Search PubMed⌕ Search

Biomedical subjects

F Duru

Publications and source records attributed to F Duru.

At least 19 recordsLinked to original sources
PubMed2007

N-terminal pro-brain natriuretic peptide used for the prediction of coronary artery stenosis.

BACKGROUND: The level of the inactive N-terminal fragment of pro-brain (B-type) natriuretic peptide (NT-proBNP) is a prognostic marker in patients with acute and chronic coronary artery disease (CAD). It might also be valuable for non-invasive diagnosis of coronary artery disease. MATERIALS AND METHODS: The NT-proBNP was measured in 781 consecutive patients with normal left ventricular function referred for coronary angiography owing to symptoms or signs of CAD. The diagnostic value of NT-proBNP was assessed for predicting CAD at angiography. RESULTS: Elevated NT-proBNP levels were associated with the extent of CAD and with the female sex (P < 0.001). The ability of NT-proBNP to predict significant coronary disease at angiography was assessed separately for men using a cut-off point of 85 pg mL(-1), positive likelihood ratio 2.2 (95% CI, 1.7-3.0), negative likelihood ratio 0.53 (95% CI 0.45-0.63) and area under the receiver-operating-characteristic (ROC) curve 0.72: for women, it was assessed using a cut-off point of 165 pg mL(-1), positive likelihood ratio 2.4 (95% CI, 1.7-3.4), negative likelihood ratio 0.55 (95% CI, 0.44-0.70) and area under ROC curve 0.71. In multiple logistic-regression analysis, NT-proBNP added significant independent predictive power to other clinical variables in models predicting CAD (odds ratio 2.76, 95% CI, 1.76-4.32, P < 0.001). CONCLUSIONS: The NT-proBNP is a marker of non-obstructive CAD and of significant coronary stenosis. In conjunction with other clinical information, measurement of NT-proBNP with the use of sex-specific reference ranges may improve the non-invasive prediction of CAD.

Aged↗
PubMed2005

Radar soundings of the ionosphere of Mars.

We report the first radar soundings of the ionosphere of Mars with the MARSIS (Mars Advanced Radar for Subsurface and Ionosphere Sounding) instrument on board the orbiting Mars Express spacecraft. Several types of ionospheric echoes are observed, ranging from vertical echoes caused by specular reflection from the horizontally stratified ionosphere to a wide variety of oblique and diffuse echoes. The oblique echoes are believed to arise mainly from ionospheric structures associated with the complex crustal magnetic fields of Mars. Echoes at the electron plasma frequency and the cyclotron period also provide measurements of the local electron density and magnetic field strength.

Journal Article↗
PubMed2005

Simple criteria for differentiation of Fabry disease from amyloid heart disease and other causes of left ventricular hypertrophy.

AIMS: Fabry disease may be difficult to differentiate from other causes of left ventricular hypertrophy such as other myocardial storage diseases (including amyloidosis), hypertrophic cardiomyopathy (HCM), or hypertensive heart disease (HHD). We sought to determine simple criteria to best differentiate the above mentioned cardiac diseases. METHODS AND RESULTS: All patients in a six-year time period with left ventricular hypertrophy due to Fabry disease (13 patients), biopsy proven cardiac amyloidosis (16 patients), non-obstructive HCM (17 patients), and 22 randomly selected patients with advanced HHD were compared. Retrospective analysis of clinical characteristics, findings of electrocardiogram (ECG) and echocardiography by blind review was performed. RESULTS: No single clinical characteristic or findings of ECG or echocardiography could reliably differentiate between the various diseases. Increased echogenicity/granular sparkling, valvular abnormalities, abnormal renal function, and diastolic function were not helpful discriminators. In a univariate analysis, four criteria (acroparesthesia, anhydrosis, absence of hypertension and presence of Sokolow criteria for left ventricular hypertrophy in the ECG) were significant for Fabry disease. By logistic regression analysis, the following most suitable discriminative parameters were identified: hypertension in HHD (specificity 82%), orthostasis and/or pericardial effusion for amyloidosis (specificity 93%), papillary muscle anomaly in non-obstructive HCM (specificity 92%), and Fabry disease if neither hypertension orthostatis, pericardial effusion nor a papillary muscle anomaly was present (specificity 87%). CONCLUSION: A combination of symptoms, echocardiographic findings and ECG in unexplained left ventricular hypertrophy may help to differentiate amyloidosis, non-obstructive HCM and hypertensive heart disease from Fabry disease. The results of this preliminary study will have to be confirmed in a prospective study.

