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Biomedical subjects

V Mühlberger

Publications and source records attributed to V Mühlberger.

At least 19 recordsLinked to original sources
PubMed1992

Side-branch occlusion during percutaneous transluminal coronary angioplasty.

Concentrations of creatine kinase (CK) MB mass and cardiac troponin T were measured in serial peripheral venous blood samples from 21 patients who underwent percutaneous transluminal coronary angioplasty (PTCA). Angiography showed side-branch occlusion during PTCA without clinical signs of myocardial injury in 5 patients. After PTCA, CKMB mass concentrations were substantially higher than normal in all 5 patients with side-branch occlusion, and troponin T concentrations were high in 3. By contrast, only 2 patients and 1 patient, respectively, without side-branch occlusion had slight rises in CKMB and troponin T. Release of the contractile protein troponin T reflects more severe damage to myocytes than simple leakage of CKMB. Therefore, myocardial damage induced by side-branch occlusion can be graded by measurement of troponin T in plasma.

Adult↗
PubMed1992

Relation of triglyceride metabolism and coronary artery disease. Studies in the postprandial state.

The status of fasting triglycerides as a risk factor for coronary artery disease (CAD) has been considered weak because in multivariate analyses, triglycerides tend to be eliminated by high density lipoprotein (HDL) cholesterol. To further evaluate the role of triglycerides in CAD, we employed postprandial lipemia as a more informative means of characterizing triglyceride metabolism. In 61 male subjects with severe CAD and 40 control subjects without CAD as verified by angiography, we measured cholesterol; triglycerides; HDL cholesterol; HDL2 cholesterol; and apolipoproteins A-I, A-II, and B in fasting plasma and triglycerides before and 2, 4, 6, and 8 hours after a standardized test meal. Both the maximal triglyceride increase and the magnitude of postprandial lipemia (area under the triglyceride curve over 8 hours after the meal) were higher in cases than in control subjects. Single postprandial triglyceride levels 6 and 8 hours after the meal were highly discriminatory (p < 0.001), and by logistic-regression analysis displayed an accuracy of 68% in predicting the presence or absence of CAD. In this respect, accuracy was higher than that of HDL2 cholesterol (64%) and equal to that of apolipoprotein B (68%), the most discriminatory fasting parameter. Multivariate logistic-regression analysis was performed to reduce the number of risk factors to those that were statistically independent. This statistical procedure selected postprandial but not fasting triglycerides into the most accurate multivariate model, which also contained the accepted risk factors HDL2 cholesterol, apolipoprotein B, and age. This model classified 82% of subjects correctly. We conclude that triglycerides are independent predictors of CAD in multivariate analyses including HDL cholesterol, provided that a challenge test of triglyceride metabolism such as postprandial lipemia is used. The study suggests that the metabolism of triglycerides is a critical determinant of cholesterol metabolic routing. The findings support the concept that the negative association between HDL cholesterol levels and CAD actually originates in part from a positive relation between CAD and plasma triglycerides, as ascertained in the postprandial state.

Adult↗
PubMed1992

[Complications during directional coronary atherectomy (DCA): catheter fracture between housing assembly and shaft point with subsequent vascular occlusion].

Directional coronary atherectomy of a severe stenosis of the left anterior descending coronary artery was complicated by device fracture between the cylindric housing portion and the distal nose-cone collecting chamber. After successful removal of the DCA device, an early occlusion of the coronary vessel occurred, which could be successfully treated by perfusion balloon catheter.

Adult↗
PubMed1992

[Is it necessary to treat silent myocardial ischemia?].

Since the mid eighties of our century the clinical importance of silent myocardial ischemia, concerning definition, prevalence and pathophysiology is well established. The implication of silent myocardial ischemia, or its combination with other parameters of coronary heart disease on the outcome of ischemic heart disease concerning the endpoints myocardial infarction, myocardial insufficiency or death is still not clear. In consequence therapeutic guidelines at the moment can not be given for the entire spectrum of silent ischemia, whereas some details are becoming more and more evident.

