Heartdrug : excellence in cardiovascular trials最新文献

{"title":"Dobutamine-Atropine Stress Echocardiography","authors":"S. Carstensen","doi":"10.1159/000083667","DOIUrl":"https://doi.org/10.1159/000083667","url":null,"abstract":"on wall motion analysis, a subjective method for evaluation of regional LV function, and a reduction in systolic endocardial excursion or myocardial thickening during increasing stress has been the universal diagnostic criterion for stress-induced ischemia [1, 5, 6] . Stress echocardiography has gained widespread use in several countries and a huge amount of experience has accumulated in the literature over the past 10–15 years. In spite of several reports of high diagnostic accuracies with regard to the presence of CAD, it has become evident that the interpretation criteria are vaguely defi ned and in case of dobutamine-atropine stress echocardiography (DASE), that the variation in test interpretation between institutions is substantial [7] . This is a problem with regard to a widespread use of the test because a high reproducibility is mandatory when results from one centre are to be extrapolated to another. In the search for a more objective and reproducible interpretation of the 2D recordings obtained during DASE, the substudies of this thesis were conducted with the following objectives: (i) To describe global and regional systolic LV function in healthy subjects undergoing DASE. (ii) To identify the cornerstones of qualitative DASE analysis and to assess the reproducibility and diagnostic performance of strictly defi ned diagnostic criteria. (iii) To investigate the usefulness of certain quantitative parameters of systolic LV function in the appreciation of stress-induced ischemia during DASE.","PeriodicalId":87985,"journal":{"name":"Heartdrug : excellence in cardiovascular trials","volume":"5 1","pages":"101 - 116"},"PeriodicalIF":0.0,"publicationDate":"2005-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000083667","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65273359","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":"Use of Computers and Software in Medical Research","authors":"Jan Bech, K. Kjeldsen, T. Schmidt","doi":"10.1159/000083661","DOIUrl":"https://doi.org/10.1159/000083661","url":null,"abstract":"New computers, software and updated versions of already established programs are constantly being released, and from a practical point of view it may be considered nearly impossible to remain up-to-date with this constantly evolving market. The aim of the present paper is to share our own experiences with software we found convenient to use in medical research. We give an overview over different programs and provide references to relevant websites for more information. The focus is on backup programs/devices, word processors, spreadsheets/databases, graphics pages, statistics programs, Reference Manager and antivirus programs. This review will not focus on specific computers or details in various programs, it is not intended to serve as a manual.","PeriodicalId":87985,"journal":{"name":"Heartdrug : excellence in cardiovascular trials","volume":"5 1","pages":"63 - 67"},"PeriodicalIF":0.0,"publicationDate":"2005-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000083661","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65273499","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":"Reduction of Soluble E-Selectin after Combined Treatment with Simvastatin and Vitamins C and E","authors":"P. Burger, A. Schoeberlein, B. Seifert, G. Zund","doi":"10.1159/000083663","DOIUrl":"https://doi.org/10.1159/000083663","url":null,"abstract":"Objective: We investigated the influence of treatment with simvastatin and vitamins C and E on serum levels of soluble cell adhesion molecules (sCAM) as markers of atherosclerosis and endothelial activation. Methods: In 11 hypercholesterolemic patients, serum levels of sCAM were measured by enzyme immunoassay before and after 6 weeks of treatment with either simvastatin (20 mg) or vitamin C (1 g) plus vitamin E (600 mg) and after an additional 6 weeks of combined treatment. In 8 of the patients angiography was performed at study entry. Results: Baseline levels of soluble intercellular adhesion molecule-1 (sICAM-1) showed an age-dependent increase (coefficient of correlation 0.71, p = 0.014) and were higher in patients with established atherosclerotic lesions than in patients with no such lesions (369.5 ± 61.8 vs. 238.4 ± 56.4 ng/ml, p = 0.023). Whereas either treatment alone had no influence on the serum levels of sCAM, combined treatment with simvastatin and vitamins C and E reduced serum levels of soluble E-selectin from 43.2 ± 18.9 ng/ml at baseline to 39.7 ± 16.5 ng/ml (p = 0.027) at study end. Although not significant, levels of soluble P-selectin were also reduced from a mean of 125.9 ± 64.1 ng/ml at baseline to 115 ± 64.9 ng/ml (p = 0.1). Serum levels of sICAM-1 and soluble vascular cell adhesion molecule-1 (sVCAM-1) remained unchanged by this treatment. Conclusion: Combined treatment with simvastatin and vitamins C and E reduced serum levels of soluble E-selectin but had no influence on sICAM-1 and sVCAM-1 levels.","PeriodicalId":87985,"journal":{"name":"Heartdrug : excellence in cardiovascular trials","volume":"5 1","pages":"75 - 80"},"PeriodicalIF":0.0,"publicationDate":"2005-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000083663","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65273128","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":"Congress Calendar","authors":"","doi":"10.1159/000084583","DOIUrl":"https://doi.org/10.1159/000084583","url":null,"abstract":"","PeriodicalId":87985,"journal":{"name":"Heartdrug : excellence in cardiovascular trials","volume":"5 1","pages":"117 - 119"},"PeriodicalIF":0.0,"publicationDate":"2005-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000084583","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65281083","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":"Sufficient Weight Reduction Decreases Cardiovascular Complications in Diabetic Patients with the Metabolic Syndrome","authors":"G. Cocco, Stefano Pandolfi, V. Rousson","doi":"10.1159/000083662","DOIUrl":"https://doi.org/10.1159/000083662","url":null,"abstract":"Background: The metabolic syndrome is associated with an increased risk of cardiovascular complications. Especially patients with evident cardiac pathology are at high risk for further complications. A sufficient weight reduction would improve the metabolic pathology and reduce the cardiovascular risk. Unfortunately, overweight and obese patients, even with complicated coronary heart disease, do not alter lifestyles regarding fat intake and physical activity, and in a quarter of these patients body weight increases in the follow-up period. Nonetheless, these patients need a weight reduction to be protected from further cardiovascular complications. Therefore, in overweight patients with insulin resistance in whom lifestyle recommendations have failed, orlistat has been used as an adjunct to decrease significantly overweight and to improve the metabolic pathology without increasing mortality. In our opinion, orlistat could also be an adjunct to lifestyle changes in adipose, diabetic patients with the metabolic syndrome and established heart pathology and signs of incipient cardiac dysfunction. Furthermore, we hypothesize that following a sufficient weight reduction improvements in metabolic pathology and, more important to us, in cardiac dysfunction should be observed. Methods: We selected 90 adipose patients with the metabolic syndrome, diabetes type 2, hypertension, mostly with coronary heart disease and concomitant cardiac dysfunction. Cardiac dysfunction was stated when the amplitude of dyspnea was greater than class 2 of the New York Heart Association (NYHA) and when resting left ventricular ejection fraction (LVEF) was <50%. Patients attended standardized nutritional counseling sessions. The caloric restriction was sufficient to create a deficit of 500 calories per day with <30% of total calories derived from fat. All patients were also enrolled in a standardized physical program and were also encouraged to walk briskly for at least 30 min per day. Patients were divided into two groups. Orlistat (120 mg t.i.d.) and placebo (1 capsule t.i.d.) were administered according to a double-blind protocol. Results: Baseline pathology was similar in the two groups, with the exception of hemoglobin (Hb) A1C, which was slightly higher in the orlistat group, the difference being statistically significant (p = 0.031). Unfortunately, lifestyle changes (diet and exercise) induced only small changes with respect to overweight in the placebo group (no orlistat). The metabolic pathology and the cardiac dysfunction did not improve. As expected, in the other group treated with orlistat in addition to lifestyle changes, weight and body mass index decreased significantly (p < 0.001 and p = 0.013, respectively). In parallel the metabolic pathology, especially dyslipidemia, was significantly reduced. Total cholesterol, LDL cholesterol, and triglycerides decreased, while HDL cholesterol increased. These changes were very significant (p < 0.001, p = 0.001, p = 0.001 an","PeriodicalId":87985,"journal":{"name":"Heartdrug : excellence in cardiovascular trials","volume":"5 1","pages":"68 - 