W Rutishauser

Inselspital, Universitätsspital Bern, Berna, Bern, Switzerland

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Publications (259)233.43 Total impact

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    ABSTRACT: The aim of this study was to test the hypothesis that ear oximetry immediately after the release of a sustained Valsalva maneuver accurately detects patent foramen ovale (PFO). One hundred sixty-five scuba divers underwent transesophageal echocardiography (TEE; reference method) for PFO assessment. Ear oximetry of the right earlobe was performed in a different room within a time frame of 2 hours before or after TEE. The subject and the oximetry operator were unaware of the results of TEE. Oxygen saturation (SO(2)) measurements were obtained at baseline and during the release phase of 4 Valsalva maneuvers within 10 minutes, and the average SO(2) change (SO(2) at baseline minus SO(2) at Valsalva release) was determined as the primary study end point. One hundred seventeen divers had no PFO, and 48 (29%) had PFO by TEE (mean age 39 ± 8 years). The average SO(2) change was 0.79 ± 1.13% (i.e., a slight absolute SO(2) decrease in response to the Valsalva maneuver) in the group without PFO and 1.67 ± 1.19% in the PFO group (p <0.0001). Using receiver-operating characteristic curve analysis, a PFO as defined by TEE could be detected at a threshold of a Valsalva-induced decrease in SO(2) of ≥0.825 percentage points in comparison to baseline (sensitivity 0.756, specificity 0.706, area under the receiver-operating characteristic curve 0.763, p <0.0001, negative predictive value 0.882). In conclusion, the entirely noninvasive method of ear oximetry in response to repetitive Valsalva maneuvers is accurate and useful as a screening method for the detection of a PFO, as shown in this study of divers.
    The American journal of cardiology 10/2012; 111(2). DOI:10.1016/j.amjcard.2012.09.030 · 3.28 Impact Factor
  • J Sztajzel · M Périat · V Marti · P Krall · W Rutishauser ·
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    ABSTRACT: The purpose of this study was to investigate the effect of sexual activity on cycle ergometer stress test parameters, on plasmatic testosterone levels and on concentration capacity in high-level male athletes. Experimental design. Analysis of two days of testing accomplished in a laboratory setting, comparing a day with to a day without sexual activity (control day). Participants. Fifteen high-level male athletes, consisting of 8 team players, 5 endurance athletes and 2 weight-lifters, participated in the study. Measures. Each subject completed the following on each test day: two maximal graded stress tests on a cycle ergometer and a one-hour exercise stress test coupled to an arithmetic mental concentration test. Blood samples of testosterone were obtained and cardiac activity of each athlete was monitored with a 24-hour ECG tape recording over the two test days. Significantly higher differences were achieved for post-effort heart rate (HR) values at 5 minutes (p<0.01) and at 10 minutes (p<0.01) during the recovery phase of the morning stress test 2 hours after sexual activity. These differences disappeared during the recovery phase of the afternoon stress test performed approximately 10 hours after sexual intercourse took place. Our findings show that sexual activity had no detrimental influence on the maximal workload achieved and on the athletes' mental concentration. However, the higher posteffort HR values after the maximal stress test on the morning of sexual intercourse suggest that the recovery capacity of an athlete could be affected if he had sexual intercourse approximately 2 hours before a competition event.
    The Journal of sports medicine and physical fitness 09/2000; 40(3):233-9. · 0.97 Impact Factor
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    W Rutishauser ·
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    ABSTRACT: Several methods of measuring coronary blood flow in intact conscious man are reviewed, on the basis of personal contributions or the experiences of our teams. It is important to distinguish between global, regional and transmural blood flow measurements. The advantages and limitations of the following methods are discussed: diffusible inert and radioactive tracers, dye dilution, roentgendensitometry, magnetic resonance imaging and contrast echocardiography. In interventional cardiology it is most important to be able to measure flow through single coronary vessels. Information on coronary artery Doppler velocity during vasodilation and at rest is less useful than the concept of fractional flow reserve. This is based on pressure measurements under maximal vasodilation to ascertain the presence of borderline flow-limiting lesions. This information is necessary in order to decide whether to proceed with angioplasty or not. The historical design of percutaneous coronary angioplasty and beta-irradiation of coronary restenosis, established under the author's guidance, are put into perspective. The author pays tribute to many excellent colleagues who worked with him at the Zurich and Geneva University Hospitals.
