Impact of prehospital delay on mortality in patients with acute myocardial infarction treated with primary angioplasty and intravenous thrombolysis.

Abstract Background In patients with acute myocardial infarction treated with thrombolysis, longer times to treatment are associated with increasingly worse clinical outcome. This relation may be different for treatment with primary angioplasty. Methods We analyzed the pooled data of the German acute myocardial infarction registries Maximal Individual Therapy in Acute Myocardial Infarction (MITRA) and Myocardial Infarction Registry (MIR) to determine the influence of prehospital delays on hospital mortality rates. Primary angioplasty was performed in 1063 patients and thrombolysis in 7552 patients. Results In patients treated with thrombolysis, in-hospital time to treatment was constantly 3…

Flußquantifizierung von intrakardialen Shuntvolumina unter Verwendung der MR-Phasenkontrast-Technik in Atemanhaltephase

PURPOSE Comparison of a breath-hold, velocity-encoded, phase-difference magnetic resonance (MR) sequence for intracardiac shunt flow measurement with the invasive shunt size determination by oximetry. PATIENTS AND METHODS 10 patients with different cardiac shunts (6 ASD/3 VSD/1 PDA) and four healthy individuals were investigated using a 1.5 Tesla Siemens Vision system. For flow measurements a breath-hold, velocity-encoded, phase-difference magnetic resonance (MR) sequence was used ('through plane', FLASH 2D-sequence, TR/TE 110/5 ms, 'velocity encoding' 250 cm/s). Mean flow (ml/R-R interval) in the ascending aorta, the pulmonary trunk, and the right and left pulmonary arteries was determined…

Importance of calibration for diameter and area determination by intravascular ultrasound

Intravascular ultrasound (IVUS) permits quantitative assessment of the lumen diameter and area of coronary arteries. The experimental study was performed to evaluate the accuracy of diameter and area measurements.Lumen quantitation (lumen diameter D and cross-sectional area A) in lucite tubes (lumen diameter 2.5 to 5.7 mm, Plexiglas) was performed using a mechanical IVUS system (HP console, 3.5 F catheter, Boston Scientific, 30 MHz). The influence of fluid type (blood, water and saline solution), fluid temperature (20 degrees C/37 degrees C), catheter to catheter variation, gain setting and ultrasound frequency (12, 20 and 30 MHz) was determined. In blood at 20 degrees C there was a constan…

The German CPU Registry: Comparison of troponin positive to troponin negative patients

Lars S. Maier ⁎, Harald Darius , Evangelos Giannitsis , Raimund Erbel , Michael Haude , Christian Hamm , Gerd Hasenfuss , Gerd Heusch , Harald Mudra , Thomas Munzel , Claus Schmitt , Burghard Schumacher , Jochen Senges , Thomas Voigtlander , Jan B. Schuttert a a Dept. of Cardiology & Pneumology/Heart Centre, Georg-August-University, Gottingen, Germany b Dept. of Cardiology, Angiology & Intensive Care Medicine, Vivantes Hospital Neukolln, Berlin, Germany c Dept. of Cardiology, Angiology & Pneumology, Ruprecht-Karls-University, Heidelberg, Germany d Dept. of Cardiology, West-German Heart Centre, University of Essen, Germany e Dept. of Cardiology & Nephrology, Lukas Hospital, Neuss, Germany f …

MR-Perfusionsbildgebung des Herzens mit TrueFISP

OBJECTIVE Development and test of a saturation-recovery TrueFISP (SR-Trufi) pulse sequence for myocardial perfusion MR imaging (MRI) using improved gradient hardware. MATERIAL AND METHODS Measurements were performed on a 1.5 T scanner with prototype gradients (50 mT/m, minimum rise time 300 microseconds). T1-weighted first-pass MRI of Gd-DTPA (0.025 mumol/kg) kinetics in the myocardium was performed using an SR-Trufi pulse sequence (TR/TE/alpha = 2.6 ms/1.4 ms/55 degrees) with a saturation preparation of TD = 30 ms before the TrueFISP readout. Measurements were performed in volunteers (n = 4) and in a pig model of chronic ischemia (n = 1). RESULTS In phantoms, the signal intensity was linea…

Development of a coronary aneurysm 6 months after stent implantation assessed by intracoronary ultrasound.

Paroxysmal atrial fibrillation and high degree AV block: use of single-lead VDDR pacing with mode switching.

