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Biomedical subjects

K Reynen

Publications and source records attributed to K Reynen.

At least 19 recordsLinked to original sources
PubMed1998

Natural course of angiographic parameters after myocardial infarction: an evaluation in the prethrombolytic and pre-angiotensin converting enzyme inhibition era.

BACKGROUND: After myocardial infarction, left ventricular dilation is a frequent cause of cardiac insufficiency, which is associated with high morbidity and mortality. In this angiographic study, the natural course of postinfarction ventricular dilation could be followed up because patients undergoing revascularization procedures were excluded and only some few patients received angiotensin-converting enzyme inhibitors. METHODS AND RESULTS: Of 85 patients suffering from angina after myocardial infarction, 59 could be examined twice by angiocardiography in a mean interval of 52 +/- 14 months; 37 of the 59 patients had sustained posterior myocardial infarction, 20 had anterior myocardial infarction, and 2 had both. During follow-up, end-diastolic volume index increased from 100 +/- 27 mL/m2 to 110 +/- 34 mL/m2; in 26 of the 59 patients the increase was greater than 15 mL/m2. Irrespective of the time since infarction, patients with an end-diastolic volume index greater than 100 mL/m2 and an ejection fraction less than 50% at the time of first angiography were at high risk of progressive ventricular dilation and further deterioration of left ventricular function (for both, P = .003). This process was independent of extent of coronary artery involvement and coronary disease progression. Multivariate analysis identified ejection fraction at the time of index angiography as the strongest predictor of further left ventricular dilation (P = .0004). CONCLUSIONS: Continuing left ventricular dilation occurs in less than half the patients who had myocardial infarction. Left ventricular ejection fraction is the most sensitive parameter to predict the risk of ventricular dilation after infarction.

Adult↗
PubMed1997

[Friedreich disease. A neurocardiologic syndrome with uncertain nosologic classification of heart involvement].

Friedreich's ataxia (FA) represents a degenerative, genetically determined disease of the nervous system in combination with myocardial affection and in some cases endocrinological disturbances. Manifestation of myocardial involvement usually follows symptoms of nervous system degeneration later in the course, but seems not to be secondary. These cardiac disturbances are the main cause of death in FA-patients. Therapeutic management of heart disease is possible and interdisciplinary neurologic-cardiologic cooperation should start early in the course of FA.

Adult↗
PubMed1997

[Malignant primary tumors of the heart].

Primary tumors of the heart are rare, and a quarter of these tumors prove to be histologically malignant. Benign and malignant primary as well as secondary heart tumors belong to the differential diagnosis when a new heart murmur, heart rhythm disturbances, or cardiac insufficiency appear. In the diagnostics of intracardiac space-occupying lesions, two-dimensional echocardiography represents the method of choice, supplemental examination by computer tomography or nuclear magnetic resonance imaging may be helpful.

Diagnosis, Differential↗
PubMed1997

Coronary arteriography in elderly patients: risk, therapeutic consequences and long-term follow-up.

OBJECTIVE: Elderly people comprise the fastest-growing segment of the German population. This study evaluated the benefit of coronary arteriography in the management of selected old-age patients suffering from symptomatic coronary heart disease. METHOD: From 1982 to 1992, with annually increasing frequency, coronary arteriography was performed in 398 patients with suspected or proven coronary artery disease who were 75 years of age or older. RESULTS: Compared with 300 consecutive patients younger than 75 years, patients older than 75 years presented significantly more often with unstable angina, history of myocardial infarction, and multivessel disease; mean ejection fraction was significantly lower and risk of cardiac catheterization significantly higher. In more than half the older patients, balloon angioplasty (n = 130) or bypass surgery (n = 73) were judged to be indicated. Long-term prognosis was significantly worse with medical therapy: the 5-year survival rate was 58% for those receiving medical therapy, whereas it was 73% for those undergoing angioplasty, and 67% for those undergoing surgery. Multivariate analysis revealed history of diabetes and left ventricular ejection fraction as the most powerful predictors of death. Prognosis was significantly improved by surgery compared with medicine in patients with extensive coronary artery disease and impaired left ventricular function. More revascularized patients were free of angina at follow-up after a mean of 35 months, whereas intensity of antianginal medication was lower only in the surgically treated patients. CONCLUSIONS: In about half the selected aged patients, coronary angioplasty or bypass surgery was deemed feasible. Long-term prognosis, however, was primarily determined by left ventricular ejection fraction and history of diabetes. Compared with medical therapy, bypass surgery improved prognosis in patients with extensive coronary artery disease and impaired ventricular function. Interventions were effective in alleviating anginal complaints and reducing the need for antianginal drugs.

Age Factors↗
PubMed1996

[Diagnosis and therapy of cardiovascular diseases in elderly patients. Do different criteria apply?].

The risks associated with cardiac catheterization and coronary angiography increase with advancing age while at the same time, cardiovascular morbidity and mortality also rise. This means that the risks attendant on the two invasive diagnostic procedures can be accepted if they can be expected to identify the prognostically best form of treatment for the individual patient. Even in old age, CAD patients undergoing PTCA or coronary surgery are at an advantage in terms of long-term results and quality of life over patients receiving medical treatment only. From this it follows that the geriatric patient must not be excluded from such diagnostic and therapeutic procedures. Similarly, in the case of coronary thrombolysis following myocardial infarction, age per se must not be considered a contraindication. Finally, hypertension needs to be treated rigorously in the elderly too, albeit with consideration being given to certain differential therapeutic aspects.

Aged↗
PubMed1996

Frequency of primary tumors of the heart.

