Laszlo Voith - Academia.edu (original) (raw)
Papers by Laszlo Voith
Orvosi Hetilap, Mar 13, 2015
There are only very few data on gender differences in patients with ST-elevation myocardial infar... more There are only very few data on gender differences in patients with ST-elevation myocardial infarction. To compare the clinical data and prognosis of patients with ST-elevation myocardial infarction in the Hungarian Myocardial Infarction Registry database. Between January 1, 2010 and December 31, 2011 4981 patients (3038 men) were included in the database. Women were significantly older (67.7±13.5 vs. 60.5±12.5 years; p<0.001). Hypertension, diabetes, and stroke were more frequent among women, whereas smoking and previous myocardial infarction were found more often among men. Percutaneous coronary intervention was significantly more frequently performed in men than in women (82.4% vs. 75.3%; p<0.001), and the time between the onset of pain and arrival of patients to the site of percutaneous coronary intervention was longer in women than in men. Hospital mortality was higher among women than men (7.5% vs. 4.4%; p<0.001). At present women have a poorer hospital outcome than men. By increasing the revascularization treatment ratio in women an improvement may be achieved in the prognosis.
Orvosi hetilap, Jan 31, 2005
At the two hospitals, first percutaneous coronary intervention was performed on 1031 patients (70... more At the two hospitals, first percutaneous coronary intervention was performed on 1031 patients (700 male and 331 female, average age 59.8 +/- 15.1 years) between July 2000 and June 2002. The indications were: stable effort angina 679 (65.8%), unstable angina and non-ST elevation myocardial infarction 267 (26.0%), ST elevation myocardial infarction 85 (8.2%). Single vessel dilatation was performed on 906 (87.9%), double and triple vessel on 125 (12.1%) pts in 1170 vessels (1145 native, 24 saphenous vein and 1 mammary artery graft) and in 1372 stenoses. During the interventions, 1043 stents were implanted in 797 pts, average 1.3/pt. The intervention was clinically successful in 950 (92.1%) and unsuccessful in 81 (7.9%) pts. In most of cases, the lack of success was a result of ineffective recanalisation. 65 major adverse cardiac events occurred in 35 (3.4%) pts (acute redilatation 20 (1.9%), acute surgery 4 (0.4%), acute myocardial infarction 34 (3.3%) and fatal outcome 7 (0.7%). Fatal...
Orvosi hetilap, Jan 8, 1999
Left ventricular aneurysm had detected at the 55-year-old woman after extensive anterior myocardi... more Left ventricular aneurysm had detected at the 55-year-old woman after extensive anterior myocardial infarction in association with progressive ventricular dilatation and symptoms of heart failure. Coronary angiogram revealed a serious lesion in the proximal segment of the left anterior descending coronary branch with a poor run off tract. 18FDG-PET and 99mTc-MIBI-SPECT investigation were performed in order to differentiate the scarred regions from the viable myocardial segments. Taking into consideration the results an aneurysm resection was performed without revascularisation procedure. After the surgery not only the ejection fraction and the left ventricular dilatation had improved but the tissue perfusion in the segments surrounding the resected aneurysm had also showed a significant increase at the follow up MIBI-SPECT imaging.
