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Biomedical subjects

H Klepzig

Publications and source records attributed to H Klepzig.

At least 55 records · Page 3Linked to original sources
PubMed1992

Effect of propranolol and disopyramide on left ventricular function at rest and during exercise in hypertrophic cardiomyopathy.

In 19 patients with hypertrophic cardiomyopathy (15 males, 4 females, mean age 49.2 +/- 10.8 years) left ventricular function was studied with radionuclide ventriculography at rest and during exercise in a crossover design without intervention and after disopyramide and propranolol treatment. 15 of the 19 patients had a resting or latent intraventricular gradient of more than 30 mm Hg. Left ventricular function at rest and during exercise was evaluated before medication, 90 min after oral administration of 200 mg disopyramide or 160 mg propranolol and after 3 weeks of oral therapy with disopyramide 200 mg 2 times a day or propranolol 80 mg 4 times a day. After long-term treatment with disopyramide, resting ejection fraction decreased from 72 +/- 12 to 69 +/- 14% (p less than 0.01) and peak ejection rate (PER) decreased from 3.46 +/- 135 to 3.24 +/- 65 end-diastolic volume (EDV).s-1 (p less than 0.01). Peak filling rate (PFR) at rest decreased from 3.01 +/- 0.8 to 2.77 +/- 0.63 EDV.s-1 (p less than 0.05). Time to peak filling rate (TPFR) at rest and during exercise after acute and chronic therapy did not change compared to control values. Acute and long-term administration of propranolol lead to a significant reduction in heart rate at rest and during exercise.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed1992

[Myocardial function before and after reopening of chronic coronary occlusion].

To assess the myocardial function before and after reopening of chronic coronary artery occlusions, 20 patients were investigated at rest and during exercise with ECG and equilibrium radionuclide ventriculography. The recanalisation of the chronically occluded vessel was carried out by means of Rotacs-catheter in 17 patients, of a guide wire enforced by recanalisation-catheter in 2 patients and of a thin guide wire alone in 1 patient, always followed by conventional balloon angioplasty. After successful PTCA the average coronary artery stenosis diameter decreased from 100% to 34 +/- 6%. Angina pectoris and/or dyspnea observed during exercise were improved in 83% of the patients. The radionuclide global left ventricular ejection fraction at rest increased from 55 +/- 9% to 59 +/- 10% (p < 0.05), and during exercise from 52 +/- 12% to 61 +/- 12% (p < 0.05). The improvement in global ejection fraction at rest was more pronounced in 5 patients, who suffered from angina pectoris at rest before PTCA (from 56 +/- 4% to 65 +/- 9%, p < 0.05). It is concluded that reopening of chronically occluded coronary arteries in properly selected patients leads to a significant improvement of the global left ventricular function at rest and during exercise.

Adult↗
PubMed1992

[Cholesterol lowering and life expectancy: a critical evaluation].

Numerous studies have confirmed a positive correlation between serum cholesterol levels and the occurrence of coronary artery disease. Lowering cholesterol by 1% is accompanied by a reduction of coronary events by 2%. The rate of fatal coronary events is not significantly influenced. Coronary angiography demonstrated only a mild average reduction of coronary lesions after cholesterol-lowering therapy. This might be explained by the low lipid content of a coronary plaque (5-15%). The majority of intervention trials revealed an increase of the extracardiac mortality in treatment groups. Thus, up to the present, it remains unproven that cholesterol-lowering therapy leads to an increase in life expectancy.

Cholesterol↗
PubMed1991

Impairment of left ventricular function during coronary angioplastic occlusion evaluated with a nonimaging scintillation probe.

