William R Slater, M.D.

Electrocardiographic predictors of adverse cardiovascular events in suspected poisoning
Manini, Alex F; Nelson, Lewis S; Skolnick, Adam H; Slater, William; Hoffman, Robert S
2010 Jun;6(2):106-115, Journal of medical toxicology
Poisoning is the second leading cause of injury-related fatality in the USA and the leading cause of cardiac arrest in victims under 40 years of age. The study objective was to define the electrocardiographic (ECG) predictors of adverse cardiovascular events (ACVE) complicating suspected acute poisoning (SAP). This was a case-control study in adults at three tertiary-care hospitals and one regional Poison Control Center. We compared 34 cases of SAP complicated by ACVE to 101 consecutive control patients with uncomplicated SAP. The initial ECG was analyzed for rhythm, intervals, QT dispersion, ischemia, and infarction. ECGs were interpreted by a cardiologist, blinded to study hypothesis and case data. Subjects were 48% male, with mean age 42 +/- 19 years. In addition to clinical suspicion of poisoning in 100% of patients, routine toxicology screens were positive in 77%, most commonly for benzodiazepines, opioids, and/or acetaminophen. Neither the ventricular rate, the QRS duration, nor the presence of infarction predicted the risk of ACVE. However, the rhythm, QTc, QT dispersion, and presence of ischemia correlated with the risk of ACVE. Independent predictors of ACVE based on multivariable logistic regression were prolonged QTc, any non-sinus rhythm, ventricular ectopy, and ischemia. Recursive partitioning analysis identified very low risk criteria (94.1% sensitivity, 96.2% NPV) and high risk criteria (95% specificity). Among patients with SAP, the presence of QTc prolongation, QT dispersion, ventricular ectopy, any non-sinus rhythm, and evidence of ischemia on the initial ECG are strongly associated with ACVE
— id: 138121, year: 2010, vol: 6, page: 106, stat: Journal Article,

Hypersensitivity myocarditis associated with azithromycin exposure
Pursnani, Amit; Yee, Herman; Slater, William; Sarswat, Nitasha
2009 Feb 3;150(3):225-226, Annals of internal medicine
— id: 114157, year: 2009, vol: 150, page: 225, stat: Journal Article,

Factors associated with adverse cardiovascular events among patients with suspected acute poisoning
Manini, AF; Nelson, LS; Skolnick, A; Slater, W; Hoffman, RS
2008 ;46(7):631-632 SUM, Clinical Toxicology (Philadelphia)
— id: 86834, year: 2008, vol: 46, page: 631, stat: Journal Article,

Clinical factors associated with abandonment of a rate-control or a rhythm-control strategy for the management of atrial fibrillation in the AFFIRM study
Curtis, AB; Seals, AA; Safford, RE; Slater, W; Tullo, NG; Vidaillet, JH; Wilber, DJ; Slee, A
2005 FEB ;149(2):304-308, American heart journal
Objective The objective of the current study was to determine the clinical factors that were associated with abandonment of a rate-control or a rhythm-control strategy in patients with atrial fibrillation (AF). Background Although the AFFIRM Study demonstrated that outcomes are similar with a primary strategy of rate-control or rhythm-control for AF, there may be clinical or demographic factors associated with abandonment of the initial treatment strategy. Knowledge of these risk factors would be useful so that patients may be given appropriate initial therapy and, as appropriate, switched to alternative treatments earlier. Methods Patients in the AFFIRM Study were subdivided into those who were maintained on their initial treatment strategy versus those who abandoned initial treatment strategy for alternative therapies. We determined the clinical and demographic factors associated with change in initial treatment strategy. Results At 5 years the original treatment strategy was maintained in 85% of the patients in the rate-control arm versus 62% of those in the rhythm-control arm (P <.0001). Length of the qualifying episode of AF was associated with abandonment of both rhythm-control and rate-control strategies. Antiarrhythmic drug failure before randomization and a history of thyroid disease also were associated with abandonment of rhythm-control. Patients were more likely to maintain rate-control if they already had an implanted pacemaker or if they were older than 75 years, while an ejection fraction <30% was associated with abandonment of the rate-control strategy. Conclusions In patients with AF, rhythm-control strategies are abandoned significantly more often than rate-control strategies. Patients with long durations of AF on presentation or previous antiarrhythmic drug failure might be considered for rate-control as initial treatment
— id: 50168, year: 2005, vol: 149, page: 304, stat: Journal Article,

