0
Back To Top Jump Location
Sign In  | Cart
Left Shadow
Right Shadow
Articles |

Effect of chronic supraventricular tachycardia on left ventricular function and structure in newborn pigs FREE

Ryuhei Tanaka, MD; Francis G. Spinale, PhD; Fred A. Crawford, MD, FACC; Michael R. Zile, MD, FACC
[+] Author Information

This research was supported by Grants-in-Aid to Dr. Zile from the Research Service of the Department of Veterans Affairs, Washington, DC and to Dr. Spinale from the American Heart Association, Dallas, Texas, South Carolina Heart Association, Charleston and National Institutes of Health (Grant R29-HL45024), Bethesda, Maryland.Address for correspondence: Michael R. Zile, MD, FACC. Cardiology Division, Medical University of South Carolina, 171 Ashley Avenue, Charleston South Carolina 29425.

J Am Coll Cardiol. 1992;20(7):1650-1660. doi:10.1016/0735-1097(92)90462-V
Published online

  Objectives. The purpose of this study was to examine the effects of supraventricular pacing tachycardia on left ventricular function and myocardial structure in newborn, immature pigs and to determine whether immature pigs respond to suproventricular tachycardia differently from adults.Background. Previous studies have shown that supraventricular tachycardia causes dilated cardiomyopathy in adult animals; however, in humans, supraventricular tachycardia-induced congestive heart failure occurs most frequently in children and newborns. Because some clinical diseases may cause myocardial failure in adults but rarely do so in children, it was hypothesized that the effects of supraventricular tachycardia in newborns may be different from those in adults.Methods. In two groups of newborn swine (3 weeks of age), left ventricular volume, mass and function were assessed with simultaneous echocardiography and cardiac catheterization and myocardial structure was examined with light and electron microscopy. Six piglets underwent 3 weeks of left atrial pacing tachycardia (240 beats/min) and six littermates served as a control group. Both groups were followed up for 3 weeks.Results. At the end of the protocol, left ventricular dimensions increased in the piglets with supraventricular tachycardia compared with values in the control group, but there were no differences in left ventricular mass. Systolic function, assessed by fractional shortening, peak ejection rate and maximal rate of pressure development, was decreased in the group with supraventricular tachycardia. The fractional shortening-end-systotic stress relation in the piglets with supraventricular tachycardia decreased below normal values. Left ventricular diastolic function assessed by the relaxation time constant was prolonged, the peak filling rate was decreased and left ventricular stiffness was increased in the supraventricular tachycardia group. The morphologic data demonstrated that supraventricular tachycardia did not change total myocyte volume but did decrease total myofibrillar volume.Conclusions. Supraventricular tachycardia caused dilated cardiomyopathy in immature pigs. These changes in left ventricular function were associated with a decrease in cellular contractile proteins. Thus, the effects of supraventricular tachycardia on left ventricular function and structure in immature animals were comparable to previous findings in mature animals.

