Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The purpose of this study is to increase understanding of the prognosis of coronary artery disease (CAD) patients whose anginal symptoms have been removed by medical therapy, and to evaluate the prognostic and clinical significance of silent myocardial ischemia (SMI). Cardiac events including cardiac death, acute myocardial infarction, PTCA/CABG and unstable angina were examined in 253 CAD patients who underwent ambulatory Holter monitoring, treadmill exercise testing and coronary angiography. The subjects were classified into two groups: 93 patients with exertional angina (AP) without previous myocardial infarction and 160 patients with old myocardial infarction (MI). SMI was diagnosed by Holter monitoring. Cox's proportional hazard regression model and the survival curves using the Kaplan-Meier method were used to analyze 9 variables in patients with AP, including Holter monitoring parameters, exercise parameters and angiographic findings, and 12 variables in patients with MI, including the same parameters as in AP patients. The cardiac event rate was 19% in patients with AP and 18% in patients with MI. The independent and common predictors of unfavorable outcome in both groups were severe coronary lesion and SMI. The incidence of SMI was 30% in AP patients and 38% in MI patients, the same incidence as reported in previous studies. The cardiac event rate in patients with SMI was higher than in those without SMI for both groups (28% vs 9% and 32% vs 9%; p less than 0.05). However, the most frequent cardiac event was different in the groups with SMI: PTCA/CABG in AP patients and re-infarction in MI patients. The significant predictors of cardiac events in patients with SMI were severe coronary lesion, short exercise duration, severe asynergy and exercise-induced angina in patients with AP and lower ejection fraction and maximum ST depression on Holter monitoring in patients with MI. In conclusion, it was ascertained that SMI is a significant and independent marker of unfavorable outcome in patients with CAD and that the cardiac event rate in patients with SMI was significantly higher than in those without SMI. However, severe complications such as acute myocardial infarction were more frequent in MI patients than in AP patients. Therefore, it was suggested that the use of re-vascularization procedure (PTCA/CABG) should be considered as soon as possible in patients with SMI, regardless of whether anginal symptoms are present or not.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[A study on the prognostic significance of silent myocardial ischemia in angina pectoris and myocardial infarction patients]. 201 42

To know whether the pathogenesis of impending myocardial infarction(IMI) could be predicted by the direction of ST segment shifts during an ischemic chest pain, we studied 62 patients with IMI and undergoing emergent coronary angiography(CAG). They were selected from a consecutive number of 474 patients with unstable angina. IMI was defined when patients had more than 2 episodes of chest pain at rest under intensive pharmacological interventions after their CCU admission, and at least one of those was not relieved by nitroglycerin given intravenously. They were divided into 2 groups according to ST segment shifts during chest pain; 35 patients with ST elevation (G-1) and 27 patients with ST depression (G-2). The time of CAG was individually determined in each patient according to the severity of illness. Those with acute MI within 3 months before the study and 24 hours following the chest pain just before CAG were excluded from the study. New onset angina accounted for 49% in G-1 and 4% in G-2(p less than 0.01). Average history length of IMI, frequency of symptoms after CCU admission, and interval from the last symptom to CAG were similar in each groups. Single vessel disease was more predominant in G-1 than in G-2 (54% vs 11% p less than 0.01). Intracoronary thrombus(IT) in an ischemia related artery(IRA) was found in 97% of G-1 and 22% of G-2(p less than 0.001), while complex lesions(CL) proposed by Ambrose as another genesis of IMI were in 26% of G-1 and 74% of G-2(p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Clinical significance of ST segment shifts during chest pain in predicting the pathogenesis of impending myocardial infarction]. 202 79

The incidence and prognostic significance of silent myocardial ischaemia in 165 patients who survived a first acute myocardial infarction were assessed by means of maximal exercise stress test and 24 h continuous ECG monitoring performed before discharge. During the 1 year follow-up period 10 cardiac deaths occurred; moreover seven patients suffered a fatal myocardial re-infarction and 14 developed unstable angina. Cardiac death occurred in five of 40 patients (12.5%) with ST segment depression on stress test by in only three of 117 (2.6%) without ST segment changes (P less than 0.01). One-hundred-and-three of 117 patients (88.0%) without angina or ST segment depression on stress testing survived 1 year without cardiac events, compared with 24 of 40 patients (60.0%) with ST segment depression whether or not associated with angina (P less than 0.001). Cardiac death occurred in five of 25 patients (20.0%) with ST segment depression on continuous ECG monitoring, compared with five of 140 (3.6%) without (P less than 0.01). One-hundred-and-seventeen out of 140 patients (83.6%) without angina or ST segment depression survived 1 year follow-up without cardiac events, compared with 13 of 25 (52.0%) with ST segment depression with or without angina (P less than 0.01). Classifying patients in a 2 x 5 contingency table according to the occurrence of ST segment depression on exercise testing and/or ECG ambulatory monitoring, the Yates corrected chi-square test showed a significant pattern when cardiac deaths and cardiac events were considered together (P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Prevalence and prognostic significance of silent myocardial ischaemia detected by exercise test and continuous ECG monitoring after acute myocardial infarction. 204 52

