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R Willenheimer

Publications and source records attributed to R Willenheimer.

At least 19 recordsLinked to original sources
PubMed2002

Improved cardiac function and quality of life following upgrade to dual chamber pacing after long-term ventricular stimulation.

AIMS: Many patients with sinus node disease or atrioventricular block have previously received pacemakers with only ventricular stimulation (VVI or VVIR). This study aimed to investigate whether quality of life and cardiac function were affected by an upgrade to dual chamber pacing (DDDR or DDIR) following long-term ventricular stimulation. METHODS: After implantation of an atrial lead and a DDDR pulse generator, a randomized, double-blind crossover study was performed in 19 patients, previously treated with ventricular pacing for a median time of 6 X 8 years. Patients were randomized to 8 weeks with either VVIR or DDDR/DDIR pacing; after this time, the other mode was programmed for 8 weeks. At the end of each period, the patients' quality of life was evaluated and echocardiography was performed together with Holter monitoring and blood samples for brain natriuretic peptide. RESULTS: Sixteen of the patients preferred DDDR and two VVIR pacing (P=0 X 001); one was undecided. Seven patients demanded an early crossover while paced in the VVIR mode, vs none in the DDDR mode (P=0 X 008). Quality of life was higher in the DDDR mode in 11 of 17 modalities, reaching statistical significance for dyspnoea (P<0 X 05) and general activity (P<0 X 05). Echocardiography showed significantly larger left ventricular end-diastolic dimensions in the DDDR mode (P=0 X 01), whereas end-systolic dimensions did not differ. Left ventricular systolic function was significantly superior in the DDDR mode (mean aortic velocity-time integral: P<0 X 001) and left atrial diameter was significantly smaller in the DDDR mode (P=0 X 01). The plasma level of brain natriuretic peptide was significantly lower in DDDR mode (P=0 X 002). CONCLUSION: An upgrade to dual chamber rate adaptive pacing results in significantly improved quality of life and cardiac function as compared to continued VVIR stimulation and should thus be considered in patients with ventricular pacemakers who have not developed permanent atrial fibrillation or flutter.

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PubMed2001

Effects on quality of life, symptoms and daily activity 6 months after termination of an exercise training programme in heart failure patients.

BACKGROUND: Exercise training in heart failure patients improves exercise capacity, physical function, and quality-of-life. Prior studies indicate a rapid loss of these effects following termination of the training. We wanted to assess any sustained post-training effects on patients global assessment of change in quality-of-life (PGACQoL) and physical function. METHODS: Fifty-four stable heart failure patients were randomised to exercise or control. The 4-month exercise programme consisted of bicycle training at 80% of maximal intensity three times/week, and 49 patients completed the active study period. At 10 months (6 months post training) 37 patients were assessed regarding PGACQoL, habitual physical activity, and dyspnea-fatigue-index. RESULTS: Both post-training patients (n=17) and controls (n=20) deteriorated PGACQoL during the 6-month extended follow-up, although insignificantly. However, post-training patients improved PGACQoL slightly but significantly from baseline to 10 months (P=0.006), differing significantly (P=0.023) from controls who were unchanged. Regarding dyspnea-fatigue-index, post-training patients were largely unchanged and controls deteriorated insignificantly, during the extended follow-up as well as from baseline to 10 months. Both groups decreased physical activity insignificantly during the extended follow-up, and from baseline to 10 months post-training patients tended to decrease whereas controls significantly (P=0.007) decreased physical activity. CONCLUSION: There was no important sustained benefit 6 months after termination of an exercise training programme in heart failure patients. A small, probably clinically insignificant sustained improvement in PGACQoL was seen in post-training patients. Controls significantly decreased the habitual physical activity over 10 months and post-training patients showed a similar trend. Exercise training obviously has to be continuing to result in sustained benefit.

Activities of Daily Living↗
PubMed2001

Left ventricular early diastolic inflow velocity and atrial ventricular plane downward velocity: useful parameters to test diastolic function in clinical practice? Diastolic parameters tested in a clinical setting.

