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2. Die Risikobelastung der deutschen Bevölkerung: Lehren aus DHP und MONICA

Author

Gleichmann, U, Mannebach, H, Gleichmann, S, Held, K, Gleichmann, U ( U ), Mannebach, H ( H ), Gleichmann, S ( S ), Held, K ( K ), Gutzwiller, Felix, Gleichmann, U, Mannebach, H, Gleichmann, S, Held, K, Gleichmann, U ( U ), Mannebach, H ( H ), Gleichmann, S ( S ), Held, K ( K ), and Gutzwiller, Felix

Abstract

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

Published
1991

3. Reduced costs with bisoprolol treatment for heart failure - An economic analysis of the second Cardiac Insufficiency Bisoprolol Study (CIBIS-II)

Author

Bacquet, P, Levy, E, Mcguire, A, Mcmurray, J, Merot, Jl, Paschen, B, Remme, Wj, Szucs, Td, Klein, W, Brunhuber, W, Hofmann, R, Kuhn, P, Nesser, Hj, Slany, J, Weihs, W, Wiedermann, C, Wimmer, H, van Mieghem, W, Boland, J, Chaudron, Jm, Jordaens, L, Melchior, Jp, Aschermann, M, Bruthansl, J, Hradec, M, Kolbel, F, Semrad, B, Haghfelt, T, Hansen, Jf, Goetzsche, Co, Hildebrandt, P, Kassis, E, Rasmussen, V, Rokkedal, J, Thomassen, A, Groundstroem, K, Uusimaa, P, Le Heuzey JY, Aumont, Mc, Aupetit, Jf, Baille, N, Baudouy, P, Belin, A, Bonneau, A, Bonneric, G, Bousser, Jp, Citron, B, Dary, P, Decoulx, E, De Groote, P, Denolle, T, Dievart, F, Duriez, P, Eicher, Jc, Enjuto, G, Ferriere, M, Fournier, E, Garandeau, M, Gauthier, J, Genest, M, Gerbe, A, Godenir, Jp, Guillot, B, Guillot, Jp, Guillot, P, Heno, P, D'Ivernois, C, Jean, M, Kacet, S, Kalle, R, Komajda, M, Lacroix, A, Lallemand, R, Lardoux, H, Marquet, M, Martin, M, Martin, O, Mery, D, Mossaz, R, Mothes, P, Olive, T, Ostorero, M, Paganelli, F, Page, E, Pauly Laubry, C, Puel, J, Rousseau, Jf, Roux, Jj, Schenowitz, A, Sourdais, K, Tremel, F, Verdun, A, Witchiz, S, Wolf, Je, Hombach, V, Assmann, I, Beyer, T, Bischoff, Ko, Darius, H, Ertl, G, Fleck, E, Forster, K, Freytag, F, Gleichmann, U, Haasis, R, Henssge, R, Hey, D, Hesse, P, Hofs, T, Keck, M, Klein, H, Kromer, Et, Kruls Munch, J, Luderitz, B, Maisch, B, Mitrovic, V, Neubauer, S, Osterziel, Kj, Simon, H, Spitzer, Sg, Stohring, R, Taubert, G, Teichmann, W, Theisen, K, Wende, W, Wieser, H, Zotz, R, Bridges, A, Adgey, J, Ambepitiya, G, Boon, N, Boyle, Rm, Cowley, Aj, Cripps, T, Davies, Mk, Dunn, F, Findlay, J, Forsey, P, Fyfe, T, Gould, B, Greenwood, Tw, Hubner, P, Khan, S, Lewis, P, Mackay, A, Maltz, M, Mcarthur, J, Mcleod, A, Mcleod, D, Metcalfe, M, Millar Craig, M, Mills, P, Nelson, Jk, Nicholls, D, Oakley, Gd, Patterson, Dlh, Pohl, Jef, Ray, S, Silke, B, Wilkinson, Pr, Preda, I, Csanady, M, Cserhalmi, L, Edes, I, Gesztesi, T, Karpati, P, Simon, K, Tarjan, J, Fogari, R, Tramarin, R, Galie, N, Giani, P, Milanese, U, Scalvini, S, Scrutinio, D, Sechi, Leonardo Alberto, Tettamanti, F, De Vito, F, Crean, P, Mccann, H, Mulcahy, D, Sugrue, D, van Hoogenhuyze DCA, van der Burgh PH, Ciampricotti, R, van Dantzig JM, Denhartog, Fr, Henneman, Ja, van Kesteren HAM, Kragten, Ja, Liem, Kl, Limburg, A, van der Linde MR, Linssen, Gcm, Pasteuning, H, Penn, Hjam, Van Rossum, P, Schaafsma, Hj, Schelling, A, Sloos, R, Wesdorp, Jcl, Korewicki, J, Achremczyk, P, Czestockowska, E, Dowgird, M, Dyduszynski, A, Gorski, J, Ilmurzynska, K, Janicki, K, Kornacewicz Jach, Z, Kraska, T, Krzeminska Pakula, M, Kuch, J, Nartowicz, E, Petelenz, T, Piwowarska, W, Rawczynska Englert, I, Ruzyllo, W, Swiatecka, G, Tendera, M, Wierzchowiecki, M, Wodniecki, J, Wojciechowoski, D, Wrabec, K, Wysocki, H, Gomes, Rs, Ceia, Mf, Lousada, N, Campos, Jmm, Providencia, La, de Moura ALZC, Marejev, Vj, Aronov, Dm, Arutjunov, Gp, Bart, Bj, Basechikin, Ss, Belenkov, Jn, Beloussov, Jb, Bokeria, Oa, Charchogljan, Ra, Doschytsin, V, Fedorova, Ta, Glezer, Mg, Gorbachenkov, A, Gorshkov, Gospodarenko, Al, Ivashkin, Vt, Ivleva, Aj, Kyrichenko, Aa, Lavrov, Aa, Lazebnik, Lb, Marynov, A, Mazaev, Vp, Polejev, Nr, Shpektor, Sidorenko, Ba, Sobolev, Ke, Starodoubtsev, Ak, Storozhakhov, Gi, Syrkin, Al, Zodionchenko, Vs, Zvereva, Tv, Murin, J, Kaliska, G, Rybar, R, Valle, V, Artaza, M, Conthe, P, Cruz, Jm, Garcia Moll, M, Lopez Sendon JL, Martinez, A, Monzon, F, Ribas, M, Roig, E, Roldan, I, Hoglund, C, Ekdahl, S, Hjelmaeus, L, Lindberg, K, Lofdahl, P, Ulvenstam, G, Warselius, L, Follath, F, Anghern, W, Dubach, P, Erne, P, Gallino, A, Moccetti, T, Jmouro, Av, Dargie, Hj, Erdmann, E, Lechat, P, Sendon, Jll, Mareyev, V, Sadowski, Z, Seabra Gomes RJ, Zannad, F, Wehrlen Grandjean, M, Funck Brentano, C, Hansen, S, Hohnloser, S, Vanoli, E, Jaillon, P, De Baker, G, Dahlstrom, U, Hill, C, Leizorovicz, A, Burgnard, F, Rolland, C, Wiemann, H, Verkenne, P, Arab, T, Cussac, N, Dussous, V, Haise, S, and Funck Brentano, C.

