Zeitschrift fur Kardiologie最新文献

{"title":"Plasma levels of NT-pro-BNP in patients with atrial fibrillation before and after electrical cardioversion.","authors":"D-I Shin,&nbsp;K Jaekel,&nbsp;Ph Schley,&nbsp;A Sause,&nbsp;M Müller,&nbsp;R Fueth,&nbsp;T Scheffold,&nbsp;H Guelker,&nbsp;M Horlitz","doi":"10.1007/s00392-005-0301-7","DOIUrl":"https://doi.org/10.1007/s00392-005-0301-7","url":null,"abstract":"<p><strong>Objective: </strong>Plasma levels of brain natriuretic peptide (BNP) have been examined in studies on patients with persistent atrial fibrillation, both before and after electrical cardioversion. Studied patients often showed a comorbidity with congestive heart failure, which complicates interpretation of measured BNP values as a natriuretic peptide. The aim of this study was to examine plasma levels of N-terminal fragment pro-brain natriuretic peptide (NT-pro-BNP), which is the more stable but inactive cleavage product of pro-BNP in patients with atrial fibrillation, but normal left ventricular ejection fraction, before and after electrical cardioversion.</p><p><strong>Patients and methods: </strong>NT-pro-BNP plasma levels of 34 consecutive patients were measured before, shortly after and 11 days after electrical cardioversion. All patients showed a normal ejection fraction after echocardiographic or laevocardiographic criteria.</p><p><strong>Results: </strong>At baseline, all patients showed elevated NT-pro-BNP compared to a healthy control group (1086 vs. 66.9 pg/ml, p<0.001). After a mean follow-up time of 11 days in patients with persistent restored sinusrhythm, NT-pro-BNP decreased from 1071 pg/ml at baseline to 300 pg/ml (p<0.001). In contrast, patients with recurrence of atrial fibrillation showed increased levels from 1570.5 pg/ml at baseline to 1991 pg/ml (p=0.13; n.s.). Recurrence of atrial fibrillation was independent from height of NT-pro-BNP levels at baseline (p=0.23).</p><p><strong>Conclusions: </strong>Atrial fibrillation in patients with a normal left ventricular ejection fraction is associated with elevated NT-pro-BNP plasma levels, which decrease when a persistent sinus-rhythm can be restored by electrical cardioversion. On the other hand, NT-pro-BNP seems to increase (n.s.) when recurrence of atrial fibrillation occurs. Finally, NT-pro-BNP is no valid predictor for long-term success of sinus-rhythm restoration by electrical cardioversion.</p>","PeriodicalId":23757,"journal":{"name":"Zeitschrift fur Kardiologie","volume":"94 12","pages":"795-800"},"PeriodicalIF":0.0,"publicationDate":"2005-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00392-005-0301-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25773772","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":"Treatment of in-stent restenosis with sirolimus-eluting-stents -- a six month clinical and angiographic follow-up.","authors":"M Rau,&nbsp;C Maikowski,&nbsp;M Weber,&nbsp;E Keil,&nbsp;A Elsässer,&nbsp;H Möllmann,&nbsp;C Hamm","doi":"10.1007/s00392-005-0298-y","DOIUrl":"https://doi.org/10.1007/s00392-005-0298-y","url":null,"abstract":"<p><p>Treatment of in-stent restenosis (ISR) remains a therapeutic challenge since many pharmacological and mechanical approaches have shown disappointing results except for brachytherapy. Drug-eluting stents (DES) have been reported to effectively reduce ISR in de novo lesions. We studied 55 consecutive patients with ISR in native coronary arteries and 7 with ISR in saphenous vein grafts (SVG) with elective indication for percutaneous coronary intervention (PCI), who underwent successful implantation with DES. No in-hospital postprocedural major adverse cardiac events were observed. All but one patient (n=61) underwent an angiographic follow-up at 183+/-30 days. Grade of stenosis was assessed by quantitative coronary angiography (QCA) at index procedure and at control angiography. Restenosis (>50%) occurred in 5 patients (8.2%). Target vessel revascularization was performed in an additional 4 patients. Minimal intimal hyperplasia was observed in all segments covered by DES (late loss 0.08+/-0.37 mm, loss index 0.11+/-0.47). One patient suffered from subacute stent thrombosis due to discontinuation of clopidogrel medication. At six month follow-up two patients had died. Death was not related to a restenosis in the treated segment. Conclusion Our experiences with DES treatment of ISR lesions show good angiographic and clinical results at index procedure and at the 6 month follow-up with low sub acute thrombosis rate as compared with existing treatment modalities. Restenosis rate seems to be at least as low as reported for brachytherapy.