Biomedical subjects

F Holm

Publications and source records attributed to F Holm.

At least 19 recordsLinked to original sources

PubMed2004

[Main clinical and surgical determinants of in-hospital mortality after surgical revascularization of left main coronary artery stenosis: 2 year retrospective study (1998-1999)].

UNLABELLED: Stenosis of left main coronary artery (LMCA) is a common finding on coronary angiographies (7 to 10%). Mortality is very high for conservative therapy in comparison with surgery, which provides very good long-term outcome and is accepted as the standard therapy of this condition. Over the last few years, percutaneous coronary intervention (PCI) has become a new alternative in selected patients. AIM OF THE STUDY: To assess in hospital mortality in subjects referred to our surgical unit for coronary artery bypass grafting (CABG) and to identify the main clinical and surgical determinants of in-hospital mortality. METHODS: Two year retrospective analysis (1998-1999) of in-hospital mortality and morbidity of patients having left main stenosis referred for CABG. RESULTS: Among a group of 1443 patients operated for coronary heart disease, LMCA stenosis was found in 330 patients (22.9%). The mean age was 63 +/- 8.6 years. Elective surgery was done in 173 patients (52.4%), and acute operation (i.e. urgent, emergent or desperate) in 157 patients (47.6%). The total in-hospital mortality was 4.2% (14/330). Elective surgery in-hospital mortality was 1.7% (3/173) and urgent surgery in-hospital mortality was 7% (11/157). The main risk factors of in-hospital mortality were age > 68 years, low ejection fraction (LVEF<0.4), history of myocardial infarction, gender (female) and urgency of the operation. CONCLUSION: The proportion of patients undergoing CABG for left main stenosis is relatively high in our center and their mortality is quite low especially for elective operations. As the mortality of patients treated by PCI for LMCA stenosis is similar to surgery in high-risk patients, we postulate that this approach can be a real alternative treatment for such patients. Because of its potential benefit, combined revascularisation is also an alternative that should be considered in some cases. Furthermore, as a new generation of coated stents has emerged in the treatment of restenosis after PCI, we hypothesize that this method can in the near future be accepted as equivalent to surgery. However several randomized clinical trials must first be conduced prove this point.

Age Factors↗

PubMed2004

[Effect of primary coronary angioplasty on long-term prognosis in patients with diabetes mellitus].

OBJECTIVES: To investigate feasibility and safety of primary PCI in diabetic patients. BACKGROUND: Diabetic patients with acute myocardial infarction (AMI) have been shown to be at high risk for adverse clinical outcomes. Limited data is available on long term prognosis of diabetics treated with primary PCI. METHODS: Retrospective analysis of consecutive 67 diabetic patients and 211 non diabetic patients treated with primary PCI from 1/1995 to 12/1999, follow up for 38 +/- 12 months. RESULTS: The baseline characteristics were comparable in both groups. The mean age was 62 years in diabetic patients and 59 years in non diabetic patients. Hypertension (50% vs. 36%, p = 0.05), contraindications to thrombolytic treatment (13.4% vs. 5.7%, p = 0.037), cardiogenic shock (16.4% vs. 7.1%, p = 0.023), multivessel disease (34% vs. 23%, p = 0.07) and longer time delay to treatment (240 vs. 180 min., p = 0.05) were more often present in diabetic group. 47% of diabetic and 42% of nondiabetic patients received stents. The TIMI 2 or 3 flow rates were reached in 91% of diabetic patients and in 90% of nondiabetic patients, but TIMI 2 flow was found more often in diabetics (9% vs. 2.4%, p = 0.016). Higher rate of bleeding complications leading to significant change in the blood count (7.5% vs. 1.4%, p = 0.01) and higher 30 day mortality (11.9% vs. 5.2%, p = 0.05) was observed in diabetic group. However when the shock patients were excluded from the analysis, the 30 day mortality was different insignificantly in both groups (4.5% vs. 2.4%, p = 0.36). During follow up of 259 acute phase survivors 24 patients died. There was a trend to higher total long term mortality (22.3% vs. 13.2%, p = 0.07) and higher rate of nonfatal reinfarction (13.4% vs. 6.2%, p = 0.05) in diabetic group. CONCLUSIONS: Primary PCI is safe and effective treatment of diabetic patients presenting with AMI. The higher rate of slow flow in infarct related artery after PCI observed in diabetics can be one of reasons for higher 30 day mortality in this group. Mean ischemic time in diabetics is behind the 4 hour border, where the possible benefit from reperfusion decreases. The main reason for higher mortality in our diabetic group was the higher rate of cardiogenic shock. Higher risk of bleeding complications at puncture site in diabetic patients can be explained by the lower quality of vessel wall.

