Prognosis Of Heart Disease Research Articles

The clinical value of detection of thyroid hormones in patients with coronary heart disease

Objective To evaluate the clinical value of the detection of thyroid hormone in patients with coronary heart disease.Methods 74 cases of patients with coronary artery disease and 36 cases of nornal healthy adults of serum TT4,TT3,FT3,FT4,TSH level,using SPSS11.0 software availability for each indicator of the level of statistical differenee.Results The coronary heart disease group and healthy control group in the TT4,TT3,FT3,FT4,TSH level on the level of the difference was not significant (P＞O.05);coronary heart disease heart failure group the serum FT3 level of coronary heart disease was significantly lower than that of non-heart failure group (P＜0.05) and nonCHD group (P＜0.01);non-heart failure and coronary heart disease serum FT3 level compared with non-CHD group had no significant difference (P＞0.05).Conclusions Coronary Heart Disease and FT3 in patients with heart failure decreased significantly with the severity of heart failure was positively related to clinical reflect on can be used as an indicator of coronary heart disease prognosis. Key words: Coronary heart disease; Thyroid hormone; Detected

Heart rate, pacing, and outcome in the Dual Chamber and VVI Implantable Defibrillator (DAVID) trials

Slower heart rates are believed to confer a better prognosis in heart disease. The Dual Chamber and VVI Implantable Defibrillator (DAVID) Trial found that patients with ventricular dysfunction and isolated sinus bradycardia (rate <60 with normal PR interval) had an unusually low incidence of heart failure (HF) hospitalization and mortality when paced infrequently. The purpose of this study was to prospectively test our hypotheses that a similar benefit from bradycardia would be conferred in DAVID II as in DAVID but that this would be nullified by the faster heart rate achieved during atrial pacing in DAVID II. Effects of atrial versus minimal ventricular pacing on outcome in defibrillator recipients with isolated bradycardia in DAVID II were prospectively evaluated. Ninety-eight DAVID II patients with isolated bradycardia were similar to 502 patients without it but had less baseline HF. HF medications were used comparably in both groups at baseline and throughout the study. Overall, patients with isolated bradycardia were less likely to die or be hospitalized for HF than others (12.2% vs. 26%; P = .01). There was no evidence that atrial pacing diminished this association. Adjusted for covariates, particularly baseline HF and its treatment, isolated bradycardia patients had substantially reduced risk for HF/death (P = .018) with or without atrial pacing (relative risk 0.47 and 0.71, respectively). Isolated bradycardia identifies patients at lower risk for HF and mortality, an association that is not necessarily negated by accelerating heart rate with atrial pacing. This apparent conundrum challenges the use of heart rate as a therapeutic target in patients with ventricular dysfunction. http://www.clinicaltrials.gov NCT00187187.

H015 Initial Heart rate variability could help to identify the patients with myotonic dystrophy at risk of death

Heart rate variability evaluation (HRV) is used to evaluate the prognosis in heart diseases at risk of cardiac mortality. Myotonic dystrophy (MD) is complicated by cardiac involvement. The purpose of the study was to evaluate the prognostic value of HRV determination for the stratification risk in MD. 60 asymptomatic patients, 26 men, 34 women, mean age 39±12 years at inclusion, had a MD. The studies were performed at inclusion and repeated 4±2.5 years later. Recording of 24 hour Holter monitoring and measurement of HRV in the time domain was calculated every 5 minutes (Elatec system); standard deviation of mean RR intervals (SDNN) was determined. Left ventricular ejection fraction (LVEF) was evaluated by 2D echocardiography. 1 – General changes of studies: LVEF tended to decrease (63±8, 61.5±19.5 %) (p< 0.06). Mean values of SDNN did not change between the first inclusion (129±41 ms) and the last study (134±51 ms). 2 – Modifications of studies according to initial data: LVEF was normal in 56 patients at inclusion. And decreased at second study 64±6 %, 61.5±7 % (p<0.01). LVEF was less than 50 % in 4 patients at inclusion and did not change at second study (43.5±7 vs 45±8 %). At inclusion, SDNN was normal in 42 patients (>100 ms) (147±35 ms) and was 148±52 at second study (NS); SDNN was < 100 ms in 2 of them at second study. SDNN was decreased (50 to 100 ms) in 17 patients at inclusion (mean 85±9 ms) and tended to increase at second study (97±34 ms) (NS). 3 – Follow-up: Initial SDNN could be predictive of the mortality: four patients died from heart and respiratory failure ; Three had an initial SDNN < 100 ms (3/17 ; 18 %) and the last one had a normal SDNN (1/42 ; 2 %) (p < 0.08). The modifications of HRV during the follow-up were not useful for the prediction of the adverse events in myotonic dystrophy, although LVEF decreased with time. However, a relatively low HRV at the first evaluation could be predictive of increasing mortality from 2 to 18 %.

