Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 31-year-old man was admitted to our hospital for further evaluation of heart failure symptoms. Crow-Fukase syndrome was diagnosed on the basis of findings of polyneuropathy, hepatomegaly, monoclonal hypergammaglobulinemia, and hypertrichosis. Dipyridamole-stress thallium-201 perfusion imaging, contrast left ventriculography, and coronary angiography revealed a markedly dilated and dysfunctioning left ventricle, extensive reversible ischemia with fixed defect, and multiple coronary lesions. Histopathology of myocardial biopsy specimens demonstrated ischemia-induced myocardial necrosis. These findings suggested that ischemic cardiomyopathy, probably due to inflammatory reactions of coronary arteries in Crow-Fukase syndrome, was responsible for the heart failure symptoms and left ventricular dysfunction in this patient.
 ...
PMID:Crow-Fukase syndrome with ischemic cardiomyopathy. 1151 11

Repetitive myocardial ischemia during daily life has been suggested as the underlying mechanism of reversible myocardial dysfunction, which may progress into a hibernating state. Thirty-seven patients with ischemic cardiomyopathy (ejection fraction 35 +/- 7%) underwent positron emission tomography (N-13 ammonia and 18-F-fluoro-2-deoxy-glucose [FDG]) and exercise testing before coronary artery bypass grafting (CABG) and 48- hour ambulatory electrocardiographic monitoring to detect ischemia before CABG and 6 months postoperatively. Reversibility of regional myocardial dysfunction was detected by echocardiographic follow-up at 5 days, 2 months, and 6 months after the operation. Preoperatively, ischemic episodes during daily activities were more common (2 [25th to 75th percentiles 0 to 4] vs 0 episodes, p <0.01) and duration of ischemia longer (9 [25th to 75th percentiles 0 to 37] vs 0 [25th to 75th percentiles 0 to 1] minutes, p <0.02) in patients with reversible dysfunction (n = 15) than in patients with irreversible dysfunction (n = 22). The number of ischemic episodes per patient correlated with the numbers of reversibly dysfunctional segments (p = 0.003), viable segments as seen by positron emission tomography (p <0.05), and flow-metabolic mismatch segments (p <0.05). CABG eliminated ambulatory ischemic episodes in patients with reversible dysfunction (0 episodes, p <0.05 vs before CABG). Preoperatively, all patients with reversible dysfunction had a positive exercise test (14 of 15 patients), whereas daily life ischemia was present in 60% of patients. Reversibly dysfunctional segments in patients with ambulatory ischemia had faster recovery of function (15 of 28 patients vs 2 of 12 patients recovered at 5 days, p <0.05), higher FDG uptake (0.86 +/- 0.19% vs 0.71 +/- 0.24%, p <0.05) than in patients without ambulatory ischemia, whereas perfusion was similar (0.63 +/- 0.20 and 0.62 +/- 0.19 ml/g/min). Thus, exercise-induced myocardial ischemia is associated with reversibility of myocardial dysfunction, but not all patients with reversible ischemic cardiomyopathy have ischemic attacks during daily life.
 ...
PMID:Impact of daily life myocardial ischemia in patients with chronic reversible and irreversible myocardial dysfunction. 1177 17

Coronary artery disease (CAD) is very prevalent in Western societies and is a leading cause of mortality and morbidity. Despite decreases in mortality rates from CAD over the past 30 years, ischemic heart failure remains an important problem because people with CAD are now living longer. Hibernating myocardium may be defined as reversible left ventricular dysfunction due to chronic CAD that shows improvement in function after revascularization. Many patients with ischemic cardiomyopathy have areas of hibernating myocardium, and thus can potentially show improvement in left ventricular regional and global function if they are revascularized. Whether hibernating myocardium represents an adaptive response to hypoperfusion in the face of chronic ischemia or whether it is a degenerative process is not entirely clear. Clearly, ultrastructural changes of de-differentiation are seen, and include loss of sarcomeres and the appearance of small mitochondria and glycogen accumulation. Although the mechanisms underlying the changes in morphology and depressed contractility, and the factors governing recovery of function are not clear, changes in adrenergic receptor density, cytokine upregulation, and the degree of fibrosis may all play a role. Identification of viability is commonly performed with dobutamine echocardiography or nuclear imaging. Because patients with extensive CAD and poor left ventricular systolic function are high-risk candidates for coronary bypass surgery, the preoperative identification of viability provides important prognostic information. Patients with viable myocardium who are treated with revascularization rather than medical therapy have better outcomes in terms of survival, left ventricular function, symptoms, and exercise capacity.
 ...
PMID:Myocardial hibernation in coronary artery disease. 1182 79