AIMS: To study the clinical value of the colour-M-mode slope of the early diastolic left ventricular filling phase (Vp) and the early diastolic downward M-mode slope of the left atrioventricular plane displacement (EDS), compared with diastolic function assessed by traditional Doppler evaluation. METHODS AND RESULTS: In 65 consecutive patients EDS and Vp were compared with a four-degree traditional diastolic function classification, based on pulsed Doppler assessment of the early to atrial transmitral flow ratio (E/A), the E-wave deceleration time (Edt), and the systolic to diastolic (S/D) pulmonary venous inflow ratio. Vp (P=0.006) and EDS (P=0.045) were related to traditional diastolic function (Kruskal--Wallis analysis). EDS showed a trend brake between the moderate and severe diastolic dysfunction groups by traditional Doppler evaluation. Vp and EDS correlated weakly in simple linear regression analysis (r=0.33). Vp and EDS discriminated poorly between normal and highly abnormal diastolic function. CONCLUSIONS: Vp and EDS were significantly related to diastolic function by traditional Doppler evaluation. They were, however, not useful as single parameters of left ventricular diastolic function due to a small difference between normal and highly abnormal values, allowing for little between-measurement variability. Consequently, these methods for the evaluation of left ventricular diastolic function do not add significantly to traditional Doppler evaluation.

Adult↗
PubMed2001

Left ventricular diastolic filling is related to the atrioventricular plane displacement in patients with coronary artery disease.

OBJECTIVE: Left atrioventricular plane displacement (AVPD) is often decreased and abnormalities in left ventricular diastolic filling are common in patients with coronary artery disease (CAD). This study was designed to assess the relationship between AVPD and diastolic filling in patients with CAD. DESIGN: AVPD was assessed by echocardiography and diastolic filling by transmitral and pulmonary venous pulsed Doppler in 170 consecutive patients (66 +/- 11 years) with proven CAD at coronary angiography. Diastolic filling was grouped as normal, mildly impaired and moderately to severely impaired. RESULTS: A simple linear regression analysis showed that AVPD decreased in relation to increased severity of diastolic filling impairment (r = -0.36, p < 0.0001). In a multiple regression analysis, ejection fraction, diastolic filling, age and body surface were independently correlated with AVPD. Each millimetre of decrease in AVPD increased the probability of impaired diastolic filling by 28%. CONCLUSION: AVPD was independently correlated with both left ventricular systolic function and diastolic filling in patients with CAD. Thus, given the same degree of ejection fraction, it was found that the greater the impairment in diastolic filling, the lower the AVPD.

Aged↗
PubMed2000

A reply.

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Journal Article↗
PubMed2000

Left ventricular remodelling and dysfunction. Can the process be prevented?

Due to continuous remodelling myocardial dysfunction is a progressive condition. Even if the initial event is so mild that it causes no immediate cardiac dysfunction (e.g. a small myocardial infarction), the remodelling process is triggered. Although the remodelling process can be adaptive, the process becomes maladaptive when the stimuli are continuous and pathological. A similar remodelling process is seen in most primary myocardial disorders, suggesting common mechanisms for the development of heart failure. Although clinical heart failure may develop acutely, for example, after an acute myocardial infarction, the progressive changes in myocardial structure and deterioration of myocardial function can go on silently for a very long time and overt heart failure may develop several years after an initial insult, even if there are no further events. In order to fundamentally improve prognosis in cardiac failure it is necessary to identify patients with an ongoing remodelling process and to effectively counteract this process as early as possible.

Calcium↗
PubMed1999

Left atrioventricular plane displacement at rest is reduced in relation to severity of coronary artery disease irrespective of prior myocardial infarction.

OBJECTIVE: To examine whether left atrioventricular plane displacement (AVPD) at rest was related to severity of coronary atherosclerosis. DESIGN AND PATIENTS: Global and regional left AVPD was evaluated by echocardiography in 159 consecutive patients with significant stenoses at coronary angiography and in 15 age-matched healthy controls. The setting was the University hospital with a primary catchment area of 250,000 inhabitants. RESULTS: Mean AVPD in controls, patients with one-, two-, and three-vessel disease was 13.5+/-1.1, 12.4+/-1.5, 11.3+/-2.2 and 10.9+/-2.1 mm, respectively (P<0.0001). Similar significant differences were found both in those with (n=69) and without (n=90) a diagnosis of prior myocardial infarction. Regional AVPD did not correspond to the localization of infarction or coronary atherosclerosis. CONCLUSION: Irrespective of a diagnosis of prior myocardial infarction, left AVPD was related to the degree and extent of coronary artery disease. It was significantly decreased compared to controls in patients with one-vessel disease, and was further decreased with increasing extent of coronary atherosclerosis. Determination of regional left AVPD could not be used to identify regions perfused by stenotic coronary arteries or regions affected by prior myocardial infarction.