References

Spinale  FG, Hendrick  DA, Crawford  FA, Smith  AC, Hamada  Y, Carabello  B; Chronic supraventricular tachycardia causes ventricular dysfunction and subendocardial injury in swine. Am J Physiol. 259 1990:H218-H229.
PubMed
Tomta  M, Spinale  FG, Crawford  FA, Zile  MR; Changes in left ventricular volume, mass, and function during the development and regression of supraventricular tachycardia-induced cardiomyopathy: disparity between recovery of systolic versus diastolic function. Circulation. 83 1991:635-644.
CrossRef | PubMed
Spinale  FG, Tomita  M, Zellner  JL; Reduced myocardial blood flow and altered capillary structure occur with chronic supraventricular tachycardia induced cardiomyopathy. Am J Physiol. 261 1991:H140-H148.
PubMed
Spinale  FG, Zellner  JL, Tomita  M, Crawford  FA, Zile  MR; Relation between ventricular and myocyte remodeli with the development and regression of suptaventricular tachycardia-induced cardiomyopathy. Circ Res. 69 1991:1058-1067.
CrossRef | PubMed
Coleman  HN, Taylor  RR, Pool  PE; Congestive heart failure following chronic tachycardia. Am Heart J. 81 1971:790-798.
CrossRef | PubMed
Riegger  AJG, Liebau  G; The renin-angiotensin-aldosterone system, antidiuretic hormone and sympathetic nerve activity in an experimental model of congestive heart failure in the dog. Clin Sci. 62 1982:465-469.
PubMed
Wilson  JR, Douglas  P, Hickey  WF; Experimental congestive heart failure produced by rapid ventricular pacing in the dog: cardiac effects. Circulation. 74 1987:857-867.
CrossRef
Damiano  RJ, Tripp  HF, Asano  T, Small  KW, Jones  RH, Lowe  JE; Left ventricular dysfunction and dilatation resulting from chronic supraventricular tachycardia. J Thorac Cardiovasc Surg. 94 1987:135-143.
PubMed
Howard  RJ, Stopps  TP, Mor  GW, Gotlieb  A, Armstrong  PW; Recovery from heart failure: structural and functional analysis in a canine model. Can J Physiol Pharmacol. 66 1988:1505-1512.
CrossRef | PubMed
Morgan  DE, Tomlinson  CW, Qayumi  AK, Toleikis  PM, Conville  B, Jamieson  WRE; Evaluation of ventricular contractility indexes in the dog with left ventricular dysfunction induced by rapid atrial pacing. J Am Coll Cardiol. 14 1989:489-495.
CrossRef | PubMed
Chow  E, Woodard  JC, Farrar  DJ; Rapid ventricular pacing in pigs: an experimental model of congestive heart failure. Am J Physiol. 258 1990:H1603-H1605.
PubMed
Shaunon  RP, Komamura  K, Stambler  BS, Bigaud  M, Manders  T, Vatner  SF; Alterations in myocardial contractility in conscious dogs with dilated cardiomyopathy. Am J Physiol. 260 1991:H1903-H1911.
PubMed
Garson  A, Gillette  PC, McNamara  DG; Supraventricular tachycardia in children: clinical features, response to treatment and long-term follow-up in 217 patients. J Pediatr. 98 1981:875-882.
CrossRef | PubMed
Packer  DL, Bardy  GH, Worley  SL; Tachycardia induced cardiomyopathy: a reversible form of left ventricular dysfunction. Am J Cardiol. 57 1986:563-570.
CrossRef | PubMed
Fyfe  DA, Gillette  PC, Crawfwd  FA, Kline  CH; Resolution of dilated cardiomyopathy after surgical ablation of ventricular tachycardia in a child. J Am Coll Cardinol. 9 1987:231-234.
CrossRef
Cruz  FES, Cheriex  EC, Smeets  LRM; Reversibility of tachycardia-induced cardiomyopathy aftercure of incessant supraventricular tachycardia. J Am Coll Cardiol. 16 1990:739-744.
CrossRef | PubMed
Donner  R, Carabello  BA, Black  I, Spann  JF; Left ventricular wall stress in compensated aortic stenosis in children. Am J Cardiol. 51 1983:946-951.
CrossRef | PubMed
Carabello  BA, Green  LH, Grossman  W, Cohn  LH, Koster  JK, Collins  J  Jr; Hemodynamic determinants of prognosis of aortic valve replacement in clinical aortic stenosis and advanced congestive heart failure. Circulation. 62 1980:42-48.
CrossRef | PubMed
Spotnitz  WD, Spotnitz  HM, Truccone  NJ; Relation of ultrastructure and function. Sarcomere dimension, pressure-volume curves, and geometry of the intact left ventricle of the immature canine heart. Circ Res. 44 1979:679-691.
CrossRef | PubMed
Romero  TE, Friedman  WF; Limited left ventricular response to volume overload in the neonatal period: a comparative study with the adult animal. Pediatr Res. 13 1979:910-915.
CrossRef | PubMed
Assey  ME, Wisenbaugh  T, Spann  TF, Gillette  PC, Carabello  BA; Unexpected persistence into adulthood of low wall stress in patients with congenital aortic stenosis: is there a fundamental difference in the hypertrophic response to a pressure overload present from birth?. Circulation. 75 1987:973-979.
CrossRef | PubMed
Dorn  GW, Donner  R, Assey  ME, Spann  JF, Wiles  HB, Carabello  BA; Alterations in left ventricular geometry, wall stress, and ejection performance after correction of congenital aortic stenosis. Circulation. 78 1988:1358-1364.
