coronary artery disease, 40% (236/585) had calcification. Patients with calcification demonstrated poorer survival at all follow-up intervals (from six months to five years); the five-year survival rate was 87% for patients without calcification, compared to 58% for those with calcification. The prognostic significance of coronary artery calcification appears to be independent of information obtained by cardiac catheterization and angiocardiography.

Calcinosis↗
PubMed1980

Outcome in medically treated coronary artery disease. Ischemic events: nonfatal infarction and death.

In this study we extended the characterization of outcome in 1214 medically treated patients with coronary disease by considering nonfatal infarction and death together as ischemic events. At 7 years, the cumulative event rate was 47% (18% for nonfatal infarction as the initial event and 29% for death as the initial event). In multivariable analysis of 81 baseline descriptors, 11 (six clinical and five catheterization) were independent predictors of events. Progressive chest pain, number of diseased vessels, left main stenosis and left ventricular (LV) function were the most important predictors. Progrressive pain was a more important predictor of total events than of survival alone. In patients with one-, two- or three-vessel disease and normal LV function, nonfatal infarcation accounted for at least 50% of initial events. In patients with left main disease or severe LV dysfunction, death was the predominant event. These results have important implications for interpreting the natural history of coronary artery disease.

Adrenergic beta-Antagonists↗
PubMed1979

Left bundle branch block: angiographic segmental wall motion abnormalities.

Ventricular wall motion as studied with contrast ventriculography has been judged normal in the few previously reported cases of patients with left bundle branch block who have neither coronary artery disease nor diffuse cardiomyopathy. However, recent echocardiographic studies have demonstrated a high frequency of segmental asynergy of the septal wall in such patients. In this study left ventricular wall motion was analyzed in 15 patients with left bundle branch block and without significant coronary artery disease or diffuse cardiomyopathy. Biplane cineangiograms from these patients were compared with those from 100 consecutive patients with normal intraventricular conduction and without coronary artery disease or cardiomyopathy using two techniques: qualitative visual inspection and a computer-assisted quantitative method. By qualitative review, 6 of 15 patients with left bundle branch block had regional akinesia or dyskinesia as compared with none of 100 patients with normal intraventricular conduction (chi square = 42.3; P less than 0.001). By quantitative review, 10 of 12 patients with left bundle branch block had abnormal wall motion along at least one hemiaxis. It is concluded that angiographic regional wall motion abnormalities are common in patients with left bundle branch block, even in the absence of coronary artery disease or diffuse cardiomyopathy. The abnormalities may result from the abnormal sequence of ventricular activation rather than from myocardial fibrosis.

Adult↗
PubMed1979

Detection and exclusion of interatrial shunts by two-dimensional echocardiography and peripheral venous injection.

Two-dimensional echocardiography (2-D echo) was used with peripherally injected contrast material to detect interatrial shunts in 33 patients. Group 1 consisted of 11 patients having classic clinical findings of atrial septal defect. Group 2 consisted of 12 patients with problems requiring that atrial shunting be excluded. Group 3 (control group) consisted of 10 patients undergoing cardiac catheterization for chest pain. Confirmation of the 2-D echo findings was provided by cardiac catheterization in 32 patients and postmortem examination in one. Right-to-left atrial shunts were detected in all 11 patients in group 1, although seven had no right-to-left shunt calculable by oximetry. Four patients in Group 2 had right-to-left atrial shunts. None of the patients in Group 3 had atrial shunts. In the 15 patients with atrial shunts, the degree of right-to-left shunting could be qualitatively assessed as small, moderate, or large. There were no false-negative or false-positive results by contrast 2-D echo.

Adolescent↗
PubMed1978

Detection of tricuspid regurgitation with two-dimensional echocardiography and peripheral vein injections.

"Contrast echocardiography", utilizing a two-dimensional ultrasound system and peripheral venous injections, was used for the detection of tricuspid regurgitation in 30 patients. The appearance of contrast in the inferior vena cava and the back and forth movement of contrast across the tricuspid valve were considered evidence for tricuspid regurgitation. Echocardiographic findings were correlated with clinical and angiographic data. Patients were assigned on the basis of clinical data to one of three groups. Group I included five patients whose clinical findings were diagnostic for tricuspid regurgitation. Group II included patients (15) whose clinical findings were equivocal for tricuspid regurgitation and patients whose recognized primary problem is frequently associated with tricuspid regurgitation. Group III contained ten patients serving as controls. All group I patients had positive echocardiographic studies for tricuspid regurgitation, while all group III patients had negative studies, suggesting that this technique may be specific for tricuspid regurgitation. Among the group II patients were three who had positive echocardiographic studies despite the absence of specific clinical findings of tricuspid regurgitation, suggesting that this technique may be more sensitive than the methods in common use.

Adult↗
PubMed1978

The role of the exercise test in the evaluation of patients for ischemic heart disease.

A cohort of 1472 patients who underwent both exercise stress testing and coronary angiography within six weeks was examined. The data indicated that a combination of exercise parameters is both diagnostically and prognostically important. Almost all patients (greater than 97%) who had positive exercise tests at Stage I or Stage II had significant coronary artery disease. More than half of these (greater than 60%) had three vessel disease and over 25% had significant narrowing (greater than 50%) of the left main coronary artery. Patients who achieved Stage IV or greater exercise durations with either negative or indeterminate ST-segment response had less than a 15% prevalence of three vessel disease and less than a 1% prevalence of left main coronary artery disease. A low risk subgroup (75% of all non-operated patients) was identified with a twelve month survival greater than 99%. A high risk subgroup (11% of all nonoperated patients) was identified with a twelve month survival of less than 85%. The exercise test is a noninvasive, reproducible method to assess the presence and extent of anatomic disease and the prognosis when significant disease has been defined. It should be used in conjunction with other noninvasive tests to determine optimal management in patients evaluated for ischemic heart disease.

