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PubMed2007

A preliminary study of JM-27: a serum marker that can specifically identify men with symptomatic benign prostatic hyperplasia.

PURPOSE: Benign prostatic hyperplasia is a common disease in men that until recently was considered a single disease with varying symptoms. Our recent analysis has revealed that a molecular marker, JM-27, is able to distinguish at the tissue level between highly symptomatic individuals and those with histological disease. The goal of these studies was to determine if a serum based assay to detect JM-27 could distinguish men with different forms of benign prostatic hyperplasia. MATERIALS AND METHODS: A serum based enzyme-linked immunosorbent assay was developed using a novel anti-JM-27 monoclonal antibody. The assay was sensitive, detecting JM-27 at the low ng/ml level within the serum. A quantitative measurement of serum JM-27 levels was performed in 68 patients. The patients consisted of 3 groups of 29 patients with asymptomatic benign prostatic hyperplasia (American Urological Association symptom score of 15 or less), 39 with symptomatic benign prostatic hyperplasia (American Urological Association symptom score 16 to 32) and 17 with confirmed prostate cancer. The assay cutoff was determined after a pilot run of samples and applied prospectively. RESULTS: Using the determined cutoff, serum levels of JM-27 can distinguish between symptomatic and asymptomatic patient sets. The sensitivity and specificity of the assay are 90% and 77%, respectively. The presence of prostate cancer in these men does not appear to alter the marker levels. CONCLUSIONS: The present study is believed to represent the first characterization of a serum based marker for severe benign prostatic hyperplasia.

Antigens, Neoplasm↗
PubMed2005

Upper- vs lower-limb aerobic exercise rehabilitation in patients with symptomatic peripheral arterial disease: a randomized controlled trial.

OBJECTIVES: To investigate the effects of a 24-week program of upper- and lower-limb aerobic exercise training on walking performance in patients with symptomatic peripheral arterial disease (PAD) and to study the mechanisms that could influence symptomatic improvement. METHODS: After approval from the North Sheffield Local Research Ethics Committee, 104 patients (median age, 69 years; range, 50 to 85 years) with stable PAD were randomized into an upper- or lower-limb aerobic exercise training group (UL-Ex or LL-Ex), or to a nonexercise training control group. Training was performed twice weekly for 24 weeks at equivalent relative exercise intensities. An incremental arm- and leg-crank test (ACT and LCT) to maximum exercise tolerance was performed before and at 6, 12, 18, and 24 weeks of the intervention to determine peak oxygen consumption (VO(2)). Walking performance, defined as the claudicating distance (CD) and maximum walking distance (MWD) achieved before intolerable claudication pain, was assessed at the same time points by using a shuttle-walk protocol. Peak blood lactate concentration, Borg ratings of perceived exertion (RPE) and pain category ratio (CR-10) were recorded during all assessments. RESULTS: CD and MWD increased over time (P < .001) in both training groups. At 24 weeks, CD had improved by 51% and 57%, and MWD had improved by 29% and 31% (all P < .001) in the UL-Ex and LL-Ex groups, respectively. An increase in peak heart rate at MWD in the UL-Ex group (109 +/- 4 vs 115 +/- 4 beats/min; P < .01) and LL-Ex group (107 +/- 3 vs 118 +/- 3 beats/min; P = .01) was accompanied by an increase in the amount of pain experienced in both groups (P < .05), suggesting that exercising patients could tolerate a higher level of cardiovascular stress and an increased intensity of claudication pain before test termination after training. Patients assigned to exercise training also showed an increase in LCT peak VO2 at the 24-week time point in relation to baseline (P < .01) and control patients (P < .01), whereas ACT peak VO2 was only improved in the UL-Ex group (P < .05). CONCLUSIONS: Our results suggest that a combination of physiologic adaptations and improved exercise pain tolerance account for the improvement in walking performance achieved through upper-limb aerobic exercise training in patients with PAD. Furthermore, that both arm- and leg-crank training could be useful exercise training modalities for improving cardiovascular function, walking performance, and exercise pain tolerance in patients with symptomatic PAD.