CrossRef | PubMed
Leman  RB, Spinale  FG, Dorn  GW  II; Supernormal ejection performance is isolated to the ipsilateral congenitally pressure-overloaded ventricle. J Am Coll Cardiol. 13 1989:1314-1319.
CrossRef | PubMed
Aoyagi  T, Fujii  AM, Colan  SD, Flanagan  MF, Currer  JJ, Mirsky  L; Myocardial function of immature and mature sheep with pressure over-load hypertrophy (abstr). J Am Coll Cardiol. 17 (suppl A) 1991:75A
CrossRef
Nakanishi  T, Jarmakani  JM; Developmental changes in myocardial mechanical function and subcellular organelles. Am J Physiol. 246 1984:H615-H625.
PubMed
Nakanishi  T, Okuda  H, Nakazawa  M, Takao  A; Effect of acidosis on contractile function in the newborn rabbit heart. Pediatr Res. 19 1985:482-488.
CrossRef | PubMed
Bove  EL, Stammers  AH; Recovery of left ventricular function after hypothermic global ischemia, Age-related differences in the isolated working rabbit heart. J Thorac Cardiovasc Surg. 91 1986:115-122.
PubMed
Pridjian  AK, Levitsky  S, Krukenkamp  I, Silverman  NA, Feinberg  H; Developmental changes in reperfusion injury. A comparison of intracellular cation accumulation in the newborn, neonatal, and adult heart. J Thorac Cardiovasc Surg. 93 1987:428-433.
PubMed
Grice  WN, Konishi  T; Apstein CS: Resistance of neonatal myocardium to injury during normothermic and hypothermic ischemic arrest and reperfusion (abstr). Circulation. 76 (suppl V) 1987:V-150.
Avkiran  M, Hearse  DJ; Projection of the myocardium during global ischemia. Is crystalloid cardioplegia effective in the immature myocardium?. J Thorac Cardiovasc Surg. 97 1989:220-228.
PubMed
Zak  R; Cell proliferation during growth. Am J Cardiol. 31 1973:211-215.
CrossRef | PubMed
Zak  R, Kizu  A, Bugaisky  L; Cardiac hypertrophy: its characteristics as a growth process. Am J Cardiol. 44 1979:911-916.
CrossRef
Wikman-Coffelt  J, Parmley  WW, Mason  DT; The cardiac hypertrophy process. Analyses of factors determining pathological vs physiological development. Cire Res. 45 1979:697-707.
CrossRef
Rakusan  K, Korecky  B, Mezl  V; Cardiac hypertrophy and/or hyperplasia?.Alpen  MR; Perspectives in Cardiovascular Research. VII. Myocardial hypertrophy and Failure. 1983 Raven New York:103-123.
Zak  R; Factors controlling cardiac growlh.Zak  R; Growth of the Heart in Health and Disease. 1984 Raven New York:165-185.
Rakusan  K; Cardiac growth, maturation, and aging.Zak  R; Growth of the Heart in Health and Disease. 1984 Raven New York:131-164.
Swynghedauw  B; Developmental and functional adaptation of cotractile proteins in cardiac and skeletal muscles. Am J Physiol. 66 1986:710-750.
Sahn  DJ, DeMaria  A, Kisslo  J, Weyman  A; The Committee on M-Mode Standardization of the American Society of Echocardiography. Recommendations regarding quantilation in M-Mode echocardiography: results of a survey of echocardiographic measurements. Circulation. 58 1978:1072-1083.
CrossRef | PubMed
Weiss  JL, Frederiksen  IW, Weisfeldt  ML; Hemodynamic determinants of the time course of fall in canine left ventricular pressure. J Clin Invest. 58 1976:751-760.
CrossRef | PubMed
Yellin  EL, Nikolic  S, Frater  RWM; Left ventricular filling dynamics and diastolic function. Prog Cardiovasc Dis. 32 1990:247-271.
CrossRef | PubMed
Mirsky  I, Pasipoularides  A; Clinical assessment of diastolic function. Prog Cardiovasc Dis. 32 1990:291-318.
CrossRef | PubMed
The Armed Forces Institute of Pathology;Lina  LG;Manual of Histological and Special Staining Techniques 1966 McGraw-Hill New York:58-159.
Hoyt  RH, Ericksen  E, Collins  SM, Skorton  DJ; Computer-assisied quantilation of myocardial fibrosis in histologic sections. Arch Pathol Lab Med. 108 1984:280-283.
PubMed
Loud  AV, Anversa  P; Biology of disease: morphometric analysis of biologic processes. Lab Invest. 50 1984:250-261.
PubMed
Loud  AV, Anversa  P, Giacomelli  F, Wiener  J; Absolute morphometric study or myocardial hypertrophy in experimental hypertension. Determination of myocyte size. Lab Invest. 5 1978:586-596.
Mendez  J, Keys  A; Density and composition of mammalian muscle. Metabolism. 9 1960:184-188.
Burton  K; A study of the conditions and mechanism of the diphenylamine reaction for the colorimetric estimation of DNA. Biochem J. 62 1956:315-323.
PubMed
Waterborg  JH, Matthews  HR; The Burton assay for DNA.Walker  JM; Methods in Molecular Biology. II., Nucleic Acids. 1984 Humana Clifton, NJ:1-3.
Lowry  OH, Rosebrough  NJ, Farr  AL, Randall  RJ; Protein measurement with the Folin phenol reagent. J Biol Chem. 193 1951:265-275.
PubMed
Steel  RGD; Principles and Procedures of Statistics: A biometrieal approach. 1980 McGraw-Hill New York:469-475.

