Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts: Gene/Protein Disease Symptom Drug Enzyme Compound   Target Concepts: Gene/Protein Disease Symptom Drug Enzyme Compound

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Query: UMLS:C0011849 (diabetes)
277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A total of 4,000 consecutive electrocardiograms covering an 8-yr period was studied and all cases with pure left anterior hemiblock reviewed on the basis of clinical diagnosis and subsequent follow-ups. There were 66 cases in all, representing 1.6% of the total series with an age range of 30--81 and a mean of 53.4 yr; 43 males to 23 females--a ratio of approximately 2 : 1. 34 cases (51.5%) were hypertensives all with a minimum diastolic pressure of 120 mm Hg before treatment. Congestive cardiomyopathy accounted for 16 cases (24.3%) and diabetes mellitus unassociated with other ailments for another 6 cases (9.1%). Other causes included mixed aortic valve disease with 2 cases (3%), endomyocardial fibrosis with 2 cases (3%). In 6 patients (9.1%), all above the age of 70, who had been admitted for minor surgical operations, no cause could be found. This etiological pattern differs from that seen in white populations where ischemic heart disease is by far the commonest cause. The extreme rarity to left anterior hemiblock in rheumatic mitral valve disease is considered of help in separating cases of lone rheumatic regurgitation from those of mitral regurgitation complicating congestive cardiomyopathy if and when diagnostic difficulty arises.
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PMID:Left anterior hemiblock in adult Africans. 64 77

Clinical, biochemical, radiological and echo-cardiographic (echo) evaluation was done prospectively in 50 patients of untreated end stage chronic renal failure (CRF). While clinically congestive cardiac failure (CCF) was diagnosed in 24%, low ejection fraction on echo was found in only 16%. Echo in these cases showed evidence of cardiac chamber dilatation in most (mean LVID (D) 54.1 +/- 6.51 and (S) 36.4 +/- 6.9 mm, but parameters of cardiac functions were normal in most. Mitral annular calcification (MAC) was detected on echo in 26%. On comparing patients with MAC (Group I) and those without MAC (Group II), the aetiological factor found more frequently in Group I was diabetes (61.5% vs 35.1%, P less than 0.05). Clinical features such as older age (mean age 54 years vs 45.5 years), severe hypertension, and grade IV and above murmur (15.2% vs none) were more common among group I patients. However, the difference was not statistically significant. Parameters of calcium metabolism were similar in the two groups. Conduction disturbances (30.7% vs 5.4%) were significantly more common in Group I (P = 0.05). The mitral regurgitation due to MAC was of no haemodynamic significance. Complications of MAC syndrome were rare.
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PMID:Mitral annular calcification in untreated chronic renal failure. 162 45

Coronary bypass surgery was performed prior to hospital discharge in 303 (22%) of 1387 consecutive patients enrolled in the TAMI 1 to 3 and 5 trials of intravenous thrombolytic therapy for acute myocardial infarction. Bypass surgery was of emergency nature (less than 24 hours from treatment with intravenous thrombolytic therapy) in 36 (2.6%) and was deferred (greater than 24 hours) in 267 (19.3%) patients. The indications for bypass surgery included failed angioplasty (12%); left main or equivalent coronary disease (9%); complex or multivessel coronary disease (62%); recurrent postinfarction angina (13%); and refractory pump dysfunction, mitral regurgitation, ventricular septal rupture or abnormal predischarge functional test (1% each). Although patients having bypass surgery were older (59.5 +/- 9.8 versus 56.0 +/- 10.2 years, (p less than 0.0001), had more extensive coronary artery disease (46% with three-vessel disease versus 11%, (p less than 0.0001), had more frequent diabetes mellitus (19% versus 15%, (p = 0.048), had more prior infarctions (p less than 0.0001), had more severe initial depression in global left ventricular ejection fraction (48.0 +/- 11.9% versus 51.8 +/- 11.9%, p = 0.0002), and regional infarct zone (-2.7 +/- 0.94 versus -2.5 +/- 1.1 SD/chord, p = 0.02) and noninfarct zone function (-0.36 +/- 1.8 versus 0.43 +/- 1.6 SD/chord, p less than 0.0001) than patients not having coronary bypass surgery, no difference in the incidence of death in hospital (7% surgical versus 6% nonsurgical) or death at long-term follow-up of hospital survivors (7% surgical versus 6% nonsurgical) was noted between groups. Surgical patients demonstrated a greater degree of recovery in left ventricular ejection fraction (3.4 +/- 9.8% versus 0.16 +/- 8.5%, p = 0.036) and infarct zone regional function (0.71 +/- 1.1 versus 0.34 +/- 0.99 SD/chord, p = 0.001) when immediate (90 minutes following initiation of thrombolytic therapy) and predischarge (7 to 14 days after treatment) contrast left ventriculograms were compared than did patients who received only intravenous thrombolytic therapy with or without coronary angioplasty. These data suggest a beneficial influence of coronary bypass surgery on left ventricular function and possibly on the clinical outcome of patients initially treated with intravenous thrombolytic therapy for acute myocardial infarction.
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PMID:Coronary bypass surgery improves global and regional left ventricular function following thrombolytic therapy for acute myocardial infarction. TAMI Study Group. 190 87

