Biomedical subjects

E Grube

Publications and source records attributed to E Grube.

At least 55 records · Page 3Linked to original sources

PubMed1988

Sodium intake modulates left ventricular hypertrophy in essential hypertension.

In order to assess the impact of dietary sodium intake on the degree of left ventricular hypertrophy, we determined posterior wall thickness, relative wall thickness and left ventricular mass by two-dimensionally guided M-mode echocardiography, and related these parameters to sodium excretion over 24 h. There was no restriction on sodium intake. The first cohort comprised 43 subjects (residents of New Orleans) with mild to moderate essential hypertension who had not been treated for at least 4 weeks; in this cohort sodium excretion correlated with posterior wall thickness (r = 0.64, P less than 0.001), relative wall thickness (r = 0.67, P less than 0.001) and left ventricular mass (r = 0.37, P less than 0.02). A stepwise multiple regression analysis confirmed that sodium excretion was a determinant of posterior wall thickness (P less than 0.02) and relative wall thickness (P less than 0.05) independently of age, arterial pressure and body weight. The second cohort comprised 60 white male patients (residents of Bonn) with mild essential hypertension who had never been treated in the past; in this cohort sodium excretion correlated with diastolic diameter (r = 0.36, P less than 0.001) and with left ventricular mass (r = 0.35, P less than 0.001). Sodium excretion and systolic pressure emerged as independent variables (P less than 0.02) for left ventricular mass as evaluated by multiple regression analysis. These results identify dietary sodium intake as an independent powerful determinant of left ventricular hypertrophy in two disparate patient cohorts. Thus, for a similar haemodynamic load, sodium intake might accelerate, and conversely salt restriction mitigate, cardiac structural adaptation in patients with essential hypertension.

Cardiomegaly↗

PubMed1988

[Intraoperative measurement of velocity and volume of coronary circulation using the Duplex system].

A high frequency ultrasound system processor was used for an intraoperative evaluation of coronary blood flow velocity and volume. In 12 patients with symptomatic coronary heart disease, morphology and hemodynamic parameters of the coronary artery system were examined intraoperatively. Optimal imaging was possible by keeping the ultrasound transducer at a constant distance of a few millimeters from the surface of the heart and the pericardial space between them filled with saline solution. Using this technique, large areas of the cardiovascular system were reproducible up to a peripheral vascular diameter of 2-3 mm. Blood flow velocity (20 to 33 cm/s) and blood volumes (33 to 94 ml/min) provide quantitative information on the degree of stenosis intraoperatively after coronary anastomosis during bypass surgery. All images were of outstanding quality and precision. This method is highly valuable for the intraoperative determination of blood flow parameters.

Adult↗

PubMed1988

[Improving color Doppler echocardiography of the right heart chambers following intravenous injection of SHU 454].

The echocardiographic contrast agent SHU 454 provides microbubbles of defined size (median 3 micron) in a solution of galactose and is available in different reproducible concentrations. In 22 patients with suspected tricuspid regurgitation, color flow mapping (CFM) Doppler echocardiography was performed before and after intravenous injection of 2-4 ml SHU 454. Without SHU 454 the diastolic blood flow was imaged on 13.6 +/- 7.5% (mean value + standard deviation) of the cross sectional area of the right ventricle (four-chamber view) in comparison to 39.0 +/- 15.0% with SHU 454 (p less than 0.001). For the right atrium, the area analyzed by CFM increased from 9.4 +/- 12.9% to 62.4 +/- 25.3% (p less than 0.001). The interindividual variability of measurements after injection of SHU 454 was 5.9 +/- 4.0% as compared to 10.7 +/- 6.9% without SHU 454 (p less than 0.05). These findings demonstrate that intravenous SHU 454 administration increases the detection of blood flow by CFM within the right heart.

Adult↗

PubMed1987

[Quantitative regional functional analysis of the left ventricle using ECG-directed cardiac computerized tomography].

ECG-gated cardio-CT using two different methods of subsequent calculation was performed in 152 patients to evaluate contractility of the anterior and posterior wall and apex of the left ventricle quantitatively. The results were compared with RAO laevo-cardiography. Apart from the localisation of abnormal contractility, CT diagnosis showed sensitivity, specificity and accuracy from 70% to 85%. ECG-gated CT was better at showing abnormal movements at the apex and of the anterior wall than of the posterior wall. Attempts to quantify abnormalities of the basis of laevo-cardiographic results.

Adult↗

PubMed1987

[Cyanotic patient with right ventricular dilatation and ventricular arrhythmias].

Uhl's disease is a very rare congenital anomaly of the heart. Extreme dilatation of the right ventricle is accompanied by virtual absence of the right ventricular myocardium. We report on a 30-year-old woman with ventricular arrhythmias and atrial-septal defect where the diagnosis was made by echocardiography and confirmed by angiocardiography. Diagnostic and therapeutic possibilities are discussed.

