Zeitschrift fur Kardiologie最新文献

{"title":"Heart failure and statins--why do we need a clinical trial?","authors":"M Böhm,&nbsp;A Hjalmarson,&nbsp;J Kjekshus,&nbsp;U Laufs,&nbsp;J McMurray,&nbsp;D J van Veldhuisen","doi":"10.1007/s00392-005-0210-9","DOIUrl":"https://doi.org/10.1007/s00392-005-0210-9","url":null,"abstract":"<p><p>The effect of statins to reduce mortality and morbidity in primary and secondary prevention as well as in acute coronary syndrome is well established. Recent data show that pleiotropic effects might also have direct effects on the myocardial cell. However, in chronic heart failure the outcome is inversely related to LDL-plasma concentrations and other pleiotropic effects might impair mitochondrial function. Since there are no safety data on the use of statins in chronic heart failure, a controlled randomized and placebo-controlled trial is urgently needed.</p>","PeriodicalId":23757,"journal":{"name":"Zeitschrift fur Kardiologie","volume":"94 4","pages":"223-30"},"PeriodicalIF":0.0,"publicationDate":"2005-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00392-005-0210-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25206298","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":"N-Terminal-proBNP (NT-proBNP) as an indicator of cardiac dysfunction. A study in patients presenting with suspected cardiac disorders.","authors":"G Hess,&nbsp;J Moecks,&nbsp;D Zdunek","doi":"10.1007/s00392-005-0205-6","DOIUrl":"https://doi.org/10.1007/s00392-005-0205-6","url":null,"abstract":"<p><strong>Background: </strong>Natriuretic peptides represent a novel diagnostic tool in the assessment of cardiac dysfunction.</p><p><strong>Methods: </strong>A total of 473 consecutive referred patients presenting to 18 cardiologists for the assessment of their cardiac state were recruited for the study. Patients received a medical history, a physical examination an electrocardiogram and an echocardiogram where left ventricular ejection fraction was recorded.</p><p><strong>Results: </strong>NT-proBNP was found to correlate with left ventricular ejection fraction (LVEF), level of symptoms (NYHA classification), history of angina pectoris (AP) and myocardial infarction (AMI). Atrial fibrillation (AF) and thyroid dysfunction as well as renal impairment were shown to influence NT-proBNP levels.</p><p><strong>Conclusion: </strong>The study supports the hypothesis that NT-proBNP determination contributes to the assessment of patients presenting to cardiologists.</p>","PeriodicalId":23757,"journal":{"name":"Zeitschrift fur Kardiologie","volume":"94 4","pages":"247-54"},"PeriodicalIF":0.0,"publicationDate":"2005-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00392-005-0205-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25206300","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":"Early time course of neointima formation and vascular remodelling following percutaneous coronary intervention and vascular brachytherapy of in-stent restenotic lesions as assessed by intravascular ultrasound analysis.","authors":"A Zimmermann,&nbsp;B Pöllinger,&nbsp;J Rieber,&nbsp;A König,&nbsp;I Erhard,&nbsp;F Krötz,&nbsp;H-Y Sohn,&nbsp;R Kantlehner,&nbsp;W Haimerl,&nbsp;E Dühmke,&nbsp;M Leibig,&nbsp;K Theisen,&nbsp;V Klauss,&nbsp;T M Schiele","doi":"10.1007/s00392-005-0204-7","DOIUrl":"https://doi.org/10.1007/s00392-005-0204-7","url":null,"abstract":"<p><p>In-stent restenosis (ISR) represents the major limitation of stent implantation. Treatment, although of relative technical ease, is unsatisfactory due to a high incidence of recurrent restenosis. Vascular brachytherapy (VBT) has emerged as a powerful adjunct therapeutic modality to treat ISR. Inhibition of neointima formation has been regarded as the relevant mechanism of action. Yet, positive remodelling has been suspected as another contributing factor. Since only very few precise analyses of the extent, distribution and time course of the respective mechanims exist, the goal of the present study was to describe the changes of the vessel geometry at the target lesion and at the reference site following angioplasty and VBT of ISR in 42 patients by means of quantitative coronary