Kerstin Wustmann - Academia.edu (original) (raw)

Papers by Kerstin Wustmann

Research paper thumbnail of Decision-making in aortic root surgery in Marfan syndrome: bleeding, thromboembolism and risk of reintervention after valve-sparing or mechanical aortic root replacement†

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, Jan 9, 2015

Valve-sparing root replacement (VSRR) is thought to reduce the rate of thromboembolic and bleedin... more Valve-sparing root replacement (VSRR) is thought to reduce the rate of thromboembolic and bleeding events compared with aortic root replacement using a mechanical aortic root replacement (MRR) with a composite graft by avoiding oral anticoagulation. But as VSRR carries a certain risk for subsequent reinterventions, decision-making in the individual patient can be challenging. Of 100 Marfan syndrome (MFS) patients who underwent 169 aortic surgeries and were followed at our institution since 1995, 59 consecutive patients without a history of dissection or prior aortic surgery underwent elective VSRR or MRR and were retrospectively analysed. VSRR was performed in 29 (David n = 24, Yacoub n = 5) and MRR in 30 patients. The mean age was 33 ± 15 years. The mean follow-up after VSRR was 6.5 ± 4 years (180 patient-years) compared with 8.8 ± 9 years (274 patient-years) after MRR. Reoperation rates after root remodelling (Yacoub) were significantly higher than after the reimplantation (David)...

Research paper thumbnail of QR in V1--an ECG sign associated with right ventricular strain and adverse clinical outcome in pulmonary embolism

European heart journal, 2003

To test the hypothesis that Qr in V(1)is a predictor of pulmonary embolism, right ventricular str... more To test the hypothesis that Qr in V(1)is a predictor of pulmonary embolism, right ventricular strain, and adverse clinical outcome. ECG's from 151 patients with suspected pulmonary embolism were blindly interpreted by two observers. Echocardiography, troponin I, and pro-brain natriuretic peptide levels were obtained in 75 patients with pulmonary embolism. Qr in V(1)(14 vs 0 in controls; p<0.0001) and ST elevation in V(1)> or =1 mV (15 vs 1 in controls; p=0.0002) were more frequently present in patients with pulmonary embolism. Sensitivity and specificity of Qr in V(1)and T wave inversion in V(2)for predicting right ventricular dysfunction were 31/97% and 45/94%, respectively. Three of five patients who died in-hospital and 11 of 20 patients with a complicated course, presented with Qr in V(1). After adjustment for right ventricular strain including ECG, echocardiography, pro-brain natriuretic peptide and troponin I levels, Qr in V(1)(OR 8.7, 95%CI 1.4-56.7; p=0.02) remaine...

Research paper thumbnail of QR in V1 – an ECG sign associated with right ventricular strain and adverse clinical outcome in pulmonary embolism

European Heart Journal, 2003

Research paper thumbnail of with coronary artery disease channel development: Functional collateral channel measurement in 450 patients Frequency distribution of collateral flow and factors influencing collateral

Research paper thumbnail of Acute Carotid T Occlusion in a Young Patient: Cryptogenic Origin?

Research paper thumbnail of Direct physiological evidence of damage to collaterals during primary coronary angioplasty for acute myocardial infarction

J Amer Coll Cardiol, 2003

with myocardial infarction (MI) and normal coronary angiography (NCA) than in pts with MI and cor... more with myocardial infarction (MI) and normal coronary angiography (NCA) than in pts with MI and coronary artery stenosis. Despite a good long-term prognosis of pts with NCA, the prognosis of those with inherited coagulation disorders is unknown. Objectives. The purpose of this study was to compare the clinical thrombosis Outcome of pts with (Gpl) or without (Gpll) an inherited coagulation disorders who suffered from an acute Ml with NCA. Methods. From September 1994 to November 2000, 82 consecutive pts (mean age 49k15 years; 29 females) with MI but NCA were recruited. Results. Twelve pts (15%) had an inherited coagulation disorder: APC resistance in 8 pts, factor XII deficiency in 3 pts and protem C deficiency in 1 pt. Gpl and Gpll were statistically similar regarding age (45*11 vs 50+16 years-old), gender (33 vs 36% female), tobacco (50 vs 53%). diabetes mellltus (8 vs IO%), hypertension (25 vs 17%), obesity (8.3 vs 14%), coronary heart disease family history (33 vs 19%), hypercholesterolemia (50 vs 21%;

