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4. New methods for noninvasive monitoring of rejection after heart transplantation

Author

Reichenspumer, Hermann, Haberl, Ralph, Angermann, Christiane, Anthuber, Matthias, Osterholzer, Georg, Kemkes, Bemhard M., Hammer, Claus, Gokel, Joachim M., and Reichart, Bruno

Subjects
17th Annual Symposium
Abstract

Between August 1981 and February 1987, 67 orthotopic heart transplants and three heart-lung transplants were performed in 69 patients at the University of Munich Hospital. The immunosuppressive regimen consisted of cyclosporine A, azathioprine, and prednisone. The diagnosis of acute rejection was based on cytoimmunologic monitoring, frequency analysis of fast Fourier transformed surface electrocardiograms (FFT-ECGs), and two-dimensional echocardiography. The results of these diagnostic methods were compared to the findings provided by endomyocardial biopsies, which were performed simultaneously with the noninvasive studies. Seventy patients underwent cytoimmunologic monitoring. In 88% of all rejection episodes, this technique revealed activated lymphocytes and lymphoblasts in the mononuclear concentrate of the peripheral blood samples; the presence of such cells is known to be an extremely early sign of acute rejection. Twenty-six patients were monitored by means of FFT-ECG. In 20 of the 21 cases of rejection, this method disclosed significant changes in the frequency spectrum of the QRS complex in the 70- to 110-Hz range; in 12 cases, these changes were the earliest sign of acute rejection. Therefore, FFT-ECG had a sensitivity of 95%. All of the QRS changes were reversible with rejection therapy. Forty-five patients were subjected to two-dimensional echocardiography. In 31 of the 35 cases of rejection, the echocardiogram showed a significant increase in the left ventricular wall thickness and a decrease in the left ventricular cross-sectional area during mild rejection. Moderate or severe rejection was characterized by an increase in the diastolic area, as well as a decrease in the systolic area change and in the diastolic maximum velocity of area change. Thus, two-dimensional echocardiography had a sensitivity of 89%. In the recent cases, the diagnosis of rejection was based on noninvasive methods alone. After rejection therapy had been instituted, endomyocardial biopsies were performed to assess the effectiveness of the treatment. With noninvasive rejection monitoring, the number of endomyocardial biopsies performed during the first three postoperative months was only 2.8 per patient; in comparison with invasive rejection monitoring, noninvasive follow-up was associated with a 75% reduction in the need for biopsy.

Published
2022

11. Multislice spiral computed tomographic angiography of coronary arteries in patients with suspected coronary artery disease: An effective filter before catheter angiography?

Author

Haberl, Ralph, Tittus, Janine, Bohme, Eike, Czernik, Andreas, Richartz, Barbara Maria, Buck, JuRgen, and Steinbigler, Peter

Subjects
Coronary heart disease -- Care and treatment, Diagnostic imaging, Medical equipment, Physiological apparatus, Health
Abstract

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ahj.2005.02.048 Byline: Ralph Haberl, Janine Tittus, Eike Bohme, Andreas Czernik, Barbara Maria Richartz, Jurgen Buck, Peter Steinbigler Abstract: Despite impressive image quality, it is unclear if noninvasive coronary angiography with multislice spiral computed tomography (CT) is powerful enough to act as a filter before invasive angiography (INV-A) in symptomatic patients. Author Affiliation: Klinikum Munich-Pasing, Munchen, Germany Article History: Received 6 August 2004; Accepted 2 February 2005

Published
2005

15. Analysis of beat-to-beat variability of frequency contents in the electrocardiogram using two-dimensional Fourier transforms

Author

Spiegl, Andreas, Steinbigler, Peter, Schmucking, Ingo, Knez, Andreas, and Haberl, Ralph

Subjects
Electrocardiogram -- Research, Fourier transformations -- Usage, Ventricular tachycardia -- Equipment and supplies, Biological sciences, Business, Computers, Health care industry
Abstract

