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  1. Article: The cardiovascular risk factor, left ventricular hypertrophy, is highly prevalent in stable, treated angina pectoris.

    Ang, Donald Swee Cheng / Pringle, Stuart D / Struthers, Allan D

    American journal of hypertension

    2007  Volume 20, Issue 10, Page(s) 1029–1035

    Abstract: Background: In coronary artery disease (CAD), a potentially reversible factor leading to cardiac death is left ventricular hypertrophy (LVH). However, LVH will only have a large impact overall in CAD if it is highly prevalent. Therefore we aimed to ... ...

    Abstract Background: In coronary artery disease (CAD), a potentially reversible factor leading to cardiac death is left ventricular hypertrophy (LVH). However, LVH will only have a large impact overall in CAD if it is highly prevalent. Therefore we aimed to assess the prevalence of LVH in patients with stable, treated angina and its relationship with blood pressure (BP).
    Methods: Three hundred twenty-two consecutive patients with angiographically confirmed coronary artery disease were recruited. Echocardiographic LV mass was performed and correlated with both office and 24-h ambulatory BP.
    Results: Of the 267 patients with LV mass measurements, 195 (73%) had LVH. The mean 24-h ambulatory BP reading was systolic 125 +/- 12 mm Hg and diastolic 68 +/- 8 mm Hg in the LVH group. Of the LVH patients 62% had a nonhypertensive 24-h BP reading. On multivariate logistic regression analysis, factors independently related to LVH were history of hypertension (odds ratio [OR] 1.848, 95% confidence interval [CI] 1.051-3.248), body mass index (OR 1.085, 95% CI 1.011-1.165), and age (OR 1.039, 95% CI 1.004-1.076).
    Conclusions: We conclude that echo LVH is very common in patients with stable, treated angina and the majority of these patients had a nonhypertensive BP at the time of study. Studies are now required to determine whether identifying and vigorously treating LVH in CAD would reduce the risk of premature death in these patients.
    MeSH term(s) Aged ; Angina Pectoris/complications ; Angina Pectoris/drug therapy ; Angina Pectoris/physiopathology ; Blood Pressure/physiology ; Coronary Artery Disease/complications ; Coronary Artery Disease/drug therapy ; Coronary Artery Disease/physiopathology ; Death, Sudden, Cardiac/etiology ; Death, Sudden, Cardiac/prevention & control ; Echocardiography ; Female ; Humans ; Hypertrophy, Left Ventricular/complications ; Hypertrophy, Left Ventricular/diagnostic imaging ; Hypertrophy, Left Ventricular/physiopathology ; Male ; Middle Aged ; Prevalence ; Risk Factors
    Language English
    Publishing date 2007-10
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 639383-4
    ISSN 1879-1905 ; 0895-7061
    ISSN (online) 1879-1905
    ISSN 0895-7061
    DOI 10.1016/j.amjhyper.2007.04.021
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    Zs.A 2329: Show issues Location:
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  2. Article: Spironolactone has antiarrhythmic activity in ischaemic cardiac patients without cardiac failure.

    Shah, Nimit C / Pringle, Stuart D / Donnan, Peter T / Struthers, Allan D

    Journal of hypertension

    2007  Volume 25, Issue 11, Page(s) 2345–2351

    Abstract: Objectives: To examine whether endogenous aldosterone can cause either arrhythmias (and some of their underlying mechanisms) or endothelial dysfunction in patients with coronary artery disease (CAD) but without heart failure.: Background: Aldosterone ...