Depression, antidepressants and heart disease

Around 1 in 5 people with coronary artery disease has major depression and the prognosis in heart disease is worse in those who are also depressed.1 Many antidepressants have unwanted...

Type D Personality as a Prognostic Factor in Heart Disease: Assessment and Mediating Mechanisms

Type D personality, a synergy between negative affectivity and social inhibition, has established itself as a serious risk factor for morbidity and mortality in patients suffering from cardiovascular disease. In this review, we summarize studies on the validity of the assessment methods of Type D, emphasizing its role as an independent vulnerability factor in the progression of cardiovascular disease. We further present evidence on the physiological characteristics that accompany the 2 psychological traits negative affectivity and social inhibition and may mediate the relation between personality and prognosis in heart disease. Further research needs to determine the mechanisms by which Type D affects the course and outcome of cardiovascular disease as well as how Type D patients may benefit from psychosocial intervention.

Marital Status, Marital Strain, and Risk of Coronary Heart Disease or Total Mortality: The Framingham Offspring Study

To determine if marriage and marital strain are related to the 10-year coronary heart disease (CHD) incidence or total mortality. Research has demonstrated associations between marital strain and prognosis of heart disease, but little research has addressed the association between specific aspects of marital strain and incident CHD. From 1984 to 1987, 3682 participants (mean age 48.5 +/- 10.1 (standard deviation) years; 52% women) of the Framingham Offspring Study were examined; measures of marital status, marital strain, and risk factors for CHD were collected at the baseline examination. The present study describes the 10-year follow-up for incident CHD and total mortality. After adjusting for age, systolic blood pressure, body mass index, cigarette smoking, diabetes, and total cholesterol/high density cholesterol, the married men compared with unmarried men were almost half as likely to die during follow-up (hazard ratio (HR) = 0.54; 95% confidence interval (CI): 0.34-0.83). Women who "self-silenced" during conflict with their spouse, compared with women who did not, had four times the risk of dying (HR = 4.01; 95% CI: 1.75-9.20). Men with wives who were upset by work were 2.7 times more likely to develop CHD (HR = 2.71; 95% CI: 1.22-6.03). Marital happiness, satisfaction, and disagreements were not related to the development of CHD or death in men or women. Our study suggests that marital communication, conflict, and strain are associated with adverse health outcomes. Further research into the influence of marital stress on health is merited.

Telecardiology for patients with acute or chronic cardiac complaints: The ‘SHL’ experience in Israel and Germany

Objective To assess the impact of a telemedicine program in which electrocardiogram (EKG), body weight and/or blood pressure are measured at home and medically trained personnel judge the transmitted data and council the patients by telephone. Method We systematically studied the outcome and cost-effectiveness of the cardiac programs carried out by Shahal (SHL) during the past 19 years. Result Most patients (85%) with acute complaints resembling coronary artery disease, could be reassured, representing a savings of about € 677.000 per 10,000 members/yr in Israël in 1989, and a marked reduction in patient delay to 44 min (median). In chronic heart failure a 66% reduction in hospitalisation days was observed, together with an improvement in quality of life. A large Healthcare Insurance Company in Germany (Taunus BKK) has calculated that it can save at least € 5 million per year with the use of such services. Conclusion Disease management with concomitant telemedicine for coronary artery disease and chronic heart failure is safe and effective and has a huge potential for cost savings, improvements in quality of life and in prognosis of heart disease.

Natriuretic Peptide Family: New Aspects

Thus far, five molecules comprise the natriuretic peptide family (NPF): ANP, urodilatin, BNP, CNP and DNP. Precursor hormones for ANP, BNP and CNP are encoded by a different gene. Final peptides are ligands for A, B and C receptors, acting the latter as a clearance receptor besides neutral endopeptidase (EC 24.11). cGMP acts as a second messenger. Natriuretic peptides (NP) have well-known functions such as natriuretic, antihypertensive and reduction of plasma renin-aldosterone concentrations. An antiinflammatory ANP potential and a pro-apoptotic action in rats endothelial cells of different NP have been described. Unlike adults, NP show a different distribution during ontogeny and a different pattern of excretion under different stimuli. Noncompetitive immunoassays have become more suitable than competitive ones for routine measurement of NP with recent advances in speed of measurement. BNP and pro-BNP are emerging as useful tools in diagnosis, management and prognosis of heart disease. Preliminary data support a role of NP in the therapy of congestive heart failure. Finally, potential therapeutic compounds of NP in different pathologies are updated with an important focus on vasopeptidase inhibitors. These are capable of strengthening NP and inhibiting renin-angiotensin system at the same time, as potential useful molecules in cardiovascular therapy.

