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Biomedical subjects

M Kaltenbach

Publications and source records attributed to M Kaltenbach.

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

Combined first-pass and equilibrium radionuclide ventriculography and comparison with left ventricular/right ventricular stroke count ratio in mitral and aortic regurgitation.

Effective and total left ventricular (LV) stroke volume were assessed in 31 patients with verified aortic or mitral regurgitation, or both, and in 22 patients with normal valvular function using combined first-pass and equilibrium radionuclide ventriculography. The difference between these 2 volumes as a fraction of LV stroke volume was taken as the radionuclide regurgitant fraction. The results were compared with the LV/right ventricular (RV) stroke count ratio and with the angiographic regurgitant fraction according to the method of Sandler and Dodge. Radionuclide regurgitant fraction derived from 2 determinations with a time interval of 1 week showed good reproducibility (n = 15, r = 0.96, SEE = 9.1). Sensitivity was 100% for radionuclide regurgitant fraction and 87% for LV/RV stroke count ratio at equal specificity (100%). Radionuclide regurgitant fraction was more sensitive, especially in severely ill patients, in whom additional RV volume overload led to false-low or false-negative ratios. Angiographic and radionuclide regurgitant fraction showed linear correlation (r = 0.79, p less than 0.001). In contrast, because 5 patients had RV volume overload, only a weak correlation could be noticed between angiography and LV/RV stroke count ratio (r = 0.47, p less than 0.05). Excluding these patients, correlation substantially improved (r = 0.74, p less than 0.001). The combination of first-pass and equilibrium radionuclide ventriculography is a sensitive, specific and well reproducible method for the evaluation of mitral and aortic regurgitation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

[2 families with dilatative cardiomyopathy].

In two brothers each of two families congestive cardiomyopathy was diagnosed. Left ventricular biopsy showed individually differing degrees of hypertrophy of the myocardial cells together with endocardial fibrosis and circumscribed interstitial fibrosis. In family I clinical symptoms appeared at the beginning of the 4th decade, conduction disturbances being predominant. One brother died after rapid progression of the disease within one year. The other has been treated as an outpatient for 9 years; he received a pacemaker implant half a year ago. In family II initial symptoms appeared in the middle of the 6th decade, progressive heart dilation and insufficiency being the predominant characteristics. In the course of 7 years one brother has developed cardiac decompensation whereas the other brother's condition has remained nearly unchanged for 4 years. The degree of myocardial changes in left ventricular biopsies correlated with the clinical course.

Adult↗
PubMed1985

[Transluminal coronary angioplasty in patients with chronic kidney failure].

Six patients with chronic renal failure (two in the predialysis state; four chronically dialysed of whom two were after renal transplantation) were treated by transluminal coronary angioplasty for severe angina and ischaemic ECG changes. In 5 patients the successful dilatation of six stenoses resulted in good clinical and angiographic findings for a follow-up period of up to 3 years. One patient had to have an emergency bypass operation. If coronary revascularisation is indicated, transluminal coronary angioplasty is thus to be preferred to primary bypass operation in patients with chronic renal failure, because it is less invasive, relatively cheap and can be more easily repeated in case of recurrence or new stenoses.

Adult↗
PubMed1985

[Anti-anginal effect of transdermally applied nitroglycerin as dependent on the size of the plaster].

Nitroglycerin plaster (in 5 cm2, 10 cm2 or 20 cm2 sizes) was applied to 12 patients with coronary heart disease, angina and exercise-induced ischemic reactions in the course of a simple-blind trial with intra-individual crossover in a randomized sequence over one week each. A 15 cm2 plaster served as a placebo. In the placebo phase the mean number of angina attacks was 9.3 per week. It decreased to 6.2 with the 10 cm2 plaster (P less than 0.05), to 2.6 per week with the 20 cm2 plaster (P less than 0.001). The ischemia reaction in the exercise ECG (sum of ST segment depressions), recorded on day 7 of the treatment phase, was improved three hours after plaster application, dependent on the size of the plaster: placebo 6.0 +/- 1.2 mm; 5 cm2 plaster 5.1 +/- 1.0 mm; 10 cm2 4.6 +/- 1.0 mm (P less than 0.05); 20 cm2 3.4 +/- 0.9 mm (P less than 0.001). The angina-free period during ergometry showed dose-dependent improvement 3 and 24 hours after application. Arterial blood pressure was decreased only after 20 cm2 plaster by 8% after three hours, as compared with the placebo (P less than 0.05). There was no effect on heart rate, at rest or on exercise, after any plaster. The results indicate that significant decrease in ischemia reaction occurred with a plaster of 10 cm2 or larger. A 24-hour effect was demonstrable only with respect to the duration of symptom-free exercise.

