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  • 1
    Electronic Resource
    Electronic Resource
    Computerized Vectorcardiography Telemetry: A New Device for Continuous Multilead ST-Segment Monitoring of Ambulatory Patients. A Preliminary Report (2002)
    Oxford, UK : Blackwell Publishing Ltd
    Annals of noninvasive electrocardiology 7 (2002), S. 0 
    Details
    ISSN: 1542-474X
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background: Continuous vectorcardiography ST-segment monitoring has become a well-established method in the surveillance of patients with acute myocardial ischemia. However, immobility of the vectorcardiography technique prevents monitoring of patients during ambulatory activities. Computerized vectorcardiography telemetry (CVT) with the capacity of real-time ST-segment analysis has been developed in an attempt to overcome this shortcoming. Recent data, however, indicate that changes in body position occasionally lead to pseudo-ischemic ST-segment changes during continuous ST-segment monitoring.Aims: This report describes the technical features of the CVT system, presents clinical examples using CVT, and assesses the influence of changes in body position on ST-vector magnitude (ST-VM) during CVT, respectively.Methods: Clinical cases involving CVT are presented. The influence of changing body position during CVT monitoring was evaluated on 24 patients with suspected acute coronary syndromes, i.e., unstable angina or acute myocardial infarction. Each patient performed a specific body positional schedule.Results: We present three discrete clinical cases where CVT provided early and valuable evidence of ongoing myocardial ischemia. The consequences of different recumbent and ambulatory body positions on ST-VM during CVT monitoring appear to be limited.Conclusion: Computerized vectorcardiography telemetry is a promising new tool for disclosing residual myocardial ischemic activity during the mobilization phase of patients with acute coronary syndromes. The clinical value of CVT needs further investigation in future trials. A.N.E. 2002;7(3):204–210
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1542-474X.2002.tb00164.x
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  • 2
    Electronic Resource
    Electronic Resource
    Continuous ST-segment Monitoring of Patients with Right Bundle Branch Block and Suspicion of Acute Myocardial Infarction (2005)
    350 Main Street , Malden , MA 02148 , USA , and 9600 Garsington Road , Oxford OX4 2XG , UK . : Blackwell Publishing, Inc.
    Annals of noninvasive electrocardiology 10 (2005), S. 0 
    Details
    ISSN: 1542-474X
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background: Patients with right bundle branch block comprise 5–9% of all patients with acute myocardial infarction. In spite of this, limited data exist on early diagnosis or the usefulness of continuous electrocardiographic monitoring in these patients. Methods: A prospective multicenter study with 14 Swedish coronary care units. Patients with right bundle branch block and suspicion of acute myocardial infarction with less than 6 hours symptom duration were included. All patients were monitored with continuous vectorcardiography for 12–24 hours. Results: Seventy-nine patients were included, 43% had acute myocardial infarction. Patients with acute myocardial infarction had significantly higher initial ST-vector magnitude values (P = 0.0014) compared to patients without acute myocardial infarction. Patients with acute myocardial infarction also showed gradual regression of ST-vector magnitude over time that was not seen for patients without acute myocardial infarction (P = 0.005). ST-vector magnitude measured at the J-point differentiated best between patients with and without acute myocardial infarction. A cutoff value of 125 μV for initial ST-vector magnitude resulted in 55% sensitivity and 87% specificity for the diagnosis of acute myocardial infarction. Over time, patients with acute myocardial infarction showed greater changes in QRS-vector difference compared to patients without acute myocardial infarction (P = 0.052). Conclusion: Vectorcardiographic monitoring shows good diagnostic abilities for patients with right bundle branch block and clinical suspicion of acute myocardial infarction and could be useful for continuous monitoring of these patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1542-474X.2005.05613.x
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  • 3
    Electronic Resource
    Electronic Resource
    ST Variability during the First 4 Hours of Acute Myocardial Infarction Predicts 1-Year Mortality (2001)
    Oxford, UK : Blackwell Publishing Ltd
    Annals of noninvasive electrocardiology 6 (2001), S. 0 
    Details
    ISSN: 1542-474X
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background: Early and complete myocardial reperfusion is the goal when treating a patient with acute myocardial infarction. To achieve this in each individual, an on-line, accurate, easily handled and preferably noninvasive technique to monitor flow alterations is needed. Recurrent ST-segment elevation has been shown to reflect cyclic disturbances in perfusion.Methods: We have retrospectively analyzed ST variability in 102 patients with acute myocardial infarction randomized to 100 mg of rt-Pa or placebo. Patients were monitored for 24 hours using vectorcardiography.Results: Patients alive at one year (86%) had significantly less ST variability during the first four hours: 4.3 versus 7.1 episodes, P = 0.007. Patients having six or more ST episodes showed a 31.3% one-year mortality as compared to no mortality in patients having no ST variability. Furthermore ST variability was reduced by fibrinolysis.Conclusion: Early ST variability detectable in real time is associated with worse outcome. A.N.E. 2001; 6(3):198–202
