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Jochen Senges

Publications and source records attributed to Jochen Senges.

46 records · Page 3Linked to original sources
PubMed2002

Exercise anaerobic threshold and ventilatory efficiency identify heart failure patients for high risk of early death.

BACKGROUND: The maximal oxygen uptake (peak VO2) is used in risk stratification of patients with chronic heart failure (CHF). Peak VO2 might be lower than maximally possible if exercise is stopped early because of lack of patient motivation or premature cessation by the investigator. In contrast, the anaerobic threshold (VO2AT) and the ventilatory efficiency (VE versus VCO2 slope) are less subject to these influences. Thus, we compared these parameters with peak VO2 in identifying patients with CHF at increased risk for death within 6 months after evaluation. METHODS AND RESULTS: We performed cardiopulmonary exercise tests with gas exchange measurements in 223 consecutive patients with CHF (114 coronary artery disease, 92 dilated cardiomyopathy, 17 others) at the Herzzentrum Ludwigshafen between 1995 and 1998. We measured peak VO2, VO2AT and VE versus VCO2 slope. We selected peak VO2 of < or =14 mL/kg per minute, VO2AT of <11 mL/kg per minute, and VE versus VCO2 slope of >34 as threshold values for high risk of death. The median follow-up time was 644 days. Patients with peak VO2 of < or =14 mL/kg per minute had a >3-fold-increased risk (OR=3.4; CI, 1.3 to 9.1), with VO2AT <11 mL/min per kg or VE versus VCO2 slope >34 a 5-fold increased risk for early death (OR=5.3; CI, 1.5 to 19.0; OR=4.8; CI, 1.7 to 13.8, respectively). In patients with both VO2AT <11 mL/kg per minute and VE versus VCO2 slope >34, the risk of early death was 10-fold higher (OR=9.6; CI, 2.1 to 44.7). After correction for age, sex, left ventricular ejection fraction, and New York Heart Association class in a multivariate analysis, the combination of VO2AT <11 mL/kg per minute and VE versus VCO2 slope >34 was the best predictor of 6-month mortality (RR=5.1, P=0.001). CONCLUSIONS: VO2AT of <11 mL/kg per minute and slope of VE versus VCO2 >34, combined, better identified patients at high risk for early death from CHF than did peak VO2 and should therefore be considered when prioritizing patients for heart transplantation.

Age Factors↗
PubMed2002

Impact of ramipril versus other angiotensin-converting enzyme inhibitors on outcome of unselected patients with ST-elevation acute myocardial infarction.

We examined the impact of treatment with ramipril versus other angiotensin-converting enzyme (ACE) inhibitors on clinical outcome in unselected patients of the prospective multicenter registry Maximal Individual Therapy of Acute Myocardial Infarction PLUS registry (MITRA PLUS). Of 14,608 consecutive patients with ST-elevation acute myocardial infarction, 4.7% received acute therapy with ramipril, 39.0% received other ACE inhibitor therapy, and 56.3% received no ACE inhibitor therapy. In a multivariate analysis, the treatment with ramipril compared with the treatment without ACE inhibitors was associated with a significantly lower hospital mortality and a lower rate of nonfatal major adverse coronary and cerebrovascular events. Compared with other generic ACE inhibitors, ramipril therapy was independently associated with a significantly lower hospital mortality (odds ratio [OR] 0.54, 95% confidence interval [CI] 0.32 to 0.90) and a lower rate of nonfatal major adverse coronary and cerebrovascular events (OR 0.65, 95% CI 0.46 to 0.93), but not with a lower rate of heart failure at discharge (OR 0.79, 95% CI 0.50 to 1.27).

Aged↗
PubMed2002

Embolic events in patients with atrial fibrillation and effective anticoagulation: value of transesophageal echocardiography to guide direct-current cardioversion. Final results of the Ludwigshafen Observational Cardioversion Study.

