American heart journal
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American heart journal · Sep 2003
Randomized Controlled Trial Clinical TrialCholinergic stimulation with pyridostigmine reduces ventricular arrhythmia and enhances heart rate variability in heart failure.
Increased ventricular arrhythmia density and reduced heart rate variability are associated with risk of death in patients with heart failure. Cholinesterase inhibition with pyridostigmine bromide increases heart rate variability in normal subjects, but its effect on patients with heart failure is unknown. In this study, we tested the hypothesis that short-term administration of pyridostigmine bromide, a cholinesterase inhibitor, reduces ventricular arrhythmia density and increases heart rate variability in patients with congestive heart failure. ⋯ In patients with heart failure, pyridostigmine reduced ventricular arrhythmia density and increased heart rate variability, most likely due to its cholinomimetic effect. Long-term trials with pyridostigmine in heart failure should be conducted.
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American heart journal · Sep 2003
Normalization for peak oxygen uptake increases the prognostic power of the ventilatory response to exercise in patients with chronic heart failure.
Peak exercise oxygen uptake (peak VO2) and ventilation to CO2 production (VE/VCO2) slope are established prognostic indicators in patients with chronic heart failure (CHF). A high VE/VCO2 slope, however, does not take into account the level of physical performance as expressed by peak VO2. We hypothesized that the prognostic value of a high VE/VCO2 slope may be improved by normalization for peak VO2 (VE/VCO2/VO2). ⋯ Discrepancies between VE/VCO2 slope and peak VO2 may generate uncertainty. Normalization of the former by the latter improves outcome prediction and may be considered a simple and effective way for maximizing the clinical applicability of these 2 indicators.
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American heart journal · Sep 2003
Obesity and the risk of early and late mortality after coronary artery bypass graft surgery.
Obesity is often considered to be a significant risk factor for postoperative mortality when selecting candidates for coronary artery bypass grafting (CABG). ⋯ Patients who are obese are not at a greater risk of early and late mortality after CABG compared with patients who are not overweight, although they appear to have a lower risk of re-operation for bleeding and a greater risk of deep sternal wound infection. Therefore, obesity per se is not a contraindication for CABG.
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American heart journal · Sep 2003
Impact of the troponin standard on the prevalence of acute myocardial infarction.
Recent recommendations are that troponin should replace creatine kinase (CK)-MB as the diagnostic standard for myocardial infarction (MI). The impact of this change has not been well described. Our objective was to determine the impact of a troponin standard on the prevalence of acute non-ST-elevation MI. ⋯ Changing to a troponin standard will have a substantial impact on the number of patients diagnosed with MI. The revised definition for MI will have important clinical and health care implications.