Search PubMed⌕ Search

Biomedical subjects

Arild Mangschau

Publications and source records attributed to Arild Mangschau.

10 recordsLinked to original sources
PubMed2006

Intracoronary injection of mononuclear bone marrow cells in acute myocardial infarction.

BACKGROUND: Previous studies have shown improvement in left ventricular function after intracoronary injection of autologous cells derived from bone marrow (BMC) in the acute phase of myocardial infarction. We designed a randomized, controlled trial to further investigate the effects of this treatment. METHODS: Patients with acute ST-elevation myocardial infarction of the anterior wall treated with percutaneous coronary intervention were randomly assigned to the group that underwent intracoronary injection of autologous mononuclear BMC or to the control group, in which neither aspiration nor sham injection was performed. Left ventricular function was assessed with the use of electrocardiogram-gated single-photon-emission computed tomography (SPECT) and echocardiography at baseline and magnetic resonance imaging (MRI) 2 to 3 weeks after the infarction. These procedures were repeated 6 months after the infarction. End points were changes in the left ventricular ejection fraction (LVEF), end-diastolic volume, and infarct size. RESULTS: Of the 50 patients assigned to treatment with mononuclear BMC, 47 underwent intracoronary injection of the cells at a median of 6 days after myocardial infarction. There were 50 patients in the control group. The mean (+/-SD) change in LVEF, measured with the use of SPECT, between baseline and 6 months after infarction for all patients was 7.6+/-10.4 percentage points. The effect of BMC treatment on the change in LVEF was an increase of 0.6 percentage point (95% confidence interval [CI], -3.4 to 4.6; P=0.77) on SPECT, an increase of 0.6 percentage point (95% CI, -2.6 to 3.8; P=0.70) on echocardiography, and a decrease of 3.0 percentage points (95% CI, 0.1 to -6.1; P=0.054) on MRI. The two groups did not differ significantly in changes in left ventricular end-diastolic volume or infarct size and had similar rates of adverse events. CONCLUSIONS: With the methods used, we found no effects of intracoronary injection of autologous mononuclear BMC on global left ventricular function.

Bone Marrow Transplantation↗
PubMed2006

[Impaired glucose tolerance in patients with acute myocardial infarction].

BACKGROUND: Diabetes and impaired glucose tolerance are associated with increased mortality in patients with acute myocardial infarction. We have used standardised oral glucose tolerance tests shortly after a myocardial infarction. METHODS: 109 patients admitted with acute myocardial infarction were prospectively enrolled in the study. An oral glucose tolerance test was performed the first morning the patients were stable, without pain, nausea or hyperglycaemia. The patients were classified into normal glucose tolerance, impaired glucose tolerance or diabetes, according to the results of the oral glucose tolerance test and fasting plasma glucose levels. RESULTS: 109 patients (25 women) were included. Eight patients were previously diagnosed with diabetes type 2. Oral glucose tolerance was tested for 90 patients, usually the day after admission. The test was positive in 47 patients; 32 of them had 2-h plasma glucose levels between 7.8 and 11.0 mmol/L and were classified as having impaired glucose tolerance, and 15 had 2-h plasma glucose > or = 11.1 mmol/L and were classified as newly diagnosed diabetes patients. Similar body mass indexes and lipid values were found in patients with different glycometabolic states. Smoking was associated with a positive oral glucose tolerance test. INTERPRETATION: More than half of the patients with acute myocardial infarction had undiagnosed impaired glucose tolerance or diabetes type 2, as determined by an oral glucose tolerance test. The test could easily be performed shortly after a myocardial infarction in most of the patients. Oral glucose tolerance testing should be considered in all patients with coronary heart disease without a history of diagnosed diabetes.

Adult↗
PubMed2006

Scintigraphic demonstration of myocardial perfusion and ischaemia associated with coronary artery bypass grafting.

OBJECTIVES: To assess if myocardial perfusion scintigraphy (MPS) at rest can be of value in elucidating myocardial perfusion, ischaemia and perioperative myocardial infarction (PMI) associated with coronary artery bypass graft (CABG) surgery. DESIGN: This was a prospective randomized study of patients undergoing elective CABG. Forty-eight patients in the control group underwent serial ECG recordings and measurements of CK-MB and cTnT. Fifty-four patients in the study group were additionally examined with MPS preoperatively and 2-4 days and 6 weeks postoperatively. RESULTS: The study showed a highly significant (p < 0.001) improvement in myocardial radionuclide uptake from preoperatively to 2-4 days postoperatively. Judged from ECG and enzymatic changes, two control patients and one study patient only had PMI and no additional cases of PMI were demonstrated by MPS. CONCLUSION: MPS at rest showed that CABG significantly improved myocardial perfusion, by demonstrating an increase in radionuclide uptake. In diagnosing PMI, we found that MPS provided no additional information beyond cardiac biochemical markers and ECG changes.

Adult↗
PubMed2005

[Primary angioplasty in acute ST elevation myocardial infarction in the elderly].

