20 results on '"Lewis, Basil S."'
Search Results
2. Left ventricular systolic and diastolic function, and exercise capacity six to eight weeks after acute myocardial infarction
- Author
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Lewis, Basil S., Emmott, Steven N., Smyllie, John, MacNeill, Andrea B., and Lubsen, Jacobus
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Heart attack -- Care and treatment ,Exercise -- Physiological aspects ,Diastole (Cardiac cycle) -- Measurement ,Heart -- Contraction ,Heart ventricle, Left -- Physiological aspects ,Health - Published
- 1993
3. Nitrate tolerance in heart failure: differential venous, pulmonary and systemic arterial effects
- Author
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Makhoul, Nabeel, Dakak, Nader, Flugelman, Moshe Y., Merdler, Amnon, Shefer, Arie, Schneeweiss, Adam, Halon, David A., and Lewis, Basil S.
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Drug tolerance -- Analysis ,Nitroglycerin -- Health aspects ,Congestive heart failure -- Drug therapy ,Health - Abstract
The hemodynamic profile of tolerance to intravenous nitroglycerin was studied in 9 patients with New York Heart Association Class III to IV congestive heart failure. After rapid dosage build-up to the maximal tolerated dose (decrease in pulmonary wedge Pressure to 10 mm Hg or systolic blood pressure to 90 mm Hg), nitroglycerin (525 [+/-] 548 [mu]g/min) was administered at a constant continuous intravenous infusion for a total of 24 hours. The extent of nitrate tolerance at 24 hours was calculated as the percentage loss of the benefit achieved at time of peak effect of nitroglycerin. Tolerance had a different time course and magnitude in the venous, arterial and pulmonary circulations. At 24 hours, right atrial pressure and pulmonary vascular resistance returned to control values in most patients, while 40 to 50% of the effect on systemic vascular resistance, cardiac index and pulmonary wedge pressure was maintained. These findings emphasize the importance of precise definitions in studies relating to nitrate tolerance. (Am J Cardiol 1990;65:28J-31J), Congestive heart failure is the inability of the heart to pump blood, which leads to congestion of fluid within the lungs. It can be treated with nitrate drugs, which dilate blood vessels. However, nitrate treatment may result in drug tolerance or decreased effectiveness, which interferes with the beneficial effects of these agents in the treatment of congestive heart failure. The characteristics of tolerance, which developed during intravenous therapy with the nitrate agent nitroglycerin, were assessed in nine patients in advanced stages of congestive heart failure. The maximal tolerated dose of nitroglycerin was given, followed by continuous intravenous administration of the drug for 24 hours. Nitrate tolerance at 24 hours was determined as the percentage of loss of beneficial effect at the time of peak or maximal effect of nitroglycerin. After 24 hours, the pressure in the right atrium (upper chamber) of the heart and pulmonary vascular resistance, the pressure against blood flow in the lungs, returned to pre-treatment values. However, improvements in systemic vascular resistance, the pressure opposing blood flow in the peripheral circulation; cardiac index, a measure of amount of blood pumped by the heart; and pulmonary wedge pressure, a measure of pressures within the left ventricle and left atrium (chambers of the heart), were partially maintained after 24 hours. The results show the importance of specifically defining nitrate tolerance in studies examining this complication of nitrate therapy. (Consumer Summary produced by Reliance Medical Information, Inc.)
- Published
- 1990
4. Identifying patients at high risk for restenosis after percutaneous transluminal coronary angioplasty for unstable angina pectoris
- Author
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Halon, David A., Merdler, Amnon, Shefer, Arie, Flugelman, Moshe Y., and Lewis, Basil S.
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Unstable angina -- Care and treatment ,Transluminal angioplasty -- Complications ,Arteries -- Stenosis ,Health - Published
- 1989
5. Exercise-induced left-axis deviation of the QRS complex in left anterior descending coronary artery disease and reversal after revascularization
- Author
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Shiran, Avinoam, Halon, David A., Merdler, Amnon, and Lewis, Basil S.
