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Biomedical subjects

D G Mathey

Publications and source records attributed to D G Mathey.

At least 37 records · Page 2Linked to original sources
PubMed1989

Bleeding after thrombolysis in acute myocardial infarction.

232 consecutive patients with acute myocardial infarction were treated either with 2 x 10(6) IU urokinase as an intravenous bolus injection, or 250,000 IU streptokinase intracoronary, or 60 mg recombinant tissue-type plasminogen activator (rt-PA) over 90 min. All patients enrolled had chest pain for more than 30 min and less than 3 h before admission and a typical electrocardiogram. Contra-indications to thrombolytic treatment were absent. All bleeding complications occurring within 24 h after admission were assumed to be due to thrombolytic therapy. Bleeding complications occurred in 14 patients (6.5%). Only seven patients received a blood transfusion (3%). No correlation was evident between previous hypertension, diabetes mellitus, smoking, sex, age, fibrinogen level before and 24 h after thrombolytic therapy and bleeding complications. The risk of bleeding was not significantly different between the different thrombolytic regimens despite marked differences in the fall of the fibrinogen level. The decrease of fibrinogen following thrombolytic therapy did not influence the patency rate of the infarct vessel. Thrombolytic therapy in acute myocardial infarction is a safe treatment even among patients advanced in years and with medically controlled hypertension and diabetes mellitus, irrespective of the kind of thrombolytic treatment.

Female↗
PubMed1989

Impact of compensatory enlargement of atherosclerotic coronary arteries on angiographic assessment of coronary artery disease.

To determine whether compensatory enlargement of atherosclerotic coronary arteries occurs and to what degree it affects the angiographic assessment of coronary artery disease, we performed postmortem coronary angiography of 30 human hearts with suspected coronary artery disease and studied 70 histologic cross sections of the proximal left anterior descending artery and proximal right coronary artery. Angiographic and morphometric analyses of 50 stenoses in proximal and middle sections of the left anterior descending artery, right coronary artery, and left circumflex artery were performed. The control group of 10 human hearts without suspected coronary artery disease was evaluated in the same way. For this purpose, coronary arteries were filled with a methylmethacrylic radiopaque resin at a pressure of 100 mm Hg and closely embedded in a methylmethacrylic resin by use of which shrinkage and mechanical artifacts could be avoided. The area circumscribed by the internal elastic lamina was taken as a measure of the area of the arterial lumen if no plaque had been present. The angiographic and corresponding morphometric degree of stenosis was assessed. A significant correlation (r = 0.85, p less than or equal to 0.0001) was found between the internal elastic lamina area and the area of the plaque (lesion area), suggesting that coronary arteries may enlarge as lesion area increases. With the morphometric degree of stenosis, the expected anatomic diminution of the coronary artery was abolished (r = 0.79, p less than or equal to 0.0001), indicating compensatory enlargement in atherosclerotic segments. Accordingly, the degree of stenosis assessed from in vitro angiograms was underestimated. Compensatory coronary enlargement of the stenotic segment was the main reason for angiographic underestimation. The underestimation factor of up to 3.50 for very mild stenoses decreased to 1.37 at an angiographic degree of 50% area stenosis and 30% diameter stenosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1989

Catheter atherectomy: functional results in peripheral arterial disease.

In 10 patients with peripheral arterial disease (PAD) atherectomy was performed with the Simpson atherectomy catheter. PAD was diagnosed by clinical evaluation, oxzillography, Doppler ultrasound examination, treadmill walking, and angiography. Eight patients belonged to stage II and 2 to stage IV. Two stenoses were located in the iliac artery, and the others in the superficial femoral artery or popliteal artery or both. The treadmill walking distance before the intervention ranged from 24 to 67 m before and 105 to 115 m after the procedure (speed 2 mph; gradient 12.5%). After atherectomy, the walking distance improved by 35% to 126%. No patient in stage II perceived pain. In these patients treadmill exercise was terminated because of dyspnea. The ankle/arm ratio (Doppler ultrasound) ranged from 0.4 to 1.0 before atherectomy with a mean improvement of 0.15 afterward (stages II and IV). Control angiography within three to six months in 4 patients did not reveal any significant change at the site of the original stenosis.

Aged↗
PubMed1989

[Myocardial noradrenaline content: a factor not considered up to now for the prognosis of patients with dilated cardiomyopathy].

