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R Engberding

Publications and source records attributed to R Engberding.

At least 19 recordsLinked to original sources
PubMed2000

[A standardized documentation structure for data documentation in echocardiography. Work Team on Standards and LV Function of the Work Group on Cardiovascular Ultrasound of the German Society of Cardiology, Heart and Circulation Research].

Presently, there are no well-defined standards for documentation of echocardiographic studies. Nevertheless, standards are essential to provide comparability of data and to realize electronic communication, both essential for quality management in echocardiography. Therefore, the working group "Standards and LV function" of the German Society of Cardiology developed a consensus for documentation of echocardiographic studies. In the present paper this consensus is presented and illustrated by typical clinical examples. Additionally, a prototype of a user-oriented software based on this data set is presented. The complete data set for transesophageal and transthoracic echocardiography and the software prototype can be downloaded at http:@echo.ma.uni-heidelberg.de.

Aortic Valve Stenosis↗
PubMed2000

[Recommendations of the International Cardiology Forum (ICF) 1998 on revision of the current guidelines for the diagnosis and treatment of unstable angina pectoris and nontransmural myocardial infarct].

Rapid progress in the understanding and treatment of unstable angina and acute coronary syndrome are prompting occasional revisions to current treatment guidelines. The recommendations contained in this paper are based on the consensus reached during discussions at the 'International Cardiology Forum' in September 1998. Consensus was reached on significant major points, although some aspects remain controversial. A substantial body of data accumulated in a host of studies justify changes to current treatment habits.

Acute Disease↗
PubMed1999

[Medicamentous prevention after electric cardioversion of chronic atrial fibrillation. Goals and design of the PAFAC Study].

Atrial fibrillation (AF) is the most frequent cardiac arrhythmia. However, despite manifold publications reflecting numerous clinical trials about treatment of AF, the management of this arrhythmia is still under controversial discussion, in daily clinical work as well as in research. The present study concentrates on three major questions: 1. How frequent are recurrences of AF in long-term follow-up? Most of the previous studies used the occurrence of symptoms as a surrogate parameter for recurrences of AF, despite the expected high rate of asymptomatic relapses. In the present study a daily transtelephonic ECG transmission enables a rhythm monitoring independent of symptoms. 2. Is the frequency of AF recurrences significantly reduced by antiarrhythmic medication? A direct comparison of class I and III antiarrhythmic drugs, which still are most frequently used for this indication, and of placebo will answer this question. 3. How safe is the long-term treatment for the prevention of AF recurrences with special respect to proarrhythmic effects? The daily transtelephonic ECG transmission enables a quantitative and qualitative monitoring of tachy- and bradyarrhythmias independent of symptoms. Additionally, the daily analysis of ECG measures may detect parameters predicting subsequent life threatening arrhythmias. The study design provides a prospective, randomised, double-blind, placebo controlled, multicenter parallel group comparison. In Germany and in the Czech Republic about 90 hospitals will include 900 patients with documented chronic AF, age 18 to 80 years, if they are eligible for electrical cardioversion without concomitant antiarrhythmic drug therapy and if they are anticoagulated for at least three weeks prior to inclusion. Neither the size of the left atrium nor the duration of chronic AF are exclusion criteria. A few hours after successful electrical cardioversion the patients are randomised either to sotalol (2 x 160 mg) or quinidine + verapamil (3 x 160 mg + 3 x 80 mg) or placebo. Starting at the day after cardioversion, the patient is asked to record and transmit electrocardiograms of one minute duration at least once a day using his personal transtelephonic ECG recording unit (Tele-ECG recorder, credit card size), in case of symptoms as often as necessary. The ECGs can be transmitted at any time by any regular phone without additional equipment using a toll free number. A custom made, computer based, fully automated receiving centre is handling the patient calls interactively with voice control, including a voice recording of the patient's symptoms. The ECG tracings and the patient's voice messages are subsequently computer based analysed by experienced technicians. All ECG measures are stored in a database. In case of AF recurrence, any other relevant arrhythmia or additional abnormalities (e.g. QT prolongation) the correspondent hospital is immediately informed by fax. In case of AF recurrence, a subsequent Holter recording discriminates in paroxysmal and permanent AF. Study medication is ended if either permanent AF or the third episode of paroxysmal AF are detected or after 12 months of follow-up. Regular follow-up visits are performed monthly. Major endpoints are the time to first recurrence of AF or the time to death, secondary parameters are the number of AF recurrences, the time to end of medication and AF related symptoms. The recruitment started in the last days of 1996. Until the end of June 1998, 424 patients have been randomised. It is expected to end recruitment in spring 1999 and to close the study in spring 2000. Final results will be available in summer 2000.

