0000000000035826
AUTHOR
Michael Haude
Parametric assessment of myocardial perfusion by densitometric evaluation of digital subtraction coronary angiograms: a comparison with tomographic TL-201 scintigraphy results
Densitometric results about local myocardial perfusion are compared with those derived from a quantitative analysis of TL-201 single photon emission computer tomograms (TL-201 SPECT). Ten patients underwent conventional TL-201 SPECT at rest and after maximum bicycle stress and dipyridamole infusion the day prior to the investigation. SPECT was applied to provide improved spatial resolution for the detection of perfusion abnormalities. During the catheterization procedure four digital subtraction coronary angiograms were performed, two of the left and two of the right coronary artery both before and after pharmacologically induced hyperemia by intracoronary papaverine. The densitometric para…
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 …
Intensivtherapie des Myokardinfarktes — Limitierung der Infarktgröße
Der akute Myokardinfarkt gehort mit der instabilen Angina pectoris und dem plotzlichen Herztod zu den drei akuten Koronarsyndromen, die sich nur im Ausmas und der Geschwindigkeit der Thrombusentstehung unterscheiden [16]. Ein solcher Koronarverschlus (Abb. 1) fuhrt zu einem akuten Ausfall der Myokardperfusion und innerhalb weniger Sekunden zum Ausfall der Funktion des nicht mehr perfundierten Myokards. Wird das Gefas innerhalb weniger Minuten wieder geoffnet [34, 37, 38, 48], erholt sich das Myokard vollstandig. Bleibt die Durchblutung langere Zeit blockiert, entwickelt sich ein Infarkt, der von subendokardial nach epikardial sich ausbreitet [24, 46, 47, 52, 53]. t bedeutet eine kurze Ischa…
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…
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…
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…
Hochfrequenz-Rotationsatherektomie bei koronarer Herzkrankheit
Percutaneous high frequency coronary rotational ablation (PTCR) was used in 10 patients with significant coronary artery disease. PTCR removes arteriosclerotic material from the vessel wall. A diamond-coated (60-80 micron) brass burr-drill, fastened to a flexible drive shaft rotating and tracking along a central coaxial guide wire, was used. The turbine rotates the drive shaft in excess of 150,000-190,000 revolutions per minute. PTCR was successful in all patients, but in three additional percutaneous transluminal coronary angioplasty (PTCA) was then successfully performed. Coronary dissection occurred only once, requiring surgery which was successful. No vessel perforation was observed. Al…
TCT-350 Safety and Performance of the Resorbable Magnesium Scaffold, Magmaris in a Real World Setting - First 400 Subjects at 12-month Follow-up of the BIOSOLVE-IV Registry
The aim of this registry is to investigate the clinical performance and long-term safety of the Resorbable Magnesium Scaffold (Magmaris) (BIOTRONIK AG, Buelach, Switzerland) in a real-world setting. Up to 2,054 subjects in up to 120 clinical sites in Europe, Asia, and Asia-Pacific countries will
Hämodynamik nach sublingualer Applikation von Captopril bei schwerer Herzinsuffizienz*: Eine Pilotstudie
In a preliminary trial, 23 patients in severe left-heart failure and, in some instances, also right-heart failure (NYHA classes III and IV) received a single sublingual dose of 25 mg captopril. Invasive measurement of various haemodynamic parameters indicated (1) an increase in cardiac index and stroke-volume index of 34% and 38%, respectively (P less than 0.001 for each); (2) decrease in pulmonary artery and systemic pressures by an average of 7% and 11.4% (P less than 0.01 and less than 0.001, respectively); (3) no significant change in heart rate and mean right atrial pressure; (4) decrease in systemic and pulmonary artery resistance by 33% and 29% (P less than 0.001 for both); (5) an in…
Quantitative Coronary Angiography and Digital Densitometric Perfusion Measurements?How to Assess the Success of Intracoronary Balloon Dilatation
Densitometric evaluation of digital subtraction angiocardiograms allows the assessment of local myocardial perfusion before and after pharmacological stimulation of coronary flow reserve during the catheterization procedure. This report deals with a case of a severe stenosis of the left coronary artery in which PTCA was regarded successful based on an appropriate increase in luminal diameter while an intima and media dissection at the dilatation site was documented. The perfusion measurements, however, pointed out a clear impairment of poststenotic myocardial perfusion after PTCA.
