Biomedical subjects

U Solzbach

Publications and source records attributed to U Solzbach.

At least 19 recordsLinked to original sources

PubMed2003

Regional myocardial perfusion defects during exercise, as assessed by three dimensional integration of morphology and function, in relation to abnormal endothelium dependent vasoreactivity of the coronary microcirculation.

OBJECTIVE: To test the hypothesis that scintigraphic regional myocardial perfusion defects during exercise in patients with normal coronary angiography may be related to abnormal endothelium dependent vasoreactivity of the corresponding myocardial territory in response to cold pressor testing. METHODS: 38 patients were classified into two groups according to the presence or absence of exercise induced scintigraphic myocardial perfusion defects. A cold pressor test was done in all patients during routine coronary angiography, followed by dynamic positron emission tomography to establish coronary blood flow mediated vasoreactivity of the epicardial coronary artery and the myocardial territories supplied by the left anterior descending, left circumflex, and right coronary arteries. RESULTS: 28 patients had regional myocardial perfusion defects while 10 had normal scintigraphic imaging. The three dimensional scintigraphic fusion image revealed 49 regional myocardial perfusion defects with a mean (SD) reversibility of the original stress defect of 20 (3)%. In patients with exercise induced regional myocardial perfusion defects, the responses of epicardial luminal area and regional myocardial blood flow (RMBF) to cold pressor testing were reduced compared with patients with normal perfusion imaging (epicardial luminal area: 5.2 (1.2) to 4.2 (0.86) mm2 v 4.7 (0.5) to 5.8 (0.5) mm2; RMBF: 0.75 (0.16) to 0.78 (0.20) ml/g/min v 0.75 (0.15) to 1.38 (0.26) ml/g/min; p < or = 0.03, respectively). In patients with regional abnormal scintigraphic perfusion, the corresponding RMBF response to cold pressor testing was more severely impaired than the mean myocardial blood flow in the remaining two vascular territories, but the difference was not significant (0.75 (0.16) to 0.78 (0.20) ml/g/min v 0.75 (0.10) to 0.87 (0.12) ml/g/min; NS). The endothelium independent increase in RMBF induced by glyceryl trinitrate did not differ between patients with exercise induced myocardial perfusion defects and those with normal perfusion images (0.75 (0.16) to 0.94 (0.09) ml/g/min v 0.75 (0.15) to 0.94 (0.09) ml/g/min; NS). There was a highly significant correlation between the endothelium dependent responses of RMBF to cold pressor testing and the severity of exercise induced scintigraphic regional myocardial perfusion defects (r = 0.95, p = 0.001). CONCLUSIONS: Exercise induced scintigraphic regional myocardial perfusion defects in patients with angina but normal coronary angiography may be related to abnormal endothelium dependent vasoreactivity of the corresponding myocardial territory.

Cold Temperature↗

PubMed2001

[Quality project in invasive/interventional cardiology].

With installing a new catheterization laboratory, a quality project with focus on indications for invasive/interventional procedures was implemented. Health insurance companies as budget holders were involved in the project, external control is accomplished by their medical service (MDK). The focus on indications is new, since most approaches in this area deal with structure and/or process quality. The actual concept of this quality project makes medical performance transparent with regard to adequate indication as the first and important step to excellent quality of results. Further, the concept contains a rational approach to the controversial discussion about the increasing frequency of catheter-based coronary interventions.

Angioplasty, Balloon, Coronary↗

PubMed2000

[New developments in diagnosis of coronary heart disease--3D fusion image].

The interpretation of three-dimensional (3D) structures of the coronary tree and the myocardium by a clinician demands a subjective visual integration of two-dimensional (2D) images of cardiac diagnostic procedures like coronary angiography and myocardial scintigraphy. Although in the conventional analysis of 2D display scintigraphic myocardial perfusion segments are arbitrarily assigned to three major coronary artery systems, the standard myocardial perfusion distribution territories correspond with the individual pathologic-anatomic coronary tree in only 50-60% of the patients. Hence, the mental integration of both 2D images of coronary angiography and myocardial scintigraphy does not necessarily allow an accurate assignment of particular myocardial perfusion regions to the corresponding vessels. For an objective assignment of each vessel segment of the coronary tree to the corresponding myocardial regions, we have developed a 3D "fusion image" technique and applied it to patients with coronary artery disease. Cause-and-effect relationships may be more obvious with 3D data fusion and may enable an easier comparison of anatomy and physiology. Preliminary results demonstrate that our newly developed 3D fusion image is useful for accurate assignment of coronary vessel segments to the corresponding myocardial perfusion regions and suggest that it may allow the clinician a comprehensive and accurate assessment of the patient's myocardial status.