Dual chamber rate responsive pacing incorporating a mode switching option is increasingly used in patients with chronic paroxysmal atrial fibrillation and high degree AV block. Single-lead VDDR pacemakers have rarely used for this indication. The purpose of this study was to determine their reliability of atrial sensing during atrial fibrillation, the percentage of atrial synchronous ventricular pacing, and the behavior of the sinus rate outside the phases of atrial fibrillation. We studied ten patients with a single-lead VDDR pacemaker implanted for this indication. Follow-up visits were performed at predischarge and after 1, 3, 6, 12, 18, and 24 months. During the mean follow-up period of…

Flussquantifizierung in Koronar- und Bypass- gefäßen mit der MR-Phasenkontrasttechnik

Ziel: Es sollte die Genauigkeit der MR-Phasenkontrastmethode zur Ermittlung des Flusses in Koronararterien und koronaren Bypassgefasen bestimmt werden. Material und Methode: Die MRT-Flussmessungen von 12 Patienten mit 22 Bypassgefasen wurden mit intraoperativ mittels Ultraschalldurchflussmethode bestimmten Flussen verglichen. Praoperativ wurden zusatzlich Flussmessungen in 28 Koronararterien von 20 Patienten durchgefuhrt. Zur MRT-Flussmessung wurde eine segmentierte 2D-Flash-Sequenz verwendet, die eine zeitliche Auflosung von 110 bzw. 125 ms aufwies. Dies ermoglichte die Akquisition von 6–8 Bildpaaren pro Herzzyklus. Ergebnisse: Es bestand eine signifikante Korrelation zwischen den Ergebnis…

Time delays in starting thrombolytic therapy

Kardio-MRT

Since initial reports in the early 1990s cardiac magnetic resonance imaging (CMR) has matured and is likely to become an established method for routine cardiac diagnostics. The development of faster gradient-echo sequences and stronger magnetic fields has led to improved temporal and spatial resolution. Myocardial viability can be examined by morphological and functional analysis. Contrast enhanced MRI (ceMRI), perfusion measurements and regional wall motion analysis are the major diagnostic tools. The ability to image in arbitrary double oblique planes provides comprehensive visualization of the heart. The introduction of the MR navigator technique allowed for free-breathing motion correct…

Recombinant growth hormone therapy in patients with ischemic cardiomyopathy : effects on hemodynamics, left ventricular function, and cardiopulmonary exercise capacity.

Background —We studied the effects of recombinant growth hormone (rhGH) on exercise capacity and cardiac function in patients with ischemic cardiomyopathy. Methods and Results —Seven patients (aged 55±9 years) with mild to moderate congestive heart failure (ejection fraction 31±4%) who were on standard therapy were included. The patients were studied at baseline, after 3 months of rhGH treatment, and 3 months after rhGH discontinuation. Cardiac function was assessed by exercise capacity, right heart catheterization at rest and after submaximal exercise, MRI, echocardiography, and Holter monitoring. When administered at a dose of 2 IU/d, rhGH doubled the serum concentration of insulin-like …

Guideline-adherence regarding critical time intervals in the German Chest Pain Unit registry

Background: Since 2008, the German Cardiac Society certified 256 Chest Pain Units (CPUs). Little is known about adherence to recommended performance measures in patients with suspected acute coronary syndrome (ACS) presenting to CPUs. We investigated guideline-adherence regarding critical time intervals and selected performance measures in German Chest Pain Units. Methods: From 2008 to 2014, 23,804 consecutive patients with suspected ACS were prospectively enrolled in the Chest Pain Unit registry of the German Cardiac Society. Results: Median time from symptom onset to first medical contact was 2 h in patients with ST-elevation myocardial infarction (STEMI) and 4 h in patients with unstable…

A simple method for preoperative assessment of the best fitting electrode length in single lead VDD pacing.

For single lead VDD pacing, electrodes with various distances between the lead tip and the floating atrial dipole (AV distance) are available. Using different AV distances allows positioning of the atrial dipole in the mid- to high right atrium, regardless of the size of the right heart. In this position, reliable atrial sensing and rejection of ventricular far-field potentials can be expected. A simple test for the preoperative assessment of the best fitting AV distance in the individual patient was tested. We studied 24 consecutive patients prior to implantation of a VDD pacemaker. With the patient in supine position, a test electrode with an AV distance of 13 cm was taped onto the thorax…

Management of Pulmonary Embolism: Results from the German Chest Pain Unit Registry.

<b><i>Introduction:</i></b> Since 2008, specialized chest pain units (CPUs) were implemented across Germany ensuring structured diagnostics in acute chest pain. This study aims to analyze the management of pulmonary embolism (PE) patients in such certified CPUs. <b><i>Methods:</i></b> Data were retrieved from 13,902 patients enrolled in the German CPU registry and analyzed for the diagnosis of PE including patient characteristics, critical time intervals, diagnostic workup, treatment, and prognosis. PE patients were compared to the overall CPU patient cohort. Only patients with a complete 3-month follow-up were included. <b><i>Resu…

Spiral-CT zum Nachweis von Koronararterienverkalkungen und Vorhersage einer koronaren Herzerkrankung - Vergleich zur Durchleuchtung und Koronarangiographie

PURPOSE Evaluation of clinical relevance of coronary calcifications detected by helical CT. Evaluation of congruence with fluoroscopy (FS) and coronary angiography. Comparison with studies reporting on application of ultrafast computed tomography. MATERIALS AND METHODS 40 patients underwent helical CT (2 mm slice thickness, table-feed 3 mm/s). Coronary angiography and FS were performed in usual technique. Stenosis and calcifications were evaluated semiquantitatively. RESULTS 28 of 28 stenoses > or = 75% were detected via helical CT by evaluation of calcification (FS: 19). One non-detected solitary stenosis was calculated as 40%. FS did not detect 4 cases with 2-vessel and 3-vessel disease e…

Invasive treatment of NSTEMI patients in German Chest Pain Units - Evidence for a treatment paradox.

