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PubMed1995

Preventive cardiology and its potential influence on the early natural history of adult heart diseases: the Bogalusa Heart Study and the Heart Smart Program.

Observations from pediatric epidemiology studies over the past 20 years document that atherosclerosis and essential hypertension begin in childhood. Evidence of coronary artery disease and hypertensive cardiovascular renal disease is found and relates strongly to clinical cardiovascular risk factors. Obesity, especially central obesity, and hyperinsulinemia are commonly found, and these cluster with other risk factors. Lifestyles, such as poor eating behavior and tobacco usage, also begin early and influence cardiovascular risk. The implication from these pediatric observations is that intervention should begin early to prevent unhealthy lifestyles and encourage adoption of healthy behaviors. Where adult heart diseases pervade the major part of the United States population and other industrialized cultures, various epidemiologic strategies of prevention are needed. A high-risk, clinical approach can be applied to individuals with heart disease or to individuals with underlying risk factors and their families. Primary and secondary prevention are both important and should be implemented by primary care physicians. A population approach is also needed because of the widespread occurrence of heart disease. A public health approach to prevention can occur through health education and health promotion programs. Physicians should play a role in encouraging prevention for the general population. The future direction of Preventive Cardiology for our nation rests on educating children to adopt and maintain healthy lifestyles. The Bogalusa Heart Study has made a major contribution in providing the background information for that direction.

Adult↗
PubMed2006

Pulmonary arterial hypertension in adults born with a heart septal defect: the Euro Heart Survey on adult congenital heart disease.

AIM: To investigate the role of pulmonary arterial hypertension (PAH) in adult patients born with a cardiac septal defect, by assessing its prevalence and its relation with patient characteristics and outcome. METHODS AND RESULTS: From the database of the Euro Heart Survey on adult congenital heart disease (a retrospective cohort study with a 5-year follow-up), the relevant data on all 1877 patients with an atrial septal defect (ASD), a ventricular septal defect (VSD), or a cyanotic defect were analysed. Most patients (83%) attended a specialised centre. There were 896 patients with an ASD (377 closed, 504 open without and 15 with Eisenmenger's syndrome), 710 with a VSD (275, 352 and 83, respectively), 133 with Eisenmenger's syndrome owing to another defect and 138 remaining patients with cyanosis. PAH was present in 531 (28%) patients, or in 34% of patients with an open ASD and 28% of patients with an open VSD, and 12% and 13% of patients with a closed defect, respectively. Mortality was highest in patients with Eisenmenger's syndrome (20.6%). In case of an open defect, PAH entailed an eightfold increased probability of functional limitations (New York Heart Association class >1), with a further sixfold increase when Eisenmenger's syndrome was present. Also, in patients with persisting PAH despite defect closure, functional limitations were more common. In patients with ASD, the prevalence of right ventricular dysfunction increased with systolic pulmonary artery pressure (OR = 1.073 per mm Hg; p<0.001). Major bleeding events were more prevalent in patients with cyanosis with than without Eisenmenger's syndrome (17% vs 3%; p<0.001). CONCLUSION: In this selected population of adults with congenital heart disease, PAH was common and predisposed to more symptoms and further clinical deterioration, even among patients with previous defect closure and patients who had not developed Eisenmenger's physiology.

Adult↗
PubMed2005

[Spanish Heart Transplantation Registry. 16th official report of the Spanish Society of Cardiology Working Group on Heart Failure, Heart Transplantation, and Associated Therapies].

This paper describes the general situation regarding heart transplantation in Spain and the results obtained using the technique, incorporating data for the year 2004. In 2004, 294 heart transplants were carried out, which brings the total number of procedures performed since 1984 to 4680. Clinically, the typical heart transplant recipient in Spain is male, aged around 50 years, has blood group A, has non-revascularizable coronary artery disease, and is in NYHA functional class IV/IV. The percentage of emergency heart transplantations was 35%, which is higher than in the previous year (29%), and higher than the mean for the preceding 5 years (22%). The early mortality rate was 10%, which is lower that the mean for the preceding 5 years (13%). After combining the results for 2004 with those of previous years, the probability of survival at 1, 5 and 10 years was 80%, 70% and 60%, respectively. When the survival rates for different time periods were analyzed, a significant improvement could be seen in the last 5 years, with recent survival rates being 85% and 72% at 1 and 5 years, respectively. The most frequent cause of death in the first month was acute graft failure; in the first year, infection and rejection; and, over the long term, tumors and a combination of graft vasculopathy and sudden death. A comparative analysis of survival rates showed that long-term results in Spain are slightly better than those published in the world literature. Moreover, survival has tended to improve gradually in recent years.

