Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: EC:4.1.1.6 (CAD)
 4,420 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

CsA-Pred therapy yields equivalently good patient survival for LRD and 2 degrees CAD versus 1 degree CAD transplants. There is a long-term graft survival advantage for LRD versus 1 degree CAD transplants (5 years; 83% vs 58%). 2 degrees CAD transplants have inferior graft survival when compared with 1 degree CAD grafts (one year; 78% vs 67%). Multiple donor factors adversely affecting graft outcome include increased warm and cold ischemia times, pulsatile perfusion, use of pressors or diuretics in the donor, donor age less than 10 years, donor blood transfusions, and kidneys shipped from other centers. Recipient factors adversely affecting graft outcome include retransplantation and CMV infection as well as noncompliance with therapy. HLA-matching and pretransplant blood transfusions have not contributed in a statistically significant way to graft outcome although they may affect the quality of graft function at this center. Immunosuppressive therapy with CsA-Pred must be tailored to the individual patient. Continuous IV CsA infusion in the preoperative period and slow steroid taper impact favorably on graft outcome. The complications of CsA therapy include neuroectodermal toxicity, hepatotoxicity, and most importantly, nephrotoxicity. Other problems unique to CsA-Pred therapy include hypertension, delayed graft thrombosis, and de novo hemolytic uremic syndrome. Hepatotoxicity may eventuate in biliary and pancreatic complications necessitating surgical therapy. The overall incidence of infection and neoplasm remains low with CsA-Pred therapy. The use of therapeutic trough CsA level monitoring, as well as pharmacokinetic and pharmacodynamic analyses may assist in clinical decision making regarding administered doses, dosing interval, and discrimination between rejection and nephrotoxicity.
 ...
PMID:Factors determining renal transplant outcome at the University of Texas at Houston. 315 93

To assess the significance and accuracy of noninvasive tests in detecting significant coronary artery disease (CAD; greater than 50% stenosis), the Master's exercise test, treadmill exercise test and dipyridamole-loading myocardial perfusion scintigraphy were performed and their results were compared with coronary angiographic findings in 60 patients with angina but without myocardial infarction. Among these, 27 patients had significant CAD. The Master's test performed in outpatient clinics had an 85% sensitivity and a 76% specificity in detecting significant CAD, when the degree of ST depression was equal to or exceeded 1 mm. The sensitivity further improved to 96% by adding chest pain to the criteria; then all patients with multivessel disease or critical ischemia were identified by the Master's test. Treadmill tests performed after admission had a 78% sensitivity and a 67% specificity. When the severity of ischemia was judged either by exercise capacity or the degree of ST depression or the coronary T wave, the treadmill test was superior to the Master's test. Although patients without significant CAD had longer exercise capacity and the higher maximum heart rate in the treadmill test than did those in the Master's test, these trends were similar but less marked in patients with significant CAD. Dipyridamole-loading myocardial perfusion scintigraphy showed an excellent sensitivity and specificity; 96% and 94%, respectively, in detecting significant CAD. It was particularly useful in distinguishing false positive exercise results due to left ventricular hypertrophy and coronary spasm and that in women, from true positive results. In conclusion, the Master's test is a simple and useful method for screening CAD in community hospitals and in outpatient clinics.
 ...
PMID:[Accuracy of the Master's exercise test in detecting significant coronary artery disease]. 326 34

To evaluate diastolic time during uninterrupted upright exercise, 28 normal volunteers (group 1) and 12 men with coronary artery disease (group 2) were studied by ear densitography. Electromechanical systole-heart rate and diastolic time-heart rate regression equations during upright exercise were obtained from group 1. Electromechanical systole-heart rate had an inverse linear relation (electromechanical systole = 480 - 1.4 heart rate) and diastolic time-heart rate had an inverse nonlinear relation (diastolic time = 1206e-0.02 heart rate). Although there were no significant differences in electromechanical systole and diastolic time at 1 minute of exercise between patients with and without CAD, at peak exercise prolongation of electromechanical systole and consequent shortening of diastolic time in patients with CAD were observed. This disproportionate shortening of diastole with lengthening of systole at peak exercise tends to decrease myocardial perfusion and, hence, oxygen supply, while increasing myocardial oxygen demand, contributing to aggravation of ischemia in patients with CAD.
 ...
PMID:Effect of exercise on ventricular diastolic time in coronary artery disease. 357 48