    European Heart Journal 09/1999; 20(15):1076-83. DOI:10.1053/euhj.1999.1676 · 15.20 Impact Factor
  • PA Dorsaz · PA Doriot · L Dorsaz · W Rutishauser ·
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    ABSTRACT: In vitro studies have demonstrated that densitometric quantification of coronary artery stenoses is superior to geometric methods to assess non-circular lumens. However, in patients, several authors have reported significant discrepancies between area reduction percentages obtained densitometrically from two different imaging projections. Some of the factors causing the discrepancies can be reduced by simple precautions taken during image acquisition. Some others may be compensated for during analysis. Nevertheless, two factors remain problematic. The first is the inadequate spatial orientation of the vessel axes at the stenotic and reference cross sections with respect to the x-rays. The second is the difficulty in identifying the same vessel cross section in both planes at the time of analysis. We have designed a new densitometric technique that eliminates the error contributions of these two factors. The technique requires simultaneously acquired biplane coronary angiograms and biplane images of a translucent cube bearing steel markers acquired in exactly the same biplane geometry. Using the two projection matrices calculated from the images of the cube, the centerlines and the edges of the coronary arteries can be reconstructed in space from the biplane angiograms. The angles between the vessel axes and the x-ray beams can be determined and the densitometric cross sections can be corrected accordingly. Moreover, the 3D reconstruction allows the identification of the same cross section in the two planes for the determination of the area reduction percentages. Validation measurements were performed on a Perspex phantom and in patients, before and after angioplasty. In both types of measurement, the interplane discrepancies could be roughly halved. The densitometric technique presented can be incorporated into routine angiography and could become a strong alternative to the geometric approach that is presently dominating this field.
    Physiological Measurement 12/1997; 18(4):277-88. DOI:10.1088/0967-3334/18/4/002 · 1.81 Impact Factor
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    F Mach · C Lovis · J M Gaspoz · P F Unger · M Bouillie · P Urban · W Rutishauser ·
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    ABSTRACT: For several years, acute coronary syndromes have been perceived as causing the most hospital admissions, and even hospital mortality. The syndrome of unstable angina frequently progresses to acute myocardial infarction but its pathogenesis is poorly understood, and prognosis determination is still problematic. We tested the hypothesis that measurement of the C-reactive protein in patients admitted for chest pain could be a marker for acute coronary syndromes. We studied 110 patients admitted with suspected ischaemic heart disease, but without elevated serum creatine-kinase levels at the time of hospital admission. Patients were subsequently divided into two groups based on their final diagnosis: group 1 comprised patients with unstable angina; group 2 patients with acute myocardial infarction. We measured the C-reactive protein at the time of hospital admission. The concentration of C-reactive protein was elevated in 59% of the patients with a final diagnosis of acute myocardial infarction, and in 5% of the patients with a final diagnosis of unstable angina, (P < 0.001). This study indicates that C-reactive protein levels measured at the time of admission in patients with suspected ischaemic heart disease could be a marker for acute coronary syndromes, and helpful in identifying patients at high risk for acute myocardial infarction. Measurement of C-reactive protein may have practical clinical significance in the management of patients hospitalized for suspected acute coronary syndromes.
    European Heart Journal 12/1997; 18(12):1897-902. DOI:10.1093/oxfordjournals.eurheartj.a015198 · 15.20 Impact Factor
  • P Urban · V Verin · Y Popowski · W Rutishauser ·
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    ABSTRACT: We have developed a technique of endoluminally centred endovascular beta irradiation aimed at preventing restenosis after PTCA. The source consists of a pure metallic 90-Yttrium coil that can be positioned within the lumen at the target site by the use of a centering device and an afterloading console. Experimental evaluation of this approach showed that a dose of 18 Gy delivered at the inner arterial surface was highly effective in preventing fibrointimal hyperplasia in rabbit carotid and iliac arteries. A pilot clinical evaluation in the coronary arteries of 15 patients using the same dose demonstrated excellent feasibility and no unexpected side-effects. A dose-finding evaluation in the clinical setting is now planned.
