Zeitschrift fur Kardiologie最新文献

{"title":"Quantification of aortic valve area and left ventricular muscle mass in healthy subjects and patients with symptomatic aortic valve stenosis by MRI.","authors":"J Haimerl,&nbsp;A Freitag-Krikovic,&nbsp;A Rauch,&nbsp;E Sauer","doi":"10.1007/s00392-005-0198-1","DOIUrl":"https://doi.org/10.1007/s00392-005-0198-1","url":null,"abstract":"<p><p>MRI allows visualization and planimetry of the aortic valve orifice and accurate determination of left ventricular muscle mass, which are important parameters in aortic stenosis. In contrast to invasive methods, MRI planimetry of the aortic valve area (AVA) is flow independent. AVA is usually indexed to body surface area. Left ventricular muscle mass is dependent on weight and height in healthy individuals. We studied AVA, left ventricular muscle mass (LMM) and ejection fraction (EF) in 100 healthy individuals and in patients with symptomatic aortic valve stenosis (AS). All were examined by MRI (1.5 Tesla Siemens Sonate) and the AVA was visualized in segmented 2D flash sequences and planimetry of the performed AVA was manually. The aortic valve area in healthy individuals was 3.9+/-0.7 cm(2), and the LMM was 99+/-27 g. In a correlation analysis, the strongest correlation of AVA was to height (r=0.75, p<0.001) and for LMM to weight (r=0.64, p<0.001). In a multiple regression analysis, the expected AVA for healthy subjects can be predicted using body height: AVA=-2.64+0.04 x(height in cm) -0.47 x w (w=0 for man, w=1 for female).In patients with aortic valve stenosis, AVA was 1.0+/-0.35 cm(2), in correlation to cath lab r=0.72, and LMM was 172+/-56 g. We compared the AS patients results with the data of the healthy subjects, where the reduction of the AVA was 28+/-10% of the expected normal value, while LMM was 42% higher in patients with AS. There was no correlation to height, weight or BSA in patients with AS. With cardiac MRI, planimetry of AVA for normal subjects and patients with AS offered a simple, fast and non-invasive method to quantify AVA. In addition LMM and EF could be determined. The strong correlation between height and AVA documented in normal subjects offered the opportunity to integrate this relation between expected valve area and definitive orifice in determining the disease of the aortic valve for the individual patient. With diagnostic MRI in patients with AS, invasive measurements of the systolic transvalvular gradient does not seem to be necessary.</p>","PeriodicalId":23757,"journal":{"name":"Zeitschrift fur Kardiologie","volume":"94 3","pages":"173-81"},"PeriodicalIF":0.0,"publicationDate":"2005-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00392-005-0198-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25155942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sirolimus-eluting stent treatment for isolated proximal left anterior descending artery stenoses. Results from the prospective multi-center German Cypher Registry.","authors":"A A Khattab,&nbsp;C W Hamm,&nbsp;J Senges,&nbsp;R Toelg,&nbsp;V Geist,&nbsp;T Bonzel,&nbsp;M Kelm,&nbsp;B Levenson,&nbsp;C A Nienaber,&nbsp;G Sabin,&nbsp;S Schneider,&nbsp;U Tebbe,&nbsp;G Richardt","doi":"10.1007/s00392-005-0200-y","DOIUrl":"https://doi.org/10.1007/s00392-005-0200-y","url":null,"abstract":"<p><strong>Background: </strong>Stenting of isolated proximal LAD stenoses is still a controversial issue since it is associated with higher target vessel revascularization (TVR) rate than both bypass surgery using the internal mammary artery, and stenting of other coronary artery territories. The sirolimus- eluting stent (SES) has been reported to significantly reduce restenosis rates in de novo coronary lesions. Therefore, we compared patients from the German Cypher Registry treated with SES for isolated proximal LAD lesions with those stented for isolated lesions in the proximal LCX or RCA.</p><p><strong>Methods: </strong>A total of 349 patients treated with SES were analyzed. 249 patients were treated for proximal LAD stenosis, and 100 for proximal LCX/RCA stenoses. The combined clinical endpoint was MACCE (death of any cause, non-fatal MI and non-fatal stroke) and TVR at 6 months.</p><p><strong>Results: </strong>In-hospital events (death, MI and TVR) did not differ significantly between both groups (3.2% for the LAD group vs 2.0% for the LCX/RCA-group, p=0.73). The combined end point of death of any cause, non-fatal MI and non-fatal stroke at six months was 2.6% in the LAD group, and 2.2% in the LCX/RCA group (p=1.0). TVR occurred in 4.8% of the LAD group and in 6.5% of the LCX/RCA group at six months (p=0.58). The percentage of patients free from angina at daily activities was 80.6% in the LAD group, and 77.4% in the LCX/ RCA group (p=0.52).