[Increase in creatine kinase and its MM isoforms after successful and uncomplicated coronary angioplasty].

During successful and uncomplicated angioplasty (PTCA), we studied the effect of a short lasting myocardial ischemia on plasma creatine kinase, creatine kinase MB-activity, and creatine kinase MM-isoforms (MM1, MM2, MM3) in 23 patients. Eleven patients, in whom diagnostic coronary angiography was performed, served as the control group. Blood was sampled after PTCA and every 2 h for the next 12 h, and after 24 h.

Early detection of coronary artery patency after thrombolysis by determination of the MM creatine kinase isoforms in patients with acute myocardial infarction. PRIMI Study Group.

To evaluate the role of MM creatine kinase isoforms in detecting infarct vessel patency in 84 patients with acute myocardial infarction, total creatine kinase, MB creatine kinase, and MM isoforms were determined at the start of thrombolytic therapy and 30, 60, and 120 minutes later. Enzyme data were related to the reperfusion grade of the infarct artery, which was assessed by angiography 60 and 90 minutes after the start of thrombolysis. In 50 patients the infarct vessel was found patent at 60 and at 90 minutes after thrombolysis; in 19 patients it was occluded at both time points.

[Results of emergency bypass operation following percutaneous transluminal coronary angioplasty].

Between 1980 and 1988, percutaneous transluminal coronary angioplasty (PTCA) was performed in 1,514 patients. Fifty-five patients (3.6%) underwent emergency coronary bypass surgery because of an acute occlusion of the vessel or a dissection with sustained angina and signs of ischemia on the electrocardiogram.

Prehospital thrombolysis in acute myocardial infarction.

The benefit and risk of prehospital thrombolysis for acute myocardial infarction (AMI) were evaluated in a double-blind randomized trial. Patients presenting less than 4 hours after symptom onset received 2 million units of urokinase as an intravenous bolus either before (group A, n = 40) or after (group B, n = 38) hospital admission. The mean time interval from onset of symptoms to thrombolytic therapy was 85 +/- 51 minutes in group A and 137 +/- 50 minutes in group B (p less than 0.

Acute and long-term haemodynamic and neurohumoral response to nisoldipine vs captopril in patients with heart failure: a randomized double-blind study.

To study the haemodynamic and neurohumoral effects of nisoldipine (2 X 10 mg) vs captopril (3 X 25 mg), 24 patients with heart failure (New York Heart Association class II and III) due to coronary artery disease were treated in a randomized double-blind trial over 3 months. Both drugs were well tolerated. Clinical status was similarly improved in both groups, nisoldipine exerted an additional antiischaemic effect.

[The thrombolysis treatment of acute myocardial infarct at the site of the emergency. A randomized double-blind study].

Two million units of urokinase were administered intravenously as a bolus, either before (group I, n = 40) or after hospital admission (group II, n = 38), to 66 men and 12 women (mean age 55 +/- 8 years) with typical symptoms of acute myocardial infarction of less than 4 hours' duration. Time elapsed between onset of symptoms and urokinase administration averaged 85 +/- 51 min for group I and 137 +/- 50 min for group II (P less than 0.005).

[Morphologic findings in dilated cardiomyopathy and their relation to hemodynamics and catecholamine concentrations in the plasma and myocardium].

In 72 patients with dilated cardiomyopathy the degree of morphological alterations were studied by transvenous endomyocardial biopsy. These findings were correlated to the clinical status, left ventricular ejection fraction, and to the catecholamine concentrations in plasma and myocardium. Muscle fiber diameter was negatively correlated to ejection fraction (r = -0.

Impact of compensatory enlargement of atherosclerotic coronary arteries on angiographic assessment of coronary artery disease.

To determine whether compensatory enlargement of atherosclerotic coronary arteries occurs and to what degree it affects the angiographic assessment of coronary artery disease, we performed postmortem coronary angiography of 30 human hearts with suspected coronary artery disease and studied 70 histologic cross sections of the proximal left anterior descending artery and proximal right coronary artery. Angiographic and morphometric analyses of 50 stenoses in proximal and middle sections of the left anterior descending artery, right coronary artery, and left circumflex artery were performed. The control group of 10 human hearts without suspected coronary artery disease was evaluated in the same way.

Catheter atherectomy: functional results in peripheral arterial disease.

In 10 patients with peripheral arterial disease (PAD) atherectomy was performed with the Simpson atherectomy catheter. PAD was diagnosed by clinical evaluation, oxzillography, Doppler ultrasound examination, treadmill walking, and angiography. Eight patients belonged to stage II and 2 to stage IV.

[Myocardial noradrenaline content: a factor not considered up to now for the prognosis of patients with dilated cardiomyopathy].

To evaluate the prognosis of patients with idiopathic dilated cardiomyopathy (EF less than 50%) in 55 patients the myocardial catecholamine concentration, plasma catecholamine concentration, and left ventricular ejection fraction were determined. The follow-up time ranged from 7 to 47 months. At the time of follow-up 10 of the 55 patients (group A) had died and three had undergone hearttransplantation.

Bleeding after thrombolysis in acute myocardial infarction.

232 consecutive patients with acute myocardial infarction were treated either with 2 x 10(6) IU urokinase as an intravenous bolus injection, or 250,000 IU streptokinase intracoronary, or 60 mg recombinant tissue-type plasminogen activator (rt-PA) over 90 min. All patients enrolled had chest pain for more than 30 min and less than 3 h before admission and a typical electrocardiogram. Contra-indications to thrombolytic treatment were absent.

Digital flashing tomosynthesis (DFTS)--a technique for three-dimensional coronary angiography.