Acute coronary artery closure following intracoronary ultrasound examination
Two patients undergoing intracoronary ultrasound examination were complicated by acute coronary artery closure. One of the complications was thought to be caused by intimal dissection and thrombus formation and the other was thought to be caused by intimal dissection and subsequent embolization. The complications were successfully managed conservatively in both cases. © 1995 Wiley-Liss, Inc.
Sublingual administration of captopril versus nitroglycerin in patients with severe congestive heart failure.
Angiotensin-converting enzyme inhibition has proven to be a successful approach for the long-term treatment of patients with congestive heart failure. This investigation compared the acute hemodynamic changes after sublingual administration of the angiotensin-converting enzyme inhibitor captopril with those after nitroglycerin. A total of 24 patients with severe left heart failure (New York Heart Association classes III and IV) were given 25 mg captopril and 0.8 mg nitroglycerin sublingually in this randomized, cross-over study. Hemodynamic monitoring revealed a clear improvement in pre- and afterload parameters for both drugs (P less than 0.01 and P less than 0.001), while captopril induce…
Densitometry and parametric imaging with quality control
X-ray contrast image series of the myocardium were studied using the approaches of densitometry and parametric imaging accompanied by quality control. Contrast angiograms were digitized at six predefined phases of the heart cycle. For densitometry, regions of interest (ROIs) were defined semi-automatically for all phases. The resulting six densograms were summed up and weighted according to their quality determined by a measure. Previously validated parameters such as rise time were calculated. The enddiastolic images were only used for the calculation of color-coded parametric images accompanied by pixel-densogram-quality information. An observer gives a score for the perfusion of roughly …
Non-invasive determination of cardiac output by transesophageal Doppler ultrasound-clinical application and validation
The authors describe the development and validation of a device using transesophageal (TE) Doppler ultrasound to provide continuous and noninvasive monitoring of cardiac output (CO) and related parameters. In intubated and artificially ventilated patients who underwent pulmonary artery catherization for hemodynamic monitoring, CO was determined by the esophageal Doppler ultrasound probe and compared to the results obtained simultaneously by means of thermodilution. A very close correlation was found between the results (r=0.99), with a standard estimate of error less than 5% as well as good reproducibility (r=0.96 and r=0.98). >
Quantitative analysis of elastic recoil after balloon angioplasty and after intracoronary implantation of balloon-expandable Palmaz-Schatz stents.
AbstractObjectives. The purpose of this study was to measure elastic recoil from sequential angiograms after balloon angioplasty and after implantation of a balloon-expandable Palmaz-Schatz stent in the same patient, and to compare the results with the late angiographic outcome.Background. The immediate result of coronary balloon angioplasty is influenced by plastic deformation, primarily of the atherosclerotic plaque, and by elastic recoil, primarily of the less or nondiseased vessel circumference,Methods. The extent of elastic recoil was measured quantitatively as the difference between maximal balloon size and the resulting vessel diameter or cross-sectional area.Results. Analysis was pe…
Tomographic left ventricular volume determination in the presence of aneurysm by three-dimensional echocardiographic imaging. I: Asymmetric model hearts
To improve the accuracy of measurements of left ventricular volume in the presence of an aneurysm, we used three-dimensional echocardiographic imaging to analyze the shape of left ventricles in 23 asymmetric model hearts with eccentric aneurysms of different sizes, shapes, and localizations. A standard 3.75 MHz ultrasound probe with a rotation motor device was used to obtain a three-dimensional data set. By rotating the probe stepwise 1 degree, 180 radial ultrasound pictures were digitized. On the basis of the three-dimensional data set, the following parameters were determined and compared with the dimensions of the model hearts obtained by direct measurement: total left ventricular volume…
Results of intracoronary stents for management of coronary dissection after balloon angioplasty.