    Seminars in interventional cardiology: SIIC 06/1997; 2(2):125-31.
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    ABSTRACT: The authors present an angiographic method to measure absolute coronary blood flow in patients. The left or right coronary tree is three-dimensional (3D)-reconstructed from biplane coronary angiograms. This allows the determination of the intravascular volumes needed for flow measurement. The 3D distance traveled by the contrast medium during one cardiac cycle is determined by appropriately thresholding the "concentration-distance", curves computed on two pairs of images taken one cardiac cycle apart. The angiographic flow measurements were compared with nearly simultaneous flow determinations obtained with an intracoronary ultrasonic Doppler flow velocity measuring device. The mean relative difference between the Doppler and the 3D measurements was 11% and the two sets of flow values correlated well (r = 0.81). A method for the determination of mean coronary flow is presented. The procedure is simple and can be incorporated easily into clinical routine.
    Investigative Radiology 05/1997; 32(4):198-204. DOI:10.1097/00004424-199704000-00002 · 4.44 Impact Factor
  • C Vuille · J Sztajzel · J L Hoffmann · F Ricou · W Rutishauser · R Lerch ·
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    ABSTRACT: Three-Dimensional (3D) echocardiography was performed during routine transesophageal examinations in 100 patients to identify the most promising applications. The approach used was based on the integration of multiple two-dimensional images recorded with a multiplane probe to achieve 3D reconstruction. A series of 90 cardiac cycles was recorded from a fixed position during computer-controlled rotation of the transducer. The images were digitized, then reorganized according to their spatial and temporal location. The cardiac structures were then represented dynamically in three dimensions. In 100 patients referred for transesophageal echocardiography, the 3D reconstruction provided good quality images, under new angles, such as the view of the atrial aspect of the mitral valve as seen from the roof of the left atrium. This method was particularly well suited to assess mitral valve prolapse or stenosis. The spatial extent, direction and number of jets of mitral regurgitation were easily appreciated throughout systole, as were the regurgitant jets of mechanical prosthetic valves. However, the sensitivity of the 3D method was not as good as 2D echocardiography for detecting bacterial vegetations in cases of infective endocarditis. On the other hand, the determination of the precise localization of infectious, degenerative and tumoral lesions and their size were facilitated by 3D reconstruction. The authors conclude that 3D echocardiography is applicable in routine practice and the complementary information provided in certain cardiac diseases should help management of these patients.
    Archives des maladies du coeur et des vaisseaux 03/1997; 90(2):217-24. · 0.40 Impact Factor
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    D Pavin · J Delonca · M Siegenthaler · M Doat · W Rutishauser · A Righetti ·
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    ABSTRACT: In order to assess the prognostic significance of normal exercise thallium-210 myocardial scintigraphy in patients with documented coronary artery disease, we studied the incidence of cardiac death and non-fatal myocardial infarction in 69 symptomatic patients without prior Q wave myocardial infarction, who demonstrated one or more significant coronary lesions (stenosis > or = 70%) on an angiogram performed within 3 months of scintigraphy (Group 1). These patients were compared to a second group of 136 patients with an abnormal exercise scintigram, defined by the presence of reversible defect(s) and angiographically proven coronary artery disease (Group 2), and to a third group of 102 patients with normal exercise scintigraphy without significant coronary lesions (stenosis < or = 30%) or with normal coronary angiography (Group 3). In contrast to coronary lesions observed in Group 2, patients in Group 1 presented more frequently with single-vessel disease (83% vs 35%, P < 0.0001) and with more distal lesions (55% vs 23%, P < 0.0001). Over a mean follow-up period of 8.6 years, one fatal and eight non-fatal cases of myocardial infarction were observed in Group 1. The majority of patients in Group 1 were treated medically: only 24 (35%) underwent myocardial revascularization, usually by coronary angioplasty. There was no significant difference in the incidence of combined major cardiac events (cardiac death, non-fatal myocardial infarction) in patients with normal exercise scintigraphy, with or without documented coronary artery disease (Groups 1 and 3), while the incidence was higher in Group 2. However, while the mortality remained very low in Group 1, the incidence of non-fatal myocardial infarction was not different from that of Group 2, where most patients underwent revascularization procedures. In conclusion, patients with coronary artery disease and a normal exercise thallium-201 myocardial scintigram usually have mild coronary lesions (single-vessel disease, distal location) and good long-term prognosis, with a low incidence of cardiac death.
