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Biomedical subjects

A Geibel

Publications and source records attributed to A Geibel.

At least 55 records · Page 3Linked to original sources
PubMed1991

Reproducibility of Doppler echocardiographic quantification of aortic and mitral valve stenoses: comparison between two echocardiography centers.

Doppler echocardiography has been widely used as a noninvasive method to quantify valvular heart diseases. This study assessed the variability between 2 echocardiography centers concerning 2-dimensional and Doppler echocardiographic results in the quantification of mitral and aortic valve stenoses. Forty-two patients were studied by 2 different echocardiography centers in a blinded, independent fashion. In patients with aortic and mitral valve stenosis, mean and maximal flow velocities were measured. The aortic valve orifice area was calculated according to the continuity equation. Mitral valve orifice area was determined by direct planimetry and by pressure half-time. In patients with an aortic valve stenosis, a close relation between the 2 centers was found for the maximal and mean flow velocities (coefficient of correlation, r = 0.72 to 0.92; coefficient of variation, 3.7 to 7.7%). A close correlation and a small observer variability was found for the flow velocity ratio determined by flow velocities measured in the left ventricular outflow tract and over the stenotic valve (r = 0.88; coefficient of variation, 0.01 +/- 0.009). In contrast, there was a poor correlation between the diameter of the left ventricular outflow tract and the aortic orifice area (r = 0.36 and 0.59, respectively). In patients with a mitral valve stenosis, mean and maximal velocities were closely correlated (r = 0.85 and 0.77, respectively). Velocities were not found to be significantly different between the 2 centers. Variability between the 2 centers for the mitral valve orifice area was 9.8% (2-dimensional echocardiography) and 5.7% (pressure half-time).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1991

Clinical and Doppler echocardiographic follow-up after percutaneous balloon valvuloplasty for aortic valve stenosis.

Percutaneous balloon valvuloplasty has been shown to increase the aortic orifice area and to improve clinical symptoms. However, there are only few data concerning long-term results after balloon valvuloplasty. In this study, 36 patients (11 men, 25 women, mean age 75 +/- 8 years) were followed after balloon valvuloplasty for a period of up to 18 months by means of clinical parameters and repeated Doppler echocardiographic measurements after 1, 3, 6, 12 and 18 months. Invasive measurements revealed a decrease of the systolic peak gradient from 78 +/- 24 to 38 +/- 13 mm Hg (p less than 0.001), and an increase in the aortic orifice area from 0.58 +/- 0.23 to 0.93 +/- 0.2 cm2 (p less than 0.001). The Doppler echocardiographic approach revealed that the maximal instantaneous gradient decreased from 96 +/- 26 to 67 +/- 22 mm Hg (p less than 0.001). The aortic orifice area increased from 0.49 +/- 0.16 to 0.73 +/- 0.21 cm2 (p less than 0.001). Three patients (8%) died in the hospital. After hospital discharge, 16 patients (44%) died and 8 patients (22%) underwent successful aortic valve replacement after a mean follow-up of 8 +/- 6 months. Nine patients (25%) were alive after a follow-up period of 18 months. Seven of these (19%) remained clinically improved. During follow-up, the Doppler echocardiographic results revealed a continuous trend toward the preprocedural severity of the aortic valve stenosis. Progression of restenosis assessed by Doppler echocardiographic measurements was accelerated in the group of patients who subsequently died or underwent repeat balloon valvuloplasty or aortic valve replacement.

Aged↗
PubMed1991

Efficacy and tolerance of the new class IB antiarrhythmic barucainide: an intravenous dose-finding study.

Barucainide is a new class IB antiarrhythmic agent that was studied for efficacy and safety after intravenous administration in patients with severe ventricular arrhythmias. All patients received 80 mg/hr barucainide intravenously for 7 hours or until ventricular arrhythmias were suppressed by greater than 90%. In responders a maintenance dose was given for 24 hours, aimed to achieve steady-state conditions. At baseline and during the treatment and washout periods 24-hour Holter recordings were performed. In addition, electrocardiogram, blood pressure, and plasma concentration of barucainide were measured. In 9 of 12 patients dose titration was effective (mean dose, 185 mg). In six of nine patients arrhythmia suppression persisted during maintenance therapy (mean dose, 18 mg/hr). Plasma concentrations correlated with given doses, rather than with antiarrhythmic efficacy. During the washout period, five patients required more than 12 hours for recurrence of arrhythmias. Treatment was stopped in one patient because of proarrhythmia; one patient had moderate heat sensations. Thus barucainide is a potent class IB agent, with a favorable side effect profile.