Aged↗
PubMed2005

A comparison of symptomatic and asymptomatic office workers performing monotonous keyboard work--1: neck and shoulder muscle recruitment patterns.

Work-related neck and upper limb disorders (WRNULD) are common problems among office workers who use computers intensively and maintain prolonged static postures. These disorders have often been attributed to result from sustained muscle activity in the neck-shoulder musculature. The present study examined whether symptomatic subjects exhibited the same muscle activity patterns as asymptomatic controls when they performed a prolonged computer task under the same conditions. Surface electromyography (EMG) of four major neck-shoulder muscles were compared between a Case Group (n=23) and a Control Group (n=20) of female office workers. The Case Group had higher activity in the right upper trapezius (UT) while the Control Group had more symmetrical muscle activity between left and right UT. The Case subjects could also be differentiated into "High Discomfort" and "Low Discomfort" sub-groups based on their discomfort scores. The High Discomfort Group had significantly higher right UT activity compared to the Low Discomfort and Control Groups. Results suggested that symptomatic individuals had altered muscle recruitment patterns that persisted throughout the sustained occupational task, while discomfort increased with time-at-task. These findings indicate that altered muscle recruitment patterns observed in the symptomatic subjects preceded the onset of task discomfort, and this finding may have important implications for the etiology of WRNULD.

Adult↗
PubMed2005

Tibolone relieves climacteric symptoms in highly symptomatic women with at least seven hot flushes and sweats per day.

OBJECTIVE: To establish the potency of four dose levels of tibolone, a tissue selective estrogenic activity regulator (STEAR), to relieve climacteric symptoms in a subgroup of highly symptomatic women experiencing a minimum of seven hot flushes and sweats per day. METHODS: In a group of 770 women receiving tibolone 0.625, 1.25, 2.5 or 5.0 mg or placebo for 12 weeks, a total of 317 women experienced at least seven hot flushes and sweats per day. Frequency and intensity of climacteric symptoms were assessed at baseline and after 4, 8 and 12 weeks of treatment. Vaginal bleeding/spotting was studied using diary cards. Occurrence of adverse events was determined by active questioning. RESULTS: Tibolone induced a decrease in the frequency and intensity of climacteric symptoms, leading to statistically significant differences compared to placebo for dose levels of 1.25 mg and higher. The incidence of vaginal bleeding/spotting and of drug-related adverse events was similar in all tibolone dose groups, except for the 5.0 mg group, where the incidence was about twice as high. Dropout rate due to insufficient therapeutic effect is substantially higher in the 0.625 and 1.25 mg group (about 10%) compared to the 2.5 and 5.0 mg group (about 1%). These results are consistent with what occurred in the total study population published previously. CONCLUSION: The effects of tibolone in highly symptomatic women experiencing at least seven hot flushes and sweats per day do not differ much from that in the total study population. A daily dose of 2.5 mg is the optimal dose for both the total study population and the subgroup of highly symptomatic women. However, in order to optimise individual treatment, the 1.25 mg dose might also be taken into consideration.

Climacteric↗
PubMed2006

A depressed peripheral cellular immune response is related to symptomatic neurocysticercosis.

Human neurocysticercosis can cause mild or severe neurological symptoms or be completely asymptomatic. This heterogeneity may depend on host factors such as gender, age and immune-inflammatory response. The present study describes the specific peripheral immune response related to the different forms of neurocysticercosis in the adult population of both sexes. Asymptomatic cases (n = 26) mainly presented single calcified cysticerci in brain parenchyma or in the subarachnoid space of the sulci with a predominantly TH2 response (IL-4, IL-5, IL-13), high levels of IL-12 in supernatants of specifically stimulated peripheral blood mononuclear cells, and low plasma levels of all specific IgG subclasses. Symptomatic patients (n = 26) constituted a heterogeneous group, and had single or multiple cysticerci in vesicular, colloidal, calcified or mixed stages. This group showed parasites located in the subarachnoid space of the base and/or in the sulci, in the ventricular cavities, in parenchyma or in mixed locations. Symptomatic patients showed a depressed specific cellular immune response and increased levels of all specific IgG subclasses. This evidence supports the existence of two clear different immune profiles according to neurocysticercosis that is asymptomatic or symptomatic.