Background: Patients with non ST-segment elevation myocardial infarction (NSTEMI) represent the largest fraction of patients with acute coronary syndrome in German Chest Pain units. Recent evidence on early vs. selective percutaneous coronary intervention (PCI) is ambiguous with respect to effects on mortality, myocardial infarction (MI) and recurrent angina. With the present study we sought to investigate the prognostic impact of PCI and its timing in German Chest Pain Unit (CPU) NSTEMI patients. Methods and results: Data from 1549 patients whose leading diagnosis was NSTEMI were retrieved from the German CPU registry for the interval between 3/2010 and 3/2014. Follow-up was available at m…

Anomalous Origins of the Left Main Coronary Artery From the Noncoronary Sinus and of the Right Coronary Artery From the Left Sinus of Valsalva

A 70-year-old man was referred for recent-onset angina. The ECG showed a right-axis deviation and signs of an old anterior infarction with loss of R waves in leads V1 through V5. Chest radiograph demonstrated a markedly enlarged heart, which was shifted to the left side with discrete signs of pulmonary congestion. Transthoracic echocardiography, which was limited by poor imaging quality, revealed a normal left ventricular cavity with reduced ejection fraction (40%) due to hypokinesia of the anterior wall. Coronary angiography showed the dominant RCA to originate from the left sinus of Valsalva. It coursed between the aorta and the pulmonary artery to the right (Figs …

The German CPU Registry: Dyspnea independently predicts negative short-term outcome in patients admitted to German Chest Pain Units.

While dyspnea is a common symptom in patients admitted to Chest Pain Units (CPUs) little is known about the impact of dyspnea on their outcome. The purpose of this study was to evaluate the impact of dyspnea on the short-term outcome of CPU patients.We analyzed data from a total of 9169 patients admitted to one of the 38 participating CPUs in this registry between December 2008 and January 2013. Only patients who underwent coronary angiography for suspected ACS were included. 2601 patients (28.4%) presented with dyspnea.Patients with dyspnea at admission were older and frequently had a wide range of comorbidities compared to patients without dyspnea. Heart failure symptoms in particular wer…

Assessment of coronary artery bypass grafts: value of different breath-hold MR imaging techniques.

Our aim was to evaluate the patency of coronary artery bypass grafts and to detect graft stenosis using different breath-hold MR imaging techniques.Twenty-two patients with 59 grafts (14 internal mammary artery grafts and 45 saphenous vein grafts) and 76 distal anastomoses (singular and sequential grafts) were studied using a 1.5-T scanner. A two-dimensional T2-weighted breath-hold half-Fourier acquisition single-shot turbo spin echo (HASTE) sequence and a three-dimensional breath-hold contrast-enhanced MR angiography sequence (fast imaging with steady-state free precession) were performed. For MR angiography, a bolus of 20 ml of gadopentetate dimeglumine was used. Time delay for contrast i…

Prospektive Machbarkeitsstudie zum Vergleich von Röntgenübersichtsaufnahme und Thorax-MRT in Atemanhaltetechnik am offenen Niederfeldgerät

PURPOSE MR investigations using a breath-hold sequence at an open low-field MR had to be compared to chest X-rays in patients with a wide spectrum of cardio-thoracic pathologies. MATERIAL AND METHODS 114 patients and three volunteers who actually received a chest X-ray due to different indications underwent triplanar breath-hold (17 - 20 s) True-FISP sequence using a 0.2 T low-field MR (Siemens Magnetom Open, TR/TE/alpha: 7.3/3.5/80 degrees, SD: 10 mm, Pixel: 2.81 x 1.41 mm) a mean of 5.1 (+/- 8.2) days later. RESULTS Signal-to-noise ratio as basics for pattern recognition was 3.2 in nodule, 5.0 in infiltration, and 12.0 in effusion, and therefore True-FISP is usable for the detection of th…

Morphologische und funktionelle Evaluation pulmonaler Gefäßanomalien mittels schneller MR-Techniken

Purpose: To evaluate breath-hold MR techniques for morphologic and functional assessment of vascular abnormalities of the pulmonary vasculature. Patients and Methods: 13 patients aged 11 to 60 years with different vascular abnormalities of the pulmonary vasculature (5 patients with 16 arteriovenous malformations, 8 patients with partial anomalous pulmonary venous return) underwent MR imaging at 1.5 T. For morphological assessment, a contrast-enhanced 3D MR angiography (ce-MRA) was performed after a timing run. Segmented cine- and velocity-encoded GRE sequences were used for delineation of associated cardiac septal defects and for determination of systemic left-to-right or intrapulmonary shu…

Human parvovirus B19 infection associated with severe acute perimyocarditis in a 34-year-old man

Single-lead VDD-Systeme: Eine Alternative zu DDD-Systemen bei Patienten mit AV-Block

VDD- und DDD-Systeme in der Therapie des isolierten AV-Blocks werden anhand der Kriterien Implantation und Komplikationen, Sicherheit der atrialen Wahrnehmung, Erhalt der AV-synchronen Stimulation, Notwendigkeit einer atrialen Stimulation, Inzidenz atrialer Rhythmusstorungen und Schrittmachernachsorge gegenubergestellt.

