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Biomedical subjects

M Zangeneh

Publications and source records attributed to M Zangeneh.

At least 19 recordsLinked to original sources
PubMed2003

ANP but not BNP reflects early left diastolic dysfunction in type 1 diabetics with myocardial dysinnervation.

OBJECTIVE: We investigated whether plasma concentrations of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) reflect impaired diastolic relaxation or its improvement after ACE inhibition. METHODS: 7 long-term Type 1 diabetic patients with normal systolic but impaired diastolic function and with sympathetic myocardial dysinnervation and 10 controls were included. Exercise tolerance and maximal O 2 uptake were evaluated by bicycle exercise prior to the study. ANP, BNP and norepinephrine/epinephrine (NE/E) were determined at baseline and at 80 % .VO2 max workload and after recovery, before and following 12 weeks of treatment with fosinopril (10 mg/d). RESULTS: Isovolumetric relaxation time (IVRT) and A/E wave ratio were increased by 26.7 +/- 11.5 % and 54.4 +/- 26.1 % in diabetic patients as compared to controls, respectively (p < 0.02). After 12 weeks of fosinopril treatment, no differences in IVRT or A/E wave ratio were detectable between groups. ANP was enhanced in Type 1 diabetes as compared to controls (baseline: 9.2 +/- 3.0 vs. 4.5 +/- 1.1; exercise: 22.4 +/- 7.7 vs. 7.9 +/- 1.2; recovery: 20.3. +/- 4.6 vs. 9.5 +/- 2.0 fmol/ml, p < 0.02). Fosinopril treatment abolished any differences between groups. BNP plasma levels did not differ between groups and no exercise dependent changes were observed. NE- and E-increase was greater at 80 % .VO2 max work load in Type 1 diabetes than in controls (p < 0.05). Again, fosinopril abolished differences between groups. CONCLUSION: In Type 1 diabetes, impaired diastolic function is associated with elevated ANP and catecholamine plasma levels that are normalized after ACE inhibition. Thus, ANP but not BNP appears to be a sensitive biochemical marker for early diastolic dysfunction in Type 1 diabetes.

Adult↗
PubMed1997

Treatment of left ventricular hypertrophy in hypertensive patients with a combination of verapamil and captopril--a multicenter study.

UNLABELLED: The regression of left ventricular hypertrophy in hypertensive patients was evaluated in a multicenter study with a combination therapy of verapamil 120 mg and captopril 25 mg given once or twice daily. The degree of left ventricular hypertrophy was assessed using echocardiography, while hypertension was evaluated by means of twice daily blood pressure self-measurements and ambulatory blood pressure monitoring. RESULTS: An overall of 61 patients was evaluated. Left ventricular mass had decreased by 13.5% during the 6-month treatment period. This reduction neither correlated with the baseline left ventricular mass nor with the extent of blood pressure decrease. CONCLUSION: The combination therapy-verapamil 120 mg plus captopril 25 mg--is well tolerated by hypertensive patients with left ventricular hypertrophy and produced a decrease of left ventricular mass that is independent of the extent of blood pressure decrease.

Adult↗
PubMed1996

Three-dimensional echocardiography using a transoesophageal imaging probe. Potentials and technical considerations.

Appreciation of three-dimensional relationships could be useful in cardiac diagnosis, decision making and planning of surgery. However, current ultrasound techniques provide only two-dimensional views. A recently developed echocardiographic computerized tomography unit allows reconstruction of three-dimensional images from a series of transoesophageal slices. To evaluate the potentials and limitations of this technique we performed echo computer tomographic examinations in 104 patients with a total number of 227 scans. All but two patients tolerated the procedure well and no serious complications were encountered. Indications for echo computer tomography included coronary artery disease, valvular heart disease, atrial masses, myocardial infarction, mitral and aortic valve replacement, aortic aneurysm and congenital defects. Most of the anatomical structures could be visualized with the best results obtained for the left atrium, the left ventricular outflow tract and the aortic and mitral valve apparatus. However, a variety of technical factors must be considered to achieve optimal results and to avoid misinterpretation. In 86% of patients the underlying pathology could be visualised by echo-computed tomography, particularly congenital defects such as those of the atrial or ventricular septa, but mitral valve pathologies provided the best results. In these cases three-dimensional imaging led to a better perception and understanding of structural relationships. In conclusion, despite current limitations in data acquisition, processing and computing power, echo computer tomography has the potential to provide relevant information in selected clinical settings.

