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Biomedical subjects

H Mayr

Publications and source records attributed to H Mayr.

At least 37 records · Page 2Linked to original sources
PubMed2000

[Coronary angiography in patients over 80 years of age: indications, results, consequences].

Due to the continuous increase of elderly individuals in the society the cardiologist has to deal with elderly patients more often. The apparative expenditures and the invasive procedure require a critical consideration of benefits and risks prior to performing coronary angiography in these patients. The indication and frequency of coronary angiography in patients with eighty years or above were investigated. Furthermore, the results of angiography, the risks of the procedure and the therapeutic consequences were evaluated. The whole study population consisted of 2,500 consecutive patients (1,557 men, 943 women), who underwent coronary angiography at our institution from January 1st to November 16th in 1998. A retrospective analysis of 66 coronary angiographies (3%) in 61 patients (26 men, 35 women) aged 80 years or older was performed. Among these 61 patients, 51 were referred because of suspected coronary artery disease. Due to the clinical presentation a high percentage (42 patients = 82%) was classified as having unstable angina. 10 patients were referred due to valvular heart disease. Single-vessel disease was found in 14, two-vessel disease in 5 and multi-vessel disease in 28 patients, respectively. Percutaneous coronary intervention was performed in 17 patients, among these were 9 patients with multi-vessel disease and PTCA of the culprit lesion, and 3 patients underwent bypass surgery. Medical therapy was decided as to 28 patients. Aortic valve replacement was performed in 2 of 9 patients with aortic stenosis. The clinical appearance of coronary artery disease in elderly patients was mostly unstable angina, explaining the need for intervention. Coronary angiography disclosed multi-vessel disease in 55% of patients. A revascularization procedure could be performed at least in 43% of patients with multi-vessel disease.

Adult↗
PubMed2000

[Apical hypertrophic cardiomyopathy--clinical and diagnostic characteristics based on a case report].

Chest pain and shortness of breath are the most common symptoms of hypertrophic non obstructive cardiomyopathy (HCM). Accurate diagnosis of HCM and ruling out more common diseases such as coronary or hypertensive heart disease are important for the further course of the patient but can be difficult to perform with non invasive diagnostic tools and invasive strategies are sometimes required. We report on a 77-year old woman suffering from chest pain for many years. Cardiac catheterisation confirmed diagnosis of apical hypertrophic cardiomyopathy.

Aged↗
PubMed1999

[Analysis of referral diagnoses of patients with normal coronary angiogram].

BACKGROUND AND AIMS: Angiography permits an evaluation of the morphology of the coronary artery, stratification of risk and optimal therapeutic management in patients with suspected coronary artery disease (CAD). The sophisticated apparatus, cost and invasiveness of the procedure necessitate well-considered application of this method. In spite of an exact documentation of the patient's medical history and careful establishment of the indication, the results of angiography are often normal. Therefore, it appears important to analyse the referral diagnoses in patients with normal coronary angiograms. PATIENTS AND METHODS: We studied 1000 consecutive patients (625 men, 375 women, mean age 63.1 years) who underwent coronary angiography at our institution from January to May 1998. All patients were included in the retrospective analysis of the referral diagnoses. RESULTS: 875 patients (554 men, 321 women) were referred due to suspected CAD; 173 of these had normal angiographic findings (20%; 73 men, 100 women; mean age 58.4 years). The referral diagnoses were as follows: unstable angina in 62 patients (36%), stable angina in 40 patients (23%), chest pain and pathological findings of non-invasive testing in 32 patients (19%), atypical chest pain in 25 patients (14%), previous myocardial infarction and multiple risk factors in 7 patients each (4% each). Gender-related differences were remarkable. Only 73 of the 554 referred men (13%) had normal angiographic findings, whereas in women the rate of normal results was more than twofold higher, i.e. 100 of the 321 referred women (31%) had normal angiographic findings (p < 0.01). CONCLUSIONS: Among 875 patients referred to our catheter laboratory for coronary angiography due to suspected CAD, normal angiographic results were documented in 20%. The high frequency of the referral diagnosis 'unstable angina' and 'pathological result of noninvasive testing' was as remarkable as the high proportion of women among patients with normal findings.

