JACC

Journal of the American College of Cardiology

Editorial Board

Editor-in-Chief

SIMON DACK, MD, New York, NY

Associate Editors

Senior Assistant Editors

ANTHONY N. DEMARIA, MD, Lexington, KY

SUZANNE B. KNOEBEL, MD, Indianapolis, IN

DAN G . McNAMARA, MD, Houston, TXJOHN A. WALDHAUSEN, MD, Hershey, PA

Editorial Consultants

GEORGE S . ABELA, MD, Gainesville, FLROBERT J . ADOLPH, MD, Cincinnati, OH

JOHN AMBROSE, MD, New York, NYFRED L. ANDERSON, MD, Salt Lake City, UTWILLIAM F. ARMSTRONG III, MD, Indianapolis, IN

DONALD S. BALM, MD, Boston, MAROBERT A . BAUERNFEIND, MD, Richmond, VA

LEWIS C . BECKER, MD, Baltimore, MDDANIEL S . BERMAN, MD, Los Angeles, CAEUGENE H. BLACKSTONE, MD, Birmingham, ALROBERTO BOLLI, MD, Houston, TXKENNETH M. BOROW, MD, Chicago, ILCHARLES A. BOUCHER, MD, Boston, MAMARTIAL G . BOURASSA, MD, Quebec, CanadaEUGENE BRAUNWALD, MD, Boston, MABRUCE H . BRUNDAGE, MD, Chicago, ILRICHARD 0 . CANNON III, MD, Bethesda, MDBLASE CARABELLO, MD, Charleston, SCKANU CHATTERJEE, MD, San Francisco, CA

JAMES H . CHESEBRO, MD, Rochester, MN

ROBERT J. CODY, MD, Columbus, OHPATRICIA C. COME, MD, Boston, MAHAROLD DASH, MD, Everett, WARICHARD B . DEVEREUX, MD, New York, NY

JOHN P . DiMARCO, MD, PhD, Charlottesville, VA

JAMES C . DILLON, MD, Indianapolis, INLEONARD S. DREIFUS, MD, Philadelphia, PAPETER J . ENGEL, MD, Cincinnati, OHTOBY R. ENGEL, MD, Omaha, NEMARY ALLEN ENGLE, MD, New York, NY

ANDREW E. EPSTEIN, MD, Birmingham, ALSTEPHEN E . EPSTEIN, MD, Bethesda, MD

STEPHEN M . FACTOR, MD, Bronx, NYJACK FERLINZ, MD, Chicago, ILROSS D . FLETCHER, MD, Washington, DC

*Died August 25, 1�8� .

**Died October 1�, 1�8� .

JAMES S . FORRESTER, MD, Los Angeles, CANOBLE 0 . FOWLER, MD, Cincinnati, OH

ARTHUR C . FOX, MD, New York, NY

GARY S. FRANCIS, MD, Minneapolis, MNGOTTLIEB C . FRIESINGER II, MD, Nashville, TN

VICTOR F. FROELICHER, MD, Long Beach, CA

EDWARD D. FROHLICH, MD, New Orleans, LAVALENTIN FUSTER, MD, New York, NYARTHUR GARSON, Jr, MD, Houston, TX

EDWARD M . GELTMAN, MD, St . Louis, MO

BERNARD J . GERSH, MB, ChB, PhD, Rochester, MN

STANLEY l . GOLDBERG, MD, Tucson, AZRICHARD A . GOLDSTEIN, MD, Houston, TX

RICHARD J . GOLINKO, MD, New York, NYTHOMAS P. GRAHAM, Jr, MD, Nashville, TNWILLIAM GROSSMAN, MD, Boston, MAROLF M. GUNNAR, MD, Maywood, ILWARREN G. GUNTHEROTH, MD, Seattle, WACHARLES B . HIGGINS, MD, San Franciso, CAL . DAVID HILLIS, MD, Dallas, TXLEO G. HORAN, MD, Augusta, GAJAMES C . HUHTA, MD, Philadelphia, PAJEFFREY M . ISNER, MD, Boston, MAMARK E . JOSEPHSON, MD, Philadelphia, PAJOEL S . KARLINER, MD, San Francisco, CAKENNETH M . KESSLER, MD, Miami, FLROBERT A. KLONER, MD, PhD, Los Angeles, CAMORRIS N . KOTLER, MD, Philadelphia, PAEDGAR LICHSTEIN, MD, Brooklyn, NYMARTIN J . LIPTON, MD, Chicago, IL

**MELVIN L. MARCUS, MD, Iowa City, IABARRY M. MASSIE, MD, San Francisco, CAISRAEL MIRSKY, PhD, Boston, MAHILTRUD S . MUELLER, MD, Bronx, NY

NAVIN C . NANDA, MD, Birmingham, AL

IRA J. GELB, MD, New Rochelle, NY*RAYMOND HARRIS, MD, Albany, NY

MELVIN KAHN, MD, New York, NY

LESLIE A. KUHN, MD, New York, NY

MILTON PACKER, MD, New York, NYBERTRAM PITT, MD, Ann Arbor, MIGARY D . PLOTNICK, MD, Baltimore, MD

GERALD M. POHOST, MD, Birmingham, ALERIC N . PRYSTOWSKY, MD, Indianapolis, INFRANCISCO J. PUGA, MD, Rochester, MNCHARLES E . RACKLEY, MD, Washington, DC

ELLIOT RAPAPORT, MD, San Francisco, CANATHANIEL REICHEK, MD, Philadelphia, PAJAMES L . RITCHIE, MD, Seattle, WA

SAMUEL B . RITTER, MD, New York, NYJEREMY N . RUSKIN, MD, Boston, MARICHARD 0 . RUSSELL, Jr, MD, Birmingham, ALTHOMAS J . RYAN, MD, Boston, MAMARK H . SCHOENFELD, MD, New Haven, CTARTHUR SELZER, MD, San Francisco, CADAVID J . SKORTON, MD, Iowa City, IAEDMUND H . SONNENBLICK, MD, Bronx, NYFRANK C . SPENCER, MD, New York, NYDAVID H . SPODICK, MD, DSc, Worcester, MALEONARD STEINFELD, MD, New York, NYBORYS SURAWICZ, MD, Indianapolis, INA. JAMIL TAJIK, MD . Rochester, MNERIC J . TOPOL, MD, Ann Arbor, MIDAVID D . WATERS, MD, Quebec, CanadaHARVEY L . WAXMAN, MD, Camden, NJ

KARL T. WEBER, MD, Chicago, ILMYRON L. WEISFELDT, MD, Baltimore, MDARTHUR E . WEYMAN, MD, Boston, MABARRY L . ZARET, MD, New Haven, CT

Executive Editor

RUTH OHMAN, New York. NY

CONTENTS OF VOLUME 14

JULY 1�8� VOLUME 14 NUMBER 1

ACC ANNIVERSARY SEMINAR 78 Medical and Surgical Management of Early Q Wave Myocardial

1

Suzanne B . Knoebel, Guest Editor

Perspective on Valvular Heart Disease � An Update .

Infarction . II . Effects on Mortality and Global and Regional LeftVentricular Function at 10 or More Years of Follow-Up.Marcus A . DeWood, Jeffrey Leonard, Ronald P. Grunwald,

24

Shahbudin H . Rahimtoola

Risk Factors for Cardiovascular Disease and Death � A Clinical

Gerald R . Hensley, Lowell T . Mouser, Robert W . Burroughs,Ralph Berg, Jr ., Lloyd D . Fisher

Perspective . Henry D. McIntosh �1 Antecedent Angina� A Predictor of Residual Stenosis After

COOPERATIVE STUDIES �6

Thrombolytic Therapy . Bruce A. Bergelson, Nicholas A .Ruocco, Jr., Thomas J. Ryan, Beth R . Hankin,Alice K. Jacobs, David P . Faxon

Nonischemic Sustained Ventricular Tachycardia � Clinical

31 Risk Stratification in Patients With First Non-Q WaveOutcome in 12 Patients With Arrhythmogenic Right Ventricular

Infarction � Limited Value of the Early Low Level Exercise TestAfter Uncomplicated Infarcts . Ronald J . Krone, Edward M .Dwyer, Jr., Henry Greenberg, J . Philip Miller, John A . 106

Dysplasia. Robert Lemery, Pedro Brugada, Johan Janssen,Ernile Cheriex, Thierry Dugernier, Hein J .J. Wellens

Subnormal Heart Period Variability in Heart Failure � Effect of

38

Gillespie, and the Multicenter Post-Infarction Research Group

Editorial Comment Non-Q Wave Myocardial Infarction �

Cardiac Transplantation . Michael L . Smith, KennethA . Ellenbogen, Dwain L. Eckberg, Szabolcs Szentpeterv,Marc D. Thames

Identification of High and Low Risk Subsets by Clinical 112 Left Ventricular Dynamics During Exercise in Elite Marathon

40

Variables. Anthony T. Gambino, Richard M . Steingart

The In-Hospital Development of Cardiogenic Shock After

Runners . Robert Fagard, Carine Van Den Broeke,Antoon Amen'

