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Biomedical subjects

A Mangschau

Publications and source records attributed to A Mangschau.

At least 19 recordsLinked to original sources
PubMed2004

Long-term prognosis after out-of-hospital cardiac arrest and primary percutaneous coronary intervention.

AIMS: To study the long-term survival after out-of-hospital cardiac arrest and successful cardiopulmonary resuscitation (CPR) in patients with acute ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). MATERIAL AND METHODS: In-hospital and 2-year survival of 40 patients treated with primary PCI after out-of-hospital cardiac arrest and STEMI was compared with that of a reference group of 325 STEMI patients, without cardiac arrest, also treated with primary PCI in the same period. RESULTS: In the group with out-of-hospital cardiac arrest, both in-hospital and 2-year mortality was 27.5%. In the reference group, in-hospital and 2-year mortality was 4.9 and 7.1%, respectively. After discharge from hospital there was no significant difference in mortality between the groups. CONCLUSION: Long-term prognosis is good in selected patients after successful out-of-hospital CPR and STEMI treated with primary PCI.

Adult↗
PubMed2001

[Long-term follow-up of 100 patients with acute myocardial infarction treated with angioplasty].

BACKGROUND: There is little information available on long-term follow up of patients treated with primary angioplasty for acute myocardial infarction. MATERIAL AND METHODS: 100 consecutive patients with acute ST-elevation myocardial infarction and symptoms of less than six hours' duration were treated with primary angioplasty. Clinical examination was performed in 97 patients and exercise stress test in 74 patients 11-37 months (mean 20 months) later. Patients were observed for survival up to 48 months. RESULTS: 24 patients had been rehospitalized, 16 because of chest pain. 77 patients were treated with beta blocker, 83 with statins, and 95 with antithrombotic medication. 84 patients were in NYHA (New York's Heart Association's classification's) class I at follow-up examination. Three patients died. 11 patients had a serious event, reinfarction (n = 3) or need for revascularization (n = 8) during the first 13 months. Total cumulative mortality rates after one and three years were 3% (95% CI 1-8) and 11% (95% CI 6-19). INTERPRETATION: The good initial results in primary angioplasty are maintained in long-term follow-up. This is in accordance with reports from centres abroad.

Adult↗
PubMed2001

[Hundred patients with acute myocardial infarction treated with primary angioplasty].

BACKGROUND: Much attention has lately been focused on primary angioplasty in the treatment of acute myocardial infarction. This report describe our results in 100 patients. MATERIAL AND METHODS: 100 consecutive patients with acute ST elevation myocardial infarction and a history of less than six hours were treated with primary angioplasty. The mean time from start of symptoms until establishment of reperfusion of the infarct related artery was 224 minutes; "the door-to-balloon" time was 69 minutes. RESULTS: Angioplasty was successful in 95% of all patients. Mean ejection fraction measured before discharge in 71 patients was 56%. Hospital and 30-days' mortality was 1%. New revascularization was needed in 6%. Average observation period in the coronary care unit was 1.8 days; no patient needed treatment for ventricular arrhythmias after angioplasty. The first 24 hours 24% had symptomatic congestive heart failure, reduced to 11% at hospital discharge on day 6. Acute rehospitalization within the first 30 days was necessary in 7%, but only in 2% for chest pain. INTERPRETATION: Our results are comparable to those of other high volume centres and show well preserved ventricular function and low hospital and 30-days' morbidity and mortality.

Adult↗
PubMed2001

[Angiographic results of primary angioplasty in acute myocardial infarction].

