Biomedical subjects

M Stauch

Publications and source records attributed to M Stauch.

At least 19 recordsLinked to original sources

PubMed1991

Left ventricular function and wall thickness in long-term insulin-dependent diabetes mellitus: an echocardiographic study.

Left ventricular function and wall thickness were evaluated in 111 type I diabetic subjects (mean age 25.5 +/- 9 years, mean duration of diabetes 13.4 +/- 6.2 years), using 2-D-derived M-mode echocardiography. Patients were carefully selected for the absence of major coronary risk factors or manifest cardiac disorders, and compared with 91 age- and sex-matched control subjects. Fractional shortening and the maximal velocity of cirumferential fibre shortening did not differ significantly between the two groups. Furthermore, no differences were found in the diastolic functional parameter of velocity of circumferential fibre extension. Posterior wall thickness was significantly increased in the diabetic patients compared to the controls (9.5 +/- 1.8 mm vs. 8.4 +/- 1.3 mm. P less than 0.01). As the thickness of the interventricular septum was also moderately increased (9.2 +/- 2.2 mm vs. 8.9 +/- 1.7 mm, NS), these findings provide evidence for an early structural change of the myocardium in young diabetic patients without clinically relevant functional consequences.

Adult↗

PubMed1991

Diastolic ventricular function in type 1 diabetic patients: a study using Doppler echocardiography.

The transmitral flow velocity pattern of 28 Type 1 diabetic patients and 39 age-matched healthy control subjects was studied for determination of left ventricular diastolic function. No patient had systemic hypertension, congestive heart failure, or ischaemic heart disease by clinical or electrocardiographic criteria. Echocardiographic measures of systolic ventricular function were within normal range in all subjects. The ratio of early to late transmitral peak flow velocity (ve/va) was significantly decreased in the diabetic patients (1.3 +/- 0.1 (+/- SE) vs 1.6 +/- 0.1, p less than 0.05), while other Doppler derived variables did not show any significant difference. No correlation of ve/va with duration of diabetes was found (r = -0.27), but it correlated with age in both groups (both r = -0.40, p less than 0.05). Furthermore, a significant correlation was found between ve/va and heart rate (r = -0.55 for diabetic patients, p less than 0.01; r = -0.58 for control subjects, p less than 0.01). After matching for heart rate (24 diabetic patients and 24 control subjects) no significant decrease of ve/va was observed in the diabetic group.

Adult↗

PubMed1990

[Relationship of the left ventricular wall thickness to the degree of late microvascular complications in diabetes mellitus type I].

Left-ventricular wall thickness, measured by echocardiography, was determined in 111 normotensive diabetics (63 men and 48 women; mean age 26 +/- 9 years; diabetes duration 13.5 +/- 6.2 years) and 91 comparable control subjects. The interventricular septum was significantly thicker in diabetics than in controls: systolic 13.3 +/- 2.3 mm, diastolic 9.2 +/- 2.2 mm vs. systolic 12.5 +/- 2.1 mm and diastolic 8.9 +/- 1.7 mm (P less than 0.05). Posterior wall thickness measurements were: systolic 15.8 +/- 2.2 mm vs 14.6 +/- 2.0 mm (P less than 0.001), diastolic 9.5 +/- 1.8 mm vs 8.4 +/- 1.3 mm (P less than 0.01). Left-ventricular wall thickness increased stepwise with increasing severity of microvascular complications (retinopathy, nephropathy, neuropathy). There was a moderately close correlation between blood pressure values and the degree of microvascular complications (r = 0.49, P less than 0.01). These correlations indicate that increases in wall thickness are diabetes specific, but may be influenced by the level of blood pressure.

Adult↗

PubMed1990

Lack of tolerance after chronic administration of controlled-release isosorbide-5-mononitrate. Interaction of nitrate and gallopamil.

The effect of a controlled-release formulation of isosorbide-5-mononitrate (IS-5-MN) was studied in patients with coronary heart disease (CHD), with the aim of comparing the acute effect with that after chronic administration on parameters of ischemia. To determine whether any tolerance developed, several aspects of ischemia were observed: ECG signs, clinical parameters, and left ventricular function. Fifteen patients with angiographically proven CHD were examined with 12-lead exercise ECG before, 2 h and 4 h after the first dose and after 10 days of therapy with 60 mg IS-5-MN (Coleb-Duriles) once daily. After 7 days, three radionuclide ventriculographies were performed: control, 2 h after nitrate and 2 h after 75 mg gallopamil. Plasma concentrations of IS-5-MN were measured before every exercise test. The results showed a reduction of total ST-segment depression from 0.59 mV to 0.29 mV after 2 h (NS) and 4 h (P less than 0.05) on the 1st day and from 0.48 mV to 0.32 mV (P less than 0.05) and 0.31 mV (NS) after 10 days. The severity of angina pectoris was diminished by about 50%. The effect on exercise duration and time to ST-segment depression by more than 0.1 mV remained unchanged after 10 days, whereas the effect on blood pressure, heart rate and time to onset of angina was attenuated. The mean decrease in ejection fraction (EF) from rest to exercise was reduced from--5.9% to -1.9% (P less than 0.05) after nitrate, while an increase of +1.4% was seen after gallopamil (P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1990