Myocardial Infarction� Incidence, Predictors of Occurrence,Outcome and Prognostic Factors . Mark E. Hands, John D .Rutherford, James E . Muller, Glenn Davies, Peter H . Stone .Corette Parker, Eugene Braunwald, and 11�

METHODS

Patterns of Regional Diastolic Function in the Normal Human

47

the MILTS Study Group

Editorial Comment Cardiogenic Shock Complicating

Left Ventricle � An Ultrafast Computed Tomographic Study .John A . Rumberger, Robert M . Weiss, Andrew J . Feiring,William Stanford, Zina D . Hajduczok, Karim Rezai,

Myocardial Infarction. Thomas Killip

127

Melvin L . Marcus

Linearity of the Left Ventricular End-Systolic Pressure-Volume4� The Effect of Diabetes Mellitus on Prognosis and Serial LeftVentricular Function After Acute Myocardial Infarction �Contribution of Both Coronary Disease and Diastolic LeftVentricular Dysfunction to the Adverse Prognosis . Peter H .Stone, James E. Muller, Tvler Hartwell, B .J. York, John D . 135

Relation in Patients With Severe Heart Failure . ConstantineN. Aroney, Howard C . Herrmann, Marc J. Semigran,G. William Dec, Charles A . Boucher, Michael A . Fifer

Peak Left Ventricular Pressure During Percutaneous Aortic

58

Rutherford, Corette B . Parker, Zoltan G . Turi, H. WilliamStrauss, James T. Willerson, Thomas Robertson, EugeneBraunwald, Allan S . Jaffe, and the MILTS Study Group

Late Thrombolytic Therapy Preserves Left Ventricular Function

Balloon Valvuloplasty � Clinical and EchocardiographicCorrelations . John A . Bittl, Satinder J .S . Bhatia, TedPlappert, Peter Ganz, Martin G . St . John Sutton,Andrew P. Selwyn

143 Depolarization Changes Early in the Course of Myocardialin Patients With Collateralized Total Coronary Occlusion �Primary End Point Findings of the Second Mount Sinai-NewYork University Reperfusion Trial . K. Peter Rentrop,Frederick Feit, Warren Sherman, Peter Stecy, Susan Hosat,Marc Cohen, Mariano Re y, John Ambrose, Mark Nachamie, 150

Infarction � Significance of Changes in the Terminal Portion ofthe QRS Complex . James E. Barnhill III, Michael Tendera,Harold Code, W. Barton Campbell . Raphael F . Smith

Increased Plasma Fibrinopeptide A Levels During Attacks

William Schwartz, William Cole, Robert Perdoncin,John C . Thornton

CLINICAL STUDIES155

Induced by Hyperventilation in Patients With CoronaryVasopastic Angina . Shuichi Oshima, Hisao Ogawa . HirofumiYasue. Ken Okumura, Koshi Matsuyama, Hiroo Miyagi

ELECTROPHYSIOLOGIC STUDIES

Use of Electrophysiologic Testing in Patients With Nonsustained65 Medical and Surgical Management of Early Q Wave Myocardial

Infarction . I . Effects of Surgical Reperfusion on Survival,Recurrent Myocardial Infarction, Sudden Death and FunctionalClass at 10 or More Years of Follow-Up . Marcus A . DeWood, 162

Ventricular Tachycardia � Prognostic and TherapeuticImplications . Richard C . Klein, Charles Machell

Editorial Comment The Dilemma of Treatment of NonsustainedRobert N . Notske, Ralph Berg, Jr., John H . Ganji, Carroll S .Simpson, Michael L . Hinnen, Samuel L. Selinger,Lloyd D. Fisher

Ventricular Tachycardia in Patients With Coronary ArteryDisease . Albert L . Waldo, Mark D . Carlson,Richard W. Henthorn

165

CARDIAC PACING

Prospective Comparison of Sequential Pulse and Single Pulse 21�

EXPERIMENTAL STUDIES

Cardioprotective Effects of Various Class I AntiarrhythmicDefibrillation With Use of Two Different Clinically AvailableSystems. Gust H. Bardy, Tom D. Ivey, Margaret D . Allen,George Johnson, H. Leon Greene

225

Drugs in Canine Hearts. Yoshihiro Hanaki, SatoruSugiyama, Nobuvuki Hieda, Kazumi Taki, Hiroshi Hayashi,Takayuki Ozawa

Ventricular Arrhythmias and Local Electrograms After Chronic

172

REVIEWS

Electrophysiologic Substrate of Torsade de Pointes � Dispersion of 233

Regional Denervation of the Ischemic Area in the Pig Heart .Juan Cinca, Alfredo Bardaji, Antonio Salas-Caudevilla

Effect of Nitroglycerin-Induced Reduction of Left VentricularRepolarization or Early Afterdepolarizations?Borvs Surativicz

242

Filling Pressure on Diastolic Filling in Acute Dilated HeartFailure . Steven J . Lavine, Colin A . Campbell,A. Christian Held, Vicki Johnson

Comparison of Monophasic With Single and Dual Capacitor

185

PEDIATRIC CARDIOLOGY

Flecainide Acetate for Resistant Arrhythmias in the Young �

Biphasic Waveforms for Nonthoracotomy Canine InternalDefibrillation . Peter D . Chapman, James W . Vetter,

Efficacy and Pharmacokinetics . James C. Perry, Roy L .McQuinn, Richard T. Smith, Jr., Cheryl Gothing, Patricia 246

Joseph J . Souza, Jule N . Wetherbee, Paul J . Troup

Myocardial Protection During Ischemia by Prior Feeding With

1�2

Fredell, Arthur Garson, Jr .

Editorial Comment Flecainide for Pediatric Arrhythmias � Dothe Creatine Analog � Cyclocreatine . Mark D. Jacobstein,Thomas A . Gerken, Abdul M. Bhat, Pierre G . Carlier

1�4

Children Behave Like Little Adults? Andrew E. Epstein

Balloon Dilation of Pulmonary Venous Pathway ObstructionAfter Mustard Repair for Transposition of the Great Arteries .Stephen G. Cooper, Ian D . Sullivan, Catherine Bull, 252

CASE REPORTS

Quinidine-Induced Long QTU Interval and Torsade de Pointes �James F.N. Taylor

258

Role of Bradycardia-Dependent Early Afterdepolarizations .Nabil El-Sherif, Soad-Saad Bekheit, Raphael Henkin

Coronary Artery to Right Ventricle Fistula in Heart Transplant

1��

REPORTS ON THERAPY

Surgical Therapy for Drug-Refractory Ventricular Tachycardia �Recipients � A Complication of Endomyocardial Biopsy . MilenaJ. Henzlova, Hrudaya Nath, R . Pat Bucy, Robert C . Bourge,

20�

Results With Mapping-Guided Subendocardial Resection .Antonis S. Manolis, Hassan Rastegar, Douglas Payne,Richard Cleveland, Mark Estes III

Arrhythmogenic Effects of Antiarrhythmic Drugs� A Study of

James K. Kirklin, William J . Rogers

SPECIAL SECTIONS

506 Patients Treated for Ventricular Tachycardia or Fibrillation 262 ACC News President's Page � The American College ofMarshall S . Stanton, Eric N . Prystowsky, Naomi S . Fineberg,William M. Miles, Douglas P. Zipes, James J. Heger

263

Cardiology and a Smoke-Free America . C . Richard Conti

Letters to the Editor216 Editorial Comment Proarrhythmia and Primum Non Nocere.

Melvin M. Scheinman 264 Correction

AUGUST 1�8� VOLUME 14 NUMBER 2

ACC ANNIVERSARY SEMINAR 28� Inducibility of Sustained Monomorphic Ventricular Tachycardia

265

Suzanne B . Knoebel, Guest Editor

Cardiac Surgery � A Glimpse Into the Future. William S .

as a Prognostic Indicator in Survivors of Recent MyocardialInfarction � A Prospective Evaluation in Relation to OtherPrognostic Variables . Tim Cripps, E. David Bennett, A . John

Pierce, Walter E . Pae, John L . Myers, John A . Waldhausen

2�7

Camm, David E . Ward

Right Coronary Artery Occlusion � Its Role in the Mechanism of

276

CLINICAL STUDIES

Long-Term Results of Thrombolytic Therapy With and Without 303

Precordial ST Segment Depression . Hiroshi Sato, KazuhisaKodama, Tohru Masuyama, Shinsuke Nanto, MasatsuguHori, Akira Kitabatake, Michitoshi Inoue, Takenobu Kamada

Editorial Comment The Right Coronary Artery and the

286

Percutaneous Transluminal Coronary Angioplasty . RaimundErbel, Tiberius Pop, Christoph Diefenbach, Jurgen Meyer

Editorial Comment Long-Term Survival After Pharmacologic 305

Anterior Ventricular Wall � Relations and Relevance . James L .Vacek, Marvin Dunn

Does the Rest Electrocardiogram After Myocardial Infarctionand Mechanical Recanalization in Acute Myocardial Infarction.Hiltrud S . Mueller

Determine the Predictive Value of Exercise-Induced STDepression? A 2 Year Follow-Up Study in a Veteran Population .