Journal of Nuclear Cardiology, 2001
A new method for the estimation of coronary flow reserve (CFR) using rest-stress Tc-99m-MIBI stud... more A new method for the estimation of coronary flow reserve (CFR) using rest-stress Tc-99m-MIBI study with combination of dynamic data acquisition at tracer injection and SPECT imaging was developed and was evaluated by comparing with CFR measured by intra coronary artery doppler flow wire (DF). Principle: CFR index (CFR-I) is derived from the following equations. Myocardial MIBI count (MC) can be expressed as follows; MC-k*I* EF*MBF/CO, where I = injected tracer dose, k = correcting factor for the count rate of the gamma camera, EF -extraction fraction of MIBI, MBF = myocardial blood flow, CO = cardiac output. CO can be calculated by the equation; CO=k*I/S, where S = area under gamma variate fitted left ventricular (LV) time activity curve during first transit of the tracer. From these equations, MBF -MC/(EF*S). When EFs at rest and during stress are arbitrary assumed to be equal, CFR-I MBFstress / MBFrest = MCstress*Srest / MCrest*Sstress. Methods: 22 patients with coronary artery disease were performed rest-stress MIBI study and measurement of coronary artery flow velocity by DF during the same hospital stay. MIBI study was performed at rest (300-370MBq) followed by adenosine triphosphate (ATP) stress (600-740MBq) 1 hr later. On anterior view, dynamic data (frame/sec) were acquired at rest and during ATP stress (0.16mg/Kg/min for 5 min)just afer the injection of M1BI. Time activity curve was generated from the LV ROI and S was calculated. SPECT was performed 40 min after rest injection and 60 min after stress injection of MIBI. Regional myocardial count was measured on the 18 areas using bull's eye map. CFR was measured by the DF. After coronary arteriography, basal average peak velocity (APV) at the distal portion (>2 cm) to stenosis was measured. Then hyperemic APV was remeasured during ATP stress (0.16mg/Kg/min for 5 min). CFR was determined by dividing APV at stress by APV at baseline. Results: CFR-1 increased as coronary flow increased, but with significant underestimation and plateaued over 2.5 to 3 times normal flow. When CFR was < 2.5, the increase in CFR-I and CFR demonstrated a good linear correlation (Y = 0.31 X + 0.72, r -0.79, p<0.005), but the increase in CFR-I at higher CFR did not correlate to CFR significantly. Conclusion: Rest-stress MIBI study with combination of dynamic data acquisition at tracer injection and SPECT might permit evaluation of coronary flow reserve.
Journal of Nuclear Cardiology, 1997
The present study sought to evaluate the accuracy of a new, combined perfusion and function testi... more The present study sought to evaluate the accuracy of a new, combined perfusion and function testing in the detection of hibernating myocardium We investigated left ventricular perfusion and systolic thickening ratio (STR) in 140 myocardial segments of l0 patients before and after coronary revascularisation. In 6 only pharmacological treated patients initial and follow-up tests were performed within 3-6 months. Rest gated SPECT was obtained lh after injection of 15 mCi Tc99m Sestamibi under the infusion of 5-10g kg/min dobutamine during acquisition and without dobutamine next day. Myocardial count increase rate between enddiastolic and endsystolic frames was calculated and related to wall thickening. Gated SPECT was considered positive for hibernating with inotropic reserve if STR reached _<20% under dobutamine by persistent perfusion deficit in matching segments.Results.After revascularisation in 85/101 dependent vascular territories a significant improvement of STR was found (p<0.05). In 51/58 segments without revascularisation only minimal changes in STR could be proven. We conclude, that assessment of Tc99m Sestamibi gated SPECT under dobutamine may predict the recovery of myocardial contractile function after coronary revascularisation.
J Nuclear Cardiology, 1999
Journal of Nuclear Cardiology, 1999
Journal of Cardiac Failure, 1999
Orvosi Hetilap, 2012
There are only very few data on gender differences in patients with ST-elevation myocardial infar... more There are only very few data on gender differences in patients with ST-elevation myocardial infarction. To compare the clinical data and prognosis of patients with ST-elevation myocardial infarction in the Hungarian Myocardial Infarction Registry database. Between January 1, 2010 and December 31, 2011 4981 patients (3038 men) were included in the database. Women were significantly older (67.7±13.5 vs. 60.5±12.5 years; p&amp;amp;amp;amp;amp;amp;amp;lt;0.001). Hypertension, diabetes, and stroke were more frequent among women, whereas smoking and previous myocardial infarction were found more often among men. Percutaneous coronary intervention was significantly more frequently performed in men than in women (82.4% vs. 75.3%; p&amp;amp;amp;amp;amp;amp;amp;lt;0.001), and the time between the onset of pain and arrival of patients to the site of percutaneous coronary intervention was longer in women than in men. Hospital mortality was higher among women than men (7.5% vs. 4.4%; p&amp;amp;amp;amp;amp;amp;amp;lt;0.001). At present women have a poorer hospital outcome than men. By increasing the revascularization treatment ratio in women an improvement may be achieved in the prognosis.
