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Biomedical subjects

F Schwarz

Publications and source records attributed to F Schwarz.

At least 55 records · Page 3Linked to original sources
PubMed1991

[Acute vascular occlusion caused by percutaneous transluminal coronary angioplasty: early and late results of repeat-PTCA].

UNLABELLED: Acute vascular occlusion after percutaneous transluminal coronary angioplasty (PTCA) often necessitates a prompt aortocoronary bypass-operation (CABG). Alternatively, a re-PTCA can be attempted. In 1500 consecutive patients there was acute symptomatic occlusion due to PTCA 5 min to 16 h after the operation in 47 cases (3.1%). An immediate re-PTCA was attempted in all cases. RESULTS: Reopening was successful in 43 of 47 cases (91%): in 15 patients (30%) within 30 min, in 36 patients (68%) within 60 min and in 42 patients (89%) within 90 min. In eight patients there was early re-occlusion 30 min to 20 h after re-PTCA, necessitating acute CABG in four patients. In 35 patients with re-PTCA the vessel remained open. Re-stenosis occurred within 1 to 10 days in 10 patients, and in additional 12 patients after 2-4 months. In most cases an additional PTCA was successful. COMPLICATIONS: Six patients had an emergency CABG (three with an exchange wire as a stent in the dissected coronary artery). Three patients died (one after CABG); 14 patients experienced myocardial infarction (30%) (in three of these 14 the infarct was large). CONCLUSION: Acute vascular occlusion after PTCA can successfully be treated by re-PTCA in four of five cases. However a rate of re-stenosis of about 60% is to be anticipated. Reperfusion with re-PTCA is fast and in these patients with transmural ischemia there are obviously less complications in comparison to emergency CABG after PTCA. 60% of the patients remain symptom free or markedly improved and without infarction or emergency CABG after 4 months.

Angina Pectoris↗
PubMed1990

[Long-term success of coronary angioplasty after repeated treatment].

To ascertain the long-term results after second and third angioplasties for coronary stenosis the coronary angiograms from 1504 consecutive patients with coronary heart disease (1211 men, 293 women, mean age 57 [27-82] years) were retrospectively surveyed. A good initial response (at least 20% reduction in stenosis) was achieved in 295 out of 306 second angioplasties (95.5%), and in all 36 third angioplasties. Viewed overall, these results are significantly better (P less than 0.005) than those achieved at the initial angioplasty (1386 out of 1504 patients; 92.2%). The reduction in the severity of the stenosis achieved at the second angioplasty (from 86 to 24%) and at the third angioplasty (from 86 to 26%) was the same as at the first angioplasty (from 88 to 28%). Serious complications after the first angioplasty were infrequent (death in 0.2%, emergency bypass in 0.4%, myocardial infarction in 0.5%), and no complications were noted after second and third angioplasties. A good long-term outcome (at least 20% reduction in stenosis at 3-4 months) was slightly more frequent after the second and third angioplasties (103 out of 170 [60.6%] and 14 out of 17 patients, respectively) than after the first intervention (532 out of 926 patients; 57.5%). In keeping with these results, the degree of stenosis found at follow-up angiography was significantly lower (first intervention 54.8%, second intervention 50.3%, third intervention 36.9%). There were only 57 patients (3.8%) who ultimately required operative treatment. These figures indicate that the probability of a good long-term outcome from coronary angioplasty increases each time the stretching operation is repeated. Only a very small proportion of patients will require bypass surgery.

Adult↗
PubMed1990

[Treatment of coronary heart disease in the aged. When balloon dilatation, when surgery?].

Data from 3029 consecutive patients (2474 men, 555 women, mean age 59 [20-88] years) in whom coronary heart disease had been diagnosed by coronary angiography were studied with the object of identifying those patients in the older age group who are suitable for treatment by balloon angioplasty. There were 884 patients with a mean age of 70 (65-88) years, and 2145 patients with a mean age of 54 (20-64) years. Single vessel disease was less common in older patients (30% vs 44%; P less than 0.001), double vessel disease was equally common in both groups (28% vs 30%) and triple vessel disease was commoner in the elderly group (42% vs 26%; P less than 0.001). For elderly patients with single vessel disease conservative treatment was chosen in 50%, angioplasty in 49% and operative treatment in only 1%. Of elderly patients with involvement of two arteries, 44% were treated conservatively, 40% by angioplasty and 16% surgically. Of elderly patients with triple artery disease, 23% were treated conservatively, 8% by angioplasty and 69% operatively. This pattern was similar to that among younger patients. The success rate and the incidence of complications after percutaneous transluminal coronary angioplasty were similar in both age groups. In elderly patients with disease of only one or two coronary arteries the prospects of success and the risks are comparable to those in younger patients, but patients with triple artery disease often need bypass surgery.

