Prediction of survival after out-of-hospital cardiac arrest: results of a community-based study in Vienna.

The objective of this study was the assessment of out-of-hospital cardiac arrest and the definition of possible predictive factors for final hospital discharge. Out of a database of 89,557 consecutive missions of the Vienna emergency medical system (EMS) during 1990, there were 623 missions due to a collapse of non-traumatic origin: in 374 cases (60.0%) the patients were declared dead without further attempts at resuscitation. The remaining 249 patients were analysed for predictive factors at site. Survival to hospital admission: 109 patients survived to hospital admission (43.7%); bystander support had a small impact (P < 0.05) on survival to hospital arrival whereas age and gender had no predictive power. Most patients with ventricular tachycardia/fibrillation (VT/VF) survived primarily (69 of 117, i.e. 59.0%). Survival to hospital discharge: 27 patients were discharged from hospital care (10.8%). ECG findings on arrival of the EMS physician at the site proved to be the only powerful predictor for survival: 24 of 117 patients with VT/VF survived compared with only one of 81 with primary asystole, two of 39 with severe bradycardia, and no patient with electromechanical dissociation.

Cardiac involvement in myotonic dystrophy, Becker muscular dystrophy and mitochondrial myopathy: a five-year follow-up.

OBJECTIVE: To assess the progression of cardiac involvement (CI), defined as 'definite', 'possible' or 'absent', based on history, clinical examination, electrocardiography, 24 h ambulatory electrocardiography and transthoracic echocardiography in patients with myotonic dystrophy (MD), Becker muscular dystrophy (BMD) and mitochondrial myopathy (MMP) over five years. DESIGN: An investigational, follow-up study. SETTING: A neurological and cardiological department in Austria. PATIENTS: Thirteen patients aged 29 to 60 years with MD, five patients aged 23 to 68 years with BMD and 10 patients aged 24 to 73 years with MMP. MAIN OUTCOME MEASURES: Muscular disability score, CI score and sum of abnormality score. RESULTS: Five patients (two with MD, one with BMD, two with MMP) died during the observational period, one died presumably from rhythm abnormalities. One patient refused to join the follow-up. At baseline/five years later, CI was 'definite' in 12/10, four/four and six/three; 'possible' in one/one, one/zero and three/four; and 'absent' in zero/zero, zero/zero and one/zero of the patients with MD, BMD and MMP, respectively. The most frequent abnormal investigations at baseline/five years later were the history (BMD/MD), the electrocardiogram (MD/MD) and the echocardiography (MMP/BMD). The mean number of abnormalities per patient with MD, BMD and MMP at baseline/five years later was 4.5/4.8, 5.6/8.3 and 4.1/3.4, respectively. CONCLUSIONS: CI is a frequent finding in patients with MD, BMD and MMP, but progression of CI within five years is found only in single cases. Patients with MD, BMD or MMP should be cardiologically investigated and treated only if CI becomes symptomatic, or if severe electrocardiographic or echocardiographic abnormalities are present.

[201-Thalium scintigraphy of the myocardium under conditions of rest and exercise (author's transl)]. / Die 201-Thalliumszintigraphie des Myokards unter Ruhe- und Belastungsbedingungen.

The results of 201-Thallium myocardial scintigraphy at rest and after stress conditions in 30 patients are discussed. Among those there were 4 patients without cardiac disease, 7 patients with anterior wall scars after transmural infarction, and 19 patients with coronary heart disease and at least one coronary stenosis greater than 75%. The obtained results were compared to findings in coronary angiography and perfusion scintigraphy. The noninvasive method of 201-Thalliumscintigraphy shows a good correlation to the results of invasive investigations when performed at rest and under stress conditions. It enables greater sensivity and specifity in selection of patients with coronary heart disease compared to stress electrocardiography alone.

[The accuracy of 201 thalium scintigraphy of the heart under conditions of stress (author's transl)]. / Sensibilität des 201 Thalliumszintigramms des Herzens unter Belastungsbedingungen.

