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Umfangreiche Ergebnisse aus grosen kardialen MR (CMR)-Bildgebungszentren zeigen, dass die CMR-basierte Bildgebung in praktisch allen Fallen eine umfassende und abschliesende Beurteilung der klinischen Situation des Patienten erlaubt. Deshalb muss auch der Kardiologe einen uneingeschrankten Zugang zu dieser Bildgebungstechnik erlangen und bei entsprechender Ausbildung die kardiale MRT (CMR) selbststandig durchfuhren konnen. In diesem Positionspapier werden Kriterien benannt, die eine hohe Qualitat im wissenschaftlichen Arbeiten und in der klinischen Anwendung von CMR berucksichtigen. Hierzu dienen die 3 unterschiedlichen Qualifikationsstufen, die eine stufenweise Weiterbildung von Kardiologen erlauben, welche dem Grundverstandnis der CMR-Diagnostik dienen (Stufe 1), zur selbststandigen Durchfuhrung und Befundung von CMR-Untersuchungen befahigen (Stufe 2) oder die Leitung eines CMR-Labors erlauben (Stufe 3). Der Vergleich des DGK-Curriculums zu dem der Deutschen Rontgengesellschaft (DRG) zeigt quantitative und vor allem qualitative Unterschiede. Dies trifft auch fur die speziellen kardiovaskularen Bildgebungszentren der DRG zu, die nach Ansicht der DGK nur zusammen und paritatisch besetzt mit Radiologen und Kardiologen etabliert und betrieben werden sollten.

Ziel des CMR (kardiale Magnetresonanztomographie)-Bildgebungscurriculums ist die Beschreibung eines Weiterbildungsprozesses fur den Kardiologen, dessen Ziel die Erlangung der Zusatzqualifikation „Kardio-MRT“ ist. Die curriculare Weiterbildung soll entsprechend den 3 unterschiedlichen Stufen den Kardiologen in die Lage versetzen, eine adaquate Indikationsstellung sowie die Durchfuhrung und Befundung von CMR-Untersuchungen an einer groseren Patientenzahl mit breitem Krankheitsspektrum zu ermoglichen. Daruber hinaus soll der Kardiologe fakultativ einen hoheren Grad der Fortbildung erreichen konnen, sodass er in der Endstufe auch in der Lage sein muss, ein Kardio-MRT-Labor zu leiten und eigenstandig wissenschaftliche CMR-Untersuchungen durchzufuhren. Das Curriculum soll in einem definierten und von der Fachgesellschaft zertifizierten Prozess durchgefuhrt werden, welcher die Qualitat der Weiterbildung sichern soll. Die Zertifizierung betrifft nicht nur den Weiterbildungsprozess, sondern auch die Zulassung von Weiterbildungszentren und die Prufung der weiterzubildenden Kandidaten. Die Weiterbildung in der CMR-Bildgebung in Deutschland soll den europaischen und internationalen Curricula angeglichen werden [ubereinstimmend mit den Anforderungen fur Level I–III der European Society of Cardiology (ESC) sowie Society for Cardiovascular Magnetic Resonance (SCMR)], sodass eine gegenseitige Anerkennung und innereuropaischer Austausch in der Weiterbildung moglich sind.

Thrombozytenaggregationshemmer (TAH) wie Aspirin und Clopidogrel spielen eine uberragende Rolle bei der Pravention kardiovaskularer Ereignisse bei Patienten mit koronarer Herzkrankheit nach einem akuten Koronarsyndrom oder nach Implantation von Koronarstents. Ein klinisches Problem dieser Substanzen stellt allerdings die „Non-Responder“-Rate von bis zu 30% dar, welche auf eine Vielzahl von klinischen, genetischen und zellularen Faktoren zuruckzufuhren ist. Deshalb wird nach neuen Substanzen – insbesondere nach Inhibitoren des P2Y12-Rezeptors – gefahndet, welche eine reversible Bindung an den Rezeptor, eine rasch einsetzende und moglichst starke und wenig streuende Wirkung ohne den Umweg einer hepatischen Metabolisierung (kein „Pro- Drug“) gewahrleisten. Zu diesen neuen TAH zahlen Cangrelor, AZD6140 und Prasugrel, drei neue P2Y12-Rezeptorantagonisten, deren bisher vorliegenden klinischen Ergebnisse dargestellt werden. Die Neuentwicklungen von TAH sind aber nicht abgeschlossen; als interessante weitere Targets werden Antikorper bzw. Aptamere gegen den Kollagenrezeptor GPVI bzw. den vWWRezeptor GP1b, Antagonisten gegen den Thromboxanrezeptor sowie Antagonisten der Proteaseaktivierten Rezeptoren (PAR) experimentell und klinisch gepruft.