Jacob Klein, Victor F . Froelicher, Robert Detrano, Paul 401 Balloon Dilation of Postoperative Right Ventricular Outflow

312

Dubach, Ray Yen

Enhanced Regional Left Ventricular Function After Distant

Obstructions . Benjamin Zeevi, John F. Keane, Stanton B .Perry, James E. Lock

Coronary Bypass by Means of Improved Collateral Blood Flow. 40� Editorial Comment Balloon Dilation � Recession or Inflation?Vasken Dilsizian, Richard 0 . Cannon III, Cynthia M . Tracy,Charles L. McIntosh, Richard E . Clark, Robert 0 . Bonow 413

Samuel B . Ritter

Treatment of Recoarctation � Balloon Dilation Angioplasty .31� Isolated Chronic Mitral Regurgitation With Preserved Systolic Stephen G . Cooper, lan D . Sullivan, Christopher Wren

Left Ventricular Function and Severe Pulmonary Hypertension . 420 Editorial Comment Angioplasty for Recoarctation .Dimitrios Alexopoulos, Charles Lazzam, Susan Borrico,Lizabeth Fiedler, John A . Ambrose

422

James C. Huhta

Marfan's Syndrome � Natural History and Long-Term Follow-Up323 Myocardial Beta-Adrenoceptor Changes in Heart Failure � of Cardiovascular Involvement . Dominic L . Marsalese,

Concomitant Reduction in Beta,- and Beta2-AdrenoceptorFunction Related to the Degree of Heart Failure in Patients WithMitral Valve Disease . Otto-Erich Brodde, Hans-ReinhardZerkowski, Norbert Doetsch, Shigeru Motomura, MassudKhamssi, Martin C . Michel 42�

Douglas S . Moodie, Michael Vacante, Bruce W . Lytle, CarlC. Gill, Richard Sterba, Delos M. Cosgrove, MatthewPassalacqua, Marlene Goormastic, Andrea Kovacs

Editorial Comment The Heart of the Matter � Cardiovascular

332 Clinical Results and in Vivo Valve Function After ImplantationInvolvement in Marfan's Syndrome . John S . Child, Joseph K .Perloff Samuel Kaplan

of a Bicer Valve Prosthesis in the Aortic Position . KanjiKawachi, Soichiro Kitamura, Ryuichi Morita, Tsutomu Nishii, 432 Risk Factors for Conotruncal Cardiac Defects in Atlanta .

338

Toshio Seki, Shigeki Taniguchi, Kiyoshi Inoue

Mechanism of the Attenuated Peak Heart Rate Response to

Melissa M. Adams, Joseph Mulinare, Kenneth Dooley

Exercise After Orthotopic Cardiac Transplantation . RebeccaJ. Quigg, Michael B . Rocco, Diane F . Gauthier, Mark A .Creager, L . Howard Hartley, Wilson S . Colucci 443

EDITORIALS

Theories of Cardiovascular Causes in Sudden Infant Death

345

METHODS

Load Dependence of the Single Beat Maximal Pressure

Syndrome . Warren G. Guntheroth

EXPERIMENTAL STUDIES(Stress)/Volume Ratios in Humans . Mark R . Starling, Daniel 44� Constriction of a Large Coronary Artery Contributes to

354

G. Montgomery, Richard A . Walsh

Editorial Comment An Appraisal of Ventricular andSerotonin-Induced Myocardial Ischemia in the Dog With PliableCoronary Stenosis. Yasunori Ichikawa, Mitsuhiro Yokoyama,

Myocardial Function Variables Based on the Elastance Concept .Israel Mirskv

460

Hozuka Akita, Hisashi Fukuzaki

Editorial Comment Potential Role of Serotonin in Dynamic357 High Dose Dipyridamole Echocardiography Early After Coronary Stenosis. Roberto Both

Uncomplicated Acute Myocardial Infarction � Correlation WithExercise Testing and Coronary Angiography . Leonardo 462 Early Identification With Ultrasonic Integrated Backscatter of

364

Bolognese, Gianni Sarasso, Donatella Aralda, Angelo S .Bongo, Lidia Rossi, Paolo Rossi

Effect of Long-Term High Intensity Aerobic Training on Left

Viable But Stunned Myocardium in Dogs. Mark R. Milunski,Gregory A . Mohr, Keith A. Wear, Burton E. Sobel, James G .Miller, Samuel A . Wickline

Ventricular Volume During Maximal Upright Exercise . 472 In Vivo Nuclear Magnetic Resonance Imaging of Myocardial

Leonard E . Ginzton, Richard Conant, Marianne Brizendine,Michael M. Laks

ELECTROPHYSIOLOGIC STUDIES481

Perfusion Using the Paramagnetic Contrast Agent ManganeseGluconate. Soul Schaefer, Richard A . Lange, Padmaker V.Kulkarni, Jose Katz, Robert W. Parkev, James T . Willerson,Ronald M . Peshock

Functional Relation Between Infarct Thickness and Regional372 Significance of Signal-Averaged Electrocardiography in Relation Systolic Function in the Acutely and Subacutely Infarcted

to Endomyocardial Biopsy and Ventricular Stimulation Studiesin Patients With Ventricular Tachycardia Without ClinicallyApparent Heart Disease. Davendra Mehta, William J.McKenna, David E . Ward, Michael J. Davies, A . John Camm

48�

Canine Left Ventricle . Douglas L . Mann, Linda D . Gillam,Robert Mich, Rodney Foale, John B . Newell,Arthur E. Wevman

Evaluation of Ventricular Contractility Indexes in the Dog With380 Editorial Comment The Arrhythmic Substrate in Patients Left Ventricular Dysfunction Induced by Rapid Atrial Pacing .

382

Without Overt Heart Disease . J. Anthony Gomes

Preferential Effect of Procainamide on the Reentrant Circuit ofDennis E. Morgan, Charles W. Tomlinson, A . Karim Qayumi,Philip M. Toleikis, Briege McConville, W . R . Eric Jamieson

Ventricular Tachycardia . G. Neal Kay, Andrew E . Epstein, 4�6 Editorial Comment Ratio of End-Systolic Stress to End-Systolic

3�1

Vance J. Plumb

Natural History of Patients With Unexplained Syncope and aVolume � Is it a Useful Clinical Tool? Blase A. Carabello

Nondiagnostic Electrophysiologic Study. Jeffrey A . Kushner,William H. Kou, Alan H . Kadish, Fred Morady

4��

CARDIAC PACING

The Hemodynamic Benefit of Differential Atrioventricular Delay

3�7

PEDIATRIC CARDIOLOGY

Caveats of Balloon Dilation of Conduits and Conduit Valves .Intervals for Sensed and Paced Atrial Events During PhysiologicPacing . Denise L. Janosik, Anthony C . Pearson, Thomas A .

Gregory J. Ensing, Donald J . Hagler, James B . Seward, PaulR. Julsrud, Douglas D. Mair

Buckingham, Arthur J . Labovitz, Robert M. Redd, with thetechnical assistance of Denise Mrosek

SEPTEMBER 1�8� VOLUME 14 NUMBER 3

535

ACC ANNIVERSARY SEMINARSuzanne B . Knoebel, Guest Editor

Current Status of Cardiac Surgery� A 40 Year Review. Wayne

van Es, Jacobus Lubsen, Patrick W . Serruvs, Maarten L .Simoons, Marc Verstraete, for the European Co-OperativeStudy Group for rt-PA

545

E. Richenbacher, John L. Myers, John A . Waldhausen

Pulmonary Hypertension� A Cellular Basis for UnderstandingCLINICAL STUDIES

58� Increased Fibrinopeptide A During Anginal Attacks in Patients

551

the Pathophysiology and Treatment . Stuart Rich,Bruce H. Brundage

Primary Pulmonary Hypertension � A Look at the Future .

With Variant Angina . Takashi Irie, Tsutomu Imaizumi,Takeyuki Matuguchi, Samon Koyanagi, Hideo Kanaide, AkiraTakeshita, Motoomi Nakamura

John H. Newman, Joseph C . Ross 5�5 Editorial Comment Fibrinopeptide A� A Ubiquitous Marker .

