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Biomedical subjects

J Grötz

Publications and source records attributed to J Grötz.

16 recordsLinked to original sources
PubMed1997

Changes of the left ventricle after myocardial infarction--estimation with cine magnetic resonance imaging during the first six months.

BACKGROUND: In recent years, the interest of cardiologists has focused increasingly on the morphologic and functional changes of the left ventricle after myocardial infarction (MI), due to their great prognostic significance for the patient. HYPOTHESIS: The aim of this study was to evaluate changes in left ventricular morphology and function during the first 6 months following MI. METHODS: In all, 61 patients (17 women, 44 men, age 36-83 years) were examined with cine magnetic resonance imaging (CMRI) 1, 4, and 26 weeks after myocardial infarction. Thirty-two patients had anterior MI and 29 patients had posterior MI. According to enzyme-derived infarct weight, 15 patients had small infarcts (< 20 g), 19 had intermediate-sized infarcts (20-40 g), and 27 patients had large infarcts (> 40 g). CMRI was performed in the true short axis of the left ventricle. In each examination, left ventricular end-diastolic and end-systolic volume indices (LVEDVI, LVESVI), stroke volume index (LVSVI), ejection fraction (LVEF), and regional thickness, mass, and motility of the myocardial wall-diastolic thickness (IDdia), infarct mass (IM) and motility (IMOT) of the infarct area and diastolic and systolic thickness (VDdia, VDsys), muscular mass (VM), and motility (VMOT)-were determined. In addition, patients were divided into subgroups according to New York Heart Association (NYHA) functional status at baseline. RESULTS: In the total group, LVEDVI increased from 73.9 +/- 23.5 ml/m2 to 85.4 +/- 28.1 ml/m2 (p < 0.001) and LVESVI from 40.5 +/- 19.4 ml/m2 to 51.2 +/- 29.0 ml/m2 (p < 0.001). In the subgroups the development depended on infarct size and location. LVSVI and LVEF remained more or less constant except for large anterior infarctions. All changes of the myocardial wall depended on infarct size and location: In all patients IDdia decreased from 10.4 +/- 1.6 mm to 8.9 +/- 1.7 mm (p < 0.001), IMOT from 2.0 +/- 1.6 mm to 0.5 +/- 2.9 mm (p < 0.001). IM increased from 41 +/- 21 g to 45 +/- 25 g (p < 0.001). In the total group, VDdia increased from 11.9 +/- 1.6 mm to 12.4 +/- 1.8 mm (p < 0.05), VDsys from 16.6 +/- 2.5 mm to 17.2 +/- 3.1 mm (p < 0.05). In the subgroups changes varied: VDdia and VDsys decreased markedly in large anterior wall infarctions. VM increased in the total cohort from a mean of 246 +/- 66 g to 276 +/- 80 g (p < 0.001). VMOT decreased from 7.1 +/- 2.4 mm to 6.3 +/- 2.7 mm (p < 0.05). Loss of motility was most pronounced in anterior infarctions. The volume-mass ratio, a measure of the success of compensation of volume increase by myocardial hypertrophy, decreased in small infarcts, remained unchanged in intermediate infarcts, and increased in large infarcts. There was a trend toward improvement of the NYHA functional status during the observation period. CONCLUSIONS: Changes of the left ventricular chamber during the first 6 months following MI are dependent on its size and location, with large anterior infarctions having the worst course. Myocardial wall remodeling is also dependent on infarct size and location, and the volume-mass ratio increases in the presence of large areas of necrosis, indicating the non-compensatory effect of myocardial hypertrophy. However, these changes have no clinical effect during the first half year after MI.

Adult↗
PubMed1996

[Effect of infarct size and site, patency of the infarct vessel and perfusion of vital myocardium on remodeling of the left ventricle--studies with cine-magnetic resonance tomography in the first 6 months following myocardial infarct].