Adult↗
PubMed1989

Four-year follow-up study in patients with angina pectoris and normal coronary arteriograms ("syndrome X")

In patients with typical stress-induced anginal pain, normal coronary arteries, and unimpaired left ventricular performance at rest ("syndrome X"), a reduced coronary dilatory capacity, abnormal lactate metabolism during stress, and reduction of left ventricular functional reserve have been described. A group of 40 patients with syndrome X was followed for several years to determine their long-term prognosis. In 27 patients pulmonary artery pressure and in 19 patients left ventricular ejection fraction were reassessed during rest and exercise approximately 4 years after the initial examination. In patients with stress-induced ST-segment depression, these variables did not change during the observation period. In patients with constant or rate-dependent left bundle branch block, however, there was significant deterioration of left ventricular performance during rest (pulmonary artery mean pressure, 16 +/- 3 vs. 17 +/- 4 mm Hg, p = NS; left ventricular ejection fraction, 62 +/- 5% vs. 55 +/- 5%, p less than 0.05) and exercise (pulmonary artery, 30 +/- 6 vs. 39 +/- 10 mm Hg, p less than 0.005; left ventricular ejection fraction, 59 +/- 6% vs. 49 +/- 5%, p less than 0.01). These findings suggest that in syndrome X two subgroups with distinctly different prognoses may be defined: In patients with stress-induced ST-segment depression during exercise, left ventricular performance remains well preserved; however, in patients with either constant or rate-dependent left bundle branch block, there is significant deterioration of left ventricular function within several years.

Angina Pectoris↗
PubMed1989

[Diagnosis of cardiac causes of cerebral embolism: a contribution to 2D echocardiography and long-term ECG].

Certain cardiac diseases are regarded as potential sources of embolic strokes. Due to the high risk of recurrent brain embolism diagnosis of a potential cardiac source implies therapeutic consequences in most cases. The contribution of 2D-echocardiography and of ECG Holter monitoring to the detection of possible cardiac sources of cerebral embolism is not yet fully established. We therefore performed 2D-echocardiography and 24-h Holter monitoring in 135 consecutive patients with regional cerebral ischemia. In 17 (12.6%) out of the 135 patients a potential cardiac source of cerebral embolism was found, four of them presented with two cardiac disorders compatible with a cardiac source of embolism. In 10 patients a cardiac disease as potential source of cerebral embolism was already detected during routine examination. 2D-echocardiography disclosed no cardiac embolic source, which was not suspected before but confirmed the diagnosis in five cases. Holter monitoring identified 16 cases with arrhythmias, which may cause systemic embolism. Among these cases seven were not detected during the routine examinations, all of them suffered from intermittent atrial fibrillation. It is concluded that Holter monitoring contributes more than 2D-echocardiography to disclose hitherto unsuspected potential cardiogenic sources of brain embolism.

Adult↗
PubMed1988

[Acute myocardial infarct: myosin-light-chain liberation and ventricular function].

Infarct size can be estimated noninvasively by analysis of circulating CK-MB and/or cardiac myosin light chains. To investigate whether myosin light chains release is correlated with the impairment of left ventricular function in acute myocardial infarction, this marker protein was determined by liquid phase radioimmunoassay in serial blood samples of 25 patients. Likewise CK-MB was measured in the same blood samples. From the serum concentration changes the cumulative appearance was calculated as an estimate of infarct size. Left ventricular end diastolic pressure, global and regional ejection fraction were measured immediately and 3 weeks after admission. Particularly during the chronic phase of myocardial infarction a close correlation was found between serological estimates of infarct size and impairment of left ventricular function. The cumulative appearance of myosin light chains was superior to CKMB in assessing the hemodynamic impact of myocardial infarction in the acute and chronic stage. Therefore, myosin light chains are an appropriate serological indicator for the hemodynamic significance of myocardial infarction during the acute and chronic stage and might allow an assessment of the patients' risk.

Cardiac Output↗
PubMed1988

Efficacy of intravenous prourokinase and a combination of prourokinase and urokinase in acute myocardial infarction.

