David Blondheim | Hillel Yaffe Medical Center Affiliated with the Technion School of Medicine (original) (raw)

Papers by David Blondheim

American Journal of Medicine, 1996

PURPOSE: The aim of this study was to determine the proportion of patients with acute myocardial ... more PURPOSE: The aim of this study was to determine the proportion of patients with acute myocardial infarction (AMI) excluded from thrombolytic therapy on a national basis and to evaluate the prognosis of these patients by reasons of ineligibility and according to the alternative therapies that they received during hospitalization.

American Heart Journal, 1991

American Journal of Hypertension, 1997

24 hour ambulatory blood pressure rmmitoring (ABPM) are increasingly used in the management of hy... more 24 hour ambulatory blood pressure rmmitoring (ABPM) are increasingly used in the management of hypertension. Unfortunately cost has limited their role in mainstream clinical practice despite accumulating evidence of cost-effectiveness with i.dicio.s .s.. Before the =advemof ABPM, %elf-determination< or 'horn.< blood pressure (SHSP) showed promise but its ml. remain. m be established despite the availability of reliable, accurate, a"d easy to use semi-aromatic devices that are relatively cheap.

Echocardiography-a Journal of Cardiovascular Ultrasound and Allied Techniques, 1991

Mitral annular calcification is known to be associated with conduction abnormalities, embolic phe... more Mitral annular calcification is known to be associated with conduction abnormalities, embolic phenomena, endocarditis, mitral regurgitation, and thromboembolic cerebrovascular events in the younger population. The size of our elderly population is growing dramatically with the fastest growth in those aged greater than 85 years. The incidence of mitral annular calcification increases sharply in these “very elderly group of patients.” To determine if mitral annular calcification in the elderly patients has the same implications as in the younger population, electrocardiographic and echocardiography (M-mode, two-dimensional, Doppler) data from 553 octogenarian patients who were referred for a variety of clinical indications were analyzed. Patients with mitral annular calcification were quantified into mild, moderate, and severe, and the association of each was determined with various cardiac abnormalities. Mitral annular calcification was found in 59% of the octogenarian patients. Out of these, mild mitral annular calcification was present in 38%, moderate in 40%, and severe mitral annular calcification in 22% of the patients. Mild mitral annular calcification was not associated with an increased incidence of any cardiac abnormalities. Moderate mitral annular calcification was also not associated with any increased incidence of significant aortic stenosis, conduction abnormalities, and enlarged left ventricular size. However, severe mitral annular calcification was associated with all these findings. Moderate and severe mitral annular calcification were associated with significant mitral regurgitation and left ventricular hypertrophy. Thus, in the majority of elderly patients with mild and moderate mitral annular calcification (78%), its presence merely represents an aging process and an innocent bystander as compared to elderly patients without mitral annular calcification. However, only severe mitral annular calcification is strongly associated with cardiac abnormalities. Therefore, quantification of mitral annular calcification in the elderly is important before associating it with various cardiac abnormalities. (ECHOCARDIOGRAPHY, Volume 8, May 1991)

Journal of The American College of Cardiology, 1991

American Heart Journal, 1990

American Journal of Cardiology, 1996

Corrosion Science, 2004

Patients with ischaemic heart disease have to perform exercise tests repeatedly. It is not clear ... more Patients with ischaemic heart disease have to perform exercise tests repeatedly. It is not clear if a small meal eaten before the test might influence it and if the meal&amp;amp;amp;amp;amp;amp;amp;#39;s composition is important. We performed a double blind, randomised, crossover study on 20 volunteers with documented ischaemic heart disease known to have positive exercise tests. Each had three symptom limited exercise tests done one hour after a 200 ml meal, rich in either fat, carbohydrate or protein. Each postprandial test was compared to a fasting exercise test performed just before the meal. Postprandial blood pressure, time to angina and to peak exercise and double product at onset of ST-depression were not significantly altered by any of the meals. Heart rate was slightly increased only after the fat meal. The nutritional composition of a small meal eaten an hour before an exercise test has no clinically important impact on the results of the test in patients with stable angina pectoris.

American Heart Journal, 1996

Functional status in chronic heart failure is evaluated in general by subjective means, such as t... more Functional status in chronic heart failure is evaluated in general by subjective means, such as the New York Heart Association class, or by invasive techniques difficult to use routinely. The aim of this study was to evaluate noninvasively the contractile reserve in cases of heart failure as a means to define the functional status of the patients. Cardiac peak power, a new noninvasively obtained afterload-independent index of contractility, was calculated from online Doppler and central arterial blood pressure estimated noninvasively in 35 patients with heart failure and 10 healthy subjects during dobutamine infusion. Cardiac output increased in all patients to the same extent, without differentiation among the functional classes. Contractile reserve, as assessed by peak power, was found to be a good marker of functional class: it was significantly higher in functional class 1 than in functional classes 2 through 4. A correlation of r= 0.99 and probability of p < 0.001 was found with the functional status. This new, noninvasive contractility index, peak power, allows an objective evaluation of the severity of heart failure. (Am Heart J 1996;132:1195-201.) Dobutamine, by its well-known direct positive inotropic action, 1 is known to increase cardiac performance in patients with heart failure. 2 Increase in performance is achieved mainly by an increase in contractility, 1 a reduction in systemic vascular resistance 3, 4 (SVR), and to some degree an increment in heart rate. 1 It is reasonable to assume that as heart failure progresses, the contractile reserve of the heart decreases and therefore augmentation in cardiac performance would be achieved in the advanced stages ofheart failure by lowering the SVR and increasing the heart rate, rather than by increasing the contractility.

