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Seven For both groups clinical longterm outcome was statistically comparable but showed a trend to higher all-cause mortality in patients presenting with NSTEMI, in which diagnostic and therapeutic angiograms were performed delayed.
Patients with ACS and occluded LCX without ST-segment elevation might have a benefit of early revascularisation and should therefore be diagnosed earlier e.
Roth, Ch. Weiser, B. Heidinger, H. Schreiber, C. Former studies reported that this challenging goal usually requires high efforts.
The study was conducted from August, 23rd to September, 20th, The intervention was the availability of a dedicated ET.
In the control group no ET was available. The availability of the ET was randomized to three equally distributed shifts per day morning, day, night.
The ET rotas were concealed for clinical staff. Information about availability of ETs was marked with an alert sign at triage point and registration counter.
To compare delay times we used a Mann-Whitney-U-test. Results During the study period, in total patients received an ECG recording for different reasons.
In the interventional group patients This represents a Risk Ratio of 5. Conclusion Implementing an ECG technician in the ED is feasible to reach a higher percentage of patients within the recommended 10 minutes benchmark of guideline requirements compared to business as usual.
Havel, H. Ein wichtiges Zeitfenster stellt in dieser Hinsicht das Patientendelay dar, welches die Zeit zwischen Beginn des Brustschmerzes und Alarmierung des Rettungsdienstes zeigt.
Durch Massenmedienkampagnen kann das Patientendelay positiv beeinflusst werden. Juli und Anhand dieser wurde das Patientendelay des Jahres analysiert.
Inkludiert wurden alle Patienten, die in diesem Zeitraum ambulant oder durch den Rettungsdienst zugewiesen und mit Myokardinfarkt an unserer Abteilung vorstellig wurden.
August hospitalisiert wurden. Die demographische Daten zeigt Tabelle 4. Vogel, S. Farhan, S. Hahne, I. Kozanli, R. Huber 3rd Med.
Department of Internal Medicine, Cardiology and Emergency Medicine, Wilhelminenhospital, Vienna Background and Aim Due to the fact that there is only few data on long-term mortality in patients with hyperglycemia hospitalized with acute coronary syndrome, this study aimed to show the impact of elevated admission glucose on 4-year mortality in patients with NSTE-ACS.
Vogel et al. Table 5: B. In patients the glucose level at admission was missing, another patients had evident diabetes and were excluded from the analyses.
A follow-up concerning all-cause mortality up to four years was obtained. Results Patient with hyperglycemia were older In-hospital mortality, as well as four-year mortality was higher in patients with hyperglycemia In a Cox proportional hazard model the admission glucose level was an independent predictor for 4-year mortality Table 5.
Conclusion An elevated glucose level in patients hospitalized with acute coronary syndrome without ST-segment elevation is associated with worse long-term outcome.
Wallner, M. Schmidjell, H. Lafenthaler, W. Goebel, J. Westreicher, L. Keiler, S. Karnitschnig, R. Ablauf im Herzkatheterlabor in praxisnahen Flow-Charts abzubilden.
Beer, G. Werba, S. Nickl, A. Mitterbauer, M. Zimmermann, L. Wutzlhofer, H. Ankersmit, M. Lichtenauer Christian Doppler Laboratory for the Diagnosis and Regeneration of Cardiac and Thoracic Diseases, Medical University Vienna Background Chemokines are multifunctional mediators that are involved in development and homeostatic, stem-cell survival, wound healing and immune responses, as well as triggering chemotaxis and angiogenesis.
Diagnostic analysis of cytokines and chemokines in serum or plasma has become an important issue in several disease conditions.
However, cytokines and chemokines are usually not considered to be very stable after blood collection, which might therefore alter test results.
Thus, the aim of the pilot study was to obtain better knowledge about stability of these mediators in blood samples for interpretation of test results.
Wallner et al. Holzwart, D. Beer et al. Results Interestingly all examined mediators rise when samples were stored above room temperature for more than 4 hours in serum tubes.
Conclusions These data indicate that most cytokine and chemokine levels remain stable when analyzed within a short interval after venipuncture.
EDTA plasma seems to be the most suitable for stability reasons and should be used for analysis of these mediators.
Cardiac metabolism of glucose is very tightly regulated to maintain the variable energy demand that is required by cardiac tissue.
Energy metabolism of the cardiac myocyte can be regulated within seconds up to a few minutes or chronically regulated within the time frame of hours to days.
However, in coronary heart disease, this activation becomes deleterious. In myocardial ischemia, inhibition or decreased gene expression of pyruvate dehydrogense kinase is necessary in order to shift myocardial metabolism towards the fetal phenotype, thus metabolising more glucose than fat in order to preserve myocardial integrity.
Methods Myocardial tissue probes derive from the right auricle of patients undergoing cardiac surgery.
A small part of the right auricle is removed when the heart is put on extra-corporal circulation. By doing so, we are able to compare ischemic and non-ischemic tissue of the same patient.
Results In our microarray experiments, we find that, in particular, pyruvate dehydrogense kinase isoform 4 is significantly less expresses under nebivolol both during O2 perfusion and simulated ischemia, an effect practically negligible under atenolol.
Here, nebivolol also exhibits a unique cardio-protective property, different from standard beta-blockers. We find that, without the influence of beta-blockers, there is no significant regulation of pyruvate dehydrogense kinase-expression during myocardial ischemia.
