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Biomedical subjects

F W Verheugt

Publications and source records attributed to F W Verheugt.

At least 127 records · Page 7Linked to original sources
PubMed1989

Comparison of two latex agglutination test kits for serum myoglobin in the exclusion of acute myocardial infarction.

The Myolex (Orion) and the RapiTex (Behringwerke) latex agglutination tests for the rapid detection of elevated levels of serum myoglobin were studied prospectively in patients suspected of acute myocardial infarction, who were admitted to hospital within 8 h of pain onset. Using admission blood samples drawn 3.4 +/- 2.0 h (mean +/- SD) after onset of symptoms, the negative predictive values of both tests were too low to use these assays in the early exclusion of myocardial infarction in the emergency department. However, the negative predictive values obtained with the second blood samples, drawn 4 h later, indicated that the myoglobin agglutination test could be of value in the exclusion of myocardial infarction.

Adult↗
PubMed1988

Relation between infarct size and left ventricular performance assessed in patients with first acute myocardial infarction randomized to intracoronary thrombolytic therapy or to conventional treatment.

Reperfusion of ischemic myocardium has been reported to increase the cumulative creatine kinase activity in plasma per gram of infarcted myocardium as assessed with the method of Shell et al. In an attempt to find out whether infarct size assessment using the method of Witteveen et al was affected by reperfusion, the relation between enzymatic infarct size was analyzed using Witteveen's method and left ventricular (LV) function parameters in 266 patients with first acute myocardial infarction randomized to intracoronary thrombolysis (n = 134) or conventional therapy (n = 132). Compared with patients allocated to conventional therapy, patients allocated to intracoronary thrombolysis had smaller enzymatic infarct size by 29% (p less than 0.001), smaller LV end-diastolic and end-systolic volume indexes by 10% (p less than 0.05) and 20% (p less than 0.005), respectively, and higher LV ejection fraction (55 +/- 1% vs 49 +/- 1%; p less than 0.001). The beneficial effects of thrombolytic therapy on LV performance were closely associated with thrombolysis-induced limitation of infarct size. The dependence from infarct size of LV end-diastolic volume, LV end-systolic volume, and ejection fraction was not different in the 2 therapy groups. It was concluded that Witteveen's method of infarct size assessment is not influenced by the presence of reperfusion. Therefore, this method was recommended for trials on recanalization in patients with acute myocardial infarction.

Angiography↗
PubMed1988

Functional pneumectomy by a saccular aneurysm of the aortic root.

This case report describes a patient with severe stenosis of the right pulmonary artery due to an expanding arteriosclerotic aneurysm of the ascending aorta. The clinical data and the lung perfusion ventilation scintigrams supported the diagnosis of pulmonary embolism, and initially the patient was treated accordingly.

Aortic Aneurysm↗
PubMed1988

Rapid enzyme release from acutely infarcted myocardium after early thrombolytic therapy: washout or reperfusion damage?

In a randomized study on early intracoronary thrombolytic therapy in patients with acute myocardial infarction (AMI), serial plasma enzyme activities were measured to analyze the rate of enzyme appearance in plasma with reference to treatment allocation, area at risk, and infarct size. Cumulative activities of alpha-hydroxybutyrate dehydrogenase (HBDH) appearing in plasma in the first 24 hours (Q24), 48 hours (Q48), and 72 hours (Q72) were calculated to obtain infarct size (= Q72) and rate of HBDH appearance in plasma (= Q24/Q72). Analyzed on the basis of "intention to treat" in 448 patients with AMI, the mean Q24/Q72 value (+/- SEM) was 0.653 +/- 0.011 in 230 patients receiving thrombolytic therapy; this value was significantly (p less than 0.001) higher than that observed in 218 patients receiving conventional therapy (0.504 +/- 0.012). In the thrombolysis group Q24/Q72 was independent of infarct size, whereas in the control group Q24/Q72 was negatively correlated with infarct size (r = -0.26; p less than 0.001). Plotted against the sum of ST segment elevations at admission (sigma ST) mean Q24 values were similar in both treatment groups, but mean Q48 and especially Q72 values were larger in the control group than in the thrombolysis group. We conclude that: (1) in reperfused infarctions the time course for development of infarct is accelerated in comparison to unreperfused infarcts; (2) this accelerated process of necrosis lasts about 40 to 50 hours, a duration that is hardly influenced by infarct size; and (3) the reperfusion-induced acceleration of enzyme release resembles the reoxygenation-induced enzyme release from anoxic hearts.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary Circulation↗
PubMed1988

Improvement of myocardial perfusion after thrombolysis assessed by thallium-201 exercise scintigraphy. Report of the Working Group on Thrombolytic Therapy in Acute Myocardial Infarction of the Netherlands Interuniversity Institute of Cardiology.