COOPERATIVE STUDIES5�7

David Waters, Jules Lam

Urinary Fibrinopeptide A Levels in Ischemic Heart Disease .556 Coronary Heart Disease Morbidity and Mortality in Robert L . Wilensky, Jack A . Zeller, Marc Wish,

Hypercholesterolemic Men Predicted From an Exercise Test �The Lipid Research Clinics Coronary Primary Prevention Trial .Lars-Goran Ekelund, Chirayath M . Suchindran, Robert P . 604

Mark Tulchinsky

Significance of Coronary Artery Tone in Patients With

McMahon, Gerardo Heiss, Arthur S . Leon, Donald W.Romhilt, Carl L. Rubenstein, Jeffrey L . Probstfield,Joseph F. Ruwitch 610

Vasospastic Angina . Akira Hoshio, Hiroshi Kotake,Hiroto Mashiba

Editorial Comment Pathogenetic Mechanisms of Coronary

564 Predictors of Total Mortality and Sudden Death in Mild to Artery Spasm . Attilio Maseri, Juan Carlos Kaski

Moderate Heart Failure. Alan Gradman, Prakash 613 Functional and Structural Abnormalities in Patients With

571

Deedwania, Robert Cody, Barry Massie, Milton Packer,Bertram Pitt, Sidney Goldstein, for the Captopril-DigoxinStudy Group

Editorial Comment Prognostic Factors in Heart Failure � 624

Dilated Cardiomyopathy . Alessandro S. Bortone, Otto M .Hess, Adele Chiddo, Antonio Gaglione, Nicola Locuratolo,Gilda Caruso, Paolo Rizzon

Acute Hemodynamic Effects of Norepinephrine Inhibition in

573

Poverty Amidst a Wealth of Variables. Jay N. Cohn

A New Thrombolytic Regimen for Acute Myocardial Infarction

Patients With Severe Chronic Congestive Heart Failure .Joseph A . Franciosa, David E. Schwartz

Using Combination Half Dose Tissue-Type Plasminogen 631 Echocardiography in Infective Endocarditis � Reassessment of

581

Activator With Full Dose Streptokinase � A Pilot Study . CindyL . Grines, Steven E. Nissen, David C . Booth, Marcelo C .Branco, John C . Gurley, Kim A . Bennett, Anthony N .DeMaria, and the KAMIT Study Group

Increased Serum Levels of Fibrinogen Degradation Products Due

Prognostic Implications of Vegetation Size Determined by theTransthoracic and the Transesophageal Approach . AndreasMiigge, Werner G. Daniel, Gunter Frank, Paul R . Lichtlen

METHODS

to Treatment With Recombinant Tissue-Type Plasminogen 63� Noninvasive Quantitation of Myocardial Blood Flow in HumanActivator for Acute Myocardial Infarction Are Related toBleeding Complications, But Not to Coronary Patency . AlfredE. R. Arnold, Ronald W . Brower, Desire Collen, Gerrit-Anne

Subjects With Oxygen- 15-Labeled Water and Positron EmissionTomography . Steven R . Bergmann, Pilar Herrero, JoanneMarkham, Carla J . Weinheimer, Mary Norine Walsh

508 Time to First Shock and Clinical Outcome in Patients Receiving EDITORIALS

an Automatic Implantable Cardioverter-Defibrillator. RobertJ. Myerberg, Richard M . Luceri, Richard Thurer, Deborah K . 528 A View of Cardio-Cortical Connections . John Jay Koriath

515

Cooper, Liaqat Zaman, Alberto Interian, Pedro Fernandez,Marilyn Cox, Frances Glicksman, Agustin Castellanos

REPORTS ON HYPERTENSION

Comparative Effects of Verapamil and Nitroprusside on Left

HISTORICAL MILESTONES

530 Alexander Filipovich Samojloff and Paul Dudley White �

523

Ventricular Function in Patients With Hypertension . John E .Brush, Jr ., James E. Udelson, Stephen L . Bacharach, Richard0 . Cannon III, Martin B . Leon, Terri F. Rumble,Robert 0 . Bonow

CASE REPORTS

Angiographic Demonstration of Spontaneous Diffuse Three

Electrocardiography and a Russian-American Friendship.Dennis M . Krikler

SPECIAL SECTIONS

Vessel Coronary Artery Spasm. Malcolm R . Bell, Andre C . 532 ACC News President's Page � Concerns About FragmentationLapeyre III, Alfred A . Bove of Adult Cardiology. C . Richard Conti

653 Assessment of Myocardial Systolic Wall Thickening Using PEDIATRIC CARDIOLOGYNuclear Magnetic Resonance Imaging . Ronald M. Peshock,Roxann Rokey, Craig M. Malloy, Patrick McNamee, L . 734 Aortic Aneurysm After Patch Aortoplasty Repair of Coarctation �

660

Maximilian Buja, Robert W . Parkey, James T. Willerson

Myocardial Perfusion Imaging by Contrast Echocardiography

A Prospective Analysis of Prevalence, Screening Tests and Risks.Burt I. Bromberg, Robert H . Beekman, Albert P . Rocchini, A .Rebecca Snider, Estelle R . Bank, Kathleen Heidelberger,

With Use of Intracoronary Sonicated Albumin in Humans .Shimon A . Reisner, Ling S . Ong, Gerson S . Lichtenberg,Antonio F. Amico, Janine R . Shapiro, Mark N . Allen, 742

Amnon Rosenthal

Surgical Options for Complex Transposition of the Great

666

Richard S . Meltzer

Quantitative Texture Analysis in Two-Dimensional

Arteries . Antonio Corno, Barbara George, Jeffrey Pearl,Hillel Laks

Echocardiography � Application to the Diagnosis of Myocardial 750 Relation Between Preoperative Left Ventricular Muscle MassAmyloidosis . Bruno Pinamonti, Eugenio Picano, Ezio MariaFerdeghini, Fabio Lattanzi, Gianni Slavich, Luigi Landini,Fulvio Camerini, Antonio Benassi, Alessandro Distante,Antonio L'Abbate 756

and Outcome of the Fontan Procedure in Patients WithTricuspid Atresia . Mohamed Seliem, Alexander J . Muster,Milton H. Paul, D . Woodrow Benson, Jr .

Congenital Cardiovascular Malformations � Questions on672 Reproducibility of Left Ventricular Mass Measurements by Inheritance . Charlotte Ferencz, Joann A . Boughman,

677

Two-Dimensional and M-Mode Echocardiography. H. WadeCollins, Marvin W. Kronenberg, Benjamin F. Byrd III

Serial Assessment of Mitral Regurgitation by Pulsed Doppler

Catherine A . Neill, Joel 1 . Brenner, Lowell W . Perry, and theBaltimore- Washington Infant Study Group

Echocardiography in Patients Undergoing Balloon AorticValvuloplasty . Patricia C . Come, Marilyn F . Riley, Aaron D .Berman, Robert D. Safian, Carol A . Waksmonski,Raymond G. McKav

765

EXPERIMENTAL STUDIES

Influence of Infarct Age on Reproducibility of Ventricular683 Effects of Active Muscle Mass Size on CardiopulmonaryResponses to Exercise in Congestive Heart Failure . Wade H.Martin III, Walter L Berman, Jay C . Bucke_v, Peter G . Snell,C. Gunnar Blomqvist 774

Tachycardia Induction in a Canine Model . Geraldine B . Hunt,David L. Ross

Editorial Comment Infarct Age and Reproducibility of

ELECTROPHYSIOLOGIC STUDIES 777

Ventricular Tachycardia Induction . Harvey L. Waxman

Effects of Flecainide on Defibrillation Thresholds in the

6�5 Derived Epicardial Potentials Differentiate Ischemic STAnesthetized Dog . Rosa Hernandez, David E . Mann, SusanBreckinridge, Gerald R . Williams, Michael J . Reiter

Depression From ST Depression Secondary to ST Elevation inAcute Inferior Myocardial Infarction in Humans . David 782 Verapamil Ameliorates Clinical, Pathologic and Biochemical

703

Kilpatrick, Anthony J . Bell, Stephen J . Walker

Editorial Comment Resolution of Nonspecific Repolarization

Manifestations of Experimental Chagasic Cardiomyopathy inMice . Stephen A. Morris, Louis M . Weiss, Stephen Factor,John P . Bilezikian, Herbert Tanowitz, Murray Wittner

Patterns From Body Surface Signals� A New Horizon of ClinicalElectrocardiography . Robert J. Myerburg, 7�0 Aortic Diameter and Pressure-Flow Sequence Identify

705

Agustin Castellanos

Isoproterenol Reversal of Antiarrhythmic Effects in Patients

Mechanism of Blood Flow During External Chest Compressionin Dogs . Alan D. Guerci, Henry R . Halperin, Rafael Beyar,Charles Beattie, Joshua E . Tsitlik, Edward C . Wurmb, Nisha

With Inducible Sustained Ventricular Tachyarrhythmias .Mohammad R. Jazayeri, Galen Van Wyhe, Boaz Avitall, JamesMcKinnie, Patrick Tchou, Masood Akhtar 7��

C. Chandra, Myron L. Weisfeldt

Characteristics of Lymphocytes Cultured From Murine Viral

712 Editorial Comment Stress (Electrophysiologic and Other) in theMyocarditis Specimens � A Preliminary and Technical Report .Chiharu Kishimoto, James T . Kurnick, John T. Fallon, Clyde

715

Electrophysiology Laboratory� When Is Enough, Enough?Leonard N . Horowitz, Steven J . Nierenberg,Charles D . Gottlieb

REPORTS ON HYPERTENSION

Plasma Atrial Natriuretic Factor in Essential Hypertension � 803

S . Crumpacker, Walter H. Abelmann

CASE REPORTS

Percutaneous Excimer Laser Angioplasty of Aortocoronary

725

Relation to Cardiac Size, Function and Systemic Hemodynamics .Antonello Ganau, Richard B . Devereux, Steven A . Atlas,Mark Pecker, Marv J . Roman, Paolo Vargiu, Robert J. Cody,John H. Laragh

Editorial Comment Atrial Natriuretic Factor � Its Role in

Saphenous Vein Grafts . Frank Litvack, Warren S . Grundfest,Tsvi Goldenberg, James Laudenslager, James S . Forrester

Hypertension . Edward D . Frohlich

80�

SPECIAL SECTIONS

ACC News President's Page � The American College of

728

CARDIAC PACING

A Prospective Randomized Evaluation of Biphasic VersusCardiology and World Cardiovascular Medicine .C. Richard Conti

Monophasic Waveform Pulses on Defibrillation Efficacy in 811 Letters to the EditorHumans . Gust H. Bardy, Tom D. Ivey, Margaret D . Allen,George Johnson, Rahul Mehra, H . Leon Greene 812 Correction

OCTOBER 1�8� VOLUME 14 NUMBER 4

813

ACC ANNIVERSARY SEMINARSuzanne B . Knoebel, Guest Editor

Platelet Inhibitor Agents in Cardiovascular Disease � An Update.