Angina Pectoris↗
PubMed1992

[The state of development of interventional cardiology in Austria].

3,157 PTCA were performed in Austria in 1991, this is 27% more compared to 1990. Prognosis for 1992 is another 27 to 30% more. Frequency of PTCA exceeded bypass surgery in 1990 for the first time in Austria. WHO-guidelines of 1,000 interventions per year and 1 million inhabitants will be achieved in Austria by 50% in 1992. In this context it is worth while to state, that installation of further cathlabs is recommended preferably within established centers including established heart surgery. The following NON-POBA-PTCA-techniques ("New devices") were used in Austria for the first time: Atherectomy, stent, lasers, TEC, ROTABLATOR, ROTACS, magnum wire and angioscopy accounted for 11.3% of all PTCA cases in Austria recently. A total of 447 valvuloplasties were performed in Austria until now, frequency of pulmonary and mitral valvuloplasties is increasing, that of aortic valve interventions decreasing. High frequency, Radiofrequency and Direct current Ablations of supraventricular- and ventricular- or WPW-arrhythmias were performed in 184 patients in Austria until now. In 247 patients with rare conditions, interventions like atrioseptostomy, implantation of umbrellas, etc. were performed. State of interventional cardiology in Austria is appropriate, compared to other European countries.

Angioplasty, Balloon, Coronary↗
PubMed1991

[The value of CT and MRT in assessing aortocoronary venous bypasses in comparison with coronary angiography].

In a follow-up study of 20 patients with a total of 52 aortocoronary venous bypass grafts (ACVB) three months after surgery, the patency of the grafts was assessed by magnetic resonance tomography (MR) followed by contrast enhanced CT-scan and selective coronary angiography on the following day. Each examination was interpreted independently and immediately after the procedure for the visibility and patency of the grafts. The statistical figures for the non-occluded grafts showed a sensitivity of 90.24% and a specificity of 54.54% for the CT scans and a sensitivity of 73.17% with a specificity of 72.72% for the MR. Although the sensitivity of the CT is somewhat higher than that of MR, neither procedure offers a clear advantage over each other and neither of both methods alone is adequate for the assessment of ACVB's. They are therefore only valuable as an adjunct to clinical data and as a screening procedure for selective coronary angiography.

Coronary Angiography↗
PubMed1990

Predictive value of computed tomographic determination of the patency rate of aortocoronary venous bypasses in relation to angiographic results.

From 1978 to 1988, 300 patients with 616 aortocoronary venous bypasses underwent computed tomography (CT) 3 months after surgery, and angiography 1 day after CT. Both angiographic patency rate and CT patency rate were 75%. The sensitivity of the CT test for the detection of patent bypass grafts was 90 +/- 1.4%, the specificity of the CT test for the detection of occluded bypass grafts 72 +/- 3.6%. The observed predictive value of a patent CT test resulted in angiographically patent bypasses in 91 +/- 1.3%; the observed predictive value of an occluded CT test resulted in angiographically occluded bypasses in 71 +/- 3.6%. The low specificity for detecting occluded grafts is a considerable limitation of the technique. The pre-post-test patency ratio curve shows better predictive values for the CT test when there is a low pre-test likelihood of patency than when this is high. Patients with a high pre-test likelihood of occlusion, but who actually have patent coronary artery bypasses are most likely to benefit from this non-invasive test.

Angiography↗
PubMed1990

[Mitochondria number as a prognostic parameter in dilated cardiomyopathy. A long-term follow-up study].

