Predicting complications in interventional cardiology.
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Angioplasty, Balloon, Coronary↗
Biomedical subjects
A Vogt
Publications and source records attributed to A Vogt.
The German experience with primary angioplasty.
From July 1994 to October 1998, 4280 primary PTCA procedures were entered into the registry of the Arbeitsgemeinschaft Leitender Kardiologischer Krankenhausärzte. The success rate of PTCA, as defined by TIMI-3 perfusion of the infarct-related artery was 87.1%, in-hospital mortality was 10.2% and 2.6% had reinfarction. The most powerful predictors of death were cardiogenic shock present in 14.6% of whom 47% died, and failed PTCA with a mortality of 32%. Stents were used in 4.1% in 1994 increasing to 64.5% in 1998 without significant changes in success rates, but associated with a slight decrease in mortality and reinfarction rates.
Age Distribution↗
[Quality assurance in the clinic--an example of interventional cardiology].
Beginning in October 1992, all PTCAs from more than 70 German hospitals were gathered in a central registry of the Working Group of the Leading Hospital Physicians in Cardiology in an intention to treat analysis. Each centre was visited twice a year and the local records were compared with the procedures entered into the registry to ensure completeness of the data. In selected patients, a quality control was performed by expert rating regarding the technical performance and the indication for the intervention. Additional registries about primary PTCA in patients with acute myocardial infarction and stent implantations were initiated in 1994 and 1995. Completeness of the registries was more than 98% and more than 150,000 PTCA procedures, more than 5,000 PTCAs in acute myocardial infarction and more than 35,000 stent implantations were entered into the specific registries until April 1998. These data demonstrate that a complete registration and monitoring of procedural outcome is feasible even in high volume procedures such as PTCA. A still unresolved problem is the determination of the appropriateness of the indication for an intervention. However, this part of quality control is very important in interventional cardiology and therefore methods to assess the quality of indications have to be elaborated.
Angioplasty, Balloon, Coronary↗
Glomerular injury induced by cationic 70-kD staphylococcal protein; specific immune response is not involved in early phase in rats.
A highly cationic staphylococal protein (designated p70, MW 70 kD, pI > 10) belongs to the groups of bacterial proteins that can bind immunoglobulin without specific antigen-antibody recognition; heparin inhibition tests indicated a charge interaction. This study evaluated the nephritogenicity of p70, which has affinity for the glomerular basement membrane (GBM), and the influence of various mediator systems on the induction of glomerulonephritis by p70. The left kidneys of intact rats, rats given cobra venom factor (complement-depleted), or rats given anti-adhesion molecules (ICAM-1 and LFA-1a) were perfused with p70. Proteinuria started within 24 h and persisted at day 5. Intraglomerular infiltration of cells was seen as early as 15 min, peaking at day 1. Deposits of rat IgG and C3 were seen in a subendothelial location 15 min after p70 perfusion in the left kidney and were found in a predominantly subepithelial location from 1 day onwards. Complement depletion and blockade of adhesion molecules suppressed proteinuria from day 2 onwards; these manipulations also prevented the recruitment of infiltrating cells and partially hindered the transfer of IgG across the GBM and the accumulation of IgG in the subepithelial region. In the non-perfused right kidneys, deposits of IgG and C3 were comparable to those in the left kidneys, suggesting that p70-IgG complexes formed in the circulation may also contribute to the deposits in the GBM. Heparin inhibition tests indicated an electrostatic interaction between p70 and immunoglobulin. Complement and inflammatory mediator systems (granulocytes, monocytes/macrophages, and/or lymphocytes) were required to provoke glomerular injury. p70 might play a role in acute glomerulonephritis following Staphylococcus aureus infection.
Animals↗
[Diagnosis of the abdominal vascular system by means of electron-beam computed tomography (EBT)].
