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Biomedical subjects

R Erbel

Publications and source records attributed to R Erbel.

At least 109 records · Page 6Linked to original sources
PubMed2001

Diagnosis of culture-negative endocarditis: the role of the Duke criteria and the impact of transesophageal echocardiography.

BACKGROUND: The Duke criteria have been shown to be more sensitive than the von Reyn criteria in the diagnosis of culture-positive endocarditis but to date have not been fully validated for culture-negative endocarditis (CNE). The aim of this study was (1) to compare the diagnostic accuracy of the Duke criteria versus clinical judgment and the von Reyn criteria in CNE and (2) to assess the diagnostic impact of transesophageal echocardiography (TEE) on the Duke criteria in CNE. METHODS: The study group consisted of 49 patients with suspected CNE in whom the presence (n = 32) or absence (n = 17) of endocarditis was confirmed by surgery, autopsy, or both. All patients underwent transthoracic echocardiography (TTE) and TEE. They were classified into a Duke category initially with TTE data only, and then the Duke categories were reevaluated with the additional TEE data. RESULTS: The Duke criteria demonstrated a significantly higher sensitivity (72%) than the von Reyn criteria (28%; P =.0008) and a higher specificity (100%) than clinical judgment (76%; P =.02). No major differences were noted between sensitivities of the Duke criteria and clinical judgement. TEE significantly augmented the capacity to diagnose CNE by Duke criteria versus TTE (P <.05). CONCLUSIONS: The Duke criteria are of high diagnostic validity for the conduction of clinical studies on CNE. They have the potential to affect clinical decision-making, based on the higher specificity versus clinical judgment. TEE appears to be crucial for the diagnosis of CNE when the Duke criteria are applied. The diagnostic differentiation between CNE, sclerotic valve degeneration, and nonbacterial thrombotic endocarditis remains a challenge.

Adult↗
PubMed2001

Increased heterogeneity of coronary perfusion in patients with early coronary atherosclerosis.

BACKGROUND: In patients with typical angina but angiographically normal coronary arteries, abnormal vasomotor function is assumed to be a major underlying cause. However, data on this issue are conflicting, and recent studies suggest that fluid dynamic abnormalities exist in these patients. The aim of the study was to evaluate whether early stages of atherosclerosis are characterized by alterations of baseline coronary hemodynamics and endothelium-independent vasomotion. Besides established intracoronary Doppler parameters, heterogeneity of perfusion was assessed and related to early signs of atherosclerosis as determined by electron-beam computed tomography (EBCT). METHODS: In 59 patients with typical angina and angiographically normal or near-normal coronary arteries, intracoronary Doppler measurements were performed in all 3 major coronary arteries. Baseline average peak velocity (bAPV) and hyperemic average peak velocity (hAPV) in response to intracoronary injection of adenosine were measured, and coronary flow velocity reserve (CFVR) was calculated. Heterogeneity was assessed as variability of bAPV, hAPV, and CFVR and was calculated as (STD/MEAN). 100. Doppler data were analyzed according to tertiles of the EBCT-derived Agatston calcium score (ie, score 0-1 [lowest tertile], 2-28 [medium tertile], and >28 [highest tertile]). RESULTS: The mean EBCT-derived Agatston calcium score was 49 +/- 107. No coronary calcium was observed in 17 (29%) patients. The mean values of bAPV, hAPV, and CFVR were not different between the calcium score tertiles. However, patients in the highest tertile had a significantly increased variability index of bAPV (29.6% +/- 11.6%) compared with patients in the lowest tertile (13.4% +/- 7.3%, P <.0001). Variability of CFVR was also increased in these patients (15.5% +/- 11.7% vs 10.5% +/- 4.0%, P =.03). CONCLUSION: These results indicate that early stages of atherosclerosis are characterized by microvascular abnormalities that do not uniformly affect the myocardium but are heterogeneous. The high variability of baseline coronary flow velocity with increasing coronary calcium suggests that in patients with early stages of atherosclerosis fluid dynamic effects may play a crucial role even in the absence of angiographically appreciable epicardial stenoses.

