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  • 1
    Electronic Resource
    Electronic Resource
    Maintenance of Sinus Rhythm after Cardioversion of Atrial Fibrillation in Patients with Lone Atrial Fibrillation and Patients with Hypertension (1998)
    Oxford, UK : Blackwell Publishing Ltd
    Annals of noninvasive electrocardiology 3 (1998), S. 0 
    Details
    ISSN: 1542-474X
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background: The success rate and prognosis of cardioversion of atrial fibrillation (AF) in patients with organic heart disease is well known. In contrast, little data exist about cardioversion success and maintenance of sinus rhythm (SR) in patients with lone AF and in patients with hypertension as the only underlying cardiovascular disease.Methods: In a prospective cardioversion registry 148 of 181 patients (81.8%) with lone AF (age 58 ± 13 years, duration of AF 7.6 ± 19 weeks) and 120 of 148 patients (81.1%) with hypertension (age 62 ± 10 years, duration of AF 6.6 ± 21 weeks) had successful cardioversion and were followed for 7.7 ± 1.9 months.Results: At follow-up, 120 patients (81.1%) with lone AF were in SR, and 18 of these patients had had repeated cardioversion during follow-up (AF total recurrence rate 31.1%). In stepwise regression analysis, the number of previous cardioversions was predictive of rhythm at follow-up (P = 0.0453). Rhythm at follow-up did not differ between patients who were or were not on antiarrhythmic drugs. At follow-up 96 patients (80%) with hypertension were in SR, and 9 of these had had repeated cardioversion during follow-up (AF total recurrence rate 27.5%). As in lone AF, the recurrence rate of AF did not differ between patients with or without antiarrhythmic drug treatment, and in multivariate regression analysis, the number of previous cardioversions was the only clinical predictor of rhythm at follow-up (P = 0.0284).Conclusions: Even in patients with such benign conditions as lone AF or hypertension as the only underlying disease, the prognosis of cardioversion in terms of maintenance of SR is poor. Future studies of rhythm control versus rate control need to include not only patients with organic heart disease but also patients with lone AF and patients with hypertension, since the long-term benefits of these two strategies remain unclear even in these subsets of patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1542-474X.1998.tb00405.x
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    Paper (German National Licenses)
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  • 2
    Electronic Resource
    Electronic Resource
    Safety and Efficacy of Angiographic Guided Elective Palmaz-Schatz Stent Implantation Without Coumadin: Comparison of Stent Implantation and Angioplasty (1997)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of interventional cardiology 10 (1997), S. 0 
    Details
    ISSN: 1540-8183
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: This study was designed to evaluate the safety and efficacy of routine high-pressure Palmaz-Schatz coronary stenting in patients with symptomatic coronary heart disease with only angiographic guidance without coumadin for poststenting treatment. Intracoronary stenting reduces restenosis rate after coronary angioplasty. High pressure stent deployment with intravascular ultrasound guidance reduces the incidence of stent thrombosis, despite reduction of anticoagulation. However, the feasibility of routine stent implantation with only angiographic guidance and without coumadin for poststenting treatment has not yet been determined. Patients undergoing coronary angioplasty for symptomatic coronary heart disease received stent implantation for abrupt or threatening vessel occlusion, vessel dissection without compromised antegrade blood flow (but at high risk for subacute occlusion and early restenosis), unsatisfactory angioplasty result with 〉 30% residual stenosis, and elective stent implantation in de novo lesions, restenotic lesions, and lesions in bypass grafts. Quantitative coronary analysis was performed before the procedure, immediately after, and at follow-up 6 ± 1 (SD) months later. This patient group was matched for clinical and angiographic characteristics with those patients who underwent balloon angioplasty during the same period. Patients who underwent coronary stenting had larger net gain (1.95 ± 1.0 vs 1.42 ± 0.9; P 〈 0.001) resulting in a larger minimal luminal diameter (2.48 ± 1.19 vs 1.78 ± 1.01; P 〈 0.001) at follow-up as compared with balloon angioplasty. Restenosis, defined as 〉 50% diameter stenosis at follow-up, occurred in 35.0% in the PTCA group and in 16.1% in the stent group (P 〈 0.001). Subacute stent thrombosis occured in one patient (0.8%) due to angiographically evident suboptimal stent expansion. Routine coronary high pressure Palmaz-Schatz stenting with angiographie guidance without coumadin for poststenting treatment represents a safe and effective option in patients with symptomatic coronary heart disease without increasing the incidence of (sub)acute stent thrombosis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8183.1997.tb00040.x
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  • 3
    Electronic Resource
    Electronic Resource
    Hemodynamic and antiischemic effects of intravenous elgodipine, a new dihydropyridine calcium channel blocker, in patients with chronic stable angina (1995)
    Springer
    Cardiovascular drugs and therapy 9 (1995), S. 595-600 
    Details
    ISSN: 1573-7241
    Keywords: elgodipine ; calcium channel blocker ; coronary artery disease ; chronic stable angina ; exercise ; hemodynamics
