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Biomedical subjects

H Kreuzer

Publications and source records attributed to H Kreuzer.

At least 289 records · Page 16Linked to original sources
PubMed1980

[Local streptokinase treatment in acute pulmonary embolism with shock (author's transl)].

Streptokinase (290 000 U/2 h) was directly infused under angiographic control into the predominantly affected right pulmonary artery in a 71-year-old patient with acute pulmonary embolism and persistent shock. This led to immediate complete remission of shock symptoms and lasting stabilisation of the patient. If, as this case demonstrates, embolectomy is not possible and high-dose intravenous streptokinase is contraindicated, localised use of streptokinase in low dosage offers a possibility for treatment of life-threatening pulmonary embolism.

Aged↗
PubMed1980

Changes in left ventricular diastolic function in coronary artery disease with and without angina pectoris assessed from exercise ventriculography.

In 11 normals and 43 patients with coronary artery disease left ventricular (LV) diastolic pressure-volume (P-V) curves were obtained from biplane ventriculograms and simultaneous high fidelity pressure measurements. During exercise ventriculography 20 patients had angina pectoris (group B), and 16 patients were asymptomatic (group A). At rest there were no akinetic segments in 28 patients (group C), and an akinetic segment was found in 15 (group D). With different total work loads (951 +/- 134 and 2100 +/- 245 kpm in groups B and A), LV minimal and end-diastolic pressures and corresponding ventricular volumes increased to a similar extent in patients with and without angina during exercise ventriculography. With comparable work loads (1,296 +/- 221 and 1,494 +/- 195 kpm in groups C and D) the mean increase in diastolic pressure and volume was larger in group D, which corresponded to the more depressed LV resting function.

Adolescent↗
PubMed1980

Changes in coronary anatomy and left ventricular function from the acute to the chronic stage of myocardial infarction.

Coronary angiography was performed in the acute stage of myocardial infarction in 65 patients. The infarct-related vessel was occluded in 50 patients; it was narrowed greater than 90% in the remaining 15 patients. Control angiography was performed 55 +/- 46 d after acute myocardial infarction in 18 patients. In the chronic stage, five of thirteen previously occluded vessels showed antegrade filling of the distal segment. The narrowing at the site of previous obstruction was 80--95%. In two of five patients with a subtotal stenosis, the lumen of the infarct-related vessel was clearly larger in the chronic stage. The end-diastolic volume index increased significantly from 86 +/- 23 ml/m2 in the acute stage to 110 +/- 35 ml/m2 in the chronic stage (p less than 0.001). The increase in the end-systolic volume index from 42 +/- 15 ml/m2 to 63 +/- 31 ml/m2 was also statistically significant (p less than 0.005). Stroke volume index, ejection fraction, and the length of the akinetic segment (AKS) did not change significantly. There was a weak correlation between the end-systolic volume index and the length of the AKS in the acute stage (r = 0.489, p less than 0.05) and a better correlation in the chronic stage (r = 0.602, p less than 0.01). The ejection fraction and the length of the AKS correlated in the chronic stage only (r = 0.795, p less than 0.001).

Angiocardiography↗
PubMed1980

Predictive value of thallium scintigraphy in coronary artery disease.

To verify the predictive value of thallium exercise scintigraphy, 20 normal individuals and 60 patients with coronary artery disease (CAD) were examined, using a quantitative standard technique and receiver operating characteristic analysis. The sensitivity of thallium scintigraphy for the presence of CAD was 97% for patients with previous infarction and 85% for those without infarction. The sensitivity for the extent of CAD was 93% for vessels perfusing infarcted areas and only 67% for vessels without infarction. In patients without myocardial infarction, sensitivity for the number of diseased vessels decreased with increasing extent of CAD. An underestimation of hemodynamically significant stenoses was proven by a comparison with the results of exercise ventriculography. The predictive value of a normal scintigram at a high prevalence of CAD is as low as the predictive value of an abnormal scintigram at a low prevalence level (screening). Thallium scintigraphy is indicated in patients with a medium prevalence of CAD, e.g., in patients with atypical angina and in asymptomatic patients with pathologic ECG.

