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R Erbel

Publications and source records attributed to R Erbel.

At least 55 records · Page 3Linked to original sources
PubMed2002

Tei-Index in coronary artery disease--validation in patients with overall cardiac and isolated diastolic dysfunction.

BACKGROUND: The index "isovolumic contraction time and isovolumic relaxation time divided by ejection time" ("Tei-Index") has been demonstrated to provide useful information about disease severity and prognosis in patients with dilated cardiomyopathy and cardiac amyloidosis. In patients with coronary artery disease (CAD), the diagnostic utility of this index is unclear. We attempted to validate the Tei-Index in CAD patients with overall cardiac or isolated diastolic dysfunction. METHODS AND RESULTS: Sixty subjects were included who underwent left heart catheterization for invasive measurement of left ventricular end-diastolic pressure (LVEDP): 20 symptomatic CAD patients with overall cardiac dysfunction (defined by a LV ejection fraction (EF) < 45% (mean 27 +/- 8%) and a LVEDP > or = 16 mmHg, (mean 22 +/- 6 mmHg), NYHA class 2.7 +/- 0.4, OCD group), 29 symptomatic CAD patients with isolated diastolic dysfunction (defined by an EF > 45% (mean 55 +/- 8%), a normal end-diastolic diameter index (mean 2.8 +/- 0.4 cm/m2) and a LVEDP > or = 16 mmHg (mean 22 +/- 6 mmHg), NYHA class 2.3 +/- 0.4, IDD group) and 11 asymptomatic control subjects (EF 65 +/- 9%, LVEDP 11 +/- 4 mmHg, CON group). After conventional 2-D- and Doppler echocardiographic examination, the Tei-Index was obtained. The Tei-Index was easily and reproducibly measured in all study subjects. In the OCD group, isovolumic contraction time was prolonged and ejection time was shortened in comparison to the CON group, resulting in a significantly increased Tei-Index (0.71 +/- 0.28 vs 0.40 +/- 0.11, p < 0.01). In the IDD group, isovolumic relaxation time was prolonged and isovolumic contraction time was shortened in comparison to controls, resulting in a largely unchanged Tei-Index (0.45 +/- 0.14, p = ns). Receiver operating characteristic curve analysis for the Tei-Index yielded an area under the curve of 0.92 +/- 0.04 for separating patients with vs without OCD. Using a Tei-Index > 0.49 as a cut-off, OCD patients were identified with a sensitivity of 96% and a specificity of 86%. CONCLUSION: The Tei-Index is a valid and readily derived indicator of global cardiac dysfunction in CAD patients with impaired systolic and diastolic LV performance. The use of this index seems to be limited in CAD patients with primary diastolic dysfunction.

Aged↗
PubMed2002

[Atherosclerosis in HIV-positive patients].

Worldwide, human immunodeficiency virus (HIV) infection is one of the main health subjects. Even, the human immunodeficiency virus primarily effects the immune system, HIV infection also has an impact on other organs. Cardiovascular manifestations in HIV-infected patients could occur by the HI-virus itself or by opportunistic infections. Reports of myocardial infarction in young HIV-infected patients, who received protease inhibitors, have raised concerns about premature arteriosclerosis and coronary artery disease in this population. In the pre-protease inhibitor era, autopsy reports were the first to describe an association between coronary artery disease and HIV infection. Long-term antiretroviral therapy, including protease inhibitors, significantly reduced mortality, morbidity and revolutionized the care of HIV-infected patients. However, class-specific metabolic side effects, such as elevated total cholesterol and triglyceride levels and insulin resistance, have been described. These metabolic alterations of antiretroviral therapy impair the cardiovascular risk profile of HIV-infected patients. Even epidemiological studies found no significant effect of antiretroviral treatment type on coronary heart disease or myocardial infarction, an increase of arteriosclerosis in HIV-infected patients is suspected. Recent results of autopsy studies and analyses of endothelial function in patients with HIV infection described an effect of HIV and antiretroviral therapy on premature arteriosclerosis. The present article gives an overview about arteriosclerosis and coronary events in HIV-infected patients and the impact of antiretroviral therapy.

Antiretroviral Therapy, Highly Active↗
PubMed2002

[Sinus node dysfunction with intermittent sinus arrest and AV-nodal escape rhythm as initial manifestation of pheochromocytoma].