Fifty-four patients with Q-wave acute myocardial infarction (AMI) were treated with heparin combined with intravenous single-chain urokinase-type plasminogen activator (prourokinase). To determine the optimal treatment regimen, prourokinase was applied in 3 different ways: group I received a bolus of 7.5 mg and a subsequent infusion of 40.5 mg over 60 minutes. Patency of the infarct artery was observed in 7 patients (50%) at the end of the infusion time. One hour after the end of the infusion the fibrinogen level had decreased to 87 +/- 12% of the preinfusion level; the plasminogen and alpha-2 antiplasmin levels to 61 +/- 13% and 59 +/- 34%, respectively. In group II prourokinase was administered as a 7.5 mg bolus followed by 66.5 mg over 60 minutes. Eleven patients (55%) had patent infarct-related coronary arteries and fibrinogen, plasminogen and alpha-2 antiplasmin levels had decreased to 58 +/- 29%, 38 +/- 18% and 21 +/- 14%, respectively. Group III was treated with a bolus of 3.7 mg prourokinase and 250,000 IU urokinase followed by 44.3 mg prourokinase, resulting in a patency rate of 65% (13 patients). Fibrinogen, plasminogen and alpha-2 antiplasmin levels decreased to 76 +/- 15%, 67 +/- 15% and 47 +/- 29%, respectively. Fibrin-specific thrombolysis can be achieved with glycosylated prourokinase. At higher dosages considerable systemic activation of the fibrinolytic system with little enhancement of the observed therapeutic effect occurred. The combination of prourokinase and urokinase yielded a higher patency rate than either dosage of prourokinase alone, although the difference was not statistically significant in this pilot trial.

Clinical Trials as Topic↗
PubMed1988

Long-term prognostic significance of ventricular arrhythmias in idiopathic dilated cardiomyopathy.

The prognostic significance of ventricular arrhythmias in idiopathic dilated cardiomyopathy is controversial. Thus, 73 patients with idiopathic dilated cardiomyopathy who had both 24-hour Holter monitoring and angiography were followed for greater than or equal to 3 years. Twenty-eight patients (38%) died, 14 patients (19%) due to pump failure and 14 patients (19%) due to sudden death. Univariate analysis revealed ventricular tachycardias as a major risk indicator, among others. However, multivariate analysis determined the major independent risk factors in the following order: patients who died from pump failure, left ventricular filling pressure, left bundle branch block, the number of beats in the longest episode of ventricular tachycardia and left ventricular ejection fraction; patients who died from sudden death, left bundle branch block and left ventricular ejection fraction, but not any form of ventricular arrhythmias. Reclassification by means of the risk factors resulted in a meaningful identification of patients who died from pump failure; however, patients who died from sudden death could not be separated from survivors. Thus, in the present study Holter monitoring was unable to distinguish between patients who died from subsequent pump failure and patients who died from subsequent sudden death.

Adolescent↗
PubMed1988

What is established in thrombolytic therapy of acute myocardial infarction? Pharmacological approaches.

Thrombolytic therapy by early reopening of an occluded coronary vessel, and hence re-establishing oxygen delivery, can significantly reduce infarct size. The result depends both on the duration of ischemia and the presence of collaterals. By early initiation of intravenous thrombolytic therapy and shortening the ischemic period, the functional results may be improved. PTCA has to be considered in order to avoid reocclusion of the infarct vessel, mainly in patients with high-grade residual stenosis and viable myocardium in the poststenotic area. The benefit of early thrombolytic therapy in acute myocardial infarction has been proven in randomized trials. However, to achieve statistical significance, a large number of patients had to be included. It is mainly the patients with previous myocardial infarction with a large area at infarct risk and/or anterior myocardial infarction that derive most benefit from this intervention.

Acute Disease↗
PubMed1988

Non-invasive assessment of infarct reperfusion: the predictive power of the time to peak value of myoglobin, CKMB, and CK in serum.

Intravenous thrombolytic therapy has become a routine therapeutic intervention in acute myocardial infarction. In order to evaluate its success in the general hospital community noninvasive methods are needed. Therefore, the effect of infarct reperfusion on the times to peak value of myoglobin, CKMB, and CK were studied in patients with acute myocardial infarction. Recanalization of the occluded coronary artery was achieved by intracoronary infusion of streptokinase in eight patients within 3.5 h, and in 18 patients more than 3.5h after onset of pain. In 10 patients, the coronary artery remained occluded, and in eight patients thrombolysis was not attempted. Analyzing the times to peak value of myoglobin, CKMB, and CK, the probability of correct classification of infarct reperfusion varied between 1 and 0.9, if recanalization was achieved within 3.5 h after onset of pain. The predictive power could be improved further by a combined analysis of the times to peak value of both myoglobin and CK. In cases where reperfusion was achieved more than 3.5 h after the onset of pain, the probability of correct classification of infarct reperfusion varied between 0.99 and 0.05. Among the marker proteins analyzed, myoglobin allowed the earliest and best discrimination between reperfusion or no reperfusion. Thus, by applying the time to peak value analysis, infarct reperfusion can only be predicted reliably if it is achieved early after onset of pain.

