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Heinrich Wieneke

Publications and source records attributed to Heinrich Wieneke.

At least 19 recordsLinked to original sources
PubMed2006

Relation between plaque progression and low-density lipoprotein cholesterol during aging as assessed with serial long-term (> or =12 months) follow-up intravascular ultrasound of the left main coronary artery.

Because of the clinical benefit of lipid lowering in older patients, we hypothesized that the relation between low-density lipoprotein (LDL) cholesterol serum levels and coronary plaque progression may persist throughout aging. We analyzed serial intravascular ultrasound (IVUS) data of 60 left main stems (18 +/- 9 months apart) and evaluated the relation between LDL cholesterol levels and coronary plaque progression at different ages. The population (n = 60) was divided into 3 groups according to age: tertile 1 (n = 20) was a mean age of 48 +/- 6 years (median 51, range 33 to 55), tertile 2 (n = 20) was a mean age of 58 +/- 2 years (median 59, range 55 to 61), and tertile 3 (n = 20) was a mean age of 66 +/- 6 years (median 65, range 61 to 83). Between groups, there was no significant difference in non-age-related demographics, clinical data, lipid profiles, or medications (e.g., statins). There was a positive linear relation between LDL cholesterol and annual changes in plaque plus media area in all age tertiles, which was statistically significant in tertiles 2 and 3 (r = 0.56, p <0.01; r = 0.50, p <0.02) and showed a strong trend in tertile 1 (r = 0.41, p = 0.07). The estimated LDL cholesterol thresholds, which, as determined by regression analysis, would correspond to no plaque progression, were 74, 60, and 78 mg/dl, respectively, in tertiles 1, 2, and 3. In conclusion, serial IVUS data in left main coronary arteries suggest that the relation between LDL cholesterol serum levels and plaque progression persists during aging.

Aged↗
PubMed2006

Relation between lipoprotein(a) and fibrinogen and serial intravascular ultrasound plaque progression in left main coronary arteries.

OBJECTIVES: Patients with elevated lipoprotein(a) [Lp(a)] and fibrinogen levels have an increased risk of coronary heart disease and adverse cardiovascular events. There is evidence that coronary plaque progression is linked to a higher risk for future cardiovascular events. BACKGROUND: There are no data demonstrating a relation between Lp(a), fibrinogen, and directly measured coronary plaque progression over time. METHODS: We performed a retrospective analysis of serial intravascular ultrasound (IVUS) studies of 60 left main stems (18 +/- 9 months apart) to evaluate plaque progression in relation to Lp(a) and fibrinogen levels and association with adverse cardiovascular events. RESULTS: There was a positive correlation between Lp(a) (r = 0.58; p < 0.0001), fibrinogen (r = 0.48; p < 0.0001), and changes in plaque-plus-media area. Patients with plaque progression (n = 41) had higher Lp(a) (30 +/- 26 mg/dl vs. 14 +/- 9 mg/dl; p < 0.0012) and fibrinogen (295 +/- 88 mg/dl vs. 240 +/- 72 mg/dl; p = 0.019) levels than patients with plaque regression (n = 19). Multivariate linear regression analysis showed Log Lp(a) (regression coefficient = 9.45; p = 0.0008) but not fibrinogen to be independently associated with plaque progression. A total of 19 patients suffered from adverse cardiovascular events; they had higher Lp(a) (44 +/- 30 mg/dl vs. 16 +/- 12 mg/dl; p < 0.0001) and fibrinogen (342 +/- 73 mg/dl vs. 248 +/- 76 mg/dl; p < 0.0001) levels. Multivariate logistic regression analysis showed Log Lp(a) (odds ratio 10.20, 95% confidence interval 2.36 to 44.13; p = 0.0019) and fibrinogen (odds ratio 1.01, 95% confidence interval 1.00 to 1.03; p = 0.018) were independently associated with adverse cardiovascular events. CONCLUSIONS: Serial IVUS showed a positive correlation between Lp(a) and fibrinogen levels and plaque progression. Lp(a), but not fibrinogen, remains independently associated with plaque progression. In addition, the present data suggest a considerable incremental value of Lp(a) in predicting cardiovascular risk.