Adult↗
PubMed1980

Validity of different gated equilibrium blood pool methods for determination of left ventricular ejection fraction.

Left ventricular ejection fractions (EF) were determined in 37 patients by biplane cineventriculography (Angio) and by four modifications of the gated equilibrium blood pool (GBP) method: 1. Region of interest (ROI) in enddiastole (ED), correction by external background, 2. ROI in ED, correction by internal background between ED and endsystole (ES), 3. ROI in ED (maximum) and ES (mimimum); no background correction, 4. ROI in ES, correction by background between ED and ES. EFGBP were determined after injection of 20 mCi 99mTc human albumin (Anger-camera, all-purpose collimator, 16 ECG-segments, 64 x 64 matrix with 1.5 zoom). EF by biplane angiography (EFangio) was calculated by the formula of Dodge. The following correlation between angiographically and scintigraphically determined EF's were found: EFGBP1 = 0.504 EFangio + 8.08, EFGBP2 = 0.847 EFangio + 10.0, EFGBP3 = 0.911 EFangio + 3.75, EFGBP4 = 0.648 EFangio - 3.51 Intraobserver variability of GBP method 2 and 3 was +/- 5%. EFS determined by GBP methods 2 and 3 are as accurate as the EFs determined by cineventriculography.

Adult↗
PubMed1980

Combined medical and surgical procedure in acute myocardial infarction--a preliminary report.

The purpose of this investigation was to evaluate a new therapeutic approach, by which acutely ischemic human myocardium could be reperfused. The procedure was as follows: intracoronary application of nitroglycerine, intraluminal recanalization by catheters and intracoronary application of streptokinase. Before and after these interventions coronary angiograms were made. Surgical coronary revascularization was performed 1--64 days after reestablishment of flow through the occluded vessels. Seven patients with acute myocardial infarction were treated in this manner. The mean preoperation ejection fraction was 48.6%, the mean enddiastolic pressure was 17.5 mmHg and the mean maximal CPK activity was 616 units/liter (u/l). By the conservative regimen outlined, reopening of the occluded vessels was achieved in all cases. Critical stenoses of 80--85%, however, persisted. But, reperfusion appeared sufficient since in none of the patients hemorrhagic myocarditis was produced intra-operatively. There was no hospital mortality. The mean post-operative ejection fraction was 60% and the mean enddiastolic pressure was 10.6 mmHg. It is concluded that ischemic myocardium can be reperfused by the active conservative regime tested. Emergency revascularization performed after induced reperfusion appears to carry a low operative risk.

Aged↗
PubMed1980

[Myocardial scintigraphy with thallium-201 for evaluation of the patency of aorto-coronary bypasses in multiple vessel disease and multiple bypasses (author's transl)].

The reliability of myocardial scintigraphy with thallium-201 in evaluating the patency of aorto-coronary bypasses was examined. In addition to coronary angiography and ventriculography in 16 patients (42 stenosed vessels, 36 bypasses of which 22 were patent) quantitative myocardial scintigraphy was performed after maximum exercise and at rest, pre- and postoperatively. In general, 12 patients with postoperatively improved angina showed an improvement in their scintigram. The analysis of myocardial areas with a bypass showed a decrease of thallium uptake at rest in 39%, regardless of patency occlusion of the bypass. In 85% of these regions an increased thallium uptake was seen after exercise, again independent of the function of the bypass. The data show that myocardial scintigraphy with thallium-201 cannot be utilized in patients with multiple vessel disease and multiple bypasses to evaluate the patency of a particular bypass, but a general assessment is possible, whether myocardial perfusion has improved.

Adult↗
PubMed1980

Hemodynamic effects of the new vasodilator drug Bay k 5552 in man.

