Long-term efficacy and safety of pimobendan in moderate heart failure. A double-blind parallel 6-month comparison with enalapril. The Pimobendan-Enalapril Study Group.

In view of growing scepticism as to the efficacy and safety of agents with predominant phosphodiesterase inhibiting properties in heart failure, the clinical efficacy and safety of pimobendan, a calcium-sensitizing and partially phosphodiesterase-inhibiting compound, was compared with enalapril in 242 patients with mild to moderate heart failure (NYHA classification II-III) despite diuretics and digitalis, and abnormal haemodynamics at baseline. Patients were randomly assigned to either pimobendan (average 10.3 mg.

[Prinzmetal's variant angina: a case report].

Prinzmetal's angina is a variant of the classic exertion dependent angina pectoris. Typical is the appearance of the symptoms at rest during early morning hours. It is due to spasms in the coronary arteries.

[Is regression of coronary sclerosis possible?].

Randomized studies with sequential coronary arteriographies have clearly documented that aggressive lipid-lowering therapy and change in life style can reduce progression and produce a modest regression of coronary artery lesions. The changes in the extent of a stenosis are determined by the level of cholesterol and LDL cholesterol achieved during treatment. Three of the randomized studies have shown that the lipid-lowering intervention has not only a beneficial influence on the coronary arteriographic lesions, but the number of clinical events is reduced as well.

[Coronary artery size in chronic mitral valve insufficiency before and following mitral valve surgery].

The increase of coronary artery size in myocardial hypertrophy represents an adaptive mechanism to keep coronary blood flow normal. The relationship between coronary cross-sectional area and left ventricular muscle mass was determined angiographically in 10 patients with severe mitral regurgitation before and 28 +/- 15 months after successful mitral valve surgery. 10 subjects with atypical chest pain without coronary artery disease served as controls (C).

[Clinical course following mitral valvuloplasty].

Percutaneous transvenous mitral valvuloplasty using the double-balloon technique has been attempted in 25 patients (mean age 39 +/- 10 years; 17 women, 8 men) with severe, non-calcified (20 patients) or only slightly calcified (5 patients) mitral stenosis. Valvuloplasty was successful in 22 of the 25 patients. The procedure resulted in a marked increase in mitral valve area from 1.

[Digital subtraction angiography for the assessment of myocardial perfusion].

Coronary angiography does not only permit to evaluate the severity of coronary disease but also to assess coronary flow reserve in various myocardial perfusion areas by digital processing. Use of colour flow mapping allows the assessment of both, density as well as distribution velocity of contrast-medium (= parametric imaging). The advantage of this technique is given by the possibility to assess coronary flow reserve not only at rest but also under physiologic situations such as bicycle ergometry.

Cutaneous and coronary flow reserve in patients with microvascular angina.

Microvascular angina is characterized by exercise-induced angina in patients with normal coronary arteries and reduced coronary flow reserve. Recently, a generalized disorder of abnormal vascular reactivity in microvascular angina has been postulated. Therefore, coronary flow reserve was determined by the coronary sinus thermodilution technique and compared with the cutaneous flux ratio in 6 control subjects (group 1) and 12 patients with microvascular angina (group 2).

Left ventricular flow from apex to base during systole and isovolumic relaxation in a patient with hypertrophic cardiomyopathy and midventricular obstruction.

The occurrence of a left ventricular anterograde flow velocity (maximal: 3.9 m.s-1) is demonstrated in a 32-year-old patient with hypertrophic cardiomyopathy and midventricular obstruction, beginning at early systole and persisting throughout the isovolumic relaxation.

Silent myocardial ischemia. How to diagnose? How to treat?

1. The diagnosis of silent ischemia in asymptomatic patients with known coronary artery disease is adequately achieved by stress testing. 24 hour monitoring allows to assess the total ischemic burden which has prognostic implications.

Right ventricular diastolic function during exercise: effect of ischemia.

The effects of exercise on right ventricular diastolic function were evaluated in 14 patients who underwent supine rest and exercise right ventricular angiography. On the basis of coronary anatomy and exercise left ventricular regional wall motion analysis, these patients were classified into two groups: Group 1 (n = 7) had no or only mild coronary artery disease and Group 2 (n = 7) had significant coronary disease and exercise-induced left ventricular wall motion abnormalities suggesting ischemia. Chamber stiffness at rest was higher in Group 2 (48 x 10(-3) ml-1/m2) than in Group 1 (18 x 10(-3) ml-1/m2, p = 0.

Quantification of aortic regurgitation with amplitude-weighted mean flow velocity from continuous wave Doppler spectra.

Aortic regurgitant fraction (RFao) was quantified by estimating the ratio of the forward blood flow through the aortic (Qao) and pulmonary (Qp) valve: RFao = 100(Qao - Qp)/Qao. Aortic and pulmonary flow were measured by the systolic time integrals of the amplitude-weighted mean velocity from continuous wave Doppler spectra recorded over the aortic and pulmonary valves. Thus, measurements are independent of the left and right ventricular outflow tract area.

Potential role of coronary vasoconstriction in ischaemic heart disease: effect of exercise.