74"},"PeriodicalIF":0.0,"publicationDate":"2005-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000083662","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65273076","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":"Lick the Stomach and Bite the Heart?","authors":"V. Prabhakar","doi":"10.1159/000083666","DOIUrl":"https://doi.org/10.1159/000083666","url":null,"abstract":"tomatic ulcers for celecoxib versus NSAIDs were 2.01 versus 2.12% (p = 0.92) and 4.70 versus 6.00% (p = 0.49) [3] . The TARGET study (Therapeutic Arthritis Research and Gastrointestinal Event Trial) claimed that the risk of cardiovascular events was comparable among lumiracoxib, naproxen and ibuprofen. Patients in TARGET were 50 years old or older, but the study excluded patients with myocardial infarction, stroke, coronary artery bypass surgery, or congestive heart failure [4] . Less than 2% of the patients had a previous myocardial infarction or a revascularization procedure. Unfortunately, this trial, like all others in the clinical development of coxibs, did not refl ect the general population but excluded patients with known preexisting coronary artery disease. In practice, osteoarthritis frequently coexists with coronary artery disease. The reduction in the protective effect of aspirin on coronary events when coadministered with coxibs has also not been suffi ciently analyzed. In the case of patients taking low-dose aspirin, it is unnecessary to add coxibs; there is no benefi t in the reduction of ulcer complications. Moreover, questions regarding the risk of myocardial infarction remain unanswered despite polypharmacy. The review by Otterstad [1] addresses a well-known controversy about Cox-2 inhibitors and cardiovascular risk, but leaves clinical questions unanswered in the light of the Vioxx withdrawal. The main reason why clinicians choose Cox-2 inhibitors is because of their relatively lesser side effects on the gastric mucosa. In osteoarthritis patients with a risk of cardiovascular events, low-dose aspirin is advised by some clinicians along with Cox-2 inhibitors like celecoxib and lumiracoxib. This combination effectively nullifi es the benefi t of Cox-2 inhibitors on the gastrointestinal (GI) system. Low-dose aspirin also carries a risk of GI bleed [2] . The question is how many of us would use two NSAIDs for two different indications or use one NSAID for two different indications? It would be more benefi cial if these patients were prescribed aspirin at doses of 1,000 mg per day in combination with proton pump inhibitors to confer protection against cardiovascular events and GI symptoms in addition to pain relief in osteoarthritis. In the CLASS study (Celecoxib Longterm Arthritis Safety Study), for patients taking aspirin with celecoxib, the annualized incidence rates of upper GI ulcer complications alone and combined with sympPublished online: January 27, 2005","PeriodicalId":87985,"journal":{"name":"Heartdrug : excellence in cardiovascular trials","volume":"5 1","pages":"100 - 100"},"PeriodicalIF":0.0,"publicationDate":"2005-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000083666","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65273302","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":"Nesiritide Usage in Decompensated Heart Failure: Cost Effectiveness and Clinical Effectiveness","authors":"T. Lenz, D. Hilleman","doi":"10.1159/000083664","DOIUrl":"https://doi.org/10.1159/000083664","url":null,"abstract":"Background: Approximately 5 million Americans have heart failure, with 550,000 new cases diagnosed each year. In the United States, approximately 500 million USD is spent annually on drug treatment for heart failure alone. Cost-effective treatment that prevents hospitalization is of high priority when treating patients with heart failure. Nesiritide, a human B-type natriuretic peptide, is indicated for the treatment of patients with acutely decompensated heart failure. Objective: The purpose of this manuscript is to provide an overview of the clinical effectiveness of nesiritide as well as the pharmacoeconomics associated with its use. Methods: Recently published articles and abstracts were identified from Pubmed, Medline and IPA using the search terms ‘nesiritide’, ‘heart failure’, ‘pharmacoeconomic’ and ‘clinical effectiveness’. Results: Randomized, multicenter trials examining the efficacy of nesiritide in patients hospitalized with decompensated heart failure have shown nesiritide to be significantly more effective than placebo and nitroglycerin at lowering pulmonary capillary wedge pressure in patients with decompensated heart failure. Nesiritide has also shown safety and efficacy when used in an outpatient setting. Additionally, four studies have examined the pharmacoeconomics associated with the use of