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PubMed1999

Left atrioventricular plane displacement is related to both systolic and diastolic left ventricular performance in patients with chronic heart failure.

AIMS: Left atrioventricular plane displacement is proposed to reflect left ventricular systolic function and is strongly related to prognosis in patients with heart failure. Left atrioventricular plane displacement is a different measure of left ventricular function compared to ejection fraction, and the factors influencing left atrioventricular plane displacement are insufficiently characterized. We wanted to assess any relationship between left atrioventricular plane displacement and left ventricular diastolic performance. METHODS AND RESULTS: Left ventricular diastolic filling, left atrioventricular plane displacement, and fractional shortening were assessed by echocardiography/Doppler in 54 patients with chronic heart failure (age 64 +/- 7 years). Left atrioventricular plane displacement correlated significantly with Doppler variables of left ventricular filling, in particular the inverse logarithm of early transmitral flow deceleration time; log-1 Edt (r = -0.61, P < 0.0001, n = 54). Left atrioventricular plane displacement also correlated with fractional shortening (r = 0.49, P < 0.001, n = 50). However, fractional shortening did not correlate with any Doppler variable. Log-1 Edt, fractional shortening, age, heart rate, left ventricular and atrial size, and degree of mitral regurgitation were included in a multiple regression analysis. Only log-1 Edt (P = 0.001) and fractional shortening (P = 0.03) correlated independently with left atrioventricular plane displacement. Among patients with similar fractional shortening, those with more compromised diastolic performance had lower left atrioventricular plane displacement. CONCLUSION: Left atrioventricular plane displacement was related to both systolic and diastolic left ventricular performance, which may explain some of the discrepancies between left atrioventricular plane displacement and ejection fraction.

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PubMed1999

ACE inhibition with ramipril improves left ventricular function at rest and post exercise in patients with stable ischaemic heart disease and preserved left ventricular systolic function.

AIMS: To assess the effects of 6 months intervention with +ramipril on resting and post exercise left ventricular function in patients with stable ischaemic heart disease and preserved left ventricular systolic function. METHODS AND RESULTS: Patients (n=98, age 65+/-9 years, 37% women) were randomized to double-blind treatment with ramipril 5 mg. day(-1)(n=32), ramipril 1.25 mg. day(-1)(n=34), or placebo (n=32). Resting and post maximum exercise echocardiography/Doppler examinations were performed at baseline and after 6 months. Changes over 6 months in resting transmitral E-wave deceleration time (Edt) and Edt adjusted for heart rate (Edt/RR) differed between the ramipril 5 mg, ramipril 1.25 mg, and placebo groups: Edt 24+/-82, -1+/-69, and -29+/-64 ms, respectively, P=0. 012; Edt/RR 30+/-105, 2+/-61, and -28+/-69 ms, respectively, P=0.015. Changes in the difference between resting and post exercise Edt/RR also varied between groups: -53+/-137, -28+/-118, and 35+/-101 ms, respectively, P=0.029. No differences in E/A indices were noted. Resting atrioventricular plane displacement improved in the combined ramipril groups vs the placebo group: 0.2+/-0.8 vs -0.2+/-1.3 mm, P<0.05.Conclusion Six months ramipril treatment in patients with stable ischaemic heart disease and preserved left ventricular systolic function improved resting left ventricular function and reduced the exercise induced diastolic filling abnormalities usually seen in these patients.

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PubMed1998

[Heart failure after myocardial infarction: diagnosis, treatment, prevention. Echocardiography should be a routine procedure in myocardial infarction].