The effects of recanalization by early intracoronary streptokinase in acute myocardial infarction on myocardial perfusion were studied in a subset of 236 out of 533 patients enrolled in a prospective multicentre trial, randomly allocated to either conventional treatment or to thrombolysis. Maximal symptom-limited thallium-201 stress testing was performed nine to 14 (median 12) weeks after the acute event in 236 patients with a first myocardial infarction, of whom 108 patients were allocated to conventional treatment and 128 patients to thrombolysis. Three-view thallium exercise and redistribution scintigrams were divided into eight segments. The number of normal thallium segments at redistribution was 5.3 +/- 1.6 (mean +/- SD) in the control group and 5.8 +/- 1.6 in the thrombolysis group (P less than 0.01), indicating increased myocardial perfusion after early thrombolytic treatment. This beneficial effect was particularly evident in patients with a first anterior infarction with 4.8 +/- 1.6 normal thallium segments in the control group and 5.9 +/- 1.6 normal segments in the thrombolysis group (P less than 0.001). There was no difference in residual ischaemia during exercise between the control and the thrombolysis group either in the patients with anterior or in those with inferior infarction. It is concluded that early thrombolysis within 4 h after onset of symptoms, in some of the patients followed by angioplasty or coronary artery bypass surgery, leads to sustained improvement of myocardial perfusion at rest without excessive ischaemia during exercise, particularly in patients with acute anterior infarction.

Aged↗
PubMed1988

Enzyme tests in the evaluation of thrombolysis in acute myocardial infarction.

The activity of alpha-hydroxybutyrate dehydrogenase, creatine kinase, creatine kinase MB and aspartate aminotransferase was measured on serial plasma samples from patients with acute myocardial infarction. The study was part of a multicentre randomised trial of the effect of thrombolytic treatment in the acute phase of acute myocardial infarction. The applicability and comparability of enzyme tests for the estimation of myocardial injury were studied in 76 control patients and 74 patients treated with streptokinase. Treatment with streptokinase caused a considerable acceleration of enzyme release after acute myocardial infarction, both in patients with persistent coronary occlusion and in those with successful reperfusion. But this changed pattern of enzyme release did not affect the rate of enzyme elimination from plasma or the released proportions of different enzymes. Thus the assessment of infarct size by measurement of these enzyme activities can also be applied to patients treated with streptokinase. Moreover, the enzymes measured in the present study are all equally valid markers of myocardial injury.

Aspartate Aminotransferases↗
PubMed1988

Cost benefit analysis of early thrombolytic treatment with intracoronary streptokinase. Twelve month follow up report of the randomised multicentre trial conducted by the Interuniversity Cardiology Institute of The Netherlands.

The costs and benefits of early thrombolytic treatment with intracoronary streptokinase in acute myocardial infarction were compared in a randomised trial. All hospital admissions were recorded and the functional class was assessed at visits to the outpatient clinic during a 12 month follow up of 269 patients allocated to thrombolytic treatment and of 264 allocated to conventional treatment. Mean survival during the first year was calculated for patients with inferior and with anterior infarction and adjusted for impaired quality of life in cases where there were symptoms or hospital admission. In patients with inferior infarction mean survival was 337 days (out of a total follow up of 365 days) for patients allocated to thrombolytic treatment and 327 days for controls. Quality adjusted survival was seven days longer in the thrombolysis group (307 vs 300 days in controls). In patients with anterior infarction mean survival was significantly longer (35 days) in the thrombolysis group than in the control group as was quality adjusted survival (38 days) (304 vs 266 days in controls). The gain in life expectancy with thrombolytic treatment was 0.7 years for patients with inferior infarction, 2.4 years for patients with anterior infarction, and 3.6 years for the subset of patients with large anterior infarction who were admitted within two hours of the onset of symptoms. The costs of medical treatment, including medication, hospital stay, cardiac catheterisation, coronary angioplasty, and bypass surgery, in the first year follow up were higher inpatients allocated to thrombolytic treatment (an additional cost ofDfl 7000 in inferior and Dfl 9000in anterior infarction (1 pounds sterling approximately Dfl 3.3.)) than in conventionally treated patients. The additional costs per year of life gained were Dfl 10 000 in inferior infarction, Dfl 3 800 in anterior infarction, and only Dfl 1 900 in patients with large anterior infarction admitted within two hours of onset of symptoms. Intracoronary thrombolysis can be recommended as a cost effective treatment in patients with extensive anteroseptal infarction.

Clinical Trials as Topic↗
PubMed1987

Tissue plasminogen activator activity and inhibition in acute myocardial infarction and angiographically normal coronary arteries.

Parameters of blood coagulation, blood platelet reactivity and fibrinolysis were analyzed in 18 patients with acute myocardial infarction (AMI) and angiographically normal coronary arteries. This study group was compared with a patient control group of 18 AMI patients with 1-vessel obstructive coronary artery disease. Patients were matched for sex, age and AMI date. A healthy control group consisted of 18 sex- and age-matched volunteers. Blood coagulation measurements and platelet reactivity were similar in the 3 groups, except for fibrinogen, which was significantly higher in the patient control group. Plasma activity of tissue plasminogen activator (tPA) was detectable in only 2 patients in the study group, 9 in the patient control group (p less than 0.02) and 12 in the healthy control group (p less than 0.0001). Median plasma tPA inhibitory activity was higher in the study group (10.3 IU/ml) and the patient control group (8.1 IU/ml) than in the healthy control group (2.7 IU/ml, p less than 0.0001 and p less than 0.03). Thus, reduced activity and enhanced inhibition of plasma tPA may be important factors in the origin of coronary thrombosis, especially in the absence of coronary artery disease.

