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[ { "id": "ZfuerKardiologie.00890667.ger.abstr-passage-0", "type": "abstract", "text": [ "Zur Einschaetzung des operativen Risikos ist eine Vielzahl von Risikoscores fuer die Herzchirurgie entwickelt worden . Obwohl sich die Risikostratifizierung als Instrument zur Analyse von Veraenderungen der Patientenpopulation und des operativen Standards bewaehrt hat , stellt sich die Frage nach ihrer Bedeutung fuer die Operationsindikation und einer Verbesserung der Operationsergebnisse . Es war das Ziel dieser prospektiven Studie , 6-gaengige Risikoscores in Bezug auf ihre Vorhersagekraft fuer die Mortalitaet des individuellen Patienten zu vergleichen . Zwischen September 1998 und Februar 1999 wurden alle herzchirurgischen Patienten , die aelter als 18 Jahre waren , prospektiv gescort . Folgende Scoresysteme kamen zum Einsatz : der initiale Parsonnet , Cleveland Clinic , French Pons , Ontario Province Risk und der Euro , Score . Die operative Fruehletalitaet wurde bis zum 30. Tag post-OP erfasst . Ein vollstaendiges Follow-up konnte bei 504 Patienten erreicht werden . Mit Ausnahme des Ontario Province Risk Scores wurde die Letalitaet in der Hochrisikogruppe von allen Scoresystemen ueberschaetzt , waehrend mehrere Scores die Letalitaet in den Gruppen mit niedrigem oder maessigem Risiko unterschaetzten . Im Vergleich zeigten die mittleren Scorewerte der ueberlebenden und verstorbenen Patienten bei allen Scoresystemen einen breiten Ueberlappungsbereich mit hohen Standardabweichungen . Risikoscores haben sich zur Risikostratifizierung von Patientenpopulationen und zur objektiven Analyse der chirurgischen Ergebnisse bewaehrt . Hierbei hat sich der Euro-Score von allen untersuchten Scores als der aussagekraeftigste erwiesen . Bei der Indikationsstellung zur Operation sollte ihnen jedoch nur eine orientierende Bedeutung beigemessen werden ." ], "offsets": [ [ 0, 1766 ] ] } ]

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[ { "id": "ZfuerKardiologie.00890674.ger.abstr-passage-0", "type": "abstract", "text": [ "Die Stent-Implantation hat zu einer Reduktion der chronischen Restenoserate gefuehrt . Verglichen mit der Stent-Implantation nativer Koronargefaesse ist allerdings die Stent-Implantation aortokoronarvenoeser Bypassgefaesse durch eine hoehere Restenoserate kompliziert . Die Ursachen fuer die unguenstigeren Langzeitergebnisse nach Stent-Implantation stenosierter Bypassgefaesse sind bis dato nicht geklaert . Diese Arbeit analysiert , ob eine spezifische Risikofaktorenkonstellation das Auftreten einer In-Stent Restenose des Bypassgefaesses beguenstigt . Zu diesem Zweck wird der angiographische Langzeitverlauf von 205 Stent-Implantationen bei 177 Patienten untersucht . Mittels schrittweiser logistischer Regressionsanalyse wird evaluiert , ob klinische interventionelle und angiographische Variable , die Inzidenz der Restenose determinieren . In 34% der Stent-Implantationen kam es zum Auftreten einer In-Stent \" \" Restenose . Diabetes mellitus ( OR6,89, CI 2,41-9,69), Bypassrekanalisation ( OR 2,69 , CI 1,08-6,63), Stenoselokalisation im Bereich der aortalen Anastomose ( OR 6,98 , CI2,76-19,25) und der koronaren Anastomose ( OR 2,95 , CI 1,18-7,49), hohe Residualstenose nach Stent-Implantation ( OR 7,01 , CI2,64-15,71), Implantation langer Stents ( OR 2,78 , CI 1,11-7,36) und Implantation von mehr als einem Stent ( OR 7,34 , CI2,08-20,15) konnten als unabhaengige Praediktoren der In-Stent \" \" Restenose definiert werden . Insgesamt zeichnen somit abgesehen von der Stenoselokalisation aehnliche Risikofaktoren fuer die In-Stent Restenose des Bypassgefaesses und des Nativgefaesses verantwortlich . Die kritische Beruecksichtigung dieser Einflussgroessen kann zur Identifikation von Patienten beitragen , die von anderen Revaskularisationsverfahren als der Stent-Implantation profitieren ." ], "offsets": [ [ 0, 1803 ] ] } ]

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[ { "id": "ZfuerKardiologie.00890682.ger.abstr-passage-0", "type": "abstract", "text": [ "Fragestellung : Veraenderungen der Na+Ca2+-Exchanger ( EXCH ) -Expression werden als Ausdruck einer gestoerten Calciumhomoeostase angesehen . Da sich diastolische und systolische Funktionsstoerungen lange vor Manifestation einer terminalen Herzinsuffizienz einstellen untersuchten , wir bei 22 Patienten mit chronischen Herzklappenfehlern ( HKF ) , in welchem Stadium der myokardialen Funktionsstoerung eine Hochregulation des EXCH erfolgt und ob diese ggf. fruehzeitig eine Erschoepfung der myokardialen Adaptationsmechanismen an chronische Druck- und/oder Volumenbelastung anzeigt . Methoden : Mittels quantitativer RT-PCR wurde die Transkriptionshoehe des EXCH in endomyokardialen Biopsien von 11 Patienten mit Aortenstenosen ( AS ) , 5 mit Aorteninsuffizienzen ( AI ) und 6 mit primaeren Mitralinsuffizienzen ( MI ) unterschiedlicher haemodynamischer Schweregrade bestimmt . Zusaetzlich wurde endomyokardiales Gewebe von 13 explantierten , terminal insufffizienten Herzen untersucht . Als Kontrollgruppe diente endomyokardiales Gewebe von sieben Individuen bei denen letztlich eine Herzerkrankung ausgeschlossen werden konnte . Ergebnisse : Die Menge an EXCH mRNA betrug im Myokard der Kontrollgruppe 2,6 +/- 1,2amol/ng totaler RNA und unterschied sich nicht von der Menge an EXCH mRNA bei AS ( 1,8 +/- 1,4amol/ng totaler RNA ) , AI ( 1,9 +/- 0,8amol/ng) oder MI ( 2,2 +/- 2,1amol/ng). Im Myokard explantierter terminal insuffizienter Herzen fand sich dagegen eine deutlich erhoehte Menge an EXCH mRNA ( 8,9 +/- 1,9amol/ng).Zwischen der EXCH-Transkription und dem Schweregrad des Vitiums oder der konsekutiven Einschraenkung der linksventrikulaeren Pumpfunktion bestand kein Zusammenhang : Cardiac Index ( CI ) > 3,5l/min/m2 ( EXCH 1,4 +/- 1,1amol/ng totaler RNA ) ; CI 3,5-2,4 ( EXCH 2,5 +/- 1,8 ) ; CI 2,4 ( EXCH 1,8 +/- 1,0 ) ; EF-angio > 50% ( EXCH 1,9 +/- 1,8 ) , EF-angio =50% ( EXCH 1,9 +/- 0,9 ) ; EF-RNV > 50% ( EXCH 2,4 +/- 1,8 ) , EF-RNV =50% ( EXCH 1,7 +/- 1,0 ) . Schlussfolgerung : Die myokardialen EXCH-Transkriptionsmengen aendern sich bei HKF nicht parallel zur Ausbildung einer myokardialen Pumpfunktionsstoerung . EXCH scheint daher nicht geeignet , eine beginnende Erschoepfung der myokardialen Adaptation an chronische Volumen- und/oder Druckbelastungen zu detektieren ." ], "offsets": [ [ 0, 2295 ] ] } ]

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[ { "id": "ZfuerKardiologie.00890691.ger.abstr-passage-0", "type": "abstract", "text": [ "Ein 52jaehriger Patient mit bekannter koronarer Herzerkrankung wurde mit akuter Aortenklappenendokarditis hervorgerufen durch Staphylococcus aureus mit Temperaturen bis 39,5 Grad C aufgenommen . Wegen einer vorangegangenen perkutanen transluminalen Koronarangioplastie ( PTCA ) war der Patient mit Ticlopidin ( Tiklyd ) vorbehandelt . Es fand sich bei Aufnahme ein C-reaktives Protein von 389mg/l. Die Spiegelbestimmungen von Interleukin-6 ( IL-6) und Interleukin-2-Rezeptor ( IL-2-Rez.) sowie der polyklonalen Immunglobuline und der monoklonalen antimyolemmalen Antikoerper ( AMLA ) bestaetigten eine starke humorale Entzuendungsreaktion . Es trat zu keiner Zeit waehrend der Behandlung eine Leukozytose auf Hoechstwert 9,8 G/l ) . ( Bei echokardiographisch nachweisbarer Vegetation an der Aortenklappe und positiven Blutkulturen wurde die Diagnose einer durch Staphylococcus aureus hervorgerufenen akuten Aortenklappenendokarditis gestellt . Daraufhin erfolgte eine antibiotische Therapie mit Imipenem , Gentamicin und Vancomycin ; nach 5 Tagen zusaetzlich mit Clarithromycin . Nach 24 Tagen wurde der Patient fieberfrei . Das C-reaktive Protein ( CRP ) fiel von 389mg/l auf 6mg/l; ebenso fielen die gemessenen Interleukine deutlich . Die Medikation mit Ticlopidin verhinderte offenbar bei diesem Patienten das Auftreten einer Leukozytose . Zwar wurden Agranulozytosen und Panzytopenien unter Ticlopidingabe beschrieben , aber eine Kasuistik , die bei einer floriden staphylokokken-induzierten Endokarditis keine adaequate zellulaere Immunantwort dokumentiert , ist unseres Wissens bisher nicht bekannt . Daher sollte der Einsatz von Ticlopidin zur Thrombozytenaggregationshemmung mit der eventuellen Folge einer geschwaechten zellulaeren Immunantwort unter kritischer Indikationsstellung erfolgen , zumal heute mit Clopidogrel eine Alternative zur Verfuegung steht ." ], "offsets": [ [ 0, 1869 ] ] } ]

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[]

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[ { "id": "ZfuerKardiologie.00890698.ger.abstr-passage-0", "type": "abstract", "text": [ "Eine 48-jaehrige Frau stellte sich mit zunehmender Dyspnoe aufgrund einer Thrombose einer Mitralkappenprothese vor . Bei der Patientin war 6 Jahre zuvor ein Mitralklappenersatz ( St. Jude Medical ) wegen einer Mitralstenose III durchgefuehrt worden . 3 Jahre spaeter kam es zu einer Klappenthrombose , die einen Klappenaustausch ( St. Jude Medical ) erforderlich machte ." ], "offsets": [ [ 0, 371 ] ] } ]

[ { "id": "ZfuerKardiologie.00890698.ger.abstr-s1-t1", "type": "umlsterm", "text": [ "Frau" ], "offsets": [ [ 17, 21 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0043210" } ] }, { "id": "ZfuerKardiologie.00890698.ger.abstr-s1-t2", "type": "umlsterm", "text": [ "Dyspnoe" ], "offsets": [ [ 51, 58 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0013404" } ] }, { "id": "ZfuerKardiologie.00890698.ger.abstr-s1-t3", "type": "umlsterm", "text": [ "Thrombose" ], "offsets": [ [ 74, 83 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0040053" } ] }, { "id": "ZfuerKardiologie.00890698.ger.abstr-s2-t1", "type": "umlsterm", "text": [ "Jude" ], "offsets": [ [ 183, 187 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0022389" } ] }, { "id": "ZfuerKardiologie.00890698.ger.abstr-s2-t2", "type": "umlsterm", "text": [ "Mitralstenose" ], "offsets": [ [ 210, 223 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0026269" } ] }, { "id": "ZfuerKardiologie.00890698.ger.abstr-s3-t1", "type": "umlsterm", "text": [ "Klappenthrombose" ], "offsets": [ [ 283, 299 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0040053" } ] }, { "id": "ZfuerKardiologie.00890698.ger.abstr-s3-t2", "type": "umlsterm", "text": [ "Jude" ], "offsets": [ [ 335, 339 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0022389" } ] } ]

[]

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[ { "id": "ZfuerKardiologie.00890706.ger.abstr-passage-0", "type": "abstract", "text": [ "Rasche Fortschritte im Verstaendnis und in der Behandlung der instabilen Angina pectoris sowie des akuten Koronarsyndromes machen von Zeit zu Zeit Ueberarbeitungen der Therapie-Leitlinien fuer diese Erkrankung erforderlich . Die hier gemachten Empfehlungen basieren auf einem Consensus , welcher aufgrund der Diskussionen des `International Cardiology Forum im September 1998 ' erreicht werden konnte . Obwohl die Empfehlungen in Teilbereichen weiterhin umstritten bleiben , gibt es wesentliche Bereiche , bei welchen zwischenzeitlich eine ausreichende Datenbasis aus Studien vorliegt , welche Aenderungen in den therapeutischen Gepflogenheiten nahe legen ." ], "offsets": [ [ 0, 657 ] ] } ]

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[ { "id": "ZfuerKardiologie.00890722.ger.abstr-passage-0", "type": "abstract", "text": [ "Die klinische Wirksamkeit von GP IIb/IIIa Antagonisten wurde bei praeinterventioneller prophylaktischer Applikation in grossen klinischen Studien nachgewiesen . Ziel dieser prospektiven Studie war es , die Wirksamkeit von Abciximab bei der Anwendung in bail-out \" \" Situationen zu untersuchen . Methoden : Insgesamt wurden bei 104 ( 5,5% ) der 1903 Patienten , welche im Beobachtungszeitraum in unserem Zentrum dilatiert wurden akute oder drohende Gefaessverschluesse , beobachtet . In dieser Situation wurde Abciximab in einer Dosierung von 0,25mg/kg als Bolus , gefolgt von einer Infusion von 10µg/min ueber 12 Stunden appliziert . Kurz nach der Gabe des Bolus wurde eine erneute PTCA durchgefuehrt . Am Ende der Intervention wurde die Schleuse belassen und nach 24 Std. eine Kontrollangiographie durchgefuehrt . Ergebnisse : Bei 100 der 104 Patienten konnte ein ausreichender ( TIMI III ) Fluss wiederhergestellt werden . Bei 4 Patienten war die zusaetzliche Implantation eines Stents notwendig . Eine Kontrollangiographie am Folgetag zeigte in allen bis auf 2 Faelle offene Gefaesse mit gutem antegraden Fluss ( TIMI III ) . Bei 4 Patienten trat nach der Intervention ein subakuter Gefaessverschluss auf . Drei von ihnen verstarben trotz einer sofort durchgefuehrten Notfall-ACVB OP . Das 12 Monats Follow-up beinhaltet den klinischen Status sowie eine Kontrollangiographie des Zielgefaesses . Waehrend des Nachbeobachtungszeitraums kam es bei 15 Patienten zu einem klinischen Ereignis ( 2 MI , 8 ACVB , 5 Re-PTCA ) . Schlussfolgerung : Die Ergebnisse dieser prospektiven Studie zeigen die hohe Wirksamkeit von Abciximab in bail-out \" Situationen \" waehrend oder direkt nach der PTCA . Weitere Studien sollten dieses Konzept mit dem der prophylaktischen Behandlung vergleichen ." ], "offsets": [ [ 0, 1782 ] ] } ]

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[ { "id": "ZfuerKardiologie.00890730.ger.abstr-passage-0", "type": "abstract", "text": [ "Alle derzeit handelsueblichen mechanischen Herzklappen und Bioprothesen weisen Einschraenkungen auf , die zu unbefriedigenden Ergebnissen fuehren koennen . Der pulmonale Autograft bietet eine vielversprechende Alternative mit theoretischen Vorteilen , die es im klinischen Umfeld zu bestaetigen gilt , um diese innovative chirurgische Methode definitiv zu evaluieren . Methoden und Ergebnisse : Ein Ueberblick wird dargestellt anhand des internationalen Registers mit 2523 Patienten seit 1987 und den 10jaehrigen Erfahrungen mit 157 Patienten des Autors . Das Alter der Patienten variierte zwischen 1 und 79 Jahren . Die Indikation hat in der letzten Zeit eine deutliche Erweiterung erfahren , insofern als Begleitoperationen wie die Rekonstruktion oder der Ersatz von Aneurysmen der Aortenwurzel oder der aszendierenden Aorta , eine Mitralklappenrekonstruktion , Koronarbypaesse usw. durchgefuehrt werden . Die operative Sterblichkeit variiert zwischen 0,6 und 2,5% . Eine Antikoagulationsmedikation ist nicht notwendig . Die Funktion des Autografts ist exzellent . Die Spaetinzidenz von signifikanten Aortenklappeninsuffizienzen ( > 2+ ) bleibt kleiner als 5% . Auch bei Belastung findet sich kein Druckgradient ueber dem Autograft . Ein Autograftversagen mit Autograftrevision oder -ersatz liegt bei 1 bis 4% . Die Homograftfunktion ist ebenfalls exzellent . Die Revisionsrate des rechtsventrikulaeren Ausflusstraktes variiert zwischen 1 und 1,3% . Bei wenigen Patienten ( 7% ) entwickelte sich ein maximaler Druckgradient ueber dem Homograft von 20 bis 35mmHg , ohne dass die rechtsventrikulaere Funktion signifikant eingeschraenkt war ." ], "offsets": [ [ 0, 1641 ] ] } ]

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[ { "id": "ZfuerKardiologie.00890754.ger.abstr-passage-0", "type": "abstract", "text": [ "Die zirkulaere Endoaneurysmorrhaphie ( EAR ) als chirurgische Therapie von Ventrikelaneurysmen ist mit exzellenten Kurzzeitergebnissen verbunden . Da nur wenig mittelfristige Ergebnisse nach EAR vorliegen , ist die Indikationsstellung fuer dieses Verfahren nicht endgueltig geklaert . Bei 157 Patienten ( 6/1993-6/1999 ) mit einem linksventrikulaeren Ventrikelaneurysma wurde eine EAR durchgefuehrt . Alle Patienten waren praeoperativ symptomatisch mit klinischen Zeichen der Herzinsuffizienz ( median NYHA III ) oder Angina pectoris Symptomatik bei geringer Belastung . Die Determinaten der Mortalitaet waehrend des Nachbeobachtungszeitraumes wurden in einer multivariaten Analyse bestimmt . Perioperativ verstarben 5% der Patienten . Die postoperative Sterberate betrug 3,3% pro Jahr , die 5-Jahres Ueberlebensrate 78% . Die kardiale Beschwerdesymptomatik der Patienten war postoperativ signifikant gegenueber dem praeoperativen Zustand verbessert ( median NYHA II , p 0,001 ) . Die multivariate Analyse identifizierte eine vorbestehende arterielle Verschlusserkrankung und fortgeschrittenes Alter ( > 70 Jahre ) als signifikante Determinanten der spaeten Mortalitaet . Die Anlage eines Arteria mammaria interna Bypasses war mit einer signifikant verbesserten Langzeitprognose assoziiert . Die Endoaneurysmorrhaphie ist mit einer geringen perioperativen Mortalitaet , einer signifikanten klinischen Verbesserung und einer guten mittelfristigen Prognose verbunden . Die Endoaneurysmorrhaphie mit begleitender Revaskularisation als therapeutisches Mittel sollte bei symptomatischen Patienten empfohlen werden ." ], "offsets": [ [ 0, 1610 ] ] } ]

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[ { "id": "ZfuerKardiologie.00890761.ger.abstr-passage-0", "type": "abstract", "text": [ "Bei einem 73-jaehrigen Patienten mit generalisierter Atherosklerose , koronarer Herzerkrankung , abdominellem Aortenaneurysma sowie Nierenarterienstenose konnte ein abgangsnahes Aneurysma der linken Arteria subclavia mittels Implantation eines ballonexpandierbaren JOSTENT©-Peripheral Stent-Grafts erfolgreich ausgeschaltet werden . Die Verlaufsbeobachtung ueber ein Jahr zeigte ein sehr gutes Langzeitergebnis bei frei perfundiertem Stentlumen und vollstaendig ausgeschaltetem Aneurysma . In einer Kontroll-Computertomographie fand sich ein vollstaendig thrombosierter Aneurysmasack . Im intravaskulaeren Ultraschall fand sich kein Hinweis auf eine Neointimahyperplasie innerhalb des Stents ." ], "offsets": [ [ 0, 693 ] ] } ]

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[ { "id": "ZfuerKardiologie.00890766.ger.abstr-passage-0", "type": "abstract", "text": [ "Die akute Therapie des tachykarden Vorhofflimmerns gestaltet sich bei Patienten mit eingeschraenkter linksventrikulaerer Pumpfunktion oftmals als schwierig , da viele Medikamente , die die Kammerfrequenz bei Vorhofflimmern senken ( Beta-Blocker Kalziumantagonisten ) , gleichzeitig eine negativ inotrope Wirkung besitzen und zu arterieller Hypotonie fuehren koennen . An 2 umschriebenen intravaskulaeren Lokalisationen in der oberen ( SVC ) und unteren Hohlvene ( IVC ) kann durch elektrische , parasympathische Stimulation mit einem neuen Elektrodenkatheter die Kammerfrequenz bei Vorhofflimmern gesenkt werden , ohne dass es zu einer Verminderung der ventrikulaeren Pumpkraft kommt . Methodik : Bei 8 Hunden wurde ein entfaltbarer Elektrodenkorb , der auf der Spitze eines 7-F-Katheters montiert war , ohne Roentgendurchleuchtung in der SVC distal der Muendung der linken vena anonyma sowie in der IVC unmittelbar an ihrer Einmuendung in den rechten Vorhof plaziert . Waehrend elektrisch induzierten Vorhofflimmerns wurden ueber diesen Katheter elektrisch parasympathische Nerven stimuliert , die den atrioventrikulaeren Knoten innervieren ( Impulsfrequenz : 20 Hz , Impulsdauer 0,1 ms ) . : Ergebnisse : Sowohl bei Stimulation in der SVC als auch in der IVC kam es mit steigender Stimulationspannung zu einer zunehmenden Verlaengerung der R-R-Intervalle bei Vorhofflimmern ( P 0,01 , ANOVA ) . Der negativ dromotrope Effekt setzte unmittelbar mit Stimulation ein und endete sofort nach Terminierung der parasympathischen Stimulation . Waehrend Parasympathikusstimulation und Ventrikelstimulation mit konstanter Zykluslaenge kam es zu keinem signifikanten Abfall des arteriellen Blutdruckes . Ein negativ dromotroper Effekt wurde in der IVC mit signifikant niedrigeren Spannungen erzielt als in der SVC . Schlussfolgerungen : Parasympathische Nerven , die den atrioventrikulaeren Knoten innervieren , koennen mit einem Katheter sowohl in der oberen als auch der unteren Hohlvene stimuliert werden , wobei die benoetigte Stimulationsspannung in der unteren Hohlvene am niedrigsten ist . Falls sich diese Beobachtungen am Patienten bestaetigen , koennte die intravaskulaere parasympathische Stimulation eine ergaenzende therapeutische Massnahme bei Patienten mit eingeschraenkter Ventrikelfunktion und tachykardem Vorhofflimmern werden ." ], "offsets": [ [ 0, 2337 ] ] } ]

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[ { "id": "ZfuerKardiologie.00890774.ger.abstr-passage-0", "type": "abstract", "text": [ "Die Mehrzahl der Neuimplantationen aller Kardioverter-/Defibrillator-Systeme erfolgt heute ohne Thorakotomie mit endovenoesen Elektrodensystemen . Fuer epikardiale Systeme wurde die Langzeitstabilitaet fuer die Defibrillationsschwelle ( DFT ) eingehend untersucht . Fuer den Verlauf der DFT bei transvenoeser Implantationstechnik liegen bisher widerspuechliche Ergebnisse vor . Ziel der vorliegenden Untersuchung war es , die akute und chronische Defibrillationseffektivitaet bei Patienten mit implantierbarem Defibrillator und \" Active-Can \" -Elektrodenkonfiguration im Langzeitverlauf ueber 12 Monate zu vergleichen . Die bei Implantation des Defibrillators mit einem endokardialen Elektrodensystem erreichte Defibrillationseffektivitaet wurde postoperativ vor Entlassung aus der Klinik , nach 3 , 6 und 12 Monaten erneut bestimmt . Das Patientenkollektiv bestand aus 8 Frauen und 38 Maennern mit einem mittleren Alter von 57,2 +/- 13,2 ( 22-76 ) Jahren . Die mittlere linksventrikulaere Ejektionsfraktion betrug 43,8 +/- 16,9 ( 15-82 ) % . Der ueberwiegende Anteil der Patienten hatte eine koronare Herzerkrankung ( 67,4 % ) ; acht Patienten hatten eine dilatative Kardiomyopathie . Bei 39 Patienten wurde die DFT zu den geplanten fuenf Testzeitpunkten bestimmt . Die mittlere DFT bei Implantation betrug 9,2 +/- 5,9 Joule ( J ) , postoperativ vor Entlassung 7,6 +/- 4,8 J , bei der 3-Monats-Kontrolle 8,6 +/- 5,7 J , nach 6 Monaten 8,1 +/- 6,0 J und nach 12 Monaten 8,6 +/- 5,8 J. Die DFT vor Entlassung war signifikant niedriger als bei Implantation ( 7,6 J versus 9,2 J ; p=0,021). Zwischen der DFT bei Implantation und der DFT bei der 3-Monats-Kontrolle und im weiteren Verlauf bestand kein signifikanter Unterschied ( 9,23 versus 8,56 ; p=0,291). In der Multivarianz-Analyse zeigte sich fuer die DFT eine zeitliche Abhaengigkeit , die durch den signifikanten Abfall der DFT zum Zeitpunkt der Entlassung bedingt ist . Diese Verringerung der DFT hatte keinen Einfluss auf die Stabilitaet der Defibrillationsschwelle . Bei ICDs mit einem \" Active-Can \" -Elektrodensystem erlaubt somit die intraoperativ bestimmte Defibrillationsschwelle eine gute Vorhersage der chronischen Defibrillationseffektivitaet ." ], "offsets": [ [ 0, 2209 ] ] } ]