Cardiomyocyte apoptotic cell death in arterial hypertension: mechanisms and potential management.

Hypertensive heart disease is a progressive condition in which the compensatory left ventricular hypertrophy that maintains cardiac output leads to myocardial remodeling, characterized by fibrosis, insufficient vascularization, and alterations in cardiomyocytes, including contractile disturbances, changes in gene expression, and decrease in the number of cells. Structural abnormalities in the myocardial wall accelerate the development of diastolic and systolic dysfunction, resulting in heart failure. Many observations point to the apoptotic cell death of cardiomyocytes as a relevant factor in the transition from compensatory hypertrophy to pump failure in experimental and human hypertension. Potential inducers of cardiomyocyte apoptosis in overloaded hearts include extrinsic factors, such as mechanical forces, neurohormonal activation, oxidative stress, hypoxia, and cytokines. Some lines of evidence indicate that angiotensin II and the overstretching of cardiomyocytes are originally involved in the triggering of apoptosis in hypertension, whereas other factors are being investigated. Furthermore, intracellular changes, such as downregulation of survival proteins or activation of death proteins, seem to play an important role. The assumption that the apoptosis of cardiomyocytes worsens hypertensive heart disease prognosis brings forth new approaches to avoid or slow the transition to pump failure. In this respect, experimental data indicate that currently used antihypertensive drugs interfere with cardiomyocyte apoptosis. Moreover, the knowledge of intracellular apoptotic processes in cardiomyocytes provides novel therapeutic strategies to be added to the multimodal approach in the prevention of heart failure.

Comparison of coronary artery computed tomography versus fluoroscopy for the assessment of coronary artery disease prognosis

Measuring the incremental gains achieved by advances in technologic proficiency is a critical step in understanding and evaluating the benefits of new medical technologies.1 Coronary computed tomography (CT) is a more expensive, accurate,2 and quantitative technique3 than cardiac fluoroscopy for identifying coronary artery calcium. A principle application of methods to detect coronary calcium is in the assessment of coronary heart disease prognosis. Although available data suggest that the prognostic accuracy of coronary CT and fluoroscopy may differ,4,5 there has been no formal comparison of the 2 techniques. Thus, this analysis compares the accuracy of coronary fluoroscopy and CT imaging for coronary heart disease outcomes in a screening cohort that underwent both tests in the South Bay Heart Watch Study.

Effects of Cilostazol on Heart Rate and Its Variability in Patients with Sick Sinus Syndrome

Objective Heart rate (HR) variability is an important factor for the prognosis of heart disease. We examined the effects of cilostazol, a quinolone derivative, on HR and HR variability in patients with sick sinus syndrome.

Longitudinal changes and prognostic implications of left ventricular diastolic function in first acute myocardial infarction

Background Left ventricular (LV) diastolic dysfunction contributes to signs and symptoms of clinical heart failure and may be related to prognosis in heart diseases. LV diastolic dysfunction is reported to be present in acute myocardial infarction (MI); however, little is known about the time course of changes in LV diastolic function and its relation to prognosis after acute MI. Methods and Results Two-dimensional and Doppler echocardiographic examinations were performed in 58 consecutive patients with first acute MI. The patients were studied serially within 1 hour and at days 5, 90, and 360 after arrival to the coronary care unit. LV diastolic function was assessed by Doppler measurements of transmitral and pulmonary venous flow. On the basis of mitral inflow, patients with MI were stratified at baseline to 3 LV diastolic filling patterns: normal, impaired relaxation, or pseudonormal/restrictive. Patients with MI were observed for development of congestive heart failure (Killip class >I) during hospitalization and for death during 1-year follow-up, and these complications were related to LV diastolic function. LV diastolic dysfunction was present in the very early phase of acute MI, with signs of impaired relaxation or restrictive LV filling dynamics in 38% and 24% of the patients, respectively, whereas 38% had normal LV filling characteristics. Impaired relaxation of the LV was most pronounced and found in 60% after 1-year follow-up. In-hospital congestive heart failure (Killip class >I) was found in 50% of the patients with initial impaired LV relaxation and in 71% of the patients with initially pseudonormal or restrictive LV filling dynamics, whereas patients with normal LV filling were free of heart failure. Patients with initial impaired relaxation and restrictive LV filling dynamics demonstrated a significant LV dilation during 1-year follow-up. Patients with initial pseudonormal/restrictive LV filling pattern were more frequently readmitted to the hospital for heart failure and had significant higher New York Heart Association class score compared with patients with normal or impaired relaxation during follow-up. Cardiac death was (n = 6) only observed in patients with pseudonormal or restrictive LV filling pattern. In a multivariate stepwise regression analysis, mitral E deceleration time ≤140 ms and age were identified as independent variables related to development of in-hospital congestive heart failure and cardiac death during 12 months of follow-up. Conclusions LV diastolic dysfunction is present in the very early phase of MI. LV remodeling and development of in-hospital congestive heart failure appear in patients with very early signs of LV diastolic dysfunction. Furthermore, mitral E deceleration time ≤140 ms best identified patients at risk of development of in-hospital congestive heart failure and cardiac death after MI. (Am Heart J 1999;137:910-8.)