Administration, Topical↗
PubMed1985

Relation of antianginal efficacy of nifedipine to degree of coronary arterial narrowing and to presence of coronary collateral vessels.

Thirty-six patients with chronic stable angina pectoris or with stable and vasospastic components of angina pectoris were classified by coronary arteriographic findings into 4 groups. Patients in group A had a single stenotic coronary artery; patients in groups B, C and D had occluded arteries, but these arteries had been collateralized to varying degrees, and an epicardial coronary steal phenomenon was possible. All patients underwent multiple exercise tests before and after randomized, double-blind, crossover treatment with 20 mg of nifedipine, 20 mg of isosorbide dinitrate, a combination of both, and placebo. Maximal and mean ST-segment depression, occurrence of angina pectoris and heart rate were evaluated. After nifedipine treatment, mean ischemic ST-segment depression was reduced 21% in group A (p less than 0.05), but was not significantly altered in the other groups (group B, 2% decrease; group C, 10% increase; group D, 3% decrease). However, isosorbide dinitrate reduced ST-segment depression significantly in all groups (group A, 29%, p less than 0.001; group B, 18%, p less than 0.01; group C, 19%, p less than 0.05; group D, 33%, p less than 0.05). The combination with nifedipine did not further improve the effect of isosorbide dinitrate. Maximal ST-segment depression and angina pectoris paralleled the changes in mean ST depression during the different medications. Heart rate at rest was not significantly changed after nifedipine treatment in any group, but increased significantly after isosorbide dinitrate treatment in groups B and C (group B, 12%, p less than 0.01; group C, 9%, p less than 0.05); heart rate during exercise did not differ significantly in any group or after any form of medication from placebo.

Adult↗
PubMed1985

Aldosterone and prolactin responsiveness after prolonged treatment of congestive heart failure with captopril.

After long-term captopril treatment, an inappropriate increase in aldosterone levels has been observed in hypertensive patients. It is not known, whether a similar change would occur in patients with severe congestive heart failure, and whether it is due to a decrease in endogenous dopaminergic inhibition of aldosterone secretion or to aldosterone stimulation by ACTH or an ACTH-related peptide. Therefore, the aldosterone and prolactin responses to metoclopramide have been studied in 10 patients with severe congestive heart failure (NYHA Class III or IV) after 6 months of captopril treatment, before and 11 h after pretreatment with dexamethasone. 7 placebo-treated patients served as double-blind controls. In captopril-treated patients, the supine aldosterone levels exceeded the normal range and were as high as in placebo-treated patients. The responsiveness of aldosterone and prolactin to metoclopramide was not influenced by captopril. Only in the placebo group were the aldosterone levels decreased by dexamethasone. Captopril increased plasma renin activity and serum potassium, and decreased supine epinephrine and norepinephrine and serum sodium. Thus, previous reports of inappropriately high aldosterone levels after long-term captopril treatment were confirmed in patients with severe congestive heart failure. It is concluded that increased aldosterone is due neither to a decrease in endogenous dopaminergic inhibition nor to dexamethasone-suppressible stimulation of aldosterone secretion.

Adult↗
PubMed1985

Sectoranalysis of left ventricular function by fully automated equilibrium radionuclide ventriculography.

