Search PubMed⌕ Search

Biomedical subjects

H Gohlke

Publications and source records attributed to H Gohlke.

At least 55 records · Page 3Linked to original sources
PubMed1995

[Benefits and risks of physical activity in patient with coronary heart disease].

Endurance training after myocardial infarction results in increased fitness and favours regression of coronary arteriosclerosis if the intensity of the training programme results in an expenditure of at least 2200 Kcalories per week. During physical exercise the risk of sudden death is increased, however the net effect of endurance training results in a decreased risk of sudden cardiac death and also of reinfarction. Very intense physical activity may trigger a myocardial infarction and should be avoided by patients with coronary artery disease. Patients with uncomplicated myocardial infarction benefit from a structured exercise programme lasting 6 months or longer. After a large anterior myocardial infarction moderate physical activity does not have an apparent effect on left ventricular size or remodelling. In patients with a low ejection fraction and borderline compensation, physical activity should be delayed until a better degree of cardiac compensation is achieved. The intensity of exercise most be closely supervised to avoid cardiac decompensation. Regular physical activity is an important component of secondary preventive measures in virtually all patients with established coronary artery disease.

Coronary Artery Disease↗
PubMed1994

[Silent ischemia--what should be done?].

The prevalence of silent, previously undiagnosed, exercise-induced ischemia is between 0.5 und 3.5% in 40-59-year-old men. Its prevalence is dependent upon the prevalence of coronary artery disease in the population or sub-population considered. The pathophysiological mechanism of silent ischemia is extracardiac. The prognosis of silent ischemia is determined by the functional impairement and the extent of coronary artery disease. The decision concerning medical and surgical treatment of patients with silent ischemia is based on the same criteria as in patients with ischemia and angina pectoris: patients at high risk (ischemia at low levels of exercise, marked exercise-induced ischemia, proximal 3-vessel disease and at least moderately impaired left ventricular function) are candidates for invasive treatment. Patients with ischemia at high levels of exercise, or with minimal ischemia with one- or two-vessel disease, are candidates for medical management. The best possible control of all cardiovascular risk factors is mandatory for all patients, from the viewpoint of prognosis in particular.

Adult↗
PubMed1994

The HELP-LDL-apheresis multicentre study, an angiographically assessed trial on the role of LDL-apheresis in the secondary prevention of coronary heart disease. II. Final evaluation of the effect of regular treatment on LDL-cholesterol plasma concentrations and the course of coronary heart disease. The HELP-Study Group. Heparin-induced extra-corporeal LDL-precipitation.

The efficacy of the heparin-induced extracorporeal LDL-precipitation (HELP)-apheresis procedure has been studied in an open prospective multicentre trial. After 2 years of regular weekly HELP-treatment the data from 39 of 51 patients could be evaluated according to the study criteria. Twelve of the initially recruited study patients were omitted from the evaluation either because of premature termination of the treatment or because they did not fulfil the exact guidelines of the study protocol. A mean of 2.831 plasma was regularly treated on average every 7.85 days. The mean pre-/post-apheresis LDL-cholesterol levels decreased from 286/121 mg dl-1 at the first HELP treatment to 203/77 mg dl-1 after 1 year and to 205/77 mg dl-1 after 2 years of regular apheresis; the corresponding values for fibrinogen were 314/144, 246/98 and 250/105 mg dl-1, respectively. In contrast, the mean pre-/post-apheresis HDL-cholesterol levels rose from 41/38 through 51/44 mg dl-1 after 1 year to 52/43 mg dl-1 after 2 years of treatment. The overall result was a normalization of the atherogenic index (LDL-/HDL-cholesterol ratio) from 6.9/3.2 to 4.0/1.9. The angiographies from 33 patients obtained before and after 2 years of regular treatment could be evaluated blindly using the cardiovascular angiography analysis system. The mean degree of stenosis of all segments decreased from 32.5% (SD = 16) to 30.6% (SD = 16.8) over the 2 years. A regression > 8% was observed in 50/187 (26.7%) segments, whereas 29/187 (15.5%) segments showed progression. In 108/187 (57.8%) segments the lesions were stable (< 8% deviation) over 2 years. We conclude that regular treatment with HELP-LDL-apheresis is able to stabilize progressive atherosclerotic disease and to induce almost twice as much regression as progression of atherosclerotic lesions.

Adult↗
PubMed1992

Exercise tolerance and working capacity after valve replacement.