Anti-Arrhythmia Agents↗
PubMed1991

[Incidence of tricuspid valve prolapse].

The incidence of tricuspid valve prolapse and its association with mitral valve prolapse was studied in 100 patients with right- and left-ventricular angiography. Coronary artery disease was present in 81 patients (pts), a dilative cardiomyopathy in 6 pts, and a hypertrophic cardiomyopathy in 2 pts. 11 pts were angiographically normal. A total of 27 pts had a tricuspid valve prolapse, and 15 pts had a mitral valve prolapse. In 19 pts prolapse of the tricuspid valve was isolated, and in 8 pts it was associated with a mitral valve prolapse. The associated finding of a prolapse of the tricuspid and mitral valve was statistically significant (p less than 0.02). Patients with a tricuspid valve prolapse experienced a higher right-ventricular ejection fraction (58 + 10 vs 53 +/- 10%; p less than 0.05) and smaller end-systolic right ventricular volume indices (39 +/- 16 vs 47 +/- 17 ml/m2; p less than 0.05) compared to those without tricuspid valve prolapse. There was no further difference in clinical and hemodynamic parameters between those with and those without tricuspid valve prolapse. The clinical significance of a tricuspid valve prolapse is still undefined.

Adolescent↗
PubMed1990

Echocardiographic evaluation of patients with clinically suspected arterial emboli.

153 patients (mean age 42 years, range 16-60) who had arterial embolic events were examined prospectively by transthoracic and transoesophageal echocardiography. Patients older than 60 years and those with evidence of extracranial carotid artery occlusive disease were excluded. 84 patients had a cerebral ischaemic event, 50 patients had embolic events in an abdominal organ or limb, and 19 patients had acute retinal ischaemia. The transthoracic echocardiographic examination was normal in 92 patients (60%), whereas only 65 patients (42%) had normal findings after both transthoracic and transoesophageal examination (p less than 0.005). Intracardiac masses, including valvular vegetations, were found in 39 patients (25%), including 27% of patients with cerebral embolism and 32% of these with peripheral embolism, but in none of the patients with retinal ischaemia (p less than 0.001). 47 patients (31%) had valvular disease, 10 (7%) had wall motion abnormalities, 23 (15%) had abnormalities of the interatrial septum, and 9 patients (6%) had diseases of the thoracic aorta. Cardiovascular abnormalities were frequently found by echocardiography in patients with arterial emboli. The transesophageal technique significantly increased the chance of detecting such abnormalities, especially intracardiac masses.

Adolescent↗
PubMed1990

[The thrombolytic treatment of acute and subacute recurrent pulmonary embolism with recombinant tissue plasminogen activator].

Thrombolytic treatment with recombinant tissue plasminogen activator (rt-PA) at a dosage of 40-150 mg was given to five patients with acute and five with recurrent pulmonary emboli (three women and seven men; mean age 54 [30-78] years). Mean pulmonary artery pressure fell from 29 +/- 7 mm Hg before to 20 +/- 5 mm Hg after treatment (P = 0.001), and in recurrent emboli from 47 +/- 19 to 18 +/- 10 mm Hg (P = 0.01). Pulmonary vascular resistance fell from 546 +/- 262 to 318 +/- 116 dyn.s.cm-5 (P = 0.02) in the former group and from 993 +/- 583 to 377 +/- 438 dyn.s.cm-5 (P = 0.01) in the latter. Pulmonary arteriograms were assessed using the Miller index. This indicated a drop from an average of 23 points before to an average of 10.5 points after treatment. Mild bleedings occurred in all patients, but in two it was severe enough to require discontinuation of treatment. These results demonstrate that rt-PA is highly effective as a thrombolytic agent in acute and in subacute recurrent pulmonary embolism.

Acute Disease↗
PubMed1990

Incidence and clinical relevance of QT prolongation caused by the new selective serotonin antagonist ketanserin. Multicenter Ketanserin Research Group.

