Biomedical subjects

G Cieslinski

Publications and source records attributed to G Cieslinski.

26 records · Page 2Linked to original sources

PubMed1991

[Multiparametric analysis using radionuclide ventriculography in the assessment of left ventricular function following heart transplantation].

Left ventricular systolic and diastolic performance was evaluated by radionuclide angiography in 17 patients following cardiac transplantation and compared with normal persons. Both groups performed supine bicycle exercise during the investigation, the control group at 102 +/- 73 W and the transplanted patients at 61.2 +/- 15 W. The ejection fraction increased in the normal persons from 61 +/- 8 to 69 +/- 10% whereas in the transplanted patients it did not increase significantly. There were no relevant changes in systolic parameters during exercise in the transplant recipients. The changes in diastolic parameters were significantly smaller in transplant patients than in normals. After correction for heart rate-induced changes a significantly different time course of the systolic-diastolic sequence during the cardiac cycle became evident in the transplanted group at rest. During exercise the systolic-diastolic sequence during the cardiac cycle became similar in both groups. It is concluded that the reduced exercise capacity of patients in the late phase after cardiac transplantation is partially due to the absence of an EF increase and a limitation of diastolic reserve during exercise.

Adult↗

PubMed1990

Retardation of development and progression of coronary atherosclerosis: a new indication for calcium antagonists?

Development of atherosclerotic lesions in animals, preferrably induced by a high-cholesterol diet, can be successfully suppressed by calcium channel blockers such as verapamil, nifedipine, nicardipine and diltiazem. The issue of a beneficial effect of calcium channel blockers on human coronary atherosclerosis is however not yet settled. At present, three prospective randomized clinical trials with calcium channel blockers (Nifedipine, Verapamil, Nicardipine) are being conducted (INTACT, FIPS, Study of the Montreal Heart Institute). Target variable for assessment of progression in these studies is the severity of coronary atherosclerosis evaluated by angiography both at entry into the study and after 2-3 years of treatment. A total of 445 patients after coronary bypass surgery (CABG) were entered in FIPS (Frankfurt Isoptin Progression Study) and randomly allocated to either verapamil 120 mg t.i.d. or placebo. The extent of coronary atherosclerosis is assessed by repeat angiography both 1 year and 3 years after randomization. Three vessel regions are evaluated separately. 1. Native vessels without bypass grafts and segments distal to the peripheral graft anastomosis ("core region") 2. Segments bridged by bypass grafts and 3. Bypass grafts. The 1-year follow-up was completed by 162 patients (Group A = 80 patients; Group B = 82 patients). There was a homogeneous distribution in the two groups for all clinical variables, graft patency rates, and the incidence of clinical events (myocardial infarction, need for cardiac surgery or PTCA, cardiac death). The overall progression rate of atherosclerosis in the first year was expectedly low.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1989

[Ischemic reaction in a young woman without coronary sclerosis: Bland-White-Garland syndrome].

A 39-year-old woman, with known mild mitral regurgitation, developed progressively more severe symptoms of angina, associated with an ischaemia response in the exercise electrocardiogram. Angiocardiography demonstrated an anomalous origin of the left coronary artery from the pulmonary artery (Bland-White-Garland syndrome). At operation an aortocoronary venous bypass graft was constructed; the patient has been without symptoms since and the exercise ECG is normal. As demonstrated by angiography, the previously marked dilatation of the right coronary artery had largely regressed and previously present collaterals to the left coronary artery were no longer visualized three months after operation. The described coronary artery anomaly, although rare, should be considered in a young patient with reproducible coronary artery ischaemia.

Adult↗

PubMed1989

Long-term results of percutaneous pulmonary valvuloplasty in adults.

We performed percutaneous balloon valvuloplasty of the pulmonary valve in 24 patients (aged 17 to 72 years) and in two juvenile patients. There were no major complications. In almost all the patients the procedure resulted in a successful pressure gradient reduction from a mean of 92 +/- 36 mmHg to 43 +/- 19 mmHg (P less than 0.01). In seven patients there was a residual pressure gradient greater than 50 mmHg which, however, decreased in all patients within the following 3-12 months due to a decrease in subvalvular muscular hypertrophy (from a mean of 70 to 35 mmHg). No restenosis was observed. Only one patient, who had calcified valve leaflets, developed pulmonary insufficiency and this was of only minor haemodynamic importance. Balloon dilatation of the pulmonary valve can be considered a technique with a high success rate and low complication rate even in the elderly. Good long-term results support this approach as the first choice in the treatment of pulmonary valve stenosis.

Adolescent↗

PubMed1989

[Can the progression of coronary heart disease be modified by calcium antagonists?].