Coronary Angiography↗

PubMed2000

3D assessment of myocardial perfusion parameter combined with 3D reconstructed coronary artery tree from digital coronary angiograms.

In patients with coronary artery disease coronary angiography plays an important role in the clinical decision-making process. However, it has been recognized that no simple relation exists between the visually or quantitatively evaluated severity of coronary artery stenoses and its effects on regional myocardial perfusion. This paper describes for the first time the development and application of a 3D technique that visualizes and quantifies regional myocardial perfusion parameters from biplane coronary angiograms by using the impulse response analysis technique. The 3D reconstructed coronary tree is automatically superimposed on the 3D perfusion image to generate and visualize an 'integrated' 3D image. The preliminary results in patients with critical coronary artery stenoses indicate that our combined 3D fusion image provides flow information from the major coronary arteries. This 3D fusion image may provide useful information in the management of patients with coronary artery disease.

Aged↗

PubMed2000

Effect of ascorbic acid on endothelial dysfunction of epicardial coronary arteries in chronic smokers assessed by cold pressor testing.

BACKGROUND: In chronic smokers there is evidence for increased formation of oxygen-derived free radicals within the vessel wall impairing endothelial function. It has been suggested that the inactivation of endothelium-derived nitric oxide by oxygen free radicals contributes to endothelial dysfunction. Hence, we tested the hypothesis that in chronic smokers the antioxidant ascorbic acid could improve abnormal endothelial function of epicardial coronary arteries. METHODS AND RESULTS: Thirty-one patients (mean age 57 +/- 9 years) referred for routine diagnostic catheterization for evaluation of chest pain and without angiographically significant coronary artery stenoses were randomly assigned to one of the study groups to assess vasomotor response of epicardial coronary arteries due to cold pressor testing (CPT) before and after intravenous infusion of 3 g of ascorbic acid or 100 ml x 0.9% saline infusion. In 6 controls (mean age 55 +/- 3 years) CPT led to a similar increase in luminal area before and after ascorbic acid administration (26.5 +/- 15.0 vs. 28.4 +/- 17.7%, p = NS). In 15 chronic smokers (mean age 55 +/- 9 years), CPT induced a decrease in the luminal area of -18.5 +/- 6.3%. This flow-dependent vasoconstriction was significantly reversed to 7.7 +/- 6.2% (p < or = 0.03) vasodilation after intravenous ascorbic acid administration. In 10 chronic smokers (mean age 57 +/- 11 years) saline infusion (placebo) did not have a significant effect on CPT-induced vasoconstriction (-12.7 +/- 5.1 vs. -13.1 +/- 5.1%, p = NS). The CPT-induced increase in luminal area in chronic smokers after ascorbic acid infusion was significant compared to controls and placebo (each p < or = 0.05). Our assessment of endothelium-independent responses to nitroglycerin revealed no significant differences between the single study groups (p = NS). CONCLUSION: In chronic smokers acute intravenous administration of ascorbic acid significantly improves CPT-induced coronary endothelium-dependent dysfunction. According to the current understanding, this effect is due to improved cellular redox imbalance and prevention of nitric oxide inactivation in the endothelium and subendothelial space.

Aged↗

PubMed1999

Fusion imaging: combined visualization of 3D reconstructed coronary artery tree and 3D myocardial scintigraphic image in coronary artery disease.