The results of 201 thalliumszintigraphy under stress condition in patients with coronary heart disease with or without myocardial scars have not been uniform. We could show that pathologic stress szintigrams were only found in patients with a singular stenosis in one branch of the left coronary artery. In all those cases who had similar stenosis in both branches of the left coronary artery the stress szintigram appeared to be unchanged or normal. Therefore an unchanged stress szintigram allows no conclusion on the condition of the coronary arteries. A normal stress szintigram can be found as well in patients with normal coronary arteries as in patients with severe coronary heart disease. The examination of 201 thallium szintigrams under stress conditions therefore needs some critical evaluation.

[Negative and positive imaging of myocardial infarct]. / Negative und positive Darstellung des Myokardinfarktes

In 41 patients myocardial scintigrams were performed using 2 mCi 201T1 and 15 mCi 99mTc-diphosphate. 9 healthy persons showed no myocardial imaging with 99mTc-diphosphate and normal 201T1 scintigrams. Transmural infarctions could be documented by both isotopes, excepted lateral and apical infarctions which could only be shown by means of 99mTc-diphosphate. Non-transmural infarctions could not be identified, myocardial scars however--as was to be expected--showed only activity defects within the 201T1 scintigrams without corresponding images in the 99mTc-diphosphate scans. One patient with severe coronary heart disease showed diffuse diphosphate uptake all over the myocardium with normal 201T1 scintigram. The combined myocardial scintigraphy provides a better diagnosis, enabling an improved localisation of infarction and avoiding misinterpretations.

Isolated left ventricular abnormal trabeculation in adults is associated with neuromuscular disorders.

BACKGROUND: Isolated left ventricular abnormal trabeculation (ILVAT) is defined as > 3 coarse trabeculations of the left ventricular wall, apically to the papillary muscles, in hearts without congenital malformations. HYPOTHESIS: The aims of the study were to assess by echocardiography the prevalence of ILVAT, to confirm the diagnosis by cardiac magnetic resonance imaging (CMRI), to look for cardiac findings in ILVAT, and to determine whether ILVAT is familial and associated with neurological disorders. METHODS: During a 1-year period (July 1995 to July 1996) all patients in whom transthoracic echocardiography visualized ILVAT, were included in the study. The examination and measurements were performed according to established guidelines. RESULTS: During 1 year, ILVAT was found in 6 of 3,397 patients (0.2%). When applied, CMRI confirmed ILVAT. Four patients had heart failure, all had electrocardiographic (ECG) abnormalities. None of the investigated relatives showed ILVAT. One patient had Becker's muscular dystrophy, three had mitochondrial myopathy, one had polyneuropathy, and one had muscle wasting of unknown origin. CONCLUSIONS: Isolated left ventricular abnormal trabeculation is rare, visible on echocardiography and CMRI, associated with ECG abnormalities, sometimes with heart failure, and always with neuromuscular disorders. Thus, when ILVAT is found, the cardiologist should consider a neurology referral.

[Measurement of pulmonary artery pressure at rest during volume loading for assessment of ventricular function in coronary artery disease (author's transl)]. / Pulmonalarteriendruckmessung in Ruhe während Volumsbelastung zur Beurteilung der Ventrikelfunktion bei koronarer Herzkrankheit.

Measurements of pulmonary artery (PA) pressure at rest with volume loading of the heart was carried out in a semirecumbent position by standardized positioning of the legs (Positioning test) in 44 patients with angiographically-proven severe coronary artery disease (CAD). The patients reacted differently and were accordingly assigned to one of the three following groups: Group I (23 patients) with normal PA pressures values showed normal results on ventriculography and accordingly, a normal ejection fraction. Group II (13 patients) showed a pathological increase in PA pressure by volume loading. Ventriculography showed hypo- or akinetic areas, with accordingly reduced ejection fraction already at rest. Group III (8 patients) showed pathological PA pressure values already at rest, in accordance with the ventriculographic existence of larger akinetic areas and a marked reduction in ejection fraction. Coronary morphology per se showed no correlation with PA pressure behaviour during volume loading at rest. Therefore, PA pressure measurement in the standardized positioning test can give a relatively accurate estimation of the functional state of the left ventricle, while statements about coronary morphology in CAD are not permissible.

