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Biomedical subjects

M Hofmann

Publications and source records attributed to M Hofmann.

At least 235 records · Page 13Linked to original sources
PubMed1985

[Long-term prognosis of acute transmural myocardial infarct after intracoronary thrombolysis treatment].

Reperfusion of the infarct vessel by a combination of intravenous and intracoronary infusion of streptokinase succeeded in 66 of 120 patients with acute transmural infarction in whom the infusion had been started less than six hours after onset of symptoms. The recanalization attempt failed in 26, and 28 were treated conventionally. Size of the infarct was determined by 201Thallium scanning before and 48 hours after the acute treatment phase. Cox analysis indicated that successful recanalization had a significantly positive effect on the long-term prognosis compared with failed thrombolysis or conventional measures. The perfusion defect (as measured by 201Thallium scan) was identical in all three groups, but after successful recanalization with streptokinase it was significantly smaller than in the other two groups. The improved long-term prognosis is presumably due to a decrease in the size of the infarct.

Aged↗
PubMed1985

[Chronic therapy of congestive cardiomyopathy: effects of prenalterol and digoxin].

UNLABELLED: Prenalterol (P), a partial adrenergic agonist with functional beta 1-specificity, has been shown to have inotropic effects when given orally and thus represents a potential substitute or adjunct to conventional digitalis therapy (D) in the long-term management of congestive cardiomyopathy (COCM). A direct comparison between both drugs has not been reported. In a blind controlled trial, 15 patients with COCM (NYHA II-III) with sinus rhythm and a left ventricular ejection fraction (LV-EF) of 34.5 +/- 2.6% received consecutively D (0.25-0.5 mg/d), placebo (PLAC), P (slow releases = SR) (80 mg/d SR) and both drugs combined in respective doses. After 4 weeks of therapy with each drug, effects were assessed by gated blood pool scintigraphy at rest (R) and during graded bicycle exercise (EX), systolic time intervals (STI), Holter monitoring and a clinical score. Plasma levels of both drugs and of catecholamines and lactate were also determined. Compared to PLAC, LV-EF was not significantly altered by D at R (34.5 +/- 2.6 vs. 31.9 +/- 2.3%, p = ns), but a shortening of the QS2-interval could be demonstrated (533 +/- 7 vs. 550 +/- 6 msec, p less than 0.05). In contrast, during EX an improvement of LV-EF was observed (34.5 +/- 3 vs. 31.3 +/- 2.8%, p less than 0.05). P alone showed no significant alterations in LV-EF and STI, along with a lack of symptomatic improvement. The addition of D (D + P) resulted in improved left ventricular performance both at R (LV-EF 37.9 +/- 3.3 vs. 31.9 +/- 2.3%, p less than 0.01, QS2 530 +/- 8 vs. 550 +/- 6 msec, p less than 0.01) and during EX (LV-EF 35.3 +/- 2.5 vs. 31.1 +/- 2.8%). Values between D and D + P were not significantly different. No drug or combination improved maximal working capacity. CONCLUSIONS: Beneficial effects of chronic treatment with D could be demonstrated in patients with COCM, particularly during EX. Further studies are needed to determine why the acute effects of P are not fully sustained during long-term therapy.

Adult↗
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

Necropsy evaluation in seven patients with evolving acute myocardial infarction treated with thrombolytic therapy.

Systemic and intracoronary streptokinase application may recanalize a coronary artery occluded by a thrombus in patients with acute myocardial infarction (MI). However, thrombolysis fails in a number of patients for unknown reasons. The coronary and myocardial histologic characteristics were studied in 3 patients in whom recanalization was successful without subsequent reocclusion, and in 4 patients in whom recanalization was unsuccessful. All patients died within 4 weeks after the acute intervention. Serial sections from the angiographically localized occlusive site of the infarct vessel, and transverse slices of the heart stained with nitroblue tetrazolium for delineation of MI, were examined by light microscopy. Successfully recanalized arteries were patent at necropsy and showed obstructive fibrous atherosclerotic plaques. Among patients in whom recanalization was unsuccessful, 1 patient had occlusions from nonatherosclerotic intramural hemorrhage and 1 from persisting long, mixed old and fresh thrombus, and 2 patients had high-grade obstructions from ruptured atherosclerotic plaques with intimal hemorrhage and residual clot. Reperfused infarct tissue consisted predominantly of contraction band necroses, whereas MIs without reperfusion showed coagulation necroses of the muscle fibers. The results suggest that the success of recanalization depends, in part, on the morphologic features of the coronary occlusion, and that reperfusion after successful thrombolysis may lead to a different pattern of muscle fiber necrosis in the irreversibly injured infarct areas.

Adult↗
PubMed1984

Ventricular arrhythmias before and late after aortic valve replacement.

The influence of aortic valve replacement on the incidence of ventricular arrhythmias was studied by 24-hour Holter electrocardiographic monitoring in 45 patients immediately before and 14 +/- 7 months after operation. Ventricular arrhythmias were graded according to the Lown criteria. Preoperative left ventricular (LV) ejection fraction (EF) was determined by angiography and postoperative LVEF by gated blood pool scintigraphy. Repetitive ventricular arrhythmias (Lown grade 4A/B) were associated with a reduced LVEF (less than 55%) before and after operation. In 24 patients with preoperative normal LVEF (greater than or equal to 55%) (group A), mean LVEF remained unchanged after operation (72% vs 71%). Pre- and postoperative ventricular premature complex (VPC) frequency (45 +/- 99 vs 39 +/- 94 VPC/24 hours) and grade (1.3 vs 1.4) were not significantly different. However, in 17 patients with preoperative impaired LVEF (less than 55%) (group B, LVEF preoperatively 40 +/- 8%) and marked postoperative improvement (greater than 10%) (LVEF postoperatively 64 +/- 7%), mean VPC frequency decreased from 536 to 69 VPCs/24 hours and mean VPC grade was reduced from 3.8 to 1.5. Complex VPCs were found preoperatively in all 17 patients of group B, but in only 5 patients after operation. Four patients had a reduced LVEF preoperatively and it did not improve postoperatively (group C). Postoperative Holter monitoring detected ventricular tachycardia in all 4 patients. This study indicates that repetitive VPCs are infrequent in patients with normal LVEF before and late after aortic valve replacement. In patients with impaired LVEF and complex VPCs preoperatively, the postoperative improvement of LV function is usually accompanied by a reduction of frequent and complex VPCs.