- Subjects
Arrhythmia -- Causes of ,Exercise -- Physiological aspects ,Coronary heart disease -- Complications ,Myocardial revascularization -- Usage ,Health - Published
- 1994
6. Relation between C-reactive protein, treadmill exercise testing, and inducible myocardial ischemia
- Author
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Shehadeh, Jeryes, Lewis, Basil S., Weisz, Giora, David, Miriam, Ashkenazi, Tamar, and Halon, David A.
- Subjects
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C-reactive protein , *CORONARY disease , *TREADMILL exercise tests , *EXERCISE tests - Abstract
This study examined the relation between high-sensitivity C-reactive protein (CRP), exercise-induced myocardial ischemia, and exercise tolerance in 288 stable patients who underwent maximal treadmill stress testing. CRP was correlated with peak exercise workload, which was consistent with the long-term predictive value of peak workload and CRP for outcome events. There was no correlation of high-sensitivity CRP with stress-induced ischemia, which is consistent with a lack of correlation between CRP and the degree of chronic luminal coronary arterial narrowing. [Copyright &y& Elsevier]
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- 2004
- Full Text
- View/download PDF
7. Same-day combined coronary angioplasty and minimally invasive coronary surgery.
- Author
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Lewis, Basil S., Porat, Eyal, Lewis, B S, Porat, E, Halon, D A, Ammar, R, Flugelman, M Y, Khader, N, Merdler, A, Weisz, G, and Uretzky, G
- Subjects
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MYOCARDIAL revascularization , *TRANSLUMINAL angioplasty , *SURGICAL stents - Abstract
Integrated myocardial revascularization combines the advantages of angioplasty, stenting, and minimally invasive surgery to revascularize patients with multivessel coronary artery disease without cardiopulmonary bypass. This pilot study showed that a new same-day management strategy, consisting of percutaneous coronary intervention followed immediately by minimally invasive surgery, was feasible and provided complete all-arterial revascularization with minimal surgical trauma, short hospital stay, and excellent early therapeutic result in 14 patients with multivessel coronary disease. [ABSTRACT FROM AUTHOR]
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- 1999
- Full Text
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8. Automatic Assessment of Coronary Artery Calcium Score from Contrast-Enhanced 256-Row Coronary Computed Tomography Angiography.
- Author
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Rubinshtein, Ronen, Halon, David A., Gaspar, Tamar, Lewis, Basil S., and Peled, Nathan
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DIAGNOSIS , *CARDIOGRAPHIC tomography , *ANGIOGRAPHY , *THICKNESS measurement , *CORONARY disease , *CONTRAST-enhanced ultrasound - Abstract
The coronary artery calcium score (CS), an independent predictor of cardiovascular events, can be obtained from a stand-alone nonenhanced computed tomography (CT) scan (CSCT) or as an additional nonenhanced procedure before contrast-enhanced coronary CT angiography (CCTA). We evaluated the accuracy of a novel fully automatic tool for computing CS from the CCTA examination. One hundred thirty-six consecutive symptomatic patients (aged 59 ± 11 years, 40% female) without known coronary artery disease who underwent both 256-row CSCT and CCTA were studied. Original scan reconstruction (slice thickness) was maintained (3 mm for CSCT and 0.67 mm for CCTA). CS was computed from CCTA by an automatic tool (COR Analyzer, rcadia Medical Imaging, Haifa, Israel) and compared with CS results obtained by standard assessment of nonenhanced CSCT (HeartBeat CS, Philips, Cleveland, Ohio). We also compared both methods for classification into 5 commonly used CS categories (0, 1 to 10, 11 to 100, 101 to 400, >400 Agatston units). All scans were of diagnostic quality. CS obtained by the COR Analyzer from CCTA classified 111 of 136 (82%) of patients into identical categories as CS by CSCT and 24 of remaining 25 into an adjacent category. Overall, CS values from CCTA showed high correlation with CS values from CSCT (Spearman rank correlation [ 0.95, p <0.0001). In conclusion, CS values automatically computed from 256-row CCTA correlated highly with standard CS values obtained from nonenhanced CSCT. CS obtained directly from CCTA may obviate the need for an additional scan and attendant radiation. [ABSTRACT FROM AUTHOR]
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- 2014
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9. Diagnostic Accuracy of 256-row Computed Tomographic Angiography for Detection of Obstructive Coronary Artery Disease Using Invasive Quantitative Coronary Angiography as Reference Standard.
