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H E Kulbertus

Publications and source records attributed to H E Kulbertus.

At least 37 records · Page 2Linked to original sources
PubMed1990

Exercise-induced sustained symptomatic ventricular tachycardia: incidence, clinical, angiographic and electrophysiologic characteristics.

Among 112 patients with sustained ventricular tachycardia, 15 were found to have exercise-induced symptomatic ventricular tachycardia. This population was divided into two subgroups: group 1A included five patients with coronary artery disease and group 1B consisted of 10 patients with no structural heart disease. All patients underwent clinical examination, exercise electrocardiography, left ventriculography, coronary angiography (n = 14) and electrophysiologic study. In group 1B, right ventriculography (n = 7), M mode and two-dimensional echocardiography were also obtained. Group 1A patients were compared with a population of 27 patients with coronary artery disease and chronic sustained ventricular tachycardia not related to exercise (group 2). There were no statistically significant differences between group 1A and group 2 in terms of age, sex, incidence of prior myocardial infarction, NYHA functional class, angina pectoris, symptoms during arrhythmia, severity and extent of coronary arterial lesions, ventricular dysfunction and wall motion abnormalities. In group 1B, coronary angiography and right and left ventricular function were normal. During electrophysiologic study, ventricular tachycardia was initiated in four group 1A patients. In group 1B, ventricular tachycardia was initiated in eight patients. In four of these patients ventricular pacing had to be combined with isoproterenol administration. In group 2, ventricular tachycardia was induced in 26/27 patients. From this study we conclude that in patients with coronary artery disease the electrophysiologic substrate of exercise-related sustained ventricular tachycardia does not differ from the substrate of non-exercise-related ventricular tachycardia. Re-entry is the most likely electrophysiologic mechanism. In patients without structural heart disease, the mechanism of the arrhythmia remains speculative.

Angiography↗
PubMed1990

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Communication↗
PubMed1990

Clinical efficacy of flecainide acetate in atrial fibrillation.

Seventy-seven patients with symptomatic atrial fibrillation (AF) received oral flecainide acetate (247 +/- 8 mg/day). In 66 patients, previous antiarrhythmic trials consisted of 1-9 drugs. In 55 cases, AF was paroxysmal. It was persistent in 22 patients. Conversion and/or no recurrence of AF was achieved in 40 patients (52%) by flecainide alone and in 11 (14%) by the combination of flecainide and amiodarone. The mean flecainide serum level was 535 +/- 46 ng/ml. Age, presence of coronary artery disease or electrocardiographic parameters were not useful for predicting clinical response. In persistent AF, flecainide efficacy decreased with the duration of arrhythmia. Side effects concerned conduction (26%) and congestive heart failure (5%).

Adult↗
PubMed1989

Characteristics associated with early (less than or equal to 3 months) versus late (greater than 3 months to less than or equal to 3 years) mortality after acute myocardial infarction.

To define the independent variables predictive of early versus late mortality after acute myocardial infarction (AMI), 420 consecutive patients were studied and divided into 3 groups: the 45 patients who died within the initial 3 months (group 1), the 45 patients who died greater than 3 months and less than or equal to 3 years after AMI (group 2) and the 330 greater than 3-year survivors (group 3). The stepwise logistic discrimination method was applied to clinical and laboratory variables recorded during hospitalization to distinguish among the 3 groups. Six independent variables were found to be predictive of early mortality: left ventricular function score (chi-square 26.2; p less than 0.00001), ventricular fibrillation (chi-square 9.3; p = 0.002), bundle branch block (chi-square 9.0; p = 0.003), history of previous AMI (chi-square 8.7; p = 0.003), age (chi-square 5.8; p = 0.02) and atrioventricular block (chi-square 3.8; p = 0.05). Three independent variables were found predictive of late mortality: age (chi-square 13.8; p = 0.0002), anterior location of the AMI (chi-square 4.0; p = 0.04) and a low peak creatine kinase-MB level (chi-square 3.8; p = 0.05). Only 2 variables were able to distinguish between early and late nonsurvivors: peak creatine kinase-MB level (chi-square 8.7; p = 0.003) and ventricular fibrillation (chi-square 4.6; p = 0.03). Thus, the sets of independent risk factors for early and late mortality after AMI are substantially different--suggesting that differing mechanisms are responsible for outcome.

