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Biomedical subjects

Bernd Eber

Publications and source records attributed to Bernd Eber.

65 records · Page 4Linked to original sources
PubMed2002

[Statins and cerebrovascular events].

UNLABELLED: PREVENTION AND RISK REDUCTION: Statins consistently have shown an ability to reduce the incidence of ischemic stroke. Two meta-analyses corroborated prospective studies with statins and estimated a 30% risk reduction in stroke which is comparable to stroke reduction noted with aspirin. Stroke rate was evaluated in patients without known coronary artery disease in the West of Scotland Primary Prevention (WOSCOPS) trial. An 11% reduction in stroke was observed in WOSCOPS during 5-year follow-up that did not reach statistical significance (p = 0.57). Documentation of clinical benefit with reductions in stroke and coronary events and long-term safety is available only from statin trials with stroke defined as a secondary end point. The strongest evidence relates to patients with CHD. In this population, statistically highly significant reductions have been reported for stroke, cardiovascular mortality, nonfatal myocardial infarction, all-cause mortality, and need for cardiovascular procedures. CONCLUSIONS: Clinical benefit of statin use for stroke prevention in patients without coronary artery disease is not yet proven. Furthermore, it is unknown whether and to what extent differences in lipid and so-called nonlipid mechanisms, half-life, solubility, potency, and effects on other risk factors influence the clinical efficacy. Future trials will be needed to clarify this issue, particularly in patients with no history of coronary artery disease.

Anticholesteremic Agents↗
PubMed2002

[Angiographic results of "atypical" chest pain].

BACKGROUND AND AIMS: Coronary angiography permits evaluation of coronary artery morphology and coronary pathology. It represents an accurate method of defining stenotic coronary lesions. Chest pain may be caused by coronary artery disease as well as by other cardiac and noncardiac disorders. However, sensitivity of clinical evaluation and noninvasive diagnostic assessment in detection of coronary artery disease is limited. Noninvasive diagnostic strategies give inconsistent results in about 10-30%. Here coronary angiography is regarded as an accurate method for appropriate diagnosis. Ist sophisticated apparatus, cost, and invasiveness necessitate well-considered application of this procedure. Therefore, it appears important to analyze coronary angiograms in patients with the referral diagnosis of "atypical" chest pain with inconsistent noninvasive testing or impossibility to perform noninvasive assessment. PATIENTS AND METHODS: We analyzed records of 1,000 consecutive patients (625 men, 375 women, mean age 63.1 years), who underwent coronary angiography at our institution from January 5, 1998 to May 5, 1998. RESULTS: 49 patients (17 women, 32 men; mean age 59 years) were referred due to "atypical" chest pain. 21 (42.9%, nine women, twelve men) of these 49 patients had normal coronary arteries at angiography. 21 (42.9%) patients showed coronary artery disease with a diameter stenosis > 50%. In seven (14.2%) patients, coronary sclerosis with a diameter stenosis < 50% could be observed. Only five (29.4%) of the 17 women but 16 of the 32 men (50%) had coronary artery disease with a diameter stenosis > 50% (p < 0.01). CONCLUSIONS: In unselected patients referred for coronary angiography due to "atypical" chest pain and inconsistent noninvasive testing or impossibility to perform noninvasive assessment. 42.9% had coronary artery disease with a diameter stenosis > 50%. Angiographic evaluation of symptomatic patients with "atypical" signs and symptoms and inconsistent noninvasive testing seems to be appropriate.

Aged↗
PubMed2002

Multiple complex coronary plaques in a patient with acute myocardial infarction.

This report describes the case of a patient who developed acute myocardial infarction with ST segment elevation in anterior and inferior leads, simultaneously. After treatment with systemic thrombolysis, and after an initial short-lasting symptomatic improvement, chest pain and ST segment elevation recurred. Coronary angiography revealed severe complex stenotic lesions at both the right coronary artery and the left anterior descending (LAD) coronary artery. Percutaneous coronary angioplasty and stent implantation were successfully performed at both lesions. This case supports the concept that, at least in some patients, acute coronary artery disease reflects a diffuse pathophysiologic process that may lead to multifocal plaque instability associated with clinical instability at multiple sites.

Angioplasty↗
PubMed2002

C-reactive protein and coronary artery disease.