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[ { "id": "ZfuerKardiologie.00890781.ger.abstr-passage-0", "type": "abstract", "text": [ "Anamnese und klinischer Befund : Ein 61-jaehriger Patient praesentierte sich in einer auswaertigen Klinik mit einer neu aufgetretenen Tachyarrhythmia absoluta . Echokardiographisch wurde zunaechst der Verdacht auf eine intrakardiale Raumforderung geaeussert , die mittels transoesophagealer Echokardiographie weiter abgeklaert werden sollte . Untersuchungen : Im Ekg fand sich eine Tachyarrhythmia absoluta mit Frequenzen bis 146/min, intermittierend wurde auch ein Sinusrhythmus dokumentiert . Bei der transthorakalen Echokardiographie konnte die beschriebene Raumforderung nicht eindeutig interpretiert werden , in der transoesophagealen Untersuchung zeigte sich eine ellipsoide , scharf begrenzte Raumforderung von 90x50 mm mit verdraengender Wirkung auf die beiden Vorhoefe . Diese konnte in der Roentgenuntersuchung des Thorax ebenfalls als grosse Raumforderung in Projektion auf das hintere Mediastinum , den rechten Mediastinalrand nach lateral ueberragend bestaetigt werden . Da sich auch computertomographisch eine eindeutige Abgrenzung zur Wand des linken Vorhofs nicht vornehmen liess und damit ein intrakardialer Tumor im Sinne eines Myxoms nicht sicher ausgeschlossen werden konnte , wurde zusaetzlich eine Kernspintomographie des Thorax durchgefuehrt . Hier konnte die Raumforderung mit einer Groesse von 8x5x4,5 cm und einer Ausdehnung nach ventral bis zur Aorta ascendens und nach dorsal bis paravertebral rechts sowie Verdraengung und Einengung der linken Arteria pulmonalis als am ehesten gutartige , bronchogene Zyste diagnostiziert werden . Therapie und Verlauf : Auf Grund des verdraengenden Wachstums der Zyste mit Ausloesung von Vorhofrhythmusstoerungen und zum sicheren Ausschluss einer malignen Entartung wurde die Zyste auf operativem Wege mittels anterolateraler Thorakotomie entfernt . Histologisch konnte die Diagnose einer dysontogenetischen , gutartigen Zyste , die von Mesothel ausgekleidet war und im Kapselgewebe eingelagerte lymphatische Strukturen , Nerven- und Gefaessanschnitte aufwies , gesichert werden . Der Patient befindet sich seitdem im Sinusrhythmus und klagt lediglich ueber vereinzelte \" Aussetzer \" am ehesten im Sinne vereinzelter ventrikulaerer Extrasystolen . Folgerung : Primaer harmlos erscheinenden Vorhofrhythmusstoerungen koennen auch seltene Ursachen wie thorakale , extra- oder auch intrakardiale Raumforderungen zu Grunde liegen , die einer spezifischen Therapie beduerfen . Es wird ein Ueberblick ueber die Entstehung intrathorakaler Zysten gegeben ." ], "offsets": [ [ 0, 2511 ] ] } ]

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[ { "id": "ZfuerKardiologie.00890795.ger.abstr-passage-0", "type": "abstract", "text": [ "Vorhofflimmern fuehrt zu Veraenderungen der atrialen Elektrophysiologie , wodurch das Auftreten und der Erhalt der Arrhythmie beguenstigt werden . Die zellulaeren und molekularen Mechanismen dieses Prozesses sind vielfaeltig , sie waren in den letzten Jahren Gegenstand intensiver Forschungsbemuehungen die wesentlich zum besseren Verstaendnis der Pathophysiologie des Vorhofflimmerns beitrugen . Ziel der Arbeit ist die Darstellung des derzeitigen Wissensstands . Auf zellulaerer Ebene kommt es bei Vorhofflimmern zu einer deutlichen Verkuerzung und verminderten Frequenzadaptation der Aktionspotenzialdauer sowie zu einer veraenderten Aktionspotenzialmorphologie . Vorhofflimmern fuehrt zu einer Modulation der Genexpression des L-Typ Kalziumkanals ( ICa , L ) und von Kaliumkanaelen ( Ito , IK1, IKACh ) . Die molekularen Mechanismen der bei Vorhofflimmern beobachteten intraatrialen Leitungsverzoegerungen sind weniger klar , ihr scheinen Veraenderungen der Expression und Verteilung von Gap-junction Proteinen oder eine Verminderung des schnellen Natriumkanals ( INa ) zu Grunde zu liegen . Ein Ausloeser fuer viele der gemachten Beobachtungen ist die Ueberladung der Myozyten mit Ca2+ mit einer Verminderung des systolischen Kalziumtransienten , ebenso lassen sich Veraenderungen der die Kalziumhomoeostase beeinflussenden Proteine bei Vorhofflimmern nachweisen . Im letzten Teil werden die klinische Bedeutung der gemachten Beobachtungen und daraus potentiell resultierende , neuartige Therapieansaetze diskutiert ." ], "offsets": [ [ 0, 1522 ] ] } ]

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[ { "id": "ZfuerKardiologie.00890803.ger.abstr-passage-0", "type": "abstract", "text": [ "Das Korruptionsstrafrecht steht auch nach seiner Verschaerfung durch das Gesetz von 1997 einer Zusammenarbeit von medizinischer Forschung und Industrie nicht entgegen . Der Unrechtskern der Korruption besteht in einem regelwidrigen Tausch zwischen Dienstausuebung und Vorteil . Danach darf ein Unternehmen einem Wissenschaftler Mittel fuer die Forschung zuwenden , wenn damit keine ueber die Forschungstaetigkeit hinausgehende Gegenleistung verknuepft ist . Anders verhaelt es sich , wenn der Wissenschaftler sich durch Beeinflussung wirtschaftlicher Entscheidungen der Klinik zugunsten des Unternehmens erkenntlich zeigen soll . Ist eine solche Unrechtvereinbarung gegeben , kommt es nach neuem Recht nicht darauf an , ob der Vorteil dem Forscher selbst oder einer anderen Person oder Organisation zufliessen soll . Es liegt im Interesse der Forschung und der Industrie , bereits den Verdacht der Korruption zu vermeiden . Das setzt die strikte Beachtung der einschlaegigen Rechts- und Verwaltungsvorschriften bei der Abwicklung von Drittmittelprojekten voraus ." ], "offsets": [ [ 0, 1063 ] ] } ]

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[ { "id": "ZfuerKardiologie.00890810.ger.abstr-passage-0", "type": "abstract", "text": [ "Fuer Patienten mit schwerer Angina pectoris aufgrund einer koronaren Herzerkrankung , bei denen aufgrund der Koronarmorphologie oder vorausgegangener Interventionen keine Moeglichkeit einer Ballondilatation oder einer Bypass-Operation mehr besteht , steht mit der transmyokardialen Laserrevaskularisation ( TMR ) ein neues Therapieverfahren zur Verfuegung . In mehreren randomisierten Studien konnte gezeigt werden , dass bei diesen Patienten durch eine TMR die klinische Symptomatik gebessert und die koerperliche Belastbarkeit gesteigert werden kann . Ein Nachteil der TMR ist die Notwendigkeit eines chirurgischen Zugangs zum Herzen , um die Kanaele vom Epikard aus in das Myokard einzubringen . Daher wurden Katheter-Systeme entwickelt , mit denen die Laserkanaele vom linksventrikulaeren Kavum aus in das Myokard eingebracht werden koennen . Diese Systeme fuer die \" perkutane myokardiale Laserrevaskularisation \" ( PMR ) verwenden einen Holmium-YAG-Laser , bei dem die Laserenergie ueber optische Fasern zum Herzen uebertragen werden kann . Eine PMR fuehrt zu einer aehnlichen Besserung der klinischen Symptomatik und zu einer Steigerung der koerperlichen Belastbarkeit wie die TMR . Der Schweregrad der Angina pectoris wird um ca. 1,5 CCS-Klassen gebessert , unabhaengig vom verwendeten Kathetersystem . Eine Verbesserung der myokardialen Perfusion nach PMR konnte allerdings bisher noch nicht nachgewiesen werden . Die pathophysiologischen Mechanismen der myokardialen Laserrevaskularisation sind zum jetzigen Zeitpunkt noch nicht geklaert . Experimentelle Studien deuten auf eine myokardiale Angioneogenese und auf eine myokardiale Denervierung nach TMR hin , in klinischen Studien konnte jedoch eine gesteigerte myokardiale Durchblutung bisher noch nicht nachgewiesen werden ." ], "offsets": [ [ 0, 1786 ] ] } ]

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[ { "id": "ZfuerKardiologie.00890903.ger.abstr-passage-0", "type": "abstract", "text": [ "Seit der Einfuehrung lungengaengiger Ultraschallkontrastmittel und der Entwicklung kontrastmittelspezifischer Bildgebungsverfahren richtet sich zunehmendes Interesse auf die Myokard-Kontrastechokardiographie ( MCE ) . Obwohl mittlerweile zahlreiche experimentelle und klinische Studien zur MCE publiziert wurden , konnte die neue Methode in der Routinediagnostik noch nicht etabliert werden . In diesem Editorial sollen die Neuentwicklungen in diesem Forschungsbereich , insbesondere die neuen \" real-time -Verfahren , \" kurz dargestellt und hinsichtlich ihrer klinischen Bedeutung beurteilt werden ." ], "offsets": [ [ 0, 600 ] ] } ]

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[ { "id": "ZfuerKardiologie.00890914.ger.abstr-passage-0", "type": "abstract", "text": [ "Die bisher in der myokardialen Kontrastechokardiografie verwendete b-mode Technik stellt unterschiedliche Perfusionszustaende in Schwarz-Weissbildern mit verschiedenen Graustufen dar . Durch nachtraegliche Bildbearbeitung und Farbkodierung kann die Erkennung von Perfusionsstoerungen verbessert werden . In einer tierexperimentellen Studie untersuchten wir , ob Perfusionsdefekte mit harmonischem Power Doppler Verfahren und dem neuartigen , lungengaengigen Ultraschallkontrastmittel SHU 563A direkt in Farbe abgebildet werden koennen . Bei 10 Hunden wurden Aeste der linken Koronararterie fuer 2-3 Stunden okkludiert und anschliessend reperfundiert . Nach Okklusion und Reperfusion erfolgte die EKG-getriggerte Bildakquisation mit harmonischem b-mode ( HBM ) bzw. Power Doppler ( HPD ) nach intravenoeser Injektion des Ultraschallkontrastmittels in verschiedenen Kurz- ( SAX ) und Laengsachsenschnitten ( LAX ) . Myokardnekrosen wurden postmortal durch TTC-Faerbung verifiziert . Verschiedene Untersucher analysierten die echokardiografischen und anatomischen Befunde . Nach akuter Koronarokklusion zeigte HPD Perfusionsdefekte bei 10 Hunden in allen SAX- und LAX-Schnitten , waehrend mit HBM Perfusionsdefekte bei 10 bzw. 8 Hunden nachgewiesen wurden . Es bestand eine gute Korrelation zwischen HPD und HBM bezueglich der Defektgroesse waehrend Okklusion ( SAX : r=0,9, p 0,001 , LAX : r=0,7, p 0,01 ) . Nach Reperfusion zeigten HPD und HBM Perfusionsdefekte bei 7 Hunden . Bei 5 Hunden konnten Myokardinfarkte mittels TTC-Faerbung nachgewiesen werden . Das Ausmass der durch HPD dargestellten Perfusionsdefekte korrelierte eng mit der anatomischen Infarktgroesse ( r=0,8, p 0,01 ) , waehrend HBM eine schlechte Korrelation zeigte ( r=0,3, p=ns). Die myokardiale Kontrastechokardiografie mit HPD und dem Kontrastmittel SHU 563A kann Perfusionsdefekte bei akutem Koronarverschluss ebenso zuverlaessig wie HBM nachweisen . Nach Reperfusion werden mit HPD Ort und Groesse des residualen Myokardinfarkts genau dargestellt . Dieses Verfahren erscheint vielversprechend fuer eine klinische Anwendung ." ], "offsets": [ [ 0, 2097 ] ] } ]

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[ { "id": "ZfuerKardiologie.00890921.ger.abstr-passage-0", "type": "abstract", "text": [ "\" Stunning \" ( kontraktile Dysfunktion trotz wiederhergestellter Durchblutung ) und hibernating myocardium \" ( Funktion \" proportional zur Durchblutung reduziert ) wurden bislang aus didaktischen Gruenden strikt getrennt . Tierexperimentelle und klinische Studien belegen jedoch , dass die Dynamik der koronaren Herzerkrankung in Form repetitiver Ischaemien fliessende Uebergaenge vom \" stunned \" zum hibernating myocardium \" \" bewirken kann . \" Hibernating myocardium \" seinerseits kann bereits bei herabgesetzter Flussreserve auftreten und ist schliesslich mit zunehmender Ausdehnung und Dauer durch eine Degeneration der Kardiozyten und Glykogenanreicherung gekennzeichnet . Extrazellulaer kommt es bei einem erhoehten Anteil von Matrixproteinen zur zunehmenden Entwicklung einer reparativen Fibrose , die die funktionelle Erholung limitiert . Werden diese strukturellen Veraenderungen bei der Bewertung der unterschiedlichen Nachweismethoden beruecksichtigt , ergeben sich im Vergleich zu nuklearmedizinischen Untersuchungstechniken nicht widerspruechliche , sondern ergaenzende Informationen . Demnach weist die Dobutamin-Echokardiografie bei befriedigender Sensitivitaet und ausgezeichneter Spezifitaet eine hohe diagnostische Genauigkeit auf . Bezog sich diese in frueheren Studien nur auf die Vorhersagbarkeit segmentaler Erholung , liegen zunehmend auch Berichte ueber die prognostische Aussagekraft vor . Hierzu wird allerdings in einem 16-Segment-Modell der Nachweis von vier oder mehr Segmenten kontraktilen Gewebes vorausgesetzt . Bei der Durchfuehrung des gesamten Dobutamin-Protokolls ( niedrige und hohe Dosierung ) sind unterschiedliche Kontraktionsmuster zu erwarten ( anhaltende Kontraktionszunahme , biphasische Antwort , Auftreten einer Kontraktionsstoerung ) , die in Abhaengigkeit eines vorausgegangenen Infarktes eine differente Wertung erfahren sollten . Im klinischen Alltag kann die Untersuchung mit ausreichender Sicherheit am Ende der ersten postinfarziellen Woche durchgefuehrt werden . Wird ein Ischaemie-/Vitalitaetsnachweis erhoben , ist unverzueglich eine Revaskularisierung anzustreben . Dieses Prozedere sollte auch beim chronisch Koronarkranken mit LV-Dysfunktion verfolgt werden , da die strukturellen Veraenderungen des hibernating myocardium \" \" einer Progression unterliegen , die den guenstigen prognostischen Effekt einer kontraktilen Reserve im weiteren Verlauf aufheben . Andererseits setzt eine verantwortungsbewusste Behandlungsstrategie aufgrund prognoselimitierender periprozeduraler Komplikationen vor jeder Revaskularisierungsmassnahme den Ischaemie-/Vitalitaetsnachweis voraus ." ], "offsets": [ [ 0, 2630 ] ] } ]

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[ { "id": "ZfuerKardiologie.00890932.ger.abstr-passage-0", "type": "abstract", "text": [ "Die Rekonstruktion einer insuffizienten bikuspiden Aortenklappe ist eine neue Alternative zum Klappenersatz . Bei gleichzeitiger Dilatation der Aortenwurzel ist durch klappenerhaltenden Aortenersatz auch eine haemodynamisch adaequate Rekonstruktion moeglich . Im Zeitraum von 10/95 bis 02/00 wurde bei 30 Patienten eine Rekonstruktion einer insuffizienten bikuspiden Aortenklappe vorgenommen . Ein zusaetzlicher Ersatz der Aorta ascendens wurde in 23 Faellen durchgefuehrt . Die Klappenrekonstruktion erfolgte in allen Faellen durch Raffen eines prolabierenden Segels . Keiner der Patienten verstarb peri- oder postoperativ . Die postoperative Freiheit von Aortenklappeninsuffizienz > =II sowie Freiheit von einer Reoperation betrugen jeweils 100% nach 48 Monaten . Die Rekonstruktion einer insuffizienten bikuspiden Aortenklappe ist mit guten mittelfristigen Ergebnissen durchfuehrbar . Bei begleitender Dilatation der Aorta ascendens ist durch eine Kombination von Aortenersatz und Klappenrekonstruktion auch bei bikuspider Anatomie ein stabiles Ergebnis zu erzielen ." ], "offsets": [ [ 0, 1070 ] ] } ]

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[ { "id": "ZfuerKardiologie.00890939.ger.abstr-passage-0", "type": "abstract", "text": [ "Das Marfan-Syndrom ist eine autosomal-dominant vererbte Bindegewebserkrankung mit Beteiligung des skelettalen , okulaeren und kardiovaskulaeren Systems . Die Erkrankung wird durch Mutationen im FBN1-Gen verursacht , das fuer das Glykoprotein Fibrillin , eine elementare Strukturkomponente der elastischen Fasern kodiert . Die Diagnose des Marfan-Syndroms basiert auf zwei Saeulen , erstens der klinischen Evaluierung der Patienten , zweitens dem direkten Mutationsnachweis im FBN1-Gen. Inter- und intrafamiliaere Unterschiede im klinischen Erscheinungsbild erschweren die phaenotypische Diagnostik . In dieser Arbeit wird die indirekte Genotypanalyse , in welcher die Segregation von allelischen DNA-Polymorphismen verfolgt wird , als ein zusaetzliches Verfahren fuer die Diagnose vorgestellt . Mittels indirekter Genotypdiagnostik und in Kombination mit den klinischen Untersuchungsbefunden kann die Diagnose oder der Ausschluss des Marfan-Syndroms noch sicherer gestellt werden , insbesondere bei klinischen Grenzfaellen ." ], "offsets": [ [ 0, 1024 ] ] } ]

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[ { "id": "ZfuerKardiologie.00890958.ger.abstr-passage-0", "type": "abstract", "text": [ "Wir beschreiben den Krankheitsverlauf einer 36-jaehrigen Frau mit unbehandelter Aortenisthmusstenose und offenem Ductus Botalli , die aufgrund einer ausgepraegten linksventrikulaeren Dysfunktion eine therapierefraktaere Herzinsuffizienz entwickelte . Nach operativer Korrektur der Aortenisthmusstenose und Ductusresektion normalisierte sich die linksventrikulaere Pumpfunktion , sodass davon ausgegangen werden kann , dass auch schwere linksventrikulaere Dysfunktionen auf dem Boden langjaehriger Druck- und Volumenbelastung durch angeborene Herzfehler nach operativer Korrektur reversibel sein koennen ." ], "offsets": [ [ 0, 604 ] ] } ]

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[ { "id": "ZfuerKardiologie.00890962.ger.abstr-passage-0", "type": "abstract", "text": [ "Ein 23-jaehriger Mann mit arteriellem Hypertonus , einem Systolikum und Linksherzhypertrophiezeichen in EKG und Echo wurde mit Verdacht auf Aortenisthmusstenose zur Aortografie vorgestellt . Die Angiografie zeigte neben einer Aortenisthmusstenose ( p max . 40mmHg ) ein aus der Stenose abgehendes Aneurysma der Aorta descendens . Aneurysma und Stenose wurden mittels direkter Implantation eines Stent-Grafts und anschliessender sequentieller Ballondilatation gleichzeitig behandelt . In der abschliessenden Darstellung der Aorta erschien die Aortenwand glatt bei guter Stentapposition , und der Aneurysmahals war verschlossen . Ein Residualgradient von max . 10mmHg wurde belassen . 6 Monate spaeter ist der Patient beschwerdefrei bei einem Blutdruck von 120/80mmHg beidseits ." ], "offsets": [ [ 0, 777 ] ] } ]

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[ { "id": "ZfuerKardiologie.00890965.ger.abstr-passage-0", "type": "abstract", "text": [ "Das intramurale Haematom ist eine spontane , lokalisierte Blutung in die Wand der thorakalen Aorta ohne Nachweis eines Intimaeinrisses . Klinisch manifestiert sich das intramurale Haematom in Form eines ploetzlichen thorakalen Schmerzereignisses bei Patienten mit bekannter arterieller Hypertonie und weist somit Parallelen zur klassischen Aortendissektion auf . In der Literatur wird kontrovers diskutiert , ob das intramurale Haematom eine eigene Aortenpathologie darstellt , oder als Vorlaeufer in der Entwicklung der klassischen Aortendissektion anzusehen ist . Wir berichten ueber einen 66-jaehrigen Patienten , bei dem ein intramurales Haematoms der Aorta descendens diagnostiziert wurde , das sich innerhalb von 3 Monaten zu einer klassischen Dissektion entwickelte . Die sekundaer nachweisbare aneurysmatische Aufweitung der deszendierenden Aorta fuehrte zur operativen Behandlung , d.h. Ersatz der proximalen Aorta descendens . Dieser Fall unterstuetzt die Hypothese , dass es sich bei dem intra-muralen Haematom um eine Fruehmanifestation der Aortendissektion handelt und unterstreicht die Notwendigkeit engmaschiger Kontrolluntersuchungen und gegebenenfalls fruehzeitiger operativer Therapie ." ], "offsets": [ [ 0, 1204 ] ] } ]

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[ { "id": "ZfuerKardiologie.0089i0v2.ger.abstr-passage-0", "type": "abstract", "text": [ "Die aktuelle Inzidenz der mikrobiell verursachten infektioesen ) Endokarditis ( ( IE ) ist mit sieben Erkrankungsfaellen pro 100.000 Bevoelkerung pro Jahr anzunehmen und steigt seit Jahren kontinuierlich an . Die Prognose ist wesentlich von einer raschen Diagnosesicherung und Einleitung der adaequaten Therapie abhaengig . Bei unbestaetigtem Endokarditisverdacht ist neben der meist diagnostisch wegweisenden klinischen Untersuchung die transoesophageale Echokardiographie unverzichtbar . Kultur-negative Endokarditiden verlangen entweder die Beendigung einer ungezielt begonnenen Antibiotika-Therapie und Ueberpruefung der eingesetzten Blutkulturtechniken oder die Anwendung serologischer/molekularbiologischer Techniken zur Identifizierung des ursaechlichen Erregers . Die antibiotische Therapie ist nach quantitativer Pruefung der Bakterizidie von Antibiotikakombinationen im Reihen-Verduennungstest durchzufuehren . Der Agar-Diffusionstest ist fuer Therapieentscheidungen ungeeignet . Die haeufige Beteiligung der Nieren am Erkrankungsprozess und die gelegentliche Beeintraechtigung der Leberfunktion erfordern ein Drug monitoring , insbesondere wenn Substanzen mit potenzierend toxischem Effekt eingesetzt werden . Grosse > 10 mm ) Vegetationen ( an der Mitralklappe sind mit einem hohen Thromboembolierisiko vergesellschaftet , sodass sie in der Regel eine eigenstaendige Operationsindikation darstellen , vor allem wenn die minimale bakterizide Konzentration der guenstigsten antibiotischen Kombination groesser 2 µg/ml betraegt . In den ersten drei Wochen nach Manifestation typischer Endokarditissymptome sind Embolien mit einem hohen Rezidivrisiko vergesellschaftet . Bei persistierendem Vegetationsnachweis ist in der Regel eine chirurgische Intervention angezeigt . Zerebrale Embolien stellen keine Kontraindikation gegen eine Operation mit der Herz-Lungen-Maschine dar , wenn mittels kranialem Computertomogramm eine primaere zerebrale Blutung ausgeschlossen wurde und die Operation fruehzeitig vor Ausbildung einer postapoplektischen Blut-Hirn-Schrankenstoerung ( 72 Std. ) durchgefuehrt wird . Eine erhebliche Prognoseverbesserung durch fruehzeitige chirurgische Intervention ist darueber hinaus fuer Krankheitsverlaeufe belegt , die durch eine myokardiale Insuffizienz ( insbesondere im Gefolge einer akuten Klappeninsuffizienz ) , durch das Auftreten eines akuten Nierenversagens , einer Abklatschinfektion primaerer Aortenklappenvegetationen auf das vordere Mitralsegel oder eine mehr als 48 Stunden trotz antibiotischer Therapie persistierenden Sepsis kompliziert sind ." ], "offsets": [ [ 0, 2590 ] ] } ]

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[ { "id": "ZfuerKardiologie.0089iii1.ger.abstr-passage-0", "type": "abstract", "text": [ "Kardiale Arrhythmien gehoeren zu den haeufigsten Erscheinungen einer Vielzahl kardiovaskulaerer Krankheitsbilder . Ueber die zellulaeren und subzellulaeren Mechanismen kardialer Arrhythmien ist in den vergangenen Jahren viel bekannt geworden ; fuer die genetischen Voraussetzungen hat man erst kuerzlich begonnen , sich zu interessieren . Durch molekulargenetische Studien konnten mehrere Krankheitsgene fuer das erbliche lange QT-Syndrom ( LQT ) aufgedeckt werden . Es handelt sich bei den LQT-Krankheitsgenen durchwegs um Gene , die fuer Ionenkanaele kodieren . Zu dieser Gruppe ist auch das idiopathische Kammerflimmern zu rechnen , das durch Mutationen in einem LQT-Krankheitsgen verursacht wird . Kardiale Arrhythmien treten aber nicht nur bei hereditaeren Arrhythmieerkrankungen auf , sondern koennen auch mit vererbten strukturellen Herzerkrankungen assoziiert sein . So koennen bei der dilatativen Kardiomyopathie sinuatriale oder atrioventrikulaere Blockierungen der Entwicklung einer myokardialen Pumpfunktionsschwaeche vorrausgehen . Eine genetische Form der hypertrophen Kardiomyopathie wird mit einem Praeexzitationssyndrom vererbt und die arrhythmogene rechtsventrikulaere Kardiomyopathie manifestiert sich meist durch ventrikulaere Arrhythmien . Vorhofflimmern tritt im Rahmen vieler verschiedener kardiovaskulaerer Erkrankungen auf , kann aber auch familiaer bedingt sein . Moeglicherweise besteht eine genetische Beziehung zur dilatativen Kardiomyopathie , da ein genomischer Lokus fuer beide Erkrankungen auf dem langen Arm des Chromosom 10 gefunden wurde ." ], "offsets": [ [ 0, 1575 ] ] } ]

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[]

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[ { "id": "ZfuerKardiologie.0089iii110.ger.abstr-passage-0", "type": "abstract", "text": [ "Bei Patienten mit chronischem und paroxysmalem Vorhofflimmern stellen die AV-Knoten-Ablation mit Schrittmachertherapie und die AV-Knoten-Modifikation keine Behandlungsmassnahmen der ersten Wahl dar - beide Behandlungsformen sind Patienten mit medikamentoes therapiefraktaeren Tachyarrhythmien vorbehalten . Eine korrekte Indikationsstellung verlangt die umfassende Kenntnis des klinischen Befundes der Patienten und der Patientenvorgeschichte bezueglich des zeitlichen Verlaufes der Arrhythmie und den Ergebnissen bisher durchgefuehrter medikamentoeser Therapieversuche . Beide Methoden sind effektive palliative Behandlungsverfahren , die den Verlauf der bestehenden Arrhythmie nicht ursaechlich beeinflussen . Die Tatsache , dass fuer beide Behandlungsverfahren eine Verbesserung der Prognose der Patienten nicht nachgewiesen werden konnte , zwingt zu einer strengen Indikationsstellung ." ], "offsets": [ [ 0, 890 ] ] } ]