The effect of diabetes on survival after coronary bypass surgery is uncertain. Also, although the overall clinical benefits of internal mammary artery (IMA) grafting are well established, the survival benefit attributable to IMA grafting in diabetics is not well characterized. To determine the influence of diabetes and IMA grafting on survival after bypass surgery in the current surgical era, characteristics related to subsequent outcome were analyzed in 5,654 consecutive patients undergoing surgery in the decade of the 1980s. The 1,132 diabetic patients (20%) had more extensive coronary disease, had more left ventricular dysfunction, were older, were more frequently female, received a greater number of grafts (mean, 3.5 versus 3.1), and received more IMA grafts (67% versus 58%) than the 4,522 nondiabetic patients (all p less than 0.001). Overall 5-year survival probability was 0.91 in nondiabetic and 0.80 in diabetic patients (p less than 0.0001). Nondiabetic survival exceeded diabetic survival even in high-risk subgroups such as ejection fraction less than or equal to 0.40 (0.80 versus 0.66, p less than 0.02), age greater than or equal to 65 years (0.85 versus 0.73, p less than 0.0003), and, urgent surgery (0.89 versus 0.76, p less than 0.0001). By multivariate analysis, impairment of left ventricular function, advanced age, failure to use an IMA graft, diabetes, female sex, urgent surgery, number of diseased vessels, and mitral insufficiency were incremental risk factors for cardiac mortality (all p less than 0.006). Failure to use an IMA graft and diabetes were equally strong predictors of outcome. Use of an IMA graft conveyed an independent survival benefit to both nondiabetic (p less than 0.0001) and diabetic (p less than 0.02) patients. The magnitude of the survival benefit attributable to IMA grafting in the two groups did not differ (p = 0.4). Diabetes is an important risk factor for late cardiac mortality after bypass surgery and should be included in analyses of the efficacy of therapies for coronary artery disease. IMA grafting conveys a similar benefit to diabetic and nondiabetic patients but does not negate the adverse effect of diabetes on survival.
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PMID:Influence of diabetes and mammary artery grafting on survival after coronary bypass. 193 20

It is common for patients to be diagnosed as having valvular regurgitation by Doppler echo when no such murmur has been heard by the referring clinician. To test the hypothesis that such patients have clinically unimportant heart disease, the authors evaluated the records of 213 consecutive men in whom mitral regurgitation had been found by pulsed Doppler. In 95 patients (group I) mitral regurgitation was audible, whereas in the other 118, it was not. In 97 patients with inaudible mitral regurgitation there were no structural mitral valve abnormalities by 2D echo. This group of 97 patients (group II) was defined as having unexpected Doppler mitral regurgitation. In group II patients there was a high prevalence of hypertension (50%), congestive heart failure (44%), alcohol abuse (46%), diabetes (27%), coronary artery disease (63%), and atrial fibrillation (13%). The following variables were distributed similarly in groups I and II: survival time, age, presence of congestive heart failure or coronary artery disease, left ventricular short-axis end diastolic and end systolic dimensions, E point septal separation, and the severity of dyssynergy. Atrial fibrillation was more common in group I (p = 0.017), and group I patients had a higher Quetelet's Index (weight/height squared) (p = 0.03). In group II, the factors most closely related to survival were the presence of dyssynergy, of atrial fibrillation, or of congestive heart failure. Although no group II patient had endocarditis or required mitral valve replacement, their survival was markedly decreased compared with people of similar age in the general population. The majority of cardiogenic deaths in group II patients were due to coronary artery disease.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The natural history of unexpected Doppler mitral regurgitation. 270 50

Mitral annulus calcification is a common finding in old people. In order to know the association of mitral annulus calcification with other pathologic conditions, 25 patients were studied by echocardiography, 20 females and 5 males. No significant differences _ere observed with respect to sex. The average age was 67 +/- 15 years. Mitral annulus calcification was associated with aortic sclerosis in 100% of the cases, to arterial hypertension in 19 (76%), to obstructive pulmonary disease in 8 (32%), to diabetes mellitus in 5 (20%), and to peripheral arterial insufficiency in 5 (20%). Mitral regurgitation was found in 14 cases, atrial fibrillation in 2 (8%). Complete A-V block was not observed, but there was enlargement of the left ventricle in 23 (92%) and of the left atrium in 17 (68%). The chest X-ray showed mitral annulus calcification in 5 (20%) with a sensitivity of 25% and a specificity of 100%. The M-mode echocardiogram showed LA-Ao ratio of 1.4 +/- 0.3, the mitral valve D-E excursion was reduced 11.9 +/- 3.1 mm. and also the E-F slope 28.6 mm/seg +/- 16.7 with appearance of mitral stenosis, but the two-dimensional study demonstrated that this was false. In all patients the left ventricle was dilated and fractional shortening was diminished. Echocardiography not only is a good diagnostic method for mitral annulus calcification, it also allow us to evaluate the hemodynamic consequences of this pathology which occurs in older patients and is often associated with other common illnesses of advanced age. In our study 56% of mitral annulus calcification cases were associated with mitral regurgitation.
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PMID:[Study of calcification of the mitral annulus. Importance of echocardiographic analysis]. 278 87