Adult↗
PubMed2005

[Diagnostic yield of the implantable loop recorder to detect the mechanism of syncope--a single center long term experience of a tertiary care center].

AIM: The aim of this study was to investigate the usefulness in providing diagnostic information about syncope by implantation of a loop recorder (ILR). METHODS AND RESULTS: The study population consisted of 48 consecutive patients (23 male, 25 female, mean age 42 +/- 17) with unexplained syncope who presented between 1998 and 2002 and underwent extensive cardiological screening and were followed with an implantable loop recorder (Reveal or Reveal Plus). The mean follow-up duration was 9 +/- 6 months. During this follow-up in 17 (35%) patients syncope recurred. Arrhythmia correlating with syncope was documented in 15 (88%) of these patients, in 2 (12%) patients an arrhythmia could be excluded. Of these 15 patients with arrhythmogenic cause of syncope 5 (33%) patients revealed higher degree AV-Block, 7 (47%) patients sinus bradycardia or sinus pauses, 4 (27%) due to sick sinus syndrome and 3 (20%) due to neurally mediated syncope, 3 (20%) patients had atrial tachycardias or atrial fibrillation with rapid AV-conduction. As a result of ILR findings 12 pacemakers were implanted and 2 radiofrequency ablations were performed. CONCLUSION: The ILR is a valuable and effective tool to establish an arrhythmic cause for unexplained syncope. In these cases they have an impact on subsequent clinical decision making. ILR can also be useful in ruling out arrhythmias as cause of syncope and presyncope.

Adult↗
PubMed2005

Predictors of adverse outcome in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy: long term experience of a tertiary care centre.

OBJECTIVE: To investigate the predictors for adverse clinical outcome in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) during long term follow up. METHODS: 61 patients with ARVD/C were studied to assess the impact of family history, clinical findings, surface ECG parameters, echocardiographic findings, and electrophysiological findings on clinical outcome. The prevalence of these risk factors were compared in two patient groups: group A (patients with adverse clinical outcome: sudden cardiac death, death from heart failure, or heart transplant) and group B (survivors excluding patients who received a heart transplant). RESULTS: Mean age at first diagnosis was 44 (14) years. The mean follow up duration was 55 (47) months. Ten patients (16%) died during follow up. The cause of death of eight of these patients was probably arrhythmic. Two patients died of advanced heart failure. Five patients underwent heart transplantation because of terminal heart failure. Risk factors significantly associated with adverse outcome were history of congestive heart failure (p < 0.001), the presence of left ventricular involvement on echocardiography (p < 0.001), left atrial dilatation (p < 0.05), prolonged PR duration (p < 0.01), prolonged QRS in V1 (p < 0.05), and bundle branch block (p < 0.05). In multivariate analysis, history of congestive heart failure and presence of left ventricular involvement were identified as independent risk predictors for an adverse outcome. CONCLUSIONS: Congestive heart failure and left ventricular involvement are independently associated with adverse outcome in patients with ARVD/C during long term follow up.

Adult↗
PubMed2004

[Electrophysiological study: procedure and indications].

The purpose of an electrophysiological study is to verify the mechanism of arrhythmias and to decide the means of therapy for the clinical arrhythmia (pharmacological, radiofrequency catheter ablation, pacemaker-, ICD-implantation). The electrode catheters are introduced percutaneously into the right atrium, to the His-bundle, into the coronary sinus and/or into the right ventricle. By this electrode catheters the intracardiac electrograms are registered and programmed stimulation of the heart is performed. The electrical conduction properties are analysed. With stimulation manoeuvres most of the clinical tachycardias can be induced. In the first part of this overview we describe the procedure of an electrophysiological study, in the second part the indications are discussed.

Anti-Arrhythmia Agents↗
PubMed2004

[Atrila fibrillation: a review].