The long-term effect of specific LDL plasma immunabsorption on the course of coronary arteriosclerosis was tested in ten patients with familial hypercholesteremia type IIa (seven females, three males; age range 15-57 years). Available were ECG, bicycle ergometry, hemodynamic and angiographic data. These tests were repeated seriatim in the course of the LDL immunabsorption. It was found that exercise tolerance markedly increased, ischemic ST-changes became less marked and the initial hemodynamic parameters remained unchanged. The morphology of the coronary arteries was influenced lastingly: among 22 stenoses only one progressed, there was no further progression in 11 stenoses and regression in ten. When there was generalized arteriosclerosis, progression occurred in two of 79 coronary artery segments, progression was arrested in 56 and regression was noted in 21 of 79 segments. These results demonstrate that specific LDL plasma immunabsorption for the elimination of LDL cholesterol favorably influences the course of coronary arteriosclerosis in patients with familial hypercholeremia type IIa. The findings support the lipid theory of atherosclerosis and coronary arteriosclerosis, at least in this special group of patients.

Modelling the electromagnetic properties of the thorax in magnetocardiographic (MCG) studies is usually performed by the Boundary Element Method (BEM). Magnetic Resonance Imaging (MRI) scans are generally used as the basis for extracting the coordinates for BEM. As MRI is a (time) expensive technique and scanners have a high use demand, in this work a strategy is presented that reduces the costs and the need for additional MRI images. This strategy is based on the use of low resolution and incomplete MRI image sets of the thorax.

Catheter ablation is an invasive treatment method for cardiac arrhythmia like atrioventricular nodal reentrant tachycardia without the need for thorax surgery. For high precision and reproducibility, an accurate temperature measurement and control at the catheter tip is crucial. Conventional ablation electrodes, which are powered with radio frequency energy (RFE) provide only a poor control of destroyed tissue (lesion) depth and direction due to inhomogeneous thermal and electrical tissue properties. In this work, a new technology using diamond heating elements is presented. Due to its exceptional properties, e.g. biocompatibility and chemical inertness, diamond possesses ideal prerequisites for medical applications. The specific electrical resistance of diamond can be adjusted through boron doping over a wide range from insulating to quasi-metallic. An activation energy of Eakt=380 meV for low doped layers allows for the fabrication of precise temperature sensors. For initial experiments, micro heaters on chemical vapor deposited (CVD) diamond films on silicon have been designed and fabricated. The experiments were performed on cardiac muscle tissue (myocardium) of pigs to demonstrate the feasibility of this new concept. It was shown that a treatment using these devices results in a defined shape of the lesion. No current flows through the body and, therefore inhomogeneous conductance of the tissue does not affect the ablation direction.

A total of 550 fertile chicken eggs (White Leghorn) were exposed to a radiofrequency (RF) electromagnetic field of 1.25 GHz (continuous wave) at six different power flux densities in the range of 9.0-0.75 mW/cm(2). The eggs were exposed either continuously throughout the whole 21 days of incubation (long-term exposure) or in a short-term exposure (1-2 h/day). The temperatures of the embryonic tissue and the amniotic fluid, respectively, were measured with inserted temperature probes. This study was designed to investigate the relationship between exposure and temperature changes in exposed tissues, without considering biological and medical effects. This knowledge is of general interest for studies of nonthermic teratological or embryo-lethal effects of exposure to electromagnetic fields (EMFs). Throughout the entire 21 days of embryonic development, the mean temperature increases in the eggs during the exposure were found to be up to 0.25 degrees C for a power flux density of 1.25 mW/cm(2) and increased to 2.3 degrees C for 9.0 mW/cm(2). The corresponding maximum whole-body SARs for the embryos over the 21 days of embryonic development were 1.45 and 10.44 W/kg, respectively. At 0.75 mW/cm(2) (0.87 W/kg) the extent of the RF-field induced hyperthermia was within the measurement accuracy (+/-0.1 degrees C) of the temperature probes used in the tests. The field-induced temperature increase was greatest in the first week of incubation and was less pronounced in the last (third) week before hatching. In both the short- and the long-term exposures, the temperature of the exposed tissue and the amniotic fluid, respectively, reached its maximum (asymptotic) approximately 40-50 min after the RF field was switched on. After the field was switched off, the temperature inside the exposed eggs returned to its initial value within 40-50 min.