Coronary vasomotion plays an important role in the regulation of coronary perfusion at rest and during exercise. Normal coronary arteries show coronary vasodilation of the proximal (+20%) and distal (+40%) vessel segments during supine bicycle exercise. However, patients with coronary artery disease show exercise-induced vasoconstriction of the stenotic vessel segments.

Validation of a new automatic system for biplane quantitative coronary arteriography.

In a collaboration between the University of Texas (software) and the University of Zürich (hardware) a compact, automatic system for biplane quantitative coronary arteriography was developed. The system is based on a 35 mm film projector, a slow-scan CCD-camera (image digitizing) and a computer workstation (Apollo DN 3000, image storage and processing). A new calibration procedure based on two fixed reference points in the center of the image intensifier was used (isocenter technique).

Effect of isradipine on left ventricular relaxation and diastolic filling.

The effect of two calcium antagonists on left ventricular (LV) relaxation and diastolic filling was evaluated in 16 randomized patients. Isradipine and nifedipine were administered intravenously in a maximum dose of 60 micrograms/min for isradipine and 63 micrograms/min for nifedipine. Heart rate was increased significantly (p less than 0.

[Long-term course of hypertrophic cardiomyopathy: drug versus surgical therapy].

139 patients with hypertrophic cardiomyopathy (HCM) have been followed up for 1-28 years (mean 8.9 years). Group 1 consisted of 60 patients (mean age 38 years) without indication for septal myectomy (SM) (no pressure gradient at rest in 8, pressure gradient less than 50 mm Hg in 52 cases); group 2 consisted of 79 patients (mean age 36 years) who had SM (pressure gradient at rest 70 mm Hg).

[Normal values of left ventricular function. Biplanar angiocardiography with reference to sex-specific differences].

Normal values of left ventricular function have been determined in 24 patients by means of biplane angiocardiography. Global parameters were chamber volume, ejection fraction and muscle mass. Regional ventricular function was determined by means of an orthogonal and radial axial system.

[Late potentials and ventricular arrhythmia in patients with chronic coronary heart disease].

To assess the value of late potential recordings in predicting complex ventricular arrhythmias in chronic coronary heart disease, signal-averaged ECG and 24-h Holter were performed in 101 consecutive patients following coronary arteriography. In 69 of 101 patients, non-sustained ventricular tachycardia (VT) (22 patients) or monotopic or polytopic ventricular premature beats (VPB) (47 patients) were detected. When the different patient groups (VT, VPB, no arrhythmias) were compared, the parameters defining the late potentials demonstrated broad variability.

[Initial experiences with thrombolysis in Swiss hospitals. Synopsis of a round-table discussion].

Thrombolytic therapy of acute myocardial infarction (AMI) has resulted in significant reduction of mortality, limitation of infarct size and preservation of left ventricular function. Among the panelists there was consensus with respect to the following recommendations for efficient thrombolytic therapy of AMI: the prehospital phase should be considerably shortened, especially by reducing patient delay. This can be achieved by rendering patients aware of symptoms of AMI and the need for immediate hospitalization on their occurrence.

[Spontaneous course of aortic valve disease and indications for aortic valve replacement].

190 adult patients with aortic valve disease have been followed up after initial cardiac catheterization until death or aortic valve replacement (event-free survival). Neither hemodynamic severity nor symptoms alone were reliable predictors of survival, but the combination of both was very helpful. In the presence of hemodynamically and symptomatically severe aortic stenosis and aortic regurgitation only 40% of patients survived for two years, but patients with hemodynamically severe aortic stenosis but with few or no symptoms had 100% survival at two years and 75% were event free at five years.

[Coronary vasomotor activity; its significance for the therapy of angina pectoris].

Using quantitative biplane coronary arteriography, coronary vasomotion of normal and stenotic coronary artery segments was studied at rest and during supine bicycle exercise in 37 patients with coronary artery disease. Normal coronary arteries showed vasodilation during exercise, whereas stenotic arteries exhibited vasoconstriction. The occurrence of coronary stenosis narrowing during exercise can be explained either by a collapse of the free vessel wall due to an increase in coronary blood flow velocity (Venturi mechanism) or by insufficient production of the endothelium-derived vasorelaxing factor (endogenous nitrate).

[Regression of myocardial hypertrophy in aortic valve disease following aortic valve replacement].

In patients with aortic valve disease successful valve replacement leads to a significant decrease in left ventricular angiographic mass, which 14-15 months postoperatively ranges between 31 and 37% of the preoperative value. Postoperative normalization of angiographic mass occurs in 2/3 of the patients with aortic stenosis and in 1/3 of the patients with aortic insufficiency. The degree of preoperative hypertrophy determines whether angiographic mass does or does not normalize after valve replacement.

[Dynamics of cardiac output in patients with hypertrophic obstructive cardiomyopathy].

To characterise the duration of aortic flow velocity waveforms in hypertrophic obstructive cardiomyopathy (HOCM) the dynamics of aortic flow were investigated in 10 normals and 11 patients with hypertrophic obstructive cardiomyopathy performing 16-gated Doppler 2D-echocardiography of the ascending aorta. 16 flow velocities were recorded along the Doppler beam axis between the anterior and posterior aortic walls, and averaged over 8 beats. Flow times were derived from the flow curves and normalised by the ejection period as determined from the carotid pulse tracing.