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Petcherski, Oleg, Gaspar, Tamar, Halon, David A., Peled, Nathan, Jaffe, Ronen, Molnar, Ron, Lewis, Basil S., and Rubinshtein, Ronen
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CORONARY disease , *QUANTITATIVE research , *CORONARY angiography , *COMPARATIVE studies , *MEDICAL centers , *TOMOGRAPHY , *PATIENTS - Abstract
We assessed the performance of a new-generation, 256-row computed tomography (CT) scanner for detection of obstructive coronary artery disease (CAD) compared to invasive quantitative coronary angiography. A total 121 consecutive symptomatic patients without known CAD referred for invasive coronary angiography (age 59 ± 12 years, 37% women) underwent clinically driven 256-row coronary computed tomographic angiography (CCTA) before the invasive procedure. Obstructive CAD (>50% diameter stenosis) was assessed visually on CCTA by 2 independent observers using the 18-segment society of cardiovascular CT model and on invasive angiograms using quantitative coronary angiography (the reference standard). Observers were unaware of the findings from the alternate modality. Nonassessable coronary computed tomographic angiographic segments were considered obstructive for the purpose of analysis. Quantitative coronary angiography demonstrated obstructive CAD in 145 segments in 82 of 121 patients (68%). Overall, 1,677 coronary segments were available for comparative analysis, of which 39 (2.3%) were nonassessable by CCTA, mostly because of heavy calcification. Patient-based and segmentbased analysis showed a sensitivity of 100% and 97% (95% confidence interval 95% to 100%) and specificity of 69% (95% confidence interval 55% to 84%) and 97% (confidence interval 96% to 98%), respectively. Four segments with obstructive CAD in 4 patients were not detected by CCTA. All 4 patients had additional coronary obstructions identified by CCTA. The predictive accuracy was 90% (range 85% to 95%) for patient based and 97% (96% to 98%) for segment based analysis. In conclusion, 256-row CCTA showed high sensitivity and high predictive accuracy for detection of obstructive CAD in patients without previously known disease. Although coronary calcification might still interfere with analysis, the rate of nonassessable segments was low. [ABSTRACT FROM AUTHOR]
- Published
- 2013
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10. Aldosterone Synthase Gene Polymorphism as a Determinant of Atrial Fibrillation in Patients With Heart Failure
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Amir, Offer, Amir, Ruthie E., Paz, Hagar, Mor, Roi, Sagiv, Michael, and Lewis, Basil S.
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ALDOSTERONE , *GENETIC polymorphisms , *ATRIAL fibrillation , *HEART failure - Abstract
We analyzed the possible association between aldosterone synthase (CYP11B2) T-344C polymorphism, which is associated with increased aldosterone activity, and the prevalence of atrial fibrillation (AF) in 196 consecutive patients who had symptomatic systolic heart failure (HF; left ventricular ejection fraction <40%) for ≥3 months before recruitment. Genomic DNA was extracted from peripheral blood leukocytes using a standard protocol. Subjects were genotyped for the CYP11B2 polymorphism using the polymerase chain reaction/restriction fragment length polymorphism approach. AF was present in 63 patients (33%) with HF. We found the −344 CC genotype to be a strong independent marker for AF. Almost 1/2 (45%) of patients with this genotype had AF compared with 1/4 (27%) with −344 TT and TC genotypes (p = 0.01). A multivariate stepwise logistic regression model that included age, gender, New York Heart Association class, CYP11B2 −344CC genotype, and echocardiographic measurements of left ventricular ejection fraction, left atrial dimension, left ventricular end-diastolic diameter, and mitral regurgitation severity showed that the CYP11B2 CC genotype (adjusted for age and left atrial size) was an independent predictor of AF (adjusted odds ratio 2.35, 95% confidence interval 1.57 to 3.51, p = 0.03). In conclusion, CYP11B2 T-344C promoter polymorphism predisposes to clinical AF in patients with HF. [Copyright &y& Elsevier]
- Published
- 2008
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11. Impact of 64-Slice Cardiac Computed Tomographic Angiography on Clinical Decision-Making in Emergency Department Patients With Chest Pain of Possible Myocardial Ischemic Origin
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Rubinshtein, Ronen, Halon, David A., Gaspar, Tamar, Jaffe, Ronen, Goldstein, Jacob, Karkabi, Basheer, Flugelman, Moshe Y., Kogan, Asia, Shapira, Reuma, Peled, Nathan, and Lewis, Basil S.