Adult↗
PubMed2005

Association between supine cerebral perfusion and symptomatic orthostatic hypotension.

The goal of this study was to investigate whether the supine resting perfusion of brain tissue in symptomatic patients suffering from orthostatic hypotension (OH) is changed compared to control subjects and whether an association exists between the resting perfusion and the severity of OH. Ten symptomatic OH patients and 8 control subjects were included in this study. One patient was retrospectively excluded because he suffered from multiple system atrophy. Systolic and diastolic blood pressure changes were measured during a tilting bed procedure. Cerebral blood flow, cerebral blood volume and mean transit time were determined by bolus-tracking perfusion MRI and correlated with blood pressure changes. Cerebral blood volume was significantly increased in OH patients compared with control subjects for white matter (P = 0.019) and the mean transit time was significantly increased for gray (P = 0.010) and white matter (P = 0.015). The cerebral blood flow of the gray (r = 0.74, P = 0.022) and white matter (r = 0.75, P = 0.020) was significantly, positively correlated with systolic blood pressure changes. The mean transit time in white matter was significantly, negatively correlated with systolic blood pressure changes (r = -0.68, P = 0.045). This study suggests that in symptomatic patients with OH the cerebral perfusion of the brain in the resting, supine position correlates with the severity of OH as measured by postural changes in blood pressure.

Aged↗
PubMed2004

Visual field loss from primary angle-closure glaucoma: a comparative study of symptomatic and asymptomatic disease.

PURPOSE: To assess the degree of visual field (VF) loss in subjects diagnosed with primary angle-closure glaucoma (PACG), and to compare the severity of such loss between those with symptomatic and asymptomatic disease. DESIGN: Observational case series. PARTICIPANTS: Seventy-six consecutive subjects with PACG who presented at a Singapore hospital. METHODS: Primary angle-closure glaucoma was defined as the presence of glaucomatous optic neuropathy and compatible VF loss associated with closed angles. There were 2 groups of subjects studied: group A consisted of those who presented with acute symptomatic angle closure, and group B consisted of those who were asymptomatic. Subjects underwent static automated threshold perimetry, and the first reliable VF was analyzed using the Advanced Glaucoma Intervention Study (AGIS) scoring system. The field tests were graded according to severity as mild, moderate, severe, and end-stage VF defects, based on AGIS scores of 0 to 5, 6 to 11, 12 to 17, and 18 to 20 respectively. MAIN OUTCOME MEASURES: Advanced Glaucoma Intervention Study scores of the first reliable threshold VF test. RESULTS: The mean age of study subjects was 61.4+/-9.6 years (range: 33-84), and the majority of subjects were female (59%) and Chinese (91%). In group A (n = 40), most eyes had mild or moderate VF defects (23 eyes [57.5%]), whereas 7 eyes (17.5%) had end-stage defects. This was in contrast to group B (n = 36), in which the majority of eyes had end-stage VF loss (19 eyes [52.8%]), with only 5 eyes (13.7%) having mild VF defects. Mean AGIS scores were 9.1+/-7.6 for group A and 14.2+/-6.9 for group B (P = 0.004). Cup-to-disc ratio was a significant predictor for VF loss, but age, gender, and level of presenting intraocular pressure were not correlated with VF outcome. CONCLUSIONS: Eyes with asymptomatic PACG often present with severe to end-stage VF loss at the time of first presentation to hospital. In contrast, most PACG eyes with previous symptomatic angle closure present with mild or moderate VF defects. The visual morbidity of PACG may be related to the finding that the asymptomatic form of the disease is visually destructive.

Acute Disease↗
PubMed2005

Measuring ADHD behaviors in children with symptomatic accommodative dysfunction or convergence insufficiency: a preliminary study.

