Biomedical subjects

R Dissmann

Publications and source records attributed to R Dissmann.

28 records · Page 2Linked to original sources

PubMed1994

Early assessment of outcome by ST-segment analysis after thrombolytic therapy in acute myocardial infarction.

As an early marker of outcome, the sum of ST-segment elevation resolution between the electrocardiogram before and 3 hours after initiation of thrombolysis was investigated in 77 patients with acute myocardial infarction. Prospectively, three groups were defined according to complete (> or = 70%, n = 34), partial (< 70% to > or = 30%, n = 26), or no (< 30%, n = 17) ST resolution. There were considerable differences in the enzyme-determined infarct size (alpha-hydroxybutyrate dehydrogenase release for complete, partial, and no ST resolution: 529 +/- 397 IU/L, 689 +/- 484 IU/L, and 1293 +/- 742 IU/L, respectively; p = 0.0001) and the angiographic left ventricular function 1 week later (ejection fraction 58% +/- 10%, 53% +/- 13%, and 43% +/- 12%, respectively, p < 0.01; regional dyssynergic area 24 +/- 19, 39 +/- 23, and 50 +/- 21 U2, respectively, p < 0.01). Early reperfusion as assessed by creatine kinase release measured in 15-minute intervals was 90%, 65%, and 18%, respectively (p = 0.0001). Differences in degrees of ST-elevation resolution at 3 hours may help facilitate timely screening of patients for appropriate therapeutic intervention. Patients with complete ST resolution may be considered for early discharge, and patients with no ST resolution may be candidates for an early invasive approach or additional thrombolytic therapy.

Cardiac Catheterization↗

PubMed1994

Extent of early ST segment elevation resolution: a simple but strong predictor of outcome in patients with acute myocardial infarction.

OBJECTIVES: This study proposed to verify the prognostic power of early ST segment elevation resolution in patients with acute myocardial infarction from the Intravenous Streptokinase in Acute Myocardial Infarction study data base. BACKGROUND: Data from a small prospective study suggested that use of two cutoff points for three different levels of ST segment resolution 3 h after the start of thrombolysis may be an efficient way to predict outcome in an individual patient. METHODS: The three groups of ST segment resolution were defined as 1) complete resolution (> or = 70% [552 patients]) or only slight ST segment elevation (127 patients); 2) partial resolution (< 70% to 30% [475 patients]); 3) no resolution (< 30% to > 0% [362 patients]). Infarct size was measured from creatine kinase isoenzyme, MB fraction, release and from the number of Q waves. Left ventricular function was assessed in 818 patients 1 month after infarction. RESULTS: For complete, partial and no ST segment resolution 3 h after the start of streptokinase or placebo infusion, enzyme release was 1.2, 1.8 and 2.1 IU/ml x h; number of Q waves 1.7, 2.5 and 3.0; and ejection fraction 60%, 53% and 49%, respectively (all adjusted p = 0.0000). Mortality rate at 21 days was 2.2%, 3.4% and 8.6%, respectively. No ST segment resolution was the most powerful independent predictor of early mortality (p = 0.0001). Survival rate curves at 6-year follow-up showed significant mortality differences with increasing divergence (p = 0.0003 anterior infarction; p = 0.005 inferior infarction). In subgroups with an overall higher risk of dying, mortality was strongly determined by the extent of early ST segment resolution. CONCLUSIONS: The extent of ST segment elevation resolution conveys useful early information about outcome in an individual patient after acute myocardial infarction.

Aged↗

PubMed1994

Early recurrence of ST-segment elevation in patients with initial reperfusion during thrombolytic therapy: impact on in-hospital reinfarction and long-term vessel patency.

AIM: To investigate the frequency and prognostic impact of early recurrent ST-segment elevation after initial ST-segment resolution in patients with acute myocardial infarction who had been treated with intravenous thrombolysis. METHODS: Eighty-one patients with acute myocardial infarction underwent 24 h Holter monitoring of the infarct-related ST-segment elevation, at the initiation of thrombolytic therapy. Angiography was performed in 88% of the patients 9 +/- 4 days after infarction. RESULTS: Resolution of the ST-segment elevation during the first 4 h, suggestive of early reperfusion, occurred in 67 (83%) patients (group 1). Of these, 31 (46%) had subsequent re-elevations (group 1a), 26 during the first 4 h, and 20 later. Thirty-six (54%) patients had no recurrence of the ST-segment elevation (group 1b). During follow-up, patients in group 1a experienced more in-hospital reinfarctions (26 versus 6%, P = 0.04) and had a higher rate of occluded infarct-related vessels at angiography than patients in group 1b (40 versus 17%, P = 0.01). CONCLUSION: During the first 24 h after initiation of thrombolytic therapy, recurrences of ST-segment elevation are frequent in myocardial infarction patients with ECG signs of an initially reperfused infarct-related artery. Recurrence of ST-segment elevation indicates a higher risk of reinfarction during hospitalization and of long-term occlusion of the infarct artery.