Between 1978 and 1987, 1270 patients who survived single aortic or mitral valve replacement at the Rehabilitation Center in Bad Krozingen, Germany, underwent a comprehensive rehabilitation program. The preoperative diagnosis was isolated aortic stenosis in 425, isolated aortic regurgitation in 159, mixed aortic lesion in 211, isolated mitral stenosis in 208, isolated mitral insufficiency in 137 and mixed mitral lesion in 130 cases. Follow up examinations were carried out one and six months after surgery, and at yearly intervals thereafter. Exercise testing was performed with an electrically braked bicycle ergometer in the supine position, and the load was increased by 25 or 50 watts every two minutes until fatigue, severe angina, more than 0.3 mV ST-segment depression, or 80% of the age predicted maximum heart rate was achieved. Patients after aortic valve replacement had a better exercise performance one month after operation than did those after mitral valve replacement. Those with mitral stenosis showed more severe impairment of exercise tolerance than did the mitral insufficiency group. There was a steady increase in exercise tolerance between one and six months postoperatively, both in patients with aortic and those with mitral valve replacement, but the difference in performance between the two groups was still present (72% versus 57% of normal). The results of univariate and multivariate analyses showed that the preoperative employment status was the most important factor for postoperative return to work, followed by gender (male > female), exercise tolerance and valualar lesion (aortic > mitral).(ABSTRACT TRUNCATED AT 250 WORDS)

Aortic Valve↗
PubMed1992

[Effect of the LDL-/HDL-cholesterol quotient on progression and regression of arteriosclerotic lesions. An analysis of controlled angiographic intervention studies].

The importance of hypercholesterolemia for the development of atherosclerotic lesions is undebatable. It is less evident, however, whether the progression of established lesions can be influenced by modifying lipid levels. The review of seven controlled angiographic intervention trials shows that different criteria are used to define progression of lesions. The relation of progression to regression (progression/regression ratio), however, is a useful marker for the activity of coronary artery disease. Patients with familial hypercholesterolemia have a progression/regression ratio of between 3 and 7. There is a consistent relationship between the progression/regression ratio and the LDL-/HDL-cholesterol ratio in both control and intervention groups in these trials. Groups with a LDL-/HDL-cholesterol ratio of 5 have six times more progression than regression. If the LDL-/HDL-cholesterol ratio is less than 2.5 regression occurs more often than progression (i.e. progression/regression ratio less than 1). Thus, in the management of hyperlipidemic patients a LDL-/HDL-cholesterol ratio of less than 2.5 should be achieved if regression of atherosclerotic lesions is desired.

Cholesterol, HDL↗
PubMed1991

Prognostic importance of collateral flow and residual coronary stenosis of the myocardial infarct artery after anterior wall Q-wave acute myocardial infarction.

Residual high-grade coronary stenosis and collateral flow are frequent findings in the chronic phase after a Q-wave acute myocardial infarction (AMI). The prognostic importance of a residual stenosis of the infarct artery and of collateral flow to the infarct area was analyzed in a group of 102 young patients (mean age 35 years, range 22 to 39) who had survived an anterior wall Q-wave AMI. Patients whose only significant lesion (greater than 50% luminal diameter reduction) was in the proximal portion of the left anterior descending artery were enrolled in the study. A 50 to 74% diameter stenosis was present in 33 of 102 patients (32%), 43 (42%) had a 75 to 99% stenosis and 26% had a total occlusion of the infarct vessel. Collateral vessels, which were evaluated by a scoring system, were present in 52 of 102 patients (51%). Four percent had only faint (score 1), 17 of 102 patients (17%) had moderate and 32 patients (31%) had good collateral flow (score greater than 4). The 8-year cumulative mortality was 15.2%--an eightfold increase compared with the age-matched general population. No patient with less than 75% stenosis died during follow-up, whereas the cumulative 8-year mortality was 23 and 17% in patients with a 75 to 99% stenosis or total occlusion, respectively (p less than 0.01). Patients with at least moderate collateral flow had a mortality rate of 21%, versus 8% for patients without or with faint collateral flow (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[Prevention of atherosclerosis by enforcing non-smoking behavior].

Cigarette smoking is the single most important cause for avoidable diseases. Malignancies, pulmonary diseases, and the different manifestations of coronary artery disease (CAD) are either caused or developed significantly earlier with cigarette smoking. Even in the young-adult-age, smokers have more raised lesions in the abdominal aorta or in the coronary arteries. The analysis of more than 800 patients with myocardial infarction at young age showed that cigarette smoking is the dominant risk factor up until myocardial infarction. In male patients with CAD myocardial infarction is the first clinical manifestation. Therefore, the potential for primary prevention is small in traditional medical practice. Based on these experiences, we tried to support nonsmoking behavior in the 7th grade in school. Knowledge about the cardiovascular system and the acute effects of cigarette smoking were taught. In addition, role plays were performed by the children to practice rejecting an offered cigarette. With this intervention, new onset of smoking could be reduced by 50% over 2 years with a limited (8h) educational intervention. Reasons for the onset of cigarette smoking are different for boys and girls. The percentage of pupils smoking decreases with the increasing social status of the parents. The tobacco industry has recognized that children are an important target group as future consumers, and it uses that fact in its public relations and advertising strategy. However, the government undertakes virtually no efforts to control illegal sales of cigarettes to minors. Tax incomes from illegal sales of cigarettes to minors by far exceed the expenses for preventive efforts of state agencies. A change of this permissive attitude appears warranted.

