Search PubMed⌕ Search

Biomedical subjects

W Rutsch

Publications and source records attributed to W Rutsch.

At least 73 records · Page 4Linked to original sources
PubMed1992

[PTCA in acute myocardial infarct: primary, immediate, delayed or elective?].

With intravenous thrombolysis mortality of acute myocardial infarction can be significantly reduced, not only in the first hours after the onset of symptoms, but also up to 24 hours. The open infarct related coronary artery is important concerning long-term clinical outcome. If thrombolysis can be administered within the first three to six hours, limitation of infarct size and preservation of left ventricular function contribute to an impressive reduction in mortality. Long-term assessments of clinical outcome have surprisingly shown that the prognosis is much more dependent upon patency of the infarct related artery than from the time to treatment. Since a correlation is suspected between the degree of residual stenosis and the clinical course, recurrence of ischemia, reinfarction, hemodynamic instability and death, and the fact that mortality is highest within the first three days after thrombolysis the emphasis of numerous investigations has been on possibilities of PTCA in the acute stage of myocardial infarction. The application of interventional techniques was tested at different times within the progression of myocardial infarction. PTCA can be applied as primary, direct therapy without thrombolysis, immediately and during intravenous thrombolysis, following successful pharmacological recanalisation, as rescue-PTCA for failed thrombolytic therapy, delayed and as a prophylactic measure up to until days after the infarction or later when accompanied by careful observation of the patient, when limited to few indications with spontaneous or stress-related angina pectoris, hemodynamic instability or predetermined angiographic criteria. Important results have been gathered by the larger studies of the last few years, TAMI, ECSG, and TIMI as well as by numerous smaller investigations, about the pathophysiology and treatment of myocardial infarction. Despite different study design, the three larger trials have come to the same conclusion regarding PTCA and rt-PA thrombolysis, early PTCA is without advantage compared to a deferred treatment; the acute results are usually worse and the clinical course more complicated. It must be mentioned however, that major problems still remain unresolved: primary or direct angioplasty, PTCA in combination with non-fibrin specific plasminogen activators, as well as rescue-PTCA after failed thrombolysis. Specially, 90 minutes after thrombolysis 23 to 44% of the coronaries are still occluded, depending on the plasminogen activator, and there is no non-invasive procedure to detect this patient-group and to advise further treatment. Due to the high mortality rate within the first three days attempts of treatment are concentrated on this time-span.(ABSTRACT TRUNCATED AT 400 WORDS)

Acute Disease↗
PubMed1991

Reasons for the lack of benefit of immediate angioplasty during recombinant tissue plasminogen activator therapy for acute myocardial infarction: a regional wall motion analysis. European Cooperative Study Group.

Regional ventricular wall motion analysis utilizing three different methods was performed on predischarge left ventriculograms from 291 of 367 patients enrolled in a randomized trial of single chain recombinant tissue-type plasminogen activator (rt-PA), aspirin and heparin with and without immediate angioplasty in patients with acute myocardial infarction. With univariate analysis, no difference in regional wall motion variables between the two treatment groups was observed. However, with individual baseline risk assessment by multivariate linear regression analysis using baseline characteristics known to be related to left ventricular function after thrombolytic therapy or outcome of coronary angioplasty, or both, an excess of high risk patients in the invasive treatment group was detected. To adjust for this unequal distribution of baseline risk, multivariate linear regression analysis was performed. No benefit of immediate coronary angioplasty was observed after adjustment. Reocclusion or reinfarction, or both, occurred more frequently in the invasive than in the noninvasive treatment group (18% versus 13%, respectively). Among patients with a patent infarct-related vessel on angiography between days 10 and 22 and without reinfarction before angiography, there was a trend toward benefit from the invasive strategy, indicating that reocclusion and reinfarction might be responsible for the lack of benefit of the invasive strategy. This implies that immediate coronary angioplasty may be beneficial in selected patients, provided that these complications can be prevented.

Angioplasty, Balloon, Coronary↗
PubMed1991

Prevention of restenosis after percutaneous transluminal coronary angioplasty with thromboxane A2-receptor blockade. A randomized, double-blind, placebo-controlled trial. Coronary Artery Restenosis Prevention on Repeated Thromboxane-Antagonism Study (CARPORT).