angiography (QCA) and intravascular ultrasound (IVUS) before and after the index procedure and at the 3 and 6 month follow-up. By QCA the acute lumen gain measured 2.2+/-0.8 mm, the late lumen loss at 3 months was 0.1+/-0.5 mm and at 6 months 0.4+/-0.7 mm. By IVUS luminal cross-sectional area increased from 1.5+/-1.2 mm(2) to 7.9+/-1.9 mm(2) (p<0.001). The intima hyperplasia cross-sectional area at 3 months was only 0.2+/-1.0 mm(2) (p=0.191), but increased to 0.7+/-0.6 mm(2) (p<0.001) at 6 months resulting in a lumen cross-sectional area of 7.1+/-1.7 mm(2). Stent dimensions did not show any significant changes over time. The external elastic membrane cross-sectional area at 3 months increased by 1.3+/-1.9 mm(2) (p<0.001), and showed a further increase by 0.7+/-2.9 mm(2) at 6 months. Positive remodelling could be demonstrated also at the reference segment. In conclusion the absolute amount of intima hyperplasia during a 6-month follow-up period after VBT of ISR is low and most pronounced between the third and sixth month. Besides this, predominantly within the first 3 months of follow-up, significant positive remodelling could be demonstrated at the target lesion and at the reference site. Both observed effects may contribute to the preservation of the vessel lumen.</p>","PeriodicalId":23757,"journal":{"name":"Zeitschrift fur Kardiologie","volume":"94 4","pages":"239-46"},"PeriodicalIF":0.0,"publicationDate":"2005-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00392-005-0204-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25206299","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 relationship between hospital or operator volume and outcomes of coronary patients undergoing percutaneous coronary interventions.","authors":"A Dibra,&nbsp;A Kastrati,&nbsp;H Schühlen,&nbsp;A Schömig","doi":"10.1007/s00392-005-0206-5","DOIUrl":"https://doi.org/10.1007/s00392-005-0206-5","url":null,"abstract":"<p><p>The relationship between volume and outcome in medicine has been intensively investigated in the last few decades. The large amount of accumulated data demonstrates that for many surgical or non-surgical procedures and medical conditions, patients being treated in high-volume hospitals or by high-volume physicians have lower mortality rates and better quality of life compared to those treated by low-volume hospitals or by low-volume physicians. Although the degree of the relationship between high volume and better outcome varies, it is persistent across a wide range of procedures and conditions. Percutaneous coronary interventions (PCIs) have an important impact on public health, given the frequency of coronary heart disease for which these procedures are performed. Studies carried out before and after the advent of stents on the relationship between volume and outcome for PCIs have almost consistently reported that performance of PCIs in high-volume institutions or by high-volume operators is associated with improved outcomes for patients, regardless of the specific indication for PCI. For those procedures for which a relationship between high volume and better outcome has been clearly demonstrated, patients as well as their referring physicians should be informed that patients can benefit both in terms of reduced mortality and improved quality of life if they are treated by high-volume health care providers. Consequently, for these procedures, a health care policy aiming at their concentration in high-volume institutions should be strongly considered.</p>","PeriodicalId":23757,"journal":{"name":"Zeitschrift fur Kardiologie","volume":"94 4","pages":"231-8"},"PeriodicalIF":0.0,"publicationDate":"2005-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00392-005-0206-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25206297","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":"Cardiac risk of coronary patients after reintegration into occupations with heavy physical exertion.","authors":"R Wolf,&nbsp;F Habel,&nbsp;M Heiermann,&nbsp;R Jäkel,&nbsp;R Sinn","doi":"10.1007/s00392-005-0209-2","DOIUrl":"https://doi.org/10.1007/s00392-005-0209-2","url":null,"abstract":"<p><p>The job related reintegration of patients with