    European Heart Journal 01/1997; 18(1):69-77. DOI:10.1093/oxfordjournals.eurheartj.a015120 · 15.20 Impact Factor
  • P.-A. Doriot · P.-A. Dorsaz · L. Dorsaz · W. Rutishauser ·
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    ABSTRACT: The indicator dilution theory is often thought to be the appropriate fundamental of most blood flow measurement techniques used daily in cardiac catheterization laboratories. By considering a simple theoretical flow system, the authors show that this theory is actually not applicable when the detector used to record the concentration-time curves is of the "trans-illumination" type, as is the case for instance in many videodensitometric applications (in these applications, pixels or groups of pixels play the role of detectors).
    Computers in Cardiology, 1996; 10/1996
  • P.-A. Doriot · P.-A. Dorsaz · L. Dorsaz · W. Rutishauser ·
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    ABSTRACT: Degrees of stenosis (DS) obtained geometrically from the angiographic projection which shows the greatest apparent diameter reduction can be suspected of overestimating the lesion severity. In comparison, biplane measurements in more or less orthogonal projections should be more accurate. These points are, however, not quite trivial because the errors depend on the shapes of stenotic lumens and on the edge detection algorithms. To investigate these aspects, 29 lumens of different shapes were computer simulated. The results of the simulation were compared to data obtained in patients by measuring geometrically and densitometrically 25 stenoses in biplane coronary angiograms. The results of the simulation and the patient data agree with the initial expectations.
    Computers in Cardiology, 1996; 10/1996
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    J Sztajzel · J Cox · J C Pache · E Badaoui · R Lerch · W Rutishauser ·

    European Heart Journal 09/1996; 17(8):1289. DOI:10.1093/oxfordjournals.eurheartj.a015048 · 15.20 Impact Factor
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    ABSTRACT: To decrease pre-hospital delay in patients with chest pain. Population based, prospective observational study. A province of Switzerland with 380000 inhabitants. All 1337 patients who presented with chest pain to the emergency department of the Hôpital Cantonal Universitaire of Geneva during the 12 months of a multimedia public campaign, and the 1140 patients who came with similar symptoms during the 12 months before the campaign started. Pre-hospital time delay and number of patients admitted to the hospital for acute myocardial infarction (AMI) and unstable angina. Mean pre-hospital delay decreased from 7h 50 min before the campaign to 4 h 54 min during it, and median delay from 180 min to 155 min (P < 0.001). For patients with a final diagnosis of AMI, mean delay decreased from 9 h 10 min to 5 h 10 min and median delay from 195 min to 155 min (P < 0.002). Emergency department visits per week for AMI and unstable angina increased from 11.2 before the campaign to 13.2 during it (P < 0.02), with an increase to 27 (P < 0.01) during the first week of the campaign; visits per week for non-cardiac chest pain increased from 7.6 to 8.1 (P = NS) during the campaign, with an increase to 17 (P < 0.05) during its first week. Public campaigns may significantly reduce pre-hospital delay in patients with chest pain. Despite transient increases in emergency department visits for non-cardiac chest pain, such campaigns may significantly increase hospital visits for AMI and unstable angina and thus be cost effective.