The hemodynamic effects of the new vasodilator drug isobutyl methyl 1,4-dihydro-2,6-dimethyl-4-(2-nitrophenyl)-3,5-pyridinecarboxylate (nisoldipine, Bay k 5552) were observed in 9 patients undergoing cardiac catheterization. The drug was administered i.v. in a dose of 1.5 microgram/kg body weight. Within 1 min after injection aortic pressure decreased by 11.5 +/- 6.4%, cardiac index increased by 23.1 +/- 13.5%, and heart rate accelerated by 18.3 +/- 10.1% of control value. Calculated total peripheral resistance was reduced by 28.2 +/- 10.1%. The whole low pressure system as well as the dp/dt max remained unaffected by the drug. The stroke volume index showed a slight and insignificant increase. Thus, Bay k 5552 represents a fast and power fully acting vasodilating substance with its actions being restricted mainly to the peripheral vasculature.

Adult↗
PubMed1980

[Results of quantitative myocardial scintigraphy with thallium-201 at rest and after maximum exercise--critical analysis of predictive value and clinical application (author's transl)].

In 20 normal individuals and 60 patients with CAD, myocardial scintigraphy with thallium-201 was performed after maximum exercise and two hours later at rest. The evaluation of digitized scintigrams was performed quantitatively by means of a 14-halfsegment model. Using ROC analysis, sensitivity and specificity were estimated. Furthermore the predictive value of a thallium scintigram was evaluated by means of the bayesian theorem, comparing the data with coronary angiography and partly also with exercise ventriculography. At a specificity of 90%, sensitivity of scintigraphy for CAD was 97% in 34 patients with previous myocardial infarction and 85% in 26 patients without infarction. Sensitivity for the extent of CAD was 93% for 44 vessels, perfusing infarcted myocardium and 67% for 96 vessels, perfusing non-infarcted myocardium. Sensitivity decreased with increasing extent of CAD and was higher for Cx than for LAD. The predictive value of a positive or negative scintigram was analyzed for different prevalences of CAD. At a low prevalence, e.g. 5%, the predictive value of a pathological scintigram is only 32%, consequently thallium scintigraphy is not applicable as a general screening procedure. At a high prevalence, e.g. 90%, the predictive value of a normal scintigram is only 40%. Therefore thallium scintigraphy seems not to be able to differentiate whether a coronary artery stenosis is hemodynamically significant or not. This was in agreement with the data from exercise cineventriculography. A high predictive value of thallium scintigraphy of about 85% is obtained only in the case of a medium prevalence of CAD, e.g. in asymptomatic patients with pathological Ecg or in patients with atypical angina pectoris. An improvement of the predictive value of myocardial scintigraphy would require other radionuclides than thallium-201, to use higher activities and to allow Ecg-gated myocardial scintigraphy.

Adult↗
PubMed1980

[Quantitative Tl-201 scintigraphy in diagnosis of severity and location of coronary artery disease. Comparison of a Tl-score to invasive and non-invasive parameters (author's transl)].

Thallium-201 scintigraphy was performed in 20 normals and 60 patients (pts) with angiographically proven coronary artery disease (CAD) at rest after maximal exercise for evaluation of severity and location of CAD. The Tl-scintigrams were quantified by a Tl-score. The results of the Tl-score were compared with invasive and non-invasive parameters. Sensitivity asnd specificity of the Tl-score in evaluation of CAD was 90%. In normals, there were no significant differences from rest to exercise (Tl-score less than or equal to 1.2). Twenty-six of the pts with CAD, who had no evidence of myocardial infarction, showed a significant increase of Tl-score from 5.0 +/- 1.7 to 8.7 +/- 2.6 after exercise (p < 0.001). In 34 pts with CAD and a history of MI, Tl-score increased from 24.9 +/- 3.1 to 33.3 +/- 3.8 (p < 0.001). Exercised-induced ischemia was assessed by exercise electrocardiography in 48%, by Tl-score in 62% and by angina pectoris in 77%. In 37 pts, the Tl-score was compared with the coronary score, ejection fraction (EF) and local wall motion derived from biplane cineventriculograms. There was a significant correlation between the Tl-score and the EF: y = 79.13 - 1.11 x, n = 74, r = 0.688 (p < 0.001). No correlation was found between the coronary score and the Tl-score. Hypokinetic wall motion disturbances were assessed by Tl-score in 34% only, whereas akinesia and dyskinesia were detected in 86% (p < 0.001). The data suggest that Tl-scintigraphy even with a quantitative Tl-score is not sufficient for exact assessment of extent and severity of CAD.