Clinical Enzyme Tests↗
PubMed1988

Primary and secondary long-term prophylaxis of thromboembolism in outpatients with the low-molecular-weight heparin Kabi 2165.

Bleeding episodes and other side effects may complicate the treatment with oral anticoagulants. We report on the results of 66 patients who were treated with a low molecular weight heparin fraction for up to 19 months. The data of the study demonstrate the effective long-term anticoagulation with low-molecular-weight heparin and the reduced incidence of hemorrhages compared with conventional anticoagulants. Thus, low-molecular-weight heparin may be effectively and safely used for long-term anticoagulation in patients with bleeding problems on conventional anticoagulants.

Clinical Trials as Topic↗
PubMed1988

Low-fat diet and regular, supervised physical exercise in patients with symptomatic coronary artery disease: reduction of stress-induced myocardial ischemia.

The effects of physical exercise and normalization of serum lipoproteins on stress-induced myocardial ischemia were studied in 18 patients with coronary artery disease, stable angina pectoris, and mild hypercholesterolemia (total serum cholesterol 242 +/- 32 mg/dl). These patients underwent a combined regimen of low-fat/low-cholesterol diet and regular, supervised physical exercise at high intensity for 12 months. At 1 year serum lipoproteins has been lowered to ideal levels (serum cholesterol 202 +/- 31 mg/dl, low-density lipoproteins 130 +/- 30 mg/dl, very low-density lipoproteins 22 +/- 15 mg/dl, serum triglycerides 105 [69 to 304] mg/dl) and physical work capacity was improved by 21% (p less than .01). No significant effect was noted on high-density lipoproteins, probably as a result of the low-fat/high-carbohydrate diet. Stress-induced myocardial ischemia, as assessed by thallium-201 scintigraphy, was decreased by 54% (p less than .05) despite higher myocardial oxygen consumption. Eighteen patients matched for age and severity of coronary artery disease served as a control group and "usual medical care" was rendered by their private physicians. No significant changes with respect to serum lipoproteins, physical work capacity, maximal rate-pressure product, or stress-induced myocardial ischemia were observed in this group. These data indicate that regular physical exercise at high intensity, lowered body weight, and normalization of serum lipoproteins may alleviate compromised myocardial perfusion during stress.

Body Weight↗
PubMed1988

[5-year survival rate in acute transmural heart infarct following thrombolysis and immediate coronary angioplasty].

Two-hundred-eighty-six patients with acute transmural myocardial infarction underwent thrombolytic treatment (Streptokinase) between 1980 and 1986. In the earlier years patients were treated by thrombolysis only (n = 158) and in more recent years by thrombolysis followed by immediate percutaneous transluminal coronary angioplasty (n = 128). Age, sex, incidence of previous infarction and incidence of multivessel disease were comparable between groups. Patency of the infarct vessel (TIMI 3) was higher after thrombolysis combined with angioplasty than after thrombolysis alone (87% vs. 70%, p less than 0.001), and the residual stenosis of the infarct vessel was lower (46% vs. 84%, p less than 0.05). Hospital mortality (thrombolysis combined with angioplasty vs. thrombolysis alone) was 6% vs. 13%; one-year mortality was 8% vs. 21%, and five-year mortality was 18% vs. 31% (p less than 0.02). We conclude that treatment of patients with acute transmural myocardial infarction by thrombolysis combined with angioplasty is followed by a better long-term prognosis than treatment by thrombolysis only.

Angioplasty, Balloon↗
PubMed1987

[Balloon dilatation in unstable angina pectoris and acute myocardial infarct].