    Heart (British Cardiac Society) 09/1996; 76(2):150-5. DOI:10.1136/hrt.76.2.150 · 5.60 Impact Factor
  • R Fabbretti · P A Dorsaz · P A Doriot · W Rutishauser ·
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    ABSTRACT: In order to master the overwhelming quantity of data produced by the different laboratories of our Cardiology Division, we are presently developing a centralized database. Our aim is to improve the quality of diagnoses and therapies by constituting patient centered medical files integrating logically the results of the results of the different examinations and allowing for a rapid access to the patient data. The database has to be accessible from an heterogeneous set of PC, MacIntoshes and UNIX workstations. It must have an ergonomic graphic user interface and generate reports which can be sent to the patient physician. It is well known that the requirements for a medical database make its conceptual analysis very difficult. As medical knowledge continually evolves, the examination protocols change and, therefore, the data sets have to be updated. The maintenance of classical databases is usually expensive because it requires specialized staff to alter the database structure and to adapt the user interface. To allow for flexibility, modularity, code reusability and reliability, the object paradigm was applied to a classical relational database. Thanks to the combination of both data structure and behavior in single entities, it is possible to build generic user interfaces which can be easily tailored to the needs of every laboratory of our Cardiology Division.
    International Journal of Bio-Medical Computing 08/1996; 42(1-2):129-34. DOI:10.1016/0020-7101(96)01191-9
  • CS Keighley · P Urban · I Killer · P Chatelain · E Morandini · V Verin · W Rutishauser ·
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    ABSTRACT: OBJECTIVES: To determine the safety and efficacy of antiplatelet therapy alone in a selected group of patients following coronary stenting. BACKGROUND: Coronary stent implantation is an effective treatment for abrupt closure, and can also reduce the restenosis rate following percutaneous transluminal coronary angioplasty. However, anticoagulation therapy following stent implantation is associated with a significant incidence of vascular complications and subacute stent thrombosis. METHODS: Between February and November 1994 we implanted 62 Palmaz-Schatz stents in 50 patients with an optimal angiographic result following stent deployment. In these patients, intravascular ultrasound was not used, and a regimen of aspirin 100 mg daily indefinitely and ticlopidine 250 mg twice daily for 3 months was started without anticoagulation. RESULTS: Of these 50 patients (10 females : 40 males, mean age 63 +/- 12 years, LVEF 64 +/- 10%), 39 (78%) were stented for a suboptimal angiographic result post angioplasty, 2 (4%) received stents as a bailout procedure, and 9 (18%) were stented electively. Average hospital stay following stent implantation was 3.7 +/- 3.0 days. After a mean follow-up period of 140 +/- 70 days, there were no instances of stent occlusion, death, stroke, need for coronary bypass surgery, Q-wave myocardial infarction or femoral artery pseudoaneurysm. There was 1 case (2%) of significant puncture site hemorrhage. CONCLUSIONS: Immediate angiographic appearance after stent implantation can be used to define patients at low risk of stent thrombosis who do not require anticoagulation and can safely be discharged early from the hospital.
    The Journal of invasive cardiology 06/1996; 8(4):185-190. · 0.95 Impact Factor
  • T Jaup · Y Allemann · P Urban · P A Dorsaz · P Chatelain · T Brzostek · V Verine · W Rutishauser · B Meier ·
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    ABSTRACT: The experience of the use of the Magnum wire in a single center is reported. Percutaneous balloon coronary angioplasty, using the Magnum 0.021 inch wire, was attempted in 723 patients with 850 lesions; of these, 453 (53%) were chronic total occlusions and 50 (7%) recent occlusions of less than 24 hours (patients presenting with acute myocardial infarction). The overall technical success rate per lesion was 655/850 (77%). It was 255/280 (91%) for non-total lesions, 311/453 (69%) for chronic total occlusions, 53/67 (79%) for functional (TIMI grade I) occlusions, and 36/50 (72%) for recent occlusions. Clinical success was achieved in 196/232 patients (84%) with non-total lesions, in 292/436 (67%) with total chronic occlusions, in 49/65 (75%) with functional occlusions, and in 34/50 (68%) with recent occlusions. Complications (significant creatine kinase rise, new Q-wave infarction, need for coronary bypass surgery or in-hospital death) occurred in 7% (3% if patients presenting with unstable ischemic syndromes were excluded from the analysis). These data confirm that the use of the Magnum wire has success rates competitive with other systems both in setting of chronic total occlusion and in that of routine percutaneous transluminal coronary angioplasty.