Adult↗
PubMed1980

[Qualitative and semi-quantitative analysis of local wall motion abnormalities by gated-blood-pool in comparison to biplane cineventriculography (author's transl)].

Left ventricular wall motion at rest was assessed by the following three methods in 37 patients of whom 12 patients had coronary artery lesions of > 75% and Ecg-signs of transmural MI: A) qualitative analysis of GBP, B) semi-quantitative analysis of GBP, C) qualitative analysis of a biplane cineventriculogram. Sensitivity and specificity of each method were evaluated based on the cineventriculographic findings. Specificity of method A was 83%, of method B 100%. Sensitivity of method A was 88%, of method B 84%. Concordance of methods B and C was 92.8% (167/180 left ventricular segments). Discordance between the two methods was found only in 1 segment judged to be akinetic and in 12 segments judged to be hypokinetic by one of the two methods.

Adult↗
PubMed1979

[Radioimmunoassay for human myoglobin: methodology and diagnostic significance in myocardial infarction (author's transl)].

A radioimmunoassay was developed to determine serum myoglobin (SMb). 50 healthy persons showed values between 0 and 90 ng/ml. Serial tests of 10 patients following acute myocardial infarction or during angina pectoris (AP) indicated that SMb reached pathological values before CK and CK-MB (average 250 +/- 95 ng/ml at the time of hospitalisation which corresponds to 3.3 +/- 1.4 h after beginning of angina pectoris). At hospitalisation the simultaneously determined CK was within normal limits and reached pathological values only 6.2 +/- 1.9 h after the onset of angina. Maximum of SMb was 506 +/- 194 ng/ml occurring 8.8 +/- 2.8 h after beginning of AP, maximum of CK was 905 +/- 475 mU/ml occurring 20.0 +/- 7.8 h after AP. CK-MB and CK differed only slightly in their time course. One patient with severe AP had pathologically increased SMb values whilst all other enzymes were completely normal. Methodical and clinical results are discussed.

Adult↗
PubMed1979

Initial experience with transluminal recanalization of the recently occluded infarct-related coronary artery in acute myocardial infarction -- comparison with conventionally treated patients.

In 7 patients, the recently occluded infarct-related vessel was recanalized by transluminal catheter techniques during acute myocardial infarction (Group A). 4 patients had single-vessel disease, 2 patients two-vessels disease and one, involvement of three vessels. Control angiography was performed in 6 patients, 8 days to 7 months later. Changes of coronary artery anatomy and left ventricular function were compared with a group of 9 conventionally treated patients, who were found to have occlusion of the infarct-related vessel in the acute stage (Group B). Five Group B patients had one-vessel disease, 3 patients two-vessel disease and 1 patient, involvement of all three vessels. In the chronic stage, all transluminally recanalized vessels were found to be patent in Group A. There was spontaneous recanalization of the infarct vessel in 4 of 9 Group B patients. In Group A, the length of the akinetic segment (AKS) decreased significantly (p less than 0.05) from 145.4 +/- 48.5 mm to 73.2 +/- 73.4 mm (mean +/- SD). Volume parameters did not change significantly. In Group B, length of the AKS did not change significantly, EDVI increased significantly from 81.1 +/- 19.8 to 106.8 +/- 4.6 ml/m2 (p less than 0.05); ESVI increased significantly from 41.7 +/- 13.7; ml/m2 to 66.8 +/- 37.9 ml/m2 (p less than 0.01). In the acute stage, length of the AKS and volume parameters did not differ significantly between the two groups. In the chronic stage, AKS was significantly shorter (A: 73.2 +/- 63.4 mm; 144.9 +/- 59 mm (p less than 0.0025) and EF was significantly higher (A: 54.6 +/- 11.6%; B: 40.9 +/- 14.5% (p less than 0.05) in Group A. Peak CPK was lower in Group A (A: 1009 +/- 827 U/l; B: 1324 +/- 655 U/l), but this difference did not achieve statistical significance. Results of this pilot study suggest that transluminal recanalization in the early phases of acute myocardial infarction might result in limitation of myocardial injury. However, further research will be needed to improve the technique and to test its results.

Adult↗