Acute and chronic effects of a diuretic monotherapy with piretanide in congestive heart failure--a placebo-controlled trial.

To evaluate the acute and chronic effects of diuretic monotherapy with 3 mg piretanide bid, 46 patients (pts) with congestive heart failure (NYHA II-III) secondary to coronary artery disease were studied. Within 3 weeks of therapy, the patients lost 1.6 kg body weight. Forty-four patients reported a subjective feeling of improvement. Echocardiographically, a highly significant (p less than 0.001) reduction of diastolic and systolic diameters was found, as well as an increase of fraction shortening. Chest x-ray indicated a reduction of heart volume from 1012 +/- 263 ml to 936 +/- 233 ml (p less than 0.001). The serum potassium level remained unchanged. A subgroup of 26 pts underwent invasive hemodynamic examinations. IV injection of 6 mg piretanide resulted in an acute reduction of pulmonary wedge pressure (pc) from 20.2 +/- 5.3 mmHg to 11.9 +/- 5.0 mmHg (p less than 0.001); simultaneously a slight decrease of cardiac index from 3.2 +/- 0.6 l/min/m2 to 3.0 +/- 0.4 l/min/m2 was observed. Invasive control after 3 weeks of oral therapy showed no decline of the piretanide effect. The exercise tolerance increased clearly from 135 +/- 161 Wmin to 249 +/- 268 Wmin (p less than 0.05). A control group of further 14 pts was treated with placebo only and did not show any significant changes of pc (20.0 +/- 6.4 mmHg vs. 22.8 +/- 19.2 mmHg), exercise tolerance, or other clinical parameters. Thus, the diuretic monotherapy of congestive heart failure with piretanide is highly effective and shows a significant improvement in all clinical and hemodynamic parameters in the absence of any remarkable side effects.

Adult↗

PubMed1990

Hemodynamic effects of alinidine (ST 567) at rest and during exercise in patients with chronic congestive heart failure.

Selective inhibition of sinus node function offers the possibility to decrease heart rate and reduce myocardial oxygen consumption in patients with impaired cardiac function, if myocardial contractility is not further attenuated. To study the influence of a specific sinus node inhibitor on myocardial function, alinidine was given to 10 patients with chronic congestive heart failure and stable sinus rhythm. Radionuclide ventriculography was used to monitor left ventricular function at rest and during a standardized exercise protocol. After a bolus injection of 45 mg of alinidine followed by infusion of 10 mg/hr, radionuclide studies were repeated 1.5 and 3 hours later. The results show that left ventricular ejection fraction, stroke volume, and end-diastolic volume index were essentially unchanged, whereas cardiac index decreased by 10% at rest and during exercise. Heart rate decreased markedly by 14% at rest and by 13% during exercise. Systolic blood pressure was reduced by 6% at rest and by 14% during exercise. As a result of the marked decrease of these two parameters, a pronounced effect was seen on rate-pressure product with a 19% decrease at rest and a 24% decrease during exercise. No significant side effects were observed. Alinidine might be given to patients with chronic congestive heart failure and sinus rhythm in doses up to 45 mg without exerting a clinically relevant negative inotropic effect. Therefore it may represent an alternative to other drugs when a decrease in heart rate is desired to reduce myocardial oxygen consumption.

Aged↗

PubMed1990

[The role of radionuclide ventriculograms in determining the indications for valve replacement in chronic aortic valve insufficiency].