coronary artery disease (CAD) is a central part of cardiac rehabilitation. However, specific occupational demands like jobs with heavy physical exertion (> 6 METs) could increase the cardiovascular risk because the relative risk for acute myocardial infarction (MI) and cardiac death is temporarily elevated after vigorous exertion (\"hazard period\"). Thus, in 2001 any male patient with proven CAD who performed a job with heavy exertion until the occurrence of an index event (MI/ACS, any interventional or surgical revascularization measure) received a questionnaire after an average of 20 months. Complete data were available in 108 from 119 included patients (90.8%), aged 51.8+/-7.8 years. Ejection fraction was 61.5+/-13.1% and the functional capacity at the time of hospital discharge averaged 130.1+/-31.2 W. 75% of the patients had a previous MI and 59.3% underwent bypass surgery. During follow-up the previous job with heavy exertion was performed over a cumulated time of 74 years. The aim of the study was to compare the observed and the expected incidence of MI and cardiac death with and without job performance. The expected (\"basal\") risk for MI and cardiac death without heavy physical exertion was determined from pooled study results and assumed to be 5.2% per year. The combined risk due to performing an occupation with strenuous exertion can be calculated from time periods with and without working hours and amounts to 11.9%. There could be expected 0.119 . 74=8.8 cardiac events related to the job. In contrast, 5 MIs (4 NSTEMI, 1 STEMI) were observed (6.8%). The relative risk for an expected event compared to the basal risk without heavy exertion was 2.3 (95% CI: 0.7-7.4). The relative risk for the observed cardiac events amounts to 1.3 (95% CI: 0.4-4.8). The lower observed risk is probably due to the high grade of physical fitness in this patient group. In spite of several limitations, our study showed no convincing evidence for increasing the cardiac risk of patients with CAD performing occupations with heavy physical exertion. Because of the importance of this prognostic finding, a representative and prospective study is strongly required.</p>","PeriodicalId":23757,"journal":{"name":"Zeitschrift fur Kardiologie","volume":"94 4","pages":"265-73"},"PeriodicalIF":0.0,"publicationDate":"2005-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00392-005-0209-2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25205630","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":"Carotid artery stenting in clinical practice results from the Carotid Artery Stenting (CAS)-registry of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausarzte (ALKK).","authors":"R Zahn,&nbsp;E Roth,&nbsp;T Ischinger,&nbsp;B Mark,&nbsp;M Hochadel,&nbsp;U Zeymer,&nbsp;K Haerten,&nbsp;K E Hauptmann,&nbsp;E-R von Leitner,&nbsp;A Schramm,&nbsp;W Kasper,&nbsp;J Senges","doi":"10.1007/s00392-005-0195-4","DOIUrl":"https://doi.org/10.1007/s00392-005-0195-4","url":null,"abstract":"<p><strong>Background: </strong>Carotid artery stenting (CAS) for symptomatic and asymptomatic carotid stenosis seems to be on the doorstep of more widespread use. However, its feasibility and safety in clinical practice at a broad spectrum of hospitals needs to be determined.</p><p><strong>Methods: </strong>We analyzed data of the prospective multi-centre Carotid Artery Stenting (CAS) Registry of the German Arbeitsgemeinschaft Leitende Kardiologische Krankenhausarzte (ALKK).</p><p><strong>Results: </strong>From 7/1996 to 5/2004 1888 patients from 28 hospitals were included in the CAS Registry. The median hospital stay from CAS until hospital discharge was 3 days (quartiles: 2-6 days). Median patients age was 70 years (quartiles: 64-76 years) with 72.1% males. CAS for symptomatic stenosis was performed in 55% of cases. Patients treated with CAS suffered from coronary artery disease in 66.5%, had arterial hypertension in 91.7%, hyperlipidemia in 86.3% and 34.2% were diabetics. The intended CAS procedure was completed in 98.1% of cases. A stent was implanted in 97.3% of completed cases. The median intervention time was 43 min (quartiles: 30-60 min). During the hospital stay death rate was 0.3% (5/1888) and the rate of ipsilateral stroke 3.2% (58/1840). A contralateral ischemic event occurred in 1.4% (26/ 1840) of patients. The combined rate of all death or strokes was 3.8% (70/1841). Between 1996 and 2004 there was a steady increase in the use of protection devices during CAS (0% in 1996 and 97.9% in 2004; p for trend <0.0001). There was also an increase in the proportion of patients treated for asymptomatic stenoses (p for trend <0.0001). We observed a decrease of the combined endpoint of death or stroke from 6.3% in 1996 to 1.9% in 2004 (p for trend=0.021).