Pitt, and the Thrombolysis and Angioplasty in MyocardialInfarction (TAMI) 4 Study Group

Bernardo Stein, Valentin Fuster, Douglas H. Israel, MarcCohen, Lina Badimon, Juan J . Badimon, James H. Chesebro 885

CLINICAL STUDIES

Painless Exercise ST Deviation on the Treadmill � Long-Term837 After Coronary Thrombolysis and Reperfusion, What Next? Prognosis . Daniel B . Mark, Mark A . Hlatky, Robert M .

Nils U. Bang, Olaf G . Wilhelm, Michael D . Clayman

PLENARY LECTURE8�3

Califf, James J . Morris, Jr., Stephen D . Sisson, Charles B .McCants, Kerry L . Lee, Frank E . Harrell, Jr ., David B . Pryor

Editorial Comment Prognosis in Exercise-Induced Silent850 Coronary Thrombolysis and the New Biology . Burton E . Sobel Ischemia � Is There a Consensus? Peter F. Cohn

COOPERATIVE STUDIES 8�5 Silent Ischemia � Evaluation by Exercise and Redistribution

861 Serial Quantitative Planar Technetium-��m Isonitrile Imaging inTomographic Thallium-201 Myocardial Imaging . Harvey S .Hecht, Richard E. Shaw, Thomas Bruce, Richard K . Myler

Acute Myocardial Infarction � Efficacy for Noninvasive �01 Editorial Comment "Silent Ischemia"� What Is It? Gerald M .Assessment of Thrombolytic Therapy. Frans J. Th . Wackers,Raymond J. Gibbons, Mario S . Verani, David S. Kayden,Patricia A . Pellikka, Thomas Behrenbeck, John J . Mahmarian, �03

Pohost

The Natural History of Left Ventricular Thrombus in

874

Barry L . Zaret

Editorial Comment Noninvasive Assessment of Myocardial

Myocardial Infarction � A Rationale in Support of MasterlyInactivity . Petros Nihoyannopoulos, Gillian C . Smith, Attilio

Salvage After Coronary Reperfusion � A Perpetual Quest ofNuclear Cardiology George A . Beller �12

Maseri, Rodney A . Foale

Editorial Comment Left Ventricular Thrombus and Stroke

877 Combined Tissue-Type Plasminogen Activator and Prostacyclin After Myocardial Infarction � Toward Prevention or Perplexity?

Therapy for Acute Myocardial Infarction . Eric J . Topol,Stephen G. Ellis, Robert M . Califf, Barry S . George, David C . �15

Jonathan L. Halperin, Valentin Fuster

Insensitivity of Right Ventricular Endomyocardial Biopsy in theStump, Eric R . Bates, Elizabeth G . Nabel, Joseph A . Walton,Richard J. Candela, Kerry L . Lee, Eva M . Kline, Bertram

Diagnosis of Myocarditis . Lawrence H. Chow, Stanley J .Radio, Thomas D . Sears, Bruce M. McManus

SEPTEMBER 1�8� VOLUME 14 NUMBER 3 (SUPPLEMENT A)

1A Preface. Robert S . Dittus, Suzanne B . Knoebel,Charles M . Clark, Jr ., August M. Watanabe

51A Consensus Committee Statements � Introduction .Suzanne B . Knoebel

2A Introduction . Suzanne B. Knoebel, Robert S . Dittus 52A Projects and Priorities in Cardiovascular Modeling .Mark A. Hlatky, Harry P . Selker

3A Payment Policy, Quality of Care and Decision Making WithInadequate Information. Donald A . Young 57A Barriers to the Dissemination of Research Findings of Decision

Modeling in the Management of Cardiovascular Disease.7A Modeling for Policy Decisions � Potential and Problems .

Suzanne B . KnoebelJohn C. Peirce

12A Future Imperfect� The Limitations of Clinical Prediction Modelsand the Limits of Clinical Prediction . George A . Diamond

60A Data for Cardiovascular Modeling . Lawrence H. Muhlbaier,David B. Pryor

23A Quantifying Uncertainty in Medical Decisions.Robert S . Dittus, Stephen D. Roberts, James R . Wilson

65A Research Collaboration . Lloyd D. Fisher, Thomas Robertson,G. M. K. Hughes, Arthur Hartz, Peter Liu, Bruce F . Waller,Mark Young

2�A A Patient With New Q Waves � Methods for Decision Making inthe Individual Patient. Alan J. Moskowitz,Stephen G. Pauker

6�A Medical Quality Assessment and the American College ofPhysicians. Richard G. Farmer, Linda Johnson White

38A Methodologic Issues in Policy Modeling for CardiovascularDisease Milton C . Weinstein

72A Comments by the Representative of the Society for MedicalDecision Making . Stephen G. Pauker

44A Development and Analysis of Observational Data Bases.Thomas H. Lee, Lee Goldman

74A Response From the American College of CardiologyRepresentative. John F . Williams, Jr.

48A Moving Forward on Quality of Care� Role of Decision Modeling .Duncan Neuhauser, Kristine Napier

76A Samuel Nathan Regenstrief� 1�10-1�88 . Suzanne B . Knoebel,Robert S . Dittus

�21 Editorial Comment Acute Myocarditis � Is Sampling Error aContraindication for Diagnostic Biopsies?Margaret E. Billingham

METHODS

��2 Electrophysiologic and Clinical Effects of Oral Encainide inParoxysmal Atrioventricular Node Reentrant TachycardiaMarcella Chimienti, Maria Li Bergolis, Maurizio Moizi,Jorge A. Salerno

��� Effect of Thyroid Replacement Therapy on the Frequency ofBenign Atrial and Ventricular Arrhythmias . Ralf Polikar,Gregory K . Feld, Howard C. Dittrich, Johana Smith, Pascal

�23 Reproducibility of Two-Dimensional Exercise Echocardiography .Albert Oberman, Po-Hoey Fan, Navin C . Nanda, Jeannette Y .Lee, William J. Huster, Julie A . Sulentic, Octavia F. Storey

Nicod

�2� Effect of Heart Rate on Doppler Indexes of Systolic Function inHumans. Michael R. Harrison, G . Dennis Clifton, Kevin L .Sublett, Anthony N . DeMaria

1003 20TH BETHESDA CONFERENCE� Insurability andEmployability of the Patient With Ischemic Heart Disease.Robert F . DeBusk, Chairman

�36 Day to Day Variability of Doppler Color Flow Jets in MitralRegurgitation . Paul A. Grayburn, Susan L . Pryor,Benjamin D. Levine, Mordecai N. Klein, Anne L . Taylor,with the technical assistance of Arvella Peters

1004 Participants

1008 Introduction . Robert F. DeBusk (Chairman)

�41 Elevation of Factor VII Activity and Mass in Young Adults atRisk of Ischemic Heart Disease . Carol J. Hoffman, Robin H .Miller, William E . Lawson, Mae B. Hultin

1010 Committee Report on Economic, Administrative and LegalFactors Influencing the Insurability and Employability ofPatients With Ischemic Heart Disease. William Guillette

�47 Arterial Wall Characteristics Determined by IntravascularUltrasound Imaging � An in Vitro Study . Elma J .

(Chairman), Richard D . Judge, Erda Koehn, Joel E . Miller,Robert K . Palmer, J . L . Guy Tremblay

Gussenhoven, Catherina E . Essed, Charles T . Lancee, FritsMastik, Peter Frietman, Frans C . van Egmond, JohannesReiber, Hans Bosch, Hero van Urk, Jos Roelandt,Nicolaas Bom

1016 Task Force I � Determination of Prognosis in Patients WithIschemic Heart Disease. David B . Pryor (Chairman), RobertA. Bruce, Bernard R . Chaitman, Lloyd Fisher, Jerzy Gajewski,Karl E. Hammermeister, Stephen G . Pauker,Joseph Stokes III

PEDIATRIC CARDIOLOGY

1025 Task Force II � Determination of Occupational Working Capacityin Patients With Ischemic Heart Disease . William L . Haskell(Chairman), Norman Brachfeld, Robert A . Bruce, Paul 0.

