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Biomedical subjects

Sergio Richter

Publications and source records attributed to Sergio Richter.

13 recordsLinked to original sources
PubMed2006

Efficacy and safety of ICD therapy in a population of elderly patients treated with optimal background medication.

INTRODUCTION: Implantable cardioverter-defibrillator (ICD) therapy has been shown to improve survival in patients with structural heart disease and at high risk for life threatening ventricular arrhythmias. Whether elderly patients benefit from device therapy in a similar way as younger patients is largely unknown. METHODS: We retrospectively analyzed data from 375 consecutive ICD recipients with structural heart disease. Patients were divided into two groups, younger than 70 years at time of ICD implantation (group 1) or 70 years or older (group 2). Main outcome measures were time to death from any cause and time from first appropriate ICD therapy to death. RESULTS: Group 1 and 2 patients were comparable with respect to clinical presentation and average follow-up duration. In the elderly patient group, 78% received an ICD for secondary prevention versus 63% in group 1 (p = 0.007). During a mean follow-up period of 26.5 +/- 18.1 months, there was no significant difference in overall mortality among the two groups: 47 patients died, 34 (12.5%) of group 1 versus 13 (12.7%) of group 2. The average time to death was 28.4 +/- 16.7 vs 30.4 +/- 22.1 months after device implantation, respectively (p = ns). There was no difference in time from device implantation to first adequate ICD therapy and time from first appropriate ICD therapy to death among the two groups (p = ns). Device associated complications were comparable in both groups. CONCLUSIONS: Elderly ICD recipients had comparable survival rates and appropriate use of the ICD compared to younger individuals.

Age Factors↗
PubMed2006

[EKG-quiz].

Explore the source record for details and available documents.

Adult↗
PubMed2005

Apropos "tachycardia begets tachycardia".

It has been shown that a tachycardia can facilitate the induction of the same ("atrial fibrillation begets atrial fibrillation") or a different tachycardia. This may also apply for pacemaker-mediated tachycardia as the present case documents.

Aged↗
PubMed2005

Prevention of sudden cardiac death: lessons from recent controlled trials.

Sudden cardiac death (SCD), presumably because of ventricular tachyarrhythmias, remains one of the major challenges of contemporary cardiology. Major randomized controlled trials conducted in patients with coronary artery disease (CAD) with the aim of primary prevention of SCD are providing insights. Several large-scale studies have demonstrated that treatment with beta-blockers, angiotensin-converting enzyme inhibitors, aldosterone antagonists, and statins results not only in a reduction in all-cause mortality but specifically also in SCD. On top of this optimized pharmacological therapy, implantable cardioverter-defibrillators (ICD) further decrease the risk of overall and SCD mortality in carefully selected patient groups. The sum of these trials indicates, however, that the benefit associated with ICD therapy is most prominent in patients with chronic stable CAD. In contrast, patients early after myocardial infarction derive less benefit from ICD treatment, presumably because of a high competing risk of non-arrhythmic cardiovascular death. Optimized pharmacological therapy, together with the ICD, can substantially improve the prognosis of high-risk CAD patients.

Coronary Artery Disease↗
PubMed2002

Vascular gene transfer of phosphomimetic endothelial nitric oxide synthase (S1177D) using ultrasound-enhanced destruction of plasmid-loaded microbubbles improves vasoreactivity.

BACKGROUND: Local gene therapy has enormous potential for the treatment of vascular disease. We determined whether diagnostic ultrasound-mediated destruction of plasmid-loaded albumin microbubbles is a feasible and efficient technique for local vascular gene delivery. For gene transfer, we used a phosphomimetic, active endothelial nitric oxide synthase (eNOS) construct in which Ser1177 was replaced by aspartic acid (S1177D) and exhibits a 2-fold higher basal activity than the wild-type enzyme. METHODS AND RESULTS: Gas-filled microbubbles (3.0 +/- 1.2 microm) were created by sonication of 5% human albumin in the presence of plasmid DNA encoding for LacZ or eNOS S1177D. Porcine coronary arteries were perfused with DNA-loaded albumin microbubbles in vitro, exposed to diagnostic ultrasound (5 seconds), and incubated for a further 24 hours. Detection of the beta-galactosidase in LacZ-transfected vessels revealed a predominant staining of endothelial cells without any functional impairment of vasoreactivity. Western blotting demonstrated the expression of the eNOS S1177D construct in extracts from the transfected segments. Vascular responsiveness was tested with prostaglandin F(2alpha) and the NOS inhibitor N(omega)nitro-L-arginine. Compared with segments treated with the expression plasmid alone, the contractile response to prostaglandin F(2alpha) was impaired in segments transfected with eNOS S1177D, whereas the contractile response to the administration of N(omega)nitro-L-arginine was markedly enhanced. CONCLUSIONS: Ultrasound-mediated destruction of eNOS S1177D DNA-loaded albumin microbubbles is a feasible and efficient method for vascular gene transfection. Transfection resulted in significant protein expression and enhanced NO-mediated relaxation of bradykinin-stimulated porcine coronary arteries.

Amino Acid Substitution↗