A 25-year-old male student complained about episodic palpitations, dizziness, nausea and headache 5 years prior to presentation. No otorhinolaryngic, neurologic or gastrointestinal causes were identified. Several ECG recordings revealed sinus node dysfunction with intermittent sinus arrest and AV-nodal escape rhythm. The patient was given a permanent DDD-pacemaker. Six months later, the clinical symptoms were unchanged. During an attack, physical examination revealed paleness, diffuse sweating and an arterial blood pressure of 250/130 mmHg, which decreased to 120/80 mmHg within a few minutes. Abdominal ultrasound and abdominal computed tomographic scan demonstrated the presence of a large (6.4 x 5.5 cm) left-sided adrenal mass. Two 24-h-urinary collections demonstrated elevated noradrenaline (mean 315 micrograms/24 h, normal < 80 micrograms/24 h) and adrenaline (mean 268 micrograms/24 h, normal < 20 mg/24 h) levels. Blood samples, which were drawn during excessive blood pressure rise, revealed elevation of plasma catecholamines (6.793 pg/ml for adrenaline (normal 50-150 pg/ml) and 10.424 pg/ml for noradrenaline (normal 200-500 pg/ml), so that the diagnosis of pheochromocytoma was considered established. The tumor was successfully removed during laparascopic surgery. After surgery, the patient remained well and normotensive. Three months later, several long-term ECG recordings showed sinus arrhythmia with no evidence of sinus arrest or AV-nodal escape rhythm, so that the DDD pacemaker was turned off. This case underlines that sinus node dysfunction with intermittent sinus arrest and AV-nodal escape rhythm is a potential early manifestation of a pheochromocytoma. These changes seem to disappear after successful removal of the tumor.

Adrenal Gland Neoplasms↗
PubMed2002

Evaluation of metal allergies in patients with coronary stents.

In-stent restenosis is a complication which impairs the success of coronary stenting. Recently, it was supposed that a delayed hypersensitivity reaction to nickel and molybdenum might be one of the triggering factors in in-stent restenosis. We have analyzed the data collected in our centre with respect to this hypothesis. Altogether, 34 patients were investigated (24 male, 10 female). Patch tests were performed with the standard series of the German Contact Dermatitis Research Group and a metal series containing the metal components of 316 L stainless steel. A positive patch test reaction to nickel was observed in 4 (11.8%) patients. None of the patients showed sensitization to the other metals. Retrospective analysis was performed in 20 patients: 2 of these patients had a positive patch test reaction to nickel, one of whom had an in-stent restenosis, and the other not. Restenoses were predominantly observed in patients with negative patch test reactions to nickel (6/18 patients). Out of the patients who were investigated prospectively only one showed sensitization to nickel. Restenosis was observed in 2 patients: neither patient had nickel allergy. Although it still cannot be excluded that metal allergy may play a role in the restenosis process in coronary stenting, there is at present little evidence for it.

Coronary Angiography↗
PubMed2002

Acromegaly: evidence for a direct relation between disease activity and cardiac dysfunction in patients without ventricular hypertrophy.