Atrial fibrillation (AF) is the most common sustained arrhythmia and increases exponentially with age. The physiologic basis are certain triggers initiating multiple micro-reentry circuits, which require a certain amount of "myocardial mass" to be sustained. There are numerous predisposing factors for AF, mostly leading to dilatation or hypertrophy of the atrial myocardium. Lone AF, however, occurs in structurally normal hearts. In the management of AF it is mandatory to decide between medical or electrical cardioversion in persistent AF and rate control in permanent AF. Medical cardioversion or prophylaxis of recurrence can be performed with Class IA, IC or Class III antiarrhythmic drugs. The choice of drugs depends on the underlying cardiac pathology of the individual patient. Patients with long duration of poor rate control during AF are at risk for tachycardia-induced cardiomyopathy. Cardioversion is safe to be performed within 48 hours after the onset of AF without prior and--if there is no risk of recurrence--without consecutive anticoagulation. When AF persists longer than 48 hours, anticoagulation for three weeks is mandatory prior to attempted cardioversion, or alternatively, transesophageal echocardiography can be performed to exclude the presence of an intraatrial thrombus. Anticoagulation has to be maintained for a minimum of four weeks after the restoration of sinus rhythm. Anticoagulation is required for paroxysmal, persistent and permanent AF. Lone atrial fibrillation in patients under the age of 60 years is an exception to these rules and does not require anticoagulation. In case of refractory AF with poor rate control, catheter ablation of the AV node with pacemaker implantation is the treatment of last choice. Early attempts to provide a cure for AF included the surgical "Maze" procedure, followed by linear catheter ablation with the goal of reducing the atrial mass. Catheter ablation of the triggers of AF, which mainly originate at the pulmonary veins and the "substrate modification" have been introduced in the last couple of years and is performed increasingly in specialized EP centers.

Anti-Arrhythmia Agents↗
PubMed2004

[ICD therapy in patients with coronary artery disease--incidence of adequate interventions].

BACKGROUND: The Implantable Cardioverter/Defibrillator (ICD) represents the therapy of choice for patients at risk of malignant ventricular arrhythmias. The survival benefit of the ICD vs antiarrhythmic therapy in patients with coronary artery disease and ventricular tachycardia has been proven. Recently, the ICD therapy has also been established for primary prevention in high risk patients. We report about the incidence of adequate ICD therapies in patients with coronary artery disease, who underwent ICD implantation at the University Hospital Zurich. METHODS: 104 consecutive patients (97 men, 7 women, mean age of 67 +/- 10 years) with coronary artery disease, who underwent ICD implantation in accordance with the AHA/ACC/NASPE guidelines between January 2000 and July 2003 were included in the study. Follow-up was performed every three to six months, when all ICD therapies were documented. This documentation was used for analysis of adequate or inadequate ICD therapies. RESULTS: The mean follow-up time was 383 +/- 195 days. The time to the first adequate therapy was 201 +/- 283 days. The cumulative incidence for the first adequate therapy was 21% at six months, 39% at two years and 59% at four years. In 64% of patients, who experienced adequate ICD therapies, antitachycardia pacing (ATP) and in 36% an initial shock was delivered. ATP was successful in 83% of adequately delivered episodes. In the follow-up period 12 patients died. CONCLUSION: The benefit of the ICD was apparent in patients at risk for ventricular arrhythmias and coronary artery disease after a relatively short period of time, which underlines the important role of the ICD in primary and secondary prevention.

Aged↗
PubMed2003

[Catheteer ablation technique of atrial fibrillation].