Angioplasty, Balloon, Coronary↗

PubMed2003

[Effect of delaying reperfusion therapy with PTCA on long term prognosis in patients with acute myocardial infarct].

BACKGROUND: The benefit of thrombolysis in patients with acute myocardial infarction (AMI) strongly depends on the time from onset of symptoms to the initiation of treatment. For AMI patients treated with PTCA this time seems to be important only to a certain time level. The aim of this study was to assess the influence of time to treatment of AMI with coronary angioplasty on short term and long term prognosis. METHODS: We followed 339 consecutive AMI patients treated with coronary angioplasty from 1995 to 1999 in a cardiac care unit. Patients were divided to five groups according to time to treatment. RESULTS: Time to treatment < 90 min. was achieved in 35 (10.5%); 91-210 min. in 105 (31%); 211-330 min. in 72 (21%); 331-690 min. in 74; > 691 min. in 53 (15.5%) patients. Ischemic time (time from symptom onset to reperfusion) in the groups was < 2 h.; 2-4 h.; 4-6 h; 6-12 h; > 12 h. respectively. The ejection fraction of left ventricle 3-5 days after AMI was 50%, 51%, 45%, 40%, 46% and the 30 day mortality was 5.7%, 2.9%, 11.1%, 10.8%, 11.3% in the groups respectively, showing no significant differences between the groups. However the higher rate of TIMI 3 flow was achieved in patients with time to treatment shorter than 3.5 h. compared to patients treated later (93.6% vs. 83.9%, p = 0.007). The lower 30 day mortality (3.6% vs. 11.1%, p = 0.012), lower 3 year mortality (8.6% vs. 19.1%, p = 0.003), lover frequency of heart failure during hospitalisation (11.4% vs. 28.1%, p < 0.001) as well as lower maximal level of released kreatinkinase (32 +/- 29 vs. 44 +/- 39 mukat/l, p = 0.005) was observed in patients treated within 3.5 h. from symptoms onset compared to patients treated later. CONCLUSION: The success rate of primary PTCA to achieve normal flow in infarct related artery is high, but decreases when treatment is started later than 3.5 h. from AMI onset. The short term and long term mortality as well as incidence of heart failure during acute phase is lowest when the intervention was started within 3.5 h. from symptoms onset. Initiation of intervention after 3.5 h. resulted in significant mortality increase, but further delay of treatment had minimal impact on patients prognosis. Great effort needs to be paid to start the primary PTCA within 3.5 h. from AMI onset in as many patients as possible. From our data we can indirectly conclude: patients without a chance for reperfusion with thrombolytic therapy within 4 h. from symptoms onset should be considered candidates for PTCA regardless the time of transportation. In patients with chance to reperfuse infarct related artery within 4 h. from symptoms onset with thrombolytic treatment (thrombolysis needs to be started before 2.5-3rd h.) while having low probability to start PTCA within 3.5 h., the thrombolysis should be given first and PTCA performed later if needed.

Angioplasty, Balloon, Coronary↗

PubMed2003

[Comparison of the occurrence of positive and negative vascular remodeling in patients with stable vs unstable angina pectoris].