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[ { "id": "ZfuerKardiologie.0089iii122.ger.abstr-passage-0", "type": "abstract", "text": [ "Die ektope atriale Tachykardie ist eine eher seltene Form , die in etwa 10-15% aller supraventrikulaeren Tachykardien diagnostiziert wird . Da sie medikamentoes oft schlecht beherrschbar ist , haben ablative Therapien hier ihre besondere Bedeutung . Die Lokalisation atrialer Foci scheint sich an anatomischen Strukturen zu orientieren : Gehaeuft treten sie entlang der Crista terminalis auf , dem inferioren Bereich des Trikuspidalklappenansatzes , des Eingangs des rechten und linken Herzohres sowie im Bereich der beiden superioren Pulmonalvenen . Eine Lokalisierung des Focus ist mit relativ grosser Sicherheit bereits aus dem Oberflaechen-EKG moeglich : Eine positive oder biphasische P-Welle in Ableitung aVL spricht eher fuer einen rechtsatrialen Focus , waehren eine positive P-Welle in V1 eher fuer einen linksatrialen Focus spricht . Bei sicherer Lokalisierung kann auch diese Tachykardie-Form zuverlaessig durch Katheterablation geheilt werden ." ], "offsets": [ [ 0, 956 ] ] } ]

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[ { "id": "ZfuerKardiologie.0089iii128.ger.abstr-passage-0", "type": "abstract", "text": [ "Die Hochfrequenzstrom-Katheterablation hat sich als kuratives Therapieverfahren der ersten Wahl bei symptomatischen Patienten mit akzessorischen atrioventrikulaeren Leitungsbahnen durchgesetzt ." ], "offsets": [ [ 0, 194 ] ] } ]

[ { "id": "ZfuerKardiologie.0089iii128.ger.abstr-s1-t1", "type": "umlsterm", "text": [ "Therapieverfahren" ], "offsets": [ [ 62, 79 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0039796" }, { "db_name": "UMLS", "db_id": "C0039798" } ] }, { "id": "ZfuerKardiologie.0089iii128.ger.abstr-s1-t2", "type": "umlsterm", "text": [ "Patienten" ], "offsets": [ [ 116, 125 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] } ]

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[ { "id": "ZfuerKardiologie.0089iii153.ger.abstr-passage-0", "type": "abstract", "text": [ "Bei typischem Vorhofflattern handelt es sich um eine intraatriale Tachykardie mit singulaerem Makroreentry um die Trikuspidalklappe . Verantwortlich fuer den stabilen Reentrykreis sind anatomische Strukturen mit leitungsblockierender Wirkung . Bei der Katheterablation wird durch eine lineare Laesion zweier gegenueberliegender Barrieren der kreisfoermige Wiedereintritt unterbunden . Etabliert ist die Ablation zwischen V. cava inferior und Trikuspidalklappe . Aufgrund einer geringeren Myokarddicke und einer relativ kuerzeren Wegstrecke wird alternativ die lineare Laesion zwischen Eustachischer Klappe und Trikuspidalklappe empfohlen . Um eine lineare Laesion zu erzeugen , werden zwischen beiden Barrieren konsekutiv Radiofrequenzimpulse abgegeben . Durch Verwendung langer Fuehrungsschleusen , anatomisch angepasster Ablationskatheter , groesserer oder gekuehlter Ablationselektroden kann die Produktion der notwendigen transmuralen Laesionen erleichtert werden . Insgesamt wird heute eine akute Erfolgsrate von ueber 90% erreicht . Fuer den Langzeiterfolg ist die Dokumentation der Kontinuitaet der linearen Laesionen notwendig . Dies erfolgt durch den Nachweis von Doppelpotentialen an der Ablationslinie und durch endokardiales Aktivierungsmapping im Bereich der Trikuspidalklappe . Neuere dreidimensionale Mapping-Systeme koennen bei der Dokumentation eines kompletten Leitungsblockes bzw. zur Lokalisation persistierender Erregungsuebertritte hilfreich sein ." ], "offsets": [ [ 0, 1470 ] ] } ]

[ { "id": "ZfuerKardiologie.0089iii153.ger.abstr-s1-t1", "type": "umlsterm", "text": [ "Vorhofflattern" ], "offsets": [ [ 14, 28 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0004239" } ] }, { "id": "ZfuerKardiologie.0089iii153.ger.abstr-s1-t2", "type": "umlsterm", "text": [ "Tachykardie" ], "offsets": [ [ 66, 77 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0039231" } ] }, { "id": "ZfuerKardiologie.0089iii153.ger.abstr-s1-t3", "type": "umlsterm", "text": [ "Trikuspidalklappe" ], "offsets": [ [ 114, 131 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0040960" } ] }, { "id": "ZfuerKardiologie.0089iii153.ger.abstr-s3-t1", "type": "umlsterm", "text": [ "Katheterablation" ], "offsets": [ [ 252, 268 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0162563" } ] }, { "id": "ZfuerKardiologie.0089iii153.ger.abstr-s4-t1", "type": "umlsterm", "text": [ "Trikuspidalklappe" ], "offsets": [ [ 442, 459 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0040960" } ] }, { "id": "ZfuerKardiologie.0089iii153.ger.abstr-s5-t1", "type": "umlsterm", "text": [ "Myokarddicke" ], "offsets": [ [ 488, 500 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0027061" } ] }, { "id": "ZfuerKardiologie.0089iii153.ger.abstr-s5-t2", "type": "umlsterm", "text": [ "Trikuspidalklappe" ], "offsets": [ [ 610, 627 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0040960" } ] }, { "id": "ZfuerKardiologie.0089iii153.ger.abstr-s6-t1", "type": "umlsterm", "text": [ "Radiofrequenzimpulse" ], "offsets": [ [ 722, 742 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0034546" } ] }, { "id": "ZfuerKardiologie.0089iii153.ger.abstr-s7-t1", "type": "umlsterm", "text": [ "Verwendung" ], "offsets": [ [ 761, 771 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0042153" } ] }, { "id": "ZfuerKardiologie.0089iii153.ger.abstr-s9-t1", "type": "umlsterm", "text": [ "Langzeiterfolg" ], "offsets": [ [ 1048, 1062 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0040223" } ] }, { "id": "ZfuerKardiologie.0089iii153.ger.abstr-s9-t2", "type": "umlsterm", "text": [ "Dokumentation" ], "offsets": [ [ 1071, 1084 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0012972" } ] }, { "id": "ZfuerKardiologie.0089iii153.ger.abstr-s10-t1", "type": "umlsterm", "text": [ "Trikuspidalklappe" ], "offsets": [ [ 1272, 1289 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0040960" } ] }, { "id": "ZfuerKardiologie.0089iii153.ger.abstr-s11-t1", "type": "umlsterm", "text": [ "Dokumentation" ], "offsets": [ [ 1348, 1361 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0012972" } ] } ]

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[ { "id": "ZfuerKardiologie.0089iii161.ger.abstr-passage-0", "type": "abstract", "text": [ "Rezidiviernende ventrikulaere Tachykardien nach abgelaufenem Myokardinfarkt sind nicht selten medikamentoes therapierefraktaer . Bei Induktion von haemodynamisch tolerierbaren und monomorphen Formen im Rahmen einer programmierten Ventrikelstimulation ist eine endokardiales Mapping moeglich . Wichtigster Baustein der Lokalisationsdiagnostik ist die Identifikation von kritischen Teilen der Kreiserregung durch Stimulationsmanoever ( \" Entrainment-Mapping \" ) und Analyse des Post-Pacing \" \" -Intervalles . Das Auftreten multipler Formen erschwert haeufig Mapping und Katheterablation . Bei klinischem Auftreten und Induktion von lediglich singulaeren Kammertachykardien ist in etwa 60-70% der Faelle durch die Hochfrequenzstrom-Katheterablation ein Akuterfolg mit Terminierung und Unterdrueckung der Induzierbarkeit moeglich . Wesentlich geringer ist diese Erfolgsrate bei multiplen Formen ventrikulaerer Tachykardien . In etwa 20-30% der Faelle muss mit einem Rezidiv gerechnet werden . Auch nach Ablation besteht bei diesen Patienten eine hohe kardiale Mortalitaet . Ursaechliche Faktoren sind eine progrediente Herzinsuffizienz und das Auftreten von haemodynamisch relevanten ventrikulaeren Tachyarrhythmien . Bei unaufhoerlichen ( \" incessant \" ) Kammertachykardien und haeufigen ventrikulaeren Tachykardien nach Implantation eines Kardioverter-Defibrillators besteht die Indikation zur fruehzeitigen Katheterablation . Derzeit ist die Katheterablation ventrikulaerer Tachykardien ein zur medikamentoesen Behandlung und der Implantation eines Kardioverter-Defibrillators komplementaeres Therapieverfahren . Es ist zu erwarten , dass die Effektivitaet dieser Methode in naher Zukunft durch neue Mapping- und Ablationstechniken weiter verbessert werden kann ." ], "offsets": [ [ 0, 1762 ] ] } ]

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[ { "id": "ZfuerKardiologie.0089iii171.ger.abstr-passage-0", "type": "abstract", "text": [ "Die Katheterablation kann zur Zeit nur bei speziellen Formen ventrikulaerer Tachykardien effektiv eingesetzt werden . Um die Erfolgsraten zu erhoehen , ist daher die Entwicklung neuer Mapping- und Ablationsverfahren von grossem Interesse . Neue Mapping-Prozeduren umfassen das Multielektroden-Kathetermapping ueber die epikardialen Arterien und Venen und den Multielektroden-Basket-Katheter zur endokardialen Diagnostik . Die computerisierten \" Non contact \" -Mappingformen eroeffnen die Moeglichkeit , dreidimensional den Erregungsablauf waehren ventrikulaerer Tachykardien zu erfassen . Zu den neuen Ablationstechniken gehoert die Weiterentwicklung der ueblicherweise verwandten Radiofrequenzablation wie die \" gekuehlte \" und die \" Mikrowellen \" -Ablation . Hierdurch koennen grossflaechigere und tiefere Laesionen erzielt werden . Waehrend die Laser- und die chemische Ablation bereits angewandt werden , sind Ultraschall- und Kryoblation bisher nur im Tierexperiment erprobt . Moeglicherweise lassen sich mit diesen Neuentwicklungen die Ergebnisse der Ablation ventrikulaerer Tachykardien verbessern ." ], "offsets": [ [ 0, 1106 ] ] } ]

[ { "id": "ZfuerKardiologie.0089iii171.ger.abstr-s1-t1", "type": "umlsterm", "text": [ "Katheterablation" ], "offsets": [ [ 4, 20 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0162563" } ] }, { "id": "ZfuerKardiologie.0089iii171.ger.abstr-s1-t2", "type": "umlsterm", "text": [ "Zeit" ], "offsets": [ [ 30, 34 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0040223" } ] }, { "id": "ZfuerKardiologie.0089iii171.ger.abstr-s1-t3", "type": "umlsterm", "text": [ "Tachykardien" ], "offsets": [ [ 76, 88 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0039231" } ] }, { "id": "ZfuerKardiologie.0089iii171.ger.abstr-s3-t1", "type": "umlsterm", "text": [ "Arterien" ], "offsets": [ [ 332, 340 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0003842" } ] }, { "id": "ZfuerKardiologie.0089iii171.ger.abstr-s3-t2", "type": "umlsterm", "text": [ "Venen" ], "offsets": [ [ 345, 350 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0042449" } ] }, { "id": "ZfuerKardiologie.0089iii171.ger.abstr-s3-t3", "type": "umlsterm", "text": [ "Diagnostik" ], "offsets": [ [ 409, 419 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0011900" } ] }, { "id": "ZfuerKardiologie.0089iii171.ger.abstr-s4-t1", "type": "umlsterm", "text": [ "Tachykardien" ], "offsets": [ [ 562, 574 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0039231" } ] }, { "id": "ZfuerKardiologie.0089iii171.ger.abstr-s5-t1", "type": "umlsterm", "text": [ "Radiofrequenzablation" ], "offsets": [ [ 681, 702 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0034546" } ] }, { "id": "ZfuerKardiologie.0089iii171.ger.abstr-s5-t2", "type": "umlsterm", "text": [ "Mikrowellen" ], "offsets": [ [ 735, 746 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0026051" } ] }, { "id": "ZfuerKardiologie.0089iii171.ger.abstr-s7-t1", "type": "umlsterm", "text": [ "Laser-" ], "offsets": [ [ 848, 854 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0023089" } ] }, { "id": "ZfuerKardiologie.0089iii171.ger.abstr-s7-t2", "type": "umlsterm", "text": [ "Ultraschall-" ], "offsets": [ [ 914, 926 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0041621" } ] }, { "id": "ZfuerKardiologie.0089iii171.ger.abstr-s7-t3", "type": "umlsterm", "text": [ "Tierexperiment" ], "offsets": [ [ 957, 971 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0003043" }, { "db_name": "UMLS", "db_id": "C0003062" } ] }, { "id": "ZfuerKardiologie.0089iii171.ger.abstr-s8-t1", "type": "umlsterm", "text": [ "Tachykardien" ], "offsets": [ [ 1081, 1093 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0039231" } ] } ]

[]

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[ { "id": "ZfuerKardiologie.0089iii177.ger.abstr-passage-0", "type": "abstract", "text": [ "Das Non-contact-mapping-System ( EnSite , Endocardial Solution ) ermoeglicht durch ein 3D-Isopotential-Mapping die simultane , raeumliche Erfassung myokardialer Depolarisation . Die Analyse von fokalen Einzelschlaegen , instabilen Arrhythmien und Makroreentrymechanismen ist moeglich . Die Anwendung des Systems wird dargestellt anhand der Analyse , Lokalisierung und Ablation von Vorhofflattern , bei durch Vorhofextrasystolen getriggertem Vorhofflimmern und bei Kammertachykardien ." ], "offsets": [ [ 0, 484 ] ] } ]

[ { "id": "ZfuerKardiologie.0089iii177.ger.abstr-s2-t1", "type": "umlsterm", "text": [ "Analyse" ], "offsets": [ [ 182, 189 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0002778" } ] }, { "id": "ZfuerKardiologie.0089iii177.ger.abstr-s2-t2", "type": "umlsterm", "text": [ "Arrhythmien" ], "offsets": [ [ 231, 242 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0003811" } ] }, { "id": "ZfuerKardiologie.0089iii177.ger.abstr-s3-t1", "type": "umlsterm", "text": [ "Analyse" ], "offsets": [ [ 340, 347 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0002778" } ] }, { "id": "ZfuerKardiologie.0089iii177.ger.abstr-s3-t2", "type": "umlsterm", "text": [ "Vorhofflattern" ], "offsets": [ [ 381, 395 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0004239" } ] }, { "id": "ZfuerKardiologie.0089iii177.ger.abstr-s3-t3", "type": "umlsterm", "text": [ "Vorhofextrasystolen" ], "offsets": [ [ 408, 427 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0033036" } ] }, { "id": "ZfuerKardiologie.0089iii177.ger.abstr-s3-t4", "type": "umlsterm", "text": [ "Vorhofflimmern" ], "offsets": [ [ 441, 455 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0004238" } ] }, { "id": "ZfuerKardiologie.0089iii177.ger.abstr-s3-t5", "type": "umlsterm", "text": [ "Kammertachykardien" ], "offsets": [ [ 464, 482 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0039231" } ] } ]

[]

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[ { "id": "ZfuerKardiologie.0089iii186.ger.abstr-passage-0", "type": "abstract", "text": [ "Die Hochfrequenzstrom-Katheterablation hat sich als kuratives Behandlungsverfahren bei vielen Formen supraventrikulaerer und atrioventrikulaerer Tachykardien sowie einigen Formen ventrikulaerer Tachykardien als Therapie der ersten Wahl etabliert . Die Erfolgsquoten der Ablationsbehandlung sind bei vielen Formen von Tachykardien beeindruckend hoch . Hinsichtlich der Haeufigkeit und dem Schweregrad verfahrensbedingter Komplikationen bestehen neben den allgemeinen , durch die invasive Kathetertechnik bedingten Risiken ( z.B. Blutungs- und Gefaesskomplikationen , Roentgenstrahlenexposition ) auch spezielle , an die Form der zu behandelnden Rhythmusstoerungen gebundene Risiken ( z.B. AV-Blockierungen bei Modulation des AV-Knotens ) . Fuer die mittels Katheterablation behandelten Patienten kann ein durch die Roentgenstrahlenexposition bedingtes geringgradig , aber messbar erhoehtes Risiko hinsichtlich dem spaeteren Auftreten einer malignen Erkrankung oder hereditaerer Schaedigungen berechnet werden . Das Risiko der malignen Erkrankung liegt bei etwa 1permil pro Stunde Roentgenstrahlenexposition , das Risiko hereditaerer Schaedigungen bei etwa 10 pro 1.000.000 Geburten pro Stunde Roentgenstrahlenexposition . Fuer den behandelnden Arzt sind bei Einsatz der etablierten Schutzvorrichtungen keine wesentlichen Risiken zu erwarten . Die Komplikationshaeufigkeit der Katheterablation supraventrikulaerer und atrioventrikulaerer Tachykardien liegt unter Beruecksichtigung der Ergebnisse groesserer Einzelstudien sowie multizentrischer Untersuchungen bei etwa 3-5% . Mit dem Auftreten schwerwiegender Komplikationen muss in etwa 1-2% der Faelle gerechnet werden . Bei der Behandlung von Patienten mit Kammertachykardien besteht ein groesseres Komplikationspotential von etwa 5-7% , schwerwiegende Komplikationen treten bei etwa 3-4% dieser Patienten auf . Das im Vergleich zu den supraventrikulaeren Tachykardien erhoehte Komplikationsrisiko ist wahrscheinlich auf die Tatsache zurueckzufuehren , dass bei Patienten mit Kammertachykardien in der Regel eine schwere kardiovaskulaere Erkrankung besteht ." ], "offsets": [ [ 0, 2108 ] ] } ]

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[ { "id": "ZfuerKardiologie.0089iii194.ger.abstr-passage-0", "type": "abstract", "text": [ "Hintergrund : Die Behandlung lebensbedrohlicher ventrikulaerer Arrhythmien mittels implantierbarer Cardioverter/Defibrillatoren ( ICD ) ist inzwischen zur Therapie der ersten Wahl geworden ; der Ueberlebensvorteil der ICD-Therapie bei Patienten mit ueberlebtem ploetzlichen Herztod und haemodynamisch kompromittierenden ventrikulaeren Tachykardien ist gegenueber einer medikamentoesen Therapie erwiesen . Auch in der Primaerpraevention des ploetzlichen Herztodes setzt sich bei Hochrisikopatienten zunehmend die ICD-Therapie durch . Ueber Langzeitverlaeufe jenseits von 10 Jahren ist jedoch bislang wenig bekannt . Zusammenfassung : Determinanten der Prognose und der Ausloeserate nach ICD-Implantation sind vor allem die linksventrikulaere Pumpfunktion und das Alter . Bei Patienten mit schlechter linksventrikulaerer Pumpfunktion nimmt bei hoeherer Ausloeserate der Ueberlebensvorteil nach 5 Jahren gegenueber Patienten mit besserer LV-Funktion signifikant ab . Patienten mit stattgehabtem Reanimationsereignis und normaler LV-Funktion weisen eine halb so hohe Ausloeserate wie Patienten mit schlechter LV-Funktion auf und erfahren gleichzeitig eine Normalisierung ihrer Lebenserwartung . Die kausale Behandlung der Grunderkrankung ist sowohl fuer die Gesamtprognose als auch fuer die Ausloeserate bedeutsam , sollte die Indikation zur ICD-Implantation bei Patienten mit hohem Arrhythmierezidivrisiko jedoch nicht beeinflussen ." ], "offsets": [ [ 0, 1430 ] ] } ]

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[ { "id": "ZfuerKardiologie.0089iii24.ger.abstr-passage-0", "type": "abstract", "text": [ "Bei Patienten mit akuter oder chronischer Entzuendung des Herzmuskels stellen Herzrhythmusstoerungen im natuerlichen Verlauf ein haeufiges , gelegentlich das einzige klinisch fassbare Symptom dar . Den potentiell malignen tachykarden und bradykarden Arrhythmieformen kommt in der Differentialdiagnose des ploetzlichen Herztodes bei der Myokarditis besondere Bedeutung zu . Fuer die erhoehte Inzidenz von Herzrhythmusstoerungen sind strukturelle ventrikel-dynamische und vaskulaere Faktoren , verantwortlich zu machen . Zum einen koennen direkt entzuendliche Vorgaenge an den Herzmuskelzellen und dem Interstitium Membranpotentialschwankungen hervorrufen . Die Ausbildung von Fibrose und Narben im Herzmuskelgewebe sowie eine sekundaere Entwicklung von Hypertrophie und Atrophie der Herzmuskelzellen beguenstigen die Entstehung von ektopen Automatiezentren , Spaetpotentialen und Kreiserregungen durch eine inhomogene Erregungsleitung . Zusaetzlich beeinflussen ventrikeldynamische Groessen wie die erhoehte Wandspannung ein erhoehter myokardialer Sauerstoffverbrauch sowie die erniedrigte Koronarreserve , bei Vorliegen einer systolischen und/oder diastolischen Funktionsstoerung des linken Ventrikels die erhoehte Inzidenz von Arrhythmien . Darueber hinaus koennen vaskulaere Faktoren durch eine begleitende mikro- bzw. makrovaskulaer bedingte Perfusionsstoerung mit konsekutiver Myokardischaemie die Arrhythmogenitaet des entzuendeten Myokards weiter steigern . Eine Risikostratifizierung des gefaehrdeten Patienten mit Myokarditis gelingt orientierend durch eine nichtinvasive rhythmologische Abklaerung mittels 24-h-Holter-EKG, Messung der ventrikulaeren Spaetpotentiale und der Herzfrequenzvariabilitaet . Einen vergleichsweise hohen praediktiven Wert in Hinblick auf spontane ventrikulaere Tachyarrhythmien ermoeglicht darueber hinaus die Durchfuehrung einer programmierten atrialen und ventrikulaeren elektrophysiologischen Stimulation . Es ist zu betonen , dass optimale elektrophysiologische Parameter mit hohem praediktivem Wert derzeit nicht zur Verfuegung stehen . Begleitend zu einer konventionellen antiarrhymischen Therapie kann in einem selektionierten Patientenkollektiv eine immunsuppressive Therapie zu einer verminderten bzw. vollstaendigen Suppression spontaner und induzierbarer Arrhythmien fuehren . Dennoch sind ueberbrueckend weitere antiarrhythmische Massnahmen zur Absicherung bei Patienten mit malignen Herzrhythmusstoerungen wie eine serielle antiarrhythmische Einstellung , eine VT-Ablation und die AICD-Implantation erforderlich . Zur Verbesserung der Differentialdiagnostik und Therapie von Patienten mit Herzthythmusstoerungen ungeklaerter Aetiologie stellt die Entnahme von rechtsventrikulaeren Herzmuskelbiopsien zum Nachweis bzw. Ausschluss einer Myokarditis eine wichtige Zusatzuntersuchung dar ." ], "offsets": [ [ 0, 2833 ] ] } ]

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[]

[]

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[ { "id": "ZfuerKardiologie.0089iii36.ger.abstr-passage-0", "type": "abstract", "text": [ "Die Inzidenz supraventrikulaerer und ventrikulaerer Arrhythmien ist bei Hpertonikern mit 96% etwa 10 mal hoeher als bei Normotonikern . Hypertensive Patienten mit bedeutsamen Arrhythmien ( > = nsVT ) weisen haeufiger eine linksventrikulaere Hypertrophie und eine groessere Muskelmasse auf , haben eine schlechtere Haemodynamik mit reduzierter Ejektionsfraktion und vergroessertem Volumina sowie signifikant haeufiger positive Spaetpotentiale bei einer grundsaetzlich hypertrophieassoziierten Zunahme von 7% auf 18% ." ], "offsets": [ [ 0, 516 ] ] } ]

[ { "id": "ZfuerKardiologie.0089iii36.ger.abstr-s1-t1", "type": "umlsterm", "text": [ "Inzidenz" ], "offsets": [ [ 4, 12 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0021149" } ] }, { "id": "ZfuerKardiologie.0089iii36.ger.abstr-s1-t2", "type": "umlsterm", "text": [ "Arrhythmien" ], "offsets": [ [ 52, 63 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0003811" } ] }, { "id": "ZfuerKardiologie.0089iii36.ger.abstr-s2-t1", "type": "umlsterm", "text": [ "Patienten" ], "offsets": [ [ 149, 158 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "ZfuerKardiologie.0089iii36.ger.abstr-s2-t2", "type": "umlsterm", "text": [ "Arrhythmien" ], "offsets": [ [ 175, 186 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0003811" } ] }, { "id": "ZfuerKardiologie.0089iii36.ger.abstr-s2-t3", "type": "umlsterm", "text": [ "Hypertrophie" ], "offsets": [ [ 241, 253 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0020564" } ] }, { "id": "ZfuerKardiologie.0089iii36.ger.abstr-s2-t4", "type": "umlsterm", "text": [ "Muskelmasse" ], "offsets": [ [ 273, 284 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0026845" } ] }, { "id": "ZfuerKardiologie.0089iii36.ger.abstr-s2-t5", "type": "umlsterm", "text": [ "Haemodynamik" ], "offsets": [ [ 314, 326 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0019010" } ] }, { "id": "ZfuerKardiologie.0089iii36.ger.abstr-s2-t6", "type": "umlsterm", "text": [ "hypertrophieassoziierten" ], "offsets": [ [ 467, 491 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0020564" } ] }, { "id": "ZfuerKardiologie.0089iii36.ger.abstr-s2-t7", "type": "umlsterm", "text": [ "linksventrikulaere Hypertrophie" ], "offsets": [ [ 222, 253 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0149721" } ] } ]

