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Simultaneous measurements of the concentration of dye by a fiberoptic catheter and of the temperature by a thermistor catheter were obtained in dogs. No significant difference for cardiac output and stroke volume was found. The slightly but significant higher residual fraction by thermodilution than by fiberoptic technique is caused by cold transfer between ventricular myocardium and cavity. It becomes evident after the fifth beat

The main advantage of the morphometric approach is that the spatial orientation of the vessel with respect to the image intensifier is not very important. Its most severe limitations are that reasonable accuracy can only be obtained with circular lumina, and that accuracy decreases rapidly with the vessel diameter. The densitometric approach is much less dependent on the shape of the lumen and on the correct identification of the vessel wall in the image. A further essential advantage is that one measures directly the cross-sectional area of the vessel instead of a ‘diameter' of low haemodynamic relevance. Severe requirements must however be met if the potential accuracy of densitometry is to be fully exploited. The morphometric approach seems thus preferable for absolute or relative diameter measurements on intact vessels, while densitometry is superior in case of irregular or small lumina. Morphometric calibration using the injection catheter can induce non-negligible errors in both approaches. Grid calibration is probably more accurate, but also more tedious. In the densitometric approach, ‘3D-calibration' by help of a cube of known size allows also determination of the spatial orientation of the vessel in space. This solution requires however biplane imaging

Background For several years, acute coronary syndromes have been perceived as causing the most hospital admissions, and even hospital mortality. The syndrome of unstable angina frequently progresses to acute myocardial infarction but its pathogenesis is poorly understood, and prognosis determination is still problematic. We tested the hypothesis that measurement of the C-reactive protein in patients admitted for chest pain could be a marker for acute coronary syndromes. Methods and Results We studied 110 patients admitted with suspected ischaemic heart disease, but without elevated serum creatine-kinase levels at the time of hospital admission. Patients were subsequently divided into two groups based on their final diagnosis: group 1 comprised patients with unstable angina; group 2 patients with acute myocardial infarction. We measured the C-reactive protein at the time of hospital admission. The concentration of C-reactive protein was elevated in 59% of the patients with a final diagnosis of acute myocardial infarction, and in 5% of the patients with a final diagnosis of unstable angina, (P<0·001). Conclusion This study indicates that C-reactive protein levels measured at the time of admission in patients with suspected ischaemic heart disease could be a marker for acute coronary syndromes, and helpful in identifying patients at high risk for acute myocardial infarction. Measurement of C-reactive protein may have practical clinical significance in the management of patients hospitalized for suspected acute coronary syndromes

In the last two years, six studies using prazosin in doses of 3-32 mg/day for two and 16 months have shown a persistent but variable benefit in 50-80% of those who initially responded favorably. However, serious side-effects occurred in up to 40% and, in many cases, tolerance developed. Mortality was 25-38% in 3-6 months, 50% by one year. In five studies using hydralazine (sometimes combined with long acting nitrates), 150 patients observed from six up to 29 months showed sustained benefit in 26 to 59%, while in many cases hemodynamic values returned to pretreatment values. Again side-effects were considerable, with worsening of angina, fluid retention, gastrointestinal symptomatology and, rarely, lupus erythematodes. Mortality was 28-41% in 10-12 months, higher in non-responders than in responders. Although exercise capacity increased in responders, no data are available today to prove that these vasodilators allow heart failure patients to live longer. Prudence is indicated in patients with congestive heart failure due to coronary artery disease. Furthermore, tolerance development, which only may be surmountable if discontinuation for a few weeks or switching to another drug is possible, is a serious problem limiting chronic vasodilator application

Changes in the circulating volume associated with haemodialysis result in modification of left ventricular loading conditions. To determine the influence of haemodialysis on Doppler indices of left ventricular filling, 12 patients (mean age 40.8 ±2.7 (SEM) years) with renal insufficiency but without overt heart disease were studied by Doppler-echocardiography immediately before and after haemodialysis. Haemodialysis resulted in a decrease in body weight from 68.0±3.8 kg to 65.0 ±3.7 kg (P< 0.01). Heart rate and blood pressure did not change significantly during haemodialysis. Left ventricular diastolic dimension (M-mode) decreased from 53.5±1.1 mm to 49.5±1.9 mm (P < 0.05), whereas the shortening fraction did not change. Haemodialysis elicited marked changes in the early diastolic rapid filling wave (E wave) recorded by pulsed Doppler at the level of the mitral annulus. Peak velocity of the early rapid filling phase (peak E) decreased significantly from 95.3 ± 8.2 cm .s−1 to 63.0 ±5.7cm .s−1 (P< 0.001) and mid-diastolic deceleration of transmitral velocity decreased from 437.3 ±54.2 cm . s−2 to 239.7 ±54.4 cm . s−2 (P<0.01). The peak filling velocity during atrial contraction (peak A) did not change (79.7 ±6.3 cm .s−1 vs 74.1±4.7 cm.s−1;P=NS). The ratio peak E/peak A decreasedfrom 1.19±0.06 to 0.85 ± 0.04 (P < 0.01) during haemodialysis. The results provide further evidence for the pronounced preload-dependence of Doppler indices of left ventricular diastolic function