Myocardial perfusion scintigraphy with 201-TL was performed in a group of subjects affected by exercise-induced, rate-dependent left bundle branch block (LBBB). The aim of the study was: to define the significance of the exercise-induced conduction abnormality: "primitive" or "ischemic". 14 patients, aging 28-58 years (x = 42), 8 with chest pain (4 typical angina, 4 atypical angina) and 6 without any symptoms were studied. None had history of prior myocardial infarction or clinical and echocardiographic signs of heart disease. LBBB appeared at a heart rate ranging from 70 to 160 beats/min. 6 patients showed repolarization abnormalities (ST changes, deep and negative T wave) suggestive for ischemia, during successive QRS normalization. 201-TL-uptake was normal in 5 subjects; in the remaining 9 ones reversible TL defects were demonstrated in the septum (6), in the septum and apex (2), in the septum and inferior-apical wall (1). No patients had irreversible impaired perfusion. All the patients had normal coronary angiography, with negative ergonovine test for coronary artery spasm. In conclusion, in the majority of our subjects (64%) with exercise-induced LBBB, a reversible TL-uptake defect, usually located in the septum without diagnostic value of obstructive CAD, has been observed. Further studies will establish if the TL-defect is only an "apparent phenomenon" due to contraction abnormality secondary to LBBB, or, on the contrary, an expression of myocardial ischemia with normal coronary vessels as a consequence of the LBBB.
 ...
PMID:[Study of myocardial perfusion by means of scintigraphy with thallium-210 in left bundle branch block induced by exertion]. 366 78

It is obvious that the indication and clinical applications of radionuclide stress testing have been expanded and that both techniques described in this article are useful for diagnostic and prognostic purposes. The sensitivity and specificity of noninvasive stress testing have been significantly enhanced by the introduction of these radionuclide approaches for detecting ischemia in patients with undiagnosed chest pain. As mentioned previously, these tests should be ordered with a sound understanding of the principle of Bayes' theorem and of probability analysis. High-risk patients with either stable CAD or recent myocardial infarction can be identified by the severity of the abnormal response elicited. Patients with multiple thallium defects, particularly of the redistribution type, appear to be at the highest risk for subsequent cardiac events. Similarly, patients with a greater than 10 per cent fall in ejection fraction with development of multiple wall motion abnormalities and an increase in end-systolic volume seem to be in a high risk subset. Further developments with single photon emission tomography and computer quantitation of thallium or ventriculographic images should make these tests even more reliable in obtaining useful information in patients with CAD.
 ...
PMID:Radionuclide exercise testing for coronary artery disease. 639 69

The effect of dobutamine on exercise performance was assessed in 20 patients with ischemic heart disease (CAD) and a positive stress test. These patients had a wide range of resting left ventricular ejection fraction (range 22% to 69%, mean 42%). Each patient entered a double-blind crossover study in which two identical exercise radionuclide ventriculograms were performed in patients on dobutamine, 5 micrograms/kg/min intravenously, or placebo. Dobutamine increased resting left ventricular ejection fraction. Although ejection fraction fell with dobutamine during submaximal exercise, it remained higher than with placebo. At peak exercise, ejection fraction fell to the same level on dobutamine as with placebo. Dobutamine diminished exercise time and time to ischemia while peak pressure-rate product was unchanged. Four of 20 patients developed complex ventricular premature beats, all while on dobutamine. Although useful when administered to resting patients with acute left ventricular failure, dobutamine's effects may be deleterious in exercising patients with chronic ischemic heart disease.
 ...
PMID:The effect of dobutamine on exercise performance in patients with symptomatic ischemic heart disease. 669 Dec 44

We used the cold pressor test as provocative of myocardial ischemia in 23 subjects evaluated for chest pain on effort. Seven of them (group N) had normal coronary arteries, and 16 (group CAD) had critical stenoses along the main branches of the left coronary artery. In both groups exposure to cold induced increase in arterial pressure and double product. Left ventricular end-diastolic pressure increased +60% from baseline (P less than 0.001). Angiocardiographic parameters, unchanged in group N, showed an impairment of left ventricular function in group CAD. End-diastolic volume increased +11% (P less than 0.01), ejection fraction decreased -8% (P less than 0.0025), with a significant reduction in segmental wall motion in the area of the diseased artery (P less than 0.001). The mean Vcf was slightly and not significantly reduced, while early-systolic and end-diastolic stress and the constant of stiffness consistently increased in both groups. The appearance or extension of ventricular wall contraction abnormalities in group CAD, in the absence of demonstrable coronary spasm and in the presence of a remarkable increase in left ventricular end-diastolic pressure and stress, was interpreted as due to ischemia secondary to increased extravascular resistances to coronary flow. The cold pressor test is proposed as a useful tool for the diagnosis and evaluation of patients with ischemic heart disease.
 ...
PMID:Effects of the cold pressor test on the left ventricular function of patients with coronary artery disease. 687 44