�53 Left Subclavian Flap Aortoplasty for Coarctation of the Aorta �Effects on Forearm Vascular Function and Growth . Jeffrey S .Shenberger, Steven A . Prophet, John A . Waldhausen,

Davis, Charles A . Dennis, Samuel M . Fox III, Peter Hanson,Arthur S . Leon

William R . Davidson, Jr ., Lawrence I. Sinoway 1034 Task Force III � Assessment of Psychological Status in PatientsWith Ischemic Heart Disease. James A. Blumenthal

�60 Detection of Coronary Artery Abnormalities in Tetralogy ofFallot by Two-Dimensional Echocardiography . Saadeh B .Jureidini, R . Scott Appleton, Soraya Nouri, with the technical

(Chairman), William Bradley, Joel E . Dimsdale, Stanislav V .Kasl, Lynda H. Powell, C . Barr Taylor

assistance of Cynthia J . Crawford 1043 Executive Summary-Determination of Cardiac Impairment andDisability . Robert F. DeBusk (Chairman)

�68 Diagnosis of Coronary Artery Fistula by Two-DimensionalEchocardiography, Pulsed Doppler Ultrasound and Color FlowImaging . Harm Velvis, Klaus G. Schmidt, Norman H .Silverman, Kevin Turley

EXPERIMENTAL STUDIES

EDITORIALS 1045 The Autoperfusion Balloon Angioplasty Catheter LimitsMyocardial Ischemia and Necrosis During Prolonged Balloon

�77 A Perspective on Color-Coded Doppler Echocardiography �Utility or Just Another Pretty Picture? Stanley J . Goldberg

Inflation . Colin A . Campbell, Shereif Rezkalla, Robert A .Kloner, Zoltan G. Turi

REPORTS ON HYPERTENSION

1051 Editorial Comment Is the Leaking Balloon Angioplasty Cathetera Better Catheter? Martial G . Bourassa

1053 Rate Dependence of Action Potential Duration and�7� Determinants of Abnormal Left Ventricular Filling in Early

Hypertension. Robert A. Phillips, Martin E . Goldman, MariaArdeljan, Rohit Arora, Howard B . Eison, Yu Buyan, LawrenceR . Krakoff

Refractoriness in Canine Ventricular Endocardium Differs FromThat of Epicardium� Role of the Transient Outward CurrentSilvio H. Litovsky, Charles Antzelevitch

REPORTS ON THERAPY

1067 Optimal Criteria for Rapid Detection of Myocardial Reperfusionby Creatine Kinase MM Isoforms in the Presence of ResidualHigh Grade Coronary Stenosis . Ryuji Nohara, Donald W .Myears, Burton E. Sobel, Dana R. Abendschein

�86 Emergent Coronary Angioplasty in the Treatment of AcuteIschemic Mitral Regurgitation� Long-Term Results in FiveCases . Fayaz A. Shawl, Mervyn B . Forman, Sudhakar Punja,Thomas S. Goldbaum

1074 Pericardiocentesis Guided by a Pulse Generator . James S .Tweddell, Ariaen N . E. Zimmerman, Constance M . Stone,Chris K. Rokkas, Richard B . Schuessler, John P. Boineau,James L. Cox

NOVEMBER 1, 1�8� VOLUME 14 NUMBER 5

1127

ACC ANNIVERSARY SEMINARSuzanne B . Knoebel, Guest Editor

Evolution of the Clinical Electrocardiogram . Charles Fisch 1200

Charles B . Treasure, Peter Ganz, David A . Cox, R . DavidFish, Andrew P . Selwyn

Editorial Comment Control of Shear Stress in the Epicardial

113� Beat to Beat Variability in Cardiovascular Variables � Noise or Coronary Arteries of Humans� Impairment by Atherosclerosis .

Music? Marvin L. Appel, Ronald D . Berger, J . Philip Saul,Joseph M. Smith, Richard J . Cohen 1202

Richard J . Bing

Sudden Paradoxic Clinical Deterioration During Angioplasty of

114�

COOPERATIVE STUDIES

Effect of Streptokinase on Left Ventricular Modeling and 1210

the Occluded Right Coronary Artery in Acute MyocardialInfarction . Gerald M. Gacioch, Eric J . Topol

Percutaneous Transluminal Aortic Valvuloplasty � AcuteFunction After Myocardial Infarction � The GISSI (GruppoItaliano per lo Studio della Streptochinasi nell'InfartoMiocardico) Trial . Paolo Marino, Luisa Zanolla, Piero 1218

Outcome and Follow-Up of 125 Patients . Ruben F . Lewin,Gerald Dorros, James F . King, Lynne Mathiak

Immediate and Short-Term Effects of Aortic Balloon

115�

Zardini, on behalf of the Gruppo Italiano per to Studio deltaStreptochinasi nell'Infarto Miocardico (GISSI)

The Use of Tissue-Type Plasminogen Activator for Acute

Valvuloplasty on Left Ventricular Diastolic Function and Fillingin Humans. Marcus F . Stoddard, Michel G. Vandormael,Anthony C . Pearson, Chalapathirao Gudipati, Morton J .

Myocardial Infarction in the Elderly� Results FromThrombolysis in Myocardial Infarction Phase I, Open LabelStudies and the Thrombolysis in Myocardial Infarction Phase IIPilot Study . Bernard R . Chaitman, Bruce Thompson, 122�

Kern, Ubeydullah Deligonul, Arthur J . Labovitz, with thetechnical assistance of Denise Mrosek

Cardiac and Peripheral Vascular Responses to AdrenoceptorMark D. Wittry, David Stump, William P. Hamilton,L. David Hillis, James G . Dwyer, Rachel E . Solomon,Genell L . Knatterud, for the TIM! Investigators

123�

Stimulation and Blockade After Cardiac Transplantation .Kenneth M. Borow, Alex Neumann, Frederick W . Arensman,Magdi H. Yacoub

Resolution of Severe Pulmonary Hypertension After HeterotopicCLINICAL STUDIES

1245

Cardiac Transplantation . Flordeliza S . Villanueva, SrinivasMurali, Barry F . Uretsky, P . Sudhakar Reddy, Bartley P .Griffith, Robert L . Hardesty, Robert L . Kormos

EPIDEMIOLOGIC STUDIES

Influence of Coronary Artery Disease on Morbidity and

1166 Ischemia in the Ambulatory Setting-the Total Ischemic Burden �Relation to Exercise Testing and Investigative and TherapeuticImplications . David Mulcahy, Jennifer Keegan, JaneSparrow, Amanda Park, Christine Wright, Kim Fox

1173 Editorial Comment Silent Myocardial Ischemia � PracticalApplication of Evolving Concepts. Ezra A . Amsterdam

1175 Exercise-Induced Silent Ischemia � Age, Diabetes Mellitus,Previous Myocardial Infarction and Prognosis . Peter R .Callaham, Victor F. Froelicher, Jacob Klein, Mona Risch,Paul Dubach, Robert Friis

1181 Coronary Vasomotion in Response to SympatheticStimulation in Humans� Importance of the FunctionalIntegrity of the Endothelium . Andreas M. Zeiher,

1253

Mortality After Abdominal Aortic Aneurysmectomy � APopulation-Based Study, 1�71-1�87 . Veronique L . Roger,David J. Ballard, John W. Hallett, Jr ., Philip J . Osmundson,Peggy A . Puelz, Bernard J . Gersh

METHODS

Assessment of Transesophageal Doppler Echography inHelmut Drexler, Helmut Wollschlaeger, Bernward Saurbier,Hanjoerg Just

11�1 Editorial Comment Endothelial Injury and CoronaryVasomotion . James H. Chesebro, Valentin Faster, MarkW. 1. Webster 1263

Dissecting Aortic Aneurysm . Satoshi Hashimoto, ToshiakiKumada, Genta Osakada, Shigeru Kubo, Shin go Tokunaga,Shunichi Tamaki, Ario Yamazato, Kazunobu Nishimura,Toshihiko Ban, Chuichi Kawai

Editorial Comment Is Transesophageal Echocardiography the11�3 Control of Shear Stress in the Epicardial Coronary Arteries of

Humans� Impairment by Atherosclerosis . Joseph A . Vita,New Standard for Diagnosing Dissecting Aortic Aneurysms?Morris N . Kotler

1085

HISTORICAL MILESTONES

The Origin of Thrombolytic Therapy . Sol Sherry 10�7

SPECIAL SECTIONS

ACC News President's Page � The American College of

1100

Cardiology and National Health Policy . C . Richard Conti

ACC News Education Update � Training Programs in the

10�3

EDITORIALS United States in Adult Cardiology, Pediatric Cardiology andCardiothoracic Surgery

Is Hypomagnesemia or Magnesium Deficiency Arrhythmogenic?Borys Surawicz 1125 Letters to the Editor