    Abstract Objectives: To examine whether endogenous aldosterone can cause either arrhythmias (and some of their underlying mechanisms) or endothelial dysfunction in patients with coronary artery disease (CAD) but without heart failure.
    Background: Aldosterone blockade has been shown to reduce the incidence of sudden death in patients with heart failure. This could be caused by a reduction in arrhythmias or in coronary events. Whether either effect also occurs in other cardiac patients without heart failure is currently unknown.
    Method: We performed a randomized, placebo-controlled, double-blind crossover study on 98 patients with CAD but without heart failure on standard therapy, comparing 12.5-50 mg/day spironolactone (3 months) with placebo. Endothelial function was assessed by bilateral forearm venous occlusion plethysmography. Ventricular extrasystoles, procollagen III N-terminal peptide (PIIINP) and QT interval length were used to represent arrhythmias and their determinants.
    Results: Spironolactone produced a highly significant 75% reduction in ventricular extrasystoles (median 192, range 48-744) on placebo compared with spironolactone (median 48, range 19.2-288, P < 0.003). Spironolactone also decreased the QT interval from a mean of 440 +/- 28 to a mean of 425 +/- 25 (P < 0.001) and a collagen marker (PIIINP) from a mean of 3.6 +/- 0.9 to a mean of 3.0 +/- 0.8 (P < 0.001), but did not significantly change endothelial dysfunction or heart rate variability.
    Conclusion: These results suggest that despite conventional therapy, endogenous aldosterone can be an arrhythmogenic influence in patients with CAD, but without heart failure. The possible mechanisms are that aldosterone promotes myocardial fibrosis and lengthens the QTc interval as well as decreasing potassium in CAD patients without heart failure.
    MeSH term(s) Aged ; Aldosterone/physiology ; Anti-Arrhythmia Agents/therapeutic use ; Arrhythmias, Cardiac/etiology ; Cross-Over Studies ; Double-Blind Method ; Electrocardiography/drug effects ; Female ; Forearm/blood supply ; Humans ; Male ; Middle Aged ; Mineralocorticoid Receptor Antagonists/therapeutic use ; Myocardial Ischemia/complications ; Myocardial Ischemia/drug therapy ; Peptide Fragments/blood ; Procollagen/blood ; Spironolactone/therapeutic use
    Chemical Substances Anti-Arrhythmia Agents ; Mineralocorticoid Receptor Antagonists ; Peptide Fragments ; Procollagen ; procollagen Type III-N-terminal peptide ; Spironolactone (27O7W4T232) ; Aldosterone (4964P6T9RB)
    Language English
    Publishing date 2007-11
    Publishing country England
    Document type Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
    ZDB-ID 605532-1
    ISSN 1473-5598 ; 0263-6352 ; 0952-1178
    ISSN (online) 1473-5598
    ISSN 0263-6352 ; 0952-1178
    DOI 10.1097/HJH.0b013e3282e9a72d
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  3. Article ; Online: Renin-angiotensin system blockers are associated with reduced mortality and heart failure hospitalization in patients paced for complete atrioventricular block.

    Elder, Douglas H J / Lang, Chim C / Rekhraj, Sushma / Szwejkowski, Benjamin / George, Jacob / Pringle, Stuart D / Struthers, Allan D / Choy, Anna Maria

    Heart rhythm

    2012  Volume 9, Issue 4, Page(s) 505–510

    Abstract: Background: Right ventricular apical pacing can cause dyssynchronous activation of the ventricles, increase sympathetic activation, cause abnormalities in myocardial perfusion, worsen cardiac output and endothelial function, and may be associated with ... ...

    Abstract Background: Right ventricular apical pacing can cause dyssynchronous activation of the ventricles, increase sympathetic activation, cause abnormalities in myocardial perfusion, worsen cardiac output and endothelial function, and may be associated with adverse cardiovascular effects. The use of rennin-angiotensin system blockers (RASBs) may be beneficial in counteracting these potentially harmful effects of right ventricular pacing.
    Objective: To explore the impact of RASB use on the outcome in patients with right ventricular pacemakers implanted for complete atrioventricular (AV) block.
    Methods: Patients implanted with right ventricular pacemakers for complete AV block between 1994 and 2009 were identified from the Tayside Pacing Registry. Cox proportional hazards model was used to assess differences in all-cause mortality and congestive heart failure hospitalizations for those receiving RASB during follow-up, adjusted for confounding variables. We also performed 2 sensitivity analyses--a propensity score-matched analysis and time-dependent analyses--to minimize bias.
    Results: Eight hundred twenty patients (57% men; median age 73 years; range 22-103 years) received pacemakers for complete AV block between 1994 and 2008 (54% dual-chamber pacemaker and 46% ventricular demand pacemaker). Two hundred seventy-eight (34%) patients had received RASBs. Mean follow-up was 4.9 ± 4.6 years, with 540 (65%) deaths. RASB use was independently associated with significantly reduced mortality (adjusted hazard ratio 0.67; 95% confidence interval 0.47-0.94; P = .017) and reduced heart failure hospitalization (adjusted hazard ratio 0.42; 95% confidence interval 0.17-0.92; P <.001).
    Conclusions: This study suggests that RASBs may confer outcome benefits in patients with right ventricular pacemakers implanted for complete AV block.
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Angiotensin II Type 1 Receptor Blockers/therapeutic use ; Angiotensin-Converting Enzyme Inhibitors/therapeutic use ; Antihypertensive Agents/therapeutic use ; Atrioventricular Block/therapy ; Cardiac Pacing, Artificial/methods ; Chi-Square Distribution ; Confidence Intervals ; Female ; Heart Failure/drug therapy ; Heart Failure/mortality ; Heart Failure/therapy ; Hospitalization ; Humans ; Male ; Middle Aged ; Propensity Score ; Proportional Hazards Models ; Registries ; Renin-Angiotensin System/drug effects ; Risk Factors ; Statistics, Nonparametric ; Treatment Outcome ; United Kingdom ; Young Adult
    Chemical Substances Angiotensin II Type 1 Receptor Blockers ; Angiotensin-Converting Enzyme Inhibitors ; Antihypertensive Agents
    Language English
    Publishing date 2012-04
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2229357-7
    ISSN 1556-3871 ; 1547-5271
    ISSN (online) 1556-3871
    ISSN 1547-5271
    DOI 10.1016/j.hrthm.2011.11.021
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  4. Article: Infective endocarditis presenting with Parinaud's dorsal midbrain syndrome.