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CARDIOGRAPHIC tomography , *MEDICAL emergencies , *ANGIOGRAPHY , *MYOCARDIAL infarction - Abstract
To examine the impact of contrast enhanced multidetector computed tomography (MDCT) on clinical decision-making in patients who present to the emergency department (ED) with chest pain of possible ischemic origin, we studied 58 consecutive patients (age 56 ± 10 years, 36% female) with chest pain, intermediate risk, and no ischemic electrocardiographic changes or increased biomarker measurements. After standard ED patient assessment including cardiology consultation, a diagnosis of acute coronary syndrome was made in 41 patients (71%), hospitalization was recommended in 47 (81%), and 32 (55%) were scheduled for an early invasive strategy. Patients underwent 64-slice contrast agent–enhanced MDCT with image reconstruction in multiple formats using retrospective electrocardiographic gating, which revealed normal (no or trivial atheroma) coronary vasculature in 15 patients, nonobstructive atheroma in 20 patients, and obstructive coronary disease (≥1 luminal narrowing of ≥50%) in 23 patients. After MDCT, the diagnosis of acute coronary syndrome was revised in 18 of 41 patients (44%; 16 normal MDCT/widely patent stents, 2 alternative diagnoses), planned hospitalization canceled in 21 of 47 patients (45%; 13 normal MDCT/patent stent, 8 minor branch vessel disease), and planned early invasive strategy altered in 25 of 58 patients (43%; unnecessary in 20 of 32, advisable in 5 of 26 others). Effect of MDCT on clinical decisions was greater in the 36 patients without known preceding coronary disease. In 32 patients discharged from the ED (11 after initial triage, 21 patients after MDCT), there were no major adverse cardiac events (e.g., death, myocardial infarction, unplanned revascularization) during a 12-month follow-up period. In conclusion, contrast agent–enhanced 64-slice cardiac MDCT was a valuable diagnostic tool in the ED triage of patients with chest pain of possible ischemic origin and decreased the need for hospitalization by almost half in this patient cohort. [Copyright &y& Elsevier]
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- 2007
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12. Usefulness of 64-Slice Multidetector Computed Tomography in Diagnostic Triage of Patients With Chest Pain and Negative or Nondiagnostic Exercise Treadmill Test Result
- Author
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Rubinshtein, Ronen, Halon, David A., Gaspar, Tamar, Schliamser, Jorge E., Yaniv, Nisan, Ammar, Ronny, Flugelman, Moshe Y., Peled, Nathan, and Lewis, Basil S.