Are transthoracic echocardlographic parameters associated with atrial fibrillation recurrence or stroke? - Results from the atrial fibrillation follow-up investigation of rhythm management (AFFIRM) study
Olshansky, B; Heller, EN; Mitchell, LB; Chandler, M; Slater, W; Green, M; Brodsky, M; Barrell, P; Greene, HL
2005 JUN 21 ;45(12):2026-2033, Journal of the American College of Cardiology
OBJECTIVES The purpose of this study was to evaluate the associations of transthoracic echocardlographic parameters with recurrent atrial fibrillation (AF) and/or stroke. BACKGROUND The Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study, an evaluation of elderly patients with AF at risk for stroke, provided an opportunity to evaluate the implications of echocardiographic parameters in patients with AF. METHODS Transthoracic echocardiographic measures of mitral regurgitation (MR), left atrial (LA) diameter, and left ventricular (LV) function were evaluated in the AFFIRM rate- and rhythm-control patients who had sinus rhythm resume and had these data available. Risk for recurrent AF or stroke was evaluated with respect to transthoracic echocardiographic measures. RESULTS Of 2,474 patients studied, 457 had >= 2(+)/4(+) MR, and 726 had a LA diameter > 4.5 cm. The LV ejection fraction was abnormal in 543 patients. The cumulative probabilities of at least one AF recurrence/stroke were 46%/1% after 1 year and 84%/5% by the end of the trial (> 5 years), respectively. Multivariate analysis showed that randomization to the rhythm-control arm (hazard ratio [HR] = 0.64; p < 0.0001) and a qualifying episode of AF being the first known episode (HR = 0.70; p < 0.0001) were associated with decreased risk. Duration of qualifying AF episode > 48 h (HR = 1.55; p < 0.0001) and LA diameter (p = 0.008) were associated with an increased risk of recurrent AF. Recurrent AF was more likely with larger LA diameters (FIR = 1.21, 1.16, and 1.32 for mild, moderate, and severe enlargement, respectively). No transthoracic echocardiographic measures were associated with risk of stroke. CONCLUSIONS In the AFFIRM study, large transthoracic echocardiographic LA diameters were associated with recurrent AF, but no measured echocardiographic parameter was associated with stroke. (c) 2005 by the American College of Cardiology Foundation
— id: 56255, year: 2005, vol: 45, page: 2026, stat: Journal Article,

Cardiac abnormalities in diabetic patients with neuropathy: effects of aldose reductase inhibitor administration
Johnson, Brian F; Nesto, Richard W; Pfeifer, Michael A; Slater, William R; Vinik, Aaron I; Chyun, Deborah A; Law, Gordon; Wackers, Frans J Th; Young, Lawrence H
2004 Feb;27(2):448-454, Diabetes care
OBJECTIVE: The goal of this study was to determine whether treatment with an aldose reductase inhibitor (ARI) has beneficial effects on asymptomatic cardiac abnormalities in diabetic patients with neuropathy. RESEARCH DESIGN AND METHODS: Diabetic subjects with neuropathy (n = 81) with either a low diastolic peak filling rate or impaired augmentation of left ventricular (LV) ejection fraction (LVEF) during maximal bicycle exercise were identified by gated radionuclide ventriculography. Coronary artery disease, left ventricular hypertrophy, and valvular heart disease were excluded by clinical evaluation, myocardial perfusion imaging, and echocardiography. Subjects were randomized to receive blinded treatment with either the placebo or the ARI zopolrestat 500 or 1,000 mg daily for 1 year. RESULTS: After 1 year of ARI treatment, there were increases in resting LVEF (P < 0.02), cardiac output (P < 0.03), LV stroke volume (P < 0.004), and exercise LVEF (P < 0.001). In placebo-treated subjects, there were decreases in exercise cardiac output (P < 0.03), stroke volume (P < 0.02), and end diastolic volume (P < 0.04). Exercise LVEF increased with ARI treatment independent of blood pressure, insulin use, or the presence of baseline abnormal heart rate variability. There was no change in resting diastolic filling rates in either group. CONCLUSIONS: Diabetic patients with neuropathy have LV abnormalities that can be stabilized and partially reversed by ARI treatment
— id: 94801, year: 2004, vol: 27, page: 448, stat: Journal Article,

Coronary artery disease: Part 2. Treatment
Link N; Slater W
2001 May;174(5):330-335, Western journal of medicine
— id: 20681, year: 2001, vol: 174, page: 330, stat: Journal Article,

T-Wave alternans during ventricular pacing
Fedor, MC; Chinitz, JS; Holmes, DS; Bernstein, NE; Ruffo, S; Manaris, A; Balch, LJ; Slater, W; Rey, M; Chinitz, LA
2000 FEB ;35(2):145A-145A, Journal of the American College of Cardiology
— id: 54748, year: 2000, vol: 35, page: 145A, stat: Journal Article,