OBJECTIVES: The primary objective was to evaluate the usefulness of transesophageal echocardiography (TEE)-guided cardioversion to prevent thromboembolic complications in patients with atrial fibrillation (AF) and effective anticoagulation (International Normalized Ratio of 2 or 3) at least three weeks before cardioversion. BACKGROUND: Transesophageal echocardiography has been proposed as a method of screening patients for left atrial thrombi before direct-current cardioversion of AF. The usefulness of TEE as a screening tool has always been evaluated in patients without long-term anticoagulation before cardioversion. METHODS: This prospective, single-center, observational study, performed on an intention-to-cardiovert basis, comprised 1,076 consecutive, unselected patients with AF. The initial two years were designed to be the control phase, during which the conventional approach was used. After that, cardioversion guided by TEE was performed in consecutive patients. RESULTS: The prevalence of left atrial thrombi was 7.7% in patients with persistent AF and effective anticoagulation. During the first four weeks after electrical cardioversion, six thromboembolic complications were observed in patients in whom the TEE-guided approach was employed (6 [0.8%] of 719 patients), compared with three thromboembolic complications in patients in whom the conventional approach was used (3 [0.8%] of 357 patients). None of the patients in whom electrical cardioversion was not performed experienced an embolic event. CONCLUSIONS: There were no differences in the rate of embolic events between the two treatment groups. In patients with AF and effective anticoagulation, TEE-guided electrical cardioversion does not reduce the embolic risk. However, TEE revealed left atrial thrombi in 7.7% of patients with AF and effective anticoagulation, before direct-current cardioversion.

Aged↗
PubMed2002

Gender differences in acute myocardial infarction in the era of reperfusion (the MITRA registry).

There is conflicting information about gender differences in presentation, treatment, and outcome after acute ST elevation myocardial infarction (STEMI) in the era of thrombolytic therapy and primary percutaneous coronary intervention. From June 1994 to January 1997, we enrolled 6,067 consecutive patients with STEMI admitted to 54 hospitals in southwest Germany in the Maximal Individual TheRapy of Acute myocardial infarction (MITRA), a community-based registry. Women were 9 years older than men, more often had hypertension, diabetes mellitus, and congestive heart failure, and had a history of previous myocardial infarction less often. Women had a longer prehospital delay (45 minutes), had anterior wall infarction more often (odds ratio [OR] 1.21; 95% confidence interval [CI] 1.08 to 1.36), and received reperfusion therapy less often (OR 0.83; 95% CI 0.74 to 0.94). The percentage of patients who were eligible for thrombolysis and received no reperfusion was higher in women (OR 1.7; 95% CI 1.56 to 1.89). Women had recurrent angina (OR 1.45; 95% CI 1.23 to 1.71) and congestive heart failure (OR 1.26; 95% CI 1.01 to 1.56) more often. There was a trend toward a higher hospital mortality in women (age-adjusted OR 1.16, 95% CI 0.99 to 1.35; multivariate OR 1.21, 95% CI 0.96 to 1.51), but there was no gender difference in long-term mortality after multivariate analysis (age-adjusted OR 0.95, 95% CI 0.78 to 1.15; multivariate OR 0.93, 95% CI 0.72 to 1.19). Thus, women with STEMI receive reperfusion therapy less often than men. They experience recurrent angina and congestive heart failure more often during their hospital stay. The age-adjusted long-term mortality is not different between men and women, but there is a trend for a higher short-term mortality in women.

Aged↗
PubMed2002

Clinical practice of primary angioplasty for the treatment of acute myocardial infarction in Germany: results from the MITRA and MIR registries.

