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Biomedical subjects

B Lösse

Publications and source records attributed to B Lösse.

At least 55 records · Page 3Linked to original sources
PubMed1986

[Percutaneous transluminal coronary angioplasty: determination of left ventricular function in physical stress using intravenous digital subtraction angiocardiography].

24 patients with coronary artery disease underwent intravenous digital subtraction angiocardiography at rest and during exercise before and after percutaneous transluminal coronary angioplasty (PTCA). Before PTCA mean pulmonary artery pressure increased pathologically in 20 patients (on average from 22 +/- 4 to 40 +/- 9 mm Hg, p less than 0.001). The increase in cardiac index from 4.2 +/- 1.3 to 6.2 +/- 2.01 I X min-1 X m-2 (p less than 0.01) was achieved by an increase in heart rate from 77 +/- 13 to 119 +/- 16 min-1 (p less than 0.001) as stroke volume remained unchanged during exercise (52 +/- 14 ml X m-2, resting value: 53 +/- 13 ml X m-2). Though end-systolic volume increased from 32 +/- 11 to 41 +/- 13 ml X m-2 (p less than 0.001) and ejection fraction fell from 63 +/- 8% to 56 +/- 10% (p less than 0.005), stroke volume remained unchanged due to an enhanced diastolic filling (EDVI: 86 +/- 19 ml X m-2 at rest, 92 +/- 18 ml X m-2 during exercise, p less than 0.001). After angiographically successful PTCA in 21 of 24 patients average mean pulmonary artery pressure during exercise remained pathologically elevated (36 +/- 9 mm Hg, no significant difference from value before PTCA). It normalized in only 6 of 17 patients. On the other hand there was a marked improvement of left ventricular systolic performance. Ejection fraction during exercise (65 +/- 11%) was higher than before PTCA (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

[Heart involvement in progressive external ophthalmoplegia (Kearns-Sayre syndrome): electrophysiologic, hemodynamic and morphologic findings].

The Kearns-Sayre syndrome is combined with a progressive external ophthalmoplegia (PEO), retinal pigmentary degeneration and heart block. In some patients, progression of incomplete forms has been described and potentially fatal conduction disturbances may occur. The disease is considered as a systemic mitochondrial disorder. As part of an ongoing prospective study 6 patients (3 female, 3 male; age 32 +/- 9 years) with PEO and typical ultrastructural changes of a mitochondrial myopathy in their skeletal muscle were examined. The ECG disclosed atrio/intraventricular conduction defects in 5 patients: 1 patient had a third degree AV block which was treated by a pacemaker. Another patient had left anterior fascicular block with complete right bundle branch block. In 3 other patients an incomplete right bundle branch block was registered. In 1 patient, His-bundle electrography disclosed a block distal to His by atrial high rate pacing before and after i.v. injection of ajmaline; prophylactically a pacemaker was implanted. The mean HV-interval increased significantly under ajmaline by 44% in patients with sinus rhythm. Hemodynamic studies were normal in 5 patients at rest; only 1 patient was abnormal during exercise. Myocardial biopsy demonstrated mitochondrial abnormalities such as variability in shape and size. In 4 patients concentric cristae mitochondriales were seen. Our results suggest that atrioventricular conduction defects are common in patients with PEO. By means of endomyocardial catheterbiopsy a mitochondrial cardiomyopathy could be detected.

Adolescent↗
PubMed1986

15-(ortho-123I-phenyl)-pentadecanoic acid, a new myocardial imaging agent for clinical use.