</p><p><strong>Conclusion: </strong>SES once implanted into isolated proximal LAD stenoses appears as effective as reported in other vessel territories. Accordingly, stenting of the proximal LAD using SES might prove a suitable alternative to surgery.</p>","PeriodicalId":23757,"journal":{"name":"Zeitschrift fur Kardiologie","volume":"94 3","pages":"187-92"},"PeriodicalIF":0.0,"publicationDate":"2005-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00392-005-0200-y","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25155944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Splenic rupture complicating periinterventional glycoprotein IIb/IIIa antagonist therapy for myocardial infarction in polycythemia vera.","authors":"E B Friedrich,&nbsp;M Kindermann,&nbsp;A Link,&nbsp;M Böhm","doi":"10.1007/s00392-005-0197-2","DOIUrl":"https://doi.org/10.1007/s00392-005-0197-2","url":null,"abstract":"<p><p>Polycythemia vera is a myeloproliferative disorder predisposing to thromboembolic and bleeding complications. We report the case of a patient with polyglobuly, leukocytosis, and thrombocytosis, who suffered from acute ST-segment elevation myocardial infarction due to thrombotic high-grade pre-stent stenosis two months after percutaneous coronary intervention for complex coronary one vessel disease. Following re-PTCA and stent implantation in conjunction with periinterventional GP IIb/IIIa antagonist treatment, the patient was initially symptom free for about two hours before rapidly developing signs of a hemorrhagic shock. An abdominal CT scan showed splenic rupture with massive intraabdominal hemorrhage as a consequence of secondary bleeding into multiple pre-existing splenic infarctions. The patient's condition stabilized after emergency splenectomy. Subsequent bone marrow biopsy revealed the presence of polycythemia vera. Post-operatively, the patient was treated with the anti-platelet agents aspirin and clopidogrel to prevent subacute stent thrombosis. Additionally, cyto-reductive therapy with hydroxyurea was initiated because of a further increase in the platelet count. In patients with polycythemia vera, the indication for treatment with GP IIb/IIIa antagonists should be carefully weighed against the potentially serious bleeding complications. Should treatment be established, a risk stratification using abdominal sonography and bleeding time testing is recommended, while during treatment red blood count, platelet count, coagulation tests, and hemodynamic parameters should be closely monitored.</p>","PeriodicalId":23757,"journal":{"name":"Zeitschrift fur Kardiologie","volume":"94 3","pages":"200-4"},"PeriodicalIF":0.0,"publicationDate":"2005-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00392-005-0197-2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25155946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[20th report of performance data from heart catheterization laboratories in Germany. 2003 results of a collaborative survey by the Committee of Clinical Cardiology and the Interventional Cardiology (for ECS) and Angiology Study Groups of the German Society of Cardiology-Cardiovascular Research].","authors":"F van Buuren,&nbsp;H Mannebach,&nbsp;D Horstkotte","doi":"10.1007/s00392-005-0227-0","DOIUrl":"https://doi.org/10.1007/s00392-005-0227-0","url":null,"abstract":"","PeriodicalId":23757,"journal":{"name":"Zeitschrift fur Kardiologie","volume":"94 3","pages":"212-5"},"PeriodicalIF":0.0,"publicationDate":"2005-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00392-005-0227-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24988982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atrial fibrillation: profit from cardiac pacing?","authors":"A Yang,&nbsp;B Lüderitz,&nbsp;T Lewalter","doi":"10.1007/s00392-005-0196-3","DOIUrl":"https://doi.org/10.1007/s00392-005-0196-3","url":null,"abstract":"<p><p>The impact of cardiac pacing on the prevention of atrial fibrillation is under scientific investigation. Several prospective randomised clinical trials have reported that atrial-based \"physiologic\" AAI(R)- or DDD(R)-pacing is associated with a lower incidence of paroxysmal and permanent atrial fibrillation than single-chamber ventricular pacing in patients with a conventional pacemaker indication. However, it is still uncertain whether atrial pacing itself has independent antiarrhythmic properties. In contrast, right ventricular pacing is considered to promote atrial fibrillation, even in preserved AV synchrony during dual-chamber pacing. The electrical secondary prevention of atrial fibrillation is mainly based on variations of the atrial