Efficacy and safety of ketanserin was studied prospectively in a randomized and double-blind trial involving 221 patients treated for hypertension and/or coronary artery disease. Since ketanserin has been suggested to cause QTc prolongation, we investigated the incidence and severity of this effect, as well as its influence on the incidence of malignant ventricular arrhythmias during Holter monitoring. After a 1-week run-in-period, all patients were examined, measuring blood pressure, electrocardiogram (ECG) and 24-hour Holter ECG. Two thirds of the patients (n = 147) were then randomized to ketanserin, 1 week 20 mg b.i.d. followed by 3 weeks 40 mg b.i.d.; one third of the patients (n = 74) received placebo b.i.d. for 4 weeks. After 4 weeks of treatment, blood pressure, ECG and 24-hour Holter ECG were performed. In hypertensive patients, ketanserin resulted in a significant reduction of systolic (mean reduction: -17 +/- 2 mm Hg; p less than 0.0001) and diastolic blood pressure (-12 +/- 1 mm Hg; p less than 0.0001) as compared to baseline, and to the placebo group (p less than 0.005 for systolic and diastolic blood pressure). The QTc interval was prolonged with ketanserin (mean value: 400 to 418 ms; p less than 0.01) but not with placebo (399 vs. 402 ms). In the ketanserin group 30% of patients and in the placebo group 8% of patients had QTc prolongation greater than 30 ms (p less than 0.01). QTc was not prolonged to greater than 500 ms in any patient. During Holter monitoring 128/147 patients (ketanserin group) and 61/74 patients (placebo group) had ventricular premature beats; in 42 (ketanserin group) and 13 patients (placebo group) ventricular pairs and tachycardia were documented. Incidence and severity of the ventricular arrhythmias after 4 weeks of treatment were not different between the ketanserin and placebo groups. No sustained ventricular tachycardia occurred in any patient after ketanserin treatment. Thus, though ketanserin prolonged QTc in one third of the patients, the drug was not arrhythmogenic or antiarrhythmic.

Aged↗
PubMed1990

[Transesophageal echocardiography in the assessment of the severity of aortic valve stenosis].

The aortic valve orifice area was measured in 95 patients with valvular aortic stenosis by means of transthoracic and transesophageal echocardiography. These results were compared to invasively determined measurements. The aortic-valve orifice area could be measured by transesophageal echocardiography in 87 patients (92%), and in 13 patients (14%) by the transthoracic approach. A comparison of the valve-orifice area determined by transthoracic and transesophageal echocardiography revealed a correlation coefficient of r = 0.91. There was also a good agreement when the aortic-valve orifice area determined by transesophageal echocardiography was compared to the invasive findings (r = 0.82; p less than 0.001). The morphology of the aortic valve could be better delineated with the transesophageal approach.

Adult↗
PubMed1990

[Transesophageal and Doppler ultrasound studies before and following percutaneous balloon valvuloplasty of the aortic valve].

Transesophageal and Doppler-echocardiography were performed in 25 patients with severe valvular aortic stenosis before and after percutaneous balloon valvuloplasty. The maximal systolic gradient over the aortic valve determined during invasive measurements before and after valvuloplasty decreased from 71 +/- 24 mm Hg to 36 +/- 14 mm Hg; the mean systolic gradient decreased from 53 +/- 18 mm Hg to 28 +/- 10 mm Hg. The aortic orifice area increased from 0.67 +/- 0.2 to 0.94 +/- 0.2 cm2. During transesophageal echocardiography the aortic orifice area was calculated by direct planimetry. The aortic valve area increased from 0.52 +/- 0.21 cm2 before the valvuloplasty to 0.72 +/- 0.17 cm2 after intervention. After valvuloplasty small thrombotic vegetations were observed in four patients and valvular lesions in two patients. Using Doppler-echocardiographic measurements to quantify the aortic valve stenosis the maximal instantaneous gradient decreased from 94 +/- 30 before valvuloplasty to 66 +/- 25 mm Hg after valvuloplasty; the mean instantaneous gradient changed from 52 +/- 17 to 37 +/- 14 mm Hg. The aortic orifice area increased from 0.5 +/- 016 to 0.76 +/- 0.21 cm2. These results confirm that transesophageal and Doppler-echocardiography are appropriate to control the success of percutaneous balloon valvuloplasty.

