Search PubMed⌕ Search

Biomedical subjects

H Tillmanns

Publications and source records attributed to H Tillmanns.

At least 109 records · Page 6Linked to original sources
PubMed1988

[5-year survival rate in acute transmural heart infarct following thrombolysis and immediate coronary angioplasty].

Two-hundred-eighty-six patients with acute transmural myocardial infarction underwent thrombolytic treatment (Streptokinase) between 1980 and 1986. In the earlier years patients were treated by thrombolysis only (n = 158) and in more recent years by thrombolysis followed by immediate percutaneous transluminal coronary angioplasty (n = 128). Age, sex, incidence of previous infarction and incidence of multivessel disease were comparable between groups. Patency of the infarct vessel (TIMI 3) was higher after thrombolysis combined with angioplasty than after thrombolysis alone (87% vs. 70%, p less than 0.001), and the residual stenosis of the infarct vessel was lower (46% vs. 84%, p less than 0.05). Hospital mortality (thrombolysis combined with angioplasty vs. thrombolysis alone) was 6% vs. 13%; one-year mortality was 8% vs. 21%, and five-year mortality was 18% vs. 31% (p less than 0.02). We conclude that treatment of patients with acute transmural myocardial infarction by thrombolysis combined with angioplasty is followed by a better long-term prognosis than treatment by thrombolysis only.

Angioplasty, Balloon↗
PubMed1987

[Balloon dilatation in unstable angina pectoris and acute myocardial infarct].

Early results after percutaneous transluminal coronary angioplasty (PTCA) in patients with unstable angina or acute myocardial infarction were compared with those in patients with stable angina. The primary success rate in 115 patients with unstable angina was 72%, in 73 with acute myocardial infarction 78%, and in 213 with stable angina 79%, i.e. there was no difference between the three groups. In patients with acute myocardial infarction and primary successful PTCA control angiography was performed one month after PTCA, in patients with unstable and stable angina 6 months after PTCA. Angiographic findings were identical in the three groups. But the results after successful balloon dilatation were dependent on the extent of primary success: in all three groups, patients in whom the post-dilatation control angiography revealed recurrence of stenosis the primary results were worse than in those without. There was no difference between those patients with lasting success and those with recurrence as regards cholesterol level, arterial hypertension, diabetes, and smoking habits. It is concluded that in every patient with acute symptoms of coronary heart disease the indication for PTCA should be considered.

Angina Pectoris↗
PubMed1987

[Thrombolysis in acute myocardial infarct. An improved long-term prognosis following balloon dilatation].

UNLABELLED: A systemic and intracoronary thrombolytic treatment was carried out in 217 patients with acute transmural myocardial infarction between March 1980 and March 1985. 141 patients were only treated with thrombolysis, and 76 were additionally treated by balloon dilation in the same session. Indications for additional balloon dilation were unsuccessful thrombolysis as well as a residual stenosis of more than 50% after primarily successful thrombolysis. Age, sex, proportion of patients with anterior and posterior wall infarction as well as with 1, 2 and 3-vessel disease did not significantly differ in the two groups. The result of therapy (complete reperfusion) was less after thrombolysis than after thrombolysis with balloon dilation (63% as compared to 88%, P less than 0.0003). The patients who were only treated with thrombolysis had a more unfavorable three-year actuarial survival than those in whom thrombolysis and balloon dilation were carried out (70% as compared to 90%, P less than 0.02). CONCLUSION: additional balloon dilation in thrombolytic treatment of acute transmural myocardial infarction improves the long-term prognosis.

Angioplasty, Balloon↗
PubMed1986

Automated determination of the right ventricular ejection fraction by digital processing of 81mKr scintigrams.

A method is presented for the automated determination of the right ventricular ejection fraction (RVEF) by digital image processing of scintigrams obtained by intravenous infusion of Krypton 81m (81mKr) dissolved in a glucose solution. End-diastolic and end-systolic sum pictures were computed by the addition of approximately 30-40 frames selected from the time-activity curve of a preliminary, manually drawn, right ventricular region of interest. After processing these two images with an adaptive Wiener filter, the right ventricular contour was determined by a recently developed algorithm using morphological and functional criteria. The RVEF was calculated for a series of 51 patients from the counts in the detected right ventricular regions in the end-diastolic and end-systolic sum images. In 16 patients without evidence of cardiopulmonary disease, the mean RVEF was 50 +/- 6.1%. RVEF was significantly reduced in 18 patients with obstructive pulmonary disease (42 +/- 6.5%) and in 17 patients with congestive cardiomyopathy (36 +/- 7.1%). The correlation coefficient between two determinations of the RVEF was r = 0.94. Through digital image processing, the determination of the RVEF by radioventriculography with 81m Kr showed high reliability and reproducibility.