Age Factors↗
PubMed1989

Prognostic significance of a low peak serum creatine kinase level in acute myocardial infarction.

To assess the prognostic significance of a low peak creatine kinase (CK) level, 723 consecutive patients admitted with acute myocardial infarction (AMI) within 16 hours after onset of symptoms were studied. Thrombolytic therapy was not attempted during the study. Patients were dichotomized according to their peak CK levels, determined from a cluster analysis of peak CK distribution among the population of patients who died within 3 years after hospital discharge. The 139 patients with low peak CK (less than or equal to 650 IU/liter) (group 1) were compared to the 584 patients with high peak CK (greater than 650 IU/liter) (group 2). Patients in group 1 were older and had a higher incidence of previous AMI, angina pectoris before AMI and non-Q-wave AMI. Despite a lower incidence of in-hospital complications and a nonsignificantly lower hospital mortality rate (4 vs 9%) the group 1 three-year posthospital mortality rate was higher (26 vs 17%; p less than 0.02), especially in the subgroup of patients with a Q-wave infarct (mortality 31% in group 1 vs 16% in group 2; p less than 0.001). Among the 491 patients who had a first Q-wave AMI, 55 had a peak CK less than or equal to 650 IU/liter. Compared to the 436 patients with a higher peak CK, these 55 patients had a higher incidence of early postinfarction angina (31 vs 14%; p less than 0.01), a similar hospital mortality (4 vs 7%) but a higher 3-year posthospital mortality (23 vs 12%; p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical Enzyme Tests↗
PubMed1989

Prediction of mortality after myocardial infarction by simple clinical variables recorded during hospitalization.

Simple clinical variables obtainable in any coronary care unit and in any patient were recorded in 769 consecutive patients who were admitted with acute myocardial infarction (AMI) and who were discharged from the hospital and followed for up to 3 years. To identify the patients at highest and lowest risk of posthospital mortality, a prognostic index was established from a stepwise logistic discriminant analysis of variables obtained in a consecutive series of 418 patients discharged alive from one of two coronary care units admitting new patients on alternate days. This prognostic index was validated by applying it to a comparison group of 351 consecutive control patients discharged from the other coronary care unit. In the training group, 59 of the 418 patients (14%) died during the first year after hospital discharge and 34 (8%) died during the second or third year. The stepwise logistic discriminant analysis made it possible to distinguish between 1-year survivors and nonsurvivors, but not between the patients who died during the second and third years and the 3-year survivors. Four variables were selected for obtaining a 1-year prognostic index: the maximum grade of left ventricular function during hospitalization (0 to 4), history of previous AMI (1 or 0), predischarge cardiothoracic ratio (0 to 0.99), and complete bundle branch block (1 or 0). Prognostic index = 7.0196-0.6515 function - 1.6623 previous AMI - 0.0729 cardiothoracic ratio - 1.0813 bundle branch block. This index was validated in the comparison group.(ABSTRACT TRUNCATED AT 250 WORDS)

Bundle-Branch Block↗
PubMed1989

Relative prognostic value of clinical, biochemical, echocardiographic and haemodynamic variables in predicting in-hospital and one-year cardiac mortality after acute myocardial infarction.

This study examined the relative value of clinical, biochemical, echocardiographic and haemodynamic variables, obtained early after acute myocardial infarction in predicting in-hospital and one-year cardiac mortality in 66 consecutive patients. Clinical examination and cross-section echocardiography were obtained in all 66 patients. An echocardiographic score index was calculated by grading wall motion from 0 to 5 in each of 16 left ventricular segments. Right-sided cardiac catheterization was performed soon after admission in 51 patients. Cardiac enzymes were measured every fourth hour in all patients and peak levels were identified in 55. During the follow-up of one year, 14 patients died of cardiac causes, seven of them during hospital stay; three patients died of a non-cardiac cause and were excluded from analysis. The echocardiographic score index was the best predictor of cardiac death and survival (chi 2 = 35), followed by Killip class on admission (chi 2 = 22), stroke volume index (chi 2 = 17) and a biochemical risk index (chi 2 = 11). Stepwise logistic discriminant analysis performed in the patients in whom all variables were obtained resulted in three independent prognostic variables: the echocardiographic score index, systemic vascular resistance at the time of catheterization and the development of infarct expansion. High- and low-risk patients are well identified by echocardiography in the acute phase of myocardial infarction.