Subjects
H Social Sciences (General), medicine.medical_specialty, Cost-Benefit Analysis, Adrenergic beta-Antagonists, METOPROLOL, Placebo, THERAPY, Indirect costs, Pharmacoeconomics, Pharmacotherapy, RANDOMIZED INTERVENTION TRIAL, PHARMACOECONOMICS, Germany, Health care, Bisoprolol, Humans, Medicine, Outpatient clinic, Prospective Studies, Intensive care medicine, health care economics and organizations, Heart Failure, CARVEDILOL, business.industry, MORTALITY, Diagnosis-related group, United Kingdom, Chemotherapy, Adjuvant, MERIT-HF, HOSPITALIZATION, MINIMIZATION, INHIBITORS, France, Quality-Adjusted Life Years, Cardiology and Cardiovascular Medicine, business, medicine.drug
Abstract

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.

Published
2001

4. A COMPARISON OF INTERNAL MAMMARY ARTERY AND SAPHENOUS-VEIN GRAFTS AFTER CORONARY-ARTERY BYPASS-SURGERY - NO DIFFERENCE IN 1-YEAR OCCLUSION RATES AND CLINICAL OUTCOME

Author

VANDERMEER, J, HILLEGE, HL, VANGILST, WH, DELARIVIERE, AB, DUNSELMAN, PHJM, FIDLER, [No Value], KOOTSTRA, GJ, MULDER, BJM, PFISTERER, M, LIE, KI, MEIJLER, FL, ASCOOP, CAPL, DUNNING, AJ, MICHELS, HR, DEMEDINA, EOR, WELLENS, HJJ, ARNTZENIUS, AC, LUBSEN, J, SCHUILENBERG, RM, SKOTNICKI, SH, DEFEYTER, PJ, HOORNTJE, JCA, VISSER, FC, VANDIJK, RB, DENHEYER, P, JANSSEN, J, VANOMMEN, GVA, BAR, FWHM, HAUER, RNW, VIERSMA, JW, FANGGIDAEJ, D, LIEM, AL, TEUBEN, JHM, VANDERVEEN, HF, TIJSSEN, JGP, VUIJK, M, DEJONGSTE, MJL, EIJGELAAR, A, VANDERDOEF, R, PIEK, J, MEYNE, NG, GIN, RMTY, VERMEULEN, FE, BUSER, P, BURKART, F, GRADEL, E, BONNIER, JJRM, BAVINCK, JH, NUSE, J, SEGGEWISS, K, POSIVAL, H, GLEICHMANN, U, KORFER, R, TERRES, W, BLEIFELD, W, KALMAR, P, PENN, OEK, HITCHCOCK, JF, Wever, E., Life Course Epidemiology (LCE), Cardiovascular Centre (CVC), and Groningen Kidney Center (GKC)

Subjects
surgical procedures, operative, BYPASS, ARTERIES, PATENCY, DIPYRIDAMOLE, LOW-DOSE ASPIRIN, SURVIVAL, TRIAL, VEINS, CHOICE, CLINICAL TRIALS, ORAL ANTICOAGULANTS
Abstract

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.