- Subjects
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TOMOGRAPHY , *CORONARY disease , *EXERCISE tests , *CORONARY arteries - Abstract
The usefulness of 64-slice multidetector coronary computed tomography (MDCT) in a diagnostic triage of 100 consecutive patients (age 55.8 ± 11.6 years; 57% men) with chest pain suspected to be ischemic in origin and a negative or nondiagnostic exercise treadmill test (ETT) result was examined. None of the patients had previously known coronary artery disease (CAD). MDCT showed obstructive (≥50%) CAD in 29 patients; 13 of 59 patients (22%) with a negative and 16 of 41 patients (39%) with a nondiagnostic ETT result. High-risk (left main and/or 3-vessel) CAD was present in 3.3% of patients with a negative and 4.9% with a nondiagnostic ETT result. The 29 patients with obstructive CAD on MDCT had a higher mean Agatston calcium score (221 ± 402 vs 40 ± 77 U, p <0.001). Invasive coronary angiography confirmed MDCT findings in 26 of 29 patients (positive predictive value 90%) and 45 of 54 stenotic segments (83%) in a per-segment analysis. For the 71 patients without obstructive CAD on MDCT, clinically driven invasive angiography detected CAD in 1 of 15 patients (1 false-negative MDCT result) and 2 of another 5 patients who were referred for invasive angiography later during a 12-month follow-up period. In the remaining 51 patients, MDCT findings effectively allowed exclusion of obstructive CAD, and there were no major adverse clinical events during follow-up. In conclusion, in patients with chest pain possibly ischemic in origin, no previously known CAD, and a negative or nondiagnostic ETT result, contrast-enhanced 64-slice MDCT scanning was a useful tool to provide direct noninvasive coronary angiography and rapidly advance diagnostic triage. [Copyright &y& Elsevier]
- Published
- 2007
- Full Text
- View/download PDF
13. Prevalence and Extent of Obstructive Coronary Artery Disease in Patients With Zero or Low Calcium Score Undergoing 64-Slice Cardiac Multidetector Computed Tomography for Evaluation of a Chest Pain Syndrome
- Author
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Rubinshtein, Ronen, Gaspar, Tamar, Halon, David A., Goldstein, Jacob, Peled, Nathan, and Lewis, Basil S.
- Subjects
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CORONARY arteries , *TOMOGRAPHY , *CHEST pain , *STENOSIS - Abstract
We examined the extent of coronary artery disease (CAD) on 64-slice contrast-enhanced multidetector computed tomography in patients who underwent investigation of a chest pain syndrome who had a zero or low coronary calcium score (CS). In 668 consecutive patients with chest pain syndromes (39% with acute presentation, 61% with long-term presentation) who underwent cardiac multidetector computed tomography, we assessed prevalence and severity of coronary stenoses (≥1 coronary artery stenosis with ≥50% luminal narrowing) in 231 patients (54 ± 12 years of age, 45% women) with a 0 (n = 125) or low (n = 106) coronary CS. Obstructive (≥50% lesion) CAD was present in 27 of 231 patients, in 9 of 125 patients (7%) with a 0 CS, in 18 of 106 (17%) with a low CS (1 to 100), and in 14 of 90 patients (16%) with an acute presentation and 13 of 141 patients (9%) with a long-term presentation (p = NS). All patients in the 0 CS group had single-vessel disease, and 9 (50%) with low CS had multivessel disease, with left main involvement in 1. Of the 27 patients with obstructive CAD on multidetector computed tomography, invasive coronary angiography confirmed these findings in 21 of 23 patients (positive predictive value 91%), and 16 (76%) of them (6.9% of the 0 CS and low CS groups) underwent a myocardial revascularization procedure after invasive coronary angiographic concordance. In conclusion, despite the high known negative predictive value of CS for coronary events, a low and even 0 CS does not exclude clinically important obstructive CAD in patients undergoing investigation of an acute or long-term chest pain syndrome. Contrast-enhanced multidetector computed tomography should be the noninvasive computed tomographic test of choice when possible in these patients. [Copyright &y& Elsevier]
- Published
- 2007
- Full Text
- View/download PDF
14. Brachial Reactivity and Extent of Coronary Artery Disease in Patients With First ST-Elevation Acute Myocardial Infarction
- Author
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Amir, Offer, Jaffe, Ronen, Shiran, Avinoam, Flugelman, Moshe Y., Halon, David A., and Lewis, Basil S.