Aged↗
PubMed2006

Single-chamber versus dual-chamber implantable cardioverter defibrillators: do we need physiologic pacing in the course?

BACKGROUND: Many patients with ICD receive different antiarrhythmic drugs (e.g. sotalol, amiodarone, beta-blockers) because of ventricular or atrial tachycardias. These drugs can cause AV-block or chronotropic incompetence resulting in a higher percentage of ventricular pacing. METHODS: We analyzed in a retrospective study the impact of DDD(R) versus VVI(R) mode on subjective (NYHA classification) and objective parameters [brain natriuretic peptide (BNP), 6 minute walk test, echocardiography] in 12 of 120 patients (age 60.2 +/- 11.2 years; 10 males, 2 females) who needed an upgrading of a single to a dual chamber ICD. The ICD had to be upgraded because of chronotropic incompetence in all patients with signs of progressing heart failure. Data were collected in VVI(R)-pacing and after 6 and 12 months in DDD(R)-pacing with a long AV-interval and AV hysteresis to reduce ventricular pacing. RESULTS: The 6 minute walk test (392.4 +/- 91.4 vs. 324.6 +/- 93.3 m, P < 0.001), NYHA-classification (1.4 +/- 0.3 vs. 2.6 +/- 0.8, P < 0.0001), BNP (234.1 +/- 73.5 vs. 410.4 +/- 297.0 pg/ml, P < 0.001), left ventricular ejection fraction (49.8 +/- 9.6 vs. 36.5 +/- 10.9 %, P < 0.0001) and A-wave (73.6 +/- 13.7 vs. 41.0 +/- 14.0 cm/sec, P < 0.0001) improved with DDD(R)-pacing after 12 months. The ventricular pacing decreased (84.2 +/- 18.1 vs. 1.1 +/- 1.7 %, P < 0.0001) after 12 months by DDD(R)-pacing with long AV-interval (220.0 +/- 10.4 ms) and AV hysteresis. CONCLUSION: Our data show a superiority of DDD(R) mode versus VVI(R) mode regarding subjective and objective parameters as NYHA-classification, BNP, 6 minute walk test, left ventricular ejection fraction and left ventricular endsystolic volume after 12 months. The improvements seem to depend on the reduction of ventricular pacing with advanced atrial contraction. But only a small number of patients needed the upgradation.

Journal Article↗
PubMed2006

Better identification of patients who benefit from implantable cardioverter defibrillators by genotyping the G protein beta3 subunit (GNB3) C825T polymorphism.

AIMS: There is a need for better identification of patients at high risk for malignant arrhythmias who would benefit from implantable cardioverter defibrillators (ICD). The purpose of this study was to assess whether the C825T polymorphism in the G-protein beta3 subunit gene, GNB3, might serve as a genetic marker for recurrent ventricular arrhythmias. METHODS AND RESULTS: Genotyping was performed in 82 patients with ischemic heart disease treated with an ICD for primary and secondary prevention of cardiac arrhythmias. The Kaplan-Meier method was used to estimate the probability of remaining free from VT/VF with cycle length (CL) < 330 ms that required treatment by the ICD. Genotyping yielded 7 individuals homozygous for the 825T allele (TT), 36 homozygous for the C825 allele (CC), and 39 heterozygotes (CT). Multivariate analysis revealed that the C825T polymorphism (P = 0.004), left ventricular ejection fraction (P = 0.009), and QRS-duration (P = 0.039) were independent determinants of severe ventricular arrhythmias. Homozygous carriers of the C825 allele had a 3.9-fold risk for severe ventricular arrhythmias. CONCLUSION: The results from this pilot study suggest that the C825T polymorphism may have a modifying effect on the propensity towards life-threatening arrhythmias. Genotyping the C825T polymorphism may help to better identify individuals at high risk for life-threatening arrhythmias who benefit from ICD therapy.

Adult↗
PubMed2006

Amiodarone prophylaxis for atrial fibrillation of high-risk patients after coronary bypass grafting: a prospective, double-blinded, placebo-controlled, randomized study.