To evaluate the prognosis of patients with idiopathic dilated cardiomyopathy (EF less than 50%) in 55 patients the myocardial catecholamine concentration, plasma catecholamine concentration, and left ventricular ejection fraction were determined. The follow-up time ranged from 7 to 47 months. At the time of follow-up 10 of the 55 patients (group A) had died and three had undergone hearttransplantation. Group A patients had a significant lower EF (27 +/- 10 vs 36 +/- 9%, p less than 0.03), a lower myocardial norepinephrine (254 +/- 168 vs 579 +/- 416 pg/mg, p less than 0.007), higher plasma norepinephrine (640 +/- 333 vs 372 +/- 254 pg/ml, p less than 0.008) and plasma epinephrine (391 +/- 340 vs 116 +/- 81 pg/ml, p less than 0.006) in comparison to patients, who were still alive and not transplanted (group B). Survival was significantly lower in patients with an EF less than 30%, a plasma norepinephrine concentration greater than 350 pg/ml, a plasma epinephrine concentration greater than 125 pg/ml, and a myocardial norepinephrine content less than 400 pg/mg. Cox regression analysis revealed that the ratio of plasma vs myocardial norepinephrine was the best prognostic indicator for patients with an EF less than 30% and this ratio plus the plasma norepinephrine concentration were the best prognostic indicators for the whole group of patients. These data suggest that myocardial norepinephrine content is an important prognostic factor in patients with idiopathic dilated cardiomyopathy.

Adult↗
PubMed1988

[Lysis treatment of left ventricular thrombi. Acute and long-term results].

Intravenous thrombolysis with urokinase (60,000 U/h) was undertaken in 15 patients with large thrombi in the left ventricle (demonstrated by echocardiography) after myocardial infarction. Complete lysis was achieved in ten, partial in four. None had post-thrombolysis signs of arterial emboli, two patients developed haematuria and one had partial separation of the thrombus which required operative removal. Four patients who had a mean ejection fraction of 37 +/- 12% had died a sudden cardiac death within six months of the thrombolysis. Nine patients survived for up to four years without recurrence of thrombi: seven of them had been treated with aspirin (acetylsalicylic acid), two with coumarin derivatives. Two patients could not be followed-up. These preliminary results suggest that large left-ventricular thrombi can be successfully lysed by intravenous thrombolysis without significant complications, probably without recurrent thrombi.

Adult↗
PubMed1988

Limitations in the interpretation of rest-exercise ejection fraction changes after early thrombolytic therapy during acute myocardial infarction.

The effect of exercise on left ventricular wall motion in the infarct and noninfarct regions, and their contribution to the global ejection fraction response to exercise was evaluated in 24 patients studied at least 2 weeks following thrombolytic therapy for acute myocardial infarction. To achieve this goal, a nonstandard protocol was used: contrast ventriculography was performed at rest and immediately following 3 minutes of supine bicycle exercise at 50 watts. Wall motion in the infarct and noninfarct regions was measured using the centerline method. The global ejection fraction response to exercise correlated poorly with the exercise response of motion in the infarct region (r = 0.38). In 15 of the 24 patients, the function of the infarct and noninfarct regions changed in opposing directions, and in only 8 (53%) of these did the global ejection fraction response follow the exercise response of motion in the infarct region. The motion of the noninfarct region was the predominant influence on the ejection fraction response in the other 7 patients. Subgroup analysis revealed that the global ejection fraction response was more dependent on the response of motion in the anterior wall (r = 0.71, p less than 0.001) than in the inferior wall (r = 0.16), regardless of infarct location. The regional wall motion response to exercise also better distinguished reperfused from nonreperfused patients than did the ejection fraction response. These results indicate that the global ejection fraction response to exercise may be an unreliable indicator of the functional status of the infarct region.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMed1988

Improved survival up to four years after early coronary thrombolysis.

The long-term prognosis after thrombolytic therapy in patients with acute myocardial infarction (AMI) is unknown. This question was investigated in a 4-year follow-up study of 227 patients. According to the status of reperfusion at the end of the acute catheterization, the patients were divided into a patent (n = 171) and an occluded (n = 56) group. Both hospital and 4-year mortality rates were significantly reduced in the patent group by 13 and 14%, respectively (p less than or equal to 0.005 for both). Baseline variables known to be important for prognosis did not differ between the 2 groups. Patients with a patent infarct artery who underwent early acute coronary artery bypass grafting (CABG) had a greater survival (p less than 0.10) and better left ventricular function (p less than 0.01) than did patients with a patent infarct artery who did not undergo CABG. This difference was associated with a lower frequency of fatal reinfarction and cardiogenic shock in the CABG group. Thus, survival is improved up to 4 years after successful thrombolysis and appears to be further enhanced by early CABG.

Cardiac Catheterization↗
PubMed1988

Recovery of left ventricular function after myocardial infarction can be predicted immediately after thrombolysis by semiquantitative intracoronary thallium and technetium pyrophosphate scintigraphy.