Angiocardiography↗
PubMed1978

Relationships among ventricular arrhythmias, coronary artery disease, and angiographic and electrocardiographic indicators of myocardial fibrosis.

This study was performed to determine the relationships among angiographic, hemodynamic, clinical, and electrocardiographic data and premature ventricular contractions (PVCs). Arrhythmias were analyzed by 24 hour Holter monitor in 244 patients evaluated for chest pain by coronary angiography and left ventriculography. Using a categorical linear model, the presence of myocardial fibrosis as indicated by both abnormal left ventricular contraction (LVC) and abnormal initial QRS on electrocardiogram was found to be the only independent predictor of both frequent and complex ventricular arrhythmias (P less than .0001). All other descriptors, including the number of diseased vessels (greater than or equal to 75% obstruction), were dependent upon abnormal LVC in their association with PVCs. When the right anterior oblique view of the left ventriculogram was divided into nine segments to allow automated quantiative analysis of LVC, the prevalence of frequent PVCs was directly related to the number of abnormally contracting segments. Of patients with 0 abnormal segments, 11% had greater than or equal to 2 PVC/hr, in contrast to 44%, 73% and 100% of patients with 1-3, 4-6, and 7-9 abnormal wall segments, respectively (P less than 0.01). A similar quantitative relationship was found between premature ventricular contractions and abnormal initial forces indicating previous myocardial infarction on the electrocardiogram.

Adult↗
PubMed1977

A comparison of real-time, two dimensional echocardiography and cineangiography in detecting left ventricular asynergy.

Left ventricular wall motion was assessed in 105 consecutive patients both invasively, using biplane cineangiography, and noninvasively, by a real-time, phased-array, two-dimensional echocardiography system. Ventricular wall motion in five anatomic areas of the ventricle (anterolateral, posterolateral, apical, septal, and inferior) was analyzed by both methods in a double-blind manner. Two-dimensional echocardiographic images were deemed adequate for analysis in 82% of the regions (430 of 525). Fifty-five discrepancies were noted in the comparison of the remaining 430 regions. The reasons for discrepancies in interpretation between the two methods were established for 54 during retrospective review: 33 were due to echocardiography (inadequate target visualization, observer error, or tangential echo views). Fifteen were related to angiography (overlay of silhouettes or observer error), and six were due to other reasons including definition problems or spatial orientation difficulties. Both real-time, two-dimensional echocardiography and cineangiography have advantages and disadvantages. The techniques used together could provide more complete information concerning ventricular wall movement than is now currently available.

Cineangiography↗
PubMed1977

Two-dimensional echocardiographic findings in atrial septal defect.

Two-dimensional echocardiographic findings in a group of 24 patients with atrial septal defects were correlated with findings obtained by cardiac catheterization and M-mode echocardiography. The prevalence of mitral prolapse was 95% by two-dimensional echocardiography and 59% by angiography in patients with secundum and sinus venosus atrial septal defects. The majority of the group with echocardiographic prolapse manifested a distinctive pattern of prolapse, with predominant involvement of the anterior mitral leaflet. Thirty-eight percent of the patients in this series manifested paradoxical septal motion by M-mode and/or two-dimensional echocardiography. In the patients with abnormal septal motion, the net systolic anterior movement of the septum was caused by an exaggerated systolic anterior movement of the main body of the left ventricle. The atrial septal defect could be visualized with confidence by two-dimensional echocardiography only in the two patients with ostium primum atrial septal defects. Cleft anterior mitral leaflets were also clearly demonstrated in these two patients.

Adolescent↗
PubMed1976

Aortocoronary bypass surgery: Correlation of angiographic symptomatic and functional improvement at 1 year.

Angiographic changes in the coronary circulation were evaluated in 60 patients 1 year after aortocoronary bypass surgery, and their relation to the postoperative clinical status was examined. Of 124 grafts implanted, 26 were closed, 7 stenotic and 91 (74 percent) patent at 1 year. Progression of occlusive disease occurred in 21 of 57 (37 percent) nongrafted and 78 of 123 (63 percent) grafted vessels. On the basis of location and severity of progression, significant lesions bypassed and patency of grafts, postoperative coronary perfusion was considered optimal in 16 patients (Group I), better in 24 (Group III). Complete freedom from chest pain or lessening of pain (improvement by two New York Heart Association functional classes) occurred in 88 and 79 percent of patients in Group III. Positive preoperative treadmill stress tests became negative after surgery in five of six patients in Group I, five of eight in Grojp II and three of eight in Group III. This study demonstrates that when progression of disease, graft patency and extent of revasculariztion are considered in combination, the postoperative angiographic status of the coronary circulation correlates well with clinical improvement at 1 year. These findings support the hypothesis that improved blood supply to ischemic myocardium is a major factor contributing to relief of angina pectoris after saphenous vein bypass surgery.

Coronary Artery Bypass↗