Gender differences in acute myocardial infarction in the era of reperfusion (the MITRA registry).

There is conflicting information about gender differences in presentation, treatment, and outcome after acute ST elevation myocardial infarction (STEMI) in the era of thrombolytic therapy and primary percutaneous coronary intervention. From June 1994 to January 1997, we enrolled 6,067 consecutive patients with STEMI admitted to 54 hospitals in southwest Germany in the Maximal Individual TheRapy of Acute myocardial infarction (MITRA), a community-based registry. Women were 9 years older than men, more often had hypertension, diabetes mellitus, and congestive heart failure, and had a history of previous myocardial infarction less often. Women had a longer prehospital delay (45 minutes), had a…

Bestimmung der myokardialen Perfusionsreserve bei KHK-Patienten mit der kontrastmittelverstärkten MRT: Ein Vergleich zwischen semiquantitativer und quantitativer Auswertung

OBJECTIVE Comparison between two semiquantitative methods and a quantitative evaluation of myocardial blood flow (MBF) for assessment of myocardial perfusion reserve (MPR) in patients with CAD. MATERIAL AND METHODS 9 patients with coronary stenoses > 50 % were examined with an ECG-gated Saturation Recovery Turbo FLASH sequence by using Gd-DTPA as contrast agent (CA). The entive measurements were performed both during rest and hyperemia induced by adenosine. The up-slopes of the signal-time S(t) curves in the myocardium and left ventricular (LV) cavity were evaluated by a linear fit. MPR was calculated from the original up-slopes of the myocardial S(t) curves and from the up-slopes, which we…

Comparison of Arterial and Venous Blood Flow Between Patients with Pressure Dressing or a New Hemostatic Puncture Closure Device After Cardiac Catheterization

The aim of the study was to compare arterial and venous flow volume in the punctured leg in patients given a conventional pressure dressing and those given a new hemostatic puncture closure device (Angio-Seal) after cardiac catheterization. We prospectively measured blood flow in 25 patients with pressure dressing (group A) and 25 patients with Angio-Seal (group B) after cardiac catheterization. Duplex sonographic measurements were performed at the superficial femoral artery and vein of the punctured leg. In group A measurements were performed before catheterization, during pressure dressing, and after removal of pressure dressing. In group B we performed the measurements before catheteriza…

A new thrombectomy catheter device (AngioJet) for the disruption of thrombi: An in vitro study

In this study we examined a new thrombectomy catheter device. Different kinds of in vitro generated thrombi and cadaver thrombi were disrupted in test tubes. The mean disruption rate (and disruption time for 1 g of thrombus) was 225 +/- 65 mg/sec (5 +/- 2 sec) for whole-blood, 117 +/- 60 mg/sec (12 +/- 9 sec) for fibrin, 41 +/- 18 mg/sec (30 +/- 18 sec) for mixed, 70 +/- 42 mg/sec (17 +/- 5 sec) for unorganized, 45 +/- 8 mg/sec (22 +/- 4 sec) for partly, and 5 +/- 1 mg/sec (216 +/- 29 sec) for completely organized cadaver thrombi (P0.05). More than 99% of fragmented particles of whole-blood thrombi were 0-12 microm in diameter. The particle size of fibrin, mixed, and cadaver thrombi was sim…

Discrimination of early/intermediate and advanced/complicated coronary plaque types by radiofrequency intravascular ultrasound analysis

Radiofrequency intravascular ultrasound (IVUS-RF) analysis, as an extension of conventional IVUS imaging, may provide more accurate plaque discrimination. Thirty-two autopsy atherosclerotic coronary arteries were investigated. Corresponding sectors in different plaques were matched by histologic and RF analysis. Histologic analysis utilized the American Heart Association plaque classification. The backscattered ultrasound RF signal was analyzed by fast-Fourier transform, providing the underlying frequency components of its power spectrum. The normalized backscattered signal power (in decibels [dB]) for frequencies between 15.3 and 40.3 MHz was then measured for plaque discrimination. Advanc…

Ectasia and Aneurysm of the Right Coronary Artery Resulting From a Shunt to the Coronary Sinus

A 65-year-old woman presented with a systolic-diastolic murmur. Further MRI investigations as well as angiography revealed an arteriovenous shunt to the coronary sinus via an enlarged right coronary artery (Figure 1A⇓ and 1B⇓). The distal part of this coronary artery was transformed to a large coronary aneurysm of such extent that the left atrium was compressed …

Primär-Dilatation versus Thrombolyse bei Patienten mit akutem Myokardinfarkt, die nicht in randomisierte Studien eingeschlossen wurden