PURPOSE: To evaluate the potential of electron-beam computed tomography (EBT) in the pre- and postinterventional assessment of vascular abdominal pathologies. MATERIAL AND METHODS: Forty patients with implanted transjugular portosystemic shunt (TIPS), 12 patients with peripheral arterial occlusive disease and 8 patients with infrarenal abdominal aortic aneurysm after endovascular implantation of bifurcation stents were prospectively examined with contrast-enhanced EBT during one year. The evaluation included analysis of time-density curves (TDC) and 3D reconstructions. Results were compared with Doppler sonography and/or DSA. RESULTS: In 30 of 40 TIPS patients, identical results were found with EBT, Doppler sonography and/or DSA. Reduced perfusions of the TIPS, which were subsequently confirmed by DSA, could not be shown with EBT in 3 patients. Nine of 12 patients with peripheral arterial occlusive disease and angiographically proven stenosis (> 75%) showed a reduced and delayed peak density of the time-density curves. The quantification of arterial stenosis, however, did not follow the angiographic values. In all patients with the implanted bifurcation stents, EBT could correctly exclude a leakage of the stent. CONCLUSION: EBT has certain advantages over conventional spiral CT in the evaluation of abdominal vascular pathologies due to the additional assessment of perfusion parameters. Clinical indications for the use of EBT are seen especially in the postinterventional follow-up of patients with implanted stents.
Abdomen↗
Assessment of myocardial viability: Dobutamine echocardiography and thallium-201 single-photon emission computed tomographic imaging predict the postoperative improvement of left ventricular function after bypass surgery.
The aim of this study was to evaluate the usefulness of dobutamine echocardiography and quantitative thallium-201 single photon emission computed tomography myocardial scintigraphy with reinjection in the detection of viable myocardium in patients with coronary artery disease and reduced left ventricular function, which will improve after aortocoronary bypass surgery. Forty-eight patients (47 men, aged 61 +/- 6 years) with angiographically documented reduced left ventricular function (ejection fraction 35 +/- 14, 63% with chronic transmural myocardial infarction) were examined by dobutamine two-dimensional echocardiography (before and during low dosage), 201Tl, and gated radionuclide ventriculography before and 3 +/- 2 months after aortocoronary bypass surgery. Four of 55 areas classified viable before operation were revascularized inadequately and discarded. Global left ventricular ejection fraction at rest rose from 35% +/- 14% before operation to 40% +/- 13% (p < 0.05) after operation. Stress-induced perfusion defects involved 40% +/- 19% of the left ventricle circumference after stress and showed a significant reduction of size to 23% +/- 14% (p < 0.01) at rest, 4 hours later, and after reinjection. This value fell to 16% +/- 12% (p < 0.05) 3 months after aortocoronary bypass surgery. We conclude that both dobutamine echocardiography (sensitivity 95%, specificity 80%, positive predictive value 87%, negative predictive value 88%) and 201Tl studies (sensitivity 87%, specificity 98%, positive predictive value 97%, negative predictive value 93%) are suitable and comparable accurate methods for predicting improvement in systolic function 3 months after revascularization in a selected population with a high prevalence of viable but hypokinetic or akinetic myocardium.
Aged↗
Selective inhibition of type-I geranylgeranyltransferase in vitro and in whole cells by CAAL peptidomimetics.
In this paper we describe the synthesis of a family of CAAL peptidomimetics as GGTase-I inhibitors. These inhibitors lack the central dipeptide AA in the key CAAL carboxy terminal sequence of geranylgeranylated proteins and are more selective for GGTase-I over FTase. In whole cells, these compounds are very potent inhibitors of the processing of the geranylgeranylated protein Rap1A without affecting the farnesylated protein H-Ras. One derivative, GGTI-298, inhibited cell division by blocking cells in the G1 phase of the cell cycle.
3T3 Cells↗
Antibody to streptococcal zymogen in the serum of patients with acute glomerulonephritis: a multicentric study.