BACKGROUND: Accommodative dysfunction and convergence insufficiency (CI) are common pediatric vision problems that have been associated with an increase in frequency and severity of vision-specific symptoms that affect children when doing schoolwork. However, the relationship between accommodative dysfunction and CI and other learning problems, such as attention deficit hyperactivity disorder (ADHD), are not well understood. The purpose of this study was to evaluate the frequency of ADHD behaviors in school-aged children with symptomatic accommodative dysfunction or CI. METHODS: Children 8 to 15 years of age with symptomatic accommodative dysfunction or CI were recruited from the teaching clinic at the Southern California College of Optometry. Children with learning disabilities or ADHD were excluded. One parent of each child completed the Conners Parent Rating Scale-Revised Short Form (CPRS-R:S). The children's scores on the CPRS-R:S were compared with the normative sample. RESULTS: Twenty-four children (9 boys and 15 girls) participated in the study with a mean age of 10.93 years (SD = 1.75). On the CPRS-R:S, cognitive problem/inattention, hyperactivity, and ADHD index were significantly different from normative values (p < or = .001 for all tests). CONCLUSIONS: The results from this preliminary study suggest that school-aged children with symptomatic accommodative dysfunction or CI have a higher frequency of behaviors related to school performance and attention as measured by the CPRS-R:S.

Accommodation, Ocular↗
PubMedDate not supplied

Incidence of symptomatic gallstones after gastric bypass: is prophylactic treatment really necessary?

BACKGROUND: Because rapid weight loss after bariatric surgery increases gallstone formation, a 6-month treatment regimen with ursodiol has been recommended. Even prophylactic cholecystectomy at the time of gastric bypass in the absence of stones has been proposed. However, the incidence of symptomatic gallstones requiring cholecystectomy in untreated patients after gastric bypass has not yet been established. METHODS: The patients in our study were not treated with ursodiol after open Roux-en-Y gastric bypass. Additional inclusion criteria were no palpable gallstones at bypass, at least 16 months of follow-up after bypass, and continuous coverage by the same health insurance plan extending from the time of the operation to study completion, to track subsequent cholecystectomies by claims paid. RESULTS: A total of 100 females and 25 males met the study inclusion criteria. Follow-up extended from 16 to 48 months. Symptomatic gallstones requiring cholecystectomy developed in 10 patients, all females. Laparoscopic cholecystectomy was performed in 9 of these patients and open cholecystectomy was performed in the remaining patient, between 3 and 21 months after bypass. There were no serious complications from the stones or the cholecystectomy. CONCLUSIONS: Prophylactic cholecystectomy would have been unnecessary in 115 of the 125 patients in the study group. A 6-month course of ursodiol for all 125 patients, at a cost of 56,250 dollars, would have had to decrease the number of cholecystectomies from 10 to 3 to demonstrate a treatment effect (P < .05). Therefore, most newly formed gallstones after gastric bypass are likely asymptomatic, prophylactic cholecystectomy is not indicated, and ursodiol therapy may be better reserved for symptomatic patients who refuse surgery.

Adult↗
PubMed2005

Technique for removal of symptomatic bone anchors placed during stress incontinence surgery.

INTRODUCTION: To present an uncomplicated, reliable technique for bone anchor removal in patients with anchor-related infections or chronic pain. TECHNICAL CONSIDERATIONS: We removed 17 anchors from 9 patients between 1999 and 2004. The surgical technique used fluoroscopy for localization of the anchors and an orthopedic broken screw removal instrument for resection of the anchor and surrounding bone. Nine patients with bone anchors had been symptomatic with chronic pain and/or wound drainage for a mean of 23.7 months before surgery. After removal, 10 anchors grew positive bacterial cultures. The most common organism was coagulase-negative Staphylococcus. During a mean follow-up period of 6.8 months after hardware removal, 8 of the 9 patients had symptomatic improvement. CONCLUSIONS: Fluoroscopic localization and en bloc resection with a broken screw removal instrument is an effective method of removing symptomatic bone anchors.

Adult↗
PubMed2005

Relative proportions of tissue components in the prostate: are they related to the development of symptomatic BPH in Korean men?