1266 Can Two-Dimensional Echocardiography and Doppler Color Analysis . Constantine N. Aroney, Marc J . Semigran,

1275

Flow Mapping Identify the Need for Tricuspid Valve Repair?H. K. Chopra, Navin C . Nanda, PoHoey Fan, Kanwal K .Kapur, Rajendra Goyal, Dinyar Daruwalla, Albert Pacifico

Editorial Comment Improved Guides to Tricuspid Valve

G. William Dec, Charles A . Boucher, Michael A . Fifer

133� Editorial Comment Second Generation Calcium ChannelBlockers in the Treatment of Chronic Heart Failure � Are TheyAny Better Than Their Predecessors? Milton Packer

1278

Repair� Two-Dimensional Echocardiographic Analysis ofTricuspid Anulus Function and Color Flow Imaging of Severityof Tricuspid Regurgitation . John S . Child

Percutaneous Cornonary Rotational Angioplasty in Humans � 1343

EXPERIMENTAL STUDIES

Comparison of the Internal Defibrillation Thresholds for

Preliminary Report . Jean L. Fourrier, Michel E . Bertrand,David C. Auth, Jean M . Lablanche, Antoine Gommeaux, JeanMarc Brunetaud

1350

Monophasic and Double and Single Capacitor BiphasicWaveforms. Katherine M . Kavanagh, Anthony S. L . Tang,Dennis L. Rollins, William M . Smith, Raymond E. Ideker

Effects of Methoxamine and Phenylephrine on Left Ventricular

1283

CARDIAC PACING

Rate-Modulated Cardiac Pacing Based on Transthoracic

Contractility in Rabbits. Marvin W. Kronenberg, Robert W.McCain, Robert J. Boucek, Jr, David W . Grambow, KiichiSagawa, Gottlieb C . Friesinger

Impedance Measurements of Minute Ventilation � Correlation 135� Selective Decrease in Lysis of Old Thrombi After RapidWith Exercise Gas Exchange . G . Neal Kay, Rosemary S .Bubien, Andrew E . Epstein, Vance J. Plumb

PEDIATRIC CARDIOLOGY 1365

Administration of Tissue-Type Plasminogen Activator . KenKanamasa, Ikuyoshi Watanabe, Bojan Cercek, Juliana Yano,Michael C . Fishbein, William Ganz

Chronic Hypertension and Left Ventricular Hypertrophy

12�1 Ventricular Septal Defects � A Surgical Viewpoint . BenignoFacilitate Induction of Sustained Ventricular Tachycardiain Dogs 3 Hours After Left Circumflex Coronary

Soto, Ricardo Ceballos, John W . Kirklin

1374

Artery Occlusion . James B. Martins, William Kim,Melvin L. Marcus

Editorial Comment Vulnerability to Ischemic Ventricular

12�8 Editorial Comment Ventricular Septa) Defects � How Shall WeDescribe, Name and Classify Them? Richard Van Praagh,

1300

Tal Geva, Jacqueline Kreutzer

Ebstein's Anomaly � Echocardiographic and Clinical Features in

Arrhythmias in Left Ventricular Hypertrophy. Hasan Garan

the Fetus and Neonate . David A . Roberson,Norman H . Silverman

1376

CASE REPORTS

Exercise-Induced Double (Atria) and Ventricular) Tachycardia�1308 Description of a Venous Technique for Selective Coronary A Report of Three Cases . Michael Eldar, Bernard Belhassen,

1312

Arteriography in Newborns With d-Transposition of the GreatArteries . Ronald W . Day, Josephine B . Isabel-Jones,Glenn T. Wetzel, George S. Oku, Jay M. Jarmakani

Remodeling of the Aorta After Successful Balloon Coarctation

Hanoch Hod, Claudio D. Schuger, Melvin M . Scheinman

EDITORIAL REVIEWS

Angioplasty . P . Syamasundar Rao, Patrick Carey 1382 From Myocardial Salvage to Patient Salvage in Acute

1318 The Value of Angiography in the Follow-Up of CoronaryMyocardial Infarction � The Role of Reperfusion Therapy .Robert M. Califf, Eric J . Topol, Bernard J. Gersh

Involvement in Mucocutaneous Lymph Node Syndrome(Kawasaki Disease) . Elfriede Pahl, Jose Ettedgui, William H . 138� Problems in the Development of New Devices for Coronary

1326

Neches, Sang C. Park

REPORTS ON THERAPY

Congestive Heart Failure Induced by Six of the Newer 13�3

Intervention� Possible Role for a Multicenter Registry .Donald S . Baim, Katherine Detre, Kenneth Kent

SPECIAL SECTIONS

President's Page � The American College of Cardiology and theAntiarrhythmic Drugs . Shmuel Ravid, Philip J . Podrid,Steven Lampert, Bernard Lown

13�5

Development of Chapters . C . Richard Conti

Newly Elected Members of the College1331 Inotropic Effect of Nicardipine in Patients With Heart Failure �

Assessment by Left Ventricular End-Systolic Pressure-Volume 13�8 Letters to the Editor

NOVEMBER 15, 1�8� VOLUME 14 NUMBER 6

1401

ACC ANNIVERSARY SEMINARSuzanne B . Knoebel, Guest Editor

Ventricular Arrhythmias � Why Is It So Difficult to Find a 142�

CLINICAL STUDIES

Angiographic Morphology of Coronary Artery Stenoses in

1417

Pharmacologic Cure? Borys Surawicz

Treatment of Cardiac Arrhythmias � When, How and Where?Prolonged Rest Angina � Evidence of Intracoronary Thrombosis .Roger Rehr, Germano Disciascio, George Vetrovec,

Hein J. J. Wellens, Pedro Brugada Michael Cowley

1438 Editorial Comment In Vivo Angiographic Pathoanatomy of ELECTROPHYSIOLOGIC STUDIESUnstable Angina � Twenty Years Later . Marc Cohen

1530 Identification of Susceptibility to Ventricular Tachycardia After1440 Exercise Echocardiographic Detection of Coronary Artery Myocardial Infarction by Nondipolarity of QRST Area Maps.

Disease in Women . Stephen G. Sawada, Thomas Ryan,Naomi S. Fineberg, William F. Armstrong, Walter E. Judson,Paul L. McHenry, Harvey Feigenbaum

1537

Hiroshi Tsunakawa, Genyo Nishiyama, Yasushi Kusahana,Kenichi Harumi

Editorial Comment QRST Area Maps and Cardiac1448 Editorial Comment Exercise Testing in Women . James A .

1450

Heinsimer, Christopher M . DeWitt

Improved Exercise Capacity With Acute Aminophylline

Arrhythmias . J. A . Abildskov

Administration in Patients With Syndrome X . Michele Emdin,Eugenio Picano, Fabio Lattanzi, Antonio L'Abbate 153�

PEDIATRIC CARDIOLOGY

"Acquired" Discrete Subvalvular Aortic Stenosis� Natural

1454 Editorial Comment Aminophylline for Angina� The "Robin

1545

History and Hemodynamics . Donald A . Leichter, IanSullivan, Welton M. Gersony

Absence of Left Ventricular Volume Loading in Infants With1456

Hood" Effect? Richard 0 . Cannon III

Spontaneous Coronary Artery Spasm in Variant Angina Is

1464

Caused by a Local Hyperreactivity to a Generalized ConstrictorStimulus . Juan Carlos Kaski, Attilio Maseri, MargaritaVejar, Filippo Crea, David Hackett, with the technicalassistance of Peter Halson

Type 1 Fiber Abnormalities in Skeletal Muscle of Patients With 1553

Coarctation of the Aorta and a Large Ventricular Septal Defect.Thomas P. Graham, Jr ., Judith Burger, Robert J . Boucek, Jr.,James A. Johns, Gordon A . Moreau, John W. Hammon, Jr .,Harvey W . Bender, Jr.