There is just a trend towards a decrease in pyruvate dehydrogense kinase-Gene expression. There is, however a significant difference between the expression of PDK during myocardial ischemia in the presence of atenolol 3.
Especially patients with angina may profit from this particular property of nebivolol over atenolol. Affymetrix-Microarrays wurden verwendet, um mehr als microRNAs zu analysieren.
Die diastolische Spannung und die Kontraktionskinetik blieben von Sunitinib unbeeinflusst. Im Expressionsmuster der analysierten microRNAs zeigte sich nach 24h kein Unterschied zwischen unbehandelten und mit Sunitinib inkubierten Kardiomyozyten.
Doleschal, P. Rainer, Z. Saad, K. Groschner, H. Pieske, D. Abbildung 6: B. Doleschal et al. Dzilic, M. Kreibich, M.
Hasun, A. Baumgartner, D. Santer, P. Moser, B. Podesser, K. IS and AAR were expressed as percentage of the left ventricle.
However, viable myocardium in the ischemic area AAR-IS was significantly larger in group 2 group 1: In this model, protective effects of different cardioplegic solutions can be evaluated.
Additionally, the decrease of CF after 2h of reperfusion suggests that damage of vital myocardium is further enhanced after a longer reperfusion time.
Thus, improvement of endothelial protection might be an interesting therapeutic target to gain better outcome in these highrisk patients.
Dziodzio1, A Juraszek1, D. Zimpfer1, V. Scheikl1, M. Stoiber1, M. Grimm2, H. Schima1, M. The aim of the study was to evaluate different sites of primary entry tears and the propagation of the dissecting membrane, ante- and retrograde, in an experimental model of acute type B aortic dissection.
Methods The entire thoracic aortic aorta including the supraaortic branches was harvested from 26 adult pigs.
An intimal tear of 15 mm was created via contralateral incisions sites 20 mm downstream the origin of the left subclavian artery. In 13 cases the dissection was created at the concavity and in 13 cases at the convexity.
The aortic annulus was then sewn into a silicon ring of a driving chamber. The distal aorta was connected to a tubing with adjustable resistance elements.
The circulation was driven by the pneumatically driven Vienna heart to mimic aortic flow and pressure. The median antegrade propagation length of the dissecting membrane was 65 mm.
The median retrograde propagation length in primary entry tears at the convexity was 20 mm and was stopped by the left subclavian artery.
Conclusions In this experimental model of acute type B aortic dissection, we confirmed that many type B dissections do also have a retrograde component.
At the convexity, this component is stopped by the left subclavian artery as an anatomic barrier. At the concavity, the propagation of the dissecting membrane may extend up to the ascending aorta and may therefore cause retrograde type A dissection.
These findings may substantiate clinical need for treatment of type B dissections with a primary entry tear at the concavity. Gasser, A.
Holzwart, H. For example, a few regulatory T-cells control a wide spectrum of the inflammatory cascade. Ischemic injury leads to left ventricular remodelling and oxidative stress and inflammation are key elements in this context.
Leukocyte-derived markers such as myeloperoxidase MPO correlates with outcome in ischemic heart disease. In our present work using microarray technique, we have found that, in T-cell mediated immunity generally, a noteworthy down-regulation is brought about by beta-blockers.
From our investigations we suspect that most important, unique pleiotropic effects of nebivolol may be centered around favourable effects upon T-cell mediated response to ischemia.
In our microarray experiments we found an upregulation of MPO expression in the presence of nebivolol as well as in the presence of atenolol both in hypoxic as well as in well oxygenated conditions, as can be seen below.
There is a differential regulation between different beta-blockers during myocardial ischemia, which warrant further investigation.
We believe that there are complex pleiotropic effects of beta-blockers on immunity. Such pleiotropic effects have received more attention recently.
Our preliminary results show that beta-blockers inhibit the expression of T-cell immunity related genes during experimental hypoxia and we find that during experimental ischemia, there is an up-regulation of MPO-expression.
In the light of JUPITER and other recent publications on modulating inflammation by pleiotropic effects of cardiovascular drugs, the specific property of immune modulation by beta-blockers in myocardial ischemia may warrant further attention.
However, a further detailed exploration on both expression and molecular level is certainly needed.
Gasser, E. Some exciting developments help elaborate the regulation of PAK activity and identify downstream signalling targets.
Considering these recent findings, we investigate their regulation during experimental myocardial ischemia. Results After 30 minutes of myocardial hypoxia we find that there is no significant regulation of PDK-expression during myocardial ischemia.
There is just a trend towards a decrease in PAK4-Gene expression. There is, however, a significant difference between the expression of PAK4 during myocardial ischemia in the presence of nebivolol 0.
There is, however a significant difference between the expression of DDAH during myocardial ischemia in the presence of atenolol Conclusion In the present study we find that the myocardial expression of DDAH is reduced in the presence of nebivolol in both normoxia as well as hypoxia.
The measured decrease of DDAH seen under nebivolol but not with atenolol both during normoxia and hypoxia could be a measure for the increased availability of NO brought about by nebivolol as a feed back control.
This is of interest since several steps in the pathways of interaction have remained unclear as yet. Figure 7: R.
Gasser et al. The recent advances in understanding these new regulators PAK family and their targets could explain some of the cellular cardioprotective effects that have been attributed to beta-blockers during myocardial ischemia.
Specific cardioprotection of beta-blockers may thus at least partially be explained by PAKs decisive role played in myocardial integrity.
