American heart journal
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American heart journal · Nov 2003
Comparative Study Clinical Trial Controlled Clinical TrialSelf- and balloon-expandable stent implantation for severe native coarctation of aorta in adults.
Balloon angioplasty for native coarctation of the aorta (CoA) in adults, though promising, is sometimes limited by significant residual gradient (>20 mm Hg). Few studies available have reported on use of balloon-expandable stents in such a situation. We evaluated the use of self- and balloon-expandable stents in patients with suboptimal response to balloon angioplasty (BA). ⋯ Stent implantation is safe and effective in improving suboptimal results after BA for CoA. Self-expandable stents were easier to implant, adapted better to the wall of the aorta, and in most patients had similar efficacy in reducing coarctation as balloon-expandable stents.
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American heart journal · Nov 2003
Randomized Controlled Trial Comparative Study Clinical TrialComparison of the effect of valsartan and lisinopril on autonomic nervous system activity in chronic heart failure.
In chronic heart failure (CHF), the derangement of autonomic nervous system activity has a deep impact on the progression of the disease. It has been demonstrated that modulation of the renin-angiotensin aldosterone system (RAAS) increases autonomic control of heart rate and reduces adrenergic activity. We sought to evaluate, in CHF, the different effects of an ACE inhibitor (lisinopril) and of an AT1 receptor antagonist (valsartan) on heart rate variability, baroreflex sensitivity and norepinephrine plasma levels. ⋯ This study shows a comparable effect of ACE inhibition (lisinopril) and of AT1 receptor antagonism (valsartan) on cardiac vagal control of heart rate, whereas valsartan has shown a more effective modulation of sympathetic activity measured by plasma norepinephrine levels.
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American heart journal · Oct 2003
Randomized Controlled Trial Multicenter Study Clinical TrialRandomized trial of a daily electronic home monitoring system in patients with advanced heart failure: the Weight Monitoring in Heart Failure (WHARF) trial.
Heart failure treatment guidelines emphasize daily weight monitoring for patients with heart failure, but data to support this practice are lacking. Using a technology-based heart failure monitoring system, we determined whether daily reporting of weight and symptoms in patients with advanced heart failure would reduce rehospitalization and mortality rates despite aggressive guideline-driven heart failure care. ⋯ This is the largest multicenter, randomized trial of a technology-based daily weight and symptom-monitoring system for patients with advanced heart failure. Despite no difference in the primary end point of rehospitalization rates, mortality was significantly reduced for patients randomized to the AlereNet system without an increase in utilization, despite specialized and aggressive heart failure care in both groups.
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American heart journal · Oct 2003
ReviewSelective COX-2 inhibition and cardiovascular effects: a review of the rofecoxib development program.
See related Editorials on pages 561 and 563. Cyclo-oxygenase-2 (COX-2) inhibitors appear to alter the balance of vasoactive eicosanoids (prostacyclin and thromboxane) and to suppress the inflammatory mediators implicated in the progression of atherogenesis and ischemic myocardial injury. Neutral, harmful, and beneficial cardiovascular (CV) effects have all been postulated to result from these changes. ⋯ Again, naproxen appeared to be the outlier, suggesting a cardioprotective benefit of naproxen. Finally, among the predominantly elderly, male population participating in Alzheimer trials, both rofecoxib- and placebo-treated patients had similar rates of CV thrombotic events. The totality of data is not consistent with an increased CV risk among patients taking rofecoxib.
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American heart journal · Oct 2003
Randomized Controlled Trial Clinical TrialEffects of eicosapentaenoic acid on cardiovascular events in Japanese patients with hypercholesterolemia: rationale, design, and baseline characteristics of the Japan EPA Lipid Intervention Study (JELIS).
The principle aim of the current study is to test the hypothesis that the long-term use of highly purified EPA (eicosapentaenoic acid: 1800 mg/day), in addition to HMG-CoA reductase inhibitor, is effective in preventing cardiovascular events in Japanese patients with hypercholesterolemia. ⋯ JELIS is a large clinical trial that will evaluate whether EPA can make an additional improvement in mortality and morbidity of coronary artery disease beyond that of HMG-CoA reductase inhibitor treatment.