Heartdrug : excellence in cardiovascular trials最新文献

{"title":"Hyperglycemia after Acute Ischemic Stroke: Prediction, Significance and Immediate Control with Insulin-Potassium-Saline-Magnesium Infusions","authors":"S. M. Vinychuk, V. Melnyk, V. Margitich","doi":"10.1159/000089600","DOIUrl":"https://doi.org/10.1159/000089600","url":null,"abstract":"Introduction: It is well known that in the first 24 h after stroke onset, plasma glucose concentrations are elevated in 20–43% of patients, of whom more than half are not known to have diabetes mellitus. Glucose levels >8 mmol/l have been found to be predictive of a poor prognosis in ischemic stroke patients. It is thought that the clinical use of insulin infusions has a beneficial effect on hyperglycemia. Indeed, insulin therapy in critically ill patients, including acute stroke patients, is safe and results in lower mortality and complication rates. Unfortunately, the impact of intensive insulin therapy in non-critically ill patients with hyperglycemia is poorly understood. Objectives: It was the aim of this study to determine the clinical efficacy and safety of early-onset therapy with human recombinant insulin: glycemic control measured by reduction in plasma glucose concentrations, vital activity measured by the Barthel index (no significant disability was defined as ≤50, moderate disability was defined as 51–75, and severe disability was defined as ≧75), and neurological deficit measured by the National Institutes of Health Stroke Scale (NIHSS; values ranging from 0 = normal to 42 = worst case) in non-critically ill ischemic stroke diabetic and non-diabetic patients. Design: We used a randomized prospec- tive open trial of insulin-potassium-saline-magnesium (IPSM) infusions in patients after acute ischemic stroke presenting with mild to moderate hyperglycemia. Acute (<24 h) ischemic stroke patients (n = 128) with hyperglycemia on admission between 7.0 and 16 mmol/l with and without type 2 diabetes mellitus (T2DM) were randomly divided into four groups: (1) hyperglycemia associated with T2DM and treated with IPSM (n = 36), (2) hyperglycemia associated with T2DM without IPSM administration (n = 40), (3) hyperglycemia without confirmed T2DM and treated with IPSM (n = 25), and (4) hyperglycemia without confirmed T2DM and without IPSM administration (n = 27). Results: Treatment with the IPSM regimen permitted to normalize blood glucose levels. The neurological deficit according to the NIHSS in stroke patients with hyperglycemia treated with insulin did not worsen in the first 3 days. Results were expressed as means ± SD of NIHSS scores at admission and at day 30. At the same time, the clinical status of patients not treated with insulin worsened. Three weeks after admission, the neurological deficit improved in treated stroke patients (13.5 ± 1.5 and 8.6 ± 1.1, respectively; p < 0.05) and untreated patients with T2DM (13.2 ± 1.7 and 8.9 ± 1.3; p < 0.05). However, the neurological deficit in stroke patients without T2DM, but with hyperglycemia not treated with insulin did not improve significantly (14.4 ± 1.5 and 10.1 ± 1.0, respectively; p > 0.05). Administration of IPSM led to a significant improvement in the neurological status (14.6 ± 1.5 and 8.9 ± 1.3; p < 0.05). Conclusions: Insulin therapy (IPSM infusion) is a safe and effective approach t","PeriodicalId":87985,"journal":{"name":"Heartdrug : excellence in cardiovascular trials","volume":"5 1","pages":"197 - 204"},"PeriodicalIF":0.0,"publicationDate":"2005-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000089600","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64295104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scientific Basis of Cardio-Pulmonary Resuscitation, an Evidence-Based Review","authors":"M. von Planta","doi":"10.1159/000089601","DOIUrl":"https://doi.org/10.1159/000089601","url":null,"abstract":"Cardiac arrest claims many lives too early. Cardiopulmonary resuscitation (CPR) is the treatment of choice in this dire situation where seconds count. Thus, a solid knowledge based on scientific data helps to guide the correct therapeutic armamentarium. Diagnostic workup, physical, electrical or pharmacological interventions are described and – where possible – classified according to published evidence. Special circumstances and ethical considerations are outlined and potentially harmful measures are summarized. Robust science should improve CPR for the majority of the patients.","PeriodicalId":87985,"journal":{"name":"Heartdrug : excellence in cardiovascular trials","volume":"5 1","pages":"205 - 