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C Spes

Publications and source records attributed to C Spes.

At least 19 recordsLinked to original sources
PubMed2006

First in-human randomized comparison of an anodized niobium stent versus a standard stainless steel stent--an intravascular ultrasound and angiographic two-center study: the VELA study.

OBJECTIVES: The purpose of this study was to test the hypothesis that a niobium stent might lower the restenosis rate in de novo coronary lesions as compared to a bare metal stent. BACKGROUND: Recent data have suggested that inflammatory and allergic reactions to certain compounds in metal stents may play a role in the onset of restenosis. Thus, niobium as an inert material might be beneficial in lowering the rate of restenosis. METHODS: In this single blind, two-center prospective trial patients were randomized into two groups; the first group (n=32) received a niobium stent (VELA STF), the second group (n=33) a bare metal stent (Antares STF). Clinical follow-up was performed at 1 and 6 months, angiographic and intravascular ultrasound analyses were performed at the 6-month follow-up. RESULTS: All stents were successfully deployed. There was one stent thrombosis in each group. There were no significant differences concerning minimal lumen diameter, percent stenosis, and late lumen loss as assessed by intravascular ultrasound (IVUS) at the 6- month follow-up. At 30 days and at 6 months, there were no differences observed between the two groups regarding the rate of major cardiac adverse events. Immediately after stent implantation minimal lumen diameter was significantly larger (p=0.01) and residual percent stenosis significantly lower (p=0.01) in the niobium stent group. CONCLUSION: The use of a niobium stent showed comparable results with other non-drug-eluting stents; however the inert qualities of this first generation niobium stent did not translate into a mid- or long-term benefit.

Aged↗
PubMed2006

Recurrent tako-tsubo-like left ventricular dysfunction (apical ballooning) in a patient with pheochromocytoma - a case report.

Primarily described in Japan, tako-tsubo-like left ventricular dysfunction is a phenomenon characterized by transient apical ballooning in the absence of significant coronary artery disease. The clinical presentation includes symptoms like chest pain, dyspnea, syncope, electrocardiographic changes and elevated myocardial markers, all compatible with the diagnosis of an acute coronary syndrome. The underlying mechanism is supposed to be a catecholamine excess caused by various triggers. We describe a patient with a recurrent tako-tsubo phenomenon, who at work-up proved to have a pheochromocytoma as the most likely underlying disease.

Diagnosis, Differential↗
PubMed2003

[Percutaneous carotid angioplasty with stent implantation and protection device against embolism--a prospective study of 100 consecutive cases].

BACKGROUND AND OBJECTIVE: Percutaneous transluminal angioplasty and stenting of internal carotid artery stenosis has been increasingly practiced as an alternative to carotid embolectomy, particularly since the development of cerebral protection devices. 100 consecutive elective percutaneous carotid stenting procedures were carried out in our centre. We here present the clinical outcome and follow-up of these patients. PATIENTS AND METHODS: 69 men and 22 women, average age 69 +/- 10 years with symptomatic (41 %) or asymptomatic and progressive (59 %) > 80 % stenosis of the internal carotid artery were treated. There was a high rate of co-morbidity and a high vascular risk. 64 % would have been excluded from the NASCET trial because of one, 31 % because of two or more contraindications. In 84 % of the patients symptomatic coronary artery disease was present, in 13 % a significantly reduced left ventricular function (LVEF < 40 %).Pre- and post-procedure all patients were given aspirin and clopidogrel and examined by an independent neurologist. 99 stents were placed with the use of an embolic protection device (28 times with distal balloon occlusion, 72 times with a filter device).The follow-up period averaged 10.4 +/- 8.2.(1 - 29 months). RESULTS: The angiographic success rate was 99 %. During the procedure transient neurological symptoms were experienced by 4 % of patients (2x TIA,2x PRIND) and a minor stroke resulted in two. In 90 % of the interventions debris was collected from the embolic protection device. The maximum diameter of particles was 311+/-431 (30 - 1850) micro m. There was some correlation between patients' symptoms prior to stent implantation and maximum particle size (p < 0,04),but none with any other angiographic or clinical parameters. The combined endpoint (death and any stroke) after 30 days occurred 5 times (5 %). A subacute stent thrombosis occurred once, restenosis in two patients. CONCLUSION: Carotid artery stenting with use of a distal embolic protection device is a feasible new alternative to carotid endarterectomy. Our results indicate high success rate and low complication rates, even in patients with severe co-morbidity. The results compare well with surgical figures. Our favourable results are supported by data emerging from current randomized multicenter trials and a large therapy registry. However, long-term follow-up will still be required.

Adult↗
PubMed1997

Epicardial intimal thickening in transplant coronary artery disease and resistance vessel response to adenosine: a combined intravascular ultrasound and Doppler study.

