[Conservative therapeutic approaches in terminal coronary heart disease. Chronic intermittent urokinase therapy].

Despite progress in the invasive revascularization procedures and even though conventional antianginal treatment has improved the quality of life in patients with symptomatic coronary artery disease considerably, an increasing number of patients suffers from end-stage coronary artery disease and refractory angina pectoris. For these refractory patients long-term intermittent urokinase therapy was developed as an antithrombotic intervention, which is based on its capacity to enhance thrombolysis and blood rheology, and may possibly lead to plaque regression. The coronary syndrome of refractory angina pectoris is characterized by a mismatch of severe coronary insufficiency and a relatively large amount of viable myocardium as indicated by an only moderately impaired left ventricular function.

Restenosis after elective coronary balloon angioplasty in patients with end stage renal disease: a case-control study using quantitative coronary angiography.

Objective: To assess the rate of angiographic restenosis in patients with end stage renal disease after elective coronary angioplasty.

Design: A retrospective case-control study of 20 patients with end stage renal disease and 20 sex and age matched controls without renal disease, who had undergone primarily successful coronary angioplasty. Control coronary angiography was performed regardless of worsening or renewed incidence of anginal symptoms.

Structural analysis of arteriolar and myocardial remodelling in the subendocardial region of patients with hypertensive heart disease and hypertrophic cardiomyopathy.

Left ventricular hypertrophy is a risk factor for cardiovascular morbidity and mortality. In arterial hypertension and in hypertrophic cardiomyopathy it may be accompanied by clinical signs of myocardial ischaemia resulting from microcirculatory dysfunction in the absence of coronary macroangiopathy. Structural changes of the vascular and interstitial compartment of the heart are involved in the pathogenesis of impaired microcirculation.

Refractory angina pectoris in end-stage coronary artery disease: evolving therapeutic concepts.

Refractory angina pectoris in coronary artery disease is defined as the persistence of severe anginal symptoms despite maximal conventional antianginal combination therapy. Further, the option to use an invasive revascularization procedure such as percutaneous coronary balloon angioplasty or aortocoronary bypass grafting must be excluded on the basis of a recent coronary angiogram. This coronary syndrome, which represents end-stage coronary artery disease, is characterized by severe coronary insufficiency but only moderately impaired left ventricular function.

Cardiac troponin T in patients with clinically suspected myocarditis.

Objectives: The present study investigated whether myocyte injury can be assessed sensitively by measurement of serum levels of cardiac troponin T (cTnT) in patients with clinically suspected myocarditis and whether cTnT levels may predict the results of histologic and immunohistologic analysis of endomyocardial biopsy specimens.

Background: Conventionally used laboratory variables often fail to show myocyte injury in patients with clinically suspected myocarditis, possibly because of a low extent of myocardial injury in these patients. Sensitive variables for myocyte injury have not yet been investigated.

[Impact of a percutaneous transluminal coronary angioplasty on the prevalence of ventricular late potentials among patients with survived myocardial infarction].

The aim of the study was to evaluate whether a causal antiischemic intervention as percutaneous transluminal coronary angioplasty (PTCA) leads to a reduction of ventricular late potentials in the chronic post myocardial infarction period. In 24 patients, signal-averaged electrocardiograms (SAECG) for two groups were recorded for the analysis of ventricular late potentials (LP) before and after 6.0+/-4.

Impaired coronary flow reserve in NIDDM: a possible role for diabetic cardiopathy in humans.

Diabetic cardiopathy represents a cardiac disorder with involvement of myocardial, interstitial, coronary, and neural structures. One of the main manifestations refers to coronary microangiopathy, which has not yet been clearly identified. Coronary hemodynamics, including the determination of coronary flow reserve, were therefore analyzed in normal subjects and in nine patients with NIDDM and clinically suspected coronary heart disease but normal coronary arteriogram.

[Formation, therapy and prevention of false aneurysm of the femoral artery following diagnostic and interventional heart catheterization].

Objective: As pseudoaneurysm of the femoral artery after catheter introduction is a frequent complication, its causes and therapeutic options were investigated in a large patient collective.

Patients And Methods: In a prospective study with colour-Doppler duplex sonography of 6928 patients after diagnostic and of 3764 after interventional cardiac catheterisation, pseudoaneurysms were diagnosed in 80 patients (0.75%), 46 after diagnostic (0.

[Prognostically relevant parameters in patients with coronary heart disease, arterial hypertension and sleep apnea disorders].

Patients with untreated sleep apnea syndrome have a higher cardiovascular mortality. It is not known which mechanisms lead to this increase in mortality and whether it is independent from the often associated coronary heart disease and systemic hypertension. In 48 consecutive patients with coronary heart disease confirmed by angiography, exercise-ECG, Holter-ECG, echocardiography, spirometric tests, analysis of ventricular late potentials, heart rate variability and a test for sleep-disordered breathing with a screening device were performed.

[Early postoperative changes in systolic and diastolic function at rest and during stress in patients with hypertrophic obstructive cardiomyopathy (HOCM) after myectomy].

Introduction: In this study systolic and diastolic function in patients with hypertrophic obstructive cardiomyopathy (HOCM) and intractable complaints to medication were investigated before and after a mean of 7 months after myectomy.