The advent of thrombolytic therapy for patients with suspected acute myocardial infarction has highlighted the importance of the initial electrocardiogram (ECG) in decision making. Thus we analysed the initial ECGs of 94 consecutive cases with suspected myocardial infarction who were seen within six hours after the onset of chest pain by a mobile coronary care unit. The study included 91 patients (three patients admitted twice) (61 male), aged 27-83 years (mean 60.5). Median time from onset of chest pain to arrival of the mobile coronary care unit was 75 minutes (range 15-345), and mean mobile coronary care unit response time was 12.3 +/- 7 (SD) minutes (range 5-45). The majority of cases (65 of 94, 69.1 per cent) were seen within two hours of the onset of symptoms. A final diagnosis of myocardial infarction was made in 48 of 94 (51.1 per cent) cases; 38 had unstable angina and eight other diagnoses. Of the 48 with myocardial infarction the initial ECG showed ST segment elevation in 37, ST depression and or T wave inversion in six, Q waves only in three and left bundle branch block in two. No patient with an initially normal ECG had a myocardial infarction. Thrombolytic therapy was given out of hospital to 33 of 38 patients with ST segment elevation. In seven patients with ST elevation (median delay time to intensive care 60 minutes), rapid resolution of ST segment elevation occurred following thrombolytic therapy and there was no significant elevation of cardiac enzymes, suggesting that the infarct had been aborted.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The initial electrocardiogram in patients seen by a mobile coronary care unit. 204 17

The prognostic value of information derived from clinical characteristics and exercise treadmill tests performed before discharge and repeated at three months was evaluated in 205 consecutive patients followed for five years. Recurrent myocardial infarction, unstable angina and mortality were tabulated. Survival was analyzed by the Kaplan-Meier life-table method and the Cox regression model. The major difference between the predischarge and three month intervals was the failure of exercise-induced ST depression to predict mortality from the predischarge test. However, it was predictive of mortality at three months when 76% survived five years with a positive ischemic response compared to 94% with a negative response (P less than 0.0005). In contrast, resting ST depression of at least 1 mm was associated with a very poor five year survival rate of 58.3% and 50% when assessed at both predischarge and three months (P less than 0.0005 and P less than 0.004, respectively). Selected univariately at the predischarge interval, the following characteristics were ranked in descending order of predictive power for five year mortality by discriminant analysis: history of previous infarction; exercise capacity; and ST depression on resting ECG greater than 1 mm. At three months, the same characteristics were selected. However, recurrent infarction and unstable angina were not predictable at either interval by any clinical or treadmill variable. Characteristics tending to reflect poor exercise capacity are stronger predictors of five year outcome than exercise-induced ischemia. While predischarge exercise testing for ST segment response failed to predict survival, this variable showed improved predictive power with repeat testing at three months.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Importance of timing of treadmill predictors for risk stratification after myocardial infarction: a five year follow-up study. 204 85

Clinical presentation and course were studied in 127 consecutive patients with angiographically proven left main coronary artery disease. Mean age was 62 (37-79) years. Thirteen patients (10%) had no history of chest pain, seven (5%) had atypical chest pain, and the remaining 107 (85%) typical angina pectoris. Eighty-two patients (65%) had unstable angina, 73 had suffered a myocardial infarction (MI) in the past, and 50 (68%) had post MI angina pectoris. The electrocardiogram was analysed in 102/125 patients during an episode of chest pain and also when they were without chest pain. Outside an episode of chest pain the ST segment was normal in 42 patients (32%), the T wave was normal in 50 patients (38%) and both the ST and T were normal in 33 patients (25%). During chest pain all patients had an abnormal ECG, the most frequent pattern being ST segment depression in leads V3, V4 and V5 (with maximal depression in V4), and ST segment elevation in leads V1 and aVR. The average number of leads with ST-T abnormalities was 6.4. A symptom-limited exercise test on a treadmill with 12-lead ECG monitoring was performed in 89 patients. The exercise test was abnormal in 88 patients (99%), most of whom (74 patients) were already in the first or second stage of the Bruce protocol. The most frequently observed abnormality was ST segment depression of 2 mm or more in leads V4, V5, and V6, and ST segment elevation in leads V1 and aVR. The systolic blood pressure during exercise fell or remained at the same level in 38 patients (43%).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Clinical presentation and prognosis of left main coronary artery disease in the 1980s. 206 83