pacing site and sophisticated preventive pacing algorithms incorporated in the pacemaker software. Dual-site right atrial and biatrial pacing were reported to exhibit modest to no benefit for the prevention of atrial fibrillation, whereas septal pacing and specific preventive pacing algorithms have been demonstrated to reduce the incidence of atrial fibrillation in a number of clinical trials. However, the role of septal pacing and preventive pacing algorithms still has to be clarified since, overall, study results have been inconsistent so far. One of the main goals of future investigations should be the identification of responder groups of preventive pacing concepts. In clinical practice, the efficacy of pacing algorithms and septal pacing has to be determined in the individual case. These options should be taken into account in patients with symptomatic bradycardia as the indication for cardiac pacing and, in addition, symptomatic atrial fibrillation.</p>","PeriodicalId":23757,"journal":{"name":"Zeitschrift fur Kardiologie","volume":"94 3","pages":"141-51"},"PeriodicalIF":0.0,"publicationDate":"2005-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00392-005-0196-3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25155939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Detection of early systolic dysfunction with strain rate imaging in a patient with light chain cardiomyopathy.","authors":"A Niedeggen,&nbsp;O A Breithardt,&nbsp;A Franke","doi":"10.1007/s00392-005-0175-8","DOIUrl":"https://doi.org/10.1007/s00392-005-0175-8","url":null,"abstract":"<p><p>Congestive heart failure (CHF) in cardiac amyloidosis has been attributed to the development of diastolic dysfunction, because severe CHF symptoms have been observed despite a normal or only mildly reduced LV ejection fraction (EF). An early impairment of longitudinal systolic function has been described by means of tissue Doppler-derived myocardial deformation imaging ('strain rate imaging', SRI). Our patient presented with signs of CHF and significantly increased brain-natriuretic peptide (BNP) levels. Conventional measures of systolic contractile function were within the normal range and mitral inflow Doppler showed only moderate diastolic dysfunction. Histopathological examination by endomyocardial biopsy revealed interstitial deposition of amyloid fibers. Quantitative assessment of myocardial velocities (TDI) and deformation properties (Strain) from the apical view demonstrated a significant impairement of systolic longitudinal myocardial function. In patients with isolated diastolic dysfunction detected by conventional Doppler echocardiography, the quantitative assessment of myocardial strain and strain rate can be helpful in the early detection of systolic dysfunction.</p>","PeriodicalId":23757,"journal":{"name":"Zeitschrift fur Kardiologie","volume":"94 2","pages":"133-6"},"PeriodicalIF":0.0,"publicationDate":"2005-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00392-005-0175-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24926102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Renal failure and ACE inhibition: how much is too much?","authors":"M-L Gross,&nbsp;M Adamczak,&nbsp;E Ritz","doi":"10.1007/s00392-005-0179-4","DOIUrl":"https://doi.org/10.1007/s00392-005-0179-4","url":null,"abstract":"<p><p>The dose-response relationship between pharmacological blockade of the renin-angiotensin system (RAS) and angiotensin II concentration in the circulation, on the one hand, and decrease of blood pressure, on the other hand, has been well established. In contrast it is currently unclear which dose of ACE inhibitors and/or angiotensin receptor blockers is optimal for nephroprotection. Clinical studies are rendered quite complex by an early decrease of glomerular filtration after RAS blockade and by side effects at higher doses such as renal sodium loss, hyperkalemia, anemia, etc. Animal experiments and recent clinical studies suggest that the doses of ACE inhibitors or angiotensin receptor blockers required for maximal reduction of proteinuria (as a surrogate marker) and for optimal nephroprotection (retardation of the loss of glomerular filtration) exceed those required for maximal lowering of blood pressure. Ongoing studies try to define the relative merits of high dose monotherapy (ACE inhibitors or angiotensin receptor blockers) versus a combination therapy of the two.