[The role of invasive procedures in the diagnosis of heart failure]. / Stellenwert invasiver Verfahren bei der Diagnostik der Herzinsuffizienz.

Definition, pathophysiologic aspects and the dynamic of heart failure as well as the increasing of incidence and mortality have been discussed. The main determinants of cardiac function like contractility, preload, afterload, ventricular wall kinetic and neurohumoral factors have been analyzed. It has been shown, that the parameters of contractility in auxotonic phase have more practical significance than parameters of isovolumic phase of contraction. The actual importance of the invasive methods for assessment of pressure and volume parameters in regard to non-invasive techniques has been demonstrated. Depending on the changing of left ventricular filling pressure and cardiac output at rest and during exercise different stages of cardiac failure can be recognized. The importance of hemodynamic monitoring for evaluation of different therapeutic interventions especially in acute cardiac failure has been emphasized.

Enzyme pattern and lipid peroxides in endomyocardial biopsies from patients with cardiomyopathy and myocarditis.

Methods have been developed for measuring several biochemical parameters (isoenzymes of LDH and ASAT, glycogen phosphorylase, lipid peroxides) in extremely small tissue samples (0.2-1.8 mg) taken using a left ventricular biopsy technique. Endomyocardial biopsies from patients with dilative and hypertrophic cardiomyopathy (CMP) and with myocarditis were investigated and compared with a reference group without actual functional and morphological evidence of chronic heart disease. Patients with myocarditis showed the highest activities of LDH and its isoenzymes, ASAT, ASATm and glycogen phosphorylase and the highest concentration of lipid peroxides. In patients with hypertrophic CMP increased activities of glycogen phosphorylase and decreased activities of ASAT and ASATm have been found. In patients with dilative CMP slightly elevated ASAT and ASATm activities have been observed. The results obtained in this study suggest that the parameters investigated could be useful in differentiating between cardiomyopathies and myocarditis.

[Initial clinical experiences with heart transplantation in East Germany]. / Erste klinische Erfahrungen mit der Herztransplantation in der DDR.

An account is given in this paper of first experience from orthotopic heart transplantation. Six of eight patients with transplants have so far survived, with two of these having been in very good general condition for more than a year. All surgical indications were derived from myocardial dilatation. A triple combination of cyclosporine A, prednisone, and azathioprine was used for immunosuppression.

Enzyme pattern in endomyocardial biopsies from patients with chronic heart diseases.

In endomyocardial biopsies from 67 patients with various chronic heart diseases (small vessel disease, cardiomyopathies and hypertensive heart disease) the isoenzymes of Lactate Dehydrogenase (LDH) and Aspartate Aminotransferase (ASAT) and Glycogen Phosphorylase (GP) were investigated and compared with a reference group without actual morphological and functional evidence of chronic heart disease. The analyzed parameters showed characteristical alterations dependent on the degree of hypertrophy of the heart muscle cells and the stage of the disease as assessed by left ventricular enddiastolic pressure (LVEDP), ventricular kinetics, left ventricular heart mass (LVHM) and exercise electrocardiogram. The biochemical alterations found reflect different metabolic situations in the myocardium and could be useful as additional information for assessing the severity of the disease.

Effect of slow-release ISDN on cardiac function in patients with coronary heart disease during bicycle ergometry.

In 10 patients with coronary heart disease (CHD), the effect of a single doses of slow-release isosorbide dinitrate (ISDN) on cardiac function was investigated. Haemo-dynamics was examined by right heart catheterization and thermodilution measurement of cardiac output. After placebo and after 2 and 6 hours with 40 mg ISDN, the heart rate (HR), cardiac index (CI), pressure values in the pulmonary artery (PASP, PAMP, PAEDP) and in the aorta (AoSP, AoMP, AoEDP) and systemic vascular resistance (SVR) were measured at rest and during bicycle ergometry. At rest, PASP and PAMP were significantly reduced only 6 hours after ISDN. Under exercise conditions, significantly reduced pressure values in the pulmonary artery were found 2 and 6 hours after ISDN. AoSP was likewise reduced 2 and 6 hours after ISDN. HR, CI and SVR showed no significant differences compared with placebo values. Thus, an effective reduction of left ventricular preload and afterload was seen in patients with CHD during bicycle ergometry.

[Left ventricular function following transluminal coronary dilatation or operative revascularization in chronic ischemic heart disease]. / Linksventrikuläre Funktion nach transvasaler Koronardilatation oder operativer Revaskularisation bei chronischer ischämischer Herzkrankheit.