[A case of chronic pulmonary hypertension after fenfluramine intake]. / Ein Fall von chronischer pulmonaler Hypertonie nach Fenfluramineinnahme.

A case of primary vascular pulmonary hypertension (PVPH) in a 53-year old woman (160 cm, 90 kg) is reported. She first complained of symptoms of breathlessness on exertion 2-3 months after completion of three courses of fenfluramine (Ponderax). The courses began in October 1977 and ended in May 1978. Despite persisting symptoms no relevant clinical findings were obtained. The patient was admitted to this hospital after complaining of short syncopal attacks on exertion, in November 1981. Typical signs of PVPH were now demonstrable, with a resting pulmonary pressure of 98/45 mm Hg. Clinical findings showed a similarity to those obtained in patients suffering from aminorex-induced PVPH, although fenfluramine shows some biological differences to aminorex. A causality between the development of PVPH and fenfluramine intake is probable on the basis of the patient's history, but it cannot be proven.

[67-Galliumscintigraphy as an auxiliary method for differentiation of mass lesions of the liver (author's transl)]. / Die 67-Galliumszintigraphie als Hilfsmittel zur Abklärung von Parenchymdefekten der Leber

Liver scintigraphy with 67-Ga citrate and alphafetoprotein (afp) determinations in the serum were carried out in 84 patients with liver mass lesions in the preceding sulphur colloid scans. Among these patients 51 cases were histologically verfied and 33 patients were regarded as clinically-proven cases. Scanning was carried out 72 hours after the intravenous injection of 3 mC 67-Ga-citrate. Corresponding to the intensity of 67-Ga uptake within the former liver lesions 3 groups of 67-Ga scans were differentiated: Ga 0 (the lesion showed no Ga uptake), Ga plus (the Ga uptake within the lesion was equal to that of the surrounding liver tissue) and Ga plus plus (the Ga uptake within the former lesion exceeded the physiological Ga uptake in the normal liver tissue). The number of cases, results of Ga scintigraphy and afp examinations as well as histological, clinical and nuclear medical diagnosis were correlated. It was shown that Ga plus plus cases were strongly suspect of hepatoma, whereas in Ga 0 cases a diagnosis of hepatoma could be excluded. In patients with Ga plus further investigations have to be performed (repeated afp examinations, angiography of the coeliac artery), because cirrhotic regeneration nodules, metastases and necrotic hepatomata were all found within this group. According to our experience liver scanning with 67Ga represents a useful auxiliary examination in liver diagnosis. Ga citrate scintigraphy of the liver is indicated in all cases with mass lesions detected by the routine sulphur colloid scan and in all patients in whom there is clinical suspicion of hepatoma, inorder to differentiate the origin of the lesions. In 2 cases of hepatoma marked Ga uptake was observed at a time when the afp was still negative.

Coronary angiography in noncompaction with and without neuromuscular disorders.

BACKGROUND AND AIMS: The prevalence of coronary pathologic findings in patients with left ventricular hypertrabeculation/noncompaction (LVHT) is unknown. The study in a cohort of consecutive LVHT patients aimed to assess how often coronary angiography (CA) had been performed, if clinical findings and prognosis differed between patients with and without CA, how often pathologic findings of the coronary arteries were found, and if there were differences between LVHT patients with and without coronary pathologic findings. METHODS AND RESULTS: Between 1995-2007 LVHT was diagnosed in 113 patients (mean age 53 years, 29% females, 67% neuromuscular disorders). CA had been performed in 52. Patients with CA had more exertional dyspnoea (79 vs. 61%, p < 0.05), angina pectoris (42 vs. 10%, p < 0.001), hypertension (44 vs. 25%, p < 0.05) and larger left ventricles (66 vs. 60 mm, p < 0.001) than patients without. No anomalously originating coronary arteries were found. Patients with coronary arteriosclerosis (n = 8) had more right-bundle-branch block than patients without (25 vs. 0%, p < 0.05). Mortality was 5.8% per year and did neither differ between patients with and without CA nor with and without coronary arteriosclerosis. CONCLUSIONS: Coronary arteriosclerosis is rarely associated with LVHT and does not seem to affect prognosis.

