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Biomedical subjects

H Hochrein

Publications and source records attributed to H Hochrein.

At least 19 recordsLinked to original sources
PubMed1992

[The effect of verapamil on left ventricular diastolic function in coronary heart disease].

Echocardiography was performed on 21 patients (6 women, 15 men; mean age 52 [40-68] years) with coronary heart disease (at least 75% stenosis), before and after taking 80 or 120 mg verapamil, to test the drug's acute effect on left-ventricular (LV) relaxation and filling. After taking 80 mg verapamil the only significant (P less than 0.05) decrease was in the proportion of isovolumetric relaxation time to cardiac cycle. The echocardiographic changes were significantly (P less than 0.01) greater after 120 mg than 80 mg: Isovolumetric relaxation time decreased by 13 and 4%, respectively, flow integral of early diastolic LV filling (E wave) increased by 17 and 2%, and atrial filling fraction (atrial component of LV filling) fell by 14 and 2%. Apparently verapamil has a positive effect on the energetically important early diastolic relaxation of the left ventricle. Thus diastolic abnormalities of LV function in patients with coronary heart disease are not fixed but can be at least partially improved with verapamil.

Adult↗
PubMed1992

Changes of diastolic function induced by cigarette smoking: an echocardiographic study in patients with coronary artery disease.

In 28 chronic smokers (11 women, 17 men, 53 +/- 10 years old) with coronary artery disease (greater than 75% stenosis), left ventricular (LV) relaxation and filling behavior was assessed before and after inhalation of 0.9 mg nicotine (1 cigarette) by echocardiography. The following acute nicotine-mediated changes were noted (one-sided Wilcoxon test): heart rate increased from 67 to 81 beats/min (p greater than .001); the early diastolic flow (E wave) integral decreased from 49 to 39 mm (p less than .001); the late diastolic flow integral (A wave) increased from 36 to 41 mm (p less than .01). Consecutively, the ratio between E and A wave flow integrals decreased from 1.4 to 0.9 (p less than .001); the atrial contribution to LV filling rose from 42 to 53% (p less than .001); and the isovolumetric relaxation period increased from 89 to 122 ms (p less than .001). In cigarette smokers with coronary artery disease acute administration of nicotine hence causes a shift of mitral blood flow from early (E wave) to late (A wave) diastole and a prolongation of the isovolumetric relaxation time. Thus, cigarette smoking significantly affects LV diastolic function independently of its role as a risk factor for coronary atherosclerosis.

Adult↗
PubMed1992

Left ventricular filling behaviour in ultra endurance and amateur athletes: a stress Doppler-echo study.

To evaluate the impact of different training levels on left ventricular (LV) filling dynamics, Doppler mitral flow was derived in 25 amateur endurance-trained athletes (amateurs) aged 31 +/- 9 years, with a personal marathon record > 200 min, and in 26 ultra endurance athletes (top athletes) aged 32 +/- 8 years, with a personal marathon record < 170 min, during bicycle exercise in supine position. In particular atrial filling fraction as the relative share of atrial contribution to LV filling was measured. During exercise (150 watt) atrial filling fraction increased significantly more in amateurs from 25% to 34% compared to top athletes from 25% to 29% (p < 0.001). Two min post exercise atrial filling fraction already reached baseline values in top athletes (25%), while it remained significantly elevated in amateurs compared to baseline values (29%, p < 0.001). Only ten min post exercise atrial filling fraction showed baseline values in amateurs (26%). Rate pressure product was not significantly different at all levels of exercise. Thus, while atrial filling fraction rose in both study groups during exercise, it returned earlier to baseline values in top athletes than in amateurs. This indicates a better cardiac adaptation to physical stress and a better diastolic performance during exercise in endurance athletes with a higher training level.

Adaptation, Physiological↗
PubMed1992

[Effects of endurance training on left ventricular filling dynamics: a study using stress Doppler echocardiography].

To evaluate the impact of endurance training on left-ventricular (LV) filling dynamics Doppler mitral flow was derived in 23 amateur endurance-trained athletes (AT) aged 31 (24-39) years with a personal marathon record greater than or equal to 200 min, and in 20 ultra-endurance athletes (UEA) aged 38 (28-42) years with a personal marathon record less than 200 min during bicycle exercise in supine position. Twenty-two untrained healthy volunteers (UT) aged 27 (24-30) years served as control. In particular, atrial filling fraction (AFF) as the relative share of atrial contribution to LV filling was measured. At rest AFF was significantly higher in UT (29%) as compared to AT (25%) and UEA (25%). During exercise (150 watt) atrial fraction increased significantly more in UT (37%) as compared to AT (34%) and UEA (29%) (p less than 0.01). At this point of measurement UEA had significantly lower values for AFF than AT (p less than 0.001). Two min post exercise atrial filling fraction already reached baseline values in UEA (24%) and AT (26%), while it remained significantly elevated in UT as compared to baseline values (38%, p less than 0.001). Ten min post exercise atrial filling fraction showed still elevated values in UT (32%), but decreased under baseline values in UEA (23%). No differences in heart rate between the two athlete groups at all times of measurement were observed. Thus, while atrial filling fraction rose in all study groups during exercise, it returned earlier to baseline values in athletes than in untrained subjects. This indicates a better cardiac adaptation to physical stress and a better diastolic performance during exercise in endurance-trained athletes, being even more pronounced in ultra-endurance athletes.