    The Journal of invasive cardiology 01/1996; 7(9):259-64. · 0.95 Impact Factor
  • J Sztajzel · D Rüfenacht · M Megret · R Sztajzel · S Burgan · W Rutishauser ·
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    ABSTRACT: A 64-year-old woman developed a severe embolic cerebral attack with total left hemiplegia approximately 30 hours after cardiac catheterization for mitral stenosis. She underwent intra-arterial thrombolysis of the right internal carotid artery four and one-half hours after the onset of neurologic deficit with subsequent recanalization of the occluded vessel and near complete neurologic recovery.
    The Journal of invasive cardiology 01/1996; 7(9):277-82. · 0.95 Impact Factor
  • P.-A. Doriot · P.-A. Dorsaz · L. Dorsaz · W. Rutishauser ·

    Biomedizinische Technik 01/1996; 41(s1):184-185. DOI:10.1515/bmte.1996.41.s1.184 · 1.46 Impact Factor
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    ABSTRACT: The objective was to determine whether physicians adhere to international guidelines and prescribe early thrombolytic and β-blockade therapy for patients with acute myocardial infarction. During 3 months, all patients admitted to the Emergency room (ER) or medical intensive care unit (ICU) of our University Hospital were included in the cohort. Medical experience and evaluation of drugs were assessed for 15 physicians at the begining and at the end of a 3 month residency in the ER or in the ICU. Two experts determined the « idealprescription as recommanded by international guidelines for each patient. All physicians were found to be highly convinced of the utility of thrombolysis and, despite their concern of its side effects, prescribed it as often as it was recommended. In contrast, β-blockers were prescribed to only 50% of the patients for whom this treatment was recommended. Prescriptions were independent of prior belief in effectiveness, side-effects and handling difficulty. In term of early therapy of acute myocardial infarction, the adherence to international guidelines was excellent for thrombolysis and very poor for β-blockers. This low prescription rate may be due to a unanimous rating of β-blockers as a moderatly efficient drug rather than due to the fear of major side-effects.
    Réanimation Urgences 01/1996; 5(3). DOI:10.1016/S1164-6756(96)80102-2
  • W Rutishauser · R Lerch ·
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    ABSTRACT: Angina pectoris and asymptomatic myocardial ischemia are part of the spectrum of coronary heart disease. Not the presence or absence of angina determines the future of the patient, but repeated ischemia and the progression of the coronaropathy. This progression is neither linear with time, nor is the moment of plaque rupture foreseeable. Silent myocardial infarctions increase with age and are very frequent in diabetics. In patients without neuropathy but with asymptomatic myocardial ischemia the central pain threshold is higher than in patients with angina pectoris. The best noninvasive test for the detection, localization and estimation of extension of myocardial ischemia, be it pain-free or symptomatic, is 201-thallium scintigraphy, combined with the exercise ECG. The fight against all amendable cardiovascular risk factors and pharmacotherapy are the first steps, if asymptomatic myocardial ischemia is suspected. Augmented dyspnea on effort and rhythm disturbances are indicators of advanced multivessel heart disease. Under these circumstances coronary angiography is indicated, and further treatment should follow the generally accepted rules such as for patients with angina pectoris.
    Praxis 11/1995; 84(42):1181-5.

Publication Stats

1k Citations
233.43 Total Impact Points


  • 2012
    • Inselspital, Universitätsspital Bern
      Berna, Bern, Switzerland
  • 1982-2000
    • University of Geneva
      • Division of Cardiology
      Genève, Geneva, Switzerland
  • 1995
    • Hôpitaux Universitaires de Genève
      Genève, Geneva, Switzerland
  • 1994
    • Hôpital Universitaire Robert Debré
      Lutetia Parisorum, Île-de-France, France
  • 1970-1981
    • University of Zurich
      • • Internal Medicine Unit
      • • Chirurgische Klinik
      Zürich, ZH, Switzerland
  • 1967
    • Psychiatrische Universitätsklinik Zürich
      Zürich, Zurich, Switzerland
  • 1965
    • ETH Zurich
      Zürich, Zurich, Switzerland