Acute Disease↗
PubMed1989

Mechanisms of termination of supraventricular tachycardias by intravenous class III antiarrhythmic agents. A comparison of amiodarone and sotalol.

The effects of amiodarone and sotalol were studied with programmed electrical stimulation of the heart in 19 patients with inducible tachycardia (AV nodal tachycardia: 10 cases, circus movement tachycardia: 9 cases). Amiodarone was administered intravenously at a dose of 300 mg over 2 min and sotalol at a dose of 1.5 mg kg-1 over 10 min. Both i.v. amiodarone and sotalol lengthened the transnodal conduction time, the effective refractory period of the AV node and the AV nodal Wenckebach cycle length. Only sotalol significantly lengthened the effective refractory periods of the right atrium and the right ventricle. Infused intravenously during tachycardia, amiodarone interrupted arrhythmia in five of six patients and sotalol in seven of ten cases. Tachycardia was stopped by blockade of the impulse into the AV node in three amiodarone patients and in five sotalol patients. In the remaining four cases, the weak link of the circuit was the accessory pathway. Thus i.v. sotalol exhibits electrophysiologic effects consistent with both class II and III activity, whereas the effects of i.v. amiodarone are the result of different activities throughout all areas of the cardiac tissue.

Adolescent↗
PubMed1989

Haemodynamic alterations during ischaemia induced by dobutamine stress testing.

To identify the haemodynamic response to ischaemia induced by dobutamine stress testing, 15 patients with a first acute myocardial infarction underwent right-sided heart catheterization during dobutamine stress cross-sectional echocardiography. Haemodynamic variables and echocardiography were recorded at rest and during dobutamine infusion at each dose from 5 to a maximum of 40 micrograms kg-1 min-1. Ischaemia was diagnosed by cross-sectional echocardiography if asynergy appeared in at least two ventricular segments other than the area of acute myocardial infarction. Ischaemia was absent in six patients (group I) and identified in nine (group II). Response curves for each haemodynamic variable in the two groups were compared by applying Zerbe's method. The response curves were similar in the two groups for heart rate, arterial, right atrial, pulmonary arterial and pulmonary artery wedge pressures. The response curves were significantly different in groups I and II for thermodilution cardiac output, stroke volume and systemic vascular resistance (P less than 0.05). An increase in stroke volume was observed at low dosage of dobutamine in both groups. From low to maximum dose, stroke volume remained unchanged in group I and was significantly decreased in group II. Ischaemia induced by dobutamine stress testing leads to a decrease in stroke volume with no change in pulmonary artery wedge pressure.

Adult↗
PubMed1989

Long-term prognostic significance of atrioventricular block in inferior acute myocardial infarction.

Among 477 consecutive patients admitted for inferior acute myocardial infarction (AMI), 2nd or 3rd degree atrioventricular (AV) block developed in 88 (20%). Compared with the 359 without AV block, these 88 patients presented a higher incidence of Killip class greater than 1 (52% vs 28%, P less than 0.001), pericarditis (30% vs 17%, P less than 0.01), atrial fibrillation (26% vs 11%, P less than 0.01), complete bundle branch block (12% vs 4%, P less than 0.01) and in-hospital mortality (24% vs 4%, P less than 0.001). The 3-year post-hospital mortality was not significantly different in the two groups (12% vs 15%). Among the 88 patients with AV block, those who died at hospital were older (66 +/- 11 vs 59 +/- 11 years, P less than 0.05), had a higher incidence of Killip class greater than 1 (86% vs 42%, P less than 0.001) and bundle branch block (29% vs 7%, P less than 0.05). Thus, patients with inferior AMI who developed AV block had a poor hospital outcome but long-term prognosis was similar in hospital survivors who had AV block and in those without this complication.