To assess changes in resting left ventricular function after reestablishment of myocardial perfusion, echocardiographic studies were performed before, at three resp. six days after as well as three months after successful PTCA in 19 patients and after coronary artery bypass grafting in 20 patients. Reference data were obtained from analog processing of values from 20 healthy control subjects. Baseline values (in addition to primary morphologic criteria) were indicative of a clearly functional selection pattern. As compared with those undergoing PTCA, patients who underwent bypass surgery had more unfavorable values for ejection fraction at rest. Immediately after the intervention, there was a consistent tendency to transiently reduced resting pump function. At three months, however, in both groups, cardiac performance had returned to control values and the global and regional parameters of contractility had either reached or exceeded the preoperative values. The mean values showed more improvement in the PTCA group, a finding most probably attributable to the more favorable baseline situation. Paradoxic septum motion was found frequently in those who had undergone bypass surgery. All patients with grafting to the right coronary artery were included in the latter group. Whether perioperative injury, the varying perfusion conditions or the pericardiotomy is responsible for this phenomenon, remains to be established.

[Hybrid ECG and its clinical significance for the detection of coronary heart disease]. / Das Hybrid-Ekg und seine klinische Bedeutung für die Erfassung der koronaren Herzkrankheit.

451 male patients with typical or atypical angina pectoris syndrome were examined and on account of the degree of severity of the coronary stenosis are subdivided into four groups. With the help of the discriminance analysis of a hybrid ECG (conventional and body surface ECG after Frank) the patients were coordinated to these four groups, in order to test its clinical valency for the recognition of the coronary heart disease. It was stated that in a scalar interpretation of the body surface ECG in every case the conventional leads V3 and/or II after Einthoven must additionally be registered and evaluated. In a scalar and vectorial interpretation of the body surface ECG a significant gain of information was possible only by taking into consideration a great number of scalar parameters of the conventional ECG. The result of the discriminance analysis with the optimum quantity (p = 88) of scalar and vectorial parameters of the two derivation systems contained a correct classification rate of 84.1%, in which case 88.6% of the post-infarction ECG were classified correctly. Neither by means of the conventional nor by means of the body surface ECG after Frank an equivalent result could be yielded. When a computer technology is existing (automatic statement of measuring values with following discriminance analysis) therefore in specialized clinics such a hybrid ECG should be used.

Improved protection in myocardial ischemia by combined prostacyclin administration and intraaortic balloon pumping.

The influence of prostacyclin (PGI2) alone or in combination with intraaortic balloon pumping (IABP) on the levels of energy-rich phosphate compounds was investigated before and after coronary artery ligation in canine myocardium. There was a higher level in creatine phosphate in the ischemic as well as non-ischemic areas of the myocardium after treatment with PGI2, however the most protective effect was registered after a combination of PGI2 and IABP. PGI2 also reduces the release of cathepsin D activity into the blood independently whether or not a mechanical support of the heart after coronary artery ligation was performed.

[Clinical significance of the corrected orthogonal ECG (Frank) in comparison with conventional ECG for the detection of coronary heart disease]. / Die klinische Bedeutung des korrigierten orthogonalen Ekg (Frank) im Vergleich zum konventionellen Ekg für die Erfassung der koronaren Herzkrankheit.

The clinical evidence of the two derivation systems is of the same value concerning the recognition of the coronary heart disease. Their information range does not significantly differ from each other statistically, when scale and vectorial parameters of the corrected orthogonal ECG after Frank are taken into consideration. But in individual cases clear differences may be present, such as the insufficient representation of localized precordial potential losses in the corrected orthogonal ECG. With the help of the discriminance analysis the high number of falsely negative findings of the ECG after resting can be reduced from about 45% to 15% to 20%. Within a diagnostic stage programme from the recognition and care of particularly endangered patients with coronary heart disease the corrected orthogonal ECG is suited, when a discriminance-analytic valuation with scale and vectorial parameters is made. In contrast to the conventional ECG it has the advantage that it is more rapidly and less expensively to be evaluated by computers.

[Measurement of left ventricle asynergy by various measuring procedures. II. Findings in patients with post-infarction states]. / Bewertung von Asynergien des linken Ventrikels durch verschiedene metrische Verfahren. II. Mitteilung: Befunde bei Patienten mit Postinfarktzustand.

In 30 patients with postinfarction condition (11 infarctions of the posterior wall, 11 infarction of the anterior wall, 8 aneurysms of the anterior wall) the regional contraction of the left ventricle was analysed by 3 different metrical methods (semiaxis, surface and angular method) on the basis of the kineventriculogramme in the 1st oblique diameter. With all 3 methods a significant reduction of the mean contraction amplitude could be proved in the affected ventricular region. Using the semiaxis method, in all 30 patients an asynergy could be identified. By the surface method 2 patients with infarction of the posterior wall and 1 patient with infarction of the anterior wall, by the angular method 3 patients with infarction of the posterior wall and 1 patient with infarction of the anterior wall were not established. According to the disturbance of the entire function of the ventricle the number of the segment with disturbed contraction was largest in the group with aneurysm of the anterior wall and smallest in the group with infarction of the posterior wall. Even here the semiaxis method showed the greatest and the angular method the smallest sensitivity.