The pooled data of two German AMI registries: the Maximal Individual Therapy in Acute Myocardial Infarction (MITRA) study and the Myocardial Infarction Registry (MIR) were analysed in order to 1) describe current clinical practice of primary angioplasty in Germany, 2) compare the results of primary angioplasty with those of thrombolysis in the "real world" and 3) define subgroups of patients profiting probably most from primary angioplasty. Between 1994 and 1998, 20,306 AMI patients were included in the registries. At the 271 participating hospitals angioplasty facilities were available at 18.5%. Thrombolysis was still the most frequently used reperfusion therapy at hospitals without (96%) as well as hospitals with such facilities (55%). Transfer of AMI patients for angiography was performed in 3.6% of AMI patients admitted to hospitals without angioplasty facilities. A total of 9906 lytic eligible AMI patients with a pre-hospital delay of no more than 12 hours were treated with either primary angioplasty (n = 1327) or thrombolysis (n = 8579). Univariate analysis of hospital mortality showed a more favourable course for patients treated with primary angioplasty: 6.4% versus 11.3%, OR = 0.54, 95% CI: 0.43-0.67, p < 0.0001. This was confirmed by logistic regression analysis: multivariate OR = 0.58, 95% CI: 0.44-0.77, p < 0.0001. Primary angioplasty was associated with a lower mortality in all subgroups analysed. There was a significant correlation between mortality and the absolute risk reduction (r = 0.82, p < 0.0001) in the different subgroups, which showed an increasing absolute benefit of primary angioplasty compared to thrombolysis with increasing mortality risk.

Angioplasty, Balloon, Coronary↗
PubMed2002

Geographic differences in implantable cardioverter defibrillator usage.

Despite the demonstrated efficacy of implantable cardioverter defibrillators (ICDs) in reducing sudden and total mortality in selected patients, their implantation rates vary greatly among countries. In the United States, the implantation rate is 185 implants per million inhabitants compared with only 31 implants per million in western Europe. The differences in ICD use may be explained by the following factors: manner in which sudden cardiac death is perceived by politicians and physicians (sudden cardiac death is perceived as a "nice way of dying"); differences in indications; physicians' information; prevalence of coronary artery disease; sudden cardiac death survival rates; perceived reliability of alternative treatment (namely, antiarrhythmics including amiodarone); economic backgrounds; and health care politics. Furthermore, the cost of this treatment strategy must be considered. This issue has been raised because generalization of ICD use in patients matching clinical characteristics of patients enrolled in the primary prevention trials may represent a significant economic burden to be added to the already overloaded health care system. This low acceptance may not be entirely related to budget constraint but also to the perceived efficacy of ICDs by physicians and health authorities.

Cost-Benefit Analysis↗
PubMed2002

Cardiac resynchronization therapy in patients with chronic heart failure: pathophysiology and current experience.

Congestive heart failure afflicts 2 to 4 million people in the US and nearly 15 million people worldwide. Accepted goals of heart failure treatment include: improvement of symptoms;prevention of disease progression; and reduction in morbidity and mortality. Complex pharmacological therapies achieve these goals, but not in all patients with heart failure. Cardiac resynchronization therapy (CRT) represents a new therapeutic approach in patients with chronic heart failure. CRT is only applicable to a subgroup of patients with ventricular conduction system delay, characterized by prolonged QRS duration. Bundle branch block impacts 20 to 30% of patients with New York Heart Association (NYHA) functional class III-IV heart failure and consists predominantly of left bundle branch block. When left ventricular (LV) conduction delay is superimposed upon ventricular dysfunction, it appears to be a marker of disease severity. These conduction abnormalities have deleterious effects both on systolic function and LV filling, and they can induce or enhance mitral functional regurgitation. CRT attempts to correct the deleterious effect of dysynchrony by increasing LV filling time, decreasing septal dyskinesis and reducing mitral regurgitation. Several observational studies and randomized, controlled trials have shown the benefit of CRT in a subgroup of patients with heart failure, with conduction delays. Improvements were found in the mean distance walked in 6 minutes, quality of life (QOL), NYHA functional class, in peak oxygen uptake (V-dot(2)), total exercise time, reduction of hospitalization, LV function and reduction of the LV end-diastolic diameter. These studies support the therapeutic value of ventricular resynchronization in patients with severe heart failure, who have intraventricular conduction delay but who do not have a standard indication for the implantation of a pacemaker. In respect to these study results, possible indications for a biventricular pacing device at this time are as follows: NYHA functional class III, LV ejection fraction <35%, sinus rhythm, QRS duration >150 msec and drug refractory despite individual optimal heart failure therapy. CRT significantly improved symptoms, exercise tolerance and QOL in most patients. However, further studies are needed to assess long-term clinical effects and prognosis, as well as economic benefit of this therapeutic approach.

Cardiac Pacing, Artificial↗