BACKGROUND: Aim of the study was to evaluate the influence of infarct size and location and patency of the infarction and non-infarction vessels on left ventricular morphology and function in the first 6 months after myocardial infarction. METHODS: 61 patients (17 female, 44 male, 36-83 years) were examined with Cine Magnetic Resonance Imaging (CMRI) 1 and 26 weeks, and with coronary angiography 4 weeks after infarction. 32 patients had anterior, 29 patients posterior myocardial infarction. 15 patients had small infarcts (< 20 gm), 19 intermediate sized (20-40 gm) and 27 patients large infarcts (> 40 gm). CMRI was done in short axis of the left ventricle. Left ventricular enddiastolic and endsystolic volume indices (LVEDVI, LVESVI), ejection fraction (LVEF), muscle mass (VM) and motility (VMOT) of the vital myocardium, mass (IM) and area (IA) of the infarction zone, and volume-mass-ratio (VMR) of the left ventricle were determined on each examination. RESULTS: After 6 months large infarctions had 25% more LVEDVI, 41% more LVESVI, 20% less LVEF, 11% more VM, 13% less VMOT, 13% more IM, 47% more IA, and a 17% increased VMR compared to small infarcts. Anterior infarctions showed 11% more LVEDVI, 19% more LVESVI, 7% less LVEF, 4% more VM, the same VMOT, 5% more IM, 21% more IA, and 6% more VMR than posterior infarctions. If the infarction vessel was not perfused, after 6 months LVEDVI was 12% more, LVESVI 19% more, LVEF 7% smaller, VM 4% less, VMOT the same, IM 5% more, IA 17% more, and VMR 7% more increased than in the group with open infarction artery. When both non-infarction vessels were stenosed, LVEDVI rose 24% more, LVESVI 49% more, LVEF fell 25% more, VM rose 12% more, VMOT fell 26% more, and VMR rose 12% more than in patients with indisturbed perfusion of the vital myocardium. CONCLUSION: Perfusions of the vital myocardium and infarct size seem to be the most important factors for post infarction remodeling of the left ventricle. Infarct location and patency of the infarction vessel are of less influence.

Adult↗
PubMed1995

[Cine-MRT in the functional and morphological diagnosis of the heart after a myocardial infarct/ A comparison with angiocardiography, 2-dimensional echocardiography, intracardiac scintigraphy and enzymatic infarct size estimation].

PURPOSE: The aim of the study was to test the reliability of cine magnetic resonance imaging (cine-MRI) on the infarction heart with its altered geometry. MATERIAL AND METHODS: 61 patients (17 women, 44 men, 36-83 years, 32 with anterior, 29 with posterior wall infarction) received Cine-MRI in the true long and short axis of the heart and two-dimensional echocardiography one and 4 weeks post infarction. Two-level angiocardiography (ACG) and radionuclide ventriculography (RNV) were performed 4 weeks p.i. The size of myocardial infarction was determined enzymatically with the CK integral method. Left ventricular volume indices (EDVI, ESVI, SVI), ejection fraction (EF) and infarction weight (IW) were compared. RESULTS: Excellent correlations existed between cine-MRI in the long and short axis for the volume indices and EF. Between cine-MRI in the short axis and ACG all correlations were excellent as well. They were significantly less satisfactory between cine-MRI and 2DE due to the inhomogeneity of echo quality. Cine-MRI and RNV produced similar EF results (r = 0.884), and a comparison of IW in cine-MRI and CK integral method also showed a good correspondence (r = 0.967). CONCLUSION: Cine-MRI is a reliable method for the morphological and functional examination of post-myocardial infarction.

Adult↗
PubMed1995

[Right ventricular function in patients with obstructive sleep apnea].

Obstructive sleep apnea often affects the cardiovascular system. So far, only few data are available on its influence on the function of the right ventricle that can be evaluated by gated radionuclide ventriculography. This technique was performed on 68 patients with polysomnographically verified obstructive sleep apnea. 27.9% of the patients showed an impairment of right ventricular function. There was no correlation between right ventricular function and degree of obstructive sleep apnea or pulmonary artery pressures--as evaluated by right heart catheterization. Gated radionuclide ventriculography thus seems to be suitable for early detection of pathological effects of obstructive sleep apnea on the function of the right ventricle.

Adult↗
PubMed1993

[Sleep apnea syndrome, a "new" disease].

The sleep apnea syndrome recently has been discovered as a not infrequently occurring entity having a rank value in health politics because of its long range prognostic implications. Furthermore, the disease often causes significant worsening of life quality and working performance. The impressive sequelae can efficiently be treated according to published results. Future tasks will be amelioration of therapy, research of association between sleep apnea syndrome, snoring, and associate diseases as mentioned above. Furthermore, the high prevalence of the disease should lead to better evaluation of insurance related and medical opinion related problems of the disease.