Aged↗
PubMed1989

Clinical experience with a new activity sensing rate modulated pacemaker using autoprogrammability.

Sensolog 703 is a new single chamber activity sensing rate modulated pacemaker that offers an automatic adjustment of settings called Autoset. Units were implanted in 11 patients (mean age: 67 years) for atrioventricular block (two patients), sinoatrial block (three patients), sick sinus syndrome (four patients), chronotropic incompetence (one patient), and atrial fibrillation with slow ventricular response (one patient). The devices were programmed in VVIR mode using Autoset. The accuracy of the settings was verified by the built-in histogram function. In 6/11 patients, these settings were not satisfactory. Autoset was repeated at 6 months (nine patients) and 10 months (five patients) after implantation. External telemetric recordings during daily life activities, Holter monitoring, bicycle or treadmill stress tests helped in the evaluation of the rate response obtained with the automatic programming. The following problems were encountered: maximum pacing rate for a low level of exercise (four patients), insufficient rate increase (four patients), higher pacing rate during low than during heavy exercises (four patients). A time-consuming (15 to 48 minutes) manual programming was necessary in eight out of nine patients (6 months) and five out of five patients (10 months). In our study, Sensolog 703 algorithm tended to behave as an on/off system; automatic programming was time consuming and only indicative.

Adult↗
PubMed1988

Prognostic significance of angina pectoris before first acute myocardial infarction.

To delineate the clinical significance and prognostic importance of a history of chronic or new onset angina pectoris before acute myocardial infarction (AMI), 732 consecutive patients admitted for a first AMI were studied and divided into 3 groups. Two hundred patients (27%) had chronic angina before AMI (greater than 1 month); 247 patients (34%) had new onset angina before AMI (less than 1 month) and the 285 remaining patients (39%) never had angina before AMI. All clinical characteristics were similar in the group of patients with chronic angina and in the group of patients with new onset angina, including in-hospital mortality (10 vs 9%) and 3-year post-hospital mortality (16 vs 16%). Compared to the 285 patients without angina, the 447 patients with angina before AMI were older, more likely to be women, and had a higher frequency of anterior AMI and early post-infarction angina. Both groups had a similar in-hospital mortality (10 vs 8%, not significant), but patients with angina had a higher 3-year post-hospital mortality (16 vs 7%, p less than 0.001). In the group of patients with angina before AMI who were discharged from the hospital, the comparison of nonsurvivors and survivors showed that the patients who died were older, presented more frequently with a non-Q-wave myocardial infarct and more often had left ventricular failure and complete bundle branch block during hospital stay. Chronic and new onset angina before AMI have the same clinical characteristics and deleterious long-term prognostic significance.

Age Factors↗
PubMed1988

Short-term risk stratification at admission based on simple clinical data in acute myocardial infarction.

Simple clinical data, available in all coronary care units, were recorded in 1,013 consecutive patients with acute myocardial infarction (AMI). In order to identify the patients at highest and lowest risk of mortality during hospital stay, a prognostic index was established from a stepwise logistic discriminant analysis of 10 clinical variables obtained at admission in a consecutive series of 477 patients hospitalized in 1 of 2 coronary care units admitting new patients on alternate days and treating them similarly. This prognostic index was applied to a comparison group of 536 consecutive patients admitted to the other coronary care unit. In the experimental group, 57 of the 477 patients (12%) died during hospital stay; 60 of the 536 patients (11%) died in the comparison group. As individual variables, age, previous history of AMI, anterior site and left ventricular function on admission were associated with increased mortality. Three variables were selected from the stepwise logistic discriminant analysis of the experimental group: age; site (anterior = 1, other = 0); and grade of left ventricular function (0 to 4). Prognostic index = 5.9019 - 0.8961 function - 0.5708 location - 0.0369 age. This index was validated in the comparison group. Patients were allocated into different classes with increasing index values associated with decreasing risk. Three subgroups of patients were identified: high risk of hospital mortality (index less than or equal to 1; mortality: 51%), intermediate risk (index 1 to 3; mortality: 18%) and low risk (index greater than 3; mortality: 4%). The use of this simple prognostic index may improve clinical management and selection of patients for intervention trials.