Die Inzidenz und Letalitat des akuten Herzinfarktes sinkt zwar in den letzten Jahrzehnten in einigen europaischen Landern und den USA. Die Bedeutung ist jedoch nach wie vor gros: So entsprach die Todesursache bei rund 20% der Frauen und Manner im Jahre 1997 den Folgen einer koronaren Herzkrankheit. Der nachfolgende Beitrag beschreibt die Ergebnisse groserer epidemiologischer Studien zum akuten Herzinfarkt. Daraus ergibt sich der Schluss, dass ein wichtiger Ansatzpunkt zur weiteren Senkung der Letalitat in der Prahospitalphase liegt. Daher werden im zweiten Teil des Beitrages die entsprechenden Masnahmen zur Verkurzung des Zeitraumes bis zur Einleitung einer definitiven Therapie durch rekanalisierende Masnahmen dargestellt und das Management der prahospitalen Notfallversorgung des akuten Myokardinfarktes beschrieben.

Die okonomische Beurteilung von Kosten und Nutzen medizinischer Masnahmen gewinnt zunehmend an Bedeutung. Dies gilt insbesondere fur die Krankheiten mit hoher Pravalenz wie der koronaren Herzkrankheit, die unverandert die haufigste Todesursache in der westlichen Welt darstellt. Gesundheitsokonomische Untersuchungen konnen unter verschiedenen Perspektiven (z.B. Krankenhaus, Versicherung, Volkswirtschaft) und mit unterschiedlichem methodischen Ansatz (Kosten-Nutzwert-Analyse, Kosten-Minimierung) durchgefuhrt werden. Diese werden am Beispiel der Primarpravention der KHK, der Implantation koronarer Stents sowie der Rehabilitation nach Myokardinfarkt diskutiert. Die medizinisch-okonomische Betrachtung erlaubt einen Vergleich von Gesundheitsstrategien auch uber das spezielle Fachgebiet hinaus. Gleichzeitig stellt die okonomische Betrachtung nur einen Teil der medizinischen Bewertung dar und impliziert nicht per se eine medizin-politische Allokationsentscheidung.

The authors of a previously published paper on the dependence of electromagnetic (EM) energy absorption concluded that homogeneous modeling of the human head is suited for assessing the spatial-peak absorption for transmitters operating at 900 MHz or below. Additional studies became necessary for the frequency bands utilized by new mobile communications systems (i.e., 1.5 and 2.5 GHz) since some peripheral tissue layers have a thickness of the range of /spl lambda//4-/spl lambda//2. The results of the simulations combined with worst-case considerations confirmed the anticipated and more complex relationship between absorption and anatomical details at these higher frequencies. Nevertheless, a homogeneous representation of the head is suited for assessing the maximum specific absorption rate (SAR) in the head of the user of mobile telecommunication equipment (MTE) if the appropriate dielectric parameters are chosen.

The dependence of electromagnetic energy absorption at 900 MHz in the human head on its anatomy and its modeling are investigated for RF-sources operating in the very close proximity of the head. Different numerical head phantoms based on MRI scans of 3 different adults were used with voxel sizes down to 1 mm/sup 3/. Simulations of the absorption were performed by distinguishing the electrical properties of up to 13 tissue types. In addition simulations with modified electric parameters and reduced degrees of complexity were performed. Thus, the phantoms greatly differ from each other in terms of shape, size, and internal anatomy. The numerical results are compared with those of measurements in a multitissue phantom and 2 homogeneous phantoms of different shapes and sizes. The results demonstrate that size and shape are of minor importance, Although local SAR values depend significantly on local inhomogeneities and electric properties, the volume-averaged spatial peak SAR obtained with the homogeneous phantoms only slightly overestimates that of the worst-case exposure in the inhomogeneous phantoms.

Human recombinant interleukin-2 (rIL-2) was bath-applied to isolated human cardiocytes while sodium currents were triggered and registered using the whole-cell recording technique. In the presence of the cytokine the sodium currents were reversibly blocked, 50% peak current reduction occurring at a concentration of 500 U/ml. The current-voltage relationship was not affected, but the steady-state inactivation curve was not affected, but the steady-state inactivation curve was shifted in the negative direction by 15 mV. When 35% of the sodium current was blocked the time constant of recovery from block at -135 mV was in the range of 63 +/- 27 ms. Use dependence was observed only at stimulation frequencies above 4 Hz. Addition of a polyclonal anti-IL-2 antibody to the extracellular solution prevented all of the above effects, while incubation of the cells with a function-blocking monoclonal anti-IL-2 receptor antibody had no influence on the described rIL-2 action. In contrast to rIL-2, recombinant tumor necrosis factor alpha (rTNF-alpha) did not affect the sodium currents. It is concluded that rIL-2 acts like a class I antiarrhythmic drug on human cardiac sodium channels. This might explain some of its proarrhythmic side effects when given intravenously in high doses.