Research paper thumbnail of Impact of imaging modality, TTE vs. TEE, on the measurement of mitral regurgitant volume by three-dimensional integrated PISA

Authors: N. Brugger1, K. Wustmann1, M. Huerzeler1, H. Steck1, C. Seiler1, 1Bern University Hospit... more Authors: N. Brugger1, K. Wustmann1, M. Huerzeler1, H. Steck1, C. Seiler1, 1Bern University Hospital, Department of Cardiology - Bern - Switzerland, Topic(s): 3-D echo Citation: European Heart Journal ( 2014 ) 35 ( Abstract Supplement ), 40 Introduction: Three-dimensional integrated PISA (3D PISA) is a new technique to measure the regurgitant volume (RVol) of mitral regurgitation (MR) without geometrical assumption and taking into account the dynamic changes of PISA during systole. Little is known about the impact of the imaging modality (transesophageal, TEE vs. transthoracic, TTE) on the measured RVol. Methods: In patients with MR, cardiac MRI (CMR), TTE and TEE were performed the same day. Color Doppler volumes focused on MR-PISA were recorded using ECG-triggered multiple beats 3D echocardiography (3-DE). For each patient, all PISA visible during systole were 3D reconstructed using a customized software (fig. 1). RVol of each PISA was calculated as: Nyquist limit x PISA x time bet...

Research paper thumbnail of Comparison of three-dimensional proximal isovelocity surface area to cardiac magnetic resonance imaging for quantifying mitral regurgitation

The American journal of cardiology, Jan 15, 2015

The aim of our study was to evaluate 3-dimensional (3D) color Doppler proximal isovelocity surfac... more The aim of our study was to evaluate 3-dimensional (3D) color Doppler proximal isovelocity surface area (PISA) as a tool for quantitative assessment of mitral regurgitation (MR) against in vitro and in vivo reference methods. A customized 3D PISA software was validated in vitro against a flowmeter MR phantom. Sixty consecutive patients, with ≥mild MR of any cause, were recruited and the regurgitant volume (RVol) was measured by 2D PISA, 3D peak PISA, and 3D integrated PISA, using transthoracic (TTE) and transesophageal echocardiography (TEE). Cardiac magnetic resonance imaging (CMR) was used as reference method. Flowmeter RVol was associated with 3D integrated PISA as follows: y = 0.64x + 4.7, r(2) = 0.97, p <0.0001 for TEE and y = 0.88x + 4.07, r(2) = 0.96, p <0.0001 for TTE. The bias and limit of agreement in the Bland-Altman analysis were 6.8 ml [-3.5 to 17.1] for TEE and -0.059 ml [-6.2 to 6.1] for TTE. In vivo, TEE-derived 3D integrated PISA was the most accurate method f...

Research paper thumbnail of Right ventricular systolic function assessment: rank of echocardiographic methods vs. cardiac magnetic resonance imaging

European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology, 2011

Right ventricular (RV) systolic function is prognostically important, but its assessment by echoc... more Right ventricular (RV) systolic function is prognostically important, but its assessment by echocardiography remains challenging, in part because of the multitude of available measurement methods. The purpose of this prospective study was to rank these methods against the reference of RV ejection fraction (EF) as obtained in a broad clinical population by magnetic resonance imaging (MRI). Two hundred and twenty-three individuals were included in the study. The following seven Doppler echocardiographic parameters were tested using receiver operating characteristic (ROC) analysis for their accuracy to distinguish between normal and moderately impaired RVEF by MRI (RVEF cut-off 50%), respectively, between moderately and severely reduced RVEF (cut-off 30%): RV fractional area and fractional long-axis change (FLC), RV myocardial performance index (MPI), tricuspid annular peak systolic excursion, Doppler tissue imaging-derived isovolumic acceleration and peak systolic velocity (S') at...

Research paper thumbnail of Effect of statin treatment on coronary collateral flow in patients with coronary artery disease

Heart (British Cardiac Society), 2004

Research paper thumbnail of Acute Carotid T Occlusion in a Young Patient: Cryptogenic Origin?

