Stanley Epstein

Usefulness of echocardiographic left ventricular hypertrophy, ventricular tachycardia and complex ventricular arrhythmias in predicting ventricular fibrillation or sudden cardiac death in elderly patients

Abstract Echocardiographic left ventricular (LV) hypertrophy is associated with an increased incidence of new coronary events. 1–3 Ventricular tachycardia (VT) and complex ventricular arrhythmias associated with heart disease are independent risk factors for new cardiac events in elderly patients. 4 We reported in a prospective study that VT was present in 30 of 196 elderly patients (15%) with echocardiographic LV hypertrophy and in 23 of 358 patients (6%) without LV hypertrophy (p 5 Complex ventricular arrhythmias occurred in 147 of 196 patients (75%) with LV hypertrophy and in 157 of 358 patients (44%) without LV hypertrophy (p 5 We are now reporting 27-month follow-up data correlating LV hypertrophy, VT and complex ventricular arrhythmias with development of primary ventricular fibrillation (VF) or sudden cardiac death in these 554 unselected patients older than 62 years in a long-term health care facility.

Usefulness of silent myocardial ischemia detected by ambulatory electrocardiographic monitoring in predicting new coronary events in elderly patients

Abstract Unrecognized myocardial infarction (MI) detected by electrocardiogram (ECG) occurred in 83 of 237 women (35%) and 130 of 469 men (28%) with initial MI in the Framingham study. 1 Unrecognized MI had as serious a prognosis as recognized MI in that study. 1 In our 1985 study, 2 we reported that unrecognized Q-wave MI detected by ECG occurred in 78 of 115 elderly patients (68%) with MI in a long-term health care facility. After instructing staff physicians on the different presenting symptoms of MI in elderly patients, the incidence of unrecognized MI detected by ECG in a prospective study was 23 of 110 MIS (21%). 3 Silent myocardial ischemia detected by ambulatory ECG monitoring is common during daily life in asymptomatic patients with coronary artery disease (CAD) and positive treadmill exercise tests. 4 In unstable angina, 80% of ischemic episodes are silent. 5 Abnormalities in regional and global left ventricular wall motion are similar in patients with CAD, with and without silent ischemia. 6 Rubidium-82 positron-emission tomographic studies have demonstrated reduced myocardial perfusion during episodes of silent myocardial ischemia detected by ambulatory ECG monitoring in patients with CAD. 7 The prognosis of asymptomatic silent ischemia in patients with CAD depends on the extent of CAD and left ventricular dysfunction. 8 The prognostic value of silent ischemia detected by ambulatory ECG monitoring has been reported in patients with unstable angina, 9–11 in high-risk postinfarction patients 12 and in patients with stable CAD. 13,14 We performed a prospective study (1) to determine the prevalence of silent ischemia in elderly patients with CAD, patients with systemic hypertension, valvular heart disease or cardiomyopathy, and in patients with no evidence of heart disease, and (2) to correlate silent ischemia with cardiac events at 26-month follow-up in these groups of patients.

Correlation of complex ventricular arrhythmias detected by ambulatory electrocardiographic monitoring with echocardiographic left ventricular hypertrophy in persons older than 62 years in a long-term health care facility

Abstract The incidence of cardiovascular morbid events is higher in patients with left ventricular (LV) hypertrophy detected by electrocardiography than in those without LV hypertrophy. 1 Hypertensive patients with electrocardiographic LV hypertrophy have more frequent and complex ventricular premature complexes (VPCs) than those without LV hypertrophy. 2 Echocardiography has a greater sensitivity, specificity, positive predictive value and negative predictive value than electrocardiography in diagnosing LV hypertrophy. 3 We performed a prospective study to correlate the prevalence of complex ventricular arrhythmias detected by ambulatory electrocardiographic monitoring with increased LV mass detected by technically adequate M-mode and 2-dimensional echocardiograms in unselected persons older than 62 years in a long-term health care facility.