Adult↗
PubMed1999

[Clinical presentation and coronary angiographic results in unstable angina pectoris].

The syndrome "unstable angina" (UA) covers a broad spectrum of patients. In this study we tried to determine the relationship between the severity of UA and angiographic findings. We evaluated 1000 consecutive patients undergoing coronary angiography. Those with the clinical diagnosis "UA" were included in the study. In a retrospective analysis of their records we categorized them, using the Braunwald-classification for determination of the severity of the disease. 352 patients were include, 209 men and 143 women, the mean age was 65 years. 47% met Braunwald-Class I, 26% Class II and 27% Class III. Coronary single-vessel disease was present in 29%, two-vessel disease in 20%, three-vessel disease in 25%, normal coronaries in 13% and coronary atherosclerosis without critical narrowing in 13%. Left ventricular function was preserved in 72%, mild systolic dysfunction was found in 10%, moderate in 13% and severe in 5%. There was no overall correlation between clinical presentation (Braunwald-Classes) and angiographic findings. Women showed a similar distribution of Braunwald-Classes, but significantly more coronary arteries without critical obstruction. In patients with reduced systolic function the percentage of multi-vessel disease was significantly higher, the percentage without relevant coronary artery narrowing was significantly lower. 1) The lack of overall correlation between clinical presentation and angiographic findings supports the importance of coronary angiography in the evaluation of patients with UA. 2) The assessment of women with chest pain is more difficult than of men with regard to coronary heart disease. 3) UA in patients with impaired left ventricular function is a predictor of severe coronary artery disease.

Aged↗
PubMed1999

[Therapy of heart failure with ACE inhibitors--"evidence-based medicine" and clinical reality].

Treatment of patients with chronic heart failure improves symptoms and NYHA functional class in about 50-80% of all patients treated. A 15% reduction can be observed in the need for hospitalisation and a 16-31% reduction in 1-year mortality. 37% risk reduction for progression to symptomatic heart failure can be achieved with ACE-inhibition in asymptomatic patients with systolic left ventricular dysfunction (55). Thus, ACE-inhibition should be part of standard treatment in symptomatic and asymptomatic patients with left ventricular dysfunction. In symptomatic patients with chronic heart failure, combination therapy of an ACE-inhibitor with digitalis and diuretics is state of the art and improves symptoms significantly. The addition of a vasodilatator can be considered in selected cases. Based on recently published data on beta-adrenoreceptor-blockade in the treatment of chronic heart failure, beta-blockers seem to get part of standard therapy of heart failure in the present and near future (2, 44, 50, 60). In spite of innovations of modern heart failure therapy prognosis is still bad. Survival after diagnosis of severe heart failure (functional class NYHA III and IV) is limited to a mean of 14 month.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1995

Comparative assessment of right ventricular volumes and ejection fraction by thermodilution and magnetic resonance imaging in dilated cardiomyopathy.

Measurements of right ventricular (RV) ejection fraction (EF) and volumes using a new thermodilution technique were compared to serially performed magnetic resonance imaging (MRI) in 21 patients with dilated cardiomyopathy. For RVEF (%) and RV volume indices (ml/m2) the following correlation coefficients were found: RVEF r = 0.82; end-diastolic volume index (EDVI) r = 0.45; end-systolic volume index (ESVI) r = 0.65; stroke volume index (SVI) r = 0.61; all p < 0.05. However, RVEF by thermodilution was significantly lower (RVEF thermo = 31 +/- 14 vs. RVEF MRI = 50 +/- 14, p < 0.01) and RV EDV and ESVI were significantly higher compared to MRI, while SVI showed no significant difference. Exclusion of patients with atrial fibrillation (n = 8) improved the correlations (RVEF r = 0.94, EDVI r = 0.77, ESVI r = 0.87, SVI r = 0.65, all p < 0.05), but did not reduce the mean difference between both methods.

Cardiomyopathy, Dilated↗
PubMed1995

[Early diagnosis of diabetic gastroparesis].