BACKGROUND: The vascular remodelling refers to the increase or decrease in EEM (external elastica membrane) area that occurs during development of atherosclerosis. The positive remodeling, which was thought only as a compensatory factor during atheroma development, was also found as a one of the main features of unstable plaque. The intravascular ultrasound is very good tool to measure different type of arterial remodelling. These findings correlate with histologic post-mortem specimen with excellent results. AIM OF THE STUDY: To correlate the remodelling index from patients suffered from stable angina pectoris (SAP) and from patients suffered from unstable angina (UA). METHOD: We performed IVUS in 51 patients. In the group of patients with unstable angina were included patients with worsening angina symptoms in last six weeks or with angina in rest. We used IVUS--endosonics In-Vision with 30 MHz probe Awanar with mechanical pull-back. We studied the occurrence of positive remodelling, negative remodeling (an index that describes remodeling is expressed as: lesion EEM CSA/reference EEM CSA. If the lesion EEM area is greater than the reference EEM area, positive remodelling has occurred, and the index will be > 1.0. If the lesion EEM area is smaller than the reference EEM area, negative remodelling has occurred, and the index will be < 1.0). RESULTS: We performed the intravascular ultrasound in 51 patients, 22 patients (43.1%) with unstable angina (UA) and in 29 patients (56.9%) stable angina (SAP). The positive remodelling was found in 14 patients (63.6%) in UA group vs. 5 patients (17.2%) in group with SAP, p < 0.05. The negative remodelling was found in 6 patients (27.3%) in UA group vs. 23 patients (79.3%) in SAP group, p < 0.05. CONCLUSION: Positive remodelling is more often found in patients with UA vs. in patients with SAP. Positive arterial remodelling is therefore one of the features of unstable atherosclerotic plaque.

Angina Pectoris↗

PubMed2003

[Idiopathic aneurysm of the pulmonary artery].

Aneurysm of pulmonary artery (PAA) is relatively rare clinical finding and appears mostly in association with significant cardiovascular or pulmonary abnormalities and is frequently caused by pulmonary hypertension. Its diagnosis is not difficult. However, guidelines for the treatment were not yet established. Patients with PAA are at risk for sudden death by a rupture of aneurysm. Therefore, surgical correction (graft replacement) is the method of choice. Nevertheless, it seems that certain group of patients with asymptomatic idiopathic aneurysm of pulmonary artery without presence of any serious cardiovascular or pulmonary abnormality can profit from conservative approach. We refer a 62-years old man with idiopathic PAA, in whom we did not indicate surgical correction. However, the long-term follow-up is necessary.

Aneurysm↗

PubMed2003

[Long-term treatment with statins in patients with ischemic heart disease after coronary angioplasty].

UNLABELLED: Long-term statin therapy is the corner-stone in management of patients with coronary artery disease. PURPOSE OF STUDY: The aim of our study was to analyze the state of the statin therapy at patients undergoing percutaneous coronary intervention (PCI) and to determine predictors of long-term statin treatment. METHODS: We performed a retrospective study in 520 patients who underwent percutaneous coronary angioplasty in 2nd Dept. of Internal Medicine, 1st School of Medicine, Charles University, Prague during the year 2000. Data were collected from hospital records and from a mailed questionnaire. RESULTS: The response rate was 61.9% and the average response time was 11.6 +/- 3.5 months after PCI. Long-term statin therapy was prescribed in 52.5%. In patients with hypercholesterolemia 67.1% were treated in comparison with 32.3% treated patients without this diagnosis (p < 0.0001). Patients aged 70 years and older were treated significantly less frequently then younger individuals (30.6% vs. 61.3%, p < 0.0001). Patients with a history of prior revascularization procedure were treated significantly more often then patients undergoing the first procedure (64.8% vs. 49.8%, p < 0.05). Multivariate logistic regression analysis was applied to detect significant predictors of long-term statin therapy. Only hypercholesterolemia and statin prescription at discharge were identified as independent positive predictors, whereas age > or = 70 years and male gender had negative predictive value. CONCLUSION: By course of evidence-based medicine, patients who underwent PCI in our study are undertreated by statins. Statin treatment should be initiated in all patients treated by PCI with increased cardiovascular risk. Patients at defined risk for undertreatment are mainly older patients and men. The prescription of statin therapy at the time of hospital discharge appears to be a very effective tool to improve long-term statin therapy.