Adolescent↗
PubMed1995

Atrial septal aneurysm in adult patients. A multicenter study using transthoracic and transesophageal echocardiography.

BACKGROUND: An atrial septal aneurysm (ASA) is a well-recognized abnormality of uncertain clinical relevance. We reevaluated the clinical significance of ASA in a large series of patients. The aims of the study were to define morphological characteristics of ASA by transesophageal echocardiography (TEE), to define the incidence of ASA-associated abnormalities, and to investigate whether certain morphological characteristics of ASA are different in patients with and without previous events compatible with cardiogenic embolism. METHODS AND RESULTS: Patients with ASA were enrolled from 11 centers between May 1989 and October 1993. All patients had to undergo transthoracic and transesophageal echocardiography within 24 hours of each other; ASA was defined as a protrusion of the aneurysm > 10 mm beyond the plane of the atrial septum as measured by TEE. Patients with mitral stenosis or prosthesis or after cardiothoracic surgery involving the atrial septum were excluded. Based on these criteria, 195 patients 54.6 +/- 16.0 years old (mean +/- SD) were included in this study. Whereas TEE could visualize the region of the atrial septum and therefore diagnose ASA in all patients, ASA defined by TEE was missed by transthoracic echocardiography in 92 patients (47%). As judged from TEE, ASA involved the entire septum in 100 patients (51%) and was limited to the fossa ovalis in 95 (49%). ASA was an isolated structural defect in 62 patients (32%). In 106 patients (54%), ASA was associated with interatrial shunting (atrial septal defect, n = 38; patent foramen ovale, n = 65; sinus venosus defect, n = 3). In only 2 patients (1%), thrombi attached to the region of the ASA were noted. Prior clinical events compatible with cardiogenic embolism were associated with 87 patients (44%) with ASA; in 21 patients (24%) with prior presumed cardiogenic embolism, no other potential cardiac sources of embolism were present. Length of ASA, extent of bulging, and incidence of spontaneous oscillations were similar in patients with and without previous cardiogenic embolism; however, associated abnormalities such as atrial shunts were significantly more frequent in patients with possible embolism. CONCLUSIONS: As shown previously, TEE is superior to the transthoracic approach in the diagnosis of ASA. The most common abnormalities associated with ASA are interatrial shunts, in particular patent foramen ovale. In this retrospective study, patients with ASA (especially with shunts) showed a high frequency of previous clinical events compatible with cardiogenic embolism; in a significant subgroup of patients, ASA appears to be the only source of embolism, as judged by TEE. Our data are consistent with the view that ASA is a risk factor for cardiogenic embolism, but thrombi attached to ASA as detected by TEE are apparently rare.

Case-Control Studies↗
PubMed1993

Transesophageal echocardiography: increased risk by repeated attempts to insert the transducer in patients with coronary artery disease?

The question of whether several attempts at transducer insertion increase the risk of performing transesophageal echocardiography (TEE) in patients with coronary artery disease (CAD) has not been addressed to date. In the course of performing TEE in 45 patients with CAD, two or more attempts to insert the transducer were necessary in 9 cases. During various attempts, heart rate, blood pressure and ST-segment depression were recorded and correlated with the findings of the exercise electrocardiogram (ECG) and coronary angiography. Insertion was successful in six patients after two attempts and in three other patients after three, four, and five attempts, respectively. Heart rate rose significantly (p < 0.005) with the increase of insertion attempts. In one patient, it continued to rise at the fourth attempt, reaching 216% compared with the initial heart rate. Systolic blood pressure rose by 5%, whereas there was hardly any change in diastolic blood pressure. As the number of insertion attempts increased, we recorded a continuous ST-segment depression in eight patients with angiographic changes of the coronary artery system. The depression was already significant at the first attempt (p < 0.05). Compared with the initial reading (0.053 mV), the increase was 335% (p < 0.01) after the second attempt (0.231 mV). One patient whose angiographic findings were normal had no ST-segment depression during TEE. In all eight patients with CAD ST-segment depression during TEE was > 0.2 mV. Since none of the patients complained of angina pectoris, the ST-segment depressions satisfied all the criteria of silent myocardial ischemia.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Diagnosis of heart tumours by transoesophageal echocardiography: a multicentre study in 154 patients. European Cooperative Study Group.