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Elgodipine is a new second-generation dihydropyridine calcium antagonist. Its hemodynamic and antiischemic properties were evaluated in a single-blind, placebocontrolled trial in 22 males with chronic stable angina. Coronary artery disease was angiographically confirmed. Measurements were performed with a Swan-Ganz thermodilution catheter during a 30-minute period of rest and before the end of a 4-minute bicycle exercise test at maximum individual workload, both with placebo (IV infusion of 5 ml saline over 30 minutes) and elgodipine (10 µg/kg/2 min bolus IV, then IV infusion of 1 µ/kg/min for 28 minutes. Elgodipine caused very similar hemodynamic changes at rest and during exercise. Its major hemodynamic modification was the marked decrease in systemic vascular resistance, which was accompanied by an increase in cardiac index and stroke volume. Mean arterial blood pressure was slightly reduced, whereas the opposite small increase in heart rate meant that the double product remained unchanged. Contrary to resting conditions, pulmonary capillary wedge pressure, pulmonary artery pressures, pulmonary vascular resistance, and mean right atrial pressure remained normal or increased to a lesser extent during exercise after elgodipine. After elgodipine ischemic ST depression during exercise was diminished, and 11 of 16 assessable patients remained free from angina pectoris. We conclude that elgodipine is an efficacious antianginal drug. Its major mechanism of action is lowering of systemic vascular resistance. Thus elgodipine improves systolic cardiac function in patients with chronic stable angina and may delay the onset of ischemic diastolic dysfunction during exercise, as indicated by a normal left ventricular end-diastolic pressure (LVEDP). The data also suggest an improvement in coronary blood flow during exercise.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00878092
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  • 4
    Electronic Resource
    Electronic Resource
    Influence of long-term treatment with ketanserin on blood pressure, pulmonary artery pressure, and cardiac output in patients with heart failure (1990)
    Springer
    Cardiovascular drugs and therapy 4 (1990), S. 85-87 
    Details
    ISSN: 1573-7241
    Keywords: ketanserin ; heart failure ; long-term treatment
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Ketanserin is a selective serotonin2-receptor blocker and by this mechanism decreases peripheral resistance and blood pressure in hyertensives. We examined the hemodynamic effects of ketanserin during long-term treatment in patients with heart failure. Five male patients with coronary artery disease and heart failure (NYHA classes II–III) were treated with ketanserin (80 mg daily) for 12 months. Before treatment, after 4 weeks, and after 12 months treatment, a Swan-Ganz catheter was placed into the pulmonary artery and pulmonary wedge pressure, cardiac output, mean arterial pressure, and heart rate were measured at rest and on exertion. The pulmonary wedge pressure at rest decreased from 8 mmHg before to 6 mmHg after 4 weeks and 12 months treatment; on exertion, it decreased from 31 mmHg before treatment to 24 mmHg after 4 weeks treatment and to 21 mmHg after 12 months treatment. The mean arterial pressure also decreased at rest and on exertion after 4 weeks treatment as well as after 12 months treatment. Cardiac output increased slightly and heart rate was unaltered. No serious side effects occurred. Ketanserin could become an alternative vasodilator drug in the treatment of patients with heart failure.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00053434
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  • 5
    Electronic Resource
    Electronic Resource
    Comparison of the pharmacokinetics and effects on the hemostatic system of saruplase and urokinase in patients with acute myocardial infarction (1996)
    Springer
    Journal of thrombosis and thrombolysis 3 (1996), S. 385-390 
    Details
    ISSN: 1573-742X
    Keywords: saruplase ; urokinase ; pharmacokinetics ; hemostasis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The aim of the study was to compare in a single trial, using identical methodology, the pharmacokinetic properties and the effect on the hemostatic system of saruplase (unglycosylated scu-PA) and urokinase (glycosylated tcu-PA). Twenty-four patients with an acute myocardial infarction were either treated with saruplase (n = 12; 20 mg IV bolus followed by a 60 mg infusion for 60 minutes) or urokinase (n = 12; 1.5 million IU IV bolus followed by 1.5 million IU infusion for 60 minutes). Blood samples from saruplase-treated patients were analyzed for u-PA antigen and total u-PA and tcu-PA activities; those from urokinase-treated patients for u-PA antigen and tcu-PA activity. The effect of treatment on, including recovery of, plasma α2-antiplasmin, fibrinogen, and plasminogen was examined in both groups. The total clearance of urokinase (179 ± 55 ml/ min) is about half that of saruplase (406 ± 154 ml/min), and the mean residence time of urokinase (59.1 ± 22.5 minutes) is nearly twice that of saruplase (28.3 ± 7.8 minutes), which results in a slower elimination of urokinase from plasma. Whether differences in the pharmacokinetic behavior of the unglycosylated saruplase and the glycosylated urokinase observed in this study are due to the difference in glycosylation or to other factors is not resolved. The systemic effect of saruplase on α2,-antiplasmin, fibrinogen, and plasminogen is similar to that of urokinase, although retarded.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00133082
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