[Evaluation of asynergies in the left ventricle using various metric methods. I. Findings in patients with normal heart function]. / Bewertung von Asynergien des linken Ventrikels durch verschiedene metrische Verfahren. I. Mitteilung: Befunde bei Patienten mit normaler Herzfunktion.

The delimitation of regional disturbances of contraction of the left ventricle (asynergies) demands knowledge of the behaviour of the contraction of the normal left ventricle. For the exact recognition of asynergies and for scientific inquiries in these cases the use of objective metrical methods is necessary. Therefore, in 14 patients without organic heart disease the behaviour of the regional contraction of the left ventricle was determined on the basis of the cineventriculography according to three different metrical methods (semiaxis, surface and angular method). For all 3 methods in the first oblique projection of 30 degree a larger mean amplitude of the contraction of the anterior wall was the result in contrast to the posterior wall. Consequently, different borderline regions for the anterior wall and the posterior wall must be established for the delimination of asynergies.

[Function of the left ventricle in pacing-induced angina pectoris]. / Funktion des linken Ventrikels unter frequenzinduzierter Angina pectoris.

In 48 patients with angiographically ascertained coronary arteriosclerosis and 15 patients with unconspicuous cardiac findings a complete pressure-flow-volume-analysis of the left ventricle in rest and under artificial atrial tachycardia (atrial pacing) was carried out. In 26 patients with coronary arteriosclerosis a typical angina pectoris could be induced, however, in this group a specific constellation of the findings of the initial values was not present. Under influence of angina pectoris an increase of the disturbances of the regional contraction, connected with a significant decrease of the ejection fraction and of the isovolumetric contractibility parameter Vpm. Apart from this a significant increase of the enddiastolic ventricular pressure and of the quotient deltaP/deltaV in the diastole as a sequel of a decreased distensibility of the ventricle was found. In one part of the patients as an expression of the efficacy of the Frank-Starling-mechanism also the enddiastolic volume increased. Altogether a broad spectre of the functional changes was the result, the direction and degree of severity of which could not be foreseen according to the adequate findings in rest.

[Isoenzyme diagnosis in the clinical course of acute myocarial infarct]. / Isoenzymdiagnostik bei der Verlaufsbeobachtung des akuten Myokardinfarktes.

For the observation of the course of the disease of patients after an acute myocardial infarction by the estimation of the isoenzymes of the LDH (LDH-H and LDH-M) the possibility of the repeated four- to eight-hour-measurement of these isoenzymes in larger groups of patients after myocardial infarction is given. Instances of the use during the observation of the course of the disease after acute myocardial infarction are discussed. In which cases at the same time the isoenzymes of the LDH (LDH-H and LDH-M) as well as of the CK (CK-MB) were repeatedly estimated.

On the problem of optimum digitlaization in man.

The low therapeutic index of cardiac glycoside requires an optimum individual digitalization. This is also a difficulty in the case of known serum glycoside concentrations because individual differences of biochemical and physiological factors (which influence both therapeutic and side effects) are important. As a rule the physician's criterion for an optimum digitalization is that side effects are avoided. This investigation attempted to find a measure for the effect of glycosides by noninvasive recording of parameters of myocardial contractility (systolic time intervals, STI). The measurements were made under oral digitalization with digoxin (Dilanacin). The serum glycoside concentration was determined by the radioimmunoassay method. The changes in STI were investigated in the rage of 1 to 3 ng digoxin per ml serum. In this concentration a significant correlation was demonstrated between STI shortening and glycoside level. It was found that the shortening of STI was maximum at the lowest concentration (1 ng/ml). It appears that the control of STI is for the physician a useful aid for an optimum digitalization in man.

[Hemodynamics of the left ventricle during myocardial infarct]. / Hämodynamik des linken Ventrikels beim akuten Myokardinfarkt

It is issued from the fact that in acute myocardial infarction depending on expansion and localisation of the necrosis, on the degree of the possible functional adaptation of the not-affected myocardium or its previous injury must be reckoned with different changes of the haemodynamics. The sufficient judgment of the function of the left ventricle which is necessary for a differentiated therapy is possible only by the combination of several haemodynamic parameters. First results of direct measurements of pressure and volume of the left ventricle in patients with acute myocardial infarctions are demonstrated. Two types of haemodynamic constellation and their therapeutic influence are demonstrated. By the provable applanation of the functional curve of the left ventricle a change of the optimum working points develops; a secure differentiation between the reduction of the contractile function and reduced diastolic distensibility, however, is not only given on account of the displacement of the functional curve of the left ventricle. The results show that for a haemodynamic monitoring apart from the direct or indirect determination of the filling pressure of the left ventricle a practicable measurement of the cardiac output which must be repeated several times is necessary for an aimed therapy from haemodynamic aspects.