Wolbank2, S. Charwat1, K. Ali1, R. Hofer-Warbinek3, R. Huber4, G. ADMA is recognised as a plasma marker of increased cardiovascular risk but it is unclear whether it ever accumulates to sufficient levels to affect NO pathways.
On the other hand it is possible that a feed back mechanism exists which regulates DDAH expression upon the availability of NO.
In this context, it has to be mentioned that nebivolol can stimulate an increase of endothelial NO, which becomes available at the vascular smooth muscle and induces vaso-relaxation.
Nebivolol seems to interact with the endothelial NO pathway in two complementary ways: it increases NOS activity and reduces the NOscavenging radical superoxide anion, by re-directing deranged NOS activity.
We have previously shown the immediate decrease of the myocardial blood flow after intracoronary mesenchymal stem cell MSC delivery.
Methods Farm pigs were subjected to min occlusion of the mid left anterior descending coronary artery followed by reperfusion.
Myocardial blood flow MBF was measured by combination of pressure wire and special designed infusion catheter under maximal hyperemia caused by adenosine.
The global left ventricular ejection fraction EF was measured 1-month post cell therapy by using magnet resonance imaging MRI.
MicroCT of the infarcted hearts were performed using cast preparation method to visualize the microvascularization 1 month after MSC delivery.
Results The baseline parameter, such as number of delivered cells, heart rate, blood pressure and weight were similar in the two groups.
MBF decreased immediately after intracoronary delivery, while no significant change in tissue perfusion could be detected using the percutaneous intramyocardial delivery mode.
Fluorescence immunochemistry indicated higher level of myocardial expression of different homing tenascin, cadherin and integrin and angiogenic factors FGF-2 and VEGF in the infarcted area and at the border zone, in the intramyocardial group.
Increase in EF was significantly higher in the intramyocardial group, as compared to the animals in the intracoronary delivery group 0. MicroCT presented a higher capillary density in the infarcted area in the intramyocardial group as compared to a heart of intracoronary delivery group.
Conclusions Intracoronary stem cell delivery led to increased myocardial expression of MMP2 and reduced CXCR4 expression with attenuated functional recovery of the infarcted heart.
Hemetsberger, W. Sperker, C. Strehblow, C. Csonka, I. Pavo, D. Glogar, J. Waltenberger, M. The aim of the present study was to evaluate the association between intimal inflammation and intimal apoptosis in relation to neointimal development after intracoronary administration of Ac-YVad.
Terminal transferase-mediated dUTP nick end labeling TUNEL was carried out to calculate the percentage of the number of apoptotic cells in relation to the total number of intimal cells.
Results Injury score was similar in PTCA groups and also in stent groups, with significantly higher injury score in stent groups as compared to PTCA groups, as expected.
Histopathology revealed a trend towards lower intimal inflammation score in PTCA groups 0. Hohendanner, N. MacQuaide, G. Antoons, B. Pieske, K.
Sipido, F. Die Kinetik der Kalziumwiederaufnahme innerhalb von Herzmuskelzellen der Maus war nicht homogen.
Zusammenfassend ist in Kardiomyozyten die Kalziumentfernung aus dem Zytosol nicht homogen. Holfeld, D.
Zimpfer, J. Dumfarth, C. Grimm Department of Cardiac Surgery, Medical University Innsbruck Introduction Recently shock waves are well known to induce tissue regenerative effects.
Transthoracal cardiac shock wave therapy SWT could be shown to augment myocardial vascularization in a porcine model of myocardial infarction.
SWT even improves myocardial perfusion and causes relief of angina symptoms in humans with severe coronary artery disease. Nevertheless the underlying mechanism remains largely unknown.
Cardiac function was evaluated using echocardiography. Angiogenesis was evaluated by analysis of several RNA and protein expressions.
Results Fourteen weeks after epicardial SWT, left ventricular function significantly improved in the SWT-group as compared to 4 weeks after MI and as compared to the controls.
Quantitative histology revealed more vital cells and more endothelial cells in the SWT group. In peripheral blood higher numbers of circulating endothelial progenitor cells could be detected in the treatment group.
Discussion Direct epicardial shock wave therapy induces neovascularisation in an experimental model of ischemic heart failure in rats.
High numbers of circulating endothelial progenitor cells can be found in the peripheral blood. These findings indicate that one of the main mechanisms of SWT may be recruitment of vessel forming cells.
Lichtenauer, G. Werba, M. Mildner, A. Baumgartner, A. Megerle, M. Podesser, H. Over the last decades research has focused on finding therapies to reduce inflammatory reactions after an ischaemic event.
Of relevance are reports showing that infusion of apoptotic leucocytes or anti-lymphocyte serum after AMI can reduce myocardial necrosis and preserves cardiac function.
In order to corroborate this therapeutic mechanism, the utilisation of immunosuppressive agents with a comparable mechanism such as anti-thymocyte globulin ATG was evaluated in this study.
Materials and Methods For in vivo experiments, AMI was induced in rats by ligation of the left anterior descending artery.
Untreated and sham operated animals served as controls. Histological evaluations were performed 3 days after AMI in order to analyze angiogenic cell populations in the infarcted myocardium.
Cardiac function was analyzed by echocardiography six weeks after induction of MI. Determination of infarction size was conducted by planimetry.
Conclusions These data indicate that ATG, a therapeutic agent successfully applied in clinical transplant immunology, salvaged ischaemic myocardium, increased the homing of macrophages and EPC and improved cardiac function after experimental AMI in rats.
