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Biomedical subjects

R Erbel

Publications and source records attributed to R Erbel.

At least 577 records · Page 32Linked to original sources
PubMed1984

Sensitivity and specificity of two-dimensional echocardiography in detection of impaired left ventricular function.

The purpose of the study was to determine the sensitivity and specificity of two-dimensional echocardiography (2dE) in the detection of impaired left ventricular function, compared with cineventriculography (CVG). Apical two-dimensional echocardiograms were performed in 110 patients undergoing heart catheterization for the evaluation of clinically suspected coronary heart disease (50 patients), valvular heart disease (38 patients) and congestive cardiomyopathy (22 patients). The left ventricle was scanned in the RAO-equivalent view; cineventriculograms were filmed in the 30 degrees RAO projection. Left ventricular volumes at end-diastole (EDV) and end-systole (ESV) were determined using a disc method; stroke volume (SV) and ejection fraction (EF) were calculated. Based on normal values, the sensitivity, specificity, and predictive accuracy were determined for two-dimensional echocardiography. For EDV, the sensitivity was 80%, specificity 88% and (+) predictive accuracy 86%. The left ventricular ejection fraction was 57.8 +/- 17.2% with CVG and 53.8 +/- 15.6% with 2dE in patients with coronary heart disease, 24.9 +/- 10.5% with CVG and 25.2 +/- 11.1% with 2dE in patients with congestive cardiomyopathy, and 61.1 +/- 13.9% with CVG and 54.2 +/- 9.1% with 2dE in patients with valvular heart disease. Sensitivity was 81%, specificity 100%, and (+) predictive accuracy 100%. The study demonstrates that impaired left ventricular function can be detected by 2dE with high sensitivity and specificity. Thus, 2dE seems to be suitable screening method for evaluation of left ventricular function.

Adult↗
PubMed1984

Long-term hemodynamic effects of prenalterol in patients with severe congestive heart failure.

In a controlled, randomized, double-blind study we investigated the long-term effects of the beta 1-adrenoceptor agonist prenalterol in 16 patients with severe congestive heart failure (NYHA class III or IV). Previous to and 1 week, 3 months, and 6 months after continuous oral intake of 40 to 120 mg prenalterol a day, catheterization of the right heart combined with an ergometer test was carried out; M mode and two dimensional echocardiograms as well as systolic time intervals were also recorded. With prenalterol the heart rate increased within 1 week from 81 +/- 7 to 90 +/- 7 beats/min (mean +/- SD) (p less than .05) and remained increased after 3 months (93 +/- 9 beats/min, p less than .01) and 6 months (91 +/- 6 beats/min, p less than .05). After 1 week the cardiac index rose from 2.7 +/- 0.7 to 3.3 +/- 0.7 l/min/m2 (p less than .01), and after 3 and 6 months it fell again to 3.0 +/- 0.9 l/min/m2 and 2.9 +/- 0.7 l/min/m2, respectively. In the ergometer test the improvement in performance was not significant. The mean velocity of circumferential fiber shortening initially increased from 0.58 +/- 0.20 to 0.79 +/- 0.28 circumferences/sec (p less than .01), but dropped after 3 months to 0.62 +/- 0.31 circumferences/sec. The ejection fraction determined from the two-dimensional echocardiogram rose after 1 week from 20 +/- 10 to 27 +/- 12% (p less than .05), but decreased again after 3 months (23 +/- 11%) and 6 months (20 +/- 10%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic beta-Agonists↗
PubMed1984

[Transluminal angioplasty--unstable angina, fresh infarct].