OBJECTIVES: To investigate the high prevalence of lower urinary tract symptoms in Korean men with a small prostate, we studied the proportions of histologic components of prostatic adenoma in patients with symptomatic benign prostatic hyperplasia. METHODS: Prostatic adenoma specimens were obtained from men with symptomatic benign prostatic hyperplasia who underwent open prostatectomy or transurethral resection of the prostate. Patients were divided into three groups according to the prostate volume as measured by preoperative transrectal ultrasonography (group 1, 20 to 40 cm3, 21 men; group 2, 41 to 80 cm3, 22 men; and group 3, greater than 80 cm3, 23 men). The age distribution and the severity of symptoms were comparable in these three groups (P > 0.05). The proportion of the stroma in the prostatic adenoma and the proportions of smooth muscle, collagen types I, II, III, and V, fibronectin, and laminin in stromal tissue were determined using automatic image analyzer quantitatively. RESULTS: The proportions of the stroma in the prostatic adenoma specimens of groups 1 and 2 were significantly greater than in group 3 (P < 0.05). The proportions of smooth muscle, collagen types I, III, and V, fibronectin, and laminin were not significantly different in the three groups (P > 0.05). The relative smooth muscle proportion in the prostatic adenoma (proportion of stroma x proportion of smooth muscle in stromal tissue) in groups 1 and 2 was significantly greater than in group 3 (P < 0.05). CONCLUSIONS: These results suggest that the dynamic component of bladder outlet obstruction, which is mediated by smooth muscle tone, may play a more important role in the development of symptomatic benign prostatic hyperplasia in Korean men.

Aged↗
PubMed2006

A comparative study of the incidence of aseptic meningitis in symptomatic natural mumps patients and monovalent mumps vaccine recipients in Japan.

To compare the incidence of aseptic meningitis associated with symptomatic natural mumps infection and in mumps vaccine recipients, we conducted a prospective comparative study. Consecutive samples of 1051 children with mumps were enrolled by 10 pediatricians and 21,465 vaccine recipients by 143 pediatric primary care practitioners, from January 1, 2000 to January 1, 2003. Parents used a daily diary to record symptoms during the period of illness (15 days) or 30-day period following immunization. Mumps infection was confirmed by virus isolation and/or detection of mumps virus genome in salivary and CSF samples. The incidence of aseptic meningitis was 13/1051 (1.24%) in patients with symptomatic natural mumps infection and was estimated to be 0.7-1.1% of overall infection in considering asymptomatic infection, and 10/21,465 (0.05%) in vaccine recipients. Although aseptic meningitis is a clear side effect of the mumps vaccine, the incidence is considerably lower than among those with symptomatic natural infection. Our results provide an informative data for consideration to resume mumps vaccine as a part of routine immunization schedule for Japanese children.

Adolescent↗
PubMed2005

Transfusion utilization during adnexal or peritoneal cancer surgery: effects on symptomatic venous thromboembolism and survival.

OBJECTIVE: To determine whether perioperative packed red blood cell (PRBC) and fresh frozen plasma (FFP) transfusions during ovarian, tubal, or peritoneal cancer surgery increase the risk of symptomatic postoperative venous thromboembolism (VTE) and adversely affect overall survival. METHODS: We conducted a retrospective review of all cases of surgical exploration for resection of stage IIIC-IV adnexal/peritoneal cancer between November 1998 and May 2002 at Memorial Sloan-Kettering Cancer Center. Patients with a history of prior or active preoperative VTE were excluded. Routine intraoperative and postoperative VTE prophylaxis including lower extremity external pneumatic compression with or without postoperative subcutaneous heparin was utilized in all cases. Symptomatic postoperative VTE was diagnosed by lower extremity Doppler or computerized tomography (excluding cases with only ovarian vein thrombosis). Clinical parameters were examined by a logistic regression analysis to identify independent prognostic predictors of postoperative symptomatic VTE, which occurred within 30 days of surgery. Survival was calculated using the Kaplan-Meier method. RESULTS: In all, 174 patients underwent exploratory surgery, and 6 (3.4%) were excluded due to active or prior history of VTE. Of the remaining 168 patients, 71 (42%) received at least one perioperative transfusion of PRBC or FFP. Postoperative VTE was documented in 5 of 46 (11%) patients who received a postoperative transfusion compared to 3 of 122 (2.5%) patients who did not (P = 0.04; odds ratio, 4.8); moreover, VTE was noted in 3:16 (19%) patients who received postoperative FFP compared to 5:152 (3.3%) patients who did not (P = 0.01, odds ratio of 6.78). Age, stage, body mass index, length of the operation, blood loss, presence of ascites, volume of ascites, residual disease status, preoperative hemoglobin level and coagulation profile were not associated with increased risk for VTE. When survival results were stratified by transfusion utilization and controlling for optimal debulking status, perioperative transfusions had no apparent effect on overall survival. CONCLUSION: In women with stage IIIC-V disease, postoperative blood product transfusions particularly FFP were associated with increased risk of DVT and PE, but transfusions had no impact on overall survival.

