Influence of gender on treatment and short-term mortality of patients with acute myocardial infarction in Berlin.

AIMS: Previous studies have shown higher hospital mortality rates in women, especially younger women, than in men. In light of the fact that myocardial infarction therapy is rapidly developing, and since gender-specific aspects have been discussed in detail during recent years, it was our goal to re-evaluate factors influencing hospital mortality rate, especially those involving gender-specific differences, in the city of Berlin, Germany. METHODS: We prospectively collected data from 5133 patients (3330 men and 1803 women) with acute myocardial infarction who were treated in 25 hospitals in Berlin during the years 1999 to 2002. RESULTS: During hospitalization the overall mortality rate was 18.6% among women and 8.4% among men. Women were older (mean age for men 62 years; women 73 years) and less likely to be married (men 74.6%; women 36.9%) than men. Women generally took longer to arrive at the hospital after infarction than did men (median time: men 2.0 h; women 2.6 h). Women furthermore demonstrated a higher proportion of diabetes (men 22.8%; women 36.5%) and hypertension (men 58.0%; women 69.3%). Reperfusion therapy (men 68.8%; women 49.7%) and administration of beta-blockers (men 76.0%; women 66.0%) took place less often for women than for men. A multivariate analysis revealed the following factors to be independent predictors of hospital mortality: age, gender, diabetes mellitus, hypercholesterolemia, pre-existing heart failure, pre-hospital cardiopulmonary resuscitation, cardiogenic shock and pulmonary congestion on admission, admission to a hospital with >600 beds, ST-elevation in the initial ECG, reperfusion therapy, as well as beta-blocker and ACE inhibitor treatment within 48 h of hospitalization. CONCLUSION: Even after adjustment in multivariate analysis, women with acute myocardial infarction still demonstrate a higher risk for in-hospital death than men.

[Comparison of the clinical effect between digoxin and a diuretic in chronic left heart failure and sinus rhythm]. / Klinischer Wirkungsvergleich zwischen Digoxin und einem Diuretikum bei chronischer Linksherzinsuffizienz und Sinusrhythmus.

Because of conflicting results from studies examining the initial treatment of patients with chronic left heart failure (CHF) and sinus rhythm, the clinical efficacy and safety of digoxin and a diuretic were compared in a multicenter, randomised, open twelve-week study. 47 patients with CHF (NYHA II and III) were treated either with digoxin or a combination of hydrochlorothiazide and triamterene. Three patients from the diuretic group and four from the digoxin group required premature termination of study periods because of increasing symptoms of CHF. Both regimens decreased significantly a heart failure score and increased distinctly the symptom-limited exercise tolerance, but results did not differ between the groups. Echocardiographic parameters, ejection fraction and radionuclide indices of diastolic function estimated by gated blood pool scan did not change with either treatment. It was concluded that digoxin or the diuretic therapy alone was effective in ameliorating the clinical signs of CHF. Due to missing differences in the clinical efficacy of both drugs an individual and not schematic treatment regimen of CHF is warranted.

[Sensitivity of the dipyridamole test. A placebo-controlled double-blind crossover study]. / Sensitivität des Dipyridamol-Tests. Eine placebo-kontrollierte Doppelblind-Crossover-Studie.

The sensitivity of the dipyridamole test was examined with the double-blind crossover technique in 30 patients with 2 or 3 coronary vessels disease, treatment-refractory stable angina and positive exercise ECG tests. On two successive days, according to a randomized code, patients received either 0.5 mg/kg dipyridamole or a placebo, both given intravenously. The test was judged to be positive if during or immediately after the injection typical angina occurred which regressed after the subsequent intravenous injection of 0.24 g aminophylline within 3 minutes, or if the ECG showed signs of acute ischemia. The test was judged to be questionably positive if the anginal symptoms regressed spontaneously or later than 3 minutes after aminophylline injection. In a total of 13 of 30 patients (43%) the dipyridamole test was positive, while in a further 4 (13%) it was questionably positive. Ischemic repolarization abnormalities occurred in 9 patients; 5 of them also had positive test signs of angina, in 2 each the results were questionably positive or negative. In 13 patients there were neither anginal symptoms nor ECG changes. Thus the dipyridamole test with its low sensitivity is not suitable for the initial routine diagnosis of coronary heart disease.

[False-positive exercise ECG in women without organic heart disease (author's transl)]. / Falsch-positives Belastungs-EKG bei organisch gesunden Frauen.