According to morphological criteria of the myocardium, patients with clinical and hemodynamic signs of dilated cardiomyopathy were divided into three groups. Group I: patients with 1-2 mitochondria per 2 sarcomeres (n = 46); Group II: patients with more than 2 mitochondria per 2 sarcomeres (n = 47); Group III: patients with histological findings of myocarditis in the past (n = 33). Mean follow-up in groups I, II, III was 29, 22, 26 months, respectively (6-58, 3-52, 3-62/median 29, 18, 22). Clinical parameters were evaluated at the beginning and at the end of the prospective observation and were classified clinically as "improved, unchanged, deteriorated"; "heart transplantation", "death of cardial causes", "death of other than cardial causes" or "lost to follow up" were the other endpoints of the observation. At the beginning there were no hemodynamic differences between groups I, II, III, except significant difference in ejection fraction and mean ventricular shortening velocity between groups I and II. Scored together with the clinical symptoms "deterioration" and "death of cardial causes" as endpoints, survival rates without event up to 5 years in group I were 83 +/- 7% compared with group II 33 +/- 13% and group III 86 +/- 8%. There were significant differences (p less than 0.01). We conclude that the increased number of mitochondria per 2 sarcomeres in biopsy specimen of patients with dilated cardiomyopathy can be a significant parameter of deteriorated prognosis.

Adult↗
PubMed1989

[Changes in the catecholamine plasma level 3 months after aortocoronary bypass operation].

Plasma catecholamine levels were obtained during diagnostic heart catheterization from the pulmonary artery and aorta and, similarly, renin levels were determined in the pulmonary artery in 31 patients with coronary heart disease and 18 normal controls. 3 months after aorto-coronary bypass surgery the patients with coronary heart disease underwent repeat heart catheterization and the epinephrine, norepinephrine and renin levels were compared with those obtained before operation. Norepinephrine decreased in the aorta from (means +/- SEM) 475 +/- 57 pg/ml to 360 +/- 38 pg/ml (p less than 0.001) postoperatively (controls 225 +/- 21 pg/ml). Epinephrine decreased from 121 +/- 11 pg/ml to 108 +/- 16 pg/ml (p less than 0.001) postoperatively (controls 84 +/- 9 pg/ml). This shows that postoperative relief from myocardial ischemia is associated with normalization of the preoperatively elevated plasma catecholamine levels).

Adult↗
PubMed1989

[Quantitative computed tomographic flow measurements in aortocoronary venous bypass. I. Analysis of variance studies].

In 36 patients, 3 months after aortocoronary venous bypass (ACVB) surgery to the anterior interventricular branch of the left coronary artery, the density-time curve was assessed in the aorta and the ramus interventricularis anterior ACVB by computed tomography (CT). Mean values for area of time-density curve (1539 HU x sec.), effective width (10.9 sec.), peak CM concentration (140 HU), maximum increase of density (71 HU/sec.) and maximum decrease (53 HU/sec.) showed a significant (p greater than 0.01) difference between the results in aorta and the anterior interventricular branch ACVB for all parameters, excepting the effective width. We conclude that assessment of time density-curve parameters in the ramus interventricularis anterior ACVB is feasible; however, the results are significantly different from those obtained in the aorta. Clinical relevance of these data will be established in a second part of the study.

Adult↗
PubMed1989

[Quantitative computed tomographic flow measurements of aortocoronary venous bypass grafts. II. Correlation with angiographic measurements].

In 26 patients with 35 aortocoronary venous bypass grafts (ACVB) quantitative invasive angiographic parameters were compared with flow parameters of contrast medium, assessed by computed tomography. Out of seven different CT-parameters, the maximum decrease of concentration of contrast medium (40 +/- 5 HE/sec; mean +/- SEM) showed a correlation with the angiographic parameter of contrast medium quantitative flow rate (7.2 +/- 0.5 cm/sec) and this correlation (r = 0.536/SEE = 23.17) is significant (p less than 0.001). We conclude that for the single patient assessment of quantitative flow in ACVB by CT with a 3-second repetition rate could be performed with limited accuracy.