Among 2,004 patients who underwent their first coronary artery bypass graft operation between January 1970 and December 1980 without concomitant valve replacement or aneurysmectomy, life-table survival was 89% at 5 years and 80% at 8 years after surgery. In a multivariate Cox model analysis, the independent correlates of long-term survival were emergent operation with cardiogenic shock (multivariate mortality rate ratio [RR] = 14.0), use of a postoperative intraaortic balloon pump (RR = 3.9), ejection fraction less than 50% (RR = 2.4), preoperative history of congestive heart failure (RR = 2.2), cardiopulmonary bypass time (RR = 1.4 for each 30-minute increment), uncorrected mitral regurgitation (RR = 1.5 for each increment of angiographic gradation), left main coronary artery narrowing (RR = 1.7) and diabetes (RR = 1.6). After controlling for these factors, age, sex and the percentage of narrowings that were bypassed were not independent correlates of long-term survival.
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PMID:Long-term survival of more than 2,000 patients after coronary artery bypass grafting. 348 71

One hundred eighteen consecutive patients undergoing valve replacement for aortic stenosis were analyzed to determine the incidence of and predisposing factors to postoperative atrial tachyarrhythmias. Univariate and multivariate analyses were performed on 70 clinical, hemodynamic, radiographic, electrocardiographic, operative, and postoperative variables. Forty-seven patients (40%) experienced atrial tachyarrhythmias at a median of 3 days after surgery (70% atrial fibrillation, 22% atrial flutter, and 6% junctional tachycardia). Preoperative descriptors associated with an increased prevalence of atrial tachyarrhythmias were age 70 years or older (p less than .02), mitral regurgitation (p less than .002), history of paroxysmal atrial fibrillation (p less than .03), or antiarrhythmic therapy (p less than .006), diabetes mellitus (p less than .01), and elevated pulmonary systolic, mean, and capillary wedge pressures (p less than .02, p less than .007, p less than .005). Postoperative descriptors were prolonged respirator therapy (p less than .001), use of catecholamines (p less than .01) or vasodilators (p less than .05), and prolonged stay in the intensive care unit (p less than .04). Multivariate analysis of these 12 variables showed advanced age, diabetes mellitus, and prolonged respirator use to be independently associated with atrial tachycardias and to predict them with a sensitivity of 62% and a specificity of 77%. Anticipation of atrial arrhythmias in patients with specific clinical descriptors may be used to guide prophylactic therapy.
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PMID:Clinical correlates of atrial tachyarrhythmias after valve replacement for aortic stenosis. 402 60

Thirty one cases of congestive cardiomyopathy previously diagnosed as "idiopathic" were retrospectively studied in order to determine the prevalence of the following pathologic myocardial factors (MFs): severe alcoholism (A), systemic arterial hypertension (SAH) and obstructive coronariopathy (OC). Sixteen (51%), 14(45%) and 9(29%) cases had an association with A, SAH and OC, respectively. Any of these MFs was present in 48% of cases, 2 of them in 19% and 3 in 13% of cases. Some peculiarities of the clinical findings, a particular interpretation of such findings by the attending physician and a modification of the psychological status of some patients were the main causes which prevented the recognition of these MFs. Besides, 67% of the cases had at least one of the following "minor" factors which contributed to the myocardial damage: mitral insufficiency, pulmonary embolism, atrial-ventricular block and diabetes mellitus. A careful investigation of these MFs should be done before a diagnosis of idiopathic congestive cardiomyopathy is considered. In some cases there is more than one pathogenic factor.
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PMID:[Importance of various myocardial factors in "primary" congestive cardiomyopathies]. 651 41

In hearts from aged rhesus monkeys, ranging from 20 to over 30 years, marked coronary arterial ectasia, dilatation, and tortuosity of the entire vessel were observed in 18 animals. Another 7 animals showed a moderate degree of ectatic changes. Dilated arteries showed remarkable thinness of the tunica media with atrophy and attenuation of the muscle cells and increased fibrous tissue. Diffuse or focal intimal fibrous thickening was present in the ectatic arterial wall, but cholesterol deposit, calcification, or the presence of lipid-laden foam cells in the intimal and medial wall was not observed. A focal degeneration and fibrosis of the myocardium were seen in the hearts of 11 cases. Clinically, 2 cases had either spontaneous diabetes mellitus or cardiac decompensation with mitral insufficiency, but the others had no abnormal metabolic or cardiovascular histories. Coronary arterial ectasia accompanied with medial fibrosis appears to be a predominant type of coronary arterial lesion in aged rhesus monkeys under long-term captivity.
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PMID:Coronary arterial ectasia, a predominant type of coronary sclerosis in aged captive rhesus monkeys (Macaca mulatta). 685 17


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