Adolescent↗
PubMed1989

[Prevention of cigarette smoking in school. A prospective controlled study].

752 schoolchildren, mean age 12.7 years, were asked by multiple-choice questionnaire about their smoking experience. After this, eight educational lessons were given in seven of the schools ("intervention schools") to reinforce non-smoking. In six control schools no activities were performed. After 2.3 years, 579 schoolchildren (301 males and 278 females, mean age 15.0 years) again filled in a similar questionnaire. In the control schools 12.4% of children had begun to smoke, (greater than 1 cigarette per month), but only 7.4% in the intervention group (P less than 0.06). Daily cigarette smoking had been taken up by 8.4% in the control schools, but by only 4% in the intervention schools (P less than 0.04). 9.9% of children in the control schools and 3.8% in the intervention schools had smoked during the 24 hours before the questionnaire was filled in (P less than 0.004). The data indicate that an eight-hour course of instruction with reinforcement of non-smoking can lastingly influence smoking behaviour of juveniles.

Adolescent↗
PubMed1988

Incidence and prognostic importance of silent ischaemia after PTCA: a prospective study.

To evaluate the influence of PTCA on symptomatic and asymptomatic ischaemic episodes in 94 patients, 24-h ambulatory, electrocardiographic Holter recordings were obtained before and after successful PTCA. Sixty-four per cent of patients had one-vessel disease, 28% two-vessel disease and 8% had three-vessel disease. Ischaemic episodes were present in 36% of patients before PTCA, of which 71% were silent; after PTCA, 23% of patients had ischaemic episodes, of which 98% were silent; thus silent ischaemic episodes were improved by PTCA to a lesser degree than symptomatic ischaemic episodes. Successful PTCA lead to a significant reduction in total number and duration of ischaemic episodes but not to a complete abolition. Patients with silent ischaemic episodes after PTCA had also a higher incidence of silent ischaemic episodes before PTCA. Functional and haemodynamic improvement was comparable in patients with and without silent ischaemic episodes. No specific cause for the persistent or newly appearing silent ischaemic episodes after PTCA could be identified; they are not indicative of an inadequate dilatation and cannot be considered as a risk factor for early restenosis. A possible explanation could be a traumatically induced, increased vascular tone in susceptible patients.

Angioplasty, Balloon↗
PubMed1988

Improved risk stratification in patients with coronary artery disease. Application of a survival function using continuous exercise and angiographic variables.

Assessment of prognosis plays an important role in the management of patients with CAD. The objective of the study was to improve risk stratification in patients with known coronary angiographic findings. We analyzed the prognostic importance of 13 angiographic, exercise, and clinical variables in 1183 medically treated patients with documented CAD. Five-year actuarial survival rate (5-YSR) was 87%. Multivariate analysis with the proportional hazards regression model revealed four continuous and one discrete variable to be of independent prognostic importance (chi 2 value): cardiac output at the highest work load (COmax) (chi 2 = 80.7); coronary score (chi 2 = 18.6); heart volume by X-ray (chi 2 = 14.7); maximal pulmonary wedge pressure during exercise (chi 2 = 5.3), and history of myocardial infarction (chi 2 = 4.8). Inclusion of these variables in the survival function according to the regression model resulted in excellent prediction of 5-YSR, e.g. in the patients with three-vessel disease (N = 399): actuarial 5-YSR was 80%, calculated 81%. Patients with three-vessel disease and COmax greater than 11.21 min-1 (N = 188) had an actuarial 5-YSR of 88%, calculated 89%; if COmax was less than 11.21 min-1 the actuarial 5-YSR was 71%, calculated 70%. Patients with three-vessel disease from an independent cohort of surgically treated patients (N = 507) had a calculated 5-YSR under an assumed medical regimen of 77%.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1987

Prognostic importance of exercise-induced ST-segment depression in patients with documented coronary artery disease.