Exercise ECGs (bicycle ergometry in recumbency) were obtained in 252 women (aged 20-49 years) without evidence of organic heart disease. In 51 (20%) there was a false-positive change in the ECG with horizontal or descending S-T depression greater than or equal to 1 mm. The frequency of this change increased with increasing age. In group I (20-29 years) it was 5%, in group II (30-39 years) 20%, in group III (40-49 years) 38%. In 34 of the 51 women abnormal repolarisation changes were present even at rest. The S-T depression during exercise in most cases amounted to less than 2 mm and often occurred only on maximum exercise during the first or second minute of the recovery phase. These "ischaemia" changes disappeared in 29 of 41 women after administration of 100 mmol potassium chloride. Nine of 12 women in whom the positive ECG signs persisted after KCl, coronary angiography failed to demonstrate any abnormalities.

[Effect of tricyclic antidepressive agents on hemodynamics and plasms norepinephrine level in man during rest and exertion]. / Wirkung trizyklischer Antidepressiva auf Hämodynamik und Noradrenalinplasmaspiegel des Menschen in Ruhe und unter Belastung

The effects of i.v. injected antidepressants Imipramine (Tofranil, Geigy) and Dimetacrine (Istonil, Siegfried) on cardiavascular functions were investigated in 18 patients at diagnostic cardiac catheterization. 4 patients were additionally studied during ergometric exercise before and 45 min. after application of both thymoleptica. Determinations of noradrenaline plasma concentrations were carried out in 8 patients. The results show of 25 mg (= 22,1 mg free base) Imipramine or 33.5 mg (= 21.4 mg free base) Dimetacrine did not induce significant changes in heart rate and cardiac index. 2. Already 15 min. after application of both drugs a clear increase in left ventricular end-diastolic pressure (LVEP) was observed. Maximal increase in LVEP - in mean, 26% after Imipramine (p less than 0.0005) and 40% after Dimetacrine (p less than 0.05) - was reached 30-45 min, after injection. 3. A simultaneous increase in mean systemic arterial pressure was related to a marked increase in noradrenaline plasma concentration in all 8 investigated patients. 4. After application of tricyclic antidepressant a larger increase in pulmonary arterial enddiastolic pressure was observed during ergometric exercise.

[Red cell mass and plasma volume in chronic cor pulmonale (author's transl)]. / Veränderungen des Erythrocyten- und Plasmoavolumens bei Patienten mit chronisch obstruktiver Lungenerkrankung und Cor pulmonale

Red cell mass and plasma volume were simultaneously measured by Cr51 and J125-albumine, respectively, in 36 patients with chronic obstructive lung disease and cor pulmonale. Additionally, pulmonary function tests and arterial blood gas analyses as well as pulmonary circulatory and right ventricular hemodynamic measurements were performed the same day. Patients were divided into 3 clinical subgroups: 1. a predominantely emphysematous A-type (n =12), 2. a predominantly bronchial B-type (n = 12), and 3. an intermediate type (n = 12) with about equal scores for A and B. With regard to the cardiac state, A-patients were clinically characterized by small ptotic hearts on chest x-ray and the absence of overt cardiac failure during the whole course of illness whereas B-patients generally showed radiological evidence of heart dilatation associated with recurrent episodes of manifest right ventricular failure. Patients of the intermediate type mostly had recovered from cardiac failure. The following results were obtained: 1. Red cell volume, plasma volume, and total blood volume were within normal limits in A-patients and in patients of the intermediate type. A marked hypervolemia in B-patients was almost entirely due to an increased red cell volume. 2. Close correlations of the red cell volume and total blood volume, respectively, to the arterial PO2 as well as to the arterial PCO2 could be established. 3. Total blood volume was significantly correlated to certain hemodynamic parameters, including cardiac output, stroke volume, pulmonary artery pressure, and right ventricular enddiastolic pressure. 4. The quotient body hematocrit/venous hematocrit was lowered to a significant degree as compared to normal subjects. As a consequence, indirect determination of red cell volume and total blood volume from plasma volume and venous hematocrit leads to a consistent overestimation of both parameters, amounting to 28% in the mean for the red cell mass and to 12% for the total blood volume in the present series.

Cardiovascular side effects of tricyclic antidepressants - a risk in the use of these drugs.

Following the increasing use of tricyclic antidepressants, numerous side effects of these drugs are reported, e.g. ECG changes and cases of "sudden death". Because of the fact that haemodynamic studies in man and studies on the possible correlation between the structure of these drugs and their negative inotropic effect are lacking, we have investigated the influence on myocardial contractility of cat papillary muscle induced by impramine and dimetacrin as well as their desmethyl compounds (n = 42). Furthermore, the effects of i.v. administration of imipramine and dimetacrine on cardiovascular functions were investigated in 18 patients at cardiac catheterization. In addition, four patients were studied during ergometric exercise before and 45 min after injection of both drugs. Finally, fluorimetric determination of norepinephrine plasma concentrations were carried out in 8 patients.