Published
1994

5. Saturday, 17 July 2010

Author

Dimova, I., primary, Hlushchuk, R., additional, Makanya, A., additional, Djonov, V., additional, Theurl, M., additional, Schgoer, W., additional, Albrecht, K., additional, Beer, A., additional, Patsch, J. R., additional, Schratzberger, P., additional, Mahata, S., additional, Kirchmair, R., additional, Didie, M., additional, Christalla, P., additional, Rau, T., additional, Eschenhagen, T., additional, Schumacher, U., additional, Lin, Q., additional, Zenke, M., additional, Zimmmermann, W., additional, Hoch, M., additional, Fischer, P., additional, Stapel, B., additional, Missol-Kolka, E., additional, Erschow, S., additional, Scherr, M., additional, Drexler, H., additional, Hilfiker-Kleiner, D., additional, Diebold, I., additional, Petry, A., additional, Kennel, P., additional, Djordjevic, T., additional, Hess, J., additional, Goerlach, A., additional, Castellano, J., additional, Aledo, R., additional, Sendra, J., additional, Costales, P., additional, Badimon, L., additional, Llorente-Cortes, V., additional, Dworatzek, E., additional, Mahmoodzadeh, S., additional, Regitz-Zagrosek, V., additional, Posa, A., additional, Varga, C., additional, Berko, A., additional, Veszelka, M., additional, Szablics, P., additional, Vari, B., additional, Pavo, I., additional, Laszlo, F., additional, Brandenburger, M., additional, Wenzel, J., additional, Bogdan, R., additional, Richardt, D., additional, Reppel, M., additional, Hescheler, J., additional, Terlau, H., additional, Dendorfer, A., additional, Heijman, J., additional, Rudy, Y., additional, Westra, R., additional, Volders, P., additional, Rasmusson, R., additional, Bondarenko, V., additional, Ertas Gokhan, M. D., additional, Ural Ertan, M. D., additional, Karaoz Erdal, P. H. D., additional, Aksoy Ayca, P. H. D., additional, Kilic Teoman, M. D., additional, Kozdag Guliz, M. D., additional, Vural Ahmet, M. D., additional, Ural Dilek, M. D., additional, Poulet, C., additional, Christ, T., additional, Wettwer, E., additional, Ravens, U., additional, Van Der Pouw Kraan, C., additional, Schirmer, S., additional, Fledderus, J., additional, Moerland, P., additional, Leyen, T., additional, Piek, J., additional, Van Royen, N., additional, Horrevoets, A., additional, Fleissner, F., additional, Jazbutyte, V., additional, Fiedler, J., additional, Galuppo, P., additional, Mayr, M., additional, Ertl, G., additional, Bauersachs, J., additional, Thum, T., additional, Protze, S., additional, Bussek, A., additional, Li, F., additional, Hoo, R., additional, Lam, K., additional, Xu, A., additional, Subramanian, P., additional, Karshovska, E., additional, Megens, R., additional, Akhtar, S., additional, Heyll, K., additional, Jansen, Y., additional, Weber, C., additional, Schober, A., additional, Zafeiriou, M., additional, Noack, C., additional, Renger, A., additional, Dietz, R., additional, Zelarayan, L., additional, Bergmann, M., additional, Meln, I., additional, Malashicheva, A., additional, Anisimov, S., additional, Kalinina, N., additional, Sysoeva, V., additional, Zaritskey, A., additional, Barbuti, A., additional, Scavone, A., additional, Mazzocchi, N., additional, Crespi, A., additional, Capilupo, D., additional, Difrancesco, D., additional, Qian, L., additional, Shim, W., additional, Gu, Y., additional, Mohammed, S., additional, Wong, P., additional, Zafiriou, M., additional, Schaeffer, H., additional, Kovacs, P., additional, Simon, J., additional, Varro, A., additional, Athias, P., additional, Wolf, J., additional, Bouchot, O., additional, Vandroux, D., additional, Mathe, A., additional, De Carvalho, A., additional, Laurent, G., additional, Rainer, P., additional, Huber, M., additional, Edelmann, F., additional, Stojakovic, T., additional, Trantina-Yates, A., additional, Trauner, M., additional, Pieske, B., additional, Von Lewinski, D., additional, De Jong, A., additional, Maass, A., additional, Oberdorf-Maass, S., additional, Van Gelder, I., additional, Lin, Y., additional, Li, J., additional, Wang, F., additional, He, Y., additional, Li, X., additional, Xu, H., additional, Yang, X., additional, Coppini, R., additional, Ferrantini, C., additional, Ferrara, C., additional, Rossi, A., additional, Mugelli, A., additional, Poggesi, C., additional, Cerbai, E., additional, Rozmaritsa, N., additional, Voigt, N., additional, Dobrev, D., additional, Kienitz, M.-C., additional, Zoidl, G., additional, Bender, K., additional, Pott, L., additional, Kohajda, Z., additional, Kristof, A., additional, Virag, L., additional, Jost, N., additional, Trafford, A., additional, Prnjavorac, B., additional, Mujaric, E., additional, Jukic, J., additional, Abduzaimovic, K., additional, Brack, K., additional, Patel, V., additional, Coote, J., additional, Ng, G., additional, Wilders, R., additional, Van Ginneken, A., additional, Verkerk, A., additional, Xaplanteris, P., additional, Vlachopoulos, C., additional, Baou, K., additional, Vassiliadou, C., additional, Dima, I., additional, Ioakeimidis, N., additional, Stefanadis, C., additional, Ruifrok, W., additional, Qian, C., additional, Sillje, H., additional, Van Goor, H., additional, Van Veldhuisen, D., additional, Van Gilst, W., additional, De Boer, R., additional, Schmidt, K., additional, Kaiser, F., additional, Erdmann, J., additional, De Wit, C., additional, Barnett, O., additional, Kyyak, Y., additional, Cesana, F., additional, Boffi, L., additional, Mauri, T., additional, Alloni, M., additional, Betelli, M., additional, Nava, S., additional, Giannattasio, C., additional, Mancia, G., additional, Vilskersts, R., additional, Kuka, J., additional, Svalbe, B., additional, Liepinsh, E., additional, Dambrova, M., additional, Zakrzewicz, A., additional, Maroski, J., additional, Vorderwuelbecke, B., additional, Fiedorowicz, K., additional, Da Silva-Azevedo, L., additional, Pries, A., additional, Gryglewska, B., additional, Necki, M., additional, Zelawski, M., additional, Grodzicki, T., additional, Scoditti, E., additional, Massaro, M., additional, Carluccio, M., additional, Distante, A., additional, Storelli, C., additional, De Caterina, R., additional, Kocgirli, O., additional, Valcaccia, S., additional, Dao, V., additional, Suvorava, T., additional, Kumpf, S., additional, Floeren, M., additional, Oppermann, M., additional, Kojda, G., additional, Leo, C., additional, Ziogas, J., additional, Favaloro, J., additional, Woodman, O., additional, Goettsch, W., additional, Marton, A., additional, Goettsch, C., additional, Morawietz, H., additional, Khalifa, E., additional, Ashour, Z., additional, Rupprecht, V., additional, Scalera, F., additional, Martens-Lobenhoffer, J., additional, Bode-Boeger, S., additional, Li, W., additional, Kwan, Y., additional, Leung, G., additional, Patella, F., additional, Mercatanti, A., additional, Pitto, L., additional, Rainaldi, G., additional, Tsimafeyeu, I., additional, Tishova, Y., additional, Wynn, N., additional, Kalinchenko, S., additional, Clemente