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[ { "id": "ZfuerKardiologie.0089iii57.ger.abstr-passage-0", "type": "abstract", "text": [ "Die Selektion von Patienten mit struktureller Herzerkrankung , die von einer prophylaktischen ICD-Therapie profitieren koennten , ist durch die ungenuegende praediktive Genauigkeit bisher verfuegbarer Stratifizierungsmethoden beeintraechtigt . Mit dem nichtinvasiv messbaren T-Wellen-Alternans im Mikrovoltbereich steht ein neuer Parameter zur Erfassung einer gestoerten ventrikulaeren Repolarisation zur Verfuegung , dessen Nachweis mit einer erhoehten Inzidenz ventrikulaerer Tachyarrhythmien assoziiert ist . Der T-Wellen-Alternans tritt frequenzabhaengig auf , zu seinem Nachweis ist ein Anstieg der Herzfrequenz entweder invasiv durch atriale Stimulation oder nichtinvasiv im Rahmen einer Ergometeruntersuchung notwendig . Die Methode wurde erstmals hinsichtlich der Praediktion der Induzierbarkeit ventrikulaerer Tachyarrhythmien wie auch des Auftretens spontaner arrhythmischer Ereignisse bei Patienten , die sich einer invasiven elektrophysiologischen Untersuchung unterzogen , validiert . In der Folge konnte eine gute Konkordanz zwischen der invasiv und der nichtinvasiv durchgefuehrten Alternans-Bestimmung nachgewiesen werden . Eine erste prospektive Validierung der nichtinvasiven Methode erfolgte bei Patienten , bei denen aufgrund eines ueberlebten praehospitalen Kammerflimmerns oder Kammertachykardie ein ICD implantiert worden war . Das Auftreten eines T-Wellen-Alternans in dieser Population war von praediktivem Wert hinsichtlich eines erneuten Arrhythmierezidivs mit konsekutiver adaequater ICD-Therapie . Der Nutzen der Methode hinsichtlich der Risikostratifikation kann erst nach Vorliegen derzeit laufender prospektiver Untersuchungen abschliessend beurteilt werden ." ], "offsets": [ [ 0, 1691 ] ] } ]

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[ { "id": "ZfuerKardiologie.0089iii6.ger.abstr-passage-0", "type": "abstract", "text": [ "Als wesentliche Ursache von Herzrhythmusstoerungen sind Aenderungen von Ionenstroemen durch Ionenkanaele der Myokardzellmembran anzusehen . Drei basale Arrhythmie-Mechanismen lassen sich fuer das Auftreten von Tachyarrhythmien verantwortlich machen : ..." ], "offsets": [ [ 0, 254 ] ] } ]

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[ { "id": "ZfuerKardiologie.0089iii62.ger.abstr-passage-0", "type": "abstract", "text": [ "Antiarrhythmisch wirksame Substanzen werden entsprechend definierter elektrophysiologischer Effekte am Myokard in 4 Vaughan Williams-Klassen I ( bis IV ) eingeteilt . Diese Einteilung entspricht auch im wesentlichen dem Hauptangriffsort der Substanzen ( myokardiale Natrium- , Kalium- , Calcium-Kanaele und -adrenerge Rezeptoren ) . Eine detailliertere Charakterisierung hinsichtlich aller moeglichen kardialen Wirkorte der Substanzen bietet das Sicilian-Gambit \" \" -Schema . Die Eignung der Substanzen fuer die Behandlung einer klinischen Arrhythmie muss von den elektrophysiologischen Effekten abgeleitet werden . Entscheidend fuer die antiarrhythmische bzw. proarrhythmische Wirkung von Antiarrhythmika ist die Frequenzabhaengigkeit der Wirkung . Dies gilt besonders fuer Klasse-I- und Klasse-III-Substanzen . Klasse-I-Antiarrhythmika ( Natrium-Kanal-Blockade ) weisen eine direkte Frequenzabhaengigkeit auf , d.h. Zunahme der Wirkung bei Frequenzsteigerung . Eine Subklassifizierung kann deshalb entsprechend der Frequenz-Wirkungs-Beziehungen erfolgen , die entweder als exponentiell \" , \" \" linear oder \" saturiert \" \" eingestuft werden kann . Klasse-III-Antiarrhythmika ( Kalium-Kanal-Blockade ) werden zusaetzlich entsprechend der beeinflussten Kalium-Auswaertsstrom-Komponente unterteilt . Substanzen , die selektiv die schnell aktivierende Komponente , IKr , inhibieren , weisen eine inverse Frequenzabhaengigkeit auf , d.h. eine Abnahme der Wirkung bei Frequenzsteigerung . Unter Bradykardie kann deshalb eine ausgepraegte Verlaengerung der Aktionspotentialdauer auftreten , die zu fruehen Nachdepolarisationen und getriggerter Aktivitaet bzw. Torsades-de-pointes-Arrhythmien fuehren kann ( erworbenes QT-Syndrom ) . Klasse-III-Substanzen , welche die langsame Komponente , IKs , inhibieren , sind weniger gut untersucht . Tierexperimentelle Befunde lassen auf eine weitgehend frequenzunabhaengige Wirkung schliessen . Ob hierdurch proarrhythmische Effekte vermieden werden koennen , bleibt abzuwarten ." ], "offsets": [ [ 0, 2013 ] ] } ]

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[ { "id": "ZfuerKardiologie.0089iii68.ger.abstr-passage-0", "type": "abstract", "text": [ "In dieser Uebersicht werden die Prinzipien der medikamentoesen und elektrischen Therapie von Vorhofflimmern und Vorhofflattern dargestellt . Bei persistierendem Vorhofflimmern einer Dauer 24 h ist mit einer hohen spontanen Konversionsrate zu rechnen . Eine fruehe aktive Konversion dieser Arrhythmie ist auch beim nichtantikoagulierten Patienten 48 h nach Episodenbeginn durchfuehrbar . Je kuerzer die Arrhythmiedauer ist , um so hoeher liegt die akute Kardioversionsrate beim Einsatz von Klasse I A , I C und III Antiarrhythmika . Die auch in tiefer Sedierung des Patienten durchfuehrbare externe elektrische Kardioversion ist unter Verwendung verschiedener Elektrodenpositionen und bei aktiver Elektrodenkompression ein hocheffektives Verfahren zur Terminierung von Vorhofflimmern . Die relativ hohe Rate eines fruehen Rezidivs nach primaer erfolgreicher elektrischer Kardioversion laesst sich durch eine akute Vorbehandlung mit Antiarrythmika deutlich reduzieren . Laesst sich die Arrhythmie mittels externer Kardioversion nicht in Sinusrhythmus ueberfuehren , besteht die vielversprechende Option einer internen niederenergetischen Kardioversion . In den meisten Faellen ist zur Aufrechterhaltung des Sinusrhythmus nach Konversion von Vorhofflimmern eine Langzeittherapie mit Antiarrhythmika erforderlich . Die Auswahl des Medikamentes ist nach individuellen Patientenkriterien zu treffen . Bei einer Subgruppe ausgewaehlter Patienten laesst sich durch serielle Kardioversion im Langzeitverlauf der Uebergang in permanentes Vorhofflimmern verhindern . Bei reinem Vorhofflattern stellt die transvenoese rechtsatriale schnelle Vorhofstimulation ein einfaches und effektives Verfahren zur Terminierung dar . Die Konversionsrate in Sinusrhythmus laesst sich durch eine akute Vorbehandlung mit Klasse I A , I C oder III Antiarrhythmika signifikant steigern ." ], "offsets": [ [ 0, 1857 ] ] } ]

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[ { "id": "ZfuerKardiologie.0089iii75.ger.abstr-passage-0", "type": "abstract", "text": [ "Die Rate an ploetzlichen Herztodesfaellen ist in den Industrielaendern nahezu unveraendert geblieben . Haeufigste zugrundeliegende strukturelle Herzerkrankung ist bei diesen Patienten die Koronare Herzkrankheit . Auch in der Aera der Thrombolysetherapie des akuten Myokardinfarktes haben Patienten in dem Zeitraum von ein bis zwei Jahren nach diesem Ereignis ein erhoehtes Risiko an einem ploetzlichen arrhythmie-bedingten Herztod zu versterben , weshalb weiterhin eine Risikostratifizierung nach AMI vor Entlassung aus dem Krankenhaus notwendig ist ." ], "offsets": [ [ 0, 551 ] ] } ]

[ { "id": "ZfuerKardiologie.0089iii75.ger.abstr-s1-t1", "type": "umlsterm", "text": [ "Herztodesfaellen" ], "offsets": [ [ 25, 41 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0018787" } ] }, { "id": "ZfuerKardiologie.0089iii75.ger.abstr-s1-t2", "type": "umlsterm", "text": [ "Industrielaendern" ], "offsets": [ [ 53, 70 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0282613" } ] }, { "id": "ZfuerKardiologie.0089iii75.ger.abstr-s2-t1", "type": "umlsterm", "text": [ "Herzerkrankung" ], "offsets": [ [ 144, 158 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0018787" } ] }, { "id": "ZfuerKardiologie.0089iii75.ger.abstr-s2-t2", "type": "umlsterm", "text": [ "Patienten" ], "offsets": [ [ 174, 183 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "ZfuerKardiologie.0089iii75.ger.abstr-s2-t3", "type": "umlsterm", "text": [ "Herzkrankheit" ], "offsets": [ [ 197, 210 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0018799" } ] }, { "id": "ZfuerKardiologie.0089iii75.ger.abstr-s2-t4", "type": "umlsterm", "text": [ "Koronare Herzkrankheit" ], "offsets": [ [ 188, 210 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0010068" } ] }, { "id": "ZfuerKardiologie.0089iii75.ger.abstr-s3-t1", "type": "umlsterm", "text": [ "Thrombolysetherapie" ], "offsets": [ [ 234, 253 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0040044" } ] }, { "id": "ZfuerKardiologie.0089iii75.ger.abstr-s3-t2", "type": "umlsterm", "text": [ "Myokardinfarktes" ], "offsets": [ [ 265, 281 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0027051" } ] }, { "id": "ZfuerKardiologie.0089iii75.ger.abstr-s3-t3", "type": "umlsterm", "text": [ "Patienten" ], "offsets": [ [ 288, 297 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "ZfuerKardiologie.0089iii75.ger.abstr-s3-t4", "type": "umlsterm", "text": [ "Risiko" ], "offsets": [ [ 373, 379 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0035647" } ] }, { "id": "ZfuerKardiologie.0089iii75.ger.abstr-s3-t5", "type": "umlsterm", "text": [ "arrhythmie-bedingten" ], "offsets": [ [ 402, 422 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0003811" } ] }, { "id": "ZfuerKardiologie.0089iii75.ger.abstr-s3-t6", "type": "umlsterm", "text": [ "Herztod" ], "offsets": [ [ 423, 430 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0018787" } ] }, { "id": "ZfuerKardiologie.0089iii75.ger.abstr-s3-t7", "type": "umlsterm", "text": [ "Herztod" ], "offsets": [ [ 423, 430 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0011065" } ] }, { "id": "ZfuerKardiologie.0089iii75.ger.abstr-s3-t8", "type": "umlsterm", "text": [ "Krankenhaus" ], "offsets": [ [ 524, 535 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0019994" } ] } ]

[]

[]

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[ { "id": "ZfuerKardiologie.0089iii87.ger.abstr-passage-0", "type": "abstract", "text": [ "Vorhofflimmern scheint meist auf multiplen , simultan aktiven Erregungskreisen zu beruhen . Deren Kreisbahnlaenge definiert sich aus lokaler Refraktaerzeit und Leitungsgeschwindigkeit . Anzahl Lokalisation und Dimension , aktiver Erregungskreise wechseln staendig . Spezifische auf einzelne Kreisbahnen gerichtete Ablationsversuche , sind daher nicht aussichtsreich . Gaengige Therapiekonzepte streben multiple elektrisch isolierte Vorhofsegmente , an , die ungenuegend Raum fuer die definierte Mindestgroesse potentieller Erregungskreise bieten . Pharmakologische Therapiemassnahmen bewirken entweder eine Leitungsverzoegerung bis hin zur kompletten Leitungsunterbrechung oder eine Verlaengerung lokaler Refraktaerzeiten und damit eine Steigerung des Raumbedarfs bestehender Erregungskreise . Die Schaffung isolierter Vorhofsegmente mittels endokardialer Katheterablation setzt die Machbarkeit langstreckiger kontinuierlicher , transmuraler Laesionen , voraus . In Mapping-Untersuchungen an gesunden Hunden konnte gezeigt werden , dass kontinuierliche langstreckige anatomische Laesionen mit konventioneller Kathetertechnik kaum zu erzielen sind , wohl aber funktionelle Leitungsblockierungen . Weiterhin fuehrt Radiofrequenzapplikation zu einer Verlaengerung lokaler Refraktaerperioden weit ueber die eigentliche anatomische Laesion hinaus . Neben dem nur schwer umzusetzenden Isolationsprinzip koennten solche funktionellen Radiofrequenzeffekte daher auch ein zumindest additives Therapiekonzept bei der interventionellen Behandlung von Vorhofflimmern darstellen ." ], "offsets": [ [ 0, 1567 ] ] } ]

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[]

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[ { "id": "ZfuerKardiologie.0089iii93.ger.abstr-passage-0", "type": "abstract", "text": [ "Die Katheterablation mit Hochfrequenzstrom ist heute als Dauertherapie der ersten Wahl bei symptomatischen Patienten mit akzessorischen Leitungsbahnen und bei haeufig rezidivierenden , symptomatischen AV-nodalen Reentrytachykardien allgemein akzeptiert . Bei beiden Arrhythmien ist heute eine Heilung in ueber 90% der Faelle bei niedriger Komplikationsrate moeglich , wobei eine Inzidenz kompletter AV-Blockierungen von ca. 1% nach Ablation der langsamen Leitungsbahn bei der Indikationsstellung beruecksichtigt werden muss . Die Rezidivrate nach Ablation liegt bei 3-10% fuer akzessorische Leitungsbahnen bzw. 0-15% fuer AVNRT . Die hohe Erfolgsrate der Katheterablationen gefuehrt mit einer deutlichen Abnahme der Ablationen akzessorischer Leitungsbahnen und einer Zunahme an AVNRT bzw. neuen Indikationen ( z . B. Vorhofflattern , fokale atriale Tachykardien ) ." ], "offsets": [ [ 0, 865 ] ] } ]

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[]

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[ { "id": "ZfuerKardiologie.0089iv30.ger.abstr-passage-0", "type": "abstract", "text": [ "Der akute Herzinfarkt stellt weiterhin eine der fuehrenden Todesursachen in der westlichen Welt dar . Ein akuter thrombotischer Verschluss eines Herzkranzgefaesses ist die Ursache des Herzinfarkts in der weit ueberwiegenden Anzahl der Patienten . Die fruehzeitige und vollstaendige Wiederherstellung des Blutflusses im Infarktgefaess ist der prinzipielle Mechanismus , mit dem rekanalisierende Therapien ( Thrombolyse und direkte PTCA ) die Sterblichkeit bei Patienten mit akutem Herzinfarkt reduzieren . Eine frueh nach Symptombeginn eingeleitete thrombolytischen Therapie verbessert die Prognose bei Patienten mit ST Hebungen oder Schenkelblock im Aufnahme EKG . Allerdings gelingt es auch mit dem effektivsten thrombolytischen Regimen nur in etwas mehr als 50% der Faelle eine fruehe komplette Wiederherstellung des Blutflusses im Infarktgefaess ( sogenannte TIMI 3 Patency ) zu erzielen . Zudem kommt es bei etwa 5-10% der Patienten zu Reokklusionen nach primaer erfolgreicher Lyse . Die gefuerchteste Komplikation der Thrombolyse , die intracerebrale Blutung , tritt je nach verwendeter Substanz in bis zu 1% der Patienten auf . Die direkte PTCA fuehrt zu einer etwas hoeheren Rekanalisationsrate und zu einer niedrigeren Rate von intrazerebralen Blutungen als die Thrombolyse , ist allerdings in den meisten Kliniken nicht verfuegbar . Kleinere randomisierte Studien zeigten eine Verbesserung der Prognose durch Anwendung der direkten PTCA im Vergleich zur der Thrombolyse . Diese Ergebnisse waren sowohl im bisher groessten randomisierten Vergleich zwischen Thrombolyse und PTCA , der GUSTO IIb Angioplastie Studie , als auch in nicht randomisierten Vergleichen in grossen Infarkt-Registern nicht nachvollziehbar . Somit ist eine generelle Ueberlegenheit der PTCA gegenueber der Thrombolyse trotz hoeherer primaerer Erfolgsraten bisher nicht gegeben ." ], "offsets": [ [ 0, 1858 ] ] } ]

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[]

[]

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[ { "id": "ZfuerKardiologie.0089s011.ger.abstr-passage-0", "type": "abstract", "text": [ "Der IVUS liefert detaillierte Informationen ueber Lumen und Wandaufbau von Koronargefaessen und ist bezueglich verschiedener morphologischer Aspekte der Angiographie ueberlegen ; daher konnten mittels IVUS wichtige Einblicke in die Entwicklung und Progression der Koronarsklerose gewonnen werden . Der IVUS hat darueber hinaus zum Verstaendnis des Mechanismus von Koronarinterventionen sowie in die Entwicklung der Restenose beigetragen . Im Rahmen der Ballondilatation gibt es Hinweise , dass durch IVUS-gestuetzte Ballonauswahl ein besseres angiographisches Resultat erreichbar ist . Die IVUS-optimierte Stentimplantation fuehrt ebenfalls zu einem groesseren akuten Lumengewinn im Vergleich zur angiographischen Kontrolle ; bezueglich der Reduktion der Restenose konnte bisher kein Vorteil des IVUS-gesteuerten Vorgehens nachgewiesen werden . Der IVUS ist heute als ein ergaenzendes Bildgebungsverfahren anzusehen , welches bei selektionierten Patienten zusaetzliche klinisch relevante Informationen , geben kann ." ], "offsets": [ [ 0, 1016 ] ] } ]

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[ { "id": "ZfuerKardiologie.0089s015.ger.abstr-passage-0", "type": "abstract", "text": [ "Die invasive Darstellung der Herzkranzarterien mittels Herzkatheter ist nach wie vor die Methode der Wahl zum Nachweis von Koronarstenosen . Die Elektronenstrahltomographie ( EBCT ) ist derzeit als Schnittbildverfahren mit extrem kurzer Akquisitionszeit bei gleichzeitig hoher Ortsaufloesung speziell fuer die nichtinvasive Darstellung des Herzens sehr gut geeignet . Mit den Nachteilen einer Exposition von Roentgenstrahlung und der Notwendigkeit einer Kontrastmittelapplikation ist die Methode bezueglich der Beurteilung der Herzmorphologie , -funktion und -perfusion konkurrierenden Verfahren wie Echokardiographie und Kernspintomographie unterlegen . Die nach einem Standardprotokoll durchgefuehrte nichtinvasive kontrastverstaerkte Darstellung von Herzkranzarterien und Koronarstenosen mit der EBCT ist derzeit jedoch in vergleichbarer Qualitaet mit keinem anderen Schnittbild moeglich . Mehrere Publikationen belegen eine fuer ein nichtinvasives Verfahren hohe Sensitivitaet und Spezifitaet zur Erkennung von Koronarstenosen . Eine eingeschraenkte Beurteilbarkeit ergibt sich in ca. 20-25% der Koronarsegmente durch extreme Kalzifizierungen , durch die schnelle Eigenbewegung speziell der rechten Kranzarterie und durch Venenueberlagerungen speziell des Ramus circumflexus . Moegliche Anwendungen der Methode sind im Follow-up nach Angioplastie ( PTCA ohne Stent ) und nach Bypassoperation zu sehen , sowie im Ausschluss einer stenosierenden koronaren Herzerkrankung bei Patienten mit geringer Krankheitswahrscheinlichkeit und bei der Evaluierung von Koronaranomalien ." ], "offsets": [ [ 0, 1575 ] ] } ]

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[ { "id": "ZfuerKardiologie.0089s021.ger.abstr-passage-0", "type": "abstract", "text": [ "Die Darstellung der Koronararterien mittels Kernspintomographie wird durch ihren geringen Durchmesser , den stark geschlaengelten Verlauf und die schnelle Bewegung der Koronargefaesse erschwert . Initiale Ergebnisse zweidimensionaler Gradienten-Echosequenzen , die die Abbildung der Koronararterien in wiederholtem inspiratorischem Atemstillstand gestatteten , waren ermutigend . Aufgrund der eingeschraenkten Qualitaet der Datensaetze , vor allem bedingt durch inkongruente Atemlage wiederholter Akquisitionen , war das Verfahren jedoch klinisch nur bedingt einsetzbar . Ein grosser Fortschritt liess sich durch dreidimensionale Sequenzen erreichen , bei denen waehrend freier Atmung ein kongruenter Volumendatensatz aus etwa 24 axialen Schnittbildern akquiriert wird . Die kontinuierliche Registrierung der Zwerchfellposition ueber Navigator-Echos gestattet hierbei ein retrospektives Atemgating , um Artefakte durch die Atembewegung zu reduzieren . Mit diesen Sequenzen konnten mehrere Gruppen bei einer Ortsaufloesung von etwa 1,2 x 1,2 x 2 mm und einer Zeitaufloesung von ca. 126 ms Sensitivitaeten von etwa 70-80% und Spezifitaeten von etwa 90% fuer den Nachweis von Koronararterienstenosen erreichen . Ein weiterer Fortschritt ist durch die Entwicklung neuer intravaskulaer verbleibender Kontrastmittel und durch ultraschnelle Sequenzen , , welche die Akquisition eines Volumendatensatzes waehrend eines Atemstillstands gestatten , zu erwarten ." ], "offsets": [ [ 0, 1452 ] ] } ]

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[]

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[ { "id": "ZfuerKardiologie.0089s027.ger.abstr-passage-0", "type": "abstract", "text": [ "Einleitung : Obwohl die Bedeutung der selektiven Koronarangiographie ( SCA ) in der Diagnostik der koronaren Herzkrankheit unumstritten ist , ergibt sich aus der Invasivitaet mit den moeglichen assoziierten Komplikationen , evtl. resultierenden Folgekosten und dem in den meisten Faellen notwendigen eintaegigen Krankenhausaufenthalt der Bedarf fuer neue , nichtinvasive Techniken im Bereich der Koronardiagnostik . Mit der intravenoesen Koronarangiographie mit Synchrotronstrahlung ( ICA ) steht ein Verfahren zur Verfuegung , welches die nichtinvasive Darstellung der Koronararterien und Stents ohne Artefakte erlaubt ." ], "offsets": [ [ 0, 621 ] ] } ]

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[ { "id": "ZfuerKardiologie.0089s034.ger.abstr-passage-0", "type": "abstract", "text": [ "Koronare Kalkablagerungen entstehen mit der Ausbildung atherosklerotischer Plaques . Die Elektronenstrahltomographie ( EBT ) ermoeglicht als nichtinvasives Verfahren den quantitativen Nachweis der koronaren Kalkablagerungen . Klinische Vergleichsstudien haben belegt , dass das Ausmass der koronaren Atherosklerose mittels der in der EBT bestimmten Kalkablagerungen abgeschaetzt werden kann . Daraus ergeben sich Moeglichkeiten fuer die diagnostische und prognostische Einschaetzung von symptomatischen und asymptomatischen Personen . Hervorzuheben ist der hohe negativ-praediktive Wert der EBT . Angiographisch nachweisbare obstruktive Koronarstenosen liegen bei fehlendem Nachweis von Kalkablagerungen nur in 5-15% der Faelle vor , eine Mehrgefaesserkrankung in unter 2-3% der Faelle . Ausserdem zeigen vorlaeufige Studienergebnisse , dass die Wahrscheinlichkeit zukuenftiger kardialer Ereignisse bei solchen Patienten sehr gering ist . Eine weitere Anwendung , die z.Z. erprobt wird , liegt in Verlaufsuntersuchungen . Es scheint zu gelingen , die natuerliche Entwicklung der koronaren Atherosklerose mittels EBT zu verfolgen und den Einfluss von Therapiemassnahmen zu messen . Insgesamt gibt es zum klinischen Stellenwert des Kalknachweises in der EBT z.Z. jedoch keine einheitliche Ansicht . Insbesondere die Wertigkeit im Vergleich mit anderen gaengigen Verfahren muss noch etabliert werden ." ], "offsets": [ [ 0, 1398 ] ] } ]

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[ { "id": "ZfuerKardiologie.0089s043.ger.abstr-passage-0", "type": "abstract", "text": [ "Elektronenstrahlcomputertomographie ( EBCT ) ist ein neues , bildgebendes Verfahren , das sich zur Erkennung und Quantifizierung von Kalzium in Koronararterien eignet . Viele Studien haben den Wert der Darstellung koronaren Kalziums in der Frueherkennung koronarer Arteriosklerose belegt . Besonders in asymtomatischen Patienten mit mehreren Risikofaktoren kann die EBCT bei der Abschaetzung des Risikos und der Prognose helfen . Im Gegensatz dazu sind nur wenige Daten vorhanden , die die oekonomischen Aspekte der Anwendung der EBCT untersuchen . Das vorliegende Manuskript besteht aus drei Teilen . Im ersten Teil werden verschiedene Methoden zur Diagnose der KHK in einem theoretischen Modell miteinander verglichen . Im zweiten Teil stellen wir die Ergebnisse einer prospektiven Studie des koronaren Kalziumscreenings bei Notaufnahmepatienten mit akutem Thorakalschmerz und der Verdachtsdiagnose einer Angina pectoris dar . Im dritten Teil diskutieren wir Aspekte der Wirtschaftlichkeit des koronaren Kalziumscreenings in der EBCT und ihren moeglichen Einsatz zur Verbesserung der Primaerpraevention auf der Basis von 1 ) Daten aus der Framingham-Studie , 2 EBCT-Studien ) der Verteilung von Koronarkalk bei asymptomatischen Patienten und 3 ) Ergebnissen longitudinaler mehrjaehriger Studien . Die EBCT ist ein vielversprechendes Verfahren zur Frueherkennung der koronaren Herzerkrankung , dessen Anwendungsbereich derzeit kritisch beleuchtet wird . Weitere Studien sind erforderlich , um den Stellenwert der Wirtschaftlichkeit der EBCT angesichts steigender Kosten im Gesundheitswesen genau zu definieren ." ], "offsets": [ [ 0, 1612 ] ] } ]

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[ { "id": "ZfuerKardiologie.0089s050.ger.abstr-passage-0", "type": "abstract", "text": [ "Die Roentgencomputertomographie ( CT ) hat in den letzten Jahren rasante technische Entwicklungen aufzuweisen , die sie inzwischen zu einer Alternative zur Elektronenstrahlcomputertomographie ( EBCT ) hat werden lassen . Neben der Entwicklung der Spiral-CT waren Rotationszeiten im Subsekundenbereich und die Entwicklung von Mehrzeilen-Detektoren die entscheidenden Schritte . Diese technischen Entwicklungen werden kurz dargestellt , die notwendigen Anpassungen bei Bildrekonstruktion und Auswertung werden erlaeutert . Besonderes Gewicht wird auf die notwendigen Massnahmen zur Qualitaetssicherung und Kalibrierung bei quantitativen Verfahren wie der Koronarkalkmessung gelegt . Die Dosis bei typischen CT-Untersuchungen des Herzens liegt in der Groessenordnung des 0.5- bis 5fachen der natuerlichen Umgebungsstrahlung pro Jahr . Bei gleichzeitiger Aufzeichnung des EKG kann das komplette Herz mit duennen Schichten und hoher Aufloesung kontinuierlich in weniger als 30 Sekunden erfasst werden . Trotz der bisher nur kurzen Erprobungszeit kann die Mehrschicht-Spital-CT bereits jetzt als eine Alternative zur EBCT angesehen werden ." ], "offsets": [ [ 0, 1134 ] ] } ]

