Journal of the American College of Cardiology
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J. Am. Coll. Cardiol. · Nov 2000
Randomized Controlled Trial Multicenter Study Clinical TrialHemodynamic and neurohumoral effects of continuous infusion of levosimendan in patients with congestive heart failure.
We sought to define the therapeutic dose range of levosimendan in patients with New York Heart Association class II-IV heart failure of ischemic origin. ⋯ Dosing of levosimendan with a 10-min bolus of 6 to 24 microg/kg followed by an infusion of 0.05 to 0.2 microg/kg/min is well tolerated and leads to favorable hemodynamic effects.
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J. Am. Coll. Cardiol. · Nov 2000
CommentAbility of troponin I to predict cardiac events in patients admitted from the emergency department.
We sought to determine the predictive ability of troponin I (TnI) in a heterogeneous group of patients with chest pain admitted from the emergency department (ED) for exclusion of myocardial infarction (MI). ⋯ Troponin I had a high sensitivity for MI when used as part of a rapid rule-in protocol; however, the sensitivity for other end points was low. Use of TnI alone failed to identify the majority of patients who had either significant disease or complications.
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J. Am. Coll. Cardiol. · Nov 2000
Comparative StudyChanges in high-frequency QRS components are more sensitive than ST-segment deviation for detecting acute coronary artery occlusion.
This study describes changes in high-frequency QRS components (HF-QRS) during percutaneous transluminal coronary angioplasty (PTCA) and compares the ability of these changes in HF-QRS and ST-segment deviation in the standard 12-lead electrocardiogram (ECG) to detect acute coronary artery occlusion. ⋯ Acute coronary artery occlusion is detected with higher sensitivity using high-frequency QRS analysis compared with conventional assessment of ST segments. This result suggests that analysis of HF-QRS could provide an adjunctive tool with high sensitivity for detecting acute myocardial ischemia.
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The study was done to determine whether race is an independent predictor of operative mortality after coronary artery bypass graft (CABG) surgery. ⋯ Black race is an independent predictor of operative mortality after CABG except for very high-risk patients. The difference in mortality is greatest for male patients and, though statistically significant, is small in absolute terms. Therefore, patients should be referred for CABG based on clinical characteristics irrespective of race.
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J. Am. Coll. Cardiol. · Nov 2000
Comparative Study Clinical Trial Controlled Clinical TrialA rapid stress-testing protocol for the detection of coronary artery disease: comparison of two-stage transesophageal atrial pacing stress echocardiography with dobutamine stress echocardiography.
We compared a new two-stage transesophageal atrial pacing stress echocardiography (TAPSE) protocol with a standard dobutamine stress echocardiography (DSE) protocol. ⋯ Two-stage TAPSE permits rapid evaluation of cardiac patients. Peak cardiac index and patient acceptance scores were similar for TAPSE and DSE. Ischemia was detected more often with TAPSE; this result was attributed to the higher peak heart rate obtained with this protocol.