Adolescent↗
PubMed1984

Thrombolysis in acute myocardial infarction: effect of intravenous followed by intracoronary streptokinase application on estimates of infarct size.

The effect of pretreatment with intravenous infusion of streptokinase (SK) (16,700 U/min for 90 minutes), started after diagnosis and followed by intracoronary application (2000 U/min) (protocol 1), was assessed retrospectively in 55 consecutive patients with acute transmural myocardial infarction (MI). Another 46 patients with acute MI treated previously by intracoronary thrombolysis served as control subjects (protocol 2). Reperfusion at first coronary injection was observed after pretreatment in 25 patients (45%), but in no control patient (p less than 0.001). Fifteen patients with successful pretreatment (group A), 20 patients with successful treatment according to protocol 2 (group B) and 9 patients with unsuccessful thrombolysis (group C) were restudied after 4 weeks. Data from patients with reinfarction, coronary bypass surgery or percutaneous transluminal coronary angioplasty before restudy were excluded. Thallium-201 scintigraphy was performed before and 24 hours after treatment, serum creatine kinase activity was measured every 8 hours for 3 days and regional ejection fraction (EF) of acute MI was determined before and 4 weeks after treatment. The scintigraphic, enzymatic and hemodynamic data before treatment indicated severe and comparable ischemia among the 3 groups. The thallium-201 perfusion defect decreased in group A (from 41 to 21%, p less than 0.01) and in group B (from 38 to 26%, p less than 0.01), but did not change in group C (from 37 to 31%, difference not significant). Peak serum creatine kinase levels normalized by the perfusion area of acute MI was 20, 33 and 58 U/liter unit in groups A, B and C. The mean values of groups A and C were significantly different (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

[Function of the right ventricle in mitral valve defects before and after surgical correction].

To ascertain whether surgical correction of mitral valve lesions can lead to postoperative improvement of right ventricular function, investigations were carried out in 17 patients with mitral valve disease, clinical severity grade III and IV, before and at an average of 18 months postoperatively. Six subjects without heart disease served as controls. Preoperatively, all patients underwent catheterization and cineangiographic evaluation of both the right and left ventricles. The right ventricular ejection fraction (RV-EF) was also determined from the radionuclide ventriculogram before and after the surgical intervention (closed mitral commissurotomy in five patients and mitral valve replacement in twelve). The patients were studied at rest and during bicycle ergometry in the supine position. As compared with control subjects, before surgery at rest, patients with mitral valve disease had significantly higher values for mean left atrial pressure (22 +/- 7 vs 8 +/- 2 mm Hg), mean pulmonary artery pressure (39 +/- 17 vs 17 +/- 5 mmHg), pulmonary arteriolar resistance (361 +/- 260, increased 5-fold, vs 69 +/- 27 dyn . s . cm-5) and right ventricular systolic pressure (55 +/- 20 vs 24 +/- 6 mmHg) while the values for right ventricular end-diastolic pressure, mean right atrial pressure, left ventricular end-diastolic pressure and left ventricular systolic pressure did not differ (Table 1).(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac Catheterization↗
PubMed1984

[Thrombolysis in acute transmural heart infarction: length of ischemia as a determinant of late results after 15 months].

In 28 patients the effect of coronary artery reperfusion in acute transmural myocardial infarction was evaluated by the clinical and hemodynamic results obtained after 15 months. Patients with successful reperfusion within 4 hours after onset of symptoms were assembled in group A1 (n = 11), patients with successful reperfusion after more than 4 hours in group A2 (n = 7). Group B consists of 10 patients with unsuccessful reperfusion. Left ventricular ejection fraction (radionuclide ventriculography) and the perfusion defect (thallium-201 scintigraphy) were measured acutely and after 15 months (at rest and during exercise). The coronary anatomy and the regional ejection fraction of infarct area were determined acutely and after 4 weeks by cineangiography. Serum creatine kinase activity was measured serially during the acute phase of the infarction. Before the acute intervention, the patients of the 3 groups were comparable with regard to killip class, location of infarction, number of previous infarctions, coronary anatomy, left ventricular ejection fraction, thallium-201 perfusion defect and base-line serum creatine kinase activity. During acute infarction peak creatine kinase activity tended to be lower in group A1 (1296 U/l) than in group A2 (2100 U/l, NS) and in group B (2240 U/l, NS). After 4 weeks regional ejection fraction of infarct area was higher in group A1 (36%) than in groups A2 (24%, NS) and B (20%, p less than 0.05). After 15 months the thallium-201 perfusion defect was smaller in group A1 (7%) than in groups A2 (28%, p less than 0.05) and B (34%, p less than 0.01). At the same time left ventricular ejection fraction was higher in group A1 (52%) than in groups A2 (34%, p less than 0.05) and B (35%, p less than 0.05). Fifteen months after acute infarction patients in group A1 tended to reach a higher workload during exercise (118 watts) compared with patients of groups A2 (82 watts, NS) and B (86 watts, NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