    Ferguson, Andrew W / Jollands, Alice / Kirkpatrick, Martin / Pringle, Stuart D / George, Nick D L

    Journal of pediatric ophthalmology and strabismus

    2006  Volume 43, Issue 1, Page(s) 41–43

    Abstract: We present a case of vertical gaze palsy in a 13-year-old girl caused by underlying infective endocarditis, secondary to an infected navel piercing. This case illustrates that infective endocarditis does not always present with classic signs. ...

    Abstract We present a case of vertical gaze palsy in a 13-year-old girl caused by underlying infective endocarditis, secondary to an infected navel piercing. This case illustrates that infective endocarditis does not always present with classic signs.
    MeSH term(s) Adolescent ; Diagnosis, Differential ; Endocarditis, Bacterial/complications ; Eye Movements/physiology ; Female ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Ocular Motility Disorders/diagnosis ; Ocular Motility Disorders/etiology ; Ocular Motility Disorders/physiopathology ; Syndrome ; Thalamus/pathology
    Language English
    Publishing date 2006-02-10
    Publishing country United States
    Document type Case Reports ; Journal Article
    ZDB-ID 800921-1
    ISSN 1938-2405 ; 0191-3913
    ISSN (online) 1938-2405
    ISSN 0191-3913
    DOI 10.3928/01913913-20060101-06
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  5. Article ; Online: Pulmonary hypertension predicts all-cause mortality in patients with heart failure: a retrospective cohort study.

    Szwejkowski, Benjamin R / Elder, Douglas H J / Shearer, Fiona / Jack, David / Choy, Anna Maria J / Pringle, Stuart D / Struthers, Allan D / George, Jacob / Lang, Chim C

    European journal of heart failure

    2012  Volume 14, Issue 2, Page(s) 162–167

    Abstract: Aims: The presence of pulmonary hypertension (PH) in left ventricular systolic dysfunction (LVSD) and symptomatic heart failure is an ominous sign. There are insufficient data regarding the risk conferred by increasing severity of PH in patients with ... ...