BACKGROUND AND AIMS: Cardiac abnormalities, such as cardiomegaly and congestive heart failure, occur frequently in advanced acromegaly. Abnormalities of systolic and diastolic function, mostly associated with left ventricular (LV) hypertrophy, have been reported. The impact of disease activity on LV performance in patients with normal or slightly elevated LV muscle mass has not been demonstrated. PATIENTS AND METHODS: Conventional two-dimensional/Doppler echocardiography and tissue Doppler imaging (TDI) of the mitral annulus were performed in 13 patients with active acromegaly (AA) and normal or slightly elevated LV muscle mass (< 140 g/m2) and in 19 cured/well-controlled patients (CA). A group of 21 volunteers without symptoms or signs of cardiac disease served as controls (CON). The combined myocardial performance index (Tei-Index) was determined in all patients and controls. RESULTS: Muscle mass index of the left ventricle, ejection fraction, fractional shorting, E/ET-ratio, systolic (ST) and late diastolic (AT) annular velocities did not differ significantly between the three groups. In the AA group, the early diastolic annular velocity ET[7.13 +/- 2.11 (AA); 9.83 +/- 3.29 (CA); 10.10 +/- 1.70 m/s (CON); P < 0.05 AA vs. CA, P < 0.005 AA vs. CON] and the ET/AT-ratio [0.71 +/- 0.26 (AA); 0.95 +/- 0.33 (CA); 1.00 +/- 0.15 m/s (CON); P < 0.05 AA vs. CA, P < 0.005 AA vs. CON] were significantly reduced. Patients with AA had a longer deceleration time [209 +/- 19 (AA); 179 +/- 22 (CA); 185 +/- 26 ms (CON); P < 0.05]. The Tei-Index was significantly higher in AA in comparison with CON [0.50 +/- 0.15 (AA); 0.48 +/- 0.12 (CA); 0.41 +/- 0.10 (CON); P < 0.05 AA vs. CON]. Subjects with CA did not differ significantly from controls with respect to 2-D/Doppler echo- and TDI-derived parameters. CONCLUSION: The data demonstrate that diastolic dysfunction can be verified by tissue Doppler imaging in patients with active acromegaly with normal or slightly elevated muscle mass of the left ventricle and seems to be related to disease activity. The Tei-Index as a sensitive combined myocardial performance index can be used to complete the assessment of systolic and diastolic LV performance in acromegalic patients.

Acromegaly↗
PubMed2002

Refinements in stress echocardiographic techniques improve inter-institutional agreement in interpretation of dobutamine stress echocardiograms.

AIMS: To determine the degree of inter-institutional agreement in the assessment of dobutamine stress echocardiograms using modern stress echocardiographic technology in combination with standardized data acquisition and assessment criteria. METHOD AND RESULTS: Among six experienced institutions, 150 dobutamine stress echocardiograms (dobutamine up to 40 microg x kg(-1) min(-1) and atropine up to 1 mg) were performed on patients with suspected coronary artery disease using fundamental and harmonic imaging following a consistent digital acquisition protocol. Each dobutamine stress echocardiogram was assessed at every institution regarding endocardial visibility and left ventricular wall motion without knowledge of any other data using standardized reading criteria. No patients were excluded due to poor image quality or inadequate stress level. Coronary angiography was performed within 4 weeks. Coronary angiography demonstrated significant coronary artery disease (> or = 50% diameter stenosis) in 87 patients. Using harmonic imaging an average of 5.2+/-0.9 institutions agreed on dobutamine stress echocardiogram results as being normal or abnormal (mean kappa 0.55; 95% CI 0.50-0.60). Agreement was higher in patients with no (equal assessment of dobutamine stress echocardiogram results by 5.5+/-0.8 institutions) or three-vessel coronary artery disease (5.4+/- 0.8 institutions) and lower in one- or two- vessel disease (5.0+/-0.9 and 5.2+/-1.0 institutions, respectively; P=0.041). Disagreement on test results was greater in only minor wall motion abnormalities. Agreement on dobutamine stress echocardiogram results was lower using fundamental imaging (mean kappa 0.49; 95% CI 0.44-0.54; P<0.01 vs harmonic imaging). CONCLUSION: Modern echocardiographic technology in combination with standardized digital image processing and uniform reading criteria results in a higher inter-institutional agreement in the interpretation of dobutamine stress echocardiogram compared to historic reports.

Adrenergic beta-Agonists↗
PubMed2002

How big is small?

Explore the source record for details and available documents.

Arteries↗
PubMed2002

[Comparison of gradient-echo and steady state free precession sequences for 3D-navigator MR angiography of coronary arteries].