Aged↗

PubMed2003

[Pharmacologic therapy of acute coronary syndromes].

Acute coronary syndromes (ACS) are caused by neoinclusive thrombosis of the coronary artery. Arterial atherothrombosis usually results from a cracked atheroma plate and includes platelet and plasmatic component of coagulation. The aim of pharmacological treatment is to influence activated platelets and plasma procoagulant activity. Several clinical studies have demonstrated the benefits of antithrombotic treatment by acetylsalicylic acid, clopidogrel and by blockers of platelet receptors IIb/IIIa. In ACS anticoagulant therapy the non-fractionated heparin are replace ed by low-molecular heparins. The new standard in ACS therapy should become a combination of the acetylsalicylic acid, enoxaparine and clopidogrel. Blockers of platelet receptors IIb/IIIa should be given namely to patients indicated for the early invasive treatment.

Acute Disease↗

PubMed2003

[Comparison of the morphology of atherosclerotic plaques in patients with stable angina pectoris and acute coronary syndrome using intravascular ultrasonography].

The article summarises present knowledge on the differences in the structure of atherosclerotic plaques in patients with stable angina pectoris and in those with acute coronary syndrome during intravascular ultrasound examination. Authors describe differences in the pathologic anatomy and also in the clinics. The review includes pictures of the typical structural features and references of papers with similar topics.

Acute Disease↗

PubMed2003

[Long-term prognosis in patients with acute myocardial infarct and treatment with direct coronary angioplasty].

BACKGROUND: Primary coronary angioplasty (PTCA) has a beneficial effect on the immediate prognosis for patients with acute myocardial infarction. Number of information about effects of direct PTCA on the long-term prognosis are less numerous. The aim of the work was to establish the long-term prognosis for not-selected patients treated by direct PTCA. METHODS AND RESULTS: The studied group consisted of 279 patients with acute myocardial infarction treated by direct PTCA in years 1995 to 1999 for the period of 38 +/- 12 months. Part of them were out-door patients of our clinic. The necessary data of the other patients were obtained by a questionnaire and by a telephone contact. 45 (16%) patients were lost from the follow up. The mortality rate of the study group was compared with data in the central register of Czech Republic. Positive angiographic effect of the direct PTCA (residual stenosis < 50% + flow TIMI 3) was achieved in 90% of patients. 30-day mortality was 6.8%, after excluding patients with cardiogenic shock it decreased to 3.2%. 6 patients (2.2%) had non-fatal infarction within 30 days after the first attack. From 259 patients who survived the acute infarction phase 24 died during the next period of follow up, 18 (7%) patients had a relapse of non-fatal infarction. PTCA of the infarcted artery was done in 15% of patients, PTCA of another artery in 9% of patients. The aorthocoronary bypass was indicated in 6% of patients. Almost half of relapses occurred during the first year after the hospitalisation. The risk factors of the death during the follow up were the age > 70 years, ejection fraction < 35%, impairment of 3 or more coronary artery branches, i.m. in the history, duration of ischemia > 4 hours, and diabetes mellitus. The total mortality was 11.4% in the first year, 1.4% in the second and 3.3% in the third year of the follow up. CONCLUSIONS: The beneficial prognostic effect of the direct PTCA on patients with acute infarction carries through the whole period of follow up. Prognosis of the risk patients remains critical. Next revascularization of the infarcted artery was in our cohort of patients necessary in 21% of patients.

Angioplasty, Balloon, Coronary↗

PubMed2002

[Direct percutaneous transluminal coronary angioplasty in patients with acute myocardial infarct treated at the Cardiac Center of the General Medical School Hospital in Prague: a 1-year retrospective study].