Timing of aortic valve replacement (AVR) in chronic aortic regurgitation (AR) remains a difficult problem in clinical practice. Radionuclide ventriculography (RNV) yields information on the extent of valvular regurgitation, the enlargement and the systolic function of the left ventricle. A "well-timed" AVR is defined by 1) postoperative improvement of clinical symptoms, decrease in left ventricular end-diastolic volume (EDV) and normalization of ejection fraction (EF) as well as by 2) greater improvement under surgical therapy as compared to conservative management. In "too early" AVR the latter condition is not fulfilled, while in "too late" AVR the first condition is not accomplished. In this study 54 patients with chronic aortic incompetence were evaluated by RNV to see whether these three groups ("too early", "well timed", "too late" AVR, resp.) can be separated by the relation between EDV and regurgitant volume (RV), the level of the EDV and the clinical status. The examination was based on pre- and postoperative RNV studies as well as on follow-up studies. A good postoperative result can be expected in cases with a preoperative EDV/RV-ratio similar to that observed in 30 patients with AR in whom AVR was not indicated. In contrast, in the majority of those cases with an EDV/RV-ratio exceeding this normal range the postoperative outcome will be unsatisfactory. If the EDV/RV-ratio is normal, AVR should be performed in cases with an EDV exceeding 400 ml, while in cases with an EDV between 300-400 ml AVR is only indicated in the presence of additional symptoms (NYHA greater than or equal to II).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1989

[Radionuclide ventriculography. The significance of global and regional ejection fractions and Fourier amplitude and phase in the diagnosis of exertion-dependent ischemia].

Electrocardiograms and radionuclide ventriculograms were obtained at rest and on exercise in 23 patients (20 men and 3 women, mean age 53.4 years) with exercise-dependent myocardial ischaemia after infarction, as well as in 22 persons (17 men and 5 women, mean age 43 years) without clinical, electrocardiographic and biochemical evidence of coronary heart disease. Among the ischaemia patients exercise-dependent loss of motility, as measured by regional ejection fraction and Fourier amplitude, occurred in 95% (50% of controls) in one sector, in 78% (4.5% of controls) in the two sectors with the highest contractility at rest, and in 74% (0% of controls) in three sectors. On exercise, phase shifts occurred in 87% (27% of controls). When combining the exercise-ECG, global ejection fraction as well as regional motility loss in one sector, in the two sectors with the highest contractility at rest and in three sectors, at least two of the five criteria of abnormality were present in 91.3% of the ischaemia patients, compared with at most one criterion in 90.9% of controls. The results indicate the greater diagnostic value of regional than global measures of ventricular function and emphasize the importance of radionuclide ventriculography as an addition to exercise electrocardiography in the pre-invasive diagnosis of coronary heart disease.

Adult↗

PubMed1989

[Stress testing of long-term type I diabetic patients with radionuclide ventriculography].

Left ventricular function was assessed by means of radionuclide ventriculography in 42 patients with long-standing (13 +/- 5 yrs) insulin-dependent diabetes mellitus and in eleven healthy age matched control subjects. Only diabetics were included in the study without diabetes related cardiac risk factors such as hypertension and CAD in order to evaluate diabetes specific changes of cardiac function. No differences were seen between diabetics and controls concerning heart rate and functional parameters of left ventricle in systole and diastole. The rapid filling period was not prolonged. According to our radionuclide data there is no evidence of diabetes related impairment of ventricular function in young patients with long-standing type-1-diabetes mellitus.

Adult↗

PubMed1989

[The effect of a combination of ridazolol and molsidomine on hemodynamics and left ventricular function in dilated cardiomyopathy].

Haemodynamics and Left Ventricular Function in Patients with Dilated Cardiomyopathy after a Combination of Ridazolol and Molsidomine. To evaluate the haemodynamic properties of the new beta-blocker ridazolol alone and in combination with the vasodilator molsidomine a randomized study was carried out in 12 patients with dilated cardiomyopathy (NYHA II/III). beta-Blockade leads to a decreasing tendency in blood pressure and heart rate. Pulmonary capillary wedge pressure (PC) was not significantly altered and ejection fraction remained unchanged. Molsidomine showed a decrease of PC. The combination of both drugs revealed both the positive haemodynamic effects of molsidomine and the reduced heart rate of beta-blockade. Negative side effects could not be observed.

Adrenergic beta-Antagonists↗

PubMed1989

[Quantification of the myocardial scar with technetium-99m-isonitrile (MIBI) in emission computerized tomography (SPECT)--comparison with serial creatine kinase determinations and radionuclide ventriculography].

Estimation of the size of myocardial infarction is of major interest for clinical patient management and a simple and reliable method is still searched for. In this study the potential of the new myocardial perfusion tracer, Technetium-99m (Tc-99m) methoxy-isobutyl-isonitril (MIBI) combined with emission computertomography (SPECT), is tested vs. the standard procedures of serial plasma creatine kinase (CK) measurements and radionuclide ventriculography (RNV). In 10 patients with first myocardial infarction, integral values for CK were obtained during the acute phase. Following three weeks of uncomplicated recovery the patient was referred for both types of myocardial imaging within four days. 370 MBq Tc-99m-MIBI were injected with the patient supine and at rest. One hour later SPECT acquisition commenced. The reconstructed slices were rearranged to long and short axes slices, which served to calculate a functional "scar image" in polar coordinates. The color-coded areas of significantly reduced tracer uptake were expressed in percent of the total myocardial area. RNV was performed with the patient supine and at rest, the left anterior oblique angle being optimized for septum visualization. Infarct localizations were antero-apical (three), anterolateral (two), postero-lateral (one), and posterior (four).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1988

Efficacy and safety of intravenous amiodarone in acute refractory arrhythmias.