Cardiac and neuromuscular implications of left bundle branch block in left ventricular hypertrabeculation/noncompaction.

BACKGROUND: Left bundle branch block (LBB) is frequently found in left ventricular hypertrabeculation/noncompaction (LVHT). OBJECTIVES: To compare LVHT patients with and without LBB regarding LVHT location and extension, left ventricular function, symptoms, electrocardiographic findings, prevalence of neuromuscular disorders (NMDs) and mortality during follow-up. METHODS: The charts of patients who underwent transthoracic echocardiographic examination at the Krankenanstalt Rudolfstiftung (Wien, Austria) between June 1995 and November 2006 were examined. RESULTS: LVHT was diagnosed in 102 patients (30 women) with a mean (+/- SD) age of 53+/-16 years (range 14 to 94 years). A specific NMD was diagnosed in 21 patients and an NMD of unknown etiology was diagnosed in 47. The neurological investigation was normal in 14 patients and 20 patients refused the investigation. The 24 patients with LBB were older (61 versus 51 years of age; P<0.01), and suffered from exertional dyspnea (96% versus 59%; P<0.01) and heart failure (79% versus 46%; P<0.01) more often than patients without LBB. LBB patients had less frequent tall QRS complexes (8% versus 47%; P<0.01) and ST-T wave abnormalities (4% versus 50%; P<0.01) than patients without LBB. Patients with LBB had a larger left ventricular end-diastolic diameter (73 mm versus 61 mm; P<0.01), worse left ventricular fractional shortening (15% versus 26%; P<0.01) and more extensive LVHT (1.8 versus 1.5 ventricular segments; P<0.05). The prevalence of NMDs did not differ between patients with and without LBB. Survival did not differ between patients with and without LBB during follow-up. CONCLUSIONS: LBB is associated with increased age, decreased systolic function and increased extension of LVHT. Whether LBB is a prognostic factor in LVHT remains speculative.

[Long-term ambulatory rehabilitation of patients with infarct. Clinical studies on patients during 1974 and 1975]. / Ambulante Langzeitrehabilitation von Infarktkranken. Klinische Beobachtungen am Krankengut der Jahre 1974 und 1975

An out-patients long-term rehabilitation program is performed in myocardial infarction for 6 to 12 months. It comprises all kinds of rehabilitation and secondary prevention. The working capacity measured by exercise tests can be improved and stabilized (mean improvement: 20%). 75.8% of office employees and 58% of workers return to work. There was not positive influence on plasma cholesterol and triglyzeride level, to be noticed. Upon inquiry, one year after myocardial infarction, 85% of patients had stopped cigarette smoking.

Isolated left ventricular abnormal trabeculation is a cardiac manifestation of neuromuscular disorders.

OBJECTIVES: Isolated left ventricular abnormal trabeculation (ILVAT) is defined as >3 coarse trabeculations of the left ventricular wall, apically to the papillary muscles, in hearts without congenital malformations. The aims of the study were to assess by echocardiography the prevalence of ILVAT, look for cardiac findings in ILVAT and find out if ILVAT is associated with neuromuscular disorders. DESIGN AND RESULTS: In the course of 3 years, ILVAT was found in 15/17, 648 patients (0.08%). Twelve patients had heart failure, all had ECG abnormalities. All patients had neuromuscular disorders. A definite diagnosis could be established in 10 patients (metabolic myopathy, n = 9; Becker's muscular dystrophy, n = 1). The remaining 5 patients refused further neurological investigations. CONCLUSIONS: ILVAT is a rare disorder associated with ECG abnormalities, heart failure and neuromuscular disorders, which is a reason why both cardiologists and neurologists should be involved.