    Abstract Aims: The presence of pulmonary hypertension (PH) in left ventricular systolic dysfunction (LVSD) and symptomatic heart failure is an ominous sign. There are insufficient data regarding the risk conferred by increasing severity of PH in patients with heart failure.
    Methods and results: We performed a record linkage study in Tayside, Scotland (population ∼400,000) utilizing the Tayside echocardiogram database (>50,000 echocardiograms) maintained by the Health Informatics Centre (HIC). Data sets from the HIC include mortality data, cardiovascular medications, and other healthcare activities linked anonymously by the community health index (CHI) number. Patients were included in the analysis if they had LVSD, had a valid right ventricular systolic pressure (RVSP) measurement, and had a loop diuretic prescription (provided not more than 1 year prior to echocardiogram). A Cox proportional hazard model was used to examine the effects of RVSP on all-cause mortality. A total of 1612 patients [mean age, 75.2 ± 10.9 (SD) years; 57.4% male] met the entry criteria. Mean RVSP for the cohort was 44.9 ± 13.1 mmHg and mean follow-up was 2.8 ± 2.5 years. For each 5 mmHg stepwise increase in RVSP, after adjustment for confounding factors including the degree of LVSD and the presence of chronic obstructive pulmonary disease, the hazard ratio (HR) for all-cause mortality was 1.06 (1.03-1.08, P < 0.001).
    Conclusions: Pulmonary hypertension predicted all-cause mortality in a heterogeneous group of patients with heart failure. Each 5 mmHg rise in RVSP was associated with a 6% increased risk of death.
    MeSH term(s) Aged ; Aged, 80 and over ; Cohort Studies ; Echocardiography ; Female ; Heart Failure/complications ; Heart Failure/diagnostic imaging ; Heart Failure/mortality ; Humans ; Hypertension, Pulmonary/complications ; Male ; Middle Aged ; Proportional Hazards Models ; Retrospective Studies ; Systole ; Ventricular Dysfunction, Left/complications ; Ventricular Dysfunction, Left/diagnostic imaging ; Ventricular Pressure
    Language English
    Publishing date 2012-02
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1483672-5
    ISSN 1879-0844 ; 1388-9842
    ISSN (online) 1879-0844
    ISSN 1388-9842
    DOI 10.1093/eurjhf/hfr159
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    Zs.A 5299: Show issues Location:
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  6. Article: Screening for left ventricular systolic dysfunction using GP-reported ECGs.

    Goudie, Barclay M / Jarvis, Rob I / Donnan, Peter T / Sullivan, Frank M / Pringle, Stuart D / Jeyaseelan, Sanjay / Struthers, Allan D

    The British journal of general practice : the journal of the Royal College of General Practitioners

    2007  Volume 57, Issue 536, Page(s) 191–195

    Abstract: Background: Diagnostic echocardiography has poor access for patients with suspected heart failure. Pre-echocardiography screening with electrocardiograms (ECGs) is recommended as a means of targeting this scarce resource. There are data to support this ... ...

    Abstract Background: Diagnostic echocardiography has poor access for patients with suspected heart failure. Pre-echocardiography screening with electrocardiograms (ECGs) is recommended as a means of targeting this scarce resource. There are data to support this policy when ECGs are interpreted by cardiologists but not by GPs.
    Aim: To assess the value of GP-reported ECGs as a pre-echocardiography screening test for left ventricular systolic dysfunction (LVSD).
    Design of study: Cross-sectional study of GPs' ECG reporting skills.
    Setting: General practice, NHS in Scotland.
    Method: A randomly selected, stratified sample of 123 Scottish GPs reviewed 180 ECGs (100 abnormal, 50 normal and 30 duplicate) from 150 patients with suspected heart failure. Forty-one patients had LVSD on echocardiography. GPs were required to categorise ECGs as normal or abnormal.
    Results: Mean sensitivity was 0.94 (95% CI = 0.92 to 0.95). Mean specificity 0.58 (95% CI = 0.56 to 0.60). Mean positive predictive value (PPV) was 0.47 (95% CI = 0.46 to 0.48). Mean negative predictive value (NPV) was 0.96 (95% CI = 0.95 to 0.97). Mean likelihood ratio was 2.39 (95% CI = 2.28 to 2.50). Seventy of 123 (57%) GPs achieved sensitivity of 0.9 and specificity of 0.5 for the detection of LVSD.
    Conclusion: Most Scottish GPs have the skills to perform pre-echocardiography screening ECGs in patients with suspected LVSD. However, differences in ECG reporting performance between individual GPs will result in widely varying referral rates for echocardiography and differences in the detection rate of LVSD. The implications of these findings need to be considered when heart failure diagnostic services are being developed.
    MeSH term(s) Clinical Competence/standards ; Cross-Sectional Studies ; Electrocardiography/standards ; Family Practice/standards ; Health Services Accessibility ; Humans ; Predictive Value of Tests ; Referral and Consultation ; Scotland ; Sensitivity and Specificity ; Ventricular Dysfunction, Left/diagnosis
    Language English
    Publishing date 2007-03
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1043148-2
    ISSN 1478-5242 ; 0960-1643 ; 0035-8797
    ISSN (online) 1478-5242
    ISSN 0960-1643 ; 0035-8797
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  7. Article: A critical re-appraisal of different ways of selecting ambulatory patients with suspected heart failure for echocardiography.