Impairment of left ventricular function during controlled myocardial ischemia induced by coronary angioplasty has been reported from angiographic and echocardiographic studies. Ejection fraction, peak ejection, peak filling rates, and end-systolic and end-diastolic volumes were investigated before, during and after coronary occlusion on-line with a nonimaging scintillation probe. The study consisted of 18 patients (mean age 59 +/- 10 years) with coronary artery stenosis of greater than 70%. During balloon inflation of 60 seconds' duration, coronary occlusion pressure was 31.6 +/- 12 mm Hg. There was no significant change in heart rate. Delay between first and second dilatation was 109 +/- 63 seconds. Ejection fraction decreased from 53 +/- 16 to 40 +/- 12% (first dilatation, p less than 0.01) and to 39 +/- 14% (second dilatation, p less than 0.01) and recovered to 51 +/- 16% 5 minutes after the second dilatation. Peak ejection rate was significantly reduced during the first and second balloon inflations. Peak filling rate decreased from 2.5 +/- 0.8 to 2.0 +/- 0.7 end-diastolic volume.s-1 (first dilatation, p less than 0.01) and to 1.8 +/- 0.7 end-diastolic volume.s-1 (second dilatation, p less than 0.01) and remained reduced at 2.2 +/- 0.7 end-diastolic volume.s-1 (p = not significant) at 5 minutes after the second dilatation. End-systolic and end-diastolic volumes increased significantly during the first and second dilatations and returned to normal after dilatation. It is concluded that short, controlled myocardial ischemia during coronary angioplasty leads to a decrease in systolic and diastolic left ventricular function. Sequential dilatations do not further decrease function if a sufficient interval is kept.

Angioplasty, Balloon, Coronary↗
PubMed1991

[Aortic valve insufficiency. Diagnosis, course, therapy].

A radionuclide ventriculographic procedure for the accurate quantification of aortic insufficiency has been developed, and its use in follow-up, pharmacotherapy and surgical planning tested. In 28 patients, follow-up over a period of 20 months revealed only slow progression of the chronic aortic insufficiency; worsening of the symptoms leading to the need for valve replacement was associated with a rapid deterioration of objective parameters. In patients with a stable condition, captopril administered for 4-8 weeks failed to reduce left ventricular overload to any significant extent, while reduction in volume overload was observed in patients with accompanying congestive heart failure or systemic hypertension. Clinical analysis revealed that, as a rule, the indication for valve replacement must be based on follow-up examination. If radionuclide ventriculography reveals a disproportionate enlargement of the ventricle, surgery is indicated even in the absence of symptoms.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1991

[Effect of bypass operation and balloon angioplasty on heart function at rest].

Improvement of exercise left-ventricular ejection fraction after successful aortocoronary bypass operation and transluminal coronary angioplasty has been demonstrated. The purpose of this study was to investigate in which patients improvement of left-ventricular function at rest can be observed. Radionuclide ventriculography and exercise stress test was carried out in 34 patients before and after successful aortocoronary bypass operation (Group 1), and in 69 patients before and after successful transluminal coronary angioplasty (Group 2). After bypass surgery, mean ejection fraction at rest increased from 42 +/- 11 to 49 +/- 13% (p less than 0.001). Marked improvement (greater than or equal to 5%) was observed in 19 patients (56%) in whom severe myocardial ischemia could be documented during exercise ECG (Group 1.1: Increase of ejection fraction from 40 +/- 14 to 54 +/- 12%, p less than 0.001; ischemia score during exercise test 8.8 +/- 10). In the remaining 15 patients no significant improvement occurred (Group 1.2: 43 +/- 16 vs. 43 +/- 16%, p = n.s.; ischemia score during exercise test 3.2 +/- 2.4, p = 0.02 vs. Group 1.1). After angioplasty, resting left-ventricular ejection fraction increased, on average, from 50 +/- 11 to 52 +/- 12% (p less than 0.001). Comparable to the results observed in patients after surgery, improvement was most pronounced in patients with severe exercise-induced ST-depression (Group 2.1: Increase of ejection fraction from 49 +/- 10 to 58 +/- 10%, p less than 0.001; ischemia score during exercise 2.5 +/- 2.3).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1991

Analysis of 100 emergency aortocoronary bypass operations after percutaneous transluminal coronary angioplasty: which patients are at risk for large infarctions?