Methods: Investigations in 19 patients with HOCM included echocardiography, Swan-Ganz-thermodilution-catheter and radionuclide-angiography.

Results: Myectomy resulted in a reduction of the intraventricular gradient at rest (40.

[Rate of restenosis after PTCA in patients with terminal renal failure. A quantitative coronary angiography study].

Patients with end-stage renal disease (ESRD) have a high incidence of coronary artery disease. In 30-60% of these patients coronary artery disease can be demonstrated by coronary angiography often prompting myocardial revascularization. Previous studies on PTCA in patients with ESRD have suggested a high rate of procedural complications and restenosis.

Activation of the fibrinolytic system in patients with coronary artery disease and hyperfibrinogenemia.

Elevated fibrinogen levels as well as an impaired activity of the fibrinolytic system are regarded as important cardiovascular risk factors. To elucidate a potential interrelation between fibrinogen as an indicator of a hypercoagulable state and the endogenous fibrinolytic function hemostatic and rheological as well as lipid parameters were determined in 224 consecutive patients, who underwent elective coronary angiography. In the selected study population of 81 men and 19 women with fibrinogen concentration either > or = 3.

Impairment of adenosine-induced dilation of forearm resistance arteries in patients with arterial hypertension.

Background: Adenosine is a potent mediator of arteriolar tone in particular during ischemia, hypoxia, and exercise. Functional disturbance of this dilatory pathway may be highly significant for the pathophysiology and pathogenesis of arterial hypertension.

Patients And Methods: Forearm blood flow (FBF) was quantified by venous occlusion plethysmography following intra-arterial infusion of adenosine at increasing doses in 13 patients with arterial hypertension (HT) and 12 age-matched normotensive controls (NT).

[Immunosuppressive therapy for effective suppression of life threatening ventricular tachyarrhythmias in chronic myocarditis].

Chronic myocarditis predisposes to the occurrence of spontaneous ventricular arrhythmias. It is not known if an immunosuppressive treatment-as a casual therapy-leads to arrhythmia suppression. In the present study, 12 patients (four female, eight male, mean age 53 +/- 15 years) with a mean left-ventricular ejection fraction of 52 +/- 19% were included.

[Incidence and therapy of peripheral arterial vascular complications after heart catheter examinations].

We analyzed the incidence and management of major vascular complications at the arterial puncture site following diagnostic or interventional cardiac catheterization. 27387 cardiac catheterization procedures were performed for diagnostic (n = 19581) or interventional (n = 7806) purposes at our institution during a 7-year study period. A total number of 114 major vascular complications (0.

[Chemoreflex and baroreflex sensitivity in patients with survived sudden cardiac death].

Introduction: To evaluate patients with an increased risk of sudden cardiac death the analysis of ventricular late potentials, heart rate variability and baroreflexsensitivity is helpful. However, the prediction of malignant arrhythmic events cannot be performed with sufficient accuracy. For a better identification of high risk patients other methods are necessary.

Cytokine removal and cardiovascular hemodynamics in septic patients with continuous venovenous hemofiltration.

Objectives: To determine whether continuous venovenous hemofiltration leads to extraction of tumor necrosis factor alpha (TNF alpha) and cytokines from the circulation of critically ill patients with sepsis and acute renal failure and to quantitate the clearance and the removal rate of these cytokines and their effect on serum cytokine concentrations.

Design: Prospective, controlled study in patients with continuous venovenous hemofiltration (24 1/24 h) using a polysulphone membrane in patients with acute renal failure.

Patients: 33 ventilated patients with acute renal failure of septic (n = 18) and cardiovascular origin (n = 15) were studied.

Left ventricular hypertrophy and coronary microcirculation in hypertensive heart disease.

Hypertensive heart disease is a major factor for left ventricular hypertrophy, the development of ischaemic syndromes, including coronary macro- and microangiopathy, and heart failure. Coronary microcirculation is impaired very early in the process of hypertensive heart disease, giving suspect that impaired coronary reserve is an early indicator for the conversion from the normal into the pathologic status. Alterations at the level of the interstitium with accumulation of collagen, of the intramyocardial resistance vessels with remodelling or hypertrophy of the vessel wall, of the endothelium with reduced vasodilators and increased vasoconstrictors as well as of the capillaries with a reduction in their numbers may all be involved in the process of the impaired coronary reserve.

Low-dose intermittent urokinase therapy in chronic symptomatic end-stage arterial disease--clinical relevance for patients with coronary artery disease or peripheral arterial occlusive disease.

Symptomatic end-stage arterial disease in coronary artery or peripheral arterial occlusive disease represents an increasing clinical problem as cardiovascular mortality in these patient groups has declined due to improved secondary prevention. While in peripheral arterial occlusive disease amputation with subsequent life-long physical disability is the major problem, patients with end-stage coronary artery disease and refractory angina pectoris repeatedly report to the emergency ward with the clinical symptoms of unstable coronary syndromes, but myocardial infarction is generally ruled out. For these patients long-term intermittent urokinase therapy has been developed as an alternative treatment modality.

[Indications and limits of conventional revascularization methods in coronary heart disease].

The number of cardiologic patients undergoing invasive diagnostic catheterization is rapidly increasing. Due to more liberal and extensive indications for invasive diagnosis patients in relatively unfavorable clinical condition (e.g.