Editorial Comment Coarctation of the Aorta and Ventricular

1474

Hypertrophic and Dilated Cardiomyopathy � Evidence ofSubclinical Myogenic Myopathy . Alida L . P . Caforio, BrunoRossi, Riccardo Risaliti, Gabriele Siciliano, AntonioMarchetti, Corrado Angelini, Filippo Crea, Mario Mariani,Alberto Muratorio

Editorial Comment Coexistence of Skeletal Muscle 1555

Septal Defect in Infancy � Left Ventricular Volume andManagement Issues . Welton M. Gersony

EXPERIMENTAL STUDIES

Assessment of Regional Myocardial Perfusion by Contrast

1477

Abnormalities in Cardiomyopathy . David G. Benditt, AnnDunnigan, Simon Milstein, Constantinos Limas

METHODS

Effect of Exercise Level on the Ability of Thallium-201

Echocardiography . II . Detection of Changes in Transmural andSubendocardial Perfusion During Dipyridamole-InducedHyperemia in a Model of Critical Coronary Stenosis . JorgeCheirif William A . Zoghbi, Roberto Bolli, Padraig G . O'Neill,Bradley D. Hoyt, Miguel A . Quinones

Tomographic Imaging in Detecting Coronary Artery Disease �Analysis of 461 Patients. Abdulmassih S . Iskandrian,Jaekyeong Heo, Barbara Kong, Edward Lyons 1566

REPORTS ON THERAPY

Improved Thrombolysis With a Modified Dose Regimen of

1570

Recombinant Tissue-Type Plasminogen Activator .Karl-Ludwig Neuhaus, Werner Feuerer, Susanne Jeep-Tebbe,Walter Niederer, Albrecht Vogt, Ulrich Tebbe

Editorial Comment Enhancing Thrombolytic Efficacy by Means

1487 Editorial Comment How Accurate Is Thallium Exercise Testing

14�1

for the Diagnosis of Coronary Artery Disease? K. Lance Gould

Limitations of Regional Myocardial Thallium Clearance for

1501

Identification of Disease in Individual Coronary Arteries .Lewis C. Becker, Walter J . Rogers, Jr ., Jonathan M . Links,Carolyn Corn

Exercise-Induced ST Segment Depression in the Diagnosis of

of "Front-Loaded" Administration of Tissue PlasminogenActivator . Eugene Braunwald

EDITORIAL REVIEWSMultivessel Coronary Disease � A Meta Analysis . RobertDetrano, Renato Gianrossi, Daniel Mulvihill, Kenneth 1572 Reperfusion Momentum � Lessons From the Randomized Trials

150�

Lehmann, Paul Dubach, Antonio Colombo, Victor Froelicher

Editorial Comment Variations and Value of Exercise

of Immediate Coronary Angioplasty for Myocardial Infarction .David R. Holmes, Jr ., Eric J . Topol

1511

Electrocardiography . Robert A. Bruce

Comparison of Baroreflex Sensitivity and Heart PeriodVariability After Myocardial Infarction . J. Thomas Bigger,Jr., Maria Teresa La Rovere, Richard C . Steinman,Joseph L . Fleiss, Jeffrey N . Rottman, Linda M. Rolnitzky, 157�

CASE REPORTS

Cardiovascular Complications of Thrombolytic Therapy in

151�

Peter J . Schwartz

Regional Sympathetic Denervation After Myocardial Infarction

Patients With a Mistaken Diagnosis of Acute MyocardialInfarction . James C. Blankenship, Adrian K . Almquist

in Humans Detected Noninvasively UsingI-123-Metaiodobenzylguanidine . Marshall S . Stanton,Mahmoud M. Tuli, Nancy L . Radtke, James J . Heger,William M. Miles, Bruce H. Mock, Robert W. Burt, Henry N .Wellman, Douglas P . Zipes

1583

SPECIAL SECTIONS

ACC News President's Page� American College of Cardiology1527 Damage to Physicians' Gloves During "Routine" Cardiac and Its Role in Fostering Academic Careers . C . Richard Conti

Catheterization� An Underappreciated Occurrence . John M.Palmisano, Jon N. Meliones 1585 Letters to the Editor

DECEMBER 1�8� VOLUME 14 NUMBER 7

ACC ANNIVERSARY SEMINARSuzanne B . Knoebel, Guest Editor

1673

METHODS

Technetium-��m Isonitrile Myocardial Uptake at Rest . I. Relation1587 Left Ventricular Hypertrophy, Cardiac Diseases and to Severity of Coronary Artery Stenosis. Vasken Dilsizian,

15�5

Hypertension � Recent Experiences . Edward D. Frohlich

The Evolution of Antihypertensive Therapy � An Overview of 1678

Thomas P. Rocco, H . William Strauss, Charles A . Boucher

Technetium-��m Isonitrile Myocardial Uptake at Rest . II .Four Decades of Experience . George L . Bakris,Edward D . Frohlich

COOPERATIVE STUDIES 1685

Relation to Clinical Markers of Potential Viability .Thomas P. Rocro, Vasken Dilsizian, H . William Strauss .Charles A . Boucher

Editorial Comment Technetium-��m Isonitrile � A Perfusion or a

160� Long-Term Benefit of Early Thrombolytic Therapy in PatientsViability Agent? Josef Machac

With Acute Myocardial Infarction � 5 Year Follow-Up of a Trial 168� Quantitative Single Photon Emission Computed Thallium-201

1616

Conducted by the Interuniversity Cardiology Institute of theNetherlands . Maarten L . Simoons, Jeroen Vos, Jan G . P .Tijssen, Frank Vermeer, Freek W. A . Verheught, X . HannoKrauss, Volkert Manger Cats

Editorial Comment Long-Term Ischemic Risks After Successful

Tomography for Detection and Localization of Coronary ArteryDisease � Optimization and Prospective Validation of a NewTechnique. Jamshid Maddahi, Kenneth Van Train, FlorencePrigent . Ernest V. Garcia, John Friedman, Enrique Ostrzega,Daniel Berman

Thrombolysis for Acute Myocardial Infarction . 1700 Editorial Comment Single Photon Emission ComputedCharles E . Racklev

CLINICAL STUDIES 1702

Tomography (SPECT) � 1�8� and Beyond . James L. Ritchie,.Marvel D. Cerqueira

Ultrasonic Tissue Characterization With a Real Time Integrated

1618 The Role of Silent Ischemia, the Arrhythmic Substrate and the Backscatter Imaging System in Normal and Aging Human

Short-Long Sequence in the Genesis of Sudden Cardiac Death.J. Anthony Games, Dimitrios Alexopoulos, Stephen L .Winters, Pramod Deshmukh, Valentin Fuster, Kiting Suh

170�

Hearts . Tohru Masuvama . Ulrich Nellessen, IngelaSchnittger . Terrence L. Tve, William L . Haskell,Richard L . Popp

Editorial Comment Ultrasonic Tissue Characterization �1626 Cardiac Asystole� A Manifestation of Neurally MediatedHypotension-Bradycardia . Simon Milstein, Jeffrey Buetikofer,John Lesser, Irvin F . Goldenberg, David G . Benditt, CharlesGornick, Walter J. Re yes 1712

Prospects for Clinical Cardiology . Samuel A . Wickline,Burton E. Sobel

Characteristic Doppler Echocardiographic Pattern of Mitral

1633 Editorial Comment Neurally Mediated Hypotension and Inflow Velocity in Severe Aortic Regurgitation . Jae K. Oh .Liv K. Hatle, Lawrence J . Sinak, James B . Seward,A. Jarnil Tajik

1635

Bradycardia� Which Nerves? How Mediated? Robert F. Rea

Prognostic Importance of Silent Myocardial Ischemia Detectedby Intravenous Dipyridamole Thallium Myocardial Imaging in 1718 Editorial Comment Insights Into the Physiologic Significance ofAsymptomatic Patients With Coronary Artery Disease . LiwaT. Younis, Sheila Byers, Leslee Shaw, Grace Barth, HenryGoodgold, Bernard R. Chaitman 1721

the Mitral Inflow Velocity Pattern . Robert A . Levine,James D. Thomas

The Value of Cine Nuclear Magnetic Resonance Imaging for1642 Editorial Comment Dipyridamole Thallium-201 Scintigraphy � Assessing Regional Ventricular Function . Chaim S. Lotan,

1645

An Excellent Alternative to Exercise Scintigraphy .George A . Beller

Percutaneous Transluminal Angioplasty of Saphenous Vein

Gregory B. Cranney, Alain Bouchard, Vera Bittner,Gerald M. Pohost

Graft Stenosis � Long-Term Follow-Up . William P . Platko, JayHollman, Patrick L . Whitlow, Irving Franco

1731

ELECTROPHYSIOLOGIC STUDIES

Fast Fourier Transformation of the Entire Low Amplitude Late1651 Value of Two-Dimensional Echocardiography in Selecting QRS Potential to Predict Ventricular Tachycardia . Dan L .

Patients and Balloon Sizes for Percutaneous Balloon MitralValvuloplasty . Chunguang Chen, Xiao Wang, Yipo Wang,Yufu Lan 1741

Pierce, Arthur R . Easley, Jr ., John R . Windle, Toby R . Engel

Editorial Comment Spectral and Temporal Interrogation of

165� Prevalence and Long-Term Significance of Exercise-InducedSignal-Averaged Electrocardiograms � The Best Is Yet to Come .Michael E. Cain, H . Dieter Ambos . Bruce D. Lindsay, Joanne

Frequent or Repetitive Ventricular Ectopic Beats in ApparentlyHealthy Volunteers . M. Janette Busby, Elliot A . Shefrin,Jerome L . Fleg 1744

Markham, R . Martin Arthur

Programmed Ventricular Stimulation in Patients With Left

1666 Cognitive Function in Patients With Symptomatic DilatedVentricular Dysfunction and Ventricular Tachycardia � Effects ofAcute Hemodynamic Improvement Due to Nitroprusside .

Cardiomyopathy Before and After Cardiac Transplantation .R. Richard Schall, Ralph J. Petrucci, Susan C . Brozena .Nicholas C. Cavarocchi, Martell Jessup

Mark D. Carlson, Mark H . Schoenfeld, Hasan Garan,Christopher Y. Choong, Ravin Davidoff. Arthur E. Weyman,Jeremy N. Ruskin, Michael A . Fifer