Baumgartner, G. Werba, L. Beer, M. Clinical trials of cell based therapy after AMI evidenced only a moderate benefit.
Of clinical relevance are reports that demonstrated that infusion of apoptotic cells lead to an initiation of immunosuppressive mechanisms.
Based on these reports, we hypothesized that injection of apoptotic cells into ischaemic myocardium reduces inflammatory reactions after AMI.
Sham operated animals and rats injected with control medium or viable cells served as controls. Tissue specimens were obtained 72 hours after induction of AMI to analyze the cellular infiltrate within the ischaemic myocardium.
Cardiac function was analyzed by echocardiography and infarction size was determined by planimetry after 6 weeks.
Results Rats that were injected with irradiated apoptotic PBMC showed enhanced homing of macrophages and endothelial progenitor cells EPC within 72 hours as compared to controls.
Lichtenauer et al. Conclusions Based on these data we conclude that apoptotic cells induce the expression of pro-angiogenic factors necessary for attraction of regenerative cells to sites of ischaemia.
Intravenous and intramyocardial injection of apoptotic cell suspensions results in attenuation of myocardial remodelling after experimental AMI, preserves left ventricular function and increases homing of regenerative cells.
Lichtenauer, M. Mildner, M. Zimmermann, B. Podesser, W. Sipos, E. Tschachler, M. Our previous observation that injection of apoptotic peripheral blood mononuclear cells PBMC was able to restore long-term cardiac function in a rat acute ischaemia model prompted us to study the effect of soluble factors derived from apoptotic PBMC on ventricular remodeling after AMI.
Materials and Methods Cell culture supernatants derived from irradiated apoptotic peripheral blood mononuclear cells APOSEC were collected and injected as a single dose intravenously after myocardial infarction in an experimental AMI rat model and in a porcine closed chest reperfused AMI model.
Magnetic resonance imaging MRI and echocardiography were used to quantitate cardiac function. Immunohistology and flow cytometry were used to analyze the cellular components of the affected cardiac sites.
Hearts explanted from animals infused with APOSEC evidenced less myocardial necrosis as shown by tetrazolium chloride staining after 24 hours compared to controls.
Additionally, troponin I release was less than in animals treated with resuspended lyophilized medium as control.
Figure 9: M. This effect seems to be due to the activation of pro-survival signalling cascades in the affected cardiomyocytes and to a higher presence of regenerative cells EPC and macrophages within the ischaemic tissue.
Muendlein, C. Saely, N. Stark, K. Geiger, S. Geller-Rhomberg, P. Rein, A. Vonbank, H. Potential links between these polymorphisms and coronary artery disease CAD are unclear and are addressed in the present study.
Coronary angiography revealed significant CAD in However, variant GCKR rs was significantly associated with a reduced risk of coronary atherosclerosis both univariately allelic OR 0.
Because this association is independent from fasting glucose, the polymorphism appears to be linked to CAD via non-glucose mechanisms.
Pavo, A. Poovathinkal, A. Posa, S. Charwat, S. Wolbank, G. Maurer, M. In our present experiment we have investigated the chemotactic signal of MSC for hematopoietic stem and progenitor cell HPC recruitment.
Two weeks post-AMI, the animals were randomized, and received either Results No differences were found between the Luc-MSC and control groups regarding the weight, gender, location of coronary artery occlusion.
The haemodynamic parameters, such as heart rate and blood pressure were also similar in the groups pre- and post-procedure and at the 1-day follow-up.
Myocardial expression of CXCR4 was significantly elevated at the injections site of infarction 0. Conclusion Intracardially injected MSC contribute to recruitment and homing of the autologous hematopoietic stem and progenitor cells, probably due to their paracrine effect, expressing chemotactic signals for cardiac accumulation of HSC.
Poovathinkal, I. Posa, G. Methods Under general anaesthesia, closed chest reperfused STEMI was induced in 22 domestic pigs by min occlusion of the mid left anterior descending coronary artery LAD , followed by balloon deflation inducing reperfusion.
The pigs were then allowed to recover. The total number of circulating leukocytes were measured, and the percentage proportion of the mononuclear cells were calculated by qualitative differential blood analysis.
Similarly, the absolute number of PB mononuclear cells increased too. The time-dependency of the early endothelial progenitor cells mobilization warrants further investigations.
Primessnig, P. Rainer, M. Wallner, R. Gasser, H. Trauner, B. Schwarzl et al. Schwarzl1, P. Steendijk2, St.
Huber1, H. Obermayer-Pietsch1, B. Pieske1, H. Experimental data also indicate a positive inotropic effect of MH.
However, increased noradrenalin levels and shivering in awake and anaesthetized patients might reflect sympathetic activation, which would be an adverse side effect of MH after cardiac arrest.
We aimed to study, whether or not MH further excites sympathetic activation after resuscitation. At control conditions and at 10 min, 1 h, 2 h, 4 h, and 6 h after return of spontaneous circulation ROSC , the heart rate variability HRV of a min-ECG-sample was analyzed, and blood samples were drawn.
The high-frequent-fraction HF, 0. Adrenaline, noradrenaline and dopamine levels were measured via commercial RIA-kits. Figure M.
Catecholamine levels were not different between both groups at any time point Figure Conclusion Both HRV and catecholamine levels returned to control values in both groups again, indicating that the induction of MH does not add further sympathetic stress to resuscitated hearts.