Research paper thumbnail of Frequent Atrial Premature Beats Predict Paroxysmal Atrial Fibrillation in Stroke Patients: An Opportunity for a New Diagnostic Strategy

Research paper thumbnail of Direct physiological evidence of damage to collaterals during primary coronary angioplasty for acute myocardial infarction

Journal of the American College of Cardiology, 2003

with myocardial infarction (MI) and normal coronary angiography (NCA) than in pts with MI and cor... more with myocardial infarction (MI) and normal coronary angiography (NCA) than in pts with MI and coronary artery stenosis. Despite a good long-term prognosis of pts with NCA, the prognosis of those with inherited coagulation disorders is unknown. Objectives. The purpose of this study was to compare the clinical thrombosis Outcome of pts with (Gpl) or without (Gpll) an inherited coagulation disorders who suffered from an acute Ml with NCA. Methods. From September 1994 to November 2000, 82 consecutive pts (mean age 49k15 years; 29 females) with MI but NCA were recruited. Results. Twelve pts (15%) had an inherited coagulation disorder: APC resistance in 8 pts, factor XII deficiency in 3 pts and protem C deficiency in 1 pt. Gpl and Gpll were statistically similar regarding age (45*11 vs 50+16 years-old), gender (33 vs 36% female), tobacco (50 vs 53%). diabetes mellltus (8 vs IO%), hypertension (25 vs 17%), obesity (8.3 vs 14%), coronary heart disease family history (33 vs 19%), hypercholesterolemia (50 vs 21%;

Research paper thumbnail of TNFa and IL-6 release during primary percutaneous coronary intervention for acute myocardial infarction is related to coronary collateral flow

Journal of the American College of Cardiology, 2003

Research paper thumbnail of Frequency distribution of collateral flow and factors influencing collateral channel development

Journal of the American College of Cardiology, 2001

We sought to determine the pathogenetic predictors of collateral channels in a large cohort of pa... more We sought to determine the pathogenetic predictors of collateral channels in a large cohort of patients with coronary artery disease (CAD). BACKGROUND The frequency distribution of collateral flow in patients with CAD is unknown. Only small qualitative studies have investigated which factors influence the development of collateral channels.

Research paper thumbnail of Aortic Distensibility Independently Predicts Exercise Capacity in Adults with Repaired Conotruncal Defects

Journal of the American College of Cardiology, 2013

Research paper thumbnail of Is there collateral flow in normal coronary arteries?

Journal of the American College of Cardiology, 2002

Noon 11:15 a.m. 814-5 BACKGROUND: Relatively little is understood concerning how macromolecules (MM)

Research paper thumbnail of Promotion of collateral growth (arteriogenesis) by granulocyte-macrophage colony-stimulating factor (GM-CSF) in patients with coronary artery disease

Journal of the American College of Cardiology, 2002

Research paper thumbnail of Outcome in adult patients after arterial switch operation for transposition of the great arteries

International Journal of Cardiology, 2013

The arterial switch operation (ASO) is currently the treatment of choice in neonates with transpo... more The arterial switch operation (ASO) is currently the treatment of choice in neonates with transposition of the great arteries (TGA). The outcome in childhood is encouraging but only limited data for long-term outcome into adulthood exist. We studied 145 adult patients (age&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;16, median 25 years) with ASO followed at our institution. Three patients died in adulthood (mortality 2.4/1000-patient-years). Most patients were asymptomatic and had normal left ventricular function. Coronary lesions requiring interventions were rare (3 patients) and in most patients related to previous surgery. There were no acute coronary syndromes. Aortic root dilatation was frequent (56% patients) but rarely significant (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;45 mm in 3 patients, maximal-diameter 49 mm) and appeared not to be progressive. There were no acute aortic events and no patient required elective aortic root surgery. Progressive neo-aortic-valve dysfunction was not observed in our cohort and only 1 patient required neo-aortic-valve replacement. Many patients (42.1%), however, had significant residual lesions or required reintervention in adulthood. Right ventricular outflow tract lesions or dysfunction of the neo-pulmonary-valve were frequent and 8 patients (6%) required neo-pulmonary-valve replacement. Cardiac interventions during childhood (OR 3.0, 95% CI 1.7-5.4, P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.0001) were strong predictors of outcome (cardiac intervention/significant residual lesion/death) in adulthood. Adult patients with previous ASO remain free of acute coronary or aortic complications and have low mortality. However, a large proportion of patients require re-interventions or present with significant right sided lesions. Life-long cardiac follow-up is, therefore, warranted. Periodic noninvasive surveillance for coronary complications appears to be safe in adult ASO patients.