    Jeyaseelan, Sanjay / Goudie, Barclay M / Pringle, Stuart D / Donnan, Peter T / Sullivan, Frank M / Struthers, Allan D

    European journal of heart failure

    2007  Volume 9, Issue 1, Page(s) 55–61

    Abstract: Background: ECG and BNP have been assessed as screening tests for LVSD and heart failure. However, echocardiography also provides information about valvular disease and LVH. We assessed how good these screening tests are in identifying whether the ... ...

    Abstract Background: ECG and BNP have been assessed as screening tests for LVSD and heart failure. However, echocardiography also provides information about valvular disease and LVH. We assessed how good these screening tests are in identifying whether the subsequent echocardiogram will have any significant abnormality.
    Aims: To re-appraise the ECG and BNP as screening tests for echocardiography since there are important practical deficiencies in our current knowledge in this area.
    Methods: General practitioners referred suspected heart failure patients for clinical assessment, echocardiography, electrocardiography, and BNP measurement. The accuracy of each screening test and combinations of screening tests were calculated for LVSD, heart failure, valvular disease, and LVH.
    Results: The sensitivities of the ECG for LVSD, heart failure, LVH and valvular disease were 97%, 95%, 76%, and 69%, respectively. The corresponding figures for BNP were 86%, 82%, 59%, and 48%, respectively. When patients with atrial fibrillation and murmurs were excluded, the values for ECG were 94%, 87%, 53%, and 55%, while for BNP they were 83%, 73%, 50%, and 32%.
    Conclusions: ECG interpretation and BNP are adequate screening tests to detect LVSD or heart failure but fail to screen for other echocardiographic abnormalities, like valvular disease and LVH. This remains the case even if patients with atrial fibrillation or heart murmurs are excluded on the basis that they require echocardiography anyway.
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Diagnosis, Differential ; Echocardiography ; Electrocardiography ; Family Practice ; Female ; Heart Failure/diagnosis ; Heart Failure/diagnostic imaging ; Humans ; Male ; Middle Aged ; Patient Selection ; Scotland ; Sensitivity and Specificity ; Ventricular Dysfunction, Left/diagnosis ; Ventricular Dysfunction, Left/diagnostic imaging
    Language English
    Publishing date 2007-01
    Publishing country England
    Document type Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
    ZDB-ID 1483672-5
    ISSN 1879-0844 ; 1388-9842
    ISSN (online) 1879-0844
    ISSN 1388-9842
    DOI 10.1016/j.ejheart.2006.04.003
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  8. Article ; Online: The impact of renin-angiotensin-aldosterone system blockade on heart failure outcomes and mortality in patients identified to have aortic regurgitation: a large population cohort study.

    Elder, Douglas H J / Wei, Li / Szwejkowski, Benjamin R / Libianto, Renata / Nadir, Adnan / Pauriah, Maheshwar / Rekhraj, Sushma / Lim, Tiong K / George, Jacob / Doney, Alex / Pringle, Stuart D / Choy, Anna-Maria / Struthers, Allan D / Lang, Chim C

    Journal of the American College of Cardiology

    2011  Volume 58, Issue 20, Page(s) 2084–2091

    Abstract: Objectives: The aim of this study was to investigate the effect of renin-angiotensin system blockade on outcomes in patients with aortic regurgitation (AR).: Background: Angiotensin-converting enzyme (ACE) inhibitors have the potential to reduce ... ...