Adenosine↗
PubMed2001

Rapid progression of bacterial aortitis to an ascending aortic mycotic aneurysm documented by transesophageal echocardiography.

A case of bacterial aortitis of the ascending aorta caused by Staphylococcus aureus progressed to an aortic mycotic aneurysm. Transesophageal echocardiography was the diagnostic approach of choice. The different stages of the disease from the initial aortic wall infection to formation of an abscess that communicated with the aortic lumen were documented by transesophageal echocardiography.

Aneurysm, Infected↗
PubMed2001

eNOS 894T allele and coronary blood flow at rest and during adenosine-induced hyperemia.

The 894T allele of a G894T polymorphism in the endothelial nitric oxide synthase (eNOS) gene is associated with decreased eNOS activity, cleavage of the protein, and endothelial dysfunction. The present study evaluated the association with coronary blood flow (CBF) at rest and during adenosine (ADO)-induced hyperemia. CBF was determined by Doppler flow wire and angiography in 97 left anterior descending arteries of individuals without coronary artery disease. At rest, average peak velocity (APV) was lower and coronary vascular resistance (CVR) was higher in homozygous carriers of the 894T allele than in heterozygotes and individuals without the 894T allele. CBF tended to be lower in eNOS 894T allele carriers. During ADO-induced hyperemia (18 microg ic), APV, CVR, and CBF were not statistically different between the genotypes. The reduced APV at rest in conjunction with an increased CVR indicates a vasomotor dysfunction related to an increased microvascular resting tone in eNOS 894T allele carriers.

Adenosine↗
PubMed2001

Natural history and topographic pattern of progression of coronary calcification in symptomatic patients: An electron-beam CT study.

Electron-beam CT may assess the progression of coronary atherosclerosis by visualizing changes in calcification. The present investigation analyzes (1) the rate of progression of calcification in symptomatic patients, (2) the topographic pattern, and (3) the influence of baseline plaque burden and risk factors. Progression of calcification during a mean (median) interval of 18 (15) months was measured in 102 symptomatic outpatients (aged 59+/-9 years, 80% male) with calcification. In 4 patient groups with a baseline total score (Agatston criteria) of 1 to 30, >30 to 100, >100 to 400, and >400, the median was 3.1, 26.1, 58.9, and 109.7, respectively, for absolute annual progression of the score (P<0.05) and 57%, 49%, 32%, and 15%, respectively, for relative progression (P<0.05). On the coronary segmental level, changes were largely restricted to typical predilection sites of coronary atherosclerosis. The presence of angiographically defined coronary narrowing influenced absolute, but not relative, progression. Of the risk factors, only low density lipoprotein cholesterol levels showed a trend, although not significant, for predicting progression. These data indicate that baseline plaque burden determines the rate of progression of calcification. This appears to be a coronary systemic process, reflecting the natural history of coronary atherosclerosis.

Aged↗
PubMed2000

Usefulness of topography of coronary calcium by electron-beam computed tomography in predicting the natural history of coronary atherosclerosis.