BACKGROUND: Cationic streptococcal proteinase (erythrotoxin B) and its precursor, zymogen, are putative nephritogenic antigens. The present study was designed to test whether serum titers to these antigens were good markers of streptococcal infection associated with glomerulonephritis. METHODS: We studied 153 patients (male/female = 104/49, age range, 2 to 23 years old) with acute poststreptococcal glomerulonephritis (APSGN) from three countries (Venezuela, Chile and Argentina). The site of the initial infection was the skin in 84 patients, the throat in 55 patients and was unknown in 14 patients. In addition, we studied 23 patients (1 to 24 years old) with streptococcal infection not associated with glomerulonephritis (14 patients with impetigo and 9 patients with pharyngitis). As control group, 93 healthy individuals (54 males, 2 to 19 years old) were studied. Anti-zymogen and anti-proteinase titers were determined in a single laboratory by ELISA, and the intra- and interassay coefficients of variation were 5.3% and 8.5%, respectively. ASO titers and anti-DNAse B titers were also done. RESULTS: Anti-zymogen titers of 1:800 to 1:3200 had likelihood ratios (sensitivity/1-specificity) for detection of streptococcal infection in APSGN patients ranging from 2.00 to 44.2 in Argentina, Chile and Venezuela. Anti-zymogen titers decreased one to two months after APSGN and they were 1 to 3 log2 dilutions higher that anti-proteinase titers. Receiver operating characteristic (ROC) curves showed that anti-zymogen titers were consistently superior to anti-streptolysin O and anti-DNAse B titers as markers for streptococcal infection in APSGN. CONCLUSIONS: These results suggest that increased anti-zymogen antibody titers are the best available marker for streptococcal infection associated with acute glomerulonephritis.
Acute Disease↗
Direct percutaneous transluminal coronary angioplasty in acute myocardial infarction. Predictors of short-term outcome and the impact of coronary stenting. Study Group of The Arbeitsgemeinschaft Leitender Kardiologischer Krankenhausärzte (ALKK).
BACKGROUND: Direct percutaneous transluminal coronary angioplasty (PTCA) is widely accepted in the treatment of acute myocardial infarction since excellent results had been reported from several small randomized trials. Less favourable results were observed in large-scale registries. In particular, the use of stents in acute myocardial infarction has become common practice without documented evidence of clinical efficacy. METHODS: Data were analysed from a registry of all consecutive percutaneous transluminal coronary angioplasty procedures from 62 centres in Germany, including 2331 direct percutaneous transluminal coronary angioplasty in acute myocardial infarction from July 1994 to April 1997. RESULTS: The overall angiographic success rate of percutaneous transluminal coronary angioplasty, defined as complete antegrade perfusion of the infarct vessel, was 87%. In-hospital mortality was 11.2%. The most important predictor of death was the presence of cardiogenic shock in 15% of patients, of whom 52% died. Mortality in patients without shock was 3.9%. Failed percutaneous transluminal coronary angioplasty was associated with a mortality of 36%. Further independent predictors of death were older age, multivessel disease, and anterior myocardial infarction. Stents were used in 4.1% of the procedures in 1994, increasing to 53% in 1997. However, this was not accompanied by improved clinical outcome. Mortality with coronary stenting was 9.9% vs 11.6% without stents (ns). CONCLUSIONS: Direct percutaneous transluminal coronary angioplasty is a valuable treatment strategy in acute myocardial infarction, although the results are less exceptional than reported from some highly specialized centres. Failed percutaneous transluminal coronary angioplasty seems to be harmful, thus outweighing much of the benefit from successful procedures. Stents did not improve the clinical outcome significantly, despite technically successful placement in 98%. Mortality from cardiogenic shock continues to be excessively high despite direct PTCA.
Adult↗
[The value of a fabric-coated self-expanding stent in iliac arterial occlusions or aneurysms--the primary and long-term results].
PURPOSE: The objective of this study was to analyze the primary and long-term results of implanting self-expanding covered nitinol stents (EndoPro I) in iliac arteries. MATERIAL AND METHODS: A total of 48 EndoPro (length 8.3 +/- 4.2 cm) were implanted in 39 patients. In 22 cases (group A) the implantation was performed after excimer laser-assisted recanalization (PTLA) of long iliac occlusions (mean 9.8 +/- 3.9 cm). Other indications were aneurysmatic lesions (n = 16) and one arterial perforation (group B). RESULTS: In 21 of 22 patients of group A the patency of the blood vessel was successfully restored. In all cases of group B the aneurysmatic lesions were finally excluded. This was correlated with a clinical improvement of at least one grade (Rutherford criteria) in 86.4% of patients (group A). The primary patency rate based on clinical examination (treadmill test) and color-coded Doppler was evaluated at 6 (89.7%), 12 (87.1%), and 24 (84.2%) months follows up, respectively. Subacute thromboses occurred in two, relevant restenoses in three cases (group A). In three of these 5 cases the vessel segment was successfully reopened by PTLA or rt-PA thrombolysis, leading to secondary patency rates of 94.9% at 6 and 92.1% at 12 and 24 months, respectively. CONCLUSION: In cases of relevant dissection following PTLA of long pelvic artery occlusions implantation of covered stents is effective to stabilize the results. Furthermore, the device is well applicable to seal arterial ruptures or aneurysms.