BACKGROUND: GR32191B is a novel thromboxane A2-receptor antagonist with potent antiagregational and antivasoconstrictive properties. We have conducted a randomized, double-blind placebo-controlled trial to study its usefulness in restenosis prevention. METHODS AND RESULTS: Patients received either GR32191B (80 mg orally before angioplasty and 80 mg/day orally for 6 months) or 250 mg i.v. aspirin before angioplasty and placebo for 6 months. Coronary angiograms before angioplasty, after angioplasty, and at 6-month follow-up were quantitatively analyzed. Angioplasty was attempted in 697 patients. For efficacy analysis, quantitative angiography at follow-up was available in 522 compliant patients (261 in each group). Baseline clinical and angiographic parameters did not differ between the two treatment groups. The mean difference in coronary diameter between postangioplasty and follow-up angiogram (primary end point) was -0.31 +/- 0.54 mm in the control group and -0.31 +/- 0.55 mm in the GR32191B group. Clinical events during 6-month follow-up, analyzed on intention-to-treat basis, were ranked according to the highest category on a scale ranging from death (control, six; GR32191B, four) to nonfatal infarction (control, 22; GR32191B, 18), bypass grafting (control, 19; GR32191B, 22) and repeat angioplasty (control, 52; GR32191B, 48). No significant difference in ranking was detected. Six months after angioplasty, 75% of patients in the GR32191B group and 72% of patients in the control group were symptom free. CONCLUSIONS: Long-term thromboxane A2-receptor blockade with GR32191B does not prevent restenosis and does not favorably influence the clinical course after angioplasty.

Angioplasty, Balloon, Coronary↗
PubMed1990

Left ventricular hyperkinesis in acute myocardial infarction and at control angiography after 1 month.

One-hundred-and-fifty-four consecutive patients were treated with intravenous and intracoronary streptokinase within 3 h of the onset of acute myocardial infarction. Left ventricular function was determined from contrast ventriculograms obtained in the acute phase and at follow-up at 28 (15-37) days in 123 patients with matched ventriculograms. Regional wall motion analysis was performed with a radial axis system and asynergy determined by comparing percentage radial shortening with findings in ten normal controls. Reperfusion was achieved in 79% of patients. However, there was no significant difference in global ejection fraction between the acute phase (60.6%) and follow-up (60.4%) ventriculograms, although a significant reduction of hypokinetic areas was seen. An increase in regional ejection fraction in anterior (+10%) and inferior (+9%) hypokinesis was counterbalanced by a reduction of incidence (-11%) of hyperkinesis and regional ejection fraction (-10%) in the contralateral wall. In patients with a patent infarct-related vessel at follow-up, no difference in global or regional parameters was found in the acute phase, but at follow-up these patients showed improved regional wall motion with an increase in global ejection fraction (1.6%, n.s.). In patients with occluded vessels at follow-up global ejection fraction decreased (-5.4%, P less than 0.05). The decrease of frequency and extent of hyperkinesis in the clinical course of acute myocardial infarction tends to counterbalance recovery of wall motion in the infarcted region, resulting in little change in global ejection fraction.

Adult↗
PubMed1988

[Normal echo-Doppler values in Duromedics valvular prostheses].

To determine the value of Doppler echocardiography in the normal clinical use of functional diagnosis, and to define normal values of prosthetic mitral and aortic valves, of different sizes and in different positions, 48 patients (53 Duromedics prosthesis) were examined. Two groups were formed: the first group (12 patients) was studied soon after operation, i.e. less than 3 weeks; the second group (36 patients) was examined at a later stage i.e. 2-60 months later. This group did not present any associated valvular disease (i.e. there was no aortic disease in patients with mitral prostheses nor mitral disease in patients with aortic prostheses). In the first group the following results were found: DP max = 12.70 +/- 4 mmHg, DP mean = 4.0 +/- 3 mmHg, Half Time Pressure (T 1/2) = 79.57 +/- 17 ms in mitral prostheses; DP max = 25 +/- 10.9 mmHg, DP mean = 6.8 +/- 4 mmHg in aortic prostheses. In the second group the findings were as follows: mitral prostheses: DP max = 9.28 +/- 3.32 mmHg, DP mean = 3.0 +/- 1.0 mmHg, T 1/2 = 80 +/- 17.96 ms; aortic prostheses: DP max = 19.0 +/- 9.59 mmHg, DP mean = 6.0 +/- 3 mmHg. A trend towards higher DP values was noted in the first group of mitral prostheses (p = 0.05 only for DP max; for DP mean no statistic significance). No differences were noted either between the first and second group as regards aortic prostheses. For prosthetic mitral valves permissible upper limits of DP max, DP mean and T 1/2 in the first and second groups were respectively: 16.70 mmHg, 7.0 mmHg, 96.57 ms; and 12.26 mmHg, 4.0 mmHg, 105.96 ms.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

[Results and limits of fibrin-unspecific thrombolysis in acute myocardial infarct].

