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Biomedical subjects

M Aschermann

Publications and source records attributed to M Aschermann.

At least 19 recordsLinked to original sources
PubMed1992

[Present possibilities of use of intravascular ultrasound examinations].

Catheter intravascular imaging is currently used as an adjunct to contrast angiography and angioscopy in peripheral and coronary arteries. At present the smallest catheters are 3.0 F (1.0 mm). Frequencies used are from 10 to 40 Mz, which allow high resolution imaging of structures close to the transducer. Mechanical and phased array systems are used, introduced either on the wire or through fine plastic catheter. More recent is the monorail system improving the flexibility and tracking of the mechanical systems. The review presents current status of catheters and diagnostic possibilities. Normal arteries have typical three layered appearance (intima, media, adventitia). Ultrasound can be reliably used to distinguish abnormal vascular segments. Atherosclerotic plaques can be subclassified on the basis of plaque composition. Thrombus is characterized by granular appearance with varying sonographic gray levels. Dissection and intimal flaps are also visualized by intravascular ultrasound. Potential utility of intravascular ultrasound in the assessment of endovascular interventions and its limitations are discussed.

Blood Vessels↗
PubMed1992

[Noninvasive diagnosis of coronary spasm].

The objective of this work was to compare the sensitivity of non-invasive tests used for the diagnosis of variant angina pectoris (VAP). In a group of 38 patients with VAP the authors compare the sensitivity of the cold test (CT), hyperventilation test (HT), handgrip (HG), bicycle ergometry (BE) and a newly suggested combination of hyperventilation with HG and BE resp. The authors evaluated first the sensitivity of ST elevations which are an entirely specific sign and in particular denivelization of ST (by depression or elevation) which is a less specific sign. The sensitivity of different tests was as follows: CT 5% and 5% resp., HT 18% and 39% resp., HG 13% and 29% resp., BE 26% and 66% resp., HV+HG 37% and 63% resp., HV+BE 50% and 87% resp. Then the authors assessed the sensitivity of repeated examinations HV+HG 47% and evaluation during denivelization of ST 63%, HV+BE 66% and 89% resp. The authors evaluated moreover the sensitivity of ST elevations in patients according to the activity of the disease. Patients with at least five stenocardias per week had a higher sensitivity, as compared with patients with less frequent attacks: HV+HG 42% and 25% resp., HV+BE 60% and 33% resp. The highest sensitivity was found in a combination of HV+BE. Repetition of the test in case of a negative result increased markedly the sensitivity, a higher sensitivity was found also in patients with more frequent stenocardias.

Adult↗
PubMed1991

[Significance of coronarography for therapeutic strategy in patients with ischemic heart disease].

In 100 consecutive patients where planned coronary arteriography was performed, in the majority on account of IHD, the authors analyzed retrospectively information on risk factors of IHD, medicamentous treatment and the reasons for coronarography, findings on the coronary arteries, the size and function of the left ventricle and the final choice of subsequent treatment. A significant finding on the coronary arteries (stenosis of more than 50%) was recorded in 65% of the patients, in 22% of the patients the coronarographic finding was normal, in another 7% only insignificant changes were found (stenosis of less than 50%) and in 6% of the patients on coronarography a spasm of the coronary artery was recorded. A bypass operation was performed in 15% of the patients subjected to coronarography, in another 6% successful PTCA was performed, i.e. a total of 21% patients were revascularized. These results are compared with those of other departments in Czechoslovakia and abroad and the causes of revealed differences are discussed. Finally the authors emphasize the necessity of stratification of IHD patients according to risk and the selection of suitable candidates of coronarography and subsequent possible revascularization of the heart muscle according to accepted criteria for indication.

Adult↗
PubMed1990

[Changes in the extent of residual stenosis in coronary arteries after thrombolytic therapy in acute myocardial infarct].