Adolescent↗
PubMed1989

Blood pressure, heart rate, and heart rhythm changes in patients with heart disease during talking.

Blood pressure and heart rate were recorded in 37 patients with cardiac disease while they were resting quietly and talking. Heart rate, systolic blood pressure, and diastolic blood pressure were all significantly greater while the patients were speaking than while they were resting silently. In addition, ventricular and atrial arrhythmias were more frequent while they were talking than while they were quiet. Higher resting systolic blood pressure levels also were associated with larger blood pressure increases while the patients were speaking. Older patients exhibited significantly greater systolic pressure increases while talking than younger patients. Therapeutic doses of antihypertensive medications, including beta-blockers, calcium channel blockers, and diuretics did not block the heart rate and blood pressure increases while the patients were talking. These findings suggest that more attention needs to be paid to the hemodynamic consequences of communication in patients with coronary heart disease. Coupled with previous research findings, these data also suggest that clinicians need to attend to verbal communications during routine diagnostic procedures for evaluating cardiovascular function.

Adult↗
PubMed2005

Depression and heart rate variability in patients with stable coronary heart disease: findings from the Heart and Soul Study.

CONTEXT: Depression is associated with low heart rate variability (HRV) in patients following myocardial infarction, suggesting that alterations in the autonomic nervous system may contribute to the adverse cardiac outcomes associated with depression. Whether depression is associated with low HRV in patients with stable coronary heart disease (CHD) is not known. OBJECTIVE: To examine the association between major depression and 24-hour HRV in patients with stable CHD. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional study of 873 outpatients with stable CHD recruited from outpatient clinics in the San Francisco Bay Area, California. MAIN OUTCOME MEASURES: Major depression was assessed using the Computerized National Institute of Mental Health Diagnostic Interview Schedule. Heart rate variability was measured by 24-hour ambulatory electrocardiography. RESULTS: A total of 195 participants (22%) had major depression. Overall, we observed no association between depression and HRV as measured by time domain or frequency domain variables. Mean HRV was similar in participants with and without depression (all P values >.10), and participants with depression were no more likely than those without depression to have low HRV (all P values >.10). CONCLUSIONS: We found no evidence of an association between depression and HRV in 873 outpatients with stable CHD. These findings raise questions about the potential role of HRV in the association between depression and cardiovascular disease.

Aged↗
PubMed1995

Assessment of autonomic tone over a 24-hour period in patients with congestive heart failure: relation between mean heart rate and measures of heart rate variability.

Patients with congestive heart failure (CHF) are characterized by an imbalance of the autonomic nervous system, which may contribute to the progression of circulatory failure and influence survival. However, it is still unclear whether CHF is characterized by a suppression of the diurnal variation in autonomic tone that is observed in normal subjects. To characterize the circadian variation in autonomic tone in patients with ventricular failure, ambulatory 24-hour Holter monitor recordings were obtained in 20 patients with CHF; 4-minute epochs of data from every hour of each 24-hour recording were selected. For each epoch we calculated the mean heart rate (HR) and, by applying spectral analysis of heart rate variability (HRV), we quantified the magnitude of the total (0.02 to 0.9 Hz), sympathetically governed low frequency variability (0.02 to 0.1 Hz), and parasympathetically mediated high-frequency variability (0.1 to 0.9 Hz). These areas were also expressed as a ratio to total variability and a ratio of high to low variability. A highly significant change in the mean HR over 24 hours was observed (p = 0.0001); no changes in the measures of HRV were obtained (p < 0.3). No significant correlation was found between mean HR and any frequency domain measures. We conclude that the sustained imbalance of autonomic tone over a 24-hour period, as shown by the spectral analysis of HRV, may promote the progression of circulatory failure and predispose patients with CHF to malignant ventricular arrhythmias and sudden cardiac death.(ABSTRACT TRUNCATED AT 250 WORDS)

Autonomic Nervous System↗
PubMed1961

Immunologic studies of heart tissue. III. Occurrence of bound gamma globulin in auricular appendages from rheumatic hearts. Relationship to certain histopathologic features of rheumatic heart disease.