Die randomisierten Studien zum Vergleich der Thrombolyse und der Primar-Dilatation beim akuten Myokardinfarkt schlossen keine Patienten mit Linksschenkelblock, nichtdiagnostischem ersten Elektrokardiogramm, einer Prahospitalzeit von ≥ 12 h oder einer unbekannten Prahospitalzeit ein. Im klinischen Alltag werden jedoch haufig solche Patienten mittels Thrombolyse oder Primar-Dilatation behandelt. Um diese Patientengruppen zu beschreiben und den Einflus der Lyse und der Primar-Dilatation zu vergleichen, untersuchten wir die Daten aus der “Maximale Individuelle Optimierte Therapie beim Akuten Myokardinfarkt” (MITRA)-Studie. Bei 737 von 3308 (22,3 %) mittels Primar-Dilatation oder Lyse behandelte…

Diagnose eines intramyokardialen Hämatoms nach traumatischem Myokardinfarkt durch Magnetresonanztomographie

Thoraxverletzungen treten bei etwa 30% aller traumatisierten Patienten auf, wobei in den meisten Fallen Verkehrsunfalle die Ursache sind. Wir berichten uber den Fall eines Patienten, der nach einem Skiunfall einen traumatischen Vorderwandinfarkt erlitt. Im weiteren Verlauf kam es zu einer ausgedehnten intramyokardialen Einblutung. Differentialdiagnostisch kam zunachst ein linksventrikulares Pseudo- bzw. Pseudopseudoaneurysma in Frage, kernspintomographisch konnte jedoch durch den Nachweis eines schmalen Myokardsaums sowohl ventral als auch dorsal der Raumforderung die Diagnose eines intramyokardialen Hamatoms gestellt werden. Bei dem Patienten wurde daraufhin eine aortokoronare Bypass-Opera…

On versus off-hour care of patients with acute coronary syndrome and persistent ST-segment elevation in certified German chest pain units

BACKGROUND Regional healthcare projects improve the off-hour care of patients with acute coronary syndromes and persistent ST-segment elevation myocardial infarction (STEMI). To analyse differences in quality of care between on and off-hour care of STEMI patients admitted to certified German chest pain units. METHODS A total of 1107 STEMI patients from the German chest pain unit registry were enrolled. Analyses comprised critical time intervals (symptoms to first medical contact (FMC), FMC to admission, symptoms to admission, symptoms to balloon, FMC to balloon, door to balloon times) and major adverse cardiac and cerebrovascular events at follow-up. RESULTS 54.8% of patients were admitted …

Comparison of prognostic usefulness (three years) of computed tomographic angiography versus 64-slice computed tomographic calcium scanner in subjects without significant coronary artery disease.

Coronary computerized tomographic angiography (CTA) has been used as a noninvasive method for ruling out high-grade stenoses. Even in the absence of such stenoses, analysis of coronary atherosclerosis may provide for important prognostic information, and this may be superior to exclusive coronary artery calcium scoring. We tested this hypothesis in patients undergoing CTA for clinical indications who had no stenoses requiring revascularization. From December 2004 to December 2006, 706 consecutive patients who underwent CTA but had no high-grade stenoses were included (58% men, mean age 59 ± 11 years). CTA and coronary artery calcium scoring (Agatston method) were performed using a 64-slice …

Kernspintomographische Flussquantifizierung in Koronargefäßen zur Evaluierung hochgradiger Koronarstenosen

Ziel: Zweck der Studie war die Bestimmung des intrakoronaren Blutflusses im Verhaltnis zum Aortenfluss bei Patienten mit hochgradigen Koronarstenosen. Die MR-Flussmessung wurde bei 15 Patienten in 18 Koronargefasen durchgefuhrt. Zur Flussmessung eine segmentierte 2-D-Flash-Sequenz mit einer zeitlichen Auflosung von 110 bzw. 125 ms verwendet. Der mittlere Koronarfluss im Verhaltnis zum aortalen Fluss war bei Patienten mit hochgradigen Koronarstenosen signifikant (p < 0,001) erniedrigt. Die MR-Phasenkontrastmethode ermoglicht eine genaue Bestimmung des Blutflusses in Koronargefassen und in Korrelation zum Aortenfluss eine Aussage uber hochgradige Koronarstenosen. Weiterentwicklungen der Metho…

Comparison of ReoPro((R)) (abciximab) versus intracoronary thrombolysis for early coronary stent thrombosis.

