Massive Audio PAT50 Uživatelský manuál stáhnout pdf (Strana 7)

144 J KARDIOL 2008; 15 (5–6)

ÖKG-Jahrestagung – Abstracts

Methods and Results In 31 patients after acute myocardial

infarction (AMI) with reopened infarct-related artery unselected

autologous bone marrow derived stem cells were injected percu-

tanously using the NOGA-Myostar catheter mapping system. The

injected area (region of interest, ROI) was delineated as a best poly-

gon by connecting the injection points marked on NOGA polar

maps. The ROI was projected onto the baseline and follow-up rest

maps of the 99m-Tc-tetrofosmin single-photon emission computed

tomography scintigraphy calculating the extent and severity (ex-

pressed as the mean normalized tracer uptake) of the ROI automati-

cally. The patients were divided into three groups according to the

NOGA determined mean unipolar voltage values of the ROI. In pa-

tients with a moderate impairment in the myocardial viability (mean

unipolar voltage value in the treated area between 7 and 14 mV) the

normalized mean activity in scintigraphy increased significantly

(from 60.07 ± 1.68 to 67.07 ± 9.62; p < 0.05 3 months after the stem

cell injections). There was a trend to increase in the normalized

mean activity of the injected area in patients with a normal unipolar

voltage (from 66.80 ± 23.78 to 75.93 ± 17.56; p = 0.26) and no

change in those with severely impaired myocardial viability in the

treated area (from 54.11 ± 15.13 to 54.6 ± 12.86; p = 0.81).

Conclusions Projection of the NOGA-guided injection area onto

the single-photon emission computed tomography polar maps per-

mits quantitative evaluation of myocardial perfusion in the targeted

area. On the basis of our results only myocardial areas showing

moderate viability in the NOGA unipolar voltage map should be

treated with intramyocardial stem cell therapy.

Unique Course of An Ischaemic Ventricular Septal

Defect 038

W. Cozzarini

, R. Spinka

, A. Saldjiyska

, M. Voegele-Kadletz

, H. Weber

Department of Internal Medicine I, SMZ Ost/Donauhospital, Vienna;

Division of Cardiovascular Surgery, Medical University of Vienna

Background Though the establishment of early reperfusion

therapy has decreased the incidence of ischaemic VSD in acute

myocardial infarction to less than 1 %, the mortality in this compli-

cation is still excessive high. A spontaneous closure of an acquired

VSD is very rare and was reported just in a few cases.

Case report A 56 year old male patient was admitted with angina

pectoris over 30 hours.

The ECG showed typical signs of a subacute anterior myocardial

infarction with a highest CK of 2060 IU/L (MB-fraction 13 %).

Transthoracic echocardiography revealed a large akinesia involving

the anterior wall, the apex, the apical septum und the apical inferior

wall with mildly reduced systolic function of the left ventricle.

The coronary angiogram showed an occluded mid-LAD, a chronic

occluded mid-RCA and a 90 % stenosis of the lower marginal

branch of the dominant CX.

The condition of the haemodynamically stable patient improved

soon, though the heavily calcified LAD could not be recanalized.

14 days later the patient suffered from atypical chest pain again.

A harsh holosystolic murmur was now heard with p. m. at Erb.

The TTE demonstrated a new small VSD in the apical septal region,

which enlarged even during the echocardiographic investigation.

The patient deteriorated haemodynamically slowly. The now two

centimetres sized VSD was closed with a polyester patch in combi-

nation with a single venous graft to the CX.

Two weeks later a small rerupture of the ventricular septum at the

edges of the patch could be found in TTE.

During close follow-up the VSD slowly increased in size with fur-

ther enlargement of the right ventricle and further impairment of

LVEF.

Four months later the septal rerupture showed surprisingly a sponta-

neous closure and has remained sealed during further follow-up for

more than 1.5 years.

The patient is well and achieves about 70 % of predicted workload

in exercise test.

Conclusion To our knowledge the first case of spontaneous clo-

sure of a post surgery reruptured ischaemic VSD is reported.