We describe a fully automated method for quantification of left ventricular performance by equilibrium radionuclide ventriculographic studies, based on subdivision of the left ventricular region into 9 equiangular sectors. The precise identification of the left ventricular contours is achieved by the use of morphological and functional criteria in a sequential edge detection algorithm with a success rate of 96%. In addition to left ventricular global and sectorial ejection fraction the first harmonic of the corresponding Fourier spectrum is approximated to each sectorial time-activity curve and to the global one. Sectorial phase is calculated as the difference between the phase of the sectorial and global first Fourier component. Computerized comparison between the sectorial parameters at rest and during peak exercise localizes and classifies the degree of global and regional impairment in response to exercise. The processing time of 60 sec makes this method suitable for routine use. The validity of our procedure has been tested in 34 patients before and after successful transluminal coronary angioplasty. In these patients, 73% of the stenosed vessels before dilatation were localized by sectorial ejection fraction, 77% by sectorial phases, and 88% by the combination of both.

Angioplasty, Balloon↗
PubMed1985

Active and passive changes in coronary diameter after vasodilation with SIN-1, the active metabolite of molsidomine.

The vasodilating effects of intracoronary injections of 0.4 mg of SIN-1, the active metabolite of molsidomine, on epicardial coronary arteries and coronary stenoses were evaluated in 14 patients with coronary artery disease in a double-blind, randomized fashion vs placebo. Nine additional patients with well defined coronary stenoses received 0.4 mg of SIN-1 as well. Diameter changes of nonstenotic coronary arteries in proximal, medial, and distal coronary segments as well as changes of the residual luminal diameters within coronary stenoses were determined before (K), immediately after (M1), and 10 minutes after (M2) intracoronary administration of SIN-1. Aortic pressures and heart rate were monitored continuously. After administration of SIN-1, the diameters of nonstenotic coronary arteries increased in proximal segments by 9.4% (M1) and 11.7% (M2), in medial segments by 17.9% (M1) and 17.6% (M2), and in distal segments by 25.6% (M1) and 28.8% (M2). Within coronary stenoses the residual luminal diameters showed mean increases of 31.5% (M1) and 48.3% (M2). Placebo administration did not alter coronary diameters significantly. Aortic pressure and heart rate did not change after administration of SIN-1 or placebo. SIN-1 effectively dilates nonstenotic and stenotic coronary segments, as do nitrates and calcium channel blockers. By intracoronary injections, the direct effects on coronary vessels can be evaluated without interference with systemic effects. The increase in the residual luminal diameters within dynamic coronary stenoses after administration of SIN-1 is probably an important antianginal mechanism also for molsidomine.

Coronary Angiography↗
PubMed1985

Hemodynamic effects of molsidomine in patients with acute myocardial infarction.

The hemodynamic effects of molsidomine were studied in 48 patients with acute myocardial infarction and compared with hemodynamic properties in a control group of 24 patients. The most pronounced decrease in pulmonary artery diastolic pressure occurs between 30 and 60 minutes after oral administration of 8 to 12 mg (n = 16). There is no major difference in action between the oral and intravenous application of 8 to 12 mg (n = 22). Its effect lasts about 3 to 4 hours and may exceed up to 8 hours in patients with left heart failure (n = 10). The mean arterial pressure is affected only with high doses (12 mg). Cardiac output decreases slightly only in patients without left heart failure. An additional intraindividual comparison of nitroglycerin (1.6 mg sublingually) and molsidomine (12 mg intravenously) (n = 11) revealed no significant difference in hemodynamic effectiveness. Molsidomine, like nitroglycerin, acts primarily to reduce cardiac preload. An additional moderate action on afterload with a slight decline in arterial pressure may be noticed at high doses.

Blood Pressure↗
PubMed1985

Treatment of hypertrophic cardiomyopathy: relation to pathological mechanisms.

