[Sleep-related apnea disorders and associated cardiovascular diseases].
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Cardiovascular Diseases↗
Biomedical subjects
M Konermann
Publications and source records attributed to M Konermann.
[Constancy of the nCPAP pressure values in the long-term monitoring of patients with obstructive sleep apnea].
A retrospective study was undertaken to discover how often mask pressures had to be adjusted over time in patients treated for sleep apnoea by continuous positive airway pressure (nCPAP). Data were analysed on 106 such patients (95 men, 11 women; mean age 55.6 [33-74] years). Their body-mass index was 31.5 +/- 5.5 kg/m2, the apnoea hypopnea index before adjustment 7.6 +/- 2.2 mbar. At the first control, after a median of 7.5 months, the pressure had to be adjusted in 55% of patients, by an average of 8.3 +/- 2.4 mbar (P < 0.001). At the second and third follow-ups (after 19.5 and 31.5 months, respectively), no further significant adjustment in mean pressure was necessary, while changes had to be made in 34.0% and 17.9%, respectively. Changes in body weight correlated with changes in pressure level (r = 0.4614 for difference between initial setting and first control; r = 0.6708 for first and second controls; r = 0.7013 for second and third controls). 61% of patients in whom mask pressure had to be altered had symptoms. Of those in whom the pressure had to be increased 82% had symptoms. Only 17% of patients requiring no change had symptoms. These findings indicate that patients on nCPAP must be monitored by polysomnography about 6 months after the initial setting, and further tests should be performed about a year apart. If body weight and feeling of well being are maintained, non-laboratory monitoring should be adequate.
Adult↗
[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↗
Clinical significance of ventricular late potentials in patients with obstructive sleep apnoea.
Patients with obstructive sleep apnoea (OSA) have an increased cardiovascular mortality and probably also an increased incidence of sudden cardiac death. Thus the question arises whether ventricular late potentials can constitute markers for an increased electric vulnerability in these patients. Signal-averaged electrocardiograms were recorded in 64 patients (6 female, 58 male; mean age 53.2 y) with OSA (mean apnoea-hypopnoea index (AHI) 41.7 h-1 +/- 24.3 h-1). Furthermore, a continuous ambulatory electrocardiogram and gated radionuclide ventriculography were performed. Ventricular late potentials were recorded in 5 men out of 64 patients. Two of them had coronary artery disease (1 patient post-myocardial infarction), 2 hypertension, and 1 nocturnal hypertension. No correlation could be traced between left ventricular ejection fraction, severity and extent of ventricular premature beats, or severity of OSA and occurrence of ventricular late potentials. It was noticeable, however, that the patients with ventricular late potentials had severe OSA (mean AHI 50.2/h vs. 40.9/h). Although OSA may lead to structural myocardial changes that could be the basis for re-entrant circuits, ventricular late potentials were found in only 7.8% of these patients. The results of this study demonstrate that at present ventricular late potentials and signal-averaged electrocardiograms do not prove useful as screening methods for risk stratification of patients with OSA.
Journal Article↗
[Sleep disorders in patients with dialysis-dependent renal failure].
A questionnaire was performed in order to classify the prevalence of sleep disorders in patients with end-stage renal disease treated with hemodialysis. 69 patients (41 male, 28 female) with a median age of 57 years completed the questionnaire. 67% of these patients complained of sleep disorders. 31 patients (45%) had evidence of periodic leg movement syndrome, 22 patients (32%) of restless legs syndrome. 29 patients (42%) had difficulties in falling asleep, 27 patients (39%) in maintaining sleep and 17 (25%) experienced both. Snoring was found in 25 patients (36%), 13 patients (19%) seemed to have sleep apnea. These data show an increased prevalence of sleep disorders in patients with end-stage renal disease on hemodialysis treatment. We conclude that these patients should consequently be asked for sleep disorders, as a specific diagnostic and therapeutic regime could improve quality of life and life expectancy. Especially sleep apnea is a disease that has a high prevalence in this patient group and which can be treated successfully.
Adult↗
[Structural cardiac changes in patients with obstructive sleep apnea].