Adult↗
PubMed1991

[Effect of smoking on relaxation and filling behavior of the left ventricle in healthy probands. An echocardiography study].

UNLABELLED: To examine the impact of acute nicotine consumption echocardiographic examination was performed in 22 healthy subjects (nine women, 13 men, 20 to 50 cigarettes/day over a minimum of five years) without any evidence of organic heart disease (normal 2D and Doppler echo, normal ECG at rest and during exercise) aged 20 to 51 years (mean +/- SD: 37 +/- 9 years) before and after cigarette smoking (0.9 mg nicotine). Left ventricular filling parameters were derived by transmitral pulsed Doppler ultrasound with the flow profile along the mitral valve being characterized by the early diastolic (E-wave) and late diastolic (A-wave) inflow into the left ventricle. The isovolumetric relaxation period was determined by simultaneous M-mode registrations over the aortic and mitral valve. During smoking the early diastolic peak velocity decreased from 56 to 52 cm/s (p less than .01) and the early diastolic flow integral fell from 64 to 56 mm (p less than .01). The A/E ratio of the peak velocities rose from 68 to 82% (p less than .001), the A/E ratio of the flow integrals increased from 46 to 56% (p less than .001) and the atrial contribution to ventricular filling rose from 33 to 36% (p less than .001). Furthermore during cigarette smoking the isovolumetric relaxation period rose from 70 to 77 ms (p less than .001). - CONCLUSION: In healthy subjects cigarette smoking causes an increase of the atrial contribution to ventricular filling and the isovolumetric relaxation period. Thus, acute nicotine consumption significantly impairs the energy-consumpting process of early diastolic relaxation, independently of its role as a risk factor for atherosclerosis.

Adult↗
PubMed1991

Noninvasive diagnosis of cardiac allograft rejection by means of pulsed Doppler and M-mode ultrasound.

The changes of left ventricular (LV) diastolic function associated with cardiac rejection were evaluated. Twenty-one cardiac allograft recipients aged 41 +/- 9 years, 11 with moderate to severe and 10 allograft rejection without rejection at myocardial biopsy underwent serial echo examination, including peak velocity (PEV), pressure half-time (PHT), velocity-time integral (VTI-E) of early mitral flow, and isovolumetric relaxation period (IVRP). In transplant recipients, significantly higher values than in 22 age-matched healthy controls were found for PEV (71 versus 56 cm/s; P less than 0.01), PHT (51 versus 43 ms; P less than 0.001), VTI-E (72 versus 57 mm; P less than 0.001), and IVRP (90 versus 73 ms; P less than 0.001). During rejection, heart rate increased significantly from 78 to 91 beats per minute (P less than 0.01). Furthermore, a significant decrease was found for PEV from 73 to 63 cm/s (P less than 0.01), for PHT from 52 to 40 ms (P less than 0.001), for VTI-E from 75 to 61 mm (P less than 0.001), and for IVRP from 90 to 74 ms (P less than 0.001) during cardiac rejection. Thus, sonographic evaluation of LV diastolic function helps to early detect cardiac rejection and to decrease the frequency of myocardial biopsy.

Adult↗
PubMed1991

[Non-invasive detection of left ventricular diastolic function in variously trained endurance athletes during a marathon run with pulsed Doppler sonography].