Aortic Valve↗
PubMed1995

Free fat autotransplantation for the cosmetic treatment of first web space atrophy.

The results of free fat autotransplantation for the correction of first web space atrophy were reviewed for 25 patients who sustained war injuries resulting in ulnar nerve palsies. In anticipation of partial graft resorption, a 30% overcorrection of the first web space deformity was performed compared with the normal hand. Average follow-up was 5 years. All patients were satisfied with their cosmetic results. Whereas 21 patients (84%) demonstrated less bulk when compared to their normal side, 4 (16%) retained slight overcorrection of the web space. After 1 year of follow-up, there was no further evidence of graft resorption. There were no long-term complications. We conclude that free fat autotransplantation for the cosmetic correction of atrophy of the first web space is a safe and effective procedure. Although graft resorption was encountered, overcorrection provided patients with dramatic cosmetic improvement.

Adipose Tissue↗
PubMed1993

Hemodynamic and hemorheologic determinants of left atrial spontaneous echo contrast and thrombus formation in patients with idiopathic dilated cardiomyopathy.

The purpose of the present study was to evaluate the specific role of hemorheologic and hemodynamic parameters for spontaneous echo contrast and thrombus formation in vivo. We therefore investigated the association between the presence of left atrial spontaneous echo contrast and thrombus formation by transesophageal echocardiography and multiple clinical, hemodynamic, and hemorheologic parameters in 70 patients with idiopathic dilated cardiomyopathy. Transesophageal echocardiography showed left atrial spontaneous echo contrast and left atrial thrombi in 33% and 19% of patients, respectively. Patients with left atrial spontaneous echo contrast had a lower cardiac index (2.1 +/- 0.9 versus 2.6 +/- 0.9 L/min/m2; p < 0.02), a lower left atrial (21 +/- 8 versus 38 +/- 10 cm/sec; p < 0.001) and left atrial appendage flow velocity (17 +/- 14 versus 39 +/- 13 cm/sec; p < 0.001), a larger left atrial diameter (53 +/- 6 versus 46 +/- 10 mm; p < 0.002), and more often presented with atrial fibrillation (62% versus 32%; p < 0.02). Plasma fibrinogen concentration (4.0 +/- 1.1 versus 3.5 +/- 0.7 gm/L; p < 0.02) and plasma viscosity (1.83 +/- 0.10 versus 1.76 +/- 0.15 mPa.sec; p < 0.05) were higher in patients with spontaneous echo contrast. Multivariate analysis revealed an association between the presence of spontaneous echo contrast and left atrial flow velocity p < 0.0001) and plasma viscosity (p < 0.01). In patients with left atrial (appendage) thrombus or a history of embolism, left atrial appendage flow velocity was lower (15.0 +/- 8.2 versus 29.6 +/- 14.5 cm/sec; p < 0.005) and spontaneous echo contrast was more frequently observed (52% versus 23%; p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Significance of left-sided heart disease for the detection of patent foramen ovale by transesophageal contrast echocardiography.

Detection of patent foramen ovale by contrast echocardiography is based on transient inversion (right atrial pressure higher than left atrial pressure) of the interatrial pressure gradient. Therefore, the presence of left-sided heart disease with potential elevation of left atrial pressure might obscure the diagnosis of patent foramen ovale. Accordingly, 150 patients (88 men, 62 women; mean age 51.7 +/- 15.2 years) were evaluated for a patent foramen ovale by transesophageal contrast echocardiography. Additionally, atrial septal motion during normal respiration and during the Valsalva maneuver was analyzed. Patency of the foramen ovale was observed in 20 (27%) of 74 patients without left-sided heart disease and with previous arterial embolism, in none (0%) of 25 patients with left-sided heart disease and embolism, in 7 (39%) of 18 patients without left-sided heart disease and without embolism and in 3 (9%) of 33 patients with left-sided heart disease and without embolism. The detection rate of patent foramen ovale was lower in patients with than without left-sided heart disease (5% vs. 29%, p = 0.0007) but was similar in patients with and without embolism (20% vs. 19.5%, p = NS). Abnormal atrial septal motion was more frequently observed in patients with left-sided heart disease (p = 0.0003) and was inversely correlated to detection of patent foramen ovale (p = 0.0003). Multivariate analysis revealed an independent association between the absence of left-sided heart disease and the detection of patent foramen ovale (p = 0.0003). These data suggest that in patients with left-sided heart disease, patency of the foramen ovale may be missed even by transesophageal contrast echocardiography.