AIM: Purpose of our study was to compare the image quality of 3D-navigator steady state free precession (SSFP) and gradient echo (GE) sequences for magnetic resonance coronary angiography (MRCA) in volunteers and patients. METHODS: Following informed consent 8 volunteers and 12 patients were included into this study. In all subjects a 3D navigator MRCA of the right and the left coronary artery was performed with a SSFP (TR 3.9 ms, TE 1.7 ms, FA 65 degrees, bandwidth 540 Hz) and a GE (TR 5.8 ms, TE 2.2 ms, FA 25 degrees, bandwidth 200 Hz) sequence using a 1.5 T-MR-System (Magnetom Sonata, Siemens Erlangen). The slice thickness was 1.5 mm and the in-plane resolution was 0.9 x 0.7 mm (2) for all measurements. RESULTS: The blood pool showed a significantly (p < 0.01) higher signal intensity on SSFP images (147 +/- 36) compared to GE images (103 +/- 36). Although noise increased with SSFP (9.3 +/- 1.4 versus 5.3 +/- 0.9), the contrast-to-noise ratio between myocardium and the coronaries was significantly (p < 0.01) higher on SSFP images (7.8 +/- 3.7 versus 3.4 +/- 3.3). The CNR between the coronaries and the epicardial fat showed no significant differences (12 +/- 5 versus 13 +/- 4). CONCLUSION: The 3D-navigator SSFP sequence is a promising new technique for MRCA which improves the contrast between the coronaries and the myocardium and shortens the data acquisition compared to gradient-echo imaging.

Adult↗
PubMed2002

Prognostic implication of cardiac troponin T increase following stent implantation.

OBJECTIVE: To identify the incidence and clinical significance of myocardial injury following elective stent implantation. DESIGN: Prospective clinical study with 278 consecutive patients undergoing stenting of de novo coronary or saphenous vein graft lesions. Incidence of periprocedural myocardial injury was assessed by analysis of 12 lead ECG, creatine kinase (CK; upper limit of normal (ULN) 70 IU/l for women, 80 IU/l for men), and cardiac troponin T (cTnT; point of care test; threshold 0.1 ng/ml) before and 6, 12, and 24 hours after the intervention. Major adverse cardiac events (MACE: acute myocardial infarction, bypass surgery, and cardiac death) were recorded during clinical follow up (mean (SD) 7.8 (5.3) months). RESULTS: Following elective stenting, the rate of a positive cTnT status was 17.3%, the rate of CK increase of 1-3x ULN 14.7%, the rate of CK increase of > 3x ULN 1.4%, and the rate of Q wave myocardial infarction 0.4%. Cardiac mortality during follow up was higher in patients with postprocedurally increased CK (7.1% v 1.3%, p = 0.01, log rank) and cTnT (9.1% v 0.9%, p < 0.001, log rank). In addition, postprocedurally increased cTnT was associated with a higher overall incidence of MACE (13.1% v 4.0%, p < 0.01, log rank) and was identified as an independent factor for MACE during follow up (hazard ratio 3.27, 95% confidence interval 1.14 to 9.41, p = 0.028). CONCLUSIONS: Following elective stent implantation, a positive cTnT status identified patients at risk of a worse long term outcome. Treatment strategies have to be developed that lead to prognostic improvement by reducing periprocedural myocardial injury.

Biomarkers↗
PubMed2001

Unstable coronary plaque and its relation to coronary calcium.

Coronary calcium is intimately associated with coronary atherosclerotic plaque development. The use of electron-beam computed tomography (EBCT) for accurate quantitative measurements has led to an increased interest in understanding the clinical importance of coronary calcium, particularly in terms of the ability to identify unstable coronary plaques that underlie the clinical acute coronary syndromes. Histopathologic studies have demonstrated that calcium is a frequent feature of ruptured plaques, but the presence or absence of calcium does not allow for reliable distinction between unstable versus stable plaques. This issue is complicated by the lack of a prospective definition for "unstable." Plaque rupture is sometimes found in apparently healthy subjects and in patients with clinically stable disease. Coronary atherosclerosis is a coronary systemic disease process. Imaging of coronary calcium, although unable to identify a localized unstable plaque, potentially can identify the more clinically pertinent "unstable patient." Almost all patients with a recent acute coronary syndrome have measurable coronary calcium because moderate-to-advanced coronary plaque disease is already present, although obstructive disease frequently is not. Prospective studies have demonstrated that extensive coronary calcium detected by EBCT is associated with a significantly increased incidence of subsequent myocardial infarction, need for revascularization, and coronary death. The incremental prognostic value of coronary calcium compared with that of risk factor assessment remains to be fully defined. The occurrence of an acute coronary syndrome is determined by many factors apart from the extent of atherosclerotic plaque disease. Large prospective trials in the general population are needed to define the subgroups that will benefit most from quantitative assessment of coronary calcium.

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