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[ { "id": "ZfuerKardiologie.0089s054.ger.abstr-passage-0", "type": "abstract", "text": [ "Die Myokardszintigraphie ist ein seit etwa 3 Jahrzehnten stetig weiterentwickeltes , an Zehntausenden von Patienten validiertes Verfahren zur Untersuchung der myokardialen Perfusion und Vitalitaet . Der Artikel beschreibt aktuelle Entwicklungen sowohl auf der Seite der Radiopharmazeutika als auch auf der Seite der Detektorsysteme ; zusaetzlich werden Vergleiche zur Stressechokardiographie und zur Myokard-PET gezogen ; weiterhin wird anhand neuester Literaturergebnisse die prognostische Wertigkeit und guenstige Kosten-Nutzen-Relation dieses Verfahrens belegt ." ], "offsets": [ [ 0, 565 ] ] } ]

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[ { "id": "ZfuerKardiologie.0089s074.ger.abstr-passage-0", "type": "abstract", "text": [ "Die MR-Spektroskopie ist die einzige Methode , die eine fuer den Patienten nichtinvasive Analyse des Myokardstoffwechsels ohne den Einsatz externer radioaktiver \" Tracer \" erlaubt . Die 31-P-Spektroskopie ermoeglicht die Untersuchung des Stoffwechsels der energiereichen Phosphate ATP und Phosphocreatin . Klinische Studien zur 31P-Spektroskopie konzentrieren sich bisher im wesentlichen auf drei Themenkomplexe : Herzinsuffizienz Herzklappenfehler und koronare Herzkrankheit . , Ob sich das Verfahren in der klinischen Routine durchsetzen wird , kann derzeit noch nicht abgeschaetzt werden ." ], "offsets": [ [ 0, 592 ] ] } ]

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[ { "id": "ZfuerKardiologie.0089s078.ger.abstr-passage-0", "type": "abstract", "text": [ "Die Stressechokardiographie hat sich mit dem letzten Jahrzehnt des ausgehenden Jahrtausends zur Diagnostik und Verlaufsuntersuchung der koronaren Herzkrankheit etabliert . Grundlage ist der technische Geraetefortschritt : Zum einen die verbesserte echokardiographische Bildaufloesung und zum anderen die digitalisierte Bildspeicherung eines ganzen Herzzyklus , welcher unter verschiedenen Belastungsbedingungen Bild-an-Bild EKG-synchronisiert und damit simultan befundet werden kann . Eine Myokardischaemie kann durch umschriebene Kontraktionsstoerungen des linksventrikulaeren Myokards wesentlich frueher und damit sensitiver als im konventionellen Belastungs-EKG festgestellt werden . Auch die Beurteilung von Ausmass und Lokalisation mit Zuordnung zur stenosierenden Koronararterie ist moeglich . Durch Einsatz pharmakologischer Stressinduktoren ( Dobutamin Arbutamin , Dipyridamol , Adenosin ) oder elektrischer Stimulationsmethoden ( , transoesophageal intrakardial ) , koennen nicht ergometrierbare Patienten genauso zuverlaessig untersucht werden ." ], "offsets": [ [ 0, 1055 ] ] } ]

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[ { "id": "ZfuerKardiologie.0089s086.ger.abstr-passage-0", "type": "abstract", "text": [ "Die i.v. -Gabe von Ultraschallkontrastmitteln fuehrt zu echogener Markierung des Blutstromes . Die klinische Anwendung dieses Prinzips in der Kardiologie beinhaltet derzeit vor allem die davon abzuleitende Signalverstaerkung von Farb- und Spektraldoppler zur verbesserten Quantifizierung von angeborenen und erworbenen Vitien und die verbesserte Endokarderkennung bei Belastungsuntersuchungen und LV-Funktionsdiagnostik ." ], "offsets": [ [ 0, 421 ] ] } ]

[ { "id": "ZfuerKardiologie.0089s086.ger.abstr-s1-t1", "type": "umlsterm", "text": [ "Ultraschallkontrastmitteln" ], "offsets": [ [ 19, 45 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0041621" } ] }, { "id": "ZfuerKardiologie.0089s086.ger.abstr-s1-t2", "type": "umlsterm", "text": [ "Ultraschallkontrastmitteln" ], "offsets": [ [ 19, 45 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0009924" } ] }, { "id": "ZfuerKardiologie.0089s086.ger.abstr-s2-t1", "type": "umlsterm", "text": [ "Kardiologie" ], "offsets": [ [ 142, 153 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0007189" } ] }, { "id": "ZfuerKardiologie.0089s086.ger.abstr-s2-t2", "type": "umlsterm", "text": [ "Farb-" ], "offsets": [ [ 229, 234 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0009393" } ] }, { "id": "ZfuerKardiologie.0089s086.ger.abstr-s2-t3", "type": "umlsterm", "text": [ "angeborenen" ], "offsets": [ [ 292, 303 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0009678" } ] }, { "id": "ZfuerKardiologie.0089s086.ger.abstr-s2-t4", "type": "umlsterm", "text": [ "Endokarderkennung" ], "offsets": [ [ 346, 363 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0014124" } ] }, { "id": "ZfuerKardiologie.0089s086.ger.abstr-s2-t5", "type": "umlsterm", "text": [ "Endokarderkennung" ], "offsets": [ [ 346, 363 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0025260" } ] } ]

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[ { "id": "ZfuerKardiologie.0089s097.ger.abstr-passage-0", "type": "abstract", "text": [ "Im folgenden werden verschiedene semiquantitative Hilfen zur Analyse der Myokardfunktion eroertert . Grundsaetzlich sind die Auswertung der Endokardbewegung im 2D-Graustufenbild oder die direkte Geschwindigkeitsmessungen im Gewebe moeglich . Erstere ist eine zweidimensionale Technik , die jedoch auf gute Bildqualitaet angewiesen und durch Relativbewegungen artefaktbelastet ist . Der Myokarddoppler erlaubt die Quantifizierung der regionalen Myokardfunktion mit besserem Signal-Rausch-Verhaeltnis . Die Auswertung von insbesondere diastolischen Parametern bietet dabei neue Perspektiven . \" Strain Rate Imaging \" stellt einen neuen und interessanten Ansatz zur direkten echokardiographischen Erfassung der Herzmuskel-Formveraenderung dar ." ], "offsets": [ [ 0, 741 ] ] } ]

[ { "id": "ZfuerKardiologie.0089s097.ger.abstr-s1-t1", "type": "umlsterm", "text": [ "Analyse" ], "offsets": [ [ 61, 68 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0002778" } ] }, { "id": "ZfuerKardiologie.0089s097.ger.abstr-s1-t2", "type": "umlsterm", "text": [ "Myokardfunktion" ], "offsets": [ [ 73, 88 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0027061" } ] }, { "id": "ZfuerKardiologie.0089s097.ger.abstr-s2-t1", "type": "umlsterm", "text": [ "Endokardbewegung" ], "offsets": [ [ 140, 156 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0014124" } ] }, { "id": "ZfuerKardiologie.0089s097.ger.abstr-s2-t2", "type": "umlsterm", "text": [ "Gewebe" ], "offsets": [ [ 224, 230 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0040300" } ] }, { "id": "ZfuerKardiologie.0089s097.ger.abstr-s3-t1", "type": "umlsterm", "text": [ "Technik" ], "offsets": [ [ 276, 283 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0039421" } ] }, { "id": "ZfuerKardiologie.0089s097.ger.abstr-s4-t1", "type": "umlsterm", "text": [ "Myokarddoppler" ], "offsets": [ [ 386, 400 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0027061" } ] }, { "id": "ZfuerKardiologie.0089s097.ger.abstr-s4-t2", "type": "umlsterm", "text": [ "Myokardfunktion" ], "offsets": [ [ 444, 459 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0027061" } ] } ]

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[ { "id": "ZfuerKardiologie.0089s104.ger.abstr-passage-0", "type": "abstract", "text": [ "Die dreidimensionale Erweiterung der echokardiographischen Bildgebung ist technisch auf zweierlei Weise realisiert worden : zunaechst als nachtraeglich ) ( Rekonstruktion aus multiplen zweidimensionalen Schnittebenen , sowie neuerdings als Echtzeit-3D-Echokardiographie. Mit beiden Ansaetzen lassen sich quantitative Parameter wie Volumen und Masse kardialer Strukturen mit einer Praezision erfassen , die die der zweidimensionalen Echokardiographie erheblich uebertrifft und der Magnetresonanztomographie zumindest ebenbuertig ist , allerdings um den Preis einer erheblichen Konturierungsarbeit . Auch andere raeumlich komplexe Strukturen und Vorgaenge , etwa Herzklappen Vorhof- und Ventrikelseptumdefekte oder die dynamische Ausflussbahnobstruktion , bei hypertroph-obstruktiver Kardiomyopathie , lassen sich mittels 3D-Echokardiograpie qualitativ und quantitativ adaequat erfassen . Die Entwicklung der Echtzeit-3D-Echokardiograpie eroeffnet ausserdem die Moeglichkeit der Akquisition des gesamten echokardiographischen Datensatzes in wenigen Sekunden , wodurch sich zusaetzliche Anwendungsbereiche etwa in der Stressechokardiographie abzeichnen ." ], "offsets": [ [ 0, 1151 ] ] } ]

[ { "id": "ZfuerKardiologie.0089s104.ger.abstr-s1-t1", "type": "umlsterm", "text": [ "Erweiterung" ], "offsets": [ [ 21, 32 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0012356" } ] }, { "id": "ZfuerKardiologie.0089s104.ger.abstr-s1-t2", "type": "umlsterm", "text": [ "Echokardiographie" ], "offsets": [ [ 432, 449 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0013516" } ] }, { "id": "ZfuerKardiologie.0089s104.ger.abstr-s1-t3", "type": "umlsterm", "text": [ "Magnetresonanztomographie" ], "offsets": [ [ 480, 505 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0040395" } ] }, { "id": "ZfuerKardiologie.0089s104.ger.abstr-s1-t4", "type": "umlsterm", "text": [ "zweidimensionalen Echokardiographie" ], "offsets": [ [ 414, 449 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0013524" } ] }, { "id": "ZfuerKardiologie.0089s104.ger.abstr-s2-t1", "type": "umlsterm", "text": [ "Herzklappen" ], "offsets": [ [ 661, 672 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0018826" } ] }, { "id": "ZfuerKardiologie.0089s104.ger.abstr-s2-t2", "type": "umlsterm", "text": [ "Kardiomyopathie" ], "offsets": [ [ 782, 797 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0027049" } ] } ]

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[ { "id": "ZfuerKardiologie.0089s110.ger.abstr-passage-0", "type": "abstract", "text": [ "Die transoesophagele Echokardiographie ( TEE ) ist eine ergaenzende Untersuchungstechnik zur konventionellen Echokardiographie ( TTE ) bei allen Patienten mit unzureichender Schallqualitaet . Darueber hinaus bestehen eine Reihe von Indikationen , bei denen sich die TEE-Technik als hilfreich bzw. aussagekraeftiger als die TTE erwiesen hat , u.a. Abklaerung von Fieber unklarer Ursache , akuten thorakalen Schmerzsyndromen und kardiogenen Emboliequellen , Beurteilung von Kunstklappenfunktionen , Abklaerung von hypotonen und hypoxischen Patienten , intraoperative Monitoring der linksventrikulaeren Funktion und Beurteilung der Korrektur komplexer Vitien oder Mitralklappenrekonstruktionen . TEE ist eine semiinvasive Technik , die in > 95% der Patienten erfolgreich und komplikationslos durchgefuehrt werden kann . Lebensbedrohliche Komplikationen sind mit 0,1% selten . Der prinzipielle Vorteil der TEE im Vergleich zu anderen bildgebenden Verfahren ist die bettseitige , universell verfuegbare und kostenguenstige Anwendbarkeit , sowohl in der Notfallaufnahme , auf der Intensivstation als auch im Operationssaal . Darueber hinaus verbindet TEE in der kardialen Diagnostik einzigartig strukturelle mit funktionellen Daten . Damit ist die TEE-Tecnik bereits heute geruestet , neben alternativen bildgebenden Verfahren wie dem NMR auch zukuenftig bestehen zu koennen ." ], "offsets": [ [ 0, 1370 ] ] } ]

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[]

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[ { "id": "ZfuerKardiologie.0089s124.ger.abstr-passage-0", "type": "abstract", "text": [ "Atherosklerotische Veraenderungen der Carotiden umfassen Veraenderungen der Wandstruktur , der Wandsteifigkeit und der lokalen Blutflusseigenschaften . Sie treten zusammen mit atherosklerotischen Veraenderungen in anderen arteriellen Gefaessprovinzen wie den koronaren oder zerebralen Arterien und mit manifesten atherosklerotischen Erkrankungen . Es wurde auch gezeigt , dass sie zumindest partiell aussagekraeftige Praediktoren fuer zukuenftige kardiovaskulaere Erkrankungen sind . Der transkutane Ultraschall der Carotiden ermoeglicht die nichtinvasive Erkennung von atherosklerotischen Veraenderungen . Im Folgenden soll ein kurzer Ueberblick ueber die verschiedenen Methoden der Erhebung von atherosklerotischen Gefaessveraenderungen der Wandstruktur , -steifigkeit und der lokalen Haemodynamik der Carotiden mit nichtinvasivem Ultraschall gegeben werden . Die kombinierte Erfassung aller genannten arteriellen Eigenschaften koennte den praediktiven Wert des nichtinvasiven Ultraschalls bei der Erkennung von atherosklerotischen Veraenderungen der Arterien steigern . In dieser Hinsicht scheinen jedoch noch mehr prospektive Studien notwendig zu sein , um den denkbaren Wert einer erhoehten Wandsteifigkeit , veraenderter lokaler Haemodynamik und ihrer kombinierten Erfassung zusammen mit der Wandstruktur zu untersuchen . Dafuer muessen jedoch die derzeit verfuegbaren Ultraschallverfahren zur Messung von Struktur , Funktion und Haemodynamik der Arterien fuer die Verwendung in der taeglichen Routine der medizinischen Diagnostik optimiert werden ." ], "offsets": [ [ 0, 1555 ] ] } ]

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[ { "id": "ZfuerKardiologie.0089vii107.ger.abstr-passage-0", "type": "abstract", "text": [ "Die chirurgische Behandlung von Erkrankungen der proximalen Aorta besteht traditionell im Kombinationsersatz von Klappe und Aorta . Neue reokonstruktive Operationsverfahren der Aortenwurzel erlauben die Behandlung der kombinierten Pathologie von Aortenwurzel und Aortenklappe , ohne die Nachteile der Herzklappenprothese in Kauf nehmen zu muessen . Von Oktober 95 bis September 99 sahen wir bei 84 Patienten eine Insuffizienz der Aortenklappe mit deutlicher Dilatation von Aortenwurzel und Aorta ascendens ; bei 68 Patienten wurde ein klappenerhaltender Ersatz der Aortenwurzel in Form von Remodellieren der Aortenwurzel , bei 16 Patienten als Reimplantation der Aortenklappe in eine Gefaessprothese durchgefuehrt . Die Gesamtletalitaet fuer klappenerhaltende Eingriffe war gegenueber herkoemmlichen Operationen nicht erhoeht ( 3,6% vs 5,6% ) ; dies traf zu fuer elektive Eingriffe ( 1,8% vs 2,3% ) wie auch fuer Notfalleingriffe ( 9,3% vs 16,3% ) . Initial konnte bei allen Patienten eine adaequate Funktion der Aortenklappe erzielt werden . Die aktuarische Freiheit von Aortenklappeninsuffizienz Grad II oder mehr nach 2 Jahren war 89% nach Remodellieren und 92% nach Reimplantation . Die Freiheit von Reoperation betrug nach 2 Jahren 96% nach Remodellieren und 100% nach Reimplantation der Aortenklappe . Bei 17 Patienten wurde die haemodynamische Funktion der rekonstruierten Aortenklappe in Ruhe und unter Belastung gemessen ; im Vergleich zu 9 Patienten mit mechanischer Kombinationsprothese fanden sich signifikant niedrigere Gradienten sowohl in Ruhe als auch unter Belastung ." ], "offsets": [ [ 0, 1585 ] ] } ]

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[ { "id": "ZfuerKardiologie.0089vii11.ger.abstr-passage-0", "type": "abstract", "text": [ "Mit der Elektronenstrahltomographie steht ein nichtinvasives Schnittbildverfahren fuer die Herzdiagnostik zur Verfuegung , das insbesondere neue Einblicke in die Erkrankungen der Herzkranzgefaesse gestattet . Durch Quantifizierung koronararterieller Verkalkungen kann eine schnelle , wenig belastende und kostenguenstige Einschaetzung des koronaren Risikos geleistet werden , die bisherige Methoden an prognostischer Aussagekraft deutlich uebertrifft . Als Methode zur nichtinvasiven Diagnostik koronararterieller Stenosen unter periphervenoeser Injektion von Roentgenkontrastmittel erreicht die Elektronenstrahltomographie hoehere Testqualitaeten als bisher verfuegbare nichtinvasive Methoden . Die Quantifizierung der Myokardperfusion stellt insbesondere als Belastungsuntersuchung eine realistische Alternative zu anderen Perfusionsuntersuchungen dar . Die hohe zeitliche Aufloesung der Elektronenstrahltomographie gestattet ausserdem eine akkurate Erfassung der kardialen Bewegungsablaeufe . Zusaetzliche Indikationen bestehen in der Abklaerung kardialer Raumforderungen , perikardialer Erkrankungen sowie in der Untersuchung der grossen Gefaesse ." ], "offsets": [ [ 0, 1152 ] ] } ]

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[]

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[ { "id": "ZfuerKardiologie.0089vii31.ger.abstr-passage-0", "type": "abstract", "text": [ "Bei Patienten mit schwerer Angina pectoris aufgrund einer koronaren Herzerkrankung , bei denen aufgrund der Koronarmorphologie oder vorausgegangener Interventionen keine Moeglichkeit einer Ballondilatation oder einer Bypassoperation mehr besteht , kann die klinische Symptomatik und die koerperliche Belastbarkeit haeufig durch eine transmyokardiale Laserrevaskularisation ( TMR ) gebessert werden . Ein Nachteil der TMR ist die Notwendigkeit eines chirurgischen Zugangs zum Herzen , um die Kannaele vom Epikard aus in das Myokard einzubringen . Daher wurde ein Kathetersystem entwickelt , mit dem die Laserkanaele vom linksventrikulaeren Kavum aus in das Myokard eingebracht werden koennen ." ], "offsets": [ [ 0, 692 ] ] } ]

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"ZfuerKardiologie.0089vii31.ger.abstr-s1-r23-t3.1-t6.1", "type": "treats", "arg1_id": "ZfuerKardiologie.0089vii31.ger.abstr-s2-t3", "arg2_id": "ZfuerKardiologie.0089vii31.ger.abstr-s1-t6", "normalized": [] }, { "id": "ZfuerKardiologie.0089vii31.ger.abstr-s2-r1-t1.1-t2.1", "type": "surrounds", "arg1_id": "ZfuerKardiologie.0089vii31.ger.abstr-s3-t1", "arg2_id": "ZfuerKardiologie.0089vii31.ger.abstr-s3-t2", "normalized": [] }, { "id": "ZfuerKardiologie.0089vii31.ger.abstr-s2-r2-t2.1-t1.1", "type": "developmental_form_of", "arg1_id": "ZfuerKardiologie.0089vii31.ger.abstr-s3-t2", "arg2_id": "ZfuerKardiologie.0089vii31.ger.abstr-s3-t1", "normalized": [] } ]

[ { "id": "ZfuerKardiologie.0089vii37.ger.abstr-passage-0", "type": "abstract", "text": [ "In der neuzeitlichen Herzchirurgie nimmt die Bypasschirurgie am schlagenden Herzen unter Vermeidung der extrakorporalen Zirkulation einen zunehmenden Stellenwert ein . Durch die Entwicklung neuer mechanischer Stabilisationssysteme wurde es moeglich , auch Gefaessprovinzen der Hinterwand und der distalen rechten Kranzarterie zu erreichen . Insbesondere Hochrisikopatienten mit multiplen Risikofaktoren profitieren , da die negativen Effekte der extrakorporalen Zirkulation ausgeschaltet werden koennen , von der Revaskularisation am schlagenden Herzen ." ], "offsets": [ [ 0, 554 ] ] } ]

[ { "id": "ZfuerKardiologie.0089vii37.ger.abstr-s1-t1", "type": "umlsterm", "text": [ "Herzchirurgie" ], "offsets": [ [ 21, 34 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0524727" } ] }, { "id": "ZfuerKardiologie.0089vii37.ger.abstr-s1-t2", "type": "umlsterm", "text": [ "Bypasschirurgie" ], "offsets": [ [ 45, 60 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0038894" }, { "db_name": "UMLS", "db_id": "C0038895" } ] }, { "id": "ZfuerKardiologie.0089vii37.ger.abstr-s1-t3", "type": "umlsterm", "text": [ "Herzen" ], "offsets": [ [ 76, 82 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0018787" } ] }, { "id": "ZfuerKardiologie.0089vii37.ger.abstr-s2-t1", "type": "umlsterm", "text": [ "Kranzarterie" ], "offsets": [ [ 313, 325 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0003842" } ] }, { "id": "ZfuerKardiologie.0089vii37.ger.abstr-s3-t1", "type": "umlsterm", "text": [ "Risikofaktoren" ], "offsets": [ [ 388, 402 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0035648" } ] }, { "id": "ZfuerKardiologie.0089vii37.ger.abstr-s3-t2", "type": "umlsterm", "text": [ "Herzen" ], "offsets": [ [ 546, 552 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0018787" } ] } ]

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[ { "id": "ZfuerKardiologie.0089vii37.ger.abstr-s1-r1-t2.2-t1.1", "type": "issue_in", "arg1_id": "ZfuerKardiologie.0089vii37.ger.abstr-s1-t2", "arg2_id": "ZfuerKardiologie.0089vii37.ger.abstr-s3-t1", "normalized": [] } ]

[ { "id": "ZfuerKardiologie.0089vii55.ger.abstr-passage-0", "type": "abstract", "text": [ "Multizentrische Studien zur Sekundaerprophylaxe des ploetzlichen Herztodes ( SCD ) bei Patienten mit Herzinsuffizienz belegen eindeutig , dass der implantierbare Kardioverterdefibrillator ( ICD ) medikamentoesen Therapieverfahren ueberlegen ist . ICD-Studien zur Primaerprophylaxe des SCD sind bisher nur vereinzelt durchgefuehrt worden und lassen sich vor Abschluss weiterer Studien noch nicht sicher beurteilen . Eine Primaerprophylaxe des SCD mit Amiodaron bei Patienten mit Herzinsuffizienz oder mit neuen Klasse-III-Antiarrhythmika ( z . B. Dofetilide ) erbrachte keine Senkung der Mortalitaet . Inwieweit die kardiale Mortalitaet bei Herzinsuffizienz und Linksschenkelblock durch biventrikulaeres \" pacing \" gesenkt werden kann , wird durch prospektive Studien zu klaeren sein ." ], "offsets": [ [ 0, 784 ] ] } ]

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[ { "id": "ZfuerKardiologie.0089vii55.ger.abstr-s1-r1-t2.1-t4.2", "type": "associated_with", "arg1_id": "ZfuerKardiologie.0089vii55.ger.abstr-s3-t2", "arg2_id": "ZfuerKardiologie.0089vii55.ger.abstr-s1-t4", "normalized": [] }, { "id": "ZfuerKardiologie.0089vii55.ger.abstr-s1-r2-t4.2-t3.1", "type": "occurs_in", "arg1_id": "ZfuerKardiologie.0089vii55.ger.abstr-s1-t4", "arg2_id": "ZfuerKardiologie.0089vii55.ger.abstr-s1-t3", "normalized": [] }, { "id": "ZfuerKardiologie.0089vii55.ger.abstr-s1-r3-t1.1-t4.2", "type": "location_of", "arg1_id": "ZfuerKardiologie.0089vii55.ger.abstr-s5-t1", "arg2_id": "ZfuerKardiologie.0089vii55.ger.abstr-s1-t4", "normalized": [] }, { "id": "ZfuerKardiologie.0089vii55.ger.abstr-s1-r5-t4.2-t2.1", "type": "associated_with", "arg1_id": "ZfuerKardiologie.0089vii55.ger.abstr-s1-t4", "arg2_id": "ZfuerKardiologie.0089vii55.ger.abstr-s3-t2", "normalized": [] }, { "id": "ZfuerKardiologie.0089vii55.ger.abstr-s1-r6-t3.1-t4.1", "type": "performs", "arg1_id": "ZfuerKardiologie.0089vii55.ger.abstr-s1-t3", "arg2_id": "ZfuerKardiologie.0089vii55.ger.abstr-s1-t4", "normalized": [] }, { "id": "ZfuerKardiologie.0089vii55.ger.abstr-s1-r7-t1.1-t4.1", "type": "location_of", "arg1_id": "ZfuerKardiologie.0089vii55.ger.abstr-s5-t1", "arg2_id": "ZfuerKardiologie.0089vii55.ger.abstr-s1-t4", "normalized": [] }, { "id": "ZfuerKardiologie.0089vii55.ger.abstr-s1-r8-t4.1-t3.1", "type": "affects", "arg1_id": "ZfuerKardiologie.0089vii55.ger.abstr-s1-t4", "arg2_id": "ZfuerKardiologie.0089vii55.ger.abstr-s1-t3", "normalized": [] }, { "id": "ZfuerKardiologie.0089vii55.ger.abstr-s1-r9-t2.1-t4.2", "type": "result_of", "arg1_id": "ZfuerKardiologie.0089vii55.ger.abstr-s3-t2", "arg2_id": "ZfuerKardiologie.0089vii55.ger.abstr-s1-t4", "normalized": [] }, { "id": "ZfuerKardiologie.0089vii55.ger.abstr-s1-r11-t1.1-t2.1", "type": "location_of", "arg1_id": "ZfuerKardiologie.0089vii55.ger.abstr-s5-t1", "arg2_id": "ZfuerKardiologie.0089vii55.ger.abstr-s3-t2", "normalized": [] }, { "id": "ZfuerKardiologie.0089vii55.ger.abstr-s1-r12-t4.2-t2.1", "type": "evaluation_of", "arg1_id": "ZfuerKardiologie.0089vii55.ger.abstr-s1-t4", "arg2_id": "ZfuerKardiologie.0089vii55.ger.abstr-s3-t2", "normalized": [] }, { "id": "ZfuerKardiologie.0089vii55.ger.abstr-s1-r13-t4.1-t2.1", "type": "affects", "arg1_id": "ZfuerKardiologie.0089vii55.ger.abstr-s1-t4", "arg2_id": "ZfuerKardiologie.0089vii55.ger.abstr-s3-t2", "normalized": [] }, { "id": "ZfuerKardiologie.0089vii55.ger.abstr-s1-r14-t4.2-t2.1", "type": "result_of", "arg1_id": "ZfuerKardiologie.0089vii55.ger.abstr-s1-t4", "arg2_id": "ZfuerKardiologie.0089vii55.ger.abstr-s3-t2", "normalized": [] } ]

