[Correlation of TEI Index and invasive parameters of rightheart function in PAH]. / Korrelation des Tei-Index mit invasiv ermittelten Parametern der Rechtsherzfunktion bei Patienten mit pulmonaler Hypertonie.

BACKGROUND: The reduction of right ventricular function characterizes patients with severe pulmonary hypertension (PAH). Monitoring right ventricular function therefore is important. Echocardiography is the method of choice for this purpose. The so called Tei-Index seems to be an adequate diagnostic tool with prognostic relevance. We here compared Tei-Index with parameters of right heart catheterization in patients with PAH. PATIENTS AND METHODS: Tei-Index was calculated in 42 patients from the sum of isovolumetric contraction time and relaxation time divided by ejection time. A right heart catheter was performed the same day and pulmonary arterial mean pressure (PAPm) as well as pulmonary arterial resistance (PAR), central venous saturation (SVO (2)), central venous pressure (ZVD) stroke volume (SV) and right ventricular ejection fraction (RVEF) were recorded. RESULTS: Correlation were observed between in each case Tei-Index and RVEF (r = - 0.72; p < 0.001), SV (r = - 0.52; p < 0.001), ZVD (r = 0.65; p < 0.001) and SVO (2) (r = - 0.58; p < 0.001). Tei-index did not correlate with PAPm and PAR. CONCLUSION: Correlations of Tei-Index with parameters of right ventricular function derived from right heart catheterization support the usefulness of 2D-doppler echocardiography for monitoring right heart function in PAH patients.

Factors influencing breath condensate volume.

Analysis of breath condensate (BC) has received interest recently due to the need for easy and repetitive monitoring or airway and pulmonary disease. While many authors have used custom built systems, commercial systems are now available and will probably be used more widely. Early studies of markers and mediators in BC have reported concentrations following varying periods of sampling time. However, factors that influence the generation of BC have not been analysed and it is unclear whether breathing rate, tidal volume, lung function, body weight, height or age influence the amount of BC collected. We therefore studied the influence of these factors on breath condensate volume and breath condensate urea and protein concentrations in 22 healthy volunteers and 23 COPD patients. A strong correlation of total respired volume and breath condensate volume was observed for both groups (volunteers: r=0.952, p < 0.0001, COPD: r=0.883, p < 0.001) while no significant correlation existed for breath condensate volume and TLC, RV, Vc, FEV1, R(tot), height or body weight, As long as ventilation remained fairly constant, breath condensate volume increased linearly with time. The fraction of breath condensate extracted from total vapour contained in the exhalate was estimated by measuring relative atmospheric humidity before and after the collecting tube. The amount calculated by the change in temperature and saturation corresponded closely to the amount actually collected. We conclude from these results that breath condensate volume is primarily dependent on V(E), and does not seem to depend on lung function parameters. For standardisation it is suggested to report breath condensate measurements per volume respired. Both, urea and protein are present in measurable quantities in breath condensate and protein as well as BCV may be helpful denominators for comparison with e.g. cytokines in lung disease.

Prolonged oral L-carnitine substitution increases bicycle ergometer performance in patients with severe, ischemically induced cardiac insufficiency.

Acute and chronic L-carnitine application exerts protective effects in a number of cardiac diseases. These favourable effects are attributed to improvements of the energy metabolism and have been found both in animal experiments and in man. In order to investigate the effect of long-time oral L-carnitine substitution on physical performance, 41 patients suffering from class NYHA II or III cardiac insufficiency were recruited for a clinical study. Following the double-blind, randomized, placebo-controlled design of the study, 20 patients were given 3 x 1 g L-carnitine daily for 120 days whereas the control group (21 patients) received placebo. Bicycle ergometer tests were used to determine maximum performance, systolic and diastolic blood pressure, heart rate, and ST changes. Four series of tests were carried out: on day 0 (before the first substrate application), on the 60th and the 120th day (during L-carnitine or placebo application), and on the 180th day (60 days after the end of substitution). A significant improvement in performance (significantly higher maximum performance during bicycle ergometry) could be found within the carnitine group on the 60th and 120th day of L-carnitine application; and haemodynamical parameters showed a tendency to improve, too. These effects, which were attributed to L-carnitine, could be detected even 60 days after the end of substitution. No corresponding changes were found in the placebo group. The findings presented in this paper support suggestions of other authors that L-carnitine in combination with the usual medication (digitalis, beta-blockers, calcium antagonists, nitrates) improves performance and effort tolerance in patients with cardiac insufficiency. Moreover, the findings suggest a favourable long-term effect, which lasts beyond the actual L-carnitine application, on the performance of patients with advanced cardiac insufficiency.

