Apoproteins and lipids as discriminators of severity of coronary heart disease.

Serum apoprotein and lipid concentrations were measured in 63 patients undergoing coronary angiography. Thirty-eight patients had 50% or higher grade stenoses, 25 had chest pain, but no significant stenoses. Among the patients with higher grade stenoses 71% had hyperlipoproteinemias as opposed to 12% in patients without stenoses. As compared to suitable normal controls, patients with angiographically documented coronary heart disease showed significant changes in all lipid and apoprotein concentrations under study. However, differences between the two patients groups were also noted. Among these, apo A-I, A-II and B, total cholesterol and LDL cholesterol were statistically significant. These results indicate that apoprotein A and B levels, total cholesterol and LDL cholesterol are good discriminators of the severity of coronary heart disease, while HDL cholesterol is a more suitable parameter for epidemiological studies.

Electrocardiographic detection of left ventricular hypertrophy in the presence of left anterior fascicular block.

The hitherto available electrocardiographic indexes for the detection of left ventricular hypertrophy in the presence of left anterior fascicular block do not provide a reliable diagnosis. Consequently, a new index based on the behavior of the QRS complex in left anterior fascicular block in the frontal and horizontal plane was constructed and its value assessed by echocardiographic measurements. The new index SIII + (R + S) maximal precordial greater than or equal to 30 mm was applied to the electrocardiograms of 50 patients without myocardial infarction and without right bundle branch block, showing a specificity of 87%, a sensitivity of 96%, a positive predictive value of 89% and a negative predictive value of 95%. Echocardiographic measurements were used as reference. Compared with the electrocardiographic indexes used so far (which were also applied to the 50 electrocardiograms), the new index showed a comparable high specificity and a distinctly superior sensitivity. The apparent paradox--why the electrocardiographic diagnosis of left ventricular hypertrophy is easier in the presence rather than in the absence of left anterior fascicular block--is discussed.

[ECG diagnosis of left ventricular hypertrophy associated with a left anterior fascicular block]. / EKG-Diagnose der linksventrikulären Hypertrophie beim Vorliegen eines linksanterioren Faszikelblocks.

The hitherto available ECG indices for the detection of left ventricular hypertrophy in the presence of left anterior fascicular block do not provide a reliable diagnosis. We have therefore constructed a new ECG index, based on vectorcardiographic considerations, and assessed its value by echocardiographic measurements. The new ECG index SIII + (R + S)max precordial greater than or equal to 30 mm, applied to the ECGs of 50 patients without myocardial infarction and without right bundle branch block, showed a specificity of 87.5%, a sensitivity of 96.1% and a positive predictive value of 89.2%.

Hemodynamic changes after angiocardiography with a new low osmolar contrast medium (sodium-meglumin-joxaglat).

We evaluated the hemodynamic effects of sodium-meglumin-joxaglat (Hexabrix) compared to sodium-meglumin-diatrizoat (Urografin 76) after left ventriculography in a double-blind randomized study on 24 patients (12 patients per group). Hemodynamic measurements at rest and the extent of ischemic heart disease were comparable in the two groups. Measurements were made at rest and between the second and third minute, between the fifth and sixth minute, and between the eighth and ninth minute following injection of 0.7 ml/kg of contrast medium into the left ventricle. Additionally left ventricular volumes and ejection fraction of the second and fifth beat following the onset of injection were calculated. The discomfort was graded by the patients on a scale of 1-4. After 3 min there was a significant but comparable increase in right atrial, pulmonary artery, and pulmonary capillary wedge pressure (64, 35, and 61%, respectively for the Hexabrix group and 61, 36, and 58% for the Urografin group). Cardiac index and stroke volume index rose significantly higher in the Urografin group and left ventricular work index increased significantly only after injection of Urografin 76. Ejection fraction decreased 11% in the Hexabrix group and 9% in the Urografin group. The grade of discomfort was 1.83 +/- 1 in Hexabrix group and 2.83 +/- 0.8 in the Urografin group (p less than 0.05). Thus, Hexabrix represents an advance in angiocardiography, both from the subjective and objective standpoint.