Despite therapeutic advances in heart failure treatment, this syndrome still presents a poor prognosis, with a relevant mortality due to both systolic dysfunction progression and sudden death. Sudden cardiac death appears to be relatively more frequent in less compromised patients (NYHA functional class I) but in absolute numbers it is more frequent in more functionally compromised patients. The ability to predict sudden cardiac events with current available tests is poor, with the possible exception of electrophysiological test in ischemic cardiomyopathy. The risk of sudden death is proven to be increased in more advanced cardiac dysfunction and frequently the acute event can be precipitated by ischemia. Therefore the best approach in the prevention of sudden cardiac death may well be the proper treatment of ischemia and cardiac dysfunction. Beta-blockers have demonstrated a favorable effect in the prevention of sudden cardiac death. ACE-inhibitors can significantly reduce global death in heart failure patients, but their impact on sudden death appears to be limited. The same may be true for angiotensin II blockers. Diuretics have generally been demonstrated to increase sudden death, possibly via electrolyte imbalance; this may explain why spironolactone has a pronounced impact in reducing sudden death. Inotropes, in spite of their good effect on refractory heart failure and their usefulness in the compassionate care of terminally ill heart failure patients, have demonstrated an increase in sudden cardiac death. The same holds true for digoxin, in spite of its ability to reduce death due to heart failure deterioration. Antiarrhythmic drugs, with the possible exception of amiodarone, have demonstrated an unfavorable effect on sudden death incidence.
 ...
PMID:[Arrhythmia risk stratification in patients with heart failure according to drug treatment and its effects]. 1183 48

This study examined the value of wall motion scores at rest and with low- and high-dose dobutamine infusion for prediction of outcome and benefit from revascularization in patients with ischemic cardiomyopathy. Follow-up was obtained in 139 patients with ischemic cardiomyopathy who had echocardiography at rest, and during low- (10 microg/kg/min) and high-dose dobutamine (maximal dose 50 microg/kg/min) infusion. Both rest and low-dose wall motion scores were multivariate predictors of cardiac death, but ischemia and peak dose scores were not predictors. Rest scores risk stratified patients into 3 groups: score (1.00 to 1.99) with 11% cardiac death; score (2.00 to 2.49) with 30% death; and score > or =2.50 with 47% death. One third of patients with rest scores > or =2.50 had improvement in scores to < 2.50 with low-dose dobutamine. Their frequency of cardiac death was reduced to 23% compared with 60% (p = 0.04) in those who remained with low-dose scores > or =2.50. Low-dose scores also identified those who benefited from revascularization. In patients with low-dose scores (1.00 to 1.99), the frequency of cardiac death was marginally lower in revascularized than nonrevascularized patients (10% vs 21%, p = 0.28). In patients with scores (2.00 to 2.49), revascularized patients had a significantly lower frequency of cardiac death than nonrevascularized patients (15% vs 41%, p < 0.05). The frequency of death in those with low-dose scores > or =2.50 was very high in both revascularized (75%) and nonrevascularized (56%, p = 0.42) patients. Thus, rest and low-dose wall motion scores enable risk stratification of patients with ischemic cardiomyopathy and identify those who do and do not benefit from revascularization.
 ...
PMID:Usefulness of rest and low-dose dobutamine wall motion scores in predicting survival and benefit from revascularization in patients with ischemic cardiomyopathy. 1190 64

Clinical experience is accumulating that coronary artery bypass grafting is of great benefit in patients with advanced ischemic cardiomyopathy. At Yale University, we have analyzed short- and long-term results in 188 consecutive patients with an ejection fraction (EF) of 30% or less undergoing coronary artery bypass grafting by a single surgeon. This experience permits the following conclusions: (1) Surgery can be performed safely (mortality 2.8% in elective patients); (2) Major improvement in left ventricular (LV) function is objectively demonstrable (EF change from 23.3% to 33.2%); (3) Symptomatic improvement is noted by patients (NYHA class change from 3.1 to 1.4); and (4) Good long-term survival is realized, relative to expectations with medical management alone (88%, 77%, and 60% at 1, 3, and 5 years). If coronary artery disease is severe and proximally situated and there are adequate target arteries, we do not deny patients surgery based on EF or LV size criteria, nor do we require objective demonstration of reversible ischemia. In fact, hearts in the largest size range (left ventricular end-systolic volume index > 100 mL) actually showed beneficial reverse remodeling subsequent to coronary artery bypass grafting. Surgical revascularization is recommended strongly for patients with advanced ischemic cardiomyopathy. Results rival those of transplantation.
 ...
PMID:Coronary bypass in left heart failure. 1198 50