213"},"PeriodicalIF":0.0,"publicationDate":"2005-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000089601","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64295273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety of Bone Marrow Stem Cell Mobilization Induced by Granulocyte-Colony Stimulating Factor: 30 Days’ Blinded Clinical Results from the Stem Cells in Myocardial Infarction (STEMMI) Trial","authors":"R. Ripa, Yongzhong Wang, E. Jørgensen, H. Johnsen, P. Grande, J. Kastrup","doi":"10.1159/000089596","DOIUrl":"https://doi.org/10.1159/000089596","url":null,"abstract":"Background: Mobilization of circulating stem cells from the bone marrow with granulocyte-colony stimulating factor (G-CSF) might promote the repair of myocardial damage after ST-elevation myocardial infarction. However, concern has been raised about the safety of G-CSF. Objective: To determine the short-term (30 days) safety of G-CSF therapy after an ST-elevation myocardial infarction treated with acute percutaneous coronary intervention (PCI). Methods: Patients with an ST-elevation myocardial infarction (treated with PCI <12 h after symptom onset) were enrolled in the STEMMI trial and randomized to G-CSF (10 µg/kg/day) or placebo for 6 days in a double-blind design. Clinical follow-up for this report was done after 1 month. The treatment allocation remains blinded and long-term follow-up is ongoing. Results: Seventy-eight patients (age 56 ± 8.4 years, 80% males, maximal creatine kinase MB 307 ± 193 µg/l) were included. G-CSF treatment was initiated 1 day (range 0–2) after PCI. Three (4%) patients suffered major adverse cardiac events in the first 30 days (1 died in progressive shock, 1 had a subacute stent thrombosis, and 1 developed significant mitral valve regurgitation). No patients had symptoms of early aggressive restenosis, and there were no cases of unstable angina or re-infarction. Eleven patients had minor musculoskeletal pain during the G-CSF treatment period. Conclusion: In this relatively small population of patients there were few major adverse cardiac events and G-CSF treatment after ST-elevation myocardial infarction seemed safe in the short (30 days) term. Further studies of long-term safety will clarify the future role of G-CSF treatment in this setting.","PeriodicalId":87985,"journal":{"name":"Heartdrug : excellence in cardiovascular trials","volume":"8 1","pages":"177 - 182"},"PeriodicalIF":0.0,"publicationDate":"2005-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000089596","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64294652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nicorandil – Review of Pharmacological Properties and Clinical Applications","authors":"J. Schmid, V. Schroeder","doi":"10.1159/000089603","DOIUrl":"https://doi.org/10.1159/000089603","url":null,"abstract":"Nicorandil is a drug which has been developed as an anti-anginal medication. Its structure is characterized by a dual mechanism of action. The nicotinamide moiety acts as an opener of ATP-sensitive potassium channels, whereas the NO2 group explains its nitrate-like properties. The nitric oxide-like action leads to a dilatation of the large coronary arteries, whereas its potassium channel opening action is responsible for the dilatation of coronary resistance vessels. Nicorandil has also been found to dilate veins, enabling it to decrease both preload and afterload and to increase coronary blood flow. The ATP-sensitive potassium channel opening mimics preconditioning in the absence of ischemia and may therefore exert cytoprotective effects. These have been thought to be the reason for a reduction in major coronary events and all cardiovascular events of nicorandil in addition to a specific anti-anginal medication in the Impact Of Nicorandil in Angina study. This review summarizes the pharmacologic properties of nicorandil and assesses its actual place in different cardiovascular disease states.","PeriodicalId":87985,"journal":{"name":"Heartdrug : excellence in cardiovascular trials","volume":"5 1","pages":"220 - 229"},"PeriodicalIF":0.0,"publicationDate":"2005-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000089603","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64295132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Ticlopidine and Aspirin versus Clopidogrel and Aspirin after Percutaneous Coronary Interventions in High-Risk Patients","authors":"P. di Pasquale, S. Cannizzaro, S. Scalzo, F. Giambanco, G. Tricoli, S. Fasullo, S. Paterna","doi":"10.1159/000089598","DOIUrl":"https://doi.org/10.1159/000089598","url":null,"abstract":"Background: Studies have shown that ticlopidine and clopidogrel in association with aspirin reduce the short- and long-term incidence of major adverse coronary events in patients undergoing stent implantation. Furthermore, clopidogrel seems to show a better side-effect profile than ticlopidine, and recent evidence supports its efficacy in long-term prevention in high-risk patients. Methods: From May 2002 to December 2003, 428 consecutive patients with 1st coronary event underwent a percutaneous coronary intervention (PCI) for non-ST elevation myocardial infarction. All patients received a glycoprotein IIb/IIIa inhibitor and were randomized in double-blind fashion to ticlopidine (500 mg/day) + aspirin or clopidogrel (75 mg/day) + aspirin before PCI. After 48– 72 h, PCI with stent implantation was performed and the treatment was continued for 6 months. Two groups were obtained. The clopidogrel group contained 214 patients (146 M/68 F), mean age 61.3 ± 11.8 years, and the ticlopidine group contained 214 patients (150 M/64 F), mean age 60.7 ± 10.5 years. A protocol that included clinical follow-up at 1, 3 and 6 months was used. Results: Both groups were comparable in baseline characteristics. We observed 14 cases of non-cardiac side effects in the clopidogrel group in the first 30 days after discharge. The ticlopidine group showed 20 non-cardiac side effects (not significant). None of the patients died during the follow-up. Both groups were similar in number of diseased vessels and number of stents. During follow-up (180 days), 48 patients from the clopidogrel group and 44 from the ticlopidine group showed reocclusion in vessels treated with percutaneous transluminal coronary angioplasty (p value not significant). In addition, we observed that reocclusion was mostly evidenced in the first 90 days (44 from the clopidogrel and 40 from the ticlopidine group). In the remaining time (90 days), we observed only 4 cases of reocclusion from the clopidogrel and 4 cases from the ticlopidine group. Conclusion: Our data suggest that ticlopidine or clopidogrel associated with aspirin determine similar effects.","PeriodicalId":87985,"journal":{"name":"Heartdrug : excellence in cardiovascular trials","volume":"5 1","pages":"187 - 192"},"PeriodicalIF":0.0,"publicationDate":"2005-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000089598","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64295379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can Statins Be Considered as a Tertiary Level Agent in Patients with Failure of Conventional Oral Hypoglycemic Agents?","authors":"V. Prabhakar, P.V. Krishna Kishore, M. Balaji, V. Balaji, V. Seshaiah","doi":"10.1159/000089597","DOIUrl":"https://doi.org/10.1159/000089597","url":null,"abstract":"Background: The effect of statins in diabetic dyslipidemia has been proven in terms of lipid lowering and mortality benefit in diabetic patients. Although experimental evidence supports the beneficial effect of statins in insulin resistance, their role in clinical practice has not been studied. In this study, the effect of rosuvastatin on fasting blood glucose (FBG) and its correlation with lipid lowering was analyzed ad hoc. Objective: This open-label, prospective rosuvastatin safety and efficacy (ROSE) study was conducted to assess the safety and efficacy of rosuvastatin in the treatment of diabetic dyslipidemia. Method: Male and female diabetic patients aged 18–75 years, with low-density lipoprotein cholesterol (LDL-C) levels greater than or equal to 2.5 mmol/l were enrolled. Rosuvastatin 10 mg once daily was administered for 8 weeks. The primary endpoint was a change in LDL-C from baseline. Secondary endpoints included a change from baseline in total cholesterol, high-density lipoprotein cholesterol and triglycerides. Liver enzymes, creatine kinase, creatinine and FBG were the safety laboratory parameters assessed. The correlation between reduction in FBG and lipid parameters was calculated using Pearson’s correlation coefficient. Results: Forty-one patients were screened and 34 were enrolled. Four were lost to follow-up and not included in efficacy analysis. Thirty patients completed 8 weeks of treatment and were analyzed for efficacy. Their mean LDL-C was significantly reduced from 4.1 mmol/l at baseline to 2.1 mmol/l (p < 0.0001) after 8 weeks of treatment. Total cholesterol, high-density lipoprotein cholesterol and triglycerides also showed a significant decrease from baseline. The mean FBG was reduced from 11.1 to 5.1 mmol/l (p < 0.0001) after 8 weeks. The decrease in lipid parameters correlated with