Severe vascular complications are an inherent risk of percutaneous transluminal coronary angioplasty (PTCA). Data from 100 emergency aortocoronary bypass operations required after 2850 interventions (3.5%) were retrospectively analysed in order to identify factors that determine postoperative infarct size. Large infarctions were assumed if the patient died of cardiogenic shock (n = 12), if postoperative angiography demonstrated a decrease in left ventricular ejection fraction of more than 20% of if R-waves in the ECG decreased by more than 40% and a QRS-score increased by more than 5. According to these definitions, 29 patients experienced large infarctions, while 71 experienced no or only small infarctions. The following factors differentiated the two groups: age (58 vs 53 years, P = 0.008), pre-PTCA exercise work load (88 vs 118 Watts, P = 0.0001), exercise ischaemia score (2.7 vs 1.9, P = 0.045), degree of pre-PTCA stenosis (83 vs 86%, P = 0.03), coronary multivessel versus single vessel disease (60 vs 38%, P = 0.02), collaterals to the target vessel (10 vs 34%, P = 0.05), total vascular occlusion during PTCA (76 vs 56%, P = 0.035), and long duration of ischaemia after onset of the complication (253 vs 179 min, P = 0.012). Data from patients with large postoperative infarctions who survived ranged between those with no or small infarctions and those who died of cardiogenic shock. Higher age (P = 0.04), reduced exercise tolerance (P = 0.0004), absence of collaterals (P = 0.04), and duration of ischaemia until reperfusion (P = 0.001) were independent predictors of large postoperative myocardial infarctions.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon, Coronary↗
PubMed1991

[Experiences with the application of monoclonal Indium-111 antimyosin scintigraphy in the diagnosis of rejection episodes following orthotopic heart transplantation].

Indium-111-labeled Fab fragment imaging using a murine antimyosin monoclonal antibody (Myoscint, Centocor, Leiden) was evaluated for efficacy in detecting cardiac allograft rejection. Diagnosis of rejection was made by endomyocardial biopsy with four to five samples taken for each procedure. Eighty-one studies were performed in 25 patients (21 men, four women, mean age 50 +/- 9 years) from 2 weeks to 45 months after cardiac transplantation. 0.5 mg of the monoclonal antibody labeled with 60 MBq Indium-111 (Antimyosin-Fab-DTPA) was administered i.v. Planar scintigraphic images were obtained in LAO 45 and anterior projections as well as "half-body-scintigrams" 48 h after injection. Using the regions-of-interest-(ROI)technique the relative uptake over the lung and the heart was determined and an index of In-111 uptake was calculated. A heart-to-lung ratio of 1.5 or higher was considered indicative for moderate to severe rejection. Specificity was 86% (nine false-positive In-111 studies in 68 negative biopsy studies), sensitivity was 85% (two false-negative In-111 studies in 13 pathological biopsy studies). It is concluded that the In-111 method has a high sensitivity and specificity in detecting heart transplant rejection and may be useful in the monitoring of patients in the chronic phase after heart transplantation. The 48-h delay in establishing the diagnosis limits the applicability in acute severe rejection.

Adult↗
PubMed1991

[Improved left ventricular function and perfusion at rest following transluminal coronary angioplasty].

The purpose of this study was to evaluate left ventricular function and perfusion at rest before and after percutaneous transluminal coronary angioplasty. In consecutive 69 patients in whom coronary stenoses were dilated, the radionuclide left ventricular ejection fraction at rest increased significantly. In 26 of these patients, the ejection fraction increased by at least 4%. In these patients, exercise-induced ischemic ST depression had been more pronounced than in the others. 36 other patients underwent 201TI myocardial scintigraphy before and after angioplasty. Twelve patients in whom pre-PTCA images had revealed regions with irreversible 201TI uptake defects, showed normal 201TI distribution patterns on post-PTCA scintigrams. Post-exercise 201TI uptake (representing myocardial perfusion and metabolic activity) during pre-PTCA exercise stress tests was significantly lower in these cases. It is concluded that PTCA can improve left ventricular function and perfusion at rest. This improvement is most obvious in patients with pronounced exercise-induced myocardial ischemia as diagnosed by typical ST segment depression and reduced thallium uptake.

