R. Dörr

Impact of various compression rates on interpretation of digital coronary angiograms

According to the ACC/ACR/NEMA/ESC-guidelines, digital techniques should be replaced by cinefilm for coronary angiography. The ad hoc group of experts recently chose CD-R (CD recordable) as transport media and the JPEG standard for image compression. To avoid a possible loss of image quality, the guidelines allow a maximal data compression of only 2:1. This, however, leads to a considerable limitation: coronary angiograms cannot be viewed in real-time directly from CD. Since the possible influence of higher compression rates on image quality of coronary angiograms had not been investigated in a controlled study, we evaluated 8 various compression rates (ranging from 5:1 to 43:1) according to a prospective, randomized and blinded protocol. Four independent observers assessed 1440 angiograms using a semiquantitative score. We found that angiograms with a compression rate of 5:1 and 6:1 did not lead to a clinically relevant deterioration of image quality, whereas 11:1 was still acceptable, but 43:1 becomes unacceptable. Since no clinically relevant loss of information at a compression rate of 6:1 was experienced in our study, a modification of the ACC/ACJ/NEMA/ESC-guidelines allowing higher compression rates should be considered.

Sequential intervention procedures after intracoronary thrombolysis; balloon dilatation, bypass surgery, and medical treatment☆

After successful intracoronary thrombolysis of an acute myocardial infarction in 145 patients subsequent intervention procedures were evaluated. In 48 of 62 patients (43%), percutaneous transluminal coronary angioplasty was performed successfully (success rate 77%), 41 patients (28%) were operated on and 56 patients (39%) were treated only medically. During the hospital phase in the angioplasty group, 4 reinfarctions were noted and 3 repeat angioplasties were required, while 41 of the 48 successfully treated patients (85.4%) remained clinically stable. In the surgical group, one cardiac failure occurred, while 40 patients (97.6%) were without cardiac event. In the medical group, 5 patients died (8.9%), 8 patients (14.3%) had a reinfarction, and 76.8% were clinically stable. During the follow-up period in the surgical group of 6 months 37 patients (90.2%) were clinically stable, all in functional classes I and II. In the angioplasty group 33 patients were stable (68.8%), and in the medical group 26 patients were stable (46.6%). In the whole group of 145 patients the hospital mortality together with that in the 6 months follow-up period was 9.7% with a reinfarction rate of 22.8%.

Improved outcome with longer radiation sources: final results of the RENO registry in 1098 patients

RENO is a European registry trial to assess the clinical event rate (MACE defined as death, MI and/or TVR) in patients with discrete lesions (de novo or restenotic) in single or multiple vessels (native and bypass grafts) treated with beta radiation (Novoste Beta-Cath). Between April 1999 and September 2000, 46 sites have enrolled 1098 patients. 77.7% were treated for in-stent restenosis (ISR) and 17.7% for de-novo lesions in predominantly (94.1%) native coronary arteries. Mean dose was 18.8±3.2 Gy with 16.5% 30mm, 79.2 % 40mm and 4.3% 40 mm sources. The results are listed in the table. Conclusions: These data surprisingly show an improved outcome regarding angiogr. restenosis, total occlusion and MACE with longer radiation sources despite longer lesions.

Positionspapier Nuklearkardiologie – Update 2018 : Aktueller Stand der klinischen Anwendung

Das gemeinsame Positionspapier der Arbeitsgemeinschaft „Kardiovaskulare Nuklearmedizin” der Deutschen Gesellschaft fur Nuklearmedizin (DGN) und der Arbeitsgruppe „Nuklearkardiologische Diagnostik” der Deutschen Gesellschaft fur Kardiologie (DGK) aktualisiert das Positionspapier aus dem Jahr 2009. Es gibt einen Uberblick uber die Einsatzbereiche, den State of the Art und den aktuellen Stellenwert der nuklearkardiologischen Bildgebung. Behandelt werden die Themenfelder der chronischen KHK einschlieslich der Vitalitatsdiagnostik, ferner der Kardiomyopathien, der entzundlichen Endokarditiden, der kardialen Sarkoidose und Amyloidose.

Positionspapier Nuklearkardiologie – Update 2018

ZusammenfassungDas gemeinsame Positionspapier der Arbeitsgemeinschaft „Kardiovaskuläre Nuklearmedizin“ der Deutschen Gesellschaft für Nuklearmedizin (DGN) und der Arbeitsgruppe „Nuklearkardiologische Diagnostik“ der Deutschen Gesellschaft für Kardiologie (DGK) aktualisiert das Positionspapier aus dem Jahr 2009. Es gibt einen Überblick über die Einsatzbereiche, den State of the Art und den aktuellen Stellenwert der nuklearkardiologischen Bildgebung. Behandelt werden die Themenfelder der chronischen KHK einschließlich der Vitalitätsdiagnostik, ferner der Kardiomyopathien, der entzündlichen Endokarditiden, der kardialen Sarkoidose und Amyloidose.AbstractThe joint position paper of the working community on Cardiovascular Nuclear Medicine of the German Society of Nuclear Medicine (DGN) and the working group on Nuclear Cardiology Diagnostics of the German Cardiac Society (DKG) updates the former position paper from 2009. The purpose of this paper is to provide an overview of the fields of application, the state of the art and the current value of nuclear cardiology imaging. The topics covered are chronic coronary artery disease including viability diagnostics, cardiomyopathies, inflammatory endocarditis, cardiac sarcoidosis and amyloidosis.

