Obstruction of coronary blood flow and the resultant consequences are the center stage pathophysiologic events in cardiology today. The speculations of Jenner, Burns, Heberdin, McKenzie, Prinzmetal and many others had until now been left to observations of isolated tissue and intact animal experimentation. Only with the advent of Gruentzig's technique, which allowed us to 'work safely inside the coronary arteries' are we able to observe the effects of coronary occlusion in living conscious man. PTCA provides not only a therapeutic modality for non-operatively opening coronary obstructions, but has also provided the best model for studying the effects of acute ischemia on the heart. The procedure also lead the way to all other interventional cardiology developments, including modern thrombolysis in the setting of acute myocardial infarction. In his previous works, Serruys has examined how PTCA can serve as a model for studying acute ischemia. In this book, he and his co-authors discuss the effects of balloon-induced ischemia on the electrocardiographic changes, coronary blood flow dynamics, cardiac muscle metabolism and left ventricular function, as well as measures to counter these effects and provide for reperfusion in unstable angina and acute myocardial infarction. Technology has expanded the 'eyes' of the observer of these events. The authors use many techniques including ECG recording from surface, endocardium, and intracoronary electrodes; angiographic assessment of coronary flow pattern using digital techniques, as well as doppler flow measurements; biochemical assessment of metabolic products stimulated by ischemia; and digital angiographic and echo doppler assessment of left ventricular function.

Although there are many books on angina, few are devoted to the important problem of how to evaluate drug efficacy in angina pectoris. Drug Evaluation in Angina Pectoris has two fundamental aims: the first is to review the methodological aspects of drug evaluation in stable and unstable angina pectoris; the second is to provide a logical and methodological background for future studies aimed at assessing the ability of medical treatment to improve prognosis. Part I updates the pathophysiology, clinical presentation and prognosis of angina pectoris. Part II aims to `put in numbers' the symptoms and signs of myocardial ischemia, starting from a revision of the currently used parameters. It is extremely important to quantify the variability of the disease for the correct design of clinical trial, a subject dealt with in Part III, which also discusses some clinico-pharmacological aspects of therapy. Part IV is a critical review of the drugs currently used for the treatment of stable and unstable angina, and particularly considers some important unresolved issues concerning their use. The current FDA and EC guidelines for the evaluation of antianginal drugs are briefly discussed in Part V, giving clinical investigators insight into how antianginal drugs are evaluated by regulatory agencies and what is considered as proof of a valid efficacy/tolerability ratio. Drug Evaluation in Angina Pectoris will assist discerning cardiologists, pharmacologists, and advanced students of cardiology as well as innovative pharmaceutical companies, all of whom need to understand what angina is, how to evaluate treatment, and how to judge the agents used in its treatment.

In open heart surgery, protection of the myocardium against injury by ischemia-reperfusion is an issue of utmost clinical interest. The knowledge on the causal mechanisms of myocardial injury in ischemia-reperfusion has greatly progressed in recent years, both to clinical and experimental research. This book provides a critical and comprehensive overview on the current discussion of myocardial protection in cardiac experimental research and surgery. Leading groups from Europe, the U.S. and Japan have contributed reviews of their special fields. On the basic science side, major topics discussed are the mechanisms of stunning and lethal reperfusion injury, the role of the endothelium and leukocyte activation in postischemic myocardial dysfunction, and the differences between the adult and neonatal myocardium. On the clinical side, the major concepts and procedures for cardioplegic myocardial protection, their rationales, application and respective merits are discussed. In a third part of the book, possible approaches for the monitoring of myocardial injury during ischemia and reperfusion are evaluated, with particular attention to their intraoperative use. This book brings together the scientific discussions on ischemia-reperfusion in experimental cardiology and cardiac surgery, a task needed for a long time. It is of general interest for clinicians as well as research workers and students in the cardiac field.