Research paper thumbnail of Effects of Chronic Baroreceptor Stimulation on the Autonomic Cardiovascular Regulation in Patients With Drug-Resistant Arterial Hypertension

Hypertension, 2009

In patients with drug-resistant hypertension, chronic electric stimulation of the carotid baroref... more In patients with drug-resistant hypertension, chronic electric stimulation of the carotid baroreflex is an investigational therapy for blood pressure reduction. We hypothesized that changes in cardiac autonomic regulation can be demonstrated in response to chronic baroreceptor stimulation, and we analyzed the correlation with blood pressure changes. Twenty-one patients with drug-resistant hypertension were prospectively included in a substudy of the Device Based Therapy in Hypertension Trial. Heart rate variability and heart rate turbulence were analyzed using 24-hour ECG. Recordings were obtained 1 month after device implantation with the stimulator off and after 3 months of chronic electric stimulation (stimulator on). Chronic baroreceptor stimulation decreased office blood pressure from 185Ϯ31/ 109Ϯ24 mm Hg to 154Ϯ23/95Ϯ16 mm Hg (PϽ0.0001/Pϭ0.002). Mean heart rate decreased from 81Ϯ11 to 76Ϯ10 beats per minute Ϫ1 (Pϭ0.001). Heart rate variability frequency-domain parameters assessed using fast Fourier transformation (FFT; ratio of low frequency:high frequency: 2.78 versus 2.24 for off versus on; PϽ0.001) were significantly changed during stimulation of the carotid baroreceptor, and heart rate turbulence onset was significantly decreased (turbulence onset: Ϫ0.002 versus Ϫ0.015 for off versus on; Pϭ0.004). In conclusion, chronic baroreceptor stimulation causes sustained changes in heart rate variability and heart rate turbulence that are consistent with inhibition of sympathetic activity and increase of parasympathetic activity in patients with drug-resistant systemic hypertension; these changes correlate with blood pressure reduction. Whether the autonomic modulation has favorable cardiovascular effects beyond blood pressure control should be investigated in further studies. (Hypertension. 2009;54:530-536.) Key Words: baroreflex Ⅲ arterial hypertension Ⅲ electric baroreflex stimulation Ⅲ heart rate variability Ⅲ heart rate turbulence Ⅲ drug-resistant arterial hypertension Ⅲ cardiac autonomic system

Research paper thumbnail of Decision-making in aortic root surgery in Marfan syndrome: bleeding, thromboembolism and risk of reintervention after valve-sparing or mechanical aortic root replacement†

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, Jan 9, 2015

Valve-sparing root replacement (VSRR) is thought to reduce the rate of thromboembolic and bleedin... more Valve-sparing root replacement (VSRR) is thought to reduce the rate of thromboembolic and bleeding events compared with aortic root replacement using a mechanical aortic root replacement (MRR) with a composite graft by avoiding oral anticoagulation. But as VSRR carries a certain risk for subsequent reinterventions, decision-making in the individual patient can be challenging. Of 100 Marfan syndrome (MFS) patients who underwent 169 aortic surgeries and were followed at our institution since 1995, 59 consecutive patients without a history of dissection or prior aortic surgery underwent elective VSRR or MRR and were retrospectively analysed. VSRR was performed in 29 (David n = 24, Yacoub n = 5) and MRR in 30 patients. The mean age was 33 ± 15 years. The mean follow-up after VSRR was 6.5 ± 4 years (180 patient-years) compared with 8.8 ± 9 years (274 patient-years) after MRR. Reoperation rates after root remodelling (Yacoub) were significantly higher than after the reimplantation (David)...

Research paper thumbnail of QR in V1--an ECG sign associated with right ventricular strain and adverse clinical outcome in pulmonary embolism

European heart journal, 2003

To test the hypothesis that Qr in V(1)is a predictor of pulmonary embolism, right ventricular str... more To test the hypothesis that Qr in V(1)is a predictor of pulmonary embolism, right ventricular strain, and adverse clinical outcome. ECG's from 151 patients with suspected pulmonary embolism were blindly interpreted by two observers. Echocardiography, troponin I, and pro-brain natriuretic peptide levels were obtained in 75 patients with pulmonary embolism. Qr in V(1)(14 vs 0 in controls; p<0.0001) and ST elevation in V(1)> or =1 mV (15 vs 1 in controls; p=0.0002) were more frequently present in patients with pulmonary embolism. Sensitivity and specificity of Qr in V(1)and T wave inversion in V(2)for predicting right ventricular dysfunction were 31/97% and 45/94%, respectively. Three of five patients who died in-hospital and 11 of 20 patients with a complicated course, presented with Qr in V(1). After adjustment for right ventricular strain including ECG, echocardiography, pro-brain natriuretic peptide and troponin I levels, Qr in V(1)(OR 8.7, 95%CI 1.4-56.7; p=0.02) remaine...