BACKGROUND: Percutaneous angioplasty is an alternative to thrombolysis to reestablish coronary blood flow in patients with transmural myocardial infarction. At present, this treatment option is not widely accepted in Norway. MATERIAL AND METHODS: From 1996 to 1998, one hundred consecutive patients were treated with angioplasty for acute transmural infarction. The angiography showed one-vessel disease in 55%, two-vessel in 25%, and multivessel in 20%. The infarct related artery was the LAD in 44%, the CX in 14%, the RCA in 41%, and bypass graft in one. 92% had TIMI 0 or 1 flow. Stent was placed in 73%, GPIIb/IIIa was used in 11% and temporary pacemaker placed in 5%. RESULTS: Successful angioplasty was performed in 95%, 3% was not done, and 2% failed. Peripheral stenoses were treated in 15% and stenoses in other arteries in 10%. Complications and events within 24 hours related to the angioplasty were seen in 9%. CONCLUSION: Primary angioplasty for acute myocardial infarction can be done with high primary success, good short-term results and few complications.

Adult↗
PubMed2001

[New cardiac markers--clinical benefits in early diagnosis of acute heart disease].

BACKGROUND: New cardiac markers that may be analysed around the clock in emergency can now be performed in our hospitals with commercially available reagents and equipment. Upon the introduction of a new clinical biochemical regime based on these new markers for the diagnosis of acute coronary syndromes, we evaluated the clinical benefit achieved by the new set-up, especially with respect to early diagnosis. MATERIAL AND METHODS: cTroponinT, CK-MBmass, myoglobin and total-CKactivity were analysed in blood sample taken on admission, after 2-3 hours, and further once or twice over the next 24 hours in 300 patients admitted on suspicion of acute coronary syndromes (ACS). The study was based on results of the cardiac markers and information given on questionnaires by the physicians in charge. RESULTS: With the decision limits applied, CK-MB and myoglobin showed slightly higher sensitivity than cTroponinT for detecting acute myocardial infarction within the first 2-3 hours. cTroponinT showed the highest sensitivity for detecting heart muscle damage in patients with unstable angina. cTroponinT was the most cardiospecific marker. If the patient was considered not having ACS after the first few hours, only 3% ended with a diagnose of unstable angina and none with acute myocardial infarction. Of those considered certain ACS cases after the first few hours, 92% ended up with the diagnosis acute myocardial infarction or unstable angina. Treatment and/or supervision were changed in 68 of 220 patients based on the results of the two first blood samples, 85% of them to a lower level of supervision. INTERPRETATION: cTroponinT and CK-MB are useful markers for early detection of acute myocardial injuries. A prerequisite is that they are determined in two samples with an interval of at least two hours. In this case, myoglobin did not give additional information. Based on the results from two early blood samples, about one quarter of the patients could immediately be transferred to a less expensive level of care.

Adult↗
PubMed2001

Left ventricular function and infarct size 20 months after primary angioplasty for acute myocardial infarction.

OBJECTIVE: To study changes in left ventricular function and infarct size during long-term follow-up after acute myocardial infarction treated with primary angioplasty. DESIGN: From 1996 to 1998, 100 consecutive patients were treated with primary angioplasty for acute ST-elevation myocardial infarction. Angioplasty was successful in 95% of the patients. Global left ventricular ejection fraction (LVEF) was determined by radionuclide ventriculography before discharge, after 6 weeks and after a mean follow-up time of 20 months. Infarct size was assessed by technetium 99m-tetrofosmin myocardial perfusion tomography (SPECT) at rest, performed at the same time intervals. RESULTS: Mean LVEF was 56% at discharge, 55% after 6 weeks and 57% after 20 months of follow-up. No significant improvement in LVEF was observed. Only 8% of the patients at follow-up had LVEF lower than 40%. After 1 week, a mean perfusion defect of 19% was measured by SPECT. After 6 weeks and 20 months of follow-up, the mean perfusion defects were reduced to 14% (p < 0.001) and 15%, respectively. CONCLUSION: Left ventricular function was well preserved with a mean LVEF of 57% 20 months after primary angioplasty for acute myocardial infarction. No significant change in LVEF was observed from 1 week after angioplasty to follow-up. Infarct sizes as assessed by SPECT imaging with tetrofosmin were reduced from 1 to 6 weeks, but did not change further during long-term follow-up. The reduction in the perfusion defects over time was probably due to gradual relief of stunning.