Adult↗
PubMed1998

Coronary calcium and standard risk factors in symptomatic patients referred for coronary angiography.

OBJECTIVES: The purpose of this study was to compare quantitative estimates of coronary calcification with traditional coronary risk factors to determine their independent predictive power for the diagnosis of obstructive angiographic coronary artery disease in symptomatic patients. METHODS: Three hundred sixty-eight symptomatic patients underwent coronary angiography and electron beam computed tomography at four different centers between April 1989 and December 1993. A blinded cardiologist interpreted the electron beam computed tomograms. Coronary risk factors were obtained in all 368 patients. Both bivariate and multivariate analyses were used to investigate the relation between risk factors and angiographic disease. RESULTS: One hundred fifty-eight patients (43%) had angiographically obstructive coronary artery disease (>50% luminal stenosis) and 297 (81%) had coronary calcification. At the bivariate level, only male sex and log-transformed coronary calcification were predictive of angiographic disease (p = 0.008, p = 0.001). By multivariate analysis, only male sex and coronary calcification were predictive (p = 0.001, p = 0.001). Sixty-four of the 71 patients without coronary calcification did not have disease, yielding a negative predictive value of 90%. Receiver operating characteristic curve analysis showed that the amount of coronary calcium was a significantly better discriminator of disease than were the other risk factors. CONCLUSIONS: Coronary calcification is a stronger predictor of angiographic coronary artery disease in symptomatic patients undergoing angiography than are standard risk factors.

Aged↗
PubMed2003

Prognostic value of exercise cardiac tomography performed late after percutaneous coronary intervention in symptomatic and symptom-free patients.

The long-term prognostic value of single-photon emission computed tomography (SPECT) performed late after percutaneous coronary intervention (PCI) has not been extensively evaluated. Moreover, the role of myocardial ischemia at SPECT in symptom-free patients after PCI is not clear. This study was designed to determine the long-term prognostic value of SPECT in predicting cardiac events after PCI in symptomatic and symptom-free patients. Exercise technetium-99m sestamibi SPECT was performed in 206 patients between 12 and 18 months after PCI. All patients were followed for a mean period of 37 +/- 16 months. Cardiac death, nonfatal myocardial infarction, and late revascularization procedures were considered to be events. Myocardial ischemia at SPECT was detectable in 44 patients. During follow-up, 24 patients experienced events (cardiac death in 4 patients, myocardial infarction in 10, and late revascularization in 10). At univariate analysis, the summed stress score (p <0.05) and summed difference score (p <0.001) were significant predictors of cardiac events. Event-free survival curves showed a higher event rate in patients with than without ischemia (p <0.001). The occurrence of cardiac events was higher in the presence of ischemia at SPECT in symptomatic and symptom-free patients (both p <0.001). The results of this study demonstrate that the extent and severity of myocardial ischemia at exercise SPECT performed between 12 and 18 months after PCI predicts cardiac events during long-term follow-up in symptomatic and symptom-free patients.

Angioplasty, Balloon, Coronary↗
PubMed1983

Intravenous amiodarone in the acute treatment of recurrent symptomatic ventricular tachycardia.