Cardiovascular magnetic resonance (CMR) imaging is a tomographic technique, which allows three-dimensional slice orientation without limitations from acoustic windows inherent to echocardiography. Further advantages of CMR are its high temporal and spatial resolution, its excellent soft tissue resolution and its high blood-to-tissue contrast. Cardiovascular magnetic resonance is currently the only imaging technique, which provides a comprehensive study of both structure and function of the heart as well as myocardial perfusion and viability. Moreover, post-processing of CMR images does not require any geometric assumptions as in echocardiography to determine ventricular dimensions. This is particularly important when evaluating ventricles of patients with chronic heart failure with severely altered morphology that may have regional variations in wall thickness and contractility at least in ischemic cardiomyopathy. The highly reproducible results of CMR imaging have turned this technique into a reference standard for the non-invasive assessment of ventricular dimensions, mass and function. In cases with indeterminate results of clinical, electrocardiographic and particularly echocardiographic findings CMR should be used early in the process of diagnosis of patients with heart failure. Not only can altered structure and degree of ventricular and valvular dysfunctions be accurately assessed but also regional perfusion deficits and/or myocardial scars are easily detected. For therapeutic and prognostic reasons a simple differentiation between ischemic and non-ischemic cardiomyopathy should be achieved as the first diagnostic step. In addition, the type and localization of the late gadolinium enhancement (LGE) phenomenon may aid in non-invasively differentiating the etiology of non-ischemic cardiomyopathy. CMR may also improve the assessment and extent of interventricular and intraventricular dyssynchrony in patients to be selected for cardiac resynchronization therapy (CRT). Lastly, the LGE phenomenon may provide independent prognostic information in patients with a CRT system implanted, as well as in patients with ischemic and non-ischemic cardiomyopathy. Thus, CMR imaging should be implemented early in the diagnostic process of patients with heart failure to significantly improve the speed and accuracy of diagnostic procedures, to control the effect of therapeutic measures, and to select patients with a limited prognosis by assessing the degree of ventricular dysfunction and the extent of myocardial scarring.

ZusammenfassungIn der vorliegenden Studie wurde eine Methode zur quantitativen myokardialen Ruhedurchblutungsmessung in absoluten Einheiten mit dem Generatornuklid 82Rb und PET bei Patienten vorgestellt. Der auf dem Fickschen Prinzip basierende methodische Ansatz, der von Herrero und Mitarb. (Circulation 1990; 82: 1377-86) im tierexperimentellen Modell validiert wurde, lieferte bei 11 herzgesunden Patienten einen globalen Wert der linksventrikulären Myokarddurchblutung von 0,68 ± 0,10 ml/min/g Herzmuskelgewebe. Mit Ausnahme des apikalen Segmentes fanden sich in 12 linksventrikulären Myokardsegmenten keine signifikanten regionalen Unterschiede der Myokarddurchblutung. Bei 5 simultan mit der Argon-Methode und 82Rb-PET-untersuchten Patienten wurde kein signifikanter Unterschied der Myokarddurchblutung zwischen der 82Rb-PET-Messung und der Argonmethode beobachtet (0,60 ± 0,05 vs 0,68 ± 0,15 ml/min/g, n.s.). Diese Resultate zeigen, daß 82Rb PET eine korrekte nichtinvasive quantitative Bestimmung der myokardialen Ruhedurchblutung auch bei Patienten erlaubt.