[Videodensitometry analysis of stomach wall motility--presentation of a new method]. / Videodensitometrische Analyse der Magenwandmotilität--Vorstellung einer neuen Methode.

The videodensitometry is a suitable method for recording the gastric wall motility. It provides biosignals amenable by computer. There are no special demands to any organic form or kind of contraction. The asymmetry of the stomach makes no difference, therefore. The hitherto usual manometry will not be superseded. Both methods complete themselves in an ingenious manner. The radiation exposure by videodensitometry can be diminished by modifying the system for image causation.

Selenium in cardiology and angiology.

The effect selenium in the form of sodium selenite on central hemodynamic conditions and coronary artery flow was studied in pig hearts infarcted by a ligature of the ramus interventricularis anterior. Infusions of sodium selenite solutions at levels of 1-3 mg/kg body wt improved the survival of infarcted pigs. Both short-term and long-term protective effects of selenite could be demonstrated. It is of potential therapeutic importance that sodium selenite administration suppresses the electrical vulnerability of the cell membrane, notably the occurrence of ventricular late potentials in the ischemic border zone. Coronary blood circulation, as evidenced by an increase of heart rate and coronary artery dilatation and peripheral vasodilation was also improved. The pulsatile coronary blood flow thus is altered, increasing total perfusion of the infarcted heart. Initial observations with human subjects suggest that selenium deficiency is a factor in the pathogenesis of ischemic and arteriosclerotic heart disease. In 54 hospitalized patients with clinical diagnosis of acute myocardial infarction, serum selenium levels were 670 +/- 266 nmol/L, as compared to 981 +/- 209 nmol/L in 93 healthy controls. In 32 patients with general arteriosclerosis, the serum Se level was 375 +/- 85 nmol/L, in 64 patients with arteriosclerotic occlusional disease in the leg region, 366 +/- 85 nmol/L, respectively. Serum selenium levels of healthy subjects were found to be age- and sex dependent. In men, the selenium concentrations reached maximum levels of 1083 nmol/L in the 41-50 y age group. In women in the same age group, the serum Se level was 1385 nmol/L. Evidence is presented to suggest that selenium is preventing oxidative damage of heart cell membranes by lipid peroxidation.

[Behavior of late ventricular potentials in acute experimental myocardial ischemia]. / Verhalten ventrikulärer Spätpotentiale während akuter experimenteller Myokardischämie.

Locally retarded depolarizations of the ischaemic myocardium are regarded as frequent trigger mechanisms of dangerous ventricular arrhythmias. Up to now, however, there are scarcely systematic investigations concerning their concrete developmental conditions in man, since late potentials can be made evident only by means of expensive invasive methods or signal mediation techniques. Therefore, an animal model should be built, which is suitable for the control of new therapy conceptions with antiarrhythmic drugs. The investigations were performed on 22 pigs in whom under insufflation anaesthesia altogether 10 pressure, flow and contractility parameters as well as 6 epicardial ECG signals were continuously recorded. The episodes of ischaemia were caused by LAD occlusions of different duration and intensity. Typical late potentials could be registered in 5 animals who all had survived complete interruptions of the coronary blood flow of longer than 10 min. The mean duration of the late potentials was 20 +/- 9.2 ms, their amplitudes reached from 150 to 600 microV. Also with regard to time and cycle constancy, the delay of the late Q-potential and the morphology they corresponded to the homogeneous phenomenon, known from man. They always could be derived only from electrodes outside the immediate zone of ischaemia. Neither partial occlusions nor complete interruption of the coronary blood flow in intervals shorter than 10 minutes led to the development of a late potential. The animal model used altogether appears very suitable to investigate the medicamentous influencibility of arrhythmogenic areas of the myocardium under direct control of the dynamic behaviour of ventricular late potentials.

