Zeitschrift für Kardiologie
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The benefits of coronary thrombolysis appear to depend primarily on achieving and maintaining coronary artery patency. Unfortunately, failure of coronary thrombolysis or recurrent occlusion may occur in up to 40% of patients treated with fibrinolytic agents. Results of recent studies suggest that recurrent thrombosis may be due to multiple factors including: plasmin-mediated activation of the coagulation system, procoagulant activity of the residual thrombus, presence of high shear forces that promote platelet deposition, and attenuation of physiologic fibrinolytic activity after pharmacologic thrombolysis. Preliminary data suggest that recently developed novel anticoagulants and antiplatelet agents may improve the rate of initial recanalization and prevent recurrent thrombus.
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The proportion of patients with acute myocardial infarction who are currently being treated with thrombolytic therapy is small. It is not readily apparent why the use of thrombolytic therapy is not more widespread. ⋯ Recent data suggests that the benefits of thrombolytic therapy should be extended to these selected high-risk subgroups. A philosophy of finding a reason not to treat with thrombolytic therapy should be adopted by all practicing clinical cardiologists.
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A primary failure rate to achieve reperfusion by thrombolytic therapy in acute myocardial infarction of 20-40%, an early reocclusion rate of 5-20%, as well as an increased risk of bleeding that excludes many patients from this form of therapy are today considered main problems. Better application of conventional thrombolytic agents, new conjunctive therapies and development of improved plasminogen activators are investigated with the aim of minimizing these problems.
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Doppler echocardiography and radionuclide angiography were shown to provide valuable tools with comparable functional parameters for the noninvasive assessment of left ventricular (LV) diastolic function in patients with coronary artery disease or LV hypertrophy. In order to examine the influence of an impaired systolic function on both methods, we studied LV filling simultaneously by Doppler echocardiography and radionuclide angiography in 47 patients with idiopathic dilated cardiomyopathy and stable sinus rhythm. The Doppler echocardiographic peak velocities (VE, VA) and radionuclide angiographic peak filling rates (PFRFF, PFRA) normalized to either left ventricular enddiastolic volume or stroke volume were measured and systolic function was assessed by obtaining the ejection fraction (EF) with the radionuclide angiography. ⋯ However, VE was increased with reduced systolic function (0.75 +/- 0.20 vs. 0.53 +/- 0.16 m/s; p < 0.01). No relation was found between PFRFF and VE and only a weak relation between the atrial filling parameters of Doppler echocardiography and radionuclide angiography. The peak filling rates were closely correlated with the systolic function (PFRFF:r = 0.86; p < 0.001) and were reduced with an impaired systolic function.(ABSTRACT TRUNCATED AT 250 WORDS)
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Comparative Study
[Intravascular ultrasound in patients with suspected aortic dissection: comparison with transesophageal echocardiography].
Thirteen patients with suspected aortic dissection (two women, 11 men, age 61 +/- 10.8 years) underwent transesophageal echocardiography (TEE), intravascular ultrasound (IVUS), angiography, and in part computed tomography (CT). TEE was performed using 3.5 or 3.75 MHz ultrasound transducers. IVUS examination was done using a 6F 20 MHz "rotational-tip" IVUS catheter (Boston Scientific) advanced over a guiding-wire positioned in the ascending aorta by the "side-saddle" technique. ⋯ No adverse effects occurred. Intravascular ultrasound allows to scan the entire aorta in patients with suspected aortic dissection. The current limitations can be solved only by the introduction of steerable and/or low frequency catheters.