Post-infarction prognosis is considerably impaired if left ventricular systolic dysfunction and/or symptomatic heart failure develops. As the symptoms of left ventricular dysfunction are often subtle or completely lacking, such patients can be identified only by objective evaluation of left ventricular function. However, as symptoms of heart failure may develop despite normal left ventricular function, objective evaluation of left ventricular function is also important in symptomatic patients, since prognosis is especially poor in the presence of systolic dysfunction. As echocardiography is the most suitable and accessible method in the context, also allowing assessment of cardiac dimensions and valvular function, its extended use in post-infarction patients is imperative. Left ventricular dysfunction should be prevented by adequate measures to limit the extent of infarction and prevent its recurrence. To improve prognosis, the use of ACE (angiotensin converting enzyme) inhibitors should be considered whenever left ventricular dysfunction is present, irrespective of symptomatology. Treatment with amiodarone has recently been shown to reduce mortality among patients with post-infarction heart failure, and should also be considered in such cases, especially if there is a need of antiarrhythmic therapy. Although beta-receptor blockers have well-documented beneficial effects in myocardial infarction, their effect on patients with latent or overt heart failure has not been specifically studied. The use of angiotensin II antagonists in patients with post-infarction heart failure or left ventricular dysfunction is currently under investigation.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1998

Exercise training in heart failure improves quality of life and exercise capacity.

AIMS: Benefit from exercise training in heart failure has mainly been shown in men with ischaemic disease. We aimed to examine the effects of exercise training in heart failure patients < or = 75 years old of both sexes and with various aetiology. METHODS AND RESULTS: Fifty-four patients with stable mild-to-moderate heart failure were randomized to exercise or control, and 49 completed the study (49% > or = 65 years; 29% women; 24% non-ischaemic aetiology; training, n = 22; controls, n = 27). The exercise programme consisted of bicycle training at 80% of maximal intensity over a period of 4 months. Improvements vs controls were found regarding maximal exercise capacity (6 +/- 12 vs -4 +/- 12% [mean +/- SD], P < 0.01) and global quality-of-life (2 [1] vs 0 [1] units [median ¿inter-quartile range¿], P < 0.01), but not regarding maximal oxygen consumption or the dyspnoea-fatigue index. All of these four variables significantly improved in men with ischaemic aetiology compared with controls (n = 11). However, none of these variables improved in women with ischaemic aetiology (n = 5), or in patients with non-ischaemic aetiology (n = 6). The training response was independent of age, left ventricular systolic function, and maximal oxygen consumption. No training-related adverse effects were reported. CONCLUSION: Supervised exercise training was safe and beneficial in heart failure patients < or = 75 years, especially in men with ischaemic aetiology. The effects of exercise training in women and patients with non-ischaemic aetiology should be further examined.

Activities of Daily Living↗
PubMed1998

Assessment of left ventricular dysfunction and remodeling by determination of atrioventricular plane displacement and simplified echocardiography.

Heart failure is a common disease characterised by poor prognosis and frequent hospitalisations, constituting a major economic burden to society. Mortality and morbidity can be reduced by optimal treatment, requiring objective evaluation of cardiac function and anatomy. The development of symptomatic HF can be prevented by initiating adequate treatment in early stages when LVD is still asymptomatic. Asymptomatic patients can be identified only by screening for LVD among patients at risk of developing HF, such as those with IHD, HT, and diabetes. However, there is a severe lack of resources to assess cardiac function and anatomy in all patients at risk. Consequently, many patients with latent HF will remain undetected, and in patients with symptomatic HF treatment will not be optimal. Simplified echocardiography, a 5-minute echocardiogram based on visual estimation of cardiac function and anatomy, is an inexpensive and accurate method for diagnosis and screening for latent and symptomatic HF. The long axis shortening of the LV is related to LV function and can be measured by AVPD. Determination of left AVPD is a reliable, reproducible, readily mastered, quickly performed and, therefore, inexpensive method that can be used in almost all patients for evaluation of LV function, as well as for prognostication in HF. Left AVPD reflects both systolic and diastolic LV function. Simplified echocardiography is useful for screening of asymptomatic patients at risk of developing HF, and for routine diagnostic purposes in patients with symptoms suggestive of HF. In patients with LVSD, simplified echocardiography may be combined with a determination of left AVPD for prognostication and for optimal detection of changes in LV function over time.

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