Adult↗
PubMed1992

[The value of echocardiography in diagnosis of bacterial endocarditis].

In recent years echocardiography has become the most important method for the diagnosis of bacterial endocarditis. Though identification of valve vegetations by M-mode echocardiography was rather limited, two dimensional echocardiography--especially with transoesophageal application--has a sensitivity of more than 90% and a specificity of 98%. In addition, echocardiography is able to supply valuable contributions for the evaluation of the patient's prognosis and in the identification of complications of infective endocarditis, such as: the extent of valve destruction, rupture of chordeae and other parts of the valves, as well as the presence of intramyocardial and paravalvular abscesses. In addition, the application of Doppler-echocardiography allows the semiquantitative evaluation of the degree of any valve insufficiency.

Abscess↗
PubMed1991

Distribution of ischemic cerebrovascular events in cardiac embolism.

Distribution and number of ischemic cerebrovascular events were studied in 57 patients who suffered from heart disorders with proven or highly probable source of cardiac embolism and compared to 39 patients with ulcerations of the craniocervical vessels. Patients with coexisting lesions were excluded from the present study. Out of the 57 patients with cardiac disorders, a single episode of cerebral embolism occurred in 33 patients. Of the 24 patients with recurrent ischemic episodes, different vascular territories were involved in only six cases. There was no evidence of a distinct distribution of vascular territories involved in cerebral embolism. The left middle cerebral artery was affected in 42.9%, the right middle cerebral artery in 23.8%, the vertebrobasilar territory in 19%, and the ophthalmic arteries in 14.2%. Statistical analysis revealed no significant differences in lesion localization between the group with a cardiac source of embolism and the group with ulcerations of the craniocervical vessels. There was a high frequency of patients with recurrent cardiogenic emboli in the ophthalmic (6 of 9 patients) as well as in the vertebrobasilar (6 of 12 patients) circulation who experienced a delayed initiation of cardiac assessment. The possibility of cardiac embolism should be considered in any patient with cerebral ischemia, independently of the vascular territory affected.

Adult↗
PubMed1988

Day to day reproducibility of Doppler sonographic measurements in patients with valvular aortic stenosis.

High reproducibility of Doppler gradient measurements is necessary for both the reliable noninvasive assessment of the severity of aortic stenosis and for repeated follow-up examinations in individual patients. We therefore studied day to day reproducibility of Doppler sonographically measured peak pressure drops in 46 patients with valvular aortic stenosis. Clinically stable patients were examined twice within 29 +/- 18.2 days by the same examiner. Peak pressure drop (PPD) and peak flow velocity differed between the two examinations by 8.6 +/- 7.0 (range 0-29) mmHg and by 0.25 +/- 0.18 (range 0-0.7) m/s, respectively. Reproducibility was comparable in patients with excellent, good, and moderate quality examinations, but was lower in the 6 patients with poor quality examination. Variability of PPD, but not of peak flow velocity was higher (p less than 0.05) in patients with severe (PPD greater than 60 mmHg) stenosis. Reproducibility was comparable in patients with or without concomitant aortic incompetence and in patients with normal or reduced left ventricular function. Similar reproducibility was obtained in patients with heart rate changes below or above 10 beats/min between the two examinations. It is concluded that good reproducibility of Doppler measurements in patients with aortic stenosis allows reliable noninvasive assessment of the severity of the stenosis. In follow-up studies of patients with mild to moderate aortic stenosis increases in peak flow velocity in excess of 15% (mean day to day variability +2 SD) are highly indicative of the true progress of the stenosis.

Aged↗
PubMed1988

[The effect of concomitant aortic valve insufficiency on the values of Doppler sonographic gradient determination in patients with aortic stenosis].

We examined the influence of concomitant significant aortic incompetence (AI) on Doppler-gradient measurements in valvular aortic stenosis (AS) by comparing catheter and Doppler gradients of 51 patients with isolated AS and of 24 patients with additional AI. In patients with additional AI there was a significantly greater overestimation of the peak-to-peak gradient by the maximal instantaneous Doppler gradient (AS + AI: overestimation 31.0 +/- 17.6 mm Hg, AS: overestimation 10.5 +/- 20.2 mm Hg; p less than 0.01) and also by the maximal instantaneous catheter gradient (AS + AI: overestimation 32.8 +/- 11.8 mm Hg, AS: overestimation 20.4 +/- 14.0 mm Hg; p less than 0.01). Comparison of the respective catheter-derived and Doppler-sonographically measured instantaneous and mean gradients showed no differences between the two patient subgroups. Higher instantaneous gradients in patients with additional AI are mainly explained by the lower end-diastolic aortic pressure. However, Doppler-sonographic overestimation of the severity of stenosis in patients with combined AS + AI, due to the sole measurement of the instantaneous gradient in clinical practice, should be of limited importance because in these patients significant AI already sufficiently indicates aortic valve replacement.