Aged↗

PubMed1994

[Left ventricular filling behavior in stress-induced myocardial ischemia--correlation between Doppler echocardiography determined transmitral flow profile and pulmonary capillary pressure].

The way Doppler-derived transmitral filling patterns are changed because of myocardial ischemia is controversial. Furthermore, the influence of the filling pressure has not been investigated sufficiently. To evaluate the relationship between transmitral flow profile and pulmonary capillary wedge pressure (PC), 35 patients with exercise-induced myocardial ischemia were examined. Both Doppler-derived transmitral filling patterns and PC were determined simultaneously at rest and during three stages of supine bicycle exercise. Patients were subdivided into two groups according to the hemodynamic response (group 1 = PC < 20 mm Hg; n = 10, and group 2 = PC > or = 20 mm Hg; n = 25). The correlation between PC and transmitral filling patterns was low at rest for all patients, but improved at maximal workload, particularly for the atrial contribution (r = -0.79), as well as the ratio of maximal and integrated early to late diastolic flow velocities (rE/A = 0.74; rEi/Ai = 0.72). Both groups revealed different flow profiles in regard to the hemodynamic response. While group 1 showed an E/A-ratio < 1, an E/A-ratio > 1 was registered in group 2 (0.9 m/s versus 1.61 m/s; p < 0.001). Exercise-induced myocardial ischemia lead to different Doppler-derived transmitral flow patterns with regard to the filling pressure. The relationship to the pulmonary capillary wedge pressure is so close that an E/A-ratio > 1 is a reliable parameter to predict a filling pressure > 20 mm Hg.

Adult↗

PubMed1994

[Recurrent ST segment elevations in continuous ECG analysis in the acute phase of myocardial infarct treated with thrombolytic therapy].

Early fluctuations of the ST-segment elevation indicating intermittent opening and reocclusion of the infarct artery has been well documented by angiographic monitoring in individual acute myocardial infarction patients undergoing thrombolytic therapy. However, the frequency of such episodes has not been studied in a consecutive patient group. Furthermore, it is not known what impact this finding has on the reinfarction risk during hospitalization and on left ventricular healing. The present investigation included 79 patients with acute myocardial infarction (pain < or = 6 h). Continuous Holter monitoring of the infarct-related ST elevation was initiated before or directly after starting thrombolytic therapy. During the 24-h observation period, 34 patients (43%) showed episodes of recurrent ST elevation after an initial resolution (group 1). Among those without episodes, ST elevation resolved within 4 h in 34 (43%, group 2) and persisted > or = 4 h in 11 (14%, group 3). Episodes of re-elevation were more frequent during the first 4 h (0.25 episodes per hour) than in the late part of the observation period (0.04 episodes per hour). Most episodes were transient and short lasting; only nine patients showed persistent re-elevations longer than 60 min. During hospitalization, group 1 patients had a higher incidence of reinfarctions and severe ischemic events than those without episodes (group 1 12/34 (35%) vs. group 2 4/34 (12%) vs. group 3 1/11 (9%), p = 0.03).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1993

[The indications for transesophageal echocardiography after cerebral ischemia].

Possible intracardiac sources of emboli were looked for by transoesophageal echocardiography (TOE) in 271 patients (149 men, 122 women; mean age 60 +/- 11 years) a mean of 12 +/- 8 days after suffering an episode of cerebral ischaemia. Left atrial thrombi were revealed in 9 patients: they were more frequent in those with atrial fibrillation (odds ratio [OD] 25.2; P < 0.0001) or known cardiac disease (OD 3.5; P = 0.06). Using the two factors together, the 9 left atrial thrombi could be predicted in 96 patients, while in the remaining 175 patients without cardiac abnormalities no left atrial thrombi were found. Overall, TOE is not an essential investigation additional to transthoracic echocardiography to exclude left atrial thrombi in patients without heart disease who are in sinus rhythm. But in those with atrial fibrillation and/or organic heart disease, TOE can in many instances facilitate the indication for anticoagulation.

Adult↗

PubMed1993

Sudden increase of the ST segment elevation at time of reperfusion predicts extensive infarcts in patients with intravenous thrombolysis.