Adult↗
Postoperative lactic acidosis in patients receiving metformin.
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Acidosis, Lactic↗
Enzyme-linked immunosorbent assay using recombinant OspC and the internal 14-kDa flagellin fragment for serodiagnosis of early Lyme disease.
The outer surface protein C (OspC) and the internal 14-kDa flagellin fragment of strain GeHo of Borrelia burgdorferi sensu stricto were expressed as recombinant proteins in Escherichia coli and were purified for use in an immunoglobulin M (IgM) enzyme-linked immunosorbent assay (OspC-14-kDa antigen ELISA). No hint at disturbing protein-protein interferences, which might influence the availability of immunoreactive epitopes, was found when the recombinant antigens were combined in the ELISA. The recombinant OspC-14-kDa antigen ELISA was compared to a commercial IgM ELISA that used a detergent cell extract from Borrelia afzelii PKo as the antigen. According to the manufacturer's information, the cell extract contains, in addition to other antigens, the following diagnostically relevant antigens: the 100-kDa (synonyms, 93- and 83-kDa antigens), 41-kDa, OspA, OspC, and 17-kDa antigens. The specificity was adjusted to 95% on the basis of data for 154 healthy controls. On testing of 104 serum samples from patients with erythema migrans (EM), the sensitivity of the recombinant ELISA (46%) for IgM antibodies was similar to that of the commercial ELISA (45%). However, when 42 serum samples from patients with polyclonal B-cell stimulation due to an Epstein-Barr virus infection were tested, false-positive reactions were significantly less frequent in the recombinant ELISA (10%) than in the whole-cell-extract ELISA (23%). OspC displays sequence heterogeneity of up to 40% according to the genomospecies. However, when the reactions of serum specimens from controls and EM patients with OspC from representative strains of B. burgdorferi sensu stricto (strain GeHo) and B. afzelii (strain PKo) were compared in an ELISA, almost no differences in specificity and sensitivity were seen. This demonstrates that the sera predominantly recognize the common epitopes of OspC tested in this study. In conclusion, we suggest that the OspC-14-kDa antigens ELISA is a suitable test for the detection of an IgM response in early Lyme disease.
Antibodies, Bacterial↗
Detection of cell surface determinants for anti-Leu M3 (CD14), MY9 (CD33) and MY4 (CD14) and phagocytic function of cord blood monocytes in the course of gestational age.
To investigate immunological functions of cord blood cells, cord blood monocytes of 84 term and preterm newborn infants were examined in presenting cell surface determinants for the monoclonal antibodies anti-Leu M3 (CD14), My9 (CD33) and My4 (CD14) using an alkaline-phosphatase-anti-alkaline-phosphatase staining method. We also tested the phagocytic function of these cells by incorporation of Candida albicans in a 60 min incubation assay. Mean values for antigen expression ranged from 60 to 70%, whereby My4 showed a statistically significant higher level compared to Anti-Leu M3 and My9 (P = 0.05). Changes of antigen expression were statistically significant by the time of maturation. Statistically significant differences between male and female newborns were observed in 26-33 and 36-37 weeks of gestation. Considering the modus of delivery, no significantly higher amount of antigen-presenting monocytes were found in newborns of spontaneous birth compared to cesarean sections. However, no statistically significant differences in phagocytosis were observed between term and preterm newborn infants, mature newborns showed higher levels of both antigen expressing and phagocytic monocytes in contrast to a higher number of phagocytic cord blood monocytes only in premature infants.
Antibodies, Monoclonal↗
Increased fraction of circulating activated platelets in acute and previous cerebrovascular ischemia.
