The American journal of cardiology
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Dual-chamber cardiac pacing (DDD) offers obvious theoretical advantages over traditional ventricular demand (VVI) pacing. Nevertheless, no widely agreed upon criteria exist for the selection of patients for physiologic DDD pacemakers compared with the simpler VVI systems. Accordingly, a non-invasive method for measuring cardiac output (Doppler ultrasound) was used to identify candidates for pacing who would derive the greatest hemodynamic benefit from DDD vs VVI pacing. ⋯ In these patients, the mean improvement in cardiac output was 30.4 +/- 8.6% with DDD vs VVI pacing, as opposed to an average increase of only 14.4 +/- 3.4% in the remaining 20 patients (p = 0.02). Thus, Doppler ultrasound can be used to quantitate the change in cardiac output at rest that occurs with DDD vs VVI pacing. The change is independent of the level of left ventricular function but is substantially higher when there is evidence of ventriculoatrial conduction or the pacemaker syndrome.
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Comparative Study
An exponential formula for heart rate dependence of QT interval during exercise and cardiac pacing in humans: reevaluation of Bazett's formula.
A new exponential formula to characterize the human RR-QT relation was evaluated in comparison with Bazett's formula in 16 subjects: 10 healthy, normal men (ages 18 to 30 years) who exercised on a stationary bicycle, and 6 patients (ages 50 to 80 years; 2 women and 4 men) with rate-programmable VVI pacemakers whose rates were changed by an external programmer. The RR and QT intervals for heart rate in the range of 50 to 180 beats/min were measured from electrocardiographic tracings recorded at a paper speed of 100 mm/s. ⋯ This analysis confirmed that F1 is the best model among the formulas tested and F4 (Bazett's formula) is the least acceptable for both exercised and paced groups. The deviations from Bazett's formula were more striking for the paced group than for the exercised group, as reflected by the mean-squared residual values for F4 (715 +/- 86 for the paced group vs 384 +/- 41 for the exercised group, p less than 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)
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The utility of Bayes' theorem in the noninvasive diagnosis of coronary artery disease (CAD) was analyzed in 147 patients who underwent electrocardiographic stress testing, thallium-201 perfusion imaging and coronary angiography. Eighty-nine patients had typical anginal chest discomfort and 58 had atypical chest pain. Sensitivity and specificity of the tests and prevalence of CAD at each level of testing were tabulated and compared with the results generated from Bayes' theorem. ⋯ However, the probabilities calculated from Bayes' theorem when used for sequential testing are remarkably close to the tabulated data. Thus, Bayes' theorem is useful clinically despite some evidence of test dependence. Sequential test analysis by Bayes' theorem is most useful in establishing or ruling out a diagnosis when the pretest prevalence is approximately 50% and when the 2 tests are concordant.
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Randomized Controlled Trial Clinical Trial
Göteborg Metoprolol Trial: design, patient characteristics and conduct.
The Göteborg Metoprolol Trial was a double-blind, placebo-controlled, stratified trial aimed at evaluating the effect of the beta 1-selective blocker, metoprolol, in suspected acute myocardial infarction and during 2 years of follow-up. The primary end-point was 3-month mortality (blind treatment period). Secondary end-points were 2-year mortality, indirect signs of infarct size, chest pain, arrhythmias and tolerability. ⋯ Treatment started as soon as possible after arrival in hospital with intravenous administration followed by oral treatment for 3 months. All patients were randomized 48 hours or less after estimated onset of infarction and 69% were randomized at 12 hours or less. The blind treatment had to be withdrawn in 19% of all randomized patients before the end of the 3-month follow-up.
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Randomized Controlled Trial Clinical Trial
Göteborg Metoprolol Trial: effects on chest pain.
The effect of metoprolol on chest pain was compared with that of placebo in all randomized patients. The pain score before and 15 minutes after the injection of trial medication was registered and a reduction in chest pain was observed in the metoprolol group. Increasing chest pain after blind injection was observed in only 16 and 9 patients from the placebo and metoprolol groups, respectively. ⋯ Either metoprolol does not induce coronary vasospasm or spasm does not play a role in these patients with definite and suspected acute myocardial infarction as well as unstable angina pectoris. Metoprolol reduced the need for analgesics during the first 4 days and shortened the duration of pain. The effects were similar in patients with early and late treatment, but may depend on initial heart rate, blood pressure and site of infarction.