Angioplasty, Balloon, Coronary↗
PubMed2000

[Troponins and other biochemical cardiac markers--time for a change].

BACKGROUND: During the last ten years new, more sensitive and specific cardiac markers in blood for detection of acute myocardial injuries have been characterised and clinically evaluated. Of practical importance is also the fact that rapid and robust methods and equipments suitable for emergency service have been developed. MATERIAL AND METHODS: Based on literature study and on own experiences we give a survey of the most promising cardiac markers with emphasis on the troponin T and troponin I. RESULTS: Methodological and pathobiochemical aspects are discussed. The diagnostic characteristics and advantages of the new markers are in focus, especially with respect to early detection of acute myocardial injuries. Finally, we discuss their potential use for stratification of patients with acute coronary syndromes with respect to optimal treatment, resource-saving monitoring, and more precise prognostication. INTERPRETATION: It is recommended that one of the troponins, either I or T, should be included in the diagnostic regime for detecting acute coronary syndromes in Norwegian hospitals. CKMB, determined as mass and not as activity, ought to be retained, at least until more clinical experience with the troponins have been gained by the hospital. Myoglobin may only be of interest if early exclusion of myocardial injuries has practical consequences. In this connection the transaminases and LDH are no longer of any interest.

Biomarkers↗
PubMed1999

[Angioplasty in heart arrest].

Early onset of cardiopulmonary resuscitation (CPR) and defibrillation are the most important factors for improving outcome after cardiac arrest. Many patients do not receive thrombolytic therapy after prolonged CPR, as there is a fear of serious bleeding complications. Ten patients with cardiac arrest and acute myocardial infarction were treated with primary angioplasty after prolonged CPR. Angioplasty was successful in nine of the patients, and left ventricular function was well preserved after six weeks. Primary angioplasty is highly effective and safe in establishing reperfusion in selected patients with acute myocardial infarction and cardiac arrest.

Adult↗
PubMed1998

[Angioplasty in acute myocardial infarction].

20 patients with acute myocardial infarction and a medical history of less than six hours were treated with immediate percutaneous transluminal coronary angioplasty. The median time from start of symptoms until establishment of reperfusion of the infarct related artery was 190 minutes, and the time from admission to insertion of the balloon was 52 minutes. Angioplasty was successful in all patients, with no serious complications. All patients experienced pain relief immediately after angioplasty. No patients died or had further infarctions. None needed hospitalization during the first three months of follow up. Eight patients had an exercise test between five and seven days after angioplasty and the other 12 at their six-week check up; there were no signs of ischemia or anginal pain. Measurement of global ejection fraction one week and six weeks after treatment showed median normal values and no significant changes (58% versus 57%). Myocardial perfusion imaging was carried out in eight patients both before hospital discharge and six weeks later. Normalization and improvement was seen in six patients using this method, whereas the perfusion was found unaltered in two patients. Hibernation or stunning, or both are suggested as possible explanations for this. We found the method highly effective and safe in selected patients.

Adult↗
PubMed1998

Sustained benefit of stenting chronic coronary occlusion: long-term clinical follow-up of the Stenting in Chronic Coronary Occlusion (SICCO) study.