</p>","PeriodicalId":23757,"journal":{"name":"Zeitschrift fur Kardiologie","volume":"94 11","pages":"742-7"},"PeriodicalIF":0.0,"publicationDate":"2005-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00392-005-0298-y","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25677928","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":"Female patient with proximal myotonic myopathy and ventricular tachycardia.","authors":"S Schenk,&nbsp;S Löscher,&nbsp;F Mickley,&nbsp;A Hartmann","doi":"10.1007/s00392-005-0281-7","DOIUrl":"https://doi.org/10.1007/s00392-005-0281-7","url":null,"abstract":"<p><p>A 68-year-old woman with known proximal myotonic myopathy was transferred to our hospital for further diagnostic and therapeutic evaluation after successful termination of an episode of sustained ventricular tachycardia. In 2001, the myopathy was diagnosed after symptomatic weakness of the hip flexors. A cardiomyopathy with slight reduction of systolic left ventricular function was found in 2002. Coronary angiography excluded relevant coronary artery disease. The electrophysiologic examination could provoke atrial flutter, but neither a ventricular tachycardia nor a delay in the AV conduction was found. ECG and Holter ECG did not reveal any abnormalities. A reduction of the left ventricular systolic function (EF 45%) with normal size of cardiac chambers was demonstrated by echocardiography. It is known that in the patient group with myotonic dystrophies cardiac involvement manifests itself as cardiomyopathy, conduction disturbance or arrhythmia. However, only a small percentage of all patients with myotonic myopathy actually suffer from cardiac involvement. Among the different types of cardiac involvement, conduction disturbances requiring pacemaker implantation are most frequent. Only some patients develop ventricular tachycardias, and even cases of sudden cardiac death have been described. As a result of the case reports in the literature and the findings in our patient an ICD system was implanted on March 4, 2004.</p>","PeriodicalId":23757,"journal":{"name":"Zeitschrift fur Kardiologie","volume":"94 11","pages":"754-60"},"PeriodicalIF":0.0,"publicationDate":"2005-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00392-005-0281-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25677930","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":"Near syncope while chewing food.","authors":"J Herold,&nbsp;R C Braun-Dullaeus,&nbsp;R H Strasser","doi":"10.1007/s00392-005-0292-4","DOIUrl":"https://doi.org/10.1007/s00392-005-0292-4","url":null,"abstract":"","PeriodicalId":23757,"journal":{"name":"Zeitschrift fur Kardiologie","volume":"94 11","pages":"740-1"},"PeriodicalIF":0.0,"publicationDate":"2005-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00392-005-0292-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25686584","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":"Hypereosinophilic syndrome associated with acute necrotizing myocarditis and cardiomyopathy.","authors":"M Huntgeburth,&nbsp;M Lindner,&nbsp;J W U Fries,&nbsp;U C Hoppe","doi":"10.1007/s00392-005-0288-0","DOIUrl":"https://doi.org/10.1007/s00392-005-0288-0","url":null,"abstract":"<p><p>We report the rare case of a 55-year-old female with massive eosinophilic myocarditis and severe, however reversible, impairment of left ventricular function. The patient presented with reduced physical condition, progressive dyspnea on exertion and peripheral edema. The white blood count revealed a leukocytosis and markedly elevated peripheral blood eosinophilics (48.8%). An endomyocardial biopsy demonstrated massive myocardial infiltration with eosinophilic granulocytes and necrosis. The symptoms and laboratory parameters indicate the presence of a hypereosinophilic syndrome. The differential diagnosis of a Churg-Strauss syndrome is discussed. Medical heart failure treatment according to international guidelines and an immunosuppressive treatment with prednisolone (Decortin H) 1.5 mg/kgBW) were initiated. This therapy led to a dramatic reduction of the eosinophilic granulocyte count and normalization of the peripheral blood count, which correlated with a significant improvement of clinical symptoms. Consistently, an increase of left-ventricular function was observed. Upon successive dose reduction to a maintenance dosage of 10 mg prednisolone, the patient's clinical status and peripheral blood count remained stable.