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Biomedical subjects

A Mangschau

Publications and source records attributed to A Mangschau.

At least 19 recordsLinked to original sources
PubMed1994

[Stress echocardiography with dobutamine. A new method for diagnosis of ischemia].

Dobutamine stress echocardiography was performed in 24 patients with angiographically defined coronary artery stenosis, before they underwent percutaneous transluminal coronary angioplasty. Ischemia was detected on stress-ECG in 13 patients. In 19 patients ischemia could be detected with dobutamine stress echocardiography. The method was highly sensitive for detecting ischemia in patients with two vessel or three vessel disease and in patients with affection of only the left anterior descending artery. In patients with one vessel disease the method showed low sensitivity. The most common side effects of dobutamine infusion were flushing and palpitations. One patient suffered atrial fibrillation and one patient had a short and self-limiting ventricular tachycardia. The method seems to be a useful and safe supplementary tool for detecting myocardial ischemia. It is also useful for characterizing the physiological effect of coronary artery stenosis.

Coronary Disease↗
PubMed1994

[Heart failure in Norwegian hospital departments. Prevalence, diagnostic and therapeutic aspects].

The prevalence of congestive heart failure was studied in the medical departments of eight Norwegian hospitals for two days. A mean of 179 patients with heart failure was identified, representing 20% of the total number of in-patients in the participating hospital departments. About 60% of the patients studied were over 70 years of age. There were equal numbers of men and women, but men dominated below 70 years. Ischemic heart disease (59%), valvular heart disease (15%) and hypertension (14%) were the most common primary heart diseases. The drugs used most frequently were diuretics (91%), digitalis (60%), nitrates (40%), and ACE-inhibitors (38%); the last were used more often among patients with severe heart failure (56%).

Aged↗
PubMed1992

[Treatment of heart failure. A questionnaire among Norwegian hospital physicians].

A questionnaire on the treatment of congestive heart failure was distributed to physicians in the medical departments of five hospitals in the Oslo area. The 117 (81%) respondents selected first, second and third line therapy in the treatment of mild, moderate and severe heart failure. Diuretics and restrictions on sodium/water dominated as first line therapy for mild heart failure; less than 5% suggested ACE-inhibitors or digitalis. Some differences in priorities were revealed for moderate and severe heart failure. The majority again suggested diuretics and restrictions on sodium/water, but 20% preferred ACE-inhibitors, which were also stated as second or third line therapy by 60% of the physicians. Less than 50% chose digitalis or nitrates as one of the three first therapies.

Heart Failure↗
PubMed1991

[Shunt quantification in adults with atrial septal defects using the radionuclide technique].

Quantification of left to right shunt was carried out in 15 adult patients, mean age 49 years, with a suspected ostium secundum atrial septal defect (ASD II). Radionuclide shunt quantitation correlated well with the results of right heart catheterization (r = 0.85). The radionuclide technique failed in two patients for technical reasons, but revealed no false negative or false positive results when technically satisfactory. The diagnosis was confirmed at operation. It is concluded that the radionuclide technique is a useful and reliable method which can also be used at follow-up after surgery in patients with atrial septal defects of secundum type.

Adult↗
PubMed1991

[Nuclear medical methods in cardiology].

201-Thallium scintigraphy and radionuclide ventriculography with 99m-Technetium are the two most important nuclear imaging techniques in clinical cardiology. The sensitivity and specificity of tomographic Thallium scintigraphy for detection of coronary heart disease is about 90%. Radionuclide ventriculography may be used to describe systolic and diastolic function of the left and right ventricles with results comparable to those of angiographic studies. Both methods are non-invasive and feasible during exercise. These methods provide important information on myocardial ischaemia and cardiac function which may be difficult to obtain by other methods. In county hospitals with no equipment for invasive studies these methods provide important diagnostic and prognostic information. In the university hospitals, however, the techniques are of a more supportive nature and may help the clinician to select appropriate treatment.

Coronary Disease↗
PubMed1991

First myocardial infarction: 5-year survival predicted from routine clinical, laboratory, and radionuclide findings during the acute stage.

Five-year survival amongst 485 consecutive patients with their first acute myocardial infarction (AMI) was 78.2%. Univariate survival analysis showed that the following variables during the acute stage were of prognostic significance for survival: signs of left ventricular heart failure, enlarged cardiac volume, pulmonary congestion on chest X-ray, anterior myocardial infarction on ECG, and low left ventricular ejection fraction (LVEF), whereas enzyme analysis and Q/non-Q signs on ECG were not. In the multivariate analysis two equivalent models were found. The first pinpointed age and LVEF as independent predictors of mortality, and the second age and left ventricular heart failure. Finally, our subcohort of patients aged less than the mean 63 years and with normal LVEF values of greater than or equal to 50%, or no left ventricular failure had an observed survival for 5 years close to an age- and sex-matched group from the Norwegian population.