The relation between the results of the early submaximal symptom-limited bicycle ergometry [correction of veloergometric] test and coronary angiography were examined in 127 patients with unstable angina pectoris stabilized by medicaments. In 19 (15.0%) patients the test was negative and in 108 (85%) patients the test was positive (angina pectoris and/or ST depression greater than or equal to 0.1 mV at 80 ms after the point J of the ECG). Between the results of the early bicycle ergometry [correction of veloergometric] test and the coronary angiography, performed soon after the test, there was a close correlation. By using strict criteria or a combination of criteria for assessment of residual ischemia the test can with great accuracy differentiate the patients with multivascular from those with monovascular disease or with healthy coronary vessels.
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PMID:[The early bicycle ergometry test in drug-stabilized patients with unstable angina pectoris--the correlation with coronary angiography]. 208 Jun 9

In patients with coronary artery disease, angina pectoris provides an unreliable underestimation of disease activity and risk. Unheralded myocardial infarction and sudden death are common clinical presentations. Furthermore, objective testing, in hospital and more recently during the patient's normal daily activities, has demonstrated frequent and asymptomatic episodes of ischemia, as indicated by transient ST-segment depression. Since the underlying pathophysiologic disturbances of myocardial perfusion appear to be similar in painful and painless episodes, it seems appropriate to consider them together as the "total ischemic burden" on the myocardium. Research into this functional expression of coronary disease has indicated that active ischemia is associated with an increased risk of morbid events in all clinical subgroups of patients, including those with stable angina, unstable angina, peripheral vascular disease and following myocardial infarction. If this is confirmed in prospective trials, the assessment of total ischemic burden is likely to become part of the clinical investigation of patients with coronary disease. Clinical trials testing the efficacy of interventions will need to examine the effect on ischemic activity during normal daily life, in addition to symptoms and exercise tolerance. Evidence is still required to demonstrate whether therapy aimed at reducing the total ischemic burden will prolong life. The total ischemic burden provides a marker to follow the dynamic changes of the atherosclerotic lesion. Future research may have to concentrate on treatment aimed at altering the natural history of obstructive coronary atherosclerosis in order to affect the long-term outlook for patients with coronary artery disease.
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PMID:Total ischemic burden in patients with coronary artery disease. 209 78

Platelet behavior was compared in two groups of patients with unstable angina: 13 patients with rest pain and ST depression on the electrocardiogram (the intermediate coronary syndrome), 14 patients with progressive angina without rest pain, and 20 healthy controls. Both patient groups had hyperaggregating platelets when compared with the controls (p less than 0.01). Platelet aggregation was measured ex vivo in the presence of arachidonic acid. Serum thromboxane B2, plasma beta-thromboglobulin, and platelet factor 4 were all temporarily increased in the group with intermediate coronary syndrome (p less than 0.01), whereas measurements in patients with progressive angina were not significantly different from the controls. Thus, patients with the intermediate coronary syndrome, who have a high frequency of suboccluding coronary artery thrombus and a very serious prognosis, had severely altered platelet behavior in contrast to patients with progressive angina.
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PMID:Unstable angina pectoris. Platelet behavior and prognosis in progressive angina and intermediate coronary syndrome. 213 15

In a prospective study the significance of silent ischemia was evaluated in 66 patients with a clinical diagnosis of unstable angina (no requirement for reversible ST-T changes during pain on 12-lead electrocardiograms before entry), and the results of continuous 2-channel electrocardiographic (ECG) recordings, begun within 24 hours of admission, were compared with other clinical and ECG predictors of adverse outcome. Ischemic changes were detected in 7 patients (11%) during a mean of 41 hours of recording. There were 37 episodes of transient ST-segment change (16 ST elevation, 21 ST depression) of which 11 (30%) were symptomatic and 26 (70%) were silent. All 7 patients had at least 1 silent episode and 5 also had symptomatic episodes during the recording but only 2 patients had exclusively silent episodes. During a mean follow-up of 13.3 months, 3 patients died, 5 had a nonfatal myocardial infarction and 32 required revascularization. Although transient myocardial ischemia during the continuous ECG recording, whether silent or symptomatic, was a specific predictor of subsequent nonfatal myocardial infarction or death (specificity 92%), its sensitivity for these events was low (25%). In contrast, recurrent rest pain (greater than or equal to 1 episode) occurred in all patients with these serious adverse events (sensitivity 100%, specificity 49%). Transient ischemia occurs infrequently during continuous ECG recordings in patients with unstable angina not selected by reversible ST-T changes on a 12-lead electrocardiogram at entry. Recurrent rest pain after hospital admission is a more sensitive predictor of serious events in this group.
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PMID:Clinical significance of silent ischemia in unstable angina pectoris. 218 94


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