AIMS: This study evaluated the treatment of early coronary stent thrombosis with intracoronary urokinase or the platelet glycoprotein IIb/IIIa receptor inhibitor ReoPro (abciximab). METHODS AND RESULTS: Seventy-four patients (126 stents) were treated immediately after identification of early (0-30 days) coronary stent thrombosis. Twenty-nine patients were treated with intracoronary urokinase (UK) (UK alone in 19; UK and additional balloon angioplasty in 10) and another 45 patients were given ReoPro((R)) (abciximab) (0.25 mg/kg as a bolus alone in 26, abciximab with additional balloon angioplasty in 19) within 30 days of stent implantation. TIMI grade 3 flow was obtained in 23 patients (79%)…

Interventional cardiology: Differences in the morphology of unstable and stable coronary lesions and their impact on the mechanisms of angioplasty. An in vivo study with intravascular ultrasound

The aim of this study was to compare the morphology of stable and unstable coronary lesions using intravascular ultrasound in patients undergoing coronary balloon angioplasty and to determine whether lesion morphology had any influence on the mechanism of balloon angioplasty. Thirty three (15 stable and 18 unstable) patients undergoing single lesion percutaneous transluminal coronary angioplasty were studied with intravascular ultrasound before and after intervention. All examinations, recorded on S-VHS video tape, were studied off-line and matched sites from the point of minimum lumen area after the procedure and the corresponding site prior to intervention were compared. The morphology of…

The Adverse Events and Hemodynamic Effects of Adenosine-Based Cardiac MRI

OBJECTIVE We wanted to prospectively assess the adverse events and hemodynamic effects associated with an intravenous adenosine infusion in patients with suspected or known coronary artery disease and who were undergoing cardiac MRI. MATERIALS AND METHODS One hundred and sixty-eight patients (64 ± 9 years) received adenosine (140 µg/kg/min) during cardiac MRI. Before and during the administration, the heart rate, systemic blood pressure, and oxygen saturation were monitored using a MRI-compatible system. We documented any signs and symptoms of potential adverse events. RESULTS In total, 47 out of 168 patients (28%) experienced adverse effects, which were mostly mild or moderate. In 13 patie…

Coronary artery and bypass flow measurement—basic methodology and current status

Noonan-Syndrom mit der ungew�hnlichen Kombination von hypertropher Kardiomyopathie, konnatal bikuspider Aortenklappe und Aortenisthmusstenose mit hypoplastischem Aortenbogen

Das Noonan-Syndrom ist gekennzeichnet durch kraniofaziale Dysmorphien wie Ptosis der Augenlider, Pterygium colli und durch einen tiefen nuchalen Haaransatz, durch Skelettveranderungen wie Kleinwuchs, Klinodaktylie, Kiel- und Trichterbrust und durch Organfehlbildungen, hauptsachlich Herzfehler, seltener einer Retentio testis und Nierenfehlbildungen. Das Noonan-Syndrom weist ein ahnliches Erscheinungsbild auf wie das Ullrich-Turner-Syndrom. Im Gegensatz zu dieser Chromosomenaberration sind aber Patienten beiderlei Geschlechts betroffen, sie weisen einen unauffalligen Chromosomensatz (46, XX bzw. 46, XY) auf und sind zeugungsfahig. Bei etwa der Halfte der Patienten mit Noonan-Syndrom bestehen …

Revaskularisation mit der A. gastroepiploica dextra — Bewertung der Indikation und des perioperativen Risikos

Bei 35 Patienten (mittleres Alter 64,0 Jahre (±10,4 Jahre) wurde bei fehlender oder unbrauchbarer V. saphena magna neben der einoder beidseitigen A. thoracica interna (ITA) die rechte A. gastroepiploica (GEA) zur Revaskularisation der rechten Koronararterie (RCA) verwendet. Ausgeschlossen wurden Patienten mit erheblicher Adipositas (Broca-Index >20%) sowie Patienten mit abdominellen Voroperationen. In einem Fall konnte die GEA wegen Plaquebildung nicht verwendet werden. Bei 23 Patienten wurde die GEA mit dem R. interventricularis posterior (RIVP), bei 11 Patienten mit der RCA vor bzw. in Hohe der Crux anastomosiert.

Clinical application of a new rheolytic thrombectomy catheter system for massive pulmonary embolism

Evaluation of post-myocardial infarction regional and global left ventricular function by monoplane ventriculography: superiority of right versus left anterior oblique projection at any infarct location.

OBJECTIVES To study the significance of serial quantitative regional wall motion analysis, volumes, and ejection fraction findings as well as their prognostic implications derived from cineventriculography in 30 degrees right anterior oblique (RAO) projection in comparison with 60 degrees left anterior oblique (LAO) projection in post-myocardial infarction patients. Ventriculographic left ventricular parameters are accepted surrogates of mortality in myocardial infarction. Nowadays, in contrast to a biplanar approach in most institutions and clinical trials, the investigation is reduced to monoplanar ventriculography. However, it is not known whether the relevance of the two established pro…

Beurteilung der Durchgängigkeit von koronaren Bypassgefäßen mit einer 2D T2-gewichteten Turbo-Spin-Echo-Sequenz (HASTE) in Atemanhaltetechnik

AIM To evaluate the patency of coronary artery bypass grafts with a 2D T2-weighted breath-hold turbo-spin-echo sequence. METHODS 38 patients with 97 grafts (19 internal mammary artery and 78 saphenous vein grafts) and a total of 120 distal anastomoses were studied at 1.5 Tesla in supine position using a phased array body coil. An ECG gated 2D T2-weighted breath-hold turbo-spin-echo sequence (HASTE) was performed. Reference method was selective coronary angiography. The image material was evaluated independently by two radiologists (observer one, a radiological fellow and the second a staff radiologist). RESULTS Observer 1 reached a sensitivity of 96% (72/75) and a specificity of 91% (20/22)…

Intravascular ultrasound detected classification of coronary lesions as a predictor of dissections after balloon angioplasty.