Adult↗
PubMed1989

Akinetic versus dyskinetic left ventricular aneurysms diagnosed by gated scintigraphy: difference in surgical outcome.

Forty-one patients selected for left ventricular aneurysm resection and coronary artery bypass grafting were studied by gated radionuclide ventriculography, and right heart catheterization before and after operation to establish whether the presence of paradoxically systolic expansion, as defined by radionuclide ventriculography, influenced the surgical outcome. Patients with systolic paradoxically moving left ventricular aneurysms (n = 28) improved their functional classification (New York Heart Association) (p less than 0.01) and exercise tolerance (watt-minutes) (p less than 0.001) compared with preoperative values, in contrast to the patients with akinetic aneurysms (n = 13), whose status remained unchanged. Left ventricular ejection fraction at rest (p less than 0.001) and exercise (p less than 0.0001) improved along with a significant reduction in left ventricular end-diastolic (p less than 0.002) and end-systolic volume indices (p less than 0.001) among the patients with paradoxical left ventricular aneurysms versus no change in the akinetic group. In a multivariate analysis of different preoperative variables, the presence of dyskinesia was found to be the only independent predictor of a favorable surgical outcome (p less than 0.004). In conclusion, the presence of dyskinesia represents an important marker of the outcome after aneurysmectomy.

Adult↗
PubMed1989

Evaluation for left ventricular aneurysm resection: a prospective study of clinical and haemodynamic characteristics.

A consecutive series of 97 patients with a left ventricular aneurysm (LVA) was evaluated for aneurysmectomy. A wide range in left ventricular (LV) function was found. Angina pectoris was the primary indication (51%) in 55 patients who were operated upon, whereas poor LV function was the main reason (67%) for rejecting surgery in 42 patients. Operative mortality was 9% and exclusively seen in patients with congestive heart failure and/or sustained ventricular arrhythmias. Functional status improved from (NYHA) 3.0 +/- 0.7 to 2.3 +/- 0.5 (P less than 0.0001) after surgery, while haemodynamics at rest remained unchanged. In the medically treated group, 10 patients underwent heart transplantation without mortality during follow-up. Of the remaining 32, 7 had died (22%), all with severely impaired LV function. The best prognosis with no deaths was observed in the 14 medically treated patients with moderate complaints and well preserved LV function. Those with poor LV function and/or ventricular arrhythmias had a poor prognosis whether they were treated medically or by conventional aneurysm surgery. In young selected patients with a short life expectancy, heart transplantation may represent an alternative.

Angina Pectoris↗
PubMed1989

Do X-ray determined cardiac volume and signs of congestive heart failure provide additional prognostic information after myocardial infarction if the left ventricular ejection fraction is known?

Cardiac volume (CV) was measured and indices of pulmonary congestion (PCG) were judged from routine chest films taken post myocardial infarction (AMI) in a consecutive series of 477 patients (340 first and 137 recurrent AMIs). Cardiac volume (CV) and signs of PCG were compared to left ventricular ejection fraction (LVEF), measured with isotope technique, and the prognostic value of all the parameters was assessed after 1 and 5 years. The accuracy of CV and PCG in predicting impaired LVEF was low (62% and 50% respectively). Although specificity is suboptimal, however, these parameters provided valuable prognostic information. For example, patients with signs of PCG had a very high 1 and 5 years' mortality, and two-thirds of those who died during the first year of observation had enlarged CV. The independent value of LVEF determination was mainly observed in re-AMI patients. A more restricted use of this expensive procedure may therefore be recommended.

Cardiac Volume↗
PubMed1989

Encircling endocardial ventriculotomy for malignant ventricular arrhythmias. Effect on cardiac performance.

Cardiac performance and hemodynamics were studied with radionuclide ventriculography in 19 survivors of aneurysmectomy and encircling endocardial ventriculotomy for recurrent, sustained ventricular arrhythmia (group I). To characterize the effect of the ventriculotomy on cardiac function, comparisons were made with a similar group of patients who underwent aneurysm surgery for angina pectoris and/or congestive heart failure (group II). Functional classification revealed no difference between the groups and they achieved the same level of exercise after surgery. No intergroup difference was found postoperatively with respect to right or left ventricular ejection fraction, regional ejection fractions, peak ejection rate, cardiac index or stroke volume. Peak filling rate was also similar, as were cardiac volumes. Exercise did not change any parameter of this intergroup similarity. The authors conclude that most patients with moderately impaired left ventricular function who undergo left ventricular aneurysmectomy with encircling endocardial ventriculotomy do not differ in postoperative hemodynamics and systolic or diastolic function from those treated with simple aneurysmectomy.