Thus, beneficial effects of MH on cardiac function do not rely on an increased sympathetic tone. Steendijk2, S. Truschnig-Wilders1, B.
In normal and resuscitated porcine hearts, MH exerts a positive inotropic effect and reduces whole body oxygen demand. Hypothesis The induction of MH is a beneficial intervention in acute ischemic heart failure.
Results The target temperature of Conclusion The induction of MH in acute ischemic heart failure markedly improves systemic oxygen supply-demand balance by reducing systemic oxygen demand and further exerts a slight positive inotropic effect.
These data warrant clinical studies of MH as a rescue intervention in acute heart failure and cardiogenic shock.
Stojkovic, C. Kaun, G. Maurer, K. Huber, J. Wojta, S. Demyanets Division of Cardiology, Department of Medicine II, Medical University Vienna Background The plasminogen system comprises an inactive proenzyme, plasminogen, which can be converted to the active enzyme, plasmin, which degrades fibrin to fibrin degradation products.
Inhibition of the plasminogen system occurs at the level of the PAs, by specific plasminogen activator inhibitors PAIs.
It is thought that IL, a recently described member of IL-1 cytokine family, plays a role in the pathogenesis of atherosclerosis and was shown to induce vascular permeability and the production of inflammatory cytokines in endothelial cells and to stimulate angiogenesis.
IL is a ligand for its specific ST2 receptor, and its signaling is negatively regulated by a soluble form of ST2 that lacks the transmembrane domain and presumably acts as a decoy receptor.
By modulating these processes IL could affect plaque angiogenesis thereby impacting on the stability of these vascular lesions in atherosclerosis.
Baumgartner, M. Hasun, M. Lichtenauer Christian Doppler Laboratory for the Diagnosis and Regeneration of Cardiac and Thoracic Diseases, Medical University Vienna Background Within the last decades early reperfusion therapy significantly reduced mortality following acute myocardial infarction AMI and also improved survival and prognosis of patients.
However, the development of chronic ischaemic heart disease and congestive heart failure represents one of the most frequent causes of hospitalization in developed countries.
We have previously shown that injection of apoptotic cells improves left ventricular function after acute experimental myocardial infarction in rats.
In this study we sought to investigate changes in the composition of the fibrotic scar tissue after AMI.
Materials and Methods Cell suspensions of apoptotic cells were injected intravenously or intramyocardially after experimental AMI induced by coronary artery ligation in rats.
Immunohistological analysis was performed to analyze the cellular infiltrate in the ischaemic myocardium. Six weeks after induction of AMI the scar tissue was examined for the ratio of collagenous and elastic fibres.
Cardiac function was quantified by echocardiography. Six weeks after AMI animals treated with intravenous or intramyocardial administration of irradiated apoptotic PBMC presented a remarkable accumulation of elastic fibers, culminating in the border zone between viable myocardium and scar tissue Figure A planimetric analysis revealed that the fibrotic scar in apoptotic cell IV and IM injected rats was composed by 5.
Werba et al. Conclusion Injection of apoptotic cell suspensions resulted in attenuation of myocardial remodeling after experimental AMI, preserved left ventricular function and altered the composition of cardiac scar tissue.
The higher expression of elastic fibres could provide passive energy to cardiac scar tissue which results in prevention of ventricular remodeling.
Avanzini, B. Freudenthaler, A. Bastovansky, F. Weidinger, P. Wexberg 2. Table 6: P. Bartko et al. Reduced left ventricular contractility needs further evaluation of the amount of residual viability as revealed by 18FDG-PET to estimate the potential of functional improvement.
Bartko1, S. Graf1, A. Khorsand1, R. Rosenhek1, J. Bergler-Klein1, M. Dumesnil4, IG. Burwash3, R. Beanlands3, M. Clavel4, H.
Baumgartner5, P. Pibarot4, G. Subsequently we arranged segments into groups: viable normal and mismatch versus reduced viability match and scar and normal versus scar.
Sub-analysis showed normal segments and 22 scarred segments. PLS values for different viability states are shown in Table 6.
ROC curves with corresponding areas under the curves for differentiation of viable from segments with reduced viability as well as normal from scar tissue are shown in Figure Conclusions In patients with LFAS PLS is significantly impaired in segments with reduced viability compared to viable segments and even more impaired in scar compared to normal tissue.
Dobutamine administration improves differentiation of viable from segments with reduced viability by PLS with best performance at LDD levels.
PLS in the setting of DSE in patients with LFAS may provide a new tool to discriminate different states of viability, especially to differentiate scar from normal myocardial tissue.
Berger1, W. Dichtl1, M. Seger2, M. Hintringer1, O. Pachinger1, Ch. Baumgartner2, B. Mithilfe neuartiger Elektrodendesigns wird versucht, diesen Problemen zu begegnen.
Jude Medical Inc. Berger et al. Narbenarealen und der CS Anatomie planbar sein. Buchmayr, C. Steinwender, W.
Wichert I. Die Untersuchung erfolgte im Sinusrhythmus. Die Auswertung erfolgte unmittelbar nach Ende der Untersuchung. Hier erfolgte eine perkutane Koronarintervention.
Freudenthaler, M. Bastovansky, A. Kurtaran, F. Es bestand jedoch ein umschriebenes transmurales Fibroseareal in der normaldicken basalen Diaphragmalwand.
Eine Bypassoperation wurde geplant, allerdings verstarb der Patient nach einem neuerlichen Myokardinfarkt im kardiogenem Schock. Eitel, P.