Adult↗

PubMed1987

[Evaluation of aortic valve insufficiency using color Doppler echocardiography].

UNLABELLED: Colour flow mapping Doppler echocardiography is a new, noninvasive method for studying the direction and velocity of blood flow within the cardiac chambers. In order to estimate the sensitivity and specificity of this method in the evaluation of aortic regurgitation, 44 patients were examined consecutively. In 24 patients, aortic valve incompetence was proven by angiography; in 20 patients aortography revealed no regurgitation. Quantification of the severity of aortic insufficiency was performed by grading the amount of colour of the regurgitant flow (grade I-IV) and comparing it with the angiographic data. In 43 out of 44 patients diagnostic images could be obtained with colour flow mapping Doppler echocardiography. With this method aortic insufficiency was detected in all cases (sensitivity 100%). The specificity was 97% (one false positive diagnosis). For quantification of the severity of regurgitation agreement with the angiographic findings was obtained in 18 out of 24 cases. In the remaining 6 patients the difference was one grade. CONCLUSION: Colour flow mapping Doppler echocardiography is an important advance in the noninvasive preoperative diagnostics of aortic incompetence.

Adult↗

PubMed1987

[Fungal endocarditis of the tricuspid valve in Crohn disease].

In a 59-year-old patient with Crohn's disease, tricuspid valve endocarditis caused by candida albicans was observed. Prior to fungal endocarditis a treatment with prednisone and azathioprine was performed. The patient had severe embolic pneumonia with abscesses. Following the echocardiographic examination, the infected valve was replaced by a Hancock bioprosthesis. Despite high dose antifungal chemotherapy the patient died. Septic disorders in patients with Crohn's disease, who are treated with prednisone and azathioprine, can be caused by fungal endocarditis and should be investigated by echocardiography.

Candidiasis↗

PubMed1986

[Indoramin in severe cardiac insufficiency. Acute hemodynamic effectiveness].

Systemic peripheral resistance, right and left heart pressures, cardiac output and left ventricular ejection fraction were measured in 12 patients with severe heart failure (stages III-IV of the NYHA), before and after intravenous injection of indoramin (0.2-0.4 mg/kg bodyweight). Peripheral resistance decreased from a mean of 2738.5 to 1294.4 dyn X s X cm-5 (P less than 0.001), mean pulmonary artery pressure from 39.4 to 21.4 mm Hg (P less than 0.001), mean aortic pressure from 105.3 to 86.0 mm Hg (P less than 0.001), left ventricular end-diastolic pressure from 35.3 to 18.3 mm Hg (P less than 0.001), arterio-venous oxygen difference from 36.1 to 25.4% (P less than 0.001), while cardiac output rose from 2.1 to 3.3 l X min-1 X m-2 (P less than 0.001), and the ejection fraction increased from 29.0 to 42.5% (P less than 0.001). Heart rate remained nearly unchanged. There were no significant side effects, such as hypotension or arrhythmias. The results indicate that the parenteral injection of indoramin favourable influences haemodynamic parameters of patients in severe heart failure.

Adult↗

PubMed1986

[Comparison between i.a. DSA and cineangiography for evaluating the coronary arteries and the left ventricle].

In twenty-two patients with coronary heart disease, selective coronary angiography and laevo-cardiography were carried out by means of conventional cine angiography and intra-arterial DSA. For evaluating left ventricular function, intra-arterial DSA and cine angiography were of equal value (r = 0.97). A significant advantage of DSA was the fact that it is easily reproducible. On the other hand, DSA is less good for quantifying coronary stenoses and for demonstrating the peripheral vessels.

Adult↗

PubMed1986

[Accuracy of cardiac CT and echocardiography in the diagnosis of space-occupying processes in the heart].

CT of the heart and echocardiography was performed on 107 patients with various space-occupying lesions of the heart. In addition, 27 patients were subjected to angiocardiography. A comparison of the findings has shown that cardio-CT is superior to two-dimensional echocardiography for demonstrating pericardial masses and intracavity thrombi. There was no significant difference as far as intracavity or intramural tumours were concerned. CT and sonography are superior to angiography in the diagnosis of cardiac space-occupying lesions.

Adolescent↗

PubMed1986

Antihypertensive therapy in the Federal Republic of Germany: clinical practice experience with indoramin (Wydora).