Clinical Cardiology, 1997
Left ventricular wall rupture after myocardial infarction is a mechanical complication that may r... more Left ventricular wall rupture after myocardial infarction is a mechanical complication that may result in a pseudoaneurysm. Between January 1994 and October 1996, false or pseudoaneurysms were detected in 6 (0.0026%) of 2,600 consecutive patients (4 women, 2 men; mean age 59.4 years) undergoing cardiac catheterization at University Medical School, Debrecen, Hungary. All patients had a history of cardiovascular disease, with diagnosis of pseudoaneurysm confirmed by echocardiography. The average time from the occurrence of acute infarction to diagnosis was 37.0 days (range 3-80 days). All patients were in New York Heart Association functional class IV congestive heart failure; in four patients cardiogenic shock was present. Five patients underwent coronary angiography, which demonstrated multivessel disease and occlusion of the infarct-related artery (TIMI 0) without adequate collateral circulation (grade 0-1). Five patients had surgical repair of the false aneurysm, and, in three patients, concomitant coronary bypass grafting was performed. The 2-year mortality rate for all patients was 50%. Early diagnosis of false aneurysm is facilitated by echocardiography, and coronary angiography is required before surgery. Early surgical correction with coronary revascularization is advised.
Orvosi Hetilap
In the two institutions between January 1992 and December 1998 PTCA-s were done in 196 pts (123 m... more In the two institutions between January 1992 and December 1998 PTCA-s were done in 196 pts (123 male and 73 female) aged 70 years or more, with the 57 (20.1%) 6 months redo procedures performed out to June 1999, totally 247 interventions. The dilatations were done in 230 vessels (218 natives and 12 grafts) and in 254 stenoses, as of 1996 in 73 cases with stent deployment, too. PTCA was clinically successful in 178 (90.8%) pts, suboptimal result and/or MACE (AMI, emergency PTCA or CABG, fatal outcome) occurred in 18 (9.2%) cases. Due to unsuccessful PTCA-s, 3 (1.5%) pts underwent acute, 3 elective bypass surgery, in 1 (0.5%) case thoracal sympathectomy without revascularisation, in 1 no further intervention was done. The in-hospital as well as the 30 days mortality was 5 (2.6%). Taking into consideration the higher risk of CABG surgery at an old age, in the case of indication for coronary revascularisation the possibility of angioplasty should be considered first.
Orvosi Hetilap, Mar 13, 2015
There are only very few data on gender differences in patients with ST-elevation myocardial infar... more There are only very few data on gender differences in patients with ST-elevation myocardial infarction. To compare the clinical data and prognosis of patients with ST-elevation myocardial infarction in the Hungarian Myocardial Infarction Registry database. Between January 1, 2010 and December 31, 2011 4981 patients (3038 men) were included in the database. Women were significantly older (67.7±13.5 vs. 60.5±12.5 years; p&amp;amp;amp;amp;amp;amp;amp;lt;0.001). Hypertension, diabetes, and stroke were more frequent among women, whereas smoking and previous myocardial infarction were found more often among men. Percutaneous coronary intervention was significantly more frequently performed in men than in women (82.4% vs. 75.3%; p&amp;amp;amp;amp;amp;amp;amp;lt;0.001), and the time between the onset of pain and arrival of patients to the site of percutaneous coronary intervention was longer in women than in men. Hospital mortality was higher among women than men (7.5% vs. 4.4%; p&amp;amp;amp;amp;amp;amp;amp;lt;0.001). At present women have a poorer hospital outcome than men. By increasing the revascularization treatment ratio in women an improvement may be achieved in the prognosis.
Orvosi hetilap, Jan 31, 2005
At the two hospitals, first percutaneous coronary intervention was performed on 1031 patients (70... more At the two hospitals, first percutaneous coronary intervention was performed on 1031 patients (700 male and 331 female, average age 59.8 +/- 15.1 years) between July 2000 and June 2002. The indications were: stable effort angina 679 (65.8%), unstable angina and non-ST elevation myocardial infarction 267 (26.0%), ST elevation myocardial infarction 85 (8.2%). Single vessel dilatation was performed on 906 (87.9%), double and triple vessel on 125 (12.1%) pts in 1170 vessels (1145 native, 24 saphenous vein and 1 mammary artery graft) and in 1372 stenoses. During the interventions, 1043 stents were implanted in 797 pts, average 1.3/pt. The intervention was clinically successful in 950 (92.1%) and unsuccessful in 81 (7.9%) pts. In most of cases, the lack of success was a result of ineffective recanalisation. 65 major adverse cardiac events occurred in 35 (3.4%) pts (acute redilatation 20 (1.9%), acute surgery 4 (0.4%), acute myocardial infarction 34 (3.3%) and fatal outcome 7 (0.7%). Fatal...