Evidence suggests that inflammation plays a key role in the pathogenesis of atherosclerosis. The chronic inflammatory process can develop to an acute clinical event by the induction of plaque rupture and therefore cause acute coronary syndromes. The aim of this study was to determine the serum levels of the circulating acute-phase reactant C-reactive protein (CRP), which is a sensitive indicator of inflammation, in patients with chronic stable coronary artery disease (CAD) and acute coronary syndromes (ACS). We studied 56 subjects: 1) 25 consecutive patients (18 men, 7 women; mean age, 68.5 +/- 14.3 years, range, 40-86) with unstable angina (UA) or acute myocardial infarction (AMI); 2) 31 consecutive patients (25 men, 6 women; mean age 64 +/- 12.7; range, 47-83, years) with signs and symptoms of clinically stable CAD. High-sensitivity-C-reactive protein (hs-CRP) levels were determined with a commercially available enzyme-linked immunoassay method. In patients with unstable angina and AMI before reperfusion therapy, CRP levels were not significantly different to those in patients with stable CAD (5.96 +/- 2.26 versus 4.35 +/- 2.6 mg/L; P = 0.12), but tended to be higher in patients with unstable angina and AMI. Baseline CRP levels in the subgroup of patients with AMI (6.49 +/- 2.28 mg/L) were significantly higher than levels in patients with stable CAD (4.35 +/- 2.6 mg/L; P = 0.02). CRP levels in patients with unstable angina and AMI were measured four times during a 72-hour period (0, 12, 24, and 72 hours). The lowest value was observed at baseline and differed significantly from values measured at any other time of the observation period (P < 0.001; 5.96 +/- 2.26; 9.5 +/- 9.04, 18.25 +/- 11.02; 20.25 +/- 10.61). CRP levels after 12, 24, and 72 hours were also significantly different to the initial values for patients with stable CAD (P < 0.01). There was no correlation between CRP and creatine kinase (CK), CK-MB isoenzyme, or troponin I positivity as markers for the extent of the myocardial injury during the observation period. Baseline levels of serum CRP tended to be higher in patients with unstable angina or AMI but were not significantly different from levels in patients with chronic stable CAD. In the subgroup of patients with AMI, baseline CRP levels were significantly higher than the levels in patients with stable CAD. CRP as a marker of inflammation is significantly increased in patients with AMI and unstable angina shortly after the onset of symptoms (after a period of 12 hours), supporting the hypothesis of an activation of inflammatory mechanisms in patients with an acute coronary syndrome or AMI.

Acute-Phase Reaction↗
PubMed2002

Lack of association between plasma lipoprotein(a) concentrations and the presence or absence of coronary atherosclerosis.

BACKGROUND: Findings from previous studies relating lipoprotein(a) [Lp(a)] as an independent risk factor for coronary atherosclerosis and the presence of angiographically detectable coronary atherosclerotic lesions are not consistent. This study was performed to determine whether the plasma concentration of Lp(a) is associated with coronary atherosclerosis asessed by coronary angiography. METHODS: We studied a total of 100 men and women (41 women, 59 men, age 63.7 +/- 11.0 years) who were referred for coronary angiography. Base-line data collection comprised conventional risk factors for coronary artery disease, lipids, fasting total homocysteine, and clinical characteristics. The relation between plasma Lp(a) levels and the presence or absence of coronary lesions was studied. The coronary angiograms were evaluated in a blinded manner. Any coronary stenosis was considered as coronary artery disease (CAD). RESULTS: From the 100 patients, 40 were found to have no CAD and 60 had CAD assessed by coronary angiography. Estimates of the relative risk of coronary heart disease for the fifth quintile of plasma Lp(a) as compared with the first quintile were 0.87 (95 percent confidence interval, 0.66 to 1.34). After adjustment for age, sex, lipoproteins, and homocysteine levels, estimates of the relative risk of coronary heart disease for the fifth quintile of plasma Lp(a) as compared with the first quintile were 1.06 (95 percent confidence interval, 0.81 to 1.39). The presence of angiographic CAD was associated with patient age (p=0.048), male sex (p<0.01), high LDL-cholesterol levels (p=0.02), low HDL-cholesterol levels (p=0.02), high plasma fibrinogen levels (p<0.01) and high fasting total homocysteine levels (p=0.04). CONCLUSION: These results suggest that the plasma concentration of Lp(a) is not associated with the presence of coronary artery disease in patients referred for coronary angiography.

Age Distribution↗
PubMed2002

Current and new drugs for the treatment of arrhythmias.

Sudden cardiac death is a leading cause of mortality in industrialized nations, accountingfor 50% of all cardiovascular deaths. Carefully performed randomized trials, technological advances and better understanding of arrhythmia mechanisms have resulted in improved approaches to rhythm disturbances. Risk assessment has to be individualized and can be approached through an analysis based upon all other clinical characteristics of the patient. The need for long-term therapy must be carefully individualized to each patient, since the severity and importance of symptoms are highly variable. This review will summarize the classification of antiarrhythmic drugs and main pharmacokinetic properties. Newer antiarrhythmic drugs either block a specific ionic current (eg, dofetilide-induced blockade of the rapidly activating component of the delayed rectifier potassium current) or block multiple ionic channels (eg, ibutilide and azimilide) in order to prolong atrial and ventricular action potentials without other specific pharmacological effects. Additionally, this manuscript reviews the newer class III agents' effectiveness in treating atrial and ventricular arrhythmias, and the development of novel antiarrhythmic drugs that act specifically to alter cell communication.