Research paper thumbnail of QR in V1 – an ECG sign associated with right ventricular strain and adverse clinical outcome in pulmonary embolism

European Heart Journal, 2003

Research paper thumbnail of with coronary artery disease channel development: Functional collateral channel measurement in 450 patients Frequency distribution of collateral flow and factors influencing collateral

Research paper thumbnail of Acute Carotid T Occlusion in a Young Patient: Cryptogenic Origin?

Research paper thumbnail of Direct physiological evidence of damage to collaterals during primary coronary angioplasty for acute myocardial infarction

J Amer Coll Cardiol, 2003

with myocardial infarction (MI) and normal coronary angiography (NCA) than in pts with MI and cor... more with myocardial infarction (MI) and normal coronary angiography (NCA) than in pts with MI and coronary artery stenosis. Despite a good long-term prognosis of pts with NCA, the prognosis of those with inherited coagulation disorders is unknown. Objectives. The purpose of this study was to compare the clinical thrombosis Outcome of pts with (Gpl) or without (Gpll) an inherited coagulation disorders who suffered from an acute Ml with NCA. Methods. From September 1994 to November 2000, 82 consecutive pts (mean age 49k15 years; 29 females) with MI but NCA were recruited. Results. Twelve pts (15%) had an inherited coagulation disorder: APC resistance in 8 pts, factor XII deficiency in 3 pts and protem C deficiency in 1 pt. Gpl and Gpll were statistically similar regarding age (45*11 vs 50+16 years-old), gender (33 vs 36% female), tobacco (50 vs 53%). diabetes mellltus (8 vs IO%), hypertension (25 vs 17%), obesity (8.3 vs 14%), coronary heart disease family history (33 vs 19%), hypercholesterolemia (50 vs 21%;

Research paper thumbnail of Impact of imaging modality, TTE vs. TEE, on the measurement of mitral regurgitant volume by three-dimensional integrated PISA

Authors: N. Brugger1, K. Wustmann1, M. Huerzeler1, H. Steck1, C. Seiler1, 1Bern University Hospit... more Authors: N. Brugger1, K. Wustmann1, M. Huerzeler1, H. Steck1, C. Seiler1, 1Bern University Hospital, Department of Cardiology - Bern - Switzerland, Topic(s): 3-D echo Citation: European Heart Journal ( 2014 ) 35 ( Abstract Supplement ), 40 Introduction: Three-dimensional integrated PISA (3D PISA) is a new technique to measure the regurgitant volume (RVol) of mitral regurgitation (MR) without geometrical assumption and taking into account the dynamic changes of PISA during systole. Little is known about the impact of the imaging modality (transesophageal, TEE vs. transthoracic, TTE) on the measured RVol. Methods: In patients with MR, cardiac MRI (CMR), TTE and TEE were performed the same day. Color Doppler volumes focused on MR-PISA were recorded using ECG-triggered multiple beats 3D echocardiography (3-DE). For each patient, all PISA visible during systole were 3D reconstructed using a customized software (fig. 1). RVol of each PISA was calculated as: Nyquist limit x PISA x time bet...

Research paper thumbnail of Comparison of three-dimensional proximal isovelocity surface area to cardiac magnetic resonance imaging for quantifying mitral regurgitation

The American journal of cardiology, Jan 15, 2015

The aim of our study was to evaluate 3-dimensional (3D) color Doppler proximal isovelocity surfac... more The aim of our study was to evaluate 3-dimensional (3D) color Doppler proximal isovelocity surface area (PISA) as a tool for quantitative assessment of mitral regurgitation (MR) against in vitro and in vivo reference methods. A customized 3D PISA software was validated in vitro against a flowmeter MR phantom. Sixty consecutive patients, with ≥mild MR of any cause, were recruited and the regurgitant volume (RVol) was measured by 2D PISA, 3D peak PISA, and 3D integrated PISA, using transthoracic (TTE) and transesophageal echocardiography (TEE). Cardiac magnetic resonance imaging (CMR) was used as reference method. Flowmeter RVol was associated with 3D integrated PISA as follows: y = 0.64x + 4.7, r(2) = 0.97, p <0.0001 for TEE and y = 0.88x + 4.07, r(2) = 0.96, p <0.0001 for TTE. The bias and limit of agreement in the Bland-Altman analysis were 6.8 ml [-3.5 to 17.1] for TEE and -0.059 ml [-6.2 to 6.1] for TTE. In vivo, TEE-derived 3D integrated PISA was the most accurate method f...