Coronary artery bypass surgery in the elderly: Too often or too seldom? It is a testimony to scientific advances that raising a simple inquiry today, such as whether coronary artery bypass surgery is done too often or too seldom in elderlypatients, requiresanexplorationofwhatviewsonemightholdonseveral medical as well as non-medical issues. Unlike earlier years when doctors were clinically free to decide what should be done with a patient, health has become an expensive human right, decisions about which also involve the patient, the epidemiologist, the health policy administrator, politicians, the exchequer, and the philosopher. In its broadest definition health has come to mean the core of well-being and, therefore, the goal ofany socio-economic system. Until only a decade ago, medical opinion regarding how often coronary artery bypass surgery (CABG) was indicated or useful was unclear. Becauseof multi-organ senescence, the elderly were expected to have a higher rate operative morbidity and mortality and, having crossed an advanced life span, might not live very long after the operation. Decision making on medical grounds first depends on knowing if a patient can survive an operation compared to how long they would survive without it, i. e.

A unique overview of all major angiographic lipid intervention trials, presented by their principal investigators. Basic mechanisms and methodological aspects, including biochemical as well as angiographic aspects, are discussed by experts in these fields. A careful comparison of all available data permits an analysis to be made of what may currently be considered proved, which aspects merit further investigation, and which hypotheses should be rejected. Audience: Clinicians involved in the practice of lipid lowering and investigators involved in lipid-lowering clinical trials. Scientists involved in other areas of lipid research and investigators conducting coronary angiographic trials designed to study the influence of different interventions will find a wealth of information and practical guidelines in this book.

Interest in the humane and scientifically justifiable use of research animals has intensified since the publication of the first edition of this textbook. This completely revised and updated text provides information essential to any researcher interested in using animal models for cardiovascular research, or any research which requires normal cardiovascular function. The format and presentation have been changed to make the text more easy to read and use. An introductory chapter offers general principles of animal selection, pre and post-operative care, preanesthesia, chemical restraint, analgesia, and the recognition of pain. The number of references cited has been almost doubled over the previous text and the chapter tabulating normal cardiovascular parameters from intact, awake animals, of those species commonly used in research, has been greatly expanded. Other chapters providing comprehensive data on the cardiovascular effects of opioids, tranquilizers, anesthetic agents and other drugs commonly used in cardiovascular research have been expanded with special emphasis on species variability to drug effects. The chapters on both naturally occurring and iatrogenic models of cardiovascular disease have also been expanded and updated.

primary goal of all forms of therapy is not just prolonging life, but improving the quality of life, has forced analysis of what constitutes quality of life, a concept whose structure pervades all walks of life and eludes definition. Global well being, happiness, morale, vitality, fullness of social life, and satisfaction must be integrated and assessed for the effects of the disease and the therapy, in the context of specific personality traits, attitudes to life, family situation, and socio-economic and political freedom. A growing inter est in research on this subject has led to a clearer understanding of the components which come to determine quality of a patient's life, and how they can be measured in a reproducible manner so that valid comparisons can be made. Keeping these recommendations of analysing quality of life within the context of patients who have undergone open heart surgery, it seemed appro priate to me to separate the influence of various forms of open heart surgery into five aspects of life which can comprehensively reflect the quality of life outcome of the operation. These five 'components' are (1) Physiological state, which summarises the traditionally reported incidence of operative mortality and morbidity, objectively and subjectively measured physical ca pacity, and the residual symptoms, treatment and long-term survival. (2) Intellectual functioning relates to the psychoneurolgocial deficit in memory, reasoning or judgement because of cerebral microembolism and hypo perfusion during cardiopulmonary bypass.