Diabetes mellitus and raised serum triglyceride concentration in treated hypertension--are they of prognostic importance? Observational study.

To analyse whether metabolic changes during long term treatment with antihypertensive drugs are associated with an increased risk of coronary heart disease. Observational study. Gothenburg, Sweden. 686 middle aged hypertensive men, recruited after screening of a random population sample, and followed for 15 years during treatment with predominantly beta adrenoceptor blockers or thiazide diuretics, or both. Coronary heart disease and diabetes mellitus were registered at yearly patient examinations. Entry characteristics, as well as within study serum concentrations of cholesterol and triglycerides and the development of diabetes mellitus, were related to the incidence of coronary heart disease in a time dependent Cox's regression analysis. Coronary heart disease morbidity. Diabetes mellitus, raised serum cholesterol and triglyceride concentrations present at the beginning of the study were all significantly predictive of coronary heart disease in univariate analysis. The relative risk of diabetes mellitus and of a 1 mmol/l increase in the cholesterol and triglyceride concentrations was 2.12 (95% confidence interval 1.11 to 4.07), 1.21 (1.05 to 1.39), and 1.21 (1.03 to 1.43) respectively. However, when the within study metabolic variables were analysed, only the serum cholesterol concentration was significantly and independently associated with coronary heart disease (relative risk 1.07 (1.02 to 1.13)). Although the triglyceride concentrations increased slightly during the follow up, the within study serum triglyceride concentrations were not associated with the incidence of coronary heart disease (1.04 (0.96 to 1.10)). New diabetes mellitus-that is, onset during follow up-was not significantly associated with an increased risk for coronary heart disease (1.48 (0.37 to 6.00)). Metabolic disturbances such as diabetes mellitus and hyperlipidaemia presenting before the start of antihypertensive treatment have a prognostic impact in middle aged, treated hypertensive men. Moreover, while within study cholesterol concentration was an independent predictor of coronary heart disease, drug related diabetes mellitus and raised serum triglyceride concentrations that are associated with treatment do not seem to have any major impact on the coronary heart disease prognosis in this category of patients.

Post-ischaemic cardiac dilatation and remodelling: reperfusion injury of the interstitium.

Cardiac size and geometry have an important influence on clinical prognosis in heart disease. The cardiac interstitium would appear to play a major role in modulating muscle configuration after ischaemic insults. Ischaemic reperfusion injury of the heart should not be viewed as confined to the myocyte compartment. There are major events occurring in the interstitial compartment which could ultimately determine the long-term configuration and topography of the heart. Thus, permanent plastic changes in cardiac dimensions appear to evolve after initial alterations in the collagen matrix. The physiological, cellular, biochemical, and molecular considerations in the cardiac interstitium are quite different from those of the myocyte compartment. Accordingly, therapeutic interventions to modulate cardiac geometry and remodelling may differ.

Heart Disease in Infancy and Childhood

Three cardiologists have written the second edition of their book presenting the knowledge accumulated during the last nine years regarding the incidence, embryology, pathophysiology, clinical features, electrocardiographic changes, radiologic examination, treatment, and prognosis of heart disease in the pediatric age group. Dramatic progress has been made in the diagnosis and treatment of congenital heart disease. Technological advances have made possible diagnostic studies and surgical procedures previously inconceivable. Consecutive studies of the pathophysiology of pulmonary over-circulation have established guide lines for the management of patients with left to right shunts. Follow-up evaluation of the individual methods of surgical treatment has permitted an assessment of the merits of each. After reviewing their own observations and those recorded in the literature, the authors summarize the pertinent information and experience concerning types of heart disease found in infancy and childhood. Congenital, rheumatic, metabolic, infectious, collagen, endocrine, pulmonary, chromosomal, neuromuscular, and arteriosclerotic heart disorders are

Design of a Computer Supported Clinical Study

A computer supported clinical study concerning the natural history and prognosis of heart disease was carried out. The use of automated data processing system facilitated the collection of clinical data and permitted the use of advanced statistical- procedures in the evaluation of these data. Clinical shock was found to be the most important factor in the prognosis of this disease. Other important clinical and laboratory features of this disease were investigated statistically. Further studies concerning the application of computer systems and techniques to clinical diagnosis are in progress and will be reported upon in the future.