Within 4 hours from the onset of symptoms in 61 patients with myocardial infarction and intravenous thrombolysis, ST segment elevation and creatine phosphokinase (CK) were measured every 15 minutes. Because of a premature enzyme rise, 42 patients (69%) were reperfused early (group 1). Immediately following reperfusion, eight of them (13%, group 1a) showed a marked increase of the ST elevation, in six of whom it was associated with clearly intensified chest pain. These patients exhibited a much steeper enzyme release and developed a larger enzymatic infarct size than patients (group 1b) without an additional transient ST elevation at reperfusion (CK peak 5.1 +/- 1.6 vs 9.8 +/- 4.2 hours after the start of thrombolysis; CK release 48 +/- 22 vs 19 +/- 18 IU/ml x hours, both p < 0.005). At angiography 11 days later, left ventricular function was significantly worse in group 1a than in group 1b (regional dyssynergic area 51 +/- 24 vs 21 +/- 18, global ejection fraction 39 +/- 14 vs 58 +/- 11; both p < 0.0005). During intravenous thrombolysis in acute myocardial infarction, some patients show a marked transient increase of the ST segment elevation at reperfusion. Their enzyme rise is very rapid and suggests a special reperfusion pattern. Most of these patients suffered large infarcts.

Adult↗

PubMed1993

Does cardiac function modify left heart opacification with transpulmonary echo contrast agents?

Dependence of left heart opacification on ventricular function was evaluated for the new transpulmonary echo enhancing agent (SH U 508-A). The contrast agent was injected intravenously in 5 patients with normal cardiac function (ejection fraction [EF] greater than 60% and echocardiographic left ventricular end-diastolic diameter [LVED] less than 56 mm) and in five patients with pathological ventricular function (EF less than 40%, LVED greater than 65 mm). A concentration of 400 mg/mL with dosages of 5, 9, and 16 mL was used in all patients. The visually assessed signal enhancement as well as the videodensitometrically determined peak intensity and duration of signal enhancement did not differ significantly between the two patient groups, while the transit times were markedly prolonged in patients with impaired ventricular function. No significant alteration was found for systemic blood pressure and heart rate. Side effects were transitory and dose related. The noninvasive nature of the procedure and the absence of hemodynamic effects make repeated studies of left ventricular performance with SH U 508-A in patients with varied hemodynamic status possible.

Aged↗

PubMed1993

[Detection of early reperfusion and prediction of left ventricular damage from the course of increased ST values in acute myocardial infarct with thrombolysis].

In 60 patients with acute myocardial infarction (pain < or = 4 h), we examined the value of ST segment monitoring in predicting early reperfusion, resulting left ventricular damage, and complications during hospitalization. Two criteria were determined by observation of the ST segment elevation during the first 4 h following initiation of thrombolysis. Early reperfusion was assessed by an early increase of the creatine phosphokinase (CK) with measurements taken in 15-min intervals. Cardiac catheterization was performed on days 11 +/- 5. According to the CK measurements, a reduction of the ST elevation > or = 50% within 1 h of serial ECG follow-up (ST criterion A) was the best indicator of early reperfusion (sensitivity 84%, specificity 80%, positive predictive value 93%, negative predictive value 67%). Simple comparison of the ST segment in the initial ECG and an ECG recorded 3 h later (ST criterion B) was less accurate according to the detection of early reperfusion (sensitivity 68%, specitivity 93%, positive predictive value 97%, negative predictive value 50%). However, contrary to ST criterion A, criterion B was useful in predicting subsequent left ventricular damage. Patients with a resolution of the initial ST elevation > or = 70%/3 h showed smaller regional wall motion abnormalities (dyssynergic area 21.3 +/- 20.3 vs 33.8 +/- 18.4, p < 0.01) and a better left ventricular ejection fraction (57.7 +/- 11.6 vs 50.2 +/- 12.6, p < 0.05). Patients with early reduction of the ST elevation following either criterion experienced fewer critical events (reinfarction, reischemia, death). In conclusion, the investigated criteria are useful in assessing reperfusion of the infarcted artery following thrombolysis.(ABSTRACT TRUNCATED AT 250 WORDS)

Anistreplase↗

PubMed1984

[Normal ranges of the regional movement of the left ventricular wall in 2-dimensional echocardiography].

Two-dimensional echocardiographic (2D-Echo) studies were performed in 51 healthy subjects to set up normal ranges of regional left ventricular (LV) wall motion for three different standard planes: the short axis (SA), recorded at a level between the mitral valve and the papillary muscles, the apical two-chamber view (2 CV) and the apical four-chamber view (4 CV). Wall motion analysis was performed using a fixed (Fix) as well as a floating reference system (Float). For regional wall motion, calculated by segmental area shortening, tolerance limits were estimated by using two well established statistical methods. The lowest coefficient of variation (V) was found for the SA (VFix = 0.18; VFloat = 0.11). The apical planes showed higher variations (2 CV: VFix = 0.20, VFloat = 0.20; 4 CV: VFix = 0.26, VFloat = 0.19). Defining the normal LV contraction ranges, a comparison of the reference systems showed advantages of the floating procedures, mainly in the SA and in the 4 CV. The obtained normal contraction ranges can be used for the evaluation of regional LV contraction abnormalities after acute myocardial infarction (AMI) if the 2D-Echo images are of excellent quality. We suggest an "index of dyssynergy" as a measure of wall motion abnormality.

Adult↗