European heart journal
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European heart journal · Mar 2000
Dispersion of ventricular repolarization is determined by the presence of myocardial viability in patients with old myocardial infarction. A dobutamine stress echocardiography study.
The study sought to investigate the relationship of myocardial viability detected by dobutamine stress echocardiography to changes of QT dispersion and to the presence of arrhythmias during dobutamine infusion in patients with old myocardial infarction. We also examined whether patency of the infarct-related artery is associated with the presence of myocardial viability and QT dispersion. ⋯ The combination of a resting QT dispersion +/-65 ms or an increase in QT dispersion >30% predicts the presence of viable myocardium and thus, may represent a simple index for the assessment of viability in everyday clinical practice. Myocardial viability is related to a patent coronary artery and to a high incidence of arrhythmias accompanied by a greater increase in QT dispersion at peak dobutamine infusion.
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European heart journal · Mar 2000
Surgical treatment of active infective aortic valve endocarditis with associated periannular abscess--11 year results.
The aim of the study was to evaluate the long-term results of allograft and prosthetic valve replacement in the treatment of infective aortic valve endocarditis with periannular abscess. ⋯ Aortic allografts are an effective treatment for infective aortic valve endocarditis with associated periannular abscess. The operative mortality and recurrent infection rates are lower than in the prosthetic group, resulting in a significantly higher survival rate. Diagnosis and surgical management of these cases should be based on pre-operative transoesophageal echocardiography.
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European heart journal · Feb 2000
Randomized Controlled Trial Clinical TrialOptimizing the initial 12-lead electrocardiographic diagnosis of acute myocardial infarction.
The optimum definition of ST elevation for diagnosis of acute myocardial infarction, with respect to both the minimum height and the minimum numbers of leads, is unknown. Furthermore, only 50% of patients with acute myocardial infarction present with ST elevation. We thus quantified the sensitivity and specificity of different ST elevation criteria for diagnosis of acute myocardial infarction, and determined whether models incorporating multiple QRST features in addition to ST elevation, could improve detection of acute myocardial infarction. ⋯ Different definitions of 'significant' ST elevation led to marked variations in sensitivity and specificity for diagnosis of acute myocardial infarction. Multiple QRST features in addition to ST elevation only marginally improved overall classification.
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European heart journal · Jan 2000
Randomized Controlled Trial Clinical TrialOral amiodarone increases the efficacy of direct-current cardioversion in restoration of sinus rhythm in patients with chronic atrial fibrillation.
Direct current cardioversion of persistent atrial fibrillation is one of the most widely used and effective treatments for the restoration of sinus rhythm, but may be hampered by a low success rate and a high percentage of early recurrence. Pre-treatment with amiodarone or a glucose-insulin-potassium solution could improve the efficacy of electrical cardioversion by reversing the partially depolarized diastolic potential of the subsidiary pacemakers in atrial fibrillation. In a controlled randomized study, we assessed the effectiveness of electrical cardioversion in patients with persistent atrial fibrillation after pre-treatment with amiodarone or potassium infusion and the efficacy of amiodarone in maintaining sinus rhythm after electrical cardioversion. ⋯ Pre-treatment with low-dose oral amiodarone, compared with oral diltiazem or glucose-insulin-potassium treatments, induces a significantly high percentage of instances of spontaneous conversion, increases electrical cardioversion efficacy and reduces atrial fibrillation recurrence.