</p>","PeriodicalId":23757,"journal":{"name":"Zeitschrift fur Kardiologie","volume":"94 2","pages":"81-6"},"PeriodicalIF":0.0,"publicationDate":"2005-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00392-005-0179-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24926172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Initial experience using the NuMED Cheatham Platinum (CP) stent for interventional treatment of coarctation of the aorta in children and adolescents.","authors":"N A Haas,&nbsp;M A G Lewin,&nbsp;W Knirsch,&nbsp;R Nossal,&nbsp;V Ocker,&nbsp;F Uhlemann","doi":"10.1007/s00392-005-0180-y","DOIUrl":"https://doi.org/10.1007/s00392-005-0180-y","url":null,"abstract":"<p><p>We report the immediate results in a group of selected patients with native or recurrent coarctation of the aorta who underwent endovascular stent implantation using the newly designed Cheatham-Platinum (CP)-stent. The balloon-expandable stents were implanted in 6 patients (mean age 12.7 years) with coarctation of the aorta (5 native, 1 recurrent). The maximal systolic peak pressure gradient was decreased from 49 to 3 mmHg (p <0.001). There was a 350% increase in the mean diameter at the original coarctation site (3.8 to 13.8 mm, p <0.01). Although the maximal diameter varied from 8 to 18 mm, there was only a minor reduction in the length of the CP-stents used (max. 11%). The dilatation was successful in all patients and there were no complications during balloon dilatation or stent implantation. All patients were hypertensive prior to stent implantation, with three of them requiring antihypertensive drug therapy. In 2 patients only a moderate dilatation diameter was chosen initially due to the extremely small coarctation site (1 mm) and repeat dilatation after 12 months was performed in order to obtain a maximal aortic diameter. At a mean of 18 months of follow-up, 5 of 6 patients are normotensive. There is no recurrence of coarctation, aortic dissection or aneurysm formation and no stent displacement. These findings suggest that the implantation of CP-stents for coarctation of the aortamay cover a wide spectrum of aortic diameters and consequently hereby offer an effective alternative approach to surgery or ballon dilatation alone even in infancy and childhood. The potential for redilatation of CP-stents in a wide range of diameters without significant shortening adds to the benefit of this device in growing children.</p>","PeriodicalId":23757,"journal":{"name":"Zeitschrift fur Kardiologie","volume":"94 2","pages":"113-20"},"PeriodicalIF":0.0,"publicationDate":"2005-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00392-005-0180-y","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24926176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bidirectional ventricular tachycardia due to digitalis intoxication.","authors":"W Grimm,&nbsp;M Ritter,&nbsp;P Alter,&nbsp;R Funck,&nbsp;B Maisch","doi":"10.1007/s00392-005-0178-5","DOIUrl":"https://doi.org/10.1007/s00392-005-0178-5","url":null,"abstract":"","PeriodicalId":23757,"journal":{"name":"Zeitschrift fur Kardiologie","volume":"94 2","pages":"79-80"},"PeriodicalIF":0.0,"publicationDate":"2005-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00392-005-0178-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24926171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Effect of caffeine on myocardial blood flow during pharmacological vasodilation].","authors":"J P Wielepp,&nbsp;E Fricke,&nbsp;D Horstkotte,&nbsp;W Burchert","doi":"10.1007/s00392-005-0173-x","DOIUrl":"https://doi.org/10.1007/s00392-005-0173-x","url":null,"abstract":"<p><p>Pharmacologic stress with adenosine is frequently used for noninvasive detection of coronary artery disease. Dietary intake of caffeinated food, beverages or medications might alter adenosine-induced hyperemic blood flow, thereby compromising the diagnostic sensitivity of adenosine stress testing. In this case we report on a male patient with CAD. Myocardial blood flow at rest and during adenosine-induced hyperemia 2 hours after consumption of decaffeinated coffee and again without caffeine intake were quantified by ammonia PET. After caffeine intake there was a clearly diminished increase of myocardial blood flow during adenosine. The average coronary flow reserve in the myocardium was 1.3 after caffeine. In the baseline study without caffeine the coronary flow reserve has been improved to 2.3. Caffeine intake alters the coronary vasodilatory capacity. These findings emphasize the importance of carefully screening patients for intake of caffeinated food prior to adenosine stress testing.</p>","PeriodicalId":23757,"journal":{"name":"Zeitschrift fur Kardiologie","volume":"94 2","pages":"128-32"},"PeriodicalIF":0.0,"publicationDate":"2005-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00392-005-0173-x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24926178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}