AIMS: Atrial fibrillation (AF) occurs often in patients after coronary artery bypass grafting (CABG) and can result in increased morbidity and mortality. Previous studies using P-wave signal-averaged electrocardiogram (P-SAECG) have shown that patients with a longer filtered P-wave duration (FPD) have a high risk of AF after CABG. We have shown that patients with an FPD > or = 124 ms and a root-mean-square voltage of the last 20 ms of the P-wave 20 < or = 3.7 microV have an increased risk of AF after surgery. Accordingly, the aim of this study was to investigate whether or not prophylactic peri-operative administration of amiodarone could reduce the incidence of AF in this high-risk group undergoing CABG identified by P-SAECG. METHODS AND RESULTS: In this prospective, double-blinded, placebo-controlled, randomized study, 110 patients received either amiodarone (n = 55) or placebo (n = 55). During CABG, two patients of both groups died. Amiodarone was given as 600 mg oral single dose one day before and from days 2 through 7 after surgery. In addition, amiodarone was also administered intravenously during surgery in a 300-mg bolus for 1 h and as a total maintenance dose of 20 mg/kg weight over 24 h on the first day following surgery. The primary endpoint was the occurrence of AF after CABG. The secondary endpoint was the hospitalization length of stay after CABG. The baseline characteristics were similar in both treatment groups. The incidence of post-operative AF was significantly higher in the placebo group compared with the amiodarone group (85 vs. 34% of patients, P < 0.0001). The prophylactic therapy with amiodarone significantly reduced the intensive care (1.8 +/- 1.7 vs. 2.4 +/- 1.5 days, P = 0.001) and hospitalization length of stay (11.3 +/- 3.4 vs. 13.0 +/- 4.3 days, P = 0.03). In the amiodarone group, concentrations of amiodarone and desethylamiodarone differed significantly between patients with AF and sinus rhythm (amiodarone: 0.96 +/- 0.5 vs. 0.62 +/- 0.4 microg/mL, P = 0.02; desethylamiodarone: 0.65 +/- 0.2 vs. 0.48 +/- 0.1 microg/mL, P = 0.04). CONCLUSION: The incidence of post-operative AF among high-risk patients was significantly reduced by a prophylactic amiodarone treatment resulting in a shorter time of intensive care unit and hospital stay. Our data supports the prophylactic use of amiodarone in peri-operative period in patients at high risk for AF after CABG.

Aged↗
PubMed2006

Remodeling index compared to actual vascular remodeling in atherosclerotic left main coronary arteries as assessed with long-term (> or =12 months) serial intravascular ultrasound.

OBJECTIVES: We present the remodeling index (RI) versus serial intravascular ultrasound (IVUS) data. BACKGROUND: The RI, derived by comparing lesion external elastic membrane (EEM) cross-sectional area versus the reference at one time point, is used in various IVUS studies as a substitute of true remodeling (change in EEM over time), assuming that it represents true remodeling. METHODS: We studied 46 non-stenotic left main arteries using serial IVUS (follow-up 18 +/- 8 months). Plaques were divided into subgroups according to the follow-up RI: follow-up RI >1 (n = 27) versus follow-up RI < or =1 (n = 19). RESULTS: Lesions with a follow-up RI >1 had an increase in lumen despite an increase in plaque because of an increase in EEM. Conversely, lesions with a follow-up RI < or =1 had a reduction in lumen as a result of both a plaque increase and EEM decrease. Overall, the follow-up RI correlated directly with changes in lesion site EEM (baseline-to-follow-up). Although there was no correlation between the follow-up RI and changes in reference EEM area, changes in reference EEM area did correlate directly with changes in lesion EEM area. In nearly 90% of lesions with a follow-up RI >1, there was a previously documented increase in EEM area. Using multivariate linear regression analysis, the follow-up RI was dependent on the baseline RI, the increase in lesion EEM area, and the decrease in reference EEM area. The follow-up RI was not dependent on changes in lesion plaque area. CONCLUSIONS: The vast majority of left main lesions with a remodeling index >1 had evidence of a previous increase in lesion-site EEM area.