Exercise-induced ST-segment depression is a marker of impaired prognosis in patients with suspected or manifest CAD. Whether ST-segment depression remains of prognostic importance, after exercise tolerance and extent of CAD have been considered, is unknown. We analysed the prognostic importance of exercise-induced ST-segment depression (greater than 0.15 mV) in 1250 medically treated patients with angiographically determined CAD (mean follow-up after angiography 4.5 years). Based on exercise tolerance (supine bicycle ergometry) patients were divided into two groups: group A patients (n = 677) with lower exercise tolerance (less than or equal to 75 W) and group B patients (n = 573) with better exercise tolerance (greater than 75 W). Group A patients had a lower 5-year survival rate than group B patients (81.5% versus 94%, P less than 0.00001). In group A, patients with ST-segment depression had a lower 5-year survival rate than patients without ST-segment depression (76% versus 85%, P = 0.01). In group B, patients with and without ST-segment depression had similar 5-year survival rates (90% versus 96%, P = 0.11). Subgroup analysis of groups A and B according to number of diseased vessels and presence or absence of ST-segment depression revealed that exercise-induced ST-segment depression (greater than 0.15 mV) was of additional prognostic importance only in patients with triple vessel disease. 5-year survival rates in group A with triple vessel disease were 71% with and 80% (P = 0.057) without ST-segment depression.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

Myocardial infarction at a young age (under 40 years).

Coronary morphology, risk factors, long-term prognosis, and progression of coronary arteriosclerosis were investigated in 679 (649 mean and 30 women) post-infarction patients under 40 years of age. These patients represented 80% of 844 MI patients under 40 who were referred to our hospital in the years 1973-1980; 20% had refused coronary angiography; 465 patients were followed up for 1-7 years (mean 3.5 years). In 164 patients, a second coronary angiography was performed 3.8 years after the first angiogram, which was done an average 3 months after the acute episode. The main results were as follows: 8.4% of the patients had zero-vessel disease and 3.7% had a normal coronary angiogram. The majority had single-vessel disease (57.3%). The prevalence of zero-vessel disease decreased with age while that of multivessel disease increased. With increasing vessel involvement, the prevalence of hypercholesterolemia, hypertriglyceridemia, and hypertension increased. A history of smoking was equally common in patients with zero-, single-, double-, and triple-vessel disease. In women the combination of smoking and the use of oral contraceptive drugs was frequently seen. In one-quarter of the zero-vessel disease patients, the infarction occurred during unusually intense physical exercise. The statistical analysis of the survival data using the proportional hazards model (univariate analysis) showed the variables heart volume/body wt., ventricular arrhythmias, PCP at rest, PCP max, work capacity, ventricular function, and number of diseased vessels to be of prognostic importance. Multivariate analysis using this model revealed the following independent variables to be relevant to prognosis: heart volume/body wt., ventricular arrhythmias, ventricular function, and number of diseased vessels. After an average of 3.8 years since the first coronary angiography, 28.6% of the patients showed a significant progression of coronary arteriosclerosis (at least two degrees of stenosis according to the AHA classification). In the subgroup of patients with multilocular disease in the first angiogram, progression was 10 times as frequent as in a group with initial unilocular disease (34.3% vs 3.6%). Patients with progression had continued to smoke significantly more often than patients without progression (38.4%) vs 14.5%). Regression of coronary angiographic findings was significantly more frequent in the group of patients with initial unilocular disease than in those with multilocular disease in the first angiogram (28.6% vs 10.6%). Regression might be explained as recanalization and organization of a thrombus.(ABSTRACT TRUNCATED AT 400 WORDS)

Age Factors↗
PubMed1984

[Prognostic significance of stress studies in patients with coronary 2-vessel disease--effect of stenosis of the proximal ramus intraventricularis anterior].

To determine whether exercise testing can provide additional prognostic information in patients with angiographically determined 2-vessel disease and normal or mildly impaired left ventricular function, we followed 316 medically treated patients (pts) for a mean of 4.5 years. The 5-year survival rate (5-YSR) was 89.7%. On the basis of the results of exercise testing (supine bicycle ergometry) pts were divided into 3 equally sized groups. Pts with an exercise tolerance (ET) of more than 110 W had a 5-YSR of 95% compared to 81% for pts with an ET of less than or equal to 90 W (p less than 0.003). The 5-YSR was 86% and 91% for pts with (n = 87) and without (n = 229) a proximal LAD stenosis (p = 0.12). Pts with a proximal LAD stenosis and an ET of more than greater than 80 W (the better half) had a 5-YSR of 97% in contrast to 76% in pts with an ET of less than or equal to 80 W (p less than 0.02). Pts without proximal LAD disease had a 5-YSR of 93% (ET greater than 80 W) and 87% (ET less than or equal to 80 W) (p = n.s.). Thus in pts with 2-vessel disease and good left ventricular function, exercise testing can differentiate patients with a good long-term prognosis from pts with a markedly reduced prognosis. Exercise testing appears particularly useful in patients with proximal LAD disease and can facilitate the decision-making process for aortocoronary bypass surgery.

Angina Pectoris↗