BACKGROUND: Transplant coronary artery disease is the major factor limiting long-term survival after cardiac transplantation. Both intravascular ultrasound imaging (IVUS) and intracoronary flow studies have been used to assess the morphologic and functional importance of the disease. However, the impact of epicardial intimal thickening, as quantitated by IVUS, on the resistance vessel response to adenosine has not been explored. METHODS AND RESULTS: Seventy-six coronary arteries without angiographically overt coronary disease (diameter stenosis visually, < or =50%) were studied with both IVUS and intracoronary Doppler in 54 patients 0.5 to 127 months after transplantation. Mean intimal index and mean lumen cross-sectional area (CSA) were determined by IVUS, and the average was obtained for every coronary artery. Coronary flow average peak velocity (APV) was obtained by Doppler before and after administration of 16 microg adenosine to calculate coronary flow velocity reserve (CFVR) and coronary vascular resistance index (CVRI). The hyperemic pressure-flow velocity ratio (hyperemic mean aortic pressure/hyperemic APV) as an index of minimal coronary resistance was further derived. The intimal index (mean, 20.0+/-10%) did not correlate with either CFVR (mean, 2.9+/-0.7, r=.12) or CVRI (mean, 0.33+/-0.1, r=.16). However, a significant correlation between the intimal index and the hyperemic pressure-flow velocity ratio (mean, 1.52+/-0.47 mm Hg/cm/s, r=.74, P<.0001) was found. The hyperemic pressure-flow velocity ratio was not influenced by the presence or absence of left ventricular hypertrophy or a mild acute rejection period (International Society for Heart and Lung Transplantation grades IA and IB). CONCLUSIONS: This study shows that in patients without angiographically overt coronary disease, the degree of epicardial intimal thickening as quantified by IVUS did not predict the adenosine vasodilator response, when determined by commonly used parameters such as CFVR and CVRI. The hyperemic pressure-flow velocity ratio best reflected the functional significance of transplant coronary artery disease.

Adenosine↗
PubMed1997

[Prospective study of the frequency and extent of donor-transmitted coronary disease after heart transplantation by intravascular ultrasound].

PROBLEM AND OBJECTIVE: Cardiac allograft vasculopathy influences long-term survival of patients after heart transplantation. Donor-transmitted coronary artery disease may contribute to the further development of cardiac allograft vasculopathy. The aim of this study was to characterize by intracoronary ultrasound the extent and frequency of transmitted coronary artery disease. PATIENTS AND METHODS: Intravascular ultrasound studies were performed at routine angiography in 33 patients (26 men, 7 women, mean age 51 [23-69] years) early after heart transplantation. Plaque morphology was analysed in 153 coronary segments of 52 epicardial coronary arteries. RESULTS: Relevant atherosclerosis (defined as maximal plaque thickness > or = 0.5 mm in at least one coronary segment) was found in 17 patients (52%), while angiography showed irregularities in only 7 patients (21%). Maximal plaque thickness in patients with relevant atherosclerosis was 1.13 +/- 0.32 mm, mean plaque index was 19.2 +/- 10.2%. Plaque formation was eccentric, and plaques were predominantly located in proximal segments. Morphologic changes affecting more than one segment were found in 52% of the patients. Comparing clinical factors, only donor age predicted the degree of atherosclerosis. CONCLUSIONS: In more than one half of the patients studied early after heart transplantation, Intravascular ultrasound revealed epicardial atherosclerotic lesions which were incompletely identified by coronary angiography. The degree of atherosclerosis was closely related to donor age. The potential influence of donor transmitted coronary artery disease on the progression of transplant coronary artery disease requires further longitudinal studies.

Adult↗
PubMed1995

Atrial septal aneurysm in adult patients. A multicenter study using transthoracic and transesophageal echocardiography.

BACKGROUND: An atrial septal aneurysm (ASA) is a well-recognized abnormality of uncertain clinical relevance. We reevaluated the clinical significance of ASA in a large series of patients. The aims of the study were to define morphological characteristics of ASA by transesophageal echocardiography (TEE), to define the incidence of ASA-associated abnormalities, and to investigate whether certain morphological characteristics of ASA are different in patients with and without previous events compatible with cardiogenic embolism. METHODS AND RESULTS: Patients with ASA were enrolled from 11 centers between May 1989 and October 1993. All patients had to undergo transthoracic and transesophageal echocardiography within 24 hours of each other; ASA was defined as a protrusion of the aneurysm > 10 mm beyond the plane of the atrial septum as measured by TEE. Patients with mitral stenosis or prosthesis or after cardiothoracic surgery involving the atrial septum were excluded. Based on these criteria, 195 patients 54.6 +/- 16.0 years old (mean +/- SD) were included in this study. Whereas TEE could visualize the region of the atrial septum and therefore diagnose ASA in all patients, ASA defined by TEE was missed by transthoracic echocardiography in 92 patients (47%). As judged from TEE, ASA involved the entire septum in 100 patients (51%) and was limited to the fossa ovalis in 95 (49%). ASA was an isolated structural defect in 62 patients (32%). In 106 patients (54%), ASA was associated with interatrial shunting (atrial septal defect, n = 38; patent foramen ovale, n = 65; sinus venosus defect, n = 3). In only 2 patients (1%), thrombi attached to the region of the ASA were noted. Prior clinical events compatible with cardiogenic embolism were associated with 87 patients (44%) with ASA; in 21 patients (24%) with prior presumed cardiogenic embolism, no other potential cardiac sources of embolism were present. Length of ASA, extent of bulging, and incidence of spontaneous oscillations were similar in patients with and without previous cardiogenic embolism; however, associated abnormalities such as atrial shunts were significantly more frequent in patients with possible embolism. CONCLUSIONS: As shown previously, TEE is superior to the transthoracic approach in the diagnosis of ASA. The most common abnormalities associated with ASA are interatrial shunts, in particular patent foramen ovale. In this retrospective study, patients with ASA (especially with shunts) showed a high frequency of previous clinical events compatible with cardiogenic embolism; in a significant subgroup of patients, ASA appears to be the only source of embolism, as judged by TEE. Our data are consistent with the view that ASA is a risk factor for cardiogenic embolism, but thrombi attached to ASA as detected by TEE are apparently rare.