Late potentials are very small signals (1-20 mu V) in the surface ECG with high-frequency components, which are found in patients prone to sustained ventricular tachycardia. Evaluation of these signals requires either very sophisticated recording techniques for single-beat analysis or signal averaging. Signal averaging, however, might disregard information about risk stratification. Therefore, we developed the Single-Beat Spectral Variance (SBSV) based on two-dimensional (2-D) Fourier transform of 80 ms segments of 128 consecutive beats. This approach depicts the beat-to-beat variability of the frequency contents of these ECG segments. An index function enables an objective detection of late potentials. We investigated 35 patients after myocardial infarction and sustained ventricular tachycardia (Group 1), 50 patients after myocardial infarction without ventricular arrhythmias (Group 2) and ten healthy volunteers. SBSV classified 29 of 35 patients (83%) of Group 1 as pathologic, 14 of these 29 patients (48%) exclusively on the basis of marked Wenckebach-like conduction pattern. In Group 2, only five of 50 patients showed abnormal SBSV. In Group 3, we found no pathologic result. Thus, SBSV is a promising new method to investigate late potentials in patients after myocardial infarction. SBSV contains not only the results of frequency analysis after signal averaging, but also evaluates variable ECG components. Index Terms - Beat-to-beat variability, electrocardiogram, Fourier transform, frequency analysis, late potentials, ventricular tachycardia.

Published
1998

17. A comparison of electrophysiologically guided antiarrhythmic drug therapy with beta-blocker therapy in patients with symptomatic, sustained ventricular tachyarrhythmias

Author

Steinbeck, Gerhard, Andresen, Dietrich, Bach, Peter, Haberl, Ralph, Oeff, Michael, Hoffmann, Ellen, and Von Leitner, Enz-Rudiger

Subjects
Ventricular tachycardia -- Drug therapy, Metoprolol -- Health aspects, Anti-arrhythmia drugs -- Health aspects, Electrocardiography -- Usage
Abstract

Electrophysiologically-guided antiarrhythmic drug therapy may not be more effective than a beta-blocker for treatment of patients with sustained ventricular tachyarrhythmia, or rapid heartbeat. Electrophysiologically-guided antiarrhythmic drug therapy involves the use of programmed electrical stimulation to induce arrhythmia and to evaluate the efficacy of different antiarrhythmic drugs. Of 155 patients with sustained ventricular tachyarrhythmia, 61 were treated with electrophysiologically-guided drug therapy and 54 were treated with the beta-blocker metoprolol without testing. During an average follow-up period of 23 months, 44 patients suffered recurrent non-fatal arrhythmia, and 27 died suddenly from cardiac causes. Forty-six percent of these patients were in the electrophysiologically-guided drug therapy group and 48% were in the metoprolol treatment group.

Published
1992

18. Prognosis of patients with sustained ventricular tachycardia and of survivors of cardiac arrest not inducible by programmed stimulation

Author

Andresen, Dietrich, Steinbeck, Gerhard, Bruggemann, Thomas, Haberl, Ralph, Fink, Lutz, and Schroder, Rolf

Subjects
Cardiac arrest -- Prognosis, Ventricular tachycardia -- Prognosis, Heart ventricle, Left -- Physiological aspects, Health
Abstract

The aim of this study was to analyze the long-term clinical outcome of 60 prospectively studied patients with documented sustained ventricular tachyarrhythmia that was not inducible during baseline programmed ventricular stimulation: 39 with cardiac arrest due to noninfarction ventricular fibrillation (VF) and 21 with mild hemodynamically compromising sustained ventricular tachycardia (VT). Left ventricular ejection fraction was 55 [+ or -] 14% in the VF group and 50 [+ or -] 13% in the VT group (difference not significant). Patients were discharged without conventional antiarrhythmic drugs and received only empirical [beta]-blocker therapy. During a mean follow-up period of 21 [+ or -] 16 months (mean [+ or -] SD), 10 of 60 patients (17%) died suddenly. The actuarial incidence of sudden death at 1 and 4 years was similar in both groups (VF group, 10 and 20%; VT group, 16 and 16%) (p = 0.48). The actuarial incidence of sudden cardiac death was significantly higher in patients with left ventricular ejection fraction [is less than or equal to] 40% than in those with >40% (1-year incidence in VF group, 40 vs 0%; VT group, 50 vs 0%) (p = 0.005 and p = 0.01, respectively). Multivariate regression analysis identified left ventricular ejection fraction [is less than or equal to] 40% and previous myocardial infarction as the only independent predictor of sudden cardiac death. The occurrence of frequent ventricular pairs during Holter monitoring was the only independent predictor of sustained VT recurrences. It is concluded that patients with sustained ventricular tachyarrhythmia in whom arrhythmia was noninducible during baseline ventricular stimulation and not treated with antiarrhythmic therapy have a favorable outcome if left ventricular ejection fraction is high. However, reduced left ventricular ejection fraction identifies a subgroup at high risk of sudden cardiac death. Patients with mild hemodynamically compromising sustained VT have a similar risk of dying suddenly as those resuscitated earlier from cardiac arrest.

