The Experts below are selected from a list of 1767 Experts worldwide ranked by ideXlab platform
Wilbert S Aronow - One of the best experts on this subject based on the ideXlab platform.
-
comparison of prevalence of unrecognized Myocardial infarction and of Silent Myocardial Ischemia detected by a treadmill exercise sestamibi stress test in patients with versus without diabetes mellitus
American Journal of Cardiology, 2006Co-Authors: Albert J Deluca, Wilbert S Aronow, Sarah Kaplan, Rasham Sandhu, Abid Butt, Armais Akoybyan, Melvin B WeissAbstract:We investigated, in 287 patients with diabetes (71% men; mean age 63 +/- 8 years) and 292 age- and gender-matched patients with diabetes, the prevalence of unrecognized Myocardial infarction (MI) and Silent Myocardial Ischemia (SMI) detected by a treadmill exercise sestamibi stress test. In the patients without a history of MI, MI was diagnosed by treadmill exercise sestamibi stress test in 40 of 217 patients (18%) with diabetes and 16 of 224 patients (7%) without diabetes (p <0.001). In patients with a history of angina, SMI was diagnosed in 35 of 98 patients (36%) with diabetes and 30 of 101 patients (30%) without diabetes (p = NS). In patients without a history of angina, SMI was diagnosed in 62 of 189 patients (33%) with diabetes and 35 of 191 patients (15%) without diabetes (p <0.001). In patients with 2 or 3 risk factors, SMI was diagnosed in 58 of 144 patients (40%) with diabetes and 41 of 142 patients (29%) without diabetes (p <0.005). In patients with 0 or 1 risk factor, SMI was diagnosed in 39 of 143 patients (27%) with diabetes and 24 of 150 patients (16%) without diabetes (p <0.02). In conclusion, patients with diabetes have a higher prevalence of unrecognized MI and a higher prevalence of SMI without a history of angina than patients without diabetes.
-
increased prevalence of coronary artery disease Silent Myocardial Ischemia complex ventricular arrhythmias atrial fibrillation left ventricular hypertrophy mitral annular calcium and aortic valve calcium in patients with chronic renal insufficiency
Cardiology in Review, 2006Co-Authors: Manisha Das, Wilbert S Aronow, John A Mcclung, Robert N BelkinAbstract:Cardiovascular morbidity and mortality is high in patients with chronic renal insufficiency. Patients with chronic renal insufficiency have an increased prevalence of coronary artery disease, Silent Myocardial Ischemia, complex ventricular arrhythmias, atrial fibrillation, left ventricular hypertrophy, mitral annular calcium, and aortic valve calcium than patients with normal renal function. These risk factors for cardiovascular morbidity and mortality contribute to the increased incidence of cardiovascular morbidity and mortality seen in patients with chronic renal insufficiency.
-
prevalence of Silent Myocardial Ischemia in persons with diabetes mellitus or impaired glucose tolerance and association of hemoglobin a1c with prevalence of Silent Myocardial Ischemia
American Journal of Cardiology, 2005Co-Authors: Albert J Deluca, Wilbert S Aronow, Leonardo N Saulle, Gautham Ravipati, Melvin B WeissAbstract:Silent Myocardial Ischemia detected by exercise treadmill or pharmacologic sestamibi stress testing was present in 67 of 196 patients (34%) who had diabetes mellitus or impaired glucose tolerance and in 89 of 640 patients (14%) who had normal glucose tolerance (p 1c level ≥7.6% and in 39 of 137 patients (28%) with a hemoglobin A 1c level
-
prevalence of coronary artery disease complex ventricular arrhythmias and Silent Myocardial Ischemia and incidence of new coronary events in older persons with chronic renal insufficiency and with normal renal function
American Journal of Cardiology, 2000Co-Authors: Wilbert S Aronow, Chul Ahn, Anthony D Mercando, Stanley EpsteinAbstract:In a prospective study of 98 persons > or = 65 years of age with chronic renal insufficiency (serum creatinine > 3.0 mg/dl) for > 1 year and 98 age- and sex-matched persons with normal renal function (serum creatinine < or = 1.2 mg/dl), new coronary events developed at 23-month follow-up in 69 persons (70%) with chronic renal insufficiency and at 48-month follow-up in 24 persons (24%) with normal renal function (p < 0.0001). Significant independent risk factors for new coronary events were age (risk ratio 1.1), prior coronary artery disease (risk ratio 3.5), complex ventricular arrhythmias diagnosed by 24-hour ambulatory electrocardiography (risk ratio 2.5), Silent Myocardial Ischemia diagnosed by 24-hour ambulatory electrocardiography (risk ratio 1.9), and chronic renal insufficiency (risk ratio 3.4).