Acute myocardial infarction is caused by thrombotic occlusion of a coronary vessel. Mortality and quality of life are both determined by the extent of infarction. It is possible to interrupt the development of necrosis by early fibrinolytic therapy. If reperfusion is initiated within three to six hours, a significant reduction in mortality is likely. Currently available fibrin-unspecific plasminogen activators such as streptokinase and urokinase are effective thrombolytic agents but do not fulfill all the criteria of an ideal plasminogen activator. Recanalisation rates are relatively low after intravenous administration, since the agents are not fibrin-specific and because the effect is delayed. Serious hemorrhagic complications may occur, since therapeutically effective dosage results in a hemostatic defect. The possible advantages of reduction in blood viscosity for collateral circulation in the ischemic region and a possible antithrombotic effect have not been defined. A complex strategy is necessary for optimal treatment of acute myocardial infarction. Early intervention is decisive in regard to recanalisation rate, infarct size, left ventricular function and mortality, while delayed interventions serve to maintain the advantages of early recanalisation by limiting angina pectoris and preventing reinfarction. Therefore, a combination of early intravenous administration of a fibrinolytic agent with subsequent invasive intervention appears reasonable and advantageous. Progress in the treatment of acute myocardial infarction will depend on development of effective plasminogen activators capable of achieving rapid and complete recanalisation without major side effects after intravenous administration.

Coronary Circulation↗
PubMed1987

Residual coronary stenosis after thrombolysis with rt-PA or streptokinase: acute results and 3 weeks follow-up.

Ninety-one patients with acute myocardial infarction were assigned to intravenous treatment with streptokinase or rt-PA as part of the randomized trial carried out by the European Study Group for Recombinant Tissue-Type Plasminogen Activator (rt-PA). A patent coronary artery was found in 37 of 45 (82%) patients treated with rt-PA and in 27 of 46 (59%) patients treated with streptokinase 75-90 minutes after start of infusion. Patients were subsequently anticoagulated with heparin or dicoumarol up to a repeat angiography 3 weeks after the infarction. Of the 64 patients with successful reperfusion, 3 died and 3 suffered reocclusion of the vessel. Quantitative analysis of the coronary stenosis both immediately after thrombolysis and at 3 weeks follow-up was possible in 33 cases. Residual stenosis (percentage narrowing of diameter) decreased from 74 +/- 14% to 56 +/- 17% (P less than 0.05). No difference was observed between the groups of patients treated with streptokinase (74 +/- 9% to 57 +/- 12%, N = 17) and with rt-PA (74 +/- 17% to 56 +/- 21%, N = 16). Despite the significant regression, a coronary stenosis of more than 50% of the diameter persisted in 82% of the patients three weeks after the infarction.

Cineangiography↗
PubMed1986

Magnetic resonance imaging (MRI) in different stages of myocardial infarction using the contrast agent gadolinium-DTPA.

We investigated 26 patients admitted to our catheterization laboratory with a diagnosis of acute myocardial infarction. In each case acute revascularization was unsuccessful, but the diagnosis was confirmed by angiography. In 11 patients with an uncomplicated course of acute myocardial infarction magnetic resonance imaging was carried out within 7 days of the acute event. In three additional cases imaging was performed within 3 weeks, while a remaining 12 patients underwent studies more than 3 weeks after the onset of symptoms. We determined signal intensity at three points within the area of infarction and at three other points in adjacent myocardial tissue. Decreased signal intensity within the area of infarction was present in native scans in 60% of all cases. Application of 0.1 mmol/kg body weight gadolinium-DTPA was followed by an average 70% increase in signal intensity within zones of acute infarction, as compared to a 20% increase in surrounding myocardial tissue. In cases of subacute and chronic infarction there was no significant signal enhancement after administration of gadolinium-DTPA. Uptake of gadolinium-DTPA in the area of acute myocardial infarction may be a positive marker of acute myocardial necrosis, which may be of potential clinical benefit.

Adult↗
PubMed1986

Intracoronary thrombolysis: organizational prerequisites, technique, and results.