Transluminal coronary angioplasty is successfully used in stable and unstable angina. Out of 107 patients admitted with unstable angina 28% were treated medically, 24% operatively and 48% by angioplasty. In a total of 116 patients the stenosis diameter was enlarged from 75.0 +/- 11.0% obstruction to 25.1 +/- 16.4% (improvement 49.9 +/- 16.5%) without differences between concentric and eccentric or right and left coronary stenosis. In 11 out of 22 patients with total coronary occlusion of recent origin the vessel was reopened by the balloon and enlarged to a resting stenosis of 22.3 +/- 16.4%. There were no differences in the success- and the complication rate between stable and unstable angina. After successful thrombolysis residual stenoses greater than 50% are dilated during the same session. In a randomized prospective study 51 patients were dilated immediately (group I) and 48 patients (group II) treated conservatively. In group I the reinfarction- and the cardiac death-rate was two patients compared to seven patients in group II. After four weeks there was one reocclusion (3%) compared to five (17%) and a residual stenosis of 31.9 +/- 24.4% versus 78.0 +/- 15.2%. Angioplasty can be used with good results and a low complication rate in unstable angina and following successful thrombolysis.

Aged↗
PubMed1984

[Echocardiographic monitoring of acute myocardial infarct following intracoronary streptolysis treatment].

Two-dimensional echocardiography is helpful in the detection of wall motion abnormalities and in the evaluation of time courses of regional function due to interventions. Of 301 patients with acute myocardial infarction treated with selective intracoronary infusion of streptokinase, 229 (76%) revealed a totally occluded infarct related vessel at the first angiography. In 64 patients a two-dimensional apical long-axis view of good technical quality could be obtained after admission, on the 1st, 2nd and 3rd day and again in the 4th to 6th week and the 9th to 14th month after the acute intervention. The collective was divided into two subgroups according to the different time interval between the beginning of symptoms of infarction and the reopening of the occluded vessel. 35 patients had a total time of occlusion of less than 4 hours (group A), while in 29 others this time exceeded 4 hours or thrombolysis was unsuccessful (group B). Using a computer system, the center of gravity of the end-systolic frame of the left ventricle was used as an inner fix point. 10 end-systolic and end-diastolic area segments were constructed. Regional wall motion was determined as a percentual change of the enclosed area, normalized to the end-diastolic area (% delta F). The ejection fraction was calculated using a disc method. In group A the ejection fraction increased from initially 46 +/- 9% to 51 +/- 8%, 52 +/- 8% (p less than 0.05) and 53 +/- 8% (p less than 0.01) on the 1st, 2nd and 3rd day, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac Output↗
PubMed1983

[Emergency diagnosis of acute aortic insufficiency using one- and two-dimensional echocardiography].

Acute aortic valve insufficiency generally leads to an emergency situation followed by surgery. Using echocardiography pathological findings of the aortic valve or the ascending aorta leading to acute aortic insufficiency could be differentiated exactly and rapidly in 12 out of 13 cases. Dissecting aneurysms of the aorta and bacterial endocarditis were the most frequent causes (50 and 43%). Our results showed clear-cut superiority of combined use of one- and two-dimensional echocardiography to M-mode techniques. Both methods complement each other with their advantages and disadvantages. With their help recognition of causes of aortic insufficiency is possible more rapidly, safer and with a higher sensitivity than with the M-mode method alone. Invasive diagnostics may thus become unnecessary in the appropriate cases.

Adult↗
PubMed1983

Percutaneous transluminal coronary angioplasty in patients with stable and unstable angina pectoris: analysis of early and late results.

Percutaneous transluminal coronary angioplasty (PTCA) was performed in 50 patients with stable and in 50 patients with unstable angina pectoris, each patient showing an isolated stenosis of more than 80% of the cross-sectional area of a single coronary artery. The technical success rate was 66% in the stable groups (26 of 37 patients [70%] with left anterior descending artery [LAD], 7 of 12 patients [58%] with right coronary artery [RCA]) and 74% in the unstable group (27 of 34 patients [79%] with LAD, 10 of 15 patients [67%] with (RCA). The increase in stenotic area in the unstable group exceeding that in the stable group for LAD stenoses (41.5 +/- 15.1% vs 32.3 +/- 14.5%, p less than 0.03), while in RCA stenoses the results in the stable group were better (45.1 +/- 17.6% vs 32.7 +/- 12.3%, n.s.). One acute vessel occlusion necessitating an emergency bypass operation occurred in each group (2%). The patient in the stable group died (total mortality rate 1%). Sixty-three of the successfully treated patients were routinely restudied 6 months later. According to clinical symptoms, 23% of the stable and 36% of the unstable group were in functional classes III and IV. From the anatomical viewpoint, a restenosis (greater than 85%) was found in 17% of the stable and in 24% of the unstable group. A further spontaneous decrease (greater than 10%) of the vessel obstruction was found in 47% of the stable group and in 12% of the unstable group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