-
prognostic significance of Silent Myocardial Ischemia in patients 61 years of age with extracranial internal or common carotid arterial disease with and without previous Myocardial infarction
American Journal of Cardiology, 1993Co-Authors: Wilbert S Aronow, Chul Ahn, Anthony D Mercando, Stanley Epstein, Myron R SchoenfeldAbstract:Abstract Patients with extracranial carotid disease (ECD) have an increased incidence of coronary events. 1–3 We are reporting data from a prospective study correlating Silent Myocardial Ischemia detected by 24-hour ambulatory electrocardiography with the incidence of new coronary events at 43-month mean follow-up in elderly patients with 40 to 100% ECD with and without coronary artery disease (CAD).
Bernard R Chaitman - One of the best experts on this subject based on the ideXlab platform.
-
effectiveness of percutaneous coronary intervention in patients with Silent Myocardial Ischemia post hoc analysis of the courage trial
American Journal of Cardiology, 2012Co-Authors: Gilbert Gosselin, Koon K Teo, Jeanfrancois Tanguay, Rohit Gokhale, Pamela M Hartigan, David J Maron, Vipul Gupta, G John B Mancini, Eric R Bates, Bernard R ChaitmanAbstract:Previous studies have suggested that percutaneous coronary intervention (PCI) decreases long-term mortality in patients with Silent Myocardial Ischemia (SMI), but whether PCI specifically decreases mortality when added to intensive medical therapy is unknown. We performed a post hoc analysis of clinical outcomes in patients in the COURAGE trial based on the presence or absence of anginal symptoms at baseline. Asymptomatic patients were classified as having SMI by electrocardiographic Ischemia at rest or reversible stress perfusion imaging (exercise-induced or pharmacologic). Study end points included the composite primary end point (death or Myocardial infarction [MI]); individual end points of death, MI, and hospitalization for acute coronary syndrome; and need for revascularization. Of 2,280 patients 12% (n = 283) had SMI and 88% were symptomatic (n = 1,997). There were no between-group differences in age, gender, cardiac risk factors, previous MI or revascularization, extent of angiographic disease, or Ischemia by electrocardiogram or imaging. Compared to symptomatic patients, those with SMI had fewer subsequent revascularizations (16% vs 27%, p <0.001) regardless of treatment assignment and fewer hospitalizations for acute coronary syndrome (7% vs 12%, p <0.04). No significant differences in outcomes were observed between the 2 treatment groups, although there was a trend toward fewer deaths in the PCI group (n = 7, 5%) compared to the optimal medical therapy (OMT) group (n = 16, 11%, p = 0.12). In conclusion, addition of PCI to OMT did not decrease nonfatal cardiac events in patients with SMI but showed a trend toward fewer deaths. Although underpowered, given similar outcomes in other small studies, these findings suggest the need for an adequately powered trial of revascularization versus OMT in SMI patients.
-
significance of Silent Myocardial Ischemia during exercise testing in patients with diabetes mellitus a report from the coronary artery surgery study cass registry
American Journal of Cardiology, 1991Co-Authors: Donald A Weiner, Thomas J Ryan, Lori Parsons, Lloyd D Fisher, Bernard R Chaitman, Thomas L Sheffield, Felix E TristaniAbstract:To evaluate the significance of ischemic ST depression without anginal chest pain during exercise testing among patients with diabetes mellitus, the data on 45 such patients from the Coronary Artery Surgery Study registry were analyzed. These patients (group 1, Silent Ischemia) were compared with 37 diabetic patients with both ischemic ST depression and chest pain (group 2, symptomatic Ischemia), with 31 diabetic patients without ischemic ST depression or chest pain (group 3, no Ischemia), and with 429 patients without diabetes who had Silent Ischemia during exercise testing. All patients had documented coronary artery disease (CAD) (>70% diameter narrowing). The 6-year survival among patients with Silent Ischemia was worse in diabetic than nondiabetic patients (59 vs 82%, respectively, p < 0.001). By contrast, the 6-year survival among patients without Ischemia was similar among diabetic and nondiabetic patients (93 vs 85%, respectively, p = 0.476). Among diabetic patients, survival at 6 years with medical treatment was 59% for group 1,66% for group 2 and 93% for group 3 (p = 0.008). Survival among subsets of patients with diabetes and Silent Ischemia (group 1) based on the extent of CAD and left ventricular function ranged from 100 to 32% (p = 0.093). The survival of the 45 patients with diabetes mellitus and Silent Ischemia (group 1) treated medically was compared with that of 28 patients receiving coronary artery graft bypass surgery. Survival at 6 years was enhanced by surgery compared with medical treatment among group 1 diabetic patients with 3-vessel CAD and either preserved left ventricular function (85 vs 52%, respectively, p = 0.080) or impaired left ventricular function (100 vs 32%, respectively, p = 0.015). These data suggest that, among patients with diabetes and CAD, Silent Myocardial Ischemia during exercise testing adversely affects survival, and that coronary artery bypass graft surgery improves the survival of diabetic patients with Silent Myocardial Ischemia and 3-vessel CAD.