Aged↗
PubMed2006

Impact of intraventricular conduction delay on coronary haemodynamics: a study with intracoronary Doppler in patients with bundle branch blocks and normal coronary arteries.

AIMS: The impact of right bundle branch block (RBBB) and left bundle branch block (LBBB) on myocardial perfusion is not completely understood as data are often blurred by underlying cardiac disease. The present study investigates whether conduction delays per se affect coronary perfusion-an indirect measure of myocardial oxygen demand. METHODS AND RESULTS: Intracoronary Doppler and ultrasound were performed in 8 patients with RBBB, 10 patients with LBBB, and 10 control subjects. All patients had angiographically normal coronary arteries and normal left ventricular function. Baseline (bAPV) and adenosine-induced hyperaemic average flow velocity and coronary flow velocity reserve (CFVR) were measured in left anterior descending arteries. Intravascular ultrasound showed no difference in lumen cross-sectional area and plaque burden between groups. Patients with RBBB and LBBB had higher bAPV values than controls (19.0 +/- 4.9, 21.9 +/- 5.1, and 14.6 +/- 2.4 cm/s, respectively; ANOVA P = 0.003). There was no difference between patients with LBBB and RBBB compared with controls in CFVR (2.8 +/- 0.5, 3.0 +/- 1.0, and 3.4 +/- 0.7, respectively; ANOVA P = 0.21). CONCLUSION: Bundle branch blocks, in particular LBBB, are associated with an increased coronary flow velocity, which indicates enhanced myocardial oxygen demand on the basis of mechanoenergetic disturbance. This may contribute to the unfavourable outcome of patients with intraventricular conduction delay.

Adenosine↗
PubMed2005

Risk factors of ventricular tachyarrhythmias after coronary artery bypass grafting.

BACKGROUND: Ventricular arrhythmias are rare and represent the most serious arrhythmic complication after coronary artery bypass grafting (CABG). METHODS: The present retrospective study was conducted for identifying patients at risk of ventricular arrhythmias with ventricular signal averaged ECG, standard deviation of all normal RR intervals (SDNN), angiographic and echocardiographic data. We defined ventricular arrhythmias as sustained ventricular fibrillation and ventricular tachycardia. The study population consisted of 209 consecutive patients with sinus rhythm undergoing CABG. The primary endpoint was the occurrence of VA after CABG. The secondary endpoints were hospital length of stay after CABG and the occurrence of VA after hospital discharge. RESULTS: During the postoperative follow-up ventricular arrhythmias were observed in 11 patients (5%). Patients with ventricular arrhythmias showed a higher incidence of ventricular late potentials (91 vs. 9% of patients, p<0.0001) than patients without ventricular arrhythmias. In addition patients with ventricular arrhythmias had a lower left ventricular ejection fraction (44.2+/-15.2 vs. 60.1+/-13.1%, p<0.0001) and a SDNN (22.4+/-8.8 vs. 34.4+/-16.1 ms, p<0.02). A stepwise logistic regression analysis of all variables identified the combination of ventricular late potentials, ejection fraction < or = 38% and SDNN < or = 28 ms (odds rate 26.00; 95% CI, 3.44-196.67, p<0.002) as an independent predictor of ventricular arrhythmias. CONCLUSIONS: The results of our study suggest that the probability of ventricular arrhythmias could be predicted after CABG by a combination of low left ventricular ejection fraction and a measurement of ventricular signal averaged ECG and standard deviation of all normal RR intervals. Patients who can be identified as having a high risk of ventricular arrhythmias should be observed carefully after surgery.

Aged↗
PubMed2005

Long-term outcome after cardioversion of atrial fibrillation: prediction of recurrence with P wave signal averaged ECG and chemoreflexsensitivity.