Electron-beam computed tomography (EBCT) allows for accurate noninvasive detection and quantification of coronary calcium that is representative of underlying atherosclerotic disease. The present study quantitatively analyzes the topography and establishes the natural history of coronary calcium in patients with variable degrees of coronary atherosclerosis. EBCT was performed in 330 consecutive patients aged 56 +/- 12 years (70% men) with recent (<3 months) onset of signs or symptoms of coronary artery disease (CAD) or who were evaluated because of a presumed high risk. Total calcium scores, computed by the Agatston method, were positive in 269 patients (82%) (mean age 58 +/- 11 years, 73% men). These patients were classified into 4 groups, with total calcium scores ranging between 1 and 30, >30 and 100, >100 and 400, and >400, respectively. The presence and amount of calcium was additionally assessed in 10 major segments of the coronary arterial tree, including the major coronary arteries. Of the 72 patients with calcium of only 1 of the major coronary arteries, the left anterior descending coronary artery was involved in 39 patients (54%) and the right coronary artery in 18 patients (25%). Left main stem calcium was observed in only 10 of 139 patients (7%) with 1- or 2-vessel calcium and in 17 of 77 patients (23%) with 3-vessel calcium. Calcium was consistent most frequently in the proximal left anterior descending coronary artery, followed by the proximal left circumflex and right coronary artery segments. A significant decrease of frequency and amount of calcium from the proximal to distal segments was observed in the left coronary system but not in the right coronary artery, where the distribution was more even. With increasing total calcium scores, segmental scores in the more distal segments were enhanced, but the increase was most pronounced in the proximal segments and particularly in the proximal left anterior descending coronary artery. EBCT-derived coronary calcium shows an axial distribution that appears comparable to that of atherosclerotic lesions observed in pathologic and angiographic studies, highlighting the potential role of EBCT for studying the natural history of CAD.

Aged↗
PubMed2000

[Heart failure as a cardiac symptom of sarcoidosis. Successful treatment of heart failure with steroids, digitalis and an angiotensin-1-receptor antagonist in sarcoidosis].

BACKGROUND: Sarcoidosis is a multisystemic disorder that may involve every organ. A symptomatic manifestation of the myocardium is possible, in these cases arrhythmias are the most common symptoms. CASE REPORT: This case report presents a 26-year-old female with the recurrence of Boeck's sarcoid. Fever, chill and a severe reduction in stress tolerance were the first symptoms. At the time of admission she complained of Grade III dyspnea according to the NYHA classification. The echocardiogram showed a severe impairment of the global and left ventricular function. The left ventricular ejection fraction was reduced to 30% and the Tei index was elevated to 1.0. A specimen taken from a mediastinal tumor confirmed the hypothesis of the recurrence of the sarcoidosis. Myocardial perfusion scintigraphy showed typical lesions for myocardial sarcoidosis. There were signs of an old anteroseptal infarction in the resting ECG without evidence of myocardial ischemia during a stress test. Repeated Holter-ECGs were without signs of severe arrhythmias whereas ventricular late potentials were positive. After the combined therapy with steroids, digitalis and an angiotensin-1 receptor antagonist, mediastinal mass and Tei index were reduced and the ejection fraction moved to 56%. Dyspnoea was classified with Grade II according to the NYHA classification. CONCLUSION: Treatment of asymptomatic sarcoidosis is still controversial, whereas the treatment of life-threatening sarcoidosis, eye involvement or severe hypercalcemia is accepted. This case report presents the successful treatment of severe heart failure with prednisone, glycosides and an angiotensin-1 receptor antagonist. With this combined therapy an improvement of subjective and objective parameters was possible.

Adult↗
PubMed2000

Ten-year outcome after coronary angioplasty in patients with single-vessel coronary artery disease and comparison with the results of the Coronary Artery Surgery Study (CASS).

The 10-year results of randomized trials comparing percutaneous transluminal coronary angioplasty (PTCA) in patients with single-vessel coronary artery disease (CAD) with coronary artery bypass grafting (CABG) and medical treatment are not available yet. The aim of this evaluation was to compare our 10-year follow-up results after PTCA in patients with single-vessel CAD with the 10-year follow-up results after CABG and medical treatment in the Coronary Artery Surgery Study (CASS) trial. We evaluated the clinical outcome of 509 patients with single-vessel CAD 10 years after coronary angioplasty. The data were compared with the results of 214 patients with single-vessel CAD after CABG or medical treatment from the CASS trial. End points were defined as death and myocardial infarction. Statistical evaluation was performed by life-table analysis and 2-sided Fisher's exact test. The rate of survival was 86% 10 years after PTCA compared with 85% after CABG and 82% after medical treatment in patients from the CASS trial (p = NS). Survival free from myocardial infarction was 77% after coronary angioplasty, 70% after CABG, and 72% after medical treatment (p = NS). Thus, in patients with single-vessel CAD, infarct-free survival 10 years after coronary angioplasty compared favorably with the results after bypass surgery or medical treatment from the CASS trial.