The result of previous experiments in rodents indicated different kinetics for the para- and ortho-isomers of 15-(iodophenyl)-pentadecanoic acid (p-IPPA, o-IPPA), with o-IPPA showing an enhanced rate of washout. To test the relevance of this phenomenon for clinical diagnosis, 15 fasting male patients with confirmed coronary heart disease (1-VD/7, 2-VD/4, 3-VD/4) were investigated under exercise. Serial images were recorded at a rate of 3 frames min-1 for 70 to 90 min, corrected for tracer in blood and compared with thallium-201 images obtained from these patients within less than 2 weeks. Time-activity curves were also taken from the peripheral blood. Ortho-IPPA was well taken up by healthy myocardium and, contrary to rodents, retained with elimination half times longer than 200 min. A decreased myocardial uptake was seen which was very similar to the pattern obtained with thallium. Ortho-IPPA was eliminated from the blood to less than 10% at 4 min. Almost all radioactivity was in the organic phase (greater than 95% at 5 min) and chromatography showed only one major peak (o-IPPA) indicative of minimal organic catabolism.

Adult↗
PubMed1985

[Causes and importance of mitral valve insufficiency in the surgical treatment of hypertrophic obstructive cardiomyopathy].

In hypertrophic obstructive cardiomyopathy (HOCM) mitral incompetence is a frequent additional lesion. Echocardiography shows a SAM-phenomenon and the mitral suspension apparatus is transponed. In such cases myoectomy at typical spots alone or in combination with removal of the hypertrophied myocardium on the posterior wall of the left ventricle can influence the outflow tract positively. From 1963 to 1985 183 patients were operated with such lesions, 119 of them had preoperative mitral insufficiency of different degrees. In 9 patients mitral valve replacement was necessary. Hospital mortality was high in cases with mitral valve replacement. The decision whether the valve has to be replaced can be made after myocardectomy during the operation, but it should be done immediately, if mitral insufficiency persists.

Adolescent↗
PubMed1985

[Qualitative evaluation of myocardial perfusion using digital subtraction angiocardiography].

The purpose of this study was to discover whether the passage of contrast medium through the myocardium can be visualized by digital subtraction angiocardiography and whether myocardial perfusion can be determined qualitatively from the difference images. Cineangiograms (duration 20 s) were obtained during routine coronary angiography and analyzed by means of a computerized image processing system. The results show that the passage of contrast medium through the coronary artery system, myocardium and coronary veins can be visualized. In 10 patients myocardial perfusion at rest was classified qualitatively into four categories (well perfused, slightly reduced perfusion, markedly reduced perfusion and perfusion defect) from local contrast intensity and the time dependent wash-in phase of the contrast medium. Intra- and interobserver comparison of the qualitative estimation of myocardial perfusion showed a close correlation (p less than 0.001 to p less than 0.0001). In the same 10 patients myocardial perfusion at rest was evaluated from Tl-201 scintiscans by two independent observers. A comparison between the qualitative classification of local myocardial perfusion assessed by both methods revealed a close correlation (p +/- 0.049). These results indicate that myocardial perfusion at rest can be visualized by digital image processing and evaluated qualitatively from cineangiograms.

Adult↗
PubMed1985

[Light and electron microscopy findings in early and late stages of heart failure. Studies of endomyocardial biopsies of patients with latent (LCM) and dilated (DCM) cardiomyopathy].

Right-ventricular myocardial biopsies were obtained from 28 patients with LCM (EF 72 +/- 10.4%) and 36 patients with DCM of different degrees (EF 45 +/- 15%). Using paraffin sections and electron micrographs, 16 structural variables were semiquantitatively evaluated. Hypertrophy of myofibres, and nuclear and mitochondrial alterations were significantly more pronounced in patients with DCM. A score of 9 selected variables was found to be significantly higher in the DCM-group as compared with the LCM-group. The diameter of the myofibres was significantly thicker in DCM (17.5 +/- 2.2 microns) than in LCM (14.6 +/- 0.95 microns), but no significant difference of the volume density of myofibrils and of mitochondria could be determined. In the myocytes of DCM the mitochondria were significantly smaller than in LCM. The EF correlates with the myofibre thickness, with the semiquantitative score, and with the size of the mitochondria, but no significant correlation was seen with the volume density of myofibrils or mitochondria. The study has shown: At present no alterations in myocardial biopsies are known to be diagnostic for LCM or DCM. The findings support the concept of a diffuse myocardial disease in LCM. Only one patient out of 28 exhibited a myocardium without any pathologic changes. There is no evidence for small vessel disease in LCM. From the morphological point of view DCM and LCM are different only in quantity, but not in quality of their structural alterations.(ABSTRACT TRUNCATED AT 250 WORDS)

Biopsy↗
PubMed1985

Long-term follow-up of pulmonary hypertension in patients with and without anorectic drug intake.