Timing of aortic valve replacement (AVR) in chronic aortic regurgitation (AR) remains a difficult problem in clinical practice. Radionuclide ventriculography (RNV) yields information on the extent of valvular regurgitation, the enlargement and the systolic function of the left ventricle. A “well-timed” AVR is defined by 1) postoperative improvement of clinical symptoms, decrease in left ventricular enddiastolic volume (EDV) and normalization of ejection fraction (EF) as well as by 2) greater improvement under surgical therapy as compared to conservative management. In “too early” AVR the latter condition is not fulfilled, while in “too late” AVR the first condition is not accomplished. In this study 54 patients with chronic aortic incompetence were evaluated by RNV to see whether these three groups (“too early”, “well-timed”, “too late” AVR, resp.) can be separated by the relation between EDV and regurgitant volume (RV), the level of the EDV and the clinical status. The examination was based on pre- and postoperative RNV studies as well as on follow-up studies. A good postoperative result can be expected in cases with a preoperative EDV/RV- ratio similar to that observed in 30 patients with AR in whom AVR was not indicated. In contrast, in the majority of those cases with an EDV/RV-ratio exceeding this normal range the postoperative outcome will be unsatisfactory. If the EDV/RV-ratio is normal, AVR should be performed in cases with an EDV exceeding 400 ml, while in cases with an EDV between 300 and 400 ml AVR is only indicated in the presence of additional symptoms (NYHA > II). In general, AVR is not required in AR patients with an EDV below 300 ml. In cases with an EDV > 300 ml and an EDV/RV-ratio exceeding the normal range, AVR should not be deferred though the postoperative result may be unsatisfactory especially in cases with long-standing left ventricular dysfunction.

We compared the intracoronary beta-brachytherapy using a liquid rhenium-188 filled balloon with the slow-release, polymer-based, paclitaxel-eluting Taxus-Express stent for treatment of in-stent restenoses.During the same study period, patients with restenoses in bare-metal stents were either treated with Taxus-Express stents (n = 50) or beta-brachytherapy after successful angioplasty (n = 51). For brachytherapy 30 Gy in 0.5 mm tissue depth were administered. The irradiated segment exceeded the traumatized segment 7.5 mm on both sides. Primary endpoint was the minimal lumen diameter (MLD) at the target lesion at six months follow-up. Angiographic follow-up was available in 78% (n = 79/101) and clinical follow-up in all patients.Baseline parameters did not differ statistically. The Taxus-Express stent resulted in a significantly larger MLD and a significantly lower percent diameter stenosis post intervention compared to beta-brachytherapy, which both maintained until angiographic follow-up (primary endpoint 2.44 +/- 0.74 mm versus 1.73 +/- 0.74 mm, p0.0001). Therefore, Taxus-Express stents were associated with a lower angiographic restenosis rate compared with beta-brachytherapy, both for the target lesion (6.1% versus 17.4%) and the total segment (9.1% versus 23.9%). Moreover, use of Taxus-stent was associated with a clinical benefit based on a significantly lower MACE rate compared with beta-brachytherapy (p0.05).Paclitaxel-eluting Taxus-Express stents resulted in superior clinical and angiographic outcomes compared to intracoronary beta-brachytherapy with a liquid (188)Re filled balloon for treatment of restenosis within a bare-metal stent.

In this prospective study, reliability of integrated (18)F-FDG PET/CT for staging of NSCLC was evaluated and compared to MDCT or PET alone.240 patients (pts) with suspected NSCLC were examined using PET/CT. Of those patients 112 underwent surgery comprising 80 patients with NSCLC (T1 n = 26, T2 n = 37, T3 n = 11, T4 n = 6). Imaging modalities were evaluated independently.MDCT, PET and PET/CT diagnosed the correct T-stage in 40/80 pts (50%; CI: 0.39-0.61), 40/80 pts (50%; CI: 0.39-0.61) and 51/80 pts (64%; CI: 0.52-0.74), respectively, whereas equivocal T-stage was found in 15/80 pts (19%; CI: 0.11-0.19), 12/80 pts (15%; CI: 0.08-0.25) and 4/80 pts (5%; CI: 0.01-0.12), respectively. With PET/CT, T-stage was more frequently correct compared to MDCT (p = 0.003) or PET (p = 0.019). Pooling stages T1/T2, T-stage was correctly diagnosed with MDCT, PET and PET/CT in 54/80 pts (68%; CI: 0.56-0.78), 56/80 pts (70%; CI: 0.59-0.80) and 65/80 pts (81%; CI: 0.71-0.89). T3 stage was most difficult to diagnose. T3 tumors were correctly diagnosed with MDCT in 2/11 pts (18%; CI: 0.02-0.52) versus 0/11 pts (0%; CI: 0.00-0.28) with PET and 5/11 pts (45%; CI: 0.17-0.77) with PET/CT. In all imaging modalities, there were no equivocal findings for T4 tumors. Of these, MDCT found the correct tumor stage in 4/6 pts (67%; CI: 0.22-0.95), PET in 3/6 pts (50%; CI: 0.12-0.88) and PET/CT in 5/6 pts (83%; CI: 0.36-0.99).Integrated PET/CT was significantly more accurate for T-staging of NSCLC compared to MDCT or PET alone. The advantages of PET/CT are especially pronounced combining T1- and T2-stage as well as in advanced tumors.

