American heart journal
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American heart journal · Apr 1993
Comparative StudyNoninvasive evaluation of right ventricular and pulmonary artery systolic pressures in patients with ventricular septal defects: simultaneous study of Doppler and catheterization data.
The method for evaluating right ventricular and pulmonary artery systolic pressures by subtracting the systolic pressure gradient across the ventricular septal defect from the cuff systolic blood pressure is documented. To confirm the reliability and accuracy of this method, simultaneous continuous wave Doppler echocardiography and left and right cardiac catheterization were performed in 66 patients with congenital ventricular septal defects. ⋯ There was a close agreement between the Doppler-derived right ventricular or pulmonary artery systolic pressures and those measured by catheters, and the differences between the two measurements did not differ significantly from zero. It is concluded that Doppler echocardiography offers a reliable and accurate method for noninvasive assessment of right ventricular and pulmonary artery systolic pressures in patients with ventricular septal defects.
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American heart journal · Jan 1993
Comparative StudyThe cough test is superior to the Valsalva maneuver in the delineation of right-to-left shunting through a patent foramen ovale during contrast transesophageal echocardiography.
A patent foramen ovale may result in paradoxical embolization and serious morbidity. Thus a sensitive method to diagnose a patent foramen ovale is important. It is unknown whether the cough test or the Valsalva maneuver is superior in delineating right-to-left shunting through a patent foramen ovale during contrast transesophageal echocardiography. ⋯ In subjects (n = 55) without a patent foramen ovale during quiet respirations, the incidence of a patent foramen ovale was higher during the cough test (15/55) as compared with the Valsalva maneuver (9/55, p < 0.05). In a subgroup (N = 17) of patients with nonhemorrhagic stroke (n = 11), transient ischemic attack (n = 2), or peripheral embolus (n = 4), the cough test had a higher yield (9/17) in delineating a patent foramen ovale as compared with the Valsalva maneuver (7/17) but did not reach statistical significance. These data demonstrate that the cough test is superior to the Valsalva maneuver in delineating a patent foramen ovale during contrast transesophageal echocardiography.(ABSTRACT TRUNCATED AT 250 WORDS)
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American heart journal · Jan 1993
Comparative StudyIdentification of high-risk patients with left main and three-vessel coronary artery disease using stepwise discriminant analysis of clinical, exercise, and tomographic thallium data.
This large-scale study examined the ability of stepwise discriminant analysis of clinical, exercise, and thallium tomographic data to detect high-risk patients with three-vessel or left main disease. There were 834 patients, 229 with three-vessel or left main disease (group 1) and 605 (group 2) with either two-vessel disease (n = 236), one-vessel disease (n = 195), or no coronary artery disease (n = 174). The two groups were different in age, exercise heart rate, ST segment depression during exercise, exercise systolic blood pressure, abnormal thallium scans, reversible perfusion defects, extent of thallium abnormality, number of vascular territories with perfusion abnormalities, left ventricular cavity dilatation, and increased lung thallium uptake. ⋯ Based on these three variables, patients could be stratified into three categories with different prevalences of left main or three-vessel disease; the prevalence was 53% in 239 patients, 24% in 271 patients, and 12% in 324 patients. Thus high-risk patients with left main or three-vessel disease can be identified by exercise thallium tomographic imaging that uses a model based on stepwise discriminant analysis. The thallium data are far more powerful than the clinical or treadmill exercise data.
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American heart journal · Nov 1992
Randomized Controlled Trial Comparative Study Clinical TrialA prospective study of the efficacy and safety of adjuvant metoprolol and xamoterol in combination with amiodarone for resistant ventricular tachycardia associated with impaired left ventricular function.
Combination antiarrhythmic drug therapy may be more effective than treatment with a single agent for control of refractory cases of sustained ventricular tachycardia (VT). In a prospective randomized crossover study of 20 patients with impaired left ventricular function (ejection fraction of 28% +/- 8%) and recurrent VT in spite of treatment with amiodarone, we compared the efficacy and safety of adjuvant therapy with metoprolol, 50 mg two times daily and xamoterol, 200 mg two times daily. Metoprolol caused hemodynamic deterioration in five patients, and only one also experienced intolerance to xamoterol. ⋯ Both beta-blockers suppressed exercise-induced VT in 3 of 4 patients, and addition of xamoterol significantly increased treadmill exercise duration (7.1 +/- 1.8 min) compared with administration of amiodarone alone (3.8 +/- 1.5 min; p < 0.01). Fourteen patients were discharged with prescriptions for amiodarone-beta-blocker combinations. During a mean follow-up period of 13 months (range, 2 to 24 months), there were three cases of recurrent VT (in all patients VT remained inducible) and no sudden deaths.(ABSTRACT TRUNCATED AT 250 WORDS)