American heart journal
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American heart journal · Mar 2010
Comparative StudyCuff and aortic pressure differences during dobutamine infusion: a study of the effects of systolic blood pressure amplification.
Central aortic systolic blood pressures (SBPs) differ from and are preferable to cuff pressures when calculating cardiac work, left ventricular wall stress, and rate-pressure product. Despite the widespread use of dobutamine, differences between aortic and brachial SBP (pulse amplification) and pulse transmission during dobutamine infusion have not been previously studied. This study assessed these differences and used applanated radial pulses with the Sphygmocor (AtCor Medical, Sydney, Australia) device to investigate the effects of dobutamine on arterial pulse transmission and pulse amplification. ⋯ Similar to exercise, dobutamine induced cuff SBPs and pulse pressures higher than those measured in the aorta-uncorrected by the cuff-calibrated Sphygmocor. This increasing pulse amplification was explained by the effects of dobutamine on the properties of the conduit arterial walls, on changes in pulse wave velocity, on increasing heart rate, and on reflected waves.
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American heart journal · Mar 2010
Randomized Controlled Trial Multicenter Study Comparative StudyRationale, design, and baseline data of the Japanese Primary Prevention Project (JPPP)-a randomized, open-label, controlled trial of aspirin versus no aspirin in patients with multiple risk factors for vascular events.
Prevention of atherosclerotic disease has become an important public health priority in Japan due to the aging of the population and changes in diet and lifestyle factors. ⋯ The JPPP is the largest primary prevention trial of aspirin in a Japanese population that is investigating whether the benefit of aspirin in reducing risk of vascular events outweighs any bleeding risk in elderly patients with multiple risk factors.
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American heart journal · Mar 2010
Clinical relevance of clopidogrel unresponsiveness during elective coronary stenting: experience with the point-of-care platelet function assay-100 C/ADP.
Early identification of nonresponders to clopidogrel may be important in identifying subgroups of patients that might be at risk for future thrombotic events. ⋯ Unresponsiveness to clopidogrel as assessed by the point-of-care test PFA-100C/ADP is an independent major risk factor for thrombotic complications after coronary intervention.
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American heart journal · Mar 2010
Randomized Controlled Trial Multicenter Study Comparative StudyRivaroxaban-once daily, oral, direct factor Xa inhibition compared with vitamin K antagonism for prevention of stroke and Embolism Trial in Atrial Fibrillation: rationale and design of the ROCKET AF study.
Atrial fibrillation (AF), the most common significant cardiac arrhythmia, increases the risk of stroke, particularly in the elderly. Warfarin is effective in reducing stroke risk but is burdensome to patients and is difficult to control. Rivaroxaban is an oral direct factor Xa inhibitor in advanced development as an alternative to warfarin for the prevention and treatment of thromboembolic disorders. ⋯ The ROCKET AF study will determine the efficacy and safety of rivaroxaban as an alternative to warfarin for the prevention of thromboembolism in patients with AF.
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American heart journal · Mar 2010
Randomized Controlled Trial Multicenter Study Comparative StudyDifferences in mortality in acute coronary syndrome symptom clusters.
The timely and accurate identification of symptoms of acute coronary syndrome (ACS) is a challenge for patients and clinicians. It is unknown whether response times and clinical outcomes differ with specific symptoms. We sought to identify which ACS symptoms are related-symptom clusters-and to determine if sample characteristics, response times, and outcomes differ among symptom cluster groups. ⋯ Most ACS symptoms occur in groups or clusters. Uncharacteristic symptom patterns may delay diagnosis and treatment by clinicians even when patients seek care rapidly. Knowledge of common symptom patterns may facilitate rapid identification of ACS.