Female↗
PubMed1988

Short- and long-term prognostic importance of complete bundle-branch block complicating acute myocardial infarction.

Among 1013 consecutive patients with acute myocardial infarction (AMI), 104 (10%) developed complete bundle-branch block (BBB). The clinical characteristics and the short- and long-term prognosis were similar in the 53 patients with right and the 51 patients with left BBB. Compared to the 909 patients without this conduction disturbance, these 104 patients were older (64 +/- 9 vs. 58 +/- 10 years, p less than 0.001), more frequently women (26 vs. 17%, p less than 0.05), had a larger infarct (peak CK 1672 +/- 1124 vs. 1356 +/- 1089 IU/l, p less than 0.001), more frequently anterior (60 vs. 37%, p less than 0.001). They had a higher incidence of Killip class greater than 1 (63 vs. 38%, p less than 0.001), pericarditis (40 vs. 23%, p less than 0.001), atrial fibrillation or flutter (22 vs. 12%, p less than 0.01), ventricular fibrillation (15 vs. 9%, p less than 0.05), and atrioventricular block (23 vs. 11%, p less than 0.001). Both hospital mortality (32 vs 10%, p less than 0.001) and 3-year posthospital mortality (37 vs. 18%, p less than 0.001) were much higher among patients with complete BBB. Transient BBB had the same deleterious prognosis as BBB persistent at discharge (mortality 33 vs. 39%, NS). The prognostic importance of BBB was more prominent during the first 6 months after infarction (mortality between 6 and 36 months: 18% with BBB vs. 11% without BBB, NS).

Bundle-Branch Block↗
PubMed1988

Treatment of congestive heart failure: pharmacological principles.

Heart failure may result from different aetiologies: excessive afterload, depressed intrinsic contractility (generalized or regional), volume overload, and changes in diastolic properties. Compensatory mechanisms, such as the reflex increase in sympathetic tone, may initially be beneficial, but, in the long run, may become deleterious. Thus heart failure represents a very complex situation. Treatment should aim at: (a) removing the cause of heart failure; (b) improving contractile performance (by enhancement of the intrinsic contractile properties or by decreasing afterload); (c) moderating the major symptom-producing features (increased filling pressure), and decreasing peripheral demands for cardiac output.

Cardiotonic Agents↗
PubMed1987

Hemodynamic profile of patients with acute myocardial infarction at risk of infarct expansion.

To identify patients at risk of cardiac expansion during hospital stay for a first acute myocardial infarction (AMI), 41 patients underwent right-sided cardiac catheterization soon after admission and serial 2-dimensional echocardiography on days 1, 3 or 4 and between days 7 and 10. Infarct expansion was recognized by echocardiography in 11 patients (27%), most often on the second recording (day 3 or 4). Age, sex, time from onset of pain to catheterization, peak levels of creatine kinase and creatine kinase-MB isoenzyme, heart rate, mean pulmonary artery wedge pressure and left ventricular stroke work index were similar in the 2 groups. Patients in whom infarct expansion developed had a higher incidence of previous systemic hypertension (73% vs 27%, p less than 0.01) and anterior AMI (91% vs 30%, p less than 0.001) and a higher mortality rate at 1 year (73 vs 7%, p less than 0.001) than those who did not. They also had higher systolic (139 +/- 24 vs 126 +/- 18 mm Hg, p less than 0.05) and diastolic (91 +/- 14 vs 75 +/- 13 mm Hg, p less than 0.001) arterial pressures, lower stroke volume index (31 +/- 10 vs 40 +/- 10 ml/m2, p less than 0.01) and much higher systemic vascular resistance (SVR) values (1,713 +/- 380 vs 1,253 +/- 264 dynes s cm-5, p less than 0.0001). In the subgroups of patients with anterior AMI, differences were significant for diastolic arterial pressure, stroke volume index, SVR and mortality.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