[Application of therapy with atrial controlled ventricular pacemakers with shortened AV delay time]. / Applikative Aspekte der Therapie mit vorhofgesteuerten Ventrikelschrittmachern (VAT) mit verkürzter AV-Verzögerungszeit.

For the reduction of the functional obstruction of the left-ventricular outflow in hypertrophic obstructive cardiomyopathy since 1978 in selected cases conventional VAT cardiac pacemakers with shortened AV retardation time have been implanted. On the basis of 4 casuistics the insufficient adaptation of these systems to unexpectedly appearing disturbances of the cardiac rhythm is demonstrated. Thus already extreme sinus bradycardias lead to parasystole by the unchangeably given asynchronous basic frequency of the pacemakers. Furthermore, all tachycardiac supraventricular arrhythmias and retrograde atrium activations evoke haemodynamically unfavourable and partly even threatening ventricular tachycardies caused by the pacemakers. Control ECG made under these conditions are frequently inexactly interpreted by the continuing intact natural AV conduction and technical defects of the pacemakers are assumed. The individual diagnostic steps necessary for the assessment of the function of the devices and the inevitable immediate therapeutic measures are, therefore, explained. Finally the demands to more modern differentiated physiological pacemaker systems are derived which should be used in patients with hypertrophic obstructive cardiomyopathy.

[Atrial synchronous ventricular stimulation with reduced a.v. delay time as a therapeutic principle in hypertrophic obstructive cardiomyopathy]. / Vorhofsynchrone Ventrikelstimulation mit verkürzter a.v. Verzögerungszeit als Therapieprinzip der hypertrophischen obstruktiven Kardiomyopathie.

For the hypertrophic obstructive cardiomyopathy with left-ventricular pressure gradient in rest a causal therapy is nowadays not yet known. Therefore, it should be tested, in what respect from former observations over reductions of the pressure gradient by an untimely foreign excitation of the ventricles from the apex of the right ventricle a therapy principle can be derived. For this purpose out of a group of 84 patients by left-right heart catheterization, coronarography, computer cardio-tomography and scintigraphy of the myocardium 23 test persons with typical hypertrophic obstructive cardiomyopathy and a left-ventricular gradient in rest greater than or equal to 30 mm Hg were selected for the transitory electrostimulation. After placing of one electrode in the right atrium and another one in the right ventricle one after another a VOO-, VAT- and DOO-pacing were used. For the two last mentioned forms of stimulation as electronic atrio-ventricular retardation times 100, 40, 20, 10 and 5 ms were selected. With all three kinds of stimulation in 5 of the patients (group A) reductions of gradients greater than or equal to 51% and in 12 cases of hypertrophic obstructive cardiomyopathy (group B) diminishments between 30 and 50% could be obtained. Only in 6 patients (group C) reductions of less than or equal to 29% were registered. The optimum of prematurity necessary for obtaining maximum pressure reductions is individually different, but is almost in every case between 5 and 20 ms. Further seven parameters measured during the stimulation phases showed that these reductions are not caused by a decrease of the stroke volume, but by an enlargement of the effective opening of the outlet. Apparently, in a part of the patients with hypertrophic obstructive cardiomyopathy by the foreign excitation from the apex of the ventricle a temporary and spatial course of excitation can be induced, by means of which the degree of functional stenosing is decreased. Since for several patients the removal of the disturbance of the systolic function is to be regarded as therapeutically reasonable partial success, the transitory diagnostic pacing is recommended for all patients with typical hypertrophic obstructive cardiomyopathy and a gradient in rest greater than or equal to 30 mm Hg. The indications and technical prerequisites for a permanent electrostimulation with suitable systems are represented.

Cadmium, cobalt, chromium, and experimental myocardial infarction.

In the case of experimental heart muscle infarction, the infarcted tissue of 18 pigs had a cadmium content of 0.38 µg/g dry weight and a cobalt content of 0.45 µg/g dry weight. In 25 non-infarcted pig hearts, the cadmium concentration amounted to 0.27 µg/g dry weight and the cobalt concentration to 0.37 µg/g dry weight. Thus, as far as the infarcted heart muscle tissue is concerned, there is a highly significant increase in the cadmium content (p<0.01) and a significant increase in cobalt content (p<0.05) compared to a non-infarcted heart. No differences were established with regard to chromium concentrations.