Figures

Tables

Interactive Graphics

Video

References

Spinale  FG, Hendrick  DA, Crawford  FA, Smith  AC, Hamada  Y, Carabello  B; Chronic supraventricular tachycardia causes ventricular dysfunction and subendocardial injury in swine. Am J Physiol. 259 1990:H218-H229.
PubMed
Tomta  M, Spinale  FG, Crawford  FA, Zile  MR; Changes in left ventricular volume, mass, and function during the development and regression of supraventricular tachycardia-induced cardiomyopathy: disparity between recovery of systolic versus diastolic function. Circulation. 83 1991:635-644.
CrossRef | PubMed
Spinale  FG, Tomita  M, Zellner  JL; Reduced myocardial blood flow and altered capillary structure occur with chronic supraventricular tachycardia induced cardiomyopathy. Am J Physiol. 261 1991:H140-H148.
PubMed
Spinale  FG, Zellner  JL, Tomita  M, Crawford  FA, Zile  MR; Relation between ventricular and myocyte remodeli with the development and regression of suptaventricular tachycardia-induced cardiomyopathy. Circ Res. 69 1991:1058-1067.
CrossRef | PubMed
Coleman  HN, Taylor  RR, Pool  PE; Congestive heart failure following chronic tachycardia. Am Heart J. 81 1971:790-798.
CrossRef | PubMed
Riegger  AJG, Liebau  G; The renin-angiotensin-aldosterone system, antidiuretic hormone and sympathetic nerve activity in an experimental model of congestive heart failure in the dog. Clin Sci. 62 1982:465-469.
PubMed
Wilson  JR, Douglas  P, Hickey  WF; Experimental congestive heart failure produced by rapid ventricular pacing in the dog: cardiac effects. Circulation. 74 1987:857-867.
CrossRef
Damiano  RJ, Tripp  HF, Asano  T, Small  KW, Jones  RH, Lowe  JE; Left ventricular dysfunction and dilatation resulting from chronic supraventricular tachycardia. J Thorac Cardiovasc Surg. 94 1987:135-143.
PubMed
Howard  RJ, Stopps  TP, Mor  GW, Gotlieb  A, Armstrong  PW; Recovery from heart failure: structural and functional analysis in a canine model. Can J Physiol Pharmacol. 66 1988:1505-1512.
CrossRef | PubMed
Morgan  DE, Tomlinson  CW, Qayumi  AK, Toleikis  PM, Conville  B, Jamieson  WRE; Evaluation of ventricular contractility indexes in the dog with left ventricular dysfunction induced by rapid atrial pacing. J Am Coll Cardiol. 14 1989:489-495.
CrossRef | PubMed
Chow  E, Woodard  JC, Farrar  DJ; Rapid ventricular pacing in pigs: an experimental model of congestive heart failure. Am J Physiol. 258 1990:H1603-H1605.
PubMed
Shaunon  RP, Komamura  K, Stambler  BS, Bigaud  M, Manders  T, Vatner  SF; Alterations in myocardial contractility in conscious dogs with dilated cardiomyopathy. Am J Physiol. 260 1991:H1903-H1911.
PubMed
Garson  A, Gillette  PC, McNamara  DG; Supraventricular tachycardia in children: clinical features, response to treatment and long-term follow-up in 217 patients. J Pediatr. 98 1981:875-882.
CrossRef | PubMed
Packer  DL, Bardy  GH, Worley  SL; Tachycardia induced cardiomyopathy: a reversible form of left ventricular dysfunction. Am J Cardiol. 57 1986:563-570.
CrossRef | PubMed
Fyfe  DA, Gillette  PC, Crawfwd  FA, Kline  CH; Resolution of dilated cardiomyopathy after surgical ablation of ventricular tachycardia in a child. J Am Coll Cardinol. 9 1987:231-234.
