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R Sinn

Publications and source records attributed to R Sinn.

8 recordsLinked to original sources
PubMed2005

Cardiac risk of coronary patients after reintegration into occupations with heavy physical exertion.

The job related reintegration of patients with coronary artery disease (CAD) is a central part of cardiac rehabilitation. However, specific occupational demands like jobs with heavy physical exertion (> 6 METs) could increase the cardiovascular risk because the relative risk for acute myocardial infarction (MI) and cardiac death is temporarily elevated after vigorous exertion ("hazard period"). Thus, in 2001 any male patient with proven CAD who performed a job with heavy exertion until the occurrence of an index event (MI/ACS, any interventional or surgical revascularization measure) received a questionnaire after an average of 20 months. Complete data were available in 108 from 119 included patients (90.8%), aged 51.8+/-7.8 years. Ejection fraction was 61.5+/-13.1% and the functional capacity at the time of hospital discharge averaged 130.1+/-31.2 W. 75% of the patients had a previous MI and 59.3% underwent bypass surgery. During follow-up the previous job with heavy exertion was performed over a cumulated time of 74 years. The aim of the study was to compare the observed and the expected incidence of MI and cardiac death with and without job performance. The expected ("basal") risk for MI and cardiac death without heavy physical exertion was determined from pooled study results and assumed to be 5.2% per year. The combined risk due to performing an occupation with strenuous exertion can be calculated from time periods with and without working hours and amounts to 11.9%. There could be expected 0.119 . 74=8.8 cardiac events related to the job. In contrast, 5 MIs (4 NSTEMI, 1 STEMI) were observed (6.8%). The relative risk for an expected event compared to the basal risk without heavy exertion was 2.3 (95% CI: 0.7-7.4). The relative risk for the observed cardiac events amounts to 1.3 (95% CI: 0.4-4.8). The lower observed risk is probably due to the high grade of physical fitness in this patient group. In spite of several limitations, our study showed no convincing evidence for increasing the cardiac risk of patients with CAD performing occupations with heavy physical exertion. Because of the importance of this prognostic finding, a representative and prospective study is strongly required.

Coronary Artery Disease↗
PubMed2003

[Cardiac risk in men with angiographically normal coronary arteries or minimal coronary arteriosclerosis].

It is accepted that the assessment of the global cardiac risk for the occurrence of a coronary event is basically for preventive strategies. In a retrospective study, we have estimated the initial 10-year risk in 54 consecutive men (mean age 53.1 years) without clinically coronary artery disease (CAD) by using the PROCAM Score Scheme and the FRAMINGHAM Scoring System. All individuals underwent coronary angiography for diagnostic reasons. Inclusion criteria were angiographically normal coronary arteries or coronary vessels with minimal arteriosclerosis (luminal diameter reduction <35%). The extent of initial coronary arteriosclerosis was estimated semiquantitatively by the number of wall changed vessel segments S (proximal, medial, distal) of the 3 large epicardial coronary arteries. Individuals were divided into 3 risk categories with a 10-year risk/PROCAM <5% (gr. I), 5-20% (gr. II) and >20% (gr. III). The mean 10-year risk/PROCAM and FRAMINGHAM of the entire group was 14.0 and 14.1%, respectively. The number of vessel segments with minimal arteriosclerosis averaged S=2.6. There was a significant linear relation between the number of arteriosclerotic segments, grouped by S=0, 1-2, 3-4, >4 and the mean corresponding 10-year risk/PROCAM (r=0.97; p<0.025). The mean 10-year risk/PROCAM and FRAMINGHAM in gr. I was 2.1+/-1.1 and 5.1+/-3.5%, in gr. II 11.1+/-4.4 and 14.5+/-7.1% and in gr. III 25.4+/-3.3 and 20.4+/-6.2%, respectively (gr. I vs II vs III: p<0.005). In gr. I an average of S=0.8+/-1.4 segments, in gr. II of S=2.4+/-1.8 and in gr. III of S 4.1+/-1.8 vessel segments revealed initial coronary arteriosclerosis (gr. I vs II vs III: p<0.01 <0.0025, respectively). In 42 of the 54 men (78%) there were 10-year follow-up data regarding sudden cardiac death, fatal and non-fatal myocardial infarction available. Thirty-two men of the follow-up group (78%) showed no cardiac event (gr. A, mean age 53.3+/-8.3 years). In 10 men (23.8%, 95% CI 19.7-32.5%) a fatal or non-fatal event occurred (gr. B, mean age 55.6+/-7.5 years). At the beginning of the study, the 10-year risk/PROCAM and FRAMINGHAM in gr. A was 12.0+/-9.3 and 14.1+/-8.0%, respectively. In gr. B the estimated 10-year risk was 18.7+/-8.0% (gr. A vs B: p<0.025) and 17.6+/-7.6%, respectively (gr. A vs B: p=ns). No cardiac event occurred in the low risk group <5% (mean 2.4+/-1.2%). In 23.8% (95% CI 19.2-36.8%) of the group with mild or moderate risk (5-20%, mean 10.4+/-4.1%) and in 38.5% (95% CI 29.5-53.1%) of the high risk group (>20%, mean 25.6+/-3.3%) a fatal or non-fatal event occurred. The total cardiac mortality was 7.1% (95% CI 6.6-15.1%). Our study indicates that men mean aged 53 years without clinical CAD and with a high 10-year risk (>20%), judged by the PROCAM Score Scheme, have a high probability of subclinical coronary arteriosclerosis and for the occurrence of a cardiac event. Thus, a strict distinction between primary and secondary prevention does not seem to be justified any more.