A prospective evaluation of the electrocardiographic manifestations of hypothermia
Vassallo SU; Delaney KA; Hoffman RS; Slater W; Goldfrank LR
1999 Nov;6(11):1121-1126, Academic emergency medicine
OBJECTIVE: To determine the effects of body temperature, ethanol use, electrolyte status, and acid-base status on the electrocardiograms (ECGs) of hypothermic patients. METHODS: Prospective, two-year, observational study of patients presenting to an urban ED with temperature < or =95 degrees F (< or =35 degrees C). All patients had at least one ECG obtained. Electrocardiograms were interpreted by a cardiologist blinded to the patient's temperature. J-point elevations known as Osborn waves were defined as present if they were at least 1 mm in height in two consecutive complexes. RESULTS: 100 ECGs were obtained in 43 patients. Presenting temperatures ranged between 74 degrees F and 95 degrees F (23.3 degrees C-35 degrees C). Initial rhythms included normal sinus (n = 34), atrial fibrillation (n = 8), and junctional (n = 1). Osborn waves were present in 37 of 43 initial ECGs. Of the six initial ECGs that did not have Osborn waves present, all were obtained in patients whose temperatures were > or =90 degrees F > or =32.2 degrees C). For the entire group, the Osborn wave was significantly larger as temperature decreased (p = 0.0001, r = -0.441). The correlation between temperature and size of the Osborn wave was strongest in six patients with four or more ECGs (range r = -0.644 to r = -0.956, p = 0.001). No correlation could be demonstrated between the height of the Osborn waves and the serum electrolytes, including sodium, chloride, potassium, bicarbonate, BUN, creatinine, glucose, anion gap, and blood ethanol levels. CONCLUSIONS: The presence and size of the Osborn waves in hypothermic patients appear to be a function of temperature. The magnitude of the Osborn waves is inversely correlated with the temperature
— id: 56484, year: 1999, vol: 6, page: 1121, stat: Journal Article,

Induction of myocardial insulin-like growth factor-I gene expression in left ventricular hypertrophy
Donohue TJ; Dworkin LD; Lango MN; Fliegner K; Lango RP; Benstein JA; Slater WR; Catanese VM
1994 Feb;89(2):799-809, Circulation
BACKGROUND: Left ventricular hypertrophy is a generalized adaptation to increased afterload, but the growth factors mediating this response have not been identified. To explore whether the hypertrophic response was associated with changes in local insulin-like growth factor-I (IGF-I) gene regulation, we examined the induction of the cardiac IGF-I gene in three models of systolic hypertension and resultant hypertrophy. METHODS AND RESULTS: The model systems were suprarenal aortic constriction, uninephrectomized spontaneously hypertensive rats (SHR), and uninephrectomized, deoxycorticosterone-treated, saline-fed rats (DOCA salt). Systolic blood pressure reached hypertensive levels at 3 to 4 weeks in all three systems. A differential increase in ventricular weight to body weight (hypertrophy) occurred at 3 weeks in the SHR and aortic constriction models and at 4 weeks in the DOCA salt model. Ventricular IGF-I mRNA was detected by solution hybridization/RNase protection assay. IGF-I mRNA levels increased in all three systems coincident with the onset of hypertension and the development of ventricular hypertrophy. Maximum induction was 10-fold over control at 5 weeks in the aortic constriction model, 8-fold at 3 weeks in the SHR, and 6-fold at 6 weeks in the DOCA salt model. IGF-I mRNA levels returned to control values by the end of the experimental period despite continued hypertension and hypertrophy in all three systems. In contrast, ventricular c-myc mRNA content increased twofold to threefold at 1 week and returned to control levels by 2 weeks. Ventricular IGF-I receptor mRNA levels were unchanged over the time course studied. The increased ventricular IGF-I mRNA content was reflected in an increased ventricular IGF-I protein content, as determined both by radioimmunoassay and immunofluorescence histochemistry. CONCLUSIONS: We conclude that (1) hypertension induces significant increases in cardiac IGF-I mRNA and protein that occur coordinately with its onset and early in the development of hypertrophy, (2) IGF-I mRNA levels normalize as the hypertrophic response is established, (3) in comparison to IGF-I, both c-myc and IGF-I receptor genes are differentially controlled in experimental hypertension. These findings suggest that IGF-I may participate in initiating ventricular hypertrophy in response to altered loading conditions. The consistency of these findings in models of high-, moderate-, and low-renin hypertension suggests that they occur independently of the systemic renin-angiotensin endocrine axis
— id: 56521, year: 1994, vol: 89, page: 799, stat: Journal Article,

CAN QUANTITATIVE STRESS TL-201 IMAGING PREDICT THE INFARCT VESSEL IN MULTIVESSEL CORONARY-ARTERY DISEASE
GLOTZER, TV; WALTUCH, J; SANGER, JJ; REY, M; SLATER, WR
1994 APR ;42(2):A191-A191, Clinical research
— id: 52493, year: 1994, vol: 42, page: A191, stat: Journal Article,