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1542-474X.2001.tb00108.x
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  • 4
    Electronic Resource
    Electronic Resource
    Similar Risk Reduction of Death of Extended-Release Metoprolol Once Daily and Immediate-Release Metoprolol Twice Daily During 5 Years After Myocardial Infarction (1999)
    Springer
    Cardiovascular drugs and therapy 13 (1999), S. 127-135 
    Details
    ISSN: 1573-7241
    Keywords: acute myocardial infarction ; beta-blockade ; metoprolol ; prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Summary. The pooled results from five placebo-controlled postinfarction studies with metoprolol have shown a significant reduction in total mortality. All five studies used immediate-release metoprolol twice daily. An extended-release formulation of metoprolol for once-daily use has since been developed. The aim of the present study was to compare the two different forms of metoprolol with regard to the risk reduction of death for 5 years postinfarction and to analyze whether treatment with the beta-blocker metoprolol is associated with a reduced mortality after the introduction of modern therapies such as thrombolysis, aspirin, and ACE inhibitors. All patients discharged after an acute myocardial infarction (AMI) from Sahlgrenska University Hospital (SU) during 1986–1987 (n = 740, Period I) and during 1990–1991 (n = 1446, Period II) from both SU and Östra Hospital, Göteborg, Sweden, were included in the study during Period I, 56% were prescribed immediate-release metoprolol compared with 61% prescribed extended-release metoprolol during Period II. Immediate-release metoprolol was not available for outpatient use during Period II. In a multivariate analysis, all variables significantly associated with either increased or decreased postinfarction mortality during Periods I and II (univariate analysis of patient characteristics, medical history, complications during the AMI medication at discharge) studied were with Cox's proportional hazards model. Treatment with immediate-release metoprolol was significantly associated with reduced mortality over 5 years during Period I (relative risk reduction for total mortality, −34%, P = 0.003; 95% CI for RR, 0.51–0.87), and treatment with extended-release metoprolol was significantly associated with reduced mortality during Period II (−34%, P 〈 0.0001; 95% CI for RR, 0.53–0.82). Thrombolysis and the use of aspirin and ACE inhibitors were more frequently used during Period II. The results showed that postinfarction treatment with extended-release metoprolol given once daily was associated with a similar risk reduction of death over 5 years as immediate-release metoprolol given twice daily. The data, furthermore, indicate that the beta-blocker metoprolol is associated with a reduced risk of death after the introduction of modern therapy such as thrombolysis, aspirin, and ACE inhibitors.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1007736226093
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  • 5
    Electronic Resource
    Electronic Resource
    Long-term Mortality after Acute Myocardial Infarction in Relation to Prescribed Dosages of a Beta-Blocker at Hospital Discharge (2000)
    Springer
    Cardiovascular drugs and therapy 14 (2000), S. 589-595 
    Details
    ISSN: 1573-7241
    Keywords: beta blockers ; dosage ; prognosis ; myocardial infarction
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract This study was designed to describe the 5-year mortality rate in relation to the dose of metoprolol prescribed at hospital discharge after hospitalisation for acute myocardial infarction (AMI). All patients discharged alive after being hospitalized for AMI at Sahlgrenska Hospital (covering half of the community of Göteborg, with 500,000 inhabitants) during 1986–1987 (period I) and all patients discharged alive after hospitalization for AMI at Sahlgrenska Hospital and östra Hospital (covering the whole area of the community of Göteborg) in 1990–1991 (period II) were included. Overall mortality was retrospectively evaluated over 5 years of follow-up. In all there were 2161 patients who were discharged after AMI. Seventy-three percent of these patients were prescribed a beta-blocker and 59% were prescribed metoprolol. Of the patients prescribed metoprolol, 34% were on 200 mg, 46% on 100 mg, and 20% on 50 mg or less. Information on 5-year mortality was available for 2142 of the 2161 patients (99.1%). The 5-year mortality was 24% among patients prescribed 200 mg, 33% among patients prescribed 100 mg, and 43% among patients prescribed 50 mg (P 〈 0.0001). Patients prescribed another beta-blocker had a 5-year mortality of 39%, and patients prescribed no beta-blocker at all had a 5-year mortality of 61%. When correcting for dissimilarities at baseline, patients who were prescribed ≤100 mg had an adjusted risk ratio for death of 0.79 (95% confidence limit 0.64–0.96; P = 0.021) as compared with patients not prescribed a beta blocker. The corresponding figure for patients prescribed 〉100 mg was 0.63 (95% confidence limit 0.48–0.84; P = 0.001). Both patients prescribed high and low doses of metoprolol after AMI appeared to benefit from treatment. There was a trend indicating more benefit when larger doses were prescribed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1007894210131
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