Andrew P Goldberg - One of the best experts on this subject based on the ideXlab platform.
-
exercise induced Silent Myocardial Ischemia and future cardiac events in healthy sedentary middle aged and older men
Journal of the American Geriatrics Society, 1999Co-Authors: Leslie I Katzel, John D Sorkin, Andrew P GoldbergAbstract:OBJECTIVES Before men older than age 45 participate in vigorous exercise programs, the American Heart Association and the American College of Sports Medicine recommend they undergo a screening maximal exercise treadmill test. We examined the predictive value for subsequent cardiac events of exercise-induced Silent Myocardial Ischemia (SI) during the exercise treadmill test in healthy, sedentary, obese, middle-aged and older men recruited for research studies. DESIGN A cohort study with 7 years of follow-up SETTING Out-patient research at a tertiary hospital PARTICIPANTS 170 healthy, sedentary, obese, middle-aged and older (ages 45–79 years) men with no prior history of coronary artery disease (CAD) recruited for research studies MEASUREMENTS Cardiac risk factors, exercise-induced SI (ST segment depression on the electrocardiogram during a maximal exercise treadmill test), maximal aerobic capacity (VO2max), and 7- year follow-up data on incident CAD RESULTS At baseline, 37 of the men (22%) had exercise-induced SI on their treadmill tests. Seven-year follow-up data was obtained in 97% of the patients. In the interim, 31 men had cardiac endpoints (sudden cardiac death, Myocardial infarction, angioplasty, coronary artery bypass graft surgery, angina), and four had noncardiac deaths. Seventeen of the 37 men (46%) with exercise-induced SI on their baseline exercise tests had cardiac endpoints compared with 14 of 133 (11%) men with normal exercise tests (P < .001). Compared with the men with no cardiac endpoints, the men with subsequent cardiac endpoints were older (63 ± 1 vs 58 ± 1 years, mean ± SEM, P < .001) and had a lower maximal aerobic capacity (VO2max) (24 ± 1 vs 29 ± 1 mL/kg/min, P < .001). In Cox proportional hazards analysis, exercise-induced SI and a low VO2max were independent predictors of subsequent cardiac endpoints. CONCLUSION In a healthy population of obese, sedentary, middle-aged and older men, exercise-induced SI and low VO2max were predictors of incident CAD. This suggests that exercise treadmill testing is beneficial in assessing risk for future cardiac events in obese, sedentary individuals. J Am Geriatr Soc 47:923–929, 1999.
-
exercise induced Silent Myocardial Ischemia in master athletes
American Journal of Cardiology, 1998Co-Authors: Leslie I Katzel, Jerome L Fleg, Janette M Busbywhitehead, John D Sorkin, Lewis C Becker, Edward G Lakatta, Andrew P GoldbergAbstract:High-physical activity levels are associated with reduced risk of symptomatic coronary artery disease (CAD). However, there are a number of reports of exercise-related sudden death and Myocardial infarction in aerobically trained athletes. This study compared the prevalence of exercise-induced Silent Myocardial Ischemia on maximum graded exercise tests with tomographic thallium scintigraphy in 70 master male athletes (63 +/- 6 years, mean +/- SD) (maximum aerobic capacity, VO2max >40 ml/kg/min) and in 85 healthy untrained men (61 +/- 7 years) with no history of CAD. The prevalence of Silent Ischemia (exercise-induced ST-segment depression on electrocardiogram and perfusion abnormalities on thallium scintigraphy) was similar in athletes and untrained men; 16% of the athletes (11 of 70) had Silent Ischemia compared with 21% of the untrained men (chi-square = 0.81, p = 0.36). No athletes had hyperlipidemia, systemic hypertension, or diabetes mellitus. However, the apolipoprotein E4 allele was present in 9 of the 11 athletes with Silent Ischemia compared with 2 of 32 athletes with normal exercise tests (chi-square = 24, p = 0.0001). These results suggest that older male athletes with the apolipoprotein E4 allele are at increased risk for the development of exercise-induced Silent Ischemia.