[2-dimensional echocardiography in acquired heart valve defects].

A fundamental improvement in the diagnosis of acquired valvular defects has been achieved by the introduction of two-dimensional echocardiography. For the first time, it has now become possible to visualize the underlying morphological changes direct and true to anatomy. Additional information is supplied by a detailed study of the dynamics of the affected valve. At present, limited information only can be obtained in respect of the haemodynamic severity of the defect. In the near future, however, we may expect advances also in quantitative respect, from a combination of this method with Doppler echocardiography or contrast echocardiography.

Aortic Valve Insufficiency↗
PubMed1983

[Quantification of the function of the left ventricle using 2-dimensional echocardiography].

Left ventricular volumes and the ejection fraction can be determined by two-dimensional echocardiography. Because of methodological problems, cineventriculographic normal values can not be transferred to two-dimensional echocardiography. Therefore, normal values for two-dimensional echocardiographically determined left ventricular volumes and the ejection fraction were established in 55 normal controls. Basing on these volumes, the sensitivity and specificity of two-dimensional echocardiography for detection of impaired left ventricular function was analysed and compared with results from cineventriculography. Sensitivity for detection of a reduced ejection fraction was 84%, specificity 89% and predictive accuracy 98%. Thus, two-dimensional echocardiography can be used as a screening method for analysing left ventricular function. Analysis of beat-to-beat variation revealed that for two-dimensional echocardiography 3 consecutive beats should be analysed because evaluation of 5 instead of 3 beats increased reliability only by less than 1%. It was necessary to analyse the day-to-day variations. To separate a random error from a non-random error for an individual change, an absolute change of volumes of more than 10-12% and of ejection fraction of more than 10% had to be observed. Group changes can of course be smaller and yet significant. Intraobserver variation was not significant and below 5%. However, interobserver variability must be considered. This depends on observer experience. For a 4-chamber view no significant variability was observed, but for the RAO-equivalent view the observer variation was significant for end-diastolic and end-systolic volume. For the ejection fraction no significant difference was found. Two-dimensional echocardiography can be used for pharmacodynamic studies if percentage changes instead of absolute changes are listed.

Cardiac Output↗
PubMed1983

[Gated blood pool scanning in the diagnosis of coronary disease. A prospective study to compare cineventriculography and 2-dimensional echocardiography].

38 patients with clinically suspected coronary artery disease were studied by contrast ventriculography, 2-dimensional echocardiography and multiple gated blood pool imaging (MUGA) without stress. The results were compared with each other and with the final diagnosis confirmed by coronary angiography. The left ventricular ejection fraction is evaluated nearly identically and with sufficient accuracy by both non-invasive methods, local motion abnormalities are on the other hand diagnosed in the best way by MUGA imaging in our own cases.

Adult↗
PubMed1983

Echoventriculography -- a simultaneous analysis of two-dimensional echocardiography and cineventriculography.