Orvosi hetilap, Jan 8, 1999
Left ventricular aneurysm had detected at the 55-year-old woman after extensive anterior myocardi... more Left ventricular aneurysm had detected at the 55-year-old woman after extensive anterior myocardial infarction in association with progressive ventricular dilatation and symptoms of heart failure. Coronary angiogram revealed a serious lesion in the proximal segment of the left anterior descending coronary branch with a poor run off tract. 18FDG-PET and 99mTc-MIBI-SPECT investigation were performed in order to differentiate the scarred regions from the viable myocardial segments. Taking into consideration the results an aneurysm resection was performed without revascularisation procedure. After the surgery not only the ejection fraction and the left ventricular dilatation had improved but the tissue perfusion in the segments surrounding the resected aneurysm had also showed a significant increase at the follow up MIBI-SPECT imaging.
Journal of Nuclear Cardiology, 2001
A new method for the estimation of coronary flow reserve (CFR) using rest-stress Tc-99m-MIBI stud... more A new method for the estimation of coronary flow reserve (CFR) using rest-stress Tc-99m-MIBI study with combination of dynamic data acquisition at tracer injection and SPECT imaging was developed and was evaluated by comparing with CFR measured by intra coronary artery doppler flow wire (DF). Principle: CFR index (CFR-I) is derived from the following equations. Myocardial MIBI count (MC) can be expressed as follows; MC-k*I* EF*MBF/CO, where I = injected tracer dose, k = correcting factor for the count rate of the gamma camera, EF -extraction fraction of MIBI, MBF = myocardial blood flow, CO = cardiac output. CO can be calculated by the equation; CO=k*I/S, where S = area under gamma variate fitted left ventricular (LV) time activity curve during first transit of the tracer. From these equations, MBF -MC/(EF*S). When EFs at rest and during stress are arbitrary assumed to be equal, CFR-I MBFstress / MBFrest = MCstress*Srest / MCrest*Sstress. Methods: 22 patients with coronary artery disease were performed rest-stress MIBI study and measurement of coronary artery flow velocity by DF during the same hospital stay. MIBI study was performed at rest (300-370MBq) followed by adenosine triphosphate (ATP) stress (600-740MBq) 1 hr later. On anterior view, dynamic data (frame/sec) were acquired at rest and during ATP stress (0.16mg/Kg/min for 5 min)just afer the injection of M1BI. Time activity curve was generated from the LV ROI and S was calculated. SPECT was performed 40 min after rest injection and 60 min after stress injection of MIBI. Regional myocardial count was measured on the 18 areas using bull's eye map. CFR was measured by the DF. After coronary arteriography, basal average peak velocity (APV) at the distal portion (>2 cm) to stenosis was measured. Then hyperemic APV was remeasured during ATP stress (0.16mg/Kg/min for 5 min). CFR was determined by dividing APV at stress by APV at baseline. Results: CFR-1 increased as coronary flow increased, but with significant underestimation and plateaued over 2.5 to 3 times normal flow. When CFR was < 2.5, the increase in CFR-I and CFR demonstrated a good linear correlation (Y = 0.31 X + 0.72, r -0.79, p<0.005), but the increase in CFR-I at higher CFR did not correlate to CFR significantly. Conclusion: Rest-stress MIBI study with combination of dynamic data acquisition at tracer injection and SPECT might permit evaluation of coronary flow reserve.
Journal of Nuclear Cardiology, 1997
The present study sought to evaluate the accuracy of a new, combined perfusion and function testi... more The present study sought to evaluate the accuracy of a new, combined perfusion and function testing in the detection of hibernating myocardium We investigated left ventricular perfusion and systolic thickening ratio (STR) in 140 myocardial segments of l0 patients before and after coronary revascularisation. In 6 only pharmacological treated patients initial and follow-up tests were performed within 3-6 months. Rest gated SPECT was obtained lh after injection of 15 mCi Tc99m Sestamibi under the infusion of 5-10g kg/min dobutamine during acquisition and without dobutamine next day. Myocardial count increase rate between enddiastolic and endsystolic frames was calculated and related to wall thickening. Gated SPECT was considered positive for hibernating with inotropic reserve if STR reached _<20% under dobutamine by persistent perfusion deficit in matching segments.Results.After revascularisation in 85/101 dependent vascular territories a significant improvement of STR was found (p<0.05). In 51/58 segments without revascularisation only minimal changes in STR could be proven. We conclude, that assessment of Tc99m Sestamibi gated SPECT under dobutamine may predict the recovery of myocardial contractile function after coronary revascularisation.