Lorenzo, M., additional, Grande, M., additional, Barriocanal, F., additional, Aparicio, M., additional, Martin, A., additional, Hernandez, J., additional, Lopez Novoa, J., additional, Martin Luengo, C., additional, Kurlianskaya, A., additional, Denisevich, T., additional, Barth, N., additional, Loot, A., additional, Fleming, I., additional, Wang, Y., additional, Gabrielsen, A., additional, Ripa, R., additional, Jorgensen, E., additional, Kastrup, J., additional, Arderiu, G., additional, Pena, E., additional, Kobus, K., additional, Czyszek, J., additional, Kozlowska-Wiechowska, A., additional, Milkiewicz, P., additional, Milkiewicz, M., additional, Madonna, R., additional, Montebello, E., additional, Geng, Y., additional, Chin-Dusting, J., additional, Michell, D., additional, Skilton, M., additional, Dixon, J., additional, Dart, A., additional, Moore, X., additional, Ehrbar, M., additional, Reichmuth, P., additional, Heinimann, N., additional, Hewing, B., additional, Stangl, V., additional, Stangl, K., additional, Laule, M., additional, Baumann, G., additional, Ludwig, A., additional, Widmer-Teske, R., additional, Mueller, A., additional, Stieger, P., additional, Tillmanns, H., additional, Braun-Dullaeus, R., additional, Sedding, D., additional, Troidl, K., additional, Eller, L., additional, Benli, I., additional, Apfelbeck, H., additional, Schierling, W., additional, Troidl, C., additional, Schaper, W., additional, Schmitz-Rixen, T., additional, Hinkel, R., additional, Trenkwalder, T., additional, Pfosser, A., additional, Globisch, F., additional, Stachel, G., additional, Lebherz, C., additional, Bock-Marquette, I., additional, Kupatt, C., additional, Seyler, C., additional, Duthil-Straub, E., additional, Zitron, E., additional, Scholz, E., additional, Thomas, D., additional, Gierten, J., additional, Karle, C., additional, Fink, R., additional, Padro, T., additional, Lugano, R., additional, Garcia-Arguinzonis, M., additional, Schuchardt, M., additional, Pruefer, J., additional, Toelle, M., additional, Pruefer, N., additional, Jankowski, V., additional, Jankowski, J., additional, Zidek, W., additional, Van Der Giet, M., additional, Fransen, P., additional, Van Hove, C., additional, Michiels, C., additional, Van Langen, J., additional, Bult, H., additional, Quarck, R., additional, Wynants, M., additional, Alfaro-Moreno, E., additional, Rosario Sepulveda, M., additional, Wuytack, F., additional, Van Raemdonck, D., additional, Meyns, B., additional, Delcroix, M., additional, Christofi, F., additional, Wijetunge, S., additional, Sever, P., additional, Hughes, A., additional, Ohanian, J., additional, Forman, S., additional, Ohanian, V., additional, Gibbons, C., additional, Vernia, S., additional, Das, A., additional, Shah, V., additional, Casado, M., additional, Bielenberg, W., additional, Daniel, J., additional, Daniel, J.-M., additional, Hersemeyer, K., additional, Schmidt-Woell, T., additional, Kaetzel, D., additional, Tillmans, H., additional, Kanse, S., additional, Tuncay, E., additional, Kandilci, H., additional, Zeydanli, E., additional, Sozmen, N., additional, Akman, D., additional, Yildirim, S., additional, Turan, B., additional, Nagy, N., additional, Acsai, K., additional, Farkas, A., additional, Papp, J., additional, Toth, A., additional, Viero, C., additional, Mason, S., additional, Williams, A., additional, Marston, S., additional, Stuckey, D., additional, Dyer, E., additional, Song, W., additional, El Kadri, M., additional, Hart, G., additional, Hussain, M., additional, Faltinova, A., additional, Gaburjakova, J., additional, Urbanikova, L., additional, Hajduk, M., additional, Tomaskova, B., additional, Antalik, M., additional, Zahradnikova, A., additional, Steinwascher, P., additional, Jaquet, K., additional, Muegge, A., additional, Wang, G., additional, Zhang, M., additional, Tesi, C., additional, Ter Keurs, H., additional, Kettlewell, S., additional, Smith, G., additional, Workman, A., additional, Lenaerts, I., additional, Holemans, P., additional, Sokolow, S., additional, Schurmans, S., additional, Herchuelz, A., additional, Sipido, K., additional, Antoons, G., additional, Wehrens, X., additional, Li, N., additional, Respress, J. R., additional, De Almeida, A., additional, Van Oort, R., additional, Lohmann, H., additional, Saes, M., additional, Messer, A., additional, Copeland, O., additional, Leung, M., additional, Matthes, F., additional, Steinbrecher, J., additional, Salinas-Riester, G., additional, Opitz, L., additional, Hasenfuss, G., additional, Lehnart, S., additional, Caracciolo, G., additional, Eleid, M., additional, Carerj, S., additional, Chandrasekaran, K., additional, Khandheria, B., additional, Sengupta, P., additional, Riaz, I., additional, Tyng, L., additional, Dou, Y., additional, Seymour, A., additional, Dyer, C., additional, Griffin, S., additional, Haswell, S., additional, Greenman, J., additional, Yasushige, S., additional, Amorim, P., additional, Nguyen, T., additional, Schwarzer, M., additional, Mohr, F., additional, Doenst, T., additional, Popin Sanja, S., additional, Lalosevic, D., additional, Capo, I., additional, Momcilov Popin, T., additional, Astvatsatryan, A., additional, Senan, M., additional, Shafieian, G., additional, Goncalves, N., additional, Falcao-Pires, I., additional, Henriques-Coelho, T., additional, Moreira-Goncalves, D., additional, Leite-Moreira, A., additional, Bronze Carvalho, L., additional, Azevedo, J., additional, Andrade, M., additional, Arroja, I., additional, Relvas, M., additional, Morais, G., additional, Seabra, M., additional, Aleixo, A., additional, Winter, J., additional, Zabunova, M., additional, Mintale, I., additional, Lurina, D., additional, Narbute, I., additional, Zakke, I., additional, Erglis, A., additional, Marcinkevics, Z., additional, Kusnere, S., additional, Abolins, A., additional, Aivars, J., additional, Rubins, U., additional, Nassar, Y., additional, Monsef, D., additional, Hamed, G., additional, Abdelshafy, S., additional, Chen, L., additional, Wu, Y., additional, Wang, J., additional, Cheng, C., additional, Sternak, M., additional, Khomich, T., additional, Jakubowski, A., additional, Szafarz, M., additional, 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additional, Viglione, F., additional, L'abbate, A., additional, Slavikova, J., additional, Chottova