The extent of residual coronary artery stenosis has been studied immediately after thrombolysis using streptokinase and after 3.-4. weeks follow-up in 28 patients with acute myocardial infarction. Thrombolysis was successful in 19 patients (67.9%). In these patients the extent of residual coronary artery stenosis (percentage narrowing of diameter) decreased from 73.4% to 66.1% (p less than 0.05). The residual stenosis did not change in 5 patients (26.3%), increased in 1 patient (5.2%), 3 patients suffered reocclusion of the vessel (15.8%). Marked improvement was found in 10 patients (52.6%). It means despite significant regression a coronary artery stenosis of more than 50% of diameter persisted in 47.4% of patients with successful thrombolysis 3.-4. weeks after the infarction. The factors which could be involved in regression of residual stenosis of vessel related to myocardial infarction are discussed.

Coronary Angiography↗
PubMed1990

[Relation of angina pectoris before myocardial infarct to coronarographic findings after thrombolytic therapy].

Patients with significant residual stenosis after thrombolytic therapy during acute myocardial infarction have higher risk of reinfarction, periinfarction ischemia and sudden death. Early revascularisation can prevent such complications. To find out patients who are at increased risk and are candidates for early angiography 74 patients undergoing angiography after thrombolytic therapy were reviewed. Significant residual stenosis (greater than or equal to 50% diameter reduction) of infarct related artery was present in 85%, high grade stenosis (greater than or equal to 75%) in 58% of patients respectively. The group of patients with preinfarction angina (Canadian class I to IV. 24 hours before infarction) had higher mean residual stenosis than patients without angina (76.5% vs 64%). There was significant difference in presence of preinfarction angina in patients with high grade stenosis and without high grade stenosis (79% and 21% respectively). Thus preinfarction angina can be used to identify patients with higher risk of reocclusion after thrombolytic therapy during acute myocardial infarction. Early coronary angiography and revascularisation can prevent serious complications in these patients.

Angina Pectoris↗
PubMed1990

Randomized double-blind comparison of isosorbide dinitrate and nifedipine in variant angina pectoris.

The antianginal and anti-ischemic effect of isosorbide dinitrate (ISDN), 120 mg once daily, and nifedipine, 20 mg twice daily, both in slow-release formulations, were compared in 17 patients with variant angina pectoris in a randomized, double-blind trial. The design included a placebo run-in period and two 6-week crossover periods of active treatment. Mean frequency of angina decreased significantly from 43 attacks per week during the placebo period to 4 per week with ISDN and 8 with nifedipine (p less than 0.001). Sublingual nitroglycerin consumption decreased significantly from 37 tablets per week with placebo to 3 tablets per week with ISDN and 7 with nifedipine (p less than 0.001). Both drugs reduced the silent and symptomatic ST-segment deviations on ambulatory electrocardiographic recording and increased maximal exercise tolerance. Episodes of coronary spasm could be provoked, by hyperventilation, in all patients during the placebo phase but in no patient during therapy with either active drug. Thus, both ISDN and nifedipine, in their slow-release formulations, are effective in the treatment of variant angina pectoris.

Adult↗
PubMed1990

[Restenosis after percutaneous transluminal coronary angioplasty].

Restenosis after percutaneous transluminal coronary angioplasty is a critical factor limiting the usefulness of this procedure. It has been reported to occur in 25% to 50% of patients averaging 33%. In the majority of patients it appears within 6 months after procedure. Some clinical, angiographic and procedural factors can predict higher incidence of restenosis--they are discussed in the article. Main mechanisms which result in restenosis are intimal hyperplasia and smooth muscle cellular proliferation. Exercise thallium-201 scintigraphy and coronary angiography are the best methods in diagnosis of restenosis. The prevention and the therapy of restenosis appear as a difficult problems. Successful pharmacological approach doesn't exist until now. In about 50% of patients with restenosis coronary angioplasty is repeated with the same success and restenosis rate as in the first angioplasty.

Angioplasty, Balloon, Coronary↗
PubMed1990

[Thrombolytic therapy in acute myocardial infarct].

The purpose of this review is the evaluation of the available data related to thrombolytic therapy. The pharmacological and clinical characteristics of thrombolytic agents of the first, second and third generations are discussed. The results of the cooperative studies dealing with thrombolysis using streptokinase, tissue plasminogen activator, urokinase and prourokinase are reviewed. Short-term mortality has decreased about 50% in patients with acute myocardial infarction with thrombolytic treatment. The main factors which influence outcome are: the time interval between onset of symptoms and beginning of the treatment, the extent of restoration of myocardial function, the degree of residual stenosis and concomittant medication. During the follow-up after thrombolysis the benefit of aspirin was shown, the question of immediate coronary angioplasty is unresolved. The important risk of thrombolytic treatment is intracerebral bleeding, which appears up to 2% of patients treated with streptokinose and tissue plasminogen activator.