AIM: The recurrence of atrial fibrillation after cardioversion was a general problem in medical practice. METHODS: We wanted to test the hypothesis that the recurrence of atrial fibrillation could be predicted by measurements of P wave triggered P wave signal averaged ECG and chemoreflexsensitivity (CHRS) in 118 consecutive patients one day after successful electrical cardioversion. We measured the filtered P wave duration (FPD) and the root mean square voltage of the last 20 ms of the P wave (RMS 20) with P wave triggered P wave signal averaged ECG. The CHRS was calculated of a ratio between the difference of RR intervals in ECG and venous pO2 before and after 5-min oxygen inhalation. The pathologic CHRS was predefined as a CHRS below 3.0 ms/mm Hg. RESULTS: A recurrence of atrial fibrillation was observed in 57 patients (48%) during a 9.3-month follow-up. The left atrial size (41.9+/-4.0 vs. 39.3+/-3.1 mm, P<0.0003) was larger, the FPD (139.6+/-16.0 vs. 118.2+/-14.1 ms, P<0.0001) was longer, the RMS 20 (2.57+/-0.77 vs. 3.90+/-0.99 muV, P<0.0001) and the CHRS (2.66+/-1.18 vs. 4.01+/-1.66 ms/mm Hg, P<0.0001) were lower in patients with recurrence of atrial fibrillation. A cut-off point was defined with FPD > or =126 ms and RMS 20 < or =3.1 muV and could predict atrial fibrillation with a specificity of 77%, a sensitivity of 72%, a positive value of 75%, a negative predictive value of 75% and an accuracy of 75%. Patients with FPD > or =126 ms and RMS 20 < or =3.1 muV had nearly a 7-fold increase risk for recurrence of atrial fibrillation. CONCLUSION: The recurrence of atrial fibrillation after cardioversion could be detected by P wave signal averaged ECG and an analysis of CHRS. These methods seem to be appropriate to show a delayed atrial conduction and a neurovegetative imbalance which might be possible trigger mechanisms of reinitiating of atrial fibrillation.

Aged↗
PubMed2005

[Coronary stents. From a simple idea to a medical high-tech device].

BACKGROUND: Coronary stents were introduced in clinical cardiology in the middle of the 1980s, as balloon angioplasty was associated with a high incidence of acute vessel closure and restenosis. EVOLUTION OF CORONARY STENTS: However, primarily designed to counteract elastic recoil after angioplasty, initial results were complicated by acute and subacute stent thrombosis. With the introduction of drugs effectively inhibiting platelet aggregation like ticlopidine and clopidogrel, stent could exhibit its superiority in comparison to angioplasty. Although the incidence of restenosis could be decreased significantly by coronary stents, restenosis remained a major drawback of this interventional technique. Several modifications of stent design and stent material had been tested, but without a real breakthrough. The introduction of active stent coating with anti-inflammatory and antiproliferative drugs marks a milestone in the development of this technology. With this approach the restenosis problem could be, even though not solved, but essentially mitigated. Current developments address bioabsorbable materials to make stents compatible with new upcoming noninvasive imaging techniques. CONCLUSION: Introduced 20 years ago as a simple wire mesh, modified by new designs and materials, and coated by highly effective drugs, coronary stents have advanced to medical high-tech devices in interventional cardiology.

Adult↗
PubMed2005

P wave signal averaged ECG and chemoreflexsensitivity in paroxysmal atrial fibrillation.

Detailed analysis of the QRS-complex and autonomic dysfunction can identify patients at risk to suffer from ventricular arrhythmias. To determine whether patients at risk for paroxysmal atrial fibrillation (PAF) could be identified while in sinus rhythm, a P wave triggered signal averaged ECG and an analysis of the autonomic function by chemoreflexsensitivity (CHRS) were examined. The ratio between the difference of RR intervals in the ECG and the venous partial pressure of oxygen before and after 5-min oxygen inhalation was measured for the determination of CHRS. We examined 224 patients (group A) who suffered from PAF, 250 patients (group B) without arrhythmic history and 30 young volunteers (group C). The filtered P wave duration (FPD) was significantly longer in group A than in group B (140.9+/-21.0 vs. 118.2+/-9.4 ms, p<0.0001) or C (105.2+/-14.1 ms, p<0.0001) while the root mean square voltage of the last 20 ms of the P wave (RMS 20) was significantly lower in group A than in group B (2.68+/-1.12 vs. 4.06+/-1.57 microV, p<0.0001) or C (3.97+/-1.36 microV, p<0.0001). Atrial late potentials (ALP) were defined as a FPD>120 ms and a RMS 20< or =3.5 microV. ALP could identify patients of group A with a specificity of 78% and a sensitivity of 83%. Patients with PAF (2.32+/-1.15 ms/mm Hg) showed a significantly lower CHRS than group B (4.14+/-1.58 ms/mm Hg, p<0.0001) or group C (4.98+/-1.51 ms/mm Hg, p<0.0001). The sensitivity for the presence of atrial fibrillation was 71% for a CHRS below 3.0 ms/mm Hg with a specificity of 70%. A combination of both methods showed a specificity of 85% and a sensitivity of 65% when ALP and pathological CHRS were present. The results of our study suggest that risk of atrial fibrillation could be detected by P wave signal averaged ECG and CHRS. An analysis of CHRS seems to be an appropriate method to demonstrate a neurovegetative imbalance, which might be one possible trigger mechanism.