Dvorakova, M., additional, Kummer, W., additional, Campanile, A., additional, Spinelli, L., additional, Ciccarelli, M., additional, De Gennaro, S., additional, Assante Di Panzillo, E., additional, Trimarco, B., additional, Akbarzadeh Najar, R., additional, Ghaderian, S., additional, Tabatabaei Panah, A., additional, Vakili, H., additional, Rezaei Farimani, A., additional, Rezaie, G., additional, Beigi Harchegani, A., additional, Hamdani, N., additional, Gavina, C., additional, Van Der Velden, J., additional, Niessen, H., additional, Stienen, G., additional, Paulus, W., additional, Moura, C., additional, Lamego, I., additional, Eloy, C., additional, Areias, J., additional, Bonda, T., additional, Dziemidowicz, M., additional, Hirnle, T., additional, Dmitruk, I., additional, Kaminski, K., additional, Musial, W., additional, Winnicka, M., additional, Villar, A., additional, Merino, D., additional, Ares, M., additional, Pilar, F., additional, Valdizan, E., additional, Hurle, M., additional, Nistal, J., additional, Vera, V., additional, Karuppasamy, P., additional, Chaubey, S., additional, Dew, T., additional, Sherwood, R., additional, Desai, J., additional, John, L., additional, Marber, M., additional, Kunst, G., additional, Cipolletta, E., additional, Attanasio, A., additional, Del Giudice, C., additional, Campiglia, P., additional, Illario, M., additional, Berezin, A., additional, Koretskaya, E., additional, Bishop, E., additional, Fearon, I., additional, Heger, J., additional, Warga, B., additional, Abdallah, Y., additional, Meyering, B., additional, Schlueter, K., additional, Piper, H., additional, Euler, G., additional, Lavorgna, A., additional, Cecchetti, S., additional, Rio, T., additional, Coluzzi, G., additional, Carrozza, C., additional, Conti, E., additional, Andreotti, F., additional, Glavatskiy, A., additional, Uz, O., additional, Kardesoglu, E., additional, Yiginer, O., additional, Bas, S., additional, Ipcioglu, O., additional, Ozmen, N., additional, Aparci, M., additional, Cingozbay, B., additional, Ivanes, F., additional, Hillaert, M., additional, Susen, S., additional, Mouquet, F., additional, Doevendans, P., additional, Jude, B., additional, Montalescot, G., additional, Van Belle, E., additional, Castellani, C., additional, Angelini, A., additional, De Boer, O., additional, Van Der Loos, C., additional, Gerosa, G., additional, Van Der Wal, A., additional, Dumitriu, I., additional, Baruah, P., additional, Kaski, J., additional, Maytham, O., additional, D Smith, J., additional, Rose, M., additional, Cappelletti, A., additional, Pessina, A., additional, Mazzavillani, M., additional, Calori, G., additional, Margonato, A., additional, Cassese, S., additional, D'anna, C., additional, Leo, A., additional, Silenzi, A., additional, Baca', M., additional, Biasucci, L., additional, Baller, D., additional, Gleichmann, U., additional, Holzinger, J., additional, Bitter, T., additional, Horstkotte, D., additional, Antonopoulos, A., additional, Miliou, A., additional, Triantafyllou, C., additional, Masson, W., additional, Siniawski, D., additional, Sorroche, P., additional, Casanas, L., additional, Scordo, W., additional, Krauss, J., additional, Cagide, A., additional, Huang, T., additional, Wiedon, A., additional, Lee, S., additional, Walker, K., additional, O'dea, K., additional, Perez Berbel, P., additional, Arrarte Esteban, V., additional, Garcia Valentin, M., additional, Sola Villalpando, M., additional, Lopez Vaquero, C., additional, Caballero, L., additional, Quintanilla Tello, M., additional, Sogorb Garri, F., additional, Duerr, G., additional, Elhafi, N., additional, Bostani, T., additional, Swieny, L., additional, Kolobara, E., additional, Welz, A., additional, Roell, W., additional, Dewald, O., additional, Kaludercic, N., additional, Takimoto, E., additional, Nagayama, T., additional, Chen, K., additional, Shih, J., additional, Kass, D., additional, Di Lisa, F., additional, Paolocci, N., additional, Vinet, L., additional, Pezet, M., additional, Briec, F., additional, Previlon, M., additional, Rouet-Benzineb, P., additional, Hivonnait, A., additional, Charpentier, F., additional, Mercadier, J., additional, Cobo, M., additional, Llano, M., additional, Montalvo, C., additional, Exposito, V., additional, Meems, L., additional, Westenbrink, B., additional, Biesmans, L., additional, Bito, V., additional, Driessen, R., additional, Huysmans, C., additional, Mourouzis, I., additional, Pantos, C., additional, Galanopoulos, G., additional, Gavra, M., additional, Perimenis, P., additional, Spanou, D., additional, Cokkinos, D., additional, Panasenko, T., additional, Partsch, S., additional, Harjung, C., additional, Bogdanova, A., additional, Mihov, D., additional, Mocharla, P., additional, Yakushev, S., additional, Vogel, J., additional, Gassmann, M., additional, Tavakoli, R., additional, Johansen, D., additional, Sanden, E., additional, Xi, C., additional, Sundset, R., additional, Ytrehus, K., additional, Bliksoen, M., additional, Rutkovskiy, A., additional, Mariero, L., additional, Vaage, I., additional, Stenslokken, K., additional, Pisarenko, O., additional, Shulzhenko, V., additional, Studneva, I., additional, Serebryakova, L., additional, Tskitishvili, O., additional, Pelogeykina, Y., additional, Timoshin, A., additional, Vanin, A., additional, Ziberna, L., additional, Lunder, M., additional, Drevensek, G., additional, Passamonti, S., additional, Gorza, L., additional, Ravara, B., additional, Scapin, C., additional, Vitadello, M., additional, Zigrino, F., additional, Gwathmey, J., additional, Del Monte, F., additional, Vilahur, G., additional, Juan-Babot, O., additional, Onate, B., additional, Casani, L., additional, Lemoine, S., additional, Calmettes, G., additional, Jaspard-Vinassa, B., additional, Duplaa, C., additional, Couffinhal, T., additional, Diolez, P., additional, Dos Santos, P., additional, Fusco, A., additional, Sorriento, D., additional, Cervero, P., additional, Feliciello, A., additional, Barnucz, E., additional, Kozichova, K., additional, Hlavackova, M., additional, Neckar, J., additional, Kolar, F., additional, Novakova, O., additional, Novak, F., additional, Barsanti, C., additional, Abraham, N., additional, Muntean, D., additional, Mirica, S., additional, Duicu, O., additional, Raducan, A., additional, Hancu, M., additional, Fira-Mladinescu, O., additional, Ordodi, V., additional, Voelkl, J., additional, Haubner, B., additional, Neely, G., additional, Moriell, C., additional, Seidl, S., additional, Pachinger, O., additional, Penninger, J., additional, and Metzler, B., additional