Aged↗
PubMed1990

[Predictive value of programmed electrostimulation in patients with spontaneous idiopathic ventricular tachycardia].

In contrast to patients with organic heart disease, there are only few data available on the incidence and type of inducible arrhythmias during programmed electrical stimulation (PES) in patients with spontaneous ventricular tachycardia (VT) but without evidence of underlying heart disease. Additionally, no consensus has been achieved in these patients on the most appropriate stimulation protocol required to reproduce the clinical arrhythmia. In a prospective study we analyzed in 40 patients without idiopathic VT, incidence and type of inducible VT, as well as the mode of initiation during a right ventricular PES protocol with 1-2 (part I) and three extrastimuli (part II). Twelve patients had spontaneous sustained monomorphic VT (group A), 28 patients were studied with spontaneous non-sustained VT (group B). During PES, a non-sustained polymorphic VT was induced in 3/12 patients (group A, 25%) and in 10/28 patients (group B, 36%); a non-sustained monomorphic VT was induced in 5/12 patients (group A, 41%) and in 4/28 patients (group B, 14%). In all 7/12 patients (59%) of group A with inducible sustained monomorphic VT, the arrhythmia was initiated with 1-2 extrastimuli. In group B, only 2/28 patients (7%) were induced to a sustained monomorphic VT. When the clinical arrhythmia was exercise-related, 5/6 patients (83%) in group A and 7/13 patients (54%) in group B were induced to a VT, while 2/6 patients (33%) in group A and 1/13 (8%) patients in group B were induced to a sustained monomorphic VT. Isoprenaline was not effective to increase the incidence of sustained monomorphic VT.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

[Transfemoral, transatrial double-balloon valvuloplasty of rheumatic mitral stenosis].

A percutaneous transfemoral, transatrial double-balloon valvuloplasty was performed on 21 patients (53 +/- 14 years) with rheumatic mitral stenosis. An open commissurotomy was performed in six patients, 20 +/- 9 years previously; in three patients an arterial embolism had occurred previously. Balloon valvuloplasty resulted in a reduction of the mean diastolic gradient from 16 +/- 7 to 8 +/- 3 mm Hg (p less than 0.001), and the mitral valve orifice area increased from 1.1 +/- 0.3 to 2.2 +/- 0.8 cm2 (p less than 0.001). Mitral insufficiency increased in three patients and was first observed after valvuloplasty in four patients. Complications were seen in three patients: a left ventricular perforation resulting in pericardial tamponade occurred in two patients, which required cardiothoracic intervention. In one patient a pulmonary embolism occurred five days after the invasive procedure. The study shows that percutaneous transfemoral balloon valvuloplasty can successfully be performed in patients with severe or even calcified mitral valve stenosis. The risk of severe complications is, however, not negligible.

Adult↗
PubMed1989

Incidence and clinical relevance of QT prolongation caused by the new selective serotonin antagonist ketanserin.

Efficacy and safety of ketanserin were studied prospectively in a randomized, double-blind trial involving 221 patients treated for hypertension or coronary artery disease, or both. Since ketanserin has been suggested to cause QTc prolongation, the incidence and severity of this effect were investigated, as was the incidence of malignant ventricular arrhythmias during Holter monitoring. After a 1-week run-in period, all patients were examined: blood pressure was measured and electrocardiograms and 24-hour Holter electrocardiograms were obtained. Two thirds of the patients (n = 147) were then randomized to receive ketanserin for 1 week (20 mg twice daily) followed by 3 weeks of 40 mg twice daily; one third of the patients (n = 74) received placebo (twice daily) for 4 weeks. After 4 weeks of treatment, blood pressure, electrocardiograms and 24-hour Holter electrocardiograms were repeated. In hypertensive patients, ketanserin significantly reduced systolic (mean reduction 17 +/- 2 mm Hg, p less than 0.0001) and diastolic blood pressure (12 +/- 1 mm Hg, p less than 0.0001) compared to baseline, and to the placebo group (p less than 0.005 for systolic and diastolic blood pressure). The QTc interval was prolonged with ketanserin (mean 400 to 418 ms, p less than 0.01) but not with placebo (399 vs 402 ms). In the ketanserin group 30% of patients and in the placebo group 8% of patients had QTc prolongation greater than 30 ms (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1989

Antiarrhythmic efficacy and tolerance of oral propafenone in patients with frequent ventricular arrhythmias: experience of a multicentre study.