CrossRef
Cruz  FES, Cheriex  EC, Smeets  LRM; Reversibility of tachycardia-induced cardiomyopathy aftercure of incessant supraventricular tachycardia. J Am Coll Cardiol. 16 1990:739-744.
CrossRef | PubMed
Donner  R, Carabello  BA, Black  I, Spann  JF; Left ventricular wall stress in compensated aortic stenosis in children. Am J Cardiol. 51 1983:946-951.
CrossRef | PubMed
Carabello  BA, Green  LH, Grossman  W, Cohn  LH, Koster  JK, Collins  J  Jr; Hemodynamic determinants of prognosis of aortic valve replacement in clinical aortic stenosis and advanced congestive heart failure. Circulation. 62 1980:42-48.
CrossRef | PubMed
Spotnitz  WD, Spotnitz  HM, Truccone  NJ; Relation of ultrastructure and function. Sarcomere dimension, pressure-volume curves, and geometry of the intact left ventricle of the immature canine heart. Circ Res. 44 1979:679-691.
CrossRef | PubMed
Romero  TE, Friedman  WF; Limited left ventricular response to volume overload in the neonatal period: a comparative study with the adult animal. Pediatr Res. 13 1979:910-915.
CrossRef | PubMed
Assey  ME, Wisenbaugh  T, Spann  TF, Gillette  PC, Carabello  BA; Unexpected persistence into adulthood of low wall stress in patients with congenital aortic stenosis: is there a fundamental difference in the hypertrophic response to a pressure overload present from birth?. Circulation. 75 1987:973-979.
CrossRef | PubMed
Dorn  GW, Donner  R, Assey  ME, Spann  JF, Wiles  HB, Carabello  BA; Alterations in left ventricular geometry, wall stress, and ejection performance after correction of congenital aortic stenosis. Circulation. 78 1988:1358-1364.
CrossRef | PubMed
Leman  RB, Spinale  FG, Dorn  GW  II; Supernormal ejection performance is isolated to the ipsilateral congenitally pressure-overloaded ventricle. J Am Coll Cardiol. 13 1989:1314-1319.
CrossRef | PubMed
Aoyagi  T, Fujii  AM, Colan  SD, Flanagan  MF, Currer  JJ, Mirsky  L; Myocardial function of immature and mature sheep with pressure over-load hypertrophy (abstr). J Am Coll Cardiol. 17 (suppl A) 1991:75A
CrossRef
Nakanishi  T, Jarmakani  JM; Developmental changes in myocardial mechanical function and subcellular organelles. Am J Physiol. 246 1984:H615-H625.
PubMed
Nakanishi  T, Okuda  H, Nakazawa  M, Takao  A; Effect of acidosis on contractile function in the newborn rabbit heart. Pediatr Res. 19 1985:482-488.
CrossRef | PubMed
Bove  EL, Stammers  AH; Recovery of left ventricular function after hypothermic global ischemia, Age-related differences in the isolated working rabbit heart. J Thorac Cardiovasc Surg. 91 1986:115-122.
PubMed
Pridjian  AK, Levitsky  S, Krukenkamp  I, Silverman  NA, Feinberg  H; Developmental changes in reperfusion injury. A comparison of intracellular cation accumulation in the newborn, neonatal, and adult heart. J Thorac Cardiovasc Surg. 93 1987:428-433.
PubMed
Grice  WN, Konishi  T; Apstein CS: Resistance of neonatal myocardium to injury during normothermic and hypothermic ischemic arrest and reperfusion (abstr). Circulation. 76 (suppl V) 1987:V-150.