Tissue regeneration with human hematopoietic or mesenchymal stem cells has become a fashionable research topic. In cardiology, intracoronary injection of adult stem cells has already been used for the treatment of human myocardial infarction and ischemic cardiomyopathy. The experimental background of such therapies, however, i.e. the potential of adult stem cells to regenerate myocardium through "transdifferentiation" of hematopoietic or mesenchymal stem cells into cardiomyocytes described in animal models, has recently been challenged by other experimental data. Nonetheless, clinical trials are continuing. This may be due to the fact that, in open-labeled pilot trials, a benefit of intracoronary injection of adult stem cells for the treatment of myocardial infarction has been described. As pilot trials may overemphasize the beneficial effects of intracoronary injection of bone marrow stem cells, controlled double-blinded randomised multicenter studies are warranted. Furthermore, a careful characterization of the cells involved in the proposed cardiac repair as well as in vivo-monitoring of such cells following intracoronary injection in humans might help to answer many essential questions linked to this important research topic. The latter requires biocompatible labeling. This review focuses on the technologies available for stem cell labeling and summarizes the arguments and contra-arguments to use these labeling technologies for application in humans.

C-reactive protein (CRP) is a powerful cardiovascular risk marker. Evidence suggests that this may be due to its direct proatherogenic properties. Because of different biological functions of CRP in different species, an appropriate animal model for the study of its role in atherogenesis is difficult to set up. Binding to low density lipoprotein (LDL), activation of the complement system and interaction with monocyte/macrophages are rigorously defined pathogenic properties of CRP which might contribute to an active role of the molecule in human atherogenesis. Furthermore, direct effects on arterial wall cells, i.e. endothelial cells and smooth muscle cells, have been reported. The molecular basis of CRP interaction with these cells, however, remains unclear. Should CRP indeed be actively involved in human atherogenesis, the molecule may become a target for therapy. Pharmaceutical companies develop CRP-inhibitors.

In-vitro studies revealed that nitric oxide (NO) may affect rheological parameters. We studied the effect of highly-dosed NO-donor molsidomine on blood rheology and the impact of rheological parameters on the incidence of severe cardiovascular events.In this randomized, placebo-controlled and double-blind trial 166 patients (60 +/- 10 years) with stable angina pectoris and coronary intervention received molsidomine 3 x 8 mg t. i. d. (controlled release tablets) or placebo for 6 months. Patients with inflammatory/neoplastic disorders or elevated values of C-reactive protein were excluded from analysis. A rheological profile (plasma viscosity, blood viscosity, aggregation and flexibility of erythrocytes, filtrability of leukocytes, fibrinogen levels) was done initially and after 6 months. Adverse cardiovascular events (death, myocardial infarction, stroke, coronary/peripheral revascularization) were recorded during 12 months. Furthermore, the impact of rheological parameters regarding the occurrence of severe cardiovascular events (death, myocardial infarction, stroke) was evaluated during a follow-up of median 38 months.The data of 137 patients (n = 71 placebo, n = 66 molsidomine) were analysed. The difference of rheological parameters between the two measurements did not vary between the two groups. Analysis of event-free survival with Kaplan-Meier technique revealed no difference between the two groups. Multivariate Cox regression analysis with adjustment for diabetes mellitus, smoking and therapy with statin showed a significant association of fibrinogen and plasma viscosity with the occurrence of severe cardiovascular events.Treatment with molsidomine 3 x 8 mg/day for 6 months does not improve blood rheology or reduce cardiovascular events. But elevated levels of fibrinogen and plasma viscosity were associated with the occurrence of severe cardiovascular events.

High resolution electrocardiography (HRECG) recordings have already shown an increased beat-to-beat microvariability of the QRS duration of the terminal QRS in patients with a history of ventricular tachycardia (VT). The purpose of this study is to detect QRS-duration microvariability with magnetocardiographic (MCG) recordings in normals, patients with coronary heart disease (CHD), patients with a history of myocardial infarction (MI), and VT patients. QRS microvariability is calculated as the variance of time-shifts of single beats respectively to the average of all beats. The average over all channels of the MCG is performed. QRS microvariability was evaluated from 55-channel MCG in 15 normal persons, in 12 patients with CHD, in 13 patients with MI, and in 10 patients with VT. We found a significantly higher microvariability in patients with MI compared to normals. The highest microvariability was found in VT patients.

