[Monitoring of heart function in the treatment with cardiotoxic cytostatic drugs]. / Uberwachung der Herzfunktion bei der Behandlung mit kardiotoxisch wirkenden Zytostatika.

UNLABELLED: It is the purpose of this paper to show the concept of noninvasive assessment of cardiomyopathy (CM) in cytostatic treatment, esp. with daunorubicin A (A). Our follow-up study during therapy with A shows 255 patients, examined by ECG, by systolic time intervals (STI)-PEP/LVET (normal value less than or equal to 0.44) and PEPI (normal value less than or equal to 148 ms) by echocardiography (UCG) with measurement of shortening fraction (SF), normal value less than or equal to 30% and in 6 cases by microcatheter with exercise test. RESULTS: (1) ECG does not predict CM. (2) 23 patients (8%) had abnormal SF in UCG, 6 patients of these having no symptoms of cardiac failure. These patients were examined by microcatheter, all 6 having abnormal values during exercise. So all patients with abnormal SF had objective signs of latent or over CM. (3) PEP/LVET was abnormal in all patients with CM, but false positive in 22% of all investigations, mostly by shortening of LVET. PEPI, abnormal in all patients with CM, was false positive only in 8.8. UCG is the most specific noninvasive method for assessment of CM in cytostatic treatment. STI are less specific, but highly sensitive to CM and therefore a useful screening method. PEPI gives the highest specificity, allowing a better selection than PEP/LVET. STI in contrast to UCG can easily be obtained outside cardiologic centers, ie., in the oncologic department itself. UCG by cardiologic units are needed only about 10-15% of investigations. If all values are abnormal, cardiotoxic treatment should be stopped, even when patients are asymptomatic.

[Functional diagnosis by directional doppler-ultrasound in patients with Raynaud's disease (author's transl)]. / Funktionelle Diagnostik mit der direktionalen Doppler-Untersuchung beim Raynaud-Syndrom.

7 patients with primary and 3 patients with secondary Raynaud's disease were studied by directional Doppler-ultrasound. Flow curves were registered of radial and ulnar artery in rest and during reactive hyperemia following ischemia and muscle work before and under medical treatment. Flow at rest and after provocation was much less than in normal persons. Effect of treatment could be demonstrated, so that this method seems to be very helpful in followup studies of patients with Raynaud's disease.

[Hypertrophic obstructive cardiomyopathy: non-invasive diagnosis by directional Doppler-ultrasound (author's transl)]. / Hypertrophische obstruktive Kardiomyopathie Nicht invasive Disgnostik durch direktionale Doppler-Sonographie.

Directional Doppler-ultrasound has been found to be helpful in detecting disturbances of the left ventricular outflow tract, especially in aortic incompetence. Also in hypertrophic obstructive cardiomyopathy characteristic changes of flow in carotid artery have been demonstrated by directional Doppler-ultrasound, similar to those of the carotid pulse curve. These changes lead to diagnosis but usually do not allow an information about the hemodynamic status of hypertrophic obstructive cardiomyopathy. However, characteristic changes of the flow curve in the subclavian artery -- which are described in this paper -- seem to appear only in severe cases, when an intraventricular gradient was measurable, either at rest or under provocation test. So a combination of two non-invasive methods, echocardiography and directional Doppler-ultrasound of the carotid and the subclavian artery enables us to diagnose hypertrophic obstructive cardiomyopathy and at the same time informs us about hemodynamic conditions.