The postexercise electrocardiogram ∗: Its value in the diagnosis and prognosis of coronary arterial disease

The results of long-term clinical follow-up evaluation and postmortem evaluation in a large series of patients, and in a smaller series of normal healthy persons who have had postexercise electrocardiograms, are briefly reviewed and summarized. The postexercise electrocardiogram with an ischemic S-T configuration has been found to be the only reliable electrocardiographic manifestation of coronary insufficiency. It has both diagnostic and prognostic value. The presence of electrocardiographic changes in either the resting or postexercise electrocardiogram should not be considered synonymous with organic coronary arterial disease, especially obstructive coronary atherosclerosis. Such changes have been observed in patients who have normal coronary arteries but in whom metabolic and hemodynamic abnormalities are associated with either severe anemia, electrolyte disorders, drug therapy, pulmonary and systemic hypertensive vascular disease, or obstructive valvular and vascular lesions with a low and fixed cardiac output. However, since obstructive coronary atherosclerosis is by far the most common cause of coronary insufficiency, its presence should be strongly considered as the cause of coronary insufficiency until proved otherwise. Correlation with abnormalities in the coronary arteries of deceased persons who had had postexercise ischemic electrocardiographic changes indicate that, in general, ischemic S-T segment changes occur only when advanced and diffuse occlusive coronary disease is present. This finding is in agreement with physiologic and radiologic correlations as made by others in living patients. Usually people who show such ischemic S-T changes have a poor prognosis and are sensitive to complicating factors, such as thrombosis or hemorrhage into sclerotic placques, which further compromise the coronary circulation. Sudden death or arrhythmic deaths in the early stages of an infarction are common. The interval between the initial finding of ischemic changes and death, however, was quite variable and a positive test result does not indicate a grave prognosis. After 10 years, 40 per cent of the subjects studied were still living. This finding indicates the type of coronary death which might be expected. The degree and severity of S-T depression are not important in diagnosis, but they do reflect to a significant degree the severity of the insufficiency and the prognosis of heart disease. Other postexercise electrocardiographic changes, such as isolated changes in T wave polarity and junctional RS-T depression with adequate precordial tracings, presented poor correlation with subsequent clinical coronary disease or coronary disease at autopsy. These changes are not considered useful in the diagnosis and prognosis of obstructive coronary disease. When coronary atherosclerosis was the only condition found at necropsy, neither lesser degrees of generalized occlusive disease nor complete occlusive lesions in an isolated vessel, either with or without myocardial infarction or fibrosis, was regularly associated with ischemic changes. Therefore, the absence of abnormal changes in a postexercise electrocardiogram does not exclude organic coronary disease. Such a finding may occur with a different type and a lesser degree of coronary disease which has been observed to provide a more favorable prognosis for longevity but not for the eventual development of significant clinical coronary disease.

PROGNOSIS IN HEART DISEASE

Medical Journal of AustraliaVolume 1, Issue 19 p. 713-714 Leading Article PROGNOSIS IN HEART DISEASE First published: 01 May 1954 https://doi.org/10.5694/j.1326-5377.1954.tb85766.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume1, Issue19May 1954Pages 713-714 RelatedInformation

Laboratory Aids in the Diagnosis and Prognosis of Heart Disease

Laboratory Aids in the Diagnosis and Prognosis of Heart Disease

THE PRINCIPLES GOVERNING PROGNOSIS IN HEART DISEASE

Medical Journal of AustraliaVolume 2, Issue 23 p. 677-682 Original Article THE PRINCIPLES GOVERNING PROGNOSIS IN HEART DISEASE† L. E. Hurley M.D., M.S. (Melbourne), L. E. Hurley M.D., M.S. (Melbourne) Honorary Physician to Out-Patients Melbourne HospitalSearch for more papers by this author L. E. Hurley M.D., M.S. (Melbourne), L. E. Hurley M.D., M.S. (Melbourne) Honorary Physician to Out-Patients Melbourne HospitalSearch for more papers by this author First published: 01 December 1932 https://doi.org/10.5694/j.1326-5377.1932.tb90080.xCitations: 1 †Read at a meeting of the Victorian Branch of the British Medical Association on September 17, 1932. AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume2, Issue23December 1932Pages 677-682 RelatedInformation