Algorithms↗
PubMed1986

Syndrome X: diagnostic criteria and long term prognosis.

Patients with syndrome X have an appreciable reduction in coronary reserve, i.e. the dilatory capacity of the coronary resistance vessels. Whereas the intramyocardial vessels are normal, there are degenerative changes in myocardial cells, shown on electron microscopy. Left ventricular function is normal under resting conditions but becomes abnormal during isometric or dynamic stress. The diagnosis of syndrome X is predominantly based on a marked reduction in coronary reserve. Furthermore, delayed T1-wash out and increased glutamate turnover have been observed. Follow-up studies reveal some heterogeneity of patients studied; in patients with syndrome X and left bundle branch block left ventricular function deteriorates progressively.

Angina Pectoris↗
PubMed1984

Effect of successful thrombolytic therapy on right ventricular function in acute inferior wall myocardial infarction.

In 19 patients undergoing intracoronary fibrinolytic therapy for acute myocardial infarction, the site of coronary obstruction was in the proximal right coronary artery. Time between onset of symptoms and hospitalization was less than 4 hours. These patients were studied prospectively by radionuclide techniques immediately after admission, 48 hours and 4 weeks after AMI. Right and left ventricular (RV and LV) ejection fractions (EF) were calculated from gated blood pool scintigrams and the size of the LV perfusion defect was assessed by thallium-201 scintigraphy. Before the intervention, RV performance was significantly lower (RVEF 29 +/- 8%) than normal (53 +/- 7%). The size of the LV perfusion defect was relatively small (less than 25% of LV circumference), and as a consequence, LV pump function was only marginally impaired (LVEF 54 +/- 11%). Recanalization of the infarct artery was achieved in 12 patients (group A); in 7 patients the infarct artery remained occluded (group B). Early after the intervention (48 hours), RV performance in group A recovered significantly (RVEF: 30 +/- 9% vs 39 +/- 7%, p less than 0.01), and further improvement was noted at 4 weeks (RVEF 43 +/- 5%, p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

[Is the quotient: systolic peak pressure/end-systolic volume a useful parameter in the assessment of left ventricular function?].

The quotient: peak systolic pressure/end-systolic volume (SP/ESVI) has been proposed as a parameter of LV function and as a substitute for the slope k of the end-systolic pressure-volume relation (P-Ves), because SP/ESVI is much easier to obtain. Therefore, the relation between SP/ESVI and k and the relation between SP/ESVI and ejection fraction (EF) were investigated. In 18 patients P-Ves was obtained after vegetative blockade (1.5 mg atropine and 0.15 mg/kg propranolol) from three LV angiograms at three different afterloads (control, isosorbide dinitrate, methoxamine). - SP/ESVI and slope k showed a moderate correlation: SP/ESVI = 0.50k + 2.35; r = 0.76. SP/ESVI and EF were correlated best in an exponential way: SP/ESVI = 0.267 X e0. 045EF ; r = 0.82.- An essential disadvantage of the quotient SP/ESVI resides in the fact, that the P-Ves line has varying intercepts on the abscissa. Secondly, any quotient may belong to several P-Ves lines. The quotient SP/ESVI may be used only with caution and under specific conditions as a substitute of the slope k of the P-Ves.

Blood Pressure↗
PubMed1984

[Improvement of the non-invasive diagnosis of coronary heart disease using a new double-isotope method for the noninvasive determination of coronary transit times].

In conventional myocardial Thallium-201 scintigraphy, regional myocardial Thallium-201 activity is compared to the area of normal, i.e., maximal activity. In the presence of multivessel coronary artery disease, this mode of evaluation may yield false negative results. -In 87 patients suffering from coronary artery disease and in 26 controls, after simultaneous i.v. injection of Thallium-201 and Technetium-99m coronary transit times of Thallium-201 were determined as the interval between arrival of the tracer in the aortic root and the onset of its extraction in different myocardial areas. - Patients with hemodynamically significant coronary artery stenoses (greater than or equal to 75%) revealed a significant increase in coronary transit times over septum, apex, or posterolateral wall of the left ventricle. Using maximal coronary transit times, i.e., the largest of the regional values, an excellent discrimination between patients with severe coronary artery stenoses and controls was achieved. Following coronary vasodilatation with dipyridamole, even subcritical (50-75%) coronary artery stenoses could be detected with high sensitivity, since the shortening of coronary transit times in patients with subcritical stenoses was less pronounced as compared to controls. - Especially in the presence of diffuse three-vessel coronary artery disease, the quantitative assessment of regional coronary transit times yields important parametric data in addition to those obtained by conventional Thallium-201 scintigraphy combining static imaging with rapid sequence analysis of time-activity curves.

Coronary Disease↗
PubMed1982

Processing of 201T1 serial images for the assessment of myocardial clearance and redistribution.