[ { "id": "ZfuerKardiologie.0089vii60.ger.abstr-passage-0", "type": "abstract", "text": [ "Thrombozyten spielen in der Pathogenese der Arteriosklerose und insbesondere in der oft resultierenden Organischaemie , wie beispielsweise dem akuten Koronarsyndrom , eine entscheidende Rolle . Zudem ist die Thrombozytenaktivierung oft die Ursache fuer akute und subakute Komplikationen bei Koronarinterventionen . Die Moeglichkeit , Thrombozyten therapeutisch zu hemmen , ist deshalb zentralem Interesse in der Kardiologie . In dieser Uebersichtsarbeit werden drei unterschiedliche therapeutische Strategien zur Thrombozytenhemmung dargestellt . Zudem wird versucht , einen representativen Ueberblick ueber klinische Studien dieser drei Therapieprinzipien zu geben ." ], "offsets": [ [ 0, 667 ] ] } ]

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[ { "id": "ZfuerKardiologie.0089vii7.ger.abstr-passage-0", "type": "abstract", "text": [ "Uebergewicht ( UeG ) wurde schon fruehzeitig als Risikofaktor fuer eine koronare Herzerkrankung ( KHE ) erkannt . Als man herausfand , dass es ueber eine Insulinresistenz ( IR ) die als Hauptrisiken betrachteten Leiden Diabetes Hypertonie und Fettstoffwechselstoerungen , hervorrufen kann , wurde klar , dass es wohl eine der wichtigsten Ursachen fuer die heute so haeufig auftretende KHE ist . Seine Schluesselrolle in der Pathogenese der KHE wurde noch durch neueste Untersuchungen unterstrichen , die zeigten , dass das UeG ueber erhoehte Serumfettsaeurespiegel eine Endothelfunktionsstoerung an den Gefaessen hervorruft , welche die molekularen Vorgaenge in Gang setzt , die zur KHE fuehren . Damit kommt der Suche nach den Ursachen des UeGS eine grosse Bedeutung zu . Wahrscheinlichste Ursache ist die heutige Genausstattung , die eine Anpassung der Grosshirnrinde and die geaenderten Umweltverhaeltnisse beim Gros der Menschen unmoeglich macht ." ], "offsets": [ [ 0, 951 ] ] } ]

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[ { "id": "ZfuerKardiologie.0089vii76.ger.abstr-passage-0", "type": "abstract", "text": [ "Die Mortalitaet der chronischen Herzinsuffizienz in den Industielaendern ist trotz Fortschritten in der medikamentoesen Behandlung unakzeptabel hoch . Die Herztransplantation , Goldstandard in der Behandlung der terminalen Herzinsuffizienz , ist wegen des Mangels an Spendeorganen jedoch nur wenigen Patienten vorbehalten . Chirurgische Alternativen beinhalten die dynamische Cardiomyoplastie ( CMP ) , die Mitralklappenueberkorrektur , die partielle linksventrikulaere Reduktion ( PLVR ) sowie die Implantation von Assist-Systemen ( VAD ) . Die CMP in der Behandlung der dilatativen Kardiomyopathie konnte weder im Ueberleben noch in objektiven physiologischen Parametern eine Verbesserung aufzeigen . Dagegen zeigte die Mitralklappenueberkorrektur erste ansprechende Ergebnisse . Die PLVR ist ein innovatives Verfahren , bei dem das Herz chirurgisch verkleinert wird und sich schon direkt nach dem Eingriff in seiner Funktion deutlich verbessert zeigt . Ob es langfristige Auswirkung hat , ist noch nicht bekannt . VAD haben sich als extrem effizient in der Kurz- und Langzeitueberbrueckung zur Herztransplantation erwiesen . Sie sind bisher fuer einen permanenten Gebrauch nicht genehmigt . Eine randomisierte Studie in den USA vergleicht die Effektivitaet der VAD mit der Effektivitaet medikamentoeser Therapie im Hinblick auf Lebensqualitaet , Ueberleben und Kosten bei Patienten im NYHA-Status IV ." ], "offsets": [ [ 0, 1404 ] ] } ]

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[ { "id": "ZfuerKardiologie.0089vii85.ger.abstr-passage-0", "type": "abstract", "text": [ "Die Transplantation thorakaler Organe hat im letzten Jahrzehnt eine festen Stellenwert in der Therapie von Patienten im Endstadium kardialer und pulmonaler Erkrankungen erlangt . Mittlerweile wurden weltweit etwa 50.000 Herz- , 2500 Herz-Lungen- und 10.000 Lungentransplantationen vorgenommen . Verbesserungen in der Patientenselektion und dem postoperativen Management ermoeglichen mittlerweile Einjahresueberlebensraten zwischen 70 und 90% nach diesen Eingriffen . Langfristig werden die Ergebnisse noch durch das Auftreten einer Transplantatvaskulopathie , einer obliterativen Bronchiolitis oder durch die Entwicklung von Malignomen beeintraecktigt . Weiters werden die Indikationen und Ergebnisse der einzelnen Verfahren praesentiert , Alternativverfahren diskutiert und neue Entwicklungen aufgezeigt ." ], "offsets": [ [ 0, 806 ] ] } ]

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[ { "id": "ZfuerKardiologie.0089vii91.ger.abstr-passage-0", "type": "abstract", "text": [ "Mechanische Kreislaufunterstuetzungssysteme wurden zunaechst entwickelt , um das versagende Herz permanent zu ersetzen . Heute werden diese Systeme aber hauptsaechlich zur Ueberbrueckung bis zur Herztransplantation eingesetzt . Auf diesem Wege konnten wertvolle Erfahrungen im Umgang mit mechanischen Kreislaufunterstuetzungssystemen gewonnen werden . Wir beschreiben unsere Erfahrungen , die wir in den zurueckliegenden Jahren auf dem Gebiet der Indikationsstellung , postoperativen Patientenversorgung und Geraetebedienung am Deutschen Herzzentrum Berlin haben sammeln koennen . Hier wurde 1987 mit dem Einsatz von Assistsystemen begonnen . Bisher wurden ueber 450 Patienten mit derartigen Systemen von uns versorgt . Die mechanische Kreislaufunterstuetzung fuehrt nicht nur zur Erholung von sekundaeren Organschaeden infolge des kardiogenen Schocks wie Leber- und Nierenversagen , sondern kann auch eine Erholung der Myokardfunktion selbst bewirken . Neue kleinere und effektivere Blutpumpen , eroeffnen neue Moeglichkeiten des Einsatzes . In Zukunft werden mehr Patienten mit derartigen Systemen ausgestattet werden , wobei nunmehr auch der permanente Einsatz diskutiert werden kann ." ], "offsets": [ [ 0, 1188 ] ] } ]

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[ { "id": "ZfuerKardiologie.0089x002.ger.abstr-passage-0", "type": "abstract", "text": [ "Die moderne Krankheitsursachenforschung wird in wachsendem Ausmass von den technischen Moeglichkeiten der molekularen Biologie und Genetik bestimmt . Auch die Rhythmologie ist von dieser Entwicklung nicht unbeeinflusst geblieben . Ganz im Vordergrund des aktuellen Interesses stehen die Ionenkanaele . Die Verfuegbarkeit neuer molekulargenetischer Techniken hat dazu gefuehrt , dass wir heute den Aufbau , die Funktion und die Regulationsmechanismen von Ionenkanaelen und ihre Bedeutung fuer die Arrhythmogenese viel besser verstehen als noch vor wenigen Jahren . Die in den letzten Jahren gewonnenen Erkenntnisse sind jedoch nicht nur hinsichtlich der Mechanismen und der Pathogenese von Rhythmusstoerungen von Interesse . Es ist anzunehmen , dass sie in den naechsten Jahren in zunehmend staerkerem Masse auch die Diagnostik bei Herzrhythmusstoerungen und unser therapeutisches Handeln beeinflussen werden ." ], "offsets": [ [ 0, 909 ] ] } ]

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[ { "id": "ZfuerKardiologie.0089x021.ger.abstr-passage-0", "type": "abstract", "text": [ "Vorhofflimmern stellt die am haeufigsten behandlungsbeduerftige Herzrhythmusstoerung dar . Dennoch beruhen viele Therapieprinzipien bei dieser Arrhythmie auch heute noch auf empirischen Grundsaetzen und nicht auf gesicherten , in klinischen Studien gewonnenen Erkenntnissen . Insbesondere lassen die wissenschaftlichen Daten eine Therapieempfehlung zur Frage \" Frequenzkontrolle oder Rhythmisierung \" bisher nicht zu . Gegenwaertig wird in randomisierten klinischen Studien diese Fragestellung nachgegangen , wobei erste aussagekraeftige Ergebnisse in diesem Jahrhundert nicht mehr zu erwarten sind . Bis diese Ergebnisse vorliegen , ist die Therapiestrategie ( Frequenzkontrolle versus Rhythmisierung ) individuell festzulegen , wobei die Beschwerdesymtomatik des Patienten und das Prinzip \" nihil nocere \" die Entscheidung vorrangig bestimmen ." ], "offsets": [ [ 0, 846 ] ] } ]

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[ { "id": "ZfuerKardiologie.0089x029.ger.abstr-passage-0", "type": "abstract", "text": [ "Vorhofflimmern ( VHF ) ist die haeufigste Rhythmusstoerung . Therapierefraktaeres VHF kann heute erfolgreich durch die Maze-III-Operation ( M III ) behandelt werden . Diese Untersuchung beschreibt die Ergebnisse einer Minivariante ( Mini ) der Maze-III-Operation : ..." ], "offsets": [ [ 0, 268 ] ] } ]

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[ { "id": "ZfuerKardiologie.0089x035.ger.abstr-passage-0", "type": "abstract", "text": [ "Die guenstigen Ergebnisse mit der internen , niederenergetischen atrialen Kardioversion haben die Entwicklung eines implantierbaren atrialen Defibrillators angeregt . Erste klinische Studien mit dem Metrix-System bei einer hoch selektierten Patientengruppe mit refrektaerem Vorhofflimmern haben gezeigt , dass unter Verwendung eines ausschliesslich atrialen Defibrillators Vorhofflimmern effektiv und sicher terminiert werden kann . Weitere Studien muessen durchgefuehrt werden , um den klinischen Stellenwert dieses neuen Therapieverfahrens , insbesondere im Vergleich zu anderen neuen nicht medikamentoesen Behandlungsformen des Vorhofflimmerns , zu evaluieren . Zahlreiche Untersuchungen haben gezeigt , dass Vorhofflimmern mit niedrigen Energien unter Verwendung einer Elektrodenkonfiguration , die primaer zur Ventrikeldefibrillation konzipiert wurde , terminiert werden kann . Da Vorhofflimmern haeufig ein relevantes klinische Problem bei Patienten mit einem ventrikulaeren Defibrillator darstellt , wurde kuerzlich ein Zweikammerdefibrillator entwickelt ( Jewel-AF-System ) . Erste klinische Erfahrungen mit diesem System , das sowohl im Vorhof als auch im Ventrikel die Wahrnehmung und Therapie von Tachyarrhythmien ermoeglicht , weisen daraufhin , dass mit einem Zweikammerdefibrillator eine vielversprechende therapeutische Option bei Patienten mit supraventrikulaeren und ventrikulaeren Arrhythmien gegeben ist ." ], "offsets": [ [ 0, 1424 ] ] } ]

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[ { "id": "ZfuerKardiologie.0089x043.ger.abstr-passage-0", "type": "abstract", "text": [ "Hinter dem Begriff \" supraventrikulaere Tachyarrhythmien \" verbergen sich elektrophysiologisch unterschiedliche Rhythmusstoerungen . Nach Identifizierung des Arrhythmiemechanismus ' ist eine Lokalisation des Schwachpunktes der Rhythmusstoerung durch verschiedene Mappingtechniken erforderlich . Danach erfolgt in der Regel die Ablation als fokale Ablation bei automatischen Arrhythmien ( Sinustachykardie , ektope atriale Tachykardie , fokales Vorhofflimmern ) oder zur Unterbrechung von Leitbahnen ( Praeexzitationssyndrom , AV-Knoten-Tachykardie ) . Eine singulaere Ablationslinie ist fuer das isthmusabhaengige Vorhofflattern und fuer einige inzisionale Tachykardien erforderlich ; dieses Vorgehen ist bereits weniger verbreitet . Multiple Ablationslinien sind fuer die Ablation eines Vorhofflimmerns erforderlich , was gegenwaertig nur in wenigen Zentren erfolgen kann . Verschiedene Arrhythmien sind bislang zu wenig verstanden , nicht induzierbar , nicht genau lokalisierbar und damit bislang nicht abladierbar . Neue dreidimensionale Mappingmethoden , koennten hier weiterhelfen . Die gegenwaertig groesste Herausforderung der interventionellen Elektrophysiologie ist die Ablation des Vorhofflimmerns ." ], "offsets": [ [ 0, 1209 ] ] } ]

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[ { "id": "ZfuerKardiologie.0089x051.ger.abstr-passage-0", "type": "abstract", "text": [ "Der Wert der Antiarrhythmika ist in der Akuttherapie haemodynamisch stabiler ventrikulaerer Tachykardien unbestritten . Im Vordergrund stehen hier Antiarrhythmika der Klasse I wie Lidocain und Ajmalin . Bei haemodynamisch instabilen ventrikulaeren Tachykardien empfiehlt sich die Elektrotherapie ( Kardioversion ) . Eine anschliessende Dauerinfusion mit Antiarrhythmika ist nicht obligat und richtet sich nach der zugrunde liegenden kardialen Erkrankung und der Haeufigkeit von Arrhythmierezidiven . Bei Therapieineffizienz von Klasse I-Antiarrhythmika sind Substanzen der Klasse III wie Amiodaron in Erwaegung zu ziehen . Fuer die Primaerpraevention des ploetzlichen Herztodes sind nur -Sympathikolytika und/oder Amiodaron geeignet . In der Sekundaerpraevention ist die Therapie mit implantierbarem Kardioverter/Defibrillator jeder medikamentoesen Therapie ueberlegen ." ], "offsets": [ [ 0, 870 ] ] } ]

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[]

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[ { "id": "ZfuerKardiologie.70860001.ger.abstr-passage-0", "type": "abstract", "text": [ "Die chronische sympathische Stimulation vermindert bei der Herzinsuffizienz die sympathische Wirkung ueber eine veraenderte kardiale -adrenerge Signaltransduktion . Eine Therapie mit -Blockern kann diesen Signalweg partiell normalisieren . Wahrscheinlich traegt auch die Reduktion der basalen Herzfrequenz zu diesem Effekt mit bei . Die linksventrikulaere Ejektionsfraktion nimmt unter der Therapie mit -Blockern signifikant um 7-8% zu und bewirkt sekundaer eine Herzarbeit mit verbessertem Wirkungsgrad in Ruhe und unter Belastung ." ], "offsets": [ [ 0, 533 ] ] } ]

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[ { "id": "ZfuerKardiologie.70860009.ger.abstr-passage-0", "type": "abstract", "text": [ "Eine 66jaehrige Patientin mit pulmonaler Sarkoidose hatte eine eineinhalbjaehrige Anamnese einer rezidivierenden Linksherzinsuffizienz . Klinisch bestand das Bild einer dilatativen Kardiomyopathie . Endomyokardiale Biopsien zeigten initial eine lymphozytaere Myokarditis , bei erneuter Biopsie jedoch ein epitheloidzelliges Granulom ohne Nekrose vom Typ der Sarkoidose . Die Patientin wurde neben der Standardtherapie mit Kortikosteroiden behandelt ." ], "offsets": [ [ 0, 450 ] ] } ]

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[ { "id": "ZfuerKardiologie.70860020.ger.abstr-passage-0", "type": "abstract", "text": [ "Die modifizierte Fontan-Operation stellt gegenwaertig die definitive Palliation fue ; r eine wachsende Anzahl an Patienten mit funktionell univentrikulaerem Herz dar . Um den Einfluss verschiedener Operationstechniken zu vermeiden , wurden in diese retrospektive Analyse praeoperativer Risikofaktoren nur Patienten nach Anlage einer totalen kavopulmonalen Anastomose ( TCPA ) eingeschlossen ." ], "offsets": [ [ 0, 392 ] ] } ]

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[ { "id": "ZfuerKardiologie.70860020.ger.abstr-s1-r1-t4.1-t2.1", "type": "produces", "arg1_id": "ZfuerKardiologie.70860020.ger.abstr-s2-t4", "arg2_id": "ZfuerKardiologie.70860020.ger.abstr-s2-t2", "normalized": [] }, { "id": "ZfuerKardiologie.70860020.ger.abstr-s1-r2-t4.1-t1.1", "type": "location_of", "arg1_id": "ZfuerKardiologie.70860020.ger.abstr-s2-t4", "arg2_id": "ZfuerKardiologie.70860020.ger.abstr-s2-t1", "normalized": [] }, { "id": "ZfuerKardiologie.70860020.ger.abstr-s1-r3-t3.1-t1.1", "type": "performs", "arg1_id": "ZfuerKardiologie.70860020.ger.abstr-s2-t3", "arg2_id": "ZfuerKardiologie.70860020.ger.abstr-s2-t1", "normalized": [] }, { "id": "ZfuerKardiologie.70860020.ger.abstr-s1-r4-t1.1-t3.1", "type": "affects", "arg1_id": "ZfuerKardiologie.70860020.ger.abstr-s2-t1", "arg2_id": "ZfuerKardiologie.70860020.ger.abstr-s2-t3", "normalized": [] }, { "id": "ZfuerKardiologie.70860020.ger.abstr-s2-r1-t4.1-t2.1", "type": "performs", "arg1_id": "ZfuerKardiologie.70860020.ger.abstr-s2-t4", "arg2_id": "ZfuerKardiologie.70860020.ger.abstr-s2-t2", "normalized": [] }, { "id": "ZfuerKardiologie.70860020.ger.abstr-s2-r2-t2.1-t1.1", "type": "method_of", "arg1_id": "ZfuerKardiologie.70860020.ger.abstr-s2-t2", "arg2_id": "ZfuerKardiologie.70860020.ger.abstr-s2-t1", "normalized": [] }, { "id": "ZfuerKardiologie.70860020.ger.abstr-s2-r3-t4.1-t1.1", "type": "issue_in", "arg1_id": "ZfuerKardiologie.70860020.ger.abstr-s2-t4", "arg2_id": "ZfuerKardiologie.70860020.ger.abstr-s2-t1", "normalized": [] }, { "id": "ZfuerKardiologie.70860020.ger.abstr-s2-r4-t2.1-t1.1", "type": "issue_in", "arg1_id": "ZfuerKardiologie.70860020.ger.abstr-s2-t2", "arg2_id": "ZfuerKardiologie.70860020.ger.abstr-s2-t1", "normalized": [] } ]

[ { "id": "ZfuerKardiologie.70860026.ger.abstr-passage-0", "type": "abstract", "text": [ "Zur Klaerung moeglicher pathogenetischer Zusammenhaege werden die haemodynamischen Parameter von 10 Patienten , die unmittelbar postoperativ nach Fontanscher Operation , und 6 Patienten , die spaetpostoperativ zentralvenoese Stauungssymptome entwickelt haben , mit 18 Patienten ohne diese Komplikation verglichen . Dabei zeigt sich , dass der erhoehte ZVD fruehpostoperativ ( 17,1 +/- 2,9 mmHg ) durch einen vergleichsweise erhoehten Cardiac Index ( 3,6 +/- 0,6 l/min-2 gegenueber 2,4 l/min-2) bedingt ist und sich der totale pulmonale Widerstand nicht signifikant von den symptomlosen Patienten unterscheidet . Der erhoehte ZVD ( 17,2 +/- 2,9 mmHg ) der Patienten mit einer chronisch venoesen Stauung spaetpostoperativ ist vor allem durch einen erhoehten totalen pulmonalen Widerstand ( 552 +/- 131 dyn s/cm5-2) bedingt . Bei beiden Gruppen mit venoesen Stauungssymptomen faellt ein niedriges Widerstandsverhaeltnis ( Systemwiderstand zu totalem pulmonalem Widerstand ) unter 4,5 auf . Das entsprechende Widerstandsverhaeltnis der symptomlosen Patienten liegt durch einen hochsignifikanten Anstieg des Systemwiderstandes im Vergleich zur fruehpostoperativen Gruppe ( 2687 +/- 527 dyn s/cm5-2 gegenueber 1486 +/- 340 dyn s/cm5-2) signifikant hoeher ( 6,8 +/- 2,3 ) . Der arterielle Mitteldruck ist bei den Patienten ohne venoese Stauung gegenueber einer Kontrollgruppe signifikant erhoeht ( 93 +/- 11 mmHg gegenueber 81 +/- 11 mmHg ) . Aufgrund theoretischer Ueberlegungen fuehrt der Anstieg des Systemwiderstandes zu einem Abfall des mittleren kapillaeren Filtrationsdruckes und damit zum Sistieren der Stauungssymptome . Anhand von Fallbeispielen wird gezeigt , dass durch eine pharmakologische Erhoehung des Systemwiderstandes Stauungssymptome behandelt werden koennen bzw. dass durch eine pharmakologische Erniedrigung des Systemwiderstandes Stauungssymptome induziert werden koennen ." ], "offsets": [ [ 0, 1889 ] ] } ]

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[ { "id": "ZfuerKardiologie.70860042.ger.abstr-passage-0", "type": "abstract", "text": [ "Ziel dieser Arbeit ist es , Effektivitaet und Komplikationsrate des interventionellen Ductusverschlusses zu ermitteln . Ferner sollte das inzwischen etablierte Rashkind-PDA-Occluder-System ( ROS ) mit den Ergebnissen der wesentlich preisguenstigeren Ductusokklusion durch neuartige , abloesbare Metallspiralen ( PDA-S ) verglichen werden . Zu diesem Zweck wurden die Daten von 53 konsekutiven Patienten ausgewertet , bei denen 28 ROS und 25 PDA-S implantiert worden waren . Die ROS wurden im Durchschnitt bei den etwas groesseren ( ( Ø 3,1 +/- 0,6 mm ) , die PDA-S bei den kleineren Ductus ( Ø 2,2 +/- 0,6 mm ) eingesetzt . Die Haeufigkeit von Restshunts in der ROS-Gruppe betrug 20% Nachbeobachtungszeitraum : ( 104 bis 1099 Tage , im Mittel 580 +/- 300 Tage ) , in der PDA-S-Gruppe 7,7% ( Nachbeobachtungszeitraum : 90 bis 384 Tage , im Mittel 161 +/- 101 Tage ) . Bei einer Patientin war ein Restshunt nach ROS-Implantation 2,5 Jahre spaeter durch eine zusaetzliche Spirale beseitigt worden . Bei einer weiteren Patientin fuehrte der Versuch , 2 Spiralen in einen 4 mm grossen Ductus zu implantieren , zur Embolisation der ersten Spirale in die rechte Pulmonalarterie , wo sie nach erfolglosem Extraktionsversuch ohne nachteilige Folgen fuer die Patientin belassen wurde . In allen anderen Faellen implantierten wir nur jeweils ein ROS oder eine PDA-S . Weitere Komplikationen traten nicht auf , so dass die Komplikationsrate fuer alle interventionellen Verschluesse bei 1,9% ( 0% fuer die ROS-Gruppe ; 4,0% fuer die PDA-S-Gruppe ) lag . Im Vergleich zu den seit 1975 verfuegbaren Gianturco-Coils liegt der Vorteil der neuartigen , abloesbaren Metallspiralen in der besseren Manipulierbarkeit des Systems , da die Spirale am Deliverydraht verankert bleibt , bis eine ideale Position erreicht ist . Erst dann erfolgt die Freigabe der Spirale durch Abschrauben vom Draht . Fuer Ductusdurchmesser bis ca. 3 mm stellt die PDA-S eine preisguenstige , effiziente und leicht handhabbare Alternative zum ROS dar . Die im Vergleich zum ROS wesentlich kleineren Deliverykatheter ( 4-5 F versus 8 F bzw. 11 F ) lassen die PDA-S auch fuer kleine Kinder und Saeuglinge geeignet erscheinen . Groessere Ductus sollten mittels ROS verschlossen werden ." ], "offsets": [ [ 0, 2239 ] ] } ]

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[ { "id": "ZfuerKardiologie.70860050.ger.abstr-passage-0", "type": "abstract", "text": [ "In dieser Untersuchung wurden 41 Patienten ( m/w=25/16) mit korrigierter Coarctatio aortae ( Alter : 28 +/- 11 Jahre ) ( 14-57 Jahre ) ; Operationsalter : 12 +/- 9 Jahre ( 0,5-35 Jahre ) ) im Durchschnitt 16 Jahre nach dem operativen Eingriff ( 16 +/- 8 Jahre ( 3-44 Jahre ) ) mittels ausfuehrlicher klinischer Untersuchung . Bestimmung der peripheren Arteriendrucke ( Dopplerultraschall Echokardiographie , Ergometrie und Magnetresonanztomographie ) , kontrolliert . Bei 24 Patienten wurde eine End-zu-End-Resektion , bei 9 Patienten eine Erweiterungsplastik nach Vossschulte , bei 7 Patienten eine Interposition einer Gefaessprothese und bei einem Patienten eine Subclavian flap aortoplasty durchgefuehrt ." ], "offsets": [ [ 0, 708 ] ] } ]