A videodensitometric method for quantification of aortic regurgitation which requires neither measurement of cardiac output nor determination of enddiastolic and endsystolic left ventricular volumes has been developed. The injection of 20 ml of contrast medium into the left ventricle is digitally recorded at 25 images s−1 during 20 s using an equipment for digital subtraction angiography (Digitron 2, Siemens). The Digitron computes 2 ‘time dilution curves' (TDC) from the unsubtracted image sequence, for 2 regions of interest drawn around the angiographic enddiastolic and endsystolic left ventricular silhouettes. Enddiastolic and endsystolic points of the TDC are then entered into a VAX-750 computer, which calculates the ejection fraction (EF), the forward ejection fraction (FEF) and the regurgitant fraction (RGF). This is performed by a complex fitting algorithm based on a physical model of the washout process of contrast medium, which reconstructs the two best enddiastolic and endsystolic baselines in the washout parts of the two TDC. The EF, FEF and RGF obtained in 9 regurgitant and 11 nonregurgitant patients have been compared with the corresponding values EFv, FEFv and RGFv obtained by a conventional technique (Cardiogreen and biplane LV area-length volumetry). Regression analysis yielded: EF = 0.88 × EFv (regression line forced through the origin), r = 0.77, FEF = 0.76 × FEFv + 3, r = 0.96, RGF = 0.94 × RGFv + 5, r = 0.98 (v stands for volumetry)

Aim Several methods of measuring coronary blood flow in intact conscious man are reviewed, on the basis of personal contributions or the experiences of our teams. Methods and Results It is important to distinguish between global, regional and transmural blood flow measurements. The advantages and limitations of the following methods are discussed: diffusible inert and radioactive tracers, dye dilution, roentgendensitometry, magnetic resonance imaging and contrast echocardiography. In interventional cardiology it is most important to be able to measure flow through single coronary vessels. Information on coronary artery Doppler velocity during vasodilation and at rest is less useful than the concept of fractional flow reserve. This is based on pressure measurements under maximal vasodilation to ascertain the presence of borderline flow-limiting lesions. This information is necessary in order to decide whether to proceed with angioplasty or not. Conclusions The historical design of percutaneous coronary angioplasty and beta-irradiation of coronary restenosis, established under the author's guidance, are put into perspective. The author pays tribute to many excellent colleagues who worked with him at the Zurich and Geneva University Hospitals

In order to assess the prognostic significance of normal exercise thallium-210 myocardial scintigraphy in patients with documented coronary artery disease, we studied the incidence of cardiac death and non-fatal myocardial infarction in 69 symptomatic patients without prior Q wave myocardial infarction, who demonstrated one or more significant coronary lesions (stenosis ≤70%) on an angiogram performed within 3 months of scintigraphy (Group 1). These patients were compared to a second group of 136 patients with an abnormal exercise scintigram, defined by the presence of reversible defect(s) and angiographically proven coronary artery disease (Group 2), and to a third group of 102 patients with normal exercise scintigraphy without significant coronary lesions (stenosis ≥30%) or with normal coronary angiography (Group 3). In contrast to coronary lesions observed in Group 2, patients in Group I presented more frequently with single- vessel disease (83% vs 35%, P>0·0001) and with more distal lesions (55% vs 23%, P>0·0001). Over a mean follow-up period of 8·6 years, one fatal and eight non-fatal cases of myocardial infarction were observed in Group 1. The majority of patients in Group 1 were treated medically: only 24 (35%) underwent myocardial revascularization, usually by coronary angioplasty. There was no significant difference in the incidence of combined major cardiac events (cardiac death, non-fatal myocardial infarction) in patients with normal exercise scintigraphy, with or without documented coronary artery disease (Groups 1 and 3), while the incidence was higher in Group 2. However, while the mortality remained very low in Group 1, the incidence of non-fatal myocardial infraction was not different from that of Group 2, where most patients underwent revascularization procedures. In conclusion, patients with coronary artery disease and a normal exercise thallium-201 myocardial scintigram usually have mild coronary lesions (single-vessel disease, distal location) a