Angiography↗
PubMed1989

Risk factors for coronary artery disease: a study comparing hypercholesterolaemia and hypertriglyceridaemia in angiographically characterized patients.

Fifty-two male patients undergoing coronary angiography were allocated to four groups each consisting of 13 subjects: group I had normal coronary arteries and patients in groups II-IV exhibited coronary artery disease. In group II, plasma cholesterol was below 250 mg dl-1 and triglycerides below 160 mg dl-1; in group III, cholesterol was above 270 mg dl-1 and triglycerides under 160 mg dl-1; and in group IV, cholesterol was under 270 mg dl-1 and triglycerides above 180 mg dl-1. The hypertriglyceridaemic group IV had the highest coronary score. In addition, it had lowest lipoprotein lipase activity, lowest HDL-cholesterol and lowest high-density lipoproteins-2 (HDL-2) levels, suggesting that this type of hypertriglyceridaemia is caused--at least in part--by lipoprotein lipase deficiency with impaired removal of the triglyceride-rich lipoproteins and increased catabolism of HDL-2. Our findings point towards a type of hypertriglyceridaemia strongly associated with coronary artery disease which should therefore be treated accordingly.

Adult↗
PubMed1988

Functional cardiac assessment before and after left ventricular anterior aneurysm repair, especially as related to work capacity.

Clinical, angiographic and hemodynamic parameters were assessed preoperatively and 12-20 weeks (mean +/- SD: 14 +/- 2) after left ventricular anterior aneurysmectomy in 31 consecutive patients. In 18 patients, associated coronary artery bypass surgery was necessary (1.4 grafts/patient). One patient with mitral valve insufficiency postoperatively required mitral valve replacement. No other complications and no deaths arose. The working capacity of the patients, as measured by bicycle exercise testing, compared a stage of exercise that the patient reached to the expected level of exercise for a normal person of the same sex, age and body surface. Expressed as percent of normals it increased from 39.3 +/- 28.9% (mean +/- SD) to 60.8 +/- 15.5% (p less than 0.001), angina-pectoris-free working capacity increased from 52.6 +/- 41.4 to 89.2 +/- 33.2 W (p less than 0.001). Left ventricular end-diastolic volume was determined by simultaneous biplane angiography and decreased from 277.1 +/- 84.7 to 191.0 +/- 49.1 ml (p less than 0.001). Ejection fraction increased from 35.4 +/- 12.4 to 41.0 +/- 9.6% (p less than 0.05). Left ventricular end-diastolic pressure after angiography decreased from 24.6 +/- 9.2 to 21.1 +/- 11.3 mm Hg (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

[Plasma catecholamine level in diagnostic heart catheterization studies].

Plasma catecholamine levels were obtained during diagnostic heart catheterization from pulmonary artery and aorta before and after injection of contrast medium in 31 patients with coronary heart disease and in 18 normals. The most striking difference between both groups is a significant decline of norepinephrine concentration in aortas after injection of contrast medium in the normals (from 296 +/- 24 [mean +/- SEM] to 225 +/- 21 pg/ml [p less than 0.01]) and no change in patients with coronary heart disease. The cause seems to be rather increased elimination than a decrease of secretion of norepinephrine. Adrenalin shows only partially similar results. Further studies will have to show, what could be the reason for these different reactions of catecholamine level in normals and in patients with coronary heart disease.

Adult↗
PubMed1988

[Decrease in left ventricular stroke performance following bypass of a significant main coronary artery stenoses].