[ { "id": "ZfuerKardiologie.70860050.ger.abstr-s1-t1", "type": "umlsterm", "text": [ "Patienten" ], "offsets": [ [ 33, 42 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "ZfuerKardiologie.70860050.ger.abstr-s1-t2", "type": "umlsterm", "text": [ "Coarctatio aortae" ], "offsets": [ [ 73, 90 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0003492" } ] }, { "id": "ZfuerKardiologie.70860050.ger.abstr-s2-t1", "type": "umlsterm", "text": [ "Arteriendrucke" ], "offsets": [ [ 352, 366 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0003842" } ] }, { "id": "ZfuerKardiologie.70860050.ger.abstr-s2-t2", "type": "umlsterm", "text": [ "Arteriendrucke" ], "offsets": [ [ 352, 366 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0033095" } ] }, { "id": "ZfuerKardiologie.70860050.ger.abstr-s2-t3", "type": "umlsterm", "text": [ "Dopplerultraschall" ], "offsets": [ [ 369, 387 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0162481" } ] }, { "id": "ZfuerKardiologie.70860050.ger.abstr-s2-t4", "type": "umlsterm", "text": [ "Dopplerultraschall" ], "offsets": [ [ 369, 387 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0041621" } ] }, { "id": "ZfuerKardiologie.70860050.ger.abstr-s2-t5", "type": "umlsterm", "text": [ "Echokardiographie" ], "offsets": [ [ 388, 405 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0013516" } ] }, { "id": "ZfuerKardiologie.70860050.ger.abstr-s2-t6", "type": "umlsterm", "text": [ "Ergometrie" ], "offsets": [ [ 408, 418 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0085143" } ] }, { "id": "ZfuerKardiologie.70860050.ger.abstr-s2-t7", "type": "umlsterm", "text": [ "Magnetresonanztomographie" ], "offsets": [ [ 423, 448 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0040395" } ] }, { "id": "ZfuerKardiologie.70860050.ger.abstr-s3-t1", "type": "umlsterm", "text": [ "Patienten" ], "offsets": [ [ 475, 484 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "ZfuerKardiologie.70860050.ger.abstr-s3-t2", "type": "umlsterm", "text": [ "Patienten" ], "offsets": [ [ 525, 534 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "ZfuerKardiologie.70860050.ger.abstr-s3-t3", "type": "umlsterm", "text": [ "Patienten" ], "offsets": [ [ 585, 594 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "ZfuerKardiologie.70860050.ger.abstr-s3-t4", "type": "umlsterm", "text": [ "Gefaessprothese" ], "offsets": [ [ 620, 635 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0175649" } ] }, { "id": "ZfuerKardiologie.70860050.ger.abstr-s3-t5", "type": "umlsterm", "text": [ "Patienten" ], "offsets": [ [ 650, 659 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] } ]

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[ { "id": "ZfuerKardiologie.70860050.ger.abstr-s1-r1-t2.1-t1.1", "type": "occurs_in", "arg1_id": "ZfuerKardiologie.70860050.ger.abstr-s3-t2", "arg2_id": "ZfuerKardiologie.70860050.ger.abstr-s3-t1", "normalized": [] }, { "id": "ZfuerKardiologie.70860050.ger.abstr-s2-r1-t1.1-t7.1", "type": "location_of", "arg1_id": "ZfuerKardiologie.70860050.ger.abstr-s3-t1", "arg2_id": "ZfuerKardiologie.70860050.ger.abstr-s2-t7", "normalized": [] }, { "id": "ZfuerKardiologie.70860050.ger.abstr-s2-r2-t1.1-t3.1", "type": "location_of", "arg1_id": "ZfuerKardiologie.70860050.ger.abstr-s3-t1", "arg2_id": "ZfuerKardiologie.70860050.ger.abstr-s3-t3", "normalized": [] }, { "id": "ZfuerKardiologie.70860050.ger.abstr-s2-r3-t1.1-t5.1", "type": "location_of", "arg1_id": "ZfuerKardiologie.70860050.ger.abstr-s3-t1", "arg2_id": "ZfuerKardiologie.70860050.ger.abstr-s3-t5", "normalized": [] } ]

[ { "id": "ZfuerKardiologie.70860056.ger.abstr-passage-0", "type": "abstract", "text": [ "Es wurde ein Ivalonpfropf ( PDA-Plug ) zum transvenoesen Verschluiss des persistierenden Ductus arteriosus entwickelt . Er kann durch Standardschleusen vom Kaliber 8-16 French in den Ductus eingefuehrt werden . Mit 4 distalen ( aortalen ) und 2 proximalen ( pulmonalen ) Nitinol-Federbeinchen wird das System im Ductus fixiert . Bei Fehlplazierung kann der Propf in die Schleuse zurueckgezogen und entfernt werden . In Tierexperimenten wurde eine Endothelialisierung des implantierten Materials nachgewiesen . Bisher wurde bei 58 Patienten ein Ductusverschluss versucht ; in 57 Faellen gelang der Eingriff , ein Residualshunt war bei 8 Patienten nachweisbar . Im Verlauf von bis zu 24 Monaten traten keine Komplikationen auf ." ], "offsets": [ [ 0, 726 ] ] } ]

[ { "id": "ZfuerKardiologie.70860056.ger.abstr-s1-t1", "type": "umlsterm", "text": [ "Ductus arteriosus" ], "offsets": [ [ 89, 106 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0013273" } ] }, { "id": "ZfuerKardiologie.70860056.ger.abstr-s2-t1", "type": "umlsterm", "text": [ "Standardschleusen" ], "offsets": [ [ 134, 151 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0038137" } ] }, { "id": "ZfuerKardiologie.70860056.ger.abstr-s5-t1", "type": "umlsterm", "text": [ "Tierexperimenten" ], "offsets": [ [ 419, 435 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0003043" }, { "db_name": "UMLS", "db_id": "C0003062" } ] }, { "id": "ZfuerKardiologie.70860056.ger.abstr-s6-t1", "type": "umlsterm", "text": [ "Patienten" ], "offsets": [ [ 530, 539 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "ZfuerKardiologie.70860056.ger.abstr-s6-t2", "type": "umlsterm", "text": [ "Patienten" ], "offsets": [ [ 636, 645 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "ZfuerKardiologie.70860056.ger.abstr-s7-t1", "type": "umlsterm", "text": [ "Komplikationen" ], "offsets": [ [ 706, 720 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0009566" } ] } ]

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[ { "id": "ZfuerKardiologie.70860065.ger.abstr-passage-0", "type": "abstract", "text": [ "Die steigende Zahl der Stentimplantationen gruendet sich auf bislang zumeist ungesicherte Annahmen ." ], "offsets": [ [ 0, 100 ] ] } ]

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[ { "id": "ZfuerKardiologie.70860071.ger.abstr-passage-0", "type": "abstract", "text": [ "Hintergrund : Inhalatives Stickmonoxyd ( NO ) wirkt selektiv auf den pulmonalen Gefaesswiderstand und wird bei der Therapie von Patienten mit pulmonaler Hypertension ( PHT ) eingesetzt , jedoch mit hohem apparativem Aufwand und nicht immer erfolgreich ( \" non-responder \" ) . Wir evaluierten die Wirksamkeit von aerosolisiertem Prostazyklin ( aePGI2 ) als therapeutische Alternative zu NO ." ], "offsets": [ [ 0, 390 ] ] } ]

[ { "id": "ZfuerKardiologie.70860071.ger.abstr-s1-t1", "type": "umlsterm", "text": [ "Gefaesswiderstand" ], "offsets": [ [ 80, 97 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0042380" } ] }, { "id": "ZfuerKardiologie.70860071.ger.abstr-s1-t2", "type": "umlsterm", "text": [ "Therapie" ], "offsets": [ [ 115, 123 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0039796" }, { "db_name": "UMLS", "db_id": "C0039798" } ] }, { "id": "ZfuerKardiologie.70860071.ger.abstr-s1-t3", "type": "umlsterm", "text": [ "Patienten" ], "offsets": [ [ 128, 137 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "ZfuerKardiologie.70860071.ger.abstr-s1-t4", "type": "umlsterm", "text": [ "Hypertension" ], "offsets": [ [ 153, 165 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0020538" } ] }, { "id": "ZfuerKardiologie.70860071.ger.abstr-s1-t5", "type": "umlsterm", "text": [ "pulmonaler Hypertension" ], "offsets": [ [ 142, 165 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0020542" } ] } ]

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[ { "id": "ZfuerKardiologie.70860071.ger.abstr-s1-r1-t4.1-t2.1", "type": "associated_with", "arg1_id": "ZfuerKardiologie.70860071.ger.abstr-s1-t4", "arg2_id": "ZfuerKardiologie.70860071.ger.abstr-s1-t2", "normalized": [] }, { "id": "ZfuerKardiologie.70860071.ger.abstr-s1-r2-t2.1-t4.1", "type": "treats", "arg1_id": "ZfuerKardiologie.70860071.ger.abstr-s1-t2", "arg2_id": "ZfuerKardiologie.70860071.ger.abstr-s1-t4", "normalized": [] }, { "id": "ZfuerKardiologie.70860071.ger.abstr-s1-r3-t4.1-t1.1", "type": "result_of", "arg1_id": "ZfuerKardiologie.70860071.ger.abstr-s1-t4", "arg2_id": "ZfuerKardiologie.70860071.ger.abstr-s1-t1", "normalized": [] }, { "id": "ZfuerKardiologie.70860071.ger.abstr-s1-r4-t5.1-t2.2", "type": "occurs_in", "arg1_id": "ZfuerKardiologie.70860071.ger.abstr-s1-t5", "arg2_id": "ZfuerKardiologie.70860071.ger.abstr-s1-t2", "normalized": [] }, { "id": "ZfuerKardiologie.70860071.ger.abstr-s1-r5-t2.1-t5.1", "type": "associated_with", "arg1_id": "ZfuerKardiologie.70860071.ger.abstr-s1-t2", "arg2_id": "ZfuerKardiologie.70860071.ger.abstr-s1-t5", "normalized": [] }, { "id": "ZfuerKardiologie.70860071.ger.abstr-s1-r6-t1.1-t5.1", "type": "result_of", "arg1_id": "ZfuerKardiologie.70860071.ger.abstr-s1-t1", "arg2_id": "ZfuerKardiologie.70860071.ger.abstr-s1-t5", "normalized": [] }, { "id": "ZfuerKardiologie.70860071.ger.abstr-s1-r7-t2.1-t4.1", "type": "associated_with", "arg1_id": "ZfuerKardiologie.70860071.ger.abstr-s1-t2", "arg2_id": "ZfuerKardiologie.70860071.ger.abstr-s1-t4", "normalized": [] }, { "id": "ZfuerKardiologie.70860071.ger.abstr-s1-r8-t4.1-t1.1", "type": "evaluation_of", "arg1_id": "ZfuerKardiologie.70860071.ger.abstr-s1-t4", "arg2_id": "ZfuerKardiologie.70860071.ger.abstr-s1-t1", "normalized": [] }, { "id": "ZfuerKardiologie.70860071.ger.abstr-s1-r9-t5.1-t4.1", "type": "associated_with", "arg1_id": "ZfuerKardiologie.70860071.ger.abstr-s1-t5", "arg2_id": "ZfuerKardiologie.70860071.ger.abstr-s1-t4", "normalized": [] }, { "id": "ZfuerKardiologie.70860071.ger.abstr-s1-r11-t5.1-t1.1", "type": "result_of", "arg1_id": "ZfuerKardiologie.70860071.ger.abstr-s1-t5", "arg2_id": "ZfuerKardiologie.70860071.ger.abstr-s1-t1", "normalized": [] }, { "id": "ZfuerKardiologie.70860071.ger.abstr-s1-r12-t4.1-t5.1", "type": "associated_with", "arg1_id": "ZfuerKardiologie.70860071.ger.abstr-s1-t4", "arg2_id": "ZfuerKardiologie.70860071.ger.abstr-s1-t5", "normalized": [] }, { "id": "ZfuerKardiologie.70860071.ger.abstr-s1-r14-t5.1-t2.1", "type": "associated_with", "arg1_id": "ZfuerKardiologie.70860071.ger.abstr-s1-t5", "arg2_id": "ZfuerKardiologie.70860071.ger.abstr-s1-t2", "normalized": [] }, { "id": "ZfuerKardiologie.70860071.ger.abstr-s1-r15-t1.1-t4.1", "type": "result_of", "arg1_id": "ZfuerKardiologie.70860071.ger.abstr-s1-t1", "arg2_id": "ZfuerKardiologie.70860071.ger.abstr-s1-t4", "normalized": [] }, { "id": "ZfuerKardiologie.70860071.ger.abstr-s1-r16-t2.1-t1.1", "type": "affects", "arg1_id": "ZfuerKardiologie.70860071.ger.abstr-s1-t2", "arg2_id": "ZfuerKardiologie.70860071.ger.abstr-s1-t1", "normalized": [] }, { "id": "ZfuerKardiologie.70860071.ger.abstr-s1-r17-t4.1-t2.2", "type": "occurs_in", "arg1_id": "ZfuerKardiologie.70860071.ger.abstr-s1-t4", "arg2_id": "ZfuerKardiologie.70860071.ger.abstr-s1-t2", "normalized": [] } ]

[ { "id": "ZfuerKardiologie.70860081.ger.abstr-passage-0", "type": "abstract", "text": [ "Bei Patienten mit AV-Block 2. 3. Grades und intermittierendem Vorhofflimmern , bestaende die Indikation fuer ein VDDR-Schrittmachersystem , wenn nicht oder nur selten im Vorhof stimuliert wuerde . Deshalb wurde bei 23 Patienten mit diesen Charakteristika 1 Monat nach Implantation eines DDDR-Schrittmachers geprueft , wie haeufig sie im Vorhof stimuliert wurden ; Patienten mit 10 % Vorhofstimulation wurden solchen mit > = 10 % Vorhofstimulation gegenuebergestellt . Falls automatischer Moduswechsel aktiviert war , wurde die Anzahl der Moduswechselepisoden als Marker fuer die Haeufigkeit atrialer Tachyarrhythmien erfasst . Vorhofstimulation 10 % der Zeit lag bei 7 Patienten , eine Stimulation zwischen 10 und 19 % bei 6 , zwischen 20 und 29 % bei 2 und > = 30 % der Zeit bei 8 Patienten vor . Fuenf der 7 Patienten mit 10 % Vorhofstimulation wurden im DDD-Modus , hingegen nur 4 der 16 Patienten mit > = 10 % stimuliert . Patienten mit seltenerer Vorhofstimulation liessen sich nicht anhand ihrer klinischen Befunde vorhersagen . Sowohl Patienten mit 10 % als auch solche mit > = 10 % Vorhofstimulation hatten jeweils in 67 % 10 Moduswechselepisoden . Schlussfolgerungen : Im Kurzzeitverlauf nach DDDR-Schritmacherimplatation wurden bei z.Z. ueblichen Schrittmacherprogrammierungen 30 % der Patienten mit intermittierendem Vorhofflimmern und AV-Block 2. 3. Grades , selten - d.h. 10 % der Zeit im Vorhof - stimuliert . Diese Patienten waeren moeglicherweise fuer VDDR-Stimulation geeignet . Seltenere Vorhofstimulation hatte keinen Einfluss auf die Haeufigkeit eines automatischen Moduswechsels ." ], "offsets": [ [ 0, 1601 ] ] } ]

[ { "id": "ZfuerKardiologie.70860081.ger.abstr-s1-t1", "type": "umlsterm", "text": [ "Patienten" ], "offsets": [ [ 4, 13 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "ZfuerKardiologie.70860081.ger.abstr-s1-t2", "type": "umlsterm", "text": [ "AV-Block" ], "offsets": [ [ 18, 26 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0018794" } ] }, { "id": "ZfuerKardiologie.70860081.ger.abstr-s1-t3", "type": "umlsterm", "text": [ "Vorhofflimmern" ], "offsets": [ [ 62, 76 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0004238" } ] }, { "id": "ZfuerKardiologie.70860081.ger.abstr-s2-t1", "type": "umlsterm", "text": [ "Patienten" ], "offsets": [ [ 218, 227 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "ZfuerKardiologie.70860081.ger.abstr-s2-t2", "type": "umlsterm", "text": [ "Patienten" ], "offsets": [ [ 364, 373 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "ZfuerKardiologie.70860081.ger.abstr-s3-t1", "type": "umlsterm", "text": [ "Marker" ], "offsets": [ [ 563, 569 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0005516" }, { "db_name": "UMLS", "db_id": "C0001730" } ] }, { "id": "ZfuerKardiologie.70860081.ger.abstr-s4-t1", "type": "umlsterm", "text": [ "Zeit" ], "offsets": [ [ 654, 658 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0040223" } ] }, { "id": "ZfuerKardiologie.70860081.ger.abstr-s4-t2", "type": "umlsterm", "text": [ "Patienten" ], "offsets": [ [ 669, 678 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "ZfuerKardiologie.70860081.ger.abstr-s4-t3", "type": "umlsterm", "text": [ "Zeit" ], "offsets": [ [ 771, 775 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0040223" } ] }, { "id": "ZfuerKardiologie.70860081.ger.abstr-s4-t4", "type": "umlsterm", "text": [ "Patienten" ], "offsets": [ [ 782, 791 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "ZfuerKardiologie.70860081.ger.abstr-s5-t1", "type": "umlsterm", "text": [ "Patienten" ], "offsets": [ [ 810, 819 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "ZfuerKardiologie.70860081.ger.abstr-s5-t2", "type": "umlsterm", "text": [ "Patienten" ], "offsets": [ [ 891, 900 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "ZfuerKardiologie.70860081.ger.abstr-s6-t1", "type": "umlsterm", "text": [ "Patienten" ], "offsets": [ [ 927, 936 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "ZfuerKardiologie.70860081.ger.abstr-s7-t1", "type": "umlsterm", "text": [ "Patienten" ], "offsets": [ [ 1042, 1051 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "ZfuerKardiologie.70860081.ger.abstr-s8-t1", "type": "umlsterm", "text": [ "Kurzzeitverlauf" ], "offsets": [ [ 1181, 1196 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0040223" } ] }, { "id": "ZfuerKardiologie.70860081.ger.abstr-s8-t2", "type": "umlsterm", "text": [ "Patienten" ], "offsets": [ [ 1296, 1305 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "ZfuerKardiologie.70860081.ger.abstr-s8-t3", "type": "umlsterm", "text": [ "Vorhofflimmern" ], "offsets": [ [ 1328, 1342 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0004238" } ] }, { "id": "ZfuerKardiologie.70860081.ger.abstr-s8-t4", "type": "umlsterm", "text": [ "AV-Block" ], "offsets": [ [ 1347, 1355 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0018794" } ] }, { "id": "ZfuerKardiologie.70860081.ger.abstr-s8-t5", "type": "umlsterm", "text": [ "Zeit" ], "offsets": [ [ 1394, 1398 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0040223" } ] }, { "id": "ZfuerKardiologie.70860081.ger.abstr-s9-t1", "type": "umlsterm", "text": [ "Patienten" ], "offsets": [ [ 1430, 1439 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] } ]

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[ { "id": "ZfuerKardiologie.70860095.ger.abstr-passage-0", "type": "abstract", "text": [ "\" Single-Lead \" -VDD-Schrittmacher stellen bei Patienten mit hoehergradigen AV-Blockierungen und normaler Sinusknotenfunktion eine interessante Alternative zu konventionellen DDD-Schrittmachern dar . Der Vorhofwahrnehmung kommt bei diesen Systemen eine zentrale Bedeutung zu ." ], "offsets": [ [ 0, 276 ] ] } ]

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[ { "id": "ZfuerKardiologie.70860105.ger.abstr-passage-0", "type": "abstract", "text": [ "Der implantierbare KardioverterDefibrillator ( ICD ) stellt heute bei der Therapie schwerwiegender ventrikulaerer Tachyarrhythmien vielfach die Behandlungsmethode der ersten Wahl dar . In bis zu 15 % der Patienten zwingen bradykarde Rhythmusstoerungen zur gleichzeitigen Therapie mit antibradykarden Schrittmachersystemen . Bis zur Verfuegbarkeit integrierter Systeme wird deshalb immer wieder die Situation eintreten , dass ein Patient sowohl mit einem ICD- als auch mit einem antibradykarden Schrittmachersystem versorgt werden muss . Im eigenen Patientenkollektiv war dies bei 4 von 75 konsekutiven Patienten ( 5 % ) der Fall . Bei allen Patienten konnte nach ausgedehnten intraoperativen Testungen zum Ausschluss saemtlicher moeglicher Interaktionen beider Systeme wie Oversensing von Schrittmachersignalen durch den ICD mit konsekutiver inadaequater Therapieabgabe , Nichterkennen von Kammerflimmern durch den ICD bei Erkennung asynchroner Schrittmachersignale oder schockinduzierte Fehlfunktionen des Schrittmachersystems , ein transvenoeses ICD-System implantiert werden . Die Auswertung der zu dieser Frage publizierten Literatur ergab insgesamt 91 Faelle einer simultanen ICD- und Schrittmachertharapie . Ueber eine oder mehrere der oben genannten Komplikationen wird bei insgesamt 16 % der Patienten berichtet , wobei die Komplikationsrate insgesamt bei Verwendung unipolarer Schrittmachersysteme groesser war als bei bipolaren . Zusammenfassend kann festgestellt werden , dass eine kombinierte Therapie mit antibradykarden Schrittmacher- und rein transvenoesen ICD-Systemen sicher moeglich ist ." ], "offsets": [ [ 0, 1606 ] ] } ]

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[ { "id": "ZfuerKardiologie.70860113.ger.abstr-passage-0", "type": "abstract", "text": [ "Um den Energiestoffwechsel in vitalem Restmyokard nach nichttransmuralem Vorderwandinfarkt in vivo zu charakterisieren , wurden Patienten Gruppe A , ( n = 19 ) mit einer Stenose des Ramus interventricularis anterior RIVA ) und laevokardiographisch nachgewiesener Vorderwand-Hypokinesie ( nach nichttransmuralem Vorderwandinfarkt phosphor-spektroskopisch untersucht und mit einem gesunden Probandenkollektiv verglichen . Das Messvolumen wurde zunaechst mittels Kernspin-Bildgebung in der anterioren Vorderwand positioniert . Die Phosphorspektren wurden dann unter voller antianginoeser Medikation aufgezeichnet . Um einen Einfluss der Koronarstenosen ausschliessen zu koennen , wurden zusaetzlich Patienten ( Gruppe B , n = 4 ) mit RIVA-Stenose ohne Vorderwand-Kontraktionsstoerung untersucht . Der Einfluss einer antianginoesen Medikation auf den PCrATP-Quotienten wurde bei einem weiteren Patientenkollektiv ( Gruppe C , n = 4 ) mit den gleichen klinischen Kriterien wie Gruppe A zuerst ohne antianginoese Medikation ( Auswaschphase > 1 Tag ) und danach unter laufender i.v. Medikation von Glyceroltrinitrat bestimmt . Im Vergleich zum Normalkollektiv ( 1,74 +/- 0,23 ) zeigte sich bei Gruppe A ( 1,4 +/- 0,18 ) eine signifikante Erniedrigung ( p 0,01 ) des mittleren PCrATP-Quotienten . Bei Patienten mit normaler Ventrikelfunktion ( Gruppe B ) fand sich hingegen keine wesentliche Abweichung des Quotienten gegenueber dem Nornmalkollektiv ( PCrATP : 1,64 +/- 0,22 ; p = 0,23 ) . Nach i.v. Gabe von Glyceroltrinitrat stieg der PCrATP-Quotient bei der Patientengruppe C von 1,12 +/- 0,08 auf 1,32 +/- 0,13 ( p 0,01 ) . Hypokinetisches Myokard nach nichttransmuralemn Vorderwandinfarkt geht bereits unter Ruhebedingungen mit einer Verminderung des Energiezwischenspeichers PCr im Vergleich zum ATP-Gehalt des Myokards einher . Als moegliche Ursachen kommen sowohl eine Myozytendegeneration aufgrund gestoerter Mikroperfusion als auch Remodelingprozesse von vitalen Myozyten im Infarktgebiet in Frage . Beide Moeglichkeiten koennen dann z.B. ueber eine Anpassung der zellulaeren Enzymkonzentrationen zu dem erniedrigten PCr-Gehalt der Myozyten fuehren ." ], "offsets": [ [ 0, 2152 ] ] } ]

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[ { "id": "ZfuerKardiologie.70860131.ger.abstr-passage-0", "type": "abstract", "text": [ "Die quantitative Gewebe-Doppler-Echokardiographie ist eine neue Methode zur Diagnostik der linksventrikulaeren Funktion . Das Ziel dieser Untersuchung war es , eine neuentwickelte Methode zu validieren , die auf der Computer-Software TDI-Labor basiert und Geschwindigkeitsmessungen ueber variable Zeitintervalle und beliebig grosse Gewebeareale erlaubt . Hierzu wurde bei 63 Probanden die mittlere Wandgeschwindigkeit einer 2 mm starken Myokardschicht ueber die systolische Austreibungsphase aus Gewebe-Doppler-M-mode-Bildern der linksventrikulaeren Hinterwand bestimmt . Zum Vergleich wurde in denselben Standbildern die mittlere endokardiale Geschwindigkeit mittels konventionellem M-mode-slope gemessen . Die gewebe-Doppler-echokardiographisch bestimmte Wandgeschwindigkeit zeigte eine hohe Uebereinstimmung mit der mittleren endokardialen Geschwindigkeit ( y = 0,97x + 0,17 ; r = 0,77 ; p 0,0001 ) . Der durchschnittliche Wandbewegungsgradient aller Probanden betrug 1,33 +/- 0,35 . Eine Altersabhaengigkeit der Wandgeschwindigkeit oder des Wandbewegungsgradienten besteht nicht ." ], "offsets": [ [ 0, 1084 ] ] } ]

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[ { "id": "ZfuerKardiologie.70860138.ger.abstr-passage-0", "type": "abstract", "text": [ "Bei 31 Patienten ( 34 Laesionen ) mit mehrdeutigen angiographischen Befunden vor Intervention wurde eine intravaskulaere Ultraschalluntersuchung ( IVUS ) zur Klaerung der koronaren Anatomie durchgefuehrt . Der IVUS-Befund einer mindestens 50%-Flaechenstenose im Stamm der linken Koronararterie bzw. einer mindestens 75%-Flaechenstenose in anderen groesseren Koronaraesten wurde als interventionsbeduerftig angesehen . Um die Richtigkeit der auf dem IVUS-Befund basierenden Therapieentscheidung zu kontrollieren , wurden die Patienten nach 1 Jahr nachuntersucht ." ], "offsets": [ [ 0, 562 ] ] } ]