Using fluorescent antibody methods, deposits of bound gamma globulin, as determined in unfixed washed sections of auricular appendages from rheumatic hearts, were noted in a significant number (18 per cent) of 100 specimens studied. Such deposits were observed in myofibers, sarcolemma, interstitial connective tissue, and vessel walls. Albumin and fibrin were generally found absent from these sites. Control hearts from normal and pathologic material, including postmortem and biopsied specimens, in general, did not reveal such deposits. These various tissue sites which contained bound gamma globulin frequently exhibited evidence of alteration as indicated both by enhanced affinity for eosin and by strongly positive reaction with the periodic acid-Schiff reagent, and appeared comparable in some cases to "fibrinoid." Bound gamma globulin was not observed in cellular or stromal components of Aschoff lesions, nor was the occurrence of Aschoff lesions correlated with presence of bound gamma globulin. It is suggested that deposition of gamma globulin and the eosinophilic alteration associated with such deposition are related to certain of the pathologic changes of rheumatic heart disease. The nature of such deposits of gamma globulin was considered from immune and non-immune points of view.

Atrial Appendage↗
PubMed2003

Cardiac rehabilitation following percutaneous revascularization, heart transplant, heart valve surgery, and for chronic heart failure.

This review discusses the scientific and clinical evidence for cardiac rehabilitation in patients who have undergone percutaneous revascularization, heart transplant, and heart valve surgery, and in patients with chronic heart failure. Across these diagnoses, regardless of age, there is considerable benefit of cardiac rehabilitation and supervised exercise training for increasing functional capacity, favorably modifying disease-related risk factors, decreasing symptoms, detecting signs and symptoms of disease before they become serious complications, and improving quality of life. The available evidence for this component of cardiovascular disease management, albeit not perfect, still warrants its more widespread application.

Angioplasty, Balloon, Coronary↗
PubMed1993

Element concentrations (selenium, copper, zinc, iron, magnesium, potassium, phosphorous) in heart tissue of patients with coronary heart disease correlated with physiological parameters of the heart.

The element concentrations (Cu, Zn, Se, Fe, K, Mg, P) of heart tissue taken from patients with coronary heart disease during bypass surgery were measured and related to physiological parameters of the heart. There was no relationship between the element concentrations and the number of vessels stenosed, the occurrence of myocardial infarction or classification according to the NYHA. When the element concentrations of the heart were related with parameters characterizing cardiac output, such as ejection fraction and cardiac index, positive statistically significant correlations were found for selenium, iron, copper, zinc and phosphorus.

Adult↗
PubMed1984

[Should closed-heart mitral commissurotomies still be performed? Apropos of 168 operations, 108 open-heart and 60 closed-heart].

Mitral commissurotomy is known to give good results but the best surgical technique (open heart or closed heart) remains uncertain. Results of open heart commissurotomy (OC), 108 patients (Group I) and closed heart commissurotomy (CC), 60 patients (Group II) were compared. The population comprised 81% females and the average age was 39 +/- 12 years. Only cases of pure or very predominant mitral stenosis (MS) were included. The preoperative state of the patients in Group I was poorer than the one in Group II (repeat commissurotomy 8.3% compared to 1.7%, p less than 0.04; associated mitral regurgitation 41% compared to 27%, p less than 0.04; cardiothoracic ratio 0.54 +/- 0.07 compared to 0.51 +/- 0.06, p less than 0.01). A more complete surgical cure was possible in Group I. Both commissures were liberated in 99% of OC compared to 25% CC (p less than 0.001). Mitral valvuloplasty was associated in 87% of OC (63 cases on the papillary muscles, 21 cases on the chordae tendinae and 60 cases on the mitral annulus). Operative mortality was low and did not differ significantly between the two groups (zero in CC; 1.8% in OC). Overall survival rates were excellent (95% 5 year survival, 85% 7 year survival). The reoperation rate at 5 years was 7.4% and at 7 years, 23.9%, and did not differ with the surgical technique used. The functional result was good (patients in Class I or II of the NYHA classification 84% at 5 years; 75% at 7 years; identical for both groups). Significant late valvular "dysfunction" was rare after OC.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2006

Heart rate variability following neonatal heart surgery for complex congenital heart disease.