Dissection after balloon angioplasty of coronary arteries may give rise to an unfavourable early outcome. Compared with coronary angiography, intravascular ultrasound (IVUS) allows more detailed characterisation of dissections. We investigated the incidence and type of dissections after balloon angioplasty in calcified coronary lesions. IVUS was performed in 43 patients with 48 lesions before and after percutaneous balloon angioplasty. Significant calcification was defined as an arc of more than 90 degrees with typical acoustic shadowing. Dissections were classified as type A when the media was not involved by the dissection and as type B when media involvement had occurred. In the group wi…

Primary percutaneous transluminal coronary angioplasty for Acute Myocardial Infarction in patients not included in randomized studies

Abstract Patients with acute myocardial infarction included in randomized trials comparing primary percutaneous transluminal coronary angioplasty (pPTCA) with thrombolysis represent a special subgroup of patients with a low event rate. Patients excluded from these trials represent a variety of different subgroups, with different patient characteristics and possibly different clinical event rates. Primary PTCA was performed in 491 consecutive patients with acute myocardial infarction in the prospective multicenter observational Maximal Individual Therapy in Acute Myocardial Infarction trial. They were divided into the following groups: group I, patients fulfilling the inclusion criteria of t…

Primary angioplasty versus intravenous thrombolysis in acute myocardial infarction: can we define subgroups of patients benefiting most from primary angioplasty?

Abstract OBJECTIVES We sought to determine the effectiveness of primary angioplasty compared with thrombolysis in clinical practice. BACKGROUND In clinical practice, primary angioplasty for the treatment of acute myocardial infarction (AMI) has not yet been proven more effective than intravenous thrombolysis, nor have subgroups of patients been identified who would perhaps benefit from primary angioplasty. METHODS The pooled data of two AMI registries—the Maximal Individual TheRapy in Acute myocardial infarction (MITRA) study and the Myocardial Infarction Registry (MIR)—were analyzed. A total of 9,906 lytic-eligible patients with AMI, with a pre-hospital delay of ≤12 h, were treated with ei…

Self-referral to chest pain units: results of the German CPU-registry

Chest pain units (CPUs) are increasingly established in emergency cardiology services. With improved visibility of CPUs in the population, patients may refer themselves directly to these units, obviating emergency medical services (EMS). Little is known about characteristics and outcomes of self-referred patients, as compared with those referred by EMS. Therefore, we described self-referral patients enrolled in the CPU-registry of the German Cardiac Society and compared them with those referred by EMS.From 2008 until 2010, the prospective CPU-registry enrolled 11,581 consecutive patients. Of those 3789 (32.7%) were self-referrals (SRs), while 7792 (67.3%) were referred by EMS. SR-patients w…

Möglichkeiten und Perspektiven der nichtinvasiven Bypassdiagnostik

Ziel: Das Studienziel war die kernspintomographische Evaluierung koronarer Bypassgefase mit der Hast-, Fisp-3-D- und Navigatorsequenz unter besonderer Berucksichtigung der distalen Bypassanastomose.

Die akute Gefäßperforation mit Shuntbildung in den rechten Ventrikel nach perkutaner transluminaler Koronarangioplastie. Kernspintomographischer und dopplersonographischer Nachweis des Shuntflusses

Die Gefasperforation nach transluminaler Koronarangioplastie (PTCA) stellt eine seltene Komplikation dieser etablierten Behandlungsmethode dar. Die Therapie wird bestimmt durch die hamodynamische Beeintrachtigung des linken oder rechten Ventrikels. Wir berichten uber den Fall einer Gefasperforation nach PTCA mit Shuntbildung von der rechten Koronararterie in den rechten Ventrikel, wobei der Shuntflus sowohl kernspintomographisch als auch dopplersonographisch dargestellt werden konnte.

Timing of percutaneous coronary intervention in troponin-negative patients with acute coronary syndrome without persistent ST-segment elevation: preliminary results and status quo in German chest pain units.

OBJECTIVE Management of acute coronary syndromes without persistent ST-segment elevation (NSTE-ACS) and unstable angina pectoris (UAP) remains challenging. The study aimed to analyze the current management of UAP patients in German chest pain units focussing on the different time lines of invasive strategy. METHODS A total of 1400 UAP patients admitted to a certified chest pain unit were enrolled. Analyses of high-risk criteria with indication for invasive management and of 3-month clinical outcomes were performed by subgrouping UAP patients to immediate and early invasive (<8 hours), early elective invasive (8-24 hours), late elective invasive (24-72 hours) strategy, and without percutaneo…

Characterization and referral patterns of ST-elevation myocardial infarction patients admitted to chest pain units rather than directly to catherization laboratories : Data from the German Chest Pain Unit Registry

Abstract Background Direct transfer to the catheterization laboratory for primary percutaneous coronary intervention (PCI) is standard of care for patients with ST-segment elevation myocardial infarction (STEMI). Nevertheless, a significant number of STEMI-patients are initially treated in chest pain units (CPUs) of admitting hospitals. Thus, it is important to characterize these patients and to define why an important deviation from recommended clinical pathways occurs and in particular to quantify the impact of deviation on critical time intervals. Methods and results 1679 STEMI patients admitted to a CPU in the period from 2010 to 2015 were enrolled in the German CPU registry (8.5% of 19…

Diagnose und Verlaufsbeurteilung eines intramuralen Hämatoms der Aorta ascendens mit der Magnetresonanztomographie

Comparison of antiplatelet effects of aspirin, ticlopidine, or their combination after stent implantation.