The clinical experience of 763 medical practitioners who treated 3,708 hypertensive patients (51% men) with indoramin, administered alone or in combination with diuretics and/or beta-adrenergic antagonists, is reported. All patients had baseline diastolic blood pressure (DBP) of 95 mm Hg or greater, even though most of the patients (62%) already were receiving optimum doses of diuretics (20%), beta-adrenergic antagonists (15%), or diuretics and beta-adrenergic antagonists (27%). After 6 to 10 weeks of indoramin therapy, the DBP of 70% of the patients was 90 mm Hg or lower; another 17% had treated DBP between 91 and 95 mm Hg. Response rates were similar among patients treated with indoramin alone and those who received concomitant antihypertensive treatment. Indoramin doses of 50 mg/day or less (dose range, 12.5 to 125 mg/day) were required in approximately 70% of the patients. Weight gain and reflex tachycardia were not observed. The most frequently reported side effects were drowsiness/tiredness, dizziness, and dry mouth. Only 6% of the patients discontinued indoramin treatment because of side effects. The results of this study indicate that indoramin, administered alone or in combination with diuretics and/or beta-adrenergic antagonists, is a safe and effective antihypertensive agent when used in relatively low doses in clinical practice.

Adolescent↗

PubMed1986

Indoramin in severe congestive heart failure.

The acute and chronic effects of indoramin, a new alpha 1-adrenoceptor antagonist with vasodilating properties, were examined in patients with severe congestive heart failure (New York Heart Association class III or IV). In the acute phase, indoramin, 0.2-0.4 mg/kg body weight, was given intravenously to 12 patients, and systemic peripheral resistance, right and left heart pressures, cardiac output, and left ventricular ejection fraction were determined. After indoramin, hemodynamic parameters improved significantly without heart rate changes. At peak effect (10-20 min), there were significant (p less than 0.001) decreases in mean arterial pressure from 105.3 +/- 20.4 to 86.0 +/- 16.8 mm Hg, mean pulmonary artery pressure from 39.4 +/- 10.4 to 21.4 +/- 5.8 mm Hg, total systemic peripheral resistance from 2,738.5 +/- 660 to 1,294.4 +/- 314 dyn s/cm-5, and left ventricular end-diastolic pressure from 35.3 +/- 6.8 to 18.3 +/- 4.7 mm Hg. There were increases (p less than 0.001) in cardiac index from 2.1 +/- 0.73 to 3.3 +/- 0.88 L/min/m2 of body surface area and in left ventricular ejection fraction from 29.0 +/- 6.4 to 42.5 +/- 4.6%. The arteriovenous oxygen difference fell from 36.1 +/- 6.4 to 25.4 +/- 3.8% (p less than 0.001); heart rate did not change significantly (73.3 +/- 5.4 beats/min control; 76.3 +/- 7.9 beats/min after indoramin). Eight patients were studied in the chronic phase. There were no significant changes in systolic or diastolic blood pressure and heart rate in the supine or upright position.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1986

Current concepts in the treatment of cardiac arrhythmias.

Attention has been paid to the recognition of patients at risk of sudden cardiac death. Whereas the long-term prognosis of healthy subjects with frequent and complex ventricular premature complexes is similar to that of the normal population, coronary patients with frequent and complex ectopy are at high risk of sudden cardiac death; in this group, recent myocardial infarction and impaired left ventricular function increase the likelihood for sudden death. In a similar way, patients with idiopathic dilated cardiomyopathy and reduced left ventricular function, in whom frequent episodes of ventricular tachycardias or ventricular pairs are detected, are at high risk of sudden death. These patient groups with left ventricular impairment may potentially be treated with the alpha 1-antagonist indoramin, which has exhibited antiarrhythmic properties in animal experiments. In a therapeutic dose, indoramin prohibited reflex tachycardia but did not show any additional electrophysiologic effects. Therefore, no adverse effects on sinus node function or on atrioventricular conduction, or intraventricular conduction must be expected during therapy with indoramin.

Adolescent↗

PubMed1986

[Improved reproducibility of contrast echocardiography by SH U 454. Experimental studies using digital subtraction echocardiography].

The right heart chambers of 10 animals were contrasted by conventional (NaCl, CO2, H2O2, indocyanine green (ICG), haemaccel) and a newly developed echo-contrast medium (SH U 454) and studied by 2-D echocardiography. By means of digital subtraction echocardiography (DSE) endocardial borders were defined automatically and the results were compared with the manual input of endocardial borders of original and contrast echocardiograms. The area enclosed by these borders served as basis for the calculation of reproducibility (in %) and correlations. The following correlation coefficients (r) and SEE were calculated between the areas defined by the different contrast media and DSE and manually derived borders: r = 0.85, 3.98 cm2 (ICG), and 0.89, 1.00 cm2 (haemaccel). The best calculations were found using SH U 454 in concentrations between 100 and 300 mg/ml. The correlation coefficients were in the range of r = 0.95 and 0.98 with an SEE of 0.21 to 0.56 cm2 between manually and automatically derived contours. Comparing the reproducibility of data between the different evaluation methods we found the following results: manual input of endocardial borders in original echocardiograms 12.3%-16.9%; manual definition of endocardial borders in contrast echocardiograms 2.0% (SH U 454) - 15.7% (CO2); automatic contour finding in original echocardiograms 8.6%-28.9% (mean 21.6%); automatic definition of endocardium by DSE in contrast echocardiograms 7.6% (ICG) - 0.9% (SH U 454, 300 mg/ml). Our results demonstrate that digital subtraction echocardiography is a simple an safe procedure to define endocardial contours if echo contrast media lead to a uniform and homogeneous opacification of the left and right cardiac cavities.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1986

[Echocontrast ventriculography. Determination of left ventricular functional parameters with special reference to digital subtraction echocardiography].