[Quantitative measurement of arterial flow by means of directional Doppler technic in hemodynamic animal experiments]. / Untersuchungen zur quantitativen Erfassung arterieller Strömungen mit der direktionalen Dopplertechnik im hämodynamischen Tierexperiment.

The usability of the continuous ultrasonic Doppler-method for the measurement of the blood flow in the haemodynamic animal experiment was tested. For this purpose measurements at the ascending aorta and the commune carotid artery were performed on different current conditions and compared with the electromagnetically registered blood flow. The causes for the non-conformity are discussed.

[The effect of early appearing extrasystoles on systemic and coronary circulation]. / Zum Einfluss von früh einfallenden Extrasystolen auf System- und Koronarkreislauf.

In 10 anaesthesized dwarf pigs with an open thorax the effects of extrasystoles on systemic and coronary circulation were investigated. The actual effect of an extrasystole depends on the time of its onset. Early extrasystoles hamper the cardiac blood perfusion, with decreases in the stroke volume, mean arterial pressure, coronary blood flow, and elevation of coronary resistance. Extrasystoles setting on later are of minor haemodynamic and coronarodynamic importance. The effects of bigeminy and 2:1 extrasystolia are more adverse than the consequences of extrasystoles with later onset. With cumulation of several consecutive extrasystoles also adverse the haemodynamic coronarodynamic sequelae increase, in dependence on the magnitude of the quotient coupling time /extrasystolic excitation period [ greater than 1.1], or of the quotient: duration of pre- and postextrasystolic intervals/ normal interval of heart action [ greater than 1.5]. The authors point out the importance of haemodynamic findings during early extrasystoles in ischaemic heart disease.

[The effect of cardiovascular hypertrophy on the work capacity of hypertensive patients]. / Der Einfluss der kardiovaskulären Hypertrophie auf die Leistungsfähigkeit von Hypertonikern.

Hypertensive persons with pathological ECG in rest compared with healthy persons and hypertensives with normal ECG in rest show a significantly decreased physical efficiency. In hypertensives in stage II disturbances in form of references to a stress heart insufficiency, to a stress coronary insufficiency and a circulatory dysregulation are the cause of the disturbed function of the circulation. Thus the pathological ECG in rest in the hypertensive is an important diagnostic and prognostic criterion for practice.

[Behavior of cardiopulmonary function in hypertonics under ergometer load]. / Das Verhalten der kardiopulmonalen Funktion bei Hypertonikern unter Ergometerbelastung.

In 56 male hypertensive patients a complex cardiopulmonary functional diagnosis was performed in rest and under ergometer load. The total functional capacity of the hypertensive patients is decreased already in the early stage and also in juvenile age, compared with healthy persons. Furthermore disturbances of the regulations of the minute output of the heart, hypertensive stress reactions, disturbances of the coronary blood supply and disturbed functions of the myocardium are provable.

[Importance of continuous recording of vascular resistance]. / Die Bedeutung der fortlaufenden Registrierung des Gefässwiderstandes

The behaviour of resistance in the periphery of the circulation and in the organic regions underlies different influences. Depending on the function of the organs, on the situation of heart and circulation and on the therapeutic influences the vascular resistance changes. To the study of the dynamics of the behaviour of resistance particularly the continuous electronic recognition is suitable. The gain of time and information is great. Especially for the determination of the coronary perfusion in different functions of heart and circulation the continuous registration of the vascular resistance is necessary. Its importance was as an example demonstrated for the left-ventricular ejection resistance and for the left- and right-coronary influx resistance.