In a multicentre study efficacy and safety of propafenone 450 mg day-1 and 750 mg day-1 was studied in 97 patients with frequent ventricular premature beats (VPB greater than 30 h-1). 70 patients suffered from organic heart disease, in 27 patients no organic heart disease was present during an initial work-up. After a 1-week washout period, all patients underwent 24 h Holter monitoring. Patients were then treated by propafenone 450 mg day-1 and controlled for 24 h Holter, ECG, blood pressure, blood chemistry and side-effects after 1 week of treatment. At this time, 35 patients were responders (reduction of VPB greater than 84%, of ventricular pairs greater than 90% and of ventricular tachycardia 100%). The mean reduction of VPB in all patients was 60%, of ventricular pairs 88% and of ventricular tachycardia 100%. When treatment was continued for 3 weeks 20/35 patients (56%) were still responders. The mean reduction of VPB was 83%. In 42 non-responders to 450 mg day-1 the dose was increased to 750 mg day-1. Of these patients, 17 (41%) became responders after 3 weeks of treatment; the mean reduction of VPB increased from 17% (first week, 450 mg day-1) to 63% (750 mg day-1). Ventricular pairs were reduced by 80%, ventricular tachycardia by 100%. Side-effects occurred in 11/97 patients and limited therapy in six patients. The most frequent complaints were dryness of the mouth, nausea, tiredness, headache and gastrointestinal upset. In conclusion, propafenone in a dose of 450-750 mg day-1 seems to be an effective and safe antiarrhythmic agent in the majority of patients.

Administration, Oral↗
PubMed1989

[Validation of a discontinuously recording, digital long-term ECG system (Siemens-Sirecust 802/850) using a single beat analysis].

Using beat-to-beat analysis we studied the annotation of 44 data-bases of the Massachusetts Institute of Technology (MIT) in comparison to the classification performed by a new microprocessor of a 24-h-ambulatory electrocardiographic device, which is based on real-time analysis and a solid-state ECG documentation. QRS detection was performed with an accuracy of 99%. Sensitivity and positive predictive accuracy were 70% and 87% for supraventricular ectopy. Using a fixed prematurity index of 80%, ventricular ectopy with a total of 7,845 beats was identified with a sensitivity of 64% and a positive predictive accuracy of 97%. With the additional consideration of late premature ventricular beats (PVB) sensitivity increased to 91% with a positive predictive accuracy of 96%. A sensitivity of more than 80% for singular PVB was achieved in 28/33 databases (85%), a similar positive accuracy was achieved in 27/33 databases (82%). Altogether, ventricular pairs and ventricular tachycardia resulted in a sensitivity of 83% and 76%, respectively, and in a positive predictive accuracy of 87% and 73%, respectively. Sensitivity exceeded 80% for ventricular pairs in 11/15 databases (77%) and for ventricular tachycardia in 10/14 databases (71%); similar results were observed for the positive predictive accuracy with 11/15 (73%) and 9/14 (64%) databases. In 42/44 databases and in all databases for arrhythmias of Lown class IVA and IVB, Lown classification was determined correctly. The Sirecust-Holter-ECG-system, a new device with real-time analysis and solid-state memory results in an accuracy for singular and complex ventricular arrhythmias, comparable to some of the presently available Holter systems.

Arrhythmias, Cardiac↗
PubMed1989

Electrophysiologic effects of enoximone in patients with congestive heart failure.

The electrophysiologic effects of enoximone were evaluated in 12 patients with idiopathic dilated cardiomyopathy undergoing routine programmed electrical stimulation (PES). Enoximone (1.5 mg/kg for 20 min followed by 0.75 mg/kg for 20 min) significantly shortened the spontaneous sinus cycle length as well as the atrial and ventricular refractory period. Neither during control PES nor during enoximone infusion were sustained ventricular arrhythmias provoked. However, in 5 of 12 patients, there was an increase in the number of repetitive ventricular responses induced by PES during enoximone administration. The observed electrophysiologic changes may be indicators for increased electrical instability of the myocardium in selected patients.