Seven patients with ischemic cardiomyopathy who underwent elective endoventricular circular patch plasty (EVCPP) were included in this study. The mean age of the patients at the time of surgery was 63 years old. All seven patients had anterior left ventricular aneurysms following old myocardial infarction. Two patients were graded NYHA class II, 4 patients class III, and one patient class IV. EVCPP was performed under cardiac arrest with moderate hypothermia in five patients. The two most recent patients underwent EVCPP under on-pump beating and normothermia. Coronary artery bypass grafting was conducted in all cases and the mean number of grafts was 1.8, ranging from one to three. The mitral valve was replaced in one patient. One patient died of myonephrotic metabolic syndrome caused by ischemia of the lower limb. In the follow-up of six patients, the left ventricular end-diastolic volume index (LVEDI) decreased significantly from 128 +/- 31 mL/ m2 to 108 +/- 37 mL/m2. Left ventricular end-systolic volume index (LVESI) decreased in five patients. Left ventricular end-diastolic and end-systolic diameter remained unchanged after surgery. The left ventricular ejection fraction (LVEF) increased from 0.28 +/- 0.08 to 0.321 +/- 0.1. LVESI and LVEF did not improve in one patient with a large residual dyskinetic area at the distal LV septum. A residual dyskinetic area at the distal LV septum was observed in two of four patients who underwent EVCPP under cardiac arrest. This condition, however, was not detected in two patients who underwent EVCPP under on-pump beating conditions. In the follow-up study, the grade of NYHA functional classification improved in all six patients. In conclusion, EVCPP under on-pump beating is a realistic and effective procedure with which to complete ideal LV geometry and promote good results in patients with ischemic cardiomyopathy.
 ...
PMID:Early results and operative considerations of endoventricular circular patch plasty for ischemic cardiomyopathy. 1202 1

Transmyocardial laser revascularization (TMLR) has been approved as an indirect coronary revascularization measure through angiogenesis around created channels in patients who are not amenable to direct revascularization methods such as coronary artery bypass grafting (CABG) or percutaneous transluminal coronary angioplasty (PTCA). TMLR is less invasive and there are no contraindications in terms of left ventricular function. Therefore all patients who have untreatable lesions by CABG or PTCA with reversible ischemia are candidates for TMLR therapy. In a Japanese clinical trial, improvement of left ventricular function associated with relief of persistent angina and improved perfusion was seen in 54% of patients. Significant reduction of operative risk in adjunctive TMLR (combination of TMLR with CABG) compared with isolated CABG has been also demonstrated in a randomized trial. These results indicate the usefulness of adjunctive TMLR in multivessel-disease patients with left ventricular dysfunction. Because TMLR is a simple and less-invasive technique, combined use of TMLR with off-pump CABG or MIDCAB is also an attractive revascularization strategy in ischemic cardiomyopathy patients.
 ...
PMID:[The role of transmyocardial laser revascularization in congestive heart failure]. 1238 50

There are some human diseases associated with mitochondrial DNA genome defect. Now many studies think that: oxygen radical resulting from oxidative phosphorylation(OXPHOS) disorder caused by myocardium ischemia and the increased OXPHOS induction damage mitochondrial DNA. Chronic damage accumulations lead to mitochondrial DNA deletion or point mutation in the end which show mitochondrial DNA 5.0 kb or 7.4 kb deletion and point mutation at position C15452A in the cytochrome b gene; the conservative sequence mutation of tRNA gene such as A4300G, C4320T point mutation in the tRNA Ilegene, A3243G point mutation in the tRNA leu gene etc result in defective contractile proteins whose persistent and inefficient contraction may increase the myocardium's metabolic demands for ATP and leads to cardiac hypertrophy. In this article, we review the study on the association of mitochondrial DNA mutation with ischemic cardiomyopathy and hypertrophic cardiomyopathy.
 ...
PMID:[The research progress of the association of mitochondrial DNA mutation with cardiomyopathy]. 1253 76

Plasma levels of hepatocyte growth factor (HGF) are increased within hours of cardiac ischemia/reperfusion in rats, and HGF has been shown to be cardioprotective toward acute ischemic injury. Myocardial levels of HGF mRNA and protein are increased for several days after myocardial infarction (MI), however, indicating a possible additional protective effect of HGF toward the progression of MI to heart failure. The purpose of this study was to determine whether HGF administration during the time course of endogenous cardiac HGF induction would lead to long-term improvement in cardiac function in rats with MI. MI was induced by 2-h occlusion of the left coronary artery, followed by reperfusion. HGF was given by intravenous infusion at 0.45 mg/kg/day for 6 days beginning on the day after surgery. Cardiac function and hemodynamic parameters were measured by using indwelling catheters and perivascular flow probes in conscious animals 8 weeks post-MI. Myocardial infarcts were approximately 30% of the left ventricle, and there was no difference in infarct size between the vehicle-treated and HGF-treated groups. Compared with untreated sham-operated rats, vehicle-treated MI animals had significantly lower cardiac index and stroke volume index and higher systemic vascular resistance, indicating heart failure developed. Treatment with HGF caused a significant increase in cardiac index and stroke volume index and a reduction in systemic vascular resistance in rats with MI, restoring these parameters close to those observed in sham-operated control animals. These results provide direct evidence that HGF may be of benefit to cardiovascular function in ischemic cardiomyopathy.
 ...
PMID:Early treatment with hepatocyte growth factor improves cardiac function in experimental heart failure induced by myocardial infarction. 1253 18


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