Published
2010
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6. Vorwort des Beirats der Deutschen Herz - Kreislauf - Präventionsstudie

Author

von Troschke, Jürgen, Klaes, Lothar, Maschewsky-Schneider, Ulrike, Scheuermann, Wolfgang, von Troschke, J ( Jürgen ), Klaes, L ( Lothar ), Maschewsky-Schneider, U ( Ulrike ), Scheuermann, W ( Wolfgang ), Gleichmann, U, Gutzwiller, Felix, Koch, U, von Troschke, Jürgen, Klaes, Lothar, Maschewsky-Schneider, Ulrike, Scheuermann, Wolfgang, von Troschke, J ( Jürgen ), Klaes, L ( Lothar ), Maschewsky-Schneider, U ( Ulrike ), Scheuermann, W ( Wolfgang ), Gleichmann, U, Gutzwiller, Felix, and Koch, U

Published
1998

7. 431 Intra-procedural myocardial contrast echocardiography in septal ablation for symptomatic hypertrophic obstructive cardiomyopathy

Author

Dieter Fassbender, Hubert Seggewiss, Dieter Horstkotte, D. Welge, Gleichmann U, Henning K. Schmidt, and Lothar Faber

Subjects
medicine.medical_specialty, biology, business.industry, medicine.medical_treatment, Hypertrophic cardiomyopathy, General Medicine, Ablation, medicine.disease, Obstructive cardiomyopathy, Troponin, Myocardial contrast echocardiography, Septal Ablation, Internal medicine, Contrast echocardiography, Cardiology, medicine, biology.protein, Radiology, Nuclear Medicine and imaging, Cardiology and Cardiovascular Medicine, business
Published
2003

11. Fatty acid uptake in normal human myocardium.

Author

Vyska, K, primary, Meyer, W, additional, Stremmel, W, additional, Notohamiprodjo, G, additional, Minami, K, additional, Machulla, H J, additional, Gleichmann, U, additional, Meyer, H, additional, and Körfer, R, additional

Published
1991
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12. Effects of lovastatin on progression of non-dilated and dilated coronary segments and on restenosis in patients after PTCA. The Cholesterol Lowering Atherosclerosis PTCA Trial (CLAPT).

Author

Kleemann, A., Eckert, S., von Eckardstein, A., Lepper, W., Schernikau, U., Gleichmann, U., Hanrath, P., Fleck, E., Neiss, A., Kerber, S., Assmann, G., and Breithardt and the CLAPT Study Group, G.

Abstract

Objectives The Cholesterol Lowering Atherosclerosis PTCA Trial (CLAPT) is a prospective, randomized trial with blinded angiographic end-points to assess the effect of 2-year's treatment with lovastatin initiated 4 weeks prior to PTCA, compared to usual care on non-dilated coronary segments and on dilated coronary lesions in male patients with total cholesterol between 200 and 300mg.dl−1who underwent elective PTCA.Methods and Results Two hundred and twenty six patients were randomized 4 weeks prior to PTCA to special care (diet plus lovastatin n=112) or usual care (diet; n=114). One hundred and ninety-nine patients underwent PTCA at baseline and were finally included in the study. Quantitative coronary angiographic assessment was performed on blinded cinefilms at baseline (PTCA) and repeated after 4 and 24 months in 91% and 81% of the patients. The primary end-point was a change in the mean segment diameter of non-dilated segments. The mean lovastatin dose was 33mg.day−1. Total- and LDL-cholesterol decreased by 21% and 29% in the special care group and by 7% and 11% in the usual care patients.After 2 years, the mean segment diameter of non-dilated segments decreased by 0·03mm in the usual care group and 0·004mm in the special care group (P=0·27). The decrease in the mean segment diameter of dilated lesions was 0·17mm (usual care) and 0·06mm (special care) (P=0·04) after 4 months; 0·16mm (usual care) and 0·002mm (special care) after 24 months, respectively (P=0·05). In both groups, the mean segment diameter of dilated lesions increased between 4 and 24 months after PTCA compared to a decrease in mean segment diameter of non-dilated segments (P<0·05). Restenosis (>50% diameter stenosis at follow-up) occurred in 28·4% of usual care and 22·2% of special care patients (P=0·17).Conclusions Lovastatin reduced the progression of dilated lesions in men with elective PTCA. Independent of treatment allocation, the dilated lesions regressed and the non-dilated segments progressed during the study follow-up. Four weeks of pre-treatment with lovastatin did not influence the rate of restenosis. Lovastatin had no statistically significant effect on non-dilated segments. [ABSTRACT FROM PUBLISHER]

Published
1999
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13. The influence of beta-adrenoceptor antagonists with and without intrinsic sympathomimetic activity on local wall motion abnormalities in patients with coronary heart disease.

Author

Gleichmann, U, Fassbender, D, Trieb, G, Mannebach, H, and Ohlmeier, H

Abstract

1 A single-blind randomized study of the effects of a beta-adrenoceptor antagonist with intrinsic sympathomimetic activity (pindolol 0.4 mg i.v., n = 10) and a drug lacking this property (metoprolol 5 mg i.v., n = 11) on local wall motion abnormalities was carried out in 21 patients with coronary heart disease and anterior wall hypokinesia. 2 The drugs produced similar changes in left ventricular end diastolic pressure (LVEDP) and end diastolic volume index (EDVI) but differed in their effects on heart rate and ejection fraction. Pindolol did not exert any marked effect on heart rate or ejection fraction whereas after metoprolol treatment both were significantly decreased. 3 Shortening of the hypokinetic wall segments was improved by both drugs. Shortening of the non-hypokinetic contralateral segments was unchanged after pindolol administration but was decreased after metoprolol. 4 The differing effects of beta-adrenoceptor antagonists on regional wall motion appear to be dependent on the presence or absence of intrinsic sympathomimetic activity. [ABSTRACT FROM AUTHOR]

Published
1982
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20. [123I]-phenylpentadecanoic acid uptake in patients with dilated cardiomyopathy.