Hemodynamic parameters and left ventricular function were assessed 14 +/- 4 (means +/- SEM) days preoperatively and 101 +/- 5 days after aortocoronary bypass surgery in eight men (51-65 years of age) with left main coronary stenosis (greater than or equal to 75%). Working capacity on bicycle exercise stress test increased from 43 +/- 7 to 68 +/- 7% of age-, and body-surface matched normals; at the same time cardiac output (thermodilution) decreased from 5.7 +/- 0.5 to 4.7 +/- 2 l/min (p less than 0.05), stroke volume decreased from 78 +/- 6 to 63 +/- 3 ml (p less than 0.01), stroke work from 1.16 +/- 0.10 to 0.89 +/- 0.07 Joule (p less than 0.001), and stroke power from 4.0 +/- 0.3 to 3.4 +/- 0.2 Joule/s (p less than 0.01) postoperatively. Left ventricular volumes decreased postoperatively but not significantly, ejection fraction remained unchanged (57 +/- 13/59 +/- 13%). A control group (PTCA of LAD) showed no significant changes of these parameters. As all patients had a good postoperative result, decrease of stroke work after aortocoronary bypass surgery is not necessarily an expression of postoperative deterioration, since it can coincide with good left ventricular function, angiographically successful revascularization, and an increase in working capacity.

Adult↗
PubMed1988

[Clinical, hemodynamic and morphologic findings in dilated cardiomyopathy].

45 patients (39 men, six women), mean 41 (19-63) years of age with clinical, angiographic and morphologic diagnosis of dilated cardiomyopathy were evaluated in respect of three morphologic classes. Two groups of patients without signs of previous myocarditis were formed, with one-to-two mitochondria per two sarcomeres (group Ia, n = 19), or with more than two mitochondria per two sarcomeres, respectively (group Ib, n = 14); and one group with signs of previous myocarditis (group II, n = 12). The mean relative mitochondrial volume fraction in relation to myofibril volume fraction was significantly lower in group Ia (33 +/- 4/67 +/- 4%) compared to group Ib (39 +/- 5/61 +/- 5%) (p less than 0.01). Mean values of group II (36 +/- 6/64 +/- 6%) were in between the two other groups. Left ventricular enddiastolic pressure (18 +/- 11, 18 +/- 8, 16 +/- 10 mm Hg), pulmonary vascular resistance (473 +/- 414, 406 +/- 205, 458 +/- 495 dyn x s x cm-5), ejection fraction (36 +/- 21, 32 +/- 16, 28 +/- 16%), endsystolic volume index (131 +/- 82, 127 +/- 66, 132 +/- 60 ml/m2), enddiastolic volume index (187 +/- 81, 176 +/- 62, 181 +/- 63 ml/m2), dp/dt max (1951 +/- 875, 1737 +/- 575, 1741 +/- 478 mmHg x s-1) and mean VCF (0.76 +/- 0.58, 0.44 +/- 0.32, 0.54 +/- 0.39 s-1) showed no significant differences between the three groups. Follow-up of the patients in the three groups to median 19, 22, 24 months, respectively, after biopsy, showed an improvement of the clinical findings, especially concerning the groups with one-to-two mitochondria only and with signs of previous myocarditis, but no difference in survival within the three groups. For the individual case our morphologic parameters seem to be without predictive value.

Adult↗
PubMed1987

[Cardiokymography: relative quantification of results in normal probands].

The main problem with cardiokymography (CKG) and the principal reason for its limited clinical application to date is the deficiency of calibration and quantification of results. We tried to improve the value of the procedure by quantification of the results in 14 healthy young men (age: 23, 18-31 years) in place of subjective assessment. Before and after a bicycle exercise stress test CKG tracings were obtained in a lying position at rest, immediately after exercise and after recovery. Two different methods were applied to quantify the CKG tracings (distance method and area method). The relative height of the curves at rest was 89 +/- 72% (68 +/- 39%), immediately after exercise 111 +/- 60% (73 +/- 27%) and, after recovery 121 +/- 88% (78 +/- 49%). The relative change in the height of the curves between rest and exercise was not significant according to both methods (+22 +/- 64%/+5 +/- 32%), but the variation of values in an individual patient between rest and exercise was large. Interobserver variability was rather large, according to two independent investigators. Hence, it was not possible to establish limits of normal values in quantitative CKG, but only mean values.

Adult↗