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

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).

Decrease in mortality by propranolol in patients with heart disease and complex ventricular arrhythmias is more an anti-ischemic than an antiarrhythmic effect

Abstract We reported in a prospective, randomized study of 245 patients (mean age 81 years) with heart disease, complex ventricular arrhythmias, and a left ventricular ejection fraction of ≥40% that, compared with no antiarrhythmic drug, propranolol caused a 47% significant decrease in sudden cardiac death, a 37% significant decrease in total cardiac death, and a 20% insignificant decrease in total death. 1 Follow-up 24-hour ambulatory electrocardiograms were obtained in 112 of 123 patients (91%) treated with propranolol and in 109 of 122 patients (89%) treated with no antiarrhythmic drug. This article presents data correlating the reduction in mortality by propranolol with reduction in complex ventricular arrhythmias and in abolition of myocardial ischemia.

Usefulness of echocardiographic abnormal left ventricular ejection fraction, paroxysmal ventricular tachycardia and complex ventricular arrhythmias in predicting new coronary events in patients over 62 years of age.

Abstract Patients with an abnormal left ventricular (LV) ejection fraction (EF), with paroxysmal ventricular tachycardia (VT) or with complex ventricular arrhythmias associated with heart disease are at increased risk for cardiac events. 1–9 We previously reported the prevalence of an abnormal LVEF determined by M-mode and 2-dimensional echocardiography and the prevalence of VT and complex ventricular arrhythmias detected by 24-hour ambulatory electrocardiographic recordings in unselected patients older than 62 years in a long-term health care facility. 10 In the present report we present the results from a prospective study correlating abnormal LVEF, VT and complex ventricular arrhythmias with development of cardiac events at 2-year follow-up in 467 unselected patients older than 62 years.

Prevalence of and association between silent myocardial ischemia and new coronary events in older men and women with and without cardiovascular disease.

OBJECTIVES: To investigate the prevalence of silent ischemia (SI) in older men and women detected by 24‐hour ambulatory electrocardiograms (AECGs) and the association between SI and new coronary events.

Usefulness of silent ischemia, ventricular tachycardia, and complex ventricular arrhythmias in predicting new coronary events in elderly patients with coronary artery disease or systemic hypertension

Abstract Ventricular tachycardia (VT), complex ventricular arrhythmias and silent ischemia detected by 24-hour ambulatory electrocardiographic monitoring contribute to new coronary events in elderly patients with heart disease. 1–3 We performed a prospective study to find the correlation of VT, complex ventricular arrhythmias and silent ischemia to new cardiac events in patients over 62 years of age with coronary artery disease (CAD) or hypertension.

Prevalence of arrhythmias detected by ambulatory electrocardiographic monitoring and of abnormal left ventricular ejection fraction in persons older than 62 years in a long-term health care facility

Abstract The prevalence of arrhythmias detected by ambulatory electrocardiographic (ECG) monitoring in healthy elderly or active elderly persons has been reported in studies involving 13 to 106 persons. 1–4 We performed a prospective study to determine the prevalence of arrhythmias detected by ambulatory ECG monitoring in unselected persons older than 62 years in a long-term health care facility who had technically adequate M-mode and 2-dimensional echocardiograms for measuring left ventricular (LV) ejection fraction (EF).

Prevalence of silent myocardial ischemia detected by 24-hour ambulatory electrocardiography, and its association with new coronary events at 40-month follow-up in elderly diabetic and nondiabetic patients with coronary artery disease

Abstract Patients with diabetes mellitus have a higher prevalence and incidence of coronary artery disease (CAD) than nondiabetic patients. The prevalence of silent myocardial ischemia was found to be increased in diabetic patients by some investigators,1,2 but not by others.3,4 We report the results from a prospective study determining the prevalence of silent myocardial ischemia and the incidence of new coronary events associated with silent ischemia in diabetic and nondiabetic patients with CAD.