[Assessment of the coronary circulation regulation by means of the so-called isometric contraction index]. / Die Beurteilung der Herz-Kreislauf-Regulation mit dem sog. Anspannungsindex

The index of isometric contraction formed from the quotient period of isometric contraction in the erect position by period of isometric contraction in lying position gives the possibility to separate between cardially sufficient and cardially insufficient patients with adequately disturbed regulation of the cardiac circulation. The recognition of early stages of the disturbed left-ventricular function is possible. The use of an adequate exact technique in gaining the primary data is to be presumed. Corrections of the frequency of the index of isometric contraction do not improve the evidence. In the borderline region of the index of isometric contraction with values between 1.03 and 1.1 in questionable cases a further differentiation into still normal or already latent insufficient will do by the analysis of the trend of the index of isometric contraction after the application of medicaments. The determination of the change of the direction of the index of isometric contraction after peroral application of nitroglycerin would be justifiable in routine work after the recognition of the initiaction increases in patients with latent heart insufficiency, in patients with a healthy heart it decreases. The clinical value of the index of isometric contraction as a simple test of the circulatory function is highly to be estimated.

[Vetorial presentation of left-ventricular pressure parameters for the assessment of ventricular function]. / Die vektorielle Darstellung von linksventrikulären Druckparametern zur Beurteilung der Ventrikelfunktion

The ventricle function can be established by the vectorial description of left-ventricular pressure parameters or flow sizes, respectively. The vector diagrammes result from the momentaneous pressure within the ventricle on the X-axis and the differentiated pressure curve or the aortic flow, respectively, on the Y-axis. Well surveyable from the vector loop received (LVP/dp/dt) are established dp/dtmax, dp/dtmin, LVPmax, LVEDP as well as the tg of the pressure increase speed or the pressure decrease speed, respectively, pro developed pressure. By way of example medicamentous changes of the vector diagrammes were induced and the parameters mentioned established. The vectorial demonstration of the left-ventricular haemodynamics seems to give additional informations concerning the phase of centraction and relaxation

[Electronic processing of intravascular by measured blood pressure]. / Elektronische Verarbeitung des intravasal gemessenen Blutdrucks

With the help of electronic processing of measurement values the possible information content of the dynamic blood pressure measured by means of the electromanometer is explained. Commericial writing systems and pressure changers are supplemented by self-constructed and especially dimensioned additional devices. Partly in connection with flow sizes by multiplication, division, addition, subtraction, differentiation and integration from pressure values special references to the behaviour of the haemodynamics of certain parts of the circulation are to be obtained. This is explained by examples. In addition to this the authors deal with the systolic and diastolic indication of blood pressure important for haemodynamic measuring programs, with the electronic mean value formation, with the limitaor connection for the indication of the enddiastolic ventricular pressure as well with the short-term accumulation. The electronic processing of the intravasally measured blood pressure as well as of flow values is necessary for analyses of the circulation.

[Cardiopulmonary diagnosis in patients with ischemic heart disease]. / Kardiopulmonale Diagnostik bei Patienten mit ischämischer Herzkrankheit

It may be established that the complex cardiopulmonary functional diagnostics in patients with chronic ischaemic heart disease obtained the following essential results: 1. The ergometrically achieved total functional capacity is clearly decreased in all age groups compared with the healthy persons, the differences are highly significant. 2. The proof of a coronary insufficiency got by the electrocardiogram after work is to be regarded as a factor limiting the functional capacity. 3. 72% of the patients reveal under load a PAEDP increased more than the normal of 25 Torr. After exclusion of a respiratory insufficiency these findings must be regarded as a disturbed myocardial function. 4. Thus the increased PAEDP under load apart from the well-known triad (angina pectoris under load, decreased total functional capacity, pathological ECG after work) is a sensitive and decisive factor for proving the disturbed cardial function in chronic ischaemic heart disease.

[The value of the diastolic pulmonary arterial pressure for the estimation of the cardiac functional capacity in patients with myocardial infarct].

From 4 weeks to several months after infarction the patients revealed an altogether clearly decreased total physical functional capacity compared with healthy persons. Behaviour of pulse and blood pressure as well as ventilatory indices in comparable Watt-degrees did not reveal any significant differences compared with persons with a healthy heart. The stroke volume pro surface and the heart-time-volume did also not reveal any determinable deviation concerning the mean values compared with normal persons. In patients with compensated infarction the pulmonary arterial pressure in rest was, as a rule, within the normal. However, under load it increased more than in healthy persons. Patients with decompensated infarction revealed a PAEDP in rest between 20 and more than 30 Torr. The question about a critical PAEDP under load should further be pursued. The ECG gives reliable limiting findings in functional examinations.