The efficacy, safety, and cost of prostaglandin E-1 (PGE(1)) in the treatment of severe intermittent claudication was studied comparing a long-term treatment protocol (LTP) with a short-term treatment protocol (STP) i...
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The efficacy, safety, and cost of prostaglandin E-1 (PGE(1)) in the treatment of severe intermittent claudication was studied comparing a long-term treatment protocol (LTP) with a short-term treatment protocol (STP) in a randomized 20-week study. The study included 980 patients (883 completed the study) with an average total walking distance of 85.5 +/- 10 m (range 22-119). Phase 1 was a 2-week run-in phase (no treatment) for both protocols. In LTP, phase 2 was the main treatment phase. In the LTP, treatment was performed with 2-hour infusions (60 mu g PGE(1), 5 days each week for 4 weeks. In phase 3 (4-week interval period) PGE(1) was administered twice a week (same dosage). In phase 4 (monitoring lasting 3 months, from week 9 to 20) no drugs were used. In STP phase 2 treatment was performed in 2 days by a 2-hour infusion (first day: morning 20 mu g, afternoon 40 mu g;second day morning and afternoon 60 mu g). The reduced dosage was used only at the first cycle (week 0) to evaluate tolerability or side effects. Full dosage (60 mu g bid) was used for all other cycles. The same cycle was repeated at the beginning of weeks 4, 8, and 12. The observation period was between weeks 12 and 20. A treadmill test was performed at inclusion, at the beginning of each phase, and at the end of 20th week. A similar progressive physical training plan (based on walking) and a reduction in risk factors levels plan was used in both groups. Intention-to-treat analysis indicated an increase in walking distance, which improved at 4 weeks and at 20 weeks in the STP more than in the LTP group. At 4 weeks the variation (increase) in pain-free walking (PFWD) was 167.8% (of the initial value) in the LTP group and 185% in the STP group (p < 0.05). At 4 weeks the variation (increase) in total walking distance (TWD) was 227.6% of the initial value in the LTP group and 289% in the STP group (p < 0.05). At 20 weeks the increase in PFWD was 496% of the initial value in the LTP group vs 643% in the S
Interactive Grand Rounds is designed to provide health care providers with the opportunity to earn CME credit by accessing the Internet at www. ***. The program features a clinical case accompanied by a discussion of ...
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Interactive Grand Rounds is designed to provide health care providers with the opportunity to earn CME credit by accessing the Internet at www. ***. The program features a clinical case accompanied by a discussion of the case.
The use of vasodilator therapy in chronic AR and MR may be beneficial in selected patients and harmful in others. The hemodynamics of the two conditions are different and must be taken into account. In AR, vasodilator...
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The use of vasodilator therapy in chronic AR and MR may be beneficial in selected patients and harmful in others. The hemodynamics of the two conditions are different and must be taken into account. In AR, vasodilators reduce afterload mismatch and can preserve LV function and delay the need for surgery. However, if the patient has severely reduced diastolic blood pressure, vasodilators could potentially impair coronary perfusion. In MR, vasodilators may reduce regurgitant volume and LV preload depending on the mechanism of MR. In patients with MR caused by dilated cardiomyopathy, vasodilators reduce symptoms, and improve functional class. However, in mitral valve prolapse or hypertrophic cardiomyopathy, vasodilators may worsen the MR and should be avoided. In other primary causes of MR, vasodilators could potentially mask the development of LV dysfunction and lead to unnecessary and harmful delays in surgery.
OBJECTIVES The purpose of this study was ro determine whether antianginal medications modify the prognostic significance of exercise single photon emission computed tomography (SPECT) ischemia. BACKGROUND Antianginal ...