UNLABELLED: To evaluate left ventricular (LV) diastolic function in long distance runners LV filling parameters were assessed by Doppler echocardiography during marathon race in 23 male subjects. On the basis of their personal record the athletes were divided into two groups: 12 endurance athletes (END; 218 min over 42 km) aged 34 years (29/37, median and 25%/75%-percentiles) and 11 ultra endurance athletes (ULTRA; 152 min over 42 km) aged 32 years (28/37). At rest 21 healthy untrained subjects (UT) aged 33 years (28/37) served as control group. In long distance runners the values for LV mass and LV mass index were significantly higher in END with 210 (168/253) g rsp. 110 (87/135) g/m2 and in ULTRA with 225 (179/267) g rsp. 118 (93/142) g/m2 as compared to UT with 129 (105/162) g rsp. 68 (57/79) g/m2 (p less than 0.001 each). Doppler-derived mitral flow was characterized by the early passive (E wave) and late (A wave) diastolic inflow. In particular atrial filling fraction (AFF) as the relative atrial contribution to LV filling was measured. At rest and at km 21 we saw a normal filling behaviour (AFF = 27% bzw. 28%) in both groups of long distance runners with an AFF of 27 (26/29)% in END and an AFF of 28 (26/29) in ULTRA. In END AFF rose to 42 (38/47)% at km 42 (p less than 0.001) and remained significantly elevated with 37 (35/42)% until 30 min post marathon (p less than 0.05). Only 60 min post exercise AFF returned to baseline values with an AFF of 28 (25/39)% in END. In contrast at km 42 in ULTRA AFF was significantly lower and at baseline levels with 26 (25/29)% compared to END (p less than 0.001) and did not significantly change in the further course of the post running period. CONCLUSION: Long distance runners show a normal LV filling behaviour at rest despite significant LV hypertrophy. In contrast to top class athletes (ULTRA) there is a shift of LV filling from early (E wave) to late (A wave) diastole in less trained runners (END) during marathon. Thus, the results indicate an impairment of early diastolic LV filling in amateur endurance athletes (END) during extreme physical exercise.

Adult↗
PubMed1990

[Variant (Prinzmetal's) angina with diffuse coronary spasm without coronary sclerosis].

A 49-year-old man developed, over a period of three years, progressively more frequent nocturnal attacks of angina and palpitations. Exercise electrocardiogram was negative. 24-hour Holter monitoring revealed ventricular extrasystoles and tachycardia with ST segment elevations. The dominant left coronary artery, which was free of atherotic changes, went into diffuse spasm after ergonovine administration, accompanied by angina and ventricular extrasystoles. Registration of spontaneous ischaemia confirmed the diagnosis of variant (Prinzmetal) angina. Administration of twice daily 90 mg diltiazem retard and once daily 120 mg isosorbide dinitrate retard at night ended the spasms and with it the attacks of angina and the arrhythmias. This case illustrates that typical angina and ventricular tachyarrhythmias can be caused by spontaneous coronary spasms, even in the presence of normal exercise ECGs and coronary angiograms. If coronary artery spasms are not detectable by ECG, the ergonovine test may further the diagnosis.

Angina Pectoris, Variant↗
PubMed1990

[Antihypertensive treatment of silent myocardial ischemia in hypertensives without coronary heart disease].

To evaluate clinically silent S-T segment depression in hypertensives with normal coronary arteriograms, 48-hour ECG recordings of S-T segments were analysed in 25 patients (15 men, 10 women; mean age 57 +/- 9.2 years) before starting antihypertensive drug therapy. Ischaemic episodes were recorded in 14 patients, ten of whom had an abnormal exercise ECG and 13 had hypertensive fundus changes. After antihypertensive drug therapy had been given for 2-3 weeks (pre-treatment blood pressure systolic 174 +/- 8.5, diastolic 90 +/- 5.4 mm Hg; post-treatment 132 +/- 12.9/77 +/- 8.3 mm Hg) the number of ischaemic episodes per 48 hours fell significantly from 219 to 113 (P less than 0.05), the median of ischaemic episodes decreased from 16 to 5 per 48 hours (P less than 0.05), and the median of maximal S-T segment analysis of long-term ECG monitoring is a suitable method for demonstrating silent ischaemia in hypertensives, and danger of ischaemic attacks in hypertensives is reduced by effective antihypertensive drug treatment.

Aged↗
PubMed1990

[Effects of nicotine on left ventricular diastolic function in patients with coronary disease. An echocardiographic study].

Echocardiography was performed before and after inhalation of 0.9 mg nicotine in 21 patients (6 women and 15 men with a mean age of 51.8 [38-73] years). All of them had angiographically confirmed coronary heart disease (stenosis greater than 50%) and smoked 20-50 cigarettes daily for at least 5 years. In addition, left ventricular filling parameters were determined by transmitral pulsed Doppler ultrasonography. In this technique the flow profile across the mitral valve is divided into the passive, early diastolic inflow (E wave) phase and the active, late diastolic inflow phase caused by atrial contraction (A wave). Isovolumetric relaxation time was measured by simultaneous M-mode recordings over the aortic and mitral valves. The following significant changes were noted after the dose of nicotine (medians; one-sided Wilcoxon test; P less than 0.05): peak velocity of the E wave decreased from 43 to 34.4 cm/s; the ratio between A and E wave peak velocities increased from 1.02 to 1.37; the velocity/time integral of the E wave decreased from 4.77 to 3.57 cm; the ratio between the velocity/time integrals of the A and E waves rose from 0.66 to 1.15; isovolumetric relaxation time increased from 90 to 121 ms. - In cigarette smokers with coronary heart disease, acute administration of nicotine hence caused a decrease in early diastolic transmitral blood flow and an increase in isovolumetric relaxation time. These changes point to significant impairment of left ventricular diastolic function.