Dissections after coronary balloon angioplasty are risk factors for acute or subacute vessel closures. Intracoronary stenting was developed to avoid these complications by pressing the intimal and medial flaps against the vessel wall, thus reducing the risk of acute thrombosis. A total of 22 stents were implanted into the coronary arteries of 15 patients with dissections after balloon angioplasty causing angina pectoris or ischemic electrocardiographic changes. Stent delivery was successful in all cases. In 1 patient acute stent thrombosis was documented and treated successfully by thrombolytic therapy. Another patient underwent coronary artery bypass surgery 24 hours later because of persi…
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 …
High-Frequency Rotational Angioplasty
In 19 patients with significant coronary artery disease, PTCR was used instead of PTCA. The PTCR was successful in all patients, but in nine patients additional PTCA was successfully performed. Coronary luminal narrowing could be reduced from 78 ± 19% to 32 ± 14% after rotablation and by combined treatment to 21 ± 14%. Only in one patient did coronary dissection occur; the patient was sent to surgery and had an uneventful outcome. No vessel perforation was observed. In one patient peripheral diagonal branch occlusion occurred. All vessels were open according to 24-control coronary angiography. Restenosis (>70% stenosis) occurred in 4/15 patients controlled after 6 months, mainly in those wi…
The effect of balloon dilatation on post-stenotic myocardial perfusion before and after stimulation of coronary flow reserve: evaluation by the densitometric parameter 'mean rise time'.
From densitometric evaluation of digital subtraction cineangiocardiograms the parameter 'Mean Rise Time' (MRT), defined as the time from the onset of local myocardial contrast medium opacification to the point of maximal opacification can be derived; this parameter revealed a close correlation with the results on myocardial perfusion obtained by Thallium-201 scintigraphy. A prolonged 'Mean Rise Time' was indicative of an impairment of myocardial perfusion. We have developed a heart-phase gated real-time digitization procedure and computer-supported method for the densitometric estimation of the MRT to obtain information about the effect of coronary balloon dilatation on myocardial perfusion…
Sublingual administration of captopril in patients with acute myocardial ischemia.
Summary: To investigate the anti-ischemic capability of the angiotensin-converting enzyme inhibitor captopril, 10 patients with acute myocardial ischemia (angina pectoris >1 h, ST-segment depression ±0.1 mV, no rise in creatine phosphokinase) received 25 mg captopril sublingually after being treated with an intravenous infusion of nitroglycerin (3 mg/h) and heparin (1200 IU/h) for 1 hour. A control group of 10 patients received placebo instead of captopril. Results showed a decrease of the initial ST-segment depression from 0.25±0.04 to 0.2±0.03 mV (p>0.01) with nitroglycerin for the captopril group and from 0.26±0.05 to 0.21±0.05 mV (p>0.01) for the control group. An additional decrease to…
New techniques for visualization of losses due to image compression in grayscale medical still images
To evaluate the visual influence of irreversible compression on medical images, changes of the images have to be visualized. The authors have explored alternative techniques to be used instead of the usual side-by-side comparison, where the information contained in both images is perceived in a single image, preserving the context between compression errors and image structures. Thus fast and easy comparison can be done. These techniques make use of the human ability to perceive information also in the dimensions of color, space, and time. A study was performed with JPEG-compressed coronary angiographic images. Changes in the resulting images for six compression factors from 7 to 30 were sc…
Comparison of myocardial perfusion reserve before and after coronary balloon predilatation and after stent implantation in patients with postangioplasty restenosis.