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OBJECTIVES The purpose of this study was ro determine whether antianginal medications modify the prognostic significance of exercise single photon emission computed tomography (SPECT) ischemia. BACKGROUND Antianginal medications (especially beta-adrenergic blocking agents) limit exercise SPECT ischemia, but it is not known whether such medications also modify the prognostic effect of exercise SPECT ischemia. METHODS We included 352 patients with coronary heart disease, who had exercise T1-201 SPECT and coronary angiography, and who were initially treated medically. Survival Cox models were applied in patients for whom classes of antianginal medications taken at exercise SPECT were the same as those prescribed for follow-up (GI;n = 136), and in patients for whom new classes of antianginal medications, including beta-blockers (GII;n = 79) or not including beta-blockers (GIII;n = 113), were added for follow-up. RESULTS During a mean 5.3 +/- 1.6 years of follow-up, 45 patients had cardiac death or myocardial infarction. Variables reflecting necrosis (irreversible defect extent, left ventricular ejection fraction) and those from coronary angiography provided equivalent prognostic information in the three groups. In contrast, the SPECT variable reflecting ischemia (reversible defect extent), which provided comparable prognostic information in GI (p = 0.005) and Gm (p = 0.004), lost its prognostic significance (p = 0.54) in GII, and was associated with a lower relative risk in GII than in GI or GIII (both p < 0.05). CONCLUSIONS In patients with coronary heart disease, the introduction of antianginal medications, when including beta-blockers, appears to have a favorable effect on the deleterious prognostic effect of exercise ischemia. (C) 1999 by the American College of Cardiology.
Endovascular treatment of cerebral vasospasm induced by subarachnoid hemorrhage has become a useful therapy. The two main treatments that have been used are balloon angioplasty and int ra-arterial papaverine infusion....
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Endovascular treatment of cerebral vasospasm induced by subarachnoid hemorrhage has become a useful therapy. The two main treatments that have been used are balloon angioplasty and int ra-arterial papaverine infusion. both treatments have been shown to reverse subarachnoid hemorrhage-induced vascular spasm, increase cerebral blood flow and improve delayed ischemic neurologic deficits induced by vasospasm. Balloon angioplasty is superior to papaverine for treatment of proximal vessel vasospasm by virtue of a more sustained effect on the vessels. Papaverine can be useful as an adjunct to balloon angioplasty and also for the treatment of distal vessels that are not accessible for balloon angioplasty.
This study examined the acute effects of amlodipine treatment on left ventricular pump function, systemic hemodynamics, neurahormonal status, and regional blood flow distribution in an animal model of congestive heart...
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This study examined the acute effects of amlodipine treatment on left ventricular pump function, systemic hemodynamics, neurahormonal status, and regional blood flow distribution in an animal model of congestive heart failure (CHF), both at rest and with treadmill exercise. A total of 14 pigs were studied under control conditions and after the development of pacing-induced CHF (240 beats per minute, 3 weeks, n = 7) or with CHF and acute amlodipine treatment for the last 3 days of pacing (1.5 mg/kg per day, n 7). Under resting conditions, left ventricular stroke volume (mt) was reduced with CHF compared with the normal state (15 +/- 2 vs 31 +/- 1, p <0.05) and increased with amlodipine treatment (23 +/- 4, p <0.05). At rest, systemic vascular resistance increased with CHF compared with the normal state (3,078 +/- 295 vs 2,131 +/- 120 dyne.s cm(-5) p <0.05) and was reduced after amlodipine treatment (2,472 +/- 355 dyne.s cm(-5), p <0.05). With exercise, left ventricular stroke volume remained lower and systemic vascular resistance higher in the CHF group, but was normalized with amlodipine treatment. With exercise, left ventricular myocardial blood flow increased from resting values, but was reduced from the normal state with CHF (normal: 1.69 +/- 0.12 to 7.62 +/- 0.74 mL/min per gram vs CHF: 1.26 +/- 0.12 to 4.77 +/- 0.45 mL/min per gram, both p <0.05) and was normalized with acute amlodipine treatment (1.99 +/- 0.35 to 6.29 +/- 1.23 mL/min per gram). Resting plasma norepinephrine was increased by >5-fold in the CHF group at rest and was not affected by amlodipine treatment. However, with exercise, amlodipine treatment blunted the increase in plasma norepinephrine by >50% when compared with untreated CHF values.-Resting plasma endothelin levels increased with CHF compared with the normal state (10.9 +/- 0.9 vs 2.8 +/- 0.4 fmol/ml, p <0.05) and was reduced with amlodipine treatment (7.5 +/- 1.5 fmol/mL, p <0.5). In other vascular beds, acute amlodipine treatment with
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