BACKGROUND: Altered cardiac autonomic control may play a role in the morbidity and mortality suffered by neonates who undergo surgery for complex congenital heart disease (CHD). The purpose of this study was to evaluate cardiac autonomic activity, as measured by spectral indices of heart rate variability (HRV), prior to and early after infant surgery for CHD and attempt to correlate HRV indices with clinical outcome. In addition, we assessed the hypothesis that single-ventricle physiology and surgical interruption of the great arteries negatively affects HRV. METHODS: Sixty neonates prospectively wore 24-hour Holter monitors at three time points: before and early after CHD surgery, and at 3- to 6-month follow-up. Standard spectral indices of HRV were measured. RESULTS: In the early postoperative time point, patients with single-ventricle physiology had lower low-frequency power (LF) compared to patients with two ventricles (P=0.040). Surgical interruption of the great arteries did not affect HRV in this cohort. For the entire cohort, LF (P=0.004) and high-frequency power (HF) (P<0.001) increased over the three time points, while LF/HF (P=0.119) did not significantly change. In the multivariable linear regression model, significant predictors of longer postoperative hospital stay included longer total support time (P=or<0.001), longer duration of inotrope support (P=0.012), elevated mean heart rate at postoperative time point (P=0.002), and lower LF/HF ratio at the postoperative time point (P=0.014). CONCLUSION: Patients with single-ventricle physiology have a significant physiologic reduction in LF in the early postoperative period compared to patients with two ventricles. Diminished cardiac autonomic control is associated with longer hospitalization following neonatal cardiac surgery.

Arrhythmias, Cardiac↗
PubMedDate not supplied

Early and late postoperative complete heart block in pediatric patients submitted to open-heart surgery for congenital heart disease.

The incidence of complete heart block (CHB) following open-heart surgery for congenital heart disease is about 1%. Most of postoperative CHBs are the consequence of procedures involving the closure of ventricular septal defect; they usually occur immediately after surgery or early in the postoperative period; in few cases they also may occur many months or years after surgery. Early postoperative CHB can be transient or permanent. Permanent pacing is generally not recommended in the former. On the contrary, if CHB persists after at least two weeks of temporary pacing, permanent pacing is needed because the block is usually due to His bundle damage or to trifascicular damage and this is associated with excessive bradycardia and risk of asystole. Late postoperative CHB can be due to the recurrence of previous transient early postoperative CHB or to the progression of postoperative His-Purkinje conduction troubles suggesting trifascicular damage. Permanent pacing is obviously needed in case of documented late postoperative CHB. The prophylactic use of permanent pacing in patients at risk of late postoperative CHB is still a controversial point. Electrophysiologic studies should be performed in such patients. The occurrence of second degree AV block within or below the bundle of His during atrial pacing at rate lower than 200/min can be considered a good marker of impending CHB. In this case prophylactic permanent pacing should be recommended, especially in patients with coexisting problems of troublesome or malignant tachyarrhythmias who have to be treated with antiarrhythmic drug therapy that may favour the progression to CHB.

Adolescent↗
PubMed2005

Relation of anemia to low heart rate variability in patients with coronary heart disease (from the Heart and Soul study).

We examined the association between anemia (hemoglobin < or =12 g/dl) and 6 indexes of heart rate variability (HRV) as measured by 24-hour ambulatory electrocardiography in a cross-sectional study of 874 outpatients who had stable coronary heart disease. Of 90 participants who had anemia, 29% to 41% had low HRV, defined as the lowest quartile of each HRV index, compared with 23% to 25% of the 784 participants who did not have anemia (comparison p values <0.05 for all HRV indexes except high-frequency power). With the exception of high-frequency power, each 1 g/dl decrease in hemoglobin was associated with increased odds of having low HRV. This association remained strong after adjustment for potential confounding variables, including ischemia, left ventricular mass, left ventricular ejection fraction, and diastolic dysfunction. Thus, anemia is associated with low HRV in ambulatory patients who have stable coronary heart disease. Low HRV could potentially mediate the association of anemia with increased cardiac risk.