Cardiology, 2000

Familial occurrence of idiopathic dilatation of the right atrium is extremely rare. This is the f... more Familial occurrence of idiopathic dilatation of the right atrium is extremely rare. This is the first description of a family in which 2 siblings had a syndrome of idiopathic dilatation of the right atrium associated with complete atrio-ventricular block. The family workup did not show other family members to be affected, and the question we raise is whether or not this might be a new syndrome.

European Journal of Cardiovascular Prevention & Rehabilitation, 2004

Echocardiography-a Journal of Cardiovascular Ultrasound and Allied Techniques, 2004

Midazolam is often used for conscious sedation before transesophageal echo (TEE) studies. It is n... more Midazolam is often used for conscious sedation before transesophageal echo (TEE) studies. It is not clear to what extent midazolam administration or the insertion of the TEE probe itself is responsible for the respiratory and hemodynamic depression during TEE examinations. We compared the performance of TEE with versus without midazolam to elucidate the effects of each. Patients were given the choice of having midazolam prior to their TEE. Thirty-one patients preferred to have sedation (Sed+) and 31 others declined sedation (Sed-). Both groups had SaO(2) and blood pressure measured before the study, following sedation (in Sed+) and at the end of the TEE study. Increase in HR was greater in Sed+ than in Sed- (12 +/- 19% vs 6 +/- 11%, both P &amp;amp;amp;amp;amp;lt; 0.05). There was a greater decrease in saturation of O(2) in Sed+ than in Sed- (3 +/- 3% vs 2 +/- 3%, both P &amp;amp;amp;amp;amp;lt; 0.05). Systolic blood pressure (SBP) increased in Sed- by 6 +/- 11% (P&amp;amp;amp;amp;amp;lt; 0.05) but dropped in Sed+ immediately after sedation (16 +/- 8%, P &amp;amp;amp;amp;amp;lt; 0.000001). Diastolic blood pressure decreased in Sed+ after sedation by 11 +/- 9% (P &amp;amp;amp;amp;amp;lt; 0.05). Midazolam sedation before TEE examinations causes more prominent tachycardia and depression of SaO(2)than insertion of the TEE probe alone. It also causes a substantial drop in SBP. Midazolam should be offered only to hemodynamically stable patients without preceding respiratory depression.

Amino-terminal pro-B-type natriuretic peptide (NT-proBNP) level is useful to diagnose or exclude ... more Amino-terminal pro-B-type natriuretic peptide (NT-proBNP) level is useful to diagnose or exclude acutely decompensated heart failure (ADHF) in dyspnoeic patients presenting to the emergency department (ED). To evaluate the impact of ED NT-proBNP testing on admission, length of stay (LOS), discharge diagnosis and long-term outcome. Dyspnoeic patients were randomized in the ED to NT-proBNP testing. Admission and discharge diagnoses, and outcomes were examined. During 17 months, 470 patients were enrolled and followed for 2.0±1.3 years. ADHF likelihood, determined at study conclusion by validated criteria, established ADHF diagnosis as unlikely in 86 (17%), possible in 120 (24%), and likely in 293 (59%) patients. The respective admission rates in these subgroups were 80, 91, and 96%, regardless of blinding, and 61.9% of blinded vs. 74.5% of unblinded ADHF-likely patients were correctly diagnosed at discharge (p=0.029), with similar LOS. 2-year mortality within subgroups was unaffected by test, but was lower in ADHF-likely patients with NT-proBNP levels below median (5000 pg/ml) compared with those above median (p=0.002). Incidence of recurrent cardiac events tracked NT-proBNP levels. ED NT-proBNP testing did not affect admission, LOS, 2-year survival, or recurrent cardiac events among study patients but improved diagnosis at discharge, and allowed risk stratification even within the ADHF-likely group. (ClinicalTrials.gov#NCT00271128).