UNLABELLED: Direct percutaneous transluminal coronary angioplasty (d-PTCA) in patients with acute myocardial infarctions (AIM) has become an alternative of thrombolytic treatment. If the involved department has adequate experience the success rate of the procedure is high and the immediate and long-term results are better than those of thrombolysis. Moreover contrary to thrombolytic treatment successful percutaneous coronary intervention in AIM is more beneficial for patients also later than 6 hours after the development of infarction pain. In the Cardiocentre of the General Faculty Hospital (GFH) patients with AIM are constantly attended, i.e. those indicated for reperfusion therapy are treated solely by the d-PTCA method. OBJECTIVE AND METHOD: Retrospective analysis of d-PTCA in AIM made during the annual period from Jan. 1 2000 to Dec. 31 2000. Into the observation study patients were included with clinical and/or ECG signs of AIM when the period from the onset of pain to the beginning of intervention did not exceed 12 hours. All patients were given before the procedures 500 mg of acetylsalicylic acid and 10,000 u. heparin. Cardiac catheterization was implemented by the percutaneous Seldinger technique via the a. femoralis l.dx., in exceptional cases from the left femoral artery. An approach via the a. radialis and/or a. brachialis was not used in any of the patients. From the investigation patients were excluded who had before the percutaneous coronary intervention (PCI) a thrombolytic preparation (so-called rescue-PTCA). RESULTS: During the mentioned period in the Cardiocentre of the GFH a total of 673 PTCA were performed, incl. 127 (18.9%) d-PTCA in patients with AIM. In the mentioned group of 127 patients subjected to intervention were 87 (68.5%) men and 40 (31.5%) women. The mean age of the men was 59.1 +/- 12 years and the mean age of the women 68.2 +/- 12 years. As to the main risk factors of coronary atherosclerosis arterial hypertension was present in 48%, smoking in 42%, diabetes in 23% and hyperlipoproteinaemia in 31% of the treated patients. More than one third of the patients had a history of myocardial infarction (38%). The infarcted artery was the r. interventricularis anterior (LAD) in 51 (40.2%), the right coronary artery (RCA) in 54 (42.5%), the r. circumflex (LCX) in 16 (12.6%), the left main coronary artery in 2 (1.6%) and the bypass in 4 (3.1%). Multiple coronary affections were recorded in 80 (63%) patients, affections of one artery in 47 (37%). Primary procedural success (flow TIMI 3/2) was achieved in 121 patients (95.3%). Normal flow through the infarcted artery TIMI 3 was achieved in 118/127 (85.8%) patients. In 91 (71.7%) into the infarcted artery a coronary stent was implanted, during hospitalization no subacute stenosis of the stent developed. The mean period between the onset of infarction pain--injection was 4.4 +/- 2.3 hours. The mean period of the entire procedures was 48 +/- 14.5 minutes. As contrast material only non-ionic contrast substances were used (Iomeron 350) with a mean consumption of 150 ml per patient. The mean skiascopic time was 13.6 +/- 1.8 min. A total of 9 (7.1%) patients were treated with GP IIb/IIIa receptor blockers (abciximab). The total hospitalization mortality of the intervened group was 7.1% (9 patients). In a sub-group of 9 patients who at the onset of the procedure were in cardiogenic shock 3 (33%) died. The hospitalization mortality of the sub-group of patients with AIM without cardiogenic shock, treated with d-PTCA was 5.1% (6/118). During hospitalization the authors did not observe any intracranial haemorrhage. DISCUSSION: The group of subjects with AIM subjected to catheterization who are treated by d-PTCA is relatively numerous in our department. According to a number of clinical studies successful d-PTCA in AIM gives better short-term and long-term results as compared with thrombolytic therapy. The primary success rate of d-PTCA was high and the hospital mortality was low and comparable with contemporary data in the literature. CONCLUSION: Direct PTCA is effective treatment in patients with acute myocardial infarction. The authors results confirm the high procedural success rate and acceptable hospital mortality. These favourable results of an invasive approach to treatment of AIM must be compared in future with bolus thrombolytic treatment by new types of thrombolytic preparations in combination with anti-platelet treatment with blockers of platelet glycoprotein receptors IIb/IIIa with/or without subsequent percutaneous coronary intervention.

Aged↗

PubMed2002

[Video-assisted myocardial revascularization and left-sided minithoracotomy using the Symmetry automatic connector].