Regional activity changes over the myocardium after IV injection of 201T1 were assessed in 90 patients by applying a superposition algorithm for paired images. The kinetics were expressed as quotients C1/C2 of the initial divided by the delayed count rate within any myocardial segment. Regarding the total left ventricular myocardium, normal subjects showed count rate ratios (C30 min/C4 h) of 1.75 +/- 0.075 (SD, n = 19) when the nuclide was injected under submaximal (80% of maximum) exercise. In patients with triple-vessel disease (n=21) the corresponding values were 1.46 +/- 0.05, in single-vessel (n=14) disease the quotients averaged 1.62 +/- 0.12. Average quotients in poststenotic myocardial segments increased from 1.46 before to 1.73 following bypass surgery in cases of graft patency (n=8), while a decrease was observed in a patient with occlusion of the bypass graft. In small-vessel disease and in congestive cardiomyopathy, global values of 1.50 +/- 0.07 (n=7) and 1.53 +/- 0.12 (n=19) were obtained. The display of C1/C2 matrices provided typical patterns in uptake defects caused by ischemic heart disease and by congestive cardiomyopathy. The procedure described may provide diagnostic information in addition to conventional myocardial scintigraphy in triple-vessel disease, in patients with angina who fail to demonstrate hemodynamically significant coronary artery stenoses, and in patients with inhomogeneous T1-scintigrams.

Coronary Disease↗
PubMed1982

Uptake and turnover of L-(13N)-glutamate in the normal human heart and in patients with coronary artery disease.

L-(13N)-glutamate (4-8 mCi) was administered IV to 27 patients with coronary artery disease and to 12 control subjects. Quantitative whole body imaging of the 13N label was performed in 31 individuals at different time intervals following the injection. Initial uptake of the total myocardium was estimated to be 5.0 +/- 0.88% of the dose. Standardized areas of reduced size on the projection plane contained 2.38 +2- 0.41% of the total dose in control subjects and 2.67 +/- 0.49% in coronary patients. Subsequent imaging exhibited significant differences in the dynamic behavior of both groups: 13N activity loss within 10 min was 3.2 +/- 4.2% of the initial value in control subjects and 16.0 +/- 9.8% in coronary patients. In individual cases a high myocardial accumulation of the 13N label was observed in regions of reduced 201Tl uptake. The findings are explained by an augmented extraction efficiency in cases of flow reduction. Glutamate utilization may be involved in metabolic adaptations of the myocardium to chronic or repetitive ischemia and may be worthy of further investigation by positron emission tomography.

Adolescent↗
PubMed1982

Intracoronary thrombolysis in acute myocardial infarction: duration of ischemia as a major determinant of late results after recanalization.

To define the effect of duration of myocardial ischemia on the late results after successful thrombolysis in patients with acute transmural myocardial infarction, data on 39 patients treated with intracoronary infusion of streptokinase were analyzed. Patients with successful recanalization of infarct vessel and a time lag between onset of symptoms and reperfusion less than 4 hours were assembled in group A1 (n = 15), and patients with successful recanalization but a time lag of more than 4 hours (n = 17) in group A2. Group B consisted of 7 patients with unsuccessful thrombolysis. Coronary anatomy, left ventricular volume, ejection fraction, and regional ejection fraction of infarct area were determined before and 4 weeks after thrombolysis with cineangiography. Serum creatine kinase activity was serially measured. Before intervention, the groups were comparable with regard to age, Killip class, localization of infarction, incidence of previous infarction, Gensini score of coronary anatomy, left ventricular volume, ejection fraction, regional ejection fraction of infarct area, and serum creatine kinase activity. Four weeks after the intervention, patients in group A1 had a higher ejection fraction (59%) and regional ejection fraction of infarct area (39%) than patients in group A2 (ejection fraction: 49%, p less than 0.05; regional ejection fraction: 26%, p less than 0.05) and group B (ejection fraction: 44%, p less than 0.05; regional ejection fraction: 25%, p = 0.05). Peak serum creatine kinase activity measured during the acute illness was lower in group A1 (764 U/liter) than in group A2 (1,580 U/liter, p less than 0.05) and group B (2,106 U/liter, p less than 0.05). Thus, contraction of infarct area was improved and enzymatic estimate of infarct size was reduced after early as compared with late reperfusion in patients with acute myocardial infarction.

Aged↗
PubMed1981

[Effect of intracoronary fibrinolysis on left ventricular diastolic function in patients with acute myocardial infarction (author's transl)].