Primary tumors of the heart are rare. Based upon the data of 22 large autopsy series, the frequency of primary cardiac tumors is approximately 0.02%--corresponding to 200 tumors in 1 million autopsies (Table I).

Autopsy↗
PubMed1996

[Coronary angiography in patients over 80 years of age. Therapeutic consequences and long-term follow-up].

Today, an increasing number of old and very old patients is referred for invasive cardiovascular procedures. At our institution, cardiac catheterization has been performed in 82 patients 80 years of age or older (50 m, 32 f; mean age 82 +/- 2 years) during the last 11 years; in 70 patients, because of clinically proven or suspected coronary heart disease, and in 12 patients, because of heart valve disease. In comparison with younger patients, elderly patients with coronary heart disease more often presented with unstable angina, or had multivessel disease and reduced ejection fractions. PTCA (n = 25) and bypass grafting (n = 7) aimed at revascularization in 32 patients; in 38 patients, medical treatment was continued. Furthermore, valve replacement (n = 7) or valvuloplasty (n = 1) were judged to be indicated in 8 of the 12 patients with heart valve disease. Diagnostic procedure was more frequently burdened with serious complications in elderly than in younger patients (5/82 versus 3/300, p < 0.01). During follow-up of 25 +/- 23, median 21 months, cardiovascular events were significantly less frequent in patients with coronary heart disease who had undergone revascularization procedures than in those with medical therapy (2/29 versus 9/36; p = 0.05); more revascularized patients were free of angina at the time of reevaluation. Thus, risks of invasive diagnostic procedures are increased in very old patients. Diagnostics, however, result in therapeutical consequences, revascularization obviously improves symptomatology and prognosis in patients at extremely advanced age suffering from coronary heart disease.

Aged↗
PubMed1995

Cardiac myxomas.

Although cardiac myxomas are histologically benign, they may be lethal because of their strategic position. They can mimic not only every cardiac disease but also infective, immunologic, and malignant processes. Myxomas must therefore be included in the differential diagnosis of valvular heart disease, cardiac insufficiency, cardiomegaly, bacterial endocarditis, disturbances of ventricular and supraventricular rhythm, syncope, and systemic or pulmonary embolism. The symptoms depend on the size, mobility, and location of the tumor. Echocardiography, including the transesophageal approach, is the most important means of diagnosis; CT and MRI may also be helpful. Coronary arteriography in patients over 40 years of age is generally required to rule out concomitant coronary artery disease. Surgical removal of the tumor should be performed as soon as possible; the long-term prognosis is excellent, and recurrences are rare. In follow-up examinations as well, echocardiography is essential.

Diagnosis, Differential↗
PubMed1995

[Right ventricular metastasis of renal cell carcinoma 10 years after kidney transplantation].

In a 61-year-old man, renal cell carcinoma of the right kidney was diagnosed 10 years after renal transplantation. Echocardiography revealed a right ventricular mass 5.5 x 3.5 m in size. The patient died suddenly 10 weeks later, post-mortem examination confirmed diagnosis of right ventricular metastasis of renal cell carcinoma. This case underlines the importance of echocardiographic examination in tumor patients if signs of heart failure, angina pectoris, embolism, or rhythm disturbances arise; or if cardiac murmur becomes audible, or heart size increases.

Carcinoma, Renal Cell↗
PubMed1993

[Nitrates].

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Angina Pectoris↗
PubMed1993

[Percutaneous transluminal coronary angioplasty in patients with clearly restricted left ventricular pump function].

Among nearly 2000 consecutive PTCA-patients 42 (36 male, six female; mean age 60 +/- 11 years) had ejection fractions < or = 35% (mean 30 +/- 5%). 34 patients suffered from unstable and eight from stable angina. All had previous myocardial infarction and of these 23 had recent myocardial infarction. Four patients had prior coronary bypass surgery and one had undergone aneurysmectomy. 31 of 42 (= 74%) patients had multiple vessel disease (stenoses > 50%). Successful procedure was achieved in 35 of 42 patients (= 83%). The lesion-related success rate of PTCA was 89%, of recanalization 60%. Six procedures were multiple vessel PT-CA. Major complications occurred in two of 42 patients (one myocardial infarction, one emergency bypass operation). The in-hospital mortality was 2.4%. Follow-up angiography was performed in 22 patients and showed restenoses in nine cases. All patients underwent repeat coronary angioplasty, of these one patient had postprocedural myocardial infarction. The ejection fraction had meanwhile significantly improved from 29 +/- 5% to 36 +/- 7%. Clinical follow-up after 18 +/- 14 months (two to 53 months) was available in 39 of 40 patients, who were discharged from hospital without major complications. 29 patients were free of angina or anginal class II, one had a late cardiac transplant. Five patients had died of cardiac and one of noncardiac causes. Thus, PTCA in patients with severely depressed ventricular function shows acceptable acute results, which are comparable to those of routine angioplasty, continued symptomatic improvement can be achieved. However, the late outcome is significantly worse than in patients with normal left ventricular function.

Adult↗
PubMed1993

Surgical removal of a lipoma of the heart.

In a 29-year-old woman echocardiography revealed a tumour originating from the anterior wall of the right ventricle. Noninvasive findings aroused suspicion of a lipoma. The tumour was removed under cardiopulmonary bypass, the resulting defect in the right ventricular wall being covered with a Goretex patch. Histological examination classified the tumour as a rhabdomyolipoma.

Adult↗
PubMed1993

[Cardiac myxomas].

Explore the source record for details and available documents.

Diagnosis, Differential↗