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Background Beta-blockers, used as an adjunctive to diuretics, digoxin and angiotensin converting enzyme inhibitors, improve survival in chronic heart failure. We report a prospectively planned economic analysis of the cost of adjunctive beta-blocker therapy in the second Cardiac Insufficiency BIsoprolol Study (CIBIS II). Methods Resource utilization data (drug therapy, number of hospital admissions, length of hospital stay, ward type) were collected prospectively in all patients in CIBIS . These data were used to determine the additional direct costs incurred, and savings made, with bisoprolol therapy. As well as the cost of the drug, additional costs related to bisoprolol therapy were added to cover the supervision of treatment initiation and titration (four outpatient clinic/office visits). Per them (hospital bed day) costings were carried out for France, Germany and the U.K. Diagnosis related group costings were performed for France and the U.K. Our analyses took the perspective of a third party payer in France and Germany and the National Health Service in the U.K. Results Overall, fewer patients were hospitalized in the bisoprolol group, there were fewer hospital admissions perpatient hospitalized, fewer hospital admissions overall, fewer days spent in hospital and fewer days spent in the most expensive type of ward. As a consequence the cost of care in the bisoprolol group was 5-10% less in all three countries, in the per them analysis, even taking into account the cost of bisoprolol and the extra initiation/up-titration visits. The cost per patient treated in the placebo and bisoprolol groups was FF35 009 vs FF31 762 in France, DM11 563 vs DM10 784 in Germany and pound 4987 vs pound 4722 in the U.K. The diagnosis related group analysis gave similar results. Interpretation Not only did bisoprolol increase survival and reduce hospital admissions in CIBIS II, it also cut the cost of care in so doing. This `win-win' situation of positive health benefits associated with cost savings is Favourable from the point of view of both the patient and health care systems. These findings add further support for the use of beta-blockers in chronic heart failure.

Background Superior patency rates for internal mammary artery (IMA) grafts compared with vein coronary bypass grafts have been demonstrated by retrospective studies. This difference may have been affected by selection bias of patients and coronary arteries for IMA grafting. Methods and Results To estimate the difference between IMA and vein grafts, we analyzed graft patency data of 912 patients who entered a randomized clinical drug trial. In this trial, 494 patients received both IMA and vein grafts (group 1) and 418 only vein grafts (group 2). Occlusion rates of IMA grafts and IMA plus vein grafts in group 1 were compared with those of vein grafts in group 2. Multivariate analysis was used to compare occlusion rates of IMA and vein grafts while other variables related to graft patency were controlled for. In addition, 1-year clinical outcome was assessed by the incidence of myocardial infarction, thrombosis, major bleeding, and death. Occlusion rates of distal anastomoses in group 1 versus group 2 were 5.4% (IMA grafts) versus 12.7% (vein grafts) (P Conclusions The observed difference in 1-year occlusion rates between IMA and vein grafts can be explained by a maldistribution of graft characteristics by selection of coronary arteries for IMA grafting rather than being ascribed to graft material. One-year clinical outcome is not improved by IMA grafting.

Of 7 patients who had Carpentier anuloplasty, two had very good, two had good and two had unsatisfactory results in postoperative cardiac catheterization one year after operation. One patient died of acute hepatitis. Reasons for the poor results are false indications and inadequate operative technic. These results show that the Carpentier-technic can well be recommended for critical use in carefully selected patients with mitral insufficiency.

Endomyocardial biopsies were obtained from the right ventricle in 25 patients with the clinical diagnosis of congestive cardiomyopathy. The biopsies were subjected to virological and histological studies (light and electronmicroscopy) and the findings correlated with clinical data. Abnormal morphological findings were present in all patients. The presumed clinical diagnosis was confirmed in 19, the morphological changes not being consistent with the clinical diagnosis of CCM in six patients. Electronmicroscopy revealed cardiac storage disease in one patient and pathological changes secondary to previous myocarditis in the other five. Clinical follow-up studies of the five patients apparently confirmed the morphological results, because in no case was there clinical deterioration, three patients in fact being in a fairly normal cardiac state at present. Using a morphological scoring system, the 19 patients with morphologically confirmed diagnosis of CCM were subdivided into two groupds, those with four points or less (group I, n equal to 9), and those with five pints or more (group II, n equal to 10). During a mean follow-up period of nearly 12 months the first group had a low mortality rate (n equal to 2), while the other had a high one (n equal to 6). The occurrence of signs of degeneration and mitochondrial alterations, in particular, was associated with a poor clinical prognosis. This differentiation into two groupds could not be achieved by clinical means alone. Type B3 Coxsackie virus was isolated from one biopsy, but no patient had significant serological evidence of virological infection.

Bei 15 Herzgesunden wurde die Wirkung von Prenylamin (0.43 mg/kg Korpergewicht i. v.) auf Blutdruck, Schlag- und Minutenvolumen, Herzfrequenz, Herzarbeit, peripheren Widerstand und maximale Druckanstiegsgeschwindigkeit untersucht. — Im Mittel nach 60 sec kommt es zu einem Abfall des systolischen und diastolischen Blutdruckes um 10 bzw. 12% des Ausgangswertes. — Das HZV steigt im Mittel um 0.71 l/min/m2 = 20% an. Der periphere Widerstand sinkt um 40% ab. —Die Herzfrequenz steigt um 9%, das Schlagvolumen von 44 ml/m2 auf 50 ml/m2 = 14%. Die Herzarbeit bleibt etwa konstant. dp/dt max nimmt um 34% gegenuber dem Ausgangswert zu. Nach 4 min sind die Ausgangswerte wieder erreicht. Lediglich die Frequenz ist unter den Ausgangswert erniedrigt, dementsprechend ist das Schlagvolumen vergrosert.