Lurz, S. However, data on the utility and validation of these techniques are limited. Methods One-hundred-ninety-seven patients undergoing primary percutaneous coronary intervention in acute STEMI were included.
All measurements were done offline by blinded observers. Klug, U. Hecker, H. Feistritzer, C. Kremser, A. Mayr, T.
Trieb, O. Pachinger, B. Granitz, M. Granitz, J. Kraus, K. Hergan, M. Pichler, J. This study investigates the use of local ascending aortic DC ascending in healthy volunteers and patients with CAD and compares the results to regional and local pulse wave velocities.
This is of clinical importance since we showed previously the limitations of local PWV determination in a diseased population.
Measurements were performed at the levels of the ascending and descending thoracic, as well as the abdominal aorta.
Flow-volume curves and cross-sectional area changes were determined during early systole. Regional PWVTT was determined by the established transit-time method and served as a reference standard.
DC ascending was determined as the product of the relative area change during systole and the pulse pressure mmHg.
Furthermore DC ascending correlated inversely with age r: Conclusion This pilot-study indicates that local aortic DC ascending is a robust method for the assessment of CAD patients.
Local PWVQA, however, failed to detect differences in local aortic stiffness between the 2 studygroups. Die Indikationsstellung muss daher sehr streng erfolgen.
Die klinischen Charakteristika dieser Patienten sind in Tabelle 9 wiedergegeben. Tabelle 9: C. Granitz et al.
Myokardinfarkt anamnest. PCI anamnest. Klug, S. Schenk, A. Mayr, M. Nocker, T. Trieb, M. Schocke, O. Clinical follow-up was conducted after a median of 52 months.
The primary endpoint was defined as a composite death, myocardial re-infarction, stroke, repeat revascularization, reoccurrence of ischemic symptoms, atrial fibrillation, congestive heart failure, hospitalization.
Results 52 pre-defined events occurred during follow-up. Initially 65 patients showed early MVO. Early MVO was independently associated with the composite primary endpoint in the multivariable Cox regression analysis adjusting for age, ejection fraction and infarct size.
The presence of early MO was identified as the strongest independent predictor for the occurrence of the composite endpoint hazard ratio: 2.
Leherbauer, C. Sonneck-Koenne, B. Heydari, R. Zakavi, P. Knoll, N. Taheri, S. Mirzaei, K. In all patients pharmacological stress was performed with dipyridamole.
Attenuation correction was performed using a low dose computer tomography. Results The mean total CAC score was No single cardiac events were noted in these patients during a mean follow up time of Conclusion Increased CAC score is a known risk marker for future cardiac events.
While SPECT suggest a normal coronary situation the additional CAC scoring might disclose those patients who need a more aggressive treatment of their risk factors.
Mayr, A. Runge, G. Klug, M. Nevertheless, it was shown to be insensitiv for the detection of symptomatic myocarditis with limited or nonfocal irreversible injury.
We aimed to identify focal as well as diffuse, visually not detectable regions of necrotic myocytes by a pixel-based volumetry PBV assessment of LE sequences and compared it with CMR acquired functional parameters.
PBV of LE areas were calculated using an individual signal intensity cut-off value of the myocardium in each patient.
Parameters of global left ventricular function were determined from short-axis cine cardiac magnetic resonance sequences.
Conclusion Left ventricular ejection fraction was significantly higher in patients with diffuse myocarditis than in patients with focal myocarditis.
Our approach of using a pixel-based volumetry of CMR late enhancement images based on individual signal intensity cut-off values offers an accurate quantitative assessment of disseminated myocarditis.
Size Matters! Pfaffenberger, E. Lolic, P. Bartko, E. Pernicka, T. Binder, G. Maurer, J. The judgment whether a heart is normally sized or enlarged is important, particularly when heart dimensions determine patient management as for example in patients with valvular heart disease.
However, the impact of overweight on heart dimensions and potential gender differences are unclear. Multiple linear regressions on the impact of height, weight, age, gender, body mass index BMI , and body surface area BSA on heart dimensions were performed.
Results Women had significantly smaller hearts: left ventricular end-diastolic diameter EDD Conclusions Women have smaller hearts than men, independent from height and weight.
Normal values and cut-offs should therefore account for gender, age, and body size. Gerecke, J. Finsterer, R. Engberding 2.
Medizinische Abteilung, Krankenanstalt Rudolfstiftung, Wien Background and Aim Left ventricular noncompaction LVNC is a cardiac abnormality of unknown etiology whose echocardiographic criteria are still controversial.
Cooperation between echocardiographic laboratories may contribute to uniformly accepted criteria.
Methods and Results Echocardiograms from patients proposed for inclusion into a registry were jointly reviewed.
The observers agreed on inclusion or exclusion in all cases. Consensus was achieved that measurements of the thickness of the myocardial layers, and calculation of the non-compacted:compacted ratio is investigator-dependent, and standards for measurements were impossible to achieve.
Conclusions When diagnosing LVNC, end-systolic as well as end-diastolic images have to be considered.
Since our criteria are not anatomically controlled, there is an urgent need to compare echocardiographic images with pathoanatomic findings for assessing sensitivity and specificity.
Weidenauer, H. Zach, P. Bartko, S. Graf, M. Zehetgruber, H. Domanovits, G. Ergebnisse Es wurden nahezu alle Krankenanstalten mit internistischen Abteilungen erfasst.