OBJECTIVE: Introduction of the new method of videoassisted multiple direct revascularization of the heart muscle from left-sided minithoracotomy (LAST--Left Anterior Small Thoracotomy) using an automatic connector of central anastomoses Symmetry (St. Jude Medical ATG, Inc., St. Paul, MN) in patients indicated for re-operation of bypasses of the coronary arteries or with pathological conditions of the sternum and for the cosmetic effect of submammary incisions in women. METHOD: From September 2001 to the end of February 2002 15 patients with affections of three arteries had an operation from a LAST approach with videoscopic construction of central anastomoses by means of a Symmetry connector with portal entries and the use of extracorporeal circulation introduced from the groin without cardioplegic arrest. Nine men and six women were operated with a mean age of 68.7 years and a mean ejection fraction (EF) of 58.2%. In seven instances reoperation of aortocoronary bypasses was involved; two patients with multiple myelomas (morbus Kahler) had a brittle and cavernously altered sternum, all six women wanted a small skin incision below the breast. The criterion for ruling out the mentioned procedure was marked atherosclerotic affection of the ascendent aorta, affection of the arteries in the aortoiliac area and affection of one or two coronary arteries suitable for miniinvasive revascularization without extracorporeal circulation. Fourteen patients had an angiographic check up examination of the patency of grafts before they were discharged. RESULTS: The total number of distal anastomoses per patient was 3.13 +/- 0.6, the median period of extracorporeal circulation was 112 +/- 34 minutes and the mean time of operation 186 +/- 52 minutes. Blood losses were on average 425 ml/24 h without necessity of revision on account of haemorrhage. Eleven (73%) patients were subjected to an ultra fast track protocol with extubation on the operating table. The mean time spent in the postoperative department was 8.6 hours and the total hospitalization period 5.5 days. None of the operated patients died. Peroperative ischaemia of the heart muscle was not observed, in one instance the authors observed a newly developed atrial fibrillation. During an angiographic check-up the authors detected 6 (13.6%) stenoses and occlusions in 44 checked bridged vessels. CONCLUSION: The alternative approach reduces the risk of cardiac injury during reoperation and the danger of impaired healing of the sternotomical wound in patients with pathological conditions of the sternum, with contamination of the surrounding tissue (e.g. in tracheostomy) or malignant disease. The cosmetic effect of the submammary incision, the small inguinal incision and endoscopic saphenous vein harvesting should be considered in elective direct revascularization of the heart muscle in women. Bridging of the coronary arteries with optical assistance from minithoracotomy and with an automatic connector of central anastomoses seems to be a safe alternative of standard sternotomy only with methodological but not anatomical or functional restriction.

Aged↗

PubMed2001

[Complications in administration of contrast media in the catheterization laboratory: a 5-year retrospective study].

UNLABELLED: Iodine contrast substances (CS) are used since the twenties of the 20th century. From the chemical aspect benzoic acid derivatives are involved which are classified according to their osmolality (high-low- and isoosmolar) tendency of ionization (ionic and non-ionic) and according to the molecular structure monomers and dimers). Side-effects are due to their osmotic, ionic and chemical action on tissues. They include a number of systemic and organ symptoms (cardiovascular, immunological, haemocoagulation, neurological and renal), from the clinical aspect divided into mild, medium severe and severe. The relatively high incidence of undesirable reactions when ionic high-molecular CS are used led to the-development of non-ionic preparations with a lower osmolality, the more extensive use of which is limited by economic factors. Moreover so far convincing clinical data are lacking that the higher incidence of undesirable reactions after the use of CS has a clinical impact. OBJECTIVE: To summarize experience with administration of CS in the catheterization laboratory of the Cardiocentre of the General Faculty Hospital during diagnostic and intervention procedures within 5 years with regard to the occurrence of undesirable effects when comparing ionic and non-ionic CS. METHOD: Retrospective analysis of a group of patients examined in the catheterization laboratory to whom a CS was administered during the period between Jan. 1 1995 and Dec. 31 1999. RESULTS: In 1995-1999 (5 years) in the catheterization laboratory a total of 10,149 procedures where implemented where ionic (ioxitalam-Telebrix 350) and non-ionic (iopromide Ultravist 370, ioversol--Optiray 370 and iomeprol-Iomeron 350) contrast substances were administered. Ionic CS were administered in 4,668 (46%) and non-ionic CS in 5,481 (54%) instances. Undesirable effects were recorded in a total of 107 (1.1%) patients, incl. ventricular fibrillation in 76 (0.75%), cardiac arrest in 12 (0.12%) and in 19 (0.19%) there were other undesirable effects (weakness, nausea, hypotension, flush, urtica etc.). Ionic and non-ionic CS participated equally in complications: ionic CS in 53 (49.5%) cases and non-ionic CS in 54 (50.5%), whereby no difference was observed in the type of complications. No death in conjucntion with administration of CS was observed. CONCLUSION: The use of contemporary contrast substances in the catheterization laboratory for diagnostic and intervention procedures on the heart is relatively safe with a minimal risk of development of serious complications. No difference was observed between the use of ionic and non-ionic CS.