Reestablishing myocardial perfusion during evolving myocardial infarction may limit the ultimate extent of infarction if viable myocardial tissue is present when recanalization of the occluded vessel is achieved. This will result in improved left ventricular function and decreased mortality. In addition to their therapeutic benefits, recanalization procedures have contributed greatly to our knowledge of acute myocardial infarction. It has been demonstrated that myocardial infarction most often occurs after thrombotic occlusion of a coronary artery. This has settled a controversy that has preoccupied cardiologists for decades. Selective intracoronary administration of fibrinolytic agents is followed by recanalization in approximately 80% of cases. Therapeutic failures are attributable to occlusion caused by other factors, to inactivation of streptokinase by high antibody concentrations, and to insufficient concentrations of streptokinase at the thrombus as a result of unfavorable flow conditions.

Angioplasty, Balloon↗
PubMed1986

[Long-term results following therapy with streptokinase in myocardial infarct].

Long term results of thrombolytic therapy in myocardial infarction are determined primarily by the effects of treatment in the acute phase. Out of a total of 370 patients undergoing recanalization therapy, 170 consecutive patients were examined over a period of one to three years (mean 1.5 years) by means of ECG, exercise testing, thallium myocardial scintigraphy, radionuclide ventriculography, coronary angiography and contrast ventriculography. Frequency of chest pain, left ventricular function, reinfarction rate and mortality were analyzed. The patient cohort was divided into three subgroups: 1. patients with successful PTCR who underwent PTCA or bypass graft surgery; 2. patients with successful PTCR who were managed medically without subsequent reinfarction; 3. patients with definitive occlusion or reinfarction. Mortality in the hospital phase (within 30 days) was 4.9% in patients undergoing successful recanalization procedures as compared to 12.3% for patients with definitive occlusion. Late mortality at 1.5 years was 12.3% and 16.2%, respectively. These figures are similar to those found in the literature. In-hospital mortality is clearly reduced by early recanalization within 200 minutes of occlusion, and there is a reduction in the ultimate extent of infarction as well as improvement in left ventricular function. In order to prevent reocclusion (in 10 to 20% of cases) and reinfarction additional interventions such as PTCA or bypass grafting should be employed as soon as possible in suitable cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac Output↗
PubMed1985

Hemodynamic effects of molsidomine, isosorbide dinitrate, and nifedipine at rest and during exercise.

In the first study the hemodynamic effects of standard doses of molsidomine (2 mg intravenously), isosorbide dinitrate (ISDN) (5 mg sublingually), and nifedipine (20 mg sublingually) were assessed at rest and under exercise conditions in a group of 30 patients with coronary heart disease. With the patients at rest both molsidomine and ISDN were associated with prompt reductions in left ventricular end-diastolic pressure and mean pulmonary artery pressure, whereas nifedipine was associated with slight reductions in left ventricular end-diastolic pressure and mean pulmonary artery pressure that did not attain statistical significance. Nifedipine and ISDN caused a decrease in mean aortic blood pressure, which resulted in a reactive increase in heart rate that was only significant with nifedipine. After administration of molsidomine, there was no significant change in mean aortic pressure at rest. There were reductions in stroke volume index and cardiac index after administration of molsidomine and ISDN. Nifedipine, however, was associated with significant increases in stroke volume index and cardiac index. None of the three test substances caused changes of contractility parameters. Under exercise conditions reductions in left ventricular end-diastolic pressure, mean pulmonary pressure, and mean aortic pressure were documented following administration of molsidomine, ISDN, and nifedipine. There were no major changes in maximum heart rate or stroke volume index during exercise with any of the three drugs. However, nifedipine was associated with a significant increase in cardiac index, whereas molsidomine and ISDN produced no major changes.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

Comparison of the acute hemodynamic effects of nifedipine with nitrendipine and a study of the electrophysiological effects of nitrendipine in man.

Calcium antagonists are known to have an inhibitory effect on the contractile status of the smooth muscle of the arterioles, the muscle fibers of the heart, and the cardiac conduction system, especially the atrioventricular node. The vasodilatation that is produced may be observed in the coronary arteries but predominates in the peripheral resistance vessels. Nifedipine and its 1,4-dihydropyridine derivative, nitrendipine, are not only useful in coronary artery disease but also have potential as antihypertensive agents. The acute hemodynamic effects of both nifedipine and nitrendipine, administered in a 1.0 mg intravenous dose, were studied. The compounds were randomly allocated to six patients, where each served as his own control. In addition, the effect of 1 mg of nitrendipine intravenously on the electrophysiological impulse formation and conduction was investigated in a second group of six patients. There were substantial differences in the intensity and duration of the hemodynamic effects of both drugs. The total peripheral resistance (TPR) fell after nifedipine from 1,730 +/- 240 to 1,280 +/- 120 and after nitrendipine from 1,960 +/- 420 to 1,200 +/- 150 dynes-s-cm-5. There was a concurrent significant reduction in the systolic aortic and left ventricular pressure after nifedipine and nitrendipine from 152 +/- 8 to 128 +/- 13 and 161 +/- 19 to 122 +/- 18 mm Hg, respectively. Heart rate increased due to baroreceptor stimulation by 21% with nifedipine and by 32% with nitrendipine. From the results of the electrophysiological study, nitrendipine did not have any significant effect on the sinus or atrioventricular node function. The substance may be safely used in patients with conduction disturbances.