J Nuclear Cardiology, 1999
Journal of Nuclear Cardiology, 1999
Journal of Cardiac Failure, 1999
Orvosi Hetilap, 2012
There are only very few data on gender differences in patients with ST-elevation myocardial infar... more There are only very few data on gender differences in patients with ST-elevation myocardial infarction. To compare the clinical data and prognosis of patients with ST-elevation myocardial infarction in the Hungarian Myocardial Infarction Registry database. Between January 1, 2010 and December 31, 2011 4981 patients (3038 men) were included in the database. Women were significantly older (67.7±13.5 vs. 60.5±12.5 years; p&amp;amp;amp;amp;amp;amp;amp;lt;0.001). Hypertension, diabetes, and stroke were more frequent among women, whereas smoking and previous myocardial infarction were found more often among men. Percutaneous coronary intervention was significantly more frequently performed in men than in women (82.4% vs. 75.3%; p&amp;amp;amp;amp;amp;amp;amp;lt;0.001), and the time between the onset of pain and arrival of patients to the site of percutaneous coronary intervention was longer in women than in men. Hospital mortality was higher among women than men (7.5% vs. 4.4%; p&amp;amp;amp;amp;amp;amp;amp;lt;0.001). At present women have a poorer hospital outcome than men. By increasing the revascularization treatment ratio in women an improvement may be achieved in the prognosis.
Clinical Cardiology, 1997
Left ventricular wall rupture after myocardial infarction is a mechanical complication that may r... more Left ventricular wall rupture after myocardial infarction is a mechanical complication that may result in a pseudoaneurysm. Between January 1994 and October 1996, false or pseudoaneurysms were detected in 6 (0.0026%) of 2,600 consecutive patients (4 women, 2 men; mean age 59.4 years) undergoing cardiac catheterization at University Medical School, Debrecen, Hungary. All patients had a history of cardiovascular disease, with diagnosis of pseudoaneurysm confirmed by echocardiography. The average time from the occurrence of acute infarction to diagnosis was 37.0 days (range 3-80 days). All patients were in New York Heart Association functional class IV congestive heart failure; in four patients cardiogenic shock was present. Five patients underwent coronary angiography, which demonstrated multivessel disease and occlusion of the infarct-related artery (TIMI 0) without adequate collateral circulation (grade 0-1). Five patients had surgical repair of the false aneurysm, and, in three patients, concomitant coronary bypass grafting was performed. The 2-year mortality rate for all patients was 50%. Early diagnosis of false aneurysm is facilitated by echocardiography, and coronary angiography is required before surgery. Early surgical correction with coronary revascularization is advised.
Orvosi Hetilap
In the two institutions between January 1992 and December 1998 PTCA-s were done in 196 pts (123 m... more In the two institutions between January 1992 and December 1998 PTCA-s were done in 196 pts (123 male and 73 female) aged 70 years or more, with the 57 (20.1%) 6 months redo procedures performed out to June 1999, totally 247 interventions. The dilatations were done in 230 vessels (218 natives and 12 grafts) and in 254 stenoses, as of 1996 in 73 cases with stent deployment, too. PTCA was clinically successful in 178 (90.8%) pts, suboptimal result and/or MACE (AMI, emergency PTCA or CABG, fatal outcome) occurred in 18 (9.2%) cases. Due to unsuccessful PTCA-s, 3 (1.5%) pts underwent acute, 3 elective bypass surgery, in 1 (0.5%) case thoracal sympathectomy without revascularisation, in 1 no further intervention was done. The in-hospital as well as the 30 days mortality was 5 (2.6%). Taking into consideration the higher risk of CABG surgery at an old age, in the case of indication for coronary revascularisation the possibility of angioplasty should be considered first.