    Abstract Objectives: The aim of this study was to investigate the effect of renin-angiotensin system blockade on outcomes in patients with aortic regurgitation (AR).
    Background: Angiotensin-converting enzyme (ACE) inhibitors have the potential to reduce afterload, blunt left ventricular wall stress, and limit left ventricular dilation and hypertrophy. However, long-term studies have yielded inconsistent results, and very few have assessed clinical outcomes.
    Methods: The Health Informatics Centre dispensed prescription and morbidity and mortality database for the population of Tayside, Scotland, was linked through a unique patient identifier to the Tayside echocardiography database. Patients diagnosed with at least moderate AR from 1993 to 2008 were identified. Cox regression analysis was used to assess differences in all-cause mortality and cardiovascular (CV) and AR events (heart failure hospitalizations, heart failure deaths, or aortic valve replacement) between those treated with and without ACE inhibitors or angiotensin receptor blockers (ARBs).
    Results: A total of 2,266 subjects with AR (median age 74 years; interquartile range: 64 to 81 years) were studied, with a mean follow-up period of 4.4 ± 3.7 years. Seven hundred and five patients (31%) received ACE inhibitor or ARB therapy. There were 582 all-cause deaths (25.7%). Patients treated with ACE inhibitors or ARBs had significantly lower all-cause mortality and fewer CV and AR events, with adjusted hazard ratios of 0.56 (95% confidence interval [CI]: 0.64 to 0.89; p < 0.01) for all-cause mortality, 0.77 (95% CI: 0.67 to 0.89; p < 0.01) for CV events, and 0.68 (95% CI: 0.54 to 0.87; p < 0.01) for AR events.
    Conclusions: This large retrospective study shows that the prescription of ACE inhibitors or ARBs in patients with moderate to severe AR was associated with significantly reduced all-cause mortality and CV and AR events. These data need to be confirmed by a prospective randomized controlled outcome trial.
    MeSH term(s) Aged ; Aged, 80 and over ; Angiotensin Receptor Antagonists/therapeutic use ; Angiotensin-Converting Enzyme Inhibitors/therapeutic use ; Aortic Valve Insufficiency/complications ; Aortic Valve Insufficiency/diagnostic imaging ; Aortic Valve Insufficiency/drug therapy ; Aortic Valve Insufficiency/mortality ; Echocardiography ; Female ; Heart Failure/etiology ; Heart Failure/mortality ; Heart Failure/prevention & control ; Humans ; Longitudinal Studies ; Male ; Middle Aged ; Retrospective Studies ; Scotland/epidemiology
    Chemical Substances Angiotensin Receptor Antagonists ; Angiotensin-Converting Enzyme Inhibitors
    Language English
    Publishing date 2011-12-11
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 605507-2
    ISSN 1558-3597 ; 0735-1097
    ISSN (online) 1558-3597
    ISSN 0735-1097
    DOI 10.1016/j.jacc.2011.07.043
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  9. Article ; Online: Impact of renin-angiotensin system blockade therapy on outcome in aortic stenosis.

    Nadir, M Adnan / Wei, Li / Elder, Douglas H J / Libianto, Renata / Lim, Tiong K / Pauriah, Maheshwar / Pringle, Stuart D / Doney, Alex D / Choy, Anna-Maria / Struthers, Allan D / Lang, Chim C

    Journal of the American College of Cardiology

    2011  Volume 58, Issue 6, Page(s) 570–576

    Abstract: Objectives: The purpose of this study was to investigate the impact of renin-angiotensin system blockade therapy on outcomes in aortic stenosis (AS).: Background: Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers ( ... ...

    Abstract Objectives: The purpose of this study was to investigate the impact of renin-angiotensin system blockade therapy on outcomes in aortic stenosis (AS).
    Background: Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are perceived to be relatively contraindicated in AS. However, inhibitors of the renin-angiotensin system may be beneficial in AS through their cardioprotective and beneficial effects on left ventricular remodeling.
    Methods: The Health Informatics dispensed prescribing, morbidity, and mortality database for the population of Tayside, Scotland, was linked through a unique patient identifier to the Tayside echocardiography database (>110,000 scans). Patients with a diagnosis of AS from 1993 to 2008 were identified. Cox regression model (adjusted for confounding variables) and propensity score analysis were used to assess the impact of ACEIs or ARBs on all-cause mortality and cardiovascular (CV) events (CV death or hospitalizations).
    Results: A total of 2,117 patients with AS (mean age 73 ± 12 years, 46% men) were identified and 699 (33%) were on ACEI or ARB therapy. Over a mean follow-up of 4.2 years, there were 1,087 (51%) all-cause deaths and 1,018 (48%) CV events. Those treated with ACEIs or ARBs had a significantly lower all-cause mortality with an adjusted hazard ratio of 0.76 (95% confidence interval: 0.62 to 0.92, p < 0.0001) and fewer CV events with an adjusted hazard ratio of 0.77 (95% confidence interval: 0.65 to 0.92, p < 0.0001). The outcome benefits of ACEIs/ARBs were further supported by propensity score analysis.
    Conclusions: This large observational study suggests that ACEI/ARB therapy is associated with an improved survival and a lower risk of CV events in patients with AS.
    MeSH term(s) Aged ; Angiotensin Receptor Antagonists/pharmacology ; Angiotensin-Converting Enzyme Inhibitors/pharmacology ; Aortic Valve Stenosis/therapy ; Cardiovascular Diseases/diagnosis ; Cardiovascular Diseases/pathology ; Cohort Studies ; Databases, Factual ; Echocardiography/methods ; Female ; Follow-Up Studies ; Humans ; Male ; Medical Informatics/methods ; Middle Aged ; Renin-Angiotensin System ; Retrospective Studies ; Risk ; Treatment Outcome ; Ventricular Remodeling
    Chemical Substances Angiotensin Receptor Antagonists ; Angiotensin-Converting Enzyme Inhibitors
    Language English
    Publishing date 2011-06-22
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 605507-2
    ISSN 1558-3597 ; 0735-1097
    ISSN (online) 1558-3597
    ISSN 0735-1097
    DOI 10.1016/j.jacc.2011.01.063
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article: Is glutamine beneficial in ischemic heart disease?