Recognition of early phases of diabetic gastroparesis is hampered by the absence of characteristic symptoms and practicable detection systems in clinical practice. Hence, a new procedure estimating phase III activity of the interdigestive migrating motor complex by monitoring gastric emptying of an undigestible marker particle by means of a metal detector was evaluated in 40 diabetic patients (13 type I, 27 type II diabetes) and 14 non-diabetic controls. Simultaneously, orocecal transit of fluids was measured by the hydrogen breath test. Gastric emptying of a solid marker was significantly delayed in diabetics as compared with controls (112.5 +/- 8.6 vs 51.2 +/- 6.8 minutes, M +/- SEM, p < 0.05). Of the diabetics investigated 77.5% had delayed gastric emptying but only 22.5% of those were clinically symptomatic as assessed by a standardized questionnaire. Gastric emptying velocity did not correlate significantly with age, length of diabetes, neuropathy, blood glucose and orocecal transit of fluids. We conclude that determination of gastric emptying time of undigestible marker particles by means of a sensitive metal detector appears to be a clinically promising and easy to perform method to detect early phases of diabetic gastroparesis.

Adult↗
PubMed1993

Primary hyperparathyroidism: incidence of cardiac abnormalities and partial reversibility after successful parathyroidectomy.

PURPOSE: This prospective study was designed to assess the effect of primary hyperparathyroidism on heart muscle, valves, and myocardial function. Echocardiography was used to evaluate changes in mechanical performance, the thickness of the left ventricular wall, myocardial calcific deposits, and valvular calcifications in patients with primary hyperparathyroidism. METHODS: Echocardiography was performed in 54 patients with hyperparathyroidism prior to surgery and 12 +/- 2 months after successful parathyroidectomy. A matched control group was followed for comparison. RESULTS: In a blinded fashion, aortic and mitral valve calcifications were detected in 63% and 49% of patients with primary hyperparathyroidism (controls: 12% and 15%, respectively). Calcific deposits in the myocardium were found in 69% of patients with hyperparathyroidism and 17% of the control subjects. After parathyroidectomy and 12 months of normocalcemia, a significant regression of left ventricular hypertrophy (p < 0.001) was observed. CONCLUSIONS: The present data show a high incidence of left ventricular hypertrophy, calcific deposits in the myocardium, and/or aortic and mitral valve calcification in patients with primary hyperparathyroidism. A 1-year follow-up after parathyroidectomy (and restoration of normocalcemia) discloses regression of hypertrophy, while calcifications persist without evidence of progression.

Adult↗
PubMed1992

Quantitative assessment of aortic regurgitation by magnetic resonance imaging.

Thirty patients with aortic regurgitation and 10 controls were examined using an 0.5 T superconducting magnet with ECG gating. In each case a multislice-multiphase spinecho study in sagittal-coronal double angulated projection (four-chamber equivalent) was performed to assess left and right ventricular volumes, ejection fraction and regurgitation fraction. Additionally, a blood-flow sensitive cine-study (gradient echo, FAME) was performed to visualize direction and area of regurgitant jet. Magnetic resonance imaging (MRI) data were compared with quantitative and qualitative assessment of aortic regurgitation by angiography, Doppler and colour flow mapping. Using the FAME mode MRI, we were able to detect the regurgitant jet as an area of signal loss within the left ventricle in all patients; moderate correlation to jet area was determined by colour flow mapping (R = 0.60, P less than 0.001). Determination of left and right ventricular end-diastolic, end-systolic and stroke volumes by MRI revealed excellent correlation with invasive data (R = 0.94, P = 0.0001). With MRI regurgitant fraction (RF) could be calculated from the difference between right and left ventricular stroke volumes, which showed good correlation with invasively determined RF (R = 0.91, P = 0.001) and with qualitative Sellers' scoring (R = 0.70, P less than 0.001), respectively. Thus MRI provides the basis for noninvasive detection and quantification of aortic regurgitation.

Adolescent↗
PubMed1992

Doppler sonographic evaluation of the CarboMedics bileaflet valve prosthesis: one-year experience.