Fifteen patients aged 59.3 +/- 11.5 years (mean +/- standard deviation [SD]) had recurrent symptomatic ventricular tachycardia (VT) refractory to at least 2 conventional antiarrhythmic drugs. All patients had organic heart disease; 4 had an acute myocardial infarction. The mean ejection fraction was 0.30 +/- 0.09. TWelve patients had overt congestive heart failure. Five had bundle branch block. Before treatment with intravenous amiodarone, the patients had had 6 to 40 episodes of symptomatic VT over 1 to 8 days of hospitalization. All patients received an initial bolus of 5 mg of amiodarone/kg over 15 minutes. Seven patients also received a continuous infusion of 600 to 1,000 mg of amiodarone over 12 to 24 hours. Additional doses depended on the patients' clinical responses. In 11 of 15 patients, antiarrhythmic drugs that had failed to suppress VT were continued during administration of amiodarone. In 12 of 15 patients acute control of VT was obtained with intravenous administration of amiodarone either alone or in combination with previously ineffective drugs. Three patients continued to have frequent episodes of VT while being treated with intravenous amiodarone. Mobitz type I atrioventricular block developed in 1 patient. No patient had high degree atrioventricular block, symptomatic hypotension, or a clinically apparent worsening of congestive heart failure. The use of intravenous amiodarone represents a significant advance in the acute treatment of frequent life-threatening VT refractory to other drugs. With appropriate monitoring, it can be used safely in patients with congestive heart failure, bundle branch block, or acute myocardial infarction.

Adult↗
PubMed1986

Prognostic usefulness of programmed ventricular stimulation in idiopathic dilated cardiomyopathy without symptomatic ventricular arrhythmias.

Twenty-four patients, mean age 42 years, with idiopathic dilated cardiomyopathy (DC) and no history of symptomatic ventricular arrhythmias underwent right ventricular programmed stimulation with up to 3 extrastimuli. Ventricular tachycardia (VT) was induced in 8 patients and ventricular fibrillation (VF) in 2. The VT was unimorphic in 2 and polymorphic in 6. No significant differences were noted between patients in whom arrhythmias were inducible and and those in whom they were not with regard to age, symptomatic class, arrhythmia severity or hemodynamic indexes. Over a mean follow-up of 12 months, 4 patients died, 3 suddenly and 1 with progressive heart failure. Only 1 of the 3 who died suddenly had inducible VT. One other patient with induced sustained unimorphic VT later presented with spontaneous sustained VT similar in rate and configuration to induced VT. In conclusion, VT or VF may be induced in approximately 40% of patients with DC and no history of symptomatic VT or VF. Inducibility of polymorphic VT or VF does not correlate with clinical or hemodynamic variables or with the risk of sudden death. However, induction of unimorphic VT may predict later occurrence of spontaneous unimorphic VT.

Adult↗
PubMed1997

Relation of coronary calcium score by electron beam computed tomography to arteriographic findings in asymptomatic and symptomatic adults.

Coronary arteriography was performed on 18 asymptomatic, apparently healthy adults with elevated coronary calcium scores. To extend the range of observation to subjects with low calcium scores, arteriograms from 18 patients with exertional dyspnea and/or valvular heart disease and low calcium scores were also analyzed; these 18 patients were considered asymptomatic from the point of view of coronary artery disease (CAD). For the comparison of symptomatic and asymptomatic persons, 3 age and sex-matched symptomatic patients were also selected for each of the original 18 asymptomatic subjects. Arteriograms were analyzed by computer-assisted quantitative coronary arteriography at a remote site without knowledge of the calcium score or any other patient characteristics. In the 18 asymptomatic subjects with elevated calcium scores, the mean calcium score was 573 +/- 504 (Agatston method) and the mean worst stenosis was 45% +/- 16%. For all 36 patients without symptoms of CAD, worst stenosis was closely correlated with the square root of the calcium score (r = 0.85, p <0.0001). Patients with symptomatic coronary disease and calcium scores < 1,000 had stenoses more severe than asymptomatic persons with similar calcium scores. Most asymptomatic adults with elevated calcium scores have nontrivial, nonobstructive CAD or preclinical obstructive CAD, and the relation between coronary calcium score and severity of stenosis is highly significant. These data indicate that electron beam tomography can be used to estimate the severity of CAD in asymptomatic persons.

Adult↗