Aged↗
PubMed2005

Different methods of heart rate variability analysis reveal different correlations of heart rate variability spectrum with average heart rate.

UNLABELLED: Heart rate variability (HRV) spectrum can be calculated from the R-R or the sequence of instantaneous heart rates (IHRs). Because these signals are reciprocal, their use in the determination of the correlation of HRV with average HR may yield opposite results. AIM: The aim of this study is to reveal how HRV parameters correlate with HR depending on the kind of signal used and whether the normalization procedure or use of corrected signals affect the correlations. METHODS: Electrocardiographic recordings (512 beats) of 55 patients were considered in the analysis. RR and IHRs were calculated. Both signals were divided by their average values yielding the corrected RR and IHR. Heart rate variability spectra were estimated from these 4 kinds of signals. Total power (TP), low frequency (LF) and high frequency (HF) components, LF/HF ratio, and normalized values (ie, nLF, nHF) were calculated. RESULTS: Total power and LF estimated from RR correlated negatively with HR, but those calculated from IHR revealed a trend toward a positive correlation (respective correlation coefficients significantly differed, P < .01). The sign of correlation between HF and HR was the same regardless of the type of signal applied. The application of corrected signals made the results almost identical despite different signal origins (RR or IHR). The correlations of LF/HF, nLF, and nHF with HR were similar in all cases. CONCLUSIONS: The type of signal determines the sign of correlation among TP, LF, and HR. The parameters obtained from corrected signals, normalized quantities, and LF/HF reveal a consistent relationship with HR.

Electrocardiography↗
PubMed1999

[The National Heart Transplant Registry. The 9th Official Report (1984-1997). The Spanish Heart Transplant Groups. The Section of Heart Transplantation of the Spanish Society of Cardiology].

The results of the Spanish National Registry of Heart Transplantation, made up of 12 centers currently performing transplantation are reported. 318 transplantations performed in 1997, which, together with those performed since 1984, totals 2, 406 transplantations. The number of procedures increased again last year, breaking the trend of recent years. This has probably been due to an increase in organ obtention and a reduction in the acceptance level required, necessary because the waiting list has increased. Over 100 variables have been analyzed per patient to measure mortality predictors. The results are comparable to those published by the International Society of Heart and Lung Transplantation. Early survival, at the first 30 days post-transplantation, is lower in the National Registry, though 1-year survival tends to be higher, with a 3% fall in the National Registry and 4% in the International one. In conclusion, heart transplantation is a procedure completely established in Spain, with results comparable to those of the International Registry, due to the great experience of the centers.

Adult↗
PubMed2005

The spectrum of adult congenital heart disease in Europe: morbidity and mortality in a 5 year follow-up period. The Euro Heart Survey on adult congenital heart disease.

AIMS: To describe clinical and demographic characteristics at baseline of a European cohort of adults with congenital heart disease (CHD) and to assess mortality and morbidity in a 5 year follow-up period. METHODS AND RESULTS: Data collected as part of the Euro Heart Survey on adult CHD was analysed. This entailed information transcribed from the files of 4110 patients diagnosed with one of eight congenital heart conditions ('defects'), who consecutively visited the outpatient clinics of one of the participating centres in 1998. The patients were included retrospectively and followed until the end of 2003 for a median follow-up of 5.1 years. Notwithstanding their overall relatively good functional class and low mortality over the follow-up period, a considerable proportion of the patients had a history of endocarditis, arrhythmias, or vascular events. There were major differences between the eight defects, both in morbidity and regarding specific characteristics. Outcomes were worst in cyanotic defects and in the Fontan circulation, but a considerable proportion of the other patients also suffer from cardiac symptoms. In particular, arrhythmias are common. CONCLUSION: The spectrum of adult CHD in Europe emerging from this survey is one of a predominantly young population with substantial morbidity but relatively low mortality in a 5 year period.

Adolescent↗