To assess the effects of walk training on external work efficiency and the determinants of myocardial oxygen demand (MVO2), we measured total somatic oxygen consumption (VO2), heart rate (HR), and systolic blood pressure (SBP) in eight male coronary (CAD) patients during submaximal treadmill walking before and after at least 14 weeks of prescribed exercise. Each patient was tested before and after training at the individually determined horizontal treadmill speed that induced ischemic ST segment depression in the pretraining test. Although maximal oxygen uptake (VO2 max) did not increase significantly with training, submaximal exercise HR and the product of HR and SBP were significantly (p less than 0.05) reduced by 10% (120 leads to 108/min) and 16% (185 X 10(2) leads to 156 X 10(2)), respectively, and none of the patients had ischemic ECG changes after training. The reductions in the cardiac response to exercise were due primarily to a 10% decrease (18.9 leads to 17.1 ml/kg/min, p less than 0.05) in somatic oxygen requirements (VO2), indicating that the patients became more efficient walkers and reduced their MVO2 in proportion to the decreased total VO2. Thus, enhancement of external work efficiency, an extracardiac factor, can lessen myocardial energy costs (MVO2) and thereby raise the exercise threshold for cardiac ischemia in CAD patients even when aerobic capacity (VO2 max) is not increased.
 ...
PMID:Reduction of submaximal exercise myocardial oxygen demand post-walk training program in coronary patients due to improved physical work efficiency. 706 69

In view of the fact that stable echocardiograms are easily obtained during atrial pacing, pacing echocardiography was performed to evaluate the usefulness for detecting regional wall motion abnormalities during pacing-induced ischemia and to investigate the relationship between changes in the R wave and left ventricular dimension. The patients were 12 cases of angina pectoris (10 of coronary artery disease; CAD, and 2 of coronary patent aortic valvular disease; AVD) and 6 control cases. Simultaneous recording of two-dimensional and M-mode echocardiograms and electrocardiograms was done before, during and after the atrial pacing at increasing heart rate until angina appeared or the heart rate of at least 140/min was reached. In 12 angina cases, angina and ST depression were induced in 10 and 11, respectively. Excursion of the interventricular septum (IVS) decreased during pacing-induced ischemia in 6 of 7 CAD cases, in which the left anterior descending coronary artery was significantly stenosed (more than 75%). Excursion of the left ventricular posterior wall (LVPW) decreased during pacing-induced ischemia in 4 of 7 CAD cases, in which the vessels giving rise to posterior descending coronary artery were significantly stenosed (more than 75%). In 2 AVD cases, excursion of both IVS and LVPW decreased during ischemia. Left ventricular end-diastolic dimension (LVEDD) increased in only 2 angina cases, although R wave amplitude increased in 6 angina cases.
 ...
PMID:Pacing echocardiography: regional wall motion, left ventricular dimension and R wave amplitude in patients with angina pectoris. 708 87

This pilot study demonstrated that (1) patients with CAD and asymptomatic cardiac ischemia can be randomized to medical or revascularization strategies using a complex and demanding protocol, (2) asymptomatic cardiac ischemia can be suppressed in 40-50% of patients with clinically advanced coronary disease with relatively low to moderate doses of medication titrated over a period of 12 weeks (3). Revascularization was the most effective of the treatment strategies studied in reducing ischemia. Any type of therapy, whether it be drugs or revascularization requiring repetitive monitoring with ambulatory ECG or other methods to detect ischemia over a long period of time, will escalate the cost of quality medical care for our patients. Thus, the health care costs implications and treatment of asymptomatic ischemia are enormous. But the apparent cost advantage of treating only symptoms, that is ignoring all ischemia, could disappear if treatment of ischemia reduces the risk of adverse events. The clinical question to be addressed in the future is what is necessary to reduce the cardiac-event rates of death and myocardial infarction in this group of patients? Will more aggressive drug therapy eliminate more ischemia and will therapy directed at the elimination of all detectable ischemia improved clinical outcome better than therapy directed to control angina only? These questions can only be answered by a large clinical trial. The results of such a trial will provide the basis and rationale for safe and effective therapy for patients with coronary disease and evidence of cardiac ischemia. Whatever the answer to this important medical and scientific question is, it will have tremendous economic implications.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:Asymptomatic cardiac ischemia pilot (ACIP). 748 81


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>