Adult↗
PubMed1990

[Psychosocial changes following resuscitation].

Of 68 patients successfully resuscitated within a period of 18 months 52 (38 men and 14 women; mean age 63 [32-90] years) were interviewed about their experience shortly after discharge. 37 reported to have been aware of the life-threatening nature of the acute episode; recurrent depressions were noted by 20; a positive change in attitude towards their life had resulted in 24 patients; 49 praised their doctors and nurses; 40 were appreciative of the medical technology used. All but one of the 52 patients would again choose to be resuscitated. After 12 months 38 patients were again interviewed (31 men and 7 women); 16 had died in the meantime. 21 of the 38 felt physically stronger than before, 25 were more cheerful and 34 were living more intensely. 36 of the 38 patients thought the interviews had been helpful and they would have liked more intensive psychiatric care even during their hospital stay.

Adult↗
PubMed1990

Noninvasive determination of pulmonary artery wedge pressure: comparative analysis of pulsed Doppler echocardiography and right heart catheterization.

To compare left ventricular filling variables as derived by transmitral pulsed Doppler echocardiography (tpDE) and hemodynamic variables as assessed at right heart catheterization (RHC), 104 ICU patients (64 male, 40 female) aged 26 to 73 yr (mean 54.6 +/- 10.3) without valvular heart disease were examined. Simultaneously with RHC, transmitral flow velocity profiles were obtained by tpDE, and the ratio of the velocity-time integrals of late diastolic active (A wave) and early diastolic passive inflow into the left ventricle (E wave) was calculated (A/E ratio). Invasively determined pulmonary capillary wedge pressure (WP) ranged from 3 to 36 mm Hg (median 13.35, 5%/95% 6/31 mm Hg). Linear regression analysis showed a highly significant correlation between the A/E ratio and WP (r = .98, p less than .001, standard error of the estimate [SEE] = 0.10). The A/E ratio also correlated with other hemodynamic variables such as cardiac output (r = -.68, p less than .001, SEE = 0.33), cardiac index (r = -.74, p less than .001, SEE = 0.31), and stroke volume index (r = -.68, p less than .001, SEE = 0.34). The interobserver agreement (derived by intraclass correlation analysis between two examiners) on the A/E ratio was high (r = .95, p less than .001, n = 26). We conclude that WP can be accurately determined noninvasively by tpDE. For the assessment of systolic ventricular function, tpDE is of limited diagnostic value.

Adult↗
PubMed1990

Osteomyelitis due to Cryptococcus neoformans in advanced age. Case report and review of literature.

In an 84-year-old man cryptococcosis with a pronounced osteomyelitic course (involvement of a rib, two thoracic vertebrae, the sacrum and a femur) was diagnosed histologically post mortem, thus directing attention to cryptococcosis in advanced age. The presumptive chronic course of the Cryptococcus neoformans (Cr. n.) infection in this patient was ascribed to chronic kidney failure, diabetes mellitus and chronic obstructive lung disease. Special reference is made to the mycological and radiological diagnosis of cryptococcosis of the bones as well as to its pathogenesis, therapy and epidemiology.

Aged↗
PubMed1990

[Noninvasive detection by Doppler and M-mode echocardiography of acute rejection reaction after heart transplantation: preliminary results of a prospective study].

Diagnosis of acute cardiac allograft rejection is still based on the results of endomyocardial biopsy. The objective of this study was to evaluate changes of left ventricular (LV) diastolic function associated with rejection using Doppler and M-mode echocardiography. The study patients, consisting of 29 cardiac allograft recipients (12 female, 17 male) aged 27 to 58 (mean 41) years, were classified into two groups on the basis of histopathologic findings: 13 patients without rejection (mean age 40 years) and 16 patients with moderate to severe allograft rejection (mean age 42 years) at myocardial biopsy. All patients underwent serial echocardiographic examination 4-10 weeks after transplantation and 8 +/- 2 days later on the day of myocardial biopsy. Twenty-five healthy volunteers (11 female, 14 male; mean age 39 years) served for assessing normal values. Echocardiographic assessment included peak velocity (PEV), pressure half-time (PHT), velocity-time integral (VTI-E) of early mitral flow (E-wave), and isovolumic relaxation period (IVRP). In transplant recipients, significantly higher values as compared to normals were found for PEV (72 vs 55 cm/s; p less than 0.01), PHT (51 vs 42 ms; p less than 0.001), VTI-E (71 vs 56 mm; p less than 0.001), and IVRP (91 vs 73 ms; p less than 0.001). During rejection, heart rate increased significantly from 78 to 93 beats/min (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