The accuracy with which intracoronary thallium and technetium pyrophosphate scintigraphy during intracoronary thrombolysis predicts myocardial salvage was studied in 58 patients with acute myocardial infarction by comparing the acute scintigraphic findings with subsequent left ventricular function. Scintigrams obtained before and immediately after thrombolysis were interpreted by three independent observers using a scoring system. Regional wall motion in the infarct area was determined from left ventricular (LV) cine angiograms using the center-line method. Patients with mild hypokinesis (hypokinesis less than or equal to -2 SD from normal) could be distinguished from those with severe hypokinesis (hypokinesis greater than -2 SD) using the prethrombolysis thallium score with an accuracy of 83%. Accuracy using the post-thrombolysis score was 76%. When the post-thrombolysis thallium and technetium pyrophosphate scores were combined, differentiation was possible in 91% of all patients studied, and in 100% of patients with anterior myocardial infarction. Thus, analysis of combined thallium and technetium pyrophosphate scintigraphy accurately predicts recovery of LV function after thrombolysis and may be helpful in deciding whether acute percutaneous transluminal coronary angioplasty or bypass surgery should be performed after thrombolysis.

Cardiac Output↗
PubMed1988

[Thallium single photon emission computed tomography following thrombolysis: missing relation to left ventricular function].

To address the question of whether infarct size after thrombolysis can comparably be estimated by thallium SPECT scintigraphy and contrast cineangiography, 32 patients in whom regional wall motion abnormality had been assessed by means of the "centerline" method, 10 to 21 days after infarction, underwent biphasic thallium SPECT scintigraphy with dipyridamole. There were no statistically significant correlations between left ventricular ejection fraction and the degree of hypokinesia in the infarct area on one hand, and thallium defect size in the early and late scintigram on the other. Hypokinesia was inversely correlated (r = -0.51) with the time interval from symptom onset to reperfusion, but no such correlation was found between thallium defect size and this parameter. In patients in whom reperfusion was achieved within 3 h of symptom onset, hypokinesia was significantly less (-1.11 +/- 0.6 standard deviations (SD] than in patients in whom reperfusion was achieved later (-2.16 +/- 0.8 SD; p less than 0.01). Thallium defect size, however, was not different in these two groups of patients. It is concluded that there is no close correlation between regional wall motion abnormality assessed subacutely after thrombolysis and infarct size determined by SPECT in the chronic state. Thus, impairment of left ventricular function may not be assessed from scintigraphic findings.

Adult↗
PubMed1987

Coronary thrombolysis with intravenous urokinase in patients with acute myocardial infarction.

Regional left ventricular wall motion, about two to three weeks after acute myocardial infarction (MI), is perhaps the best clinical measure of myocardial salvage and limitation of infarct size by thrombolytic therapy. Normal or only slightly depressed wall motion at the site of infarction indicates significant limitation of infarct size, whereas markedly abnormal wall motion indicates irreversible myocardial damage. Early studies found significant improvement in regional wall motion in only 40 percent of patients undergoing successful intracoronary thrombolytic therapy after the onset of symptoms of acute MI. Why only 40 percent of these reperfused patients demonstrated salvage of ischemic myocardium could not be answered at that time. Animal experiments show that the duration of coronary occlusion is an important factor in determining myocardial salvage after reperfusion. To study whether this time dependency also exists under clinical circumstances in patients with coronary artery disease, the relationship between regional wall motion (as an index of infarct size) and the time to thrombolytic therapy after the onset of symptoms (as an index of duration of coronary occlusion) was examined. After showing that such time dependency does indeed exist in patients with acute MI, the efficacy and safety of intravenous bolus injections of urokinase were then demonstrated.

Coronary Disease↗
PubMed1987

Relationship between myocardial norepinephrine content and left ventricular function--an endomyocardial biopsy study.

To analyze the relationships between left ventricular function, catecholamine concentrations in plasma and myocardium, and morphological alterations, 20 patients were studied. Fifteen patients had idiopathic dilated cardiomyopathy, and 5 had normal left ventricular function. All patients underwent right ventricular endomyocardial biopsy to determine muscle fibre thickness, percent volume fraction of interstitium, and myocardial catecholamine content. Blood was sampled to measure plasma catecholamine concentrations, and left ventricular cineangiography was performed to determine global ejection fraction. In a simple correlation analysis a significant correlation was found between left ventricular ejection fraction and myocardial norepinephrine content (r = 0.80, P less than 0.001). Left ventricular ejection fraction was negatively correlated with plasma epinephrine concentration (r- = 0.53, P less than 0.02), and with muscle fibre thickness (r = -0.50, P less than 0.03). Myocardial norepinephrine concentration was negatively correlated with plasma epinephrine (r = -0.62, P less than 0.01). Multiple linear regression analysis revealed a strong correlation between myocardial norepinephrine depletion and left ventricular dysfunction, which was independent of all other variables. These data suggest that myocardial norepinephrine depletion determined from right ventricular endomyocardial biopsies strongly correlates with left ventricular dysfunction in idiopathic dilated cardiomyopathy, and seems to be independent of the degree of muscle fibre hypertrophy, volume fraction of interstitium, and of the increased sympathetic tone.