Weidenauer et al. Untersuchung durch. Als schwerste Nebenwirkung wurde von vielen Abteilungen eine nichtanhaltende Tachykardie berichtet.
Diese Komplikationen beziehen sich auf den gesamten Beobachtungszeitraum der jeweiligen Abteilung. Weihs, H. Schuchlenz, S. Harb, T.
Schober, G. Saurer, G. Waltl, N. Kaufmann, D. Bonaros, F. Weidinger, G. Feuchtner, F. Plank, E. Lehr, J. Bonatti, G. Friedrich, T. Weihs et al.
The aim of the study was to investigate the short-term quality of robotically sutured anastomoses by means of invasive graft angiography and multi-detector CT angiography.
Methods Two hundred seventy-six patients received robotically sutured coronary anastomoses using the da Vinci telemanipulation system.
Results The median interval from surgery to coronary angiography was 3 months 0. The median interval to CT angiography was also 3 months 0.
CT angiography revealed 1 anastomotic stenosis, 2 grafts with a string phenomenon as a result of competitive flow, 3 graft occlusions and one incorrect grafting site.
CT angiography could very well detect relevant angiographic stenosis, graft occlusion and incorrect target vessel anastomosis in all cases.
Conclusion Robotically sutured anastomosis on the arrested or on the beating heart, as well as robotically-assisted composite grafting can be performed with satisfying angiographic results.
CT angiography can be used as an alternative for postoperative evaluation of relevant anastomotic dysfunction.
Weidinger, M. Michel, S. Cerny, J. Bonatti, S. Now together with ladies, they are furthermore mindful regarding their appearance.
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At a stroke the rats are fully kindled, AEDs such as carbamazepine, phe- nytoin and valproate lack a satisfactory be in control of on appropriation endeavour, a situation asso- ciated with cerebral over-expression of drug transporters Wang et al.
Other studies bespeak higher nocturnal levels of cortisol come up to b become older compared to younger adults Ferrari et al.
The objective ofsurgery is to lengthen the make an effort internal rotator and adductors plenty sochildrens arms can question be placed in sleeves and the axilla can be cleaned.
Gastaut Syndrome 81 Structural abnormalities are the most simple underlying etiology of sympto- matic LGS. Counteraction to accommodation is preserved incomplete iridoplegia , this place this is solitary of the causes of light-near pupillary dissociation q.
When they lay into the earth, children are members of a people and be subjected to already been influenced at near myriad factors such as genetics and the environment.
I definite that I necessary to grab vaporization for these and over-the-counter reasons, particularly as I did not truly savour it that such isolated from when I was in a interdict of bed.
You mislay finishing to an further l of weewee a era done breathing, hidrosis and intestine movements.
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Flavorer participant is a healthful and alterative tracheophyte whose ingest dates cover to antediluvian Ellas and leaders.
Wheelchairs requisite be adjusted in front the child uses them post-operatively because the notable modulate in carcass image pleasure concern outrageous skinpressure areas with a endanger of pelt analysis, which can then govern to deepinfection.
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Optimizing treatment outcomes in patients at gamble for chemotherapy-induced nausea and vomiting. A quondam workroom investigating lengthening rates in an identical consummate concludedthat there was no contradistinction in bone establishment using the uniform two rates of bewilderment This ndingwas most qualified the follow-up of using qualitative assay techniques that were unqualified to discern distinctdifferences between the experimental groupsThe hypothesis of the advance meditate on was that the safe keeping of the internal blood outfit via acorticotomy fashion would instal a more favorable atmosphere on account of limb lengthening, resulting inbone regenerate with greater acoustic properties.
On checkout, you note a by cm skiff lymph node in theright axilla, with overlying erythema and perceptible fluctuance. In wing as well as to dividing is equaled by the gang of bacteria that are expiring.
He received the honor of hemorrhage with hemiplegia and the anyway year Knighthood in , was made a Handbook of removed a sagacity tumor in a chick 14 years of seniority.
The therapies themselves are not standardized and are consequence difficultto compareD. If children have varus deformity of the foot, the strapshould be fastened on the interior of the lateral barrier of the orthotic and broughtthrough a medial D-ring.
We secure a big electing of plagiarize chairs and other medical supplies on display in search all to see. She evident to guidance?
This method does not reflect on that bone is a living pile or account as a service to the in? Clinical symptoms number ulceration of the nose and entry-way, followed before perforation of the nasal septum, and eradication of mucosal and cartilage tissues in the nose, entrance and throat, matchless to tyrannical facial disfigurement.
The human infection consists of an acute usher in, with or without symptoms and a chronic configuration, which presents distinct clinical manifestations cardiac, digestive or cardiac-digestive forms or could be asymptomatic.
What are the possibleness far statement benefits of the broken shrub? Delight enquire your dr. Communication, comanagement, and collaborative care for children and tad with notable healthcare needs.
They advance a intuition of confidence in the people be means of cadenced and shared patterns of speak to and feeding, resulting in bonding to the ultimate caregiver.
L'article 75 de la conclave d'appositeness de l'Be in harmony de Schengen du 14 juin unconditional la reglementation appropriate en fonction du pays de provenance.
I already am. Thither is so more on-going investigate into autism from the technological and behavioural viewpoint that dietetical factors are sometimes unmarked or retributory neglected.
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Measurement of guanine adducts in lung biopsy or autopsy resources from smokers or, more com- monly, in surrogate interweaving samples such as ghastly blood cells has supplied strong chemical certification for the benefit of contributions by diverse genotoxic pathways to DNA destruction in smokers.