Vascular endothelial growth factor (VEGF) and insulin-like growth factor-I (IGF-I) both play a pivotal role in diabetic microangiopathy. This study assessed the relationship between capillary permeability as a marker of endothelial dysfunction and serum VEGF and IGF-I levels in normotensive diabetics. Subjects were 10 Type 1 (6/4, male/female, age: 30 [mean] +/- 5 [SD] years, HbA1c: 7.5 +/- 1.1 %), 13 Type 2 diabetics (9/4, m/f; 63 +/- 7 years, 8.3 +/- 1.8 %), and 24 age- and sex-matched control subjects. We determined nailfold capillary permeability by intravital fluorescence videomicroscopy after intravenous injection of sodium-fluorescein. Serum VEGF, free and total IGF-I, IGF binding protein (IGFBP)-1, IGFBP-3, and insulin levels were measured by specific immunoassays. Capillary permeability was increased in both types of diabetes patients compared to age- and sex-matched controls. In Type 1 diabetics, fluorescence light intensities increased over time, reaching significance 30 minutes after dye injection. Type 2 diabetics already revealed an early onset of elevated fluorescence light intensities after one minute. Capillary permeability showed a significant positive correlation with VEGF levels in Type 1 diabetics, (r = 0.76, p < 0.05; 20 min after dye injection) but with free IGF-I levels in type 2 diabetics (r = 0.65, p < 0.05; 5 min after dye injection). IGFBP-3 correlated negatively with capillary permeability in both diabetes types, whereas IGFBP-1 levels correlated positively in Type 2 patients. In conclusion, capillary permeability is increased in both types of diabetes mellitus. However, VEGF and IGF-I may differentially affect microvascular permeability depending on the diabetes type.

Peroxisome proliferator-activated receptor alpha and gamma (PPAR alpha, PPAR gamma) are nuclear transcription factors regulating gene expression in response to their ligands. Initially, PPARs were identified as regulators of gene expression in lipid metabolism and adipogenesis, but recent work has demonstrated PPAR expression in vascular cells and suggests antiinflammatory properties in the vasculature. Since PPAR alpha activators include lipid-lowering fibric acid derivatives and since PPAR gamma can be activated by antidiabetic thiazolidinediones, activation of these receptors might be an intriguing tool to influence atherogenesis in patients with vascular disease. However, there is also evidence that PPAR activators might furnish lesion development under certain circumstances. The following review will focus on these aspects of potential anti- or proatherogenic effects in the vessel wall and discuss potential clinical implications of these findings.

In patients with suspected acute coronary syndrome, myoglobin is, according to IFCC and NACB guidelines, the marker of choice for early determination of acute infarction, in particular in combination with creatine kinase-MB, 4 hours after admission with a sensitivity of 96%, and correctly excludes Q-wave infarctions. In patients without acute myocardial infarction, a positive troponin T (relative risk 31.5%), but not an elevated myoglobin (relative risk 4.5%), is highly predictive for adverse in-hospital outcome.

In industrialized countries the rate of sudden cardiac death remains unchanged. The most frequently encountered structural heart disease in these patients is coronary artery disease. Despite the era of thrombolytic therapy of acute myocardial infarction patients carry an increased risk of sudden cardiac arrhythmogenic death within a time period of one to two years following the acute event. Therefore, risk stratification post-MI before patient discharge is furthermore mandatory. The spectrum of non-invasive techniques for risk stratification includes the clinical risk profile, measurement of left ventricular global function (LV ejection fraction), the resting ECG (QT dispersion), an ECG stress test (detection and severity of myocardial ischemia), ambulatory ECG monitoring (number and type of ventricular arrhythmias), surface high resolution ECG (detection of ventricular late potentials), measurement of T wave alternans (TWA, alternans ratio), and measurements of the activity and balance of the autonomous nervous system (heart rate variability, baroreflex sensitivity = BRS). Programmed ventricular stimulation (PVS) serves as an invasive risk stratification technique (detection of an arrhythmogenic substrate). The prognostic power of the non-invasive techniques is limited; in general, the prognostic value of a negative test is reasonably high (90 to 100% depending on the test used), whereas the prognostic value of a positive test is rather low (4 to 42% depending on the test used). Combining several non-invasive tests may significantly improve the positive predictive value above 50%, but this goes along with a significant decreases of sensitivity below 50%. Therefore, a combination of several non-invasive tests (detection and exclusion of a large number of low-risk individuals) with the invasive method of PVS (detection of an arrhythmogenic substrate, i.e. a high-risk patient) seems reasonable, as has been convincingly shown by several smaller prognostic studies.