Adult↗
PubMed1991

[Multiparametric analysis using radionuclide ventriculography in the assessment of left ventricular function following heart transplantation].

Left ventricular systolic and diastolic performance was evaluated by radionuclide angiography in 17 patients following cardiac transplantation and compared with normal persons. Both groups performed supine bicycle exercise during the investigation, the control group at 102 +/- 73 W and the transplanted patients at 61.2 +/- 15 W. The ejection fraction increased in the normal persons from 61 +/- 8 to 69 +/- 10% whereas in the transplanted patients it did not increase significantly. There were no relevant changes in systolic parameters during exercise in the transplant recipients. The changes in diastolic parameters were significantly smaller in transplant patients than in normals. After correction for heart rate-induced changes a significantly different time course of the systolic-diastolic sequence during the cardiac cycle became evident in the transplanted group at rest. During exercise the systolic-diastolic sequence during the cardiac cycle became similar in both groups. It is concluded that the reduced exercise capacity of patients in the late phase after cardiac transplantation is partially due to the absence of an EF increase and a limitation of diastolic reserve during exercise.

Adult↗
PubMed1990

[Coronary angioplasty--can the risk of recurrence be predicted on the day of surgery? A prospective study].

Data from a retrospective study defining seven parameters of increased risk of restenosis after successful transluminal coronary angioplasty (high-grade stenoses, long stenoses, eccentric stenoses, use of high pressure, extended time of balloon inflation, stenoses in obese patients, stenoses in patients without a history of smoking) were fed into a computer. A discriminant analysis was made and an algorithm for prediction of restenosis was defined. The validity of prediction was prospectively tested in 101 patients. In 80/101 (79.2%) prediction was possible; in 21/101 (20.8%) it was not possible. In 15/80 patients (18.8%) the prediction was: "restenosis probable"; in 65/80 patients (81.2%): "restenosis not probable". After 4.4 months 93/101 patients (92.1%) had an angiographic follow-up. The prediction "restenosis" proved to be correct in 13/15 patients (86.7%), and the prediction "no restenosis" was correct in 56/65 patients (86.2%). It is concluded that in the majority of patients the risk of restenosis can be predicted immediately after the intervention.

Adult↗
PubMed1990

[Long-term clinical follow-up after coronary dilatation].

To determine the long-term clinical course after percutaneous transluminal coronary angioplasty (PTCA), 841 patients, 615 with successful PTCA and 226 without, were restudied by questionnaire 2-9 years after the intervention. After successful PTCA a lasting symptomatic improvement was seen in 78% of patients vs 55% of patients without successful PTCA (p less than 0.0001). The probability of myocardial infarction 8 years after successful PTCA was 6% vs 24% after unsuccessful PTCA (p less than 0.0005). The 8-year survival probability (non-cardiac deaths excluded) was 95.7% in patients with demonstrable PTCA success, and 92.0% in patients without (p less than 0.05). Similar significant differences in favor of patients with successful PTCA were seen in the long-term prognosis of patients with single-vessel disease (n = 580). It is concluded that a long-term improvement of the cardiac prognosis by successful PTCA is probable.

Angioplasty, Balloon, Coronary↗
PubMed1989

[Long-term therapy following myocardial infarct with isosorbide dinitrate in a low and high dose].

The favorable response to nitrates in the case of coronary heart diseases is based on both reduction in left ventricular pre- and afterload and improvement in coronary flow. These effects were studied in the setting of a long-term ISDN therapy with reference to the prognosis of patients after myocardial infarction. Following acute treatment in the respective hospitals, 608 patients with myocardial infarctions were allocated to two double-blind treatment groups with different ISDN dosage levels (group 1 = 5 x 2.5 mg i.d.; group 2 = 5 x 40 mg i.d.) and followed up over a period of 2 years. No differences were found with regard to the end points sudden cardiac death, reinfraction, and indication for revascularization. There was, however, a more frequent additional administration of calciumantagonists to patients of the low-dose group (p less than 0.05), a more frequent drop-out due to the lack of beneficial therapeutic results, and a more exceptional drop-out due to side effects in patients treated with low doses of ISDN (n.s.). The absence of any significant difference with regard to the end points might be attributed to; 1) a loss of potency of high-dose ISDN and simultaneous ineffectiveness of low-dose ISDN; 2) an efficacy of low doses; 3) an absence of actual influence on the target parameters, and 4) an inadequate follow-up time period.