Determination of circulating activated platelets may be helpful to estimate the prognosis and to stratify therapies in arterial vascular disorders including stroke. We used flow cytometry and phase contrast microscopy to study whether the fraction of platelets expressing p-selectin and CD63 and the fraction of platelets with shape change are increased in patients with acute and previous cerebrovascular ischemia. The proportion of platelets expressing activation dependent antigens was higher in patients with acute (n = 24; p-selectin: 8.23 +/- 4.21%; CD63: 3.53 +/- 2.53%) and with previous cerebrovascular ischemia (n = 46; 3.86 +/- 1.98%; 2.80 +/- 1.79%) as compared to age- and sex-matched control subjects (n = 35; 2.17 +/- 0.96%; 1.79 +/- 0.75%; p < or = 0.005, respectively). In patients with previous ischemia, there was no difference between treatment with aspirin (n = 25) or phenprocoumon (n = 21). Hypertension, diabetes mellitus and smoking were not associated with increased antigen expression (analysis of variance). The fraction of discoid platelets and platelet counts were not significantly different between groups. Our results indicate increased expression of platelet neoantigens in acute and to a less degree in previous cerebrovascular ischemia. Ongoing platelet activation after cerebrovascular ischemia despite therapy with aspirin or phenprocoumon indicates that new anti-platelet drugs may be of benefit for these patients. Flow cytometry appears to be a useful tool to assess platelet function in cerebrovascular ischemia.
Aged↗
Disruption of insulin-like growth factor-1 signaling and down-regulation of cdc2 by SC-alphaalphadelta9, a novel small molecule antisignaling agent identified in a targeted array library.
We previously reported the generation of a library of hydrophobic oxazole-based small molecules designed as inhibitors of phosphatases involved in cellular signaling and cell cycle control. One member of the targeted array library, 4-(benzyl-(2-[(2, 5-diphenyl-oxazole-4-carbonyl)-amino]-ethyl)-carbamoyl)-2-decanoylami no butyric acid (SC-alphaalphadelta9), inhibited cell growth in the G0/G1 phase of the cell cycle. To investigate potential mechanisms for SC-alphaalphadelta9 antiproliferative activity, we have used mouse embryonic fibroblasts transformed with simian virus 40 large T antigen mouse embryonic fibroblasts as a model system for a malignant phenotype that depends on overexpression of cell cycle regulators and autocrine stimulation by insulin-like growth factor-1. Structure-activity relationship studies with SC-alphaalphadelta9 and four library congeners demonstrated that antiproliferative activity was not a result of overall hydrophobicity. Rather, SC-alphaalphadelta9 decreased insulin-like growth factor-1 receptor tyrosine phosphorylation, receptor expression, mitogen-activated protein kinase activation and levels of the cyclin-dependent kinase Cdc2. Less toxic congeners only partially affected receptor expression, receptor tyrosine phosphorylation and Cdc2 levels. Thus SC-alphaalphadelta9, which is structurally distinct from other known small molecules that decrease intracellular Cdc2 levels, has profound effects on intracellular signaling. Furthermore, SC-alphaalphadelta9, but not vanadate or okadaic acid, selectively inhibited the growth of simian virus 40 large T antigen mouse embryonic fibroblasts compared to the parental cells. These results suggest that overexpression of Cdc2 and increased dependence on insulin-like growth factor-1 autocrine stimulation are responsible for the increased sensitivity of simian virus 40 large T antigen mouse embryonic fibroblasts to SC-alphaalphadelta9. The SC-alphaalphadelta9 pharmacophore could be a useful platform for the development of novel antisignaling agents.
Animals↗
[Endovascular reconstruction of the infrarenal abdominal aortic aneurysm--experiences with 3 endovascular stent prosthesis systems].
Seventeen patients were treated with endovascular stent grafts for AAA (seven Stentor, two Vanguard, three Talent and three EVT grafts). Intraoperative conversion to open procedure was necessary in three cases. One patient had open operation 24 h postoperatively for graft thrombosis. All patients had uneventful recovery. During follow-up (1-35 months) nine patients did not require reintervention. One patient had open repair for persistent endoleak: within 2 months postoperatively one midgraft endoleak, one graft limb thrombosis and one groin infection were treated. We did not observe any late complications.
