American heart journal
-
American heart journal · Oct 1999
Randomized Controlled Trial Clinical TrialEffects of long-term adrenergic beta-blockade on left ventricular diastolic filling in patients with acute myocardial infarction.
Left ventricular (LV) systolic and diastolic function are known to be affected in the wake of a myocardial infarction (MI). beta-Adrenergic blocking agents have demonstrated improvement of LV systolic and diastolic function in patients with dilated cardiomyopathy and theoretically would have same beneficial effects in MI. beta-Adrenergic blocking agents are widely used in MI; however only few reports on changes of LV systolic and diastolic function during long-term treatment after acute MI are available. ⋯ Long-term treatment with the beta-blocking agent metoprolol seems to improve LV diastolic filling after acute MI. Less restrictive LV filling was noted during beta-blockade indicated by a significant prolongation of the mitral E deceleration time, which was predominantly noted in patients with restrictive LV filling. This observation might have prognostic implications because this LV filling pattern is known to be associated with poor outcome. The changes of LV diastolic filling occurred during the first 3 months, whereas systolic recovery was seen at up to 12 months of treatment.
-
American heart journal · Oct 1999
Costs and cost-effectiveness of routine transesophageal echocardiography in congenital heart surgery.
The safety and efficacy of transesophageal echocardiography (TEE) during congenital heart surgery is well established. The economic costs and benefits associated with its routine use in this setting are, however, uncertain. We sought to analyze the impact that routine intraoperative TEE had on echocardiographic costs in the setting of congenital heart surgery. ⋯ The findings of improved surgical outcomes in a percentage of patients, coupled with the lack of any significant increment in echocardiographic costs, confirm that intraoperative TEE is a beneficial and cost-effective intervention in children requiring complex cardiac repair.
-
American heart journal · Oct 1999
Review Comparative StudySafety of glycoprotein IIb-IIIa inhibitors: A heart surgeon's perspective.
Platelet-mediated coronary thrombosis is the primary pathophysiologic mechanism of acute coronary syndromes (ACS) and acute ischemic complications of percutaneous coronary intervention (PCI). The final common pathway of platelet aggregation that leads to thrombotic occlusion of coronary arteries involves cross-linking of receptor glycoprotein (GP) IIb-IIIa on adjacent platelets by adhesive plasma proteins, primarily fibrinogen. Clinical trials of several GP IIb-IIIa inhibitors have demonstrated an unequivocal clinical benefit of this potent antithrombotic therapy in patients with ACS as well as in those undergoing PCI. ⋯ Therefore, among patients requiring CABG after treatment with GP IIb-IIIa inhibitors, eptifibatide and tirofiban may be associated with fewer bleeding episodes than is abciximab. With recent approval of eptifibatide for patients with ACS and those scheduled for PCI and of tirofiban for patients with ACS, the number of patients receiving GP IIb-IIIa inhibitor therapy who subsequently undergo CABG is expected to increase significantly. Strategies for improved management of bleeding complications in these patients, including the choice of a GP IIb-IIIa inhibitor, are clearly needed and are discussed in detail.
-
American heart journal · Oct 1999
Editorial CommentBiplane and multiplane transesophageal echocardiography.
-
American heart journal · Oct 1999
Review Comparative StudyPharmacokinetics and pharmacodynamics of glycoprotein IIb-IIIa inhibitors.
Antagonists of the platelet receptor glycoprotein (GP) IIb-IIIa are a novel class of antithrombotic agents that provide more comprehensive platelet blockade than the combination of aspirin and heparin. Studies in patients scheduled for percutaneous coronary intervention and those with unstable angina or non-Q-wave myocardial infarction have shown that a combination of intravenous GP IIb-IIIa inhibitors with aspirin and heparin is associated with a reduction in death or myocardial infarction compared with therapy with aspirin and heparin alone. As with other antithrombotic agents, the principal safety issue with GP IIb-IIIa inhibitors is bleeding, because the potent antiplatelet effect of these drugs may adversely affect hemostasis. ⋯ Additionally, antagonists of GP IIb-IIIa may increase the risk of thrombocytopenia. The safety profiles of various GP IIb-IIIa inhibitors are largely a function of their pharmacokinetic and pharmacodynamic properties, most notably the reversibility of platelet inhibition and the rate of plasma clearance. Knowledge of the pharmacokinetic and pharmacodynamic properties of the GP IIb-IIIa inhibitors is critical for the appropriate utilization of this new class of drugs.