Two-dimensional echocardiography underestimates left ventricular volume compared with cineventriculography. To exclude the influence of difference in heart rate, blood pressure, respiration phases and any effect of the contrast material on left ventricular function, simultaneous studies of two-dimensional echocardiography and cineventriculography-echoventriculography were performed in 46 patients. Apical two-dimensional echocardiograms in the right anterior oblique (RAO) equivalent view were recorded before and during cineventriculography in the 30 degrees RAO projection. End-diastolic and end-systolic volumes (EDV and ESV) were calculated using a disc method with a semiautomatic computer system. The echo transducer position relative to the left ventricular apex and long axis was analyzed. For EDV determined by two-dimensional echocardiography and cineventriculography, the linear regression equation was y = 0.659x + 0.8, SEE = +/- 26.2 ml, r = 0.907. For ESV, the regression equation was y = 0.571x + 17.8, r = 0.938, SEE = +/- 18.6 ml, and for ejection fraction (EF) it was y = 0.606x + 13.0, r = 0.803, SEE = +/- 9.1%. Injection of contrast material resulted in only a small increase of stroke volume, caused by an increase of EDV as analyzed by echoventriculography. In all but two patients, the transducer position was found to be anterior and superior to the left ventricular anatomic apex, as evaluated by filming the echo transducer position during cineventriculography in 46 patients in the 30 degrees RAO projection and in 15 patients consecutively in the 60 degrees left anterior oblique and 30-40 degrees cranial projections. Thus, tangential cuts of the ventricle resulted in underestimation of diameters, long axis and ventricular volumes. These methodologic problems are exacerbated by slice-thickness artifacts. Furthermore, different outlining of left ventricular contour -- outer border of ventricular trabeculae for cine ventriculography and inner border for two-dimensional echocardiography -- seemed to result in underestimation of volume by echocardiography.

Adult↗
PubMed1983

Percutaneous transluminal coronary angioplasty in patients with unstable angina.

A comparison of clinical data has shown that percutaneous transluminal coronary angioplasty can be performed with equally good results in unstable and stable angina pectoris. Transluminal coronary angioplasty and coronary bypass surgery do not alter the natural progression of coronary atherosclerosis, but coronary angioplasty provides a real chance at least to postpone bypass graft surgery if not to provide lasting relief of angina.

Angina Pectoris↗
PubMed1983

Improved ischemic tolerance during percutaneous transluminal coronary angioplasty by intracoronary injection of nitroglycerin.

Intracoronary injection of nitroglycerin increases ischemic tolerance in 70% of patients with unstable angina during PTCA, thus delaying development of angina pectoris and/or ventricular arrhythmias. Intracoronary injection of nitroglycerin thus seems to be a suitable way of prolonging dilation time in PTCA, an important factor of success rate. Combination with calcium-antagonists may be more effective than injection of nitroglycerin alone.

Adult↗
PubMed1983

Emergency treatment of hypertensive crisis with sublingual nifedipine.

Sublingual nifedipine 20 mg as an emergency treatment for severe hypertension or hypertensive crisis in 30 patients gave an effective and gradual reduction in blood pressure. Side effects were rare and not severe. The heart rate remained fairly stable or sometimes even decreased. Thus, sublingual nifedipine may now be considered a reasonable first choice in the treatment of severe hypertension or hypertensive crisis.

Administration, Oral↗
PubMed1983

Myocardial imaging and metabolic studies with [17-123I]iodoheptadecanoic acid in patients with idiopathic congestive cardiomyopathy.

In twenty patients with primary congestive cardiomyopathy (COCM) the patterns of accumulation and washout of the fatty acid analogue [17-123I]iodoheptadecanoic acid (I-123 HA) were studied. In contrast to patients with ischemic heart disease, where reduced I-123 HA accumulation was correlated with stenosis of the main coronary arteries, thus usually involving larger wall segments, the patients with COCM concentrated I-123 HA heterogeneously in small spotty segments throughout the entire left-ventricular myocardium. The regional washout half-times varied between 15.1 and 116.2 min. It seems that in patients with severe COCM the elimination half-times are more prolonged than in early stages of the disease. There was no correlation between the regional uptake and the elimination half-times. Sequential myocardial imaging with I-123 HA appears useful for noninvasively diagnosis of COCM.

Cardiomyopathies↗