Adult↗
PubMed1987

[Doppler echocardiographic determination of aortic valve gradients].

Doppler-echocardiography is the most important non invasive method for the assessment of the severity of aortic stenosis. After measuring the maximal transstenotic flow velocity (= Vmax) the maximal pressure drop between left ventricle and aorta (= maximal instantaneous gradient) can bei calculated according to a simple formula. The accurate determination of Vmax may be difficult and time consuming, however, and when interpreting the Doppler-data it is important to realize that there is always a systematic numerical difference between the instantaneous gradient and those gradients which one usually measures at catheterization (peak to peak and mean gradient respectively). In mixed aortic valve disease the aortic insufficiency will distort the relationship between the various gradients still further. Despite these problems Doppler-echocardiography is extraordinarily useful in quantitating aortic stenosis and obviates the need for catheterization in most patients.

Aortic Valve↗
PubMed1986

[Doppler sonography quantification of mitral valve stenosis in patients with and without mitral valve insufficiency].

Fifty-three patients with mitral stenosis (MS) were examined by two dimensional (2DE) and Doppler echocardiography (Dop). Twenty-nine of them also had mitral insufficiency (MI) as judged by Dop. The mitral valve area (MVA) was calculated from Doppler using the "pressure half time" and was compared with MVA by 2 DE. There was a good correlation between both methods in all 53 patients (r = 0.88; SEE = 0.34 cm2) but also in the subgroups with pure MS (r = 0.86; SEE = 0.29 cm2) and MS + MI respectively (r = 0.90; SEE = 0.38 cm2). The accuracy and the reproducibility of the Doppler method was highly dependent on the severity of the stenosis. In 19 cases with mild MS (MVA by 2 DE greater than 1.5 cm2) the absolute difference between MVA 2 DE and Dop averaged 0.39 cm2. The difference between the maximal and minimal Doppler MVA which reflects the variability of this method averaged 0.65 cm2 in this group. In cases with significant MS (MVA by 2 DE less than or equal to 1.5 cm2) the average difference 2 DE -Dop and Dop max-Dop min was only 0.20 cm2 and 0.27 cm2 respectively. In patients with comparable degrees of stenosis additional MI did not adversely affect the accuracy of the Doppler method. We conclude that Doppler echo allows an accurate quantitation of mitral stenosis even in patients with associated MI.

Adolescent↗
PubMed1984

Impact of thallium-201 imaging on clinical assessment and management of patients with chest pain.

The histories, rest, and exercise ECG results of 60 patients without myocardial infarction complaining of chest pain were submitted to 6 physicians (3 cardiologists and 3 noncardiologists) who were unaware of the angiographic findings. The physicians were requested to estimate the probability of coronary artery disease present in percentages and to assess the need for coronary angiography on a five-point scale (1 = definitely not indicated, 5 = definitely indicated). After obtaining the results of thallium-201 imaging following dipyridamole (0.50 mg/kg intravenously) administration, the physicians were again requested to estimate probability and need for angiography. In the 43 patients with coronary artery disease the judgment of probability was increased significantly after 201Tl from 75.6 +/- 20.2% to 82.9 +/- 23.2% (p less than 0.001) and the need for angiography from 4.3 +/- 0.9% to 4.5 +/- 0.9% (p less than 0.001). In the subgroup of patients with atypical angina the relative change in probability was higher than in other subgroups of patients with coronary artery disease. In the 17 patients with normal coronary arteries the probability estimation fell after 201Tl from 36.7 +/- 22.0% to 24.8 +/- 21.0% (p less than 0.001), the need for angiography was decreased from 2.7 +/- 1.1% to 2.2 +/- 1.2% (p less than 0.001). With the 201Tl information, cardiologists performed a better diagnostic differentiation of patients with and without coronary artery disease than noncardiologists. The study demonstrates the improvement of clinical diagnosis in patients with chest pain by thallium-201 imaging and confirms the favorable influence of the method on the management of the patients in terms of indications for coronary angiography.

Angiography↗