In a retrospective multicentre study, the diagnostic potential of transoesophageal 2D-echocardiography (TEE) as compared to precordial 2D-echocardiography (TTE) was determined in 154 patients with primary or secondary tumours of the heart. Additionally, the value of standard diagnostic parameters, such as symptoms, X-ray of the chest and electrocardiogram were evaluated. In 84 patients (24 male, 60 female; age 20-85, mean 56.6 years) intracardial tumours were present, and 70 patients (37 male, 33 female; age 18-79, mean 44.3 years) presented with peri- or paracardial tumours. The main symptoms of patients with intracardial tumours were dyspnoea (60.7%), vena cava syndrome (22.2%) and chest pain (20.2%). Embolization was found in 11.9%. Left or right atrial enlargement was observed on chest X-ray in 23 patients, and echocardiographic abnormalities in 17 cases. The patients with peri- or paracardial tumours presented with dyspnoea in 51.4% of cases, loss in body weight in 20.0% and with vena cava syndrome and chest pain in 17.1%. The chest X-ray was abnormal in 56 patients. Unspecific ST segment changes in the electrocardiogram were observed in five, and arrhythmias in seven cases. Diagnosis of atrial myxomas was achieved by TTE in 95.2%, by TEE in 100%, by angiography in 78.4%, by computed tomography (CT) or magnetic resonance tomography (NMR) in 70%. Identification of the attachment point was made by angiography in 8.1%, by TTE in 64.5% and by TEE in 95.2%. In 22 patients with intracardial tumours (myxomas excepted) diagnosis was achieved by TTE in 90.9%, by TEE in 100%, by CT or NMR in 88.9% and by angiography in 50%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Doppler echocardiographic assessment of the pressure gradient during bicycle ergometry in hypertrophic cardiomyopathy.

To assess the behavior of the subvalvular pressure gradient under physical exercise, 13 patients with obstructive hypertrophic cardiomyopathy were examined during upright bicycle ergometry by means of Doppler echocardiography. Additionally, right-sided cardiac catheterization was performed within 7 days. In 10 patients adequate Doppler tracings could be obtained during exercise. The Doppler-derived systolic pressure gradient increased from 75 +/- 24 to 140 +/- 42 mm Hg (p less than 0.0005). This was associated with an increase in the duration of the systolic mitral-septal contact from 59 +/- 21 to 136 +/- 28 ms (p less than 0.0005). Correlation between the pressure gradient and the duration of mitral-septal contact at rest and during exercise was good (r = 0.86), whereas correlation between the resting and exercise pressure gradient (r = 0.34) did not reach statistical significance. The increase in stroke volume during exercise, from 90 +/- 18 to 95 +/- 24 ml, was significant (p less than 0.05) but minimal. Therefore, only a moderate increase in systolic flow, from 205 +/- 54 to 268 +/- 78 ml/s (p less than 0.0005), was observed. Outflow tract resistance, defined as the ratio of the pressure gradient to systolic flow, increased from 0.38 +/- 0.11 to 0.57 +/- 0.24 mm Hg.s/ml (p less than 0.01). Thus, in a selected group of patients with hypertrophic cardiomyopathy a substantial increase in the maximal pressure gradient during upright bicycle ergometry was demonstrated in most patients. Exercise Doppler echocardiography may be valuable to assess the hemodynamic significance of obstruction in individual patients in a physiologic setting and has a potential to monitor the effect of therapeutic interventions.

Adult↗
PubMed1991

Safety of transesophageal echocardiography. A multicenter survey of 10,419 examinations.