Digital Flashing Tomosynthesis (DFTS) represents a technique for three-dimensional (3D) coronary angiography. Four ECG-gated simultaneously flashed X-ray tubes generate a multiperspective digital substraction image as DFTS multiangiogram for 3D reconstruction and visualization. Computerized morphologic and morphometric quantitative analysis can be performed including videodensitometry.

[Magnetic resonance tomography of a thoracic aortic aneurysm].

The results of magnetic resonance imaging in 16 patients with non-dissecting aneurysm of the thoracic aorta are presented. Scans with ECG-gated spin-echo sequences in transversal, coronal, and left anterior oblique views demonstrated the size and extent of the aneurysms. Measurements of the maximum aneurysmal diameter differed by less than 5 mm from measurements obtained with computed tomography.

Iodine-123 meta-iodobenzylguanidine scintigraphy: a noninvasive method to demonstrate myocardial adrenergic nervous system disintegrity in patients with idiopathic dilated cardiomyopathy.

Iodine-123 (I-123) meta-iodobenzylguanidine (MIBG) imaging was performed in 31 patients. Three patients were without cardiac disease and 28 had idiopathic dilated cardiomyopathy with various degrees of left ventricular dysfunction. The qualitatively assessed myocardial I-123 MIBG scintigrams and the myocardial versus mediastinal I-123 MIBG uptake ratio were related to I-123 MIBG activity and norepinephrine concentration determined from endomyocardial biopsy samples taken from the right side of the interventricular septum.

Recovery of left ventricular function after myocardial infarction can be predicted immediately after thrombolysis by semiquantitative intracoronary thallium and technetium pyrophosphate scintigraphy.

The accuracy with which intracoronary thallium and technetium pyrophosphate scintigraphy during intracoronary thrombolysis predicts myocardial salvage was studied in 58 patients with acute myocardial infarction by comparing the acute scintigraphic findings with subsequent left ventricular function. Scintigrams obtained before and immediately after thrombolysis were interpreted by three independent observers using a scoring system. Regional wall motion in the infarct area was determined from left ventricular (LV) cine angiograms using the center-line method.

[Lysis treatment of left ventricular thrombi. Acute and long-term results].

Intravenous thrombolysis with urokinase (60,000 U/h) was undertaken in 15 patients with large thrombi in the left ventricle (demonstrated by echocardiography) after myocardial infarction. Complete lysis was achieved in ten, partial in four. None had post-thrombolysis signs of arterial emboli, two patients developed haematuria and one had partial separation of the thrombus which required operative removal.

[Thallium single photon emission computed tomography following thrombolysis: missing relation to left ventricular function].

To address the question of whether infarct size after thrombolysis can comparably be estimated by thallium SPECT scintigraphy and contrast cineangiography, 32 patients in whom regional wall motion abnormality had been assessed by means of the "centerline" method, 10 to 21 days after infarction, underwent biphasic thallium SPECT scintigraphy with dipyridamole. There were no statistically significant correlations between left ventricular ejection fraction and the degree of hypokinesia in the infarct area on one hand, and thallium defect size in the early and late scintigram on the other. Hypokinesia was inversely correlated (r = -0.

Recombinant single-chain urokinase-type plasminogen activator during acute myocardial infarction.

Recombinant single-chain urokinase-type plasminogen activator was intravenously administered in 2 different doses in 24 patients with acute myocardial infarction and angiographically proved occlusion of the infarct-related artery. Patients with first infarction without contraindications of thrombolysis were treated within the first 4 hours after the onset of symptoms. Group A (12 patients) received 20 mg of rscu-PA as a bolus followed by 60 mg infused over 1 hour and group B received 10 mg as a bolus and 30 mg as infusion.

Limitations in the interpretation of rest-exercise ejection fraction changes after early thrombolytic therapy during acute myocardial infarction.

The effect of exercise on left ventricular wall motion in the infarct and noninfarct regions, and their contribution to the global ejection fraction response to exercise was evaluated in 24 patients studied at least 2 weeks following thrombolytic therapy for acute myocardial infarction. To achieve this goal, a nonstandard protocol was used: contrast ventriculography was performed at rest and immediately following 3 minutes of supine bicycle exercise at 50 watts. Wall motion in the infarct and noninfarct regions was measured using the centerline method.

Improved survival up to four years after early coronary thrombolysis.

The long-term prognosis after thrombolytic therapy in patients with acute myocardial infarction (AMI) is unknown. This question was investigated in a 4-year follow-up study of 227 patients. According to the status of reperfusion at the end of the acute catheterization, the patients were divided into a patent (n = 171) and an occluded (n = 56) group.

Lack of correlation after reperfusion between ventricular function and infarct size estimated by thallium single-photon emission computed tomography.

In 32 patients with acute myocardial infarction, who had undergone successful intracoronary thrombolysis, the results of regional wall motion measured from contrast cineangiograms 10 to 21 days after thrombolysis were related to the results of thallium single-photon emission computed tomography (SPECT) after intravenous dipyridamole. Wall motion was measured by means of the centerline method, and thallium defect size was estimated by comparing the patient's circumferential profile with that of 20 normals. No correlation was found between ejection fraction or regional wall motion and thallium defect size.

[Randomized double-blind study comparing tissue-type plasminogen activator with placebo in acute myocardial infarct].

In a double-blind randomised trial 129 patients with first myocardial infarction of less than 6 h duration were allocated to treatment with human recombinant tissue-type plasminogen activator (rt-PA) given intravenously over 90 min, or to placebo infusion. Coronary angiography at the end of this infusion showed that the infarct-related vessel was patent in 61% of 62 assessable coronary angiograms in the rt-PA-treated group compared with 21% in the control group. Treatment with rt-PA was not accompanied by any major complications.