Adult↗
PubMed1987

Value of admission electrocardiogram in predicting outcome of thrombolytic therapy in acute myocardial infarction. A randomized trial conducted by The Netherlands Interuniversity Cardiology Institute.

To determine the value of the admission 12-lead electrocardiogram to predict infarct size limitation by thrombolytic therapy, data were analyzed in 488 of 533 patients with acute myocardial infarction (AMI) from a randomized multicenter study. All patients had typical electrocardiographic changes diagnostic for an AMI and were admitted within 4 hours after the onset of chest pain; 245 patients were allocated to thrombolytic treatment and 243 to conventional treatment. Cumulative 72-hour release into plasma of myocardial alpha-hydroxybutyrate dehydrogenase (HBDH) was used as a measure of infarct size. In general, the amount of infarct limitation due to thrombolytic therapy was proportional to the size of the area at risk. Patients with new Q waves, high QRS score and high ST-segment elevation or depression had the largest enzymatic infarct size in both treatment groups, irrespective of location of the AMI. Compared with conventionally treated patients, patients with anterior AMI treated with streptokinase had significant infarct size limitation (480 U/liter HBDH, 37%), and limitation was most prominent in those with Q waves (820 U/liter HBDH) or high ST elevation (750 U/liter HBDH). Infarct size limitation in inferior AMI was less impressive (330 U/liter HBDH, 33%) and patients with high ST-segment elevation (460 U/liter HBDH) or marked contralateral ST-segment depression (430 U/liter HBDH) had the most notable infarct limitation.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1986

Prognostic implications of regional hyperkinesia and remote asynergy of noninfarcted myocardium.

To determine the clinical significance of regional hyperkinesia and remote asynergy of noninfarcted areas in patients with a first acute myocardial infarction (AMI), 2-dimensional echocardiography was performed in 113 consecutive patients within 12 hours after admission to the coronary care unit. In 98 patients (87%) all segments of the left ventricular wall were recorded. Infarct-associated asynergy was anterior in 63 and inferior in 35 patients. Regional hyperkinesia was present in 66 patients (67%)--44 of 63 with anterior (69%) and 22 of 35 with inferior (63%) infarcts--and was more frequently seen in patients with 1- and 2-vessel coronary artery disease (CAD) than in patients with 3-vessel CAD (87 and 72% vs 25%, p less than 0.001). In contrast to enzymatic infarct size, absence of regional hyperkinesia was significantly associated with a higher left ventricular wall motion score (p less than 0.01). Twenty patients died within 30 days after onset of AMI; in 15 (75%) regional hyperkinesia was absent. Absence of regional hyperkinesia, especially in anterior infarcts, was associated with a high mortality rate (13 of 19 patients [68%]). Remote asynergy, i.e., not adjacent to the infarct area and supposed to be related to another vascular region, was present in 17 of 98 patients (17%)--11 of 63 with anterior (17%) and 6 of 35 with inferior (17%) infarcts. Remote asynergy was present only in patients with multivessel CAD and was significantly related to a higher wall motion score (p less than 0.001), but not to enzymatic infarct size.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

Detection of ventricular thrombosis in acute myocardial infarction: value of indium-111 platelet scintigraphy in relation to two-dimensional echocardiography and clinical course.

In order to detect left ventricular (LV) thrombosis, 111In-platelet scintigraphy and two-dimensional echocardiography were performed in 40 patients 15 days +/- 6 days after acute myocardial infarction. A dual isotope subtraction method, using 111In-platelet scintigraphy and 99mTc-blood pool scintigraphy, was used to assess LV platelet deposition expressed as LV counts per pixel. Seven patients (group A) had a positive 111In-platelet scintigram and 33 patients (group B) had a negative 111In-platelet scintigram (LV counts per pixel: 0.56 +/- 0.23 and 0.28 +/- 0.19, respectively, P less than 0.05). Three group A patients but no group B patients had a positive echocardiogram. Arterial embolism was noted in four patients, of whom two showed both positive echocardiogram and platelet scintigram. LV counts per pixel were 0.57 +/- 0.13 and 0.31 +/- 0.21, respectively (P less than 0.02) in patients with and without arterial embolism. Thus, both 111In-platelet scintigraphy and two-dimensional echocardiography can detect LV thrombosis. 111In-platelet scintigraphy may help to define patients at risk for embolization and may be used in conjunction with echocardiography to study the effect of antithrombotic therapy.

Blood Platelets↗