the decrease in FBG (r = 0.083; p < 0.001). Clinically, no patient complained of any adverse event during the study period. Conclusion: Rosuvastatin significantly lowered FBG in addition to its cholesterol-lowering effect. This action could be attributed to an independent action by rosuvastatin or else be brought about indirectly by lowering lipids. Statins can be considered as a tertiary level agent when conventional oral hypoglycemic agents have failed. However, large-scale trials are necessary before application in clinical practice.","PeriodicalId":87985,"journal":{"name":"Heartdrug : excellence in cardiovascular trials","volume":"5 1","pages":"183 - 186"},"PeriodicalIF":0.0,"publicationDate":"2005-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000089597","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64295201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inhibition of the Renin-Angiotensin System and Atrial Fibrillation in Heart Failure","authors":"Maryse Palardy, A. Ducharme","doi":"10.1159/000089602","DOIUrl":"https://doi.org/10.1159/000089602","url":null,"abstract":"Background: Atrial fibrillation (AF) is the most common sustained arrhythmia encountered clinically in patients with congestive heart failure (CHF) and has been associated with increased morbidity and possibly mortality. Small retrospective studies have shown a preventive effect on AF development with the use of agents interfering with the renin-angiotensin system (RAS). Method and Results:We carried out a systematic search of the literature in the English language in order to elucidate the potential mechanism underlying this added beneficial effect of RAS inhibitors in CHF. The concepts of ionic, electrical and structural remodelling of the atrium induced by AF are discussed. Conclusion: Inhibition of RAS could prevent AF development in patients with CHF.","PeriodicalId":87985,"journal":{"name":"Heartdrug : excellence in cardiovascular trials","volume":"5 1","pages":"214 - 219"},"PeriodicalIF":0.0,"publicationDate":"2005-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000089602","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64295531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subject Index Vol. 5, 2005","authors":"J. Kastrup, V. Prabhakar, P. Kishore, M. Balaji, V. Balaji, V. Seshaiah, P. Pasquale, S. Cannizzaro, S. Scalzo, F. Giambanco, Y. Sakata, Hiroshi Satō, Kunihiro Kinjo, K. Fujii, K. Kodama, J. Tanouchi, M. Mishima, H. Kusuoka, D. Nakatani, H. Mizuno, M. Shimizu, M. Hori, M. Planta, P. Grande, G. Tricoli, S. Fasullo, S. Paterna, S. M. Vinychuk, R. Ripa, Yongzhong Wang, E. Jørgensen, H. Johnsen, V. Melnyk, V. Margitich, Maryse Palardy, A. Ducharme, J. Schmid, V. Schroeder","doi":"10.1159/000090325","DOIUrl":"https://doi.org/10.1159/000090325","url":null,"abstract":"","PeriodicalId":87985,"journal":{"name":"Heartdrug : excellence in cardiovascular trials","volume":"5 1","pages":"231 - 231"},"PeriodicalIF":0.0,"publicationDate":"2005-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000090325","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64304027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contents Vol. 5, 2005","authors":"J. Kastrup, V. Prabhakar, P. Kishore, M. Balaji, V. Balaji, V. Seshaiah, P. Pasquale, S. Cannizzaro, S. Scalzo, F. Giambanco, Y. Sakata, Hiroshi Satō, Kunihiro Kinjo, K. Fujii, K. Kodama, J. Tanouchi, M. Mishima, H. Kusuoka, D. Nakatani, H. Mizuno, M. Shimizu, M. Hori, M. Planta, P. Grande, G. Tricoli, S. Fasullo, S. Paterna, S. M. Vinychuk, R. Ripa, Yongzhong Wang, E. Jørgensen, H. Johnsen, V. Melnyk, V. Margitich, Maryse Palardy, A. Ducharme, J. Schmid, V. Schroeder","doi":"10.1159/000090326","DOIUrl":"https://doi.org/10.1159/000090326","url":null,"abstract":"","PeriodicalId":87985,"journal":{"name":"Heartdrug : excellence in cardiovascular trials","volume":"5 1","pages":"232 - 232"},"PeriodicalIF":0.0,"publicationDate":"2005-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000090326","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64304129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Author Index Vol. 5, 2005","authors":"","doi":"10.1159/000090324","DOIUrl":"https://doi.org/10.1159/000090324","url":null,"abstract":"","PeriodicalId":87985,"journal":{"name":"Heartdrug : excellence in cardiovascular trials","volume":"5 1","pages":"230 - 230"},"PeriodicalIF":0.0,"publicationDate":"2005-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000090324","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64304168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}