Case-Control Studies↗
PubMed1995

[Stress reaction of pulmonary artery pressure in the early and chronic phase after heart transplantation: comparison with healthy control probands].

The pulmonary artery pressure response to exercise frequently reflects ventricular diastolic properties. The aim of this study was to determine noninvasively cardiac allograft function and pulmonary artery pressure response to stress in the early and late phases after heart transplantation (HTX). Ten patients in the early postoperative phase (3.7 +/- 1.6 months postoperatively, group I) and ten patients at least 2 years after HTX (34.3 +/- 8.3 months postoperatively, group II) were studied by two-dimensional (2 D-), M-Mode, and Doppler echocardiography during supine graded bicycle exercise (25, 50, 75, 100 watts). The patients' data were compared to those obtained in eight normal controls. The peak pressure gradient between the right ventricle and right atrium during systole was derived from saline contrast-enhanced Doppler echocardiography of the tricuspid regurgitant jet and used as an estimate of pulmonary artery systolic pressure. In group I- and group II-patients, resting and exercise left ventricular diameters as well as systolic function were normal. The right ventricle was enlarged (3.2 +/- 0.4 cm/3.0 +/- 0.6 cm in group I/group II versus 2.1 +/- 0.3 cm in normal controls, p < 0.05). During exercise, heart rate increased less in heart transplant recipients (+26%/+36% in group I/group II, p < 0.05) than in normals (+67% at 100 watts, p < 0.05). Resting pulmonary artery pressures were similar in heart transplant recipients in the early and late postoperative stage and in normals.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

The clinical spectrum of Friedreich's ataxia in German families showing linkage to the FRDA locus on chromosome 9.

The clinical features of Friedreich's ataxia are described and reevaluated in a group of 14 German patients from 9 independent families. In contrast to previous studies, demonstration of linkage to the Friedreich's ataxia locus (FRDA) on chromosome 9p allowed confirmation of the genetic homogeneity of the disease in the patients under study. Marked variability within families was observed for age of onset of the disease (4-24 years) and for age of becoming wheelchair bound (17-37 years). Electrocardiographic changes were present in all and echocardiographic changes in 50% of the patients. Pathological changes of visual evoked potentials were detected in only 50% of the patients while brainstem auditory evoked potentials and somatosensory evoked potentials were always abnormal.

Adolescent↗
PubMed1991

[Myocardial contrast echocardiography with sonicated iopromide (Ultravist 370) before and after coronary angioplasty].

Thirty-one patients (3 female, 28 male, mean age 56 years) were investigated with myocardial contrast echocardiography before and after successful PTCA (= less than 30% residual stenosis) of one major coronary artery. 2 ml of sonicated lopromid (Ultravist 370, microbubble-size 6 +/- 4 microns) were injected into the coronary vessel. Before, during and after injection a short-axis view or an apical four chamber view was obtained and recorded on videotape. Computer-assisted videodensitometry was performed in a region of interest placed between endo- and epicardium of the myocardial area supplied by the dilated vessel to analyze contrast decay half-time (t/2), time from onset of opacification to t/2 (T-t/2) and maximal videointensity (Imax). 27 patients (87%) had adequate echorecordings before and after PTCA, no side-effects occurred. Contrast decay half-time and T-t/2 showed a decrease in 21/27 (78%) patients (8.7 +/- 6.1 vs 5.8 +/- 3.7s, p less than 0.001) and in 19/27 (70%) patients (12.0 +/- 8.4 vs 8.7 +/- 5.0 s, p less than 0.002) respectively. Imax was not significantly altered by the intervention. Most of the patients without decrease of t/2 and T-t/2 either had moderate coronary stenosis or a preexisting myocardial infarction in the region supplied by the dilated vessel. Thus contrast echocardiography seems to be suitable to assess alterations in myocardial blood flow during PTCA by determination of contrast decay half-time and T-t/2.

Angina Pectoris↗