Published
1992

21. Influence of Lipid-Lowering Therapy on the Progression of Coronary Artery Calcification

Author

Achenbach, Stephan, primary, Ropers, Dieter, additional, Pohle, Karsten, additional, Leber, Alexander, additional, Thilo, Christian, additional, Knez, Andreas, additional, Menendez, Theresa, additional, Maeffert, Ralph, additional, Kusus, Magda, additional, Regenfus, Matthias, additional, Bickel, Andrea, additional, Haberl, Ralph, additional, Steinbeck, Gerhard, additional, Moshage, Werner, additional, and Daniel, Werner G., additional

Published
2002
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25. Usefulness of calcium scoring using electron beam computed tomography and noninvasive coronary angiography in patients with suspected coronary artery disease

Author

Leber, Alexander W, primary, Knez, Andreas, additional, Mukherjee, Rahul, additional, White, Carl, additional, Huber, Armin, additional, Becker, Alexander, additional, Becker, Christoph R, additional, Reiser, Maximilian, additional, Haberl, Ralph, additional, and Steinbeck, Gerhard, additional

Published
2001
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26. Coronary Artery Calcium Measurement

Author

Becker, Christoph R., primary, Kleffel, Timm, additional, Crispin, Alexander, additional, Knez, Andreas, additional, Young, Jason, additional, Schoepf, U. Joseph, additional, Haberl, Ralph, additional, and Reiser, Maximilian F., additional

Published
2001
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28. Pulmonary Embolism: Comprehensive Diagnosis by Using Electron-Beam CT for Detection of Emboli and Assessment of Pulmonary Blood Flow

Author

Schoepf, U. Joseph, primary, Bruening, Roland, additional, Konschitzky, Hita, additional, Becker, Christoph R., additional, Knez, Andreas, additional, Weber, Juergen, additional, Muehling, Olaf, additional, Herzog, Peter, additional, Huber, Armin, additional, Haberl, Ralph, additional, and Reiser, Maximilian F., additional

Published
2000
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37. T wave spectral variance

Author

Steinbigler, Peter, primary, Haberl, Ralph, additional, Nespithal, Kirsten, additional, Spiegl, Andreas, additional, Schmücking, Ingo, additional, and Steinbeck, Gerhard, additional

Published
1998
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43. Electrophysiologic and antiarrhythmic efficacy of oral sotalol for sustained ventricular tachyarrhythmias: Evaluation by programmed stimulation and ambulatory electrocardiogram

Author

Steinbeck, Gerhard, Bach, Peter, and Haberl, Ralph

Abstract

Programmed ventricular stimulation and ambulatory electrocardiography were performed both before and during oral Sotalol therapy in 39 patients with ventricular tachyarrhythmia inducible by programmed stimulation (sustained ventricular tachycardia [n = 31], ventricular fibrillation [n = 3], nonsustained ventricular tachycardia [n = 5]). Oral Sotalol was started at 80 mg twice daily and the dose thereafter was then gradually increased until a mean daily dose of 300 mg (range 160–480) was reached. In 12 of 34 patients with inducible sustained ventricular tachycardia or fibrillation the arrhythmia was suppressed; in 19 patients it was not and in 3 the spontaneous arrhythmia recurred. Reproducibly inducible nonsustained ventricular tachycardia was suppressed by Sotalol in all five patients with this arrhythmia. Thus, a favorable electrophysiologic response was obtained in 17 (44%) of 39 patients.

Published
1986
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44. Comparison of frequency and time domain analysis of the signal-averaged electrocardiogram in patients with ventricular tachycardia and coronary artery disease: Methodologic validation and clinical relevance

Author

Haberl, Ralph, Jilge, Gerhard, Pulter, Regine, and Steinbeck, Gerhard

Abstract

Frequency analysis with fast Fourier transform and time domain analysis after signal averaging of the electrocardiogram (ECG) have given contradictory results in patients with sustained ventricular tachycardia after myocardial infarction. Therefore, the same orthogonal ECGs were analyzed in the frequency domain (Blackman-Harris window) and the time domain after signal averaging and high gain, low noise amplification (0 to 300 Hz) in 30 patients with sustained ventricular tachycardia after myocardial infarction, 15 patients without ventricular tachycardia after infarction and 15 healthy subjects. Patients with bundle branch block were not excluded.

Published
1988
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