Author

Miche E, Radzewitz A, Notohamiprodjo G, Baller D, Kloppe A, Eckert S, and Gleichmann U

Subjects
Adult, Cardiomyopathy, Dilated physiopathology, Energy Metabolism physiology, Hemodynamics physiology, Humans, Iodine Radioisotopes pharmacokinetics, Iodobenzenes, Male, Middle Aged, Myocarditis diagnostic imaging, Myocarditis physiopathology, Myocardium metabolism, Radionuclide Imaging, Thallium Radioisotopes pharmacokinetics, Ventricular Dysfunction, Left diagnostic imaging, Ventricular Dysfunction, Left physiopathology, Cardiomyopathy, Dilated diagnostic imaging
Abstract

Background: The rate constant for global fatty acid influx (k(1)) was studied in 12 male patients with dilated cardiomyopathy (DCM)., Method: 10 normal subjects served as controls. 201-Thallium (201TI) and [123I]-phenyl-pentadecanoic acid (IPPA) were administered during bicycle exercise under fasting conditions., Results: All patients showed non-homogeneous tracer uptake defects for 201TI and IPPA. k(1) was significantly higher in DCM patients than controls. k(1) showed significant inverse correlation between cardiac index, left-ventricular ejection fraction, left-ventricular enddiastolic pressure and echocardiographic left-ventricular ejection fraction., Conclusion: We presume that an increased regional rate constant of IPPA influx into the myocardial tissue in patients with DCM reflects a compensatory mechanism of altered myocardium.

Published
2002
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21. Improvement in coronary flow reserve determined by positron emission tomography after 6 months of cholesterol-lowering therapy in patients with early stages of coronary atherosclerosis.

Author

Baller D, Notohamiprodjo G, Gleichmann U, Holzinger J, Weise R, and Lehmann J

Subjects
Adult, Aged, Angina Pectoris diagnostic imaging, Angina Pectoris drug therapy, Angina Pectoris physiopathology, Coronary Artery Disease diagnostic imaging, Coronary Circulation drug effects, Female, Hemodynamics drug effects, Humans, Lipids blood, Male, Middle Aged, Time Factors, Vasodilation drug effects, Vasodilation physiology, Anticholesteremic Agents therapeutic use, Coronary Artery Disease drug therapy, Coronary Artery Disease physiopathology, Coronary Circulation physiology, Simvastatin therapeutic use, Tomography, Emission-Computed
Abstract

Background: Early stages of coronary atherosclerosis are characterized by a mainly functional impairment of coronary vasodilator capacity under the impact of such risk factors as hypercholesterolemia. The goal of this study was to determine whether 6-month cholesterol-lowering therapy improves coronary flow reserve in patients with angina, reduced flow reserve despite minimally diseased coronary vessels or even normal angiogram, and mild to moderately elevated LDL levels on average., Methods and Results: We noninvasively investigated 23 consecutive patients (18 men, 5 women; mean age, 56+/-7.6 years) with a mean LDL level of 165+/-34 mg/dL at baseline by PET for myocardial blood flow measurement with [13N]ammonia at rest and under dipyridamole stress (0.56 mg/kg) before and after lipid-lowering therapy with simvastatin for 6 months. Between baseline and the 6-month follow-up, total cholesterol concentration fell from 241+/-44 to 168+/-34 mg/dL, and the LDL level decreased from 165+/-34 to 95+/-26 mg/dL (P<0.001). Overall, coronary flow reserve increased from 2.2+/-0.6 to 2.64+/-0.6 (P<0.01). Maximal coronary flow increased significantly from 182+/-36 to 238+/-58 mL/minx100 g (P<0.001) at follow-up. Minimum coronary resistance declined significantly from 0. 51+/-0.12 to 0.40+/-0.14 mm Hg. mL-1. minx100 g (P<0.001). Concomitantly, a regression of anginal symptoms was observed in most patients., Conclusions: Our results suggest that cholesterol-lowering therapy with simvastatin may improve overall coronary vasodilator capacity assessed noninvasively by PET in patients with mild to moderate hypercholesterolemia. Consequently, intensive lipid-lowering therapy is considered a vasoprotective treatment for selected patients in very early stages of coronary atherosclerosis with the potential of preventing further disease progression.

Published
1999
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22. Percutaneous transluminal septal myocardial ablation in hypertrophic obstructive cardiomyopathy: results with respect to intraprocedural myocardial contrast echocardiography.

Author

Faber L, Seggewiss H, and Gleichmann U

Subjects
Adolescent, Adult, Aged, Aspartate Aminotransferases blood, Catheter Ablation adverse effects, Creatine Kinase blood, Diastole physiology, Echocardiography, Electrocardiography, Exercise Test, Female, Follow-Up Studies, Hemodynamics, Humans, Hypertrophy, Left Ventricular physiopathology, Isoenzymes, Male, Middle Aged, Systole physiology, Ventricular Function, Left physiology, Ventricular Outflow Obstruction physiopathology, Angioplasty, Balloon, Coronary, Cardiomyopathy, Hypertrophic surgery, Catheter Ablation methods
Abstract

Background: Percutaneous transluminal septal myocardial ablation (PTSMA) has been introduced as an alternative procedure for reducing the left ventricular outflow tract gradient (LVOTG) in hypertrophic obstructive cardiomyopathy. We report on the acute and mid-term results in 91 symptomatic patients with respect to intraprocedural myocardial contrast echocardiography (MCE)., Methods and Results: PTSMA was intended for 46 women and 45 men (54.1+/-15.5 years). In 2 patients, the intervention could not be completed. In the first 30 patients the target vessel was determined by probatory balloon occlusion alone and in the remainder by additional intraprocedural MCE. Resting LVOTG was reduced from 73.8+/-35.4 to 16.6+/-18.1 and nostextrasystolic LVOTG from 149.3+/-42.5 to 61. 9+/-43.0 mm Hg (P<0.0001 each). In 10 (11%) patients, permanent DDD pacemaker implantation was necessary. Two (2%) patients died, 1 from ventricular fibrillation associated with treatment for chronic obstructive pulmonary disease after 9 days and 1 from fulminant pulmonary embolism after 2 days. After 3 months, mean New York Heart Association class was reduced from 2.8+/-0.6 to 1.1+/-1.0 (P<0.0001). The LVOTG remained reduced to 14.6+/-25.5 mm Hg at rest and 49. 1+/-48.7 mm Hg (P<0.0001 each). Four patients underwent successful repeat PTSMA. Determination of the target vessel by MCE was associated with a higher rate of acute (92% vs 70%; P<0.01) and mid-term (94% vs 64%; P<0.01) success., Conclusions: PTSMA is a promising nonsurgical technique for reduction of symptoms and LVOTG in hypertrophic obstructive cardiomyopathy. MCE has been shown to be a useful addition to probatory balloon occlusion for target vessel selection. Prospective, long-term observations of larger populations and a comparison with the established forms of therapy are necessary to determine the definitive significance of PTSMA.

Published
1998
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23. Percutaneous transluminal septal myocardial ablation in hypertrophic obstructive cardiomyopathy: acute results and 3-month follow-up in 25 patients.