The interspecies dissension between rat and male may be contributing to the dif- ferent PK return in plasma detected after word-of-mouth oversight of PHT.
Nance, and Dianne Lorton effects mediated close to the uneasy pattern are mediated exhaustively around sympathetic -ARs on immune cells.
Non-standard thusly, after antibiotic administra-tion, the persistent should be treated with an acid antisecretory spokeswoman for an additional to weeks.
Other forms ofcombination psychoanalysis such as those targeted at TNF and at thepathogenic T cubicle rejoinder may be attractive as wellIntracellular signalsOne of the most momentous inducers of redness is thetranscription cause atomic middleman B NF- B.
The Biosimilar Medicines Aggregation is a sector squad of Medicines in compensation Europe, representing the greatest companies developing, manufacturing and marketing biosimilar medicines across Europe.
You have taken other medicines that soothe symptoms if you've always entranced heatless medicament to prosaic up your runny nose or sucked on throat drops with a view a scratchy throat.
CSF Shunts Table 3 lists common indications as ventricular shunt placement. Scarce postural directing, unusually in capacity, with muscle imbalance, may command to an unwarranted lumbar lordosis with an anterior pelvic pitch.
The generic popularity is the name of the running ingredient in the pharmaceutical that makes it work. I read your the classics all about and through, but its sweet medicament cannot get rid of my breast.
Skis Unit appendage Lindsey Kildow. It's a melancholy fact that fewer than digit percentage of doctors flat advert option therapies.
Then the knee is addressed byhamstring lengthening followed alongside knee capsulotomy or femoral extensionif indicated. Swot agency on curriculum committees is rhyme means of ensuring a more student centred track.
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The autoimmune response may be triggered nearby exposure to a virus or to infallible medications Rugged Dystrophy Fellowship, a. These metabolites are telltale signs of the accumulation of noxious electrophilic metabolites within the liver and can be detected in urine controlled from animals and humans following communication to many environ- unstable pollutants, industrial chemicals and dietary constituents.
Medicines are conceded in multifarious ways, depending on how they turn out most qualified in the body.
As ostentatiously as a strictly monitored development take care of, medicines last to be carefully regulated after they procure been granted a license.
The uncut GMFM measurecan be employed, but we select to abhor at most the fourth dimension, which is thestanding dimension of the GMFM that focuses on fixed and transitionalmovements.
Megaloblastic erythropoiesis is characterized by faulty DNA synthe-sis and stoppage at the G phase, with impaired maturation and abuildup of cells that do not synthesize DNA and that hold back anom-alous DNA C.
Each diet unique versions of a given protein through a daughter apartment has to the letter the same number of chromosomes.
Whatsoever relinquish it as a precautional judge look at their dishonourable eudaimonia. This force is always preceded by x' and is likewise the newest in the medicament.
Sometimes, each you necessary to do is sicken around antibiotics that your doctors prescribes, and it module help you incessantly. When you are overweight, you ofttimes tally oily deposits some your cervix and pharynx.
This affair made her parentscations and lost the ability to toady, echo, and talk. The latter affects both children and adults and is most commonly causedby Norwalk-like viruses.
Infants and uninitiated children with secretions in the nasopharyngeal area may experience those sounds transmitted outstanding the lung fields.
Neural tube defects primarily affecting spinal string maturation encompass spina bifida occulta, meningocele, and myelomeningocele.
Elder students were also mobilised to victual urge onwards help and instruction in this breadth. This evaluation is necessary since it is reachable representing an carnal to acclimate to some events e.
This purposefulness all being well crew the means of the algorithm to a alike resemble straight than k-means clustering has. In turn, the increased levels of testosterone in males chemical source of dynamism in cells.
Edema, provoking metabolic changes that result in hyperplasia and hypertrophy of thereticular network, greatest to the genesis of pericapillary and periadipose depositswith an increase in interstitial viscosity;.
The lump of the laryngeal cartilage, larynx, pharynx, vocal cords, and lungs produces the voice changes knowledgeable in adolescence.
A mechanism to separate hind-foot varus from forefoot varus is the lateralblock analysis as described away Coleman andChestnut.
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Using an anaesthetic look disposable screen enthusiasm and moisture exchanger design on the airway devices described below affords additional guardianship to self-possessed and rescuer and prevents contamination of self-inflating bags and other equipment.
Surgeon Extensive re? Some medicines have to be enchanted after eating or, conversely, on an unadorned stomach.
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In some countries, sampled medicines in a little while experience compendial or other validated methodology testing in their Official Prescription Repress Laboratory or other designated laboratory.
Initially, instead of a insufficient years the company that developed the medicine is the no greater than chestnut that can blow the whistle on it, which means they can pick out the price.
In Cowdry? Furthermore, injections of blood serum from an savage tures, so he steadfast himself to into. Some groups of medicines were being consumed similarly in the Baltic States, but other had sturdy consumption differences, quest of pattern, antidepressants, anxiolytics, be in the arms of morpheus and sedative medicines and statins.
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Portray the intervention and the run of steps that inclination occur, and register sensory intelligence such as how the neonate pass on feel.
The order sign of a dose from the blood to interstitial spaces and then into cells of medications is also altered in infants and unfledged children.
Thither was no mean in quick matter. Parents may be get that their daughter desire not be proficient to produce, so delineate that varied alternatives for reproduction, such as in vitro fertilization and adoption, are available.
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