Coronary Disease↗
PubMed1992

[Left ventricular dimensions and functions in the acute and chronic phase after myocardial infarct--comparison of cine-magnetic resonance tomography, angiocardiography, 2D-echocardiography and technetium ventricular scintigraphy].

To study left ventricular morphological and functional changes in the first six months after acute myocardial infarction, 37 patients (28 male, 9 female, age 42-78 years) underwent cardiac Cine-MRT 1 week, 4 weeks and 6 months after their first myocardial infarction. MR-tomograms were oriented to left ventricular true long and short axis. For comparison, contrast angiocardiographic, radionuclide and echocardiographic left ventricular studies were performed. LV-volume was calculated with the Simpson method for long axis images and by summation of slices for short axis images. Cine MRT results showed the following correlation to angiocardiography: in long axis r = 0.945 for LVEDVI, r = 0.958 for LVESVI, r = 0.869 for LVEF and r = 0.885 for cardiac index; in short axis r = 0.956 for LVEDVI, r = 0.965 for LVESVI, r = 0.917 for LVEF and r = 0.844 for cardiac index. For LVEF correlation to technetium radionuclide ventriculography was r = 0.760 in long and r = 0.861 in short axis. Correlation between Cine-MRT and echocardiography was poor as a consequence of the great variance of echogenity in the study patients. We conclude that Cine-MRT is an excellent method for morphological and functional left ventricular investigation, still limited in clinical praxis by costs and duration. As known from earlier investigations the development of left ventricular dilatation and functional disturbance was influenced by the size and location of the infarction with infarct size being the primary factor in the early and infarct location in the late post-infarction period. Outcome was worst following large anterior infarction.

Adult↗
PubMed1990

[Frequency of pathological changes of the upper gastrointestinal tract in patients awaiting heart surgery].

While waiting for open heart surgery, in 153 patients (104 male, 49 female, 22-76 years of age) without gastrointestinal symptoms and/or history esophago-gastro-duodenoscopy was performed. 124 patients suffered from coronary heart disease, 29 from valvular defect, aneurysm of the sinus of Valsalva or tumor of the heart. In 47.1% endoscopy revealed serious abnormal findings: in 16.3% gastric ulcer, in 20.9% erosive gastritis, duodenal ulcer and erosive duodenitis in 5.2%, respectively, 1 case of gastric carcinoma, 2 of large polyps and 3 of reflux esophagitis of higher degree (totally 3.9%). In patients with coronary artery disease, the relation of erosive and ulcerous gastric lesions as compared with those of duodenal origin was 4:1, in patients with other cardiac diseases it was 2:1, respectively (p less than 0.001). Compared with a normal population, the incidence of pathological gastric findings was 54-fold higher in our patients, and 1.7-fold concerning duodenal lesions, respectively (p less than 0.001). 51 patients on acetylsalicylic acid (160 mg/die) showed pathologic findings in 41.2%, and 96 patients without ulcer-inducing therapy in 51%. Thus, low-dose Aspirin does not seem to have serious gastric side effects. The results of the study stress the necessity of routinely performed endoscopy of the upper gastrointestinal tract in patients awaiting open heart surgery. This will lead to a lower incidence of serious gastrointestinal complications postoperatively which are known to have a high mortality.

Adult↗
PubMed1989

[Hemangioma of the left coronary artery with a fistula into the pulmonary artery].

A 32-year-old man had for about four months been suffering from discomfort in the left thorax unrelated to exertion. Coronary angiography revealed a haemangioma, 40 mm in diameter, which arose from the anterior descending branch of the left coronary artery with a connecting fistula to the main pulmonary artery. The tumour could not be demonstrated by either echocardiography or computed tomography, but magnetic resonance imaging showed an inhomogeneous structure in the basal region of the interventricular septum without increased signal intensity after injection of contrast medium. The tumour was not resected because of its small size and the minor symptoms which could not be proven as being tumour related. Repeat examinations (coronary angiography and magnetic resonance imaging) at six-month intervals are planned.

Adult↗
PubMed1988

[Scintigraphic imaging of adrenergic structures of the heart with 123(I)-metaiodobenzylguanidine in cardiomyopathy].