Avkiran  M, Hearse  DJ; Projection of the myocardium during global ischemia. Is crystalloid cardioplegia effective in the immature myocardium?. J Thorac Cardiovasc Surg. 97 1989:220-228.
PubMed
Zak  R; Cell proliferation during growth. Am J Cardiol. 31 1973:211-215.
CrossRef | PubMed
Zak  R, Kizu  A, Bugaisky  L; Cardiac hypertrophy: its characteristics as a growth process. Am J Cardiol. 44 1979:911-916.
CrossRef
Wikman-Coffelt  J, Parmley  WW, Mason  DT; The cardiac hypertrophy process. Analyses of factors determining pathological vs physiological development. Cire Res. 45 1979:697-707.
CrossRef
Rakusan  K, Korecky  B, Mezl  V; Cardiac hypertrophy and/or hyperplasia?.Alpen  MR; Perspectives in Cardiovascular Research. VII. Myocardial hypertrophy and Failure. 1983 Raven New York:103-123.
Zak  R; Factors controlling cardiac growlh.Zak  R; Growth of the Heart in Health and Disease. 1984 Raven New York:165-185.
Rakusan  K; Cardiac growth, maturation, and aging.Zak  R; Growth of the Heart in Health and Disease. 1984 Raven New York:131-164.
Swynghedauw  B; Developmental and functional adaptation of cotractile proteins in cardiac and skeletal muscles. Am J Physiol. 66 1986:710-750.
Sahn  DJ, DeMaria  A, Kisslo  J, Weyman  A; The Committee on M-Mode Standardization of the American Society of Echocardiography. Recommendations regarding quantilation in M-Mode echocardiography: results of a survey of echocardiographic measurements. Circulation. 58 1978:1072-1083.
CrossRef | PubMed
Weiss  JL, Frederiksen  IW, Weisfeldt  ML; Hemodynamic determinants of the time course of fall in canine left ventricular pressure. J Clin Invest. 58 1976:751-760.
CrossRef | PubMed
Yellin  EL, Nikolic  S, Frater  RWM; Left ventricular filling dynamics and diastolic function. Prog Cardiovasc Dis. 32 1990:247-271.
CrossRef | PubMed
Mirsky  I, Pasipoularides  A; Clinical assessment of diastolic function. Prog Cardiovasc Dis. 32 1990:291-318.
CrossRef | PubMed
The Armed Forces Institute of Pathology;Lina  LG;Manual of Histological and Special Staining Techniques 1966 McGraw-Hill New York:58-159.
Hoyt  RH, Ericksen  E, Collins  SM, Skorton  DJ; Computer-assisied quantilation of myocardial fibrosis in histologic sections. Arch Pathol Lab Med. 108 1984:280-283.
PubMed
Loud  AV, Anversa  P; Biology of disease: morphometric analysis of biologic processes. Lab Invest. 50 1984:250-261.
PubMed
Loud  AV, Anversa  P, Giacomelli  F, Wiener  J; Absolute morphometric study or myocardial hypertrophy in experimental hypertension. Determination of myocyte size. Lab Invest. 5 1978:586-596.
Mendez  J, Keys  A; Density and composition of mammalian muscle. Metabolism. 9 1960:184-188.
Burton  K; A study of the conditions and mechanism of the diphenylamine reaction for the colorimetric estimation of DNA. Biochem J. 62 1956:315-323.
PubMed
Waterborg  JH, Matthews  HR; The Burton assay for DNA.Walker  JM; Methods in Molecular Biology. II., Nucleic Acids. 1984 Humana Clifton, NJ:1-3.
Lowry  OH, Rosebrough  NJ, Farr  AL, Randall  RJ; Protein measurement with the Folin phenol reagent. J Biol Chem. 193 1951:265-275.
PubMed
Steel  RGD; Principles and Procedures of Statistics: A biometrieal approach. 1980 McGraw-Hill New York:469-475.