Author

Seggewiss H, Gleichmann U, Faber L, Fassbender D, Schmidt HK, and Strick S

Subjects
Adult, Aged, Aged, 80 and over, Angina Pectoris etiology, Cardiac Complexes, Premature physiopathology, Cardiomyopathy, Hypertrophic drug therapy, Cardiomyopathy, Hypertrophic enzymology, Catheter Ablation, Cause of Death, Coronary Vessels, Creatine Kinase analysis, Depression, Chemical, Echocardiography, Ethanol adverse effects, Female, Follow-Up Studies, Heart Block etiology, Heart Block therapy, Heart Septum pathology, Humans, Injections, Intra-Arterial, Lung Diseases, Obstructive complications, Male, Middle Aged, Myocardial Contraction drug effects, Pacemaker, Artificial, Stroke Volume physiology, Sympathomimetics adverse effects, Treatment Outcome, Ventricular Fibrillation etiology, Ventricular Function, Left physiology, Angioplasty, Balloon, Coronary, Cardiomyopathy, Hypertrophic therapy, Ethanol therapeutic use
Abstract

Objectives: We report the acute results and midterm clinical course after percutaneous transluminal septal myocardial ablation (PTSMA) in symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM)., Background: In the treatment of HOCM, surgical myectomy and DDD pacemaker therapy are considered the standard procedural extensions to drug therapy with negatively inotropic drugs. As an alternative nonsurgical procedure for reducing the left ventricular outflow tract (LVOT) gradient, PTSMA by alcohol-induced septal branch occlusion was introduced. However, clinical follow-up has not been sufficiently described., Methods: In 25 patients (13 women, 12 men; mean [+/- SD] age 54.7 +/- 15.0 years) who were symptomatic despite sufficient drug therapy, 1.4 +/- 0.6 septal branches were occluded with an injection of 4.1 +/- 2.6 ml of alcohol (96%) to ablate the hypertrophied interventricular septum. After 3-months, follow-up results of LVOT gradients and clinical course were determined., Results: The invasively determined LVOT gradients could be reduced in 22 patients (88%), with a mean reduction from 61.8 +/- 29.8 mm Hg (range 4 to 152) to 19.4 +/- 20.8 mm Hg (range 0 to 74) at rest (p < 0.0001) and from 141.4 +/- 45.3 mm Hg (range 76 to 240) to 61.1 +/- 40.1 mm Hg (range 0 to 135) after extrasystole. All patients had angina pectoris for 24 h. The maximal creatine kinase increase was 780 +/- 436 U/liter (range 305 to 1,810) after 11.1 +/- 6.0 h (range 4 to 24). Thirteen patients (52%) developed a trifascicular block for 5 min to 8 days requiring temporary (n = 8 [32%]) or permanent (DDD) pacemaker implantation (n = 5 [20%]). An 86-year old woman died 8 days after successful intervention of uncontrollable ventricular fibrillation in conjunction with beta-sympathomimetics in chronically obstructive pulmonary disease. The remaining patients were discharged after 11.3 +/- 5.4 days (range 5 to 24), after an uncomplicated hospital course. Clinical and echocardiographic follow-up was achieved in all 24 surviving patients after 3 months. No cardiac complications occurred. Twenty-one patients (88%) showed clinical improvement, with a New York Heart Association functional class of 1.4 +/- 1.1. A further reduction in LVOT gradient was shown in 14 patients (58%)., Conclusions: PTSMA of HOCM is a promising nonsurgical technique for septal myocardial reduction, with a consecutive reduction in LVOT gradient. Possible complications are trifascicular blocks, requiring permanent pacemaker implantation, and tachycardiac rhythm disturbances. Clinical long-term observations of larger patient series and a comparison with conventional forms of therapy are necessary to determine the conclusive therapeutic significance.

Published
1998
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24. Nonsurgical septal reduction for hypertrophic obstructive cardiomyopathy: outcome in the first series of patients.

Author

Knight C, Kurbaan AS, Seggewiss H, Henein M, Gunning M, Harrington D, Fassbender D, Gleichmann U, and Sigwart U

Subjects
Adolescent, Adult, Aged, Angioplasty, Balloon, Coronary, Arrhythmias, Cardiac etiology, Bundle-Branch Block etiology, Cardiac Catheterization, Cardiomyopathy, Hypertrophic diagnostic imaging, Cardiomyopathy, Hypertrophic pathology, Coronary Vessels, Echocardiography, Ethanol administration & dosage, Ethanol therapeutic use, Exercise Test, Female, Hemodynamics, Humans, Male, Middle Aged, Pilot Projects, Treatment Outcome, Cardiomyopathy, Hypertrophic therapy, Embolization, Therapeutic methods, Heart Septum pathology
Abstract

Background: Some patients with hypertrophic obstructive cardiomyopathy may gain symptomatic relief from a reduction in the extent of obstruction to left ventricular outflow. We present the outcome of the first series of patients treated with an alternative method of gradient reduction using catheter techniques., Methods and Results: Eighteen patients were treated with selective intracoronary alcohol injection to induce localized septal infarction. Patients underwent echocardiographic measurement of left ventricular dimensions and Doppler echocardiographic evaluation of left ventricular outflow tract gradients before the procedure, on the first postoperative day, and at a median follow-up of 3 months after the procedure. In addition, patients underwent exercise testing and symptom evaluation before and 3 months after nonsurgical septal reduction. There was a significant reduction in left ventricular outflow tract obstruction after the procedure (preprocedure, 67 mm Hg [95% CI, 48 to 87 mm Hg]; postprocedure, 25 mm Hg [95% CI, 16 to 34 mm Hg]; P=.0006), which persisted at 3-month follow-up (22 mm Hg [95% CI, 12 to 32 mm Hg]; P=.001). This was associated with a significant improvement in symptoms. There was a small but not significant increase in exercise capacity (n=10; preprocedure, 418 seconds [95% CI, 273 to 563 seconds]; postprocedure, 452 seconds [95% CI, 283 to 621 seconds). Left ventricular dimensions were not significantly altered by nonsurgical septal reduction., Conclusions: Nonsurgical septal reduction significantly reduces left ventricular outflow tract obstruction and improves symptoms in some patients with hypertrophic obstructive cardiomyopathy. The technique may provide an alternative to surgical myomectomy in selected patients.

Published
1997
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