In 22 patients with acute myocardial infarction, intracoronary infusion of streptokinase was begun 3.2 +/- 1.4 hours after the onset of symptoms. In 71% of patients recanalization of a completely occluded artery could be achieved. In 12 successfully treated patients left ventricular hemodynamics (left ventricular diastolic compliance and regional wall motion) were compared before and 4 weeks after recanalization. 4 weeks after intracoronary fibrinolysis left ventricular end-diastolic pressure had fallen (from 20 to 15 mm Hg, p less than 0.05), diastolic compliance had improved (p less than 0.05) and infarct size was reduced (p less than 0.05) compared to the acute stage of myocardial infarction. Left ventricular hemodynamics of 16 patients without heart disease (group A) and 22 patients with chronic myocardial infarction treated medically (group B) were compared to the findings of patients with acute myocardial infarction (group C). Group B and C showed reduced diastolic compliance as compared to group A (p less than 0.001). When group B and c were compared with identical size of akinesis (as measured by the number of asynergic hemiaxes), there was no significant difference of diastolic compliance. Reduction of diastolic compliance correlated linearly with infarct size (r = 0.73, r = 0.78). The results indicate that successful early reperfusion of acute myocardial infarction leads to a reduction of infarct size.

Adult↗
PubMed1980

Short-lived radionuclides for the assessment of rapid cardiovascular drug effects.

Continuous monitoring of cardiac output and sequential studies of right ventricular ejection fraction and of fractional myocardial uptake of substances with high cell affinity can be realized using 13N (t 1/2 = 9.6 min) and 81mKr (t 1/2 = 13 sec). Thus, it is possible to measure rapid changes of absolute myocardial blood flow and of the inotropic state of the right heart myocardium. This is shown in patients who underwent interventions with Dipyridamole and with Dobutamine which produce a marked increase in myocardial blood flow or cardiac dynamics, respectively.

Cardiac Output↗
PubMed1979

[Catecholamines for treatment of severe heart failure (author's transl)].

In patients with severe heart failure there is increased sympathetic-adrenergic activity functioning as a compensatory mechanism. Despite of increased plasma catecholamine levels myocardial sensivity to catecholamines administered for therapeutic reasons is not diminished. The positive inotropic effect of catecholamines is more pronounced as compared to digitalis glycosides. The therapeutic efficacy of catecholamines, particularly their capability to increase cardiac output, is strongly dependent on their action on alpha- and beta2-receptors. In order to enhance cardiac performance, catecholamines are mainly used under three clinical settings: 1. severe heart failure and cardiogenic shock secondary to acute myocardial infarction, 2. 'Low cardiac output syndrome" following cardiac surgery, and 3. chronic congestive heart failure refractory to therapy with glycosides and diuretics. The use of catecholamines in the presence of acute myocardial infarction may be hazardous due to the accompanying increase of myocardial oxygen consumption. Among the available catecholamines, clinical interest recently focused on dopamine and dobutamine. Particularly with the primarily cardioselective beta-stimulating agent dobutamine a marked positive inotropic effect can be achieved in a range of dosage not significantly affecting heart rate and peripheral resistance. Positive inotropic agents may be even more effective when used in combination with vasodilators, which decrease impedance to left ventricular ejection.

Catecholamines↗
PubMed1979

Microcirculation of the epimyocardial layer of the rat heart: no recruitment after hypoxia.

1. In vivo microscopic studies of the microcirculation of the beating mammalian heart are accomplished by use of small needles connected to the operation table, restricting excessive movement of the cardiac surface. 2. Fluorescence microscopic techniques combined with a highly sensitive TV tape system, enable to determine microvascular diameters, intercapillary distances, as well as directions and velocities of capillary flow in the epimyocardial layer of the mammalian heart. 3. During acute hypoxia, no recruitment of previously resting capillaries could be observed. 4. The capillary flow pattern of the epimyocardial layer reveals a mixed countercurrent system.

Animals↗
PubMed1978

Microcirculation of the epimyocardial layer of the heart. I. A method for in vivo observation of the microcirculation of superficial ventricular myocardium of the heart and capillary flow pattern under normal and hypoxic conditions.

To study microcirculation of the heart in vivo, we developed a new technique of epi-illumination of the beating rat ventricular myocardium. Five tiny needles connected to the operation table were horizontally inserted into the ventricular myocardium just beneath the epicardium in order to restrict cardiac movement during contraction and to enhance the amount of light reflected from the structures under study. The in vivo light and fluorescent microscopy were performed with the Ultropak and the Fluopak systems (Leitz) combined with a highly sensitive television camera and recording system. In 142 individual in vivo measurements (6 animals) the mean capillary diameter amounted to 6.0 +/- 1.0 mu. In the same experiments, the mean intercapillary distance was 18.7 +/- 1.7 mu. In agreement with the literature, the capillaries of the epimyocardial layer of the rat heart demonstrate a mixed countercurrent flow pattern. In contrast to other authors, we observed no recruitment of resting capillaries after hypoxia.

Animals↗