Over a period of up to 18 years, 24 patients (mean age: 33.8 years) with primary vascular pulmonary hypertension (PVPH) of unknown aetiology (group A) and 18 subjects (mean age: 45.3 years) with PVPH due to anorectic drug intake (group B) were comparatively studied. The following main tendencies became apparent: 1) The 10-year cumulative survival rate in group A (0.31) was lower than in group B (0.63). 2) Patients of group A showed more marked X-ray and ECG signs of pulmonary hypertension and right ventricular hypertrophy in comparison with group B. In contrast to group B, the ECG signs of hypertrophy in group A increased during the observation period. 3) Mean pulmonary artery pressure (PAP) significantly increased in group A (from 48.8 to 61.0 mmHg), while it decreased (from 47.6 to 33.3 mmHg) in group B. 4) The diameter of the descending branch of the right pulmonary artery increased with rising PAP only in group A, while the relationship between PAP and the Sokolow-Lyon index was significant only for the whole group of PVPH patients but not for the subgroups A and B. A regression of pulmonary hypertension in patients with anorectic drug intake was obvious, in contrast to the course in patients with PVPH of unknown aetiology.

Adolescent↗
PubMed1985

[Hypertrophic obstructive cardiomyopathy: surgical treatment and results].

The natural history of hypertrophic obstructive cardiomyopathy is characterized, in particular, in younger patients by sudden cardiac death, in the majority of patients by progressive congestive heart failure [14, 26, 27, 33-36]. With the aid of beta-adrenergic receptor blockers, calcium channel blockers and antiarrhythmic agents the clinical outlook for most of the patients can be improved [17, 19, 23, 28]. Patients who do not respond to medical treatment can be regarded as possible candidates for surgical revision of the left ventricular outflow tract. In consideration of surgical treatment, two morphologic and hemodynamic forms of the disease must be differentiated: the typical subaortic muscular hypertrophy in the region of the outflow tract and the atypical, more mid-ventricular muscular hypertrophy with systolic entrapment of a distal portion of the ventricle in which frequently a typical subaortic hypertrophy also may be present [15, 43]. As a result of septal subvalvular hypertrophy which may substantially compromise left ventricular ejection during systolic contraction, in hypertrophic obstructive cardiomyopathy there is a deviation of the left ventricular major axis, dyscoordination in the sequence of contraction, hypertrophy of the left ventricular walls, diminished diastolic compliance and, to a varying extent, mitral regurgitation. Diagnostically useful findings are a mid-systolic murmur at the aortic valve, bisferiens carotis pulse, systolic pressure gradient between the left ventricle and the aorta and a postextrasystolic paradoxical pressure response. Echocardiographically, asymmetric septal hypertrophy, systolic anterior motion of the anterior mitral valve leaflet, premature mid-systolic closure of the aortic valve and an enlarged left atrium will be detected. Surgical intervention is indicated for patients with class III clinical symptoms (NYHA) not amenable to medical treatment and pressure gradients between left ventricle and aorta, at rest or postextrasystolically, in excess of 50 mm Hg. An overview of the variety of surgical approaches and procedures employed for hypertrophic obstructive cardiomyopathy is provided by Table 1. From initial attempts to eliminate the outflow tract obstruction by myotomy, the subvalvular myectomy was developed in which an about 1 cm wide section of muscle is resected; this procedure can be carried out from a transaortic, transatrial or transventricular approach [4, 9, 21, 22, 24, 38, 39, 47]. Under the assumption that the anterior motion of the anterior mitral valve leaflet contributes to systolic obstruction, some authors recommended reconstructive procedures or replacement of the mitral valve.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1984

[Risk of stress-induced ventricular arrhythmias in hypertrophic cardiomyopathy].