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CORONARY disease , *MYOCARDIAL infarction , *HEART diseases , *HEART blood-vessels - Abstract
We examined peripheral endothelial function, as measured by brachial artery reactivity, in 49 stable patients with a first episode of acute ST-segment elevation myocardial infarction to examine the relation between extent of coronary disease and peripheral vascular reactivity. Brachial artery reactivity was assessed by ultrasound and flow-mediated dilation (FMD) was calculated as the change in brachial artery diameter after release of suprasystolic blood pressure cuff inflation. FMD was classified as abnormal in (≤6%) 19 patients (group 1) and as normal in 30 patients (group 2). Average FMDs were 2 ± 2% in group 1 and 11 ± 4% in group 2. Patients in group 1 were older (62 ± 5 vs 54 ± 11 years, p = 0.02) and more often had a history of hypertension (n = 10, 52%, vs 6, 20%, p = 0.017). Patients with abnormal endothelial function (group 1) had a larger number of coronary obstructive (≥50%) lesions (3.6 ± 2.4 vs 2.0 ± 1.7, p = 0.01) and more extensive coronary disease (1.9 ± 0.8 vs 1.4 ± 0.8 vessel disease, p = 0.05). In patients with 3-vessel disease, FMD was lower (4.0 ± 1.8% vs 8.2 ± 0.8%, p = 0.04) than in those with lesser coronary involvement. In conclusion, in patients with a first episode of ST-segment elevation myocardial infarction, there was a strong correlation between extent of coronary artery disease and brachial artery reactivity. Patients with localized coronary disease had relatively normal brachial reactivity, whereas those with diffuse coronary disease had more severe abnormal brachial artery reactivity. [Copyright &y& Elsevier]
- Published
- 2006
- Full Text
- View/download PDF
15. Relation Between Obesity and Severity of Coronary Artery Disease in Patients Undergoing Coronary Angiography
- Author
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Rubinshtein, Ronen, Halon, David A., Jaffe, Ronen, Shahla, Johnny, and Lewis, Basil S.
- Subjects
- *
BODY mass index , *CORONARY disease , *ANGIOGRAPHY , *HYPERLIPIDEMIA - Abstract
We examined the relations among body mass index (BMI), extent of coronary artery disease, and frequency of high-risk coronary anatomy (HRCA) in 928 consecutive patients who underwent coronary angiography during a 6-month period. HRCA was defined as ≥50% stenosis of the left main coronary artery and/or significant 3-vessel coronary artery disease (≥70% narrowing). BMI was classified into 5 subgroups: low (<21 kg/m2), normal (21 to 24 kg/m2), overweight (25 to 29 kg/m2), obese (30 to 34 kg/m2), and severely obese (≥35 kg/m2). Obese patients (BMI ≥30 kg/m2) were younger (61.4 ± 10.7 vs 65.3 ± 11.4 years, p <0.0001) and had higher prevalences of hyperlipidemia, systemic hypertension, and diabetes mellitus. HRCA was present less often in obese patients (56 of 245, 23%, vs 250 of 683, 37%, p = 0.0002). Multivariate regression analysis showed that advancing age (p <0.0001), male gender (p = 0.007), diabetes mellitus (p = 0.0004), and hyperlipidemia (p = 0.0008) were independent predictors of high-risk anatomy, whereas obesity remained a significant negative independent predictor (p = 0.02). Late (30 to 36 months) mortality was not different between obese (6.9%) and nonobese (8.2%) patients but was significantly higher in patients with HRCA (12.4%) than in those without HRCA (5.6%, p = 0.0003). In conclusion, obese patients who were referred for coronary angiography were younger and had a lower prevalence of HRCA. Obese patients were probably referred for angiography at an earlier stage of their disease, thus explaining the “obesity paradox” in several reports of better short-term outcome in obese patients who undergo cardiac procedures. [Copyright &y& Elsevier]
- Published
- 2006
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16. Transesophageal echocardiographic findings in patients with nonobstructed prosthetic valves and suspected cardiac source of embolism.