Myokard-Perfusions-SPECT

The S1 guideline for myocardial perfusion SPECT has been published by the Association of the Scientific Medical Societies in Germany (AWMF) and is valid until 2/2022. This paper is a short summary with comments on all chapters and subchapters wich were modified and amended.

Angioplasty After Thrombolysis: Early and Late Angiographic Results

In 433/543 patients (80%) with acute myocardial infarction (AMI), initial angiography revealed a complete thrombotic obstruction of the infarct-related coronary artery. Reperfusion was established either medically (intracoronary streptokinase) or mechanically (guide-wire perforation of thrombus) within 1 h after the start of therapy in 88% (380/433). Of successfully reperfused patients, 37% had subsequent medical therapy, immediate PTCA was performed in 42%, and 21% underwent early bypass surgery. In addition, PTCA was performed in 31/ 543 patients whose infarct-related artery was subtotally occluded before start of treatment.

Koronaranatomische Veränderungen nach Thrombolyse beim akuten Myokardinfarkt

Es besteht heute kein Zweifel mehr, das der akute thrombotische Koronararterienverschlus mit Abstand die haufigste Ursache des frischen Myokardinfarktes darstellt [1–4]. Der Thrombus entsteht regelhaft an einer zuvor uber lange Zeit sich entwickelnden arteriosklerotisch bedingten Stenose [2, 3, 5]. Trotz medikamentoser Antikoagulation tritt an der Reststenose nach primar erfolgreicher Lyse in bis zu 30% der Falle ein Reverschlus mit oder ohne Reinfarkt auf [6–10], wobei offenbar das Ausmas der verbleibenden Gefaseinengung eine bedeutsame Rolle spielt [11]. Die bisher in der Literatur mitgeteilten Daten bezuglich des Grades dieser Reststenose sind durchaus widerspruchlich: Mitteilungen uber eine hochgradige verbleibende Lumeneinengung nach Thrombolyse [3, 11] stehen solche uber eine nur unbedeutende verbleibende Reststenose gegenuber [12–15]. Dies erschwert vor allem im Einzelfall die richtige Indikationstellung zu weiterfuhrenden Masnahmen nach erfolgreicher Thrombolyse, mit Hilfe derer die Reverschlusrate vermindert werden konnte: die perkutane transluminale Koronarangioplastie (PTCA) [7, 16] oder die aortokoronare Bypass-Operation [17]. Die widerspruchlichen Befunde sind z. T. sicherlich durch dynamische Prozesse erklarbar, wie sie auch bei der chronisch stabilen koronaren Herzkrankheit, vor allem aber bei der instabilen Angina pectoris bekannt sind [13, 18–20]. Andererseits werden die Untersuchungen z. T. nach intrakoronarer, z. T. nach intravenoser Thrombolyse vorgenommen; es bleibt meist unberucksichtigt, ob initial ein kompletter oder lediglich inkompletter thrombotischer Verschlus bestand; die medikamentose Therapie nach Thrombolyse ist unterschiedlich.

Short and long term results with intracoronary SK with regard to further treatment and age of patients — experiences in Aachen —

Twenty-five years ago Boucek and co-workers (4) described treatment with thrombolysin of eight patients who had suffered acute myocardial infarction. Using a catheter they introduced the drug directly into the sinus of Valsalva and could observe a return to normal within 6 h in the electrocardiograms of two patients. This was then followed in more extensive investigations (29) by systemic application of streptokinase in acute myocardial infarction. The results of eight randomised studies were published between 1969 and 1979 (1–3, 5, 7, 12–14). A significant drop in mortality could only be demonstrated in three of these studies with intravenous injection of streptokinase (5, 12, 13) and for this reason systemic streptokinase treatment was discontinued in most cardiology centres.

Financial background of PTCR and PTCA and regional distribution of cardiac catheterization laboratories in the Federal Republic of Germany

In comparison with percutaneous transluminal coronary recanalization (PTCR) [1, 2, 3] intravenous administration of a thrombolytic agent [4, 5, 6] has many potential advantages. The former requires only the placement of a peripheral intravenous line and can be initiated any where immediately after the diagnosis of acute myocardial infarction. On the other hand intracoronary reperfusion procedures require an expensive cardiac catheterization laboratory and an emergency team being on call 24 hours a day. Although there may be a possible delay until the initiation of the intracoronary thrombolysis due to the mobilization of experienced personel, reperfusion rates have been reported to be higher in intracoronary than in intravenous thrombolysis (75%–90% versus 50%–65%), and in addition, the time from the onset of therapy to recanalization was shorter with the intracoronary route [7].