In 57 consecutive patients we examined whether digital subtraction echocardiography (DSE) is able to determine left ventricular function parameters, in particular the ejection fraction (LV-EF). The most important step in DSE consists of the subtraction of digitized grey level information of the original echocardiogram from a phase-identical contrast image. In addition LV-EF, end-diastolic (EDV) and end-systolic volumes (ESV) were calculated by manual definition of endocardium in the original (Na) and contrast-echocardiograms (Ko). The results were then compared with the invasive cardiac catheterisation (Hk) data. We used 5.5% oxypolygelatine (Gelifundol S) as echo-contrast material and injected 2-4 ml as a bolus directly into the left ventricle. LV-EF calculated on the basis of automatic contour definition by DSE demonstrated a better correlation with cineangiographic data (r = 0.89, SEE 5.8% in 44 patients) than the manual input of endocardial borders in original echocardiograms (r = 0.71, SEE 8.1% in 47 patients). Good correlations were also found between EF-Ko and EF-Hk with r = 0.92 and an SEE of 4.3%; because there is a good agreement between EF-Ko and EF-DSE (r = 0.91, SEE 5.3%) these calculations closely approach the results of the invasive data. The EF-Na underestimates the EF-Hk markedly as a consequence of a systematic error: as compared to the contrast image the volumes of the original echocardiograms, in particular the ESV are overestimated and the ejection fraction as a derived parameter is calculated as too small. ESV-Hk versus ESV-Na: y = 0.82x + 24.4, ESV-Hk versus ESV-DSE: y = 0.88x + 37.0.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1986

[A rare pacemaker complication of a perforation by a ventricular screw electrode causing hemothorax].

The myocardial perforation of a pacemaker electrode is an extremely rare complication associated with the danger of cardiac tamponade. We report on a perforation of a ventricular screw-in electrode with migration through the pericardium and bleeding in the left thoracic cavity. Two-dimensional echocardiography in combination with clinical, electrocardiographic and X-ray examination permits a reliable non-invasive diagnosis.

Aged↗

PubMed1985

[Determination of left ventricular global ejection fraction using ECG-gated cardiac computed tomography].

The left ventricular ejection fraction was calculated in 100 patients by means of ECG-gated cardio-CT and the results compared with those obtained by laevo-cardiography. A moderately good correlation of r = 0.736 was obtained. In general, CT under-estimated the ejection fraction. The normal range of the ejection fraction obtained by CT was 62.7% +/- 12.4%. Its specificity was high at 96%, but sensitivity was low, with 48.6%.

Adult↗

PubMed1985

[Automatic and semiautomatic contour finding of the left ventricle in the 2 dimensional echocardiogram. In vitro studies in formalin-fixed swine hearts].

In order to test semiautomatic and automatic contour finding procedures in 2-dimensional echocardiograms we determined endocardial borders in 42 short-axis slices of post-mortem animal hearts after interactive image enhancement such as scaling, normalisation and linearisation of grey levels semiautomatically and automatically by a complex contour finding algorithm. The areas calculated on the basis of these semiautomatic and automatic procedures were compared with "true" anatomic areas derived from planimetry. The complex computer algorithm is based on the detection and analysis of grey level gradients. The algorithm first creates a raw contour which still contains intra- and extracavitary artefacts as well as interrupted endocardial strings. Using a statistical iterative classification procedure and a least-square polynomial approximation the endocardial strings were structured, completed and smoothed and the artefacts eliminated. We were able to determine endocardial contours by semiautomatic methods in 33 (79%) and by automatic procedures in 30 (73%) of the echocardiograms. The correlation between semiautomatic and "true" contours was r = 0.97; y = 1.01x-0.46; standard error of the estimate (SEE) 0.51 cm2, between automatic and "true" contours r = 0.98; y = 0.99x - 0.31; SEE 0.43 cm2; the correlation parameters between the anatomic "true" areas and the areas calculated on the basis of manually derived borders were r = 0.98; y = 0.97x - 0.05; SEE 0.45 cm2. From our studies we conclude that left ventricular endocardium in short axis slices of postmortem animal hearts could reliably and reproducibly be detected by semiautomatic as well as by automatic procedures using a contour finding algorithm.

Animals↗