Five-year follow-up of patients after thromboendarterectomy of the internal carotid artery: Relevance of baroreceptor sensitivity.

BACKGROUND AND PURPOSE: In patients after myocardial infarction, baroreceptor sensitivity has been identified as a factor of prognostic relevance. This study was designed to assess the effects of an increased baroreceptor sensitivity in patients after surgery in the area of the internal carotid artery with respect to blood pressure variability, therapeutic interventions, and vascular events during a 5-year follow-up. METHODS: Receptor sensitivity before and immediately after carotid surgery was measured in 84 patients. Blood pressure variability, carotid artery status, and echocardiographic findings were assessed before and after surgery and at the end of follow-up. Vascular events as well as changes in blood pressure therapy during the follow-up period were evaluated. RESULTS: Significant negative correlations between an increase of baroreceptor sensitivity after surgery and the range of systolic (r=-.47; P<.001) and diastolic (r=-.33; P<.01) blood pressure were found for the immediate postoperative period. For the range of systolic blood pressure, this relation persisted (4.3 to 7 years after surgery) at the end of the observation period (r=-.38; P<.001). An inverse relation to the increase in baroreceptor function was also found for the average annual number of therapeutic interventions during follow-up (r=-.38; P<.001). Furthermore, the subgroup of patients without a postoperative increase of receptor sensitivity was characterized by a significantly higher risk of major vascular events (log-rank test, P<.018). CONCLUSIONS: Because an improvement of receptor sensitivity after carotid surgery is related to a long-lasting reduction of blood pressure levels and variability, baroreceptor function may be considered an indirect indicator for the later postoperative course.

[An improved exercise test in coronary-heart disease: effect of molsidomin on erogometrically controlled exercise (author's transl)]. / Zur Verbesserung der Arbeitsbelastung Koronarkranker. Wirkung von Molsidomin auf die ergometrisch gemessene Arbeitstoleranz

The protective effect of molsidomin (N-ethoxycarbonyl-3-morpholinosydnonimine) during ergometric exercise was tested on 40 patients with coronary insufficiency proven by preliminary exercise tests or coronary arteriography. Changes in arterial blood pressure, heart rate, pulmonary artery pressure, ischaemic S-T depression and maximal working capacity were used as criteria. The drug increased maximal working capacity and decreased S-T segment depression. In addition it caused a fall in systolic and diastolic blood pressure and pulmonary artery pressure, at rest and during exercise. Resting heart rate increased slightly but during exercise the heart rate was reduced at comparable load stages. The results suggest that molsidomon may be an effective drug in the treatment of angina pectoris.

[Mold allergies--a challenge in diagnosis and therapy]. / Schimmelpilzallergien--Eine Herausforderung in Diagnose und Therapie.

Problems in the diagnosis of mould allergies arise from a large number of mould species, different expression of allergens and limited supply of allergens in test systems. Only the use of many different and special diagnostic methods enables an accurate clearing up of diseases. Not until all diagnostic problems are resolved, an adequate therapy is possible and should use new ways.

Complex mitochondriopathy associated with 4 mtDNA transitions.

In a 33-year-old man, mitochondriopathy was diagnosed upon short stature, auditory impairment, gynaecomastia, hypogonadism, vertical ophthalmoplegia, cerebral atrophy, leucencephalopathy, cataract, hypertrabeculated left ventricle, hypothyroidism, diabetes mellitus, glomerulonephritis necessitating kidney transplantation, general wasting, polyneuropathy, abnormally high lactate levels on exercise, partially reduced cytochrome-c oxidase staining and abnormally structured mitochondria on muscle biopsy. Mitochondrial DNA (mtDNA) analysis revealed 1 novel (A15662G) and 3 known mtDNA transition(s) (T3398C, T4216C, G15812A) affecting the cytb and ND1 gene, respectively. Three of the patient's transitions were also detected in blood leukocytes of the patient's maternal grandmother, mother and brother. Mutant mtDNA was heteroplasmic at >75% in the patient's skeletal muscle.