QUANTITATIVE-ANALYSIS OF TL-201 IMAGING PREDICTS RISK OF MYOCARDIAL-INFARCTION
WALTUCH, J; GLOTZER, TV; REY, M; SANGER, JJ; SLATER, WR
1994 APR ;42(2):A191-A191, Clinical research
— id: 52492, year: 1994, vol: 42, page: A191, stat: Journal Article,

Autonomic manipulation influences both temporal and frequency analyses of late potentials
Schwartzman D; Demopoulos L; Schrem S; Caracciolo E; Perez J; Chinitz L; Slater W
1992 Nov;15(11 Pt 2):2200-2205, Pacing & clinical electrophysiology
Previous studies of late potentials have not standardized the autonomic milieu at the time of testing. We studied the effects of autonomic manipulation in seven patients with previous Q wave myocardial infarction. Late potentials were evaluated using standard temporal (TD) and spectral temporal mapping techniques (STM) in the drug free state, and during separate intravenous administration of each of the following: isoproterenol, esmolol, and atropine. Isoproterenol was titrated to achieve a heart rate of 130% of baseline. Esmolol was infused at a rate of 250 micrograms/kg per minute, after a loading dose of 500 micrograms/kg. Atropine was given as a 2-mg bolus. In addition, five patients who received no drug infusions acted as controls, undergoing four serial signal-averaging studies in the baseline state: a 'baseline' study, and then three additional studies at time intervals similar to those incurred by the study patients. Therefore, a total of 21 TD and 21 STM tests were done in the study group (seven patients; three drugs per patient) during the drug infusions, and 15 TD and 15 STM tests were done in the control group (five patients; three 'nonbaseline' tests per patient). A change (normal to abnormal, or vice versa) in TD during a drug infusion occurred in 24% of the tests. No such change occurred in the control group (P < 0.01). A change in STM during a drug infusion occurred in 38% of tests, versus 13% of tests in the control group (P = 0.14). Overall, six of seven patients had a change in TD and/or STM diagnosis with infusion of one or more of the study drugs.(ABSTRACT TRUNCATED AT 250 WORDS)
— id: 13392, year: 1992, vol: 15, page: 2200, stat: Journal Article,

INDUCTION OF CARDIAC INSULIN-LIKE GROWTH FACTOR-I MESSENGER-RNA PRECEDES VENTRICULAR HYPERTROPHY IN RESPONSE TO PRESSURE OVERLOAD
Donohue, TJ; Benstein, JA; Dworkin, LD; Slater, WR; Catanese, VM
1990 Oct;82(4):761-761, Circulation
— id: 31914, year: 1990, vol: 82, page: 761, stat: Journal Article,

SEQUENTIAL INDUCTION OF CARDIAC C-MYC AND INSULIN-LIKE GROWTH FACTOR-I GENES PRECEDES VENTRICULAR HYPERTROPHY IN RESPONSE TO PRESSURE OVERLOAD
Donohue, TJ; Benstein, JA; Dworkin, LD; Slater, WR; Catanese, VM
1990 Oct;38(3):A766-A766, Clinical research
— id: 31920, year: 1990, vol: 38, page: A766, stat: Journal Article,

SEQUENTIAL INDUCTION OF CARDIAC C-MYC AND INSULIN-LIKE GROWTH FACTOR-I GENE-EXPRESSION IN RESPONSE TO ELEVATED LEFT- VENTRICULAR AFTERLOAD
Donohue, TJ; Dworkin, LD; Slater, W; Catanese, VM
1990 Apr;38(2):A240-A240, Clinical research
— id: 31952, year: 1990, vol: 38, page: A240, stat: Journal Article,

EFFECT OF COLLATERAL VESSELS ON EXERCISE TEST-PERFORMANCE IN SEVERE SINGLE VESSEL CORONARY-ARTERY DISEASE
Katz, E; Kaplan, B; Perez, J; Slater, J; Glassman, E; Rey, M; Slater, W
1990 Oct;38(3):A764-A764, Clinical research
— id: 31919, year: 1990, vol: 38, page: A764, stat: Journal Article,

Cocaine-induced torsades de pointes in a patient with the idiopathic long QT syndrome
Schrem SS; Belsky P; Schwartzman D; Slater W
1990 Oct;120(4):980-984, American heart journal
— id: 64554, year: 1990, vol: 120, page: 980, stat: Journal Article,

The hemodynamics of left ventricular pseudoaneurysm: color Doppler echocardiographic study
Tunick PA; Slater W; Kronzon I
1989 May;117(5):1161-1165, American heart journal
— id: 10638, year: 1989, vol: 117, page: 1161, stat: Journal Article,

VPBs, who requires treatment?
Slater WR; Patt MV; Podrid PJ
1985 ;1(5):21-28, Cardiology emergency decisions
— id: 84013, year: 1985, vol: 1, page: 21, stat: Journal Article,