BACKGROUND: During the past few years, transesophageal echocardiography (TEE) has been increasingly used in clinical cardiology; data concerning the practicability and safety of the technique, however, are rare. METHODS AND RESULTS: This report analyzes the experience of 15 European centers performing TEE studies for at least 1 year. At the time of this survey, 10,419 TEE examinations had been attempted or performed in these institutions. These TEE examinations were carried out by 54 physicians, 53.7% of whom had been trained in endoscopic techniques. Within the same time period, 160,431 precordial echocardiographic examinations were performed in the 15 institutions; the ratio between TEE and transthoracic studies averaged 9.03 +/- 6.4% (range of the 15 centers, 1.4-23.6%). Of the 10,419 patients, 9,240 (88.7%) were conscious inpatients or outpatients at the time of the TEE examination; the vast majority of the conscious patients did not receive intravenous sedation before TEE. In 201 cases (1.9%), insertion of the TEE probe was unsuccessfully attempted because of a lack of patient cooperation and/or operator experience (98.5%) or because of anatomical reasons (1.5%). In 90 of 10,218 TEE studies (0.88%) with successful probe insertion, the examination had to be interrupted because of the patient's intolerance of the echoscope (65 cases); because of pulmonary (eight cases), cardiac (eight cases), or bleeding complications (two cases); or for other reasons (seven cases). One of the bleeding complications resulted from a malignant lung tumor with esophageal infiltration and was fatal (mortality rate, 0.0098%). CONCLUSIONS: This multicenter survey documents that TEE studies are associated with an acceptable low risk when used by experienced operators under proper safety conditions.

Data Collection↗
PubMed1990

The influence of nicardipine on left ventricular hemodynamics and compliance in patients with coronary heart disease.

The hemodynamic effects of nicardipine were studied in 10 normotensive patients (nine men, one woman; age 43-70 years, mean 56 years) and five patients with mild to moderate hypertension (four men, one woman; age 46-72 years, mean 62.8 years); in all patients coronary heart disease was confirmed by angiography. Hemodynamic parameters were determined before and after intravenous administration of nicardipine in cumulative doses of 2.5, 7.5, and 12.5 mg for 10 min each. Nicardipine significantly reduced systolic aortic pressure, diastolic aortic pressure, and mean aortic pressure in normotensive patients [139 +/- 8.7 vs. 114 +/- 9.2 mm Hg (p < 0.001), 73 +/- 9.1 vs. 56 +/- 7.9 mm Hg (p < 0.001), 97 +/- 7.8 vs. 7.8 +/- 7.9 mm Hg (p < 0.001), respectively] and in hypertensive patients [166 +/- 7.4 vs. 128 +/- 8.6 mm Hg (p < 0.001), 83 +/- 9.4 vs. 56 +/- 10.9 mm Hg (p < 0.001), 110 +/- 15.5 vs. 78 +/- 12.0 mm Hg (p < 0.001), respectively]. Systemic vascular resistance was decreased significantly in hypertensive patients [1,363 +/- 188 vs. 707 +/- 137.7 dyn sec cm-5 (p < 0.001)] and in normotensive patients [1,110 +/- 225.3 vs. 682 +/- 92.4 dyn sec cm-5 (p < 0.001)]. Heart rate increased from 68 +/- 6.8 to 83 +/- 11.4 beats/min (p < 0.001) in normotensive patients but the increase from 72 +/- 14.7 to 80 +/- 14.2 beats/min in hypertensive patients was not significant. Mean pulmonary artery pressure did not change significantly in hypertensive patients and increased slightly in normotensive patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1989

[Diagnosis of intra- and pericardial tumor with transthoracic and transesophageal 2D echocardiography].

To examine the value of the combined approach of transthoracic and transesophageal 2D-echocardiography in diagnosis of heart tumors this study was performed on 30 patients (11 males, 19 females, age 15 to 82 years) with atrial (n = 17) and pericardial (n = 13) tumors. Echocardiography was performed using an electronic sector scanner (Varian 3400 R) and a 2.25 MHz transducer for the transthoracic approach and a 3.5 MHz transducer at the tip of a 9 mm gastroscope for examination from the esophagus. In 9 of 11 patients with atrial myxoma diagnosis was established by transthoracic echocardiography, whereas in 2 cases with reduced image quality at the conventional approach the tumor was identified by the transesophageal technique. In one of 5 patients with atrial thrombi acoustic properties and mobility could be better judged by transesophageal echocardiography. In 7 of 13 cases with pericardial tumors diagnosis was established by transthoracic echocardiography, whereas in 6 cases diagnosis was achieved by the transesophageal approach only. Thus, transesophageal echocardiography is suggested a decisive additional tool in diagnosis of heart tumors.

Adolescent↗
PubMed1989

Echocardiography in diagnosis of aortic dissection.