Adult↗
PubMed1989

[Echocardiography detection of reversible regional disorders of contraction in patients with unstable angina pectoris and Prinzmetal angina during an attack].

We studied seven patients with Prinzmetal's angina and three patients with unstable angina pectoris type III (according to the criteria of Conti) during and after a spontaneous attack of angina pectoris by two-dimensional echocardiography. All patients underwent coronary angiography. The echocardiographic studies were performed during the attack (phase I), immediately after the attack (phase II), and 24 h after the attack (control). Left ventricular ejection fraction was significantly decreased during the attack (38.1 +/- 11% vs 59.8 +/- 7%), while left ventricular end-diastolic volume was increased (71.9 +/- 28 ml/m2 vs 50.3 +/- 13 ml/m2). The double product of heart rate and systolic blood pressure was equal at the 3 different examination times. In all patients transient regional disturbances of left ventricular contraction could be observed. In six patients the wall motion disturbances had already disappeared at phase II, while in four patients hypokinetic regions could still be found. At control, nine patients showed a normal left ventricular contraction pattern, while one patient with previous anterior myocardial infarction showed a small region of anterior akinesia. In all patients coronary artery obstructions were found in the same region of the left ventricle, where transient wall motion abnormalities occurred. Thus, two-dimensional echocardiography performed during an attack of angina pectoris in patients with Prinzmetal's angina and unstable angina pectoris type III can evaluate the localization, as well as the extent of transient myocardial wall motion abnormalities.

Angina Pectoris↗
PubMed1989

[Echocardiography in the diagnosis of lung embolism].

In the Federal Republic of Germany, approximately 10,000 to 20,000 persons die of pulmonary embolism (PE) each year. The mortality of treated PE is about 8% as compared with 18 to 35% in nondiagnosed PE. Massive PE is detected in only about 15 to 30% of the patients while, on the other hand, in 30 to 80% of those in whom PE is suspected the pulmonary angiogram may be normal. On use of pulmonary ventilation-perfusion scintigraphy, in 30 to 40% of the cases, both false negative as well as false positive findings have been described. ROLE OF ECHOCARDIOGRAPHY IN PATIENTS WITH ACUTE PULMONARY EMBOLISM. With echocardiographic imaging, the right heart as well as the central vessels in the proximity of the heart, in particular the pulmonary arteries, can be visualized. In addition to direct detection of right-sided-intraluminal thrombi, echocardiographic diagnosis is based predominantly on indirect signs, such as evidence of an acute cor pulmonale with dilatation of the right atrium and ventricle, the central pulmonary vessels and the inferior vena cava which, however, are relatively unspecific and may also be found in the presence of other diseases. Echocardiographic changes in acute pulmonary embolism can only be expected in the presence of increased pressure in the pulmonary circulation, that is, when at least a 30%-reduction in the cross-sectional area of the pulmonary vascular bed can be found. This can be documented in 60 to 70% of patients with acute PE. According to the literature and our own studies, of a total of 284 patients 84% had dilatation of the right ventricle, 70% paradoxic or hypokinetic motion of the interventricular septum in 102/141 patients there was dilatation of the right pulmonary artery. These changes regressed rapidly after therapeutic intervention. In about 30% of the patients a reduction in the left ventricular dimensions can be seen. Paradoxic septum motion and a decrease in the closing amplitude (EF-slope) of the anterior mitral leaflet can be seen. The extent of dilatation of the right ventricle and the right pulmonary artery correlate with the extent of the angiographic severity of acute PE provided that there is no marked preexisting left ventricular function impairment. NONINVASIVE ESTIMATION OF THE PRESSURE INCREASE IN THE PULMONARY CIRCULATION. On use of Doppler echocardiography, most patients with acute cor pulmonale have tricuspid regurgitation. This enables through determination of the systolic RV-RA pressure gradient an estimation of the systolic right ventricular pressure and, accordingly, the pulmonary artery pressure. In our experience, a systolic acceleration time in the pulmonary artery of less than 90 to 95 ms is

Echocardiography↗