Research paper thumbnail of Right ventricular systolic function assessment: rank of echocardiographic methods vs. cardiac magnetic resonance imaging

European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology, 2011

Right ventricular (RV) systolic function is prognostically important, but its assessment by echoc... more Right ventricular (RV) systolic function is prognostically important, but its assessment by echocardiography remains challenging, in part because of the multitude of available measurement methods. The purpose of this prospective study was to rank these methods against the reference of RV ejection fraction (EF) as obtained in a broad clinical population by magnetic resonance imaging (MRI). Two hundred and twenty-three individuals were included in the study. The following seven Doppler echocardiographic parameters were tested using receiver operating characteristic (ROC) analysis for their accuracy to distinguish between normal and moderately impaired RVEF by MRI (RVEF cut-off 50%), respectively, between moderately and severely reduced RVEF (cut-off 30%): RV fractional area and fractional long-axis change (FLC), RV myocardial performance index (MPI), tricuspid annular peak systolic excursion, Doppler tissue imaging-derived isovolumic acceleration and peak systolic velocity (S') at...

Research paper thumbnail of Effect of statin treatment on coronary collateral flow in patients with coronary artery disease

Heart (British Cardiac Society), 2004

Research paper thumbnail of Acute Carotid T Occlusion in a Young Patient: Cryptogenic Origin?

Research paper thumbnail of Frequent Atrial Premature Beats Predict Paroxysmal Atrial Fibrillation in Stroke Patients: An Opportunity for a New Diagnostic Strategy

Research paper thumbnail of Direct physiological evidence of damage to collaterals during primary coronary angioplasty for acute myocardial infarction

Journal of the American College of Cardiology, 2003

with myocardial infarction (MI) and normal coronary angiography (NCA) than in pts with MI and cor... more with myocardial infarction (MI) and normal coronary angiography (NCA) than in pts with MI and coronary artery stenosis. Despite a good long-term prognosis of pts with NCA, the prognosis of those with inherited coagulation disorders is unknown. Objectives. The purpose of this study was to compare the clinical thrombosis Outcome of pts with (Gpl) or without (Gpll) an inherited coagulation disorders who suffered from an acute Ml with NCA. Methods. From September 1994 to November 2000, 82 consecutive pts (mean age 49k15 years; 29 females) with MI but NCA were recruited. Results. Twelve pts (15%) had an inherited coagulation disorder: APC resistance in 8 pts, factor XII deficiency in 3 pts and protem C deficiency in 1 pt. Gpl and Gpll were statistically similar regarding age (45*11 vs 50+16 years-old), gender (33 vs 36% female), tobacco (50 vs 53%). diabetes mellltus (8 vs IO%), hypertension (25 vs 17%), obesity (8.3 vs 14%), coronary heart disease family history (33 vs 19%), hypercholesterolemia (50 vs 21%;

Research paper thumbnail of TNFa and IL-6 release during primary percutaneous coronary intervention for acute myocardial infarction is related to coronary collateral flow

Journal of the American College of Cardiology, 2003

Research paper thumbnail of Frequency distribution of collateral flow and factors influencing collateral channel development

Journal of the American College of Cardiology, 2001

We sought to determine the pathogenetic predictors of collateral channels in a large cohort of pa... more We sought to determine the pathogenetic predictors of collateral channels in a large cohort of patients with coronary artery disease (CAD). BACKGROUND The frequency distribution of collateral flow in patients with CAD is unknown. Only small qualitative studies have investigated which factors influence the development of collateral channels.

Research paper thumbnail of Aortic Distensibility Independently Predicts Exercise Capacity in Adults with Repaired Conotruncal Defects

Journal of the American College of Cardiology, 2013

Research paper thumbnail of Is there collateral flow in normal coronary arteries?