Correspondence

Latest JACC CME

Continuing Medical Education through JACC is a convenient way to fulfill your CME requirements while learning important information about the latest advances in cardiovascular medicine.

April 2013- JACC CME Activity
Repeat Revascularization and Outcome

March 2013- JACC CME Activity
Extreme Lipoprotein(a) Levels and Improved Cardiovascular Risk Prediction

Feb 2013- JACC CME Activity
Results from the BARI 2D Trial

Jan 2013- JACC CME Activity
Prognosis Among Healthy Individuals Discharged With a Primary Diagnosis of Syncope

Dec 2012- JACC CME Activity
Incidence of Heart Failure or Cardiomyopathy After Adjuvant Trastuzumab Therapy for Breast Cancer

Nov 2012- JACC CME Activity
A Collaborative Analysis of Individual Patient Data From 10 Randomized Trials

Oct 2012- JACC CME Activity
Radiofrequency Ablation of Premature Ventricular Ectopy Improves the Efficacy of Cardiac Resynchronization Therapy in Nonresponders

Sept 2012- JACC CME Activity
Exercise and Pharmacological Treatment of Depressive Symptoms in Patients With Coronary Heart Disease

Aug 2012- JACC CME Activity
Reduction in Life-Threatening Ventricular Tachyarrhythmias in Statin-Treated Patients With Nonischemic Cardiomyopathy Enrolled in the MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy)

July 2012- JACC CME Activity
Relationship of Beta-Blocker Dose With Outcomes in Ambulatory Heart Failure Patients With Systolic Dysfunction

For previous CME quizzes, please follow this link to CardioSource Lifelong Learning and MOC.

 

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment
Submit a Comment

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Topics