- Author
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Shiran, Avinoam, Weissman, Neil J., Merdler, Amnon, Karkabi, Basheer, Khader, Nader, Aviram, Sigal, Goldstein, Steven A., Pinnow, Ellen, Lewis, Basil S., Shiran, A, Weissman, N J, Merdler, A, Karkabi, B, Khader, N, Aviram, S, Goldstein, S A, Pinnow, E, and Lewis, B S
- Subjects
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TRANSESOPHAGEAL echocardiography , *CARDIOVASCULAR diseases , *THROMBOEMBOLISM - Abstract
Evaluates the yield of transesophageal echocardiography (TEE) for detecting thrombi in patients with a prosthetic valve (PV) and suspected thromboembolism and assesses the utility of TEE findings in their management. Detection of PV thrombus in a few patients with PV and a recent embolic event; Types of patients that may benefit from TEE.
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- 2001
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17. Importance of diabetes mellitus and systemic hypertension rather than completeness of revascularization in determining long-term outcome after coronary balloon angioplasty (the LDCMC registry). Lady Davis Carmel Medical Center.
- Author
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Halon, David A., Merdler, Amnon, Flugelman, Moshe Y., Shifroni, Galia, Khader, Nader, Shiran, Avinoam, Shahla, Johnny, Lewis, Basil S., Halon, D A, Merdler, A, Flugelman, M Y, Shifroni, G, Khader, N, Shiran, A, Shahla, J, and Lewis, B S
- Subjects
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TRANSLUMINAL angioplasty , *CORONARY disease , *PATIENTS - Abstract
The study examined the 10-year outcome in a cohort of 227 unselected, consecutive patients (age 58+/-10 years) undergoing coronary balloon angioplasty between 1984 and 1986 and followed in a single cardiac center (Lady Davis Carmel Medical Center registry). In particular, we sought to identify the relative importance of the systemic risk factors diabetes and hypertension and the extent of coronary disease as opposed to procedure-related technical variables, the immediate success of the procedure, or completeness of revascularization. By life-table analysis (99% follow-up), 94% of the patients were alive at 5 years, and 77% at 10 years after angioplasty. Ten-year survival was reduced in patients with diabetes mellitus (59% vs 83%, p = 0.0008), in patients with previous myocardial infarction (68% vs 85%, p = 0.01), in patients with ejection fraction <50% (55% vs 82%, p = 0.005), and in patients with 3-vessel disease (58% vs 84% and 86% for 1- and 2-vessel disease, respectively, p = 0.04). Diabetes mellitus was the major independent predictor of poor survival (adjusted odds ratio 3.1, 95% confidence interval 1.55 to 6.19, p = 0.001). Survival at 10 years was identical in 199 patients in whom angioplasty was complete and in 25 in whom the balloon catheter did not cross the lesion, although bypass surgery was more frequent in the latter group (45% vs 21%, p = 0.001). Incomplete revascularization did not predict poor survival (72% vs 79% with complete angioplasty, p = NS). Event-free survival at 10 years for the whole group was 29%, and 49% of patients survived with no event other than a single repeat angioplasty procedure. Multivessel disease, hypertension, and diabetes mellitus were independent predictors of decreased event-free survival, but incomplete revascularization was not. Thus, long-term outcome after coronary balloon angioplasty was related to diabetes mellitus, systemic hypertension, and extent of coronary disease, but not to the immediate success of the procedure or completeness of revascularization. [ABSTRACT FROM AUTHOR]
- Published
- 1998
- Full Text
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18. Evaluation of isoproterenol in patients undergoing resuscitation for out-of-hospital asystolic cardiac arrest (the Israel Resuscitation with Isoproterenol Study Prospective Randomized Clinical Trial)
- Author
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Jaffe, Ronen, Rubinshtein, Ronen, Feigenberg, Zvi, Talor, Eran, Michaelson, Moshe, Karkabi, Basheer, Halon, David A., Flugelman, Moshe Y., and Lewis, Basil S.