BACKGROUND: In patients with coronary artery disease, coronary angiography is performed for assessment of epicardial coronary artery stenoses. In addition, myocardial scintigraphy is commonly used to evaluate regional myocardial perfusion. These two-dimensional (2D) imaging modalities are typically reviewed through a subjective, visual observation by a physician. Even though on the analysis of 2D display scintigraphic myocardial perfusion segments are arbitrarily assigned to three major coronary artery systems, the standard myocardial distribution territories of the coronary tree correspond only in 50-60% of patients. On the other hand, the mental integration of both 2D images of coronary angiography and myocardial scintigraphy does not allow an accurate assignment of particular myocardial perfusion regions to the corresponding vessels. To achieve an objective assignment of each vessel segment of the coronary artery tree to the corresponding myocardial regions, we have developed a 3D 'fusion image' technique and applied it to patients with coronary artery disease. The morphological data (coronary angiography) and perfusion data (myocardial scintigraphy) are displayed in a 3D format, and these two 3D data sets are merged into one 3D image. RESULTS: Seventy-eight patients with coronary artery disease were studied with this new 3D fusion technique. Of 162 significant coronary lesions, 120 (74%) showed good coincidence with regional myocardial perfusion abnormality on 3D fusion image. No regional myocardial perfusion abnormality was found in 44 (26%) lesions. Furthermore, the 3D fusion image revealed 24 ischemic myocardial regions that could not be related to angiographically significant coronary artery lesions. CONCLUSION: The results of this study demonstrate that our newly developed 3D fusion technique is useful for an accurate assignment of coronary vessel segments to the corresponding myocardial perfusion regions, and suggest that it may be helpful to improve the interpretative and decision-making process in the treatment of patients with coronary artery disease.

Aged↗

PubMed1999

Vitamin C improves endothelial function of epicardial coronary arteries in patients with hypercholesterolaemia or essential hypertension--assessed by cold pressor testing.

AIMS: There is evidence that formation of free radicals increases in patients with hypertension or hypercholesterolaemia, which may contribute to endothelial dysfunction of epicardial coronary arteries due to inactivation of the vasodilator NO. The present study was designed to test whether the abnormal constriction of epicardial coronary arteries due to sympathetic stimulation by the cold pressor test in patients with essential hypertension or hypercholesterolaemia could be reversed by administration of the antioxidant vitamin C. METHODS AND RESULTS: In 28 patients without relevant coronary artery stenosis the cold pressor test was performed before and after a 3 g infusion of vitamin C. In five normal controls the cold pressor test led to a similar increase in luminal area before and after vitamin C (3.7+/-1.3% and 1.9+/-0.8%, ns vs before vitamin C). In nine hypercholesterolaemic patients the cold pressor test led to a -14.1+/-2.8% reduction in cross-sectional area before vitamin C. This constriction was significantly improved after vitamin C to -7.6%+/-2.0, P=0.027 vs before vitamin C. In nine hypertensive patients, the cold pressor test led to a -17.1+/-3.2% decrease in cross-sectional area before vitamin C, which was improved to -7.1+/-3.1 after vitamin C, P=0.004 vs before vitamin C. This increase in luminal area was significant in each group in comparison with normal controls (each P<0.05). Administration of saline (placebo group, five patients) had no significant effect on cold pressor test-induced constriction (-6.9+/-3.9% before and -6. 8+/-3.7% after saline). CONCLUSION: The antioxidant vitamin C reverses cold pressor test-induced vasoconstriction of epicardial coronary arteries in patients with hypertension or hypercholesterolaemia. Our data suggest that enhanced oxidative stress contributes to impaired endothelial function in this patient population.

Aged↗

PubMed1998

[Bypass perforation by stent implantation: complication management. A case report].

We describe a case-report on an perforation of an aorto-coronary venous bypass graft, a complication induced by a stent-implantation. Perforations of coronary arteries are rare, however, for interventional cardiologists well-known complications. This case report is of special interest (1) because the perforation did not occur in a coronary artery but rather in an eight year old venous bypass graft and (2) because the perforation was induced by a stent-implantation. In addition, this case report describes in great detail the management of vessel perforation: several invasive methods contributed to minimize pericardial effusion and to stabilize the patient until surgical revision could be performed.

Aged↗

PubMed1997

Vitamin C improves endothelial dysfunction of epicardial coronary arteries in hypertensive patients.