Few data are available on intravenous amiodarone therapy in refractory arrhythmias. This retrospective study in 50 patients (14 with supraventricular and 36 with ventricular tachyarrhythmias) revealed a favorable effect of intravenous amiodarone in the treatment of life-threatening arrhythmias with an overall success rate of 76%. In the subgroup of patients with ventricular fibrillation and concomitant severe congestive heart failure success rate was low (25%, 2/8), whereas effectiveness in patients with ventricular tachycardias was high (greater than 90%) and proved to be independent of left ventricular function. If patients with recurrent ventricular fibrillation were excluded from the analysis, successful treatment with intravenous amiodarone was achieved in 90%, even in those patients with severely compromised myocardium.

Acute Disease↗

PubMed1988

Long term inotropic effects of flecainide and propafenone.

This study was undertaken to evaluate the effect of flecainie (Fle) and propafenone (Pro) on rest and exercise myocardial contractility after prolonged oral administration. Standardized, fully automated, gated radionuclide angiograms at rest and during maximum exercise were performed single blinded and prospectively in 19 patients before and after oral treatment with either 150 mg b.i.d. of Fle or 150 mg t.i.d. of Pro. The left ventricular ejection fraction (EF%) as a hemodynamic indicator presented as follows: (Table: see text) In general, there was no significant effect of either drug on resting ventricular function. In only one patient of the Fle group with decreased baseline function did the left ventricular EF fall from 40% to 29%. During exercise, ventricular performance showed deterioration in the Pro group, but, interestingly, improvement in the Fle group. As a result of these opposite changes, the effect of the two drugs on the exercise response of ventricular function was significantly different (P less than 0.05). This study thus gives first evidence that no significant cardiodepressive effects are to be expected after prolonged application of Fle or Pro in normal hearts. There might even be a mild beneficial effect on exercise performance after Fle.

Administration, Oral↗

PubMed1988

Left ventricular function at rest and during exercise in acute hypothyroidism.

The effect of hypothyroidism on left ventricular function at rest and during exercise was studied in nine patients without demonstrable cardiovascular disease who had had total thyroidectomy and ablative radioiodine treatment for thyroid cancer. Radionuclide ventriculography and simultaneous right heart catheterisation were performed while the patients were hypothyroid two weeks after stopping triiodothyronine treatment (to permit routine screening for metastases) and while they were euthyroid on thyroxine replacement treatment. When the patients were hypothyroid, cardiac output, stroke volume, and end diastolic volume at rest were all lower and peripheral resistance was higher than when they were euthyroid. Pulmonary capillary wedge pressure, right atrial pressure, heart rate, left ventricular ejection fraction, and the systolic pressure:volume relation of the left ventricle, which was used as an estimate of the contractile state, were not significantly different when the patients were hypothyroid or euthyroid. During exercise, heart rate, cardiac output, end diastolic volume, and stroke volume were higher when the patients were euthyroid than when they were hypothyroid. Again, pulmonary capillary wedge pressure, ejection fraction, and the systolic pressure:volume relation were similar in both thyroid states. The data suggest that the alterations in cardiac performance seen in short term hypothyroidism are primarily related to changes in loading conditions and exercise heart rate; they do not suggest that acute thyroid hormone deficiency has a major effect on the contractile properties of the myocardium.

Acute Disease↗

PubMed1988

[Hemodynamics and ventricular function in dilated cardiomyopathies following administration of the new beta-blocker ridazolol].