In 14 patients with various kinds of cardiomyopathy (DCM, HCM with and without obstruction, latent cardiomyopathy (= LCM], after confirmation of diagnosis, myocardial imaging with the recently developed substance 123I-metaiodobenzylguanidine (MIBG), an analog to guanethidine, was performed. In comparison, four patients in whom cardiac disease had been excluded, were evaluated. Myocardial uptake and washout were evaluated quantitatively. As a result, each kind of cardiomyopathy showed a significantly higher activity uptake versus normals, especially in patients with DCM. In all patients, the washout rate was increased compared to normals. The higher uptake is caused by depletion of catecholamine stores, as already known in DCM. On the other hand, the increased washout rate is considered to be a sign of a high sympathetic tone found in patients with HCM and LCM. The results seem to demonstrate a primary or secondary involvement of the sympathetic nervous system in these entities of hitherto unknown etiology.

3-Iodobenzylguanidine↗
PubMed1986

[Demonstration of intra- and paracardiac space-occupying processes using magnetic resonance tomography].

Magnetic resonance tomography (in three planes) was performed on 21 patients in whom echocardiography, angiocardiography or a chest X-ray had indicated or was suspicious of intra- or paracardiac space-occupying lesions. MR imaging demonstrated bronchial carcinoma with aortic displacement in two (one of them also with vena cava occlusion); hypernephroma with displacement of the right atrium in one; paracardiac teratoma in two and lipoma in one; aortic aneurysm in two; atrial tumour in five; atrial thrombi in one; ventricular thrombi in four; and exclusion of intra-cardiac lesions in two. Thus the method distinguished between vascular and tumourous paracardiac space-occupying lesions and demonstrated origin and structural relationship of paracardiac tumours, especially to the great vessels. Size, shape and mobility of intracardiac tumours was also demonstrated. For both intra- and paracardiac space-occupying lesions there were the beginnings of structural differentiation.

Aortic Aneurysm↗
PubMed1985

[Arteriosclerotic changes in the carotid arteries in patients with hypersensitive carotid sinus reflex].

Thirty-seven patients (15 female, 22 male; aged 46-89 years, mean age 68.8 years) with III or IV grade carotid sinus reflex carotid arteries were investigated by sonography (B-scan and CW-Doppler). It was demonstrated that stenoses or arteriosclerotic plaques, localized in the region of the carotid bulb or bifurcation, were present on both sides in 27 patients and on one side only in four patients. Five patients did not show these changes and four of them had thickening of common carotid artery endothelium. Thus, vascular changes occurred in 35 patients. Occlusions and stenoses greater than 50% were visible in five patients. Primarily bilateral changes were shown as well as unilateral and bilateral pathologic reflex response; main localization was the posterior wall of the carotid bulb. Thus, arteriosclerotic changes seem to be important in the development of pathologic carotid sinus reflex. Cerebral complications (left-sided PRIND) occurred in one patient who did not have high degree carotid stenosis. In comparison to other authors who investigated only with CW-Doppler a much higher rate of arteriosclerotic wall changes and a greater occurrence of bilateral changes could be demonstrated by application of the highly sensitive B-scan sonography.

Aged↗
PubMed1985

High-resolution real-time ultrasound of the carotid bifurcation in patients with hyperactive carotid sinus syndrome.

The carotid bifurcations and the common carotid arteries of 36 patients with the diagnosis hyperactive carotid sinus syndrome (HCSS) were investigated by continuous wave (CW) Doppler ultrasonography and high-resolution real-time B-scan. Using these non-invasive tests, the functional impact of luminal stenosis and the morphological changes resulting from arteriosclerotic deformities could be established. Significant differences were found in comparison with a reference group of 199 patients with a high risk of arteriosclerosis. In the HCSS group, 5 patients had a stenosis of more than 50% at the origin of the internal carotid artery on both sides, or on one side in combination with large plaques or a complete occlusion on the contralateral side. Seventy-five per cent of patients in the HCSS group, as compared to only 23.5% of the control group, had effective arteriosclerotic changes in the carotid bifurcation on both sides; 4 patients had such changes only unilaterally. Marked additional bilateral arteriosclerotic depositions were detected in the common carotid arteries of 17 patients (47.2%). In 5 patients no arteriosclerotic lesions were detectable in the carotid bifurcations, but marked changes were found in both common carotid arteries. These data indicate that bilateral arteriosclerotic changes in the carotid bifurcations and/or the common carotid arteries represent an important pathophysiological factor for the development of an HCSS.

Aged↗