Background —This study was performed to analyze the influence of either aspirin, ticlopidine, or their combination on platelet activation and aggregation parameters after stent implantation. Methods and Results —Sixty-one patients with successful implantation of a single Palmaz-Schatz stent in a native coronary artery were randomly assigned to either group A (aspirin 300 mg/d+ticlopidine 2×250 mg/d), group B (ticlopidine 2×250 mg/d), or group C (aspirin 300 mg/d). Platelet activation was evaluated on days 1, 7, and 14 by flow cytometry measurement of expression of CD62p (p-selectin) and the binding of fibrinogen to the platelet surface glycoprotein IIb/IIIa receptor. Platelet aggregation w…

Acute myocardial infarction occurring in versus out of the hospital: patient characteristics and clinical outcome

OBJECTIVES We describe the baseline characteristics and clinical course of patients who had an acute myocardial infarction (AMI) during their hospital stay. BACKGROUND In comparison with patients who had an AMI outside of the hospital (prehospital AMI), the data on patients who had an AMI in the hospital are poorly described. METHODS Patients with an in-hospital AMI were prospectively registered in the Southwest German Maximal Individual TheRapy in Acute myocardial infarction (MITRA) study and compared with patients with prehospital AMI. RESULTS Of 5,888 patients with AMI, 403 patients (6.8%) had an in-hospital AMI. These patients were older, more often male and sicker as compared with the …

Guideline-adherence and perspectives in the acute management of unstable angina - Initial results from the German chest pain unit registry.

Abstract Background We investigated the current management of unstable angina pectoris (UAP) in certified chest pain units (CPUs) in Germany and focused on the European Society of Cardiology (ESC) guideline-adherence in the timing of invasive strategies or choice of conservative treatment options. More specifically, we analyzed differences in clinical outcome with respect to guideline-adherence. Method Prospective data from 1400 UAP patients were collected. Analyses of high-risk criteria with indication for invasive management and 3-month clinical outcome data were performed. Guideline-adherence was tested for a primarily conservative strategy as well as for percutaneous coronary interventi…

Comparison of primary angioplasty with conservative therapy in patients with acute myocardial infarction and contraindications for thrombolytic therapy

The benefit of primary angioplasty in patients with acute myocardial infarction (AMI) and contraindications for thrombolysis compared to a conservative regimen is still unclear. Out of 5,869 patients with AMI registered by the MITRA trial, 337 (5.7%) patients had at least one strong contraindication for thrombolytic therapy. Out of these 337 patients 46 (13.6%) were treated with primary angioplasty and 276 (86.4%) were treated conservatively. Patients treated conservatively were older (70 years vs. 60 years; P = 0.001), had a higher rate of a history with chronic heart failure (14.8% vs. 4.4%; P = 0.053), a higher heart rate at admission (86 beats/min vs. 74 beats/min; P = 0.001), and a hig…

Transthoracic three-dimensional echocardiographic volumetry of distorted left ventricles using rotational scanning

The purpose of this study was to evaluate the relation of transthoracic three- and two-dimensional echocardiographic left ventricular volumetry to cineventriculographic volumetry. Twenty-five patients with distorted left ventricles were included in the study. To demonstrate the impact of acquiring data by rotational scanning, we performed three- and two-dimensional echocardiography in 36 latex ventricles with data acquisition in different areas of the ultrasound sectors. Interobserver and intraobserver variability were calculated to test for reproducibility. The three-dimensional imaging system consisted of a rotation motor device, a transthoracic 2.5 MHz transducer, a conventional ultrasou…

Gender Differences in Patients Admitted to a Certified German Chest Pain Unit: Results from the German Chest Pain Unit Registry.

&lt;b&gt;&lt;i&gt;Introduction:&lt;/i&gt;&lt;/b&gt; Gender-specific atypical clinical presentation in acute coronary syndrome and sex-specific outcomes in cardiovascular disease in women are well known. The aim of this study is to analyze possible differences between men and women presenting to certified German chest pain units (CPUs). &lt;b&gt;&lt;i&gt;Methods:&lt;/i&gt;&lt;/b&gt; Data from 13,900 patients derived from the German CPU registry were analyzed for gender differences in patient characteristics, cardiovascular disease manifestation, critical time intervals, treatment and prognosis. &lt;b&gt;&lt;i&gt;Results:&lt;/i&gt;&lt;/b&gt; A total of 37.8% of patients were female. Typical c…