The main aim of this monograph is to provide an overview of calcium regulation in cardiac muscle cells, particularly with respect to excitation-contraction coupling and the control of cardiac contractile force. It is my hope that this book will be useful to students of the cardiovascular system and muscle at all different levels and in different disciplines (such as physiology, biochemistry, pharmacology and pathophysiology). I also hope that it will find use for those studying developmental, comparative and disease processes as well as more integrative phenomenon. I kept several goals in mind in writing this monograph. First, it should be easily readable. Second, I chose to include numerous illustrations and tables to help integrate results from numerous investigators in practical formats and also present key figures from important papers. Thus, this monograph may serve as a resource of information for people working in the areas described herein. Third, the presentation is a very personal one, and I have necessarily drawn extensively on my personal experience in this field over the past 15 years. This, I think, helps maintain a certain continuity of thought from chapter to chapter. Fourth, I have made serious attempts to make each chapter "up to date", despite the breadth of topics covered. I have also tried to be equitable in choosing references while not intending to be comprehensive or exhaustive. Neither of these aims can be perfectly matched, and I apologize to the many investigators whose papers I have not cited, but should have.

In the past, coronary arteriography was the only modality available to provide high quality images of the coronary anatomy. Quantitative coronary arteriography (QCA) was developed, implemented, validated and extensively applied to obtain accurate and reproducible data about coronary morphology and the functional significance of coronary obstructions. Over the last few years extensive basic technological research supported by clinical investigations has created competing modalities to visualize coronary morphology and the associated perfusion of the myocardial muscle. Currently, the following modalities are available: X-ray coronary arteriography, intracoronary ultrasound, contrast- and stress-echocardiography, angioscopy, nuclear cardiology, magnetic resonance imaging, and cine and spiral CT imaging. For all these imaging modalities, the application of dedicated quantitative analytical software packages enables the evaluation of the imaging studies in a more accurate, reliable, and reproducible manner. These extensions and achievements have resulted in improved diagnostics and subsequently in improved patient care. Particularly in patients with ischaemic heart disease, major progress has been made to detect coronary artery disease in an early phase of the disease process, to follow the atherosclerotic changes in the coronary arteries, to establish the functional and metabolic consequences of the luminal obstructions, and accurately to assess the results of interventional therapy. Aside from all these high-tech developments in cardiac imaging techniques, the transition from the analogue to the digital world has been going on for some time now. For the future, it has been predicted that the CD-R will be the exchange medium for cardiac images and DICOM-3 the standard file format. This has been a major achievement in the field of standardization activities. Since these developments will have a major impact on the way images will be stored, reviewed and exchanged in the near future, an important part of this book has been dedicated to DICOM and the filmless catheterization laboratory. Cardiovascular Imaging will assist cardiologists, radiologists, nuclear medicine physicians, image processing specialists, physicists, basic scientists, and fellows in training for these specialties to understand the most recent achievements in cardiac imaging techniques and their impact on cardiovascular medicine.

The most salient feature of the infor last four chapters of the book evaluate the mation provided by nuclear medicine is its information from an analytical and pathophysiological and functional charac statistical point of view. This approach is ter. For adequate experimental or clinical required for correct decision-making. interpretation, such information should This book is therefore the result of necessarily be interpreted alongside the accumulated experience in nuclear cardiology views of the clinical cardiologist, who is with the invaluable cooperation of medical able to apply it to the individual patient. statisticians. It is directed to physicians This approach, which is routine in every with an interest in nuclear cardiology, to day clinical practice, reaches its plenitude nuclear medicine specialists wishing to when the whole process is completed and learn the uses and limitations of these an intimate cooperation is established procedures in everyday clinical cardiology, between the nuclear medicine specialist and to cardiologists who feel the need to and the clinical cardiologist. In such understand the rationale and methodology instances, each one of these professionals of the studies which benefit their patients. understands the needs, limits and possi We understand that the ultimate reason bilities of the other. for any scientific book is the transmission The present book is the fruit of such of knowledge, and we are fully conscious cooperation. In our hospital, an efficient of the enthusiasm of the authors of the nuclear cardiology team has been made up present text to achieve that aim.