Impaired myocardial perfusion and perfusion reserve associated with increased coronary resistance in persistent idiopathic atrial fibrillation.

Aims: Patients with atrial fibrillation (AF) present with symptoms of myocardial ischaemia despite exclusion of coronary artery disease. A small vessel disease has been suggested. We quantified myocardial perfusion, perfusion reserve, and coronary vascular resistance (CVR) in AF patients using positron emission tomography (PET).

Vasoactive peptides during long-term follow-up of patients after cardiac transplantation.

Background: Vasoactive peptides are accepted indicators of the degree of heart failure and its progression or improvement following medical therapy. Normalization of cardiac hemodynamics by cardiac transplantation (HTx) may lead to normalization of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) plasma levels shortly after the procedure.

Methods: Long-term follow-up was done for 14 consecutive patients, 12 men and 2 women, 49 years of age (range 24 to 64 years).

[Proinflammatory cytokines and cardiac pump function].

In situations of depressed myocardial function, the role of immunological mechanisms has been studied recently. In different pathophysiological situations, such as chronic heart failure, open heart surgery with extracorporal circulation, cardiac transplantation, myocardial infarction and angina pectoris, patterns have been described with elevation of proinflammatory cytokines, such as tumor necrosis factor-alpha, interleukin-1, interleukin-6, and reversible myocardial dysfunction, which may represent a final common pathway. The available data suggest a modulation of important determinants of pump function, i.

Ischemic versus idiopathic cardiomyopathy: differing neurohumoral profiles despite comparable peak oxygen uptake.

Objective: We tested the hypothesis that neurohormonal and immunological activation differs in ischemic and idiopathic dilated cardiomyopathy since recent intervention trials indicate that ischemic cardiomyopathy seems to carry a worse prognosis than idiopathic cardiomyopathy of comparable clinical severity.

Methods: In ten patients with ischemic cardiomyopathy undergoing spiroergometric evaluation venous levels of norepinephrine, epinephrine, renin, angiotensin, atrial natriuretic peptide as well as soluble interleukin-2-receptor were determined before, during and 10 min after exercise. Results were compared to sixteen patients with idiopathic cardiomyopathy with similar peak oxygen uptake (13.

Interleukin-6 correlates with hemodynamic impairment during dobutamine administration in chronic heart failure.

Proinflammatory cytokines have been implicated in the pathophysiology of chronic heart failure. We determined mixed venous levels of interleukin-6 (IL6) in 18 heart transplant candidates before, 1, 4, and 24 h after initiation of dobutamine infusion (3 micrograms/kg/min) during hemodynamic evaluation. During the first 4 h of dobutamine, systemic vascular resistance decreased (1358 to 1024 dyn x s x cm-5, P = 0.

Diagnostic assessment of macrophage phenotypes in cardiac transplant biopsies.

Forty-one endomyocardial biopsies of the right interventricular septum have been investigated in 24 immunosuppressed patients after orthotopic heart transplantation. Monoclonal antibodies 27E10, 25F9, and RM3/1, which react with different macrophage phenotypes, and antisera MRP-8 and MRP-14, specific for proteins expressed on endothelial and monocyte cell surfaces in inflammation as well as markers for CD4+ and CD8+ T-lymphocytes, were employed in an indirect immunoperoxidase staining technique. This methodology permits more physiological recognition of the inflammatory process within the myocardium.

Phenotyping of macrophages with monoclonal antibodies in endomyocardial biopsies as a new approach to diagnosis of myocarditis.

Cryostat sections of endomyocardial biopsies from 53 patients (mean age 41 +/- 5 years, 38 male and 15 female) clinically indicated to suffer from myocarditis were stained using monoclonal antibodies against subpopulations of T-lymphocytes and macrophages and with polyclonal rabbit-anti-human sera marking two calcium-binding proteins expressed by monocytes and macrophages appearing in inflammatory sites only. No inflammatory infiltrate cells were found in 13 cases (25%). Mononuclear cell infiltrates were present in 40 cases (75%).

[Combination therapy with slow release isosorbide nitrate and diltiazem in silent myocardial ischemia].

In 11 patients (2 female, 9 male) suffering from angiographically proven CHD (age 45-60 years; 54.3 years on an average) the efficacy of a once-daily oral medication with 120 mg ISDN/50 mg ISMN and diltiazem (D) each in a long-acting preparation was examined in a placebo-controlled study. Each period lasted for 3 days; 2 capsules were given at 0700 a.

[Clinical vectorcardiography: the Fritz-Schellong commemorative lecture].

The continuous and direct registration of the vectorcardiogram was realized by cathode-ray oscillographic methods by F. Schellong in 1937 and hence introduced into clinical diagnostics. The following development of different lead systems resulted in the standardization of the corrected orthogonal Frank system, which yielded almost identical information when compared to the Schellong system.

[Heart rate and contractile reserve of the aging heart].

In standardized experiments on both conscious and anaesthetized young (n = 11) and old (n = 7) dogs differences in haemodynamics, contractility and myocardial oxygen consumption correlated to age were evaluated. Under resting conditions no significant differences were observed. Following stimulation with catecholamines young (n = 6), and old (n = 6) dogs displayed an almost parallel increase in (dp/dt) max.

[Comparative studies on the anti-arrhythmic and anti-fibrillatory effectiveness of verapamil and nifedipine following acute coronary artery occlusion and reperfusion].