Atrial fibrillation is the most frequent arrhythmia with a prevalence of 1.7% in the general population and 5% in the population over 65 year old [1], the prevalence in men over 65 years is even 9.1% [2]. Atrial fibrillation is divided dependent on its frequency in intermittent, persisting and chronic. The symptoms and the clinical course are individually very different. Responsible for the initiation of atrial fibrillation are triggers, which initiate atrial fibrillation, and a substrate, that means an atrial myocardium altered by remodelling, which maintains atrial fibrillation. A curative treatment was not available until recently. Different ablation techniques were developed: Linear, focal ablation techniques and the isolation of pulmonary veins. The observation that atrial fibrillation will maintain only in large atria, led to the linear ablation techniques with the goal of reducing the atria functionally. The linear ablations have however a small value because of low success rates and high complication rates. Arrhythmogenic foci are of crucial importance in the initiation of atrial fibrillation, these foci are mostly located in the pulmonary veins. This observation led to the focal ablation in the pulmonary veins, which was left again because of the limitations, however. For some years the isolation of pulmonary veins is performed at some large centers. This paper summarizes the most important techniques, success rates and complications of the pulmonary vein isolation. The present indication and the preinterventional diagnostics are discussed. Due to the constantly improving success rates and decreasing complication rates (pulmonary vein stenosis, thrombembolie, cardiac tamponades, mortality practically) the pulmonary vein isolation is an alternative possibility of treatment which can be considered for a subgroup of patients with drug-resistant, symptomatic atrial fibrillation.

Atrial Fibrillation↗
PubMed2003

Osteopetrosis and Glanzmann's thrombasthenia in a child.

Autosomal recessive osteopetrosis is a rare, fatal disease characterized by accumulation of excessive bone mass due to defective bone resorption. The pathogenesis of osteopetrosis is controversial. Osteoblast-osteoclast interaction defects, incorrect differentiation of osteoclasts, abnormal contact between osteoclast and extracellular matrix, and abolished signaling are included in this process. Recently, mutations in the gene of the vacuolar proton pump have been described in some cases of recessive osteopetrosis. Glanzmann's thrombasthenia (GT) is a rare hereditary qualitative platelet disorder characterized by a lifelong bleeding tendency due to quantitative and qualitative abnormalities of the platelet integrin alpha(IIb) beta3. Several mutations on either integrin alpha(IIb) [glycoprotein (GP) IIb] or integrin beta(3) (GP IIIa) were reported in GT. We report on a patient with autosomal recessive osteopetrosis concurrently diagnosed with variant type Glanzmann's thrombasthenia. To our knowledge, our patient was the first case reported in the literature in which osteopetrosis and Glanzmann's thrombasthenia were diagnosed together.

Genes, Recessive↗
PubMed2003

[Stress, depression and cardiac arrhythmias].

A relationship between behavioural factors and cardiac arrhythmogenesis in humans has been described. Three sets of conditions contribute to the occurrence of arrhythmias: myocardial electrical instability, most often due to coronary artery disease; an acute triggering event, frequently related to mental stress; and a chronic, pervasive, and intense psychological state, often including depression and hopelessness. The autonomic nervous system plays an important role in the occurrence of cardiac arrhythmias and it is well documented that mood alterations as mental stress and depression influence cardiac autonomic balance. There is an increasing body of evidence that patients with the greatest changes in cardiac neural regulation with decreased parasympathetic tone coupled with increased sympathetic activity are at the greatest risk for developing fatal ventricular arrhythmias. These patients have a reduced heart rate variability, increased QT-dispersion and a decreased baroreceptor sensitivity. The influence of stress and depression on the autonomic nervous system and the impact on the occurrence of both atrial and ventricular arrhythmias is being discussed.

Arousal↗
PubMed2002

[Radiofrequency catheter ablation of ventricular tachycardias].

Management of patients with ventricular tachycardia (VT) is often difficult. Drug therapy is often ineffective. Implantable cardioverter defibrillators (ICDs) can terminate VT episodes but do not prevent them. Radiofrequency (RF) catheter ablation can suppress arrhythmias in selected patients. However, the procedure is often challenging and success rates lower than for ablation of supraventricular tachycardias. The mapping and ablation approach depends on the VT mechanism. Monomorphic VT in patients without structural heart disease is referred to as idiopathic and has a focal origin. These VTs can be abolished by ablation in most of the patients. In VT due to reentry within an area of scar from an old myocardial infarction or cardiomyopathic process, critical parts of the circuit may be difficult to localize, rendering RF ablation challenging. In patients with monomorphic VT, prevention of VT recurrence can be achieved in 55% to 80% of patients. Multiple morphologies of VTs and circuits that are located deep in the endocardium are common problems that reduce efficacy. Furthermore, mapping to identify target regions for ablation can be more difficult if VT is rapid and not tolerated, or not inducible. Recently, multisite mapping of the arrhythmia substrate during sinus rhythm or multisite activation mapping of a few VT beats were shown to be effective for ablation of these "unmappable VTs". Bundle branch reentry tachycardia occur in patients with nonischemic cardiomyopathies, mostly valvular heart disease and can be successfully abolished with RF ablation of the right bundle. However, some of these patients may develop recurrences due to other types of VT. Recent technical developments have increased efficacy and simplified the approach of RF ablation of VT in patients with structural heart disease. However, long-term efficacy is not accurately predictable and implantation of an ICD is mandatory in most of the patients with severely depressed left ventricular function.