</p><p><strong>Conclusion: </strong>The multi-centre ALKK CAS Registry data confirm the feasibility and shot-term safety of CAS even in daily clinical practice. There was a rapid penetration of the use of embolic protection devices, an increase in treatment of asymptomatic carotid stenoses and a decrease in acute complication rates from 1996 to 2004.</p>","PeriodicalId":23757,"journal":{"name":"Zeitschrift fur Kardiologie","volume":"94 3","pages":"163-72"},"PeriodicalIF":0.0,"publicationDate":"2005-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00392-005-0195-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25155941","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":"Self-management of oral anticoagulation in nonvalvular atrial fibrillation (SMAAF study).","authors":"H Völler,&nbsp;J Glatz,&nbsp;U Taborski,&nbsp;A Bernardo,&nbsp;C Dovifat,&nbsp;K Heidinger","doi":"10.1007/s00392-005-0199-0","DOIUrl":"https://doi.org/10.1007/s00392-005-0199-0","url":null,"abstract":"<p><strong>Unlabelled: </strong>Most patients with atrial fibrillation are at risk of suffering thromboembolic events. This risk can be reduced by twothirds by efficient anticoagulation. This prospective multi-center trial investigated whether the quality of treatment can be improved by self-management in patients with atrial fibrillations (SMAAF Study) compared to conventional patient management by the family doctor.</p><p><strong>Methods: </strong>Two thousand patients suitable for self-management were to be randomized into the two arms of the study. In the period of investigation from December 1999 to July 2001, only 202 patients (64.3+/-9.2 years, 69.3% men) consented to participate. The study was discontinued prematurely since the number of patients was too low. As a consequence, the group comparison is confined to the evaluation of the INR values measured using the two-tailed t test.</p><p><strong>Results: </strong>Of the 202 patients included, 101 were assigned to the self-management group (64.6+/-9.6 years, 71.4% men) and 101 (64.1+/-8.9 years, 61.4% men, n.s.) were assigned to the group managed by the family doctor. The total number of INR measurements was 2 865. This comprised 2 072 measurements in patients under self-management and 793 in the family doctor group. The values were within the target range significantly more frequently (p=0.0061) in patients under self-management (67.8%) as compared to the family doctor group (58.5%). There was a trend with regard to the time within target range, but the difference was not significant (178.8+/-126 days as compared to 155.9+/-118.4 days). In the self-management group, there were two severe hemorrhages, and there was one thromboembolic event in the family doctor group.</p><p><strong>Conclusion: </strong>Management of oral anticoagulation by INR self-management in patients with atrial fibrillation is not inferior to conventional care.</p>","PeriodicalId":23757,"journal":{"name":"Zeitschrift fur Kardiologie","volume":"94 3","pages":"182-6"},"PeriodicalIF":0.0,"publicationDate":"2005-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00392-005-0199-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25155943","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":"Radiofrequency ablation of accessory pathways. Contemporary success rates and complications in 323 patients.","authors":"R Kobza,&nbsp;H Kottkamp,&nbsp;C Piorkowski,&nbsp;H Tanner,&nbsp;P Schirdewahn,&nbsp;A Dorszewski,&nbsp;U Wetzel,&nbsp;J-H Gerds-Li,&nbsp;A Arya,&nbsp;G Hindricks","doi":"10.1007/s00392-005-0202-9","DOIUrl":"https://doi.org/10.1007/s00392-005-0202-9","url":null,"abstract":"<p><strong>Introduction: </strong>17 years ago the first radiofrequency catheter ablation of an accessory pathway (AP) was performed. The aim of this study was to describe the contemporary success rates and procedure related complication rates of radiofrequency (RF) ablation of accessory pathways (APs). In addition, the present study describes the anatomical distribution of APs according to the new nomenclature introduced by NASPE and ESC in 1999.