Humans↗
PubMed1989

[Comparison of isosorbide dinitrate and nifedipine in the treatment of variant angina pectoris. Randomized study].

The effects of isosorbide dinitrate single dose 120 mg daily and nifedipine 20 mg twice daily were studied in 17 patients with variant angina pectoris due to coronary artery spasm. After a placebo phase the patients were randomized to treatment with either isosorbide dinitrate or nifedipine. After six weeks the patients were crossovered for another six weeks period of treatment. There was significant decrease of number of angina attacks during both treatment regimens. Using 24 hours Holter monitoring we also proved significant decrease of number of ST segment elevation or depression, either symptomatic or asymptomatic. There was increase of performed work during exercise tests after both treatment periods. The efficacy of Isoket 120 mg and Adalat Retard 2 x 20 mg daily in the treatment of patients with active variant angina pectoris was comparable in our study. 3 patients suffered untolerable headache during isosorbide dinitrate phase and had to terminate treatment after first day only.

Adult↗
PubMed1989

[Percutaneous transluminal coronary angioplasty. Initial clinical experience].

Percutaneous transluminal coronary angioplasty was performed in 20 patients with angina pectoris (16 patients with stable AP, class II-III., 4 patients with unstable AP) in the period of 1 year. There was single-vessel disease in all patients. Left ventricular function was normal as well in all patients. PTCA was successful in 16 patients (80%), in the remaining 4 patients coronary artery stenosis was not reached with balloon catheter. There were no death, Q-wave myocardial infarction or emergency bypass surgery. Transient ischemic changes on ECG has been found in 2 patients (10%). All patients with successful PTCA were symptomatically improved in period of 1-12 months, in one half of them this improvement was confirmed with stress ECG. Control coronary angiography was made in 2 patients until now, restenosis was not found.

Adult↗
PubMed1989

[Long-term prognosis of patients with chronic post-infarct aneurysms. II. Comparison of patients treated conservatively and surgically].

UNLABELLED: Survival rates were determined for a group of 136 patients in whom left ventricular aneurysm was determined by angiography. They were treated medically (99 patients) or surgically (37 patients). Congestive heart failure was predominant in all patients. The two groups did not differ in regard to clinical and haemodynamic data except for a more extensive coronary artery disease in the surgical group. Survival rates at the 5, 7 and 9 years were 62.5%, 52.5% and 37.5% in the medicaly treated group and 50%, 40% and 32.5% in the surgical group. Functional improvement at least one Functional Class NYHA was present in 75% patients postoperatively, and in 27% of patients treated medically. CONCLUSION: In patients with left ventricular aneurysm with predominant congestive heart failure surgical treatment improved quality of life but did not increase long-term survival.

Chronic Disease↗
PubMed1989

[Long-term prognosis in patients with chronic postinfarct aneurysms. I. Conservative treatment of patients].

Natural history of 99 patients with angiographically defined left ventricular aneurysm (LVA) has been studied. Congestive heart failure (CHF) was predominant in 52.5% patients. Mean follow-up was 94 months. The cumulative survival at 1, 5, 7, 10 years were 92, 65, 60 and 28% respectively. Left ventricular end-diastolic pressure averaged 2.8 kPa (LVEDP), ejection fraction (EF) 31%, contractile segment ejection fraction (CSEF) 45%, stroke work 6.7 mj. g-1, diastolic compliance 0.36 kPa-1 and passive elastic modulus 64.1 kPa. High risk groups of patients were those with LVEDP more than 3.3 kPa, CSEF less then 40%, EF less then 20% and with extent of LVA more then 40% of the diastolic area of the left ventricle. The Cox analysis of survival indicated following variables predicted outcome: functional impairment due to CHF, LVEDP, LVEDVI and number of vessels diseased.

Heart Aneurysm↗