Between April 1989 and March 1991, 237 CarboMedics bileaflet valve prosthesis carriers (165 aortic and 72 mitral valves, mean age 54.4 years) were studied prospectively with pulsed- and continuous-wave Doppler at a mean interval of 11.4 months following surgery in order to establish ranges of normal flow velocities and pressure gradients. Physical examination revealed no signs of prosthetic dysfunction or heart failure. Postoperative left ventricular function as measured by fractional shortening was 37% for aortic valve carriers and 30% for mitral valve carriers (p = NS). Mean peak velocity (+/- SD) across the aortic valve was 2.6 m/sec (+/- 0.4) and calculated instantaneous peak pressure gradient ranged from 11 to 58 mmHg (mean 28.1 +/- 10.3). It has to be emphasized that occasional patients with normally functioning valve prostheses can show unusual high gradients. Ring diameters between 21 and 27 mm showed no significant difference with regard to flow velocities and pressure gradients, whereas in 19-mm valves, significantly higher values could be demonstrated. The 123 aortic valve carriers with normal left ventricular function (fractional shortening greater than 25%) showed significantly higher pressure gradients than the 19 patients with reduced left ventricular function (28.6 +/- 11.6 mmHg vs 16.2 +/- 5.1 mmHg, p less than 0.05). In the mitral position, the mean of peak velocity (+/- SD) was 1.7 +/- 0.4 m/sec and pressure half-time was 108 +/- 26 msec, representing a calculated valve area between 1.4 to 3.1 cm2 (mean orifice size 2.1 +/- 0.5 cm2). No significant difference between valves of different sizes was found.(ABSTRACT TRUNCATED AT 250 WORDS)

Aortic Valve↗
PubMed1992

[Pimobendan (UDCG 115 BS) in long-term therapy of chronic heart failure].

Pimobendan is a positive inotropic agent with additional calcium-sensitizing effects of the phosphodiesterase III-inhibitor group. In short-term studies, beneficial hemodynamic effects have been demonstrated in patients with congestive heart failure. The aim of this prospective study was to examine the long-term effect of pimobendan (during at least 6 months) on subjective state, hemodynamic parameters, and arrhythmias in patients with congestive heart failure NYHA classes II and III. After double-blind randomization, 24 patients received pimobendan 5 mg bid or placebo orally in addition to a basic therapy (diuretics, digitalis). After 3 months, pimobendan-treated patients showed a significant clinical improvement (p < 0.03). In the placebo group, one patient underwent acute cardiac transplantation due to rapid clinical deterioration; another patient died suddenly after 5 months. No cardiac events occurred in the pimobendan group. In comparison to placebo, no proarrhythmogenic effect of pimobendan was detected. Clinical stabilization of patients in the pimobendan group was not paralleled by improvement of the hemodynamic parameters of left-ventricular performance.

Cardiac Volume↗
PubMed1991

[Diagnosis of arrhythmogenic right ventricular disease using magnetic resonance tomography].

In our study, 12 patients with ventricular arrhythmias, but without any documented cardiac disease, and 10 healthy volunteers were investigated by spin echo magnetic resonance tomography (MRT) using a 0.5 Tesla magnet. Axial T1-weighted spin-echo sequences, as well as double angulated, multislice-multiphase sequences were acquired. Left- and right-ventricular volumes were then evaluated by outlining the endocardium in an end-systolic and an end-diastolic frame. The right-ventricular free wall and the right-ventricular outflow tract were investigated for myocardial thickness and intramural fat.

Adipose Tissue↗
PubMed1991

[Evaluating the function of aortocoronary bypasses with magnetic resonance tomography].

Following an aortocoronary bypass operation the differential diagnosis of chest pain of recent onset may be difficult (ischaemia, thoracotomy induced pain). At this point noninvasive methods are preferable to angiography in order to reach exact diagnosis. Magnetic Resonance Imaging (MRI), a new noninvasive imaging method, makes it possible to get anatomical and blood flow information without the use of ionizing radiation or contrast agents. It was the aim of our study to examine the diagnostic impact of MRI for the assessment of aortocoronary bypass graft patency. We compared three different acquisition techniques (a spinecho sequence and two fast-gradient echo sequences). 26 patients were examined, 49 bypass grafts were eligible for comparative evaluation. As compared with the spinecho technique, fast echo gradient sequences had a higher sensitivity (FISP 93%, FLASH 88%) than the spinecho technique 79%, and a higher accuracy (FISP 88%, FLASH 82%) versus 73%, respectively. We conclude that MRI may have a high diagnostic potential in the evaluation of early postoperative aortocoronary bypass graft patency.