Adult↗
PubMed1991

Case report 672: Gorham's disease.

A confusing early "benign" appearance which preceded subsequent radiographic progression of a case of massive osteolysis is presented. Proof of Gorham's disease was obtained by open biopsy of the left femur in this 21-year-old woman who presented with an unusual cortical lesion in the femoral shaft. The lesion initially was subtle in its radiological features but progressed considerably over a 2-year period before biopsy was undertaken.

Adult↗
PubMed1991

[Effect of collateral circulation on the progression of left ventricular dilatation after myocardial infarct].

48 patients (aged 50.5 +/- 8.5 years) with proven acute first myocardial infarction underwent coronary angiography 1.6 weeks to 4 years (mean 13.3 weeks) after infarction. No reperfusion interventions were performed, no patient received a longterm therapy with diuretics, glycosides, beta-blockers or ACE-inhibitors. In accordance with the angiographic results, patients were divided into two groups: 25 patients demonstrated a proximal occlusion of one major coronary artery with retrograde contrast filling by non-compromised collaterals; in 23 patients no collateral filling of the distal vessel segment was visible. The contralateral coronary arteries and corresponding LV wall segments were normal. Age, sex distribution, localization of the infarction and infarct related vessel and intraventricular pressures (LVSP = 121.2 +/- 13.5 vs. 122.1 +/- 18.9 mm Hg; LVEDP = 13.1 +/- 5.2 vs. 11.9 +/- 4.1 mm Hg) were not significantly different between both groups. Between both groups patients were compared in whom angiography was performed less than 4, 4-6, and greater than 6 weeks after infarction. In addition, occlusion of the LAD was compared with LCX- and RCA-obstructions both with and without collaterals. Patients with collaterals revealed no significant time dependent changes of the endsystolic (48.1 +/- 11.3; 56.7 +/- 20.5; 43.8 +/- 16.2 ml/m2), enddiastolic (114.9 +/- 30.6; 121.3 +/- 10.8; 99.0 +/- 22.5 ml/m2) volumes and ejection fraction (57.7 +/- 6.5; 53.9 +/- 13.5; 56.4 +/- 9.9%). In contrast in patients without collaterals ESVI increased significantly (44.2 +/- 16.2; 50.8 +/- 17.5; 68.3 +/- 30.9 ml/m2) by an exponential function (y = 28.11 e0.13x; r2 = 0.99; p less than 0.0005).(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac Output↗
PubMed1989

[Effect of 75 mg retard gallopamil on stress-induced myocardial ischemia].

In a randomized, double-blind, placebocontrolled study 40 patients with exercise-induced ischemic ST depression were given 75 mg gallopamil in slow release form twice daily. The study had 2 periods. After a 3 day run-in-period and a 14 day open therapy period exercise stress-tests were performed on a bicycle ergometer. 5 patients were dropped from this study. 25 of the remaining 35 patients were "responder" defined as a greater than 30% reduction of the ischemic St depression by gallopamil. These patients were randomly assigned to gallopamil or placebo. At the end of the first open period gallopamil significantly reduced the mean ischemic ST depression by 47% from 0.15 to 0.8 mV (p less than 0.0005). Compared with placebo control, the decrease of the ST depression remained unchanged during gallopamil (0.7 mV). In contrast a statistically significant increase of the ischemic St reaction was observed during placebo. Gallopamil significantly improved exercise tolerance. No side effects or adverse reactions were observed. This study demonstrates that gallopamil slow release is a potent calcium-antagonist in reducing exerciseinduced myocardial ischemia and improving stress tolerance.

Administration, Oral↗