- Subjects
- *
HEART failure , *CARDIOVASCULAR agents , *CRITICAL care medicine , *CARDIAC arrest - Abstract
The Israel Resuscitation with Isoproterenol Study included 79 consecutive patients with witnessed out-of-hospital asystolic cardiac arrest who were resuscitated with epinephrine and atropine and randomized to receive additional isoproterenol or no isoproterenol. The rate of return of spontaneous circulation and survival to hospital admission did not differ in patients receiving standard therapy and those receiving additional isoproterenol. [Copyright &y& Elsevier]
- Published
- 2004
- Full Text
- View/download PDF
19. Brachial artery endothelial function in residents and fellows working night shifts
- Author
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Amir, Offer, Alroy, Sharon, Schliamser, Jorge E., Asmir, Ihab, Shiran, Avinoam, Flugelman, Moshe Y., Halon, David A., and Lewis, Basil S.
- Subjects
- *
HYPEREMIA , *NIGHT work , *PHYSICIANS , *MEDICAL care - Abstract
Brachial artery endothelial function, which is measured as responsiveness to reactive hyperemia (flow-mediated dilation [FMD]) was abnormal in residents and house staff after a 24-hour shift, including night duty. The greatest decrease in FMD was observed in physicians with a longer history of night-shift duty and in those reporting fewer sleeping hours during the shift. The finding that FMD is decreased after night duty raises the issue of the effects of shift duty on cardiovascular function in healthcare personnel, particularly in those undertaking night duty for a prolonged period of time. [Copyright &y& Elsevier]
- Published
- 2004
- Full Text
- View/download PDF
20. Automated Computer-Assisted Diagnosis of Obstructive Coronary Artery Disease in Emergency Department Patients Undergoing 256-Slice Coronary Computed Tomography Angiography for Acute Chest Pain.
- Author
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Hashoul S, Gaspar T, Halon DA, Lewis BS, Shenkar Y, Jaffe R, Peled N, and Rubinshtein R
- Subjects
- Acute Disease, Adolescent, Adult, Aged, Aged, 80 and over, Chest Pain etiology, Coronary Occlusion complications, Feasibility Studies, Female, Follow-Up Studies, Humans, Male, Middle Aged, Reproducibility of Results, Retrospective Studies, Young Adult, Chest Pain diagnostic imaging, Coronary Angiography methods, Coronary Occlusion diagnostic imaging, Emergency Service, Hospital, Multidetector Computed Tomography methods, Pattern Recognition, Automated methods, Radiographic Image Interpretation, Computer-Assisted methods
- Abstract
A 256-slice coronary computed tomography angiography (CCTA) is an accurate method for detection and exclusion of obstructive coronary artery disease (OBS-CAD). However, accurate image interpretation requires expertise and may not be available at all hours. The purpose of this study was to evaluate the usefulness of a fully automated computer-assisted diagnosis (COMP-DIAG) tool for exclusion of OBS-CAD in patients in the emergency department (ED) presenting with chest pain. Three hundred sixty-nine patients in ED without known coronary disease underwent 256-slice CCTA as part of the assessment of chest pain of uncertain origin. COMP-DIAG (CorAnalyzer II) automatically reported presence or exclusion of OBS-CAD (>50% stenosis, ≥1 vessel). Performance characteristics of COMP-DIAG for exclusion and detection of OBS-CAD were determined using expert reading as the reference standard. Seventeen (5%) studies were unassessable by COMP-DIAG software, and 352 patients (1,056 vessels) were therefore available for analysis. COMP-DIAG identified 33% of assessable studies as having OBS-CAD, but the prevalence of OBS-CAD on CCTA was only 18% (66 of 352 patients) by standard expert reading. However, COMP-DIAG correctly identified 61 of the 66 patients (93%) with OBS-CAD with 21 vessels (2%) with OBS-CAD misclassified as negative. In conclusion, compared to expert reading, automated computer-assisted diagnosis using the CorAnalyzer showed high sensitivity but only moderate specificity for detection of obstructive coronary disease in patients in ED who underwent 256-slice CCTA. The high negative predictive value of this computer-assisted algorithm may be useful in the ED setting., (Copyright © 2015 Elsevier Inc. All rights reserved.)
- Published
- 2015
- Full Text
- View/download PDF
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