Adolescent↗
PubMed2005

[Niacin--an additive therapeutic approach for optimizing lipid profile].

BACKGROUND: Large interventional studies have shown that the reduction of total cholesterol and low-density lipoprotein cholesterol (LDL-C) is one of the cornerstones in the prevention of coronary artery disease. However, in up to 40% of patients the recommended target of LDL-C is not reached with a monotherapy. Furthermore, risk stratification only by LDL-C disregards a substantial number of patients with dyslipidemia with increased triglycerides and decreased high-density lipoprotein cholesterol (HDL-C). EFFECT OF NIACIN ON LIPID METABOLISM: In consequence, niacin has gained attention as a component of a combined therapeutic approach in patients with dyslipidemia. Niacin substantially increases HDL-C and decreases triglycerides, LDL-C and lipoprotein (a). By this mechanism of action niacin exhibited, in combination with statins or bile acid-binding resins, favorable effects on the incidence of cardiovascular events in selected patients. Side effects like flush and hepatotoxicity seem to be in part dependent on the niacin formulations used. However, niacin has been shown to be a well-tolerated and safe therapy in controlled studies. CONCLUSION: On the basis of current data niacin should be considered a valuable therapy component in patients with dyslipidemia, in which a monotherapy fails to optimize an increased risk of coronary artery disease.

Cholesterol↗
PubMed2005

[Clinical and pharmacological testing of patients with pulmonary hypertension for treatment decision].

Pulmonary arterial hypertension (PAH) is a rare and rapidly progressing disease characterized by an increase in pulmonary resistance, which, if untreated, inevitably progresses to right ventricular heart failure and death. New treatment options were developed in the last 10 years. Endothelin receptor antagonists (ERAs) and prostanoids are an effective treatment with a better survival. Phosphodiesterase inhibitors (PDIs) are of a great interest, and first results in the treatment of patients are promising. PDIs are different in pulmonary selectivity and half-life.Right heart catheterization is the "gold standard" in the diagnosis of pulmonary hypertension. Direct classification of the pulmonary hypertension is feasible, and the effects of the drugs are directly measurable. The results of right heart catheterization are comparable for inhalative and oral drugs. New generations of drugs resulted in special testing protocols. Furthermore, individual concepts of therapy can be developed.

Antihypertensive Agents↗
PubMed2005

[Non-compaction cardiomyopathy].

Isolated non-compaction of the ventricular myocardium (INVM), also known as left ventricular hypertrabeculation or spongy myocardium, belongs to the "unclassified" cardiomyopathies according to the World Health Organization. The main characteristic of this entity is a prominent trabeculation of the left ventricle with deep intertrabecular recesses communicating with the ventricular cavity. The pathomechanism of INVM is thought to be an arrest in cardiac myogenesis with persistence of embryonic myocardial morphology. The most frequent clinical manifestations include congestive heart failure, ventricular arrhythmias and systemic thromboembolic events. The therapy of INVM comprises standard medical therapy for heart failure.

Cardiomyopathies↗
PubMed2005

Late enhancement: a new feature in MRI of arrhythmogenic right ventricular cardiomyopathy?