Biopsy↗
PubMed1987

Right ventricular ejection fraction from equilibrium krypton-81m blood pool scans: a noninvasive predictor of pulmonary arterial hypertension.

Based on the relation between the impedance to right ventricular ejection and ejection fraction of the right ventricle (RVEF) we tested the hypothesis that radionuclide RVEF correlates inversely with pulmonary artery pressure and allows the noninvasive prediction of pulmonary hypertension. A recently developed improved equilibrium right ventricular blood pool imaging technique using ultrashort-lived krypton-81m and simultaneous right heart catheterization were combined for assessment of right ventricular systolic performance in relation to right ventricular loading in a heterogeneous group of cardiopulmonary disorders. The study group included 9 patients with pulmonary artery hypertension secondary to left ventricular dysfunction, 5 with primary pulmonary hypertension, 5 with corrected tetralogy of Fallot, and 10 normal subjects. Linear regression analysis between radionuclide RVEF and simultaneously recorded hemodynamic measurements of right ventricular loading revealed a significant inverse correlation with mean PA pressure (r = -0.87; P less than 0.001), with total pulmonary resistance index (r = -0.81; P less than 0.001) and with pulmonary vascular resistance index (r = -0.78, P less than 0.01). The sensitivity and specificity of a resting RVEF less than 40% to indicate pulmonary hypertension (mean PA pressure greater than 20 mmHg) were 71% and 100%, respectively; positive and negative predictive values were 100% and 80%, respectively. Thus, radionuclide RVEF as a parameter of right ventricular systolic performance is predominantly dependent on right ventricular afterload and has the potential for the noninvasive prediction of pulmonary hypertension in a heterogeneous group of cardiopulmonary disorders.

Humans↗
PubMed1987

Hemodynamic and neurohumoral response to hydralazine versus captopril: a controlled study in idiopathic dilated cardiomyopathy.

To study the hemodynamic and neurohumoral effects of hydralazine versus captopril after the first dose, 15 patients with idiopathic dilated cardiomyopathy (NYHA Class II and III) were included in a crossover trial with a washout period of three days. Hemodynamic parameters were measured by using a Swan-Ganz thermodilution catheter, and venous blood was sampled during supine rest and standardized upright exercise before (control) and 60 min after drug administration. Compared to the control phase, hydralazine induced an increase in heart rate and cardiac index (p less than 0.01), and a decrease in mean arterial pressure and pulmonary wedge pressure (p less than 0.01, p less than 0.05, respectively). The hemodynamic effects were associated with increased norepinephrine plasma concentration during upright exercise (p less than 0.05) and increased plasma renin activity (p less than 0.01). After administration of captopril, heart rate at rest (p less than 0.05), mean arterial pressure, and pulmonary wedge pressure decreased significantly (p less than 0.01). Cardiac index remained unchanged. Norepinephrine plasma concentrations were not significantly influenced despite a tendency to lower levels during upright exercise. Plasma renin activity increased (p less than 0.01) and aldosterone at rest decreased significantly (p less than 0.05). These differences in neurohumoral response between both drugs may be important for their long-term effects.

Adult↗
PubMed1987

[Left ventricular diastolic function in PTCA: a Doppler echocardiographic study].

The measurement of left ventricular inflow by Doppler echocardiography provides a continuous, non-invasive assessment of parameters of diastolic function. We studied changes in left ventricular diastolic function during percutaneous transluminal coronary angioplasty (PTCA) of the left anterior descending coronary artery (LAD). In ten patients, the diastolic flow velocity profile across the mitral valve was measured by Doppler echocardiography, before and 60 s after inflation and 60 s after deflation of the balloon. The peak velocity of early diastolic filling (VE) significantly decreased during angioplasty, from 68 +/- 12 to 56 +/- 10 cm/s (p less than 0.001), while the peak velocity of late diastolic filling caused by atrial contraction (VA) showed no change. This resulted in a significant decline in the diastolic velocity ratio (VE/VA) from 1.11 +/- 0.47 to 0.92 +/- 0.35 (p less than 0.01). The total area under the diastolic flow velocity profile representing the total filling volume fell from 14.3 +/- 4.1 to 10.9 +/- 3.6 cm (p less than 0.001). The early diastolic filling fraction decreased from 68 +/- 5% to 64 +/- 7%, in favor of the filling fraction due to atrial contraction, which increased from 32 +/- 5%, to 36 +/- 7% (p less than 0.01). 60 s after deflation of the balloon, the parameters of diastolic filling returned to baseline values. We conclude from our results that diastolic dysfunction caused by angioplasty of the LAD results in a decrease in early diastolic left ventricular filling, which is completely reversible after 60 s.

Adult↗