Adult↗
PubMed1988

Impairment in right ventricular performance after left ventricular aneurysm surgery.

To study the effect of operation for left ventricular (LV) aneurysm on right ventricular (RV) performance, we studied 50 patients before operation with right heart catheterization, RV angiography, and radionuclide ventriculography. Forty patients were followed up and underwent the same investigations 10 +/- 4 months after operation. At baseline, regional RV dysfunction was observed in 89% of the patients whereas global RV dysfunction was present in approximately a third. After operation, no changes in RV regional dysfunction or RV pressures were observed. However, a significant increase in RV end-diastolic (p less than 0.03) and end-systolic volume indices (p less than 0.02) along with a significant decrease in resting and exercise RV ejection fractions (p less than 0.05) was found. We were unable to demonstrate any significant relationship between preoperative RV dysfunction and surgical outcome. We conclude that RV dysfunction is common in patients with LV aneurysm. Current techniques of operative intervention for this type of aneurysm seem to be followed by RV dilatation and impairment in RV function.

Adult↗
PubMed1988

Improvement in cardiac performance and exercise tolerance after left ventricular aneurysm surgery--a prospective study.

Forty two patients were studied prospectively by rest and exercise radionuclide ventriculography before and after (10 +/- 4 months) left ventricular aneurysm resection. Functional classification (NYHA) improved from 3.0 +/- 0.6 to 2.3 +/- 0.5 (p less than 0.0001) with an increase in double product (p less than 0.01) and total exercise workload (p less than 0.04) over preoperative values. End-diastolic volume was significantly reduced (p less than 0.0001) and resting global left ventricular ejection fraction (LVEF) improved significantly (p less than 0.03) after surgery, as did regional ejection fractions of the lateral/inferior wall (p less than 0.01). Cardiac index (CI) at rest, however, remained unchanged. Under exercise, improvement of global (p less than 0.0003) and regional ejection fractions (p less than 0.02) was more pronounced and a significant increase was also observed for CI (p less than 0.003). Improvement in left ventricular performance occurred both in patients with single and multiple vessel disease, but was more distinct in the latter group who additionally received coronary artery bypass grafts. These patients were furthermore postoperatively able to increase global LVEF at exercise (p less than 0.05). We conclude that aneurysm resection with or without coronary bypass relieves cardiac symptoms and improves exercise tolerance and left ventricular function at rest and on exercise in most patients.

Adult↗
PubMed1986

Congestive heart failure and ejection fraction in acute myocardial infarction.

Left ventricular ejection fraction (EF) was determined by means of radionuclide ventriculography (RNV) in 477 patients 8-12 days after an acute myocardial infarction (AMI). EF was correlated to infarct size and clinical and radiological parameters of congestive heart failure (CHF). The 138 patients (29%) who had signs of CHF had a mean (+/- SD) EF of 35 +/- 14% and a relative heart volume of 597 +/- 112 ml/m2 compared to 51 +/- 14% and 487 +/- 88 ml/m2 among those without CHF. The 52 patients who also had radiological signs of CHF had a mean EF of 27 +/- 12% versus 35 +/- 14% among those with clinical signs and symptoms of CHF. Presence of CHF was positively correlated to the size of AMI and to the reduction of EF. CHF was seen with increasing frequency from 16% in small to 46% in large first infarctions. Patients with reinfarctions showed the same correlation between these parameters, however, with subsequently more depressed EF values and more frequent presence of CHF due to previous myocardial damage. CHF was seldom (8%) observed in patients with EF greater than 50%. In contrast, 67% of the patients with EF less than 35% had CHF. Thus patients with an EF less than 35% represent a high risk group with regard to development of CHF and should be followed closely. It is suggested that radionuclide measurement of EF adds important clinical information in patients with diagnostic uncertainty of CHF.

Cardiac Volume↗
PubMed1985

Cardiac performance in hyperthyroidism assessed by systolic time intervals and radionuclide ventriculography.

Systolic time intervals (STI) and radionuclide ventriculography (RNV) were used in the assessment of cardiac performance in 22 patients with hyperthyroidism before and after antithyroid treatment. STI as well as RNV showed enhanced myocardial contractility which was normalized after antithyroid treatment. Beta-blocker treatment did not influence the hypercontractility in hyperthyroidism. This implies that beta-blockers alone cannot be regarded as satisfactory long-term treatment and that mechanisms other than increased sympathoadrenal drive are involved in the hypercontractility in hyperthyroidism. RNV suggested valvular regurgitation, probably of the mitral valve, in 11 patients. Possible hemodynamic consequences are discussed.

Adolescent↗