Cardiac Catheterization↗

PubMed2000

[Humoral profile of patients with severe aortic stenosis].

BACKGROUND: While the effect of neurohormones is often studied in congestive heart failure, their role in aortic stenosis needs to be elucidated. METHODS: 54 consecutive patients with symptomatic aortic stenosis without overt heart failure were studied at the age of 64.4 +/- 9.3 yrs with echocardiography, x-ray and catheterization. Levels of circulating atrial natriuretic factor endothelin-1, catecholamines, plasma renin activity, immunoreactive insulin and C-peptide were assessed, related to hemodynamic data and compared to those in 23 healthy controls, aged 59.2 +/- 12.8 yrs. RESULTS: Patients had significantly higher plasma levels of endothelin-1 (z-value 0.64 +/- 1.19, p = 0.019), atrial natriuretic factor (z-value 2.46 +/- 2.46, p < 0.001) and dopamine (z-value 0.91 +/- 2.33, p = 0.02). Levels of endothelin-1 and ANF positively correlated with mean (r = 0.631, p < 0.001) and wedged pulmonary artery pressures and with left atrial diameter index (r = 0.602, p < 0.001). Endothelin-1 levels correlated negatively with aortic valve area (r = -0.306, p = 0.041). No correlation was found between neurohumoral plasma concentrations and left ventricular mass index. CONCLUSIONS: In patients with symptomatic aortic stenosis without overt heart failure, elevated plasmatic levels of endothelin-1, atrial natriuretic factor and dopamine were documented. The increase of ET-1 levels is related to pulmonary hypertension and severity of the disease. Left ventricular hypertrophy is not related to neurohormonal levels. Neither circulating system renin-angiotensin nor noradrenaline are activated in these patients.

Adult↗

PubMed1997

[Effect of a revascularization procedure on functioning of the hibernating myocardium].

Persistent abnormalities of left ventricular wall motion in patients with chronic coronary artery disease can be reversed by successful coronary artery bypass surgery or coronary angioplasty. The identification of hibernating myocardium has therefore important therapeutic and prognostic implications. Echocardiography with low dose dobutamine infusion can detect viable myocardium in patients with chronic left ventricular dysfunction. We have studied 32 patients with angiographically confirmed coronary artery disease and left ventricular dysfunction. The effect of dobutamine infusion (5 micrograms/kg/min. followed by 10 micrograms/kg/min) on left ventricular function was evaluated before coronary revascularization (PTCA, n = 20); CABGm b = 12) and compared with early period after revascularization (1-7 days) and 6-7 months later. Before revascularization 226 segments were hypokinetic, akinetic or dyskinetic, improvement was observed in 122 segments during dobutamine echocardiography. Mean (+/- SD) segment score indexes were 2.50 +/- 0.17 at baseline, 2.04 +/- 0.19 (p < 0.001) after dobutamine infusion, 2.24 +/- 0.25 (p < 0.001) early after and 1.87 +/- 0.25 (p < 0.001) late after revascularization. Sensitivity of dobutamine infusion to predict improvement early and late after revascularization was 84% and 85% respectively, specificity was 85% and 90% respectively. Echocardiography during low dose dobutamine infusion is save and accurate method for identifying of hibernating myocardium and predicts early and late reversibility of wall motion in selected patients with coronary artery disease and chronic left ventricular dysfunction.