We investigated the association between seropositivity to chlamydial lipopolysaccharide (cLPS) or Chlamydia pneumoniae (CP) and angiographically documented coronary artery disease (CAD), and we examined the relationship between serostatus and markers of systemic inflammation.The potential contribution of CP to atherogenesis is still a matter of debate, and inflammation has been suggested to represent the link between infection and atherosclerotic disease.Subjects age 40 to 68 years were recruited for this case-control study between October 1996 and November 1997: 312 patients with at least one coronary stenosis50% and 479 age- and sex-matched blood donors without manifest CAD or history of angina. Antibodies against cLPS and CP, C-reactive protein (CRP), fibrinogen, plasma viscosity, leukocytes and neutrophils were determined. The study had a power of80% to detect an odds ratio (OR) of 1.55 or above for the prevalence of immunoglobulin (IgG) antibodies against cLPS at a significance level of alpha = 0.05.Prevalence of IgG antibodies against cLPS was not different between cases and controls (61% vs. 62%; p = 0.7). The adjusted OR for the presence of CAD given positive IgG serostatus against cLPS was 0.9 (95% CI; 0.6 to 1.3). Similarly, no difference in the prevalence of IgG antibodies against CP was seen (88% vs. 87%; p = 0.6); the adjusted OR was 1.0 (95% CI; 0.6 to 1.6). Markers of inflammation did not show any statistically significant difference between cLPS seropositives and seronegatives.Our results indicate no strong association between CP and CAD, and increased systemic inflammation in patients with CAD does not seem to be due to seropositivity to cLPS or CP.

In 1963 Baule and McFee used an induction coil to measure magnetic signals produced by the human heart (1). The technique of super conducting technology in a specially shielded room was introduced in 1970 by Cohen and co-workers (2) and further described in 1974 by Lepeschkin (3). The next improvement was the development of gradiometric detection coils that allowed MCG recordings in unshielded laboratories (4–8). In 1974 Siltanen (9) described the current MCG lead system, a standard grid and the normal MCG pattern. Recordings of the His-Purkinje-system by magnetocardiography from body surface were first reported by Farrell in 1978 (10), and ventricular late fields as correlates to ventricular late potentials by Erne in 1983 (11). In 1985 the first three-dimensional localization of abnormal cardiac microfields by MCG was described by Erne (12). Since 1983 isofield contour maps for imaging the magnetic field distribution during cardiac de- and repolarisation have been used routinely (12, 13, 14). In general, among the the pioneers of magnetocardiography the names of Katila (15), Awano (8), Cohen (2), Siltanen (9), Fenici (13), Romani (16) and Erne (11, 12) have to be mentioned in particular, because they have contributed significantly to the technical development and clinical application of modern magnetocardiography.

In patients with mitral (n=77: organic=49, functional=28) and tricuspid regurgitation (n=55: functional=54) quantified by angiography, the temporal variation of the proximal flow convergence region throughout systole was assessed by colour Doppler M-Mode, and peak and mean radius of the proximal isovelocity surface area for 28 cm/s blood flow velocity were measured. Additionally, the peak radius derived from two-dimensional colour Doppler was obtained. About 50% of the patients with mitral and tricuspid regurgitation showed a typical temporal variation of the flow convergence region related to the mechanism of regurgitation. The different proximal isovelocity surface area radii were similarly correlated to the angiographic grade in mitral and tricuspid regurgitation (rank correlation coefficients 0.55-0.89) and they differentiated mild to moderate (gradeor =II) from severe (gradeor =III) mitral and tricuspid regurgitation with comparable accuracy (82-96%). However, moderate mitral regurgitation due to leaflet prolapse in two patients was correctly classified by the mean M-mode radius and overestimated by both peak radii. Only half of the patients showed a typical variation of the flow convergence region related to the mechanism of regurgitation. The different proximal isovelocity surface area radii were suitable to quantify mitral and tricuspid regurgitation in most patients. However, in mitral regurgitation due to leaflet prolapse the use of the mean M-mode radius may avoid overestimation.

Economic evaluation of medical treatment in terms of costs and utility has gained increasing interest within the medical community and in political discussions. In particular this applies for highly prevalent diseases such as coronary artery disease, still the most common cause of death in the western world. Health economy studies can be performed from different perspectives (e.g., hospital, insurance company, society) and with various approaches (e.g., cost-utility analysis, cost minimization). Those will be discussed for the primary prevention of myocardial infarction, coronary stent implantation, and for rehabilitation programs after myocardial infarction, serving as examples. Health-economical analyses provide data to compare treatment strategies beyond a certain speciality. However, economic evaluation is only one step within the medical assessment process and does not per se imply the political allocation of financial resources.