Animals↗
PubMed2002

Amiodarone in the prevention and treatment of arrhythmia.

There is good evidence that amiodarone is effective against a variety of arrhythmias and that it may be superior to other drugs in some settings. Because of its proven efficacy and safety, amiodarone is currently the leading antiarrhythmic drug. The electrophysiological actions of amiodarone are complex and not completely understood. It is generally classified as a Vaughan-Williams class III agent, prolonging repolarization by inhibition of outward potassium channels. Amiodarone is particularly useful because its safety has been clearly demonstrated by a large body of evidence, including several randomized trials. Compared with many other antiarrhythmic drugs, amiodarone causes few cardiovascular adverse effects; however, its overall tolerance is limited by considerable non-cardiac toxicity. Although amiodarone will continue to give way to the implantable cardioverter defibrillator (ICD) as primary therapy for many patients presenting with sustained ventricular tachycardia (VT) or ventricular fibrillation (VF), it is likely that the use of amiodarone in ICD patients will continue to prevent ICD discharges. Evaluation of combined use of amiodarone and ICD may provide the first opportunity to conduct a placebo-controlled trial of amiodarone efficacy against VT recurrence. Pharmacological therapy remains the major approach to management of atrial fibrillation (AF), and the use of amiodarone is likely to increase in future years. This review will analyze the evidence that amiodarone is a safe and effective antiarrhythmic drug.

Amiodarone↗
PubMedDate not supplied

Influenza A and B IgG seropositivity and coronary atherosclerosis assessed by angiography.

Infectious agents, in particular intracellular pathogens that can establish long-term, persistent seropositivity, may play an important role in atherogenesis. The possible association between influenza type A and B infection and angiographically proven coronary artery disease (CAD) and the effect of the aggregate pathogen burden on CAD was studied by testing blood from 218 patients undergoing coronary angiography for serum IgG antibodies to influenza A and B, and for antibodies to four other pathogens (hepatitis A, Chlamydia pneumoniae, Helicobacter pylori, and cytomegalovirus). This analysis demonstrates that although influenza (A and B) seropositivity represents no predictor of risk for CAD, infectious burden is independently associated with coronary atherosclerosis.

Aged↗
PubMedDate not supplied

Risk factors of postoperative atrial fibrillation after cardiac surgery.

BACKGROUND: Postoperative atrial fibrillation (AF) occurs in up to 50% of cardiac surgery patients and represents the most common postoperative arrhythmic complication. The etiology of AF after open-heart surgery is incompletely understood and its prevention remains suboptimal. Identification of patients vulnerable for postoperative AF would allow targeting of those most likely to benefit from aggressive prophylactic intervention. The aim of the present study was to evaluate clinical predictors of postoperative AF. METHODS AND RESULTS: Patients undergoing elective cardiac surgery in the absence of significant left ventricular dysfunction (n = 253; average age 65 +/- 11 years) were recruited to the present prospective study. Ninety-nine patients (39.1%) of the total study population developed AF during the postoperative period. The median age for patients with postoperative AF was 69 years compared with 64 years for patients without (p < 0.001). In addition to advanced age, AF patients were more likely to have surgery for valvular heart disease and less likely to have preoperative beta-adrenergic blockers than patients without AF. Multivariate logistic regression analysis (odds ratio, +/-95% CI, p value) was used to identify the following independent clinical predictors of postoperative AF: increasing age (above vs. below median [OR = 2.6; CI, 1.2 to 3.9; p < 0.01]), and surgery for valvular heart disease (vs. coronary artery bypass grafting [OR 2.8; CI, 1.1 to 3.5; p < 0.01)]). Additionally, postoperative complications (stroke, infections, unstable hemodynamics [OR = 1.9; CI, 1.0 to 7.5; p < 0.05]), and preoperative nonuse of beta-adrenergic blockers (OR = 1.7; CI, 1.1 to 4.9; p < 0.05) were associated with increased risk for postoperative AF. Both, patients with and without AF had similar body mass index, preoperative heart rate, preoperative blood pressure, and duration of surgery. Male sex did not identify patients at high risk for development of AF after cardiac surgery. CONCLUSIONS: Postoperative AF remains the most common complication after cardiac surgery. A combination of advanced age and type of surgery identifies patients at high risk for development of AF after cardiac surgery.

Adult↗