Cardiomyopathy, Dilated↗
PubMed2002

ICD implantation with and without combined myocardial revascularisation--incidence of ICD therapy and late survival.

BACKGROUND: Our aim was to evaluate the occurrence of implanted cardioverter-defibrillator (ICD) shock and antitachycardia pacing (ATP), the effect of ICD therapies on mortality and the impact of revascularisation strategies on arrhythmic events. PATIENTS AND METHODS: We investigated 130 CAD patients undergoing ICD implantation between 1984 and 1999. RESULTS: Freedom of shock was 66 +/- 7 %, 48 +/- 9 % and 48 +/- 9 % after 1, 3 and 5 years in patients with revascularisation and 62 +/- 8 %, 43 +/- 8 % and 23 +/- 11 % in patients without revascularisation, respectively; p = n. s. Freedom from ATP was similar in both groups - in patients with revascularisation, 64 +/- 6 %, 58 +/- 7 % and 58 +/- 7 % and without revascularisation 56 +/- 8 %, 51 +/- 9 % and 38 +/- 10 %, respectively; p = n. s. There were no significant differences in cumulative survival between patients with and without revascularisation; p = n. s. CONCLUSIONS: CAD patients with VT/VF and with implanted ICD have, despite successful revascularisation, the same rate of device therapy and mortality as patients without an indication of revascularisation. This implies that patients with chronic ischemic heart disease and ventricular tachyarrhythmias continue to be at risk of sudden death after CABG/PTCA; evaluation for ICD implantation is warranted.

Angioplasty, Balloon, Coronary↗
PubMed2002

Spontaneous haemothorax: an uncommon presentation of Glanzmann thrombasthenia.

UNLABELLED: Glanzmann thrombasthenia is a rare hereditary qualitative platelet disorder characterized by a lifelong bleeding tendency due to quantitative and qualitative abnormalities of the platelet integrin alpha(IIb)beta3. Common clinical manifestations include purpuric type skin bleeding, prolonged bleeding from minor cuts, epistaxis, gingival bleeding and menorrhagia. Less frequently, gastrointestinal system bleeding may occur. Haemarthrosis, haematuria, intracranial and visceral haemorrhage are very rare symptoms. This study reports a 3-y-old girl with Glanzmann thrombasthenia who presented with life-threatening haemothorax. There was no history of recent trauma or drug usage and no vascular or parenchymal abnormalities to explain the development of haemothorax. CONCLUSION: To the authors' knowledge this is the first case of Glanzmann thrombasthenia complicated by spontaneous haemothorax.

Child, Preschool↗
PubMed2001

[Ventricular tachycardia].

In patients with ventricular tachycardias, various structural and functional conditions can be influenced by certain triggers, initiating the mechanism of the arrhythmia. Thorough understanding of these different factors is paramount for the appropriate choice of treatment. Several options are available for the management of ventricular tachycardias: antiarrhythmic drugs, ICD implantation and catheter ablation or a combination of the above. The prognosis of an individual patient is determined by the underlying disease, the mechanism of tachycardia and the selected therapy. The complexity of several conditions requires a specialized diagnostic approach and tailored medical management. Therefore the patients with the following diagnoses should be referred to a specialized electrophysiology center: survivors of sudden cardiac death old infarct scar, reduced ejection fraction and complex ectopy Cardiomyopathy with syncope or ventricular tachycardias Long QT-Syndrome Brugada Syndrome Right Ventricular Dysplasia recurrent syncopes of unclear etiology.

Anti-Arrhythmia Agents↗