200 exercise tests in 106 patients with hypertrophic obstructive cardiomyopathy (HOCM) and 45 exercise tests in 30 patients with hypertrophic non-obstructive cardiomyopathy (HNCM), primarily performed to assess the hemodynamic impairment during stepwise increased maximal exercise, were analysed with respect to incidence and severeness of ventricular arrhythmias by evaluating the continuously recorded ECG. The exercise tests were subdivided in 4 phases: 1. introduction of a Swan-Ganz pulmonary wedge catheter; 2. resting phase until constant hemodynamic basal values were reached; duration 5 to 51, mean 18 +/- 8 min; 3. exercise phase; bicycle ergometer exercise in supine position; increase in work load by steps of 25 Watts to the maximum which was defined by onset of angina pectoris, dyspnea or exhaustion; total duration 6 to 41, mean 18 +/- 6 min; 4. resting phase after exercise, duration 1 to 30, mean 5 +/- 3 min. Ventricular arrhythmias were classified in a modified Lown classification: 1. no ventricular ectopic beats (VEB); 2. single VEB, less than 0.5/min; 3. single VEB, more than 0.5/min; 4. ventricular pairs; 5. ventricular salvos or tachycardias (3 or more QRS complexes). In the total series of 200 exercise tests in patients with HOCM, the highest incidence of ventricular arrhythmias was found during insertion of the pulmonary wedge catheter, i.e., in 75% of the cases. In nearly 20% of the cases, ventricular pairs or tachycardias were observed. The longest tachycardia consisted of 17 QRS complexes. All tachycardias terminated spontaneously. During the following resting phase, ventricular arrhythmias were documented in 52% of the cases, with ventricular pairs, however, in only 11 (5.5%) and ventricular tachycardias in only 5 (2.5%) tests.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1984

[Early and late hemodynamic changes following operative therapy of hypertrophic obstructive cardiomyopathy].

10 patients (8 men, 2 women; 24 to 72 years of age at the time of operation) with hypertrophic obstructive cardiomyopathy (HOCM) underwent exercise tests a mean of 10 +/- 3.7 months before as well as 12 +/- 1.1 and 52 +/- 6.3 months after subvalvular septal myectomy. The following hemodynamic parameters were assessed: heart rate, arterial pressure, total body oxygen consumption, arterio-venous oxygen difference, stroke volume, cardiac output, and pulmonary artery pressure. Clinical symptoms improved in all patients after surgery, at the first postoperative investigation in 8 patients by one class and in 2 patients by two classes according to the New York Heart Association's classification. At the second postoperative study, 2 patients reported a further improvement, 5 patients no further change, and 3 patients a partial deterioration of symptoms. Exercise tolerance, however, did not decrease in any patient. It increased from a preoperative mean of 68 +/- 7.5 watts to 90 +/- 10.0 watts (p less than 0.02) at the first and 102 +/- 14.1 watts at the second postoperative study. The hemodynamic parameters showed the following alterations at the highest exercise levels (mean 68 +/- 7.5 watts) reached by individual patients in all three exercise studies: heart rate, at the first postoperative study, was an average of 16 bpm, i.e. 13% lower than in the preoperative test, and then remained constant. Arterial blood pressure showed no definite alterations. Total body oxygen consumption was unchanged at the first postoperative evaluation, but increased at the second postoperative test by an average of 132 ml/min, i.e. 10% (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

Minimal cardiac transit times--a sensitive parameter reflecting changes in cardiac volume-to-flow ratios.

Minimal cardiac transit times (MTTs) are differences between times of appearance of the indicator at consecutive segments of the cardiopulmonary circulation. The MTTs are shown to be directly proportional to the quotient of volume to flow. The relationship of the cardiac MTTs to ventricular ejection fraction was derived. Utilizing this technique the ejection fractions of the left and right ventricles in 72 normal individuals were calculated. Theoretical aspects of measuring cardiac MTTs were related to experience of clinical application and confirmed its usefulness.