BACKGROUND: There is evidence for increased formation of free radicals in patients with hypertension, raising the possibility that NO is inactivated by free radicals, which impairs coronary endothelial function. Therefore, we tested the hypothesis that the antioxidant vitamin C could improve abnormal endothelial function of coronary arteries in patients with hypertension. METHODS AND RESULTS: In 22 hypertensive patients without relevant coronary artery stenoses, endothelium-dependent vascular responses of the left anterior descending coronary artery (LAD) to acetylcholine (0.01, 0.1, and 1.0 micromol/L) were determined before and immediately after intravenous infusion of 3 g vitamin C (17 patients) or placebo (5 patients). In a subgroup of 10 patients, papaverine-induced flow-dependent vasodilation (FDD) was measured before and after vitamin C (5 patients) or placebo (5 patients) infusion. Segmental responses of the coronary artery luminal area were analyzed with quantitative coronary angiography. Before vitamin C infusion, the mean changes of LAD luminal areas at increasing doses of acetylcholine were -6.1+/-2.2%, -15.2+/-4.9%, and -33.9+/-8.1% (negative numbers symbolize vasoconstriction) and during FDD, 5.4+/-1.0%. The vasoconstrictor response during acetylcholine was reduced and FDD was augmented by vitamin C. After vitamin C infusion, LAD luminal areas changed by -3.2+/-2.3%, -5.8+/-3.6%, and -10.2+/-5.6% (P<.05, acetylcholine) and 17.8+/-2.8% (P<.05, FDD). Doppler flow velocity (during baseline, acetylcholine, and FDD) was not significantly affected by vitamin C. CONCLUSIONS: Vitamin C improves the endothelium-dependent vasomotor capacity of coronary arteries in patients with hypertension and patent coronary arteries. These findings suggest that increased oxidative stress contributes to endothelial dysfunction in hypertensive patients.

Acetylcholine↗

PubMed1995

Digital angiographic impulse response analysis of myocardial perfusion: influence of heart rate and blood pressure changes on microcirculatory transit time measurement in the normal canine coronary circulation.

The study describes the effect of acute changes in aortic blood pressure and heart rate in the intact normal canine coronary circulation on digital angiographic measurements of the mean transit time of the microcirculation compartment and on direct flow meter measurement of resting and maximal hyperemic coronary blood flow. The mean transit time of the radiographic contrast material through the normal coronary circulation was calculated in 20 dogs by the impulse response analysis from serial digital coronary angiograms under systematically changed blood pressure and heart rate conditions. The mean aortic blood pressure (MAP) was controlled by the inflation of a balloon in the descending aorta (70-150 mmHg). The heart rate was altered by atrial pacing (90, 120, and 150/min). The mean transit times (T mu) of contrast material across the myocardial microcirculation which had been recently shown to correlate with coronary flow reserve (CFR) in stenosed arteries in the canine model were calculated under resting and hyperemic flow conditions from 428 selective coronary angiograms after a hand-injected contrast bolus, T mu was found to be heart rate independent. T mu-1 was linearly correlated with MAP (r = 0.7). There was no difference in T mu under resting and hyperemic flow conditions at comparable MAP. The corresponding distribution volume (V mu) of the microcirculation was calculated as the product of the mean transit time T mu and the measured coronary blood flow. Under resting flow conditions, V mu decreased with rising MAP. Furthermore, V mu increased with rising heart rate, V mu was constant during blood pressure or heart rate changes under hyperemic flow conditions. The data suggest that CFR whether by direct measurements of flow or by radiographic assessment of contrast material kinetics should be standardized with respect to hemodynamic conditions of heart rate and MAP.

Animals↗

PubMed1994

Optimum angiographic visualization of coronary segments using computer-aided 3D-reconstruction from biplane views.