Adrenergic beta-Antagonists↗
PubMed2000

Potential embolization by atherosclerotic debris dislodged from aortic wall during cardiac catheterization:: histological and clinical findings in 7,621 patients.

Embolic events during cardiac catheterization have been attributed to atherosclerotic aortic debris dislodged by catheter manipulation. We evaluated the frequency and the histologic morphology of atherothrombotic material retrieved during placement of coronary catheters in patients undergoing diagnostic or interventional cardiac procedures. Over a 4-year period, macroscopically visible aortic debris from coronary catheters, if present after advancement to the ascending aorta, was obtained for histologic examination. In 41 of 7,621 patients (0.54%), visible atherothrombotic material was present in the backflow of catheters. Debris occurred most frequently with 8 Fr guiding catheters (98%). Histologic examination showed foam cells, cholesterol crystals, and amorphic lipoid substance as markers of atheromatous material from atherosclerotic plaques in 38/41 patients (93%) with former plaque hemorrhage in 55% of them. In three patients, fresh thrombus material was observed (7%). None of these patients showed in-hospital ischemic complications. Although visible atheromatous material is a rare phenomenon in cardiac catheterization, an increased risk of scraping debris is associated with large-lumen guiding catheters. In order to avoid vascular embolization, the use of smaller guiding catheters and sufficient free backflow of catheters after advancement are recommended.

Adult↗
PubMed2000

Nonsurgical retrieval of embolized coronary stents.

Embolization of coronary stents before deployment is a rare but challenging complication of coronary stenting. Different methods for nonsurgical stent retrieval have been suggested. There were 20 cases (0.90%) of intracoronary stent embolization among 2,211 patients who underwent implantation of 4,066 stents. Twelve of 1,147 manually crimped stents (1.04%) and eight of 2,919 premounted stents were lost (0.27%, P < 0.01) during retraction of the delivery system, because the target lesion could not be either reached or crossed. Percutaneous retrieval was successfully carried out in 10 of 14 patients (71%) in whom retrieval was attempted. In 10 patients, stent retrieval was tried with 1.5-mm low-profile angioplasty balloon catheters (success in 7/10) and in seven cases with myocardial biopsy forceps or a gooseneck snare (success in 3/7). Three patients (15%) underwent urgent coronary artery bypass surgery after failed percutaneous retrieval, but their outcomes were fatal. In two patients, stents were compressed against the vessel wall by another stent, without compromising coronary blood flow. In two patients, a stent was lost to the periphery without clinical side effects; treatment was conservative in these cases. Embolization of stents before deployment is a rare but serious complication of coronary stenting, with hazardous potential for the patient. Manual mounting of stents is associated with a significantly higher risk of stent embolization. Stent retrieval from the coronary circulation with low-profile angioplasty balloon catheters is a readily available and technically familiar approach that has a relatively high success rate.

Aged↗
PubMed2000

Percutaneous transluminal laser guide wire recanalization of chronic subclavian artery occlusion in symptomatic coronary-subclavian steal syndrome.

Treatment of subclavian artery stenosis by percutaneous balloon angioplasty and adjunctive stent placement was shown to be safe and efficacious, but it may be limited in tight stenoses and long occlusions. We describe the case of a patient who experienced progressive angina pectoris associated with signs of cerebrovertebral insufficiency 9 yr after bypass surgery, including left internal mammary artery (LIMA) grafting to the left anterior descending coronary artery. Angiography showed reversed flow through the LIMA graft into the subclavian artery and a 4-cm occlusion beginning at the origin of the left subclavian artery, representing a rare coronary-subclavian steal syndrome. After a conventional approach failed, recanalization was performed successfully using laser guide wire angioplasty with adjunctive stent placement in a combined radial and femoral approach.

Angioplasty, Balloon, Laser-Assisted↗