Cardiac Output↗
PubMed1983

Clinical course and prognosis of patients with typical and atypical hypertrophic obstructive and with hypertrophic non-obstructive cardiomyopathy.

In a total of 339 patients with hypertrophic cardiomyopathies (typical HOCM, n = 224; atypical HOCM, n = 30; HNCM, n = 80) the clinical course, the Sokolow-Lyon index in the ECG and the prognosis as demonstrated by cumulative survival rates were analysed to get more differentiated information for the characterization of these myocardial disorders. No change in the type of hypertrophic cardiomyopathy was found, indicating different clinical entities. No increase of the Sokolow-Lyon index was observed during follow-up. Only a small proportion of patients seemed to benefit from treatment with propranolol. Surgical treatment appears to be the therapy of choice, at least in the advanced stage of the disease refractory to medical treatment. In addition, strong evidence was obtained that surgical treatment improved the prognosis in patients with typical HOCM.

Adult↗
PubMed1983

Exercise performance in hypertrophic cardiomyopathies.

Based on bicycle ergometer tests in 50 patients with hypertrophic obstructive cardiomyopathy (HOCM) and 19 patients with hypertrophic non-obstructive cardiomyopathy (HNCM) if clinical (NYHA) class I to IV, the profile of several haemodynamic parameters (heart rate, stroke volume index, cardiac index, pulmonary artery pressure) during exercise was evaluated. The following pattern was found: (1) with increasing degree of clinical symptoms, the mean values of stroke volume decrease and the mean values of pulmonary artery pressure increase; (2) stroke volume does not show the normal increase during exercise in a considerable number of patients (48% of HOCM, 26% of HNCM patients); (3) failing increase in stroke volume is in part compensated by increase in heart rate; (4) pathological increase in mean pulmonary artery pressure correlates with severity of clinical symptoms, but even a considerable number of clinically asymptomatic patients exhibit extremely pathological pressure increase; (5) there is no fundamental difference of the behaviour of the measured haemodynamic parameters between HOCM and HNCM; (6) there is marked overlapping of exercise-induced haemodynamic changes between patients of different NYHA classes of clinical impairment. Therefore, measurements of exercise haemodynamics are necessary to define clearly the degree of functional impairment in the individual patient. Based on identically performed exercise tests in 53 patients with HOCM, the clinical and haemodynamic effects of medical therapy with propranolol (n = 12) or verapamil (n = 25) and of surgical treatment (n = 21) were compared. Maximal exercise capacity was on an average not changed after propranolol but increased after verapamil and, most significantly, after surgery. This could be attributed to corresponding haemodynamic changes, especially concerning cardiac output and pulmonary artery pressure. As a whole, verapamil was clinically and haemodynamically superior to propranolol, but not as effective as surgical treatment.

Adult↗
PubMed1983

[Clinical aspects, course and prognosis of various forms of hypertrophic cardiomyopathy].

To characterize the different types of hypertrophic cardiomyopathy [typical (subaortic) hypertrophic obstructive cardiomyopathy (HOCM) (n = 235), atypical (midventricular or apical) HOCM (n = 33), and hypertrophic nonobstructive cardiomyopathy (HNCM) (n = 85)], studies of the clinical picture, course, and prognosis were performed in 353 patients. Clinical picture. There were found to be distinct differences between the diseases in terms of incidence, symptoms, findings at auscultation, carotid pulse tracings, ECG (incidence of abnormal negative T-waves), and echocardiography. Echochardiography proved to be diagnostically less specific than invasive methods, however, and in particular often failed to distinguish between atypical HOCM and HNCM. Clinical course. There was no evidence of a change from one form of hypertrophic cardiomyopathy to the other. The Sokolow-Lyon index in the ECG did not increase in any group. The rate of complications (endocarditis, systemic emboli) varied between 0.61 and 1.28 events per 100 patient years. Only 7.4%-23.5% of patients with HOCM improved as a result of conservative treatment, compared to 83%-87.5% of surgical patients. In addition, the rate of postoperative syncope was reduced by 90%. Prognosis. 90 patients were operated on. Operative mortality in typical HOCM was 4.5% over the last 5 years. If this is disregarded, the cumulative survival rates are significantly higher in surgical patients with typical HOCM than in those treated conservatively. The data confirm surgical treatment to be the therapy of choice in patients with HOCM refractory to conservative treatment. The prognosis seems to be improved by operation.