Cardiotonic Agents↗

PubMed1995

[Aneurysms of the left atrium and left atrial appendage].

BACKGROUND: The authors deal with the problem of rare congenital and acquired aneurysm of the left atrium and auricular appendage. The authors attempted to compare findings on operation with results of preoperative examinations and evaluate the yield of echocardiographic and angiocardiographic examinations. METHODS AND RESULTS: The authors had the opportunity to encounter this unusual finding of cardiac aneurysms in five patients operated in 1987-1990 on account of an advanced mitral defect associated in two patients with ischaemic heart disease. In all patients acquired aneurysms were involved. In two a large thrombus was found. CONCLUSIONS: In the diagnosis of aneurysms of the left atrium and auricular appendage transoesophageal echocardiography proved to be the most reliable method.

Aged↗

PubMed1993

[Indications for cornary angiography].

This is a summary of relative indications for the selection of patients for coronary angiography. Coronary angiography is an important part of clinical evaluation of patients with ischemic heart disease, valve heart disease, cardiomyopathies. Main groups of patients with ischemic heart disease are: angina pectoris after low levels of effort despite a good medical treatment, unstable angina, variant angina, angina with high risk of acute coronary syndromes from noninvasive exercise testing. In addition coronary angiography is indicated in patients with unexplained congestive heart failure, in patients with acute myocardial infarction with mechanical complication requiring cardiac surgery such as hemodynamically important mitral insufficiency, large ventricular septal defect or a large aneurysm leading to heart failure. Also in patients with sudden death syndrome unrelated to acute myocardial infarction. Patients with silent ischemia with known coronary artery disease and with known risk factors should undergo coronary angiography. Indication for coronary angiography is also in patients with hemodynamically important valvular, subvalvular or supravalvular heart disease in whom corrective surgery is contemplated.

Coronary Angiography↗

PubMed1993

[Uncommon indications for coronary angioplasty].

During the period between March 16, 1989 and October 7, 1992 at the Second Medical Clinic of the First Medical Faculty, Charles University Prague a total of 173 coronary angioplasties were performed. With expanding experience and greater availability of controllable super thin conductors and balloon catheters with a small profile, gradually the indication criteria of coronary angioplasty were extended. In 93.1% of patients simple balloon dilatation of a significant stenosis of the coronary arteries was performed and in 6.9% before dilatation in addition an attempt of recanalization of a chronic occlusion of the coronary artery was made. In 74% of the patients one coronary stenosis was dilated, in 16.7% several stenoses, in 1.2% of the patients a covered stenosis of the trunk of the left coronary was dilated and in the same number an aortocoronary bypass was performed. Even in the group of patients where only one coronary stenosis was dilated the type B coronary affection according to the classification ACC/AHA predominated and the same applied to the entire group of patients.

Angioplasty, Balloon, Coronary↗

PubMed1991

A versatile method for integration of genes and gene fusions into the lambda attachment site of Escherichia coli.

We have developed a versatile method for integration of modified genes and gene fusions into the bacteriophage lambda attachment site (attB) of the Escherichia coli chromosome. The method relies on two components: (1) a DNA integration cassette, flanked by multiple restriction enzyme sites, which contains the lambda attP site and, as a selectable marker, the Tn5 aphA gene conferring kanamycin resistance (KmR); and (2) a plasmid with the lambda int gene transcribed from the tet promoter. A fragment carrying the gene in question is ligated to the integration cassette, resulting in a circular piece of DNA unable to replicate. The ligation product is then transformed into a strain that contains the int-carrying plasmid. Selection for KmR results in colonies with the cassette integrated into the attB site of the E. coli chromosome. This method was used for integration of several lacZ and phoA promoter fusions. The integration products were analyzed by Southern hybridization. In addition, we found, fortuitously, that the ligated DNA circles could also integrate by homologous recombination, although usually at a much lower frequency than the Int-mediated integration into attB.

Alkaline Phosphatase↗