Adult↗
PubMed1990

[Cine-MR for the quantification of regurgitation defects by a volume method].

We have examined 46 patients with angiographically confirmed regurgitant lesions (26 mitral insufficiency, 20 aortic insufficiency) using a 0.5 Tesla magnet. In each patient, multiplane and multiphase spin-echo sequences were obtained in a plane angled in the sagittal and coronal direction in the long axis of the heart; left and right ventricular volumes, ejection fractions and regurgitation fractions were calculated. In addition, a blood-flow sensitive gradient echo sequence was obtained in order to determine the direction and extent of the regurgitant jet. The data was compared with the results of angiography and echocardiography. By means of the gradient echo technique, MRI was able to show the regurgitant jet in every patient. There was a linear correlation between volumes determined by MRI and angiography. The best agreement was found for left ventricular contraction volume (R = 0.82, p is less than 0.0001). Comparison of the noninvasive and angiographic method showed a linear correlation for AI patients of R = 0.91 (p is less than 0.001), which is somewhat better than for patients with MI (R = 0.84, p less than 0.001). Semiquantitative grading of MI with a gradient echo technique showed a linear correlation with angiography of R = 0.73 (p less than 0.001), for AI there was agreement between both methods in 72% of cases. A comparison between MRI and colour Doppler sonography showed only moderately good correlation R = 0.69 (p less than 0.01).

Adult↗
PubMed1990

[MRT using Gd-DTPA in the diagnosis of tumor and pseudotumor intracardiac masses].

Magnetic resonance examinations were performed in 15 patients suffering from echocardiographically detected intracardiac masses. All patients were examined with a 1.5 T superconducting machine, using spin echo technique, including Gd-DTPA, and gradient echo sequences. The MR findings were confirmed partially by histology and angiography, otherwise by good correlation to clinical findings. MR results were divided into three groups: 1. tumour, 2. thrombosis, 3. pseudotumorous mass, and corresponded well with the final diagnosis: in 8 patients tumour, in 5 patients thrombosis, and in two patients pseudotumorous masses, including one hydatid cyst and one case of lipomatosis. Tumours showed in contrast to thrombosis marked enhancement after gadolinium injection, whereas the hydatid cyst and the lipomatosis demonstrated characteristic signal behaviour. Problems existed in differentiation mass vs slow flow, in the detection of very small masses, and in the assessment of wall-fixation and motion of a mass during cardiac cycle. The results demonstrate that MRI with Gd-DTPA can give important additional information in the differential diagnosis of echocardiographically detected intracardiac masses.

Adolescent↗
PubMed1990

Cardiac calcific deposits in patients with primary hyperparathyroidism: preliminary results of a prospective echocardiographic study.

To explain the incidence and significance of mitral and aortic valve calcification and calcific deposits in the myocardium, a prospective echocardiographic study was performed with 21 consecutive patients who had primary hyperparathyroidism (PHP) and with 21 age- and sex-matched control subjects with normocalcemia. Calcific deposits in the myocardium were seen in 13 patients (62%) with PHP, mainly in the interventicular septum, and in one control subject. Aortic valve calcification was observed in 12 patients (57%) with PHP and in one control subject. Calcification of the mitral valve was found in seven patients with PHP (33%) and three controls (14%). Calcification led to mild or moderate stenosis of the aortic valve in three patients with PHP and of the mitral valve in two patients with PHP. No stenosis was found in the subjects in the control group. Both calcification of the aortic and mitral valves and calcific deposits in the myocardium are common in patients with PHP and can be detected noninvasively by echocardiography. Because of the potential relationship of elevated calcium, calcification, and valvular heart disease, clinical evaluation of PHP should include echocardiographic studies before surgery is performed and during follow-up examination.

Adult↗