Experimental atherosclerosis in animals preferentially induced by cholesterol-rich food can be successfully suppressed by calcium channel blocking agents such as verapamil, nifedipin, nicardipin, and diltiazem. The question whether calcium channel blockers can favorably influence atherosclerosis in humans remains a matter of debate. A few observational investigations in the past showed positive results of calcium channel blocker therapy in patients with angiographically proven coronary artery disease (CAD). At present three prospective randomized clinical trials are under way (INTACT-study, FIPS-study, study from the Montreal Heart Institute). Target variable is the severity of coronary atherosclerosis assessed by angiography both at entry into the study and after 2-3 years of treatment. 445 patients after coronary bypass surgery were included in the FIPS study (Frankfurt Isoptin Progression Study) and were randomly allocated to either verapamil 120 mg t.i.d. or placebo treatment. Extent of coronary atherosclerosis, assessed by repeat angiography 1 and 3 years after randomization, is expressed by scores with separate evaluation of non-bypassed vessels, segments distal to the peripheral bypass insertion, bypassed segments and grafts. The 1-year follow-up was completed for 162 patients (Group A = 80 patients; group B = 82 patients). There was a homogeneous distribution in both groups for all clinical variables, graft patency rates (76%/75%), and the incidence of clinical events (myocardial infarct, need for cardiac surgery or PTCA, cardiac death: 5%). The overall progression of atherosclerosis in the first year after bypass surgery was small. Thus, the question of whether calcium channel blockers can retard progression of coronary atherosclerosis cannot be answered before completion of the aforementioned trials.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1988

Rate response during submaximal exercise: comparison of three different sensors.

Since 1983, 248 rate responsive pacemakers were implanted at our hospital. The main emphasis during clinical follow-up has to be placed on the adjustment and control of its rate adaption, to meet the requirements of the aged patient's daily life. Repeated submaximal exercise but not extreme strain, come to the fore. Kaltenbach's step test (individually by stencils defined normal ranges of the heart rate during a 6 minute submaximal exercise and a 6 minute recovery period; age and sex dependent work load relative to body surface area) is able to mimic everyday efforts in an easy and reliable way. Nineteen patients with QT-related pacemaker, 12 patients with respiratory dependent pacemaker and 45 patients with body activity directed pm Activitrax were exercised using kaltenbach's step test (mean wattage QT: 56 +/- 14, RDP: 75 +/- 29, Activitrax: 64 +/- 20). Fifty-two patients performed 3 rounds. In comparison, 42 patients with DDD-pm underwent the same test (75 +/- 28 Watt). The average curve (heart rate) with QT-pm settled in the normal range of the step test but was distorted. Only 42% of the patients reached normal range in all three rounds. The mean heart rate of the RDP-group bordered on the basis of the normal range. The average curve (heart rate) of patients with Activitrax or DDD settled exactly in the desirable range. Problems with the rate response under repeated exercise did not occur either in the RDP or in the DDD group. The rate response behavior of the QT-related pm, the RDP and the Activitrax was of different quality.(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗

PubMed1987

[Can beta-receptor blockers trigger coronary spasm?].

Beta-blockers are frequently administered in therapy of arterial hypertension and coronary heart disease. They mostly lead to an asymptomatic increase of peripheral and coronary resistance. Three patients in whom there were indications of a deterioration of myocardial blood flow under beta-blockade were observed within a few weeks. After discontinuation of the beta-blockers and instituting a therapy with calcium antagonists, both a reduction of ischemia in the exercise ECG and a reduction of symptoms could be observed. The possibility that beta-blockers trigger coronary spasms and thus give rise to unfavorable effects on myocardial blood flow must be considered in the context of therapy monitoring, especially in patients with coronary heart disease.

Cardiac Catheterization↗

PubMed1986

Rate responsive pacemakers: assessment after two years.

Rate responsive pacemakers (RRPM) for patients without sufficient response of the heart rate (HR) to exercise represent an alternative to improve cardiac output (CO) and capacity for exercise via an increase of HR. From 1983 until December 1985, we implanted 30 QT-related (TX), 25 respiratory dependent (RDP), and 35 body activity directed (ACT) pacemakers. The follow-up examination consisted of Holter-ECG, treadmill and/or bicycle workload, and determination of CO (TX: thermodilution technique, n = 11; 6 months after implantation. RDP: equilibrium radionuclide ventriculography, n = 13; 1 month after implantation). The capacity for exercise of patients with ACT was studied using a climbing step. Adaptation of HR could be achieved with TX, RDP, and ACT. There was a significant increase in CO during exercise TX or RDP versus VVI-mode (TX: delta = 1.7 l/min, RDP: delta = 2.1 l/min). Although all systems exhibited weak points, RRPM are reliable devices. We abide by using these pacemakers.

Aged↗