    Khogali, Shihab E O / Pringle, Stuart D / Weryk, Brian V / Rennie, Michael J

    Nutrition (Burbank, Los Angeles County, Calif.)

    2002  Volume 18, Issue 2, Page(s) 123–126

    Abstract: Objective: Glutamine enhances recovery from acute normothermic ischemia in isolated rat heart by a dose-dependent effect (Khogali et al. J Mol Cell Cardiol 1998;30:819). We compared the cardioprotective effects of equimolar concentrations of glutamine, ... ...

    Abstract Objective: Glutamine enhances recovery from acute normothermic ischemia in isolated rat heart by a dose-dependent effect (Khogali et al. J Mol Cell Cardiol 1998;30:819). We compared the cardioprotective effects of equimolar concentrations of glutamine, glutamate, and aspartate in isolated rat heart. We also explored the potential cardioprotective effects of glutamine in patients with chronic stable angina.
    Methods: The isolated perfused working rat heart was subjected to ischemia, followed by reperfusion with or without an amino acid (2.5 mM). Patients with chronic stable angina received a single oral dose of glutamine (80 mg/kg) or placebo in a double-blind, random fashion 40 min before a standard Bruce exercise test.
    Results: Postischemic reperfusion of isolated rat heart with glutamine (but not with glutamate or aspartate) resulted in full recovery of cardiac output. Only glutamine prevented the decrease in the myocardial ratio between adenosine triphosphate to adenosine diphosphate and significantly enhanced the myocardial ratio of reduced to oxidized glutathione. A single oral dose of glutamine given to patients with chronic stable angina significantly increased plasma glutamine concentration from 419 to 649 microM and delayed time to onset of more than 1.0 mm of ST segment depression on the ECG by 38 s.
    Conclusion: Glutamine may be cardioprotective in patients with coronary heart disease.
    MeSH term(s) Adenosine Diphosphate/analysis ; Adenosine Triphosphate/analysis ; Administration, Oral ; Aged ; Angina Pectoris/drug therapy ; Angina Pectoris/prevention & control ; Animals ; Aspartic Acid/administration & dosage ; Aspartic Acid/therapeutic use ; Cardiac Output/drug effects ; Dose-Response Relationship, Drug ; Double-Blind Method ; Drug Evaluation ; Exercise Test ; Glutamic Acid/administration & dosage ; Glutamic Acid/therapeutic use ; Glutamine/administration & dosage ; Glutamine/blood ; Glutamine/therapeutic use ; Glutathione/analysis ; Heart/drug effects ; Humans ; Male ; Middle Aged ; Myocardial Ischemia/drug therapy ; Myocardial Ischemia/prevention & control ; Myocardial Reperfusion/methods ; Myocardium/chemistry ; Rats ; Rats, Sprague-Dawley ; Time Factors
    Chemical Substances Glutamine (0RH81L854J) ; Aspartic Acid (30KYC7MIAI) ; Glutamic Acid (3KX376GY7L) ; Adenosine Diphosphate (61D2G4IYVH) ; Adenosine Triphosphate (8L70Q75FXE) ; Glutathione (GAN16C9B8O)
    Language English
    Publishing date 2002-01-28
    Publishing country United States
    Document type Clinical Trial ; Comparative Study ; Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
    ZDB-ID 639259-3
    ISSN 1873-1244 ; 0899-9007
    ISSN (online) 1873-1244
    ISSN 0899-9007
    DOI 10.1016/s0899-9007(01)00768-7
    Database MEDical Literature Analysis and Retrieval System OnLINE

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