Aim of the study was to evaluate whether late enhancement (LE) in contrast-enhanced MRI can be used to characterize fibrofatty myocardial replacement in patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC). Fifteen patients with suspected ARVC underwent CE-MRI using a 1.5 T scanner. Long and short axis SSFP cine images and T1-weighted fast spin echo images were collected in all patients. After injection of 0.2 mmol/kg Gd-DTPA (Magnevist, Schering, Berlin, Germany), inversion recovery gradient echo images were acquired in long and contiguous short axes to detect myocardial LE indicating areas of fibrous tissue within the myocardium. For definition of ARVC, the ESC Task force criteria were used. In 7 (47%) of 15 patients, ARVC was diagnosed based on the ESC criteria. In all of these 7 patients, MRI showed morphologic or functional criteria of ARVC according to the ESC. LE of the right ventricular myocardium was detected in 5 (71%) of the 7 ARVC patients, additional LE of the left ventricular myocardium in 2 of these patients. None of the 7 patients meeting the ARVC diagnostic criteria had fatty RV infiltration demonstrable by conventional T1-weighted imaging. Eight patients neither showed morphologic criteria of ARVC nor LE. In conclusion, late enhancement can be detected in the right and left ventricular myocardium in some ARVC patients. LE might represent intramyocardial areas of fibrous tissue.

Adult↗
PubMed2005

Prediction of the recurrence of atrial fibrillation after successful cardioversion with P wave signal-averaged ECG.

BACKGROUND: The recurrence of atrial fibrillation (AF) was often observed after cardioversion. METHODS: In our study, a P wave triggered P wave signal-averaged ECG (P-SAECG) was performed on 118 consecutive patients 1 day after successful electrical cardioversion in order to evaluate the utility of this method to predict AF after cardioversion. We measured the filtered P wave duration (FPD) and the root mean square voltage of the last 20 ms of the P wave (RMS 20). RESULTS: During a 1-year follow-up, a recurrence was observed in 57 patients (48%). Patients with recurrence of AF had a larger left atrial size (41.9 +/- 4.0 vs 39.3 +/- 3.1 mm, P < 0.0003), a longer FPD (139.6 +/- 16.0 vs 118.2 +/- 14.1 ms, P < 0.0001), and a lower RMS 20 (2.57 +/- 0.77 vs 3.90 +/- 0.99 microV, P < 0.0001). A cutoff point (COP) of FPD > or =126 ms and RMS 20 < or =3.1 microV could predict AF with a specificity of 77%, a sensitivity of 72%, a positive value of 75%, a negative predictive value of 75%, and an accuracy of 75%. A stepwise logistic regression analysis of variables identified COP (odds ratio 9.97; 95% CI, 4.10-24.24, P < 0.0001) as an independent predictor for recurrence. CONCLUSIONS: We conclude that the probability of recurrence of AF after cardioversion could be predicted by P-SAECG. This method seems to be appropriate to demonstrate a delayed atrial conduction that might be a possible risk factor of reinitiation of AF.

Atrial Fibrillation↗
PubMed2005

Preliminary investigation of mitoxantrone coating on stent-grafts to inhibit neointimal proliferation.

PURPOSE: To investigate the inhibition of neointimal proliferation induced by a stent-graft loaded with mitoxantrone. METHODS: Stent-grafts with and without mitoxantrone loading (150 microg per device) were inserted into the carotid artery of 7 and 6 rabbits, respectively. After an observation period of 28 days, the animals were sacrificed, and a detailed morphological and morphometric workup of the stented vessels was performed. RESULTS: Uncoated stent-grafts induced a thick neointima (median diameter 97+/-99 microm), whereas no neointima formed in mitoxantrone-loaded stent-grafts. However, the loaded devices were not fully covered by an endothelial layer. The underlying media was significantly thinner (31.8+/-5.6 versus 48.6+/-3.3 microm, p=0.002) and showed a widespread loss of smooth muscle cells. CONCLUSIONS: Mitoxantrone loading of a stent-graft inhibited the formation of a neointima. However, important regenerative processes were prevented as well, indicating a local overdose. More experiments using lower doses are warranted.

Animals↗