OBJECTIVES: This study assessed the long-term clinical outcome of stenting chronic occlusions. BACKGROUND: In the Stenting in Chronic Coronary Occlusion (SICCO) study, patients were randomized to additional stent implantation (n = 58) or not (n = 59) after successful recanalization and dilation of a chronic coronary occlusion. Palmaz-Schatz stents were used with full anticoagulation. The previously published 6-month angiographic follow-up results showed reduction of the restenosis rate from 74% to 32%. METHODS: The primary end point was the occurrence of major adverse cardiac events (cardiac death, lesion-related acute myocardial infarction, repeat lesion-related revascularization or angiographic documentation of reocclusion). RESULTS: Late clinical follow-up was obtained in all patients at 33 +/- 6 months. Major adverse cardiac events occurred in 14 patients (24.1%) in the stent group compared with 35 patients (59.3%) in the percutaneous transluminal coronary angioplasty (PTCA) group (odds ratio 0.22, 95% confidence interval 0.10 to 0.49, p = 0.0002). Target vessel revascularization (including failed PTCA attempts) was performed in 24% of the stent group and in 53% of the PTCA group (p = 0.002). There were no events in the stent group after 8 months, whereas events continued to occur in the PTCA group. By multivariate analysis, allocation to the PTCA group, left anterior descending coronary artery lesion and lesion length were significantly related to the development of major adverse cardiac events. CONCLUSIONS: These data demonstrate the long-term safety and clinical benefit of stenting recanalized chronic occlusions. There is a continued risk of late clinical events related to nonstented lesions. Implantation of an intracoronary stent should therefore be considered after successful opening of a chronic coronary occlusion.

Angioplasty, Balloon, Coronary↗
PubMed1996

Stenting in Chronic Coronary Occlusion (SICCO): a randomized, controlled trial of adding stent implantation after successful angioplasty.

OBJECTIVES: This study investigated whether stenting improves long-term results after recanalization of chronic coronary occlusions. BACKGROUND: Restenosis is common after percutaneous transluminal coronary angioplasty (PTCA) of chronic coronary occlusions. Stenting has been suggested as a means of improving results, but its use has not previously been investigated in a randomized trial. METHODS: We randomly assigned 119 patients with a satisfactory result after successful recanalization by PTCA of a chronic coronary occlusion to 1) a control (PTCA) group with no other intervention, or 2) a group in which PTCA was followed by implantation of Palmaz-Schatz stents with full anticoagulation. Coronary angiography was performed before randomization, after stenting and at 6-month follow-up. RESULTS: Inguinal bleeding was more frequent in the stent group. There were no deaths. One patient with stenting had a myocardial infarction. Subacute occlusion within 2 weeks occurred in four patients in the stent group and in three in the PTCA group. At follow-up, 57% of patients with stenting were free from angina compared with 24% of patients with PTCA only (p < 0.001). Angiographic follow-up data were available in 114 patients. Restenosis (> or = 50% diameter stenosis) developed in 32% of patients with stenting and in 74% of patients with PTCA only (p < 0.001); reocclusion occurred in 12% and 26%, respectively (p = 0.058). Minimal lumen diameter (mean +/- SD) at follow-up was 1.92 +/- 0.95 mm and 1.11 +/- 0.78 mm, respectively (p < 0.001). Target lesion revascularization within 300 days was less frequent in patients with stenting than in patients with PTCA only (22% vs. 42%, p = 0.025). CONCLUSIONS: Stent implantation improved long-term angiographic and clinical results after PTCA of chronic coronary occlusions and is thus recommended regardless of the primary PTCA result.

Angioplasty, Balloon, Coronary↗
PubMed1994

[Stress echocardiography with dobutamine. A new method for diagnosis of ischemia].

Dobutamine stress echocardiography was performed in 24 patients with angiographically defined coronary artery stenosis, before they underwent percutaneous transluminal coronary angioplasty. Ischemia was detected on stress-ECG in 13 patients. In 19 patients ischemia could be detected with dobutamine stress echocardiography. The method was highly sensitive for detecting ischemia in patients with two vessel or three vessel disease and in patients with affection of only the left anterior descending artery. In patients with one vessel disease the method showed low sensitivity. The most common side effects of dobutamine infusion were flushing and palpitations. One patient suffered atrial fibrillation and one patient had a short and self-limiting ventricular tachycardia. The method seems to be a useful and safe supplementary tool for detecting myocardial ischemia. It is also useful for characterizing the physiological effect of coronary artery stenosis.