In patients with hypertrophic cardiomyopathy, clinical symptoms such as exertional dyspnea, angina and collapse are considered to be rather the consequence of diastolic than of systolic dysfunction of the left ventricle. Beta-blocker therapy is aimed at reducing systolic overcontraction while calcium blockers predominantly therapy is aimed at reducing systolic overcontraction while calcium blockers predominantly improve diastolic filling characteristics. Therefore 61 consecutive patients with well defined hypertrophic cardiomyopathy were treated with calcium channel blockers: 60 patients with verapamil at average dose 530 mg (320 to 720 mg/d) and one patient received 30 mg nifedipine. All patients had clinical, noninvasive and cardiac catheterization evaluation at the time of entry into the study. Therapy was continued for an average of 54 months (10 to 96). Follow-up studies were performed at 6-month intervals. Subjective improvement was achieved in 47 of 55 symptomatic patients (85%). Heart size, judged as heart volume from tele-chest X-ray in supine position, showed a reduction in 36/61, no change in 15/61 and increase in 10/61. On average in all 61 patients, a significant reduction from 947 to 833 ml/1.73 m2 was seen. Twenty-six patients who had been followed for an average of 24 months prior to verapamil therapy on beta blockers or no treatment had heart volume increases averaging 12% in the pre-verapamil period. Electrocardiography (ECG) showed a significant reduction in QRS amplitude and a tendency towards normalization of ST/T segments. Serial echocardiography study showed small but significant reduction in left atrial diameter. Repeat catheterization was performed in 19 patients and a significant reduction in intraventricular pressure gradient, left ventricular muscle mass and coronary artery diameter was demonstrated. Three patients died during the study (256 patient-treatment-years) for an annual mortality rate of 1.3%. This mortality is considerably lower than reported for patients receiving no treatment, beta-blockade, or surgery. Of all 61 patients only one had surgery related to the hypertrophic cardiomyopathy. One patient had the dose of verapamil reduced because of the occurrence of heart block. No patient discontinued the drug because of side-effects. Utilizing serial noninvasive and invasive studies, we conclude that verapamil therapy in hypertrophic cardiomyopathy results in objective and subjective improvement, a low death rate and little need for operation as compared to standard therapy.

Adolescent↗
PubMed1985

Recurrence rate after successful coronary angioplasty.

Among 356 consecutive patients with successful TCA performed between October 1977 and June 1983 follow-up angiograms were performed in 333 patients (94%). A total of 439 follow-up angiograms at 1-48 (average 5.6) months after successful angioplasty were analysed. Restenosis rate was 12% if defined as remaining widening of less than 20% compared with the situation before angioplasty. It was 16% if defined as loss of at least half of the initial gain in luminal diameter, and 17% if defined as increase from immediate post-TCA-stenosis of much greater than 30% or the loss of at least half of the initial gain in luminal diameter. This value dropped to 15% if the subgroup of 30 patients with second TCA and of 14 patients with dilatation of an aortocoronary bypass stenosis were excluded; in both subgroups recurrence rate was higher (33% and 45%, respectively). The observed restenosis rate is less than 50% of that reported by the PTCA registry of the NHLBI. Several factors can possibly be responsible for the reduction in restenosis rate: selection of patients; technique of TCA; medical treatment during and after TCA; modification of risk factors, compliance of patients; unknown factors. Long-term medical treatment with acetyl salicylic acid, nitrates and calcium blockers in high doses is considered to be most probably responsible for the favourable results.

Angiography↗
PubMed1985

[Transluminal coronary angioplasty 1977-1985. Experience with 1000 interventions].

Transluminal coronary angioplasty (TCA) was introduced in 1977 for dilatation of coronary stenoses. From October 1977 to December 1984 1087 procedures have been performed in Frankfurt. The mean success rate was 77% with an increase from 58% to 84% since 1977. Recurrences were seen within the first year in 15% of the patients, which could be treated successfully in a high percentage with a second TCA. Emergency bypass operations were necessary in 5.2%. Four patients (fatality rate 0.37%) died as consequence of the intervention. Within few years TCA has become an established procedure for myocardial revascularisation, with a high success rate. Major progress has been possible in the last few years due to technical developments, which are still going on. They may lead to further improvement of the results and enlargement of the indication for TCA.

Adult↗
PubMed1985

[Coronary perfusion in acute vascular occlusion within the scope of transluminal coronary angioplasty].