Der Natrium-, Kalium- und Wassergehalt im Myokard des rechten Vorhofes wurde bei 18 Patienten vor und nach kunstlichem ischamischem Herzstillstand wahrend der extrakorporalen Zirkulation bestimmt. Der Kaliumgehalt des Myokards betrug unmittelbar vor der Ischamie 40,4 (s=±8,6) mval/100 g Trockengewicht. Unmittelbar nach einer mittleren Ischamiedauer von 30 min war der Kaliumgehalt auf 28,7 (s=±8,6) mval/100 g Trockengewicht abgefallen (p

Untersucht wurde die Traumatisation des Blutes durch arterielle Gegenpulsation (SIMAS-Pumpe) in vitro (5 l Rinderblut) und an 10 Hunden. Die Hamolyse ist direkt abhangig von Pumpdauer, Pumpfrequenz, Pumpvolumen, Hamoglobingehalt und umgekehrt proportional zur Grose des Blutreservoirs. In vitro betragt die Hamolyse im Mittel 2,9±0,9 mg% pro 100 l gepumptes Blut. Beim Hund betragt die Hamolyse im Mittel 4,0±1,2 mg% pro 100 l gepumptes Blut. Wenn das kritische Pumpvolumen nicht uberschritten wird, last sich die Hamolyse nach folgender Formel errechnen: Hamolyse=a·t·f·V·Hgb· 1/B a=Proportionalitatsfaktor;t=Pumpzeit;f=Pumpfrequenz;V=Pumpvolumen;Hgb=Hamoglobinkonzentration des Blutes;B=Blutreservoir. Die Thrombocytenkonzentration erreicht unter arterieller Gegenpulsation niemals kritische Werte. Nach anfanglich starkem Abfall stellt sich spater ein Gleichgewicht bei etwa 100000 Thrombocyten pro Kubikmillimeter ein.

From the opening of our institution in November 1984 to December 1986, 2770 open heart procedures for congenital and acquired heart disease have been performed. There were 680 patients who had valve replacement; isolated or in combination with other operations, i.e., myocardial revascularization, thromboendarterec-tomy of carotid artery [TEA]. Of these, 182 patients (69 male and 113 female) were between 66 and 82 years of age (mean age 71.3 years). Early mortality (within 30 days postoperation) was 3.1% (2 patients). Eight patients have required reoperation. It is our policy to use bioprostheses in patients of more than 65 years of age, except in those who are on anticoagulation for special reasons. Nevertheless, all patients have anticoagulant therapy for at least 3 months postoperatively. Operative risk and rate of perioperative complications in this age group are similar to those in younger patients. Thus, older patients with good motivation, a desire for an improved lifestyle, in good mental status, and with no other major disease are good candidates for valve replacement and additional procedures if necessary.

Zur Behandlung der pulmonalen Hypertonie sind in den letzten Jahren zahlreiche Berichte uber die Anwendung von Vasodilatatoren erschienen [8, 11, 13, 14, 17,18, 22–26].

Bipolare Brustwandableitungen (BPA) sind, insbesondere im Bereich der Intensivuberwachung, seit langem weit verbreitet. Der Grund hierfur liegt in der wenig problematischen Elektrodenfixierung am Thorax sowie in ihrer geringen Storanfalligkeit.

Die diagnostische Abklarung kleiner, gasanalytisch nicht fasbarer Kurzschlusse und Klappeninsuffizienzen bei der Herzkatheterisierung kann nur mit Hilfe von Indicatorverdunnungsmethoden erfolgen. 1959 wurde zu den bis dahin bekannten Teststoffen wie Rontgenkontrastmittel, Farbstoffe, Kalte, Kochsalz oder Wasserstoff die Ascorbinsaure in die kardiologische Diagnostik eingefuhrt [1, 2]. Uber das methodische Vorgehen und die Erfahrungen bei 350 Patienten mit diesem Indicator soll im folgenden berichtet werden.

Durch die arterielle Gegenpulsation soll der linke Ventrikel bei akuten Insuffizienzen entlastet werden. Hierzu wird in der Systole ein bestimmtes Volumen aus der Arterie abgesaugt und dieselbe Menge Blut in der Diastole bei geschlossener Aortenklappe wieder zuruckgepumpt. Durch das Absaugen soll der periphere Widerstand vermindert und damit der Ventrikeldruck gesenkt werden. Durch das Zuruckpumpen in der Diastole soll der periphere Kreislauf aufrecht erhalten werden.

In diesem Beitrag wollen wir zunachst einen Blick auf die epidemiologische Situation Deutschlands hinsichtlich der Herz-Kreislauf-Krankheiten tun, dann kurz die Akronyme DHP und MONICA klaren. Der Hauptteil des Beitrages wird schlieslich mit der Darstellung der Risikobelastung der deutschen Bevolkerung und der daraus zu ziehenden Lehren befast sein.