Coronary Disease↗
PubMed1994

[Heart failure in Norwegian hospital departments. Prevalence, diagnostic and therapeutic aspects].

The prevalence of congestive heart failure was studied in the medical departments of eight Norwegian hospitals for two days. A mean of 179 patients with heart failure was identified, representing 20% of the total number of in-patients in the participating hospital departments. About 60% of the patients studied were over 70 years of age. There were equal numbers of men and women, but men dominated below 70 years. Ischemic heart disease (59%), valvular heart disease (15%) and hypertension (14%) were the most common primary heart diseases. The drugs used most frequently were diuretics (91%), digitalis (60%), nitrates (40%), and ACE-inhibitors (38%); the last were used more often among patients with severe heart failure (56%).

Aged↗
PubMed1993

[Thallium scintigraphy in the diagnosis of coronary disease].

A retrospective analysis was performed in 371 patients who underwent stress thallium scintigraphy over a three-year period. The patient-group was highly selected. The majority had normal or uninterpretable exercise EKG. The purpose was to assess the clinical value of thallium scintigraphy, and to determine the accuracy of the test compared with coronary arteriography for diagnosis of coronary artery disease in 108 of the patients who had undergone cardiac catheterisation. For 79 patients (73%), the scintigraphic results were in complete accordance with the coronary arteriograms. Furthermore, critical review of the arteriograms showed discrete stenosis of less than 50% in another 12 of the patients with abnormal scans. This yields an overall diagnostic accuracy of 84%. The authors discuss some limitations of the method and possible causes of "false" perfusion defects. The results of the analysis are consistent with earlier reports, and emphasize thallium scintigraphy as a valuable diagnostic tool in coronary heart disease.

Adult↗
PubMed1992

[Treatment of heart failure. A questionnaire among Norwegian hospital physicians].

A questionnaire on the treatment of congestive heart failure was distributed to physicians in the medical departments of five hospitals in the Oslo area. The 117 (81%) respondents selected first, second and third line therapy in the treatment of mild, moderate and severe heart failure. Diuretics and restrictions on sodium/water dominated as first line therapy for mild heart failure; less than 5% suggested ACE-inhibitors or digitalis. Some differences in priorities were revealed for moderate and severe heart failure. The majority again suggested diuretics and restrictions on sodium/water, but 20% preferred ACE-inhibitors, which were also stated as second or third line therapy by 60% of the physicians. Less than 50% chose digitalis or nitrates as one of the three first therapies.

Heart Failure↗
PubMed1991

[Shunt quantification in adults with atrial septal defects using the radionuclide technique].

Quantification of left to right shunt was carried out in 15 adult patients, mean age 49 years, with a suspected ostium secundum atrial septal defect (ASD II). Radionuclide shunt quantitation correlated well with the results of right heart catheterization (r = 0.85). The radionuclide technique failed in two patients for technical reasons, but revealed no false negative or false positive results when technically satisfactory. The diagnosis was confirmed at operation. It is concluded that the radionuclide technique is a useful and reliable method which can also be used at follow-up after surgery in patients with atrial septal defects of secundum type.

Adult↗
PubMed1991

[Nuclear medical methods in cardiology].

201-Thallium scintigraphy and radionuclide ventriculography with 99m-Technetium are the two most important nuclear imaging techniques in clinical cardiology. The sensitivity and specificity of tomographic Thallium scintigraphy for detection of coronary heart disease is about 90%. Radionuclide ventriculography may be used to describe systolic and diastolic function of the left and right ventricles with results comparable to those of angiographic studies. Both methods are non-invasive and feasible during exercise. These methods provide important information on myocardial ischaemia and cardiac function which may be difficult to obtain by other methods. In county hospitals with no equipment for invasive studies these methods provide important diagnostic and prognostic information. In the university hospitals, however, the techniques are of a more supportive nature and may help the clinician to select appropriate treatment.

Coronary Disease↗