In a multicentre study the accuracy of echocardiography was measured in 164 consecutive patients with suspected aortic dissection. The diagnosis was subsequently proven (82 patients) on the basis of transthoracic and transoesophageal echocardiography and additional diagnostic procedures, including computed tomography (CT), aortic angiography, and surgery and/or necropsy. The sensitivity and specificity of echocardiography were 99% and 98%, respectively, with positive and negative predictive values of 98% and 99%. For CT sensitivity was 83%, specificity 100%, and positive and negative predictive values 100% and 86%, respectively. For aortography sensitivity and specificity were 88% and 94%, and the positive and negative predictive values 96% and 84%, respectively. Echocardiography, including the transoesophageal route, can provide accurate diagnosis of aortic dissection within 15 min. Diagnostic difficulties occur only in a few type II dissections, when complementary diagnostic procedures, including CT or angiography, may be needed. To clarify branch involvement angiography is required.

Acute Disease↗
PubMed1987

[Transthoracic and transesophageal 2-D echocardiography in the diagnosis of peri- and paracardiac tumors].

Twelve consecutive patients (five males and seven females, aged 24-61 years) with peri- or paracardial space-occupying lesions were studied by transthoracic and transesophageal 2-D echocardiography (2-DE). The tumor was localized by transthoracic 2-DE in six patients. In four patients the lesion was suspected after transthoracic 2-DE, but only transesophageal 2-DE defined the tumor and separated it from surrounding tissues. In two cases of pericardial tumor transthoracic 2-DE at first misdiagnosed it as pericarditis with pericardial effusion. In eight patients transthoracic and in four transesophageal 2-DE made it possible to assess cardiac function. The findings demonstrate that transthoracic 2-DE may not demonstrate peri- or paracardial tumors; transesophageal 2-DE adds an at times decisive additional diagnostic method.

Adult↗
PubMed1986

[Hemangiosarcoma of the heart].

The clinical appearance, typical localization, diagnostic procedure and the treatment of hemangiosarcoma--the most frequent malignant tumor of the heart are reported by the case of a 27 years old woman. The patient suffered from dyspnea, congestion of the superior caval vein and paroxysmal tachycardia. X-ray showed cardiac enlargement due to pericardial effusion. Echocardiography revealed a large tumor in the right atrium. Computertomography and angiocardiography showed tumor masses at the orifice of the superior caval vein and a bypass of the blood flow via the azygos vein. Thoracotomy yielded an inoperable hemangiosarcoma. By the combined treatment of irradiation and chemotherapy the cardiac tumor completely disappeared, the patient was temporary symptomless. Later metastases occurred and the patient died 13 months after diagnosis.

Adult↗
PubMed1986

[Diagnosis of thoracic aortic aneurysms by combined transthoracic and transesophageal 2D echocardiography].

Transthoracic (tth) and transesophageal (TEE) 2D-echocardiography (E) were performed in 20 consecutively examined patients (17 males, 3 females, age 18 to 76 years, mean age 48.6 +/- 18.9 years) with dissecting (n = 11) and nondissecting thoracic aortic aneurysms confirmed by angiography or surgery. In 7 out of 9 cases, nondissecting aneurysms were detected by 2-DE, whereas in 2 patients diagnosis was established only by TEE. Three out of 6 type I dissections and 1 type II dissection could be diagnosed by tth 2-DE. But in 3 type I dissections and in all cases with type III aneurysms (n = 4) the intimal flaps and the DeBakey type of classification were identified only by TEE. In 1 patient with an extensive aneurysm of the ascending aorta and severe aortic insufficiency, a dissection was erroneously diagnosed by TEE, but not confirmed by surgery. In 1 case with type I dissection, spontaneous echo contrast within the false lumen was revealed by TEE. Complications due to TEE were not observed. Thus, in the diagnosis of thoracic aortic aneurysms and dissections the combination of tth 2-DE and TEE is superior to only tth 2-DE.

Adolescent↗
PubMed1985

[Diagnosis of extensive dissections of the thoracic aorta by 2-D echography].

Dissecting aortic aneurysms require immediate diagnosis and accurate knowledge of extension. In two patients with dissecting aortic aneurysms the extension of the dissection could be evaluated by the noninvasive method of 2-D-echography. All aortic regions could be visualized in both cases, The diagnosis of dissection was established by visualization of intimal flaps in short and long exis views.

Adult↗