Using a biplane multidirectional isocentric X-ray system, a computer-aided simulation procedure was developed to calculate the 3D structure of the coronary arteries. The algorithm uses the geometry of the biplane X-ray system and the alignments of corresponding points of the coronary arteries in two X-ray images acquired under different viewing angles. The identification of the corresponding points is greatly simplified by the calculation and display of the intersection lines of the confocal plane with the image intensifier entrances on the computer monitor. To minimize the total number of necessary corresponding points we used Bézier curves to match the courses of the coronary segments between neighboring corresponding points. The projection of the calculated 3D structure was found to be in very good agreement with the 2D course of the coronary arteries in the angiograms. The 3D structure can be viewed on the computer screen under any desired simulated projection angle within the geometrical limitation of the X-ray gantries. The user can select views on the computer monitor with orthogonal projection angles and minimal overlapping problems caused by under- and overlying structures. The method was applied in 10 cases of elective angioplasty. Previously taken diagnostic angiograms were used to reconstruct the arterial structure and to select favorable views for the forthcoming intervention.

Cineangiography↗

PubMed1993

Comparing wall motion quantification methods by numerical classification.

Quantitative left ventriculography has been studied for many years as a method for assessing left ventricular function. All currently used quantitative left ventriculography methods evaluate functional status based on different assumptions concerning the time course of contraction, shape of the ventricular silhouette, and/or fixed points of reference. Commonly, analyses are performed using only end-diastolic (ED) and end-systolic (ES) frames. However, myocardial infarction manifests itself not only in spatial parameters, e.g., area of affected myocardium, but also in temporal parameters, e.g., deviation from a synchronous contraction during systole. ED/ES comparisons omit information contained in other frames of the cardiac cycle. Therefore, each single method has a limited reliability or usefulness. The present study used several quantitative methods, fitted curvatures, correlation coefficients of the percentage of radial shortening from end diastole to end systole, and Fourier coefficients of the polar coordinates of the endocardial contour points. Features were derived from a sequence of ventriculograms of a whole cardiac cycle from patients with anterior myocardial infarction (AMI group) and without (NV group) to address three major goals: (1) Determine features derived from LV-grams that discriminate between the two patient groups and do so with the highest accuracy, "recognition rate," or lowest error rates; (2) compare the accuracy of features generated by different quantitative methods; and (3) group features generated by the different quantitative methods to achieve higher accuracy. The discriminant capabilities of several feature sets were tested on a patient sample containing 102 patients (63 patients with AMI, 39 patients with no infarction) using numerical classification. The numerical classification had a Supervised Learning design with two cardiologists assigning the patients to the two patient groups. Each quantification method showed a characteristic pattern for detecting pathologic or normal wall motion. Combining features generated by different extraction methods into one feature set improved the correct classification rates.

Algorithms↗

PubMed1989

[ACPA reaction in atypical Wegener's disease. Diagnostic test].

Clinical and biopsy findings in six patients (aged 29-64 years), suspected of having Wegener's granulomatosis, were not diagnostic. Cardinal signs were skin necroses, isolated deficits of cranial nerves, sudden amaurosis, renal failure with shunt sepsis and lung opacities suspicious of tumour. Only positive tests for anti-cytoplasmatic antibodies (ACPA) in serum made the diagnosis and led to appropriate treatment. This simple yet highly specific immunofluorescence test should be performed in every case of vasculitis of uncertain cause, even if typical clinical signs of Wegener's granulomatosis are at first absent.

Adult↗

PubMed1989

[Status of the technic of angiography procedures].

Angiocardiography continues to expand inspite of competitive non-invasive imaging techniques (echocardiography, CT, nuclear magnetic resonance). Only angiography yields images of sufficient spatial and temporal resolution as they are needed for coronary diagnostic work and interventional catheter therapy. Angiographic systems are mono- or biplane with high degree of mobility and flexibility for oblique and angulated projections. Currently available systems do not fulfill the requirements. Image resolution and contrast are today satisfactory, however, still not sufficient for interventional techniques. Only digital image processing will allow further improvement, thereby enhancing contrast and detail while reducing radiation dose (pulsed, high-contrast fluoroscopy, on-line image processing). Cine-filming seems not needed in all cases. In the future, angiocardiography will hardly be needed for study of cardiac chambers, valves or great vessels. Instead, specialized systems of extreme mobility and flexibility with high resolution and digital image processing for image improvement and documentation, radiation reduction for coronary and general arterial diagnostic and therapeutic interventions will be developed.

Angiocardiography↗

PubMed1989