Felix E Tristani - One of the best experts on this subject based on the ideXlab platform.
-
significance of Silent Myocardial Ischemia during exercise testing in patients with diabetes mellitus a report from the coronary artery surgery study cass registry
American Journal of Cardiology, 1991Co-Authors: Donald A Weiner, Thomas J Ryan, Lori Parsons, Lloyd D Fisher, Bernard R Chaitman, Thomas L Sheffield, Felix E TristaniAbstract:To evaluate the significance of ischemic ST depression without anginal chest pain during exercise testing among patients with diabetes mellitus, the data on 45 such patients from the Coronary Artery Surgery Study registry were analyzed. These patients (group 1, Silent Ischemia) were compared with 37 diabetic patients with both ischemic ST depression and chest pain (group 2, symptomatic Ischemia), with 31 diabetic patients without ischemic ST depression or chest pain (group 3, no Ischemia), and with 429 patients without diabetes who had Silent Ischemia during exercise testing. All patients had documented coronary artery disease (CAD) (>70% diameter narrowing). The 6-year survival among patients with Silent Ischemia was worse in diabetic than nondiabetic patients (59 vs 82%, respectively, p < 0.001). By contrast, the 6-year survival among patients without Ischemia was similar among diabetic and nondiabetic patients (93 vs 85%, respectively, p = 0.476). Among diabetic patients, survival at 6 years with medical treatment was 59% for group 1,66% for group 2 and 93% for group 3 (p = 0.008). Survival among subsets of patients with diabetes and Silent Ischemia (group 1) based on the extent of CAD and left ventricular function ranged from 100 to 32% (p = 0.093). The survival of the 45 patients with diabetes mellitus and Silent Ischemia (group 1) treated medically was compared with that of 28 patients receiving coronary artery graft bypass surgery. Survival at 6 years was enhanced by surgery compared with medical treatment among group 1 diabetic patients with 3-vessel CAD and either preserved left ventricular function (85 vs 52%, respectively, p = 0.080) or impaired left ventricular function (100 vs 32%, respectively, p = 0.015). These data suggest that, among patients with diabetes and CAD, Silent Myocardial Ischemia during exercise testing adversely affects survival, and that coronary artery bypass graft surgery improves the survival of diabetic patients with Silent Myocardial Ischemia and 3-vessel CAD.
Stanley Epstein - One of the best experts on this subject based on the ideXlab platform.
-
prevalence of coronary artery disease complex ventricular arrhythmias and Silent Myocardial Ischemia and incidence of new coronary events in older persons with chronic renal insufficiency and with normal renal function
American Journal of Cardiology, 2000Co-Authors: Wilbert S Aronow, Chul Ahn, Anthony D Mercando, Stanley EpsteinAbstract:In a prospective study of 98 persons > or = 65 years of age with chronic renal insufficiency (serum creatinine > 3.0 mg/dl) for > 1 year and 98 age- and sex-matched persons with normal renal function (serum creatinine < or = 1.2 mg/dl), new coronary events developed at 23-month follow-up in 69 persons (70%) with chronic renal insufficiency and at 48-month follow-up in 24 persons (24%) with normal renal function (p < 0.0001). Significant independent risk factors for new coronary events were age (risk ratio 1.1), prior coronary artery disease (risk ratio 3.5), complex ventricular arrhythmias diagnosed by 24-hour ambulatory electrocardiography (risk ratio 2.5), Silent Myocardial Ischemia diagnosed by 24-hour ambulatory electrocardiography (risk ratio 1.9), and chronic renal insufficiency (risk ratio 3.4).
-
prognostic significance of Silent Myocardial Ischemia in patients 61 years of age with extracranial internal or common carotid arterial disease with and without previous Myocardial infarction
American Journal of Cardiology, 1993Co-Authors: Wilbert S Aronow, Chul Ahn, Anthony D Mercando, Stanley Epstein, Myron R SchoenfeldAbstract:Abstract Patients with extracranial carotid disease (ECD) have an increased incidence of coronary events. 1–3 We are reporting data from a prospective study correlating Silent Myocardial Ischemia detected by 24-hour ambulatory electrocardiography with the incidence of new coronary events at 43-month mean follow-up in elderly patients with 40 to 100% ECD with and without coronary artery disease (CAD).