nesiritide. All four studies showed a decreased length of stay in either intensive care and critical care units or total hospital stay, and three of the four studies performed a cost analysis which demonstrated cost savings. Conclusion: In several studies, nesiritide has been shown to be similar or significantly more effective than standard therapy at improving the status of patients with decompensated heart failure while demonstrating cost savings and decreasing length of stay.","PeriodicalId":87985,"journal":{"name":"Heartdrug : excellence in cardiovascular trials","volume":"5 1","pages":"81 - 88"},"PeriodicalIF":0.0,"publicationDate":"2005-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000083664","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65273195","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":"Pharmacological Basics of ƒ-Current Inhibition","authors":"F. Mahlberg-Gaudin, M. Bouly, C. Chezaubernard, G. Lerebours","doi":"10.1159/000083381","DOIUrl":"https://doi.org/10.1159/000083381","url":null,"abstract":"Elevated heart rate (HR) contributes to myocardial ischaemia, especially when coronary blood supply is restricted, and is recognised as an independent risk factor for increased morbidity and mortality. Heart beat is driven by cellular automaticity of pacemaker cells in the sinus node. The slow spontaneous diastolic depolarisation phase (phase 4) of the action potential is a unique feature of pacemaker cells that confers automaticity. The ƒ-current (Iƒ) determines the slope of the diastolic depolarisation and is modulated by the autonomic system, and thus plays a key role in the regulation of heart rate. Ivabradine is a novel selective use-dependent Iƒinhibitor which exerts a pure heart rate reduction in all animal species tested, without any direct effect on myocardial contractility and relaxation, cardiac output, coronary haemodynamics, blood pressure, peripheral resistance and cardiac conduction parameters and thus affords the advantage of preserving the haemodynamic adaptations occurring spontaneously in response to exercise. These features markedly differentiate ivabradine from current anti-anginal therapies. Ivabradine was demonstrated to exert cardioprotection both on ischaemic and stunned myocardium. Pharmacological inhibition of Iƒ by ivabradine thus represents a new and promising concept in the treatment of myocardial ischaemic diseases.","PeriodicalId":87985,"journal":{"name":"Heartdrug : excellence in cardiovascular trials","volume":"5 1","pages":"14 - 20"},"PeriodicalIF":0.0,"publicationDate":"2005-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000083381","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65269762","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":"Epidemiology and Genetics, Morbidity and Mortality of Lipid-Associated Cardiovascular Disorders","authors":"S. Tonstad","doi":"10.1159/000083384","DOIUrl":"https://doi.org/10.1159/000083384","url":null,"abstract":"Cardiovascular disease has increased substantially in countries of central and eastern Europe and remains the major cause of premature death in Western populations. Cholesterol plays the major role in the underlying cause of cardiovascular disease, namely atherosclerosis. Epidemiological studies have demonstrated the prospective, strong and dose-dependent relationship between low density lipoprotein cholesterol and cardiovascular disease. In addition, evidence from molecular biology and randomized clinical trials supports the concept that elevated low density lipoprotein cholesterol is both sufficient and necessary for the development of atherosclerosis. Other risk factors than cholesterol greatly enhance the likelihood of symptomatic disease. Monogenic lipid disorders including familial hypercholesterolemia and familial defective apolipoprotein B illustrate the consequences of the dysregulation of cholesterol metabolism.","PeriodicalId":87985,"journal":{"name":"Heartdrug : excellence in cardiovascular trials","volume":"5 1","pages":"29 - 33"},"PeriodicalIF":0.0,"publicationDate":"2005-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000083384","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65270332","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":"Congress Calendar","authors":"","doi":"10.1159/000083609","DOIUrl":"https://doi.org/10.1159/000083609","url":null,"abstract":"","PeriodicalId":87985,"journal":{"name":"Heartdrug : excellence in cardiovascular trials","volume":"21 1","pages":"59 - 61"},"PeriodicalIF":0.0,"publicationDate":"2005-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000083609","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65273052","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}