The American journal of cardiology
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Acute myocardial infarctions were generally believed to result from plaque rupture and thrombosis at the site of a "mild to moderate" coronary stenosis. To assess the severity of coronary stenoses that predisposed to acute coronary syndrome, the 317 patients prospectively included were (1) 102 patients with acute ST-elevation myocardial infarction (STEMI) referred for primary percutaneous coronary intervention (PCI), (2) 135 patients with non-STEMI or unstable angina pectoris (UAP) referred for semiurgent PCI, and (3) 80 patients with stable angina pectoris (SAP) admitted for elective PCI. Patients with STEMI were included if thrombus aspiration could restore normal antegrade coronary blood flow. ⋯ In patients with STEMI, only 11% of culprit stenoses were found to have diameter stenosis <50% after removal of the thrombus. In conclusion, most STEMIs occurred at the site of severe coronary stenosis. Diameter stenosis severity was <50% in a minority of cases.
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Left ventricular (LV) ejection fraction (EF) was known as a conventional predictor of heart failure (HF). However, early transmitral flow velocity (E)/early diastolic velocity of mitral annulus (E') correlated well with LV end-diastolic pressure, and E/E' ratio >15 was an excellent predictor of adverse outcomes in patients with HF. This study was designed to determine the prognostic value of a new combined index, E/E' ratio and LVEF, in patients with HF. ⋯ On univariate analysis, E/E' ratio, group IV, E', and age were significant predictors. In multivariable analysis, the most powerful independent prognostic indicator of events was group IV (hazard ratio 12.6, 95% confidence interval 2.2 to 74.2, p = 0.005). In conclusion, a new index, a combination of LVEF and E/E' ratio, allowed the identification of patients at higher risk of readmission and cardiac death in patients with HF.
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Comparative Study
Relation of increased short-term variability of QT interval to congenital long-QT syndrome.
Apart from clinical symptoms the diagnosis and risk stratification in long-QT syndrome (LQTS) is usually based on the surface electrocardiogram. Studies have indicated that not only prolongation of the QT interval but also an increased short-term variability of QT interval (STV(QT)) is a marker for a decreased repolarization reserve in patients with drug-induced LQTS. The aims of this study were to determine if STV(QT) (1) is higher in patients with LQTS compared with controls, (2) if this effect is more pronounced in a high-risk LQTS population, and (3) could increase the diagnostic power of the surface electrocardiogram in identifying mutation carriers. ⋯ Receiver operator characteristic analysis showed that an STV(QT) of 4.9 ms was the optimal cut-off value to predict mutation carriers. When incorporating an STV(QT) >4.9 ms for those whose QTc interval was within the normal limits, sensitivity to distinguish mutation carriers increased to 83% with a specificity of 68%, so that another 15 mutation carriers could be identified. In conclusion, these are the first results in humans showing that STV(QT) is increased in congenital LQTS, this effect is increased in patients with symptoms before therapy, and, hence, STV(QT) could prove to be a useful noninvasive additive marker for diagnostic screening to bridge the gap before results of genetic testing are available.