The ability of the two calcium-antagonists Verapamil and Nifedipine to reduce ventricular electrical instability following acute transient coronary artery occlusion and release and to prevent ventricular arrhythmias, particularly fibrillation, was evaluated on a total of 25 anaesthetized and artificially ventilated dogs. In all animals repeated coronary occlusions, lasting 20 min each, with a reperfusion period of 120 min between subsequent ligations, were performed. Time course and extent of ventricular ectopic activity were continuously registered, and the changes in ventricular vulnerability were assessed by measuring the ventricular fibrillation threshold at different times both after coronary artery occlusion and reperfusion.

Comparative study of stress reactions during oral surgery after pindolol and metoprolol.

The prophylactic effect of a single oral dose of 5 mg pindolol (P) or 100 mg metoprolol (M) on sympathetic and adrenergic stress reactions was investigated by a double blind study in 40 patients undergoing oral surgery. A reduction of systolic and diastolic blood pressure as well as heart rate was noted after both, P and M, as was the increase of these parameters during surgery. Adrenaline-, noradrenaline- and c-AMP-level were reduced after systematic beta-blockade by P only, not after M.

Management of cardiac arrhythmias with tiapamil.

37 patients with either chronic atrial fibrillation (AF), atrial premature beats (APBs) or ventricular premature beats (VPBs) received tiapamil as antiarrhythmic treatment. Tiapamil reduced A-V conduction by an average 20% in the group with AF (10 patients), the magnitude of response being dependent on the initial ventricular rate. In 3 of the 7 patients with APBs, the frequency of ectopic beats was reduced following a single i.

Beta-adrenoceptor blockade in stress due to oral surgery.

1 The effects of a single oral dose of 5 mg pindolol (P) and 100 mg metoprolol (M) were assessed in a double-blind study in 30 patients undergoing oral surgery. 2 Systolic and diastolic blood pressures and heart rate were reduced 90 min after oral medication and did not exceed initial values at rest during the procedure. 3 Noradrenaline, adrenaline and c-AMP concentrations did not differ at any time from the control values at rest after P, but were increased after local anaesthesia and during oral surgery after M as were the metabolic responses reflected by plasma concentrations of glucose and free-fatty acids.

[Age dependence of increase in heart rate after vagolysis (author's transl)].

Age dependent decrease of heart rate in sinus rhythm at rest was shown under clinical and experimental conditions and correlated with a decrease of sympathetic storage granula and membranes indicated by the tissue concentrations of c-AMP, which can be regarded as a messenger at the receptor sites. A slower maximal heart rate after Atropine and a reduced increase during oral medication with Ipratropium bromide can be explained by a reduced cardiac sympathetic threshold. The mentioned age dependent differences of the sympathetic stimulation can not be deduced to myocardial changes, because CPK and CK-MB activities were similar in the different age groups.

[Antiarrhythmic therapy with flecainide in acute experimental myocardial infarction (author's transl)].

Clinical and experimental studies indicate that ventricular arrhythmias, especially ventricular fibrillation, are in almost all cases the mechanism for sudden death occurring during the first 24 hours after the onset of an ischaemic myocardial event. Therefore a higher survival rate seems to depend on advances in antiarrhythmic therapy. The present study investigates the efficacy of the new local anaesthetic compound Flecainide in reducing or preventing ventricular arrhythmias and primary ventricular fibrillation, using a standardized experimental canine preparation.

Effects of cloxazolam and pindolol on the sympathetic and adrenal stress reaction during oral surgery in man.

In two studies including 73 patients the stress reducing effects of the tranquilizer Cloxazolam (Olcadil) and the beta-receptor-blocking drug pindolol (Visken) were investigated after the application of a single oral dose (3 mg Cloxazolam, 5 mg pindolol). The drugs were tested against placebo by the double blind method. After local anesthesia and during oral surgery an increase of dopamine-beta-hydroxylase (DBH)-activity, noradrenaline-, c-AMP-, ACTH and cortisol concentration was found in the placebo group.

[Combination treatment of atrial arrhythmias with quinidine-verapamil].

Between 1977 and 1979, a combined antiarrhythmic therapy with Quinidine and Verapamil was used to treat 66 patients (aged 16 to 69 years) with chronic atrial arrhythmias of different etiology. In 60% of the 43 cases with atrial fibrillation the combined therapy was effective in reversing atrial fibrillation to regular sinus rhythm. The frequency of successful responses to Quinidine - Verapamil amounted to more than twice compared with earlier therapeutic results with Quinidine only.

[Clinical study on stress protective action of cloxazolam in jaw surgery in double blind comparison to placebo (author's transl)].

An investigation in 50 patients has shown that biochemical measurements of dopamine-beta-hydroxylase (DBH), ACTH and cortisol as well as the concentration of glucose and insulin signal a reduction of surgical stress under the medication of the tranquilizer 10-chloro-11b-(2-chlorophenyl)-2,3,5,6,7,11b-hexahydrobenzo[6,7]-1,4-diazepino[5,4-b]oxazol-6-one (cloxazolam, MT 14-411). There was an inhibition of the DBH-increase during the surgical procedure and an inhibition of the ACTH- and cortisol-secretion before and during surgery as well as a reduction of the insulin antagonizing effect during sympathicoadrenal stimulation. With the exception of a sedative action no other side effects have been observed.