Aged↗
The geranylgeranyltransferase-I inhibitor GGTI-298 arrests human tumor cells in G0/G1 and induces p21(WAF1/CIP1/SDI1) in a p53-independent manner.
Recently we have shown that in fibroblasts (NIH 3T3 and Rat-1 cells) inhibition of protein geranylgeranylation leads to a G0/G1 arrest, whereas inhibition of protein farnesylation does not affect cell cycle distribution. Here we demonstrate that in human tumor cells the geranylgeranyltransferase-I (GGTase-I) inhibitor GGTI-298 blocked cells in G0/G1, whereas the farnesyltransferase (FTase) inhibitor FTI-277 showed a differential effect depending on the cell line. FTI-277 accumulated Calu-1 and A-549 lung carcinoma and Colo 357 pancreatic carcinoma cells in G2/M, T-24 bladder carcinoma, and HT-1080 fibrosarcoma cells in G0/G1, but had no effect on cell cycle distribution of pancreatic (Panc-1), breast (SKBr 3 and MDAMB-231), and head and neck (A-253) carcinoma cells. Furthermore, treatment of Calu-1, Panc-1, Colo 357, T-24, A-253, SKBr 3, and MDAMB-231 cells with GGTI-298, but not FTI-277, induced the protein expression levels of the cyclin-dependent kinase inhibitor p21WAF. HT-1080 and A-549 cells had a high basal level of p21WAF, and GGTI-298 did not further increase these levels. Furthermore, GGTI-298 also induces the accumulation of large amounts of p21WAF mRNA in Calu-1 cells, a cell line that lacks the tumor suppressor gene p53. There was little effect of GGTI-298 on the cellular levels of another cyclin- dependent kinase inhibitor p27KIP as well as cyclin E and cyclin D1. These results demonstrate that GGTase-I inhibitors arrest cells in G0/G1 and induce accumulation of p21WAF in a p53-independent manner and that FTase inhibitors can interfere with cell cycle events by a mechanism that involves neither p21WAF nor p27KIP. The results also point to the potential of GGTase-I inhibitors as agents capable of restoring growth arrest in cells lacking functional p53.
Alkyl and Aryl Transferases↗
[Balloon dilatation in acute myocardial infarct in routine clinical practice: results of the register of the Working Society of Leading Cardiologic Hospital Physicians in 4,625 patients].
Balloon angioplasty as the treatment of first choice in the setting of an acute myocardial infarction (AMI) is gaining widespread acceptance because of favourable results from specialised centres concerning high patency rates and low mortality. This study reports the results of angioplasty for AMI at large community hospitals during 1992-1995. 4625 procedures were performed at 68 centres of the Arbeitsgemeinschaft Leitender Kardiologischer Krankenhausärzte (ALKK). The age of the patients was 60.8 +/- 11.3 years, with 75.1% men. The infarct related artery was the left anterior descendent in 43%, the right coronary artery in 37%, the circumflex artery in 16%, a bypass graft in 2.3% and the left main stem in 1.4% of patients. The success rate (residual stenosis < 50%) of the intervention was 86%. There was a wide range of procedures per centre, with a median of 40 AMI angioplasties per year and centre. The amount of angioplasties for AMI in relation to all angioplasties performed during this period rose from 5.2% in 1992 to 5.9% in 1995 (p = 0.01). Local complications at the puncture site occurred in 3.2%, with the need for a surgical intervention in 1.1% of patients. In 273 (5.9%) of the patients a second angioplasty was performed during the hospital stay. Aortocoronary bypass surgery was performed in 3% of the patients. Hospital mortality was 9.5% (438/4625 patients). The mortality rate remained constant during the years investigated (1992: 10.6%; 1993: 8.6%; 1994: 9.7%; 1995: 9.8%; p = ns). Higher mortality was observed in older patients, patients with multiple vessel disease, the left anterior descending artery or a bypass graft as infarct related artery as well as in patients with failed reperfusion (residual stenoses > 50%). Hospitals with a case load of more than 40 angioplasties for AMI per year showed a lower mortality as compared to the others. In clinical practice at large community hospitals results of angioplasty for AMI concerning mortality, complications and technical success rate are comparable to those of highly specialised centres. The absolute numbers of angioplasties for AMI increased constantly over the years.
Aged↗