Important pathophysiological mechanisms in obstructive sleep apnea at night are increasing pleural pressure swings, hypoxia and hypercapnia, as well as central nervous arousals with consecutive fragmentation of regular sleep structure. They influence the cardiovascular system, at first only at night and at a later stage also during the day. This might result in cardiac structural changes: dilation and hypertrophy of the right ventricle, hypertrophy of the left ventricle, (especially of the muscular ventricular septum), dilation of right and left atrium. It is suggested that these cardiac structural changes are characteristic for obstructive sleep apnea and therefore define the "sleep apnea heart".
Cardiomegaly↗
[Effects of nCPAP therapy on the blood picture in patients with obstructive sleep apnea].
In some patients with obstructive sleep apnea, changes in red blood cell count resembling polycythemia can be observed. If these changes result from the sleep-related breathing disorder, its adequate treatment should in turn induce a decrease of, for instance, hemoglobin concentration. We therefore set out by examining retrospectively the development of hemoglobin concentration under nCPAP in 130 patients with polysomnographically verified obstructive sleep apnea, comparing the values before treatment and after a mean of 12.0 months. During this period, hemoglobin mass concentration dropped from a mean of 153 +/- 13 g/Ls to 148 +/- 11 g/Ls (p < 0.001). Afterwards we prospectively examined in 50 patients the changes in complete blood cell count before and immediately after initiation of nCPAP treatment. It turned out that hemoglobin mass concentration dropped from a mean of 154 +/- 14 g/Ls to 148 +/- 14 g/Ls (p < 0.001), the erythrocyte count from 5.02 +/- 0.42/pl to 4.79 +/- 0.51/pl (p < 0.001), and hematocrit from 45.4 +/- 3.1% to 43.1 +/- 4.3% (p < 0.001) after only one night; no more significant change occurred after that. Increased hemoglobin mass concentrations, erythrocyte counts and hematocrit values can be the result of obstructive sleep apnea. Treatment of this sleep disorder with nCPAP will induce a quick and significant decrease of hemoglobin mass concentration, erythrocyte count, and hematocrit, independent of the initial values. This phenomenon points to the fact that changes in blood cell counts are not caused by a disturbance of erythropoesis but rather by alterations in volume regulation.
Adult↗
[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↗
[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↗
[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↗
[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↗
[Potentials of high-resolution native computed tomography in meniscal diagnosis].
42 patients with symptoms suggestive of meniscus abnormalities were examined by CT immediately before undergoing arthroscopy. The appearances of normal menisci, various types of rupture, primary degeneration and congenital and acquired abnormalities are described. Using arthroscopy for reference, CT had an accuracy of 83%. The place of CT in relation to other non-invasive forms of tomography is discussed.
Adolescent↗
[Staged diagnosis and treatment of acute arterial and venous peripheral vascular occlusion].
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Arterial Occlusive Diseases↗
[Informing angiography patients. Results of a survey and critical comments].
100 patients subjected to angiography have been interviewed about their knowledge of the previous diagnostic procedure. The group having cerebral angiography keeps more details and risks in mind than a group having an angiography of the limbs. No patient regards the informed consent as an unnecessary affair and the majority expects to be examined by the informing physician. The radiologist therefore has the opportunity to establish a trustful relationship to the patient and to master his roll as a physician.
Angiography↗
[Diastolic left ventricular dysfunction--significance for differential diagnosis and therapy of heart failure in the aged].
The discrimination of the pathogenesis of the clinical picture "heart failure" as caused by a dominant systolic or diastolic LV-dysfunction is of a special importance in the elderly patient because of the consequences for the choice of pharmacological therapy, resulting from the age-related physiological increase of stiffness of the myocardium. The pathophysiology of diastolic dysfunction is characterized by a prolonged relaxation period as well as by compromised passive filling properties, caused by myocardial and external determinants. Typical clinical signs of diastolic dysfunction are dyspnea or pulmonary edema. Cardiac disorders with a dominance of diastolic dysfunction are coronary and hypertensive heart disease as well as hypertrophic or uremic cardiomyopathies. Diagnosis of diastolic dysfunction easily can be performed noninvasively by means of Doppler-echocardiography. Pharmacological therapy in diastolic dysfunction should prefer beta blocking drugs and calcium-antagonists against vasodilators or digitalis.
Aged↗