</p><p><strong>Methods: </strong>The analysis included all patients, who underwent RF ablation of an AP in the Heart Center Leipzig between January 2000 and December 2003.</p><p><strong>Results: </strong>Over a 4 year period 336 APs were ablated in 323 patients. 201 APs (60%) presented with antegrade and retrograde conduction and showed preexcitation on ECG. For the remaining 135 APs (40%), only retrograde conduction over the AP was documented. According to the new nomenclature APs were classified as left-sided, right sided, septal and paraseptal APs. 188 APs (56%) were located on the left, 41 (12%) on the right, 64 (19%) in the paraseptal space and 31 APs (9%) presented with a septal or parahisian localization, respectively. Because of atypical course and/or characteristics 12 APs (4%) could not be classified. Ablation of all pathways were successful in 315 patients (98%). In 289 patients (89%) success was achieved within a single ablation session. The left-sided pathways had a re-intervention rate of 5%, which was significantly lower compared to the remaining localizations. The highest re-intervention rate was observed in the septal APs (23%). Complications were observed in less than 2% of all treated patients.</p><p><strong>Conclusions: </strong>17 years after the first RF catheter ablation of an AP this therapy is established as a highly effective procedure. The success rate has improved to 98% and the complication rate has been minimized to less than 2%. The most frequent localization of APs is left posterior. Left sided APs also presented with the lowest re-intervention rate. The introduction of the new nomenclature in 1999 by NASPE and ESC has simplified the description of the exact anatomical localization of an AP.</p>","PeriodicalId":23757,"journal":{"name":"Zeitschrift fur Kardiologie","volume":"94 3","pages":"193-9"},"PeriodicalIF":0.0,"publicationDate":"2005-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00392-005-0202-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25155945","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":"[First diagnosis of Fallot tetralogy in a 74-year-old man].","authors":"H Bielik,&nbsp;M-A Ohlow,&nbsp;B Hügl,&nbsp;K Reinig,&nbsp;R Gröger,&nbsp;B Lauer","doi":"10.1007/s00392-005-0203-8","DOIUrl":"https://doi.org/10.1007/s00392-005-0203-8","url":null,"abstract":"<p><p>Tetralogy of Fallot is the most common cyanotic cardiac malformation in late childhood and adult, occurring in approximately 0.25 of 1000 live births. Most patients undergo early surgical correction. Therefore, the natural history of this disease has been evaluated in only a few cases. We report a complex case of a tetralogy of Fallot, who reached the age of 74 years without surgical or medical treatment and who was transferred to our clinic after syncope due to ventricular tachycardia.</p>","PeriodicalId":23757,"journal":{"name":"Zeitschrift fur Kardiologie","volume":"94 3","pages":"205-10"},"PeriodicalIF":0.0,"publicationDate":"2005-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00392-005-0203-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24988981","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 first coronary angioplasties in Germany.","authors":"M Kaltenbach","doi":"10.1007/s00392-005-0201-x","DOIUrl":"https://doi.org/10.1007/s00392-005-0201-x","url":null,"abstract":"","PeriodicalId":23757,"journal":{"name":"Zeitschrift fur Kardiologie","volume":"94 3","pages":"152-62"},"PeriodicalIF":0.0,"publicationDate":"2005-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00392-005-0201-x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25155940","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}