Adult↗
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↗
PubMed1982

[The etiology, course and prognosis of dilated cardiomyopathy].

UNLABELLED: In order to study the etiology, the clinical course and the prognosis of patients with DCM, clinical, morphological (endomyocardial catheter biopsy), angiographic and hemodynamic data of patients with DCM were studied. The total number of patients was 396. In 258 patients definite DCM was diagnosed, in 138 patients DCM was suspected, e.g., because of an additional history of alcoholism. ETIOLOGY: In no case acute subacute or chronic myocarditis was found in myocardial biopsies (n = 114) and at autopsy (n = 18). However, from the history strong evidence was obtained for DCM being the late stage of diphtheric heart disease predominantly among patients with complete left bundle branch block. As far as the alcoholic etiology is concerned, the only significant difference between DCM and alcoholic heart disease was a higher proportion of women among patients with DCM (28% and 5%, resp.). Clinical course and prognosis: 221 patients were studied prospectively (mean follow-up time 3.1 +/- 2.3 years), 44% of patients died or deteriorated. However, in patients with normal cardiothoracic ratio this rate amounted only to 12%. The mean annual mortality rate was 9.8% and varied significantly in relation to different subsets of patients from 0% to 17%. A bad prognosis was significantly indicated by young age, high cardiothoracic ratio, pronounced elevation of enddiastolic volume index and of left ventricular enddiastolic pressure at rest and of mean pulmonary artery pressure at exercise, by severe morphologic changes of myocardial biopsies, severe ventricular arrhythmias, the absence of transient abnormal elevation of arterial blood pressure during follow up, of complete left bundle branch block and of a positive history of diphtheria. However, the wide scatter of data diminished the significance of them for the definite prognostic evaluation of individual case. The cumulative survival curves of patients with a history of alcohol abuse did not differ from that of patients with DCM. The data demonstrate that DCM in patients with the history of diphtheria together with left bundle branch block is possible caused by an inflammatory process. According to the analysis of the clinical course and the prognosis, DCM is one of the most severe heart disease. However, in different subsets of patients, the clinical course may be stable for long time and even normal longevity cannot be excluded.

Adult↗
PubMed1982

[Exercise studies in patients with cardiomyopathy (author's transl)].

Exercise tests were performed on 50 patients with hypertrophic obstructive cardiomyopathy (HOCM) and 19 patients with hypertrophic nonobstructive cardiomyopathy (HNCM) of NYHA classes I to IV, and on 16 patients with congestive cardiomyopathy (CCM) of NYHA classes III and IV as well as, for detection of latent cardiomyopathy (LCM), i.e. functional impairment during exercise with normal findings at rest, on 102 patients with typical or atypical angina pectoris and ECG abnormalities of unknown etiology (left bundle branch block or ST segment depression) but normal coronary arteries and normal left and right ventriculogram. Measurements included heart rate, stroke volume, cardiac output, pulmonary artery pressure and minimal cardiac transit times of Indium-113m. Furthermore, in a large number of patients with latent cardiomyopathy, thallium-201 myocardial imaging and measurements of myocardial lactate extraction during high-rate atrial pacing were performed. The findings suggest that 1. the functional classification based on the patients' complaints often differs from the grade of hemodynamic impairment detected by exercise testing, 2. therapeutic effects (propranolol or surgery in HOCM, prazosin in CCM) are more pronounced under exercise as compared with resting conditions. Latent cardiomyopathy can be diagnosed only by detection of impaired function during exercise (increased pulmonary artery pressure, impaired myocardial lactate extraction during high-rate stimulation), since ventricular function and hemodynamics are normal at rest.

Adult↗