Recent reports in the literature indicate that beta-blockade may improve survival in patients with dilated cardiomyopathy (DCMP). This goal can obviously not be attained if the beta-blocker employed effects deleterious actions on the left ventricular function or hemodynamics. Accordingly, to assess the suitability of the new beta-blocker ridazolol for use in this regard, in nine patients with DCMP NYHA class II/III, studies were performed (by means of balloon-tipped pulmonary artery catheter and radionuclide ventriculography) at rest and during exercise prior to and one hour after oral administration of a 40 mg-dose of the agent. At rest, there was a decreasing tendency in systolic blood pressure from 123 +/- 18.5 mm Hg to 113 +/- 15.2 mm Hg and heart rate from 94 +/- 19 beats/min to 83 +/- 17 beats/min. Pulmonary capillary wedge pressure was not significantly altered at 16.2 +/- 7.9 mm Hg and 17.1 +/- 8.4 mm Hg, respectively. Ejection fraction remained unchanged with 29 +/- 14%. The slight decrease in cardiac output from 5.1 +/- 1.3 l/min to 4.5 +/- 1.3 l/min was not significant. During exercise, there were also decreasing tendencies in the heart rate from 128 +/- 21 beats/min to 102 +/- 22 beats/min and the systolic blood pressure from 148 +/- 20.5 mm Hg to 141 +/- 18.4 mm Hg. Essentially unchanged were the pulmonary capillary wedge pressure (26.1 +/- 7.2 mm Hg/27.8 +/- 5.0 mm Hg) and ejection fraction (30 +/- 10%/27 +/- 8%) during exercise.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic beta-Antagonists↗

PubMed1988

[Drug therapy of coronary heart disease following thrombolysis and PTCA or bypass operation].

Successful thrombolysis with reperfusion and salvage of jeopardized myocardium frequently necessitates invasive therapeutic strategies such as angioplasty or bypass surgery. Medical treatment in this situation has to consider the possibility of recurrence of infarction before invasive measures can be obtained. It must be specially directed towards preventing such an event, besides applying therapeutic measures in the acute and subacute phase after myocardial infarction. Several different therapeutic principles were considered: 1. In the days after thrombolysis with or without PTCA anticoagulants, mostly in the form of heparin, are used routinely in an attempt to prevent reocclusion and reduce thromboembolic complications. The latter indication seems to yield the most benefit of this type of drug. 2. Platelet-modifying drugs reduce the risk of reocclusion after thrombolysis and PTCA. The vein graft patency seems to be higher after aspirin treatment than after coumarine therapy. A reduction of coronary events was reported especially in patients with non Q-wave infarction, a situation particularly liable for reinfarction. 3. Calcium antagonists are used widely after PTCA to attenuate coronary spasm. No global beneficial effects have been observed after bypass surgery and in the therapy of acute myocardial infarction. Special indications e.g. for certain types for arrhythmias remain unchanged after thrombolysis, PTCA and bypass surgery. 4. Antianginal drugs with nitrates and betablockers are indicated to relieve symptoms in the acute phase. In chronic treatment, prevention of reinfarction and reduction of mortality was reported after the use of betablockers, the latter mainly by increasing the fibrillation threshold, thus reducing deaths due to arrhythmias.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon↗

PubMed1987

Radionuclide ventriculography and hemodynamic evaluation by right heart catheterization with exercise for assessing the functional significance of coronary artery stenoses. A comparative study.

A series of 13 patients with significant coronary stenoses but without prior myocardial infarction were simultaneously studied by right heart catheterization and radionuclide ventriculography to determine the extent to which abnormal responses in left ventricular ejection fraction and wall motion to maximum exercise are paralleled by abnormal left ventricular filling pressures. The correlations of the filling pressure as evaluated by the diastolic pulmonary artery pressure with both the exercise ejection fraction and the rest-to-exercise change in ejection fraction were high (r = -0.89, P less than 0.01 and r = -0.76, P less than 0.01, respectively). In addition, the filling-pressure response to stress separated the patients into distinct radionuclide categories. All the 7 patients with grossly abnormal filling pressures (P greater than or equal to 30 mmHg) developed regional wall motion abnormalities with exercise as evaluated by visual interpretation or quantitative phase analysis. These patients also had a decrease in ejection fraction from rest to exercise ranging from -9% to -32% together with an exercise ejection fraction below 50%. Conversely, these abnormalities were never found in patients with filling pressures below this threshold level. The data suggest that radionuclide ventriculography and measurement of left ventricular filling pressure with exercise yield corresponding results when assessing the functional significance of coronary stenoses in normotensive patients without prior myocardial infarction and normal global left ventricular function at rest.

Blood Pressure↗

PubMed1987

[Use of digital subtraction angiography in localizing an anomalous pulmonary vein return in a case of congenital shunt disease].

The exact analysis of an anomalous pulmonary venous return in patients with congenital shunt disease can lead to some difficulties when using the standard catheterization techniques. A left-sided anomalous pulmonary vein was suspected in a case with atrial and ventricular septal defects, but could not be evaluated during the catheterization procedure. The pathological vessel could be demonstrated exactly only by venous digital subtraction angiography. Thus, the digital subtraction angiography showed a diagnostic benefit in this complex shunt disease and should be considered in further problematic cases.

Adult↗