Epidemiologie des kardiogenen Schocks in Öster-

reich: Das Österreichische Schockregister 085

M. Vafaie, I. Pretsch, A. Geppert, B. Fellner, H. Weber, P. Lechleitner, W. Grander,

P. Siostrzonek, J. Reisinger, T. Publig, G. Heinz, G. Delle Karth für die Arbeits-

gruppe Kardiovaskuläre Intensiv- und Notfallmedizin der Österreichischen Kardio-

logischen Gesellschaft

Klinische Abteilung für Kardiologie, Universitätsklinik für Innere Medizin II,

Medizinische Universität Wien

Hintergrund Mit Spitalsmortalitätsraten um die 50 % ist der kar-

diogene Schock (KS) immer noch mit einer sehr schlechten Progno-

se assoziiert. Die häufigste Ursache des KS ist das akute Koronar-

syndrom (ACS) und im besonderen der ST-Elevations-Myokardin-

farkt (STEMI). Die Datenlage zum KS in Österreich ist spärlich.

Ziel dieses Registers war es, epidemiologische Daten zum KS in

Österreich zu erfassen.

Methoden Zwischen Juli 2004 und Juni 2006 wurden 179 Patien-

ten (Pat.) mit KS in 19 Zentren erfasst und mittels Datenblatt doku-

mentiert. Einschlusskriterien waren ein systolischer arterieller Blut-

druck < 90 mmHg oder die Notwendigkeit von Vasopressoren, kli-

nische Zeichen der Organ-Minderperfusion und Zeichen für ein er-

höhtes intravasales Volumen. Patienten nach OP, mit Sepsis oder

Blutung wurden ausgeschlossen.

Vorläufige Ergebnisse 64,2 % der registrierten Pat. waren

männlich. Das mittlere Alter betrug 66,5 ± 13 Jahre, der Aufnahme-

SAPS-II-Score lag bei 45 ± 26. Die häufigste Ursache für den KS

war mit 46 % ein STEMI, gefolgt von einer dekompensierten Herz-

insuffizienz unterschiedlicher Genese mit 42 %. 19 % der Pat. ent-

wickelten einen KS im Rahmen eines NSTEMI. Zur initialen Kreis-

laufstabilisierung wurde in 68 % der Pat. Noradrenalin, in 42 %

Dobutamin und in 30 % bzw. 10 % Suprarenin und/oder Dopamin

eingesetzt. Interessanterweise wurde auch bei 24 % der Pat. Levosi-

mendan verwendet. 39 % der Pat. (50 % der Pat. mit ACS) erhielten

innerhalb von 24 Stunden nach Schockbeginn eine intraaortale Bal-

lonpumpe (IABP), 65 % der Pat. wurden maschinell beatmet. Bei

64 % der Pat. (bei 79 % der Pat. mit ACS) wurde eine Herzkatheter-

untersuchung durchgeführt. Die Hospitalsletalität betrug 59 %.

Zusammenfassung Unsere Daten weisen darauf hin, dass der

KS wie andere kardiovaskuläre Erkrankungen mehr Männer als

Frauen betrifft. Bei einem Durchschnittsalter von 66,5 Jahren

scheint es sich nicht primär um eine Erkrankung der sehr alten Men-

schen zu handeln. Besonders unter diesem Blickwinkel ist die

Spitalssterblichkeit mit knapp 60 % sehr hoch.

Valvular Calcification in Asymptomatic Aortic Steno-

sis: Prognostic and Therapeutic Implications 005

W. Dichtl, H. F. Alber, G. M. Feuchtner, M. Reinthaler, A. Süssenbacher, T. Bartel,

W. Grander, H. Ulmer, O. Pachinger, S. Müller

Clinical Department of Cardiology, Medical University of Innsbruck

Aims The prospective, randomized, placebo-controlled Tyrolean

Aortic Stenosis Study (TASS) sought to characterize the natural

history, risk factors and their possible modulation by new-onset

atorvastatin treatment (20 mg daily versus placebo) in patients with

asymptomatic calcified aortic stenosis.

Methods and Results 47 patients without previous lipid-lower-

ing therapy or an indication for it according to guidelines at study

entry were randomized to atorvastatin treatment or placebo and pro-

spectively followed for a mean study period of 2.3 (± 1.2) years.

Patient prognosis was worse than expected, as 23 (48 %) suffered

from a major adverse clinical event (new onset of symptoms fol-

lowed by aortic valve replacement in most cases). Mean systolic

pressure gradient and an increased NT-proBNP plasma level

allowed prediction of clinical outcome, which was not influenced

by concomitant coronary calcification, age or initiation of atorva-

1 2 3 4 5 6 7 8 9 10 11 12 ... 45 46

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