Background Stents provide a scaffold for coronary arteries after angioplasty and inhibit elastic recoil. Methods and Results In 25 patients with postangioplasty restenosis of the left anterior descending artery, ECG-gated digital subtraction coronary angiograms were recorded at baseline and during hyperemia (12 mg papaverine IC) before and after balloon predilatation (PTCA), after implantation of a Palmaz-Schatz stent, and after 6 months. Densitometric evaluation revealed different time and density parameters to calculate two definitions of myocardial perfusion reserve (MPR1 and MPR2) and maximum flow ratio (MaxFR). Poststenotic MPR1 increased from 1.57±0.14 to 2.59±0.86 after PTCA and to …
Parametric assessment of myocardial perfusion during interventional cardiac catheterization by means of X-ray densitometry-short-and long-term results.
X-ray densitometric evaluation of digital subtraction angiocardiograms allows an assessment of myocardial perfusion by means of the parameter 'MEAN RISE TIME' (MRT), defined as the time from the onset of local myocardial contrast medium opacification to the point of maximum opacification. Best results are obtained when the response of that parameter is compared before and after stimulation of coronary flow by papaverine. A prolongation of this parameter, especially after papaverine, was indicative of an impairment of myocardial perfusion, when compared to the results of TL-201 scintigraphy. In 50 patients with single vessel coronary artery disease the results of MRT pre and post papaverine …
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…
Short and long term results after intracoronary stenting in human coronary arteries: monocentre experience with the balloon-expandable Palmaz-Schatz stent.
OBJECTIVE--Intracoronary stenting was designed to overcome acute complications after percutaneous transluminal coronary angioplasty and to achieve a reduced rate of restenosis, both of which are major limitations of this well accepted method for treating coronary heart disease. This report describes the experience at one centre with the implantation of balloon-expandable Palmaz-Schatz stents and focuses on device related complications and the short and long term angiographic outcome. DESIGN--A retrospective data analysis. PATIENTS--Stenting was attempted in 50 patients. Restenosis after an initially successful angioplasty procedure, inadequate postangioplasty results, saphenous coronary byp…
Computerized estimation of quality standards for the X-ray densitometric assessment of myocardial perfusion
The densitometric evaluation of heart-phase-gated digital subtraction coronary angiograms derives different parameters which provide information about coronary blood flow, myocardial perfusion, and coronary flow reserve: appearance time, rise time, mean ascending time, and maximum intensity. The reliability and reproducibility of these measurements and of the derived parameters were investigated. Four digital subtraction coronary angiograms were obtained in ten patients, including two baseline measurements and two measurements under hyperemia induced by papaverine ic. Different reproducibility results were found for the parameters, depending on the heart phase of the densogram (diastolic be…
Coronary stent implantation in acute vessel closure 48 hours after an unsatisfactory coronary angioplasty
We report the implantation of a balloon-expandable stent in a patient with acute vessel closure in the state of evolving myocardial infarction following 48 hr after unsatisfactory coronary angioplasty. The stent was implanted after successful recanalization of an occluded left anterior descending artery, with repeated unsatisfactory results of balloon angioplasty. Adjunct thrombolytic therapy was contraindicated. No residual stenosis was documented in immediate control angiograms, or after 24 hr, 3 weeks, and 4 months.
Determination of myocardial perfusion and coronary flow reserve by densitometric measurements: a selective classification of regions of interest
To evaluate the functional effect of a coronary artery stenosis on the dependent myocardium, digitized coronary angiograms (DCAs) were recorded. The DCAs, acquired during heart catheterization, provide information about myocardial perfusion and coronary flow reserve of areas supplied by this coronary artery. For each analysis the myocardium is separated into different regions of interest (ROIs); 16 ROIs in the distribution of the LCA and 8 ROIs for the RCA. In addition to that, the ROIs of the diseased vessels are divided into ROIs which are proximal, within and distal to the stenosis. Using a semiautomatic procedure, densograms are constructed from which the parameter rise time is calculat…