</p>","PeriodicalId":23757,"journal":{"name":"Zeitschrift fur Kardiologie","volume":"94 11","pages":"761-6"},"PeriodicalIF":0.0,"publicationDate":"2005-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00392-005-0288-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25677931","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":"The heart in muscular dystrophies.","authors":"J Finsterer,&nbsp;Claudia Stöllberger","doi":"10.1007/s00392-005-0297-z","DOIUrl":"https://doi.org/10.1007/s00392-005-0297-z","url":null,"abstract":"","PeriodicalId":23757,"journal":{"name":"Zeitschrift fur Kardiologie","volume":"94 11","pages":"791-2"},"PeriodicalIF":0.0,"publicationDate":"2005-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00392-005-0297-z","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25677933","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":"Risk stratification models fail to predict hospital costs of cardiac surgery patients.","authors":"K Hekmat,&nbsp;A Raabe,&nbsp;A Kroener,&nbsp;U Fischer,&nbsp;M Suedkamp,&nbsp;H-J Geissler,&nbsp;R H Schwinger,&nbsp;S Kampe,&nbsp;U Mehlhorn","doi":"10.1007/s00392-005-0300-8","DOIUrl":"https://doi.org/10.1007/s00392-005-0300-8","url":null,"abstract":"<p><strong>Background: </strong>The aim of this prospective study was to determine if commonly used risk stratification models can predict total hospital costs in cardiac surgical patients.</p><p><strong>Methods: </strong>Between October 1st and December 31st 2003, all consecutive adult patients undergoing cardiac surgery on CPB at our institution were classified using seven risk stratification scoring systems: EuroSCORE, Cleveland, Parsonnet, Ontario, French, Pons, and CABDEAL. Total hospital costs for each patient were calculated on a daily basis including preoperative diagnostic tests, operating room costs, disposable materials, drugs, blood components, costs for personnel, and hospital fixed-costs. Linear regression analysis was used to determine the correlation between costs and the seven risk stratifications models as well as length of stay (LOS) on ICU. The Spearman correlation coefficient was calculated from the regression line, and an analysis of residuals was performed to determine the quality of the regression.</p><p><strong>Results: </strong>A total of 252 patients were operated for CABG (n=175), valve (n=39), CABG plus valve (n=21), thoracic aorta (n=13) and miscellaneous (2 myxoma, 1 ASD, 1 pulmonary embolism). Mean age of the patients was 66.0+/-11.4 years, 29.4% were female. LOS on ICU was 3.3+/-6.3 days and the 30-day mortality rate was 6.7%. Spearman correlation between the seven risk stratification models and hospital costs was below r=0.32 (p=0.0001), but was r=0.94 (p=0.0001) between ICU LOS and costs.</p><p><strong>Conclusions: </strong>Total hospital costs can be identified by length of ICU stay. None of the common risk stratification models accurately predicted total hospital costs in cardiac surgical patients.</p>","PeriodicalId":23757,"journal":{"name":"Zeitschrift fur Kardiologie","volume":"94 11","pages":"748-53"},"PeriodicalIF":0.0,"publicationDate":"2005-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00392-005-0300-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25677929","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":"Impedance cardiography and beat-to-beat blood pressure monitoring in diagnosis of syncope in long-QT syndrome.","authors":"R Dalla Pozza,&nbsp;A Kleinmann,&nbsp;S Bechtold,&nbsp;H Netz","doi":"10.1007/s00392-005-0290-6","DOIUrl":"https://doi.org/10.1007/s00392-005-0290-6","url":null,"abstract":"<p><p>Syncope represents a diagnostic challenge in patients affected by long-QT syndrome (LQTS). It is crucial for the therapeutic decision to distinguish between potentially life-threatening ventricular tachycardias (Torsadede-pointes) and-especially during adolescence-neurocardiogenic syncopes. This case report presents a patient with LQTS2 (mutation in the HERG gene) on medication with beta-blocker, in whom a head-up-tilt table test was performed after syncope of unknown origin. The test was chosen in order to reproduce the circumstances under which the syncope had happened. The monitoring device consisted of impedance cardiography as well as non-invasive beat-to-beat blood-pressure measurement. By these means it was possible to register a reduced peripheral vascular resistance after tilting the patient, a reduced cardiac output and bradycardia leading to syncope after four minutes of upright posture. This was suggestive for neurocardiogenic syncope as a cause for the spell experienced. Further non-invasive diagnostic methods were normal. As the patient's family history was negative for syncopes, Torsade-de-pointes seemed unlikely.In this special case the non-invasive monitoring system of cardiac output, peripheral vascular resistance and beat-to-beat blood pressure measurements was useful as a supplemental tool during evaluation of syncope and helpful in decision-making against implantation of an ICD and for a more intense treatment with betablockers. Such monitoring devices offer new insights into the orthostatic regulation in young patients.