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[ { "id": "ZfuerKardiologie.70860149.ger.abstr-passage-0", "type": "abstract", "text": [ "Das Koronarsystem des menschlichen Herzens ist unter normalen Bedingungen nicht hermetisch gegen die Umgebung und die Ventrikel abgeschlossen , sondern auf vielfache Weise mit benachbarten Arterien und Herzhoehlen verbunden . Diese natuerlichen Verbindungswege sind Vorbilder fuer die meisten chirurgischen Revaskularisationsbemuehungen . Die zahlreichen Anastomosen zwischen Aorten- und Koronararterienaesten aehneln funktionell einem aorto-koronaren Bypass . Auch verschiedene koronaro-ventrikulaere Anastomosen gehoeren zur natuerlichen Ausstattung jedes menschlichen Herzens , und entsprechend soll eine transmurale Laserrevaskularisierung dem Blut aus der Ventrikellichtung einen Weg in das Myokard hinein bahnen . Dabei kann aber nicht von einer , \" Reptilisation \" des menschlichen Herzens gesprochen werden , denn die Ernaehrung umfangreicher innerer Anteile von Reptilienherzen durch Diffusion ist als alleiniger Mechanismus unwahrscheinlich ." ], "offsets": [ [ 0, 952 ] ] } ]

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[ { "id": "ZfuerKardiologie.70860165.ger.abstr-passage-0", "type": "abstract", "text": [ "Die Baroreflexsensitivitaetsmessung ist eine neue Methode zur Indentifikation von Postinfarktpatienten mit einem hohen Mortalitaetsrisiko bzw. mit hohem Risiko fuer den ploetzlichen Herztod , Kammerflimmern oder Kammertachykardien . Fuer die hier geschilderte Untersuchung wurde die Baroreflexsensitivitaet nichtinvasiv gemessen . Intravenoese Gabe von Norfenefrinhydrochlorid ( Novadral ) erzielte einen Blutdruckanstieg von 15-40 mm Hg , und die Steigung der Korrelationsgeraden zum Herzfrequenzabfall , also zur Verlaengerung der Sinuszykluslaenge , wurde errechnet . Hierbei wurden Messungen mit einer Korrelation > 0,7 ( bei einem Signifikanzniveau p 0,05 ) als auswertbar angesehen . Bei 302 Patienten ( mittleres Alter 59 +/- 17 Jahre , 224 Maenner , 78 Frauen ) wurden Baroreflexuntersuchungen durchgefuehrt . Bei insgesamt 69 Patienten ( 29% ) war die Baroreflexsensitivitaet ( BRS ) 3 ms/mm Hg und wurde als pathologisch gewertet . Bei 236/313 Untersuchungen ( 75% ) war das Ergebnis verwertbar , wobei 14% der Untersuchungen Mehrfachmessungen benoetigten . Bei 17 nicht auswertbaren Untersuchungen ( 25% ) konnten in 18 Faellen ( 6% aller Untersuchungen ) ventrikulaere Extrasystolen verantwortlich gemacht werden . 41 Untersuchungen ( 13,1% aller Untersuchungen ) waren jedoch aus unklarer Ursache wegen mangelnder Korrelation nicht auswertbar . Eine Erklaerung fuer die mangelnde Korrelation der Messung konnte bei diesen Patienten nicht gefunden werden . Diese 41 Patienten hatten signifikant haeufiger eine linksventrikulaere Auswurffraktion ( EF ) 40% , einen Diabetes mellitus und eine induzierbare anhaltende Kammertachykardie oder Kammerflimmern bei der elektrophysiologischen Untersuchung als das Kollektiv der auswertbaren Patienten ." ], "offsets": [ [ 0, 1755 ] ] } ]

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[]

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"normalized": [] }, { "id": "ZfuerKardiologie.70860165.ger.abstr-s11-r4-t5.1-t2.1", "type": "degree_of", "arg1_id": "ZfuerKardiologie.70860165.ger.abstr-s11-t5", "arg2_id": "ZfuerKardiologie.70860165.ger.abstr-s11-t2", "normalized": [] }, { "id": "ZfuerKardiologie.70860165.ger.abstr-s11-r5-t2.1-t4.1", "type": "occurs_in", "arg1_id": "ZfuerKardiologie.70860165.ger.abstr-s11-t2", "arg2_id": "ZfuerKardiologie.70860165.ger.abstr-s11-t4", "normalized": [] }, { "id": "ZfuerKardiologie.70860165.ger.abstr-s11-r6-t3.1-t5.1", "type": "associated_with", "arg1_id": "ZfuerKardiologie.70860165.ger.abstr-s11-t3", "arg2_id": "ZfuerKardiologie.70860165.ger.abstr-s11-t5", "normalized": [] }, { "id": "ZfuerKardiologie.70860165.ger.abstr-s11-r7-t3.1-t2.1", "type": "associated_with", "arg1_id": "ZfuerKardiologie.70860165.ger.abstr-s11-t3", "arg2_id": "ZfuerKardiologie.70860165.ger.abstr-s11-t2", "normalized": [] }, { "id": "ZfuerKardiologie.70860165.ger.abstr-s11-r8-t2.1-t5.1", "type": "degree_of", "arg1_id": "ZfuerKardiologie.70860165.ger.abstr-s11-t2", "arg2_id": "ZfuerKardiologie.70860165.ger.abstr-s11-t5", "normalized": [] }, { "id": "ZfuerKardiologie.70860165.ger.abstr-s11-r9-t5.1-t3.1", "type": "associated_with", "arg1_id": "ZfuerKardiologie.70860165.ger.abstr-s11-t5", "arg2_id": "ZfuerKardiologie.70860165.ger.abstr-s11-t3", "normalized": [] }, { "id": "ZfuerKardiologie.70860165.ger.abstr-s11-r10-t5.1-t2.1", "type": "associated_with", "arg1_id": "ZfuerKardiologie.70860165.ger.abstr-s11-t5", "arg2_id": "ZfuerKardiologie.70860165.ger.abstr-s11-t2", "normalized": [] }, { "id": "ZfuerKardiologie.70860165.ger.abstr-s11-r11-t3.1-t1.1", "type": "occurs_in", "arg1_id": "ZfuerKardiologie.70860165.ger.abstr-s11-t3", "arg2_id": "ZfuerKardiologie.70860165.ger.abstr-s11-t1", "normalized": [] }, { "id": "ZfuerKardiologie.70860165.ger.abstr-s11-r12-t2.1-t3.1", "type": "degree_of", "arg1_id": "ZfuerKardiologie.70860165.ger.abstr-s11-t2", "arg2_id": "ZfuerKardiologie.70860165.ger.abstr-s11-t3", "normalized": [] }, { "id": "ZfuerKardiologie.70860165.ger.abstr-s11-r13-t3.1-t4.1", "type": "occurs_in", "arg1_id": "ZfuerKardiologie.70860165.ger.abstr-s11-t3", "arg2_id": "ZfuerKardiologie.70860165.ger.abstr-s11-t4", "normalized": [] }, { "id": "ZfuerKardiologie.70860165.ger.abstr-s11-r14-t5.1-t1.1", "type": "occurs_in", "arg1_id": "ZfuerKardiologie.70860165.ger.abstr-s11-t5", "arg2_id": "ZfuerKardiologie.70860165.ger.abstr-s11-t1", "normalized": [] }, { "id": "ZfuerKardiologie.70860165.ger.abstr-s11-r15-t5.1-t4.1", "type": "occurs_in", "arg1_id": "ZfuerKardiologie.70860165.ger.abstr-s11-t5", "arg2_id": "ZfuerKardiologie.70860165.ger.abstr-s11-t4", "normalized": [] }, { "id": "ZfuerKardiologie.70860165.ger.abstr-s11-r16-t3.1-t2.1", "type": "degree_of", "arg1_id": "ZfuerKardiologie.70860165.ger.abstr-s11-t3", "arg2_id": "ZfuerKardiologie.70860165.ger.abstr-s11-t2", "normalized": [] } ]

[ { "id": "ZfuerKardiologie.70860171.ger.abstr-passage-0", "type": "abstract", "text": [ "Die transmyokardiale Laserrevaskularisation ( TMR ) wurde als neues Behandlungskonzept fuer die Angina pectoris vorgestellt . Wir untersuchten die Wertigkeit des Verfahrens im Rahmen eines prospektiven Studienprotokolls mit klinischen , invasiven und szintigraphischen Methoden ." ], "offsets": [ [ 0, 279 ] ] } ]

[ { "id": "ZfuerKardiologie.70860171.ger.abstr-s1-t1", "type": "umlsterm", "text": [ "Angina pectoris" ], "offsets": [ [ 96, 111 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0002962" } ] }, { "id": "ZfuerKardiologie.70860171.ger.abstr-s2-t1", "type": "umlsterm", "text": [ "Methoden" ], "offsets": [ [ 269, 277 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0025663" }, { "db_name": "UMLS", "db_id": "C0025664" } ] } ]

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[ { "id": "ZfuerKardiologie.70860183.ger.abstr-passage-0", "type": "abstract", "text": [ "Die neueren QCA-Systeme weisen bei In-vitro-Messungen eine vergleichbare Reproduzierbarkeit und Genauigkeit der Messergebnisse auf . Wir untersuchten , welchen Einfluss die Morphologie von Koronararterienstenosen und die Bildqualitaet auf die Messergebnisse von drei fuehrenden QCA-Systemen ( AWOS , Cardio und CMS ) hat . Hierzu waehlten wir 57 Stenosen aus , die eine klinisch repraesentative Verteilung bezueglich des Stenosegrades , verschiedener Laesionscharakteristika und der Bildqualitaet aufwiesen . Prozedurale Fehlerquellen wurden , soweit moeglich , eliminiert . Drei Untersucher fuehrten je Stenose fuenf Messungen mit jedem der drei Systeme durch . Bei drei Stenosen war eine Auswertung nicht moeglich ." ], "offsets": [ [ 0, 717 ] ] } ]

[ { "id": "ZfuerKardiologie.70860183.ger.abstr-s2-t1", "type": "umlsterm", "text": [ "Koronararterienstenosen" ], "offsets": [ [ 189, 212 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0003842" } ] }, { "id": "ZfuerKardiologie.70860183.ger.abstr-s2-t2", "type": "umlsterm", "text": [ "Koronararterienstenosen" ], "offsets": [ [ 189, 212 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0009814" } ] }, { "id": "ZfuerKardiologie.70860183.ger.abstr-s3-t1", "type": "umlsterm", "text": [ "Stenosen" ], "offsets": [ [ 346, 354 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0009814" } ] }, { "id": "ZfuerKardiologie.70860183.ger.abstr-s3-t2", "type": "umlsterm", "text": [ "Stenosegrades" ], "offsets": [ [ 421, 434 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0009814" } ] }, { "id": "ZfuerKardiologie.70860183.ger.abstr-s5-t1", "type": "umlsterm", "text": [ "Stenose" ], "offsets": [ [ 604, 611 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0009814" } ] }, { "id": "ZfuerKardiologie.70860183.ger.abstr-s6-t1", "type": "umlsterm", "text": [ "Stenosen" ], "offsets": [ [ 672, 680 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0009814" } ] } ]

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[ { "id": "ZfuerKardiologie.70860183.ger.abstr-s2-r1-t1.1-t2.1", "type": "location_of", "arg1_id": "ZfuerKardiologie.70860183.ger.abstr-s6-t1", "arg2_id": "ZfuerKardiologie.70860183.ger.abstr-s3-t2", "normalized": [] }, { "id": "ZfuerKardiologie.70860183.ger.abstr-s3-r1-t2.1-t1.1", "type": "associated_with", "arg1_id": "ZfuerKardiologie.70860183.ger.abstr-s3-t2", "arg2_id": "ZfuerKardiologie.70860183.ger.abstr-s6-t1", "normalized": [] }, { "id": "ZfuerKardiologie.70860183.ger.abstr-s3-r2-t1.1-t2.1", "type": "associated_with", "arg1_id": "ZfuerKardiologie.70860183.ger.abstr-s6-t1", "arg2_id": "ZfuerKardiologie.70860183.ger.abstr-s3-t2", "normalized": [] } ]

[ { "id": "ZfuerKardiologie.70860189.ger.abstr-passage-0", "type": "abstract", "text": [ "Bei 300 Patienten mit 339 Koronarlaesionen wurde im Rahmen einer diagnostischen Angiographie die prozentuale Diameterstenose ( %-DS) visuell von Untersuchern eingeschaetzt und gleichzeitig unabhaengig durch digitale quantitative Koronarangiographie ( DQCA ) objektiv vermessen . Aufgrund der subjektiven Schaetzung des Stenosegrades wurde die Entscheidung zu einer Koronarangioplastie in gleicher Sitzung ( \" prima vista \" -PTCA ) getroffen . Die Vermessung der 339 Stenosen durch DQCA zeigte eine Normalverteilung des Stenosegrades mit einem Mittelwert von 58,4 +/- 11,3% . Im Gegensatz zur DQCA fuehrte die visuelle Einschaetzung des Stenosegrades zu einer bimodalen Verteilung mit einem Nadir bei ~55% zwischen zwei Gipfeln bei ~45% und ~75% Diameterstenose mit einem Mittelwert von 70,5 +/- 19,6% . Im Vergleich zur DQCA wurde bei visueller Schaetzung der Stenosegrad zwischen 30 und 55% unterschaetzt und zwischen 55 und 99% ueberschaetzt . Aufgrund der visuellen Schaetzung wurde bei 251 ( 74,0% ) der 339 Koronarlaesionen eine \" prima vista \" -PTCA durchgefuehrt . Die DQCA objektivierte nur 184 Stenosen ( 54,3% ) mit einer %-DS > = 60% ; bei 86 Stenosen ( 25,3% ) lag das morphologische Kriterium zur PTCA nicht vor . Die bei visueller Einschaetzung registrierte bimodale Verteilung des Stenosegrades mit tendenzieller Ueberschaetzung von haemodynamisch grenzwertigen Stenosen koennte einen Trend zur Selbstzuweisung von Patienten zur PTCA reflektieren . Die DQCA liefert eine objektive Entscheidungshilfe fuer eine Indikationsstellung zur PTCA und koennte ueberfluessige kosmetische \" PTCA \" vermeiden . Besonders bei der Auswahl von Patienten zur \" prima vista \" -PTCA empfiehlt sich die Quantifizierung des Stenosegrades durch DQCA ." ], "offsets": [ [ 0, 1745 ] ] } ]

[ { "id": "ZfuerKardiologie.70860189.ger.abstr-s1-t1", "type": "umlsterm", "text": [ "Patienten" ], "offsets": [ [ 8, 17 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "ZfuerKardiologie.70860189.ger.abstr-s1-t2", "type": "umlsterm", "text": [ "Angiographie" ], "offsets": [ [ 80, 92 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0002978" } ] }, { "id": "ZfuerKardiologie.70860189.ger.abstr-s1-t3", "type": "umlsterm", "text": [ "Diameterstenose" ], "offsets": [ [ 109, 124 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0009814" } ] }, { "id": "ZfuerKardiologie.70860189.ger.abstr-s1-t4", "type": "umlsterm", "text": [ "Koronarangiographie" ], "offsets": [ [ 229, 248 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0085532" } ] }, { "id": "ZfuerKardiologie.70860189.ger.abstr-s1-t5", "type": "umlsterm", "text": [ "Koronarangiographie" ], "offsets": [ [ 229, 248 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0002978" } ] }, { "id": "ZfuerKardiologie.70860189.ger.abstr-s2-t1", "type": "umlsterm", "text": [ "Stenosegrades" ], "offsets": [ [ 319, 332 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0009814" } ] }, { "id": "ZfuerKardiologie.70860189.ger.abstr-s3-t1", "type": "umlsterm", "text": [ "Stenosen" ], "offsets": [ [ 466, 474 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0009814" } ] }, { "id": "ZfuerKardiologie.70860189.ger.abstr-s3-t2", "type": "umlsterm", "text": [ "Normalverteilung" ], "offsets": [ [ 498, 514 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0028377" } ] }, { "id": "ZfuerKardiologie.70860189.ger.abstr-s3-t3", "type": "umlsterm", "text": [ "Stenosegrades" ], "offsets": [ [ 519, 532 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0009814" } ] }, { "id": "ZfuerKardiologie.70860189.ger.abstr-s4-t1", "type": "umlsterm", "text": [ "Stenosegrades" ], "offsets": [ [ 636, 649 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0009814" } ] }, { "id": "ZfuerKardiologie.70860189.ger.abstr-s4-t2", "type": "umlsterm", "text": [ "Diameterstenose" ], "offsets": [ [ 745, 760 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0009814" } ] }, { "id": "ZfuerKardiologie.70860189.ger.abstr-s5-t1", "type": "umlsterm", "text": [ "Stenosegrad" ], "offsets": [ [ 860, 871 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0009814" } ] }, { "id": "ZfuerKardiologie.70860189.ger.abstr-s7-t1", "type": "umlsterm", "text": [ "Stenosen" ], "offsets": [ [ 1103, 1111 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0009814" } ] }, { "id": "ZfuerKardiologie.70860189.ger.abstr-s7-t2", "type": "umlsterm", "text": [ "Stenosen" ], "offsets": [ [ 1154, 1162 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0009814" } ] }, { "id": "ZfuerKardiologie.70860189.ger.abstr-s7-t3", "type": "umlsterm", "text": [ "PTCA" ], "offsets": [ [ 1210, 1214 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0002997" } ] }, { "id": "ZfuerKardiologie.70860189.ger.abstr-s8-t1", "type": "umlsterm", "text": [ "Stenosegrades" ], "offsets": [ [ 1296, 1309 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0009814" } ] }, { "id": "ZfuerKardiologie.70860189.ger.abstr-s8-t2", "type": "umlsterm", "text": [ "Stenosen" ], "offsets": [ [ 1377, 1385 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0009814" } ] }, { "id": "ZfuerKardiologie.70860189.ger.abstr-s8-t3", "type": "umlsterm", "text": [ "Trend" ], "offsets": [ [ 1400, 1405 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0040833" } ] }, { "id": "ZfuerKardiologie.70860189.ger.abstr-s8-t4", "type": "umlsterm", "text": [ "Patienten" ], "offsets": [ [ 1430, 1439 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "ZfuerKardiologie.70860189.ger.abstr-s8-t5", "type": "umlsterm", "text": [ "PTCA" ], "offsets": [ [ 1444, 1448 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0002997" } ] }, { "id": "ZfuerKardiologie.70860189.ger.abstr-s9-t1", "type": "umlsterm", "text": [ "PTCA" ], "offsets": [ [ 1549, 1553 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0002997" } ] }, { "id": "ZfuerKardiologie.70860189.ger.abstr-s9-t2", "type": "umlsterm", "text": [ "PTCA" ], "offsets": [ [ 1595, 1599 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0002997" } ] }, { "id": "ZfuerKardiologie.70860189.ger.abstr-s10-t1", "type": "umlsterm", "text": [ "Patienten" ], "offsets": [ [ 1644, 1653 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "ZfuerKardiologie.70860189.ger.abstr-s10-t2", "type": "umlsterm", "text": [ "Stenosegrades" ], "offsets": [ [ 1719, 1732 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0009814" } ] } ]

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[ { "id": "ZfuerKardiologie.70860196.ger.abstr-passage-0", "type": "abstract", "text": [ "Einleitung . Zur Untersuchung von Patienten mit einem erhoehten Risiko des ploetzlichen Herztodes sind die Analyse ventrikulaerer Spaetpotentiale , der Herzfrequenzvariabilitaet und der Baroreflexsensitivitaet hilfreich . Jedoch gelingt die Vorhersage eines malignen arrhythmischen Ereignisses bislang nicht mit genuegender Genauigkeit . Zur besseren Risikoabschaetzung sind weitere Methoden notwendig . In dieser Arbeit soll die Wertigkeit der Chemoreflexsensitivitaet fuer die Vorhersage ventrikulaerer Tachyarrhythmieereignisse untersucht werden ." ], "offsets": [ [ 0, 550 ] ] } ]

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[]

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[ { "id": "ZfuerKardiologie.70860204.ger.abstr-passage-0", "type": "abstract", "text": [ "Die QT-Dispersion ( QTD ) im 12-Kanal-Oberflaechen-EKG sowie die QT-Dynamik im Holter-EKG , definiert als Tagesgang des nach Bazett frequenzkorregierten QT-Intervalls ( mQTc ) und daraus abgeleiteter Parameter , wurde an 42 Patienten mit koronarer Herzerkrankung im chronischen Postinfarktstadium ohne ventrikulaere Tachyarrhythmien ( KHK/VTA- ) und an 24 KHK-Patienten mit lebensbedrohlichen VTA ( KHK/VTA+) bestimmt . Als Kontrollgruppe ( KG ) wurden 14 herzgesunde Probanden untersucht . Korrelationen zu haemodynamischen Daten ( LVEF Schweregrad , der KHK ) und validierten Risikoparametern ( ventrikulaere Spaetpotentiale , Kurzzeit-Herzfrequenzvariabilitaet ) wurden berechnet . Die QTD fuer die Gruppe KHK/VTA- war im Vergleich zur KG signifikant erhoeht ( 48,4 ms +/- 19,6 vs. 31,4 ms +/- 9,8 , p 0,05 ) . Keine Unterschiede konnten bei den Parametern der QT-Dynamik beobachtet werden . Die Gruppe KHK/VTA+ zeigte die hoechste QTD ( 59,5 ms +/- 13,1 , p 0,05 gegen KG/KHK/VT- ) und eine statistisch signifikant veraenderte QT-Dynamik im Vergleich zur KG bzw. zur Gruppe KHK/VTA- ( mQTc : 431,3 ms +/- 38,8 vs. 400,8 ms +/- 25,5 vs. 406,3 ms +/- 10,6 , p 0,05 ) . Nur Parameter der QTD waren statistisch signifikant zum Schweregrad der KHK ( r = 0,41 , p 0,01 ) und zur LVEF /r = 0,43 , p 0,01 ) korreliert . Keine statistisch signifikanten Zusammenhaenge fanden wir zwischen den Parametern der QT-Dispersion/QT-Dynamik untereinander sowie zu den mituntersuchten Risikoparametern . Die Befunde sprechen dafuer , dass KHK-Patienten noch im chronischen Postinfarktstadium eine erhoehte QT-Dispersion aufweisen . KHK-Patienten mit VTA sind des weiteren durch eine pathologisch veraenderte QT-Dynamik charakterisiert . Parameter beider Methoden stellen offenbar im Vergleich zu bereits validierten Indizes unabhaengige Risikomarker dar . Die Messung der QT-Dispersion und der QT-Dynamik als Indikatoren einer inhomogenen Repolarisation koennte zu einer Verbesserung der Risikostratifizierung von KHK-Patienten bezueglich des ploetzlichen Herztodes beitragen ." ], "offsets": [ [ 0, 2062 ] ] } ]

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[ { "id": "ZfuerKardiologie.70860221.ger.abstr-passage-0", "type": "abstract", "text": [ "In dieser Studie wurden die Befunde von 1076 konsekutiven Patienten , bei denen eine Hochfrequenzstrom-Katheterablation von akzessorischen Leitungsbahnen durchgefuehrt worden war , retrospektiv unter der Fragestellung analysiert , ob es hinsichtlich der anatomischen Verteilung und den Leitungseigenschaften der akzessorischen Buendel sowie dem Rezidivverhalten nach Ablation Unterschiede zwischen Patienten mit multiplen Leitungsbahnen und Patienten mit singulaerer Leitungsbahn gibt ." ], "offsets": [ [ 0, 486 ] ] } ]

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[ { "id": "ZfuerKardiologie.70860239.ger.abstr-passage-0", "type": "abstract", "text": [ "Als Nettoeffekt von ACE-Inhibitoren und AT1-Rezeptorblockern ist eine Kardioprotektion bedingt durch Vasodilatation ( Blutdrucksenkung Verminderung , der Nachlast ) , Antiproliferation ( vermindertes Zellwachstum , Reduktion des vascular \" undoder \" ventricular remodeling \" , \" verminderte extrazellulaere Matrixbildung ) , antiadrenerge Effekte sowie durch Foerderung der Wasser- und Natriumausscheidung ( Blutdrucksenkung Verminderung , der Vorlast ) zu erwarten . Diese Therapieziele konnten fuer ACE-Inhibitoren in experimentellen , aber auch in klinischen Studien weitgehend bestaetigt werden , waehrend ueber die diesbezueglichen Wirkungen von AT1-Rezeptorblockern mit Ausnahme der Hypertoniebehandlung und erster praeliminarer Ergebnisse bei der Behandlung der Herzinsuffizienz noch relativ wenig klinische Daten vorliegen . Es wurde bisher nur fuer ACE-Inhibitoren eine antithrombotische und profibrinolytische Wirkung beschrieben Mechanismen , , denen vor allem bei der Behandlung von Patienten mit koronarer Herzkrankheit ein Teil der beschriebenen Verbesserung der Langzeitprognose zugeschrieben wird ( 120 ) . Trotz des aehnlichen Wirkungsspektrums gibt es zwischen ACE-Inhibitoren und AT1-Rezeptorblockern wichtige Unterschiede , die einen individuellen Einsatz beider Substanzen rechtfertigen : das duale Wirkprinzip von ACE-Inhibitoren hat viele nachgewiesene Vorteile , fuehrt aber in einem relativ hohen Prozentsatz der Patienten zu unerwuenschten Nebeneffekten wie z.B. in 8-14% der Faelle zu chronisch-trockenem Husten , der zum Absetzen des ACE-Inhibitors fuehrt . Mit AT1-Rezeptorblockern kann diese Nebenwirkung weitgehend vermieden werden . Moeglicherweise traegt eine inkomplette Hemmung der Ang-II-Wirkung bei einer Behandlung mit ACE-Inhibitoren zu einer verminderten Effizienz des Praeparates bei . Im Vergleich zu anderen Medikamentenklassen ist allerdings die mit ACE-Hemmern erzielbare Effizienz bei 75%-80% der behandelten Patienten als sehr positiv zu werten . Fuer AT1-Rezeptorblocker besteht daher auch in der Indikation Herzinsuffizienz eine potentiell wichtige Einsatzmoeglichkeit . Wenn man ueber die positiven Effekte einer verstaerkten Kininaktivierung zusaetzlich zu einer direkten Hemmung der AT1-Rezeptor-mediierten Wirkungen verfuegen moechte , kann dies moeglicherweise durch eine Kombinationstherapie zwischen ACE-Hemmern und AT1-Rezeptorblockern erreicht werden . Entsprechende klinische Studien sind derzeit im Gange . Ein zusaetzlicher Vorteil der AT1-Rezeptor-Blockade duerfte letztlich auch darin liegen , dass die ehoehten AT-II-Spiegel die AT2-Rezeptor-vermittelten Wirkungen ( Hemmung der Angiogenese und Vasodilatation ) aktivieren koennen und auf diese Weise eine additive vasoprotektive Wirkung hervorrufen ." ], "offsets": [ [ 0, 2765 ] ] } ]

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