BACKGROUND: Based on data from the literature, it has been suggested that elderly patients with acute myocardial infarction will benefit more from primary angioplasty than from thrombolysis. MATERIAL AND METHODS: Data for 100 consecutive patients, age 75 years or more, presenting with an acute ST elevation myocardial infarction (STEMI) without cardiogenic shock and treated with primary angioplasty were analysed retrospectively. Some variables were compared with previously published data on a group of 100 younger patients (mean age 59) with STEMI. RESULTS: Angiographically, the success rate of revascularization was similar between the elderly (mean age 80) and the younger STEMI patients. Mortality, both at 30 days and at 1 year, was higher among the elderly patients compared with the younger (15% vs. 1% and 21% vs. 3% respectively, both p < 0.001). In the same time period, primary angioplasty was performed in seven patients > or = 75 years who presented with cardiogenic shock at admission. All of these died during hospitalization. INTERPRETATION: Technically, the success rate of primary angioplasty in elderly patients with STEMI was similar to that in younger STEMI patients. Mortality after 30 days was significantly higher among the elderly patients, but the mortality rate from 30 days to 1 year after the infarction was similar to that of the same age group in the general population. Patients > or = 75 years presenting with STEMI and cardiogenic shock had no benefit of angioplasty; all died during hospitalization.

Aged↗
PubMed2005

[Cardiogenic shock-- new therapeutic strategies].

BACKGROUND: Cardiogenic shock is a condition associated with high mortality. The evidence base for choice of treatment is insufficient, but new therapeutic options and new understanding have lead to some improvement in the prognosis. A new class of heart failure medication is now approved in Norway (calcium sensitizers). METHODS: We present a case history that illustrates new options in the treatment of cardiogenic shock complicating acute myocardial infarction. We have searched available literature and give a review of the treatment of cardiogenic shock with special emphasis on the role of inotropic drug therapy. RESULTS AND INTERPRETATION: A 46-year-old man with cardiogenic shock complicating myocardial infarction because of occlusion of the left-main coronary artery was treated with acute revascularization, intra-aortic balloon counterpulsation (IABP) and levosimendan. Early revascularization is a key factor in the treatment of cardiogenic shock; rapid transfer of patients to a revascularization centre is recommended. IABP should be considered after successful revascularization because of post-ischaemic dysfunction that persists despite restoration of epicardial blood flow. Beta-adrenergic stimulation of the heart should, if possible, be avoided, because of increased myocardial oxygen requirement, calcium overload of the cardiomyocytes, and increased mortality. Drug therapy using calcium sensitizers is promising, but more controlled clinical trials are needed.

Cardiotonic Agents↗
PubMed2004

[Reduction of myocardial infarction size after primary percutaneous coronary intervention].

BACKGROUND: Achieving reperfusion as soon as possible is essential in order to reduce myocardial infarction size and thus improve prognosis. An increasing number of patients with myocardial infarction are treated with primary percutaneous coronary intervention (PCI). Technetium 99m-tetrofosmin myocardial perfusion tomography (SPECT) is a valid test for assessing myocardium at risk and final infarct size expressed by a hypoperfusion index (HPI) of the left ventricular mass. MATERIAL AND METHODS: 20 patients with acute ST-elevation myocardial infarction were treated with primary percutaneous coronary intervention within six hours of onset of symptoms. Myocardium at risk and final infarct size were assessed by Technetium 99m-tetrofosmin immediately before and a few hours, one week and six weeks after. RESULTS: The hypoperfusion index immediately before percutaneous coronary intervention was 31%, four to six hours after PCI 25%, one week later 16% and six weeks later 12%, i.e. a relative reduction of 60% (p < 0.01). Anterior wall infarctions had a higher level of myocardium at risk before primary PCI compared to inferior wall infarctions (36% vs. 24%), but anterior wall infarctions had a higher salvage index compared to inferior wall infarctions. INTERPRETATION: This non-controlled study shows a marked reduction in final infarction size in patients with acute ST-elevation myocardial infarction treated with primary PCI.

Adult↗
PubMed2003

[Aortic dissection--a differential diagnosis in patients with chest pain and ECG changes].

BACKGROUND: The effect of thrombolytic therapy in patients with myocardial infarction is well documented. In patients presenting with chest pain it may, however, be difficult to discriminate between myocardial infarction and aortic dissection only on the basis of clinical manifestations. Moreover, patients with type A dissection may have ECG changes caused by affection of the coronary flow. MATERIAL AND METHODS: We retrospectively investigated all patients admitted to our hospital with type A dissection of the aorta over the period 1999 to March 2001. RESULTS: Fourteen patients were identified. Only two patients had normal ECG, six had ST elevation. Two patients had received antithrombotic or thrombolytic therapy. INTERPRETATION: In patients with chest pain and ST elevation, aortic dissection must be considered as a differential diagnosis before thrombolytic therapy.

Adult↗
PubMed2002

[Left ventricular function and infarction size after primary angioplasty for acute myocardial infarction].

BACKGROUND: There is little information available on long-term changes in left ventricular function and infarct size after acute myocardial infarction treated with primary angioplasty. MATERIAL AND METHODS: From 1996 to 1998, 100 consecutive patients were treated with primary angioplasty for acute ST-elevation myocardial infarction. Left ventricular ejection fraction was determined by radionuclide ventriculography before discharge, after six weeks and after a mean follow-up time of 20 months (range 11-37). Infarct size was assessed by technetium 99m-tetrofosmin myocardial perfusion tomography (SPECT) at rest, performed at the same time intervals. RESULTS: Mean ejection fraction was 56% at discharge, 55% after six weeks and 57% after 20 months of follow-up. A mean perfusion defect of 19% was measured by SPECT after one week. After six weeks and 20 months of follow-up, the mean perfusion defects were reduced to 14% (p < 0.001) and 15%, respectively. INTERPRETATION: Left ventricular function was well preserved and infarct sizes small to moderate 20 months (range 11-37) after primary angioplasty for acute myocardial infarction, demonstrating that the initial successful effect of the treatment was maintained.

Aged↗