</p>","PeriodicalId":23757,"journal":{"name":"Zeitschrift fur Kardiologie","volume":"94 11","pages":"767-71"},"PeriodicalIF":0.0,"publicationDate":"2005-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00392-005-0290-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25677932","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":"Current understanding of coronary in-stent restenosis. Pathophysiology, clinical presentation, diagnostic work-up, and management.","authors":"T M Schiele","doi":"10.1007/s00392-005-0299-x","DOIUrl":"https://doi.org/10.1007/s00392-005-0299-x","url":null,"abstract":"<p><p>In-stent restenosis is the limiting entity following coronary stent implantation. It is associated with significant morbidity and cost and thus represents a major clinical and economical problem. Worldwide, approximately 250 000 in-stent restenotic lesions per year have to be dealt with. The pathophysiology of instent restenosis is multifactorial and comprises inflammation, smooth muscle cell migration and proliferation and extracellular matrix formation, all mediated by distinct molecular pathways. Instent restenosis has been recognised as very difficult to manage, with a repeat restenosis rate of 50% regardless of the mechanical angioplasty device used. Much more favourable results were reported for the adjunctive irradiation of the in-stent restenotic lesion, with a consistent reduction of the incidence of repeat in-stent restenosis by 50%. Data from the first clinical trials on drug-eluting stents for the treatment of in-stent restenosis have shown very much promise yielding this strategy likely to become the treatment of choice. This review outlines the histological and molecular findings of the pathophysiology, the epidemiology, the predictors and the diagnostic work-up of in-stent restenosis and puts emphasis on the various treatment options for its prevention and therapy.</p>","PeriodicalId":23757,"journal":{"name":"Zeitschrift fur Kardiologie","volume":"94 11","pages":"772-90"},"PeriodicalIF":0.0,"publicationDate":"2005-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00392-005-0299-x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25677935","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":"Hypertriglyceridemia-why, when and how should it be treated?","authors":"I Gouni-Berthold,&nbsp;W Krone","doi":"10.1007/s00392-005-0295-1","DOIUrl":"https://doi.org/10.1007/s00392-005-0295-1","url":null,"abstract":"<p><p>The relationship between serum triglyceride levels and cardiovascular disease has remained enigmatic despite four decades of research. The majority of the available evidence tends to support the role of hypertriglyceridemia as an independent risk factor for cardiovascular disease. However, there are no guidelines recommending a target triglyceride level for prevention of cardiovascular disease. The focus of lipid lowering therapy still remains the reduction of global cardiovascular risk by optimizing LDL cholesterol levels. Therapeutic options for triglyceride-lowering include lifestyle modification and pharmacological agents, such as fibrates, omega 3 fatty acids and niacin. Post-hoc analyses of the Helsinki Heart Study, Veterans Affairs High-Density Lipoprotein Cholesterol Intervention Trial and Bezafibrate Infarction Prevention Study suggest a beneficial effect of the treatment of hypertriglyceridemia with fibrates, mainly in obese subjects with insulin resistance. However, in order to establish the actual clinical relevance of lowering triglyceride levels, prospective trials need to be conducted with the specific purpose of studying the effects of triglyceride reduction on clinical end points, i. e. coronary events and stroke.</p>","PeriodicalId":23757,"journal":{"name":"Zeitschrift fur Kardiologie","volume":"94 11","pages":"731-9"},"PeriodicalIF":0.0,"publicationDate":"2005-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00392-005-0295-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25686585","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}