Angina Pectoris↗
PubMed1984

[The value of two-dimensional echocardiography in the diagnosis of acute transmural primary infarctions].

The validity of two-dimensional echocardiography (2 DE) in the diagnosis of evolving myocardial infarction was assessed in 123 patients with a suspected acute myocardial infarction (chest pain for less than 4 hours). 84 patients developed a myocardial infarction, 39 did not. Detection and extent of a regional wall motion disorder in 2 DE were compared to ECG, enzymes, hemodynamics, coronary angiography and clinical data. The reliability of ECG and 2 DE in the diagnosis of acute myocardial infarction was found to be similar: sensitivity 89% for 2 DE, 96% for ECG; specificity 89% vs (= versus) 73%; positive predictive value 95% vs 89%; negative predictive value 79% vs 90%. This means that in most cases the ECG is a sufficient and reliable method in detecting or excluding acute myocardial infarction. Because of the equipment needed, the limited practicability and because of specific problems (distinction between new and old infarction), the 2 DE should be regarded as a supporting method to the ECG but not as an essential one in the diagnosis of acute myocardial infarction. The possible benefit of echocardiographic examination is the identification of high risk patients by non-invasive determination of the size of infarction. There was a significant correlation between the extent of wall motion disorder and the maximum CK levels as well as the incidence of cardiac complications such as hypotension, pulmonary congestion, and ventricular arrhythmias.

Acute Disease↗
PubMed1983

[Relation between late potentials, ventricular arrhythmias, left ventricular dysfunction and occlusion time following intracoronary thrombolysis].

25 patients who had undergone intracoronary thrombolysis (ICT) during acute myocardial infarction were studied an average of 9.8 months after the event in order to test the effect of the procedure on the incidence of complex ventricular tachyarrhythmias, late potentials determined by the signal-averaging technique, ejection fraction, and left ventricular asynergy. The relationships between these findings were tested. ICT was successful in 17 patients. There was a statistically significant relationship (p less than 0.05) between demonstrable akinesia and dyskinesia, late potentials, and complex ventricular tachyarrhythmias. Akinesia and dyskinesia and complex tachyarrhythmias were found more often in the 8 patients in whom ICT was unsuccessful than in the remaining 17 subjects (p less than 0.05). In the latter group no relationship was found between duration of occlusion and the incidence of asynergy, complex tachyarrhythmias, and late potentials; occlusion time was more than 200 min in 7 patients and less than 200 min in 10 patients. It is desirable to hold occlusion time below 200 min if there is no collateral circulation to the jeopardized myocardium.

Arrhythmias, Cardiac↗
PubMed1982

[Recanalization by intracoronary infusion of streptokinase in acute myocardial infarction. Hospital course in 204 patients (author's transl)].

A multicenter study evaluated the early management and subsequent hospital course of 204 patients with acute myocardial infarction who were receiving intracoronary infusions of streptokinase (STK). The in-hospital mortality in 37 patients with thrombotic occlusion of the infarct-related vessel, in whom recanalization could not be achieved, was 24%. However, the cardiac mortality in 129 patients who were successfully treated by percutaneous transluminal coronary recanalization (PTCR) was only 5.4%. Cardiac deaths (5 patients) and nonfatal reinfarctions (20 patients) occurred in the early period in the cardiac care unit (CCU) in 21% of the latter group and, despite anticoagulation measures, could not be consistently prevented. Hemorrhagic complications, necessitating blood transfusion, occurred in 15 (7.4%) of the total 204 patients in the group, usually in the acute CCU stage, and were positively related to decline of fibrinogen serum concentrations below 100 mg/dl and to use of the Judkins technique. The later course of most of the patients on the general ward was uneventful until hospital discharge. Thus there were only 2 more cardiac deaths, and of 64 successfully treated STK-PTCR patients who left the CCU without clinical indications of reinfarction and agreed to repeat coronary angiography before hospital discharge, the infarct-related vessel was patent in 59 patients and reoccluded in only 5 (7.8%).

Aged↗