Journal of the American College of Cardiology, 2002

Noon 11:15 a.m. 814-5 BACKGROUND: Relatively little is understood concerning how macromolecules (MM)

Research paper thumbnail of Promotion of collateral growth (arteriogenesis) by granulocyte-macrophage colony-stimulating factor (GM-CSF) in patients with coronary artery disease

Journal of the American College of Cardiology, 2002

Research paper thumbnail of Outcome in adult patients after arterial switch operation for transposition of the great arteries

International Journal of Cardiology, 2013

The arterial switch operation (ASO) is currently the treatment of choice in neonates with transpo... more The arterial switch operation (ASO) is currently the treatment of choice in neonates with transposition of the great arteries (TGA). The outcome in childhood is encouraging but only limited data for long-term outcome into adulthood exist. We studied 145 adult patients (age&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;16, median 25 years) with ASO followed at our institution. Three patients died in adulthood (mortality 2.4/1000-patient-years). Most patients were asymptomatic and had normal left ventricular function. Coronary lesions requiring interventions were rare (3 patients) and in most patients related to previous surgery. There were no acute coronary syndromes. Aortic root dilatation was frequent (56% patients) but rarely significant (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;45 mm in 3 patients, maximal-diameter 49 mm) and appeared not to be progressive. There were no acute aortic events and no patient required elective aortic root surgery. Progressive neo-aortic-valve dysfunction was not observed in our cohort and only 1 patient required neo-aortic-valve replacement. Many patients (42.1%), however, had significant residual lesions or required reintervention in adulthood. Right ventricular outflow tract lesions or dysfunction of the neo-pulmonary-valve were frequent and 8 patients (6%) required neo-pulmonary-valve replacement. Cardiac interventions during childhood (OR 3.0, 95% CI 1.7-5.4, P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.0001) were strong predictors of outcome (cardiac intervention/significant residual lesion/death) in adulthood. Adult patients with previous ASO remain free of acute coronary or aortic complications and have low mortality. However, a large proportion of patients require re-interventions or present with significant right sided lesions. Life-long cardiac follow-up is, therefore, warranted. Periodic noninvasive surveillance for coronary complications appears to be safe in adult ASO patients.

Research paper thumbnail of Effects of Chronic Baroreceptor Stimulation on the Autonomic Cardiovascular Regulation in Patients With Drug-Resistant Arterial Hypertension

Hypertension, 2009

In patients with drug-resistant hypertension, chronic electric stimulation of the carotid baroref... more In patients with drug-resistant hypertension, chronic electric stimulation of the carotid baroreflex is an investigational therapy for blood pressure reduction. We hypothesized that changes in cardiac autonomic regulation can be demonstrated in response to chronic baroreceptor stimulation, and we analyzed the correlation with blood pressure changes. Twenty-one patients with drug-resistant hypertension were prospectively included in a substudy of the Device Based Therapy in Hypertension Trial. Heart rate variability and heart rate turbulence were analyzed using 24-hour ECG. Recordings were obtained 1 month after device implantation with the stimulator off and after 3 months of chronic electric stimulation (stimulator on). Chronic baroreceptor stimulation decreased office blood pressure from 185Ϯ31/ 109Ϯ24 mm Hg to 154Ϯ23/95Ϯ16 mm Hg (PϽ0.0001/Pϭ0.002). Mean heart rate decreased from 81Ϯ11 to 76Ϯ10 beats per minute Ϫ1 (Pϭ0.001). Heart rate variability frequency-domain parameters assessed using fast Fourier transformation (FFT; ratio of low frequency:high frequency: 2.78 versus 2.24 for off versus on; PϽ0.001) were significantly changed during stimulation of the carotid baroreceptor, and heart rate turbulence onset was significantly decreased (turbulence onset: Ϫ0.002 versus Ϫ0.015 for off versus on; Pϭ0.004). In conclusion, chronic baroreceptor stimulation causes sustained changes in heart rate variability and heart rate turbulence that are consistent with inhibition of sympathetic activity and increase of parasympathetic activity in patients with drug-resistant systemic hypertension; these changes correlate with blood pressure reduction. Whether the autonomic modulation has favorable cardiovascular effects beyond blood pressure control should be investigated in further studies. (Hypertension. 2009;54:530-536.) Key Words: baroreflex Ⅲ arterial hypertension Ⅲ electric baroreflex stimulation Ⅲ heart rate variability Ⅲ heart rate turbulence Ⅲ drug-resistant arterial hypertension Ⅲ cardiac autonomic system