International Journal of Cardiology, 2001

This study addresses the impact of availability of on-site catheterization laboratories on the 1-... more This study addresses the impact of availability of on-site catheterization laboratories on the 1-year survival of patients with post-acute myocardial infarction ischemia (P-AMI-I), a high-risk subgroup of AMI patients. A prospective 5 month national survey was conducted in 1996 in all operating intensive care units (ICCUs) in Israel (N=26) and included 2377 patients. Four hundred and three (17%) had P-AMI-I, 317 of them were admitted to 18 ICCUs with on-site catheterization laboratories (CATH+) and 86 patients to 8 ICCUs without such facilities (CATH-). A retrospective analysis was performed comparing the in-hospital course and 7 day, 1 month and 1 year mortality data of CATH+ vs. CATH- patients. Patient characteristics in both groups were similar with regard to age, gender AMI location, risk factors, hemodynamic parameters on admission and rate of thrombolytic therapy. Of patients in CATH+, 79% were catheterized before hospital discharge vs. 42% in CATH- (P<0.0001), 45 vs. 15% had PTCA (P<0.0001) and 19 vs. 9% had CABG (P<0.05). At 30 days, patients in CATH+ still had significantly more revascularization procedures (71 vs. 48%, P<0.001). Patients hospitalized in ICCUs with CATH+ and CATH- facilities had similar cardiac mortality rates at 7 days (2.0 vs. 2.3%), 30 days (5.7 vs. 4.7%) and at 1 year (7.6 vs. 7.0%). Despite a more invasive strategy used during the index hospitalization of patients with P-AMI-I hospitalized in CATH+ ICCUs, their survival was similar to CATH- patients at 7 days, 30 days and at 1 year follow-up.

Journal of The American Society of Echocardiography, 2010

Background: The purpose of this multicenter study was to determine the reliability of visual asse... more Background: The purpose of this multicenter study was to determine the reliability of visual assessments of segmental wall motion (WM) abnormalities and global left ventricular function among highly experienced echocardiographers using contemporary echocardiographic technology in patients with a variety of cardiac conditions.

Journal of Cardiac Failure, 2011

treatment, and both EDV and ESV decreased significantly (P ! 0.05) 3 months after treatment in al... more treatment, and both EDV and ESV decreased significantly (P ! 0.05) 3 months after treatment in all patients; EDV decreased from 264 6 91ml to 146 6 86ml and ESV decreased from 184 6 85ml to 86 6 76ml. Ejection fraction increased from 32% to 47% during that period. Volumetric-averaged wall thickness increased in all patients, from 1.06 6 0.21cm (baseline) to 1.3 6 0.26cm (3 months). This increase was accompanied by about a 35% decrease in myofiber stress at end-of-diastole and at end-of-systole. Post-treatment myofiber stress became more uniform in the LV as a result. These results support the novel concept that injection of Algisyl-LVR into the LV decreases myofiber stress, restores LV geometry and improves its function.

American Heart Journal, 2010

Background The validity of angiographic collateral grade according to the Rentrop classification ... more Background The validity of angiographic collateral grade according to the Rentrop classification during acute myocardial infarction (AMI) and its relation to flow in occluded coronary arteries before angioplasty have never been evaluated.

Circulation-cardiovascular Imaging, 2010

grams is of paramount clinical importance but is still performed by a subjective visual method. W... more grams is of paramount clinical importance but is still performed by a subjective visual method. We constructed an automatic tool for assessment of wall motion based on longitudinal strain. Methods and Results-Echocardiograms of 105 patients (3 apical views) were blindly analyzed by 12 experienced readers.

American Heart Journal, 2008

Patients presenting with ST-elevation myocardial infarction (STEMI), whose symptoms and electroca... more Patients presenting with ST-elevation myocardial infarction (STEMI), whose symptoms and electrocardiographic changes completely resolve upon admission and before the administration of reperfusion therapy, pose a therapeutic dilemma. The optimal management of this syndrome, termed here as transient STEMI (TSTEMI), has not yet been fully determined. We describe 69 prospectively recorded patients with TSTEMI, of which 63 patients (56.7 ± 11 years, 48 men) were available for long-term follow-up out of 1244 consecutive patients with acute myocardial infarction (5%). Patients with TSTEMI treated with intravenous isosorbide dinitrate, aspirin, and clopidogrel, and/or with glycoprotein IIb/IIIa inhibitors were compared with a control group of matched patients with STEMI without resolution, who were treated conventionally. The time interval from symptom onset to presentation at the emergency department of patients with TSTEMI was 1.7 ± 1.3 hours, and to first recording of ST elevations, 1.5 ± 1.4 hours. Symptoms and electrocardiographic changes fully resolved 1.2 ± 0.8 hours later, 1 hour after aspirin and nitrate administration. Coronary angiography, performed 36 ± 39 hours (median, 24 hours) from admission, demonstrated no obstructive lesion or single-vessel obstructive disease in 43 patients (70%). Primary coronary intervention was performed in 48 patients (77%), and 8 patients (13%) were referred to surgery. Left ventricular ejection fraction was within normal limits, and peak creatine kinase was mildly elevated. Patients with TSTEMI had less extensive coronary artery disease (P b .038), better thrombolysis in myocardial infarction flow on angiography (P b .01), lower peak creatine kinase level (P b .001), higher left ventricular ejection fraction (P b .0001), and lower likelihood to sustain a second additional coronary event after index admission (P = .024) than patients with STEMI. Transient STEMI was associated with less myocardial damage, less extensive coronary artery disease, higher thrombolysis in myocardial infarction flow grade in culprit artery, and better cardiac function. These data suggest that immediate intense medical therapy with an early invasive approach is an appropriate therapy in patients with TSTEMI. (Am Heart J 2008;155:848-54.)