Coronary Circulation↗
PubMed1989

[Diastolic ventricular function in hypertrophic, obstructive and non-obstructive cardiomyopathy--effect of gallopamil].

Left ventricular function was investigated by radionuclide ventriculography in 13 patients (11 male, two female) with hypertrophic cardiomyopathy, aged from 22-57 years (mean 45.5 years) at rest and during exercise. Ten patients had hypertrophic obstructive cardiomyopathy with maximal left ventricular outflow tract gradients of 64-290 mmHg (mean 147 mmHg). Left ventricular enddiastolic pressure of all patients ranged from 8-35 mmHg (mean 21 mmHg). Radionuclide ventriculography was performed without therapy, after acute application of a single oral dose of gallopamil (50 mg), and after longterm treatment for 3 weeks (50 mg tid). Ejection fraction at rest after single dose increased from 69.2% to 72.9% (p less than 0.02), peak ejection rate (PER) increased from 333.5 to 362.0/s (p less than 0.01) and peak filling rate (PFR) from 284.5 to 316.5/s (p less than 0.02). Under exercise single dose as well as longterm treatment led to a slight but significant shift in the ratio of PFR/PER (from 1.02 to 1.12 after single dose [p less than 0.04], and to 1.18 with longterm treatment [p less than 0.03]). There was no correlation between the individual response to gallopamil treatment and histopathological parameters such as hypertrophy or fibrosis. These data demonstrate that gallopamil in patients with hypertrophic cardiomyopathy leads to an improvement mainly in left ventricular diastolic function which appears to be most effective under exercise.

Adult↗
PubMed1989

[The spectrum of side effects of gallopamil in comparison with other calcium antagonists].

Severe adverse effects associated with the use of calcium channel blockers do not occur very often. Sometimes nifedipin produces hypotension, tachycardia, and headache, whereas verapamil, gallopamil, and dilitiazem show more negative chronotropic effects such as bradycardia or sinuatrial and atrioventricular nodal conduction disturbances. Gastrointestinal side effects are constipation after verapamil and stomach problems after gallopamil.

Arrhythmias, Cardiac↗
PubMed1988

Late results of prosthetic valve replacement for aortic regurgitation and the prognostic significance of the end-diastolic and regurgitated blood volumes.

Between January 1975 and December 1985 214 patients underwent prosthetic aortic valve replacement for isolated aortic regurgitation. Patient follow-up averaged 5.4 years after the operation (range 0.7-10.7 years). Preoperative staging showed 9 patients to be in NYHA stage II, 111 patients in stage III, and 94 patients in stage IV. At follow-up 3 patients complained of increased fatigue, 9 patients remained stable and 167 patients had improved. 103 of these patients were free of symptoms under stress, i.e. NYHA stage I. The hospital mortality was 3.7% (8/214 patients). An additional 26 patients died within an average of 2.8 years. The cumulative 5-year survival rate was 85%; the 10-year survival rate was 81.5%. 10 patients underwent a second operation within an average of 3.4 years. The correlation between the end-diastolic volume and the regurgitated blood volume has prognostic significance. 25 patients with appropriate enlargement of the left ventricle showed a significant decrease of the end-diastolic volume and the roentgenographic heart volume combined with an increase of ejection fraction. None of these 25 patients died from cardiac complications. A control group of 9 patients with myocardial damage showed no significant change in the above parameters. 4 patients in the control group died. We conclude that the relationship of regurgitated blood volume and the left ventricular end-diastolic volume is of prognostic significance for patients with chronic aortic regurgitation presenting with minimal symptoms.

Adult↗