The procedure of coronary perfusion during transluminal coronary angioplasty (TCA) is described. By using guide wires of a length of 300 cm it is possible to exchange a balloon catheter for a perfusion catheter in acute vascular occlusion. Arterial blood is withdrawn and correspondingly supplied distal to the occlusion to meet the myocardial need for sufficiently oxygenated blood. Ischemia resolves, resulting in the normalization of left ventricular function and resolution of subjective complaints. This procedure can maintain myocardial oxygen supply until emergency coronary bypass graft surgery or repeat angioplasty. It might help to reduce mortality secondary to transluminal coronary angioplasty.

Angioplasty, Balloon↗
PubMed1985

[Percutaneous pulmonary valvuloplasty].

Five patients (aged between 11 and 59 years) with valvular pulmonary artery stenosis and pressure gradients between 60 and 143 mm Hg underwent percutaneous transluminal balloon valvuloplasty. Selection of the appropriate balloon size was based on the measurement of the dimension of the value anulus as a determinant from the angiogram. Balloon catheters were used with a diameter of 18 to 20 mm. After placement in the stenotic valve the balloon was filled with diluted contrast material for 10-20 s. The balloon indention by the stenotic valve disappeared suddenly during expansion with one to three atmospheres. The pressure gradient in individual patients decreased from 60 to 25, from 143 to 60, 100 to 55, 143 to 60, and 60 to 37 mm Hg, in the mean from 101 to 52 mm Hg. All patients were discharged two to four days after the procedure. During follow-up with recatheterization after three to nine months (four patients) the gradients decreased as compared to the value immediately after valvuloplasty. The exercise capacity increased in all patients. No complications were observed. Balloon valvuloplasty of pulmonary valvular stenosis seems to be an alternative to the operative procedure.

Adolescent↗
PubMed1985

[Long-term results of transluminal coronary angioplasty of chronic coronary artery occlusions].

In 43 patients an occlusion of the coronary artery, which had occurred a few weeks or months previously, was diagnosed between 1977 and 1983. Angiograms were available prior to the occlusion in 35 patients but not in 8 patients. In 31 patients mechanical revascularization was attempted with acute success in 42 percent of the patients. The primary success rate in a control population without occlusion but high-grade stenoses at similar sites was 83 percent. Reocclusions or high-grade restenoses occurred in 54 percent of the revascularized vessels. Taking into account successful repeated dilatations, 62 percent of the successfully treated patients showed long-term success a year after intervention. With reference to all patients in whom revascularization had been attempted, the long-term success rate was 26 percent. Hence, mechanical revascularization of subacute and chronic artery occlusions by angioplasty shows much less chance of acute success together with a markedly increased restenosis rate compared to angioplasty of chronic stenoses. Regarding the good long-term results in a quarter of patients, the technically unproblematic approach as well as minimal dangers for the patients, a revascularization attempt seems to be justified in corresponding clinical presentations.

Angina Pectoris↗
PubMed1985

[Biopsy and autopsy frequency of myocarditis].

Mononuclear infiltrations indicative for myocarditis were found in 3 out of 171 left ventricular biopsies from patients with cardiomyopathies (1.2%). One patient had a normal EF, one had a minimally and one a markedly reduced ventricular function. Among 5,804 consecutive necropsies myocarditis was diagnosed in 308 cases (5.3%). 1.3% were septic in origin while mononuclear infiltrations were found in 3.7% and special morphology in 0.3%. Combined detailed analysis both of clinical and autopsy data could be performed in 84 patients who had died in our own hospital. 82 patients had severe additional diseases determining clinical symptoms and course. Myocarditis without other underlying diseases was found in 2 patients only. Infiltrations were widespread and diffuse in both ventricles and atria in these cases. Myocardial inflammation could not be diagnosed from clinical parameters (X-ray, symptoms, ECG) in any case. Our bioptical data demonstrate that myocarditis does not play a major role in the pathogenesis of dilated cardiomyopathies. Diffuse myocarditis of clinical relevance rarely occurs in adults while focal myocardial infiltrations can be found in a majority of diseases. Reliable clinical symptoms indicative for inflammatory myocardial disease could be found neither in cases with concomitant nor in patients with diffuse myocarditis.

Biopsy↗