Early results after percutaneous transluminal coronary angioplasty (PTCA) in patients with unstable angina or acute myocardial infarction were compared with those in patients with stable angina. The primary success rate in 115 patients with unstable angina was 72%, in 73 with acute myocardial infarction 78%, and in 213 with stable angina 79%, i.e. there was no difference between the three groups. In patients with acute myocardial infarction and primary successful PTCA control angiography was performed one month after PTCA, in patients with unstable and stable angina 6 months after PTCA. Angiographic findings were identical in the three groups. But the results after successful balloon dilatation were dependent on the extent of primary success: in all three groups, patients in whom the post-dilatation control angiography revealed recurrence of stenosis the primary results were worse than in those without. There was no difference between those patients with lasting success and those with recurrence as regards cholesterol level, arterial hypertension, diabetes, and smoking habits. It is concluded that in every patient with acute symptoms of coronary heart disease the indication for PTCA should be considered.

Angina Pectoris↗
PubMed1987

Holter monitoring before, during and after percutaneous transluminal coronary angioplasty for evaluation of high-resolution trend recordings of leads CM5 and CC5 for ST-segment analysis.

Frequency-modulated Holter monitoring of leads CM5 and CC5 was performed before, during and after percutaneous transluminal coronary angioplasty (PTCA) in 16 patients with stenosis of the left anterior descending coronary artery, in 5 patients with stenosis of the left circumflex coronary artery, and in 5 patients with stenosis of the right coronary artery. All patients presented with 1-vessel coronary artery disease and stable or unstable angina pectoris. ST-segment analysis was based on high-resolution trend recordings. During balloon inflations all patients had significant (at least 0.1 mV) ST-segment changes in lead CM5. In lead CC5, associated ST-segment deviations were found in 22 of 26 patients. During 29.2 +/- 13.6 hours before PTCA, 90 spontaneous episodes with significant ST-segment deviations were detected in 10 patients. Of these episodes, 17% were characterized by ST-segment deviations in lead CC5 only, 57% by ST-segment deviations in lead CM5 only, and 27% by simultaneous ST-segment deviations in both leads. Asymptomatic episodes occurred twice as frequently as symptomatic episodes (66 vs 34%). Symptomatic episodes were more often characterized by ST-segment deviations of at least 0.15 mV (48 vs 9%, p less than 0.001) and by ST-segment deviations observed in both leads simultaneously (48 vs 15%, p less than 0.001). During 34.8 +/- 10.6 hours after successful PTCA, 5 spontaneous asymptomatic episodes with significant ST-segment deviations were detected in 2 patients.

Adult↗
PubMed1987

Influence of reperfusion on serum concentrations of cytosolic creatine kinase and structural myosin light chains in acute myocardial infarction.

The kinetics of cytosolic and structural marker protein release from myocardium were studied in 44 patients with acute myocardial infarction. After intracoronary infusion of streptokinase, there was early recanalization of the infarct-related artery in 8 patients and late recanalization in 18. In 18 patients the infarct-related artery remained occluded. Creatine kinase (CK) level peaked and normalized significantly earlier in patients with early reperfusion than in patients with late reperfusion, and in patients with late reperfusion earlier than in patients with permanent occlusion. Thus, the interval of absolute diagnostic sensitivity of CK depends on early infarct perfusion. In contrast, release of myosin light chains was not significantly changed by recanalization of the infarct-related artery compared with that in nonreperfused myocardial infarction. Thus, in patients with acute myocardial infarction, myosin light chains may be superior to CK as a diagnostic means and for estimation of infarct size.

Aged↗
PubMed1987

[Silent ischemia in stable angina pectoris. Characteristics in frequency-modulated long-term ECG].

Frequency-modulated (FM) long-term ECGs, leads CM5 and CC5, were analysed to define the features which characterize silent ischemia in stable angina. Of 40 consecutively examined out-patients with angiographically proven coronary heart disease 22 had more than three ischemia-type episodes, of which at least one each was symptomatic or asymptomatic. Compared with the asymptomatic ones, the symptomatic episodes had significantly more ST deviations of greater than or equal to 0.15 mV (45.5% vs 17.3%; P less than 0.001) or greater than or equal to 0.2 mV (24.2% vs 5.8%; P less than 0.001). Simultaneous ST deviations in both leads were registered more frequently during symptomatic than silent episodes (43.9% vs 22.4%; P less than 0.01). The incidence of prolonged (greater than or equal to 10 min) ST-deviations was not significantly different during symptomatic and asymptomatic episodes (47.0% vs 40.4%; P greater than 0.05). While only 29.7% of all identified episodes were accompanied by symptoms, interindividual comparison indicated that in 63.6% of patients the ischemic episode with maximal ST deviation was symptomatic. It is concluded from these results that in stable angina the occurrence of anginal symptoms is influenced by the intensity and extent of the myocardial ischemia.

Ambulatory Care↗